Global analysis of the apple fruit microbiome: are all apples the same?

We present the first worldwide study on the apple (Malus × domestica) fruit microbiome that examines questions regarding the composition and the assembly of microbial communities on and in apple fruit. Results revealed that the composition and structure of the fungal and bacterial communities associated with apple fruit vary and are highly dependent on geographical location. The study also confirmed that the spatial variation in the fungal and bacterial composition of different fruit tissues exists at a global level. Fungal diversity varied significantly in fruit harvested in different geographical locations and suggests a potential link between location and the type and rate of postharvest diseases that develop in each country. The global core microbiome of apple fruit was represented by several beneficial microbial taxa and accounted for a large fraction of the fruit microbial community. The study provides foundational information about the apple fruit microbiome that can be utilized for the development of novel approaches for the management of fruit quality and safety, as well as for reducing losses due to the establishment and proliferation of postharvest pathogens. It also lays the groundwork for studying the complex microbial interactions that occur on apple fruit surfaces.

Characterization of the free and glycosidically bound aroma potential of two important tomato cultivars grown in Turkey.

Free and glycosidically bound volatiles from two major tomato cultivars (Lycopersicon esculantum L. cv. Alida and Merve) of Turkey were determined. Free volatile compounds were extracted using liquid-liquid microextraction, while bound volatiles were extracted using solid phase extraction. The compounds were analyzed using GC-FID and GC-MS. Alida showed presence of, 39 free and 32 bound aroma compounds again 38 free and 31 bound aroma compounds is Merve. The odor activity values of the volatile compounds suggested that hexanal, (Z)-3-hexenal, (E,Z)-2,4-decadienal, (E,E)-2,4-decadienal and 2-phenylethanol were most significant odorants in both cultivars. Guaiacol and eugenol were flavor contributors for Merve. The norisoprenoids 5,6-epoxy-ß-ionone and 3-hydroxy-ß-ionone were observed in free form in tomato. Norisoprenoids, terpenoids, volatile phenols and higher alcohols were present in the glycosidic extract. Among the glycosidically bound compounds, 2-phenylethanol, guaiacol and eugenol were found to be potential contributors to overall tomato flavor upon hydrolysis.

Ultra-high dose of intra-amniotic or direct fetal intramuscular betamethasone for lung maturation in the preterm goat model.

OBJECTIVE: To evaluate the effects of intra-amniotic (IA) and fetal injections of a single ultra-high dose of betamethasone (BM) 48 h before preterm delivery on neonatal pulmonary function, using an experimental goat model. STUDY DESIGN: Eighteen date-mated singleton pregnant Hair goats were randomized into four groups. At gestational day 118 (alveolar phase, term 150-155 days) after obtaining a sample of amniotic fluid, fetuses in group 1 (n=5) received 8 mg/kg IA BM, and in group 2 (n=5) 4 mg/kg fetal IM BM. In group 3 (n=4) (0.3mg/kg/day) maternal BM was administered at day 118 and 119 with a 24h interval; control fetuses (n=4) received 1 mL/kg of IA saline at day 118. At gestational day 120, after obtaining second sample of amniotic fluids 18 kids were delivered by preterm cesarean section, entubated, weighed, and mechanically ventilated for 15 min. Arterial blood gas samples and deflation/inflation lung pressure-volume measurements were obtained. After sacrifice, lungs were removed, weighed, gross examined and processed for further histological and immunohistochemical (IHC) evaluations. On hematoxylin and eosin (HE) stained slides, presence and severity of lung emphysema was evaluated; slides stained for surfactant proteins, and caspases were used for semi-quantitative evaluation of lung maturation. Kruskal-Wallis, Mann-Whitney, Wilcoxon signed rank, and chi-square tests were used for comparisons. RESULTS: IA BM was associated with increased number of stillbirths (60% vs. 0% in control) (p=0.06) and emphysematous changes. Bodyweight-adjusted pressure-volume measurements were improved after maternal, but not IA or fetal, BM (p=0.06). Following mechanical ventilation, arterial blood gas parameters did not significantly alter across maternal and fetal administrations. However, pH was significantly lower (p<0.05) and carbon dioxide partial pressure was higher (p<0.05) in the control group, indicating hypercapnic acidemia in non-treated pregnancies. None of the treatments induced measurable alterations in amniotic fluid lecithin/sphingomyelin (L/S) values. IA and fetal routes were associated with decreased surfactant protein expressions and increased apoptotic activity in alveolar and bronchio-alveolar epithelial cells. CONCLUSION: Ultra-high dose IA and fetal IM BM is not superior to the standard dose and maternal way of administration in our experimental design.

