Comparison of diagnostic methods for evaluation of postmenopausal bleeding.

OBJECTIVE: To determine and compare diagnostic accuracy parameters of saline infusion sonohysterography (SIS), transvaginal ultrasonography (TVUSG), and hysteroscopy (H/S) based on histopathologic results which are accepted to be the gold standard in patients with postmenopausal bleeding (PMB). MATERIALS AND METHODS: Forty-seven patients who applied to Gynecology clinic of Adnan Menderes University, School of Medicine with PMB complaint aged between 43-76 years were included to the study. Fractioned curettage (F/C) and H/S guided biopsy were used for endometrial sampling. Diagnostic accuracy parameters (sensitivity, specificity, and positive and negative predictive values) of different methods; TVUSG, SIS, and H/S based on histopathologic findings were investigated. RESULTS: Specificity and sensitivity values calculated based on histopathologic results for all endometrial cavity lesions were found, respectively: 44.4% and 25% for TVUSG, 88.8% and 60.7% for SIS, and 100% and 77.7% for HIS. CONCLUSION: SIS is superior to TVUSG and as effective as H/S for assessment of endometrial cavity lesions in patients with PMB.

Thrombin activatable fibrinolysis inhibitor (TAFI) is not associated with recurrent miscarriage.

AIM(S): The present study aimed to discover whether there is an association between thrombin-activatable fibrinolysis inhibitor (TAFI) antigen levels and recurrent miscarriage (RM). In particular, TAFI antigen levels of women with RM were compared with those of a control group of women with previous uncomplicated pregnancies. METHOD(S): Group 1 comprised 48 women with RM, defined as the occurrence of two or more fetal losses before 20 weeks of gestation. Group 2 (the control group) was made up of 40 women who had undergone at least two healthy pregnancies and had no history of miscarriage. Group 1 was then stratified in to two groups according to the number of pregnancy losses and group 1A (2 pregnancy losses) consisted of 22 women whereas group 1B (three or more pregnancy losses) consisted of 26 women. RESULTS: No difference was observed with regard to serum TAFI antigen levels between groups 1 and 2. There was also no statistical difference in serum TAFI antigen levels between group 1A and group 1B. CONCLUSION: The findings of the current study indicated that TAFI antigen levels are not associated with RM. Further multi-centric research with more subjects is needed to better evaluate the role of TAFI in RM.

Rectal cancer in pregnancy: a case report.

Rectal cancer in pregnancy is a rare but a life-threatening disease. This paper presents a case of rectal cancer in pregnancy, discussed in light of the literature.

The effect of low-dose combined oral contraceptive containing 100 ug levonorgestrel on plasma plasminogen activator inhibitor-1 concentrations.

OBJECTIVE: The objective of the current study was to investigate the effect of a combined oral contraceptive (COC) containing 20 ug ethinyl estradiol (EE) and 100 ug levonorgestrel (LNG) which is currently used on plasma plasminogen activator inhibitor-1 (PAI-1) concentrations. MATERIAL AND METHODS: Twenty-five women who had not used any COC for at least three months before the initiation of the study were enrolled in the control group. Twenty women who had been using COC containing 20 ug EE and 100 ug levonorgestrel LNG for at least three months prior to the study were enrolled in the LNG/EE group. Serum samples for PAI-1 and other biochemical parameters were obtained at the early follicular phase (cycle day 2-5). RESULTS: No significant difference was observed in PAl- 1 concentrations between the LNG/EE and control group (group LNG/EE: 62.4 +/- 30.2 ng/ml; control group: 58.7 +/- 26.0 ng/ml). CONCLUSION: Although we observed similar PAI-1 concentrations in both groups, there is need for further interventions to evaluate the clinical relevance of our findings.

Lost intrauterine contraceptive device inserted 42 years before: a case report.

OBJECTIVE: The management of a lost abdominal intrauterine contraceptive device (IUD) is discussed together with a review of the relevant literature. THE CASE: The IUD is one of the most commonly used, effective, cheap and safe methods of contraception in Turkey. However, IUD insertion may result in uterine perforation which may lead to a variety of abdominal complications or can remain asymptomatic in the abdomen for a long time without causing any complications. An asymptomatic case of a woman with an IUD inserted 42 years before is presented. To the best of our knowledge this is the longest time an IUD (found by X-ray) has been localized in the abdomen. CONCLUSION: We suggest that in asymptomatic patients with an IUD localized in the abdomen, the risks of both operating and not operating should be discussed thoroughly and in such cases, follow-up without surgery may be considered as an alternative approach.

A prospective randomized comparative study of the effects of intranasal and transdermal 17 beta-estradiol on postmenopausal symptoms and vaginal cytology.

