Plasma L-carnitine levels of obese and non-obese polycystic ovary syndrome patients.

It is well-known that plasma L-carnitine concentrations are significantly decreased in obese individuals. A study showed that L-carnitine concentrations are significantly lower in lean PCOS patients than in lean healthy women. Thus, it has been suggested that lowered L-carnitine is associated with PCOS. This study also showed that the women with PCOS had significantly lower L-carnitine levels than those of the healthy controls. In addition, this study hypothesised that low L-carnitine levels in PCOS patients were associated with obesity and/or insulin resistance. Moreover, plasma L-carnitine concentrations were found to be statistically similar in PCOS patients and healthy controls, when controlled for obesity. This study implied that L-carnitine could be used as an adjunctive therapy in the management of insulin resistance or obesity in women who have PCOS. Further research might be planned to clarify the clinical effects of L-carnitine administration in PCOS patients with insulin resistance and/or obesity.

L-Carnitine: a new insight into the pathogenesis of endometrial cancer.

OBJECTIVES: The present study aims to specify the role of L-carnitine in the pathogenesis of endometrial cancer by comparing the serum total L-carnitine levels of endometrial cancer patients with those of healthy women. METHODS: Serum total L-carnitine concentrations were measured in patients with endometrioid-type endometrial cancer (n = 20) and healthy controls (n = 20) who were matched with respect to age and body mass index (BMI). RESULTS: Stage I endometrial cancer was diagnosed in 12 women (60.0%) whereas three women (15.0%) had stage II disease, three women (15.0%) had stage III disease and two women (10.0%) had stage IV disease. The healthy controls and endometrial cancer patients were statistically similar in aspect of age, gravidity, parity, BMI, waist-to-thigh ratio, waist-to-hip ratio, menopause, complete blood count parameters, and serum biochemistry. Serum total L-carnitine levels of women with endometrial cancer were significantly lower than those of healthy women (respectively, 5,519.4 ± 2,712.5 vs 7,940.8 ± 3,566.6 ng/dl, p = 0.021). Moreover, serum total L-carnitine levels decreased significantly and progressively with advancing stage (stage I vs II vs III vs IV; 6,294.0 ± 2,885.1 vs 5,800.0 ± 441.2 vs 4,016.0 ± 2,833.3 vs 2,560.0 ± 67.9 ng/dl; p = 0.021). CONCLUSIONS: This is the first study to hypothesize that L-carnitine deficiency participates in the pathogenesis of endometrial cancer by means of a mechanism which is unrelated with obesity and increased amount of fat in human body.

Could mean platelet volume in late first trimester of pregnancy predict intrauterine growth restriction and pre-eclampsia?

AIM: The present study aims to determine whether mean platelet volume (MPV) specified in late first trimester of pregnancy can be used to predict pre-eclampsia and intrauterine growth restriction (IUGR). METHODS: This study prospectively reviews 200 healthy women with 11-14-week-old pregnancies. RESULTS: Average pregnancy-associated plasma protein-A (PAPP-A) multiples of the median (MoM) value was significantly lower and MPV was significantly higher in pre-eclamptic pregnancies (P = 0.001 for both). MPV values of 10.5 fl or more can predict pre-eclampsia with 66.7% sensitivity and 63.8% specificity. The combination of MPV of 10.5 fl or more and PAPP-A MoM of 0.33 or less can predict pre-eclampsia with 75% sensitivity and 70.0% specificity. MPV values of 10.5 fl or more can predict IUGR with 82.4% sensitivity and 60.0% specificity. The combination of MPV of 10.5 fl or more and PAPP-A MoM of 0.33 or less can predict IUGR with 85.3% sensitivity and 62.0% specificity. CONCLUSION: Increased MPV reflects enhanced platelet activation which may be caused by impairment in uteroplacental circulation. When MPV of 10.1 or more and PAPP-A MoM of 0.33 or less are combined as a threshold, the pregnancies that are destined to develop IUGR and pre-eclampsia can be predicted with considerably high sensitivity and specificity. The MPV and PAPP-A combination can be addressed as a useful biochemical tool for the prediction of IUGR and pre-eclampsia in late first trimester.

