Impact of testicular histopathology as a predictor of sperm retrieval and pregnancy outcome in patients with nonobstructive azoospermia: correlation with clinical and hormonal factors.

In this study, our objective was to evaluate the impact of testicular histopathology on the outcome of intracytoplasmic sperm injection (ICSI) cycles of patients with nonobstructive azoospermia and correlate with clinical and hormonal parameters. For this purpose, 271 patients with nonobstructive azospermia (NOA) who underwent testicular sperm extraction (TESE) for ICSI cycles were retrospectively evaluated for sperm retrieval, fertilisation, embryo cleavage, clinical pregnancy and live birth rates among different testicular histology groups. We also correlated hormonal and clinical factors with histological findings. Sperm retrieval and fertilisation rates (FR) were found to be significantly different among all testicular histological groups of NOA except for embryo cleavage, clinical pregnancy and live birth rates. Furthermore, serum follicle stimulating hormone (FSH) level was the most significant variable to predict sperm recovery on TESE. Separate analyses within each testicular histological group revealed that higher FSH was also associated with lower pregnancy rates in only maturation arrest group. In conclusion, testicular histology significantly influences sperm retrieval and FRs but not pregnancy and live birth rates in nonobstructive azoospermia. However, FSH is the best predictor of a successful TESE.

IL-6 gene promoter polymorphisms: genetic susceptibility to recurrent pregnancy loss.

Recurrent pregnancy loss (RPL) is defined as three or more pregnancy losses before 20 weeks. RPL is a multifactorial condition with several etiologic factors including genetic abnormalities of the parents, anatomical, endocrinological, hematologic and immunologic abnormalities, infections, nutritional and environmental factors. The causes of pregnancy loss in about half of the women with RPL even after extensive investigations remain unknown. We analyzed IL-6 -174 G/C, -572 G/C, -597 G/A, -1363 G/T, -2954 G/C promoter region polymorphisms in 113 RPL patients and 113 healthy subjects by using polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) assay. The -174G/C genotypic and -174C allelic frequency and the -2954G/C genotypic and -2954C allelic frequency of IL-6 was higher in RPL patients than healthy controls and a significant association was found between RPL and -174G/C, -2954G/C polymorphisms (p < 0.0001, OR: 0.28, 95% CI: 0.15-0.51, p < 0.034, OR: 0.16, 95% CI: 0.01-1.12 respectively). We found remarkably similar frequencies in RPL patients compared to controls for IL-6 -572G/C,-597G/A and -1363G/T genotypes/alleles and no association was observed between RPL and these polymorphisms. Our study supported that IL-6 -174G/C and -2954G/C polymorphisms were associated with an increased risk of RPL in Turkish patients (Tab. 3, Ref. 24).

Relationship of vaspin and apelin levels with insulin resistance and atherosclerosis in metabolic syndrome.

AIMS: We aimed to investigate, circulating vaspin, apelin-12 and apelin-36 levels in subjects with metabolic syndrome (MetS) and also to search for the association of vaspin and apelin levels with insulin resistance (IR), high sensitivity C-reactive protein (HsCRP), Carotid Artery Intima-Media Thickness (CIMT) and cardiovascular risk factors. METHODS: In this observational case-control study, a total of forty one patients with MetS (30 women and 11 men mean age, 41.3±9.4 years) and thirty nine healthy comparison subjects (27 women and 12 men; mean age, 38.4±6.1 years) were enrolled. Serum HsCRP, lipid profile, insulin levels and the homeostasis model assessment of insulin resistance (HOMA-IR) were evaluated. Apelin-12, apelin-36 and vaspin serum levels were measured via ELISA. High-resolution B-mode ultrasonography was performed. RESULTS: The two study groups did not differ as to age, sex, blood pressure, smoking history. Vaspin, apelin-12 and apelin-36 levels were significantly elevated in patients with MetS when compared with that of control subjects (P<0.001). Serum vaspin levels showed a statistically significant association with CIMT (r=0.365, P<0.001) and HsCRP (r=0.316, P<0.01) levels, whereas both serum apelin-12 and 36 levels were positively correlated with HOMA-IR (r=0.344/0.462 P<0.01). CONCLUSION: Based on the findings of this study, Serum vaspin and apelin levels were found significantly higher in patients with MetS than age-matched control subjects and significantly associated with coronary atherosclerosis. These adipocytokines might play a part in the pathogenesis of MetS. Also serum Apelin levels can be used as specific markers for insulin sensitivity in patients with MetS.

