Erdal Malatyalioglu

Maternal and umbilical serum levels of interleukin-6, interleukin-8, and tumor necrosis factor-α in normal pregnancies and in pregnancies complicated by preeclampsia

Objectives. The aim of this study was to investigate the relationship of maternal and umbilical cord interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) serum levels with the existence and severity of preeclampsia. A particular objective was the comparison of normal umbilical serum levels to preeclamptic values. Materials and Methods. The study group consisted of 24 patients with third trimester singleton pregnancies complicated by preeclampsia (15 severe and 9 mild preeclampsia). The gestational age-matched 19 healthy pregnant women were compared by study group. Maternal and umbilical serum IL-6, IL-8, and TNF-α were calculated by using enzyme-linked immunosorbent assay. Results. Significantly increased maternal and umbilical serum levels of IL-6, IL-8, and TNF-α were found in preeclamptic patient group in comparison with the control group. Maternal serum IL-8 and TNF-α concentration were significantly higher in patients with severe preeclampsia than in mild preeclampsia. Increased umbilical serum levels of IL-6 and IL-8 were found in severe preeclampsia than in mild preeclampsia. There were significantly higher levels of maternal serum IL-8 and TNF-α in patients with preeclampsia with IUGR than in patients with preeclampsia with normal fetal growth. Conclusion. Our findings suggest that increased concentrations of IL-6, IL-8, and TNF-α in the maternal and umbilical serum play a significant role in pathogenesis of preeclampsia. Alterations in maternal and umbilical serum levels of IL-6, IL-8, and TNF-α may also play role in preeclampsia complicated by intrauterine growth retardation. These associations may offer insight into the etiology and pathogenesis of preeclampsia.

Estimation of the amniotic fluid volume using the Cavalieri method on ultrasound images

Objectives: Presently, a design‐based and practical method for measuring amniotic fluid volume (AFV) for routine clinical examinations has not been proposed. In this study we describe a new method, which combines the Cavalieri method with ultrasound imaging to estimate AFV. Methods: We measured the AFVs of 14 women in the third trimester of pregnancy, and repeated our measurements three times for each woman. Parallel planimetric ultrasonographic images were obtained at every 2 cm along the longitudinal uterine axis. AFVs were calculated as the total of the multiples of the estimated cut surface areas by the section thickness. Results: The mean estimated AFV was 380.5 cm3. The coefficient of error of each measurement was calculated and the mean was 0.108. The coefficient of correlation between the amniotic fluid index and our AFV estimations was 0.87. Conclusions: Design‐based and efficient estimation of AFV is possible with the combination of consecutive ultrasound images and the Cavalieri method.

Comparison of the effects of transdermal estrogen, oral estrogen, and oral estrogen-progestogen therapy on bone mineral density in postmenopausal women

Abstract. It is now clear that estrogen intervention reduces bone loss in postmenopausal osteoporosis. The aim of this study was to investigate whether the route of estrogen administration or addition of progesterone changes this positive effect. Transdermal estrogen (T-E), oral estrogen (E), and oral estrogen plus progestogen (E-P) were administered to 15, 18, and 17 postmenopausal women, respectively, who all had normal bone mineral density (BMD) before hormone replacement therapy (HRT). Calcium (500 mg/day) was routinely added to all HRT regimens. The BMD of the lumbar spine (L2–L4) was measured initially and at the end of the first and second years of treatment. The paired-sample t test, independent-sample t test, and Pearson correlation analysis were used for the statistical evaluation. The initial BMD measurements and the values at the end of the first and second years of the therapy were not significantly different either within or among the groups (P > 0.05). These results indicate a similar therapeutic value of each HRT regimen in the prevention of bone loss in postmenopausal women.

