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Human papillomavirus (HPV) infection is the most significant risk factor of the development of cervical cancer. The distribution of HPV prevalence and genotype varies widely between regions. In this study, it was aimed to investigate the prevalence and genotype distribution of HPV, retrospectively. One thousand one hundred and seventy patients who applied to the department of obstetrics and gynecology were included in this study. Samples were collected from patients for cervical HPV DNA and Pap smear. The Pap samples taken for Pap smear were fixed with alcohol and analyzed according to the modified Bethesda system. HPV identification and typing were performed using the "Linear Array HPV Genotyping Test (Roche Molecular System, USA)". Patients were divided into 5 groups due to their age. Total HPV ratio was most frequently found among the patients who were between 17-30 years old, while HR-HPV was most frequently found between 51-60 years. Nine hundred seventy-eight of 1170 (83.6%) patients had normal cytologic findings whereas 192 (16.4%) had abnormal cytologic findings. HPV was detected in 37.2% of the total patients. high-risk HPV (HR-HPV) rate was 21.2%, probable high risk (PR-HPV) rate was 6.4% and low risk HPV (LR-HPV) rate was 9.5%. When the relationship between cytologic findings and HPV was examined, normal cytology/HPV negative 67.8%; abnormal cytology/HPV negative 37.5%, normal cytology/HPV positive 32.2%, abnormal cytology/HPV positive 62.5% were detected. The highest prevalence of HPV was 8.9% with HPV 16, followed by 6, 53 and 52/53/35/58. A total of 354 patients were biopsied, 177 of whom were normal, 111 of whom were cervical intraepithelial neoplasia (CIN) 1, 66 of whom were CIN 2 and over. In the group with normal pathological findings, HR-HPV ratio was found as 15.8%, while in CIN 1 44.1% in CIN 2-3 63.6%. Sensitivity, specificity, positive predictive value, and negative predictive value of screening tests were examined in CIN 2 and more lesions. Sensitivity and specificity for HR-HPV were 63.6% and 73.3%, respectively, the same rates were 81.8% and 58.7% for HPV. The highest sensitivity was found in combination of HRHPV and Pap smear, the highest specificity in HPV. In conclusion, the HPV prevalence and genotype distribution in our study are similar to those reported in the world, but higher than previous studies in our country. These results may be due to our methodology and hospital based nature of our study group. We conclude that only smear or HR-HPV testing are not sufficient as a single pronged screening test, and that the participation of other genotypes of HPV in screening increases the sensitivity.

Objective: This study aimed to determine the factors associated with Human Papillomavirus (HPV) persistence in women undergoing cervical excision for pre-invasive lesions, after they have been referred from a primary HPV screening program. Methods: A retrospective study design involving patients who were treated at a Cervical Disease Screening and Treatment Unit, in a university hospital setting. After initial treatment, cervical HPV infection status was analyzed at the sixth month, first year and then subsequently after the second year. Results: Totally, 395 patients who were diagnosed with pre-invasive cervical lesions and who subsequently undergone cervical excision were identified. In the first-year visit after cervical excision, HPV 18 was cleared in almost all (95.8%) cases, followed by HPV 16 (69.9%) and other hrHPV types (65.6%). Available data documented that 88.6% of women reached clearance after the two-year follow-up. Univariate analysis revealed a significantly higher proportion of HPV clearance among women who were younger (p = 0.019), premenopausal (p = 0.002), and who had been found to have a negative cytology result on their initial Pap test (p = 0.018). However, only cervical cytology result remained as the independent predictor of HPV persistence on a multivariate logistic regression (OR 0.43; 95% CI 0.21–0.87; p = 0.019). Conclusions: A low risk of HPV persistence was found among every HPV genotype in women undergoing cervical excision for pre-invasive cervical lesions. Initial cervical cytology result was the only independent predictor of HPV clearance during surveillance, which indicates the prognostic value of Pap test in primary HPV screening. © 2020 Elsevier Inc.

