Umur Kuyumcuoğlu

Risk factors for postmenopausal osteoporosis: anthropometric measurements, age, age at menopause and the time elapsed after menopause onset

Objectives. The aim of this study was to determine, how much the anthropometric measurements and age affect the femur and vertebra T-scores by using correlation and regression analysis in postmenopausal women. Methods. Data of 540 healthy postmenopausal women were included in this analysis. Bone mineral density was determined by dual energy X-ray absorptiometry (DXA). The data of the patients related to height, weight, age, age at menopause were obtained from records, and body mass index (BMI) was calculated (BMI = W (kg)/H(m2)). Statistical analyses were performed with SPSS 15.0 for Windows (SPSS, Chicago, IL). Results. Mean age and standard deviation of 540 postmenopausal women was 59.3 ± 8.4 years. The correlation coefficients among femur, vertebra T-scores, weight, the time elapsed after the menopause onset, age, BMI and height were found as follows, from higher to lower values with 0.465, 0.453, 0.411, 0.382, 0.232, respectively, and were statistically significant (p < 0.001). Conclusions. We determined the effects of the anthropometric measurements on osteoporosis from higher to lower influence as follows: weight, menopause age, age, BMI and height. Weight and menopause age of the patients were the major determinants for osteoporosis.

Analysis of Sensitivity, Specificity, and Positive and Negative Predictive Values of Smear and Colposcopy in Diagnosis of Premalignant and Malignant Cervical Lesions.

Background This study aimed to examine the positive and negative predictive value in the diagnosis of premalignant and malignant lesions of cervical colposcopy, the sensitivity and specificity of smear, and to evaluate the correlation with histopathology of abnormal cytology and colposcopy. Material/Methods The criteria for inclusion of patients with unhealthy cervix in the study were: Erosion, Chronic cervicitis, and Healed lacerations, Hypertrophied cervix, bleeding on touch, suspicious growth/ulcer/polyp on the cervix, and abnormal discharges from the cervix. Women with frank carcinoma cervix, pregnant females, patients with bleeding per vaginum at the time of examination, and those who had used vaginal medications, vaginal contraceptives or douches in the last 48 h of examination were excluded from the study. Demographic analysis was performed for 450 patients who were admitted to the clinic. Sensitivity, specificity, positive predictive value and negative predictive values of patients to identify cervical pathologies of smear and colposcopy were histopathologically calculated. The statistical software package SPSS 15.0 (SPSS Inc., Chicago, IL, USA) and Spearman‘s and Chi-Square tests were used for statistical analysis. Results Sensitivity, specificity, PPD and NDP of smear were 0.57%, 0.76%, 0.26%, 0.92% respectively. Sensitivity, specificity, PPD and NDP of colposcopy were 0.92%, 0.67%, 0.52%, 0.96% respectively. A statistically significant correlation was found between abnormal cytology and histopathology, and abnormal colposcopy finding and histopathology. Conclusions Women with clinical diagnosis of unhealthy cervix should be evaluated by cytology to detect any premalignant or malignant lesions. It was concluded that Pap smear, colposcopy and histopathology should be collectively evaluated to evaluate cervical findings in low socio-economic regions.

The Effect of Flurbiprofen as Prophylactic Analgesic before Hysterosalpingography

Hysterosalpingography (HSG) is associated with pain during the four-step procedure. This prospective, double-blind, randomized, placebo-controlled study was conducted to investigate the effect of the analgesic flurbiprofen, administered prior to HSG, in 60 women. Thirty women were randomized to receive 100 mg of flurbiprofen, orally, 1 h prior to HSG and a further 30 women were randomized to receive placebo. Injection of contrast medium was more painful than the other steps in the HSG procedure in both groups; however, there was no significant between-group difference in terms of pain experienced in the individual steps of HSG. Pain scores at 5 and 30 min after the procedure were compared between the two groups. There was a significant decrease in the visual analogue scale pain score in the flurbiprofen-treated group compared with the placebo-treated group at both time points. Thus, the authors recommend flurbiprofen as a prophylactic analgesic to be administered before HSG procedures.

Homologous type of malignant mixed Mullerian tumor of the uterus presenting as a cervical mass.

Malignant mixed Mullerian tumors are composed of a mixture of sarcoma and carcinoma. The carcinomatous element is usually glandular, whereas the sarcomatous element may resemble normal endometrial stroma (homologous or so-called carcinosarcoma). Here, we present a homologous type of malignant mixed Mullerian tumor of the uterus that presented as a cervical mass. We describe a 55-year-old patient who had a cervical mass arising from the uterus. We performed total abdominal hysterectomy and bilateral salpingo-oophorectomy and surgical staging (including (peritoneal washings, suspicious areas or peritoneal surfaces sampled, infracolic omental sampling, pelvic and paraaortic lymph node sampling, and appendectomy). Carcinosarcomas of the uterine cervix are extremely rare, and when a postmenopausal woman with a cervical mass is admitted to the gynecology clinic, the physician should keep in mind that the mass might be a carcinosarcoma.

