Is depression associated with glucose tolerance abnormality in pregnant women? A cross-sectonal study.

This study aims to examine the association between glucose tolerance abnormality and depression and anxiety in pregnant women. One hundred and sixty-seven women with gestational ages ranging from 24 to 28 weeks were screened with the 50 g oral glucose challenge test. All participants were assessed with the Beck Depression Inventory and the Beck Anxiety Inventory. The rate of depression was higher in women with abnormal glucose results (44.3%) than in women with normal glucose results (21.7%). Similarly, depressed women had higher glucose levels than non-depressed women. Findings suggest that depression and anxiety may be associated with glucose tolerance abnormality in pregnant women.

Malignant Brenner tumor of the ovary: analysis of 13 cases.

OBJECTIVE: Most Brenner tumors are benign, with only 1% being malignant. In this study we report on 13 cases with malignant Brenner tumor of the ovary and discuss the clinical, demographic and histologic features. METHOD: Thirteen patients with malignant Brenner tumor of the ovary who were treated at Selçuk University Gynecology Department over a 6-year period from January 2004 to December 2010 were retrospectively analysed from hospital electronic medical records. Clinical and pathologic findings were reported. RESULTS: The median age of the study population was 55.69 ± 11.81 years (range 43-79 years). Most of the patients presented with abdominal pain (6/13, 46.2%). The mean size of the ovarian tumors was 9.19 ± 1.34 cm (range 4-16.5 cm). Six patients (46.2%) were in stage III, five (38.5%) in stage I, and two (15.4%) in stage IV. Ten patients (76.9%) received chemotherapy. The mean follow-up was 38.38 ± 23.25 months (range 5-84 months). During follow-up, recurrence was detected in 7 patients (53.8%). The mean recurrence time was 23.8 ± 14.46 months (range 11-48 months). CONCLUSION: In our study, we found that diagnosis was at an advanced stage, and recurrence rate was high. The mainstay of treatment is surgical resection, but the exact regimen and benefit of adjuvant therapy remain unknown.

Ovarian cancer during pregnancy.

OBJECTIVE: To evaluate the clinical features, pregnancy outcome, and treatment of patients with ovarian cancer diagnosed during pregnancy. METHODS: The present study was a retrospective review of 11 cases of ovarian cancer detected during pregnancy. The women were treated and followed up at Selçuk University, Meram Faculty of Medicine, Konya, Turkey, during 2006-2010. RESULTS: Approximately half the patients were asymptomatic (5 [45.5%]) and diagnosed during cesarean delivery (6 [54.5%]). The histopathologic tumor categories comprised malignant epithelial ovarian tumor (4 [36.4%]), borderline tumor (4 [36.4%]), malignant germ cell tumor (2 [18.2%]), and sex cord stromal tumor (1 [9.1%]). Nine (81.8%) tumors were classified as stage I. Conservative surgery was performed in 10 (90.9%) patients. A patient with stage IIIC serous papillary adenocarcinoma underwent hysterectomy with bilateral salpingo-oophorectomy. A patient with dysgerminoma in stage IV died on follow-up. Three infants were born premature; they were followed up in the neonatal intensive care unit with satisfactory outcomes. CONCLUSION: Early diagnosis and appropriate treatment are crucial for patients with ovarian cancer diagnosed during pregnancy. Tumor staging is possible during pregnancy, but the appropriateness of surgery needs to be considered carefully. Ideally, the treatment strategy should be discussed and structured on an individual basis.

Are major depression and generalized anxiety disorder associated with intrauterine growth restriction in pregnant women? A case-control study.

OBJECTIVE: This study examined the prevalence of major depression and generalized anxiety disorder in pregnant women with and without a diagnosis of intrauterine growth restriction (IUGR). METHOD: The study sample included 56 pregnant women with a diagnosis of IUGR and 92 control subjects. IUGR was determined by means of ultrasound assessment and was defined as estimated fetal weight, by ultrasound scan, which falls below the 10th percentile for the gestational age. Psychiatric evaluations were performed with depression and anxiety symptom scales and with structured clinical interviews. RESULTS: Pregnant women with IUGR had higher scores of depressive and anxiety symptom scores and had a higher prevalence rate of major depression and generalized anxiety disorder. CONCLUSIONS: According to the results of the present study, both major depression and generalized anxiety disorder appear to be associated with IUGR in pregnant women.

A new technique for the treatment of transverse vaginal septum by Foley catheter.

We report a new surgical technique for the management of transverse vaginal septum in a 13-year-old girl who presented with abdominal pain. Imaging techniques yielded hematocolpos. The patient and her family refused vaginal surgery in order to preserve hymenal integrity for sociocultural beliefs. At laparotomy, a vertical incision was made on posterior vaginal wall. An artery forceps was introduced from the hymenal opening while preserving the hymenal integrity. The septum located on the upper third of vagina was perforated by the help of a forceps introduced from posterior vaginal wall via an abdominal route. A Foley catheter was introduced from the introitus toward the septal perforation and was held by the forceps. The balloon of the catheter was placed on the perforated septum and it was insufflated with 10 ml of fluid. The Foley catheter was in place for 2 weeks. After removal of the catheter, she received oral contraceptive pills for 3 months postoperatively. She had regular spontaneous menses on follow-up for 6 months duration.

[Cardiac autonomic function and cardiac arrhythmias in patients with obstructive sleep apnea]. / Tikayici uyku apneli hastalarda kardiyak otonomik fonksiyonlar ve kardiyak aritmi.

