Ozgur Yeniel

Protective effect of oxytocin on ovarian ischemia-reperfusion injury in rats

Oxytocin (OT), a neurohypophysial nonapeptide, plays dual role as a neurotransmitter/neuromodulator and a hormone. It has also well known protective properties against ischemia/reperfusion organ damage. This study investigated the effect of OT on experimentally induced ovarian torsion/de-torsion ischemia/reperfusion (I/R) injury in rats. Sprague-Dawley rats were assigned to five treatment groups (n=7/group): Group 1, sham-operated; Group 2, torsion; Group 3, 80 IU/kg of OT administration 30 min prior to torsion; Group 4, torsion/de-torsion; and Group 5, torsion followed by 80 IU/kg of OT administration 30 min prior to de-torsion. OT administration significantly decreased the tissue malondialdehyde (MDA) levels in both the torsion and OT group (Group 3), and torsion/de-torsion OT group (Group 5) in comparison with the torsion-only group (Group 2) and torsion/de-torsion group (Group 4). Histopathological finding scores including follicular degeneration, edema, hemorrhage, vascular congestion, and infiltration by inflammatory cells were found to be significantly decreased in the torsion and OT group (Group 3), and torsion/de-torsion OT group (Group 5) when compared with the torsion-only group (Group 2) and torsion/de-torsion group (Group 4). In conclusion, these results, verified with histopathologic evaluation and biochemical assays, suggest a probable protective role for OT in ischemia and I/R injury in rat ovaries.

Effects of Resveratrol on Ovarian Morphology, Plasma Anti-Mullerian Hormone, IGF-1 Levels, and Oxidative Stress Parameters in a Rat Model of Polycystic Ovary Syndrome

Objective: To evaluate the effects of resveratrol in a rat model of polycystic ovarian syndrome (PCOS). Study Design: After PCOS model was formed by subcutaneous dihydrotestosterone pellets, rats were randomly divided into 2 groups. The first group (n = 7) was treated with 1 mL/kg/d isotonic saline and the second group (n = 7) was treated with 10 mg/kg/d resveratrol. Seven rats were taken as controls without any medication. Results: Our results showed (1) significant reduction in the number of antral follicle counts (P < .01); (2) significantly decreased plasma anti-Mullerian hormone and insulin-like growth factor 1 levels (P < .01 and P < .05, respectively); (3) significantly lower superoxide dismutase activity (P < .05); and (4) significantly increased glutathione peroxidase content (P < .01) following resveratrol treatment. Conclusion: Resveratrol appears to be effective in the treatment of PCOS due to its antioxidant properties. Future clinical studies with different dosages might provide useful implementations to our practice.

Restless legs syndrome is related to obstructive sleep apnea symptoms during pregnancy

BackgroundTo investigate the relation between restless legs syndrome (RLS) and obstructive sleep apnea symptoms during pregnancy.MethodsA questionnaire consisting of diagnostic criteria of restless legs syndrome, demographic characteristics, personal behavior, muscle cramps during pregnancy, past medical illnesses, family history of RLS, and the major symptoms of obstructive sleep apnea syndrome was administered during a face-to-face interview. Pregnant women with and without RLS were compared in terms of serum hemoglobin, hematocrit, calcium, phosphor, iron, folate, vitamin B12 levels, and obstructive sleep apnea symptoms.ResultsThere were statistically significant differences between two groups in terms of two of the obstructive sleep apnea symptoms (witnessed apnea and fatigue) (p < 0.01). No statistically significant difference was found with regard to serum calcium, magnesium, iron, hemoglobin, hematocrit, vitamin B12, phosphor, and folate levels; however, there were significant differences in terms of total iron-binding capacity.ConclusionsIncreasing awareness of restless legs syndrome among obstetricians is essential as it might be related to obstructive sleep apnea syndrome, which is associated with adverse pregnancy outcomes.

Octreotide protects ovary against ischemia–reperfusion injury in rats: Evaluation of histological and biochemical parameters

This study investigated the efficacy of octreotide for prevention of ischemia–reperfusion injury in rat ovary.

