Biomedical subjects

Ioannis E Messinis

Publications and source records attributed to Ioannis E Messinis.

11 recordsLinked to original sources

PubMed2006

Live birth after laparotomy for concurrent heterotopic pregnancy and appendicitis in a 6 weeks IVF pregnancy.

BACKGROUND: A term delivery after concurrent appendectomy and salpingectomy at 6 weeks in an appendicitis coexisting with a heterotopic pregnancy after in vitro fertilization (IVF) treatment is reported. METHODS: Case report. RESULTS: The patient presented with severe low abdominal pain at 6 weeks of pregnancy after IVF and had explorative laparotomy for appendicitis, during which she had appendectomy and salpingectomy for an undiagnosed concurrent heterotopic pregnancy. The patient delivered a 3,960 g healthy infant at 38 weeks. CONCLUSION: In patients with severe abdominal pain after IVF, appendicitis and heterotopic pregnancy should be included in the differential diagnosis. A dual pathology is possible and when treated appropriately it can result in survival of the precious intrauterine pregnancy. This is the second and earliest ever reported case of that resulted in live birth. It shows that explorative surgery must be performed timely in acute abdomen in pregnancy.

Adult↗

PubMed2006

Ovarian feedback, mechanism of action and possible clinical implications.

The secretion of gonadotrophins from the pituitary in women is under ovarian control via negative and positive feedback mechanisms. Steroidal and non-steroidal substances mediate the ovarian effects on the hypothalamic-pituitary system. During the follicular phase of the cycle, estradiol (E(2)) plays a key role, while circulating progesterone (at low concentrations) and inhibin B contribute to the control of LH and FSH secretion respectively. During the luteal phase, both E(2) and progesterone regulate secretion of the two gonadotrophins, while inhibin A plays a role in FSH secretion. The intercycle rise of FSH is related to changes in the levels of the steroidal and non-steroidal substances during the luteal-follicular transition. In terms of the positive feedback mechanism, E(2) is the main component sensitizing the pituitary to GnRH. Activity of a non-steroidal ovarian substance, named gonadotrophin surge-attenuating factor (GnSAF), has been detected after ovarian stimulation. It is hypothesized that GnSAF, by antagonizing the sensitizing effect of E(2) on the pituitary, regulates the amplitude of the endogenous LH surge at midcycle. Disturbances in the feedback mechanisms can occur in various abnormal conditions or after treatment with pharmaceutical compounds that interfere with the production or the action of endogenous hormones.

Estradiol↗

PubMed2006

Novel serum inflammatory markers in patients with adnexal mass who had surgery for ovarian torsion.

OBJECTIVE: To determine the diagnostic value of preoperative levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8), and E-selectin in patients with an adnexal mass who had surgery for ovarian torsion. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Fifty consecutive women with adnexal mass who were admitted with a diagnosis of ovarian torsion. INTERVENTION(S): All had a single preoperative measurement of IL-6, IL-8, TNF-alpha, and E-selectin by ELISA. MAIN OUTCOME MEASURE(S): To determine if a single preoperative serum sampling of IL-6, IL-8, TNF-alpha, and E-selectin by ELISA can diagnose ovarian torsion. RESULT(S): Thirteen patients had proven torsion of the ovary. Serum levels of IL-6 were significantly higher in the 13 patients with proven ovarian torsion compared with the 37 without ovarian torsion. Patients with IL-6 serum values > or =10.2 pg/mL had a 16 times higher risk of having ovarian torsion. No significant difference was found in TNF-alpha, IL-8, and E-selectin between the two groups. CONCLUSION(S): The IL-6 levels might assist in the prompt diagnosis of ovarian torsion and allow a timely surgical intervention.

Adnexal Diseases↗

PubMed2006

Uterine perforation as a rare complication of attempted pregnancy termination with misoprostol: a case report.

BACKGROUND: Abortion induced by drugs is now a viable alternative to surgically induced abortion, but it can cause severe complications. CASE: Products of conception were found in the peritoneal cavity after administration of misoprostol. CONCLUSION: The administration of misoprostol for pregnancy termination should be performed carefully in women with uterine wall defects.