Following a previous cesarean section, trial labour followed by spontaneous birth is currently popular but is still debatable. In an effort to assess the risks of unmonitored labor, the outcomes of 165 patients with previous cesarean section who delayed coming to hospital were reviewed. Seventy-one patients were allowed to continue labor and 62 achieved successful vaginal delivery, a success rate of 87.3%. Sixty-one of 71 patients had an unknown uterine scar type prior to birth and, of these, 57 were delivered vaginally. The scar separation rate of this group was found to be 3.5% and the overall scar separation rate in our patients was 3.6%. Other than scar separation and febrile morbidity, no maternal morbidity or mortality was observed. The vast majority (98.4%) of infants delivered vaginally had 5-min Apgar scores of 7 or greater. We suggest that increasing the use of trial labor in patients with prior cesarean section, even in the presence of an unknown scar, may reduce the number of patients laboring in an unmonitored environment who wish to give birth vaginally.

To investigate the ovarian lipid peroxidation pattern in polycystic ovary syndrome (PCOS).Twenty-six women with PCOS who underwent in vitro fertilization and embryo transfer (IVF-ET) cycles between January 1999 and November 2000 at the hospital IVF unit were included in the study. Seventeen regularly cycling women with male factors (oligospermia or azoospermia) were enrolled as the control group. Malondialdehyde (MDA) levels in preovulatory follicular fluid were measured.There was a significant difference in follicular fluid MDA levels among the control (median, 2.23 nmol/mL; range, 0.98-4.93) and PCOS group (median, 3.53 nmol/mL; range, 1.51-4.81). Follicular fluid MDA and plasma progesterone levels correlated positively in the subjects (r = 0.55, p = 0.041) and PCOS group (r = 0.074, p = 0.0001). Plasma luteinizing hormone/follicle stimulating hormone (LH/FSH) levels correlated positively with follicular fluid MDA levels in the PCOS group (r = 0.72, p = 0.0001).The specific ovarian lipid peroxidation profile of PCOS patients is probably related to insufficient progesterone production and higher FSH/LH levels.

Preeclampsia continues to be a major cause of maternal and perinatal mortality and morbidity worldwide. The etiopathogenesis of preeclampsia is not fully understood. Neopterin and interleukin‐2 (IL‐2) production reflects cellular immunity. Our purpose was to determine the levels of neopterin and interleukin‐2 receptor (IL‐2R) in pregnant women with severe preeclampsia, and assess the implications of these findings in the pathophysiology of preeclampsia. Fourteen women with preeclampsia were compared with 14 healthy pregnant women. Serum levels of neopterin were measured by an enzyme‐linked immunoassay (ELISA), and IL‐2R levels were determined by an immunoassay method with an Immulite analyzer. The levels of neopterin and IL‐2R were significantly higher in the preeclamptic subjects than in normotensive women (P

The aim of this study was to investigate the presence of human papillomavirus DNA (HPV-DNA) in cervical specimens of those randomly selected women, age between 18-62 years and applied to Gynecology and Obstetric Clinics in a six months period. Two hundred and six women were enrolled during the study. HPV-DNA in the cervical specimens were investigated with Hybrid Capture System (Digene Hybrid Capture System, UK) and also the cytologic specimens were examined simultaneously. HPV-DNA positivity was 4.9% overall. HPV-DNA positivity was found to be higher among younger population (30-39 age group: 7.3%), women with lower education level (6.9 %) and with lower income level (11.8%). Additionally, HPV-DNA positivity rate was found higher among women who experienced their first sexual intercourse at lower ages (15-19 age group: 6.3%) and who use oral contraceptives (7.7%). HPV-DNA positivity was found to be 2.1% in women with normal cervical cytology and 42.9% in women with epithelial cell abnormalities, and this difference was statistically significant (p=0.000). The presence of HPV together with high rates of epithelial cell abnormalities leading to cervical cancer, supported the association between HPV and malignancy. Thus, HPV-DNA testing should be included in the cervical cancer screening programmes.

