The polycystic ovary syndrome: an update on metabolic and hormonal mechanisms.

Polycystic ovary syndrome (PCOs) is a public health important disease, affecting one in five women at reproductive age. The clinical implications include reproductive, metabolic and psychological features. This article reviews the literature data related to the new metabolic and hormonal mechanisms in PCOs. Recognizing the real diagnostic of PCOs, using the right criteria, is a challenge in current practice.

Metformin-clinical pharmacology in PCOs.

Oligo-anovulation, hyperandrogenism and insulin resistance characterizes polycystic ovary syndrome (PCOs). Metformin is the oldest insulin sensitizer used in the management of type 2 diabetes mellitus. In PCOs, metformin decreases the serum lipids, androgen and insulin; induces ovulation and regular menstrual cycle; increases the pregnancy rate.

Ups and downs in physician - cancer patient relationship.

INTRODUCTION: Over the past years, there has been an increasing interest in involving the cancer patients in the decision making regarding the therapy management due to several factors. The most important aspect to be taken into consideration is the principle of patient autonomy. More and more patients have become interested in making informed decisions regarding their therapy options and physicians need to be able to provide data on the aspect. Some patient-physician models have been proposed and used for 40 years now. Still, the debate is very important for most of the physicians due to the shifts in the approach. MATERIALS AND METHODS: To really express the concerns that the authors address, the case of a head and neck cancer patient and the possible dialogues with the physician were presented. Each type of communication model with the patient is very important because nowadays, intrications between the four are likely to occur. There are legal aspects that need to be taken into consideration such as the informed consent, the ethical and moral aspects. CONCLUSIONS: The possibility of individualized oncological therapy for the cancer patient leads to different decisions for both the patient and the physician. The decision making process involves the patient at different levels. Legal implications tend to affect the healthiness of the dialogue between the physician and the cancer patient and might be a key-point in the further development of the ethical aspects.

Fallopian tubes--literature review of anatomy and etiology in female infertility.

RATIONALE: Around 30% of the infertile women worldwide have associated Fallopian tubes pathology. Unfortunately, for a long time, this aspect of infertility has been neglected due to the possibility of bypassing this deadlock through IVF. OBJECTIVE: Up to date free full text literature was reviewed, meaning 4 major textbooks and around 100 articles centered on tubal infertility, in order to raise the awareness on this subject. METHODS AND RESULTS: The anatomy of the Fallopian tube is complex starting from its embryological development and continuing with its vascular supply and ciliated microstructure, that is the key to the process of egg transport to the site of fertilization. There are many strongly documented causes of tubal infertility: infections (Chlamydia Trachomatis, Gonorrhea, and genital tuberculosis), intrauterine contraceptive devices, endometriosis, and complications after abdominal surgery, etc. DISCUSSIONS: Although there are still many controversies about the etiology of tubal sterility with the advent of molecular diagnosis of infections there has been cleared the pathway of infection through endometriosis or through ciliary immobility towards the tubal obstruction.

Current management of tubal infertility: from hysterosalpingography to ultrasonography and surgery.

RATIONALE: The development of IVF techniques has diminished the importance of tubal infertility but recent discoveries shed a new light on reproductive tubal surgery prior to any IVF cycle. OBJECTIVE: To adapt current state of the art recommendations concerning tubal factor infertility to actual possibilities in Romanian healthcare system and to grow the awareness of fellow fertility specialists and general practitioners to the improved outcomes of novel management and treatment modalities. METHODS AND RESULTS: 67 free full text articles centered on the subject of management in tubal infertility were identified in international databases. Four articles described general diagnosis using data from medical history, 21 works approached the diagnosis through hysterosalpingography, 14 papers introduced the use of different sonographic procedures, 8 files analyzed the importance of exploratory laparoscopy and 20 articles reviewed different treatment modalities. DISCUSSIONS: Current data show that active implementation of the large scale use of tubal surgery prior to any IVF cycle will reduce up to 30% the costs associated with obtaining a viable pregnancy in cases with tubal factor sterility.