The role of 15-lipoxygenase-1 expression and its potential role in the pathogenesis of endometrial hyperplasia and endometrial adenocarcinomas.

PURPOSE OF INVESTIGATION: To investigate the presence of 15-lipoxygenase-1 (15-LOX-1) expression and its potential role in the pathogenesis of endometrial hyperplasia and endometrial adenocarcinomas. MATERIALS AND METHODS: The authors investigated the presence of 15-LOX-1 expression in samples from patients diagnosed with normal endometrium (n = 12), endometrial hyperplasia (n = 12), and endometrial cancer (n = 12). The immunohistochemical stainings were scored by three independent pathologists. A Western blot of 15- LOX-1 determined the presence of protein expression in normal endometrium. A Kolmogorov-Smirnov test was used to evaluate the data's distribution pattern. For pairwise comparisons of the combined scores between groups, the Mann-Whitney U test was used. RESULTS: Based on the combined scores for 15-LOX-1 expression, strong immunochemistry staining was observed in samples diagnosed with normal endometrium. There was a significant difference in 15-LOX-1 expression between normal endometrium and endometrial adenocarcinoma (p = 0.03). Comparing tissues from normal endometrium and endometrial hyperplasia, there was a decline in the expression from normal endometrium to endometrial hyperplasia. However, the difference was not statistically significant. CONCLUSION: The present results show that a decrease of 15-LOX-1 expression in the endometrial tumorigenesis process, starting from normal endometrium to hyperplasia and endometrial cancer, might be a trigger. Further studies are required to determine its potential use as a marker in a larger randomized multicenter study.

Serum levels of the adipokines, free fatty acids, and oxidative stress markers in obese and non-obese preeclamptic patients.

PURPOSE OF INVESTIGATION: To investigate the roles of adipokines, free fatty acid (FFA), and oxidative stress in obese and non-obese preeclamptic patients. MATERIALS AND METHODS: Gestational age-matched obese preeclamptic (n=32), non-obese preeclamptic (n=32), and non-obese normotensive healthy (n=32) pregnant women were included in the study. Serum insulin, insulin resistance, leptin, nesfatin, ghrelin, chemerin, FFA levels, total antioxidant status, total oxidant status, and oxidative stress index were determined. RESULTS: Leptin and nesfatin levels were significantly lower and ghrelin levels were significantly higher in the normotensive group as compared to the preeclamptic groups, while no difference was observed between obese and non-obese preeclamptic groups. Chemerin and FFA levels were significantly higher in obese preeclamptics as compared to non-obese preeclamptics and normotensive group. Total antioxidant status (TAS) levels were significantly higher in the normotensive group as compared to the preeclamptic groups, while no difference was observed between obese and non-obese preeclamptics. Total oxidative status (TOS) and oxidative stress index (OSI) levels were significantly lower in the normotensive group as compared to the preeclamptic groups, while no difference was observed between obese and non-obese preeclamptics. CONCLUSION: Serum levels of adipokines, TOS, and FFAs were significantly higher in pregnants with preeclampsia as compared to non-obese normotensive controls. Chemerin and FFA levels were significantly higher in obese preeclamptics as compared to non-obese preeclamptics.

Increased platelet count in severe peritoneal endometriosis.

OBJECTIVE: Platelet count (PC) is higher in chronic inflammatory diseases. The aim of this study was to evaluate the PC in patients with severe pelvic endometriosis. MATERIALS AND METHODS: Patients with advanced stage pelvic endometriosis were retrospectively evaluated in a tertiary center between January 2009 and December 2011. Patients with pelvic endometriosis were divided into two groups; advanced stage peritoneal endometriosis were classified as Group 1 (n = 28). Group 2 consisted of 29 patients which had ovarian endometrioma without clinically apparent peritoneal endometriosis foci. Group 3 included 51 women as control subjects. PC between the groups was tested by Student's t test. The mean values of three groups were analyzed by using one way ANOVA test followed post-hoc test Bonferroni. RESULTS: PC in patients with pelvic endometriosis were found to be higher from the control group (290 +/- 67 10(9)/1; 264 +/- 63 10(9)/1, respectively; p = 0.038). Patients with peritoneal endometriosis (Group 1) had significantly higher PCs compared with the healthy controls (309 +/- 65 10(9)/1; 264 +/- 63 10(9)/1; respectively; p = 0.011). CONCLUSION: Increased PC in advanced stage pelvic endometriosis may be a sign of increased systemic inflammation. The systemic inflammation may be more apparent in advanced stage peritoneal endometriosis.

