Case Report Mayer-Rokitansky-Kuster-Hauser Syndrome Associated with Severe Inferior Vena Cava Stenosis

Precis. The postoperative course of a neovagina creation procedure in a young woman with Meyer-Rokitansky-Kuster-Hauser syndrome was complicated, despite prophylaxis, by extensive pelvic deep venous thrombosis secondary to unsuspected severe inferior vena cava stenosis. Background. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by congenital vaginal agenesis and an absent or rudimentary uterus in genotypical females. Malformations of the inferior vena cava (IVC) are not commonly associated with MRKH syndrome. We report a case of a patient with MRKH syndrome with severe IVC stenosis that was diagnosed when the patient presented with extensive pelvic deep venous thrombosis (DVT) during the postoperative course of a neovagina creation. Case. A 19-year-old female underwent a McIndoe procedure. Despite DVT prophylaxis, extensive pelvic DVT of the femoral vein was diagnosed on postoperative day 7. Therapeutic anticoagulation was initiated, and pharmacological and mechanical thrombolysis were performed. During these procedures, a hypoplastic IVC was noted. Conclusion. MRKH syndrome can be associated with IVC malformations, which constitute an anatomical risk factor for postoperative DVT

Stimuli from Pups of Adrenalectomized and Malnourished Female Rats

The present study was designed to examine the effects of maternal adrenalectomy on pup cues. In Experiment 1, pituitary-adrenal activity of test mothers was differentially affected by cues from handled and shocked pups of adrenalectomized (ADX) and control (CON) mothers. The results suggest that the cues provided by pups of ADX mothers are less arousing to lactating females than are cues from pups of CON mothers. In Experiment 2, ultrasonic vocalizations in response to handling and shock were measured in pups of CON, ADX and malnourished (MAL) mothers. For all types of pups, shocking evoked more signaling than did handling on postnatal Days 8, 9 and 11. Pups of CON mothers showed a peak of vocalizations on Day 4. Pups of ADX and MAL mothers vocalized as frequently as did pups of CON mothers, but did not reach their peak of signaling until Day 11. This experiment demonstrates a retardation in the development of ultrasonic signaling in pups of ADX mothers. This effect appears to be due to the pup malnutrition that maternal adrenalectomy produces because pups of MAL mothers show a similar retardation

The impact of luteal phase support on gene expression of extracellular matrix protein and adhesion molecules in the human endometrium during the window of implantation following controlled ovarian stimulation with a GnRH antagonist protocol

Objective: To evaluate the impact of two different luteal phase support protocols on gene expression of extracellular matrix (ECM) proteins and adhesion molecules in the human endometrium. Design: Eighty-four ECM protein and adhesion molecule genes were analyzed using array-based reverse-transcription polymerase chain reaction. Setting: Academic hospital. Patient(s): Nine oocyte donors. Intervention(s): Endometrial biopsies were obtained on the day of oocyte retrieval (group I) and 3-5 days later (group II) after randomization into 3 groups. Group IIa had no luteal phase support, group IIb had luteal support with micronized progesterone, and group IIc had luteal support with progesterone plus 17 beta-estradiol. Main Outcome Measure(s): Gene expression profiles in relation to different types of luteal phase support protocols. Result(s): Compared with the day of retrieval (group I), 24 genes were significantly up-regulated (4 in group IIa, 14 in group IIb, 22 in group IIc) and 14 genes were down-regulated (5 in group IIa, 2 in group IIb, 10 in group IIc) on day 3-5 (P < .05). In the luteal support group, up-regulation occurred predominantly in genes encoding for matrix metallopeptidases (MMP10, MMP3, MMP9), integrins (ITGA3, ITGA5, ITGB3, ITGB4), and laminin (LAMB3). In contrast, the most significant suppression was documented in genes encoding for catenin-D2, collagen-11A1, and the laminins (LAMA1 and LAMA3). Significant changes between groups IIb and IIc were also observed in 9 genes. Conclusion(s): Luteal phase support following controlled ovarian stimulation has a profound impact on the ECM pathway targeted genes. (Fertil Steril (R) 2010;94:2264-71. (C) 2010 by American Society for Reproductive Medicine.

Stimuli from Pups of Adrenalectomized and Malnourished Female Rats

The present study was designed to examine the effects of maternal adrenalectomy on pup cues. In Experiment 1, pituitary-adrenal activity of test mothers was differentially affected by cues from handled and shocked pups of adrenalectomized (ADX) and control (CON) mothers. The results suggest that the cues provided by pups of ADX mothers are less arousing to lactating females than are cues from pups of CON mothers. In Experiment 2, ultrasonic vocalizations in response to handling and shock were measured in pups of CON, ADX and malnourished (MAL) mothers. For all types of pups, shocking evoked more signaling than did handling on postnatal Days 8, 9 and 11. Pups of CON mothers showed a peak of vocalizations on Day 4. Pups of ADX and MAL mothers vocalized as frequently as did pups of CON mothers, but did not reach their peak of signaling until Day 11. This experiment demonstrates a retardation in the development of ultrasonic signaling in pups of ADX mothers. This effect appears to be due to the pup malnutrition that maternal adrenalectomy produces because pups of MAL mothers show a similar retardation

Breakage of suture material leading to fascial dehiscence

Background: Fascial dehiscence is a feared complication associated with abdominal surgery. This case evaluates a case of dehiscence caused by breakage of the fascial stitch. Case: A 60-year-old woman (G2P1011) underwent abdominal myomectomy. During the closure of the fascia, a single knot within the segment of suture was noted. The knot was then loosened and untied. Thirty hours later, fascial dehiscence was noted secondary to breakage of the suture material at approximately the area where the knot had been noted earlier in the suture. The fascia was closed again and the patient had an unremarkable postoperative course. We could not find a mention in the package insert or the medical literature regarding how a knot could undermine the suture strength. We obtained a new suture and tied a single knot, which was then loosened. The suture was photographed and compared to a control. Conclusions: There is no way to necessarily attribute the compromise in the suture to this event. However, this case report warrants further research to better define all events that could compromise the integrity of suture material