Emre Zafer

Detection and Typing of Human Papillomavirus in Non-Small Cell Lung Cancer

Background: Lung cancer is the most frequent cause of death in both men and women. Smoking is the greatest risk factor for lung cancer and the relation of human papillomavirus (HPV) infection with lung cancer has been reported. HPV can be detected in small cell lung cancer samples with the methods like in situ hybridization, polymerase chain reaction (PCR), Southern blotting, dot blotting. Objective: We aimed to detect and type HPV infection in non-small cell lung carcinoma tissue samples. Methods: Tumor samples from 40 patients were collected during surgery and PCR and restriction fragment length polymorphism (RFLP) were used in order to detect HPV infection in the samples. Results: Two HPV DNA were detected among 40 of the patients, revealing a low frequency of HPV in the samples. Conclusions: HPV can be regarded as an environmental factor in tumor development. There might be a relationship between HPV infection and some non-small cell lung cancers, especially in the smoking group.

Maternal serum concentrations of s-Endoglin and IL-6 in pregnancy complicated by preterm premature membrane rupture

Abstract Objective: This study aimed to investigate maternal serum concentrations of s-Endoglin and compare s-Endoglin with other inflammatory markers in prediction of time to delivery, in pregnancies complicated by preterm premature rupture of membranes (PPROM). Materials and methods: Fifty five patients complicated by PPROM whose gestational age were between 2433 weeks and 44 matched healthy pregnant women were included in present study. Maternal concentrations of s-Endoglin concentrations were measured by an enzyme-linked immunosorbent assay (ELISA) and compared with maternal inflammatory markers including interleukin-6 (IL-6), white blood cell (WBC) count and serum C-reactive protein (CRP). The best variable for prediction of preterm birth was computed. Results: Mean s-Endoglin levels in PPROM were lower than control groups (0.24 ± 0.12 pg/ml and 0.69 ± 0.25 pg/ml, respectively, p < 0.01). Besides IL-6 (p < 0.01), WBC (p = 0.016) and CRP (p = 0.010) levels were higher in PPROM group. In PPROM group, ROC analysis results of s-Endoglin for prediction of preterm delivery <48 h, <7 days, <32 weeks were not different (p > 0.05). For predicting preterm birth before 48 h and 7 days, only IL-6 at cut off value >0.70 (pg/ml) and >0.55 (pg/ml) had area under curve (AUC); 0.871 (0.7750.965), p < 0.01, AUC; 0.925 (0.8560.993), p < 0.001, respectively. Conclusion: s-Endoglin as an anti-angiogenic marker seemed to have a role in pathogenesis but results of present study showed that, unlike IL-6, it was unsatisfactory for estimating time to delivery in PPROM.

Comparison of maternal and umbilical cord blood HIF-1α and nitric oxide levels in early and late onset preeclamptic pregnancies.

Abstract Objective: Despite the absence of a complete physiologic–pathologic understanding, common accepted theory for development of preeclampsia is incomplete trophoblastic invasion leading to failed uterine and spiral arteriolar remodeling, causing maternal vascular endothelial dysfunction by secreted molecules in response to decreased placental perfusion, placental hypoxia, and ischemia. Placental angiogenesis is especially ineffective in early onset preeclampsia and fetal morbidity/mortality rates are higher because of further decreased blood flow. In this study, we aim to compare the maternal and umbilical cord blood levels of hypoxia-inducible transcription factor-1α (HIF-1α), which is believed to regulate hypoxia-related transcriptional responses, to play role in activating genes for initial phases of placental development and angiogenesis and a physiologic vasodilator molecule nitric oxide (NO) in normal, early and late onset preeclamptic pregnant women. Methods: Pregnant women who were diagnosed with preeclampsia (early onset ≤34 weeks; late onset >34 weeks) and delivered in our clinic were enrolled for this prospective case-controlled study. Pregnant women without preeclampsia were recruited as control group. HIF-1α and NO levels in maternal and umbilical cord blood measured and compared among groups. Findings: A total of 46 cases were enrolled for this study, including 25 preeclamptic (13 in the early onset group and 12 in the late onset group) and 21 normal pregnant women in the control group. Comparison of preeclampsia group to controls revealed higher maternal blood HIF-1α levels in the control group, however higher umbilical cord NO levels in the preeclampsia group (p < 0.05 and p < 0.001, respectively). In a second analysis, when compared to control group, both early and late onset preeclampsia subgroups were found to have higher umbilical cord blood NO levels (p < 0.001). Results: In this study, we observed lower maternal blood HIF-1α levels and higher umbilical cord NO levels in preeclampsia group than controls. These findings suggest that umbilical cord blood NO levels in pregnant women with preeclampsia increase in response to hypoxia. However, lower HIF-1α levels in preeclampsia group can be due to our limited number of cases and we think that there is a need for further studies with larger sample size.

