Ovarian Enlargement Research Articles

Beneficial effect of polyherbal formulation in letrozole induced Polycystic ovarian syndrome (PCOS)

Aim of the studyPCOS is an endocrine condition that results in enlarged ovaries with tiny cysts on the margins. The present study aims to investigate the beneficial effect of polyherbal formulation in Letrozole induced PCOS in female Albino Wistar rats. Materials and methodsAcute toxicity study of the polyherbal formulation by administering a single dose (2000 mg/kg) was done in female Albino Wistar rats (20 weeks, 250 g) following OECD guideline 423. For PCOS induced study female Albino Wistar rats were divided into six groups (6 animals/group). Group I (control) was given 0.5% carboxymethylcellulose (CMC) suspension daily as vehicle control. Letrozole (1 mg/kg) was orally administered for 21 days in Group II to VI for induction of PCOS. After induction of PCOS, animals were treated with standard drug (Group III- Clomiphene citrate- 1 mg/kg) and polyherbal tablets (Group IV – 500 mg/kg, Group V- 750 mg/kg, and Group VI – 1000 mg/kg) up to 50 days. Vaginal smears were taken daily to check the estrous cycle. Body weight was measured weekly. Blood samples were withdrawn on 0,21 and 50 days for the determination of fasting blood glucose, lipid profile, LH, FSH, and hormonal levels. ResultsAdministration of letrozole caused the abnormality in serum sex hormone profile, lipid profile, glucose, and the estrous cycle. The treatment with polyherbal formulation significantly decreased (P < 0.0001) the level of testosterone and improved estradiol and progesterone levels (P < 0.0001). There was a decrease in elevated glucose levels from 71.51 ± 0.15 mg/dl in disease induced group to 57.33 ± 1.90 mg/dl in treatment groups. The triglycerides level was normalized to 33.41 ± 1.81 mg/dl and HDL level was increased to 40.63 ± 1.35 mg/dl in treatment groups. The polyherbal formulation by exerting its beneficial effect also caused the disappearance of the cysts in the ovaries. ConclusionThe polyherbal formulation was found to be effective in PCOS. The effect may be attributed to the individual herbs reported having a significant effect on the pathophysiology of letrozole induced PCOS.

Adnexal torsion: a review of diagnosis and management strategies.

Adnexal torsion remains a diagnostic challenge heavily reliant on high clinical suspicion, with patient presentation and imaging used as adjuncts to aid in its diagnosis. This review summarizes diagnostic and management techniques of adnexal torsion to assist providers when encountering this surgical emergency. Common findings of adnexal torsion include abdominal pain, nausea, vomiting, and adnexal mass or ovarian enlargement. An elevated neutrophil to lymphocyte ratio may be useful for diagnosis. A 'whirlpool' sign, 'follicular ring' sign, enlarged/edematous ovary, and absent Doppler flow to the ovary are highly suggestive of adnexal torsion. Intraoperative visual diagnosis of ovarian death is highly inaccurate, with only 18-20% of ovaries necrotic on pathological examination. Necrotic appearing ovaries have been shown to have follicular activity on ultrasound one year postoperatively. Pelvic ultrasound remains the first-line imaging modality. In patients of reproductive age, we recommend performing detorsion with ovarian conservation, even in cases where the tissue appears necrotic, given poor intraoperative diagnostic rates of tissue death. Retention of ovarian function is also reliant on a timely diagnosis and intervention. We emphasize that the risk of ovarian damage/loss outweigh the risk of a diagnostic laparoscopy in patients of reproductive age.

Metabolic syndrome and risk factors for atherosclerotic diseases in reproductive aged females

