Objective: Boron is a nutritionally important trace element that interacts with other micronutrients. Boron plays a critical role in bone mineralization and metabolism. In the present study, the association between boron and micronutrients related to bone metabolism was analysed in postmenopausal women. Methods: In a prospective cohort study in 40 postmenopausal women 24-hour urine and blood samples were collected for sodium, phosphorus, calcium, magnesium, and boron. Daily food consumption, bone mineral density, and Fracture risk assessment tool scores were recorded. Results: The mean age was 53.2 ± 5.9 years. Dietary habits revealed insufficient dietary fiber and excessive dietary sodium. The serum and urine boron levels were 26.80 μg/L and 21.22 μg/day, respectively. Urine boron levels were lower in the osteoporosis group (p = 0.66). A negative correlation between urine Na and boron was detected (p < 0.001). Urinary Na and Ca are negatively correlated with Fracture risk assessment tool scores (p = 0.010, p = 0.019, respectively). Conclusion: The low urinary boron levels in our participants might be due to increased Na excretion due to excessive consumption of Na. Therefore, consulting postmenopausal women about their dietary habits is of concern. Further understanding of the role of boron in bone metabolism will help to accomplish new treatment strategies for osteoporosis and standardization of boron supplementation.

This study was designed to explore matrix metalloproteinase-9 (MMP-9), neutrophil gelatinase-associated lipocalin (NGAL) levels and MMP-9/NGAL ratio in women with and without endometriosis diagnosed surgically and/or histopathologically. The correlation between biomarkers and the severity of the disease is analysed. The revised American Fertility Society classification system was used to determine the severity of endometriosis. Serum MMP-9 and Ca125, urine NGAL levels were measured in all participants. Serum MMP-9 levels were significantly higher in the study group (n = 60) compared to controls (n = 31) (15.0 pg/mL (6.0-143.0) vs. 12.0 (4.0-18.0), respectively; p=.002). MMP-9 levels were significantly higher in severe endometriosis compared to mild endometriosis subgroups (p<.001). No significant difference was found between NGAL levels in study and control groups (p>.05). The diagnostic value of MMP-9 and NGAL is not superior than CA-125 for endometriosis. Nevertheless, MMP-9 might be a potential predictive marker for advanced stage of the disease.Impact Statement What is already known on this subject? The gold standard diagnostic test for diagnosis of endometriosis is laparoscopy combined with histopathological confirmation of eutopic endometrial glands and/or stroma. Both invasiveness and possible accompanying complications limit the preference regarding the surgical approach. Among non-invasive markers none has been accepted as gold standard neither for diagnosis nor for determining the severity of the disease. MMPs are extracellular endopeptidases, which have a significant role in degradation and remodelling of extracellular matrix for cellular migration and invasion. Among these, MMP-9 has been shown to be higher in eutopic/ectopic endometrial tissue in women with endometriosis and has been suggested to have a role in pathogenesis of endometriosis by promoting invasion of the endometriotic lesions. NGAL is an acute phase protein, which is involved in a variety of physiological and pathophysiological processes. The molecule has also been revealed to correlate with endometriosis pathophysiology through the epithelial-mesenchymal transition process which is the basis for the onset of endometriosis. But also, NGAL which composes a complex with MMP-9 (MMP-9 and NGAL complex), has been shown to protect MMP-9 from autodegradation in vitro which might be a contributing factor for endometriosis pathophysiology. What the results of this study add? MMP-9 cut-off level for prediction of severe endometriosis is a novel finding obtained from this study with acceptable sensitivity and specificity. On the other hand, NGAL seems to have no significant value either for diagnosis of for determining severity of the disease. After all, MMP-9 might be an easy use acceptable biomarker for endometriosis but further studies on larger populations are needed. What are of these findings for clinical practice and/or further research? MMP might be a potential non-invasive predictive marker for advanced stage disease.

