Ozer Oztekin

Serum total l-carnitine levels in non-obese women with polycystic ovary syndrome

BACKGROUND Carnitine plays essential roles in energy production, oxidative stress and glucose metabolism. This study was planned to determine serum total L-carnitine levels in non-obese women with polycystic ovary syndrome (PCOS). METHODS There were 27 non-obese women with PCOS and 30 healthy, age- and body mass index (BMI) matched controls were evaluated in this controlled clinical study. Serum lipid sub-fractions, fasting glucose, insulin and other hormones (gonadotrophins, androgens) and total L-carnitine levels were measured. Homeostasis model assessment (HOMA-IR) was used to estimate insulin resistance. RESULTS The women with PCOS had significantly higher serum dehydroepiandrosterone sulfate, total testosterone, free androgen index (FAI), luteinizing hormone (LH), low-density lipoprotein (LDL) cholesterol, non-high density lipoprotein (HDL) cholesterol, fasting insulin levels and HOMA-IR measurement and LH/FSH ratios than healthy women. However, total L-carnitine and sex hormone-binding globulin (SHBG) levels were significantly lower in women with PCOS. L-Carnitine level was negatively correlated with FAI, but positively correlated with SHBG. Multiple regression analysis revealed that SHBG was a strong predictor of serum total L-carnitine level. CONCLUSIONS Decreased total L-carnitine levels may be associated with hyperandrogenism and/or insulin resistance in non-obese women with PCOS. Long-term studies are needed to evaluate carnitine metabolism in PCOS, especially with regard to the molecular basis.

Brucellar spondylodiscitis: magnetic resonance imaging features with conventional sequences and diffusion-weighted imaging

PurposeIn this retrospective study, we evaluated the contribution and role of diffusion-weighted imaging (DWI) in differentiating acute and chronic forms of brucellar spondylodiscitis. We also describe the characteristics and some indistinguishable features of brucellar spondylodiscitis on magnetic resonance imaging (MRI) to emphasise the importance and limitations of MRI.Materials and methodsMRI examinations of 25 patients with brucellar spondylodiscitis were retrospectively reviewed and analysed by two experienced radiologists. Signal and morphological changes were assessed. The imaging characteristics of acute and chronic forms of spondylodiscitis were compared. Both discriminative imaging findings of brucellar spondylodiscitis and some uncommon findings were interpreted.ResultsOf 25 patients with spinal brucellosis, eight had thoracic, ten had lumbar, five had both thoracic and lumbar and two had both lumbar and sacral vertebral involvement. We detected posterior longitudinal ligament elevation in 11 patients, epidural abscess formation in 11 and paravertebral abscess formation in nine. Ten patients had cord compression and eight had root compression. Three patients had facet-joint involvement, and one had erector spinae muscle involvement. Eight patients (32%) were in the acute stage, six (24%) in the subacute stage and 11 (44%) in the chronic stage. Vertebral bodies, vertebral end plates and intervertebral disc spaces were hypointense and hyperintense in the acute stage, whereas they were hypointense and heterogeneous in the subacute and chronic stages on T1- and T2-weighted images, respectively. In the acute stage on the DWI series, vertebral bodies, end plates and discs were all hyperintense but hypointense in the chronic stage.ConclusionsAlthough conventional MRI has several advantages over other imaging modalities and is very useful in the differential diagnosis between brucellar spondylodiscitis and other spinal pathologies, it has some difficulties in discriminating acute and chronic forms of spondylodiscitis. DWI is a sensitive, fast sequence that has the potential for differentiating acute and chronic forms of spondylodiscitis, which makes it crucial in spinal imaging.AbstractObiettivoIn questo studio retrospettivo abbiamo valutato il contributo e il ruolo della sequenza pesata in diffusione nella diagnosi differenziale tra forme acute e croniche di spondilodiscite brucellare. Abbiamo inoltre descritto le caratteristiche e alcuni aspetti patognomonici della spondilodiscite brucellare nell’imaging di Risonanza Magnetica (RM) per sottolineare l’importanza e i limiti della RM.Materiali e MetodiLe indagini RM di 25 Pazienti con spondilodiscite brucellare sono state rivalutate e analizzate retrospettivamente da due radiologi esperti. Sono state valutate le alterazioni morfologiche e del segnale. Sono state inoltre messe a confronto le caratteristiche di immagine delle forme acute e croniche. Infine sono stati interpretati sia alcuni aspetti di immagine discriminativi della spondilodiscite brucellare che alcuni reperti rari.RisultatiDei 25 Pazienti con brucellosi spinale, 8 presentavano un interessamento toracico, 10 lombare, 5 sia toracico che lombare e 2 sia lombare che sacrale. Abbiano rilevato sollevamento del legamento longitudinale posteriore in 11 Pazienti, formazione di ascessi epidurali in 11 e presenza di ascessi paravertebrali in 9. Dieci Pazienti avevano compressione del midollo e 8 compressione radicolare. Tre Pazienti presentavano coinvolgimento delle faccette articolari e uno del muscolo erettore spinale. Otto Pazienti (32%) erano in fase acuta, 6 (24%) in fase subacuta e 11 (44%) in fase cronica. I corpi vertebrali, i piatti vertebrali e i dischi intervertebrali erano ipointensi e iperintensi nello stadio acuto, mentre erano ipointensi e eterogenei negli stadi subacuto e cronico, rispettivamente nelle sequenze T1- e T2 dipendenti. In fase acuta, nella sequenza pesata in diffusione, i corpi vertebrali, i piatti e i dischi erano tutti iperintensi mentre erano ipointensi in fase cronica.ConclusioniNonostante la RM convenzionale abbia parecchi vantaggi rispetto ad altre metodiche di immagine e sia molto utile nella diagnosi differenziale tra la spondilodiscite brucellare e altre patologie spinali, tale metodica presenta delle difficoltànel differenziare le forme acute e croniche della spondilodiscite. L’imaging pesato in diffusione è una sequenza sensibile e veloce che possiede il potenziale per differenziare le forme acute e croniche di spondilodiscite rendendola pertanto fondamentale nella diagnostica per immagini spinale.

