Gineco.ro nr.26 (4/2011) - Primary Ovarian Pregnancies
Title: Primary Ovarian Pregnancies
Author: Prof. Vlad Tica, M.D., M.Sc., Ph.D.
Introduction: Primary ovarian pregnancy is an uncommon form of ectopic implantation. Its incidence after natural conception has been reported to range from 1 in 59740 to 1 in 1439 deliveries, comprising up to 3.3% of all ectopic pregnancies. Depending on the observation period, these values may be as high as 1 in 1100 or 5.2%. Ectopic pregnancy is also a well known complication after in vitro fertilization and embryo transfer. The increased incidence of primary ovarian pregnancy varies between 1 in 938 to 1 in 375 clinical pregnancies. The share of primary ovarian pregnancies, i.e. 1.7 to 5.9% of all ectopic pregnancies, appears unchanged. Higher reported incidences, such as 10%, may be explained by the small number of patients studied.
Title: Coagulation factor deficiency associated with the recurrent abortion
Author: Corina-Alina Ispasoiu
Afiliation: Department of Obstetrics and Gynecology, „Iuliu Haţieganu“ University of Medicine and Pharmacy, Cluj-Napoca, Romania
Abstract: Recurrent abortion is defined as three or more consecutive spontaneous abortions before 20 weeks of gestation. The incidence is 0.5-1% of all pregnancies, but the risk of recurrence increases with the number of previous pregnancy failure. Only in 50% of the cases it is possible to identify a causing factor. Most of the cases are due to genetic factors, anatomic abnormalities of the uterus, endocrine factors, infections and immunological factors. Increasingly, however, are discussed the hematological factors, acting either via specific antibodies, or directly, with implications for coagulation and thrombosis process. The fibrinogen deficiencies, the disorders of the Factor XIII and the thrombophilia are still studied and their treatment requires randomized clinical trials for clarification.
Keywords: recurrent abortion, thrombophilia, Factor XIII, fibrinogen
Title: The effects of hormone replacement and tamoxifen on spatial learning and active avoidance learning in ovariectimized rats
Authors: Mustafa Cosan Terek1,2, Aysegul Keser2,3, Yusuf Hakan Dogan2,3, Taner Dagcı2,3, Burak Zeybek1, Lutfiye Kanit2,3, Serdar Ozsener1, Sakire Pogun3
Afiliation: 1. Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey; 2. Department of Physiology, Ege University School of Medicine, Izmir, Turkey; 3. Center for Brain Research, Ege University, Izmir, Turkey
Abstract: Background/Aims. The aim of the present study is to investigate the effects of an estrogen receptor modulating agent tamoxifen, and different protocols of hormone replacement therapy that mimic clinical applications, on spatial learning and active avoidance learning in rats. Methods. We used 2 groups of normal rats for tamoxifen experiments (control group and drug group) and 4 groups for hormone replacement experiments: (1) ovariectomized rats with sesame oil injection, (2) ovariectomized rats with continuous estrogen injection, (3) ovariectomized rats with continuous combined estrogen and progesterone injection and (4) ovariectomized with continuous estrogen and intermittent (sequential) progesterone injection. Properly assigned control groups were used and cognitive processes were studied on animal models of surgical menopause using the Morris water maze and active avoidance learning paradigms. Results. In the Morris water maze no significant differences in spatial learning were observed between the hormone replacement and tamoxifen groups. Active avoidance learning was impaired by ovariectomy. Conclusions. In female ovariectomized rats, spatial learning is not influenced by circulating ovarian hormones and tamoxifen. On the other hand, active avoidance learning is impaired by the absence of gonadal hormones.
Keywords: tamoxifen, hormone replacement, Morris water maze, spatial learning
Title: Cyclic ADP-ribose/Ca2+ system in uterine smooth muscle cells
Authors: Vlad Iustin Tica1, Victor Cojocaru2, Oana Sorina Tica3, Sabina Berceanu4, Andrei Adrian Tica3
Afiliation: 1. Department of Obstetrics and Gynecology, Faculty of Medicine, Ovidius University, Constanta (Romania); 2. Department of Anesthesiology, University of Medicine and Pharmacy, Chisinau (Moldova); 3. Department of Pharmacology, University of Medicine and Pharmacy, Craiova (Romania; 4. Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Craiova (Romania)
Abstract: Ryanodine (Ry)-sensitive calcium stores can be activated by cyclic adenosine diphosphate ribose (cADPR) and by Ca2+ through Ca2+-induced Ca2+-release (CICR), both intracellular signaling pathways being initiated by almost all oxytocics. Objective. We investigated the role of Ry-sensitive calcium stores on spontaneous and angiotensin II (AGII)-induced uterine contraction by blocking Ry receptors with Ry in a rat model. From our knowledge, this is the first study on AGII effects on internal calcium mobilization, after cADPR pathway activation. Methods. The characteristics of myometrial contraction before and after Ry 10-6M administration were measured, using non pregnant female Sprague-Dawley rats (n=20) uterus. Results. Ry 10-6M did not influence spontaneous activity. Using Ry at 10-6M concentration, the amplitude and the frequency of AGII-induced contraction were showed to decrease with 11.62±4% and 9.78±3%, respectively. Conclusions. Our results suggest that one of the mechanisms through which angiotensin II induces an oxytocic effect is the mobilization of calcium from the calcium stores by activating the Ry-sensitive calcium channels.