Abortifacient Agents, Nonsteroidal↗

PubMed2005

Ovulation induction: a mini review.

Ovulation induction is the method for treating anovulatory infertility. For patients with hypogonadotrophic hypogonadism, the treatment involves administration of both FSH and LH, while HCG is injected for follicle rupture. Pulsatile GnRH has the same effectiveness as gonadotrophins and the advantage of the low multiple pregnancy rate. In polycystic ovary syndrome (PCOS), the first treatment choice is clomiphene citrate. With this drug, in properly selected patients, the cumulative pregnancy rate approaches that of normal women. Low-dose protocols of FSH are the second line of treatment, effective in inducing monofollicular development. Laparoscopic ovarian drilling can be an alternative but not as a first choice treatment in clomiphene-resistant patients. Other treatments, such as pulsatile GnRH and GnRH agonists, are hardly used today in PCOS. However, in obese women with PCOS, weight loss and exercise should be recommended as the first line of therapy. Newer agents including aromatase inhibitors and insulin sensitizers, although promising, need further evaluation.

Aromatase Inhibitors↗

PubMed2005

Recombinant human erythropoietin in a triplet pregnancy: a case report.

BACKGROUND: Women carrying triplets are at greater risk for both anemia, due to the increased demands of the developingfetuses, and peripartum hemorrhage. Jehovah's witnesses are a unique obstetric population since women of this faith refuse blood transfusion. CASE: A Jehovah's Witness with a triplet pregnancy was successfully administered recombinant human erythropoietin (rHuEpo), 200 IU/kg 3 times per week subcutaneously, in order to correct her peripartum anemia. No side effects were observed during rHuEpo therapy, and the patient delivered healthy triplets. CONCLUSION: rHuEpo can be safely administered, with a beneficial effect in pregnancy, and seems to be an effective option in preventing transfusions as demonstrated in this case in a Jehovah's Witness.

Adult↗

PubMed2004

What is the most relevant standard of success in assisted reproduction? Should BESST really be the primary endpoint for assisted reproduction?

A major problem in IVF procedures is a high rate of induced iatrogenic complications including multiple gestations. Until now, transfer of at least three embryos followed by the subsequent elective reduction of triplet or higher order gestations to twins, single embryo transfer (SET) with cryopreservation of the remaining embryos, as well as the application of SET in unstimulated cycles, serves to illustrate the diversity characterizing the worldwide effort of achievement of pregnancy that aims to avoid possible complications. The BESST (birth emphasizing a successful singleton at term) endpoint constitutes an interesting parameter imposing the safety of SET. However, the observed success rate (11.1%) requires elucidation of the specific pattern of endometrial behaviour around the implantation window as well as its involvement in the further support of gestation. Consequently, research has to focus primarily on the improvement of technical parameters to achieve an acceptable success rate during the IVF procedures as compared with spontaneous gestations.

Embryo Transfer↗

PubMed2004

The recombinant subdomain IIIB of human serum albumin displays activity of gonadotrophin surge-attenuating factor.

BACKGROUND: Gonadotrophin surge-attenuating factor (GnSAF) is an as yet unidentified ovarian factor that acts on the pituitary to attenuate the pre-ovulatory LH surge. In a previous study, GnSAF bioactivity was proposed to derive, at least in part, from a C-terminal domain (95peptide) of human serum albumin (HSA). METHODS AND RESULTS: We employ here the expression-secretion system of Pichia pastoris to produce and assay selected recombinant polypeptides of HSA for GnSAF activity. We show that the C-terminal 95peptide of HSA (residues 490-585; subdomain IIIB) can be expressed from P.pastoris in secreted form and supernatants from clones expressing this polypeptide reduce the GnRH-induced LH secretion of primary rat pituitary cultures by 50-82%. When expressed in the same system, HSA domain III (residues 381-585) or full-length HSA (residues 1-585) are inactive. The bioactive subdomain IIIB is also separable from either domain III or full-length HSA on Blue Sepharose chromatography. CONCLUSIONS: Taken together, the findings highlight the putative importance of HSA subdomain IIIB as a GnSAF-bioactive entity and introduce a unique experimental tool to engineer this molecule for structure-function analysis.

