Analysis of Changes in Serum Levels and Gene Expression Profiles of Novel Adipocytokines (Omentin, Vaspin, Irisin and Visfatin) and Their Correlation with Serum C-reactive Protein Levels in Women Diagnosed with Endometriosis

Objectives: This study aimed to investigate the role of new adipocytokines (omentin, vaspin, irisin and visfatin) in the development of endometriosis and the relationship of these adipocytokines with the inflammatory marker, C-reactive protein (CRP) levels in serum. Materials and Methods: In this study, endometriosis (n=16) and control groups (n=14) were determined via ultrasound. Serum omentin, vaspin and irisin levels were measured by ELISA method. CRP levels in serum and the gene expression of visfatin and vaspin in whole blood samples were determined by clinical analyzer and the real-time polymerase chain reaction, respectively. Results: Serum irisin and CRP levels in the endometriosis group were significantly higher than in the control group. Irisin protein levels demonstrated a positive correlation with body mass index and CRP in women diagnosed with endometriosis. No statistically significant difference was found in serum omentin and vaspin levels between groups. The visfatin and vaspin gene expression in whole blood samples from the endometriosis group was found to be significantly lower than the control group. Conclusion: Increased levels of serum irisin and decreased visfatin and vaspin gene expressions in blood may be considered as a potential biomarker in endometriosis. The identification of new adipocytokines, which demonstrate an alteration in the presence of endometriosis and the relationship between these adipocytokines and inflammation will facilitate the detection of mechanisms involved in endometriosis and will lead to the development of targeted therapy.

Beneficial Effects of Human Umbilical Cord Blood Mononuclear Cells on Persistent Erectile Dysfunction After Treatment of 5-Alpha Reductase Inhibitor in Rats.

BACKGROUND: Effects of human umbilical cord blood (HUCB) as a valuable source for stem cell-based therapies have not been studied in persistent post-5-alpha reductase inhibitors (5ARI) erectile dysfunction (PPED). AIM: To determine the effect of intracavernosal injection of HUCB mononuclear cells (MNCs) on ED associated with dutasteride treatment. METHODS: Twenty five adult male Sprague-Dawley rats were divided into 5 groups (n = 5 per group): (i) control, (ii) 8-week dutasteride (0.5 mg/kg/day, in drinking water), (iii) 12-week dutasteride, (iv) 8-week dutasteride+HUCB-MNCs (1 × 106) and (v) 12-week dutasteride+HUCB-MNCs. HUCB-MNCs were administered intracavernosally after eight weeks of dutasteride treatment. Experiments were performed at 4 weeks following the injection of HUCB-MNCs. Erectile responses and isometric tension of corpus cavernosum (CC) were measured. The protein expressions of phosphodiesterase type 5 (PDE5), endothelial nitric oxide synthase (eNOS), neuronal NOS (nNOS), hypoxia-inducible factor (HIF)-1α and smooth muscle/collagen contents in penile tissue were evaluated by Western blotting, immunohistochemistry, and Masson's trichrome staining, respectively. MAIN OUTCOME: In vivo erectile function, in vitro relaxant and contractile responses of CC, protein expression and localization of PDE5, eNOS, nNOS, HIF-1α, and smooth muscle content in penile tissue. RESULTS: Erectile responses in the dutasteride-treated groups were significantly decreased compared with controls (P < .001), persisting after 4-wk of washout. HUCB-MNCs restored diminished intracavernosal pressure responses, acetylcholine-, sodium nitroprusside-, sildenafil-induced relaxations, and increased phenylephrine and electrical field stimulation (EFS)-induced contractions. Decreased EFS-induced relaxations in dutasteride-treated groups were not restored by HUCB-MNCs. Increased PDE5 and reduced nNOS expressions in dutasteride groups were restored by HUCB-MNCs in the 12-week dutasteride group. eNOS and HIF-1α protein expression and serum total and free testosterone  levels were similar among groups. HUCB-MNCs reversed the decreased smooth muscle/collagen ratio in dutasteride-treated tissues. There was a significant increase in PDE5 and HIF-1α staining in 8-week dutasteride animals. CLINICAL TRANSLATION: This study demonstrates the corrective potential of HUCB-MNCs on some persistent structural and functional deterioration caused by 5ARI treatment in rats, which may encourage further evaluation of HUCB-MNCs in men with PPED. STRENGTHS AND LIMITATIONS: Therapeutic application of intracavernosal HUCB-MNCs is a novel approach for the rat model of post-5ARI ED. Lack of serum and tissue dihydrotestosterone measurements, vehicle injections and characterization of the cells remain limitations of our study. CONCLUSION: The persistent ED after prolonged administration of dutasteride in rats is reversed by HUCB-MNC treatment, which holds promise as a realistic therapeutic modality for this type of ED. Oztekin CV, Yilmaz-Oral D, Kaya-Sezginer E, et al. Beneficial Effects of Human Umbilical Cord Blood Mononuclear Cells on Persistent Erectile Dysfunction After Treatment of 5-Alpha Reductase Inhibitor in Rats. J Sex Med 2021;18:889-899.

