In vitro effect of danazol on endometrioma cells in culture.

OBJECTIVE: To evaluate the effect of danazol on endometrioma cells in culture, in relation to cell proliferation. STUDY DESIGN: Danazol has been shown to be effective in treating endometriosis, leading to remission. The mode of action is through suppression of gonadotropins. A direct effect on endometriosis implants has been suggested. This study was conducted on endometrioma cell lines using various concentrations of danazol in ethanol solution. RESULTS: Danazol showed a decrease in proliferation ofendometrioma cells in culture. This was also associated with an increase in apoptosis and necrosis ofcultured cells. CONCLUSION: This study demonstrates the direct effect of danazol on endometrioma cells in culture.

Celiac disease and its effect on human reproduction: a review.

Celiac disease is an intestinal inflammatory disease that is triggered by gluten in the diet. Patients present with a wide array of symptoms due to malabsorption that include diarrhea, abdominal pain, bloating and weight loss. In women, this disease may have implications on menstrual and reproductive health. The symptom complex includes delayed menarche, early menopause, secondary amenorrhea, infertility, recurrent miscarriages and intrauterine growth restriction. These women benefit from early diagnosis and treatment. Therefore, celiac disease should be considered and screening tests performed on women presenting with menstrual and reproductive problems and treated accordingly. The objective of this article is to review the current literature on celiac disease and its association with the above-mentioned disorders.

Cigarette smoking impairs sperm bioenergetics.

OBJECTIVE: The growing consensus on the negative impact of cigarette smoking on fertility prompted us to compare the rate of sperm respiration in smokers and non-smokers. MATERIALS AND METHODS: Semen samples from 20 smokers and 58 non-smokers consulting at the andrology laboratory for fertility evaluation were used. Smoking was defined as consumption of at least a half a pack per day. A phosphorescence analyzer that measures O(2) concentration in sperm suspensions as function of time was used to determine the rate of respiration. In a sealed vial, the rate of sperm respiration (k) was defined as -d[O(2)]/dt; where [O(2)] was obtained from the phosphorescence decay rate of a palladium phosphor. [O(2)] in solutions containing sperm and glucose declined linearly with time, showing the kinetics of O(2) consumption was zero-order. Inhibition of O(2) consumption by cyanide confirmed the oxidations that occurred in the sperm mitochondrial respiratory chain. RESULTS: There were no differences (p > 0.28) between smokers and non-smokers for ejaculate volume, motility, concentration, normal morphology, viability and hypo-osmotic swelling test. The rate (mean + or - SD, in microM O(2)/min/10(8) sperm) of sperm mitochondrial O(2) consumption in the smokers was 0.96 + or - 0.58 and in the non-smokers 1.39 + or - 0.67 (p = 0.004). CONCLUSIONS: The rate of sperm respiration was significantly lower in smokers. This negative impact of cigarette smoking on sperm aerobic metabolism may, in part, explain the lower rate of fertility in smokers.

Gossypol inhibits proliferation of endometrioma cells in culture.

AIM: To evaluate the anti-proliferative activity and mitochondrial toxicity of gossypol in endometrioma cells maintained in short-term cultures. METHODS: (A) Three endometrioma cell lines from patients were treated with 25 or 50 nmol/L gossypol for up to 12 days. The effect of gossypol on the cell growth was recorded. (B) A phosphorescence oxygen analyzer was used to determine the effects of gossypol on mitochondrial oxygen consumption of six endometrioma cell lines from patients. (C) Cellular gossypol accumulations in three endometrioma cell lines from patients were measured by high-pressure liquid chromatography. RESULTS: Proliferation of the endometrioma cells was inhibited by 25 and 50 nmol/L gossypol. Respiration of the endometrioma cells was inhibited by 10 micromol/L gossypol. Cellular gossypol was detected in the endometrioma cell lines that were treated for 24 h with 10 and 0.3 micromol/L gossypol. CONCLUSION: Gossypol invokes a potent toxicity on cultured endometrioma cells.

Cell growth effects of leuprolide on cultured endometrioma cells.