Is three-dimensional prenatal ultrasound necessary: pregnant women's point of view.

OBJECTIVES: The role and applicability of three-dimensional ultrasound (3D-US) in perinatology has been repeatedly discussed in the literature. Regardless, our knowledge about patient expectations remains limited. We aimed at determining the expectations, perception and knowledge of pregnant women about 3D-US. MATERIAL AND METHODS: Upon admission to the labor unit, the women filled out a questionnaire, with the help of a doctor investigating sociodemographic data, pregnancy and delivery history previous experiences and expectations for US imaging. RESULTS: A total of 644 pregnant women were included in the study Respondents declared that approximately 70% of all kinds of structural abnormalities could be detected by 3D-US and estimated its reliability at nearly 70%. While 60% of the participants underwent 3D-US, 70% of them believed that every pregnant woman should undergo such test. Also, 457 (70.9%) of the participants were of the opinion that every pregnant woman must undergo 3D-US imaging, whereas 173 (26.8%) did not think 3D-US imaging was necessary CONCLUSIONS: To the best of our knowledge, this has been the first study on patient opinions regarding the need for 3D-US imaging during pregnancy Although the participants were not certain about the harmful effects of 3D-US, the majority believed that it was necessary for every pregnant woman to undergo such testing. Obviously patients must be instructed on the limitations of US imaging before the examination to clarify any misunderstandings about the possibilities such a technique may offer

Cystic lymphangiomatosis with severe intra-abdominal bleeding in a newborn: case report.

We report the case of a newborn girl with intestinal cystic lymphangiomatosis who presented with abdominal distension and intra-abdominal bleeding following a prenatal ultrasound diagnosis of intestinal anomaly. Postnatal abdominal ultrasound revealed disseminated submucosal and intramural cystic dilatations of various sizes in the bowel and intestinal lymphangiomatosis was diagnosed. The presence of severe bleeding diathesis and widespread disease led to conservative treatment. The patient died on postnatal day 7 and postmortem examination confirmed cystic lymphangiomatosis. Detection of intestinal hyperechogenicity and/or dilatation in prenatal ultrasonography and the persistence of these findings during pregnancy are suggestive for pathologies such as meconium ileus, meconium peritonitis, and intestinal atresia. Although rare, intestinal lymphangiomatosis should be kept in mind in patients whose prenatal sonographic findings persist until birth.

Very rare cause of vaginal mass in pregnancy: cavernous hemangioma.

Vaginal cavernous hemangioma is a considerably rare condition during pregnancy. There has only been one reported case to date. A multiparous, 24-year-old woman in the 32nd week of pregnancy was admitted with a mass prolapsed from the vagina, which had suddenly increased in size over the previous few days. A necrotic mass obstructing the vaginal canal and originating from the posterior wall was observed in a pelvic physical examination and carefully excised. The patient had contractions after the intervention and was administered tocolytic treatment with bed-rest and fluids. Her obstetric clinical status was stable after treatment and she gave birth without complication at 37 weeks and 5 days from the vaginal canal. The main approach to these very rare tumors of pregnancy, especially in the presence of necrosis, infection and/or obstruction, should be excision. But the potential for increased blood loss that may occur due to the hypervascular structure of the tumor should be taken into account.

Efficacy of transcutaneous electrical nerve stimulation for pain relief in women undergoing office endometrial biopsy.

