Adnan Incebiyik

Bilateral femur fracture in a newborn: an extreme complication of cesarean delivery

AbstractIntroductionBilateral femoral fracture due to birth trauma which is extremely rare, can occur during cesarean section.Material and methodsThis case represents a newborn delivered by cesarean section for breech presentation who sustained bilateral subtrochanteric fracture of the femur.ResultThe newborn was treated with immobilization in pelvipedal cast.ConclusionIt has been concluded that performing accurate delivery technique and immediate evaluation–orthopedic consultation of the newborn in the presence of forced obstetrical maneuver are important.

DNA damage and oxidative stress in patients with mild preeclampsia and offspring

OBJECTIVE Oxidative stress has been shown to play an important role in the pathogenesis of pre-eclampsia, and DNA damage frequently occurs in cells exposed to such stress. The aim of the present study was to investigate DNA damage and oxidative stress in mildly pre-eclamptic women and their offspring. STUDY DESIGN We studied 25 mildly pre-eclamptic mothers, 20 healthy controls, and their infants. Mononuclear leukocyte DNA damage, total antioxidant status (TAS), and total oxidant status (TOS) were determined and the oxidative stress index (OSI) was calculated. RESULTS DNA damage, and TOS and OSI levels were significantly increased, and TAS levels significantly decreased, in maternal and cord blood samples of the mildly pre-eclamptic group. A positive correlation between the extent of DNA damage and diastolic blood pressure was evident in pre-eclamptic mothers and there was a negative correlation between the extent of DNA damage and TOS. CONCLUSION Both oxidative stress and DNA damage are elevated in mildly pre-eclamptic patients and their offspring. Increased oxidative stress may be important in inducing DNA damage in pre-eclamptic patients.

May mean platelet volume levels be a predictor in the diagnosis of pelvic inflammatory disease

SummaryBackgroundOur aim in this study was to investigate whether mean platelet volume (MPV) value could be used as an early marker to predict pelvic inflammatory disease (PID).MethodsOverall, 44 patients with PID and 44 healthy women were included in the study. The control group consisted of 44 women who applied to the clinic for a routine gynaecological check-up, without chronic disease or a history of medication use. Owing to the fact that it would affect thrombocyte function, women who have the following conditions were excluded from the study: women who were taking anticoagulant therapy, oral contraceptives, nonsteroid anti-inflammatory medications and who had chronic diseases. The leukocyte count, platelet count, neutrophil ratio and MPV values were collected from PID and the control group. C reactive protein values of patients with PID were also noted.ResultsMPV values in patients with PID were lower than those in the control group. This reduction in MPV is statistically significant when the PID patient group is compared with the control group (p < 0.001). A negative correlation was discovered between platelet count and MPV values (p = 0.019, r = − 0.425). Receiver-operating curve analysis pointed out that MPV has greater area under curve value than neutrophil rate, leukocyte and platelet count (0.73, 0.64, 0.72 and 0.49 respectively).ConclusionSince the MPV value was significantly decreased in patients with PID, it may serve as an additional and even more valuable marker than leukocyte count in the diagnosis of PID.ZusammenfassungGrundlagenZiel dieser Studie war es zu untersuchen, ob das mittlere Thrombozytenvolumen (MPV) als früher Marker einer Erkennung von Entzündungen im Beckenbereich verwendet werden kann.Methodik44 Patienten mit Entzündungen im Becken und 44 gesunde Frauen wurden in die Studie aufgenommen. Die Kontrollgruppe waren Frauen, die die Ambulanz der Klinik zur gynäkologischen Routineuntersuchung aufgesucht hatten. Um andere Einflüsse auf die Thrombozytenfunktion zu vermeiden, wurden Frauen, die unter oraler Antikoagulationstherapie standen, die orale Kontrazeptiva und/oder nicht-steroidale antiinflammatorische Medikamente nahmen oder die eine chronische Erkrankung hatten, nicht in die Studie aufgenommen. Die Leukozytenzahl, die Thrombozytenzahl, der Neutrophilen Quotient und die MPV Werte wurden bei beiden Gruppen erhoben. Bei der Patientengruppe wurden zusätzlich die CRP Werte gemessen.ErgebnisseDie MPV Werte bei den Patientinnen waren niedriger als in der Kontrollgruppe (p < 0,001). Es bestand eine negative Korrelation zwischen der Thrombozytenzahl und den MPV Werten (p = 0,019, r = − 0,425). ROC Analysen ergaben, dass die MPV eine größere Fläche unter der Kurve hatte als die Neutrophilen Rate, oder die Leukozyten- beziehungsweise die Thrombozytenzahl (0,73, 0,64, 0,72 und 0,49 respektive).SchlussfolgerungDa das MPV bei Patientinnen mit Entzündungen im Beckenbereich signifikant erniedrigt war, kann dieser Parameter als ein zusätzlicher und im Vergleich zur Leukozytenzahl sogar wertvollerer Marker bei der Diagnose von Entzündungen im Beckenbereich dienen.

