Yusuf Aytaç Tohma

Is ultrasonographic evaluation essential for diagnosis of retained products of conception after surgical abortion

The aim of this study was to evaluate the predictive value of symptomatic evaluation with transvaginal ultrasonographic findings for diagnosis of retained products of conception (RPOC) after voluntary pregnancy termination via manual vacuum aspiration (MVA).

Effect of Etanercept on the Success of Assisted Reproductive Technology in Patients with Endometrioma

Aims: To determine the effects of a tumor necrosis factor inhibitor (etanercept) on pregnancy outcomes in patients with endometrioma who were treated with assisted reproductive technology. Methods: Sixty-eight infertile patients who had endometrioma were included in our retrospective case-control study. We administered etanercept (Enbrel, 50 mg in 1 mL intramuscularly) to 19 patients on the second day of their previous menstrual cycle. All patients were treated with assisted reproductive technology. Pregnancy and live birth rates (LBR) were documented. Results: When all other parameters (age, body mass index, infertility) are supposed to be constant, the clinical pregnancy rate was significantly higher in patients who used etanercept in an antagonist protocol than in patients who did not use etanercept (χ2 = 5.547; p = 0.019) but LBR did not reach a statistical significance (χ2 = 3.179; p = 0.075). The use of etanercept had an OR of 4.17 (95% CI 1.23–14.14) compared with not using etanercept for clinical pregnancy rate. The use of etanercept increased the rate of pregnancy (χ2 = 6.55; p = 0.01). The pregnancy rate with the use of etanercept had an OR of 4.23 (95% CI 1.35–13.25) compared with patients who did not use etanercept. In the same way, the use of etanercept increased LBR twofold, but it is not significant in the border line (χ2 = 3.771; p = 0.052). Conclusions: Etanercept may be a new non-hormonal therapy that may be an adjunct to treatment of infertile women with endometrioma. However, the safety of etanercept on embryos and fetuses has not been fully clarified.

Bilateral synchronous ovarian tumours: an uncommon case and review of the literature

Synchronous ovarian tumours are rare. Management of these patients can differ from that of patients with uniform tumours. We present a case of synchronous epithelial ovarian cancer and malignant mixed Müllerian tumour in different ovaries, its follow-up and management until death. To our knowledge this is the second case in the English literature to date. A 61-year-old woman with bilateral adnexal masses underwent complete debulking surgery for ovarian cancer. The final pathology was reported as malignant mixed Müllerian tumour in the right ovary with intact borders and stage 2 grade 3 serous carcinoma in the left ovary. She had a 17-month disease-free interval after 6 cycles of paclitaxel and carboplatin. Recurrence of malignant mixed Müllerian tumour was reported in the pathology after secondary debulking including a partial ileal resection. After 6 cycles of gemcitabine and cisplatin she had a widespread recurrence in the thorax and abdomen. The patient died of disease recurrence at the 25th month after diagnosis. Coexistence of serous and malignant mixed Müllerian tumour in different ovaries is very rare. The main treatment is complete cytoreduction followed with chemotherapy. Platinum-taxane based chemotherapy resulted in an acceptable disease-free interval in our case, but it is not standard yet. A management protocol may be developed with the increasing number of similar cases in the literature.

Oncological and obstetric outcomes after fertility-sparing radical abdominal trachelectomy for early stage cervical cancer: a tertiary centre’s 10 years’ experience

