Asprosin: a novel peptide hormone related to insulin resistance in women with polycystic ovary syndrome.

Asprosin associated with insulin resistance is a newly discovered peptide hormone. The peptide promotes hepatic glucose production. Polycystic ovary syndrome (PCOS) is a metabolic disorder. Insulin resistance plays a vital role in the pathogenesis of the disease. The aim of this study was to discover the association between insulin resistance and asprosin in women with PCOS. We recruited 78 subjects with PCOS and 78 age-matched and body mass index (BMI)-matched controls into this cross-sectional study. Circulating asprosin levels were validated using ELISA method. We also determined metabolic and hormonal parameters of the involved subjects. We found that circulating asprosin levels were elevated in women with PCOS with respect to controls. Asprosin levels showed a positive correlation with insulin resistance, BMI, and free androgen index (FAI). Moreover, subjects with the highest tertile of asprosin levels represented increased odds of having PCOS as compared to those subjects with the lowest tertile asprosin levels. Increased asprosin levels resulted to high possibility of having PCOS risk associated with insulin resistance.

Urinary Incontinence in Puberty: A Rare Clinical Presentation of the Herlyn-Werner-Wunderlich Syndrome.

BACKGROUND: We report on an unusual presentation of Herlyn-Werner-Wunderlich syndrome in two 11-year-old girls within a year of menarche. The setting was a training and research hospital. CASE: We present two patients in the pubertal period with cyclic abdominal pain and urinary incontinence who received hysteroscopic septal resection. Menstrual flow was resumed and the complaints of incontinence were eliminated after the hysteroscopic resection of the vaginal septum. SUMMARY AND CONCLUSION: Overflow incontinence was completely resolved after septum resection in two patients. The risk of stricture is high in Herlyn-Werner-Wunderlich syndrome if the septum is partially excised to open the obstruction, whereas the risk of stricture is low if a complete or wide excision is performed. In the presence of abdominal pain and urinary incontinence in puberty, Herlyn-Werner-Wunderlich syndrome must be considered in the differential diagnosis, and a detailed evaluation of the urinary system and pelvic anatomy must be performed.

Methotrexate treatment in progressive tubal ectopic pregnancies and hCG-related clinicosurgical implications.

Our aim was to evaluate the relationship between the success of methotrexate treatment and ß-hCG levels in progressive tubal ectopic pregnancies. We defined a retrospective cohort of 394 progressive tubal ectopic pregnancy patients treated with methotrexate. A single-dose methotrexate protocol using 50 mg/m(2) was administered to patients with progressive tubal ectopic pregnancy. Surgery was performed in patients who exhibited signs of acute abdomen due to tubal rupture. Of 394 patients that received methotrexate treatment, 335 (84.6%) responded to medical treatment, while the remaining 59 (15.36%) underwent surgery due to treatment failure. ß-hCG levels in the failure group were significantly higher as compared with the success group at Day 1, Day 4, and Day 7 (2116±3157 vs. 4178±3422, 2062±3551 vs. 4935±4103, and 1532±3007 vs. 3900±4783, respectively). The receiver operating characteristics curve for ß-hCG levels at Day 1 was 0.738, with a cutoff value of 1418 mIU/mL, while sensitivity and specificity values reached the optimum for treatment success (83.1% and 59.4%, respectively). Medical treatment with methotrexate achieved an 85.02% success rate for the treatment of progressive tubal ectopic pregnancy, while success rates for medical treatment decreased significantly when initial ß-hCG levels were >1418 mIU/mL.

Intrahepatic cholestasis of pregnancy may lead to low birth weight.

