Dissertations / Theses on the topic 'Ovarian cysts'

Ovarian cysts are a cause of reproductive failure and economic loss in postpartum dairy cows. Using a unique combination of research to approach this problem, this thesis aimed to better understand mechanisms of ovarian cyst formation. The use of progesterone as a tool in cyst diagnosis was initially examined. Results demonstrated that 13/30 (43%) cows had progesterone profiles that disagreed with veterinarian diagnosis. Furthermore treatment in 21/30 (70%) cows was ineffective within 4 weeks of administration, and no pregnancy was established earlier than 8 weeks post treatment in all cows. When veterinarian and hormonal diagnosis agreed pregnancy was achieved, on average, two weeks earlier than when they disagreed. Effects of cow management, specifically the NEB experienced during late gestation and early lactation were investigated to determine whether these increased requirements resulted in the development of ovarian cysts. Results demonstrated that from early lactation all 85 cows were in a state of NEB. Ovarian cysts were confirmed in 31/79 cows, and these cows had significantly higher or lower peripheral concentrations of some metabolites, vs. no-cyst cows. Long term down-regulation with a GnRH agonist, followed by a period of observation to monitor the recovery of reproductive function, was conducted for evaluation as a potential model for ovarian cyst formation. Results indicated that 6/12 cows exhibited an LH surge within 104 hours of luteal regression while 6 animals did not (P<0.001). FSH concentrations in 6/12 cows showed divergence comparable with LH surges. 8/12 had at least 1 follicle >8mm and 5/12 had at least 1 follicle >20 mm. Follicle appearance was heterogeneous, with 63% of follicles showing some degree of luteinisation. Positive immunostaining for steroidogenic enzymes was detected in 12.5% of follicles. In conclusion, these results have important clinical significance in improving the diagnosis and management of ovarian cysts in dairy cows.

Objetivo: O objetivo deste estudo foi avaliar em mulheres com tumores císticos de ovário, a proporção que, somente com o tratamento clínico e/ou punção, não necessitaram de cirurgia; a influência da medicação e das doenças associadas na indicação de cirurgia e se a punção reduziu significativamente o tamanho dos cistos. Casuística e métodos: Selecionaram-se 71 mulheres com idade entre 19 e 70 anos de idade, portadoras de tumores císticos de ovário maior que 5 cm, com características de benignidade ao ultra-som transvaginal com Doppler colorido e pulsado e com perfil endócrino e marcadores séricos tumorais normais. Foram divididas em cinco grupos: 1) Grupo A: 15 mulheres que fizeram uso de acetato de noretisterona; 2) Grupo B: 13 mulheres que fizeram uso de acetato de medroxiprogesterona; 3) Grupo C: 14 mulheres que utilizaram contraceptivo oral; 4) Grupo D: 15 mulheres que foram tratadas com análogo de GnRH e 5) Grupo E: 14 mulheres que não fizeram uso de medicação. Todos os grupos foram acompanhados por um ano. No final do primeiro trimestre, se o cisto persistiu, foi realizada a punção. No final do segundo trimestre, se houve recidiva do cisto, foi indicada cirurgia. As pacientes tiveram alta após um ano de acompanhamento com o tratamento do cisto concluído. Resultados: Não houve diferenças significantes entre os cinco grupos. Constatou-se que a condição de uso de medicação para doença associada teve influência significativa no resultado dos tratamentos. Verificou-se que a redução do tamanho do cisto com a punção foi efetiva após 9 meses de acompanhamento. Observou-se que 7% das mulheres tiveram indicação direta para cirurgia sem a punção, portanto, a proporção de recidiva da punção foi de 19,3% enquanto a porcentagem de mulheres que não fizeram a cirurgia foi de 73,2%. Conclusão: A proporção de mulheres que responderam adequadamente somente com o tratamento clínico e/ou a punção, não necessitando pois de cirurgia foi de 73,2%. A influência da medicação/ doença associada no tratamento não cirúrgico foi significativa. A redução do tamanho dos cistos benignos em função do tratamento instituído incluindo a punção foi significativa, a qual foi observada após 9 meses de tratamento.
