Effect of laparoscopic ovarian drilling on vascular endothelial growth factor and ovarian stromal blood flow using 3-dimensional power Doppler.

OBJECTIVE: To determine, by using 3-dimensional power Doppler ultrasonography, the effect of laparoscopic ovarian drilling (LOD) on the serum level of vascular endothelial growth factor (VEGF) and ovarian stromal blood flow changes in polycystic ovary syndrome (PCOS). METHODS: A prospective controlled clinical study was conducted on 26 clomiphene-resistant women with PCOS who were scheduled for LOD and a control group of 22 fertile regularly menstruating women. VEGF and 3 ovarian Doppler indices-vascularization index, flow index, and vascularization flow index-were measured and compared between the 2 groups, and before and after LOD in the PCOS group. RESULTS: Serum VEGF and the Doppler indices of ovarian stromal blood flow were significantly higher in the PCOS group than in the control group. Serum VEGF and the ovarian stromal blood flow Doppler indices were significantly reduced in the PCOS group after LOD. CONCLUSION: Increased vascularity in PCOS demonstrated by Doppler blood flow measurements might be explained by the high level of VEGF. LOD reduced ovarian vascularization and serum VEGF.

Angiogenic factors for the prediction of pre-eclampsia in women with abnormal midtrimester uterine artery Doppler velocimetry.

OBJECTIVE: To determine whether assessing uterine perfusion and angiogenic factors concurrently in the second trimester improves the prediction of pre-eclampsia and intrauterine growth restriction (IUGR). METHOD: Plasma levels of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) were measured for 108 women with abnormal uterine perfusion on Doppler velocimetry in the 23rd week. Later, 33 cases of pre-eclampsia and 9 of IUGR developed. RESULTS: Compared with the plasma levels of the women whose pregnancies remained normal, sFlt-1 levels were significantly higher and PlGF levels significantly lower in the women whose pregnancies became complicated by pre-eclampsia and/or IUGR (P<0.001). The alterations were more pronounced in cases of early-onset pre-eclampsia and in cases of IUGR that necessitated delivery before 34 weeks. Using the sFlt-1/PlGF ratio, these complications could be predicted with 98% sensitivity, 95% specificity, and 93% positive predictive value. CONCLUSION: Measuring uterine perfusion and angiogenic factors concurrently in the second trimester improved the prediction of pre-eclampsia and IUGR.

Impact of Schistosoma mansoni co-infection on serum profile of interferon-gamma, interleukin-4 and interleukin-10 in patients with chronic hepatitis C virus infection.

T cell immunoregulatory cytokines may play a crucial role in the host response to hepatitis C virus infection. While T-helper type 1 (Th1) cytokines are required for host antiviral immune responses, T-helper type 2 (Th2) cytokines can inhibit the development of these effector mechanisms. The aim of this study was to investigate the serum levels of IFN-gamma, IL-4 and IL-10 and their roles in the pathogenesis of chronic HCV infection. Also, to explore the influence of Schistosoma mansoni co-infection on that profile of cytokines. Serum levels of IFN- gamma, IL-4 and IL-10 were measured by ELISA in 15 healthy control subjects (group 1), 18 patients with chronic HCV infection (group II) and 17 patients with chronic HCV co-infected with S. mansoni (group III). Routine liver function tests were performed for all groups. All patients had positive HCV RNA by reverse transcription polymerase chain reaction and elevated alanine amino transferase (ALT) levels for more than 6 months. Diagnosis of S. mansoni infection was based on detection of the parasite in the stools and/or rectal snips and seropositivity for schistosomal antibodies by ELISA. Hematoxylin and eosin stained liver biopsy sections were available and were examined for 25 patients (12 of group II and 13 of group III). There was no statistical difference in serum IFN- gamma levels between patients with chronic HCV infection and healthy controls. IL-4 and IL-10 serum levels were significantly elevated in chronic HCV patients compared to controls (P < 0.05). Chronic HCV patients co-infected with S. mansoni had significantly lower IFN-gamma and significantly higher IL-4 and IL-10 serum levels compared to the other groups (P < 0.05). Serum levels of IL-4 and IL-10 did not correlate to each others in both groups of patients (r = 0.29, P > 0.05 for group II, r = 0.30, P > 0.05 for group III). Patients co-infected with HCV and S. mansoni had necro-inflammatory scores significantly higher in comparison to patients infected with HCV alone (P < 0.05). Serum levels of IFN-gamma, IL-4 and IL-10 did not correlate with the different laboratory parameters, histological activity index or HCV-RNA viral load for all patients population (P > 0.05 for all comparisons). In Conclusions, Th1/Th2 cytokines imbalance is probably involved in the pathogenesis of chronic HCV infection. S. mansoni co-infection induces more alteration in the cytokine milieu, along with more-severe liver disease.