Süleyman Engin Akhan

Postmenopausal Hormone Replacement Therapy Use Decreases Oxidative Protein Damage

Objectives: The aim of this study is to evaluate oxidative protein damage (OPD) by investigating protein carbonyl (PCO) and nitrotyrosine (NT) levels, oxidative stress by total thiol (T-SH), erythrocyte glutathione (GSH) and nitric oxide (NO) levels in women receiving hormone replacement therapy (HRT). Materials and Methods: To examine the influence of oxidative stress on OPD, we studied 12 postmenopausal women who had received HRT for 6 months, and 13 postmenopausal women who did not receive HRT, as the control group. All subjects were non-smokers. Blood samples were drawn in the fasting state and processed within 1 h of collection. For NT and NO, serum samples were stored at –70°C until analysis; all other parameters were determined on the same day of collection. Results: After 6 months, plasma PCO and T-SH levels were decreased, GSH and NO levels were increased, and NT levels were not changed in 12 postmenopausal women receiving HRT. Except the NT levels, the rest of the parameters did not significantly change in the control group. Interestingly, mean NT levels in the control group increased significantly. Conclusions: A crucial part of the protective effect of HRT on the cardiovascular system arises secondary to the interaction between estrogen and vessel wall. Our results suggest that an important component of the mechanism underlying this interaction may depend on estrogen’s antioxidant effect and its preventive role in OPD.

The values of intratumoral mast cell count and Ki-67 immunoreactivity index in differential diagnosis of uterine smooth muscle neoplasms

In this study, the role of the count of intratumoral mast cells was examined and compared with the proliferative activity exhibited by Ki‐67 indices in the differential diagnosis of uterine smooth muscle tumors. Sixteen cases of leiomyosarcoma, nine cases of atypical leiomyoma and 16 cases of ordinary leiomyoma were included. The pathological features of the cases were determined by reviewing the archive materials including the patient records and hematoxylin‐eosin‐stained sections. Toluidine blue stain was used to highlight the intratumoral mast cells and they were counted in at least 40 high power fields. A standard streptavidin–biotin method was applied to the sections to highlight the Ki‐67 immunoreactive tumor cell nuclei. These proliferative cells were counted in at least 10 high‐power fields. Atypical leiomyomas tended to have a higher quantity of intratumoral mast cells than leiomyosarcomas and ordinary leiomyomas (P= 0.027 and P= 0.021, respectively). Leiomyosarcomas tended to have higher Ki‐67 immunoreactivity rates than atypical leiomyomas, although the difference was not statistically significant (P= 0.82). We concluded that the quantity of intratumoral mast cells is useful in the differential diagnosis between leiomyosarcomas and atypical leiomyomas, while the cell proliferation rate expressed by Ki‐67 immunoreactivity has a limited value.

Effects of Long-Term Oral Hormone Replacement Therapy on Plasma Nitric Oxide and Beta-Endorphin Levels in Postmenopausal Women

Objectives: The aim of this study is to evaluate the relationship between plasma nitric oxide (NO) and β-endorphin levels in women using hormone replacement therapy (HRT) for 12 months. Material and Methods: Our study group was composed of 55 patients who were in at least their second postmenopausal year. Of the 55 patients, 25 were in the control group. All 30 women in the study group received 2 mg 17β-estradiol + 1 mg norethisterone acetate tablets daily for 12 months. Plasma NO and β-endorphin levels were measured both before and after the study period and possible relationships were analyzed. Results: There was a significant increase in both β-endorphin (p = 0.0001, 10.93 ± 2.25 vs. 14.85 ± 2.49) and NO (p = 0.0001, 19.79 ± 4.01 vs. 27.83 ± 10.27) levels measured after the study in the HRT group. A correlation was seen between the increments in β-endorphin and NO levels in the HRT group. Conclusion: Continuous combined HRT raises both plasma NO and β-endorphin levels and a close relationship was found between the two molecules after therapy. We postulate that the increment in these molecules may explain some of the beneficial effects of HRT on cognitive function and mood.

