Ozlem Dural

Role of inflammatory mediators in patients with recurrent pregnancy loss

OBJECTIVE To examine interleukin-12 (IL-12), IL-18, IFN-γ, intracellular adhesion molecule-1 (ICAM-1), leukemia inhibitory factor (LIF), and migration inhibitory factor (MIF) levels in precisely-timed blood and endometrial tissue samples from women with idiopathic recurrent pregnancy loss (RPL). DESIGN Case-control study. SETTING University hospital. PATIENT(S) Twenty-one women with RPL and 20 women with proven fertility (controls). INTERVENTION(S) Primary endometrial cells and blood samples during the midsecretory phase (days 19-23). MAIN OUTCOME MEASURE(S) Detection of IL-12, IL-18, IFN-γ, ICAM-1, LIF, and MIF via enzyme-linked immunosorbent assay in both blood and endometrial tissue samples. RESULT(S) The blood and tissue levels of IL-12, IL-18, and IFN-γ were statistically significantly higher, and the blood and tissue levels of LIF and MIF were statistically significantly lower in patients with RPL. Only the level of tissue ICAM-1 was higher in patients with RPL. There was a strong correlation between blood and tissue level measurements of IL-12, IL-18, LIF, and MIF. CONCLUSION(S) Our findings support the hypothesis that inflammatory processes may contribute to pregnancy loss, possibly through their role in implantation. We found that blood and tissue levels of IL-18, LIF, and MIF, and tissue levels of IL-12, IFN-γ, and ICAM-1 have statistically significant prognostic relevance.

Stage-Related Outcome after Fetoscopic Laser Ablation in Twin-to-Twin Transfusion Syndrome

Aim: To review the perinatal outcome of twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser coagulation in a developing country with detailed analysis according to the stage of the syndrome. Methods: This was a retrospective study of 85 TTTS cases treated with fetoscopic laser coagulation at the Fetal Diagnosis and Treatment Unit of Istanbul Faculty of Medicine between January 2006 and March 2013. Results: The surgical failure rate was 5.8% (5/85). Among all the cases of the total cohort, only 1 fetus survived in 27 pregnancies (31.8%), and both fetuses survived in 22 pregnancies (25.9%). In 49 pregnancies (57.6%) at least one fetus survived at the end of the neonatal period. The overall survival and live birth rates were 41.8% (71/170) and 56.4% (96/170), respectively, and they significantly decreased as the stage of disease increased. Delivery occurred before 32 weeks of gestation in 54 (63.5%) pregnancies. Logistic regression analysis showed that gestational age at delivery was the only independent factor, and the risk of nonsurvival significantly decreased with increasing age. Conclusion: Based on our experience, the outcome of fetoscopic laser coagulation of the placental anastomoses for TTTS became worse as the Quintero stage of the disease advanced.

Bipolar Cord Coagulation in the Management of Complicated Monochorionic Twin Pregnancies

Aim: To report our experience in selective termination of monochorionic twin pregnancies with bipolar cord coagulation and to analyze the pregnancy outcomes and complications based on the indication of the procedure. Methods: This is a retrospective study of 71 complicated monochorionic pregnancies treated with bipolar cord coagulation between August 2006 and March 2013. Results: The rates of live birth and survival up to 28 days after birth were 73.2% (52/71) and 63.4% (45/71), respectively. The highest rates of survival up to 28 days after birth were in the procedures with an indication of selective intrauterine growth restriction, while the lowest rates of survival were recorded with the indication of twin reversed arterial perfusion sequence and discordant anomaly. However, there were no statistically significant differences in the live birth and perinatal survival rates among the four different groups of indications. Conclusion: The survival rate of bipolar cord coagulation in complicated monochorionic pregnancies such as twin-to-twin transfusion syndrome, twin reversed arterial perfusion sequence, selective intrauterine growth restriction and discordant anomaly was 63% in our series.