Introduction: Puerperal infection remains a significant cause of maternal morbidity and mortality. Those infections occur more likely after cesarean delivery (CD). Prophylactic antibiotics are administered at the time of CD to prevent complications. In addition to intraoperative prophylaxis; prescription of antibiotics during hospital discharge to prevent surgical site infections (SSI) is quite common. Purpose of this study is to determine the utility of prophylactic oral antibiotic prescription in a cohort of low-risk women undergoing CD. Materials and methods: A prospective observational study was conducted between 2014 and 2018 at Ufuk University School of Medicine, Department of Obstetrics and Gynaecology. Total of 389 low risk elective cesarean deliveries were selected. All cases received intraoperative prophylaxis. In group I (157 subjects), no further antibiotics were given and in group II (232 cases), oral cephuroxime 500 mg was given during hospital discharge. Primary outcome was SSI. Secondary outcomes were endometritis and other infectious conditions. Results: Overall SSI rate was 2.5%. Only 2 SSIs were noted in group 1 (1.2%) compared to eight in group II (3.4%). There was no statistical difference in SSI rate between two groups. Secondary outcomes were also comparable. Conclusion: In this study, we failed to reveal any beneficial effect of oral antibiotic prescription during hospital discharge in low risk elective CDs. Therefore, use of oral antibiotics in addition to intraoperative prophylaxis should be questioned in terms of increased costs, emergence of bacterial resistance and long term effects on new born as a consequence of changes in gut microbiome.

Objective: Management of incidentally diagnosed thick endometrium in asymptomatic postmenopausal women is controversial.Current study aims to evaluate the hysteroscopy and histopathological findings in postmenopausal women who have either postmenopausal bleeding or incidentally found thickened endometrium.Material and Methods: The retrospective study was conducted in the Gynecology Department of an University Hospital covering medical records of women between 2012 and 2018.Totally the records of 65 postmenopausal women, all of whom were evaluated with hysteroscopy, either with postmenopausal bleeding (Group A, n=30) or incidentally found thickened endometrium (Group B, n=35) were included.All patients were evaluated with transvaginal ultrasound and hysteroscopy.Intraoperative and postoperative findings were recorded and evaluated for two groups.Results: In Group A, histopathological evaluation revealed endometrial hyperplasia without atypia in one patient (1/30, 3%) and endometrioid adenocarcinoma in one patient (1/30, 3%).In Group B, one case (1/35, 3%) was reported to have endometrial hyperplasia without atypia, one case had endometrial hyperplasia with atypia (1/35, 3%) and one woman endometrioid adenocarcinoma (1/35, 3%).Accuracy of hysteroscopic findings were 70% (21/30) in Group A and 91% (32/35) in Group B. Conclusion: As an incidental finding, thick endometrium seems to be as important as postmenopausal bleeding, as the results of this study shows similar outcomes in terms of premalignant lesions and endometrial cancer in both groups.Even in the absence of risk factors further evaluation and endometrial sampling should be considered for postmenopausal women with incidentally diagnosed thick endometrium.

Uterine compression sutures may be life and fertility saving interventions in management of uterine atony. However, unintended long-term outcomes may occur and there is scarce literature about management. Herein, management of long-term adverse outcomes (synechia, pelvic pain and pelvic collection) of three different cases who had to be treated by uterine compression sutures is reported with review of the literature.

OBJECTIVE: Aquacryl hydrogel is one of the cervical dilatators which is a synthetic rigid hydroscopic gel rod, indicated to be used for cervical preparation. The authors aimed to determine whether preoperative cervical preparation with Aquacryl hydrogel before hysteroscopy has any favorable effects either for the patient (pain scores) or for the surgeon (ease of the procedure). STUDY DESIGN: The randomized controlled trial was undertaken in the Obstetrics and Gynecology Department of a University setting. Forty-three reproductive age women scheduled for hysteroscopy due to gynecological indications were randomized to receive hydroscopic dilatators for cervical preparation (n=19) or no intervention before the procedure (n=27). Visual analog scale (VAS) was used to evaluate pain scores until the operation. Analgesic administration was done in case of a VAS score ≥40 or patients’ demand for analgesia.Intraoperatively, mean arterial pressure and pulse were documented in order to evaluate analgesic requirement. RESULTS: Median VAS scores at hydroscopic dilatator administration 0th, 1st, 2nd, 3rd, and 4th hours after insertion were 29±24 (0 - 80), 14±15 (0 - 6), 13±15 (0 - 5), 8±9 (0 - 30) and 5±9 (0 -3), respectively; where pain score significantly decreased in time (p<0.05). There was no significant difference between mean arterial pressure and heart rate values between groups throughout the preoperative and intraoperative follow up (p>0.05). CONCLUSION: This study revealed that, Aquacryl hydrogel for cervical priming before office hysteroscopy is not effective to reduce the pain of patients’ during the procedure but also does not ease access to the uterine cavity. Therefore, it is not advantageous for the patient to use this agent before hysteroscopy.