BACKGROUND/AIM: To evaluate patients hospitalized in our clinic in the last 5 years with the diagnosis of intrahepatic cholestasis of pregnancy (ICP). MATERIALS AND METHODS: One hundred and fifty patients hospitalized with a diagnosis of ICP between January 2008 and May 2013 were evaluated retrospectively and age, week at diagnosis, gestational age at delivery, period between diagnosis and delivery, fetal weight, transaminases, and coagulation parameters were recorded. Patients were divided into groups according to their diagnosis weeks and gravida. Accordingly, patients diagnosed before 32 weeks formed group A (n = 49) and those after 32 weeks formed group B (n = 101). Data were evaluated with SPSS 16.0. RESULTS: There was a significant difference between group A and group B in terms of delivery period and fetal weights (P = 0.001, P 0.035). Accordingly, the period between diagnosis and delivery and fetal weight were found to be longer and lower, respectively, in the early-onset group. In terms of distribution of ICP according to time of diagnosis, patients were diagnosed mostly in the spring season (60 cases, 40%) and in the month of March (27 cases, 18%). CONCLUSION: According to our study, the birth weight of fetuses of patients with ICP diagnosed before 32 weeks are lower, although they have the same gestational age at delivery as the fetuses of the patients with ICP diagnosed after 32 weeks.

The impact of intrahepatic cholestasis of pregnancy on fetal cardiac and peripheral circulation.

OBJECTIVE: The aim of this study was to evaluate changes in fetal cardiac and peripheral circulation in pregnancies complicated with intrahepatic cholestasis. MATERIAL AND METHODS: The Doppler examination results of 22 pregnant subjects complicated with intrahepatic cholestasis of pregnancy (ICP) and 44 healthy controls were compared. The parameters of fetal cardiac circulation were pulmonary artery and aortic (Ao) peak systolic velocity (PSV), pulmonary vein (Pv), peak velocity index (PVI) and pulsatility index (PI), mitral valve (MV) and tricuspid valve (TV), early diastole (E)- and atrial contraction (A)-wave peak velocity ratio (E/A), and isthmus aortic peak systolic velocity (IAo PSV). The parameters of fetal peripheral circulation were middle cerebral artery (MCA) and umbilical artery (UA) PI, resistance index (RI), systolic/diastolic (S/D) ratio. Fetal obstetric Doppler monitoring was conducted weekly before 36 weeks and biweekly after that, and the results were compared with the normal reference values for gestational age. RESULTS: The Doppler parameters of fetal cardiac and peripheral circulation did not significantly differ between the two groups. S/D ratio readings in the ICP group were significantly above 2 SD before 35 weeks of gestation. Women with ICP had increased risks of preterm delivery, neonatal unit admission, and meconium-stained amniotic fluid compared with those in the controls. CONCLUSION: Fetuses of pregnant women with ICP showed no differences in the evaluation of cardiac and peripheral Doppler measurements compared with fetuses of healthy mothers. The Doppler investigation of the umbilical artery may be useful in monitoring of pregnancies complicated by early onset intrahepatic cholestasis.

Risk factors and perinatal outcomes associated with latency in preterm premature rupture of membranes between 24 and 34 weeks of gestation.

PURPOSE: To identify risk factors and perinatal outcomes associated with the duration of latency period in women who experience preterm premature rupture of membranes (PPROM). METHODS: A retrospective study of women who experienced PPROM between 24 and 34 weeks of gestation was performed in a single tertiary center between 2009 and 2013. Patients were divided into two groups based on the duration of the latency period after PPROM: Group 1 ≤72 h and Group 2 >72 h. Risk factors and perinatal outcomes were compared according to latency period. Student's t test and Chi-square test were used to compare continuous and categorical variables, respectively, between the two groups. Multivariate regression analysis was performed to control for potential confounding variables. RESULTS: In total, 3,257 patients presented with PPROM during the study period; of these, 204 (6.3 %) met the inclusion criteria. Higher gestational age upon admission (odds ratio [OR] = 0.83, 95 % confidence interval [CI] = 0.79-0.87; p < 0.001), oligohydramnios (OR = 0.47, 95 % CI = 0.25-0.91; p = 0.018), and twin gestation (OR = 0.67, 95 % CI = 0.45-0.89; p = 0.032) were independently associated with a shortened latency period. In addition, prolonged latency significantly increased the occurrence of chorioamnionitis (OR = 2.23, 95 % CI = 1.48-3.14; p = 0.002), placental abruption (OR = 1.9, 95 % CI = 0.95-3.53; p = 0.033), and decreased the length of stay of neonates in the intensive care unit (OR = 0.85, 95 % CI = 0.39-1.79; p = 0.021). CONCLUSION: Gestational age at PPROM, twin gestation, and oligohydramnios significantly affected the latency period. Although a latency period >72 h was associated with chorioamnionitis and placental abruption, adverse neonatal outcomes were not affected.