Abnormal ductus venosus flow and tricuspid regurgitation at 11-14 weeks' gestation have high positive predictive values for increased risk in first-trimester combined screening test: results of a pilot study.

OBJECTIVE: To investigate the relationship between two novel first-trimester ultrasound markers (abnormal fetal ductus venosus [DV] flow and presence of tricuspid regurgitation [TR]) and the results of the first-trimester combined screening test in pregnancies with a normal karyotype. The screening test involves nuchal translucency measurement by ultrasound, and measurement of serum free beta-chorionic gonadotropin and pregnancyassociated plasma protein A. MATERIALS AND METHODS: The study included 58 pregnancies with amniocentesis-proven normal karyotypes and ultrasound-proven normal fetal anatomy. DV flow and TR were initially evaluated by ultrasound at 11-14 weeks' gestation. Sensitivity, specificity, and positive and negative predictive values of abnormal DV flow and TR for determining increased test risk (> 1 in 300) were calculated. RESULTS: Abnormal DV flow and TR were detected in seven (12%) and six (10%) women, respectively. The sensitivities of abnormal DV flow, TR, and dual abnormalities (abnormal DV flow plus TR) for predicting increased risk in the combined screening test were low (33.3%, 27.7%, and 26.3%, respectively). However, their corresponding specificities (97.5%, 97.5%, and 100%) and positive predictive values (85.7%, 83.3%, and 100%) were reasonably high, with particularly low false-positive rates (2.5%, 2.5%, and 0%). When abnormal DV flow and TR were both positive, the combined test risk was consistently above 1 in 300. CONCLUSION: Determination of DV flow and TR as initial markers in unselected pregnancies merits further investigation, as the combination of these parameters might reliably predict an increased risk in combined screening test result, with low false positivity.

Raloxifene decreases serum malondialdehyde and nitric oxide levels in postmenopausal women with end-stage renal disease under chronic hemodialysis therapy.

AIM: We prospectively aimed to investigate the relationship between raloxifene administration and serum malondialdehyde (MDA), nitric oxide (NO), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglyceride levels in postmenopausal women undergoing hemodialysis treatment for chronic renal failure. METHODS: Twenty-four women scheduled for twice-weekly hemodialysis treatment were given 60 mg/day raloxifene for 3 months. Serum MDA, estimated NO, HDL, and LDL measurements were assessed initially and at month 3. We used the Mann-Whitney U and Wilcoxon signed-rank tests for comparisons. Five women discontinued the study. RESULTS: After controlling for baseline characteristics, mean serum MDA and estimated NO levels decreased (P = 0.0001 and P = 0.0001, respectively) from 2.01 +/- 0.40 micromol/L and 21.3 +/- 17.9 micromol/L at baseline to 1.27 +/- 0.23 micromol/L and 7.7 +/- 7.5 micromol/L at month 3, respectively. Mean serum LDL level declined (P = 0.004) from 120.0 +/- 24.3 mg/dL to 103.3 +/- 12.1 mg/dL, and mean HDL level increased (P = 0.024) from 52.2 +/- 7.8 mg/dL to 57.2 +/- 5.7 mg/dL with raloxifene administration. CONCLUSION: Oral raloxifene administration (60 mg/day) for 3 months lowered serum MDA and NO levels with favorable effects on serum lipid parameters in postmenopausal women, who were undergoing long-term hemodialysis treatment for chronic renal failure.

Serum malondialdehyde, erythrocyte glutathione peroxidase, and erythrocyte superoxide dismutase levels in women with early spontaneous abortions accompanied by vaginal bleeding.

