Evaluation of sialic acid levels in patients with hydatidiform mole: a preliminary study.

PURPOSE OF INVESTIGATION: This study aims to investigate whether hydatidiform mole (HM) disease with malignant potential is significantly associated with increased sialic acid (SA) levels. MATERIALS AND METHODS: A total of 114 women were enrolled in this study. Patients were divided into three groups including HM (Group 1, n = 34), control group including non-pregnant healthy patients (Group 2, n = 42), and another control group including healthy pregnant patients within 12 weeks of gestation (Group 3, n = 38). Serum-free SA levels were measured. RESULTS: There was a statistically significant difference in serum-free SA levels among the groups (p ≤ 0.001). Patients with HM had significantly higher levels compared to the control groups. CONCLUSION: The present study results showed that there was a significant correlation between HM and serum SA level.

An analysis of hysteroscopy experience over a seven-year period.

PURPOSE OF INVESTIGATION: Over the years, hysteroscopy has been increasingly performed for various gynecological disorders. In this study, we present a review of hysteroscopic procedures performed over a 7-year period. METHODS: Five hundred and eighty hysteroscopic procedures performed at the Department of Gynecology and Obstetrics, University of Gaziantep, Turkey from 2002 to 2009 were reviewed particularly highlighting the preoperative indications, postoperative diagnoses and complications associated with the procedure retrospectively. RESULTS: The most common indication for diagnostic hysteroscopy was infertility followed by AUB. The most common pathologies for referal to operative hysteroscopy were uterine septum, endometrial polyps, Asherman's syndrome, submucous myomas, and other uterine anomalies. The complication rate was 0.86% of the total hysteroscopies. False passage and uterine perforation were the most common acute complications. No late complications occurred. CONCLUSION: Our data is consistent with reports from other studies supporting that hysteroscopy is a safe and effective minimally invasive procedure with a low rate of complications with certain surgical principles.

Role of dietary habits on fetal anomaly development: review of 315 consecutive fetal anomaly cases.

OBJECTIVE: This study aimed to investigate and speculate on the dietary habits and certain environmental factors of the Southeast Anatolia region which are thought to be related with fetal anomaly development. MATERIALS AND METHODS: Patients admitted to Gaziantep University Faculty of Medicine Obstetrics and Gynecology Department with fetal anomalies between January 2003 and June 2007 were evaluated. Three hundred and fifteen patients with intrauterine fetal anomaly were detected. The number of total deliveries during this period were 7,554. Twenty-eight of the patients were above the age of 35. According to the history of patient, mean gravidity was 6.6 (1-13), consanguineous marriage rate was 25%, previous abnormal rate was 15%, and previous missed abortion was 35%. Eighty-eight percent of patients were of low sociocultural status. The frequency of daily dietary habits, especially tea consumption, red chili pepper consumption and eating barbecued meat were questioned with the anamnesis. RESULTS: Total fetal anomaly incidence was found to be 4.17%, neural tube defects 1.37%, renal anomalies 0.54%, non-immune fetal hydrops 0.46%, cystic hygroma 0.39%, central nervous system anomalies 0.36%, chromosomal anomalies 0.17%, gastrointestinal system anomalies 0.147%, sacrococcygeal teratoma 0.12%, cardiac anomalies 0.09%, and respiratory system anomalies 0.049%. Mean daily tea comsumption during pregnancy was 8 cups/day. Mean frequency of eating barbecued meat was 4 times/week. Mean chili pepper consumption was 10 g/day. CONCLUSION: In this study, four times higher overall fetal anomaly incidence appeared to be strongly correlated with Southeast Anatolia region's dietary habits. In the future monitoring women's dietary habits should have an important role in the prevention of fetal anomaly development.

Two cases of uterine septum with intrauterine device.

