Cesarean delivery rates in adolescent pregnancy.

OBJECTIVES: To investigate the rates of cesarean deliveries in two different hospitals, which serve different populations in Turkey. METHODS: The study was conducted at two centers, one of which is a university hospital in a rural area and the other a community hospital in capital city, for 5 years (1999-2003). The subjects were < 18 years old adolescent mothers. The adult controls ( 18 years) were further divided in two age groups: 18-35 years and > 35 years. RESULTS: A total of 40,391 pregnant women were evaluated in both hospitals. Cesarean delivery rates in adolescent pregnancies were not higher than adults. Moreover, in community hospital, cesarean delivery rate in adolescents was significantly lower (17.12% vs. 28.84%). CONCLUSIONS: We concluded that, the cesarean deliveries are not increased, and even decreased in adolescent pregnancies and biological immaturity is not a significant problem in adolescent pregnancy.

Efficacy of pulsed estrogen therapy in relatively younger patients with surgically induced menopause.

BACKGROUND: Pulsed estrogen therapy is a new approach in estrogen replacement therapy. We carried out a prospective study to evaluate the efficacy of pulsed estrogen therapy in relatively younger patients with surgically induced menopause. METHODS: Patients (n=138) <45 years old and suffering from severe vasomotor symptoms secondary to surgically induced menopause were included in the study. After the initiation of pulsed estrogen therapy (300 microg/day), the patients were re-evaluated every 4 weeks. The dose was increased at each follow-up, if necessary (to a maximum of 600 microg/day). The patients who preferred another method after the first 12 weeks were prescribed oral conjugated estrogen (0.625 mg/day) and at the end of the second 12 weeks their satisfaction levels were assessed. RESULTS: At the end of the first 12 weeks, 26 patients were completely satisfied (18.8%) and 47 were moderately satisfied (34.1%), whereas 65 concluded that the pulsed estrogen therapy they received was ineffective (47.1%). At the end of the second 12 weeks, all the patients were completely satisfied. CONCLUSION: Pulsed estrogen therapy for 12 weeks reduced the frequency of hot flushes in relatively younger patients with surgically induced menopause; however, 81.2% of patients were not completely satisfied at the end of this period.

Evaluation of bone turnover in postmenopausal patients with type 2 diabetes mellitus using biochemical markers and bone mineral density measurements.

Although osteoporosis is reported as a potential complication of type 1 diabetes mellitus (DM), the effects of type 2 DM on bone mass are conflicting. Most of the studies conducted in recent years reveal that bone mineral density (BMD) values of type 2 DM patients are not decreased and even increased when compared with healthy control groups. In this study we evaluated bone turnover in 57 postmenopausal type 2 DM patients utilizing biochemical markers for bone formation and resorption, and BMD measurements. We found that BMD values in diabetic patients (0.91 +/- 0.11 g/cm(2) for lumbar region, 0.89 +/- 0.14 g/cm(2) for hip region) were higher than healthy postmenopausal control group (0.81 +/- 0.12 g/cm(2) for lumbar region, 0.76 +/- 0.10 g/cm(2) for hip region). Serum alkaline phosphatase values were similar to the control group, whereas serum osteocalcin and N-telopeptide/creatinine (NTx/Cr) values were significantly lower than the control group (osteocalcin: 8.82 +/- 4.03 ng/ml, NTx/Cr: 122.70 +/- 81.76 nMBCE/mMCr) in diabetic patients (osteocalcin: 4.44 +/- 3.53 ng/ml, NTx/Cr: 42.24 +/- 29.97 nMBCE/mMCr). Also a significant correlation was observed between body mass index and BMD values. Our findings suggested that the bone turnover rate is remarkably lower in type 2 DM patients compared to healthy postmenopausal patients.

Endometrial patterns and endocrinologic characteristics of asymptomatic menopausal women.

The endometrial histology and endocrinologic and demographic characteristics of 556 asymptomatic postmenopausal women, who attended the menopause outpatient clinic at Ankara Numune Education and Research Hospital were studied before initiating estrogen replacement therapy. Of these women, 486 (87.4%) had atrophic endometrium, 37 (6.65%) had proliferative endometrium, 27 (4.86%) had endometrial hyperplasia without atypia, three (0.54%) had endometrial hyperplasia with atypia and three (0.54%) had endometrial adenocarcinoma on their biopsy specimens. When demographic characteristics of the patients were considered, we found that the patients with endometrial adenocarcinoma and endometrial hyperplasia with atypia had potential risk factors for endometrial pathology such as chronic anovulation, diabetes or hypertension. This study confirms that routine endometrial sampling in asymptomatic postmenopausal women is not warranted, but patients with associated risk factors should be screened for endometrial pathology before starting estrogen replacement therapy.

Nucleated red blood cells as a marker in acute and chronic fetal asphyxia.

