Yuksel Isik

Personality profile in patients with polycystic ovary syndrome

Abstract Aim: To investigate the personality traits of patients with polycystic ovary syndrome (PCOS). Methods: Forty-nine patients with PCOS and 34 healthy controls were enrolled in the study. Psychometric evaluation was made with the Minnesota Multiphasic Personality Inventory. Additionally, Short Form-36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) were also performed. Results: Polycystic ovary syndrome patients had significantly higher absolute and clinical elevation scores on depression, hysteria, psychasthenia and hypomania compared with the controls. Patients with PCOS had lower SF-36 physical and mental health summary scores and higher HADS anxiety and depression subscale scores. Conclusion: Polycystic ovary syndrome patients seem to have depressive, hysterical, psychasthenic and hypomanic personality traits.

The role of early determination of β-human chorionic gonadotropin levels in predicting the success of single-dose methotrexate treatment in ectopic pregnancy.

OBJECTIVE The aim of the study was to determine the importance of β-hCG level on day 4 following methotrexate (MTX) administration, and the difference between β-hCG levels assessed on day 0 and day 4 in predicting treatment success. MATERIAL AND METHODS A total of 68 women with tubal pregnancy, treated with a single dose of MTX, were selected for this retrospective study. RESULTS The success rate of single-dose MTX treatment in our clinic was 75% (51/68). Among 51 patients in whom MTX treatment was successful, 25 (36.8%) showed a decrease in β-hCG level of > 15% on days 0 and 4, and 44 (64.7%) showed a β-hCG level decrease of > 15% on days 4 and 7. For subjects with β-hCG decrease of > 15% on days 4 and 7, the standard error was 6.5%, and the area under the ROC curve was 81.7%, while the corresponding values for days 0 and 4 were 7.2% and 64%, respectively. CONCLUSIONS A decrease of > 15 % in β-hCG levels between days 0 and 4 does not seem to be a better predictor for success of single-dose MTX treatment for ectopic pregnancy than between days 4 and 7. A statistically significant difference was observed only in β-hCG levels on day 7 in both, successful and unsuccessful single-dose MTX groups.

Autonomic dysfunction in patients with polycystic ovary syndrome

OBJECTIVE To assess the autonomic system in patients with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS Thirty-seven adult patients with PCOS and 33 healthy controls were enrolled in the study. The electrophysiological assessments of the autonomic nervous system function were performed using sympathetic skin response and R-R interval variation tests. RESULTS The mean latency of sympathetic skin response in PCOS patients was significantly delayed compared with the controls (p = 0.001). The mean amplitude of sympathetic skin response was significantly lower in comparison with the controls (p = 0.01). Mean R-R interval variation during deep breathing was also significantly delayed (p = 0.04). CONCLUSION There are parasympathetic dysfunction and sympathetic dysfunction in patients with PCOS. This may be easily demonstrated with sympathetic skin response and R-R interval variation tests.

The evaluation of temperament and quality of life in patients with polycystic ovary syndrome

Abstract Aims: To evaluate the temperament and quality of life (QoL) of patients with PCOS. Materials and methods: Fifty-three adult patients with PCOS and 38 healthy controls were enrolled in the study. Demographic characteristics including age, education and body mass index (BMI) were recorded. Affective temperaments were assessed by the temperament evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A) scale. The general health-related quality of life (HRQoL) instrument used in this study was short Form 36. Hospital anxiety and depression scale (HADS) were also performed. Results: The patients with PCOS had significantly higher rates of depressive, anxious and hyperthymic scores compared to controls. The PCOS patients had significantly lower mean SF-36 health summary scores. Conclusions: TEMPS-A seems to be an easy and reliable test to evaluate temperament in PCOS patients.

Early postpartum lactation effects of cesarean and vaginal birth.

OBJECTIVES Breastfeeding has positive effects for both, the mother and the infant. The purpose of the study was to ex-amine how cesarean delivery and vaginal delivery influenced subsequent breastfeeding. The study was conducted at the Kırıkkale University Medical School. MATERIAL AND METHODS Breastfeeding outcomes after an elective cesarean delivery and after a planned vaginal delivery were compared. The study included 169 consenting mothers who gave birth to healthy infants (86 cesarean deliveries and 83 vaginal deliveries) between March and September 2001. All cesarean deliveries were performed under regional anesthesia. RESULTS Elective cesarean delivery was performed at a significantly earlier gestational age as compared to vaginal delivery (p = 0.001). Maternal age in the planned vaginal delivery group was significantly lower (p = 0.003). As for the change in prolactin levels, the results were similar but not statistically significant (p = 0.21). The frequency of breastfeeding per day did not differ significantly between the groups (p = 0.20). However, women after cesarean delivery tended to breastfeed more often than after vaginal delivery (p = 0.003). Mean number of points recorded at the first breastfeeding session, according to the LATCH charting system, was lower in the group after cesarean delivery as compared to vaginal labor. The difference between the average point scores of vaginal delivery and cesarean delivery mothers was found to be meaningful in favor of the women after vaginal delivery (p = 0.05). CONCLUSIONS Elective cesarean section has negative effects on breastfeeding. Our results indicate that cesarean section constitutes a risk factor for delayed lactogenesis.