Background and Aims : Abdominal obesity, insulin resistance (IR), hyperinsulinemia (HI), dyslipidemia, arterial hypertension (AH), impaired glucose tolerance, hyperuricemia, polycystic ovary syndrome (POS) and hyperandrogenemia - are established cardiovascular risk factors. Purpose: to study risk factors for atherosclerotic diseases in reproductive aged women.Methods: A total of 1786 people (598 adolescent females and 1188 reproductive aged women) with suspected MS were examined. As a result of the screening, a group of 306 people (92 adolescents and 214 reproductive women) were selected for an in-depth study for components of MS.Results: In adolescent girls hypoalphacholesterolemia (34%), hypercholesterolemia (27%), hypertriglyceridemia (21%), overweight and obesity (59%), cystic enlarged ovaries (58%), hyperuricemia (59%) were noted. In women of reproductive age hypertriglyceridemia (58%), hypercholesterolemia (35%) and hypoalphacholesterolemia (34%), overweight and obesity (66%), AH (46%), hyperuricemia (41%) were noted. In reproductive women there was a decrease of sex hormone binding globulin (SHBG) regardless of obesity. The value of SHBG less than 60 nmol/l was observed in 79% of patients with MS. In patients of reproductive age with a sedentary lifestyle and predominance of fatty foods in the diet, the incidence of IR and HI increases, which is not a leading factor. The absence of a statistically significant effect of smoking on metabolic parameters in women with MS and POS may be due to the powerful effect of other factors, primarily genetic IR.Conclusions: The high frequency of MS among women of reproductive age necessitates their mandatory examination for IR, HI and associated disorders, as cardiovascular risk factors. Social factors can contribute to MS manifestations. Background and Aims : Abdominal obesity, insulin resistance (IR), hyperinsulinemia (HI), dyslipidemia, arterial hypertension (AH), impaired glucose tolerance, hyperuricemia, polycystic ovary syndrome (POS) and hyperandrogenemia - are established cardiovascular risk factors. Purpose: to study risk factors for atherosclerotic diseases in reproductive aged women. Methods: A total of 1786 people (598 adolescent females and 1188 reproductive aged women) with suspected MS were examined. As a result of the screening, a group of 306 people (92 adolescents and 214 reproductive women) were selected for an in-depth study for components of MS. Results: In adolescent girls hypoalphacholesterolemia (34%), hypercholesterolemia (27%), hypertriglyceridemia (21%), overweight and obesity (59%), cystic enlarged ovaries (58%), hyperuricemia (59%) were noted. In women of reproductive age hypertriglyceridemia (58%), hypercholesterolemia (35%) and hypoalphacholesterolemia (34%), overweight and obesity (66%), AH (46%), hyperuricemia (41%) were noted. In reproductive women there was a decrease of sex hormone binding globulin (SHBG) regardless of obesity. The value of SHBG less than 60 nmol/l was observed in 79% of patients with MS. In patients of reproductive age with a sedentary lifestyle and predominance of fatty foods in the diet, the incidence of IR and HI increases, which is not a leading factor. The absence of a statistically significant effect of smoking on metabolic parameters in women with MS and POS may be due to the powerful effect of other factors, primarily genetic IR. Conclusions: The high frequency of MS among women of reproductive age necessitates their mandatory examination for IR, HI and associated disorders, as cardiovascular risk factors. Social factors can contribute to MS manifestations.

Kallistatin prevents ovarian hyperstimulation syndrome by regulating vascular leakage.

Angiogenesis and increased permeability are essential pathological basis for the development of ovarian hyperstimulation syndrome (OHSS). Kallistatin (KS) is an endogenous anti‐inflammatory and anti‐angiogenic factor that participates in a variety of diseases, but its role in OHSS remains unknown. In this study, treating a human ovarian granulosa‐like tumour cell line KGN and human primary granulosa cells (PGCs) with human chorionic gonadotropin (hCG) reduced the expression of KS, but increased the expression of VEGF. Furthermore, we found that KS could attenuate the protein level of VEGF in both KGN cells and human PGCs. More interestingly, we observed that exogenous supplementation of KS significantly inhibited a series of signs of OHSS in mice, including weight gain, ovarian enlargement, increased vascular permeability and up‐regulation of VEGF expression. In addition, KS was proved to be safe on mice ovulation, progression of normal pregnancy and fetus development. Collectively, these findings demonstrated that KS treatment prevented OHSS, at least partially, through down‐regulating VEGF expression. For the first time, these results highlight the potential preventive value of KS in OHSS.

