Bülent Duran

Choroidal Thickness Changes During the Menstrual Cycle

Abstract Purpose: To evaluate the effects of the menstrual cycle on the choroidal thickness of healthy women of reproductive age using spectral-domain optical coherence tomography. Materials and methods: A total of 23 right eyes of 23 women with regular natural menstrual cycles of 28–30 d and ages 22–30 years were included in this prospective study. The choroidal thicknesses of the women were measured using high-resolution spectral-domain optical coherence tomography line scans with the activated enhanced depth imaging mode in the early follicular, ovulatory and mid-luteal phases of the menstrual cycle (3rd, 14th and 21st days) using a follow-up scanning protocol of the Spectralis optical coherence tomograph by setting the early follicular phase scan as the reference image. Choroidal thickness measurements were taken at the fovea and at two points that were 1500 µm nasal and temporal to the fovea. The mean arterial pressure, spherical equivalent, intraocular pressure, central corneal thickness and retinal and retinal nerve fiber layer thicknesses were also measured. All measurements were taken within the same menstrual cycle. Results: The mean ± standard deviation (standard error of the mean) of subfoveal choroidal thicknesses in the early follicular, ovulatory and mid-luteal phases were 383.87 ± 84.38 (17.59), 373.74 ± 82.40 (17.18) and 359.09 ± 79.65 (16.61) µm, respectively. The relative reductions in choroidal thickness between early follicular and ovulatory phases and early follicular and mid-luteal phases were 2.64% and 6.47%, respectively. The subfoveal choroidal thickness was decreased significantly in the mid-luteal phase when compared with both the early follicular (p < 0.001) and ovulatory phases (p = 0.003). However, the measures of subfoveal choroidal thickness in the early follicular phase were non-conclusively greater (p = 0.071) than in the ovulatory phase. Additionally, the mean arterial pressure, spherical equivalent, intraocular pressure, central corneal thickness and retinal and retinal nerve fiber layer thicknesses did not significantly differ during the menstrual cycle (p > 0.05 for all). Conclusions: The choroidal thickness decreased significantly in the mid-luteal phase of the menstrual cycle in young, healthy women. These findings emphasize the importance of the menstrual phase in the interpretation of choroidal thickness measurements in women of reproductive age.

The effect of parity on pelvic floor muscle strength and quality of life in women with urinary incontinence: a cross sectional study.

[Purpose] The purpose of this study was to analyze the pelvic floor muscle (PFM) activity after vaginal birth, and the effect of parity on PFM strength and quality of life (QoL) in women with urinary incontinence. [Subjects and Methods] Patients (n=241) who gave birth vaginally and experienced urinary incontinence were divided into three groups: group 1 consisted of women having 1–3 children, group 2 consisted of women having 4–6 children, and group 3 consisted of women having more than 6 children. All patients underwent detailed examination of the PFM. The Turkish version of the self-administered Incontinence Quality of Life Instrument (I-QoL) questionnaire was used to evaluate the effects of stress urinary incontinence on participants’ QoL. [Results] Comparison of PFM strengths showed a significant intergroup difference. Group 1 showed significantly higher PFM strength scores than those of groups 2 and 3. I-QoL scores related to stress incontinence showed a significant intergroup difference. As number of deliveries increased, quality of life decreased. Comparison of PFM strengths and I-QoL scores related to stress incontinence showed a significant intergroup difference. [Conclusion] Increasing the awareness of PFM training in women will reduce potential postpartum incontinence due to a weak PFM strength; and will increase quality of life.

Effects of pinealectomy and melatonin supplementation on endometrial explants in a rat model

OBJECTIVE To determine the effects of pinealectomy on endometrial explants in rats and evaluate the activity of superoxide dismutase (SOD) and catalase (CAT) and the levels of malondialdehyde (MDA) in the rat endometriosis model. STUDY DESIGN Rats with experimentally induced endometriosis were randomly divided into three groups after second-look laparotomies. Group 1 (pinealectomy, n = 8) and Group 2 (pinealectomy+melatonin, n = 8) underwent pinealectomies after the second-look laparotomies. Group 3 was presented as control group (vehicle solution+without pinealectomy (n = 6)). Melatonin was administered intraperitoneally for 4 weeks in Group 2, whereas an equal volume of vehicle solution was given to Groups 1 and 3. Evaluation of the volume of the endometrial explants, histopathological examination and preservation of explant epitheliums according to the scoring system were undertaken. RESULTS There was a statistically significant increase in spherical explant volumes of Group 1 compared to Groups 2 and 3. In Group 1, the level of MDA was significantly higher and SOD and CAT activity was significantly lower compared to Groups 2 and 3. A statistically significant increase in the epithelial lining scores of explants was noted in Group 1 compared to Groups 2 and 3. CONCLUSION The effects of pinealectomy on the progression of endometriosis explants were reversed by melatonin.

Use of progestogens in pregnant and infertile patients

Progesterone is an essential hormone in the occurence and maintenance of pregnancy. Natural or synthetic progestogens are commonly used in pregnant patients or patients undergoing infertility treatments for various indications. Most frequently put indications for the use of progestogens in these patient populations are the prevention of spontaneous preterm birth, the prevention of pregnancy loss in pregnancies with an unexplained recurrent pregnancy loss and in patients with threatened abortion. It is also used in pregnant women undergoing nonobstetric surgery, for infertility or recurrent pregnancy loss that is thought to be due to luteal phase defect or as a luteal support in stimulated IVF cycles. We aimed to review the current evidence for the use of progestogens in each of these settings.