1–Alpha, 25–Dihydroxyvitamin D3 Regresses Endometriotic Implants in Rats by Inhibiting Neovascularization and Altering Regulation of Matrix Metalloproteinase

Abstract Background: The exact pathogenesis of endometriosis has not been completely discerned. 1–alpha,25–dihydroxyvitamin D3 (1,25[OH][2]D[3]) has been shown to have an anti–angiogenic effect and extracellular matrix–proteases–degrading properties. We hypothesized that 1,25(OH)(2)D(3) may have therapeutic value in the treatment of endometriosis. Methods: Endometrial tissue was implanted into the abdominal peritoneum of 21 Wistar albino rats; the rats were randomized into 3 groups. In Group A (simultaneous group), we simultaneously induced endometriosis and began 1,25(OH)(2)D(3) treatment. Group B rats (sequential group) were treated after endometriosis was documented. Animals in Group C (control group) were followed without any treatment after the development of endometriosis. Results: Histologic score, mean volume, and weight of the explants in Group A and B were found to be significantly lower than those of the control group. Levels of vascular endothelial growth factor (VEGF) and matrix metalloproteinase–9 (MMP–9) immunoreactivities in Group A and B were also significantly lower compared with Group C. In contrast, intensities of immunoreactivity staining for tissue inhibitor of metalloproteinase–2 (TIMP–2) in Group A and B were significantly higher than that of the control group. Conclusion: 1,25(OH)(2)D(3) regresses endometriotic implants in rat models by altering implant levels of VEGF, TIMP–2, and MMP–9.

Hepatic and splenic hydatid cyst during pregnancy: a case report

Abstract. Hydatid disease is primarily a disease of sheep and cattle. Human beings are accidental hosts. We present a 32-year-old multigravida at 25 weeks of pregnancy in whom splenic and liver cysts were diagnosed by ultrasonography and magnetic resonance imaging (MRI). The splenic cyst was removed and a healthy baby was delivered vaginally at term.

Spontaneous ovarian hyperstimulation syndrome in a normal singleton pregnancy.

OBJECTIVE It is known that most cases of ovarian hyperstimulation syndrome (OHSS) are associated with the therapies for ovulation induction. However, OHSS may rarely be associated with a spontaneous ovulatory cycle, usually in the case of multiple gestations, hypothyroidism or polycystic ovary syndrome. CASE REPORT A case of OHSS in a woman who became pregnant naturally and who had no underlying disease is presented here. The patient was managed expectantly with no complications. CONCLUSION Although spontaneous ovarian hyperstimulation is a rare entity, it is important to differentiate it from other causes of ovarian enlargement. Occasionally, life-threatening situations may occur, but it is usually a self-limiting process.

Serum Fetuin-A levels, insulin resistance and oxidative stress in women with polycystic ovary syndrome

Abstract This study was designed to determine serum Fetuin-A levels and establish whether serum Fetuin-A level is related with insulin resistance, oxidative stress, ovarian hyperandrogenism and dyslipidemia in women with polycystic ovary syndrome (PCOS). Twenty-two patients with PCOS and twenty-one healthy control women were evaluated in this controlled clinical study. Serum Fetuin-A, lipid fractions, glucose, insulin, malondialdehyde (MDA), myeloperoxidase (MPO), glutathione (GSH), superoxide dismutase (SOD) and other hormone (gonadotropins, androgens) levels were measured. The estimate of insulin resistance was calculated by homeostasis model assessment (HOMA-R). The women with PCOS had significantly higher serum fasting glucose, insulin, luteinizing hormone (LH), MDA, Fetuin-A levels, and LH/follicle-stimulating hormone (FSH) ratio, free androgen index (FAI), HOMA-IR than healthy women. However, sex hormone-binding globulin (SHBG) and GSH levels were significantly lower in patients with PCOS compared with controls. Fetuin-A was positively correlated with insulin, HOMA-IR and FAI. Multiple regression analysis revealed that FAI was strong predictor of serum Fetuin-A level. Serum Fetuin-A level was related with insulin resistance and ovarian hyperandrogenism in women with PCOS. These results suggest that Fetuin-A may have a role in triggering the processes leading to insulin resistance and androgen excess in PCOS.

