Adnexal infarction after conservative surgical management of torsion of a hyperstimulated ovary.

OBJECTIVE: To report a case of postoperative necrosis after conservative management of torsion of a hyperstimulated ovary. DESIGN: Case report and literature review. SETTING: Tertiary care center. PATIENT: Infertility patient undergoing IVF-ET. INTERVENTIONS: Detorsion followed by unilateral salpingo-oophorectomy 2 days later. MAIN OUTCOME MEASURE: Postoperative course. RESULTS: Postoperative necrosis after detorsion. CONCLUSIONS: Postoperative necrosis is an uncommon but serious complication of conservative surgical management of adnexal torsion.

The use of methotrexate and arterial embolization to avoid surgery in a case of cervical pregnancy.

OBJECTIVE: To describe the management of a case of cervical ectopic pregnancy (EP) DESIGN: Case report. SETTING: University-affiliated teaching hospital. PATIENT(S): A 26-year-old woman, gravida 4, para 0-1-2-0 with the diagnosis of a cervical EP. INTERVENTION(S): Systemic methotrexate (MTX) and arterial embolization. RESULT(S): A cervical EP was diagnosed by ultrasonography. The patient was treated with systemic MTX. Vaginal bleeding began 4 days later and was treated with arterial embolization, thus eliminating the need for surgical intervention. The pregnancy resolved and the patient has resumed normal menstruation and again is attempting pregnancy. CONCLUSION(S): Arterial embolization can be used to avoid surgical intervention in cases of cervical EP in which hemorrhage occurs after treatment with chemotherapy.

Evaluation of the stimulated menstrual cycle by magnetic resonance imaging.

Changes in uterine zonal anatomy in six women during a cycle of treatment with clomiphene citrate is studied by magnetic resonance imaging. There was a rapid rate of increase in endometrial thickness during the periovulatory period that was similar to the pattern seen in a prior study of women with normal (nonstimulated) cycles. Junctional zone thickness did not parallel the endometrial pattern and differed from the response seen in nonstimulated cycles. Results of large scale studies may help to further understand the effects of these medications.

Pelvic adhesions contain sex steroid receptors and produce angiogenesis growth factors.

OBJECTIVE: To evaluate female pelvic adhesion tissue for the presence of estrogen receptor (ER), progesterone receptor (PR), basic fibroblastic growth factor (basic-FGF), and vascular endothelial growth factor (VEGF). DESIGN: Descriptive study. SETTING: Patients at a tertiary medical center. PATIENTS: Female reproductive age patients undergoing gynecologic surgery who were not receiving hormonal therapy. INTERVENTIONS: Female reproductive tract peritoneal adhesion tissue was excised, frozen, and sent for immunohistologic evaluation. MAIN OUTCOME MEASURE: Presence of ER, PR, basic-FGF, and VEGF in adhesion tissue. RESULTS: Nineteen of 19 specimens were positive for PR; 16 of 19 specimens were positive for ER, which was present in a variety of the different cell types constituting adhesion. Vascular endothelial growth factor and basic-FGF were detected in endothelial cells of blood vessels supplying this tissue as well as in mesothelial cells. CONCLUSION: Adhesion tissue contains ER, PR, and growth factors that may be important in the genesis of the permanent fibrovascular bands between pelvic organs. This supports the theoretical possibility of hormonal manipulation of these tissues to negatively influence postoperative pelvic adhesion formation.

Comparison of magnetic resonance imaging and ultrasound in evaluating follicular and endometrial development throughout the normal cycle.

A prospective study was undertaken to evaluate and compare magnetic resonance imaging (MRI) and ultrasound (U/S) in monitoring follicular and endometrial development during the normal menstrual cycle. Results of MRI, U/S, estradiol (E2), and progesterone were obtained from five ovulatory volunteers on days 4, 8, 12, 16, 20, and 24 of the cycle. On U/S, all the women had only one dominant follicle, whereas MRI was able to detect a secondary cohort of follicles in three of five volunteers. Endometrial development on U/S and MRI showed similar patterns of growth with an increase on MRI from 5.8 +/- 1.1 mm on day 4 to a mean peak of 10.3 +/- 1.7 mm on day 24. A distinct feature of MRI was the demonstration of a junctional zone (JZ), which has a pattern of growth that resembles that of the endometrium, with accelerated growth from day 8 to day 16 (5.1 +/- .7 mm to 6.7 +/- .7 mm). The JZ corresponds anatomically to the distribution of the arcuate vessels and may therefore represent changes in blood supply to the endometrium. MRI, similar to U/S, is noninvasive and does not involve any radiation exposure but provides new information on uterine changes in the normal cycle. At present, its clinical applications are limited.

Magnetic resonance imaging of the menstrual cycle.

This study examines the ability of magnetic resonance imaging (MRI) to monitor follicular and endometrial development during the menstrual cycle. MR scans, sonograms and hormonal levels of estradiol (E2) and progesterone (P) obtained from five ovulatory volunteers were evaluated on approximately days 4, 8, 12, 16, 20 and 24 of the cycle. MRI reliably demonstrated folliculogenesis in all of the volunteers. Changes depicted in the endometrial and junctional zones of the uterus reflected physiologic events occurring during the normal cycle. Important implications exist for infertile women undergoing stimulated cycles and/or in-vitro fertilization.