Objectives: To evaluate the efficacy of Vitamin D for relieving vaginal atrophy. Methods: In our cross-sectional study, 60 eligible women were consecutively identified among patients who were followed in physical medicine and rehabilitation's outpatient clinic, during the period March June 2001. The sample consisted of 30 postmenopausal women on 1,25-dihydroxy Vitamin D (calcitriol) treatment, 30 postmenopausal women taking neither hormone replacement nor osteoporosis treatment. Vaginal atrophy was determined by symptoms, physical examination and maturation index (MI). Results: The mean physical findings score in Vitamin D treatment (VDT) group was significantly lower than the mean physical findings score in the group without treatment. Symptom scores were lower in both groups and there was not significantly difference between two groups. As maturation indices: in VDT group, superficial cells proportion was significantly higher and basal, parabasal cells proportion was lower than in the group without treatment. Conclusion: The results of current study seem to indicate that vaginal tissue may be a new target organ for therapeutically applied Vitamin D analogues. (C) 2004 Elsevier Ireland Ltd. All rights reserved. C1 Pamukkale Univ, Fac Med, Dept Obstet & Gynaecol, Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Pathol, Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Phys Med & Rehabil, Denizli, Turkey.

Trichomonas vaginalis is the causative agent of human trichomoniasis which is a sexually transmitted disease mainly in women. The infection may be asymptomatic or symptomatic such as severe vaginitis and cervicitis. The aim of this study was to compare direct microscopic examination, acridine orange stained examination and culture in Modified Diamond medium, for the detection of T. vaginalis from the vaginal swab samples of 310 patients (age ranges: 17-45 years old) who were complaining from vaginal discharge. Of them 40 (12.9%) samples were found positive with culture, 20 (6.5%) were positive with direct microscopy and 19 (6.1%) were positive with acridine orange staining method. The positive results were obtained in 17 cases by each of the three methods, in 3 cases by direct microscopy and culture, in 2 cases by acridine orange staining and culture, and in 18 cases by culture only. T. vaginalis has been detected in 19.5% of 41 patients with itching, 15.7% of 190 patient with groin pain and 23.2% of 43 patients with cervical erosion, in addition to vaginal discharge, by at least one of the methods. In conditional evaluation, there were no statistically significant differences between T. vaginalis positivity with age groups and the contraceptive methods used. As a result, it was concluded that for the laboratory diagnosis of T. vaginalis, acridine orange staining technique does not have any superiority over direct microscopy. Although direct microscopy is a practical and economical method, it has low sensitivity, so all of the suspected samples which are found negative by this method, should be cultivated for a definite diagnosis.

Background. Many postmenopausal women currently receive hormone replacement therapy. The use of low-dose 17β-estradiol plus norethisterone acetate and tibolone for hormone replacement therapy is not uncommon in postmenopausal women. Homocysteine, which is known to be an independent risk factor for the development of cardiovascular disease, is found in increased levels postmenopause. This study compared the effects of low-dose 17β-estradiol plus norethisterone acetate and tibolone on the fasting plasma homocysteine level in healthy postmenopausal women. Methods. Healthy postmenopausal women (n = 44) were enrolled in the study. Women randomly assigned received 1 mg of 17β-estradiol plus 0.5 mg of norethisterone acetate or 2.5 mg tibolone during a period of 12 weeks. Fasting plasma homocysteine levels were measured at baseline, the 4th week, and the 12th week of therapy. Results. In the 4th week there were no significant changes in plasma homocysteine levels in both groups (p > 0.05). However at the end of the 12th week the plasma homocysteine levels were reduced significantly in both groups (p < 0.05). Conclusion. Low-dose 17β-estradiol plus norethisterone acetate and tibolone lower the fasting plasma homocysteine levels in healthy postmenopausal women.

