Ulaş Fidan

Comparison of aromatase inhibitor (letrozole) and immunomodulators (infliximab and etanercept) on the regression of endometriotic implants in a rat model.

OBJECTIVE Novel treatment strategies are needed in the treatment of endometriosis due to limited success rates with the currently available options. As inflammatory and immunological mechanisms have been shown to be involved in the mechanism of the disease, new modalities are likely to emerge. We investigated the effects of infliximab (INF), etanercept (ETA) and letrozole on the regression of experimental endometriosis. STUDY DESIGN In this experimental randomized trial, endometriosis was induced surgically in 44 adult female Sprague-Dawley rats. Establishment of implants was confirmed in 41 animals by a second operation on the 21st day. The rats were then randomly divided into four groups. Group I (n = 10) served as controls. Group II (n = 11) received letrozole (0.18 mg/kg, i.p.), group III (n = 10, i.p.) ETA (2.016 mg/kg, i.p.), and group IV (n = 10) INF (15.12 mg/kg, i.p.) for a second 21-day period. Endometriotic implant size along with peritoneal fluid VEGF level and immunoreactivity were determined before and after the treatment in each group. RESULTS Endometriotic implant size reduced in all treatment groups. The effect of letrozole and ETA on implant size was similar but was significantly better than INF. Level of VEGF in peritoneal fluid did not change in any treatment group but post-treatment VEGF immunoreactivity was found significantly lower in the letrozole treated group. CONCLUSIONS Letrozole and ETA caused a regression on the implant size in experimental endometriosis. The only group with decreased VEGF expression was letrozole.

Increased neopterin level and chitotriosidase activity in pregnant women with threatened preterm labor

Abstract Objectives: To determine whether the cellular inflammatory markers of activated macrophages, neopterin (NEO), chitotriosidase activity and the acute-phase inflammatory marker C-reactive protein (CRP) are elevated in pregnancy with threatened preterm labor (TPL). Methods: Thirty-two pregnant women with TPL and 32 women with uncomplicated pregnancy (UP) were included this study. The primary aim was to compare the NEO, chitotriosidase activity and CRP levels between women with TPL and women with UP. Results: NEO levels were all significantly elevated in patients with TPL compared to UP (median 25–75%; 9.61 [8.47–12.29] versus 4.46 [3.59–6.92], respectively; p < 0.001). Chitotriosidase activity was significantly elevated in pregnant women with TPL compared to UP (median 25–75%; 59.00 [38.00–87.25] versus 43.50 [23.25–65.25], respectively; p = 0.036). However, CRP levels were not different in women with TPL compared to UP (p = 0.573). Furthermore, a significant moderate negative correlation was found between delivery week and NEO level (r = −0.557, p = 0.001). However, a significant correlation was not seen between delivery week and chitotriosidase activity (r = −0.042, p = 0.741). Conclusions: Inflammatory markers such as NEO and chitotriosidase activity, which are markers of macrophages, are more elevated in pregnant women with TPL than in women with UP. These data suggest that there are striking increases in inflammation and cellular immune activation in TPL.

Postpartum symphysis pubis separation

Sir We wish to call attention to a case of symphysis pubis separation after term vaginal birth in a 41-year-old gravida 3, with insulin-regulated gestational diabetes, who previously had two spontaneous vaginal deliveries (4000 g and 3200 g babies 16 years and 11 years ago). She delivered a 4790 g baby vaginally with McRobert’s maneuver due to shoulder dystocia, but without fetal complications. Three hours after the delivery she complained of gradually increasing severe pelvic pain and difficulty in getting up and walking. Orthopedic consultation was obtained and a pelvic X-ray showed a massive 5-cm symphyseal separation (Figure 1). There was no sign of genitourinary injury/hematoma formation. She was put on strict bed rest, mostly in the lateral decubitus position, with elastic bandages wrapped around her pelvis tightly and was given paracetamol. The control X-rays on the 2nd and 3rd days showed 3-cm and 1-cm separations, showing a surprising remission. Her pain had diminished by the second day, and she was mobilized after 72 h, to be discharged at 96 h after delivery. At a control examination 7 days later she had no pain or walking difficulties. At the 3-month examination, she had no clinical symptoms of pubic diastasis, as confirmed by the orthopedic surgeon (TE) except for a known chronic lumbar discopathy. She consented for her case to be published. The pubic symphysis has the capacity to expand to facilitate delivery – this increases the sagittal diameter of the pelvic plane under the specific hormonal action of relaxin and progesterone (1). The pubic cartilage is about 4 mm, and it may reach 10 mm during the pregnancy and delivery; 10 mm is acknowledged as the highest limit for physiological distension (2). Severe symptomatic and documented postpartum symphysis pubis separation of 5 cm is an extremely rare complication. A few wider separations have been mentioned in the literature, with healing periods of around 6 weeks, however, our case showed unusually quick remission (1). The diagnosis is mainly by radiology and anteroposterior radiography is the standard diagnostic method. The factors causing intrapartum symphysis pubis separation are not known completely. The injury mechanism involves rapid, forceful descent of the fetal head into the birth canal and wedging of the head against the anterior pelvic ring, therefore creating mechanical shear forces and ligament rupture, while hyperabduction of the thighs is also blamed (1). Except for intrapartum symphysis pubis separations, pelvic ring disruptions usually involve high-energy injuries commonly observed after traffic accidents, which are classified based on the vector of force involved and the quantification of disruption from that force, i.e. lateral compression, anteroposterior compression, vertical shear and combined mechanical injury. These are conditions that require extensive surgery (3). In our case, McRobert’s maneuver with hyperabduction for the thighs for shoulder dystocia might have facilitated the complication. In conjunction with symphysis pubis separation, complications such as bladder and urethral injury and hematoma in the space of Retzius can be observed (4). When any of these complications present, suitable alternative treatment should be planned. If separation is isolated, as in our case, a conservative approach is justified with bed rest – especially in the first days as described previously (5).

