Mustafa Albayrak

Circulating Oxidized Low-Density Lipoprotein and Paraoxonase Activity in Preeclampsia

Preeclampsia is one of the most frequent complications of pregnancy, however, little is known about its etiology. The objective of this study was to investigate the association of oxidized low-density lipoprotein (oxLDL) and paraoxonase (PON1) activity in women with either preeclampsia or normotensive (NT) pregnancy. The study groups included 41 pregnant women with preeclampsia and 33 normotensive pregnant women. In all patients maternal serum total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TGs) were measured using enzymatic methods. Serum PON1 activities and malondialdehyde (MDA) concentrations were measured by spectrophotometric methods, and oxLDL was measured by enzyme-linked immunoassay (ELISA). Serum concentrations of lipid parameters (TC, LDL, VLDL, and TGs) were significantly higher in preeclampsia compared with NT controls (p < 0.001, p < 0.05, p < 0.05, and p < 0.001, respectively). Serum concentrations of MDA and oxLDL were significantly higher, while PON1 activity was significantly lower in preeclampsia compared with NT controls (p < 0.001, p < 0.001, and p < 0.001, respectively). A positive correlation was detected between oxLDL and MDA (r = 0.876), and a negative correlation was detected between both MDA and oxLDL and PON1 (r = –0.837 and r = –0.759, respectively). Our data demonstrate that preeclampsia is associated with increased oxLDL and decreased PON1 activity. Elevated oxidative stress, oxLDL, dyslipidemia and decreased PON1 activities may cause vascular endothelial damage and contribute to the pathophysiology of preeclampsia.

Tramadol and levobupivacaine wound infiltration at cesarean delivery for postoperative analgesia.

PurposeThe aim of the present study was to investigate whether levobupivacaine and tramadol wound infiltration decreases postoperative pain following Cesarean section and reduces the need for analgesics in the immediate post-delivery period.MethodsNinety patients (aged 18–40xa0years) scheduled for elective Cesarean section under general anesthesia were randomly allocated to one of the three groups: the placebo group (group P) received 20xa0mL local wound infiltration with 0.9xa0% saline solution; the levobupivacaine group (group L) received 20xa0mL local wound infiltration with levobupivacaine 0.25xa0%; and the tramadol group (group T) received 20xa0mL local wound infiltration with 1.5xa0mg/kg tramadol within 0.9xa0% saline solution. Following the closure of the uterine incision and the rectus fascia, 20xa0mL solution was infiltrated subcutaneously along the skin wound edges. The primary outcome was 24-h tramadol consumption. Secondary outcomes were recorded VAS scores, diclofenac requirement, fever, vomiting, and wound infection.ResultsAt 15xa0min postoperatively, VAS values were lower in groups T and L than group P (Pxa0=xa00.0001). The mean 24-h tramadol consumption was lowest in group T (Pxa0=xa00.0001) and it was lower in the group L compared to group P (Pxa0=xa00.007) (401.6, 483.3, and 557.5xa0mg for T, L, and P groups, respectively). There was no difference among groups regarding the need for supplemental analgesia (rescue diclofenac doses) (Pxa0>xa00.05).ConclusionsWe conclude that wound infiltration with tramadol and levobupivacaine in patients having Cesarean section under general anesthesia may be a good choice for postoperative analgesia.

Placental stem cell markers in pre-eclampsia.

To investigate the placental CD34, CD44, and leukemia inhibitory factor (LIF) levels in normotensive and pre‐eclamptic women.

Ghrelin, acylated ghrelin, leptin and PYY-3 levels in hyperemesis gravidarum

Abstract Objective: To assess the serum levels of gut and adipocyte-derived metabolic hormones that control appetite, adipocity, weight gain and energy hemostasis, namely total ghrelin (TG), acylated ghrelin (AG), leptin and PYY-3 in hyperemesis gravidarum (HG). Methods: Plasma samples of 86 women in their first trimester pregnancies with HG (nu2009=u200930), morning sickness of pregnancy (MSP) (nu2009=u200934) and control (nu2009=u200922) groups were obtained. Serum levels of TG, AG, leptin and PYY-3 were compared between the groups, and the correlations with severity of symptoms using modified PUQE (Pregnancy Unique Quantification of Emesis) scoring, BMI, E2, hCG and TSH were calculated. Results: Levels of TG, AG, PYY-3 and the TG/leptin ratio were significantly higher in HG group compared to MSP and the control groups (pu2009≤u20090.017). AG/TG ratio was significantly lower in the HG group compared to both MSP and control groups (pu2009≤u20090.017). There were either weak or no significant statistical correlations between the gut and adipose-related hormones and the modified PUQE scores, BMI, E2, hCG and TSH. Conclusion: Gut-derived metabolic hormones ghrelin, AG and PYY-3 may be involved in the HG pathophysiology.

