Retinol-binding protein 4 is elevated and is associated with free testosterone and TSH in postmenopausal women.

The aim of this study was to understand the relationship of retinol-binding protein 4 (RBP4) with hormonal and biochemical parameters in pre- and postmenopausal women. We included 69 postmenopausal women and 27 regularly menstruating premenopausal women. Postmenopausal women had statistically significantly higher RBP4 levels when compared to premenopausal women. RBP4 levels were negatively associated with free testosterone and positively associated with thyroid stimulating hormone in postmenopausal women. In premenopausal women RBP4 was positively associated with body mass index. RBP4 levels were increased in postmenopausal women. Although the mechanism is not clear, these findings suggest that RBP4 has a role in the regulation of hormonal and metabolic parameters.

Endogenous sex hormones and their associations with cardiovascular risk factors in post-menopausal women.

AIMS: Our aim was to understand the relationship between endogenous sex hormones and cardiovascular disease (CVD) risk factors in post-menopausal women. MATERIALS AND METHODS: Eighty-three post-menopausal women from a previous prospectively designed study were included. We analyzed endogenous sex hormones and biochemical parameters. RESULTS: Levels of estradiol and free testosterone were higher in patients with metabolic syndrome. Estradiol correlated positively with interleukin-6 (IL-6), weight, body mass index (BMI), insulin, homocysteine, and homeostasis model assessment of insulin resistance (HOMA-IR). Free testosterone correlated positively with weight, waist circumference (WC), BMI, insulin, HOMA-IR and negatively with HDL and SHBG. DHEAS correlated only with HDL. FSH correlated negatively with age, weight, WC, hip circumference, BMI, systolic blood pressure, diastolic blood pressure, duration of menopause, fasting glucose, HDL, C-reactive protein, and insulin. LH correlated negatively with IL-6, age, WC, duration of menopause and SHBG. CONCLUSIONS: We identified endogenous estradiol and free testosterone as the strongest links to CVD risk. They can be used as biomarkers for CVD risk estimation.

A short rib polydactyly syndrome overlapping both lethal and nonlethal types.

Short rib polydactyly syndrome (SRPS) type II is a rare, autosomal recessively inherited, lethal skeletal dysplasia characterized by polydactyly, short limbs, short and horizontal ribs, a short ovoid tibia and major organ anomalies. We report a patient with a fetus with SRPS type II that presented at the 19th week of pregnancy for amniocentesis because of maternal age. During ultrasound pre-axial synpolydacytly, a short and ovoid tibia, nuchal edema, vertebral irregularities, hypoplastic thorax with short ribs and talipes were detected. All of the extremities were under the 5th percentile. Thorax-abdomen ratio was 0,56. The family was counselled for a diagnosis of lethal SRPS. After termination of pregnancy, radiological and histopathological examination allowed us to reach the diagnosis ofMajewski syndrome (SRPS type II). SRPSs are a continuous spectrum of both lethal and nonlethal forms. Prenatal diagnosis and termination depending on ultrasound findings should be done very precociously considering different phenotypic expressions, even in families previously affected by a lethal SRPS.

Prenatal diagnosis of congenital harlequin ichthyosis with 2D, 3D, and 4D ultrasonography.

Harlequin fetus is a rare and mostly fatal form of congenital ichthyosis that can be diagnosed by fetal skin biopsy in patients with a family history of the disease. More recently DNA analysis of amniocentesis and chorion villus sampling materials have also been utilized. We report a case of prenatally diagnosed congenital ichthyosis with no previous family history. Diagnosis was mainly achieved by 3D and 4D ultrasonography findings such as diffuse scaling of the skin, digital contractures, flattened rudimentary external ear, nasal hypoplasia, everted eyelids, typical fish mouth appearance, macroglossia, and persistently open fetal mouth.

Prenatal diagnosis of a digynic triploid fetus in the second trimester: transvaginal two-dimensional ultrasound, color doppler and fetoplacental Doppler velocity waveform findings.

