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Abstract Enterobius vermicularis is an intestinal nematode of humans. Adults usually have low worm burdens and are asymptomatic. Ectopic infections in the pelvic area or urinary tract rarely occur in women. We report a case of the patient with mild voiding difficulties such as urgency, frequency, nocturia, dysuria, mild low back pain or perineal discomfort. The patient's prostatic secretions showed a large number of inflammatory cells and several eggs. The size and the shape of the eggs identified them as a group of E. vermicularis. On examination we found a soft palpable material which was 5 mm diameter in size and spherical shape. Palpation gave the impression of a tissue than a stone. An incision was performed and a 4 mm long living worm was found. The microscopic examination identified the worm as E- vermicularis. It is an extremely rare manifestation of enterobius vermicularis infection since an intestinal-breeding worm is rarely found in the male genital tract.

Problem: Cytokines play a fundamental role at the feto-maternal interface. A dysregulation of the cytokine profile could be linked with fetal rejection. This study investigated differences in the expression of the Th1 cytokine interleukin-15 (IL-15) of normal and disturbed pregnancy., Method of Study: Analysis of IL-15 expression by immunohistochemistry and real-time RT-PCR in placental tissue from normal pregnancies, spontaneous miscarriage and recurrent miscarriage (RM) was performed., Results: Expression of IL-15 was upregulated on mRNA and protein level in the placenta of miscarriage patients, especially in patients with RM. Immunohistochemistry and immunofluorescence double staining revealed extravillous trophoblast cells (EVT) as IL-15-expressing cells. Staining results were confirmed by real-time PCR (TaqMan)., Conclusion: Increased expression of IL-15 in the decidua of patients with RM may be linked to disturbed implantation and vascularization with consecutive placental and fetal rejection., (© 2010 John Wiley & Sons A/S.)

Study Objective: To study clinical features of patient presented with severe hydramnios, associated with hydronephrosis, that was antenatally diagnosed and has been successfully treated immediately after birth. At a molecular level, we investigated the gene expression of key steroidogenic enzymes from the maternal ovary., Design: Ultrasound scan, MRI, semi-quantitative RT-PCR SETTING: The patient was admitted to the University Hospital, University of Crete, Medical School, Greece, where all clinical data has been obtained. Gene expression studies took place at Biosciences, Brunel University, UK., Results: Semi-quantitative RT-PCR analyses revealed that there is upregulation of key steroidogenic genes in the maternal ovary, including steroidogenic acute regulatory protein, and the cytochrome P450 heme-containing proteins CYP11A, CYP17 and CYP19. From a clinical perspective, the prenatal ultrasound scan and MRI findings showed a multicystic pelvic mass, bilateral hydronephrosis and prior to delivery severe polyhydramnios., Conclusion: This clinical case is the only one that we have found in the current literature where congenital imperforate hymen accompanied with hematocolpos is associated with renal obstruction in combination with polyhydramnios and increase in maternal steroidogenic enzymes., (Copyright 2010. Published by Elsevier Inc.)

Objectives: : Overactive bladder (OAB) is a major cause of suffering in many patients, requiring long-term therapy to maintain symptoms relief. Incontinence or even the fear of leaking urine interferes with sexual function. However, studies evaluating the burden of OAB on female sexual function are limited. The aim of this study was to assess the prevalence of sexual dysfunction among women with OAB compared with healthy controls., Methods: : A total of 112 female patients with clinical and urodynamically proven OAB and 165 healthy controls, free from urinary symptoms were included in our study. Women younger than 18 or sexually inactive were excluded, while the 2 groups were matched to age, parity, and menopause status. All women were investigated in accordance with the Female Sexual Function Index (FSFI) which contains 19 questions and categorizes sexual dysfunction in 6 domains., Results: : According to FSFI, and using as a cut off score, the value of 26.5, sexual dysfunction was diagnosed in 47% of urge incontinent women compared with 22% among healthy controls. We noticed that from the incontinent women with FSFI score lower than 26.5, 47% reported sexual pain disorders, 34% hypoactive sexual desire, 25% sexual arousal disorders, 25% lubrication disorder, and 22% complained of orgasmic deficiency. Furthermore 6 of 10 women with sexual arousal disorders and 10 of 15 with sexual pain disorders also complained for recurrent bacterial cystitis. The FSFI median values in both groups scored as follows (patients vs. controls: median value): desire: 2.9 versus 4.4; arousal: 2.9 versus 4.5; lubrication: 3.3 versus 4.6; orgasm: 3.5 versus 4.3; sexual satisfaction: 2.9 versus 4.4; sexual pain: 2.8 versus 4.3 and full scale 18.3 versus 26.5 (P < 0.001)., Conclusions: : Women with OAB reported sexual dysfunction in a considerably higher number than a general, healthy female population without urinary symptoms.

Implantation of mammalian conceptus in uterine cavity is the result of evolutionary adaptation, through high level of physiological procedures to ensure its success. However the majority of pregnancy losses occur before or during implantation. It is expected that exploring and defining the molecular and physiological road map during the crucial time of implantation will enable us to decode and effectively treat fertility defects. Immunological, hormonal and molecular factors participate in the feto-maternal cross talk during implantation and designate the effectiveness of the process. The atypical expression of major histocompatibility complex and other protein-antigens, such as Fas/FasL and petformin in human trophoblast, the modified function of cellular constituents of the feto-maternal interface, as well as the specific role of some hormones and cytokines, represent substantive parameters of feto-maternal immunotolerance during implantation.

