Vol. XXXVI, no. 4, 2009 ISSN: 0390-6663


CLINICAL AND EXPERIMENTAL
OBSTETRICS & GYNECOLOGY

an International Journal


Founding Editor
A. Onnis
Montréal (CND)


Editors-in-Chief
M. Marchetti
Montréal (CND)
J.H. Check
Camden, NJ (USA)


Assistant Editor
J. Wilson
San Diego - CA (USA)
Editorial Board
Audet-Lapointe P., Montréal (Canada)
Axt-Fliedner R., Lübeck (Germany)
Basta A., Krakow (Poland)
Bender H.J., Dusseldorf (Germany)
Bhattacharya N., Calcutta (India)
Bonilla Musoles F., Valencia (Spain)
Charkviani T., Tbilisi (Georgia)
Dargent D., Lyon (France)
Dexeus S., Barcelona (Spain)
Di Paola G., Buenos Aires (Argentina)
Eskes T.K.A.B.,Nijmegen (The Netherlands)
Franchi M., Verona (Italy)
Friedrich M., Homburg (Germany)
Gomel V., Vancouver (Canada)
Gorins A., Paris (France)
Holub Z., Kladno (Czech Republic)
Jordan J.A., Birmingham, England (UK)
Kaplan B., Petach Tikva (Israel)
Kralj B., Ljubljana (Slovenia)
Lalonde A.B., Ottawa (Canada)
Markowska J., Poznan (Poland)
Marth C., Innsbruck (Austria)
Meden-Vrtovec H., Ljubljana (Slovenia)
Ohara N., Kobe (Japan)
Papadopoulos N., Alexandroupolis (Greece)
Rakar S., Ljubljana (Slovenia)
Sciarra J.J., Chicago, IL (USA)
Stelmachow J., Warsaw (Poland)
Varras M.N., Athens (Greece)
Vîrtej P., Bucharest (Romania)
Winter R., Graz (Austria)

Publishing Organization (M. Morsani):
I.R.O.G. CANADA, Inc. - 4900 Côte St-Luc - Apt # 212 - Montréal, Qué. H3W 2H3 (Canada)
Tel. +514-4893242 - Fax +514-4854513 - E-mail: canlux@mgroup-online.com - http://www.irog.net/

Editorial Office (M. Critelli):
Galleria Storione, 2/A - 35123 Padua (Italy) - Tel. (39) 049 8756900 - Fax (39) 049 8752018

CLINICAL AND EXPERIMENTAL OBSTETRICS AND GYNECOLOGY (ISSN 0390-6663) publishes original work, preferably brief reports, in the fields of Gynecology, Obstetrics, Fetal Medicine, Gynecological Endocrinology and related subjects. (Fertility and Sterility, Menopause, Uro-gynecology, Ultrasound in Obstetrics and Gynecology, Sexually Transmitted Diseases).The Journal is covered by INDEX MEDICUS, MEDLINE, EMBASE/Excerpta Medica.

CLINICAL AND EXPERIMENTAL OBSTETRICS AND GYNECOLOGY is issued every three months in one volume per year by IROG CANADA Inc. Montréal. Printed in Italy by "La Garangola", Tipografia Editrice - Via E. Dalla Costa, 6 -35129 Padova (Italy).

 

Clinical and Experimental Obstetrics and Gynecology
http://www.irog.net/


General Information

CLINICAL AND EXPERIMENTAL OBSTETRICS AND GYNECOLOGY (ISSN 0390-6663) publishes original peer-reviewed work, preferably brief reports, in the fields of Gynecology, Obstetrics, Fetal Medicine, Gynecological Endocrinology, Fertility and Sterility, Menopause, Uro-gynecology, Ultrasound diagnosis in Obstetrics and Gynecology, Sexually transmitted diseases and related topics. It is indexed in INDEX MEDICUS, MEDLINE, EMBASE/ Excerpta Medica.

AIMS AND SCOPE
Since its inception, the CLINICAL AND EXPERIMENTAL OBSTETRICS AND GYNECOLOGY Journal has had the primary aim to assemble and diffuse scientific researches, particularly original researches, contributions, reviews, and proceedings of meetings in every field of the Discipline.
Today its large diffusion all over the world allows us to collect high quality papers and clinical reports on many interesting studies from every country, even from developing countries. This is the target goal of the Journal – aiming at the diffusion of knowledge and advances in female genital diseases.
This publication tries to cover all aspects of obstetrics and gynecology in an interdisciplinary approach among gynecologists, epidemiologists, pathologists, oncologists, radiologists, microbiologists, surgeons, urologists, neonatologists, genetists and so on.
The first target goal of the Journal is to publish high quality papers in the shortest time possible. Research papers, editorial reviews, case reports, technical notes, book reviews and letters to the Editor are published.

