Evaluation of Epithelioid Trophoblastic Tumor in the Light of Literature.

Epithelioid trophoblastic tumors (ETTs) are extremely rare gestational trophoblastic neoplasia and a subtype of the placental site trophoblastic tumors (PSTTs). To our knowledge, there have been only 110 patients diagnosed with the ETT. ETT is generally seen in the reproductive period, following term pregnancy. Generally, as in PSTT, ß-HCG levels are normal or slightly elevated. The most common complaint is abnormal vaginal bleeding. At the time of diagnosis, findings of metastasis can be seen in 50% of the cases. Transvaginal ultrasonography (TV-USG) and computed tomography (CT) are used for imaging in the literature. Surgical treatment and follow-up are sufficient in the early stages. We present a case of a 37-year-old ETT patient who suffered from irregular vaginal bleeding.

COVID-19 Pandemic Action Plan of a University Hospital.

In December 2019, in Wuhan, China, scientists observed a sudden and sharp increase in the number of cases of pneumonia and acute respiratory distress syndrome of an unknown origin. By the end of January 2020, the outbreak had spread to Asia, Europe, America, and Australia. In this article, we have outlined the pandemic action plan of our university hospital.

Anesthetic effect of intrauterine lidocaine plus naproxen sodium in endometrial biopsy.

OBJECTIVE: To compare the efficacy of intrauterine lidocaine with oral naproxen sodium on pain perception of the patients during endometrial biopsy using the Pipelle instrument and to investigate their effects when used in combination. METHODS: One-hundred twenty women were randomly assigned to receive either 5 mL of intrauterine 2% lidocaine or saline and either 550 mg of naproxen sodium or a similar-appearing placebo tablet. Subsequently, each woman completed a 10-cm visual analog scale for subjective pain experience and a physician scored visible signs of the women's distress during the procedure using a 3-point observer scale. RESULTS: There was no statistically significant difference between the 4 groups in age, vaginal parity, history of chronic pelvic pain, menopausal status, tenaculum use, previous endometrial biopsy, or difficulty in passing the cervical os. The mean pain scores of the women in the naproxen only (5.8 +/- 2.2) and lidocaine only (5.9 +/- 2.2) groups were not significantly different compared with placebo group (7.1 +/- 2.0). However, the mean pain score in the lidocaine plus naproxen group (4.6 +/- 1.8) compared with the placebo group showed significant reduction in pain (P <.05). Pain rated by the physician was significantly lower in the lidocaine plus naproxen group compared with other groups, and a significant correlation was noted between the visual analog pain score and the patients' distress recorded by the physician (r =.791, P <.001). One patient in the naproxen-only group had vasovagal syncope after the procedure. CONCLUSION: Intrauterine lidocaine instillation significantly decreases pain associated with Pipelle endometrial biopsy when used in combination with oral naproxen sodium. LEVEL OF EVIDENCE: I

Delayed interval delivery of a second twin after the preterm labor of the first one in twin pregnancies: delayed delivery in twin pregnancies.

A diamnionic dichorionic twin pregnant women (due to in vitro fertilization) admitted to emergency department at the 21st week of gestation because of regular contractions. By gynecological examination, we observed 8 cm dilated cervix with 80% effacement. Amniotic membrane was also bulging through the cervix. After evaluation delivery of the presenting fetus occurred quickly. The baby's weight was 610 gr and no heart activity was detected. Placenta of the first fetus expulsed immediately. We decided to retain the second fetus to allow the improvement in the outcome. McDonald cerclage was performed and the patient treated with tocolytics and antibiotics, and she was continuously monitored up to the 28th week of pregnancy. After she was discharged in the 28th week, she was controlled weekly in obstetrics clinic. At the 36th gestational week which was 101 days after the cerclage procedure, 3639 g male fetus was delivered with cesarean section and had an uneventful neonatal course. Delayed-interval delivery is useful and acceptable therapeutic option for the management of the remaining fetus in twin pregnancies even after the expulsion of the placenta. Antibiotic and tocolytic administration with cervical cerclage application can be associated with longer interdelivery interval.

Angiomyxoma: a rare tumor of the umbilical cord.

Tumors of the umbilical cord are rare anomalies and should be considered when using prenatal ultrasound for detection of cystic lesions. Differential diagnosis of umbilical cord tumors should comprise umbilical cord teratoma, hemangioma and angiomyxoma. It can also be an umbilical cord polyp, umbilical cord cyst, hernia into the cord and omphalocele, which are mostly isolated findings, except omphalocele. Angiomyxoma is a rare tumor of the umbilical cord and is associated with incresaed perinatal morbidity and mortality. We present a 22-year-old woman with a large umbilical cord tumor who underwent a caesarean section. As in our case, neither chromosomal aberrations nor elevated alphafetoprotein were found after amniocentesis or chordocentesis. Macroscopical and microscopical pathological examinations of the mass after delivery revealed an angiomyxoma with cystic degenerations in myxoid stroma.

Follicular dynamics and apoptosis following unilateral oophorectomy.

