Browsing by Author "Baytur, YB"

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    Mode of delivery and pelvic floor muscle strength and sexual function after childbirth
    Baytur, YB; Deveci, A; Uyar, Y; Ozcakir, HT; Kizilkaya, S; Caglar, H
    Objective: To investigate the respective roles of the mode of delivery and strength of pelvic floor muscles in the sexual function of women. Method: Thirty-two women who were delivered vaginally and 21 women who underwent cesarean delivery at the Celal Bayar University School of Medicine Obstetrics Department were enrolled in the study, and 15 nulliparas were recruited as controls. Sexual function was assessed in all women by a validated questionnaire (the Female Sexual Function Index). Desire, arousal, lubrication, orgasm, satisfaction, and pain were measured separately, and pelvic floor muscle strength was assessed by a perineometer. Sexual function was compared among the 3 groups. The correlation between pelvic floor muscle strength and sexual function was also investigated. Results: Pelvic floor muscle strength was significantly lower in the group vaginally delivered compared with the group delivered by cesarean section and the nulliparous group (P < 0.05). There was no difference between the groups regarding sexual function (P > 0.05), and there was also no correlation between sexual function and pelvic muscle strength. Conclusion: Pelvic floor muscle strength and mode of delivery did not affect sexual function in our study participants. The muscular component of female sexual function should be further investigated. (c) 2005 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
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    Hormone receptor expressions and proliferation markers in postmenopausal endometrial polyps
    Inceboz, US; Nese, N; Uyar, Y; Ozcakir, HT; Kurtul, O; Baytur, YB; Kandiloglu, AR; Caglar, H; Fraser, IS
    Background/Aims: Endometrial polyps are quite common in the general population, they have a significant role in postmenopausal bleeding, and the pathogenesis is unclear. The aim of this study was to investigate proliferation markers and expression of estrogen and progesterone receptors in endometrial polyps in postmenopausal women. Methods: Endometrial polyps were removed by hysteroscopy from 36 women who presented with postmenopausal bleeding. None were using hormonal therapy. The control group consisted of 16 inactive-atrophic postmenopausal endometrial specimens removed at hysterectomy. Immunohistochemistry was used to demonstrate expression of estrogen and progesterone receptors and the cell growth and apoptosis markers, Ki67, bcl-2, c-erbB-2. Results: In both the glandular epithelium and stroma of endometrial polyps, estrogen and progesterone receptors, Ki67 and bcl-2 showed significantly more positive staining than the inactive endometrium from the control group. There was no difference in expression of c-erbB-2 between the two groups. Conclusions: Estrogen may have a role in the development of postmenopausal endometrial polyps, either by direct stimulation of localized proliferation or by stimulation of proliferation via other pathways, such as activation of Ki67 or through inhibition of apoptosis via bcl-2. c-erbB-2 is unlikely to play any role in development of these lesions. Copyright (C) 2006 S. Karger AG, Basel.
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    Intrauterine-diagnosed diastematomyelia
    Uyar, Y; Baytur, YB; Calli, C; Cetinkaya, B; Caglar, H
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    De novo Reciprocal Translocation t(5;11)(q22;p15) Associated with Hydrops Fetalis (Reciprocal Translocation and Hydrops Fetalis)
    Pala, HG; Artunc-Ulkumen, B; Uyar, Y; Bal, F; Baytur, YB; Koyuncu, FM
    Objective: This is a case of a prenatally diagnosed non-immune hydrops fetalis (NIHF) associated with translocation t(5;11)(q22;p15). An association between NIHF and this translocation has not been reported previously. Case Report: The patient was referred to the perinatology clinic with hydrops fetalis diagnosis at 23 weeks' gestation. We noted that the fetus had bilateral pleural effusion, ascites, widespread subcutaneous edema, membranous ventricular septal defect, hypoplastic fifth finger middle phalanx, clinodactyly, single umbilical artery. We performed cordocentesis. Chromosomal analysis on blood showed a balanced translocation between the long arm of chromosome 5 and the short arm of chromosome 11 with karyotype of 46,XX,t(5;11)(q22;p15). Conclusion: We present prenatal diagnosis of a de novo translocation (5;11) in a hydropic fetus with ultrason abnormalities. In our case, karyotype analysis of the fetus, mother and father provided evidence of a de novo translocation, that might explain the NIHF.
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    Is the menstrual cycle affecting the skin prick test reactivity?
