Histological assessment of endometrial polyps resected by hysteroscopy.

OBJECTIVE: This study aimed to analyze the clinical data and pathologic aspects of endometrial polyps (EMPs) excised completely during surgical hysteroscopy and assess the connection between premalignant and malignant EMPs. PATIENTS AND METHODS: This retrospective study includes 489 participants who underwent hysteroscopy due to endometrial polyps, and the clinical features and histological findings of the resected polyps analyzed. RESULTS: Participants with EMPs were divided into six groups according to histologic findings. The histologic finding of most cases was simple benign endometrial polyp [397 patients (81.2%)]. Malignant polyp was detected in 3 patients (0.6%). The histologic findings according to age, menopausal status, and menstrual bleeding patterns at the time of presentation to the outpatient clinic were compared; however, no significant difference was observed. 237 patients were observed to have menometrorrhagia, which was the most prevalent symptom reported. The distribution of polyp sizes observed at hysteroscopy according to histologic findings was compared, but no significant difference was observed. CONCLUSIONS: EMPs are often benign but can include premalignant or malignant tissue changes. Hysteroscopy is used for direct observation of the uterine cervix and resection of existing polyps, considering the increasing frequency of its use as a diagnostic and treatment tool.

Protruding vs. visible prolapsed fetal membranes adversely affects the outcome of cervical insufficiency.

OBJECTIVE: This study aimed to determine how prolapsed fetal membranes (PFM) affect perinatal outcomes in cases of cervical insufficiency undergoing emergency cerclage or expectant management. PATIENTS AND METHODS: This retrospective study analyzed perinatal outcomes in 100 pregnant women with cervical insufficiency, including those with visible PFM at the cervical external os and those with protruding PFM to the vagina. The participants were subjected to either expectant management involving prescribed bedrest or emergency cerclage. RESULTS: In the study population, 41 (41%) preferred bedrest, while 59 (59%) chose emergency cerclage. Among those managed expectantly, 10 (10%) had visible PFM, and 31 (31%) had protruding PFM. Among those who underwent emergency cerclage, 32 (32%) had visible PFM, and 27 (27%) had protruding PFM. Delivery after 32 weeks of gestation showed similar rates between women with visible and protruding PFM, regardless of the management approach chosen. These rates were significantly higher compared to those with protruding PFM managed with bed rest and emergency cerclage. Prolongation of pregnancy in protruding-cerclage and protruding-bedrest groups was 42.3±34 and 17.9±22 days, respectively. CONCLUSIONS: Our findings provide support for considering emergency cerclage as a viable option when addressing cases involving a visible form of PFM, although the recommendation is somewhat less robust in instances of protruding PFM. The implementation of an emergency cerclage procedure has the potential to extend the time frame between diagnosis and delivery, enhance neonatal survival rates, and increase the likelihood of births occurring after 28 weeks of gestation. However, it does not seem to significantly affect the rate of births taking place after 32 weeks of gestation. This could potentially lead to complications associated with premature births and extended stays in the postnatal neonatal intensive care unit. Therefore, it is crucial to offer families detailed information regarding the pros and cons of emergency cerclage.

Angiotensin-1 and vimentin expression and ultrastructural examination in severe preeclampsia complicated by HELLP syndrome changes in the structure of the umbilical cord.

OBJECTIVE: The purpose of this study was to examine the histopathologic, ultrastructural and immunohistochemical changes in the umbilical cord in women diagnosed with HELLP syndrome. MATERIALS AND METHODS: Postpartum umbilical cords of 40 patients at the 35-38th week of pregnancy were included. 20 severe preeclamptic (HELLP) and 20 normal umbilical cords were used. After the follow-up of tissue parts of 10% formaldehyde solution for histopathology and immunohistochemistry, histopathological and angiopoietin-1 and vimentin antibodies were examined as immunohistochemical after routine paraffin follow-up. For electron microscope analysis, umbilical cord samples were taken into 2.5% glutaral aldehyde solution. RESULTS: In the statistical comparison, mean difference in increased diameter and additional anomaly on the ultrasound of preeclamptic patients was statistically different compared to control patients. In the HELLP group, hyperplasia and degenerative changes, pyknosis of the endothelial cell nuclei of the vessels and apoptotic changes in some regions were observed. Immunohistochemical analysis showed that endothelial cells, basal membrane and fibroblast cells in the HELLP group expressed high levels of vimentin. Angiotensin-1 expression was increased in amniotic epithelial cells, endothelial cells and some pericyte cells. CONCLUSIONS: As a result, it was observed that the signaling that started with trophoblastic invasion with the effect of hypoxia in severe preeclampsia and continued with dysfunction in endothelial cells was parallel to the increase in angiotensin and vimentin receptors. It is thought that the ultrastructural change in endothelial cells may cause disruption of the collagenized structure in Wharton gel, which supports this, and may cause adverse effects in fetal development and nutrition.

