Gynecologic and Obstetric Investigation

Wedler, V.; Meuli-Simmen, C.; Guggenheim, M.; Schneller-Gustafsson, M.; Künzi, W.

doi: 10.1159/000076476pmid: 14752211

Between 1995 and 2002, 53 primary sex reassignments in male to female transsexuals were performed at our division. The objective of this procedure is to mimic the female external and part of the internal genitalia both esthetically and functionally. In 11 of the 53 patients, a secondary vaginal lengthening had to be performed due to a short neovagina. This was achieved using a pedicled sigmoid segment, with an open approach in the first 2 patients and using a laparoscopic method in the following 9. This paper focuses on the laparoscopic technique, its benefits and potential complications. Where a primary vaginoplasty, combining inversion of the penile and scrotal skin flaps, yields unsatisfactory functional results, a secondary vaginoplasty using the pedicled sigmoid represents an elegant means to achieve functional improvement. Furthermore, we report a modified surgical approach to the conventional sigmoid transition.

Cetin, Meral; Duran, Bulent; Demirkoprulu, Nihal; Guvenal, Tevfik; Erden, Omur; Cetin, Ali

doi: 10.1159/000076477pmid: 14752212

We investigated the effects of spermine NONOate (SPER/NO), diethylenetriamine NONOate (DETA/NO) and methylene blue for preventing postoperative adhesion in a rat uterine horn model. Before operations, rats were randomly assigned into 6 groups, each composed of 12 rats. These were the sham, control, normal saline, SPER/NO, DETA/NO and methylene blue groups. Each rat was anesthetized with ketamine hydrochloride (40 mg/kg i.v.). The abdominal wall was shaved; the surgical site was scrubbed with povidone iodine and rinsed with sterile saline 3 times before surgery. Under sterile conditions, a 3-cm vertical midline incision was made in all groups. In the sham group, we closed the abdominal wall without any procedure. In the other groups, a 2-cm segment of each uterine horn was injured in 10 spots on the antimesenteric surface using unipolar cautery. Before the final abdominal closure, no adjuvant therapy was administered intraperitoneally to the rats in the control group; 2 ml of normal saline solution, 1% methylene blue solution, SPER/NO (0.5 mg/ml) and DETA/NO (0.1 mg/ml) were instilled into the uterine horns of the rats in the respective groups. The incision was closed with a running 4-0 monofilament delayed absorbable suture in a single layer of muscle and fascia in a running pattern, excluding the peritoneum, and in the covering layer of skin in an interrupted pattern, in all groups. Two weeks after the surgery, all animals were killed, second laparotomies were performed, and the extent and severity of adhesions were determined by a blinded examiner. The adhesion scores of the sham group were significantly lower than those of the other groups (p < 0.05). In the methylene blue, SPER/NO and DETA/NO groups, adhesion scores were significantly lower than in the normal saline and control groups (p < 0.05). However, there were no significant differences related to the extent and severity scores of adhesions between the methylene blue, SPER/NO and DETA/NO groups (p > 0.05). This study showed that SPER/NO, DETA/NO and methylene blue administered at the end of surgery reduced the adhesion formation in a rat uterine horn model.

Kiran, Hakan; Kiran, Gurkan; Ekerbicer, Hasan C.; Kilinc, Metin

doi: 10.1159/000076627pmid: 14770012

The aim of the present study was to evaluate the effects of intranasal estradiol on lipid metabolism and lipoprotein(a) [Lp(a)] levels. A prospective comparative study was designed: 49 hysterectomized, healthy postmenopausal women received intranasal 17β-estradiol (E₂; 300 µg/day). Blood samples were collected at baseline and at the end of the 3 and 6 months of therapy. After 6 months, the serum levels of total cholesterol, LDL-cholesterol and triglycerides did not show any significant change with intranasal 17β-E₂ therapy. HDL-cholesterol levels at 3 and 6 months of treatment were significantly increased compared with baseline levels (p = 0.031, p = 0.000, respectively). There was a significant change in serum Lp(a) levels at the 6th month (p = 0.003) but not at the 3rd month (p = 0.183) compared with the baseline levels. Further studies are needed to detect whether these changes are significant and permanent or not.

