Partial Oophorectomy Research Articles

A retrospective study of ovarian tissue cryopreservation in female patients with hematological diseases for fertility preservation.

To investigate the effect and safety of ovarian tissue cryopreservation (OTC) for fertility preservation in female patients with hematological diseases. We designed a retrospective study. The clinical data of patients with hematological diseases undergoing OTC admitted to Peking University People's Hospital from April 2017 to January 2023 were analyzed and summarized. A total of 24 patients were included in the study, including 19 patients with malignant hematological diseases and 5 patients with non-malignant hematological diseases. The former included 14 patients with acute leukemia, 1 patient with chronic leukemia, and 4 patients with myelodysplastic syndrome, while the latter 5 patients were aplastic anemia (AA). 16 patients had received chemotherapy before OTC. The average age of 24 patients was 22.80 ± 6.81years. The average anti-Mullerian hormone (AMH) was 1.97 ± 2.12ng/mL, and the average follicle-stimulating hormone (FSH) was 7.01 ± 4.24IU/L in examination before OTC. FSH was greater than 10.0IU/L in 4 cases. The pre-OTC laboratory tests showed that the average white blood cell (WBC) count was (3.33 ± 1.35) × 109/L, the average hemoglobin was 91.42 ± 22.84g/L, and the average platelet was (147.38 ± 114.46) × 109/L. After injection of recombinant human granulocyte colony-stimulating factor (rhG-CSF), blood transfusion, and iron supplementation in pre-OTC treatment, the average WBC count was (4.91 ± 3.07) × 109/L, the average hemoglobin was 98.67 ± 15.43g/L, and the average platelet was (156.38 ± 103.22) × 109/L. Of the 24 patients, 22 underwent laparoscopic bilateral partial oophorectomy and oophoroplasty, and 2 underwent laparoscopic unilateral oophorectomy. The average duration of OTC was 59.54 ± 17.58min, and the average blood loss was 32.1 ± 41.6mL. The maximum blood loss was 200mL. There was no significant difference in WBC count and hemoglobin concentration after OTC compared to pre-OTC period. Only the platelet count after OTC surgery was significantly different from that before surgery ([134.54 ± 80.84 vs. 156.38 ± 103.22] × 109/L, p < 0.05). None of the 24 patients had serious complications after OTC. 2 patients had mild infection symptoms, but both recovered well. 23 patients underwent hematopoietic stem cell transplantation (HSCT) after OTC. The median and interquartile range from OTC to the pretreatment of HSCT was 33 (57) days, and the median and interquartile range from OTC to HSCT was 41 (57) days. Seven of them began pretreatment of HSCT within 20days and began HSCT within 30days after OTC. All patients were followed up. Of the 23 patients who underwent HSCT after surgery, 22 presented with amenorrhea and 1 with scanty menstrual episodes. Seven patients underwent hormone replacement therapy (HRT) after HSCT. A patient with AA underwent ovarian tissue transplantation (OTT) 3years after HSCT and resumed regular menstruation 6months after OTT. Ovarian tissue cryopreservation has a promising future in fertility protection in patients with hematological diseases. However, patients with hematological malignancies often have received gonadotoxic therapy before OTC, which may be accompanied by myelosuppression while patients with non-malignant hematological diseases often present with severe hemocytopenia. So perioperative complete blood count of patients should be paid attention to. There was no significant difference in the WBC count and hemoglobin concentration in patients with hematological diseases before and after OTC surgery, and the platelet count decreased slightly within the normal range. Infection is the most common post-OTC complication, and HSCT pretreatment can be accepted as early as the 10th day after OTC. OTC has no adverse effects on patients with hematological diseases and does not delay HSCT treatment. For young patients with hematological diseases, OTC is an effective method of fertility preservation.

Effect of Two-Port Laparoscopic Surgery on Pregnancy Outcomes of Patients with Concurrent Adnexal Masses.

