Passive smoking is associated with lower age at menopause.

OBJECTIVE: The aim of the study was to investigate the age at menopause in women exposed to passive smoking. METHODS: The study was designed as a case-control study. The main outcome measure was to compare the age at menopause of women exposed to second-hand smoking to non-exposed women. RESULTS: The age at menopause in the group exposed to second-hand smoking was significantly lower than that of women in the non-exposed group (47.0 ± 4.7 vs. 48.1 ± 5.2 years, p = 0.002). In regression analyses, the age at menopause had an inverse correlation with second-hand smoking, and a positive correlation with the mother's age at menopause. We further stratified women according to their smoking status. Women exposed to second-hand smoking who had never smoked had a significantly lower age at menopause than the non-exposed women only when the duration of exposure exceeded 20 years (46.6 ± 5.6 vs. 48.4 ± 3.7 years, p = 0.008). Furthermore, women who had never smoked and who were exposed to ≥ 10 cigarettes per day had a significantly lower mean age at menopause than non-exposed women who had never smoked. These differences were not observed among women who had ever smoked. CONCLUSIONS: Our findings suggest that earlier age at menopause should be added to the negative effects of passive smoking, in addition to increased risks for overall, cardiovascular and cancer mortality as well as increased risk for osteoporosis.

The importance of size of cervical ectopy to predict postcoital bleeding: is there any cut-off value?

OBJECTIVE: To investigate the relationship between size of cervical ectopy and existence of postcoital bleeding (PCB) in non-symptomatic women. MATERIALS AND METHODS: Study population were recruited from women ages 18-65 years, sexually active who applied to the present outpatient department. They were asked whether they had had postcoital bleeding in the last three months. After ful visualization of the cervix, the existence of ectopy was noted and measured. The smears were taken from all patients with endobrushes. RESULTS: The authors found a relationship between the size of ectopy and PCB. In the prediction of PCB, the lesion's size (of both antero-posterior and transverse diameters) of 3.5 mm as the cut off level, sensitivity, and specificity were found to be 70% and 76%, respectively. CONCLUSION: The full visualization of the cervix is important because of the relationship between the existence of ectopy and PCB.

Complications of gynecological laparoscopy: experience of a single center.

BACKGROUND: The purpose of this study was to describe the prevalence and type of laparoscopic complications seen in a teaching hospital. MATERIALS AND METHODS: Four hundred and forty-one diagnostic and operative laparoscopic procedures were performed by the same senior resident/resident surgical team. Direct entry technique was used for all procedures. RESULTS: The procedures included 74 (16.8%) diagnostic and 367 (83.2%) operative laparoscopies. The overall complication rate was 7.7% (34 cases). Conversion to laparotomy occurred in 16 cases (3.6%). CONCLUSIONS: The complication rate was found to be slightly higher than the rates quoted in the literature. This rate of 7.7% is still an acceptable one.

Effects of natural progesterone on endometriosis in an experimental rat model: is it effective?

UNLABELLED: To assess the effects of the natural progesterone on the endometriosis in a rat model. MATERIALS AND METHODS: Endometriosis was surgically induced in 20 rats by transplanting an autologous fragment of endometrial tissue onto the inner surface of the abdominal wall. Rats in control group had no medication but 2.5 mg/kg/weekly natural progesterone was administered to rats in study group for four weeks. After that, all rats were sacrificed and dimensions of endometriosis were measured and they were evaluated morphologically and histologically. Scoring systems were used to evaluate preservation of epithelia. RESULTS: Two rats in the study group and one rat in the control group died of complications related to surgery. At the end of the treatment, there was a reduction in the size of the endometriotic lesions in the study group (p < 0.01). According to histological evaluation, the study group had lower score than control goup which was statistically significant (p = 0.014). CONCLUSIONS: Natural progesterone is effective against endometriosis in rat model.

Relevance of lipogenesis and AMPK/Akt/mTOR signaling pathway in endometrial cancer.

