Ümran Küçükgöz Güleç

Comparison of clinical and laboratory findings in early- and late-onset preeclampsia

Abstract Objective: To compare clinical and laboratory findings between the early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP). Methods: This prospective longitudinal study was performed at a tertiary referral university clinic. All patients meeting the inclusion criteria were divided into two groups, the EOP group and the LOP group, according to gestational age at the onset of disease. The distinction criterion for early versus late onset was set as week 34 of gestation. Clinical and laboratory findings, and maternal–perinatal outcomes were compared between the groups. Results: A total of 157 patients with preeclampsia were included. A significant difference was observed between the groups in terms of diagnosis and severity of the disease (p = 0.007 and <0.001, respectively). The history of previous preeclampsia, diastolic blood pressure and hourly urine output on admission to the hospital were significantly different between the groups (p = 0.016, 0.018 and 0.024, respectively). Latent period for delivery and postpartum hospitalization time were longer in the EOP group than in the LOP group (p = 0.024 and 0.002, respectively). The patients with EOP received betamethazone (p < 0.001) and MgSO4 (p = 0.029) more frequently. Neonatal characteristics such as birth weight, low APGAR score and admission to neonatal intensive care unit were significantly different between the groups (p < 0.001, for all variables). Total proteinuria at 24 h was found significantly higher in the EOP group than in the LOP group (p = 0.012). Conclusion: The results confirmed the opinion that EOP is a distinct and more severe clinical entity than LOP. In particular, higher proteinuria is associated with EOP.

An Analysis of C-Reactive Protein, Procalcitonin, and D-Dimer in Pre-Eclamptic Patients

The aim of this study was to evaluate serum procalcitonin (PCT), C‐reactive protein (CRP), and plasma D‐Dimer levels in mild and severe pre‐eclampsia.

Misoprostol for midtrimester termination of pregnancy in women with 1 or more prior cesarean deliveries.

To evaluate the safety and efficacy of vaginal misoprostol for midtrimester termination of pregnancy (TOP) in women with 1 or more prior cesarean deliveries (CDs).

Prenatal Determination of the Upper Lesion Level of Spina Bifida with Three-Dimensional Ultrasound

Introduction: To evaluate the role of three-dimensional (3D) sonography in the prenatal detection of the upper pole in fetuses with spina bifida. Material and Methods: Women admitted to a tertiary center with pregnancies with isolated open spina bifida were enrolled in the study. All fetuses had 3D sonography to predict the lesion level. The exact lesion level was ascertained using radiography and/or autopsy following the delivery at term or abortion. Results: Forty-eight cases were eligible for this study. Twenty-eight fetuses were diagnosed in the second trimester and the lesion level was precisely predicted in 24 (86%) of them. In 14 (70%) of the 20 fetuses diagnosed in the last trimester, the level was accurately determined. The remaining 10 fetuses, from both the second and third trimesters, were found to have a lesion level that was within one segment of the predicted lesion level. The correct matching rate was 38/48 (79%), and agreement within one segment was achieved in all cases. Discussion: According to our data, 3D ultrasound is useful for the prenatal determination of lesion level in spina bifida, which is an important prognostic factor.

Fetal Oropharyngeal and Neck Tumors: Determination of the Need for Ex-Utero Intrapartum Treatment Procedure.

BACKGROUND The aim of this study was to assess the ex-utero intrapartum therapy (EXIT) applied to 3 of the 7 cases with oropharyngeal or neck masses and review the indicators of the need for an EXIT procedure. CASE REPORT Prenatal presentation, size and localization of the masses, existence of fetal hydrops and associated findings such as polyhydramnios, intraoperative managements, complications, and maternal and neonatal outcomes were evaluated through a retrospective analysis. Four cases had neck masses and three cases had oropharyngeal masses. Prenatal sonography was used as the main diagnostic tool for all patients. The median gestational age was 34.5 weeks at the time of diagnosis and 36 weeks at delivery. Polyhydramnios was observed in three of the seven cases and they were delivered prematurely. Interventions such as endotracheal intubation or tracheostomy were performed to provide patency of the airway during delivery by the EXIT procedure in three cases. Hemangioma was found in two cases, teratoma in two cases, lymphangioma in two cases and hamartoma in one case following pathological examination of the masses. CONCLUSION The localization of mass, its characteristics, invasion (if it exists), and relation to the airway are the main factors used to determine the need for EXIT. The presence of polyhydramnios may be an important indicator to predict both the need for EXIT and fetal outcomes.

