Glutathione s-transferase m1 and t1 gene polymorphisms are not associated with increased risk of gestational diabetes mellitus development.

AIM: The aim of this study was to investigate whether the glutathione S-transferase M1 (GSTM1) and T1 (GSTT1) gene polymorphisms contributed to development of gestational diabetes mellitus (GDM). SUBJECTS AND METHODS: Fifty women with diagnosis of GDM and 50 control individuals without GDM or altered glucose intolerance during their pregnancy were enrolled in the study. Multiplex polimerase chain reaction-restriction fragment length polymorphism method was applied to determine the GSTM1 and GSTT1 gene polymorphisms. Genotypes were determined according to bands detected with the agarose gel electrophoresis. RESULTS: The difference in the frequencies of GSTM1 null genotypes between GDM and control groups was not statistically significant (60% and 54%, respectively). There was no statistically significant difference between GDM and control groups with respect to GSTT1 null genotype rates (22% and 20%, respectively).There was no statistically significant difference between GDM and control groups with respect to GSTT1 null genotype rates (22% and 20%, respectively). CONCLUSION: This study shows no association between GST gene polymorphisms and GDM.

No effect of perianal application of topical anaesthetic on patient comfort during nonsedated flexible sigmoidoscopy: a randomized, placebo-controlled clinical trial.

AIM: A literature review revealed no data on the effects of topical anaesthetic on patient comfort during flexible sigmoidoscopy. We therefore aimed to evaluate this in a randomized manner. METHOD: One hundred and forty-six patients who underwent flexible sigmoidoscopy were randomly allocated to one of three groups. Vaseline (n = 49), 2% lidocaine gel (n = 51) or a cream of 2.5% lidocaine plus 2.5% prilocaine (n = 46) were applied to the patients 30 min before the procedure. Demographic data and haemodynamic monitoring during procedures were recorded. Pain was assessed by visual analogue scale (VAS) and anxiety levels by the State-Trait Anxiety Inventory (STAI-I and STA-II). RESULTS: Median pre-procedural STAI-I scores were 45, 46 and 40.5 and median post-procedural STAI-I scores were 35, 34 and 33.5 for the vaseline, lidocaine, and lidocaine/prilocaine treatments, respectively. There was no statistical difference among the groups in terms of STAI-I and II scores. However, post-procedural STAI-I scores were significantly lower than pre-procedural values in each group (P < 0.001). There was no significant difference in VAS scores among the groups. In all groups there were statistically higher VAS scores during the procedure compared with the pre- and post-procedural scores (P < 0.001). CONCLUSION: Perianal application of topical anaesthetic does not influence patient comfort during sigmoidoscopy.

Perinatal asphyxia is associated with the umbilical cord nucleated red blood cell count in pre-eclamptic pregnancies.

Nucleated red blood cells are commonly present in the blood of newborns. Our objective was to investigate the value of umbilical cord nucleated red blood cell (NRBC) count in predicting fetal asphyxia in pre-eclamptic women. NRBCs were counted in umbilical cord blood samples of neonates born to 43 pre-eclamptic and 25 healthy pregnant women. Pre-eclamptic women were further subgrouped based on the presence or absence of intrauterine growth restriction. The NRBC count differed significantly between pre-eclamptic women with and without intrauterine growth restriction, and controls (26.3 +/- 7.5; 17.1 +/- 6.8; and 9.9 +/- 2.7; p < 0.001). A NRBC count of 18.5 or above could predict fetal asphyxia with a sensitivity of 94.4% and a specificity of 80.0%. The umbilical cord NRBC count is effective in predicting fetal asphyxia in pre-eclamptic women.

Neonatal outcomes of pregnancy complicated by idiopathic thrombocytopenic purpura.