PRENATAL DIAGNOSIS OF DIGEORGE SYNDROME

Velocardiofacial syndrome, conotruncal congenital heart disease and DiGeorge syndrome present different aspects of the same clinical situation, but congenital heart disease is common to them all [1]. Other defects found in these syndromes include abnormal facies, thymic hypoplasia, cleft palate, and hypocalcemia. A deletion at chromosome 22q11 is the second most common chromosomal defect detected in patients with congenital heart disease. Although familial inheritance occurs, most cases are sporadic [2]. A patient aged 29 years, gravida 2, para 1, presented to our outpatient clinic with an initial diagnosis of polyhydramnios at the 33 rd week of gestation. Her medical history revealed that her first delivery was at term by cesarean section, but the baby died in infancy of cyanotic heart disease, diffuse bronchopulmonary disease, and infection. Postmortem genetic investigation revealed that the neonate had a 22q11 deletion, with associated cardiovascular anomalies. The parents were genetically normal. Obstetric examination determined that the patient was at 33 weeks of gestation, and fetal biometric measurements suggested a gestational age of 31–32 weeks. The amniotic index was 18 cm and mild polyhydramnios was detected. Systematic ultrasonographic investigation revealed a ventricular septal defect, a secundum-type atrial septal defect, pulmonary atresia, and an anomaly of the overriding aorta. These findings were interpreted as components of tetralogy of Fallot (TOF). The patient had not attended the hospital for prenatal screening during her second trimester. Cordocentesis was performed for prenatal diagnosis. The cytogenetic analysis was evaluated as normal, but considering the clinical findings and the patient’s prior history, locus-specific fluorescence in situ hybridization (FISH) was planned to detect possible DiGeorge syndrome. A Tuple1-Hira

Safety, Efficiency, and Outcomes of Perineoplasty: Treatment of the Sensation of a Wide Vagina

Background. The sensation of a wide vagina is a common problem for women after childbirth. As its etiology is unknown, there is no uniform management strategy. We hypothesized that, rather than vaginal laxity, the cause was level 3 pelvic support deficiency. Methods. This retrospective study compared preoperative and postoperative genital hiatus length, perineal length, and total vaginal length in patients treated with perineoplasty for the sensation of a wide vagina. A telephone survey was used to determine postoperative patient and male partner satisfaction rates. Results. Mean age of patients was 48 (26–68) years; mean body mass index (BMI) was 25.3 (17.6–33.2); and mean parity was 2.5 (2–5). Preoperative and postoperative genital hiatus, perineal length, and total vaginal length were 4.62 and 3.18 (p < 0.01), 3.06 and 4.04 (p < 0.01), and 9.43 and 9.43 (p = 0.882), respectively. At the 6-month follow-up, the success rate of the perineoplasty procedure was 87.9%; according to a visual analog scale, partner satisfaction rate was 92.6%. Ten percent (n = 4) of patients said they experienced dyspareunia during sexual intercourse at the introitus of the vagina. Conclusion. With low dyspareunia rates, low complication rates, high patient satisfaction, and satisfactory anatomical success, perineoplasty can be considered successful for treatment of the sensation of a wide vagina.

