Histomorphology of the placenta and the placental bed of growth restricted foetuses and correlation with the Doppler velocimetries of the uterine and umbilical arteries.

The aim of the present study was to evaluate the histomorphology of the placenta and the placental bed and to correlate this with the Doppler study of the uterine and umbilical arteries of intrauterine growth restricted pregnancies. The study group consisted of 47 women with intrauterine growth restricted foetuses. Twenty-five uneventful pregnancies with appropriate for gestational age foetuses were selected as controls. Doppler studies of umbilical and uterine arteries were performed within the last week before delivery. Placental bed biopsies were obtained at Caesarean section with direct visualization of the placental site. The incidence of pathologic bed biopsies in control, IUGR with normal uterine artery Doppler velocimetry and IUGR with abnormal uterine artery Doppler velocimetry was 0 per cent, 16.6 per cent and 79.3 per cent respectively (P< 0.001). Placentae from IUGR cases with abnormal umbilical artery Doppler velocimetries had a significantly increased number of villous infarcts, cytotrophoblast proliferation and thickening of the villous trophoblastic basal membrane (P=0.001, P=0.038 and P=0.02 respectively). Abnormal placental bed biopsy pathology was significantly associated with abnormal uterine artery velocimetry (OR 33.7, 6.5-173.6; P< 0.001). Abnormal placental pathology was significantly associated with abnormal umbilical artery Doppler velocimetry (OR 21.04, 3.8-115.9;P< 0.001). Women with both abnormal uterine and umbilical artery Doppler velocimetries were delivered earlier and their babies had lower mean birth and placental weight (P< 0.001). In conclusion, placental bed biopsy and placental pathologies are best reflected by abnormal uterine and umbilical artery velocity waveforms, respectively. The most severe clinical outcomes and perinatal mortality are present when both uterine and umbilical districts are altered.

Mammographic density increase in women receiving different hormone replacement regimens.

OBJECTIVE: we investigated effects of different regimens of hormone replacement therapy (HRT) on mammographic density. METHODS: ninety-five postmenopausal women, who were on different HRT regimens and completed their 4-year mammographic follow-up, were included into this retrospective and comparative study. Twenty-three of these women, who had surgical menopause, received conjugated equine estrogens (CEE) (Group I) only, 26 of them received CEE and continuous medroxyprogesterone acetate (MPA) (Group II), 21 women received CEE and cyclic MPA (Group III), and the remaining 25 women received tibolone (Group IV) therapy. Before commencing on HRT, a baseline high-resolution mammography was performed, and repeated at 6-12-month intervals during the period of 4-year follow-up. All mammographies were evaluated according to the Wolfe classification. RESULTS: a diffuse increase in mammographic density was detected in five women (22%) in group I, nine women (35%) in group II, four women (19%) in group III, and two women (8%) in group IV. The increase in mammographic density was more common among women in group II than those in the other three groups. However, a statistically significant difference was found only between groups II and IV. CONCLUSIONS: different HRT regimens have different effects on breast parenchymal density on mammography. Continuous combination HRT may be more commonly associated with an increase in breast density than other forms of HRT.

Craniopharyngioma and Bardet-Biedl syndrome. A case report.

BACKGROUND: Bardet-Biedl syndrome is a rare disorder and associated with a variety of anomalies. CASE: An 18-year-old woman was referred with primary amenorrhea. Following physical, ophthalmologic, psychiatric, hormonal and radiologic examinations, the diagnosis of both craniopharyngioma and Bardet-Biedl syndrome was established. CONCLUSION: Although the pathogenesis of hypogonadism in a woman with Bardet-Biedl syndrome remains unclear, cranial structures, especially the hypothalamus and pituitary gland, should be investigated to reveal any possible abnormalities.

Prognostic factors that affect survival after the treatment of early stage cervical carcinoma.

