The detection of anti-β2-glycoprotein I antibodies is associated with increased risk of pregnancy loss in women with threatened abortion in the first trimester

OBJECTIVE

This study was designed to evaluate whether the detection of serum antiphospholipid autoantibodies may be useful in predicting pregnancy outcome in women with threatened abortion in the first trimester.

STUDY DESIGN

A group of 77 pregnant women of between 8 and 12 weeks' gestation with vaginal bleeding was tested for serum antiphospholipid, lupus anticoagulants, anticardiolipin, antinuclear antibodies, and anti-beta2-glycoprotein I antibodies, and was followed up until the spontaneous end of pregnancy. A control group composed of 15 healthy women with uncomplicated gestation was tested contemporarily for the same antibody panel.

RESULTS

Of the 77 patients with threatened abortion, 32 (41.5%) progressed to deliver at term and 45 (58.5%) experienced early pregnancy loss. Among the antibodies evaluated, only anti-beta2-glycoprotein I was significantly more frequent in those women whose pregnancy resulted in spontaneous abortion (22/45, 49%) than in those who progressed to term (6/32, 19%) or in the control group (2/15, 13%; p=0.004). This difference was specific to the IgM isotype (p=0.001). After adjustment by multivariate analysis, the odds ratio for pregnancy loss associated with a positive beta2-glycoprotein I antibody test was 5.18 (p=0.001).

CONCLUSION

The detection of anti-beta2-glycoprotein I antibodies is associated with an increased risk of pregnancy loss in women with threatened abortion in the first trimester.

Umbilical endometriosis in pregnancy: a case report

To our knowledge, this is the first case reported in the literature of umbilical endometriosis in a pregnant woman. We report a case of umbilical endometriosis in a pregnant woman at 16 weeks of gestation. The patient revealed a reddish-brown polypoid nodule within the umbilical depression, with the typical history of monthly bleeding from the umbilicus. A nodule biopsy, testing of serum levels of CA-125 and a transabdominal ultrasound examination were performed. The diagnosis of endometriosis was confirmed by pathological examination. Serum levels of CA-125 were slightly increased and the pelvic ultrasound examination did not identify ovarian cysts of a possible endometriotic nature. The patient was also examined at 24 weeks' gestation, after delivery and in the late postpartum period. No therapy was given and the lesion resolved spontaneously 2 months after the biopsy was taken.

High plasma concentrations of di-(2-ethylhexyl)-phthalate in women with endometriosis

BACKGROUND

Emerging evidence suggests a potential role for ubiquitous environmental contaminants in the physiopathology of endometriosis. Di-(2-ethylhexyl)-phthalate (DEHP), the most commonly used plasticizer in flexible polyvinylchloride (PVC) formulations, is a widespread environmental contaminant with potentially adverse effects on fertility in animal models. In the present study, we tested the hypothesis that DEHP and/or and its main metabolite, mono-ethylhexyl phthalate (MEHP), play a role in the pathogenesis of endometriosis.

METHODS

Specimens of blood and peritoneal fluid were collected in a group of women with endometriosis (n = 55), and in age-matched control women (n = 24). Concentrations of DEHP and MEHP were measured in plasma and peritoneal fluid by using high performance liquid chromatography (HPLC). Differences between groups were tested using the Fisher's exact test, Wilcoxon-test, and Kruskal-Wallis analysis of variance.

RESULTS

Endometriotic women showed significantly higher plasma DEHP concentrations than controls (median 0.57 micro g/ml, interquartile range: 0.06-1.23; values range: 0-3.24 versus median 0.18 micro g/ml, interquartile range: 0-0.44; values range: 0-1.03; P = 0.0047) and 92.6% of them had detectable DEHP and /or MEHP in the peritoneal fluid. No significant differences in either the DEHP/MEHP plasma concentrations (P >/= 0.31) or DEHP/MEHP peritoneal fluid concentrations (P >/= 0.66) were observed in the endometriotic patients as a function of the disease stage at the time of diagnosis.

CONCLUSIONS

The present findings showed for the first time an association between DEHP plasma concentrations and endometriosis, suggesting a possible role for phthalate esters in the pathogenesis.

Serum inhibin B correlates with successful ovulation in infertile women

PURPOSE

To investigate whether inhibin B and activin A serum and follicular fluid levels in infertile women undergoing induction of superovulation correlate with successful ovulation.