Identifying the risk factors and incidence of Asherman Syndrome in women with post-abortion uterine curettage.

AIM: To evaluate the risk factors and incidence of Asherman Syndrome in women with post-abortion uterine evacuation and curettage. METHODS: A total of 2546 patients who had surgical abortion (uterine evacuation and curettage) before the 20th gestational week with indications of missed abortion, anembryonic pregnancy, incomplete abortion, and elective curettage in a tertiary antenatal care center were recruited. The patients were called and surveyed for their symptoms; including infertility, oligo-amenorrhea and recurrent pregnancy loss, preterm birth and intrauterine growth retardation and abnormal placentation as criteria of Asherman Syndrome. Diagnostic (office) hysteroscopy was performed for 177 who had one of those complaints. RESULTS: The incidence of Asherman Syndrome was 1.6% (n = 43/2546). History of ≥3 abortions was the main factor that increased the risk of Asherman Syndrome for by 4.6 times. Use of vacuum aspiration or sharp curettage, premedication for cervical priming, and having a pregnancy >10th gestational weeks were not risk factors for Asherman Syndrome. CONCLUSION: When the diagnosis was based on presence of symptoms who underwent uterine instrumentation, the incidence of Asherman Syndrome was found to be 1.6%. Repeated abortions were the main risk factor for Asherman Syndrome and avoiding from repeated uterine instrumentations may have a role in prevention.

Identifying strategies to reduce cesarean section rates by using Robson ten-group classification.

OBJECTIVE: To assess the cesarean section (CS) rates using Robson ten-group classification system (RTGCS) and the interventions combined with RTGCS which may reduce the CS rates. METHODS: A total of 100,326 deliveries at Zekai Tahir Burak Research and Training Hospital in Ankara, Turkey between 2012 and 2018 were included in this study. Interventions including free mobilization of pregnant women, CS decision with the signature of three obstetricians, re-evaluate the CS decision, strictly obeying the failed induction algorithm to reduce the CS rates were started to be applied in 2017. The CS rates between 2012 and 2017 and in 2017 were compared to evaluate the effects of the interventions on CS rate regarding the Robson groups. RESULTS: The overall CS rates in between 2012 and 2017 significantly reduced from 37,703/84,279 (44.7%) to 6738/16,047 (42.0%) in 2017, p < .001. Cephalopelvic disproportion and suspected macrosomia rates reduced from 4992/37,703 (13.3%) to 683/6738 (10.0%), p < .001 and from 668/37,703 (1.8%) to 96/6738 (1.4%), p = .030, respectively. CONCLUSIONS: To the best of our knowledge, this study is the first that gives the birth data from Turkey using RTGCS and showed that some interventions combined with RTGCS to reduce CS rates should be properly used.

Fertility issue in early stage endometrial cancer patients.

