H. Guler Sahin

Sigmoid volvulus in pregnancy and puerperium: a case series.

Intestinal obstruction due to sigmoid volvulus during pregnancy is rare. The presenting signs/symptoms seen in these patients are the same as with non-pregnant patients. Fetal and maternal mortality rates are higher during pregnancy due to delays in diagnosis. We aimed to present four patients diagnosed with sigmoid volvulus during pregnancy and puerperium in our clinic. Diagnosis requires a high index of suspicion in a patient who presents with complaints of abdominal pain and evidence of bowel obstruction. Prompt intervention is necessary to minimize maternal and fetal morbidity and mortality.

Increased plasma thrombin-activatable fibrinolysis inhibitor levels in young obese women with polycystic ovary syndrome

OBJECTIVE To evaluate carotid intima-media thickness and thrombin-activatable fibrinolysis inhibitor levels in young women with polycystic ovary syndrome (PCOS) and age-matched healthy controls, and to investigate their relationship with each other and with clinical, metabolic, and hormonal parameters. DESIGN Clinical study. SETTING University hospital. PATIENT(S) Fifty young women with PCOS (overweight or obese [n = 24] and nonobese [n = 26]) and 25 age-matched healthy controls. INTERVENTION(S) History and physical examination, peripheral venous blood sampling, carotid ultrasonography. MAIN OUTCOME MEASURE(S) Plasma thrombin-activatable fibrinolysis inhibitor, serum FSH, LH, DHEAS, total T, E(2), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, insulin resistance defined by the homeostasis model assessment insulin resistance index, and carotid intima-media thickness. RESULT(S) Plasma thrombin-activatable fibrinolysis inhibitor levels in the overweight or obese PCOS group were significantly higher than those in the nonobese PCOS and control groups. Carotid intima-media thickness did not significantly differ between the groups. Obesity and insulin resistance were associated positively with plasma thrombin-activatable fibrinolysis inhibitor levels, but there was no association between carotid intima-media thickness and thrombin-activatable fibrinolysis inhibitor. CONCLUSION(S) Young overweight or obese women with PCOS have increased plasma thrombin-activatable fibrinolysis inhibitor levels. Impaired fibrinolysis may be responsible for the increased risk of cardiovascular diseases in women with PCOS.

Short-term results of posterior intravaginal slingplasty in grade 4 uterine prolapse

PurposeThe purpose of this study was to evaluate the short-term efficacy and complication rates of posterior intravaginal slingplasty (IVS) procedures.MethodsThirty-four patients who had advanced (grade 4) uterine prolapse were recruited. All patients underwent vaginal hysterectomy and the cuff was suspended with a posterior IVS operation. The mean follow-up duration was 12 months (range 3–20 months).ResultsThirty-three patients (97.1%) had satisfactory level I support defined objectively as stage 0 or I for point C as described in the pelvic organ prolapse quantification system. There were no rectal, vesical, ureteric, or vascular injuries in this series. During the postoperative period no complications, including tape erosion, were seen.ConclusionsPosterior IVS is a minimally invasive procedure for grade 4 genital prolapse with a high success rate.

Uterine rupture: A twelve-year clinical analysis.

Objective. To review the experience of uterine rupture at a tertiary obstetric unit in Eastern Turkey and to propose preventive measures. Methods. All uterine rupture cases managed from November 1995 to March 2007 at the Department of Obstetrics and Gynecology of the Medical School of Yuzuncu Yıl University, Van, Turkey, were analyzed retrospectively. Results. There were 33 cases of uterine rupture with an incidence of 1/287 deliveries. Of these, 72.72% had complete and 27.27% had incomplete uterine rupture. Of the patients, 39.39% had a scarred uterus, 90.90% received no antenatal care, 60.60% were referred after various interventions had been attempted, and 42.42% required subtotal or total hysterectomy. The maternal mortality rate was 15.15% and the perinatal mortality rate was 42.42%. Conclusions. Improvements in antenatal care, reduction in cesarean rates, the place where the birth occurs, and skilled attendants are important factors in reducing uterine rupture.