Detection Rate of Trisomy 21 in Fetuses with Isolated and Non-Isolated Aberrant Right Subclavian Artery

Objective: The purpose of this study was to determine the frequency of chromosomal anomalies among the fetuses with isolated and non-isolated aberrant right subclavian artery (ARSA), and to evaluate the sonographic findings associated with ARSA. Methods: This is a retrospective study conducted during the period between January 2008 and December 2012 at the maternal fetal medicine units of three different referral centers. Results: Among the 148 cases of ARSA, 98 were isolated and 50 were associated with cardiac anomalies, extracardiac malformations or soft markers. Trisomy 21 was the only chromosomal anomaly with a prevalence of 6.8% (10/148). The corresponding rate was 6.1% (6/98) and 8% (4/50) for isolated and non-isolated ARSA, respectively. Cardiac anomalies, extracardiac findings and soft markers were detected in 5.4% (8), 10.8% (16) and 24.3% (36) of cases, respectively. Among the 10 fetuses with trisomy 21, 6 were isolated, 4 were associated with soft markers, 2 were associated with fetal growth restriction and 1 was associated with hydrops fetalis. Cardiac anomalies were not observed in any of these fetuses. Conclusion: The prenatal diagnosis of ARSA should prompt meticulous anatomic survey, and karyotype analysis might be offered even in the absence of associated findings.

Recurrent pyoderma gangrenosum after cesarean delivery successfully treated with vacuum‐assisted closure and split thickness skin graft: A case report

We describe the case of a 32‐year‐old woman (gravidity: 4; parity: 2) who underwent cesarean delivery at 37 weeks of gestation and presented with dehiscence and infection of the surgical wound. She had a history of wound infection and dehiscence of the scar from a previous cesarean delivery and dehiscence in the dorsal side of her left hand at the site of intravenous catheterization. The patient was initially diagnosed with a skin infection and later with pyoderma gangrenosum. No evidence of any underlying disease was found. The lesions were treated with systemic corticosteroids and azathioprine, but the lesions were unresponsive to treatment. This complicated case of pyoderma gangrenosum after cesarean delivery, which initially mimicked wound infection, was successfully treated with vacuum‐assisted closure and split‐thickness skin graft. This synergistic approach with vacuum‐assisted closure could be an important treatment option for aggressive and slow‐healing lesions.

Apoptosis through regulation of Bcl-2, Bax and Mcl-1 expressions in endometriotic cyst lesions and the endometrium of women with moderate to severe endometriosis.

The aim of the study was to evaluate apoptosis through regulation of Bcl-2, Bax and Mcl-1 proteins by comparing their expressions in endometriotic cyst lesions and the endometrium of the patients with moderate to severe endometriosis. This is a cross-sectional study of 30 women in reproductive age with a clinical or sonographic suspicion of endometrioma, who underwent laparoscopy. Bcl-2 expression was positive both in cystic endometriotic lesions and endometrium, and its expression was significantly reduced in the cystic endometriotic lesions (p < 0.0001). There was a significant difference in Bcl-2 expression between cystic endometriotic stromal cells and endometrial stromal cells (p < 0.0001). Bax expression was positive both in cystic endometriotic lesions and endometrium, and its expression was significantly lower in the endometrium (p < 0.0001). There was a significant difference in Bax expression between cystic endometriotic stromal cells and endometrial stromal cells (p = 0.03). Mcl-1 expression was positive both in cystic endometriotic lesions and endometrium, and its expression was significantly lower in the cystic endometriotic lesions (p = 0.003). Apoptosis may play a role in the pathophysiology of endometriosis by potentially contributing to the survival of regurgitating endometrial cells in the peritoneal cavity.

Effect of infertility on quality of life of women: a validation study of the Turkish FertiQoL.

