Serum TNF-alpha, IL-6, lupus anticoagulant and anticardiolipin antibody in women with and without a past history of recurrent miscarriage.

OBJECTIVE: The aim of the this study was to investigate Lupus Anticoagulan (LA), Anticardiolipin Antibody (ACA), Tumor Necrosis Factor-alpha (TNF-alpha) and Interleukin-6 (IL-6) serum levels in 40 pregnant and 20 nonpregnant. MATERIALS AND METHODS: The women were divided into three groups. The first group consisted of 20 pregnant women of less than 20 gestational weeks and a past history of habitual abortion . The second group consisted of 20 non pregnant patients with a past history of habitual abortion. The third group consisted of 20 healthy non pregnant women. RESULT: LA was found in only one patient in the Group 2. ACA Ig G positivity were found 1 patient in the Group 1, 3 patients Group 2 and 1 patient in Group 3. Mean ACA IgG was highest in the Group 2. High serum TNF-alpha levels were found in the 12 (60%), 6(30%) and 2 (10%) women in the Groups 1, 2, and 3, respectively. Significant difference were found for TNF-alpha among the groups (P<0.05). The highest level of TNF-alpha was found in the Group 1 and the lowest in the Group 3. There were statistically significant differences for IL-6 among the three groups (P>0.05). CONCLUSION: We propose that cytokines especially TNF-alpha was found to be related to the pregnancy loss.

The value of laboratory tests and ultrasonography in evaluating ovarian response to ovulation induction treatment with low-dose recombinant follicle-stimulating hormone.

OBJECTIVE: To compare basal (cycle day 3) follicle-stimulating hormone (FSH) level, clomiphene citrate challenge test (CCCT), gonadotropin-releasing hormone agonist stimulation test (GAST), and mean ovarian volume estimation by ultrasound for predicting the subsequent ovarian response. DESIGN: Prospective, randomized, clinical study. SETTING: Referral university hospital. PATIENTS: One hundred and forty-four women with unexplained infertility undergoing their first ovulation induction treatment with low-dose recombinant FSH. INTERVENTIONS: Patients were randomized into four groups. Basal FSH levels were evaluated in group I (n = 36). Clomiphene citrate challenge test (CCCT) and gonadotropin-releasing hormone agonist stimulation test (GAST) were carried out in group II (n = 36) and group III (n = 36), respectively. Transvaginal ultrasound was performed for ovarian volume measurements in group IV (n = 36). In the subsequent cycle, all women received ovulation induction therapy with recombinant FSH. MAIN OUTCOME MEASURES: Number of mature (> or = 14 mm) follicles and the number of recombinant FSH ampules required for successful ovulation induction. RESULTS: Ovarian volume estimation by transvaginal ultrasound, compared to the other three tests, had the most powerful positive correlation with the number of mature follicles (r = 0.84, P < .0001) and the most powerful negative correlation (r = -0.75, P < .0001) with the amount of recombinant FSH used per cycle. CONCLUSION: Mean ovarian volume estimation by transvaginal ultrasound might be more useful than basal FSH values, CCCT, and GAST for predicting ovarian response to low-dose recombinant FSH treatment.

Effect of postmenopausal hormone replacement therapy on cardiovascular performance.

UNLABELLED: Postmenopausal hormone replacement therapy (HRT) has usually been evaluated the relationship with atherosclerotic disease, whereas its effect on direct cardiac functions hasn't been investigated in detail. This study was planned to investigate the long-term effects of HRT on cardiac functions and exercise performance. METHODS: Thirty-six postmenopausal women (mean age: 51 +/- 4 years, 39-60 years) were prospectively analyzed with pulsed wave Doppler echocardiography and symptom-limited exercise stress test before HRT (oral 0.625 mg conjugated estrogen and 2.5 mg medroxyprogesteron acetate/day), and at the third and the sixth months. The effect of HRT on left ventricular ejection fraction (EF), early filling velocity (E wave) and late filling velocity (A wave), E wave deceleration time (EDT), E/A ratio, myocardial performance index (MPI), exercise duration and METS changes were examined. RESULTS: HRT did not significantly alter the left ventricular EF. At the third month of HRT, there was an insignificant increase in E wave, EDT, and E/A ratio, whereas an insignificant decrease was noted in MPI (P > 0.05). However, at the sixth month of HRT, these changes became significant (68 +/- 12 vs. 75 +/- 13 cm/s, P < 0.01; 171 +/- 24 vs. 184 +/- 14 ms, P < 0.01; 1.01 +/- 0.23 vs. 1.11 +/- 0.27, P < 0.01, and 44 +/- 9 vs. 39 +/- 8%, P < 0.001, respectively). On the other hand, exercise duration and exercise METS values showed significant improvements at the third month of HRT (423 +/- 104 vs. 482 +/- 104 s, P < 0.001; 8.2 +/- 1.7 vs. 9.1 +/- 2 METS, P < 0.001). These improvements also continued at the sixth month of HRT. In conclusion, postmenopausal HRT leads to a progressive improvement on left ventricular function parameters, and in parallel, in exercise performance.

