Plasma lipocalin-2 levels in pregnancy.

UNLABELLED: OBJECTIVE. To evaluate plasma levels of lipocalin-2, which is a novel adipokine associated with obesity and insulin resistance, in pregnant women. DESIGN: Prospective case-control study. SETTING: University hospital. POPULATION: Pregnant women with pre-pregnancy body mass index >25kg/m(2) (overweight; n=29) and body mass index <25kg/m(2) (n=27), whose gestational ages were between 24 and 28 weeks, as study groups and nonpregnant control women with body mass index <25kg/m(2) (n=29). METHODS: Plasma lipocalin-2 levels, fasting plasma glucose and fasting plasma insulin levels; homeostasis model assessment insulin resistance index and fasting plasma glucose/fasting plasma insulin ratio were measured for each subject. MAIN OUTCOME MEASURES: Comparisons among the groups and correlations for lipocalin-2 and the parameters of insulin resistance. RESULTS: Plasma lipocalin-2 levels among the pregnant women were significantly higher than those of the control group (p<0.001 for both group comparisons). Lipocalin-2 levels were significantly higher in the group with pre-pregnancy body mass index >25kg/m(2) compared with the group with pre-pregnancy body mass index <25kg/m(2) (p=0.003). Lipocalin-2 levels were positively correlated with homeostasis model assessment insulin resistance index and fasting plasma insulin and negatively correlated with fasting plasma glucose/fasting plasma insulin ratio in both pregnant groups. CONCLUSIONS: Lipocalin-2 was found to be higher in pregnant women, especially when pre-pregnancy body mass index was >25kg/m(2) , and it was correlated with markers of insulin resistance.

The association of serum androgens and insulin resistance with fat distribution in polycystic ovary syndrome.

OBJECTIVE: The aim of the study was to compare the body fat distribution of women with polycystic ovary syndrome (PCOS) with age and body mass index matched healthy controls and to investigate if androgens and insulin resistance associated with fat distribution. STUDY DESIGN: Thirty-three PCOS and 21 age and body mass index (BMI) matched healthy control women were evaluated in terms of body fat distribution with dual X-ray absorpsiometry (DEXA). Blood samples were obtained for follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, thyroid stimulating hormone (TSH), dehydroepiandrosterone-sulfate (DHEA-S), free testosterone, sex hormone binding globulin (SHBG), insulin and glucose levels. A 75 g 2 h glucose tolerance test was performed for each woman. Insulin resistance was estimated by fasting insulin level, fasting glucose/insulin ratio and 75 g 2 h glucose tolerance test. The Student's t-test and Mann-Whitney U-test were used to compare the groups. Pearson and Spearman rank correlation coefficients were calculated for normally and nonnormally distributed variables, respectively. Partial correlation coefficients were calculated using age and BMI as covariates. RESULTS: Fat mass in trunk and arms were significantly higher in patients with PCOS (p < 0.043 and 0.036, respectively). The ratio of fat mass in trunk to fat mass in legs were significantly higher in patients with PCOS (p < 0.011). Free testosterone was found to be positively correlated with fat mass in arms (r = 0.401, p < 0.05). There was still significant correlation between free testosterone and fat mass in arms (r = 0.5964, p < 0.05) after controlling for age and BMI. CONCLUSION: Free testosterone level is positively correlated with the fat mass in arms in women with PCOS.

The effects of hormone therapy, estrogen therapy and tibolone on apoptosis and cyclin D1 expression in postmenopausal vaginal epithelium.

