Trace metal fractions, sources, and risk assessment in sediments from Umurbey Stream (Çanakkale-Turkey).

Trace metal contamination has become a worldwide problem for aquatic systems, as sediments act as a sink for trace metals. This study was conducted to assess geochemical fractions, sources and potential risks of trace metals (Cd, Cr, Cu, Ni, Pb, and Zn) in sediments of Umurbey stream (Çanakkale-Turkey). Sediment samples were taken from seven different locations of Umurbey stream. Aqua regia wet digestion procedure was applied to determine total contents of trace metals and BCR sequential extraction procedure was applied to determine geochemical fractions of trace metals. Trace metal total values were ordered as Zn > Pb > Cr > Cu > Ni > Cd. Just because of topography, geology, and agricultural practices, S4, S5, S6, and S7 sampling points had greater total trace metal concentrations than the other locations. Potential mobility of trace metals in sediment samples was ordered as Cd (62.1%) > Zn (60.8%) > Pb (54.8%) > Cu (46.1%) > Cr (43.0%) > Ni (29.7%). Cd, Zn, Pb, and partially Cu were encountered mostly in mobile phases. Multivariate analyses revealed that pollution in sediment samples was originated from not only anthropogenic but also natural factors. Except for Zn, trace metal concentrations were found to be at tolerable levels of biota. When the contamination factor and risk assessment code results were assessed together, it was observed that Cd, Zn, and partially Pb were weakly adsorbed onto sediments, thus might pose risks on environment in the long run.

Is there a relationship between endometrial polyps and obesity, diabetes mellitus, hypertension?

OBJECTIVE: The purpose of our study was to evaluate the relationship between endometrial polyps and obesity, diabetes mellitus (DM) and hypertension (HT). MATERIALS AND METHODS: 202 patients who applied to our gynecology clinic with complaints of infertility, recurrent pregnancy loss and abnormal uterine bleeding, diagnosed to have endometrial polyps by hysteroscopy, were compared with 79 patients without polyps, retrospectively. The relationships between risk factors and presence of a polyp and polyp size were analyzed. RESULTS: The mean age of cases with endometrial polyps was significantly greater than the controls. The mean body mass index (BMI) of the cases with polyps was also significantly greater than the controls. There was no significant difference between groups with respect to prevalence of DM or HT. CONCLUSION: This study suggests that obesity is an independent risk factor in the development of endometrial polyps. Clinicians should be aware in terms of endometrial polyps in the assessment of patients with BMI ≥30. There was no relationship between HT or DM with presence of polyps.

Pregnancy outcomes by mode of delivery among breech births.

OBJECTIVE: To compare maternal and neonatal outcomes of the vaginal delivery versus cesarean delivery for the breech presentation. METHODS: We reviewed the maternal and neonatal charts of all singleton breech deliveries of <1,000, 1,000-1,500, 1,501-2,500, 2,501-4,000, and >4,000 g delivered between 2000 and 2006 at our institution. The study population consisted of 1,537 women with a fetus in a breech presentation. A group of 478 women that had delivered vaginally was compared with a group of 1,059 women, who had cesarean delivery, regarding neonatal mortality and morbidity (asphyxia, bone fractures, intraventricular hemorrhage, convulsions, respiratory distress syndrome, necrotizing enterocolitis, congenital hip dislocation), and maternal morbidity (febrile morbidity, anemia, wound infection). RESULTS: Neonatal complications did not differ between the group of women with term babies, <1,000 g babies, >1,500 g babies in breech presentation for women that had vaginal delivery and those that had cesarean delivery. On the other hand, breech presentation in preterm delivery between 1,000 and 1,500 g birth weight appears an independent risk factor for the neonatal mortality. There were fewer maternal complications in the vaginal group than in the cesarean group. CONCLUSION: Vaginal delivery of 1,000-1,500 g babies presenting as breech is associated with the increased neonatal mortality compared with cesarean delivery. Cesarean delivery is associated with maternal morbidity compared with the vaginal delivery.

Uterine junctional zone thickness, cervical length and bioelectrical impedance analysis of body composition in women with endometriosis.

OBJECTIVE: We aimed to evaluate uterine junctional zone thickness, cervical length and bioelectrical impedance analysis of body composition in women with endometriosis. MATERIAL AND METHODS: This is a prospective study conducted in a tertiary teaching hospital. A total of 73 patients were included in the study. Endometriosis was surgically diagnosed in 36 patients (study group). The control group included 37 patients. MAIN OUTCOME MEASURE(S): Bioelectrical impedance analysis was used to measure body composition. Uterine junctional zone thickness and cervical length were measured by transvaginal ultrasonography. RESULTS: Patients' characteristics (age, gravida, parity, live baby, age of menarche, lengths of menstrual cycle, percentage of patients with dysmenorrhea, positive family history), body mass index (BMI) (kg/m(2)), amount of body fat (kg), percentage of body fat were not statistically different between the two groups (p>0.05). The length of menstruation and cervical length were longer in women with endometriosis. Similarly, the inner myometrium was thicker in women with endometriosis than the control group. CONCLUSION: The relation between endometriosis and demographic features such as age, gravida, parity, gravida, BMI, lengths of the menstrual cycle, age of menarche are controversial. Longer cervical length and thicker inner myometrial layer may be important in the etiopathogenesis of endometriosis.

