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Folic acid (FA) supplements and food fortification are used to prevent neural tube defects and to lower plasma homocysteine. Through exposure to food fortification and vitamin supplement use, large populations in the United States and elsewhere have an unprecedented high FA intake. We evaluated dietary and supplemental intakes of folate and FA in relation to an index of immune function, natural killer cell (NK) cytotoxicity, among 105 healthy, postmenopausal women. Among women with a diet low in folate (<233 microg/d), those who used FA-containing supplements had significantly greater NK cytotoxicity (P = 0.01). However, those who consumed a folate-rich diet and in addition used FA supplements > 400 microg/d had reduced NK cytotoxicity compared with those consuming a low-folate diet and no supplements (P = 0.02). Prompted by this observation, we assessed the presence of unmetabolized FA in plasma as a biochemical marker of excess FA. Unmetabolized folic acid was detected in 78% of plasma samples from fasting participants. We found an inverse relation between the presence of unmetabolized FA in plasma and NK cytotoxicity. NK cytotoxicity was approximately 23% lower among women with detectable folic acid (P = 0.04). This inverse relation was stronger among women >or= 60 y old and more pronounced with increasing unmetabolized FA concentrations (P-trend = 0.002). Because of the increased intake of FA in many countries, our findings highlight the need for further studies on the effect of long-term high FA intake on immune function and health.

Adhesive/abrasive wear in ultra-high molecular weight polyethylene (UHMWPE) has been minimized by radiation cross-linking. Irradiation is followed by melting to eliminate residual free radicals and avoid long-term oxidative embrittlement. However, post-irradiation melting reduces the crystallinity of the polymer and hence its strength and fatigue resistance. We proposed an alternative to post-irradiation melting to be the incorporation of the antioxidant alpha-tocopherol into UHMWPE prior to consolidation. alpha-Tocopherol is known to react with oxygen and oxidized lipids, stabilizing them against further oxidative degradation reactions. We blended GUR 1050 UHMWPE resin powder with alpha-tocopherol at 0.1 and 0.3 wt% and consolidated these blends. Then we gamma-irradiated these blends to 100-kGy. We characterized the effect of alpha-tocopherol on the cross-linking efficiency, oxidative stability, wear behavior and mechanical properties of the blends. (I) The cross-link density of virgin, 0.1 and 0.3 wt% alpha-tocopherol blended, 100-kGy irradiated UHMWPEs were 175+/-19, 146+/-4 and 93+/-4 mol/m3, respectively. (II) Maximum oxidation indices for 100-kGy irradiated UHMWPE previously blended with 0, 0.1 and 0.3 wt% alpha-tocopherol that were subjected to accelerated aging at 80 degrees C in air for 5 weeks were 3.32, 0.09, and 0.05, respectively. (III) The pin-on-disc wear rates of 100-kGy irradiated UHMWPE previously blended with 0.1 and 0.3 wt% alpha-tocopherol that were subjected to accelerated aging at 80 degrees C in air for 5 weeks were 2.10+/-0.17 and 5.01+/-0.76 mg/million cycles, respectively. (IV) Both accelerated aged, alpha-tocopherol-blended 100-kGy irradiated UHMWPEs showed higher ultimate tensile strength, higher yield strength, and lower elastic modulus when compared to 100-kGy irradiated, virgin UHMWPE. These results showed that alpha-tocopherol-blended 100-kGy irradiated UHMWPEs were not cross-linked to the same extent as the 100-kGy irradiated, virgin UHMWPE.

Young assisted-reproduction patients with diminished ovarian reserve (DOR) are one of the most challenging issues for IVF specialists. A retrospective study of 70 assisted reproduction patients younger than 35 years with DOR determined based on antral follicle count was conducted, investigating: (i) correlation of day 3 FSH measurement with antral follicle count; and (ii) cycle outcome of young DOR patients compared with 53 young assisted reproduction patients with normal ovarian reserve (NR). DOR was considered as antral follicle count of <6 per ovary. Day 3 FSH in the DOR group was significantly higher than in the NR group (8.3 and 6.6 mIU/ml respectively; P < 0.05). Implantation rates between the groups were similar (15% in DOR and 18% in NR). Pregnancy rate was 35.8% in the DOR group, significantly lower than that of the NR group, which was 54.7% (P = 0.028). Although the pregnancy rate was significantly lower in the DOR group compared with the NR group, the statistically insignificant difference in implantation rates demonstrated that the problem in young DOR patients was mainly the number of retrieved oocytes. Therefore, such couples should be informed that lower oocyte numbers will result in statistically lower, but still encouraging, pregnancy rates. Basal FSH should also be measured during evaluation as an adjunct to antral follicle count.

Background: Obesity is characterised by insulin resistance and by elevated levels of proinflammatory markers. We investigated whether, in the absence of changes in glucose, thiazolidinediones (TZDs) have anti-inflammatory effects and whether improvement of insulin sensitivity correlates with suppression of inflammatory markers., Methods: We performed a randomised double-blind placebo-controlled crossover study with troglitazone (400 mg daily for eight weeks) in 15 normoglycaemic obese subjects. We measured plasma high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), leptin, tissue-type plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and tumour necrosis factor-alpha (TNF-alpha) after each of the two treatment periods and in 13 age- and sex-matched lean individuals., Results: Obese subjects were insulin resistant (decreased glucose infusion rate (GIR) during euglycaemic hyperinsulinaemic clamp) and had higher plasma levels of hsCRP, IL-6, leptin, tPA, and PAI-1 compared with lean subjects. TNF-alpha also tended to be higher. Troglitazone improved insulin sensitivity (mean increase in whole body glucose uptake 23.1 +/- 10.5% (p = 0.047)) and normalised plasma concentrations of hsCRP, tPA and TNF-alpha, whereas it did not significantly change IL-6, leptin and PAI-1. Changes in GIR did not correlate with changes in inflammatory markers., Conclusion: Troglitazone induces suppression of some of the inflammatory markers that are elevated in normoglycaemic obese subjects. The suppression of inflammatory markers, however, does not correlate with improvement in insulin sensitivity, suggesting involvement of partially differential mechanisms in these effects of TZDs.