Uterine incarceration during pregnancy is a rare complication with an incidence of 1 in 3000 pregnancies (Gibbons and Paley, 1969). Anatomic displacement of the growing uterus may cause adjacent or...

Postpartum urinary retention (PUR), which is defined as difficulty in emptying the bladder completely after delivery, may be clinically pronounced or silent. The incidence differs according to the definition. Although many risk factors for this disturbance are identified in the literature, every patient at risk does not necessarily present with PUR. There is no consensus in the literature regarding management.

Aims: To evaluate the association between serum prolactin, high-sensitivity C-reactive protein (hs-CRP) levels and cardiovascular disease risk in postmenopausal women regarding the Framingham Risk Score (FRS). Methods: Fifty-eight menopausal women were enrolled into the cross-sectional study. All participants had 24-hour ambulatory blood pressure monitoring, echocardiography, electrocardiography, and carotid intima-media thickness measurement. Blood samples were obtained for prolactin, hs-CRP, lipid profile, fasting glucose, and insulin. Results: Among the participants, 67.24% had a FRS <10%, and 32.75% had a FRS ≥10%. Levels of prolactin and hs-CRP did not differ between the FRS groups. In the FRS <10% group, significantly higher levels of prolactin were found. Cases with hypertension have significantly higher levels of hs-CRP. Prolactin and hs-CRP were found to be associated with hypertension in the FRS <10% and ≥10% groups, respectively. Conclusions: Hypertensive postmenopausal women with low risk for cardiovascular diseases have increased levels of prolactin, suggesting a possible role in the pathogenesis of hypertension. The correlation of hs-CRP with systolic blood pressure can be interpreted as a potential effect of hypertensive heart disease reflecting a state of high-risk milieu with elevated inflammatory markers.

Objectives: To assess the effects of oral and transdermal hormone replacement therapies (HRT) on levels of important cardiovascular disease (CVD) markers, MCP-1 and homocyteine, in the early postmenopausal period.Study design: Seventy-six healthy, early postmenopausal women were enrolled in the study. Patients were randomly assigned to receive oral or transdermal HRT for 6 months. The first group received continuous combined oral HRT containing 1 mg 17 beta-estradiol and 0.5 mg norethisterone acetate (n = 39), and the second group received sequential transdermal HRT releasing 50 mu g/day estradiol alone given twice a week on days 1-14 and 50 mu g/day estradiol plus 0.25 mg/day norethisterone acetate given twice a week on days 15-28 (n = 37). Circulating levels of MCP-1 and homocysteine, along with other CVD markers, were assessed before and after treatment in all patients.Results: There were no significant differences between the baseline characteristics of the two groups. Baseline serum MCP-1 levels were similar between the oral and transdermal HRT groups (150.1 +/- 12.8 vs. 145.2 +/- 11.6 pg/ml; P = .219). The mean MCP-1 levels did not change after 6 months of HRT in both oral (150.1 +/- 12.8 vs. 153.6 +/- 12.5 pg/ml; P = .192) and transdermal HRT groups (145.2 +/- 11.6 vs. 146.1 +/- 15.1 pg/ml; P = .419). Moreover, there was no significant difference between the groups in MCP-1 serum levels after 6 months of HRT. Similarly, no difference was found in serum homocyteine levels following 6 months of HRT.Conclusions: Both oral continuous and sequential transdermal HRTs do not have significant effects on serum MCP-1 and homocyteine levels in women during the early postmenopausal period. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

INTRODUCTION:Paraovarian or paratubal cysts (PTCs) constitute about 10 % of adnexial masses. Although they are not uncommon; they rarely cause symptoms and are usually incidentally found. Actual incidence is not known. The symptoms occur when they grow excessively, or in case of hemorrhage, rupture or torsion.METHODS:Here, literature review reporting the incidence, presentation and complications of PTCs is performed. Uncommon presentations of PTCs in three different cases, a giant PTC, torsion of PTC and borderline paratubal tumor, are also reported and discussed.RESULTS:Ultrasonography, CT or MRI may be performed in preoperative evaluation; but none of these imaging techniques have specific criteria for diagnosis. So, in most cases misdiagnosis as an ovarian mass remains to be a problem.CONCLUSION:Paratubal cysts can become extremely big before causing symptoms. Torsion is another urgent issue regarding PTCs, necessiating urgent surgery for preservation of the ovary and the tube. Although malignancy is rare, borderline paratubal tumors have been reported in the literature.

