Nesfatin-1 levels and metabolic markers in polycystic ovary syndrome.

Nesfatin-1 is a novel hormone synthesized in hypothalamus and several other specific organs to regulate eating habits, appetite and is thought to be related to ovarian functions. In our study, we aimed to evaluate the nesfatin-1 levels with other metabolic parameters in polycystic ovary syndrome (PCOS), a condition that is known to be related to both ovarian functions and obesity. Study subjects were chosen from the women attended to the Obstetrics and Gynecology Department of Istanbul Bilim University, Avrupa Florence Nightingale Hospital. Thirty-five healthy control subjects and 55 PCOS patients were included. Blood samples were obtained on the 3rd day of the menstrual cycle. Luteinizing hormone (LH), follicle stimulating hormone (FSH), free testosterone (FT), dehydroepiandrosterone sulfate (DHEA-S), insulin, fasting blood glucose (FBG), high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides (TG), sex hormone binding globulin (SHBG) levels were measured; homeostatic model assessment-insulin resistance (HOMA-IR) value was calculated. The nesfatin-1 levels were measured by competitive inhibition ELISA method. Due to our results, PCOS patients were having lower nesfatin-1 levels compared to the control group and this was not seemed to be related to body mass index (BMI) levels. This is an important result to be investigated in larger study groups and is related to other metabolic markers.

High DHEAS/free testosterone ratio is related to better metabolic parameters in women with PCOS.

AIMS: To demonstrate the effects of DHEAS/free testosterone (DHEAS/FT) ratio on metabolic parameters in women with and without polycystic ovary syndrome (PCOS). METHODS: The data of 91 women with PCOS and 66 women in the control group were collected retrospectively. RESULTS: DHEAS/FT of the control group was higher than that of PCOS group (684.93 ± 300.54 to 517.2 ± 300.8, p < 0.001). DHEAS/FT correlated with BMI (r = -0.352, p = 0.001), WHR (r = -0.371, p = 0.0219), LDL (r = -0.227, p = 0.031), HOMA-IR (r = -0.36, p = 0.001) and FAI (r = -0.639, p = 0.001) negatively and with HDL (r = 0.344, p = 0.001) and SHBG (r = 0.646, p = 0.001) positively. In the control group, DHEAS/FT correlated with BMI (r = -0.334, p = 0.007), CRP (r = -0.297, p = 0.016) and FAI (r = -0.399, p = 0.01) negatively. CONCLUSIONS: High DHEAS/FT ratios are related to a better metabolic phenotype in women with PCOS and low levels can be used to detect women with PCOS that have a higher risk of metabolic problems.

Quadruple test parameters in art pregnancies.

AIM: Quadruple test is used for Down's syndrome screening in the second trimester of pregnancy. The aim of this study was to investigate differences in quadruple test parameters between pregnancies achieved by assisted reproductive treatments (ART) and spontaneous conception. MATERIALS AND METHODS: We retrospectively compared levels of alfa-fetoprotein (AFP), unconjugated Estriol (uE3), inhibin-A and hCG and also screen positive test results. RESULTS: Levels of all quadruple test parameters were statistically significantly increased in ART pregnancies when compared to spontaneous pregnancies, AFP was 1.4±0.74 and 1.16±0.53, (p=0.001), uE3 was 1.10±0.37 and 1.00±0.28, (p=0.004), hCG was 1.56±1.04 and 1.26±0.76, (p=0.001), inhibin A was 1.38±0.76 and 1.08±0.57, (p=0.001), screen positive tests were nearly doubled (4.8% and 8.4%). CONCLUSIONS: Increased screen positive test results and quadruple test parameters in ART pregnancies may lead to unnecessary amniocentesis.

25-Hydroxyvitamin D levels are related to hyperinsulinemia in polycystic ovary syndrome.

AIM: To determine 25-hydroxyvitamin D levels and the relationship between 25-hydroxyvitamin D and metabolic disturbances including insulin resistance in women with PCOS. MATERIALS AND METHODS: We compared biochemical, hormonal parameters and 25-hydroxyvitamin D levels of 58 women with PCOS and 38 body mass index matched controls. RESULTS: There was no difference in 25-hydroxyvitamin D levels of women with PCOS and the control group. Low 25-hydroxyvitamin D levels in women with PCOS were related to higher insulin levels (r = -0.271 and p = 0.042). More than 90% of the subjects had hypovitaminosis D. The negative relationship between 25-hydroxyvitamin D levels and body mass index did not reach statistical significance. CONCLUSION: Low 25-hydroxyvitamin D levels were related to hyperinsulinemia in women with PCOS.