The efficacy of hysteroscopy for endometrial pathology: the experience of a university clinic on diagnostic accuracy and the comparison with the other methods

Hysteroscopy procedures were retrospectively reviewed in order to reveal the diagnostic accuracy and the efficiency of the diagnostic procedures (transvaginal ultrasonography/TvUsg, saline infusion sonography/SIS, hysteroscopy) for an educational institution in the management of abnormal uterine bleeding. The study was completed in the Department of Gynecology and Obstetrics of the Istanbul University Cerrahpaşa School of Medicine by reviewing the hospital records of the patients on whom hysteroscopy had been performed between 1 January 1997 and 31 December 2002. The records of 385 patients were eligible. The sensitivity, specificity and positive and negative predictive values for saline infusion sonography and hysteroscopy were calculated for specific histopathological diagnoses. The sensitivity and specificity of hysteroscopy for the detection of endometrial polyps were calculated as 83.9 and 63.0%, respectively. The positive predictive value (PPV) was 74.6% and negative predictive value (NPV) 75.2%. The sensitivity and specificity of saline infusion sonography for the detection of endometrial polyps were found to be 87.2 and 33.3%, respectively. PPV was 71.4% and NPV was 57.6% for SIS. The sensitivity and specificity of hysteroscopy for the detection of submucosal leiomyoma were determined to be 80.0 and 92.4%, respectively. PPV was 43.2% and NPV was 98.0%. The sensitivity and specificity of SIS for the detection of submucosal leiomyoma were 71.4 and 92.3%, respectively. PPV was calculated as 52.6% and NPV as 75.2% for SIS. Due to its high diagnostic accuracy and lower complication rate even in the educational setting, we believe that hysteroscopy will retain its place as the “gold standard” procedure for the investigation of endometrial pathology.

Evaluation of Chromosomal Abnormalities and Common Trombophilic Mutations in Cases with Recurrent Miscarriage

BACKGROUNDnRecurrent miscarriage (RM) is a frequent obstetric problem. Its pathophysiology is poorly understood. Infections, genetic, endocrine, anatomic and immunologic problems have been suggested as causes for RM.nnnOBJECTIVEnTo evaluate the frequency of chromosomal abnormalities and 3 common thrombophilic mutations in couples with RM.nnnMETHODSnA retrospective data collection was performed for the results of the cytogenetic analysis of the couples and Methylenetetrahydrofolate Reductase (MTHFR) C677T, Factor V Leiden (FVL) G1691A and Prothrombin (PTm) G20210A mutations of the mother in 142 couples suffering from RM.nnnRESULTSnPrevalence of FVL, MTHFR, and PTm gene mutations were similar between cases shaving 2 or ≥3 abortions (P=0.528; P=0.233; P=0.375). In patients with FVL, MTHFR and PTm gene mutations, the ORs of having ≥3 abortions when compared to having 2 abortions were 1.515 (95% CI: 0.414-5.552), 0.573 (95% CI: 0.228-1.441), and 2.848 (95% CI: 0.355-22.871). All cases with PTm mutation had ≥3 abortions and all abortions occurred between 6-8 gestational weeks.nnnCONCLUSIONnChromosomal abnormalities and thrombophilic mutations (especially PTm) seem to have an important role in RM. Additional larger studies involving investigation of more genes that may have a role in pregnancy are needed to assess this association.

Increased Maternal Serum and Cord Blood Fibronectin Concentrations in Preeclampsia are Associated with Higher Placental Hyaluronic Acid and Hydroxyproline Content

Background. Total or cellular fibronectin (FN) determinations have been used to differentiate between normal and preeclamptic pregnants. The purpose of this study was to examine the relationship between maternal serum FN levels and the extracellular matrix molecule contents of placental tissue, such as FN, hyaluronic acid (HA) and hydroxyproline (HP) levels. Material and Methods. We obtained maternal blood samples and placental tissue samples from healthy (n = 17, controls) and preeclamptic pregnants (n = 29). We also obtained cord blood samples for FN and HA determination from the same patients. FN and HA concentrations in the placenta and maternal and cord blood were measured by and enzyme-linked immunosorbent assay and HP contents in the placenta were measured by a colorimetric assay. Results. FN levels in maternal serum, cord blood, and placenta were significantly higher in preeclamptics than in controls (p<0.001, p<0.001 and p<0.05, respectively). HA concentrations in the cord blood and placenta were found to be elevated in preeclamptics (p<0.05 and p<0.01). Preeclamptics had significantly higher placental HP levels than controls (p<0.001). Similar statistically significant results were obtained when the pregnant subjects classified as nulliparous and multiparous. There was no difference in ECM molecule levels between nulliporous and multiparous women in preeclamptic pregnant group. In regression analysis maternal serum FN levels were correlated with placental HA and HP levels (p<0.01 and p<0.01). There was a positive correlation between cord blood FN and both placental HP (p<001) and HA levels (p<0.01). FN levels in maternal serum, cord blood, and placenta were also negative correlated with fetal birth weight (p<0.01, p<0.05 and p<0.05, respectively). Conclusion. FN in maternal serum, cord blood, and placenta is increased with elevated placental HA and HP levels, probably reflecting placental basement membrane alterations during preeclampsia.

Ultrasound-Guided Hysteroscopic Removal of IUD with Missing Tails in a 15-Weeks' Pregnant Woman

Unexpected pregnancy with an intrauterine device (IUD) in situ is not an uncommon finding in daily practice. It is generally agreed that an IUD should be removed in the first trimester when its tail is visible vaginally. However, because of limited experience and data in the literature, uncertainty exists about the management and technique of IUD removal during pregnancy when the tails are inaccessible on examination, especially in the second trimester. The IUD may be left in situ or removed using a grasping tool under ultrasonographic guidance or by hysteroscopy. Here, we report a case of ultrasound-guided hysteroscopic removal of an IUD with retracted tail in a woman at 15 weeks’ gestation. We believe when the decision is made to remove an IUD, ultrasound-guided hysteroscopy may be a safer option in experienced hands compared with an ultrasound-guided grasping tool, especially during the second trimester.