Role of CYP2C19 polymorphisms in patients with endometriosis.

AIM: To investigate the association of CYP2C19 genotypes with endometriosis. METHODS: The study included 100 women who underwent laparotomy or laparoscopy: 50 patients with endometriosis diagnosed with surgery and histopathology, and 50 control subjects who had no evidence of endometriosis during exploratory laparotomy or laparoscopy. Genomic DNA of subjects was extracted from the whole blood using High Pure PCR template preparation kit. Genotyping of CYP2C19 polymorphisms were detected by using a LightCycler CYP2C19 mutation detection kit in a real-time PCR, and were compared between the two groups. RESULTS: Logistic regression analyses showed that the CYP2C19*2 heterozygote genotype was associated with a significantly increased risk of endometriosis. The odds ratio of endometriosis for the CYP2C19*2 heterozygote genotype was 3.165 (p = 0.023) compared with the control group. CYP2C19*3 genotype was detected as wild in all subjects in the endometriosis and control groups. CONCLUSION: Our results suggest that CYP2C19*2 heterozygote genotype has higher risk of developing endometriosis. Therefore, CYP2C19*2 allele gene polymorphisms may be associated with genetic susceptibility of endometriosis.

Modulating interaction of glutathione-S-transferase polymorphisms with smoking in endometriosis.

OBJECTIVE: To evaluate the interaction of glutathione-S-transferase (GST) gene polymorphisms and smoking as a risk factor for endometriosis. STUDY DESIGN: The study group consisted of 150 women who were diagnosed by means of surgery and histopathology as having endometriosis. The control group consisted of 150 women who displayed no evidence of endometriosis during exploratory laparotomy or laparoscopy. We assessed the interaction of smoking and GSTM1 and GSTT1 polymorphisms in these patients. RESULTS: Logistic regression analyses showed that the GSTM1-null allele was associated with a significantly increased risk of endometriosis and smoking with a decreased risk of endometriosis separately. There was no association between endometriosis and the GSTT1-null allele. The interaction of smoking and GST polymorphisms showed a joint effect. We found that the GSTM1-null allele was more prevalent in active smoking endometriosis patients (63.4%) than in the controls (35.0%), and the difference was statistically significant. A similar tendency was also observed in the GSTT1 allele distribution. CONCLUSION: Genetic factors could modify the response to environmental pollutants in endometriosis.

Mislocated extrauterine intrauterine devices: Diagnosis and surgical management.

OBJECTIVE: Presentation of the diagnostic and surgical treatment methods of our extrauterine intrauterine device (IUD) cases. MATERIAL AND METHODS: We retrospectively evaluated the data of 21 extrauterine IUD cases at our clinic between 2008 and 2010. The symptoms, diagnostic methods, and surgical treatments were evaluated. RESULTS: A total of 14 copper and seven levonorgestrel (LNG) IUDs were used. IUD had been inserted during lactation in 71.4% of the patients. The reasons for presentation of patients were unintended pregnancy in 19.05%, pelvic pain in 19.05%, and pelvic pain with vaginal bleeding in 23.8%. IUD in two patients were located the retroperitoneal area. IUD string had not been visible during routine follow-up in 38.1% of the patients. Laparoscopy was performed in 14 patients and laparotomy was performed for dense adhesions in seven patients. CONCLUSION: Extrauterine IUDs can present with various clinical symptoms. Ultrasonography and X-Ray are sufficient for the diagnosis. Surgical removal is needed to prevent possible complications, and the preferred surgical technique in appropriate patients is laparoscopy.

The effects of hormone replacement therapy type on pulmonary functions in postmenopausal women.