CONTEXT: Investigating the adverse effects of oral hormone replacement therapy (HRT), the clinical effectiveness of alternative combinations and route of administrations. AIM: To compare the effects of intranasal and transdermal 17 beta-estradiol combined with vaginal progesterone on vasomotor symptoms and vaginal cytology. SETTINGS AND DESIGN: A 12-week, prospective, randomized comparative study was conducted between July 2005 and September 2006. MATERIALS AND METHODS: Eighty postmenopausal women aged between 42-57 years, who had scores of > or =1.7 on the menopause rating scale-I (MRS-I) items "1-6", were randomly assigned to receive intranasal (300 microg/day, n =40) or transdermal (50 microg/day, n =40) 17 beta-estradiol continuously. All patients also received a vaginal progesterone gel twice weekly. Vasomotor symptoms were evaluated at weeks 0, 4, 8 and 12. Vaginal maturation index (VMI) was evaluated at weeks 0 and 12 of the study. STATISTICAL ANALYSES: The Mann-Whitney U and the Wilcoxon tests were used. P < 0.05 was regarded as significant. RESULTS: Thirty-two women in the intranasal and 29 women in the transdermal group completed the study. The total score of the MRS, the sum-scores of Factor 1 "HOT FLUSHES" and Factor 2 "PSYCHE" significantly decreased in both groups at week 4. Factor 3 "ATROPHY" scores significantly decreased only in the transdermal group at week 12. The VMI showed no changes within and between the two groups at the end of the study. CONCLUSION: Intranasal and transdermal 17beta-estradiol combined with vaginal progesterone gel as a continuous HRT caused a similar decrease in vasomotor symptoms but did not have any significant effect on VMI after 12 weeks of treatment in this study population.

Folate and vitamin B12 levels in abnormal pap smears: a case control study.

OBJECTIVE: This study aimed to explore the risk of abnormal cervical cytology in relation to serum folate and vitamin B12 levels, and demographic characteristics. PATIENTS AND METHODS: A case-control study was carried out among women attending the gynecology clinic for cervical cytology screening. At the follow-up clinic visit, fasting blood samples were collected from 103 cases with abnormal cervical cytology of the cervix and 175 controls with cytological normal smears and serum folate and vitamin B12 levels were measured. Data from cases and controls were compared. Logistic regression analysis was used to estimate the relative odds of abnormal cytology with increasing vitamin B12 levels. RESULTS: There were no significant differences between cases and controls in demographic characteristics and mean folate levels (p > 0.05). The mean vitamin B12 level of cases was significantly lower than that of controls (p < 0.001). Dichotomized logistic regression analyses of vitamin B12 levels were significantly different (p < 0.001). The predicted percentages at a cut-off value of 0.5 were as follows: sensitivity 70.0%, specificity 74.6%, positive predictive value 71.8% and negative predictive value 72.6%. The logistic regression analysis of the 1st and the 4th quartiles of vitamin B12 levels showed a significant difference p < 0.001, OR: 1.525 (CI, 1.175-1.875). CONCLUSION: The results of this study suggest that lower vitamin B12 levels are associated with abnormal cervical cytology. It is recommended that women should consume not only folate-rich foods such as fruits and vegetables but also vitamin B12-rich foods such as meat, fish, milk products and eggs in a balanced way.

Clitoromegaly in type 2 neurofibromatosis: a case report and review of the literature.

OBJECTIVE: Genitourinary neurofibromatosis (NF) is a rare disorder and clitoral involvement has been reported infrequently. In the English literature there are only 26 reported cases with clitoral involvement in NF. CASE: A 28-year-old female with clitoral enlargement, previously diagnosed with NF 2, was successfully treated by removal of the clitoral mass that increased in size during the previous two years. Clitoroplasty was performed while preserving the glans of clitoris. Histopathologic examination revealed plexiform neurofibroma. CONCLUSION: To the best of our knowledge the patient is the 27th reported clitoromegaly case with NF, but the first case reported with NF 2 or central NF in the English literature.

Do the suppression criteria in GnRH-a cycles predict in vitro fertilization outcome?

The addition of gonadotropin releasing hormone analog (GnRH-a) to controlled ovarian hyperstimulation regimes has been reported to have several advantages, such as reduced cancellation rate, fewer premature luteinizations and increased clinical pregnancy rate. The aim of this study was to determine the effect of pituitary/ovarian suppression, in terms of the levels of luteinizing hormone (LH), estradiol and follicle stimulating hormone (FSH), and the duration of GnRH-a administration, on in vitro fertilization (IVF) outcome. Retrospectively, 153 IVF cycles with GnRH-a and human menopausal gonadotropin (hMG) were examined. After a minimum of 10 days of GnRH-a administration, the patients were started on hMG. The correlations were investigated between the fertilization rates, the numbers of retrieved oocytes and transferred embryos, the cancellation rates, the suppressed LH, FSH and estradiol levels, the total ampules of hMG used and the duration of GnRH-a usage. The duration of GnRH-a usage and the total ampules of hMG used were not correlated. The number of oocytes retrieved and total number of hMG ampules used showed weak correlations with suppressed levels of FSH (-0.297 and 0.285, respectively). However, the fertilization, cleavage and pregnancy rates did not correlate with the LH, FSH and estradiol levels on hMG start days. In conclusion, for selected cases, 10 days of GnRH-a administration is sufficient to suppress endogenous gonadotropin levels. Since FSH and LH are protein hormones and their bioactivity may change in a manner that is unrelated to their immunological levels, it is not necessary to measure FSH, LH and estradiol levels to detect whether suppression is adequate.