A new technique for endoscopic treatment of gastric phytobezoars: fragmentation using guidewire.

BACKGROUND AND STUDY AIMS: Bezoars result from accumulation of indigestible materials in the gastrointestinal tract and often occur in the stomach. In this study, we evaluated the use of guidewires in patients with gastric phytobezoars (PBs) as a new method for PB removal and examined the safety of the procedure. PATIENTS AND METHODS: Between February 2009 and January 2013, we analyzed data from 11 patients with gastric PBs. We fitted a transparent cap to a standard endoscope (EG450WR5, Fujinon), and a 0.025 inch guidewire was passed through the standart endoscope. PBs were surrounded by a loop in the guidewire and destroyed. After 2 weeks of treatment, patients were re-evaluated for effectiveness. RESULTS: PB fragmentation time was 5-11 minutes. In five patients with a history of gastric surgery, we needed an additional 16-28 minutes for removal of the fragments. In six patients additionally treated with enzymatic degradation after the breaking procedure, PBs completely disappeared within 2 weeks. There were no complications during the procedure. CONCLUSIONS: The guidewire and fragmentation procedure for PBs is an efficient and reliable method. When combined with enzymatic degradation, PBs can be managed quickly and effectively.

Cardiovascular risk factors, carotid artery intima media thickness, and HSCRP levels in patients with impaired glucose metabolism.

AIM: The aim of this paper was to compare serum high sensitivity C-reactive protein (HsCRP) levels and carotid artery intima-media thickness (CIMT) of patients with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) with that in control subjects. METHODS: Ninety-six subjects with prediabetes, 48 with IFG, of mean age 50.7±11.3 years, and 48 with IGT, of mean age 50.9±12.3 years, were enrolled, along with 44 age-, sex-, and body mass index-matched controls with normal glucose tolerance. Serum HsCRP, lipid profile, insulin levels and the homeostasis model assessment of insulin resistance (HOMA-IR) was evaluated. High-resolution B-mode ultrasonography was performed. RESULTS: Serum HsCRP levels were significantly elevated in pre-diabetic patients when compared with that of control subjects. Median HsCRP values were 3.1 mg/L in IFG group, 3.47 mg/L in IGT group, and 1.5 mg/L in the controls (P<0.001). CIMT was significantly higher in pre-diabetic groups than that in the control group (IFG: 0.612±0.09; IGT: 0.625±0.1; control: 0.517±0.09, P<0.001). CIMT and HsCRP levels were similar in pre-diabetic groups. CIMT values were positively correlated with HsCRP (r=0.793, P=0.000), age (r=0.435, P=0.000), waist-hip ratio (r=0.170, P=0.044), fasting plasma glucose (r=0.302, P=0.000), HOMA-IR (r=0.173, P=0.041), and low-density lipoprotein cholesterol (r=0.168, P=0.047) levels. CONCLUSION: Both IFG and IGT were associated with increased cardiovascular risk as assessed by serum hsCRP levels and CIMT. In contrast to previous studies, risk appears to be the same in the two categories of prediabetes.

The relation of serum 25-hydroxyvitamin-D levels with severity of obstructive sleep apnea and glucose metabolism abnormalities.

Obstructive sleep apnea (OSA) and 25-hydroxyvitamin-D3 (25-OH-D) deficiency are two separate disorders associating with obesity, inflammation, and impaired glucose metabolism. We aimed to investigate the vitamin D status of OSA patients regarding to potential links between lower vitamin D levels and abnormal glucose metabolism, which is one of the main adverse outcomes of OSA. Study group is composed of 190 non-diabetic subjects who were suspected of having OSA. Subjects undergone polysomnography and were grouped due to apnea-hypopnea indices (AHI) as controls (AHI < 5, n = 47), mild OSA (5 ≤ AHI < 15, n = 46), moderate OSA (15 ≤ AHI < 30, n = 47), and severe OSA (AHI ≥ 30, n = 50). Serum 25-OH-D, HbA1c, insulin levels were measured and 75-g oral glucose tolerance test was performed. Serum 25-OH-D level (ng/ml) of OSA patients were lower than control subjects (17.4 ± 6.9 vs. 19.9 ± 7.8), and decrement was parallel to severity of OSA; as 18.2 ± 6.4 (5 ≤ AHI < 15), 17.5 ± 7.4 (15 ≤ AHI < 30), and 16.3 ± 6.9 (AHI > 30), respectively (P = 0.097, r = -0.13). However, severe female OSA patients had significantly lower 25-OH-D levels (11.55 ng/ml), while control males had the highest mean value (21.7 ng/ml) (P < 0.001). Frequency of insulin resistance (IR) was 48%, prediabetes 41%, diabetes 16% in OSA patients. Mean 25-OH-D level of insulin resistant subjects (HOMA-IR ≥ 2.7, n = 77, AHI = 35.5) was lower than non-insulin resistant subjects (HOMA-IR < 2.7, n = 113, AHI = 19.8) as 16.18 ± 7.81 versus 19.2 ± 6.6, respectively (P = 0.004). 25-OH-D level of 91 non-diabetic subjects (n = 91, AHI = 19.7) was 19.5 ± 7.4, prediabetics (n = 75, AHI = 28.7) was 17.45 ± 6.9, and diabetics (n = 24, AHI = 46.3) was 13.8 ± 5.3 (P = 0.02). We showed that subjects with more severe OSA indices (AHI ≥ 15) tended to present lower vitamin D levels correlated to increased prevalence of IR, prediabetes, and diabetes. Vitamin D deficiency may play a role and/or worsen OSA's adverse outcomes on glucose metabolism. OSA patients may be considered for supplementation treatment which was shown to ameliorate abnormal glucose metabolism and inflammation.

