Using the LigaSure vessel sealing device in the large uterus at laparoscopic hysterectomy.

OBJECTIVE: To compare intraoperative hemorrhage and other operative parameters between patients with large and small weighted uterus who underwent laparoscopic hysterectomy (LH). MATERIALS AND METHODS: Forty-six patients intending to have LH were divided into two groups according to uterine weight (group 1 > 300 grams vs. group 2 < 299 grams). Intraoperative blood loss, operating time, periopera- tive complications, and duration of hospitalization were compared. RESULTS: Intraoperative blood loss was significantly higher in the large uterus group (group 1); 350 (227-454) ml vs. 250 (182-320) ml (p < 0.001). However, it was not significantly different between the groups in the laparoscopy step. Mean operating time was 90 (77-103) minutes and 80 (62-98) minutes in groups 1 and 2, respectively (p < 0.001) revealing ten-minute delay in group 1. Similarly, this was also not significantly different in the laparoscopy step. No significant differences were found between two groups; in terms of hemoglobin concentration decrease, major and minor complications, and hospitalization duration. CONCLUSION: The authors conclude that LigaSure can be safely used for LH in patients with a large uterus.

Effect of fetal sex on apoptosis-regulating proteins in trophoblasts of full-term human placenta.

OBJECTIVE: Pregnant women with female fetuses have higher maternal serum human chorionic gonadotropin (hCG) levels compared to those pregnant women with male fetuses. Apoptosis in the placenta has a role in hCG secretion. In the present study, we examined the effect of fetal gender on apoptosis-regulating proteins in the trophoblast cells of human term placenta. STUDY DESIGN: 34 uncomplicated, singleton, term pregnancies, 17 had male and 17 had female fetuses, were recruited in the study. Apoptosis-regulating proteins of the trophoblast cells were measured by using immunohistochemistry for Bcl-2 and Bax. Staining index values were compared between the female and male pregnancies. RESULTS: There were no sex differences in Bcl-2 and Bax proteins. There were no correlations between maternal serum and cord blood hCG levels, and staining index values of two proteins in trophoblast cells. CONCLUSIONS: The difference in maternal serum and cord blood hCG levels in correlation with fetal sex is not associated with apoptosis-regulating proteins in the trophoblast cells of human term placenta.

The effect of raloxifene on cardiac autonomic regulation in osteoporotic women.

OBJECTIVE: There are suggestive data that raloxifene may have favorable effects on the arterial systems in postmenopausal women and thereby lowering the incidence of future adverse cardiovascular events. Reduction of heart rate variability appears to be a marker for identifying subjects with an increased risk for cardiac mortality, particularly in patients after myocardial infarction and in elderly people. Although there are conflicting data with regard to the effects of estrogen and progesterone on heart rate variability in postmenopausal women, the impact of raloxifene treatment on heart rate variability is fully unknown. STUDY DESIGN: Forty-three osteoporotic postmenopausal women were recruited in a prospective, randomized, and placebo-controlled 6-month study. Of these women, 23 received raloxifene hydrocloride, 60 mg once daily, whereas 20 women received alendronate, 10 mg daily. Time and frequency domains of heart rate variability were measured at baseline and at 3 months and 6 months of the treatment. RESULTS: Time domain indices of heart rate variability, mean RR, and SD of all beat-to-beat intervals remained identical within the groups at the end of treatment. The square root of the mean of the sum of squares of successive RR intervals, a sensitive index of parasympathetic activity, tended to increase with raloxifene. Frequency domain indices of heart rate variability were as follows: low-frequency power of heart rate variability tended to stay the same, compared with the baseline values in both treatment regimens. High-frequency power of heart rate variability increased significantly in the raloxifene group (P = .039) at 3 months, and this significance persisted at the end of the treatment. A nonsignificant decrease was observed in the alendronate group. Accordingly, the low-frequency power/high-frequency power ratio, an index of sympathovagal balance, decreased significantly by the raloxifene treatment (P = .028) at 3 months and persisted at 6 months. There was no significant change in low-frequency power/high-frequency power ratio of patients taking alendronate. CONCLUSION: Raloxifene seems to have a positive effect on cardiac autonomic regulation in postmenopausal osteoporotic women. This observation could at least partially explain the reduced cardiovascular events in the subset of women with increased cardiovascular risk in the Multiple Outcomes of Raloxifene Evaluation trial. However, the results of ongoing studies should be awaited to have a conclusion of its effects on the cardiovascular system.