BACKGROUND: Malondialdehyde (MDA) is a marker of lipid peroxidation. Glutathione peroxidase (GPX) and superoxide dismutase (SOD) are the main enzymes responsible for the detoxification of superoxide anion. The aim was to assess whether serum MDA, erythrocyte GPX, and erythrocyte SOD levels altered during early spontaneous abortions presenting with vaginal bleeding. MATERIAL/METHODS: A group of pregnant women at less than 8 weeks' gestation with spontaneous abortion and vaginal bleeding (n=23) and a control group of healthy pregnancies with similar characteristics (n=25) were included. Serum MDA levels, erythrocyte GPX, and SOD activities were determined and compared among the groups. RESULTS: Characteristics, including maternal age, parity, gestational age, complete blood count values, serum total protein, serum albumin, and serum lipid profile, were similar across the groups. Spontaneous abortion prior to 8 weeks of gestation was associated with increased mean serum MDA levels and decreased mean erythrocyte SOD activity. Erythrocyte GPX values did not differ among the groups. CONCLUSIONS: Increased lipid peroxidation and inhibition of SOD activity might be involved in the termination of spontaneous abortions and expulsion of fetoplacental material out of the uterine cavity.

Does sphingosine-1-phosphate have a protective effect on cyclophosphamide- and irradiation-induced ovarian damage in the rat model?

The aim of this study was to assess the possible protective effect of sphingosine-1-phosphate (S1P), a polar sphingoid metabolite that seemingly promotes cell survival, on cytotoxin- and irradiation-induced ovarian injury in the rat model. Administration of S1P into ovarian bursa before whole-body irradiation led to decreased percentage of apoptotic cells, mostly in primordial follicles; however, S1P was not effective against apoptosis in rats that were given intraperitoneal cyclophosphamide.

Total salpingectomy during abdominal hysterectomy: effects on ovarian reserve and ovarian stromal blood flow.

AIM: To investigate the short- and medium-term consequences of performing total salpingectomy during abdominal hysterectomy (without oophorectomy) on certain ovarian reserve parameters and blood flow velocity measurements through the ovarian stroma. METHODS: Twenty-four patients were recruited and randomized into two groups. Group 1 patients (n = 12) underwent total hysterectomy and complete excision of the fallopian tubes bilaterally. In group 2 (classical approach), fallopian tubes were removed partially leaving behind the neighboring paraovarian tissue. Pre- and postoperative (at 1 and 6 months) serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol values, ovarian volume estimation by transvaginal ultrasound, and ovarian stromal blood flow Doppler velocimetry were assessed during the early follicular phase. Mann-Whitney U-test, Student's t-test and Freidman's test were used for comparisons. RESULTS: Baseline data were similar across the groups (P > 0.05). Mean FSH, LH, estradiol values, and ovarian volume were unchanged after both of the techniques. However, mean pulsatility index, resistance index, and systole/diastole (S/D) ratio were significantly decreased in both groups compared to baseline values (group 1, P = 0.027, P = 0.018, and P = 0.013, respectively; group 2, P = 0.01, P = 0.002, and P = 0.0001, respectively). Postoperative decline in the mean pulsatility index was more pronounced (P = 0.02) in group 2 (partial removal). CONCLUSION: It appears that complete removal of fallopian tubes during hysterectomy has no advantageous effect on ovarian blood supply. It might be important to protect the ovarian blood supply as much as possible while performing hysterectomy in the reproductive period.

Expectant management of severe preeclampsia presenting before 25 weeks of gestation.