Effect of single-dose methotrexate on ovarian reserve in women with ectopic pregnancy.

OBJECTIVE: To evaluate ovarian reserve in women with ectopic pregnancy treated with single-dose systemic methotrexate in the early post-treatment period. DESIGN: Prospective study. SETTING: Women's health education and research hospital. PATIENT (S): Eighty-two patients with ectopic pregnancy and 80 healthy women in the same age group were included in the study. Of the 82 patients, 49 with ectopic pregnancy were treated with single-dose systemic methotrexate (MTX) and 33 were treated surgically with laparoscopy or laparotomy (salpingectomy or salpingostomy). INTERVENTION(S): Ovarian reserve testing. MAIN OUTCOME MEASURE(S): Basal FSH on the 3rd day of the menstrual cycle, E2, basal antral follicle count (AFC), and ovarian volume. RESULT(S): There were no differences among the groups in terms of basal FSH, E2, AFC, and ovarian volume. CONCLUSION(S): The single-dose MTX treatment had no effect on ovarian reserve in women with ectopic pregnancy as measured by the above-mentioned parameters.

The use of ultrasound during intrauterine insemination in unexplained infertility may improve pregnancy outcomes.

OBJECTIVE: To investigate the role of ultrasound guidance in intrauterine insemination (IUI). MATERIALS AND METHODS: A retrospective study was conducted. The data was collected from the records of 197 couples with unexplained infertility who underwent IUI with a total of 267 IUI cycles in the in vitro fertilization center of our hospital between January 2009 and December 2010. RESULTS: Of the 267 IUI cycles, 145 were carried out as US-guided, while 122 cycles IUI were performed with a blind procedure. In the US-guided IUI and blinded IUI groups, the pregnancy rates were 23.4 and 13.9%, respectively. The difference between the groups was statistically significant (p = 0.049), thereby indicating that US guidance improves pregnancy rates. In the US-guided IUI group, 9.7% of the cases were difficult, while in the blinded IUI group, 26.2% were difficult and the difference between the groups was also statistically significant (p < 0.001). CONCLUSION: US guidance in IUI improves pregnancy rates and reduces the frequency of difficult IUI.

Lack of influence of pregnancy on the prognosis of survivors of thyroid cancer.

OBJECTIVE: The aim of this study is to investigate the influence of pregnancy on prognosis of thyroid cancer. METHODS: A total of 72 patients aged between 15-45 years who underwent total or subtotal thyroidectomy and subsequently radioablation were followed up under suppression. Individuals who had term pregnancies after diagnosis of cancer (group 1, n: 36) and who were non-pregnant (group 2, n:36) were included in the study. Both groups were compared in terms of scintigraphic relapse and metastasis, ultrasonographic relapse, stage change of lympadenopathy at the beginning and at the end of the study. RESULTS: Relapse was detected in 4 out of 36 pregnant patients (11.1%) and in 5 out of 36 non-pregnant patients (13.9%) with no significant difference between groups (p=1.00). Pathologic lymphadenopathy was detected in 2 out of 36 pregnant patients (5.6%) and in 2 out of 36 non-pregnant patients (5.6%) (p=1.00), and metastasis in 3 (8.3%) and in 1 (2.8%), respectively (p=0.61). While stage change was detected in only one pregnant patient (2.8%), and none of the non-pregnant again there was no significant difference (p=1.00). CONCLUSIONS: We conclude that pregnancy does not have an influence on prognosis of thyroid cancer.