Objective: To investigate the effect of leptin on the actions of growth hormone (GH) and insulin-like growth factor-I (IGF-I) in ovarian steroidogenesis in vitro., Design: In vitro cell culture study., Setting: Research laboratory of a university hospital., Patient(s): Luteinized granulosa cells (GC) were obtained from 20 healthy women undergoing ovarian stimulation for IVF treatment., Intervention(s): Granulosa cells were cultured in serum free conditions for 72 hours with either GH or IGF-I, or their combination, in the absence or presence of leptin (1, 10, and 100 ng/mL)., Main Outcome Measure(s): At 24 and 72 hours of the culture estradiol (E(2)) and progesterone (P) concentrations were measured in culture supernatants by enzyme immunoassays., Result(s): Leptin at the doses of 1 and 10 ng/mL significantly stimulated, whereas at the dose of 100 ng/mL it significantly suppressed E(2) and P production as compared to control. Estradiol production was significantly stimulated by both GH (72 hours) and IGF-I (24 and 72 hours) and that of P only by IGF-I (72 hours). Leptin at the low doses enhanced, whereas at the high dose it suppressed the effect of GH or IGF-I on E(2) and P synthesis., Conclusion(s): These results demonstrate for the first time that leptin can modulate the effect of GH on steroids production by human luteinized GC in culture.

Aim: This study examined the effect of pelvic floor muscle exercises after 12 months of successful treatment for stress urinary incontinence based on subjective (incontinence episodes and pad test) and objective outcome variables (urethral closure pressure, UCP, functional profile length and pressure transmission ratio, PTR)., Methods: Fifty women aged 24-58 years old with genuine stress urine incontinence who successfully underwent pelvic floor muscle exercises, as measured by incontinence episodes and pad test, were included in the study. All women underwent a comprehensive standardized evaluation of urethral pressure profilometry at baseline assessment and at the end of 12 months of pelvic floor exercise program. Maximal UCP, mean UCP, functional profile length or PTR were recorded in all patients., Results: At baseline, the study population had a mean maximal UCP of 33 +/- 20 cm H(2)O, a mean UCP of 18 +/- 10 cm H(2)O, a mean functional urethral length of 22 +/- 5 mm and a mean PTR of 81 +/- 12%. At the end of 12 months of successful and continuous pelvic floor exercises and a significant improvement of incontinence episodes, no difference could be recorded concerning urethroprofilometry parameters studied apart from mean PTR, which was significantly increased., Conclusions: The results of this study indicate that apart from the mean PTR no other urodynamic parameter reflected the continence improvement of pelvic floor exercise program., (2008 S. Karger AG, Basel)

Objective: The aim of the study is to evaluate the efficacy of desmopressin therapy in the symptomatic treatment of nocturia in patients with multiple sclerosis (MS) and neurogenic detrusor overactivity, and to investigate the validity of maximal bladder capacity as a predictor of response to intranasal desmopressin inhalation., Material and Methods: A set of 20 women with MS and neurogenic detrusor overactivity enrolled in a prospective pilot study and were divided into two groups: Group A, the large bladder capacity group (maximal bladder capacity >250 ml, compliance >20 ml/cm H(2)O, n=10) and Group B, the small bladder capacity group (maximal bladder capacity <250 ml, compliance <20 ml/cm H(2)O, n=10). Maximal bladder capacities were measured by urodynamic evaluation. The dosage selected for the study was based on the established dose of commercially available desmopressin nasal spray (20 mug before bedtime) and on clinical trial experience. All patients were monitored for arterial blood pressure before and after treatment and for weight increase for the first 5 days of treatment. Night time voiding diaries were maintained for the 6 weeks of the trial; similarly, serum electrolyte levels and urine osmolality were measured twice weekly during the trial., Results: The mean volume of nocturnal incontinence decreased significantly in both groups (P<0.005). The average number of episodes of nocturia per night in Group A decreased from 2.35 to 0.89 and in Group B from 2.31 to 1.65. The maximum hours of sleep uninterrupted by nocturia increased from 2.54 to 4.62 in Group A and from 2.45 to 3.23 in Group B. Side effects were infrequent; only 2 patients complained of transient headaches. Neither hyponatremia nor serum electrolyte abnormalities occurred., Conclusions: Our results suggest that desmopressin is effective in the symptomatic management of nocturia in patients with MS and neurogenic detrusor overactivity. Maximal bladder capacity is a valuable predictor of response to desmopressin.

Background: Pancreatic pseudocysts (PP) are considered to be one of the major complications of acute, chronic, and posttraumatic pancreatitis. Their treatment has always been a surgical challenge. Surgical treatment was for many years the only choice in the management of PP. However, technological development has provided new alternatives in their management., Purpose: The purpose of this retrospective study is to present our experience in the treatment of PP and to define the criteria for the selection of the treatment method., Methods: During the past decade, 14 patients were treated for PP in our clinic. We classified our patients in three groups based on the treatment: A, conservative treatment; B, surgical treatment with internal drainage; and C, percutaneous external drainage (PED) under CT guidance., Results: Conservative treatment had excellent outcome when it was applied in patients with small cysts. Internal drainage was always successful, but patients needed more hospitalization and showed increased morbidity compared to PED. PED was successful in two of three patients., Conclusions: Conservative treatment is a good choice for small asymptomatic cysts, particularly for patients who are poor candidates for operation. Internal drainage is a good method of treatment and should be used as the first choice by experienced surgeons. Finally, PED is a good first choice for patients with a unilocular cyst and contraindications for surgery.