Diabetes alters aromatase enzyme levels in gonadal tissues of rats.

Diabetes mellitus (DM) is associated with increased risk of reproductive problems. Estrogens have important roles in reproductive processes in both genders. Aromatase catalyzes the conversion of androgens to estrogens and is expressed in a variety of tissues. Although it is known that insulin regulate the activity of aromatase, there are few data about the effects of diabetes on this enzyme. The aim of the present study was to investigate the effects of experimental diabetes on aromatase expression levels in ovary, testis, uterus, and vas deferens tissues of female and male rats. Rats were injected with streptozotocin to induce diabetes. At the end of 4 and 12 weeks, tissue homogenates were prepared and evaluated for aromatase proteins by western blot. Uterus and vas deferens smooth muscle responses were also evaluated. Aromatase expression levels in ovary were significantly decreased both in 4 and 12 weeks of diabetes. In testis, enzyme levels were not altered at 4 weeks, but significantly decreased at 12 weeks of diabetes. In uterus and vas deferens tissues, no significant differences were observed at aromatase immunoreactivity but uterus and vas deferens smooth muscle responses were altered. These results indicated for the first time that DM altered the expression levels of aromatase both in ovary and testis but did not affect enzyme levels in uterus and vas deferens tissues. Altered smooth muscle responses did not correlate with tissue aromatase levels. Altogether, these findings lead us to suggest that aromatase might be an important target molecule in sexual dysfunction seen in DM.

Correlations of fetal-maternal outcomes and first trimester 3-D placental volume/3-D power Doppler calculations.

OBJECTIVE: To investigate correlations between first trimester placental volume, placental vascularization indexes and the outcome of those pregnancies. The possible prediction of macrosomia and intrauterine growth restriction in the first trimester are studied. METHODS: We prospectively examined 145 pregnant patients at 11-14 weeks of gestation using transvaginal 3D gray-scale and power Doppler ultrasound. The acquired volumes were analyzed using the VOCAL imaging program, for assessing placental volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI). The results were correlated with the pregnancy outcome. RESULTS: Correlations between placental volume and the intrauterine growth restriction group of infants classified according to their anthropometric measurements were significant. As the placental volume decreases, percentage of intrauterine growth restriction increases. In the aspect of placental vascularisation indexes, VI showed a positive lineer correlation with newborn weight. CONCLUSION: The 3D placental volume and blood flow calculations could be important in the prediction and easy, rapid diagnostic evaluation of fetal growth restriction presenting with placental volume and vascular tree alterations even beginning at the first trimester.

Evaluation of the sexual function and quality of life in raloxifene treated postmenopausal women.

OBJECTIVE: To evaluate the net effect of raloxifene on overall quality of life and sexual function in postmenopausal women. METHODS: The study was performed in the Gynecology and Obstetrics outpatient clinic of Gazi University Faculty of Medicine between January 2002 and February 2005. Fifty postmenopausal women, in whom raloxifene was indicated for prevention and treatment of osteoporosis, were considered the study group. Fifty postmenopausal women who were not osteoporotic were enrolled as the control group. Participants completed a questionnaire composed of several parts (GRISS, BDI and ISI), at the beginning and end of the 12-month treatment period. RESULTS: Two groups were similar to each other with respect to total GRISS scores at the beginning and at the end of the study (P=0.929 and P=0.508; respectively). Raloxifene was associated with a significant improvement from baseline in the total scores of BDI (P=0.0001), whereas this improvement was not significantly different from the control group (P=0.216). With regard to ISI scores, there were no differences between groups in total scores. Raloxifene use did not seem to affect subscores of ISI either. CONCLUSIONS: This study failed to prove any deleterious effect of raloxifene on quality of life and sexual functions.

