The novel predictor of metabolic risk in patients with polycystic ovary syndrome: could it be the visceral adiposity index?

OBJECTIVE

Polycystic ovary syndrome (PCOS) is the most common endocrinological disorder in women of reproductive age, often accompanied by high androgen levels, irregular menstrual cycles and polycystic ovaries. In addition, patients with PCOS also present with an increase in abdominal adipose tissue and insulin resistance. Recently, the gender-specific mathematical formulation called visceral adiposity index (VAI) has been widely used in assessing cardiometabolic risk. This study aimed at comparing the VAI values of patients with PCOS, patients with idiopathic hirsutism (IH) and a control group.

PATIENTS AND METHODS

We obtained demographic data, laboratory results and anthropometric measurements of patients from the hospital database. We retrospectively grouped all cases included in the study as PCOS (n = 52), IH (n = 57) and control (n = 58) according to the diagnoses. We also took venous samples for hormone and biochemical tests in the early follicular phase of the menstrual cycle, at least 8-10 hours after fasting in the early morning hours. Finally, we evaluated the variables using SPSS 22.0 software (IBM Corp., Armonk, NY, USA).

RESULTS

We included 167 female individuals in the study. Of these, 57 (34.1%) were diagnosed with IH, while 52 (31.1%) were diagnosed with PCOS. The control group comprised 58 (34.8%) healthy female individuals. The median age of the study group was 25 years [interquartile range (IQR) = 8 years]. The age, height, weight, body mass index (BMI) and waist circumference values of the groups were similar. We found that the VAI values among the groups were significantly different (p = 0.028). Post-hoc analysis determined that this was due to the difference between the group with PCOS and the control group. In addition, we found significantly high HOMA-IR, fasting insulin and androgen levels in the group with PCOS (p < 0.001).

CONCLUSIONS

After comparing data in groups with similar BMI levels, we found significantly high VAI values in patients with PCOS. The results reinforce the idea that VAI is a useful marker easily obtained in daily practice for assessing the cardiometabolic risk of patients with PCOS.

Identification of Schizosaccharomyces pombe ird Mutants Resistant to Glucose Suppression and Oxidative Stress

Glucose is both the favourite carbon and energy source and acts as a hormone that plays a regulating role in many biological processes. Calorie restriction extends the lifespan in many organisms, including Schizosaccharomyces pombe, while uptake of high glucose leads to undesired results, such as diabetes and aging. In this study, sequence analysis of Schizosaccharomyces pombe ird5 and ird11 mutants was performed using next-generation sequencing techniques and a total of 20 different mutations were detected. ird11 is resistant to oxidative stress without calorie restriction, whereas ird5 displays an adaptive response against oxidative stress. We selected nine candidate mutations located in the non-coding (6) and coding (3) region among a total of 20 different mutations. The nine candidate mutations, which are thought to be responsible for ird5 and ird11 mutant phenotypes, were investigated via forward and backward mutations by using various cloning techniques. The results of this study provide report-like information that will contribute to understanding the relationship between glucose sensing/ signalling and oxidative stress response components.

Serum vitamin D concentrations in young Turkish women with primary dysmenorrhea: A randomized controlled study

OBJECTIVE

This study aims to investigate the possible role of vitamin D deficiency in primary dysmenorrhea by assessing serum 25-hydroxyvitamin D₃ levels in a cohort which includes young Turkish women with primary dysmenorrhea and healthy controls.

MATERIALS AND METHODS

A total of 683 women who were aged between 18 and 25 years and who were consecutively admitted to the study center were eligible. After the exclusion of 55 women, 184 women with primary dysmenorrhea were randomly assigned into the dysmenorrhea group and 184 women without dysmenorrhea were randomly allocated into the control group.

RESULTS

The dysmenorrhea group had significantly less consumption of dairy products (p = 0.001), lower serum calcium (p = 0.001), lower serum vitamin D (p = 0.001) and higher serum parathyroid hormone (p = 0.001) than those of the control group. Hyperparathyroidism was significantly less frequent whereas vitamin D deficiency was significantly more frequent in the dysmenorrhea group (p = 0.001 for each). The dysmenorrhea patients with vitamin D deficiency had significantly higher visual analogue scale (VAS) scores (p = 0.001). Depression, irritability, mood swings, fatigue, headache and breast tenderness were significantly more frequent in the vitamin D deficiency group (p < 0.05 for all). The VAS scores of the dysmenorrhea patients correlated positively and significantly with serum parathyroid hormone levels (r = 0.666, p = 0.001) whereas these VAS scores correlated negatively and significantly with serum vitamin D levels (r = -0.713, p = 0.001).

DISCUSSION

The significant and positive correlation between vitamin D levels and VAS scores and the significant reduction in serum vitamin D levels of the dysmenorrhea patients designate the possible role of vitamin D deficiency in the primary dysmenorrhea.

Two-Year Follow-Up Results of Transobturator Tape Procedure with and without Concomitant Vaginal Surgery

OBJECTIVE

This study aims to evaluate the subjective and objective outcomes of the transobturator tape (TOT) procedure performed to treat stress urinary incontinence and to determine the efficacy and safety of the TOT procedure when used along with vaginal surgery.

METHODS

This is a prospective review of 24 women who had the TOT procedure done only due to stress incontinence; 22 women who underwent concomitant TOT and pelvic floor repair; and 20 women who received concurrent TOT, transvaginal hysterectomy, and sacrospinous ligament fixation.

RESULTS

When compared to the patients who had TOT with pelvic floor repair, the patients who underwent TOT with hysterectomy declared to have more dyspareunia (p = 0.008) and they were found to have significantly higher post-void residual volume (p = 0.014). When compared to the patients who had only TOT, the patients who underwent TOT with hysterectomy claimed to have more pelvic pain (p = 0.012) and significantly higher post-void residual volume (p = 0.020).

CONCLUSION

The TOT procedure results in moderately high objective cure rates, and concurrent application of pelvic floor repair or transvaginal hysterectomy does not affect these rates. The relatively higher incidences for voiding problems and pelvic pain in women who underwent TOT, hysterectomy, and sacropinous fixation simultaneously suggest that the extent of surgery directly correlates with the severity of postoperative complications.

