Herman İşçi

Placental volume and vascularization flow indices by 3D power Doppler US using VOCAL technique and correlation with IGF-1, free beta-hCG, PAPP-A, and uterine artery Doppler at 11–14 weeks of pregnancy

Abstract Aims: The purpose of this study was to investigate correlations between first trimester placental volume (PV) and blood flow indexes (FIs), bilateral uterine artery pulsatility indexes, notching, and biochemical parameters: pregnancy-associated plasma protein-A (PAPP-A), free beta-human chorionic gonadotropin (f-β-hCG), and insulin-like growth factor-1 (IGF-1) to predict the high-risk pregnancies in the first trimester. Methods: We prospectively examined 310 patients at 11–14 weeks of pregnancy using transabdominal 3D gray scale and power Doppler ultrasound for assessing PV, vascularization index, FI, and vascularization FI (VFI). The acquired volumes were analyzed using VOCAL™ imaging software. The results were correlated with biochemical parameters. Results: We found significant correlations between PV and biochemical parameters, and between placental blood flow studies and other parameters. Finally, PV/crown-rump length so called the placental quotient is also related to both PAPP-A and VFI. Conclusions: Placental volumetry, uterine artery Doppler studies, blood flow calculations and biochemical parameters, such as f-β-hCG, PAPP-A, and IGF-1 could be important in the early and rapid diagnosis of high-risk pregnancies. Thus, they may be useful in first trimester prediction of fetal growth restriction presenting with alterations in PV and vascularity.

Herlyn-Werner-Wunderlich Syndrome—Timely Diagnosis is Important to Preserve Fertility

BACKGROUND Herlyn-Werner-Wunderlich syndrome is an urogenital malformation with uterus didelphys and obstructed hemivagina with ipsilateral renal agenesis. Most of these patients present after the onset of menstruation. We describe two cases diagnosed too late to prevent the complications. CASE The first patient presented with acute abdomen one year after the onset of menstruation and had salpingectomy due to pyosalpinx. The blind hemivagina was not recognized and she had severe endometriosis. She underwent hysterectomy 8 years later. The second patient presented with foul smelling vaginal discharge when she was 21 years old. She had a simple vaginal septum resection. SUMMARY AND CONCLUSION In the presence of uterine cavities in a regularly menstruating girl with dysmenorrhea, the presence of both kidneys should be checked. When unilateral renal agenesis and uterus didelphys coexist the first thing that we should remember is to confirm or refute the presence of a blind vagina.Background: Herlyn-Werner-Wunderlich syndrome is an urogenital malformation with uterus didelphys and obstructed hemivagina with ipsilateral renal agenesis. Most of these patients present after the onset of menstruation. We describe two cases diagnosed too late to prevent the complications. Case: The first patient presented with acute abdomen one year after the onset of menstruation and had salpingectomy due to pyosalpinx. The blind hemivagina was not recognized and she had severe endometriosis. She underwent hysterectomy 8 years later. The second patient presented with foul smelling vaginal discharge when she was 21 years old. She had a simple vaginal septum resection. Summary and Conclusion: In the presence of uterine cavities in a regularly menstruating girl with dysmenorrhea, the presence of both kidneys should be checked. When unilateral renal agenesis and uterus didelphys coexist the first thing that we should remember is to confirm or refute the presence of a blind vagina.

Serum visfatin levels in women with polycystic ovary syndrome

The aim of this study is to determine the serum levels of visfatin in patients with polycystic ovary syndrome (PCOS) and to understand its correlations with other metabolic and hormonal parameters. Thirty-seven patients with PCOS and 30 women without concomitant disease were included in this study. Serum visfatin levels were similar in patients with PCOS and control group. Visfatin levels were higher in normal weight PCOS when compared with obese PCOS, but it did not reach statistical significance. Visfatin levels correlated negatively with fasting blood glucose, total cholesterol (TC), low-density lipoprotein (LDL) and lipoprotein-a levels in PCOS patients. CRP levels increased both in obese PCOS and in obese controls. Plasma visfatin levels had no correlation with homeostasis model assessment-insulin resistance and fasting insulin levels, but the negative correlation between plasma visfatin levels and lipoprotein-a, fasting plasma glucose, TC and LDL levels may indicate a role for visfatin in cardiovascular disease independent of insulin resistance.

Serum visfatin levels do not increase in post-menopausal women with metabolic syndrome.

Background: The aim of this study was to determine the serum visfatin levels in post-menopausal (PM) women with and without metabolic syndrome (MS) and to understand the correlation between serum visfatin levels and various other hormonal and metabolic parameters. Materials-Methods: We conducted a prospective cross-sectional study including 17 PM women with MS and a control group of 51 PM women without MS. MS was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Results: Women with MS had statistically significantly higher fasting blood glucose, HDL, triglycerides, insulin, homeostasis model assessment of insulin resistance, and SHBG levels when compared to women without MS. Estradiol, high sensitivity C-reactive protein, and free testosterone levels were higher in the MS group, but there was no statistically significant difference between the two groups. Visfatin levels did not differ between the two groups. There was no correlation between serum visfatin levels and other parameters. Conclusions: There was no association between serum visfatin levels and MS in PM women.

