Levent Tütüncü

Longitudinal study of platelet size changes in gestation and predictive power of elevated MPV in development of pre-eclampsia

The aim of this cohort is to investigate whether any haematologic changes detectable by simple complete blood count (CBC) precede pre‐eclampsia development and the diagnostic value of these markers in clinical practice for prediction of pre‐eclampsia.

Increasing the Stimulation Dose of rFSH in Unexpected Poor Responders Is Not Associated with Better IVF Outcome

OBJECTIVES The aim of this retrospective study is to determine whether increasing the stimulation dose of rFSH in unexpected poor responders is associated with better IVF outcome or not. METHODS A total of forty eligible women who fulfilled our definition of poor responders (< or = 3 follicles, < 4 oocytes or E2 levels < or = 500 pg/ml on day of hCG administration) and who did not achieve an ongoing pregnancy in the first cycle and who returned for a second higher rFSH dose IVF cycle with a long-agonist protocol were included to the study. The first-low dose cycles and the second-high dose cycles were compared to each other. Each patient functioned as her own control. Main outcome measures of the study were daily and total dose of rFSH, duration of stimulation, number of follicles, number of oocytes retrieved, number of embryos and E2 level on day of hCG injection. RESULTS The first-low dose cycles and the second-high dose cycles were comparable regarding patient characteristics. There were no significant differences in duration of stimulation, number of follicles, number of oocytes retrieved, number of embryos and E2 level on day of hCG injection between the first-low and second-high dose cycles. Daily and total dose of rFSH were significantly higher in the second-high dose cycles. Fewer cycles were cancelled during the second higher gonadotrophin dose after first unexpected poor response. CONCLUSIONS Increasing the starting dose of gonadotrophin after an unexpected poor response in the first IVF cycle is not an effective approach. It may increase the oocyte retrieval rates and embryo transfer rates, but will not add any significant improvement in the number of oocytes retrieved and the number of transferable embryos. The only important benefit of increasing the dose was the low cancellation rate.The aim of this retrospective study is to determine whether increasing the stimulation dose of rFSH in unexpected poor responders is associated with better in vitro fertilization (IVF) outcome or not. A total of forty eligible women who fulfilled our definition of poor responders and who did not achieve an ongoing pregnancy in the first cycle and returned for a second higher rFSH dose IVF cycle with a long-agonist protocol were included to the study. The first low-dose cycles and the second high-dose cycles were compared to each other. Main outcome measures of the study were duration of stimulation, number of follicles, number of oocytes retrieved, number of embryos, and E2 level on day of hCG injection. There were no significant differences in duration of stimulation, number of follicles, number of oocytes retrieved, number of embryos, and E2 level on day of hCG injection between the first low- and second high-dose cycles. Daily dose and total dose of rFSH were significantly higher in the second high-dose cycles. Increasing the dose of rFSH in a second stimulation cycle after first unsuccessful treatment cycle will add only to the cost and discomfort of the treatment and might adversely affect pregnancy rates.

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.

Second trimester amniotic fluid annexin A5 levels and subsequent development of intrauterine growth restriction

The purpose of this study was to investigate the levels of annexin A5 in second trimester amniotic fluid, and evaluate its correlation with subsequent development of intrauterine growth restriction (IUGR).

The status of telomerase enzyme activity in benign and malignant gynaecologic pathologies.

BACKGROUND Telomeres are essential for the function and stability of eukaryotic chromosomes. Telomerase consists of three subunits: human telomerase reverse transcriptase (hTERT), human telomerase RNA (hTR), and telomerase protein 1 (TP1). The hTERT subunit determines the activity of telomerase as an enzyme and is detected in most human tumors and regenerative cells. Telomerase activity is a useful cancer-cell detecting marker in some types of cancers. AIMS The aim of this study was to assess of telomerase hTERT mRNA in gynaecological tumors for diagnosis of malignancy. STUDY DESIGN Cross-sectional study. METHODS A total of 55 gynaecologic tumor samples (35 ovarian, 13 endometrial, 6 cervical and 1 placental site trophoblastic tumor tissue) were obtained at the time of surgery. Quantification of hTERT mRNA was performed in a real-time reverse transcriptase polymerase chain reaction (RT-PCR) using the LightCycler TeloTAGGG hTERT Quantification Kit. RESULTS It was histopathologically detected that 18 of the tissue samples were malignant and 37 of the samples were benign. 16 of the malignant tissue samples (88.9%) and 3 (8.1%) (endometrial tissue in proliferative phase, mucinous cyst adenoma and endometriosis) of the benign tissue samples were found to be hTERT positive. With the presence of these data, sensitivity and specificity of hTERT for the diagnosis of malignancy were calculated to be 88.9% and 91.9%, respectively. CONCLUSION It was suggested that the measurement of telomerase activity in gynaecologic tumors, except for endometrial tissue in the reproductive phase, is a valuable method for pathological investigation.

