RESUMEN
OBJECTIVE: To characterize hyperosmolarity-responsive genes in leiomyoma cells and determine whether gonadotropin-releasing hormone (GnRH) agonist treatment altered their expression. DESIGN: Laboratory study. SETTING: University hospital. PATIENT(S): None. INTERVENTION(S): Cell culture under hypertonic conditions and with GnRH agonist treatment, RNA isolation, and real-time reverse-transcriptase polymerase chain reaction (RT-PCR). MAIN OUTCOME MEASURE(S): Expression of nuclear factor of activated T cells 5 (NFAT5), aldose reductase (AR), and sodium myo-inositol transporter 1 (SMIT) messenger RNA (mRNA) in immortalized leiomyoma and patient-matched myometrial cells. RESULT(S): Leiomyoma cells had increased basal expression of NFAT5 mRNA (1.7±0.08-fold) compared with myometrial cells. The NFAT5 increased further in leiomyoma cells cultured under hyperosmolar conditions (3.0±0.46-fold at 50 mM NaCl and 3.3±0.48-fold at 100 mM NaCl). The NFAT5-regulated mRNA transcripts for AR and SMIT were increased in untreated leiomyoma cells compared with myometrial cells and further increased in leiomyoma cells exposed to osmotic stress. The NFAT5 transcripts were decreased with low-dose GnRH agonist treatment but increased with supraphysiologic doses. CONCLUSION(S): Expression of hyperosmolarity genes was increased in leiomyoma cells relative to myometrial cells. Pharmacologic concentrations of GnRH agonist decreased NFAT5 expression, suggesting that water flows out of leiomyoma cells at pharmacologic doses.
Asunto(s)
Antineoplásicos Hormonales/farmacología , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Hormona Liberadora de Gonadotropina/agonistas , Leiomioma/genética , Leuprolida/farmacología , Neoplasias Uterinas/genética , Equilibrio Hidroelectrolítico/efectos de los fármacos , Aldehído Reductasa/genética , Estudios de Casos y Controles , Proliferación Celular/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Femenino , Hormona Liberadora de Gonadotropina/metabolismo , Proteínas de Choque Térmico/genética , Humanos , Leiomioma/metabolismo , Leiomioma/patología , Presión Osmótica , ARN Mensajero/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Simportadores/genética , Factores de Transcripción/genética , Células Tumorales Cultivadas , Neoplasias Uterinas/metabolismo , Neoplasias Uterinas/patología , Equilibrio Hidroelectrolítico/genéticaRESUMEN
OBJECTIVE: To evaluate assisted reproduction technology (ART) usage and outcomes in minority women seeking care at enhanced access, military ART programs. DESIGN: Retrospective cohort. SETTING: Federal ART programs. PATIENT(S): Two thousand fifty women undergoing first cycle, fresh, nondonor ART from 2000 to 2005. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Rate of ART use, clinical pregnancy rate, live birth rate. RESULT(S): African American women had an almost fourfold increased use of ART and Hispanic women had decreased use. Clinical pregnancy rates were significantly lower for African American women compared with white women (46.1% vs. 52.6%, relative risk [RR] 0.88; 95% confidence interval [CI], 0.78-0.99) as were live birth rates (33.7%. vs. 45.7%, RR 0.74; 95% CI, 0.63-0.91). CONCLUSION(S): Economics appear to influence ART use by African American women but not Hispanic women. Despite increased use by African American women, outcomes in this group were worse when compared with Caucasian women. Improving access through decreased cost may increase use by some but not all minority groups. Improved access may not translate into improved outcomes in some ethnic groups.
Asunto(s)
Grupos Minoritarios , Técnicas Reproductivas Asistidas/economía , Técnicas Reproductivas Asistidas/estadística & datos numéricos , Adulto , Negro o Afroamericano/estadística & datos numéricos , Estudios de Cohortes , Costo de Enfermedad , Análisis Costo-Beneficio , Femenino , Disparidades en Atención de Salud/economía , Disparidades en Atención de Salud/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Infertilidad/economía , Infertilidad/epidemiología , Infertilidad/terapia , Grupos Minoritarios/estadística & datos numéricos , Embarazo , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To describe provocative testing and alternative imaging strategies used to localize an androgen-producing tumor in a 58-year-old woman with severe hirsutism. DESIGN: Case report. SETTING: Clinical Research Center. PATIENT(S): A 58-year-old woman who was seen for evaluation of severe hirsutism. INTERVENTION(S): Serum androgen levels were measured at baseline, 4 hours after administration of 2000 IU of hCG, and 11 days after administration of 3.75 mg of leuprolide acetate (LA). Magnetic resonance imaging and F 18-fluoro-D-glucose-positron emission tomography-computed tomography (FDG-PET/CT) were performed. MAIN OUTCOME MEASURE(S): Description of preoperative provocative testing and imaging. RESULT(S): In response to hCG, T rose from 243 to 288 ng/dL then decreased to 233 ng/dL after LA administration. The FDG-PET/CT scan demonstrated focal hypermetabolism in the right pelvis, corresponding to a soft-tissue density on the noncontrast CT scan. Magnetic resonance images were correlated with the PET/CT, and the right ovary was identified. Right salpingo-oophorectomy was performed, and final pathologic examination revealed a hilar cell tumor with ovarian cortical hyperplasia. CONCLUSION(S): This case demonstrates the utility of provocative testing in the evaluation of a patient with severe hirsutism and illustrates the value of FDG-PET/CT when traditional imaging is nondiagnostic.