Role of diffusion-weighted MRI in the differential diagnosis of endometrioid and non-endometrioid cancer of the uterus.

Background Many publications have examined the relationship between apparent diffusion coefficient (ADC) values and tumor grade in endometrial cancer. Nevertheless, none were designed to evaluate according to the histopathological type of endometrioid and non-endometrioid tumors. Purpose To evaluate the role of diffusion-weighted imaging (DWI) in the differential diagnosis of endometrioid and non-endometrioid cancer of the uterus, by comparing them with contrast-enhanced magnetic resonance imaging (MRI) findings. Material and Methods Institutional review board approval and informed consent were obtained. The MRI findings of 63 patients with endometrial cancer were retrospectively evaluated and divided into four groups: Grades I, II, and III endometrioid tumors, and non-endometrioid tumors. ADC values, DWI quotients ( b = 1000 s/mm2), and post-contrast signal intensities between lesions and the myometrium (b1000q-Cq values) were evaluated. The one-way-ANOVA, student's t-test, Kruskal-Wallis test, and receiver operating characteristic (ROC) analysis were used for statistical evaluation. Results Mean ADC values were 0.86 ± 0.14 in Grade I, 0.80 ± 0.7 in Grade II, 0.71 ± 0.14 in Grade III for endometrioid tumors, and 0.70 ± 0.12 in non-endometrioid tumors. There was a significant difference in ADC values between Grade I and Grade III ( P = 0.006), and non-endometrioid tumors ( P = 0.003). The difference was also significant between Grades I + II and Grade III ( P = 0.009), and non-endometrioid tumors ( P = 0.004). Besides, there was a significant difference between endometrioid and non-endometrioid tumors ( P = 0.022). However, when considering b1000q (F = 0.640, P = 0.593) and Cq (χ2 = 6.233; P = 0.101), no significant difference was detected among the groups. Conclusion The difference in ADC values between the endometrioid and non-endometrioid tumors was statistically significant. However, the difference in DWI and contrast-enhancement findings were not statistically significant. Furthermore, the mean ADC values had an inverse relationship with tumor grade in the endometrioid cancer group.

Ramadan fasting and pregnancy: implications for fetal development in summer season.

AIMS: In the Islamic religion, Ramadan is a month in the year that is passed by fasting. Healthy adult individuals are prohibited to eat, drink, and smoke from sunrise to sunset. In the present study, our aim was to assess the relation of Ramadan fasting with fetal development and maternal-fetal Doppler indices in pregnant women. METHODS: This is a prospective case-control study carried out in the month of Ramadan in 2013 (9 July-7 August). One hundred and six pregnant women at the second and third trimesters of pregnancy were enrolled into the study. The sample size of the fasting group was 83 and the non-fasting group sample size was also 83. Fetal biometric measurements, such as biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight, amniotic fluid index, and Doppler indices of both uterine and umbilical arteries were evaluated by gray scala and color Doppler ultrasound at the beginning and end of Ramadan. RESULTS: At the end of the Ramadan, increase in biparietal diameter, head circumference, and femur length showed a statistically significant difference from initial measurements (P<0.05). When fasting and non-fasting groups were compared separately, an increase in amniotic fluid index was statistically significant in the non-fasting group (P<0.05). CONCLUSION: We demonstrated some adverse effects of Ramadan fasting on fetal development. In the Islamic religion, pregnant individuals have the privilege of not fasting; therefore, they should consider postponing fasting to the postpartum period, especially in the summer season. If they are willing to do so, an appropriate nutritional program should be recommended.

Role of VDR gene polymorphisms and vitamin D levels in normal and overweight patients with PCOS.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases in women. In recent years, the effects of vitamin D receptor (VDR) gene variants and VitD3 levels on clinical features of PCOS have been frequently described. In this study, we aimed to determine the relationship between VDR ApaI, TaqI and Cdx2 gene variants and VitD3 levels in PCOS patients. Patients were divided into two groups: BMI<25 and BMI>=25. VDR genotypes were determined by real-time polymerase chain reaction (PCR) and serum VitD3 levels were examined by ELISA. We observed that frequencies of the Apa1 AC genotype, C allele and Cdx2 T allele are increased in the BMI>=25 group compared to BMI<25 group. Also, the ApaI C allele, Taq1 AA genotype and A allele, Cdx2 CC genotype and C allele are associated with increased triglyceride, total cholesterol, LDL-cholesterol levels in patients with BMI>=25. When examining the relationship between VitD3 levels and clinical profiles in all PCOS patients, regardless of BMI distinction, it is determined that there is a positive correlation between LDL-cholesterol and ftestosterone levels. The present findings suggest that VDR variants are one of the most important risk factors for PCOS, especially for patients with BMI>=25.

