Primary omental pregnancy on the gastrocolic ligament.

Omental pregnancy is an extremely rare form of abdominal pregnancy. Only 16 cases had been reported in the literature, and most were secondary omental pregnancies. We presented a case of primary omental pregnancy located on "gastrocolic ligament" diagnosed at surgical operation. The aim of this presentation is to remember that pregnancy can exist in unusual localizations, so abdominal observation and examination is very important during operations.

Assessment of mammographic density changes on plain film mammograms in postmenopausal women on hormone replacement therapy.

BACKGROUND & OBJECTIVES: Mammographic screening is an effective tool for the early detection of breast cancer. Hormone replacement therapy (HRT) has been shown to increase mammographic density and thus may hinder early detection of small tumours. We undertook this study to determine and compare the frequency and degree of change in mammographic density in postmenopausal women in HRT using two different methods: the classical Wolfe classification and a new semiquantitative method, which we named as the comparison wheel. METHODS: This study included 285 women, 206 under hormone treatment, and 79 control subjects. All women underwent baseline mammographic study before the beginning of treatment. Mean interval of the follow up mammograms was 16 months. The methods were compared in evaluating the effects of three types of hormone therapies on mammographic density. RESULTS: The frequency of change was only significant in the combined hormone replacement group when Wolfe classification was used. However, the frequency of increase in density (estrogen group 21%, combined therapy group 42%, tibolone group 28%) was markedly higher when the comparison wheel was used. The inter-rater Kappa value was calculated as 0.977 for the first and 0.957 for the second readings of the two radiologists for the comparison wheel, and 0.973 and 0.968 for the Wolfe classification. The intra-rater Kappa values were determined as 0.972 and 0.957 for the first and and 0.963 and 0.926 for the second radiologist for comparison wheel and Wolfe classification respectively. INTERPRETATION & CONCLUSION: Our findings indicate that the estimated increase of mammographic density depends on the selected hormone regimen, as well as the method of evaluation. The comparison wheel is a semiquantitative method of evaluating changes of mammographic density and is sensitive and reproducible with high inter- and intra-rater Kappa values. This method can be used as an alternative for comparison of digital mammographic applications in the future.

Changes in distribution patterns of integrins in endometrium in copper T380 intrauterine device users.

Intrauterine contraception is the most cost-effective reversible method of contraception today, but its mechanism of action is not well understood. Our objective was to investigate immunohistochemical distribution patterns of alphav, alpha3, beta1 integrins in women using a copper T380 intrauterine device (IUD) for different periods of time to obtain insight into the role of integrins in intrauterine contraception. Endometrial biopsies were obtained from patients using T Cu380A IUD in follicular and luteal phases and in menopausal women grouped according to the period of time of IUD use (group 1: <3 year, and group 2:>or=3 years). Each group consisted of 10 patients, with a total number of 60 patients. Labelling intensity of all integrins, except for beta1 which increased in the follicular phase, were decreased in women who used IUD for>or=3 years when compared with group 1 in the follicular and luteal phases and in the menopause. We conclude that long-term use of IUD affects integrin expression in endometrium not only in follicular and luteal phases of premenopausal women but also in postmenopausal women. Copper IUD can inhibit binding of integrins to the extracellular matrix and it may cause inhibition of the implantation stage, which is crucial for pregnancy.

The aromatase inhibitor anastrozole is associated with favorable embryo development and implantation markers in mice ovarian stimulation cycles.

OBJECTIVE: To investigate the embryonic and endometrial effects of anastrozole in preimplantation and implantation phases in FSH-induced cycles in mice. DESIGN: Blind randomized study. SETTING: University research laboratory. ANIMAL(S): Twenty-seven mature female mice. INTERVENTION(S): Single-dose anastrozole (25 mg/kg [0.75 mg]), recombinant FSH (5 IU/mL), and hCG (5 IU/mL) (n = 9); recombinant FSH (5 IU/mL) and hCG (5 IU/mL) (n = 9); or sterile saline (1 mL) (n = 9). The morning of finding the vaginal plug was designated as day 1 of embryonic development (E1). Three mice from each group were sacrificed on E1 and embryos aspirated from uterine tubes. The rest of the mice were sacrificed on E2.5-3 and uteruses removed. MAIN OUTCOME MEASURE(S): Embryo quality, endometrial histologic evaluation, and immunohistochemical analysis of tumor necrosis factor-alpha, leukemia inhibitory factor, laminin, and collagen IV staining. RESULT(S): Anastrozole use in FSH-induced cycles not only caused an increase in preimplantation receptivity and implantation but also supported release of implantation markers. The enhanced embryo development seen in this study would explain the higher implantation because embryo development is synchronized with endometrial development. CONCLUSION(S): In mice, the use of anastrozole in FSH-induced cycles has a positive effect on embryo quality and implantation. This effect might be species dependent, and human studies are needed.