Surgical management of 58 patients with placenta praevia percreta

SummaryObjectiveThe aim of this study is to present our experience with surgical management of placenta praevia percreta.MethodsThis study was conducted from January 2009 through March 2014 at Harran University Hospital and was a chart review of all patients who underwent caesarean hysterectomy with the placenta left in situ for placenta praevia percreta.ResultsThe study group comprised 58 patients. All of the patients underwent ultrasound mapping of the placental area before surgery. Emergent caesarean hysterectomy was only performed in 9 patients; 49 patients underwent planned caesarean hysterectomy. Bilateral internal iliac artery ligation was performed in all cases. Four patients (6.9 %) had bladder damage, one patient (1.7 %) required cystotomy, and one patient (1.7 %) required re-operation because of postoperative hemorrhage. The mean operative time was 141.6 (range: 95–355) minutes. Only 17 (29.3 %) patients were administered more than four units of red blood cells. There was no ureteral damage or maternal death. Furthermore, there were no complications in 42 (72.4 %) patients.ConclusionsCaesarean hysterectomy for placenta praevia percreta is associated with increased maternal morbidity. However, preoperative diagnosis of placenta praevia percreta, ultrasound mapping of the placenta, and the presence of a multidisciplinary experienced team may decrease maternal morbidity and mortality. Moreover, the urinary system may be protected in the patients with placenta praevia percreta without serious morbidity.

Does a risky outcome of antenatal screening test indicate oxidative stress

Abstract Objective: The study aimed to investigate a possible relationship between second trimester aneuploidiy screening results and oxidative stress in foetal amnion and maternal serum. Methods: Concerning the outcome of the second-trimester screening test, 50 pregnant women of high risk were included in the experimental group, whereas 50 pregnant women with normal scores who wished to proceed with the amniocentesis procedure due to advanced maternal age and counselling were included in the control group. The biochemical parameters of total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) were measured in the amniotic fluid samples and maternal serum samples. Results: OSI in the maternal serum samples, as well as TAS and TOS in the amniotic fluid, was significantly higher in the control group compared to the experimental group (p < 0.001, p = 0.047, p = 0.005, respectively). There was no significant difference in the TAS and TOS in the maternal serum samples or the OSI in the amniotic fluid between the groups. Conclusions: The results indicate that the positivity of the screening test is not significantly correlated with oxidative stress, a factor regarded as a pathological mechanism in various diseases. Potential maternal anxiety could underlie the elevated oxidative stress in the control group.

The association of endothelial nitric oxide synthase gene G894T polymorphism and serum nitric oxide concentration with microalbuminuria in patients with gestational diabetes.

AIM Gestational diabetes mellitus (GDM) is a glucose intolerant condition that affects 14% of all pregnancies. Diabetes mellitus (DM) occurs in 30 - 70% of patients with GDM after delivery. DM and GDM are associated with structural and functional deterioration of the renovascular system. Our aim is to investigate the association Glu- 298Asp polymorphism of the endothelial nitric oxide synthase (eNOS) gene with serum nitric oxide levels and microalbuminuria in patients with GDM and healthy pregnancies. MATERIAL AND METHODS Serum nitric oxide (NO) levels, urinary excretion of albumin and Glu298Asp polymorphism of the eNOS gene were analyzed in 68 patients with GDM and 73 healthy controls. High performance liquid chromatography (HPLC-Griess) method was used to analyze serum NO levels. Microalbuminuria was evaluated by rate nephelometry method. The Glu298Asp polymorphism of the eNOS gene was determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). RESULTS Nitric oxide, glucose, creatinine, and microalbuminuria were significantly different between the patients and the control subjects (p = 0.001, p = 0.001, p = 0.002, and p = 0.005, respectively). There was a significant difference between groups in terms of the ratio of GG/GT+TT of eNOS gene Glu- 298Asp (p = 0.02). The patients with GT+TT genotype had significantly higher microalbuminuria levels and lower NO concentrations (22.16 vs. 9.51, p = 0.005, and 10.56 vs. 12.73, p = 0.021, respectively). The presence of T allele of eNOS gene is an independent predictor of microalbuminuria (OR: 2.346, 95% confidence interval: 1.247 - 5.238, p = 0.02) as well as serum glucose and NO concentration. CONCLUSION The G894T polymorphism of eNOS gene and decreased NO concentration seem to be independent predictors of increased urinary excretion of albumin in patients with GDM. Determining the frequency of eNOS gene G894T polymorphism may help to identify pregnancies at increased risk of microalbuminuria.

