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GNRH-agonist induced ovarian cysts aspiration: their impact on controlled ovarian hyperstimulation and pregnancy outcome
102 endometritis, therapy.
WEDNESDAY,
in which Ax+Sb proved clinically effective as empirical
P3.09.04 BUSCHKE-LOWENSTEIN TUMOR OF THE VULVA: HOW WE CAN DO DIFFERENTIAL DIAGNOSIS WITH CONDYLOMA ACUMINATUM N.S. Carvalho, C.A. Maestri, E. Schunemann, R.P.G. Xavier, A. Bini. Dept OBIGYN, Clinic Hospital, Federal University of Parana, Parana; Brazil Giant condyloma acuminatum or Busche-Lowenstein tumor of the vulva and perinal regions is a uncommon entity that has not been extensively studied. Sometimes the appearance of common condyloma acuminatum with large size shown any doubts about the correct diagnosis. In this short communication, we discuss the clinical features, the histological criteria for diagnosis and methods of treatment available about this rare vulvar and perennial regions tumor. To illustrate the theme we show our experience with five cases about it.
P3.09.05 CHARACTERISTICS OF NEUTROPHlL SUPEROXIDE GENERATION IN HUMAN FETUSES H. K. Tsukimori, K. Hata, H. Nakano, Dept. OBIGYN, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JAPAN Objectives: To investigate the defensive sysytem against bacterial infections in human fetuses, we studied neutrophil superoxide generation in fetuses and adults. Study Methods: After an appropriate informed consent, neutrophils were obtained from cord blood of neonates immediately after transvaginal delivery, which consisted of two groups: group I, 11 neonates (22 to 36 weeks’ gestation) and group II, 10 neonates (37 to 41). Ten healthy adults served as controls (group III). A SOD-inhibitable MCLA chemiluminescence assay was used to evaluate 0,~ production activity of neutrophils stimulated by PMA and fMLP. The [3H]fMLP binding assay was performed according to the modified method of O’Flaherty et al. as previously described. Statistical analysis was performed using one-way ANOVA and Bonferroni test. Results: For PMA-stimulated 0; production activity of neutrophils, both group I (1.42~0.18_10’cpm; mean&EM) and II (1.64*0.15_10’) were significantly lower than group III (2.37_10’~0.22_10’) (p
P3.09.06 DISTURBANCES OF INTERFERONAL STATUS AND ITS CORRECTION BY VIFERON IN PATIENTS WITH ACUTE TUBEOVARIAN INFLAMMATORY DISEASES A.N. V.V. Malinovskaya, J.A. Kagramanova, Dept. OBIGYN, Moscow Medical Academy, Moscow, Russia. Objectives: The aim of the study was to investigate the disturbances of interferonal status and to improve complex treatment of tube-ovarian inflammatory by viferon, which include human a2 interferon recombinantly and antioxidants. Study Methods: 50 women were included in the study of interferonal status in the blood serum. Results: 96% of the patients had deep decrease of interferonal status (aand y- interferon on 70%) after antibioticans only. After
SEPTEMBER
immunocorrection therapy by viferon rectal suppositorians, the parameters of the interferonal status has achieved normal meanings. Conclusions: Complex antibacterial treatment of acute tube-ovarian inflammations in combination with viferon 500000 IU was found to have a significant effect in 94% of patients.
P3.09.07 GNRH-AGONIST INDUCED OVARIAN CYSTS ASPIRATION: THEIR IMPACT ON CONTROLLED OVARIAN HYPERSTIMULATION AND PREGNANCY OUTCOME W. El Deeb, S. Farid, H. Assem, S. El Sahwi, International Fertility Center (IFC) Lauran, Alexandria, Egypt. Objective: To evaluate the impact of GnRH-a induced ovarian cysts aspiration on controlled ovarian hyperstimulation (COH) and pregnancy outcome. Study Methods: The design was a retrospective study. Patients and intervention: Eighteen patients form our IVF & ICSI program with who administration of GnRH-a failed to induce pituitary desensitisation as evidenced by both the presence of an ovarian cyst, and prolonged high oestrogen (E2) level. All patients underwent 23 cycles and had a baseline transvaginal sonographic evaluation prior to GnRH-a administration (Superfact, Hoechst, Frankfurt, Germany) 0.3 ml two times daily S.C. starting from the second day of the menstrual cycle as a follicular phase long protocol. DlO, inappropriate pituitary desensitization was considered if we have an ovarian cyst and prolonged hyperestrogenaemia. Dll we had 16 cycles in which transvaginal ultrasonographic guided cyst aspiration (TSVA) was performed, the rest of the cycles (7cycles) we had either very small cyst to be aspirated or persistent hyperestrogenaemia without cyst formation. D14 the patients were re-evaluated by ultrasonography and serum E2 concentration, HMG was stared when serum E2 was below 50pgiml and routine follow-up of the patients until HCG administration. Main outcome measures: Ovarian responsiveness to subsequent COH and pregnancy outcome. Results: Out of the 23 cycles, 13 trials were completed (all had TSVA). Nine were cancelled due to ovarian irresponsiveness to COH and in one cycle a single injured oocyte was retrieved. We had four pregnancies and the pregnancy rate per transfer was 30% and 17% per cycle. This compares favorably with our concurrent pregnancy rate in the center. Conclusion: Aspiration of GnR-H-a induced ovarian cysts do not appear to interfere with COH and outcome.
