Ismet Gun

The effect of hormone therapy on plasma homocysteine levels: a randomized clinical trial.

Objective: An elevated plasma homocysteine level is a risk factor for cardiovascular diseases. Hormone therapy (HT) may reduce fasting plasma homocysteine levels. We studied 80 postmenopausal women to determine the effect of medroxyprogesterone acetate (MPA) combined with conjugated equine estrogens (CEE) on fasting plasma homocysteine levels. Design: In a randomized, double blind, prospective, placebo-controlled study, we randomly assigned 80 healthy postmenopausal women between CEE 0.625 mg/d combined with MPA 2.5 mg/d (n = 20), CEE 0.625 mg/d combined with MPA 5 mg/d (n = 20), unopposed CEE 0.625 mg/d (n = 20), and placebo (n = 20) all given for a duration of 6 months. Fasting plasma homocysteine levels were measured before and at the end of the treatment. Results: Before treatment, plasma homocysteine concentrations were similar in all groups. After 6 months of unopposed CEE, the mean fasting plasma homocysteine levels decreased by 19.02% when compared with baseline levels (P < 0.05). The mean fasting plasma homocysteine concentrations decreased by 17.63% and 19.56% from baseline in both the CEE plus MPA 2.5 mg/d and CEE plus MPA 5 mg/d groups, respectively (P < 0.05 for each group). In contrast, plasma homocysteine levels increased by 11.66% in the placebo group. The homocysteine lowering effect did not differ significantly among the three groups of women receiving unopposed CEE alone and CEE plus MPA at two different doses. Conclusion: Six months of estrogen therapy (ET) and combined estrogen-progestogen therapy (EPT) significantly lower fasting plasma homocysteine levels in healthy postmenopausal women with equal efficacy.

What is the role of primary methotrexate treatment in scar ectopic pregnancy

REFERENCES 1. Brewer J, Owens MY, Wallace K, et al. Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. Am J Obstet Gynecol 2013;208:468.e1-6. 2. Loureiro R, Leite CC, Kahhale S, et al. Diffusion imaging may predict reversible brain lesions in eclampsia and severe preeclampsia: initial experience. Am J Obstet Gynecol 2003;189:1350-5. 3. Zeeman GG, Fleckenstein JL, Twickler DM, Cunningham FG. Cerebral infarction in eclampsia. Am J Obstet Gynecol 2004;190:714-20.

The effect of total hysterectomy on sexual function and depression.

Background & Objectives: To investigate whether the operations of Type 1 hysterectomy and bilateral salpingo-oophorectomy performed for benign reasons have any effect on sexual life and levels of depression. Method: This is a multi-center, comparative, prospective study. Healthy, sexual active patients aged between 40 and 60 were included into the study. Data was collected with the technique of face-to-face meeting held three months before and after the operation by using the demographic data form developed by the researchers i.e. the Female Sexual Function Index (FSFI) and the Beck Depression Scale (BDS). Results: In the post-operative third month, there was an improvement in dysuria in terms of symptomatology (34% and 17%, P<0.001), while in FSFI (41.47±25.46 to 34.20±26.67, P<0.001) and BDS (12.87±11.19 to 14.27±10.95, P=0.015) there was a deterioration. For FSFI, 50-60 age range, extended family structure; and for BDS, educational status, not working and extended family structure were statistically important confounding factors for increased risk in the post-operative period. Conclusion: While hysterectomy and bilateral salpingo-oophorectomy performed for benign reasons brought about short-term improvement in urinary problems after the operation for sexually active and healthy women, they resulted in sexual dysfunction and increase in depression. The age, educational status, working condition and family structure is also important.

Laparoscopic splenectomy for the treatment of wandering spleen in a pregnant woman: a case report.

Laparoscopic splenectomy became the gold standard recently for the removal of spleen. One of its rare indication is wandering spleen (WS). WS is characterized by incomplete fixation of the spleen. Patients usually have an asymptomatic abdominal mass. When they are symptomatic, abdominal pain with a mobile mass is the major finding. Laboratory data are nonspecific, but the diagnosis can be confirmed by imaging studies; computed tomography, magnetic resonance imaging, and ultrasonography are preferred modalities. It can predispose one to life-threatening complications such as splenic infarction, portal hypertension, pancretitis, and hemorrhage, due to torsion of its vascular pedicle. Herein, we present a female patient, a 24-year-old, 18-week primigravida. She was admitted with an intra-abdominal mass and lower abdominal pain. Ultrasonography revealed a mass behind the uterus. Magnetic resonance imaging was planned, and the spleen was seen at this area. We performed laparoscopic splenectomy for the treatment of a WS, which would be dangerous for pregnancy. The patient was discharged without any postoperative complication on the third day postoperatively. A healthy baby was delivered at term. Minimally invasive procedures should also be the primary choice in the treatment of such pregnant women. This is the first case of laparoscopic splenectomy in a pregnant woman for WS in the English literature.

The role of maternal serumbeta-HCG and PAPP-A levels at gestational weeks 10 to 14 in the prediction of pre-eclampsia.

