Raloxifene increases serum leptin levels in postmenopausal women: a prospective study

OBJECTIVE: The purpose of this study was to investigate the effect of raloxifene on leptin and insulin-like growth factor-I levels and their relation with the biochemical markers of bone metabolism in postmenopausal women. STUDY DESIGN: Sixty-four women were given 60 mg/d raloxifene for 6 months. Serum leptin, insulin-like growth factor-I, alkaline phosphatase, calcium, osteocalcin, and collagen type I cross-link C-telopeptide levels were measured before and after the treatment. The patients were grouped as obese (body mass index, > or =25 kg/m2) or non-obese (body mass index, <25 kg/m2). RESULTS: The mean basal leptin level was significantly higher (P < .001), and the mean cross-link C-telopeptide level was significantly lower (P = .001) in obese patients. Raloxifene therapy increased leptin levels (P < .001) and decreased insulin-like growth factor-I, alkaline phosphatase, and cross-link C-telopeptide levels significantly (P < .001). There was a strong negative correlation between leptin and cross-link C-telopeptide (r = -0.703; P < .001). Insulin-like growth factor-I was not correlated with any parameter. CONCLUSION: Raloxifene increases serum leptin levels while decreasing bone resorption in postmenopausal women.     

Use of additional oxytocin to reduce blood loss at elective caesarean section: A randomised control trial

Objective:  The purpose of this prospective, randomised, double-blind, placebo-controlled study was to assess the effects of a 5-IU oxytocin bolus and placebo infusion versus a 5-IU oxytocin bolus and 30 IU infusion on the control of blood loss at elective lower segment caesarean section (C/S).
Methods:  Participants with indication for elective C/S were randomly allocated to two groups. Group A, 360 women, received oxytocin 5 IU bolus and placebo; group B, 360 women received oxytocin 5 IU bolus and 30 IU infusion. Blood loss was estimated based on the haematocrit values before and 48 h after delivery. The primary outcome was the incidence of excessive bleeding (estimated blood loss of >1000 mL), while secondary outcomes included use of additional uterotonics, estimated blood loss, need for blood transfusion, duration of hospital stay and the incidence of adverse effects.
Results:  No demographic difference was observed between groups. Mean estimated blood loss ( P  < 0.001) and the proportion of women with blood loss estimated to be greater than 1000 mL were significantly less for group B than for group A (relative risk (RR) 0.35, 95% confidence interval (CI) 0.20–0.63). In addition, more women in the group A required additional uterotonic agents (RR 0.35, 95% CI 0.22–0.56) and blood transfusion (RR 0.12, 95% CI 0.01–0.98).
Conclusion:  An additional oxytocin infusion after 5 IU oxytocin bolus infusion at elective C/S may reduce blood loss and required blood transfusion.     

Results of the tension-free vaginal tape procedure for treatment of female stress urinary ıncontinence: a 5-year follow-up study

Objective  We evaluated the long-term cure rates, surgical complications rates after treatment of urodynamically confirrmed primary genuine stress incontinence with tension-free vaginal tape (TVT). Methods  We performed a retrospective review of all patients undergoing the TVT procedure over a 5-year period to report intraoperative complication, postoperative complications and subjective cure rates. Results  TVT was performed on 600 patients under general anesthesia. Among these patients, 563 were followed up for least 5 years; the remaining 47 patients could not be followed up. The mean follow-up interval was 63.1 ± 3.1 (range 60–70) months. The mean age of the women was 51.7 ± 11.6 years and mean body mass index 31.7 ± 3.0 kg/m². Sixty-two percent (347) of women underwent the TVT procedure in conjunction with other vaginal surgery, and 38% (216) underwent TVT alone. The subjective analysis of the effect of surgery on the symptom of GSI was that, overall, 86.7% were completely cured, 6.0% were significantly improved and 7.3% found no change in the severity of her incontinence. No major nerve or vessel injury occurred, but 17 patients (3.0%) incurred bladder injury during the surgery. De novo voiding urgency occurred in 36 patients (6.4%). Thirty patients (5.3%) developed voiding problem, of which 19 patients had short-term voiding problem. Conclusion  The TVT procedure is a relatively safe and effective, minimally invasive surgical technique for the treatment of female urinary stress incontinence.     

