Exploring the Role of Levonorgestrel Intrauterine System (LNG-IUS) as a Method of Emergency Contraception (EC)

Copper T 380-A (CuT380A) intrauterine device (IUD) has been an effective method of emergency contraception (EC). Levonorgestrel intrauterine system (LNG-IUS) has not been approved by the Food and Drug Association for EC till now. There are few studies that provide data regarding the efficacy of LNG-IUS as EC. This systematic review tried to explore the efficacy of LNG-IUS in preventing accidental pregnancies up to five days of unprotected intercourse. A systematic review of the published studies on the use of LNG-IUS as EC was done. All randomized trials, prospective cohorts, retrospective cohorts. and case-control study designs pertaining to this topic were included in this review. Abstracts were retrieved and reviewed by two authors independently. Variables pertaining to socio-demographic parameters, EC use-related variables (reason for use, frequency, time elapsed since coitus), and those associated with sexual habits were selected and recorded. A total of six articles were rendered for the review. High school students and those attending college accounted for 36.8%-51.8% of the study population. Data on the reason for seeking EC showed noncompliance to routine contraception as the most common reason, followed by failure of withdrawal method, breach of barrier contraception, and unplanned intercourse. With a negligible failure rate, LNG-IUS seemed to be a good alternative to the existing copper EC. Considering the plethora of noncontraceptive benefits associated, LNG-IUS can be safely provided as an option of EC in the cafeteria approach within five days of unprotected intercourse.

Role of Preoperative and Postoperative Pelvic Floor Distress Inventory-20 in Evaluation of Posthysterectomy Vault Prolapse

Background:

Posthysterectomy vault prolapse is a common problem after vaginal or abdominal hysterectomy. The objective was to assess the role of Pelvic Floor Distress Inventory 20 (PFDI-20) in evaluation of vault prolapse.

Materials and Methods:

Prospective study in 20 women with posthysterectomy vault prolapse of Stage 2 and above. The outcome measure was to calculate PFDI-20 score in all cases before surgical intervention and to recalculate it again in 6 months after different surgical procedures for vault prolapse and to statistically compare the PFDI-20 score in different types of surgery over 4 years period at a tertiary referral hospital for surgical treatment. Prolapse was classified using Pelvic Organ Prolapse Quantification and intraoperative findings. All women were operated for vault prolapse as per hospital protocol and stage of prolapse by either vaginal sacrospinous fixation or abdominal sacrocolpopexy.

Results:

Mean age, parity, and body mass index were 54.8 years, 3.5, and 22.71 kg/m² respectively. Preceding surgery was vaginal hysterectomy in 75% women and abdominal hysterectomy in 25% women. Complaints were bulge or mass feeling at perineum (100%), pressure in lower abdomen and perineum (55%), and constipation (60%). The type of prolapse was vault prolapse (100%), cystocele (100%), rectocele (100%), and enterocele (45%). The range of PFDI-20 was 88–152 with mean being 123.50 ± 22.71 before surgery while its range decreased significantly to 80–126 with mean being 106.40 ± 16.45 after surgery (P < 0.01). Mean postoperative PFDI-20 score was 107.40 in vaginal sacrospinous fixation group and was 105.30 in abdominal sacrocolpopexy group and was not statistically different (P = 0.18).

Conclusion:

PFDI-20 score can be used to see the adverse impact of vault prolapse on pelvic floor and to assess the beneficial effect of different types of surgeries on the score.

Maternal and Perinatal Outcomes of Pregnancy in Women With Autoimmune Disorder

Objective

Pregnancy with an autoimmune disorder is faced with several risks for mother and fetus. The aim of the present study is to analyze the course and outcome of pregnancy in women with autoimmune disorders (AIDs).

Methods

A retrospective cohort study was conducted at a tertiary care teaching hospital. The hospital records of 153 pregnancies with autoimmune disorders and 1095 low-risk pregnant women who served as controls were reviewed. An adverse perinatal outcome was defined as the presence of any obstetric complications, including preeclampsia, eclampsia, abruption, antepartum hemorrhage (APH), prematurity, fetal growth restriction (FGR), intrauterine death (IUD), intrapartum event, mode of delivery, birth weight, neonatal intensive care unit (NICU) stay, or disease-specific neonatal complications. For all statistical tests with two-tailed probability, p<0.05 was considered statistically significant.

Results

A high incidence of adverse perinatal outcomes was observed in all women with AIDs when compared with age-matched controls. The highest incidence of adverse perinatal outcomes was observed in women with Takayasu’s arteritis. The incidence of abortions was more in women with antiphospholipid antibody syndrome (APS) and Grave’s disease (22.2% and 33.3%, respectively). The incidence of prematurity, fetal growth restriction (FGR), and low birth weight were highest in women with systemic lupus erythematosus (SLE). Pregnancy with myasthenia gravis and rheumatoid arthritis did not have any significant adverse impact on pregnancy outcomes.

Conclusion

We found a strong association between autoimmune disorders and obstetric complications. The multidisciplinary team approach and pre-pregnancy optimization of the disease improve maternal and fetal outcomes.

NADPH oxidase 5 (NOX5)-induced reactive oxygen signaling modulates normoxic HIF-1α and p27Kip1 expression in malignant melanoma and other human tumors

NADPH oxidase 5 (NOX5) generated reactive oxygen species (ROS) have been implicated in signaling cascades that regulate cancer cell proliferation. To evaluate and validate NOX5 expression in human tumors, we screened a broad range of tissue microarrays (TMAs), and report substantial overexpression of NOX5 in malignant melanoma and cancers of the prostate, breast, and ovary. In human UACC‐257 melanoma cells that possesses high levels of functional endogenous NOX5, overexpression of NOX5 resulted in enhanced cell growth, increased numbers of BrdU positive cells, and increased γ‐H2AX levels. Additionally, NOX5‐overexpressing (stable and inducible) UACC‐257 cells demonstrated increased normoxic HIF‐1α expression and decreased p27^Kip1 expression. Similarly, increased normoxic HIF‐1α expression and decreased p27^Kip1 expression were observed in stable NOX5‐overexpressing clones of KARPAS 299 human lymphoma cells and in the human prostate cancer cell line, PC‐3. Conversely, knockdown of endogenous NOX5 in UACC‐257 cells resulted in decreased cell growth, decreased HIF‐1α expression, and increased p27^Kip1 expression. Likewise, in an additional human melanoma cell line, WM852, and in PC‐3 cells, transient knockdown of endogenous NOX5 resulted in increased p27^Kip1 and decreased HIF‐1α expression. Knockdown of endogenous NOX5 in UACC‐257 cells resulted in decreased Akt and GSK3β phosphorylation, signaling pathways known to modulate p27^Kip1 levels. In summary, our findings suggest that NOX5 expression in human UACC‐257 melanoma cells could contribute to cell proliferation due, in part, to the generation of high local concentrations of extracellular ROS that modulate multiple pathways that regulate HIF‐1α and networks that signal through Akt/GSK3β/p27^Kip1.