BACKGROUND: The treatment of preeclampsia before 25 weeks of gestation remains controversial. The aim was to evaluate the outcome of expectant management of preeclamptic women presenting prior to 25 weeks of gestation. MATERIAL/METHODS: During a five-year period, 55 women presenting with severe preeclampsia at or before 24 weeks and 6 days of gestation were admitted to a high-care unit for expectant management. Indications for delivery were the development of severe maternal morbidity secondary to preeclampsia. Complications were identified from individual patient and infant records. RESULTS: Mean prolongation of gestation was 4.8+/-4.1 days (range: 1-13 days) and the mean maternal hospitalization period was 10.0+/-8.3 days (range: 2-31 days). Conservative management was associated with a 94.5% (52/55) intrauterine fetal loss rate. Of the three live-born infants, one died secondary to respiratory distress syndrome followed by neonatal sepsis and the other two survived with cognitive and motor developmental delay. HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome was diagnosed in 12 women (21.8%). Nine women (16.3%) required transfusions with blood or blood products. There was 1 case (1.8%) of eclampsia. Overall, 15 women (27.2%) had developed some maternal morbidity without any significant differences between <23 weeks' and >/=23 weeks' gestation. Nulliparity was not associated with stillbirth (p=0.8), HELLP syndrome (p=0.8), or overall maternal morbidity (p=0.7). None of the women died or required any long-term treatment. CONCLUSIONS: Conservative management of severe preeclampsia before 25 weeks of gestation is associated with considerable perinatal mortality and morbidity. Maternal complications are relatively common, but generally short-lived.

Does marriage between first cousins have any predictive value for maternal and perinatal outcomes in pre-eclampsia?

AIM: To assess the consequences of consanguineous unions between first cousins on the severity of pre-eclampsia and associated perinatal morbidity. METHODS: Six hundred and eighty-six women admitted with a diagnosis of pre-eclampsia were included. The study group consisted of 62 preeclamptic women with a union between first cousins. The remaining patients admitted throughout the same period (n = 624) served as controls. The groups were compared regarding the presence of severe pre-eclampsia, hemolysis elevated liver enzymes low platelets (HELLP) syndrome, eclampsia, placental abruption, hematological complications, renal failure, requirement for antihypertensive or magnesium sulfate treatments, cesarean section for acute fetal distress, birthweight, Apgar scores, perinatal mortality and neonatal morbidity including admission to the neonatal intensive care unit, respiratory distress syndrome, sepsis, convulsions, intracranial hemorrhage, hypoglycemia, hypocalcemia, and jaundice. Student's t-test, chi(2)-test and logistic regression analysis were used for statistical evaluation. RESULTS: Univariate analysis yielded significant differences in parity (P = 0.034), maternal platelet counts (P = 0.02), and maternal serum potassium levels (P = 0.016) among the groups. Respiratory distress syndrome was more frequent (P = 0.043) in infants of unrelated couples. Multivariate analysis, controlling for the confounding factors, revealed that marriages between first cousins had no effect on any of our outcome variables including neonatal respiratory distress syndrome. CONCLUSIONS: Third-degree consanguinity in terms of a union between first cousins seems to have no effect on the development of maternal and perinatal complications in established pre-eclampsia.

Leukocytosis might precede in-hospital eclampsia in preeclamptic women who do not receive magnesium sulfate.

In an effort to better define preeclamptic women at risk of eclampsia, we examined the predictive value of maternal demographic characteristics and admission maternal laboratory values for the risk of subsequent development of eclampsia in preeclamptic women, who were not receiving magnesium sulfate during hospitalization. The decision to use magnesium sulfate prophylaxis was at the discretion of the treating physician. Preeclamptic women admitted throughout a 3-year period and treated with a protocol exempting magnesium sulfate therapy were retrospectively included (n=497). Maternal data at admission were recorded and analyzed. Eight women developed an eclamptic seizure during subsequent hospital follow-up. Logistic regression models were used to assess the independent predictive role of each variable on the development of eclampsia. Lower serum fibrinogen values, increased leukocyte counts, and increased diastolic blood pressure at admission were independent predictors of a subsequent in-hospital eclamptic seizure. An initial diastolic blood pressure >or=120 mm Hg, blood leukocyte count >16,000/microL, and serum fibrinogen value <450 mg/dL were associated with a 25.4-, 7.1-, and 26.6-fold increased risk of eclampsia, respectively. We conclude that marked leukocytosis and diastolic blood pressure increment might precede the development of eclampsia. Serum fibrinogen concentrations >450 mg/dL seem to be protective for eclampsia. The association between inflammation and eclampsia merits further investigation.