Efficacy of passive uterine straightening during intrauterine insemination on pregnancy rates and ease of technique.

AIM: The aim of the present study was to evaluate the efficacy of passive uterine straightening during intrauterine insemination (IUI). MATERIAL AND METHODS: A randomized controlled trial was conducted at Zeynep Kamil Maternity and Pediatric Research and Training Hospital. Participants were 460 women with unexplained infertility. Interventions were IUI by passive straightening of the uterus by means of bladder filling, or IUI performed with an empty bladder. Main outcome measures included pregnancy rate and difficulty of IUI. RESULTS: Four hundred and sixty couples were allocated: 230 couples were allocated to the full bladder group, and 230 couples were allocated to the empty bladder group (control). The pregnancy rate was higher in the full bladder group than in the empty bladder (control) group (P=0.03, 13.5% vs 7.4%; relative risk [RR] 1.95 for pregnant patients; 95% confidence intervals [CI] 1.048-3.637). The risk of undergoing difficult IUI was higher in the empty bladder group than the full bladder group (P<0.001; 10.0% vs 37.8%, RR 0.18 for difficulty IUI; 95% CI 0.11-0.30). The clinical pregnancy rate was also higher in the group of patients who had easy IUI than in the group of patients who had difficult IUI (P<0.05, 12.7% [42/331] vs 5.5% [6/110]); RR 2.51 for pregnancy; 95% CI 1.04-6.09). CONCLUSION: Passive straightening of the uterus makes the procedure less difficult and improves the clinical pregnancy rate.

Serum lipids level assessed in early pregnancy and risk of pre-eclampsia.

AIM: The purpose of this study investigated the relationship between early pregnancy plasma lipid concentrations and risk of pre-eclampsia. MATERIAL AND METHODS: In a prospective cohort study, maternal blood samples were collected between 10-20 weeks of gestation. From the cohort, we selected 30 women who developed pre-eclampsia and 320 who remained normotensive and served as control subjects. Linear logistic regression test was used for confounding factors identification. RESULTS: Women who subsequently developed pre-eclampsia had higher concentrations of fasting plasma, total cholesterol and triglycerides than in those remaining normotensive group. After using linear logistic regression analyses for the potential confounding factors, triglyceride concentrations were significantly higher in pre-eclamptic cases as compared with control. CONCLUSION: Early pregnancy dyslipidemia, particularly hypertriglyceridemia appears associated with increased risk of pre-eclampsia.

Post-abortion hysteroscopy: a method for early diagnosis of congenital and acquired intrauterine causes of abortions.

OBJECTIVE: Recurrent pregnancy loss is often defined as three or more consecutive pregnancy losses but there are no strict criteria for initiation of investigations after a miscarriage. We compared the frequency of uterine anomalies diagnosed by hysteroscopy following one, two and three or more miscarriages. STUDY DESIGN: In our study 151 patients underwent diagnostic hysteroscopy following a missed or an incomplete abortion. Uterine septum, subseptum, arcuate uterus, and uterine hypoplasia are classified as congenital uterine anomalies and polyps, synechia, and submucous myomas are classified as acquired uterine abnormalities. RESULTS: 151 Patients were enrolled in the study. The pregnancy numbers of the patients varied between 1 and 12. Sixty nine (46%) of the patients had one miscarriage, 42 (28%) had two miscarriages and 40 (26%) had three or more miscarriages. Diagnostic hysteroscopy revealed normal uterine cavity in 61.1% of the patients, congenital uterine anomalies in 20.4% and acquired uterine pathologies in 18.5%. Among the congenital anomalies, 14 (9.3%) were uterine septum, 10 (6.6%) were subseptate uterus, 4 (2.6%) were arcuate uterus and 3 (1.9%) were uterine hypoplasia. Among acquired abnormalities 14 (9.3%) were uterine synechia, 12 (7.9%) were endometrial polyps, and 2 (1.3%) were submucous myoma. Among patients who had one miscarriage 64.1% had a normal uterine cavity, 18.2% had congenital abnormalities and 17.7% had acquired uterine pathologies. Of patients with two miscarriages, 52% had a normal uterine cavity, 21.9% had congenital anomalies and 26.1% had acquired uterine pathology. In the three or more miscarriage group, 58.4% had normal uterine cavity, 25.3% had congenital anomalies, and 16.3% had acquired uterine pathology. We did not find any statistically significant difference between the number of miscarriages and pathologic diagnostic hysteroscopy findings. CONCLUSIONS: Post-abortion office hysteroscopy is a simple and efficient tool in the early diagnosis of congenital and acquired uterine pathologies. Diagnostic hysteroscopy can be performed after the first miscarriage in order to determine congenital and acquired uterine pathologies, with regard to the patient's age and anxiety level.