Bilateral megalocystic ovaries in frozen-thawed embryo transfer detected during cesarean section: A rare case presentation

In cases of in vitro fertilisation and extremely infrequently with frozen embryo transfer, hyperstimulated, enlarged ovaries and their consequences might be detected in the late stages of pregnancy, even at term.. Ovarian torsion induced by hyperstimulated ovaries can be difficult to diagnose during pregnancy, hence pregnant IVF patients should be closely monitored whether or not they have OHSS.. Although severe and critical OHSS cannot be totally prevented, early detection of high-risk variables, as well as sensible prevention and treatment techniques, can help to minimise the complications and long-term consequences of this iatrogenic illness.

P-698 Pituitary functioning gonadotroph adenomas (FGA)-induced ovarian hyperstimulation syndrome (OHSS): results from tertiary neuroendocrine centres in the UK

Abstract Study question There are no published series of OHSS due to FGA. What FGA features should clinicians look for during OHSS, and what treatments are effective? Summary answer FGA tumour size is always &amp;gt;10mm. Other pituitary hormones may be deficient. Surgical resection of FGA is an effective treatment for OHSS. What is known already Pituitary adenomas affect 1:1000 adults and are classified as functioning or non-functioning. Non-functioning pituitary adenomas do not secrete hormones, but most commonly stain histologically gonadotroph cells. Functional pituitary adenomas secrete hormones such as prolactin causing prolactinoma. However, it is rare for a pituitary tumour to cause clinical features of excessive gonadotrophins (functioning gonadotroph adenoma; FGA). Single case reports, but no case series, have been published on the presentation of FGA-induced OHSS in women. Surgical excision of adenomas has been reported to cause remission of symptoms, though systematic data are lacking owing to rarity of these tumours. Study design, size, duration National case series from tertiary neuroendocrine units in England, Wales and Scotland. Participants/materials, setting, methods Eight high-volume pituitary endocrine tertiary units within England, Wales and Scotland audited their records for any cases of FGA-induced OHSS; only seven patients have been identified to date. In all cases, there had been no recent exposure to assisted reproductive technologies (ART) or drugs known to induce OHSS including gonadotrophins or selective oestrogen receptor modulators (SERMS). Main results and the role of chance Seven cases of FGA were identified with mean age 31.6 years (range 16-48) at diagnosis. Two-of-seven women presented acutely unwell with abdominal pain, distention and palpable mass requiring oophorectomy for ovarian torsion/ruptured ovarian cyst. The remaining five women presented with abdominal pain (n = 2), thyrotoxicosis (n = 1), menstrual irregularities/galactorrhoea (n = 1) and visual disturbances (n = 1). All women experienced intermittent pelvic pain during medical attendance. Pelvic ultrasound demonstrated enlarged multiseptated ovaries (volume ranging 27-442cm3). Ascites was noted in one woman. Six women had visual field defects due to optic chiasm compression on formal assessment. Median FSH was 26.10 u/L (8.3-33), but LH was &amp;lt;2.5 u/L in all cases. Estradiol (E2) far exceeded the reference range in 5/7 women (2990 to &amp;gt; 18000pmol/L);E2 was at the upper limit of normal in the remaining 2/7 women (960-1450pmol/L). Hyperprolactinaemia, hyperthyroidism and other pituitary hormones deficiency were noted in 6/7, 1/7 and 4/7 women respectively. All FGAs were macroadenomas with diameters ranging 16-48mm. Two patients were administered a somatostatin analogue prior to surgery, but FSH, E2 and tumour size did not change. Transsphenoidal surgery was performed in 6/7 women, and always improved symptomatic and biochemical features of OHSS; however, residual FGA tumour was present post-operatively in all cases studied. Limitations, reasons for caution It is possible that some ‘non-functioning’ gonadotroph adenomas cause subclinical problems including menstrual irregularity and mild OHSS which were never diagnosed. We have insufficient data to determine the prognosis for future pregnancy after FGA-induced OHSS. This study utilised historical case-notes, so some data is missing. Wider implications of the findings The ‘spontaneous’ presentation of OHSS may be confusing for clinicians. We report that FGA is an important cause of spontaneous OHSS which has well-defined biochemical and radiological characteristics, which may be treated effectively in the short-to-medium with pituitary surgery. Results of this study may provide greater awareness of FGA-induced OHSS. Trial registration number N/A

Ultrasonographic scoring system for the diagnosis of adnexal torsion.