A comparative study of the effect of rofecoxib (a COX 2 inhibitor) and naproxen sodium on analgesic requirements after abdominal hysterectomy.

This study evaluated the analgesic efficacy of administering preoperatively rofecoxib or naproxen sodium to patients undergoing abdominal hysterectomy. A randomized, double-blinded prospective study was conducted with 60 women undergoing elective abdominal hysterectomy under general anesthesia. Patients were randomly allocated into one of three equally sized groups. Patients in the first group received rofecoxib 50 mg 1 h before operation (group R), patient in the second group received naproxen sodium 550 mg 1 h before surgery (group N) and patients in the third group received a placebo tablet in the same time (group P). Total amount of used morphine mixture was higher in placebo group (93+/-6 ml) than in the group R (50+/-4 ml) and group N (64+/-6 ml). There were significant difference for total amount of used morphine mixture between group P and other two groups. There was significant difference in the volumes of morphine mixture used in the first 12 h in group P and other two groups. The occurrence of side effects such as, dyspepsia, epigastric discomfort, heartburn, were similar in group R and group P. However, this side effects were increased in group N. Rofecoxib receiving preoperatively was provided clinical efficacy for postoperative pain control and well tolerated for gastrointestinal side effects comparable with naproxen sodium.

Ovarian osteoma.

Ovarian osteoma is very rare pathology. In this case report, an ovarian osteoma is presented.

Results of the pregnancies with HELLP syndrome.

In this study, clinical features, developing complications, and results of thirty-six patients, which were followed up in our Obstetrics and Gynecology and Nephrology departments between 1997 and 2001, with the diagnosis of HELLP syndrome were searched retrospectively. The mean age of the cases followed up with diagnosis of HELLP syndrome were 30.2 +/- 5.9 (17-46) years. HELLP syndrome was diagnosed on average in the 32.6 +/- 4.8th (23-41) week of gestations. Seventy percent of the cases were with severe preeclampsia and 30% of the cases were with mild preeclampsia. Eleven cases (30%) were nullipara and twenty-five cases (70%) multipara. The average of arterial systolic blood pressure of the cases were 161.6 +/- 26 mmHg, and that of diastolic blood pressure was 98.5 +/- 16.8 mmHg. In thirteen cases (36%) acute renal failure (ARF), six cases (17%) placenta detachment, two cases disseminate intravascular coagulation (DIC), one case Adult Respiratory Distress Syndrome (ARDS) were developed. In seven cases (19%) intrauterine dead fetuses were detected. In twenty-three cases by cesarian section (64%), in thirteen cases by induction (36%) the pregnancies were terminated in 72 h after diagnosing HELLP syndrome. Birth weights of eleven babies (30%) were below 1500 g. Five of the eleven babies were dead in the neonatal period. Six of the thirteen patients who had ARF were given hemodialysis. Two patients died because of the development of ARF + DIC and ARDS. No predicting factors for the development of HELLP syndrome could be detected, but severe preeclampsia. Therefore we think that preeclamptic pregnancies must be followed up very closely and if HELLP syndrome develops, termination of the pregnancy would be proper as soon as possible.

The comparison of clinical and hormonal parameters in PCOS patients treated with metformin and GnRH analogue.

In this study, our aim was to compare the effects of metformin and gonadotropin releasing hormone (GnRH) analogues in clinical and hormonal parameters in women with polycystic ovary syndrome (PCOS). There were 50 women with PCOS who were included in our study and they were divided into two groups. In this randomized trial, metformin (850 mg, two times per day) was administered to the first group and GnRH analogue (goserelin 3.6 mg, every 28 days) was given to the second group for 3 months. Because of the previous treatments, PCOS patients served as their own controls. The results of 42 women who completed the study were evaluated. Insulin resistance was not ascertained in patients. Metformin treatment resulted in a significant decline in mean body mass index, body weight, circumferences of waist and hip and total hirsutismus score. There was a significant decrease in luteinizing hormone (LH) levels and a significant increase in follicle stimulating hormone (FSH), progesterone, and sex hormone binding globulin (SHBG) concentrations. No changes in fasting glucose and insulin levels were observed. The GnRH analogue resulted in a significant increase in FSH and SHBG levels and a significant decrease in LH, total testosterone, dehydroepiandrosterone sulfate (DHEAS) levels and LH to FSH ratio and an improvement in hirsutism scores. Metformin and GnRH analogues had effects upon the abnormal steroid-gonadotropin metabolism and the clinical findings of hyperandrogenism with different mechanisms.

