The pharynx and respiratory tract may be involved, with thickening of the mucous membrane. This can result in abnormal placentation including placenta accreta or percreta, uterine rupture, higher spontaneous abortion rates, preterm delivery, ectopic pregnancy, and fetal limb malformations. On the penis, although leukoplakia may occur, a similar precancerous process called erythroplasia (of Queyrat) is usually seen instead. Side effects of acetylcholineblocking agents may also cause or aggravate such conditions as glaucoma and convulsions. Features useful in distinguishing the two include lack of highgrade atypia, lack of necrosis, rarity of mitoses, a lack of Ki-67 expression, evidence of transition between the cells of the nodule and those of the adjacent nevus, and lack of compressive expansile growth. This chapter considers the processes of oocyte meiosis, fertilization and early cleavage, implantation, development of the genitourinary system, and sex differentiation. Histologically, there is marked hyperkeratosis and parakeratosis, as well as pseudoepitheliomatous hyperplasia. The concha and external auditory canal are variably innervated by branches of the vagus, glossopharyngeal, and facial nerves. For example, in children who present with genital bleeding, the differential diagnosis may also include urethral prolapse, foreign bodies, and lichen sclerosus, vaginal tumors, or nonabusive trauma. These have been called generalized dermal melanocytosis or dermal melanocytic hamartomas. Time intervals from two pronuclei to two-cell, two-cell to three-cell, three-cell to four-cell, and four-cell to fivecell are 26 hours, 12 hours, 0. The ovarian artery unites with the ascending branch of the uterine artery in the mesovarium just under the suspensory ligament of the ovary. The physician should also consider the use of electrocautery (heat only, no electrical transmission) or a bipolar device (current transmitted between two tips) when treating these patients. As the cost of new treatments for cancer continues to rise, the value of this care is an important question. Thus it is helpful for gynecologists to inquire about sexual issues in women with cardiovascular disorders. Open communication, with an awareness of and sensitivity to the vast diversity of our patient population, will help to create a collaborative environment in which to explore health issues. The sympathetic Obstetrics & Gynecology Books Full 3 Reproductive Anatomy in the area just below the bifurcation of the common iliac arteries. The return to a 1/pulse/90-minute frequency is essential to create the optimal conditions for the new menstrual cycle. Eruptive lingual papillitis is thought to result from a viral infection, and the 50% transmission among family members further supports this theory. For a normal cell line to be transformed into a malignant cell line, several genetic mutations in that somatic cell line must occur that alter cell growth and differentiation. The second, uveitic phase is characterized by anterior and/or posterior uveitis and inflammation of many other parts of the eye. Each of these elements is required to be proved by way of "competent" expert testimony. JosephA,etal: the efficacies of affected-limb care with penicillin diethylcarbamazine, the combination of both drugs or antibiotic ointment, in the prevention of acute adenolymphangitis during bancroftian filariasis. Epistatic interaction between the monoamine oxidase A and serotonin transporter genes in anorexia nervosa. In addition, the sparing of normal adjacent tissue can improve cosmesis and decrease the risk of functional defects in a sensitive anatomic location. A shallow shave excision suffices to cure it and to rule out precancerous leukoplakia; no fulguration is required. Women with a past history of depression, or moderate to severe depressive symptoms as part of grief, should be treated aggressively, even in the first month or two after the loss, with antidepressant medication and psychotherapy, whereas those with milder depression can be monitored or referred for psychotherapy alone. A battered woman is defined as any woman over the age of 16 with evidence of physical abuse on at least one occasion at the hands of an intimate male partner.
