Adiponectin levels in gestational diabetes mellitus and in pregnant women without glucose intolerance.

OBJECTIVES: The aim of the study was to determine serum adiponectin levels among patients with gestational diabetes mellitus (GDM) and normal pregnant women without glucose intolerance, and to investigate the relationship between these levels and clinical factors at the time of the diagnosis, at delivery and in the post-partum period. MATERIAL AND METHODS: The subjects' serum adiponectin concentration was measured using the enzyme-linked immunosorbent assay (ELISA) method at 24th-28th week of gestation, at delivery (in maternal circulation and the umbilical cord) and 24 h after delivery. The relationship between these groups' measurements and other established clinical-laboratory factors were investigated. RESULTS: Serum adiponectin concentrations were significantly lower (p = 0.02) in GDM patients compared with patients with normal glucose tolerance at 24th-28th week of gestation. During delivery, maternal serum adiponectin concentrations were significantly lower (p = 0.03) in GDM patients compared with patients with normal glucose tolerance. In the post-partum period, serum adiponectin concentrations were significantly higher (p = 0.009) in GDM patients compared with patients with normal glucose tolerance. Umbilical cord adiponectin concentrations were significantly lower (p = 0.005) in GDM patients compared with patients with normal glucose tolerance. CONCLUSIONS: Adiponectin concentrations in GDM patients' circulation were regulated by changes in glucose and insulin metabolism. A reduction in serum adiponectin levels seems to play a role in GDM patients' insulin resistance.

Prospective comparison of tissue trauma after laparoscopic hysterectomy types with retroperitoneal lateral transsection of uterine vessels using ligasure and abdominal hysterectomy.

OBJECTIVE: The aim of this study was to evaluate the level of tissue trauma after laparoscopic and total laparoscopic hysterectomy with retroperitoneal lateral transsection of uterine vessels using ligasure as compared with abdominal hysterectomy. STUDY DESIGN: A total of 45 women with various indications for hysterectomy were randomized into laparoscopic hysterectomy, total laparoscopic hysterectomy and abdominal hysterectomy. Laparoscopic and total laparoscopic hysterectomy with retroperitoneal lateral transsection of uterine vessels was performed by four-puncture laparoscopy and pre-, postoperative and postoperative 24th hour levels of interleukin-6 (IL-6) and C-reactive protein (CRP), the mean operative time, drop in hemoglobin concentration, weight of removed uterus, VAS scores, hospitalization period and major and minor operative complications were analyzed prospectively. RESULTS: CRP and IL-6 levels were significantly higher in the abdominal hysterectomy group compared to either laparoscopy groups at the postoperative 24th hour. There were no significant differences in the levels of CRP and IL-6 between the two laparoscopy groups. The longest operative times were observed in the total laparoscopic hysterectomy group. CONCLUSION: Laparoscopic surgery causes less tissue trauma than the conventional open surgery; however, we observed no difference between the laparoscopic hysterectomy groups concerning the postoperative inflammatory response. We may prefer laparoscopic hysterectomy instead of total laparoscopic hysterectomy under suitable conditions, since laparoscopic hysterectomy causes the same level of tissue trauma as total laparoscopic hysterectomy, but has the advantage of a significantly shorter operative time. Meanwhile, hysterectomy done by laparoscopy with retroperitoneal lateral transsection of uterine vessels using ligasure is an effective and safe procedure.

Tubo-ovarian abscess mimicking ovarian tumor in a sexually inactive girl.

Tubo-ovarian abscess is a serious complication of pelvic inflammatory disease rarely seen in sexually inactive girls. Early diagnosis and treatment are essential to prevent further sequela including infertility, ectopic pregnancy, and chronic pelvic pain. We present a case of 19-year-old sexually inactive girl who presented with abdominal pain and pelvic mass resembling ovarian tumor. Unilateral tubo-ovarian abscess with extensive bowel adhesions was determined at laparotomy. Drainage of the abscess and postoperative antibiotic therapy cured the patient.

The values of urinary NTx in postmenopausal women undergoing HRT; the role of additional alendronate therapy.

OBJECTIVE: To determine the changes in levels of urinary NTx at the end of the 6th month of oral and transdermal hormone replacement therapy (HRT) and the effects of additional alendronate therapy for osteoporotic women. METHOD: Of 66 postmenopausal women 23 were treated with oral estradiol+norethisterone acetate (E+P), and 22 were treated with transdermal estradiol+norethisterone acetate. The third group consisted of 21 women with osteoporosis (bone mineral density < 100 mg/cm(3)) and treated with oral E+P plus alendronate 10 mg/day. RESULT: Significant decreases of urinary NTx levels were seen after HRT in all study groups (P < 0.05). But the decline of NTx levels was not different between the oral and transdermal HRT groups (P > 0.05). There was no additional decrease in the levels of NTx with alendronate therapy (P > 0.05) but NTx excretion diminished more in patients with high baseline levels. CONCLUSION: The decline of NTx at the end of the 6th month of HRT reflects the decrease of bone resorption and it is not related to the route of administration.

Can serum CA-125 levels predict the optimal primary cytoreduction in patients with advanced ovarian carcinoma?

OBJECTIVE: The aim of this study was to investigate the predictive value of serum CA-125 levels to ability of optimal primary cytoreduction in patients with advanced epithelial ovarian carcinoma. METHODS: Preoperative serum CA-125 levels were determined by a commercial enzyme immunoassay kit in a series of 92 patients with stage IIIC epithelial ovarian carcinoma. The abilities of various cutoff value of CA-125 to predict suboptimal cytoreductive surgery were determined. A receiver operating characteristic curve was used to find the most clinically useful CA-125 cutoff value. RESULTS: Optimal cytoreduction was obtained in 48 patients (52%) using the diameter of the largest residual tumor nodule less than 1 cm. Receiver operating characteristic curve showed that the most clinically suitable CA-125 cutoff value was 500 U/ml. Forty-seven patients (51%) had preoperative serum CA-125 levels below 500 U/ml. Of these patients, optimal cytoreductive surgery was performed in 36 (77%). Of the 45 patients with serum CA-125 levels greater than 500 U/ml, optimal cytoreductive surgery was achieved in 12 (27%). True- and false-positive rates were 73 and 23%, respectively. CONCLUSIONS: Although our results showed that preoperative serum CA-125 levels might predict the optimal resectable patients, larger prospective studies are needed to prove its predictivity. Gynecologic oncologists should evaluate the sum of all criteria until more data are available.

Primary endometrioid adenocarcinoma with coexisting endometrial tuberculosis. A case report.

BACKGROUND: The most important cause of postmenopausal bleeding is endometrial cancer, whereas genital tuberculosis is uncommon in this age group. The association of these two disorders is extremely rare. CASE: Endometrial curettings performed on a 63-year-old woman with a bloody vaginal discharge and thickened endometrium disclosed complex atypical hyperplasia and granulomatous inflammation with caseation necrosis. The uterus contained a well-differentiated endometrial adenocarcinoma with squamous differentiation invading about one-half the myometrial thickness and granulomatous inflammation with caseation necrosis. The lymph nodes were free of disease. CONCLUSION: Although the coexistence of endometrial cancer and tuberculosis is extremely rare, it may occur in patients who live in the regions with a high prevalence of tuberculosis.