Abstract The aim of this study is to present our clinical experience about fertility-sparing procedures in early stage cervical cancer and its obstetrical and oncological outcomes. Between the years 2006 and 2016, a total of 22 early stage cervical cancer patients who underwent a fertility-sparing radical abdominal trachelectomy in our clinic were retrospectively analysed. The median age was 33 (range: 28–39) years. The median follow-up was 47 (range: 22–125) months. Five patients (22.7%) had Stage IA1, three patients had (13.6%) Stage IA2, and 14 patients (63.6%) had Stage IB1 disease. Only one patient had a recurrence. A pregnancy was obtained in five patients (22.7%) and one of them (20%) had a live birth. A pregnancy was obtained spontaneously in two patients (40%), whereas assisted reproductive techniques were used in three of the patients (60%). A miscarriage occurred in two patients (40%), and one of them was within the first trimester and the other was within the second trimester. Impact statement What is already known on the subject? Currently, the first-line treatment of early stage cervical cancer is surgery. However, a fertility-sparing trachelectomy is the most widely adopted approach in the reproductive aged patients who have a desire to be pregnant later. What does this study add? In the literature, there is a growing number of studies on this subject. However, it would take time to obtain adequate knowledge. We believe that our study would contribute to the existing data. What are the implication of these findings for clinical practice? This study is important as it indicates that a multidisciplinary approach is required to preserve fertility among gynaecologic oncologists and the outcomes would be reflected into the clinical practice. In addition, we believe that our study would pave the way for further studies regarding this subject among oncologists.

Vitamin D receptor gene TaqI single nucleotide polymorphism is not associated with lead levels in maternal and umbilical cord blood

Abstract Purpose: We aimed to investigate the association of vitamin D receptor (VDR) gene TaqI single nucleotide polymorphism (SNPs) with serum lead (Pb) levels in maternal and umbilical cord blood. Materials and methods: Eighty-one patients who lived in Konya, Turkey for the last 3 years and had delivery at Başkent University Konya Hospital in 2016 were included in this study. Venous blood samples were drawn from each volunteer immediately before giving birth to determine the maternal Pb levels and VDR SNPs. Additionally, umbilical cord blood samples were collected from the umbilical vein into tube with EDTA as an anticoagulant immediately after birth to determine Pb levels of the fetus. Results: The median level of Pb in the maternal blood was 29.00 (Interquartile Range (IQR) = 16.35) μg/L and the median Pb level in the cord blood was 22.50 (IQR = 9.75) μg/L. Blood Pb level of women living in the urban area was significantly higher than in those living in the rural area (Z = 2.118; p = .034). There was a very strong positive correlation between the Pb levels in the maternal blood and in the umbilical cord blood (ρ = 0.825, p < .001, respectively). Regarding VDR SNPs, “TT”, “TC”, and “CC” VDR TaqI genotypes were observed in 28 (34.6%), 45 (55.5%), and eight samples (9.9%), respectively. Pb levels in maternal and cord blood were higher in women with the “CC” VDR TaqI genotype; however, there was no statistically significant difference (p > .05). Conclusions: Although women with the “CC” VDR TaqI genotype had higher maternal and cord blood Pb levels, this was statistically insignificant and therefore, VDR TaqI SNPs did not significantly affect maternal and umbilical cord blood Pb levels.

Possible impact of immunosuppressive therapy regimens on histopathologic outcomes of abnormal uterine bleeding in solid-organ transplant recipients

In this study, we aimed to determine the frequency of histopathologic outcomes of solid‐organ transplantation in women with abnormal uterine bleeding (AUB) receiving immunosuppressive therapies.

Single-port laparoscopy for treatment of concomitant adnexal masses and chole-cystectomy or appendectomy

Objective: To report our experience treating adnexal masses concomitant appendectomy or cholecystectomy using of the Single-Incision Laparoscopic Surgery (SILS). Methods: Nine women with symptomatic and persistent adnexal masses with appendicitis or cholecystitis are included to study. Removal of adnexal masses and performed appendectomy or cholecystectomy via single-incision laparoscopic surgery using a combination of the SILSTM port and straight non-roticulating laparoscopic instruments. Results: 6 patients had symptomatic complex adnexial masses and 3 patients had symptomatic myoma uteri. In 2 of the patients had myoma uteri appendectomy (hysterectomy+bso+appendectomy) were performed concomitantly and in 1 of patients had myoma uteri cholecystectomy (hysterectomy+BSO +cholecystectomy) were performed concomitatly. In 4 of the patients had symptomatic adnexal masses appendectomy (hysterectomy+bso or uso or cystectomy+appendectomy) were performed concomitantly and in 2 of patients had complex adnexial masses cholecystectomy (hysterectomy+USO or USO+cholecystectomy) were performed concomitatly. Mean duration of surgery was 128 min. None of the patients converted to laparotomy. All patients were discharged on postoperative d 1. None of the patients required readmission to hospital. Post-surgery all patients reported that they were satisfied with their incision and cosmetic results. Conclusion: SILS can result in better aesthetic result than conventional laparoscopy for the treatment of adnexal masses concomitant appendectomy or cholecystectomy.

