Kemal Öztekin

Mammographic density changes during different postmenopausal hormone replacement therapies

OBJECTIVE To determine the degree of change in mammographic breast densities during different types of postmenopausal hormone replacement therapies. DESIGN A retrospective study. SETTING Ege University Hospital. PATIENT(S) The mammographies of 216 women on various postmenopausal hormone replacement therapies were evaluated. INTERVENTION(S) Estrogen alone (n = 76) or estrogen in cyclic (n = 44) or continuous (n = 61) combination with progestin or tibolone-only (n = 35) replacement therapies were used. Mammographic density was quantified according to the Wolfe classification in patients with different hormone replacement regimens. MAIN OUTCOME MEASURE(S) Mammographic density changes were interpreted. RESULT(S) An increase in mammographic density was much more common among women receiving continuous combination hormone replacement therapy 31.1% (19 of 61) than among those receiving estrogen-only 3.9% (3 of 76) treatment. There were no significant mammographic breast density changes among women receiving cyclic continuous combination hormone replacement therapy or tibolone-only treatment. The increase in density was apparent already at first visit after the start of hormone replacement therapy. In continuous combined postmenopausal hormone replacement therapy with norethisterone acetate, the increase in mammographic density was 34.1% (15 of 44), followed by medroxyprogesterone acetate 23.5% (4 of 17). CONCLUSION(S) Our findings show that mammographic breast density changes related to postmenopausal hormone replacement therapy are dependent on the selected hormone regimen. The continuous administration of the progestin component of the combined-hormone replacement therapy seems to effect the breast density most.

The comparison of uterine artery Doppler velocimetry with the histopathology of the placental bed.

We determined the relationship between the histopathological findings of the placental bed and Doppler flow measurements of the uterine artery in women with preeclampsia and fetal growth retardation. Doppler velocimetry in the uterine artery was evaluated in 17 pregnant women with preeclampsia, 15 of whom had fetal growth retardation, and 20 normal pregnant women, within 14 days of Caesarean delivery and placental bed biopsy. The placental bed biopsies were evaluated in terms of trophoblast migration into the myometrium and physiological changes of the spiral arteries. The results were compared with Doppler velocimetry values. Trophoblast migration and physiological changes were not detected in 10 (59%) cases with preeclampsia and in 4 (20%) with normal pregnancies (p<0.05). In the preeclamptic group, 9 of 15 cases that were complicated with intrauterine growth retardation had no trophoblastic migration into the myometrium. The mean systolic/diastolic ratio, resistance index and pulsatility index of the uterine artery in women with preeclampsia and fetal growth retardation was significantly higher than women with normal pregnancies (p<0.01). The mean resistance index of the uterine artery in the impaired migration group was significantly higher than the migration group (p=0.02). The incidence of impaired trophoblast migration was significantly higher in the group with a high systolic/diastolic ratio (above 2.5) and resistance index (above 0.58) than cases with low systolic/diastolic ratio and resistance index (72%, 23% respectively, p<0.05). The incidence of early diastolic notch in the impaired trophoblast migration group was significantly higher than the migration group (57% versus 13%, p<0.01). Our study supports the hypothesis that high uterine artery flow resistance is related to the reduced trophoblast migration into the myometrium and inadequate physiological changes in the spiral arteries in women with intrauterine growth retardation and preeclampsia.

Comparison of the reduction of postoperative adhesions by two barriers, one solution, and two pharmacologic agents in the rat uterine model

OBJECTIVE To evaluate the effects of two barriers, one solution, and two pharmacologic agents, in single or in combined use, for preventing postsurgical adhesion formation in the rat model. DESIGN A randomized, prospective study to evaluate the ability of leuprolide acetate, oxidized regenerated cellulose, medroxyprogesterone acetate, sodium hyaluronate, sodium hyaluronate/carboxymethyl cellulose, in single or in combined use, for preventing adhesion formation in a rat model. ANIMAL(S) Wistar female rats. SETTING University animal laboratory. INTERVENTION(S) Intramuscular injection of pharmacologic agents before surgery and intraperitoneal application of barriers and solution at the end of surgery. MAIN OUTCOME MEASURE(S) Two weeks after surgery, a second laparotomy was performed and the extent of adhesion formation was determined. RESULT(S) All the treatment groups had fewer, less severe adhesions when compared with controls. The combination of medroxyprogesterone acetate and oxidized regenerated cellulose did enhance the adhesion-reducing capacity of oxidized regenerated cellulose. The performance of sodium hyaluronate solution for adhesion prevention was statistically significant, when compared with oxidized regenerated cellulose alone, or sodium hyaluronate used with carboxymethyl cellulose film. CONCLUSION(S) Pharmacologic agents, barriers, or solutions result in significant reduction of postsurgical adhesions. The sodium hyaluronate solution alone and medroxyprogesterone acetate treatment alone had the least adhesion prevention scores. However, neither monotherapy nor combined therapy proved to be significantly more beneficial.