Sağlık çalışanları, tıp öğrencileri ve hemşirelik öğrencilerinde insan papilloma virüsü, servikal kanser ve HPV aşısı farkındalığı

Objectives: Establishment of the knowledge and the need to make conscious in medicine students, nursing students and nurses due to the effective role of updating conscious of the health workers, we aimed to assess the knowledge of nurses and students of Istanbul Bilim University and affiliated hospitals about HPV and cervical cancer. Materials and methods: Because healthcare personnel illuminate and influences the public, the survey was conducted to medicine students of the first three years, nursing students and nurses. The reason of choosing the first three years of medicine students is with the begining of the gynecology courses at the 4th year of education in medical faculty, learning takes the place of awareness. Totally 743 participants were asked to survey but 603 subjects responded (81.2%) then the surveys that was not asked for the identity information were taken into consideration Results: Nurses and students of nursing had better knowledge about smear test when compared to students of medicine (first 3 years) and other healthcare person nel. Only 52% accepted to get a daughter vaccinated. The main reasons for vaccine rejection were the concerns about vaccine safety (41%), cost of the vaccine (10%) and sexual promiscuity (5%) after vaccination. Religious aspects were not considered as an obstacle. Conclusions: The awareness of HPV, cervical cancer and HPV vaccination should be increased. J Clin Exp Invest 2012; 3(3): 318-325

Management of a rare case of arrhythmogenic right ventricular dysplasia in pregnancy: a case report

IntroductionArrhythmogenic right ventricular dysplasia is a heritable disease of the heart muscle characterized by fibrofatty degeneration of cardiomyocytes. Patients present with ventricular arrhythmias or congestive heart failure, and sometimes sudden cardiac death occurs. Prenatal diagnosis has become possible with the detection of mutations, but, to the best of our knowledge, no case of prenatal diagnosis has been reported previously. There is little information about the management of arrhythmogenic right ventricular dysplasia in pregnancy, and the preferred mode of delivery is not certain; therefore, we present the case of a patient with arrhythmogenic right ventricular dysplasia and discuss the prenatal diagnosis, patient management and prognosis in pregnancy.Case presentationA 26-year-old Caucasian woman who presented to our hospital with heart palpitations was diagnosed with arrhythmogenic right ventricular dysplasia, and, after three years of follow up with anti-arrhythmic drugs, she wanted to conceive. During pregnancy, she ceased taking her medication. She tolerated pregnancy very well but her cardiac symptoms recurred after her 30th week of pregnancy. She delivered a baby via cesarean section under general anesthesia in her 38th week of pregnancy. She was discharged without any medications and continued lactation for six months.ConclusionPatients with mild to moderate arrhythmogenic right ventricular dysplasia tolerate pregnancy and breastfeeding very well, but patients with end-stage arrhythmogenic right ventricular dysplasia should be discouraged from conception.

Patients with epithelial cell abnormality in PAP smears: correlation of results with follow-up smears and cervical biopsies.