Laparotomy or laparoscopic surgery? Factors affecting the surgeons choice for the treatment of ectopic pregnancy

Purpose:In this study, we aim to compare the surgeons’ choice on the ectopic pregnancy cases during the last four years. The differences between laparoscopy and laparotomy cases and the factors which directed the surgeon to choose either of the surgical methods were evaluated. Methods:Our study comprises 135 patients who were diagnosed as ectopic pregnancy and were hospitalized in the Gynecology Department of Istanbul Medical Faculty during 1996–1999. Results: During 1996–1999 a total of 118 cases had been diagnosed as tubal ectopic pregnancy and had been treated surgically. Seventy three patients (62%) had been treated with laparotomy while the rest 45(38%) had been treated laparoscopically. When compared, the amount of intraabdominal free blood volume was significantly higher in laparotomy group [270.45±466.72 mL laparoscopy group – 889.75±714 mL laparotomy group, (p=0.0001)]. When we considered haemoperitoneum amount according to the patients’ parity, intraabdominal blood volume was interestingly higher in multiparas [507±599.32 mL nulliparas vs. 768.68±749.15 mL mulltiparas, (p=0.044)]. The percent of cases with ruptured tubes was 64% for the laparotomy and 38% the laparoscopic cases; and the difference between two groups was significant (p=0.0013). Conclusion: Our study implied that haemodynamic stability and less intraabdominal free blood affect the surgeons’ decision between laparotomy and laparoscopy. Fewer multiparous patients are suitable for these criteria which leads to less laparoscopic surgery. These findings, which need to be clarified, lead to the idea of human factor affecting the surgeons’ choice indirectly.

OHVIRA syndrome presenting with acute abdomen: a case report and review of the literature☆

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) or Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital urogenital anomaly. A 13-year-old female presented with acute abdominal pain and dysmenorrhea. Ultrasonography and magnetic resonance imaging showed uterus didelphys, hematometrocolpos, obstructed hemivagina, and right renal agenesis. Hemivaginal septal resection and anastomosis between the obstructed hemivagina and the normal vagina was tried, but it was not possible. Unilateral hysterectomy was performed. HWW syndrome may present with acute abdomen and is usually treated with vaginal septum resection and drainage of the hematometrocolpos.

Treatment of vaginal agenesis using a modified McIndoe technique: Long-term follow-up of 23 patients and a literature review

BACKGROUND Congenital vaginal agenesis is a rare malformation with an incidence of one in 4000 to 5000 female newborns. The purpose of vaginal agenesis treatment is not only to create an adequate passageway for penetration but also to facilitate satisfactory sexual intercourse. OBJECTIVE To present the results of a modified McIndoe technique with respect to sexual function, vaginal length and complication rates in patients with vaginal agenesis. METHODS Between 2002 and 2010, 23 patients with vaginal agenesis were admitted to the Gynecology Clinic of Istanbul University School of Medicine (Istanbul, Turkey) for vaginal reconstruction. All patients underwent a modified McIndoe procedure. The long-term results with a follow-up period ranging from 18 to 118 months are presented. RESULTS The postoperative mean vaginal length was 8.4 cm (range 6 cm to 11 cm) in 19 patients who used the mould regularly. Among 14 patients who used the mould regularly and had partners, only one experienced severe pain during intercourse and 13 reported that they were engaging in satisfactory sexual activity with mild or no pain, and with good mucosal sensitivity. Conversely, two of three patients who used the mould irregularly experienced severe pain during intercourse and had a mean vaginal length of 6 cm (range 4 cm to 8 cm). CONCLUSION The findings suggest that a modified McIndoe technique is a simple, effective procedure for the treatment of vaginal agenesis; however, proper mould use after surgery remains the cornerstone of the treatment.

