Does high maternal first trimester iron status have an effect on the 50 g oral glucose test?

We aimed to test the hypothesis that 1st trimester high body iron status is associated with a high positive 50 g oral glucose tolerance test. In this study, 29 pregnant women with positive 50 g oral glucose tolerance test were compared with 94 negative 50 g OGTT patients as the control group in terms of 1st trimester iron status. Both groups had similar age, weight, height, body mass index and also median gravidity and parity values. Our results showed that there were no differences between groups in mean haemoglobin, haematocrit, serum iron, serum ferritin, total iron binding capacity and transferrin. Since it seems that free radicals have much influence on oxidative stress and glucose metabolism, prospective, randomised clinical trials should be designed to demonstrate the possible relation between maternal iron status and glucose intolerance.

Clinical evaluation of vulvar lichen sclerosus: case series.

INTRODUCTION: Vulvar lichen sclerosus is a chronic dermatitis which is located in labial, perineal and perianal areas. The etiology of lichen sclerosus is multifactorial including genetic, autoimmune, hormonal and infectious aspects. MATERIALS AND METHODS: A retrospective analysis was carried out of the medical records of 82 patients who were suffering from pruritus vulva. All patients had vulvar biopsy-proven diagnosis of lichen sclerosus. RESULTS: Sixty-six of patients (80.4%) were in the postmenopausal period and 16 patients (19.5%) were in the premenopausal phase. Fifteen patients (18.2%) had thyroid disease, six had (7.3%) diabetes mellitus, five had (6.09%) asthma and five patients had (6.09%) other autoimmune diseases. Lichen sclerosus was most commonly located on the labia majora--58 cases (70.7%). Sixty-four patients (78.04%) had used only potent corticosteroid therapy as the sole treatment. CONCLUSION: The first-line treatment is topical-potent or ultra-potent corticosteroids in the treatment of lichen sclerosis. Vulvar lichen sclerosis may be associated with autoimmune and thyroid diseases.

Evaluation of LOOP electrosurgical excisional procedure: case series.

OBJECTIVE: To evaluate the loop electrosurgical excisional procedure (LEEP) which is performed to treat high-grade cervical intraepithelial lesions (HGSIL). MATERIAL AND METHODS: Twenty-one cases diagnosed as LGSIL and HGSIL after histopathological examination were included in the study among patients who had cervical colposcopy-directed biopsies after an abnormal cytology report at Ege University School of Medicine, Obstetrics and Gynecology Department between the years of 2007 and 2009. The patients underwent LEEP or LEEP-cone procedures. RESULTS: The patients with cervical smear results of ten ASCUS, eight LGSIL, and three HGSIL underwent colposcopy-guided punch biopsies. Those with the result of CIN 1 and CIN 2 underwent LEEP or LEEP-cone procedures. Pathologic examination correlated with biopsy results and surgical margins were all negative. All patients were followed-up with cervical cytology. CONCLUSION: LEEP and LEEP-cone procedures are therapeutic procedures in cervical intraepithelial lesions.

Retrospective analysis of hysteroscopic findings in breast cancer patients having adjuvant tamoxifen treatment.

PURPOSE OF INVESTIGATION: To evaluate the effects of tamoxifen on the endometrium of breast cancer patients by hysteroscopy and endometrial sampling. METHODS: Thirty-seven breast cancer patients using tamoxifen underwent hysteroscopy because of postmenopausal endometrial thickening or abnormal uterine bleeding. Hysteroscopic findings were compared with histopathology and ultrasonographic measurement of the endometrium. RESULTS: Nineteen women showed endometrial abnormalities (51%) out of 37 patients. Negative and positive predictive values for hysteroscopy in detecting endometrial abnormalities were 100% and 94%, respectively. CONCLUSION: Endometrial surveillance is an important part of gynecological follow-up in breast cancer patients using tamoxifen and the liberal use of hysteroscopy aids in the diagnosis of abnormal endometrium.

Reproductive outcomes after hysteroscopic metroplasty for uterine septum.

