Mert Kazandi

Role of perineal sonography in the evaluation of patients with stress urinary incontinence.

Objective: The aim of the study was to determine the role of perineal sonography in diagnosis of stress urinary incontinence.

Large cell neuroendocrine carcinoma of the uterine cervix: a report of a case and review of the literature

IntroductionLarge cell neuroendocrine carcinoma is a rare aggressive cervical neoplasm, considerably rarer than the well-recognized small cell neuroendocrine carcinoma of the cervix. Cervical large cell neuroendocrine carcinomas are distinctive cervical carcinomas that are frequently misdiagnosed and have an unfavorable outcome, similar to that of small cell carcinoma.Case reportWe report a 45-year-old woman with large cell neuroendocrine uterine cervical carcinoma.

Post-mortem Caesarean section performed 30 minutes after maternal cardiopulmonary arrest.

During the past century post-mortem Caesarean sections were held in ill repute because infant salvage rates were very poor among the reported cases. Over the past 50 years as the nature of maternal mortality has changed, the potential for infant survival has increased. Changes in common causes of maternal deaths from chronic diseases and infection to acute causes, such as anaesthetic complications, embolism and cerebrovascular accidents in a previously healthy mother, have increased the potential for infants survival. In addition, improvements in neonatal care have led to a strong motivation that, with appropriate and timely management, a healthy infant can be saved by perimortem Caesarean delivery. The actual percentage of post-mortem Caesarean sections remains difficult to ascertain, probably because of underreporting of unsuccessful cases. Nevertheless, because of the potential for survival of normal infants, obstetricians must consider a Caesarean delivery in a woman who has a cardiopulmonary arrest in the third trimester. We present a case of post-mortem Caesarean section performed 30 mins after maternal cardiopulmonary arrest. The infant survived with minimal neurological sequelae.

Effect of BCG vaccine on peritoneal endometriotic implants in a rat model of endometriosis

Objective:  To investigate the effect of Bacillus Calmette–Guerin (BCG) vaccine on peritoneal implantation of endometrial tissue in rats.

Splenectomy Combined with Cesarean Section in a Patient with Severe Immunological Thrombocytopenic Purpura Refractory to Medical Therapy

Splenectomy as a treatment for severe immunological thrombocytopenic purpura is rarely performed in the third trimester of pregnancy. We report a 28‐year‐old patient who presented at the 34th gestational week with severe immunological thrombocytopenic purpura resistant to both corticosteroid and intravenous immunoglobulin therapies. Splenectomy combined with delivery by cesarean section provided remission of the disease.

Prenatal Evaluation of MicroRNA Expressions in Pregnancies with Down Syndrome

Background. Currently, the data available on the utility of miRNAs in noninvasive prenatal testing is insufficient in the literature. We evaluated the expression levels of 14 miRNAs located on chromosome 21 in maternal plasma and their utility in noninvasive prenatal testing of Down Syndrome. Method. A total of 56 patients underwent invasive prenatal testing; 23 cases were carrying Down Syndrome affected fetuses, and 33 control cases carrying unaffected, normal karyotype fetuses were included for comparison. Indications for invasive prenatal testing were advanced maternal age, increased risk of Down Syndrome in screening tests, and abnormal finding in the sonographic examination. In both the study and control groups, all the pregnant women were at 17th and 18th week of gestation. miRNA expression levels were measured using real-time RT-PCR. Results. Significantly increased maternal plasma levels of miR-3156 and miR-99a were found in the women carrying a fetus with Down Syndrome. Conclusion. Our results provide a basis for multicenter studies with larger sample groups and microRNA profiles, particularly with the microRNAs which were found to be variably expressed in our study. Through this clinical research, the utility of microRNAs in noninvasive prenatal testing can be better explored in future studies.

The Disappearing Brain-Sparing Effect in Early-Onset Fetal Growth Restriction Fetuses Revisited

Objective: To evaluate the association between the brain-sparing situation and perinatal outcomes in fetuses with early-onset fetal growth restriction (EO-FGR) with absent or reverse end-diastolic flow in the umbilical artery (UA A/REDF). Methods: We evaluated fetuses with EO-FGR who had patterns of UA A/REDF without abnormal venous Doppler indices. Participants were divided into two groups according to measurements of mid-cerebral artery pulsatility index (MCA PI) just before delivery. Group 1 (n = 45) included those with a brain-sparing effect (BSE) (a MCA PI <5th percentile for the gestational age) and group 2 (n = 14) included those with a disappearing BSE, defined as an MCA PI increase towards normal values after the BSE detected at the initial evaluation. Short-term perinatal outcomes were analyzed. Results: Compared to group 1, group 2 had a significantly low birth weight (p = 0.018) and high rates of extended neonatal intensive care unit hospitalization (p = 0.049 respectively). Conclusion: On the basis of longitudinal measurements of MCA PI, increases after the reduction <5th percentile might be related to poor perinatal outcomes in fetuses with EO-FGR who had UA A/REDF without abnormal venous flow patterns.

