The Comparison of Patient Characteristics, Therapy Outcome, and Sexual Functions in Vaginismus Patients Prior to and During the COVID-19 Pandemic.

Background The objective of this study conducted at one center is to compare the demographic features and female sexual functions of patients treated for vaginismus before the COVID-19 pandemic to those treated for vaginismus during the pandemic. Aim Additionally, the study intends to evaluate the results of vaginismus therapy and assess the post-treatment sexual functioning of women. Methods A retrospective analysis was conducted on the medical records of patients diagnosed with vaginismus who sought treatment between March 2018 and March 2022. The enrolled patients were categorized into two groups: the pre-COVID-19 group and the COVID-19 group. The following data have been collected: age, education level, occupation, and marriage duration. After three months of treatment, the patients were called for a follow-up examination and evaluation of their sexual functions. Outcomes Compared to the pre-COVID-19 group, an increase of 52.51% was observed in the number of patients admitted for treatment in the COVID-19 group. Results The severity of vaginismus in the patients was similar in both groups. There were no statistically significant changes observed in any of the areas of the Female Sexual Function Index (FSFI) scale. Clinical implications According to our findings, there was no significant difference in female sexual functioning between women who had vaginismus treatment during the pandemic and those who underwent pre-pandemic treatment. Strengths and limitations The research sample comprised women who sought medical care at our women's health clinic. Conclusions We believe that vaginismus patients who had previously avoided seeking treatment are now seeking it during the pandemic.

The Impact of the COVID-19 Pandemic and Social Isolation on the Sexual Functioning of Women Who Have Been Treated for Vaginismus.

BACKGROUND: Multiple factors that impact the mental and hormonal condition of the person influence female sexual function. To our knowledge, however, hardly any research has investigated the sexual function during the COVID-19 pandemic for women who were treated for vaginismus. AIM: The purpose of this research is to examine how sexual function, frequency of sexual activity, and dyspareunia altered in women who had been treated for vaginismus before the pandemic. METHODS: This observational study ultimately included 204 patients with completely treated vaginismus at the Women's Health Clinic . Before and during the pandemic, the following data was collected: age, education level, profession, frequency of sexual activity, Arizona Sexual Experiences Scale (ASEX) scores, Golombok-Rust Inventory of Sexual Satisfaction (GRISS) scores, and Hamilton Depression Rating Scale (HDRS) scores. RESULTS: Before the pandemic, the mean ASEX score of women in the research group was 12.56±3.41 , and during the pandemic, ASEX average scores of the women significantly increased to 16.88±5.56 . The GRISS total scores were 28.7±10.1 (range, 14-50) following therapy and 23.9±14.8 (8-58) during the pandemic. After therapy, the HDRS score was 9.58±5.53 (1-19) , while it was 15.21±6.43 (5-26) during the pandemic. During the coronavirus disease 2019 (COVID-19) pandemic, mental health declined significantly, indicating a mild state of depression unrelated to vaginismus. During the pandemic, the mean frequency of sexual activity was 2.9±1.4 per week, and the frequency of sexual encounters did not considerably vary. CLINICAL IMPLICATIONS: Therapists should examine the pandemic's impacts on all sexual function symptom categories and modify their treatment plans appropriately. The findings indicate that lowering COVID-19-related stress may be especially useful in minimizing the negative impact of COVID-19 on symptoms. We noticed that vaginismus-treated women did not relapse during the pandemic. LIMITATIONS: The study population was comprised of women attending a particular women health clinic. This can place a certain bias on the demography of the patient population. CONCLUSION: The present research indicated that the frequency of sexual activity among women treated for vaginismus did not alter, and notwithstanding a rise in stress and depression ratings, the majority of sexual function scores, including pain, improved during the pandemic. Nonetheless, dissatisfaction and anorgasmia subscales deteriorated, while ASEX satisfaction did not improve to the same extent, suggesting deleterious consequences on sexual function.

Obstetric outcomes of 297 women treated for vaginismus.