INTRODUCTION: Triploidy in the second trimester is a sporadic, rare lethal chromosomal abnormality characterized by an extra haploid chromosome set (3n = 69). Doppler blood flow study in fetal triploidy syndrome is rarely reported in the literature. CASE PRESENTATION: A 19-year-old woman at 18 weeks of gestation was referred to our fetal medicine unit. Examination revealed a digynic triploid fetus presenting with asymmetric intrauterine growth restriction, oligohydramnios, relative macrocephaly together with a small thin trunk, low-set ears, micrognathia, bilateral talipes, bilateral syndactyly on the third, fourth and fifth fingers and toes, a large ventricular septal defect, bradycardia, bilateral hyperechogenic kidneys and small placenta. The pattern of abnormalities suggested that the extra set of chromosomes was maternal in origin. Although bilateral maternal uterine artery Doppler measurements were normal, there was increased resistance to blood flow in the umbilical artery and reversed flow in the ductus venosus which were probably due to abnormal placental development and severe intrauterine growth retardation. CONCLUSION: It can be assumed that among the most frequent indicators of triploidy are the sonographic proof of the existence of early retardation of growth and the presence of oligohydramnios together with other malformations. Triploidy must be in the differential diagnosis and karyotyping is advised in these cases.

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.

Three fetuses karyotyped as Turner syndrome with cystic hygroma developing hydrops: prognosis and outcome.

INTRODUCTION: We present three cases of fetuses diagnosed as Turner syndrome with cystic hygroma (CH) developing hydrops to discuss the prenatal diagnostic and prognostic criteria of CH in ultrasound and outcome of the fetuses. CASES: The first case was 30-year-old pregnant woman with a nuchal translucency measurement of 8 mm at 12 weeks' gestation. Serial ultrasound examinations revealed non-septated cystic hygroma and hydrops. The pregnancy was terminated at the 18th week of gestation. Diagnosis of CH was made at 14 and 15 weeks of gestation in case 2 and case 3, respectively. Ultrasound revealed large cystic septated sacs in the nuchal area combined with serosal fluid collection and cutaneous edema. Spontaneous fetal demise occured at 21 and 16 weeks of gestation in cases 2 and 3, respectively. All fetuses were diagnosed as Turner syndrome.

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.

Squamous cell carcinoma developing in a huge dermoid cyst of the ovary in an 80-year-old woman--case report.

A case of an 80-year-old patient with squamous cell carcinoma originating from a huge septated dermoid cyst of the right ovary is reported. There were bilateral dermoids in the patient. The tumor sizes were 30 x 40 x 20 cm and 4 x 3 x 5 cm in the right and left ovary, respectively, confirmed by ultrasound and computed tomography. Squamous cell carcinoma arose in the solid part of a huge dermoid cyst of the left ovary. Total abdominal hysterectomy and bilateral salpingo-oophorectomy, omentectomy and appendectomy were performed. The tumor was confined to the right ovary. The patient was categorized as FIGO Stage IA. She recovered uneventfully and there was no evidence of recurrence in the early-stage case during one year of follow-up. The clinical and pathological features, treatment modalities and prognosis of squamous cell carcinoma are described.

Two cases of HELLP syndrome with fatal outcomes.

Severe preeclampsia and HELLP syndrome are still the leading causes of maternal and perinatal morbidity and mortality. We present two cases of pregnancies which were complicated by HELLP syndrome at 31 weeks of gestation and 25 weeks of gestation, the first one with maternal and the second with perinatal fatal outcomes. The aim of this report is to draw attention to the life-threatening complications that might occur in cases of preeclampisa and HELLP syndrome. The importance of early diagnosis with implications for management is also discussed.

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.

Prenatal diagnosis of Wolf-Hirschhorn syndrome (4p-) in association with congenital diaphragmatic hernia, cystic hygroma and IUGR.

Wolf-Hirschhorn syndrome (WHS) is a rare distinct clinical entity caused by a deletion of the short arm of chromosome 4. We report a case in which intrauterine growth restriction (IUGR), severe oligohydramnios, left-sided congenital diaphragmtic hernia (CDH), and cystic hygroma were detected by prenatal ultrasound examination at 27 weeks of gestation. A 29-year-old gravida 3, para 2, woman was referred at 26 weeks' gestation with suspicion of IUGR and cystic hygroma. Sonographic examination revealed IUGR with severe oligohydramnios, increased nuchal fold with cystic hygroma (left-sided diaphragmatic defect of Bochdalek type), and congenital diaphragmatic hernia. Chromosome analysis revealed a 46, XX, del(4)(p15.2) karyotype. Autopsy confirmed the ultrasound findings. Congenital diaphragmatic hernia (CDH) has rarely been described to be associated with WHS. CDH and cystic hygroma can lead to a diagnosis of this syndrome very early in life. We recommend genetic evaluation of a fetus with cystic hygroma, IUGR and CDH taking into consideration 4p deletion syndrome.