Intraoperative frozen section in ovarian neoplasms; a tertiary center experience.

Abstract Objective: Frozen section is an accurate diagnostic tool with some unavoidable pitfalls in gynecologic tumors. We aimed to evaluate the diagnostic value of frozen section, and to detect the factors causing erroneous diagnosis in ovarian tumors. Material and Method: Frozen section and paraffin section reports of 282 patients with ovarian neoplasms diagnosed between July 2006 and January 2013 in our institute were re-analyzed. Results were grouped into benign, borderline (for epithelial tumors) and malignant categories and compared between frozen section and paraffin section diagnosis, statistically. Results: Overall diagnostic accuracy of frozen section was 96.5%. Sensitivity of frozen section for benign, borderline and malignant tumors were 97.5%, 95.8%, and 95.6% and the related specificities were 97.5%, 97.6%, and 100%, respectively. We found the lowest positive predictive value in borderline group (79.3%), all of them with mucinous type epithelium. Second frequent discordant tumor type was immature teratoma. Conclusion: Apart from the limitations of frozen section, pathologists should be aware of the pitfalls of technique and tumor types and tend to sample from the solid areas particularly in mucinous tumors and teratomas to avoid inappropriate surgery. Öz Amaç: Jinekolojik tümörler için frozen kesit inceleme bazı tanısal tuzaklara karşın yeterli bir tanısal yöntemdir. Bu çalışmada, over tümörlerinde frozen incelemenin tanısal değerini ve tanısal yanlışlıkların nedenlerini tespit etmeyi amaçladık. Gereç ve Yöntem: Kurumumuzda Haziran 2006 ve Ocak 2013 yılları arasında over tümörü nedeni ile frozen inceleme yapılmış olan toplam 282 hastaya ait sonuçlar yeniden değerlendirildi. Tanılar benign, borderline (epitelyal tümörler için) ve malign olmak üzere üç alt gruba ayrıldı. Frozen ve parafin kesit sonuçları istatistiksel olarak karşılaştırıldı. Bulgular: Frozen incelemenin genel tanısal doğruluk oranı %96,5 idi. Benign, borderline ve malign tümörler için frozen incelemenin duyarlığı sırasıyla %97,5, %95,8 ve %95,6 idi. Özgüllük ise aynı sırayla, %97,5, %97,6 ve %100 idi. En düşük pozitif prediktif değer borderline grubunda saptandı (%79,3) ve hataya neden olan tüm olgular müsinöz tip epitelyal tümörler idi. Tanı uyumsuzluğu bulunan ikinci tümör grubu ise immatür teratom idi. Sonuç: Frozen incelemenin kısıtlılıkları yanısıra, patoloğun frozen incelemenin teknik veya tümör tipi ile ilgili tuzaklarını bilmesi, özellikle müsinöz tümörler ve teratom olgularında solid görünen alanlardan örneklenmesi yetersiz veya gereksiz operasyon yapılmasını önlemek adına yararlı olacaktır.

Primitive uterine neuroectodermal tumours: Two case reports

Primitive neuroectodermal tumor (PNET) arise from Kulchitsky cells and are rarely seen in the female genital tract. Differential diagnosis of PNET can be made based on immunohistochemical profiles and genetic analyses. Genital tract pNETs are very aggressive pathologies with different clinical and molecular manifestations and there are no standard guidelines for treatment. We aimed to present two cases of uterine PNETs with different symptomatology and clinical findings.

Prognostic value of pre-operative neutrophil/lymphocyte ratio, monocyte count, mean platelet volume, and platelet/lymphocyte ratio in endometrial cancer