The aim of this study was to investigate the presence of risk factors for predicting survival and to evaluate the efficacy of the radical surgery in patients with early stage cervical carcinoma. A total of 200 women who underwent radical hysterectomy and bilateral pelvic lymph node dissection for early stage cervical carcinoma were retrospectively analysed. We found that lymph node involvement (P <0.0015) and lymphovascular invasion (P <0.05) were the best prognostic factors for disease-free survival in our cases. The depth of cervical invasion, lymphovascular invasion and parametrial spread were closely related with lymph node involvement. Parametrial spread was shown in 38 patients (19%), assessed as stage Ia-IIa pre-operatively. Seventy-six stage Ib patients, at high-risk of recurrence, received adjuvant radiotherapy. Although there was some local tumour recurrence in the control group, adjuvant radiotherapy did not improve the overall survival in stage Ib patients. As a consequence, primary surgery would be definitive in estimating survival from histopathological evaluation. This study demonstrates that lymph node involvement and lymphovascular space infiltration were the best predictor factors for survival.

Correlation between placental bed biopsy findings, vascular cell adhesion molecule and fibronectin levels in pre-eclampsia.

OBJECTIVE: To determine the correlation between placental bed biopsy findings, and blood levels of the vascular cell adhesion molecule (VCAM-1) and fibronectin in pre-eclampsia/eclampsia, and to evaluate the relationship between these variables and severity of the disease. DESIGN: A prospective case-control study. SETTING: Department of Obstetrics and Gynaecology, Cerrahpasa Medical Faculty, Istanbul. SAMPLE: Thirty-five women with pre-eclampsia/eclampsia were compared with 25 healthy women with uncomplicated pregnancies. Twenty-one placental bed biopsies from pre-eclamptic pregnancies were compared with 17 from normal pregnancies. MAIN OUTCOME MEASURES: Peripheral venous blood levels of VCAM-1 and fibronectin, measured by enzyme-linked immunoassay and radial immune diffusion technique. RESULTS: In pre-eclampsia/eclampsia, blood VCAM-1 and fibronectin levels were higher than in normal pregnancy. Levels of both fibronectin and VCAM-1 correlated significantly with the diastolic blood pressure (r = 0.49 and r = 0.65, P < 0.001). There was also a significant direct linear correlation between plasma fibronectin and VCAM-1 levels (r = 0.57, P < 0.001). Normotensive women all had normal placental bed biopsy findings and the incidence of pathological placental bed biopsy findings increased with the severity of the pre-eclampsia. CONCLUSION: Inadequate trophoblastic invasion of spiral arteries, and elevated levels VCAM-1 and fibronectin were found in women with pre-eclampsia. The magnitude of defective trophoblastic invasion, and blood levels of VCAM-1 and fibronectin correlate with the clinical severity of pre-eclampsia.

Does leukocytospermia associate with poor semen parameters and sperm functions in male infertility? The role of different seminal leukocyte concentrations.

To investigate the effect of leukocytospermia on standard semen analysis and sperm function tests such as acrosome reaction, hypoosmotic swelling, antisperm antibody binding and cervical mucus penetration, a prospective clinical study was performed. Two hundred and nineteen male infertility patients undergoing investigation and treatment were included in the study. There was a significant association between acrosome reaction positivity and leukocytospermia according to WHO (World Health Organization) criteria. Increased hypoosmotic swelling test score, higher sperm concentration and enhanced acrosome reaction were closely related to leukocytospermia. When the patients were divided into subgroups according to seminal leukocyte concentrations, acrosome reaction and hypoosmotic swelling were observed to be higher in semen samples with higher leukocyte concentrations compared to those with low seminal leukocyte concentration. In addition, higher sperm concentrations were observed in semen samples with increased leukocyte levels compared to semen samples with low leukocyte levels. These results suggest that leukocytospermia may have a favorable effect on some sperm functions at seminal leukocyte concentrations between 1 and 3x10(6)/ml.

[The calligrapher and the doctor]. / Hattat hamid aytaç "tugra uçlemesi": yasaminin bilinmeyen yönleri.