Plasma L-carnitine levels of obese and non-obese polycystic ovary syndrome patients

It is well-known that plasma L-carnitine concentrations are significantly decreased in obese individuals. A study showed that L-carnitine concentrations are significantly lower in lean PCOS patients than in lean healthy women. Thus, it has been suggested that lowered L-carnitine is associated with PCOS. This study also showed that the women with PCOS had significantly lower L-carnitine levels than those of the healthy controls. In addition, this study hypothesised that low L-carnitine levels in PCOS patients were associated with obesity and/or insulin resistance. Moreover, plasma L-carnitine concentrations were found to be statistically similar in PCOS patients and healthy controls, when controlled for obesity. This study implied that L-carnitine could be used as an adjunctive therapy in the management of insulin resistance or obesity in women who have PCOS. Further research might be planned to clarify the clinical effects of L-carnitine administration in PCOS patients with insulin resistance and/or obesity.

Cesarean section: requested mode of delivery?

AIM

To constitute accurate policies for reducing the cesarean section (C/S) the authors evaluated the attitudes and knowledge of health workers and public population towards the mode of delivery, C/S on demand, and delivery complications in a large population.

MATERIALS AND METHODS

1,892 female volunteers in reproductive age were enrolled in the study and 589 of them were health workers. Patients were evaluated with questionnaire about their delivery mode and their answers were analyzed.

RESULTS

The overall cesarean rate of the study population was 45.4%. This rate were 51.4% and 28.2%, respectively, for the health workers and public group (p < 0.001). Medical indication ratio ivere 57.7% and 40.1% for the healthcare group and the public population respectively and 20.2% of health workers and 13.9% of the public group had C/S by their preference without any medical indications (p < 0.001).

CONCLUSION

C/S rate is high in Turkey and an action plan is needed to decrease the rate. When a patient's preference towards the mode of the delivery is C/S on demand, obstetricians, in their capacity as patient advocate, should help guide their patient through the sophisticated detailed medical information toward a decision that respects both the patient's attitude and the physician's obligation to optimize the health of both the mother and the newborn.

Could the platelet-to-lymphocyte ratio be a novel marker for predicting invasiveness of cervical pathologies?

PURPOSE

To determine whether the preoperative platelet to lymphocyte ratio (PLR) could predict invasiveness of cervical pathologies.

MATERIALS AND METHODS

Patients with preinvasive and invasive diseases were reviewed retrospectively, over a nine-year period, 2005-2014. The pathological records and completed blood counts of the patients were collected and recorded in the SPSS program. Patients were divided in two groups, preinvasive and invasive.

RESULTS

The median PLR was significantly higher in the invasive group than in the preinvasive group (p=0.03). There was a correlation between invasion of cervical cancer and white blood cell count, red cell distributing width (RDW), neutrophil-lymphocyte ratio (NLR), and PLR.

CONCLUSIONS

This study showed that patients with uterine cervical cancer may present with leukocytosis, increased RDW, NLR and PLR. These cheap and easily available parameters, especially PLR, may provide useful information about the invasiveness of cervical lesions.

L-Carnitine: a new insight into the pathogenesis of endometrial cancer

OBJECTIVES

The present study aims to specify the role of L-carnitine in the pathogenesis of endometrial cancer by comparing the serum total L-carnitine levels of endometrial cancer patients with those of healthy women.

METHODS

Serum total L-carnitine concentrations were measured in patients with endometrioid-type endometrial cancer (n = 20) and healthy controls (n = 20) who were matched with respect to age and body mass index (BMI).

RESULTS

Stage I endometrial cancer was diagnosed in 12 women (60.0%) whereas three women (15.0%) had stage II disease, three women (15.0%) had stage III disease and two women (10.0%) had stage IV disease. The healthy controls and endometrial cancer patients were statistically similar in aspect of age, gravidity, parity, BMI, waist-to-thigh ratio, waist-to-hip ratio, menopause, complete blood count parameters, and serum biochemistry. Serum total L-carnitine levels of women with endometrial cancer were significantly lower than those of healthy women (respectively, 5,519.4 ± 2,712.5 vs 7,940.8 ± 3,566.6 ng/dl, p = 0.021). Moreover, serum total L-carnitine levels decreased significantly and progressively with advancing stage (stage I vs II vs III vs IV; 6,294.0 ± 2,885.1 vs 5,800.0 ± 441.2 vs 4,016.0 ± 2,833.3 vs 2,560.0 ± 67.9 ng/dl; p = 0.021).

CONCLUSIONS

This is the first study to hypothesize that L-carnitine deficiency participates in the pathogenesis of endometrial cancer by means of a mechanism which is unrelated with obesity and increased amount of fat in human body.

In contrast to leptin, serum concentrations of ghrelin are not related to premenstrual syndrome

OBJECTIVE

Premenstrual syndrome (PMS) is a disorder related to mood and appetite changes during the premenstrual phase. Unfortunately, the understanding of the pathophysiology of PMS is quite poor. Though, ghrelin and leptin play important roles in the control of food intake. The aim of this study was to evaluate leptin and ghrelin serum concentrations in PMS patients.

PATIENTS AND METHODS

Forty-five PMS patients diagnosed according to ICD-10 diagnostic criteria and 45 healthy women as a control group, were included in the study. These groups were matched for age, body mass index and duration of menstrual cycle. Symptoms of the patients were evaluated using "Menstrual Distress Questionnaires". Serum leptin and ghrelin serum concentrations were measured using ELISA in the postmenstrual phase (5-9 days) and 2-3 days before menstruation. Mann-Whitney U test, independent sample t-test and Wilcoxon test were used for statistical analyses.

RESULTS

In the PMS group, there was no difference in the serum concentrations of ghrelin; however, leptin serum concentrations were 31.05 (± 14.16) and 16.42 (± 15.81) ng/ml during the premenstrual and postmenstrual periods, respectively (p < 0.05). Ghrelin serum concentrations in the premenstrual period were 6.9 (± 9.3) ng/ml in the PMS group and 8.8 (± 9.3) ng/ml in the control group, but this difference was not statistically significant (p = 0.79).

