Could maternal serum MFG-E8 level predict adverse first trimester pregnancy outcome? A preliminary study.

BACKGROUND: Milk fat globule-epidermal growth factor 8 (MFG-E8) is expressed in the endometrial epithelium and its expression increases during the implantation process. Due to this knowledge, we aimed to investigate the maternal serum MFG-E8 levels on both healthy pregnant women in the first trimester and pregnant women complicated with missed abortion and threatened abortion in the first trimester. METHODS: This prospective, cross-sectional study was conducted in a tertiary referral hospital, department of obstetrics between July 2020 and February 2021 after ethical committee approval. The study population was consisted of 30 healthy pregnant women (HP) in the first trimester, 30 pregnant women suffering from threatened abortion (TA) in the first trimester and 30 pregnant women suffering from missed abortion (MA) in the first trimester. Maternal serum MFG-E8 levels were analyzed with enzyme linked immunosorbent assay. Delivery and neonatal outcomes of the study population was evaluated. The continuous variables were compared among three groups with variance analysis with post hoc tests. The categorical variables were compared with chi-square and Fisher's exact tests where applicable. RESULTS: The mean age of the study population was 29.36 ± 5.31 years. There was no significant difference among three groups for parameters of age, body mass index, parity number, and gestational week. Despite being within normal ranges, the mean neutrophil and international normalized ratio values of the three groups showed statistically significant difference (p < 0.05). The mean maternal serum MFG-E8 levels of MA, TA, and HP groups were 270 ± 152.3, 414.7 ± 236.7, and 474 ± 222.5 ng/mL, respectively (p = 0.001). It was found that mean of MFG-E8 of the MA group was statistically significantly lower than those of the other two groups (p < 0.05). DISCUSSION: Although maternal serum MFG-E8 level seems to be a parameter that differ between live and nonlive pregnancies, studies with large number of cases are needed to discuss our results and to determine a cut-off value for prediction.

What is the impact of intraperitoneal surfactant administration against postoperative intraabdominal adhesion formation? an experimental study.

Background/Aim: Surfactant is a surface-active substance that, in addition to its detergent effect, also has effects that reduce inflammation and fibrosis. Because of these effects, it was aimed herein to investigate the effect of intraperitoneal surfactant application on preventing postoperative peritoneal adhesion formation in a uterine horn adhesion model. Materials and methods: Twenty-one Wistar albino rats were randomly divided into 3 groups (G1-G3), as follows: G1 (n = 7): control group. The abdomen was opened and then closed; G2 (n = 7): adhesion group. The abdomen was opened. Then, a 2-cm linear incision was made over the right uterine horn, 2 mL of isotonic saline was administered intraperitoneally, and the abdomen was closed; and G3 (n = 7): treatment group. The abdomen was opened, a 2-cm linear incision was made over the right uterine horn, 2 mL (70 mg/kg) of surfactant was administered intraperitoneally, and the abdomen was closed. After 15 days, the rats were euthanized, the abdomens were reopened, and adhesion scoring was performed. After the right uterine horns were removed and fixed with 10% formalin, appropriate sections were taken from the traumatized tissue, stained with Masson's trichrome, and fibrosis and inflammation scoring were performed. Results: The adhesion area and intensity were significantly higher in G2 than in G1 and G3 (p = 0.001) and were similar in G1 and G3 (p = 0.165). While fibrosis and inflammation were significantly higher in G2 than in G1 and G3 (p = 0.001), there was no difference between G1 and G3 (p = 0.5). Conclusion: Intraperitoneal surfactant administration at a dose of 70 mg/kg was found to be effective in preventing intraabdominal adhesion formation in a rat uterine horn model.

Comparison of the efficacy between bilateral proximal tubal occlusion and total salpingectomy on ovarian reserve and the cholinergic system: an experimental study