Objectives: To evaluate the rate of women with ovarian cystic tumors submitted to diferent regimens of hormonal treatment and/or aspiration that didn’t need surgery. To access the effectiveness of ovarian cyst aspiration guided by ultrasonography (USG) and to study the influence of medication and associated diseases in the need for surgery. Patients and Methods: Seventy one (71) women, in an age range from 19 to 70 years, diagnosed with ovarian cysts larger than 5 cm in length, with benign aspect, examined using an ultrasonographic transvaginal probe and color Doppler. All the women have been submitted to measurements of ser um tumor markers and hormonal levels. They were grouped in five different categories: 1) Group A: 15 women treated with noretisterone acetate; 2) Group B: 13 subjects treated with medrooxiprogesterone acetate; 3) Group C: 14 patients treated with combined oral contraceptive; 4) Group D: 15 women treated with GnRH analog, and 5) Group E: 15 women with no treatment control). After 3 months, all the patients were reevaluated. In those ones whose cysts remained, cyst aspiration guided by ultrasonography was indicated. After 3 extra months, the women were submitted to a new USG examination and in those whose cysts still remained, surgery was performed. All the patients were followed for one year. Results: There was no significant difference among the groups of hormonal treatment. The use of medication promoted a significant influence in the treatment outcomes. We also noted that the cyst aspiration was effective in reducing the size of the cysts after 9 months of follow up. Seven per cent (7%) of the patients have had immediate indication for surgery. Among those who was submitted to cyst aspiration, 19.3% had to be resubmitted to treatment because of re-incidence of the cyst, whereas, 73.2% avoid the need for surgery. Conclusions: The proportion of subjects treated with hormones and/or cyst aspiration, with no need for surgery, was of 73.2%. The influence of medication/associated disease in the treatments without surgery was significant. The reduction of size of the cysts because of the hormonal and/or aspiration treatment was significant, which was observed after 9 months of therapy.

Ендометріоз - відноситься до числа найбільш поширених гінекологічних захворювань.Зростає чисельність жінок вУкраїні, які хворіють на ендометріоз. Однією з найбільш часто розповсюджених форм зовнішнього генітального ендометріозу є ендометріоз яєчників, частота захворюваності спостерігається до 64%. Важливим аргументом, що пояснює значимість вивчення ендометріозу яєчників, є вплив на репродуктивну функцію пацієнток, в зв'язку з чим, проблема набуває соціального і демографічного значення. Репродуктивне здоров'я жінок має ключове значення для благополуччя самої жінки, її сім'ї і суспільства в цілому. Коефіцієнт фертильності, що розраховується як відношення числа народжень до чисельності жінок репродуктивного віку, у здорових жінок становить 0,15 - 0,20, в той час як у хворих на ендометріоз його значення варіюють від 0,02-0,1 . У пацієнток з ЕКЯ порушення репродуктивної системи визначається, як на рівні центральних, так і периферичних ланок - фолікулярного апарату яєчника. Тому своєчасна діагностика і повноцінне лікування ендометріоза яєчників мають велике значення. Основним методом лікування хворих репродуктивного віку з ендометріоїдними кістами яєчників (ЕКЯ), є лапароскопічна енуклеація новоутворення.

Thesis (M.S.)--University of Florida, 2004.
Typescript. Title from title page of source document. Document formatted into pages; contains 176 pages. Includes Vita. Includes bibliographical references.

Доброякісні пухлини та пухлиноподібні утворення яєчників є досить поширеною патологією серед жінок. За даними літератури, пухлини яєчників займають друге місце серед пухлин жіночих статевих органів (6-25 %) і друге-третє місце у структурі невідкладної гінекологічної патології. Слід визначити, що до 11-12 % лапаротомій виконуються в гінекологічних відділеннях з приводу утворень яєчників або їх ускладнень [42,57]. Окрім онкологічних аспектів при операціях на яєчниках у жінок репродуктивного віку дуже важливими є питання збереження репродуктивної функції, тобто виконання органозберігаючих оперативних втручань. Збереження яєчників є запорукою подальшої реалізації репродуктивної функції у жінок, які не здійснили свої репродуктивні плани, особливо у пацієнток із оваріоектомією в анамнезі, а також у жінок із безплідністю, серед яких доброякісні кістозні утворення яєчників діагностуються в 25-33 % випадків [49,71]. Основним методом лікування хворих репродуктивного віку з доброякісними