CONCLUSIONS

Ghrelin serum concentrations were not associated with PMS, while leptin serum concentrations were found to be higher in the premenstrual period in PMS patients. Though, these two hormones work antagonistically to control the food intake and body weight, we suggest that this function is not relevant to PMS.

Maternal blood pressure and dominant sleeping position may affect placental localization

OBJECTIVE

This study investigates whether maternal socio-demographic and clinical characteristics influence the site of placental implantation so that placental localization and associated abnormalities can be predicted.

METHODS

This study reviews 500 healthy women with singleton pregnancy that were consecutively admitted to the study center and eventually delivered healthy newborns.

RESULTS

The most frequently observed sites of placentation were anterior uterine wall (53.2%), posterior uterine wall (28.8%), lateral uterine walls (10.0%) and uterine fundus (8.0%), respectively. The women with fundal placentation had significantly higher systolic and diastolic blood pressures (p = 0.044 and p = 0.040, respectively). Supine sleeping position was more frequent in women with anterior placenta and (OR: 11.568, 95% CI: 2.720-49.193) and prone sleeping position was more frequent in women with posterior placenta (OR: 15.449, 95% CI: 2.151-52.978) (p = 0.001). The women who favored to sleep in right lateral position were more likely to have lateral placentation, while the women who used to sleep in left lateral position were more likely to have fundal placentation (p = 0.001).

CONCLUSIONS

Sleeping position in early pregnancy may influence placental implantation site. The probable mechanism may refer to the alterations in uterine perfusion which is induced by the change in systemic blood pressure and dominant sleeping position.

Is three-dimensional prenatal ultrasound necessary: pregnant women's point of view

OBJECTIVES

The role and applicability of three-dimensional ultrasound (3D-US) in perinatology has been repeatedly discussed in the literature. Regardless, our knowledge about patient expectations remains limited. We aimed at determining the expectations, perception and knowledge of pregnant women about 3D-US.

MATERIAL AND METHODS

Upon admission to the labor unit, the women filled out a questionnaire, with the help of a doctor investigating sociodemographic data, pregnancy and delivery history previous experiences and expectations for US imaging.

RESULTS

A total of 644 pregnant women were included in the study Respondents declared that approximately 70% of all kinds of structural abnormalities could be detected by 3D-US and estimated its reliability at nearly 70%. While 60% of the participants underwent 3D-US, 70% of them believed that every pregnant woman should undergo such test. Also, 457 (70.9%) of the participants were of the opinion that every pregnant woman must undergo 3D-US imaging, whereas 173 (26.8%) did not think 3D-US imaging was necessary

CONCLUSIONS

To the best of our knowledge, this has been the first study on patient opinions regarding the need for 3D-US imaging during pregnancy Although the participants were not certain about the harmful effects of 3D-US, the majority believed that it was necessary for every pregnant woman to undergo such testing. Obviously patients must be instructed on the limitations of US imaging before the examination to clarify any misunderstandings about the possibilities such a technique may offer

Very rare cause of vaginal mass in pregnancy: cavernous hemangioma

Vaginal cavernous hemangioma is a considerably rare condition during pregnancy. There has only been one reported case to date. A multiparous, 24-year-old woman in the 32nd week of pregnancy was admitted with a mass prolapsed from the vagina, which had suddenly increased in size over the previous few days. A necrotic mass obstructing the vaginal canal and originating from the posterior wall was observed in a pelvic physical examination and carefully excised. The patient had contractions after the intervention and was administered tocolytic treatment with bed-rest and fluids. Her obstetric clinical status was stable after treatment and she gave birth without complication at 37 weeks and 5 days from the vaginal canal. The main approach to these very rare tumors of pregnancy, especially in the presence of necrosis, infection and/or obstruction, should be excision. But the potential for increased blood loss that may occur due to the hypervascular structure of the tumor should be taken into account.

What should be the ideal time for ischemic preconditioning in a laparoscopic rat model?

BACKGROUND

Pneumoperitoneum (Pp) induces an ischemia and reperfusion (I/R) injury as a result of released oxidative stress markers. Ischemic preconditioning (IP) is one of the used methods to reduce the harmful effects of Pp, which is a mechanism for reducing organ I/R injury by a brief period of organ ischemia. The aim of this study was to investigate the ideal time for IP in the laparoscopic model.

METHODS

Thirty-two rats were assigned into four groups: group 1 (control, n = 8) was subjected to a sham operation. Group 2 (5-minutes IP, n = 8) was subjected to 5 minutes of Pp with 15 mm Hg of pressure followed immediately by 5 minutes of deflation, and after that, 60 minutes of Pp with 15 mm Hg, followed by 60 minutes of deflation. Group 3 (10-minutes IP, n = 8) was subjected to 10 minutes of Pp and 10 minutes of deflation. Group 4 (Pp only, n = 8) was subjected to 60 minutes of Pp with 15 mm Hg of pressure, followed by 60 minutes of deflation. At the end of the experiment, plasma malondialdehyde (MDA) values, the oxidative stress marker, and plasma-reduced glutathione (GSH) levels, the marker showing antioxidant activity, were determined.

RESULTS

Highest plasma MDA values were in group 4 (Pp only), followed by groups 2 and 3 and group 1 (P = 0.181). In addition, IP groups had almost the same values for MDA. Plasma GSH levels in the control group were significantly higher than those in the IP groups and the Pp-only group (P < 0.001). Similarly, as in MDA levels, no difference was found between plasma GSH levels of the IP 5-minutes and IP 10-minutes groups.

CONCLUSIONS

Five minutes of the IP model may be as reliable as 10 minutes of the IP model. In that case, 5 minutes of IP can be more suitable in reducing I/R injury in laparoscopy.

Insulin sensitivity does not differentiate by hirsutism in non-obese women with polycystic ovary syndrome

OBJECTIVE

Hirsutism is one of the component of polycystic ovary syndrome. According to the Rotterdam Consensus has concluded that principially obese women with polycystic ovary syndrome (PCOS) should be evaluated for the metabolic syndrome. The aim of the present study was to investigate the insulin sensitivity in PCOS women with and without hirsutism regardless of obesity.

