Hearing levels in menopausal women and the effect of tibolone on audiological functions.

The aim of this study was to examine the hearing levels of menopausal and premenopausal women of the same age and to evaluate the effect of tibolone on hearing. The study involved 83 postmenopausal women. Cases using tibolone were grouped into the tibolone group (T-group) and women without any hormone therapy were grouped into the non-tibolone group (NT-group). A total of 45 premenopausal women of the same age were taken as controls. Hearing levels of both ears were measured by audiometry. Significantly lower levels of hearing threshold at different levels were detected in the control group compared with the other groups. Postmenopausal women with and without tibolone therapy have poorer thresholds compared with still menstruating women of the same age. Thus, intrinsic oestrogen at physiological levels might slow down hearing loss in ageing women. Tibolone had no negative effect on hearing function.

Effect of tibolone on audiologic functions in menopausal women.

OBJECTIVE: The aim of this study was to examine the effect of tibolone on hearing function in postmenopausal women. METHODS: This prospective study involved 60 postmenopausal women. Participants were randomly divided into two groups. The tibolone group was assigned to receive a tibolone tablet daily (n = 30). The other 30 cases who had not received any kind of hormone therapy were taken as the control group. The hearing levels of both ears in all women were measured by audiometry before initiation of tibolone therapy and 6 months after therapy. RESULTS: The baseline hearing threshold levels of the two groups were similiar. After 6 months, audiometry results did not differ from baseline levels in the control group. In the tibolone group, there was some improvement in almost all hearing threshold levels after therapy. Statistically significant differences were only observed on the right side at pure tone audiometry and at the 500 and 6000 Hz levels. CONCLUSIONS: Although tibolone has both gestagenic and androgenic properties together with estrogenic properties, no negative effect on hearing after 6 months of treatment was observed. On the contrary, there was significant improvement in audiometry results at low frequencies after 6 months' treatment. Although statistically not significant, there was some improvement at high frequencies.

A life-threatening second trimester disseminated intravascular coagulopathy with protein s deficiency.

Disseminated intravascular coagulopathy (DIC) is an uncommon but serious complication of pregnancy. Placental abruption is the most common associated condition among the causes of acute obstetrical DIC. We present a case of life-threatening DIC complicating placental abruption in the second trimester of pregnancy with protein S deficiency as a triggering factor, which necessitated urgent termination of pregnancy.

Assessment of glucose tolerance and pregnancy outcome of polycystic ovary patients.

OBJECTIVES: To determine the impact of polycystic ovary syndrome (PCOS) on glucose tolerance during pregnancy and perinatal outcome. METHODS: Pregnancy records of 38 PCOS patients were compared retrospectively with 136 non-PCOS patients randomly. Patients with glucose challenge tests values of >130 mg/dl were referred for the 3-h, 100-g oral glucose tolerance test (OGTT). RESULTS: A family history of diabetes mellitus, pre-pregnancy body mass index (BMI), gestational weight gain was significantly higher in PCOS patients than controls. The prevalence of gestational diabetes mellitus (GDM) was similar in both groups. Impaired glucose tolerance (IGT) was observed in 18.4% of PCOS patients vs. 5.1% of controls. The main predictor of GDM was found pre-pregnancy BMI >25 while main predictor of IGT was found as PCOS. Mean gestational age at delivery, prevalence of preterm labor, modes of delivery, mean birthweight, mean Apgar score at 5 min, proportion of babies admitted to the neonatal intensive care unit (NICU) were similar in both groups. CONCLUSIONS: Higher IGT prevalence in PCOS patients might be related to maternal obesity and excess gestational weight gain and does not affect perinatal outcome.

Growth of the fetal lens and orbit.

OBJECTIVES: To present normal lens and orbital measurement ranges by gestational age. METHODS: Three hundred and thirty-five women with uneventful pregnancies were evaluated from the 15th to the 40th week of gestation. Lens and orbital measurements were added to routine biometric measurements for normal fetuses. RESULTS: A strong linear correlation was observed between gestational age (GA) and lens diameter (R(2)=0.89; P<0.0001), circumference (R(2)=0.89; P<0.0001), and surface (R(2)=0.90; P<0.0001). A linear correlation was also found between GA and orbital diameter (R(2)=0.92; P<0.0001), circumference (R(2)=0.92; P<0.0001) and surface (R(2)=0.95; P<0.0001). A linear growth function was observed between biparietal diameter and both lens diameter (R(2)=0.90; P<0.0001) and orbital diameter (R(2)=0.94; P<0.0001). CONCLUSION: Lens and orbital measurements provide normative data for fetal growth and development. These data may be also helpful in detecting fetal ocular anomalies.