Hysterectomy was associated with longer operative and recovery times, and patients were more likely to experience postoperative complications. Communicating uteri: review and classification with introduction of two previously unrecorded types. SardanaK,etal: Which therapy works for melasma in pigmented skin: lasers, peels or triple combination creams. The early changes of acral-lentiginous melanoma may be light brown and uniformly pigmented. Trichoblastomas usually occur in adult men and women, but children can also develop them. The most common type is the mucous extravasation phenomenon, which is usually seen inside the lower lip because it is caused by trauma from biting. This will often wash off the semipermeable dressing and may require the use of fenestrated dressings and even the application of absorbent padding over the dressing for the first few weeks. KerkN,etal: Rivaroxaban prevents painful cutaneous infarctions in livedoid vasculopathy. Cases caused by spread from an underlying bladder carcinoma are typically uroplakin and p63 positive. KubbaA,etal: Tumor of follicular infundibulum: an unsuspected cause of macular hypopigmentation. Therefore many surgeons routinely inject indigo carmine and either open the bladder or perform cystoscopy near the end of the operative procedure. The protocol recommended a preprocedure verification process, marking the operative site and performing a "time out. The blades should be inserted to their full length and then opened so that the physician may inspect for the position of the cervix. High-dose single exposures to radiation may result in similar radiation lentigines in exposed skin. Most people have secure attachment styles and assume both that they themselves are deserving of care and that others can be trusted. Cosmoderm 1 has a concentration of 35 mg/mL and is in phosphate-buffered saline with 0. The clitoris generally swells and becomes erect because of increased genital blood flow and the neurotransmitter nitric oxide, causing it to be tightly applied to the clitoral hood. SantosaputriE,etal: A multisystem granulomatous disease: necrobiotic xanthogranuloma with hepatic involvement. Symptoms and Signs It is important to recognize several gynecologic and obstetric signs and symptoms that may indicate a uterine anomaly and to also remember that many females with congenital uterine anomalies are asymptomatic. Flexible minihysteroscopic instruments and microendoscopes are convenient and well tolerated in the office for diagnostic and simple operative procedures such as directed biopsies. Ulceration can occur despite the meticulous technique of the dermatologist and regardless of the sclerosing agent used. Childhood cases appear at any age from 1 year to adolescence, with one congenital case reported. Distressing sexual problems in United States women revisited: prevalence after accounting for depression. Epigenetics is a growing field for understanding complex genotype-phenotype interactions. It is worthwhile calling these, as a group, "orofacial granulomatosis" so that various underlying disease states or etiologic factors will not be missed when evaluating such patients. Non-pigment-specific ablative lasers have been used in the treatment of pigmented lesions and tattoos. This group is the first secondary chain to receive the efferent lymphatics as lymph flow progresses in a cephalad direction from the majority of other pelvic nodes. Incisional biopsies remove a portion of a clinical lesion and are often performed on larger plaques or patches when an excisional biopsy is not cosmetically acceptable or feasible.
Much of the treatment for calciphylaxis is directed at altering abnormal calcium metabolism. CagnanoE,etal: Compound nevus with congenital features and balloon cell changes: an immunohistochemical study. Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials. Chemotherapy should be considered only when all other treatment options have failed. Throughout their course they are in close proximity to the ureters, which are anterior, and to the hypogastric veins, which are posterior. Red light should be used instead of blue light because it penetrates more deeply and thus more effectively treats adnexal extensions. Long-term intravaginal presence of foreign bodies in children: a preliminary study. There is marked production of collagen fibers in the cutaneous lesions by the mechanism previously described. Individual lesions average at least several centimeters in diameter but may be much larger. The disease is often associated with keratosis pilaris of the extensor surfaces, temples, and back of the neck. A systematic review and meta-analysis (King, 2008) found an increased rate of depression, anxiety disorders, and substance abuse and dependence in lesbian, gay, and bisexual individuals. This regimen appears to be safe in women with a prior cesarean delivery, as uterine rupture is uncommon. Thompson and Ciechanowski (2003) recommended providing care through a number of different clinic providers or a treatment team if possible, so that the woman can develop a relationship with the clinic rather than needing to trust a single person. Although systemic corticosteroids may be very effective, the high doses required and the usual immediate relapse as the steroids are tapered make this approach untenable in most situations. The potential complications of the distending media include anaphylaxis to dextran, circulatory overload with D5W, pulmonary and cerebral edema, hyponatremia, seizure, coagulopathies, and the potential of air or gas embolism with carbon dioxide. Groves has suggested that these patients are afraid of losing the relationship with the physician if they improve. Digital epiluminescence microscopic surveillance of atypical nevi may also be of value. A rare subset of patients with hypocomplementemic urticarial vasculitis has Jaccoud arthropathy and serious valvular heart disease. Sexual arousal disorder is characterized by a persistent inability to sense genital arousal. Low-dose methotrexate, 735 Cutaneous lymphomas 32 Cutaneous Lymphoid Hyperplasia, Cutaneous T-Cell Lymphoma, Other Malignant Lymphomas, and Allied Diseases. The history should include whether the patient is currently sexually active or has been in the past. Under diascopic pressure, the reddish brown area, containing telangiectases, becomes pale, and the light-brown pigmentation becomes more apparent. Age and gender of the patient as well as the size, site, and type of lesion are important factors to be considered when choosing the proper method of treatment. Women who experience menstrual-related seizures should have serum levels of their anticonvulsant medications checked during menses. Annularsarcoidosis Papular lesions may coalesce or be arranged in annular patterns, usually with a red-brown hue. Additional signs include submandibular or cervical adenopathy (40%) and angular cheilitis (10%). However, most cases of alopecia areata occur without associated disease, and routine screening for these disorders is of little value unless prompted by signs or symptoms. The physician can empathically understand that the woman feels overwhelmed and unable to cope, but in order to preserve an effective treatment relationship the physician needs to be clear about what he or she realistically can and cannot do for the woman. The septum separates the cloaca into the urogenital sinus ventrally and the anal canal and rectum dorsally (Hynes, 2004). Elastophagocytosis is prominent and elastic tissue is absent in areas of inflammation.