MATERIAL AND METHODS

Clinical characteristics, sex hormones and fasting glucose and insulin levels of fifty-eight women with PCOS were analyzed. Hirsutism has been evaluated through the Ferriman-Gallwey (FG) map scoring system.

RESULTS

Twenty-two women (38%) were hirsute. They were not any significant difference between hirsute and nonhirsute women for their sex steroids and insulin sensitivity (P>0.05). There were no correlation among sex steroids, WHR and insulin sensitivity in relation to FG score in the subgroup with hirsutism (P>0.05).

CONCLUSION

Our study suggests that normal weight and overweight women with hirsutism can have normal insulin sensitivity and normal levels of circulating androgens in PCOS women.

Nausea and vomiting in early pregnancy: relationship with anxiety and depression

OBJECTIVE

To investigate the association between either depression or anxiety early in pregnancy, and nausea and vomiting, in a clinical sample.

METHODS

Anxiety and depression scores of 230 women were investigated by using the Hospital Anxiety and Depression Scale. Nausea and vomiting of pregnancy (NVP) were scored by using the Rhode's system. These scores and demographic data were compared and P < 0.05 was considered significant.

RESULTS

A significant correlation between Rhode's score and both anxiety (r=0.388, P < 0.001) and depression score, (r=0.351, P < 0.001) was found. Gestational age showed and inverse correlation with anxiety scores (P=0.019). There was no significant correlation between demographic data and anxiety/depression scores, or Rhode's scores.

CONCLUSION

There is an association between anxiety and depression early in pregnancyand severity of NVP.

Meibomian gland alterations in polycystic ovary syndrome

PURPOSE

Polycystic ovary syndrome (PCOS) is an endocrinopathy characterized by chronic anovulation and hyperandrogenism where hyperinsulinemia can be seen. Hormonal changes can affect meibomian gland function. In this study, we evaluated tear function in PCOS.

MATERIALS AND METHODS

Twenty-seven women having PCOS and 22 normal individuals aged between 18-42 years were enrolled in the study. Patients were asked about dry eye symptoms. Schirmer test, tear film breakup time, and rose Bengal staining were performed. Conjunctival brush cytology specimens were obtained and goblet cell count was done.

RESULTS

Dry eye symptoms were more frequent in subjects with PCOS (p=0.025). Mean breakup time was shorter in women with PCOS (p=0.034). Schirmer test results, rose Bengal staining scores, and goblet cell count were not different between groups (p=0.48, p=0.18, p=0.82, respectively).

CONCLUSION

Meibomian gland function and tear film lipid layer can be affected in cases with PCOS.

Resting metabolic rate and exercise capacity in women with polycystic ovary syndrome

OBJECTIVE

To assess the resting metabolic rate (RMR) and exercise capacity (or maximal oxygen consumption [VO2 max]) of women with polycystic ovary syndrome (PCOS) and central adiposity.

METHOD

In a cross-sectional study, RMR was measured by indirect calorimetry and VO2 max by the Astrand test for 31 women with PCOS and 29 controls matched for age and body mass index, but with a different body fat distribution. Differences between the means were analyzed.

RESULTS

There were no significant differences in RMR or VO2 max values between the 2 groups.

CONCLUSION

Central adiposity was not predictive of an altered RMR or of decreased exercise capacity in women with PCOS.

Comparison of placental PTEN and beta1 integrin expression in early spontaneous abortion, early and late normal pregnancy

BACKGROUND

PTEN seems to play an important role in cell cycle, growth, migration, and death. Integrins are cell surface receptors that play a role in the regulation of cell proliferation, differentiation, implantation, and embryogenesis. PTEN inhibits beta1 integrin signaling. The objective of this study is to investigate the expression of PTEN and beta1 integrin in placental tissues of early spontaneous abortion and first and third trimesters of normal pregnancy.

METHOD

A total of 43 placental tissue samples were evaluated using immunohistochemistry for PTEN and beta1 integrin. Group 1 included placental tissues of volunteer termination of normal pregnancy during the first trimester (5-10 wk gestation). Group 2 included placental tissues of normal vaginal delivery at the third trimester of pregnancy (36-40 wk gestation). Group 3 included placental tissues of pregnancy termination because of spontaneous abortion during the first trimester (5-10 wk gestation).

RESULTS

PTEN expression of villous trophoblast was decreasing as the pregnancy advanced. PTEN staining of decidual cells was significantly stronger in tissue samples from early spontaneous abortion than in tissue samples from early and late normal pregnancy (p=0.003, p=0.001, respectively). There was no significant difference between beta1 integrin expression of villous trophoblast and decidual cells in three groups.

CONCLUSION

Our findings suggest that altered patterns of PTEN expression may be associated with abortion, but it seems that beta1 integrin does not contribute to this process as a signaling protein. Further evaluation is needed to highlight this subject.

Squamous cell carcinoma arising in a mature cystic teratoma of the ovary in young patient with elevated carbohydrate antigen 19-9

Squamous cell carcinoma is the most common type of malignant transformation in mature cystic teratomas. It mainly effects postmenopausal women but is rarely seen in young patients. Carbohydrate antigen 19-9 (CA19-9) tumor marker is a high-molecular-weight glycoprotein, frequently elevated in gastrointestinal adenocarcinomas. CA19-9 levels can increase in both dermoid cysts and in malignant transformation of dermoid cysts. Herein we report a case of squamous cell carcinoma originating from a dermoid cyst in a 31-year-old, gravida 0, para 0, single woman with high levels of CA19-9 and normal levels of CEA. Preoperative CA19-9 was 1000 U/ml (normal range below 27 U/ml). The patient underwent unilateral salpingo-oophorectomy, omentectomy, appendectomy, pelvic and paraaortic lymphadenectomy. After the pathologic analysis of the material, the patient was categorized as FIGO Stage IIa due to metastasis to the left tube. She received six cycles of cisplatin and paclitaxel at 21-day intervals. The postoperative first day, second month, and sixth month CA19-9 values were 602 U/ml, 33.5 U/ml and 22.3 U/ml, respectively. She is now doing well without recurrence of disease six months after the surgery. Squamous cell carcinomas originating from dermoid cysts are rare tumors especially seen in elderly patients with high levels of tumor markers (like CEA, SCCA). Every case may not have the same characteristics and management should be individualized.