P3.09.08 PREVENTION OF VERTICAL HIV TRANSMISSION C. 0. Parada, M. Martinez, B.Chomski, R. Voita, R.H. Winograd, Dept. OB, Argenich Hospital, Buenos Aires, Argentina. Objectives: We sought to determine the decrease of perinatal transmission in pregnant women who are seropositive for the human immunodeficiency virus (HIV) that had been treated with antiretroviral drugs. Study Methods: We examined 85 newborns of mothers seropositive (HIV). During the period from 1995 to 1999 treated with the protocol 0.76 and other drugs. We evaluated several factors: 1. Condition clinical maternal 2. Antiretroviral drugs during the pregnancy; two or more drugs. 3. Rupture of the membranes 4. Delivery or cesarean section. Results: In the last 2 years (1998.1999), the 53 to 70% of the pregnant women (HIV) positive had in plasma HIV 1 RNA less than 5,000 copies/ml, and CD4 T cell count more than 200. During the period 1998.1999, the 42% of pregnant women HIV positive were treated with AZT associated to one or two drugs during the pregnancy. There was no difference respect the rupture of the membranes occurred less than 4 hours prior to delivery; we have 91% of patients in these conditions. Cesarean section was increased from 25% to 47% during 1999. Was significant the reduction of vertical transmission during the period (1998.1999), to the 6% incidence respect the period (1995.1997) in our maternity.
6
WEDNESDAY,
in which Ax+Sb proved clinically effective as empirical
P3.09.04 BUSCHKE-LOWENSTEIN TUMOR OF THE VULVA: HOW WE CAN DO DIFFERENTIAL DIAGNOSIS WITH CONDYLOMA ACUMINATUM N.S. Carvalho, C.A. Maestri, E. Schunemann, R.P.G. Xavier, A. Bini. Dept OBIGYN, Clinic Hospital, Federal University of Parana, Parana; Brazil Giant condyloma acuminatum or Busche-Lowenstein tumor of the vulva and perinal regions is a uncommon entity that has not been extensively studied. Sometimes the appearance of common condyloma acuminatum with large size shown any doubts about the correct diagnosis. In this short communication, we discuss the clinical features, the histological criteria for diagnosis and methods of treatment available about this rare vulvar and perennial regions tumor. To illustrate the theme we show our experience with five cases about it.
P3.09.05 CHARACTERISTICS OF NEUTROPHlL SUPEROXIDE GENERATION IN HUMAN FETUSES H. K. Tsukimori, K. Hata, H. Nakano, Dept. OBIGYN, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JAPAN Objectives: To investigate the defensive sysytem against bacterial infections in human fetuses, we studied neutrophil superoxide generation in fetuses and adults. Study Methods: After an appropriate informed consent, neutrophils were obtained from cord blood of neonates immediately after transvaginal delivery, which consisted of two groups: group I, 11 neonates (22 to 36 weeks’ gestation) and group II, 10 neonates (37 to 41). Ten healthy adults served as controls (group III). A SOD-inhibitable MCLA chemiluminescence assay was used to evaluate 0,~ production activity of neutrophils stimulated by PMA and fMLP. The [3H]fMLP binding assay was performed according to the modified method of O’Flaherty et al. as previously described. Statistical analysis was performed using one-way ANOVA and Bonferroni test. Results: For PMA-stimulated 0; production activity of neutrophils, both group I (1.42~0.18_10’cpm; mean&EM) and II (1.64*0.15_10’) were significantly lower than group III (2.37_10’~0.22_10’) (p
P3.09.06 DISTURBANCES OF INTERFERONAL STATUS AND ITS CORRECTION BY VIFERON IN PATIENTS WITH ACUTE TUBEOVARIAN INFLAMMATORY DISEASES A.N. V.V. Malinovskaya, J.A. Kagramanova, Dept. OBIGYN, Moscow Medical Academy, Moscow, Russia. Objectives: The aim of the study was to investigate the disturbances of interferonal status and to improve complex treatment of tube-ovarian inflammatory by viferon, which include human a2 interferon recombinantly and antioxidants. Study Methods: 50 women were included in the study of interferonal status in the blood serum. Results: 96% of the patients had deep decrease of interferonal status (aand y- interferon on 70%) after antibioticans only. After
SEPTEMBER
immunocorrection therapy by viferon rectal suppositorians, the parameters of the interferonal status has achieved normal meanings. Conclusions: Complex antibacterial treatment of acute tube-ovarian inflammations in combination with viferon 500000 IU was found to have a significant effect in 94% of patients.
