Alterations in lipid peroxidation and T-cell function in women with hyperemesis gravidarum.

The objective of this study was to investigate serum adenosine deaminase (ADA) activity as a marker of T lymphocyte activation and parameters of oxidative stress and antioxidant defence in hyperemesis gravidarum (HG). Serum ADA activity, malondialdehyde (MDA), catalase (CAT) and glutathione peroxidase (GPx) levels were investigated in 40 pregnant women with the HG and 40 with healthy pregnancies, in a descriptive study. Although serum ADA and CAT were measured to be higher in HG group, the difference was not significant. Serum MDA and GPx levels were significantly elevated in women with HG when compared with those without HG. The significance of changes in lipid peroxidation and T-cell activation in the pathogenesis of HG and whether this is a cause or a compensatory reaction to HG requires further investigations with larger multicentre trials.

Trimethoprim/sulfamethoxazole-induced hypoglycemia in a malnourished patient with severe infection.

Hypoglycemia resulting from the combination of sulfonylurea and sulfonamides is a recognized drug interaction. Hypoglycemia induced by sulfonamides alone may be encountered less frequently. Because of their structural similarities to sulfonylureas, sulfonamides are liable to facilitate hypoglycemia by increasing insulin release in susceptible individuals. Sulfonamides can potentiate the hypoglycemic effect of sulfonylurea agents when given in combination. We describe a malnourished patient with severe infection who developed hypoglycemia during high-dose trimethoprim/sulfamethoxazole therapy. Elevated C-peptide concentrations during the hypoglycemic episode indicate that hypoglycemia resulted from increased endogenous insulin secretion. As malnourished patients are prone to hypoglycemia, we suggest that they should be monitored carefully if they are on sulfonamide therapy.

Comparison of meropenem with amikacin plus ceftazidime in the empirical treatment of febrile neutropenia: a prospective randomised multicentre trial in patients without previous prophylactic antibiotics. Meropenem Study Group of Turkey.

Eighty three patients with neutropenia and cancer were randomised to receive either 1 g meropenem tds or amikacin 15 mg/kg single dose daily plus ceftazidime 2 g tds. No prophylactic antibiotics were allowed before entry to the trial. Seventy seven patients were available for analysis. Infection was microbiologically or clinically documented in 53 episodes (69%). The overall success rate without adjustment was 49% in monotherapy, 37.5% in the combination group. These rates were increased to 65% and 56%, respectively when secondary infection episodes requiring a different class of chemotherapy were taken into account. Median duration for defervescence was 3 days in successfully treated patients in both groups. Only minor reversible side effects were noted in both treatment arms. Meropenem monotherapy seemed as effective and safe as amikacin plus ceftazidime for the empirical treatment of neutropenic cancer patients with fever.

Structure of premenstrual endometrium in HMG + HCG induced anovulatory women.

In this study structural alterations were tested on anovulatory infertile women who had undergone treatment of HMG + HCG to induce ovulation and subsequently to achieve pregnancy. For this purpose, a single premenstrual endometrial fundal biopsy was performed and evaluated using light and electron microscopy. The aim of the study was to evaluate the biopsies with respect to 'in-phase' or 'out-of-phase' at light microscopic level, in which a series of strict criteria were chosen, and then to detect the additional structural abnormalities at electron microscopic level, if present. Only one of the women in our study who had an in-phase endometrium became pregnant after proper treatment protocol individually adjusted and consequently terminated by an early abortion. Histologic features of the biopsies revealed that about half were normal while the rest had various types of structural abnormalities in the transformation of the secretory endometrium detected by light and/or electron microscopy. At the electron microscopic level, multiple alterations were seen in cellular and intercellular components even in those diagnosed as normal by light microscopy. As a result of the above data it was concluded that the cause of inconceivability might arise from some fine structural alterations which may affect the endometrial receptivity of an implanting embryo.

Clomiphene citrate challenge test in the assessment of ovarian reserve before controlled ovarian hyperstimulation for intracytoplasmic sperm injection.