Iwaki, Takayuki; Yamamoto, Koji; Matsuura, Toshiki; Sugimura, Motoi; Kobayashi, Takao; Kanayama, Naohiro

doi: 10.1159/000076688pmid: 14963368

Invasion of the trophoblast into the decidua and the myometrium is very important for the establishment of a normal pregnancy. This invasion is regulated by the expression of integrins in the trophoblast. Recently, it has been shown that invasion of the trophoblast is impaired in preeclampsia. We report the effect of hypoxia on the expression of integrins and extracellular matrices at the mRNA level in early placenta and BeWo cells. Tissue RNA levels of fibronectin and integrin α5 were significantly higher in the hypoxic condition than under normoxic conditions. In contrast, tissue RNA levels of integrin α1 were significantly lower for the hypoxic condition than those under normoxic conditions. Alteration of the integrin components and increases in fibronectin expression were observed in early placenta and BeWo cells under hypoxic conditions. These results suggest that hypoxic stress regulates the synthesis of integrin and fibronectin mRNAs in early placenta.

Kaiser, Thomas; Grehan, Madonna; Brennecke, Shaun P.; Moses, Eric K.

doi: 10.1159/000076689pmid: 14963369

The genetic background predisposing pregnant women to the disorder pre-eclampsia/eclampsia (PE/E) is still unknown. There is compelling evidence to suspect involvement of the immune system in the development of PE/E. The aim of this current study was to investigate whether there is an association between the tumor necrosis factor (TNF)-α –307 polymorphism and PE or eclampsia. In this study, 51 cases of eclampsia, 122 cases of PE and 100 normotensive control cases were genotyped for the TNF-α –307 polymorphism. We found a significant difference between the TNF2 allele frequencies of eclamptic and normotensive controls (χ² = 6.3 and p = 0.025), but not of pre-eclamptic and normotensive controls (χ² = 0.5 and p = 1.0). We conclude from this study that the TNF2 allele contributes to the occurrence of eclampsia in our population.

Martin Chaves, E.B.; Brum, I.S.; Stoll, J.; Capp, E.; Corleta, H.v.E.

doi: 10.1159/000076690pmid: 14963370

Uterine leiomyomas are the most common tumors of the genital tract. Growth factors seem to be implicated in the development of leiomyoma. The aim of this study was to determine insulin-like growth factor 1 receptor (IGF-1-R) mRNA levels and IGF-1-R tyrosine kinase activity in normal myometrium and leiomyoma. Plasma membranes of myometrium and leiomyoma of 14 women subjected to hysterectomy were prepared, and samples were incubated in the absence or presence of recombinant human IGF-1 to assess the tyrosine kinase activity (Western blot). Reverse-transcriptase polymerase chain reaction with specific primers for IGF-1-R was used to determine IGF-1-R mRNA levels. IGF-1-R mRNA levels in myometrium (0.8216 ± 0.096) and in leiomyoma (0.7905 ± 0.136) were not statistically significantly different (p = 0.648). The degree of IGF-1-R autophosphorylation stimulated by recombinant IGF-1 was not different in myometrium (1.020 ± 0.120) and leiomyoma (1.620 ± 0.656) either (p = 0.075). There was no difference in IGF-1-R expression and IGF-1-R autophosphorylation between normal myometrium and leiomyoma.

Öner-İyidoğan, Yıldız; Koçak, Hikmet; Gürdöl, Figen; Korkmaz, Düzgün; Buyru, Faruk