AIM: To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) for decreasing pain related with office endometrial biopsy. METHODS: In this prospective study, 65 women undergoing office endometrial biopsy were randomly allocated to receive 550 mg oral naproxen sodium plus active TENS (Group I, n = 33) or 550 mg oral naproxen sodium plus placebo TENS (Group II, n = 32). The intensity of pain perceived by the patients was measured using a 10-cm visual analog scale (VAS) before insertion of the speculum, when the cervix grasped, immediately after biopsy, and 15 min after the procedure. The effect of anxiety (Spielberger's state anxiety inventory) on pain scores was also investigated. RESULTS: There were no statistical significant differences between groups in age, weight, body mass index, gravidity, parity, education, and menopausal status (p > 0.05). The pain scores before insertion of the speculum, when the cervix grasped, and immediately after biopsy were similar in both groups (p > 0.05). But at 15 min after the procedure, there was a significant reduction of the mean VAS pain score in naproxen sodium plus TENS group, compared with the naproxen sodium plus placebo TENS group (0.14 ± 0.47, 1.44 ± 1.37, respectively, p < 0.0001). The mean anxiety scores were 48.19 ± 6.71 and 45.85 ± 6.22 in Group I and Group II, respectively. We did not find any significant correlation between anxiety and VAS pain scores (p > 0.05). CONCLUSIONS: TENS appears to be successful in decreasing pain only after the procedure undergoing office endometrial biopsy. It can be used as a simple, cheap, safe, and effective pain relief method.

Maternal and fetal leptin and ghrelin levels: relationship with fetal growth.

PURPOSE: In our study, we investigated the influence of plasma levels ghrelin, leptin and other metabolic hormones (ILGF-1 and ILGF-2) in pregnants in regulating fetal body weight and mode of delivery. METHODS: A total of 36 appropriately healthy pregnants 19-36-year-old were involved in the study. Demographic characteristics, serum ghrelin, leptin, IGF-1 and IGF-2 levels of the pregnants were studied. RESULTS: Plasma ghrelin and leptin levels did not differ significantly among trimesters and delivery, in contrast to IGF-I and IGF-II concentrations were significantly higher in the first half of the pregnancy (P < 0.05). Serum leptin was significantly associated with mode of delivery (r = 0.231; P = 0.008), BMI (r = 0.462; P = 0.004). CONCLUSION: Metabolic factors are associated with fetal growth, but in AGA babies, there were no differences between any parameter and clinical factor.

Assessment of pulmonary functions and anthropometric measurements in women with polycystic ovary syndrome.

OBJECTIVES: The aims of this study were to compare pulmonary function tests of patients with polycystic ovary syndrome (PCOS) versus healthy women, and to investigate correlations between pulmonary function tests and anthropometric measurements of them. MATERIALS AND METHODS: A total of 31 women with PCOS and 29 controls matched for age and body mass index (BMI) were enrolled into the study. Pulmonary function tests were performed with spirometer. Body fat percentage was calculated from the skinfold thicknesses using the formula. Biacromial, chest antero-posterior and lateral diameter measurements were carried out with anthropometric set. RESULTS: There were no significant differences between patients with PCOS and healthy controls in the pulmonary function tests, body fat %, chest and abdomen region anthropometric measurements. There were moderate negative correlations only between forced expiratory volume per 1 s and BMI, abdomen circumference, body fat percentage in patients with PCOS. In the control group, however, there were moderate or strong negative correlations between anthropometric measurements (BMI, body fat percentage, abdominal circumference, chest lateral diameter) and at least three different pulmonary function tests. CONCLUSION: These results suggest that the upper body anthropometry and respiratory function relations might have impaired in patients with PCOS. We think that this situation might support the increased tendency for poor health status in patients with PCOS.

Acute effect of intranasal estrogen on cerebral and cerebellar perfusion in postmenopausal women.