Adnexal masses are common in pregnancy, with 2–10% of pregnancies presenting with an ovarian mass and approximately 1–6% of these masses being malignant. For suspected malignancy or masses with symptoms, surgery must be performed as early as possible. We retrospectively investigated the effect of two-port laparoscopic surgery on the outcomes of patients with concurrent adnexal masses between 2012 and 2019 (including large mucinous tumor, large teratoma, serous borderline tumor, and heterotopic pregnancy). Laparoscopic right partial oophorectomy was performed for a 27 cm ovarian mucinous tumor at a gestational age (GA) of 21 weeks, laparoscopic right oophorocystectomy for an 18 cm teratoma at a GA of 10 weeks, and laparoscopic left salpingo-oophorectomy for a 7 cm serous borderline tumor at a GA of 7 weeks after ultrasonographic confirmation of an intrauterine gestational sac with a fetal heartbeat. Laparoscopic excision of a tubal pregnancy was performed in a heterotopic pregnancy at a GA of 12 weeks with massive internal bleeding. Laparoscopic surgery is easier and safe to perform during early pregnancy because a smaller uterus allows for superior visualization. All of these patients had optimal postoperative recovery and normal spontaneous delivery at term. We discussed several aspects of treatment and delivery, namely treatment option (expectant management or surgery), surgery timing (early or advanced pregnancy), surgery type (laparoscopy or laparotomy), and delivery route (normal spontaneous delivery or cesarean section), in patients with concurrent adnexal tumors and their effects on pregnancy outcomes.

P.005 Ovarian resection in anti-NMDAr encephalitis

Background: Anti-N-methyl-D-aspartate receptor encephalitis (NMDArE) is commonly associated with ovarian teratomas, surgical resection of which can lead to significant neurologic improvement. However, the necessity of aggressive resection at the time of diagnosis is unknown; specifically, whether unilateral or bilateral oophorectomy, versus lesionectomy and partial oophorectomy (ovariotomy), is required. Methods: Eleven patients with NMDArE who underwent ovarian resection between January 1st 2012 and December 31st 2020 were retrospectively identified. Primary outcome was good one-year functional status, defined as modified Rankin Scale (mRS) score of 0-1. Results: Median age at encephalitis onset was 24 years (19–38); median delay from symptom onset to surgery was 39 days (16–129). Six patients (54.5%) had good mRS scores, unrelated to surgical resection type. Conclusions: Added clinical benefit of aggressive ovarian resection techniques at one-year follow-up was not identified in our data. Further longitudinal studies are needed to determine the indications for different surgical techniques in patients with NMDArE. Ovarian resection approaches and associated functional outcomes in patients with NMDArE

O-062 In vitro maturation of oocytes in connection with ovarian tissue cryopreservation

Abstract Abstract text Discussing fertility preservation (FP) in young cancer patients has become a key component of routine oncological health care. Although ovarian stimulation followed by oocyte cryopreservation has been recommended in cases where two to three weeks are available before the start of chemotherapy, ovarian tissue cryopreservation (OTC) is the preferred option when this timeframe is not available and when the potential gonadotoxic impact of cancer therapy is deemed moderate or severe, or in prepubertal girls. During ovarian tissue processing in the laboratory, cumulus-oocyte complexes can be identified. In vitro maturation and further vitrification of oocytes retrieved in ex vivo from the extracted ovarian tissue (ovarian tissue oocytes in vitro maturation; OTO-IVM) can be attempted to enhance the future reproductive options of the patient. Although the number of reported live births after OTO-IVM are limited, this experimental FP procedure has potential to become a standard appended procedure in conjunction with OTC. In cancer patients with haematological tumours and ovarian invasion, or patients with primary tumours of the ovary, ovarian tissue grafting may be contraindicated because of the risk of reintroducing malignant cells. Utilisation of vitrified oocytes after OTO-IVM may be the only hope for genetic offspring for these patients. Moreover, exogenous hormonal pretreatment is not required and COC can be recovered during ovarian tissue processing in the majority of patients who undergo partial or total unilateral oophorectomy. Nevertheless, maturation rates after OTO-IVM vary and are generally lower compared to IVM of transvaginally harvested IVM oocytes; currently available IVM systems registered for clinical use will have to be adapted to accommodate the in vitro requirements of oocytes derived from extracorporeal ovarian tissue, and follow-up data are needed to assess the success rate and safety of this novel approach.