Histologically, there is a lymphohistiocytic infiltrate extending through the dermis into the subcutaneous fat. Histologically, the arsenical keratosis on the palms and soles shows hyperkeratosis, parakeratosis, acanthosis, and papillomatosis. Whereas 25% of treated patches repigment completely, treatment-resistant areas (elbows, knees, wrists, dorsal hands and feet) have only a 2% rate of at least 75% repigmentation. Careful sampling of early lesions, with large and deep biopsies, if necessary, may be required to find the "primary" vascular pathology. Milia can be considered primary, appearing spontaneously, or secondary, caused by trauma, skin disease, or medication. In short, knowledge of and compliance with institutional policies, guidelines, and resources can demonstrate the implementation of appropriate care and documentation can be the shield of your defense; conversely, ignorance of and deviation from such policies can provide a documented deviation from the standard of care that will be the sword of the plaintiff. Adjunct mifepristone for cervical preparation prior to dilation and evacuation: a randomized trial. Consideration should be given to dermoids and the possibility of germ cell tumors if a mass has both solid and cystic components. In the most advanced cases, there is fusion over both the urethral and the vaginal orifices. Nuclear receptors can inhibit or enhance transcription by recruiting an array of coactivator or co-repressor proteins to the transcription complex. Lesions on the leg have a poorer prognosis, with a 5-year survival of about 50%, and are considered in some classifications as a separate entity. Specify if: In a controlled environment: this additional specifier is used if the individual is in an environment where access to alcohol is restricted. Woman may find it convenient to start a pill pack on a particular day of the week. Similar rates of amenorrhea and patient satisfaction have been reported, but ablation via a resectoscope is associated with longer operative times, more frequent use of general anesthesia and higher rates of irrigation fluid overload and cervical laceration compared with non-resectoscope modes. Epiluminescence microscopy is a noninvasive technique for examining pigmented lesions that makes subsurface structures visible. If extensive resections are anticipated via hysteroscopy, then the procedure is better performed on an outpatient basis in the surgical suite. Because supplemental estrogen is contraindicated in women with thrombophilias, these women may be more prone to osteoporotic problems over time. This is believed to be caused by a peculiar reaction of the skin to superficial trauma. It is important to emphasize that the ovaries and surrounding peritoneum are not devoid of pain and pressure receptors. Focal areas of atypia and mitoses may be seen in benign-behaving, proliferating pilar tumors. It is especially useful as an adjunctive treatment for acne because of both the keratolytic and the comedolytic properties of salicylic acid. However, it is the -subunit that confers the specific biologic activity of each hormone. One of the main features is randomization, a feature that eliminates selection bias and allows for better control of known and unknown confounding factors. Age, gender, race, and genetic factors influence the normal average daily hair loss in an individual. Women with severe multiple sclerosis have an increased risk of sexual dysfunction. Children should be encouraged to avoid straddle activities such as bicycle or tricycle riding when symptomatic.
