A clinicopathologic study of gynecologic organ involvement at radical cystectomy for bladder cancer

Objective

To report the clinicopathologic analysis of women who underwent radical cystectomy for bladder cancer in Egypt from 1997 to 2005.

Methods

Clinicopathologic data for 250 women who underwent radical cystectomy for bladder cancer at 3 centers in Cairo were retrospectively reviewed from hospital charts and pathology sheet records. Cystectomy specimens were evaluated pathologically for involvement of internal genitalia.

Results

The uterus was not available for histopathologic examination in 11 specimens; 1 ovary was absent from 18 specimens; and both ovaries were absent from 2 specimens. Uterine involvement was observed in 1 case of transitional cell carcinoma. Benign uterine pathology was detected in 25 cases. All patients had normal ovaries, and the vagina was involved in 11 cases. There was urethral involvement in 10% of patients. Of the 50 patients available for follow-up, 11 had 1 ovary preserved and 2 had the uterus plus both ovaries preserved. None of them experienced late ovarian or uterine recurrence.

Conclusion

Involvement of female internal genitalia in bladder cancer is uncommon. Thus, preservation of these organs in young women undergoing radical cystectomy should be considered in selected cases after careful preoperative assessment.     

Insulin resistance, dyslipidemia, and metabolic syndrome in women with polycystic ovary syndrome

Objective

To investigate the association of insulin resistance with dyslipidemia and metabolic syndrome (MBS) in women with polycystic ovary syndrome (PCOS).

Methods

Fasting glucose (G), insulin (I), and lipid levels were measured in 50 infertile women with PCOS. A fasting G/I ratio of 4.5 or less (n = 29) defined insulin resistance (IR).

Results

The mean levels of total cholesterol (P < 0.001), low-density lipoprotein (P = 0.02), and triglycerides (P < 0.001) were significantly higher and the mean levels of high-density lipoprotein were significantly lower (P < 0.001) in the IR group. The prevalence of MBS (P = 0.02) and obesity (P = 0.04), hypertension (P = 0.02), fasting hyperglycemia (P = 0.03), low high-density lipoprotein levels (P = 0.02), and hypertriglyceridemia (P = 0.02) were also significantly higher in the IR group.

Conclusion

Insulin resistance is associated with dyslipidemia and MBS in women with PCOS. Lifestyle modification and insulin-sensitizing agents should be part of the management plan.     

Study of tinea cruris in Egypt

The results of clinical and mycological study of 215 mycologically proved cases of tinea cruris done at Ain Shams University, Cairo are reported. Of these 36 cases are associated with tinea corporis. Four clinical varieties are described. The age and sex incidence are analysed and discussed.
T. rubrum is the most common organism isolated (62.02 %) followed by E. floccosum (25.14 %). The results are discussed and compared with reports from other parts of the world.

Zusammenfassung

Die Ergebnisse der klinischen und mykologischen Untersuchung von 215 mykologisch gesicherten Fällen von Tinea cruris aus der Ain Shams-Universität in Cairo werden mitgeteilt. 36 dieser Fälle hatten zusätzlich eine Tinea corporis. 4 klinische Variationen sind beschrieben. Der Einfluß von Alter und Geschlecht auf die Häufigkeit des Vorkommens wurde analysiert und diskutiert.
Trichophyton rubrum wurde am häufigsten isoliert, nämlich in 111 von 179 Fällen mit Befall der Genitocruralgegend (62,02 %). Am zweithäufigsten wurde Epidermophyton floccosum gefunden: 45 Fälle = 25,14 %. Dann folgte mit 21 Fällen (= 11,73 %) Trichophyton mentagrophytes und schließlich Trichophyton violaceum mit 2 Fällen (= 1,11 %).
Die Befunde wurden mit Berichten aus anderen Teilen der Welt verglichen und diskutiert. Der stärkere Befall der Männer (132 Fälle) gegenüber 47 entsprechend erkrankten Frauen wird durch die anatomischen Unterschiede erklärt.
Auffállig ist, daß nur in 2 Fällen Trichophyton violaceum isoliert wurde, obwohl dieser Pilz in Ägypten als Erreger von Tinea capitis und Tinea corporis häufig vorkommt.     