пухлинами яєчників (ДПЯ), за даними більшості авторів, є лапароскопічна цистектомія із максимальним збереженням незміненої тканини яєчника [47,73]. Незважаючи на значне число робіт, які продемонстрували перевагу органозберігаючих лапароскопічних операцій у пацієнток з ДПЯ, дослідження з вивчення особливостей функціонального стану яєчників до оперативного втручання, наслідків хірургічного лікування в залежності від глибини і тяжкості ушкодження нечисленні і суперечливі [7,35,36,58]. Проблема фолікулогенезу та зниження фолікулярного запасу яєчників як до, так і після оперативного втручання, залишається недостатньо вивченою, що є надзвичайно актуальною при плануванні вагітності на сучасному етапі. Відповідно до існуючої точки зору, вікова інволюція репродуктивної системи жінки може розвинутися внаслідок зниження фолікулярного пулу, порушення процесу фолікулогенезу, посилення апоптозу та атрезії фолікулів [8,53]. Більшість досліджень основані на оцінці стану яєчників після операції за даними тестів функціональної діагностики, аналізу гормонального статусу і сучасних ультразвукових досліджень [21,38]. Роботи останніх років значно розширили уявлення про репродуктивну систему жінки і дозволили сформувати поняття про індивідуальний біологічний вік яєчників – оваріальний резерв [11,12,18]. В даний час з'явилася можливість об'єктивної оцінки оваріального резерву за допомогою тривимірного ультразвукового дослідження із застосуванням енергетичної доплерометрії. За допомогою створених вручну контурів обертового тривимірного ехографічного зображення, можливо визначити обсяг яєчникової тканини, прилеглої до утворення, оцінити стан фолікулярного апарату і кровотоку в заданому обсязі. Крім цього, виявлені значущі маркери, такі як антимюлерів гормон (АМГ), інгібін В, ФСГ та інші, що характеризують функціональний резерв репродуктивної системи [36,45,52]. Разом з тим, дані про ефективність хірургічного лікування гінекологічної патології суперечливі, несистематизовані, роз’єднані і не дають конкретного уявлення про оптимальні можливості реалізації репродуктивного потенціалу після перенесених оперативних втручань. У зв’язку з вищевикладеним, виникає необхідність розробки і впровадження ефективної системи охорони репродуктивного здоров’я, з урахуванням державної програми з даної тематики, що включає забезпечення безперервного лікувально-діагностичного процесу на всіх етапах надання медичної допомоги жінкам. Найбільш актуальною і невивченою є проблема настання, перебігу та результатів вагітності в залежності від параметрів оваріального резерву та фолікулогенезу, а також спайкового процесу як результату оперативного втручання на органах малого тазу.

Wert der MR-angiographischen Technik für die Dignitätsbeurteilung von Ovarialraumforderungen Ziel der Studie war die Überprüfung der Wertigkeit der kontrastmittelunterstützten MRT und der Aussagekraft der arteriellen und venösen Phase in der Charakterisierung ovarieller Raumforderungen. 51 Patientinnen (97 Ovarien) mit ovariellen Raumforderungen in der klinischen und sonographischen Kontrolle wurden in einem 1,5 Tesla MRT mit einer Body-phased-array-Spule untersucht. Dabei kamen T1- und T2-gewichtete Sequenzen zur Anwendung (axiale, sagittale und coronare). Zusätzlich wurde eine MR-Angiographie mit Aufnahmen in der arteriellen und venösen Phase durchgeführt. Als Kontrastmittel kam Gadolinium-DTPA zur Anwendung. 43 Patientinnen wurden operiert, die übrigen Patientinnen mit als gutartig gewerteten Tumoren im Verlauf von 13 bis 23 Monaten klinisch kontrolliert. Die Histologische Untersuchung zeigte 21 bösartige (einschließlich 4 Borderline-Tumoren) und 43 gutartige Tumoren. Die Sensitivität, Spezifität und Treffsicherheit wurde mit Hilfe der folgenden Kriterien berechnet: Größe der Tumoren, Wand- und Septendicke, Vorhandensein solider Anteile und die Kontrastmittelanreicherung in der arteriellen und venösen Phase. Zusätzlich wurde die Aussagekraft der Substraktionsangiographie sowie der maximum intensity projections (MIP) überprüft. Die MRT war korrekt bei 17 von 21 malignen Tumoren und 73 von 76 benignen Tumoren bzw. unauffälligen Ovarien und hat somit eine Sensitivität von 81%, eine Spezifität von 96% und eine Treffsicherheit von 93%. Die Treffsicherheit der Kriterien für Malignität liegt bei 85% für die Kontrastmittelanreicherung in der arteriellen Phase, bei 86% für die soliden Anteile, bei 78% für die Wanddicke und bei 69% für die Septendicke. Die Ergebnisse zeigen, dass die kontrastmittelanreichernde MRT einen nützlichen zusätzlichen Faktor darstellt, um die Spezifität der MRT in der Charakterisierung gutartiger und bösartigen Tumoren zu erhöhen.
