Serum leptin and erythropoietin during menstruation

OBJECTIVE: The potential influence of leptin and erythropoietin on the angiogenesis and bleeding of the endometrium during normal menstrual cycles and possible correlations between them. STUDY DESIGN: Serum concentrations of leptin and erythopoietin were measured at menstrual days 20, 1 and 3 or 4 in healthy, non-obese, normal menstruating women. RESULTS: Mean leptin and erythropoietin concentrations showed no significant alteration over time (F = 0.588, p = 0.563 and F = 0.654, p = 0.528, respectively). There was, however, a strong negative linear relationship between the concentration of the two substances on days 1 and 3 or 4 (p = 0.018 and p = 0.028, respectively). CONCLUSIONS: If the two substances affect endometrial angiogenesis, they may do this in a locally limited way, so that peripheral concentration changes cannot be observed. Their inverse correlation prompts further study with receptor determination.     

Late onset of spontaneous pneumothorax complicating acute bronchiolitis in a 5-month-old infant: case report and literature review

The literature contains only a few reported cases of spontaneous pneumothorax complicating acute bronchiolitis in infants. We present a case of a 5-month-old infant with a presentation of spontaneous pneumothorax 7 days after hospitalization for acute bronchiolitis. The characteristics of this particular manifestation are discussed.     

Primary biliary cirrhosis and Henoch-Schonlein purpura: report of two cases and review of the literature.

We describe, for the first time, two adult patients with primary biliary cirrhosis (PBC) who presented palpable purpuric lesions on the lower extremities and buttocks. Skin biopsy was consistent with Henoch-Schonlein purpura (HSP). One of the patients exhibited renal and gastrointestinal involvement, as well. A favourable outcome was achieved in both the patients (after treatment with prednisolone only in the patient with renal and gastrointestinal manifestations). The possible pathophysiological relationships between PBC and HSP--particularly on the significance of the IgA antimitochondrial autoantibodies--are discussed. To the best of our knowledge, these are the first two cases of HSP, which developed in PBC patients. Therefore, this case study suggests that HSP may be rarely involved in the extensive list of immune-mediated diseases associated with PBC.     

Immunoadsorption in lupus myocarditis

Reduction of pathological autoantibodies may be useful in the treatment of systemic lupus erythematosus (SLE). On the other hand clinically manifested myocarditis in SLE, though uncommon, may be life-threatening and its pathogenesis has been ascribed to autoimmunity. The aim of this study is to present a rare case of a patient with severe lupus myocarditis, where immunoadsorption (IA) was evaluated as rescue therapy. A case of SLE with initial manifestation of myocarditis is reported in a 29-year-old male who presented with arthritis, fever, lymphadenopathy, joint swelling and morning stiffness. Laboratory evaluation revealed increased antinuclear antibody (ANA), slightly decreased complement and positive anticoagulant panel. From the above clinical and laboratory features, criteria of SLE seemed applicable. During his hospitalization, the patient developed pericardial effusion and cardiogenic shock. Although pericardiotomy was performed and was treated with immunosuppressive agents, plasmapheresis and supported with current medications, his clinical condition remained critical with an ejection fraction of 20%. At this point it was decided to receive IA onto staphylococcal protein A. After 6 sessions with IA and concomitant immunosuppression, the patient responded well, his condition improved and was dismissed with an ejection fraction of 50%. Fulminant lupus myocarditis is a severe and rare situation lacking a satisfying specific therapy available today. In our presented case, IA in addition to immunosuppressive therapy was beneficial. Considering the benefits of our case and the current knowledge, it might be useful to clarify the open question in scale pilot studies.     

Inhibition of Aortic Valve Calcification by Local Delivery of Zoledronic Acid—an Experimental Study

The aim of this study was to evaluate in an experimental model of aortic valve (AV) stenosis the effectiveness of zoledronate on the inhibition of calcification. Sixteen New Zealand rabbits were placed on vitamin D-enriched diet for 3 weeks. All animals underwent PET/CT at baseline and before euthanasia to assess calcification. Thereafter, the AVs of eight animals were treated with local delivery of 500 μg/l zoledronate. A placebo mixture was administered in the remaining eight animals. Standardized uptake values were corrected for blood pool activity, providing mean tissue to background ratios (TBRmean). In the zoledronate group, there was no progression of AV calcification (TBRmean 1.20?±?0.12 vs 1.17?±?0.78,p?=?0.29), while AV calcification progressed in the placebo group (1.22?±?0.15 vs 1.53?±?0.23,p?=?0.006). Ascending aorta (AA) calcification progressed in both zoledronate and placebo groups. Histology confirmed the results of the PET/CT. Inhibition of AV calcification by local delivery of zoledronate is feasible and effective.     