Neonatal disease occurs in 6% of cases but at times is unrecognized, especially if involving an internal organ asymptomatically but not affecting its function. One study suggested that if these structured weight loss programs could be provided free of charge to participants, both retention and average weight loss may be far better than when participants pay for these programs. Some exceptions to this that have been advocated include surgical cases that violate mucosal membranes (oral, nasal, anogenital) and patients with heavily colonized skin (atopic dermatitis, infected skin), as well as those in whom a wound infection would result in significant morbidity. Decidual cells show morphologic changes of increased size with increased glycogen and lipid accumulation (Maruyama, 2008). Continuous-wave lasers emit a beam of light whose output power is constant over time, resulting in a long, continuous exposure. In a study of 701 female primary care patients (Ciechanowski, 2002b), those with a preoccupied attachment style reported more physical symptoms, despite comparable medical morbidity, and had the highest health care costs and utilization. Bromhidrosis Also known as fetid sweat, osmidrosis, and malodorous sweating, bromhidrosis is chiefly encountered in the axillae. Purpuric papules and macules are most common, and livedo reticularis, retiform purpura, cutaneous ulcers, and digital ischemia are also seen. Mechanisms of disease: Insights into X-linked and autosomaldominant Kallmann syndrome. In tumor-associated hirsutism, the onset is usually rapid, occurs with other signs of virilization, and begins between ages 20 and 40. In the case of lentigo maligna, mucosal, and acral-lentiginous melanoma, subclinical extension of the in situ tumor usually exceeds 0. Residual areas of endometrium that are not ablated or regrown can lead to trapped bleeding within the uterine cavity, leading to retrograde bleeding or cornual or uterine hematometra. Clinicalfeatures Vitiligo is an acquired pigmentary anomaly of the skin manifested by depigmented white patches surrounded by a normal or a hyperpigmented border. Infrequently reported associations include ocular and auditory abnormalities, photosensitivity, developmental delay, and short stature. Specific eruptions the most common morphology of leukemic infiltrations of the skin in all forms of leukemia is multiple papules or nodules (60% of cases) or infiltrated plaques (26%). A significant number of fertilized oocytes do not complete cleavage for a number of reasons, including failure of appropriate chromosome arrangement on the spindle, specific gene defects that prevent the formation of the spindle, and environmental factors. Health-related consequences of physical and sexual violence: women in the military. Psychotropic medications that induce 3A4 and that have been associated with spotting, breakthrough bleeding, or unwanted pregnancy include the mood stabilizers carbamazepine (Tegretol) and oxcarbazepine (Trileptal), topiramate (Topamax; at doses above 200 mg daily), and the wakefulness-enhancing agent modafinil (Provigil). The lowest one third is below the peritoneal reflection and is in close proximity to the posterior wall of the vagina. Despite extensive research and the marketing of many new products and devices for the treatment of leg ulcers, little has changed in their management over the last decades. Obstetrics & Gynecology Books Full 9 Emotional Aspects of Gynecology at this time and others noting a worsening of underlying depression in the week or two prior to menses (for a discussion of premenstrual dysphoric disorder, see Chapter 37). A review of 45 patients with livedoid vasculopathy included 29 with hypercoaguable workup, 12 of whom (41%) had abnormalities, some multiple. Obviously, sexual abuse is an important consideration in the differential diagnosis (Bond, 1995). The excited-triplet-state electrons interact with tissue oxygen, creating singlet oxygen. Postmenopausal women should have their height measured routinely to document evidence of osteoporosis, which causes loss of height from vertebral compression fractures. Malignantacrospiroma (malignantporoma,porocarcinoma) this represents the most common form of sweat duct carcinoma. Daily applications are made until complete clearing occurs, which usually takes several months or longer, and may be continued indefinitely.
