Nomograms of Iranian fetal middle cerebral artery Doppler waveforms and uniformity of their pattern with other populations' nomograms

<p>Abstract</p> <p>Background</p> <p>Doppler flow velocity waveform analysis of fetal vessels is one of the main methods for evaluating fetus health before labor. Doppler waves of middle cerebral artery (MCA) can predict most of the at risk fetuses in high risk pregnancies. In this study, we tried to obtain normal values and their nomograms during pregnancy for Doppler flow velocity indices of MCA in 20 – 40 weeks of normal pregnancies in Iranian population and compare their pattern with other countries' nomograms.</p> <p>Methods</p> <p>During present descriptive cross-sectional study, 1037 normal pregnant women with 20^th–40^thweek gestational age were underwent MCA Doppler study. All cases were studied by gray scale ultrasonography initially and Doppler of MCA afterward. Resistive Index (RI), Pulsative Index (PI), Systolic/Diastolic ratio (S/D ratio), and Peak Systolic Velocity (PSV) values of MCA were determined for all of the subjects.</p> <p>Results</p> <p>Results of present study showed that RI, PI, S/D ratio values of MCA decreased with parabolic pattern and PSV value increased with simple pattern, as gestational age progressed. These changes were statistically significant (P = 0.000 for all of indices) and more characteristic during late weeks of pregnancy.</p> <p>Conclusion</p> <p>Values of RI, PI and S/D ratio indices reduced toward the end of pregnancy, but PSV increased. Despite the trivial difference, nomograms of various Doppler indices in present study have similar pattern with other studies.</p

Germ cell tumors of the ovary

Purpose: Malignant ovarian germ cell tumors (MOGCTS) are rare but curable at all stages of disease. This review gives an outline of the management of this disease. Methods: We performed a literature search in the PubMed of almost all relevant articles concerning MOGCTs on pathology, prognostic factors, surgery, post-operative therapy and late effects of therapy. The available literature is mainly composed of retrospective reviews and articles. Results: Prognostic factors include stage, amount of residual tumor, histologic type and raised tumor markers. For patients with early stage disease, cure rates approach 100%, while for those with advanced-stage disease are at least 75%. Appropriate surgical treatment for patients where fertility needs to be preserved consists in laparotomy with unilateral salpingo-oophorectomy (USO) and resection of all visible disease. For patients with advanced-stage disease, the role and the extent of debulking surgery remain controversial despite its routine use. However, it is suggested a benefit from minimal residual disease at completion of primary surgical cytoreduction with both non-platinum and platinum-based chemotherapy regimens. Second-look surgery clearly is not indicated in patients with early stage non-dysgerminoma or in all patients with dysgerminoma. However, teratoma patients may benefit from secondary cytoreduction. Three courses of bleomycin, etoposide and cisplatin (BEP) is the current standard adjuvant chemotherapy and four courses of BEP are recommended in case of bulky residual tumor after surgery. More evidence is required to show that surveillance is a safe option. There is a hint that high-dose chemotherapy may play a role in relapsed patients. The majority of MOGCTs patients who undergo fertility-sparing surgery and chemotherapy retain their gonadal and reproductive function. There is an increasing concern about life-threatening long-term effects of treatment. Conclusion: MOGCTs are rare neoplasms that affect girls and young women and have excellent prognosis at all stages of disease with optimal therapy. The majority of MOGCTs patients retain their reproductive function. © 2008 Elsevier Ltd. All rights reserved

Congenital adrenal hyperplasia because of 21-Hydroxylase deficiency a genetic disorder of interest to obstetricians and gynecologists

Congenital adrenal hyperplasia (CAH) due to deficiency of the enzyme 21 -hydroxylase (21 -OH), is distinguished in its classical and nonclassical form and is one of the most common autosomal recessive inherited diseases in humans. The classical form appears between 1:5000 and 1:15000 among the live neonates of North America and Europe, whereas the nonclassical form occurs in approximately 0.2% of the general white populations. Three alleles are associated with the 21-OH locus and can be combined in various ways to individuals who are either unaffected, heterozygote carriers, or affected with the classical or nonclassical disease. Variable signs and symptoms of hyperandrogenism are common to both types of the disorder. In women with CAH, hyperandrogenism may be present, extending from virilization of external genitalia and salt-wasting in classical (C)-CAH cases, to menstrual irregularity, obesity, short stature, infertility or subfertility and skin disorders such as hirsutism, in nonclassical (NC)-CAH cases. These clinical characteristics of NC-CAH cases do not differ unmarkedly from those shown in patients with polycystic ovary syndrome, idiopathic hirsutism, or hyperinsulinemia. The significant advances in molecular biology and gene analysis over the past 2 decades have led to the development of novel sensitive methods of DNA analysis and study, including polymerase chain reaction and Southern blot analysis. Thus it has been revealed that the 21 -OH gene (CYP21A2) and its nonfunctional pseudogene (CYP21A1P) are located on chromosome 6 (6p21.3), sharing a high homology of about 98%. Inactivating mutations occur as complete gene deletions, large gene conversions and pseudogene-derived mutations. Copyright © 2009 by Lippincott Williams &amp; Wilkins

