Congenital Ewing's Sarcoma, a Rare and Difficult Diagnosis: A Case Report.

We have interestedly read the article written by Thalia Wong BS in July 2015, which is about Pediatric Blood Cancer, including clinical findings and results of infants <1 year of age with Ewing sarcoma. We report a case with congenital Ewing's sarcoma that easily interfered with rabdomyosarcoma in a pregnant woman. A 32-year-old multigravida with a big neck mass at 35 weeks was referred to our clinic. The final diagnosis of extraskeletal Ewing's sarcoma was made. Hepatic metastasis was detected and treatment by chemotherapy was initiated. Ewing's sarcoma is usually noted among adolescents or young adults and more rarely than among newborns. This case is important because of its rarity.

Serum vitamin D and vitamin D-binding protein levels in mother-neonate pairs during the lactation period.

BACKGROUND: To determine longitudinally the relationship between serum 25-hydroxyvitamin D (vitamin D) and vitamin D-binding protein (DBP) levels in mother-neonate pairs and evaluate the efficiency of prophylactic vitamin D on lactation days 45-60. METHODS: Mother-neonate pairs whose serum calcium (Ca), phosphorus (P), magnesium (Mg), alkaline phosphatase (ALP), and parathyroid hormone (PTH) levels were in normal ranges on postpartum/postnatal days 5-10 were classified into two groups by their serum vitamin D concentrations (Group A: < 10 ng/ml and Group B: > 20 ng/ml). Both maternal and neonatal Ca, P, Mg, ALP, and PTH concentrations in group A and B were not different. Maternal and neonatal serum DBP levels were measured in two groups. The mother-neonate pairs in both groups were given 400 IU/d vitamin D orally. The same biochemical markers in group A were remeasured on days 45-60 of the lactation period. RESULTS: In group A, the mean maternal and neonatal vitamin D levels on postpartum/postnatal days 5-10 were significantly lower and the DBP levels were significantly higher than those in group B (P = 0.000; P = 0.000 and P = 0.04; P = 0.004, respectively). On lactation days 45-60, the maternal and neonatal DBP concentrations were not different from those on postpartum/postnatal days 5-10. However, the maternal and neonatal vitamin D levels were significantly increased (P = 0.000 and P = 0.000, respectively), while the neonatal PTH concentrations were significantly decreased (P = 0.000). The maternal and neonatal vitamin D concentrations were negatively correlated with their DBP concentrations (P = 0.048 and P = 0.002, respectively). CONCLUSION: High maternal and neonatal DBP levels may lead to an incorrect low estimate of the true Vitamin D concentration. In this case, only prophylactic vitamin D (400 IU/d) is indicated for mothers and their infants.

Evaluation of oxidative status in patients with chronic periodontitis and polycystic ovary syndrome: A cross-sectional study.

BACKGROUND: In patients with polycystic ovary syndrome (PCOS), chronic periodontitis (CP) contributed to increased oxidative stress (OS), owing to an increase in serum and salivary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) levels and a decrease in serum total antioxidant status (TAS) levels. The aim of the present study is to investigate salivary and serum 8-OHdG and MDA levels as well as total antioxidant status (TAS) in females with CP and PCOS compared with healthy females. METHODS: Four groups, each consisting of 22 individuals, were: 1) women with both PCOS and CP (PCOSCP); 2) systemically healthy women with CP; 3) periodontally healthy women with PCOS (PCOSPH); and 4) periodontally and systemically healthy women (PH). Demographic and clinical periodontal parameters were measured. Oxidative parameters were evaluated in serum and salivary samples. RESULTS: Salivary 8-OHdG levels in the PCOSCP and CP groups were statistically higher than those in both the PCOSPH and the PH groups (P < 0.05). There was no statistical difference between the PCOSCP, CP, and PCOSPH groups with regard to salivary MDA and TAS levels (P > 0.05). Highest serum 8-OHdG and MDA levels and lowest serum TAS levels were seen in the PCOSCP group (P < 0.05). Serum 8-OHdG and MDA levels in the PCOSPH group were higher than those in both systemically healthy groups (PH and CP) (P < 0.05). Salivary TAS levels were highest (P < 0.05) in the PH group. There was no statistical difference between the CP and PCOSPH groups, but serum TAS levels were lower than those in the PH group (P < 0.05). CONCLUSIONS: CP, which led to an increase in serum and salivary 8-OHdG and MDA levels and a decrease in serum TAS levels in patients with PCOS, contributed to increased OS. This effect was more prominent in serum levels than in salivary levels.