P3.09.07 GNRH-AGONIST INDUCED OVARIAN CYSTS ASPIRATION: THEIR IMPACT ON CONTROLLED OVARIAN HYPERSTIMULATION AND PREGNANCY OUTCOME W. El Deeb, S. Farid, H. Assem, S. El Sahwi, International Fertility Center (IFC) Lauran, Alexandria, Egypt. Objective: To evaluate the impact of GnRH-a induced ovarian cysts aspiration on controlled ovarian hyperstimulation (COH) and pregnancy outcome. Study Methods: The design was a retrospective study. Patients and intervention: Eighteen patients form our IVF & ICSI program with who administration of GnRH-a failed to induce pituitary desensitisation as evidenced by both the presence of an ovarian cyst, and prolonged high oestrogen (E2) level. All patients underwent 23 cycles and had a baseline transvaginal sonographic evaluation prior to GnRH-a administration (Superfact, Hoechst, Frankfurt, Germany) 0.3 ml two times daily S.C. starting from the second day of the menstrual cycle as a follicular phase long protocol. DlO, inappropriate pituitary desensitization was considered if we have an ovarian cyst and prolonged hyperestrogenaemia. Dll we had 16 cycles in which transvaginal ultrasonographic guided cyst aspiration (TSVA) was performed, the rest of the cycles (7cycles) we had either very small cyst to be aspirated or persistent hyperestrogenaemia without cyst formation. D14 the patients were re-evaluated by ultrasonography and serum E2 concentration, HMG was stared when serum E2 was below 50pgiml and routine follow-up of the patients until HCG administration. Main outcome measures: Ovarian responsiveness to subsequent COH and pregnancy outcome. Results: Out of the 23 cycles, 13 trials were completed (all had TSVA). Nine were cancelled due to ovarian irresponsiveness to COH and in one cycle a single injured oocyte was retrieved. We had four pregnancies and the pregnancy rate per transfer was 30% and 17% per cycle. This compares favorably with our concurrent pregnancy rate in the center. Conclusion: Aspiration of GnR-H-a induced ovarian cysts do not appear to interfere with COH and outcome.
P3.09.08 PREVENTION OF VERTICAL HIV TRANSMISSION C. 0. Parada, M. Martinez, B.Chomski, R. Voita, R.H. Winograd, Dept. OB, Argenich Hospital, Buenos Aires, Argentina. Objectives: We sought to determine the decrease of perinatal transmission in pregnant women who are seropositive for the human immunodeficiency virus (HIV) that had been treated with antiretroviral drugs. Study Methods: We examined 85 newborns of mothers seropositive (HIV). During the period from 1995 to 1999 treated with the protocol 0.76 and other drugs. We evaluated several factors: 1. Condition clinical maternal 2. Antiretroviral drugs during the pregnancy; two or more drugs. 3. Rupture of the membranes 4. Delivery or cesarean section. Results: In the last 2 years (1998.1999), the 53 to 70% of the pregnant women (HIV) positive had in plasma HIV 1 RNA less than 5,000 copies/ml, and CD4 T cell count more than 200. During the period 1998.1999, the 42% of pregnant women HIV positive were treated with AZT associated to one or two drugs during the pregnancy. There was no difference respect the rupture of the membranes occurred less than 4 hours prior to delivery; we have 91% of patients in these conditions. Cesarean section was increased from 25% to 47% during 1999. Was significant the reduction of vertical transmission during the period (1998.1999), to the 6% incidence respect the period (1995.1997) in our maternity.
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