Evaluation of Urethrovesical Angle by Ultrasound in Women with and without Urinary Stress Incontinence

Abstract: Our aim was to investigate the role of ultrasonographic imaging in the evaluation of genuine stress incontinence (GSI). The posterior urethrovesical angles (PUVA) of each of 50 incontinent (group I) and 50 control cases (group C) were measured by both transperineal and transvaginal ultrasonography (TP-USG, TV-USG). In group I the angles were 94.9 ± 10.9 at rest and 102.7 ± 16.1 by TP-USG (P<0.001), and 100.6 ± 11.1 at rest and 103.3 ± 9.6 during Valsalva by TV-USG (not significant). In the control group these measurements were 93 ± 5.3, 96.2 ± 7.9 (P<0.001) and 98 ± 8.8, 101.1 ± 10.3 (P=0.001) by TV-USG, respectively. The degree of alteration of the angle, originating with Valsalva maneuver (D-PUVA) was 7.7 ± 11.8 in group I and 3.2 ± 4.95 in group C (P=0.014) by TP-USG, and 2.7 ± 11.8 and 3.2 ± 6.16 by TV-USG (NS). Our data reveal that PUVA and D-PUVA have important roles in GSI pathophysiology; however, ultrasonography, especially by the transvaginal route, cannot be a reliable useful method as a diagnostic tool in the evaluation of GSI.

May ratio of neutrophil to lymphocyte be useful in predicting the risk of developing preeclampsia? A pilot study.

Abstract Objective: The aim of the study was to evaluate the relationship between neutrophil to lymphocyte ratio (NLR) and preeclampsia. Methods: Demographic data and laboratory tests for NLR of 203 pregnant women (73 normotensive pregnants, 23 pregnants with mild preeclampsia and 107 pregnants with severe preeclampsia) were retrospectively analyzed. Neutrophil to lymphocyte ratios were compared between the study groups. Results: Preeclamptic pregnant women had smaller gestation weeks, lower hemoglobin level and fetal birth weight than that of normal pregnant women. NLR in preeclamptic group was significantly higher than that of normal group (p = 0.023) and area under ROC curve was found statistically significant (p = 0.023). However, there was no statistically significant relationship between NLR and severity, proteinuria level, subjective symptoms and onset time of the disease. Conclusion: The findings showed that the measurement of NLR periodically may be useful to predict high-risk pregnancies in terms of preeclampsia, but further studies are needed to determine its contribution.

May the Platelet to Lymphocyte Ratio be a Prognostic Factor for Epithelial Ovarian Cancer

BACKGROUND The study aimed to evaluate changes in hematologic parameters, including white blood cell, platelet count, platelet indices, the platelet to lymphocyte and neutrophil to lymphocyte ratios in patients with early and advanced stages of epithelial ovarian cancers. MATERIALS AND METHODS The study included 100 patients with epithelial ovarian cancer who underwent primary staging exploratory laparotomy. Preoperative hematologic parameters, tumor histopathologic type, grade, stage and serum CA-125 levels were retrospectively analyzed. These parameters were compared between the patients with early (stage I-II) and advanced (stage III-IV) ovarian cancer. RESULTS White blood cell count and platelet indices, including mean platelet volume, platelet distribution width and platelet crit did not show a statistically significant difference between groups with early and advanced ovarian cancer. However, the neutrophil to lymphocyte ratio, platelet count, the platelet to lymphocyte ratio and CA-125 level showed a statistically significant difference between the two groups (p<0.05, p<0.01, p<0.001, p<0.01 respectively). CONCLUSIONS It was found that the neutrophil to lymphocyte ratio, platelet count and the platelet to lymphocyte ratio increased with the increasing stage of ovarian cancer. Furthermore, it was seen that the platelet to lymphocyte ratio is an independent prognostic factor related to the stage of epithelial ovarian cancer.

CA‐125 levels in ruptured and unruptured tubal ectopic pregnancies

Aim:  This prospective, single‐blind and controlled clinical study aimed to research if CA‐125 levels could be a useful test in the differential diagnosis of intact and ruptured tubal ectopic pregnancy.

