Faik Mümtaz Koyuncu

Aromatase inhibitors: possible future applications

In premenopausal women ovaries are the major sites of estrogen production, while in postmenopausal women estrogen is produced by aromatization of ovarian and adrenal androgens in extragonadal sites, mostly in adipose tissue. Aromatase is a cytochrome P450 hemoprotein‐containing enzyme complex that catalyzes the rate‐limiting step in the conversion of androstenedione and testosterone to estrone and estradiol (E2). Aromatase inhibitors (AIs) have been developed primarily for use in either natural or surgical postmenopausal patients. In premenopausal women, the ovary can overcome the estrogen blockade by reflex increments of luteinizing hormone (LH) and follicle stimulating hormone (FSH), so AIs must be combined with a gonadotropin releasing hormone (GnRH) agonist to prevent the reflex LH and FSH increments. In advanced hormone‐dependent breast cancer treatment, AIs have been shown to be superior to tamoxifen. Preliminary evidence also suggests superiority in the adjuvant, neoadjuvant settings and also for breast cancer prevention. AIs have been used in infertility and can increase ovulation rate. Reducing FSH dose, estrogen levels, improving response to FSH, implantation rates, and developing multiple follicles that can be used in in vitro maturation procedures are potential areas that AIs might be used in in assisted reproductive technologies (ART), besides simple ovulation induction. AIs are reported to be successful in treatment of endometriosis, an estrogen‐dependent process. The use of AIs in gynecomastia, puberte precox, leiomyoma uteri, some estrogen‐dependent cancers (ovarian), endometrial cancer and male infertility are reported; some of the results are promising but more clinical trials are needed. AIs are predicted to become the gold standard in the treatment of estrogen‐dependent diseases in reproductive medicine in the near future.

Tear function changes of postmenopausal women in response to hormone replacement therapy.

OBJECTIVE The goal of this study was to search the effect of hormone replacement therapy (HRT) on tear function changes in postmenopausal women. METHODS Following initial ophtalmic evaluation and tear sample collection, the subjects were given daily 0.625 mg conjugated estrogen, and either continuous combined or cyclic 5 mg medroxyprogesterone acetate was added. Eye examination included visual acuity, slit-lamp examination, fundus examination, tonometry, Schirmers test, and break up time (BUT) evaluation. Six months later, control examination was done and repeat tear samples were obtained. Tear immune globulin A (IgA) and lysozyme levels were measured by gel electrophoresis. The pictures of the bands were evaluated by digital image analysis with Scion Image program. RESULTS Conjunctival vascular congestion, laxity and corneal desquamation did not change before and after HRT (P>0.05). A significant improvement was noted in meibomian gland inflammation (P=0.034). We have not observed any significant difference in burning, foreign body sensation, and tearing (P>0.05). In addition, no significant difference was noted in BUT (P=0.370) and Schirmers test values (P=0.271). Though both lysozyme and IgA levels were elevated following the therapy, only IgA levels increased significantly (P=0.04). CONCLUSION HRT decreased meibomian gland inflammation and increased tear lysozyme and IgA levels in postmenopausal women.

Atherogenic profile in preeclampsia.

Abstract. Atherosis is accepted to underlie the pathogenesis of preeclampsia, therefore we aimed to determine malonyldialdehyde (MDA) levels as a marker of lipid peroxidation, and lipoprotein(a) (Lp(a)), apolipoprotein A-1 (Apo A-1) and apolipoprotein B (Apo B) levels as a marker of atherogenic profile in preeclamptic and normal pregnant women. Twenty preeclamptic and 20 gestational-age matched normal pregnant patients were enrolled in the study, mean gestational ages for the preeclamptic and the control group were 33.9±1.4 and 35.5±0.7 weeks, respectively. Blood was withdrawn from the patients soon after diagnosis, and from the controls at their routine prenatal visits. MDA levels was significantly higher in preeclamptic patients (P=0.0003), but no difference was observed in Apo A-1 and Apo B and Lp(a) levels between the 2 groups. We consider that higher MDA was due to oxidative stress seen in preeclampsia, and similar Apo A-1 and Apo B and Lp(a) levels were due to lack of systemic atherosis.

Sexual Behaviour During Pregnancy

Summary: The effects of pregnancy on sexuality were studied in 158 pregnant women. They were surveyed by questionnaire about sociodemographic variables and sexual behaviour. Dyspareunia was common in our study group during pregnancy. Pregnancy had a negative effect on orgasmic quality. Dyspareunia and orgasmic quality influenced coital frequency. Coital frequency declined as the month of the pregnancy increased. Pregnancy is a potent influence on sexuality irrespective of an individuals conditioning.

Postpartum depression: is mode of delivery a risk factor?

