The predictive power of endocrine tests for the diagnosis of polycystic ovaries in women with oligoamenorrhea.

Various hormonal parameters and the best logistic regression model to predict disease probability were evaluated in women with polycystic ovary syndrome (PCOS). Concentrations of LH, FSH, LH/FSH ratio, testosterone, free testosterone, SHBG and insulin in serum were recorded in 32 women with PCOS and in 25 controls. A model including LH/FSH ratio, insulin and testosterone measurements yielded the best goodness of fit for classification of women with and without PCOS in the logistic regression analysis. Only LH/FSH ratio and insulin were retained as significant variables. The diagnostic characteristics of LH/FSH ratio and insulin for PCOS when compared by receiver-operator characteristic analysis were found to be equally effective. By combining these two variables a higher area under curve was obtained. LH/FSH ratio, insulin or the combination of these two can predict the disease probability in women with PCOS.

Pyelocaliectasis and intrarenal artery doppler indices in uncomplicated pregnancies.

The effect of pyelocaliectasis on intrarenal arterial Doppler indices was evaluated in healthy pregnant women with respect to nonpregnant controls. There was no significant difference between the pregnant and nonpregnant subjects regarding the systolodiastolic ratio, resistivity index and pulsatility index throughout the second and third trimesters (p for all > 0.05). There were 134 kidneys with grade 0, 38 kidneys with grade I and 24 cases with grade II pyelocaliectasis in the pregnant population. Grade II caliectasis was found only in the right kidneys. The nonpregnant women all had grade 0 caliectasis. Doppler indices were not significantly different in various grades of caliectasis, and right and left kidneys had similar Doppler indices. The results of this study suggest that pyelocaliectasis increases with advancing gestational age and is more frequent and prominent on the right side but has no effect on intrarenal Doppler indices in healthy pregnant women. In cases of prominent alterations in Doppler indices, renal pathological conditions should be sought.

Placental aging, fetal prognosis and fetomaternal Doppler indices.

OBJECTIVE: To investigate the possible effects of the morphological changes in the placenta on fetal prognosis and on umbilical artery and uterine artery Doppler indices in late, low-risk pregnancies. STUDY DESIGN: Placental changes were evaluated ultrasonographically and pathologically in 224 pregnant women after the 25th gestational week. The placental morphology were graded ultrasonographically into five subgroups according to increasing severity of the changes. Postnatally, the neonate was examined, Apgar scores, and adverse events if any, were noted. Placentas with infarction, decidual necrosis, ischemic villitis, chorioangioma, placenta previa or placental abruption and high risk pregnancies were excluded. RESULTS: There were 21, 38, 52, 56 and 57 cases in grades I, II, III, IV, and V respectively. Apgar scores of the babies in all placental grades were similar (P>0.05). In all cases, Doppler indices of both uterine and umbilical artery were within normal limits. No significant association between placental morphological characteristics and Doppler indices of either uterine or umbilical arteries could be demonstrated. There was no correlation between Apgar scores and morphological characteristics of the placenta or Doppler indices. CONCLUSIONS: Morphological changes of placental aging are common and seem to have no effect on fetus and on Doppler flow of the umbilical and uterine arteries, provided these are not high-risk pregnancies and placental changes are not infarction, villitis or severe structural or localization anomaly.

Ultrasonographic dimensions of the vertical span of the fetal iliac bone and relationship with some fetal parameters.

Using fetal ultrasonography, disorders of developmental delay and congenital malformations are promptly diagnosed. Skeletal abnormalities are relatively easy to notice once standards of growth are established. The iliac bone is frequently affected in skeletal problems, yet it has not been extensively studied. In this study, a total of 296 fetuses were evaluated and the vertical span of the iliac bone was measured in the oblique coronal plane. The size of the fetal iliac bone (in cm) was calculated according to the cubic regression formula y = -4.6891 + 0.5757x (gestational age in weeks) - 0.0159x2 + 0.0001x3. Standards of normal vertical growth of the iliac bone were established and it was noted that the humerus/iliac bone and femur/iliac bone ratios were uniform with minimal variation after the 16th gestational week, with mean values (SD) of 1.82 (0.14) and 2.09 (0.15), respectively. The iliac wing may be unaltered and the vertical span may be changed considerably in some skeletal dysplasias. For complete evaluation of the skeletal system and to distinguish between different conditions with different prognoses and outcomes, measurement of the vertical span of the iliac bone as a complementary measurement is recommended.

Serum tumor markers in chronic liver disease.

Tumor markers have been used for the evaluation of various malignancies though the existence of false positive results in some benign diseases is known. In this study, several established markers including carcinoembryonic antigen, alpha fetoprotein, beta human chorionic gonadotropin, ferritin, CA 19-9 and CA 125 were measured in 60 patients with chronic active hepatitis, 70 patients with cirrhosis and 40 normal subjects in order to evaluate the rate of false elevation of tumor markers in chronic liver disease. Prostate specific antigen and prostatic acid phosphatase levels were also measured in male patients and controls. Serum alpha fetoprotein levels were found elevated in 20% of patients with cirrhosis. The serum CA 19-9 level showed significant elevation in chronic active hepatitis (32%) and cirrhosis (44%). Increase in CA 125 concentration was also remarkable in chronic active hepatitis (23%) and especially in cirrhosis (74%). These results indicate that it is necessary to consider the presence of high false positivity rate of CA 19-9 and CA 125 during clinical interpretation of tumor markers in patients with chronic liver disease.

Transverse cerebellar diameter and transverse cerebellar diameter/ abdominal circumference index for assessing fetal growth.