OBJECTIVE: Vaginismus is a disease characterized by vaginal spasms that impede sexual penetration and lead to sexual dysfunction. The association between this disease and infertility is quite well acknowledged. This paper aims to assess the obstetric outcomes and patient characteristics of vaginismus-treated women. STUDY DESIGN: This cross-sectional research comprised 297 vaginismus patients who were effectively treated. METHODS: The following information was collected: age, degree of education, occupation, length of marriage, and obstetric history (primigravida, multigravida, and previous abortions). Following pregnancy, the following data were collected: The results of pregnancy, obstetrics, and neonatology, such as maternal age, gestational age, and birth weight. As obstetrical outcomes, miscarriage, early delivery, hypertension, and fetal loss were recorded. In addition, the mode of delivery (cesarean section vs vaginal birth), reasons for selecting it, analgesic techniques, and potential problems during or after delivery were evaluated. RESULTS: The mean maternal age was 29.2 ± 4.7 years, and the pregnancy rate was 86.86% (n = 258). 258 individuals were reported to have had at least one term pregnancy and delivery. In the feedback for vaginismus, no recurrence was reported 16 weeks after hospital release. CONCLUSION: Vaginismus patients should be treated prior to being deemed infertile, and other fertility treatments should be attempted. Moreover, the caesarean delivery rates of individuals with treated vaginismus are the same as those of the general population. Vaginal delivery after vaginismus treatment seems to be safe, with no increased perineal morbidity or vaginismus recurrence.

Regression of endometrial autografts in a rat model of endometriosis treated with etanercept.

OBJECTIVE: To determine the efficacy of anti-tumor necrosis factor therapy (etanercept) for treating endometriosis in the rat endometriosis model. STUDY DESIGN: A randomized, placebo-controlled, blinded study using rat endometriosis model. After the peritoneal implantation of endometrial tissue, twenty-eight Wistar female rats were randomized to two equal intervention groups: the control group and the etanercept-treated group. After measuring implant volume, pretreatment blood and peritoneal fluid samples were obtained. A vehicle treatment of 2 mL saline to the rats in control group and 0. 4 mg/kg etanercept SC once weekly were administered in the etanercept-treated group. After four weeks treatment period, the volumes and histopathological properties of the implants were evaluated. A scoring system was used to evaluate preservation of epithelia. Endometrial explants were evaluated immunohistochemically for tumor necrosis factor receptor type 2 (TNFR2). A scoring system was used to evaluate expression grade of TNFR2. RESULTS: There was not a significant difference in spherical volume between control (131.0 (60.3-501.2)) and treatment groups (72.8 (31.2-149.6)) (p>0.025). There was a significant change in between the volumes of implants before and after treatment in etanercept group (p<0.05). At the end of the treatment significant differences among the groups were found in histopathological and immunohistochemical parameters (p<0.05) also histologic scores and HSCORES were decreased in the treatment group significantly (p<0.05). CONCLUSION: These results indicate that etanercept was found to effectively reduce the development of endometriosis in this experimental rat model.

Circulating levels of copeptin, a novel biomarker in pre-eclampsia.

AIMS: Increasing evidence supports the participation of metabolic syndrome and insulin resistance in the pathogenesis of pre-eclampsia. Copeptin is co-synthesized with vasopressin and is a new and promising novel marker of metabolic syndrome and insulin resistance. Our aim was to investigate copeptin levels in normotensive pregnant, mild and severe pre-eclamptic women. MATERIALS AND METHODS: We included 96 pregnant women who received antenatal and obstetric care at the perinatology clinic of our hospital. They were divided into three groups: women with normal ongoing pregnancy (n=32), those with mild pre-eclampsia (n=32) and those with severe pre-eclampsia (n=32). Doppler velocimetry measurements of the uterine and umbilical arteries were performed for each patient. Plasma levels of copeptin were quantified with enzyme-linked immunosorbent assay. RESULTS: Plasma levels of copeptin were 0.31±0.09 ng/mL in the normotensive pregnant group, 0.62±0.16 ng/mL in the mild pre-eclamptic group and 0.85±0.18 ng/mL in the severe pre-eclamptic group (P<0.001). Copeptin levels in pre-eclamptic patients with abnormal Doppler velocimetry were significantly higher than in those with normal Doppler velocimetry. CONCLUSIONS: These results suggest that increased maternal levels of copeptin may be involved in the pathogenesis of pre-eclampsia and it may be useful in the assessment of the severity of the disease.

