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Nec Ebryogenesis | Πρότυπο Μαιευτικό - Γυναικολογικό Ιατρείο
Dr. Νεκτάριος Ε. Χαλβατζάς M.D., Ph.D. Λάρισα

Εξειδίκευση στην Λαπαροσκόπηση & στην Εξωσωματική γονιμοποίηση
 
 Laparoscopic para-aortic and pelvic lymphadenectomy and radical hysterectomy in a patient with cervical cancer, six months after primary chemoradiation.

Treatment of Stage IB-IIA cervical carcinoma is controversial. The choice to perform surgery or chemoradiation depends on the FIGO Stage, which does not include evaluation of lymph node involvement, although the prognosis of the patients depends on this evaluation. There is no method however, to safely evaluate preoperative lymph nodes metastasis, as both magnetic resonance imaging (MRI) and computed tomography (CT) have poor sensitivity and high specificity. As a result, inaccurate preoperative lymph node assessment can lead to suboptimal treatment. The authors report the case of a 42-year-old patient with cervical cancer Stage IB2, who was primary treated with chemoradiation. Although at the time of diagnosis no lymph node metastasis was detected, six months after treatment, an enlarged five-cm lymph node was found in the area of left iliac vein. The patient underwent laparoscopic pelvic and para-aortic lymphadenectomy and nerve sparing radical hysterectomy. Pathologic examination revealed one positive lymph node out of the 41 removed and no cancer cells in the uteral structures. There are cases of cervical cancer in which chemoradiation seems to be insufficient. Laparoscopic nerve-sparing radical hysterectomy can be the treatment in patients with lymph node metastasis after primary chemoradiation. It offers oncological safety combining the advantages of laparoscopy and the nerve-sparing technique. Furthermore, adjuvant chemotherapy or radiation can be initiated immediately, offering the best therapeutical choice in the authors' opinion.

 Metformin reduces the expression of corticotropin-releasing hormone and urocortin in the endometrium of healthy women.
OBJECTIVE:
To investigate the effect of metformin administration on the expression of endometrial corticotrophin-releasing hormone (CRH) and urocortin (UCN) in the midluteal phase of the cycle.

DESIGN:
Experimental study, performed in 2010-2011.

SETTING:
University hospital.

PATIENT(S):
Eight healthy, normally cycling and parous women volunteered for the study.

INTERVENTION(S):
All women were investigated in two nonconsecutive cycles (control cycle, untreated and after one cycle break; trial cycle, oral administration of metformin [850 mg × 2]). Endometrial pipelle biopsies were obtained on day LH+7.

MAIN OUTCOME MEASURE(S):
The endometrial biopsies were immunohistochemically assessed for CRH and UCN expression. Evaluation of positivity was performed by applying the immunoreactive score.

RESULT(S):
Compared with samples from control cycles, CRH and UCN were significantly reduced in endometrial samples obtained during metformin treatment. This down-regulation was significant both in the endometrial cells and in the endometrial stroma.

CONCLUSION(S):
This is the first study showing that during the midluteal phase of the cycle, metformin may decrease the production of CRH and UCN in the endometrium. Metformin interference to decidualization could happen by CRH/UCN modification.

Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
 Laparoscopic myomectomy of a giant myoma

We present the case of an infertile woman with a giant myoma which was laparoscopically removed. A 34-year-old patient was referred to our department with a large abdominal mass. Ultrasound revealed an 18 cm uterine myoma. Diagnostic laparoscopy showed a giant uterine myoma and with the help of a bent angle camera we started myoma enucleation. The myoma was totally enucleated and removed without disturbing the endometrial cavity. The uterine defect was closed with an absorbable suture in two layers. The myoma was removed using a PK (Gyrus) morcelator, without tissue or blood spillage in the abdomen. The operation time was 165 minutes and the myoma's weight was 1,200 g. The patient recovered uneventfully. Laparoscopic myomectomy can be an option even for giant myomas, with the condition of an expert surgeon and appropriate surgical instruments.

