Nevin Sağsöz

Anatomical landmarks regarding sacrospinous colpopexy operations performed for vaginal vault prolapse

AIM To investigate the anatomical relationships of the structures and the topographic anatomy of the sacrospinous ligament and validate current anatomic knowledge of this area. MATERIALS Nine embalmed half female cadaver pelvises were dissected to reveal the anatomy of the sacrospinous ligament. RESULTS The average length of the sacrospinous ligament was measured to be 43.04 +/- 6.58 mm. The inferior gluteal complex emerges from the infrapiriform foramen at a distance of 17.02 +/- 3.08 mm from the ischial spine and courses to inferior-laterally with a slight curve. During this course, it passes close to the upper-lateral half of the sacrospinous ligament. The pudendal complex passes above the spine in six of the nine cases (66.6%) and lies maximum of 5.5 mm medial to the spine. On average the sciatic nerve is measured to be 25.14 +/- 3.94 mm lateral to the ischial spine. CONCLUSION Placing the suture inferomedially and close to sacrum, the risk of complication will be minimal.

Pelvic ultrasound measurements in normal girls: relation to puberty and sex hormone concentration.

Pelvic ultrasonography was performed on 75 normal girls. Values were obtained for uterine length, fundal/cervical ratio (FCR), ovarian volume and sex hormones. The resultant data were grouped according to age and pubertal stage (Tanner). For uterine length, FCR and ovarian volume, the data were positively skewed, and the variance increased with age and pubertal stage (p < 0.001). The uterus underwent a regular increase in size and the corpus gradually became larger than the cervix. Uterine length, right ovary volume, FCR and hormones (serum estradiol, follicle-stimulating hormone and luteinizing hormone) showed a correlation with the Tanner score (p < 0.001). Although the correlations were significant, the best correlation was between pubertal stage and serum estradiol level.

Serum paraoxonase 1 activity, asymmetric dimethylarginine levels, and brachial artery flow-mediated dilatation in women with polycystic ovary syndrome

OBJECTIVE To evaluate endothelial function via serum asymmetric dimethylarginine (ADMA) levels, paraoxonase 1 (PON1) activity, and brachial artery flow-mediated dilatation (FMD) in women with polycystic ovary syndrome (PCOS). DESIGN Prospective case-control study. SETTING University hospital. PATIENT(S) Thirty patients with PCOS with a mean age of 24.33 ± 4.50 years and 30 healthy controls matched for body mass index (BMI) and age. INTERVENTION(S) Endothelial function was assessed biochemically with serum ADMA levels and serum PON1 activity and functionally with brachial artery FMD by ultrasonography. MAIN OUTCOME MEASURE(S) Serum ADMA levels, serum PON1 activity, brachial artery FMD, hormonal and biochemical parameters. RESULT(S) Patients with PCOS had higher levels of free testosterone and insulin, and higher waist-hip ratio and Ferriman Gallwey scores when compared with the controls. Fasting glucose and homeostasis model assessment of insulin resistance were not different between the groups. There was no statistically significant difference in ADMA levels between two groups. Serum PON1 activity and brachial artery FMD were statistically significantly lower in women with PCOS. There was negative correlation between ADMA and PON1 in patients with PCOS. CONCLUSION(S) Serum PON1 activity and brachial artery FMD, as markers of endothelial dysfunction and cardiovascular risk, were statistically significantly lower in women with PCOS compared with healthy controls matched for age and BMI. Endothelial dysfunction may be seen at earlier ages in patients with PCOS.

The effects of oral contraceptives including low-dose estrogen and drospirenone on the concentration of leptin and ghrelin in polycystic ovary syndrome.

