Management of parapneumonic effusion in pregnant women.

Pneumonia and parapneumonic effusion (PPE) are not more common in pregnant women compared to normal population. Pneumonia is considered the second most common infection in pregnant women. PPE is a serious complication of pneumonia and occurs especially in case of treatment delay or inappropriate antibiotic selection. The data on the management of PPE in pregnant women is limited to few case reports.

Pseudocholinesterase in gestational diabetes: positive correlation with LDL and negative correlation with triglyceride.

OBJECTIVE: Low pseudocholinesterase (PChE) activity accompanies pregnancy, liver disease, renal failure, and certain drug therapies. The aim of this study was to investigate a possible relationship among PChE and plasma insulin levels, lipid profile, and inflammatory response ingestational diabetes. METHODS: This study included 165 women aged 20­40 years. Subjects were divided into four groups as follows:Control group, 29 non-pregnant healthy women; GroupNGT, 61 healthy pregnant women (normal glucose tolerance);Group GD, 62 pregnant women with gestational diabetes; and Group AGT, 13 pregnant women with abnormal glucose tolerance. Gestational ages were between 34 and 40 weeks. Plasma PChE, triglyceride, high-/lowdensity lipoprotein (HDL, LDL), glycated hemoglobin A1c(HbA1c), insulin, C-reactive protein (CRP), and white blood cell (WBC) levels were measured in all subjects. RESULTS: There were no statistically significant differences in plasma PChE, insulin, and LDL levels between the groups. Plasma triglyceride, HbA1c, WBC, and CRP levels were significantly higher in Group GD and Group AGT compared to the other groups (P\0.000). There was a positive correlation between increased PChE and LDL,while a negative correlation was observed between PChE and triglyceride in Group GD. There was a positive correlation between increased CRP and HbA1c and a negative correlation among CRP and LDL and triglyceride in Group GD. CONCLUSION: PChE activity was not significantly different between the groups. However, there was a positive correlation between PChE and LDL levels in pregnant women with GD, suggesting that LDL levels in pregnant women with GD may help to predict the risk of prolonged apnea in situations in which PChE activity cannot be measured.

Intraoperative frozen section is essential for assessment of myometrial invasion but not for histologic grade confirmation in endometrial cancer: a ten-year experience.

PURPOSE: To evaluate the accuracy of endometrial biopsy (EB), transvaginal ultrasonography (TVS) and intraoperative frozen section (FS) for assessment of myometrial invasion and histologic grade to predict more conservative surgery in endometrial carcinoma. METHODS: Demographic and clinical data of 220 patients with endometrial carcinoma were retrospectively reviewed. Preoperatively, the subjects were evaluated by EB and TVS. Intraoperatively, FS was also performed to evaluate histological grading and myometrial invasion. All patients underwent surgical-pathological staging after removal of the uterus, adnexa and pelvic lymph nodes. Sensitivity and specificity values were calculated for EB, TVS and FS with regard to detection of histological grading and neoplastic invasion of the myometrium according to the final histopathologic examination. RESULTS: Bilateral pelvic and common iliac lymphadenectomy was performed in 80 patients without performing intraoperative biopsy because of preoperative high risk. Evaluation of the tumor grade by preoperative EB showed a sensitivity, specificity and accuracy of 73, 97 and 91%, respectively. Evaluation of the tumor grade by intraoperative biopsy showed a sensitivity, specificity and accuracy of 73, 96 and 90%, respectively. Evaluation of the depth of myometrial invasion with TVS showed a sensitivity, specificity and accuracy of 52, 91 and 79%, respectively. Evaluation of the depth of myometrial invasion with intraoperative biopsy showed a sensitivity, specificity and accuracy of 86, 94 and 92%, respectively. CONCLUSIONS: Evaluation of the histologic grade by EB and of the depth of myometrial invasion by intraoperative biopsy is a good option for deciding the necessity of lymphadenectomy.

Seroprevalence of hepatitis B among pregnant women in southern Turkey.

The aim of the present cross sectional seroprevalence study was to determine the frequency of HBV carriers in pregnant women registered at the Gaziantep Maternity Hospital, Turkey. The records of a total of 11,840 pregnant women were examined retrospectively. HBsAg was detected in 252 (2.1%) of 11,840 women. The prevalence of HBV infection in pregnant women in the southern region of Turkey is at an intermediate level. The observed low seroprevalence might be attributed to the lower mean age of the study population compared to the adult population.