Placebo-controlled randomized comparison of vaginal with rectal misoprostol in the prevention of postpartum hemorrhage.

AIM: To compare vaginally administered misoprostol to rectally administered misoprostol and placebo in a prospective randomized placebo-controlled study. METHODS: One hundred and fifty women with singleton vaginal deliveries were randomized (50 women in each arm) to receive 400-microg misoprostol tablets (crushed and suspended in a microenema) intravaginally, or 400-microg misoprostol tablets rectally, or two placebo lactose tablets rectally. The medication was administered immediately after delivery of the placenta. Women with profuse hemorrhage and delayed placental separation (>30 min) were excluded. Our outcome measures were postpartum blood loss 1 h after administration, and change in hemoglobin and hematocrit values from baseline to postpartum day 1. Analysis of variance and chi-squared tests were used to compare the outcome variables between groups. RESULTS: One hundred and twenty-six women were available for analysis. Baseline characteristics were similar across the groups. The number of excluded subjects, the estimated blood loss, and the drop in hemoglobin and hematocrit values did not differ between the three groups (P > 0.05). CONCLUSIONS: Misoprostol administered vaginally or rectally at a dosage of 400 microg following placental separation was not effective for decreasing postpartum bleeding in women without excessive hemorrhage.

Evaluation of a new surgical approach for the treatment of clomiphene citrate-resistant infertility in polycystic ovary syndrome: laparoscopic ovarian multi-needle intervention.

Laparoscopic ovarian drilling (LOD) is the accepted second-line treatment for clomiphene citrate-resistant anovulatory infertility in polycystic ovary syndrome (PCOS). Although multiple pregnancy rates are reduced with ovarian drilling procedures, postoperative adhesion formation is a potential complication in up to 85% of the women subjected to laparoscopic destructive ovarian procedures. Our objective was to determine the effectiveness of a new, specially designed laparoscopic device and technique that might enable treatment for patients with anovulatory PCOS with less trauma and fewer postoperative adhesions. Thirty-five infertile clomiphene citrate-resistant women with PCOS were included. Seventeen women underwent laparoscopic ovarian multi-needle intervention (LOMNI), and 18 women received step-up ovulation induction treatment with recombinant follicle-stimulating hormone followed by intrauterine insemination for three cycles. Patients were followed for a period of 6 months after either laparoscopic surgery or the initiation of ovulation induction therapy. Outcome measures were cycle regularity, pregnancy rate, safety, postoperative adhesion formation, and cost effectiveness. There were no significant differences between the two groups in terms of age, body-mass index, duration of infertility, and basal cycle-day 2 hormone levels. Significant improvement in cycle regularity (p <.01) was found after LOMNI. Cumulative pregnancy rates (35.3% in the LOMNI group vs 33.3% in the ovulation induction group) did not differ between the groups. No adverse events following surgery were noted. Moderate ovarian hyperstimulation syndrome and multiple pregnancies occurred in four and two patients, respectively, in the ovulation induction group. Eight nonpregnant women in the LOMNI group underwent repeat laparoscopy at the end of the follow-up period. No adhesion formation attributable to LOMNI was observed in any of those eight women. The cost of LOMNI was significantly (p <.001) lower than the ovulation induction treatment. In conclusion, LOMNI may be a safe, inexpensive, and effective procedure for the treatment of CC-resistant infertility in patients with PCOS. It seems to preserve the beneficial effects and probably omits unwanted effects (such as adhesion formation) of LOD.

Does the diameter of an endometrioma predict the extent of pelvic adhesions associated with endometriosis?