OBJECTIVE: The aim of this study was to determine the factors associated with the prognosis of newborns born to mothers with idiopathic thrombocytopenic purpura (ITP), and to compare the infants with/without thrombocytopenia in terms of maternal and neonatal characteristics. STUDY DESIGN: We reviewed the charts of 29 parturients with ITP and their newborns who were born between January 1998 and December 2008. RESULT: A total of 16 (55%) gravidas had been diagnosed with ITP before pregnancy and 13 (45%) were diagnosed during pregnancy. Thrombocytopenia was observed in 21 gravidas. In total, 17 (58%) gravidas received treatment to increase the platelet count. The majority of deliveries (72.5%) were vaginal. The infant platelet counts at birth ranged from 20 to 336 x 10(9) per liter. None of the neonates had complications attributable to the mode of delivery. Normal platelet counts were determined in 15 newborns, whereas 14 infants had thrombocytopenia at birth. Three (10.3%) neonates had mild, four neonates (13.7%) had moderate and seven neonates (24.1%) had severe thrombocytopenia. The age of the mothers having infants with thrombocytopenia was significantly higher (30+/-5.3 vs 25.3+/-3.8 years), most of the infants (10/14 (71%)) were males (P<0.05). CONCLUSION: Pregnancy complicated with ITP generally has a good outcome. Although ITP in pregnancy carries a low risk, careful observation is required for the newborn of gravidas with ITP even when the infant has no bleeding complications at delivery, and infants may require treatment for thrombocytopenia.

Barrett's esophagus and endoscopically assessed esophagogastric junction integrity in 1000 consecutive Turkish patients undergoing endoscopy: a prospective study.

Barrett's esophagus (BE) appears to be more common in Western than in Asian countries. BE is a complication of gastroesophageal reflux disease (GERD). Anatomical abnormalities of the esophagogastric junction (EGJ) are an important factor in the pathogenesis of GERD. We aimed to determine the prevalence of BE in Turkey, which is geographically located between Europe and Asia, and to investigate the frequency of BE according to the degree of anatomical disruption in the EGJ. This prospective study was performed on 1000 consecutive patients referred for endoscopy for any clinical indication. All patients underwent a structured interview that assessed major symptoms of GERD (regurgitation and heartburn). BE was diagnosed when specialized intestinal metaplasia was detected histologically in the esophageal biopsy specimens. Endoscopically assessed integrity of the EGJ was classified as one of three types, as follows: 1 Normal EGJ. The endoscope shaft was gripped tightly by the cardia in retroflexed endoscopy, or it was gripped less tightly but the cardia was seen to open and close with respiration. 2 Widened EGJ. The cardia was open during all phases of respiration in retroflexed endoscopy, but there was no endoscopic evidence of hiatal hernia (HH) on the antegrade view. 3 HH. The axial length from the EGJ to the diaphragmatic hiatus was at least 2 cm. BE was found in 12 patients (1.2%). Normal EGJ was seen in 90.7% of patients, widened EGJ in 4.3%, and HH in 5%. Patients with widened EGJ had a significantly higher incidence of major reflux symptoms and erosive esophagitis compared with those with normal EGJ (P= 0.001). BE was found in 14% of patients with HH and in 0.5% of patients with a normal EGJ (P= 0.001). None of the patients with widened EGJ had BE. In terms of BE frequency, these patients did not differ significantly from those with normal EGJ (P= 0.793) but did differ significantly from those with HH (P= 0.014). The prevalence of BE was 1.2% in a Turkish population undergoing endoscopy for any reason. In terms of EGJ integrity, comparison of the groups showed that even in the absence of HH, patients with widening of the EGJ had an increased prevalence of major reflux symptoms and erosive esophagitis. However, histologically confirmed BE was not seen among patients with widened EGJ.

Spontaneous bacterial peritonitis in terminal renal failure.

We herein report a case of spontaneous bacterial peritonitis (SBP) caused by Staphylococcus epidermidis in an adult patient on regular hemodialysis (due to terminal renal failure caused by hypertension) and not on immunosuppressive therapy.

Fulminant hepatic failure due to secondary amyloidosis.