Ovarian Ectopic Pregnancy – A Case Report of Two Cases

Primary ovarian pregnancy occurs very rarely and usually in young women using intra uterine device. We present two case reports where young primigravida females presented with pain abdomen and were diagnosed as ectopic pregnancy on ultrasonography and confirmed on histopathology examination as Ovarian ectopic after partial oophorectomy.

Ovarian Pregnancy

Objective: To report cases of ovarian pregnancyMaterials and Methods: This article describes a case report of a 33 year old woman, with a diagnosis of Ovarian Pregnancy at 6-7 weeks gravid G2P0A1H0. The patient came to the emergency room Dr. M. Djamil Padang. The ultrasound examination gives the impression of an ectopic pregnancy in the right ampulla tube. After laparoscopy, an ectopic pregnancy was seen in the right ovary without bleeding. Right ovarian pregnancy impression. Partial Oophorectomy was performed and tissue evacuation with bleeding during the procedure ± 30 cc.Results: Patients receiving laparoscopic intervention showed an ectopic pregnancy in the right ovary without bleeding, the left ovary was within normal limits. Right ovarian pregnancy impression. Partial Oophorectomy was performed and tissue evacuation with bleeding during the procedure ± 30 cc. The tissue was examined for histology of anatomic pathology.Conclusion: Ovarian pregnancy is one of the rarest forms of ectopic pregnancy, it is sometimes difficult to diagnose because it can be confused with tubal ectopic pregnancy or hemorrhagic ovarian cyst. Pregnancy ovaries can rupture in the first trimester of pregnancy.Keywords: Ovarian Pregnancy, Laparoscopy, Partial Oophorectomy

Premature ovarian aging in BRCA carriers: a prototype of systemic precocious aging?

PurposeThough former evidence implies a correlation of breast cancer susceptibility gene (BRCA) mutation with reduced ovarian reserve, the data is yet inconsistent. Our aim was to investigate biomarkers of ovarian aging in a cohort of young healthy carriers of the BRCA mutation. We hypothesized that the role played by BRCA genes in aging pathways is not exclusive to the ovary.Experimental DesignHealthy female BRCA carriers, 40 years or younger and healthy male BRCA carriers, 50 years or younger, were enrolled in the study. Serum anti-mullerian Hormone (AMH), fibroblast growth factor-23 (FGF-23), Klotho and IL-1 were measured by enzyme-linked immunosorbent assay (ELISA). Ovarian AMH and protein kinase B (AKT) mRNA from BRCA carriers who underwent prophylactic oophorectomy and from age-matched, healthy, non-carriers who underwent partial oophorectomy due to benign conditions were analyzed by qPCR.ResultsThirty-three female (median age 35y) and 20 male (44y) BRCA carriers were enrolled into the study and matched to control non-carriers (34y and 43y, respectively). Serum AMH level was significantly lower in BRCA female carriers than in both non-carrier controls and age-matched nomograms. The levels of ovarian AMH and AKT mRNA were significantly lower in carriers than in controls. The systemic aging cytokines FGF-23, klotho and IL-1 displayed a differential expression in carriers of both genders. FGF-23 level was higher in carriers (P=0.06).ConclusionsOur results suggest a link between BRCA mutation, accelerated ovarian aging and systemic aging-related pathophysiology.