Role of MR Angiography in the Characterization of Ovarian Lesions The aim was to investigate the role of contrast-enhanced magnetic resonance (MR) angiography and the arterial and venous contrast medium enhancement for lesion characterization. Fifty-one patients (97 ovarian) with ovarian masses identified in the clinical examination and by endovaginal ultrasound underwent MR imaging on a 1.5-T scanner using a body phased-array coil. Images were acquired with T1- and T2-weighted sequences (axial, sagittal and coronal). An MR angiography sequence was performed before and after intravenous injection of Gd-DTPA during the arterial and venous phase after determination of the transit time of the contrast medium bolus. Forty-three patients were operated on; the remaining patients with benign lesions were followed up clinically for 13 to 23 months. Histology demonstrated 21 malignant lesions (including 4 borderline tumors) and 43 benign lesions. The sensitivity, specificity and diagnostic accuracy were calculated for the following criteria: size of ovarian mass, thickness of walls and septae, solid portions, and arterial and venous contrast medium enhancement. In addition, the diagnostic benefit of maximum intensity projections (MIP) and thin slices acquired with the MR angiography technique was evaluated. MRI correctly identified 17 of the 21 malignant tumors and 73 of the 76 benign findings (benign lesions or normal ovaries) and had a sensitivity of 81%, a specificity of 96%, and a diagnostic accuracy of 93%.The accuracies of the different malignancy criteria were 85% for arterial contrast medium, 86% for the solid portions, 78% for the wall thickness and 69% for septal thickness. The results presented show that arterial contrast medium enhancement is a useful criterion to improve the specificity of MRI in characterizing ovarian lesions.

The first aim of the research conducted as part of this thesis was to investigate the expression and activities of 110HSD enzymes in porcine mural granulosa cells and COCs from small, medium and large antral follicles, as well as from ovarian cysts. Both cloned lipHSD enzymes (lipHSDl and 110HSD2) were expressed in porcine granulosa cells however the results of the expression studies in COCs were inconclusive. In granulosa cells from antral follicles, the 11-dehydrogenase (11P-DH) activities of the lipHSD enzymes increased by approximately 3-fold with antral follicle growth (P<0.01). Similarly, COCs isolated from large follicles had approximately 10-fold higher lip-DH activities than COCs from small follicles (PO.001). These results suggested that antral follicle growth occurred alongside increasing levels of intracellular Cortisol metabolism in both granulosa cells and COCs. In granulosa cells from ovarian cysts, there were significantly decreased net lip-DH activities compared to cells from large antral follicles (P<0.01), suggesting that decreased Cortisol metabolism occurred in the cells of porcine ovarian cysts. The next aim of this thesis was to investigate the levels of ovarian enzyme modulators in FF from small, medium and large antral follicles and in the fluid from ovarian cysts. The levels of inhibitors appeared to decrease in FF with follicle growth but were significantly increased in ovarian cysts (PO.01). These intrafollicular 1 lpHSDl inhibitors in FF and cyst fluid were also able to modulate lipHSD activities in the granulosa cells and COCs. Furthermore, cyst fluid, and the hydrophobic components thereof (which were likely to have included the ovarian enzyme modulators), were shown to significantly increase the rates of porcine oocyte maturation (PO.001). In summary, the findings of the studies conducted in this thesis suggest that the intrafollicular modulators of lipHSDl could influence local cortisol-cortisone inter-conversion in granulosa cells and oocytes during antral follicle growth. In addition the ovarian enzyme inhibitors could possibly influence oocyte maturation with follicle growth. In ovarian cysts however, the high levels of intra-follicular lipHSDl inhibitors in the cyst fluid, and the decreased levels of intracellular Cortisol metabolism observed in the granulosa cells, could be factors contributing to cyst development.