Background and aim: To compare the effects of bilateral proximal tubal occlusion and bilateral total salpingectomy on ovarian reserve and the cholinergic system via rat experiment. Materials and methods: Twenty-one adult female rats were randomly divided into the following three groups:G1 (n = 7), sham group;G2 (n = 7), bilateral total salpingectomy group; and G3 (n = 7), bilateral proximal tubal occlusion group. Four weeks later, the abdomen of the rats was opened. The right ovarian tissues were stored in 10% formaldehyde, whereas the left ovarian tissues were stored at ­80 °C in aluminum foil. Serum samples were evaluated for antimullerian hormone. The right ovary was used for histological and immunoreactive examination, and the left ovary was used for tissue MDA analysis. Tissue samples were analyzed for MDA levels with spectrophotometric measurement, apoptosis with TUNEL staining, fibrosis score with Mason trichrome staining, ovarian reserve with HE staining, and cholinergic receptor muscarinic 1 (CHRM1) level with immunoreactivity method. Results: Compared to G1 and G3, the number of corpus luteum with secondary follicles was significantly lower in G2, whereas the number of ovarian cysts and fibrosis and apoptosis scores increased significantly. The CHRM1 immunoreactivity was significantly lower in G2 than in G1 and G3. Conclusions: Compared to the bilateral proximal tubal occlusion performed by using bipolar cautery, bilateral total salpingectomy in rats leads to a significant damage in ovarian histopathology and the cholinergic system.

What is the effect of the early follicular phase FSH/LH ratio on the number of mature oocytes and embryo development?

Background/aim: Basal level of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and antral follicle count are used as predictors of ovarian reserve before starting ovulation induction. We aimed to investigate the predictor potential of early follicular phase FSH/LH ratio on controlled ovarian hyperstimulation-intracytoplasmic sperm injection (COH-ICSI) cycle outcomes. Materials and methods: This retrospective cohort study was conducted with 648 COH-ICSI cycles performed between 2012 and 2014. Cycles were classified according to their basal FSH/LH ratio, group 1(G1) = FSH/LH ratio < 2, N = 473 and group 2(G2) = FSH/LH ratio ≥ 2, N = 175. Demographic characteristics and stimulation parameters were evaluated. Retrieved total oocyte count (TOC), mature oocyte count (MOC), transferred embryo number, and pregnancy results were obtained and transferred to computer by SPSS 21.0 programme. Results: TOC and MOC of G1 were significantly higher than those of G2. The total gonadotrophin doses of G2 were significantly higher than G1. There was no significant difference between groups for transferred embryo number. Pregnancy and live birth rates were similar in both groups. Conclusion: In our population, increased FSH/LH ratio did not affect the rates of pregnancy and live birth negatively.

Ovarian stimulation modalities in poor responders

Abstract: In a group of IVF/ICSI cycles, despite the appropriate ovarian stimulation, the number of oocytes collected is below the expected value. This condition is defined as poor ovarian response (POR) to stimulation. POR brings the risk of cycle cancellation with an estimated rate of 20%. Infertility experts are trying to improve cycle outcomes of POR cases with multiple modifications. This review article will present the latest modifications on the management of POR. The studies performed for improving cycle outcome in POR cases were evaluated and their notable results were presented. The first intervention among infertility specialists is to make a standard definition for POR. The BOLOGNA criteria and the subsequent POSEIDON group definitions are the latest updates in POR management. GnRH antagonists, estradiol priming, double stimulation, letrozole administration, DHEA, and herbal therapy supplementations are the recent modifications done to improve oocyte retrieval and subsequent embryo transfer for POR cases. This review article presents the encouraging methods applied for POR cases to improve cycle outcome.

The impact of plasma SOCS3 levels and endometrial leukocytes on unexplained infertility

Background/aim: To investigate the possible differences in endometrial leukocyte subtype distribution between women with unexplained infertility and normal fertile women and to determine whether there is a correlation between endometrial leukocyte counts and plasma cytokine levels in unexplained infertility. Materials and methods: This case-control study involved 79 infertile and 40 fertile women. Peripheral venous blood samples and endometrial samples were obtained on day 21 of the menstrual cycle. Plasma interleukin-4 (IL4), IL6, IL10, IL17, IL35, interferongamma (IFN-g), tumor necrosis factor-alpha (TNF-a), transforming growth factor-beta (TGF-b), and suppressor of cytokine signaling-3 (SOCS3) levels were determined by enzyme-linked immunosorbent assay. Endometrial CD8, CD56, and CD163 counts were detected by immunohistochemistry. Results: CD8 and CD56 counts were significantly higher, while CD163 count was significantly lower in infertile women than in fertile women. Plasma SOCS3, IL35, and IL4 levels of the infertile group were significantly lower than those of the fertile group (P < 0.01); the remaining cytokine levels were significantly higher in the infertile group than in the fertile group (P < 0.01). Conclusion: We observed aberrant cytotoxic immune activity in infertile women. The interaction between plasma SOCS3 levels and staining degree of endometrial leukocytes may be either the reason for or result of infertility leading to unavailability of the environment for implantation.