Low-grade fibromyxoid sarcoma of the vagina: A tumor, not previously reported at this site.

This report presents the first case of low-grade fibromyxoid sarcoma (LGFMS) arising from the vaginal wall (a rare soft-tissue sarcoma of subfascial planes) and draws attention to differential diagnosis of masses arising from the vaginal wall. A patient presenting with abdominal pain to emergency department was diagnosed to have an ovarian mass filling the Douglas space. At laparoscopy, the origin of the mass was identified as the posterior vaginal wall. After vaginal excision of the gelatinous mass, pathologic diagnosis revealed a rare tumor, LGFMS. We discussed the differential diagnosis of vaginal LGFMS.

Patients with epithelial cell abnormality in PAP smears: correlation of results with follow-up smears and cervical biopsies.

OBJECTIVE: Cervical carcinoma has been included in the preventable diseases category ever since the use of cervical cytology in routine practice. The Pap test is an efficient screening test. We aimed to compare the cervical cytology diagnosis with biopsy and smear follow up results in our institution. MATERIAL AND METHOD: We aimed to compare the diagnosis of cytology material examined in our institution during the 2009-2012 period with their biopsy and smear follow ups. The diagnoses were compared with the follow up smears and/or cervical biopsies. RESULTS: 13610 Pap tests were examined during September 2009-July 2012. Among these cases, there were 370 atypical squamous cells of undetermined significance (ASCUS), 29 atypical squamous cells-high grade intraepithelial lesions cannot be excluded (ASC-H), 155 low grade squamous intraepithelial lesion (LSIL), 33 high grade squamous intraepithelial lesion (HSIL), and 5 atypical glandular cell (AGC) diagnoses. The ratio of atypical squamous cell (ASCUS and ASC-H) to squamous intraepithelial lesions was 2.12. Squamous intraepithelial lesion was verified in 47 of 91 ASCUS cases. Among patients who had a cervical biopsy, 52 of 64 LSIL cases and all of the 21 HSIL cases had biopsy-proven SIL. CONCLUSION: Atypical squamous cell (ASC) is the most common diagnosis in abnormal cervical cytology. As it is indefinite, ASC is used as a quality assurance parameter and the aim is to decrease its use. As the ratio of epithelial cell abnormality is variable in different populations, the ASC/SIL is a more definite variable to be used for quality assurance. The efficiency in clinical use of the cervical cytology screening test is determined by biopsy verification. Our epithelial cell abnormality, ASC/SIL ratio and cytology-histology correlation values were parallel to the literature, proving that the methods are used reliably at our institution.

The utility of transrectal ultrasound in adolescents when transabdominal or transvaginal ultrasound is not feasible.

STUDY OBJECTIVE: To present the indications and diagnosis in adolescents undergoing transrectal ultrasound (RU). DESIGN: Retrospective chart review. PARTICIPANTS: Adolescents presenting to gynecology clinic between January 1, 2005 and December 31, 2012. MAIN OUTCOME MEASURES: Detection of RU, transvaginal, and transabdominal (AU) ultrasound indications, and final diagnosis. RESULTS: The main indications for RU were menstrual abnormalities, pelvic pain-dysmenorrhea, and vulvovaginitis. When compared according to final diagnosis adolescents with vulvovaginitis (13.9%) and amenorrhea (8.3%) were evaluated more with RU. CONCLUSION: RU is highly acceptable and it provides images superior to AU. It can be used in adolescents to visualize the pelvic organs and to exclude genital abnormalities and mass lesions.

Three-step approach versus see-and-treat approach in patients with cytological abnormalities.

The aim of this study was to compare the results of see-and-treat procedure with the classical three-step procedure in terms of initial cytology and LEEP reports. We searched the pathology charts of patients that had LEEP were searched retrospectively and then they were divided into 2 groups according to the presence or absence of a cervical biopsy before LEEP. There were 116 patients in the study. Of the patients with ASCUS/LSIL cytology and a positive cervical biopsy 48.4% had CIN 2-3 at LEEP, in contrast only 19% of the patients without a prior cervical biopsy had CIN 2-3 at LEEP (p=0.031); there was no statistically significant difference between the 2 procedures in patients with a HSIL and ASC-H smear result (p=0.726 and p=1.0 respectively). In conclusion patients with ASC-H and HSIL cytology see-and-treat approach seems more advantageous, avoids delay in treatment, noncompliance and risk of skipping lesions at biopsy.

