The place of four-dimensional ultrasound in evaluating fetal anomalies.

OBJECTIVE: To analyze the capability of four-dimensional surface rendering mode ultrasound (4D SRM USG) in the detection of fetal abnormalities, and also compare it with 2D USG. MATERIALS AND METHODS: A total of 1,379 pregnant women were enrolled in the study, and they all underwent 2D USG screening. In the same session, they were all subsequently screened using 4D USG. The findings of both methods were compared. RESULTS: A total of 194 fetal anomalies were detected in 176 of 1,379 pregnant women by 2D USG. When all cases, including superficial and non-superficial anomalies, were evaluated together, we found that 2D USG was significantly better than 4D SRM USG in detecting anomalies (p < 0.001). However, 4D SRM USG was superior to 2D USG in terms of image quality, clarity, the distinction between the surrounding structures, and intelligibility among the cases with a superficial anomaly (p < 0.005). CONCLUSION: 4D USG is superior to 2D USG in detecting malformations related to fetus face, spine, extremities, abdominal wall, and the body surface. However, 4D SRM USG detected only approximately half of the cases with anomalies, and showed a better quality of image in only 15 % of all cases. Therefore, 4D SRM USG may only be suitable for use as a complementary tool in the evaluation of fetal anomalies, especially those of the face, spine, extremity, and abdominal wall.

Expression of ALS1, HWP1 and SAP4 genes in Candida albicans strains isolated from women with vaginitis.

Total mRNA of Candida strains( isolated form whole vaginal swabs) was investigated and the in vivo expression of C. albicans secreted aspartyl proteinase (SAP4), aglutinin-like sequence (ALS1) and hyphal wall protein (HWP1) genes was determined. A spectrum of gene expression profiles of strain isolated from vulvovaginal candidiasis(VVC) cases consisting of 10 pregnant, 4 postmenopausal, and 15 reproductive age (12 primary and 3 recurrent) 9 women with different estrogen level. Expression of SAP4, ALS1 and HWP1 genes was evaluated by reverse-transcriptase polymerase chain reaction using specific primer sets. The expression of ALS1, HWP1, and SAP4 was detected as 69, 62, and 38 %, respectively, in all cases. In pregnant, postmenopausal, and reproductive age women with VVC, the expression of ALS1 was observed as 70, 75, 67%, and HWP 60, 25, 73% respectively . Expression of SAP4 was found in pregnant, postmenopausal, and reproductive age women as 40, 50, and 33% respectively. Expression of teh adhesion genes in VVC does not correlate with estrogen level of patients.

Transposition of great arteries in an infant born after prenatal diagnosis of trisomy 20 mosaicism.

We report a case of prenatally diagnosed mosaic trisomy 20 in cells cultured from amniotic fluid. Trisomy 20 was present in 7 cells (13 percent) in a total of 52 investigated cells. Following the normal findings of an ultrasound scan, the couple decided to continue the pregnancy. A dysmorphic infant was born at the 38 weeks of gestation with generalized dysmorphic features and multiple cardiac anomalies including transposition of great arteries. Chromosome analysis on both cord blood and placenta at birth revealed a normal 46,XX karyotype. This patient is the first case of a liveborn infant with mosaic trisomy 20 cells detected in amniotic fluid culture with transposition of great arteries, atrioventricular concordance and ventricoarterial discordance.

Assessment of protein oxidation in women using raloxifene.

OBJECTIVES: To assess the oxidative effects of raloxifene use in postmenopausal women by investigating protein carbonyl levels in the plasma. METHODS: Nineteen osteoporotic postmenopausal women treated with raloxifene for 12 months were included in the study. Another seventeen postmenopausal women matched for age and postmenopausal years, without any medication were chosen as a control group. Protein carbonyl levels were determined as oxidative stress markers by the use of Levine's method in the plasma of these women. RESULTS: Serum protein carbonyl levels of postmenopausal women treated with raloxifene (1.27 +/- 0.32 nmol/mg protein) were significantly lower than the control group (2.18 +/- 0.27 nmol/mg protein) (p < 0.05). CONCLUSIONS: Oxidative stress has been found responsible for several diseases including cancer. Protein carbonyl levels, which are the products of protein oxidation, are one of the indicators of oxidative stress. Therefore, the decline in protein carbonyl levels in this study revealed the decreasing oxidative stress. According to our results, it might be interpreted that raloxifene does not cause oxidative stress, and it may even have protective effects in long-term use.