 Laparoendoscopic single-site surgery (LESS) - is it feasible in gynecological surgery?
Increases in technical expertise in gynecological surgery and advances in surgical instrumentation have led to the development of laparoendoscopic single-site surgery (LESS). Between March and September 2009, 24 patients underwent adnexal surgery at our institution with laparoendoscopic single-site surgery. The LESS technique was performed using the TriPort through an umbilical incision of 10 mm and bent laparoscopic instruments. We furthermore compared the LESS technique with a control group of 24 patients operated consecutively in the same period and for the same procedures with conventional multiport laparoscopy. Comparing the two techniques we found differences between the operation time and mean hospital stay. The surgeon must master the use of novel bent instruments in close proximity to each another. The LESS technique for benign adnexal surgery is technically feasible and safe, representing a reproducible alternative to conventional multiport laparoscopy.

© 2010 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2010 Nordic Federation of Societies of Obstetrics and Gynecology.
 Laparoscopic-assisted vaginal hysterectomy with and without laparoscopic transsection of the uterine artery: an analysis of 1,255 cases.
INTRODUCTION:
To evaluate the operative outcomes of patients managed by laparoscopic-assisted vaginal hysterectomy (LAVH) with and without laparoscopic transsection of the uterine artery for benign gynaecologic diseases.

PATIENTS AND METHODS:
A retrospective analysis of 1,255 women from two different centers undergoing hysterectomy between 1998 and 2009 with benign indications is presented. 856 patients were treated by LAVH type I (vaginal transsection of the uterine artery) and 399 patients by LAVH type II (laparoscopic transsection of the uterine artery). Operative outcomes, intraoperative and postoperative complications, as well as laparoconversion rates were the main objectives of the study.

RESULTS:
Median operative time was similar between LAVH type I and II (136 vs. 126 min, respectively, P = NS). Intraoperative complication rate was not significantly different between the two groups of the study (LAVH type I: 1.5% vs. LAVH type II: 1.26%, respectively, P = NS). The injury of the urinary tract, especially of the bladder, was the most common intraoperative complication for both the groups of the study. Laparoconversion rate was similar in LAVH type I and II (0.5 vs. 0.35%, respectively, P = NS), while postoperative complications were significantly higher in LAVH type I (2.25%) compared to LAVH type II (1.16%), mainly because of postoperative vaginal and intrabdominal haemorrhage in the group of the LAVH type I.

CONCLUSION:
LAVH with laparoscopic transsection of the uterine artery is an effective and safe technique with less postoperative complication compared to LAVH with vaginal transsection of the uterine vessels.
 Laparoscopic nerve-sparing radical hysterectomy: description of the technique and patients' outcome.
OBJECTIVE:
The radical hysterectomy type three can be accompanied by postoperative morbidity, such as dysfunction of the lower urinary tract with loss of bladder or rectum sensation. We describe the technique of laparoscopic nerve-sparing radical hysterectomy and patient's outcome.

METHODS:
Thirty-two patients underwent laparoscopic nerve-sparing radical hysterectomy with pelvic lymphadenectomy. Both the hypogastric and the splanchnic nerves were identified bilaterally during pelvic lymphadenectomy.

RESULTS:
The median age of the patients was 52 years, and the average operating time was 221 min. There were no intraoperative or postoperative complications considering the nerve-spring radical hysterectomy. Postoperatively, in all patients spontaneous voiding was possible on the third postoperative day with a median residual urine volume of <50 ml.

CONCLUSIONS:
Laparoscopic identification (neurolysis) of the inferior hypogastric nerve and inferior hypogastric plexus is a feasible procedure for trained laparoscopic surgeons who have a good knowledge not only of the retroperitoneal anatomy but also of the pelvic neuro-anatomy as this qualification could prohibit long-term bladder and voiding dysfunction during nerve-sparing radical hysterectomy.

Copyright © 2010 Elsevier Inc. All rights reserved.
 Laparoscopic nerve-sparing surgery of deep infiltrating endometriosis: description of the technique and patients' outcome.
INTRODUCTION:
The radical surgery of the deep infiltrating endometriosis of the rectovaginal septum and the uterosacral ligaments with or without bowel resection can cause a serious damage of the pelvic autonomic nerves with urinary retention and the need of self-catheterization.
 