OBJECTIVE: To investigate the effects of hormone therapy, estrogen therapy and tibolone on markers of apoptosis including bcl-2, and bax and cyclin D(1) expression in postmenopausal vaginal epithelium. STUDY DESIGN: Thirty postmenopausal women were randomized to the treatment protocols (0.625 mg conjugated equine estrogen (CEE) + 2.5 mg medroxyprogesterone acetate (MPA); 2mg estradiol valerate; 2.5mg tibolone). After baseline vaginal biopsy, control biopsies were performed after 70 days following the initiation of the therapy. Bcl-2, bax, Bcl-2/bax ratio, cyclin D(1) measurements were performed immunohistochemically. Data were analyzed by Kruskal-Wallis, Mann-Whitney U and Wilcoxon tests. RESULTS: After the treatment period the above-mentioned parameters were not different among the groups except for cyclin D(1) levels. Cyclin D(1) expression was found to be strong in patients with treated estradiol valerate. CONCLUSIONS: The effects of estrogen on cyclin D(1) expression were not detected with tibolone or with the addition of progesterone to estrogen in the vaginal epithelium. Cyclin D(1) appeared to have stronger effects on the estrogen related proliferation compared to apoptotic markers in vaginal epithelial cells.

Serum leptin levels in patients with polycystic ovary syndrome.

OBJECTIVE: To determine whether polycystic ovary syndrome (PCOS) is related to leptin dysregulation. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology in a university hospital. PATIENT(S): Fifty patients with PCOS (33 nonobese and 17 obese) and 32 control women (19 nonobese and 13 obese) were included in the study. INTERVENTION(S): Serum leptin levels were measured in patients with PCOS and the controls. Correlations between leptin levels and serum hormone levels (FSH, LH, free testosterone, androstenedione, DHEA-S and fasting insulin) were studied. MAIN OUTCOME MEASURE(S): Serum leptin levels and correlations between leptin levels and the hormonal parameters. RESULT(S): Mean serum leptin levels were not significantly higher in patients with PCOS compared to the control group. Leptin levels were found to be significantly higher in the obese subgroups both in patients with PCOS and in the control women. Leptin levels were found to be higher in obese patients with PCOS compared to obese controls; however, when the levels were evaluated again with covariance analysis excluding body mass index, there was no statistically significant difference. Leptin levels had a positive correlation with body mass index, both in patients with PCOS and the controls. CONCLUSION(S): Leptin levels were not higher in patients with PCOS compared to the control group; the leptin level was correlated with the amount of fat tissue not only in patients with PCOS but also in healthy women.

Change in retrobulbar circulation during menstrual cycle assessed by Doppler ultrasound.

Our purpose was to study the hemodynamic changes in the ophthalmic, central retinal and posterior ciliary arteries during the normal menstrual cycle and to relate the vascular changes to menstrual cycle. A total of 23 healthy women underwent serial color Doppler ultrasonography at least six times during a normal menstrual cycle, twice each in follicular, ovulatory and luteal phases. Pulsatility and resistance index and peak systolic velocity of the each arteries were assessed with color Doppler imaging. There was no statistical difference in any of the parameters during the menstrual cycle. This was supposed to be because generalized hormonal effects on heart rate, blood pressure, blood volume, cardiac output and on the diameter of the vessel cancel each other and this effect maintains the same ocular blood flow and perfusion during the menstrual cycle.

The association of bone mineral density with insulin resistance in patients with polycystic ovary syndrome.

OBJECTIVE: The aim of the study was to compare the bone mineral density (BMD) measurements between the patients with polycystic ovary syndrome (PCOS) and age and the body mass index (BMI) matched healthy controls, and to examine whether insulin resistance was associated with BMD. STUDY DESIGN: Twenty-nine consecutive patients with PCOS and seventeen, age and BMI matched healthy control women were included in the study. Blood samples were obtained for follicle stimulating hormone, luteinizing hormone, estradiol, dehydroepiandrosterone-sulfate, 17 hydroxy-progesterone, free testosterone, sex hormone binding globulin, insulin, and glucose levels and BMD measurements were performed for total body, lumbar spine (L2-L4), and femoral neck for each participant. Insulin resistance was estimated by fasting insulin level, fasting glucose/insulin ratio and 75 g of glucose tolerance test for 2 h. Differences between the groups were analyzed by Student's t-test and Mann-Whitney U-test where appropriate. Correlation analysis between the parameters concerning insulin resistance and BMD measurements were performed in patients with PCOS using Pearson's correlation coefficient (r). Correlation analysis was also performed between serum hormone levels and BMD measurements in the PCOS group. Partial correlation coefficients were calculated for these parameters, using age and BMI as covariates. RESULTS: Free testosterone and 17 hydroxy-progesterone levels were significantly high in patients with PCOS compared to the control women (P = 0.001 and 0.04, respectively). Fasting insulin was significantly higher and fasting glucose/insulin ratio was significantly lower in the PCOS group compared to the controls (P = 0.021 and 0.008, respectively). BMD measurements did not differ between the groups (P > 0.05). There were significant correlations between fasting insulin and total BMD (r = 0.424, P < 0.05) and fasting glucose/insulin ratio and L2-L4 BMD (r = -0.401, P < 0.05) after controlling for age and BMI. CONCLUSION: BMD measurements are not different between the patients with polycystic ovary syndrome and healthy control women and hyperinsulinemia, and insulin resistance might play a role in the preserved BMD.