PURPOSE OF INVESTIGATION: To evaluate reproductive outcome after hysteroscopic metroplasty. METHODS: We analyzed the reproductive outcome of 30 patients with different degrees of septate uterus undergoing hysteroscopic metroplasty. In all cases the procedure was performed by resectoscope. RESULTS: The patients had a total 74 pregnancies before metroplasty. Of these, ten (14%) were carried to term, six (8%) ended in preterm delivery, and 58 (78%) ended in spontaneous abortion. At least one year following hysteroscopic metroplasty a total of 20 pregnancies occurred. Of these, 11 (55%) were carried to term, two (10%) ended in preterm delivery, seven (35%) ended in spontaneous abortion. CONCLUSION: Correction of uterine septum significantly improves the prognosis of the pregnancies in patients with a history of severe obstetric problems. These results are similar to the results reported in the literature. Our data analysis suggests that hysteroscopic metroplasty for uterine septum improves pregnancy outcome of patients who come to us with a desire to conceive.

Grade 2 endometrioid adenocarcinoma arising from adenomyosis of the uterus: report of a case.

Adenomyosis is defined by the presence of endometrial tissue (glands and stroma) within the myometrium and malignant transformation of adenomyosis in premenopausal women with normal endometrium is extremely rare. Adenocarcinomas arising within adenomyosis need to be distinguished from endometrial carcinomas which arise from the eutopic endometrium, then extend into preexisting adenomyosis of the uterine wall. We report a case of grade 2 endometrioid adenocarcinoma arising from an adenomyotic focus in the uterus.

In vitro effects of ritodrine, magnesium sulfate and their combination on spontaneous contractions of myometrial strips of pregnant rat uteri.

OBJECTIVE: To investigate in vitro effects of ritodrine, magnesium sulfate and their combination on spontaneous contractions of myometrial strips obtained from pregnant rat uteri. METHOD: A total of 13 pregnant Sprague Dawley rats with weights between 180-200 g were used in this study. Three strips from each rat were kept in an organ bath containing 20 ml Krebs-Henseleit solution (pH: 7.4 and 37 degrees C). 10(-8) 10(-6) and 10(-4) M concentrations of ritodrine, magnesium sulfate and the combination was applied over myometrial strips in Groups I (n: 10), II (n: 10) and III (n: 8), respectively. Amplitude and frequency of spontaneous myometrial contractions, which were recorded at the beginning of each experiment, were considered as reference values. Amplitude and frequency changes in spontaneous myometrial contractions were calculated at approximately ten-minute intervals right after the application of drugs as the percentage of difference at the first reference response. RESULTS: Magnesium sulfate application did not lead to any significant difference on the amplitude and frequency of contractions at any of its concentrations. 10 and 10(-4) M concentrations of ritodrine caused a significant decrease in the amplitude of contractions. It was also found that ritodrine significantly decreased the frequency values at all concentrations. A significant decrease in amplitude was observed at 10(-8) and 10(-6) M concentrations in the combination group. No significant decrease in frequency values was found at any concentration in the combination group. CONCLUSION: The tocolytic effect of ritodrine is superior to that of magnesium sulfate.

Pelvic actinomycosis in a postmenopausal patient with systemic lupus erythematosus mimicking ovarian malignancy: case report and review of the literature.

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by an anaerobic gram-positive organism Actinomyces israelii usually associated with intrauterine devices. Systemic lupus erythematosus is an autoimmune disorder associated with multiple primary and drug-related immunological defects that predispose patients to infections. The combination of both diseases in a postmenopausal patient is a rare occurrence. A case of a pelvic mass in a 49-year-old postmenopausal patient with systemic lupus erythematosus treated with immunosuppressive therapy for two years is presented. The patient presented with lower abdominal pain to the gynecology clinic and was found to have a pelvic tumor. She had no history of intrauterine device use. Histopathologic examination of the laparotomy specimen revealed pelvic actinomycosis.

Mammographic density changes during different postmenopausal hormone replacement therapies.