PATIENTS AND METHODS:
We introduce a case series report of 16 patients with laparoscopic nerve-sparing surgery of deep infiltrating endometriosis. We describe the technique step by step and compare the patients' outcome with patients who had undergone a non-nerve-sparing surgical technique. In 12 patients, a double-sided and in four patients, a single-sided identification of the inferior hypogastric nerve and plexus were performed.

RESULTS:
In all patients at least single-sided resection of the uterosacral ligaments were performed. Postoperatively dysmenorrhoea, pelvic pain, and dyspareunia disappeared in all patients. The average operating time was 82 min (range 45-185). Postoperatively, the overall time to resume voiding function was 2 days. The residual urine volume was in all patients <50 ml at two ultrasound measurements.

DISCUSSION:
Identification of the inferior hypogastric nerve and plexus was feasible. In comparison with non-nerve-sparing surgical technique, no cases of bladder self-catheterization for a long or even life time was observed, confirming the importance of the nerve-sparing surgical procedure.
 Prognostic value of follicular fluid 25-OH vitamin D and glucose levels in the IVF outcome.
OBJECTIVES:
The aim of the present study was to measure serum and follicular fluid 25-OH vitamin D and glucose levels in women who underwent IVF-ET treatment and to further investigate whether the circulating 25-OH vitamin D and glucose levels correlate with IVF success.

METHODS:
This prospective observational study included 101 consecutive women who underwent 101 IVF-ICSI ovarian stimulation cycles and were allocated to one of the three groups according to their follicular fluid 25-OH vitamin D concentrations. Group A (n = 31) with less than 20 ng/ml, group B (n = 49) with vitamin levels between 20.1 and 30 ng/ml and group C (n = 21) with more than 30 ng/ml vitamin concentration.

RESULTS:
Follicular fluid vitamin levels significantly correlated with the quality of embryos in total (r = -0.27, p = 0.027), while the quality of embryos of group C were of lower quality as compared to those of groups A and B (p = 0.009). Follicular fluid glucose levels were lower in women of group C as compared to the respective levels of groups A and B (p = 0.003). Clinical pregnancy rate demonstrated in 14.5% in women of group C and 32.3% and 32.7% in groups A and B, respectively (p = 0.047).

CONCLUSION:
The data suggests that excess serum and follicular fluid vitamin levels in combination with decreased follicular fluid glucose levels have a detrimental impact on the IVF outcome.
 Standardized technique of laparoscopic pelvic and para-aortic lymphadenectomy in gynecologic cancer optimizes the perioperative outcomes.
INTRODUCTION:
The main objective of this study is to illustrate the effectiveness and the safety of standardized technique of laparoscopic lymphadenectomy (LNE), newly introduced in a University Hospital, in patients with gynecologic malignancy.

MATERIALS AND METHODS:
A cohort of 104 patients with gynaecologic malignancies (71 with endometrial and 33 with cervical cancer), who underwent laparoscopic pelvic with or without para-aortic LNE between September 2008 and March 2010, were analyzed. Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH & BSO) was the standard approach for patients with endometrial cancer (n = 71), while laparoscopic (nerve sparing) radical hysterectomy (n = 29), laparoscopic-assisted radical vaginal hysterectomy (n = 2) and radical trachelectomy was the treatment for patients with cervical cancer. All LNE were performed by a learning team under the supervision of an expert surgeon, familiar with the technique.

RESULTS:
The median number of pelvic lymph nodes yielded was 22 (range 16-34) and of para-aortic 14 (range 12-24). The mean operative time ± standard deviation for pelvic LNE for each side was 29 ± 17 and 64 ± 29 min for para-aortic LNE. The overall complication rate was 7.6% (n = 8). Two patients were reoperated laparoscopically, one because of postoperative hemorrhage and the other because of lymphocyst formation; laparoconversion was not necessary.

