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Objective: This study was aim to investigate the relationship of vaginal bacterial species with High-Risk Human Papillomavirus (HR-HPV) and bacterial vaginosis (BV).Methods: One hundred and twenty-one women were included in the study. Gram stain was performed for the diagnosis of BV and evaluated according to the Nugent score. HR-HPV diagnosis was made by real-time PCR . Detection of vaginal microbial species and Gardnerella vaginalis subtypes were also performed by real-time PCR.Results: The prevalence of BV was found as 38.8%. The mean number of species was found significantly higher in BV-positive samples compared to BV-intermediate and BV-negative samples (p=0.001). Lactobacillus iners (p=0.036), BVAB2 (p=0.043), Provetella spp. (p=0.015), Leptotrichia/Sneathia (p=0.001), Megaspheara (p=0.048) were found to be associated with bacterial vaginosis. Gardnerella vaginalis subtypes were evaluated in 50 randomly selected samples. The most common strain that was found was “clade 4”. The prevalence of HR-HPV was 9.9%. HPV 16 was the most common HR-HPV type (58.3%). There was no significant difference between the mean value of Lactobacillus sp. HR-HPV-positive and negative samples (p=0.23). No association was found between the specified species and HR-HPV-positive samples (p=0.436).Conclusion: Bacterial diversity was greater in BV-positive patients and BV was significantly associated with Lactobacillus iners, Megaspheara, BVAB2, Provetella spp. and Leptotrichia / Sneathia.

Objective: To assess the indications for termination of pregnancy (TOP) in pregnant patients who were followed up with suspicion of fetal anomaly in a Turkish tertiary referral center. Material and Methods: This retrospective study was carried out in patients who were followed up with suspicion of fetal anomaly between May 2016 and May 2019 at the Perinatology Clinic of Obstetrics and Gynecology Department in Pamukkale University Hospital, which is a tertiary hospital in Denizli province in Turkey. Women were divided into two depending on gestational period: group 1 23 weeks of gestation). Results: Four hundred and seventeen pregnant women were evaluated and TOP was performed at a mean gestational age of 27.7 +/- 6.3 weeks. There were 308 (73.8%) women in group 1 and 109 (26.2%) in group 2. The decision to terminate pregnancy was due to fetal anomaly in 117 (28.1%). The majority of termination pregnancies in group 2 were performed because of multiple malformations and/or central nervous system defects. All chromosomal diseases were detected in group 1. Conclusion: With a good perinatal screening program, fetal anomalies can be diagnosed early. Therefore, early TOP is possible. Thus, pregnancy termination can be made before reaching the life limit.

Purpose: Polycystic Ovary Syndrome (PCOS) is related to metabolic diseases such as endothelial dysfunction, systemic inflammation, insülin resistance and dyslipidemia. Adropin is a peptide secretion that positively affects glucose homeostasis and hepatic steatosis in patients with PCOS. Lipocalin-2 mediates obesity, insulin resistance, and apoptosis induced by IL-3. The levels of adropin and lipocalin-2 in PCOS patients were studied in this study.Materials and methods: Women with PCOS (n=37) and healthy controls (n=34) were assessed in this observational and cross-sectional study. Anthropometric measurements, demographic data, metabolic and hormonal profiles, Adropin and Lipocalin-2 levels were measured in both groups.Results: In the study it was determined that PCOS group Adropin and Lipocalin-2 levels were significantly reduced. LDL-C cholesterol, Total cholesterol, Total testosterone, LH, FAI, Triglyceride and LH/FSH values and hirsutism score considerably lower in the control group than the PCOS group.Conclusion: The fact that adropin levels were reduced significantly in PCOS patients who had not yet acquired insulin resistance or who could not be detected using existing methods suggests that adropin changes in PCOS are independent of insulin. The study shows that the level of adropin decreases significantly before insulin resistance reaches pathological levels, which is associated with the young population. Low Lipocalin-2 levels in patients with PCOS suggest that this cannot be blamed for insulin receptor dysfunction secondary to apoptosis in PCOS.