Abstract 2809: ROS signaling by NADPH oxidase 5 (Nox5) modulates proliferation of human melanoma UACC-257 cells and prolongs growth in the absence of serum or growth factors

Reactive oxygen species (ROS) produced by the NADPH oxidase (Noxs) homologs participate in signaling cascades regulating proliferation. Recently, we have reported substantial overexpression of Nox5 in several human cancers including those of prostate, ovary and melanomas. Despite being upregulated in many human cancers and implicated in promoting cell proliferation, the molecular mechanisms modulated by Nox5 are poorly understood. In this study, the functional significance of Nox5 was assessed in human UACC-257 and WM-852 melanoma cells by generating Nox5-overexpressing and knockdown cells. Stable overexpression of Nox5 in UACC-257 cells resulted in enhanced cell growth, increased BrdU positive cells and decreased protein tyrosine phosphatase activity. Additionally, these cells had increased normoxic Hif-1α expression and decreased p27Kip1 expression. Conversely, knockdown of endogenous Nox5 in UACC-257 cells resulted in decreased cell growth, decreased BrdU positive cells, decreased Hif-1α expression and increased p27Kip1 expression. Likewise, in human WM-852 melanoma cells, transient overexpression of Nox5 decreased p27Kip1 expression and knockdown of endogenous Nox5 resulted in increased p27Kip1 and gamma-H2AX expression with decreased cell growth. Cadherin switch, loss of E-cadherin expression and upregulation of N-cadherin was observed in UACC-257 Nox5 overexpressing cells indicative of an invasive phenotype; conversely, an upregulation of E-cadherin expression in Nox5 knockdown cells was noted. Cell invasion assay through matrigel-coated membranes also demonstrated enhanced invasion by Nox5 overexpressing cells. Additionally, 3D cultures of Nox5 overexpressing UACC-257 cells exhibit an amoeboid morphology compared to that of the Nox5 knockdown cells that were mesenchymal, suggestive of an amoeboid - mesenchymal (AMT) transition. Strikingly, UACC-257 cells that overexpress Nox5 were able to proliferate in serum-free conditions for over a month. In summary, our findings suggest that ROS signaling by Nox5 in human melanoma could modulate multiple signaling networks that regulate Hif-1α and p27Kip1 expression, contributing in part, to cell proliferation and the ability to grow in the absence of serum or growth factors.

Citation Format: Smitha Antony, Yongzhong Wu, Diana C. Haines, Guojian Jiang, Jennifer L. Meitzler, Agnes Juhasz, Jiamo Lu, Krishnendu K. Roy, James H. Doroshow. ROS signaling by NADPH oxidase 5 (Nox5) modulates proliferation of human melanoma UACC-257 cells and prolongs growth in the absence of serum or growth factors. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2809.

Six months versus nine months anti-tuberculous therapy for female genital tuberculosis: a randomized controlled trial

OBJECTIVE

To compare six months versus nine months anti-tuberculous therapy in patients of female genital tuberculosis.

STUDY DESIGN

It was a randomized controlled trial in a tertiary referral center teaching institute on 175 women presenting with infertility and found to have female genital tuberculosis on clinical examination and investigations. Group I women (86 women) were given 9 months of intermitted anti-tuberculous therapy under directly observed treatment short course (DOTS) strategy while Group II (89 women) were given 6 months of anti-tuberculous therapy under DOTS. Patients were evaluated for primary end points (complete cure, partial response, no response) and secondary end points (recurrence rate, pregnancy rate) during treatment. All patients were followed up further for one year after completion of therapy to assess recurrence of disease and further pregnancies.

RESULTS

Baseline characteristics were similar between two randomized groups. There was no difference in the complete clinical response rate (95.3% vs 97.7%, p=0.441) between 9-months and 6-months groups. Four patients in 9-months group and two patients in 6-months group had recurrence of disease and required category II anti tuberculous therapy (p=0.441). Pregnancy rate during treatment and up to one year follow up was also similar in the two groups (23.2% vs 21.3%, p=0.762). Side effects occurred in 27(31.4%) and 29(32.6%) in 9-months and 6-months of therapy and were similar (p=0.866).

CONCLUSIONS

There was no difference in complete cure rate, recurrent rate and pregnancy rate for either 6-months or 9-months of intermittent directly observed treatment short course anti-tuberculous therapy in female genital tuberculosis.

CLINICAL TRIAL REGISTRATION

The trial was registered in clinicaltrials.gov with registration no: CTRI/2009/091/001088.

Effect of antitubercular treatment on ovarian function in female genital tuberculosis with infertility

AIM:

To evaluate the effect of antitubercular therapy (ATT) on an ovarian function such as ovarian reserve, ovarian dimensions, and ovarian stromal blood flow.

SETTINGS AND DESIGN:

Prospective study design.

MATERIALS AND METHODS:

Fifty infertile women with female genital tuberculosis (FGTB) without tubo-ovarian masses diagnosed by positive acid-fast bacilli culture or epithelioid granuloma on endometrial aspirate or positive polymerase chain reaction with positive findings on laparoscopy or hysteroscopy were recruited. The ovarian function tests were performed on day 2/3 as follicle-stimulating hormone (FSH) levels and anti-Mullerian hormone (AMH) levels. Ovarian dimensions (length, width, and depth) were measured using a transvaginal ultrasound. Mean antral follicle count (AFC) and ovarian stromal blood flow (peak systolic velocity [PSV], pulsatility index (PI), and resistive index [RI]) were measured using a transvaginal ultrasound. All women were started on ATT for 6 months by directly observed treatment strategy. After completion of ATT, all the parameters were repeated.

