Frequency and risk factors of fetal malnutrition among liveborn singleton term neonates using a computerised perinatal database, 2000-2006.

AIM: The aim of this study was to determine the frequency, risk factors and anthropometric measurements of fetally malnourished, liveborn singleton term neonates. METHODS: The computed delivery room data of 11.741 liveborn singleton term neonates was used to compare malnourished and nourished newborns. RESULTS: Of the total subjects, 577 (4.9%) were malnourished. There were no differences between the groups with regard to gender distribution, Apgar scores, maternal parity, smoking during pregnancy and type of delivery. Maternal age and neonatal gestational age (GA) were significantly lower in malnourished newborns (P < 0.001). Birthweight (BW), birth length (BL) and head circumference (HC) were significantly lower in the malnourished group compared with well-nourished group (P < 0.001). Mean BW (g) was 2724.7 ± 17.0 in the malnourished group versus 3234.3 ± 3.8 in the well-nourished group; BL (cm) was 47.8 ± 0.1 in malnourished versus 49.5 ± 0.0 in well-nourished neonates; HC (cm) was 33.25 ± 0.1 in the malnourished versus 34.3 ± 0.0 in the well-nourished group. Between the groups, there were significant differences in the ratio of small, appropriate and large for GA (P < 0.001). Of the malnourished newborns, 35.5% were small for GA, 63.3% were appropriate for GA and 1.2% were large for GA. CONCLUSION: Fetal malnutrition (FM) still exists despite the advances in current obstetric care. Neonates of adolescent mothers and of low GA are particularly at risk for FM. The BW, BL and HC of fetally malnourished neonates are lower than that of well-nourished neonates. Like term singleton appropriate and small for GA neonates, term singleton large for GA neonates could also have been fetally malnourished.

Do different delivery systems of hormone therapy have different effects on psychological symptoms in surgically menopausal women? A randomized controlled trial.

OBJECTIVE: To compare the influence of different delivery forms of estrogen therapy on menopausal and psychological symptoms in surgically menopausal women. STUDY DESIGN: Surgically menopausal women were assigned to a 1-year-therapy with oral conjugated estrogen 0.625mg/day (n=35), intranasal 300microg/day estradiol hemihidrate (n=33), percutaneous gel 1.5mg/day estradiol hemihidrate (n=32) or no treatment (control group, n=32). Serum E(2) and FSH levels, Kupperman's Scale used to assess climacteric symptoms, Hamilton Depression Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) scores were assessed before and after 1-year-therapy. RESULTS: After 1 year, the greatest increase in E(2) was in the oral group, followed by the transdermal gel, and then the intranasal group (oral vs transdermal gel: p=0.022: oral vs intranasal: p=0.0001; transdermal gel vs intranasal: p=0.0001). All treatment groups improved significantly in total Kupperman index score and HARS (p<0.05) with no difference between the groups. With regard to HDRS, all treatment groups improved significantly (p<0.05) with the greatest improvement in the oral group, and no difference between transdermal gel and intranasal groups (oral vs transdermal gel: p=0.015; oral vs intranasal: p=0.001; transdermal gel vs intranasal: p=0.735). Control group scored worse in all tests after study (p<0.05). All scores correlated significantly with post-treatment serum E(2) and FSH levels (p<0.001). CONCLUSION: Oral, intranasal and percutaneous gel estradiol therapies significantly improve menopausal and psychological symptoms in surgically menopausal women with oral route better than transdermal gel and intranasal modalities against depressive mood.

Do different delivery systems of estrogen therapy influence serum lipids differently in surgically menopausal women?

AIM: To compare the influence of different delivery forms of estrogen therapy (ET) on serum lipid levels. METHODS: For this prospective, randomized, controlled study, 132 surgically menopausal women were assigned to 12 months of therapy with oral conjugated estrogen 0.625 mg/day (n = 35), intranasal 300 microg/day estradiol hemihydrate (n = 33), percutaneous gel 1.5 mg/day estradiol hemihydrate (n = 32) or no treatment (control group, n = 32). Total cholesterol (t-Chol), triglycerides, high-, low-, and very low-density lipoprotein (HDL-Chol, LDL-Chol, and VLDL-Chol, respectively) levels were determined at baseline, and cycles 6 and 12. Data were analyzed using repeated measures ANOVA. RESULTS: All delivery forms significantly decreased t-Chol and LDL-Chol while increasing HDL-Chol after 6 and 12 cycles. The oral route significantly increased whereas other modalities significantly decreased serum triglycerides after cycle 6 and 12. VLDL-Chol levels were significantly increased using the oral route after cycle 12 while intranasal and percutaneous gel forms decreased the level after cycles 6 and 12. CONCLUSION: Oral, intranasal and transdermal gel delivery modes of ET have beneficial effects on serum lipids, as shown by decreased t-Chol and LDL-Chol, and increased HDL-Chol levels in surgically menopausal women. The oral form should be used with care in women with hypertriglyceridemia and with increased VLDL-Chol levels. However, the oral route seems to be more effective in decreasing LDL-Chol levels than the percutaneous gel form.

Recurrent mucinous cystadenoma in a 20-year-old woman: was hysterectomy inevitable?

A recurrence of ovarian mucinous cysts is very rare. Over a period of 21 months, a 20-year-old patient had three laparotomies resulting initially in the removal of one ovary with a mucinous cystadenoma and two cystectomies for the same pathology, but ultimately leading to hysterectomy and salphingo-oopherectomy. Because mucinous tumors are usually benign and most of the time multilocular, management of young patients is challenging, especially in the case of recurrence. Follow-up of these patients is very important and transvaginal ultrasound seems to be currently the most effective diagnostic tool for the follow-up of young patients treated with cystectomy for benign mucinous cystadenomas.

Bilateral sertoli cell adenoma and serous cyst in a patient with androgen insensitivity syndrome.

Thirty-year-old woman with lower abdominal pain was operated due to adnexial mass. Cystectomy on right gonad revealed sertoli cell adenoma and simple serous cyst and left gonadal biopsy showed immature testis tissue. Later, laparoscopic left gonadectomy was made. Histopathology of the left gonad was consistent with sertoli cell adenoma.