1/17. fibrinogen St. Gallen I (gamma 292 Gly--> Val): evidence for structural alterations causing defective polymerization and fibrinogenolysis.fibrinogen St. Gallen I was detected in an asymptomatic Swiss woman. Routine coagulation tests revealed a prolonged thrombin and reptilase time. Functionally measured fibrinogen levels were considerably lower than those determined immunologically. polymerization of fibrin monomers derived from purified fibrinogen was delayed in the presence of either calcium or EDTA. Normal fibrinopeptide a and B release by thrombin was established. An abnormal degradation of fibrinogen St. Gallen I by plasmin was observed. Fragment D1 of normal fibrinogen was fully protected against further proteolysis in the presence of 10 mM calcium, whereas fibrinogen St. Gallen I was partially further degraded to fragments D2 and D3. In the presence of 10 mM EDTA, the conversion of variant fragment D1 to D2 was accelerated whereas the degradation of fragment D2 to D3 was delayed in comparison to degradation of fragments D1 and D2 of normal fibrinogen. Three high-affinity calcium binding sites were found in both normal and variant fibrinogen. mutation screening with SSCP analysis suggested a mutation in exon VIII of the gamma-chain gene. Cycle sequencing of this gene portion revealed a single base substitution from G to T of the base 7527, leading to replacement of gamma 292 glycine by valine. The same mutation has already been described for the fibrinogen variant baltimore I. Molecular modeling was performed of a part of the gamma-chain containing the mutation site, based on recently published X-ray crystal structures of human fibrinogen fragment D and of a 30 kD C-terminal part of the gamma-chain. Significant structural alterations due to the substitution of glycine by valine at gamma 292 were observed, e.g. spreading of the protein backbone, probably leading to a modified accessibility of the plasmic cleavage sites in the gamma-chain at 356 Lys and 302 Lys. A shift of gamma 297 Asp that is involved in interactions of fragment D with the Gly-Pro-Arg-Pro-peptide was noted by molecular modeling. The latter observation is compatible with delayed polymerization of fibrin monomers.- - - - - - - - - - ranking = 1keywords = replacement (Clic here for more details about this article) |
2/17. Successful use of recombinant VIIa (Novoseven) and endometrial ablation in a patient with intractable menorrhagia secondary to FVII deficiency.menorrhagia is a well-recognized complication of inherited bleeding disorders. In the past, the only viable option for women who were unresponsive to medical therapy was hysterectomy. Endometrial ablation has been recently developed as an alternative therapy for these patients and is associated with decreased morbidity. We report the successful use of activated recombinant factor VII (FVIIa) and endometrial ablation in the treatment of excessive menstrual blood loss in a 34-year-old women with severe factor VII (FVII) deficiency. Recombinant FVIIa (40 microg/kg) was administered pre-operatively and every 6 h (20 microg/kg) for 24 h postoperatively. The procedure was uncomplicated with a 200 ml surgical blood loss. FVIIa was used because it allowed FVII replacement with a recombinant product and also has the ability to bind to tissue factor expressed at the site of vascular injury, resulting in site-specific thrombin generation. We believe that endometrial ablation with recombinant VIIa should be considered in patients with severe FVII deficiency and menorrhagia unresponsive to medical therapy.- - - - - - - - - - ranking = 1keywords = replacement (Clic here for more details about this article) |
3/17. Case of hemorrhagic shock due to hypermenorrhea during anticoagulant therapy.We report the case of a patient with uterine myoma who developed uncontrollable massive hemorrhage from the uterus during anticoagulant therapy after cardiac valve replacement and required hysterectomy. There was a discrepancy between the laboratory findings regarding the blood coagulation system and the clinical manifestations, suggesting a combination of multiple factors, such as a hormonal imbalance. This was a case that demanded strict attention to the management of the uterine lesions during the conduct of anticoagulant treatment.- - - - - - - - - - ranking = 1keywords = replacement (Clic here for more details about this article) |
4/17. Abnormal genital tract bleeding.The etiology of abnormal genital tract bleeding encompasses a wide range of disorders that can be secondary to anatomic changes of the female genital tract, infection, endocrinologic disorders, malignancies, and systemic illness. Appropriate workup is guided by age-related differential diagnoses for abnormal bleeding. Modern diagnostic tools can quickly focus the evaluation and allow timely intervention. Most abnormal genital tract bleeding is uterine bleeding, which is one of the most common gynecologic problems that health care providers will face. It accounts for approximately 15% of office visits and 25% of gynecologic operations. Abnormal uterine bleeding in reproductive-age women is defined as bleeding at abnormal or unexpected times or by excessive flow at the time of an expected menses. The average menstrual cycle length and duration of flow is 28 days and 4 days, respectively, with an average blood loss of 35 cc (1). Any bleeding should be considered abnormal in premenarchal girls and in post-menopausal women except for those with predictable withdrawal bleeding taking hormone replacement therapy. This article will review the categories of abnormal genital tract bleeding and the diagnostic tools needed to establish the correct diagnosis. Common clinical cases will be presented to illustrate the presenting symptoms, differential diagnoses, workup, treatment, and long-term follow-up.- - - - - - - - - - ranking = 51.091819076545keywords = replacement therapy, hormone, replacement (Clic here for more details about this article) |
