Arif Kokcu

Pre-eclampsia and eclampsia associated with increased lipid peroxidation and decreased serum vitamin E levels

Objective: To evaluate lipid peroxidation and the serum levels of the antioxidant vitamin E in pre‐eclampsia according to the disease severity. Method: Serum malondialdehyde (MDA) and vitamin E levels were measured in 18 pre‐eclamptic, 15 eclamptic and 25 normotensive pregnant women in Ondokuz Mayis University Hospital. The correlation of these levels with the factors indicating disease severity was tested. Mann–Whitney U‐test and correlation coefficients were used for the statistical analysis. Result: Both the pre‐eclamptic and the eclamptic patients had higher MDA and lower vitamin E levels compared with control (P<0.05); but these values were not significantly different from each other (P>0.05). MDA levels were significantly correlated with the systolic and diastolic blood pressure (BP) and with serum uric acid levels. There was significant but negative correlation with the vitamin E levels. Conclusion: There is an imbalance between lipid peroxidation and serum vitamin E levels in pre‐eclampsia and eclampsia. Increased lipid peroxidation is well correlated with the increase in systolic and diastolic BP measurements and serum uric acid levels.

Estimation of the amniotic fluid volume using the Cavalieri method on ultrasound images

Objectives: Presently, a design‐based and practical method for measuring amniotic fluid volume (AFV) for routine clinical examinations has not been proposed. In this study we describe a new method, which combines the Cavalieri method with ultrasound imaging to estimate AFV. Methods: We measured the AFVs of 14 women in the third trimester of pregnancy, and repeated our measurements three times for each woman. Parallel planimetric ultrasonographic images were obtained at every 2 cm along the longitudinal uterine axis. AFVs were calculated as the total of the multiples of the estimated cut surface areas by the section thickness. Results: The mean estimated AFV was 380.5 cm3. The coefficient of error of each measurement was calculated and the mean was 0.108. The coefficient of correlation between the amniotic fluid index and our AFV estimations was 0.87. Conclusions: Design‐based and efficient estimation of AFV is possible with the combination of consecutive ultrasound images and the Cavalieri method.

Premature ovarian failure from current perspective

Premature ovarian failure (POF) is a syndrome characterised by amenorrhoea, hypoestrogenism and hypergonadotropinism before the age of 40. It is a disorder affecting approximately 1% of women <40 years, 1/1,000 women by the age of 30 and 1/10,000 women by the age of 20. POF is not merely an early menopause. Up to 50% of the patients with POF will have intermittent and unpredictable ovarian function which may persist for some years. Heterogeneity of POF is also reflected by the variety of possible causes, including autoimmunity, toxics, drugs, radiation, infectious as well as genetic defects. HRT remains the cornerstone of treatment and the only proven method of achieving pregnancy in these patients is by ovum donation.

Comparison of the effects of raloxifene and anastrozole on experimental endometriosis.

OBJECTIVE To compare the efficacies of anastrozole and raloxifene on endometriosis. STUDY DESIGN A randomized, placebo-controlled, single-blind, experimental study was performed on 45 adult Wistar female rats in the Experimental Surgery Laboratory at Ondokuz Mayis University in Turkey. Endometrial tissues were implanted on the abdominal peritoneum in 45 rats. Six weeks later, the implant volumes were measured (volume-1) by performing a second laparotomy. Rats were randomized to one of three equal study groups. Saline solution (0.1 cc/rat/week, subcutaneously) was administered to group 1 (control group), anastrozole (0.004 mg/rat/day, orally) to group 2 (anastrozole group), and raloxifene (0.24 mg/rat/day, orally) to group 3 (raloxifene group) for 8 weeks. At the end of administration, a third laparotomy was performed to remeasure implant volumes (volume-2), and implants were totally excised for histopathologic examination. Volume-1 and volume-2 within the groups, as well as stromal and glandular tissues between the groups, were compared. RESULT(S) In the anastrozole and raloxifene groups, volume-2 values were significantly lower than those of volume-1. When compared to the control group, in both anastrozole and raloxifene groups, while glandular tissue scores were found significantly lower, stromal tissue scores were not different than that of the control group. There was no significant difference between both the GT and ST scores of the anastrozole and raloxifene groups. CONCLUSION(S) Anastrozole and raloxifene were seen to have caused equally the regression of the experimental endometriosis statistically significantly.