Inflammatory-metabolic parameters in obese and nonobese normoandrogenemic polycystic ovary syndrome during metformin and oral contraceptive treatment.

Our aim was to evaluate the optimal treatment strategy addressing cardiovascular risk in obese and nonobese patients with polycystic ovary syndrome (PCOS). We planned a prospective randomized clinical study. Normoandrogenemic and oligoamenorrheic women with PCOS and impaired glucose tolerance (n = 96) were enrolled in the study. Six months of treatment with metformin HCL or oral contraceptive pills (OCPs) were given to the patients. Group 1 were obese and receiving metformin. Group 2 were obese and receiving OCPs. Group 3 were nonobese and receiving metformin, and Group 4 were nonobese receiving OCPs. ADMA, homocysteine, high sensitive C-reactive protein (hs-CRP) and homeostasis model assessment estimate of insulin resistance (HOMA-IR) were investigated. ADMA, homocysteine, hs-CRP and HOMA-IR were similar in obese and nonobese groups before the treatment. After 6 months of treatment, a significant decrease was observed in ADMA, homocysteine and HOMA-IR levels in Groups 1 and 3. An increase in ADMA and hs-CRP levels was observed in Groups 2 and 4. In this study, metformin treatment leads to improvement in hormonal and metabolic parameters and decreases ADMA and homocysteine levels possibly independent of BMI. However, the use of oral contraceptives in obese and nonobese patients with PCOS with impaired glucose tolerance increases ADMA and hs-CRP levels and creates an increase in the metabolic risk.

Predictive value of middle cerebral artery to uterine artery pulsatility index ratio in preeclampsia.

OBJECTIVE: To determine the predictive value of middle cerebral artery (MCA) to uterine artery pulsatility index (PI) ratio in preeclamptic patients. METHODS: This prospective cross-sectional study was performed on 64 preeclamptic and 131 normal pregnancies at or beyond 26 weeks of gestation between June 2007-August 2008 in the high-risk pregnancy unit of Dr. Zekai Tahir Burak Women Health Teaching and Research Hospital, Ankara. Doppler blood flow velocimetry of the uterine and umbilical arteries and fetal MCA was measured. The ratios between the PI of MCA and the mean PI value of both uterine arteries were calculated and values below the fifth percentile were considered as brain-sparing. The ratios between the PI of MCA and PI of the umbilical artery were calculated and values lower than 1.08 were considered as brain-sparing and the results were related to perinatal outcome. Statistical analysis were performed using the SPSS Software (SPSS, Chicago, IL, USA) version 9.0 for Windows. Odds ratio with 95% confidence interval (95%) was also used for statistical analysis. RESULTS: In 11 (42.3%) of the preeclamptic pregnancies that had abnormal MCA/uterine artery PI, 4 of them had severe preeclampsia and 7 had mild preeclampsia. In the low MCA/uterine artery PI ratio group, a statistically significantly higher rate of Cesarean section (66 vs. 88.46%), NICU admission (26.3 vs. 57.6%), preterm birth (52.6 vs. 92.3%) was found. Abnormal MCA/uterine artery PI ratio and abnormal MCA/umbilical artery PI ratio in the prediction of adverse outcome of pregnancy was compared. In the prediction of preterm birth, which was better for the MCA/uterine artery, there was a significant difference between the ratios (P = 0.005). CONCLUSION: Our results suggest that MCA/uterine artery PI ratio is a good predictor of neonatal outcome in preeclamptic patients in the third trimester and could be used to identify fetuses at risk of morbidity and mortality.

Efficacy of anti-tumor necrosis factor therapy on endometriosis in an experimental rat model.