OBJECTIVE: To study whether hormone replacement therapy (HRT) or Tibolone has an effect on pulmonary function in postmenopausal women. METHODS: Seventy-five postmenopausal women without any risk factor for pulmonary disease were included in this randomized, prospective study. Fifty women had undergone natural menopause and 25 had had a hysterectomy/ooforectomy. Twenty-five natural menopause women were randomly allocated to two groups: 25 patients (Group I) were treated with Tibolone 2.5 mg/day, 25 patients (group II) with Estradiol Hemihidrate 2 mg+Norethindron Asetate 1 mg/day. Twenty-five induced menopause women were treated with 17 beta-estradiol 2 mg/day. Lung function tests including forced vital capacity (FVC), forced expiratory volume (FEV(1)), FEV(1)/FVC, forced expiratory flow rate over the 25-75% of the forced vital capacity volume (FEF(25-75%)), and peak expiratory flow rate (PEF) were evaluated at the beginning and 3 months after the treatment to assess the effects of HRT and Tibolone on respiratory function. RESULTS: Regardless of HRT types a significant difference was observed in FVC and FEV(1) after 3 months of the therapy (P=0.001, 0.0001, respectively). No significant difference was found between pre and post therapy values in the other parameters (P>0.05). CONCLUSIONS: We determined a significant increase in FVC and FEV(1) parameters of pulmonary functions after 3 months of the therapy regardless of HRT types. Therefore, we think that HRT regimens have modifying effects on pulmonary function in postmenopausal women.

The effect of inducible nitric oxide synthase on postoperative adhesion formation in rats.

OBJECTIVE: To evaluate the effect of iNOS on adhesion formation and to assess whether inhibition of iNOS expression affected adhesion formation according to adhesion maturation days. STUDY DESIGN: Forty Wistar Albino rats were subjected to standardized lesion by cecal abrasion and parietal peritoneal defect and were randomly divided into four groups. Group I (control) received no treatment; groups II-IV received N-acetyl-cystein (NAC) 15 mg/100 g per day intramuscularly on days 4-14, 0-14 and 0-3, respectively, after surgery. On the postoperative 14th day adhesion score, tissue iNOS expression, inflammatory cell reaction (ICR) and tissue fibrosis score were determined. RESULTS: Inflammation score of groups I and II was lower than that of groups III and IV (P < 0.05). Adhesion scores and tissue fibrosis of group II were significantly lower than that of the other groups (P < 0.001). CONCLUSION: iNOS inhibition during the first 3 days postoperatively caused a delay in the resolution of inflammatory cell reaction. On the other hand, when inhibited after the first 3 days, adhesion formation and fibrosis were reduced both clinically and histopathologically.

Ovarian function and vascular resistance after tubal sterilization.

OBJECTIVE: To investigate the effect of tubal sterilization (laparoscopic bipolar coagulation) on serum baseline follicle-stimulating hormone (FSH) and estradiol levels, ovarian volume, antral follicle counts and ovarian artery blood flow rate and to evaluate the correlation of these parameters. STUDY DESIGN: Nineteen women who underwent tubal sterilization with laparoscopic bipolar coagulation were enrolled in the study. Ovarian volume, antral follicle counts, serum hormone levels and ovarian artery resistivity index values were measured before and 1 year after the sterilization procedure on the third day of the menstrual cycle. RESULTS: Serum hormone levels, mean ovarian volume (MOV) and mean follicle counts (MFC), were not statistically significant before and 1 year after the operation (P > .05). The difference in ovarian artery resistivity index values was not statistically significant before and 1 year after the operation (P > .05). A significant correlation was observed between FSH, MOV and MFC before and after the operation (P < .05). No correlation was observed between MOV or MFC and resistivity index. CONCLUSION: Ovarian function and vascular resistance do not seem to be affected by laparoscopic bipolar tubal coagulation.

The association of mast cell density with myometrial invasion in endometrial carcinoma: a preliminary report.

It is known that cancer is not a single transformational event. It is rather a multistage process involving complex interactions with the surrounding cellular microenvironment. Mast cells accumulate at sites of tumor growth in response to numerous chemoattractants. Our aim was to investigate the relationship between mast cell density (MCD) and myometrial invasion in endometrial carcinomas. Immunohistochemistry was performed on 35 unselected consecutive hysterectomy specimens from patients with endometrial adenocarcinoma. C-kit-positive mast cell assessment was performed in the myometrium adjacent to tumor tissue. A mean number of or=16 mast cells was regarded as high mast cell density (H-MCD). A significant correlation (p=0.018, Pearson Chi-Square test) between H-MCD and the presence of myometrial invasion was demonstrated in endometrial carcinomas. H-MCD was found in 54% of all cases, and 94% of H-MCD cases had myometrial invasion, suggesting a role of mast cells or an interaction with tumor. Therapeutic modalities orientated to these cells or their microenvironment as a new target for adjuvant treatment might determine the prognosis in endometrial carcinomas.

Excision of endometriotic cyst wall may cause loss of functional ovarian tissue.

