Role of shear wave elastography in predicting the metabolic and androgenic alterations in patients with polycystic ovary syndrome.

AIM: To evaluate the variation in tissue stiffness caused by the changes in ovarian volume and stroma in polycystic ovary syndrome (PCOS) using a novel method of ultrasonography, that is shear wave elastography (SWE). The current study also aimed to evaluate the potential applications of this method in predicting the metabolic and androgenic alterations in patients with PCOS. METHODS: The present study included 33 patients with PCOS. The blood samples for the metabolic and androgenic parameters and SWE values pertaining to the patients were obtained on the same day during the early follicular phase. The predictive ability of SWE to reflect the metabolic and androgenic abnormalities was evaluated using the receiver operating characteristic curve (ROC) analysis. RESULTS: The mean SWE value pertaining to the group with higher total testosterone levels was significantly lower, compared to the group with normal testosterone levels (p = 0.041). The ROC analysis revealed that the predictive potential of SWE was statistically significant in regard to the serum testosterone levels alone (area under the curve [AUC] = 0.755, 95% confidence interval [CI]: 0.573-0.938, p = 0.041). There was no significant relationship between the SWE values and metabolic parameters. CONCLUSIONS: Based on the results of the present study, decreased SWE values appear to be associated with increased serum testosterone levels. However, the present study did not observe any significant relationship between the SWE values and metabolic parameters. SWE can be used as a practical and non-invasive method to predict the serum testosterone levels during the follow-up evaluations of the patients with PCOS.

Is joint hypermobility related to preterm birth?

AIM: The aim of this study was to investigate whether women giving preterm birth have joint hypermobility. METHODS: The study included 44 women giving preterm birth (study group) and 48 women with the history of term birth (control group). After demographic data were recorded, the presence of joint hypermobility based on the Beighton diagnostic criteria and subgroup scores were noted down. Total Beighton scores were compared between the study and control groups. RESULTS: The total Beighton scores were significantly higher in the study group (p < .001). The study group had the highest hypermobility score for elbow hyperextension and the lowest hypermobility score for thumb hyperextension. CONCLUSIONS: It should be kept in mind that joint hypermobility detected during follow-up of pregnancy can be related to the risk of preterm birth. Informing pregnant women with joint hypermobility about the possibility of preterm birth could be helpful.

An assessment of the protective effect of gonadotropin-releasing hormone agonist and antagonist on bleomycin-induced ovarian toxicity in rats.

The aim of this study is to evaluate the effect of GnRH agonist or GnRH antagonist therapy on bleomycin-administered rats by examining ovarian follicle counts and AMH levels. A total of 30 female Wistar albino rats aged 4-6 months were randomly divided into 4 groups. First, an intramuscular injection of bleomycin (30 mg/m2) was administered to all except the control group on the 1st, 8th and 15th days. The control group (Group I) was administered 0.1 mL intramuscular saline on those days. The bleomycin group (Group II) was followed up without any further treatment. The bleomycin + GnRH agonist group (Group III) was administered subcutaneous GnRH agonist triptorelin (1 mg/kg) at the same time as the bleomycin injections. The bleomycin + GnRH antagonist group (Group IV) was administered 1 mg/kg cetrorelix acetate subcutaneously, concurrently with the bleomycin. Although AMH levels were lower in the bleomycin group than in all the other groups, there was no statistically significant difference between the groups in terms of AMH levels (p > .05). In the bleomycin + cetrorelix acetate and bleomycin + triptorelin groups, significantly higher primordial, secondary and tertiary follicle counts were determined compared to the bleomycin group (p < .001). In conclusion the harmful effects of bleomycin on ovarian reserve can be reduced by the simultaneous administration of GnRH agonist or GnRH antagonist.

A new type of abdominal incision for emergencies in pregnancy: a case report.

Adnexal torsion in pregnancy is a rare gynecologic emergency that causes severe abdominal pain. The current paper reports a case of a woman with 18 weeks pregnancy who was referred to our tertiary clinic with sudden lower abdominal pain. Ultrasound scan showed a very large multicystic adnexal torsion mass on the right side displacing the gravid uterus to the anterior left. An oblique paramedian incision was made for right salpingo-oophorectomy. To our knowledge the incision presented in this case has not been described in the literature previously. We suggest an alternative incision to be used during pregnancy especially for emergencies due to an adnexal mass.