OBJECTIVES: Estrogen action in the brain influences many neurochemical processes. The aim of the study was to evaluate the acute effect of intranasal 17beta-estradiol on cerebral and cerebellar perfusion in postmenopausal women. METHODS: The study group included 24 healthy postmenopausal women who had been in natural menopause for at least 1 year (mean age: 47.38+/-5.9 years). We conducted an experimental, randomized, placebo-controlled, cross-over, double-blind study. Cerebral and cerebellar perfusion was measured after placebo (saline serum physiologic) or intranasal 17beta-estradiol administration by Single Photon Emission Computed Tomography (SPECT) using technetium-99m-hexamethylpropylene amine oxime (Tc99m-HMPAO). Regions of interest (ROIs) were drawn manually. Cerebral and cerebellar perfusions were calculated for each ROI using average number of counts per pixel. Semiquantitative analysis was performed in bilateral frontal, temporal, parietal and occipital lobes, thalamus, putamen, hippocampus, amygdala, caudate nuclei, cerebellar region, anterior/posterior of cingulate gyrus and pons. RESULTS: After intranasal 17beta-estradiol administration, SPECT study revealed significant increases in cerebral and cerebellar perfusion compared to placebo measurements in all studied slices (p<0.05). There was a positive correlation between serum estrogen levels after 17beta-estradiol and cerebral and cerebellar perfusion. CONCLUSIONS: Administration of single dose intranasal 17beta-estradiol increases cerebral and cerebellar perfusions in healthy postmenopausal women.

Insulin sensitivity does not differentiate by hirsutism in non-obese women with polycystic ovary syndrome.

OBJECTIVE: Hirsutism is one of the component of polycystic ovary syndrome. According to the Rotterdam Consensus has concluded that principially obese women with polycystic ovary syndrome (PCOS) should be evaluated for the metabolic syndrome. The aim of the present study was to investigate the insulin sensitivity in PCOS women with and without hirsutism regardless of obesity. MATERIAL AND METHODS: Clinical characteristics, sex hormones and fasting glucose and insulin levels of fifty-eight women with PCOS were analyzed. Hirsutism has been evaluated through the Ferriman-Gallwey (FG) map scoring system. RESULTS: Twenty-two women (38%) were hirsute. They were not any significant difference between hirsute and nonhirsute women for their sex steroids and insulin sensitivity (P>0.05). There were no correlation among sex steroids, WHR and insulin sensitivity in relation to FG score in the subgroup with hirsutism (P>0.05). CONCLUSION: Our study suggests that normal weight and overweight women with hirsutism can have normal insulin sensitivity and normal levels of circulating androgens in PCOS women.

Nausea and vomiting in early pregnancy: relationship with anxiety and depression.

OBJECTIVE: To investigate the association between either depression or anxiety early in pregnancy, and nausea and vomiting, in a clinical sample. METHODS: Anxiety and depression scores of 230 women were investigated by using the Hospital Anxiety and Depression Scale. Nausea and vomiting of pregnancy (NVP) were scored by using the Rhode's system. These scores and demographic data were compared and P < 0.05 was considered significant. RESULTS: A significant correlation between Rhode's score and both anxiety (r=0.388, P < 0.001) and depression score, (r=0.351, P < 0.001) was found. Gestational age showed and inverse correlation with anxiety scores (P=0.019). There was no significant correlation between demographic data and anxiety/depression scores, or Rhode's scores. CONCLUSION: There is an association between anxiety and depression early in pregnancyand severity of NVP.

Body fat composition and distribution in women with polycystic ovary syndrome.

OBJECTIVES: The aims of the present study were to compare the distribution and accumulation of body fat in women with polycystic ovary syndrome (PCOS) and healthy controls matched for age and body mass index (BMI), and to investigate the association between androgen levels, insulin resistance and fat distribution. MATERIALS AND METHODS: Thirty-one PCOS women and 29 age- and BMI-matched healthy control women were evaluated in terms of subcutaneous adipose tissue thickness determined with a skinfold caliper and body composition analyzed by bioelectrical impedance analysis. Blood samples were obtained for determination of follicle-stimulating hormone, luteinizing hormone, 17beta-estradiol, 17-hydroxyprogesterone, basal prolactin, testosterone, dehydroepiandrosterone sulfate, sex hormone-binding globulin (SHBG), androstenedione, insulin and glucose levels. Insulin sensitivity was estimated by fasting glucose/insulin ratio and free androgen index (FAI) was calculated as 100 x testosterone/SHBG. Differences between means were analyzed by Student's t test or the Mann-Whitney U test according to distribution of the data. Correlation analysis was performed between the body fat distribution and parameters concerning insulin resistance and androgens. RESULTS: FAI was significantly higher in patients with PCOS compared with the control group (p = 0.001). Fasting insulin was significantly higher and fasting glucose/insulin ratio was significantly lower in the PCOS group vs. controls (p = 0.03 and 0.001, respectively). There was significantly less subcutaneous adipose tissue in the controls than the PCOS women at the triceps (p = 0.04) and subscapular region (p = 0.04). Waist-to-hip ratio of PCOS women was significantly higher than that of control subjects (p = 0.04). CONCLUSION: Upper-half type body fat distribution is linked with PCOS, high free testosterone levels and insulin resistance.