Effects of estrogen, raloxifene, and hormone replacement therapy on serum C-reactive protein and homocysteine levels.

OBJECTIVES: To investigate the effects of conjugated equine estrogen (CEE), CEE plus medroxyprogesterone acetate (MPA), CEE plus Nomegestrol acetate (NA), and raloxifene on serum high sensitivity C-reactive protein (hs-CRP) and homocysteine (Hcy) levels in healthy postmenopausal women. MATERIALS: One hundred seven healthy postmenopausal women were recruited in a prospective, randomized, and placebo-controlled 6 months study. Of these, 18 were hysterectomized and received daily oral 0.625 mg CEE. Eighty nine non-hysterectomized women were randomly allocated to one of four groups: a group (22 patients) treated with CEE, 0.625 mg/daily plus MPA 2.5 mg/daily; a group (22 patients) treated with CEE, 0.625 mg/daily plus NA 5 mg/daily; a group (23 patients) treated with raloxifene hydrochloride, 60 mg once daily; and a placebo group (22 patients). Hcy and hs-CRP were measured at baseline and at 3 and 6 months. RESULTS: CEE (20%, P=0.03) and CEE+MPA (59%, P=0.006) increased serum hs-CRP levels significantly, whereas CEE+NA decreased serum hs-CRP by 25% (P=0.01). Raloxifene had no significant effect on serum hs-CRP levels during and after the treatment. In all active treatment groups serum Hcy levels decreased significantly compared to baseline and placebo. CONCLUSIONS: Conjugated equine estrogen, hormone replacement therapies, and raloxifene lower serum Hcy levels to a comparable extent in postmenopausal women. Hs-CRP, as a cardiovascular risk factor, is not influenced by raloxifene, whereas CEE and CEE plus MPA significantly increase hs-CRP levels. Treatment with CEE plus NA reduces serum hs-CRP levels.

Fetal gender affects maternal serum total and placental alkaline phosphatase levels during pregnancy.

OBJECTIVE: To analyze whether fetal gender affects total alkaline phosphatase (ALP) and placental ALP levels in normal pregnancy, and to determine the gestational age at which the difference occurs. METHODS: In this longitudinal study, serum total and placental ALP measurements were carried out in 30 normal pregnant women during different ranges of gestational weeks. Infant sex was recorded at the delivery for all women included in the study. Total and placental ALP levels were compared between pregnant women bearing female and male fetuses. RESULTS: At all gestational weeks studied, both total and placental ALP levels were higher in pregnant women carrying female fetuses than in male bearing pregnant women. Particularly, both total (260.9+/-110.2 versus 239.9+/-102.3; p=0.03) and placental (73.1+/-22.4 versus 61+/-18.2; p=0.04) ALP levels were significantly higher in the female group than in the male between 24 and 28 weeks, and the significant difference persisted between 32 and 36 weeks (p=0.02). CONCLUSIONS: Fetal gender seems to affect total and placental ALP levels in healthy pregnant women, particularly during the second and third trimester of pregnancy. Higher ALP levels in pregnant women with female fetuses than in those with male fetuses may suggest that knowledge of the fetal gender may be in particular importance for the studies using ALP as a marker for the prediction of variety of diseases and complications seen during pregnancy.

Effects of chronic liver disease on bone mineral density and bone metabolism markers in postmenopausal women.

OBJECTIVES: Patients with chronic liver disease (CLD) have an increased prevalence of osteoporosis. However, there is limited information about the effects of end-stage liver disease on bone metabolism and bone mineral density values in postmenopausal women. The aim of this study was to investigate the effects of chronic liver disease on bone mineral density (BMD) and bone metabolism markers in postmenopausal women. METHODS: We studied BMD by using dual-energy X-ray absorptiometry (DEXA), biochemical markers of bone turnover and calcium-parathyroid hormone (PTH)-Vitamin D axis in 22 postmenopausal women with CLD. Control group consisted of randomly recruited 30 healthy postmenopausal women. RESULTS: Based on WHO criteria, the prevalence of osteoporosis was significantly higher in patients with CLD (72 versus 33%) compared to healthy postmenopausal women. Bone loss was more significant at the lumbar spine than femur in the study group. Urinary excretion of bone resorption marker deoxypyridinoline was increased significantly in patients with CLD. There were no significant differences in bone formation markers (osteocalcin and bone alkaline phosphatase) between the groups. CONCLUSIONS: CLD increases the prevalence of osteoporosis in postmenopausal women, particularly in the lumbar spine. Increased bone resorption seems to be the main reason for osteoporosis in these patients. We suggest that treatment strategies should be improved in these women to protect them from subsequent fractures.