OBJECTIVE: New evidence is presented for differences in lipid metabolism between healthy and cancer cells, which has increased considerably in recent years. Alterations in lipid metabolism affect important processes such as cell growth, proliferation, and differentiation. Therefore, the purpose of this study is to determine the gene expression levels of the enzymes which have a function in lipid metabolisms such as fatty acid synthase (FASN), sterol regulatory element-binding protein (SREBP), phosphatidylinositol 3-kinase (PI3K), mammalian target of rapamycin (mTOR), protein kinase B (Akt), and AMP-activating protein kinase (AMPK) in patients with endometrial cancer. PATIENTS AND METHODS: This study included 60 patients diagnosed with endometrial adenocarcinoma which subgrouped as Grade 1 (n = 20), Grade 2 (n = 20), Grade 3 (n = 20). For control group endometrial tissues from 30 individuals subgrouped as control 1 (n = 15) secretory phase and control 2 (n = 15) proliferative phase healthy endometrial tissues. Gene expression analysis was performed using Real-time polymerase chain reaction (RT-PCR). RESULTS: PI3K gene expression levels were decreased in patients with Grade 3 endometrial cancer compared to Grade 1 and 2 (p <0.05). The gene expression levels of Akt and mTOR were decreased in the Grade 3 patients compared to control groups. The gene expression levels of SREBP, FASN, and AMPK were decreased in all patients' groups compared to control groups (p <0.05). CONCLUSIONS: The results suggest that while lipogenesis may show different tissue-specific behaviors related to some pathways, it may have a direct relationship with endometrial cancer.

The role of hormone replacement therapy in endometrial polyp formation.

OBJECTIVE: To evaluate the iatrogenic effect of different protocols of hormone replacement therapy (HRT) on endometrial polyp formation adjusting for the confounding effects of other factors such as age, parity, weight and menopausal status at menopause. METHODS: Out of 2685 menopause patients 375 (13.9%) eligible patients were enrolled. Patients were randomized to three HRT types and three equal groups were formed. The first group received Premelle 2.5 mg (Group-I) (0.625 mg conjugated estrogen + 2.5 mg medroxyprogestorone), the second received Kliogest (Group-II) (2 mg estradiol + 1 mg norethisterone) and the last received Livial (Group-III) (2.5 mg tibolone) at least for 36 months without giving a break. After the first 18 months patients had their first office hysteroscopy and it was repeated in every 6 months until the end of third year to find out new and recurrent endometrial polyps. RESULTS: Multiple regression analysis revealed that the type of HRT, late menopause and obesity increased the occurrence of endometrial polyps. In Group-I five polyps, in Group-II ten polyps and in Group-III two polyps were detected. There were significant differences between G-II and G-I and G-II and G-III (P < 0.05), but there was no significant difference between G-I and G-III (P > 0.05). 82.3% of the polyps were detected in the third and fourth hysteroscopic examinations. Endometrial polyp recurrence was encountered in 4 (23.5%) patients, 1 in G-I and 3 in G-II without a significant difference (P > 0.05). No malignancy was detected in any of the specimen. CONCLUSION: We observed that endometrial polyp formation may be dependent on the type and dosage of the estrogen and progestogen. Especially a progestogen with high antiestrogenic activity may play an important preventive role in the development of endometrial polyps.

Is leptin associated with serum lipid profile or any other parameters of blood biochemistry in post-menopausal women with osteoporosis?

We investigated the relationship between serum leptin concentration, serum lipid profile and other blood biochemistry parameters in healthy post-menopausal women. Blood samples for analysis of serum leptin concentration, blood biochemistry and hormonal status, and urine samples for calcium measurement were taken from 122 women. No significant correlation was found between serum leptin concentration and serum lipid profile. The concentration of serum leptin was significantly associated with body mass index (BMI), luteinizing hormone (LH) and alanine transaminase (ALT). BMI was found to be a statistically significant independent factor for serum leptin concentration. We conclude that leptin was not associated with serum lipids and lipoproteins in post-menopausal women. Leptin was associated with BMI, ALT and LH, however, with BMI being an independent predictor of leptin concentration. There was a relationship between LH and serum leptin concentration even after menopause, and ALT correlated with serum leptin concentration through BMI.