Serum levels of androgens and prostate-specific antigen in endometriosis.

OBJECTIVE: The aim of the present study was to evaluate the levels of serum androgens and prostate-specific antigen (PSA) levels in patients with endometriosis. MATERIALS AND METHODS: Patients with Stage III/IV (advanced stage) endometriosis were compared to controls with respect to basal serum levels of total testosterone (T), free testosterone (fT), androstenedion (A), dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulphate (DHEA-S), and PSA in the early follicular phase of menstrual cycle for this prospective case control study. RESULTS: Level of T, fT, A, DHEA, and DHEA-S were higher in patients with endometriosis when compared to control subjects, but the difference was not statistically significant. The mean PSA level was 0.0074 +/- 0.0120 ng/ml in patients with endometriosis and 0.0059 +/- 0.0056 ng/ml in control group and there was no statistically significant difference between groups (p = 0.58). CONCLUSION: Serum basal androgens and PSA levels are higher in endometriosis group with respect to control but the differences are not statistically significant.

Which factors may influence the duration of misoprostol-induced abortion in the second trimester?

BACKGROUND: To investigate the factors that may affect the time interval between induction and fetal expulsion in misoprostol-induced termination of second trimester pregnancy. MATERIALS AND METHODS: A retrospective analysis of second-trimester pregnancies terminated in the second trimester between October 2008 and 2010 was performed. Induction was done by administration of 400 mcg intravaginal misoprostol. The correlation between the duration of abortion and maternal, fetal, and clinical features were statistically analyzed with multivariate regression analysis. RESULTS: One hundred and seventy-five singleton pregnancies that met the inclusion criteria were evaluated. The average gestational age at the first induction was 18.3 weeks. The mean time interval between the first induction and expulsion was 37.2 +/- 21.3 (range 3 to 160) hours. Fetal expulsion occurred significantly at a later gestational age and those with a higher blood glucose level at admission. However, no correlation could be established between the duration of abortion and the number of pregnancies, deliveries, age, hemoglobin levels or platelet count. CONCLUSIONS: Misoprostol is safe and effective in induction of abortion during second-trimester pregnancies. The induction-to-abortion interval is longer in patients with hyperglycemia and advanced gestational age. Prospective, randomized studies are necessary to better understand the factors influencing the duration of abortion.

CD34 expression of chorionic villous in pre-eclamptic placenta: an immunohistochemical and ultrastructural study.

In this study, pre-eclampsia, proteinuria, and edema associated with hypertension in pregnancy were assessed at the Dicle University School of Medicine Department of Obstetrics and Gynecology Clinic. One group included 20 pre-eclamptic pregnant women with gestational age 20-35 weeks of pregnancy and the same in the control group that included; however, 20 normotensive pregnant women. Histochemistry, immunohistochemistry, and electron microscopy techniques were used. Histopathological examination of syncytial nodes and stromal cells were observed in the increase in hyperplasia and hyalinization. The evaluation immunohistochemical of chorionic villi, placenta, and hematopoietic stem cell markers showed a positive reaction with CD34. Ultrastructural examination showed endoplasmic reticulum dilatation, degeneration of mitochondria in endothelial cells, and capillary vessel edema.

Association between mean platelet volume and different phases of menstrual cycle in primary dysmenorrhea.