Oxidative stress markers in pregnant women who snore and fetal outcome: a case control study

BACKGROUND

To determine the levels of oxidative stress markers in pregnant women who snore and compare with non-snoring pregnant women. Fetal outcome of these 2 groups was also evaluated.

MATERIALS AND METHODS

Prospective, case control study. Some 40 pregnant women who snored and 43 non-snoring pregnant women were evaluated. The glutathione peroxidase (GSH-Px), malondialdehyde (MDA) and myeloperoxidase (MPO) levels of the 2 groups were studied. Infant birthweight, Apgar scores, and other indicators of fetal outcome were obtained.

RESULTS

The mean level of GSH-Px was significantly lower in the pregnant women who snored (p=0.005), while the mean level of MDA was significantly higher in this group (p=0.005). Levels of MPO were comparable between the groups (p>0.05). The pregnant women who snored did not have infants with evidence of an increase in compromised outcome.

CONCLUSION

Although the pregnant women who snored had high levels of MDA, they did not appear to be at increased risk for delivering infants with fetal compromise.

Obstructive sleep apnea in pregnancy and fetal outcome

OBJECTIVE

To simultaneously investigate the polysomnography (PSG) and nonstress test (NST) records of pregnant women with obstructive sleep apnea (OSA) to observe NST changes during maternal desaturation and determine maternal and fetal outcomes.

METHODS

A prospective observational study of pregnant women assessed by questionnaire for symptoms of OSA. Women with self-reported frequent snoring or apnea were offered PSG and NST.

RESULT

OSA was diagnosed in 4 (11.4%) of the 35 pregnant women who underwent PSG. Three (75%) had fetal heart decelerations accompanying maternal desaturation. The neonates of women diagnosed with OSA had lower mean Apgar scores and birth weights compared with neonates of women without OSA. Three neonates from the women diagnosed with OSA were admitted to the newborn healthcare unit.

CONCLUSION

OSA in pregnancy has important maternal and fetal outcomes. Pregnant women should be assessed for symptoms of OSA and suspected cases should be offered PSG.

The effect of low-flow sevoflurane and desflurane on pulmonary mechanics during laparoscopic surgery

BACKGROUND

This study was designed to investigate the effects of inhaled anesthetic agents on respiratory mechanics with low flow anesthesia in laparoscopic abdominal surgery. Two inhaled anesthetics, desflurane and sevoflurane, have a lower solubility in blood and tissues than all previous volatile anesthetics, and have become the preferred volatile anesthetics for routine surgical procedures.

METHODS

Twenty-six patients were examined. Patients were randomly assigned to two groups, to receive sevoflurane (n = 13) or desflurane (n = 13). Tidal volume and ventilation rate were kept unchanged throughout the operation. Intra-abdominal pressure was kept constant at the level of 12 mm Hg. Respiratory mechanics such as peak inspiratory pressure (PIP), respiratory resistance (Rr), and dynamic compliance (Cdyn) measurements were recorded by a Datex-Ohmeda respiratory device (Datex-Ohmeda, Finland) at four timepoints: 5 minutes after mechanical ventilation started (T1), after insufflation of the peritoneum (T2), in the 30-degree Trendelenburg position (T3), and after desufflation of the peritoneum (T4).

RESULTS

In our study, desflurane caused a statistically significant increase in PIP and Rr and decrease in C(dyn). When the two groups were compared, Rr values in the deslurane group showed significant increases at T2, T3, and T4 compared to the sevoflurane group (P < 0.05). These values did not change in the sevoflurane group, while PIP significantly increased at T2, T3, and T4 after desufflation in the desflurane group (P < 0.05). Cdyn values decreased significantly at all 4 timepoints in the desflurane group compared to the sevoflurane group (P < 0.05).

CONCLUSION

We concluded that respiratory mechanics were affected by desflurane with low flow anesthesia in patients undergoing laparoscopic abdominal surgery. No significant influence on respiratory mechanics was seen with sevoflurane anesthesia.

Examination of changes caused by tubal sterilization in ovarian hormone secretion and uterine and ovarian artery blood flow rates

OBJECTIVES

To examine the changes caused by tubal sterilization (TS) in ovarian hormone secretion and uterine and ovarian circulation.

DESIGN

Tubal sterilization was performed by minilaparotomy and laparoscopy methods in 36 women. Blood samples were taken for hormonal tests on Preoperative Day 3 (D3) of the menstrual cycle, on Postoperative Days 13-15 (periovulatory period) of the same cycle and on D3 in the 1st and 6th months post-TS. Uterine and ovarian artery blood flow rates of the women were measured on the same days as hormonal tests by transvaginal color Doppler ultrasonography (TVCDUSG). The control group was composed of 15 volunteers in the same age group who preferred the barrier method and who had the same TVCDUSG and hormonal analyses in the same periods.

RESULTS

There was a decrease in the uterine and ovarian artery pulsatility index (PI) measurements and an increase in serum luteinizing hormone (LH) and estradiol (E2) values during the periovulatory period as compared with preoperative and postoperative menstrual measurements in all groups. There was no difference between baseline uterine and ovarian artery PI and serum follicle-stimulating hormone, LH and E2 values and those measured on D3 of the menstrual cycle in the 1st and 6th months post-TS.

CONCLUSIONS

The 6-month postoperative follow-up of groups that had undergone different TS methods showed no difference in uterine or ovarian artery blood flow rates or ovarian hormone secretion in comparison with baseline values.

The effects of hormone therapy on pulmonary function tests in postmenopausal women

OBJECTIVE

To investigate the effects of hormone therapy (HT) administered to postmenopausal women on pulmonary function tests (PFT).