Intrauterine devices (IUDs) have been used worldwide for contraception for decades. They are easily deployed, inexpensive and one of the most reliable contraceptive methods. Though ease of placement is such that they are frequently placed by midwives in the outpatient setting in developing countries, some complications due to its misplacement occasionally can occur. We present two cases with unknown uterine septum in which IUDs were placed without prior ultrasound examination of the pelvis. We conclude evaluation of the pelvis by ultrasound prior to placement of IUDs in women with a history of breech presentation, preterm labour, or recurrent miscarriage may be helpful in identifying uterine anomalies that make IUD placement unsuitable.

Is there a change in serum CA-125 levels after laparoscopy?

There is no adequate data in the medical literature defining serum CA-125 levels after laparoscopy. Therefore we designed this prospective study to evaluate the effects of laparoscopy on serum CA-125 levels. Eighty-two women (mean age 34.2 +/- 12.30 years) were included in the study between January, 2001 and April, 2003. Laparoscopies were performed in patients with chronic pelvic pain, dysmenorrhea, infertility, ovarian cysts and for tubal ligation. Mean serum CA-125 levels of the patients before and after the laparoscopic procedures were 13.96 +/- 4.86 U/ml and 14.02 +/- 4.96 U/ml, respectively. The change in serum CA-125 levels prior to laparoscopy was statistically insignificant when compared with the levels obtained at 24 hours after laparoscopic procedure (p > 0.05). We found that diagnostic laparoscopy or laparoscopic surgical procedures did not change the levels of CA-125 at the 24th hour after laparoscopy indicating either serum CA-125 levels are not correlated, at least within 24 hours, with peritoneal irritation or peritoneal irritation is minimal or absent in our operations.

Unthreatened late pregnancy with a huge mucinous cyst adenoma of the left ovary: report of an unusual case.

Benign cystadenomas or cystic teratomas are most frequently diagnosed in pregnancy. In the latter half of pregnancy ovarian tumors are particularly difficult to diagnose. In this report we present a case of a huge mucinous cyst adenoma of the ovary diagnosed in the 26th week of pregnancy. To our knowledge this is the first report of a case of unthreatened late pregnancy with a huge mucinous cyst adenoma of the ovary.

Ruptured heterotopic pregnancy: a report of unusual acute abdominal syndrome in two cases.

A heterotopic pregnancy is in effect a multiple pregnancy with one or more intrauterine pregnancies coexisting with an ectopic pregnancy. Prompt diagnosis, rapid fluid and blood resuscitation, heart-sparing anesthesia and gentle, expeditious surgery collectively contribute to a favorable outcome for the mother and fetus in patients with a ruptured tubal pregnancy. In this report we present two cases of heterotopic pregnancies with ruptured tubal components; one spontaneous and the other one after clomiphene citrate treatment. Explorative laparotomy and salpingectomy were performed in both patients. After surgery, the intrauterine pregnancies were not damaged, and were still healthy on progression.

A study of prolidase in mothers, their newborn babies and in non-pregnant controls.

The prolidase activity in serum and in erythrocytes was measured in 28 healthy mothers and in the cord blood of their newborn babies in using a modified Chinard method. 45 healthy non-pregnant women aged between 15-36 years formed a control group. Biochemical parameters (CK, BUN, C-peptid, AFP, Uric acid) were also measured. The serum and erythrocyte prolidase activities in maternal blood were 45.8+/-13.4 U/L and 37.8+/-2.7 U/g Hb respectively. There was no significant difference in the enzyme activities between pregnant women and the control group (p>0.05). However serum and erythrocyte prolidase activity in cord blood (20.3+/-8.2 U/L and 31.6+/-7.3 U/g Hb) was significantly different when compared with control group (53.4+/-14.7 U/L in serum and 42.3+/-10.3 U/g Hb in erythrocyte, p<0.001). There was a significant correlation between maternal and cord blood serum enzyme activity (r: 0.76 p<0.01). This correlation was also shown in erythrocyte prolidase activities of both groups (r: 0.49, p<0.05). Cord blood prolidase activity was positively correlated with birth weight (r: 0.89, p<0.01). Prolidase activity in cord blood was low even though collagen turnover is increased in fetal growth.

Bilateral primary squamous cell carcinoma of the ovary: a case report of isolated metastasis to the lateral pelvic wall.