ANNOUNCEMENTS regarding meetings, postgraduate courses and symposia will be accepted 6 months before publication and will be published free of charge.
BOOK SAMPLES for review should be sent to the Editorial offices in Montréal or in Padova.
COPYRIGHT: the Journal has been registered with the Copyright Clearance Center, Inc. Reproductions are not allowed without the written consent of the Publisher. All photocopy fees should be paid to the Copyright Clearance Center, Inc., 21 Congress Street, Salem, MA 01970, USA stating the ISSN number, the volume and the first and last page numbers of each article copied.
ADVERTISING INFORMATION: advertising orders and inquiries may be sent to: I.R.O.G. CANADA Inc., Publisher, 4900 Côte St. Luc, Apt. 212, Montréal (Quebec) Canada H3W 2HS, Tél. 514.4893242-4893640 - Fax 514.4854513 - E-mail: canlux@mgroup-online.com - www.irog.net
RESPONSIBILITY: although every effort is made by the editorial staff and the printer to eliminate misleading or inaccurate information, the publisher accepts no responsibility for the consequences of faultful or incorrect information. The authors recognize that the editor and publisher have no responsibility and are indemnified against any liability or claim that may result from the publication of misleading or incorrect data.

SUBSCRIPTION INFORMATION
The Journal is issued every three months (January, April, July and October); one volume per year. Subscriptions start from January and are automatically renewed if not cancelled by the end of September.
Subscriptions include four issues per year plus supplements and monographs and all official communications of Meetings, Courses, Symposia and all scientific activities in the fields of Obstetrics and Gynecology and related topics.
Subscriptions are entered with prepayment only. The annual subscription is $280 US for Institutions and $170 US for Individuals all over the world. For air mail add $20. Single copies prepaid cost $75.00 US.
Send subscription requests with cheque or credit card payment (Amex - Visa - Diners - Master Card) to I.R.O.G. CANADA Inc., 4900 Côte St. Luc, Apt. 212, Montréal, Québec H3W 2H3, Canada. Only US Funds are accepted.
Claims for missing issues can be honored up to six months. Changes of address: allow six weeks for all changes to become effective. All communications should include both old and new addresses (with postal codes) - better if accompanied by a mailing label from a recent issue and should be sent to the printer La Garangola, Via E. Dalla Costa, 6 - 35129 Padova (Italy) - also by Tel. +39.049.8075557, Fax +39.049.7806580. Claims should be made within six months of publication date. Duplicate copies will not be sent to replace those undelivered through failure to notify of change of address.
Single copies and back issue and volume information is available from the printer La Garangola, Padua, Tel. +39.049.8075557, Fax +39.049.7806580. Certain back issues may only be available as photocopies of the originals.
All other business correspondence including orders for offprints and advertising space and any communication and requests should be addressed to I.R.O.G. CANADA Inc., 4900 Côte St. Luc, Apt. 212, MONTRÉAL, QUÉBEC H3W 2H3 (Canada), Tel. (514) 4893242, fax (514) 4854513.

IN ALL LEGAL MATTERS THE COURT OF MONTREAL IS COMPETENT.




Instructions to Authors

SUBMISSION OF MANUSCRIPTS
Papers should be submitted to A. ONNIS Editor-in-Chief of the EUROPEAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY, 4900 Côte St. Luc, Apt. 212 MONTREAL, QUÉBEC H3W 2H3 (Canada) - Tel. +514-4893242 - Fax +514-4854513, or Galleria Sto-rione 2/A - 35123 PADOVA (Italy) - Fax +39-049-8752018.

Editorial articles for publication in the "Distinguished Expert Series" should be submitted to P. Bösze, Editor-in-Chief of this section, Department of Gynecology, Saint Stephan Hospital, 1096 Budapest, Nagyvárad tér 1, Telephone (36-1) 275 2172, Fax (36-1)
275 2172, E-mail: bosze@axelero.hu

When a manuscript is submitted, an acknowledgement card is sent to the corresponding author within two or three weeks.

Submitted papers are reviewed by the Editor-in-Chief and his Peer Referees. Authors may be required to modify the manuscript according to the reviewers' suggestions.

