O. Taskin

Sleep pattern changes in menstrual cycles of women with premenstrual syndrome: a preliminary study.

OBJECTIVE The objective of this study was to investigate the sleep pattern changes across the menstrual cycle in patients with premenstrual syndrome. STUDY DESIGN This prospective study was conducted in a university-based premenstrual syndrome clinic. The patients were selected on the basis of the comprehensive interview and visual linear analog scale. Well-matched control subjects were also selected. All the subjects underwent two consecutive sleep pattern recordings during each of three different menstrual phases in 1 month. Nine sleep parameters were recorded. RESULTS Three patients and six controls completed the study. No cycle-related fluctuation in any parameter was noted in either the patients or the controls. No significant differences in sleep pattern were noted in the patients when compared with the controls during the same phase of the menstrual cycle. CONCLUSION Abnormal sleep pattern in relation to premenstrual syndrome or phases of the menstrual cycle was not demonstrated in this preliminary study.

Menstrual Cycle-Dependent Changes in Visual Field Analysis of Healthy Women

Purpose: To determine the effect of menstrual cycle phases on the visual field analysis of healthy females. Material and Methods: One randomly selected eye each of 59 healthy normally menstruating women, and of 54 men with no systemic and ocular problems, other than refractive error, were included in the study. Subjects underwent complete ocular examination, and standard achromatic perimetric (SAP) and short-wavelength automated perimetric (SWAP) analysis in both follicular (7th to 10th day of the cycle) and luteal phases (days 3–7 before the menstrual bleeding) of the menstrual cycle. Visual field analysis was performed using a Model 750 Humphrey Field Analyzer II (Humphrey Instruments Inc., San Leandro, Calif., USA) with full-threshold, central 30-2 program. Visual fields were divided into four regions as superior temporal, inferior temporal, superior nasal and inferior nasal, respectively. Results: The mean age of female (n = 59) and the male subjects (n = 54) were 34.6 ± 2.9 and 35.0 ± 2.7 years, respectively (p = 0.49). SWAP tests demonstrated a significantly decreased mean MS value in the luteal phase (p < 0.05). However, it did not change significantly with SAP tests. Regional MS values of both SAP and SWAP tests were not different in both phases of the menstrual cycle (all p values >0.05). Mean perimetric test durations obtained with both SAP and SWAP were not different throughout the menstrual cycle (both p values >0.05). Conclusion: Clinicians should verify menstrual status when evaluating a suspected loss of visual field sensitivity in menstruating women. The findings of the present study suggest that the SWAP test may be more sensitive to determine subtle sex hormone-dependent changes in visual field analysis of healthy women.

Effect of the menstrual cycle on standard achromatic and blue-on-yellow visual field analysis of women with migraine

BACKGROUND It has been postulated that migraine and glaucoma may have common vascular causative factors. Significant sex-based differences in the incidence of many important ocular conditions raise the possibility that estrogens may have direct effects on the eye. We performed a study to determine the effect of the menstrual cycle on standard achromatic automated perimetry (SAP) and short-wavelength automated perimetry (SWAP) (blue-on-yellow perimetry) of women with migraine. METHODS Both eyes of 73 normally menstruating women (31 subjects with migraine and 42 healthy control subjects) were included in the study. Subjects underwent a complete ocular examination including SAP and SWAP in both the follicular phase (12th to 13th day of the cycle) and the luteal phase (1 to 2 days before the onset of bleeding) of two consecutive menstrual cycles.We performed visual field analysis using the Humphrey Field Analyzer II with the full-threshold central 30-2 program. Mean sensitivity was calculated for the superior temporal, inferior temporal, superior nasal and inferior nasal regions separately. RESULTS Thirteen subjects were lost to follow-up (5 in the migraine group and 8 in the control group), leaving 26 subjects and 34 subjects respectively. There was no significant difference in mean age between the two groups (33.9 years [standard deviation (SD) 3.4 years] vs. 35.1 years [SD 3.3 years]). The mean duration of migraine was 7.6 (SD 3.1) years (range 3-14 years). In both groups, serum estradiol levels were significantly lower (p = 0.001) and serum progesterone levels were significantly higher (p < 0.001) in the luteal phase than in the follicular phase. In the control group, the mean sensitivity values with SWAP were significantly lower in the luteal phase than in the follicular phase (p = 0.04). A similar decrease was observed for the subjects with migraine with both SAP and SWAP (p = 0.01). There was no difference in regional mean sensitivity between the two phases with either perimetric test in the control group. For the subjects with migraine, there was no difference in regional mean sensitivity between the two phases with SAP. However, with SWAP, the mean sensitivity for the nasal visual field locations was significantly lower in the luteal phase than in the follicular phase (p = 0.01). INTERPRETATION Our study provides further evidence of an effect of sex hormones on the visual field of women with migraine. In addition to assessment of intraocular pressure, menstrual cycle phases should be considered in women with migraine at risk for glaucomatous optic neuropathy.

