Engin Korkmazer

Study on potential role of apolipoprotein E in recurrent pregnancy loss

The role of apolipoprotein E (Apo E) gene polymorphisms in the etiology of recurrent pregnancy loss (RPL) is not clearly understood. We evaluated this polymorphism in unexplained pregnancy losses in a group of Turkish women. In our prospective case-control study, 45 well-characterized RPL cases were examined for their Apo E genotypes, based on restriction fragment length polymorphism analysis of polymerase chain reaction (PCR)-amplified fragments. The observed genotypes were compared with those obtained from equal number matched controls. We observed similar Apo E genotypes and E2, E3 and E4 allele frequency distribution among RPL patients and controls. The allele frequencies obtained in patients and controls, respectively, were as follows: E2=8 (9%) and 12 (13.4%) (P=0.342), E3=66 (73.3%) and 60 (66.6%) (P=0.328) and E4=16 (17.7%) and 18 (20%) (P=0.703). Our data did not support the association of Apo E gene polymorphisms with RPL as reported by previous studies. We endorse adequate characterization of RPL cases and adequate sample size prior to addressing such studies.

Ultrasound guidance during hysteroscopic myomectomy in G1 and G2 Submucous Myomas: for a safer one step surgery

OBJECTIVE Hysteroscopic myomectomy is the gold standard method for treatment of submucous fibroids. Hysteroscopic myomectomy techniques for removal of submucous fibroids still have controversies. In this study we aimed to describe usefulness of ultrasound guidance in hysteroscopic myomectomy for a safe and effective removal of submucous G1 and G2 fibroids. STUDY DESIGN This is a multicentre study. 64 symptomatic patients with submucous fibroid underwent ultrasound guided hysteroscopic myomectomy. First we excised intrauterine dome of fibroid until reaching the level of cavity wall by the method of resectoscopic (electrosurgical resection using a loop electrode) slicing. Next remnant intramural node was squeezed by uterine contractions induced. After we had excised the intrauterine dome of fibroid by slicing method, we formed cavitation for the intramural part (newly raised myoma dome). The cavity was filled with distension solution and we evaluated the margins of the uterus and the margins of the myoma by sonographically. Then the myoma was excised under ultrasonographic guidance by transabdominal probe. We obtained a regular uterine cavity. RESULTS Mean operation time was 42±7min. Mean Mannitol volume was 4.3±1.7l and the mean intraoperational fluid deficit was 500ml. Not in any case uterine perforation was occurred. All fibroids removed totally. In 8 (19%) cases intrauterine synechiae detected and all these synechiaes were incised by a scissor during hysteroscopy. CONCLUSION There is still no single technique proven to be unequivocally superior to the others for treating fibroids with intramural development (G1-G2). Ultrasound guided hysteroscopy seems to be an effective and safe method for resection of G1 and G2 fibroids.

Nuchal translucency measurement: who is right, who is not?

Objective: Fetal nuchal translucency (NT) measurement at first trimester provides prediction for fetal aneuploidy and cardiac anomalies. Performance of NT as a screening marker has not been consistent in studies. Measurement of NT has high intraand interobserver variability. Radiologists, obstetricians and perinatology experts measure the NT. There is no consensus about who should perform the NT measurement. In this study we compared the correlation of NT measurement in three groups depend on mean thickness and distribution of NT. Methods: A total of 929 participants were recruited for this study. 7 radiologists, 8 obstetricians and 1 perinatology expert measured NT. Crown-rump length (CRL), mean NT and NT distribution were calculated for each group. Results: Perinatology expert’s mean NT measurement was significantly higher than that of radiologists and obstetricians (p<0.05). Measurements of the perinatal expert also had significantly different distribution than other groups (p<0.05). There was no significant difference between the groups in terms of CRL values. Interobserver reliability coefficients with 95% confidence intervals for CRL and NT were 0.967 (0.910–0.987, p<0.001) and 0.596 (0.455–0.845, p<0.001), respectively. Conclusion: There are statistically significant differences for mean NT value and distribution in three groups. Measurements of the perinatal expert has higher mean thickness and distribution. It is obvious that there is a need for standardization in NT measurement and it is necessary to evaluate the perinatal outcomes of these three groups and to approximate the two groups with the most accurate result group.

