Correlation between first-trimester maternal serum markers, second-trimester uterine artery doppler indices and pregnancy outcome.

AIMS: The aim of this study was to assess the correlation between first trimester maternal serum free beta-human chorionic gonadotropin (fBHCG), pregnancy-associated plasma protein A (PAPPA), second-trimester uterine artery (UA) Doppler measurements and adverse pregnancy outcomes. METHODS: Serum levels of PAPPA and fBHCG were determined at the first trimester, and patients underwent bilateral UA Doppler assessments at 20-25 weeks of gestation. A serum PAPPA level <0.4 MoM was termed as low and the abnormal Doppler findings were the presence of bilateral notches and RI >0.52 (mean) or unilateral notch and RI >0.66 (90th percentile). RESULTS: Mean PAPPA level was significantly lower in cases with unilateral or bilateral notches (1.09; 0.79 and 0.80 MoM for 0, 1 and 2 notches, p < 0.001). Fifty-two cases (12.8%) had a low PAPPA level; in this group the incidence of abnormal Doppler was significantly higher (34.6 vs. 18.4%, p = 0.011). In the presence of abnormal Doppler in a case with a low serum PAPPA the risk of pregnancy-induced hypertension (OR = 4.56, p = 0.0067), low birth weight (OR = 6.8, p = 0.0002) and the risk of at least one complication (OR = 7.6, p = 0.00001) were significantly high. CONCLUSION: Combination of first- and second-trimester findings might improve the efficiency of screening for pregnancy complications.

Vaginal Schwannoma in a case with uterine myoma.

Only 1% of gynecological neoplasms are vaginal, and mesenchymal tumors constitute only 2% of vaginal neoplasms. The most common form is leiomyomas. Schwannomas arise from the peripheral nerve sheath. We report a case of vaginal schwannoma associated with uterine myoma. A 52-year-old woman presented with lower abdominal pain and menorrhagia for a duration of 6 months. At sonographic examination, the patient was found to have uterine myomas and a solid mass measuring 5x4.5 cm beneath the vaginal wall. At laparotomy, the uterus with myoma was removed using our standard operation procedures. Surgical excision of the mass from vaginal aspect was also undertaken, and the histology demonstrated schwannoma. The tumor cells were vimentin (+), desmin (-), smooth muscle alpha-actin (-), HMB-45 (-), MART-1 (-) and S-100 (+). There is no evidence of recurrence during 6 months follow-up. The differential diagnosis of a mass in the vagina includes also schwannomas. Immunocytochemical labeling of the tumor cells is essential. Simple resection of the mass is the preferred method of treatment.

Verrucous carcinoma of the cervix in a case with uterine prolapse.

Verrucous carcinoma of the female tract is rare. We present a case involving association of verrucous carcinoma of the cervix with uterine prolapse. A 86-year-old woman was admitted with postmenopausal vaginal bleeding. The gynecologic examination revealed the uterine prolapse with a exophytic tumorous mass (3 x 6 x 8 cm) on the cervix. A punch biopsy was taken from the tumor, which revealed coilocytotic and mild dysplastic changes in the squamous epithelium; invasion of the underlying stroma could not be evaluated. A cervical swab was tested for human papillomavirus (HPV) DNA using the polymerase chain reaction, and HPV type 31 was detected. The tumorous mass was totally excised. The histopathologic diagnosis was consistent with verrucous carcinoma of the cervix: exophytic lesion was composed of thickened, acanthotic papillary squamous epithelium with mild dysplasia and diffuse parakeratosis, and no obvious invasion was observed. The patient was periodically controlled by pelvic examination and was free of progressive disease at 6 months. The diagnosis and treatment of verrucous carcinoma of the cervix may be difficult in some cases. The presence of HPV type 31 in our case might indicate the possibility that HPV is the etiology of this neoplasm.

Association of psoriasis and vulval fibroepithelial polyp: first reported case.

Fibroepithelial stromal polyps of the vulvovaginal region display a wide range of morphologic appearances. This morphologic spectrum allows the correct diagnosis to be made in some cases but when histology reveals unusual features, the lesion may be misinterpreted as malignant. We present a case of a 35-year-old woman with psoriasis who developed a 15-cm polypoid lesion localized in the left labium. The labial lesion was resected and no recurrence was detected 12 months after the initial treatment. Histologically, the lesion exhibited the characteristics of a fibroepithelial stromal polyp with focal myxoid areas and underlying vulval psoriasis disease. The clinical, microscopic, and immunohistochemical findings of this case suggest a fibroepithelial polyp of the vulva. This vulval lesion represents a unique example of giant fibroepithelial stromal polyp developed in association with psoriasis.

Haemostasis after cold-knife conisation: a randomised prospective trial comparing cerclage suture versus electro-cauterization.