OBJECTIVE: To determine the degree of change in mammographic breast densities during different types of postmenopausal hormone replacement therapies. DESIGN: A retrospective study. SETTING: Ege University Hospital. PATIENT(S): The mammographies of 216 women on various postmenopausal hormone replacement therapies were evaluated. INTERVENTION(S): Estrogen alone (n = 76) or estrogen in cyclic (n = 44) or continuous (n = 61) combination with progestin or tibolone-only (n = 35) replacement therapies were used. Mammographic density was quantified according to the Wolfe classification in patients with different hormone replacement regimens. MAIN OUTCOME MEASURE(S): Mammographic density changes were interpreted. RESULT(S): An increase in mammographic density was much more common among women receiving continuous combination hormone replacement therapy 31.1% (19 of 61) than among those receiving estrogen-only 3.9% (3 of 76) treatment. There were no significant mammographic breast density changes among women receiving cyclic continuous combination hormone replacement therapy or tibolone-only treatment. The increase in density was apparent already at first visit after the start of hormone replacement therapy. In continuous combined postmenopausal hormone replacement therapy with norethisterone acetate, the increase in mammographic density was 34.1% (15 of 44), followed by medroxyprogesterone acetate 23.5% (4 of 17). CONCLUSION(S): Our findings show that mammographic breast density changes related to postmenopausal hormone replacement therapy are dependent on the selected hormone regimen. The continuous administration of the progestin component of the combined-hormone replacement therapy seems to effect the breast density most.

Intracranial venous thrombosis associated with severe antithrombin-III deficiency in pregnancy.

We report a patient with intracranial venous thrombosis in the third trimester of pregnancy associated with severe antithrombin-III deficiency. The evaluation of protein C, protein S and antithrombin-III levels in patients with thrombotic events during pregnancy may reveal the specific cause of the thrombotic event and thereby influence patient management

Maternal and perinatal outcomes in women with gestational diabetes mellitus as compared to nondiabetic controls.

OBJECTIVE: To determine maternal and fetal outcomes in pregnancies complicated by gestational diabetes mellitus as compared to nondiabetic pregnancies matched on the basis of age and parity and to study the association between different treatment regimens and fetal outcomes. STUDY DESIGN: The records of 128 consecutive pregnancies complicated with gestational diabetes mellitus and 138 nondiabetic controls matched on the basis of age and parity were studied. Patients with gestational diabetes mellitus were treated either with diet only or diet in combination with insulin. Data were collected from medical records of the patients and birth records of the newborns. RESULTS: Despite treatment, the gestational diabetes mellitus group had a significantly higher frequency of cesarean section, preterm delivery and admission to a neonatal unit (P < .05). Preterm delivery and admission to a neonatal unit were significantly higher in the gestational diabetics treated with diet plus insulin as compared to the diet-only group (P < .05). CONCLUSION: Pregnancies complicated by gestational diabetes mellitus are associated with a higher frequency of adverse maternal and fetal outcomes, and adverse outcomes seems to be more frequent in patients treated with diet plus insulin.

A comparison of continuous combined hormone replacement therapy, HMG-CoA reductase inhibitor and combined treatment for the management of hypercholesterolemia in postmenopausal women.

OBJECTIVE: To compare the lipid-altering effects of hormone replacement therapy alone and in combination with HMG-CoA reductase inhibitor in postmenopausal women with hypercholesterolemia. METHODS: This was a prospective randomized controlled trial with 3 parallel groups. The patients (n = 35) were randomly assigned to receive pravastatin 20 mg/day (n = 12); continuous combined hormone replacement therapy (0.625 mg conjugated estrogen/day combined with medroxyprogesterone 5 mg/day) (n = 12); continuous combined hormone replacement therapy plus pravastatin (n = 11) for 16 weeks. RESULTS: Among patients treated with continuous combined hormone replacement therapy levels of total cholesterol (10.7%) and LDL cholesterol (12.6%) decreased significantly (p < 0.05), while levels of high density lipoprotein cholesterol (5%) and triglycerides (6.2%) increased insignificantly (p > 0.05). Patients in the pravastatin group achieved significant reductions of 18.8 and 21.4% in total cholesterol and low density lipoprotein cholesterol levels, respectively (p < 0.05). Among patients treated with a combination of continuous combined hormone replacement therapy plus pravastatin, levels of total cholesterol (20.5%) and low density lipoprotein cholesterol (23.8%) decreased the most, while levels of triglycerides (2.1%) decreased lower than the pravastatin-only group. The mean percentage of the differences between the baseline and treatment levels of the lipids and lipoproteins were not significant between the 3 study groups (p > 0.05). CONCLUSION: No significant difference between hormone replacement therapy alone and in combination with HMG-CoA reductase inhibitor in the treatment of postmenopausal women with hypercholesterolemia was noted in this study. The combination of hormone replacement therapy not only does not adversely affect the lipid-lowering effect of pravastatin alone, but hormone replacement therapy also offers additional benefits in the treatment of hypoestrogenic hypercholesterolemia in postmenopausal women.