Systemic amyloidosis frequently involves liver, however, clinically apparent liver disease is rare and, if observed, is usually mild. Rarely, primary amyloidosis may present with evidence of portal hypertension or hepatic failure. Although secondary amyloidosis may involve the liver and rarely causes liver pathologies such as cholestatic hepatitis and portal hypertension, to our knowledge, hepatic failure due to secondary amyloidosis has been reported once before. Herein, we presented a woman with subacute fulminant hepatic failure who had no known history of a chronic disease other than episodes of urinary tract infection, and secondary amyloidosis was diagnosed with post-mortem liver biopsy.

The role of plasma renin activity in distinguishing patients with polycystic ovary syndrome (PCOS) from oligomenorrheic patients without PCOS.

All the components of the renin-angiotensin system have been identified in the human ovary. Renin plays a major role in folliculogenesis, and possibly in follicular atresia. Polycystic ovary syndrome (PCOS) is characterized by early follicular atresia. We studied whether assessment of plasma renin activity would be useful for diagnosing PCOS and distinguishing PCOS and non-PCOS in oligomenorrheic patients. Patients were divided into three groups: PCOS group (group 1, n = 40), non-PCOS oligomenorrheic group (group 2, n = 30) and ovulatory control group (group 3, n = 30). Plasma renin activity was determined in the early follicular phase of the menstrual cycle. Baseline serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, insulin, aldosterone and androgens (total testosterone, free testosterone, androstenedione, dehydroepiandrosterone sulfate and 17alpha hydroxyprogesterone) were determined in all groups. The mean LH level was lower (4.94 +/- 4.65 mIU/ml) in control patients than in PCOS patients (12.9 +/- 1.75 mIU/ml) and non-PCOS oligomenorrheic patients (10.8 +/- 1.65 mIU/ml). There was no statistically significant difference between the groups regarding FSH levels. The mean plasma renin activity was 3.47 +/- 0.29 ng/ml in the PCOS group. The mean plasma renin activity was 1.59 +/- 0.21 ng/ml the non-PCOS oligomenorrheic group (statistically significiant differrence). There was no statistically significant difference between the non-PCOS oligomenorrheic (1.59 +/- 0.21 ng/ml) and control groups (1.2 +/- 0.16 ng/ml). Use of plasma renin activity alone as a diagnostic marker in PCOS is not useful, because the clinical findings of PCOS are heterogeneous and the pathogenesis is unclear. However, it can be used together with other variables to diagnose women with PCOS and to distinguish non-PCOS oligomenorrheic women from those with PCOS.

Acute Effects of Maternal Smoking on the Uterine and Umbilical Artery Blood Velocity Waveforms

> Objective: The acute effects of smoking during pregnancy on the uterine and umbilical blood flow velocity waveform were assessed. Methods: Twenty-two chronic women smokers at a mean gestational age of 194.17 +/- 58.02 days and 21 women non-smokers at a mean gestational age of 193.24 +/- 34.71 days were studied. Systolic-diastolic (S/D) ratio, resistance index, and pulsatility index of uterine and umbilical arteries were measured in the control group and before and after smoking a single standard 100-mm filtered cigarette in the study group. Results: There was no significant change in the uterine artery and umbilical artery blood velocity waveform indices that could be attributed to the acute effect of smoking in the study group, but all of the uterine artery indices and S/D ratio in the umbilical artery were statistically higher in the study group in comparison with the control group both before and after smoking. Conclusion: Our results suggest that smoking causes an increase in vascular resistance of the placenta and umbilical cord when used chronically.

A randomized trial of intracervical prostaglandin gel and intravenous oxytocin in prelabor rupture of membranes with unripe cervix at term.

In order to compare the efficacy of immediate intravenous oxytocin administration and intracervical prostaglandin E2 gel application in premature rupture of membranes with unfavorable cervices at term, 45 term pregnant patients with premature rupture of membranes were randomized into two groups. Twenty women received immediate intravenous oxytocin after cleansing enema while the rest were treated with intracervical prostaglandin E2 gel. Means of maternal age, gestational age, Bishop score at admission and the rates of nulliparity did not show any significant differences between the two groups (p > 0.05). The mean rupture to delivery time was 12.6 +/- 4.4 hours in the oxytocin group and 16.5 +/- 4.5 hours in the prostaglandin group (p < 0.01). Mean birth weights and Apgar scores were insignificant. Cesarean section rates were 24% in the oxytocin group and 5% in the other (p < 0.05). No infectious morbidity was seen in any case. In conclusion, although delivery is delayed with the intracervical prostaglandin approach, cesarean section rate is lowered without an increase in infectious morbidity.