Determination of oestrous cycle of the rats by direct examination: how reliable?

For determination of the oestrous cycle in rats classical Papanicolaou technique has long been used successfully. Instead of using many stains in Papanicolaou, staining the vaginal secretions with only methylene blue has also been defined. Recently a new technique in which vaginal samples are directly examined under light microscope has been introduced. The aim of this study was to assess the reliability of this new technique by comparing it with the classical staining techniques. From 20 Wistar rats 60 vaginal samples were collected with a micropipette, three from each. Briefly, the vagina was flushed two to three times then the fluid was placed onto a glass slide. The fluid was equally distributed onto three glass slides. The glass slides were coded. Two samples were stained with Papanicolaou and methylene blue while the other one was examined directly. Determination of the phases of the oestrous cycle was made by the same histologist who was blinded to the groups and coding system. After determination of the oestrous phase in all samples, the results were compared and it was found that the results were matching. In conclusion, the same results can be obtained with the direct examination technique and this technique is reliable, so there is no need to use relatively time-consuming, less practical and more expensive techniques such as Papanicolaou or methylene blue.

The effect of rosiglitazone in the prevention of intra-abdominal adhesion formation in a rat uterine horn model.

BACKGROUND: Effects of rosiglitazone in the prevention of adhesion formation were evaluated. METHODS: Eighty Wistar albino rats were randomly grouped into eight equally sized groups. A 2-cm segment of the antimesenteric surface of the right uterine horn was traumatized to form a standardized lesion, using bipolar cautery. A dose-response study was performed with 0.1, 0.3, 1 and 3 mg/kg/day rosiglitazone. Fifteen days later, adhesions were evaluated clinically and histopathologically. A time-response study was performed with 1 mg/kg/day rosiglitazone (the minimum dose found to significantly affect adhesion formation). Rosiglitazone was given for 7 days post-operatively and results were compared with those of control and the 15-day group (time-response). In all these studies, rosiglitazone was orally administered 3 days before the operation and continued post-operatively. In two further experimental groups, rosiglitazone was only administered pre-operatively or post-operatively. RESULTS: Approximately 1 mg/kg/day rosiglitazone was found to reduce adhesion scores both clinically and histopathologically. Duration of treatment was also found to affect the extent of adhesion formation. However, giving rosiglitazone either just pre-operatively or post-operatively did not significantly reduce adhesion formation. CONCLUSION: Rosiglitazone with peroxisome proliferator-activated receptor (PPAR)-gamma agonist activity reduced the formation of i.p. adhesion possibly by reducing the initial inflammatory response and the subsequent exudation in this study.

Doppler study of myometrium in invasive gestational trophoblastic disease.

OBJECTIVE: In this prospective study, we aimed to assess the prognostic and diagnostic role of color Doppler flow of myometrium in patients with invasive gestational trophoblastic disease (GTD). METHODS: Thirty-seven patients, who were enrolled in the study with invasive mole, were assessed with the help of transvaginal color Doppler ultrasound before and after chemotherapy. The place and the size of the myometrial invasions were assessed. RESULTS: Thirty patients of 37 were treated with the help of single-agent chemotherapy--methotrexate (mtx). In this group, the resistance index (RI) ratios ranged between 0.26 and 0.45 and the size of the myometrial invasion varied between 10 and 50 mm. On the other hand, six patients were treated with mtx and actinomycin D combination and one patient was treated with the help of total abdominal hysterectomy. In this group, the RI ratios ranged between 0.16 and 0.25 and the size of the myometrial invasion varied between 60 and 90 mm. Remission was achieved in all patients. CONCLUSION: Transvaginal color Doppler study can easily detect invasive GTD. When the depth and the width of the myometrial invasion increase and when there is a low diastolic/systolic ratio, the number of courses and the need for combination of chemotherapy increase.