Female sexual function and associated factors during pregnancy.

AIM: The objective of this study was to assess the changes in female sexual function during pregnancy and to identify associated factors among Turkish population using a validated questionnaire. Furthermore, we aimed to examine Turkish pregnant women's beliefs regarding sexual activity and describe their source of information about sexuality during pregnancy. MATERIAL AND METHODS: In this cross-sectional study, healthy heterosexual pregnant women who had been living with their partners within the last four weeks were asked to complete two self-administered questionnaires, one of which was Female Sexual Function Index (FSFI). RESULTS: A significant association was found between the decrease in intercourse frequency and trimesters, as a decline in frequency was reported by 58.3%, 66.1% and 76.5% of women in each trimester, respectively (P = 0.01). Only the trimester of gestation and employment status were independent factors associated with the decline in sexual intercourse frequency during pregnancy. When the overall FSFI score were compared according to each trimester of pregnancy, there were no statistical significant differences between the first and second trimesters (P = 0.71). The overall FSFI score in the third trimester was found to be significantly lower than the overall scores in the first two trimesters (P < 0.001 for both). In linear regression analysis, overall FSFI scores were adversely affected by only being in the last trimester. 38.7% of women and 36.2% of male partners worried that sexual intercourse may harm the pregnancy. Among the total sample, only 23.8% of women discussed sexuality with the medical staff. CONCLUSION: The third trimester is the independent variable for both decreased sexual activity frequency and sexual function scores in pregnancy. Counseling about sexuality during pregnancy is not frequent in the clinical setting, but conversations about this topic should happen on a regular basis during prenatal care visits.

The role of pregnancy awareness on female sexual function in early gestation.

INTRODUCTION: Female sexual function is negatively influenced by pregnancy due to the physical and emotional changes. Although the most significant effect is seen in the third trimester of pregnancy, a considerable decrease in the frequency of intercourse and sexual desire in the first trimester has also been shown. AIM: To investigate the factors that affect sexuality in early pregnancy and the impact of awareness of pregnancy on female sexual function in the first trimester of pregnancy using two self-reported questionnaires. METHODS: In this cross-sectional study, 130 healthy, married pregnant women who were admitted to the gynecology clinic between the 4th and 10th week of gestation were asked to complete a self-administered questionnaire and the female sexual function index (FSFI). MAIN OUTCOME MEASURES: The factors associated with FSFI score and monthly sexual activity frequency in the first trimester, as well as the differences in sexual activity frequency and FSFI scores between the women who were previously aware of their pregnancy and those who were yet unaware of their pregnancy. RESULTS: Women who were unaware of their pregnancy had significantly higher coitus frequency in comparison with the aware group (P = 0.002). Total FSFI score was 21.99 ± 8.13 in the aware group and 24.66 ± 3.76 in the unaware group (P = 0.02). None of the obstetric and sociodemographic variables had an influence on desire and pain scores. Arousal, lubrication, and satisfaction scores were adversely affected by awareness of pregnancy. Orgasm scores were influenced negatively by awareness and positively by love marriage; however, in multivariate linear regression analysis none of these were defined as independent factor for orgasm scores. Overall FSFI scores and monthly frequency of sexual activity were only affected by awareness. CONCLUSION: The results of this study suggest that in early gestation, awareness of pregnancy is associated with lower female sexual function. Furthermore, obstetric and sociodemographic factors seem to be ineffective on sexual function in early pregnancy.

Role of diffusion weighted MRI in the differential diagnosis of endometrial cancer, polyp, hyperplasia, and physiological thickening.

Our purpose was to evaluate the role of diffusion-weighted imaging (DWI) in the diagnosis of various common pathologies of the uterine cavity, by comparing them with contrast-enhanced MRI findings. One hundred sixty-four patients with lesions in endometrial cavity were included in the study. The patients were grouped in four (one malignant and three benign groups). We have observed that the differences of the apparent diffusion coefficient, b1000q, and Cq values between various common benign and malignant lesions were statistically significant (P<.001). However, the differences of the values between benign groups were not statistically significant (P>.05). Alternatively, endometrial polyp group's signal intensity on DWI was different than the other groups.

Systematic review: What is the best first-line approach for cesarean section ectopic pregnancy?