Purpose: To report on the treatment results and demographic characteristics of patients with locally advanced non small cell lung carcinoma (NSCLC) who were treated with concomitant or sequential chemoradiotherapy., Patients and Methods: 132 patients with locally advanced NSCLC (stage IIIB) were evaluated. Their median age was 60 years (range 33-80). Histopathological diagnosis was epidermoid carcinoma in 96 (73%) patients, adenocarcinoma in 33 (25%) patients and large cell carcinoma in 3 (2%) patients. Karnofsky performance status (KPS) score was >/= 70 in 112 (85%) patients. Weight loss was greater than 5% in 34 (26%) patients at presentation. One hundred and six (80%) patients were treated with sequential chemoradiotherapy which consisted of 3 monthly cycles of cisplatin (100 mg/m(2), day 1) and etoposide (100 mg/m(2)/day, days 1-3) before radiotherapy. Radiotherapy consisted of a total dose of 60 Gy in 30 fractions (2 Gy / fraction), given to a volume including primary tumor and mediastinum. Two to 4 cycles of chemotherapy were administered after completion of radiotherapy to patients whose disease had not progressed after initial chemotherapy. Twenty-six patients were treated with concomitant chemoradiotherapy. The same radiotherapy regimen was started with the 2nd cycle of chemotherapy which consisted of cisplatin (80 mg/m(2), day 1) and etoposide (100 mg/m(2)/day, days 1-3). Chemotherapy was completed after 4 cycles in all patients., Results: Overall survival (OS) was 14.5 months in 106 patients treated with sequential chemoradiotherapy and 14.6 months in 26 patients treated with concomitant chemoradiotherapy (p=0.99). Median time to progression was 9.77 months in the concomitant group and 11.6 months in the sequential group (p=0.47). However, progression-free survival was better in patients of both groups whose KPS was >70 (12.4 months versus 11.5 months, p= 0.02). While presence of anemia was found as an adverse prognostic factor only in univariate analysis, non-epidermoid histology, KPS less than 70 and presence of N2-N3 disease were found as adverse prognostic factors in both univariate and multivariate analysis., Conclusion: The addition of chemotherapy to radiation concomitantly or sequentially prolongs survival in locally advanced NSCLC patients with acceptable adverse event profiles in both arms compared with results of the trials in the literature in which radiotherapy is used as single treatment modality.

Median rhomboid glossitis (MRG) is an uncommon benign abnormality of the tongue, most frequently affecting men. It is typically located around the midline of the dorsum of the tongue, anterior to the lingual "V", appearing as a reddish, rhomboid area, depapillated, flat maculate or mamillated and raised by 2 - 5 mm. This paper reports a case of rhomboid glossitis in a 61-year-old man who consulted for a painless raised lesion on the dorsum of the tongue, in left paramedial (not medial) location. Histopathological findings were compatible with rhomboid glossitis. Other diagnoses considered but ruled out on the basis of the clinical and histopathological findings were haemangioma, pyogenic granuloma, amyloidosis, granular cell tumour, and squamous cell carcinoma. This case confirms that rhomboid glossitis may occur in paramedial locations.

Objective: Our objective was to review the hysterectomies performed in our clinic for the last 17 years to reveal the facts in relation to the operation., Materials and Methods: The records of the patients who had undergone hysterectomy in Istanbul University Cerrahpasa School of Medicine Department of Obstetrics and Gynecology between January 1985 and August 2001 were reviewed retrospectively. Students' t-test and one-way ANOVA test were utilized to compare the data of different hysterectomy groups., Results: Between 1985 and 2001, there were 3,956 women who had undergone hysterectomy operation in the Department of Obstetrics and Gynecology of Cerrahpasa School of Medicine, Istanbul University. There were 3,274 (82.7%) total abdominal hysterectomies (TAH), 424 (10.7%) total vaginal hysterectomies (TVH), 28 (0.7%) subtotal hysterectomies and 230 (5.8%) radical hysterectomies. There were no significant differences in the distribution of hysterectomy type with respect to interval of years. The common indications for hysterectomy were myoma uteri (38.49%), followed by gynecological cancers (21.6%) and uterine prolapse (11.9%). The rate of concurrent procedures were 87.3% for TAH (2,856/3,274) and 95.8% for TVH (406/424). The rate of 'unjustified' hysterectomies (pathological diagnosis that is inappropriate to the indication of the operation) determined as 8.9% in all of the cases. The pathological examination of the specimen was normal in 170 cases (5.1%) of TAH. This rate was 42.1% (183/435) in TVH group. In the TAH group there was no complication in 86.5% of the cases while it was 89.3% in the TVH group. The most common complication was febrile morbidity in the whole group. During the study period, 5 deaths that can be attributed to the hysterectomy operation were observed. The mortality rate was calculated as 0.1% for hysterectomy operation in the study period., Conclusion: Although it is widely performed, hysterectomy is a relatively safe surgical procedure. The morbidity and mortality of the operation may be further decreased by the efforts to minimize the rate of the unnecessary hysterectomies and selecting the most appropriate mode for the surgery.

