What are the factors affecting IVF success in women with hypogonadotropic hypogonadism?

OBJECTIVE: This study aimed to investigate in vitro fertilization (IVF) outcomes in women with hypogonadotropic hypogonadism (HH) and unexplained infertility and investigate factors affecting the pregnancy rate among HH patients. MATERIALS AND METHODS: This retrospective cohort study was conducted at Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, Turkey, a tertiary care referral center. The medical records of 143 women who underwent IVF treatment at this hospital between 2015 and 2020 were reviewed. Sixty-three had hypogonadotropic hypogonadism (HH) and 74 had unexplained infertility. Demographics, hormonal profile, IVF cycle characteristics, and pregnancy rates were recorded. The factors affecting the ongoing pregnancy rates were evaluated among HH patients. RESULTS: Anti-Mullerian hormone (AMH) levels were lower among women with HH compared to those with unexplained infertility (1.64±1.2 vs. 3.0±2.13). IVF cycle characteristics and ongoing pregnancy outcome (20.28% vs. 22.97%) were similar between the groups; however, the total dose of human menopausal gonadotrophin (HMG) used (5127.74±1845.8 vs. 2035.71±1387.45) was higher in the HH group. Increased estradiol level (2596.35±1085 vs. 1869.9±1203.4), endometrial thickness (10.82±1.74 vs. 8.43±2.33), higher number of total oocytes retrieved (12.14±4.34 vs. 8.43±5.44) were correlated with higher ongoing pregnancy rates among the HH group. CONCLUSIONS: IVF success rates were similar between the HH and unexplained infertility groups. Although AMH level was not a prognostic factor for IVF success, higher doses of HMG were needed to achieve pregnancy in the HH group. The factors affecting the ongoing pregnancy rates in the HH group were higher estradiol level, increased endometrial thickness, and a higher number of oocytes retrieved.

STAT3 expression is correlated with pathological stage in luminal subtypes of breast carcinoma.

AIM: STATs and HIFs in human solid tumors play an important role in mechanisms of tumor growth. The aim of this study was to determine the prognostic role of STATs and HIFs in breast cancers. METHODS: Twenty­four breast carcinoma cases who underwent mastectomy and axillary dissection were included into the study. The presence of STATs and HIFs in 24 breast cancer cases was evaluated immunohistochemically. We evaluated the differences in tumor grade, diameter, limits, intratumor desmoplasia, inflammatory infiltration, necrosis, axillary lymph node involvement, estrogen, progesterone and CerbB2 staining. RESULTS: In this study, the presence of STATs and HIFs expressions in breast tumors is shown. In our study, no statistically significant correlation was found between tumor grade, diameter, limits, intratumor desmoplasia, inflammatory infiltration, necrosis, axillary lymph node involvement, CerbB2 staining status and STATs and HIFs expressions. However, STAT5a and estrogen staining and HIF2α and progesterone staining were found statistically significant. In addition, STAT3 expression was found to have significantly higher correlation with luminal breast cancer. CONCLUSIONS: The findings suggest that STATs and HIFs may play a role in the development of invasive ductal carcinomas; concerning their future use as treatment options due to their association with hormone receptors, new studies are required (Tab. 6, Fig. 7, Ref. 65).

Relationship between betatrophin levels and metabolic parameters in patients with polycystic ovary syndrome.

To evaluate the status of serum betatrophin levels and potential relations between metabolic parameters and betatrophin levels in patients with polycystic ovary syndrome. We included patients newly diagnosed with PCOS in our study. Fifty-seven female patients (30 patients with PCOS and 27 healthy control subjects) were enrolled in this study. Serum betatrophin levels were measured using a betatrophin enzyme-linked immunosorbent assay kit. Insulin resistance was calculated using the homeostasis model of the assessment-insulin resistance index formula. The betatrophin level was 1538,85 ng/L in the patient group and 2440,46 ng/L in the control group, and the difference was statistically significant (p=0.003). A significantly negative correlation was found between betatrophin level and insulin, HOMA-IR, and BMI. Betatrophin levels in patients with PCOS are lower than those without PCOS and inversely related to insulin resistance.