Primary squamous cell carcinoma of the ovary is rare. The majority of cases arise most commonly from the lining of a dermoid cyst, and less often in endometriosis or a Brenner tumor. A 40-year-old woman underwent exploratory laparotomy and was found to have a right ovarian tumor adherent to the lateral pelvic wall with no ascites. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic lymphadenectomy, infracolic omentectomy, appendectomy, and right nephrectomy for bilateral primary squamous cell carcinoma of the ovary. She was started on multiagent chemotherapy. On follow-up after two years the patient had died of cerebral metastases. To our knowledge in this report we present the first case in the English literature of bilateral pure squamous cell carcinoma of the ovary.

Huge primary mucinous cystadenoma of the retroperitoneum mimicking a left ovarian tumor.

Primary mucinous cystic tumors of the retroperitoneum are rarely encountered and have been reported in approximately 25 cases in the literature. The histogenesis of primary mucinous cystadenomas is not clear. Most authors suggest that it develops through mucinous metaplasia in a pre-existing mesothelium-lined cyst. Surgery is the only treatment. In this report we present an additional case of primary retroperitoneal mucinous cystadenoma in a 44-year-old female.

Ruptured granulosa cell tumor of the left ovary and mature cystic teratoma of the right ovary: a case report of unusual acute abdominal syndrome.

Although granulosa cell tumor combined with a dermoid cyst in the same ovary is rarely seen, adult granulosa cell tumor of the ovary with contralateral teratoma has not been reported to date. In this report we present the first case in the English language literature of a ruptured granulosa cell tumor of the left ovary and mature cystic teratoma of the right ovary presenting as acute abdominal syndrome. The patient underwent total abdominal hysterectomy, bilateral-ophorectomy, and multiple pelvic lymph node sampling and infracolic omentectomy. She received combined chemotherapy consisting of bleomycin, etoposide. and cisplatin for six cycles. Subsequent follow-up and workups have revealed no evidence of disease. At 19 months after initial diagnosis, she is disease-free.

Adenoid cystic carcinoma of the vulva: conservative surgery using a de-epithelized rhomboid flap.

Adenoid cystic carcinoma of the vulva is a very rare entity manifested by an indolent clinical course, late recurrence and a propensity for perineural and local invasion. A 41-year-old women underwent radical local excision and ipsilateral superficial lymph-node dissection using a de-epithelized rhomboid flap for adenoid cystic carcinoma of the left vulva. On follow-up after two years the patient is alive and well with no evidence of disease. In this report we present the first case of adenoid cystic carcinoma of the vulva using a de-epithelized rhomboid flap.

Menstrual cycle dependent variability for serum tumor markers CEA, AFP, CA 19-9, CA 125 and CA 15-3 in healthy women.

Information on menstrual cycle dependent variation of tumor markers in healthy women is a subject of diagnostic efficiency and has an impact in elucidating the normal function of these markers. In this study midfollicular and midluteal concentrations of serum CEA, AFP, CA 19-9, CA 125, CA 15-3 and their relations with LH, FSH, prolactin, estradiol and progesterone were evaluated during ovulatory cycles in a group of 23 healthy female individuals. Samples were collected on the 7th and 21st day of the same menstrual cycle. Tumor marker and hormone concentrations were determined with chemiluminescence or electrochemiluminescence EIA methods. A significant phase-dependent difference was observed for CA 15-3, midluteal concentrations (mean +/- SEM; 26.33 +/- 1.56 U/ml) higher than the midfollicular (mean +/- SEM; 19.27 +/- 1.49 U/ml) concentrations (p < 0.001). But an obvious difference for other tumor markers investigated did not exist. Significant correlations of follicular and luteal CA 125 levels with body mass index of the subjects were observed (r:0.52, p < 0.05 and r:0.57, p < 0.005, respectively). CA 15-3 antigen is a product of the MUC-1 gene which is expressed in abundance by endometrial epithelial cells in the secretory phase of the menstrual cycle which may be the potential source of variability. The association of CA 125 levels with obesity suggests a possible role of adipose tissue in CA 125 metabolism. In conclusion our data suggest that in healthy women serum CA 15-3 levels are significantly elevated in the midluteal phase of the menstrual cycle compared to midfollicular phase. Therefore, consideration of menstrual cycle dependent variability for CA 15-3 appears indicated in interpretation of individual results.

