Peritoneal fluid and serum leptin concentrations in women with primary infertility

Aim  Leptin is proposed to participate in the reproductive system of women by acting on either ovaries or hypothalamic-pituitary axis. The objective of the present study is to investigate the leptin concentrations in peritoneal fluid and serum samples of women diagnosed with primary infertility. Methods  A prospective study was carried out in women who underwent laparoscopy within the diagnostic process of primary infertility between January 2005 and January 2007. Leptin concentrations were determined in blood samples obtained before surgery and in peritoneal fluid samples collected during laparoscopy. Results  Peritoneal fluid was obtained from 112 subjects; 21 with unexplained infertility 28 with polycystic ovary syndrome (PCOS), 30 with bilateral tubal occlusion, and 33 with endometriosis. Subjects with PCOS have significantly higher body weights, BMI values and plasma leptin levels when compared to other study groups. Peritoneal fluid levels of leptin were significantly higher in the endometriosis group compared to other three study groups. A positive correlation was found between peritoneal fluid leptin levels and the endometriosis stage (r = 0.51, P = 0.01). However, plasma leptin levels were unrelated to the disease extent. Discussion  It might be hypothesized that leptin may be an active factor in the pathogenesis of PCOS and endometriosis, which are two major causes of primary infertility. A mild leptin deficiency in peritoneal environment may interrupt follicular development and ultimately lead to PCOS. Leptin has angiogenic and mitogenic properties, which trigger inflammatory cytokines and eventually result in the development of endometriosis implants. Significantly, higher levels of leptin in peritoneal environments of endometriosis subjects strongly imply the important role of this common pathology.     

Effect of cervical mucus aspiration before intrauterine insemination

Objective

To determine whether cervical mucus aspiration before intrauterine insemination (IUI) has any effect on clinical pregnancy rates.

Method

The outcomes of 186 IUI cycles in 95 consecutive patients in whom mucus was aspired prior to IUI were compared retrospectively with those of 1057 IUI cycles in 505 women.

Results

The pregnancy rate was 15.1% (28 pregnancies for 186 cycles) in the cervical mucus aspiration group and 9.9% (105 pregnancies for 1057 cycles) in the control group (P = 0.05). Mucus aspiration led to significantly increased pregnancy rates for women with unexplained infertility (24% in the aspiration group vs 9.5% in the control group; P = 0.04).

Conclusion

Cervical mucus aspiration before IUI might improve clinical pregnancy rates by yet-to-be-defined mechanisms.     

An unusual case of incidental rupture of liver hemangioma during labor

Cavernous hemangiomas are the most common benign tumors of the liver and are found in about 2% of autopsy patients. 1,2 The vast majority of these tumors are small and asymptomatic; however, there have been a few reported cases in which these lesions led to spontaneous fatal hemorrhage. 1,2 Although liver hemangiomas occur in both sexes, most studies point to a female predominance; one study reported a ratio of female predominance of 4. 5: 1.3 It has been suggested that estrogen may be associated with the growth of liver hemangiomas, but the incidence of these lesions in pregnancy and the effect on them of the increased estrogen levels during pregnancy are unknown. 2 Symptomatic liver hemangiomas have been treated by steroids, radiation therapy, surgical resection and recently embolization, but surgeons may sometimes be confronted with intraabdominal hemorrhage originating from rupture of asymptomatic liver hemangiomas. This case describes an incidental intraabdominal hemorrhage originating from a liver hemangioma in a 36 weeks twin pregnancy being delivered emergently by Cesarean section due to fetal distress.     