A hiperplasia adrenal congênita (HAC) por deficiência no P450c17 é uma doença de herança autossômica recessiva raramente relatada em pacientes 46, XX. Nosso objetivo foi o de caracterizar o fenótipo e genótipo desta doença rara revendo os dados clínicos, laboratoriais, genéticos, e da função ovariana de pacientes 46,XX de uma coorte brasileira avaliada no HCFMUSP e dos casos já publicados na literatura. Foram avaliados retrospectivamente os dados de 18 pacientes brasileiras pertencentes a 12 famílias avaliadas no HCFMUSP, e revisados os dados de literatura de pacientes de 10 coortes com deficiência da atividade P450c17 (14 pacientes, 6 delas com defeitos no CYP17A1 e 8 com defeitos no POR). Fenótipo: A maioria das pacientes apresentou-se com amenorreia primária (74 %) e 90 % das pacientes não desenvolveram pubarca; 69,5 % das pacientes apresentavam hipertensão arterial no momento do diagnóstico. Observamos uma alta incidência de distúrbios psiquiátricos (76%), como depressão, ansiedade e síndrome do pânico, em nossa coorte, mas não foram encontrados relatos na literatura. O ultrassom mostrou um aumento de pelo menos um dos ovários em 87 % dos pacientes antes do tratamento e macrocistos ovarianos em 65%, 6 pacientes (26%) referiram terem sido submetidas a cirurgia anterior para tratamento de torção ou ruptura de ovário. O tratamento com dexametasona, estrogênio e progesterona resultou em redução efetiva do volume ovariano. Todos os pacientes apresentaram níveis basais elevados de progesterona e LH e redução dos níveis de androgênios. Não observamos correlação entre os níveis de LH, da relação LH/FSH e de progesterona com o volume ovariano nos dois defeitos. Genótipo: O estudo molecular revelou que 17 pacientes de nossa coorte apresentavam mutações inativadoras no gene CYP17A1 e 1 paciente no gene POR. Duas novas mutações foram identificadas no gene CYP17A1, a p.R362H no éxon 6 e a p.G478S no éxon 8. A mutação mais prevalente no CYP17A1 foi a p.W406R identificada em 41 % das nossas famílias. Algumas das mutações no CYP17A1 foram encontradas apenas na coorte brasileira, mas a mutação p.A287P encontrada no gene POR em uma das nossas pacientes é a mais prevalente na literatura. Em relação à etnia, houve um predomínio dos defeitos moleculares no CYP17A1 em pacientes chinesas e brasileiras, enquanto que os defeitos no gene POR foram mais relatados nas pacientes europeias e norte - americanas. Em conclusão, a análise retrospectiva do fenótipo, genótipo e morfologia ovariana de trinta e duas pacientes 46,XX portadoras de deficiência da atividade P450c17, nos permitiu destacar os seguintes aspectos: a importância da dosagem da progesterona basal para este diagnóstico, a alta prevalência de aumento dos ovários com a presença de macrocistos ovarianos com risco de torção, e de transtornos psiquiátricos identificados em nossa coorte. Acreditamos que esta revisão possa contribuir para o diagnóstico mais precoce desta rara doença congênita
Congenital adrenal hyperplasia due to P450c17 deficiency is rarely reported on 46,XX patients. Our aim was to characterize the phenotype and genotype of this rare disorder reviewing the clinical, laboratory, genetic and ovarian imaging of 46,XX patients of our cohort and of other already reported cases. We retrospectively reviewed 32 patients with deficiency of P450c17 activity: 18 Brazilian patients belonging to 12 families and 10 cohorts already published (fourteen 46,XX patients, 6 of them with CYP17A1 defects and 8 with POR defects). Phenotype: most patients had primary amenorrhea (74%) and 90% of the patients did not develop pubarche; 69.5% of the patients had blood hypertension at diagnosis. We observed a high incidence of psychiatric disorders such as depression, anxiety and panic (76%) in our cohort but no reports were found in the literature. Ultrasound showed an increase of at least one of the ovaries in 87% of the patients before treatment and ovarian macrocysts in 65% of them; 6 patients (26%) had had previous surgery for twisting or ovarian rupture. Treatment with dexamethasone, estrogen and progesterone resulted in ovarian volume reduction. All patients showed elevated basal progesterone and LH and levels, and decreased androgen levels. There was no correlation between the levels of LH and progesterone and of LH/FSH ratio and the ovarian volume in both defects. Genotype: the molecular study showed that 17 patients from our cohort had inactivating mutation in the CYP17A1 gene and 1 in POR gene. Two novel mutations were identified in the CYP17A1 gene, the p.R362H in exon 6 and p.G478S in exon 8. The most prevalent mutation in the CYP17A1 was the p.W406R, identified in 41% of our families. Some of the CYP17A1 mutations were found only in the Brazilian cohort, but the mutation p.A287P found in the POR gene is the most prevalent in the literature. Regarding the ethnicity of the defects, there was a predominance of Chinese and Brazilian patients with defects in the CYP17A1 whereas defects in POR were most reported in European and North-American subjects.Conclusion: In this data review of thirty-two 46,XX patients with dysfunction of P450c17 activity we characterized the phenotype and genotype of this rare disorder and emphasize: the importance of basal progesterone measurement for this diagnosis, the high prevalence of ovarian macrocysts with risk of twisting, and the psychiatric disorders. We believe that this review may contribute to the early diagnosis of this disorder