Effects of short-term maternal fasting in the third trimester of pregnancy on fetal biophysical profile and Doppler indices scores.

INTRODUCTION: It was aimed to investigate the effects of short-term maternal fasting on fetal biophysical profile (BPP) scores and obstetric doppler indices. MATERIALS AND METHODS: Thirty healthy uncomplicated singleton pregnancy cases were enrolled into the study. RESULTS AND CONCLUSION: Fasting decreased BPP reversibly, but not to a level below 8/10. AFI, umbilical and MCA impedances were unchanged while pulsatility, resistance and systolic/diastolic values of uterine arteries were increased.

Route of delivery of thoracoomphalopagus twins: analysis of three cases.

BACKGROUND: The management of thoracoomphalopagus twins depends on gestational age and life expectancy of the fetuses. Vaginal route of delivery is limited to small nonviable fetuses. Cesarean section should be reserved for larger fetuses or when the life expectancy of the fetuses is of concern. CASES: The first case was that of heavily malformed fetuses of 28 weeks in preterm labor, delivered vaginally according to their parent's request, but the fusion between fetuses was torn cephalad. The second case was diagnosed and underwent cesarean section at her 29th gestational week, but her babies were lost after birth due to cardiorespiratory arrest. The third case was 34 weeks pregnant and not diagnosed until birth. Presentation of the first fetus was vertex, while the other was breech. Totally 3,700 g twins were delivered by vaginal route without any serious complication. CONCLUSION: Successful vaginal delivery of the third trimester fetuses is possible. The technique of the delivery is important.

Comparison of two forms of continuous combined hormone replacement therapy with respect to metabolic effects.

OBJECTIVE: To compare the metabolic effects of two frequently used continuous hormone replacement therapies. MATERIALS AND METHODS: Two hundred and forty-six menopausal women, aged between 41 and 57 years were enrolled in the present study. They were randomized to receive either estrogen + 2.5 mg medroxyprogesterone acetate (CEE/MPA) or 1 mg 17 estradiol + 0.5 mg norethindrone acetate (E2/NETA). Women in group I (n = 139) and group II (n = 107) were followed up for 1 year and compared with respect to total cholesterol, triglycerides, HDL, LDL, VLDL, weight gain during this period. RESULTS: The basal and 12th month weight of the patients of two groups were not statistically different (P = 0.57 and P = 0.17, respectively, in the groups I and II). No changes were detected in the levels of triglycerides, HDL and VLDL, while total cholesterol (P = 0.01) and LDL (P = 0.003) levels significantly decreased in the CEE/MPA group. In group 2, total cholesterol and triglyceride levels showed no significant change, however, levels of HDL cholesterol (P = 0.001) increased and LDL (P = 0.001) and VLDL cholesterol (P = 0.006) decreased significantly. CONCLUSION: Administration of E2/NETA regimen has better results on lipid profile when compared to CEE/MPA regimen. No weight gain is recorded in E2/NETA group.

Effects of two different regimens of continuous hormone replacement therapy on endometrial histopathology and postmenopausal uterine bleeding.

OBJECTIVE: To compare the effects of frequently used two different regimens of combined continuous hormone replacement therapy; 0.625 mg conjugated equine estrogen (CEE) + 2.5 mg medroxyprogesterone acetate (MPA) and 1 mg 17beta estradiol (E2) + 0.5 mg norethindrone acetate (NETA), on endometrial histopathology and postmenopausal uterine bleeding. MATERIALS AND METHODS: Two hundred and forty-six outpatient subjects aged 41-57 years were enrolled in the study conducted at the menopause clinic between November 2003 and November 2004. One hundred and thirty-nine patients were assigned to receive 0.625 mg conjugated equine estrogen + 2.5 mg medroxyprogesterone acetate (CEE/MPA), whereas 107 patients were to receive 17beta estradiol + 0.5 mg norethindrone acetate (E2/NETA). Inclusion criteria of the study were: normal values of endometrial thickness at basal evaluation, women with intact uterus, at least 12 months of amenorrhea, normal vaginal smear, bilateral mammography and biochemical blood parameters. All women were questioned every 3 months for vaginal bleeding/spotting. Endometrial sampling was performed by Pipelle catheter in the 12th month of therapy. RESULTS: For the first 3 months, vaginal bleeding/spotting rate for the CEE/MPA group was 38.7%, whereas it was higher (45%) in the E2/NETA group. For the second 3-month period, vaginal bleeding/spotting frequencies were 41.1 and 37.8%, respectively. In the third 3-month period 30.6 and 29.6%, and in the fourth 3-month period, 18.5 and 12.5% of the patients reported vaginal bleeding or spotting. None of the results of endometrial sampling have shown findings of cancer histopathology. CONCLUSION: Compared to CEE/MPA regimen, E2/NETA therapy has not shown more favorable effects on postmenopausal bleeding abnormalities. Irregular endometrial proliferation was seen more with the E2/NETA regimen.