Gurkan Kiran

Relationship between Oxidative Stress in Cord Blood and Route of Delivery

Objective: To investigate the effect of route of delivery on the antioxidant system of newborns. Methods: We used the cord blood taken during labor of 56 vaginal deliveries and 50 elective cesarean sections. The specimens were analyzed for the plasma malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT) and glucose 6-phosphate dehydrogenase (G6PD) activity and leukocyte count. Results: SOD and CAT activities were significantly higher in the elective cesarean group than the vaginal delivery group (p < 0.01 and p < 0.005, respectively), but G6PD activity was similar between the groups. Plasma MDA level was lower in the cesarean group compared to the vaginal delivery group (p < 0.001). Leukocyte count was higher in the vaginal delivery group (p < 0.005). Conclusion: Our findings suggest that the route of delivery has an effect on oxidative stress in newborns exposed to oxidative stress during delivery. It can be suggested that the antioxidant system works more efficiently to overcome oxidative stress in newborns delivered via cesarean section.

Uterus didelphys with an obstructed unilateral vagina by a transverse vaginal septum associated with ipsilateral renal agenesis, duplication of inferior vena cava, high-riding aortic bifurcation, and intestinal malrotation: a case report

OBJECTIVE To present a case of müllerian defects associated with other anomalies, including ipsilateral renal agenesia, duplication of inferior vena cava, high-riding aortic bifurcation, and intestinal malrotation. DESIGN Case study. SETTING Academic medical center. PATIENT(S) A 16-year-old woman with müllerian defects associated with vascular and intestinal anomalies. INTERVENTION(S) Excision of vaginal septum. MAIN OUTCOME MEASURE(S) Improvement of symptoms caused by obstructed müllerian defect. RESULT(S) After an incision on the vaginal septum, a large amount of chocolate-colored fluid was drained, and the dimensions of the right uterus were diminished. Then the vaginal septum was excised completely; we saw a second distinct cervical portion. CONCLUSION(S) Uterus didelphys with obstructed hemivagina is almost always associated with renal agenesis ipsilateral to the obstruction. Inferior vena cava duplication associated with müllerian anomalies is an extremely rare condition. In addition, the presented case also had a high-riding aortic bifurcation and intestinal malrotation. To the best of our knowledge, this is the first case to include all of these anomalies.

Modified Ferriman–Gallwey hirsutism score and androgen levels in Turkish women

OBJECTIVE(S) To evaluate a modified Ferriman-Gallwey (mFG) scoring system and serum total testosterone (tT) and dehydroepiandrosterone sulfate (DHEAS) levels, in women with polycystic ovary syndrome (PCOS) and in control subjects. STUDY DESIGN Women with any gynecological problem who presented to the Kahramanmaras Sutcuimam University Medical Faculty Gynecology and Obstetric Outpatient Clinic in the Mediterranean region of Turkey were assessed prospectively. Oligo-anovulation, clinical and biochemical hyperandrogenism, and PCO appearance on ultrasound that met the 2003 Rotterdam Consensus Criteria were used for PCOS diagnosis. Group 1 consisted of 43 cases with a diagnosis of PCOS and group 2 (control group) consisted of 75 age and BMI matched control subjects without PCOS. RESULTS In groups 1 and 2, clinical hyperandrogenism (hirsutism) appearance ratio was 86.0% (37/43) and 18.0% (15/75) (p < 0.001); while biochemical hyperandrogenism (high serum tT or DHEAS level) was 65.1% (28/43) and 36% (27/75) (p < 0.05), respectively. In groups 1 and 2, mean serum tT levels were 115.2 and 73.4 ng/dL (p < 0.001), mean serum DHEAS levels were 256.1 and 177.7 ng/dL (p < 0.001), and mean hirsutism scores were 11.2 and 5.5 (p < 0.001), respectively. Serum mean tT, DHEAS and hirsutism scores for group 1 were significantly higher than those of group 2 (<0.001). No correlation was observed between BMI and the hirsutism scores or the biochemical hyperandrogenism in both groups. CONCLUSION(S) In our study, mean serum androgen levels and hirsutism ratio in the PCOS group were higher than the control group. These values were also substantially higher than those previously published in the literature.