Sigmoid Colon Perforation Mimics a Tuboovarian Absces.

INTRODUCTION: An adnexal mass may be diagnosed after a routine pelvic ultrasonographic examination or an emergent hospital admission due to rupture of ectopic pregnancy, adnexal torsion or rupture of tuboovarian abscess. It is necessary to evaluate the origin of the mass initially and to classify patients who need further evaluation and treatment for an urgent condition. CASE PRESENTATION: We report a case of sigmoid colon rupture due to sigmoid colon adenocarcinoma presenting as acute abdomen with left adnexal mass in a 28 years old woman. Abdominopelvic computed tomography revealed a left adnexal mass with suspicion of tuboovarian abscess. In laparatomy, rupture of sigmoid colon was observed and resection of sigmoid colon was performed. Histological examination of resection part revealed diagnosis of sigmoid colon adenocarcinoma due to familial adenomatous polyposis. CONCLUSION: This case may be interesting for clinicians because pelvic pain, fever, increased infection markers in the laboratory and mass at ultrasonography or other screening methods could cause a misdiagnosis of tubaovarian abscess especially in reproductive age women. Before the operation of the pelvic mass of all age women with the diagnosis of tuboovarian abscess other causes of the pelvic abscess should come into mine and necessary preparation for operation must be done.

Could erythropoietin reduce the ovarian damage of cisplatin in female rats?

The aim of this study is to investigate whether erythropoietin (EPO) can reduce the ovarian damage of cisplatin or not. Thirty, female, Wistar-Albino rats were used in the study. Control group (N = 10): Intraperitoneal saline infusion, Cisplatin group (N = 10): Intraperitoneal 7 mg/kg cisplatin, Cisplatin + EPO group (N = 10): Intraperitoneal 7 mg/kg cisplatin and subcutaneous 200 IU/kg/day EPO. Serum AMH concentrations were measured by enzyme-linked immunosorbent assay kit of AMH. Follicular counts were evaluated according to mean diameter of the follicles. Ovarian damage; including follicular cell degeneration, vascular congestion, hemorrhage, and inflammation was scored histologically using a graduated scale. Posttreatment AMH levels of cisplatin group were significantly lower than control and cisplatin + EPO groups. In cisplatin group, there was a significant decrement in posttreatment AMH level compared to pretreatment AMH level. The total damage score of cisplatin group was significantly higher than scores of control and cisplatin + EPO groups. The mean primordial follicle counts of control and cisplatin + EPO groups were significantly higher than that of cisplatin group (p = .007 and p = .003). The results of this study revealed that EPO administration to cisplatin chemotherapy could ameliorate the ovarian damage. Erythropoietin administration to chemotherapeutic agents might suggest to protect ovarian failure and infertility.

Investigation of the maternal and cord plasma levels of IL-1 beta, TNF-alpha and VEGF in early membrane rupture.

OBJECTIVE: Recent studies indicate a relationship between early membrane rupture (EMR) and proinflammatory cytokines like tumor necrosis factor (TNF) and interleukin (IL) and angiogenic factors like vascular endothelial growth factor (VEGF). In this study, we aimed to investigate the relationship between EMR and maternal and cord blood plasma levels of TNF-alpha, IL-1 beta and VEGF. METHODS: This prospective, cross-sectional study was conducted with 85 pregnant women. The patients were divided into four groups as Group I (term EMR group, n = 21), Group II (preterm EMR group, n = 23), Group III (preterm non-EMR group, n = 19) and Group IV (term non-EMR group, n = 22). Plasma levels were assayed with ELISA method. RESULTS: IL-1 beta levels were significantly lower, but TNF-alpha levels were significantly higher in maternal and cord plasma of EMR participants compared to non-EMR participants. There was no significant difference for VEGF levels. Cord plasma TNF-alpha levels were significantly higher than maternal plasma levels in EMR participants and cord plasma. VEGF levels were significantly higher than maternal levels in all participants. CONCLUSIONS: Higher TNF-alpha levels in our EMR participants indicate an inflammatory process during EMR. Higher cord plasma VEGF levels may point out placental or fetal production. Further studies conducted with expanded populations are needed to discuss our results.

Effect of varying doses of tamoxifen on ovarian histopathology, serum VEGF, and endothelin 1 levels in ovarian hyperstimulation syndrome: an experimental study.