Endometrial cancer (EC) is the most common cancer of the female reproductive system in developed countries. The incidence of EC has been increasing in young women. Approximately 4% of cases are aged <40 years. These young women may wish to delay therapy until after they have children. Common complaints in patients with EC include irregular vaginal bleeding, pelvic pain, and enlarged uterus. Imaging techniques such as transvaginal ultrasound (TVUS) or magnetic resonance imaging (MRI) can be utilized in detecting EC. Although the recommended treatment of EC is hysterectomy and bilateral salpingo-oophorectomy with or without systemic lymph node dissection, loss of reproductive function is the primary limiting factor of this surgical approach. Some studies have reported favorable results with high-dose oral progestins or levonorgestrel-releasing intrauterine system or hysteroscopic tumor resection followed by treatment with high-dose oral progestins. The most widely utilized medical treatment regimens are medroxyprogesterone acetate (MPA) 250-600 mg/day or megestrol acetate (MA) 160-480 mg/day. However, there is still a lack of evidence to establish the optimal dose and duration of progestin treatment. Patients with complete remission (CR) who wish to conceive must be encouraged, and referral to a fertility clinic should be offered as soon as possible. The key aspect of fertility-sparing management in women with EC appears to be the selection of appropriate candidates. Owing to the rarity of this condition, management may often be suboptimal. The aim of this review is to assess the current approaches to management of young women with EC who wish to preserve their fertility.

Are the cesarean section skin scar characteristics associated with intraabdominal adhesions located at surgical and non-surgical sites.

OBJECTIVE: To investigate whether skin scar characteristics are associated with the presence and severity of abdominal or pelvic adhesions in women who have undergone previous cesarean section. METHODS: In this prospective study, 104 women who had undergone at least one previous cesarean section and were scheduled for laparoscopic surgery due to benign gynaecologic indications were included. Preoperative skin scar characteristics as well as intraoperative adhesions were evaluated using the modified Manchester Scar Scale and the Peritoneal Adhesion Index, respectively. RESULTS: During laparoscopic surgery, adhesions were detected in the upper region of the abdominal cavity in 30 women, in the middle region in 46 women and in the lower region in 82 women. Total abdominal scar scores were significantly increased in women with adhesions in all three adbominal regions. Multiple cesarean section scars and palpable scars were more common in women with adhesions. Significant positive correlations were found between the skin scar and adhesion scores in all abdominal regions. CONCLUSION: The skin scar characteristics of the previous caesarean section are associated with the presence and severity of pelvic and abdominal adhesions. Skin scarring especially with palpable texture may be an indicator of adhesion formation in the entire abdominopelvic cavity.

Invasive molar pregnancy in rudimentary uterine horn.

OBJECTIVE: Incidence of molar pregnancy is 1-3/1000 pregnancies. Invasive mole is a local invasive form of gestational trophoblastic neoplasias which is mostly seen in reproductive age and usually follows a molar pregnancy and rarely has an initial presentation. Ectopic pregnancy in rudimentary uterine horn is extremely rare and is seen in 1/100,000 - 140,000 pregnancies. Invasive mole has seldom been reported in ectopic localizations but not in a patient with Müllerian duct anomaly. Here we represent a case of invasive mole in a reproductive age patient with unicornuate uterus and rudimentary communicating uterine horn. Invasive mole presented initially, mimicking ectopic pregnancy. The patient underwent diagnostic laparoscopy and resection of rudimentary uterine horn was performed. The pathology result was reported as an invasive mole. Serum b-hCG levels normalized on post-operative first month and no additional chemotherapy was needed.

25-Hydroxy vitamin D levels in premenopausal Turkish women with uterine leiomyoma.

We aimed to evaluate the relationship between serum 25-hydroxy vitamin D levels and the risk of uterine fibroids in premenopausal women in Turkish population in this prospective observational cross-sectional study. Sixty-eight women with at least one uterine leiomyoma ≥10 mm were compared with 56 healthy controls. Serum 25-(OH) vitamin D3 levels were measured by electrochemiluminescence immunoassay. The groups were similar in terms of age, BMI, gravidity and parity numbers. The mean level of 25-(OH) D3 were 7.28 ± 4.94 ng/ml and 78% of patients (n = 97) had severe vitamin D deficiency ( < 10 ng/mL). Vitamin D levels were significantly lower in the study group (6.54 ± 4.66 ng/ml vs. 8.18 ± 5.16 ng/ml, respectively; p = .009). Vitamin D levels were not correlated with size, volume, localization and number of leiomyomas. Traditional covered clothing style, low education level and being housewife were risk factors for Vitamin D deficiency. This is the first study that investigates the vitamin D levels in women with leiomyomas in Turkish population. Influence of vitamin D on uterine leiomyoma formation to may lead to new preventive strategies in the future.