Vulvar lymphangioma circumscriptum

⁎ Corresponding author. Tel.: +90 5059113736. E-mail address: volkanturan@yahoo.com (V. Turan). Lymphangioma circumscriptum is a benign malformation of inner lymphatic channels that can extend to the dermis, the subcutaneous layers, and rarely the muscle. Although it is frequently seen on the proximal sites of extremities, vulvar and oral mucosal presentation is rare. A 51-year-oldwomanwas referredwith bilateral itching/oozing vulvar lesions and bilateral leg edema. Upon vulvar examination, groups of vesicleswere found to be infected (Fig.1). Therewasnohistory of sexually transmitted disease, filariasis, tuberculosis, trauma, or Crohns disease. Histologic examination revealed multiple dilated lymphatic vessels containing mostly of fibrin, with a small number of erythrocytes, in the papillary dermis. The vessels were lined by a thin wall comprising endothelial cells and an inflammatory infiltrate. Acanthosis and papillomatosis were present in the epidermis. The patient refused surgical removal andwas treatedmedically. Subsequently, the pruritus and oozing regressed but the vulvar mass remained. There are 3 types of lymphangioma—circumscriptum, cavernous, and cystic. The most common type is lymphangioma circumscriptum, which is frequently seen in females and usually develops as congenital and unilateral lesions. This disorder is characterized by a localized group of thin-walled vesicles, and the diameter of the lesions—which are filled with translucent fluid—ranges from 1 mm to 5 mm. Lymphangioma circumscriptum can be further characterized as classic or localized. The former is more common, presenting at birth or before 30 years of age, with a lesion diameter of more than 1 cm. The latter is not age specific and the lesion diameter is less than 1 cm. Risk factors for acquired lymphangioma circumscriptum are radical surgery, genital tuberculosis, pelvic radiation, and Crohns disease. In the differential diagnosis of vulvar lymphangioma circumscriptum, infections such as herpes zoster, molluscum contagiosum, genital warts, angiomyofibroblastoma, and aggressive angiomyxoma must be considered; furthermore, biopsy of the lesion is required for diagnosis. Two cases of lymphangiosarcoma arising from lymphangioma circumscriptum have been reported [1,2]. In both cases, the pre-existing lesion was exposed to extensive X-ray therapy, indicating that radiation therapy for lymphangiomas should be avoided. Emanuel et al. [2] reported a Dabska tumor with lymphangioma circumscriptum; during a follow-up of 9 years, subsequent to a full excision, the lymphangioma circumscriptum recurred, but without evidence of Dabska tumor recurrence ormetastasis. Short and Peacock [3] reported a case of lymphangioma circumscriptum involving the vulvar and perianal areas, which recurred after surgery and seemed to predispose Fig. 1. Vulvar lymphangioma circumscriptum in a 51-year-old patient.

Incomplete androgen insensitivity (Reifenstein syndrome) - a case report

We report a 20 year old case of partial androgen insensitivity syndrome, referred to our clinic with complaints concerning external genital organs and left undescended testicle. The phenotypically male case was first evaluated for secondary sex development. Axillary hair was scanty and no pubic hair was found. There was no breast development. In the gynecological examination, the clitoris was hypertrophic (4.6 cm) and a blind vagina with intact hymen was seen. Abdominopelvic ultrasonography revealed the absence of an uterus and adnexes which was supported by magnetic resonance imaging (MRI). There was a palpable mass in the left inguinal canal (cryptorchism), seen as atrophic tissue under the skin in MRI. Although the other testis was in the labioscrotal fold, it was atrophic. The Karyotype was 46 XY after genetic investigation.

The prediction of myometrial infiltration by three-dimensional ultrasonography in patients with endometrial carcinoma: a validation study from Ege University Hospital.

AIM To predict the myometrial invasion with three-dimensional (3D) ultrasonography in a cohort of patients with endometrial carcinoma by a previously described technique. MATERIAL AND METHODS The moyometrial infiltration was evaluated by 3D ultrasonography before surgery in 54 patients with endometrial carcinoma. After scanning the whole uterus by ultrasonography, three perpendicular planes were identified to find the shortest myometrial tumor-free distance to serosa (TDS) by examining the lateral, anterior, posterior, and fundal parts of the myometrium. Myometrial infiltration was also estimated by the subjective impression of the examiner. The reference standards consist of myometrial infiltration and TDS which are measured by an experienced pathologist. RESULTS Forty-five patients (age range 45-86 years) were included for the final analysis. Myometrial invasion was ˂50% in 36 and ≥50% in 9 cases at histologic sections. The TDS which is measured with 3D ultrasonography was positively correlated with histologically measured TDS (r=0.474, p=0.001). The best cut-off value for ultrasonographically measured TDS was 9 mm with a sensitivity of 89%, specificity of 61%, positive predictive value of 36%, and negative predictive value of 96%. Subjective impression has a sensitivity of 100%, specificity of 88%, positive predictive value of 69%, and negative predictive value of 100%. Cervical involvement was correctly identified in all 6 cases by subjective impression. CONCLUSION This validation study confirms the 3D ultrasonography as a valuable tool for the evaluation of myometrial infiltration in patients with endometrial carcinoma.

