Aykut Barut

Intrauterine growth restriction and placental angiogenesis

BackgroundVascular endothelial growth factor (VEGF), basic-fibroblast growth factor (b-FGF), and endothelial nitric oxide synthase (eNOS) are factors that take part in placental angiogenesis. They are highly expressed during embryonic and fetal development, especially in the first trimester. In this study, we aimed to investigate the role of placental angiogenesis in the development of intrauterine growth restriction (IUGR) by comparing the levels of expression of VEGF-A, b-FGF, and eNOS in normal-term pregnancy and IUGR placentas.MethodsThe expression of VEGF-A, b-FGF, and eNOS was studied using the avidin-biotin-peroxidase method in placental tissues diagnosed as normal (n = 55) and IUGR (n = 55). Results were evaluated in a semi-quantitative manner.ResultsThe expression of all the markers was significantly higher (p < 0.001) in cytotrophoblasts, syncytiotrophoblasts, extravillous trophoblasts, vascular smooth muscle cells, chorionic villous stromal cells, and villous vascular endothelial cells of the IUGR placentas when compared with those collected from normal-term pregnancies.ConclusionIncreased expression of VEGF-A, b-FGF, and eNOS may be the result of inadequate uteroplacental perfusion, supporting the proposal that abnormal angiogenesis plays a role in the pathophysiology of IUGR.

Effect of Progesterone as a Tocolytic and in Maintenance Therapy during Preterm Labor

Aims: To assess the efficacy of vaginal micronized natural progesterone as a tocolytic and in maintenance therapy during threatened preterm birth. Methods: Eighty-three women with symptoms of threatened preterm birth were either randomized to study groups receiving tocolytic treatment combined with intravaginal micronized natural progesterone (200 mg daily) or to a control group receiving only tocolysis. Results: Micronized natural progesterone treatment resulted in a prolonged latency period of 32.1 ± 17.8 versus 21.2 ± 16.3 days in the control group and heavier birth weights of 2,982.8 ± 697.8 g versus 2,585.3 ± 746.6 g. No significant differences were found between the groups in admission to the neonatal intensive care unit, stay at the neonatal intensive care unit, need for a mechanical ventilator, respiratory distress syndrome or neonatal sepsis. Conclusion: The treatment of threatened preterm birth with tocolytics combined with intravaginal micronized natural progesterone significantly prolonged pregnancy and increased birth weight. However, an improvement in adverse perinatal outcomes was not observed.

Expression of heat shock protein 70 and endothelial nitric oxide synthase in placental tissue of preeclamptic and intrauterine growth-restricted pregnancies

Ischemia, hypoxia, and elevated vascular resistance disturb placental functions by increasing oxidative stress. Heat shock protein 70 (HSP70) is an oxidative stress marker. Endothelial nitric oxide synthase (eNOS) is a nitric oxide enzyme with a key role in pathologic and physiologic angiogenesis and vasculogenesis. This study was performed to investigate the role of oxidative stress in the pathogenesis of preeclampsia and intrauterine growth-restricted (IUGR) pregnancies by comparing the levels of HSP70 and eNOS in placentas from women with these diseases and those with healthy pregnancies. HSP70 and eNOS were examined using the streptavidin-biotin-peroxidase complex technique on formalin-fixed, paraffin-embedded sections from 135 placental villous tissues obtained from normal pregnancies (n=45) and pregnancies complicated with preeclampsia (n=45) and IUGR (n=45). The intensity of labeling in placental tissues with antibodies to HSP70 and eNOS was scored between 0 and 3, using a semiquantitative scale. HSP70 and eNOS levels were increased in the syncytiotrophoblasts, cytotrophoblasts, and extravillous trophoblast cells of preeclamptic and IUGR placentas (P<0.001), compared with normal pregnancies. However, their levels were increased only in the villous endothelial cells of IUGR placentas (P<0.001). Oxidative stress is thought to play an important role in the pathogenesis of preeclampsia and IUGR pregnancies.

Comparison of the histopathological diagnoses of preoperative dilatation and curettage and hysterectomy specimens

Aim:  A biopsy is often taken as part of the preoperative workup, regardless of the indication for hysterectomy. Some authors believe that dilatation and curettage is a poor diagnostic procedure for intrauterine pathologies, but dilatation and curettage has been the method of choice for obtaining an endometrial sample. The aim of this study was to investigate the concordance between endometrial histopathological diagnoses from preoperative dilatation and curettage and hysterectomy specimens. The differences between premenopausal and postmenopausal women were also investigated.

