Ayla Uckuyu

Bladder perforation related to intrauterine device.

Intrauterine devices (IUDs) are currently one of the most popular reversible contraception methods used world wide. Uterine perforation is a rarely observed complication. The bladder is one of the organs that an IUD can migrate to because of its close proximity to the uterus. There are about 70 cases in the literature of IUDs that have migrated into the bladder. The resulting bladder perforation can be complete or partial. Here, we report 2 cases, 1 of complete migration and the other of partial migration.

Diagnosis of gestational diabetes mellitus by use of the homeostasis model assessment–insulin resistance index in the first trimester

Objective. Gestational diabetes mellitus (GDM) affects 2–10% of all pregnant women, causing increased morbidity and mortality, and is tested for in the second trimester of pregnancy. The purpose of the present study was to predict GDM in the first trimester. Design and methods. The study included 271 patients who were between the 10th and 14th week of gestation. Fasting glucose and insulin were measured in the first trimester and the homeostasis model assessment–insulin resistance index (HOMA-IR) was calculated for each patient. These values were compared with the results of the second-trimester glucose tolerance test. Results. HOMA-IR values were higher in women with GDM. A cut-off value of 2.60 for HOMA-IR was calculated at the end of the study. Conclusion. Accepting patients whose HOMA-IR value is higher than 2.60 in the first trimester seems to be a good method to predict GDM.

Polycystic ovary syndrome is associated with elevated plasma soluble CD40 ligand, a marker of coronary artery disease

OBJECTIVE To determine the level of plasma soluble CD40 ligand (sCD40L) in patients with polycystic ovary syndrome (PCOS). DESIGN Prospective study. SETTING Baskent University School of Medicine in Turkey. PATIENT(S) Thirty-one patients with PCOS and 31 non-PCOS (control) patients. INTERVENTION(S) Determination of plasma sCD40L and homocysteine levels. MAIN OUTCOME MEASURE(S) Plasma sCD40L, fasting glucose, fasting insulin, homeostatic model assessment insulin resistance index (HOMA-IR), LH, FSH, E(2), total T, DHEAS, total cholesterol, high- and low-density lipoprotein cholesterol, triglyceride, homocysteine, and high-sensitivity C-reactive protein (hsCRP). RESULT(S) The mean serum fasting insulin and HOMA-IR levels were significantly higher in the PCOS group. The mean serum homocysteine level was significantly higher in the PCOS group. Despite a trend for higher high-sensitivity C-reactive protein levels in the PCOS group, the difference did not reach statistical significance. The mean plasma sCD40L level in the PCOS group was significantly higher than that in the control group (5.14 +/- 3.65 ng/mL vs. 3.45 +/- 2.64 ng/mL, respectively). CONCLUSION(S) Polycystic ovary syndrome is associated with elevated levels of sCD40L and homocysteine.

Unilateral congenital ovarian and partial tubal absence: Report of four cases with review of the literature

OBJECTIVE To present four rare cases of congenital unilateral tubal and ovarian abnormalities with their laparoscopic images. DESIGN Case report. SETTING Baskent University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey. PATIENT(S) Three patients with infertility showing abnormality on hysterosalpingography and a fourth patient with acute pelvic pain who were admitted to our clinic. INTERVENTION(S) All four patients underwent laparoscopic surgery. MAIN OUTCOME MEASURE(S) Case 1 showed an absence of a distal tubal segment with ipsilateral ovarian agenesis. Case 2 showed a unilateral partial distal tubal absence with normal adjacent ovary. Case 3 showed a twisted and adherent tube with ipsilateral ovarian absence. Case 4 showed a unilateral ovarian agenesis and contralateral acute adnexal torsion. RESULT(S) We detected four cases of unilateral ovarian and partial tubal absence in these operations. CONCLUSION(S) We present four unusual cases of unilateral ovarian and partial tubal absence. The absence of one ovary and tube may be explained by two possible etiopathogenic causes: asymptomatic adnexial torsion or congenital malformation.

Efficacy of Vaginal Misoprostol Before Hysteroscopy for Cervical Priming in Patients Who Have Undergone Cesarean Section and No Vaginal Deliveries

We wanted to investigate the effect of misoprostol administered vaginally before operative hysteroscopy on cervical dilation, complications, and failure rates in patients who have undergone cesarean section and who have never delivered vaginally. Sixty patients who had undergone cesarean section, who had never delivered vaginally before, and were about to undergo hysteroscopy for various intrauterine lesions were included in this randomized controlled study. Thirty-two patients in the study group were given misoprostol 400 microg, and 28 patients in the control group were given placebo (hexetidine pill) vaginally twice, 6 and 12 hours before the procedure. Primary endpoints were cervical width detected with Hegar dilators and complication and failure rates. Mean cervical width was greater in patients in the study group (6.5 +/- 0.8) than it was in patients in the control group (3.0 +/- 0.6), (p = .0001). Complication and failure rates were lower in patients in the study group (p = .01). Administration of vaginal misoprostol before hysteroscopy proved to be effective in cervical ripening and in reducing complication and failure rates.

