Semra Oruç

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.

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.

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).

Sexual life following total abdominal hysterectomy.

AimThe goal of this study was to evaluate the effect of total abdominal hysterectomy (TAH) on sexual lives of patients in the postoperative period.Materials and methodsEighty-six patients who accepted to participate a phone-questionnaire were recruited in the study after TAH or TAH + BSO. They were asked about sexual desire, pain during sexual intercourse, frequency and satisfaction of sexual intercourse at pre- and postoperative periods, and loss of “feeling a woman” in the postoperative period. Sexual desire, pain during sexual intercourse, loss of “feeling a woman” questions were answered as “yes” or “ no”, number of weekly sexual intercourse was recorded, and satisfaction was graded as no = 0, mild = 1 and complete = 2 points.ResultsWhile sexual desire and frequency were found to be significantly lower (p=0.026 and p=0.01 respectively), no difference was noted in dyspareunia and satisfaction. When the patients were divided into two groups according to the presence of endogenous or exogenous estrogen, no difference was seen between the two groups in the postoperative period.ConclusionWe concluded that the effect of TAH or TAH+BSO operations were mainly on sexual desire and the number of weekly intercourse, and estrogen in the postoperative period did not make any difference between the two groups.

Assessment of the effectiveness of postmenopausal tibolone therapy on neural functions by measuring visual evoked potentials: a placebo-controlled study

OBJECTIVE To assess the effect of hormone replacement therapy on neural transmission in postmenopausal women using tibolone by a non-invasive, objective way. STUDY DESIGN In a randomised, 3 cycle, placebo-controlled study, neurovisual transmission in optic pathways were evaluated by measuring visual evoked potentials (VEP). After neuroophtalmologic examination, eligible subjects were randomised into two groups. Treatment group (n=38) were given tibolone 2.5mg daily continuously for 3 months and control group (n=20) were treated with placebo. A baseline VEP measurement before the treatment and then at the end of first, second and third month were obtained by the EMG-evoked system in the Department of Neurology, University of Celal Bayar, Manisa, Turkey. RESULTS Data from 31 women from treatment group and 16 from control group were available for evaluation. The mean P(100) latency values, which indicate the transition time period between the optic stimuli and electrical change recorded on the occipital area by the skin electrodes, have showed a significant decrease for the study group (from 100.39+/-0.58 to 97.90+/-0.65 ms, P<0.01) at the end of the first month of treatment according to the baseline values. This difference between two groups has remained constant during the study period. CONCLUSION The change in latency measurements of VEP, reflecting the functional status in optic pathways from retina to occipital cortex were significantly different in the treatment group than in that of control. We concluded that a facilitating effect of tibolone was observed on neurovisual transmission.

Ectopic pregnancy following tubal sterilisation: a case report.

References 1 Attard EG, Spiteri AS. Ecballium elaterium: an invitro source of Cucurbitacins. Fitoterapia 2001; 72: 46–53. 2 Satar S, Gokel Y, Toprak N, Sebe A. Life-threateing uvular angioedema caused by Ecbalium elaterium. Eur J Emerg Med 2001; 8: 337–9. 3 Raikhlin-Eisenkraft B, Bentur Y. Ecbalium elaterium (squirting cucumber) – remedy or poison? J Toxicol Clin Toxicol 2000; 38: 305–8. 4 Koussidis GA, Mountantonakis S, Petrichou CC. Folk remedies still in use: a case of soft palate and uvular oedema due to Ecbalium elaterium. Int J Clin Pract 2002; 56: 817. 5 Eray O, Tuncok Y, Eray E, Gunerli A, Guven H. Severe uvular angioedema caused by intranasal administration of Ecbalium elaterium. Vet Hum Toxicol 1999; 41: 376–8. 6 Yesilada E, Ustun O, Sezik E, Takaishi Y, Ono Y, Honda G. Inhibitory effects of Turkish folk remedies on inflammatory cytokines: interleukin-1alpha, interleukin-1beta and tumor necrosis factor alpha. J Ethnopharmacol 1997; 58: 59–73. 7 Hussain A, Kay N. Tragal cartilage inferior turbinate mucoperiosteal sandwich graft technique for repair of nasal septal perforations. J Laryngol Otol 1992; 106: 893–5. 8 Sezik E, Yesilada E. Clinical effects of the fruit juice of Ecbalium elaterium in the treatment of sinusitis. J Toxicol Clin Toxicol 1995; 33: 381–3. 9 Vlachos P, Kanitsakis NN, Kokonas N. Fatal cardiac and renal failure due to Ecbalium elaterium (squirting cucumber). J Toxicol Clin Toxicol 1994; 32: 7.