OBJECTIVE: To show the efficacy of anti-tumor necrosis factor therapy (etanercept) for treating endometriosis in an experimental model. DESIGN: A randomized, placebo-controlled, blinded study using rat endometriosis model. SETTING: Experimental research center of Ankara Education and Research Hospital. ANIMAL(S): Twenty-two Wistar female rats. INTERVENTION(S): After peritoneal implantation of endometrial tissue, rats were randomized to two equal intervention groups: control and etanercept-treated groups. After measuring implant volume, blood and peritoneal fluid samples were obtained. Vehicle treatments of 2 mL saline to rats in control and 0.4 mg/kg etanercept SC once weekly were administered in treatment group. Four weeks later, a third laparotomy was performed to remeasure implant volumes, blood, and peritoneal fluid samples. MAIN OUTCOME MEASURE(S): To compare spherical volume, peritoneal fluid and serum levels of VEGF, IL-6, and TNF-α between groups. RESULT(S): There was a significant difference in spherical volume between control [131.0 (60.3-501.2)] and treatment groups [72.8 (31.2-149.6)] (p < 0.025). In etanercept-treated group, a significant difference was found between peritoneal fluid and serum levels of VEGF, IL-6, and TNF-α (p < 0.01). CONCLUSION(S): These results indicate that etanercept was found to effectively reduce the development of endometriosis.

Giant hemorrhagic adrenal pseudocyst in a primiparous pregnancy: report of a case.

Adrenal cysts are rare and are usually discovered incidentally during diagnostic imaging, surgery, or autopsy. Most cystic lesions of the adrenal gland are nonfunctioning and become symptomatic when complicated by rupture, hemorrhage, or infection. A 40-year-old woman presented with a history of gradual-onset pain in her left flank region at 20 weeks' gestation. Ultrasound showed a 20-cm cystic mass in her left abdominal cavity. Pertinent laboratory tests were within normal limits. The patient underwent exploratory laparotomy, which revealed a 20 × 15-cm left adrenal cyst; thus, we performed left adrenalectomy with complete excision of the cyst. Histological examination confirmed a hemorrhagic adrenal pseudocyst. The patient had an uneventful postoperative course, and subsequent routine obstetric ultrasound examinations showed normal fetal activity and development until the pregnancy terminated with a stillbirth caused by pre-eclampsia at 34 weeks' gestation. To the best of our knowledge, this is only the 12th reported case of adrenal pseudocyst discovered during pregnancy. We analyze the clinicopathologic findings and discuss the possible association of pregnancy, with special reference to etiopathogenesis, presentation, diagnosis, and treatment.

Abdominal and pelvic hydatid cyst obstructing the labor.

Hydatid cystic disease is a parasitic disease primarily infesting the sheep and cattle. It is a rare condition in pregnancy with an incidence of 1/20000 pregnancies. An eighteen-year-old primigravida was evaluated due to obstructed labor. Multiple abdominal and pelvic hydatid cysts were diagnosed by ultasonography and a healthy infant with birthweight of 3330 g was delivered by cesarean section. While the cysts situated on the posterior uterine wall, paraovarian region and omentum were removed totally, the hepatic cysts were only partially removed and then drained. The hydatid disease should be considered in differential diagnosis of adnexal masses obstructing the labor in pregnancy (Fig. 3, Ref. 9).

The long-term effects of progesterone-only contraceptives on endometrium and ovary in rats.

Progestin-only (p-only) contraceptives often cause breakthrough bleeding for unknown reasons. In this study, we aimed to evaluate the long-term effects of p-only contraceptives to gain a better understanding of breakthrough bleeding mechanism. Wistar rats were divided into etonorgesterel implant (Group 1, n = 25), depot medroxyprogesterone acetate injectable (Group 2, n = 25), and control groups (n = 5). Five rats each from groups 1 and 2 were examined every 10 days for up to 50 days after the medication. Uteri and ovaries were removed and prepared for immunohistochemistry and scanning electron microscopy. The tissue nitric oxide (NO) levels were determined by Griess reaction. Dynamic changes of endometrial estrogen and progesterone receptor immunoreactivity were observed in a time-dependent manner in groups 1 and 2. The number of endometrial pinopodes, which are small endometrial protrusions, increased in both groups. There was no difference between groups for the estrogen receptor in the surface epithelium of the ovary. Estrogen-alpha and progesterone receptor in follicular cells decreased in a time-dependent manner. The granulosa cells underwent atrophic and were disorganized. Decreased levels of uterine tissue NO were determined in groups 1 and 2. The effect of some p-only contraceptives make some dynamic changes in the endometrium, ovaries, steroid hormone receptors, cell morphology, and biochemical features of the tissues during their use.

Obesity alters retrieved oocyte count and clinical pregnancy rates in high and poor responder women after in vitro fertilization.