The hormonal changes and maternal adaptations of human pregnancy are among the most remarkable phenomena in nature. Endocrinologic parameters in the early gestation period have been used to predict abnormal pregnancies and to identify fetuses that have chromosomal aberrations. This article focuses on the changes in hormones that are secreted by the maternal-fetal-placental unit that are unique for the first trimester of pregnancy and their impact on clinical outcome.

Longevity of total joints has been compromised by wear and fatigue of ultrahigh molecular weight polyethylene (UHMWPE) components. Crosslinking reduces UHMWPE wear, but combined with postirradiation melting, also reduces its fatigue strength, therefore limiting its use in high-stress applications. We hypothesized that a lipophilic antioxidant (alpha-tocopherol, alpha-T) can protect UHMWPE against oxidation eliminating the need for postirradiation melting of crosslinked UHMWPE and improve its fatigue strength. To test these hypotheses, 65- and 100-kGy irradiated, alpha-T-doped and subsequently gamma-sterilized UHMWPE were used. (I) alpha-T-doped irradiated UHMWPEs showed significantly lower oxidation levels (0.48+/-0.25 and 0.44+/-0.06) compared to 100-kGy irradiated UHMWPE (3.74+/-0.16) after 5 weeks of accelerated aging at 80 degrees C in air. (II) Wear rate of alpha-T-doped irradiated UHMWPE (1.9+/-0.5, and 0.9+/-0.1mg/million cycles (MC) for 65- and 100-kGy irradiated UHMWPE, respectively) were comparable to that of 100-kGy irradiated/melted UHMWPE (1.1+/-0.7mg/million cycles). (III) The stress intensity factor at crack inception ( DeltaKi) of 100-kGy irradiated UHMWPE increased significantly upon doping with alpha-T from 0.74 to 0.87MPam(1/2) ( p<0.01 ). The DeltaKi for the 100-kGy irradiated and melted UHMWPE, currently in clinical use, was 0.55MPam(1/2). Doping with alpha-T eliminated the need for postirradiation melting to protect irradiated UHMWPE against long-term oxidation. The fatigue strength was improved by 58% for alpha-T-doped 100-kGy irradiated UHMWPE compared to irradiated and melted UHMWPE. The increase in oxidative stability of alpha-T-doped UHMWPE is attributed to the ability of alpha-T to react with peroxy free radicals on lipid chains and arrest the oxidation reactions. The improved fatigue strength is attributed to the increase in plasticity of UHMWPE due to the lipophilic nature of alpha-T.

Depressive episodes are significant in bipolar illness since patients can spend up to one-third of their lives in depression. Although the treatment of bipolar depression remains an understudied area, new data from randomized, controlled trials and naturalistic studies have expanded the range of treatments available. The main aim in the treatment of bipolar depression is the prevention of the patient switching to mania and cycle acceleration, and antidepressant therapy may be contraindicated because of the risk for switching. Guidelines for the acute treatment of bipolar depression emphasize treatment with a mood stabilizer, of which lithium has been the most thoroughly studied in randomized, controlled trials in acute bipolar depression. Lamotrigine has also demonstrated significant efficacy in recent studies and has been approved by the FDA.

Objective: To compare the prevalence of dental caries in two groups of schoolchildren: (1) schoolchildren participating in a weekly 0.2% sodium fluoride mouth-rinsing program and (2) schoolchildren not participating in the program., Methods: This cross-sectional study was conducted in the city (municipality) of Londrina, in the state of Paraná, Brazil; the city has fluoridated drinking water. We examined 367 12-year-old children: 190 participants in the weekly mouth-rinsing program (51.8%) and 177 nonparticipants (48.2%). The prevalence of caries was determined based on the scores for decayed, missing, and filled teeth and for decayed, missing, and filled surfaces. The examinations were performed by three examiners, with nearly perfect agreement in their diagnosis of caries (kappa = 0.90). The dependent variable was dental caries. The independent variables were: participation or nonparticipation in the mouth-rinsing program, attending a private school or a public school, frequency of tooth-brushing, amount of toothpaste used, consumption of sweets between meals, and visits to the dentist., Results: The decayed, missing, and filled teeth score (mean and standard deviation) at 12 years of age was 0.85 +/- 0.059 overall, 1.0 +/- 0.058 for program participants, and 0.70 +/- 0.060 for nonparticipants. The decayed, missing, and filled surfaces score (mean and standard deviation) was 1.16 +/- 0.017, with it ranging from a low of 0.34 in one private school to a high of 1.66 in one public school. Bivariate analysis showed an association between caries (P < 0.05) and the following variables: attending a public school, participating in the mouth-rinsing program, and consuming sweets between meals more than once a day. In the multivariate analysis, attending a public school (P = 0.0004) and consuming sweets (P = 0.001) remained associated with the presence of caries., Conclusions: The weekly mouth-rinsing program was not associated with a decreased prevalence of caries, in either the public schools or the private schools. However, additional research is needed to assess the cost-effectiveness of fluoride mouthrinsing programs in populations with a higher prevalence of caries. Given the caries prevalence that we found in the schoolchildren whom we studied, the resources allocated to the fluoride mouth-rinsing program for them should probably be used to pay for other health-promotion activities with them.