The objective of this study is to evaluate the performance of clomiphene citrate (CC) challenge test to predict diminished ovarian reserve before controlled ovarian hyperstimulation for intracytoplasmic sperm injection (ICSI). The 198 women who underwent the CC challenge test fulfilled the following criteria; over 35 years of age, removal of one ovary or previous ovarian surgery, the presence of ovarian endometrioma or previous poor response to ovarian hyperstimulation. Of the patients tested, 141 were found to have a normal CC challenge test while 57 had an abnormal result. The cancellation rate of the cycle with a poor response was significantly higher in women with an abnormal test (36.8%) than in those with a normal test (19.8%) (P < 0.05). The sensitivity of CC test for cycle cancellation was found to be 43% with a specificity of 76%, positive and negative predictive values of 37 and 80%, respectively. The estradiol values on hCG day, the number of retrieved oocytes and metaphase II oocytes and the rate of transfer cycles were significantly lower in females with an abnormal test. Women with normal test results had higher pregnancy rates per embryo transfer than those with abnormal test results (21.5 vs. 13.3%) and the predictive value of an abnormal test for failing to conceive was 93% (53/57) with a sensitivity of 31%, specificity of 84% and negative predictive value of 15.6%. Of 57 women with an abnormal test result, 25 (43.8%) were abnormal due only to an elevated day 10 or 11 value of FSH, which could not be detected using only basal FSH screening. In this group, the cancellation rate (48 vs. 19.8%, P < 0.01), the rate of transfer cycles (48 vs. 72.3%, P < 0.05) and the mean number of retrieved oocytes (4.9 +/- 2.5 vs. 6.4 +/- 3.1, P < 0.01) were all significantly different from normal test group. Although the rate of pregnancies per started cycle (8 vs. 15.6%) did not show a statistically significant difference, this is most probably due to the low number of patients. In conclusion, an abnormal CC challenge test is a good predictor of diminished ovarian reserve and it is better than a basal FSH concentration on day 3. It provides valuable information for both patients as to their chances of achieving a pregnancy and also for the medical team deciding on options for stimulation protocols.

Bone mineral density in Turkish postmenopausal women.

OBJECTIVE: To determine the bone mineral density curve in Turkish postmenopausal women and to evaluate the efficacy of estrogen replacement therapy in the prevention of bone loss. METHOD: Spinal bone mineral density was measured using dual photon absorptiometry in 118 postmenopausal women, prospectively. Parity, previous and current use of estrogen preparations were correlated with BMD using Student's t-test and the chi 2-test. RESULTS: With a mean BMD value of 0.967 +/- 0.013 g/cm2, 62.5% of our postmenopausal study population had a mean BMD value of < 1.0 g/cm2 and 33.7% were already osteoporotic (< 0.9 g/cm2). Bone loss was faster and more intense in the surgically menopausal than in the naturally menopausal group (P < 0.05). Parity after the fourth delivery dropped the mean BMD value (P < 0.05). Previous and current use of estrogen treatment seemed to decrease bone mineral loss in the postmenopausal years. CONCLUSION: Our data stress the need for locally obtained normal BMD values in every country in the world. High parity, surgical menopause and duration of 5 or more years of natural menopause are risk factors for bone loss. Estrogen replacement diminishes the annual bone loss.

Bone loss rate in the lumbar spine: a comparison between natural and surgically induced menopause.

OBJECTIVE: To compare the bone loss between natural and surgically induced menopause by dual photon absorbsiometry (DPA) and quantitative computed tomography (QCT). METHODS: The study group included 365 women, who were in menopause for at least 6 months. Of all patients, 272 became menopausal naturally and 93 surgically. Spinal bone mineral density (BMD) of the women was determined by DPA in 201 patients and by QCT in 164. Regression analysis was used to correlate BMD and months since menopause. RESULTS: Measurements with DPA did not show any significant difference in bone loss between natural and surgical menopause patients, whereas in the group of patients of whom BMD is measured by QCT, a relatively increased bone loss rate is found in surgically induced menopause patients. CONCLUSIONS: Oopherectomized women seemed to suffer a relatively higher bone loss rate compared with natural menopause.

The use of intraurethral prostatic spiral in high risk patients for surgery with benign prostatic hyperplasia.

Under local anaesthesia, 31 patients underwent insertion of an expandable stainless steel tubular spiral into the prostatic urethra under fluoroscopic control. All were considered to be at major risk from prostatic surgery. Most of them had long-term indwelling urethral catheters (14 patients). The spiral allowed unobstructed voiding and is a good alternative to an indwelling urethral catheter. We recommend insertion of a spiral in patients with urinary obstruction if they are unfit for surgery.