Expression of laminin receptor 1 in gestational trophoblastic diseases and normal placenta and its relationship with the development of postmolar tumors

OBJECTIVES To investigate the expression of laminin receptor 1 (LR1), a non-integrin-type laminin receptor, in gestational trophoblastic diseases and normal first-trimester placenta, since it may play a role in controlling trophoblast invasion in normal and molar pregnancies. METHODS Paraffin sections from 24 gestational age controlled normal first-trimester placentas, 47 partial moles, 56 complete moles, 3 invasive moles, 4 gestational choriocarcinomas, and 1 placental-site trophoblastic tumor were studied immunohistochemically for expression of LR1. RESULTS In complete and partial moles, decidual cells showed significantly stronger LR1 protein staining compared to the normal placenta (p<0.01). When compared to the partial moles, weak staining in less than 33% of decidual cells was also more prominent in the normal placenta (p<0.05). Complete and partial moles, invasive moles, choriocarcinomas, and placental-site tumors did not differ from each other with respect to staining intensity. Strong immunostaining for LR1 in decidual cells, cytotrophoblasts, syncytiotrophoblasts, and extracellular matrix cells of partial and complete moles was not significantly correlated with the development of persistent postmolar gestational trophoblastic tumors. CONCLUSIONS LR1 may be important in the pathogenesis of gestational trophoblastic diseases. The increased expression of LR1 in decidual cells of partial and complete moles may not influence the development of persistent gestational trophoblastic tumor. Since they are seen rarely, multicentric studies should be planned to study LR1 expression in invasive moles and gestational trophoblastic neoplasms.

Chemerin level in pregnancies complicated by preeclampsia and its relation with disease severity and neonatal outcomes

Abstract The aims of this prospective study were to detect maternal serum chemerin level in patients with preeclampsia and investigate its association with disease severity and neonatal outcomes. Maternal serum chemerin levels were significantly elevated in severe preeclamptic women (394.72 ± 100.01 ng/ml) compared to mild preeclamptic women (322.11 ± 37.60 ng/ml) and healthy pregnant women (199.96 ± 28.05 ng/ml) (p = .001). Maternal serum chemerin levels were positively correlated with systolic and diastolic blood pressure, C-reactive protein levels, homeostasis model assessment of insulin resistance, proteinuria, AST, ALT, and duration of hospitalisation. Gestational week at delivery, birthweight, and APGAR scores at 1 and 5 min were negatively correlated with maternal serum chemerin level. A maternal serum chemerin level of >252.0 ng/ml indicated preeclampsia with 95.5% sensitivity and 95.7% specificity. There was a positive correlation between maternal serum chemerin level and severity of preeclampsia. Additionally, adverse neonatal outcomes were significantly associated with high maternal serum chemerin levels.

Management of haemangiopericytoma located in the spinal cord diagnosed during pregnancy.

Correspondence: Z. Kurdoglu, Yuzuncu Yil Universitesi Tip Fakultesi, Kadin Hastaliklari ve Dogum Anabilim Dali, Dursun Odabas Tip Merkezi, Kampus, 65080 Van, Turkey. E-mail: zehrakurdoglu@hotmail.com Introduction Haemangiopericytoma (HPC) is an extremely rare vascular tumour with a high potential for local recurrence and distant metastasis. It accounts for 1% of all primary central nervous system (CNS) tumours. HPC originates from Zimmerman pericytes of blood vessels and shares a common arachnoidal location with meningioma. Th e diff erential diagnosis between HPC and other tumours is important for survival of the patient. Curative treatment of HPC involves complete tumour resection followed by adjuvant radiotherapy (Rutkowski et al. 2012; Bassiouni et al. 2007; Louis et al. 2007). We present here a case of a pregnant woman with spinal HPC diagnosed during pregnancy and our management of the tumour. Although four cases of HPC in diff erent locations during pregnancy have been reported to-date (Annunziato et al. 2005; Hern á ndez-Dur á n et al. 2014; Petignat et al. 1998; Ustaalioglu et al. 2010), we present the fi rst case in the literature of HPC located in the spinal cord at 28 weeks ’ gestation.

Ileal penetration and tubo-ovarian abscess in the presence of an intrauterine device

This case study reports on a 32-year-old sexually active woman that suffered from abdominal pain vomiting and intermittent diarrhoea after the insertion of an IUD at her 3rd month postpartum visit. It suggests that tubo-ovarian abscess and uterine perforation in patients with abdominal complaints diarrhoea and vomiting should be considered even in the presence of an ultrasound scan showing that the IUD is in the uterine cavity.