Management of ovarian cysts is still controversial especially when dealing with endometriomas. Cyst excision was accepted surgical method by many centers; however, relationship between the excision and the loss of functional ovarian tissue is still uncertain.

Ischemic preconditioning reduces caspase-related intestinal apoptosis.

PURPOSE: To investigate the preventive effect of ischemic preconditioning (IPC) on ischemia/reperfusion (I/R)-induced apoptosis and injury in the rat intestine. METHODS: We divided 30 male Wistar rats, weighing 300-350 g, randomly into three groups. The control group rats (n = 10) were subjected to laparotomy only; the I/R group (n = 10) rats were subjected to occlusion of the superior mesenteric artery for 45 min, followed by reperfusion for 60 min; and the IPC group (n = 10) rats were subjected to IPC, achieved with two cycles of 5 min ischemia and 5 min reperfusion immediately before the I/R, as in the I/R group. Blood samples were collected by cardiac puncture, to measure nitrate and myeloperoxidase (MPO) levels. Histopathological and immunohistochemical studies were done to evaluate the I/R-induced apoptosis and injury. RESULTS: The blood MPO and nitrate levels were increased in the I/R group, but IPC prevented their increase. There were significantly fewer apoptotic cells in the IPC group than in the I/R group, and this finding was supported by the caspase-3 expression in the ileum. The intestinal histopathology was also protected by IPC against I/R-induced injury. CONCLUSION: Ischemic preconditioning clearly prevented I/R-induced injury and apoptosis by a mechanism related to the caspase-3-dependent pathway. We also showed that IPC inhibited leukocyte activation, with the suppression of myeloperoxidase levels in I/R and nitric oxide-related oxidoinflammatory pathway upregulation.

Expression of nuclear factor-kappa B and placental apoptosis in pregnancies complicated with intrauterine growth restriction and preeclampsia: an immunohistochemical study.

Preeclampsia affects 7-10% of all pregnancies, and is a major cause of maternal and fetal morbidity and mortality. Although enhanced apoptosis is well known in placentas with preeclampsia, the role of transcription factor nuclear factor-kappa B (NF-kappa B) in the process is still being debated. In this work, we investigate the relationship between NF-kappa B expression and trophoblastic cell apoptosis in pregnancies complicated with preeclampsia or intrauterine growth restriction (IUGR) by immunohistochemical analysis of NF-kappa B and three apoptosis related markers: bcl-2, caspase-3, and M30 CytoDeath antibody that identifies early apoptotic changes in the cytoskeleton related to action of caspase. The study was conducted on placental samples from 19 preeclamptic, 5 IUGR-complicated and 10 normal pregnant women. The three conclusions from the statistical analysis of the data are obtained; (i) Significantly higher expression of NF-kappa B in IUGR-complicated (p = 0.003) and preeclamptic placentas (p = 0.004) than the control placentas, (ii) significantly higher M30 index and caspase 3 expression in IUGR and preeclampsia placentas (p = 0.003), and (iii) decreased expression of bcl-2 in IUGR and preeclampsia placentas (p = 0.001). Based on these observations, we suggest that increased trophoblastic apoptosis is at least partially induced by NF-kappa B and reduced bcl-2 expression.

Treatment of a cervical viable pregnancy with a single intraamniotic methotrexate injection: a case report.

INTRODUCTION: Cervical pregnancy is a rare condition, constituting <1% of all ectopic pregnancies. CASE REPORT: We report here, the successful management of a viable 7 weeks gestation cervical pregnancy. Feticide with 2 ml of potassium chloride 15% was performed under the guidance of transvaginal ultrasonography. Then 70 mg methotrexate (50 mg/m(2)) was injected through this spinal needle in to the amniotic cavity. Also serial changes in the color Doppler imaging after the methotrexate injection were emphasized.

Polycythemia vera and pregnancy: a case report with the use of hydroxyurea in the first trimester.

Polycythemia vera (PV) is rarely associated with pregnancy. A 34-year-old patient treated with hydroxyurea for PV became pregnant and was referred to our clinic. At the patient's request, pregnancy was continued. The patient's hematocrit level remained below 45% without any treatment throughout her pregnancy, and a healthy male infant (without any congenital malformations or complications) was delivered at 37 weeks. This case report suggests that normal pregnancy and delivery is possible in patients with PV.