Selçuk Özden

The Significance of Amniotic Fluid Interleukin‐6 Levels in Preterm Labour

Summary: This study was performed to determine the prevalence of subclinical intraamniotic infection in patients with preterm labour and intact membranes, and to evaluate the significance of interleukin‐6 levels for diagnosis and prognosis of tocolysis failure, amniocentesis‐delivery interval and neonatal mortality and morbidity. Transabdominal amniocentesis was performed on 74 randomly‐selected patients with preterm labour and intact membranes. The prevalence of amniotic fluid infection in this group was found to be 33.7% (25 of 74). The most sensitive test to identify the intraamniotic infection was found to be the measurement of interleukin‐6 level. However the most specific test was confirmed to be Gram staining. Interleukin‐6 level measurement was the best test to correlate with positive amniotic fluid culture and histological chorioamnionitis. Also, interleukin‐6 level measurement had the advantage of predicting preterm delivery risk and neonatal complications compared to the other tests.

The Effects of Vaginal Delivery and Cesarean Section on Bladder Neck Mobility and Stress Urinary Incontinence

Abstract: We investigated the effects of vaginal delivery (VD) and cesarean section (CS) on bladder neck (BN) mobility and genuine stress incontinence (GSI). Of the 230 patients included in the study, 95 had CS, 95 had VD and the remaining 40 continent nulliparous women served as controls. In both the CS and the VD groups 40 women had delivered once, 35 women twice and 20 women three times. Perineal ultrasonography was performed in all patients. Vaginal delivery affects BN mobility and its position more negatively than does CS, and increases its mobility in two directions. The CS group also has similar findings after the third delivery. The GSI rate was not significantly different between the CS and the VD groups, but the VD group had a higher percentage. Our study also shows that BN mobility is associated with GSI compared to the continent controls.

Effects of hormone replacement therapy on mammographic findings.

Abstract. To evaluate the effects of different hormone replacement therapy (HRT) protocols on mammographic findings. One-hundred-eighty-two women in menopause were recruited for this prospective study. Breast examination was performed and four basal mammograms were obtained in all cases. Eighty of the cases received HRT by estrogen only; 40 used combined pills of estrogen plus progestagen sequentially; 44 used combined pills of estrogen plus progestagen continuously; 18 used tibolone. Breast examination and mammography were repeated after 11.6±2.1 months of HRT. Mammographic parenchymal density was found to be increased in all cases (17.6%). This finding was most prominent in the continuous combined estrogen plus progestagen group (25%) and the lowest in the tibolone group (5.5%). The use of estradiol resulted in more increased density than conjugated estrogen. The increase in the mammographic density is related directly with breast tenderness. Hormone replacement therapy is not contraindicated in the cases of breast disease without atypia. The increase in mammographic density was found to be higher in obese women.

A Retrospective Review of Perioperative Complications in 360 Patients who had Burch Colposuspension

EDITORIAL COMMENT: We accepted this paper for publication because it reports a large experience with the Burch colposuspension operation and presents the complications encountered. It also provides a detailed review of the complications reported by others. In this series of 360 patients, 75.8% had an abdominal hysterectomy performed at the time of the Burch colposuspension. Our urogynaecologist reviewer tells us that this is a very high proportion of hysterectomies although there is a body of opinion that believes that a hysterectomy improves the results when the Burch operation is done in the treatment of women with genuine stress incontinence of urine. The incidence of hysterectomy has to be factored in to the data presented in this paper with regard to the complications that followed the operation. N.B.

The Effects of Abdominal Hysterectomy on Bladder Neck and Urinary Incontinence

We assessed the bladder neck (BN) by perineal ultrasonography of 39 patients before and 1 year after hysterectomy, and we compared them with 30 control cases in terms of stress urinary incontinence. We evaluated the BN position and mobility in the downwards and backwards directions. The bladder neck was found to be significantly lower at rest, in the downwards direction, in the postoperative period. The stress position of the BN was not significantly different. Its downwards mobility decreased, but not significantly. There was no significant difference in the location of the BN with respect to the pubis, at rest and during stress, in the backwards direction, between the preoperative and postoperative periods. Backwards mobility of the BN decreased significantly following hysterectomy. Stress incontinence was not significantly different between the study group and the control group after one year. We concluded that hysterectomy did not weaken urethral support and did not increase the rate of stress incontinence.

Significance for fetal outcome of poor prognostic features in fetal heart rate traces with variable decelerations.