Does antenatal betamethasone have negative effects on fetal activities and hemodynamics in cases of preeclampsia without severe features? A prospective, placebo-controlled, randomized study.

AIM: To evaluate whether antenatal betamethasone affects the fetal biophysical profile (BPP) and Doppler indices of umbilical and middle cerebral arteries (MCAs) in cases of preeclampsia without severe features. MATERIALS AND METHODS: Forty singleton preeclamptic pregnancies without severe features at gestational ages of 28-34 weeks were randomly divided into two groups of 20 patients: betamethasone and control groups. Patients in the betamethasone group were administered two consecutive doses of 12 mg betamethasone intramuscularly, 24 h apart, and patients in the control group were administered the same volume of saline as a placebo. All participants were evaluated before (0 h) and at hours 24, 48, and 72 of betamethasone/placebo administration using BPP scoring and umbilical and MCA Doppler examinations. RESULTS: Total BPP scores were significantly lower in the betamethasone group across the three time points during the follow-up period (p < 0.001). None of the Doppler indices differed significantly between the groups (p > 0.05). CONCLUSION: Antenatal betamethasone negatively affects fetal BPP score parameters, including the non-stress test, fetal body and breathing movements, without affecting vascular indices of umbilical arteries and MCAs. Clinician awareness of this transient drug-induced effect might be valuable for preventing iatrogenic preterm delivery for fetuses in preeclamptic pregnancies without severe features.

Relationship between mean platelet volume and recurrent miscarriage: a preliminary study.

INTRODUCTION: The aim of the study was to examine the relationship between mean platelet volume (MPV) and recurrent miscarriage in order to illuminate the etiopathogenesis of recurrent miscarriage. MATERIAL AND METHODS: We retrospectively investigated the data of 120 patients with unexplained recurrent miscarriage (group 1), and compared them with the data of 120 match-paired patients in the control group (group 2). The definition of recurrent miscarriage was accepted as two or more failed clinical pregnancies which were documented by ultrasonography or histopathologic examination. All patients in the recurrent miscarriage group were evaluated with diagnostic tests for the etiology of recurrent miscarriage. Total blood count parameters, including hemoglobin, mean corpuscular volume, red cell distribution width, white blood cells, platelets, and mean platelet volume, were compared. RESULTS: The average patient age at the time of examination was 29.07 ±2.81 years in group I and 28.53 ±3.5 years in group II (p > 0.05). Mean body mass index (BMI) was similar between group 1 and group 2, 22.54 ±3.17 and 22.99 ±2.38, respectively (p > 0.05). Mean hemoglobin, mean corpuscular volume, red cell distribution width, and white blood cell and platelet levels were similar in both groups (p > 0.05). Mean platelet volume levels were significantly higher in group I (9.45 ±1.09 fl) than in group II (7.63 ±0.52 fl) (p = 0.001). CONCLUSIONS: Higher MPV values in the study group suggest and support the importance of thromboembolic events in the etiology of recurrent miscarriage.

An investigation about the inhibition of acute ischemia/reperfusion damage by dexmedetomidine in rat ovarian tissue.

Reperfusion has always been "the emergency intervention" to ischemic tissue. For a given period of time, tissue injury due to ischemia and reperfusion is more serious than injury due to ischemia only. Groups were as: Group 1: 25 µg/kg dexmedetomidine + ischemia/reperfusion group. Group 2: 10 mg/kg yohimbine +25 µg/kg dexmedetomidine + ischemia/reperfusion group. Group 3: Ischemia/reperfusion (control) group. Group 4: Healthy rats. Rat ovaries were exposed to a 3-hour ischemia and then reperfusion ensured for 2 hours. After ischemia/reperfusion, total glutathione, malondialdehyde, 8-hydroxyguanine levels and histopathological investigation were studied. The highest total glutathione and the lowest malondialdehyde and DNA damage levels were determined in dexmedetomidine group when compared to control group. The difference between yohimbine + dexmedetomidine and the control group was insignificant. Dexmedetomidine protects the ovarian tissue of the rat from I/R injury. It is hypothesized that this protective effect of dexmedetomidine is mediated by the α-2 adrenergic receptors. Dexmedetomidine could be useful for attenuation of tissue damage after I/R and prevention of I/R-related complications.