Apoptosis in raloxifene-treated postmenopausal women.

As raloxifene is a mixed estrogen receptor agonist and antagonist, it exerts different effects on apoptosis in different tissues. In this study, we aimed to evaluate apoptosis in the peripheral lymphocytes of postmenopausal women treated with raloxifene and compare it with untreated control subjects. In this way, we expected to deduce some results about the effect of raloxifene on the immune system and to serve as a guide for future studies on this newly proposed effect of a well-known agent. Twenty osteoporotic postmenopausal women treated with raloxifene for 12 months were included in this study. Another 20 osteoporotic postmenopausal women matched for age and postmenopausal years, but without any medication, were chosen as the control group. Apoptosis was evaluated using a morphological and DNA fragmentation assay, in the peripheral lymphocytes of these women. Our results revealed a decrease in the apoptosis percentages of the patients treated with raloxifene (14.6%) with respect to the control subjects (15.8%), but the difference was not statistically significant (p=0.467). This study indicated that raloxifene treatment had no apoptotic effect on peripheral human lymphocytes compared to controls.

A new technique in tubal reconstruction: microsurgery.

PIP: The use of microsurgery in uterine tubal reconstruction significantly improves the pregnancy rate. Microsurgery is a new surgical procedure and discipline which requires meticulous hemostasis, delicate tissue handling, and accurate suture placment in addition to the use of magnification. In short, it is the application of good surgical technique. The author's experience with tubal reanastomosis using a microsurgical technique is presented. 34 patients underwent microanastomosis following thorough evaluation in order to rule out any other absolute cause of infertility. The postoperative tubal patency rate was 87.4%. Overall, intrauterine pregnancy rate was found to be approximately 50% with an ectopic pregnancy rate of 13.6%.^ieng

Treatment of estrogen-dependent gynecological disorders with the gonadotropin releasing hormone agonist buserelin.

The authors examined the effect and tolerability of buserelin in 40 women with endometriosis and ten women with uterine leiomyoma. Buserelin was given intranasally, 200 micrograms three times a day for 6 months. Laparoscopy was performed before and after, and ultrasonography during the treatment. Hormone and lipid profiles and other biochemical tests were run during the treatment. The bone mineral density was tested by dual photon absorptiometry before and after therapy in a group of patients. Although most of the patients complained of hot flushes, no women dropped out. AFS mean pelvic score decreased from 24.10 to 6.95 and the size of the fibroids decreased by 69% at the end of 6 months of treatment. In conclusion, our data suggest that the use of GnRH agonist has a place in the treatment of endometriosis and uterine leiomyoma but further studies are needed to conclude that buserelin given intranasally at a dose of 600 micrograms/day for 6 months is an alternative to other conventional medical treatment modalities in terms of pregnancy and recurrence rates.

Hirsutism: diagnostic approach and stimulation-suppression dynamics of androgens in the female.

Total 24-hour urinary 17-ketosteroid (17-KS) and serum testosterone (T), androstenedione (A), and dehydroepiandrosterone sulfate (DHEA-S) concentrations were measured before and after the administration of Cortrosyn and dexamethasone in 46 hirsute and 18 nonhirsute women. Both the baseline urinary 17-KSs and serum androgen levels were significantly higher (P less than 0.05) in hirsute than in nonhirsute subjects. In 58% of the patients in the hirsute group serum androgen concentrations were found to be elevated, while 17-KS levels in 24-hour urine collections were within normal limits. In 87% of our hirsute subjects at least one serum androgen was elevated. Serum DHEA-S concentration was elevated in almost half of the patients with hirsutism. For the evaluation of hyperandrogenism, measurements of serum androgens give more accurate information to the clinician. Dynamic stimulation-suppression studies do not appear to offer any better understanding of the type of androgens involved or a rational guide to the choice of therapy. Hirsute patients were found to be responding less to corticotropin stimulation in comparison to nonhirsute patients. The stimulation rate was significantly higher in 17-KS, A, T, and DHEA-S concentrations in nonhirsute than in hirsute patients.