Primary dysmenorrhea and uterine blood flow: a color Doppler study.

OBJECTIVE: To examine pulsatility index (PI) and resistance index (RI) values in the uterine and arcuate arteries of patients with primary dysmenorrhea (PD) by color Doppler ultrasonography. STUDY DESIGN: A total of 49 female university students were recruited for this prospective, observational study. The study group consisted of 25 nulliparous women with PD and a control group of 24 healthy, nulliparous women without dysmenorrhea. The women were examined using transabdominal color Doppler ultrasonography during the midluteal phase (days 18-22) and on the first day of the menstrual cycle. The mean PI and RI values for the right and left uterine arteries and arcuate artery were determined. Student's t test was used to compare the results between and within groups. RESULTS: The mean PI and RI values for the uterine and arcuate arteries in patients with PD were significantly higher on the first day of the menstrual cycle than in the midluteal phase (p < 0.001). Women with PD had significantly higher mean PI and RI values in all 3 arteries on the first day of the menstrual cycle than did the controls (p < 0.05). The Doppler index values of all 3 arteries during the midluteal phase were not significantly different between the groups. CONCLUSION: There is increased impedance to blood flow within the uterus of women with PD on the first day of the menstrual cycle. This may be a sign of constriction of the uterine vessels and the cause of pain.

Does manual removal of the placenta affect operative blood loss during cesarean section?

OBJECTIVE: To investigate whether manual removal of the placenta is associated with significantly more blood loss compared to spontaneous separation of the placenta during cesarean section. STUDY DESIGN: This was a randomised study of 200 women with normal pregnancies undergoing cesarean section. Patients were randomly assigned to the study group, manual removal (n=100) or the control group, spontaneous separation (n=100). Operative blood loss was measured using a volume and gravimetric method. Patients postoperative complications were recorded and hemoglobin levels measured at 24 and 48 h. RESULTS: The amount of blood loss associated with spontaneous and manual removal of the placenta was 626+/-253 ml and 589+/-272 ml, respectively. This difference was not significant. There was a decrease in the postoperative hemoglobin levels in both groups which was not significantly different. The incidence of endometritis, wound infection, and the need for blood transfusion was similar in the two groups. CONCLUSION: Manual delivery of the placenta is not associated with a significantly greater risk of operative blood loss, decreased postoperative hemoglobin levels or increased incidence of endometritis compared with spontaneous placental separation.

Recurrent pregnancy loss and its relation to combined parental thrombophilic gene mutations.

BACKGROUND AND AIM: Recurrent pregnancy loss (RPL) is a heterogeneous disorder that has been associated with antiphospholipid syndrome and other prothrombotic parameters. We aimed to investigate the prevalence of 12 thrombophilic gene mutations in RPL couples in the current results. METHOD: In a total of 543 Turkish women with RPL and 327 of their male partners (870 individuals with RPL), and a control group of 106 fertile couples (control) were analyzed for factor V leiden (FVL), factor V H1299R, factor II prothrombin G20210A, FXIII V34L, ß-fibrinogen -455G>A, plasminogen activator inhibitor-1 (PAI-1), GPIIIa L33P (HPA-1 a/b L33P), methylenetetrahydrofolate reductase (MTHFR) C677T, MTHFR A1298C, ACE I/D, Apo B R3500Q, and Apo E genes. RESULTS: The overall, heterozygous and/or homozygous point mutations in FVL-FVR2, ApoE2, PAI-1, MTHFR C677T-A1298C, and ACE genes were associated with RPL. There was no meaningful association between RPL and other studied genes. CONCLUSION: The homozygosity of 4G in PAI-1 and MTHFR C677T genes in women with RPL, and heterozygosity of FVL, FVR2, ACE, and ApoE2 genes in both parents play crucial role in RPL and should be considered as a risk factor in RPL. Current results showed that RPL is related to combined parental (not only maternal) thrombophilic gene mutations.