Biological and histopathological investigations of moclobemide on injured ovarian tissue following induction of ischemia-reperfusion in rats.

BACKGROUND: The effects of moclobemide on damaged ovarian tissue induced by ischemia- reperfusion and damaged contralateral ovarian tissue were investigated in rats, biochemically and histologically. MATERIALS AND METHODS: In this experimental study, 40 rats were equally divided into four groups: 10 mg/kg moclobemide, 20 mg/kg moclobemide, ischemia/reperfusion control, and intact control groups. A 2-2.5-cm-long vertical incision was made in the lower abdomen of each rat in order to reach the ovaries, after which a vascular clip was placed on the lower side of the right ovary of each animal in the two treatment groups and the ischemia-reperfusion control group, but not in the healthy (intact control) animal group. The purpose of this procedure was to create ischemia over the course of three hours, then the clips were unclamped to provide reperfusion for the next two hours. At the end of the two hours of reperfusion, all the animals were killed by high-dose anaesthesia and their ovaries were taken and subjected to histological and biochemical (malondialdehyde, nitric oxide, glutathione) studies. RESULTS: The obtained results showed that moclobemide suppressed nitric oxide and malondialdehyde production in the ischemia-reperfusion damage area, and prevented the decrease in endogenous antioxidant levels (glutathione) in the rat ovarian tissue. Moclobemide also prevented infiltration of leukocytes to the ovarian tissue. These results showed that moclobemide protected ovarian tissue against ischemiareperfusion injury. CONCLUSION: This study shows that moclobemide represses malondialdehyde and nitric oxide production in the rat ovarian tissue subjected to ischemia-reperfusion injury and keeps the endogenous antioxidant glutathione level from decreasing. Moclobemide also inhibits leukocytic migration into ovarian tissue following ischemia-reperfusion injury. From these results, it is suggested that moclobemide can be used in the treatment of ovarian ischemia-reperfusion injury.

Biochemical and histological investigation of famotidine effect on postischemic reperfusion injury in the rat ovary.

BACKGROUND/PURPOSE: In this study, an investigation was performed on the ovarian tissue of rats subjected to ischemia-reperfusion for the effect of famotidine on certain parameters of oxidation-antioxidation, cell DNA damage, and histological appearance. METHODS: The effects of famotidine on certain parameters of oxidation-antioxidation (total glutathione [tGSH], superoxide dismutase [SOD], malondialdehyde) and cellular DNA injury in the ovarian tissue of rats subjected to ischemia-reperfusion were investigated and underwent histological examination. RESULTS: The results show levels of 5.2 ± 0.6 nmol/g protein for tGSH, 8.3 ± 0.8 U/g for SOD activity, and 7.7 ± 0.9 µmol/g protein for malondialdehyde (P < .0001 when compared with controls) in ovarian tissue subjected to ischemia-reperfusion following famotidine treatment. The tGSH levels in control rats and in a healthy animal group were, respectively, 1.76 ± 0.7 and 5.5 ± 0.3 nmol/g protein (P < .0001). The SOD activity was 3.2 ± 0.9 U/g in control and 9.2 ± 0.6 U/g in healthy animal tissues. The differences between the values in the treatment and the control group, and between the healthy animal group and the control group were both highly significant (P < .0001). It was also observed that famotidine prevented, to a significant extent, an increase in the level of 8-hydroxy-2-deoxyguanine/guanine, a DNA damage product, as compared with the control group. CONCLUSION: These biochemical and histological results show that famotidine protects the ovarian tissue from ischemia-reperfusion injury.

Minimally invasive approach to cases of lost intra-uterine device: a 7-year experience.