Obstructive sleep apnea in pregnancy and fetal outcome.

OBJECTIVE: To simultaneously investigate the polysomnography (PSG) and nonstress test (NST) records of pregnant women with obstructive sleep apnea (OSA) to observe NST changes during maternal desaturation and determine maternal and fetal outcomes. METHODS: A prospective observational study of pregnant women assessed by questionnaire for symptoms of OSA. Women with self-reported frequent snoring or apnea were offered PSG and NST. RESULT: OSA was diagnosed in 4 (11.4%) of the 35 pregnant women who underwent PSG. Three (75%) had fetal heart decelerations accompanying maternal desaturation. The neonates of women diagnosed with OSA had lower mean Apgar scores and birth weights compared with neonates of women without OSA. Three neonates from the women diagnosed with OSA were admitted to the newborn healthcare unit. CONCLUSION: OSA in pregnancy has important maternal and fetal outcomes. Pregnant women should be assessed for symptoms of OSA and suspected cases should be offered PSG.

Resting metabolic rate and exercise capacity in women with polycystic ovary syndrome.

OBJECTIVE: To assess the resting metabolic rate (RMR) and exercise capacity (or maximal oxygen consumption [VO2 max]) of women with polycystic ovary syndrome (PCOS) and central adiposity. METHOD: In a cross-sectional study, RMR was measured by indirect calorimetry and VO2 max by the Astrand test for 31 women with PCOS and 29 controls matched for age and body mass index, but with a different body fat distribution. Differences between the means were analyzed. RESULTS: There were no significant differences in RMR or VO2 max values between the 2 groups. CONCLUSION: Central adiposity was not predictive of an altered RMR or of decreased exercise capacity in women with PCOS.

Arterial stiffness and dipper/nondipper blood pressure status in women with preeclampsia.

INTRODUCTION: The aim of this study was to investigate the clinical relevance of dipper status in women with preeclampsia by comparing arterial stiffness index (SI) values, and dipper and nondipper status. METHODS: A total of 60 pregnant women in their third trimester were enrolled in the study. SI values were measured using a digital photoplethysmographic method (Pulse Trace System, Micro Medical Ltd., Gillingham, Kent, UK). Twenty-four-hour ambulatory blood pressure was measured by a SpaceLabs 90217 oscillometric device (SpaceLabs Inc., Redmond, WA, USA). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) were recorded. Those preeclamptic women whose mean nighttime blood pressure measurements were at least 10% lower compared with mean daytime measurements were classified as dipper status, and those with a decrease of less than 10% were classified as nondipper status. RESULTS: Seventeen women were preeclamptic with a dipper status, 13 women had nondipper status preeclampsia, and 30 women were normotensive. SI values were significantly higher in preeclamptic women compared with normotensive women (8.8+/-1.2 m/s vs. 5.9+/-0.8 m/s, P<0.001), but SI values of preeclamptic women with dipper status and preeclamptic women with nondipper status did not differ significantly from each other (P=0.485). CONCLUSION: There was no significant difference in SI values between the dipper and nondipper preeclamptic groups. These results indicate that dipper and nondipper measurements may not be suitable for clinical follow-up of preeclamptic women.

A prenatal diagnosed case of primitive neuroectodermal tumor.