Is lower uterine segment involvement a prognostic factor in endometrial cancer?

BACKGROUND/AIM: The purpose of this study is to investigate the prognostic significance of lower uterine segment (LUS) involvement in endometrial cancer (EC). MATERIALS AND METHODS: We reviewed the patients who were operated at our institution between July 2007 and March 2015 with the diagnosis of EC. Tumors localized in the corpus and involving the LUS or localized entirely in the LUS formed Group A, while tumors in the uterine corpus without LUS involvement formed Group B. Clinicopathological characteristics and survival of the patients were compared in both groups. RESULTS: A total of 500 patients were included in the study. There were 139 patients who had tumors involving the LUS and formed Group A, while 361 patients with endometrial tumors in the uterine corpus without LUS involvement formed Group B. We did not detect a significant difference between survival of the patients in group A and group B (78 months vs. 87 months, respectively; P > 0.05). CONCLUSION: We found that LUS involvement was not an independent prognostic factor for poor survival, but it is associated with other poor prognostic factors such as deep myometrial invasion, uterine serosal involvement, lymphovascular space invasion, lymph node metastasis and higher FIGO grade.

Evaluation of risk factors in women with puerperal genital hematomas.

AIM: Our aim was to assess the incidence and risk factors of the puerperal genital hematomas (PGH). METHODS: We retrospectively reviewed recorded cases of PGH at Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey, between January 2010 and 2014. Next three patients were chosen as control group. RESULTS: There were 47 cases of PGH with an incidence of 1 in 762 deliveries. Patients with PGH were younger, more likely to be nulliparous and had a greater weight gain during pregnancy than the control group. Patients with PGH had a longer first and second stage of labor than the control group. Mediolateral episiotomy and operative delivery were more frequently performed in patients with PGH than the control group. Neonates born to mothers with PGH were heavier than the control group (3525 ± 428 versus 3325 ± 579; p = 0.031). In the logistic regression model, nulliparity (OR: 8.68, 95% CI = 2.96-25.3), instrumental delivery (OR: 7.96, 95% CI = 1.37-49.0) and mediolateral episiotomy (OR: 6.67, 95% CI = 2.61-17.1) were factors which had an independent impact on risk of PGH. CONCLUSIONS: Nulliparity, instrumental delivery and mediolateral episiotomy are the main risk factors for hematomas.

Factors That Affect Perinatal Outcomes of the Second Pregnancy of Adolescents.

STUDY OBJECTIVE: We assessed factors that might affect perinatal outcomes in second pregnancies in adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, MAIN OUTCOME MEASURES: This longitudinal retrospective study was carried out on 66 adolescents who experienced 2 deliveries during their adolescence. Data were collected for the first and second pregnancies. Odds ratios (ORs) and 95% confidence intervals (CIs) for adverse perinatal outcomes in the second pregnancy were calculated using a logistic regression model and SPSS software (version 17.0 for Windows; SPSS Inc, Chicago, IL). A P value < .05 was considered to indicate statistical significance. RESULTS: Body mass index, number of antenatal care visits, weight gain during pregnancy, incidence of anemia, smoking status, gestational week at delivery, cesarean section rate, and birth weight were similar between the first and second pregnancies of these adolescents. Neonatal intensive care unit admission rate, preeclampsia rate, low neonatal birth weight rate, and 5-minute Apgar scores <7 were significantly higher in the first than in the second pregnancy (P < .001). Age of 16 years or younger at the time of first pregnancy (OR = 1.5; 95% CI, 0.9-2.1; P < .01), less than an 18-month interval between births (OR = 1.4; 95% CI, 0.2-1.7; P < .04), presence of gestational complications in the first pregnancy (OR = 1.9; 95% CI, 1.0-3.4; P < .01), and the presence of perinatal complications in the first pregnancy (OR = 1.3; 95% CI, 1.0-1.9; P < .01) were found to be significant indicators for adverse neonatal outcomes in second pregnancies of adolescents. CONCLUSION: We found that the second pregnancies of adolescents were associated with fewer adverse perinatal outcomes than were their first pregnancies. However, some factors regarding the presence of perinatal complications in the first pregnancy, such as maternal age of 16 years or younger at the time of the first pregnancy and interval between first and second pregnancy of less than 18 months, were found to increase the risk of adverse perinatal outcomes for the second births.