RESULTS:

There was a significant increase in AMH (2.68 ± 0.97 ng/ml to 2.8 ± 1.03 ng/ml) pre- to post-ATT, nonsignificant increase in FSH (7.16 ± 2.34 mIU/ml to 7.26 ± 2.33 mIU/ml) post-ATT, significant increase in mean AFC (7.40 ± 2.12–8.14 ± 2.17), PSV in the right ovary (6.015–6.11 cm/s) and left ovary (6.05–6.08 cm/s), PI in the right ovary (0.935–0.951 cm/s) and left ovary (0.936–0.957 cm/s), and RI in the right ovary (0.62 ± 0.01–0.79 ± 0.02) and left ovary (0.65 ± 0.02–0.84 ± 0.01) with ATT. There was no significant change in mean ovarian dimensions (ovarian length, breadth, and width) and summed ovarian volume with ATT. On laparoscopy, tubercles were seen in 27 (54%) women. Caseous nodules and encysted ascites were seen in 8% cases each.

CONCLUSION:

ATT improves the ovarian function (AMH and AFC) and ovarian blood flow in women with FGTB.

Feto-maternal outcome in pregnancies complicated by isolated fetal congenital complete heart block

A retrospective analysis of eleven pregnancies complicated by isolated fetal congenital complete heart block (CCHB) in anti-SSA/Ro antibody positive women was carried out at a tertiary hospital in India to study the perinatal outcome. The mean gestational age at the time of detection of fetal CCHB was 24.5 ± 3.1weeks. Six mothers were asymptomatic; two had Sjögren's syndrome and three had systemic lupus erythematosus. Oral dexamethasone was given to all the patients after the diagnosis was made. There was one case of intrauterine death. Seven (63.6%) neonates needed a permanent pacemaker. There was no significant difference in the perinatal outcome in asymptomatic women with fetal CCHB and in women with connective tissue disorder and fetal CCHB. To conclude, fetal CCHB is associated with high morbidity but the presence of underlying connective disorder in the mother does not worsen the prognosis of the affected neonate.

Characterization of NADPH oxidase 5 expression in human tumors and tumor cell lines with a novel mouse monoclonal antibody

Reactive oxygen species generated by NADPH oxidase 5 (Nox5) have been implicated in physiological and pathophysiological signaling pathways, including cancer development and progression. However, because immunological tools are lacking, knowledge of the role of Nox5 in tumor biology has been limited; the expression of Nox5 protein across tumors and normal tissues is essentially unknown. Here, we report the characterization and use of a mouse monoclonal antibody against a recombinant Nox5 protein (bp 600-746) for expression profiling of Nox5 in human tumors by tissue microarray analysis. Using our novel antibody, we also report the detection of endogenous Nox5 protein in human UACC-257 melanoma cells. Immunofluorescence, confocal microscopy, and immunohistochemical techniques were employed to demonstrate Nox5 localization throughout UACC-257 cells, with perinuclear enhancement. Tissue microarray analysis revealed, for the first time, substantial Nox5 overexpression in several human cancers, including those of prostate, breast, colon, lung, brain, and ovary, as well as in malignant melanoma and non-Hodgkin lymphoma; expression in most nonmalignant tissues was negative to weak. This validated mouse monoclonal antibody will promote further exploration of the functional significance of Nox5 in human pathophysiology, including tumor cell growth and proliferation.

A prospective study on role of dehydroepiandrosterone (DHEA) on improving the ovarian reserve markers in infertile patients with poor ovarian reserve

AIM

The aim of this study was to evaluate the role of dehydroepiandrosterone (DHEA) supplementation on the ovarian reserve markers in infertile patients who were poor responders in previous in vitro fertilization (IVF) cycles.

STUDY DESIGN

A prospective clinical trial was conducted on 30 patients with history of poor response in previous IVF cycles. These patients were treated with DHEA, (Tab Eema-D, Corona Remedies Pvt Ltd., Ahmedabad, Gujurat, India) 25 mg thrice a day for four months. Ovarian stimulation was done using the previous protocol. Clinical parameters were measured before and treatment with DHEA. Results were analysed using Student's "t" paired test.

RESULTS

DHEA resulted in a significant increase (p < 0.05) in the serum Antimullerian hormone in all age groups (35, 36-38 and >38 years). Peak estradiol level on the day of human chorionic gonadotrophin administration also increased significantly (p < 0.05). A significant decrease (p < 0.05) was noted in Day 2 follicle-stimulating hormone (FSH) in all age groups. There was no statistically significant difference in the antral follicle count (AFC). Pregnancy rate was 16.7% after treatment. Thus, DHEA has a significant effect in improving the ovarian reserve in poor responders with previously failed IVF cycles. It can help in enhancing clinical pregnancy rate in these patients.

Abstract 4796: Characterization of NADPH oxidase 5 expression in human tumors and tumor cell lines with a novel mouse monoclonal antibody

NADPH oxidase (Nox) family enzymes (Nox1-5 and Duox1-2) generate reactive oxygen species (ROS) and modulate cellular pathways that regulate tumorigenesis. Recent studies have proposed that Nox5 plays a role in the proliferative capacity of Hairy cell leukemia, Barrett's esophageal adenocarcinoma, and in prostate cancer cells. Although implicated in several malignancies, the role of Nox5 in tumor cell biology is still unclear. This impediment is due to a lack of reliable immunological probes as well as the fact that little is known regarding Nox5 expression in human tumors. In this study, we report for the first time the generation and characterization of a mouse monoclonal antibody against a recombinant Nox5 protein (600-746), and the expression profile of Nox5 in human tumors by tissue microarray analysis. We also report the detection of endogenous Nox5 protein in the UACC-257 human melanoma cell line using our novel Nox5 antibody. Specificity of the antibody for Nox5 was confirmed by generating stable Nox5 over-expressing UACC-257 cell clones, and by transiently silencing both endogenous Nox5 and stably overexpressed Nox5. Additionally, no cross-reactivity of the antibody with other Nox homologs was detected. Sub-cellular fractionation studies revealed that Nox5 was predominantly expressed in the membranes of UACC-257 cells and its Nox5 overexpressing clones. Immunofluorescence, confocal microscopy, and immunohistochemistry demonstrated that Nox5 localizes throughout parental UACC-257 cells and Nox5 overexpressing clones, with perinuclear enhancement. To evaluate the clinical significance of Nox5 in human cancer, we determined the expression of Nox5 protein in a representative set (382 samples) of human tumors. Tissue microarray analysis revealed substantial Nox5 overexpression in several human tumors of epithelial origin including breast, colon, lung, prostate, and ovarian cancers, as well as non-epithelial malignancies (glioblastoma multiforme, melanoma, and lymphoma). Expression was markedly increased in tumors compared to normal tissues of the same organ. Collectively, our study provides the first demonstration of Nox5 overexpression in human tumors by tissue microarray, and reports on the first mouse monoclonal antibody against Nox5. The elevated expression of Nox5 in tumors provides impetus to explore the functional significance of Nox5 in the context of tumor development and maintenance.