Dosage aspects of danazol therapy in endometriosis: short-term and long-term effectiveness.

The use of danazol (Danocrine) appears to be the most effective medical form of therapy for endometriosis. A double-blind study on 32 patients with laparoscopically proved pelvic endometriosis was designed to evaluate the immediate short-term and long-term effectiveness of daily dosages of danazol (100, 200, 400, and 600 mg) on the amelioration of the disease, with the use of posttreatment surgical findings and symptomatic changes. The American Fertility Society classification based on a point system was used. The clinical and surgical improvement rates varied from 75% to 85% and 50% to 70%, respectively. Ovarian endometriomas of even 1 cm in size generally do not respond to danazol. The pregnancy rate was 45%. We have demonstrated that lower than maximum doses of danazol produce similar beneficial effects in the treatment. With the low dosages, we did not achieve freedom from side-effects. The average symptomatic recurrence rate was 36%, with a mean duration of 19 months of follow-up, and was dose dependent.

Bone loss in young women with primary hypogonadism and its prevention with calcitonin.

A total of 63 healthy young women with primary amenorrhea, 37 control women at the same age with normal ovarian function and 118 postmenopausal women underwent bone mineral density (BMD) measurements at the lumbar spine (L2-L4) by dual photon absorptiometry. Mean +/- SE BMD value in the primary amenorrheic patients (0.878 +/- 0.015 g/cm2) was significantly lower than in both the control ovulatory women (1.069 +/- 0.026 g/cm2) and the postmenopausal patients (0.967 +/- 0.013 g/cm2) (p < 0.05). When hormonal parameters were compared between primary amenorrheic and ovulatory control cases, only the prolactin mean levels were found to be significantly lower in the first group (8.74 +/- 0.86 vs. 16.31 +/- 1.05 ng/ml; p < 0.001). Serum total alkaline phosphatase activity and LDL-cholesterol were negatively correlated with bone mineral density. Total cholesterol and lipid levels were significantly higher in women with primary amenorrhea when compared with the eumenorrheic control group (p < 0.001).

Tolerability, safety and efficacy of two formulations of Parlodel--a slow release oral form (SRO) versus registered Parlodel capsules.

Twenty hyperprolactinemic patients who entered a randomized parallel-group, double-blind, double-dummy study were investigated regarding safety, tolerability and efficacy. Half of the patients received 5 mg Parlodel SRO plus placebo for Parlodel while the other half received 2.5 mg Parlodel b.i.d. and placebo for Parlodel SRO for a period of 15 days. In the second following period of 15 days, the daily dose was increased to 10 mg Parlodel administered either as a single dose of Parlodel SRO or two doses of Parlodel 5 mg. The plasma prolactin levels, clinical signs and symptoms of hyperprolactinemia, physical examination, blood pressure, heart rate assessments and adverse events were recorded during the study. Complete blood count, blood chemistry and standard ECG were performed before and at the end of treatment. In conclusion, both formulations are equally efficacious, well tolerated and safe. Due to the comfort of once-a-day administration and the excellent compliance, one could recommend to replace the b.i.d. or t.i.d. administration of Parlodel with the once-a-day Parlodel SRO in hyperprolactinemic patients.

Comparison of different treatment modalities for postmenopausal patients with osteopenia: hormone replacement therapy, calcitonin and clodronate.