Purpose: To investigate the robustness of permanent prostate implant dosimetry for various (125)I seed activities and various seed models. The dosimetric impact of seed misplacement and seed migration (seed loss) is also taken into account using various standard dose indices., Methods and Materials: A dose-based inverse planning algorithm is used for automated dosimetric plan creation (45-60 s per plan) and provides an unbiased way to compare the robustness of various optimal dosimetric plans. Seed misplacement and seed migration are simulated by way of Monte Carlo, based on the measured displacement distributions from clinical postimplant cases. Plans were generated for seed activities between 0.2 and 1.4 mCi (0.25 to 1.78 U) and for 11 different seed models., Results: The numbers of seeds and needles are shown to decrease rapidly for a seed activity between 0.3 mCi and 0.6 mCi (0.38 and 0.76 U). The loss in V100, from 100%, because of seed misplacement is below 10% for an apparent activity ranging from 0.2 to 0.9 mCi (0.25 to 1.14 U). A minimum degradation in V100 is observed around 0.6-0.7 mCi (0.76-0.89 U). D90 increases from 150 to 170 Gy between 0.3 and 0.7 mCi (0.38 and 0.89 U) and decreases afterward to fall below 140 Gy at higher activity. V200 and D10 to the target volume both show an increase in hot spots up to 0.7 mCi, and then decrease linearly at higher activities for all seed models. V200 and D10 to the urethra remain about constant for all seed activities up to 0.8 mCi (1.02 U), at which point they start to decrease. All seed models follow this general trend., Conclusions: Plans were shown to be robust to misplacement and migration of seeds over a wide range of seed activity and for various seed models. With a properly tuned inverse planning algorithm able to ensure the dose coverage and protection for the organs at risk in the presence of placement errors (displacement and migration), the choice of a preferred seed activity, in a range up to about 0.7 mCi (0.89 U), is open. The upper part of this range offers the opportunity to significantly reduce the number of seeds and needles, thus reducing surgical trauma to the patient, saving time in an operating room planning setting, and reducing the cost of a permanent prostate implant procedure.

Polymeric networks that have inherent capabilities to recognize different molecules and chemical changes in their environment are the next generation of materials that will aid in the diagnosis and treatment of diseases. We have prepared new networks based on star polymers that were designed to be responsive and recognitive. Using molecular imprinting with D-glucose and crosslinking with poly(ethylene glycol) dimethacrylate with an ethylene glycol chain of nominal molecular weight 600, we prepared star polymer networks, which exhibited over 300% more uptake for D-glucose compared to D-fructose. Using copolymerization with methacrylic acid, we prepared star polymer networks with pH-sensitivity, which showed a sharp transition in swelling around a pH of 4.5., (Copyright 2004 Wiley Periodicals, Inc.)

Hemolytic activity was evaluated in the putative periodontopathogens Prevotella intermedia and Prevotella nigrescens. Whole cells of both species present weak hemolytic activity evidenced only by solid media assays after 48 h of bacterial growth or after 5 h of interaction with erythrocytes at 37 degrees C in liquid assays. In this work we show that the use of crude extract allowed the detection of a higher hemolytic activity for P. intermedia, but surprisingly not for P. nigrescens. Incubation at 37 degrees C for 9 h, or treatment with trypsin or proteinase K, increased or exposed the hemolytic activity of P. intermedia and P. nigrescens crude extract, respectively. The activation process was inhibited by TLCK and PMSF but not by EDTA, E-64 or pepstatin A, indicating the serino-protease nature of the factor involved in activation of P. intermedia and P. nigrescens hemolysins. Both the buffer and the pH employed for cell fractionation influenced the activation of hemolysin, and the best results were obtained with Universal buffer at pH 8.0. The activated hemolysins acted optimally at pH 6.5 at 37 degrees C and the maximum hemolytic activity was detected at the early log phase of growth. The results of this study show for the first time a strong hemolytic activity for P. nigrescens and evidence of proteolytic activation of hemolysins produced by periodontopathogens.

Matched-filtering is applied to an algorithm similar to confocal microwave imaging of the breast in order to better detect tumors in a 3-D FDTD model. Strongly scattering objects detected by the imaging algorithm are examined for tumor existence through matched-filtering. Based on the matched-filtering examination, early-time clutter is well suppressed by this method. Also, an antenna-array with a spatial resolution of 8.3 mm is shown to be effective in reducing the clutter level for the successful detection of a 5-mm-diameter spherical tumor.

Objective: To determine the prevalence of ovarian endometriosis in malignant epithelial ovarian tumours., Study Design: A retrospective analysis of 160 malignant and 23 borderline ovarian tumours during the period 1995-2001., Results: Fourteen (7.7%) of the tumours contained endometriosis. This affected 22% of the endometrioid and 10.8% of the mixed adenocarcinomas. The mean age of the ovarian endometriosis patients was 43+/-13 range 26-70 years. The incidence in borderline tumours 13% (3/23) was higher than that in ovarian cancer 6.9% (11/160) (P>0.05). Eight (57%) of cases were classified as atypical and six (43%) as typical endometriosis. Nine cases were FIGO (International Federation of Gynaecology and Obstetrics) stage I and 5 stage III., Conclusions: Both malignant and borderline ovarian tumours are associated with ovarian endometriosis. In addition, atypical endometriosis was found associated with endometrioid and mixed epithelial ovarian tumours.

The influence of growth medium, hemin and menadione, blood source and atmosphere of incubation on the expression of hemolytic activity of 25 strains of Prevotella intermedia and Prevotella nigrescens was evaluated. The best hemolytic activity was observed for samples of both species growing in brain heart infusion agar and incubated in Brewer-like anaerobic jars for 48 h. Hemolysis was less intense and occurred later in the presence of hemin and menadione in solid media. beta-Hemolysis was detected for medium supplemented with horse or human blood and alpha-hemolysis was observed when sheep blood was used. These results suggesting some specificity for the hemolytic activity were also observed in liquid assays in which sheep erythrocytes were found to be resistant to hemolysis while horse and human cells where lysed. In liquid assays, the hemolytic activity of all studied strains remained stable in the pH range of 6.0 to 8.5 and was not altered by iron-scavenging compounds or atmosphere of incubation. The phenomenon of hot/cold hemolysis was ruled out as the mechanism of action of P. intermedia and P. nigrescens hemolysin.

