Özgür Bige

Influence of follicular fluid GDF9 and BMP15 on embryo quality

OBJECTIVE To evaluate the association between follicular fluid levels of propeptide and mature forms of growth differentiation factor (GDF) 9 and bone morphogenetic protein (BMP) 15 with subsequent oocyte and embryo quality. DESIGN Prospective clinical study. SETTING University hospital. PATIENT(S) Eighty-one infertile patients who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). INTERVENTION(S) The expression levels of the propeptide and mature forms of follicular fluid GDF9 and BMP15 were determined by western blot analysis. The levels of follicular fluid hormones (FSH, E2, and P) were measured with automated chemiluminescent enzyme immunoassays. MAIN OUTCOME MEASURE(S) The relationships between the levels of GDF9 and BMP15, hormones, oocyte maturation, and embryo quality. RESULT(S) Mature GDF9 levels were significantly correlated with the nuclear maturation of oocytes. The mean mature GDF9 level was 4.87±0.60 in the high-embryo-quality group and 1.45±0.81 in the low-embryo-quality group. There were no statistically significant differences in embryo quality among the patients regarding propeptide GDF9 and BMP15 expression status. There was a negative correlation between follicular fluid levels of P and the mature form of GDF9. CONCLUSION(S) Higher mature GDF9 levels in the follicular fluid were significantly correlated with oocyte nuclear maturation and embryo quality.

Collision tumor: serous cystadenocarcinoma and dermoid cyst in the same ovary

IntroductionCollision tumor means the coexistence of two adjacent, but histologically distinct tumors without histologic admixture in the same tissue or organ. Collision tumors involving ovaries are extremely rare.CaseWe present a case of 45-year-old parous woman with a left dermoid cyst, with unusual imaging findings, massive ascites and peritoneal carcinomatosis. The patient underwent cytoreductive surgery. The histopathology revealed a collision tumor consisting of an invasive serous cystadenocarcinoma and a dermoid cyst.

Analysis of perinatal outcome by combination of first trimester maternal plasma homocysteine with uterine artery Doppler velocimetry

To analyse the pregnancy outcome by combining plasma homocysteine with uterine artery Doppler velocimetry at 11 to 14 weeks of gestation.

Second primary gynecologic cancers after breast cancer in Turkish women.

Objectives: To determine the risk of gynecologic cancers among women with previous breast cancer. Methods: A population-based longitudinal study was conducted using the Izmir cancer registry centers data on 6356 breast cancer patients diagnosed in the period 1992 to 2006. Standardized incidence ratios (SIR) and absolute excess risks (AER) were calculated. Results: In total, 88 (1.3%) women developed a second primary cancer (other than second primary breast cancers) versus 49.8 expected (SIR, 1.76; 95% confidence interval [CI], 1.43-2.2; AER, 86.9/100.000 patients/y) and 33 of 88 (37.5%) women developed gynecologic cancer (21 endometrial, 8 ovarian, and 4 cervical) versus 8.8 expected (SIR, 4.03; 95% CI, 2.8-5.7; AER, 48.2/100.000 patients/y). High SIR and AER were observed for uterine (SIR,2.2; 95% CI, 1.5-2.7; AER, 35/100.000 patients/y), ovarian (SIR, 3.63; 95% CI, 1.6-7.2; AER, 12.2/100.000 patients/y), and cervical cancer (SIR, 1.68 95% CI: 0.46-4.3; AER, 2.2/100,000 patients/y). Conclusions: Our data show that women with previous breast cancer have an elevated risk of developing a second primary gynecologic cancer compared with the general population. These patients should be followed up frequently.

Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study

OBJECTIVE To compare the results of total laparoscopic hysterectomy and total abdominal hysterectomy in morbidly obese women with early stage endometrial cancer. MATERIAL AND METHODS This prospective study was conducted on 140 morbidly obese women with body mass indices ≥35 kg/m(2) and presenting with clinical stage 1 endometrial cancer. The patients underwent total laparoscopic hysterectomy (n=70) or total abdominal hysterectomy (n=70), bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and peritoneal washing. Age, parity, menopausal status, weight, height, medical problems, history of previous laparotomy, surgical procedure, operative time, estimated amount of blood loss, preoperative hematocrit, postoperative hematocrit, operative complications, conversion to laparotomy, need for intraoperative or postoperative blood transfusion, intraoperative and postoperative complications, secondary surgery, tumor stage, grade, histology, number of recovered lymph nodes, and visual pain scores of the patients were recorded. RESULTS Postoperative complications were significantly higher in the laparotomy group. Hospital stay in the laparoscopy group was significantly lower than that in the laparotomy group. The visual pain scores were significantly higher in the laparotomy group on the first, second, and third postoperative days and on the day of discharge from the hospital. Resuming activity took a significantly longer time in the laparotomy group (34.70 days) than in the laparoscopic group (17.89 days). CONCLUSION With the availability of skilled endoscopic surgeons, most obese women with early stage endometrial cancer can be safely managed by performing laparoscopy with an excellent surgical outcome, shorter hospitalization, less postoperative pain, and faster resumption of full activity.