Antepartum prophylactic transabdominal amnioinfusion in preterm pregnancies complicated by oligohydramnios.

OBJECTIVE: To assess the role of amnioinfusion in preterm pregnancies with oligohydramnios. METHOD: 29 women between 23 and 35 weeks' gestation were enrolled in the study. Transabdominal amnioinfusion was performed in 15 pregnancies, 14 patients were managed expectantly. The latency period and perinatal outcome of both groups were compared using the Mann-Whitney U-test and chi(2)-test. RESULT: The amniotic fluid index significantly increased from a median value of 6 to 11 cm (P<0.0001) in the amnioinfusion group after amnioinfusion. The latency period of the amnioinfusion group was significantly longer (median 15 vs. 8 days P<0.05). Gestational week of the amnioinfusion group was earlier on admission (median 30.6 vs. 33.4 weeks, P=0.01) but at delivery this diversity disappeared (median 33.4 vs. 34.8 weeks, P=0.10). The perinatal outcomes of the two groups were similar. CONCLUSION: Transabdominal amnioinfusion prolongs the latency period and improves perinatal outcome in preterm pregnancies complicated by oligohydramnios.

Acute uterine inversion due to a growing submucous myoma in an elderly woman: case report.

A case of acute non-puerperal uterine inversion due to a growing submucous myoma in elderly woman is presented. This is rare and the diagnosis is often difficult.

Intermittent versus continuous sertraline therapy in the treatment of premenstrual dysphoric disorders.

OBJECTIVE: Premenstrual dysphoric disorder (PMDD) is a combination of mood disturbances and physical symptoms that reduce the quality of individual life and the functionality of the individual. Many women do not consider the complaints arising in the luteal phase of the menstrual cycle as a psychiatric disorder and, thus, do not seek treatment. Those who take their complaints to doctors usually apply to gynecology clinics. The aim of the present study is to analyze the psychiatric disorders observed in patients with PMDD and to compare the continuous and intermittent administration of sertraline. MATERIALS AND METHODS: PMDD was investigated in the patients admitted to the Gynecology Clinic of the Medical School of Fatih University. The patients were asked to fill out forms designed in accordance with PMDD diagnosis criteria as defined in DSM IV. RESULTS: Among the 267 patients who filled out the forms, 162 (60.7%) were PMDD positive. Of the PMDD-positive patients, 133 accepted a psychiatric interview; 36 (27%) of them had depression, obsessive-compulsive disorder, anxiety and somatoform disorders as an accompanying disorder. Out of 162 PMDD-positive patients 94 accepted medical treatment; 71 patients were given sertraline on a continuous basis, and 23 patients took sertraline intermittently in the luteal phase of the cycle. Because of side effects, 44 (62%) of the continuous therapy and 22 (96%) of the intermittent therapy group stopped medication. At the end of 6-month follow-up, continuous use of sertraline was found to be significantly more tolerated than intermittent therapy in the treatment of PMDD (chi2 = 7.88, p = 0.005). CONCLUSION: In patients with the symptoms of PMDD, psychiatric evaluation should be encouraged by gynecology clinics, and continuous administration of sertraline should be the choice because of patients' greater acceptance of the therapy.

Benign cystic teratoma of the douglas.

We report a case of a benign cystic teratoma in a 30-year-old woman who underwent laparoscopy for a persisting pelvic mass in the posterior cul-de-sac. Our review of the literature indicates that, this is the second teratoma case of the douglas and the first one removed laparoscopically.

Maternal serum interleukin 6 levels in preterm labor: prediction of admission-to-delivery interval.