Objective: To investigate the relationship of neonatal bilirubin levels to oxytocin infusion and the diluent used for oxytocin infusion., Materials and Methods: The study was carried out as a prospective, randomized study in Istanbul University Cerrahpasa School of Medicine, Department of Obstetrics and Gynecology between January to December in 1995. A total of 80 patients managed with oxytocin during labor, enrolled to the study. These patients randomly divided into isotonic % 0.9 saline (Group 1) and 5% glucose solutions (Group 2) by a consecutive order using a balanced block randomization scheme. Forty multiparous patients delivering without oxytocin infusion formed the control group (Group 3). The details of maternal age, gestational age, labor duration, mode of delivery, birth weight of the babies, total volume of fluid administered until delivery and total oxytocin dose were noted in each case. Sodium and initial bilirubin levels were measured in the cord blood. Later on, capillary blood bilirubin and hematocrit concentrations were measured on day 1 and 2 in the newborn nursery. The groups were compared according to these parameters., Results: The data of 29 patients in Group 1, 36 patients in Group 2 and 40 patients in Group 3 were suitable for analysis. The difference between study and control groups regarding the rate of hyponatremia, neonatal hyperbilirubinemia and neonatal jaundice was not statistically significant. Cord plasma sodium levels, cord plasma bilirubin levels and day 1 and 2 hematocrit and plasma bilirubin levels were not statistically different between the groups. irrespective of the diluent used, the cord plasma bilirubin levels and day 2 plasma bilirubin levels were significantly higher in the accelerated group., Conclusion: No significant effect of oxytocin infusion was revealed on neonatal hyperbilirubinemia unless oxytocin was for the augmentation of labor.

Background: The purpose of this study is to determine the frequency of underlying hematological disorders as the cause of acute adolescent menorrhagia., Methods: The records of 25 patients that were hospitalized with acute adolescent menorrhagia in the Obstetrics and Gynecology Department of Cerrahpaşa Medical School of Istanbul University between 1988 and 1995 were analyzed., Results: The mean age of the patients was 13.9 +/- 1.6 (SD) years. A hematological abnormality that caused bleeding diathesis and acute menorrhagia was diagnosed in 7 of the 25 patients (28%). There were four cases of immune thrombocytopenic purpura, two cases of Van Willebrand disease and one case of acute promyelocytic leukemia. All seven patients with a coagulation disorder required blood transfusions and the mean hemoglobin level at presentation was 6.2 g/dl.

Objective: To determine the perinatal and maternal outcome of the macrosomic infants., Study Design: A case-control, retrospective study is performed in the Department of Gynecology and Obstetrics, Istanbul University Cerrahpasa Medical Faculty, between 1988-1992. The maternal and neonatal records of infants with birthweight of at least 4000g (n=1000) were reviewed. Another 1000 cases amongst the newborns delivered in the same period between 2500 and 3999g formed the control group. The obstetrical outcome variables of the groups including mode of delivery and the incidence of maternal and perinatal complications were compared., Results: A total of 16,112 deliveries occurred during the study period. The rate of macrosomic deliveries was 6.21% and the rate of the deliveries (4500g or heavier) was 1.04%. The mean birthweight of the study group was 4272+/-239 and 3277+/-316g of the control group (P<0.001). While the cesarean section rate was 28.8% for the study group and it was 16.6% for the control group (P<0.001). In the study group, 17 cases of brachial plexus palsy (2.4%), 16 cases of clavicular fracture (2.3%) and one case of humeral fracture were observed (P<0.001). The rate of perinatal mortality was 0.8% in the study group. No perinatal mortality was recorded in the control group. There were 14 cases (1.4%)of asphyxia related to delivery in the study group (P<0.01). The rate of maternal complications, were significantly higher in the study group (P<0.01)., Conclusion: The macrosomic infants are in increased risk for birth trauma and asphyxia. The risk of birth trauma for the infants weighing 4500g or more is even greater.

Background: Bardet-Biedl syndrome is a rare disorder and associated with a variety of anomalies., Case: An 18-year-old woman was referred with primary amenorrhea. Following physical, ophthalmologic, psychiatric, hormonal and radiologic examinations, the diagnosis of both craniopharyngioma and Bardet-Biedl syndrome was established., Conclusion: Although the pathogenesis of hypogonadism in a woman with Bardet-Biedl syndrome remains unclear, cranial structures, especially the hypothalamus and pituitary gland, should be investigated to reveal any possible abnormalities.

A short-term evaluation of 6 months of estrogen therapy on oxidant status in 38 postmenopausal women was conducted. The levels of serum lipid peroxidation products, glutathione (GSH) status, and glutathione-related enzymes were evaluated before and after 6 months of hormone replacement therapy. After 6 months of estrogen treatment there was a significantly increased concentration of thiobarbituric acid-reactive substances (TBARS), which are an end product of lipid peroxidation. This was accompanied by a significant increase in the activity of glutathione peroxidase (GSH-Px). However, the activities of glutathione reductase (GSSG-R) and superoxide dismutase (SOD) were significantly decreased and total protein thiols were reduced. Data suggest that hormone replacement therapy in postmenopausal women is associated with oxidant mechanisms.

Objective: To compare the effects of various IUDs on intrauterine activity., Patients and Methods: 57 women volunteers aged 18 to 25 in the outpatient clinic of the Department of Obstetrics and Gynecology at Cerrahpasa Medical Faculty of Istanbul University were included in the study. All were in good health and menstruating normally. The subjects were introduced to different types of IUDs on the fifth to eighth days of their menstrual cycle. Intrauterine activities with and without naproxen were recorded, for at least 20 minutes each time, with a micro-tip transducer before insertion, just after insertion, and 1 month later., Results: Intrauterine activity increased just after insertion of both IUDs and disappeared 1 month later in copper-T wearing women, but persisted in multiload wearers. Naproxen seemed to be useful in preventing intrauterine activity caused by the IUD., Conclusions: The IUD itself causes an increase in intrauterine activity which is preventable by naproxen, suggesting the possible role of prostaglandins. Persistence of intrauterine activity depends upon the type of device. Optimal designing of IUDs is required to decrease side effects and make them more acceptable.