Laparoscopic intracorporeal ultrasound guidance during hysteroscopic adhesiolysis.

We introduce a case of hysteroscopic adhesiolysis by the guidance of laparoscopic intracorporeal ultrasound (LIU) in a patient complaining of amenorrhea and infertility found to have total intrauterine synechia. Adequate intrauterine adhesiolysis was performed by resectoscope with a wire loop, coordinating images of the endometrial cavity, uterine wall and the tip of the hysteroscope. She had regular menses after the operation and follow-up hysterosalpingogram at 3 months demonstrated satisfactory surgical results, with no evidence of intrauterine adhesions. To avoid the possibility of inadvertent uterine perforation, complex intrauterine procedures can be easily performed by the guidance of endoscopic ultrasonography.

Cytotoxin associated gene A-positive Helicobacter pylori strains in dyspeptic pregnant women.

OBJECTIVE: The aim of the present study was to compare the Helicobacter pylori (HP) seropositivity and cytotoxin associated gene A (cagA) status in pregnant women with dyspeptic complaints and pregnant women with no gastrointestinal symptoms. STUDY DESIGN: Seventy-one consecutive pregnant women with gastrointestinal complaints and 72 age-matched pregnant women without any gastrointestinal symptoms or a history of gastrointestinal disease were included in the study. Demographic characteristics and H. pylori and cytotoxin associated gene A status of the groups were analysed. RESULTS: The prevalence of H. pylori seropositivity was slightly but not significantly higher in patients with dyspeptic complaints compared to the controls (74.6% versus 63.8%, respectively, P > 0.05). The incidence of dyspeptic complaints were 53.5% in HP-seropositive and 40.9% in HP-seronegative women (P > 0.05). The prevalence of cytotoxin associated gene A positivity among H. pylori-seropositive women was significantly higher in dyspeptic pregnants compared to the controls (75.5% versus 45.7%, respectively, P = 0.002). Among HP-seropositive women, the incidence of dyspeptic complaints was significantly higher in cagA-positive patients compared to the cagA-negative ones (65.6% versus 34.2%, respectively, P = 0.002). When analysed according to the trimesters, the prevalence of cytotoxin associated gene A positivity among H. pylori-seropositive women was significantly higher in dyspeptic pregnants compared to the controls in the first trimester (68.0% versus 34.8%, respectively, P = 0.021). CONCLUSION: Cytotoxin associated gene A-positive, virulent H. pylori strains were found to be more frequently associated with dyspeptic complaints in pregnant women.

Ovarian wedge resection by minilaparatomy in infertile patients with polycystic ovarian syndrome: a new technique.

