Effects of subtelomeric copy number variations in miscarriages.

PURPOSE: This study was performed on miscarriage samples for chromosome analysis to detect copy number variations (CNVs) related to subtelomeric regions, and with these results we aimed to adapt multiplex ligation-dependent probe amplification (MLPA) method for prenatal diagnosis. MATERIALS AND METHODS: The cell cultures and DNA isolations were performed on 60 miscarriage samples. For maternal contamination analysis, DNA isolations and quantitative fluorescent polymerase chain reactions were done using peripheric blood of mothers who had miscarriages. We compared short tandem repeat peak profiles of miscarriage samples and mothers. The subtelomeric regions of the chromosomes were assessed using the MLPA method. RESULTS: Of 43 miscarriage samples, 19 had normal karyotype (44.2%), 10 had numerical abnormalities (23.3%), and 2 had structural abnormalities (4.7%). Subtelomeric 16q duplication was determined in 2 of the 30 miscarriage samples investigated with MLPA method (6.6%). CONCLUSION: There is no statistically significant difference between two groups (p > 0.05). However, the fact that the 6.6% subtelomeric CNV found in miscarriage samples was not found in controls, showed that further studies are required. We recommend that the miscarriage samples of the couples with recurrent miscarriage should be analyzed in terms of subtelomeric CNV after the exclusion of other clinical reasons.

Cytoreductive surgery (SRC) and hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of peritoneal carcinomatosis: Our initial experience and technical details.

OBJECTIVE: The aim of this study is to present our initial experience in peritoneal carcinomatosis treatment and the technical details of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the light of current literature. MATERIAL AND METHODS: Data of 27 consecutive patients who were treated with CRS and HIPEC for peritoneal carcinomatosis in Medical Park Samsun Hospital, between November 2012 and September 2014 were retrospectively reviewed. Treatment indication and management were evaluated at the multidisciplinary oncology council. All patients underwent CRS and HIPEC with the aim of complete cytoreduction. Patients with unresectable disease and/or palliative surgery were excluded from analysis. Perioperative complications were classified according to Clavien-Dindo classification, and HIPEC-related side effects were identified using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) criteria. Demographic, clinical and histopathological data of the patients were analyzed. RESULTS: The mean age was 54 (32-72). Nineteen patients were female. The origin of peritoneal carcinomatosis was colorectal cancer in 12 patients, ovarian cancer in 12 patients, gastric cancer in 2 patients and pseudomyxoma peritonei in 1 patient. The mean Peritoneal Carcinomatosis Index was 12 (3-32), with a mean operative time of 420 (300-660) minutes. Perioperative morbidity, HIPEC-related toxicity and perioperative mortality were observed in eight (30%), one (3.7%) and four patients (14.8%), respectively. During a mean follow up of 13 (1-22) months, overall and disease-free survival rates were 95.8% and 82.6%, respectively. Two patients with colorectal cancer (after 9 and 12 months) and one patient with ovarian cancer (after 11 months) had intra-abdominal recurrence. One patient with ovarian cancer had liver metastases 13 months after surgery, and underwent resection of segments 6-7. The remaining patients are being followed-up without any recurrence. CONCLUSION: Cytoreductive surgery and HIPEC have favorable results in the treatment of patients with peritoneal carcinomatosis. Compatible with the literature, surgical outcomes of the presented series are encouraging for this treatment modality that have been recently popularized in our country. Careful perioperative evaluation, proper patient selection and multidisciplinary approach are essential for success in curative treatment of peritoneal carcinomatosis.

A Comparative Multicentric Study on Serosal and Endometrial Myomectomy During Cesarean Section: Surgical Outcomes.

OBJECTIVE: This multi-center study aims to determine the efficiency and safety of endometrial myomectomy (EM) for the removal of uterine fibroids during cesarean section (CS). METHODS: Retrospective review of 360 women diagnosed for fibroids during pregnancy. They all delivered by CS between 2014 and 2019. The study groups included 118 women who only underwent EM, 120 women who only had subserosal myomectomy by traditional technique and 122 women with fibroids who decided to avoid cesarean myomectomy, as control group. They were analyzed and compared the surgical outcomes. RESULTS: The EM, subserosal myomectomy and control groups were statistically (p > 0.05) similar for to age, body mass index (BMI), gravidity, parity, gestational age at delivery, indications for CS, number of excised fibroids, size of the largest myoma. Postoperative hemoglobin values and ? (?) hemoglobin concentrations were lower in SM group (10.39gr/dl vs 9.98 gr/dl vs 10.19 - 1.44 gr/dl vs 1.90 gr/dl vs 1.35; p = 0.047, p = 0.021; respectively) Hybrid fibroids were significantly more frequent in the EM group than subserosal myomectomy and control groups (respectively, 33.1% vs 23.3% vs 27.0%, p = 0.002). Surgery time was significantly longer in the subserosal myomectomy group than EM and control groups (respectively, 46.53 min vs 37.88 min vs 33.86 min, p = 0.001). Myomectomy took significantly longer time in the subserosal myomectomy than EM group (13.75 min vs 8.17 min, p = 0.001). CONCLUSIONS: Endometrial myomectomy is a feasible choice for treatment of fibroids during CS, and, basing on our results could be an alternative to traditional cesarean subserosal myomectomy.

Pretreatments before the induction of ovulation in assisted reproduction technologies: evidence-based medicine in 2007.