Detection of intrauterine growth retardation in twins using individualized growth assessment. II. Evaluation of third-trimester growth and prediction of growth outcome at birth.

Second- and third-trimester growth in 34 twin fetuses was evaluated with ultrasonography by measurement of five anatomic parameters. Rossavik growth models, derived from second-trimester measurements, were used to specify expected third-trimester growth curves. Actual measurements were compared to predicted measurements by calculation of the percent deviations. Growth outcome at birth [normal, intrauterine growth retardation (IUGR)] was determined from Neonatal Growth Assessment Scores. Growth in the second trimester was similar in normal and IUGR twins. In the third trimester, abnormal negative deviations were larger and more numerous in IUGR twins. However, there was considerable individual variability and normal twins also had abnormal negative deviations. In IUGR twins, the first appearance of an abnormal negative deviation was quite variable (range: 28.6 weeks to 35.1 weeks), as was the parameter to show such a deviation. Prediction of neonatal outcome was poor using individual anatomic parameters but improved considerably with use of all five parameters. However, some fetuses were misclassified when only the number of abnormal negative deviations was used. The Prenatal Growth Assessment Score (PGAS), determined by both the number and magnitude of abnormal negative deviations, predicted neonatal outcomes with a sensitivity of 100% and specificity of 100%. On average, PGAS values were abnormal 5 weeks before delivery. These results indicate that normal and IUGR twins can be separated, using third-trimester growth patterns, if multiple parameter Individualized Fetal Growth Assessment is employed.     

A case of partial mole and atypical type I triploidy associated with severe HELLP syndrome at 18 weeks' gestation.

Partial mole is a rare complication of pregnancy and 90% of cases are associated with triploidy. HELLP syndrome is also a rare and life-threatening condition that occurs after 20 weeks' gestation. We report a case presenting with a combination of severe HELLP syndrome, partial mole, triploidy type I and fetal growth restriction at 18 weeks' gestation. Partial mole and any type of triploidy must be considered in cases of hydrocephalus and severe growth restriction in the second trimester of pregnancy. Our case highlights the fact that growth restriction can be associated with type I triploidy and that severe HELLP syndrome can develop in such cases even before 20 weeks' gestation.     

The ovarian response to standard gonadotrophin stimulation depends on FSHR, SHBG and CYP19 gene synergism

Purpose

Follicle stimulating hormone, sex hormone-binding globulin and cytochrome P450 aromatase play crucial roles in the regulation of mammalian reproduction. The synergistic effect of FSHR 307(T/A)/FSHR 680(N/S), SHBG(TAAAA)_n and CYP19(TTTA)_n genotypes on ovarian response to standard gonadotrophin stimulation of women undergoing medically assisted reproduction (IVF/ICSI) was explored.

Methods

The study population consisted of 300 women under IVF/ICSI treatment and 300 women with at least with at least one successful child birth as controls. The polymorphisms were genotyped while the follicular size, the follicle and oocyte numbers were recorded during oocyte retrieval.

Results

The genotype analysis, excluding heterozygotes for each particular polymorphism, revealed eight combined homozygotic FSHR/SHBG/CYP19 genotypes. A gradual reduction in the number of follicles and oocytes from FSHR 307Thr/680Asn allele/long SHBG allele/long CYP19 allele homozygotes to FSHR 307Ala/680Ser allele/short SHBG allele/short CYP19 allele homozygotes was observed (20.36 ± 6.74 vs. 8.05 ± 2.47, p < 0.008 and 13 ± 4.63 vs. 6.1 ± 2.32, p < 0.02, respectively).

Conclusions

FSHR/SHBG/CYP19 combined genotypes are associated with ovarian response to standard gonadotrophin stimulation of women undergoing medically assisted reproduction.