Antioxidant status in cerebrovascular accident.

Ischemia is associated with the pathological changes caused by the accumulation of reactive oxygen metabolites (ROM) in cerebrovascular accident (CVA). The aim of this study was to determine red cell copper/zinc-superoxide dismutase (Cu/Zn-SOD) and catalase activities and copper and zinc concentrations both in plasma and in red cells in CVA. Cu/Zn-SOD and catalase activities of 16 patients, with an average age of 64 yr, were measured spectrophotometrically; copper and zinc concentrations were determined by atomic absorption spectrophotometer. The results showed that Cu/Zn-SOD activity was increased markedly in patients compared to the young controls and reached a peak on the d 5 of the disease, whereas the catalase activity of the patients on d 3 and d 5 were in the normal range, but higher on d 10. The enzyme activities of the elderly group were generally increased compared to the young controls. Copper and zinc concentrations showed corresponding alterations. These findings suggested that the effects of oxidative stress in CVA might be reflected in red cell and plasma parameters.

Contralateral recurrence of atrial myxoma - case report and review of the literature.

Cardiac myxomas are the most frequent cardiac tumors, and they have the capability for recurrence years after resection, in the same or in different cardiac chambers. Hence, follow-up is important. Contralateral recurrences of myxoma are uncommon. We report a 7 year old boy who had a right atrial myxoma resected, and who had recurrent myxoma in the left atrium. The literature regarding such recurrence is reviewed.

Siblings with cystic leukoencephalopathy and megalencephaly.

Cystic leukoencephalopathy with megalencephaly is a newly described entity with mild clinical involvement. Patients suffer from developmental problems and seizures in childhood. Progression is gradual into adulthood. Typical magnetic resonance imaging findings include subcortical cysts and diffuse leukoencephalopathy. The etiology is unknown with possibly autosomal-recessive inheritance. We present two pairs of siblings with this disease and emphasize the characteristic and variable patterns even within the same family.

Headache etiology in children: a retrospective study of 125 cases.

BACKGROUND: To determine the headache etiology in children in the middle Anatolia region of Turkey. METHODS: The clinical and laboratory findings of 125 patients, who were followed up after a diagnosis of headache in our hospital, were reviewed retrospectively. The criteria defined by the International Headache Society (IHS) were used in the classification of patients. The patients were divided into two subgroups according to age intervals: (i) group 1, 5-10 years of age; and (ii) group II, 11-16 years of age. RESULTS: There were 62 males and 63 females in the study. The patients' ages ranged from 5 to 16 years (mean (+/- SD) age 10.67+/-2.72 years). Headache was more commonly noted between 11 and 16 years of age. While headache was more frequent in male children in group I, there was female predominance in group II. However, there was no significant difference between the groups with respect to age and gender (P>0.05). The most frequent cause of headache was migraine and the remaining causes, in decreasing order, included sinusitis (no. 11 according to IHS criteria) and tension-type and psychosomatic headaches (no. 13 according to IHS criteria). Of the 125 patients in the study, 85 (68%) had acute headache and 40 (32%) had chronic headache; 44 (35.2%) patients had acute localized-type headache, 39 (31.2%) suffered from acute recurrent-type headache, 38 (30.4%) had chronic non-progressive headache and acute generalized and chronic progressive-type headache were diagnosed in two (1.6%) patients. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain were performed in 50 and seven patients, respectively; there were abnormal findings in six patients on CT examiniation and in two patients following MRI. CONCLUSIONS: In conclusion, we stress that the most frequent cause of headache in childhood is migraine and the remaining causes, in decreasing order of frequency, were sinusitis and tension-type and psychosomatic headaches. Neuroimaging studies, such as CT or MRI, need to be performed, especially in patients with complicated symptoms.

A case of cardiac hydatid cyst localized on the interventricular septum and causing pulmonary emboli.

Cardiac hydatid cyst is rarely encountered. In this article, a case of hydatid cyst localized in multiple organs including the ventricular septum and causing pulmonary emboli is reported.