Plasma interleukin-1alpha, interleukin-1beta and interleukin-1 receptor antagonist levels in pre-eclampsia.

The values of plasma interleukin-1alpha (IL-1alpha), interleukin-1beta (IL-1beta) 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-1alpha, IL-1beta 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-1alpha and IL-1beta 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.

Anticardiolipin antibodies in pregnancy induced hypertension.

It was suggested that anticardiolipin antibodies (ACA) were found positive in some obstetrical problems such as recurrent foetal losses, intrauterine growth retardation, etc. The aim of this study was to determine ACA levels in pregnancy induced hypertension (PIH) cases. ACA IgG and IgM levels were measured by the ELISA method in 65 PIH cases and 23 control pregnancies. We could not find any difference between the PIH and the control groups. There was not any statistically significant difference between the subtypes of PIH. According to these results, we say that ACA IgG and IgM levels have no diagnostic and prognostic value in PIH.

Hemodynamic profiles in severe preeclamptic and superimposed preeclamptic pregnancies.

In this study, we investigated the hemodynamic profiles of pregnancy-induced hypertension cases. Hemodynamic measurements were performed in five severe preeclamptic and three superimposed preeclamptic cases. We applied Swan-Ganz catheters and measured hemodynamic parameters. According to the results, we suggest that pulmonary edema occurs more easily in severe preeclampsia than in superimposed preeclampsia.

Confined placental mosaicism in term placentae: analysis of 125 cases.

In order to determine the incidence of confined placental mosaicism (CPM) in term placentae and to show the presence of specific sites and the effect on fetal development, 125 placentae from uneventful pregnancies were analysed by cytogenetic methods. The incidence was at least 4.8 per cent and there were no specific sites on the placenta. Although the number of cases is still too small, we found CPM to be associated with intrauterine growth retardation in six cases.

Gestational herpes: 3 cases.

Three histologically proven gestational herpes cases were presented. All were complaining of itching and vesiculobullous skin lesions. The diagnosis was confirmed by skin biopsies and they all gave a complete response to 1 mg/kg-day oral prednisolone therapy. No neonatal morbidity was observed.

Postoperative adhesion formation following ovarian reconstruction with fibrin glue in the rabbit.

To compare postoperative adhesion formation following ovarian reconstruction with fibrin glue or the microsurgical suturing technique, an experimental study was performed on sixteen adult female rabbits. While left ovaries were reapproximated with 6-0 coated polyglactin using a microsurgical technique, right ovaries were reconstructed with fibrin glue following ovarian bisection. Four weeks later, second-look laparotomies were performed to evaluate the adnexal adhesions. These were scored according to the American Fertility Society classification. Mean adnexal adhesion scores were 8.2 +/- 2.3 in the sutured ovary and 5.0 +/- 1.1 in the glued ovary (p > 0.05). Ovarian reconstruction with fibrin glue does not reduce postoperative adhesion when compared with the usual suturing technique.

The comparison of 50 grams glucose challenge test, HbA1c and fructosamine levels in diagnosis of gestational diabetes mellitus.

We evaluated the sensitivity, specificity, positive and negative predictive values of 50 grams glucose challenge test, serum fructosamine and HbA1c levels as screening tests for gestational diabetes mellitus. Forty-two pregnant patients between the 24th and 28th week of their pregnancies were included in the study. Blood fructosamine and HbA1c levels did not differ significantly from the 50 grams glucose challenge test and were concluded to be alternatives to this test. Any combination of these 3 tests gives better results than a single test, but no one of the combinations is superior to the others.

Pregnancy and myasthenia gravis. A case report.

Myasthenia gravis in pregnancy is seen very rarely. We present such a case who was diagnosed and treated in our department.