Is routine cervical dilatation necessary during elective caesarean section? A randomised controlled trial

Objective: The purpose of this prospective randomised study was to determine the effect of routine cervical dilatation during elective caesarean section on maternal morbidity.
Methods: Participants with indication for elective caesarean section were randomly allocated to two groups. Group A ( n  = 200) women with intraoperative cervical dilatation; group B ( n  = 200) women with no intraoperative cervical dilatation.
Results: No demographic differences were observed between groups. There was no significant difference between groups in infectious morbidity ( P  = 0.87) (relative risk (RR) 1.11, 95% confidence interval (CI) 0.58–2.11), endometritis ( P  = 0.72) (RR 1.68, 95% CI 0.39–7.14), febrile morbidity ( P  = 0.66) (RR 1.21, 95% CI 0.51–2.87), wound infection ( P  = 0.82) (RR 1.11, 95% CI 0.44–2.81), endometritis ( P  = 0.72) (RR 1.68, 95% CI 0.39–7.14) or urinary tract infection ( P  = 1.00) (RR 1.00, 95% CI 0.28–3.50), and estimated blood loss ( P =  0.2). However, group A had longer operative times compared with the group B ( P =  0.01).
Conclusion: Intraoperative digital cervical dilatation during elective caesarean section did not reduce blood loss and postoperative infectious morbidity. The routine digital cervical dilatation during elective caesarean section is not recommended.     

Port-site Metastasis after Laparoscopic Extraperitoneal Paraaortic Lymphadenectomy for Stage IIb Squamous Cell Carcinoma of the Cervix

We report a case of port-site metastasis near the optic trocar site after extraperitoneal laparoscopic lymphadenectomy for cervical carcinoma. A 42-year-old woman with International Federation of Gynecology and Obstetrics clinical stage IIb squamous cell carcinoma of the cervix was evaluated with laparoscopic extraperitoneal paraaortic lymphadenectomy for staging. The aortic nodes were positive. The patient was treated with chemotherapy and radiotherapy. Then brachytherapy was performed. The patient was treated with 6 cycles of weekly topotecan. At month 12, a 4-cm left retroperitoneal mass was detected and excised. Pathologic examination showed an invasive squamous cell carcinoma with tumor-positive margins. Laparoscopic surgery for cancer may result in iatrogenic metastases at the port sites. But all of the port-site recurrence can not be explained by current factors leading to tumor metastases.     

Melatonin and cortisol rhythm in patients with extensive nasal polyposis

Purpose

Extensive nasal polyposis is an inflammatory disease which effects 1%–4% of normal population. The mechanism of its formation and the circadian rhythm of cortisol and melatonin in ENP have not investigated.

Materials and methods

Salivary levels of melatonin and cortisol were measured by radioimmunoassay in 31 patients with extensive nasal polyposis and in 27 control subjects matched for age and gender. In both groups none of the subjects did not have obstructive sleep apnea.

Results

The baseline and the peak levels of salivary melatonin in the extensive nasal polyposis group were significantly lower than in the control group (p < 0.001). However, no differences were found in the acrophase and the peak duration of salivary melatonin between the study and control groups (p > 0.05). The highest values of melatonin were recorded at 04:00 h in both the study and control groups.The amplitude and the 24 h mean levels of salivary cortisol in the extensive nasal polyposis group were significantly lower than in the control group (p < 0.001). The acrophase was delayed by about 8 h in extensive nasal polyposis patients (p < 0.001).

Conclusion

The circadian rhythms of salivary melatonin and cortisol were found to be disrupted in patients with extensive nasal polyposis. These results may be applicable as therapeutic tools in the future and melatonin drugs might be useful in the therapy of nasal polyposis like cortisol drugs.     

Scintigraphic evaluation of nasal mucociliary activity in unilateral chronic otitis media

Mucociliary clearance is a key defence mechanism in human upper and lower airways. Although mucociliary activity is present in both ears of the patients, most cases of chronic otitis media are unilateral.In this study, we aim to evaluate the difference between nasal mucociliary activity of the affected and non-affected sides in patients with unilateral chronic otitis media. Both nasal transport times of 36 patients with unilateral chronic otitis media were compared statistically with each other and with the control group by independent samples t-test. The nasal mucociliary transport times of the nasal cavity at the same side as the affected ear and as the non-affected ear are significantly different, in the same patients. Our study shows that impaired or decreased nasal mucociliary activity may result in dysfunction of the eustachian tube and middle-ear ciliary activity, which plays an important role in the aetiopathogenesis of chronic otitis media.     

Is there any effect of anxiety and depression scores on the improvement of tinnitus after surgery in chronic otitis patients with tinnitus

Background

Tinnitus is a common disease in public. It is not only associated with neuronal, muscular, vascular pathologies, but also with related psychological parameters. In this study, we aimed to investigate the relationship between tinnitus, anxiety and depression in patients undergoing tympanoplasty.