OBJECTIVE: To examine the effect of the GnRH agonist leuprolide on the growth of cultured endometrioma cells. STUDY DESIGN: Experimental study in an academic setting on endometrioma cell lines cultured from 15 women undergoing laparoscopy or laparotomy for excision of endometrioma. RESULTS: Mean cell counts resulting from treatment with lower concentrations were not significantly different from those of the controls. Increasing concentrations of leuprolide resulted in inhibition of cell growth. The inhibitory effect of leuprolide was statistically significant when the 1,000 ng/mL concentration was compared with the control concentration. CONCLUSION: Increased concentrations of leuprolide has suppressive effects on the growth of cultured endometrioma cells. This suggests a direct effect of GnRH agonists acting via GnRH agonist receptors. Long-acting gonadotropin-releasing hormone (GnRH) agonists cause pituitary receptor down-regulation and ovarian suppression, a function that has made this class of agents useful for the treatment of endometriosis. Recent work has also revealed that this class of agents may also have a direct suppressive effect on peripheral target tissue, mediated by GnRH and GnRH agonist receptors. Preliminary work has suggested that there are GnRH receptors in endometriotic cells and that the growth of these cells is inhibited by GnRH agonists. This activity, however, has not been extensively studied in the growth of endometrioma cells. The present study evaluated the effect of the GnRH agonist leuprolide on 15 endometrioma cell lines.

Arteriovenous malformation in a bicornuate uterus leading to recurrent severe uterine bleeding: a case report.

BACKGROUND: Uterine arteriovenous malformations (AVMs) are rare entities that have been documented in a wide age range. Several treatment modalities have been highlighted in the literature. Uterine artery embolization appears to be effective therapy for select cases. Embolization provides an alternative to hysterectomy and the potential for future fertility. To our knowledge, only 1 other case report describes an AVM existing within a bicornuate uterus. CASE: A 31-year-old, married, Caucasian woman with a history of infertility presented with intermittent uterine hemorrhage resulting in symptomatic anemia. The patient was diagnosed with a uterine AVM existing within the left horn of a bicornuate uterus. The patient underwent uterine artery embolization, with resolution of the vascular mass and resumption of regular menstrual flow. CONCLUSION: AVM in a bicornuate uterus is rarely reported. Selective uterine artery embolization offers an effective modality of treatment.

Aromatase inhibitor (anastrozole) affects growth of endometrioma cells in culture.

OBJECTIVE: To study the effects of aromatase inhibitor (anastrozole) on the growth and estradiol secretion of endometrioma cells in culture. DESIGN: Endometrioma cells are grown in vitro until maximum growth before used in this study. This was done in the research laboratory for tissue culture, in an academic hospital. INTERVENTIONS: Testosterone at a concentration of 10 µg/mL was added as a substrate for the intracellular aromatase. In addition, aromatase inhibitor was added at a concentration of 200 and 300 µg/mL. The effect on cell growth and estradiol secretion is evaluated using Student's t-test. RESULTS: The use of testosterone increased estradiol secretion by endometrioma cells in culture. The use of aromatase inhibitor significantly inhibited the growth of endometrioma cells, and estradiol secretion. CONCLUSION: Aromatase inhibitor (anastrozole) may be an effective treatment for endometriosis due to inhibition of cellular aromatase.

Recurrent catamenial pneumothorax suggestive of pleural endometriosis.

A 42-year-old multiparous patient presented for consultation as a referral for management of recurrent catamenial pneumothorax. Evaluation by a pulmonologist failed to reveal any chest masses. She was treated for endometriosis using Danazol 800 mg daily for 6 months. Pneumothorax did not recur during treatment and during follow-up visits.

Vaginal Atrophy following Long-Term Depot Medroxyprogesterone Acetate Use: A Case Report.

Depot medroxyprogesterone acetate (DMPA) is a commonly used form of contraception, with noncontraceptive benefits for the user. The mode of action is through the suppression of ovulation. It leads to hypoestrogenism which causes dryness of the vagina and dyspareunia. We present in this paper a patient that was very symptomatic with regard to vaginal atrophic changes determined by vaginal cytology. This side effect may become increasingly more common as we see more long-term use of DMPA.

A rare mullerian duct anomaly not included in the classification system by the american society for reproductive medicine.

This is a case report of a 37-year-old female with a uterine septum (two cavities), a normal single fundal contour, two cervices, and a longitudinal vaginal septum. This is a rare finding that is not described in the current classification system by the American Society for Reproductive Medicine.

Autoimmune progesterone dermatitis: a case report.

Background. Autoimmune progesterone dermatitis is a rare cyclic premenstrual allergic reaction to progesterone produced during the luteal phase of a woman's menstrual cycle. Patients present with a variety of conditions including erythema multiforme, eczema, urticaria, angioedema, and progesterone-induced anaphylaxis. Case. Thirty-eight-year-old woman G2P2002 presents with erythema multiforme and urticarial rash one week prior to her menses starting one year after menarche. She was treated with oral contraceptive pills and the symptoms resolved. Conclusion. This is a typical case of progesterone autoimmunity. The diagnosis is based on cyclic nature of the dermatitis. This differentiates the condition from other allergies or systemic diseases with skin manifestations. Inhibition of ovulation in such cases results in decrease in progesterone secretion and prevention of symptoms.