Keywords: calcium stores, myometrium, angiotensin II, ryanodine, cADP ribose, rats
Title: Importance of biochemical markers in placentation at the end of the first trimester
Authors: Turos Janos Levente1, Lucian Puscasiu1, Kiss Szilard Leo1, Bereczky Lujza Katalin1, Rozsnyai Florin Francisc2, Szabo Bela1
Afiliation: 1. University of Medicine and Pharmacy, Târgu-Mureş, Romania; 2. County Emergency Clinical Hospital Târgu-Mureş, Romania
Abstract: Our objective was to study some aspects of placental development at the end of the first trimester of pregnancy and assessment of biochemical markers in terms of placentation. We studied 64 pregnant women at the end of the first trimester of pregnancy. Pregnant women were grouped according to the double test results into two groups: those with genetic risk (study group, n=7) and without genetic risk (control group, n=57). We measured the ratio between placental volume and crown-rump length, the ratio between the distance from the umbilical cord insertion site at the placenta and fundical edge of placentation and the distance between the umbilical cord insertion site at the placenta and cervical edge of placentation. We obtained biochemical data by double-test (pregnancy-associated plasma protein A and free beta human chorionic gonadotropin). The data obtained were processed with Student’s t Test and Chi-Test. We did not noticed statistically significant difference between the group with positive double-test and control group on terms of placentation by the end of the first trimester of pregnancy. Low pregnancy-associated plasma protein A values associate significantly with smaller placental volume and a small amount of amniotic fluid. Interestingly, we observed a higher frequency of eccentric umbilical cord insertion in women with pregnancyassociated plasma protein A <.5 MoM compared to the control group (OR=10.9, p=.002). The results showed that biometric data measured with ultrasound at the end of the first trimester correlates positively with pregnancyassociated plasma protein A levels and this could help us screening high risk pregnancies in the near future.
Keywords: placentation, placental volume, umbilical cord, PAPP-A
Title: Laparoscopic management of ovarian pregnancies: three cases
Authors: Ilhan Sanverdi, Ebru Ebru Cogendez, Yesim Akdemir
Afiliation: Department of Obstetrics and Gynecology, Zeynep Kamil Women and Child Education Training Hospital
Abstract: Primary ovarian pregnancy is rarely seen. The definitive diagnosis of ovarian pregnancy is difficult before operation and based on Spiegelberg’s four criteria. However, destroyed ovarian tissue around the gestational sac in laparoscopic surgery or ruptured ovary at the time of operation can not fulfill Spiegelberg’s criteria in some cases. The treatment of choice is laparoscopy, to preserve the reproductivefunctions of ovary. We suggest that Spiegelberg’s criteria require modification for the histopathologic diagnosis of ovarian pregnancy after performed ovarian tissue sparing surgery to preserve fertility.
Keywords: laparoscopy, ovarian pregnancy, surgery, fertility
Title: Late diagnosis of pseudo-renal failure associated with bladder injury after cesarean section
Authors: Mehmet Kucukbas1, Yesim Akdemir2, Serhan Cevrioglu1, Hamdullah Sozen2, Ahmed Namazov2
Afiliation: 1. Sakarya Education and Traning Hospital, Turkey; 2. Department of Obstetrics and Gynecology, Zeynep Kamil Women and Child Education Training Hospital, Turkey
Abstract: Nowadays bladder injury during cesarean section is quite uncommon and potentially serious complications are urinary tract infection and formation of vesicovaginal or vesicouterine fistula. There are only few case series of bladder injury at the time of cesarean section in the literature. Most injuries were found intraoperatively, but rarely some may not be recognized during the case. We present a case of late diagnosed bladder perforation at the time of cesarean section and managed by conservative approach. Her clinical picture mimicked renal failure. Conventional cystography failed to demonstrate the bladder perforation, cystoscopy allows recognition of undetected urinary system injury by conventional cystography and intravenous pyelogram. Nonoperative management by concomitant transuretral catheter drainage and ciprofloxacin treatment could be a safe alternative treatment option for even late diagnosed small injuries.