OBJECTIVE To evaluate short-term leptin and ghrelin concentrations in women with polycystic ovary syndrome (PCOS) who use low-dose oral contraceptives containing drospirenone. DESIGN Prospective study. SETTING Department of obstetrics and gynaecology in a university hospital. PATIENT(S) Twenty women with PCOS were enrolled in the study. INTERVENTION(S) A low-dose oral contraceptive containing ethinyl estradiol and drospirenone was given for three cycles. MAIN OUTCOME MEASURE(S) Serum androstenedione, free T, T, dehydroepiandrosterone sulphate, sex hormone-binding globulin, FSH, LH, E(2), lipid profiles, leptin, and ghrelin levels were measured in each subject. Insulin resistance was estimated by the homeostasis model assessment-insulin resistance (HOMA-IR). RESULT(S) While leptin concentrations did not change with therapy, ghrelin levels increased statistically. Baseline leptin concentrations were correlated positively with body mass index, waist-to-hip ratio, insulin, and HOMA-IR and negatively with ghrelin. After controlling for body mass index and waist-to-hip ratio in a partial correlation analysis, leptin levels were not correlated with these parameters. Ghrelin was inversely correlated with body mass index, waist-to-hip ratio, insulin, HOMA-IR, and free T. CONCLUSION(S) In patients with PCOS, an oral contraceptive containing ethinyl estradiol and drospirenone increases ghrelin levels but not leptin levels in a 3-month period. Ghrelin might be related to the metabolic and androgenic changes in patients with PCOS.

The association of androgenic sex steroids with serum lipid levels in postmenopausal women

Background.  The aim of the present study was to examine the correlations between androgenic sex steroids and serum lipid levels in postmenopausal women.

The Effect of Treatment on Endothelin‐1 Concentration and Mean Arterial Pressure in Preeclampsia and Eclampsia

Objective: The aim of this study was to determine the effect of treatment on endotelin‐1 concentration that is considered to have role in etiopathogenesis of eclampsia and preeclampsia. Methods: Nine patients with eclampsia and 12 patients with preeclampsia were included to the study. Endothelin‐1 levels were measured before and after magnesium sulfate treatment. After the magnesium sulfate administration, if the blood pressure was still elevated, nifedipine was given. Results: Endothelin‐1 levels of preeclamptic patients before and after magnesium sulfate treatment were 16.9 ± 2.3 fmol/ml and 14.6 ± 1.9 fmol/ml respectively (p < 0.05). The same measurements of eclamptic patients were 18.1 ± 3.2 and 14.7 ± 3.4 respectively (p < 0.05). The mean blood pressures of preeclamptic patients before and after magnesium sulfate were 125.8 ± 7.3 mm‐Hg, 118.2 ± 8.7 mm‐Hg respectively, and the same measurements of eclamptic patients were 136.0 ± 12.4 mm‐Hg and 123.1 ± 10.6 mm‐Hg respectively (p < 0.05, p < 0.05). Conclusion: Treatment had been found to have negative effects on endothelin‐1 levels that is considered to play an important role on etiopathogenesis of eclampsia and preeclampsia.

Plasma apelin levels in patients with polycystic ovary syndrome.

OBJECTIVE The aim of the study was to evaluate plasma apelin levels in patients with polycystic ovary syndrome (PCOS) and healthy controls. MATERIAL AND METHODS Plasma apelin levels, serum lipid levels, serum hormone levels, and homeostasis model assessment-insulin resistance (HOMA-IR) values of 32 patients with PCOS and 31 healthy women forming the control group were checked. RESULTS Plasma apelin levels of the PCOS group (0.350±0.083 ng/ml) were significantly higher than those of the control group (0.246±0.045 ng/ml) (p<0.001). No significant correlation was detected between apelin levels and biochemical or clinical data in PCOS group. CONCLUSION Plasma apelin levels were significantly higher in PCOS patients.