Methotrexate for cervical pregnancy. A case report.

BACKGROUND: The incidence of cervical pregnancy is 1:1,000-95,000 pregnancies and represents < 1% of all ectopic pregnancies. Evacuation of the pregnancy by curettage does not always stop the bleeding because there is little contractile muscle in the cervix. If there is uncontrollable bleeding, hysterectomy is necessary. In selected cases, nonsurgical management offers high success rates. Among medical treatments, the most common is systemic or local administration of methotrexate. CASE: A 36-year-old woman, gravida 2, para 2, presented with vaginal bleeding and subacute pain in the lower abdomen. The patient was 7 weeks' pregnant according to her last menstrual period. Transvaginal ultrasonography showed a gestational sac of approximately 5 weeks' gestational age implanted in the wall of the cervix. Fifty milligrams of methotrexate was injected into the gestational sac and another 50 mg administered intramuscularly. The hCG level decreased continuously and was no longer detectable after 35 days. CONCLUSION: The use of methotrexate for cervical pregnancy is safe and effective and preserves fertility.

Effects of long-term hormone replacement therapy on QT and corrected QT dispersion during resting and peak exercise electrocardiography in post-menopausal women.

It is known that the QT interval is longer in women than men. Estrogen is reported to account for the QT interval prolongation in several studies conducted with hormone replacement therapy (HRT) in postmenopausal women. Along with this, there are conflicting data as regards the effects of HRT on QT interval and dispersion. Moreover, there is no evidence about the effect of HRT on exercise QT parameters. We compared QT parameters obtained from surface electrocardiograms during resting and peak exercise before and after 6 months of HRT consisting of estrogen plus progesterone in healthy postmenopausal women. Twenty-four healthy postmenopausal women were given 0.625 mg/day conjugated estrogens and 2.5 mg/day medroxyprogesterone acetate for 6 months. Exercise stress testing using the Bruce protocol was performed before and after HRT. QT maximum, minimum, dispersion and corrected QT maximum, minimum and dispersion were calculated during resting and peak exercise. HRT resulted in a significant increase in estradiol plasma levels from 24+/-10 pg/mL to 117+/-66 pg/mL (P<0.001). There was no significant difference in resting QT parameters after HRT, whereas QT dispersion and corrected QT dispersion were significantly increased during peak exercise (20+/-7 versus 25+/-10 ms; P<0.05, 33+/-12 versus 41+/-16 ms; P<0.05, respectively). Nonetheless, the other exercise QT parameters were unchanged. The resting QT parameters are not affected by long term HRT consisting of estrogen plus progesterone, which leads to an increase in QT dispersion and corrected QT dispersion during peak exercise.

Can myomectomy be performed during pregnancy?

OBJECTIVE: To evaluate the effectiveness, safety, complications and outcome of pregnancy after myomectomy performed during pregnancy. MATERIAL AND METHODS: Five pregnant women with myomas requiring operation because of severe abdominal pain were included in the series at the Department of Obstetrics and Gynecology, Selçuk University Faculty of Medicine between October 1, 1996 and February 24, 2001. The patients were controlled with ultrasonography and cardiotocography every month up to 32 gestational weeks and then every 2 weeks. Cesarean section was performed on all patients at 37-40 weeks. Complications and fetoneonatal outcome were recorded. RESULTS: The mean age of the patients was 31.4 +/- 3.5 years. The mean parity was 1.4 +/- 1.6. The median gestational age at the time of myomectomy was 17.8 +/- 3.4 weeks. The mean size of the myomas was 14.0 +/- 3.8 cm. The main symptom of all patients was severe abdominal pain in spite of analgesic medication. The mean duration of the operation was 40.0 +/- 7.9 min. The mean blood loss was 280.0 +/- 83.6 ml. The mean number of myomas removed was 2.8 +/- 1.3. CONCLUSION: Myomectomy during pregnancy can be performed if necessary.