DISCUSSION:
Laparoscopic lymphadenectomy performed by a learning team with standardized technique is effective with adequate number of harvested nodes, in acceptable operative time and with low rate of perioperative complications.
 Laparoscopic management of ectopic pregnancy during a 9-year period.
Abstract
The present study analyzed the epidemiology and outcome of ectopic pregnancy during a 9-year period on a total of 473 women. Our follow-up shows that laparoscopic salpingostomy, performed in 84.9% of the patients, is a safe and effective treatment for ectopic pregnancy.
Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
 Effect of the position of the polar body during ICSI on fertilization rate and embryo development.
Abstract
This prospective study was designed to evaluate and clarify further whether the position of the polar body (PB) in relation to injection site during intracytoplasmatic sperm injection (ICSI) has an impact on fertilization and developmental rates and consequently clinical pregnancy outcome. The study included 264 patients undergoing 306 ICSI cycles from September 2007 to January 2009 performed by the same practitioner. Of all oocytes retrieved, 1736 were in metaphase II (MII). From every woman reaching ovum pick up, all MII-collected oocytes were allocated to 1 of the 4 groups according to PB orientation. In group A, MII oocytes were injected with the PB at 6 o'clock, group B with the PB at 7 o'clock, group C with the PB at 11 o'clock, and a group D with the PB at 12 o'clock. A significantly higher proportion of fertilized oocytes were produced from oocytes that had been injected with the PB at 11 o'clock (79.2%) as compared to those at 6 o'clock (70.5%), 7 o'clock (64.4%), and 12 o'clock (68.8%). Furthermore, embryos derived from oocytes that were injected with the PB at 11 o'clock appeared to be of higher quality score than those of the other groups of oocytes. A higher clinical pregnancy rate (28.7%) was obtained after the transfer of embryos from oocytes that had been injected with the PB at 11 o'clock. Given the higher fertilization, developmental, and pregnancy rate in the 11 o'clock group, it is suggested that this may be the preferred position of the PB at ICSI.
 Effect of ghrelin and metoclopramide on prolactin secretion in normal women.
Abstract

BACKGROUND:
Administration of ghrelin to women stimulates the secretion of PRL but the mechanism is not known.

AIM:
The aim of the study was to investigate the effect of the dopamine receptor blocker, metoclopramide, on ghrelin-induced PRL release.

SUBJECTS AND METHODS:
Ten healthy normally cycling women were studied in the midluteal phase of 4 menstrual cycles. A single dose of normal saline (cycle 1), ghrelin (1 μg/kg) (cycle 2), metoclopramide (20 mg) (cycle 3), and ghrelin plus metoclopramide (cycle 4) was given to the women iv. Blood samples in relation to the iv injection (time 0) were taken at -15, 0, 15, 30, 45, 60, 75, 90, and 120 min. The response of PRL and GH was assessed.

RESULTS:
Following ghrelin administration (cycles 2 and 4), plasma ghrelin and serum PRL and GH levels increased rapidly, peaking at 30 min (p<0.001). PRL was also increased after the injection of metoclopramide (p<0.001, cycle 3), but the increase was much greater than after the administration of ghrelin. The combination of ghrelin and metoclopramide stimulated PRL secretion to the same extent with metoclopramide alone. No changes in GH and PRL levels were seen after saline injection.

CONCLUSIONS:
These results demonstrate that the stimulating effect of ghrelin on PRL secretion is not additive with that of metoclopramide, although a dose range study might provide further information.
 94 months follow-up after laparoscopic assisted vaginal resection of septum rectovaginale and rectosigmoid in women with deep infiltrating endometriosis.
Abstract

BACKGROUND:
Endometriosis with bowel involvement is the most invasive form and can cause infertility, chronic pelvic pain and bowel symptoms. Effective surgical treatment of endometriosis requires complete excision of endometriosis and in same case may require segmental rectosigmoid resection.

METHODS:
Between December 1997 and October 2003, 55 patients with rectovaginal endometriosis underwent a combined laparoscopic vaginal technique. 30 patients were found at a follow-up and underwent a telephone interview. The questionnaire covered questions about symptoms related to recurrences of intestinal endometriosis, dyspareunia, dysmenorrhea and pregnancy.