OBJECTIVE: Ovarian responsiveness to ovulation induction agents is essential for a successful clinical outcome in assisted reproductive technology (ART) cycles. We aimed to evaluate the accuracy of multinominal logistic models for the prediction of ovarian reserve and pregnancy in women undergoing ART cycles. PATIENTS AND METHODS: 1,970 patients who underwent ovarian stimulation for ART programs were evaluated. Patients were designated to ovarian response with body mass index (BMI) and age. RESULTS: When evaluating the factors affecting the egg quantity in poor responder and high responder patient groups according to the BMI, we observed that there was a lower probability of extracting less than five eggs in patients with a BMI of over 30 kg/m(2). The BMI was not an influential parameter for the amount of eggs obtained when comparing norm responder and high responder patient groups. Otherwise, obesity does not constitute a risk factor for positive pregnancy. Being 36-40 years of age is an important risk factor in foreseeing pregnancy. CONCLUSION: Predicting and managing the variability between patients is a significant clinical challenge in stimulation protocols. Research into predictive factors and the construction of multivariate models are the first steps towards evidence-based individualized treatment. The current practice of individualized treatment is based only on clinical experience and has poor reproducibility.

Plasma visfatin levels in preeclamptic and normal pregnancies.

OBJECTIVE: Increasing evidences support the participation of adipokines in the pathogenesis of preeclampsia (PE). Visfatin is a novel adipokine secreted by fat tissue and macrophages and is involved in the regulation of glucose homeostasis. Our aim is to investigate visfatin levels in women with PE, women with the third trimester of normal pregnancy and healthy non-pregnant women. PATIENTS AND METHODS: We included 32 preeclamptic patients who received antenatal and obstetric care at Perinatology Clinic. A total of 32 pregnant women with normal ongoing pregnancies and 32 non-pregnant women were taken as the control groups. Plasma levels of visfatin were quantified by ELISA. RESULTS: Plasma levels of visfatin were 63.8 +/- 4.9 ng/ml in women with PE, 43.6 +/- 7.8 ng/ml in pregnant control and 31.6 +/- 4.2 ng/ml in the non-pregnant control, respectively (P < 0.001). Visfatin level was significantly higher in PE compared with non-pregnant control (P < 0.001) and pregnant control (P < 0.001); also, plasma level of visfatin was significantly higher in severe PE (75.3 +/- 4.6 ng/ml) than mild PE (41.8 +/- 5.2 ng/ml) (P < 0.001). CONCLUSION: The results of the present study indicate that women with PE had significantly increased visfatin concentrations in the third trimester. Furthermore, visfatin levels were significantly higher in severe PE group.

Expression of intercellular adhesion molecule-1 in umbilical and placental vascular tissue of gestational diabetic and normal pregnancies.

OBJECTIVE: Expression of intercellular adhesion molecule-1 (ICAM-1), a marker of endothelial dysfunction leading to damaging vascular disorders, in umbilical and placental vascular tissue of gestational pregnancies was compared to non-diabetic controls. METHODS: We included 32 pregnant women with gestational diabetes mellitus (GDM) and 28 women with normal ongoing pregnancies were taken as the control group. Pregnant women with GDM were selected from the ones who had glycosylated haemoglobin (HbA(1c)) values lower from 6%. CD54/ICAM-1 expression profile was evaluated by immunohistochemistry, and cellular localization was determined under light microscopy. The immunoreactivity was assessed using a four-tiered scale: 0-5% (0), 6-20% (+1), 21-50% (+2), 51-100% (+3). RESULTS: In gestational diabetic patient's umbilical artery, +1 immunostaining group was observed (62.5%), and in their placenta, the highest percentage was seen in the 0 immunostaining group (43.8%). Diabetic patient's umbilical vein has the highest percentage in the +1 immunostaining group. In the control group, in both umbilical artery and vein, the highest percentage was seen in the +2 immunostaining group (46.4%) and their placenta has the +3 immunostaining group with the highest percentage (57.1%). CONCLUSION: The main outcome of our study was that, although underlying diabetes does have some effects on the pregnant mother, fears of endothelial dysfunction leading to damaging vascular disorders are probably unfounded in well-controlled GDM women.

Immunohistochemical expression of estrogen and progesterone receptors in endometrial polyps and its relationship to clinical parameters.

