Association between patellofemoral congruence and patellofemoral chondropathy in patients with anterior knee pain: A T2 mapping knee MRI study.

OBJECTIVES: In this study, the T2 mapping magnetic resonance imaging technique was used to evaluate early cartilage changes associated with patellofemoral alignment and morphology. PATIENTS AND METHODS: Fifty four patients (Study group: 38 females, 16 males) with anterior knee pain and a randomly selected and age-matched 50 controls (Control group; 37 females, 13 males) were compared by two blinded authors in terms of T2 values of the patella medial, lateral facet, and trochlea, Insall-Salvatti index, lateral trochlear inclination angle, patellar tilt angle, sulcus angle, and patella medial and lateral facet lengths. The inter- and intra-observer reliability tests were assessed. RESULTS: The T2 medial patellar facet value, T2 lateral patellar facet value, T2 trochlea value, Visual Analog Scale, tibial tubercle - greater trochanter distance, and patellar tilt angle measure were statistically significantly higher in the study group. CONCLUSION: Based on our study findings, the T2 mapping magnetic resonance imaging (MRI) technique was found to be reliable test that can be used to diagnose early cartilage damage in patients with anterior knee pain. In patients with anterior knee pain, especially with decreased Insall Salvatti index, low lateral trochlear inclination angle, and higher patellar tilt angle, adding a T2 mapping sequence to the standard knee MRI protocol is recommended to help detect early cartilage damage.

Volumetric Muscle Measurements Indicate Significant Muscle Degeneration in Single-Level Disc Herniation Patients.

BACKGROUND: There is a strong relationship between lower back pain and paraspinal muscle atrophy. In this study, we aimed to investigate the prevalence of lumbar paravertebral muscle atrophy in patients with and without single-level disc herniation. METHODS: The 110 retrospectively analyzed patients in this study were divided into 2 groups. Group A included 55 patients with radiologically confirmed single-level disc herniation with back pain and radiculopathy. Group B included 55 patients with back pain without radiologic lumbar disc herniation. The paravertebral muscle cross-sectional areas were measured in both groups by 2 independent observers. RESULTS: In total, 68 women and 42 men were examined. Their mean age was 40.85 years old. The mean ages of groups A and B were 42.49 and 39.22 years, respectively. The cross-sectional areas of the multifidus muscles (MM) and erector spinae muscles were significantly greater in group B than in group A (P < 0.0001). However, there were no statistically significant differences in the psoas major cross-sectional areas, disc heights, and perpendicular distances between the MM and the laminae. CONCLUSIONS: The MM and erector spinae muscle groups are innervated by the dorsal root of the spinal nerve arising from the same level; therefore, long-term pressure on the root caused by disc herniation can cause atrophy and degeneration of that muscle group.

The evaluation of temperament and quality of life in patients with polycystic ovary syndrome.

AIMS: To evaluate the temperament and quality of life (QoL) of patients with PCOS. MATERIALS AND METHODS: Fifty-three adult patients with PCOS and 38 healthy controls were enrolled in the study. Demographic characteristics including age, education and body mass index (BMI) were recorded. Affective temperaments were assessed by the temperament evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A) scale. The general health-related quality of life (HRQoL) instrument used in this study was short Form 36. Hospital anxiety and depression scale (HADS) were also performed. RESULTS: The patients with PCOS had significantly higher rates of depressive, anxious and hyperthymic scores compared to controls. The PCOS patients had significantly lower mean SF-36 health summary scores. CONCLUSIONS: TEMPS-A seems to be an easy and reliable test to evaluate temperament in PCOS patients.

The role of early determination of ß-human chorionic gonadotropin levels in predicting the success of single-dose methotrexate treatment in ectopic pregnancy.

OBJECTIVE: The aim of the study was to determine the importance of ß-hCG level on day 4 following methotrexate (MTX) administration, and the difference between ß-hCG levels assessed on day 0 and day 4 in predicting treatment success. MATERIAL AND METHODS: A total of 68 women with tubal pregnancy, treated with a single dose of MTX, were selected for this retrospective study. RESULTS: The success rate of single-dose MTX treatment in our clinic was 75% (51/68). Among 51 patients in whom MTX treatment was successful, 25 (36.8%) showed a decrease in ß-hCG level of > 15% on days 0 and 4, and 44 (64.7%) showed a ß-hCG level decrease of > 15% on days 4 and 7. For subjects with ß-hCG decrease of > 15% on days 4 and 7, the standard error was 6.5%, and the area under the ROC curve was 81.7%, while the corresponding values for days 0 and 4 were 7.2% and 64%, respectively. CONCLUSIONS: A decrease of > 15 % in ß-hCG levels between days 0 and 4 does not seem to be a better predictor for success of single-dose MTX treatment for ectopic pregnancy than between days 4 and 7. A statistically significant difference was observed only in ß-hCG levels on day 7 in both, successful and unsuccessful single-dose MTX groups.

