Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729 S675

polycystic ovarian syndrome (PCOS) and determine the efficacy of

metformin in treatment of (AN).

Materials and Methods: 69 obese females having (AN) were

categorized into Group I: 32 (AN) with PCOS; Group II: 37 (AN)

without PCOS. On the other hand, Group III as control: 35 obese

females without (AN) nor PCOS. (AN) patients were treated with

metformin (500mg t.i.d.) for 24 weeks. Body mass index (BMI),

Waist to hip ratio (WHR); serum fasting glucose (FG), fasting insulin

(FI), IGF-1, IGFBP-1, and IR were assessed by Homeostasis Model

(HOMA-IR).

Results: FI & HOMA-IR were significantly elevated while IGFBP-1

was significantly lower in (AN), and in PCOS than control group.

These changes were positively correlated with severity of (AN) in

both groups. Metformin led to a significant reduction in BMI, WHR,

IR and in the severity of (AN) in both groups. A non significant

decrease in plasma IGF-1 and a significant increase in plasma

IGFBP-1 were also found.

Conclusions: Metformin not only improved (AN) lesions but also

restores normal levels of insulin and decreases the free-bioactive

IGF-1 by increasing the circulating IGFBP-1 in (AN); with and

without PCOS. Therefore, hyperinsulinemic women with (AN) +

PCOS may benefit from metformin for improvement of (AN).

P931

Fluid overload during operative hysteroscopy: a case report

M. Erman Akar1, N. Kayacan2, F. Ertugrul, B. Karslı. 1Akdeniz

University Department of Obstetrics and Gynecology, 2Department of

Anaesthesiology and Reanimation, 3

Severe hyponatremia and fluid overload are rare but severe

complications of operative hysteroscopy. A 47 year-old, 69 kg female

patient is presented who applied for hysteroscopic resection of

submucous myoma uteri.

Approximately 60 minutes after hysteroscopic resection under

general anesthesia, the value of SpO2 declined about 90%. Because

of rales on auscultation, the bronchi was aspirated through the

endotracheal tube and excessive secretions were sucked out.

She suffered from severe absorbtion syndrome leading to severe

hyponatremia of 107mEq/L and low osmolality of 220mosm/kg

necessitating discontinuation of the operative procedure. The

patient was monitored in the Post Anaesthetic Care Unit for two

hours. Postoperatively, physical and mental status was normal. The

patient was discharged from the hospital in the following day

without any complications.

P932

Prevalence of weight gain in the gynecologic endocrinopaties

H. Fonseca, R. Barbosa, C. Beltran, A. Scapinelli, A. Ribeiro,

S. Tamanaha, T. Aoki, J. Aldrighi

Objectives: To evaluate the prevalence of weight gain in patients

in the Clinic of Gynecologic Endocrinology and correlate this data

with different endocrine metabolic diseases.

Patients and Methods: A retrospective cross through the random

survey of medical records, with analysis of 80 patients with

different gynecologic-endocrine diseases. It adopted the criterion

of the World Health Organization (WHO) for low weight,

BMI < 18.5 kg/m2; for normal weight 18.5 BMI< 25kg/m2; for

overweight, the 25 BMI < 30kg/m2; for obesity I 30 BMI < 35kg/m2;

obesity II 35 BMI < 40kg/m2 and obesity III BMI > 40kg/m2. The

patients were divided according to the basic pathology, defined

as primary amenorrhea and secondary amenorrhea. The more

prevalent of the primary amenorrheas is gonadal digenesias and of

the secondary amenorrheas is polycystic ovary syndrome (PCOS),

the premature ovarian failure (POF) and hyperprolactinemia (PRL).

Results: We found that 65% of the patients had BMI greater than

25, and the most frequently associated diseases are PCOS (22%),

PRL (14%) and POF (7%).

Conclusion: The frequency of weight gain in women with

endocrinopathy is higher than the general female population, and

the PCOS and the PRL are the most prevalent diseases in this

sample.

P933

Diagnosis of breast tumors by examination of freezing

specimens obtained by percutaneous biopsy

T. Fontes1, R. Santos1, R. Fonseca2, R. Santos3, F. Gomes4,

K. Mendonca1, R. Bigni5, P. Soares1. 1Hospital Municipal da

Piedade, Universidade Gama Filho, 2Hospital Municipal da Piedade,

Universidade Gama Filho, Instituto Naconal do Cancer, 3Hospital

Municipal da Piedade, Universidade Gama Filho, Universidade do

Estado do Rio de Janeiro, 4Universidade Gama Filho, 5Instituto

Nacional do Cancer

Objectives: Evaluate reliability and index of concordance of

histological exam of slices obtained by freezing compared to

paraffin slices of specimens obtained through thick needle

percutaneous biopsy for diagnosis of breast cancer of palpable and

suspects tumors.

