Circulating insulin-like peptide 5 levels and its association with metabolic and hormonal parameters in women with polycystic ovary syndrome.

PURPOSE: Insulin-like peptide 5 (INSL5) is a gut peptide hormone that is a member of relaxin/insulin superfamily. Growing evidence implicates the crucial role of the peptide in some metabolisms including food intake, glucose homeostasis and reproductive system. Polycystic ovary syndrome (PCOS) is involved in both reproductive and metabolic issues. The aim of the study was determination of circulating levels of INSL5 alteration in women with PCOS and evaluation of the relationship between INSL5 and hormonal-metabolic parameters as well as carotid intima media thickness (cIMT). METHODS: A total of 164 subjects were recruited in this cross-sectional study (82 women with PCOS and 82 age- and BMI-matched controls). Circulating INSL5 levels were assessed via ELISA method. High-resolution B-mode ultrasound was used to measure cIMT. The hormonal and metabolic parameters of the recruited subjects were determined. RESULTS: Circulating INSL5 levels were significantly elevated in women with PCOS compared to controls (27.63 ± 7.74 vs. 19.90 ± 5.85 ng/ml, P < 0.001). The mean values of INSL5 were significantly higher in overweight subjects compared to lean weight subjects in both groups. The women with PCOS having insulin resistance have increased INSL5 compared to those of PCOS subjects without insulin resistance. INSL5 is associated with insulin resistance, BMI, luteinizing hormone and free androgen index. Multivariate logistic regression analyses revealed that the odds ratio for having PCOS in the highest tertile of INSL5 was higher than in the lowest tertile. CONCLUSIONS: PCOS subjects exhibited an elevation in circulating INSL5 levels along with a link between INSL5 level induction and metabolic-hormonal parameters.

The efficacy of intrauterine versus oral progestin for the treatment of endometrial hyperplasia. A prospective randomized comparative study.

OBJECTIVES: This study compared the efficacy of the levonorgestrel-releasing intrauterine device (LNG-IUD) to oral medroxyprogesterone acetate (MPA) applied for the same length of time for the management of endometrial hyperplasia without atypia. STUDY DESIGN: This was single-center, open, randomized, and clinical trial. One hundred four patients aged between 30-50 years and diagnosed with endometrial hyperplasia without atypia by endometrial biopsy, were randomized to receive LNG-IUD or MPA. Both groups were further divided into two groups as three-month and six-month treatment subgroups. The primary objective was to compare the complete regression rates of hyperplasia, and the secondary objective was to determine the minimum duration of time required for the achievement of regression. RESULTS: At two-year follow-up, the success rates of LNG-IUD treatment and oral MPA for three months therapy were 84% and 50%, respectively. While the regression rate was 100% in the six-month LNG-IUD group, it was 64% in the oral MPA group. LNG-IUD appeared to have a significantly higher success rate (p = 0.0001). CONCLUSION: It is believed that by this study LNG-IUD applications may be a reliable preference for younger patients who wish to preserve their uterus and especially for non-atypical cases, and if the patient demands fertility, even a six-month application will provide effective treatment.

The efficacy of dinoprostone vaginal insert for active management of premature rupture of membranes at term: a randomized controlled trial.

PURPOSE: To evaluate the efficacy and safety of the vaginal insertion of dinoprostone in terms of achieving cervical ripening, shortening the length of labor, and lowering the cesarean delivery rate for term pregnancies complicated with premature rupture of membranes. METHODS: A prospective, randomized, controlled trial enrolled 100 women with term pregnancies complicated with premature rupture of membranes. Each had a normal non stress test, unscarred uterus, a singleton pregnancy with cephalic presentation, and a Bishop score of less than 4. Patients were randomized to receive a 10 mg dinoprostone vaginal insert single dose or no medication. After cervical ripening, oxytocin induction was performed during labor for both the study and control group. Cervical ripening in the 12th hour, total delivery time and delivery mode were compared between the two groups. RESULTS: More often cervical ripening was obtained in the study group women who used dinoprostone vaginal inserts compared to the control group (p: 0.001). Latent phase of labor and total delivery time was shorter in the study group women than the control group (p: 0.022 and p: 0.026). There was no difference in terms of delivery mode and indication of section between study and control groups. CONCLUSION: The use of dinoprostone vaginal inserts in patients with term pregnancy of premature rupture of membranes reduced both the latent phase of labor and total delivery time without increasing the rate of cesarean section.