OBJECTIVE: To determine the effects of ovarian wedge resection by minilaparotomy in infertile patients with polycystic ovarian syndrome (PCOS). STUDY DESIGN: One hundred and thirty-four anovulatory patients with PCOS, who were previously treated with clomiphene citrate and gonadotropins and did not conceive were operated via minilaparotomy with microsurgical principles and ovarian wedge resection was performed on each subject. Pregnancy rates and adhesion formation were investigated retrospectively. RESULTS: A total of 121 pregnancies were achieved in 2 years (90%). One hundred and four patients conceived within the first 6 months (78%) and the remaining 17 patients conceived within 2 years (13%) following the operation. Sixty-eight patients had a second pregnancy later. In the post-operative period, 24 patients had cesarean delivery and 20 had diagnostic laparoscopy. Out of these 44 patients, only 5 of them were found to have minimal adhesions. CONCLUSION: This technique offers high pregnancy rates and minimal adhesion formation. Ovarian wedge resection by minilaparotomy might be an alternative treatment approach in patients with PCOS who did not conceive with standard ovulation induction protocols.

Total and lipid bound sialic acid levels in patients with polycystic ovary syndrome.

OBJECTIVE: To evaluate serum total and lipid bound sialic acid (TSA&LBSA) levels in patients with polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: Forty women with PCOS and 35 healthy controls were enrolled in the study. Serum TSA, LBSA, follicle stimulating hormone, lutenizing hormone, estradiol, thyroid stimulating hormone, prolactin, dehydroepiandrosterone sulphate, androstenedione, free testosterone, total testosterone, 17-OH progesterone, sex hormone binding globulin, cortisol, total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein were measured in each subject. Insulin resistance was estimated by fasting insulin level, fasting glucose: insulin ratio and 75-g glucose tolerance test for 2 hours. RESULTS: Serum TSA levels were not significantly different between the groups. Serum LBSA levels were higher in patients with PCOS compared to the control group. TSA was correlated with androstenedione and HOMA-IR in the PCOS group. Positive correlations were found between LBSA and dehydroepiandrosterone sulphate in patients with PCOS. After correction for BMI, the only existing significant correlation was between LBSA and follicle stimulating hormone. CONCLUSION: Serum LBSA levels, which has previously been found to be higher in cardiovascular diseases and diabetes mellitus, are elevated in PCOS.

Plasma apelin levels in patients with polycystic ovary syndrome.

OBJECTIVE: The aim of the study was to evaluate plasma apelin levels in patients with polycystic ovary syndrome (PCOS) and healthy controls. MATERIAL AND METHODS: Plasma apelin levels, serum lipid levels, serum hormone levels, and homeostasis model assessment-insulin resistance (HOMA-IR) values of 32 patients with PCOS and 31 healthy women forming the control group were checked. RESULTS: Plasma apelin levels of the PCOS group (0.350±0.083 ng/ml) were significantly higher than those of the control group (0.246±0.045 ng/ml) (p<0.001). No significant correlation was detected between apelin levels and biochemical or clinical data in PCOS group. CONCLUSION: Plasma apelin levels were significantly higher in PCOS patients.

Serum paraoxonase 1 activity, asymmetric dimethylarginine levels, and brachial artery flow-mediated dilatation in women with polycystic ovary syndrome.

OBJECTIVE: To evaluate endothelial function via serum asymmetric dimethylarginine (ADMA) levels, paraoxonase 1 (PON1) activity, and brachial artery flow-mediated dilatation (FMD) in women with polycystic ovary syndrome (PCOS). DESIGN: Prospective case-control study. SETTING: University hospital. PATIENT(S): Thirty patients with PCOS with a mean age of 24.33 ± 4.50 years and 30 healthy controls matched for body mass index (BMI) and age. INTERVENTION(S): Endothelial function was assessed biochemically with serum ADMA levels and serum PON1 activity and functionally with brachial artery FMD by ultrasonography. MAIN OUTCOME MEASURE(S): Serum ADMA levels, serum PON1 activity, brachial artery FMD, hormonal and biochemical parameters. RESULT(S): Patients with PCOS had higher levels of free testosterone and insulin, and higher waist-hip ratio and Ferriman Gallwey scores when compared with the controls. Fasting glucose and homeostasis model assessment of insulin resistance were not different between the groups. There was no statistically significant difference in ADMA levels between two groups. Serum PON1 activity and brachial artery FMD were statistically significantly lower in women with PCOS. There was negative correlation between ADMA and PON1 in patients with PCOS. CONCLUSION(S): Serum PON1 activity and brachial artery FMD, as markers of endothelial dysfunction and cardiovascular risk, were statistically significantly lower in women with PCOS compared with healthy controls matched for age and BMI. Endothelial dysfunction may be seen at earlier ages in patients with PCOS.