    Kirmaz, C; Yuksel, H; Mete, N; Bayrak, P; Baytur, YB
    Allergen skin prick tests (SPT) are very sensitive and specific tests to detect allergic sensitization in atopic patients. Certain factors like antihistamines, antidepressant therapies or circadian rhythms can alter the results of SPT. In women, the changes in endogenous hormone levels throughout the menstrual cycle may affect the allergic: responses and natural course of allergic diseases. The aim of this study was to investigate the probable influence of the phases of the menstrual cycle on SPT reactivity to allergen extracts and histamine. Forty-two female patients with seasonal allergic rhinoconjunctivitis were enrolled ill the study. Skin prick test reactivities to allergens and histamine were measured at the beginning of the menstrual cycle (3(rd) or 4(th) day), mid-cycle (14(th) or 15(th) day) and end-cycle (27(th) or 28(th) day) consecutively. Serum estradiol, progesterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels were determined simultaneously. We observed the most significant reactions to allergens when SPT is performed at mid-cycle. However, SPT reactivity to histamine did not vary throughout the menstrual cycle. Serum estradiol and LH levels showed positive correlation with SPT reactivity to allergens at mid-cycle. Our results suggest that SPT give the best results when they are performed at mid-cycle. Additionally, allergens seem to cause mast cell degranulation to a greater extent in subjects in which endogenous hormones like estradiol and LH are elevated.
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    Three-dimensional placental volume and mean grey value: Normal ranges in a Turkish population and correlation with maternal serum biochemistry and Doppler parameters
    Pala, HG; Ulkumen, BA; Uyar, Y; Koyuncu, FM; Baytur, YB
    The aim of this study is to evaluate the relationship between three-dimensional (3D) ultrasound measurements of placenta at 11-13(6) weeks' gestation and maternal serum levels of pregnancy associated plasma protein-A (PAPP-A), free beta human chorionic gonadotrophin (f beta hCG), Doppler parameters in early pregnancy. This prospective study consisted of 334 singleton pregnancies at 11-13(6) weeks' gestation. Placental volume and placental volumetric mean grey values were evaluated. The placental volume (cm(3)) was analysed using the Virtual Organ Computer-aided AnaLysis (VOCAL) imaging program and 3D histogram was used to calculate the volumetric mean grey value (%). Mean maternal age was 28.35 +/- 7.55. Mean gestational age was 12.29 +/- 0.68 weeks. Placental volume was 77.04 +/- 35.74 cm(3). Mean grey value of the placenta was 34.38 +/- 8.02%. Correlation analysis revealed that placental volume was significantly correlated with the crown-rump length (r = 0.173, p = 0.002), gestational week (r = 0.116, p = 0.036), ductus venosus pulsatility index (r = -0.101, p = 0.04) and maternal weight (r = 0.099, p = 0.037). There was a significant relation between the mean grey value of the placenta and maternal age (r = 0.131, p = 0.02), nuchal translucency (r = -0.109, p = 0.048), PAPP-A (r = 0.108, p = 0.04) and f beta hCG (r = 0.104, p = 0.042). Volumetry of the placenta can be carried out with a high percentage of 1st trimester pregnancies. Volumetry during the 1st trimester could be helpful because of the less advanced state of placentation. This examination is easy to perform and the measurements can be acquired correctly and quickly.
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    Ductus venosus doppler flow velocity after transplacental and non-transplacental amniocentesis during midtrimester
    Ulkumen, BA; Pala, HG; Baytur, YB; Koyuncu, FM
    Objective: We aimed to evaluate ductus venosus Doppler waveforms before and after amniocentesis in order to investigate any effect of amniocentesis on fetal myocardial hemodynamics. We also evaluated the umbilical artery, uterine artery and fetal mid-cerebral artery Doppler waveforms in order to investigate any relationship with ductus venosus Doppler changes. Methods: The study population consisted of 56 singleton pregnancies having genetic amniocentesis. Twenty seven of them had transplacental needle insertion; whereas 29 of them had non-transplacental amniocentesis. Uterine artery, umbilical artery, mid-cerebral artery and ductus venosus pulsatiliy index and resistance index were measured just before and after amniocentesis. Results: Amniocentesis does not cause any significant changes in fetal ductus venosus Doppler waveforms. There is also no significant changes in uterine artery, umbilical artery, mid-cerebral artery pulsatility and resistance index. Conclusion: Amniocentesis-whether transplacental or not- does not cause any significant effect on fetal myocardial hemodynamics.