Evaluation of endometrium by transvaginal ultrasonography and Doppler in tamoxifen-treated women with breast cancer.

PURPOSE: The purpose of this study was to investigate the discriminative role of transvaginal ultrasonography and Doppler measurements on the detection of endometrial pathologies in tamoxifen-treated breast cancer patients. METHODS: Tamoxifen-treated breast cancer patients were included in this prospective study between February 2009 and June 2010. The subjects were assessed by gynecologic examination and transvaginal gray-scale and Doppler sonography. The patients whose endometrial thicknesses were more than 6 mm underwent endocervical/endometrial curettage for histopathological examination. RESULTS: There were 98 tamoxifen-treated patients with breast cancer enrolled in the study, providing 141 ultrasound evaluations. Uterine artery pulsatility index was significantly lower in postmenopausal than premenopausal patients (p: 0.013). Endocervical and endometrial curettage was performed in 52 patients. It was more prevalent that the endometrial strip was > or = 6 mm in women with abnormal endometrial histopathology (p: 0.020). However the women with abnormal endometrial histopathology presented lower vascular indices; the only significant difference was in myometrial pulsatility index (p: 0.036). CONCLUSION: The most evident tool for evaluating the endometrium in tamoxifen-treated breast cancer patients is still the transvaginal measurement of its thickness. It exists that Doppler ultrasonographic assessment of uterine, radial and spiral vasculature has no additional benefit for detection of endometrial pathology.

Cancer in elderly: A study of hospital-based cancer registry in the Western Turkey.

AIM: The aim of the study is to evaluate the data of cases who were 65 years and older among cancer records from the data of Izmir Cancer Registry (ICR), in Izmir Ataturk Research Training Hospital (IAEAH), according to topography, histology, sex and having multiple tumors and to compare them with the data of cases younger than 65 years. MATERIAL AND METHODS: Twenty thousands eight hundred and thirty (20,830) cases (7148 cases are ≥65 years) recorded during the period of 1993-2005 by office of ICR, located in IAEAH, were analyzed. Assessment of data was carried out by SPSS 10.0 for Windows package program. For statistical analysis Pearson's Chi-Square Test and Yates 'corrections were performed. RESULTS: Of 20,830 cases with cancer, recorded in the hospital data-base during 1993-2005, 34.3% were diagnosed at the age of 65 years and older. The most frequent tumor localizations in the cases younger than 65 years were breast, larynx, digestive system, skin and hematopoietic-reticuloendothelial system whereas the tumors in the, skin, digestive system and the urogenital system were more common in cases older than 65 years. When histological diagnoses were taken into consideration, basal cell carcinomas and squamous and transitional cell carcinoma were seen more frequent in the group of cases 65 years or older. The incidence of synchronous and metachronous tumors were not different in the cases younger or older than 65 years. CONCLUSION: There is a strong need to establish a communication between national and international database systems, which would yield an opportunity in the comparison of the incidence of the diseases.

The clinical and pathological features of patients with hematological neoplasms: a study of hospital-based Cancer Registry from western Turkey.