Stage I small cell carcinoma of the endometrium: survival and management options

Small cell carcinoma (SCC) of the endometrium is a rare but aggressive disease with early systemic involvement. Patient survival is short. To date, no effective treatment protocol has been established. Surgery, radiotherapy, and chemotherapy have been used either alone or in combination. The case of a patient with stage IB endometrial SCC is presented with an overview based on all reported cases of SCC of the endometrium and its treatment with particular reference to stage I cases.

Prenatal diagnosis and early treatment of fetal goitrous hypothyroidism and treatment results with two-year follow-up.

A 24-year-old primiparous woman with no prior history of thyroid problems was referred to our prenatal unit at 25 weeks of gestation for evaluation of a fetal neck mass incidentally detected by ultrasound. A fetal ultrasound scan was performed for measurements of thyroid gland size (diameter; Figure 1). Sonography showed a large anterior cervical symmetrical blobbed mass (176236 22 mm) with mild hyperextension of the fetal neck. No other anomaly was noted in the fetus. The amniotic fluid volume was normal. Fetal growth and movements were normal. Maternal serum thyroid function tests were normal. Ultrasound of the maternal thyroid was unremarkable. Cordocentesis was performed at 25 weeks of gestation to evaluate the fetal thyroid function. Fetal hypothyroidism was detected with a low concentration of thyroxin in the fetal serum (FT4 0.65 ng/dL) and TSH markedly elevated in fetal serum (100 mU/L). Normal values at 19–27 weeks: FT4 7.79+ 2.02 mg/ mL and TSH 4.1+ 1.4 mU/L. Fetal karyotype 46 XX was confirmed. The fetus was treated with a 500-mg injection of levothyroxine sodium into the amniotic fluid at 26 weeks of gestation at the request of both parents after consent. Nine intraamniotic injections were performed weekly, with the last injection given at 38 weeks of gestation. Meanwhile, regular ultrasound evaluations showed a progressive decrease in the thyroid volumes. At 39 weeks of gestation, a live female was delivered weighing 3600 g. Neonatal airway obstruction was not found and resuscitation was not required. The newborn had no respiratory problems. Measurement of serum TSH and iodothyronines confirmed the diagnosis of primary hypothyroidism. Thyroid hormone therapy started on the first day of life with a daily oral dose of 50-mg levothyroxine. She has returned for regular follow-up at the pediatric endocrinology outpatient clinic. After two years of follow-up, she has been euthyroid on 80-mg/day levothyroxine treatment, and her physical and neurological development is normal. Congenital hypothyroidism has an incidence of one in every 4000 live births and is one of the most common treatable causes of mental retardation [1]. Congenital hypothyroidism presenting with a goiter is very rare (1/40 000) and can be found in only about 10–15% of all cases of congenital hypothyroidism [2]. Of primary congenital hypothyroidism, 85% is due to developmental defects of the thyroid gland. Of the remaining 15% of cases, 10% are attributable to an inborn error of thyroxin synthesis and 5% are the result of transplacental maternal thyrotropin receptor blocking antibody [3]. Fetal hypothyroidism is usually unrecognized without a maternal history of thyroid disease or anti-thyroid medication. However, the consequences of both fetal goiter and impaired thyroid function are serious. Long-term follow-up of children with fetal hypothyroidism shows that it may be associated with mental retardation, delayed skeletal maturation, hearing defects, and deficit in focusing, even with immediate postnatal screening and replacement therapy [4]. A large fetal goiter may result in dystocia during delivery because of neck hyperextension and enlargement of the thyroid [5]. The particular impairment correlates with severity and duration of fetal hypothyroidism [6]. Fetal goiter may sometimes be difficult to diagnose ultrasonographically when moderate, so it must be The Journal of Maternal-Fetal and Neonatal Medicine, March 2007; 20(3): 263–265

The Effect of the Menstrual Cycle on the Optic Nerve Head Analysis of Migrainous Women