Early postpartum lactation effects of cesarean and vaginal birth.

OBJECTIVES: Breastfeeding has positive effects for both, the mother and the infant. The purpose of the study was to ex-amine how cesarean delivery and vaginal delivery influenced subsequent breastfeeding. The study was conducted at the Kirikkale University Medical School. MATERIAL AND METHODS: Breastfeeding outcomes after an elective cesarean delivery and after a planned vaginal delivery were compared. The study included 169 consenting mothers who gave birth to healthy infants (86 cesarean deliveries and 83 vaginal deliveries) between March and September 2001. All cesarean deliveries were performed under regional anesthesia. RESULTS: Elective cesarean delivery was performed at a significantly earlier gestational age as compared to vaginal delivery (p = 0.001). Maternal age in the planned vaginal delivery group was significantly lower (p = 0.003). As for the change in prolactin levels, the results were similar but not statistically significant (p = 0.21). The frequency of breastfeeding per day did not differ significantly between the groups (p = 0.20). However, women after cesarean delivery tended to breastfeed more often than after vaginal delivery (p = 0.003). Mean number of points recorded at the first breastfeeding session, according to the LATCH charting system, was lower in the group after cesarean delivery as compared to vaginal labor. The difference between the average point scores of vaginal delivery and cesarean delivery mothers was found to be meaningful in favor of the women after vaginal delivery (p = 0.05). CONCLUSIONS: Elective cesarean section has negative effects on breastfeeding. Our results indicate that cesarean section constitutes a risk factor for delayed lactogenesis.

Autonomic dysfunction in patients with polycystic ovary syndrome.

OBJECTIVE: To assess the autonomic system in patients with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: Thirty-seven adult patients with PCOS and 33 healthy controls were enrolled in the study. The electrophysiological assessments of the autonomic nervous system function were performed using sympathetic skin response and R-R interval variation tests. RESULTS: The mean latency of sympathetic skin response in PCOS patients was significantly delayed compared with the controls (p = 0.001). The mean amplitude of sympathetic skin response was significantly lower in comparison with the controls (p = 0.01). Mean R-R interval variation during deep breathing was also significantly delayed (p = 0.04). CONCLUSION: There are parasympathetic dysfunction and sympathetic dysfunction in patients with PCOS. This may be easily demonstrated with sympathetic skin response and R-R interval variation tests.

Atypical eclampsia and postpartum status epilepticus.

Preeclampsia is an entity that may present from 20th week of gestation up to 48 hours postpartum and is associated with hypertension and proteinuria. Eclampsia is emergence of convulsions pre-eclampsia in pregnant women with signs and symptoms. Recent studies showed that in some women, preeclampsia and even eclampsia may occur without hypertension or proteinuria. Here, we present a case of 26 years old women who had an uneventful pregnancy until 30 weeks' of gestation. She had only proteinuria in laboratory tests and was diagnosed as status epilepticus in early postpartum period. Preeclampsia and eclampsia is related with serious fetal and maternal morbidity and mortality and may present with atypical course. The awareness of atypical cases of preeclampsia enhances early diagnosis and management which are critical to avoid feto-maternal complications.

Personality profile in patients with polycystic ovary syndrome.

AIM: To investigate the personality traits of patients with polycystic ovary syndrome (PCOS). METHODS: Forty-nine patients with PCOS and 34 healthy controls were enrolled in the study. Psychometric evaluation was made with the Minnesota Multiphasic Personality Inventory. Additionally, Short Form-36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) were also performed. RESULTS: Polycystic ovary syndrome patients had significantly higher absolute and clinical elevation scores on depression, hysteria, psychasthenia and hypomania compared with the controls. Patients with PCOS had lower SF-36 physical and mental health summary scores and higher HADS anxiety and depression subscale scores. CONCLUSION: Polycystic ovary syndrome patients seem to have depressive, hysterical, psychasthenic and hypomanic personality traits.

HELLP Syndrome and Cerebral Venous Sinus Thrombosis Associated with Factor V Leiden Mutation during Pregnancy.

Preeclampsia is a leading cause of maternal mortality and morbidity worldwide. The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality for women and their infants alike. Hormonal changes during pregnancy and the puerperium carry an increased risk of venous thromboembolism including cerebral venous sinus thrombosis (CVST). Factor 5 leiden (FVL) is a procoagulant mutation associated primarily with venous thrombosis and pregnancy complications. We report a patient with FVL mutation who presented with CVST at 24th week of pregnancy and was diagnosed as HELLP syndrome at 34th week of pregnancy.