OBJECTIVES: To evaluate the effectiveness of hysteroscopy and laparoscopy for diagnosis and treatment in women with lost intra-uterine devices (IUDs), and to elucidate the most common extra-uterine locations of lost IUDs. STUDY DESIGN: Retrospective clinical study at Atatürk University Hospital, Erzurum, Turkey. Women with lost IUDs presenting in the last 7 years were referred to the obstetrics and gynaecology clinics. Women whose lost IUDs were removed using a Novak curette were excluded from the study. RESULTS: Of the 55 cases studied, 29 (52.7%) lost IUDs were located inside the uterine cavity, 23 (41.8%) were located outside the uterine cavity, and three (5.5%) were embedded in the myometrium. The most common extra-uterine location of lost IUDs was around the uterosacral ligaments (n=8, 34.7%). Considerable association was found between the position of the uterus and the extra-uterine location of lost IUDs. In all eight cases where the lost IUD was located around the uterosacral ligaments, the uterine position was anteverted and perforation was found on the posterior side of the uterus. IUD removal was performed successfully in 46 women (83.6%) by either hysteroscopy or laparoscopy. CONCLUSIONS: Lost IUDs inside or outside the uterine cavity can be managed by minimally invasive approaches. If an anteverted uterus is seen on laparoscopy, the initial exploration for the lost IUD should be made around the uterosacral ligaments.

Gamma-ray energy absorption and exposure buildup factor studies in some human tissues with endometriosis.

Human tissues with endometriosis have been analyzed in terms of energy absorption (EABF) and exposure (EBF) buildup factors using the five-parameter geometric progression (G-P) fitting formula in the energy region 0.015-15 MeV up to a penetration depth of 40 mfp (mean free path). Chemical compositions of the tissue samples were determined using a wavelength dispersive X-ray fluorescence spectrometer (WDXRFS). Possible conclusions were drawn due to significant variations in EABF and EBF for the selected tissues when photon energy, penetration depth and chemical composition changed. Buildup factors so obtained may be of use when the method of choice for treatment of endometriosis is radiotherapy.

A Case of Primary Postpartum Bleeding due to Vaginal Laceration after Vaginal Delivery: Successful Management with Transcatheter Arterial Embolization.

Postpartum hemorrhage is one of the major causes of maternal mortality. There are medical and surgical options to control the bleeding, some of which can impair future fertility. Transcatheter arterial embolization might be a useful option in the management of intractable postpartum bleeding before the consideration of more invasive and radical methods. In this report, we report a 33-year-old patient who presented with primary postpartum hemorrhage due to vaginal laceration and was eventually treated with transcatheter arterial embolization.

Preeclampsia and eclampsia incidence in the eastern anatolia region of Turkey: the effects of high altitude.

OBJECTIVE: Hypertensive disorders of pregnancy remain a leading cause of maternal and perinatal mortality and morbidity. The purpose of this study was to determine the distribution map related to pregnancy toxicosis of provinces in our region and the effects of altitude on hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome and eclampsia. MATERIALS AND METHODS: Patients who were admitted to Atatürk University, Obstetrics and Gynecology Department with preeclampsia, eclampsia and a diagnosis of HELLP syndrome for the 5 years between1998-2002 were chosen. The birth rate was obtained from the health directorate of provinces in our area during the same period. Provinces were divided into two groups by altitude: less than and more than 1500 m above sea level. RESULTS: The rates of HELLP syndrome and eclampsia diagnoses were 1.4 per 10.000 patients living above 1500 m altitude. However, this rate was 0.96 per 10.000 patients living below 1500 m altitude (p < 0.01). The highest rate of eclampsia and HELLP syndrome was seen in the Ardahan province, in 36 patients per 10,000 births, whereas the lowest rate was seen in the Igdir province, 9.9 patients per 10,000 births. CONCLUSION: Altitude contributes to occurrence of HELLP syndrome and eclampsia. Since the rate of pregnancy related hypertension is higher at high altitude, it is vital that these patients should be diagnosed during the early stages of the diseases in order to decrease complications.

Effects of female sex hormones on caffeine-induced epileptiform activity in rats.