Animals↗

PubMed2004

Ovulation induction and successful pregnancy outcome in two patients with Prop1 gene mutations.

OBJECTIVE: To describe ovulation induction and pregnancy outcome in a unique model of genetically determined combined pituitary hormone deficiency (CPHD), with respect to the necessity for GH substitution therapy. DESIGN: Case report. SETTING: Academic units. PATIENT(S): Two patients with childhood onset of CPHD (GH, PRL, TSH, LH, FSH) caused by a genetic defect (GA296del mutation) of the Prop1 gene. MAIN OUTCOME MEASURE(S): Ovulation, pregnancy outcome, and fetal growth. RESULT(S): Successful pregnancy outcome and delivery of normal, full-term newborns were achieved in both patients with the use of gonadotropins and L-T(4). Growth hormone supplementation was not necessary. No lactation was observed. CONCLUSION(S): Patients with Prop1 gene mutations constitute a unique model for studying the role of GH and PRL in ovulation, pregnancy, and fetal growth. Our data indicate that for women with CPHD, ovulation and pregnancy are possible with a classic regimen for hypogonadotropic hypogonadism, without the need for GH substitution therapy.

Adolescent↗

PubMed2003

Modulatory effect of the ovary on LH secretion.

Ovarian steroids are important regulators of gonadotropin secretion during the normal menstrual cycle. Estradiol is the predominant factor in the follicular phase, while progesterone plays an important role in the luteal phase. Gonadotropin surge attenuating factor (GnSAF) is a nonsteroidal ovarian substance that attenuates the endogenous LH surge in superovulated women. Attempts to purify GnSAF from various sources have provided several sequences. In human follicular fluid, GnSAF is shown to be the carboxyl terminal fragment of human serum albumin (HSA) and a molecular mass of 12.5 kDa. Preliminary data have shown the expression of the carboxyl terminal fragment of HSA in human granulosa cells. In vivo studies have provided evidence that GnSAF may participate in the control of LH response to GnRH in the context of a mechanism that facilitates the full expression of the midcycle LH surge. Further research is expected to clarify the role of GnSAF in women's physiology.

Adolescent↗

PubMed2002

Evidence of differential control of FSH and LH responses to GnRH by ovarian steroids in the luteal phase of the cycle.

BACKGROUND: It is known that during the follicular phase of the cycle, estradiol sensitizes the pituitary to GnRH. The aim of this study was to determine the role of ovarian steroids in the control of GnRH-induced gonadotrophin secretion in the luteal phase of the cycle. METHODS: Eighteen normally cycling women were studied during the week following bilateral ovariectomy plus hysterectomy performed in early to mid-luteal phase. Six of the women received no hormonal treatment post-operatively (group 1, control), six received estradiol through skin patches (group 2) and the remaining six received estradiol plus progesterone (group 3). In all women the response at 30 min of LH (deltadeltaLH) and FSH (deltadeltaFSH) to GnRH (10 microg i.v.) was investigated on a daily basis. RESULTS: In group 1, serum FSH, LH and deltadeltaFSH values increased progressively following ovariectomy, while in groups 2 and 3 this increase was postponed or abolished. In contrast to deltadeltaFSH, deltadeltaLH values showed the same pattern of changes in all three groups with a significant decline up to post-operative day 4 and a gradual increase thereafter. CONCLUSIONS: These results demonstrate, for the first time, that in the early to mid-luteal phase of the cycle, estradiol and progesterone participate in the control of GnRH-induced FSH, but not LH, secretion. It is possible that in the luteal phase, the response of LH to GnRH is partly regulated by gonadotrophin surge attenuating factor.

Adult↗