PURPOSE: To evaluate the frequency and the main features of patients with hematological neoplasms (HNs) who were diagnosed between 1992-2005 at the Izmir Ataturk Education and Research Hospital (IAEAH), affiliated with Izmir Cancer Registry (ICR) database. METHODS: A total of 2,424 HNs were recorded with reference to ICD-0-3 according to Surveillance, Epidemiology, and End Results (SEER) data among 20,895 recorded cancer patients from 1993 to 2005. The percentages of male and female patients were 58.5% and 41.5%, respectively. The age ranges were as follows: 15-44 years (37.3%), 45-64 (36%), and > 64 (26.6%). One thousand and nineteen (56%) patients had B cell and 108 (5.9%) patients had T/NK (natural killer) cell lymphoid neoplasms. One hundred and ninety-four (10.7%) patients had lymphoblastic leukemia, 267 (14.7%) had Hodgkin's lymphoma (HL), and 603 (24.9%) had myeloid leukemia. Three hundred and five (16.7%) patients had extranodal involvement (in 1821 regions). The major extranodal location was the stomach. CONCLUSION: It seems that our data make a contribution to the relevant literature, because the epidemiologic data of Turkey are inadequate, and hematopoietic neoplasms have different geographic distribution.

Development of secondary ovarian lesions after hysterectomy without oophorectomy versus unilateral oophorectomy for benign conditions: a retrospective analysis of patients during a nine-year period of observation.

PURPOSE: The effect of retained one or both ovaries on the de novo ovarian pathologies required re-operation after hysterectomy due to benign gynecologic conditions were investigated retrospectively. This study was done to determine the occurrence of disease in retained ovaries after hysterectomy. METHODS: A retrospective analysis of patient charts was performed, comparing the patient reports of women who had secondary ovarian lesions those whose previously undergone total abdominal hysterectomy with unilateral oophorectomy or without oophorectomy in our Department during the nine year period of observation (2000-2009). The study included 1242 women with at least one ovary saved after hysterectomy for benign indications. RESULTS: De novo ovarian disease was established in 5.1% of patients of hysterectomy without oophorectomy and in 17.6% of patients of at least one ovary saved after hysterectomy for benign indications (p = 0.005). Ovarian pathology requiring re-operation developed in 3.8% of patients who underwent hysterectomy without oophorectomy and in 5.9% of patients who underwent hysterectomy with unilateral oophorectomy (p = 0.536). CONCLUSION: Women with unilateral oophorectomy at the time of hysterectomy had more than twice the risk of secondary ovarian lesions, compared with those without oophorectomy at hysterectomy. Determinants, such as age, parity and gravidity must be considered when deciding whether or not to perform oophorectomy at hysterectomy.

Cardiac troponin levels in pregnant women with severe pre-eclampsia.

Pre-eclampsia is a multisystem disorder that involves vascular endothelial dysfunction and diffuse inflammatory response. The cardiac troponin (cTn-I) levels in pre-eclampsia are controversial. The objective of this study was to compare the cTn-I levels between normal pregnant women and those with severe pre-eclampsia. A total of 78 patients who underwent caesarean section were included in the study. The patients were assigned into two groups as the severe pre-eclamptic pregnant group (study group, n = 36) and normotensive pregnant group (control group, n = 42).The cTn-I levels of all patients were measured preoperatively and postoperatively. A statistically significant difference was not determined between the preoperative and postoperative cTn-I levels (p > 0.05) between the two groups. In the present study, a relation was not determined between pre-eclampsia and increased cTn-I levels. If high cTn-I levels are determined in pre-eclamptic patients, other pathologies that may cause myocardial damage should be investigated.

A case with three different synchronous primaries of the female genital system and their treatment.

Multiple carcinomas of the genital system are rare in the literature. We report a 43-year-old female patient who presented with 3 different synchronous primary genital system malignancies (cervix, endometrium and ovary). After Wertheim's hysterectomy there was a 4 x 2 cm residual mass for which systemic chemotherapy and radiotherapy were administered. The patient rapidly deteriorated and died due to disease progression. Registration of cases with multiple tumors in a single centre using a standardized investigation for predisposing parameters may contribute much to the management of such conditions.

