Malon dialdehyde, nitrite and adrenomedullin levels in patients with premenstrual syndrome.

OBJECTIVE: To assess the levels of malon dialdehyde (MDA); a lipid peroxide product, total nitrite; a stabile product of nitric oxide (NO), and adrenomedullin (AM), to determine whether their levels are altered in premenstrual syndrome (PMS) and to search for their possible pathophysiological role in this peculiar syndrome. STUDY DESIGN: Twenty-one patients aged between 28 and 37 years, who had regular menses for at least six previous cycles, and were in general good health condition, were taken into the study. Blood samples were obtained from each patient at the 3rd and 21st day of their menstrual cycles. AM, nitrite, MDA and estradiol levels have been assessed in these samples for each patient. RESULTS: No statistically significant difference in terms of age, parity and body mass index was detected among groups (P > 0.05). Nitric oxide levels were higher on the 3rd day, compared to 21st day in the study group, and this difference was statistically significant (P < 0.05). In the study group, 21st day AM levels were significantly higher when compared to the control group (P < 0.05). CONCLUSION: Even though various stress symptoms are present in PMS, there is no change in the levels of MDA, an oxidative distress indicator but AM and NO may have a pathophysiological role on this enigmatic disease.

Acute abdomen in a case with noncommunicating rudimentary horn and unicornuate uterus.

Unicornuate uterus with a rudimentary horn is the rarest congenital anatomic anomaly of the female genital system, causing many obstetrical and gynecologic complications. The frequency of this pathology is approximately 1/100 000. A rudimentary horn usually develops following insufficient development of mullerian ducts. These patients present with dysmenorrhea, dyspareunia, and chronic pelvic pain because of endometriosis and rarely with acute abdominal symptoms following distention and torsion of the noncommunicating rudimentary horn. The case of a patient referred for acute abdomen after distention of a noncommunicating rudimentary horn is presented herein.

Priming effect of misoprostol on estrogen pretreated cervix in postmenopausal women.

Misoprostol, which is a prostaglandin E1 analogue, is effectively used in cervical priming in women both for labor induction and for gynecological procedures. Although its efficacy is well documented in reproductive age women, during postmenopausal period this efficacy is limited probably due to estrogen deficit. Our objective is to evaluate if estrogen deficit in postmenopausal women is important for the effect of misoprostol on cervical ripening before diagnostic procedures. In this study, 45 patients were randomly allocated to estrogen or placebo group. The study group received local estrogen cream and other group received chlindamycine phosphate cream as placebo. The patients were given oral misoprostol 24 and 12 hours before the procedure for uterine cavity evaluation. Cervix was dilated by using Heagar dilator up to 6 mm. Data were analyzed by Student t-test, Mann-Whitney's U-test, chi-square test and paired samples t-test where appropriate. Basal cervical widths for the estrogen and placebo groups were 4.4 +/- 0.7 and 3.7 +/- 0.7 mm, respectively (p < 0.01). Mean time required for dilatation of cervix was 44.4 +/- 16.2 seconds for the estrogen group and 61.4 +/- 18.3 seconds for the placebo group (p < 0.01). As a conclusion, misoprostol treatment alone is not effective to get cervical priming in postmenopausal women, and as shown in our study, pretreatment with local estrogen overcome the failure. To get a beneficial effect of misoprostol on cervical ripening, estrogenic activity is necessary and when pretreated with local estrogen, misoprostol ameliorates cervical priming in postmenopausal women.