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    Pelvic floor function and anatomy after childbirth
    Baytur, YB; Serter, S; Tarhan, S; Uyar, Y; Inceboz, U; Pabuscu, Y
    OBJECTIVE: To investigate pelvic floor musclefunction and anatomy after childbirth in continent women differing in obstetric history. STUDY DESIGN: Young, continent women, age range 20-40 years, were recruited into 3 groups: I elective prelabor cesarean delivery (n = 12); 2. vaginal delivery (n = 15); and 3. age-matched nulliparas as controls (n = 13). Pelvic floor muscle strength was measured by a perineometer and also assessed by vaginal palpation. Magnetic resonance imaging of the pelvic floor at rest and on maximal strain was performed. Statistical analysis was carried out using SPSS 10.0 (Chicago, Illinois) for Windows (Microsoft, Redmond, Washington); p < 0.05 was considered significant. RESULTS: Pelvic floor muscle strength was not different between the vaginal delivery and cesarean groups. The descent of the bladder and cervix on straining was greater in the subjects who delivered vaginally than in the cesarean delivery and nulliparous groups. There was a positive and significant correlation between the duration of labor and the area of the levator sling and also between birth weight and the descent of the cervix on straining. CONCLUSION: The results of this study show that delivery method does not affect pelvic muscle strength.
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    Outcomes and management strategies in pregnancies with early onset oligohydramnios
    Ulkumen, BA; Pala, HG; Baytur, YB; Koyuncu, FM
    Objective: To evaluate the outcomes and management options in pregnancies with early onset oligohydramnios. Materials and Methods: The file datas of all pregnancies diagnosed as oligohydramnios or anhydramnios before 27 gestational weeks between January 2006 and September 2013 were evaluated retrospectively. The underlying pathology and associated anomalies, karyotype analysis, the outcome of the pregnancy (either termination or labour), and gestational week at the time of diagnosis were analyzed. Results: A total of 54 pregnancies were evaluated; mean gestational week at the time of the diagnosis was 19.8 +/- 4.6. Mean maternal age was 27.28 +/- 6.03. Thirty-seven pregnancies were anhydramniotic, 13 fetuses had associated anomalies, five of them had multicyctic dysplastic kidney, five had bilateral renal agenesis, one had hypoplastic right heart syndrome, one had clubfoot, and one had ventricular septal defect and cleft palate. Karyotyping was normal regarding the fetuses with structural anomalies. Nineteen patients had premature preterm rupture of membranes and 39 patients had termination of pregnancy. Conclusion: The prognosis of early onset oligohydramnios is poor. Main determinant is gestational week at the time of the diagnosis.
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    Assessment of fetal cerebral arterial and venous blood flow before and after vaginal delivery or Cesarean section
    Baytur, YB; Tarhan, S; Uyar, Y; Ozcakir, HT; Lacin, S; Coban, B; Inceboz, U; Caglar, H
    Objectives To compare perinatal intracranial arterial and venous blood velocity changes between healthy term neonates delivered vaginally or by Cesarean section and to correlate these changes with cord blood gases and pH values at birth. Methods The study involved 43 healthy term neonates who were delivered vaginally (n = 20) or by Cesarean section (n = 23). All fetuses/neonates were examined by Doppler ultrasound to obtain middle cerebral artery (MCA) and cerebral transverse sinus (Tsin) Doppler waveforms on three occasions (before delivery, and 1 h and 24 h after birth). Pulsatility index (PI) and peak systolic velocity (PSV) for MCA and Tsin were measured and compared between neonates who were delivered vaginally or by Cesarean section. Umbilical cord blood samples were analyzed for umbilical artery and vein pH, pO(2) and pCO(2) and values were correlated with MCA and Tsin Doppler indices. Results MCA-PI increased and MCA-PSV decreased at 1 h after birth, and Doppler measurements returned to predelivery values at 24 h after birth. Tsin Doppler measurements remained unchanged at 1 h and 24 h when compared to predelivery values in both the Cesarean and vaginal delivery groups. There was a negative correlation between Tsin-PI before birth and umbilical venous pH. There was a positive correlation between Tsin-PSV at 1 h after birth and umbilical vein PCO2. Conclusions Cerebral arterial blood velocity decreases immediately after birth and increases within 24 h, probably as part of neonatal adaptation. Cerebral venous blood velocity remains constant during the perinatal period and is likely to be regulated in a different and more complex manner than that of arterial blood velocity. Mode of delivery does not affect cerebral blood velocity. Copyright (C) 2004 ISUOG. Published by John Wiley Sons, Ltd.