Clinical and Mycological Study of the Macerated Toe Web in Egypt

448 nicht ausgesuchte ambulante Patienten des Hospitals der Ain Shams-Universität wurden klinisch auf Pilzbefall-der Zehengewebe untersucht. 174 davon waren Männer, 274 waren Frauen. Zeichen von Tinea interdigitalis pedis wiesen 54 (= 31,1%) Männer und 92 (= 33,6 %) Frauen auf.
Aufgrund dieser orientierenden Voruntersuchung wurden nun 304 Fälle mit klinischen Erscheinungen mykologisch untersucht, 89 Männer und 215 Frauen. Das Alter betrug meist zwischen 11 und 50 Jahren, unter 10 Jahren waren nur 3 Personen, über 50 Jahre deren 12.
Das Nativpräparat erwies sich in 112 Fällen als positiv; nicht nur Pilzfäden, sondern auch sicher erkennbare Sproßzellen wurden als "positiv" gewertet.
Kulturell wurden in weitaus überlegener Anzahl Hefen der Gattung Candida gezüchtet, insgesamt 64,4 %, nur eine verhältnismäßig geringe Anzahl von Dermatophyten, nämlich 4,6 %, und 10, 5 % Schimmelpilze.
Die Differenzierung der Pilze ergab: 164 C. albicans, 4 C. tropicalis, 2 C. stellatoidea, 2 C. catenulata, 24 nicht identifizierte Candida-Hefen; 12 Trichophyton rubrum und 2 T. mentagrophytes.
Die besondere Rolle von C. albicans, die nicht zur normalen, sondern zur pathogenen Hautflora gehört, wird diskutiert. Die enttäuschenden Ergebnisse der Grieofulvinbehandlung bei Hefebefall werden hervorgehoben. Die Behandlung mit Candida-wirksamen Medikamenten ist erforderlich.     

Circulating ghrelin levels and the polycystic ovary syndrome: correlation with the clinical, hormonal and metabolic features

Objectives

Dysregulation of ghrelin levels may lead to physiological problems including obesity and polycystic ovary syndrome (PCOS). The aim of the study was to compare ghrelin levels in women with and without PCOS.

Study design

Serum ghrelin levels (pre- and post-prandial) were compared between 30 Saudi women suffering from PCOS and 30 healthy controls. The relationship between circulating ghrelin levels and other hormones was investigated. Anthropometric measurements were made for all subjects. Biochemical and hormonal investigations included plasma glucose, insulin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), 17β-estradiol (E2), progesterone, testosterone and sex hormone binding globulin (SHGB), and serum ghrelin levels. The data were statistically analyzed using independent T-test and ANOVA. Correlation studies were performed between ghrelin levels and other variables.

Results

No differences were observed in the levels of ghrelin during fasting and the postprandial period in the PCOS (p = 0.487) and control groups (p = 0.378). A significant inverse correlation was observed in ghrelin levels (fasting and postprandial) levels and BMI (PCOS: r = −0.529; p = 0.009, controls: r = −0.670; p = 0.005); PCOS: r = −0.421; p = 0.007, controls: r = −0.491; p = 0.004 respectively). No correlations between ghrelin levels and other parameters were observed.

Conclusion

The findings of the study suggest that circulating plasma ghrelin levels were found to be normal and were inversely related to BMI in women with PCOS. No relationship between circulating ghrelin levels and the abnormal hormonal pattern of the PCOS were observed.     