Comparison of Epidural and General Anaesthesia for Elective Caesarean Delivery According to the Effects on Apgar Scores and Acid‐Base Status

Summary: The objective of this study was to determine the effects of lumbar epidural anaesthesia on the Apgar score and acid‐base status of the newborn. Umbilical artery blood gases were obtained in 85 singleton, term, uncomplicated pregnancies delivered by elective Caesarean section. The umbilical artery blood pH, PaCO2, PaO2 and HCO3 values and Apgar scores (1 and 5 minutes) were compared between lumbar epidural and general anaesthesia groups. General anaesthesia was used in 45 (52.9%) women and lumbar epidural anaesthesia in 40 (47.1%). Only 2 of the newborns exposed to epidural anaesthesia had umbilical artery blood pH values 7.19 or less. The mean umbilical artery blood pH was found to be significantly lower in the newborns exposed to lumbar epidural anaesthesia (p = 0.011). None of the newborns in the 2 groups were severely depressed (Apgar scores less than 4). The mean umbilical artery blood PaCO2, PaO2 and HCO3 values did not show any significant difference between the groups. In conclusion, lumbar epidural anaesthesia is associated with lower umbilical artery blood pH values, occasionally with severe fetal acidaemia.

Mammographic density changes in postmenopausal women using tibolone therapy

Mammography is an effective tool for the early detection of breast cancer. Hormone replacement therapy is associated with an increase in mammographic breast density in a significant proportion of postmenopausal women 1,2 . Current use of postmenopausal hormone replacement therapy may also be associated with lower sensitivity of screening mammography 3 . In this preliminary study, we investigated the degree of change in mammographic breast densities in postmenopausal women receiving tibolone Ž . Livial , Organon at a daily dose of 2.5 mg. The mammographies of 50 postmenopausal women receiving tibolone therapy were evaluated retrospectively. Mammographic density was quantified according to the Wolfe classification 4 . Forty-two Ž . Ž . Ž . 84% , 6 12% , and 2 4% patients were sub-

Early menopause association with employment, smoking, divorced marital status and low leptin levels.

Aims. The aims of this study were (1) to investigate the determining risk factors related to early menopause and (2) to compare the relationships between demographic characteristics and hormonal status and leptin levels in subjects with early (no surgical) and natural menopause. Study design. The prospective study was conducted on 500 women with early and 2700 women with natural menopause. Detailed information was collected about their employment status, past and present smoking habits, coffee and alcohol use, educational level and other factors relevant to health. Thirty participants with early menopause and 30 participants with natural menopause were evaluated for hormone and leptin levels. Results. Employment status (OR: 1.94), current smoking (OR: 1.80) and divorced marital status (OR: 1.79) were found to be significant risk factors for early menopause. Mean levels of leptin in natural and early menopause were measured 11.40 ± 4.1 ng/ml and 8.01 ± 3.9 ng/ml, respectively (p = 0001). Leptin levels in the early (r = 0.765, p = 0.001) and natural (r = 0.750, p = 0.001) menopause subjects correlated positively with oestradiol (E2) levels. Conclusion. This study shows that early onset of menopause is correlated with smoking, employment status, divorced marital status and lower leptin levels.

Prenatal sonographic detection of nasopharyngeal teratoma.

We present the case of a 34‐year‐old pregnant woman who had an elevated maternal serum α‐fetoprotein level and sonographic findings of a semisolid mass protruding from the fetuss oral cavity. The large, heterogeneous mass filled the oropharynx and nasopharynx. Abnormal Doppler waveforms were detected in the umbilical artery of the fetus, who died in utero. Postmortem examination revealed a nasopharyngeal teratoma.

Does tibolone affect serum leptin levels and body weight in postmenopausal women

ObjectivesLeptin has a significant role in body weight regulation and energy balance. We examined the effect of tibolone on the body weight and serum leptin levels in postmenopausal women.Study designTwenty women (aged 43–60 years) participated in this prospective study. All women in this study protocol received 2.5 mg/day of tibolone. Absolute and body mass index (BMI)-corrected serum leptin concentrations and BMI values were measured at baseline, after 3 months, and after 6 months of the tibolone therapy.ResultsTibolone did not affect absolute and BMI-corrected serum leptin levels, and BMI values during the treatment. A significant linear correlation between BMI values and serum leptin levels was observed (p<0.05, r=0.67).ConclusionsTibolone seems not to affect serum leptin levels, body weight and BMI values of postmenopausal women. There is a significant correlation between serum leptin levels and BMI values.