Maternal hypoglycemia on 50 g glucose challenge test: outcomes are influenced by fetal gender.

OBJECTIVE: To assess the perinatal outcomes in pregnant women with maternal hypoglycemia following a second trimester oral glucose challenge test (GCT). MATERIALS AND METHODS: This retrospective case control study consisted of 2091 pregnant women with hypoglycemia (glucose levels >88 mg/dL 1 h following a 50 g GCT in the second trimester of pregnancy) and a control group of 2091 pregnant women with a GCT result between 88 and 130 mg/dL. Perinatal and neonatal characteristics obtained from electronic medical records were compared between groups. RESULTS: The rates of pregnancy complications were similar in both groups, with the exception of a lower incidence of polyhydramnios and a higher rate of deliveries before the 34th week of gestation in patients with hypoglycemia (0.5% vs. 1.1%, P=0.016 vs. 2.6% vs. 1.7%, P=0.033); respectively. Neonates born to mothers with hypoglycemia had significantly less birth trauma (0.3% vs. 0.9%, P=0.027) and neonatal hypoglycemia. When the data for male and female infants were analyzed separately, male infants had a 1.5-fold (95% CI: 1.05-2.18) increased chance of being small for gestational age (SGA), whereas the risk for female infants did not increase (OR: 0.79, 95% CI: 0.56-1.11). CONCLUSION: A low maternal plasma glucose level on the GCT is associated with favorable outcomes, such as decreased rates of birth trauma and neonatal hypoglycemia. In addition, male infants have a higher risk of being SGA than female infants when maternal GCT results were <88 mg/dL.

Krukenberg carcinoma metastasized from stomach resembling mucinous cystadenocarcinoma of the ovary.

The ovaries are common site of metastasis in a variety of primary neoplasms. Multiple tumors such as breast, lung, and pancreas have been reported to metastasize to the ovary, however; the colon and stomach are the most common primary cancer sites that of ovarian metastasis. An ovarian mass mostly originates from its self-tissue, but sometimes it can be a metastasis of a gastrointestinal system tumor. Such cases are often misdiagnosed as primary ovarian cancers. A 42-year-old woman was admitted to our hospital with pelvic pain. She had a history of her complaints for two months. Bilateral large ovarian mass was detected in transvaginal ultrasound. Laparotomy was performed, the pathologist suggested inspection of the stomach after the frozen section analysis; therefore, an irregular mass on the stomach was detected. The general surgeon was attended to the operation, and an inoperative stomach tumor was reported by the general surgeon. After that due to the partial obstruction of jejunum, a gastrojejunostomy was performed. It is in fact difficult to distinguish between metastatic mucinous carcinomas and primary mucinous carcinomas of the ovary, due to the similar appearance of as cystic tumors on gross examination. The clinicians should be aware of the likely concomitant gastrointestinal system tumor when a large and bilaterally mass was detected on physical examination. This case also reminds that a systemic examination is necessary even if the large ovarian tumors suspicious of primary malignancy were noticed.

Clinical significance of serum follistatin levels in the diagnosis of ovarian endometrioma and benign ovarian cysts.