A rare case of early onset nephrotic syndrome in pregnancy.

Nephrotic syndrome occurs very rarely, about 0.012-0.025% of all pregnancies. Here, we report a rare case of early onset nephrotic syndrome developing de novo in the 17th week of pregnancy. A renal biopsy was done and the specimens revealed typical features of focal segmental glomerulosclerosis. The patient had a progressive clinical course of disease despite steroid treatment. Suffering from severe intrauterine growth restriction, the fetus died in utero. After delivery, steroid treatment was continued. The patient had normal renal function with a decrease in proteinuria in the second and fifth month postpartum. This report points out the poor fetal prognosis associated with an early onset nephrotic syndrome. Pregnant patients with early onset nephrotic syndrome should be carefully evaluated for the presence of chronic renal disease, and primary renal pathology should be included in the differential diagnosis of massive proteinuria in early pregnancy.

Hydatid cyst of the uterus.

BACKGROUND: Hydatidosis is a common zoonosis that affects a large number of humans and animals, especially in poorly developed countries. The infesting parasite has four forms named Echinococcus granulosis, E. multilocularis, E. vogeli and E. oligarthrus (very rare in humans). The most frequently involved organs are liver followed by the lung. The involvement of the genital tract is rare and the occurrence in the uterus is an extreme rarity. We report a case of hydatid cyst in the uterus. CASE: A 70-year-old female with a history of hydatid cysts of the liver, was admitted to hospital after complaining of low abdominal pains. On physical and gynecological examinations, no pathological finding was detected. However, the uterus was significantly large for a postmenopausal patient. Transvaginal sonography (TS) revealed a cystic mass in the uterus with a size of 7 x 6 cm. After further examinations a subtotal hysterectomy was performed. Microscopic examination showed scolices of Echinococcus granulosis. CONCLUSION: Hydatid cysts in the genital tract are rare and the occurrence in the uterus is an extreme rarity. Differentiation between hydatid cyst and malignant disease of the related organ is difficult. To avoid misdiagnosis, a careful examination of pelvic masses should be carried out in endemic areas for detection of hydatid cysts.

Short-term outcome of newborn infants: spinal versus general anesthesia for elective cesarean section. A prospective randomized study.

OBJECTIVE: To compare general and spinal anesthesia with respect to the short-term outcome of newborns born by elective cesarean deliveries. METHODS: Pregnant women admitted to our hospital from January 1999 to July 2000, for whom elective repeat cesareans were planned after 37 weeks gestation, were allocated randomly after their informed consent to spinal anesthesia or general anesthesia. Maternal age, gestational age, birth weight, Apgar's score, hospital stay duration, and duration of cesarean section time were all noted. The rate of the neonatal respiratory depression, perinatal asphyxia, and admittance to the neonatal intensive care unit of the infants were documented. We also studied arterial samples withdrawn from the cord for the pH, bicarbonate, PaO(2) (oxygen pressure, arterial), and PaCO(2) (carbon dioxide pressure, arterial). The serum levels of creatine kinase with myocardial-specific isoform, aspartate aminotransferase, alanine aminotransferase, and total cortisol levels of the newborns were measured and served in ruling out perinatal stress and in confirming the diagnosis of perinatal asphyxia (and of myocardial damage). Statistical analyses was performed with the use of an unpaired Student's t-test, Chi-square test, and a power calculation was done. RESULTS: From the randomly selected patients, we had 38 (45.2%) infants for general anesthesia and 46 (54.8%) for spinal anesthesia. None of our primary endpoints favored any of the study groups, and the clinical short-term outcome of the infants was similar in the neonates born both by spinal and general anesthesia (P>0.05). The biochemical assays did not rule out or confirm any differences in the occurrence of perinatal stress (P>0.05). CONCLUSION: Anesthesia type does not seem to influence the short-term outcome of the newborn infants for the elective cesarean deliveries. We believe that both spinal and general anesthesia could be performed in elective term cesarean deliveries without any risk to the newborn infants.