No association between serum paraoxonase, arylesterase activities, and hydatidiform mole.

BACKGROUND: In this study, we aimed to evaluate the association between hydatidiform mole (HM) and paraoxonase 1 (PON1) activity and phenotyping in comparison with healthy subjects (both pregnant and nonpregnant women). METHODS: Eighty women were enrolled in this study. Of these, 26 had HM (group 1). Twenty-seven healthy women in the first trimester of pregnancy with a single viable fetus were included in the study as control subjects (group 2). The remaining 27 subjects were healthy nonpregnant women who also participated as control subjects (group 3). Paraoxonase and arylesterase activities were measured using commercially available kits (Relassay, Gaziantep, Turkey). Paraoxonase activity measurements were performed both in the absence (basal activity) and presence of NaCl (salt-stimulated activity). The phenotype distribution of PON1 activity was determined by the double-substrate method. RESULTS: Basal and salt-stimulated paraoxonase and arylesterase activities were not significantly different between the HM, healthy pregnant control, and healthy nonpregnant control groups. Hence, PON1 phenotype distribution of the subjects was not significantly different between these 3 groups. CONCLUSIONS: We determined no association between HM (complete or partial) and PON1 activity and phenotyping in comparison with pregnant and nonpregnant healthy subjects. Further studies including metastatic or invasive HM are needed.

The prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in the endocervical swab specimens of symptomatic, asymptomatic and infertile women in Turkey.

PURPOSE: To investigate C. trachomatis and N. gonorrhoeae prevalence in three different female populations in Turkey. METHODS: A total of 370 women, 170 symptomatic, 100 asymptomatic, and 100 infertile, were included. Of the endocervical specimens collected from all women using a Dacron swab, the first one was taken to Stuart's transport medium to culture, while the second one was transferred onto slides to perform direct fluorescent antibody test (DFA) and Gram staining, and the third specimen was used for Becton Dickinson BDProbeTec ET system (BDPT). RESULTS: C. trachomatis was detected in 5.16% of symptomatic, 1.11% of asymptomatic, and 2.15% of infertile women with BDPT. Sensitivity and specificity of the DFA test were 72.73 and 97.85%, respectively. N. gonorrhoeae was detected in 2.42% of symptomatic and in 1.02% of infertile women. N. gonorrhoeae was not detected in any asymptomatic women. In N. gonorrhoeae-positive patients, sensitivity and specificity of culture were 60 and 100%, respectively, while they were 80 and 100% for BDPT. CONCLUSIONS: Prevalence of N. gonorrhoeae and C. trachomatis was detected to be low in Turkish women, and the difference between the groups was not significant. Both agents were more prevalent in subjects over 25 years of age.

Homocysteine, folic acid and vitamin B12 levels in maternal and umbilical cord plasma and homocysteine levels in placenta in pregnant women with pre-eclampsia.

AIM: The aim of this study was to evaluate maternal and fetal serum levels of homocysteine, folic acid, vitamin B12 and placental tissue levels of homocysteine and their association with severity of pre-eclampsia. MATERIAL & METHODS: A case-control study, performed by a single center, included 26 pregnant women with mild pre-eclampsia, 26 pregnant women with severe pre-eclampsia and 26 healthy pregnant women. Maternal blood was collected before delivery and fetal blood was collected from the umbilical cord at delivery. Placental tissue samples were obtained after delivery of placenta. Homocysteine, folic acid, vitamin B12 levels in serum and homocysteine levels in placental tissue homogenates were analyzed by immunochemiluminescent assay. RESULTS: Homocysteine levels in both maternal and fetal serum were significantly higher in the severe pre-eclampsia group compared to mild pre-eclampsia and control groups. However, homocysteine levels in both maternal and fetal serum were not significantly different between mild pre-eclampsia and control groups. No significant differences were observed in folic acid and vitamin B12 levels in both maternal and fetal serum between the groups. Homocysteine levels in placental tissue homogenates were too low to be measured in the three groups (<2 µmol/l). CONCLUSION: Maternal and fetal serum homocysteine levels were found to be significantly higher in severe pre-eclampsia group compared to mild pre-eclampsia and control groups suggesting that elevated serum levels of homocysteine might be associated with severity of pre-eclampsia. On the other hand it seems like elevated serum homocysteine levels were not associated with deficiency of folic acid and vitamin B12.