The value of fallopian tube sperm perfusion in the management of mild-moderate male factor infertility

ObjectiveTo investigate whether fallopian tube sperm perfusion (FSP) would improve pregnancy rates compared with standard intrauterine insemination (IUI) in cases of male factor infertility.MethodsIn a randomized controlled trial at a university teaching hospital in Egypt, 120 couples with mild or moderate male factor infertility underwent a mild controlled ovarian stimulation protocol (clomiphene citrate plus human menopausal gonadotropin). Women were randomly allocated to group 1 (FSP via Foley catheter with 4 mL of inseminate) or group 2 (standard IUI with 0.5 mL of inseminate) (n = 60 for both). The main outcome measure was clinical pregnancy rate.ResultsThere were no significant differences between the groups in terms of baseline clinical characteristics, semen parameters, or characteristics of stimulation cycles. The pregnancy rate was significantly higher in group 1 than in group 2 (16 [26.7%] vs 7 [11.7%]; P < 0.04). There was no significant difference in the incidence of multiple pregnancy, abortion, or ectopic pregnancy between the groups.ConclusionFallopian tube sperm perfusion is an effective technique in the management of mild–moderate male factor infertility and should, therefore, be considered before resorting to more sophisticated techniques of assisted reproduction.     

Anti-Müllerian hormone in polycystic ovary syndrome and normo-ovulatory women: Correlation with clinical,hormonal and ultrasonographic parameters

BackgroundAlthough the ultimate pathogenesis of polycystic ovary syndrome (PCOS) remains obscure, the distinctive feature is failure of follicular maturation resulting in anovulation and accumulation of preantral and small antral follicles which contribute significantly to the production of anti-Müllerian hormone (AMH).ObjectivesTo compare serum AMH levels between PCOS and normo-ovulatory women; and to investigate whether AMH correlates to clinical, hormonal and ultrasonographic parameters in both groups.DesignComparative observational cross-sectional study.SettingDepartment of Obstetrics and Gynecology, Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University.SubjectsThirty-five women with PCOS according to the Rotterdam consensus; and 35 normo-ovulatory-matched controls with male, tubal or unexplained infertility.MethodsSerum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, androstenedione, estradiol, fasting insulin and AMH were measured in the early follicular phase (day 3–4) of natural cycle or progestin-induced withdrawal bleeding (in PCOS); together with transvaginal sonography for detection of the number of small follicles (<10mm) and calculation of ovarian volume.Main outcome measuresCorrelation between AMH and clinical, hormonal and ultrasonographic parameters in both groups.ResultsAMH was significantly higher in the PCOS group. In the whole group of patients and in each group separately, AMH was positively correlated to LH, LH/FSH, number of follicles <10mm and ovarian volume; and negatively correlated to FSH. No correlation was found between AMH and age, BMI, estradiol or fasting insulin. Testosterone and androstenedione were positively correlated to AMH in the PCOS group exclusively (r=0.557; P=0.001 and r=0.451; P=0.007, respectively). Multiple regression analysis demonstrated that testosterone was the only determinant for AMH level (r=0.485; P<0.001).ConclusionsHyperandrogenism is associated with increased AMH secretion in PCOS patients, possibly due to increased number of small antral follicles. Assessment of AMH levels before and after the treatment of hyperandrogenism should be recommended in the plan of management of PCOS.     

Doppler study of uterine hemodynamics in women with unexplained infertility

Objective

To evaluate uterine artery blood flow using pulsed Doppler, and endometrial and subendometrial microvascularization using three-dimensional (3D) power Doppler, in women with unexplained infertility.

Study design

In a prospective clinical trial at a university teaching hospital, 40 women with unexplained infertility were compared to 40 fertile parous controls. In the mid-luteal (peri-implantation) phase, the endometrial thickness and volume, uterine artery pulsatility index (PI) and resistance index (RI), endometrial and subendometrial 3D power Doppler vascularization index (VI), flow index (FI), and vascularization flow index (VFI), and serum estradiol and progesterone levels were measured in both groups.

Results

The uterine artery PI (P = 0.003) and RI (P = 0.007) were significantly increased and the endometrial VI (P = 0.029), FI (P = 0.031), and VFI (P = 0.001) and subendometrial VI (P = 0.032), FI (P = 0.040), and VFI (P = 0.005) were significantly decreased in the unexplained infertility group. The endometrial thickness and volume and serum estradiol and progesterone levels, however, were not significantly different between the two groups.

Conclusion

Peri-implantation endometrial perfusion is impaired in women with unexplained infertility: Doppler study of uterine hemodynamics should therefore be considered in infertility work-up.