Role of coagulation factor XII in unexplained recurrent abortions in the Greek population.

OBJECTIVE: To investigate the prevalence and clinical significance of congenital factor XII (FXII) deficiency in the South-European Caucasian (Greek) population in a cohort of women with recurrent spontaneous abortions (RSAs). STUDY DESIGN: One hundred women with a history of > or =2 RSAs of unexplained nature were compared to 100 age-matched, healthy controls with no history of thrombotic disease or adverse pregnancy outcomes, regarding FXII activity. Women were included in the RSA group if they had normal coagulation parameters and no congenital or acquired thrombophilia. RESULTS: Fifteen of 100 women with RSA had reduced FXII activity, whereas all controls had normal FXII activity. FXII activity was significantly lower in the RSA than in the control group (median 100.5, range 10-150 vs. median 104.2, range 58.3-143.2, p < 0.016 by Mann-Whitney test). FXII activity was positively correlated with age in both the RSA and the control groups (r = +0.1, p = 0.04 and r = +0.04, p = 0.2, respectively), but this correlation reached statistical significance in the RSA group only. A negative correlation between FXII activity and the number of abortions in the RSA group was found (r = -0.2, p = 0.03). CONCLUSION: Congenital FXII deficiency is strongly associated with RSA in the Greek population.

Antepartum and postpartum serum heme oxygenase-1 levels in preeclamptic and normotensive pregnant women.

AIM: To determine antepartum and postpartum serum heme oxygenase-1 (HO-1) levels in pre-eclamptic (PE) and normotensive pregnant women and to investigate the relationship between HO-1 levels and severity of PE. PATIENTS AND METHODS: Ten normotensive women were compared to 9 women with mild PE and 12 women with severe PE. Serum HO-1 levels were measured at 30-34 gestational weeks and 12-14 weeks postpartum. RESULTS: The severe PE group had significantly higher serum HO-1 levels antepartum compared to the mild PE and normotensive groups (5.50 ± 1.54 vs. 3.04 ± 0.72 ng/ml, p=0.0003, and 5.50 ± 1.54 vs. 3.12 ± 1.57 ng/ml, p=0.002, respectively). Serum HO-1 levels decreased significantly postpartum in the normotensive group only (3.12 ± 1.57 vs. 2.00 ± 0.97 ng/ml, p=0.0005). In the severe PE group, HO-1 levels antepartum were positively correlated to mean blood pressure (r=+0.79, p=0.004). CONCLUSION: Severe PE is associated with elevated serum HO-1 levels both antepartum and postpartum, suggesting a key role of chronic oxidative stress in the pathogenesis of PE and the endothelial dysfunction of these patients later in their life.

Maternal serum resistin concentrations in gestational diabetes mellitus and normal pregnancies.

AIM: To investigate changes in maternal serum resistin levels during pregnancy and postpartum and clarify their relationship to insulin resistance. METHODS: Thirty normal pregnant women were compared to 30 women diagnosed with gestational diabetes mellitus (GDM). Serum resistin levels were collected at the time of glucose challenge test (26-28 weeks), at 38 gestational weeks and at the third postpartum day and measured with enzyme immunoassay. Correlation of resistin to the homeostatic model assessment-insulin resistance (HOMA-IR) was performed. RESULTS: Maternal serum resistin levels at 38 weeks were significantly higher in pregnant women with GDM compared to the control group (0.28 vs 0.21 ng/mL, P = 0.02) and the same was true for the immediate puerperium (0.25 vs 0.19 ng/mL, P = 0.03). A significant increase in resistin levels was observed in GDM women from 26-28 weeks to 38 weeks (0.21 vs 0.28 ng/mL, P = 0.02), but not in controls. A decrease in serum resistin levels was noted in both the GDM and control groups, at 38 weeks and the immediate postpartum period, but this decrease did not reach statistical significance in either of the two groups. Resistin levels were positively correlated to HOMA-IR at 26-28 weeks of gestation (r = +0.253, P = 0.05). CONCLUSION: GDM is associated with increased resistin serum levels in term pregnancy as well as postpartum. Resistin is positively correlated to HOMA-IR at 26-28 weeks of gestation. A reduction in maternal resistin after delivery indicates a significant placental or fetal contribution in the production of resistin.

Effect of pentoxifylline on vascular endothelial growth factor C and flk-1 expression on endometrial implants in the rat endometriosis model.

OBJECTIVE: To investigate the effects of pentoxifylline, on vascular endothelial growth factor (VEGF)-C and flk-1 expression in the rat endometriosis model. DESIGN: Prospective, randomized, placebo-controlled study. SETTING: Academic institution. ANIMAL(S): Twenty Wistar rats with surgically induced endometriosis. INTERVENTION(S): Animals were evaluated after surgical induction of endometriosis and random allocation to a group that received pentoxifylline and a control group that received NaCl 0.9%, for 3 weeks. At the end of the treatment period the animals were killed and the implants evaluated macroscopically as well as by immunohistochemistry. MAIN OUTCOME MEASURE(S): Morphologic changes of the endometriotic implants; and evaluation of VEGF-C and flk-1 expression by a semiquantitative analysis (HSCORE) for the intensity of immunohistochemical reactivity. RESULT(S): A significant reduction was observed in the mean volume of the endometriotic implants per animal in the treatment group as compared with the control group. There was a significant reduction not only in the mean volume of implants per animal but also in the mean number of implants per animal after treatment. By immunohistochemical evaluation (HSCORE), there was a significant reduction in VEGF-C expression after treatment in all areas examined. A significant reduction of flk-1 expression was also noted in the glandular compartment after treatment but not in the epithelial surface or stroma. CONCLUSION(S): Pentoxifylline may cause suppression of endometriotic lesions by suppressing angiogenesis through VEGF-C and flk-1 expression.