Endocervical glandular involvement, multicentricity, and extent of the disease are features of high-grade cervical intraepithelial neoplasia.

This study aimed to evaluate the rate of endocervical glandular involvement, positive surgical margins, multicentricity, and disease extent between low-grade and high-grade cervical intraepithelial lesions after loop electrosurgical excision procedure (LEEP). Pathology medical records of patients who underwent LEEP were reviewed retrospectively. Patients with negative LEEP results were excluded. Loop electrosurgical excision procedure reports of patients with cervical intraepithelial neoplasia (CIN) 1, 2, and 3 were compared. There was no statistically significant difference between patients with CIN 1 (n=24), CIN 2 (n=27), and CIN 3 (n=64) when age and surgical margin positivity were considered. Endocervical glandular involvement, multicentricity, and disease extent were higher in patients with CIN 3 (P=.001, P=.002, and P=.001, respectively). In conclusion, we recommend that patients with endocervical glandular involvement, lesions involving more than two-thirds of the LEEP specimen, and multicentricity be followed up more closely.

Results of midtrimester emergency cerclage.

OBJECTIVE: To evaluate the outcomes of midtrimester emergency cerclage and to find out the contributing factors. STUDY DESIGN: Twenty-five patients presenting with cervical dilation and effacement with the membranes at the level of the external os or prolapsed into the vagina were included in the study. At the time of the cervical cerclage placement, gestational age ranged from 14-26 weeks. A good outcome was defined as the take-home baby rate, but also the interval between the time of the cervical cerclage placement and delivery and the gestational age at delivery were discussed. RESULTS: The mean gestational age at the time of the cervical cerclage placement was 21.2 +/- 2.73 weeks, the mean gestational age at delivery was 29.4 +/- 5.37 weeks, and the mean birth weight was 1,511 g. Eighteen patients had McDonald type cerclage, and 7 patients had both McDonald and Saling type cerclages. The overall take-home baby rate was 64%. Patients presenting with membranes at the level of external os had a take-home baby rate of 68.8%, whereas patients presenting with membranes prolapsed into the vagina had a take-home baby rate of 31.3%. CONCLUSION: Cervical dilation at midtrimester has a poor outcome which can be improved with emergency cerclage. Patients presenting with membranes prolapsed into the vagina have a decreased success rate. Total closure of the cervix may improve results.

Herlyn-Werner-Wunderlich syndrome--timely diagnosis is important to preserve fertility.

BACKGROUND: Herlyn-Werner-Wunderlich syndrome is an urogenital malformation with uterus didelphys and obstructed hemivagina with ipsilateral renal agenesis. Most of these patients present after the onset of menstruation. We describe two cases diagnosed too late to prevent the complications. CASE: The first patient presented with acute abdomen one year after the onset of menstruation and had salpingectomy due to pyosalpinx. The blind hemivagina was not recognized and she had severe endometriosis. She underwent hysterectomy 8 years later. The second patient presented with foul smelling vaginal discharge when she was 21 years old. She had a simple vaginal septum resection. SUMMARY AND CONCLUSION: In the presence of uterine cavities in a regularly menstruating girl with dysmenorrhea, the presence of both kidneys should be checked. When unilateral renal agenesis and uterus didelphys coexist the first thing that we should remember is to confirm or refute the presence of a blind vagina.

Serum visfatin levels in women with polycystic ovary syndrome.

The aim of this study is to determine the serum levels of visfatin in patients with polycystic ovary syndrome (PCOS) and to understand its correlations with other metabolic and hormonal parameters. Thirty-seven patients with PCOS and 30 women without concomitant disease were included in this study. Serum visfatin levels were similar in patients with PCOS and control group. Visfatin levels were higher in normal weight PCOS when compared with obese PCOS, but it did not reach statistical significance. Visfatin levels correlated negatively with fasting blood glucose, total cholesterol (TC), low-density lipoprotein (LDL) and lipoprotein-a levels in PCOS patients. CRP levels increased both in obese PCOS and in obese controls. Plasma visfatin levels had no correlation with homeostasis model assessment-insulin resistance and fasting insulin levels, but the negative correlation between plasma visfatin levels and lipoprotein-a, fasting plasma glucose, TC and LDL levels may indicate a role for visfatin in cardiovascular disease independent of insulin resistance.

