Tuncay Küçüközkan

Impact of hot flashes and night sweats on carotid intima–media thickness and bone mineral density among postmenopausal women

To determine whether postmenopausal women with vasomotor symptoms have a lower bone mineral density (BMD) and a higher carotid intima–media thickness (CIMT) than those without vasomotor symptoms.

Comparison of Sublingual Misoprostol With Lidocaine Spray for Pain Relief in Office Hysteroscopy: A Randomized, Double-Blind, Placebo-Controlled Trial

STUDY OBJECTIVE To compare the effectiveness of sublingual misoprostol with lidocaine pump spray for office hysteroscopy. DESIGN Premenopausal women who had an indication for office hysteroscopy were included in this randomized, double-blind, placebo-controlled study. Eighty-two patients were evaluable for the final analysis. SETTING A tertiary referral center. PATIENTS Premenopausal women who had an indication for office hysteroscopy were included. Eighty-two patients were evaluable for the final analysis. INTERVENTIONS Patients were randomized to receive either sublingual misoprostol and placebo of lidocaine or lidocaine pump spray applied to the cervix and placebo of misoprostol. MEASUREMENTS AND MAIN RESULTS When compared with the lidocaine group, patients in the misoprostol group reported less pain by the immediate visual analog scale scores (2.2 ± 0.98 vs. 2.6 ± 0.99, p = .030), whereas visual analog scale scores at 10 minutes were similar between groups (2.1 ± 0.98 vs. 2.36 ± 1.06, p = .156). CONCLUSION Sublingual misoprostol is more effective than lidocaine spray in pain reduction during office hysteroscopy. Misoprostol may cause vaginal spotting, which may impair the vision during hysteroscopy especially just after the menstrual period. Preventive measures should be taken to make the procedure pain free because the physician may underestimate pain perception during the procedure.

Ovarian gonadoblastoma with dysgerminoma in a 15-year-old girl with 46, XX karyotype: case report and review of the literature

ObjectiveTo present a challenging case of hCG positivity in a young patient and to review similar cases reported in the literature.MethodsLiterature search of gonadoblastoma cases with pure 46, XX karyotype using PubMed database.ResultsA 15-year-old girl with hCG positivity was investigated for the source and the initial diagnosis was an ectopic pregnancy. An ovarian tumor was identified after failed methotrexate therapy and the pathological diagnosis was gonadoblastoma with dysgerminoma. To the best of our knowledge, the case was unique in the literature for having the smallest diameter of a gonadoblastoma tumor with 46, XX karyotype.ConclusionDifferential diagnosis of perimenarcheal vaginal bleeding may be challenging for the clinician. Rare causes such as pregnancy both intrauterine and extrauterine and hormone producing tumors should be kept in mind.

Chocolate or orange juice for non-reactive non-stress test (NST) patterns: a randomized prospective controlled study

Abstract Objective: The objective of the study was to compare bitter chocolate and orange juice with the control group for non-reactive non-stress test (NST) patterns and for maternal perception of fetal movements. Study design: Pregnant women who were followed-up on an outpatient basis and admitted for a NST and had a non-reactive result were randomized prospectively into bitter chocolate, orange juice and control groups. 180 patients were evaluable for the final analysis. Results: Although there was a trend for orange juice group for having higher percentages of reactive NST patterns on control, there was no statistically significant difference between three groups (p = 0.159). Besides this, maternal perception of increased fetal movements was similar between groups (p = 0.755). The control group had lower post-test capillary blood glucose concentrations when compared with chocolate and orange juice groups (p = 0.01) and after post-hoc tests, this difference was found to be between orange juice and control groups. Conclusions: Although orange juice resulted in higher blood glucose levels, this was not synonymous with better NST results on control; in such a way that bitter chocolate, orange juice and no intervention had similar effects on non-reactive NST patterns and also on maternal perception of fetal movements.