This is the first case of tubal polyp detected at the age of menapouase causing postmenapousal bleeding. The only finding was thickened endometrium at transvaginal ultrasonography. After hysteroscopic polypectomy, the endometrial thickness were within normal range for menapouse and at the follow-up the bleeding did not recur. Hysteroscopic polypectomy lead to subjective improvement in symptoms of bleeding and high satisfaction rates in this case. In postmenopausal persistent vaginal bleeding and increased endometrial thickness, intramural tubal polyps might be kept in mind in differential diagnosis. In such a situation hysteroscopy seems to be a simple method both for diagnosis and treatment instead of repetetive endometrial biopsies.

OBJECTIVE: To emphasize the neglected vulva/vaginal lesions and symptoms commonly encountered in daily practice. STUDY DESIGN: The data of 98 patients with vulva or vaginal biopsies were collected retrospectively. The histopathological diagnosis of 82(83.67%) vulvar and 16(16.32%) vaginal biopsy cases were evaluated. RESULTS: The most common symptom was mass in 67% and 62% of cases in vulvar and vaginal region, respectively. Among the vulvar lesions the most frequent histopathological diagnoses were condyloma acuminatum (20.73%), hyperkeratotic papilloma (14.63%), non-spesific inflammatory changes (12.19%), fibroepithelial polyp (9.75%) and bartholin cyst (8.53%). On the other hand, the histopatological evaluation of the vaginal lesions revealed vaginal stromal polyp (25%) and gartner cyst (25%) as the most frequent lesions. CONCLUSIONS: The results of the study document lesions commonly not well known or disregarded by gynecologists. The literature is inconclusive about vulvavaginal diseases. Expanded data will help the clinicians in making correct diagnoses and patient managament.

Polycystic ovary syndrome (PCOS) shares some or most components of metabolic cardiovascular syndrome, manifested by abdominal obesity, insulin resistance, dyslipidaemia and atherosclerosis. It has been previously demonstrated that folate and vitamin B12 treatment improved insulin resistance in patients with metabolic syndrome. This study first investigated whether PCOS patients have lower or higher vitamin B12, folate and homocysteine concentrations when compared with healthy, age and body mass index matched controls, and, then examined associations between vitamin B12, folate, homocysteine and insulin resistance and obesity in PCOS patients. Homocysteine concentrations and homeostasis model assessment index were higher, whereas concentrations of vitamin B12 were lower in PCOS patients with insulin resistance compared with those without insulin resistance. Serum vitamin B12 concentrations were significantly lower in obese PCOS women in comparison with obese control women (P < 0.05). Fasting insulin, insulin resistance and homocysteine are independent determinants of serum vitamin B12 concentrations in PCOS patients. Insulin resistance, obesity, and elevated homocysteine were associated with lower serum vitamin B12 concentrations in PCOS patients.

Objective: To test the hypothesis that statins improve hyperhomocysteinemia in women with polycystic ovary syndrome (PCOS).Design: A prospective randomized study.Setting: University Hospital.Patient(s): Fifty-two women with PCOS and 52 women matched for age and body mass index as controls.Intervention(s): Patients were randomly divided into two groups for treatment: group 1, atorvastatin, 20 mg daily (n = 26), and group 2, simvastatin, 20 mg daily (n = 26). Blood samples were obtained before and after treatment.Main Outcome Measure(s): Serum homocysteine levels.Result(s): After 12 weeks of treatment, serum homocysteine levels in group 1 had decreased from 14.3 +/- 2.9 to 10.6 +/- 1.7 mu mol/L; in group 2, the levels decreased from 13.6 +/- 2.1 to 11.1 +/- 1.9 mu mol/L. Both two groups, free testosterone and total testosterone declined statistically significantly (38.3% and 36.5%; and 40.6% and 46.0%, respectively). In group 1, vitamin B-12 increased from 362.1 +/- 107 to 478.7 +/- 267 pg/mL; in group 2, it increased from 391.3 +/- 107 to 466 +/- 211 pg/mL, but the change did not reach statistical significance. There was a considerable decline in the homeostatic model assessment index in group 1 (40.0% to 32.1%).Conclusion(s): Treatment with statins in women with PCOS leads to decreases in serum homocysteine levels. (Fertil Steril (R) 2009;92:635-42. (C)2009 by American Society for Reproductive Medicine.)