5/17. Hysteroscopic endometrial resection.Endometrial resection (TRCE) is a well-examined alternative therapy to hysterectomy in the treatment of menorrhagia that preserves the uterus at long term in at least 70% of patients. The technique and safety considerations are described and an overview of the existing evidence is given. Complication rates (2.5%) and performance of the personal series of 465 operative hysteroscopies including 244 endometrial resections with a follow-up of at least 18 months are shown. 3.3% of patients with endometrial resection needed a hysterectomy up to now (follow-up 18-90 months). The combination of endometrial resection and the insertion of the levonorgestrel hormone-releasing intrauterine device (LNG-IUD) is described. Especially in patients with adenomyosis, the combination of LNG-IUD with endometrial resection augments the success rate. 96 of 99 patients with the combined therapy (TRCE and LNG-IUD) and a follow-up of 18-48 months still have their uterus.- - - - - - - - - - ranking = 1.4181014976407keywords = hormone (Clic here for more details about this article) |
6/17. Atypical complex endometrial hyperplasia treated with the GyneLase system.A 47-year-old premenopausal, para 1, gravida 1 woman complained of menometrorrhagia. She had no risk factors for endometrial hyperplasia or cancer, and office endometrial biopsy indicated focal, nonatypical endometrial hyperplasia. Seven months later the patient was scheduled for hysteroscopic endometrial resection. Instead she was treated by hysteroscopy, curettage, and the GyneLase system. The curetting indicated atypical, complex endometrial hyperplasia. The woman refused hysterectomy and salpingo-oophorectomy and adjunctive therapy with progesterone. She agreed to close surveillance and further treatment if she had any vaginal bleeding. At 13 months she remains amenorrheic, the endometrial echo is 2 mm, and follicle-stimulating hormone level is 63 IU/L. Based on the patient's amenorrhea and ultrasound uterine measurement, it is tempting to assume that GyneLase treatment may have cured her atypical hyperplasia. However, at this time, we have no evidence to substantiate this assumption.- - - - - - - - - - ranking = 1.4181014976407keywords = hormone (Clic here for more details about this article) |
7/17. Severe menorrhagia due to factor vii deficiency successfully treated by thermal balloon endometrial ablation.factor vii deficiency, a rare inherited bleeding disorder, is often complicated by menorrhagia leading to severe anemia. These women are treated by repeated blood product transfusions, various hormone preparations, and repeated endometrial curettage. Despite the high risks involved, women with refractory disease were usually advised to undergo hysterectomy. A 36-year-old patient was known to suffer from factor vii deficiency and common variable immune deficiency, and had a long history of worsening menorrhagia. As various medical therapies failed to improve her menorrhagia, and she often required curettage and blood transfusions, we offered her more definitive treatment with thermal balloon endometrial ablation. The procedure was uneventful, and during 24 months of follow-up the patient has had several events of spotting but no heavy periods. It is suggested that thermal balloon endometrial ablation is a suitable minimally invasive therapeutic option for menorrhagia in women with factor vii deficiency.- - - - - - - - - - ranking = 1.4181014976407keywords = hormone (Clic here for more details about this article) |
8/17. Gonadotropin releasing hormone agonist treatment for severe menorrhagia in patients with contraindications to surgery.Four patients with heavy menorrhagia, severe iron-deficiency anemia and contraindications to surgery were treated with a gonadotropin-releasing hormone agonist in a depot formulation. At 2 months of therapy they were all amenorrheic, and at 6 months the hematologic values had improved markedly. gonadotropin-releasing hormone agonists may obviate emergency surgery in patients at high surgical risk or could constitute the first line of sequential therapeutic regimens, once general health conditions have improved.- - - - - - - - - - ranking = 8.5086089858439keywords = hormone (Clic here for more details about this article) |
9/17. Menometrorrhagia and tachyarrhythmia after using oral and topical ginseng.Widespread and uncontrolled use of ginseng has raised the question of its side effects and drug interactions. A 39-year-old female patient experienced menometrorrhagia. Her complaints had started 5 months earlier. The laboratory tests revealed follicle-stimulating hormone (FSH) and estradiol levels to be 10 mIU and 90 mIU, respectively. Endometrial biopsy was planned for the diagnosis of abnormal uterine bleeding. During the preoperative evaluation, the patient stated that she had been using both oral and topical ginseng for cosmetic reasons. The ECG revealed sinus tachycardia with occasional atrial premature beats. The procedure was postponed for 2 weeks so that the patient would stop taking ginseng, smoking, and drinking coffee. Arrhythmia stopped 10 days later. tachycardia continued during the procedure but did not require treatment, as it did not cause any hemodynamic instability. An endometrial biopsy specimen showed a disordered proliferative pattern. The patient was advised to stop using oral and topical ginseng. During a follow-up visit, she had no sign of menometrorrhagia or tachyarrhythmia and her hemoglobin levels were in the normal range. smoking and coffee consumption, along with ginseng use, can be responsible for arrhythmogenic effects. Abnormal uterine bleeding can cause tachycardia secondary to anemia. The clinical progress of this patient is consistent with our hypothesis that ginseng is responsible for menometrorrhagia, although this could be coincidental. patients should always be asked prior to surgery if they use herbal medications, food supplements, or cosmetics as well as prescription drugs. This is of great importance for both diagnosis and avoidance of drug interactions and side effects during anesthesia.- - - - - - - - - - ranking = 1.4181014976407keywords = hormone (Clic here for more details about this article) |
10/17. gonadotropin-releasing hormone agonist (leuprolide acetate) induced ovarian hyperstimulation syndrome in a woman undergoing intermittent hemodialysis.Moderate ovarian hyperstimulation syndrome occurred after LA was administered to control menorrhagia in an anephric woman who required hemodialysis. We postulate that women who require dialysis may be at special risk for the development of this syndrome.- - - - - - - - - - ranking = 5.6724059905626keywords = hormone (Clic here for more details about this article) |
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