Evaluation of Bone Density Measurement in Type 2 Diabetic Postmenopausal Women with Hypertension and Hyperlipidemia

OBJECTIVES: The aim of the study was to compare bone mineral density (BMD) in healthy postmenopausal women to BMD in type 2 diabetic hypertensive postmenopausal women with hyperlipidemia. METHODS: Fifty type 2 diabetic and hypertensive postmenopausal women with hyperlipidemia and 51 age and body mass index (BMI) matched healthy postmenopausal women were included. Lumbar spine and femoral neck BMD were noted in both groups. BMD was measured using dual energy X-ray absorptiometry (DXA). Serum alkaline phosphatase (ALP), calcium and phosphorous were also measured. Pearson correlation coefficients were used to establish the relationship between various clinical characteristics. RESULTS: There were no significant differences between two groups in respect to lumbar and vertebral BMD values, age, BMI, gravidity, parity. Serum cholesterol and fasting glucose levels were significantly different between each groups (P = 0.0001, P = 0.002). CONCLUSION: We found that, accompanying chronic diseases such as diabetes, hypertension and hyperlipidemia don't affect the BMD measurements at postmenopausal period. So these postmenopausal women don't have excess risk regarding osteoporosis.

Relationship between endometrial thickness and in vitro fertilization-intracytoplasmic sperm injection outcome

This study assessed the relationship between endometrial thickness on day of human chorionic gonadotropin [hCG] administration and in vitro fertilization intracytoplasmic sperm injection [IVF-ICSI]. This prospective cross-sectional study included a total of 593 women. Patients were treated with either the agonist or antagonist protocol according to the clinician's and patient's preference. Endometrial thickness on the hCG day was measured by transvaginal ultrasonography [TV-USG]. Patients were divided into four groups according to endometrial lines, as follows: <7 mm [group 1], 7-10 mm [group 2], 10-14 mm [group 3], and >14 mm [group 4]. Implantation rate [IR], clinical pregnancy rate [CPR], and ongoing pregnancy rate [OPR] were significantly lower in group 1 than the other three groups [p<0.05]. However, there was no significant difference among groups 2, 3 and 4. Although the endometrial line in the agonist protocol was higher than in the antagonist protocol, the difference was not statistically significant. The chance of pregnancy appears to be lower in individuals with endometrial thickness less than 7 mm compared with those of higher value

Exaggerated placental site with term pregnancy

Exaggerated placental site is a non-neoplastic lesion characterized with infiltration of extravilleous intermediate trophoblasts into the myometrium and the walls of blood vessels of the normal placental implantation area. Typically, they were seen in spontaneous and/or elective abortion materials. Rarely, the clinical picture may be associated with normal pregnancy or postpartum bleeding. A case of an exaggerated placental site is presented in this article. To our best knowledge, this is the first case demonstrating an association between exaggerated placental site and term pregnancy. It is aimed to review the current information about this rare condition.

Efficacy of the local endometrial injury in patients who had previous failed IVF-ICSI outcome

The latest studies reported that local endometrial injury is a useful method to improve the success of IVF-ICSI outcome. To assess whether local endometrial injury occurred by Pipelle in the spontaneous cycle could improve implantation rate, cleavage rate, and pregnancy outcome in the subsequent IVF-ICSI cycle in patients who had recurrent IVF failure. An endometrial biopsy was performed on day 21st in 41 patients as intervention group in this retrospective cross-sectional study. The control group contained 42 women. Implantation rate was 22.5% and 10.5% in intervention and control group, respectively and this difference was found to be statistically significant [p=001]. Pregnancy rate was 43.9% in the intervention group and this parameter was significantly lower in control group [21.4%] [p=0.03]. Local endometrial injury in the nontransfer cycle increases the implantation rate and pregnancy rate in the subsequent IVF-ICSI cycle in patients who had previous failed IVF-ICSI outcome

Scar Endometriosis developing in Abdominal Wall

Endometriosis is a relatively common clinical disorder characterized with functioning endometrial tissue outside the uterine cavity. Although it is usually located in genital tract, the atypical sites may be involved including the bladder, ureter, intestine, appendix, surgical scars, and extremities. Scar endometriosis is rare, difficult to diagnose and can be easily confused entity with a suture granuloma, lipoma or cyst. The diagnosis is made by utilizing history, physical examination, ultrasonography [USG], and histopathological analysis of the surgical specimen. The definitive diagnosis of our case was made according to the histopathologic findings. In this case report, we aimed to review the diagnosis and treatment of scar endometriosis which is rarely seen via the light of the current knowledge

Robotic Surgery in Gynecology Practice: current approaches

Laparoscopic surgery has been widely used in gynecology practice for more than 20 years. Despite the advent of laparoscopy led to advances, it has not been widely used in gynecology because of some disadvantages, including two-dimensional imaging, unstable camera platform, limited mobility of laparoscopic instruments. The aim of this study was to evaluate the advantage and disadvantages of the robotic surgery, especially the da Vinci system. Robotic surgery utilization in gynecology field has been studied in many trials. The literature was searched, advantages and disadvantages of robotic surgery were evaluated. This paper showed that previous studies which have been done suggest robotic surgery can be used in gynecologic interventions. Two dimensional imaging is replaced with three dimensional technique in the da Vinci robot with increased perception and magnification. Moreover, tremor and motion scaling which complicate the operation are not seen in the robotic surgery and the surgical procedures that are typically difficult can be done easier than laparoscopy. However, the price and the loss of tactual feeling are accepted as big disadvantages of robotic surgeries. This manuscript will highlight the science behind the robotic surgery, recent advances in minimally invasive surgery, the most recent clinical trial results and important issues we need to consider prior to implementation of the robot in Turkey