Laparoscopic treatment of ovarian dermoid cysts

Objectives:Dermoid cyst which is also known as benign or mature cystic teratoma is a common disease and accounts about 21.8% of all ovarian tumors.They areone of the most common tumors in women during the reproductive yearsand they are not uncommon during pregnancy. They are mostly benign in nature but surgery is needed to relief of symptoms and to prevent complications.In the recent years, the laparoscopic approach have greatly replaced most of the gynaecological operation and specially in benign ovarian diseases as it improved significantly the outcome of these lesions.Aim of the study: reviewing the laparoscopic management of ovarian dermoid cysts and assessing the intra-operative complications, and early postoperative follow-up.Material and MethodA prospective study of 43 patient who underwent laparoscopic management of ovarian dermoid cysts.The patients are presented either with acute symptoms like pain , vaginal bleeding or chronic symptoms like abdominal pain or menstrual irregularities. This suspicion is documented by pelvic ultrasound . then the patients are qualified for laparoscopic management under general anasthesia.Results:A total of 43 women with ovarian dermoid cyst were included and treated laparoscopically . the main age is 31.31 years.Mean cyst diameter size that was measured by ultrasound was 7.24. they are bilateral in 28 % of cases. Patient age and size of cyst did not differ between those with left and right lesions.Cystectomy with enuculation of the cyst was the most commonly applied procedure , while total adnexectomy and partial oophorectomy was the least frequent.The whole gonad was removed in one postmenopausal patients.The mean duration of the operation was 53.48 minutes (± 20.61; range 35-120 ).The total number of days in the hospital excluding the period of preoperative examination (generally 1 day) was 2.54 days.All the extracted material was submitted for a final histopathological examination.Intra-operatively;a minimal spillage occurred in 18 casesand rupture of retrieval bag occurred in 2 cases but none developed post-operative chemical peritonitis.In two cases we discover bleeding from the left ileac fossa 5 mm port .Port site infections were noted in six patient.No case of postoperative peritonitis was recorded. There was one case of post-operative paralytic ileus.Discussion:Laparoscopic removal of ovariandermoid cysts has increased in the last few years. But this need aproper early qualification, based on medical history, gynaecological and sonographic examination to assure the benignity of these lesions although malignant transformation of these benign lesion is rare and it is a contra-indication to the laparoscopic treatment.611Dermoid cysts occur not often during pregnancy, but caused their complications ( high risk of torsion and rupture ) demand immediate surgical interventionLaparoscopic treatment consist of total cyst excision with preservation of the remaining ovarian tissue but partial oophorectomy or total oophorectomy can be indicated if there is suspected area specially in post-menopausal women .Laparoscopic treatment of ovarian dermoid cyst may be complicated with port site haemorrhage , intra –peritoneal spillage of the cyst content and post-operative paralytic ileus . these are mostly minimal and can be managed conservatively.Conclusion:We concludes that the minimal access surgical treatment through the laparoscopic ovariandermoid cystectomy is a safe and beneficial method in selected patients. It offers the advantages of shorter hospital stay, and better cosmetic result in comparison to classical surgery.

The Relationship between Intraoperative Rupture and Recurrence of Pediatric Ovarian Neoplasms: Preliminary Observations

Study ObjectiveWe investigated whether rupture increased the recurrence rate of pediatric ovarian neoplasms. Design20-year single-institution retrospective study. SettingTertiary, free-standing, university children's hospital. ParticipantsAll girls with ovarian neoplasms treated during between 1991 and 2011. Main Outcome MeasureTumor recurrence. ResultsFifty-nine tumors in 53 patients were managed, including 51/59 (86%) benign and 8/59 (14%) malignant. Laparotomy was employed in 44/59 (75%), laparoscopy in 8/59 (14%), and laparoscopy converted to laparotomy in 7/59 (12%). Total and partial oophorectomy (cystectomy) was used for 15/51 (29%) and 36/51 (71%) of benign tumors, respectively. All malignant tumors underwent total oophorectomy. Accidental rupture or intentional tumor puncture occurred in 26/56 cases (46%), 23/51 benign and 3/5 malignant. Rupture was associated with increasing cyst size on univariate and multivariate analyses (p = 0.002 and p = 0.004, respectively). There were 5 recurrences (9%) in 4 patients, including 4 benign (3 mature teratomas, 1 mucinous cystadenoma), and 1 malignant yolk sac tumor. Recurrence occurred in 2/30 (7%) without rupture and 3/26 (12%) with rupture, p = 0.66. Follow-up was available for 50/53 patients (94%), with a median of 23.8 months [range 0.2-189 months]. All recurrences were salvaged by surgery. ConclusionsIn this limited study, intra-operative rupture did not increase the recurrence rate or worsen the prognosis of pediatric ovarian neoplasms.