OBJECTIVE: To examine the effects of low-to-high doses of tamoxifen on ovarian histopathology, serum VEGF, and endothelin 1 levels in ovarian hyperstimulation syndrome (OHSS) in an experimental setting. MATERIALS AND METHODS: A total of 20 female Wistar albino rats, 22 days of age, were randomly divided into four groups. Follicle-stimulating hormone 10 IU was administered subcutaneously in 15 rats on 4 consecutive days, with OHSS induction on day 5 by 30 IU of human chorionic gonadotropin. Group 1 (n=5) comprised 35-day-old control rats, group 2 (n=5) 35-day-old OHSS rats, group 3 (n=5) 27-day-old OHSS rats receiving 1 mg/kg of oral tamoxifen for 7 days, group 4 (n=5) 27-day-old OHSS rats receiving 3 mg/kg of oral tamoxifen for 7 days. All rats were decapitated on day 35. Serum VEGF, endothelin 1, and ovarian follicular reserve were assessed in all rats. Kruskal-Wallis variance analysis and the Mann-Whitney U-test were used for statistical comparisons. A Bonferroni correction was performed to control the inflation of significance, with a significance level set at a P-value of less than 0.025. RESULTS: Despite higher serum VEGF, endothelin 1, follicular reserve, and angiogenesis and fibrosis of the corpus luteum in the OHSS group compared to controls, these differences were not significant (P>0.025, Mann-Whitney U-test). There was a significant reduction in the ovarian follicular reserve in tamoxifen groups compared to controls (P<0.025, Mann-Whitney U-test), while angiogenesis of the corpus luteum, number of atretic follicles, fibrosis, and serum VEGF were significantly higher in rats receiving tamoxifen (P<0.025, Mann-Whitney U-test). Also, significantly lower follicular reserve and fibrosis were observed among rats in the low-dose tamoxifen group in comparison with rats in the high-dose tamoxifen group (P<0.025, Mann-Whitney U-test). No groups had a significant change in endothelin 1 levels (P>0.025, Mann-Whitney U-test). CONCLUSION: Tamoxifen 1 g and 3 g resulted in a dose-dependent increase in VEGF and endothelin 1 levels, and ovarian follicle reserves were significantly reduced in our experimental model.

Evaluation of vitamin C and vitamin E for prevention of postoperative adhesion: a rat uterine horn model study.

AIM: To investigate the effectiveness of intraperitoneal vitamin C (VC) and vitamin E (VE) in the prevention of postoperative adhesion formation in a rat uterine horn model. METHODS: Twenty-eight Wistar albino rats were divided into four groups in which: control group, the abdomen was opened and closed without any intervention; adhesion group, a 2-cm linear incision was performed on the uterine horn and closed; VC group, VC was administrated i.p., and 15 min later a 2-cm incision was performed on the uterine horn and closed; and VE group, VE was administrated i.p., and 15 min later a 2-cm incision was performed on the uterine horn and closed. Re-laparotomy was performed 15 days later. Right uterine horn adhesions were evaluated according to macromorphological characteristics and tissue sections were further examined for fibrosis, angiogenesis and vascular endothelial growth factor (VEGF), type I collagen and malondialdehyde (MDA) scoring. Kruskal-Wallis anova and Mann-Whitney U-test were utilized for statistical analysis. RESULTS: Adhesion area and also strength were significantly lower in the VC group and the VE group compared with the adhesion group. Fibrosis and angiogenesis scores were observed to be significantly higher in the adhesion group compared with the VC group and the VE group. MDA and VEGF immunoreactivity were also found to be significantly lower in the VC group and the VE group compared with the adhesion group. However, there was no significant difference between the VC group and the VE group with respect to all the above parameters. CONCLUSION: Administration of VC or VE i.p. was observed to be effective in the prevention of postoperative adhesion formation in an experimental model.

What is the impact of SOCS3, IL-35 and IL17 in immune pathogenesis of recurrent pregnancy loss?

