Semih Kaleli

Perinatal and maternal outcomes of fetal macrosomia

OBJECTIVE To determine the perinatal and maternal outcome of the macrosomic infants. STUDY DESIGN A case-control, retrospective study is performed in the Department of Gynecology and Obstetrics, Istanbul University Cerrahpasa Medical Faculty, between 1988-1992. The maternal and neonatal records of infants with birthweight of at least 4000g (n=1000) were reviewed. Another 1000 cases amongst the newborns delivered in the same period between 2500 and 3999g formed the control group. The obstetrical outcome variables of the groups including mode of delivery and the incidence of maternal and perinatal complications were compared. RESULTS A total of 16,112 deliveries occurred during the study period. The rate of macrosomic deliveries was 6.21% and the rate of the deliveries (4500g or heavier) was 1.04%. The mean birthweight of the study group was 4272+/-239 and 3277+/-316g of the control group (P<0.001). While the cesarean section rate was 28.8% for the study group and it was 16.6% for the control group (P<0.001). In the study group, 17 cases of brachial plexus palsy (2.4%), 16 cases of clavicular fracture (2.3%) and one case of humeral fracture were observed (P<0.001). The rate of perinatal mortality was 0.8% in the study group. No perinatal mortality was recorded in the control group. There were 14 cases (1.4%)of asphyxia related to delivery in the study group (P<0.01). The rate of maternal complications, were significantly higher in the study group (P<0.01). CONCLUSION The macrosomic infants are in increased risk for birth trauma and asphyxia. The risk of birth trauma for the infants weighing 4500g or more is even greater.

Apoptosis in the placenta of pregnancies complicated with IUGR

Objective: In this study we have investigated the presence of apoptosis in the placental tissue of pregnancies complicated with intra‐uterine growth restriction (IUGR). Method: Placental samples were obtained from 22 normal third trimester pregnancies and 20 pregnancies complicated with IUGR. The criteria for fetal growth impairment were clinical evidence of sub‐optimal growth, ultrasonographic demonstration of deviation from normal percentiles of growth and birth weight under 10th percentile. Terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate nick end labelling (TUNEL) staining was used to demonstrate the apoptotic cells in all samples. Student‐t, Mann–Withney U‐test, Fisher exact test and Spearman correlation were used for statistical analysis. Result: We detected apoptosis in 10 placentas in the study group vs. none in the control group. Placentas from pregnancies complicated with IUGR demonstrated 0.12% (0.1%–0.4%) apoptotic cells. The rate of apoptotic cells in the placenta was significantly higher in pregnancies complicated with IUGR than normal uncomplicated pregnancy (P=0.0019). Apoptosis were more abundant in the trophoblasts, especially cytotrophoblasts, in the placenta. We could not find a correlation between the apoptosis in the placenta of pregnancies complicated with IUGR and birth weight, multi‐parity, gestational age, birth weight percentile and mode of delivery (C/S vs. vaginal delivery). Conclusion: We believe that the increased number of apoptosis in the placenta of pregnancies complicated with IUGR may have an important compensatory role to transmit nutrition and gas exchange easily to the fetus.

Does leukocytospermia associate with poor semen parameters and sperm functions in male infertility? The role of different seminal leukocyte concentrations.

To investigate the effect of leukocytospermia on standard semen analysis and sperm function tests such as acrosome reaction, hypoosmotic swelling, antisperm antibody binding and cervical mucus penetration, a prospective clinical study was performed. Two hundred and nineteen male infertility patients undergoing investigation and treatment were included in the study. There was a significant association between acrosome reaction positivity and leukocytospermia according to WHO (World Health Organization) criteria. Increased hypoosmotic swelling test score, higher sperm concentration and enhanced acrosome reaction were closely related to leukocytospermia. When the patients were divided into subgroups according to seminal leukocyte concentrations, acrosome reaction and hypoosmotic swelling were observed to be higher in semen samples with higher leukocyte concentrations compared to those with low seminal leukocyte concentration. In addition, higher sperm concentrations were observed in semen samples with increased leukocyte levels compared to semen samples with low leukocyte levels. These results suggest that leukocytospermia may have a favorable effect on some sperm functions at seminal leukocyte concentrations between 1 and 3x10(6)/ml.

Hematological abnormalities in adolescent menorrhagia.

Background: The purpose of this study is to determine the frequency of underlying hematological disorders as the cause of acute adolescent menorrhagia. Methods: The records of 25 patients that were hospitalized with acute adolescent menorrhagia in the Obstetrics and Gynecology Department of Cerrahpa¸sa Medical School of ˙Istanbul University between 1988 and 1995 were analyzed. Results: The mean age of the patients was 13.9±1.6 (SD) years. A hematological abnormality that caused bleeding diathesis and acute menorrhagia was diagnosed in 7 of the 25 patients (28%). There were four cases of immune thrombocytopenic purpura, two cases of Van Willebrand disease and one case of acute promyelocytic leukemia. All seven patients with a coagulation disorder required blood transfusions and the mean hemoglobin level at presentation was 6.2 g/dl.