OBJECTIVE: To correlate ovarian endometrioma diameter with the extent of pelvic adhesions. STUDY DESIGN: Forty women with unilateral ovarian cysts thought to be endometriomas were prospectively recruited. The interventions were transvaginal ultrasound to measure the size of the ovarian endometrioma and a laparoscopic surgical procedure, including detailed pelvic assessment. Main outcome measures were pelvic adhesion scores using the American Fertility Society revised classification of endometriosis. RESULTS: Thirty-two women met the inclusion criteria. Twelve had an endometrioma < 3 cm in diameter; 12, 3-5 cm; and 8, > 5 cm. Adhesion scores from various anatomic areas did not differ across these 3 groups. No correlation between the size of the endometrioma and associated pelvic adhesions was found using multiple regression analysis. CONCLUSION: The size of an endometrioma measured by transvaginal ultrasound does not correlate with the extent of adhesive disease. Small (< 3 cm) endometriomas may be associated with a considerable degree of pelvic adhesions.

Effects of raloxifene on serum malondialdehyde, erythrocyte superoxide dismutase, and erythrocyte glutathione peroxidase levels in healthy postmenopausal women.

OBJECTIVE: To investigate the relationship between raloxifene administration and serum malondialdehyde (MDA), erythrocyte superoxide dismutase (SOD), erythrocyte glutathione peroxidase (GPx) levels in healthy postmenopausal women. METHODS: In a randomized and placebo-controlled design, 80 women received either 60 mg/day raloxifene or placebo for 24 weeks. MDA, SOD, and GPx levels were assessed at 0,4,12, and 24 weeks. Wilcoxon signed-rank test and Mann-Whitney U test were used for comparisons. RESULTS: Six women in the treatment arm and eight women in the placebo group discontinued the study. Mean serum MDA levels were significantly (p = 0.001) decreased from 11.4 nmol/ml at baseline to 8.9 nmol/ml at week 12 with raloxifene treatment. Mean erythrocyte SOD activity was significantly (p = 0.02) reduced from 1472 U/g Hb at baseline to 1173 U/g Hb at week 12 following raloxifene administration. Lowered serum MDA and erythrocyte SOD levels persisted during treatment. On contrary, erythrocyte GPx levels did not change significantly with raloxifene administration. CONCLUSIONS: Raloxifene (60 mg/day) lowers serum MDA levels and erythrocyte SOD activity in postmenopausal women after 12 weeks of treatment. The clinical implications of these findings need to be determined.

Relationship between the timing of hysterosalpingography before gamete intrafallopian transfer and the subsequent fertility outcome.

AIM: To investigate the prognostic significance of hysterosalpingography carried out before one-sided gamete intrafallopian transfer for unexplained infertility. METHODS: Fifty-nine first gamete intrafallopian transfer cycles in 59 couples with unexplained infertility were evaluated in two groups: 30 women with a hysterosalpingogram carried out 1-6 months prior to gamete intrafallopian transfer procedure combined with diagnostic laparoscopy, and 29 women with a hysterosalpingogram carried out during any other interval up to 2 years. The outcome measures were biochemical pregnancy, clinical pregnancy, miscarriage, preterm delivery, and term delivery. Groups were compared using Student's t-test and chi-squared tests. Logistic regression was used to predict the effects of hysterosalpingography on subsequent fertility outcomes. RESULTS: Univariate analysis yielded no significant differences across groups regarding the baseline characteristics and outcome measures. When confounding factors were controlled, carrying out hysterosalpingography at some time before 6 months of gamete intrafallopian transfer was associated with 5.2- and 3.4-fold increased clinical pregnancy and term delivery rates, respectively. CONCLUSIONS: An additional hysterosalpingography at most 6 months prior to gamete intrafallopian transfer procedure might improve fertility prospects. This effect could be attributed to proper selection of the fallopian tube for cannulation during transfer or some therapeutic effect of hysterosalpingography.

Color Doppler ultrasound in ovarian fibrosarcoma.

BACKGROUND: Primary ovarian fibrosarcoma is a very rare tumor. Its Doppler waveform characteristics have not been described before. CASE: A 35-year-old woman presented with a 5-cm solid ovarian mass. Intratumoral artery resistance index (RI) and pulsatility index (PI) were very low (0.19 and 0.21, respectively). Peak systolic velocity calculated by using transvaginal Doppler ultrasound was higher than expected (24.8 cm/s). Postoperatively, the histopathologic diagnosis was primary ovarian fibrosarcoma, stage Ia. CONCLUSIONS: Low vascular resistance can be encountered in ovarian fibrosarcomas. In young patients presenting with a solid adnexal mass, intratumoral Doppler waveform investigations might offer some help for earlier prediction of rare malignant tumors like fibrosarcomas.

