Emine Seda dag Guven

Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: a prospective randomized study

Objective. To compare the success rates of single and multiple dose methotrexate protocols for the treatment of unruptured tubal ectopic pregnancy. Design. Prospective randomized controlled trial. Setting. Maternity and teaching hospital in Turkey. Population. One hundred twenty women treated with methotrexate therapy for unruptured tubal ectopic pregnancy. Methods. Sixty‐two women received a single dose and 58 received a multiple dose methotrexate regimen. Main outcome measures. Success rate of methotrexate therapy (women successfully treated with one injection and women who completed four doses). Results. In the single dose group, treatment was considered successful in 50 women (80.6%), whereas in the multiple dose group, 52 women (89.7%) responded to treatment (p = 0.21; OR 0.90, 95%CI 0.77–1.05). The average number of days required for human chorionic gonadotropin (hCG) levels to fall below 5 mU/mL was longer in the single dose (22.3 ± 7.6) compared with the multiple dose group (18.3 ± 10.7) (p = 0.03). In the single dose group fewer or 17 women (24.7%) experienced side‐effects compared to 28 (48.3%) of those who had multiple doses (p = 0.02, OR 0.57, 95%CI 0.35–0.92). Conclusion. A multiple dose methotrexate regimen for the treatment of unruptured tubal ectopic pregnancy is not more effective than a single dose one. In addition, multiple doses may cause more side‐effects, but the time for hCG levels to fall below 5 mU/mL is shorter.

Is there a correlation between tumor marker panel and tumor size and histopathology in well staged patients with borderline ovarian tumors

Aims. To investigate whether there is a correlation between serum tumor markers panel (CA 125, CA 19‐9, CA 15‐3, and carcinoembryonic antigen (CEA)) and tumor size and histopathology in well staged patients with borderline ovarian tumors (BOTs). Methods. Four tumor markers (CA 125, CA 19‐9, CA 15‐3, and CEA) were analysed clinically in 60 well staged patients with borderline ovarian tumor, for this retrospective observational study. Results. Most patients had serous histology and early stage disease, and the mean age at the time of diagnosis was 40.70 years (range: 19–73). Twenty‐nine patients (48.3%) had high CA 125 levels (>35 U/l), 15 patients (25%) had high levels of CEA (>4 ng/ml), 12 patients (20%) had high levels of CA 19‐9 (>37 U/ml), and 9 patients (15%) had high levels of CA 15‐3 (>30 ng/ml) at the time of initial surgery. The positive rate of CA 125, CA 19‐9, CA 15‐3, and CEA in serous tumor were 57.9, 7.9, 7.9 and 15.8%, respectively. These figures were 31.8, 40.9, 27.3 and 40.9% in mucinous tumor. The positive rate of CA 125 in the serous group was statistically significantly higher than that in the mucinous group, while the positive rates for CA 19‐9 and CEA in mucinous histology was significantly higher than those in serous tumors. In case of grouping the tumor size as <4, 4.1‐10 and >10 cm, the mean serum levels of tumor markers had significantly increased by increasing tumor size (p<0.05 for CA 125, and CA 19‐9, p>0.05 for CA 15‐3, and CEA). Conclusion. The high levels of tumor markers, especially for CA 125 and CA 19‐9, may indicate the larger tumor size. The elevation of serum CA 125 may suggest serous tumors, while the high level of serum CA 19‐9 and CEA may indicate mucinous BOTs.

ORIGINAL ARTICLE: Serum IL‐6 Level May Have Role in the Pathophysiology of Unexplained Infertility

Problem  The aim of this study was to compare the serum levels of interleukin (IL)‐6 of women with unexplained infertility with fertile subjects.

Can serum oestradiol be a predictor of quality of oocytes and embryos, maturation of oocytes and pregnancy rate in ICSI cycles?

Our aim was to assess the influence of ratios of oestradiol (E2) to either number of follicles ≥14 mm on the day of human chorionic gonadotropin administration (E2/fol) or the number of oocytes retrieved (E2/o) during oocyte pick up and total serum E2 levels on the day of embryo transfer (ETE2) on the outcome of ICSI cycles. The assessed outcomes were number of oocytes retrieved (NRO), number of mature oocytes (NMO), number of fertilised oocytes (NFO), number of transferred embryos (NTE), qualities of oocytes (OQS), qualities of embryos (EQS) and pregnancy rates (PR). Two hundred and twenty-seven ICSI-ET cycles admitted to our IVF clinic during a 2-year period with normal ovarian reserve receiving long luteal GnRH agonist protocol were included. The E2/fol levels correlated positively with NRO (r = 0.202, p = 0.002), NMO (r = 0.199, p = 0.003) and NFO (r = 0.159, p = 0.018). However, we observed negative correlations between E2/o and NMO (r = −0.329, p <0.001), NFO (r = −0.219, p = 0.001), EQ5 (r = −0.203, p = 0.040). Oocyte quality scores were not affected from either E2/fol or E2/o levels. Implantation, clinical and ongoing PRs were comparable between groups categorised due to E2/fol, E2/o and ETE2. It seems that high E2/fol ratio may have beneficial effects on NRO, NMO and NFO while E2/o may adversely affect these parameters. Neither of the E2 levels is associated with pregnancy rates in women with normal ovarian reserve.

Partial molar pregnancy and coexisting fetus with diploid karyotype.