To establish the utility of an ultrasonographic scoring system for the diagnosis of adnexal torsion. We retrospectively analyzing 358 adnexal torsion cases. Using Pearson's χ2 test we determined whether ultrasonographic signs were significantly associated with adnexal torsion. Receiver operating characteristic curves were used to evaluate the diagnostic efficacy of the system. Ultimately by using binary logistic regression we established a precise and convenient scoring system. The torsion score was based on five criteria that were identified to be independently associated with adnexal torsion: (1) abnormal position of the index adnexa (odds ratio [OR], 2.311); (2) presence of a mass or cyst (OR, 3.495); (3) unilateral ovarian enlargement (OR, 3.051); (4) vascular pedicle twisting (OR, 2.105); and (5) peripheral hypervascularity of the corpus luteum with ovarian edema(encapsulating cyst sign) (OR, 4.164).patients with torsion who scored 0, have a predicted diagnosis rate of 20.9%; patients whose scores were 1,2 have a predicted probability of 41.8% and 66.15%, respectively. For patients with torsion scores of 3, 4, and 5, predicted diagnosis rates were 84.16%, 93.52%, and 98.27%, respectively. The ultrasonographic scoring system is feasible and precisely diagnoses adnexal torsion using ultrasound.

ABO Blood Grouping in Partial and Complete Hydatidiform Molar Pregnancy

Objective: The present study was conducted to analyze the correlation of ABO blood groups in pregnant mother’s suffering from partial and complete Hydatidiform mole (HM) reporting at our tertiary care hospital. Study Design: Observational study Place and Duration: Liaquat University Hospital, Hyderabad/Jamshoro from May 2018 to October 2018. Methods: The present observational study analyzed the ABO blood groups of diagnosed cases of partial and complete type HM reporting at the Department of Obstetrics and Gynecology. A sample of 100 pregnant women suffering from Partial and complete HM and of their husbands was studied by inclusion criteria. ABO blood groups of these patients were determined as A, B, AB and O groups. Blood samples were processed for complete blood counts. Tests were performed at the Diagnostic and Research Laboratory, Liaquat University Hospital Hyderabad by forward and reverse ABO blood typing. Severity of GTD was assessed by WHO index score. Statistical comparisons of continuous and categorical variables run on SPSS ver. 21.0 at 95% confidence interval (P≤0.05). Results: Clinical presenting features bleeding PV, pain, hyperemesis gravidarum, grape like vesicles passage PV, no fetal heart sound, ovarian enlargement and hyperthyroidism. Partial and complete Hydatidiform mole was common in blood group A noted in 53 and 13 respectively. While Partial and complete Hydatidiform mole in blood group O was noted in 20 and 8 patients respectively (P=0.0001). The β–hCG ranged from 50,000 to 10, 00,000 mIU/mL. Conclusion: It is concluded, the hydatidiform mole proves strong association with blood groups A and O. Pregnant women complaining of bleeding PV, hyperemesis gravidarum, grape like vesicles passage with blood group A and O should be thoroughly investigated to minimize the maternal health risk. Keywords: Hydatidiform mole, Molar pregnancy, ABO blood groups

Clinical features of isolated Fallopian tube torsion: evidence from a large series

We aimed at studying isolated Fallopian tube torsion (IFTT) in a relatively large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). This was a retrospective cohort study. We included women with surgically confirmed ovarian and/or Fallopian tube torsion between March 2011 and June 2020. Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Oedematous and enlarged ovaries were less common in the IFTT group. In multivariate regression analysis, the following factors were independently associated with IFTT: (i) vaginal discharge [adjusted odds ratio (aOR) 95% CI 8.16, 1.98–33.55]; (ii) cervical motion tenderness (aOR 95% CI 2.71, 1.01–7.29); (iii) fertility treatments (aOR 95% CI 0.26, 0.70–0.77); (iv) previous abdominal surgery (aOR 95% CI 0.46, 0.22–0.96); (v) vomiting (aOR 95% CI 0.38, 0.19–0.76); and (vi) enlarged ovary (aOR 95% CI 0.34, 0.18–0.65). In conclusion, we have identified factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion.