Abstract The fertility quality of life (FertiQoL) measure specifically evaluates the impact of fertility problems in various life areas. The aim of this study was to examine the relationship between FertiQoL and the hospital anxiety and depression scale (HADS) in the Turkish population. All female patients who underwent various fertility treatments in our infertility clinic from May 2011 to May 2014 were approached to participate in the study and 389 completed the questionnaires. Our results showed that the four core scales of the FertiQoL measure had a Cronbach’s α value that was between 0.70 and 0.89. Two scales (anxiety and depression) of HADS both had a Cronbach’s α value of 0.80. These values present a reliable usage of FertiQoL and HADS measures (α > 0.60). Significant negative correlations were found between the FertiQoL scales and HADS scales, ranging from −0.27 (between relational scale of FertiQoL and anxiety scale of HADS) to −0.65 (between mind–body scale of FertiQoL and depression scale of HADS). The results of this study provide supportive data to confirm that the Turkish version of FertiQol can accurately evaluate QoL in women who seek fertility treatment in Turkey.

Reproductive Outcomes of Hysteroscopic Septoplasty Techniques.

Background and Objectives: Since little is known regarding the correlation between different techniques used during hysteroscopic septoplasty and reproductives outcomes, we amied to evaluate the results of two different techniques of hysteroscopic septoplasty (HS). Methods: Data were retrospectively reviewed on 49 patients who underwent HS for symptomatic septate uterus from January 1, 2010, through April 30, 2014. The patients were divided into 2 groups based on the HS technique used. Group I consisted of 27 patients who underwent HS by monopolar hook cautery with the operating hysteroscope. Group II consisted of 22 patients who had the procedure performed with scissors and guided by an office hysteroscope. All the procedures in the both groups were performed in the operating room under general anesthesia. Pregnancy outcomes within the first year after HS for both groups were evaluated. Results: Reproductive outcomes were obtained from 44 patients who attempted to conceive after HS within the first year. In the 25 patients in group I, 23 had pregnancies, of which 15 (65.2%) continued to term, 3 (13%) ended in a preterm live birth, and 5 (21.7%) ended in loss of pregnancy (abortion). In the 19 patients in group II, there were 17 pregnancies, of which 11 (64.7%) continued to term, 2 (11.7%) ended in a preterm live birth, and 4 (23.5%) ended in first- or second-trimester abortion. The overall live-birth rate was 78.2% in group I and 76.4% in group II (P = .85). Conclusions: Our data show that the rates of pregnancy that reach term and overall rates of live births are similar between the 2 HS techniques. Additional studies are needed to evaluate the impact of the techniques on reproductive outcomes.

Prenatal Diagnosis of a Liver Cavernous Hemangioma

Liver tumors seldom occur in the perinatal period. Hepatic hemangiomas are the most common tumors of the liver diagnosed during fetal and neonatal life. The diagnosis can be suspected antenatally by ultrasound and MR scan. The differential diagnosis is often challenging. While small hepatic hemangiomas are usually asymptomatic, large tumors can lead to complications such as high-output congestive heart failure, consumptive thrombocytopenic coagulopathy and hemorrhage after tumor rupture. We describe a case of hepatic hemangioma presenting as a solid abdominal mass with several cystic areas on an obstetric ultrasound and report on the contribition fetal MR imaging to the diagnosis.

Metastatic gastric signet-ring cell carcinoma: A rare cause of acute appendicitis

We report a 32-year-old patient who underwent laparoscopy with classical symptoms and signs of acute appendicitis. An inflamed, edematous and non-perforated appendix, also a large amount gelatinous ascites, omental and peritoneal implants were seen. Appendectomy was performed and multiple biopsies were taken from omentum and peritoneum for definitive diagnosis. Histopathologic diagnosis was a metastatic gastric signet-ring cell carcinoma (GSRCC) involving appendix and other specimens. A flat lesion involving corpus to antrum was diagnosed by gastroscopy and GSRCC was verified histopathologically in a tertiary centre and the case evaluated as stage IV gastric carcinoma. This case with no sign of gastric cancer was presented as an acute appendicitis. Metastatic carcinoma to the appendix, causing acute appendicitis is extremely rare in clinical practice and usually associated with high morbidity and mortality.