C-reactive protein and lipoprotein-a as markers of coronary heart disease in polycystic ovary syndrome.

OBJECTIVE: The aim of this study was to investigate the risk factors of coronary heart disease, CRP and Lipoprotein-a in polycystic ovary syndrome patients. MATERIAL AND METHODS: Prospectively collected data of polycystic ovary syndrome patients (n=62) and control group (n=40) were compared. RESULTS: PCOS patients had higher HOMA-IR, CRP, DHEAS, free testosterone, FAI, LH and prolactin levels when compared to the control group. Lipoprotein-a levels did not differ between the groups. The obese PCOS group had statistically significantly higher fasting blood glucose, total cholesterol, triglyceride, free testosterone, insulin, CRP and HOMA-IR and statistically significantly lower HDL and SHBG when compared to normal weight PCOS persons. Fasting blood glucose, total cholesterol, LDL, SHBG, CRP, Lipoprotein-a, FSH, LH, TSH, DHEAS and prolactin levels did not differ between the normal weight and obese control groups. CONCLUSION: CRP levels increase in polycystic ovary syndrome patients and can be used as a marker of coronary heart disease. Future studies can be directed at treatments to decrease CRP levels, including antiinflammatory treatments.

Management of a rare case of arrhythmogenic right ventricular dysplasia in pregnancy: a case report.

INTRODUCTION: Arrhythmogenic right ventricular dysplasia is a heritable disease of the heart muscle characterized by fibrofatty degeneration of cardiomyocytes. Patients present with ventricular arrhythmias or congestive heart failure, and sometimes sudden cardiac death occurs. Prenatal diagnosis has become possible with the detection of mutations, but, to the best of our knowledge, no case of prenatal diagnosis has been reported previously. There is little information about the management of arrhythmogenic right ventricular dysplasia in pregnancy, and the preferred mode of delivery is not certain; therefore, we present the case of a patient with arrhythmogenic right ventricular dysplasia and discuss the prenatal diagnosis, patient management and prognosis in pregnancy. CASE PRESENTATION: A 26-year-old Caucasian woman who presented to our hospital with heart palpitations was diagnosed with arrhythmogenic right ventricular dysplasia, and, after three years of follow up with anti-arrhythmic drugs, she wanted to conceive. During pregnancy, she ceased taking her medication. She tolerated pregnancy very well but her cardiac symptoms recurred after her 30th week of pregnancy. She delivered a baby via cesarean section under general anesthesia in her 38th week of pregnancy. She was discharged without any medications and continued lactation for six months. CONCLUSION: Patients with mild to moderate arrhythmogenic right ventricular dysplasia tolerate pregnancy and breastfeeding very well, but patients with end-stage arrhythmogenic right ventricular dysplasia should be discouraged from conception.

Prenatal early diagnosis of dacryocystocele, a case report and review of literature.

Dacryocystocele (mucocele, amniocele) is a relatively rare variant of nasolacrimal duct obstruction which refers to the cystic dilatation of lacrimal pathway above and below the lacrimal sac. It is a benign pathology and can be treated successfully after birth, but its prenatal detection is important, because it may be seen in numerous syndromes and may serve as their marker. Bilateral cysts have the possibility for intranasal extension and an obstruction to the nasal passages may result in neonatal respiratory distress requiring surgical intervention Unilateral cases are important for the differential diagnosis with serious facial abnormalities. We present a case of early prenatal detection of a 28 year-old G: 1 P: 0 pregnant woman with bilateral dacryocystocele. She presented a live, normally developed singleton fetus on sonographic examination at 12, 16 and 22 weeks. At 25(th) weeks, we diagnosed a hypoechogenic mass, that was situated inferomedially to the eyes in the fetal face with 2 and 3-D ultrasound. A 3850-g live female infant was delivered by Cesarean section due to breech presentation at 39 weeks following preterm rupture of membranes. We report the case with intranasal components studied during fetal life by 2 and 3-D ultrasound and magnetic resonance (MR) imaging.