L-myc gene polymorphism and risk of thyroid cancer.

UNLABELLED: L-myc gene polymorphism is a representative genetic trait responsible for an individual's susceptibility to several cancers. However, there have been no reports concerning the association between thyroid cancer and L-myc gene polymorphism. AIM: To analyze the distribution of L-myc gene polymorphism in Turkish patients with thyroid disorders and thyroid cancers. METHODS: We used a molecular genotyping method, polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP). We studied 138 patients of whom 47 had multinodular goiter, 13 had follicular cancer and 69 had papillar cancer, in comparison with control group of 109 healthy individuals. RESULTS: No significant difference in the distribution of genotypes was observed between thyroid patients and controls. Carrying SS or LS genotype revealed a 1.96-fold (95% CI 0.573-6.706) risk for the occurrence of follicular cancer when compared with controls, and 3.11-fold (95% CI 0.952-10.216), when compared with multinodular goiter patients (p=0.04). CONCLUSION: We suggest that L-myc genotype profiling together with other susceptibility factors, may be useful in the screening for thyroid nodular malignancy.

The role of frozen section evaluation in the diagnosis of adnexal mass.

The purpose of this study was to evaluate the accuracy of frozen section diagnosis in patients who were subjected to the exploratory laparotomy for pelvic mass. Overall, 207 patients were included in this study and the mean age of the patients was 50.9 +/- 14.9 years (range, 18-84 years). Of these patients, 98 (47%) had benign, 16 (8%) had borderline, and 93 (45%) had malignant histologies at permanent section. The diagnosis at frozen section was deferred for three patients (1.4%) and these patients were excluded from the further analyses. The overall discordance rate was 5.3%. To calculate the sensitivity and specificity values, 2 x 2 contingency tables were constructed in two ways. In the first calculation, borderline histology was considered malignant, and the sensitivity and specificity rates were 97% and 92%, respectively. In the second analysis, it was accepted as benign, and these values were 100% and 98%, respectively. To determine the possible factors related with discordant diagnoses, age, menopausal status, tumoral size, laterality of tumors, and histologic diagnoses were analyzed. Significant association was noted for size and borderline and mucinous histologies. In patients with borderline histology, the discordance rate was 40%. This value for the remaining patients was 3.2% (P < 0.001). The rate of misdiagnosis was 17.4% for mucinous tumors, whereas it was 4.8% for the remaining epithelial tumors (P = 0.03). Frozen section evaluation revealed high sensitivity and specificity values in this study. To increase the accuracy of diagnosis, further diagnostic markers are needed especially for patients with large lesions, borderline tumors, and mucinous histologies.

Impact of tubal sterilization on women's health.

In this study we aimed to investigate the possible health effects of tubal sterilization on women who had chosen this method. A total of 127 women who had tubal sterilization between 2000-2005 were asked about their satisfaction with the method; their regrets and complaints, the effects of the tubal sterilization on their sexual life and their actual health. While 95% of the women were satisfied with the operation, only 76.9% of the patients would recommend this method to other woman. Although 23.1% reported changes in their sexual life after the sterilization, 30% reported changes in their menstrual cycle and 35% reported lower abdominal pain, two-thirds of the women did not state any significant complaint. Women who underwent the procedure at least two years before had fewer complaints; high school graduates and more educated women reported more changes in their sexual life. Women who had tubal sterilization were mostly satisfied with the method and were willing to recommend it to another woman.

Primary yolk sac tumor (endodermal sinus tumor) of the vulva: case report and review of the literature.

INTRODUCTION: Endodermal sinus tumor (EST) or primary yolk sac tumor (YST) of the vulva is extremely rare and a highly malignant germ cell tumor. Only nine cases of vulvar YST have been reported to the world literature to date. We present the tenth case of endodermal sinus tumor of the vulva. CASE: A 32-year-old white virgin presented with a 3.5 cm right labial mass without any other signs or symptoms. Excisional biopsy showed YST with a predominantly solid pattern. Unilateral hemivulvectomy with bilateral inguinal lymphadenectomy was performed. Six months after surgery there was a recurrence. She was treated with three courses of the BEP regimen (bleomycin, etoposide, cisplatin). The patient refused to take any further treatment including radiotherapy. The serum alpha-fetoprotein (AFP) was not elevated at the initial diagnosis however it was elevated during recurrence. The patient is alive with the disease 42 months after the first appearance of the vulvar mass.

