Statement of the Problem: The knowledge about the endometrial receptive stage for embryo transfer in IVF treatment is very important but unknown as well. Measuring the endometrial thickness and trilaminar pattern by ultrasound provides only a hind of a sucessful start of the menstrual cycle at the end of the follicular phase. Aim of this study was to monitor the endometrial transformation process applying our Personal Endometrial Maturation Analysis (PEMA®). We wanted to get information about the transformation process and to exclude an arrest of that organ, which cannot be done by  one biopsy.  Methodology & Theoretical Orientation: Two biopsies were taken mainly at days +5 and +10 after ovulation (OV, n = 76)/hormone replacement therapy (HRT, n = 58) within one cycle. Endometrial dating is done with our new modified endometrial dating method, a combination of histomorphological analysis, based on the Noyes criteria, with a typical pattern of hormone receptors and the proliferation marker Ki-67 for each cycle day between OV/P +2 and +11. Findings: The results were correlated with the clinically expected day of the cycle and showed temporal delays or hypercompensations, diverging from the expected cycle days by 0.5–5 days. In comparison with the first biopsies, the transformation rate in the second biopsies showed constant transformation, compensation or augmented delay in 28.94, 48.69 and 22.37 % of cases for ovulation in natural cycles and 17.26, 56.89 and 25.85 % for HRT cycles respectively.

Conclusion & Significance: The study revealed an individually dynamic transformation process of the endometrium using PEMA®, with the ability to compensate or enlarge an initial “delay”, which is now identified as a normal individual transformation process during the secretory phase. This information will lead to a new consideration of IVF procedures and will influence timing of embryo transfers.

Statement of the Problem: Low-grade-endometrial-cancer (LGEC) is the most common gynecological-cancer in developed-countries. Women who develop LGEC tend to be obese and to suffer from many co-morbidities that challenge the surgeon. The literature demonstrates the supremacy of minimal-invasive-surgeries (MIS) for this group of patients. Robotic-surgery (RS), an advanced MIS, costs are high and healthcare-systems do-not include specific reimbursement for this approach.

Methodology &Theoretical-Orientation: This retrospective study compared perioperative-measures, costs, quality-of-life and survival after open (OS) vs. RS, among obese-women (BMI≥30) diagnosed with LGEC. in two tertiary-medical-centers in the center of Israel during 2013–2016. Quality-of-life was evaluated by Physical&Mental Components of the SF-36 and a recovery-from-surgery questionnaire. Overall-survival-outcomes were obtained from patients’ files. Surgical-outcomes (operating and anesthesia times, length of hospital-stay, and intraoperative&postoperative-complications according to the Clavien-Dindo-classification scale) were reviewed. Findings:  In all, 138 women underwent OS (n = 61) or RS (n = 77) during the study-period. The groups had similar BMI, comorbidities, demographics and tumor characteristics. RS was associated with shorter hospital-stays (mean 1.7 vs. 4.8 days; P<.0001) and fewer postoperative-complications (Clavien-Dindo > 2, 5.2% vs. 19.7%; P=.0008), but longer operating-theater time (3.8 vs. 2.8 h; P<.001). Costs are equivalent when at least 350 RSs are performed annually, without the initial system costs. Quality-of-life measures were better after RS. SF-36 showed better measures for RS. After RS, patients tended to recover quicker. Overall, 5-year-survival was 89.8% for the OS group vs. 94% for the RS group (log-rank, P=0.330). Conclusions: Obese-women with LGEC had better quality-of- life after RS vs. OS. They also had shorter hospital-stays and fewer postoperative-complications. Centers with high-volumes of RS can achieve similar costs when comparing both methods. These results were achieved without jeopardizing survival.

Sertoli-Leydig cell tumor is a rare sex cord-stromal tumor of the ovary that accounts for less than 0.5% of all primary ovarian neoplasms. Since these tumors have testicular cell types (Sertoli and Leydig cells), androgenic symptoms are common, causing signs of virilization (e.g., hirsutism, acne, irregular menstrual periods, male-pattern baldness, loss of female fat distribution, and hoarse voice). In many cases, secondary amenorrhea is the only symptom of the disease. This leads to an intensive search for the source of the disorder. We report the case of an 18-year-old woman who presented with amenorrhea of two years’ duration and severe viriliza¬tion with hirsutism, clitoromegaly and hoarse voice. Her testosterone levels were in male ranges. Imaging examination showed a mass in her left ovary. The tumor was removed with surgery and the pathological examination revealed a “moderately differentiated Sertoli-Leydig tumor”. The patient’s serum testosterone levels normalized a few days after treatment and her menses resumed spontaneously one month after the operation.