Septic shock resulting in death after operative delivery.

BACKGROUND: We report a young woman who developed septic shock after operative delivery in the 32nd week of pregnancy. Clinical features, treatment modalities and prognosis of this high-mortality-rate disorder are presented and discussed. CASE: A 24-year-old woman, gravida 1, para 1, was referred to our clinic in a confused state and immediately admitted to our emergency unit. She apparently had eclampsia antenatally. Termination of pregnancy with induction of labor and vacuum extraction had been employed in gestational week 32 of pregnancy. One day after delivery, her clinical and laboratory parameters worsened, so she was referred to our clinic. After a thorough physical examination and laboratory evaluation, the patient was diagnosed as having sepsis and disseminated intravascular coagulation. After blood and urine cultures were taken, aggressive management included volume repletion, antibiotics and positive inotropic therapy. Because she had persistent fever and unimproved laboratory values despite these therapies, the uterus and ovaries were thought to be the source of sepsis, and total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Neither clinical nor laboratory parameters improved, and the patient died 28 days after delivery as a result of respiratory failure. CONCLUSION: It is our purpose to emphasize that a rapid and appropriate decision for surgery may prevent the maternal mortality in obstetric septic shock patients. Successful management depends on early identification and aggressive treatment.

The effect of tamoxifen on the endometrium, serum lipids and hypothalamus pituitary axis in the postmenopausal breast cancer patients.

BACKGROUND: There is still no cost-effective endometrial screening method for asymptomatic postmenopausal breast cancer patients using tamoxifen. We investigated the effectivity of transvaginal ultrasonography and endometrial sampling as a screening method for asymptomatic patients. Additionally the effect of tamoxifen on hypothalamus-pituitary axis and serum lipid profiles were investigated. METHODS: Sixty-seven gynecologically asymptomatic postmenopausal breast cancer patients were enrolled in this randomized crossover study. Endometrial thickness was determined by transvaginal ultrasonography, endometrial biopsy was obtained by Pipelle or fractional curettage, hormone and lipid profiles were compared in the two groups which consisted of forty-seven tamoxifen user (cases) and twenty nonuser (controls) patients. RESULTS: The mean endometrial thickness measured by transvaginal sonography was 7.8 mm (3-20 mm) versus 3.7 mm respectively. The difference was significant in tamoxifen users. The most common histopathologic finding was endometrial polyp, detected in five patients. In the control group there was no endometrial polyp. The positive histopathologic findings were present in twenty-two patients in the case group but there were only two patients with positive histopathologic findings in the control group. Ultrasound findings did not correlate with the presence of endometrial abnormalities on biopsy and no endometrial cancer or hyperplasia were detected. In tamoxifen users serum FSH and LH levels were significantly lower than in nonusers. Serum HDL levels were significantly higher in the case group. CONCLUSION: Ultrasonographic imaging of the endometrium in asymptomatic postmenopausal breast cancer patients using tamoxifen should be interpreted with caution. Other imaging techniques should be used for more specific information about the endometrium.

A randomized comparison of the 3 Papanicolaou smear collection methods.

The purpose of this study was to compare the effectiveness of 3 cervical smear sampling devices for obtaining acceptable yields of endocervical cells in Papanicolaou smears. In a randomized, controlled clinical trial, we collected 346 smears over a 6-month period, 110 with the Cervex brush, 125 with the cotton swab plus Ayre spatula and 111 with the Cytobrush plus Ayre spatula. The Cytopathology Laboratory, blinded to the Papanicolaou smear method, screened the smears using the Bethesda system guidelines. Statistical analyses were performed using the Pearson X2 and analysis of variance tests. There was an increased detection of endocervical cells in the Cytobrush plus Ayre spatula and the Cervex brush methods, compared with the cotton swab plus Ayre spatula group (p = 2.39 x 10(-6), p = 4.49 x 10(-7) respectively). There was no statistically significant difference between the Cytobrush-Ayre spatula and the Cervex brush sampling methods were equally effective in obtaining endocervical cells in Papanicolaou smears.