Do Leukocyte and Platelet Counts Have Benefit for \Preoperative Evaluation of Endometrial Cancer?

PURPOSE The aim of this study was to investigate the association between preoperative leukocyte and platelet counts and the stage of the disease in patients with endometrial cancer. MATERIALS AND METHODS Data for 100 patients undergoing total abdominal hysterectomy and bilateral salpingoophorectomy for benign uterine diseases and 177 patients surgically staged for endometrial cancer at Ondokuz Mayis University, Department of Gynecology and Obstetrics between 2005 and 2013, with preoperative complete blood count in the week prior to surgery including WBC, platelet count, pathologic evaluation for both benign and malign endometrium lesions, tumor stage and presence of lymphovascular space invasion (LVI), were retrospectively analyzed. RESULTS The preoperative leukocyte count was significantly higher in patients with endometrial cancer when compared to the patients with benign diseases. However, there were no significant differences in platelet counts between the groups. Patients with advanced stage endometrial cancer had higher preoperative leukocyte counts when compared to the early stage disease whereas there was no difference in platelet count. Multivariate regression analysis identified preoperative leukocytosis as an independent prognostic factor for endometrial cancer. The optimal cut-off point for WBC was calculated as 10,500 to differentiate stage 1-2-3 and 4 with 88.9% sensitivity and 86.3% specificity (AUC: 0.901, 95% CI: 0.829-0.973, p<0.001, PPV: 25.8%, NPV: 99.3%). CONCLUSIONS Preoperative leukocytosis is independently associated with advanced endometrial cancer.

Tibolone versus four estrogen replacement therapy protocols and plasma lipid levels in postmenopausal women

Objectives: To compare tibolone therapy with four different estrogen replacement therapy protocols, with regard to the effects on plasma lipid profiles. Methods: The plasma lipid levels of 178 postmenopausal women in five different therapy groups were compared with each other as well as their baseline levels with 6‐month intervals during 2‐year follow‐up. Students t‐test, paired t‐test and Pearson correlation analysis were utilized for statistical analysis. Results: HDL cholesterol levels increased significantly from baseline in groups using oral estrogen (P<0.05) but a slight non‐significant decrease was seen in tibolone therapy (P>0.05). LDL cholesterol levels significantly decreased at the end of the second year in oral estrogen and tibolone users (P<0.05). Triglyceride levels increased non‐significantly with estrogen therapy (P>0.05), whilst decreased significantly in the tibolone group (P<0.05). Conclusion: Tibolone may be a good alternative to estrogen replacement therapy in postmenopausal women, as it has beneficial effects on LDL cholesterol and triglyceride levels, which play important role in atherosclerosis.

Serum VEGF and PGF may be significant markers in prediction of severity of preeclampsia.

Abstract Objective: The aim of this study evaluate the value of vascular endothelial growth factor (VEGF) and placental growth factor (PGF) serum levels in prediction of preeclampsia, severity and onset time of the disease. Methods: Twenty five placentas of pregnant women diagnosed with preeclampsia (15 severe preeclampsia, 10 mild preeclampsia) and peripheral venous blood samples were collected. The placental and serum levels of VEGF and PGF were measured. Results: VEGF level was significantly higher in cases and the optimal cut-off point was calculated as 600.5 to differentiate the cases and the controls, with 64% sensitivity and 100% specificity. There was a significant increase in median serum level of VEGF in severe cases compared to the mild cases and the controls. The optimal cut-off point for VEGF was calculated as 673.5 to differentiate mild and severe cases, with 93.3% sensitivity and 90% specificity. Whereas, PGF was significantly lower in severe cases than that in the mild cases and controls. The optimal cut-off point for PGF was calculated as 16.1 to differentiate mild and severe cases, with 66.7% sensitivity and 100% specificity. Conclusion: VEGF and PGF may be significant markers in prediction of severity of preeclampsia, and VEGF may also be valuable in prediction of preeclampsia.