The value of laboratory tests and ultrasonography in evaluating ovarian response to ovulation induction treatment with low-dose recombinant follicle-stimulating hormone.

OBJECTIVE: To compare basal (cycle day 3) follicle-stimulating hormone (FSH) level, clomiphene citrate challenge test (CCCT), gonadotropin-releasing hormone agonist stimulation test (GAST), and mean ovarian volume estimation by ultrasound for predicting the subsequent ovarian response. DESIGN: Prospective, randomized, clinical study. SETTING: Referral university hospital. PATIENTS: One hundred and forty-four women with unexplained infertility undergoing their first ovulation induction treatment with low-dose recombinant FSH. INTERVENTIONS: Patients were randomized into four groups. Basal FSH levels were evaluated in group I (n = 36). Clomiphene citrate challenge test (CCCT) and gonadotropin-releasing hormone agonist stimulation test (GAST) were carried out in group II (n = 36) and group III (n = 36), respectively. Transvaginal ultrasound was performed for ovarian volume measurements in group IV (n = 36). In the subsequent cycle, all women received ovulation induction therapy with recombinant FSH. MAIN OUTCOME MEASURES: Number of mature (> or = 14 mm) follicles and the number of recombinant FSH ampules required for successful ovulation induction. RESULTS: Ovarian volume estimation by transvaginal ultrasound, compared to the other three tests, had the most powerful positive correlation with the number of mature follicles (r = 0.84, P < .0001) and the most powerful negative correlation (r = -0.75, P < .0001) with the amount of recombinant FSH used per cycle. CONCLUSION: Mean ovarian volume estimation by transvaginal ultrasound might be more useful than basal FSH values, CCCT, and GAST for predicting ovarian response to low-dose recombinant FSH treatment.

Intrafascial versus extrafascial abdominal hysterectomy: effects on urinary urge incontinence.

Our aim was to evaluate urinary urge incontinence following intrafascial and extrafascial abdominal hysterectomies in a prospective randomized study. Women scheduled for total abdominal hysterectomy were randomized to the extrafascial (n=38) and the intrafascial techniques (n=42). The groups were controlled for demographic variables, obstetric and gynecologic history, uterine size, indications for hysterectomy, and preoperative hemoglobin values. Short-term surgical morbidity and presence of urge incontinence defined as urodynamically established detrusor overactivity at the end of 12 months were the main outcome measures. Major surgical morbidity did not differ between the two groups. Percentages of women with urge incontinence at the end of the follow-up period were also similar. However, when women with pre-existing urge incontinence were evaluated separately, there was a trend towards the intrafascial operation to be associated with more urge-incontinence-free patients at the end of the follow-up period ( p=0.06, borderline significant). As a result, short-term surgical morbidity seems to be similar across the intrafascial and extrafascial techniques of abdominal hysterectomy. The effects of intrafascial abdominal hysterectomy on women presenting with urge incontinence in the preoperative period merit further investigation.

Mayer-Rokitansky-Küster-Hauser syndrome associated with unilateral gonadal agenesis. A case report.

BACKGROUND: Mayer-Rokitansky-Küster-Hauser syndrome is the second most frequent cause of primary amenorrhea, with a reported incidence of 0.002%. Patients have a normal karyo-type and usually normal ovaries. Associated ovarian abnormalities are rarely reported. CASE: A 17-year-old woman with primary amenorrhea was evaluated by diagnostic laparoscopy, which showed complete müllerian agenesis. On the left side, the uterine tube and round ligament were hypoplastic, and the ovary was absent. The karyotype was 46, XX. Intravenous urography revealed a right kidney below the normal site with malrotation abnormality. CONCLUSION: Müllerian duct agenesis coexisting with unilateral ovarian agenesis and a contralateral renal abnormality has not been widely described before. Unilaterality might play a role in the etiologic factor of Mayer-Rokitansky-Küster-Hauser syndrome.