Depression and anxiety disorder in hyperemesis gravidarum: A prospective case-control study.

OBJECTIVE: To assess the anxiety and depression status of women with hyperemesis gravidarum (HG); the risk factors for developing both depression and anxiety in women with HG were evaluated. MATERIALS AND METHODS: A total of 200 women, 100 diagnosed as having HG before the 20th week of gestation at a tertiary referral center and 100 gestational-age-matched controls were enrolled. The socio-demographic data and the depression and anxiety scores, as assessed using the Beck depression and anxiety inventory were compared between the two groups. RESULTS: The median depression and anxiety scores were significantly higher in the HG group compared with controls (19.5 vs. 9.0 and 22.0 vs. 10.0). Women with HG have the highest relative risks for moderate depression and severe anxiety [relative risk (RR): 16.88 and RR: 20.50, respectively]. In the univariate analysis, having HG, low education level, low income and poor social relationships were significant predictors of depression and having HG. Moreover, poor social relationships significantly predicted the presence of anxiety disorder. However, having HG and poor social relationships were found as the only independent predictors of both depression and anxiety. Patients with HG were 5.5 and 6.7 times more prone to having depression and anxiety disorder compared with controls, respectively. CONCLUSION: Both depression and anxiety disorder were more frequent in women with HG who have weak family and social relationships, lower education and income levels. Therefore, the determination of the psychological status of women with HG should be an integral part of the evaluation.

Seasonal variation of human sperm cells among 4,422 semen samples: A retrospective study in Turkey.

We aimed to assess the possible presence of a seasonal pattern in three parameters of semen analysis: sperm concentration, morphology, and motility as a function of the time of ejaculation and sperm production (spermatogenesis) in normal and oligozoospermic men. This retrospective study included a consecutive series of 4,422 semen samples that were collected from patients as a part of the basic evaluation of the infertile couples attending the Reproductive Endocrine Outpatient Clinic of a tertiary women's hospital in Ankara, Turkey, between January 1, 2012 and December 31, 2013. The samples were classified according to sperm concentration: ≥15 x106/mL as normozoospermic samples and 4 -14.99 x106/mL as oligozoospermic samples and seasonal analysis of the semen samples were carried out separately. When the data was analyzed according to the season of semen production, there was no seasonal effect on the sperm concentration. A gradual and consistent decrease in the rate of sperm with fast forward motility was observed from spring to fall with a recovery noticed during the winter. The percentage of sperms with normal morphology was found to be statistically significantly higher in the spring samples compared with the summer samples (p=0.001). Both normozoospermic and oligozoospermic semen samples appeared to have better sperm parameters in spring and winter. The circannual variation of semen parameters may be important in diagnosis and treatment desicions. ABBREVIATIONS: WHO: World Health Organization; mRNA:messenger ribonucleic acid.

Sonographic Assessment of the Fetal Penile Development.

The intrauterine diagnosis of micropenis is an important clue in the discernment of some syndromes and hormonal deficiencies. In this study, we tried to establish reference ranges for the fetal penile length and penile width. This prospective cross-sectional study included 179 healthy singleton male fetus pregnancies that were between 17 and 37 weeks of gestation. Of these pregnancies, the fetal penile length and width were measured using trans-abdominal ultrasound. The correlation coefficients of gestational age with penile measurements were calculated. We observed that as the gestational age increased both the penile length and width increased (p < .0001, correlation coefficients R(2) = 0.854 and R(2) = 0.883; respectively). Reference values of the penile length in the Turkish Population were similar to previously evaluated populations including English, American and Israeli populations. The penile width measurement is a convenient way to diagnose micropenis, but penile width measurement alone might miss some penile abnormalities including chordee and hypospadias.

Do anxiety and depression statuses differ in differentpolycystic ovary syndrome phenotypes?

BACKGROUND/AIM: To evaluate psychological parameters and health quality profiles in women with reproductive polycystic ovary syndrome (PCOS) phenotypes and age matched controls. MATERIALS AND METHODS: The study groups included 101 women with PCOS (54 with the National Institutes of Health [NIH] phenotype and 47 with the non-NIH phenotype) and 49 healthy female controls. The participants completed anxiety and depression scales and four quality of life domains. RESULTS: We identified the women with PCOS as having a 3.39 times increased risk for depression (subscale ≥ 7) and a 3.64 times increased risk for anxiety (subscale ≥ 10) compared to the controls. Both NIH and non-NIH phenotypes showed similar rates of depression (46.3% vs. 46.8%, respectively; P = 0.57) and anxiety (31.5% vs. 36.2%, respectively; P = 0.47). Regarding the quality of life scale, the women with NIH PCOS had significantly lower mental health scores compared to those with non-NIH PCOS (P = 0.03). Furthermore, while mental health scores were similar in the women with PCOS and the controls, physical health scores were significantly lower in the women with PCOS (P = 0.007). CONCLUSION: Nearly half of the women with PCOS had higher depression scores and one third had higher anxiety scores. Thus, psychiatric evaluations appear necessary for PCOS patients in order to diagnose and treat clinical depression and anxiety.

Do vitamin D and high-sensitivity-C reactive protein levels differ in patients with hyperemesis gravidarum? A preliminary study.