An extremely rare case of pituitary functioning gonadotroph microadenoma accompanied by ovarian hyperstimulation syndrome in a woman of reproductive age

ObjectiveTo report a case of pituitary functioning gonadotroph microadenoma accompanied by ovarian hyperstimulation syndrome (OHSS) in a woman of reproductive age.DesignA case report.SettingTertiary care unit of a university hospital.PatientsA 42-year-old parous woman with bilateral ovarian enlargement presumed to be secondary to a functioning gonadotroph pituitary microadenoma.InterventionsOral contraceptives and endoscopic transsphenoidal surgery for adenoma that initially could not be visualized on a magnetic resonance imaging (MRI) scan.Main Outcome MeasuresMedical and radiographic assessment of endogenously induced OHSS and its resolution after treatment.ResultsThe patient was diagnosed with OHSS secondary to elevations in endogenous levels of follicle-stimulating hormone (FSH). The cranial contrast-enhanced MRI scan did not show any apparent tumor in the pituitary gland. She was, therefore, treated with oral contraceptives, which resulted in a modest resolution of ovarian enlargement; however, this treatment became ineffective 3 years later. A small pituitary adenoma (maximum diameter of 8 mm) was suspected on repeated MRI (2 years after the first MRI). Selective adenomectomy was performed, which resulted in normalization of the ovarian size and resumption of regular menstrual cycles.ConclusionsWe report a case of a functional pituitary microadenoma secreting FSH in quantities significant enough to result in OHSS. The excessive FSH production was resistant to medical therapy; however, surgical treatment was ultimately successful.

Ovarian torsion: diagnosis, surgery, and fertility preservation in the pediatric population.

Ovarian torsion is rare in the pediatric population. Delayed diagnosis can significantly impact fertility. The aim of this review is to highlight current knowledge regarding clinical presentation, diagnosis, surgical management, and follow-up in the pediatric population. Whilst the presentation is often very unspecific, most children will present with sudden severe unilateral pelvic pain associated with vomiting. A key diagnostic test is pelvic ultrasonography, which may help demonstrate an asymmetric enlarged ovary with peripherally displaced follicles. In the pediatric population, ovarian torsion may occur in a normal ovary. However, underlying lesions can be found in half of cases. Benign neoplasms (teratomas or cystic lesions) represent the commonest etiology, with the risk of malignancy being less than 2%. Surgical management should be focused on fertility preservation. This is achievable through ovarian detorsion ± ovarian cystectomy ± oophoropexy to avoid recurrence. Follow-up studies demonstrate excellent recovery rates of detorsed ovaries including those with ischemic appearances. What is Known: • Ovarian torsion is a rare diagnosis in the pediatric population. • Aspecific symptoms and differential diagnoses lead to missed or delayed diagnosis increasing the risk of oophoprectomy and further infertility. What is New: • Reviewing the latest knowledge about clinical presentation, diagnostic, surgical management, and follow-up of ovarian torsion in the pediatric population. • Adiponectin was negatively associated with diastolic blood pressure and HOMA-IR, and chemerin was negatively associated with glucose.

A validated predictive model for adnexal torsion pre-operative diagnosis.

To develop a simple predictive model for pre-operative diagnosis of adnexal torsion (AT). A retrospective cohort study with a retrospective validation, including669 separate episodes of women who underwent laparoscopy due to a suspected AT between January 2011 and June 2020. We compared the pre-operativecharacteristics between women with surgically confirmed AT and those without. The derivation cohort included 615 episodes of suspected AT. AT was surgically confirmed in 445episodes (72%). The retrospectively collected validation cohort included 54 episodes, with 31 (57.4%) surgically confirmed AT. In a multivariate regression analysis, vomiting, neutrophils to lymphocytes ratio > 3.5 and sonographic finding of enlarged ovary were independently associated with AT [OR 95% CI 2.78 (1.21-6.36), 3.15 (1.42-6.97) and 2.80 (1.33-5.88), respectively]. In the derivation cohort, the PPV for AT diagnosis was 69.7%, 84.5% and 93.1% if 1, 2 and 3 risk factors were present, respectively. Retrospective validation analysis underlined a PPV of67.6%, 82.6 and 66.6% for 1, 2 and 3 risk factors, respectively. We have developed and validated a simple predictive model for pre-operative diagnosis of AT, based on three parameters. Our model may assist clinicians while evaluating patients with suspected AT and improve pre-operative diagnosis.