Are small adrenal incidentalomas solely a radiological finding?

OBJECTIVE: The criterium defining the threshold size of adrenal incidentaloma (AI) is a size greater than 1 cm diameter. However, data concerning AI≤1 cm in diameter is scant. The aim of this study was to evaluate the function of adrenal masses≤1 cm and to compare them with adrenal masses>1 cm. MATERIALS AND METHODS: The study included 130 consecutive patients with AI (38 and 92 AI at ≤ 1 cm and > 1 cm, respectively). The patients were evaluated according to demographic and hormonal characteristics. RESULTS: The prevalence of SCS was 5.3 and 12% in AI≤1 cm and > 1 cm diameter, respectively. Hyperaldosteronism was found only in patients with > 1 cm AI. Pheochromocytoma were not found in either group. Patients with > 1 cm AI had a higher prevalence of SCS and primary hyperaldosteronism than patients with ≤ 1 cm AI, but the difference was not significant. The prevalence of diabetes and hypertension was high both in non-functional AI with ≤ 1 cm and > 1 cm patients and showed no significant difference between the 2 groups. CONCLUSION: Our study is the first to focus on the clinical and hormonal characteristics of patients with ≤ 1 cm AI. Those with AI≤1 cm harboured SCS, as was the case for AI>1 cm. Similar to AI>1 cm, non-functional AI≤1 cm also had a higher prevalence of diabetes and hypertension.

Intrinsic factors rather than vitamin D deficiency are related to insulin resistance in lean women with polycystic ovary syndrome.

OBJECTIVE: To investigate the correlation between insulin resistance (IR) and serum 25-OH-Vit D concentrations and hormonal parameters in lean women with polycystic ovary syndrome (PCOS). PATIENTS AND METHODS: 50 lean women with PCOS and 40 body mass index (BMI) matched controls were compared in terms of fasting insulin and glucose, homeostatic model assessment insulin resistance (HOMA-IR), 25-OH-Vit D, high sensitivity C-reactive protein (hs-CRP), luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, dehydroepiandrosterone sulfate (DHEA-S), total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides and Ferriman-Gallway (FG) scores. Correlation analyses were performed between HOMA-IR and metabolic and endocrine parameters. RESULTS: 30% of patients with PCOS demonstrated IR. Levels of 25-OH-Vit D, hsCRP, cholesterol, HDL, LDL, triglyceride and fasting glucose did not differ between the study and control groups. Fasting insulin, HOMA-IR, LH, total testosterone, and DHEA-S levels were higher in PCOS group. HOMA-IR was found to correlate with hs-CRP and total testosterone but not with 25-OH-Vit D levels in lean patients with PCOS. CONCLUSIONS: An association between 25-OH-Vit D levels and IR is not evident in lean women with PCOS. hs-CRP levels do not indicate to an increased risk of cardiovascular disease in this population of patients. Because a strong association between hyperinsulinemia and hyperandrogenism exists in lean women with PCOS, it is advisable for this population of patients to be screened for metabolic disturbances, especially in whom chronic anovulation and hyperandrogenism are observed together.

Vertebral osteomyelitis: clinical features and diagnosis.