Segmental distribution of muscle weakness in SMA III: implications for deterioration in muscle strength with time

We examined 26 spinal muscular atrophy type III (SMA III) patients with SMNt deletions, searching for possible segmental distribution of muscle weakness. In those with disease duration of ≤11 years, the weakest muscles were upper lumbar innervated ones in the lower extremities. In the upper extremities, early involvement of triceps muscle suggested the possibility of lower cervical (C7) onset. Electrophysiologically, weaker muscles had a more severe reduction in the recruitment pattern, particularly in the lower extremities. However, severe reduction in recruitment was sometimes also observed in clinically strong muscles. In patients with disease duration of ≥16 years and regardless of disease duration, in those with disease onset at ≤3 years of age, weakness and severe electrophysiological changes were more widespread. These findings may suggest a progression in muscle weakness with time. When compared to 12 patients with Becker muscular dystrophy (BMD), early stage SMA III with weak iliopsoas-strong gluteus maximus stood in contrast to BMD with weak gluteus maximus-strong iliopsoas.     

Short-Term Treatment with Sevelamer Increases Serum Fetuin-A Concentration and Improves Endothelial Dysfunction in Chronic Kidney Disease Stage 4 Patients

Background and objectives: Vascular calcification and endothelial dysfunction contribute to the development of cardiovascular disease in patients with chronic kidney disease (CKD). Sevelamer, a non–calcium-based phosphate binder, has been shown to attenuate cardiovascular calcification in CKD patients, although the exact mechanism has not been clarified. This study was designed to investigate the effect of short-term sevelamer treatment on both serum fetuin-A concentrations and endothelial dysfunction seen in CKD patients.Design, setting, participants, & measurements: Fifty nondiabetic stage 4 CKD patients whose phosphate levels were ≥5.5 mg/dl were enrolled in this 8-wk randomized prospective study. Thirty-six healthy volunteers served as matched controls. Patients were treated with either sevelamer (n = 25, 12 males) or calcium acetate (n = 25, 13 males). Fetuin-A, high-sensitivity C-reactive protein, Ca × PO₄ product, flow-mediated dilation (FMD), insulin, and homeostasis model assessment (HOMA) were obtained at baseline and after the treatment period.Results: As expected, CKD patients had significantly lower levels of fetuin-A and FMD, and significantly higher levels of intact parathyroid hormone, Ca × PO₄ product, and high-sensitivity C-reactive protein than controls (P < 0.001 for all). The use of sevelamer led to a significant increase in the fetuin-A concentration with improvement in FMD, whereas no significant difference was observed in the calcium acetate group. In a multiple regression analysis, FMD levels were independently related to fetuin-A both before (β = 0.63, P < 0.001) and after (β = 0.38, P = 0.004) treatment.Conclusions: This small, randomized, prospective study shows that short-term sevelamer treatment significantly increases fetuin-A levels and improves FMD in nondiabetic stage 4 CKD patients.Cardiovascular disease (CVD) is prevalent in patients with chronic kidney disease (CKD) (1). Strong correlation between the derangement in mineral metabolism, such as hyperphosphatemia, hyperparathyroidism, as well as elevated calcium × phosphorus product (Ca × PO₄) and mortality has been reported in hemodialysis (HD) patients (2). These derangements have also been shown to result in vascular calcification, an independent risk factor for cardiovascular mortality (3,4). Elevated Ca × PO₄ product and higher doses of oral calcium ingestion significantly predicted coronary artery calcification (CAC) in patients with end-stage kidney disease (5). Moreover, London et al. (4) have shown significant association between the uses of calcium-based phosphate binders and arterial medial calcification in HD patients. Based on the deleterious effect of high calcium intake on vascular calcification, a calcium-free nonabsorbed phosphate binder, sevelamer hydrochloride, has been developed for the treatment of hyperphosphatemia in CKD patients (6). Studies have shown that sevelamer provides effective control in serum PO₄ levels without inducing hypercalcemia (6,7). Additionally, these studies have also shown beneficial effects of sevelamer on the progression of vascular calcification, although the underlying mechanisms were not clarified (8). Recent studies on vascular calcification have evaluated a number of circulating systemic calcification inhibitors, such as fetuin-A, matrix-Gla protein, osteoprotegrin, etc. (9). Fetuin-A, the major circulating inhibitor of vascular calcification, has been shown to be lower in dialysis patients and to be associated with cardiovascular mortality (10).Recent data have shown a relationship between vascular calcification and endothelial dysfunction (ED) in vascular disease. Nigam et al. (11) showed that there was a significant correlation between ED and large conduit vessel stiffness in patients with coronary artery disease (CAD). Additionally, in 201 healthy subjects, Budoff et al. (12) evaluated the relation between arterial distensibility, arterial reactivity, and CAC scores (electron beam computed tomography). They showed a significant relationship between brachial artery reactivity and CAC. In accordance, Huang et al. (13) have also reported a significant relationship between CAC and ED in patients with suspected CAD.This study was designed to investigate whether the suggested beneficial effects of sevelamer on vascular calcification are related to changes in serum fetuin-A concentration in patients with CKD. On the basis of the recent evidence linking vascular calcification and ED, we also evaluated the effect of sevelamer treatment on ED.     

