Sevim Dincer Cengiz

Comparative effects of atorvastatin and simvastatin on the plasma total homocysteine levels in women with polycystic ovary syndrome: a prospective randomized study.

OBJECTIVE To test the hypothesis that statins improve hyperhomocysteinemia in women with polycystic ovary syndrome (PCOS). DESIGN A prospective randomized study. SETTING University Hospital. PATIENT(S) Fifty-two women with PCOS and 52 women matched for age and body mass index as controls. INTERVENTION(S) Patients were randomly divided into two groups for treatment: group 1, atorvastatin, 20 mg daily (n = 26), and group 2, simvastatin, 20 mg daily (n = 26). Blood samples were obtained before and after treatment. MAIN OUTCOME MEASURE(S) Serum homocysteine levels. RESULT(S) After 12 weeks of treatment, serum homocysteine levels in group 1 had decreased from 14.3 +/- 2.9 to 10.6 +/- 1.7 micromol/L; in group 2, the levels decreased from 13.6 +/- 2.1 to 11.1 +/- 1.9 micromol/L. Both two groups, free testosterone and total testosterone declined statistically significantly (38.3% and 36.5%; and 40.6% and 46.0%, respectively). In group 1, vitamin B(12) increased from 362.1 +/- 107 to 478.7 +/- 267 pg/mL; in group 2, it increased from 391.3 +/- 107 to 466 +/- 211 pg/mL, but the change did not reach statistical significance. There was a considerable decline in the homeostatic model assessment index in group 1 (40.0% to 32.1%). CONCLUSION(S) Treatment with statins in women with PCOS leads to decreases in serum homocysteine levels.

Sex-hormone-binding globulin early in pregnancy for the prediction of severe gestational diabetes mellitus and related complications.

Aims:  The aim of this study was to evaluate the predictive value of sex‐hormone‐binding globulin (SHBG) for the diagnosis of gestational diabetes mellitus (GDM), and to clarify the association between SHBG levels and GDM complications/medication requirements.

Depot-medroxyprogesterone acetate in anticoagulated patients with previous hemorrhagic corpus luteum

Objective To investigate the safety of depot-medroxyprogesterone acetate (DMPA) in women of reproductive age with prosthetic heart valves, as well as the impact of DMPA on the prevention of hemorrhagic corpus luteum in these patients with previous bleeding events. Methods In this prospective study we enrolled 13 patients who were receiving chronic anticoagulation for prosthetic heart valves, and who suffered from ovarian bleeding. After the initial bleeding episode(s), DMPA was initiated with the intent of preventing recurrent bleeding events by means of ovulation suppression. Follow-up included close monitoring of anticoagulation intensity, lipid profile, measurement of systolic and diastolic blood pressures and weight, and a general physical and gynecological examination. Results Of the participating 13 patients, one stopped DMPA after the third injection because she wanted to have a child. Among the remaining 12 women, over a mean follow-up of 39.9 months all patients were well and no hemorrhagic corpus luteum was observed. During the follow-up, anticoagulation intensity, assessed by the international normalized ratio (INR), was in the optimum therapeutic ranges at all times (range 2.5–3.5), except for values of 4.6, 5.8 and 5.9 in three patients at 9, 12 and 24 months, respectively. With regard to lipid profile, we observed a significant decrease in high-density lipoprotein cholesterol levels at 12 months, and significant increases in total cholesterol and triglyceride levels after 30 months compared to baseline serum levels. No significant changes were observed in serum low-density lipoprotein cholesterol levels. Mean body weight was higher at months 12 and 30, compared with baseline values (p > 0.05). Conclusion DMPA, which is an effective contraceptive agent, can be used to prevent bleeding from the corpus luteum by means of ovulation suppression in anticoagulated patients with prosthetic heart valves. However, meticulous surveillance should be provided during the follow-up, including close monitoring of anticoagulation intensity and lipid profile.