Saethre-Chotzen Syndrome Presenting with Incomplete Renal Fanconi Syndrome

Here we report on a patient with findings of acrocephaly, craniosynostosis, low frontal hairline, ptosis of eyelids, deviated nasal septum, broad great toes, moderate hallux valgus, bilateral symmetrical complete soft tissue syndactyly of toes 2 and 3, and partial soft tissue syndactyly of toes 4 and 5 consistent with the diagnosis of Saethre-Chotzen syndrome. Additionally, the patient had some unusual findings as part of generalized dysfunction of the renal tubules including hypophosphatemia with renal phosphate wasting, normocalcemic hypercalciuria, hypomagnesemia with renal magnesium wasting, low-molecular-weight proteinuria, decreased serum PTH levels, osteopenia, and nephrolithiasis. In the light of these findings, the diagnosis of incomplete renal Fanconi syndrome was made. In conclusion, on the basis of the present findings, it is difficult to say whether renal tubular dysfunction are somehow connected to the Saethre-Chotzen syndrome or not. Therefore, we consider that this is probably just a coincident. However, further studies may show the connection between renal tubular dysfunction and Saethre-Chotzen syndrome.

Correlation between maternal serum-amniotic fluid anti-angiogenic factors and uterine artery Doppler indices

Abstract Purpose: Elevated sFlt-1 and sEng is usually a clue for impending preeclampsia and intrauterine growth restriction. Likewise, uterine artery Doppler ultrasound is being investigated for prediction of similar conditions. In this study, we aimed to explore the possible relations of these two proteins in different body compartments with uterine artery Doppler indices (UtAD) in a healthy second trimester obstetric population. Methods: Levels of sFlt-1 and sEng were measured in serum and amniotic fluid samples of 43 patients. UtAD were measured on the days of sample collections. Findings were then analyzed for possible correlation. Results: There was a positive correlation between the levels of maternal serum sFlt-1 (MSsFlt-1) and sEng levels (MSsEng) (r= 0.516, p< 0.001). The negative correlation between MSsFlt-1 and UtAD was disappeared after elimination of poor obstetric outcome pregnancies (r= −0.371, p= 0.016). No correlation was found between UtAD and studied protein levels in amniotic fluid. Mean MSsFlt-1 level was 305.2 ± 220.1 pg/ml and mean AFsFlt-1 was 48.9 ± 11.8 ng/ml. Mean MSsEng level was 4.5 ± 1.3 ng/ml, mean AFsEng level was found 0.7 ± 0.3 ng/ml. Mean values for UtAD were 1.3 ± 0.4, 0.6 ± 0.1 and 3.5 ± 1.3 for PI, RI, and S/D, respectively. Conclusion: In normal second trimester pregnancies, there is a positive correlation between serum levels of sFlt-1 and sEng levels. Amniotic fluid levels of sEng and sFlt-1 are not correlated with UtAD in uncomplicated pregnancies.