Intraperitoneal administration of single dose type I collagen or low dose melatonin to prevent intraperitoneal adhesion formation: A comparative study

OBJECTIVE To compare the prevention of adhesion formation by type I collagen or melatonin solutions in the rat model. STUDY DESIGN A total of 40 female Wistar albino rats were randomly assigned to four groups-type I collagen, melatonin, vehicle control and sham groups. Following midline laparotomy, a standard injury was made on the right uterine horn using bipolar cautery. The animals in the sham group underwent midline laparatomy only. One milliliter of type I collagen, melatonin or vehicle control was instilled onto the injured area immediately before abdominal closure. Fourteen days after the surgery, the type and extent of adhesion formation as well as the uterine horn tissue superoxide dismutase (SOD) and catalase (CAT) activity, and malondialdehyde (MDA) levels were measured. RESULTS Both the type and extent of adhesion formation were significantly lower in the type I collagen and melatonin groups compared to the control group. The tissue SOD and CAT activity was significantly higher, and MDA levels were significantly lower in the type I collagen and melatonin groups compared to the control group. CONCLUSION Intraperitoneal administration of type I collagen or low dose melatonin solution onto the injured areas may be an attractive adjuvant to reduce postoperative adhesion formation.

Labial fusion causing acute urinary retention in a young adult: a case report.

Labial fusion is defined as a partial or complete adherence of the labia minora. The labia minora adhesion is a common paediatric gynaecological problem, and occurs more frequently between three months and three years. Adhesions of the labia are rare in adult population. There are a few cases in the literature. The aetiology of labial adhesion probably relates to vaginal inflammation or irritation, and is associated with low oestrogen status. Labial fusions may be caused by infections, inflammatory conditions, dermatological conditions, lack of sexual activity, local trauma, genital circumcision and recurrent urinary tract infections. If the labial adhesions are severe or related to urinary problems, surgical treatment should be considered.

Oxytocin versus sustained‐release dinoprostone vaginal pessary for labor induction of unfavorable cervix with Bishop score ≥4 and ≤6: A randomized controlled trial

To compare the efficacy and safety of high‐dose intravenous oxytocin and sustained‐release dinoprostone vaginal pessaries for cervical ripening and labor induction in pregnant patients at term with poor Bishop scores.

In Vivo Evaluation of the Genotoxic Effects of Gonadotropins on Rat Reticulocytes

BACKGROUND Gonadotropins, as ovulation-inducing drugs, have been used widely to treat infertility. An epidemiologic correlation between infertility therapy and ovarian cancer development has been reported. However, the effect of gonadotropins in the formation of reproductive tract cancers is controversial. OBJECTIVE The aim of the study was to determine the in vivo genotoxic effects of gonadotropins on rat reticulocytes. METHODS In this prospective, randomized, controlled study, rats were randomly assigned to 1 of 5 groups. The calculated rat doses of 0.65 human menopausal gonadotropin (hMG), 0.95 hMG, 0.65 follitropin beta (FB), 0.95 FB, or normal saline (control group) were injected, respectively. These calculated rat doses (U/g) are based on average human gonadotropin doses of 150 and 225 IU/d for a 70-kg woman given in 2-mL saline (the control group received 2 mL of saline). Injections were administered once per day for 5 days, followed by 5 days of rest. Each treatment was repeated for 6 estrus cycles in the rats for a total of 12 estrus cycles. Six months after the last day of the 12(th) cycle, the rats were euthanized. Bone marrow tissues were removed, and pluripotent reticulocyte cells with micronuclei, nuclear buds, and binuclear abnormalities were analyzed using an in situ micronuclei assay under light microscopy. The proportion of micronucleated cells, cells with anaphase bridge, nuclear buds, and other nuclear abnormalities were measured. RESULTS The number of cells with nuclear buds and binuclear abnormalities in the hMG 225 and FB 225 groups was significantly higher (P < 0.05) than that from the hMG 150, FB 150, and control groups in the cytogenetic analysis of bone marrow stem cells. An increased rate of genotoxicity in all gonadotropin groups versus that of placebo was found. CONCLUSION In rats, the micronucleus genotoxicity assay suggests a dose-dependent gonadotropin effect on genomic instability in bone marrow stem cells in vivo.

Relationship of thyroid hormone levels and thyroid autoantibodies with early pregnancy loss and infertility

Prevalence of abnormalities in thyroid hormones and thyroid autoantibodies in patients with a history of early pregnancy loss (EPL) (n = 17) and unexplained infertility (UI) (n = 25), were compared with that of 45 control patients. TSH, antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TG) antibody levels in UI and EPL groups were similar to that of the control group. TSH was normal in 39, 22 and 13 of control, UI and EPL patients, respectively. Among patients with a normal TSH, fT4 was higher (p < 0.001) and fT3 was lower (p < 0.001) in infertile patients when compared with the control group. Thyroid function tests seem to be associated with infertility but their association with EPL is weaker. Infertility seems to be associated with a high fT4 and low fT3 status. Thyroid autoantibodies do not seem to be associated with either infertility or EPL.