Prognostic value of p53 accumulation in epithelial ovarian carcinomas

Abstract Aim: To evaluate the prognostic significance of p53 expression in epithelial ovarian carcinomas (EOC), and to look for correlations between p53 and other disease parameters. Material and methods: Immunohistochemical techniques were used to evaluate p53 expression in paraffin-embedded tissue specimens of 50 EOC cases. Results: p53 immunoreactivity was present in 33 of the 50 cases (66%). The expression of the p53 did not show any association with the tumor histologic type, grade or with the disease stage. However, p53 accumulation was significantly more prevalent among tumors with high mitotic index (p<0.01). Although median survival was low in the p53 negative cases, this biologic marker did not reveal as an independent prognostic factor in Cox’s regression analysis. Conclusion: Abnormalities of p53 expression which is an inducer of apoptosis occur commonly in EOC. Although we could not find it as an independent prognostic factor, p53 expression should be studied in larger series to reveal its accurate prognostic significance.

Effect of hormone replacement therapy on serum levels of tumor markers in healthy postmenopausal women

OBJECTIVE The effect of hormone replacement therapy (HRT) on serum levels of tumor markers is barely defined. The aim of this study was to evaluate the effect of HRT on levels of tumor markers CA 125, CA 15-3, CA 19-9, CEA and alpha-FP. METHODS Retrospective analysis of prospectively collected data in healthy postmenopausal women under oral estrogen replacement therapy (ERT, conjugated equine estrogen (CEE) 0.625 mg (n = 21) or estradiol 2 mg (n = 31)), and continuous combined estrogen and progesterone regimen (HRT, CEE 0.625 mg plus medroxyprogesterone acetate 2.5 mg (n = 34) or estradiol 2 mg plus norethisterone acetate 1 mg (n = 37)). One hundred and twenty-three healthy women among a sampled population of 654 postmenopausal patients with complete records, initial normal tumor marker levels, and at least 1 year of follow-up were included into the study. Tumor markers were measured with 1-year interval. RESULTS Fifty-two (41.5%) patients were under ERT and 71 (58.5%) were under combined HRT. The number of months since menopause, age and age at menopause did not influence tumor marker levels at first admission. All of the tumor marker levels were in normal range after 1 year. Pretreatment CA 125 II, CA 15-3 and CEA levels were significantly low (median and range) 5.0 (1.0-11.8) versus 7.45 (1.0-18.1) U/ml for CA 125, 27.05 (7.3-37.5) versus 32.6 (12.5-37.9) U/ml for CA 15-3, 0.88 (0.58-2.8) versus 1.34 (0.53-2.41) ng/ml for CEA in women with hysterectomy when compared to women without hysterectomy. There was no effect of ERT on CA 125 II, CA 19-9, CEA and alpha-FP levels. E2 led to a significant decrease in post-treatment CA 15-3 levels [32.9 (8.1-34.9) vs. 18.1 (6.7-31.4); P < 0.001]. CA 125 levels were only significantly reduced in hysterectomised women using continuously combined HRT [7.9 (2.6-17.7) vs. 5.6 (1.3-19.2) for CEE+MPA, and 7 (1-18.1) vs. 5.8 (1.8-17.4) for E2 + NETA; P < 0.05]. There was a small, but not significant, increase in CA 125 levels in women under ERT. CONCLUSION Although there was a statistically significant decrease in CA 15-3 levels in current E2 and E2 + NETA users, and a decrease in CA 125 levels in combined regimens, this change is clinically not relevant in healthy postmenopausal women. This data will be useful for the caregivers in the management and follow-up of cancer survivors who preferred replacement therapy as the only treatment of their postmenopausal symptoms.

The Association of Osteocalcin and Adiponectin with Glucose Metabolism in Nondiabetic Postmenopausal Women

Background/Aim: This study was designed to determine if osteocalcin is associated with insulin resistance, metabolic risk factors and adiponectin levels in nondiabetic postmenopausal women. Methods: A total of 87 menopausal nondiabetic subjects were enrolled into the study. Levels of fasting plasma glucose (FPG), insulin and serum lipids were determined. To estimate insulin sensitivity, homeostasis model assessment (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) were used. Serum total osteocalcin and adiponectin levels were measured and the features of metabolic syndrome were identified. Results: The mean age of the patients was 54.7 years. Among the participants, 28.7% were obese (body mass index, BMI, ≥30). Insulin resistance was detected by HOMA-IR in 42.5% and by the QUICKI index in 63.2% of the cases. Metabolic syndrome was present in 29.8% of the patients. Neither the baseline characteristics nor the metabolic risk factors were correlated with osteocalcin or adiponectin levels (p > 0.05). When the patients were analyzed regarding BMI, osteocalcin levels were significantly lower in overweight women. Serum adiponectin levels were significantly lower in women with metabolic syndrome. Conclusion: No correlation between total osteocalcin and FPG, fasting insulin and insulin resistance parameters was found in nondiabetic postmenopausal women. Serum levels of adiponectin were associated with metabolic syndrome.