Citation Format: Smitha Antony, Yongzhong Wu, Stephen M. Hewitt, Miriam R. Anver, Guojian Jiang, Jennifer L. Meitzler, Han Liu, Agnes Juhasz, Jiamo Lu, Krishnendu K. Roy, James H. Doroshow. Characterization of NADPH oxidase 5 expression in human tumors and tumor cell lines with a novel mouse monoclonal antibody. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4796. doi:10.1158/1538-7445.AM2013-4796

Hierarchical virtual screening: identification of potential high-affinity and selective β(3)-adrenergic receptor agonists

The hierarchical virtual screening (HVS) study, consisting of pharmacophore modelling, docking and VS of the generated focussed virtual library, has been carried out to identify novel high-affinity and selective β(3)-adrenergic receptor (β-AR) agonists. The best pharmacophore model, comprising one H-bond donor, two hydrophobes, one positive ionizable and one negative ionizable feature, was developed based on a training set of 51 β(3)-AR agonists using the pharmacophore generation protocol implemented in Discovery Studio. The model was further validated with the test set, external set and ability of the pharmacophoric features to complement the active site amino acids of the homology modelled β(3)-AR developed using MODELLER software. The focussed virtual library was generated using the structure-based insights gained from our earlier reported comprehensive study focussing on the structural basis of β-AR subtype selectivity of representative agonists and antagonists. The HVS with the sequential use of the best pharmacophore model and homology modelled β(3)-AR in the screening of the generated focussed library has led to the identification of potential virtual leads as novel high-affinity and selective β(3)-AR agonists.

Abstract 2060: NADPH oxidase NOX5 regulates the expression of the cell cycle inhibitor p27kip1 in the human melanoma UACC-257 cancer cells

NADPH oxidase (NOX) family enzymes (NOX1-5 and DUOX1-2) generate reactive oxygen species (ROS) and modulate cellular pathways that regulate proliferation. While high doses of ROS are clearly toxic, the effects of low doses of NOX-mediated ROS as signaling molecules are less clear. Recent work has proposed that NOX5 plays a role in cell proliferation in Hairy cell leukemia, Barrett's esophageal adenocarcinoma and in prostate cancer cells, yet relatively little is known of the signaling pathways mediated by NOX5. In this study we explored the functional role of NOX5 in cancer cells obtained from the NCI-60 cell line panel. Initial screening of the NCI-60 cancer cell line panel for expression of the Nox family members by real time PCR revealed several melanoma cell lines that express Nox5. Of the NOX5 expressing NCI-60 human cancer cell lines, subsequent studies were carried out in human UACC-257 melanoma cancer cells. Two molecular approaches were undertaken to determine the functional role of NOX5 in UACC-257 cells: 1) generating NOX5 over-expressing stable clones and 2) transiently silencing endogenous NOX5 and the stably over-expressed NOX5. Redox-sensitive assays for both intra- and extracellular ROS production confirmed that NOX5 is functional and generates superoxide in both UACC-257 cells and stable Nox5-over-expressing clones. NOX5 can be activated both by the protein kinase C activating phorbol ester PMA and by the Ca2+ ionophore ionomycin. Furthermore, this enzymatic activity is calcium- and flavin dehydrogenase-dependent; both the calcium chelator BAPTA-AM and the flavoprotein inhibitor DPI (200nM) significantly decreased NOX5-mediated ROS production. Silencing NOX5 over-expression significantly inhibited both endogenous and PMA-stimulated ROS production, suggesting that the ROS production is NOX5-mediated. Furthermore, knockdown of both endogenous and over-expressed NOX5 in UACC-257 cells resulted in increased p27Kip1 expression. Conversely, over-expression of NOX5 in UACC-257 cells resulted in decreased p27Kip1 expression both at the mRNA and protein levels. As the AKT signaling pathways are known to modulate p27Kip1 levels, we observed that knockdown of both endogenous and over-expressed NOX5 in UACC-257 cells resulted in decreased Akt and GSK-3β phosphorylation. Studies to characterize additional mechanisms of translational and transcriptional regulation of p27Kip1 by NOX5 are ongoing. In summary, our findings suggest that NOX5 expression could contribute to cell proliferation in human cancers in part due to the generation of high local concentrations of extracellular ROS that regulate the Akt/GSK-3β/p27Kip1 signaling network.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2060. doi:1538-7445.AM2012-2060

Abstract 4205: Regulation of Hif-1α expression by NADPH oxidase 5 (Nox5) in human cancer cell lines