Outcome of 1040 consecutive breech deliveries: clinical experience of a maternity hospital in Turkey.

OBJECTIVE: To determine the optimal route of delivery in breech presentation. METHOD: One-thousand and forty singleton breech deliveries among a total of 41785 deliveries that occurred at Zubeyde Hanim Maternity Hospital between 1990 and 1994 were analyzed. RESULT: The breech deliveries accounted for 2.4% of all deliveries. Of the patients, 572 (56.3%) were delivered vaginally and 468 (43.7%) were delivered by cesarean section. The mean ages of vaginal and cesarean delivery groups were 25.2 and 24.6 years, respectively. Forty-one (3.9%) of the fetuses had congenital anomaly. The leading congenital anomalies were meningocele in seven and hydrocephalus in six patients. Mullerian anomalies were encountered in 29 (6.1%) patients at cesarean section. Fetal morbidity observed in cesarean deliveries were fracture of the humerus in one and fracture of the femur in one and soft tissue injury in four cases. Fracture of the humerus was observed in two, Erb's paralysis in four, facial paralysis in one and soft tissue injury in 43 fetuses delivered vaginally. The leading causes of puerperal maternal morbidity were genital tract lacerations in vaginal delivery group and wound infection in cesarean delivery group. The overall perinatal mortality of this series was 54.8/1000 (57/1040). The corrected figures for cesarean delivery and vaginal delivery groups were 8.5/1000 (4/467) and 57.9/1000 (32/552), respectively. CONCLUSION: We favor a selective approach for mode of delivery in patients with breech presentation in order to balance the fetal morbidity associated with vaginal delivery and maternal morbidity and cost associated with cesarean delivery.

Maternal mortality in a maternity hospital in Turkey.

BACKGROUND: To determine the leading causes of maternal mortality in a large maternity hospital and to define priorities regarding this subject throughout Turkey. METHODS: Retrospective, institutional study among 100,531 live births between 1983 and 1992. RESULTS: Seventeen maternal deaths took place in this institution. Thus, the overall maternal mortality ratio was 16.9 per 100,000. The leading causes of maternal mortality were hemorrhage in seven (41.2%) and pulmonary embolism in six (35.3%) patients. The majority of deaths were observed in the 25-29 and 30-34 age groups and in patients with parity more than two. CONCLUSION: The relatively low figure of 16.9/100,000 for maternal mortality may be seen as a promising health index. However, obstetric hemorrhage is still the leading cause of this series. Pregnant women less than 20 years old and greater than 35 years old, and grand multiparous women as well as women with hypertension and heart disease are at high mortality risk. The observation of such cases demands further efforts for improved obstetric care in the hospital and throughout Turkey.

PIP: During 1983-1992 in Turkey, 17 maternal deaths occurred out of 100,531 live births at the Zubeyde Hanim Maternity Hospital in Ankara for a maternal mortality ratio (MMR) of 16.9/100,000 live births. Hemorrhage (41.2%) and pulmonary embolism (35.3%) were the leading causes of maternal death. Cases referred to the hospital after home deliveries accounted for 57% of the hemorrhage-related deaths. Other causes of maternal death were eclampsia (11.7%), puerperal infection (5.9%), and heart failure attributed to rheumatic heart disease (5.9%). The MMR fell over time from 22.6 (1983-1984) to 12.8 (1991-1992). Women younger than 20 and those 35 and older suffered from the highest MMRs. MMR increased with parity (8 for primigravida, 10 for parity 1-2, 27.3 for parity 3-4, and 62.1 for parity =or 5). Cesarean delivery was associated with a higher MMR than vaginal delivery (44.7 vs. 14.1). This association was likely a result of pregnancy complications that led to a cesarean section rather than the cesarean section itself.