RESULTS:
Twenty-seven of 30 (90%) women have no clinical symptoms of reported recurrence of endometriosis. Two patients (6.6%) had evidence of recurrence of bowel endometriosis. Dysmenorrhoea disappeared in 28 (93.3%), dyspareunia in 26 (86.7%) and pelvic pain in 27 (90%) patients. 17 patients (31%) tried to become pregnant and 11 of these patients (65%) became pregnant: 9 patients delivered healthy newborns, 18 pregnancies occurred and 19 healthy children were born.

CONCLUSIONS:
Despite the small number of follow-up patients, our 94-month follow-up data demonstrated that endometriosis with bowel involvement and radical resection was associated with significant reductions in painful and dysfunctional symptoms, a low recurrence rate (6.6%) and high pregnancy rate (36.6%).
 Total laparoscopic hysterectomy without uterine manipulator: description of a new technique and its outcome.
Abstract

INTRODUCTION:
Hysterectomy remains the most common major gynecological operation. This is the first study that describes a new technique of TLH without using any kind of uterine manipulator or vaginal tube (TLHwM) and analyzes the intra- and postoperative surgical outcome of the first 67 cases.

PATIENTS AND METHODS:
Between October 2008 and December 2009, 67 patients underwent TLH without uterine manipulator or vaginal tube. We analyzed the differences in the outcome by using three different kinds of surgical instruments: in 21 cases the TLHwM was performed using conventional 5 mm bipolar and scissors, in 22 cases using Sonosurgical, and in 24 cases using PKS cutting forceps.

RESULTS:
There was no intra- or postoperative complications. The overall mean operating time was by TLHwM with salpingo-oophorectomy 98 min and without salpingo-oophorectomy, 80 min. The mean operating time using cutting forceps was significantly lower. The mean uterine weight was 263 g.

DISCUSSION:
Uterine manipulator seems to be a safe and practical surgical method, especially for patients with vaginal stenosis and in cases of enlarged uterus. With its short operation time and no complication rate, we believe that this method is an enrichment of the laparoscopic hysterectomy techniques.
 The effect of estrogens on plasma ghrelin concentrations in women.
Abstract

BACKGROUND:
Data regarding the possible effects of estrogen on ghrelin secretion in humans are limited and contradictory.

AIM:
To investigate the effect of estradiol (E2) on ghrelin levels in normal pre- and post-menopausal women.

SUBJECTS AND METHODS:
A total of 21 women divided into 3 groups, i.e.13 normally cycling women (no.=7, group 1 and no.=6, group 2) and 8 post-menopausal women (group 3). Women of group 1 received increasing doses of E2 through skin patches from cycle days 3 to 5. Women of group 2, underwent total abdominal hysterectomy plus bilateral salpingo-oophorectomy (TAH+BSO) on cycle day 3. Women of group 3 received po increasing doses of E2 valerate for 15 days. Acylated ghrelin and E2 were measured in all blood samples.

RESULTS:
In group 1, plasma ghrelin levels did not show any significant changes for the week following cycle day 3. In group 2, ghrelin levels were similar before and after TAH+BSO and remained stable during the first 7 post-operative days. In group 3, no significant changes in plasma ghrelin levels were seen during the 15 days of E2 administration.