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    Endometrial thickness and the Doppler sonographic parameters of the uterine arteries as discriminators of endometrial status in postmenopausal women receiving anti-hypertensive treatment
    Ozcakir, HT; Inceboz, US; Utuk, O; Baytur, YB; Caglar, H
    Aim: The aim of the present study was to establish the Doppler sonographic parameters of the uterine arteries in postmenopausal patients with or without hypertension and to determine the value of their measurement in the prediction of endometrial pathology. Methods: Healthy postmenopausal women (n = 23) and the ones receiving anti-hypertensive medication (n = 34) examined for both endometrial thickness and Doppler velocimetry of the uterine arteries by transvaginal sonography. Results: There was no sigificant difference between endometrial thickness and uterine artery Doppler sonographic parameters in hypertensive postmenopausal women compared to normotensive controls. Conclusion: The role of Doppler examination in the differential diagnosis of endometrial pathology in patients with or without hypertension seemed not to be effective.
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    The assessment of placental volume and mean gray value in preeclamptic placentas by using three-dimensional ultrasonography
    Ulkumen, BA; Pala, HG; Uyar, Y; Koyuncu, FM; Baytur, YB
    Objectives: We aimed to evaluate the placental volume and placental mean gray value in preeclampsia and healthy placentas by using three-dimensional (3D) ultrasonography and Virtual Organ Computer-aided AnaLysis (VOCAL). Methods: This case-control prospective study consisted of 27 singleton pregnancies complicated by preeclampsia and 54 healthy singleton pregnancies matched for gestational age, maternal age and parity. Placental volume and placental volumetric mean gray values were evaluated. The placental volume (cm(3)) was analyzed using the VOCAL imaging program, and 3D histogram was used to calculate the volumetric mean gray value (%). Results: Preeclamptic and control group consisted of 27 (mean age: 28.90 +/- 5.95 years, mean gestation: 32.0 +/- 4.55 weeks) and 54 (mean age: 29.48 +/- 5.78 years, mean gestation: 32.61 +/- 4.23 weeks) singleton pregnancies, respectively. Placental volume was significantly smaller in preeclampsia (250.62 +/- 91.69 versus 370.98 +/- 167.82 cm(3); p = 0.001). Volumetric mean gray value of the placenta was significantly higher in preeclampsia (38.24 +/- 8.41 versus 33.50 +/- 8.90%; p = 0.043). Placental volume was significantly correlated with the estimated fetal weight (r = 0.319; p = 0.003). There was negative significant relation between placental volume and umbilical artery pulsatility index, resistance index and systolic/diastolic ratio (r = -0.244, p = 0.024; r = -0.283, p = 0.005; r = -0.241, p = 0.024, respectively). Conclusions: Placental volume diminishes significantly in preeclampsia, whereas volumetric mean gray values increases. This may reflect the early alterations in preeclamptic placentas, which may help to understand the pathophysiology better.
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    The effect of parity on first trimester uterine artery Doppler waveforms in low-risk singleton pregnancies
    Ulkumen, BA; Pala, HG; Uyar, Y; Baytur, YB; Koyuncu, FM
    Objectives: The aim of the study was to evaluate the effect of parity on uteroplacental blood flow during the first trimester in low-risk singleton pregnancies. Materials and methods: Uterine artery Doppler examinations were performed in 190 singleton pregnancies between 11-14 gestational weeks. Twenty-five pregnancies were excluded from the study due to history of preeclampsia, diabetes mellitus or inherited thrombophilia. A total of 165 low-risk singleton pregnancies were included in the study. Mean uterine artery pulsatility index (PI) was recorded and compared between nulliparous and multiparous women. The relation between maternal age, gestational week, maternal weight, parity, biochemical markers and abnormal uterine artery Doppler flows was evaluated. T-test and logistic regression analyses were used for the statistical analysis. Results: A total of 165 singleton pregnancies without any risk factors for uteroplacental insufficiency were included in the study. Of them, 58 (36.7%) were nulliparous and 107 (63.3%) were parous. Correlation analysis revealed that the uterine artery pulsatility indices during the first trimester were not affected by maternal age and parity. Conclusions: Mean uterine artery pulsatility indices are not different in nulliparous and multiparous low risk pregnancies at 11-14 weeks of gestation.