Manuscripts accepted for publication will be copyedited by the editorial staff for typographical and grammatical mistakes and to guarantee clarity and conciseness.

Publication time will be the shortest possible based on scientific and publishing needs. Manuscripts submitted for publi-cation cannot be returned.

Published papers will become property of the Journal and copyrighted under I.R.O.G. CANADA Inc.

After six months no grievances will be accepted regarding published articles.

All statements are the responsibility of the authors. Product dosages, indications and methods referred to in the papers reflect the author's experience. No responsibility is assumed by the Editor-in-Chief or the Publisher for any damage from use of any products, operation methods or instructions contained in the published materials.

Trade names, trademarks, etc. are protected by the law and regulations. The Editor-in-Chief and the Publisher cannot accept any legal responsibility for any errors or omissions that may be made in press, particularly for information about drug dosage and appli-cation thereof contained in the Journal. Consult the prescribing information before administering any drug.

MANUSCRIPT REQUIREMENTS
The Journal follows the "Uniform requirements for manuscripts submitted to biomedical journals" published in the New England Journal of Medicine 1991, 324, 424-8 and in the British Medical Journal 1991, 302.

Three manuscripts, typed and double spaced should be submitted with an electronic disk, formatted in Word for Macintosh or Windows, version 6.0. Manuscripts without an electronic disk will not be accepted. A cover letter signed by all authors must state that all authors who have participated in the work take responsibility for the manuscript which has never been pub lished or submitted for publication elsewhere. Without a cover letter the publication will not be possible. Name, address and phone/fax numbers of the Corresponding Author, responsible for revision and approval of the proofs, should be indicated. Full-length articles should not exceed 8 printed pages including tables and references.

After the title page (full title and names of authors, institutions, eventual acknowledgement for financial support, running title of no more than 60 characters or spaces), original works should be arranged in the conventional order: Summary (purpose of investiga-tion, methods, results, conclusion - about 150 words), Key words, Content (a 20-word summary), Introduction, Materials and Methods, Results, Discussion, Conclusion, Acknowledgement (if any), References, Tables, Legends.

Authors should supply a complete address for reprint requests.

In the text only standard abbreviations can be used and must be avoided in the title. The full term for which an abbreviation stands should precede its first use in the summary and text unless it is a standard unit of measurement.

Authors must give their complete professional identifications and affiliations, including all academic titles and positions.

Letters to the editor should be brief (500 words or less) and offer objective, constructive and educational criticism of published material. The editor reserves the right to publish.

Figures: Two original copies (not negatives) of each figure are requested. Each figure should have a label on the back indicating its number, author's name and top of the figure. Do not write on the back of the figures and do not mount them on cardboard. If sending colour pictures advise if they must be printed in colour or black and white (colour costs ten times more).

Legends should be typed on a separate page with Arabic numerals corresponding to the illustrations.

Tables should be titled, typed in double space on separate pages and numbered in Arabic numerals in the order of their first cita-tion
in the text. Do not use internal rules. Only standard, universally understood abbreviations should be used.

References should be numbered consecutively in the order in which they are first mentioned in the text. Identify references in the text, tables, and legends by Arabic numerals in parentheses.

Use the style of the examples below, which are based with slight modifications on the format used by the U.S. National Library of Medicine in Index Medicus. The titles of journals should be abbreviated according to the style used in Index Medicus.

References must be verified by the Author(s) against the original documents.

Examples of correct forms of references are given below:

Articles in Journals: Authors' surname and initials (if more than six names, give six followed by "et al."), Title, Abbreviated Journal Title, Year of Publication, Volume, Issue and first page.

Books: Authors' surname and initials, title of the book and title of chapter, in: Title, Editor(s), Place, Publisher, Year, Page.

Acknowledgments
will be limited to appropriate professionals who were contributors to the paper.

PROOFS revised by the editorial staff will be sent to the corresponding author and should be checked and returned within ten days. The corresponding author is responsible for detecting typesetting errors. After this deadline the proofs will be considered approved. Only essential corrections should be made; extensive changes will be charged to the authors.

BUSINESS MATTERS
The Journal has no commercial advertisements.

Authors will be expected to contribute to the printing expenses, tables, figures and postage. For every published article a copy of the Journal will be provided free of charge. Only payments in US dollars will be accepted. No bank transfers.

Reprints should be requested with the form enclosed with the acceptance letter. No free reprints will be supplied.