CONCLUSIONS:
The present study demonstrates for the first time that ghrelin values were not affected either by exogenous short-term estrogen administration to pre- and post-menopausal women or following ovariectomy in pre-menopausal women. It is suggested that ovarian hormones are not involved in the regulation of ghrelin secretion in women.
 Seven years' experience in laparoscopic dissection of intact ovarian dermoid cysts.
Abstract
A large case series on laparoscopic removal of dermoid cysts with a diameter between 3 and 12 cm, via an endobag, is reported (127 cysts in 121 premenopausal women). The incidence of spillage and recurrence rate of laparoscopic ovarian dermoid cystectomy, the duration of the surgical procedure, the length of hospitalization, the incidence of recurrence and pregnancies was evaluated. In 2.5% of cases, the endobag ruptured during removal, and a total spillage rate of 12% was seen. No signs or symptoms of peritonitis were observed regardless of cystic spillage or not. Laparoscopic cystectomy of dermoid cysts in premenopausal women is safe and effective and appears to be a valuable alternative to laparotomy. Controlled intraperitoneal spillage of cyst contents does not increase postoperative morbidity as long as an endobag is used and the peritoneal cavity is washed out thoroughly.
 Effect of ghrelin and thyrotropin-releasing hormone on prolactin secretion in normal women.
Abstract
It is known that ghrelin stimulates the secretion of prolactin in women. The aim of this study was to examine the effect of exogenous thyrotropin-releasing hormone (TRH) on ghrelin-induced prolactin release. Ten healthy normally cycling women were studied in four menstrual cycles. The women were injected intravenously in late follicular phase (follicle size 16-17 mm) with a single dose of normal saline (cycle 1), ghrelin (1 microg/kg) (cycle 2), thyrotropin-releasing hormone (200 microg) (cycle 3), and ghrelin plus thyrotropin-releasing hormone (cycle 4). Blood samples in relation to saline or drugs injection (time 0) were taken at -15, 0, 15, 30, 45, 60, 75, 90, and 120 min. The prolactin and growth hormone responses were assessed. After ghrelin administration (cycles 2 and 4), plasma ghrelin, serum prolactin, and growth hormone levels increased rapidly, peaking at 15-30 min (p<0.001). The injection of thyrotropin-releasing hormone (cycle 3) stimulated prolactin secretion markedly (p<0.001), but reduced growth hormone levels significantly (p<0.05). Ghrelin induced a smaller prolactin increase than thyrotropin-releasing hormone (p<0.05). The combination of ghrelin and thyrotropin-releasing hormone induced a similar increase in prolactin levels as with thyrotropin-releasing hormone alone. No changes in growth hormone and prolactin levels were seen after saline injection. These results demonstrate that the stimulating effect of ghrelin on prolactin secretion is not additive with that of thyrotropin-releasing hormone.
 Blockage of ghrelin-induced prolactin secretion in women by bromocriptine.
Abstract

OBJECTIVE:
To investigate the effect of bromocriptine on ghrelin-induced PRL secretion in women.

DESIGN:
Longitudinal study.

SETTING:
University hospital.

PATIENT(S):
Ten healthy, normally cycling women.

INTERVENTION(S):
The women were injected IV on day 3 of three cycles with a single dose of normal saline (cycle 1) or ghrelin (1 microg/kg) after pretreatment for 2 days either with placebo (cycle 2) or with bromocriptine (cycle 3) per os. Blood samples were taken before and frequently after drugs administration for 120 minutes.

MAIN OUTCOME MEASURE(S):
The PRL and GH responses to ghrelin were assessed.

RESULT(S):
Bromocriptine suppressed basal PRL levels significantly. The injection of ghrelin stimulated a significant increase in serum PRL levels in cycle 2 but not in cycle 3, in which PRL levels remained stable. The response of GH to gherlin was significantly attenuated in cycle 3 as compared with cycle 2.

CONCLUSION(S):
The present study demonstrates for the first time that bromocriptine blocked the stimulating effect of ghrelin on PRL release and attenuated the GH response to the same stimulus. The mechanism of these interactions needs to be clarified.
Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
 Effect of ghrelin on gonadotrophin secretion in women during the menstrual cycle.
Abstract

BACKGROUND:
It has been suggested that ghrelin may affect reproduction in animals by decreasing pituitary LH secretion. The role of ghrelin on LH secretion in women has not been investigated. Our aim was to assess the effect of ghrelin administration on basal and GnRH-induced LH secretion during the menstrual cycle.

METHODS:
Normally cycling women (n = 10) received on Day 3 of three consecutive cycles a single bolus i.v. of either ghrelin (1 microg/kg, cycle 1) or GnRH (100 microg, cycle 2) or GnRH plus ghrelin (cycle 3). In cycle 1, ghrelin was also injected in late follicular and mid-luteal phase of the cycle. Saline was injected in a preceding cycle (cycle 1, control). Blood samples were taken before drugs or saline injection (time 0) as well as at -15, 15, 30, 45, 60, 75, 90 and 120 min.

