A randomized controlled trial for cervical priming using vaginal misoprostol prior to hysteroscopy in women who have only undergone cesarean section.

PURPOSE: To evaluate the efficacy of misoprostol administrated vaginally on cervical priming and its complications prior to diagnostic or operative hysteroscopy in women who have undergone at least one cesarean section and who have never delivered vaginally before and/or had other transcervical procedure. METHODS: A total of 55 patients undergoing hysteroscopy for various intra-uterine lesions were included in this study and were randomly allocated to two groups finally. Thirty patients in the study group were given 200 µg misoprostol vaginally 12 h before the procedure, whereas 25 patients in the control group did not receive any cervical priming. The countered outcome included the cervical width detected with Hegar dilatators and complication rates. RESULTS: Mean cervical width was greater in the study group (6.6 ± 1.3) than in the control group (5.1 ± 0.9). Complications and failure rates were lower in the study group. CONCLUSION: Application of 200 µg misoprostol vaginally 12 h before hysteroscopy softens the cervix, reduces cervical resistance and consequently the need for cervical dilatation, with only mild side effects.

Fenticonazole activity measured by the methods of the European Committee on Antimicrobial Susceptibility Testing and CLSI against 260 Candida vulvovaginitis isolates from two European regions and annotations on the prevalent genotypes.

The activity of fenticonazole was studied against 260 West and Southeast European vulvovaginal candidiasis isolates, and low MICs were displayed. Fenticonazole was assessed by European Committee on Antimicrobial Susceptibility Testing and CLSI microdilution methods for the first time, and the results showed excellent agreement (97%) and significant interclass correlation coefficient (P < 0.0001). Also, the levels of agreement for the results for itraconazole, fluconazole, and ketoconazole were 84%, 90%, and 98% (P < 0.0001), respectively. Multilocus typing by PCR fingerprinting and subsequent cluster analysis delineated geographically associated alignments for Candida albicans and fluconazole resistance-related clusters for Candida glabrata.

Greek experience in the use of Thermachoice for treating heavy menstrual bleeding: prospective study.

Heavy menstrual bleeding (HMB) occurs in a considerable percentage of the general population and is one of the main causes due to which a patient is referred to health services. Despite the efforts for pharmaceutical interventions, the symptom usually persists, therefore operative techniques are needed to control the bleeding. Today, apart from the choice of hysterectomy, other less aggressive techniques have been invented. The first results of the Greek Study Group on Gynecological Endoscopy regarding the use of the Thermachoice device are hereby presented. One hundred patients suffering HMB were treated with the Thermachoice device following a standard protocol designed by the Study Group. The follow-up meetings with the patients were held at 3, 6, 12, 24, and 36 months. It seems that the overall effectiveness rate (96%) is satisfactory and it is similar to the overall effectiveness rate reported in other relevant studies upon the Thermachoice device.

Prevalence of clinical vaginal candidiasis in a university hospital and possible risk factors.

OBJECTIVE: The aim of this study was to evaluate the prevalence of symptomatic vaginal candidiasis and probable predisposing factors in a university-based hospital. STUDY DESIGN: A total of 576 cases of clinical vaginal candidiasis were enrolled in this survey and wet mount preparations, Gram-stained smears and vaginal cultures were assessed. Possible risk factors, such as pregnancy, diabetes mellitus, contraceptive and antibiotic use were evaluated. RESULTS: Clinical vaginal candidiasis was detected in 12.1% of the cases. Candida albicans was isolated in 80.2% of patients and non-albicans species in 19.8%. Pruritus was the most common symptom (85.9%), followed by vaginal discharge (66.1%), soreness (31.1%) and dyspareunia (5.0%). Reproductive age, pregnancy, diabetes, contraception as well as recent antibiotic use correlated positively with both C. albicans and non-albicans isolates. Soreness and dyspareunia were significantly related to non-albicans species. The overall recurrence rate was 8.5%. Recurrences correlated positively to non-albicans infections. CONCLUSIONS: C. albicans was, by far, the predominant yeast isolate. Non-albicans isolates caused significantly more frequent soreness, dyspareunia and recurrences than C. albicans. Clinical and laboratory findings, together with possible predisposing factors must be taken into consideration in order to achieve appropriate treatment.

The value of cervical length and plasma proMMP-9 levels for the prediction of preterm delivery in pregnant women presenting with threatened preterm labor.

OBJECTIVE: To assess the value of plasma proMMP-9 levels in predicting the progress of threatened preterm labor to true preterm labor and delivery within 7 days of presentation, along with the ultrasonographic measurement of cervical length. STUDY DESIGN: The study included sixty two pregnant women presented in the 2nd Department of Obstetrics and Gynecology of University of Athens at Aretaieion Hospital with threatened preterm labor. On subjects' presentation, cervical length was evaluated with transvaginal ultrasonography, plasma proMMP-9 levels were measured with the use of a solid phase enzyme immunoassay, and maternal characteristics (smoking, history of preterm delivery and parity) as well as the use of tocolytics were recorded. Subjects were followed up for premature delivery within 7 days. ROC analysis for plasma proMMP-9 levels was performed and logistic regression analysis was used for the evaluation of the prognostic effect of the parameters. RESULTS: The only significant predictors for establishment of true preterm labor and delivery within 7 days of presentation were cervical length (with cutoff value 15 mm: odds ratio=0.022, 95% CI=0.002-0.243, p=0.002) and plasma proMMP-9 (with cutoff value 67.15 ng/ml: odds ratio=0.035, 95% CI=0.003-0.388, p=0.006). The combination of the adopted proMMP-9 and cervical length cutoff values was characterized by a sensitivity of 90.9% and a specificity of 98.3% for predicting the progress to true preterm labor and delivery. CONCLUSION: Plasma proMMP-9 levels could possibly serve as a predictive factor for the progress of threatened preterm labor to true preterm labor and delivery within 7 days of presentation, along with the ultrasonographic evaluation of cervical length.