PURPOSE: Blood cells play a major role in homeostasis and inflammation. Primary dysmenorrhea (PD) involves the production of prostaglandins and leukotrienes, which cause inflammation in uterine tissue. Aim of this study was to investigate whether there is a relation between complete blood count parameters and PD during the menstrual cycle. MATERIALS AND METHODS: The study included 41 cases diagnosed as primary dysmenorrhea (mean age, 23.02 +/- 3.43 years) and 40 individuals who control subject (mean age, 23.76 +/- 3.13 years). Hematologic parameters were measured on menstrual phase (day 1-4), follicular phase (day 9-12), and luteal phase (day 21-23) during menstrual cycle. RESULTS: There were no statistically differences between hematological parameters of two groups except for mean platelet volume (MPV). MPV of PD and control groups at each phase of menstrual cycle were 7.71 vs 8.61 (p = 0.01); 7.66 vs 8.56 (p = 0.005); 7.75 vs 8.53 (p = 0.01), respectively. CONCLUSION: PD is associated with decreased MPV and platelets may be involved in the inflammatory process of PD.

Evaluation of the relationship between preeclampsia and seropositivity of infectious disease in maternal plasma.

PURPOSE: The aim of the present study was to investigate the association between maternal infections and preeclampsia. MATERIALS AND METHODS: Fifty-four pregnant women with preeclampsia (study group) and 54 healthy pregnant women (control group) were enrolled in this study. Chlamydia pneumoniae (CP), Mycoplasma hominis (MH), Helicobacter pylori (HP), Cytomegalovirus (CMV), Herpes simplex virus type 2 (HSV-2), and Toxoplasma gondii (TG) antibodies were analyzed in the maternal plasma of all of the participants. RESULTS: There was no difference in the demographic data between groups. Maternal plasma seropositivity for CP IgM; MH IgA and IgG; HP IgM, IgA and IgG; TG, CMV and HSV-2 IgM and IgG were not significantly different between the preeclampsia and control groups. The seropositivity for CP IgG was significantly higher in women with preeclampsia versus the control women. CONCLUSIONS: Our results suggested that preeclampsia is associated with CP IgG seropositivity.

Placental expression of vimentin, desmin and ultrastructural changes in the villi in patients with HELLP syndrome.

OBJECTIVES: To examine placental expression of vimentin and desmin in relation to ultrastructural changes within the placental villi in cases of HELLP syndrome. STUDY DESIGN: Formaldehyde-fixed and paraffin-embedded specimens of 15 healthy pregnant and 13 Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, placentas were used for Harris hematoxylin staining, vimentin and desmin immunohistochemistry, and transmission electron microscopy (TEM). RESULTS: Increased of fibrinoid necrosis in vascular wall and the periphery of villi were observed in sections of the placentas with HELLP syndrome. Increased expression of vimentin in the intravillous area and increased expression of desmin on blood vessel wall, were seen in placentas of patients with HELLP syndrome when compared to placentas of healthy pregnant. CONCLUSIONS: Augmentation of intermediate filaments, desmin, vimentin may disturb normal movements of endothelial cells, and may display placental dysfunction that is unable to compensate the endothelial instability and the related hypertension in HELLP syndrome. Further studies are needed to get more definit results and also to compare HELLP syndrome with preeclampsia.

Fibroblast growth factor-1 expression in the endometrium of patients with repeated implantation failure after in vitro fertilization.