Famous Turkish calligrapher Musa Azmi Hamid Aytaç (Am'idi) partially known life story and his family has been summarised by his relatives. The only three tougra like unpublished original calligrafics which has designed by Hamid to his relatives "l) Dr. Fethi Aksu, 2) Feridun Aksu, 3) Fikret Aksu" has been presented in this brief biography.

Vascular cell adhesion molecule-1 (VCAM-1) and leukocyte activation in pre-eclampsia and eclampsia.

OBJECTIVE: To evaluate the levels of VCAM-1 in pre-eclampsia/eclampsia as a possible marker of leukocyte activation and endothelial damage. METHODS: We performed a case-control study on 25 healthy pregnant women and 35 patients diagnosed as pre-eclampsia or eclampsia which were randomly selected. Peripheral venous blood samples were obtained and serum levels of VCAM-1 were measured by enzyme-linked immunoassay (ELISA). RESULTS: In pre-eclampsia/eclampsia, VCAM-1 levels were higher than in normal pregnancy. Serum concentrations of VCAM-1 were significantly higher in severe pre-eclampsia and eclampsia compared to mild pre-eclampsia or healthy controls. ROC analysis detected that VCAM-1 > or = 450 ng/ml had a sensitivity of 0.79 and a specificity of 0.90 in detecting severe pre-eclampsia and eclampsia. CONCLUSION: This is the first study to correlate VCAM-1 levels with severity of disease in pre-eclampsia. Our findings indicate that increasing levels of soluble VCAM-1 are present in the circulation of patients with severe pre-eclampsia/eclampsia compared to mild pre-eclampsia or healthy pregnant women. Elevated VCAM-1 levels may represent a possible mechanism by which endothelial cells attract leukocytes and cause endothelial cell damage.

Significance of yolk sac measurements with vaginal sonography in the first trimester in the prediction of pregnancy outcome.

BACKGROUND: The purpose of this prospective clinical study was to determine and evaluate the prognostic value of secondary yolk sac diameter of the embryo on pregnancy outcome. METHODS: One hundred and thirty pregnant women in the first trimester were included in the study. Crown-rump length (CRL) and yolk sac diameters were measured in every patient and the outcome of the pregnancies were compared with the measurements. Intact normal pregnancy (group A), threatened abortion (group B) and missed abortion (group C) were diagnosed in 67, 43 and 20 pregnancies, respectively. RESULTS: We detected a significant linear correlation between secondary yolk sac diameter and gestational age in group A (r = 0.5085; p < 0.0001) and a moderate correlation in group B (r = 0.4048; p = 0.007) and C patients (r = 0.3478; p = 0.1333). When the groups were evaluated irrespective of gestational age, a significant difference in secondary yolk sac diameters among the groups was noted (p = 0.037). When confidence intervals for secondary yolk sac diameters of intact normal pregnancies (group A) were calculated by linear regression, two patients in group B were below the 5% confidence interval. However, in group C patients, the yolk sac diameter of six patients were detected below the 5% confidence interval, while two of the measurements were above 95% confidence interval. Therefore, eight measurements (40%) of group C patients were outside the 5-95% confidence interval. CONCLUSION: In the first trimester, when discrepancy is detected between secondary yolk sac diameter and gestational age, additional sonographic investigation should be performed one or two weeks later, in order to estimate the pregnancy outcome.

The significance of oestriol in the management of the post-menopause.

Oestrogen replacement therapy relieves many post-menopausal symptoms and has been successfully employed clinically for this purpose for more than four decades. Recently the alleged relationship between oestrogens and cancer has stimulated a re-evaluation of an old oestrogen preparation, oestriol (E3). The dosages of E3 employed appear to vary considerably, and the need was felt to establish the dosage on a scientific basis. Accordingly in the study reported here E3 was administered in various dosages (2, 4, 6, and 8 mg/d) to 52 symptomatic post-menopausal women as oestrogen replacement therapy for a six-month period. Assays of follicle-stimulating hormone (FSH), luteinizing hormone (LH), oestrone (E1) and oestradiol (E2) were performed before and during therapy and vaginal cytology, cervical mucus and endometrial studies were performed during the period of administration. The clinical effectiveness of E3 was found to be directly related to dosage. E3 did not induce endometrial proliferation and proved a poor suppressor of FSH and LH. The ability of oestriol to relieve vasomotor instability and to improve vaginal maturation without inducing notable side effects is sufficient reason for it to be included in the management of the post-menopausal syndrome.

