Yalçın Kimya

Maternal and fetal outcomes in pregnancy complicated with acute leukemia: a single institutional experience with 10 pregnancies at 16 years

The incidence of acute leukemia in pregnancy is low and the management of acute leukemia during pregnancy is difficult. We have observed a total of 10 pregnancies in 8 patients. Six of the patients had acute myeloblastic leukemia (AML) and two of them had acute lymphoblastic leukemia (ALL). Three of the pregnancies were diagnosed when the leukemia was in remission, six at the time of leukemia diagnosis and one at the time of leukemic relapse. Six of the pregnancies were found in first trimester, three in the second and one early in the third. Three pregnancies ended with spontaneous abortion, three with intrauterine death and three with medical termination. One of spontaneous abortions and one intrauterine death developed during combination chemotherapy (daunorubicin, cytarabine). Only 1 healthy baby survived from the 10 pregnancies and this child was the not exposed to chemotherapeutic agents. None of the cases had gynecologic and obstetric complications. Five of eight pregnant women with leukemia died because of the primary disease.

Plasma interleukin-1α, interleukin-1β and interleukin-1 receptor antagonist levels in pre-eclampsia

Abstract The values of plasma interleukin-1α (IL-1α), interleukin-1β (IL-1β) and interleukin-1 receptor antagonist (IL-1ra) levels were evaluated as the markers of pre-eclampsia in 35 serial plasma samples from ten pregnant women who subsequently developed pre-eclampsia and in 74 plasma samples from 20 uncomplicated pregnancies, retrospectively. No correlation was found between plasma IL-1α, IL-1β and IL-1ra levels, liver and renal function tests. thrombocyte and white blood cell counts, proteinuria, systolic and diastolic blood pressures and gestational weeks. Almost equal levels of IL-1α and IL-1β were measured in all corresponding groups, but these were too few in number to statistically analyze. IL-1ra values were higher in the pre-eclampsia group than in the uncomplicated pregnancy group, at 20–25 and 31–35 gestational weeks significantly and 26–30 gestational weeks insignificantly and showed an increase during labor in both groups. It was found to have 58% positive predictivity, 100% negative predictivity, 50% specificity and 100% sensitivity at gestational weeks 20–25. According to these results, IL-1ra seems to be considered for its high negative predictivity in the exclusion of the probability of pre-eclampsia development during antenatal visits, but its plasma level is not correlated with the severity of the disease.

Idiopathic thrombocytopenic purpura in pregnancy: a single institutional experience with maternal and neonatal outcomes

We observed 13 pregnant women of 70 females with idiopathic thrombocytopenic purpura (ITP) from January 1992 through September 2002. Thirteen mothers with ITP gave birth to twelve babies and two fetuses died. One of the pregnancies produced twins. Seven of the cases were diagnosed with ITP before pregnancy and six during pregnancy. One of the thirteen pregnancies was complicated by preeclampsia, one by ablatio placentae, and one by intrauterine death. Seven mothers received corticosteroid treatment, four high-dose immunoglobulin therapies, and one underwent splenectomy in the second trimester of gestation. At the time of delivery six mothers had normal platelet counts and seven had low platelet counts. Nine deliveries were by vaginal route and four were by cesarean section. Eleven infants were born with normal platelet counts and one was thrombocytopenic at the time of delivery. No infant showed any clinical signs of hemorrhage and there were no neonatal complications. Two fetuses died; one of them because of ablatio placentae and the other was intrauterine dead. In conclusion, ITP in pregnancy requires the management of two patients, the mother and her baby; hence, the close collaboration of a multidisciplinary group composed of a hematologist, obstetrician, anesthesiologist, and neonatologist is essential.

Plasma anti-oxidant status and lipid profile in non-gravida women with a history of pre-eclampsia

Objective:  To investigate the total plasma anti‐oxidant status, the plasma lipid profile and the uterine artery Doppler velocity waveform in formerly pre‐eclamptic women.

Meiotic segregation analysis of reciprocal translocations both in sperms and blastomeres

Balanced chromosomal rearrangements could lead to unbalanced segregation gametes during meiosis. In this study, sperm flourescence in situ hybridization (FISH) analysis of meiotic segregation products of four reciprocal translocations; 46,XY,t(7;10)(q21;q22), 46,XY,t(15;17)(q11;p12), 46,XY,t(6;13)(p21.1;q32), and 46,XY,t(1;13)(q24;q10) are presented. In three out of these four cases with t(15;17), t(6;13), and t(1;13) additional blastomere FISH analyses are also provided. Multi‐color FISH analysis was applied using diverse probe combinations specific for translocated chromosome segments. The average frequency of sperm nuclei bearing unbalanced products for t(7;10), t(15;17), t(6;13), and t(1;13) were 48.7%, 59.5%, 60.5%, and 62.9%, respectively. Frequencies of blastomeres comprising unbalanced products in cases with t(15;17), t(6;13), and t(1;13) were 80% (12 of 15), 60% (3 of 5), and 50% (2 of 4), respectively. Chi‐square test analysis showed significant differences in the meiotic segregation patterns due to the distribution and numbers of the chiasmatas that could depend on the size of the translocated segments (P < 0.001). In conclusion, FISH analysis of sperm and blastomere for reciprocal translocation carriers effectively estimates the approximate risk of unbalanced products and this result might ensure valuable genetic counseling.