METHODS

Eighty-two postmenopausal women who were having natural or surgically initiated menopause and had no risk factor that could affect the respiratory system were included into this prospective, randomized study. Twenty-five women who refused to use HT were assessed as the control group (Group I). Nineteen women who accepted using HT and who were having surgically initiated menopause were given continuous estrogen (Group II), 23 were given continuous estrogen and progesterone in combination (Group III) and 15 were given cyclic estrogen and progesterone combination (Group IV). Forced expiratory volume (FEV1), forced vital capacity (FVC), FEV1/FVC, forced expiratory flow rate over 25-75% of the forced vital capacity volume and peak expiratory flow rate were assessed at the beginning of the treatment and in the third month in order to evaluate the effects of HT regimens on the women's PFT.

RESULTS

A statistically significant increase was observed only in the FEV1 and FVC parameters of Group III after three months of therapy (P<0.05). The comparison between pre- and posttherapy FEV1 and FVC values showed an increase in the Group IV, but the difference was not statistically significant, while there was no difference between basal and third month FEV1 and FVC values of the group receiving estrogen only.

CONCLUSIONS

It was seen that particularly continuous combined HT regimen positively affected the FEV1 and FVC parameters of the postmenopausal women.

Comparison of the effects of low intra-abdominal pressure and ischaemic preconditioning on the generation of oxidative stress markers and inflammatory cytokines during laparoscopy in rats

BACKGROUND

Pneumoperitoneum (Pp) induces ischaemia in intra-abdominal tissues. We investigated the effects of ischaemic preconditioning (IP) and low-pressure Pp methods used to reduce ischaemic injury during Pp on oxidative stress and inflammatory cytokine response.

METHODS

Thirty-two rats were divided into four groups. Rats in the control group were subjected to only anaesthesia for 90 min. The other groups were subjected to Pp for 60 min with 15 (Pp15), 10 (Pp10) or 15 mmHg intra-abdominal pressure (IAP) after IP (IPPp15), all of which were followed by deflation (D) for 30 min. IP was defined as 10 min of Pp with 15 mmHg IAP followed immediately by 10 min of D. Peritoneum and blood samples collected at the end of the experiment were examined to determine inflammatory cytokine [tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6)], oxidative stress [malondialdehyde (MDA)] and antioxidant [reduced glutathione (GSH) and glutathione reductase (GR)] levels.

RESULTS

Blood and peritoneum MDA values and peritoneum TNF-alpha and IL-6 values decreased, while GR values increased in the Pp10 group in comparison with the Pp15 group. Blood and peritoneum MDA, TNF-alpha and IL-6 values decreased and GR values increased in the IPPp15 group in comparison with the Pp15 group. Blood MDA and IL-6 values in the IPP15 group were lower than those in the Pp10 group, whereas GR values were higher in the former. Except for high peritoneal IL-6 levels, no difference was found between the parameters in the IPP15 and those in the control group.

CONCLUSIONS

IP may be more effective than low-pressure Pp in reducing ischaemic insult associated with laparoscopy.

Efficient and non-invasive method for investigating Helicobacter pylori in gravida with hyperemesis gravidarum: Helicobacter pylori stool antigen test

AIM

To investigate the relationship between Helicobacter pylori infection and severe hyperemesis gravidarum (H. Gravidarum) by using Helicobacter pylori Stool Antigen (HpSA) and other serologic test results.

METHODS

Twenty-seven pregnant women with H. Gravidarum and 97 asymptomatic pregnant women of matching gestational age without gastric problems were enrolled in a prospective study. Serum samples collected from cases were investigated in terms of specific antibodies for H. pylori (immunoglobulin-IgG, IgA) and feces samples were investigated for HpSA. Statistical analysis of the data obtained from the groups was made by appropriate chi2 tests.

RESULTS

Rate of HpSA positivity in patients with H. Gravidarum was 40.7%, while the same rate was 12.4% in the control group. The difference between the two groups was significant (P = 0.001). Rates of positivity for specific IgG formed against H. pylori in gravida with H. Gravidarum and in the asymptomatic gravida were 85.2% and 73.2%, respectively, and the rates for IgA were 48.1% and 41.2%, respectively. There was no difference between groups in terms of specific Igs formed against H. pylori (P > 0.05).

CONCLUSION

The HpSA scan showed a statistically significant relation between H. pylori infection and H. Gravidarum. HpSA test gives more efficient, reliable and realistic results than specific Igs formed against H. pylori in the identification of H. pylori positivity in gravida with H. Gravidarum.

Ovarian abscess due to Brucella melitensis

The case of a 25-y-old woman with brucellar ovarian abscess is reported. Cultures of blood, ascites and a pus specimen yielded Brucella melitensis. The possibility of ovarian abscess being caused by Brucella melitensis should be considered in countries where the infection is endemic.

Laparoscopic management following ultrasonographic-guided drainage in a patient with giant paraovarian cyst

BACKGROUND

Giant and paraovarian cysts are unusual masses that are usually treated by laparotomy. The safety of laparoscopic management of benign paraovarian cysts has been demonstrated, but it is believed that the size of benign paraovarian cysts is a limiting factor for laparoscopic surgery.

METHODS

We describe a new technique for the laparoscopic removal of a giant and benign paraovarian cyst in a 40-year-old woman. A paraovarian cystic mass was detected on the right part of her body that extended to the liver. It was confirmed on both ultrasonography and computed tomography scans. After ultrasound-guided aspiration of the cyst, the mass was resected laparoscopically.

RESULTS

No complications were noted during or after the surgical procedure. The patient was discharged on postoperative day 2.

CONCLUSIONS

Laparoscopic surgery can be safely applied in patients with giant and benign paraovarian cysts.

Hormone replacement therapy, C-reactive protein, and fibrinogen in healthy postmenopausal women

OBJECTIVE

To investigate short-term and long-term effects of combined hormone replacement therapy (HRT) on C-reactive protein (CRP) and fibrinogen plasma concentrations in healthy postmenopausal women.

METHODS

In this cross-sectional study 241 healthy postmenopausal women were enrolled. A total of 81 women were receiving the following treatments for 3 months; transdermal 17beta-estradiol (17beta-E2) + medroxyprogesterone acetate (MPA) (n = 21), oral 17beta-E2 + norethisterone acetate (NETA) (n = 27), and conjugated equine estrogens (CEE) + MPA (n = 33). The same combined therapies were implemented in another 58 women for 12 months; transdermal 17beta-E2 + MPA (n = 10), oral 17beta-E2 + NETA (n = 16), and CEE + MPA (n = 32). Control group included 102 healthy postmenopausal women not receiving HRT. The effect of the type and the duration of HRT regimens on plasma levels of CRP, fibrinogen and lipids were investigated.