Many pretreatment modalities used prior to ovulation induction have been proposed to increase the success rate in women undergoing assisted reproductive technologies. However, no clear evidence from well-designed clinical trials has shown a benefit of these treatments. We conducted a systematic review to explore the effect of different pretreatment therapies on outcomes of in vitro fertilization (IVF) cycles. Studies were limited to women treated prior to undergoing controlled ovarian hyperstimulation in IVF cycles with low-dose aspirin, metformin, growth hormone, oral contraceptives, or corticosteroid supplementation versus placebo or no supplementation. Searches were conducted in the Cochrane Library, MEDLINE, EMBASE, and ISI Proceedings, and all randomized controlled trials that evaluated the effectiveness of those therapies compared with placebo or no treatment in women before IVF were included. The main outcome measures considered were clinical pregnancy and live birth rates, miscarriage rate, number of oocytes retrieved, cycle cancellations, and the incidence of ovarian hyperstimulation syndrome. We conclude that, currently, no clear evidence indicates that using any of these pretreatment modalities is superior to no treatment in IVF cycles. Even when the studies are pooled, small sample size and low power preclude a complete assessment of adjuvant treatment modalities before ovulation stimulation in IVF cycles.

Serum leptin and body composition in polycystic ovarian syndrome.

BACKGROUND: The role of leptin in polycystic ovarian syndrome (PCOS) is unclear. We investigated the relationship between serum leptin levels, body composition and insulin resistance in polycystic ovarian syndrome (PCOS). METHODS: We analyzed differences between 27 patients with PCOS and 25 control subjects in serum glucose and leptin levels, insulin resistance, body fat mass, lean body mass, and water volume. RESULTS: Serum leptin was significantly correlated with basal insulin levels, BMI and IR in both groups (P<0.01). Fat mass, fat percentage, lean mass and water volumes were positively correlated and lean percentage and water percentage were negatively correlated with leptin levels (P<0.05). Leptin levels were significantly different between the groups in a multivariate regression analysis after correcting for the difference in BMI and body fat percentage (P<0.05). When the effects of fat percentage on serum leptin were eliminated, the levels were significantly different between the PCOS and control groups, and were statistically more powerful than BMI (P<0.01). CONCLUSION: These findings support the idea that factors other than excess fat mass or fat-free mass might be important in the regulation of serum leptin levels in PCOS.

Comparison of single and double courses of antenatal corticosteroid administration on neonatal mortality and morbidity.

OBJECTIVE: We aimed to evaluate the effects of single and double courses of antenatal corticosteroid administration on neonatal mortality and morbidity. MATERIALS AND METHODS: 232 preterm babies delivered between 01. April 2007 and 31. March 2008 with gestational ages of 26-34 weeks were evaluated prospectively. Infants were divided into three groups. The first group did not receive any antenatal betamethasone therapy. The second group received single (two doses of 12 mg betamethasone administered at 24 hour intervals) and the third group received double (repeated course after one week) courses of betamethasone therapy. RESULTS: 156 (67.2%) infants received at least one dose of corticosteroid treatment whereas 76 (37.8%) did not. Of 156 infants who had received antenatal betamethasone, 36 (23.1%) developed respiratory distress syndrome (RDS), while the incidence of RDS was 35.5% in 76 preterms who received no antenatal betamethasone (27/76) (p<0.05). When single and double courses of bethamethasone administration were compared, 20 (24.7%) infants with single course and 16 (21.3%) infants with two course developed RDS (p>0.05). CONCLUSION: When single and two courses of antenatal steroid therapy were compared, there was no statistically significant difference between groups regarding the incidence of RDS and mechanical ventilator treatment.

Markedly elevated serum alkaline phosphatase level in an uncomplicated pregnancy.

In normal pregnancy, although maternal serum alkaline phosphatase increases and reaches the two-fold of non-pregnant serum level, above this level, hepatic, renal, osteal diseases and malignancies should be kept in mind. We report a case of 28-year-old pregnant woman with increased maternal serum level of alkaline phosphatase activity (17-fold) due to an increased level of placental isozyme. She delivered vaginally a healthy female baby. After delivery, maternal serum alkaline phosphatase activity returned to normal reference range. The aim of this case report is to show this exaggerated isozyme activity of alkaline phosphatase in pregnancy, and to differentiate it from other causes of elevated level of alkaline phosphatase.

Effects of menstrual cycle on postoperative analgesic requirements, agitation, incidence of nausea and vomiting after gynecological laparoscopy.

BACKGROUND: Several studies have suggested that the menstrual cycle has an impact on postoperative nausea and vomiting (PONV). No previous study has evaluated the effect of the menstrual cycle on the incidence of postoperative agitation and analgesic/antiemetic requirements. METHODS: On the basis of the phase of the menstrual cycle [pre+/-menstrual (Pd 25-6), early follicular phase (Pd 8-12), ovulatory phase (Pd 13-15), and luteal phase (Pd 20-24)], 67 patients enrolled in this blinded, prospective study. Anesthesia was standardized. Fentanyl was given to the patients who had severe pain in the recovery room. The patients who had agitation were given midazolam. When pain intensity was >5 on the Visual Analog Scale, metamizol was administered in the Gynecology Department. A blinded anesthesiologist recorded episodes of PONV in the recovery room, and 2 and 24 h postoperatively. RESULTS: The opioid requirement and the frequency of agitation were similar in each group. Metamizol consumption was highest in the luteal phase (p < 0.05). The follicular and luteal phases were predictors for vomiting at recovery (p < 0.05 and p < 0.001, respectively). At the postoperative 2nd hour, nausea was higher in the follicular phase than in the other phases (p < 0.05) and the luteal phase was a predictor for retching (p < 0.001). At the postoperative 24th hour, nausea was the common symptom in the luteal phase (p < 0.05). The need for ondansetron was highest in the luteal phase (p < 0.01). CONCLUSIONS: In conclusion, we suggest that the scheduling of all surgical procedures according to the menstrual phase may serve to reduce the incidence of PONV and metamizol/ondansetron consumption and hospital costs.