Contraception and cervical colonization with mycoplasmas and infection with cytomegalovirus.

The relationship of cervical colonization of genital mycoplasmas and infection with cytomegalovirus (CMV) was studied in 66 intrauterine device (IUD) users as contrasted to 60 patients using oral contraception and 50 patients using neither an IUD nor oral contraception. No significant increase in colonization or genital mycoplasmas or infection with CMV was noted in IUD users. No CMV was isolated from users of the cooper-t IUD. It is unlikely that genital mycoplasmas are related to either the increased immunoglobulin levels seen in patients using the IUD or the antifertility effects of the IUD.     

Treatment of men with oligoasthenozoospermia and asthenozoospermia with kallikrein

A randomised group of 75 men with idiopathic oligoasthenozoospermia and asthenozoospermia were subjected to control study with kallikrein. Kallikrein was given to 45 men 600 units daily in a period of 3-6 months. The other group of 30 infertile men was followed during the same period of time. Percentage of motile sperm was significantly improved after 3-6 months treatment with kallikrein. Sperm count and percentage of morphologically normal sperm showed improvement but was not statistically significant. Infertile men with sperm count below 20 X 10(6)/ml had greater improvement in sperm count than men with sperm count over 20 X 10(6)/ml. This study emphasizes that kallikrein is a relatively good drug for restoring sperm motility in idiopathic oligoasthenozoospermia and asthenozoospermia.     

Reactive hypoglycemia in lean young women with PCOS and correlations with insulin sensitivity and with beta cell function

Reactive hypoglycemia (RH), which is a postprandial hypoglycemic state, occurs within 2-5 h after food intake. It is classified as idiopathic, alimentary, or diabetic reactive hypoglycemia. We studied the incidence of reactive hypoglycemia and looked for any correlations between it and the presence of insulin sensitivity and/or beta cell function in young lean polycystic ovary syndrome (PCOS) patients. This study was designed as a cross-sectional study in 64 lean young women with PCOS (BMI < or = 25 kg/m2). Various indices of insulin sensitivity and beta cell function derived from the oral glucose tolerance test (OGTT) results were used. We found the rate of RH to be 50% in lean young women with PCOS. DHEA-S and PRL levels were found to be lower in subjects with RH (P < 0.05 and P > 0.05, respectively). Beta cell function indices such as the insulinogenic index (at 120 min), CIR (at 120 min) and HOMA beta cell index were found to be insignificantly higher in the RH group than the nonreactive hypoglycemia (NRH) group. The 4 h glucose level, but not the 3 h glucose level, was significantly correlated with insulin resistance indices, such as fasting insulin level, HOMA-IR, Quicky index, and FIRI in the RH group. Significantly decreased DHEA-S levels were an interesting finding. In conclusion, there is an urgent need to investigate RH in lean young women with PCOS. Our results indicate that more definite insulin resistance occurs in subjects with RH in the fourth hour of the OGTT than those with RH in the third hour. In addition, RH in the fourth hour together with a low DHEA-S level may be predictive of future diabetes in young women with PCOS even when they are not obese.     

Chronic pelvic pain associated with autoimmunity and systemic and peritoneal inflammation and treatment with immune modification

OBJECTIVE: To determine the prevalence of chronic inflammation of the pelvic peritoneum, systemic inflammation and autoimmunity in chronic pelvic pain and to explore the significance of these findings and assess the response to treatment with immune modification. STUDY DESIGN: Prospective, observational clinical studies from 2 centers were performed on 3,238 women presenting with pelvic pain to determine the prevalence of chronic inflammation by biopsy when endometriosis was absent. A second study included 40 women with chronic pelvic pain not resulting from endometriosis; immunologic investigations were carried out and therapy instituted. RESULTS: Chronic inflammation of the peritoneum, while not evident in the absence of pelvic pain, was present in 15.7% of women with chronic pelvic pain. In the second group, 10% had histologic evidence of chronic inflammation, 55% demonstrated evidence of systemic inflammation, and 37.5% were found to have autoimmune disorders. Chronic inflammation of the vagina was found in 42.5% and polycystic ovary syndrome in 22% of those with systemic inflammation. Twelve of the 40 were subsequently treated, with considerable success, with immune-modifying drugs, hydroxychloroquine and methotrexate. CONCLUSION: Chronic pelvic pain is frequently associated with systemic inflammation, including autoimmune diseases. Peritoneal chronic inflammation is sometimes also associated. It is often successfully treated with immune-modifying drugs.     