Methods: During 26 months 41 patients were submitted a thick-

needle biopsy (bioptycut), using automatic pistol PRO-MAG™

ULTRA and needle 14G with 12 cm in length, being removed from

each one a minimum of 3 and a maximum of 5 fragments with

good quality, limited to 8 punctures. The fragments submerged

in formol were immediately sent for histological exam, having

the slices obtained through freezing, being sectioned with 5m of

thickness, using cryostat and microtome After that the slices were

applied to not-permanent slides, colored with toluidine blue and

studied with optic microscopy.

Subsequently the residual fragments were included in paraffin for

histological confirmation.

Results: The histological analysis trough freezing was concordant

with the paraffin one in 40 cases, regarding the presence or absence

of malignancy. Only 1 case of breast tumor didn’t reveal malignancy

on freezing exam (fake negative). The concordance index of this

technic was 97.6% when compared to the paraffin one, having no

fakes positives. 29 of the 40 cases were maligns (carcinomas) being

the rest (11) benign.

Conclusion: The exam through frozen pieces obtained through

Bioptycut revealed itself being useful and reliable at Hospital

Municipal Piedade, allowing an increased agility during pre-surgery

period, reducing the gap from the first appointment and the breast

cancer surgery treatment.

P934

Breast involvement in Rosai-Dorfman disease – Related case

R. Santos1, T. Fontes1, R. Fonseca2, L. Frayha3, K. Mendonca1,

R. Santos4, J. Esteves5, R. Bigni6. 1Hospital Municipal Piedade,

Universidade Gama Filho, 2Hospital Municipal Piedade, Instituto

Nacional do Cancer, 3Hospital Municipal da Piedade, 4Hospital

Municipal da Piedade/ Universidade do Estado do Rio de Janeiro,5Hospital Municipal da Piedade, Instituto Nacional do cancer,6Instituto Nacional do Cancer

Objectives: Relate the rarity of the case, so it could be use as

orientation to further diferential diagnostics of benign tumors that

mimics maligin neoplasic breast diseases.

Methods: Medical chart review of a patient who came to the

Mastology Ambulatory of Hospital Municipal da Piedade in 2007.

Results: This report describes the case of a 55-year-old woman

with a 2.5 cm lump in the right breast inferior internal quadrant

that appeared 5 months before, with a solid consistency, irregular

surface and smoothly fixed to deeper structures near the infra-

mammary sulcus. Mammography described this lesion as a 2.4 cm

partially defined lump. Sonography showed a ill-defined solid lump

with irregular surface, sizing 1.9 cm. Once the histological lesion

study of fragments obtained by core-biopsy and incisional biopsy

S676 Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729

were inconclusive, complete excision of the lump was the choice.

Histopathological and immunohistochemical studies revealed a

Rosai-Dorfman disease, characterized by proliferation of fusiforms

cells without atypia in a chronic inflammatory infiltrated with

predominance of lymphocytes, plasmocytes and histiocytes, many

contained lymphocytes in cytoplasmic vacuoles (emperipolesis),

forming a 2.0 cm lump with tumoral markers Vimentin and S100

positives, Ceratin negative.

Conclusion: Breast involvement in Rosai-Dorfman disease is

rare, few cases have been previously reported in the world

literature, However it has clinical and macroscopy characteristics

indistinguishable from breast cancer, judicious histological

and immunohistochemical studies are necessary to a correct

diagnostic.

P935

Study of prevalence of intra-operative adhesions and its

association with risk factors

K. Gajjar1, D. Shukla2, A. Mahendru3, L. Chauhan4. 1St Johns Hospital,

Chelmsford, Essex, UK, 2VIMS, A-18, Gulabvatika Duplex, Vadodara,

390020. Gujarat, India, 3Colchester hospitals university foundation

trust, colchester, Essex, UK, 4Shri Krishna Hospital, Karamsad, Gujarat,

India

Study of prevalence of intra-operative adhesions and its association

with risk factors. Intra-abdominal or pelvic adhesions, which

can be encountered during various gynaecological operations,

are a major contributing factor to pelvic pain, intestinal

obstruction and subfertility. Such adhesions are either due to

prior surgical intervention or due to inflammatory process like

pelvic inflammatory disease and endometriosis. To gain a better

understanding of the prevalence of intra operative adhesions in

gynaecological surgery and possible risk factors associated with

adhesion formation, we studied all trans-abdominal operations in

Obstetric and Gynecology Department of S.S.G. Hospital during one

year period from February 2001 to January 2002, for evaluation of

adhesions by a cross sectional observational study.

Aims and Objectives: To know the prevalence of adhesions and

study the possible risk factors for adhesion formation and correlate

the adhesions with the clinical findings. Evaluation of adhesions if

present i.e. type, scoring and Vascularity.

Materials and Methods: The study set out to determine the

prevalence of adhesions by recording the incidence of adhesions

in Obstetrics and gynaecological surgeries. Sample of 534 patients

underwent gynaecological surgery at SSG Hospital, Baroda, India.