Congenital brain tumors presenting in the first year of life account for 1.4-8.5% of all childhood brain tumors. Only 18% of congenital brain tumors are diagnosed before or at delivery. Primitive neuroectodermal tumor (PNET) is a highly malignant, small, blue-cell tumor which is characterized by early recurrence, metastasis, and high mortality. It makes up 13% of all fetal and neonatal brain tumors. Prenatal diagnosis of PNET or other congenital brain tumors is important because the presence of tumors may alter the time and mode of delivery and postnatal care planning. A prenatal case of PNET is described that was diagnosed with ultrasonography and magnetic resonance imaging; the case was confirmed histopathologically at postmortem examination.

Prenatal diagnosis of a fetal intracranial immature teratoma.

Congenital intracranial teratoma is a rare disease. A fetus with a congenital intracranial teratoma presenting with a hydrocephalus at 27 weeks' gestation is presented. Prenatal ultrasonography and fetal magnetic resonance imaging demonstrated a huge, heterogeneous intracranial mass including the infra- and supratentorial region and polyhydramnios. At 28 weeks' gestation, a cesarean section was performed to avoid divisive operation during delivery. The infant died after 10 min from respiratory failure. Histological examination revealed the diagnosis of immature teratoma. Early detection of congenital intracranial tumors is crucial. The prognosis is poor with death usually occurring shortly after birth.

Oxidative stress markers in pregnant women who snore and fetal outcome: a case control study.

BACKGROUND: To determine the levels of oxidative stress markers in pregnant women who snore and compare with non-snoring pregnant women. Fetal outcome of these 2 groups was also evaluated. MATERIALS AND METHODS: Prospective, case control study. Some 40 pregnant women who snored and 43 non-snoring pregnant women were evaluated. The glutathione peroxidase (GSH-Px), malondialdehyde (MDA) and myeloperoxidase (MPO) levels of the 2 groups were studied. Infant birthweight, Apgar scores, and other indicators of fetal outcome were obtained. RESULTS: The mean level of GSH-Px was significantly lower in the pregnant women who snored (p=0.005), while the mean level of MDA was significantly higher in this group (p=0.005). Levels of MPO were comparable between the groups (p>0.05). The pregnant women who snored did not have infants with evidence of an increase in compromised outcome. CONCLUSION: Although the pregnant women who snored had high levels of MDA, they did not appear to be at increased risk for delivering infants with fetal compromise.

Stepwise rising CO2 insufflation as an ischemic preconditioning method.

BACKGROUND: The pneumoperitoneum (Pp) is associated with ischemia and reperfusion (I/R) injury and oxidative stress. Various ischemic-preconditioning (IP) methods were used to reduce ischemic injury in intra-abdominal organs. In this experimental, randomized, controlled trial with a blind assessment of the outcome, we evaluated the effects of a new IP method, stepwise rising CO(2) insufflation, on oxidative stress and inflammatory cytokine response. METHODS: Twenty-one rats were divided into three groups. Rats in the control group were subjected to general anesthesia for only 60 minutes. The stepwise group was subjected to 5 mm Hg for 10 minutes, 10 mm Hg for 10 minutes, and 15 mm Hg of CO(2) insufflation for 60 minutes without deflation. In the Pp15 group, the pressure of CO(2) insufflation was fixed at 15 mm Hg for 60 minutes without deflation. Liver and blood samples were examined to determine malondialdehyde (MDA), the antioxidant, superoxide dismutase (SOD), and inflammatory cytokine (tumor necrosis factor-alpha [TNF-alpha], interleukin-6 [IL-6]) levels. Histopathologic scores of liver tissue were examined in all groups. RESULTS: The highest plasma and liver MDA, TNF-alpha, and IL-6 values were in the Pp15 group, followed by the stepwise and control groups. However, plasma and liver SOD levels determined in the control group were significantly higher, compared to stepwise and Pp15 groups. The lowest plasma and liver levels of SOD were in the Pp15 group, followed by the stepwise and control groups. Significantly higher histopathologic scores were found in the Pp15 group, followed by the stepwise and control groups, as well as MDA and inflammatory cytokine (TNF-alpha, IL-6) levels. CONCLUSIONS: We concluded that the stepwise rising CO(2) insufflation method may be an alternative IP method that may lead to a reduction in I/R injury.