We aimed to describe clinical and diagnostic features of vertebral osteomyelitis for differential diagnosis and treatment. This is a prospective observational study performed between 2002 and 2012 in Ankara Numune Education and Research Hospital in Ankara, Turkey. All the patients with vertebral osteomyelitis were followed for from 6 months to 3 years. In total, 214 patients were included in the study, 113 out of 214 (53%) were female. Out of 214 patients, 96 (45%) had brucellar vertebral osteomyelitis (BVO), 63 (29%) had tuberculous vertebral osteomyelitis (TVO), and 55 (26%) had pyogenic vertebral osteomyelitis (PVO). Mean number of days between onset of symptoms and establishment of diagnosis was greater with the patients with TVO (266 days) than BVO (115 days) or PVO (151 days, p <0.001). In blood cultures, Brucella spp. were isolated from 35 of 96 BVO patients (35%). Among 55 PVO patients, the aetiological agent was isolated in 11 (20%) patients. For tuberculin skin test >15 mm, sensitivity was 0.66, specificity was 0.97, positive predictive value was 0.89, negative predictive value was 0.88, and receiver operating characteristics area was 0.8. Tuberculous and brucellar vertebral osteomyelitis remained the leading causes of vertebral osteomyelitis with delayed diagnosis. In differential diagnosis of vertebral osteomyelitis, consumption of unpasteurized cheese, dealing with husbandry, sweating, arthralgia, hepatomegaly, elevated alanine transaminase, and lumbar involvement in magnetic resonance imaging were found to be predictors of BVO, thoracic involvement in magnetic resonance imaging and tuberculin skin test > 15 mm were found to be predictors of TVO, and history of spinal surgery and leucocytosis were found to be predictors of PVO.

Positive correlation of serum parathormone and prostate specific antigen levels in prostate cancer.

OBJECTIVES: Clinical and experimental observations reveal the exact role of vitamin D in prostate cancer. Yet, a complete understanding of the issue necessitates the evaluation of the exquisite mechanisms that involve full actors of the calcium homeostasis in relation. BACKGROUND: Besides the role of vitamin D, parathyroid hormone (PTH) is now understood to be a mitogen for prostate cancer cells, and calcium has already been known for such role. The interplay between renin-angiotensin-aldosterone system effector hormones and calcium homeostasis attracts attention in recent studies. METHODS: Twenty five patients with prostate cancer (median age 66 (62-67) years) who had presented at the Urology Outpatient Clinic were prospectively included in the study. Also, 30 volunteer controls (median age 63 (60-70) years) were enrolled for comparison. Serum total PSA, intact PTH, calcium, aldosterone and 25-hydroxy vitamin D levels were detected in a selected group of patients with prostate cancer. RESULTS: The vitamin D levels were lower in PCa patients in line with some of the previous studies, supporting the role of vitamin D in prostate cancer. We also observed a positive correlation between PTH and PSA both in PCa patients and the controls. CONCLUSION: Our findings indicate that like age and race, PSA is associated with PTH. The role of PTH, as a master of calcium homeostasis, seems to be neglected in prostate carcinogenesis, concerning a very few number of studies pertaining to the subject in the literature (Tab. 2, Fig. 2, Ref. 19).

Ureterovesical malignancy following renal transplantation: a case report.

We present a case of ureterovesical stenosis that developed in 2 of 203 renal transplant patients operated between 1997 and 2005 in our department. In the current case, an ureterovesical region tumor was identified 1.5 years after renal transplantation, while being operated for the correction of ureterovesical stenosis. This report sought to remind physicians about the possibility of a malignancy in patients with ureterovesical stenosis following renal transplantation.

Extracorporeal shock wave treatment for defective nonunion of the radius: a rabbit model.

PURPOSE: To investigate the effect of extracorporeal shock wave treatment (ESWT) on bony union using volume analysis of the callus mass by computed tomography and histology. METHODS: Both radii of 13 rabbits were osteotomised and a defective bony nonunion created by placing a polyethylene pad between the osteotomy site for 40 days. Nonunion was confirmed by radiography using Lane-Sandhu criteria. ESWT (14 kW, 0.46 mJ/mm(2), 1000 shock waves) was applied to the right radius of the rabbits. The left radius served as a control. Five rabbits were killed 4 weeks after ESWT (group 1) and 8 after 6 weeks (group 2). Volume analysis of the callus mass was performed using computed tomography and the bone healing process was assessed by histology. RESULTS: In group 1, callus volume on the treated side was invariably greater than that on the control side; the difference being statistically significant (p=0.032). In group 2, the callus volume of the treated side was greater than that of the control side, except in rabbits 4 and 9. Only after excluding the findings from the latter did the difference attain statistical significance (p=0.020). Histology confirmed that the bone-healing process was faster in the treated side. CONCLUSION: ESWT enhanced the bone-healing process by increasing both volume and speed of callus formation.