AIMS: The purpose of this study was to compare two different techniques of obtaining haemostasis after cold-knife conisation. METHODS: Seventy-eight women who required conisation for treatment of cervical intraepithelial neoplasia were prospectively enrolled in a randomised clinical trial to receive either cerclage with cold-knife conisation or cautery with cold-knife conisation. Outcome measures evaluated include estimated blood loss, operative time, early late haemorrhage and dysmenorrhoea. The short- and long-term morbidity was compared, and a six-month follow up was completed. RESULTS: The procedure-related complication rate was 16.7% in the cautery group, compared with 7.0% in the suture group (P < 0.05). The cerclage group had significantly shorter operative time and intraoperative blood loss than the cautery group (P < 0.05). Postoperative bleeding and dysmenorrhoea were observed in eight (10.2%), and 14 cases (17.9%), in cerclage and cautery group, respectively. Three cases (3.8%) had postoperative infections and were cured with oral antibiotics. CONCLUSIONS: These results suggest that cerclage suturing technique provided excellent haemostasis and restoration of normal cervical anatomy. Cerclage suture of the cone bed is superior to only cauterization as a method of achieving haemostasis, with significantly less blood loss and shorter operative time.

Imperforate hymen-a rare cause of abdominal pain: two cases and review of the literature.

STUDY OBJECTIVE: To document an unusual cause of abdominal pain in premenarcheal adolescent girls. DESIGN: Case report. SETTING: A training and research hospital in Istanbul. RESULTS: Two cases of hematocolpos in two adolescent girls due to imperforate hymen were reported. Both of them manifested lower abdominal pain and urinary retention. Hymenotomy was performed in both the cases. CONCLUSION: Imperforate hymen is a rare diagnosis, but should be considered when dealing with premenarcheal adolescent girls with lower abdominal symptoms or back pain.

Primary Uterine Lymphoma: A Rare Cause of Postmenopausal Bleeding.

Although uterus and cervix infiltration is a frequent finding in the later stages of lymphomatous disease, non-Hodgkin's lymphoma (NHL) of the female genital tract is extremely rare. We present the case of a 63-years- old woman diagnosed with postmenopausal bleeding, Ann Arbor stage IE, primary, diffuse, large B-cell NHL of the uterus. Disease status was monitored with physical examination and imaging studies. We administered chemotherapy according to CHOP protocol (cyclophosphamide, adriamycin, vincristine, and prednisone). Primary pelvic NHL may present symptoms like other more common gynecologic cancers. It should be considered in the differential diagnosis of gynecologic malignancy. Our case emphasizes the importance of chemotherapy that can provide a control of the distant microscopic metastases.

Effect of risedronate on biochemical marker of bone resorption in postmenopausal women with osteoporosis or osteopenia.

OBJECTIVE: The primary objective of the present study was to evaluate the effectiveness and adverse events of risedronate use in postmenopausal woman by measuring its effects on urinary crosslinked C-terminal telopeptides of type I collagen (CTx), a biochemical marker of bone resorption. METHODS: One hundred osteoporotic (control and treatment) and 111 osteopenic (control and treatment) postmenopausal women, selected according to World Health Organization criteria, were included in the study. The treatment groups (osteopenic and osteoporotic) were given risedronate 35 mg once a week. The primary endpoint was mean percentage change in CTx from baseline to 6 months. The secondary endpoints included evaluation of the incidence of clinical or laboratory adverse events occurring during the 6-month study period. The least significant change (LSC), calculated from the within-subject variability in the two control groups, was used to define response. RESULTS: Of the 211 women enrolled, 157 (74.4%) completed the study. After 6 months, urinary CTx levels were -54.7% (range -67% to -48%) below baseline in the osteoporotic treatment group and -66.7% (range -74% to -59%) below baseline in the osteopenic treatment group. Analysis of LSC showed that 89% of risedronate treatment groups were categorized as responders after 6 months of treatment. CONCLUSION: The study shows that osteoporotic and osteopenic women on risedronate treatment have statistically significant suppressed bone turnover and CTx can be useful to confirm this observation. The low withdrawal rate and adverse effects rate show that risedronate was well tolerated by the study population.

Comparison of the effects of raloxifene and low-dose hormone replacement therapy on bone mineral density and bone turnover in the treatment of postmenopausal osteoporosis.

OBJECTIVE: The aim of the present study was to compare the effects of raloxifene and low-dose hormone replacement therapy (HRT) on bone mineral density (BMD) and bone turnover markers in the treatment of postmenopausal osteoporosis. METHODS: Forty-two postmenopausal osteoporotic women, who were randomized to receive raloxifene 60 mg or estradiol 1 mg/norethisterone acetate 0.5 mg daily for 1 year, were studied. All women received calcium 600 mg/day and vitamin D 400 IU/day. BMD and markers of bone turnover were measured at baseline and at 12 months. RESULTS: After 12 months of treatment, there were statistically significant increases in BMD in both groups at all sites (all p < 0.05). For the lumbar spine, the increase in BMD was 2.3% for raloxifene compared with 5.8% for low-dose HRT and corresponding values for total body BMD were 2.9% for raloxifene and 4.6% for low-dose HRT; the increases being significantly greater in the low-dose HRT group (p < 0.001 and p = 0.02, respectively). Although the increase in BMD at the hip was significant for both raloxifene (2.1%) and low-dose HRT (3.2%) compared with baseline, the difference between the two regimens did not reach statistical significance. The decrease in serum C-terminal telopeptide fragment of type I collagen and serum osteocalcin levels for the low-dose HRT group (-53% and -47%, respectively) was significantly greater than for the raloxifene group (-23% and -27%, respectively; both p < 0.01). CONCLUSIONS: In postmenopausal women with osteoporosis, low-dose HRT produced significantly greater increases in BMD of the lumbar spine and total body and greater decreases in bone turnover than raloxifene at 12 months.