Objective: We aimed to detect whether maternal serum free β-hCG and PAPP-A levels and NT measurements vary between normal pregnancies and those that subsequently develop pre-eclampsia and to evaluate the role of these screening serum analytes in the prediction of pre-eclampsia. Methods: Using a case-control study design, we identified all women who had been screened by double test within 11+0 and 13+6 weeks of gestation and who had developed pre-eclampsia during the subsequent pregnancy course, over a 6-year period between January 2006 and December 2012 at two tertiary referral hospital. All women who had undergone a double test during that time, without a diagnosis of pre-eclampsia and who had not had any adverse obstetric outcomes, were also identified, and three women among them were randomly selected as controls for each case. Maternal and neonatal data were abstracted from the medical records and PAPP-A, β-hCG, NT and CRL MoM values were compared between the two groups. Results: Although β-hCG values show no statistically significant difference (p=0.882), PAPP-A levels were significantly reduced in the pre-eclampsia group compared to the control group (p<0.001). NT and CRL values showed no significant difference between the two groups (p=0.674 and p=0.558, respectively). Conclusion: Measuring PAPP-A in the first trimester may be useful in the prediction of pre-eclampsia.

Assessment of the relationship between follicular fluid calcium ion concentration and reproductive outcomes

Background: Quantification of follicular fluid (FF) composition can provide valuable information about the oocyte state which can be helpful in distinguishing high and low quality oocyte. In the absence of appropriate calcium signaling at fertilization, the embryo may fail to implant and/or develop to full term. We herein aimed to investigate whether FF levels of Ca 2+ ion concentrations vary between patients who achieved pregnancy and those who did not following a standard ICSI treatment regimen, and hence to determine whether FF Ca 2+ levels could predict reproductive outcomes in patients undergoing ICSI. Methods: Patients seeking treatment for solely unexplained infertility were recruited in the period between June and December 2013 and were assigned to the groups according to their reproductive outcomes. Group 1 consisted of patients who conceived and Group 2 consisted of those who did not achieve pregnancy following ICSI. Parametric comparisons were performed using Student’s t-test. Categorical data were evaluated by using χ 2 test. Results: Groups 1 and 2 consisted of 34 and 66 patients, respectively. Although FF Ca 2+ ion concentrations were higher in those who did not achieve any pregnancy, the difference did not reached to statistical significance level (7.6±0.4 mg/dl and 7.9±0.9 mg/dl respectively, p=0.070). Conclusions: FF Ca 2+ ion concentrations did not significantly differ between patients who achieved pregnancy and who did not followed ICSI attempts. Thus FF Ca 2+ levels do not appear to be of benefit in predicting reproductive outcomes in unexplained infertility patients undergoing ICSI cycles.

Severe Sirenomelia following frozen-thawed embryo transfer cycle

Sirenomelia is a rare congenital syndrome caused by anomalous development of the caudal region of the fetal body, resulting in a single limb or fused lower limbs [1]. Other anomalies associated with Sirenomelia include a single umbilical artery, bilateral renal agenesis or dysgenesis, absent bladder, absent rectum, imperforate anus, and absent external genitalia, lumbosacral and pelvic malformations, sacral agenesis, malformed vertebrae and hemivertebrae, and corresponding anomalies of the central nervous system [2]. We present a 37-year-old female who was referred for routine antenatal follow-up care after conceiving via a frozen-thawed embryo transfer cycle. She reported an 8-year period of infertility, including three unsuccessful cycles of in vitro fertilization. She had no past medical or surgical history. On a follow-up ultrasound at 11 weeks, a fetal cystic hygroma and absence of one lower extremity were noted. FISH results of chorionic villus sampling confirmed that chromosomes 13, 18, and 21 were normal, as were the sex chromosomes. Following termination of the pregnancy at 13 weeks, external examination of the fetus revealed a single, severely hypoplastic lower extremity engaged posteriorly and cranially (Fig. 1). The external genitalia were not apparent. Multiple anomalies were reported on computed tomographic scan and pathologic examination: a single umbilical artery, renal agenesis, absence of the ureters and bladder, bilateral hypoplasia of the renal arteries; anorectal atresia, and a blind-ending ileum. This combination of findings confirmed the diagnosis of Sirenomelia. Many theories have been proposed as a means of explaining Sirenomelia. At present, there are two acceptable hypotheses: the defective blastogenesis hypothesis and the vascular steal hypothesis [3]. According to the defective blastogenesis hypothesis, Sirenomelia is a primary defect of blastogenesis that occurs during the final stages of gastrulation at the tailbud stage, in conjunction with the primary embryonic process [4]. The phenotypic variability depends on the intensity, the time of initiation, and the duration of the underlying event (days 1-28) [4]. The defects of the primary embryonic period lead to failure of axis formation, mid-line, primitive node and streak, gastrulation, segmentation of the paraxial mesoderm, and defects in the determination of laterality [5]. Although frozen-thawed embryo transfers have not been associated with an increased risk of congenital abnormalities [6], the possibility exists that this anomaly may have been caused by defective blastogenesis due to the stress exerted during freezing and thawing of the embryo. According to the vascular steal hypothesis, a single umbilical artery emerging from the fetal abdominal aorta immediately below the celiac branch leads to insufficient blood supply, resulting in deficient development of the caudal mesoderm, kidneys, large intestine and genitalia [7]. S. Bodur (&) Department of Obstetrics and Gynecology, Maresal Cakmak Military Hospital, Erzurum 25070, Turkey e-mail: serkan_bodur@yahoo.com; bodurs@mail.magee.edu

Terme ulaşan bir uterus didelfis olgusu ve yönetimi

A Case Of Uterus Didelphys Reached Term and Management Abstract It is important to diagnose early in gestation the uterine abnormalities which are rarely seen or may leed to several obstetrics complications. Despite the real incidence of congenital uterine abnormalities not known so well, the incidence is 0.001 % to 10 % in whole population. The incidence of uterus didelphys is estimated as 2-8 % between them. In this case, report a pregnant with uterus didelphys who had a healthy pregnancy period from first trimester till term and delivered a healthy child was evaluated together with literature knowledge.