Demographic details were obtained from case notes. Details of

the current operation obtained were probable diagnosis, type

of operation, Indication for operation, adhesions: present/absent,

details of adhesions, type of adhesions, adhesion scoring (scoring

of severity), Vascularity of adhesions, Associated diseases like

Endometriosis, suspected Tuberculosis – abdominal/pelvic and

suspected Pelvic infection. Data regarding presenting symptoms,

obstetric history, menstrual history, surgical history, personal and

family history were recorded.

Summary and Conclusion: Prevalence of intra abdominal and

pelvic adhesions in patients (n = 534) undergoing surgery for

gynaecological condition in present study is 49.05% (262 patients).

Out of 786 patients undergoing LSCS, adhesions were seen in 126

(16.03%) cases, while adhesions at laparotomy were seen in 38

(33.93%) patients. Out of 11 patients with Chronic Pelvic Pain, 5

(45.45%) patients had adhesions at laparoscopy.

The rate of adhesions in patient with PID at laparoscopy was 60.87%

(14 patients out of 23 patients) in present study. 243 (92.75%)

patients with adhesions had associated risk factor or risk factors

for adhesion formation while in 19 (7.25%) patients adhesions were

observed without any known risk factor. 171 (70.38%) patients with

adhesions had previous surgery as a risk factor. The prevalence

of adhesions in patients with past history of appendicectomy in

present study is 78.57%. Patients with past history of PID had

adhesions in 35 (43.75%) cases. Out of 262 patients with adhesions,

132 (50.38%) patients had mainly type A adhesions (flimsy avascular

adhesions) while 130 (49.62%) patients had mainly type B adhesions

(dense vascular adhesions). Higher adhesion score was observed in

patients with risk factors for adhesion development like previous

laparotomy (Score 3 – 42.31%) and previous appendicectomy (Score

4 – 42.86%) while lower adhesion scores are seen in LSCS (Score

2 – 25%), lap TL (Score 1 – 28.57%) and abdominal TL (Score 2 –

29.87%) as a previous surgery.

P936

Laparoscopy aided ultra-mini laparotomy in young unmarried

girls for ovarian cysts

G. Gautam. Fujairah Hospital, Fujairah, UAE

Objectives: Small Abdominal Incision in young unmarried girls to

remove ovarian tumors without intra abdominal spillage. Secure

suturing is performed under direct vision.

Materials and Methods: Between 2006 to 2008, six girls ranging

from 15–19 years of age were diagnosed as cases of ovarian cysts

of the ovary. The cyst was approached through Laparoscope. To

decrease the size of the cyst, cyst contents were sucked through

5mm port with suction & irrigation cannula. After deflating the

abdomen ovarian cyst was brought out through suprapubic incision

of 1–1.5 cm. The pedicle was transfixed and ligated outside under

direct vision like in laparotomy. Then it was reposited back and

operation was concluded after s/c suturing of the Suprapubic and

laparoscope portal. Small 5mm port was closed with steri-strip.

Patient went home next day.

Results: There were no spills. There were 4 Mucinous cyst

adenomas. One was Serous cyst adenoma. One was a Dermoid

cyst.

Conclusions: In a setting where dedicated Endoscopy teams are

not available this type of operation is safe and complete, yet the

incisions remain small like in advanced Laparoscopic operations. In

young unmarried girls the incision is very important.

P937

Assessment of the correlation between asymmetric

dimethylarginine (ADMA) levels and uteroplacental circulation

in pregnancy complicated by pregestational diabetes –

preliminary study

K. Grewling-Szmit, A. Persona-Sliwinska, A. Zawiejska, E. Wender-

Ozegowska, M. Pietryga, J. Brazert. Department of Obstetrics and

Women Diseases, Karol Marcinkowski University of Medical Sciences,

Poznan, Poland

Objectives: ADMA is considered to be an important regulator

of nitric oxide (NO) synthesis, playing a role in development of

diabetic vasculopathy. Thus, inhibition of NO synthesis by ADMA

would cause an increase in blood flow resistance in uteroplacental

circulation. The aim of the study is the evaluation of ADMA

plasma levels in particular periods of pregnancy complicated by

pregestational diabetes (PGDM pregnancy) and the assessment of

the correlations between ADMA and the blood flow characteristics

in the uteroplacental circulation.

Materials and Methods: The study group consists of 56 women

with PGDM (22 individuals at 11–14 weeks, 15 at 24–28 weeks

and 19 at 32–38 weeks) in singleton pregnancy, and 60 women

in normal pregnancy served as controls. The doppler examinations

of the blood flow in the uterine arteries (11–38 weeks) and in the

umbilical artery (26–38 weeks) were performed. ADMA levels were

assessed by HPLC method.

Results: The plasma ADMA concentration (mean ± SD) was

as follows: at 11–14 weeks: 2.24±1.15mmol/L, 24–28 weeks:

2.49±1.63mmol/L and at 32–38 weeks: 2.73±1.20mmol/L p =NS.

We noted a significant association between ADMA and doppler