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Objective To investigate whether there is any relation between oxidative stress and the antioxidant system in the development of polycystic ovary syndrome (PCOS) by measuring serum nitric oxide (NO) levels and xanthine oxidase (XO) activity (a generator of reactive oxygen species) and antioxidant status by measuring serum thiol levels and glutathione peroxidase (GSHPx) and paraoxonase 1 (PON1) activities. Design Prospective case-control study. Setting University hospital in Turkey. Sample Thirty women with polycystic ovary syndrome and 20 age- and sex-matched healthy control subjects were included. Methods Serum XO, PON1 and GSHPx activity and NO and thiol levels were determined by spectrophotometric methods. Main outcome measures Activity of serum XO, PON1 and GSH, as well as NO and thiol levels. Results Serum XO activities were higher in women with PCOS than in the control women (p 0.05). Serum PON1 activities were negatively correlated with serum XO activities and NO levels. Conclusion Increased oxidant XO activity and decreased lipid antioxidant PON1 activity, along with the observed negative correlation between these parameters, suggests that women with PCOS are under oxidative stress and that there is XO-mediated lipid peroxidation, which may be related to increased atherosclerosis seen in later life in such women.

To compare the surgical outcomes of vaginal hysterectomy and prophylactic oophorectomy in women with a uterine size12 weeks' gestation and 12-20 weeks' gestation, without decensus.In this prospective comparative study, 241 consecutive vaginal hysterectomies were planned for women with benign disease of the uterus. All hysterectomies were performed by the same surgeon (author), and divided into 2 groups: a uterine weight280 g (n=83, 280-1150 g) and a uterine weight280 g (n=158). The 2 groups were compared for success rates of hysterectomy and bilateral oophorectomy vaginally, operative time, change in haemoglobin, haemorrhage, length of hospital stay, operative complications, and febrile morbidity.All 241 hysterectomies were completed successfully vaginally, and no patients required laparotomy or additional procedures in both groups. No significant intra- and post-operative complications requiring admission to the hospital were encountered in either group. Mean operating time was significantly longer in the uteri/=280-g group than in the280-g group (69.4+/-24.4 versus 108.2+/-41.2 min, p0.0001). The rate of intraoperative haemorrhage (8.43 versus 1.2%) and the change in haemoglobin were significantly higher in the/=280-g group compared with the280-g group (p0.01). Significant positive linear correlation between uterine weight and operative time was seen in all 241 hysterectomies (p0.001). The rate of bilateral oophorectomy was similar between the uteri/=280-g group (89.8%) and the280-g group (92.9%). The main intraoperative complication of the 241 vaginal hysterectomies was bladder injury that occurred in 1 case (0.4%) in the280-g group. There were no statistically significant differences in intra- and post-operative complications, febrile morbidity, and postoperative hospital stay between the groups.Our findings demonstrate that despite the prolonged operating time and increased intraoperative blood loss, vaginal hysterectomy can be safely performed on a large uterus. Routine bilateral prophylactic oophorectomy can be performed in all patients who have sufficiently long infundibulopelvic ligaments to permit removal of the entire ovary.