Objective: To investigate the relation between intra-abdominal fat distribution and metabolic disorders in nonobese patients with the polycystic ovary syndrome (PCOS). Design: Prospective case-control study. Setting: University-based hospital. Patient(s): Thirty nonobese patients with PCOS and 30 lean women with regular menstrual cycles (controls). All participants had a body mass index < 25kg/m2. Main Outcome Measure(s): Subcutaneous and intra-abdominal visceral and preperitoneal fat thicknesses were assessed by ultrasonography. Glucose tolerance and insulin sensitivity were evaluated by standard 75-g oral glucose tolerance test and area-under-the-curve analysis. Serum hormones and lipid profile were measured. Result(s): The mean preperitoneal and visceral fat thicknesses were significantly greater in nonobese patients with PCOS. Subcutaneous fat mass was similar between the PCOS and control groups. Nonobese patients with PCOS had glucose intolerance, hyperinsulinemia, and dyslipidemia, manifested by high serum levels of triglyceride, total cholesterol, and high-density lipoprotein (HDL) levels and low serum low-density lipoprotein (LDL) levels. No correlation existed between subcutaneous fat thickness and the metabolic variables in nonobese patients with PCOS. However, serum triglyceride levels correlated with visceral fat and preperitoneal fat thickness. The mean HDL level correlated negatively with visceral fat and preperitoneal fat thickness. The area under the curve for insulin and mean fasting insulin levels correlated positively with visceral fat thickness. In multiple regression analysis, visceral fat thickness contributed significantly to high serum triglyceride and fasting insulin levels. Conclusion(s): Intra-abdominal preperitoneal and visceral fat accumulation may contribute to the development of glucose and lipid metabolism disorders in nonobese patients with PCOS. © 2003 by American Society for Reproductive Medicine.

Objecti6es: To evaluate the effects of menopausal hot flashes on arterial blood gas measurements. Methods: Twelve postmenopausal women with frequent hot flashes were enrolled in this study. Blood samples from femoral artery were collected before and during menopausal hot flashes in each subject, and all blood samples were analyzed for pH, pCO2, pO2, HCO3 standard, total CO2, and base excess. Arterial blood gas parameters before and during menopausal hot flashes were compared statistically. Results: pH measurements decreased significantly during hot flashes (PB 0.05); although the difference was found to be statistically significant, the amount of decrease and the range in which the change took place led us to conclude that this change was clinically insignificant. Other parameters did not show any statistically significant differences between the preflash and flash measurements. Conclusions: Our results indicate that menopausal hot flashes do not have any clinically significant effects on arterial blood gas measurements. © 1998 Elsevier Science Ireland Ltd. All rights reserved.

Objectives: To determine the effects of postmenopausal hormone replacement therapy on 'sympathetic skin response' test which is one of the tests to evaluate autonomic functions. Methods: Sixty postmenopausal women, 30 of whom taking hormone replacement therapy and the remaining 30 without hormone replacement therapy, were enrolled in this study. Sympathetic skin responses were recorded in each subject by Medelec Premiere electromyograph. Latency and amplitude of sympathetic skin response and area under the negative component of sympathetic skin response were measured and the groups were compared statistically regarding these results. Results: Latency values of the groups were not significantly different, whilst the difference between the sympathetic skin response amplitudes of the groups, as well as the difference between the measurements of area under the negative component of sympathetic skin response of the groups were statistically significant. Conclusion: The results of the current study seem to indicate that estrogen has a significant inhibitory effect on the sympathetic neuron pool at the spinal cord level. Copyright (C) 1998 Elsevier Science Ireland Ltd.