Effects of transdermal and oral hormone replacement therapies on monocyte chemoattractant protein-1 levels: a randomized clinical trial.

OBJECTIVES To assess the effects of oral and transdermal hormone replacement therapies (HRT) on levels of important cardiovascular disease (CVD) markers, MCP-1 and homocyteine, in the early postmenopausal period. STUDY DESIGN Seventy-six healthy, early postmenopausal women were enrolled in the study. Patients were randomly assigned to receive oral or transdermal HRT for 6 months. The first group received continuous combined oral HRT containing 1mg 17β-estradiol and 0.5mg norethisterone acetate (n=39), and the second group received sequential transdermal HRT releasing 50μg/day estradiol alone given twice a week on days 1-14 and 50μg/day estradiol plus 0.25mg/day norethisterone acetate given twice a week on days 15-28 (n=37). Circulating levels of MCP-1 and homocysteine, along with other CVD markers, were assessed before and after treatment in all patients. RESULTS There were no significant differences between the baseline characteristics of the two groups. Baseline serum MCP-1 levels were similar between the oral and transdermal HRT groups (150.1±12.8 vs. 145.2±11.6pg/ml; P=.219). The mean MCP-1 levels did not change after 6 months of HRT in both oral (150.1±12.8 vs. 153.6±12.5pg/ml; P=.192) and transdermal HRT groups (145.2±11.6 vs. 146.1±15.1pg/ml; P=.419). Moreover, there was no significant difference between the groups in MCP-1 serum levels after 6 months of HRT. Similarly, no difference was found in serum homocyteine levels following 6 months of HRT. CONCLUSIONS Both oral continuous and sequential transdermal HRTs do not have significant effects on serum MCP-1 and homocyteine levels in women during the early postmenopausal period.

Clinical and histopathologic predictors of reoperation due to recurrence of leiomyoma after laparotomic myomectomy.

To assess clinical and histopathologic risk factors for reoperation after laparotomic myomectomy due to leiomyoma recurrence.

The association between prolactin, high-sensitivity C-reactive protein and Framingham risk score in menopause.

Aims: To evaluate the association between serum prolactin, high-sensitivity C-reactive protein (hs-CRP) levels and cardiovascular disease risk in postmenopausal women regarding the Framingham Risk Score (FRS). Methods: Fifty-eight menopausal women were enrolled into the cross-sectional study. All participants had 24-hour ambulatory blood pressure monitoring, echocardiography, electrocardiography, and carotid intima-media thickness measurement. Blood samples were obtained for prolactin, hs-CRP, lipid profile, fasting glucose, and insulin. Results: Among the participants, 67.24% had a FRS <10%, and 32.75% had a FRS ≥10%. Levels of prolactin and hs-CRP did not differ between the FRS groups. In the FRS <10% group, significantly higher levels of prolactin were found. Cases with hypertension have significantly higher levels of hs-CRP. Prolactin and hs-CRP were found to be associated with hypertension in the FRS <10% and ≥10% groups, respectively. Conclusions: Hypertensive postmenopausal women with low risk for cardiovascular diseases have increased levels of prolactin, suggesting a possible role in the pathogenesis of hypertension. The correlation of hs-CRP with systolic blood pressure can be interpreted as a potential effect of hypertensive heart disease reflecting a state of high-risk milieu with elevated inflammatory markers.

Bilateral Salpingo-Oophorectomy During Vaginal Hysterectomy in Cases with Nonprolapsed Uterus: Role of Laparoscopy in a Residency Training Program Without Much Vaginal Salpingo-Oophorectomy Experience

We developed a laparoscopic-assisted vaginal salpingo-oophorectomy technique that increases the rate of successful bilateral salpingo-oophorectomy during vaginal hysterectomy. Our purpose was to de...