Amaç: Yüksek dereceli servikal intraepitelyal lezyonların (HSIL) tedavisinde eksizyon sonrası cerrahi sınırdaHSIL devamlılığı saptanır ise yeniden eksizyon veya 4-6 ay sonra kontrol seçenekleri gündeme gelmektedir.Ancak bu olgularda re-eksizyon materyalinde HSIL’in persiste edip etmediğini öngörebilen parametreler henüztanımlanmamıştır. Biz bu çalışmada lezyon persistansı ile ilişkili olabilecek klinik ve histopatolojik parametrelerideğerlendirmeyi amaçladık.Gereç ve yöntem: Elektrocerrahi ile eksizyonel tedavi sonrası cerrahi sınırda HSIL devamlılığı izlenen ve bunedenle yeniden eksizyon yapılan olguların bilgileri retrospektif olarak taranmıştır. Hastaların sosyodemografikverileri, başvuru sırasındaki HPV (Human Papillomavirus) tiplemesi (HPV tip 16/18 veya diğer yüksek risklitipler), maksimal lezyon çapları, odak sayısı, yüksek dereceli lezyonun derecesi (CIN2 veya CIN3), eksizyonelmateryalin maksimal çapı, cerrahi sınır durumu ve derecelendirilmesi (Grade 1: şüpheli veya rölatif olarak tamsınırda olan cerrahi sınır pozitifliği; Grade 2: belirgin cerrahi sınır pozitifliği) ile sonraki eksizyonel işlemde HSIL’inpersiste edip etmemesi analiz için kayıt edilmiştir.Bulgular:Çalışma kriterlerine uyan toplamda 73 hasta belirlendi. Yeniden eksizyon yapılan hastaların 23(%31,5) tanesinde yüksek dereceli lezyonun persiste ettiği saptandı. Sosyodemografik ve histopatolojik faktörler(yaş, menapoz, sigara kullanımı, başlangıçtaki yüksek riskli HPV tipi, eksizyonun büyüklüğü, histolojik tip (CIN2/CIN3) lezyon büyüklüğü, lezyonun odak sayısı ve cerrahi sınır pozitifliğinin derecesi) incelendiğinde, rezidüelhastalığın saptandığı ve saptanmadığı gruplar arasında istatistiksel anlamlı farklılık saptanmadı (p=0,116,p=0,50, p=0,601, p=0,092, p=0,719, p=0,501, p=0,699, p=0,131, p=0,884, sırasıyla).Sonuç: Olguların yaklaşık üçte birinde re-eksizyon materyalinde HSIL’in persiste ettiği saptanmıştır. Ancakne klinik özellikler ne de ilk eksizyondaki patolojik bulgular ile lezyonun varlığı arasında anlamlı bir ilişkigösterilememiştir.

Amac: β hucrelerinin fonksiyonlarindaki degisiklikler polikistik over sendromunun (PCOS) patogenezinde onemli roller oynayabilir. Pankreatic Derived Factor (PANDER), patolojik kosullar altinda pankreatik β hucre apoptozunu indukleyen sitokin benzeri bir proteindir. Bu arastirma, serum PANDER duzeylerini belirlemek ve serum PANDER duzeylerinin oksidatif stres ve PCOS'taki insulin direnci ile iliskili olup olmadigini belirlemek icin planlanmistir. Gerec ve Yontem: Bu kontrollu klinik calismada PKOS tanisi almis 27 hasta ve 24 saglikli kadin control grubu olarak degerlendirildi. Serum lipit alt fraksiyonlari, aclik glikozu, insulin, gonadotropinler ve androjenler, malondialdehit (MDA) ve PANDER duzeyleri olculdu. Insulin direncini tahmin etmek icin homeostaz model degerlendirmesi (HOMA-IR) kullanildi. Bulgular: Calisma ve kontrol grubundaki denekler bel olcumleri, gonadotropinler, lipit alt fraksiyonlari, MDA ve PANDER duzeyleri acisindan benzerdi, PKOS'lu kadinlar saglikli kadinlardan onemli olcude daha yuksek FAI ve HOMA-IR'ye sahipti. Serum PANDER duzeyleri calisilan parametrelerle iliskili degildi. Sonuc: Bu sonuclar PANDER seviyesinin PCOS'ta insulin direnci, over kaynakli hiperandrojenizm ve oksidatif stres ile iliskili olmadigini gostermistir.

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.