Appendectomy in the surgical staging of ovarian carcinoma

Objectives: Extensive debulking is accepted as the primary method of operative management for carcinoma of the ovary. However, there is no consensus regarding the role of appendectomy in primary surgical treatment. The aim of this study was to assess the role of appendectomy in the surgical staging and cytoreduction of ovarian carcinoma. Methods: The study was a retrospective review of 90 primary malignant ovarian carcinoma patients who had an appendectomy in addition to primary cytoreductive surgery. Results: Out of 90 patients, 10 (11.1%) had metastasis to the appendix. The rate of metastasis to the appendix was 11.5% (9/78) in malignant epithelial ovarian carcinomas and 8.3% (1/12) in non‐epithelial ovarian tumors. Of the patients with metastasis in the appendix, malignant epithelial ovarian tumors were identified in 90% (serous: 70%; clear cell: 20%), and non‐epithelial malignant ovarian tumor were disclosed in 10% (granulosa cell carcinoma). There were no metastases to the appendix in the other histological types. Although metastasis to the appendix was not observed in early stage ovarian carcinomas, it was detected in 21.4% (9/42) of stage III and 50% (1/2) of stage IV. Macroscopic tumor metastasis in the abdomen was noted in all patients with metastasis to the appendix. Conclusion: Appendectomy for stage I and II patients was not beneficial and did not affect final staging. As a result, for the proper staging of ovarian carcinoma there is no advantage to the addition of routine appendectomy to primary cytoreductive surgery in early stage (stage I and II) malignant epithelial ovarian tumors. Appendectomy would contribute to the cytoreduction of advanced stage disease if it is macroscopically involved.

Symptomatic Treatment of Premenstrual Mastalgia in Premenopausal Women with Lisuride Maleate: A Double-Blind Placebo-Controlled Randomized Study

OBJECTIVE To determine the therapeutic effect of lisuride maleate on premenstrual mastalgia in premenopausal women. DESIGN Double-blind randomized prospective study. SETTING Department of obstetrics and gynecology at a university hospital. PATIENT(S) Sixty women with premenstrual mastalgia were included in the study. Study and control groups consisted of 30 women each. INTERVENTION(S) Women enrolled in the study and control group were given one tablet daily (0.2 mg) of lisuride maleate or placebo orally for 2 months. Severity of mastalgia was evaluated using the visual analog scale. MAIN OUTCOME MEASURE(S) Severity of mastalgia and side effects of the drug administered. RESULT(S) Mastalgia subsided significantly in women receiving lisuride maleate compared with controls. There were no significant side effects from lisuride maleate. Prolactin levels decreased significantly in the group receiving lisuride, which correlated well with pain resolution. CONCLUSION(S) Lisuride maleate may be useful for the symptomatic treatment of premenstrual mastalgia.

Clinical evaluations of cell-free fetal DNA quantities in pre-eclamptic pregnancies

Quantitative changes of cell‐free fetal DNA in maternal plasma as an indicator for impending pre‐eclampsia was reported in different studies. Cell‐free fetal nucleic acids can be detected in maternal circulation during pregnancy. Our aim was to determine the higher rate of fetal DNA levels in maternal blood in pre‐eclampsia compared to normal pregnancies and the clinical use of real‐time polymerase chain reaction (PCR) in the Turkish population as a marker.

A strong prognostic variable in endometrial carcinoma

The purpose of this study was to determine the role of flow cytometric S‐phase fraction as a prognostic factor in patients with endometrial adenocarcinoma.

Fetal weight estimation and prediction of fetal macrosomia in non-diabetic pregnant women.

In the present study we investigated the accuracy of Shepards formula in the sonographic diagnosis of macrosomic fetus of non-diabetic pregnant women. Three hundred and eighty-one macrosomic and 450 appropriate for gestational age (AGA) fetuses born to non-diabetic mothers between 37-42 weeks of gestation were included in the study. Ultrasonographic fetal weight estimation within two days of delivery was made using Shepards formula in all patients. The estimated fetal weights were compared with the actual birth weights of the same subjects. We did not observe any macrosomic newborn birth in pregnant women with 3200 g or less fetal weight estimation. However, in patients with 3400-3499 g fetal weight estimation, a statistically significant increase in macrosomic newborn birth was observed. Only 3.2% of newborns having actual birth weights greater than or equal to 4000 g had sonographic birth weight estimation less than 4000 g. Accuracy of weight estimations using the Shepards formula was found to be low in macrosomic fetus. On the other hand, increased incidence of macrosomic newborn birth was observed in subjects with ultrasonographic fetal weight estimations above 3400 g and this level may be useful as a cut-off value for prediction of macrosomic fetus in non-diabetic pregnant women.

Cabergoline versus bromocriptine for symptomatic treatment of premenstrual mastalgia: a randomised, open-label study

OBJECTIVE To compare the effectiveness and side effects of cabergoline with bromocriptine for the symptomatic treatment of cyclic mastalgia as a part of the premenstrual syndrome. STUDY DESIGN 140 women with premenstrual mastalgia were enrolled in this randomised, open-label trial. Two groups were created (bromocriptine and cabergoline) and consisted of 61 and 67 patients respectively at the end of trial. Bromocriptine was administered 5 mg daily during second half of the menstrual cycle. Cabergoline was administered 0.5 mg weekly during the second half of the cycle. Relief of pain was evaluated using a visual analog scale (VAS). The mean percentage decrease in score for all patients in each group was calculated. A 50% or greater decrease at the end of the third month from the basal VAS score was accepted as a positive response to drug therapy. Data regarding side effects were collected systematically with review of a symptom diary. RESULTS The positive response rates to treatment were similar (bromocriptine 66.6% and cabergoline 68.4%). The pain reduction rates for each month were also similar. Moreover, the pain reduction rate was maximum in the second month of treatment for both groups. Vomiting (28%), nausea (39%) and headaches (23%) recorded in the bromocriptine group were significantly more frequent than vomiting (4.5%), nausea (20.9%) and headache (6%) recorded in the cabergoline group (p=0.023, p=0.001, p=0.006 respectively). A difference in the rate of dizziness was not statistically significant (26.4% vs. 14.9%). There was no correlation between the baseline breast pain score and prolactin level but post-treatment pain reduction was well correlated with prolactin level. CONCLUSIONS Cabergoline is as effective as bromocriptine for the treatment of cyclic mastalgia but has minimal side effects compared to bromocriptine.