Comparison of two different laparoscopic hysterectomies: laparoscopic hysterectomy vs. total laparoscopic hysterectomy.

OBJECTIVE: The aim of this study was to compare the efficacy and safety of laparoscopic hysterectomy (LH) and Total Laparoscopic Hysterectomy (TLH). METHODS: Both types of hysterectomy were performed by retroperitoneal uterine artery sealing using LigaSure™ by four-puncture. A total of 45 patients were operated on by LH and 22 by TLH. The mean operation time, amount of intraoperative bleeding, drop in hemoglobin concentration, weight of removed uterus, major and minor per-post operative complications, and rate of conversion to the classical abdominal approach in the two groups were compared. RESULTS: The mean operation time in TLH (110 min.) was significantly longer than in LH (65 min.). This was mainly due to the shorter mean operating time in the vaginal part of LH group (13 min.) compared to laparoscopic dissection of uterosacral ligaments and vaginal suturing (42 min.) in the TLH group. Median blood loss was also significantly higher in the TLH group (278 ml.) compared to the LH group (110 ml.). There were no significant differences in the mean drop of hemoglobin concentration, uterine weight, major and minor complications and conversion to laparotomy between the groups. CONCLUSION: LH seems to be a faster and more demanding method than TLH. With its shorter operation time and less bleeding, LH may be preferred to TLH.

Influence of high-dose methotrexate therapy on the primordial follicles of the mouse ovary.

OBJECTIVE: High-dose methotrexate (MTX) is one of the most prescribed agents in many malignant diseases affecting girls and young women of reproductive ages. This animal study directly measures the primordial follicle loss following exposure to high-dose MTX. STUDY DESIGN: Nine inbred Balb/c mice aged 7-8 weeks in the study group were administered 5 gr/m(2) MTX as a single agent intraperitoneally, whereas nine mice in the control group received saline. Seven days later the mice were killed and total numbers of the primordial follicles remaining in both ovaries were counted. RESULT: In the high-dose MTX group, the mean number of primordial follicles (mean +/- standard deviation) was significantly different (202 +/- 38) versus the control group (327 +/- 81.7; P = 0.002). CONCLUSIONS: Our study shows that high-dose MTX causes damage to the primordial follicles of the ovaries of mice. This result may be important because young women taking high-dose MTX may suffer diminished reproductive performance and premature cessation of menses in the years following therapy.

Laparoscopic hysterectomy with retroperitoneal uterine artery sealing using LigaSure: Gazi hospital experience.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of laparoscopic hysterectomy by retroperitoneal sealing of the uterine arteries with LigaSure. METHODS: Laparoscopic hysterectomy by retroperitoneal uterine artery sealing with LigaSure was performed by four-puncture laparoscopy in 50 women with various indications for hysterectomy. The mean operation time, amount of intraoperative bleeding, drop in hemoglobin concentration, weight of removed uterus, major and minor per-post operative complications, and the rate of conversion to classical abdominal approach were analyzed prospectively. RESULTS: The mean operation time was 85 min (range 60-125 min). The mean weight of removed uterus was 180 g (range 60-650 g). There was one major complication; one patient had cystotomy due to difficulty in dissecting severe adhesions because of two previous cesarean sections that were repaired laparoscopically. Only one patient converted to laparotomy because of severe bowel adhesions due to rectovaginal endometriosis. All patients were discharged on the first postoperative day. No minor complications occurred. Hemoglobin decreased a mean of 0.4 g/dl (range 0.2-1.4 g/dl) by postoperative day 1. CONCLUSION: Laparoscopic hysterectomy by retroperitoneal uterine artery sealing with LigaSure is an effective, safe, and fast procedure with less intra operative bleeding, short operation time and hospital stay.

Mirtazapine use in resistant hyperemesis gravidarum: report of three cases and review of the literature.