Metabolic Syndrome in Men with Low Testosterone Levels: Relationship with Cardiovascular Risk Factors and Comorbidities and with Erectile Dysfunction

IntroductionTestosterone deficiency and metabolic syndrome (MetS) are strongly associated. Patients consulting for sexual dysfunction may have testosterone deficiency, providing a valuable opportunity to assess MetS. The identification of variables predicting MetS is of great importance.AimsTo identify cardiovascular comorbidities and risk factors, including erectile dysfunction (ED), associated with MetS in men aged ≥45 with total testosterone (TT) < 8 nmol/L (or <12 nmol/L when calculated free testosterone was <250 pmol/L) and to gain further insight into the relationship between both conditions.MethodsData were collected from a multicenter, cross‐sectional, observational study conducted in Spain among men visiting men's health‐care offices with a confirmed diagnosis of testosterone deficiency. Subjects with data for MetS assessment were included in this analysis. Other data available were anthropometrics, toxic habits, cardiovascular comorbidities, ED diagnosis, and TT values.Main Outcome MeasuresThe MetS harmonized definition was used. Waist circumference threshold was 94 cm. ED was diagnosed and classified using the International Index of Erectile Function‐5 (IIEF‐5) questionnaire. Bivariate and multivariate logistic regression analyses were performed to calculate odds ratios (ORs) for MetS.ResultsMean age was 61.2 ± 8.1 years. Prevalences of ED and MetS were 97.6% and 69%, respectively, both increasing with age. Bivariate analysis showed that moderate or severe ED, obesity, and peripheral vascular disease (PVD) were the variables associated with the greatest odds of MetS (OR = 2.672 and 2.514, respectively), followed by alcohol intake (OR = 1.911). Tobacco use, ag,e and testosterone deficiency severity had a minimal effect that disappeared on multivariate analysis. Elevated triglycerides and HDL‐cholesterol were MetS risk factors associated with a lower TT level.ConclusionThe high prevalence of MetS among men with testosterone deficiency highlights the opportunity to assess cardiovascular health in patients consulting for sexual dysfunction. Moderate to severe ED, obesity, PVD, and alcohol intake significantly increase the likelihood of MetS. García‐Cruz E, Leibar‐Tamayo A, Romero J, Piqueras M, Luque P, Cardeñosa O, and Alcaraz A. Metabolic syndrome in men with low testosterone levels: Relationship with cardiovascular risk factors and comorbidities and with erectile dysfunction. J Sex Med 2013;10:2529–2538.     

Pelvic actinomycosis with abundant ascites,pleural effusion,and lymphadenopathy diagnosed with endometrial biopsy and treated with medication only

ObjectivePelvic actinomycosis almost always presents as a “dry” type, and pelvic actinomycosis with ascites is extremely rare. We present an unusual case of pelvic actinomycosis with ascites, pleural effusion, and lymphadenopathy. Because of these atypical clinical features, a malignant process such as ovarian cancer or peritoneal carcinomatosis was suspected, but an endometrial biopsy revealed pelvic actinomycosis, which was treated without surgical intervention.Case reportA 50-year-old Korean woman presented to our clinic with a 3-month history of abdominal pain and weight loss. An abdominopelvic computed tomography scan demonstrated ascites, pleural effusion, bilateral adnexal tubular structures, several enlarged lymph nodes in the paraaortic area, and diffuse peritoneal infiltration. Ultrasonography showed fluid collections measuring 2.7 cm in the cul-de-sac, 2.42 cm in the right paracolic gutter, and 3.13 cm in the left paracolic gutter. Endometrial/endocervical specimens showed marked chronic inflammation with sulfur granules, with a colony of filamentous organisms consistent with Actinomyces infection. The patient underwent antibiotic treatment for 6 months and recovered without complications or adverse events in the 13 months of follow up.ConclusionPelvic actinomycosis should always be considered in patients with a pelvic mass and peritoneal infiltration, especially in the presence of intrauterine device use, despite the fact that abundant ascites, pleural effusion, and lymphadenopathy almost never accompany pelvic actinomycosis. Endometrial/endocervical biopsy may yield a diagnosis without an invasive procedure and should be performed. Because of the excellent response to penicillin, medical treatment alone is an effective method to eradicate pelvic actinomycosis without the need for surgical intervention.     