Association of endothelial nitric oxide synthase gene polymorphisms with endometrial carcinoma: a preliminary study.

OBJECTIVE: To investigate the relationship between specific endothelial nitric oxide synthase (eNOS) gene polymorphisms and endometrial cancer (ECa). MATERIAL AND METHODS: The study group consisted of 89 patients histologically diagnosed with the endometrioid type of endometrial carcinoma. The control group consisted of 60 randomly selected individuals who had undergone total hysterectomy. Genomic DNA was isolated from paraffin-embedded endometrial tissues. We investigated the G894T polymorphisms (G894T) and variable number tandem repeats polymorphisms in intron 4 (VNTR intron 4) in the eNOS gene by using polymerase chain reaction (PCR) and/or restriction fragment length polymorphism (RFLP). The genotype distributions and allele frequencies of the two groups were compared. RESULTS: Analysis of the VNTR intron 4 polymorphisms in eNOS gene revealed that the frequency of the AA genotype was significantly higher in the control group, whereas the frequency of the BB genotype was significantly higher in the ECa group. Analysis of the G894T polymorphisms in eNOS gene revealed a significantly higher frequency of the GG genotype in the control group but a significantly higher frequency of the TT genotype in the endometrial cancer group. CONCLUSION: The G894T and VNTR intron 4 polymorphisms in eNOS gene could be an intriguing susceptibility factor that modulates an individual's risk of ECa in the Turkish population.

Association between urotensin II gene polymorphism and pre-eclampsia.

OBJECTIVE: To investigate the association of a specific polymorphism (S89N) in exon 3 of the urotensin II (UTS2) gene in pre-eclampsia. STUDY DESIGN: One hundred and forty-two subjects, 85 with a diagnosis of pre-eclampsia/eclampsia (group I) and 57 healthy pregnant subjects as a control group (group II), who had been admitted between January 2006 and December 2007, were included. All the subjects were tested for G to A transition in codon 266 in the urotensin II gene by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The distributions of genotypes and allele frequencies were compared between the groups. RESULTS: Demographics such as age, gestational age, gravidity, abortion and parity were similar in both groups (p > 0.05). No statistically significant differences were observed between the groups concerning genotype distribution and allele frequency (p = 0.305, p = 0.326, respectively). The observed genotype counts did not deviate significantly from those expected according to the Hardy-Weinberg equilibrium (HWE). CONCLUSION: The results of this study suggest that UTS2 single gene (S89N) polymorphism is not associated with pre-eclampsia. Further studies are needed to investigate the prevalence of other single nucleotide gene polymorphisms in pre-eclampsia.

Dicephalic parapagus conjoined twins: a rare second trimester sonographic diagnosis.

Conjoined twins are 1 of the rarest and most challenging congenital malformations. It occurs if twinning is initiated after the embryonic disc and rudimentary amniotic sac have been formed. We report a very rare case of dicephalic parapagus that was diagnosed by transabdominal sonography.

Morgagni hydatids: a new factor in infertility?

PURPOSE: To evaluate the effect of Morgagni hydatid (MH) on infertility by comparing women known to be fertile and infertile with respect to MH frequency. METHODS: The study was conducted in Gaziantep University Faculty of Medicine with the precipitation of total 455 patients. The 240 of them were pregnant to whom planned cesarean section (C/S) and the other 215 were infertile one who have undergone diagnostic laparoscopy. Fertile Group (Group 1) consisted of women whom have become spontaneously pregnant without any kind of infertility management. These are planned to undergo C/S with different indications. Infertile group (Group 2) consisted of women diagnosed as unexplained infertility and planned to undergo diagnostic laparoscopy according to ASRM 2006 guidelines. The frequency, number, and the bilaterality of the MH were evaluated during the C/S in fertile group and diagnostic laparoscopy in infertile group. SPSS was used for statistical analyses. RESULTS: The MH frequency was higher in Group 2 than Group 1 (P < 0.05). The bilaterality of MHs were significantly higher in Group 2 than Group 1 (P < 0.05).The number of the MHs were significantly higher in Group 2 than Group 1 (P < 0.05). CONCLUSIONS: These findings suggest a possible effect of MH on fertility. The theory of MH disturbing tubal motility with respect to the pick-up and transport of ovum appears logical in this aspect.