Advanced stage of cervical carcinoma undiagnosed during antenatal period in term pregnancy and concomitant metastasis on episiotomy scar during delivery: a case report and review of the literature.

The objective of this study is to review the implantation of malignant cells of cervical cancer in an episiotomy site. This is the second case of cervical cancer with concomitant episiotomy metastasis in the literature. The treatment consisted of radiochemotherapy. There was no confirmed recurrent disease after 1 year of follow-up in our reported case. In conclusion, pregnancy appears to be a chance for cervical cancer screening as a part of prenatal care. If cervical cancer is diagnosed in a woman after vaginal delivery, she must be examined carefully including the episiotomy site.

Effects of laparoscopic tubal ligation on ovarian blood flow and steroidogenesis.

Changes in serum ovarian hormone and gonadotrophine levels and ovarian artery blood flow rate by Doppler ultrasonography following laparoscopic tubal sterilization were evaluated. Forty-seven cases of laparoscopic tubal sterilization by electrocoagulation were included in the study. Forty-two women who used nonhormonal contraceptive methods were randomized as a control group. Serum concentrations of estradiol, FSH, LH, progesterone and bilateral ovarian artery pulsatility indexes were measured at baseline and at three, six and 12 months. In the study group, the mean value of midluteal progesterone was significantly decreased three months postoperatively 3. and bilateral ovarian artery pulsatility indexes were increased three and six months postoperatively, compared to their preoperative values. However, there was no statistical difference between bilateral ovarian PI values calculated preoperatively and at 12 months. Laparoscopic tubal ligation by electrocoagulation may temporarily cause reduced bilateral ovarian artery flow and corpus luteum dysfunction proven by low mid-luteal progesterone levels.

Accuracy of frozen section diagnosis in ovarian tumors: Is there a change in the course of time?

A retrospective study of 222 ovarian biopsy results between January 1, 2000 and August 31, 2002 was examined to determine the accuracy of frozen section diagnosis. In addition we reviewed all previous studies that examined the accuracy rates of frozen section diagnosis in ovarian tumors. Histopathologic examination results of frozen section biopsies were concordant with paraffin diagnosis in 92% of all cases. The sensitivity rates for benign, malignant, and borderline ovarian tumors were 98%, 88.7%, and 61%, respectively. There were five (2.2%) false-positive (overdiagnosed), and 13 (5.4%) false-negative (underdiagnosed) patients in frozen section examination. Frozen section examination of mucinous tumors showed higher underdiagnosis rates (20%). Review of previous studies showed no significant variation in accuracy rates of frozen section diagnosis for benign and malignant ovarian tumors, in relation with time. We found low accuracy rates for borderline ovarian tumors which was similar with the previous studies. However, there were consistent and relatively higher sensitivity rates for borderline ovarian tumors in the recent studies. As a result, we conclude that frozen section evaluation in identifying a malignant or benign ovarian tumor is accurate enough for the correct diagnosis. Since accuracy rates for borderline ovarian tumors are low, we should have more improvement in the correct diagnosis.

A randomized controlled trial of a new ovule formulation of ornidazole for the treatment of bacterial vaginosis.

OBJECTIVE: To compare the efficacy of 500 mg ornidazole vaginal ovules (VO) and vaginal tablets (VT) in the treatment of bacterial vaginosis. METHOD: Patients were allocated at random to one group of 50 subjects to be treated with a VO (500 mg) prepared in our laboratory and to a second group of 50 subjects to be treated with a VT of ornidazole (500 mg). Therapeutic efficacy was assessed by Nugent's scoring system and clinical criteria (Amsel's criteria) before and 1 week after treatment. RESULTS: At the first follow-up visit, complete disappearance of the signs and symptoms or highly significant reduction in intensity of symptoms was observed in both treatment groups. No significant difference was evident between the two ornidazole formulations.