RESUM Les masses annexials tenen una incidència del 6-7% en el nostre medi, essent la majoria d’elles benignes. La cirurgia n’és el tractament més estès, amb la morbilitat i la despesa econòmica que això comporta. Tanmateix, la tendència actual és proposar el maneig més conservador o menys invasiu possible. Aquest treball neix com a resposta a aquesta demanda creixent d’un maneig mínimament invasiu dels quists simples annexials. L’objectiu principal d’aquests estudis era comparar l’efectivitat de la punció amb aspiració i l’esclerosi amb etanol en el maneig dels quists simples annexials ≤10cm i avaluar-ne els factors de risc de recidiva. Ambdós procediments permeten l’obtenció i l’ estudi citològic del contingut quístic. La confirmació de benignitat en l’estudi citològic permet evitar l’angoixa de les pacients enfront el diagnòstic d’un quist simple annexial. D’altra banda, la resolució definitiva del quist annexial evitarà controls ecogràfics innecessaris, amb els beneficis que això comporta pel benestar de les pacients i pel sistema sanitari. Els estudis es van realizar de forma seqüencial en dos grups de pacients. En el primer grup de de pacients diagnosticades de quists annexials de baix risc de malignitat es va realitzar punció amb aspiració dels quists i se’n van avaluar l’efectivitat i la seguretat. En la segona cohort les dones diagnosticades de quists simples annexials es van tractar mitjançant esclerosi amb etanol per tal de reduir la taxa de recidives, avaluant-se també l’efectivitat i la seguretat. Les dades d’aquests estudis es van publicar en els dos primers articles presentats. Posteriorment, vam realitzar un estudi comparatiu de l’efectivitat de les dues tècniques, els resultats del qual s’integren en la tercera publicació inclosa. La taxa de recidiva va ser significativament major al grup tractat amb aspiració sense esclerosi. Els principals factors de risc de recidiva són el diàmetre inicial del quist i l’aspiració sense esclerosi amb etanol. L’estatus menopàusic segueix essent un posible factor de risc en estudi. En resum, l’esclerosi amb etanol és més efectiva que la punció amb aspiració en el maneig dels quists simples annexials <10cm.
The incidence of an adnexal mass is about 6-7% in our environment, the majority of them being benign. Surgery is the most extended treatment for them, despite the morbidity and economic costs that this entails. However, the current trend is to manage them more conservatively or with less invasive procedures. We performed these studies as a response to this growing demand of minimally invasive management of simple adnexal cysts. The main objectives of these studies were to compare the effectiveness of ultrasound (US)-guided aspiration and ethanol sclerotherapy in the management of simple adnexal cysts ≤10cm and to evaluate the possible risk factors for recurrence. Both procedures allow the collection and the cytological study of cystic content. The confirmation of benignity in the cytological analysis avoids the anxiety of patients facing a diagnosis of a simple adnexal cyst. Moreover, the complete resolution of the cyst avoids unnecessary US controls. The studies were sequentially performed in two groups of patients. In the first group of patients diagnosed with low risk of malignancy adnexal cysts, US-guided aspiration was performed. The effectiveness and safety of US-guided aspiration was evaluated. The second cohort of women diagnosed with simple adnexal cysts, was treated with ethanol sclerotherapy to reduce the relapse rate, also evaluating the effectiveness and safety of the procedure. The data from these two studies were published in the first two articles presented. Later, we made a comparative study of the effectiveness of the two techniques, the results of which are integrated into third publication included. The recurrence rate was significantly higher in the group treated with aspiration without sclerotherapy. The main risk factors for recurrence are the initial diameter of the cyst and the aspiration and sclerosis without ethanol. The menopausal status remains a possible risk factor that requires further study. As a summary, ethanol sclerotherapy is more effective than the US-guidedaspiration in the management of simple adnexal cysts <10cm.