OBJECTIVE: To determine the clinical significance of serum follistatin levels in women with an ovarian endometrioma. MATERIALS AND METHODS: This is a prospective study of 89 women, 56 with an ovarian endometrioma (endometrioma group) and 33 with a benign ovarian cyst (control group) who underwent laparoscopic excision. Age, parity, body mass index, serum CA-125, serum CA 19-9, and serum follistatin levels were determined for all participants and evaluated as potential prognostic factors prior to laparoscopic cystectomy. RESULTS: There were no significant differences in demographic factors between the endometrioma group and the control group. However, serum follistatin levels were significantly higher in the endometrioma group (9350 ± 895 pg/mL vs. control group 725 ± 72 pg/mL, p < 0.05). The optimal diagnostic cut-off values (sensitivity and specificity) of CA-125, CA 19-9, and follistatin for ovarian endometrioma were 23.2 IU/mL (82.14% and 72.73%), 30.14 IU/mL (45.28% and 87.50%), and 2350 pg/mL (53.7% and 60.61%), respectively. CONCLUSION: Despite the increased serum follistatin levels in patients with ovarian endometrioma, CA-125 was determined to be a more sensitive and specific marker than follistatin for the diagnosis of ovarian endometrioma and endometriosis.

Spontaneous Membranous Dysmenorrhea in an Adolescent Girl: A Case Report and Literature Review.

BACKGROUND: Membranous dysmenorrhea is a rare entity. It involves the sloughing of the endometrium in 1 cylindrical or membranous piece, retaining the shape of the uterine cavity. Herein, we report the first case of spontaneous membranous dysmenorrhea in an adolescent girl. CASE: A 17-year-old girl was admitted to the emergency clinic with severe painful menstrual bleeding and passage of tissue via the vagina. Bloody endometrial tissue resembling the endometrial cavity expulsed from the vagina was seen on inspection. The pathologic diagnosis of the mass was membranous dysmenorrhea. SUMMARY AND CONCLUSION: To our knowledge, this is the first case of the spontaneous occurrence of membranous dysmenorrhea. The relationship between membranous dysmenorrhea and endogenous or exogenous progesterone should be investigated further. A review of the literature on membranous dysmenorrhea is presented.

Plasma Visfatin Levels in Adolescents with Polycystic Ovary Syndrome: A Prospective Case-Control Study.

STUDY OBJECTIVE: We evaluated the plasma visfatin levels in hirsute female adolescents with polycystic ovary syndrome. DESIGN, SETTING, AND PARTICIPANTS: This prospective case-control study included 87 female patients who were seen in our adolescence department. Demographic characteristics and hormonal and biochemical parameters were evaluated between patients with and without polycystic ovary syndrome. Next, we divided the patients with polycystic ovary syndrome into the following subgroups: overweight or obese (body mass index [BMI] ≥ 25 kg/m(2)) vs normal weight (BMI < 25 kg/m(2)) and hirsute vs nonhirsute. RESULTS: There were statistically significant differences in the BMI, serum androgen levels, homeostasis model assessment-insulin resistance (HOMA-IR) levels, and insulin levels between patients with and without polycystic ovary syndrome (P < .05). The mean visfatin levels showed no statistically significant difference between these 2 groups (P > .05). The serum visfatin levels were similar between the 2 subgroups classified by BMI (P > .05). However, there were statistically significant differences in the total and free testosterone levels, 17-hydroxylase progesterone level, HOMA-IR level, and visfatin level between the 2 subgroups classified by hirsutism (P < .05). The plasma visfatin level was higher in hirsute PCOS than in nonhirsute PCOS patients. CONCLUSION: Significantly higher visfatin levels were found in hirsute than in nonhirsute adolescents with PCOS. According to these results, plasma visfatin levels may be a useful marker in hirsute adolescents with PCOS.

May maternal anti-mullerian hormone levels predict adverse maternal and perinatal outcomes in preeclampsia?