Laparo-Endoscopic Single Site Surgery of Concomitant Left Adrenalectomy, Leftc, and Bilateral Partial Oophorectomy in a Woman

Aim: We reported one case who received laparo-endoscopic single site (LESS) surgery for the left adrenal gland, left kidney, and bilateral ovarian cysts. Method: The patient was a 43 year-old female who had a left adrenal tumor, atrophic left kidney with severe hydronephrosis, and bilateral ovarian cysts. We placed a LESS device with 4 working ports through a para-umbilical wound of 3 cm in length. We concomitantly performed a left adrenalectomy, left nephroureterectomy, and bilateral partial oophrectomy with the patient lying on her right side. Results: There were no peri-operative and post-operative complications, and an extra incision was unnecessary. The patient was discharged 5 days after the operation. Discussion: LESS surgery for three concomitant operations with an un-changed position is feasible and safe. Conclusion: This is the first report of three concomitant procedures through one incision, which greatly decreases the number of wounds.

English

BACKGROUND: Ovarian pregnancy is seen rarely. Diagnosis is based on criteria established in 1878 by Spiegelberg. It is often done during surgery and requires histological consideration. The condition has not been reported locally and its diagnosis is easily missed. CASE: A 26 Years old women, primigravida with history of pulmonary tuberculosis in past presented with acute abdomen and clinical picture suggestive of ectopic pregnancy. Ultrasound showed a complex right adnexal mass. On exploration, was found to be ruptured ovarian pregnancy. Right partial oophorectomy was done. Histopathology report confirmed the diagnosis of ovarian ectopic. CONCLUSION: Ovarian ectopic is rarest of the rare condition which present late and is hazardous for the reproductive status of a women. INTRODUCTION: Primary ectopic ovarian pregnancy is seen rarely. The incidence of such pregnancies varies from 0.001% to 0.013% of normal pregnancies and from 0.17% to 1% of ectopic pregnancies. 1 A rare case of primary ovarian ectopic on antituberculous treatment for pulmonary Koch's made it still rarer and prompted us to report this case.

Occupational exposure and ovarian cancer risk.

Relatively little work has been done concerning occupational risk factors in ovarian cancer. Although studies conducted in occupational settings have reported positive associations, their usefulness is generally limited by the lack of information on important confounders. In a population-based case-control study, we assessed risk for developing epithelial ovarian cancer (EOC) associated with occupational exposure while accounting for important confounders. Participants were identified through provincial population-based registries. Lifetime occupational history and information on potential confounding factors were obtained through a self-administered questionnaire. Unconditional logistic regression and the likelihood ratio test were used to assess EOC risk with each occupation (or industry), relative to all other occupations (or industries), adjusting for potential confounders including body mass index, oral contraceptive use, menopausal hormone therapy, parity, age at first childbirth, age at menarche, age at menopause, family history of breast and ovarian cancer in mother and sister(s), tubal ligation, partial oophorectomy, and hysterectomy. Occupations and industries were coded according to the Canadian Standard Occupational Classification (SOC) and Standard Industrial Classification (SIC). Significant excess risk was observed for several groups of teaching occupations, including SOC 27, teaching and related (adjusted OR 1.77, 95% CI 1.15-2.81) and SOC 279, other teaching and related (adjusted OR 3.11, 95% CI 1.35-8.49). Significant excess was also seen for a four-digit occupational group SOC 4131, bookkeepers and accounting clerks (adjusted OR 2.80, 95% CI 1.30-6.80). Industrial sub-groups showing significant excess risk included SIC 65, other retail stores (adjusted OR 2.19, 95 % CI 1.16-4.38); SIC 85, educational service (adjusted OR 1.45, 95% CI 1.00-2.13); and SIC 863, non-institutional health services (adjusted OR 2.54, 95% CI 1.13-6.52). Our study found an elevated EOC risk for teaching occupations and is the first study to observe such an increased risk after adjustment for potential confounders. Further studies with more detailed assessment of the work environment and unique lifestyle characteristics may be fruitful in elucidating this etiology.