Abstract Objective: Cervical carcinoma has been included in the preventable diseases category ever since the use of cervical cytology in routine practice. The Pap test is an efficient screening test. We aimed to compare the cervical cytology diagnosis with biopsy and smear follow up results in our institution. Material and Method: We aimed to compare the diagnosis of cytology material examined in our institution during the 2009-2012 period with their biopsy and smear follow ups. The diagnoses were compared with the follow up smears and/or cervical biopsies. Results: 13610 Pap tests were examined during September 2009-July 2012. Among these cases, there were 370 atypical squamous cells of undetermined significance (ASCUS), 29 atypical squamous cells-high grade intraepithelial lesions cannot be excluded (ASC-H), 155 low grade squamous intraepithelial lesion (LSIL), 33 high grade squamous intraepithelial lesion (HSIL), and 5 atypical glandular cell (AGC) diagnoses. The ratio of atypical squamous cell (ASCUS and ASC-H) to squamous intraepithelial lesions was 2.12. Squamous intraepithelial lesion was verified in 47 of 91 ASCUS cases. Among patients who had a cervical biopsy, 52 of 64 LSIL cases and all of the 21 HSIL cases had biopsy-proven SIL. Conclusion: Atypical squamous cell (ASC) is the most common diagnosis in abnormal cervical cytology. As it is indefinite, ASC is used as a quality assurance parameter and the aim is to decrease its use. As the ratio of epithelial cell abnormality is variable in different populations, the ASC/SIL is a more definite variable to be used for quality assurance. The efficiency in clinical use of the cervical cytology screening test is determined by biopsy verification. Our epithelial cell abnormality, ASC/SIL ratio and cytology-histology correlation values were parallel to the literature, proving that the methods are used reliably at our institution. Öz Amaç: Servikal sitolojinin rutin pratikte kullanılması ile birlikte serviks karsinomu önlenebilir hastalıklar içine girmiştir. Pap smear etkin bir tarama testidir. Bölümümüzde incelenen servikal sitoloji materyallerinin tanıları ile biyopsi ve smear takip sonuçları karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Bu çalışmada 2009-2012 yılları arasında bölümümüzde yapılan servikal sitoloji sonuçları gözden geçirilmiştir. Tanılar, kontrol smear tekrarı ve/veya biyopsi sonuçları ile karşılaştırılmıştır. Bulgular: Bölümümüzde Ekim 2009-Temmuz 2012 tarihleri arasında 13.610 adet Pap smear raporu incelenmiştir. Bu olgular içinde 370 önemi belirlenemeyen atipik skuamöz hücre (ASCUS), 29 yüksek dereceli skuamöz intraepitelyal lezyonun ekarte edilemediği atipik skuamöz hücre (ASC-H), 155 düşük dereceli skuamöz intraepitelyal lezyon (LSIL), 33 yüksek dereceli skuamöz intraepitelyal lezyon (HSIL), 5 atipik glandüler hücre (AGH) saptanmıştır. Atipik skuamöz hücrenin (ASCUS ve ASC-H tanılarının toplamı) skuamöz intraepitelyal lezyona oranı (ASC/SIL) 2,12’ dir. Biyopsi yapılan 91 adet ASCUS olgusunun 47’sinde SIL saptanmıştır. Biyopsi yapılan 64 adet olgusunun 52’sinde LSIL; 21 adet olgusunun tamamında HSIL tanısı doğrulanmıştır. Sonuç: Atipik skuamöz hücre (ASH) anormal servikal sitolojideki en sık tanıdır. Belirsizlik ifade ettiği için fazla kullanımı önlenmeye çalışılmaktadır ve kalite kontrolünde kullanılmaktadır. Farklı toplumlarda, Epitel Hücre Anomalisi (EHA) oranı değişken olabildiği için, ASH/SIL oranı kalite yönetimi açısından daha net bir veri olarak değerlendirilmektedir. Bir tarama testi olan servikal sitolojinin klinik uygulamalarda güvenilir şekilde kullanımı ise biyopsi doğrulaması ile mümkündür. Serimizde EHA yüzdesi, ASC/SIL oranı ve smear ile biyopsi arasındaki uyum sonuçları literatür ilgilerine paralel olup, merkezimizde güvenilir bir yöntem olarak kullanılmaktadır

Can quadruple test parameters predict SGA infants

The aim of this study was to investigate the role of quadruple test parameters in predicting the risk of delivering a small for gestational age (SGA) infant. The quadruple test results of patients performed at 16–18 weeks of pregnancy were searched retrospectively. Alpha-fetoprotein (AFP) levels higher than 2 MoM were associated with a risk of delivering an SGA infant (p = 0.025), sensitivity 8%, specificity 98%, positive predictive value 25%, negative predictive value 91%. Other quadruple test parameters were not related to delivery of an SGA infant. The introduction of AFP as a screening test for the detection of SGA infants does not seem feasible, but we suggest clinicians take it into account when counselling the patients about the results of Down syndrome screening tests.

Prenatal early diagnosis of dacryocystocele, a case report and review of literature.

Dacryocystocele (mucocele, amniocele) is a relatively rare variant of nasolacrimal duct obstruction which refers to the cystic dilatation of lacrimal pathway above and below the lacrimal sac. It is a benign pathology and can be treated successfully after birth, but its prenatal detection is important, because it may be seen in numerous syndromes and may serve as their marker. Bilateral cysts have the possibility for intranasal extension and an obstruction to the nasal passages may result in neonatal respiratory distress requiring surgical intervention Unilateral cases are important for the differential diagnosis with serious facial abnormalities. We present a case of early prenatal detection of a 28 year-old G: 1 P: 0 pregnant woman with bilateral dacryocystocele. She presented a live, normally developed singleton fetus on sonographic examination at 12, 16 and 22 weeks. At 25(th) weeks, we diagnosed a hypoechogenic mass, that was situated inferomedially to the eyes in the fetal face with 2 and 3-D ultrasound. A 3850-g live female infant was delivered by Cesarean section due to breech presentation at 39 weeks following preterm rupture of membranes. We report the case with intranasal components studied during fetal life by 2 and 3-D ultrasound and magnetic resonance (MR) imaging.

Bilateral vulvar mass mimicking Bartholin's gland abscess in the postpartum period: Klippel–Trenaunay Syndrome

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