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    The alteration in placental volume and placental mean grey value in growth-restricted pregnancies assessed by 3D ultrasound
    Ulkumen, BA; Pala, HG; Uyar, Y; Koyuncu, FM; Baytur, YB
    We aimed to evaluate the volumetric and echogenic alterations in placentas between the intrauterine growth restriction (IUGR) and normal pregnancies using three-dimensional ultrasound and virtual organ computer-aided analysis (VOCAL) software. This case-control prospective study consisted of 48 singleton pregnancies complicated by IUGR and 60 healthy singleton pregnancies matched for maternal age, gestational age and parity. Placental volume (PV) and placental volumetric mean grey values (MGV) were evaluated. PV (cm(3)) was analysed using the VOCAL imaging analysis program, and 3D histogram was used to calculate the volumetric MGV (%). PV was 278.50 +/- 63.68 and 370.98 +/- 97.82 cm(3) in IUGR and control groups, respectively (p = 0.004). MGV of the placenta was 38.24 +/- 8.41 and 38.24 +/- 8.41 in IUGR and control groups, respectively (p = 0.30). receiver operator curve (ROC) curve analysis revealed that area under curve was 0.731 for PV. Correlation analysis revealed that PV was significantly associated with estimated fetal weight (r = 0.319, p = 0.003), biparietal diameter (r = 0.346, p = 0.002), head circumference (r = 0.269, p = 0.019), abdominal circumference (r = 0.344, p = 0.002) and femur length (r = 0.328, p = 0.004). PV was inversely related to the umbilical artery pulsatility index (r = - 0.244, p = 0.017). To the best of our knowledge, this is the first study evaluating volumetric MGV in IUGR placentas by comparing them with healthy pregnancies. Our study showed that PV diminishes significantly in IUGR pregnancies, whereas volumetric MGV does not alter significantly.
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    Sexual dysfunction in Turkish women with dyspareunia and its impact on the quality of life
    Ulkumen, BA; Erkan, MM; Pala, HG; Baytur, YB
    Purpose of Investigation: The authors aimed to determine the prevalence of female sexual dysfunction (FSD) among Turkish dyspareunic women and to establish the associated factors with FSD. Furthermore, they aimed to investigate if dyspareunia and possible associated sexual complaints were related to impaired quality of life (QoL). Materials and Methods: The study included 154 women admitted to the present gynecology department at a tertiary center in the west region of Turkey, 67 of which suffered from dyspareunia. The remaining 87 sexually healthy women were included in the control group. FSD was assessed with 19-item validated female sexual function index (FSFI). QoL was assessed using short form 36 (SF-36). The chi-squared test and t-test were used for analysing the group differences. Pearson's correlation test was used to determine the effect of the variables of FSFI on the SF-36. Multivariance analysis and logistic regression was used to determine independent risk factors for FSD and to estimate odds ratio (OR) with 95% confidence interval (CI). Results: The incidence of FSD in dyspareunic group and control group was 86.57% and 36.8%, respectively (p < 0.001). Dyspareunic women had lower scores with regards to sexual desire, arousal, lubrication, orgasm, satisfaction, and pain domains at significant level (p < 0.001). Education level, time period after the last delivery, duration of marriage, parity, and dyspareunia were significantly related to FSD. However, dyspareunia was an independent risk factor for FSD (OR 11.49; 95% CI 4.95-26.67). Regarding the impact on the QoL, dyspareunic women had lower scores with regards to the physical role, social function, bodily pain, and vitality domains. Conclusion: The present results show that dyspareunia has a major impact on women's sexual function and QoL. Clinicians have an important role for encouraging women to report their sexual complaints. Identifying dyspareunia and treating FSD may positively affect women's sexual function and overall QoL.
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    PRENATAL ADMINISTRATION OF GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR INCREASES MESENCHYMAL VASCULAR ENDOTHELIAL GROWTH FACTOR EXPRESSION AND MATURATION IN FETAL RAT LUNG
    Yuksel, H; Yilmaz, O; Baytur, YB; Ozbilgin, K
    The aim of this study was to determine influence of prenatal granulocyte-macrophage colony-stimulating factor (GM-CSF) administration on lung growth, maturation, and vascular endothelial growth factor (VEGF) expression. Twenty Wistar rats received sterile saline (1 mL) or recombinant human GM-CSF (50 g/kg) on day 16 of pregnancy. Rats were sacrificed on days 18 and 20 of gestation. H-score for VEGF was calculated immunohistochemically. Alveolar VEGF expression on days 18 and 20 of gestation was significantly higher in the GM-CSF group (P .01). Increase in VEGF with prenatal GM-CSF administration indicates that GM-CSF may stimulate lung growth and maturation and may be protective against lung disease due to prematurity.