Relationship between vascular cell adhesion molecule-1 and morbidly adherent placenta

INTRODUCTION Morbidly adherent placenta is a clinical condition of which prevalance is steadily increasing. It is described as the invasion of the placenta into the uterine wall through the myometrium and beyond. Vascular cell adhesion molecule-1 is a calcium independent transmembrane glycoprotein. Several studies have shown that vascular cell adhesion molecule-1 increases invasion in tumor cells. In our study we investigated the expression of vascular cell adhesion molecule-1 which has been shown to increase invasion in various tumors in morbidly adherent placenta cases. MATERIAL AND METHOD This is a prospective case-control study. Eighty-four patients who were diagnosed with morbidly adherent placenta and 96 patients without any risk factors as a control group were included in the study. Vascular cell adhesion molecule-1 staining was examined by immune-histochemical staining in placental samples. RESULTS The patients included in the study were similar in terms of demographic characteristics. Of the 84 patients in the morbidly adherent placenta group, 65 (74.7%) showed positive staining. This number was 39 (40.6%) in the control group. Staining in morbidly adherent placenta group was statistically significantly higher (p<0.05). DISCUSSION The etiology of morbidly adherent placenta is still a clinically unknown condition. This study is the first study on this field in the literature. In our study, we showed that vascular cell adhesion molecule-1 expression increased in morbidly adherent placenta group. Although the entire pathogenesis is not explained this can be considered as a step for understanding this subject.

Relationship between intercellular adhesion molecule-1 and morbidly adherent placenta

Abstract Objective Morbidly adherent placenta (MAP) is a clinical condition the prevalance of which is steadily increasing. It is described as the invasion of the placenta into the uterine wall through the myometrium and beyond. Several studies have shown that intercellular adhesion molecule-1 (ICAM-1) increases the invasion capability of tumor cells and placental cells. In our study, we investigated the expression of ICAM-1 in MAP cases. Methods This is a prospective case-control study. Eighty-nine patients who were diagnosed with MAP and 96 patients, without adherent placenta, as a control group were included in the study. ICAM-1 staining was examined by immuno-histochemical staining in placental samples. Results Of the 89 patients in the MAP group, 72 (80.8%) showed positive staining, while 26 (27%) did so in the control group. ICAM-1 positive staining in the MAP group was statistically significantly higher (P=0.03). Conclusion This is the first study investigating the relationship between MAP and ICAM-1 in the literature. In our study, we showed that ICAM-1 expression increased in the MAP group.

Relationship between endometrial thickness and neutrophil/lymphocyte ratio with endometrial malignancy in 386 postmenopausal uterine bleeding cases

Introduction: In our study, endometrial thickness with neutrophil/lymphocyte ratio and endometrial sampling results were compared in terms of outcome in women with postmenopausal bleeding. In addition, we aimed to determine the predictive value of endometrial thickness and neutrophil/lymphocyte ratio for predicting endometrial carcinoma. Material and methods: Our single-centered study was performed retrospectively. The study included 386 postmenopausal women admitted to our gynecology outpatient clinic for abnormal uterine bleeding between January 2015 and June 2017 and subjected to endometrial sampling. Results: The mean endometrial thickness for endometrial hyperplasia was calculated as 13 mm (min. 4 mm, max. 20 mm) and for endometrial carcinoma 17.19 mm (min. 8 mm, max. 27 mm). The neutrophil count and neutrophil/lymphocyte ratio (NLR) were significantly higher and the lymphocyte count was lower in the group with endometrial malignancy (p = 0.002, p < 0.001 and p = 0.011, respectively). None of the patients with endometrial thickness < 8 mm received an endometrial carcinoma diagnosis. The optimal cut-off value of endometrial thickness for detecting endometrial carcinoma was ≥ 13.50 mm, at which the sensitivity was 75% and specificity was 83.6%. The optimal cut-off value of NLR for detecting endometrial carcinoma was ≥ 2.20, at which the sensitivity was 81.3% and specificity was 60.5%. Conclusions: Co-evaluation of NLR with endometrial thickness determined by transvaginal sonography might be useful for predicting endometrial carcinoma.

Risk factors for relaparotomy after cesarean delivery and related maternal near-miss event due to bleeding

Abstract Aim: To define the risk factors for relaparotomy after cesarean delivery (RLACD) and related maternal near-miss event due to bleeding. Methods: In this retrospective descriptive case-control study, women who underwent RLACD (n = 46) only for bleeding between 2012 and 2017 were reviewed. Factors that could predict relaparotomy and related near-miss event were evaluated. Maternal characteristics, laboratory findings and surgical features were compared with a control group (n = 230) that included noncomplicated cesarean deliveries (CD). Logistic regression analysis was used to identify independent factors for relaparotomy. Results: RLACD for bleeding was required in 0.26% of patients and the incidence increased gradually over years (0.16% in 2013 versus 0.44% in 2017). Mean interval between CD and subsequent relaparotomy was 15.7 ± 3.2 hours. The sources of bleeding in descending order of frequency included; uterine fundus and placental bed (39.1%), cervix (21.7%), undetermined (17.3%), superior epigastric artery (13%), superficial epigastric artery (8.1%). Longer duration of CD (adjusted odd ratio (aOR) 1.82, 95% CI 1.02–2.53), increased number of prior CDs (aOR 2.51, 95% CI 1.09–5.78), preeclampsia (aOR 3.48, 95% CI 1.21–7.19) were found to be independent risk indicators for RLACD. Moreover, longer duration of interval between CD and relaparotomy (p = .005), longer relaparotomy duration (p = .012) and greater drop in hemoglobin level (p = .001) were found to be the predictors of maternal near-miss event. Conclusions: Patients with identified risk factors should be managed properly in order to prevent relaparotomy and near-miss event after CD. Also, urgent decision of surgical intervention might reduce the risk of maternal near-miss event.

