Mert Turgal

Outcome of sonographically suspected fetal ovarian cysts

Abstract Objective: Fetal ovarian cysts (FOCs) are the most common intra-abdominal cystic structures formed during antenatal period. The aim of this study was to evaluate prenatal characteristics and postnatal outcome of sonographically suspected FOCs. Methods: We reviewed prenatal sonographic data and postnatal medical records of 29 fetuses that were suspected to have ovarian cysts in our hospital, between January 2001 and September 2012. Perinatal outcomes were obtained for all cases. Results: In a total of 29 cases, we confirmed initial antenatal diagnosis of ovarian cyst in 20 cases (68.9%) at postnatal period. Diagnosis of remaining nine cases revealed urogenital sinus anomaly in four cases, multicystic dysplastic kidney in two cases, mesenteric cyst in one case, intestinal duplication cyst in one case and lymphangioma in one case postnatally. In seven of the 20 ovarian cysts (35%), resolution of the cyst occurred prenatally. Intrauterine death of a fetus occurred at second trimester. In the postnatal period, most often cases (11/20) were spontaneously resolved and surgery was performed on two babies due to ovarian torsion (2/20). Conclusion: Differential diagnosis of FOCs should always include genitourinary tract disorders, gastrointestinal tract disorders and other intra-abdominal cystic structures.

Anatomical and functional assessment of anterior colporrhaphy versus polypropylene mesh surgery in cystocele treatment

OBJECTIVE To compare the anatomical and functional results of traditional anterior colporrhaphy and polypropylene mesh surgery in cystocele treatment. STUDY DESIGN Prospective study conducted in the Urogynecology Clinic of Etlik Zubeyde Hanim Maternity and Womens Health Teaching and Research Hospital between June 2006 and February 2007. Forty patients with stage II and III cystocele according to the Pelvic Organ Prolapse Quantification system were allocated by a computer programme to conventional or mesh surgery. Twenty patients each underwent anterior colporrhaphy (group I) or polypropylene mesh (Sofradim(®), Parieten) surgery (group II). Both groups were followed for 12 months. RESULTS At the end of the 12th month, anatomical cure rates were 15/20 (75%) and 19/20 (95%) in groups I and II, respectively, and the difference between the two groups was statistically significant (p<0.05). De novo stress urinary incontinence developed in one patient in group I. Mesh erosion developed postoperatively in three cases (15%). CONCLUSION In terms of anatomical cure rates, polypropylene mesh surgery was the more successful treatment option when compared with anterior colporrhaphy at the end of 1 year follow-up.

Pregnancy-associated breast cancer: clinicopathological characteristics of 20 cases with a focus on identifiable causes of diagnostic delay.

Background: The primary objective of this study was to evaluate the clinicopathological characteristics of patients with pregnancy-associated breast cancer (PABC), with a special focus on diagnostic delays and the identifiable causes of diagnostic delays. Patients and methods: Clinicopathological data of patients treated for PABC between 2003 and 2012 at Hacettepe University Hospital was retrospectively reviewed. Results: 20 patients with PABC were included. The pathological examination revealed predominance of invasive ductal carcinoma (80%), grade III tumors (65%) and advanced-stage (III-IV) disease (75%). In 8 patients (40%), there was a diagnostic delay between occurrence of the presenting symptoms and the initiation of breast mass workup. For these 8 patients, the main identifiable causes of diagnostic delay were the attribution of disease-related symptoms to pregnancy or lactation in 5 (63%) and negligence of symptoms in 2 (25%). Conclusions: PABC mostly presents with advanced-stage disease, and there can be a substantial diagnostic delay before these patients receive treatment. Preconceptional, gestational and postpartum examination of women of reproductive age should include a thorough breast examination and should provide adequate information regarding the physiological changes in breast tissue and the possible pathological symptoms.

Pregnancy outcome of five patients with renal amyloidosis regarding familial Mediterranean fever.

Abstract Familial Mediterranean fever (FMF) is an autosomal recessive disease affecting mainly patients of the Mediterranean basin and its major complication is the development of renal AA amyloidosis. On the other hand pregnancy with amyloidosis is not common; nevertheless, amyloidosis will complicate pregnancies also with the underlying disease and may cause terrible perinatal morbidities and mortalities. We report here the cases of five pregnant women and their pregnancy outcomes, who have been diagnosed with FMF complicated by renal amyloidosis. In the five cases, we observed that increased pregnancy complication such as small for gestational age, intrauterine growth restriction, preeclampsia and preterm birth.

Non-immune hydrops fetalis as a diagnostic and survival problems: what do we tell the parents?