Metformin therapy improves coronary microvascular function in patients with polycystic ovary syndrome and insulin resistance

Background  Women with polycystic ovary syndrome (PCOS) are thought to have increased cardiovascular risk. Metformin therapy reduces whole‐body insulin resistance (IR) in patients with type‐2 diabetes mellitus (DM).

Impaired coronary microvascular function and increased intima–media thickness in preeclampsia

There is an association between preeclampsia (PE) and excessive morbidity and mortality. Some recent studies have revealed the presence of endothelial dysfunction in PE patients with inflammatory activity. Moreover, it has been argued that the chronic inflammatory state involved in PE leads to an acceleration in atherosclerosis. Accordingly, our goal in this study is to determine whether there is any coronary microvascular dysfunction and increase in the intima-media thickness in patients who had mild PE 5 years before, without the presence of any traditional cardiovascular risk factors. The study included 33 mild PE patients (mild preeclampsia is classified as a blood pressure (BP) of 140/90 mm Hg or higher with proteinuria of 0.3 to 3 g/d) whose mean age was 33.7 years old, and 29 healthy women volunteers whose mean age was 36.1 years old. Each subject was examined using transthoracic echocardiography 5 years after their deliveries. During the echocardiographic examination, coronary flow reserve (CFR) and carotid intima-media thickness (IMT) were measured. There was a statistically lower CFR value in PE patients as compared with controls (2.39 ± 0.48 vs. 2.90 ± 0.49; P < .001). On the other hand, there was a significant increase in their IMT and high-sensitivity C-reactive protein (hs-CRP) values (respectively, 0.59 ± 0.15 vs. 0.46 ± 0.10; P < .001 and 3.80 ± 2.10 vs. 2.33 ± 1.79; P = .004). There was a negative correlation between the CFR values of the PE patients and hs-CRP (r = -0.568; P = .001) and IMT (r = -0.683, P < .001) results.We determined in the study that there was impaired CFR and increased carotid IMT in patients with PE, and, moreover, that these adverse effects were significantly correlated with hs-CRP.

Are CD57+ Natural Killer cells really important in early pregnancy failure?

ObjectiveThe aim of this study was to compare the CD57+ Natural Killer (NK) cell counts in normal pregnancies and in cases grouped according to different types of early pregnancy failure.Materials and methodsA prospective case control study which was set in Baskent University Faculty of Medicine, Obstetrics and Gynecology Department. A total of 119 women whose pregnancies ended in the first trimester were divided into elective pregnancy termination, incomplete miscarriage, intrauterine demise, ectopic pregnancy and recurrent pregnancy loss groups. CD57+ NK cells were stained and counted in the histologic preparations of the decidua in all of these groups.ResultsCD57+ NK cell counts were 2.14 ± 1.42 in control, 2.24 ± 1.92 in incomplete miscarriage, 1.82 ± 1.34 in intrauterine demise, 2.54 ± 1.80 in ectopic pregnancy and 3.42 ± 2.15 in recurrent pregnancy failure group. There were no statistically significant differences between the control group and the other four groups with respect to the CD57+ NK cell counts.ConclusionThis study suggests that CD57+ NK cell count is not associated with early pregnancy failure.

Unilateral congenital ovarian absence with twisted tube.

A 29-year-old woman with primary infertility was referred to our hospital for inability to conceive after having been married for 10 years. Her menstrual cycle was oligomenorrheic with a 45to 50-day interval. There was no dysmenorrhea or dyspareunia and no acute/chronic pelvic pain or abdominopelvic surgery in the medical history. Transvaginal ultrasound revealed a polycystic large right ovary and absence of the left ovary. In the hysterosalpingogram, uterine cavity and the right tube were normal; there was no left tubal passage. During laparoscopy, the distal point of the left tube was attached to the omentum, and twisted, and the left ovary was absent. We observed white separated tissue resembling a hypoplastic ovary 1-cm in diameter within omentum (Fig. 1). We excised the left tube with the white separated

Do women with polycystic ovary syndrome really have predisposition to atherosclerosis

The elastic properties of the aorta were studied in 28 women with polycystic ovary syndrome (PCOS) and in 26 regularly menstruating healthy women. In PCOS and control groups, systolic and diastolic blood pressure, aortic systolic diameter, aortic diastolic diameter, aortic distensibility, aortic stiffness index, and aortic elastic modulus were similar. It is likely that PCOS does not have any innate adverse effects on the cardiovascular system if its undesirable metabolic consequences are successfully controlled.