© By I.R.O.G. CANADA INC. - Publisher - Editorial office 4900 Côte St. Luc - Apt. 212 - Montréal Québec H3W 2H3 (Canada) - Tel. (514) 4893242-4893640 -Fax (514) 4854513 - Printed in Italy by "La Garangola" - Via E. Dalla Costa, 6 - 35129 Padua (Italy) - Responsible Director: Prof. Antonio Onnis M.D. - Authorization of Padua's Court n. 633 - 28-6-1979
 
Clinical and Experimental Obstetrics & Gynecology - Vol. XXXVI, n.4, 2009
   
In Memoriam: Antonio Onnis 201
EDITORIAL ARTICLES  
A practical approach to the prevention of miscarriage: Part 1 - progesterone therapy 203
J.H. Check - Camden, NJ (USA)
Progesterone therapy is effective in reducing the risk of miscarriage in women with previous miscarriages, women needing
follicle maturing drugs for infertility, and women of advanced reproductive age.
 
ORIGINAL ARTICLES  
Reproductive Biology Section  
The effect of blastomere number on embryo survival upon freezing/thawing 209
J.H. Check, D. Horwath, D. Summers-Chase, W. Yuan, K. Swenson, C. Levito - Camden, NJ (USA)
Though 4-cell embryos have a markedly lower implantation potential upon fresh embryo transfer compared to 6-8 cell embryos, it is not reflected in their ability to survive freeze-thawing.
 
A comparison of efficacy of freezing embryos at the 2 pronuclear (2PN) stage vs multi-cell when using a simplified freezing protocol with one-step removal of cryoprotectant 210
J.H. Check, D. Summers-Chase, D. Horwath, K. Swenson, W. Yuan - Camden, NJ (USA)
When using a simplified freezing protocol with a Biocool freezer rather than a programmable freezer higher survival, live delivered pregnancy and implantation rates were found when freezing at the 2 pronuclear rather than the multi-cell stage.
 
Pregnancy rates per embryo transfer (ET) may be improved by conventional oocyte insemination for male factor rather than intracytoplasmic sperm injection (ICSI) 212
J.H. Check, B. Katsoff, D. Summers-Chase, W. Yuan, D. Horwath, J.K. Choe - Camden, NJ (USA)
A retrospective comparison of pregnancy outcome following conventional oocyte insemination versus intracytoplasmic sperm injection suggests that fertilization by ICSI could reduce the implantation potential of the embryos that are formed.
 
Relationship of serum progesterone (P) level the day after human chorionic gonadotropin (hCG) injection on outcome following in vitro fertilization-embryo transfer (IVF-ET) 214
J.H. Check, J. Amui, J.K. Choe, D. Brasile - Camden, NJ (USA)
Either too little or too much progesterone secretion following hCG injection can negatively effect embryo implantation but the effect is minimal.
 
Effect of the degree of fragmentation on embryo survival after freeze-thawing 216
J.H. Check, K. Swenson, W. Yuan, A. Nazari - Camden, NJ (USA)
Though more fragmented embryos have a lower survival rate after freeze thawing, about 50% of embryos with > 25% fragmentation will still survive the thaw and be able to be transferred.
 
A prospective comparison of in vitro fertilization (IVF) outcome following controlled ovarian hyperstimulation (COH) regimens using follitropin alpha exclusively or with the addition of low dose human chorionic gonadotropin (hCG) and ganirelix 217
J.H. Check, E. Davies, D. Brasile, J.K. Choe, J. Amui - Camden, NJ (USA)
No clinical advantage was found by adding exogenous LH activity to the drug regimen for stimulation of multiple follicles for purposes of in vitro fertilization when using follitropin alpha.
 
General Section  
Tartrate-resistant acid phosphatase (TRAP) as a serum marker for bone resorption in breast cancer patients with bone metastases 219
S. Tauchert, A. di Liberto, T. Cordes, M. Thill, D. Salehin, M. Friedrich - Krefeld, GERMANY
TRAP activity is well correlated with the grade of bone metastases and with the number of locations in the body.
 
Lesions of the subepithelial stromal zone of the lower female genital tract. An immunopathological study 226
A. Kondi-Pafiti, M. Frangou-Plemmenou, C. Bakalianou, M. Tsantopoulos, K. Papadias, A. Liapis - Athens, GREECE
Subepithelial cervical and vaginal stroma lesions were studied immunopathologically.
 
Regional anaesthesia for primary caesarean section in patients with preterm HELLP syndrome: a review of 102 cases 230
S¸. Palit, G. Palit, M. Vercauteren, Y. Jacquemyn - Edegem, BELGIUM
A retrospective study demonstrating that combined spinal-epidural anaesthesia can be used in cases of HELLP syndrome.
 