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    Antenatal administration of granulocyte-macrophage colony-stimulating factor increases fetal lung maturation and endothelial nitric oxide synthase expression in the fetal rat lung
    Baytur, YB; Ozbilgin, K; Yuksel, H; Kose, C
    Objectives: We investigated how maternal administration of granulocyte-macrophage colony-stimulating factor (GM-CSF) induced fetal lung maturation compared with dexamethasone and whether maternal administration of GM-CSF and dexamethasone influenced the fetal lung eNOS expression. Study design: Thirty pregnant rats were divided into three groups of 10 rats each to receive GM-CSF, dexamethasone or saline solution at 16 days of gestation. Lung maturation using bronchial area and immunohistochemical lung airway epithelium and the vascular endothelial eNOS expression, using H Scores, were evaluated at 18 and 20 days of gestation. The statistical analysis was done with the Kruskal-Wallis test for comparisons of more than two groups and the Mann-Whitney U-test as a post hoc test using SPSS for windows release 10.0. Values of p > 0, 0.05 were considered significant. Results: On the 20th day of gestation both GM-CSF and dexamethasone injections caused a significant increase in fetal lung bronchial area,,as compared with the controls (24.9%, 36.8%, 13.4%, respectively, p = 0.001). eNOS immunoreactivity was observed in the endothelium of large pulmonary vessels and large and small airway epithelium on the 18th and 20th day of gestation. Maternal GM-CSF and dexamethasone increased lung eNOS expression in the airway epithelium when compared to controls. Conclusion: Maternal administration of GM-CSF induced fetal lung maturation and this effect may be mediated, at least partly, by an increase in the eNOS expression. (C) 2007 Elsevier Ireland Ltd. All rights reserved.
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    A comparative study of the effect of raloxifene and gosereline on uterine leiomyoma volume changes and estrogen receptor, progesterone receptor, bcl-2 and p53 expression immunohistochemically in premenopausal women
    Baytur, YB; Ozbilgin, K; Cilaker, S; Lacin, S; Kurtul, O; Oruc, S; Koyuncu, FM
    Objective: To compare the mechanism of action of raloxifene and gosereline induced shrinkage of leiomyomas via estrogen receptor, progesterone receptor, bcl-2 and p53 expression immunohistochemically. Study design: Thirty-two premenopausal women affected by uterine leiomyomas were randomized into two equal groups. Group A was treated with gosereline (3.6 mg subcutaneous injection monthly) and group B was treated with raloxifene (60 mg daily per os) for 3 months before undergoing surgery. At entry and at the end of the treatment the leiomyoma volume was measured ultrasonografically and the volume change was calculated. Immunohistochemical detection of estrogen receptor (ER), progesterone receptor (PR), bcl-2 and p53 were performed on leiomyoma tissue samples from group A, group B and the matched-control group. H-scores for ER, PR, bcl-2 and p53 were calculated. The mean volume changes of leiomyomas and immunohistochemical H-score differences of ER, PR, bcl-2 and p53 were compared between groups. Results: The leiomyoma volume decreased significantly after treatment in gosereline group from baseline of 65 cm(3) to 35 cm(3), and in raloxifene group from 68 cm(3) to 50 cm(3), p < 0.05. The difference between the before and after treatment leiomyoma volumes between the two treatments was not statistically significant. H-score of ER expression was significantly lower in gosereline group compared to control group (54.4 versus 113.2, p = 0.001), whereas H-score of PR expression was significantly lower with both gosereline and raloxifene groups compared to control group (64.8 for gosereline versus 94.6 for control, 73.6 for raloxifene versus 94.6 for control, p = 0.001). The bcl-2 expression was higher in both gosereline and raloxifene groups compared to control group (173.7 for gosereline versus 94.7 for control, 179.7 for raloxifene versus 94.7 for control, p = 0.001). The p53 expression was only lower with gosereline than the control group (169.4 versus 205.6, p = 0.001), whereas there was no significant change between the raloxifene group and the control group (201.9 versus 205.6) (p > 0.05). Conclusion: Raloxifene was as effective as gosereline in reducing leiomyoma volumes. Decreased PR expression may be a mechanism for tumor growth reduction in raloxifene treatment. In both treatment modalities, the mechanism of shrinkage of leiomyomas could not be increased apoptosis mediated by bcl-2 and p53 expression and should be investigated by further studies. (c) 2006 Elsevier Ireland Ltd. All rights reserved.