OBJECTIVE Cancer-related inflammation is associated with poor long-term outcomes in various solid tumors. The aim of this study is to investigate the prognostic significance of pre-operative neutrophil lymphocyte ratio (NLR), monocyte count (MC), mean platelet volume (MPV), and platelet lymphocyte ratio (PLR) in endometrial cancer. STUDY DESIGN In this study, 763 patients with endometrial cancer were evaluated, who were followed between January 1996 and February 2016. Preoperative values of NLR, MC, MPV, and PLR were evaluated in terms of clinico-pathologic prognostic factors and overall survival (OS). RESULTS NLR, MC, and PLR were detected to be statistically significant with regard to advanced stage of the disease (p = 0.001, p = 0.02, and p = 0.001, respectively), but only MC was significant in terms of grade (p = 0.035). Higher NLR and PLR values were found to be associated with advanced stage of the disease, deep myometrial invasion, cervical involvement, lymphovascular space invasion (LVSI), and nodal involvement. When the cut-off value was considered as 3, sensitivity and specificity for NLR were found to be 68% and 69%, respectively, to predict lymph node metastasis. NLR was found as a prognostic factor for survival (p = 0.01). Age, the presence of comorbidity, stage, and cervical involvement were determined to be independent prognostic factors for OS in our cohort. CONCLUSION NLR was detected to be a prognostic factor for survival. Moreover, NLR and PLR are a predictive value for lymph node involvement and also for cervical invasion in endometrial cancer.

A novel technique: Carbon dioxide gas-assisted total peritonectomy, diaphragm and intestinal meso stripping in open surgery for advanced ovarian cancer (Çukurova technique)

OBJECTIVE Most of the ovarian cancers are diagnosed at advanced stages. As peritoneal carcinomatosis increases, especially when it extends to the diaphragm and intestinal mesos, probability of obtaining complete cytoreduction is reduced. Complete cytoreduction (residue zero: R0) is one of the main factors affecting survival [1-3]. Here we present a novel technique of stripping the peritoneal surfaces as a part of cytoreductive surgery in such cases. METHODS A 55year-old woman diagnosed with peritoneal carcinomatosis was considered appropriate for primary cytoreduction after assessment of her thorax-abdominopelvic tomography, which revealed resectable intra-abdominal disease. Upon laparotomy, omental cake adherent to pelvis-filling mass, disseminated implants on the diaphragm, meso of the descending colon and small intestine were observed. The mass invaded the rectosigmoid colon, uterus, adnexa and the bladder resulting in frozen pelvis. Palpable retroperitoneal pelvic and para-aortic lymph nodes were detected. On the other side, stomach, anti-mesenteric surfaces and mesentery root of the small bowel were tumor-free. Hence, upon these perioperative and preoperative imaging findings, complete cytoreduction was thought to be achievable. Therefore, primary cytoreduction was performed. Total omentectomy, hysterectomy with bilateral salpingo-oophorectomy, rectosigmoid low anterior resection and retroperitoneal lymphadenectomy were performed. With the assistance of an injector needle connected to the insufflator tube (as in laparoscopic surgery), carbon dioxide gas was blown into the right retroperitoneal area and subsequently peritoneum was rapidly stripped up to the right diaphragm. The same procedure was then applied to the diaphragm and meso of the bowels, respectively. Owing to this technique, total stripping of all involved peritoneal surfaces was clearly facilitated and R0 goal was reached. RESULTS Gas insufflation caused convenient detachment of the peritoneal surfaces along their anatomical line which led to concluding the stripping procedures easily, rapidly and safely without bleeding. Thus, according to our experience, about 10 to 15min per procedure are saved in such cases. Potential complications of CO2 gas used here are not superior to those in transperitoneal or retroperitoneal laparoscopic procedures. During the operation, patient was followed-up for potential complications such as subcutaneous emphysema and CO2 gas embolism.Thus, hourly blood gas was monitored. Another potential complication is injury of the vessels while inserting the needle which can be avoided by cautious inserting under the peritoneal surfaces superficially and using transillumination. In case such injuries happen, tamponing is a sufficient measure. In our serial, no perioperative complications belonging to this technique were encountered. However, long term outcomes such as precise time difference, difference in blood loss, complication rates, adhesions, morbidity associated with this technique and its impact on survival of the patients with advanced ovarian cancer have yet to be investigated. Therefore, a prospective study to validate this techniques long-term usefulness has been initiated in our clinic. CONCLUSION We believe that this practical and effective technique will offer significant improvements in efforts to achieve complete cytoreduction.

Propionic acidemia: a Turkish case report of a successful pregnancy, labor and lactation.

Abstract Although propionic acidemia (PA) is a devastating inherited metabolic disease, with early diagnosis and advanced treatment strategies prognosis gets better and girls can survive to child-bearing ages. We share the detailed follow-up data of the pregnancy, successful labor with cesarean section and a healthy baby of a Turkish patient with PA.