Comparison of de novo urinary incontinence after abdominal and vaginal hysterectomy.

AIM: This study aimed to compare the frequency and risk factors of de novo urinary incontinence (UI) following abdominal and vaginal hysterectomies for benign disease. METHODS: The study included patients without incontinence history who underwent abdominal or vaginal hysterectomy for benign indications. Incontinence statuses were assessed at least one year after hysterectomies. Data for age, body mass index (BMI), parity, mode of delivery, and the types of hysterectomy and postoperative UI were recorded. RESULTS: The study included a total of 196 patients with mean age of 52.8±11.4 years. Of these, 149 (76%) underwent abdominal hysterectomy (AH) and 47 (24%) had vaginal hysterectomy (VH). The mean follow-up period was 1.97±1.43 years. A total of 41 (20.9%) patients were diagnosed with UI after hysterectomy. De novo UI occurrence following AH and VH was similar(p>0.05). Also, UI types were not significantly found different in either group (p>0.05). CONCLUSION: This study showed that de novo UI occured frequently after hysterectomies. In addition, development and types of UI following AH and VH were comparable. KEY WORDS: Abdominal hysterectomy, Urinary incontinence, Vaginal hysterectomy.

Is shear wave elastography relevant in the diagnosis of polycystic ovarian syndrome?

AIM: The aim of this study was to determine the contribution of Shear Wave Elastography (SWE) to the diagnosis of polycystic ovarian syndrome (PCOS). MATERIAL AND METHODS: Thirty-seven patients with PCOS diagnosis criteria were included in the study. Sixteen volunteer patients without hormonal disturbances and with normal menstrual cycles were evaluated as the control group. Gray scale ultrasonography (US) and SWE measurements in both ovaries were performed by a single radiologist who was blinded to the clinical and laboratory results. RESULTS: The SWE measurements in PCOS group were 8.4±2.0 kPafor the right ovary and 9.4±3.9 kPa for the left ovary and in the control group 7.8±4.1 for the right ovary and 8.6±2.5 kPa for the left ovary. There was no statistically significant difference between the PCOS and the control group according to the SWE results (for right ovary p=0.356, for left ovary p=0.258, and total ovary p=0.293). CONCLUSIONS: The ovarian morphology isstill the most reliable imaging finding in the diagnosis of PCOS, although it is controversial especially among adolescents. Although the diagnostic efficacy of SWE is demonstrated in a variety of soft tissue lesions, we did not find any significant contribution of SWE to the diagnosis PCOS. Therefore, the promising value of elastography is yet to be defined for the diagnosis of PCOS.

Common Methylenetetrahydrofolate Reductase Polymorphisms (A1298C & C677T) in Ectopic Trophoblasts and Methotrexate Treatment Failure in Tubal Pregnancies.

OBJECTIVES: The success rate of methotrexate (MTX) therapy varies among tubal ectopic pregnancies. Common methylenetetrahydrofolate reductase (MTHFR) polymorphisms (C677T&A1298C) have been suggested to alter MTX effect. This study aimed to assess and compare MTX treatment failure rates with respect to MTHFR polymorphisms in trophoblasts of ectopic tubal pregnancies. MATERIAL AND METHODS: A retrospective chart review of tubal ectopic pregnancies was conducted and 34 eligible cases were found. Paraffinized blocks of ectopic trophoblastic tissues were retrieved from the archives of pathology department. Common MTHFR polymorphisms were studied on microdissected trophoblastic tissues. Sixteen cases with history of failed MTX therapy (study group) and 18 control cases were compared for their pertinent clinical characteristics and common MTHFR polymorphisms (C677T&A1298) data. RESULTS: In the study group, there were 8 (50%) C677T single nucleotide polymorphisms (SNP) and 9 (56.7%) A1298C SNP. Polymorphism rates were not found to be different between two groups for neither polymorphism (p > 0.05 for both). Number of compound heterozygotes was 3 (18.7%) in study group and 5 (27.7%) in controls (p = 0.693). In addition, MTHFR polymorphism presence seemed to have no effect on interval serum ß-hCG concentration change in MTX-fail group (p=0.693). CONCLUSIONS: Our data implied that common MTHFR polymorphisms of ectopic trophoblastic tissue are not associated with MTX failure in patients with tubal pregnancies. Additionally, serum ß-hCG concentration changes caused by MTX treatment and studied MTHFR polymorphisms are likely independent.