Prenatal diagnosis of Cantrell pentalogy in first trimester screening: case report and review of literature.

Pentalogy of Cantrell is a heterogeneous and rare thoraco-abdominal wall closure defect with the estimated prevalence of 1/65.000 to 1/200.000 births. Supraumbilical midline wall defect (generally omphalocele), deficiency of the anterior diaphragm and diaphragmatic peritoneum, defect of the lower sternum and several intracardiac defects are the components of Cantrell pentalogy. Etiology is unknown but a defect on the lateral mesoderm during the early stage of pregnancy is the most accepted hypothesis. Nowadays both 2- dimensional (2D) and 3-dimensional (3D) sonography are commonly used in diagnosis. In our case, a fetus with 11 weeks of gestation was reported as Cantrell pentalogy during first trimester screening. Additionally, unilateral limb defect and lumbar lordoscoliosis were detected through 3D sonography. Pregnancy was terminated according to parental desire. Karyotype was 46 XY. Early diagnosis is feasible in the first trimester if ectopia cordis and omphalocele exist. Additionally, development in ultrasound technology provides us with better visualization and early diagnosis. Prognosis seems to be poor in patients with complete Cantrell syndrome and patients with associated anomalies. Termination is the choice of treatment. Early diagnosis gives us a chance to reduce maternal morbidity and mortality related to termination.

Levetiracetam ameliorates ovarian function in streptozotocin-induced diabetic rats

Abstract Diabetes mellitus can adversely affect gonadal function. In the present study, we aimed to investigate the protective effects and mechanism of action of levetiracetam (LEV) on the ovaries in a streptozotocin (STZ)-induced diabetes model in rats. Twenty-one adult female rats were assigned to three groups as control, diabetes group treated with 1 mL/kg/d saline (STZ + SP) and diabetes group treated with 600 mg/kg/d LEV (STZ + LEV). Following 4 weeks treatment, blood samples were collected for biochemical analysis and ovariectomy was performed for histopathological examination. Plasma anti-Mullerian hormone (AMH), glutathione and total anti-oxidant capacity values were significantly lower whereas lipid peroxides and transforming growth factor-β (TGF-β) values were significantly higher in STZ + SP group compared to control. LEV treatment successfully decreased lipid peroxidation and TGF-β levels, and also increased anti-oxidant parameters and AMH levels in diabetic rats. Saline-treated rats significantly displayed ovarian degeneration and decreased counts of follicles. However, treatment of diabetic rats with LEV effectively prevented the degenerative changes and follicle loss. Also, LEV suppressed ovarian nuclear factor-kappa B (NF-kB) immunoexpression in diabetic rats. Taken together, we propose that LEV can ameliorate the adverse effects of diabetes on ovarian function via decreasing NF-kB expression and oxidative stress and increasing anti-oxidant status in rats. Chinese abstract 糖尿病可对性腺功能产生不利影响。本研究中，我们旨在探讨左乙拉西坦（LEV）对链脲霉素（STZ）诱导的糖尿病大鼠卵巢的保护情况及其作用机制。我们将21只雌性成年大鼠随机分为控制组、1mL/kg/天生理盐水糖尿病治疗组（STZ+SP）和600mg/kg/天左乙拉西坦糖尿病治疗组（STZ+LEV）。四周后收集血液样本进行生化分析，切除卵巢进行病理组织学检查。与对照组相比，血浆抗苗勒管激素（AMH）、谷胱甘肽、总抗氧化活性值明显降低，而STZ+SP组脂质过氧化物、转化生长因子β（TGF-β）则明显升高。在糖尿病大鼠模型中，LEV治疗组显著降低了过氧化脂质和TGF-β水平，同时升高了抗氧化参数及AMH水平。生理盐水灌胃组大鼠模型中卵巢功能明显减退、卵泡计数明显减少。然而，接受LEV治疗的糖尿病大鼠模型有效地预防了大鼠卵巢功能的减退及卵泡数的损耗。同时，LEV也抑制了糖尿病大鼠卵巢核因子kB（NF-kB）的免疫性表达。综上，我们提出LEV可通过降低NF-kB表达和氧化应激反应，同时通过增加抗氧化状态来改善糖尿病大鼠的卵巢功能。

Complete hydatidiform mole presenting as placenta previa in a twin pregnancy with a coexisting normal foetus: Case report

We present a case of a patient with a complete hydatidiform mole co-existing with a normal foetus (CMCF) who had a caesarean section in week 32 of gestation, resulting in a live female infant weighing 1590 grams. The mother, with a normal bleeding pattern, did not require any surgical intervention. She was discharged from hospital on the third post-operative day. Premature termination is recommended in this type of pregnancy because of the risks associated with molar pregnancies. However, with the close follow-up of these pregnancies, good maternal and perinatal results may be obtained.