Is hyperandrogenemia protective for fibrocystic breast disease in PCOS

The aim of this study is to evaluate the fibrocystic breast disease rates and its association with different clinical, endocrine and metabolic parameters between main polycystic ovary syndrome (PCOS) phenotypes. One hundred thirty two consecutive women were included in the study. Body mass index, serum follicle-stimulating hormone, luteinizing hormone (LH), progesterone, estradiol, testosterone, dehydroepiandrosterone sulphate, fasting glucose, low density lipoprotein (LDL-C), total cholesterol, high density lipoprotein, insulin, insulin sensitivity and fibrocystic breast disease rates were compared among different phenotypes of PCOS. Group 1: Polycystic ovaries (PCO)-anovulation (n = 32), Group 2: Hyperandrogenemia (HA)-anovulation (n = 28), Group 3: HA-PCO (n = 29), Group 4: HA-PCO-anovulation (n = 43). There were statistically significant differences between the different phenotype groups in terms of waist–hip ratio (p = 0.006), serum LDL-C (p = 0.008), LH (p = 0.002), estradiol (p = 0.022), fasting glucose (p = 0.001), progesterone (p = 0.007), free testosterone levels (p < 0.001) and Ferriman–Gallwey (FG) scores (p < 0.001). Different phenotype groups had significantly different fibrocystic breast disease rates. (p = 0.016). Higher free testosterone >3 pg/dl was protective for fibrocystic disease (RR = 0.316, 95:% CI 0.109–0.912, p = 0.033). Higher FG scores were more protective for fibrocystic disease (RR = 0.005, 95:% CI 0.001–0.042, p < 0.001). Group 3 ovulatory PCOS patients with PCO and hyperandrogenemia phenotype had lower risk to develop fibrocystic disease, while higher rates were observed in group 1 anovulatory-normoandrogenemic PCOS patients. Hyperandrogenemia is protective for fibrocystic diseases in PCOS.

Red blood cell distribution width: A simple parameter in preeclampsia

OBJECTIVE Preeclampsia is a serious disease and a leading cause of maternal and perinatal mortality and morbidity. Red blood cell distribution width (RDW), a measure of anisocytosis, is used as an inflammation marker in hypertension and cardiovascular diseases. Although the relationship between RDW and hypertension has been well documented, the association between preeclampsia and RDW is not clear. We aimed to investigate the relationship between RDW and preeclampsia and its severity. MATERIALS AND METHODS One hundred eighteen pregnant women with preeclampsia and one hundred twenty uncomplicated pregnant women were included in the study. Blood samples for routine CBC and RDW levels were analyzed. RESULTS The RDW values were significantly higher in preeclampsia group compared with the control group (15.23±1.96 vs 14.48±1.70, p<0.05). We also confirmed that RDW levels were significantly higher in severe preeclampsia group than mild preeclampsia group in subgroup analyses (15.08±2.07, 15.92±1.99, p<0.05). CONCLUSION Our study showed that there is an association between RDW and preeclampsia and also its severity. RDW, a marker which is easy, inexpensive and calculated as a part of blood cell count, can be used as a significant diagnostic and prognostic marker in patient with preeclampsia like the other cardiovascular diseases.

Does diurnal rhythm have an impact on fetal biophysical profile

Objectives. To investigate whether parameters in fetal biophysical profile (BPP) testing exhibit a diurnal rhythm and to discuss the probable factors associated with these variables. Methods. Thirty healthy primigravid patients carrying pregnancies between 35 and 40 completed weeks were enrolled for the study. Fetal BPP testing was performed for each patient both in the early morning (08:00–10:00 am) and in the late evening (08:00–10:00 pm), and the scoring parameters were compared between morning and evening tests. Results. BPP scores in the evening were significantly higher than that in the morning (p < 0.05). Deepest vertical amniotic pocket measurements and fetal breathing absence in the morning mostly contributed to this variation (p < 0.001). Fetal movement counts were also significantly lower in the morning tests (p < 0.001). Conclusions. The parameters of BPP exhibit circadian variations in healthy fetuses, which may be associated with many factors such as fetomaternal hormones. It is essential for the clinician to be aware of these changes when interpreting the results, as interventions based on false-positive results may have deleterious effects on both the mother and her fetus.