OBJECTIVE: To investigate the differences in steroid receptor expression patterns between glandular and stromal portions in endometrial polyps among premenopausal and postmenopausal patients and the relationship between the receptor expression in endometrial polyps and clinical parameters. MATERIALS AND METHODS: A total of 25 postmenopausal and 25 premenopausal patients with solitary endometrial polyp detected by office hysteroscopy were involved in the study. All patients underwent hysteroscopic polypectomy under general anesthesia or spinal anesthesia. Estrogen and progesterone expression patterns were investigated in the polyps using immunohistochemistry. The mean age was 57.6 years in postmenopausal patients and 36.9 in premenopausal patients. Average gravida, body mass index (BMI), and frequency of smokers did not differ between groups. However, the patient's age and their concomitant diseases were significantly different between premenopausal and postmenopausal patients (P = 0.01). RESULTS: Comparison in postmenopausal patients showed that glandular estrogen and progesterone receptor expression were both significantly greater than stromal estrogen and progesterone receptor expression (P = 0.037 and <0.001, respectively). Proliferative phase endometrial polyps also demonstrated significantly greater expression of progesterone receptors in glandular epithelium compared with stroma (P = 0.019). However, stromal and glandular estrogen receptor expression did not differ among premenopausal patients. There was a statistically significant correlation among stromal progesterone receptor expression, plasma estrogen and FSH level (P = 0.01). A negative correlation was found between stromal progesterone receptor expression and patient's age (P = 0. 01). CONCLUSION: Estrogen and progesterone receptor expression were lower in the stromal portion of the endometrial polyp than in the glandular portion in postmenopausal patients. Stromal progesterone receptor expression was lower in older patients and there was a relation between low estrogen hormone levels and lower stromal progesterone receptor expression.

The value of vascular endothelial growth factor, pregnancy-associated plasma protein-A, and progesterone for early differentiation of ectopic pregnancies, normal intrauterine pregnancies, and spontaneous miscarriages.

OBJECTIVE: To evaluate the capacity of vascular endothelial growth factor (VEGF), pregnancy-associated plasma protein-A (PAPP-A), and progesterone (P) to discriminate ectopic pregnancies (EP) from nonectopic ones. DESIGN: Prospective, case-controlled study. SETTING: Tertiary care center. PATIENT(S): Twenty-nine women with EP, 29 women with normal intrauterine pregnancy (nIUP), and 28 women with spontaneous miscarriage, all matched for gestational age. INTERVENTION(S): Serum samples were obtained. MAIN OUTCOME MEASURE(S): Serum concentrations of VEGF, PAPP-A, and P were measured. RESULT(S): Serum VEGF concentrations did not show statistically significant differences among women with EP (median, 55.24 pg/mL; range, 0.20-179.24), spontaneous miscarriages (median, 26.24 pg/mL; range, 0.22-365.24), and nIUP (median, 43.24 pg/mL; range, 0.86-101.24). The median level of P was significantly increased in the nIUP group (20.58 ng/mL; range, 13.9-37.04) compared with the other two groups, but there was no statistically significant difference between the spontaneous miscarriage and EP groups. Like P, PAPP-A values were also significantly higher in the nIUP group than in the other two groups, but the difference between PAPP-A values in the EP and spontaneous abortion groups was statistically insignificant. CONCLUSION(S): VEGF, PAPP-A, and P cannot be used to diagnose EPs, but PAPP-A and P can at least be used to differentiate abnormal pregnancies.

The effects of betamethasone treatment on clinical and laboratory features of pregnant women with HELLP syndrome.

AIM: The present study aims to investigate the effects of betamethasone treatment on clinical outcome and laboratory data of pregnant women diagnosed with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. METHODS: A prospective, randomized and placebo-controlled clinical trial was undertaken in a total of 60 pregnant women with HELLP syndrome who were treated at the perinatology department of the study center between January 2005 and February 2008. Betamethasone treatment (intramuscular injection of 12 mg in every 24 h) was given to 30 subjects while remaining 30 subjects received placebo. The treatment and control groups were compared in the aspects of clinical outcome and laboratory data. RESULTS: The alterations in platelet counts, alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase levels of women treated with betamethasone were statistically similar to those of the placebo group. Although there was a significant decrease in diastolic blood pressure values of control group (P = 0.04), alterations in systolic blood pressure values were statistically indifferent in both study groups. Hematological and metabolic complications occurred significantly less in women treated with betamethasone (P < 0.05). Interestingly, the percentage of women who received platelet transfusion was significantly higher in the control group (P < 0.005). No case of maternal mortality occurred. CONCLUSIONS: The betamethasone treatment has ended up with insignificant alterations in clinical outcomes and laboratory data of women with HELLP syndrome except beneficial effects on metabolic complications and need for platelet transfusion. Further investigation is required to assess the efficiency of betamethasone in management of HELLP syndrome.

