The effects of postmenopausal hormone replacement therapy on sympathetic skin response.

OBJECTIVES: To determine the effects of postmenopausal hormone replacement therapy on 'sympathetic skin response' test which is one of the tests to evaluate autonomic functions. METHODS: Sixty postmenopausal women, 30 of whom taking hormone replacement therapy and the remaining 30 without hormone replacement therapy, were enrolled in this study. Sympathetic skin responses were recorded in each subject by Medelec Premiere electromyograph. Latency and amplitude of sympathetic skin response and area under the negative component of sympathetic skin response were measured and the groups were compared statistically regarding these results. RESULTS: Latency values of the groups were not significantly different, whilst the difference between the sympathetic skin response amplitudes of the groups, as well as the difference between the measurements of area under the negative component of sympathetic skin response of the groups were statistically significant. CONCLUSION: The results of the current study seem to indicate that estrogen has a significant inhibitory effect on the sympathetic neuron pool at the spinal cord level.

Reproducibility of the Finn chamber nickel patch test in two different phases of the ovulatory menstrual cycle.

BACKGROUND: Studies on nickel patch test reactivity and reproducibility of positive tests at different points of the menstrual cycle are heterogeneous. OBJECTIVE: To investigate if non-reproducibilities of positive nickel sulphate patch tests in the two different phases of ovulatory menstrual cycles with the endocrine evidence of luteal phase adequacy are statistically different. METHODS: 15 women (group 1) with positive Finn chamber(R) nickel patch test results in the follicular phase of the ovulatory cycle and 13 women (group 2) with positive Finn chamber nickel patch test results in the luteal phase of the ovulatory cycle were tested again in the counter-phases of their ovulatory cycle, with a scheduled interval of 6 weeks following the first tests. Reproducibilities of the tests in the two groups were evaluated statistically. RESULTS: 3 of the positive test results in group 1 (20%) and 2 of the positive test results in group 2 (15.4%) were non-reproducible. The difference was not statistically significant. CONCLUSION: The reproducibility of positive Finn chamber nickel patch tests does not seem to be affected by the changes in the follicular and luteal phases of the ovulatory cycle.

Do menopausal hot flashes have any significant effects on arterial blood gas measurements?

OBJECTIVES: To evaluate the effects of menopausal hot flashes on arterial blood gas measurements. METHODS: Twelve postmenopausal women with frequent hot flashes were enrolled in this study. Blood samples from femoral artery were collected before and during menopausal hot flashes in each subject, and all blood samples were analyzed for pH, pCO2, pO2, HCO3 standard, total CO2, and base excess. Arterial blood gas parameters before and during menopausal hot flashes were compared statistically. RESULTS: pH measurements decreased significantly during hot flashes (P < 0.05); although the difference was found to be statistically significant, the amount of decrease and the range in which the change took place led us to conclude that this change was clinically insignificant. Other parameters did not show any statistically significant differences between the preflash and flash measurements. CONCLUSIONS: Our results indicate that menopausal hot flashes do not have any clinically significant effects on arterial blood gas measurements.

The effect of L-arginine and pentoxifylline on postoperative adhesion formation.

BACKGROUND: Postoperative intraperitoneal adhesion formation is a major cause of infertility, pain, intestinal obstruction, and subsequent intraoperative complication. We investigated the effects of L-arginine and pentoxifylline for preventing postoperative adhesion in rats. METHODS: Forty Sprague-Dawley rats were subjected to a standardized lesion by serosal trauma of the uterine horn and parietal peritoneal defect. The agents were administered intraperitoneally at the end of surgery. The rats were assigned randomly into control (saline treated), L-arginine, pentoxifylline and L-arginine with pentoxifylline groups. Two weeks after surgery, a second laparotomy was performed and the extent of adhesion formation was determined. The data were analyzed by Mann Whitney U test. RESULTS: In L-arginine and pentoxifylline administered groups, adhesion formation scores were significantly lower than the control group (p<0.05). However, the efficacy of L-arginine used together with pentoxifylline is not superior to those of L-arginine or pentoxifylline alone. CONCLUSION: This study showed that L-arginine and pentoxifylline administered at the end of surgery reduced adhesion formation.

Tibolone does not have a sustained measurable thermogenic effect in postmenopausal women.

BACKGROUND: Our purpose was to determine if tibolone in commonly used daily dosage (2.5 mg/day) would have a measurable thermogenic effect in women, which could be attributed to its progestogenic effect. METHODS: We enrolled twelve postmenopausal women in this study. Subjects were instructed to take their basal body temperatures for fifteen days before and for another fifteen days during tibolone usage. Mann-Whitney U test and Wilcoxon matched-pairs signed rank test were used in the statistical analysis. RESULTS: Only in one subject did the basal body temperatures before and during tibolone usage have a significantly different distribution (p=0.048). Mean basal body temperatures before and during tibolone usage of the subjects were compared using Wilcoxon matched-pairs signed rank test and the p value was found to be 0.158. CONCLUSION: The results of the statistical analysis of the basal body temperatures which were taken before and during tibolone usage in our group seem to indicate that tibolone does not have a sustained measurable thermogenic effect in postmenopausal women.

Antiphospholipid antibodies in eclamptic women.

Our purpose was to determine the prevalence of antiphospholipid antibodies (APA) in eclamptic women as well as the rates of intrauterine growth retardation (IUGR) and fetal death in APA-positive and -negative eclamptic women. Thirty-six eclamptic and 30 healthy pregnant women were enrolled in this study. APA in those groups were determined. The prevalences of IUGR and fetal death were determined in APA-positive and -negative eclamptic women. In the eclamptic group, APA were positive in 9 out of 36 patients (25%), where as only 2 out of 30 controls (6.7%) were positive (p < 0.05). Fetal death was encountered in 4 out of 9 (44.4%) APA-positive eclamptic women; this was a significantly larger proportion than that for APA-negative eclamptic women (1/27; p < 0.01). The rates of IUGR in APA-positive and -negative eclamptic women were not significantly different (p > 0.05). Similar conclusions about our results could also be made, when weakly positive anticardiolipin antibodies were regarded as negative in our study group and controls. Our study suggests that positive levels of APA in eclamptic women increase the risk for intrauterine fetal death.