Reactive oxygen species (ROS) produced by NADPH oxidases (Noxs) participate in signaling cascades regulating proliferation. However, the relative contribution to tumor cell growth by the seven Nox homologues (Nox1-5 and Duox 1 and 2) remains unclear. Several studies have proposed that Nox5 plays a role in promoting cell proliferation in Hairy cell leukemia, Barrett's esophageal adenocarcinoma cells, and in prostate cancer; however, little is known about the signaling pathways mediated by Nox5. We explored the functional role of Nox5 in a variety of tumor cell lines, including the NCI-60 cell panel; real time RT-PCR revealed that several melanoma lines express Nox4 and Nox5, but no Nox1 mRNA; and that prostate cell lines express Nox5 mRNA. Of the Nox5- expressing NCI-60 human cancer cell lines, we studied UACC-257 melanoma and PC-3 prostate cancer cells. These lines were characterized for variations in their N-terminus Ca2+ binding domains; RT-PCR revealed that both cell lines expressed the Nox5α and Nox5γ forms. The functional role of Nox5 in UACC-257 and PC-3 cells was studied by generating stable Nox5-overexpressing clones, and by transiently silencing Nox5 that was expressed endogenously, as well as that in clones stably overexpressing Nox5. Redox-sensitive assays for both intra- and extracellular ROS production confirmed that Nox5 was functional and generated superoxide in UACC-257 and PC-3 clones overexpressing Nox5. Nox5 could be activated by the phorbol ester PMA and by the Ca2+ ionophore ionomycin in overexpressing clones. This enzymatic activity was Ca2+- and flavin dehydrogenase-dependent; the calcium chelator BAPTA-AM and the flavoprotein inhibitor DPI (200nM) significantly decreased Nox5-mediated ROS production. Overexpression of Nox5 in UACC-257 cells resulted in increased normoxic Hif-1α expression that was also Ca2+-, flavin dehydrogenase- and ROS-dependent. Silencing Nox5 by RNAi significantly inhibited both endogenous and PMA-stimulated ROS production, confirming that ROS production was Nox5-mediated. Knockdown of both endogenous and overexpressed Nox5 in both UACC-257 and PC-3 cells resulted in decreased Hif-1α expression. Studies to characterize the mechanisms by which Nox5 modulates cell proliferation through the HIF-1α pathway are ongoing. Our experiments suggest that Nox5 expression may play an important role in the generation of high local concentrations of ROS that could contribute to activation of Hif-1α and promote cell proliferation in human cancers.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4205. doi:10.1158/1538-7445.AM2011-4205

A prospective randomized trial comparing the clinical and endocrinological outcome with rosiglitazone versus laparoscopic ovarian drilling in patients with polycystic ovarian disease resistant to ovulation induction with clomiphene citrate

OBJECTIVES

Rosiglitazone, an insulin sensitizing agent is used currently in women with clomiphene citrate (CC) resistant polycystic ovarian syndrome (PCOS). Our study proposed to compare the efficacy of rosiglitazone and CC with laparoscopic ovarian drilling (LOD) and CC in terms of biochemical effects, ovulation rate and pregnancy rate in patients of PCOS resistant to CC.

METHODS

This prospective randomised trial included 43 patients of PCOS resistant to CC. Twenty-two women were assigned to the rosiglitazone (4 mg twice daily) and CC group and other 21 patients underwent unilateral LOD and then received CC and multivitamins. The treatment continued for six cycles in both the groups. The biochemical response, ovulation rate and pregnancy rate over a follow up period of 6 months were compared.

RESULTS

Treatment with rosiglitazone and CC or LOD and CC resulted in increased ovulation (80.8 vs. 81.5%) and pregnancy (50 vs. 42.8%), respectively. There was no statistical difference between the two groups in terms of biochemical response, ovulation rate and pregnancy rate.

CONCLUSION

To avoid the risk of adverse effects of LOD preference may be given to the use of rosiglitazone and CC therapy in patients of PCOS resistant to CC.

Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman's syndrome

OBJECTIVES

To evaluate the outcome of hysteroscopic adhesiolysis in patients with infertility due to Asherman's syndrome.

MATERIALS AND METHODS

This was a retrospective clinical analysis of 89 patients who underwent hysteroscopic adhesiolysis by monopolar electrode knife. A second-look office hysteroscopy was performed in all cases after 2 months. On second-look hysteroscopy, 12 patients showed reformation of adhesions and needed a repeat procedure.

RESULTS

The mean age of the patient was 28.4 years. In the majority (64%) of patients, the possible cause of Asherman's syndrome was previous curettage on gravid uterus. The overall conception rate was 40.4% after hysteroscopic adhesiolysis. The mean conception time after surgery was 12.8 months. There was no conception in patients who needed repeat adhesiolysis. The conception rate was higher (58%) in mild Asherman's syndrome compared to 30% conception rate in moderate and 33.3% conception rate in severe cases. There was no significant association between conception rate and preoperative menstrual pattern. There was significant higher likelihood of conception rate (44.3%) in those who continued to have improved menstrual pattern compared to only 10% likelihood of conception in those who continued to have amenorrhea after adhesiolysis. The live birth rate was 86.1% and miscarriage rate was 11.1%. Cumulative pregnancy rate showed that 97.2% patients conceived within 24 months. There was increased incidence (43.8%) of cesarean section. Four (12.5%) patients had postpartum hemorrhage for adherent placenta.

CONCLUSION

Hysteroscopic adhesiolysis for Asherman's syndrome is a safe and effective method of choice for restoring menstrual function and fertility.

Endometrial effects of letrozole and clomiphene citrate in women with polycystic ovary syndrome using spiral artery Doppler

OBJECTIVES

To compare the effects of letrozole and clomiphene citrate (CC) on endometrial response in PCOS using subendometrial spiral artery Doppler.

METHODS

Fifty consecutive patients of anovulatory PCOS were recruited. Twenty-five patients (58 cycles) received 2.5-5 mg of letrozole; 25 patients (56 cycles) received 50-100 mg of CC (both orally on days 5-9 of menses).

MAIN OUTCOME MEASURES

number of dominant follicles, endometrial thickness (ET), spiral artery resistance index (RI) and pulsatility index (PI) and pregnancy rate.

RESULTS

The mean number of dominant follicles in letrozole group and CC groups was 1.63+/-1.02 and 1.62+/-0.96, respectively (P>0.05). The mean mid cycle ET was 6.9+/-0.74 mm in letrozole group and 5.9+/-0.53 mm in CC group (P<0.05). In letrozole and CC groups, the mean RI of spiral artery were 0.63+/-0.05 and 0.79+/-0.09, respectively, and the mean PI of spiral artery were 1.19+/-0.06 and 1.55+/-0.13, respectively. Both RI and PI in the letrozole group showed significant lower impedance compared to CC group (P<0.05). Pregnancy rate per cycle was 19% (11/58) in the letrozole group and 12.5% (7/56) in the CC group (P>0.05).

CONCLUSION

The effect of letrozole showed a significantly better endometrial response compared to CC.

Disseminated peritoneal leiomyomatosis: an unusual complication of laparoscopic myomectomy

INTRODUCTION

We report a case of disseminated peritoneal leiomyomatosis arising after laparoscopic myomectomy.