The relationship of ceruloplasmin and neural tube defects.

OBJECTIVE: To compare the levels of ceruloplasmin (cp) in the amniotic fluids and maternal bloods of second trimester fetuses with and without neural tube defects (NTD). MATERIALS AND METHODS: 66 pregnant women were included in the study. Amniocentesis was performed in 32 women in a patient group diagnosed as NTD or anencephaly and 34 pregnants in a control group with positive Down Syndrome screening test. Maternal bloods were also taken. Cp was measured with Erel's ceruloplasmin measurement method. RESULTS: The cp levels of the amniotic fluid of patients and controls were not statistically different (p>0.05). The cp levels of the maternal bloods were not different in two groups (p>0.05). CONCLUSION: As an antioxidant, no relation was found between cp and NTD.

The relation between genitourinary prolapse and joint hypermobility in Turkish women.

OBJECTIVE: In this cross-sectional study, we compared frequency of hypermobility syndrome in pelvic organ prolapse (POP) patients and normal healthy Turkish women. METHODS: Sixty-five women who had diagnosed as POP and ward to surgery and 52 healthy women with similar age group were included into this study. RESULTS: It was found that subjects with POP had a significantly higher prevalence of joint hypermobility (53.8%) when compared with normal individuals (9.6%). No significant correlation was demonstrated between Beighton scores and incontinence, exercises pattern and hormone replacement therapy. CONCLUSION: We concluded that joint laxity is associated with POP but not with urinary incontinence in Turkish women.

The changes of plasma malondialdehyde, nitric oxide, and adrenomedullin levels in patients with preeclampsia.

OBJECTIVE: The aim of the study was to investigate the role of malondialdehyde, nitric oxide and adrenomedullin in the etiopathogenesis of preeclampsia. MATERIAL AND METHODS: Forty-two pregnant women with preeclampsia and 30 healthy pregnant women were involved. The plasma concentrations of malondialdehyde, nitric oxide, and adrenomedullin were compared between the study group and the control group. RESULTS: In women with preeclampsia the plasma concentrations of malondialdehyde was higher while nitric oxide and adrenomedullin concentrations were lower compared to control subjects. CONCLUSION: We concluded that the plasma levels of ADM and NO are decreased while MDA levels are increased in subjects with preeclampsia and that might contribute to the pathophysiology of preeclampsia through the lack of a paracrine vasodilatory effect on uteroplacental blood flow.

CA-125 and CRP are elevated in preeclampsia.

OBJECTIVE: To determine the relationship between the cancer antigen-125 (CA-125) and C-reactive protein (CRP) with preeclampsia and eclampsia. METHODS: The study group included 54 preeclamptic/eclamptic women, and 56 healthy pregnant women served as the control group. Mean arterial pressure (MAP) and albumin levels were used to monitor the severity of disease. CRP and CA-125 levels were determined. The cut-offs for CRP and CA-125 were 5 mg/L and 35 IU/ml. The t-test, Pearson correlation and ANOVA were used for statistical analysis. Values of p < 0.05 were considered to be significant. RESULTS: CRP and CA-125 parameters were significantly higher in the study group (p < 0.001), and were significantly higher in severe preeclampsia and eclampsia groups than in mild preeclampsia (p < 0.001). Significant correlations were found between CRP/MAP, CRP/albumin, CA-125/MAP and CA-125/albumin (p < 0.001). CONCLUSION: CRP and CA-125 are elevating markers in preeclampsia.

The effect of Ramadan fasting on maternal serum lipids, cortisol levels and fetal development.