Mammographic and ultrasonographic study of changes in the breast related to HRT.

OBJECTIVE: To determine the frequency and degree of change in mammographic densities, and new solid or cystic formations in the breast tissue, during different types of hormone replacement therapy (HRT). SUBJECTS AND METHODS: This prospective study included 118 postmenopausal women, 88 under hormone replacement therapy and 30 control subjects. Four types of hormone therapies were compared for their effects on mammograms and sonograms obtained before and during therapy. Mean duration of follow-up was 16.92 +/- 7.65 months in the treated and 21.56 +/- 11.49 months in the control group. Density changes on mammograms were evaluated subjectively. RESULTS: Density increase was recorded in 34% of the patients receiving HRT and in none of the control subjects (P < 0.01). Highest frequency of density increase was found in the groups treated with estrogen plus cyproterone acetate (46%) and with estrogen plus medroxyprogesterone acetate (43%). Frequencies of density increase in the tibolone users, and in estrogen alone users were 28% and 18%, respectively. Degree of density increase was evidently minimal in tibolone users, compared to others. New cysts occurred in six patients receiving HRT (6%) which was not statistically different from the control group (16%) (P > 0.05). New cyst formation was not related to the degree of density increase. New solid mass formation was not observed. CONCLUSION: Our findings show that mammographic density changes related to HRT are dependent on the selected hormone regimen. Formations of breast cysts or solid lesions do not seem to be related to HRT.

Are sociodemographic factors predictive of preterm birth? A reappraisal of the 1958 British Perinatal Mortality Survey.

OBJECTIVE: Reassessment of the predictive value of sociodemographic factors on preterm birth. DESIGN: Population-based case-control study. SETTING: England, Wales and Scotland. SAMPLE: The study sample consisted of 5630 primiparous and 9538 multiparous women who were delivered during the first week of March 1958 in Britain. Multiple births were excluded. METHOD: Factors potentially predictive of preterm birth were assessed for primiparous and multiparous women separately, using the split-sample cross-validation technique. MAIN OUTCOME MEASURE: Preterm birth, defined as birth occurring before 259 days of gestation. RESULTS: Preterm birth rates for primiparous and multiparous women were 54 and 53 per 1000 births, respectively. In primiparous women low maternal age (under 20 years) was the only sociodemographic variable that was predictive of preterm birth (P = 0.01). However, only 10.7% of preterm birth among primiparous women was associated with low maternal age. In multiparous women, using univariable analysis, employment status was statistically significantly associated with preterm birth. This association disappeared when employment status was adjusted for by other variables in the model. Social class was not predictive of preterm birth in either primiparous or multiparous women. CONCLUSION: From the results of this study it is concluded that sociodemographic factors do not have a substantial impact on the risk of preterm birth. It seems unlikely that preventative measures aimed at social-demographic adversity will reduce preterm birth rates.

Surgical treatment alternatives in stress incontinence.

OBJECTIVES: This study was performed to evaluate the different surgical treatment alternatives for urinary stress incontinence and their clinical results. METHODS: Of the patients who visited our clinic between January 1989 and June 1994 complaining of urinary stress incontinence, 408 were found to have genuine stress incontinence (GSI) after undergoing clinical and laboratory investigations. These 408 patients were treated with different surgical techniques. Their postoperative results are discussed. RESULTS: After postoperative follow-up, the success rates of the different surgical techniques were as follows: anterior colporrhaphy (Kelly plication) 66.2%, Marshall-Marchetti-Krantz 88.7%, Burch procedure 94.1%, and sling urethropexy 97.5%. CONCLUSIONS: Patients with a clear-cut diagnosis of GSI must be surgically treated. There are several different techniques, all of which have advantages and disadvantages. If the right technique is used for the right patient then the success rate is high.