BACKGROUND: Hyperemesis gravidarum is a serious health problem for the fetus and the mother. Effective treatment regimens are obscure in patients with severe symptoms. Our aim was to use mirtazapine in hyperemesis gravidarum patients who failed to respond to conventional anti-emetic drugs. CASES: Three pregnant women who had severe hyperemesis gravidarum. All patients had dehydration, ketonuria, hypokalemia, and weight loss. All failed to respond to conventional anti-emesis treatment regimens, such as metoclopramide and promethazine. Al patients had mirtazapine 30 mg/day within the intravenous fluid support approximately for 1 week. All responded to mirtazapine within 24 h and were able to resume diet within a few days after the initiation of treatment. None of these pregnant women had any disturbing symptoms of emesis throughout the pregnancy and had healthy newborns. CONCLUSION: Mirtazapine seems to be an effective treatment modality in patients with severe hyperemesis gravidarum who do not respond to conventional anti-emesis treatment regimens. Larger-scaled studies should be performed to show the effectiveness of mirtazapine in pregnant women with severe hyperemesis gravidarum who may request pregnancy termination.

Effect of fetal gender on maternal serum human chorionic gonadotropin levels throughout pregnancy.

OBJECTIVES: Maternal serum human chorionic gonadotropin (MshCG) levels are higher in pregnant women with female fetuses than in pregnant women with male fetuses in the third trimester of pregnancy. Our aim was to examine the effect of fetal sex on MshCG levels throughout the pregnancy. MATERIALS AND METHODS: Twenty-nine uncomplicated pregnancies (14 had male fetus and 15 had female fetus) were included in the study. MshCG levels were measured four times between 8-12, 14-18, 24-28 and 32-36 weeks of pregnancy. RESULTS: MshCG levels were significantly higher in both sexes between 8-12 weeks than the other three measurement periods. At 8-12 and 14-18 weeks measurements, there were no sex related differences in the MshCG levels. At 24-28 (P<0.004) and 32-36 (P<0.001) weeks MshCG levels were significantly higher in pregnancies bearing female fetuses than those bearing male fetuses. CONCLUSIONS: Fetal gender has a significant effect on MshCG levels in the third trimester of pregnancy. Accordingly, no correlation seems to exist in the first and second trimesters.

Does tibolone affect serum leptin levels and body weight in postmenopausal women?

OBJECTIVES: Leptin has a significant role in body weight regulation and energy balance. We examined the effect of tibolone on the body weight and serum leptin levels in postmenopausal women. STUDY DESIGN: Twenty women (aged 43-60 years) participated in this prospective study. All women in this study protocol received 2.5 mg/day of tibolone. Absolute and body mass index (BMI)-corrected serum leptin concentrations and BMI values were measured at baseline, after 3 months, and after 6 months of the tibolone therapy. RESULTS: Tibolone did not affect absolute and BMI-corrected serum leptin levels, and BMI values during the treatment. A significant linear correlation between BMI values and serum leptin levels was observed (p<0.05, r=0.67). CONCLUSIONS: Tibolone seems not to affect serum leptin levels, body weight and BMI values of postmenopausal women. There is a significant correlation between serum leptin levels and BMI values.

p53 and mdm2 as prognostic indicators in patients with epithelial ovarian cancer: a multivariate analysis.

OBJECTIVE: The aim of the study was to investigate the prognostic significance of p53 and mdm2 protein expressions in epithelial ovarian cancer and their relationship with the clinicopathological variables. METHODS: Tumor biopsy specimens from 82 patients who were homogenously treated were examined immunohistochemically for expression of p53 and mdm2 proteins. Univariate and multivariate analyses were performed for prognostic factors, and correlations with clinicopathological parameters were examined. RESULTS: Fifty-four percent and 33% of cases stained positive for p53 and mdm2, respectively. p53 expression was associated with serous type, higher grade, positive cytology, residual tumor and stage of the disease. mdm2 expression predicted of chemosensitivity and it was related with higher grade but not with other clinicopathological variables. Significantly poorer survival was seen for those with p53 (P < 0.05) or mdm2 (P < 0.01) positive tumors than those with negative p53 or mdm2 staining. Coexpression of p53 and mdm2 was also related to poor outcome (P < 0.05). Multivariate analysis revealed that FIGO stage, mdm2 expression, response to chemotherapy and optimal cytoreduction were significant independent prognostic and predictive factors of survival. CONCLUSION: Although our findings showed that mdm2 may be used as a prognostic indicator in patients with epithelial ovarian cancer, these results should be supported by more and larger studies.