Sabahattin Altunyurt

Hydroxyurea treatment for chronic myeloid leukemia during pregnancy

The incidence of chronic myeloid leukemia (CML) associated with pregnancy is estimated to be 1/75,000. Several types of treatments have been used for CML during pregnancy. These are cytotoxic drugs, alpha-interferone, splenic irradiation (with shielding of the uterus) and leukapheresis. Hydroxyurea is a cytotoxic drug that inhibits the synthesis of DNA and can be used both in the chronic and accelerated phases of CML (1). We present a woman with CML who has successfully given birth to a live baby after treatment with hydroxyurea.

A randomized controlled trial of coil removal prior to treatment of pelvic inflammatory disease

OBJECTIVE To evaluate the effects of removing coils on the treatment of mild and moderate pelvic inflammatory disease (PID). METHODS Of 126 women who had mild to moderate PID during coil usage, 60 were treated following coil removal and 66 without. Clinical symptoms, findings of gynecologic examination, erythrocyte sedimentation rates (mm/h), leukocyte counts (mm(-3)) were recorded before and after treatment and recovery rates of symptoms and findings were compared with Chi-square and Fishers absolute Chi-square tests. Students t-test was used for the comparison of mean sedimentation rates and leukocyte counts. RESULTS Recovery rates of pelvic pain, purulent vaginal discharge, dysuria/frequency and dyspareunia and clinical improvements in abdominal and cervical tenderness were significantly higher (P<0.05) in the coil removed group. CONCLUSIONS Removing the coil before medical therapy, increases the rates of clinical improvement in mild to moderate PID.

Different maternal serum hCG levels in pregnant women with female and male fetuses: does fetal hypophyseal - adrenal - gonadal axis play a role?

Abstract Fetal gender has a significant effect on maternal and cord blood hCG levels, particularly during the last trimester of the pregnancy. However, the reason for this difference is obscure. The aim of the present study was to investigate whether term fetal hypophyseal - adrenal - gonadal axis differs between female and male fetuses thereby causing different hCG levels. The study consisted of 60 women with singleton pregnancies in the third trimester. Thirtyone pregnant women were carrying female fetuses, whereas 29 were carrying male. Human chorionic gonadotropin (hCG), estradiol, progesterone, testosterone, dehydro-epiandrosteron-sulfate (DHEAS), prolactin and growth hormone levels were measured in maternal serum and umbilical cord blood. In female bearing pregnancies maternal and cord blood hCG levels were significantly higher than in male bearing pregnancies (P<0.001). Maternal and cord blood estradiol, progesterone, testosterone, DHEAS, prolactin and growth hormone levels were not significantly different in either fetal gender. When all patients were considered as a group there were no correlations between fetal hCG levels and any of the measured hormones. Term fetal DHEAS, estrogen, progesterone, testosterone, growth hormone and prolactin levels do not contribute to different hCG levels between female and male fetuses. It is possible that fetal hypophyseal-adrenal - gonadal axis does not play a central role as the cause of different hCG levels.

Expression of IGR-IR and VEGF and Trophoblastic Proliferative Activity in Placentas from Pregnancies Complicated by IUGR

Intrauterine growth retardation (IUGR) is recognized as an important cause of low birth weight and elective preterm delivery. IUGR is associated with multiple causative factors, including placental dysfunction. The aim of this prospective study was to investigate the role of trophoblastic proliferative activity and type I insuline-like growth factor receptor (IGF-IR) and vascular endothelial growth factor (VEGF) expressions in the pathogenesis of IUGR. Immunohistochemistry using VEGF, IGF-IR, and Ki-67 antibodies was performed on formalin-fixed placental tissues of third-trimester pregnancies complicated by IUGR (n = 19) and pregnancies with appropriately grown fetuses (n = 27). In addition, histopathological examination of the placentas was performed, and histological findings were categorized into three groups: utero-placental vascular pathologies (UPVP), coagulation-related pathologies, and chronic inflammation. Statistical analysis revealed that villous trophoblastic IGF-IR immunostaining was significantly weaker in placentas with IUGR (p < 0.001), whereas trophoblastic Ki-67 proliferative index and VEGF immunoscoring did not show any significant difference. Histologically, UPVP and chronic inflammation were significant findings in placentas with IUGR (p = 0.04 and p = 0.04, respectively). In addition, placentas were significantly smaller in the IUGR group (p < 0.001). We conclude that villous trophoblastic IGF-IR expression may play a significant role in the pathogenesis of IUGR, and histopathological examination of placentas in pregnancies complicated by IUGR may yield significant findings. In contrast, based on our findings, trophoblastic proliferation and VEGF expression are unlikely to be significant parameters in the pathogenesis of IUGR.