Η δραστικότητα των λυοσωματικών ενζύμων είναι αυξημένη στο εξωκυττάριο υγρό ασθενών με μηνιγγίτιδα και περιτονίτιδα μικροβιακής αιτιολογίας. Ο σκοπός της παρούσας μελέτης ήταν να ερευνήσουμε αν η δραστικότητα αυτών των ενζύμων ήταν αυξημένη στο περιτοναϊκό υγρό ασθενών με πυελική φλεγμονή και γυναικολογικό καρκίνο. Η δραστικότητα της β-γλυκουρονιδάσης, β-γαλακτοσιδάσης και α-μαννοσιδάσης μετρήθηκε στο περιτοναϊκό υγρό 5 ασθενών με PID, 10 ασθενών με γυναικολογικό καρκίνο, 10 ασθενών που χρησιμοποιήθηκαν σαν σημείο αναφοράς και το υγρό 7 ασθενών με καλοήθεις κύστεις ωοθηκών. Η μέση τιμή της +/-SD της δραστικότητας της β- γλυκουρονιδάσης , β-γαλακτοσιδάσης, και της α- μανοσιδάσης στην PID ήταν 148+/-82, 278+/ -112, και 291+/-140 nmol 4 -methylummbelliferone/ ml / h αντίστοιχα. Στα δείγματα αναφοράς ήταν 22+/-9, 48+/-10 και80+/-23 , αντίστοιχα (p<=0,003 - 0.00001). Στο γυναικολογικό καρκίνο η δραστικότητα ήταν 113+/-35, 210+/- 82, και 243+/-123 αντίστοιχα ( διαφορά από τα δείγματα αναφοράς p<=0,0006-0,000001). Υπήρξε θετική συσχέτιση μεταξύ της δραστικότητας της β- γλυκουρονιδάσης και του σταδίου του καρκίνου. Η μέτρηση της δραστικότητας των ενζύμων στο υγρό των ωοθηκικών κύστεων δεν διέφερε σημαντικά σε σχέση με αυτή των δειγμάτων αναφοράς. Η δραστικότητα των λυοσωματικών ενζύμων είναι αυξημένη στο περιτοναϊκό υγρό ασθενών με (PID), πυελική φλεγμονή και γυναικολογικό καρκίνο. Η απουσία επικάλυψης των μετρηθέντων τιμών δραστικότητας των ανωτέρω ενζύμων μεταξύ ασθενών με γυναικολογικό καρκίνο και PID σε σχέση με τα δείγματα αναφοράς δείχνει οτι κάποιες μετρήσεις πρέπει να αρχίζουν να εφαρμόζονται για διαγνωστικούς σκοπούς.
The activity of lysosomal enzymes is increased in extracellular fluids οf patients with bacterial maningitis and peritonitis. Our objective was to investigate whether the activity of these enzymes is increased in the peritoneal fluid of pelvic inflammatory disease (PID) and gynecologic cancers. The activity of β-glucuronidase, β-galactosidase and α-mannosidase was measured in the peritoneal fluid of 5 patients with PID, 10 with gynecologic cancer, 10 control subjects, and the flouid of 7 benign ovarian cysts. The mean +/- SD β-glucoronidase, β-galactosidase, and α-mannosidase activity in PID was 148+/-82, 278+/-112, and 291+/-140 nmol 4- methylumbelliferone/ ml/h, respectively; in the controls it was 22+/-9, 48+/-10 and 80+/-23, respectively ( p<=0,003-0,00001). In the gynecologic cancers the activity was 113+/-35, 210+/-82, and 243+/-123, respectively (difference from controls p<=0.0006-0.000001). There was a positive correlaton between β-glucoronidase activity and stage of cancer.The activity of the ovarian cysts fluid did not differ significantly from the controls. The lysosomal enzyme activity is increased in the peritoneal fluid of PID and gynecologic cancers. The absence of overlapping values between patients and controls indicates that such measurements may be applied for diagnostic purposes.

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
A endometriose é uma doença inflamatória crónica de etiologia multifatorial cuja fisiopatologia não se encontra, ainda, totalmente compreendida. Os endometriomas são formações quísticas de endometriose ao nível dos ovários presentes em 17 a 44% das mulheres com endometriose. A sua etiologia, abordagem e efeitos na fertilidade permanecem controversos. A orientação dos endometriomas na mulher com desejo reprodutivo é, ainda, pouco consensual. O endometrioma levanta preocupações face à capacidade reprodutiva da mulher, dado que, a infertilidade é uma entidade que frequentemente se associa ao endometrioma. Assim, a avaliação da reserva ovárica é relevante para uma melhor abordagem destas mulheres. O tratamento ideal de mulheres com endometrioma permanece por determinar, apesar das diversas modalidades terapêuticas disponíveis. A presença do endometrioma, por si só, constitui uma agressão ao tecido ovárico que poderá resultar em efeitos nefastos na reserva ovárica e estabelece a principal dúvida relativamente à atitude expectante versus tratamento cirúrgico na abordagem aos endometriomas. Relativamente ao tratamento cirúrgico, sabe-se que, pode ter impacto negativo na reserva ovárica ao contribuir para a remoção inadvertida de tecido ovárico saudável. A orientação de mulheres inférteis com endometrioma deve ser individualizada. O impacto da presença do endometrioma nos resultados das técnicas de procriação medicamente assistida (PMA) não se encontra totalmente estabelecido. Contudo, nas mulheres inférteis que recorrem a técnicas de PMA para obtenção de gravidez, a cirurgia prévia para remoção do endometrioma não tem evidenciado qualquer benefício.