Effect of progestogens on estrogen-induced lipoprotein changes

A study was performed to evaluate the role of progestogens, on estrogen-induced changes in lipoprotein levels. Sixty postmenopausal symptomatic women, aged 36-59, were included in the study. They were prospectively randomized to a sequential schedule (n = 20), 17 beta-estradiol transdermally 0.05 mg/day on days 1-24 and medroxyprogesterone acetate 10 mg/day orally on days 15-24 or a continuous schedule (n = 20), 17 beta-estradiol transdermally 0.05 mg/day and medroxyprogesterone acetate 2.5 mg/day orally on days 1-24. Patients who had total abdominal hysterectomy+bilateral salphingooopherectomy (n = 20) received only 17 beta-estradiol 0.05 mg/day continuously. Serum total cholesterol (TC), high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and triglyceride (TG) levels were determined prior to and at the 3rd, 6th and 9th month of therapy in all groups. Mean TC, TG and LDL cholesterol levels did not change significantly during therapy (P > 0.05). Only the mean HDL cholesterol levels showed significant increases in all groups; from 42.30 +/- 9.97 mg/dl to 64.10 +/- 6.81 mg/dl in group I (P < 0.001), from 41.85 +/- 9.09 mg/dl to 60.65 +/- 7.41 mg/dl in group II (P < 0.001) and from 40.70 +/- 11.26 mg/dl to 58.80 +/- 7.74 mg/dl in group III (P < 0.001). It is concluded that medroxyprogesterone acetate, whether used continuously or sequentially, does not oppose the beneficial effects of transdermal 17 beta-estradiol on the lipoprotein profile.

Fetal İntrakraniyal Teratomun Erken Prenatal Tanısı ve Fetal İntrakraniyal Kitlelere Yaklaşım

OZET Konjenital intrakraniyal tumorler, oldukca nadir gorulen cocukluk cagi santral sinir sistemi tumorleridir. Bu tumorlerin onemli bir kismini teratomlar olusturmaktadir. Intrakraniyal teratomlarin prognozlari kotudur. Prenatal tani konulabilen olgularin sag kalim ve canli dogum oranlari oldukca dusuktur. Obstetrik ultrasonografi oncelikli tani yontemidir; bununla birlikte secilmis vakalarda, manyetik rezonans goruntuleme (MRG) taniya yardimci olabilir. MRG, tumorun fetal beyinde yol actigi hasarin ortaya konmasinda ve gebeligin prognozunun belirlenmesinde faydali olabilir. Bu yazida, 22. gebelik haftasinda tanisi konulan fetal beyin teratomu vakasi sunulmustur. Bilgimize gore, bu olgu, literaturde yayinlanan 14. gebelik haftasinda tani almis olan intrakraniyal teratom olgusundan sonra en erken tani alan ikinci intrakraniyal teratom olgusudur. Ultrasonografi ile fetal kraniyum icerisinde, heterojen eko sergileyen, duzgun sinirli, yer kaplayan kitle ile birlikte sekonder obstruktif hidrosefali saptanmistir. Olgunun MRG ile elde edilen bulgulari bu acidan ultrasonografik bulgular ile benzerlik gostermistir. Gebelik ailenin de onayi alinarak termine edilmistir. Sunulan olguda MRG taniya ve olgunun yonetimine ek katki saglayamamistir. Bu sunumda, olgunun sonografi ve MRG bulgulari ile birlikte bu vakalara obstetrik yaklasim tartisilmaktadir.

Prenatal Diagnosis of De Novo Reciprocal Translocation t(1;12)(q21.3;p11.2) with Trisomy 21 and Sperm FISH Analysis for Increased Aneuploidy Risk

Abstract Complex rearrangements such as de novo translocations together with aneuploidy are unusual situations in prenatal diagnosis. We report a case with de novo translocation t(1;12)(q21.3;p11.2) and trisomy 21. Father’s sperm was analyzed for potential of increased risk of aneuploidy. Results showed no paternal increased risk for chromosomes 13, 18, 21, X, Y. Based on our results, we suggest that possible increased maternal aneuploidy risk and other possible mechanisms should be investigated to better understand cell division errors and to give better genetic counseling.

Trakeomalazi ve bronkomalazisi olan bir Larsen sendromu

Larsen syndrome is a rare disorder characterized by congenital multiple joint dislocations presence of cleft palate hyper telorism and flat facies Our case had a flat nasal bridge frontal bossing cleft palate micrognathia bilateral dislocation of the knees equinovarus deformity on the feet left fibula hypoplasia cylindrical fingers and thoracolomber kyphosis Larsen syndrome was diagnosed prenatally He also had tracheomalacia This case of Larsen syndrome associated with tracheomalacia and bronchomalacia showing autosomal recessive inheritance is presented Key words: Larsen syndrome prenatal diagnosis tracheomalacia bronchomalacia