OBJECTIVES: We assessed the effect of obstructive sleep apnea syndrome (OSAS) on cardiac autonomic function with the parameters of heart rate variability (HRV) and heart rate turbulence (HRT) and investigated the frequency of cardiac arrhythmias in patients with OSAS. STUDY DESIGN: Seventy-six patients (27 women, 49 men; mean age 50.6±10.7 years; range 33 to 75 years) with an initial diagnosis of OSAS underwent polysomnography and simultaneous Holter monitoring. The diagnosis of OSAS was based on an apnea-hypopnea index (AHI) of ≥5. The patients were evaluated with time-and frequency-based parameters of HRV, and turbulence onset (TO) and turbulence slope (TS) parameters of HRT. Cardiac arrhythmias were also assessed on Holter monitoring. RESULTS: Fifty-three patients (69.7%) were diagnosed with OSAS, being mild in 25 (47.2%), moderate in 23 (43.4%), and severe in five (9.4%) patients based on the AHI. The patients were divided into two groups as those having an AHI of <5 (n=23) and ≥5 (n=53). There were no significant differences in HRV parameters between the two groups, but patients with OSAS exhibited a significantly higher TO (p=0.02) and a significantly lower TS (p<0.001). In bivariate correlation analysis, AHI showed a significant negative correlation with TS (r=-0.37, p=0.009) and a significant positive correlation with TO (r=0.36, p=0.01). The frequencies of short-sequence premature atrial and ventricular contractions were significantly higher in patients with OSAS (p<0.001). CONCLUSION: Our findings suggest that blunting of HRT is more prominent than changes in HRV parameters in patients with OSAS, accompanied by increased frequency of cardiac arrhythmias.

Cotyledonoid dissecting leiomyoma of the uterus with intravascular growth in postmenopausal woman: a case presentation.

Cotyledonoid dissecting leiomyoma ("Sternberg tumor") is an unusual type of a benign uterine smooth-muscle tumor with a distinctive gross appearance. A 57-year-old woman (gravida 7, para 6), in menopause for 3 years, presented with a 3-4-year history of increased pelvic pain. The transvaginal ultrasound scan showed a 2.5 cm sized heterogenic mass in the uterus cavity and 4 × 5 cm sized irregular contoured mass in the right lateral aspect of the uterus. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed with removal of the pelvic tumor extension. Definite pathologic examination result was cotyledonoid dissecting leiomyoma of the uterus with intravascular growth. The patient is receiving follow-up care every 6 months, and she has no evidence of disease after 22 months of follow-up. The worrying appearance of the gross specimen is often mistaken for malignant or non-uterine lesions that may result in overtreatment. It is important to be aware of this entity to prevent overly aggressive treatment for this benign smooth-muscle neoplasm.

Uterine smooth muscle tumors of uncertain malignant potential: a case presentation.

A 42-year-old virgin woman was admitted to our clinic with increasing menorrhagia and dysmenorrhea for several months. A pelvic ultrasound scan showed a 9 × 7 cm heterogeneous mass in the uterine cavity. Pelvic magnetic resonance imaging showed a large non-homogeneous tumor mass measuring 97 × 56 mm in the uterine cavity. After intravenous contrast material, cystic necrotic areas with marked contrast enhancement were observed in the solid lesion. Tumor markers were all within normal ranges. The patient underwent laparotomy, and total hysterectomy and bilateral salpingo-oophorectomy were performed. Our case was diagnosed as uterine smooth muscle tumor of uncertain malignant potential (STUMP). The patient was put on a close clinical follow-up schedule, and is doing well without recurrence in 2 years later. Patients with STUMP should be counseled regarding the potential for recurrence as leiomyosarcoma, and may require closer surveillance than a yearly examination and may need a consultation with a gynecologic oncologist.

The effect of taurolidine on experimental thrombus formation.

Venous thrombosis can be the source of emboli, a significant health risk encountered throughout surgical and medical clinics. Taurolidine is an antimicrobial agent used to prevent intraabdominal adhesion formation and sepsis in experimental and clinical trials. The aim of this study is to evaluate effect of taurolidine on experimental thrombus formation and make a comparison with low-molecular weight heparin. Four groups of ten Wistar-Albino rats (300-350 g) were used; with the first and second groups each being administered 10 and 20 mg of taurolidine, the third group low-molecular weight heparin and the fourth group saline solution (control group) respectively. Experimental thrombus formation was performed in rats in the area of the abdominal inferior vena cava by using a combination of stasis and hypercoagulability described by Wessler et al. [Wessler, S., Reimer, S.M., Sheps, M.C., 1959. Biologic assay of a thrombosis inducing activity in human serum. J. Appl. Physiol. 14:943-946.]. Thrombocyte count, the weight of thrombus, prothrombin time and activated partial thromboplastin time and activities of coagulation factors were measured and compared across groups. Thrombus weights in the taurolidine treated groups were lower than the control group and greater than the low-molecular weight heparin treated group. Taurolidine was found to decrease activities of coagulation factors V, VIII, IX, XI and XII. Taurolidine showed no effect on activated partial thromboplastin time and prothrombin time values; however, it decreased thrombus weight, but not as much as low-molecular weight heparin. The cause of these findings in our study may be related to the minimized effect of taurolidine on factor II, VII, and X activities. These effects likely render the agent ineffective in the prevention of venous thrombosis. Taurolidine was found to be less effective than low-molecular weight heparin in prevention of thrombus formation.