Keywords: bladder, injury, renal failure, fistula
Title: Teratoma and endometriotic ovarian cysts on ipsilateral ovary occuring after ectopic pregnancy. Case presentation of a rare association
Authors: Allia Sindilar, Razvan Socolov, Demetra Socolov, Cristina Terinte, Ivona Lupascu Anghelache
Afiliation: “Gr.T. Popa” University of Medicine and Pharmacy, Iasi (Romania)
Abstract: We present a case of ovarian endometriosis associated with teratoma ovarian cyst. This is a case of 30 years old patient,Para 1, admitted in the hospital for ovarian mass on a single ovary. She had previously been operated for ectopic pregnancy associated with mature teratoma cyst of the right ovary, which required right adnexectomy. The ultrasound scan described at present increased left ovary of 6 cm, with 2 different cystic structures: one homogenous of 40/30mm, and one of 30/44mm heterogenic mostly anechogenic with an intracystic hyperchogenic image. The CA 125 was increased- 45 IU/l, and therefore the surgical exploration was decided. It showed both an endometrioma and a teratoma, the internal echo being a tooth fragment. A double cystectomy was performed, and ovarian tissue was spared, in relation with patient’s age and wish for future pregnancies. In conclusion, we think this case presents a peculiar ovarian pathology association, in a patient in which CA 125 and ultrasound aspect were misleading regarding the nature of cysts. There are only three such cases described in the literature, and this is the first one with bilateral teratoma cyst with endometrioma, and the difficulties of diagnosis justifies its presentation here.
Keywords: ovarian cyst, ectopic pregnancy, teratoma, ultrasound
Title: The future of gynaecological surgery - telesugery with haptic sensation
Authors: Michael Stark1, Stefano Gidaro2, Emilio Ruiz Morales3
Afiliation: 1. The New European Surgical Academy (NESA), Berlin, (Germany); 2. Department of Surgical Science University “G. D’Annunzio” Chieti - Pescara (Italy); 3. ALF-X Surgical Robotics Department, SOFAR S.p.A., Milan (Italy)
Abstract: The 19th century will be remembered as the era of open surgery. The history of gynaecological surgery started in 1807 inKentucky, Missoury, when Ephraim McDowell performed the first successful cystectomy using a longitudinal abdominal incision. Throughout the 19th century, longitudinal incisions were routinely used in all gynaecological operations. In 1897, however, Johannes Pfannenstiel introduced the transverse incision, which showed to have benefits over the longitudinal one, such as less wound dehiscence(1). At the beginning of the 20th century, experimental endoscopy was introduced by Georg Kelling inGermany(2). Due to the development of light sources, insufflators, and endotracheal intubation, more and more gynaecological operations, such as the laparoscopyassisted vaginal hysterectomy, were done endoscopically(3). At the beginning of the 21st century, telesurgical systems are emerging for gynaecological procedures, both for benign and malignant indications. It seems that in the course of this century this new technology will replace many of the conventional endoscopic techniques.
Keywords: telesurgery, haptic sensation, cystectomy, endotracheal intubation
Vă aducem la cunoștință că farmaciștii care s-au înscris la Programul EFCD derulat prin Farmacist.ro pentru anul 2011, trebuie să trimită toate chestionarele până la 6 februarie a.c.
Revista „Medic.ro”, lider de piață pe segmentul de publicații adresate medicilor de familie, a ajuns în 2012 la cel de al IX-a an de apariție neîntreruptă.Publicație lunară cu acoperire națională dedicată în principal medicilor de familie, revista „Medic.ro” a fost în toți aceși ani inclusă în Catalogul publicațiilor agreate de Colegiul Medicilor din România, iar abonații au putut obține anual 5 credite de Educație Medicală Continuă.
Acest editorial are menirea de a transmite câteva mesaje care depăşesc sfera austeră a publicaţiilor ştiinţifice, deoarece marchează începutul unei etape în care, şi în medicină, preocuparea profund umană este esenţială. Se vrea, dacă acceptaţi, o chemare provocatoare spre empatie şi regăsire a unicităţii idealurilor şi preocupărilor pediatrice. Copilăria este o lume specială, o etapă importantă a vieţii nelipsite de drame şi încercări, dar receptată în întregime ca o lume palpitantă, vie, entuziastă, înnobilată de speranţă şi lumină. Acest început se doreşte ca o continuare a demersului uriaş de ridicare a standardelor de publicare a lucrărilor care reflectă preocupările şi rezultatele unei activităţi susţinute, a noastră, a pediatrilor. Cu emoţia creată de neliniştea imposibilităţii de egalare a meticulozităţii, acurateţei şi valorii domnului profesor Nanulescu, voi îndrăzni să sper că echipa întreagă va reuşi să menţină tonusul şi inserarea revistei în actual.