There are various factors related to postpartum depression. In this study we have aimed to determine the effect of mode of delivery on the risk of postpartum depression. A total of 318 women who applied for delivery were included in the study. Previously diagnosed fetal anomalies, preterm deliveries, stillbirths, and patients with need of intensive care unit were excluded from the study. Data about the patients were obtained during hospital stay. During the postpartum sixth week visit Edinburgh postnatal depression scale (EPDS) was applied. There was no significant difference between EPDS scores when compared according to age, education, gravidity, wanting the pregnancy, fear about birth, gender, family type, and income level (P > 0.05). Those who had experienced emesis during their pregnancy, had a history of depression, and were housewives had significantly higher EPDS scores (P < 0.05). Delivering by spontaneous vaginal birth, elective Cesarean section, or emergency Cesarean section had no effect on EPDS scores. In conclusion healthcare providers should be aware of postpartum depression risk in nonworking women with a history of emesis and depression and apply the EPDS to them for early detection of postpartum depression.

Changes in the plasma activities of protein C and protein S during pregnancy

Summary: The objective of the study was to determine the changes in the plasma activities of protein C and protein S that occur during normal pregnancy. In this prospective cross‐sectional study, plasma activities of protein C and protein S were measured in 32 normal pregnant women in the first, second and third trimester and 6 weeks after delivery. There was a significant fall in protein C and protein S activities during normal pregnancy compared with the post‐puerperal period. The activities of protein C and protein S also gradually decreased through‐out pregnancy (p < 0.01).

Interleukin-6 levels in hyperemesis gravidarum.

Introduction.Hyperemesis gravidarum (HG) is associated with higher levels of serum β-hCG levels and hyperthyroidism. Interleukin-6 (IL-6), a pro-inflammatory cytokine, is reported to enhance secretion of β-hCG from trophoblastic cell line.Methods.We measured serum levels of IL-6, thyroid hormones and β-hCG of hyperemetic patients and gestational age-matched controls to search for a difference between the two groups.Results.There was a significant difference in β-hCG (p=0.028), though IL-6 levels were higher in the hyperemetic group, it did not reach a significant level. Interleukin-6 positively correlated with β-hCG (r=0.38 and p=0.13).

Rupture of rudimentary horn pregnancy at the 15th week of gestation: a case report

A patient with acute abdomen at 15th week of gestation underwent an emergency laparatomy. A ruptured rudimentary horn pregnancy was diagnosed, and the rudimentary part including the fetus and the accessories was resected. The mother survived without any complications.

Increased vascular surface density in ovarian endometriosis.

Our goal in this study was to investigate the presence of angiogenesis-related factors in endometriomas by evaluating their vascular surface densities. Thirty ovarian samples were included in the study. Of these ,ten were histologically confirmed endometriomas ,ten were ovarian specimens in the follicular phase and ten were ovarian specimens in the luteal phase ,serving as controls. Histological specimens were immunostained for von Willebrand factor (vWF: factor VIII-related antigen) and CD34. The area with the highest microvessel density in endometriosis and in the normal ovary was evaluated by using an intercept grid. All microvessels in a specific field (× 100 magnification) were counted and vascular surface density was measured ,as 164.01 ± 21.26 vs. 125.15 ± 11.28 and 117.44 ± 9.27 by using vWF ,and as 172.97 ± 25.64 vs. 138.65 ± 32.21 and 120.34 ± 18.40 by using CD34 in endometriotic ,follicular and luteal ovarian samples ,respectively (p < 0.001). The mean vascular surface density was significantly higher in endometriosis than in the ovarian samples of the follicular phase or the luteal phase. No significant difference was seen between normal ovarian samples. Endometriosis was associated with angiogenic properties. Having demonstrated elevated angiogenic factors in endometriotic samples ,we concluded that activation of angiogenesis might be a key factor in the pathogenesis of endometriosis.

Collagenase treatment of sore nipples

Lesions that occur on the areola and the nipple of a breast-feeding mother during the immediate postpartum period may lead to infection, and the mother may find breast-feeding too painful to continue 1 . Approximately 65% of lactating women experience severe nipple pain with lesions 2 . Various treatment regimens have been applied to sore nipples. In this study, we compared the effectiveness of collagenase in preventing and healing sore nipples, and compared to dexpanthenol and a control group. Sixty-six primiparous mothers were randomized to one of three groups to receive either collageŽ . Ž . nase group C Novuxol, Knoll , or dexpanthenol Ž . Ž . group D Bepanthene, Roche , or only warm Ž . water and soap group W . They used their agents after breast-feeding sessions qid for 2 weeks. The lesions were evaluated just before the treatment and prior to discharge by a physician blind to