This systematic review aims to analyze the case reports, case series, or clinical studies describing the women with cesarean scar ectopic pregnancy (CSEP), and thus, to determine the efficacy and safety of different primary treatment modalities in the management of CSEP. A thorough search of electronic databases showed that 274 articles on CSEP were published between January 1978 and April 2014. Systemic methotrexate, uterine artery embolization, dilatation and curettage (D&C), hysterotomy, and hysteroscopy were the most frequently adopted first-line approaches. The success rates of systemic methotrexate, uterine artery embolization, hysteroscopy, D&C, and hysterotomy were 8.7%, 18.3%, 39.1%, 61.6%, and 92.1%, respectively. The hysterectomy rates were 3.6%, 1.1%, 0.0%, 7.3%, and 1.7% in CSEP cases that were treated by systemic methotrexate, uterine artery embolization, hysteroscopy, D&C, and hysterotomy, respectively. The ability to achieve a subsequent term pregnancy is related to successful systemic methotrexate treatment (p = 0.001) or hysterotomy (p = 0.009). Future term pregnancy was significantly more frequent in the hysterotomy group (p = 0.001). Hysteroscopy and laparoscopic hysterotomy are safe and efficient surgical procedures that can be adopted as primary treatment modalities for CSEP. Uterine artery embolization should be reserved for cases with significant bleeding and/or a high suspicion index for arteriovenous malformation. Systemic methotrexate and D&C are not recommended as first-line approaches for CSEP, as these procedures are associated with high complication and hysterectomy rates.

Association of endothelial nitric oxide synthase gene G894T polymorphism and serum nitric oxide levels in patients with preeclampsia and gestational hypertension.

OBJECTIVE: Pregnancy-induced hypertension is one of the most important cause of maternal-fetal morbidity and mortality. Pregnancy-related hypertensive disorders are usually associated with diminished nitric oxide (NO) levels. We aimed to evaluate the role of serum NO levels and eNOS gene G894T polymorphism on hypertensive disorders of pregnancy. METHODS: Eighty patients with gestational hypertension or preeclampsia, and 80 healthy pregnants were enrolled to analyze serum NO levels and G894T polymorphism of the eNOS gene. NO level was analyzed by high-performance liquid chromatography (HPLC) method. The G894T polymorphism of the eNOS gene was determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). RESULTS: There was no significant difference between groups in terms of G894T/eNOS genotype and allele frequencies (p > 0.05). Serum NO levels were significantly lower in the patients group. In the control group, subjects with thymine-thymine (TT) genotype had significantly lower NO levels when compared to subjects with guanine-guanine (GG) or guanine-thymine (GT) genotype (p < 0.05). CONCLUSIONS: We failed to demonstrate an association between eNOS gene G894T polymorphism and serum NO levels in patients with pregnancy-induced hypertensive disorders. We established a relation between pregnancy-induced hypertension and low NO levels.

Effect of body posture on intraocular pressure and ocular perfusion pressure in nonglaucomatous pregnant women.

PURPOSE: To investigate the effect of different positions on the intraocular pressure (IOP) and ocular perfusion pressure (OPP) in nonglaucomatous pregnant. MATERIAL AND METHODS: Thirty-one women in their third trimester of pregnancy were enrolled in this prospective and observational study. IOP in both eyes was measured with a Tono-pen® in the sitting position (Si-P), in the supine position (Su-P), in the right lateral decubitus position (R-LDP), and left lateral decubitus position (L-LDP). Systolic and diastolic blood pressure (sBP and dBP) were measured with a digital automatic blood pressure monitor at after 10 min in each position. Mean blood pressure ([mBP] = dBP + 1/3 [sBP-dBP]) and mean OPP (OPP = 2/3 mBP-IOP) were also calculated. Three IOP measurements were performed by the same clinician at the 15th min in each position. RESULTS: The mean IOP was 13.6 ± 3.4 mmHg in Si-P; 16.7 ± 3.5 mmHg in Su-P; 16.4 ± 3.5 mmHg in the R-LDP, and 16.6 ± 3.7 mmHg in the L-LDP. IOP was significantly lower in Si-P compared to Su-P, R-LDP, or L-LDP. The mean OPP was 46.41 ± 5.54 in Si-P; 39.71 ± 6.96 in Su-P; 36.81 ± 6.57 in the R-LDP; and 33.53 ± 7.63 in the L-LDP. OPP values were significantly different between each body position when multiple comparisons were performed. CONCLUSION: According to our data we conclude that Si-P yields the lowest IOP and the highest OPP compared with Su-P, R-LDP, and L-LDP in healthy pregnant women.