Mullerian agenesis with vaginal vault prolapse following mechanically created neovagina.

A 21-year-old with mullerian agenesis, presented with vaginal mass. Previously, she developed a neovagina by the use of vaginal dilators. Examination revealed vaginal vault prolapse. She was surgically treated with vaginal vault suspension using a mesh.

Large mesonephric cyst with acute adnexal torsion in a teenage girl.

BACKGROUND: Mesonephric duct remnants usually do not present any clinical dilemma. However, if the cellular lining remains active, it may lead to cystic lesions that may cause pain or torsion of the adnexa. CASE: This is a 13-year-old female who presented because of severe pelvic pain. Ultrasound and CT scan revealed a large cystic mass in the pelvis. Mini-laparotomy confirmed torsion of the left adnexa due to the mass. The adnexa was untwisted. The cyst and the left tube were removed and the ovary regained its blood flow and was saved. SUMMARY AND CONCLUSION: Mesonephric duct cyst should be considered in the diagnosis of pelvic masses in adolescent girls.

Unilateral non-communicating cervical atresia in a patient with uterus didelphys and unilateral renal agenesis.

A 16-year-old adolescent girl presented with chronic pelvic pain. Pelvic ultrasound and MRI showing a uterus didelphys, normal left uterus and cervix, right pelvic fluid collection and right unilateral renal agenesis. After two unsuccessful vaginal surgeries for drainage of hematotrachelos and creation of an outflow tract, patient underwent unilateral total abdominal hysterectomy with final pathology confirming hematotrachelos and non-communicating cervical atresia on the right. Patient on postoperative follow-up doing well.

Acute cardiomyopathy in a patient with acute adnexal torsion.

BACKGROUND: The severe abdominal pain associated with acute adnexal torsion causes physical stress, which may precipitate a clinical syndrome of acute cardiomyopathy mimicking myocardial infarction. CASE: A postmenopausal woman presented to the emergency department with acute abdominal pain. Clinical and ultrasonographic evaluation suggested acute adnexal torsion. Surgical intervention revealed acute torsion of the right adnexa with marked necrosis and hemorrhage. Preoperative electrocardiogram abnormalities prompted a thorough cardiology workup postoperatively. Decreased ejection fraction on echocardiography prompted immediate cardiac catheterization. Catheterization revealed no significant cardiac disease, consistent with a diagnosis of stress-induced cardiomyopathy. CONCLUSION: Acute cardiomyopathy can occur as a result of severe pain and stress related to acute adnexal torsion. As gynecologists, it is important to consider stress-induced cardiomyopathy in the differential diagnosis of women presenting with cardiac complaints, especially in the postmenopausal population.

Cigarette smoking impairs sperm bioenergetics

Objective: The growing consensus on the negative impact of cigarette smoking on fertility prompted us to compare the rate of sperm respiration in smokers and non-smokers. Materials and methods: Semen samples from 20 smokers and 58 non-smokers consulting at the andrology laboratory for fertility evaluation were used. Smoking was defined as consumption of at least a half a pack per day. A phosphorescence analyzer that measures O2 concentration in sperm suspensions as function of time was used to determine the rate of respiration. In a sealed vial, the rate of sperm respiration (k) was defined as -d[O2]/dt; where [O2] was obtained from the phosphorescence decay rate of a palladium phosphor. [O2] in solutions containing sperm and glucose declined linearly with time, showing the kinetics of O2 consumption was zero-order. Inhibition of O2 consumption by cyanide confirmed the oxidations that occurred in the sperm mitochondrial respiratory chain. Results: There were no differences (p > 0.28) between smokers and non-smokers for ejaculate volume, motility, concentration, normal morphology, viability and hypo-osmotic swelling test. The rate (mean ± SD, in µM O2/min/108 sperm) of sperm mitochondrial O2 consumption in the smokers was 0.96 ± 0.58 and in the non-smokers 1.39 ± 0.67 (p = 0.004). Conclusions: The rate of sperm respiration was significantly lower in smokers. This negative impact of cigarette smoking on sperm aerobic metabolism may, in part, explain the lower rate of fertility in smokers.