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Effect of metformin on serum visfatin levels in patients with polycystic ovary syndrome

OBJECTIVE To evaluate serum visfatin levels and to determine the effects of metformin treatment on visfatin levels in patients with polycystic ovary syndrome (PCOS). DESIGN Cross-sectional study. SETTING University hospital. PATIENT(S) Nineteen patients with PCOS and 21 controls. INTERVENTION(S) Metformin was given to patients with PCOS, and serum visfatin levels were measured before and after treatment. MAIN OUTCOME MEASURE(S) Glucose, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, DHEAS, total T, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), and visfatin levels were measured. RESULT(S) Serum visfatin levels were significantly higher in women with PCOS than in controls. Visfatin could differentiate between women with and without increased diabetogenic risk at a cut-off value of 19.24 ng/mL, with a sensitivity of 93.3% and a specificity of 84%. In bivariate analysis of subjects, T, insulin, and waist circumference were significantly and positively correlated with visfatin. Treatment resulted in a significant decrease in body mass index and a decrease in visfatin concentration. After therapy, statistically significant decreases in HOMA-IR, fasting insulin, free T, and DHEAS concentrations were observed for the PCOS group. CONCLUSION(S) Circulating visfatin levels were higher in patients with PCOS than healthy controls, and metformin treatment significantly reduced circulating visfatin concentrations after 3 months of therapy.

Effect of postpartum counseling on postpartum contraceptive use

ObjectiveThe aim of this study was to evaluate the effect of postpartum counseling on postpartum contraceptive use.MethodsOne hundred and forty-three women who delivered between 1 January 2004 and 31 September 2004 and counseled about postpartum contraception were included in the study. The participants were interviewed by telephone. Age, gravidity, parity, and mode of delivery of the participants were recorded. Their method of contraception before pregnancy, their decision on the contraceptive method after counseling and the method actually used were asked.ResultsJust after postpartum counseling, 47 women (32.9%) decided to use the intrauterine device (IUD), 23 (16.1%) condoms, 16 (11.2%) progestin injections, 7 (4.9%) oral contraceptives, and 7 (4.9%) coitus interruptus for contraception. Thirty-six women (25.2%) did not decide on any method of use. At the time of the telephone interview the actual method used was learned. Fifty-one women (35.7%) were using coitus interruptus, 45 women (31.5%) condoms, and 14 (9.8%) the IUD. Sixteen women (11.2%) were reported as not using any methods.ConclusionIn spite of postpartum counseling, a high majority of the women appeared to use traditional and less effective contraceptive methods.

Ischemia-modified albumin as an oxidative stress marker in preeclampsia

Objective. We examined serum ischaemia-modified albumin (IMA) levels in normal pregnant and preeclamptic women. The primary aim of our study was to assess IMA in women with mild and severe preeclampsia. Methods. Serum ischaemia-modified albumin levels were measured in 18 normotensive and 36 preeclamptic pregnant women by enzyme linked immuno-sorbent assay. Patients were subdivided as having either mild (n = 18) or severe preeclampsia (n = 18). Receiver operating characteristic curve was constructed, and sensitivity and specificity were calculated based on the best cut-off. Results. IMA levels were significantly higher in the mild and severe preeclamptic groups than in the control group. IMA with a cut-off point of 0.31 identified women with preeclampsia with sensitivity 80% and specificity 77.8%. Conclusion. Our study demonstrates that serum levels of IMA correlate with severity of preeclampsia.