Objective: The effect of hormone replacement therapy (HRT) on serum levels of tumor markers is barely defined. The aim of this study was to evaluate the effect of HRT on levels of tumor markers CA 125, CA 15-3, CA 19-9, CEA and α-FP. Methods: Retrospective analysis of prospectively collected data in healthy postmenopausal women under oral estrogen replacement therapy (ERT, conjugated equine estrogen (CEE) 0.625 mg (n=21) or estradiol 2 mg (n=31)), and continuous combined estrogen and progesterone regimen (HRT, CEE 0.625 mg plus medroxyprogesterone acetate 2.5 mg (n=34) or estradiol 2 mg plus norethisterone acetate 1 mg (n=37)). One hundred and twenty-three healthy women among a sampled population of 654 postmenopausal patients with complete records, initial normal tumor marker levels, and at least 1 year of follow-up were included into the study. Tumor markers were measured with 1-year interval. Results: Fifty-two (41.5%) patients were under ERT and 71 (58.5%) were under combined HRT. The number of months since menopause, age and age at menopause did not influence tumor marker levels at first admission. All of the tumor marker levels were in normal range after 1 year. Pretreatment CA 125 II, CA 15-3 and CEA levels were significantly low (median and range) 5.0 (1.0–11.8) versus 7.45 (1.0–18.1) U/ml for CA 125, 27.05 (7.3–37.5) versus 32.6 (12.5–37.9) U/ml for CA 15-3, 0.88 (0.58–2.8) versus 1.34 (0.53–2.41) ng/ml for CEA in women with hysterectomy when compared to women without hysterectomy. There was no effect of ERT on CA 125 II, CA 19-9, CEA and α-FP levels. E2 led to a significant decrease in post-treatment CA 15-3 levels [32.9 (8.1–34.9) vs. 18.1 (6.7–31.4); P<0.001]. CA 125 levels were only significantly reduced in hysterectomised women using continuously combined HRT [7.9 (2.6–17.7) vs. 5.6 (1.3–19.2) for CEE+MPA, and 7 (1–18.1) vs. 5.8 (1.8–17.4) for E2+NETA; P<0.05]. There was a small, but not significant, increase in CA 125 levels in women under ERT. Conclusion: Although there was a statistically significant decrease in CA 15-3 levels in current E2 and E2+NETA users, and a decrease in CA 125 levels in combined regimens, this change is clinically not relevant in healthy postmenopausal women. This data will be useful for the caregivers in the management and follow-up of cancer survivors who preferred replacement therapy as the only treatment of their postmenopausal symptoms.

We developed a laparoscopic-assisted vaginal salpingo-oophorectomy technique that increases the rate of successful bilateral salpingo-oophorectomy during vaginal hysterectomy. Our purpose was to determine whether this technique increases the rate of vaginal hysterectomy and bilateral salpingo-oophorectomy in a residency training program that does not have much experience with vaginal salpingo-oophorectomy in nonprolapsed uteri. Thirty-four (34) consecutive women with nonprolapsed uteri requiring hysterectomy and bilateral salpingo-oophorectomy were treated with vaginal hysterectomy and bilateral salpingo-oophorectomy. All patients underwent an initial diagnostic laparoscopy. Six (6) women (17.6%) had minimal periovarian adhesions that lysed laparoscopically. Residents' perception of their surgical skills in vaginal hysterectomy were evaluated before and after the surgeries using the five-point Likert scale. The goals were total vaginal hysterectomy, bilateral vaginal salpingo-oophorectomy, and laparoscopic-assisted vaginal salpingo-oophorectomy if vaginal access to adnexa was not possible. Senior residents performed all surgical tasks. Vaginal hysterectomy was successful in all women. Of 34 women, 12 (35.3%) had laparoscopic-assisted vaginal removal of the adnexa, 7 had unilateral, and 5 had bilateral laparoscopic-assisted salpingo-oophorectomy. There were no differences between the vaginal and laparoscopic-assisted salpingo-oophorectomy groups except the duration of salpingo-oophorectomies (15.9 versus 27.6 minutes, p < 0.001). Mean operating time, uterine weight, blood loss, and mean length of hospital stay were the same in both groups. Residents' perceptions of their surgical skills in performing vaginal hysterectomy were improved after the operations. Overall, performing vaginal hysterectomy in nonprolapsed uteri increased the total number of vaginal hysterectomies done by the senior residents by a factor of 3.04. Total vaginal hysterectomy is possible in nonprolapsed uteri. Laparoscopy enables the surgeon to observe the pelvic viscera before and after the vaginal hysterectomy to rule out ovarian pathology and any bleeding from the vaginal vault and pedicles, and, in difficult cases, serves as a portal for salpingo-oophorectomy.