Cryoconservation ovarienne : évaluation de deux techniques chirurgicales

ObjectivesTo evaluate various surgical techniques for partial oophorectomy cryopreservation. To evaluate the consequences of prior exposure to cytotoxic therapy on the quality of the ovary removed. Patients and methodsSingle center retrospective observational study over 4 years of women who had ovarian cryopreservation surgery for chemotherapy or radiotherapy which were at high risk of premature ovarian failure. Several techniques have been proposed: partial oophorectomy with clamping of the vascular gonadal pedicle (indirect tissue sample) without clamping (direct tissue sample) and partial oophorectomy with an automatic stapler. Ovarian tissue was immediately prepared for cryopreservation in the operating theatre. The whole sample was divided into small slices. For each ovary, a count of small slices was made. Additionally, one slice was examined to determine the presence of primordial follicles. ResultsOvary was successfully removed and cryopreserved in 13 patients. Two bleeding events occurred with the direct technique, without consequences for patients. The number of fragments obtained between indirect and direct techniques was respectively 19 vs 15, P=0.18; the number of primordial follicles was 38 vs 36, P=0.87. The automatic stapler consumed too much ovarian tissue to be interesting. There were fewer fragments, 15 vs 20, P<0.05 and primordial follicles, 35 vs 40, P=0.65, after a first cycle of chemotherapy. Discussion and conclusionThe vascular clamping technique is safer but with no difference in the quality of the sample tissue. One cycle of chemotherapy has a pejorative impact on the quality of the sample tissue.

Desmoplastic Medulloblastoma Arising From an Ovarian Teratoma

The primary neuroectodermal tumor of the ovary is extremely rare, and it manifests in 3 forms: differentiated, primitive, and anaplastic. The medulloblastoma belongs to the subgroup of primitive neuroectodermal tumor of the ovary. Only 3 cases of ovarian medulloblastoma have been reported in the literature, and all of them are presented without information about the specific pathological subtype. We present the fourth case of a 26-year-old woman who presented with abdominal fullness for months. Ultrasound exam showed a right adnexal mass with cystic feature and foci solid components. A partial oophorectomy was performed, and the mass was a desmoplastic medulloblastoma arising from an ovarian teratoma.

A Complicated Hematometra and Fallopian Tubal Occlusion in Uterine Didelphys With Unilateral Cervical Atresia

Uterine anomalies are uncommon Mullerian malformations without known etiology. Many hypotheses have been put forward to explain these anomalies such as the involvement of genetic, environmental, and pharmacological issues [1]. The incidence is reported to be between 0.5–5.0% of all women [2]. However, a congenital uterine anomaly involving cervical atresia is extremely rare. We report a patient, diagnosed with a uterine anomaly, who underwent a primary laparotomy for unilateral endometrioma without resectioning of the rudimentary horn. Postoperatively, the patient received 6 months of gonadotropin-releasing hormone agonist (GnRHa) treatment as a conservative therapy. After completion of the GnRHa therapy, endometriosis recurred and a hematometra developed. This occurred after her menstrual cycle had resumed for 3 months post GnRHa treatment. The patient underwent a second laparotomy and the rudimentary horn was resectioned. Recovery after the operation was uneventful. The final diagnosis of the uterine anomaly in this patient was uterine didelphys with unilateral cervical atresia. A 23-year-old nulligravid woman had complained of dysmenorrhea since menarche at the age of 14 years in 1999 and this had been partially relieved with medical management. At the age of 22 years during April 2007, the patient presented with acute abdominal pain in the left lower quadrant, in which an abdominal mass was palpable. Pelvic ultrasonography by a primary gynecologist revealed a 10 × 10 × 10 cm complex mass of the left adnexa with multiple cysts and septa. A bimanual pelvic examination showed a single vagina and single cervix. Computed tomography (CT) revealed a multicystic mass associated with the left ovary, possibly endometrioma, and two uterine horns indicating the possibility of a bicornuate uterus (Figures A and B). The right kidney was enlarged and the left kidney was absent. An elevated serum CA-125 level of 8,640 U/mL was noted. The patient underwent exploratory laparotomy by the primary gynecologist. The findings included a 10 cm left ovarian endometrioma, severe endometriosis involving the cul-de-sac and the pelvis, as well as layering of hemosiderin throughout the uterine horns, the pelvis and the omentum. Fibrous adhesions involving the sigmoid colon, small intestine and pelvic sidewall were also noted. The right uterine horn and the right fallopian tube were normal in appearance; a right ovary could also be identified. The uterine anomaly was thought to be a bicornuate uterus. Left partial oophorectomy and lysis of the adhesions were performed. The pathological findings revealed ovarian endometrioma and endometriotic cysts that had endometrial epithelium and hemosiderin-laden macrophages. Postoperatively, the patient recovered quickly and was prescribed 6 months of GnRHa therapy.