Prevalence of endometrial cancer or atypical hyperplasia diagnosed incidentally in infertility clinic

OBJECTIVE: Infertile patients may have a higher incidence of endometrial cancer (EC) compared with the general population. However, the prevalence of EC in infertile patients is still not clear, and, in the literature, there are only a few studies on the aforementioned topic. In this study, we aimed to investigate the prevalence of endometrial atypical hyperplasia (AH)/endometrial intraepithelial neoplasia (EIN) and EC in women who were seen for evaluation of infertility.

Depression and anxiety disorder in hyperemesis gravidarum: A prospective case-control study

Objective: To assess the anxiety and depression status of women with hyperemesis gravidarum (HG); the risk factors for developing both depression and anxiety in women with HG were evaluated. Materials and Methods: A total of 200 women, 100 diagnosed as having HG before the 20th week of gestation at a tertiary referral center and 100 gestational-age-matched controls were enrolled. The socio-demographic data and the depression and anxiety scores, as assessed using the Beck depression and anxiety inventory were compared between the two groups. Results: The median depression and anxiety scores were significantly higher in the HG group compared with controls (19.5 vs. 9.0 and 22.0 vs. 10.0). Women with HG have the highest relative risks for moderate depression and severe anxiety [relative risk (RR): 16.88 and RR: 20.50, respectively]. In the univariate analysis, having HG, low education level, low income and poor social relationships were significant predictors of depression and having HG. Moreover, poor social relationships significantly predicted the presence of anxiety disorder. However, having HG and poor social relationships were found as the only independent predictors of both depression and anxiety. Patients with HG were 5.5 and 6.7 times more prone to having depression and anxiety disorder compared with controls, respectively. Conclusion: Both depression and anxiety disorder were more frequent in women with HG who have weak family and social relationships, lower education and income levels. Therefore, the determination of the psychological status of women with HG should be an integral part of the evaluation.

Estimation of fetal weight by ultrasonography after preterm premature rupture of membranes: comparison of different formulas.

Abstract Objective: To compare different ultrasonographic fetal weight estimation formulas in predicting the fetal birth weight of preterm premature rupture of membrane (PPROM) fetuses. Methods: Based on the ultrasonographic measurements, the estimated fetal weight (EFW) was calculated according to the published formulas. The comparisons used estimated birth weight (EBW) and observed birth weight (OBW) to calculate the mean absolute percentage error [(EBW–OBW)/OBW×100], mean percentage error [(EBW–OBW)/OBW×100)] and their 95% confidence intervals. Results: There were 234 PPROM patients in the study period. The mean gestational age at which PPROM occured was 31.2±3.7 weeks and the mean gestational age of delivery was 32.4±3.2 weeks. The mean birth weight was 1892±610 g. The median absolute percentage error for 33 formulas was 11.7%. 87.9% and 21.2% of the formulas yielded inaccurate results when the cut-off values for median absolute percentage error were 10% and 15%, respectively. The Vintzileos’ formula was the only method which had less than or equal to 10% absolute percentage error in all age and weight groups. Conclusions: For PPROM patients, most of the formulas designed for sonographic fetal weight estimation had acceptable performance. The Vintzileos’ method was the only formula having less than 10% absolute percentage error in all gestational age and weight groups; therefore, it may be the preferred method in this cohort. Amniotic fluid index (AFI) before delivery had no impact on the performance of the formulas in terms of mean percentage errors.