Abstract Objective: Nonimmune hydrops fetalis (NIHF) is one of the most difficult problems related to pregnancy. The aim of this study was to evaluate the etiological analysis as well as the fetal and neonatal outcomes of NIHF. Methods: We reviewed the prenatal sonographic data and postnatal medical records of pregnant women diagnosed as NIHF in our hospital between January 2001 and May 2013. All cases were categorized using 12 etiological classification groups. Demographic data, diagnostic laboratory parameters, karyotyping results, sonographic and autopsy findings, postnatal final diagnoses, and perinatal mortality rates were also recorded. Results: This study included 147 cases. The mean gestational age at the time of the initial diagnosis was 23.84±6.30 weeks. Cardiovascular causes were the most common (21.7%), followed by structural abnormalities (17.0%), chromosomal abnormalities (6.8%), and skeletal dysplasias (5.4%). Chromosomal abnormalities were detected in 12.8% of these cases. The most common karyotype abnormality was monosomy X. Postmortem autopsy was performed in 50 (34%) cases, and at least one finding was detected in 40 (80%) of these cases. The overall mortality rate was 78.2%. The gestational week at delivery, birth weight, and Apgar score (1st and 5th min) showed a statistically significant difference between exitus and surviving fetuses (P<0.05). Conclusion: NIHF can lead to high perinatal morbidity and mortality, yet its etiopathology remains poorly understood. Early diagnosis of NIHF gives parents an opportunity to make an informed choice about the possible complications of a pregnancy.

Antenatal diagnosis and outcome of agenesis of corpus callosum: A retrospective review of 33 cases

OBJECTIVE To present antenatal sonographic findings and postnatal outcome of a population of foetuses diagnosed with agenesis of corpus callosum. MATERIAL AND METHODS The database of our ultrasound laboratory was retrospectively searched for cases of agenesis of the corpus callosum suspected at antenatal sonography between 2002 and 2012. The following variables were assessed: maternal age, gestational age at diagnosis, gender, any additional cerebral and extra-cerebral malformations, results of karyotype analysis and pregnancy and foetal/neonatal outcomes. RESULTS During the study period, 33 foetuses with agenesis of the corpus callosum were identified antenatally, with a male preponderance. The mean maternal age was 28.48 years. In all cases, pre/postnatal MRI and/or necropsy were performed in order to confirm the diagnosis. Among those, there were additional brain findings in 23 (69.7%) and additional extra-cerebral anomalies in 3 (9.1%) foetuses. Karyotype analysis was performed in 21 of 33 (63.6%) cases. As for pregnancy outcome, the pregnancy was terminated in 14 (42.4%) of the remaining 19 foetuses; eighteen (54.5%) were delivered near term and one (3.1%) who was delivered prematurely died during the neonatal period. CONCLUSION The diagnosis of congenital brain malformation is a challenging issue, since additional findings have a considerable effect on prognosis; detailed examination with genetic counselling should be performed.

Perinatal outcome in cases of isolated single umbilical artery and its effects on neonatal cord blood gas indices

Abstract We aimed to evaluate perinatal outcomes and blood gas indices of isolated single umbilical artery (SUA). In this retrospective study, 134 fetuses with SUA were evaluated. A total of 77 (57.4%) fetuses with isolated SUA (iSUA) were compared with maternal age-matched 95 fetuses with double umbilical arteries (DUA), with respect to pregnancy outcome and umbilical cord blood gas indices. The incidence of SUA in our cohort was 1.04%. Patients with iSUA had lower neonatal birth weight compared with the control group (2,635 ± 972 g vs 2,991 ± 669 g; p = 0.009). Small for gestational age (SGA) frequency was higher in the group of iSUA when compared with fetuses with DUA (17.4% vs 5.4%; p = 0.03). Regarding the umbilical cord blood gas, the parameters were comparable between the two groups. SUA has a favourable obstetric outcome as long as the accompanying malformations are ruled out. Furthermore, neonatal cord blood gas parameters in fetuses with iSUA do not differ from fetuses with DUA.

Prenatal diagnosis and clinicopathologic examination of a case with diastematomyelia.

Diastematomyelia is a rare form of spinal dysraphism. Here the spinal cord was split into two with a bony or cartilaginous spur, resulting in formation of two hemicords. The prenatal diagnosis of diastematomyelia is possible with ultrasonography. The unique finding is the appearance of echogenic focus within the spinal canal. This condition may not have any clinical sign during prenatal and early years of life but as the child grows, serious neurologic manifestations may occur, commonly termed the “tethered cord syndrome”. Here, we report a case of diastematomyelia in which a careful antenatal imaging was performed and postnatal pathologic examination confirmed the diagnosis.

Impaired DNA methylation leading to heterotrisomy.

To date, it is known that approximately 15–20% of all clinically recognised pregnancies result in spontaneous abortion (Robinson et al. 2001). The American Society for Reproductive Medicine defines...

Vaginoperineal Fistula as a Complication of Perianal Surgery in a Patient with Sjögren’s Syndrome: A Case Report

Forty-seven-year-old woman with Sjögrens syndrome had been operated on because of transsphincteric perianal fistula secondary to perianal abscess. Vaginal wall injury occurred during the course of the operation and injured tissue was repaired primarily. Three months later, patient suffered from the recurrence of perianal fistula symptoms and fistulectomy was performed once again under antibiotic suppression. Several months later, perineal discharge continued, and, therefore, patient was admitted to the hospital for the third time and a fistulotomy was performed. Two months after the third operation, patient was admitted with leukorrhea and a perineovaginal fistula was detected. This time, not only her surgical problem but also her immune system disorder was considered in the preoperative workup. Then, patient was hospitalized for the fourth time and “fistulectomy/perineoplasty” was performed successfully. We believe that patients with autoimmune disorders with or without medical treatment may have healing problems during the course of surgical processes and therefore such medical problems must be taken into consideration by the surgeons.