Comparison of perinatal outcome between adolescent and adult pregnancies.

OBJECTIVE: The aim of this study was to compare perinatal outcomes between adolescent and adult pregnancies. MATERIAL AND METHODS: In 527 adolescent and 1334 adult pregnant women who delivered at Ondokuz Mayis University Obstetrics and Gynecology Department between 2006 and 2013, perinatal outcomes were retrospectively compared in terms of including spontaneous abortion, induced abortion rate, dilatation and curettage (D&C), pregnancy-induced hypertension, premature prelabor and prelabor rupture of membranes, polihydramnios, oligohydramnios, maternal anemia, delivery modes and also neonatal outcomes including 5th minute Apgar score and fetal birth weight. RESULTS: The ratio of pregnancy induced hypertension and postpartum hemorrhage was higher in adults, but, anemia was more common in adolescents. There was statistically significant difference in the mode of delivery; the ratio of cesarean section was higher in adults whereas the rate of induced abortions and D&C significantly increased in adolescents. Low birth weight (LBW) and extremely LBW rates were significantly higher in adolescents, however, 5th minute Apgar scores were found to be higher than adult group. CONCLUSION: These results show that the perinatal care is fairly improved in Turkey.

Delayed diagnosis of PRES and eclampsia in a concealed pregnancy.

Pre-eclampsia and eclampsia are well-known risk factors of posterior reversible encephalopathy syndrome. Early recognition and proper treatment result in complete reversibility of this disease. Concealed pregnancy obstacles a safe prenatal care and a safe planned delivery, because of latency in the diagnosis. We present a case of unrecognized posterior reversible encephalopathy syndrome, eclampsia and premature delivery due to concealed pregnancy.

Maternal serum interleukin-6 level in preterm labor.

OBJECTIVE: The aim of this study was to measure interleukin-6 (IL-6) levels in maternal serum of women undergoing preterm labor without a clear infection. MATERIALS AND METHODS: Twenty two pregnant women with diagnosis of preterm labor who presented to the outpatient clinic of 19 Mayis University Faculty of Medicine from July 2011 through December 2011 were enrolled in the study group. Twenty two healthy pregnant women who were at the same gestational age as the study group were selected as the control group. RESULTS: Gestational age in the study and control groups varied from 24 weeks and 4 days to 34 weeks and 6 days. In the study group, 11 patients (50%) underwent preterm birth. Pregnant women in preterm labor were compared to healthy pregnant women with regards to serum IL-6 levels. No significant difference was found in the IL-6 levels of maternal serum between the 2 groups. CONCLUSION: In this study we have shown that there is no increase in lL-6 levels in patients undergoing preterm labor without clinical or biochemical infection signs.

Diffusion tensor imaging in the differentiation of adrenal adenomas and metastases.

PURPOSE: To determine the utility of diffusion tensor imaging for the differentiation of adrenal adenomas and metastases. MATERIALS AND METHODS: Thirty-three patients with a mean age of 59 years were included in this study. Each subject presented with a single adrenal lesion (19 adenomas, 14 metastases). Magnetic resonance imaging (MRI) was performed in the coronal plane using a 3 Tesla MRI and a six-channel phased array SENSE torso coil. T1-weighted in-phase and opposed-phase, T2-weighted turbo spin-echo, and single-shot echo-planar diffusion tensor imaging (DTI) sequences were used for image acquisition. To determine apparent diffusion coefficients (ADC) and fractional anisotropy (FA) values of adrenal lesions, coronal T2-weighted images were used as anatomical references and to localize regions of interest on DTI images. The signal intensity (SI) indices were obtained from in-phase/opposed-phase images by a radiologist blinded to the DTI findings. The DTI parameters were determined by a different radiologist. The SI indices and the differences in FA and ADCs between adenomas and metastases were compared. Analyses of receiver operating characteristics (ROC) were performed to determine the area under the curve (AUC). RESULTS: The SI index of adenomas was found to be significantly higher than the value determined for metastases. Moreover, the median FA value of adrenal adenomas was found to be significantly higher than that of metastases. No statistically significant difference was observed in the ADCs between adenomas and metastases. Furthermore, no significant correlation was found among the SI index and the measured DTI parameters. Based on ROC analyses, the AUC was found to be 0.936 in FA measurements with a 95% confidence interval. The cutoff value obtained from this analysis was 0.40 with maximum sensitivity and specificity values of 74% and 88%, respectively. CONCLUSION: Although no significant difference was observed in the ADCs between adrenal adenomas and metastases, the FA values differed significantly. The FA values may have the potential to differentiate between adrenal adenomas and metastases, which is a possibility that should be validated by further research.