The prevalence of Helicobacter pylori and related factors among university students in Turkey

The frequency and risk factors for contamination of Helicobacter pylori infection was investigated among Sakarya University students. Two-hundred students randomly chosen from among those who volunteered for the study and met its criteria were included. Data were obtained by a questionnaire. H. pylori positivity was checked with the monoclonal H. pylori stool antigen test. Statistical analysis was done with chi-square test. The average age of the subjects was 21.14 +/- 2.06, and 76% of them were female. Monthly family income was below 575 Euros in 69.5% of them, and 56% were living in state dormitories. H. pylori positivity was found to be as high as 63% in our group. According to the qustionnaire (age, gender, blood groups, family income, crowded family living conditions, smoking, alcohol and caffeine consumption, the presence of gastric symptoms, family history, and hygienic behaviors), no statistical differences were found between the H. pylori positive and negative students. These data support the finding that personal and environmental conditions in adults did not affect H. pylori infectivity, and that H. pylori might be acquired in childhood.     

Patients with paroxysmal atrial fibrillation but not paroxysmal supraventricular tachycardia display evidence of platelet activation during arrhythmia

It is well known that chronic atrial fibrillation (CAF) and paroxysmal atrial fibrillation (PAF) are associated with a hypercoagulable state. However, pathological hemostatic changes during the paroxysmal supraventricular tachycardia (PSVT) have not yet been elucidated. To determine platelet activity in patients with PSVT, PAF and CAF, we examined the levels of β-thromboglobulin (BTG) and platelet factor 4 (PF4) during tachyarrhythmia attacks. We measured the levels of BTG and PF4, as an index of platelet activation in 15 patients with PAF (9 men, mean age 45 ± 11), and 14 patients with PSVT (8 men, mean age 40 ± 10). Levels were compared to 22 age and sex-matched healthy controls in sinus rhythm and with 25 patients with CAF (16 men, mean age 51 ± 12). Blood samples were taken during arrhythmia and 24 hours after conversion to sinus rhythm. Patients taking medications or have clinical conditions that may affect the BTG and PF4 levels were excluded.

In patients with PAF, BTG and PF4 levels were significantly higher than in controls (?p<0.009, and p = 0.002, respectively), and in patients with PSVT (?p<0.04, and p = 0.009, respectively), however, BTG and PF4 levels were significantly lower than CAF patients (?p = 0.002, and p = 0.02, respectively). Moreover, BTG and PF4 levels were significantly decreased 24 hours after conversion to sinus rhythm (?p<0.0001, and p = 0.004, respectively). Although BTG and PF4 levels in patients with PSVT were significantly lower than in patients with PAF (?p = 0.04, and p = 0.009, respectively) and CAF (?p = 0.0001, and p = 0.0001, respectively), BTG and PF4 levels were similar to controls and did not change significantly after recovery to sinus rhythm (?p = NS for all).

These results indicate that there was no platelet activation in patients with PSVT during tachyarrhythmia but significantly increased platelet activity in PAF and CAF patients. There was a significant decrement of the platelet activity to a level of control subjects twenty-four hours after cardioversion of PAF.