In a prospective study of 330 pregnant women, measurements of the transverse cerebellar diameter (TCD), abdominal circumference (AC), biparietal diameter (BPD), head circumference (HC) and TCD/AC ratio and HC/AC ratio were obtained using conventional ultrasonography between 16th and 41st weeks of gestation. Measurement of BPD yielded a strong correlation with gestational age (r = 0.9880 and R2 = 0.9761) by cubic regression analysis. The measurement of TCD also had a very close relation with gestational age (r = 0.9767 and R2 = 0.9539). The ratio between TCD and AC was calculated and found to be 0.1436 +/- 0.0106 (SD) which remained fairly constant throughout pregnancy, while the BPD/AC ratio declined. The 5th and 95th percentiles for this ratio were 0.1279 and 0.1603. Ten of eleven fetuses with TCD/AC ratios exceeding 2 SD (0.1648) were found to have asymmetrical intrauterine growth retardation upon neonatal examination. It is demonstrated that both BPD and TCD measurements are reliable techniques that correlate well with gestational age, and the TCD/AC ratio is valuable in identifying babies with asymmetrical intrauterine growth retardation.

Periumbilical skin length measurements in the newborn.

Normal limits of periumbilical skin were determined in 304 newborn babies in the first 24 h. Cranial umbilical skin (SD) was 12.36 (3.23) mm and caudal umbilical skin (SD) was 8.76 (3.10) mm on the average. It is recommended that cranial umbilical skin measurement should be included in the examination of dysmorphic neonates, and those with cranial skin length above 18.82 mm (> 2 SD) should be carefully evaluated for Rieger syndrome.

Scapula length measurement for assessment of fetal growth and development.

To determine the value of prenatal ultrasonographic scapula measurements for fetal growth and development as an adjunct to assessing in utero development, a prospective study of ultrasonography was conducted in 343 pregnant women with uneventful pregnancies with gestational ages from 16 to 41 weeks, and several biometric measurements were obtained. The relationships of scapula length with gestational age and with biparietal diameter, femur length, abdominal circumference and scapula length were examined. With the ultrasonographic examinations of 343 healthy pregnant women, a nomogram of scapula length measurements estimating gestational age and predicting the biparietal diameter, abdominal circumference, and femur length was generated. Linear relationships were found between the scapula length and the gestational age (R2 = 0.94, p < 0.0001), the biparietal diameter (R2 = 0.94, p < 0.0001), abdominal circumference (R2 = 0.94, p < 0.0001), and the femur length (R2 = 0.95, p < 0.0001). The rate of increase of scapula length was significantly higher before 28 weeks of gestation than in later pregnancy (p < 0.0001). The correlation coefficients between gestational age and scapula length were 0.95 before 28 weeks of gestation and 0.86 in later weeks. These results suggest that scapula length measurement is a valuable parameter for the assessment of fetal growth and development.

Lactational failure--study of risk factors in Turkish mothers.

Risk factors for lactational failure in puerperium were investigated. Sixty mothers with inadequate daily milk supply for their babies were the lactational failure group, and 60 mothers with similar age having babies with similar age and weight were chosen as the control group. Low prolactin levels, low serum iron and low serum ferritin levels and low aldosterone values and birth in community hospitals were associated with significantly increased risk of deficient lactation. High income of the family, increase osmolality of breastmilk, high systolic blood pressure of the mother, birth by cesarean section were some of the variables that increased the risk that could not reach the level of significance. Prematurity of the baby was not among the risk factors if the gestational ages were more than 30 weeks. It is concluded that physicians awareness of the factors that may adversely effect the initiation and continuation of lactation is vital. Correcting iron deficiency even if it is not overt, sparing more time for the mothers discussing the benefits of breastmilk to their babies, and avoiding cesarean section if possible may help increase the incidence of breastmilk feeding.

Plasma chromium levels in hypoglycemic preterm, full-term and in intrauterine-growth-retarded babies.

Serum chromium levels of hypoglycemic preterm and full-term babies were investigated. Normoglycemic preterm and full-term babies were selected as the control group. There was no statistically significant difference in serum Cr levels between preterm and full-term, hypoglycemic and normoglycemic, preterm hypoglycemic and preterm normoglycemic, full-term hypoglycemic and full-term normoglycemic babies. Serum Cr levels of intrauterine-growth-retarded babies were relatively low compared to infants appropriate for gestational age. Serum Cr levels of babies with mothers younger than 35 years of age had significantly lower levels than older mothers' babies.

Umbilical artery blood flow characteristics in normal pregnancies.

585 pregnant women were investigated with both conventional sonographic examination and color Doppler examination. The cases with intrauterine growth retardation, preeclampsia, twin pregnancies, congenital malformations and diabetes were excluded. The remaining 550 cases (between ages 16 and 40) were investigated in the first trimester and gestational ages were compatible with the last menstrual date. In order to evaluate fetal development, biparietal diameter, femur length, abdominal circumference, and estimated fetal weight were calculated by conventional ultrasonographic method. The application of Doppler ultrasound to the study of fetal umbilical arterial blood flow velocity is a relatively new technique. The failure to obtain useful Doppler signals was about 18-22% with pulse-wave Doppler system. Recently, color Doppler technology solved this problem. We used an ALOKA 680-SSD ultrasonography device and color Doppler ultrasonography technique and recorded umbilical arterial Doppler signals from every case and calculated classical Doppler indices--systolic/diastolic (S/D) ratio, pulsatility index (PI), Pourcelot index or resistive index (RI). Statistical comparisons were made by SPSS program. Correlation coefficient and R2 values between gestational age and other indices were calculated. The aforementioned values were r:-0.79; R2:0.63 0.63; r:-0.71; R2:0.50, r:-0.64; R2:0.41, for S/D, PI, RI, respectively.