Serum lipocalin-2 as an insulin resistance marker in patients with polycystic ovary syndrome

Background: Our aim was to investigate levels of lipocalin-2 and its relationship with metabolic factors in women with polycystic ovary syndrome (PCOS). Materials/Subjects and methods: In this cross-sectional study, two groups of women were studied: group 1 consisted of women with PCOS (no.=30), and group 2 consisted of control women with normal ovulatory function (no.=30). The circulating levels of free testosterone (T), DHEAS, glucose, insulin, triglycerides (TG), HDL, LDL and lipocalin were measured. Insulin resistance was assessed using the homeostasis model assessment (HOMA-IR). In order to determine a lipocalin value indicating insulin resistance, receiver operating characteristic (ROC) curves were established. Results: Serum lipocalin was significantly higher in PCOS subjects (54.26±15.58 vs 26.09±7.47 ng/ml, p=0.0001). We found a close correlation between lipocalin and insulin, lipocalin and HOMA-IR, lipocalin and T, and lipocalin and DHEAS. A cut-off level of >39.54 ng/ml for serum lipocalin has a predictive value for insulin resistance of 81% sensitivity and 82.1% specificity. Conclusion: In our study, lipocalin-2 levels were found to be significantly higher in women with PCOS compared to body mass index-matched controls. Serum lipocalin-2 may prove to be a useful marker for insulin resistance in patients with PCOS.

Effect of Intranasal Estrogen on Vocal Quality

The objective of this study was to evaluate the effect of intranasal estrogen therapy on female vocal quality. Thirty-two women who had surgically induced menopause were included into the study group and examined through hall year for this study. Estrogen treatment was proposed to all of the patients. Twenty-three of them accepted the treatment protocols including oral (n=12) (2mg estradiol; Estrofem; Novo Nordisk, Denmark) and intranasal (n=11) (300 mc g 17beta-estradiol; Aerodiol; Servier, Chambray-les-Tours, France) form of estrogen. The rest of patients refused estrogen treatment and those patients constituted the control group (n=9). Vocal changes were evaluated with Voice Handicap Index (VHI) and acoustic analysis of voice variations (fundamental frequency [F0], SD F0, jitter, shimmer, normalized voice energy, and harmonics-to-noise ratio) at baseline and after 1-year follow-up. According to VHI, while voice improvement was not clear in oral estrogen group, it was significant at intranasal estrogen group. Voice quality in patients treated with hormone replacement therapy (HRT) was significantly higher than patients without HRT. But between two treatment groups, there were no any statistical discrepancy. According to acoustic analysis, vocal stability among the women who use HRT was significantly better than those who did not use. Intranasal estrogen exerted the most significant effects on vocal stability. The data of our study support that voice undergoes changes in lack of estrogen in surgically induced menopausal women. Taken together with the relevant studies, while oral estrogen replacement therapy shows a favorable influence on voice quality, it seems to be more pronounced with intranasal estrogen than oral form.

Evaluation of histopathological features and pregnancy outcomes of pregnancy associated adnexal masses.

Summary The aim of this study was to evaluate the pathological features and pregnancy outcomes of pregnancy-associated adnexal masses, between 2001 and 2007. During this period, 0.3% of deliveries (35) were associated with adnexal masses. Torsion or rupture of the adnexal mass complicated pregnancy in 17.1% (6/35) of the cases. The most common histopathological diagnosis was dermoid cyst in 40% of cases (14/35), and 8.5% of cases (3/35) were malignant, including borderline ovarian lesion. None of the patients had an adverse pregnancy outcome due to emergency laparotomy. Pregnancy-associated persistent adnexal masses with large size, complex or solid appearance and bilateral location can be managed surgically, which can decrease the risk of complications, such as torsion or rupture and which can diagnose malignancies early.

