Vaspin and C-reactive protein levels in hyperemesis gravidarum.

OBJECTIVES: To determine vaspin and C-reactive protein (CRP) concentrations in hyperemesis gravidarum (HEG). MATERIALS AND METHODS: Twenty-six women with HEG and 26 control subjects matched for gestational age and body mass index were examined. The levels of vaspin, CRP and lipid profile in all subjects were measured. RESULTS: The vaspin levels were significantly higher in hyperemetic patients than in the healthy pregnant women (1308.3 ± 116.5 vs. 1145.9 ± 335.1 ng/ml, respectively) (p < 0.05). Women with HEG had significantly higher levels of CRP than the control group. Serum vaspin concentrations inversely correlated with total cholesterol, triglyceride, very low-density lipoprotein-cholesterol and low-density lipoprotein-cholesterol levels. CONCLUSIONS: We found evidence of inflammation in HEG.

Tumor markers panel and tumor size of ovarian dermoid tumors in reproductive age.

OBJECTIVE: To study whether there is any relationship between a serum tumor markers panel (CA19-9, CA 125, CEA, CA15-3 and AFP) and the tumor size in patients with ovarian dermoid cyst in reproductive age. BACKGROUND: Between January 2006-2007, 160 patients were operated in the Department of Infertility, Zekai Tahir Burak Women Health Hospital due to ovarian dermoid cyst. METHODS: The clinical data and serum tumor markers levels of operated patients were retrieved from the records of the department. This was a retrospective study. RESULTS: Forty-four patients (37.6 %) had high levels of CA 19-9 , twenty-seven patients (19.3 %) had high CA 125 levels, eleven patients (9.4 %) had high levels of CEA, five patients (4 %) had high levels of CA 15-3 and one patient (0.9 %) had high AFP levels at the time of initial surgery. The bilaterality rate was 8.1 %. When grouping the tumor size as 10 cm, the mean serum levels of tumor markers had significantly increased by increasing the tumor size (p<0.05) for CA 19-9, CA 125, CEA. CONCLUSIONS: Our study suggests that serum CA 19-9 is probably more accurate marker than other tumor markers in the ovarian dermoid cysts. Also, the most important parameter that affects CA 19-9 elevation in the dermoid cysts, is the tumor size. As the tumor becomes bigger, this relationship becomes more distinct (Tab. 2, Ref. 15).

Two-year experience of obstetric cholestasis: outcome and management.

PURPOSE: Our aim was to evaluate the management and outcome of obstetric cholestasis in our perinatology unit. METHODS: We analyzed 44 pregnant women complicated by cholestasis. Data were collected retrospectively. Details of patient demographics and outcomes of pregnancy were recorded. Patients were randomized due to their decision to take ursodeoxycholic acid (UDCA) therapy or not. RESULTS: Forty-four women of age 28.09 +/- 4.6 years delivered 45 newborns. The mean gestational age at diagnosis of obstetric cholestasis was 32.36 +/- 3.75 weeks. The mean delivery time was 38.25 +/- 1.5 weeks. Spontaneous premature delivery occurred in five (11.4%) of the patients. No stillbirths were observed. Serum transaminases decreased significantly in 26 of the patients who were treated with oral UDCA therapy. Twelve (27.2%) babies were admitted to the neonatal intensive care unit (NICU). Out of 12 mothers whose babies were admitted to NICU, nine patients had not received UDCA (p = 0.07). CONCLUSION: UDCA is effective in lowering transaminases.

Ovulation induction with gonadotropins causes increased sister chromatid exchanges.

Gonadotropins are widely accepted agents for ovulation induction in infertile women. On the other hand, several authors discuss the possible effect of gonadotropins on the developmental mechanism of ovarian cancer. SCE is a method of genotoxicity investigation and it is an excellent parameter to monitor the DNA damage and repair. There are numbers of studies showing the relationship between endogenous or exogenous hormones and SCEs. The aim of this study was to investigate with SCE techniques the effects of long-term (6 months) use of gonadotropins on DNA as we couldn't find any other study on the effect of long term use. We found increased sister chromatid exchange rates in a study group as compared to a control group. This may be one of the causes of increased ovarian cancer risk in infertile population.

Sonographic assessment of ceftriaxone-associated biliary pseudolithiasis in children.

PURPOSE: Ceftriaxone is a widely used third-generation cephalosporin. In this prospective study, we used sonography to investigate the incidence and outcome of biliary complications in children receiving ceftriaxone therapy. METHODS: Ceftriaxone was administered intravenously at a dosage of 100 mg/kg/day for 1-3 weeks to 118 children hospitalized for severe infection. Serial gallbladder sonograms were obtained on days 1, 5-7, and 10-14 of therapy and the day after therapy ended if it had lasted more than 2 weeks. When sonographic abnormalities were found, additional sonograms were obtained every 3 days until the abnormalities had completely resolved. RESULTS: Twenty patients (17%), all asymptomatic, demonstrated sonographic abnormalities: 8 had gallbladder sludge, defined as echogenic material without associated acoustic shadowing, and 12 had pseudolithiasis, defined as echogenic material with acoustic shadowing. These abnormalities spontaneously resolved within 2 weeks of stopping the ceftriaxone (mean time to disappearance, 8.2 +/- 3.4 days). No significant differences were found between patients with normal versus abnormal sonographic findings in sex, age, duration of treatment, or other risk factors for drug precipitation. CONCLUSIONS: Ceftriaxone-associated biliary pseudolithiasis is usually asymptomatic and was rapidly reversible after cessation of therapy in this group of Turkish children.