The effects of oral contraceptives including low-dose estrogen and drospirenone on the concentration of leptin and ghrelin in polycystic ovary syndrome.

OBJECTIVE: To evaluate short-term leptin and ghrelin concentrations in women with polycystic ovary syndrome (PCOS) who use low-dose oral contraceptives containing drospirenone. DESIGN: Prospective study. SETTING: Department of obstetrics and gynaecology in a university hospital. PATIENT(S): Twenty women with PCOS were enrolled in the study. INTERVENTION(S): A low-dose oral contraceptive containing ethinyl estradiol and drospirenone was given for three cycles. MAIN OUTCOME MEASURE(S): Serum androstenedione, free T, T, dehydroepiandrosterone sulphate, sex hormone-binding globulin, FSH, LH, E(2), lipid profiles, leptin, and ghrelin levels were measured in each subject. Insulin resistance was estimated by the homeostasis model assessment-insulin resistance (HOMA-IR). RESULT(S): While leptin concentrations did not change with therapy, ghrelin levels increased statistically. Baseline leptin concentrations were correlated positively with body mass index, waist-to-hip ratio, insulin, and HOMA-IR and negatively with ghrelin. After controlling for body mass index and waist-to-hip ratio in a partial correlation analysis, leptin levels were not correlated with these parameters. Ghrelin was inversely correlated with body mass index, waist-to-hip ratio, insulin, HOMA-IR, and free T. CONCLUSION(S): In patients with PCOS, an oral contraceptive containing ethinyl estradiol and drospirenone increases ghrelin levels but not leptin levels in a 3-month period. Ghrelin might be related to the metabolic and androgenic changes in patients with PCOS.

Plasma adrenomedullin levels in patients with polycystic ovary syndrome.

OBJECTIVE: To evaluate adrenomedullin levels in patients with polycystic ovary syndrome (PCOS). DESIGN: Prospective study. SETTING: Department of obstetrics and gynecology in a university hospital. PATIENT(S): Thirty-eight women with PCOS and 29 healthy control subjects were enrolled in the study. INTERVENTION(S): Plasma adrenomedullin, serum androstenedione, free T, T, DHEAS, SHBG, thyrotropin, PRL, FSH, LH, and E2 were measured in each subject. Insulin resistance was estimated by fasting insulin level, fasting glucose:insulin ratio and 75-g glucose tolerance test for 2 hours. MAIN OUTCOME MEASURE(S): Plasma adrenomedullin levels and correlations among adrenomedullin and gonadotropins, female sex steroids, androgens, and insulin resistance. RESULT(S): There was no significant difference concerning plasma adrenomedullin concentrations between the groups. In patients with PCOS, fasting glucose, fasting insulin, body mass index, and free T were inversely correlated with the plasma adrenomedullin. Plasma adrenomedullin was significantly correlated with glucose:insulin ratio. After controlling for body mass index, there were no significant correlations between the above-mentioned parameters. CONCLUSION(S): Adrenomedullin may play a role in regulating the insulin metabolism in patients with PCOS.

Laparoscopic ultrasonography in the management of ovarian cysts.