Effect of sperm treatment with exogenous platelet-activating factor on the outcome of intrauterine insemination.

OBJECTIVE: To evaluate the effect of sperm treatment with exogenous platelet-activating factor (PAF) on IUI clinical pregnancy rate. DESIGN: Prospective randomized study. SETTING: Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece. SUBJECT(S): Fifty-two couples with unexplained infertility, candidates for IUI. INTERVENTION(S): Sperm treatment with an exogenous mixture of PAF (final concentration, 10(-7) mol/L) in sperm-washing medium, direct swim-up technique of sperm preparation, a maximum of six IUI cycles per couple with or without PAF treatment. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate (pregnancies confirmed by ultrasonography per hundred cycles). RESULT(S): The overall clinical pregnancy rate after a maximum of six IUI cycles was significantly higher when sperm was treated with PAF compared with the rate after the direct swim-up technique (23.07% vs. 7.92%). CONCLUSION(S): Treatment of sperm with exogenous PAF might improve the clinical outcome of IUI in cases of unexplained infertility.

Impact of isolated teratozoospermia on the outcome of intrauterine insemination.

One thousand six hundred forty-one IUI cycles performed in 615 couples were categorized, depending on the semen analysis of the male partner, in three groups of: normozoospermia, teratozoospermia, and male factor infertility. Clinical pregnancies and live births per cycle were significantly decreased in the teratozoospermia group when compared to the normozoospermia group, with the exception of the first IUI attempt (comparable outcomes), whereas the cumulative live birth rate after four IUI attempts was significantly lower in the teratozoospermia and male factor infertility groups.

Hyperandrogenism in women with polycystic ovary syndrome persists after menopause.

CONTEXT: Ovarian and adrenal hyperandrogenism characterize premenopausal women with polycystic ovary syndrome (PCOS). Androgens decline with age in healthy and PCOS women. OBJECTIVE: The objective of the study was to investigate hyperandrogenism in PCOS after menopause. DESIGN: This was a case-control, cross-sectional study. SETTING: The study was conducted at a university hospital endocrinology unit. PATIENTS: Twenty postmenopausal women with PCOS and 20 age- and body mass index-matched controls participated in the study. INTERVENTIONS: Serum cortisol, 17-hydroxyprogesterone (17-OHP), Δ(4)-androstenedione (Δ(4)A), dehydroepiandrosterone sulfate (DHEAS), total testosterone (T), and free androgen index (FAI) levels were measured at baseline, after ACTH stimulation, and after 3-d dexamethasone suppression. The ACTH and cortisol levels were measured during the CRH test. MAIN OUTCOME MEASURES: Androgen profile at baseline, after ACTH stimulation, and 3-d dexamethasone suppression tests were the main outcome measures. RESULTS: Postmenopausal PCOS women had higher 17-OHP, Δ(4)A, DHEAS, total T, FAI (P < 0.05) and lower SHBG (P < 0.05) baseline levels than control women. ACTH and cortisol responses during the CRH test were similar in the two groups. After ACTH stimulation, Δ(4)A, DHEAS, and total T levels were equally increased in both groups. After dexamethasone suppression, LH levels did not change in either group; 17-OHP-, Δ(4)A-, and FAI-suppressed levels remained higher in PCOS than in control women (P < 0.05), whereas total T and DHEAS levels were suppressed to similar values in both groups. CONCLUSIONS: In postmenopausal PCOS women, ACTH and cortisol responses to CRH are normal. Androgen levels at baseline are higher in PCOS than control women and remain increased after ACTH stimulation. The dexamethasone suppression results in postmenopausal PCOS women suggest that DHEAS and total T are partially of adrenal origin. Although the ovarian contribution was not fully assessed, increased Δ(4)A production suggests that the ovary also contributes to hyperandrogenism in postmenopausal PCOS women. In conclusion, postmenopausal PCOS women are exposed to higher adrenal and ovarian androgen levels than non-PCOS women.

Treatment of sperm with platelet-activating factor does not improve intrauterine insemination outcome in unselected cases of mild male factor infertility: a prospective double-blind randomized crossover study.

OBJECTIVES: To evaluate the effect of sperm treatment with exogenous platelet-activating factor (PAF) on intrauterine insemination (IUI) clinical pregnancy rate in cases of mild male factor infertility. PAF is a phospholipid mediator, which is present in human sperm. METHODS: The study was performed in the Assisted Reproduction Unit of the 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece, and included 92 couples who presented with mild male factor infertility-all candidates for IUI. A maximum of 4 IUI cycles per couple with or without exogenous PAF treatment were performed and the main outcome measure was the clinical pregnancy rate (pregnancies confirmed by ultrasonography per 100 cycles). RESULTS: The overall clinical pregnancy rate after a maximum of 4 IUI cycles was comparable in cases with and without sperm treatment with PAF (12.24% vs 11.11%). Addition or exclusion of PAF sperm treatment in the same patients did not significantly alter the outcome. CONCLUSIONS: The generalized use of exogenous PAF for the preparation of sperm in unselected cases of mild male infertility does not improve the clinical outcome of IUI.