CASE REPORT

The patient presented with a large abdominopelvic mass 9 months post laparoscopic myomectomy. Clinical examination and imaging revealed a mass lying separately from the uterus and the ovaries. The large myoma and several small peritoneal myomas were removed by a laparotomy.

CONCLUSION

Disseminated leiomyomas have rarely been reported after laparoscopic myomectomy and hysterectomy. They could be bits left after morcellation or could be parasitic myomas. Hence, this rare condition must be kept in mind whenever a patient presents with abdominal masses following myomectomy or hysterectomy.

Management of presacral venous bleeding with the use of thumbtacks

Massive bleeding from the sacral basivertebral vein is uncommon and can be fatal because conventional methods to control the bleeding are often futile. The authors report an effective technique of the occlusion of the bleeding site with a thumbtack.

Molecular mechanism of adaphostin-mediated G1 arrest in prostate cancer (PC-3) cells: signaling events mediated by hepatocyte growth factor receptor, c-Met, and p38 MAPK pathways

Adaphostin (NSC680410), a small molecule congener of tyrphostin AG957, has been demonstrated previously to have significant anti-proliferative effects in several leukemia models. However, this effect of adaphostin in adherent cells/solid tumor models has not been examined. In this study, we investigated the anti-proliferative effects of adaphostin in the human prostate cancer cell line PC-3. Specifically, we explored the potential molecular mechanism(s) by which adaphostin elicits its anti-proliferative effect(s). We demonstrate that adaphostin inhibits the proliferation of PC-3 cells by inducing a G(1) phase cell cycle arrest. This adaphostin-induced G(1) arrest was associated with an increase in the expression of p21 and p27 and a decrease in the expression of G(1)-specific cyclins (cyclin A, D1, and D3) and cyclin-dependent kinases 4 and 6. Consequently, a dramatic decrease in the phosphorylation of retinoblastoma protein was also observed. Additionally, we found that adaphostin treatment induced a decrease in the phosphorylation of nucleophosmin, a major nuclear phosphoprotein, and that this decreased phosphorylation was a result of the p21- and p27-mediated inactivation of cyclin E-cyclin-dependent kinase 2 complex kinase activity. Furthermore, we have determined that the adaphostin-mediated cell cycle arrest of PC-3 cells is dependent upon activation of the p38 MAPK. We also demonstrate that the hepatocyte growth factor receptor-c-Met is involved in the adaphostin-mediated signaling events that regulate p38 MAPK. Taken together, these results identify for the first time a signaling cascade of adaphostin-mediated G(1) phase-specific cell cycle arrest in PC-3 cells. These findings suggest that the tyrphostin member has a broader spectrum of activity than originally predicted.

Maternal antenatal profile and immediate neonatal outcome in VLBW and ELBW babies

OBJECTIVE

To evaluate the antenatal profile of the mother and the immediate neonatal morbidity and mortality till discharge.

METHODS

The study was a retrospective analysis of 92 patients of preterm labour who delivered babies weighing

RESULTS

A total of 92 mothers in preterm labour at 26 to 34 weeks were admitted and subsequently delivered 70 VLBW babies (< 1500 gms) and 36 ELBW babies (< 1000 gms) including 8 pairs of twins and 3 triplets pregnancies. Majority of the patients (93.4%) were booked. Amongst the various high risk factors for preterm labour, anaemia during pregnancy (32.6%), bacterial vaginosis (26%), gestational hypertension (18.4%) and pervious history of preterm labour (18.4%) were common associations. Calcium channel blocker (Depin) tocolysis was effective in postponing labour from 48 hours to more than 2 weeks. The cesarean section rate was very high (67.3%) in our study. The commoner neonatal complications in both VLBW and ELBW babies were RDS, neonatal jaundice and sepsis. Features of IUGR were seen in both the groups (22.8% in VLBW and 22.2% in ELBW babies). The neonatal mortality rate till discharge was 15.7% in VLBW group and 33.3% in ELBW group. The morality rate was highest in 26 to 30 weeks gestation babies and in babies weighing < 800 gms.

CONCLUSION

Antenatal profile of preterm labour in our series showed a number of high risk factors. The identification of common high risk factors is important for appropriate prenatal care. A better neonatal survival rate was possible due to timely intervention, appropriate management and NICU care facility available in our tertiary care centre.

Recurrent vulval congenital lymphangioma circumscriptum-a case report and literature review

Lymphangioma circumscriptum (LC) is a defect of lymphatics in deep dermis. This abnormal saccular dilatation of lymphatics occurs in dermal papillae visible as vesicles clinically. The entity may be acquired or congenital. The occurrence of congenital variety of LC in vulva is extremely rare, with only few cases reported in the literature. We communicate one such case presenting as recurrent vulval growth along with a review of literature and treatment modalities.

Diploid partial mole with neonatal survival--a case report

Partial mole is a gestational neoplastic disorder with a reported incidence of 0.005 - 0.01% of all pregnancies. The karyotype in such cases is usually triploid, baring a few exceptions. The diploid partial mole is an extremely rare entity with only few cases being documented in literature. The fetal outcome in such cases is usually poor. We describe a case of partial mole, which terminated at 28 weeks with a live diploid male fetus with good neonatal outcome. Follow-up showed no progression to malignant gestational trophoblastic disease.

In vitroCombination Treatment with Perifosine and UCN-01 Demonstrates Synergism against Prostate (PC-3) and Lung (A549) Epithelial Adenocarcinoma Cell Lines

PURPOSE

Antineoplastic agents often achieve antitumor activity at the expense of close to unacceptable toxicity. One potential avenue to improve therapeutic index might combine agents targeting distinct components of the same growth regulatory pathway. This might lead to more complete modulation of the target pathway at concentrations lower than those associated with limiting adventitious toxicities from either agent alone. The protein kinase antagonist UCN-01 is currently used in Phase I/II trials and has recently been demonstrated to inhibit potently PDK1. We have recently documented that the alkylphospholipid perifosine potently also inhibits Akt kinase (PKB) activation by interfering with membrane localization of Akt. This leads to the hypothesis that these two agents might act synergistically through distinct mechanisms in the PI3K/Akt proliferation and survival-related signaling pathway.