Objective: To determine the incidence of late-onset congenital adrenal hyperplasia (LOCAH) due to 21-hydroxylase deficiency among hirsute women and to evaluate the results of the ACTH stimulation test with the clinical characteristics., Study Design: Prospective, controlled study. One hundred women with hirsutism and 14 normally cycling women without hirsutism were included in this study at the Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Cerrahpasa School of Medicine, Istanbul University. After basal serum progesterone (P) and 17 hydroxyprogesterone (17OHP) levels were determined, an ACTH stimulation test was performed on cycle day 3-5. The same parameters were checked 30 minutes later. We estimated the 21 hydroxylase activity by calculating the change in 17OHP (17OHP 30-0) and the summed rate of the change in P and 17OHP ([P30-0] + [17OHP30-01/30 minutes). The 95th percentile for these estimates in normal women were calculated, and values above three times the 95th percentile were considered to distinguish women with LOCAH due to 21-hydroxylase deficiency., Results: The 95th percentile for 17OHP 30-0 and (P30-0) + (17OHP30-0)/30 minutes in normal women was 1.6 and 8.9 ng/dL/min, respectively. Regarding 17OHP 30-0 values, three women with hirsutism had levels above three times the 95th percentile of these estimates, and 28 women had estimates of more than the 95th percentile but less than threefold. Seventeen of 28 women had oligomenorrhea, and all had severe hirsutism. The women with severe hirsutism and oligomenorrhea had significantly higher ACTH-stimulated serum 17OHP levels and values for 17OHP 30-0 and (P30-0 + (17OHP30-0)/30 min) than did normally cycling women., Conclusion: The incidence of LOCAH due to 21-hydroxylase deficiency and mild 21-hydroxylase deficiency is 3% and 28%, respectively, in women with hirsutism. Clinical characteristics are not helpful in determining 21-hydroxylase deficiency. However, the incidence of 21-hydroxylase deficiency is more common among women with severe hirsutism and oligomenorrhea. The change in serum 17OHP 30-0 seems to be greater than the summed rate of change in serum 17OHP and P in the detection of 21-hydroxylase enzyme deficiency.

In the present study we investigated the accuracy of Shepard's formula in the sonographic diagnosis of macrosomic fetus of non-diabetic pregnant women. Three hundred and eighty-one macrosomic and 450 appropriate for gestational age (AGA) fetuses born to non-diabetic mothers between 37-42 weeks of gestation were included in the study. Ultrasonographic fetal weight estimation within two days of delivery was made using Shepard's formula in all patients. The estimated fetal weights were compared with the actual birth weights of the same subjects. We did not observe any macrosomic newborn birth in pregnant women with 3200 g or less fetal weight estimation. However, in patients with 3400-3499 g fetal weight estimation, a statistically significant increase in macrosomic newborn birth was observed. Only 3.2% of newborns having actual birth weights greater than or equal to 4000 g had sonographic birth weight estimation less than 4000 g. Accuracy of weight estimations using the Shepard's formula was found to be low in macrosomic fetus. On the other hand, increased incidence of macrosomic newborn birth was observed in subjects with ultrasonographic fetal weight estimations above 3400 g and this level may be useful as a cut-off value for prediction of macrosomic fetus in non-diabetic pregnant women.

Objective: To investigate the relationship between the ovarian stromal area and clinical hormonal characteristics in women with polycystic ovary syndrome (PCOS)., Study Design: Twenty-eight women with PCOS (group 1) and 26 healthy women (group 2) participated in this study. For measuring the ovarian stromal area, transvaginal ultrasonography was performed on all women during the early follicular phase of the menstrual cycle. Venous blood was sampled from the women to determine serum follicle stimulating hormone, luteinizing hormone (LH), estradiol, androstenedione, free testosterone (FT), total testosterone (TT), 17 alpha-hydroxyprogesterone, dehydroepiandrosterone sulfate, and fasting insulin and glucose levels. Two-tailed t and Pearson correlation tests were used for statistical analysis., Results: Women with PCOS were heavier, and their serum FT, TT and LH levels were significantly higher than in the normals (P < .001, P < .012 and P < .001, respectively). The ovarian stromal area measured by transvaginal ultrasonography was also significantly larger than in the normals (P < .001). Only basal serum insulin levels seemed to correlate positively with the ovarian stromal area in women with PCOS (r = .43 P = .09)., Conclusion: Although transvaginal ultrasonography has played an important role in the evaluation of women with PCOS, we could not demonstrate a relationship between the ovarian stromal area and hormonal characteristics of PCOS. Therefore, transvaginal ultrasonography and hormonal parameters must be used as complementary diagnostic methods in women with PCOS.

Bacteriocin production has been studied in very few anaerobic bacteria, and no report is available for Fusobacterium species. In the present study a total of 167 Fusobacterium isolates were tested for bacteriocin production: 70 isolates were obtained from the oral cavity of patients with periodontal disease, 47 were recovered from healthy oral sites of human subjects and 50 from the oral cavity of Callithrix penicillata. Autoantagonism and isoantagonism were observed when the bacteriocin-producing isolates were tested against themselves. Heteroantagonism was detected by testing the Fusobacterium isolates against 14 reference strains and 2 strains of Actinobacillus actinomycetemcomitans from our laboratory collection. The auto-, iso- and heteroantagonism phenomena observed in this comparative study suggest a possible ecological role for this (these) antagonistic substance(s) in the oral environment.