Is Preeclampsia a New Risk Factor for Cochlear Damage and Hearing Loss

Objective: We investigated whether preeclampsia is a risk factor for cochlear damage and permanent hearing loss. Study Design: Prospective case-control study design. Setting: Academic tertiary medical center. Patients: Subjects included 40 patients with preeclampsia and 30 healthy pregnant women. Interventions: Otoscopic examinations and pure-tone audiometry, tympanometry, otoacoustic emissions (OAEs), and stapedial reflex tests were conducted for all subjects. Negative audiologic tests were reevaluated after the postpartum period. Statistical analyses were performed using &khgr;2 and binary logistic regression testing. Main Outcome Measures: We searched for signs of middle ear ventilation, damage of cochlea, and sensorineural hearing loss. Results: Eight patients from the preeclampsia group had 1 or more otological problems. Two patients from the control group were determined as having otological problems. Otoacoustic emissions of the right and left ears (p = 0.029, p = 0.044), hearing levels of right and left ear bone conduction (BC) at the 500-Hz frequency (right and left-BC 500), and left ear at the 2,000-Hz frequency (left-BC 2000) differed significantly between the preeclampsia and control groups (p = 0.040, p = 0.003, and p = 0.003). There was no significant difference in the OAEs between the right and left ears in the preeclampsia group (p < 0.05). The variables BC 500-left, BC 500-right, OAE-right, and OAE-left differed significantly between groups based on binary logistic testing. The odds ratio and 95% confidence intervals (95% CI) for these 4 risk variables were as follows: BC 500-left, 1.167 (1.044-1.306); BC 500-right, 1.117 (1.002-1.244); OAE-right, 0.642 (0.505-0.815); and OAE-left, 0.576 (0.475-0.698), respectively. Conclusion: Preeclampsia is a risk factor for cochlear damage and permanent hearing loss. Even if preeclampsia resolves after delivery, cochlear damage and permanent hearing loss remain unchanged in patients with preeclampsia.

Proposal of a Diagnostic Test for the Detection of Preterm Premature Rupture of Membranes Based on the Determination of Thyroid Hormones in Vaginal Washing Fluid

Objectives: To determine whether measurement of total T3 (triiodothyronine) , total T4 (thyroxine), free T3 (free triiodothyronine) and free T4 (free thyroxine) levels in vaginal fluid is useful for the diagnosis of preterm premature rupture of membranes (PPROM). Study Design: The PPROM group and normal pregnancy group consisted of 30 and 30 pregnant patients between 26 and 36 weeks’ gestation, respectively. Vaginal fluid total T4, free T4, total T3 and free T3 levels were measured in both groups. Results: Vaginal fluid total T3 and free T3 levels were not statistically significant in the PPROM group as compared with the control group (p = 0.087, p = 0.123, respectively). Vaginal fluid total T4 and free T4 levels were significantly higher in the PPROM group as compared with the control group (p = 0.002, p < 0.000, respectively). The optimal cut-off value for total T4 (0.866 µg/dl) gave a sensitivity level of 83.3% (65.3–94.3, 95% CI) at a specificity of 60.0% (40.6–77.3, 95% CI) with positive and negative predictive values of 67.6 and 78.3%, respectively. The optimal cut-off value for free T4 (0.079 ng/dl) gave a sensitivity level of 90% (73.4–97.8, 95% CI) at a specificity of 70.0% (50.6–85.2, 95% CI) with positive and negative predictive values of 75.0 and 87.5%, respectively. Conclusions: Total and free T4 measurements from vaginal fluids appears to be a useful marker of PPROM.

Amniotic fluid amino acid levels in non-immune hydrops fetalis: a case-control study

In a prospective case-control study, we compared the amniotic fluid amino acid levels in non-immune hydrops fetalis (NIHF) and normal fetuses. Eighty fetuses underwent amniocentesis for different reasons at the prenatal diagnosis unit of the Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University. Forty of these fetuses were diagnosed with NIHF. The study included 40 women each in the NIHF (mean age: 27.69 ± 4.56 years) and control (27.52 ± 5.49 years) groups, who had abnormal double- or triple-screening test values with normal fetuses with gestational ages of 23.26 ± 1.98 and 23.68 ± 1.49 weeks at the time of sample collection, respectively. Amniotic fluid amino acid concentrations (intra-assay variation: 2.26-7.85%; interassay variation: 3.45-8.22%) were measured using EZ:faast kits (EZ:faast GC/FID free (physiological) amino acid kit; Phenomenex, USA) by gas chromatography. The standard for quantitation was a mixture of free amino acids from Phenomenex. The levels of 21 amino acids were measured. The mean phosphoserine and serine levels were significantly lower in the NIHF group, while the taurine, α-aminoadipic acid (aaa), glycine, cysteine, NH(4), and arginine (Arg) levels were significantly higher compared to control. Significant risk variables for the NIHF group and odds coefficients were obtained using a binary logistic regression method. The respective odds ratios and 95% confidence intervals for the risk variables phosphoserine, taurine, aaa, Arg, and NH(4) were 3.31 (1.84-5.97), 2.45 (1.56-3.86), 1.78 (1.18-2.68), 2.18 (1.56-3.04), and 2.41 (1.66-3.49), respectively. The significant difference between NIHF and control fetuses suggests that the amniotic fluid levels of some amino acids may be useful for the diagnosis of NIHF.

A New and Practical Aspartate Aminotransferase Test in Vaginal Washing Fluid for the Detection of Preterm Premature Rupture of Membranes

Objectives: To determine whether measurement of aspartate aminotransferase (Ast) and alanine aminotransferase (Alt) levels in vaginal fluid is useful for the diagnosis of preterm premature rupture of membranes (PPROM). Study Design: The PPROM group and normal pregnancy group consisted of 36 and 48 pregnant patients between 26 and 36 weeks’ gestation, respectively. Vaginal fluid Ast and Alt levels were measured in both groups. Results: Vaginal fluid Alt level was not statistically significant in the PPROM group as compared with the control group (p = 0.064). Vaginal Ast level was statistically significant in the PPROM (14.4 ± 17.46 U/l) group as compared with the control group (3.08 ± 7.8 U/l; p = 0.001). The optimal cutoff value of 3 IU/l for Ast gave a sensitivity level of 91% at a specificity of 83%, with positive and negative predictive values of 80 and 93%, respectively. Conclusion: Ast measurement from vaginal washing fluid appears to be a useful marker for the detection of PPROM.