BACKGROUND: Prediction of preeclampsia and adverse maternal and perinatal outcomes with biomarkers has been proposed previously. Anti-mullerian hormone (AMH) is a growth factor, which is primarily responsible of the regression of the mullerian duct, but also used to predict ovarian reserve and decreases with age similar to the fertility. AIM: To evaluate the predictive role of maternal anti-mullerian hormone (mAMH) in adverse maternal and perinatal outcomes in preeclampsia. METHODS: This prospective case-control study was conducted at current high-risk pregnancy department in a tertiary research hospital and 45 cases with preeclampsia classified as study group and 42 as control group. Data collected and evaluated were; age, body mass index (BMI), marriage duration (MD), gestational weeks (GW), gravidity, parity, mode of delivery, birth weight, newborn Apgar score, newborn gender, maternal complication, perinatal outcome, some laboratory parameters and mAMH. The association between mAMH levels and maternal and fetal outcomes were evaluated. RESULTS: There were no statistically significant differences between groups in terms of age, BMI, MD, gravidity, parity and newborn gender (p > 0.05). GW, vaginal delivery, birth weight, newborn Apgar score, were statistically significantly lower in preeclamptic patients when compared with non-preeclamptic patients (p < 0.001). Adverse maternal and perinatal outcomes were statistically significantly higher in the study group (p < 0.001). The laboratory values [alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen (BUN), creatinine, lactic dehydrogenase (LDH), uric acid and fibrinogen) were statistically significantly lower in the control group (p < 0.001). The mAMH level was significantly lower in the preeclamptic group (p: 0.035). There was no correlation between mAMH levels and demographic and clinical parameters. The area under the ROC curve (AUC) was 0.590 and the cut-off value was 0.365 ng/ml with sensitivity of 67.4% and specificity of 47.1% for mAMH. Logistic regression analysis showed a statistically insignificance between mAMH and maternal complication and perinatal outcome (p: 0.149). CONCLUSION: According to this study, mAMH level was lower in preeclamptic patients than in normal pregnants, and is found to be a discriminative factor with low sensitivity and specificity. There was no relationship between mAMH and adverse maternal and perinatal outcomes. Further randomized controlled studies with more participants are needed to evaluate the accurate effects of mAMH levels on preeclampsia and should increase the power of mAMH levels in predicting the preeclampsia.

Evaluation of the Diagnostic Accuracy of Serum D-Dimer Levels in Pregnant Women with Adnexal Torsion.

We aimed to evaluate the diagnostic accuracy of serum D-dimer levels in pregnant women with adnexal torsion (AT). The pregnant women with ovarian cysts who suffered from pelvic pain were divided into two groups; the first group consisted of the cases with surgically proven as AT (n = 17) and the second group consisted of the cases whose pain were resolved in the course of follow-up period without required surgery (n = 34). The clinical characteristics and serum D-dimer levels were compared between the groups. Patients with AT had a higher rate of elevated serum white blood cell (WBC) count (57% vs. 16%, p = 0.04) and serum D-dimer levels (77% vs. 21%, p < 0.01) on admission in the study group than in the control group. Elevated D-dimer and cyst diameter larger than 5 cm yielded highest sensitivity (82% for each); whereas the presence of nausea and vomiting and elevated CRP had the highest specificity (85% and 88%, respectively). This is the first study that evaluates the serum D-dimer levels in humans in the diagnosis of AT, and our findings supported the use of D-dimer for the early diagnosis of AT in pregnant women.

Maternal plasma homocysteine levels in intrauterine growth retardation.

OBJECTIVE: To investigate a possible correlation between maternal plasma homocysteine (HC) concentrations and intrauterine growth retardation (IUGR). METHODS: The patients were divided into the IUGR group and controls. The IUGR group consisted of 40 women and their newborns with birth weight

Pain experienced during and after office hysteroscopy with and without intracervical anesthesia.

We designed this study to evaluate if intracervical anesthesia reduces pain experienced during and after office hysteroscopy (OH). Two hundred women undergoing OH were randomized into two groups. Group I received intracervical anesthesia (10 ml %2 prilocaine), group II did not receive any anesthesia before procedure. The intensity of pain during procedure, 30 and 60 minutes later on visual analog scale (VAS) was assessed. Groups were similar in age, parity, previous number of vaginal delivery, or presence of menopausal status. The mean of pain scores during OH was less in group I (0.82 ± 0.11) than in group II (0.86 ± 0.09) and the difference was statistically significant (p = 0.04). But, the difference of mean pain scores 30 and 60 minutes after procedure between the groups were not statistially significant. In conclusion, intracervical anesthesia reduces pain experienced during OH, but this effect does not last longer.