Pregnancy-associated plasma protein A gene polymorphism in pregnant women with preeclampsia and intrauterine growth restriction

Preeclampsia (PE) and intrauterine growth restriction (IUGR) are still among the most commonly researched titles in perinatology. To shed light on their etiology, new prevention and treatment strategies are the major targets of studies. In this study, we aimed to investigate the relation between gene polymorphism of one of the products of trophoblasts, pregnancy‐associated plasma protein A (PAPP‐A) and PE/IUGR.A total of 147 women (IUGR, n = 61; PE, n = 47; IUGR + PE, n = 37; eclampsia, n = 2) were compared with 103 controls with respect to the sequencing of exon 14 of the PAPP‐A gene to detect (rs7020782) polymorphism. Genotypes “AA” and “CC” were given in the event of A or C allele homozygosity and “AC” in A and C allele heterozygosity. Our findings revealed that the rate of AA, CC homozygotes, and AC heterozygotes did not differ between groups. Moreover, there was no difference in the distribution of PAPP‐A genotypes among the patients with IUGR, PE, IUGR + PE, or eclampsia. Finally, birth weight, rate of the presence of proteinuria, and total protein excretion on 24‐hour urine were similar in the subgroups of AA, AC, and CC genotypes in the study group. Our study demonstrated no association between PAPP‐A gene rs7020782 polymorphism and PE/IUGR.

Increased stem cell marker expressions during the peri-implantation period in the rat endometrium: constructive role of exogenous zinc and/or progesterone.

Background. The aim of this study is to determine the effects of zinc and/or progesterone via the expression of αvβ5 integrins and Vitronectins and embryonic stem cell markers during the peri-implantation period. Methods. Four experimental groups were organized. All subjects were mated with males of the same strain to induce pregnancy; after 5 days, zinc and/or progesterone were administered. Blood levels of zinc and progesterone were determined on the sixth day and endometrial tissues were obtained in order to evaluate the immunohistochemical expression of integrins and embryonic stem cell markers. Results. The αvβ5 integrin and vitronectin expression increased in the zinc group compared with the control group and no difference in the progesterone group and zinc + progesterone group. Expression of Klf-4, Sox-2, and c-Myc was found to be increased in the zinc group compared to controls, while no difference was determined between the progesterone, zinc + progesterone, and control groups. Distinctively, expression of the embryonic stem cell marker Oct-4 was increased in all of the experimental groups. Conclusions. Expression of αvβ5 integrin, vitronectin, and embryonic stem cell markers might be increased by the administration of zinc. Our results suggest that zinc could be useful in the induction of implantation rates.

Assessment of Pregnancy Outcomes with Uterine Leiomyomas Larger Than 10 cm; Antepartum and Postpartum Complications

Fig. 1. A 37-year-old patient underwent hysterectomy in the postpartum period because of impaired drainage of the uterus caused by a submucosal component of an infected leiomyoma. 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 U N C O R R E We have found that the increased number of premature deliveries and cesarean deliveries, as well as the increase in postpartum bleeding and infections such as endometritis, may be caused by large uterine myomas. Sonograms in patients with fibroids were reviewed between 2007 and 2009 in the Department of Obstetrics and Gynecology at Ege University to determine the number of fibroids, their sizes, their locations, and relationship with the placenta. Cesarean ratio, preterm loss of pregnancy, and the incidence of postpartum complications were also evaluated. Our study population consisted of 21 women with uterine leiomyomas larger than 10 cm (12 subserous, 8 intramural, and 1 submucosal). The median age of patients was 34.6 years. Among patients with fibroids, 2 of the cases resulted from assisted conception. Tocolytic treatment was required in 47% of the pregnancies. Retroplacental localization of myomas was explored in 6 cases, and preterm delivery occurred in 2 of them. Cesarean section had to be performed because of preterm membrane rupture (9%) and malposition (29%) in 8 patients. Only 5 patients attempted vaginal delivery (23%), although in recent studies, median vaginal delivery rates range from 49% to 61%. Multiple myomas were identified in 66% of pregnant women and were associated with increased risk of malposition, breech presentation, and severe postpartum bleeding when compared to published articles including women with anatomically normal uteruses. Myomectomy at the time of cesarean delivery was performed in 33% of patients only for pedinculated subserosal myomas. In 1 case, postpartum fever occurred 2 weeks subsequent to cesarean delivery. The patient did not respond to intravenous antibiotic therapy and intracavity fluid collection, which was explored