Chorioangioma is the most common non-trophoblastic placental tumor, with an incidence of 1% of pregnancies. It was first described by Clarke in 1978. Although its etiology is not precisely known, it´s believed to consist of an abnormal proliferation of vessels in various stages of differentiation in the placental stroma. Prenatal diagnosis is made through ultrasound visualization of a rounded, hypoechoic, homogeneous-looking formation located on the fetal side of the placenta, with color Doppler inside.

Vulvovaginal laxity (VL) is caused particularly by vaginal delivery, excessive physical strain, ageing or due to hormonal changes. It is influenced by insufficient vaginal wetness, burning and itching in vaginal orifice, yeast infections and inflammations. The consequences are collagen changes, incontinence and worsening of sexual life, often followed by mental issues as well. The use of Jett Plasma For Her II (JPH II) device is a new promise in correction of weakened pelvic muscles and vaginal walls and improvement of the VL symptoms. Therapeutic effects are achieved through membrane depolarization, reversible electroporation and thermal stimulation. Collagen activation is started and tissue structure is strengthened. The procedure is painless, well tolerated, without anaesthetic, it solves rejuvenation of atrophied vaginal mucosa and symptoms cease significantly.

The effect of the treatment with JPH II device is currently being verified by a prospective Post-Market Clinical Follow-up study (PMCF study) via questionnaires aimed at assessment of patient's VL symptoms and sexual satisfaction. Each patient's satisfaction recorded in questionnaire was monitored at the beginning of study and then gradually over the course of study, showing excellent results with substantial improvement during the treatment. Overall increase in patient's sexual satisfaction and improvement of VL symptoms was higher than 30 %. Furthermore, a collection of biopsy samples before first and after last treatment was gathered and compared with each other. As a result, comparison of all biopsy samples before and after treatment even showed 222 % average increase in epithelial thickness of vaginal wall. In conclusion, these outstanding results indicating significant improvement in patient's state show a great potential in JPH II treatment of vaginal laxity, stress incontinence and improvement of sexual function and often related mental issues. Altogether, Jett Plasma For Her II represents an elegant solution for women dealing with the sensitive issue of vaginal laxity..

Background:

Hypertensive disorders are one of the most common medical disorders during pregnancy.It is a major cause of maternal& perinatal morbidity & mortality. In developing countries, they rank second only to anemia with approximately 7 to 10% of all pregnancies complicated by some form of hypertensive disorders. Identifying high risk patients & close monitoring can  reduce the complications. Lactate dehydrogenase is a useful biochemical marker &can be used to evaluate maternal complications like disseminated intravascular coagulation[DIC], HELLP syndrome,[haemolysis,elevated liver enzymes & lowered platelets] , Pulmonary edema, renal failure & fetal complications like fetal growth restriction[FGR], APGAR score</= 7 at 5 minutes & neonatal intensive care unit[ NICU] admissions.

Objectives:

1. To estimate Serum LDH levels in Preeclampsia patients.

2. To study the correlation between increased serum LDH levels & maternal & fetal outcome.

Methodology:

It was a prospective study at M.S.Ramaiah hospitals from October 2015 - May 2017.

Results:

The incidence of maternal & fetal complications were increased with higher serum LDH levels. With serum LDH > than 600IU/L the incidence of HELLP syndrome was 10% with p value <0.001,**significant, DIC was 1.7% with p value <0.004,**significant, Pulmonary edema was 2.6%, with p value 0.072+significant. It also correlated with increased creatinine levels & decreased platelets with p value < 0.001.** The fetal outcome was FGR in 84.2%, NICU admission in 94.7% and APGAR score <7 at 5 min in 73.6% with p value being statistically significant at 0.001.**

The liver enzymes aspartate aminotransferase [AST] & alanine aminotransferase[ALT] values and serum creatinine were also correlating with increased LDH levels with p value <0.001**.

Conclusion: With raised serum LDH levels, maternal & fetal complications are increased. LDH levels can be used as a biochemical marker. Monitoring of serum LDH levels  helps to achieve a better outcome for both mother and fetus.