OBJECTIVE: To investigate the variations of nucleated red blood cell (NRBC) counts in acute and chronic fetal hypoxia and to examine if it could be possible to establish a cutoff value for the number of NRBCs for prediction of fetal acidosis. METHOD: We prospectively studied 77 pregnant women. Patients were grouped as acute (n=11) and chronic fetal distress (n=21) and controls (n=45). At delivery the umbilical cord was double clamped and blood samples were collected. RESULTS: The mean NRBC counts in chronic fetal distress group was higher than acute fetal distress. NRBC counts were found to be correlated with umbilical cord pH (r=-0.57; P<0.001). The cutoff value predicting fetal acidosis was determined as 14/100 leukocytes (sensitivity 87%, specificity 81%) by using ROC analysis. CONCLUSION: The duration and the severity of fetal asphyxia may be predicted by the number of NRBCs per leukocyte.

The predictive value of fetal acoustic stimulation.

OBJECTIVE: To compare the predictive abilities, test duration times, and incidence of nonreactive results in the acoustic stimulation test (AST) and the nonstress test (NST). METHOD: Four-hundred randomly selected patients, delivering within 7 days of a preceding test, were divided into two groups (group I: NST; group II: AST). In the AST group, fetal heart rate tracing were recorded for the first 5 minutes as a baseline recording. If the reactivity criterion was not met, transabdominal acoustic stimulation to the fetal head was performed. In the NST group, nonreactive tests were followed by a repeat NST. In both groups, nonreactive tests were followed by oxytocin challenge test (OCT) on the same day. Depressed 5-minute Apgar scores (< 7) and an umbilical arterial blood pH of < 7.2 were taken as indicators of fetal distress. Sensitivity, specificity, and predictive values of NST and AST were calculated and compared. RESULTS: The incidence of nonreactive tests was lower in the AST group. AST decreased the test duration time by 10.1 minutes. The sensitivity values were 87.5% in the NST group and 85.7 in the AST group; specificities of were found to be 94% for AST and 88% for NST. The negative predictive value was found to be 98% in each group, but the positive predictive value was 54.5% in the AST group and 38.8% in the NST group. CONCLUSION: AST offers benefits, by decreasing the incidence of nonreactive tests and reducing the test time. AST lowers the rate of false positives without changing the negative reliability of NST. It is a safe test and allows more efficient use of perinatal services.

Treatment of bacterial vaginosis with oral or vaginal ornidazole, secnidazole and metronidazole.

OBJECTIVE: To evaluate the clinical efficacy and tolerance of oral or vaginal ornidazole, secnidazole and metronidazole or their combinations for treatment of bacterial vaginosis. METHOD: In an open, randomized, prospective study, 152 patients with bacterial vaginosis according to Amsel's criteria were included into the study. The patients were divided into eight groups: (1) oral ornidazole 2 x 500 mg/day for 5 days; (2) vaginal ornidazole 500 mg/day for 5 days; (3) oral and vaginal ornidazole for 5 days; (4) oral secnidazole 2 g in a single dose; (5) oral secnidazole 2 g in a single dose and vaginal ornidazole 500 mg/day for 5 days; (6) oral secnidazole 2 g in a single dose and vaginal metronidazole 2 x 500 mg/day for 7 days; (7) oral ornidazole 2 x 500 mg/day for 5 days and vaginal metronidazole 2 x 500 mg/day for 7 days; and (8) vaginal metronidazole 2 x 500 mg/day for 7 days. None of the partners received any treatment. RESULT: We found a 100% cure rate in both oral and vaginal ornidazole and oral secnidazole-vaginal metronidazole groups. CONCLUSION: Vaginal treatments including ornidazole and metronidazole are not as effective as both oral and vaginal drug combinations.

Bone loss rate in the lumbar spine: a comparison between natural and surgically induced menopause.

OBJECTIVE: To compare the bone loss between natural and surgically induced menopause by dual photon absorbsiometry (DPA) and quantitative computed tomography (QCT). METHODS: The study group included 365 women, who were in menopause for at least 6 months. Of all patients, 272 became menopausal naturally and 93 surgically. Spinal bone mineral density (BMD) of the women was determined by DPA in 201 patients and by QCT in 164. Regression analysis was used to correlate BMD and months since menopause. RESULTS: Measurements with DPA did not show any significant difference in bone loss between natural and surgical menopause patients, whereas in the group of patients of whom BMD is measured by QCT, a relatively increased bone loss rate is found in surgically induced menopause patients. CONCLUSIONS: Oopherectomized women seemed to suffer a relatively higher bone loss rate compared with natural menopause.

The effects of 3-day clomiphene citrate treatment on endocrine and ovulatory responses.