Objectives. To evaluate cases of partial hydatidiform mole coexisting with a live fetus, including an observation of our own, and to discuss the proper antenatal management of women wishing to continue with a partial molar pregnancy. Method. A PubMed search was then undertaken, extending over the time period from 1975 to 2006, using the keywords ‘partial hydratidiform mole’, ‘hydatidiform mole’ and ‘coexisting fetus’. Results. At 16 weeks of gestation, an ultrasonographic examination revealed a normal fetus with an extremely large, multicystic placenta. The woman was informed of future risks but wished to continue with the pregnancy. The pregnancy progressed until 28 weeks without any complication but ended spontaneously with a vaginal delivery; the fetus had died in utero. Pathologic examination of the placenta revealed areas of hydropic degeneration and necrosis. Including our own observation, 17 cases of partial hydatidiform mole associated with a fetus of normal karyotype have been documented. Conclusion. Although the rate of adverse perinatal outcome is high, we still believe that if amniocentesis or fetal blood sampling reveals a normal karyotype, then continuing the affected pregnancy with close follow-up in tertiary centers is a feasible choice.

ORIGINAL ARTICLE: Placental Fas/Fas Ligand Expression in Early Pregnancy Losses

Problem  The aim of this study was to compare the expression levels of Fas and Fas ligand (FasL) in first‐trimester placentas obtained from spontaneous abortions in patients with antiphospholipid antibody syndrome (APS) or factor V (FV) Leiden mutation, compared with values in placentas from induced abortions in patients negative for these conditions.

Angle closure glaucoma induced by ritodrine

Angle closure glaucoma (ACG) is an ophthalmologic emergency that must be managed rapidly with a proper treatment modality. The potential complications of ACG are optic nerve injury, corneal edema and decreased visual acuity. The predisposing ocular anatomy is lens–iris apposition and a shallow anterior chamber. Emotional upset, dim illumination, female gender, childbirth, pituitary apoplexy and drugs (such as vasodilators, sympathomimetic, parasympatholytic and parasympathomimetic agents that are used systemically or topically) can cause ACG to occur in susceptible eyes (1,2).

Is the measurement of serum ischemia-modified albumin the best test to diagnose ovarian torsion?

Aim: The aim of this study is to evaluate the diagnostic value of serum oxidative stress marker levels (ischemia-modified albumin, IMA; malondialdehyde, MDA) and total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) levels that occur in ovarian torsion and to determine the threshold value of these markers in the diagnosis of ovarian torsion. Methods: In this prospective case-control study, 34 women (the study group) with acute pelvic pain (20 with and 14 without ovarian torsion) and 40 control subjects were included. The diagnosis of ovarian torsion was confirmed with laparoscopy in all cases. Preoperative serum samples were collected in the study group. Serum oxidative stress marker levels (IMA and MDA) and TOS, TAS and OSI levels were measured. Results: Serum MDA, TOS and IMA concentrations were significantly higher in women with ovarian torsion than in the healthy control group. However, serum TAS, TOS and OSI concentrations were significantly higher in women without ovarian torsion than within the healthy control group. Only IMA significantly distinguished patients with or without ovarian torsion. The best IMA value, according to the receiver operating characteristic curve, was 0.7045 absorbance units, with 90.00% sensitivity and 92.31% specificity. The patients in the ovarian torsion group had significantly lower serum TAS and OSI levels compared with patients without ovarian torsion. Conclusion: The elevated serum IMA levels with high sensitivity-specificity values observed in women with ovarian torsion seem to have a potential role as a serum marker in the preoperative diagnosis of ovarian torsion in emergency settings.

Evaluation of the effects of fasting associated dehydration on maternal NGAL levels and fetal renal artery Doppler parameters

Abstract Objective: The aim of this study was to evaluate maternal neutrophil gelatinase-asssociated lipocalin (NGAL) levels and fetal renal artery (fRA) Doppler flow indices in pregnant women fasting in Ramadan in respect of dehydration in long hot summer days as a marker of hypoperfusion and early renal injury. Methods: A cross-sectional observational study was carried out at a University Hospital. Fasting pregnant women and non-fasting age, gravidity and gestational age-matched women were evaluated for hematologic, blood biochemistry and urine parameters in the first and fourth weeks of the Ramadan. Umbilical artery and fRA Doppler flows were studied in each evaluation. Results: Blood urea nitrogen, potassium and hematocrit levels, blood and urine NGAL levels were significantly higher, and fRA Doppler indices increased in fasting women (p < 0.05) during the second visit in the last week of the Ramadan, while non-fasting women had no significant alterations in each evaluation (p > 0.05). Conclusions: Adequate maternal vascular volume is essential for the maintenance of healthy pregnancy. Fasting during the long and hot summer days leads to fluid deprivation and dehydration which was found to be related to subclinical maternal renal dysfunction and increased fRA Doppler indices.

Vulvar edema as a rare complication of laparoscopy

Vulvar edema as a complication of laparoscopy is a rare condition. A 23-year-old woman was admitted with progressive dysmenorrhea and underwent laparoscopic bilateral endometrioma cystectomy. Twenty-seven hours after surgery, unilateral vulvar edema was observed. It resolved with the application of ice packs and insertion of a Foley catheter. We conclude that this is a rare, normally benign condition that is easy to manage.