BACKGROUND: The aim of the study was to determine the role of laparoscopic ultrasonography in the management of ovarian cysts extirpated by means of endoscopic surgery. METHODS: Laparoscopic ultrasonography was used during endoscopic surgery in 14 consecutive patients with an adnexal mass. The diagnostic accuracies of transvaginal and laparoscopic ultrasonography were compared according to the final pathological diagnosis. Estimations of the exact location of the ovarian mass by means of laparoscopic visualization and laparoscopic ultrasonography were compared. The presence of residual tumor tissue after cyst extirpation was monitored with laparoscopic ultrasonography. RESULTS: Using laparoscopic ultrasound and transvaginal ultrasound the correct diagnosis was made in 12 of 14 (85.7%) and 9 of 14 (64.3%) patients, respectively (not significantly different). With laparoscopic visualization, the exact location of the ovarian tumor could be demonstrated in 57.1% (8/14) of the cases, while with laparoscopic ultrasonography precise visualization of the ovarian mass was achieved in all cases (not significantly different). Two patients were found to have residual tumor tissue in the ovary when laparoscopic ultrasonography was performed again after tumor extirpation. CONCLUSION: Laparoscopic ultrasonography seems to be useful in patients with an adnexal mass managed by endoscopic surgery, in terms of evaluating the internal characteristics and predicting the histological diagnosis of the ovarian cyst, deciding on the correct placement of the incision to prevent unnecessary trauma to the ovary, and evaluation of the ovary after cyst extirpation to expose any residual tumor tissue.

The association of androgenic sex steroids with serum lipid levels in postmenopausal women.

BACKGROUND: The aim of the present study was to examine the correlations between androgenic sex steroids and serum lipid levels in postmenopausal women. Methods. The study group included 72 postmenopausal women. Correlation analysis between serum hormone [dehydroepiandrosterone sulfate (DHEA-S), androstenedione, free testosterone and sex hormone binding globulin (SHBG)] and lipid [total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), lipoprotein (a) [Lp (a)], apolipoprotein A-1 (apo A-1) and apolipoprotein B (apo B)] levels was performed. RESULTS: DHEA-S was found to be positively correlated with HDL-C (r = 0.231, p = 0.049) and negatively correlated with Lp (a) (r = - 0.355, p = 0.002). These correlations were statistically significant even after adjustment for age and body mass index (BMI) (r = 0.332, p = 0.005 and r = -0.362, p = 0.002, respectively). SHBG was positively correlated with HDL-C (r = 0.352, p = 0.002). There was a significant but weaker correlation between SHBG and HDL-C levels after controlling for age and BMI (r = 0.243, p = 0.041). No other correlations were found between sex hormone and lipid levels. CONCLUSION: DHEA-S was found to be associated with a less atherogenic lipid profile in postmenopausal women.

Resistance index in fetal interlobar renal artery with renal pelvic dilatation up to 10 mm.

PURPOSE: The purpose of this study was to compare the resistance indices (RIs) in the fetal interlobar renal arteries (IRAs) of third-trimester fetuses with or without pelvicaliceal dilatation of up to 10 mm and to compare them with those of the full-term healthy infants. METHODS: Women with uncomplicated, low-risk, singleton third-trimester pregnancies were examined sonographically. The RIs in the IRAs were measured in the fetuses, who were stratified into 3 groups according to the anteroposterior diameter of the renal pelvic dilatation: group I, no dilatation; group II, 1-5-mm dilatation, and group III, 6-10-mm dilatation. RESULTS: In total, 178 women were examined. We could study both kidneys in 139 of the fetuses; in the other 39, only 1 kidney could be imaged perfectly. This yielded a total of 317 kidneys. Group I fetuses included 172 (54%); group II, 98 (31%); and group III, 47 (15%) of the kidneys. The mean (+/- standard deviation) RIs in the IRAs were 0.81 +/- 0.09, 0.80 +/- 0.07, and 0.80 +/- 0.06 in the 3 groups, respectively, with no statistically significant difference between the groups (p = 0.72). There was also no statistically significant difference between the RIs recorded in the right and left kidneys. The mean RI in the IRAs of the 34 infants who were available for follow-up 6-12 weeks after delivery was 0.73 +/- 0.07, which was significantly less than that recorded in the third-trimester fetuses (p = 0.005). CONCLUSIONS: The RI in the fetal IRA does not differ in fetuses with and without renal pelvic dilatation of up to 10 mm. Thus, an increase in the RI or an RI that significantly differs between the right and left kidneys should be investigated further for possible renal pathology.