OBJECTIVE: To evaluate the diagnostic value of maternal serum interleukin 6 (IL-6), C-reactive protein (CRP) levels and white blood cell (WBC) count for the prediction of preterm labor and length of admission-to-delivery interval in patients with preterm labor. METHODS: Maternal serum IL-6, CRP and WBC count were prospectively determined in eighty-two patients in preterm labor and 21 controls. Data was analyzed in study and control groups, and for the assessment of clinical and laboratory risk factors in the prediction of admission-to-delivery interval in the study group. RESULTS: Maternal serum IL-6 levels were significantly higher in the study group than controls. The IL-6 value associated with the highest percent of true positives and true negatives for the prediction of preterm labor was 5 pg/ml. The area under curve of maternal IL-6 was significantly higher than the area under curve of of CRP and WBC count. In the study group maternal serum IL-6 levels were significantly higher in patients delivered within 2 and 7 days than the nondelivering ones and a cut off value of 8.3 pg/ml was determined for estimation of preterm delivery. CONCLUSION: Maternal serum IL-6 is a reliable marker in the prediction and management of preterm labor and delivery.

The predictive power of endocrine tests for the diagnosis of polycystic ovaries in women with oligoamenorrhea.

Various hormonal parameters and the best logistic regression model to predict disease probability were evaluated in women with polycystic ovary syndrome (PCOS). Concentrations of LH, FSH, LH/FSH ratio, testosterone, free testosterone, SHBG and insulin in serum were recorded in 32 women with PCOS and in 25 controls. A model including LH/FSH ratio, insulin and testosterone measurements yielded the best goodness of fit for classification of women with and without PCOS in the logistic regression analysis. Only LH/FSH ratio and insulin were retained as significant variables. The diagnostic characteristics of LH/FSH ratio and insulin for PCOS when compared by receiver-operator characteristic analysis were found to be equally effective. By combining these two variables a higher area under curve was obtained. LH/FSH ratio, insulin or the combination of these two can predict the disease probability in women with PCOS.

Routine colposcopic evaluation of patients with persistent inflammatory cellular changes on Pap smear.

OBJECTIVE: To assess the rate of undetected dysplasia in patients with two consecutive reports of inflammatory cellular changes without atypia on Pap smears despite anti-inflammatory therapy. METHOD: A prospective randomized study. RESULT: 2798 premenopausal non-pregnant patients were evaluated by Pap smears of the cervix. Of these, 397 (14.2%) were reported as 'inflammatory cellular changes'. A total of 238 (8.5%) had persistent inflammatory changes without atypia despite the anti-inflammatory therapy. Fourteen patients refused colposcope. The mean age and parity of the remaining 224 patients were 30.2 +/- 6.3 (18-46) and 1.7 +/- 2.3 (0-6), respectively. When these patients underwent colposcopically-directed biopsies of the cervix, in 51 (22.7%) patients human papillomavirus lesions, dysplasia and in situ cancer were noted. Mean age, parity, age of marriage, prevalence of smoking and contraceptive methods of the two groups of patients (173 vs. 51) did not show statistically significant differences. CONCLUSION: Colposcopically-directed biopsies of the cervix are indicated even when inflammatory cellular changes without atypia persist despite therapy.

Transverse cerebellar diameter and transverse cerebellar diameter/ abdominal circumference index for assessing fetal growth.

In a prospective study of 330 pregnant women, measurements of the transverse cerebellar diameter (TCD), abdominal circumference (AC), biparietal diameter (BPD), head circumference (HC) and TCD/AC ratio and HC/AC ratio were obtained using conventional ultrasonography between 16th and 41st weeks of gestation. Measurement of BPD yielded a strong correlation with gestational age (r = 0.9880 and R2 = 0.9761) by cubic regression analysis. The measurement of TCD also had a very close relation with gestational age (r = 0.9767 and R2 = 0.9539). The ratio between TCD and AC was calculated and found to be 0.1436 +/- 0.0106 (SD) which remained fairly constant throughout pregnancy, while the BPD/AC ratio declined. The 5th and 95th percentiles for this ratio were 0.1279 and 0.1603. Ten of eleven fetuses with TCD/AC ratios exceeding 2 SD (0.1648) were found to have asymmetrical intrauterine growth retardation upon neonatal examination. It is demonstrated that both BPD and TCD measurements are reliable techniques that correlate well with gestational age, and the TCD/AC ratio is valuable in identifying babies with asymmetrical intrauterine growth retardation.

Fetal methemoglobinemia: a cause of nonimmune hydrops fetalis.

A case of nonimmune hydrops fetalis resulting from fetal methemoglobinemia is presented. A woman with a pregnancy at 17 weeks' gestation was admitted after combustion gas intoxication. Although the mother totally recovered, the fetus showed signs of nonimmune hydrops fetalis at follow-up. Fetal methemoglobin levels were very high.