Endovascular treatment of arteriovenous fistulas complicating percutaneous renal biopsy in three paediatric cases.

DESIGN: We evaluated the incidence and history of arteriovenous fistula (AVF) after kidney biopsy and assessed the use of superselective embolization for treatment. OBSERVATIONS: During the last 10 years, 896 kidney biopsies (age range of the patients: 1 month-18.6 years) have been performed in our institution under real-time ultrasonographic guidance with a 14 gauge cutting biopsy needle, and 32 of the patients had renal allografts (3.4%). We observed three cases of AVF (two in allograft kidneys, one in a native kidney) among all biopsies (0.34%), and the incidence of developing AVF after renal allograft biopsy was 6.3%. All three patients with AVF were symptomatic, and intravascular therapy was indicated. INTERVENTIONS: An angiographic study combined with endovascular treatment of the intrarenal AVF and pseudoaneurysm was performed in all three patients. Embolization was performed with bucrylate and lipiodol in two patients and with micro-coils in one. After successful embolization, all three patients became asymptomatic (in two renal bleeding stopped, in one patient with severe uncontrollable hypertension blood pressure returned to normal limits). No complications were observed secondary to the embolization procedure. CONCLUSION: The technique of superselective embolization using a coaxial catheter is an effective and safe method in the treatment of post-biopsy AVFs and pseudoaneurysm.

Neuroradiologic aspects of West syndrome.

Cranial computed tomography (CT) or magnetic resonance imaging (MRI), or both, of 143 patients with West syndrome were retrospectively reviewed. Twenty-four children had normal CT scans. The most striking findings on pathologic scans were cerebral atrophy, ventricular enlargement, and encephalomalacia. Of 78 children who underwent MRI, 14 had normal scans. Cerebral malformations, cerebral atrophy, and delayed myelination were the most common pathologic findings and were observed in 25, 20, and 16 of the cases, respectively. MRI was found to be more informative in 21 of the 27 patients who underwent both neuroimaging methods. In fact, in two patients with normal CT scans, MRI revealed delayed myelination and hyperintensity of the hippocampal area on T2-weighted images in one and increased intensity of basal ganglia on T1-weighted images in the other. On the basis of all data, four patients were classified as cryptogenic and 126 as symptomatic. The most frequent etiologic factors were perinatal asphyxia, cerebral malformations, and infections, encountered in 34, 25, and 24 of the children, respectively. Twenty-one cases could be classified solely on the basis of the data obtained with neuroimaging modalities. The data confirm and provide additional details of the ways in which neuroimaging, especially MRI, is useful in distinguishing between cryptogenic and symptomatic cases of West syndrome.

Midtrimester termination of complicated pregnancy with oral misoprostol.

To define the mean effective dose of oral misoprostol, a PGE2 methylanalogue, for terminating midtrimester complicated pregnancy without producing significant side-effects and complications, forty-two patients with intrauterine complicated pregnancies of 14-28 weeks were treated with oral misoprostol. All patients were observed after the initial dose (200 micrograms). If there was no contraction of the uterus or no vaginal bleeding, a supplementary dose of 200 micrograms misoprostol was given once each hour, with an average total dose of 1000 micrograms being given (min. 200 micrograms, max. 1200 micrograms). Abortion was successfully induced in 39 women (92.9%); there were 3 failures (7.1%). The mean time from initial dose to abortion was 9 h. No important side-effects or complications were noted. This study demonstrated that the use of oral misoprostol is a simple, inexpensive and easy procedure for termination of second trimester complicated pregnancy.

The management of renal candidiasis in the newborn.

Renal candidiasis in the neonate is encountered infrequently. We report a newborn with ichthyosis, who during the hospital course had five episodes of culture-proven sepsis, probably due to skin lesions. For these infections various antibiotic combinations were used. During the therapy of the last sepsis attack, unilateral hydronephrosis developed secondary to renal candidiasis. Percutaneous nephrostomy with amphotericin B irrigation, coupled with five weeks of intravenous amphotericin B therapy was successful. We believe that with this approach the mortality and morbidity of renal candidiasis could be reduced.

Causes of increased renal medullary echogenicity in Turkish children.

The primary disorders of 50 children with increased renal medullary echogenicity on renal ultrasound were studied; 28 girls and 22 boys aged from 1 month to 16 years were classified into four groups based on underlying disease and ultrasound findings. Group 1 was composed of 17 patients with distal renal tubular acidosis (34%); intense echoes throughout the pyramid were predominant. Group 2 consisted of 14 patients with vitamin D toxicity (28%) and an intense echogenic rim around the pyramids. Group 3 included 10 patients with different types of tubulopathies. A slight hyperechogenic rim around the sides and tip of the medullary pyramids was detected. Group 4 was made up of 9 patients with rare underlying conditions. Abdominal X-rays detected medullary calcinosis in only 12 (24%) of the total 50 patients. Ultrasonography appears to be an important tool in the early diagnosis of increased renal medullary echogenicity and medullary nephrocalcinosis.