Relaxin stimulates expression of vascular endothelial growth factor in normal human endometrial cells in vitro and is associated with menometrorrhagia in women. (1/51)

Although the role of the reproductive hormone, relaxin, in rodents is well documented, its potential contribution to human reproduction is less well defined. In this study, we examine the effects of relaxin on human endometrial cells in vitro and describe the clinical effects of relaxin on menstrual flow in women. In cultured endometrial cells, relaxin specifically induces the expression of an angiogenic agent, vascular endothelial growth factor (VEGF). cAMP is implicated as a second messenger involved in VEGF stimulation. VEGF expression is temporally regulated in the endometrium, and our results suggest that relaxin, which is secreted by the corpus luteum and is present in the endometrium during the menstrual cycle and pregnancy, may be involved in regulating endometrial VEGF expression. Relaxin was recently tested in a clinical trial for efficacy in the treatment of progressive systemic sclerosis, and was administered at levels up to 10 times higher than that measured during pregnancy. The most frequent relaxin-related adverse event reported during the course of the study was the onset of menometrorrhagia, defined in this study as heavier-than-usual or irregular menstrual bleeding. The intensification of menstrual flow observed in these patients is consistent with the hypothesis that relaxin mediates neovascularization of the endometrial lining.  (+info)

Long-lasting remission and successful treatment of acquired factor VIII inhibitors using cyclophosphamide in a patient with systemic lupus erythematosus. (2/51)

Acquired deficiency of clotting factor VIII (FVIII) is a rare bleeding diathesis seldom encountered in systemic lupus erythematosus (SLE). Reduction of FVIII activity by autoantibodies can cause potentially life-threatening situations. Herein, an SLE patient with a positive lupus anticoagulant (LAC) test who abruptly developed metrorrhagia 4 yr after diagnosis is reported. Coagulation tests revealed FVIII activity reduced to 3% and a prolonged aPTT. FVIII inhibitor(s) were found to be as high as 3.0 Bethesda Units. Plasmapheresis, immunoglobulins, prednisolone and FVIII plasma concentrates induced the cessation of metrorrhagia, but the clotting tests were barely improved. One month later, extensive ecchymosis appeared and worsened, despite re-administration of the previous therapy. Pulse cyclophosphamide followed by oral administration was then started with normalization of coagulation parameters and long-lasting disease remission.  (+info)

The feasibility of a 'one stop' ultrasound-based clinic for the diagnosis and management of abnormal uterine bleeding. (3/51)

OBJECTIVES: We have established a 'one stop' clinic for the management of women with abnormal uterine bleeding based on transvaginal sonography and saline contrast sonohysterography. This report reviews our experience with the first 93 patients attending the clinic. DESIGN AND METHODS: Patients were seen with the intention of performing a transvaginal scan, saline contrast sonohysterography, endometrial biopsy, full blood count and thyroid function tests. The findings were prospectively recorded on a computer database and a management plan formulated. RESULTS: A transvaginal scan was performed on 89 (95.7%) women, 70 (75.3%) also undergoing saline contrast sonohysterography. An endometrial biopsy was carried out in 67 (72%) women aged 40 years and above, and 79 (84.9%) had blood tests. The median age of patients was 44 (range, 21-78) years. The majority of women presented with menstrual disorders. Uterine pathology was detected on transvaginal scan in 42 (47.2%) cases. Adnexal pathology was detected in 12 (13.5%) of the patients. Endometrial biopsy detected three (4.5%) cases of endometrial atypia, and three (4.5%) cases of adenocarcinoma. A hemoglobin level of < 10 g/dL was detected in 3 (3.4%) patients. A single clinic visit was thought sufficient for 83 (89.2%) women. Medical therapy was started in 47 (50.5%) patients, 15 (16.3%) were brought back for inpatient diagnostic hysteroscopy, and nine (9.7%) were booked for operative endoscopy, while six (6.5%) had conventional surgery; the remainder were reassured. CONCLUSIONS: This study demonstrates that a 'one stop' management philosophy based on pelvic ultrasound is feasible. Our data suggest that diagnostic hysteroscopy can be decreased using this approach, and challenge the use of hysteroscopy as the first stage test.  (+info)

Metrorrhagia and precocious puberty revealing primary hypothyroidism in a child with Down's syndrome. (4/51)

We report a child with Down's syndrome in whom metrorrhagia and precocious puberty revealed primary autoimmune hypothyroidism. The patient had a decreased growth velocity, exaggerated weight gain, bone age delay, and bilaterally enlarged multicystic ovaries. Delays in the diagnosis and treatment of hypothyroidism can lead to this peculiar presentation.  (+info)

Conservative therapy of benign uterine bleeding; with special reference to the use of ergot. (5/51)

Although operation frequently is carried out in cases of excessive uterine bleeding of benign origin, particularly if fibrous tumor is present, in many cases major surgical intervention could be averted by adequate conservative therapy. The authors have given Ergotrate(R) over long periods with good results in many cases and have noted no severe side effects. If this therapy fails, diagnostic dilatation and curettement sometimes reveals and removes the cause of bleeding. If infection is a factor, use of sulfonamides or antibiotics sometimes has dramatic effect.  (+info)

Postmenopausal bleeding of nonmalignant origin. (6/51)

A study was made of the medical records of 102 patients hospitalized because of postmenopausal bleeding. Diagnostic procedures used included vaginal examination, Papanicolaou smears, curettage and cervical biopsy. The major associated pathological conditions (possibly etiological factors) in the series were chronic cervicitis, fibromyoma of the uterus, endometrial polyps, cervical polyps and adenomyosis of the uterus. Sclerosis of the uterine vessels was suggested as another possible cause of this type of bleeding. Neither the amount and type of bleeding nor the pattern of associated symptoms were of diagnostic value.A history of hormonal therapy prior to the onset of bleeding is not sufficient evidence to establish that as the cause of the bleeding and the patient should be as completely investigated as if this history were not present. In over 61 per cent of cases in this series, uterine curettage with or without cervical biopsy, cauterization, conization or trachelorrhaphy, was the only treatment required for both diagnosis and therapy.  (+info)

Functional uterine bleeding; etiologic factors and therapy. (7/51)

Endometrial hyperplasia and irregular shedding of the endometrium comprise the largest group of known causes of functional uterine bleeding.Most patients with functional uterine bleeding have a normal endometrial pattern. In a series of patients with functional uterine bleeding, it was noted that 69.7 per cent of endometrial specimens reported as normal showed evidence of hyalinized tissue which included endometrial glands. Tissue of this type was noted in only 3.5 per cent of curetted specimens from patients without functional uterine bleeding. Diagnostic uterine curettage is the initial step in the management of functional uterine bleeding. Hysterectomy and radiation castration are seldom necessary in the management of functional uterine bleeding and are indicated only under specific circumstances.  (+info)

Dysfunctional uterine bleeding; the relationship of microscopic observations to treatment. (8/51)

Dysfunctional bleeding is not an entity, it is a symptom. With proper history, physical examination and laboratory aids a definitive diagnosis can be made. With this diagnosis rational and direct treatment may be instituted. Both diagnosis and treatment are outlined and discussed. When hormonal treatment is indicated, the type, amount and timing must be fitted to the patient's needs.  (+info)

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