RESULTS

Median CRP concentrations were significantly higher in women receiving oral 17beta-E2 + NETA (P = 0.037) and CEE + MPA (P = 0.0001) for 3 months than in women taking the same types of HRT for 12 months and of those were not on HRT. Median CRP levels were similar in women taking transdermal 17beta-E2 + MPA for 3 and 12 months, compared with controls. Fibrinogen levels were not different between nonusers and any group of HRT users.

CONCLUSIONS

These elevated levels of CRP, which appears very recently as a crucial marker for cardiovascular disease, may be responsible for the early increased cardiovascular risk after starting oral combined HRT. But this increased risk in the early period seems to decrease with long-term use. Transdermal 17beta-E2 + MPA had insignificant effect on CRP both in short-term or in long-term use.

Single dose nasal 17beta-estradiol administration reduces sympathovagal balance to the heart in postmenopausal women

AIM

Long-term estrogen replacement therapy has favorable results on autonomic cardiovascular functions in postmenopausal women. Although acute estrogen administration has beneficial modulations on autonomic tone in animal studies, there are still controversies about the effects of acute estrogen on autonomic modulation to the heart in humans. The aim of this double-blind study was to investigate the acute effects of intranasal 17beta-estradiol administration on autonomic control of heart rate.

METHODS

Nineteen postmenopausal women with typical hormone profiles were crossover randomized to 300 micro g nasal 17beta-estradiol (Aerodiol, Servier, Chambray-les-Tours, France) or an identical placebo at least 5 days apart. Both time domain and frequency domain heart rate variability (HRV) parameters were obtained during controlled respiration (CR) and handgrip exercise (HGE), before and 45 min after 17beta-estradiol or placebo administration.

RESULTS

Baseline HRV parameters were similar for each occasion. Time domain indices obtained after 17beta-estradiol administration were not significantly different from results obtained with the placebo. In frequency domain parameters, 17beta-estradiol administration resulted in a reduced low frequency to high frequency ratio (LF/HF ratio) when compared with the placebo during CR (0.72 +/- 0.09 vs 1.00 +/- 0.15, P < 0.05) but not during HGE (3.03 +/- 0.37 vs 2.86 +/- 0.30, P > 0.05).

CONCLUSION

A single intranasal 17beta-estradiol administration acutely reduced sympathovagal balance to the heart during the course of parasympathetic maneuver in healthy postmenopausal women.

The short-term effects of different regimens of hormone replacement therapy on left ventricular structure and performance in healthy postmenopausal women. A prospective, controlled echocardiographic study

OBJECTIVE

To compare the short-term effects of different hormone replacement therapy (HRT) regimens on left ventricular structure and function in healthy postmenopausal women.

METHODS

Forty-two apparently healthy postmenopausal women were evaluated prospectively in this controlled study. Subjects were divided into 4 groups. Ten subjects, who did not accept HRT or any other treatments, formed the control group. The remaining subjects were assigned to receive oral estradiol (2 mg/day) + norethisterone acetate (1 mg/day) (n = 11), transdermal estradiol (0.05 mg) + norethisterone acetate (0.25 mg) (n = 11) or tibolone (2.5 mg/day) (n = 10) therapy during 12 weeks. Echocardiography and Doppler techniques were used to assess the cardiac effects of different HRT regimens.

RESULTS

After 12 weeks of treatment, there were significant increases in left ventricular ejection fraction (transdermal group: p = 0.008, oral group: p = 0.003, tibolone group: p = 0.005) and cardiac output (transdermal group: p = 0.003, oral group: p = 0.003, tibolone group: p = 0.021) in all treatment groups. In addition, in the transdermal group, a slight increase in left ventricular end-diastolic volume was significant (p = 0.046).

CONCLUSION

These data suggest that oral and transdermal HRT regimens and tibolone may contribute to the improvement in left ventricular systolic function without having an effect on left ventricular structure after short-term administration in healthy postmenopausal women.

Association of serum complement (C3, C4) and immunoglobulin (IgG, IgM) levels with hormone replacement therapy in healthy post-menopausal women

BACKGROUND

Recently published data suggest that hormone replacement therapy (HRT) may increase cardiovascular risk during the early months of therapy. Activation of the immune system is known to be involved in several types of cardiovascular disease. In this cross-sectional study, serum C3, C4, IgG and IgM levels were evaluated in healthy post-menopausal women receiving two different short-term HRT regimens, and in untreated women.

METHODS

Serum C3, C4, IgM and IgG levels were assessed in 18 women receiving transdermal 17beta-estradiol (50 micro g/day) + continuous oral medroxyprogesterone acetate (MPA; 2.5 mg/day), in 56 women taking oral conjugated equine estrogen (CEE; 0.625 mg/day) + continuous MPA, and in 80 control women not receiving HRT.

RESULTS

The mean serum C3 level was significantly higher in women using oral CEE + MPA than in women receiving transdermal 17beta-estradiol + MPA, and those not on HRT (P = 0.02 and P < 0.001 respectively). Furthermore, women taking oral CEE + MPA had significantly higher mean levels of C4 compared with untreated women (P < 0.01). IgG and IgM levels were similar among women either of the two HRT regimens and between women not on HRT.

CONCLUSIONS

Oral HRT may be involved in the development of cardiovascular disease through inflammatory mechanisms, as suggested by increased serum levels of C3 and C4.

Decreased total antioxidant status and increased oxidative stress in women with polycystic ovary syndrome may contribute to the risk of cardiovascular disease

OBJECTIVE

To determine oxidative stress by the level of protein carbonyls and total antioxidant status (TAOS), and whether oxidative stress is associated with increased risk of cardiovascular disease in women with polycystic ovary syndrome (PCOS).

DESIGN

Controlled clinical study.

SETTING

University hospital.

PATIENT(S)

Thirty women with PCOS and 31 healthy control women.