Kortikal tabaka oluşumuyla sonuçlanan nöral migrasyon olarak adlandırılan süreç 3. ve 6. aylar arasında olmakla birlikte bu sürecin sağlıklı bir şekilde ilerleyememesi durumunda nöral migrasyon defekti oluşur. Ultrasonografi ve Manyetik rezonans görüntüleme ile bu durumun ve ek anomalilerin tespiti her geçen gün artmaktadır. Ultrasonografi ve Manyetik rezonans görüntüleme günümüzde fetusa ait bir çok anomali hakkında bilgi verebilirken, özellikle belirli haftalarda uygulandığında fetal beyin anomalilerini göstermede çok faydalıdır. Bu bildiride, literatür eşliğinde gebelikte fetal beyin yapılarının görüntüleme yöntemleri ile nöral migrasyon defekti bulguları tartışıldı.

İnsan papillomavirüs (HPV) enfeksiyonu servikal kanser gelişmesinde en önemli risk faktörüdür. Yapılan çalışmalar HPV prevalansı ve genotip dağılımının bölgeler arası büyük farklılık gösterdiğini ortayakoymuştur. Bu çalışmada HPV prevalansı ve genotip dağılımının retrospektif olarak araştırılması amaçlanmıştır. Çalışmaya Kadın Hastalıkları ve Doğum Anabilim Dalına başvuran 1170 hasta dahil edilmiştir.Çalışmaya dahil edilen hastaların Bethesda sistemine göre incelenmiş olan servikal sürüntü örneklerininsitolojik olarak incelenmesi olan “Pap smear” sonuçları ile servikal HPV moleküler test sonuçları değerlendirilmiştir. HPV tanımlama ve tiplendirmesinde “Linear Array HPV Genotyping Test (Roche MolecularSystem, ABD)” kullanılmıştır. Hastalar yaşlarına göre beş gruba ayrılarak incelenmiştir. HPV oranı en fazla17-30 yaş arasında görülürken yüksek riskli HPV (HR- HPV) en sık 51-60 yaş arasında saptanmıştır. Bin yüzyetmiş hastanın 978 (%83.6)’i normal sitolojik bulgulara,192 (%16.4)’si anormal sitolojik bulgulara sahipbulunmuştur. Hastaların toplam %37.2’sinde HPV saptanmıştır. HR-HPV oranı %21.2, olası yüksek riskliHPV oranı %6.4, düşük riskli HPV oranı %9.5 olarak tespit edilmiştir. Sitolojik bulgularla HPV arasındakiilişkiye bakıldığında normal sitoloji saptanan hastaların %67.8’inde HPV negatif, %32.2’sinde HPV pozitifsaptanırken, anormal sitoloji saptanmış olan hastaların %37.5’inde HPV negatif, %62.5’inde HPV pozitifliği saptanmıştır. En yüksek HPV prevalansı %8.9 ile HPV 16 olarak bulunmuştur. Toplam 354 hastayabiyopsi yapılmış, bunların 177’si normal, 111’i servikal intraepitelyal neoplazi (CIN) 1.66’sı CIN 2 ve üzeriolarak rapor edilmiştir. Normal patolojik bulgulara sahip grupta HR-HPV oranı %15.8 iken, CIN 1’de%44.1, CIN 2-3’te %63.6 olarak bulunmuştur. CIN 2 ve daha üzeri lezyonu olanlarda tarama testlerininduyarlılık, özgüllük, pozitif prediktif ve negatif prediktif değerleri incelenmiştir. HR-HPV’de duyarlılık veözgüllük sırasıyla %63.6 ve %73.3 olarak bulunurken, HPV’de aynı oranlar sırasıyla %81.8 ve %58.7olarak saptanmıştır. En yüksek duyarlılık HPV’de, en yüksek özgüllük ise HR-HPV ve pozitif smear sonucuolarak belirlenmiştir. Sonuç olarak, çalışmamızda bulduğumuz HPV prevalansı ve genotip dağılımı dünyada bildirilen oranlara benzer, fakat ülkemizde daha önce yapılan çalışmalardan yüksektir. Bu durumun kullanılan yönteme ve çalışma grubumuzun hastaneye başvuran hastalardan oluşmasına bağlı olduğudüşünülmüştür. Tarama testi olarak yalnız smear veya HR-HPV testleri yeterli olmayıp, HPV’nin diğer genotiplerinin de taramalara katılmasının duyarlılığı artıracağı kanaatine varılmıştır.