Comparison of the Risk of Malignancy Index and Self-Constructed Logistic Regression Models in Preoperative Evaluation of Adnexal Masses

Objective. The aim of this study was to evaluate women with adnexal masses in the preoperative period by creating 2 logistic regression models, 1 including sonographic morphologic characteristics and the other including both morphologic and color Doppler characteristics, to compare the diagnostic accuracy of these 2 models with the risk of malignancy index (RMI). Methods. This prospective study included 38 malignant, 7 borderline, and 244 benign ovarian masses. The menopausal status, presence of septa, presence of papillary projections, location of the tumor, presence of ascites, presence of metastases, cancer antigen 125 level, tumor volume, septa thickness, and percentage of the solid component were included in the initial analysis. A second regression analysis was performed with the addition of Doppler parameters (location of blood flow and lowest resistive index) in the data set. Diagnostic performance of the 2 regression models and RMI were described and compared by generating receiver operating characteristic curves for each model. Results. The area under the curve values for the morphologic model (model 1), Doppler model (model 2), and RMI were 0.907, 0.971, and 0.889, respectively. Significance levels of model 1 and the RMI were similar (P = .23), whereas model 2 had a significantly higher area under the curve compared with both model 1 (P = .037) and the RMI (P = .018). Conclusions. The addition of Doppler parameters in the regression model significantly increases the predictive performance. Nevertheless, in low‐resource settings, the RMI remains the method of choice for distinguishing adnexal masses and referral to gynecologic oncology clinics

The Effects Of The Second Trimester Maternal Hemoglobin Levels On The Birth Weight And Birth Time

Objectives: The aim of our study is to investigate the effects of anemia at the second trimester on birth weight and birth time. Patients and Methods: The medical reports of 1116 pregnant women who attended and delivered at our clinic between January 2005 and October 2007 were analyzed retrospectively. The patients were divided into two groups as having alt;9 gr/dl hemoglobin or age;9 gr/dl hemoglobin levels. The gestational and the perinatal outcomes of the normal and anemic groups were compared. Results: The age and the parity were higher in the non-anemic group than in the anemic pregnants. (p=0.03, p=0.001). There was no statistically significant difference in the mode of birth and gestational complications between the two groups. While there was no statistically significant difference in the gestational age at delivery and birth weight, prematurity and oligohydramnios ratios were significantly higher in the anemic group compared to the group with Hbagt;9 gr/dL (p=0.041, p=0.004, respectively). Conclusion: The anemia of second trimester is related with prematurity and increased rate of oligohydramnios. Iron supplementation should be given during pregnancy to improve pregnancy outcomes. Amac: Bu calismanin amaci ikinci trimester anemisinin dogum agirligi ve dogum haftasina etkisini arastirmaktir. Hastalar ve Yontemler: Ocak 2005 ve Ekim 2007 tarihleri arasinda klinigimizde takip edilen ve dogum yapan 1116 hastanin kayitlari retrospektif olarak incelendi. Hastalar ikinci trimester hemoglobin degerleri alt;9 gr/dl olanlar ve age;9 gr/dl olmak uzere iki gruba ayrildi. Anemik olan ve normal hemoglobin seviyelerine sahip gebelerin gebelik seyri ve perinatal sonuclari karsilastirildi. Bulgular: Anemik olmayan grupta yas ve parite anemik gebelere kiyasla yuksekti (sirasiyla p=0.03, p=0.001). Gruplar arasinda dogum sekilleri ve gestasyonel komplikasyonlar acisindan anlamli bir farklilik gorulmedi. Ortalama dogum zamani ve dogum kilosu acisindan anlamli bir farklilik gorulmezken ikinci trimester anemisi olan grupta prematurite ve oligohidramnios orani daha fazla goruldu ve bu fark istatistiksel olarak anlamli bulundu (p=0.041, p=0.004). Sonuc: Ikinci trimester anemisi prematurite ve artan oligohidramnios oranlariyla iliskili olabilmektedir. Gebelik sonuclarini iyilestirmek icin gebelik suresince demir destegi yapilmalidir.

Recurrent Idiopathic Nonimmune Hydrops Fetalis: A Case Report

A recurrent idiopathic nonimmune hydrops fetalis case in two subsequent pregnancies was observed in a woman with no child. In both pregnancies, all the detailed analysis, including a high level of ultrasonography, amniocentesis, serologic evaluation, routine blood work, hemoglobin electrophoresis, and glucose 6-phosphate/dehydrogenase level and postdelivery autopsy, was done, and after no clue of etiologic agent, pregnancy termination was applied for both. This case report illustrates the importance of recurrence of nonimmune hydrops fetalis in the absence of any etiology. Mostly, it is hard to establish an etiologic diagnosis for adequate management of subsequent pregnancies.

19. gebelik haftasında saptanan tek taraflı alt ekstremite anomalisi

We report the prenatal ultrasonographic diagnosis of a rare case of unilateral proximal focal femoral deficiency and fibula agenesis with clubfoot at 19 weeks gestation.