Ovarian physiology has been based on the assumption that the mammalian ovary has a constant germ cell pool. According to this accepted doctrine primordial follicles, which are limited in number, are depleted through ovulation or atresia. Therefore, the primary goal of this study was to examine the follicle dynamics and morphologic apoptotic changes following unilateral oophorectomy. In order to evaluate the short-, mid-, and long term effects of unilateral oophorectomy, three groups of rats were included in the study. One ovary was removed from each rat on day 0 and used as a control. In group A (n=7), the remaining ovaries were removed via relaparatomy on the 7th day, group B (n=8), the remaining ovaries were removed via relaparatomy on the 14th day, and group C (n=8), the remaining ovaries were removed via relaparatomy on the 42nd day. The changes in the number of primordial, primary, and growing follicles and the difference in apoptotic index were assessed. Even after 10-12 oestrus cycles (in group C) following unilateral oophorectomy, follicle reserve did not show a decrease in the remaining ovary. However, within the growing follicle the ovulatory rate increased. Atretic follicles were elevated contrary to the belief that reproductive functions are compensated as a result of the reduction in atresia. The observations suggest that the number of primordial follicles remains relatively constant.

The effect of alendronate sodium on carotid artery intima-media thickness and lipid profile in women with postmenopausal osteoporosis.

OBJECTIVE: Observational and experimental studies support that osteoporosis and atherosclerosis are two related phenomena. The aim of the present study was to investigate the probable effect of alendronate sodium, which is used in the treatment of osteoporosis, on carotid artery intima-media thickness (IMT), the lipid profile, and apolipoprotein A-I (ApoA-I) and apolipoprotein B (ApoB) levels, which are known to have a role in the atherosclerotic process. METHODS: Carotid artery IMT was measured in 39 women in whom alendronate 70 mg/week was started due to osteoporosis and in 33 control participants at the start and the 6th and 12th months of the study. Triglyceride, high-density lipoprotein, low-density lipoprotein, ApoA-I, and ApoB levels were also measured at the same time points, and ApoB/ApoA-I rates were calculated. RESULTS: Among the basal values, only the ApoA-I level was significantly lower in the alendronate group (P < 0.01). IMT measurement results (mean [SE]) of the alendronate group were 0.622 [0.015], 0.616 [0.014], and 0.597 [0.013] mm; those of the control group were 0.600 [0.010], 0.611 [0.011], and 0.620 [0.011] mm, respectively. In both groups, the difference between the start and 12-month values was significant (P < 0.05). A significant difference was not determined in the triglyceride and lipid measurement results between the groups and also within groups. ApoA and ApoB levels at the start and the 12th month of the study were as follows: 159.8 [3.6], 162.2 [3.4] (P > 0.05) and 96.2 [4.2], 101.5 [4.5] (P > 0.05) in the control group and 145.1 [4.0], 173.7 [4.3] (P < 0.05) and 98.7 [3.9], 84.6 [3.3] (P < 0.05) in the alendronate group, respectively. The ratios of ApoB/ApoA-I were 0.611 [0.029] is to 0.636 [0.031] (P > 0.05) in the control group and 0.703 [0.04] is to 0.498 [0.0] (P < 0.05) in the alendronate group. CONCLUSIONS: We concluded that alendronate sodium resulted in a significant decrease in IMT during a 1-year period compared with matched controls. Also, alendronate was associated with a positive effect on the ApoB/ApoA-I ratio.

[The importance and validity of anti-Toxoplasma gondii IgG, IgM, IgA antibodies and IgG avidity tests in the diagnosis of Toxoplasmosis infection during pregnancy.]. / Gebelikte Toxoplasmosis tanisinda anti-Toxoplasma gondii IgG, IgM, IgA antikor ve IgG avidite testlerinin birlikteligi ve önemi.

Detection of specific IgG, IgM and IgA antibodies by enzyme immunoassay (EIA) tests are not always sufficient in the diagnosis of early and late Toxoplasma gondii infection during pregnancy. For this reason, the specific IgG avidity test should be used to detect primary toxoplasmosis infection. In this study, an investigation was made of the serological status of pregnant women who were suspected of having primary or late toxoplasmosis as well as the importance and relationship of specific anti-Toxoplasma gondii IgG, IgM and IgA antibodies and specific IgG avidity in their sera. TORCH panels were also used for these patients. A total of 52 pregnant women who were admitted in the Dokuz Eylül University Gynecology and Obstetrics Clinic were included in this study. The sera were sent to the serology and immunology laboratory for investigation of the anti-Toxoplasma gondii IgG, IgM and IgA antibodies by the EIA (Cobas Core, Roche, Germany and ETI-TOXOK-A, DiaSorin, Germany) technique. The anti- Toxoplasma gondii IgG avidity test was performed on IgG as well as IgM and/or IgA in positive sera with the EIA (Toxoplasma IgG Avidity EIA Well- RADIM, Italia) technique. The anti-Toxoplasma gondii IgG avidity test was not performed on sera from 21 pregnant women negative for anti-Toxoplasma gondii IgG, IgM and IgA antibodies. Borderline and high IgM levels showed a good correlation with the IgG avidity results. The ratio for the IgM and IgA positivity was 32.3% and both the IgM positivity and IgA negativity were 29%. In conclusion, anti- Toxoplasma gondii IgG avidity and anti-Toxoplasma gondii IgM antibody tests should be used together. However, positivity or high avidity of IgA was limited in the diagnosis of active toxoplasmosis infection of pregnant women.

Splenosis presenting with adnexal mass: a case report.

CASE REPORT: A 21-year-old woman presenting with low abdominal discomfort, dysmenorrhoea and pelvic mass was misdiagnosed as endometriosis. She had post-traumatic splenic rupture and laparotomy history. RESULTS. Pelvic splenosis was diagnosed at laparotomy. Pelvic mass was removed and the other implants were left.