A Case of Distal Vaginal Agenesis Presenting with Recurrent Urinary Tract Infection and Pyuria in a Prepubertal Girl

BACKGROUND Isolated distal vaginal agenesis is a rare anomaly and mostly becomes symptomatic after menarche. We describe an unusual presentation of this anomaly in a prepubertal girl. CASE An 11-year-old prepubertal girl presented with recurrent urinary tract infection, pyuria, and right-sided renal agenesis. The findings of perineal inspection, ultrasonography, and magnetic resonance imaging were consistent with a distal vaginal agenesis with pyometrocolpos. Discharging pyometrocolpos with dissection of the atretic portion and a pull-through vaginoplasty were performed. A cystoscopy showed no sign of a vesicovaginal or uterine fistula. SUMMARY AND CONCLUSION This rare presentation of distal vaginal agenesis reminds us that congenital malformations of the female genital tract should be considered in patients with congenital anomalies of the urinary system and/or recurrent urinary tract infection, even during the prepubertal period.

Increased incidence of pelvic organ prolapse in women with acromegaly

OBJECTIVE To evaluate gynecological problems of female patients with acromegaly and the relationship of these problems with the activity of the disease. STUDY DESIGN Thirty-four women with acromegaly and 27 age- and body mass index-matched female healthy controls (HC) were included in the study. Demographic features, medical history, hormonal status and disease activity were obtained. A detailed gynecological examination was performed. RESULTS The incidence of pelvic organ prolapse (POP) was higher in patients with acromegaly (53%, n=18) compared to the HC (15%, n=4) (p=0.003). Limiting the analysis to only cases with previous pregnancy, POP was seen in 18 (60%) of 30 cases with acromegaly and in 4 (20%) of 20 of the HC (p=0.005). Additionally, in cases with prior vaginal delivery, POP was present in 18 (60%) of 30 cases with acromegaly and in 4 (24%) of 17 of the HC (p=0.02). The frequency of POP was similar in patients with controlled and uncontrolled acromegaly (p=0.3). CONCLUSION Acromegaly may facilitate occurrence of pelvic organ prolapse and may cause additional health issues in female cases.

The effect of urinary incontinence on sexual functioning in turkish women of reproductive and menopausal ages

ABSTRACT Objectives: The primary objective was to investigate the effects of urinary incontinence (UI) on Turkish womens sexual functioning. Methods: We evaluated 396 women and divided them into 4 groups: reproductive-aged women without UI (Group A), reproductive-aged women with UI (Group B), menopausal-aged women without UI (Group C), and menopausal-aged women with UI (Group D). Results: The mean Female Sexual Function Index (FSFI) score was significantly higher and the Becks Depression Inventory scores were significantly lower in Group A. FSFI scores showed a strong negative correlation with age and parity and a strong positive correlation with years of education. Conclusions: Our findings suggest that UI is an independent risk factor for female sexual problems.

Gebelikte adneksiyel kitleye yaklaşım: 27 olgunun analizi ve literatürün gözden geçirilmesi

The incidence of adnexal masses in pregnancy is approximately 1%. Most of them are corpus luteum and benign physiological cysts seen in first trimester. 90% of these cysts are resolved spontaneously in the second trimester. The rate of complication such as torsion and rupture in persisted cysts is about 25%. The risk of malignancy is between 2-5%. It is reasonable to perform surgery in cysts with high risk of malignancy or in cysts susceptible to complication, other masses can be treated conservatively. Suitable time for surgery is between 16th and 18th weeks of gestation. The traditional method of management of adnexal masses in pregnancy is laparatomy but in certain conditions laparoscopy can be performed. Most of the ovarian cancers detected inpregnacy are germ cell tumors and these can be operated conservatively. In this paper management of adnexal masses in pregnancy, difficulties in diagnosis, treatment methods and timing were mentioned. Besides that, 27 adnexal masses diagnosed during pregnancy in our clinic were analyzed under the view of the literature. i