OBJECTIVE: To investigate the plasma levels of interleukin-4 (IL-4), IL-6, IL-10, tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), transforming growth factor-beta (TGF-beta), IL-17, IL-35 and suppressor of cytokine signaling 3 (SOCS3) in the women with history of idiopathic recurrent pregnancy loss (RPL) and in the fertile controls. METHODS: This study was conducted with 60 idiopathic RPL cases and 40 age-matched fertile controls. Mid-follicular plasma levels of IL-17, IFN-gamma, TNF-alpha, TGF-beta, IL-6, IL-4, IL-10, SOCS3 and IL-35 were assayed by an enzyme linked immunosorbent assay. RESULTS: The mean age of RPL and control cases were 31.6 ± 0.6 and 32.1 ± 0.7 years, respectively. While plasma IL-35 and SOCS3 levels of RPL group were significantly lower than that of the control group; IFN-gamma, TNF-alpha, IL-4, IL-6, IL-10, IL-17 and TGF-beta levels of RPL group were significantly higher than that of the control group. The comparison of cytokine ratios between RPL and control groups indicated significantly high TNF-alpha/IL-10, TNF-alpha/IL-4, IFN-gamma/IL-10, IFN-gamma/IL-6 and IFN-gamma/IL-4 ratios in the RPL group. IL-35/IL-17 ratio was significantly low in the RPL group compared to that in the control group. Overstimulation of TNF-alpha presented moderate influence on recurrent miscarriage risk. CONCLUSION: Decreased SOCS3 and IL-35 plasma levels and increased Th1/Th2 cytokine ratios in RPL cases pointed out the supression of anti-inflammatory process and this supression might play an important role in the pathogenesis of idiopathic RPL.

Complete tamponade system for management of severe postpartum vaginal haemorrhage due to uterine atony.

A 30-year-old, 39 weeks pregnant, multiparous woman with single fetus, attended our obstetric clinic with complete cervical dilation in intractable mentum anterior presentation. The fetus was delivered by caesarean section with vertical uterine incision under general anaesthesia and lithotomy position. After surgery, examination of the vagina revealed multiple, serious tears with severe haemorrhage. Vaginal bleeding could not be controlled by sutures and concurrently uterine atony developed, which could not be controlled with medical treatment. Owing to intractable bleeding from uterus and vagina, a complete tamponade system was used. After the instillation of the uterine balloon with 500 mL and vaginal balloon with 300 mL liquid, the bleeding was controlled. The estimated blood loss was 3200 mL. The vaginal wound healed well during the postoperative 2 weeks. A complete tamponade system may be an effective treatment method for treatment of postpartum haemorrhage owing to vaginal lacerations and uterine atony.

Impact of intracystic ethanol instillation on ovarian cyst diameter and adjacent ovarian tissue.

OBJECTIVE: To investigate the regression level of simple ovarian cyst size after local ethanol application and the damage level of adjacent ovarian reserve in rats. STUDY DESIGN: This study was conducted at Firat University Animal Laboratory with 18 mature (12-14 weeks old) female Wistar albino rats weighing 200-220g, with regular cycles. Ovarian cyst induction was performed with unilateral salpingectomy. Fourteen rats with ovarian cysts after a second laparotomy were divided into two groups as follows: Group 1 (n=7): cyst aspiration group, and Group 2 (n=7): intracystic 95% ethanol application group. One month after the cyst aspiration procedure a third laparotomy was performed. The cyst number and size were recorded for each rat. Right ovariectomy was performed and formalin-fixed/paraffin-embedded tissues were sectioned at 5µm thickness. Under light microscopy, ovarian total follicle reserve and fibrosis were evaluated with Masson trichrome staining and apoptosis was evaluated with TUNEL staining. The groups were compared with the Mann-Whitney U test and Wilcoxon Rank test. p<0.05 was considered significant. RESULTS: Ovarian cyst formation was observed in 85% (15/18) of rats. The mean diameter of ovarian cysts in Groups 1 and 2 were, respectively, 10.3mm and 10.1mm. After aspiration, there was no significant reduction in the cyst diameter (10.3mm vs 8.1mm), but after ethanol application the diameter significantly reduced (10.1mm vs 3.4mm, p<0.05). Mean ovarian follicle count in Group 2 was significantly lower than in Group 1 (25 vs 42, p<0.05), and mean fibrosis and apoptosis scores in Group 2 were significantly higher than in Group 1 (2.5 vs 0.9, p<0.05). CONCLUSION: Local ethanol application reduces cyst diameter but concomitantly decreases ovarian reserve due to increased fibrosis in rats. In humans, intracystic ethanol application should be performed cautiously.

What is the impact of Th1/Th2 ratio, SOCS3, IL17, and IL35 levels in unexplained infertility?