Are polycystic ovaries associated with cardiovascular disease risk as polycystic ovary syndrome

Aim. Our aim was to assess C-reactive protein (CRP) levels and insulin resistance in women with polycystic ovary syndrome (PCOS) or polycystic ovaries (PCO). Methods. The study population included 30 women with PCOS, 30 with PCO and 30 healthy controls. CRP and insulin resistance index (IRI) (fasting glucose/insulin) were measured. A receiver–operator characteristic (ROC) curve was constructed to determine the cut-off value of CRP to predict increased cardiovascular risk. Results. There were no statistically significant differences between the three groups with regard to age and body mass index. IRI was significantly lower in the PCOS group than in the PCO and control groups. No difference existed between the PCO and control groups. Median CRP levels in the control, PCO and PCOS groups were 0.75, 1.3 and 1.5 mg/l, respectively (p = 0.005). CRP could differentiate between women with and without increased cardiovascular risk at a cut-off value of 2.42 mg/l, with a sensitivity of 79% and a specificity of 81%. Conclusion. As in PCOS patients, women with PCO have higher serum CRP levels than healthy control women. This may contribute to increased cardiovascular disease risk in patients with PCO.

Meydanli compression suture: new surgical procedure for postpartum hemorrhage due to uterine atony associated with abnormal placental adherence.

Aim:  To inform about the clinical results of a new uterine compression suture technique used in the surgical management of postpartum hemorrhage due to uterine atony associated with abnormal placental adherence.

Evaluation of asymmetric dimethylarginine, nitric oxide levels and associated independent variables in obese and lean patients with polycystic ovarian syndrome

Objective. To evaluate the asymmetric dimethylarginine (ADMA) and nitric oxide (NO) levels in obese and lean patients with polycystic ovarian syndrome (PCOS) and find out their relation with hormonal and metabolic parameters. Methods. Twenty-two obese, 18 lean patients with PCOS and 11 obese, 24 lean healthy control patients were enrolled prospectively. Plasma ADMA and NO levels and arginine/ADMA ratio were evaluated on 3rd day of menstrual cycle after at least 10 h overnight fasting. Results. Plasma ADMA, NO levels and arginine/ADMA ratio were similar in the groups. ADMA level did not correlate with the hormonal and metabolic parameters in patients with PCOS. However, NO correlated inversely with fasting insulin (r = −0.353, p = 0.041) and homeostasis model of insulin resistance (HOMA-IR) (r = −0.379, p = 0.027). Arginine/ADMA ratio also correlated inversely with fasting insulin (r = −0.339, p = 0.050). In multinomial regression analysis the risk of low NO was associated independently with high fasting insulin (OR = 1.19, 95% CI 1.001–1.42, p = 0.049) and high HOMA-IR in patients with PCOS (OR = 2.26, 95% CI 1.03–4.98, p = 0.042). Conclusions. Insulin resistance may be the underlying mechanism of endothelial dysfunction through NO pathway in PCOS.

The effect of resveratrol on prevention of the development of postoperative adhesions in a rat model

Objective. Our aim was to investigate the anti-adhesion potential of resveratrol, a phytoestrogen naturally found in wine, in a rat uterine horn model. Methods. Lesions were created by laparotomy in the uterine horn of 70 rats, randomized before the operation into seven groups consisting of ten animals each: (1) control group, no adjuvant therapy; (2) intraperitoneal (IP) application of the resveratrol dilution vehicle, 10 mg/kg, before closing the laparotomy; (3) subcutaneous (SC) injection of dilution vehicle, 10 mg/kg, 30 min before the operation; (4) IP application of resveratrol, 10 mg/kg, before closing the laparotomy; (5) SC injection of resveratrol, 10 mg/kg, 30 min before the operation; (6) IP application of resveratrol, 10 mg/kg, before closing the laparotomy and continued SC daily for 5 days; and (7) SC injection of resveratrol, 10 mg/kg, 30 min before the operation and continued SC daily for 5 days. On the 14th postoperative day adhesion scores were determined. Levels of thiobarbituric acid-reactive substances and total antioxidant capacity (TAC) were also measured. Results. In animals treated with repeated SC resveratrol, adhesions were graded as significantly less severe than in the vehicle control group or the groups treated with resveratrol IP or IP plus SC. TAC of control group rats was significantly lower than that of animals treated with repeated SC resveratrol. Conclusion. Repeated SC resveratrol significantly reduces adhesion formation.