EXPERIMENTAL DESIGN

The synergistic effects of UCN-01 and perifosine, on two cell lines (A-549 and PC-3), were examined using various long-term in vitro assays for cell growth, cell cycle distribution, clonogenicity, survival morphology, and apoptosis. Along with Western blotting experiments were performed to determine whether this synergistic combination of two drugs has significant effect on their downstream targets and on biochemical markers of apoptosis.

RESULTS

After 72 h, perifosine at concentrations of 1.5 and 10 microM UCN-01 at 40 and 250 nM did not significantly affect the growth of PC-3 and A459 cells, respectively. However, in combination at the same respective individual concentrations (1.5 microM and 40 nM of perifosine and UCN-01, respectively, in PC-3 cells and 10 microM perifosine and 0.25 microM UCN-01 in the somewhat more resistant A549 cells), virtually complete growth inhibition of both the cell lines resulted. Supra-additive inhibition of growth was also demonstrated in independent clonogenic assays. Mechanistic studies in cell culture models suggest enhanced depletion of the S-phase population in cells treated by the combination. This correlated with enhanced inactivation of Akt along with activation of caspases 3 and 9 and poly(ADP-ribose) polymerase cleavage. Evidence of synergy was formally demonstrated and occurred across a wide range of drug concentrations and was largely independent of the order or sequence of drug addition.

CONCLUSIONS

As the concentrations of UCN-01 and perifosine causing synergistic inhibition of cell growth are clinically achievable without prominent toxicity, these data support the development of clinical studies with this combination.

Perifosine, a novel alkylphospholipid, inhibits protein kinase B activation

Perifosine is a novel p.o. bioavailable alkylphospholipid. Perifosine has displayed significant antiproliferative activity in vitro and in vivo in several human tumor model systems and has recently entered phase I clinical trials. Recent studies have identified that perifosine could cause cell cycle arrest with induction of p21(WAF1/CIP1) in a p53-independent fashion; however, the basis for that effect is not known. Structurally, perifosine resembles naturally occurring phospholipids. Therefore, we hypothesized that perifosine might perturb pathways related to phospholipids modulated by growth factor action. We demonstrate here that perifosine causes dose-dependent inhibition of protein kinase B/Akt phosphorylation and thus activation at concentrations causing growth inhibition of PC-3 prostate carcinoma cells. Only the myristoylated form of Akt (MYR-Akt), which bypasses the requirement for pleckstrin homology (PH) domain-mediated membrane recruitment, abrogated perifosine-mediated decrease of Akt phosphorylation and cell growth inhibition by perifosine. We demonstrate further that perifosine decreases the plasma membrane localization of Akt, and this is substantially relieved by MYR-Akt along with relief of downstream drug effect on induction of p21(WAF1/CIP1). Perifosine does not directly affect phosphoinositide 3-kinase (PI3K), phosphoinositide-dependent kinase 1, or Akt activity at concentrations inhibiting Akt phosphorylation and membrane localization. Our results demonstrate that Akt is an important cellular target of perifosine action. In addition, these studies show that the membrane translocation of certain PH domain-containing molecules can be greatly perturbed by the alkylphospholipid class of drugs and imply further that the PI3K/Akt pathway contributes to regulation of p21(WAF1/CIP1) expression.

Early development of cyclin dependent kinase modulators

The protein kinase family presents remarkable opportunities for drug discovery and development targeting mainly to the ATP binding cleft. Cyclin-dependent kinases CDKs control the cell division in by controlling its sub phases. The regulation of CDKs is altered in a number of tumor types, and therefore CDKs are a particularly attractive target group of kinases with reference to proliferative disorders including cancer, but also extending to graft stenosis, and autoimmune disorders. Screening of chemical modulators of CDKs that modulate aberrant CDK activity might be beneficial for cancer therapy by directly inhibiting kinase activity, or influencing cell cycle "checkpoint" function, which is mediated through effects of exogenous cellular regulators of CDK activity. In this regard small molecule modulators such as flavopiridol and UCN-01 are in early clinical trials. Other more selective modulators of CDK function are being actively sought, and initial results with flavopiridol analogs, indirubins, paullones, and purine-based inhibitors will be considered.

Prenatal diagnosis of chromosomal abnormalities in women with high risk pregnancies

BACKGROUND & OBJECTIVES

Prenatal diagnosis helps in averting the birth of infants with chromosomal abnormalities. Fluorescence in situ hybridization (FISH) has been introduced as a potentially powerful tool in clinical cytogenetics. Several studies have reported successful prenatal diagnosis of chromosomal abnormalities in high risk pregnancies using FISH, however there are no reported studies from an Indian set up. Prenatal diagnosis for the detection of chromosomal abnormalities was carried out by conventional cytogenetics in the present study in the foetuses of high risk pregnancies in women attending a tertiary care facility in north India. These cases were further analyzed using FISH, to test the efficiency and utility of this technique for prenatal detection of common aneuploidies.

METHODS

A total of 82 women with high risk pregnancies (81 singleton, 1 twin) were included in the study. Prenatal diagnosis was performed in these women using conventional chromosomal analysis (CCA) and interphase or metaphase FISH on chorionic villus or amniotic fluid or cord blood samples.

RESULTS

Chromosomal analysis was successful in 80 instances and uninformative in 2. Abnormal karyotypes were detected in five (6.09%) of these women. FISH was successful in all the subjects and the results were in conformity to the cytogenetic results. In the 2 women where cytogenetic analysis was uninformative, results were given on the basis of interphase FISH.

INTERPRETATION & CONCLUSION

The study clearly demonstrates that prenatal diagnosis is useful in the detection of chromosomal abnormalities in foetuses of women with high risk pregnancies. FISH is a powerful sensitive molecular cytogenetic technique, through which specific chromosomal abnormalities can be diagnosed/identified rapidly and accurately and may be used as an adjunct to conventional cytogenetic analysis.

Indomethacin therapy in the treatment of polyhydramnios due to placental chorioangioma

A 26-year-old primigravida presented with acute polyhydramnios at 30 weeks gestation. Ultrasonography revealed a large placental chorioangioma with severe hydramnios. No anomalies were detected in the fetus. Preterm labor started with respiratory distress and indomethacin, 25 mg was given every 6 hours. The patient showed a good response with improvement of the hydramnios and respiratory symptoms. A normal infant with no neonatal complications was delivered 3 weeks later.