Prospective comparison of tissue trauma after laparoscopic hysterectomy types with retroperitoneal lateral transsection of uterine vessels using ligasure and abdominal hysterectomy

ObjectiveThe aim of this study was to evaluate the level of tissue trauma after laparoscopic and total laparoscopic hysterectomy with retroperitoneal lateral transsection of uterine vessels using ligasure as compared with abdominal hysterectomy.Study designA total of 45 women with various indications for hysterectomy were randomized into laparoscopic hysterectomy, total laparoscopic hysterectomy and abdominal hysterectomy. Laparoscopic and total laparoscopic hysterectomy with retroperitoneal lateral transsection of uterine vessels was performed by four-puncture laparoscopy and pre-, postoperative and postoperative 24th hour levels of interleukin-6 (IL-6) and C-reactive protein (CRP), the mean operative time, drop in hemoglobin concentration, weight of removed uterus, VAS scores, hospitalization period and major and minor operative complications were analyzed prospectively.ResultsCRP and IL-6 levels were significantly higher in the abdominal hysterectomy group compared to either laparoscopy groups at the postoperative 24th hour. There were no significant differences in the levels of CRP and IL-6 between the two laparoscopy groups. The longest operative times were observed in the total laparoscopic hysterectomy group.ConclusionLaparoscopic surgery causes less tissue trauma than the conventional open surgery; however, we observed no difference between the laparoscopic hysterectomy groups concerning the postoperative inflammatory response. We may prefer laparoscopic hysterectomy instead of total laparoscopic hysterectomy under suitable conditions, since laparoscopic hysterectomy causes the same level of tissue trauma as total laparoscopic hysterectomy, but has the advantage of a significantly shorter operative time. Meanwhile, hysterectomy done by laparoscopy with retroperitoneal lateral transsection of uterine vessels using ligasure is an effective and safe procedure.

Amniotic fluid angiogenin levels are decreased in pregnancies with fetal trisomy 21

Trisomy 21 is the most common chromosomal abnormality among newborns, and it is one of the most important causes of mental retardation in the population (Goshen, 1999). Angiogenin is a 14-kDa, nonglycolized polypeptide with angiogenetic and ribonucleic activities and plays a key role in the complex process of angiogenesis (Shapiro et al., 1986). Large amount of angiogenesis is required for the growth of placenta and development of vascular structures. Angiogenin expression, placental secretion and maternal plasma levels increase between the first trimester and birth. The existence of angiogenin in placental villi and increase in angiogenin levels toward birth point out that its production depends on the developmental stage (Rajeshekhar et al., 2002). Thus, changes in the level of angiogenin during placental development raise the probability of its possible role in the angiogenetic and morphological changes that are required in the placenta for a healthy gestation. Syncytiotrophoblast is a major component of the human placenta, and it plays a leading role in fetal– maternal exchanges and the secretion of pregnancyspecific hormones. In the normal placenta, multinucleated syncytiotrophoblasts are formed by the fusion of mononuclear cytotrophoblasts (Roberts et al., 2000). A defect exists in the formation of syncytiotrophoblasts in the placentas of fetuses with trisomy 21: histopathologic analysis of placentas of trisomy 21 fetuses shows trophoblastic hypoplasia and villus hypovascularity throughout pregnancy (Qureshi et al., 1997). This may lead to a decrease in the production of pregnancyspecific hormones (Massin et al., 2001). Considering the possible role of angiogenin on placental characteristics, the aim of the present study was to explore whether an association existed between Down syndrome and this angiogenetic factor. Therefore, we compared amniotic fluid angiogenin levels of fetuses with normal karyotype and those with trisomy 21. In the Perinatology Division of Department of Obstetrics and Gynecology Clinic at Dokuz Eylül University,

Endometrioma mimicking ovarian cancer with unusual high levels of serum CA 125 and Ca 19-9

Abstract A 35 year-old nulliparous woman was referred to our clinic with left ovarian mass (6x7 cm in size) accompanied by excessive free fluid at pouch of Douglas and elevated levels of serum CA 125 and CA 19-9 as 1061 IU/mL and 896 IU/mL, respectively. Laparotomy was performed with the suspect of ovarian cancer. Left ovarian endometrioma adherent to the sigmoid colon was observed and enuclated. Histopathological examination confirmed the diagnosis of endometrioma. Adnexal mass with free peritoneal fluid and high levels of tumor antigens; CA 125 and CA 19-9 mimicking ovarian cancer has been rarely diagnosed as endometrioma. Keywords: CA 125, CA 19-9, endometriosis Ozet Otuz bes yasinda, nullipar bir kadin adneksial kitle nedeni ile klinigimize sevk edildi. Douglas boslugunda belirgin sivi birikimi ve yuksek CA 125 (1061 IU/mL) ve CA 19-9 (896 IU/mL) seviyeleri ile birlikte 6x7 cm boyutlarinda sol over kitlesi vardi. Over kanseri on tanisi ile laparotomi yapildi. Sol yumurtalikta sigmoid kolona yapisik endometrioma bulundu ve cikartildi. Histopatolojik inceleme endometrioma tanisini dogruladi. Asit ve yuksek CA 125 ve CA 19-9 duzeyleri ile birlikte olan yumurtalik kanserini taklit eden endometrioma nadir saptanan bir durumdur. Anahtar sozcukler: CA 125, CA 19-9, endometrioma

Second trimester cervical ectopic pregnancy treated by conservative surgery.

Cervical ectopic pregnancy, the implantation of a fertilized oocyte distal to the internal cervical os, is a rare condition constituting B/1% of all ectopic pregnancies. All cervical pregnancies beyond 12 weeks have ultimately resulted in hysterectomy. Therefore, hysterectomy is considered as the primary therapy for these circumstances. In this case, we report a 13-week pregnancy that was treated with a combination of medical and conservative surgical treatments.