Coexistence of a prolapsed, pedunculated cervical myoma and pregnancy complications: a case report.

BACKGROUND: Different types of fibroids may affect reproductive outcome to a different extent, causing infertility and pregnancy wastage. Rectosigmoid compression, prolapse of a pedunculated submucous tumor through the cervix, venous stasis, polycythemia and ascites are infrequently associated with leiomyomas. Uterine leiomyomas arefound in approximately 2% of pregnant women; 1 in 10 causes complications during pregnancy. CASE: A 37-year-old woman, gravida 3, para 2, abortion 0, at 18 weeks of pregnancy, arrived at our outpatient clinic with a complaint of leaking vaginal fluid. On examination, a prolapsed, pedunculated myoma, measuring 5 x 6 x 7 cm, and pooling of amniotic fluid in the vaginal fornix were detected. Antibiotics were started, but the amniotic fluid leak continued, and the fetal heart beat became undetectable after 12 hours of hospitalization. We tried to excise the myoma from the vagina but because it was very large, we could not reach the proximal point it originatedfrom. We dissected the posterior cervical channel, removed the myoma and performed a total abdominal hysterectomy. CONCLUSION: Vaginal myomectomy is recommended as the initial treatment of choicefor a prolapsed, pedunculated submucous myoma except when other indications necessitate an abdominal approach. Use of Laminaria and hysteroscopic resection has been mentioned as other treatment choices. In our case a prolapsed, pedunculated cervical myoma was detected along with pregnancy complications, preterm premature rupture of membranes and fetal death. The cause-and-effect relationship between the prolapsed myoma and membrane rupture is unknown. We were unable to perform a vaginal or abdominal myomectomy because the myoma originated in the posterior cervical region, so we had to perform an abdominal hysterectomy.

Aromatase inhibitors: possible future applications.

In premenopausal women ovaries are the major sites of estrogen production, while in postmenopausal women estrogen is produced by aromatization of ovarian and adrenal androgens in extragonadal sites, mostly in adipose tissue. Aromatase is a cytochrome P450 hemoprotein-containing enzyme complex that catalyzes the rate-limiting step in the conversion of androstenedione and testosterone to estrone and estradiol (E2). Aromatase inhibitors (AIs) have been developed primarily for use in either natural or surgical postmenopausal patients. In premenopausal women, the ovary can overcome the estrogen blockade by reflex increments of luteinizing hormone (LH) and follicle stimulating hormone (FSH), so AIs must be combined with a gonadotropin releasing hormone (GnRH) agonist to prevent the reflex LH and FSH increments. In advanced hormone-dependent breast cancer treatment, AIs have been shown to be superior to tamoxifen. Preliminary evidence also suggests superiority in the adjuvant, neoadjuvant settings and also for breast cancer prevention. AIs have been used in infertility and can increase ovulation rate. Reducing FSH dose, estrogen levels, improving response to FSH, implantation rates, and developing multiple follicles that can be used in in vitro maturation procedures are potential areas that AIs might be used in in assisted reproductive technologies (ART), besides simple ovulation induction. AIs are reported to be successful in treatment of endometriosis, an estrogen-dependent process. The use of AIs in gynecomastia, puberte precox, leiomyoma uteri, some estrogen-dependent cancers (ovarian), endometrial cancer and male infertility are reported; some of the results are promising but more clinical trials are needed. AIs are predicted to become the gold standard in the treatment of estrogen-dependent diseases in reproductive medicine in the near future.

Reproductive disturbances, pituitary lactotrope adenomas, and mammary gland tumors in transgenic female mice producing high levels of human chorionic gonadotropin.

To assess the consequences of prolonged exposure to elevated levels of LH/human chorionic gonadotropin (hCG) in the female, we developed a transgenic (TG) mouse model (hCGbeta+) that overexpresses the hCGbeta-subunit cDNA. Because of the promoter used, ubiquitin C, the transgene is expressed in multiple tissues, including the pituitary gland, in which coupling with the endogenous common alpha-subunit results in synthesis of high levels of bioactive hCG. The TG females presented with precocious puberty, infertility, enhanced ovarian steroidogenesis, and abnormal uterine structure. Pituitary enlargement was evident from the age of 2 months, which progressed to adenomas by the age of 10-12 months. Immunohistochemical studies and electron microscopy demonstrated lactotrope origin for the adenomas, associated with severe hyperprolactinemia. The mammary glands of TG females showed marked lobuloalveolar development followed by mammary tumors with characteristics of adenocarcinoma at the age of 9-12 months. More than 90% of penetrance and high frequency of metastasis (47%) was observed. Formation of the pituitary and mammary gland tumors was totally abolished by ovariectomy despite persistently elevated hCG levels. Taken together, these findings suggest that the hCG-induced aberrations of ovarian function are clearly responsible for the extragonadal tumors observed in these TG mice.