Ectopic hydronephrotic kidney masquerading as an ovarian cyst during pregnancy

An ectopic iliopelvic kidney with hydronephrosis causing fetal malpresentation is a rare occurrence. We describe this case for its unusual presentation which was mistaken for an ovarian cyst. The difficulty in diagnosis and the need for a high index of suspicion is highlighted.

Factors determining the occurrence of unwanted pregnancies

BACKGROUND

We aimed to identify the factors involved in the occurrence of unwanted pregnancy in women seeking medical termination of pregnancy, and to describe their contraceptive practices.

METHODS

A descriptive interview-based study of 402 women seeking abortion was done. Information was gathered regarding demographic variables, contraceptive practices and reasons for the unwanted pregnancy.

RESULTS

All the women in our sample were married and multiparous. The husband's unwillingness for contraception and the improper use of condoms was responsible for one-third of all unwanted pregnancies. Lactation was believed to be a protection against pregnancy by 11.3% of women while 6.3% were unaware of any contraceptive method.

CONCLUSION

We believe that focusing on these areas in public health programmes will help to decrease the number of unwanted pregnancies.

Laparoscopic management of Sertoli-Leydig cell tumors of the ovary. A report of two cases

BACKGROUND

Sertoli-Leydig cell tumor is a rare ovarian tumor with an incidence of < .5% of all ovarian tumors. Laparotomy is the standard approach to these cases.

CASES

Sertoli-Leydig cell tumors were diagnosed in two young, nulliparous, infertile women. Both presented with secondary amenorrhea. Virilization was found in one. Their testosterone levels were high, and sonography revealed a solid, echogenic mass in the fornix. Laparoscopic removal was performed. Both women achieved normal menstruation one month after the operation, and one became pregnant and gave birth to a healthy infant.

CONCLUSION

There are very few case reports of laparoscopic removal of such tumors. Laparoscopic surgery, which is minimally invasive and cosmetically acceptable and has a speedy recovery, should be the approach of choice for these patients.

Recurrent eclampsia in a woman with chronic pyelonephritis

Pre-eclampsia associated with chronic pyelonephritis is not uncommon, but recurrent eclampsia in two successive pregnancies associated with chronic pyelonephritis is very rare. We present one such rare case where a patient had recurrent eclampsia with chronic pyelonephritis.

Aplastic anaemia during pregnancy: variable clinical course and outcome

Aplastic anaemia occurring during pregnancy is a rare event and is associated with high maternal and fetal morbidity and mortality. Prognosis is poorer when aplastic anaemia develops during pregnancy and many such patients have an unsuccessful pregnancy outcome. We report two cases of aplastic anaemia associated with pregnancy. Both the patients had very different antenatal course and outcome. Their etiopathogenesis and management is discussed.

Premenstrual dysphoric disorder--a study from India

OBJECTIVE

To study the prevalence of Premenstrual Dysphoric Disorder (PMDD) in Indian women.

METHODS

Prospective recording of symptoms of PMDD over two menstrual cycles using a structured proforma.

SUBJECTS

Sixty-two volunteers who returned pro formas complete in all respects.

RESULTS

Four women (6.4%) fulfilled the criteria of PMDD.

CONCLUSIONS

The prevalence of PMDD detected in this first report on the condition from India is comparable to the prevalence reported in previous studies. The group of women selected by applying such rigorous criteria appears to be heterogeneous with regard to symptom profile over the cycle.

Inversion of uterus during cesarean section

Acute inversion of the uterus is a rare complication during cesarean section. We describe one such case in which diagnosis was made immediately and reversion was performed within few minutes. A high index of suspicion and prompt management can prevent further complications.

Vesicocervical fistula: an unusual presentation

A rare case is presented of vesicocervical fistula that occurred in a woman who sought help for continuous dribbling of urine for nine years. The aetiological implications of her obstetric history are discussed in the context of previous reports in the literature. The management and outcome of this case is discussed.

Prenatal diagnosis and assessment of fetal malformations by ultrasonography in India

A multicentre study to assess the status of prenatal diagnosis of fetal malformation in India was conducted. Questionnaires were sent to the teaching hospitals and to centres in the private sector involved with ultrasonography in all the four zones. Data were obtained from 13 centres. Basic level I scans were performed on all pregnant women in 64% centres, whereas level II or targeted scans were performed as routine in 42% centres. Obstetricians performed level II scans in only 35% of cases while rest were performed by radiologists. Malformations of the central nervous system were commonest, accounting for 35-69% of all malformations, followed by genitourinary and gastrointestinal malformations. Malformations of the cardiovascular system were detected in 9.3% as abnormal four chamber view and outlet tract abnormalities, subsequently confirmed on fetal echocardiography. Invasive prenatal diagnosis by fetal blood sampling, chorion villus sampling and amniocentesis for chromosomal analysis of malformed fetuses was performed at 40% centres. At the All India Institute of Medical Sciences, approximately 11,042 ultrasound scans were performed by obstetricians as routine in all pregnant women. A total of 543 malformations were detected accounting for a 4.9% incidence of structural anomalies. A total of 98 cardiovascular malformations were detected in high and low risk pregnant women on fetal echocardiography. No database or registry exists in India to give an actual insight into the problem of congenital malformation and their prenatal diagnosis. It is important to train obstetricians in level I and II ultrasonography, to recognise centres and institutions at national and regional level, and to integrate a network of diagnostic testing. Close liaison between geneticists, radiologists, pediatric surgeons, pediatricians and obstetricians is a must for prenatal diagnosis and management of fetal malformations.

Retrieval of lost Copper-T from the rectum

A case of lost Copper-T lying partly in the rectal lumen and its removal through the rectal route is described. This case emphasises the importance of rectal examination in the case of lost intra-uterine contraceptive device (IUCD) and highlights the possibility of safe retrieval of an IUCD through the rectal route even when it is partly embedded in the rectal wall.

Uterovaginal prolapse associated with rectal prolapse

A case of combined genital prolapse and rectal prolapse in a 55-year-old multipara is reported. The mixed prolapse was treated by vaginal hysterectomy with pelvic floor repair and laparoscopic rectopexy at the same sitting. The feasibility of combined treatment of genital prolapse by the vaginal route and of rectal prolapse by laparoscopic rectopexy is emphasized.