Plasma lipocalin‐2 levels in pregnancy

Objective. To evaluate plasma levels of lipocalin‐2, which is a novel adipokine associated with obesity and insulin resistance, in pregnant women. Design. Prospective case–control study. Setting. University hospital. Population. Pregnant women with pre‐pregnancy body mass index >25kg/m2 (overweight; n=29) and body mass index <25kg/m2 (n=27), whose gestational ages were between 24 and 28weeks, as study groups and nonpregnant control women with body mass index <25kg/m2 (n=29). Methods. Plasma lipocalin‐2 levels, fasting plasma glucose and fasting plasma insulin levels; homeostasis model assessment insulin resistance index and fasting plasma glucose/fasting plasma insulin ratio were measured for each subject. Main Outcome Measures. Comparisons among the groups and correlations for lipocalin‐2 and the parameters of insulin resistance. Results. Plasma lipocalin‐2 levels among the pregnant women were significantly higher than those of the control group (p<0.001 for both group comparisons). Lipocalin‐2 levels were significantly higher in the group with pre‐pregnancy body mass index >25kg/m2 compared with the group with pre‐pregnancy body mass index <25kg/m2 (p=0.003). Lipocalin‐2 levels were positively correlated with homeostasis model assessment insulin resistance index and fasting plasma insulin and negatively correlated with fasting plasma glucose/fasting plasma insulin ratio in both pregnant groups. Conclusions. Lipocalin‐2 was found to be higher in pregnant women, especially when pre‐pregnancy body mass index was >25kg/m2, and it was correlated with markers of insulin resistance.

Effects of l-carnitine on oxidative stress parameters in oophorectomized rats

Abstract Aims The aim of this study was to investigate the antioxidant effects of l-carnitine on the oxidative stress parameters in oophorectomized rats. Methods Twenty-four female albino Wistar rats were used. Rats were divided into four groups: laparotomy-only (LOSALINE) group, oophorectomy plus l-carnitine 100 mg/kg/day (OXL100) group, oophorectomy plus l-carnitine 500 mg/kg/day (OXL500) group, and oophorectomy-only (OXSALINE) group. Experimental protocol was started on day 21 post-castration. Various dosage forms of l-carnitine or isotonic saline were administered intraperitoneally for 14 consecutive days. Nitric oxide (NO), malondialdehyde (MDA), total antioxidant status (TAS), total oxidative stress (TOS) and oxidative stress index (OSI) were evaluated in the tissues including kidney, liver and heart, and sera. Result(s) In the heart tissue samples, there was no difference in the levels of NO, OSI and TOS between the groups. However, MDA levels in OXSALINE group were significantly higher than OXL500 group. On the other hand, there was no statistically significant differences between the groups in terms of levels of NO, MDA, TAS, TOS and OSI in liver, kidney and sera samples. Conclusion(s) Levels of MDA in the heart tissue were significantly higher in OXSALINE group compared to OXL500 group. Thus, it may be suggested that l-carnitine reduces oxidative stress at least in the heart of oophorectomized rats.

Sigmoid Colon Perforation Mimics a Tuboovarian Absces

Introduction An adnexal mass may be diagnosed after a routine pelvic ultrasonographic examination or an emergent hospital admission due to rupture of ectopic pregnancy, adnexal torsion or rupture of tuboovarian abscess. It is necessary to evaluate the origin of the mass initially and to classify patients who need further evaluation and treatment for an urgent condition. Case presentation We report a case of sigmoid colon rupture due to sigmoid colon adenocarcinoma presenting as acute abdomen with left adnexal mass in a 28 years old woman. Abdominopelvic computed tomography revealed a left adnexal mass with suspicion of tuboovarian abscess. In laparatomy, rupture of sigmoid colon was observed and resection of sigmoid colon was performed. Histological examination of resection part revealed diagnosis of sigmoid colon adenocarcinoma due to familial adenomatous polyposis. Conclusion This case may be interesting for clinicians because pelvic pain, fever, increased infection markers in the laboratory and mass at ultrasonography or other screening methods could cause a misdiagnosis of tubaovarian abscess especially in reproductive age women. Before the operation of the pelvic mass of all age women with the diagnosis of tuboovarian abscess other causes of the pelvic abscess should come into mine and necessary preparation for operation must be done.