Serum adiponectin during pregnancy and postpartum in women with gestational diabetes and normal controls.

AIMS: To investigate changes in serum adiponectin during pregnancy and postpartum and assess its relationship with insulin resistance as measured by homeostasis model assessment (HOMA-IR). METHODS: Twenty-two normal pregnant women were compared with 22 women diagnosed with gestational diabetes mellitus (GDM). Serum adiponectin levels were measured at the time of the glucose challenge test as well as in the immediate postpartum period and the correlation of adiponectin to HOMA-IR was performed. RESULTS: Adiponectin was significantly lower in women with GDM than in controls during pregnancy (5381 vs. 8449 ng/dl, p = 0.004), as well as postpartum (3278 vs. 6958 ng/ml, p = 0.002). A significant reduction in adiponectin (3278 vs. 5381 ng/ml, p = 0.002) was observed postpartum in GDM women but not in controls. Using a lower cut-off value of 5253 ng/ml, maternal adiponectin could exclude GDM with a sensitivity of 86.4% and a specificity of 59.1% (area under the curve = 0.752, standard error = 0.77, 95% confidence interval 0.601-0.903, p = 0.004). Adiponectin levels during pregnancy were negatively correlated with HOMA-IR (r = -0.375, p = 0.012). CONCLUSION: GDM is associated with decreased serum adiponectin levels both in pregnancy as well as postpartum. Adiponectin is negatively correlated to HOMA-IR. A reduction in maternal adiponectin after delivery indicates a significant placental contribution to adiponectin production.

Concurrent imperforate hymen, transverse vaginal septum, and unicornuate uterus: a case report.

A 14-year-old premenarcheal adolescent girl presented with lower abdominal discomfort and urine retention. After clinical and imaging examination, an imperforate hymen and a large hematocolpos along the upper part of the vagina was diagnosed. Incision of the imperforate hymen did not lead to drainage of blood or fluid. A complete transverse vaginal septum in the middle third of the vagina was identified and when incised drained approximately 200 mL of a dense brownish fluid. Laparoscopy showed a small unicornuate uterus, confirmed by hysteroscopy. This is the first case in the literature of concurrent imperforate hymen, transverse complete vaginal septum, and unicornuate uterus, and it highlights the potential of a multifactorial embryologic genetic etiology.

Successful full-term pregnancy in a woman with Cogan's syndrome: a case report.

Cogan's syndrome (CS) is a chronic inflammatory disorder that most commonly affects young adults. Major clinical features are interstitial keratitis and vestibuloauditory dysfunction. Associations between CS and systemic vasculitis as well as aortitis also exist. The present report is the first case in the literature of pregnancy associated with Cogan syndrome, which posed a therapeutic challenge. There was a relapse of the ocular symptoms only during the first trimester of pregnancy, but the pregnancy was otherwise uneventful. The relevant literature is reviewed both with regard to the relationship of CS to pregnancy and the therapeutic approach in this situation.

Vaginal foreign body in childhood: A multidisciplinary approach.

A 5-year-old girl referred to our division for evaluation of persisting foul-smelling brown vaginal discharge with pruritus for over 2 years, not corresponding to antibiotic therapy. Transabdominal ultrasound identified a heterogeneous mass intensely fixed in the upper third of vaginal wall. Vaginography revealed a filling defect in the upper part of vagina, confirming the diagnosis of an intravaginal foreign body. The foreign body was grasped and removed by traction; it turned out to be a thin double-wrapped piece of sponge. Psychological assessment of the girl was undertaken, in order to illuminate the potential of an underlying emotional and behavioural problem and revealed the existence of psychological disturbances mostly affecting social competence and adaptiveness.

Cutaneous and sensory effects of feminine hygiene pads among women with recent genital infection.

We compared the skin compatibility of two menstrual pad technologies in a single-center, parallel, randomized, examiner-blinded study involving adult women. This report presents the results of a subset of 10 participants who had a genital infection within 12 months prior to the start of the study. In a blinded fashion, participants were randomized to receive one of the two pads for use over two menstrual periods. Participants' skin erythema was graded 24-48 hours following cessation of menstrual flow and on day 14 of each menstrual cycle. Participants subjectively reported any sensory effects. Vulvar erythema scores for the mons pubis, labia majora, labia minora, perineum, buttocks, left medial thigh, and right medial thigh assessed after both menstrual cycles were not statistically different between groups or between the two different products. A low incidence of itching and burning occurred in both groups without statistical significance; none of the participants experienced a recurrent or new genital infection. These preliminary results show that participants with recent genital infections included in clinical studies do not exhibit greater vulvar erythema or sensory effects than participants without recent genital infection. The study showed that the safety profile of the products tested remained acceptable in women with recent genital infection.