Serum Fetuin-A levels in women with polycystic ovary syndrome.

PURPOSE: The liver-derived Fetuin-A (α2-Heremans Schmid glycoprotein) is a circulating glycoprotein that may be related to insulin resistance and polycystic ovary syndrome (PCOS). We aimed to investigate the Fetuin-A levels in patients with PCOS. METHODS: A total of 88 women were included in the study. We measured the Fetuin-A levels in 44 women with PCOS and compared with 44 healthy women. RESULTS: The mean age in control group was 28.61±5.0 (18-38) and 25.5±4.1 (17-36) in PCOS group. While there was statistically significant difference in terms of age and testosterone levels, there was no difference in terms of smoking status and BMI between the groups. Accordingly, women with PCOS were older than controls [28.61±5.0 (18-38) and 25.5±4.1 (17-36), respectively, p=0.002]. The mean Fetuin-A level of PCOS group was 255.4±37.2 (203.1-388.9) ng/mL and the mean Fetuin-A level of control group was 253.0±43.2 (179.9-355.4) ng/mL. There was no difference between the groups with regard to Fetuin-A, before and after adjustment for age (p values 0.780 and 0.835, respectively). CONCLUSIONS: Serum Fetuin-A levels of women with PCOS did not change in comparison with the healthy controls.

Serum lipid levels in women with premature ovarian failure.

OBJECTIVE: The aim of this study was to investigate serum lipid and hormone levels in women with premature ovarian failure (POF) and compare them with those of healthy women of similar age. METHODS: We measured fasting total cholesterol (TC), triglyceride, low-density lipoprotein (LDL), high-density lipoprotein, estradiol (E2), follicle-stimulating hormone (FSH), progesterone, and testosterone levels in 47 women with POF not using any hormone therapy and 60 healthy women of the same age range not using oral contraceptives or any other hormonal medication. RESULTS: There were no statistically significant differences between the groups in terms of age, body mass index (BMI) and smoking status (P = 0.054, 0.250, and 0.656, respectively). The mean E2 levels of the POF and control groups were 27.9 ± 2.3 and 87.8 ± 75.2 pg/mL, respectively (P < 0.001). Women with POF presented with significantly higher TC and LDL levels (P = 0.006 and 0.040, respectively). However, no difference was found between the groups with regard to triglyceride and high-density lipoprotein levels (P = 0.128 and 0.062, respectively). We determined that there was a significant negative correlation between E2 and TC levels (r = -0.291, P = 0.047) in the POF group. However, no correlation could be identified between E2 and lipids in the control group. Likewise, no correlation was present between FSH and lipids in both groups. We divided the control group according to basal FSH level. Group A consisted of the women with a serum FSH level lower than 7 IU/L, and group B consisted of the women with a serum FSH level of 7 IU/L or higher. There was no difference between the groups in age, body mass index, E2 concentration, and smoking status. The FSH level of group A was significantly lower than that of group B (P < 0.001). We found no difference between groups A and B with regard to lipid levels. CONCLUSIONS: Higher TC and LDL levels in women with POF compared with the control group suggest that estrogen deprivation in women with POF leads to unfavorable lipid changes.

Risk factors for surgery in patients with tuba-ovarian abscess.

OBJECTIVE: To determine the factors that increases the need of surgery in the treatment of tuba-ovarian abscess. MATERIAL AND METHOD: Fifty patients, who were diagnosed with tuba-ovarian abscess between January 2005 and December 2010 at Aegean Obstetrics and Gynecology Education and Research Hospital, were reviewed retrospectively. Patients were divided into two groups as Group A includes 19 patients treated medically and Group B includes 31 patients treated surgically. Patient characteristics of both groups were compared in terms of risk factors, clinical findings, abscess size and length of hospital stay. RESULTS: The mean age of the patients was 41.2 ± 10.4 (range 19-73). A statistically significant difference was found between the mean age of the patients (37.4 ± 8.6) treated medically and the mean age of the patients (43.5 ± 10.8) treated surgically (p 0.042). The patients treated medically were younger than those treated surgically. In addition, there was a statistically significant difference between the groups in terms of abscess sizes (p 0.001, 81.7 ± 38.2 and 43.5 ± 19.0 mm, respectively). Accordingly, the size of abscess was larger in the surgical treatment group. No significant difference was found between the two groups in terms of smoking status and duration of hospital stay (p 0.157, 0.085, respectively). Previous attacks of PID, history of minor uterine operation and use of IUD's were not different between the groups (p 0.166, 0.490, 0.080, respectively). CONCLUSION: Being older in age and having larger abscess size increase proceeding to surgery in patients with tuba-ovarian abscess.