Frequency of Overweight Women and Ovarian Enlargement among Females Presented with Pelvic Pain Complains

Objective: To determine the frequency of overweight females and ovarian enlargement among women presenting with pelvic pain complaints at rural Health facilities of district Tando Muhammad Khan.&#x0D; Methodology: This descriptive study was conducted at physiology department of Sindh University with the collaboration of different rural health facilities of Tando Muhammad Khan, Sindh. All the females presented with pelvic pain and age more than 18 and up to 45 years were included. Body mass index (BMI) was assessed by the ratio of the individual's weight in kilograms divided by the height in meters squared (BMI = kg/m2). All the patients underwent ultrasound examination. Data collection was done by structured study proforma. Analysis of the data was done by the SPSS version 20.&#x0D; Results: A total of 239 women with pelvic pain complaints were studied, their mean age was 32.79+4.31 years. Neoplastic ovarian lesions were seen amogn12.54% of the cases. Cystic ovarian lesions were among 30.54% of the females, 5.01% had ovarian mass and 21.33% females had mixed pathologies. BMI was normal among 62.76% cases, while 20.08% women were overweight, 03.34% were obese and 13.8%females were underweight.&#x0D; Conclusion: Overweight females and ovarian enlargement were observed to be highly frequent among females presented with pelvic pain complaints. Cystic enlargement was observed to be the commonest cause of ovarian enlargement.

POSTMENOPAUSAL HIRSUTISM: A CASE REPORT

INTRODUCTION: Hirsutism is a common condition affecting around 5-10% of female in the childbearing age. During menopausal evolution phase some terminal hair growth can occur in few females as part of normal aging process. However in a postmenopausal female, the presence of rapidly progressive hirsutism and other features of virilization require proper assessment for a sinister cause. CASE DESCRIPTION: A 61 years old lady presented with progressive hirsutism, deepening of voice and scalp baldness. She was postmenopausal for 20 years and hirsutism started about five years ago, initially involving face and then spread to rest of body including chest, abdomen and inner thighs. Her Body-Mass-Index was 27.5 kg/m2. She had hirsutism with a Ferriman-Gallwey score of 16/36 and signs of virilization in the form of deepening of voice, clitorimegaly, complete scalp baldness and masculinization. Relevant workup showed raised testosterone with normal values of Luteinizing hormone, Follicle Stimulating hormone, Prolactin, 17-OH-progesterone and Dehydroepiandrosterone-Sulfate (DHEA-SO4). Computed-tomography imaging of pelvis confirmed enlarged right ovary with dense stroma. Histopathology confirmed a rare ovarian tumour, Sclerosal stromal tumor (SST). Resection of mass resulted in normalization of testosterone levels and improvement in virilization features. CONCLUSION: Hirsutism and virilization in postmenopausal females must be assessed for rare but sinister causes like androgen producing adrenal and/or ovarian tumors. SSTs are rare tumors and usually present in the 2nd and 3rd decades of life but in our case it occur in the postmenopausal age. They are usually hormonally inactive but sometimes can secret androgens as in our patient.

Luteoma in two mares treated by ovariectomy

Summary A 15‐year‐old Paint mare (Case 1) and a 15‐year‐old Arabian mare (Case 2) were presented for aggressive and undesired behaviour. Reproductive evaluation revealed, initially, an enlarged ovary with a smaller/normal sized contralateral ovary in each case. Granulosa cell tumour (GCT) panel testing revealed elevated inhibin B in both cases and elevated anti‐Mullerian hormone (AMH) levels only in Case 1 determined from currently established reference ranges. Based on a presumptive diagnosis of GCT, bilateral standing ovariectomy was elected for both mares. In each case neoplastic tissue consistent with luteoma was detected only on histological examination in the smaller/normal sized left ovary; the right ovary appearing normal. Long‐term follow‐up was performed 1 year and 5 years post‐operatively by telephone. The owners were satisfied with the outcome and each patient demonstrated resolution of aggressive stallion‐like behaviour. Each case returned to the owners' intended use. In conclusion, luteoma should be considered as a differential diagnosis for ovarian neoplasms in horses related to behavioural abnormalities, even in normal‐sized ovaries.