doi: 10.1159/000076691pmid: 14970668

This study was designed to determine the activities of superoxide dismutase and glutathione peroxidase and some of the lipid peroxidation indices (malondialdehyde and total sulfhydryl groups) in eutopic and ectopic endometria of patients with endometriosis. Ectopic endometrial tissues (ovarian cysts; n = 22) were obtained laparoscopically during the preovulatory period. Statistical analyses were made using the Wilcoxon signed-rank test. The levels of malondialdehyde and total sulfhydryl groups were similar in the eutopic and ectopic endometria, whereas the superoxide dismutase activity was found to be significantly higher in the latter (1,893 ± 780 vs. 3,512 ± 1,502 U/g protein; p = 0.002). Although the glutathione peroxidase activity was slightly lower in the ectopic than in the eutopic tissues, the difference was not found to be statistically significant. The malondialdehyde levels were positively correlated with the plasma 17β-estradiol concentrations in the ectopic endometria (r = 0.683, p = 0.001). No such correlation was seen in the eutopic tissue. It is suggested that various factors, such as cytokines released by activated macrophages in the peritoneal fluid and 17β-estradiol itself synthesized by the ovaries, may locally affect the oxidant status of ectopic endometria.

Hascalik, Seyma; Celik, Onder; Turkoz, Yusuf; Hascalik, Mehmet; Cigremis, Yılmaz; Mizrak, Bulent; Yologlu, Saim

doi: 10.1159/000076760pmid: 14970669

Objective: The aim of this study is to investigate the effects of resveratrol on histopathological changes, antioxidant status and lipid peroxidation, in torsion-detorsion injury in rat ovaries. Method: To determine whether ischemia followed by reperfusion can induce ovarian oxidative damage, we created a model of adnexal ischemia-reperfusion by using rats. Ischemia was induced by unilateral occlusion of the tubo-ovarian vessels for 3 h. Reperfusion was achieved by releasing the occlusion and restoring the circulation for 3 h. Thirty-two adult female albino rats were divided equally into 4 groups: sham operation, torsion, saline/detorsion and resveratrol/detorsion. Rats in the torsion group were killed after 360° clockwise adnexal torsion for 3 h. Resveratrol was injected intraperitoneally 30 min before detorsion in the resveratrol/detorsion group, and saline was administered in the saline/detorsion group. After 3 h of adnexal detorsion in both of these groups, the rats were killed and adnexa were removed. The tissue levels of malondialdehyde, reduced glutathione and xanthine oxidase activity were measured. Results: Malondialdehyde and xanthine oxidase levels in the saline/detorsion group were increased significantly when compared to the torsion and sham operation groups (p < 0.001). Malondialdehyde levels in the resveratrol group were lower than in the saline/detorsion group, and differences between the two groups were statistically significant (p < 0.001). Xanthine oxidase levels in the resveratrol group were lower than in the saline/detorsion and torsion groups, and differences between these groups were statistically significant (p < 0.001). Reduced glutathione levels in the saline/detorsion group were decreased significantly when compared to the torsion and sham operation groups. Reduced glutathione levels in the resveratrol group were significantly higher than in the saline/detorsion group (p < 0.006). Histological examination showed a significant improvement in ovarian morphology in the resveratrol-treated rats compared with the ischemia and ischemia-reperfusion groups. Conclusion: Our results demonstrated that intraperitoneal resveratrol administration reduced the lipid peroxidation products of ischemic rats and ovarian damage was reduced as indicated by histological examination.

Deb, Kaushik; Chatturvedi, Madan Mohan; Jaiswal, Yogesh Kumar

doi: 10.1159/000076761pmid: 14970670

Alleviation of infertility on the one hand and development of improved methods of contraception on the other are global concerns to woman’s health. The molecular signals that regulate implantation are of clinical relevance since understanding the nature of these signals may lead to strategies to correct implantation failure and to develop novel contraceptive approaches. The other pressing concern is the poor pregnancy rate resulting from in vitro fertilization (IVF). The pregnancy rate in IVF programs remains about 20–30% in spite of the high rate of successful fertilization. This has led to the proposition that additional uterine factors, critical for the implantation process, must be limiting. Identification of such parameters could help in determining the appropriate physiological state of the uterus for embryo transfer. Several factors are known to have a direct or indirect impact on the ability of the uterus to develop to a functionally receptive state. This would disrupt the normal coordination between embryonic and uterine development even though all molecular players may seem otherwise normal.

doi: 10.1159/000078419pmid: N/A