Oophorectomy, hormone therapy, and subclinical coronary artery disease in women with hysterectomy

Surgical menopause has been associated with an increased risk of coronary heart disease events. In this study, we aimed to determine the associations between coronary artery calcium (CAC) and hysterectomy, oophorectomy, and hormone therapy use with a focus on the duration of menopause for which there was no hormone therapy use. In a substudy of the Women's Health Initiative placebo-controlled trial of conjugated equine estrogens (0.625 mg/d), we measured CAC by computed tomography 1.3 years after the trial was stopped. Participants included 1,064 women with previous hysterectomy, aged 50 to 59 years at baseline. The mean trial period was 7.4 years. Imaging was performed at a mean of 1.3 years after the trial was stopped. Mean age was 55.1 years at randomization and 64.8 years at CAC measurement. In the overall cohort, there were no significant associations between bilateral oophorectomy, years since hysterectomy, years since hysterectomy without taking hormone therapy (HT), years since bilateral oophorectomy, and years of HT use before Women's Health Initiative enrollment and the presence of CAC. However, there was a significant interaction between bilateral oophorectomy and prerandomization HT use for the presence of any CAC (P = 0.05). When multivariable analyses were restricted to women who reported no previous HT use, those with bilateral oophorectomy had an odds ratio of 2.0 (95% CI: 1.2-3.4) for any CAC compared with women with no history of oophorectomy, whereas among women with unilateral or partial oophorectomy, the odds of any CAC was 1.7 (95% CI: 1.0-2.8). Among women with bilateral oophorectomy, HT use within 5 years of oophorectomy was associated with a lower prevalence of CAC. Among women with previous hysterectomy, subclinical coronary artery disease was more prevalent among those with oophorectomy and no prerandomization HT use, independent of traditional cardiovascular disease risk factors. The results suggest that factors related to oophorectomy and the absence of estrogen treatment in oophorectomized women may be related to coronary heart disease.

AP-2-dependent Internalization of Potassium Channel Kir2.3 Is Driven by a Novel Di-hydrophobic Signal

The localization and density of Kir2.3 channels are influenced by the balance between PDZ protein interaction at the cell surface and routing into the endocytic pathway. Here, we explore mechanisms by which the Kir2.3 channel is directed into the endocytic pathway. We found that Kir2.3 channels are constitutively internalized from the cell surface in a dynamin-dependent manner, indicative of vesicle-mediated endocytosis. The rate of Kir2.3 endocytosis was dramatically attenuated following RNA interference-mediated knockdown of either alpha adaptin (AP-2 clathrin adaptor) or clathrin heavy chain, revealing that Kir2.3 is internalized by an AP-2 clathrin-dependent mechanism. Structure-rationalized mutagenesis studies of a number of different potential AP-2 interaction motifs indicate that internalization of Kir2.3 is largely dependent on a non-canonical di-isoleucine motif (II413) embedded within the C terminus. Internalization assays using CD4-Kir2.3 chimeras demonstrate that the di-isoleucine signal acts in an autonomous and transplantable manner. Kir2.3 co-immunoprecipitates with alpha adaptin, and disruption of the di-isoleucine motif decreased interaction of the channel with AP-2. Replacement of the di-isoleucine motif with a canonical di-leucine internalization signal actually blocked Kir2.3 endocytosis. Moreover, in yeast three-hybrid studies, the Kir2.3 di-isoleucine motif does not bind the AP-2 alphaC-sigma2 hemicomplex in the way that has been recently observed for canonical di-leucine signals. Altogether, the results indicate that Kir2.3 channels are marked for clathrin-dependent internalization from the plasma membrane by a novel AP-2-dependent signal.