Prevalence of severe pelvic inflammatory disease and endometriotic ovarian cysts: a 7-year retrospective study 235
I. Grammatikakis, N. Evangelinakis, G. Salamalekis, V. Tziortzioti, C. Samaras, C. Chrelias, D. Kassanos - Athens, GREECE
The prevalence of PID in women with endometriosis is sufficiently higher than the prevalence in the general population.
 
Mid-trimester maternal serum markers in predicting adverse pregnancy outcome 237

G. Androutsopoulos, P. Gkogkos, V. Papadopoulos, G. Adonakis, V. Tsapanos, P. Vassilakos, G. Panayiotakis, G. Decavalas - Rion, GREECE
Mid-trimester maternal serum markers in predicting adverse pregnancy outcome.

 
Evaluation of pain before and after vaginal delivery 241
B. Alves, T. Zakka, M.J. Teixeira, J.T.T. Siqueira, S.R.D.T. Siqueira - São Paulo, BRAZIL
The factors associated with the pain perception of childbirth and the perception of the obstetrician about women’s pain in a prospective study are reported.
 
A comparison of low-dose and high-dose protocols of vaginal misoprostol for second trimester termination of pregnancy 245
K. Özerkan, G. Ocakog˘lu, S. Rehimli, G. Uncu, O. Develiog˘lu - Bursa, TURKEY
To induce termination of pregnancy, vaginal misoprostol is more efficient when administered in higher doses.
 
Intramuscular fetal corticosteroid therapy short-term effect on maternal-fetal Doppler velocimetry 248
I. Babovic´, S. Plesinac, J. Opalic´, I. Pilic´, Z. Radojicˇic´, M. Pervulov, N. Radunovic´, A. Ljubic´ - Belgrade, SERBIA
Fetal corticosteroid therapy includes the increase of RI in the descending aorta as well as decrease of GIL in the umbilical artery after the 32nd week.
 
Chorionic villus sampling: analysis of the first 350 singleton pregnancies by a single operator 251
G.O. Ajayi - Lagos, NIGERIA
Chorionic villus sampling is a relatively safe and reliable method of prenatal genetic diagnosis.
 
Prevalence of acute hemoperitoneum in patients with endometriotic ovarian cysts: a 7-year retrospective study 254
N. Evangelinakis, I. Grammatikakis, G. Salamalekis, V. Tziortzioti, C. Samaras, C. Chrelias, D. Kassanos - Athens, GREECE
Endometriosis should be considered in the differential diagnosis of ascites and acute abdominal pain or pelvic mass.
 
Two-year results of a new two-minute hot liquid balloon endometrial ablation system (Thermablate): a pilot study 256
D. Karamanidis, P. Nicolaou, A. Byros, Ger. Koutsougeras - Alexandroupolis, GREECE
A new two-minute hot liquid balloon system provided effective therapy for menorrhagia in 70% of women.
 
Arthrogryposis multiplex congenita: Analysis of twelve cases 259
B. Dane, C. Dane, F. Aksoy, A. Cetin, M. Yayla - Istanbul, TURKEY
Sonographic examination plays an important role in the diagnosis and obstetric management of cases with arthrogryposis multiplex congenita.
 
 
CASE REPORTS  
Spontaneous umbilical endometriosis: a case report with one-year follow-up 263
E. Spaziani, M. Picchio, A. Di Filippo, C. De Cristofano, F. Ceci, F. Stagnitti - Latina, ITALY
A case of spontaneous umbilical endometriosis is presented and the clinical and therapeutic approaches to this very rare disease are discussed.
 
Primitive breast localisation of Buruli ulcer in an endemic zone: a rare case 265
K. N’Guessan, P. Guié, P. Iovenitti, G. Carta, V. Loue, V. Angoi - L’Aquila, ITALY
A rare case of Buruli ulcer localised in the breast is described.
 
Placental chorioangioma and chorioangiosis. Clinicopathological study of six unusual vascular lesions of the placenta - case reports 268
A. Kondi-Pafiti, K. Bakalianou, N. Salakos, C. Iavazzo, K. Papadias, A. Liapis - Athens, GREECE
Two cases of placental chorioangiomas and four cases of chorioangiosis are presented because of the importance of the differential diagnoses.
 
 
Letter to the Editor 271
 
Contents index vol. XXXVI, 2009 272
 
Authors index vol. XXXVI, 2009 276