Preoperative Clinical Features of Isolated Fallopian tube Torsion: Evidence from a Large Series

Study Objective To study isolated fallopian torsion (IFTT) in a large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). Design A retrospective cohort study. Setting A tertiary, university affiliated medical center. Patients or Participants We included women with surgically confirmed ovarian and/or fallopian tube torsion between March 2011 and June 2020. We compared women with IFTT to those with NIAT during the same period. Interventions Diagnostic and operative laparoscopy. Measurements and Main Results Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Edematous and enlarged ovaries were less common in the IFTT group. In a multivariate regression analysis, the following factors were independently positively associated with IFTT; vaginal discharge [adjusted Odds Ratio (aOR) 95% CI 8.16, 1.98-33.55], and cervical motion tenderness (aOR 95% CI 2.71, 1.01-7.29). The following factors were independently negatively associated with IFTT; fertility treatments (aOR 95% CI 0.26, 0.70-0.77), previous abdominal surgery (aOR 95% CI 0.46, 0.22-0.96), vomiting (aOR 95% CI 0.38, 0.19-0.76) and enlarged ovary (aOR 95% CI 0.34, 0.18-0.65). Conclusion We have identified preoperative factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion. To study isolated fallopian torsion (IFTT) in a large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). A retrospective cohort study. A tertiary, university affiliated medical center. We included women with surgically confirmed ovarian and/or fallopian tube torsion between March 2011 and June 2020. We compared women with IFTT to those with NIAT during the same period. Diagnostic and operative laparoscopy. Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Edematous and enlarged ovaries were less common in the IFTT group. In a multivariate regression analysis, the following factors were independently positively associated with IFTT; vaginal discharge [adjusted Odds Ratio (aOR) 95% CI 8.16, 1.98-33.55], and cervical motion tenderness (aOR 95% CI 2.71, 1.01-7.29). The following factors were independently negatively associated with IFTT; fertility treatments (aOR 95% CI 0.26, 0.70-0.77), previous abdominal surgery (aOR 95% CI 0.46, 0.22-0.96), vomiting (aOR 95% CI 0.38, 0.19-0.76) and enlarged ovary (aOR 95% CI 0.34, 0.18-0.65). We have identified preoperative factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion.

Surgically confirmed adnexal torsion during pregnancy: Does the trimester make a difference?

To investigate the clinical and the sonographic characteristics of adnexal torsion (AT) during pregnancy and to underline differences in AT manifestation between pregnancy trimesters. This is a retrospective cohort study in a tertiary medical center. The study included all pregnant women with surgically confirmed AT between March 2011 and April 2020. The patients were divided into three groups according to pregnancy trimesters, and the clinical and sonographic characteristics were compared between the groups. The study cohort included 140 cases of AT. Ninety-nine (70.7%) of the cases occurred during the 1st trimester, and 31 (22.1%) and 10 (7.1%) occurred during the 2nd and the 3rd trimesters, respectively. Conception by assisted-reproductive technologies (ART), nausea, and finding of enlarged ovary on ultrasound scan were all more common among patients in the 1st trimester group as compared to the 3rd trimester group (p=0.001, 0.015, and 0.024, respectively). The mean time from admission to surgery was significantly shorter in the 1st trimester group as compared to late pregnancy (p=0.001). The majority of cases were right-sided. There was a significant difference in the organs involved in every trimester of pregnancy-ovary only, ovary and fallopian tube, and fallopian tube only (p=0.023). Most AT cases during pregnancy occurred during the 1st trimester. Conception by ART and enlarged ovary on ultrasound scan were also more common in AT cases during early pregnancy. Time from admission to surgery was longer as pregnancy progressed and organs involved differed between trimesters. Understanding the difference in manifestation of AT in every trimester might improve the preoperative evaluation of AT in pregnancy.