Background. Postoperative intraperitoneal adhesion formation is a major cause of infertility, pain, intestinal obstruction, and subsequent intraoperative complication. We investigated the effects of L-arginine and pentoxifylline for preventing postoperative adhesion in rats. Methods. Forty Sprague-Dawley rats were subjected to a standardized lesion by serosal trauma of the uterine horn and parietal peritoneal defect. The agents were administered intraperitoneally at the end of surgery. The rats were assigned randomly into control (saline treated), L-arginine, pentoxifylline and L-arginine with pentoxifylline groups. Two weeks after surgery, a second laparotomy was performed and the extent of adhesion formation was determined. The data were analyzed by Mann Whitney U test. Results. In L-arginine and pentoxifylline administered groups, adhesion formation scores were significantly lower than the control group (p

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.

Background: Studies on nickel patch test reactivity and reproducibility of positive tests at different points of the menstrual cycle are heterogeneous. Objective: To investigate if non-reproducibilities of positive nickel sulphate patch tests in the two different phases of ovulatory menstrual cycles with the endocrine evidence of luteal phase adequacy are statistically different. Methods: 15 women (group 1) with positive Finn chamber® nickel patch test results in the follicular phase of the ovulatory cycle and 13 women (group 2) with positive Finn chamber nickel patch test results in the luteal phase of the ovulatory cycle were tested again in the counter-phases of their ovulatory cycle, with a scheduled interval of 6 weeks following the first tests. Reproducibilities of the tests in the two groups were evaluated statistically. Results: 3 of the positive test results in group 1 (20%) and 2 of the positive test results in group 2 (15.4%) were non-reproducible. The difference was not statistically significant. Conclusion: The reproducibility of positive Finn chamber nickel patch tests does not seem to be affected by the changes in the follicular and luteal phases of the ovulatory cycle.

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 determine if reperfusion injury takes place in ovarian tissue following the detorsion of the torsioned ovary. Study design: Fifty-four New Zealand mature nonpregnant female rabbits were divided into six groups. One group served to determine the basal values of thiobarbituric acid reacting substance (TBARS) and another group was sham. In the third and fourth groups, ovarian torsions and subsequent oophorectomy were performed in I and 3 h, respectively. In the fifth and sixth groups, detorsions were carried out after unilateral ovarian torsion lasting I and 3 h. respectively, then oophorectomies of the detorsioned ovaries were performed 2 It after detorsion. The level of TBARS in ovarian tissues was determined in all subjects. Statistical analysis was performed using analysis of variance and Duncan's multiple range test. Differences were considered to be significant if P < 0.05. Results: The levels of TBARS were not different in the basal and sham groups (P > 0.05), while ovarian torsion caused significant increase in TBARS in the ovary (P < 0.05), and detorsion caused a further significant increase in ovarian TBARS (P < 0.05). Conclusion: Reperfusion injury in ovarian tissue, following the detorsion after the torsion of the ovary lasting up to 3 It was demonstrated biochemically in this study. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.

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.

Betamimetic drugs are commonly used for tocolytic therapy. To determine their potential role in periventricular-intraventricular neonatal hemorrhage (IVH), 103 preterm births with cranial ultrasonography results were evaluated for the history of betamimetic therapy. The study group was divided into three subgroups according to the cause of the preterm delivery: 44 patients were accepted as tocolysis failure (group A); 53 patients were too late for tocolysis (group B), and these latter cases were taken as controls for group A; for the remaining 6 patients, tocolysis was contraindicated due to fetomaternal reasons (group C), and these cases were not included in the analysis. In group A, 32 patients got ritodrine, 6 patients got combined therapy including ritodrine plus magnesium sulfate or nifedipine. When cases in group A who got ritodrine only or combined therapy are compared with the no-treatment group, no significant difference in neonatal IVH incidences could be found (p > 0.005). Ritodrine does not appear to affect the incidence of neonatal IVH.

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.

Background. Our purpose was to determine if tibolone in commonly used daily dosage (2.5 mg/day) would have a measurable thermogenic effect in women, which could be attributed to its progestogenic effect. Methods. We enrolled twelve postmenopausal women in this study. Subjects were instructed to take their basal body temperatures for fifteen days before and for another fifteen days during tibolone usage. Mann-Whitney U test and Wilcoxon matched-pairs signed rank test were used in the statistical analysis. Results. Only in one subject did the basal body temperatures before and during tibolone usage have a significantly different distribution (p=0.048). Mean basal body temperatures before and during tibolone usage of the subjects were compared using Wilcoxon matched-pairs signed rank test and the p value was found to be 0.158. Conclusion. The results of the statistical analysis of the basal body temperatures which were taken before and during tibolone usage in our group seem to indicate that tibolone does not have a sustained measurable thermogenic effect in postmenopausal women.