Relation between bone mineral content and clinical, hormonal and biochemical parameters in postmenopausal women.

We studied factors related to bone mass after a natural or surgical menopause in 73 healthy women attending the menopause clinic of a university hospital. In the natural menopause group we found inverse correlations between bone mineral density (BMD) vs. menopausal duration; BMD vs. body mass index (BMI) and BMI vs. inorganic phosphate (Pi), borderline correlations between weight vs. thyroxin (T4) and weight vs. luteinising hormone (LH) and a positive correlation between androstenedione (D4A) vs. urinary calcium (Uca). In the surgical menopause group we found some negative correlations (BMD vs. menopausal duration, BMI vs. Pi; BMI vs. dehydroepiandrosterone sulphate (DS), weight vs. DS and cortisol vs. Uca) and some positive correlations (BMD vs. free testosterone (fT), BMD vs. calcium (Ca), and BMD vs. Uca). We concluded that the serum hormone levels we measured were not useful markers of current bone mineral status.

Ovarian pregnancy; relationship to an intrauterine device.

Ovarian pregnancy is a rare form of ectopic pregnancy in which the gestational sac is implanted within the ovary. The incidence is 0.5 to 3% of all ectopic gestations. In contrast to patients with tubal pregnancies, traditional risk factors, such as pelvic inflammatory disease and prior surgical procedure upon the pelvis, may not play a role in the aetiology. In the 2 cases reported here, it seems that using an intrauterine contraceptive device was an important factor.

PIP: The etiology of primary ovarian pregnancy is unknown, although an IUD is frequently implicated. This paper presents two cases of primary ovarian pregnancy diagnosed at Dokuz Eylul University in Izmir, Turkey, in 1995 and discusses the pathogenesis in relation to the IUD. In the first case, the woman had used a copper-releasing IUD for 3 years and had had it removed 1 month before presentation. The second woman had been using a Lippes Loop device for 16 years. Ovarian pregnancy was diagnosed only after pathologic examination of the specimen. Both pregnancies were located within the corpus luteum, suggesting that fertilization and nidation occurred at the ovulation site. Although the IUD protects against ectopic pregnancy in the first 24 months of use, the risk increases over time as the reversible foreign-body histologic changes associated with IUD use become established in the Fallopian tube. The preoperative diagnosis of primary ovarian pregnancy is very difficult. It should be kept in mind, however, that ovarian pregnancy is more frequent in ectopic pregnancies associated with IUD use.

Umbilical coiling index: is it a marker for the foetus at risk?

The aim of this study was to determine the relationship between the number of coils in the umbilical cord and perinatal outcome. The umbilical cords and delivery records of 147 liveborn neonates were prospectively studied. The umbilical coiling index (UCI) of each cord was calculated by dividing the total number of complete umbilical vascular coils by the umbilical cord length. Subjects with UCIs below the 10th percentile, above the 90th percentile, and between the 10th and 90th percentiles were defined as hypocoiled, hypercoiled, and normocoiled, respectively. Several different parameters were used to measure neonatal outcome. The mean UCI was 0.20 +/- 10 (SD). No relationship was noted between UCI and maternal age, gravidity, parity, oligohydramnios, or birth weight. When we compared the hypocoiled group (n = 30) with the normocoiled group (n = 87), we detected a statistically significantly higher incidence of meconium staining, interventional delivery, apgar scores, fetal blood pH and intrapartum fetal heart rate disturbances. As a result, we concluded that the UCI has a strong relationship with perinatal outcome and may be used antenatally as a marker for identifying the fetus at risk.

Risk factors for Wolfe's dysplasia of mammograms in postmenopausal Turkish women.

OBJECTIVE: The aim was to ascertain whether menstrual, reproductive and hormonal risk factors for breast cancer are present in women with dysplastic mammographic patterns and to investigate possible trends towards breast cancer. METHOD: This prospective case-control study was designed in a university hospital. Thirty-two turkish postmenopausal women were evaluated for the associations between obesity, parity, age, age at menarche, age at menopause, total lactation period and dysplasic mammographic patterns. RESULTS: We found an increasing trend of dysplasia with increasing age at menarche. This association contradicts the well established one for breast cancer. The effects of parity and total lactation period on dysplasia were similar. Although nulliparity had some protective effects on dysplasia, relative risk (RR) increased to some extent with an increase in parity and lactation period. Later menopause and older age were associated with an increase risk of dysplasia, whereas an apparent protection was given by greater body mass index. CONCLUSION: Onset of the menopause increases the risk of dysplasia and the estrogenic milieu may have some role in the initiation and progression of dysplasia.

Prolactin and cortisol levels during spontaneous and oxytocin induced labour and the effect of meperidine.

The effect of stress during labour on the plasma concentration of prolactin and cortisol was studied in 30 healthy multiparous women. The plasma concentrations of prolactin and cortisol were measured by radioimmunoassay during oxytocin induced labour, spontaneous labour, delivery and postpartum 24 h. The parturients were divided into three groups. The first group was given oxytocin for the induction of labour, the second group was also given oxytocin for the induction of labour and 100 mg of meperidine was administered intramuscularly for relief of pain and anxiety, and the third group was the control group with normal parturients who did not receive any medication. The prolactin levels showed a fall during labour in all the groups, but this fall was more marked in the first group where stress was evident. The concentrations of cortisol tended to increase during labour and reached a maximum at delivery in all three groups but in the meperidine group this level was significantly lower than the first and control groups. These results give further support to the hypothesis that maternal stress leads to a reduced concentration of prolactin and increased concentration of cortisol whereas relief of pain and maternal anxiety with meperidine lessens both effects.