Abstract.Objective: To determine the clinical significance of the existence of poor prognostic features in fetal heart rate (FHR) traces with variable decelerations. Study design: This study was prospectively performed on 167 randomly selected women with a singleton pregnancy at term. Ninety-one patients had an FHR trace without pathological features. The remaining 76 women had variable decelerations and their FHR traces were analyzed carefully for the existence of poor prognostic features. Fetal and neonatal outcomes were compared in the normal and variable deceleration groups. Results: There were statistically significant differences between the groups in 1 and 5 minute Apgar scores, fetal heart rate (FHR), umbilical artery blood pH, pCO2; whereas no significant differences were found in the levels of umbilical artery HCO3, pO2. Conclusion: Prolonged deceleration had the highest specificity for 1 minute Apgar score <7,5 minute Apgar score <7 and umbilical artery blood pH<7.20 (95.0%, 96.3%, 97.5%, respectively). Loss of variability during deceleration showed the highest specificity for the same fetal features (66.7%, 72.3%, 63.9%, respectively). All other poor prognostic features had high specificities but low sensitivities.

Predictive value of transvaginal ultrasonography for determining the response to tocolytic therapy in cases with preterm labour

This study was performed prospectively on 144 randomly selected women carrying singleton uncomplicated pregnancies of 20 to 36 gestational weeks and 60 women with preterm labour matched for gestational age to determine the predictive value of transvaginal cervical measurements for evaluation of the response to tocolytic therapy. Cervical length and width and width of the cervical canal were measured and funnelling of internal os of the cervical canal was evaluated by transvaginal ultrasonography in each case. These measurements did not reveal any change depending on the gestational age in the control group. The mean values for cervical length and width, and width of cervical canal were 45.05+/-6.52 mm, 38.75+/-4.11 mm, 7.01+/-2.76 mm, respectively. Mean cervical length+/-standard deviations of the control group were used as cut-off values for the prediction of preterm delivery in the preterm labour group. When the cut-off value of the cervical length was accepted as 38.53 mm (-1 SD of the control group), the sensitivity, specificity, positive and negative predictive values for prediction of preterm delivery were 80.9%, 72.2%, 87.2%, 61.9%, respectively; whereas when this cut-off value was used in combination with the funnelling of the internal cervical os, the sensitivity and negative predictive value decreased to 40.5% and 41.9%, respectively; but the positive predictive value and specificity became 100.0% and 100.0%, respectively.

Comment to “Analysis of 59 cases of emergent peripartum hysterectomies during a 13-year period”

Thanks to Mr. Shukunami for his kind comments. Grand multiparity is a risk factor for emergency peripartum hysterectomy [1]. The risk of uterine rupture and placenta previa due to failure of placental migration increases in grand multiparas, whereas, there is no suggestion about the relationship between atony and grand multiparity. Multiparity and age were not found to be significant risk factors for uterine atony [2, 3]. There is great socioeconomical and educational differences between the west and east of Turkey. Unfortunately, east of Turkey is socioeconomically deprivated and due to failure of family planning studies, birth rate and the grand multiparity rate are higher in this region of Turkey than the west. So, the rate of grand multiparity is higher in Zeteroglu’s study which was performed in the east region of Turkey (14 of 24 women; 58.3%). Our study population resides in the west region of Turkey. There were only four grand multiparas in our study population (6.77%) and only one of them (25%) whose parity was 6 was hysterectomised due to atony. In two cases whose parities were 5 and 11, hysterectomy was performed with the indication of uterine rupture. The last case with the parity of 7 was operated because of excessive bleeding due to placenta previa totalis. So, we could not suggest any association of grand multiparity with postpartum atony and emergency peripartum hysterectomy. In fact, neither Zeteroglu’s nor our study has adequate statistical power to comment on this relationship. This relationship may be investigated by a meta-analysis containing great number of cases with higher statistical power.

Primeri geç saptanan Krukenberg tümörü

Summary: in this paper, a case with Krukenberg tumour of ovary whose primaiy tumour located in stomach was diagnosed lately is discussedin the light of current literature.

Perimenopozal ve postmenopozal hastalarda endometrium kalınlığın önemi

Objective: The aim of this study was to compare endometrial thickness measured by transvaginal ultrasonography and endometrial histopathology results after dilatation and curettage. Material and Method: A retrospective chart review was performed of all peri and postmenopausal women applying to our gynecology and menopause outpatient clinics f rom January 2001 to January 2002. Endometrial thickness measured by transvaginal ultrasonography was compared with endometrial biopsy results. Results: In perimenopausal group, women with malignant biopsy results had greater mean endometrial thickness than women with benign results (15.40 ± 6,87 vs 10.75 ± 6.45, p0.05). Endometrial thickness cutoff value for prediction of endometrial malignancy was found 17 mm in perimenopausal women and 7.8 mm in postmenopausal women. Conclusion: Although endometrial thickness can be used f or prediction of malignancy in peri and postmenopausal women, endometrial biopsy is still choice of diagnostic modality in management of these group of women.