METHODS

Infertile women (n = 16) (30-43 years of age) undergoing induction of superovulation for assisted reproduction were studied. A blood sample was collected before and days 3, 8, and 12 during the induction of superovulation. A follicular fluid sample at the time of ovarian pick up was also collected. Serum and follicular fluid were assayed for inhibin B, activin A, and estradiol.

RESULTS

According to the successful follicular development women were divided in two groups: (A) responders (n = 10) and (B) poor responders (n = 6). Women of group A showed mean follicular fluid inhibin B levels higher than in group B (P = 0.001), while no significant difference for activin A levels was found. During induction of superovulation serum activin A levels did not change in both groups of women, while inhibin B and estradiol levels significantly increase only in responder women (P < 0.001). Serum inhibin B and estradiol levels correlated with follicles developed > or = 10 mm (P = 0.000).

CONCLUSIONS

Serum inhibin B is an effective marker of follicular development in infertile women undergoing induction of superovulation, and may represent a further marker for ovarian follicular capacity.

Management of sexual dysfunctions in women

The deeper understanding of female physiology changed the perspective used to evaluate sexual difficulties. Systems like: vascular, neurological, biochemical, and endocrine are investigated as their modifications for aging or medical conditions may alter the sexual responsivity of women. New data imply that pharmacological interventions may become suitable for women. Gonadal steroids influence mood, wellbeing, and genital physiology but evidence of actions is controversial. Hormone imbalance provokes symptoms that may also derive from other conditions. Clinicians must exclude dismetabolism, depression and family crisis before diagnosing gonadal problems. The female androgen insufficiency syndrome was defined in July 2001 as altered mood, memory and wellbeing, and loss of desire. Estrogen maintains wellbeing and healthy genitals, influencing mood and sexuality. Progesterone provokes tension and nervousness, causing premenstrual syndrome. Hormone replacement is indicated in the treatment of endocrine deficiency. In research projects women receiving one preparation containing androgen reported improvement of mood, and arousal. Sildenafil cures approximately 25% of sexually dysfunctional, menopausal patients; being more effective with hormone replacement therapy (HRT) and consistently active against the block of antidepressants on orgasm. Added to psychiatric regimens, sildenafil ameliorates excitement. Sex therapy helps patients change behavior, overcome anger, communicate needs and redefine sex. We strongly believe that such crucial aspects must be addressed in therapy, even when the etiology is organic.

[Surgical indications and reconstructive techniques in the treatment of chronic forms of ulcerative rectocolitis. Review of the literature]

The authors have reviewed the literature particularly of the last decade, about surgical indications and timing in chronic ulcerative proctocolitis, also regarding the difficulties and the hazards the surgeon has to face depending on which type of chronic disease is considered. The various solutions for intestinal transit restoration have been reviewed, especially after the indications for terminal and continent ileostomy and for ileo-rectal anastomosis have been put aside, and total proctocolectomy with mucosectomy was advocated, with a special concern for assets and drawbacks of every type of ileal pouch. It is herein discussed the difference between the attitudes towards chronic active and recurrent ulcerative proctocolitis. The active form can't be cured with steroids and shows a greater risk of malignant transformation after 10-15 years of illness, insofar most cases (82%) in the long run need operation with this form that just often permits a one-stage surgery with mucosectomy, though. The commoner recurrent form is quite sensitive to steroids until these prove to be ineffective and surgery becomes mandatory (28% of cases). A two or three-stage surgery is advocated in this form with conservation of the rectum (mucosal fistula) as long as the acute phase is present, permitting only after its remission a restorative procedure with mucosectomy, which would be likely to be jeopardizing during the acute phase. The many designs of ileal reservoir do not differ indeed between each other as much in compliance as in maximum tolerable volume. The quadruple loop reservoir affords a volume approaching highly the original rectal volume, with better compliance and lesser frequency of bowel evacuations compared to other pouch designs. Some authors maintain that the functional outcome is independent of the reservoir shape. The anal continence basically depends upon the integrity of the internal sphincter, on the conservation of the anal inhibitory reflex and on the resting pressure. Muscular cuff is also mentioned with reference to anal function. Circular staplers have been employed for pouch-anal anastomosis 1-2 cm above the dentate line without mucosectomy. The stapled pouch-anal anastomosis entails a damage to the internal sphincter by some authors on the contrary a better sphincter function by others, compared to hand-sewn anastomosis with mucosectomy. Trials are needed to compare the risk of rectocolitis recurrence or malignancy after hand-sewn pouch-anal anastomosis with mucosectomy and after stapled anastomosis without mucosectomy. Postoperative complications are also herein discussed, with a special regard to pouchitis and its various aetiologic factors in early and late postoperative course.