Omentin and chemerin and their association with obesity in women with polycystic ovary syndrome

We aimed to investigate whether overweight/obesity is associated with omentin and chemerin. The study group consisted of 81 women with Polycystic ovarian syndrome (PCOS) (41 lean, BMI?2 and 40 overweight or obese, BMI?>?25?kg/m²) and 61 healthy subjects (31 lean, BMI?2 and 30 overweight or obese, BMI?>?25?kg/m²; control group). The clinical, endocrine, metabolic parameters, plasma omentin and chemerin levels were measured in patients and compared to control. In all subjects with PCOS (n?=?80), serum chemerin levels were higher compared with those of the controls (n?=?58) (7.71?±?1.78?ng/mL versus 6.94?±?0.82?ng/mL, p?=?0.003). However, serum omentin levels were not significantly different between the PCOS subjects and the controls (1.55?±?0.43?ng/mL versus 1.69?±?0.37?ng/mL, p?=?0.056). The mean chemerin concentrations were significantly elevated in the obese PCOS group compared with the obese control subjects (8.98?±?1.45?ng/mL versus 7.02?±?0.67?ng/mL, p?=?0.000) and the nonobese PCOS group compared with the obese control subjects (6.57?±?1.17?ng/mL versus 7.02?±?0.67?ng/mL, p?=?0.000). In conclusion, fat mass seems to be the main determinant factor of increased chemerin and decreased omentin in women with PCOS.     

Rates and risk factors associated with depressive symptoms during pregnancy and with postpartum onset

Abstract

The objectives of this study were to evaluate the prevalence of depressive symptoms in the third trimester of pregnancy and at 3 months postpartum and to prospectively identify risk factors associated with elevated depressive symptoms during pregnancy and with postpartum onset. About 364 women attending antenatal clinics or at the time of their ultrasound were recruited and completed questionnaires in pregnancy and 226 returned their questionnaires at 3 months postpartum. Depressed mood was assessed by the Edinburgh Postnatal Depression Scale (EPDS; score of?≥?10). The rate of depressed mood during pregnancy was 28.3% and 16.4% at 3 months postpartum. Among women with postpartum depressed mood, 6.6% were new postpartum cases. In the present study, belonging to a non-Caucasian ethnic group, a history of emotional problems (e.g. anxiety and depression) or of sexual abuse, comorbid anxiety, higher anxiety sensitivity and having experienced stressful events were associated with elevated depressed mood during pregnancy. Four risk factors emerged as predictors of new onset elevated depressed mood at 3 months postpartum: higher depressive symptomatology during pregnancy, a history of emotional problems, lower social support during pregnancy and a delivery that was more difficult than expected. The importance of identifying women at risk of depressed mood early in pregnancy and clinical implications are discussed.     

Pregnancy and delivery course with pregnant women with abnormal cervical cytology

DESIGN: The aim of this study was the analyze of pregnant women procedure with abnormal cervical cytology, the estimate of pregnancy and delivery course. MATERIALS AND METHODS: The study group consisted of two pregnant women with abnormal cervical cytology, treated in I Clinic Medical Academy in Warsaw in 1996-1999. RESULTS: With the first women in 7 week of pregnancy in mikroscopical examination carcinoma praeinvasivum was found. After histological control-study in 36 week of pregnancy, the caesarean section as result of obstetrical indications was conducted. In the puerperium the therapeutic-diagnostical conisation of colli uteri was done. With the second patients in the first trimester in microscopical examinations cervical dysplasia was found. In 39 week of pregnancy the caesarean section as result obstetrical indications was conducted. In puerperium control cytology was done. CONCLUSIONS: No impact of pregnancy for cervical dysplasia or cervical praeinvasivum carcinoma was diagnosed, but in two patients infection of HPV occurred.     

The pregnancy and delivery course with pregnant women with uterine myomas

OBJECTIVES, DESIGN: The pregnancy and delivery course with pregnant women with uterine myomas was analyzed. MATERIALS AND METHODS: It was presented 26 pregnant women, aged 24-42 years, with the uterine myomas diagnosed during the pregnancy or delivery. RESULTS: In 19 (73%) patients in usg examination in first trimester of pregnancy myomas was obtained. It was found myomas with 7 (27%) patients during the delivery: 5 during the caesarean section and 2 during vaginal labour. With 23 (88.5%) women with uterine myomas the complications was occurred. Five patients delivered before 37 week of pregnancy. CONCLUSIONS: No significant enlargement of the uterine myomas in the study group was observed, however often complication (imminent abortion 53.8%, preterm delivery imminent 30.8%) during pregnancy occurred. Cesarean section was performed in the majority of the patients. In 20% of patients delayed postpartum involution of uterus was observed.