Do the suppression criteria in GnRH-a cycles predict in vitro fertilization outcome?

The addition of gonadotropin releasing hormone analog (GnRH-a) to controlled ovarian hyperstimulation regimes has been reported to have several advantages, such as reduced cancellation rate, fewer premature luteinizations and increased clinical pregnancy rate. The aim of this study was to determine the effect of pituitary/ovarian suppression, in terms of the levels of luteinizing hormone (LH), estradiol and follicle stimulating hormone (FSH), and the duration of GnRH-a administration, on in vitro fertilization (IVF) outcome. Retrospectively, 153 IVF cycles with GnRH-a and human menopausal gonadotropin (hMG) were examined. After a minimum of 10 days of GnRH-a administration, the patients were started on hMG. The correlations were investigated between the fertilization rates, the numbers of retrieved oocytes and transferred embryos, the cancellation rates, the suppressed LH, FSH and estradiol levels, the total ampules of hMG used and the duration of GnRH-a usage. The duration of GnRH-a usage and the total ampules of hMG used were not correlated. The number of oocytes retrieved and total number of hMG ampules used showed weak correlations with suppressed levels of FSH (-0.297 and 0.285, respectively). However, the fertilization, cleavage and pregnancy rates did not correlate with the LH, FSH and estradiol levels on hMG start days. In conclusion, for selected cases, 10 days of GnRH-a administration is sufficient to suppress endogenous gonadotropin levels. Since FSH and LH are protein hormones and their bioactivity may change in a manner that is unrelated to their immunological levels, it is not necessary to measure FSH, LH and estradiol levels to detect whether suppression is adequate.

Scapula length measurement for assessment of fetal growth and development.

To determine the value of prenatal ultrasonographic scapula measurements for fetal growth and development as an adjunct to assessing in utero development, a prospective study of ultrasonography was conducted in 343 pregnant women with uneventful pregnancies with gestational ages from 16 to 41 weeks, and several biometric measurements were obtained. The relationships of scapula length with gestational age and with biparietal diameter, femur length, abdominal circumference and scapula length were examined. With the ultrasonographic examinations of 343 healthy pregnant women, a nomogram of scapula length measurements estimating gestational age and predicting the biparietal diameter, abdominal circumference, and femur length was generated. Linear relationships were found between the scapula length and the gestational age (R2 = 0.94, p < 0.0001), the biparietal diameter (R2 = 0.94, p < 0.0001), abdominal circumference (R2 = 0.94, p < 0.0001), and the femur length (R2 = 0.95, p < 0.0001). The rate of increase of scapula length was significantly higher before 28 weeks of gestation than in later pregnancy (p < 0.0001). The correlation coefficients between gestational age and scapula length were 0.95 before 28 weeks of gestation and 0.86 in later weeks. These results suggest that scapula length measurement is a valuable parameter for the assessment of fetal growth and development.

Lipid profiles in women with hirsutism and polycystic ovaries.

We examined the correlation between hyperandrogenemia and lipid profiles in 25 hirsute patients with polycystic ovary syndrome in our reproductive endocrinology outpatient clinic. Concentrations of triglycerides, low density lipoprotein cholesterol and total cholesterol were increased and concentrations of high density lipoprotein (HDL) cholesterol were decreased in women with severe hirsutism. Total and free testosterone levels were correlated with triglycerides (r = 0.72, p < 0.05; r = 0.55, p < 0.01, respectively) and HDL cholesterol (r = -0.55; p < 0.05; r = -0.68, p < 0.05, respectively). There was no correlation between levels of androstenedione, dehydroepiandrosterone sulfate or 17-OH progesterone and any parameters of the lipid profiles. In those with a luteinizing hormone/follicle stimulating hormone ratio > or = 1.5, total testosterone levels were higher than in those with a lower ratio (129.5 +/- 6.4 vs. 95.2 +/- 9.2 ng/dl, p < 0.05), HDL cholesterol levels were lower (45.2 +/- 4.2 vs. 60.4 +/- 4.8 mg/dl, p < 0.05) and triglyceride levels were higher (138.1 +/- 4.5 vs. 92.6 +/- 6.1 mg/dl, p < 0.001). We conclude that altered lipid profiles in women with hirsutism are a result of high testosterone levels.