Esra Bulgan Kilicdag

Early onset of subclinical atherosclerosis in women with gestational diabetes mellitus

Common carotid artery intima‐media thickness (CIMT) is a non‐invasively assessed marker of subclinical atherosclerosis. Our aim in this study was to investigate CIMT in women with gestational diabetes mellitus (GDM).

The Effect of Prior Varicocelectomy in Patients With Nonobstructive Azoospermia on Intracytoplasmic Sperm Injection Outcomes: A Retrospective Pilot Study

OBJECTIVES To examine our retrospective data on the outcomes of intracytoplasmic sperm injection (ICSI) and to determine whether a history of varicocele repair in men with nonobstructive azoospermia (NOA) undergoing an ICSI cycle was optimizing or not. METHODS This retrospective study was conducted on Baskent University Department of Obstetrics and Gynecology, IVF Unit, and Department of Urology. Infertile couples suffering from NOA scheduled to an ICSI cycle, which was controlled ovarian hyperstimulation with a gonadotropin or gonadotrophin-releasing hormone-agonist protocol, selected for the study were divided into 2 groups: group 1 (n = 31) included NOA patients who had undergone prior varicocele repair, and group 2 (n = 65) included NOA patients who had not undergone varicocele repair. RESULTS There was a significant difference between the 2 groups considering the sperm retrieval rate, which was higher in the varicocele repair group (sperm retrieval rate 60.81% and 38.46% respectively, P = .01). The clinical pregnancy rate and live birth rate were significantly higher in the varicocelectomy group (74.2% vs 52.3% and 64.5% vs 41.5%, respectively, P <.05). CONCLUSIONS Varicocele repair in NOA might be considered in patients undergoing ICSI cycle.

Single versus double intrauterine insemination in multi-follicular ovarian hyperstimulation cycles: a randomized trial

BACKGROUND The rationale for double insemination is to create the opportunity for a longer fertilization period as follicle rupture may occur over a wide interval (approximately 22-47 h) after hCG administration in ovarian hyperstimulation (OH) with intrauterine insemination (IUI) cycles. This randomized study evaluates the effectiveness of single versus double IUI in only OH cycles with multi-follicular development. METHODS We conducted a single center trial, 228 eligible patients were randomized for this study on the day of hCG. Only cycles with multi-follicular development without premature luteinization (progesterone levels >1 ng/ml on the day of hCG), were included in the study. Multi-follicular development has been defined as at least two dominant follicles reaching minimum > or = 15 mm diameter in which one of them is >17 mm. OH cycles with more than five dominant follicles (>15 mm in diameter) were excluded from the study. In the single IUI group (Group 1 = 112 patients) IUI was applied 36 h after the hCG injection and in the double IUI group (Group 2 = 114 patients) the first IUI was performed 18 h after hCG administration and the second IUI was performed 40 h after hCG administration. The primary end-point is to compare live birth rates (LBRs) between single and double IUI arms. RESULTS LBRs were 10.7% (12/112 patients) in the single IUI group and 12.3% (14/114) in the double IUI group and the difference was not statistically significant (P = 0.835, OR = 1.16, 95% CI: 0.51-2.64). In the unexplained infertility group the LBR was 11.1% (5/45 patients) with single IUI and 18.4% (9/49) with double IUI (P = 0.393). In the mild male factor group this rate was 10.4% (7/67) and 7.7% (5/65) in the single and double IUI groups, respectively (P = 0.764). CONCLUSION Our study did not find any difference in LBRs between single and double IUI groups in OH cycles with multi-follicular development. To the best of our knowledge this is the first report with this kind of study design. The study was registered at clinicaltrials.gov: NCT 00993902.

Oxidant-Antioxidant System Changes Relative to Placental-Umbilical Pathology in Patients with Preeclampsia

Objective. It is speculated that lipid peroxidation is responsible for the pathologic changes that occur in the uteroplacental vasculature of women with preeclampsia. The aim was to investigate this proposed relationship. Materials and Methods. The prospective study involved 90 pregnant women. Thirty had mild preeclampsia, 30 had severe preeclampsia, and 30 were healthy pregnant women (controls). The data collected for each case were umbilical cord and placental pathologies, plasma malondialdehyde (MDA) level, and levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activity in erythrocytes. Group findings were compared. Results. The mean MDA level in the severe preeclampsia group was higher than the corresponding findings in the mild preeclampsia and control groups (p < 0.001 for both). Also, the MDA level in the mild preeclampsia group was significantly higher than was the control level (p < 0.001). The mean SOD activity level in the severe preeclampsia group was lower than the corresponding results in the mild preeclampsia and control groups (p < 0.001 for both). The mean GSH-Px levels in the mild and severe preeclampsia groups were both significantly lower than was the corresponding finding in the control group (p < 0.01). Compared to the control group, both preeclampsia groups had significantly higher frequencies for placental infarction, villous fibrosis, increased numbers of syncytial nodes, and thickening of vessel walls and lumen obliteration (p < 0.001 for all). Villous fibrinoid necrosis, perivillous fibrosis, and increased villous vascularization were also significantly more frequent in both preeclampsia groups than in the control group, but the differences for these parameters were smaller (p < 0.01 for all). Examination of the samples from the placental ends of the umbilical cords revealed significantly higher frequencies of endothelial irregularity, endothelial shedding, and basal membrane thickening in both preeclampsia groups than in those of the control group (p < 0.001). The same findings were noted in the middle sections of the cords (p < 0.001). At the fetal ends of the umbilical cords, both preeclampsia groups had higher frequencies of endothelial irregularity than did the control group (p < 0.001); however, the frequencies of the more severe pathologic findings (endothelial shedding, basal membrane thickening) in the three groups were similar. Conclusion. The frequencies of pathologic changes in the placenta and umbilical vessels of women with preeclampsia parallel the severity of this condition. These changes also parallel plasma levels of MDA, the end product of lipid peroxidation.