Implantation necessitates complex interactions among the developing embryo, decidualizing endometrium, and developing maternal immune tolerance and/or alterations in cellular and humoral immune responses. Overstimulation of T helper 1 (Th1) or Th2 cytokines in systemic and local environments, alterations of the prevalence of IL17 and regulatory T cell (Treg) cytokines have also been suggested to contribute to the pathogenesis of implantation failure. We aimed to investigate the plasma levels of IL4, IL6, IL10, TNFα, IFNγ, TGFß, IL17, IL35, and SOCS3 in infertile and fertile women. This case-control study was conducted with 80 women suffering from unexplained infertility and 40 fertile women. Peripheral venous blood samples were drawn on day 21 of the menstrual cycle. The extracted plasma samples were assayed by an enzyme linked immunosorbent assay. Statistical analysis was performed using SPSS version 16.0. Our main findings were as follows: despite the significantly high IL17 and IL35 plasma levels of infertile women, IL35/IL17 ratio was significantly lower in the infertile group compared with that in the fertile group; SOCS3 plasma levels showed an inverse relation with plasma levels of all cytokines except IL35; increased plasma IL17 levels (>3.42 pg/mL) have a negative impact on fertility; TNFα/IL10, IFNγ/IL10, IFNγ/IL6, and IFNγ/IL4 ratios were significantly higher in infertile group compared with those in the fertile group. It is not possible to show the major immunological factor(s) of unexplained infertility, but our findings point out that the decreased suppressor activity of the immune system may play a role in implantation failure.

Plasma IL-17, IL-35, interferon-γ, SOCS3 and TGF-ß levels in pregnant women with preeclampsia, and their relation with severity of disease.

UNLABELLED: Abstract Objective: To research the hypothesis of preeclampsia (PE) is associated with increased systemic inflammatory responses of Th1-type as well as decreased Th2-type responses; we evaluated the maternal plasma levels of IFN-gamma, TNF-alpha, TGF-beta, IL-4, IL-6, IL-10, IL-17, IL-35 and SOCS3 in preeclamptic and healthy pregnants. METHODS: This study was conducted with 40 preeclamptic (study group) and 40 normotensive pregnant (control) women in third trimester when they were admitted to the labor and delivery unit. The extracted maternal plasma samples were assayed by an enzyme-linked immunosorbent assay. Statistical analysis was performed by SPSS 16.0 version. RESULTS: While IFN-gamma and TGF-beta levels of preeclamptic women were significantly higher (p < 0.01), IL-35 and IL-17 levels of preeclamptic women were significantly lower (p < 0.01) than those of controls. The ratios of IFN-gamma/IL-10, IFN-gamma/IL-6, IFN-gamma/IL-4 were significantly high and ratio of IL-35/IL-17 was significantly low in the PE group compared to those in the control group. Maternal plasma SOCS3 levels showed negative correlation with blood pressure and proteinuria severity, but none of the cytokines showed influence on blood pressure and proteinuria after adjusting for maternal and gestational age. CONCLUSIONS: Increased IFN-gamma/TGF-beta production and reduced IL-35/IL-17/SOCS3 production in preeclamptic women may lead to less cytokine inhibitory activity in PE, which may account for the increased proteinuria and blood pressure in PE.

Lower extremity venous Doppler evaluation in patients undergoing laparoscopic gynecological operations.

BACKGROUND: Laparoscopy is established as a standard of care in a variety of gynecological pathologies. Pneumoperitoneum and reverse Trendelenburg positioning during laparoscopy have been claimed to increase thrombosis risk, albeit these proposals are still controversial. The aim of this study was to assess lower extremity venous blood flow by Doppler sonography in patients undergoing laparoscopic gynecological surgeries. PATIENTS AND METHODS: A prospective, nonrandomized, controlled study was designed to compare lower extremity venous Doppler measurements in patients undergoing diagnostic and operative gynecological laparoscopies. In the period from May 2010 to April 2011, in total, 96 patients operated on for various gynecological complaints excluding malignancy were enrolled in the study. Thirty-two of these patients underwent diagnostic laparoscopy, 34 underwent operative laparoscopy, and 30 underwent open surgery. Lower extremity venous blood flow was investigated by Doppler sonography in patients the day before surgery and 24 hours afterward. Preoperative and postoperative Doppler measurements were obtained from bilateral common and superficial femoral, bilateral great saphenous, and bilateral popliteal veins. RESULTS: Lower extremity venous Doppler measurements were similar in diagnostic and operative laparoscopy groups. Femoral venous blood flow measurements were observed to be similar, but great saphenous and popliteal blood flows were found to be significantly decreased in the open surgery group compared with laparoscopic operations. CONCLUSIONS: The laparoscopic approach in gynecological surgery is not associated with an adverse effect on lower extremity blood flow and seems not to bring an additional risk of thrombosis.