Placental Chorangiosis: The Association with Oxidative Stress and Angiogenesis

Background/Aims: Chorangiosis is considered to be strongly associated with fetal, maternal, and placental disorders, and has been found to be correlated with increased fetal morbidity and mortality. In this study, it is aimed to investigate the association of angiogenesis and oxidative stress with the pathogenesis of chorangiosis. Methods: Expressions of heat shock protein 70 (HSP70), vascular endothelial growth factor-A (VEGF-A) and basic fibroblast growth factor (b-FGF), which are investigated with avidin-biotin-peroxidase method in formalin-fixed, paraffin-embedded sections from placental tissues diagnosed as no chorangiosis (n = 18) and chorangiosis (n = 18), have been evaluated in a semiquantitative manner. Results: There were significant differences between chorangiosis and no chorangiosis cases with respect to birth weight, birth length, and Apgar scores (p < 0.001). Statistically significant (p < 0.001), diffuse and strong expressions with HSP70, VEGF-A and b-FGF were observed in the villous tissue of placental chorangiosis cases when compared with no chorangiosis cases. Conclusion: The majority of the chorangiosis cases had an accompanying poor perinatal outcome, and also those with accompanying angiogenesis and increased oxidative stress demonstrated diffuse and strong expressions of HSP70, VEGF-A and b-FGF. The interaction of maternal, placental, and fetal factors with increased oxidative stress and angiogenesis may possibly contribute to this arising pathologic change.

Herlyn-Werner-Wunderlich syndrome (uterus didelphys, blind hemivagina and ipsilateral renal agenesis) - a case report.

Uterovaginal duplication with obstructed hemivagina and ipsilateral renal agenesis is referred to as the Herlyn-Werner-Wunderlich (HWW) syndrome. A 17 year old woman presented with right pelvic pain and dysmenorrhea, present since menarche at 13 and worsening over the past year. Ultrasound examination revealed a right pelvic mass (5×5 cm), double endometrial echoes, and hematocolpos. A right pelvic mass, agenesis of the right kidney, double uterus, and blind hemivagina with hematocolpos were detected by magnetic resonance imaging and intravenous pyelography. A right tubo-ovarian abscess with dense adhesions and a double uterus were observed on diagnostic laparoscopy. Adhesiolysis was carried out and purulent material irrigated. After a course of antibiotics, a vaginal septum resection was performed and the pyocolpos drained. She remained symptom free after four months of follow-up. Prompt and accurate diagnosis and treatment of this syndrome can significantly improve the lives of sufferers and prevent future complications.

Endothelial nitric oxide synthase expression in gestational trophoblastic diseases.

Objective: Nitric oxide is thought to play a role in the regulation of trophoblast activity. The aim of this study was to compare endothelial nitric oxide synthase expression in tissue samples taken from gestational trophoblastic diseases and placentas of normal pregnancies. Methods: The expression of endothelial nitric oxide synthase was tested in formalin-fixed, paraffin-embedded tissues from specimens including 8 first trimester placentas, 3 partial hydatidiform moles, 20 complete hydatidiform moles, 2 invasive moles, and 5 choriocarcinomas. The expression of antibody was scored by a semiquantitative scale to define staining intensity. Results: The first trimester placentas showed moderate expression in the villous. Gestational trophoblastic diseases displayed strong to very strong endothelial nitric oxide synthase expression in the syncytiotrophoblast, villous, and proliferating mononuclear trophoblasts. Conclusions: Endothelial nitric oxide synthase expression seems to have a strong correlation with proliferation of trophoblastic cells, in gestational trophoblastic diseases and in normal pregnancy.

Idiopathic ileoileal invagination two days after cesarean section

Postoperative enteroenteric invagination is rare. The only previously reported case post‐cesarean was secondary to colonic adenocarcinoma. A 27‐year‐old woman with preeclampsia delivered a baby by cesarean section. On the second postoperative day, she had abdominal pain, nausea, vomiting, constipation, and distention. An abdominal x‐ray showed air‐fluid levels, while free fluid (ascites) was detected by ultrasonography. A computed tomography scan did not show the typical invagination picture. Her condition did not improve after 72 h of conservative treatment, and diagnostic laparotomy was performed. A 10 × 3‐cm ileoileal invagination 80 cm proximal to the ileocecal valve was found and manually reduced. The patient was discharged on the fifth postoperative day, and her six‐month follow‐up was normal.

Comparison of serum androgens and endometrial thickness in obese and non-obese postmenopausal women

OBJECTIVE In this study, we investigated whether serum androgen levels and endometrial thickness differed in obese and non-obese women. MATERIAL AND METHODS Thirtytwo non-obese (BMI <30) and 48 obese (BMI ≥ 30) women were enrolled. Blood samples were analyzed for testosterone, free testosterone, androstenedione, DHEAS, and SHBG, and transvaginal ultrasonography was performed. RESULTS Obese women had significantly higher free testosterone and endometrial thickness and significantly lower SHBG. Eight of 17 women with endometrial thickness >5 mm had significant pathology. CONCLUSION These results suggest that obesity may be a risk factor for endometrial carcinoma and other pathologies in post-menopausal women through an action on androgen concentrations.