Basak Yildirim

Relation of intra-abdominal fat distribution to metabolic disorders in nonobese patients with polycystic ovary syndrome

OBJECTIVE To investigate the relation between intra-abdominal fat distribution and metabolic disorders in nonobese patients with the polycystic ovary syndrome (PCOS). DESIGN Prospective case-control study. SETTING University-based hospital. PATIENT(S) Thirty nonobese patients with PCOS and 30 lean women with regular menstrual cycles (controls). All participants had a body mass index < 25kg/m(2). MAIN OUTCOME MEASURES Subcutaneous and intra-abdominal visceral and preperitoneal fat thicknesses were assessed by ultrasonography. Glucose tolerance and insulin sensitivity were evaluated by standard 75-g oral glucose tolerance test and area-under-the-curve analysis. Serum hormones and lipid profile were measured. RESULT(S) The mean preperitoneal and visceral fat thicknesses were significantly greater in nonobese patients with PCOS. Subcutaneous fat mass was similar between the PCOS and control groups. Nonobese patients with PCOS had glucose intolerance, hyperinsulinemia, and dyslipidemia, manifested by high serum levels of triglyceride, total cholesterol, and high-density lipoprotein (HDL) levels and low serum low-density lipoprotein (LDL) levels. No correlation existed between subcutaneous fat thickness and the metabolic variables in nonobese patients with PCOS. However, serum triglyceride levels correlated with visceral fat and preperitoneal fat thickness. The mean HDL level correlated negatively with visceral fat and preperitoneal fat thickness. The area under the curve for insulin and mean fasting insulin levels correlated positively with visceral fat thickness. In multiple regression analysis, visceral fat thickness contributed significantly to high serum triglyceride and fasting insulin levels. CONCLUSION(S) Intra-abdominal preperitoneal and visceral fat accumulation may contribute to the development of glucose and lipid metabolism disorders in nonobese patients with PCOS.

1–Alpha, 25–Dihydroxyvitamin D3 Regresses Endometriotic Implants in Rats by Inhibiting Neovascularization and Altering Regulation of Matrix Metalloproteinase

Abstract Background: The exact pathogenesis of endometriosis has not been completely discerned. 1–alpha,25–dihydroxyvitamin D3 (1,25[OH][2]D[3]) has been shown to have an anti–angiogenic effect and extracellular matrix–proteases–degrading properties. We hypothesized that 1,25(OH)(2)D(3) may have therapeutic value in the treatment of endometriosis. Methods: Endometrial tissue was implanted into the abdominal peritoneum of 21 Wistar albino rats; the rats were randomized into 3 groups. In Group A (simultaneous group), we simultaneously induced endometriosis and began 1,25(OH)(2)D(3) treatment. Group B rats (sequential group) were treated after endometriosis was documented. Animals in Group C (control group) were followed without any treatment after the development of endometriosis. Results: Histologic score, mean volume, and weight of the explants in Group A and B were found to be significantly lower than those of the control group. Levels of vascular endothelial growth factor (VEGF) and matrix metalloproteinase–9 (MMP–9) immunoreactivities in Group A and B were also significantly lower compared with Group C. In contrast, intensities of immunoreactivity staining for tissue inhibitor of metalloproteinase–2 (TIMP–2) in Group A and B were significantly higher than that of the control group. Conclusion: 1,25(OH)(2)D(3) regresses endometriotic implants in rat models by altering implant levels of VEGF, TIMP–2, and MMP–9.

A Prenatally Detected Case of Congenital Hepatoblastoma

Hepatoblastoma is a rare tumor of childhood and its incidence in the first year of life is about one in a million. Forty-two congenital hepatoblastoma cases were reported so far. Among 42 congenital hepatoblastoma patients, only seven cases have been detected in the prenatal period. Here we report a rare case diagnosed before birth and confirmed by postmortem autopsy.

Effects of low-dose 17-β-estradiol plus norethisterone acetate and tibolone on fasting plasma homocysteine levels in postmenopausal women

Background.  Many postmenopausal women currently receive hormone replacement therapy. The use of low‐dose 17β‐estradiol plus norethisterone acetate and tibolone for hormone replacement therapy is not uncommon in postmenopausal women. Homocysteine, which is known to be an independent risk factor for the development of cardiovascular disease, is found in increased levels postmenopause. This study compared the effects of low‐dose 17β‐estradiol plus norethisterone acetate and tibolone on the fasting plasma homocysteine level in healthy postmenopausal women.

Laparoscopic management of a primary ectopic ovarian pregnancy and vaginal douching as a possible cause.

Case reportOvarian pregnancy is a rarely seen form of ectopic pregnancies. We present a 34-year-old women who had a diagnosis of ovarian ectopic pregnancy based on clinical and laboratory findings. Laparoscopic surgery was performed for conservative management of the case. Risk factors are outlined and vaginal douching as a possible cause for ectopic pregnancies have been discussed.ConclusionWe suppose that frequent vaginal douching may be a risk factor for the development of ovarian ectopic pregnancies.