Mehmet Dolanbay

Successful medical treatment of cesarean scar ectopic pregnancies with systemic multidose methotrexate: Single‐center experience

The aim of this study was to investigate the efficacy, and the safety of systemic multidose methotrexate (MTX) for the treatment of cesarean scar pregnancy (CSP).

Sonographic findings and perinatal outcome of multiple pregnancies associating a complete hydatiform mole and a live fetus: a case series.

The aim of this case series was to present the ultrasonographic findings, clinical features, management, and outcome of multiple pregnancies with complete hydatidiform mole and coexisting fetus (CHMCF).

Comparison of systemic and local methotrexate treatments in cesarean scar pregnancies: time to change conventional treatment and follow-up protocols

OBJECTIVE The aim of this study was to compare the use of systemic and local methotrexate in the treatment of cesarean scar pregnancy. STUDY DESIGN In this retrospective cohort study, we collected the data of 44 patients with cesarean scar pregnancy. The patients were grouped according to treatment modality: Group 1, local methotrexate injection (n=17) and Group 2, systemic methotrexate (n=27). The groups were compared with respect to side effects, recovery time, reproductive outcome, and treatment cost. RESULTS The mean gestational age at diagnosis (6.4±0.93 vs. 5.4±0.80 weeks, p=0.001), pretreatment serum β-human chorionic gonadotrophin level [27,970 (11,010-39,421) vs. 7606 (4725-16,996) mIU/mL, p=0.001], and lesion size (2.74±1.36 and 1.28±0.55cm, p=0.001) were higher in Group 1. All patients were cured by primary therapy without additional surgery. The mean times for β-human chorionic gonadotrophin normalization, the uterine-mass disappearance, were significantly shorter in Group 1 than in Group 2 (6.17±1.55 vs. 8.11±2.0 weeks, p=0.001 and 10.47±4.14 vs. 13.40±4.44 weeks, p=0.002, respectively). The cost of treatment was similar between groups (281.133±112.123

Acute pulmonary failure due to pulmonary edema during tocolytic therapy with nifedipine

vs. 551.134±131.792

Selective ovarian vein sampling can be crucial to localize a Leydig cell tumor: An unusual case in a postmenopausal woman

, p=0.76). The total pregnancy rates were not different between groups (5/16, 31.4% vs. 6/11, 54.6%, p=0.301). One recurrent cesarean scar pregnancy occurred after systemic methotrexate. Oral ulcers, the most common side effect, were seen in seven patients in Group 2. CONCLUSION Even though treatment success and reproductive outcomes are similar, local methotrexate is superior to systemic methotrexate with regard to recovery time, side effects, and treatment costs, even in patients with unfavorable pretreatment prognostic predictors.

A case of renal cell carcinoma with solitary metastasis to the ovary.