Is incidental Meckel's diverticulum resected safely?

AIM: Meckel's diverticulum (MD) is the most common congenital anomaly of the small intestine. The majority of MD cases are discovered incidentally. On the other hand, there is disagreement about the management of incidentally discovered asymptomatic MD. The aim of the study was to compare the clinicopathologic characteristics of incidentally found and symptomatic cases of MD, and to compare morbidity and mortality in symptomatic and asymptomatic patients. PATIENTS AND METHODS: Records of patients whose MD was resected at our institution between 1989 and 2004 were reviewed and 76 patients were found. The patients were divided into two groups. The incidental group included patients in whom the MDs were found incidentally during the course of laparotomy performed for reasons not related to the diverticular complications. The symptomatic group included patients who presented with complications related to the MDs. We compared the clinicopathologic characteristics of the patients between the two groups RESULTS: The incidental group included 40 patients (34 males) and the symptomatic group included 36 patients (30 males). There was no significant difference between the two groups with respect to age, gender, APACHE scores, postoperative complications, and hospital stay. There were two deaths in the symptomatic group. There was a significant correlation between operative mortality and APACHE II scores. CONCLUSIONS: Resection of incidentally found MD is not associated with increased operative morbidity or mortality.

Neurokinin B levels in maternal and umbilical cord blood in preeclamptic and normal pregnancies.

Neurokinin (NK) B has been recently demonstrated to be secreted by the placenta in preeclampsia suggesting it may modulate pathophysiological events of the disease. The aim of this study was to investigate whether NKB is the circulating factor associated with preeclampsia or not. In 22 preeclamptic and normotensive pregnant women, the peripheral and umbilical cord blood NKB levels were measured by radioimmunoassay. The NKB levels in women with preeclampsia were 0.70 (0.53-0.92) nmol/L in peripheral blood and 1.92 (1.42-2.35) nmol/L in umbilical cord blood. In normotensive pregnant women, NKB levels were 0.43 (0.29-0.61) nmol/L and 0.14 (0.07-0.33), respectively. Significantly higher levels of NKB were measured in preeclamptic women compared with normotensive pregnant women in umbilical cord blood. These results suggest that NKB enters both fetal and maternal circulation and may modulate fetoplacental hemodynamics.

A soluble molecule secreted by human blastocysts modulates regulation of HOXA10 expression in an epithelial endometrial cell line.

OBJECTIVE: To determine the existence of a soluble signal, secreted from the human blastocyst embryo, that induces HOXA10 gene expression before cell-cell contact. DESIGN: To analyze, by semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR), cell-free media that had contained human embryos cultured to the blastocyst stage for a soluble molecule that induces HOXA10 expression in an endometrial epithelial cell line (Ishikawa). SETTING: Assisted reproduction technology program of Yale University, New Haven, Connecticut. PATIENT(S): Patients undergoing intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF) cycles. Treatment of Ishikawa cells with blastocyst-conditioned media. MAIN OUTCOME MEASURE(S): Determination of HOXA10 gene expression. RESULT(S): We demonstrate that cell-free media that had contained human embryos cultured to the blastocyst stage contain a soluble molecule that induces HOXA10 expression in an endometrial epithelial cell line (Ishikawa). We found that hCG does not induce HOXA10 in Ishikawa cells. CONCLUSION(S): Soluble molecules induce a well-characterized marker of endometrial receptivity in endometrial cells without blastocyst apposition. Additionally, HOXA10 induction can serve as a means of evaluating human embryos cultured for IVF and ET. High quality embryos may induce local endometrial receptivity before trophectoderm-endometrial contact.