Fetal cell detection for chromosome analysis from leaking amniotic fluid in pregnancies with rupture of membranes

Objective: In this study, our goal was to assess the feasibility of using vaginally obtained amniotic fluid samples for prenatal chromosome analysis by fluorescence in situ hybridization (FISH) in pregnancies with ruptured amniotic membranes. Methods: Twenty-four pregnant women with known male fetal gender were retrieved for the study. All had ruptured membranes either artificially (AROM) or spontaneous (SROM) at term or at preterm gestations (PPROM). Samples from leaking amniotic fluid were collected during speculum examinations and slides were prepared for FISH using probes specific for chromosomes X and Y. Fetal cell detection rate was calculated as percentage of XY nuclei. Specimen volume, presence of mucus, presence of blood, gestational age, artificial versus spontaneous rupture of membranes and time elapsed until specimen processing were compared with regard to fetal cell detection rate. Results: There were 12 patients with AROM (50%) and 12 with SROM (50%). Only two of those were preterm (8.3%). Six of the specimens were bloody (25%) and 16 (66.6%) were macroscopically with mucous. The proportion of male fetuses identifiable by FISH was 100% (95% CI: 86%, 100%) after exclusion of technical failures (n=4). Overall, fetal cell detection rate was 6.4%. Samples collected after AROM had borderline higher percentage of fetal cells compared with SROM after adjusting for presence of blood in the sample (p=0.07). In addition, bloody samples had a significantly higher percentage of fetal cells than those that were not bloody (p=0.01). Conclusion: Amniotic fluid collection for prenatal chromosome analysis by interphase FISH is a feasible, non-invasive and reasonable approach on rupture of membranes patients and may be accomplished on preterm premature rupture of membranes with known male fetus pregnancies when indicated. Further studies are needed to assess the value of molecular analysis to differentiate fetal cells with higher specificity for female fetuses.

Relationship Between The Number of Cesarean Deliveries and Maternal-Fetal Complications

Öz Amaç: Sezeryan operasyonu tüm dünyada çok yaygın olarak ve giderek artan oranlarda yapılmaktadır. Sunulan bu çalışmada sezeryan sayısının maternal ve fetal sağlığı üzerine etkilerinin incelenmesidir. Gereç ve Yöntemler: Çalışmaya 1 Ekim 2014 1 Ekim 2017 tarihleri arasında kliniğimizde sezeryan operasyonu geçirmiş ve ek hastalığı olmayan, gebelik haftası 38-40 hafta arasında olan, gebeliği 18-40 yaşlarında olan kişiler dahil edilmiştir. Bu kişilerin doğum sonrası kayıtları retrospektif olarak incelenmiştir. Gebelik Objective: Cesarean operation is very common and it is being performed increasingly all over the world. In this study, the effect of the number of cesarean deliveries on maternal and fetal health was evaluated. Materials and Methods: We included patients who underwent cesarean section in our clinic between October 2014 and October 2017, who had no additional disease, between 38 and 40 gestational weeks, and ages between 18 and 40 years. Postnatal records were retrospectively reviewed. Patients who had pregnancy complications such as pregnancy hypertension, gestational diabetes, oligohydramnios, polyhydramnios, or who had a dysmorphic appearing baby or with any genetic syndrome were excluded. Patients were divided into three groups according to the number of cesareans they had undergone. Group 1 consisted of patients with history of two cesarean deliveries, group 2 consisted of patients with 3 cesarean deliveries and group three consisted of patients with 4 or more cesarean deliveries. Groups were then compared to each other for their demographic data and maternal fetal outcomes. Results: Mean age of the patients studied was 32.4 years [standard deviation (SD): 4.4], mean gestational week was 38 weeks and 2 days (SD: 0.55), and mean hospitalization duration was: 4.4 days (SD: 1.0). There was no significant correlation between the number of cesarean section and the parameters of birth weight, duration of hospital stay, and appearance, pulse, grimace, activity, and respiration scores. Conclusion: The history for the number of previous cesarean deliveries for a pregnancy may not seem to be correlated with increased maternal or fetal complications up to four previous cesarean deliveries. There is a need for future studies with even larger patients to support our findings.