Isolated Torsion of the Fallopian Tube in a Reproductive-Aged Woman: Case Report

Adnexal cystic lesions are often found in reproductive age women, most of them origins from ovary. Nearly all are functional cysts, and only few of them require aggressive management. However, isolated torsion of the fallopian tube is rare and this clinical entity mimics the torsion of the ovary. It’s hard to diagnose because of the rarity. Prior tubal surgery, tubal-paratubal cystic masses, pelvic inflammatory disease, hydrosalpinx, congenital anomalies and trauma are the main risk factors. Laparoscopic intervention is the gold standard method for diagnose and treatment. In this case, we report the isolated torsion of the fallopian tube and its management in a reproductive-aged woman, in the light of the literature.

Mean platelet volume may not show the presence and severity of hyperemesis gravidarum: Reply

We appreciate the comments of Dr Beyan with regard to plateletcrit and mean platelet volume (MPV) in our recent article in the Journal. Platelets play an important and active role in acute and chronic inflammation. Altered platelet volume is observed during inflammatory conditions. Hence, MPV, an indirect parameter of inflammation, has been considered as a marker of platelet efficiency. MPV is a cheap, readily available and practical marker that is included in the complete blood count test. Anticoagulants such as ethylenediaminetetraacetic acid (EDTA), which is found in complete blood count tubes,may lead to destruction of platelet structure.A rise in MPV is observed in platelets exposed to the EDTA found in complete blood count tubes. Lancé et al. reported that MPV must be measured within 120 min after collection of the blood sample to ensure accuracy. At our hospital, complete blood count analysis is performed in the first 2 h after blood sample collection for both the patient and control groups. Hence, EDTArelated change in MPV was similar in the two groups, even though the study was conducted retrospectively. Mean platelet volume measurement may also be affected by the instrumentation used in complete blood count. Different models of measurement devices have been used in recent studies, producing differences in measurement of up to 40%. Given that we used a single type of device, device-related measurement difference did not occur. Hyperemesis gravidarum (HG) is an inflammatory disease, and an increased plateletcrit was noted in our study. Moreover, plateletcrit was reported to be higher in the moderate HG group than in the mild group, and in the severe group than in the moderate group. In conclusion, MPV seems to be a beneficial, readily available, inexpensive measurement of inflammation. Given, however, that measurement of MPV is affected by factors such as the type of anticoagulant used in the blood collection tube; the time between blood sample collection and measurement; and the measurement device used, prospective studies with a larger population; a known, single type of anticoagulant used in the blood collection tubes; a single type of device used for measurement; and measurement done in the first 120min after blood collection, are needed to obtainmore reliable results.

Is there any role of prolidase enzyme activity in the etiology of preeclampsia

Abstract Objective: To evaluate a relationship between preeclampsia and prolidase enzyme activity. Methods: A prospective cohort study of 41 pregnant women diagnosed with preeclampsia and 31 healthy pregnant women as control group was selected at Harran University Hospital Department of Obstetrics and Gynecology. The prolidase enzyme activity was analyzed in maternal and umbilical cord plasma, amniotic fluid and placental and umbilical cord tissues by Chinard method in addition to maternal serum levels of lactate dehydrogenase (LDH), serum glutamate pyruvate transaminase (SGPT) and serum glutamate oxaloacetate transaminase (SGOT). Results: A significant relationship was found between plasma prolidase activity (635 ± 83 U/L) (p  = 0.007), umbilical cord plasma prolidase activity (610 ± 90 U/L) (p = 0.013), amniotic fluid prolidase activity (558 ± 100 U/L) (p  = 0.001), umbilical cord tissue prolidase activity (4248 ± 1675 U/gr protein) (p  = 0.013) and placental tissue prolidase activity (2116 ± 601 U/gr protein) (p  = 0.001) in preeclamptic group when compared to healthy pregnant women. Conclusion: There is a strong correlation between prolidase enzyme activity and preeclampsia. Prolidase enzyme activity may play a role in preeclampsia.