Calcium-channel blockers (CCB) are the new members of the tocolytic drugs [1]. We report a case of pulmonary edema (PE) associated with tocolytic use of oral nifedipine. According to the available literature, this is the first case of pulmonary edema associated with the use of nifedipine at conventional dose. A 39-year-old, previously healthy, G4P3 was admitted with rupture of membranes. On admission, blood pressure was 120/70 mm Hg, pulse rate was 84 beats/min. Transabdominal ultrasonography showed 33-week-old singleton fetus. Blood tests revealed that white blood cell was 9.7 9 10/mL and C-reactive protein was 12.8 mg/dL. She was started on amoxicillin 1 g intravenously every 6 h, and nifedipine 20 mg orally every 4 h and betamethasone 12 mg intramuscular daily for 2 days. For the first day of her admission, 2,000 cc parenteral fluid was given to the patient and was reduced to 1,000 cc daily. At fourth day of her admission, she complained of dyspnea with sudden onset and a vague chest, and back pain. Her condition rapidly deteriorated and cardiac and respiratory arrest ensued. After the first resuscitation she was intubated. Arterial blood gases at room air showed severe hypoxemia (PaO2: 53, CO2: 26). She was immediately transported to the operating room due to persisted fetal bradycardia, and 1,850 g/28 cm infant, with APGAR scores of 5 at 1 min and 7 at 5 min was delivered via cesarean section. She was admitted to the intensive care unit postoperatively. Chest X-ray showed bilateral haziness with mild pleural effusion and chest computed tomography revealed thickening of interlobular septums, pleural effusion, basal atelectasis, and ground glass pattern suggestive of pulmonary edema (Fig. 1). Left ventricular-ejection fraction was 60 %, and creatine kinase and creatine kinase MB were within normal limits. Intravenous furosemide was started 30 mg every 8 h for the first day and furosemide doses were adjusted thereafter based on the patient’s condition and urine output. After 4 days of the operation, she was discharged with good condition. First reported cases of CCB related pulmonary edema was associated with parenteral tocolytic use of nicardipine [2]. Later, Abbas et al. [3] reported the first case of PE associated with tocolysis with oral nifedipine at a dose of 40 mg for every 6 h in patients with preterm premature rupture of membranes. CCB has negative inotropic effect causing reflex tachycardia that impairs diastolic filling. Moreover, vasodilatation caused by CCBs predominantly affect precapillary rather than post capillary vessels and thus, leading to interstitial fluid accumulation. It seems possible that even at conventional doses, when combined with betamethasone and parenteral fluid infusion, CCB predisposes pregnant patients to the PE as in the present case. In accordance with aforementioned theory and case series, in their comprehensive analysis, Ogunyemi [4] showed that preterm delivery, antenatal steroids, magnesium sulfate, tocolysis and nifedipine use as a tocolytic were independent risk factors for the development of PE. In conclusion, CCB may cause life-threatening complications in pregnant patients taking antenatal steroids and M. S. Kutuk (&) M. T. Ozgun S. Uludag M. Dolanbay Department of Obstetrics and Gynecology, Faculty of Medicine, Gevher Nesibe Hospital, Erciyes University, 38039 Kayseri, Turkey e-mail: mskutuk@erciyes.edu.tr

A critical analysis of low molecular weight heparin use during pregnancy in a tertiary referral centre

Leydig cell tumors of the ovary are very rare, frequently associated with symptoms of virilization in postmenopausal patients. It is sometimes difficult to localize the tumor precisely even with modern imaging techniques. A 62-year-old patient presented with recent onset of rapidly progressive virilization including increased hirsutism, progressive balding, deepening voice and enlargement of the clitoris. Initial laboratory examination revealed a total serum testosterone level of 1330 ng/dL. Serum dehydroepiandrosterone sulfate, androstenedione and 17 hydroxyprogesterone levels were all within normal limits. Extensive pre-operative evaluations included transvaginal ultrasound, abdominal computed tomography and magnetic resonance imaging failed to localize the tumor. Therefore, selective ovarian venous hormonal sampling (SOVHS) was performed and they revealed that the total serum testosterone level was significantly higher in the left than in the right ovarian vein (7000 ng/dL vs. 225 ng/dL). A total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. Microscopic examination of the left ovary revealed a Leydig cell tumor. In conclusion, when the precise location of the tumor is not determined pre-operatively, SOVHS may be valuable to make accurate diagnosis.

Relationship between fetal peak systolic velocity in Middle cerebral artery and umbilical blood gas values and hemoglobin levels in diabetic pregnant women

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Laparoscopically-assisted vaginal hysterectomy for enlarged uterus: operative outcomes and the learning curve

The aim of this study was to analyse low molecular weight heparin (LMWH) use during pregnancy in terms of patient evaluation, treatment indication and social and financial costs. This was a retrospective analysis of patients using LMWH in their pregnancies. A total of 147 women were included in the study. The most common indications were thrombophilia (55/147, 37.4%); recurrent pregnancy loss (RPL); (47/147, 32.0%) and previous single pregnancy loss (18/147, 12.2%). In the RPL group, 53.1% of patients were not evaluated with standard tests; 31.9% of women were incompletely evaluated and 15% were properly evaluated. Out of 104 women screened for thrombophilia, 32 (32/104, 30.8%) were tested during pregnancy. Despite published guidelines and increasing scientific evidence against their use in some indications, LMWHs are prescribed widely during pregnancy for a variety of indications. Public and healthcare providers’ education to change this attitude should be implemented.

Conservative management of interstitial pregnancies: experience of a single centre

To assess the relationship between peak systolic velocity in the middle cerebral artery (MCA‐PSV) and fetal hypoxia in diabetic pregnant women requiring insulin therapy.