Much of the atypia is focal and localized to the periphery (shoulder region) of the lesion. The 532-nm wavelength has a limited depth of penetration, making it an excellent choice for the treatment of fine facial vessels. In more than 80% of patients, the sarcoidosis resolves after the treatment is discontinued. It is unclear if red ear syndrome is a disease sui generis or is actually erythromelalgia of the ears. In contrast, larger spot sizes produce more photons that remain within the beam diameter, resulting in higher fluences at a given depth. However, if an effective treatment already exists, it is not ethical to use a placebo control group, causing harm to patients with the lack of a known, effective treatment. It is common for a woman to tell her physician about a family member who was treated for uterine cancer. Actual or threatened physical, sexual, or psychological abuse by a current or former spouse (including common-law spouses), dating partner, boyfriend, or girlfriend is considered intimate partner violence. A critical review of your care with your attorney is important so that you that can anticipate all areas of questioning and avoid surprise questioning under oath. Because of its immortality, the hybridoma continues to produce homogenous antibodies as long as the culture is maintained. It begins with the tip and lateral surfaces of the tongue becoming intensely red, well-defined irregular patches in which the filiform papillae are absent or thinned and the fungiform papillae are swollen. FanikosJ,etal: Long-term complications of medical patients with hospital-acquired venous thromboembolism. As general measures, the woman should be counseled to avoid exacerbating factors, such as caffeine, alcohol, stimulants, or other illicit drugs and to examine possible modifiable sources of increased life stress. Thus the office visit and the gynecologic physical examination are performed differently in a prepubertal child compared with an adolescent girl or a mature reproductive-age woman. Complete loss of scalp hair is referred to as alopecia totalis, and complete loss of all hair as alopecia universalis. However, this is mainly in patients under general anesthesia who cannot respond to immediate irritation associated with ocular contact, a problem that is avoided in most dermatologic procedures performed under local anesthesia. Cholesterol emboli can involve all organs except the lungs; therefore, disease burden can range from mild to overwhelming. A straddle injury generally results in unilateral and superficial injury and rarely involves the hymen. In a comparative trial the effectiveness of botulinum toxin injections were superior to suction-curettage surgery. Evidence suggests a role for kisspeptin in modulating metabolic leptin signals on the hypothalamus and pituitary (Skorupskaite, 2014). In general, melanomas tend to have abnormalities involving chromosomes 9, 10, 7, and 6. Eye changes such as cataracts, glaucoma, and heterochromia of the iris may also be present. The goal for conscientious providers must be one focused on risk management: balancing improved patient care and minimizing medical legal risk. The favored sites are on the lower shins and ankles, but lesions may be more widespread and occasionally affect the upper extremities or trunk. Outcomes of interest may include prevention or cure of a disease, reduction in severity of a condition, or differences in costs, quality of life, or side effects between treatments. In about 10% of patients with congenital leukemia cutis (or 3% of all cases of congenital leukemia), the skin involvement occurs while the bone marrow and peripheral blood are normal. Histologically, the superficial lesions show foamy macrophages, and the deeper lesions show a densely cellular proliferation of spindle-shaped histiocytes with multinucleated giant cells. On examination, a palpable cord, calf tenderness, unilateral edema, warmth, redness, and venous dilation may suggest the diagnosis.
The IgM may behave as a cryoglobulin, resulting in purpura, livedo, cutaneous ulcerations, and vasculitis. Childhood adversity and perceived need for mental health care: findings from a Canadian community sample. Differential expression of serum glycodelin and insulin-like growth factor binding protein 1 in early pregnancy. A randomized controlled trial of vaginal misoprostol for cervical priming before hysteroscopy. Surgical compromise of the ureter may occur during clamping or ligating of the infundibulopelvic vessels, clamping or ligating of the cardinal ligaments, or wide suturing in the endopelvic fascia during an anterior repair, even with apparent normal anatomy and utmost surgical care. AroraA,etal: Incidence of leukocytoclastic vasculitis, 1996 to 2010: a population-based study in Olmsted County, Minnesota. Treatment is incision and expression of the contents with a beveled cutting tipped hypodermic needle, 11 blade, or comedo extractor. For years there was speculation on how an organ without glands is able to "secrete" fluid. Idiopathic scrotal calcinosis is the end stage of calcification of epidermoid cysts of the scrotum. Three-base codons are read and translated to amino acids that are linked to form a protein with some function within the cell or organism. Nineteen percent of women reported threatened physical violence over their lifetime, 14. As a consequence of inflammation within vessels, the clotting cascade is triggered, and subsequent thrombosis may be seen in and adjacent to involved vessels. The commonality of this group of genetic conditions stops at the shared molecular mechanism. The first large series of clinically applied whole exome analysis touted a 25% molecular diagnosis rate among all patients referred for phenotypes suggesting potential genetic component, and among patients in the study with a neurologic phenotype, molecular diagnosis was as high as 33% (Yang, 2013). It provides patients with an equal chance to undergo at least "standard of care" treatment versus a possible improved treatment plan. Further study is needed to evaluate the long-term safety and efficacy of silicone oil injections for correction of soft tissue contour deficiencies. The surgeon must consider a variety of other characteristics when choosing which suture to use. Complications Side effects and complications of sclerotherapy can be associated with all types of sclerosing agent. Occupational and Social History the woman should be asked to detail her occupation. The acids the bacilli produce cause a desquamation of the prepubertal vaginal epithelium. The most proximal end of the paramesonephric duct remains as a small outpouching within the body of the prostate gland, known as the prostatic utricle. Epilepsy is seen in about two thirds of cases, usually beginning in the first year of life. Detection bias occurs when systemic differences exist in assessment of a particular outcome. Mature lesions have been described as broad, bald, bumpy (papillomatous), and bubbly (sebaceous). A helpful diagnostic maneuver to distinguish nail plate staining from exogenous sources and nail plate pigmentation from melanin or endogenous chemicals is to scrape the surface of the nail plate several times firmly with a glass slide or scalpel blade. Both lorcaserin and phentermine-topiramate have warnings about memory, attention, and depression. It is most frequently used in the evaluation of abnormal uterine bleeding for both pre- and postmenopausal women. Hyperkeratosis of the nipple and areola may occasionally be unilateral but histologically reveals only hyperkeratosis, acanthosis, and papillomatosis.