INTERVENTION(S)

Biometric measures and blood samples collection.

MAIN OUTCOME MEASURE(S)

C-reactive protein (CRP), lipid fractions, glucose, protein carbonyls, insulin, and other hormone (gonadotropins, androgens) levels and TAOS were measured. The estimate of insulin resistance was calculated by homeostasis model assessment (HOMA-R).

RESULT(S)

The women with PCOS had significantly higher serum fasting insulin, CRP, protein carbonyl levels, HOMA-R, LH levels, and LH/FSH ratios than healthy women. However, TAOS was significantly lower in women with PCOS. TAOS was negatively correlated with fasting insulin, HOMA-R, CRP, and protein carbonyls. Fasting insulin was positively correlated with protein carbonyls. High density lipoprotein (HDL) was inversely associated with fasting insulin, HOMA-R, and protein carbonyls.

CONCLUSION(S)

Increased oxidative stress and decreased antioxidant capacity may contribute to the increased risk of cardiovascular disease in women with PCOS, in addition to known risk factors such as insulin resistance, hypertension, central obesity, and dyslipidemia.

Effects of short-time (3 months) tibolone treatment on bone turnover in postmenopausal women

This study was planned to elucidate the effects of tibolone on bone biochemistry parameters in postmenopausal women at 3 month intervals. There were 56 healthy postmenopausal women enrolled in the study. The women had not received hormone replacement therapy (HRT) previously. Tibolone (2.5 mg/day) was prescribed for 3 months. Serum osteocalcin, calcium, phosphorus, alkaline phosphatase, creatinine and urine calcium, phosphorus creatinine, deoxypyridinoline were measured, and physical examinations were performed at the onset and at the end of the study. The mean serum osteocalcin level and deoxypyridinoline/creatinine (DPD/cr) ratio both decreased significantly (50.3% and 22.9%; P=0.012 and P=0.001, respectively). The slight decreases in serum alkaline phosphatase (4.5%) and urine calcium (13.6%) levels were not statistically significant. There was a positive correlation between DPD/cr and urine calcium ( r=0.66, P=0.001). We conclude that bone formation may be increased early by tibolone after short-term administration.

Effects of short-term transdermal hormone replacement therapy on glycaemic control, lipid metabolism, C-reactive protein and proteinuria in postmenopausal women with type 2 diabetes or hypertension

BACKGROUND

The study was carried out to evaluate the effects of short-term transdermal hormone replacement therapy (HRT) on glycaemic control, lipid metabolism, C-reactive protein (CRP) and proteinuria in high-risk postmenopausal women.

METHODS

A total of 20 well-controlled type 2 diabetic, hypertensive and 21 well-controlled glucose-tolerant, hypertensive postmenopausal women were prospectively enrolled. After 12 weeks of transdermal HRT, the changes in serum lipid sub-fractions, fasting glucose, fructosamine, glycated haemoglobin (HbA(1c)), CRP, creatinine, 24 h urine protein levels, creatinine clearance and blood pressure were evaluated.

RESULTS

After 12 weeks of treatment, serum total-cholesterol and low-density cholesterols (LDL-cholesterol) appeared slightly reduced and serum triglyceride slightly elevated, although non-significantly so in both groups. The increase in HDL-cholesterol (P < 0.05) and reduction in very low density (VLDL)-cholesterol (P < 0.05) levels were significant in hypertensive patients. Elevation in the Apolipoprotein A1 (P < 0.05) and reduction in the Apolipoprotein B (P < 0.05) levels were statistically significant in all patients. HRT was associated with significant decreases in serum fasting glucose (P < 0.05) and fructosamine (P < 0.05) levels in diabetic patients. Serum HbA(1c), CRP, creatinine, 24 h urine protein levels, creatinine clearance and systolic and diastolic blood pressure did not change significantly in either group.

CONCLUSIONS

There were no detrimental effects of transdermal HRT on lipid profile, glucose metabolism, CRP and urine protein levels in our well-controlled diabetic or hypertensive patients. A decision regarding HRT use should be taken on a case-by-case basis.

Have Ureaplasma urealyticum and Mycoplasma hominis infections any significant effect on women fertility?

Ureaplasma urealyticum and Mycoplasma hominis are known as sexually transmitted agents. U. urealyticum and M. hominis jeopardize male fertility. However, it is unclear whether these infections significantly contribute to female infertility. In this controlled-study we aimed to establish whether M. hominis and U. urealyticum are risk factors for female fertility and prevalence of infection from these agents in patients attending our infertility clinic. Total 96 married women enrolled in this prospective study; the infertile (study) group consisted of 50 women and fertile (control) group comprised 46 women. The patients were searched about the presence of U. urealyticum and M. hominis by a micro-liquid culture method. The samples were collected from endocervical area with a dacron swab. 28 of 50 (56%) and 18 of 46 (39%) women were evaluated as positive for U. urealyticum culture in the study and control groups respectively. M. hominis was cultured from 4 of 50 (8%) women in the study group as no positive result in controls. There were no statistically significant differences between the groups for both agents (p>0.05), but the higher prevalence of U. urealyticum in infertile women gives emphasis to evaluate these agents in patients that have no any other etiological factor for infertility.

Factor V Leiden and prothrombin 20210 G-A mutations in controls and in patients with thromboembolic events during pregnancy or the puerperium

Factor V Leiden and prothrombin 20210 G-A mutations are independent risk factors for venous thrombosis. We studied the frequency of these mutations in 35 patients who had thromboembolic events during pregnancy and puerperium, and in 32 women who had a history of uncomplicated pregnancy, delivered either vaginally or by cesarean section, and did not have a past history of thromboembolism. Factor V Leiden mutation was present in 7 patients (20%) in the study group. Of these 7 patients, 1 was homozygote, whereas the remaining 6 were heterozygote for the mutation. Prothrombin 20210 G-A mutation was present in 2 patients (5.7%) in the study group. In the control group none of the 32 patients was positive for the factor V Leiden and prothrombin 20210 G-A mutations. Our findings indicate that the factor V Leiden mutation is an important risk factor for thromboembolic disease during pregnancy or puerperium.