Sonographic incidence of polycystic ovaries in a gynecological population

The prevalence of polycystic ovaries in a large population of 1078 women of reproductive age was determined by pelvic ultrasonography. The ovarian ultrasonic appearance of 183 (17%) women met the morphological criteria of polycystic ovaries. Of these women, 147 (80.3%) had irregular cycles (group A) and 36 (19.70%) had normal cycles (group B). The remaining women constituted the control group. Ovarian volume was calculated in all women in whom at least one ovary was visualized. Serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone were measured in 124 women from group A, 25 from group B and 50 controls. Mean ovarian volume was statistically higher in both group A (13.4 ml) and group B (11.8 ml) than in the control group (6.2 ml). Mean LH/FSH ratio and mean testosterone values were statistically higher in group A only (2.1 and 1.1 ng/ml, respectively) compared with the mean values in the control group (0.7 and 0.7 ng/ml, respectively). Obesity and hirsutism were more common in group A than in group B and the controls. Screening the ovaries in women of reproductive age and subsequent assessment of morphology in polycystic ovaries can aid in the diagnosis of this condition in patients who may have a varied clinical presentation. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecolog

Clinical complications after transvaginal oocyte retrieval: A retrospective analysis

There are little systematic data reported in the literature on complications observed after transvaginal oocyte retrieval (OR) guided by ultrasound. We report our experience in 542 in vitro fertilisation cycles. The frequency of severe complications in our patients was 0.72%; of these, two cases were bronchospasm during anaesthesia (0.36%) and two were cases of intraperitoneal bleeding (0.36%); minor vaginal bleeding was the most frequent complication (18.08%), which was treated easily. Through this retrospective analysis, it is evident that clinical suspicion is of particular importance in detecting post-OR complications on one hand, but on the other these complications are rare and most are treated conservatively. © 2013 Informa UK, Ltd

Adenomyoma and leiomyoma: Differential diagnosis with transvaginal sonography

Purpose. The purpose of this study was to evaluate the capability of transvaginal sonography to differentiate adenomyomas from leiomyomas. Methods. Two hundred six patients scheduled for surgery for symptomatic uterine masses underwent preoperative transvaginal sonography. Sonographic findings were compared with pathologic findings. Pathologic findings showed that 111 patients had leiomyomas, 48 had diffuse adenomyosis, 31 had adenomyomas, and 4 had leiomyosarcomas. Results. For the diagnosis of adenomyoma, transvaginal sonography demonstrated a sensitivity of 82.0%, specificity of 88.3%, positive predictive value of 84.6%, and negative predictive value of 87.5% compared with a sensitivity of 95.1%, specificity of 82.0%, positive predictive value of 90.7%, and negative predictive value of 85.7% for the diagnosis of leiomyoma. Two sonographic characteristics, lesion margin (p = 0.0001) and lacunae (p = 0.0001), allowed the differentiation of adenomyoma from leiomyoma. Conclusions. Transvaginal sonography is an effective procedure for the preoperative differentiation of adenomyoma from leiomyoma. If the status of the lesion&apos;s margins and the presence or absence of hypoechoic lacunae were selected for analysis, leiomyomas could be correctly diagnosed with transvaginal sonography in 95% of cases

Artificial intelligence in IVF: A need

Predicting the outcome of in-vitro fertilization (IVF) treatment is an extremely semantic issue in reproductive medicine. Discrepancies in results among reproductive centres still exist making the construction of new systems capable to foresee the desired outcome a necessity. As such, artificial neural networks (ANNs) represent a combination of a learning, self-adapting, and predicting machine. In this review hypothesis paper we summarize the past efforts of the ANNs systems to predict IVF outcomes. This will be considered together with other statistical models, such as the ensemble techniques, Classification And Regression Tree (CART) and regression analysis techniques, discriminant analysis, and case based reasoning systems. We also summarize the various inputs that have been employed as parameters in these studies to predict the IVF outcome. Finally, we report our attempt to construct a new ANN architecture based on the Learning Vector Quantizer promising good generalization: a system filled by a complete data set of our IVF unit, formulated parameters most commonly used in similar studies, trained by a network expert, and evaluated in terms of predictive power. © 2011 Informa Healthcare USA, Inc