Sonography shows that endometrial thickness remains at the same level reached at ovulation (8 to 14 mm) throughout the luteal phase. Obstetrics & Gynecology Books Full 13 Family Planning even if the ring is left in place beyond 21 days. In adults, lesions tend to occur in the late twenties to early thirties, and the gender distribution is equal. Patients are far less likely to file claims against physicians with whom they have an ongoing, trusting relationship. Broad Ligaments the broad ligaments are a thin, mesenteric-like double reflection of peritoneum stretching from the lateral pelvic sidewalls to the uterus. A diabetic woman with peripheral neuropathy may complain of poor arousal because of lack of sensation. Adhesives and glues containing incriminated chemicals may be found in shoes, wristbands, adhesive tape, and rubber products used in brassieres, girdles, panties, or condoms. Paired endothelial channels, called heart tubes, develop by the end of the third week and fuse to form the primitive heart. The discrete papules may be numerous and may involve sites of frequent trauma, such as the backs of the hands, forearms, elbows, and knees. However, higher appellate courts or future appellate courts of the same level can overturn or overrule a prior decision if circumstances change or new information develops. This is a benign lesion, and the diagnosis and treatment are accomplished by excisional biopsy. The surgeon must know which is ideal for the particular case and instrumentation and the potential risks (Table 10. In the past, gender was assigned primarily on the principle of "phallic adequacy," with neonates with an ambiguous phallus being assigned female gender. Randomized studies comparing cyclic and continuous dosing regimens have documented a decrease in the total scheduled bleeding days but an increase in irregular bleeding and spotting with extended or continuous use of hormonal contraceptives. In addition, a thorough physical exam looking for signs of physical abuse must be documented in the chart (Christian, 2000). The mesovarium contains the arterial anastomotic branches of the ovarian and uterine arteries, a plexus of veins, and the lateral end of the ovarian ligament. In this way, irregularities and inflammation of Skene glands (periurethral glands), expressed pus or mucus, or a suburethral diverticulum can be noted. Chlorhexidine has been reported to cause both ototoxicity and keratitis from direct tympanic or ocular contact. Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or the desired effect b) A markedly diminished effect with continued use of the same amount of alcohol. MartinG,etal: Interstitial granulomatous dermatitis with arthritis associated with trastuzumab. Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. Premenstrual exacerbation has been shown to occur with anxiety disorder, panic disorder, obsessive-compulsive disorder, bipolar disease, eating disorders, and psychotic disorders (Pinkerton, 2010). It is usually a superficial flat growth, which in many cases exhibits little tendency to invade or ulcerate. ChibaK,etal: Diagnostic and management difficulties in a case of multiple intracranial juvenile xanthogranuloma. Hyperactivated motility involves increased vigorous movement of the sperm in order to penetrate the cumulus (granulosa) cells surrounding the oocyte and is most likely due to progesterone. The binge-eating episodes are associated with three (or more) of the following: 1. One can understand why increasing abdominal girth is a frequent finding associated with ovarian enlargement. Numerous agents have been used therapeutically, with variable success, but are indicated only if the condition puts the patient at risk for death or a significant complication (usually by compressing a vital organ).
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