Endometriosis is an inflammatory chronic disease with multifactorial etiology in which pathophysiology is not yet totally understood. Endometriomas are cystic formations of endometriosis in the ovaries present in 17-44% of women with endometriosis. Its etiology, approach and effects on fertility are still controversial. The management of women with endometrioma and reproductive desire is not yet consensual. Endometrioma raises concerns about the woman's reproductive capacity, since infertility is an entity that is often associated with endometrioma. Thus, the evaluation of the ovarian reserve is relevant for a better approach to these women. The ideal treatment of women with endometrioma remains to be determined, despite the various therapeutic modalities available. Endometrioma, by itself, is an aggression in the ovarian tissue which can result in harmful effects in the ovarian reserve and constitutes the main question about the expectant attitude versus surgical treatment in the approach to endometriomas. Regarding surgical treatment, it is known that it can have a negative impact on the ovarian reserve by contributing to the inadvertent removal of healthy ovarian tissue. The management of infertile women with endometrioma must be individualized. The impact of the presence of endometrioma on the results of assisted reproductive techniques (ART) is not fully established. However, in infertile women who use ART to achieve pregnancy, previous surgery has not shown any benefit.

碩士
國立屏東科技大學
動物科學與畜產系所
106
Taiwan is located in the subtropical and tropical zone. Hence, Holstein is prone to heat stress at high temperature and humidity. The negative energy balance which is caused by the decreasing of feed intake reduced the estrogen synthesis. Ovarian follicular cyst is the common reproductive disorder in lactating cows, and occupying approximately 6-19 % of dairy cows. The therapy of Gonadotropin-releasing hormone (GnRH) was conducted in the past. Nowadays, the problem of drug resistance and food safety draw attention. In recent years, studies have shown that stem cells hold the capability of self-renew and differentiation, and it shares the promise to replace the damaged tissues or produce the cytokines to promote the repairing of injured tissues. Therefore, this experiment is mainly to explore the feasibility of treating follicular cysts by infusion of cattle placenta stem cells (CPSCs) and cattle amniotic membrane stem cells (CAMSCs). The experiment of follicular cyst test was divided into four major groups (control group, hormone group, placental stem cells group, and amniotic stem cells group). The experimental cattle were raised in a concrete grounded barn with cow beds. The cattle were fed total mixed ration (TMR) twice a day, mineral salt, and drinking water during the experimental period. The experimental cattle were scanned the ovaries to identify the changes by means of ultrasound once a week and serum from the tail veins of the cattle were collected to analyze progesterone and estradiol concentration. The experimental periods were 49 days (two estrus cycles). If the estrus detector pedometer system showed that the cow is in heat, artificial insemination was performed 8 to 12 hours later. Therefore, the results demonstrated that the surface antigen analysis of placental stem cells and amniotic stem cells showed high levels of CD44 (98.6 % vs. 97.6 %) and a little amount of CD4 (2.0 % vs. 2.5 %) and CD105 (3.2 % vs. 0.2 %). The proliferation rate of amniotic stem cells at 48, 72, and 96 hours were significantly higher (P < 0.05) than placental stem cells respectively. By the approach of placental stem cells and amniotic stem cells for the treatment of follicular cysts shared extinguished outcomes. Injection of 1 and 6 million placental stem cells, the recovery rate occupies 75% and the estrus detection rate is reaching to 75%. Injection of 6 million amniotic stem cells also held better recovery rate than the injection of 1 million amniotic stem cells (100 % vs. 66.6 %) and the estrus rate (100 % vs. 33.3 %). Injection of 6 million placental stem cells and amniotic stem cells shared better recovery rate (100 % vs. 75 %) and estrus rate (100 % vs. 75 %) than the hormone groups. In conclusion, the infusion of 6 million placenta and amniotic stem cells therapy may hold the promise to replace traditional hormone therapy to improve the reproductive disorders of follicular cysts in dairy cows.