Late recurrence of aggressive angiomyxoma of the vulva.

Objective Aggressive angiomyxoma (AA) is found mainly in the pelvis and perineum, with a female-to-male ratio of approximately 6:1. Although it is a slow growing tumor, AA has a marked tendency to local recurrence with a low metastasis capacity. The study aimed to describe a case of vulvar angiomyxoma recurred almost 20 years after its initial surgery. Materials and Methods We report the case of a 57-year-old gravida 5 para 4 woman with vulvar AA arising from the left labium majus, which recurred 20 years after initial surgery. There was a nontender, solid, mobile mass on the left vulva, which was 25 x 30 cm on physical examination. A pelvic computed tomographic scan showed a mass measuring 26 x 10 x 14 cm originating from left vulvar region, which has a fatty tissue density. Result Under general anesthesia, total excision of the tumor was performed. Macroscopically, the tumor weighed 723 g and measured 33 x 20 x 10 cm. The histopathological examination of the specimen revealed a myxoid tumor with sparse infiltrates of spindle-shaped to stellate cells and vessels of varying sizes. The final histopathological diagnosis was AA. Conclusions Aggressive angiomyxoma may form extremely large tumors, and recurrence is not rare even many years after primary surgery.

Age at menarche in Turkish adolescents in Kahramanmaras, Eastern Mediterranean region of Turkey

Objectives To determine the age at menarche in adolescents in the Eastern Mediterranean city of Kahramanmaras, Turkey. Methods The study was conducted in primary and high schools of Kahramanmaras, during the academic year 2003–2004. Data of 8212 female students were collected by using a standard questionnaire. Mean and median ages at menarche (with 95% confidence intervals) were calculated by Kaplan–Meier survival analysis. Also, probit analysis was performed to determine the age at menarche for all girls by estimating the age at which 10, 25, 50, 75 and 90% of the girls reached menarche. Results According to the answers obtained through the questionnaire, 5506 (67.5%) of 8161 respondents had had their menarche. Mean age at menarche was 13.04 years (95% CI: 13.01–13.06), and median age 13.00 years (95% CI: 12.97–13.03). According to probit analyses, the probability of menstruating before the age of 11.48 years was 10% and before 15.08 years 90%. Conclusion We provide data about age at menarche in Kahramanmaras, an Eastern Mediterranean city of Turkey.

Sebaceous gland hyperplasia of the vulva

A 37-year-old gravid 1, para 1 woman complained of secondary infertility and the appearence of a lesion on her vulva; vulvar discomfort and enlargement had been present for 8 years, and there was related coital pain. She had regular menstrual cycles, and was not taking any oral contraceptives. Examination revealed labia minora which were bilaterally enlarged with 2.5 × 2 × 1 cm regularly shaped polypoidal tumours. These polypoidal masses were smooth, multilobed and mildly tender with palpation; no bleeding or purulence was noted, and they were covered by normal appearing skin. The swellings were excised and her symptoms were relieved. Microscopically, the tumour originated from sebaceous ducts and sebaceous glands, and were composed of numerous lobules, and extended down into the dermis in a pattern of well-defined islands. The lobules consisted of greatly enlarged sebaceous gland composed of numerous lobules grouped around a centrally located, wide sebaceous duct (Fig. 1). Formation of ductal structures were seen in many areas. The sebaceous gland lobules were fully mature and there were no atypical features. Patchy chronic inflammatory cell infiltrate were also associated with the lesions. On the basis of such evidence, the diagnosis of sebaceous gland hyperplasia was made. Immunohistochemical investigation showed epithelial membrane antigen (Biogen, Fremont, CA, USA) expression in the keratinocytes of the infindibulum, the isthmus, and sebaceous duct and in the mature and immature sebocyte.