HELLP Syndrome and Cerebral Venous Sinus Thrombosis Associated with Factor V Leiden Mutation during Pregnancy

Preeclampsia is a leading cause of maternal mortality and morbidity worldwide. The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality for women and their infants alike. Hormonal changes during pregnancy and the puerperium carry an increased risk of venous thromboembolism including cerebral venous sinus thrombosis (CVST). Factor 5 leiden (FVL) is a procoagulant mutation associated primarily with venous thrombosis and pregnancy complications. We report a patient with FVL mutation who presented with CVST at 24th week of pregnancy and was diagnosed as HELLP syndrome at 34th week of pregnancy.

A giant adenomyotic cyst originating from the cervix.

In adenomyosis, endometrial glands and stroma are found within the uterine musculature. The ectopic endometrial tissue seems to cause hypertrophy and hyperplasia of the surrounding myometrium, leading to a diffusely enlarged uterus. An adenomyoma outside the uterus is uncommon [1]. Patients with adenomyosis commonly report menorrhagia, chronic pelvic pain, and dysmenorrhea, although approximately one-third of women are asymptomatic [2]. Diagnosis rarely occurs before hysterectomy: some patients have small areas of diffuse disease that can be identified through microscopy only, although some patients have nodules that clinically resemble leiomyomas [3]. Indeed, affected patients commonly also have uterine leiomyomas [1]. The term cystic is used to describe either diffuse adenomyosis or adenomyomas with cysts at least 1 cm in diameter [4]. In the present report, a case of treatment-resistant adenomyosis of the uterus with unusual gross features is presented. Written informed consent was obtained from the patient for the publication of the present report. In November 2014, amarriedwoman aged 47 years presented to the School of Medicine, Kirikkale, Turkey. She had a history of menorrhagia and pelvic pain, for which she had been receiving nonsteroidal antiinflammatory drugs. Dysmenorrhea had worsened during the previous month. On pelvic examination, the uterus was found to be slightly enlarged. Through vaginal examination, amass of 75× 70mm in diameter was identified. The rest of her physical examination was unremarkable. Laboratory tests revealed a white blood cell count of 9700 cells per μL, a hemoglobin concentration of 114 g/L, a hematocrit of 33.6%, and a platelet count of 221 000 per μL. The serum concentration of cancer antigen 125 was elevated (63 IU/L). The biochemical profile was unremarkable. The serum concentrations of follicle-stimulating hormone and luteinizing hormone were increased, at 30 IU/L and 20 IU/L, respectively. Ultrasonography showed a mass arising from the cervix and projecting into the endometrial cavity and vagina. The gross appearance revealed cystic and solid areas. The prominent cystic component and hypervascularity on color power Doppler distinguished this mass from a leiomyoma. The mass was diagnosed as a uterine adenomyoma. A hysterectomy was performed. Because the patient was aged 47 years and perimenopausal, bilateral salpingo-oophorectomy was also undertaken. The uterus and both ovaries were normal in appearance, but amassmeasuring 70× 75 × 65mmwas attached to the cervix (Fig. 1).Microscopic evaluation showed a thickmuscular cystwall, lined with endometrial stroma and glands. Pregnancy must always be ruled out among women with abnormal uterine bleeding, especially when the uterus is enlarged. Adenomyotic cysts are usually observed in parous women, and are usually seen in association with diffuse adenomyosis uteri, but isolated adenomyotic cysts have also been detected [3]. Most cases of adenomyosis are diagnosed on hysterectomy among older women [4]. However, pelvic imaging has identified adenomyosis among adolescents (juvenile adenomyotic cyst) [5]. Recent reports using magnetic resonance imaging criteria suggest that the disease can cause dysmenorrhea and chronic pelvic pain among adolescents and youngwomen [5]. However, there is currently no standard to determine the threshold for an imagebased diagnosis of adenomyosis. Forty cases of uterine adenomyosis have been reported previously. Small adenomyotic cysts that do not usually exceed 5 mm in diameter have been found in hysterectomy specimens but larger adenomyotic cysts are extremely rare. Women with severe symptoms that do not improve after medical treatment might have to undergo surgery. The standard surgical treatment for adenomyosis is hysterectomy. However, some improvement has been noted after conservative surgery using endomyometrial ablation or resection, laparoscopic myometrial electrocoagulation, or excision of adenomyosis, although the follow-up has been limited (3 years) [6].

Delayed diagnosis of PRES and eclampsia in a concealed pregnancy.

Pre-eclampsia and eclampsia are well-known risk factors of posterior reversible encephalopathy syndrome. Early recognition and proper treatment result in complete reversibility of this disease. Concealed pregnancy obstacles a safe prenatal care and a safe planned delivery, because of latency in the diagnosis. We present a case of unrecognized posterior reversible encephalopathy syndrome, eclampsia and premature delivery due to concealed pregnancy.