OBJECTIVE: To evaluate the effectiveness of hormone replacement therapy (HRT), clodronate, calcitonin and a clodronate plus calcitonin combination in postmenopausal patients with osteopenia. METHODS: One hundred postmenopausal patients with osteopenia, with bone mineral density (BMD) measurements at least one standard deviation below the mean value for young premenopausal subjects (T score < -1), were studied. They had no contraindications to HRT, clodronate or calcitonin use and were randomized to four different treatment groups. Patients in group I were treated with transdermal estradiol 50 micrograms/day and oral medroxyprogesterone acetate 10 mg/day during the last 12 days of the month; group II received oral clodronate 400 mg/day for 1 month out of every 3 months; group III received calcitonin nasal spray 100 IU/day; and patients in group IV were treated with oral clodronate 400 mg/day for 1 month out of every 3 months plus calcitonin nasal spray 100 IU/day. Elementary calcium 1000 mg/day was supplemented to patients in all groups. Spinal and femoral neck BMD measurements and markers of bone mineral metabolism were measured in each patient before treatment and 6, 12 and 18 months after treatment in 86 patients. RESULTS: Significant increases in mean lumbar spine BMD were found in the group receiving HRT, and at the end of 18 months there was a 2.69 +/- 0.76% increase, compared with baseline. Mean femoral neck BMD also increased by 2.22 +/- 0.57% in the HRT group; this was significantly different from baseline, resulting in a higher bone mass gain than in the other three groups. Increases in both lumbar spine and femoral neck BMD were found in patients treated with clodronate, although the only significant increase was observed in lumbar spine BMD at the end of 18 months. The mean changes in BMD were not significantly different, compared with the other groups, and at the end of 18 months there was a 2.20 +/- 0.58% increase at the lumbar spine. The mean vertebral and femoral neck BMD did not change significantly throughout the study period in patients receiving calcitonin. At the end of 18 months, there was a 0.13 +/- 0.52% decrease and a 0.11 +/- 0.49% increase in mean lumbar spine and femoral neck BMD, respectively, compared with baseline. The combination of clodronate plus calcitonin increased mean lumbar spine and femoral neck BMD by 2.08 +/- 1.05% and 1.46 +/- 1.09%, respectively, at the end of 18 months, but these increases were not significantly different from those in the groups where these agents were used alone. Significant decreases in bone resorption and in markers of bone formation were observed in all groups. CONCLUSION: HRT was found to be the most effective treatment regimen in postmenopausal patients with osteopenia, compared with clodronate, calcitonin and a clodronate plus calcitonin combination. Clodronate or calcitonin might be alternatives when HRT is contraindicated or refused by the patient; although calcitonin was found to be less effective. The clodronate plus calcitonin combination was not superior to either of these agents when used alone.

Age-related changes in ovarian volume, antral follicle counts and basal follicle stimulating hormone levels: comparison between fertile and infertile women.

Our objective was to compare the relationship between age, basal follicle stimulating hormone (FSH) level and ultrasound-measured mean ovarian volume (MOV) and mean antral follicle counts (MFC) in a group of infertile and fertile women between the ages of 35 and 45 years. Menstrual cycle day 3 serum FSH, MOV and MFC were analyzed in 62 infertile and 53 fertile women. Basal FSH and MFC did not differ between infertile and fertile women, whereas MOV was significantly smaller in infertile women (p < 0.05). In the infertile group, there was a negative correlation between MOV and age (rho = -0.389, p < 0.05), between MOV and basal FSH (rho = 0.495, p < 0.01), and between MFC and age (rho = -0.553, p < 0.01). In the fertile group, there was a strong negative correlation between MOV and basal FSH (rho = -0.631, p < 0.01), and between MFC and basal FSH (rho = -0.710, p < 0.01). Mean basal FSH, MOV and MFC did not differ between subgroups of patients with different causes of infertility. In the infertile group, patients with small ovaries of volume less than 1.8 cm(3) (mean volume -1 SD) had higher mean basal FSH (p < 0.05) and lower MFC (p < 0.01) levels than patients with normal ovarian volume. In conclusion, transvaginal ultrasound (TVU) indices and indirect hormonal parameters of ovarian reserve were similar in infertile and fertile women aged between 35 and 45 years. It is suggested that, in infertile women above 35 years of age, TVU rather than hormonal parameters be preferred, based on our data showing a stronger association between age and TVU indices of ovarian reserve than between age and increase in basal FSH level. Thus, TVU assessment of ovarian volume and antral follicle counts is a practical and cost-effective, if not better, technique for ovarian reserve testing.

Hepatitis C virus antibodies among risk groups in Turkey.

In order to determine the prevalence of hepatitis C virus (HCV) infection in the Black Sea region in Turkey, 287 serum samples taken from risk groups were investigated for anti-HCV antibodies using HCV EIA system. Anti-HCV antibodies were found to be positive in 51.2% of chronic haemodialysis patients, 20.6% of probable acute non-A, non-B hepatitis patients, 4% of patients who had multiple blood transfusions, 1.5% of the health personnel, while in new haemodialysis patients anti-HCV antibodies were not found.