Effect of Hormone Replacement Therapy on Clitoral Artery Blood Flow in Healthy Postmenopausal Women

INTRODUCTION Aging and the decline of ovarian hormonal secretion during menopause may alter libido, and sexual response and functioning. The effects of hormone replacement therapy (HRT) on the genital vascular hemodynamics have been widely studied. However, there is a lack of knowledge about the effect of HRT on basal clitoral blood flow. AIM The aims of this study were to measure clitoral artery blood flow and to determine whether HRT has a significant effect in clitoral artery blood flow in postmenopausal women. METHODS Doppler sonography of clitoral arteries was performed in 25 postmenopausal women aged 51.3 +/- 4.5 years who had been using a continuous combined HRT (0.625 mg of conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate, in 1 tablet daily) for 2.0 +/- 1.1 years, and the clitoral artery peak systolic velocity, resistance index (RI), and pulsatility index (PI) were measured. Thirty-five postmenopausal women aged 50.0 +/- 4.2 years who had not used HRT served as a control group. MAIN OUTCOME MEASURES Assessment of clitoral blood flow with color Doppler ultrasonography by measuring the peak systolic velocity, RI, and PI. RESULTS Clitoral artery circulation was easily detectable by the color Doppler sonography. The clitoral artery peak systolic velocities were significantly higher in postmenopausal women taking HRT compared with the control group (11.8 +/- 5.2 cm/second vs. 15.0 +/- 5.4 cm/second, P = 0.025). CONCLUSION HRT improves blood flow to the clitoris. A clitoral blood flow evaluation may be proposed as a potential tool to assess the impact of HRT on the genital tissues and to investigate female sexual response disorders in postmenopausal women.

Sonohysterography in evaluation of Youssef’s syndrome

A 31-year-old woman with Youssef syndrome was reported. Vesicouterine fistula is responsible for the symptoms of Youssef syndrome. An easy and feasible diagnostic method of vesicouterine fistula is sonohysterography.

The nitroxide tempol has similar antioxidant effects as physiological levels of 17β‐oestradiol in reversing ovariectomy‐induced oxidative stress in mice liver and kidney

Objective: Oestrogen defciency increases oxidative stress postmenopause, while tempol is an intracellular radical scavenger that interferes with the formation or effects of many radicals. We aimed to investigate the effects of oestrogen and tempol on oxidative stress parameters in the kidney and liver of ovariectomized mice. Material and methods: Forty 8‐week‐old female Bald/c mice were divided into five groups: sham‐operated, ovariectomized mice without treatment, ovariectomized mice treated with tempol, ovariectomized mice treated with 17β‐oestradiol and ovariectomized mice treated with 17β‐oestradiol and tempol. Oxidative stress in liver and kidney tissues was investigated by measuring 2‐thiobarbituric acid reactive substances (TBA‐RS), reduced glutathione, myeloperoxidase, superoxide dismutase and catalase levels. Results: TBA‐RS levels were increased and reduced glutathione, myeloperoxidase, superoxide dismutase levels were decreased in the tissues of ovariectomized mice. This effect of ovariectomy on oxidative stress parameters was opposed significantly by the administration of tempol and 17β‐oestradiol either alone or in combination. Ovariectomy reduced the kidney catalase levels, but the effect was not statistically significant (p>0.05). On the other hand, catalase levels were elevated significantly in all treatment groups compared to those of the ovariectomized group (p<0.05). Conclusion: These study findings demonstrate that tempol significantly opposes the oxidative stress generated by ovariectomy. This effect, which is evident in remote tissues such as liver and kidney, is comparable to that of physiological levels of oestradiol.

Endometriosis in two sisters with Glanzmann's thrombasthenia

OBJECTIVE To present two cases of endometriosis in patients with Glanzmanns thrombasthenia (GT) and discuss the underlying pathophysiology of endometriosis. DESIGN Case report. SETTING Gynecology practice in a university teaching hospital. PATIENT(S) Two sisters, aged 24 and 28 years, previously diagnosed as having GT. INTERVENTION(S) Surgical exploration. MAIN OUTCOME MEASURE(S) Pathologic examination of surgical specimens was performed. RESULT(S) A diagnosis of endometriosis was confirmed pathologically for two sisters previously diagnosed as having GT. CONCLUSION(S) Women with GT seem to represent an important human model of endometriosis from which important data on the pathophysiology of endometriosis can be acquired.