The fate of a large bolus of exogenous estrogen administered to postmenopausal women.

Seventeen postmenopausal women were given a bolus of conjugated estrogens (USP, Premarin), 17 beta-estradiol and estriol orally, intravenously or by pellet implantation, and circulating levels of estrone, estradiol and/or estriol were measured by radioimmunoassay at various intervals during a 48--72-h period. Oral administration resulted in a marked rise in serum estrone; parenteral administration resulted in a marked increased in serum estradiol. There was no significant fall in serum gonadotropins during this period. Following estriol administration orally, there was a decided elevation in estriol levels but minimal change in estrone and estradiol.

Hyperprolactinemia and polycystic ovarian syndrome.

Prolactin and pituitary gonadotropin levels were studied in eight patients with polycystic ovarian syndrome. All women were of reproductive age and had had menstrual disorders since menarche. Three patients had hyperprolactinemia with or without galactorrhea and tomograms of the sella turcica revealed pituitary microadenomas. The remaining five patients with normal baseline prolactin levels had a prolactin stimulation test which used 25 mg of thorazine per os, and a prolactin suppression test using l-dopa 500 mg per os. Analysis of the results of these tests and a comparison with tests performed in five normal individuals used as controls showed significantly different responses in the two groups of women. The preliminary information obtained indicates that an abnormal prolactin secretion status may exist in the polycystic ovarian syndrome.

Treatment of benign breast disease with danazol: a follow-up report.

One hundred thirty-five women with benign breast disease (BBD) were treated with danazol, an impeded androgen. Their ages ranged from 19 to 60 years (mean age, 30). The dose varied from 100 to 800 mg per day for 90 to 180 days, depending upon the severity of the disorder. Overall relief of pain was observed in 97% and of tenderness in 90.5%. There was complete or marked improvement of nodosities in 73%. Seventy-eight patients were followed every six months for two to four years. The recurrent symptoms were pain in 6%, tenderness in 6% and nodosities in 10%. Incidentally, we found that 29.3% of infertile women with BBD conceived within 24 months after cessation of a course of therapy. The side effects, when present, were trivial.

The significance of adrenal and ovarian catheterization in patients with polycystic ovary syndrome.

A previously unreported series of 15 anovulatory hirsute women with polycystic ovaries made up this study. Each underwent left adrenal and left ovarian vein catherization. Blood samples were obtained from the ovarian, adrenal and peripheral veins to test the levels of testosterone, delta 4 androstenedione (delta 4A), dehydroepiandrosterone (DHEA), estradiol and/or total estrogens, before and after administration of human chorionic gonadotropin (ten cases) and adrenocorticotropic hormone (ACTH) (five cases). Following intravenous human chorionic gonadotropin administration, the only response seen was a slight rise in ovarian levels of delta 4A and DHEA; after intravenous adrenocorticotropic hormone stimulation, the adrenal levels of delta 4A, testosterone and DHEA rose significantly. Peripheral concentrations of testosterone and delta 4A were in the high normal range and DHEA levels were high normal or slightly above normal range.

Estriol in the management of the menopause.

Estriol was administered for a six-month period as estrogen replacement therapy to 52 symptomatic postmenopausal women. Assays of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrone, and estradiol were performed before and during therapy. During this period of administration, vaginal cytology, cervical mucus, and endometrial studies were performed. Clinical effectiveness was directly related to dosage (2 to 8 mg/day). Estriol (8 mg/day) failed to induce endometrial proliferation and proved a poor suppressor of FSH and LH. This agent's capacity to relieve vasomotor instability and improve vaginal maturation without notable side effects is sufficient reason to include this drug in the management of the postmenopausal syndrome.