Surgical anatomy of the posterior division of the internal iliac artery: The important point for internal iliac artery ligation to control pelvic haemorrhage

Ligation of the internal iliac artery is an effective procedure both to control post-partum haemorrhage and to reduce operative blood loss at radical hysterectomy. We performed a post-mortem anatomic dissection study which aimed to determine the location of the posterior division of the internal iliac artery, an important anatomical point for the ligation of anterior division of internal iliac artery for the elective control of pelvic haemorrhage. Anatomical dissection of the internal iliac artery, with anterior and posterior divisions, was performed in 22 fresh female cadavers (aged between 13 and 76 years) that were the subjects of forensic investigation, after institutional ethical approval for the study had been obtained. The following measurements were taken from the right and left sides of the pelvis: the distance from aortic bifurcation to the bifurcation of iliac artery, the distance from bifurcation of the iliac artery to posterior division of the internal iliac artery, the distance from the sacral promontory to the posterior division of the internal iliac artery and the distance from the pelvic midline to the posterior division of the internal iliac artery. The aortic bifurcation to the bifurcation of the iliac artery measurements were 60.9 ± 11.5 mm and 66.2 ± 12.5 mm on the right and left pelvic sides, respectively. The bifurcation of iliac artery to posterior division of the internal iliac artery measurements were 40.2 ± 8.3 mm and 38.4 ± 7.2 mm, on the right and left pelvic sides, respectively. The promontory to the posterior division of the internal iliac artery measurements were 42.01 ± 7.9 mm and 47.6 ± 7 mm, on the right and left pelvic sides, respectively. The distance from the pelvic midline to the posterior division of internal iliac artery was 35.3 ± 6.3 mm and 38.09 ± 4.9 mm, on the right and left pelvic sides, respectively. The values were not significantly different between cadavers under and over the age of 40. When the right and left pelvic sides were compared only the length of sacral promontory to the posterior division of internal iliac artery was significantly shorter on the right side (P = 0.018, Mann–Whitney U-test). The present study suggests that, by measuring a point approximately 4–4.5 cms from the sacral promontory or common iliac bifurcation, the surgeon can identify the point of origin of the posterior division. The point is also located 3.5 cm away from the pelvic midline. However, in some clinical situations it may be easier or preferable to locate the anterior division by identifying the point of origin of the uterine artery or obliterated umbilical artery, and tying the internal iliac artery just proximal to their origin. There may be variations in the anterior and posterior division of the internal iliac artery. The two important structures, ureter and the internal iliac vein, should be identified by careful lateral to medial dissection under direct vision. All gynaecological surgeons should engage in cadaver and animal (pig for example) dissections to improve their pelvic surgical anatomical knowledge.

Effect of ovarian stimulation with human menopausal gonadotropin and recombinant follicle stimulating hormone on the expression of integrins alpha(3), beta(1) in the rat endometrium during the implantation period

OBJECTIVE To investigate the effect of exogenous ovarian stimulation with human menopausal gonadotropin (hMG) and recombinant follicle stimulating hormone (rFSH) on the expression of integrins alpha(3), beta(1) in the rat endometrium during implantation. STUDY DESIGN Following three successive normal estrous cycles the animals were divided into five groups: Group I (n=10, control group) received no medication; Group II (n=10) received 10 units of hMG; Group III (n=10) received 20 units of hMG; Group IV (n=10) received 10 units of rFSH; Group V (n=10) received 20 units of rFSH at midday of middiestrous. The rats were then mated with fertile males. The animals were sacrificed on the day of implantation. The uterine horns were placed in fixative and paraffin blocks of the tissue were cut in 5 microm sections. The tissues were stained with primary antibodies; monoclonal anti-integrin alpha(3) and monoclonal anti-integrin beta(1) using immunohistochemical methods. The staining intensities of alpha(3) and beta(1) integrins were calculated separately for epithelium and stroma in each group. RESULTS Staining intensities of alpha(3) and beta(1) integrins in both the epithelium and the stroma were significantly lower in the treatment groups than the control group (p<0.05). CONCLUSION Ovarian stimulation by low and high doses of HMG and rFSH may have an effect on endometrial receptivity, possibly via a decrease in expression of integrins in the endometrium during the implantation period.