Comparison of the effects of transdermal estrogen, oral estrogen, and oral estrogen-progestogen therapy on bone mineral density in postmenopausal women

Abstract. It is now clear that estrogen intervention reduces bone loss in postmenopausal osteoporosis. The aim of this study was to investigate whether the route of estrogen administration or addition of progesterone changes this positive effect. Transdermal estrogen (T-E), oral estrogen (E), and oral estrogen plus progestogen (E-P) were administered to 15, 18, and 17 postmenopausal women, respectively, who all had normal bone mineral density (BMD) before hormone replacement therapy (HRT). Calcium (500 mg/day) was routinely added to all HRT regimens. The BMD of the lumbar spine (L2–L4) was measured initially and at the end of the first and second years of treatment. The paired-sample t test, independent-sample t test, and Pearson correlation analysis were used for the statistical evaluation. The initial BMD measurements and the values at the end of the first and second years of the therapy were not significantly different either within or among the groups (P > 0.05). These results indicate a similar therapeutic value of each HRT regimen in the prevention of bone loss in postmenopausal women.

Comparison of the effects of cetrorelix, a GnRH antagonist, and leuprolide, a GnRH agonist, on experimental endometriosis

Aim:  In the present study, we aimed to compare the effects of cetrorelix and leuprolide on endometriosis.

Relationship between endometriosis and cancer from current perspective

PurposeTo examine the current mechanisms of the increased incidence of cancer in women with endometriosis.MethodsThe synthesis and review of the relevant current literature in English language.ResultsCompared with general population, women with endometriosis have two times higher risk for developing ovarian cancer, 30% higher risk for developing breast cancer, and 40% higher risk for developing hematopoietic malignancies, mainly non-Hodgkin lymphoma.ConclusionsEndometriosis comprises many predisposing factors including genetic, epigenetic, local environmental, hormonal, inflammatory and immunologic changes, for the development of some cancers.

Evaluation of Urethrovesical Angle by Ultrasound in Women with and without Urinary Stress Incontinence

Abstract: Our aim was to investigate the role of ultrasonographic imaging in the evaluation of genuine stress incontinence (GSI). The posterior urethrovesical angles (PUVA) of each of 50 incontinent (group I) and 50 control cases (group C) were measured by both transperineal and transvaginal ultrasonography (TP-USG, TV-USG). In group I the angles were 94.9 ± 10.9 at rest and 102.7 ± 16.1 by TP-USG (P<0.001), and 100.6 ± 11.1 at rest and 103.3 ± 9.6 during Valsalva by TV-USG (not significant). In the control group these measurements were 93 ± 5.3, 96.2 ± 7.9 (P<0.001) and 98 ± 8.8, 101.1 ± 10.3 (P=0.001) by TV-USG, respectively. The degree of alteration of the angle, originating with Valsalva maneuver (D-PUVA) was 7.7 ± 11.8 in group I and 3.2 ± 4.95 in group C (P=0.014) by TP-USG, and 2.7 ± 11.8 and 3.2 ± 6.16 by TV-USG (NS). Our data reveal that PUVA and D-PUVA have important roles in GSI pathophysiology; however, ultrasonography, especially by the transvaginal route, cannot be a reliable useful method as a diagnostic tool in the evaluation of GSI.

Asynchronous Bilateral Ovarian Torsion. A Case Report and Mini Review

BACKGROUND Adnexal torsion is a serious condition and delay in surgical intervention may result in loss of ovary. Children and adolescents who have suffered from uterine adnexal torsion may be at risk for asynchronous torsion of the contralateral adnexa. CASE We report the case of asynchronous bilateral ovarian torsion in a 9-year-old girl, resulting in right and subsequently left salpingo-oophorectomy. CONCLUSION The diagnosis of ovarian torsion often is delayed. When ovarian torsion is suspected, laparoscopy should be performed without delay, and conservative management should be strongly considered to prevent surgical castration. Oophoropexy of the ipsilateral and contralateral ovary should be considered to prevent a recurrent torsion.

Rhabdomyosarcoma arising in a mature cystic teratoma with contralateral serous carcinoma: case report and review of the literature.

SUMMARY Malignant transformation of a mature cystic teratoma of the ovary is rare, and occurs in approximately 2% of all cases. The most common malignancy arising in mature cystic teratoma is squamous cell carcinoma. Sarcomas very rarely develop in mature cystic teratoma. We describe the case of a 65-year-old patient with mature cystic teratoma, and with rhabdomyosarcomatous transformation and contralateral serous carcinoma. To our knowledge, this is the first case of a pure rhabdomyosarcoma arising in a mature cystic teratoma. The clinicopathologic and immunohistochemical findings of this exceptional case are reported and the literature is reviewed.