A prospective cohort, paired clinical trial was carried out to test a shorter clomiphene citrate regimen of 3 days, measuring the endocrine outcomes and ovulatory responses. The trial took place at Gazi University Medical School Department of Obstetrics and Gynecology. The 28 infertile patients were newly accepted to the clinic with hypothalamopituitary disorder according to WHO classification Group II. They were treated with 50 mg/day clomiphene citrate (CC) for 3 days in 63 cycles. The control group of 28 paired patients were treated with 50 mg/day CC for 5 days in 40 cycles. The main outcome measures were: serum estradiol levels on day 11 (E-11), 14 (E-14) and postovulatory day 7 (E+ 7); serum progesterone levels on postovulatory day 7 (P+ 7); endometrial thickness on day 14 of the cycle; mean follicular phase length; and ovulation rates. The mean ages, gravidas, paritas, menstrual histories, E-11, P+ 7 levels, mean follicular phase length and luteal phase length were similar in both groups. E-14 (229.76 +/- 156.05 pg/ml vs. 338.25 +/- 350.60 pg/ml) and E+ 7 (217.30 +/- 114.95 pg/ml vs. 310.6 +/- 11.05 pg/ml) were significantly lower, whereas mean endometrial thickness on day 14 (10.30 +/- 1.39 mm vs. 9.52 +/- 1.96 mm) were significantly higher in the study group compared to controls (p < 0.05). Ovulation occurred in 82.53% of cycles in the study group and 95% in controls. In the study group, pregnancy was achieved in 17.3% of the ovulatory cycles; this rate was 10.5% in the control group. To decrease the peripheral antiestrogenic effects of CC, a regimen of 50 mg/day for 3 days may be used as a starting dose instead of the standard 5-day regimen.

Low dose anticoagulation after St. Jude Medical prosthesis implantation in patients under 18 years of age.

Between September 1986 and January 1994, 129 St. Jude Medical prostheses were implanted in 113 patients who were 18-year-old or younger at the Cardiovascular Surgery Clinic of Turkiye Yuksek Ihtisas Hospital. Thirty-seven patients underwent aortic, 60 patients mitral and the remaining 16 patients double valve replacement. Overall hospital mortality was 7.9% (9/113). All patients received 2.5 mg/day warfarin from the first postoperative day, in addition 225 mg/day dipyridamole and 100 mg/day aspirin was given following the removal of mediastinal tubes. This regimen was continued indefinitely thereafter. Follow up period ranged between 2-94 months. Total follow up experience was 276.4 patient-years. There were five late deaths; the cause of death was prosthetic valve thrombosis in two patients, intracerebral hemorrhage in one, cardiomyopathy in one, and sudden death in one. Other late complications included one endocarditis, a further anticoagulant related bleeding and one paravalvular leak. There was no case of cerebral or peripheral embolism reported. Seven-year actuarial survival was 92.4 +/- 6.8% for the entire group, 84.6 +/- 13.8% after mitral and 100% after aortic or double valve replacement. In conclusion, low dose oral anticoagulation after heart valve replacement with St. Jude Medical prosthesis in this age group showed satisfactory clinical results.

Warm blood cardioplegia: ultrastructural and hemodynamic study.

Forty patients with coronary artery disease were included in this study. Half of them received cold crystalloid and cold blood cardioplegia (group 1), and half received normothermic blood cardioplegia (group 2). In group 1, left ventricular stroke work index was 24 +/- 3 g.m/m2 1 hour after the operation, 29 +/- 8 g.m/m2 12 hours after the operation, and 33 +/- 6 g.m/m2 24 hours after the operation. In group 2, left ventricular stroke work index was 37 +/- 4 g.m/m2 1 hour after the operation, 37 +/- 4 g.m/m2 12 hours after the operation, and 44 +/- 7 g.m/m2 24 hours after the operation. Myocardial oxygen extraction 20 minutes after the termination of cardiopulmonary bypass was 0.28 +/- 0.03 in group 1 and 0.44 +/- 0.08 in group 2. Myocardial lactate extraction at the same time was -0.09 +/- 0.02 in patients receiving cold blood cardioplegia and 0.17 +/- 0.07 in patients receiving normothermic blood cardioplegia. Electron microscopic study revealed no calcium accumulation in the mitochondria in group 2 patients, whereas calcium accumulation was present in the other group.

Heparin need of the patients with cyanotic congenital heart disease during cardiopulmonary bypass. Comparison of cyanotic, acyanotic, rheumatic and atherosclerotic subjects.

Four groups of patients were studied. Group I: Congenital cyanotic heart disease (CCHD), consisting of 24 subjects aged 5 to 28 (1.4); 18 males and 4 females. Group II: Acyanotic congenital heart disease (ACHD), consisting of 34 patients aged 5 to 42 (20.1); 17 males and 17 females. Group III: Rheumatic heart disease (RHD), consisting of 30 patients aged 11-54 (42.4); 9 males and 21 females. Group IV: Atherosclerotic heart disease (AHD), consisting of 35 patients aged 36 to 65 (49.2); 33 males and 2 females. The haematocrit value (Hct) was the highest in the CCHD group. Total amount of heparin (mg/kg) used during cardiopulmonary bypass was 5.4 in CCHD, 4.66 in ACHD, 4.8 in RHD and 4.6 in AHD group. Mean protamine values was 4.02; 4; 4.03; and 4 respectively. Although the difference of Hct value was statistically different between CCHD and RHD group (p less than 0.001), heparin need was not (p less than 0.1). One-way analysis of variance (F test) showed no difference for heparin need between the four groups (F3.119 = 0.64). Prothrombin time (PT) and activated partial thromboplastin time (aPTT) showed a positive correlation (r = 0.36 and r = 0.25) with heparin need in CCHD group but no correlation was found in RHD group.