High maternal hemoglobin and ferritin values as risk factors for gestational diabetes.

A number of studies have linked high maternal serum hemoglobin (Hb) levels in pregnancy with increased incidence of adverse pregnancy outcomes such as low birth weight and small-for-gestational-age newborns pre-term births increased perinatal mortality and pre-eclampsia. Lao et al. Identified high maternal hemoglobin at the initial prenatal visit as a risk factor for gestational diabetes mellitus (GDM). This protective study was conducted on 253 non-diabetic Turkish women with singleton pregnancies whose serum Hb level and mean corpuscular volume (MCV) at the initial visit were > 10 g/dl or > 80 fl respectively. The exclusion criteria were first prenatal visit later than 14 weeks of gestation; pre-existing anemia or hemoglobinopathy chronic disease; such as diabetes mellitus renal or gastrointestinal disorder hypo- or hyper-thyroidism GDM diagnosed before 28 weeks gestation. Values signifying the 50th percentile for Hb (12.2 g/dl) and ferritin (Fe) (19.7 µg/l) were established based on these data and two sets of groups were formed based on the initial-visit-findings (Hb above and below the 50th percentile; Fe above and below the 50th percentile). The pairs of groups were compared with respect to maternal pregnancy and infant characteristics and incidence of GDM. At the first trimester prenatal visit; a blood sample from each subject was analyzed for complete blood count MCV fasting serum glucose level and serum levels of Fe vitamin B12 folic acid and insulin. Insulin sensitivity was calculated using the HOMA index. [(Formula: fasting glucose (mmol/l) X fasting insulin (µunits/ml)/22.5]. All women were screened for GDM between 24 and 28 weeks of gestation with a 50-g oral glucose any subject with serum glucose level > 135 mg is subjected to a 3-h 100-g load OGTT. All the OGTT results at 24-28 weeks gestation were interpreted according to the criteria of Carpenter and Coustan. (excerpt)

Large pseudocyst of the umbilical cord associated with patent urachus

Cystic masses of the umbilical cord have been detected in the second and third trimesters of pregnancy in association with fetal abdominal wall defects and chromosomal anomalies. We present a case of an umbilical cord pseudocyst diagnosed using routine ultrasound at the 20 weeks of gestation. Serial sonography followed the progression of the cystic masses. A 2960‐g male infant was delivered at term, in whom a patent urachus was detected. The infant underwent repair with closure of the patent urachus and plastic reconstruction of the abdominal wall, and the postoperative course was uneventful. This case demonstrated an uneventful outcome despite the persistent multiple cord cysts.

Elevated plasma homocysteine levels in gestational diabetes mellitus

Objective.  This prospective study investigated the occurrence of hyperhomocysteinemia in a population of patients with gestational diabetes. The aim was to determine whether elevated plasma homocysteine is associated with gestational diabetes in Turkish women.

Fructus agni casti and bromocriptine for treatment of hyperprolactinemia and mastalgia

Hyperprolactinemia is the most common endocrine disorder of the hypothalamic–pituitary axis w1x. Research has proven that there is a causal connection between latent hyperprolactinemia and mastalgia w2x. The aim of this study was to investigate fructus agni casti as treatment for mild hyperprolactinemia and for mastalgia, and to compare its efficacy with that of bromocriptine (dopamine agonist ) therapy. This prospective study involved 40 women with cyclic mastalgia (Group 1) and 40 with mild hyperprolactinemia(Group 2). With respect to mastalgia, the exclusion criteria were purulenthemorrhagic breast discharge, severe endocrinopathy, malignancy, and requirement for breast surgery, simultaneous treatment with analgesics or non-steroidal antiphlogistics, pregnancy, lactation. With respect to hyperprolactinemia, the exclusion criteria were macroadenoma, other forms of endocrinopathy, and iatrogenic hyperprolactinemia due

Polycystic ovary syndrome and increased polyp numbers as risk factors for malignant transformation of endometrial polyps in premenopausal women

To determine the pre‐malignant and malignant potential of endometrial polyps and to assess whether different clinical parameters are associated with malignancy in the polyps of premenopausal women.

Congenital Intracranial Teratoma with Massive Macrocephaly and Skull Rupture

Objective: Congenital intracranial tumors are rare and only account for 0.5–1.5% of all pediatric brain tumors. Teratoma is the most frequently encountered intracranial tumor at birth. Massive congenital intracranial teratoma is an extremely rare neoplasm with a poor prognosis. They grow rapidly and cause extensive destruction in the brain. Herein we report a massive intracranial teratoma causing skull rupture. Case Report: A fetus with a congenital intracranial teratoma presenting with a disproportionately enlarged head at 25 weeks of gestation is presented. Since it was the first admission of the mother to a medical expert for a prenatal examination, there was noprevious follow-up data. Prenatal ultrasonography demonstrated a huge, heterogeneous intracranial mass, and midline structures and ventricles could not be observed. No heartbeat was detected. Autopsy was perforated, and histopathologic examination of the samples taken from the intracranial mass revealed an immature teratoma. Conclusion: Although congenital intracranial teratomas are rare, they may reach enormous sizes. Regular follow-up of the fetus may lead to early diagnosis of immature intracranial teratomas and prevent the mother from having further complications either due to intrauterine fetal death orpsychological trauma of giving birth to a heavily malformed baby.