Our purpose was to determine the prevalence of antiphospholipid antibodies (APA) in eclamptic women as well as the rates of intrauterine growth retardation (IUGR) and fetal death in APA-positive and -negative eclamptic women. Thirty-six eclamptic and 30 healthy pregnant women were enrolled in this study. APA in those groups were determined. The prevalences of IUGR and fetal death were determined in APA-positive and -negative eclamptic women. In the eclamptic group, APA were positive in 9 out of 36 patients (25%), where as only 2 out of 30 controls (6.7%) were positive (p < 0.05). Fetal death was encountered in 4 out of 9 (44.4%) APA-positive eclamptic women; this was a significantly larger proportion than that for APA-negative eclamptic women (1/27; p < 0.01). The rates of IUGR in APA-positive and -negative eclamptic women were not significantly different (p > 0.05). Similar conclusions about our results could also be made, when weakly positive anticardiolipin antibodies were regarded as negative in our study group and controls. Our study suggests that positive levels of APA in eclamptic women increase the risk for intrauterine fetal death.

Our report describes an unusual presentation of mature cystic teratoma. In this case, 3 mature cystic teratomas were encountered during cesarean section, one in each round ligament and the other in the left ovary. According to the literature, round ligament is one of the rarest sites for the presentation of mature cystic teratoma. (C) 1997 Elsevier Science Ireland Ltd.

Our purpose was to determine if blood samplings in the mornings after night shifts should be avoided for measuring the basal serum prolactin levels in women working at night and with regular menses; 20 nurses with regular menses, all working only at night shifts, were enrolled in this study. Serum prolactin levels of the subjects were determined twice, first in the morning after a typical night's sleep, with no intercourse within the previous 24 hours, second, in the morning after a typical night shift. All measurements of serum prolactin levels were performed in the follicular phase of the menstrual cycle. Prolactin levels in the mornings after typical night's sleeps and in the mornings after typical night shifts were not significantly different. Prolactin level in the morning after a night shift of a woman with regular menses may represent basal prolactin level of that woman.

Urinary calcium excretion decreases in preeclampsia. To determine the predictability of preeclampsia with hypocalciuria, we investigated the calcium to creatinine ratio and the calcium level of a spot urine sample in 56 primigravid patients aged less than 25 years. Of these 56 cases, 44 remained normotensive and preeclampsia developed in eight cases. There were four cases of gestational hypertension and they are not included in the statistical analysis. The mean age, the mean gestational age at entrance into the study, the mean urine calcium concentration, the mean birthweight, and the mean gestational age at delivery were similar between the normotensive and preeclamptic groups. The mean calcium to creatinine ratio is found to be significantly lower in the preeclamptic group (0.0475 +/- 0.0260) compared with the normotensive group (0.1466 +/- 0.1353; p < 0.0001). A cutoff level of 0.066 for the calcium to creatinine ratio with the use of a receiver operator curve yielded a sensitivity of 75%, a specificity of 86%, and a positive and negative predictive value of 55% and 95%, respectively. The results of this study suggest that a single urine calcium to creatinine ratio might be an effective marker for predicting preeclampsia in a high-risk population.

Objective: We studied whether the administration of oral contraceptives facilitates the disappearance of spontaneously formed functional ovarian cysts. Methods: Eighty patients in whom ultrasonography revealed unilateral, mobile, unilocular, thin-walled ovarian cysts without internal echoes and greater than 30 mm but not exceeding 60 mm in diameter were enrolled into the study. Patients were randomized by stratification to receive a low-dose monophasic pill, a high-dose monophasic pill, a multiphasic pill or no therapy. Patients were re-evaluated after 5 weeks of therapy and at the end of therapy (10 weeks). Results: The mean ages and the mean cyst diameters of the patients for each group were not significantly different. We did not find a significant effect of oral contraceptive administration on the disappearance rate of functional ovarian cysts over that of expectant management. Conclusion: We conclude that oral contraceptive therapy even with multiphasic pills is very effective in the management of functional ovarian cysts but expectant management achieves similar success rates and may be a good alternative to oral contraceptive therapy.