Analysis of L-myc gene polymorphism in patients with renal failure outcome to renal transplant.

BACKGROUND: Abnormalities of cell numbers and apoptosis have been observed in renal failure. As uncontrolled expression of c-myc is known to induce apoptosis, we thought that polymorphism in the other myc gene, L-myc gene, which is structually similar to c-myc and reported to be expressed in the kidney, may have a role in the induction of apoptosis and thus have role in chronic renal failure. The aim of this study was to investigate the relationship between the distribution of L-myc genotypes and renal failure. METHODS: In the present study we examined 101 chronic renal failure patients who had either live or cadaveric renal transplants and 105 healthy individuals, for L-myc gene polymorphism by polymerase chain reactions and restriction fragment length polymorphism techniques. RESULTS: Among our patient group, the distribution of the LL, LS, and SS genotypes was 24% (n=25), 71% (n=71), and 5% (n=5), respectively, versus 41% (n=43), 47% (n=49), and 12% (n=13) in our control group. The distribution of genotypes was significantly different between our patients and the control group (chi2=12.281; P=.002). The frequency of the S allele was significantly higher in the patient group (chi2=6.122; P=.013). CONCLUSION: Our study showed that having an S allele in the L-myc gene may increase the risk of renal failure.

Correlation of serum and ascitic IL-12 levels with second-look laparotomy results and disease progression in advanced epithelial ovarian cancer patients.

Forty-two consecutive patients with advanced epithelial ovarian cancer who underwent primary surgical treatment were evaluated. The control group comprised 21 patients who had undergone surgery associated with benign pathologies. Forty-one patients had stage III disease except one who had stage IV. Optimal debulking (<1 cm) was performed in all the patients who subsequently received chemotherapy. Based on the results of the second-look laparotomy and follow-up, the patients were divided into three groups: the first group had negative second-look laparotomy or no evidence of disease during follow-up (n= 21), the second group had positive second-look laparotomy or progressive disease (n= 21), and the third was the control group (n= 21). Interleukin-12 (IL-12) levels were measured in preoperative serum and intraoperative ascites samples for all the patients. The mean serum IL-12 levels (+/-SD) in serum (S) and ascites (A) were as follows: in the first group, S: 108.44 +/- 76.40 pg/mL and A: 330.93 +/- 125.25 pg/mL; in the second group, S: 51.80 +/- 40.95 pg/mL and A: 206.89 +/- 113.47 pg/mL; and in the control group, S: 36.55 +/- 33.16 pg/mL and A: 93.62 +/- 73.07 pg/mL (P= 0.01). In the patients with advanced ovarian cancer, IL-12 levels in serum and ascites were higher compared to the levels of the controls. Also, there was an inverse relationship between initial serum and ascitic IL-12 levels and disease progression.

Effects of multipurpose contact lens solutions on the protein composition of the tear film.

OBJECTIVES: To analyze the influence of multipurpose contact lens cleaning solutions on tear proteins. Changes in tear film protein profiles of contact lens wearers who used several marketed brands of multipurpose contact lens care solutions, were assessed by ProteinChip analysis. METHODS: Three studies were conducted. Study I was a comparison of Complete and OptiFree multipurpose solutions. Study II was a study with Complete Moisture Plus solution, Study II was a comparison of Renu and Solocare contact lens solutions. Wearers of soft contact lenses were assigned to use the contact lens care solutions for 4 weeks. Non-contact lens wearing patients were used as controls. Tear samples of each participant were analyzed with the ProteinChip (SELDI-TOF) system. Multivariate statistical analysis and artificial neural networks were used to determine the tear protein profiles of each study group. RESULTS: Before starting the use of the solutions, the tear protein composition in all contact lens wearers deviated from the tear composition of the non-contact lens wearing controls. After 4 weeks of using the different care regimens, the tear protein composition of the patients using Complete or Complete Moisture Plus solutions tended to move toward that of the non-contact lens wearing controls. The tear protein composition of patients using the OptiFree, Renu or Solocare solutions did not undergo a measureable change in the protein level. CONCLUSIONS: The ProteinChip system can analyze protein profiles for large-scale applications as in clinical studies. Two multipurpose solutions, Complete and Complete Moisture Plus, demonstrated a beneficial effect on the tear proteins in contact lens wearers.