We have previously shown that interleukin-8 (IL-8), a cytokine with neutrophil chemotactic/activating and T cell chemotactic activity, is produced by human endometrial stromal and glandular cells in culture. The present study investigated the temporal and spatial expression of IL-8 messenger ribonucleic acid (mRNA) and protein in the human endometrium. Endometrial tissue (n = 52) was obtained from human uteri after hysterectomy conducted for reasons other than endometrial disease or from endometrial biopsies. The day of the menstrual cycle was established from women's menstrual history and was confirmed by histology. Half of the tissues (n = 26) were snap-frozen in liquid nitrogen, cellular RNA was extracted, and Northern blots were hybridized with a riboprobe complementary to a specific sequence of IL-8 mRNA. The remaining tissues (n = 26) were processed for frozen sections, and immunohistochemistry was performed using mouse antihuman IL-8 antibody. Comparison of IL-8 mRNA levels throughout the menstrual cycle revealed that late secretory and early to midproliferative phase IL-8 expression was significantly greater than midcycle expression (P < 0.02). Analysis of the IL-8 immunohistochemistry revealed that IL-8 protein is found in the surface epithelium and glands throughout the menstrual cycle. There was no detectable immunoreactive IL-8 in the stromal cells. We conclude that IL-8 is produced in the human endometrium in vivo, and the variations of IL-8 mRNA throughout the menstrual cycle suggest that sex hormones may regulate its gene expression. We speculate that IL-8 may modulate the timely recruitment of neutrophils and lymphocytes into the endometrium.

Proliferation of endometrium is dependent on sex steroid hormones, but specific growth factors are likely to play an important role in regulating this process. A number of cytokines and growth factors are synthesized in the endometrium in response to sex steroid hormones and act to regulate endometrial function. Endometrial cells produce interleukin-8 (IL-8) both in vivo and in vitro. We hypothesized that IL-8, a neutrophil chemoattractant/activating factor and a potent angiogenic agent that has been shown to stimulate growth in other cell types, may directly stimulate proliferation of endometrial cells. We first investigated the effect of IL-8 and mouse antihuman-IL-8 neutralizing antibody on endometrial stromal cell proliferation using both a colorimetric assay and thymidine uptake. We then investigated the modulation of endometrial stromal cell IL-8 production and proliferation by antisense oligonucleotides specific for IL-8. There was a concentration-dependent increase of cell proliferation with IL-8 (2-fold at 1 ng/mL; P < 0.01 between control and concentrations above 0.01 ng/mL) and a concentration-dependent inhibition of cell proliferation with anti-IL-8 antibody (to 30% of the control at 1 microg/mL; P < 0.01 between control and concentrations above 0.1 microg/mL). IL-8 antisense oligonucleotide treatment decreased IL-8 production by endometrial stromal cells in culture as well as cell proliferation when it is compared with scrambled (nonsense) oligonucleotide treatment (P < 0.01). Addition of IL-8 (1 ng/mL) reversed the proliferation inhibitory effect of IL-8 antisense oligonucleotides. We propose that IL-8 may act as an autocrine growth factor in the endometrium, and suggest that it may also play a role in the pathogenesis of endometriosis.

Problem: Around the time of ovulation the number of neutrophils increases in the theca of the leading follicle. We hypothesized that growth-regulated alpha (GRO alpha), a neutrophil chemoat-tractant/activating factor, may be a modulator of periovulatory neutrophil chemotaxis., Method: GRO alpha levels were measured in follicular fluids (n = 61). Granulosa-lutein and ovarian stromal cells were also cultured. After experimental paradigms, GRO alpha mRNA was evaluated by Northern analysis, GRO alpha in follicular fluids, and culture supernatants were quantified using ELISA., Results: In follicular fluids the mean pre-human chorionic gonadotropin (hCG) GRO alpha level was 51 +/- 24 (+/- SEM) pg/ml, post-hCG it was 210 +/- 20 pg/ml (P = 0.04). GRO was produced constitutively by ovarian stromal and granulosa-lutein cells. Interleukin-alpha (IL-1 alpha) and tumor necrosis factor-alpha (TNF-alpha) further stimulated GRO alpha production. Treatment of stromal cells with hCG also stimulated GRO alpha production., Conclusion: GRO alpha is a constituent of periovulatory follicular fluid. Ovarian stromal and granulosa-lutein cells express the GRO alpha mRNA and produce the protein. The regulation of GRO alpha by cytokines and hCG suggests that GRO alpha may play a role in the process of ovulation.

This article reviews the pathogenesis of endometriosis, which involves retrograde dissemination of endometrium and/or development in situ by metaplasia, and there is evidence suggesting that genetic and hormonal factors may play a role. There is also substantial evidence that immunologic factors, namely peritoneal macrophages, T cells, natural killer cells, and soluble products secreted by these cells, are involved in the pathogenesis of endometriosis.