Hysterectomy for large symptomatic myomas: minilaparotomy versus midline vertical incision

ObjectiveThe aim of this study was to analyze the perioperative outcomes of laparotomy with conventional midline incision and minilaparotomy in patients with large myomas, in a prospective and randomized manner.Study designFrom January 2005 to January 2009, 205 consecutive hysterectomies for large symptomatic myomas had been performed by abdominal approach. Patients were randomly assigned to minilaparotomy or midline incision.ResultsGroups were compared and found to be similar in terms of age, gravida, parity, body mass index, uterine size, operative time and intraoperative hemorrhage volume. Length of hospital stay, rate of surgical site infection and postoperative fever were significantly higher in the conventional laparotomy group with midline incision.ConclusionMinilaparotomy is an applicable procedure in hysterectomy for large myomas in the majority of women, resulting in decreased length of hospital stay and complication rates.

Comparison of oxidative stress in pregnancies with and without first trimester iron supplement: a randomized double-blind controlled trial

Abstract Objective: Iron supplementation was found to be a cause of oxidative stress. The aim of this study was to compare oxidative stress in pregnancies with and without iron supplementation in the first trimester pregnancies. Methods: One hundred and eight women in the first trimester of normal pregnancies were randomly assigned to three groups. Patients were grouped as following: Group 1 received placebo (n = 36), group 2 received folate supplementation (n = 36) and group 3 was directed to the iron supplementation (n = 36). Oxidative stress was assessed at 14th week of gestation by the utilization of serum γ-glutamyl transferase level. Pregnancies were followed until delivery. Relationship between the oxidative stress and pregnancy outcome was assessed among groups. Results: Mean age was similar among groups, mean gravidity and parity were significantly lower in group with Fe supplementation (p < 0.05). Maternal weight and weight gain during pregnancy were also significantly lower in group 3 (p < 0.05). Mean serum albumin levels were similar among groups while serum γ-glutamyl transferase (GGT) levels were significantly higher in group 3. There were 10 cases of oligohydramnios in group 3, two cases in group 2 and no cases in group 1 (p < 0.001). Conclusion: Iron supplementation during first trimester pregnancy was found to be associated with an increased oxidative stress.

Myometrial elasticity determined by elastosonography to predict preterm labor

Abstract Aim: To determine the utility of elastosonography (ES) combined to cervical length measurement to predict preterm labor. Methods: One hundred twenty-seven women with pregnancies between 21 to 36 weeks of gestation without any risk factor for preterm labor were included in the study. All subjects underwent sonographic evaluation including fetal biometry, cervical length measurement and ES of uterine myometrium. Subcutaneous tissue was the reference point for ES evaluation. Tissue strain ratio values were obtained from all patients. Results: Cervical length was a significant predictor for preterm delivery (AUC = 0.958, p < 0.001). Optimal cut-off value was obtained at 30 mm with 92% sensitivity and 81% specificity. Elastosonographic strain ratio was also a significant predictor for preterm delivery (AUC = 0.827, p < 0.001). Optimal cut-off value was obtained at 4.7 with 79% sensitivity and 91% specificity. In linear regression analysis, strain ratio (R2 = 0.61, beta = 0.171, p = 0.03) and cervical length (R2 = 0.61, beta = −0.516, p < 0.001) were significantly associated with preterm delivery. Cervical length < 30 mm [39.1 (95 CI, 6.6–231.5, p < 0.001)] and strain ratio > 4.7 [24.5 (95 CI, 4.1–146.5, p < 0.001)] were the risk factors for preterm delivery. Conclusion: Elastosonographic evaluation of uterine myometrium was found to be significantly correlated with cervical length but cervical length measurement is a better predictor for preterm labor than ES.