Effects of HRT on serum levels of IGF-I in postmenopausal women

OBJECTIVES It is thought that insulin-like growth factor-1 (IGF-I) stimulates bone formation. We aimed to determine the effects of oral and transdermal hormone replacement therapy (HRT) on serum IGF-I levels and to investigate the effects of basal IGF-I levels on the levels obtained at the end of the therapy. METHODS Sixty-six postmenopausal women were administered either oral (n=44) or transdermal (n=22) HRT for 6 months. Serum levels of IGF-I were determined before and after HRT in all subjects. Groups were divided into two subgroups according to the median value of serum IGF-I levels (basal IGF-I levels above or below the median value). The increase of IGF-I levels after HRT were calculated (%) for all women. Mean increases of subgroups were compared. Furthermore, study groups were divided into three subgroups according to the changing of IGF-I (increase>25%, between 25% increase and 25% decrease and decrease>25%). Mean basal IGF-I levels of these three subgroups were compared. RESULTS Mean serum levels of IGF-I before and after HRT were not significantly different in both oral and transdermal groups (P>0.05). Mean increases of IGF-I after HRT for the patients with low basal IGF-I levels, were 65% in oral and 77% in transdermal groups. However, mean increase of the patients with high basal IGF-I levels were -8 and -16% respectively. Moreover, mean level of basal IGF-I was significantly low in women who have more than a 25% increase after HRT (P<0.05). CONCLUSION HRT seems to significantly increase serum levels of IGF-I in postmenopausal women with low basal levels of IGF-I.

Value of maternal procalcitonin levels for predicting subclinical intra-amniotic infection in preterm premature rupture of membranes.

To determine whether procalcitonin (ProCT) levels can be used to predict subclinical intra‐amniotic infection by comparing maternal plasma levels in preterm premature rupture of membranes (PPROM) and premature rupture of membranes (PROM) at term with the levels in healthy pregnant women.

Neonatal outcome of fetuses receiving intrauterine transfusion for severe hydrops complicated by Rhesus hemolytic disease

To evaluate neonatal outcomes among a homogeneous group of fetuses with severe hydrops treated with intrauterine transfusion (IUT).

Does fetal gender affect cytotrophoblast cell activity in the human term placenta? Correlation with maternal hCG levels

Background.  Pregnant women with female fetuses have higher maternal serum human chorionic gonadotropin (hCG) levels than pregnant women with male fetuses. Ki‐67, a cell proliferation and activity marker, is confined mostly in the nuclei of villous cytotrophoblasts of the human placenta. In this study, we examined the effect of fetal gender on the cytotrophoblast cell activity in human term placenta, with special regard to maternal serum and cord blood hCG levels.

The values of urinary NTx in postmenopausal women undergoing HRT; the role of additional alendronate therapy

OBJECTIVE To determine the changes in levels of urinary NTx at the end of the 6th month of oral and transdermal hormone replacement therapy (HRT) and the effects of additional alendronate therapy for osteoporotic women. METHOD Of 66 postmenopausal women 23 were treated with oral estradiol+norethisterone acetate (E+P), and 22 were treated with transdermal estradiol+norethisterone acetate. The third group consisted of 21 women with osteoporosis (bone mineral density < 100 mg/cm(3)) and treated with oral E+P plus alendronate 10 mg/day. RESULT Significant decreases of urinary NTx levels were seen after HRT in all study groups (P < 0.05). But the decline of NTx levels was not different between the oral and transdermal HRT groups (P > 0.05). There was no additional decrease in the levels of NTx with alendronate therapy (P > 0.05) but NTx excretion diminished more in patients with high baseline levels. CONCLUSION The decline of NTx at the end of the 6th month of HRT reflects the decrease of bone resorption and it is not related to the route of administration.

Termination of pregnancy for fetal abnormalities: main arguments and a decision-tree model.

By looking through our ethical committee cases, we demonstrate the main arguments we use for making a judgment in face of fetal abnormalities. Our decision making model is a simplified algorithm of the arguments and concepts we use in scientific‐ethic discussion.