Case report of a rare dermatosis in pregnancy: Impetigo herpetiformis

Impetigo herpetiformis (IH) is a very rare type of dermatosis seen in pregnancy. According to the published work, IH during pregnancy is associated with the risk of stillbirth, and obstetric management in such cases is very important. Early recognition is important to reduce both maternal and fetal morbidity. We present a case of IH resistant to corticosteroid therapy in a 27‐year‐old pregnant woman where the pregnancy was terminated by the induction of labor.

Green serum and pregnancy: Case report

OBJECTIVES This report investigates the etiology of green serum within pregnancy. PATIENT AND METHODS A 24-year-old patient applied to our clinic for a routine control examination at her 25th week of pregnancy. In her repeated blood analysis, green serum was observed after centrifugation of the blood sample taken for an oral glucose tolerance test. After that, records of the patients blood samples collected at the 9th and 12th weeks of pregnancy to verify that these serum samples were yellow were retrospectively examined. RESULTS In the literature, no green serum case without an accompanying increase in serum ceruloplasmin level has been reported. The routine blood biochemistry of alanine transaminase: 8 U/L (10-40 U/L), aspartate amino transferase: 10 U/L (10-40 U/L), gamma glutamyl transferase: 17 U/L (7-40 U/L), indirect bilirubin 5.13 μmol/L (0.0-18 μmol/L), and total bilirubin 11.9 μmol/L (0.0-24 μmol/L). The level of serum copper detected was 0.172 μmol/L (0.14-0.173 μmol/L) and of ceruloplasmin was 600 mg/L (260-630 mg/L) within the normal reference interval. CONCLUSIONS This case proves that generation of green serum in pregnancy is not only due to an increased serum ceruloplasmin but can also be caused by other factors. Additional studies need to be performed to understand the pathophysiological mechanism and future effects of the appearance of green serum during pregnancy.

Risk of HSIL (CIN 2–3) on colposcopic biopsy is minimal in postmenopausal women with LSIL on cytology and a negative HRHPV test

Current cervical cancer screening guidelines recommend a 1‐year follow‐up period for patients with a postmenopausal low‐grade squamous intraepithelial lesion (LSIL) who are test negative for high‐risk human papillomavirus (HrHPV). The aim of this study was to assess whether such patients had an increased immediate risk of high‐grade squamous intraepithelial lesion.

Using Wood's Light as a Diagnostic Tool for Vaginal Atrophy.

INTRODUCTION Woods light lamp is a device that emits ultraviolet (UV) light and is a useful diagnostic tool for dermatologic disorders. The change in the thickness of vaginal mucosa, in vaginal atrophy, causes a change in its colour under Woods light. We wanted to assess the feasibility of Woods light (WL) as a diagnostic tool for vaginal atrophy. MATERIALS AND METHODS The study was conducted at the Department of Obstetrics and Gynaecology from 1 March 2013 to 1 September 2014. We evaluated 45 healthy postmenopausal women with atrophic vaginitis (study group) and 45 healthy, reproductive-aged women as a control group. All patients underwent WL and routine gynaecological examinations for this study. RESULTS Ninety patients were selected for this study: 45 postmenopausal women suffering atrophic vaginitis symptoms like vaginal dryness, dyspareunia, vulvar pruritus, and signs like pale, smooth, dry, fragile vaginal epithelium, areas of petechiae, and rash, and 45 healthy reproductive-aged women without vaginal atrophy. Thirty-six of the postmenopausal womens vaginal mucosa appeared pale royal green under WL indicative of vaginal atrophy. Thirty-nine of reproductive-aged womens (n: 45) vaginal mucosa were not visualized as pale royal green fluorescent images under the WL. CONCLUSION Using Woods light to diagnose vaginal atrophy is a new use for the old device and may be a reliable, and cheap tool for diagnosing vaginal atrophy. Diagnostic accuracy and cost-effectiveness of Woods light will be better optimized in further trials.

A simple set for ıntrauterine fetal blood transfusion constructed by readily available materials in every clinic

Abstract Intrauterine fetal transfusion needs extensive experience and requires excellent eye–hand coordination, good equipment and experienced team workers to achieve success. While the needle is in the umbilical vein, an assistant withdraws and/or transfuses blood. The needle point should be kept still to prevent lacerations and dislodging. We propose a simple set for Intrauterine Fetal blood transfusion is constructed by readily available materials in every clinic to minimize needle tip movement and movements during syringe attachments and withdrawals during the intrauterine fetal transfusion. This makes possible to withdraw fetal blood sample, and to transfuse blood with minimal intervention.