Investigation of apelin expression in endometriosis.

BACKGROUND: Apelin is a mitogenic peptide; it has functions in vessel formation and cell proliferation. In this study we aimed to evaluate the serum and tissue levels and local expression pattern of apelin in eutopic and ectopic endometrium from patients with and without endometriosis and to compare the proliferative and secretory phase differences. METHODS: Thirty women with endometriosis and 15 women without endometriosis undergoing surgery for benign indications as control group were included in the study. Serum and tissue concentrations and proliferative and secretory phase expression patterns of apelin were evaluated in the ectopic and eutopic endometrium using immunoassay and immunohistochemistry methods. The results were compared with Mann-Whitney U test. The p-values smaller than 0.05 were considered as statistically significant. RESULTS: Apelin expression was detected in eutopic and ectopic endometrium of women with endometriosis and endometrium of control group. Intense immunoreactivity of apelin was observed in glandular cells of eutopic and ectopic endometrial tissues of women with endometriosis and endometrium of control group during secretory phase (p<0.01). In both groups, tissue concentrations of apelin were higher than of the serum (p=0.03) but, there were no significant differences between the two groups for tissue and serum concentrations of apelin. CONCLUSION: Apelin expression showed cyclic changes in eutopic and ectopic endometrium. Its expression may be related to menstrual changes of angiogenesis in endometrium of women.

Impact of grandmultiparity on perinatal outcomes in eastern region of Turkey.

OBJECTIVE: It is suggested that grandmultiparity is a troublesome condition in obstetric settings because of increased perinatal complications. Our objective was to compare the incidence of antenatal and intrapartum complications and perinatal outcomes among women who had delivered ≥5 times (grandmultiparous) with those of women who had delivered 1-4 times (parous). METHOD: A retrospective study was conducted in a university hospital. The study population consisted of age-matched 249 grandmultiparous women and 338 parous women, who had delivered between January 2008 and January 2011. Maternal case records were retrieved and analyzed from the labor ward records. Statistical analysis was done using SPSS version 14.0; χ(2) test was used to analyze categorical variables. RESULTS: The frequencies of hypertensive disorders and gestational diabetes mellitus did not differ between gropus (p > 0.05). Obstructed labor, cord prolapse, placenta previa and abruptio placenta were higher in grandmultiparous women. A significantly higher rate of cesarean deliveries was observed in the study population. There was no difference in terms of mode of delivery, prevalence of low and high birthweight (<2.5 and >4 kg) babies, stillbirth, multiple pregnancy and fetal distress. CONCLUSIONS: We did not observe an increased incidence of perinatal complications in grandmultiparous women.

Is there any relation between IL-6 gene -174 G>C polymorphism and postmenopausal osteoporosis?

OBJECTIVE: IL-6 gene single nucleotide polymorphisms (SNPs) have been reported to have a protective effect against bone resorption. We aimed to investigate the association between bone mineral density and IL-6 promoter region -174 G>C SNP. STUDY DESIGN: This study included 356 postmenopausal Turkish women, of whom 201 were osteoporotic (lumbar spine T score<-2.5 SD) and 155 non-osteoporotic (lumbar spine T score>-1.5 SD). Bone mineral density (BMD) measures were obtained using dual-energy X-ray absorptiometry. SNP of the IL-6 gene (-174 G>C) was examined by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: The frequencies of the variant C allele (24% vs. 30%, p=0.074) and mutant CC genotype (12% vs. 20%, p=0.094) were higher in non-osteoporotic women. Lumbar spine and total hip BMD values were lowest among women with the G/G genotype, intermediate in the heterozygotes, and highest in women with the C/C genotype. The GG (p=0.022) and GC (p=0.037) genotypes were covariates which approached statistical significance in the regression model fitting of BMD. CONCLUSION: IL-6 promoter region SNP showed an association with BMD in this postmenopausal Turkish population and these data suggest that the wild GG genotype influences the phenotype.