Objective Polycystic ovary syndrome (PCOS) is a form of functional ovarian hyperandrogenism and affects approximately 5-10% of women of reproductive age. Insulin resistance and hyperinsulinaemia appear to be almost universal feature of the polycystic ovary syndrome. Abnormal regulation of cytochrome P450c17alpha causes the exaggerated secretion of ovarian androgens in PCOS. The aim of the present study was to determine whether reduction of insulin levels by metformin would attenuate FSH, LH, 17-Hydroxyprogesterone (17-OHP) and androstenedione hyperresponsiveness to buserelin testing in PCOS women. Design The presence of hyperinsulinaemia in 16 women with PCOS was demonstrated by an oral glucose tolerance test (OGTT) and results were compared with 13 healthy women. PCOS women were also evaluated with insulin tolerance test (ITT) for the assessment of insulin sensitivity. FSH, LH, 17-OHP and androstenedione responses to buserelin testing were measured in all the women with PCOS. PCOS patients were given metformin (500 mg, orally, two times daily) for 12 weeks and re-evaluated at the end of the treatment period. Results Women with PCOS were hyperinsulinaemic (basal insulin 92.1+/-14.3 vs. 44.0+/-4.0 pmol/l; AUCinsulin 68087.4+/-8862.3 vs. 13075.5+/-1327.6 pmol/lx120 min) compared with healthy women. Metformin therapy improved menstrual disturbances in 25% of the women with PCOS and also resulted in some improvement in insulin sensitivity and reduced basal and post glucose load insulin levels. However, FSH, LH, 17-OHP and androstenedione responses to buserelin testing were unaltered in response to metformin. Conclusion It is clear that PCOS is often associated with profound insulin resistance and hyperinsulinaemia. These abnormalities explain the increased prevalence of glucose intolerance in women with PCOS and metformin has beneficial effects on insulin sensitivity in women with PCOS. Amelioration of hyperinsulinaemia has no significant effect on ovarian cytochrome P450c17alpha enzyme activity. However, it can be used in obese women with PCOS as an adjuvant therapy and long term studies should be performed to evaluate the endocrine effects of metformin in women with PCOS.

OBJECTIVE The present study was designed to determine the prevalence of 11 beta-hydroxylase deficiency in adult women with hirsutism in a Turkish population. DESIGN AND PATIENTS One hundred and twenty-four consecutive unselected hirsute patients were studied. An ACTH stimulation test was performed in the midfollicular phase of the cycle on the patients and 20 age-matched controls by administration of a single bolus of 0.25 mg ACTH (1-24) at 0900 h. MEASUREMENTS Serum 11-deoxycortisol levels were measured before, 30 and 60 minutes after ACTH injection. Basal free testosterone (fT), SHBG, cortisol and androstenedione (A) were also measured. The diagnosis of 11 beta-hydroxylase deficiency has been presumed when the serum 11-deoxycortisol response to ACTH stimulation exceeded three times the 95th percentile of controls. RESULTS Basal hormone levels including fT and A were significantly higher in the hirsute women than in the healthy women. SHBG was significantly lower in the hirsute patients. Basal and ACTH stimulated 11-deoxycortisol levels were found to be significantly increased in the patients compared with the controls. Eight patients (6.5%) had an 11-deoxycortisol response higher than three times the upper normal limit. CONCLUSIONS Using stringent diagnostic criteria, we have found that 6.5% of the hirsute women in a Turkish population could be presumed to have 11 beta-hydroxylase deficiency.

To investigate the effect of sodium carboxymethylcellulose (SCMC) and the combination of low molecular weight heparin (LMWH) with SCMC in the prevention of intraperitoneal adhesion.Thirty-eight rats underwent bilateral surgical injury to the uterine horn and the parietal peritoneum. In 13 rats, a solution of SCMC was instilled at laparotomy. In 11 rats, LMWH was delivered on to serosal and peritoneal defects, and SCMC was instilled. As a control group 14 rats were included in the study.Surgical Research Laboratory, Erciyes University.Female Wistar-Albino rats, weighing 200 to 250 g each.Adhesions between the uterine horn and the abdominal sidewall were scored for extent and severity two weeks after the initial surgery.Although the mean adhesion score both in the SCMC group (2.8, s.d. 1.15) and in the SCMC with LMWH group (1.6, s.d 1.18) was found to be significantly lower than in the control group (3.4, s.d. 0.89) (p0.05 and p0.001, respectively), more favorable adhesion prophylaxis was achieved in the SCMC with LMWH group in comparison with the SCMC treatment group without any hemorrhagic complications (p0.001).We conclude that SCMC with LMWH are highly effective in reducing postoperative adhesions in this animal model. SCMC with LMWH appears promising in adhesion prophylaxis.