OBJECTIVES: The high sensitivity-C reactive protein (hs-CRP) is an inflammatory marker and vitamin D is an immune modulator that might play a critical role in the pathogenesis of hyperemesis gravidarum. Therefore, in the current study, we tested the hypothesis that suggests women with hyperemesis gravidarum have lower 25-hydroxyvitamin D levels and higher hs-CRP levels, compared to controls. MATERIALS AND METHODS: This prospective case-control study included 30 women with hyperemesis gravidarum (study group) and 30 age- and body mass index-matched healthy women (control group). The levels of 25-hydroxyvitamin D and hs-CRP were compared between two groups. RESULTS: Both the serum 25-hydroxyvitamin D (5.30 µg/L vs. 6.44 µg/L; p=0.09) and hs-CRP levels (0.29 mg/dL vs. 0.47 mg/dL; p=0.93) were not significantly different between the study and control groups. Vitamin D deficiency was present in 27 (90.0%) women in the study group and 22 (73.3%) women in the control group (p=0.181). There was also no correlation between 25-hydroxyvitamin D and hs-CRP levels in both groups. CONCLUSION: Although it did not reach statistical significance, vitamin D levels were lower in the study group compared with controls. Therefore, vitamin D might be speculated to play a crucial role in controlling the inflammatory status associated with hyperemesis gravidarum. Larger studies are required to clarify whether there is a relation between vitamin D deficiency and hyperemesis gravidarum.

A comparison of clinico-pathologic characteristics of patients with serous and clear cell carcinoma of the uterus.

OBJECTIVE: Serous carcinoma and clear cell carcinomas account for 10% and 3% of endometrial cancers but are responsible for 39% and 8% of cancer deaths, respectively. In this study, we aimed to compare serous carcinoma and clear cell carcinoma regarding the surgico-pathologic and clinical characteristics, and survival, and to detect factors that affected recurrence and survival. MATERIALS AND METHODS: We retrospectively analyzed patients with clear cell and serous endometrial cancer who underwent surgery between January 1993 and December 2013 in our clinic. We used Kaplan-Meier estimator to analyze survival. RESULTS: The tumor type in 49 patients was clear cell carcinomas and was serous uterine carcinoma in 51 patients. Advanced stage (stage III and IV) disease was present in 42% of the patients in the clear cell group, whereas this rate was 62% in the serous group (p=0.044). Lymph node metastasis was detected in 37% of the patients with clear cell carcinomas and 51% of the patients with serous carcinoma (p=0.17). The adjuvant therapies used did not differ significantly between the groups (p=0.192). The groups had similar recurrence patterns. Five-year progression-free survival and the 5-year overall survival were 60.6% and 85.8%, 45.5% and 67.8% in the patients with clear cell carcinomas and serous tumor, respectively. CONCLUSION: With the exception that more advanced stages were observed in patients with serous carcinoma endometrial cancers at presentation, the surgico-pathologic features, recurrence rates and patterns, and survival rates did not differ significantly between the groups with clear cell carcinoma and serous carcinoma endometrial cancers.

Reimplantation of an autoamputated ovary in the omentum: A case report.

Autoamputation is one of the complications of ovarian torsion. In many cases, ovarian torsion develops as a result of mature cystic teratoma. Herein, we present a woman aged 27 years whose right ovary was autoamputated and reimplanted in the omentum. It should be noted that autoamputated ovaries can reimplant in surrounding tissues by revascularization and present as mobile abdominal masses with atypical localization.

Analysis of non-squamous vulvar cancer cases: A 21-year experience in a single center.

OBJECTIVE: To evaluate the patients with non-squamous cell type of vulvar cancer who were treated in our clinic within 21 years. MATERIALS AND METHODS: We assessed the data of 14 patients who were treated for non-squamous cancer of the vulva between January 1992 and August 2013. The age of patients, histopathological diagnosis of the tumor, tumor size, tumor location, medical or surgical treatment, response to the treatment, recurrence, and survival rates were analyzed. RESULTS: The mean age of the patients was 53 years. The main complaint was vulvar pruritus (71%). Mean tumor size was 2.4 cm (range: 0.5-6 cm). In 65% of cases, the tumor was localized in the labia majora. The histopathologic diagnosis of the patients was as follows: malignant melanoma in 5 patients, basal cell carcinoma in 5 patients, mucinous type adenocarcinoma in 2 patients, apocrine gland carcinoma in one patients, and malign peripheral nerve sheath tumor in 1 patient. For 11 patients, surgery was the primary treatment. Radical vulvectomy and bilateral inguinofemoral lymphadenectomy were performed in 8 patients. Local excision alone without lymphadenectomy was performed in other 3 patients. Five of eight patients (62.5%), who undergone radical surgery, had lymph node metastases. Of these 5 patients, two had bilateral lymph node metastasis. Mean follow-up time was 49.2 months (range 12 to 72 months). Eight (57.1%) patients had suffered first recurrence. In those patients, the mean time to recurrence was 19.5 months (range, 6-48 months). CONCLUSION: Non-squamous cell vulvar cancer is a rare disease and comprises a heterogeneous group of tumors. Malignant melanoma is the most aggressive one. Multicenter prospective studies are necessary in order to standardize the treatment of these rare tumors.