RESULTS:
Plasma ghrelin levels increased rapidly, peaking at 15 or 30 min (P < 0.001), then decreased steadily, approaching pre-injection levels at 120 min. Serum FSH, LH, estradiol and progesterone levels remained unchanged. The stimulating effect of GnRH on LH and FSH secretion was unaffected by ghrelin injection. In contrast to saline, ghrelin stimulated a significant increase in growth hormone levels.

CONCLUSIONS:
Under these experimental conditions, our results demonstrate for the first time the inability of a bolus of ghrelin to affect basal and GnRH-induced LH and FSH secretion. It is suggested that ghrelin does not play a major physiological role in gonadotrophin secretion in women.
 Growth hormone and prolactin response to ghrelin during the normal menstrual cycle.
Abstract

OBJECTIVE:
It has been suggested that exogenous oestradiol augments ghrelin-induced growth hormone (GH) secretion in postmenopausal women. Whether endogenous oestrogens exert a similar effect during the normal menstrual cycle is not known. The aim of this study was to test the hypothesis that physiological changes in ovarian steroids during the normal menstrual cycle modulate GH and prolactin (PRL) response to ghrelin.

DESIGN:
Healthy women were studied in three phases of the normal menstrual cycle.

PATIENTS:
Ten healthy normally cycling women.

MEASUREMENTS:
A single dose of ghrelin (1 microg/kg) was administered intravenously in the early and late follicular phases and in the mid-luteal phase of the cycle. Saline was injected in the preceding cycle. Blood samples were taken before ghrelin or saline injection (time 0) and also at -15, 15, 30, 45, 60, 75, 90 and 120 min. The GH and PRL responses were assessed.

RESULTS:
Serum oestradiol and progesterone concentrations showed the variations of a normal menstrual cycle. After ghrelin administration, in the three phases of the cycle, plasma ghrelin and serum GH and PRL levels increased rapidly, peaking at 30 min and declining gradually thereafter (P < 0.001). There were no significant differences in the hormone levels between the three phases at all time points. No changes in GH and PRL levels were seen after saline injection.

CONCLUSIONS:
These results demonstrate that GH and PRL responses to ghrelin do not change across the menstrual cycle. It is suggested that the action of ghrelin on the pituitary somatotrophs is modulated differentially by endogenous and exogenous ovarian steroids.
 Effect of ovarian hormones on serum adiponectin and resistin concentrations.

Abstract
OBJECTIVE:
To investigate the effect of ovarian hormones on adiponectin and resistin levels in women.

DESIGN:
Experimental study.

SETTING:
University hospital.

PATIENT(S):
Thirteen normally cycling women (7 in group 1 and 6 in group 2) and 8 postmenopausal women (group 3).

INTERVENTION(S):
Women of group 1 were investigated in a control cycle and in a subsequent cycle in which total abdominal hysterectomy plus bilateral salpingooophorectomy (TAH+BSO) was performed on day 3. In both cycles, the women received increasing doses of E(2) from days 3 to 5. Women of group 2 underwent TAH+BSO on day 3 without receiving any hormonal treatment. Women of group 3 received increasing doses of E(2) for 15 days.

MAIN OUTCOME MEASURE(S):
Adiponectin, resistin, and E(2) concentrations.

RESULT(S):
In group 1, serum adiponectin and resistin levels did not show any significant changes for the week following day 3 and were similar in the two cycles. In group 2, adiponectin and resistin levels were similar before and after TAH+BSO and remained stable during the first postoperative week. In group 3, no significant changes in adiponectin and resistin levels were seen during the 15 days of E(2) administration.

CONCLUSION(S):
Adiponectin and resistin values were not affected either by estrogen treatment or after ovariectomy in women. It is suggested that ovarian hormones are not involved in the regulation of adiponectin and resistin secretion in women.
 
Πρότυπο Μαιευτικό - Γυναικολογικό Ιατρείο 
Dr. Νεκτάριος Ε. Χαλβατζάς M.D., Ph.D.
Παπαναστασίου 53 / Λάρισα
Τηλ: 2410251500  Κιν: 6944347008