Objective: To examine the mechanism of sperm motility inhibition by peritoneal fluid (PF) from women with endometriosis., Design: Prospective, randomized study., Setting: University-based andrology laboratory., Patients: Women with and without endometriosis., Interventions: Fresh semen or Percoll-purified sperm fractions were combined with PF from women with endometriosis (n = 20), from fertile women without endometriosis (n = 10), or with physiological saline., Main Outcome Measure: Sperm motility parameters were determined with computer assisted semen analysis. Data were evaluated by the analysis of variance and the Student's t-test., Results: Peritoneal fluid from women with minimal or mild endometriosis did not inhibit sperm motility in semen. Peritoneal fluid from women with moderate or severe endometriosis caused approximately 40%, 50%, and 80% declines in sperm motility and in percent progressive motile sperm after 4,7, and 24 hours, respectively. Sperm velocity was inhibited by approximately 30% and 60% after 7 and 24 hours, respectively. However, in the Percoll-purified sperm fractions the same PF did not inhibit sperm motility within the 4- to 7-hour time frame, and only a 17% to 42% inhibition occurred after the overnight incubation. Sperm velocity was not affected., Conclusion: Cellular components of seminal fluid appear to mediate the inhibitory action of PF. Assuming that the leukocyte components of semen and PF are common, the cell-mediated inhibition of sperm motility is a likely contributor to endometriosis related infertility.

Background: To compare the success rate of DNA flow cytometry in determining the DNA ploidy status in ectopic pregnancy and first trimester spontaneous abortion., Methods: Thirteen women with ectopic pregnancy (Group I) and 17 women with first trimester spontaneous abortion (Group II) were included into this study. DNA flow cytometric analysis was performed on all specimens. Aneuploidy was classified according to DNA index. The first trimester spontaneous abortions were also karyotyped after long-term culture of chronic villi. Student-t test and Fisher's exact test were used in statistical comparisons., Results: DNA aneuploidy was found in five women with ectopic pregnancy (38.5%) versus in 12 women with first trimester spontaneous abortion (70.6%), and it was comparable. A triploidy and a tetraploidy were detected in group I. Six tubal ectopic pregnancies were unruptured at laparatomy and four of them had aneuploid DNA content., Conclusions: We believed that DNA flow cytometry was successful in determining the ploidy status of ectopic pregnancy and first trimester spontaneous abortion. In addition, it was interesting that ectopic pregnancies with aneuploid DNA content tended to be unruptured. However, this suggestion needs to be confirmed by further studies with larger numbers of cases.

Objective: To investigate the effect of endometriosis on implantation., Design: Case-control study from Yale University IVF-ET program., Patients: Two hundred eighty-four consecutive IVF cycles were analyzed retrospectively. Patients with endometriosis only (n = 35; 89 cycles) were compared with an age-matched control group with tubal infertility (n = 70; 147 cycles) and also to a group with unexplained infertility (n = 15; 48 cycles). Data from the endometriosis group was analyzed further in subgroups of minimal-mild (43 cycles) and moderate-severe (46 cycles)., Results: No difference was found in the number and the quality of oocytes retrieved and fertilization rates between the endometriosis, the tubal infertility, and the unexplained infertility groups. The quality and the number of embryos transferred in each group were comparable. A trend toward reduced pregnancy rate per transfer (14.8%) in the endometriosis versus tubal or unexplained infertility groups (25.7% and 23.3%, respectively) was observed. Implantation rate (gestational sac per transferred embryo) was significantly lower in the endometriosis versus the tubal infertility group (3.9% versus 8.1%; unexplained infertility group, 7.2%). Analysis of first cycles only across all groups revealed that the implantation rate also was significantly lower in the endometriosis versus the tubal infertility group (3.1% versus 9%; unexplained infertility group, 6.7%). Within the endometriosis group, although the pregnancy rate per cycle and per transfer were similar in subgroups, patients with minimal-mild endometriosis had the lowest implantation rate., Conclusion: We conclude that, in patients with endometriosis, implantation rate is low. Abnormal implantation, which may be secondary to endometrial dysfunction or embryotoxic environment, is a factor in endometriosis-associated subfertility.

Objective: Endometrial biopsy has been an important way of assessing infertile couples for several years. In this review of a wide-ranging series of endometrial biopsies of infertile couples in the Turkish population it was our aim to find the distribution of results according to the years 1956-1966, 1967-1980, 1981-1992., Setting: University hospital., Subjects: 12,949 endometrial biopsies, referred to our gynecological pathology laboratory for infertility investigation between 1956 and 1992., Method: Patient report files from pathology laboratory data, analyzed retrospectively. The assessment of the biopsies is made by the same pathologist., Results: 78.8% of cases had primary infertility, 21.2% secondary. Most of them were in the age group 26-35 years (48.8%). 37.58% of cases were found to show normal secretory endometrium, 20.95% proliferative endometrial changes, and 28.22% signs of luteal phase defect (LPD). Other local endometrial factors were also encountered, but in 1.79% the sample was considered insufficient for diagnosis. Moreover, in nine cases, malignancy was diagnosed with the help of endometrial biopsy. During the study period, cases of normal secretory endometrium and tuberculous endometritis were observed to decrease and LPD to increase significantly. It is worthy to note that in only 28 (0.21%) cases had endometrial biopsies been performed during a pregnancy cycle., Conclusion: We conclude that endometrial biopsy not only shows the hormonal response of endometrium but gives additional information about the local factors of endometrium concerning atrophy, specific and non-specific infections, and malignancy.

An immunohistochemical investigation for the neurospecific markers S-100 protein and protein gene product 9.5 was carried out on 12 healthy temporomandibular joint discs and capsules that were taken at autopsy from human adults. Large nerve trunks in the joint capsule and posterior disc ligament, as well as small nerve bundles and single nerves in almost all parts of the capsule, were heavily stained by anti-S-100 antiserum. The S-100 immunoreactive chondrocytes were also detected in the disc. Antiprotein gene product 9.5 similarly evidenced nerve fibers in the capsule and posterior disc ligament, and it also labeled a few small nerve bundles and a number of single fibers in the peripheral portions of the disc. No corpuscular or specialized endings were encountered in the specimens. These results give new support to the existence of a rich innervation of the human temporomandibular joint capsule and disc that should be further characterized with regard to type, function, and neuropeptide content.