Synchronous primary cancers of the female reproductive tract in Turkish women.

OBJECTIVES: To evaluate the synchronous gynecologic cancers in Turkish women. MATERIALS AND METHODS: A population-based longitudinal cohort study was conducted using Izmir Cancer Registry (ICR) data on gynecologic cancer patients diagnosed in the period 1993 to 2005. The registry covers the 3.7 million population of Izmir and has been collecting data on cancer incidence and survival of cancer patients' since 1992. The ICR collects data on all new cases of cancer from all the hospitals (n = 22) in the city. RESULTS: A total of 4,185 women were identified with gynecologic cancer between 1993 and 2005, 1,526 with endometrial, 1,206 with cervical, 1,198 with ovarian, 115 with vulvar, 67 with other uterine ( sarcoma etc.), 33 with vaginal and 40 with other gynecologic cancers ( tuba uterina etc.). Fifty-five (1.3%) patients with invasive synchronous primary cancers were identified, 43 of these tumor pairs being endometrium-ovaries (81%), 66 of all lesions being endometrioid adenocarcinomas. CONCLUSIONS: Independent primary tumors of the endometrium and ovary are the most commonly encountered synchronous tumors of the female genital tractus with endometrioid adenocarcinoma as the most frequent component.

Ectopic ovary confirmed by ovarian stimulation in a case of unicornuate uterus.

OBJECTIVE: To present a case of unicornuate uterus with ipsilateral ectopic ovary and renal agenesis. DESIGN: Case report. SETTING: Research hospital. PATIENT(S): A 26-year-old woman with a 5-year history of primary infertility was admitted to our clinic. A unicornuate uterus without contralateral horn, with ipsilateral ectopic ovary and renal agenesis, was diagnosed. INTERVENTION(S): Diagnostic laparoscopy, ovarian stimulation. MAIN OUTCOME MEASURE(S): During laparoscopy, a unicornuate uterus without a contralateral horn, together with ectopic ovary, was observed. RESULT(S): We visualized the right ectopic ovary on ultrasound after ovarian stimulation. CONCLUSION(S): We present a rare clinical entity that exhibits a unicornuate uterus without a contralateral horn, with ipsilateral right ectopic ovary and renal agenesis together. We conclude that ovarian stimulation is a useful approach in the diagnosis of ectopic ovaries.

Serum homocysteine and asymmetric dimethylarginine levels in patients with premature ovarian failure: a prospective controlled study.

OBJECTIVE: To investigate serum homocysteine and asymmetric dimethylarginine (ADMA) levels in patients with premature ovarian failure (POF). STUDY DESIGN: A total of 69 women, 32 with POF and 37 apparently healthy women were included in the study. Fasting blood samples were drawn to measure serum homocysteine and ADMA levels using ELISA method. RESULTS: The study and control group had a mean age of 37.3 + 2.6, 37.5 + 2.5 years; a mean homocysteine level of 13.54 + 5.19, 12.71 + 3.99 mmol/l and a mean ADMA level of 1.32 + 0.27, 1.26 + 0.36 mmol/l, respectively. There were no statistically significant differences between the two groups in terms of homocysteine and ADMA levels (with p values of 0.465 and 0.423, respectively). A negative significant correlation was found between estradiol and ADMA (p <0.05). CONCLUSION: Homocysteine and ADMA levels did not change in comparison with the control group, which suggests that estrogen deficiency in patients with POF does not have any effect on homocysteine and asymmetric dimethylarginine levels.