Ovarian tissue cryopreservation in hematologic malignancy: Ten years' experience

Cryopreservation of ovarian tissue is currently practiced in an attempt to preserve fertility before commencing potentially sterilizing chemotherapy. Clinical and laboratory guidelines are needed to standardize the procedure. Over the last 10 years ovarian tissue was stored in female patients with hematologic malignancies. Patients' records and consultation charts were evaluated, surgical and laboratory reports were revised and ovarian histology was investigated. Fifty-six patients with hematologic malignancies (age 24 ± 5.5) had cryopreserved ovarian tissue. Thirty-three patients had Hodgkin's disease, 14 non-Hodgkin's lymphoma, 6 acute leukemia, and 3 chronic myelocytic leukemia. Harvesting of ovarian tissue was also performed following previous exposure to chemotherapy (33 patients), 13 of them shortly after the chemotherapy. Partial oophorectomy was the preferred surgical procedure. Fertility was restored with ovarian tissue transplantation in a sterilized patient and following fertility treatment in a patient with very low ovarian reserve. We recommend that indications and timing of ovarian tissue banking should be individualized. Patients previously exposed to chemotherapy can consider ovarian tissue freezing. The extent of tissue removed should take into account the large number of follicles lost and the risk of future sterilization. Tissue handling should enable further investigation of primordial follicles and identification of cancer cells.

Laparoscopic management of ovarian dermoid cysts: a review of 47 cases

BackgroundMature cystic teratomas, often referred to as dermoid cysts, are the most common germ cell tumors of the ovary. In the recent years, transvaginal sonographic diagnosis of ovarian dermoid cysts together with laparoscopic approach have greatly improved the treatment of this benign lesion. We retrospectively reviewed the outcome of laparoscopic surgery for suspected ovarian dermoid cysts.Patients and MethodsThe preoperative findings, operative techniques and post-operative complications were retrospectively reviewed in women who underwent laparoscopic surgery for dermoid cysts, between January 2000 and May 2003.ResultsIn 47 women aged 21 to 53 years (median, 38.8 years), 93.6% had a unilateral cyst with a diameter of 17 to 108 mm (median, 51 mm). Clinical presentations were pain (62%), abnormal vaginal bleeding (21%) and ovarian torsion (2%), whilst 17% were diagnosed incidentally during routine examination. Surgery included cystectomy (57%), total (36%) or partial oophorectomy (6.4%) and laparoscopy-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy (2%). During the cyst extraction, minimal spillage occurred in 42.5% of the cases and none developed chemical peritonitis. In 2 patients, conversion to laparotomy (4.3%) was required, one for sigmoid colon injury and one for malignant ovarian tumor detected via frozen section. The median operating time was 80 minutes (range, 35–180 minutes).ConclusionUsing strict adherence to guidelines for preoperative clinical assessment and intra-operative management, laparoscopic treatment of dermoid cysts appears to be a safe procedure.

Ovarian torsion following gonadotropin therapy: a case report

Background: Ovarian torsion is a potential complication of gonadotropin stimulation, which prompts practitioners to caution patients against strenuous activity during the stimulation cycle. Patients who do not conceive are typically not monitored in the subsequent cycle unless they plan back-to- back gonadotropin stimulation. Objective: We describe a patient who developed ovarian torsion while exercising during the natural cycle following a failed gonadotropin cycle. Materials and Methods: Case report Results: A 38-year-old G1P1 underwent a gonadotropin/IUI cycle which resulted in 2 follicles on each ovary. The cycle was unsuccessful and the patient was found to have persistent cysts on a baseline ultrasound which led to the cancellation of the next gonadotropin cycle. Two weeks later, while the patient was participating in a kickboxing class, she began experiencing severe pelvic and abdominal pain, which was attributed to abdominal wall sprain by the Urgent Care physician. Over the next 2 weeks the patient had intermittent abdominal pain. She reported to her gynecologist for another baseline ultrasound after her subsequent period, in order to begin a new gonadotropin cycle. She was then noted to have an enlarged left ovary measuring 7 × 8 × 10cm. A laparoscopy was performed and showed a torsed left ovary with 80% necrosis. A partial oophorectomy was performed to remove the necrotic portion. A recent ultrasound revealed a 20 × 15mm left ovary with 3 antral follicles present. Conclusion: A significant proportion of patients who fail gonadotropin stimulation take a break before undergoing a repeat cycle, either by choice or due to persistent cysts. These women typically resume normal activities which often include exercise during this drug-free cycle. This report suggests that the risk of ovarian torsion persists beyond the treatment cycle and that patients should limit strenuous activity if regression to normal ovarian size has not been documented. Ovarian torsion should remain high on the differential diagnosis of abdominal pain following a gonadotropin cycle.