Fluoride levels in breast milk and infant foods.

The aim of the present study is to determine the fluoride concentrations of breast milk, several milk formulations, cow's milk and yogurt shake in a nonfluoridated area, in order to estimate the fluoride intake of infants and evaluate fluoride supplementation suggestions. Breast milk samples were collected from 57 lactating mothers. Ten brands of milk formulations, 9 different brands of cow's milk and 3 brands of yogurt shake were purchased from the market. Fluoride concentrations of the samples were analyzed using a specific fluoride electrode. The average fluoride level was 0.019 +/- 0.004 ppm in breast milk, 0.022 +/- 0.007 ppm in cow's milk and 0.022 +/- 0.003 ppm in yogurt shake. Fluoride levels of milk formulations prepared by distilled water were ranging between 0.118 to 0.021 ppm. It is concluded that in non-fluoridated areas, fluoride intake of infants from the above sources is not very high and fluoride supplements may be prescribed.

The comparison of uterine artery Doppler velocimetry with the histopathology of the placental bed.

We determined the relationship between the histopathological findings of the placental bed and Doppler flow measurements of the uterine artery in women with preeclampsia and fetal growth retardation. Doppler velocimetry in the uterine artery was evaluated in 17 pregnant women with preeclampsia, 15 of whom had fetal growth retardation, and 20 normal pregnant women, within 14 days of Caesarean delivery and placental bed biopsy. The placental bed biopsies were evaluated in terms of trophoblast migration into the myometrium and physiological changes of the spiral arteries. The results were compared with Doppler velocimetry values. Trophoblast migration and physiological changes were not detected in 10 (59%) cases with preeclampsia and in 4 (20%) with normal pregnancies (p<0.05). In the preeclamptic group, 9 of 15 cases that were complicated with intrauterine growth retardation had no trophoblastic migration into the myometrium. The mean systolic/diastolic ratio, resistance index and pulsatility index of the uterine artery in women with preeclampsia and fetal growth retardation was significantly higher than women with normal pregnancies (p<0.01). The mean resistance index of the uterine artery in the impaired migration group was significantly higher than the migration group (p=0.02). The incidence of impaired trophoblast migration was significantly higher in the group with a high systolic/diastolic ratio (above 2.5) and resistance index (above 0.58) than cases with low systolic/diastolic ratio and resistance index (72%, 23% respectively, p<0.05). The incidence of early diastolic notch in the impaired trophoblast migration group was significantly higher than the migration group (57% versus 13%, p<0.01). Our study supports the hypothesis that high uterine artery flow resistance is related to the reduced trophoblast migration into the myometrium and inadequate physiological changes in the spiral arteries in women with intrauterine growth retardation and preeclampsia.

Prenatal sonographic detection of nasopharyngeal teratoma.

We present the case of a 34-year-old pregnant woman who had an elevated maternal serum alpha-fetoprotein level and sonographic findings of a semisolid mass protruding from the fetus's oral cavity. The large, heterogeneous mass filled the oropharynx and nasopharynx. Abnormal Doppler waveforms were detected in the umbilical artery of the fetus, who died in utero. Postmortem examination revealed a nasopharyngeal teratoma.

Comparison of epidural and general anaesthesia for elective caesarean delivery according to the effects of apgar scores and acid-base status.

The objective of this study was to determine the effects of lumbar epidural anaesthesia on the Apgar score and acid-base status of the newborn. Umbilical artery blood gases were obtained in 85 singleton, term, uncomplicated pregnancies delivered by elective Caesarean section. The umbilical artery blood pH, PaCO2, PaO2 and HCO3 values and Apgar scores (1 and 5 minutes) were compared between lumbar epidural and general anaesthesia groups. General anaesthesia was used in 45 (52.9%) women and lumbar epidural anaesthesia in 40 (47.1%). Only 2 of the newborns exposed to epidural anaesthesia had umbilical artery blood pH values 7.19 or less. The mean umbilical artery blood pH was found to be significantly lower in the newborns exposed to lumbar epidural anaesthesia (p = 0.011). None of the newborns in the 2 groups were severely depressed (Apgar scores less than 4). The mean umbilical artery blood PaCO2, PaO2 and HCO3 values did not show any significant difference between the groups. In conclusion, lumbar epidural anaesthesia is associated with lower umbilical artery blood pH values, occasionally with severe fetal acidaemia.