Purpose: To determine the effect of the menstrual cycle on the optic nerve head topographic analysis of normally menstruating migrainous women.Material and Methods: Randomly selected one eye of 44 migrainous and 49 healthy control women with regular menstrual cycles were included in the study. All subjects underwent complete ocular examination. Optic nerve head topographic analysis were performed using a confocal scanning laser ophthalmoscope, HRT II (Heidelberg Retinal Tomograph II, software version 1.6; Heidelberg Engineering, Heidelberg, Germany). They were repeated for two times during the menstrual cycle: in follicular phase (7th to 10th day of the cycle) and in the luteal phase (days 3 to 4 before the menstrual bleeding). Serum estradiol, progesterone, and luteinizing hormone measurements were repeated at each menstrual phase. Results: The mean age of migrainous and control subjects were 31.5 ± 5.1 years and 33.4 ± 3.7 years, respectively (P > 0.05). Their mean disc areas were 2.26 ± 0.46 mm2 and 1.95 ± 0.39 mm2, respectively (P < 0.05). Control subjects did not demonstrate any difference in the disc topography (P > 0.05). The parameter rim volume decreased, while the parameters cup volume and cup shape measure increased significantly in the luteal phase of the migrainous women (all P values < 0.05). Mean intraocular pressure of the migrainous women decreased significantly in luteal phase (P < 0.05). Conclusion: Significant differences exist in the optic rim and cup parameters during the menstrual cycle of the migrainous women. Further clinical trials on ocular blood flow changes during the menstrual cycle of the migrainous women may highlight the role of sex steroids in the optic nerve head of the migrainous women.

Urinary Tract Injuries During Advanced Gynecologic Laparoscopy

Urinary tract injuries are important complications of laparoscopic surgery. The intraoperative diagnosis may be delayed, resulting in severe clinical complications, such as fistulas, in the immediate and late postoperative periods. A review of 776 endoscopic procedures revealed 6 urinary tract injuries and postoperative complications during laparoscopy. We believe that surgical experience, intraoperative diagnosis, immediate repair of the lesion, and close follow-up are the main factors contributing to decreased morbidity associated with these injuries.

Comparison of intravaginal progesterone gel and intramuscular 17‑α‑hydroxyprogesterone caproate in luteal phase support

The main objective of this study was to compare the pregnancy rates of intramuscular (IM) 17-α-hydroxyprogesterone caproate (17-HPC) and intravaginal (IV) progesterone gel administration in in vitro fertilization-embryo transfer (IVF-ET) cycles. The IM 17-HPC and IV progesterone groups included 632 (66.4%) and 320 (33.6%) women undergoing the first cycles of IVF-ET treatment, respectively. Multivariate analyses annotated for all potential confounders showed that the use of IV progesterone retained a predictive value for the total β-human chorionic gonadotropin (hCG) positivity and clinical pregnancy rates [adjusted odds ratio (OR), 1.97; 95% confidence interval (CI), 1.28–3.03; P=0.002; and OR, 1.66; 95% CI, 1.07–2.60; P=0.03, respectively]. However, biochemical and on-going pregnancy rates did not differ significantly between the groups (OR, 1.85; 95% CI, 1.00–3.41; P=0.05; and OR, 1.43, 95% CI, 0.89–2.30; P=0.14, respectively). Luteal phase support (LPS) with IV progesterone gel in comparison with IM 17-HPC appears to be associated with higher clinical pregnancy rates in IVF-ET cycles. However, this benefit is clinically irrelevant in terms of on-going pregnancy outcomes.

Effect of the menstrual cycle on the optic nerve head in diabetes: analysis by confocal scanning laser ophthalmoscopy.

BACKGROUND The purpose of this study was to examine and compare menstrual-cycle-dependent topographic changes in the optic nerve head of normally menstruating women with different grades of type 2 diabetes mellitus. METHODS We studied the right eyes of 123 normally menstruating women (36 with severe nonproliferative diabetic retinopathy [NPDR], 42 with mild NPDR and 45 healthy subjects). All subjects underwent a complete ocular examination at baseline. At 4 hormonally distinct phases of the menstrual cycle (early follicular, late follicular, mid-luteal and late luteal), we analysed the topography of the optic nerve head, using a confocal scanning laser ophthalmoscope, and measured the serum levels of estradiol, progesterone and luteinizing hormone. RESULTS We excluded from analysis the data for 8 patients with severe NPDR, 10 patients with mild NPDR and 15 control subjects who were lost to follow-up examinations during the menstrual cycle. The mean age and optic disc area did not differ significantly among the 3 groups. The duration of diabetes was significantly longer in the patients with severe NPDR than in those with mild NPDR (p < 0.05). The women with severe NPDR had a significantly increased neuroretinal rim area and a significantly decreased cup-shape measure, linear cup/disc ratio, cup/disc area ratio and cup area in the late luteal phase compared with the other phases of the menstrual cycle (p < 0.05). Those with mild NPDR or a normal retina had no significant topographic changes in the optic nerve head during the menstrual cycle. INTERPRETATION Severe NPDR is associated with significant topographic changes in the rim and cup of the optic nerve head during the menstrual cycle. This must be considered in the evaluation of women with both diabetes and glaucoma. The normal fluctuations in serum sex hormone levels during the menstrual cycle of diabetic women seem to affect the optic nerve head more when the disease is advanced.