Mature cystic teratoma in round ligament: case report.

Our report describes an unusual presentation of mature cystic teratoma. In this case, 3 mature cystic teratomas were encountered during cesarean section, one in each round ligament and the other in the left ovary. According to the literature, round ligament is one of the rarest sites for the presentation of mature cystic teratoma.

Is there any change in the prolactin levels of nurses in the morning after night shift?

Our purpose was to determine if blood samplings in the mornings after night shifts should be avoided for measuring the basal serum prolactin levels in women working at night and with regular menses; 20 nurses with regular menses, all working only at night shifts, were enrolled in this study. Serum prolactin levels of the subjects were determined twice, first in the morning after a typical night's sleep, with no intercourse within the previous 24 hours, second, in the morning after a typical night shift. All measurements of serum prolactin levels were performed in the follicular phase of the menstrual cycle. Prolactin levels in the mornings after typical night's sleeps and in the mornings after typical night shifts were not significantly different. Prolactin level in the morning after a night shift of a woman with regular menses may represent basal prolactin level of that woman.

Vaginal birth following unmonitored labor in patients with prior cesarean section.

Following a previous cesarean section, trial labour followed by spontaneous birth is currently popular but is still debatable. In an effort to assess the risks of unmonitored labor, the outcomes of 165 patients with previous cesarean section who delayed coming to hospital were reviewed. Seventy-one patients were allowed to continue labor and 62 achieved successful vaginal delivery, a success rate of 87.3%. Sixty-one of 71 patients had an unknown uterine scar type prior to birth and, of these, 57 were delivered vaginally. The scar separation rate of this group was found to be 3.5% and the overall scar separation rate in our patients was 3.6%. Other than scar separation and febrile morbidity, no maternal morbidity or mortality was observed. The vast majority (98.4%) of infants delivered vaginally had 5-min Apgar scores of 7 or greater. We suggest that increasing the use of trial labor in patients with prior cesarean section, even in the presence of an unknown scar, may reduce the number of patients laboring in an unmonitored environment who wish to give birth vaginally.

Urinary calcium to creatinine ratio for predicting preeclampsia.

Urinary calcium excretion decreases in preeclampsia. To determine the predictability of preeclampsia with hypocalciuria, we investigated the calcium to creatinine ratio and the calcium level of a spot urine sample in 56 primigravid patients aged less than 25 years. Of these 56 cases, 44 remained normotensive and preeclampsia developed in eight cases. There were four cases of gestational hypertension and they are not included in the statistical analysis. The mean age, the mean gestational age at entrance into the study, the mean urine calcium concentration, the mean birthweight, and the mean gestational age at delivery were similar between the normotensive and preeclamptic groups. The mean calcium to creatinine ratio is found to be significantly lower in the preeclamptic group (0.0475 +/- 0.0260) compared with the normotensive group (0.1466 +/- 0.1353; p < 0.0001). A cutoff level of 0.066 for the calcium to creatinine ratio with the use of a receiver operator curve yielded a sensitivity of 75%, a specificity of 86%, and a positive and negative predictive value of 55% and 95%, respectively. The results of this study suggest that a single urine calcium to creatinine ratio might be an effective marker for predicting preeclampsia in a high-risk population.

Ritodrine tocolysis and neonatal intraventricular-periventricular hemorrhage.

Betamimetic drugs are commonly used for tocolytic therapy. To determine their potential role in periventricular-intraventricular neonatal hemorrhage (IVH), 103 preterm births with cranial ultrasonography results were evaluated for the history of betamimetic therapy. The study group was divided into three subgroups according to the cause of the preterm delivery: 44 patients were accepted as tocolysis failure (group A); 53 patients were too late for tocolysis (group B), and these latter cases were taken as controls for group A; for the remaining 6 patients, tocolysis was contraindicated due to fetomaternal reasons (group C), and these cases were not included in the analysis. In group A, 32 patients got ritodrine, 6 patients got combined therapy including ritodrine plus magnesium sulfate or nifedipine. When cases in group A who got ritodrine only or combined therapy are compared with the no-treatment group, no significant difference in neonatal IVH incidences could be found (p > 0.005). Ritodrine does not appear to affect the incidence of neonatal IVH.

Expectant management of functional ovarian cysts: an alternative to hormonal therapy.

OBJECTIVE: We studied whether the administration of oral contraceptives facilitates the disappearance of spontaneously formed functional ovarian cysts. METHODS: Eighty patients in whom ultrasonography revealed unilateral, mobile, unilocular, thin-walled ovarian cysts without internal echoes and greater than 30 mm but not exceeding 60 mm in diameter were enrolled into the study. Patients were randomized by stratification to receive a low-dose monophasic pill, a high-dose monophasic pill, a multiphasic pill or no therapy. Patients were re-evaluated after 5 weeks of therapy and at the end of therapy (10 weeks). RESULTS: The mean ages and the mean cyst diameters of the patients for each group were not significantly different. We did not find a significant effect of oral contraceptive administration on the disappearance rate of functional ovarian cysts over that of expectant management. CONCLUSION: We conclude that oral contraceptive therapy even with multiphasic pills is very effective in the management of functional ovarian cysts but expectant management achieves similar success rates and may be a good alternative to oral contraceptive therapy.