Neurofibromatosis type 1 case with cerebral involvement complicating pregnancy

Objective: Neurofibromatosis-1 is a disease with an autosomal dominant inheritance pattern and heterogenous clinical presentation. Although it is not rare, its diagnosis may be overlooked except the cases evaluated by the specialists from related disciplines. In this report, we aimed to discuss the progress and complications of the disease during pregnancy over a case diagnosed with neurofibromatosis-1 during pregnancy. Case: Twenty-eight-year-old case who was pregnant for 30 weeks admitted with hypertension, proteinuria and convulsions. The patient delivered with the diagnosis of preeclampsia/eclampsia was established the diagnosis of neurofibromatosis-1 during postoperative period. Conclusion: Neurofibromatosis-1 during pregnancy may cause serious problems with the rapid growth of neurofibromas, changing characteristics or the addition of new ones. To predict possible complications that may develop and to minimize them, neurofibromatosis-1 cases should be managed with an experienced and multidisciplinary team approach.

Second trimester abortion as a cause of maternal death: a case report

Each year, an estimated 529 000 maternal deaths occur worldwide. In literature, it is known that maternal mortality can occur during pregnancy, peripartum and also in postpartum period. Although very rare, maternal deaths may occur after spontaneous abortion. In present case, 37 year old G5P4 (Caesarean Section) women was admitted to Adnan Menderes University, Obstetrics and Gynecology clinic with diagnosis of missed abortion at 18 weeks’ gestation. She had been hospitalized in the public maternity hospital for five days due to abortus incipience and prolapse of amnion membranes but had no contractions. Fetal heart beats ceased at the second day of hospitalization. Medically induced abortion was recommended but not accepted by the patient. At the fifth day of hospitalization, she was referred to our clinic due to deterioration of general health condition, low blood pressure and tachycardia. In emergency department, it was determined that she was not oriented, had confusion, had blood pressure of 49/25 mmHg and tachycardia. In ultrasonographic examination, 18 week in utero ex fetus was determined and there was free fluid in abdominopelvic cavity. The free fluid was suspected to be amniotic fluid due to rupture of uterus. Laparotomy was performed, no uterine rupture, hematoma or atony was observed. However during laparotomy, a very bad smelling odor, might be due to septicemia, was felt in the operation room. Cardiac arrest occurred during that operation. In autopsy report, it was concluded that maternal death was because of remaining of inutero ex fetus for a long time. In conclusion, although very rare, maternal deaths after spontaneous abortion may occur. Because spontaneous abortion is a common outcome of pregnancy, continued careful, strict monitoring and immediate treatment of especially second trimester spontaneous abortion is recommended to prevent related, disappointing, unexpected maternal deaths.

Wilson’s disease presenting with HELLP syndrome; A case report

Wilson’s disease (WD) is an autosomal recessive disorder. It is characterized by toxic accumulation of copper mainly in the liver and brain but also in cornea and kidney due to a defect in biliary excretion of copper. The hepatic manifestation of WD is diverse and may include asymptomatic elevation of aminotransferase, chronic hepatitis, cirrhosis, or acute/fulminant hepatic failure. Characteristic of acute hepatic failure in WD is concomitance of acute intravascular hemolytic anemia. Acute intravascular hemolytic anemia and thrombocytopenia in WD may be interpreted as a feature of Hemolysis, Elevated Liver Enzymes, Low Platelet Count (HELLP) syndrome besides acute liver failure. The differential diagnosis may be very difficult. Here, WD in pregnancy presenting with clinical symptoms of HELLP syndrome and developing acute liver failure in postpartum period is discussed.