Oxigênio Suplementar em Cesariana Eletiva sob Raquianestesia: Manejar um Punhal com Cuidado

BACKGROUND AND OBJECTIVES We aimed to investigate the effect of 21% and 40% oxygen supplementation on maternal and neonatal oxidative stress in elective cesarean section (CS) under spinal anesthesia. METHODS Eighty term parturients undergoing elective CS under spinal anesthesia were enrolled in the study. We allocated patients randomly to breathe 21% (air group) or 40% (oxygen group) oxygen from the time of skin incision until the end of the operation. We collected maternal pre- and post-operative and umbilical artery (UA) blood samples. Total antioxidant capacity (TAC), total oxidant status (TOS) and the oxidative stress index (OSI) were measured. RESULTS Age, weight, height, parity, gestation week, spinal-skin incision time, skin incision-delivery time, delivery time, operation time, 1st and 5th minutes Apgar scores, and birth weight were similar between the groups (p > 0.05 for all comparisons). There were no differences in preoperative TAC, TOS, or OSI levels between the groups (p > 0.05 for all comparisons). Postoperative maternal TAC, TOS and OSI levels significantly increased in the oxygen group (p = 0.047, < 0.001 and 0.038, respectively); umbilical artery TAC levels significantly increased in the oxygen group (p = 0.003); and umbilical artery TOS and OSI levels significantly increased in the air group (p = 0.02 and < 0.001, respectively). CONCLUSIONS The difference in impact on maternal and fetal oxidative stress of supplemental 40% compared to 21% oxygen mandates further large-scale studies that investigate the role of oxygen supplementation during elective CS under spinal anesthesia.

Supplemental oxygen in elective cesarean section under spinal anesthesia: Handle the sword with care.

BACKGROUND AND OBJECTIVES We aimed to investigate the effect of 21% and 40% oxygen supplementation on maternal and neonatal oxidative stress in elective cesarean section (CS) under spinal anesthesia. METHODS Eighty term parturients undergoing elective CS under spinal anesthesia were enrolled in the study. We allocated patients randomly to breathe 21% (air group) or 40% (oxygen group) oxygen from the time of skin incision until the end of the operation. We collected maternal pre- and post-operative and umbilical artery (UA) blood samples. Total antioxidant capacity (TAC), total oxidant status (TOS) and the oxidative stress index (OSI) were measured. RESULTS Age, weight, height, parity, gestation week, spinal-skin incision time, skin incision-delivery time, delivery time, operation time, 1(st) and 5(th) minutes Apgar scores, and birth weight were similar between the groups (p > 0.05 for all comparisons). There were no differences in preoperative TAC, TOS, or OSI levels between the groups (p > 0.05 for all comparisons). Postoperative maternal TAC, TOS and OSI levels significantly increased in the oxygen group (p = 0.047, < 0.001 and 0.038, respectively); umbilical artery TAC levels significantly increased in the oxygen group (p = 0.003); and umbilical artery TOS and OSI levels significantly increased in the air group (p = 0.02 and < 0.001, respectively). CONCLUSIONS The difference in impact on maternal and fetal oxidative stress of supplemental 40% compared to 21% oxygen mandates further large-scale studies that investigate the role of oxygen supplementation during elective CS under spinal anesthesia.

Trophoblastic E-cadherin and TGF-beta expression in placenta percreta and normal pregnancies

Abstract Objective: This study aimed to evaluate whether trophoblastic transforming growth factor beta (TGF-β) and E-cadherin expression levels have a role in placenta percreta (PP) aetiopathogenesis. Methods: This study was carried out in the Obstetrics & Gynecology and Pathology Departments of Harran University Medicine School. Forty-four women who underwent caesarean section for PP and other obstetric reasons were included in this study. PP was defined as the detection of placental invasion during the histopathological examination of the hysterectomy specimen, which passes the uterine wall as a whole layer and involves the uterine serosa. Placental tissue samples were collected from all pregnant patients to evaluate TGF-β and E-cadherin expression levels. Results: No significant difference was found in demographic features, including age, gestational week, number of pregnancies and body mass index, among the groups. Immunohistochemical staining against E-cadherin, a cell adhesion molecule, showed significantly reduced staining in PP patients (p = 0.048). TGF-β staining was also low in PP patients, but this difference was not significant (p = 0.107). Conclusions: The findings of this study suggest that a decrease in trophoblastic E-cadherin expression may have an important role in PP aetiopathogenesis.

Assessment of Apoptotic Activity Dysregulation and Oxidative Stress in the Development of Epithelial Ovarian Cancer: A Case-Controlled Descriptive Analysis

Aim: In the present study, we aimed to assess whether oxidative stress and apoptotic activity play a role in the development of epithelial ovarian cancer (EOC). Methods: The study group included patients with EOC (n = 26) and benign ovarian tumour (BOT) (n = 25), while 30 healthy women were employed as a control group. Venous blood samples were drawn to evaluate oxidative stress parameters and serum M30/M65 antigen levels before surgery. In addition, blood samples were taken for the second time on postoperative day 8 to analyse whether the postoperative tumour load was decreased. Results: When the groups were assessed regarding oxidative stress, the highest values were detected in patients with EOC. Serum M30/M65 levels were found to be higher in patients with EOC when compared to the other groups (p < 0.001). A significant decrease was determined in the M30/M65 levels of serum samples taken on postoperative day 8 from the patients in the EOC and BOT groups (p < 0.001). Conclusion: Our results suggest that dysregulation of apoptotic activity could be effective in the development of ovarian tumoural tissue, whereas oxidative stress could be effective in malignant transformation.