When is it too late? Ovarian preservation and duration of symptoms in ovarian torsion

This 10-year retrospective study between 2008 and 2018, aims to investigate the duration of symptoms of ovarian torsion and the subsequent rate of ovarian preservation. Eighty-six women with surgically confirmed ovarian torsion were included. The median duration from the onset of pain symptoms to presentation (26.0 vs 6.0 h, p < .001) and from presentation to surgery (11.0 vs 5.5 h, p = .010) were significantly longer in women who required an oophorectomy compared to women who had conservative surgery. There was no significant difference in symptoms, signs or investigations except ultrasound finding of an enlarged ovary (94.9% vs 76.9%, p = .026). Awareness of the condition among the community and healthcare is crucial and routine investigations should not delay management as positive Doppler flow on ultrasound does not exclude an ovarian torsion. Impact Statement What is already known on this subject? Ovarian torsion is a gynaecological emergency and may lead to ovarian necrosis, infection and peritonitis. Early recognition is essential in preserving the ovary, particularly in patients with future fertility aspirations. Currently there is no consensus regarding the time period of ovarian viability after the onset of symptoms. What do the results of this study add? We have demonstrated a significant difference in the duration from the onset of symptoms to surgery. Furthermore, the duration from the onset of symptoms to presentation (26.0 vs 6.0 h, p<.001) and from presentation to surgery (11.0 vs 5.5 h, p=.010) were significantly longer in women who required an oophorectomy compared to women who had conservative surgery. There was no significant difference in symptoms, signs or investigations except ultrasound finding of an enlarged ovary. What are the implications of these findings for clinical practice and/or further research? Women with known ovarian cysts in particular should be educated of the risk of ovarian torsion. Routine investigations should not delay management as it does not exclude an ovarian torsion. Although our study suggests that early presentation and management would reduce the risk of oophorectomy, prospective studies are required to confirm the findings.

Depression Due to Polycystic Ovary Syndrome in Adolescents

Introduction: Polycystic ovary syndrome(PCOS) is a common endocrinal disorder of reproductive age, that cause enlarged ovaries with small cyst on the outer edges with infrequent or prolonged menstrual cycles, excess hair growth, acne and obesity, which is nowadays prevailing among females at adolescent stage. About 5-10% of women among the general population of in the world are affected by PCOS. There is an increase in the prevalence of PCOS among the women and young girls of reproductive age, where they experience depression because of PCOS particularly. The exact cause of PCOS is unknown. The early diagnosis and treatment along with weight loss may reduce the long term complications of PCOS. It is not only a problem associated with reproduction, but also has associated vital metabolic and psychological health risks.&#x0D; Aim: Depression Due to Polycystic Ovary Syndrome in Adolescents&#x0D; Conclusion: In comparison to safe controls, adolescents with PCOS had lower self-esteem, more anxiety, and more depressive symptoms. Future research is required to look into the psychiatric issues that affect adolescents with PCOS.

Spontaneous ovarian hyperstimulation syndrome in a pregnant woman with hypothyroidism: a case report

ObjectiveTo study a rare case of spontaneous ovarian hyperstimulation syndrome in a naturally conceived pregnancy associated with overt hypothyroidism.DesignCase report.SettingEndocrinology private practice.Patient(s)A 32-year-old woman who was 13 weeks pregnant with bilaterally enlarged ovaries presumed to be secondary to hypothyroidism.Intervention(s)Administration of levothyroxine and titration of the dose.Main Outcome Measure(s)Regression of signs and symptoms of spontaneous ovarian hyperstimulation syndrome after 12 weeks of therapy.Result(s)The patient was diagnosed with severe hypothyroidism, as confirmed by her elevated thyroid-stimulating hormone level. Ultrasound evaluation revealed ovarian enlargement secondary to multiple contiguous cysts with anechoic content. The patient was administered levothyroxine 175 μg/day. Results of hormonal studies demonstrated thyroid function normality at week 12 after treatment. Incomplete regression of ovarian cysts was also noticed within this period. At week 37, the patient developed preeclampsia, and cesarean delivery was recommended. An 8-month postpartum ultrasound evaluation revealed complete regression of the cysts.Conclusion(s)Spontaneous ovarian hyperstimulation syndrome secondary to hypothyroidism may be the cause of ovarian enlargement, and levothyroxine replacement seems an appropriate primary therapeutic option. Proper endocrinological assessment of patients is recommended as it may avoid unfavorable outcomes.