OBJECTIVE: To determine the effects of fasting during the month of Ramadan on fetal development and maternal serum cortisol and lipid profile. METHODS: This study was performed in Obstetrics and Gynecology Department of Gaziantep University Hospital, between 23 September 2006 and 23 October 2006 (during the month of Ramadan). Thirty-six consecutive healthy women with uncomplicated pregnancies of 20 weeks or more, who were fasting during Ramadan, were included in the study group (group 1). The control group (group 2) consisted of 29 healthy pregnant women, who were not fasting during the study period. For evaluating Ramadan's effect on fetus, Doppler ultrasonography was performed on all subjects in the beginning and then once a week until the end of Ramadan for the following measurements: increase of fetal biparietal diameter (BPD), increase of fetal femur length (FL), increase of estimated fetal body weight (EFBW), fetal biophysical profile (BPP), amniotic fluid index (AFI), and umbilical artery systole/diastole (S/D) ratio. Maternal serum cortisol, triglyceride, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), very low density lipoprotein (VLDL), and LDL/HDL ratio were also evaluated before and after Ramadan. RESULTS: No significant difference was found between the two groups for the fetal age, maternal weight gain (kilogram), estimated fetal weight gain (EFWG), fetal BPP, AFI, and umbilical artery S/D ratio. In the fasting group, the maternal serum cortisol levels on day 20 were significantly higher than the initial levels obtained 1 week prior to Ramadan (p < 0.05). Although no significant increases were observed in total cholesterol and triglyceride levels in the fasting group, these increases were significantly higher than those in the control group (p < 0.05). LDL and VLDL levels showed a non-significant decrease at the end of the Ramadan. HDL levels showed a slight increase, but LDL/HDL ratios were significantly decreased in fasting group (p < 0.05). CONCLUSION: The results of this study showed that maternal serum cortisol level was elevated while LDL/HDL ratio were decreased in healthy women with uncomplicated pregnancies of 20 weeks or more, who were fasting during Ramadan. No untoward effect of Ramadan was observed on intrauterine fetal development.

Is pregnancy loss after amniocentesis related to the volume of amniotic fluid obtained?

OBJECTIVE: The objective was to determine whether pregnancy loss after amniocentesis is related to the amount of amniotic fluid obtained during the procedure. STUDY DESIGN: The study enrolled 2,400 women, all in their sixteenth to twentieth week of pregnancy. A 22G spinal needle was inserted for amniocentesis. The amount of amniotic fluid obtained from 1,200 patients in Group 1 was 4 ml and from 1,200 patients in Group 2 was 20 ml. In Group 1, the amniotic fluid was analyzed with a quantitative fluorescent polymerase chain reaction technique, whereas in Group 2, conventional cytogenetic analysis was used. SPSS 16.0 (chi-square and t tests) was used for statistical analyses. RESULTS: In Group 1, postamniocentesis premature rupture of membranes (PROM) occurred in four patients (0.3%). There was one unintended fetal loss and postamniocentesis miscarriage rate was 0.08%. In Group 2, postamniocentesis PROM occurred in 12 patients (1%). Eight of these patients experienced fetal loss (0.67%). Fetal loss rates were higher in Group 2 compared with Group 1. These results did not show statistical differences between the groups according to chi-square test (P>0.05). CONCLUSION: Although statistical analysis denies the positive effect of obtaining small amounts of amniotic fluid to reduce fetal loss rates in patients after amniocentesis, six to eight times lower fetal loss rates based on the amount of fluid obtained cannot be undervalued.

The risk of hepatotoxicity during long-term and low-dose flutamide treatment in hirsutism.