BACKGROUND: An examination of the alterations in Fibroblast Growth Factor-1 (FGF-1) expression in a group of repeated implantation failure after in vitro fertilization (IVF) patients, when compared to fertile patients. PATIENTS AND METHODS: Study group consisted of 24 patients with repeated implantation failure and 29 fertile control patients. Endometrial samples received at the luteal phase were exposed to immunohistochemical staining for the fibroblast growth factor-1 (FGF-1) with antibodies. RESULTS: In the study group all patients have primary infertility (n = 24), and the average duration of infertility was 3.9 ± 1.3 years. The average recurrent IVF failure was 2.6 ± 0.6 attemps. There were no significant differences in the histological data according to the Noyes classification (p = 0.226) and age (p = 0.231) between the patients in the study and control groups (n=29). The control group was found to have more severe expression of FGF-1 (< 0.001) than the study group when endometrial glandular epithelial cells, stromal cells and vascular endothelial cells were evaluated. CONCLUSIONS: Endometrial glandular epithelial cells, stromal cells and vascular endothelial cells of the control and study group were evaluated and it was found that the control group displayed a stronger expression of the FGF-1 (< 0.001). The expression of FGF-1 in the IVF implantation failure group is less than in the fertile group, which suggests that growth factors such as FGF-1 are important maternal factors effecting implantation.

Serum levels of neopterin, tumor necrosis factor-alpha and Interleukin-6 in preeclampsia: relationship with disease severity.

AIM: There are many studies evaluating the role of inflammation in the pathogenesis of preeclampsia. However, little is known about the relationship between the severity of inflammation and the severity of preeclampsia due to insufficient of studies reporting this matter. To investigate the maternal serum concentrations of IL-6, TNF-alpha and Neopterin in patients with mild preeclampsia and severe preeclampsia and HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome in preeclampsia and determine their association with the severity of the disease. PATIENTS AND METHODS: Patients, hospitalized with the diagnosis of preeclampsia between October 2011 and March 2012, were included in the study. The patients with preeclampsia were divided into three groups as mild preeclampsia, severe preeclampsia and HELLP syndrome. The control group was comprised of normotensive and uncomplicated pregnant women. The serum levels of IL-6, TNF-alpha and Neopterin (NEO) were determined, using enzyme-linked immunosorbent assay. Spearman's rank correlation tests were used for the correlations between the serum levels of inflammatory markers and the severity of preeclampsia. RESULTS: There was no observed significant difference among mean serum TNF-alpha and IL-6 levels of four groups (p > 0.05). The median serum concentration of NEO in subjects with mild preeclampsia of 14.1 nmol/L and severe preeclampsia of 14.8 nmol/L was significantly higher than that of 10.3 nmol/L in normotensive controls (p = 0.013; p = 0.000 respectively). In addition, the median serum concentration of NEO was detected to be highest in subjects with HELLP syndrome. The serum levels of NEO was well correlated with the severity of preeclampsia (r = 0.533, p = 0.000). CONCLUSIONS: The serum levels of NEO, an important marker of cellular immunity, associated with severity of disease in patients with preeclampsia.

Risk factors for maternal mortality in eclampsia: analysis of 167 eclamptic cases.

BACKGROUND: The aim of this study was to evaluate risk factors associated with maternal mortality in patients with eclampsia. METHODS: The probable risk factors of maternal mortality including maternal age, length of hospital stay, gestational age, systolic and diastolic blood pressures; hematocrit, hemoglobin, platelet count, levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase were determined from patients' charts and Odds ratios (OR) of these factors were detected using by logistic regression analysis. RESULTS: According to logistic regression model, AST [OR, (95% Confidence Interval, CI): 7.39 (2.71-20.13)]; ALT [6.45 (2.42-17.16)]; postpartum diastolic blood pressure [4.58 (1.80-11.62)]; hematocrit [3.52 (1.86-6.65)]; hemoglobin [2.67 (2.01-3.55)] were found to be significant risk factors for maternal mortality. CONCLUSIONS: In eclamptic patients, close monitoring of particular laboratory values and blood pressure, and early intervention to alterations of certain variables will provide possibility for prevention against potential complications and subsequently decreasing mortality.

Unusual case of extraovarian granulosa cell tumor.

We present a case of adult type extraovarian granulosa cell tumor in 22 years old woman. The pelvic and radiographic examination revealed right adnexial solid mass in patient who complaining from menstrual disregulation and pelvic pain. The patient underwent exploratory laparotomy which showed pelvic mass adjacent urinary bladder and fixed to the behind of pubic bone at pre-peritoneal area.