Second primary gynecologic cancers after breast cancer in Turkish women.

OBJECTIVES: To determine the risk of gynecologic cancers among women with previous breast cancer. METHODS: A population-based longitudinal study was conducted using the Izmir cancer registry center's data on 6356 breast cancer patients diagnosed in the period 1992 to 2006. Standardized incidence ratios (SIR) and absolute excess risks (AER) were calculated. RESULTS: In total, 88 (1.3%) women developed a second primary cancer (other than second primary breast cancers) versus 49.8 expected (SIR, 1.76; 95% confidence interval [CI], 1.43-2.2; AER, 86.9/100.000 patients/y) and 33 of 88 (37.5%) women developed gynecologic cancer (21 endometrial, 8 ovarian, and 4 cervical) versus 8.8 expected (SIR, 4.03; 95% CI, 2.8-5.7; AER, 48.2/100.000 patients/y). High SIR and AER were observed for uterine (SIR,2.2; 95% CI, 1.5-2.7; AER, 35/100.000 patients/y), ovarian (SIR, 3.63; 95% CI, 1.6-7.2; AER, 12.2/100.000 patients/y), and cervical cancer (SIR, 1.68 95% CI: 0.46-4.3; AER, 2.2/100,000 patients/y). CONCLUSIONS: Our data show that women with previous breast cancer have an elevated risk of developing a second primary gynecologic cancer compared with the general population. These patients should be followed up frequently.

Postmenopausal women with osteoporosis may be associated with high endothelin-1.

AIM: We aimed to find out if there was any difference of the endothelin-1 (ET-1) and asymmetric dimethylarginine (ADMA) levels between osteoporotic and non-osteoporotic healthy postmenopausal women and whether there were any associations between ET-1 and ADMA levels and bone mineral density (BMD). METHODS: A total of 75 healthy postmenopausal women were enrolled in the study. BMD was measured at lumbar spine (LS) and femur neck (FN). Serum ET-1 and ADMA levels were measured by ELISA. In this population, 41 (54%) women had BMD t-scores > or = 2.5 at the LS and/or FN defined as osteoporosis and 34 (46%) of them had normal BMDs (non-osteoporotic group). RESULTS: The mean value of ET-1 serum level in patients was 0.42 +/- 0.30, 0.28 +/- 0.12 fmol/ml in osteoporotic and non-osteoporotic groups, respectively (p = 0.018). In non-osteoporotic group, there was an only significant positive correlation was found between BMD (g/cm(2)) and total t-scores at the lumbar region and ET-1 level. In osteoporotic group, no correlation was found between BMD and total t-scores and ET-1 levels. Serum ADMA level was not significantly different between osteoporotic and non-osteoporotic postmenopausal women (p > 0.05). CONCLUSIONS: ET-1 may be a physiologic regulator in non-osteoporotic healthy postmenopausal women. Osteoporotic postmenopausal women had higher ET-1 levels than non-osteoporotic postmenopausal women. ADMA seems not to have effect on bone in postmenopausal women.

The effect of strontium ranelate on serum insulin like growth factor-1 and leptin levels in osteoporotic post-menopausal women: a prospective study.

OBJECTIVE: The aim of this study was to investigate the effects of strontium ranelate on insulin like growth factor-1 (IGF-1), leptin and osteocalcin levels in osteoporotic post-menopausal women. STUDY DESIGN: Thirty-three women were given 2 g/day strontium ranelate for 6 months. Serum IGF-1, leptin and osteocalcin levels were measured before and after the treatment. RESULTS: Strontium ranelate treatment increased IGF-1 levels significantly (P = 0.02). Leptin and osteocalcin levels did not change significantly before and after the treatment. There was no correlation between basal and 6-months treatment levels of IGF-1 and leptin. CONCLUSION: Strontium ranelate increases serum IGF-1 levels in osteoporotic post-menopausal women.