A randomized pilot study of acupuncture treatment for primary dysmenorrhea

OBJECTIVE To compare the therapeutic effect of acupuncture and non-steroidal anti-inflammatory drug (NSAID) therapy in primary dysmenorrhea patients. STUDY DESIGN Thirty-five young women with a diagnosis of primary dysmenorrhea were recruited for the study. Their dysmenorrhea severity was rated by visual analog scale (VAS) immediately prior to entry into the study. They were randomly divided into two groups; and the following month they were given NSAID (group 1, n=24) or acupuncture treatment (group 2, n=11). Pain was rated again using VAS during menstruation in both groups. RESULTS After one months treatment, pain scores were significantly lower in both groups (p<0.05). Mean pain scores decreased by 52.2% and 69.5% in the NSAID and acupuncture groups, respectively. CONCLUSION Acupuncture was as effective as NSAID therapy for patients with primary dysmenorrhea. Since this was a pilot study with a small sample size and short follow-up period, larger studies are needed to clarify the effect of acupuncture in the treatment of primary dysmenorrhea.

Changes in Copper, Zinc, and Malondialdehyde Levels and Superoxide Dismutase Activities in Pre-Eclamptic Pregnancies.

Background Preeclampsia (PE) is a hypertensive disorder that occurs in 2% to 8% of pregnancies. Although numerous studies have investigated the etiology and pathophysiology of preeclampsia, the precise pathological mechanisms remain poorly understood. Hence, in the present study malondialdehyde (MDA) levels and SOD expression, and Cu and Zn concentrations and ratios were correlated with birth weights in pregnant women with and without PE, and in non-pregnant females of reproductive age. Material/Methods Malondialdehyde (MDA) levels and superoxide dismutase (SOD) activities were determined spectrophotometrically, and Cu and Zn levels were determined using atomic absorption spectrometry in serum from 42 non-pregnant women (NP), 40 healthy pregnant women (HP), and 38 pre-eclamptic pregnant (PE) women. Subsequently, Cu/Zn ratios were calculated and associations with birth weights were analyzed using Spearman correlations. Results Cu, Zn, and MDA levels and Cu/Zn ratios were significantly higher in the PE group than in the HP and NP groups, and were significantly higher in the HP than in the NP group (p<0.001 and p<0.001; respectively). In contrast, serum Zn and SOD levels were significantly lower in the PE group than in HP and NP groups, and were significantly lower in the HP group than in the NP group (p<0.001 and p<0.001; respectively). However, only Cu and Zn levels were significantly associated with fetal birth weights (r=−0.433, p<0.001). Conclusions Serum Cu/Zn ratios may reflect vascular complications of PE, and the ensuing increases in lipid peroxidation may play important pathogenic roles.

Plasma visfatin levels in pregnant women with normal glucose tolerance, gestational diabetes and pre-gestational diabetes mellitus

Objective. Visfatin, an adipocytokine, is a peptide predominantly expressed in and secreted from visceral adipose. In this study, we aimed to compare visfatin levels in gestational (GDM) and pre-gestational diabetic (pre-GDM) women with healthy pregnant women. We also sought to determine whether there was a correlation between visfatin levels and serum glucose levels at 1 h after the 50-g oral glucose challenge test in pregnant women with GDM and normal glucose tolerance. Methods. The study consisted of 65 pregnant women: 21 patients with GDM (Group 1), 20 patients with pre-GDM (Group 2) and 24 gestational age and BMI-matched healthy pregnant women (Group 3) were enrolled. Results. Plasma visfatin levels in Groups 1 and 2 were significantly higher than in Group 3 (P < 0.001). Plasma visfatin levels in Groups 1 and 2 were similar (P > 0.05). There was no significant correlation between visfatin levels and serum glucose levels at 1 h after the glucose tolerance test in both Groups 1 and 3 (P > 0.05). Conclusions. Our results support the literature indicating higher visfatin levels in women with GDM compared to women with normal glucose tolerance. Interestingly, we found similarly high visfatin levels in women with pre-GDM.

Systemic medical management of ovarian pregnancy

Ovarian pregnancy is a rare form of ectopic implantation. Because of current availability of early diagnosis for ectopic pregnancy medical treatment may be an important alternative to surgical therapy. Stovall stated that medical management should be routinely used as primary therapy for ectopic pregnancy. There are many series in the literature reporting successful conservative management of ectopic pregnancy especially in tubal form. However reports on medical management of ovarian ectopic pregnancy are very rare. (excerpt)