OBJECTIVE: Flutamide is an effective drug in treatment of hirsutism. Hepatotoxicity occasionally may occur with therapeutic doses (750-1500 mg/day), 3 months after initiation of treatment. Monitoring of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels is recommended to obviate serious hepatotoxicity. MATERIALS AND METHODS: Two hundred and fourteen patients with mean age of 20.9+/-2.34 years suffering from hirsutism were included in the study. Of these 214 women, 117 had diagnosis of polycystic ovarian syndrome (PCOS), and 97 had diagnosis of idiopathic hirsutism. Thirty age-matched (mean age 20.3+/-2.0 years) normal women without signs of hirsutism and with normal menstrual cycle served as control group. Hirsutism was assessed using modified Ferriman-Gallwey method at the beginning and at the end of the treatment. Serum levels of luteinizing hormone (LH), follicle stimulant hormone (FSH), prolactin (PRL), estradiol (E2), androstenodion (A), testosterone (T), dehydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEAS), dehydroepiandrosterone (DHEA), 17-hydroxyprogesterone (17-P), sex hormone binding protein (SHBG), and ACTH were measured. Pelvic ultrasonography was performed for diagnosis of PCOS. Fifty-seven patients with PCOS (group 1) were given flutamide 125 mg/day + oral contraceptive. Sixty patients with PCOS (group 2) were given flutamide 250 mg/day + oral contraceptive. Forty-seven patients with IH (group 3) were given flutamide 125 mg/day alone, and 50 patients with IH (group 4) were given flutamide 250 mg alone. Thirty women in control group (group 5) were given placebo only. ALT and AST levels were measured in the beginning of the treatment, and repeated after 3, 6, 9 and 12 months. RESULTS: No incidence of increase in AST or ALT levels (>or= 45 U/L) was observed in any of the groups. No evidence of hepatotoxicity in any of the 214 hyperandrogenic women was observed on low-dose flutamide for 1 year. CONCLUSION: We conclude that flutamide in a dosage of 125 or 250 mg daily is a safe drug in the long-term treatment of hirsutism. The follow-up of patients receiving flutamide can be done by monitoring AST or ALT levels for hepatotoxicity.

Malondialdehyde, nitric oxide and adrenomedullin levels in patients with primary dysmenorrhea.

AIM: The aim of the study was to examine whether there was a relationship between primary dysmenorrhea and serum levels of malondialdehyde (MDA), nitric oxide (NO) and adrenomedullin (AM) in young women. METHODS: Sixty female subjects without serious medical problems, aged between 20 and 34, who had regular menses for at least six previous cycles, were involved. Blood samples were obtained from each patient on the first and the 21st days of her menstrual cycles. Pelvic examination and ultrasound were performed to determine any organic cause for dysmenorrhea in each patient. The subjects were divided into two groups. The study group consisted of 30 subjects with primary dysmenorrhea, and the control group consisted of 30 healthy subjects. RESULTS: No statistically significant difference was observed in comparison of the following variables between the groups: age, parity and body mass index. The serum levels of MDA, NO, and AM were significantly higher on the first day compared to those on the 21(st) day in the study group (P < 0.05). The serum levels of MDA, NO, and AM were significantly higher in the study group compared to the control group both on the first and the 21st days of the menstrual cycles (P < 0.05). CONCLUSION: In conclusion, the results of this study showed that the serum levels of MDA, NO, and AM increase in subjects with primary dysmenorrhea, suggesting the possibility that lipid peroxidation and oxidative stress play a significant role in the etiopathogenesis of primary dysmenorrhea.

Effect of fasting during Ramadan on fetal development and maternal health.

AIM: The aim of the present study was to determine whether fasting during Ramadan causes ketonemia and/or ketonuria and their effects on fetal intrauterine development. METHODS: Thirty-six consecutive healthy women with uncomplicated pregnancies of >or=20 weeks of gestation who were fasting during Ramadan were included in the study group (group 1). The control group (group 2) consisted of 29 healthy pregnant women who were not fasting. Doppler ultrasonography was performed in all subjects in the beginning and at the end of Ramadan to evaluate the changes in the following measurements: fetal biparietal diameter; fetal femur length; and estimated fetal body weight. Fetal biophysical profile, amniotic fluid index, and umbilical artery systole/diastole ratio were measured in the beginning and at the end of Ramadan. Effects of fasting on the mother were evaluated by measuring serum concentrations of 3ss hydroxybutyrate and glucose, and urinary concentration of ketone. Subjects with any of the followings were excluded: diabetes; thyroid dysfunction; Cushing's syndrome; adrenal disease; pre-eclampsia; and multiple pregnancy. RESULTS: The mean duration of fasting in the study group was 18 +/- 2.1 days. The mean maternal glucose level was significantly lower in the study group than in the control group (P = 0.003). No statistically significant differences were found between the two groups in the comparisons of other parameters. CONCLUSION: We concluded that fasting during Ramadan does not lead to maternal ketonemia or ketonuria in pregnant women. In addition, fasting during Ramadan has no significant adverse effect on intrauterine fetal development or the fetus's health.