Association between serum estradiol level on the hCG administration day and IVF-ICSI outcome

Estradiol [E[2]] is required for follicular development and lay an important role in embryo implantation. The aim of this study was to assess the impact of serum E[2] levels on the day of hCG administration in IVF-ICSI patients who are performed controlled ovarian hyperstimulation [COH]. A total of 203 women who were undergone one time IVF cyclus were evaluated in this cross sectional study. All the patients were treated either with long protocol or with microdose flare protocol. The patients were categorized into five groups according to the serum E[2] levels on the day of hCG administration. The mean number of the retrieved oocytes was [NRO] 10.6 +/- 6.7, mean fertilization rate was 55.7 +/- 24.8, and implantation rate was 9.0 +/- 19.2. Of 203 patients, 43 [21%] patients were pregnant. When the overall results are examined, the number of the retrieved oocytes and the number of transferred embryos were better in patients with serum E[2] levels >4000 pg/ml and these values were statistically significant. There were no statistical difference in patients 37 years or older. In women 4000 pg/ml. In site of the lack of high quality evidence to support a positive association between serum E[2] levels and IVF-ICSI outcomes, this study shows that high E[2] levels during COH might be associated with an increased potential of pregnancy depending on better ovarian response. When the overall results are examined, the best scores were in patients with serum E[2] levels >4000 pg/ml

Comparison of the efficacy and cost-effectiveness of highly purified urinary follicle stimulating hormone [HP-uFSH] and recombinant follicle stimulating hormone [rFSH] in Poor Responders

We aimed to compare the clinical results and effectiveness of two gonadothropin treatment protocols; HP-uFSH and rFSH in poor responders. While HP-uFSH was given to 58 patients, rFSH was given to 62 patients. The patient selection criteria were the same [FSH value>15 iu/l or antral follicle number<4, on the second day of menstruation]. Endometrial thickness on hCG day [mm] was 9.0 +/- 2.7 and 7.8 +/- 2.7 in HP-uFSH group and rFSH group, respectively and this difference was statistically significant. Contrarily, fertilization rate [%] was better in rFSH than HP-uFSH [76.6 +/- 15.9 vs. 68.2 +/- 17.8] and this value was also statistically significant. Percentage of cancelled cycles [%] was 14 +/- 34 in HP-uFSH group and this parameter was significantly lower than rFSH group [29 +/- 45]. rFSH is as efficacious as HP-uFSH in poor responders. Fertilization rate was better in rFSH than HP-uFSH. Since rFSH is more expensive, the final treatment cost with rFSH to obtain a pregnancy was slightly higher, but this difference was not statistically significant [20060 TL vs. 17150 TL]

Recurrent pregnancy loss and association with anti phospho lipid syndrome

Recurrent miscarriage, the occurrence of three consecutive first-trimester losses of pregnancy, affects 1-3% of pregnant women. The purported causes of recurrent miscarriage include chromosomal abnormalities, thrombophilia, metabolic disorders, anatomical and immunological disturbances. At present, the only recommended investigations are testing for lupus anticoagulant and anticardiolipin antibody levels to diagnose the antiphospholipid syndrome, an acquired thrombophilia and the karyotyping of both parents for chromosomal abnormalities. The Antiphospholipid Syndrome [APS] is an autoimmune disorder characterized by thrombosis, recurrent loss of pregnancy combined with laboratory tests that indicate the presence of antibodies against phospholipid binding proteins. Clinically relevant antiphospholipid antibodies are mainly anticardiolipin antibodies detected by enzyme linked immuno sorbent assay [ELISA] and lupus anticoagulants demonstrated by in vitro coagulation assay. Women with antiphospholipid syndrome should be offered treatment with aspirin and low subcutaneous heparin. We aimed to summarize current concepts on diagnosis and treatment in recurrent loss of pregnancies and APS

Primary ovarian ectopic pregnancy

Almost 1-2% of the all pregnancies implants in the ectopic localization. The incidence of primary ovarian pregnancy is reported to be one in 7000 to 40000 pregnancies. We aimed to evaluate the diagnosis and treatment of this rare condition. A 32 years-old Caucasian woman, gravida 2, parity 2, was referred to our clinic with the complaint of pelvic pain started suddenly with vomiting and nausea. There was a painful fullness at the right adnexal region in the gynecologic examination of the patient. A live embryo in size of 4x3 cm was detected in right adnexal region and within a hypoechoic soft tissue field. Embryo was almost 7 weeks. Serum beta hCG [beta -hCG] level was 50885 IU/ml. The patient underwent an urgent laparoscopy. The ruptured right ovarian ectopic pregnancy was detected during laparoscopy. Cystectomy was performed by right ovarian wedge resection. The diagnosis is usually made with the pathologic examination of the specimen. Therefore, Spiegelberg's criteria are very important for diagnosis of ectopic pregnancy. The basic principle in the medical and surgical treatment is to preserve the fertility of the patient