Research on female sex hormones has demonstrated that estrogen aggravates epileptogenesis. Theoretically, this means that the frequency of epileptic attacks should be decreased in epileptic women during menopause. However, although epilepsy attacks are reported to decrease in some women during menopause, they may not change in others. Increases in attack frequency have even been reported during menopause in some epileptic women. This study has investigated the effects of estrogen, progesterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) on caffeine-induced epileptiform activity in rats. Estrogen was found to increase epileptiform activity in a dose-dependent manner via its own receptors. In contrast, progesterone had no effect on epileptiform activity. FSH and LH suppressed epileptiform activity at low doses; however, at high doses they enhanced it. In conclusion, we suggest that the occurrence or aggravation of epilepsy, despite estrogen deficiency in the menopausal or post-menopausal period, is related to excessive accumulation of FSH and LH.

Difficulty of the surgical management of a case with placenta percreta invading towards parametrium.

A 37-year-old woman was admitted due to vaginal bleeding at 25 weeks of gestation to our gynecology unit. Placenta percreta, which stems from posterior wall of the uterus, forming a mass in Douglas cavity and invading towards right parametrium was clinically diagnosed by exploration. Bilateral internal iliac artery ligation and supracervical hysterectomy could not prevent bleeding. A right radical parametrectomy was necessary to remove invaded parametrium and to control bleeding. The placenta percreta invading parametrium may need an extended hysterectomy procedure. Excess bleeding may be prevented by leaving the placenta in situ during surgery if the placenta percreta is diagnosed before termination of pregnancy, A classical incision may help leaving placenta is situ during operation.

Periodontal disease increases the risk of severe pre-eclampsia among pregnant women.

AIM: To evaluate the possible link between the severity of periodontal disease and pre-eclampsia and to correlate this link to clinical periodontal parameters and interleukin (IL)-1beta, tumour necrosis factor-alpha (TNF-alpha), and prostaglandins (PGE(2)) levels in both gingival crevicular fluid (GCF) and serum. MATERIAL AND METHODS: Fifty-nine pregnant women (20 mild pre-eclampsia, 18 severe pre-eclampsia, and 21 healthy pregnant women) were included in the study. Dental and periodontal recordings as well as GCF and blood samples were obtained within 48 h preceding delivery. RESULTS: The results of multivariate logistic regression showed a highly significant association between mild to severe pre-eclampsia and severe periodontal disease (p<0.001). After adjusting for potential confounders (smoking, body weight, socioeconomic status, education level, and age), severe pre-eclamptic women were 3.78 (1.77-12.74) times more likely to present severe periodontal disease than normotensive pregnant women. This odds ratio (OR) was 2.43 (1.13-8.19) for mild pre-eclamptic women. IL-1beta, TNF-alpha, and PGE(2) levels in both serum and GCF were also significantly higher in the pre-eclamptic groups than the normotensive women. CONCLUSIONS: These results indicate that the presence and severity of periodontal disease seems to increase the risk for not only the occurrence but also the severity of pre-eclampsia in pregnant women.

Huge teratoma of the fallopian tube: a case report.

BACKGROUND: Primary mature solid teratomas of the fallopian tube are extremely rare and only 11 cases have been reported in the literature. A woman presented with a mature, solid teratoma of the fallopian tube, possibly the largest solid teratoma on record. CASE: A 24-year-old, nulliparous woman presented with abdominal distention, intermittent abdominal pain, nausea and vomiting for 4 weeks and was admitted to the hospital. Abdominal examination revealed a palpable, nontender mass. Computed tomography showed a hypodense lesion in the abdomen. Serum concentrations of carcinoembryonic antigen (2.6 ng/mL) and beta-human chorionic gonadotropin (0.1 mIU/mL) were within normal limits, while serum levels of CA-125 (130 U/mL) and CA-19.9 (237 U/mL) were elevated. A multilobulated, pedunculated, mature, solid teratoma of the fallopian tube measured 31 x 21 x 14 cm and weighed 2,400 g. At laparotomy, it was located in the fimbrial portion of the left fallopian tube, and a left salpingectomy was performed. The tumor consisted of bone, hair, and sebaceous and sweat glands. The cavity of the cyst was lined mainly with skin composed of keratinized squamous epithelium and contained abundant sebaceous and sweat glands. CONCLUSION: In cases of undetermined pelvic or abdominal masses, especially with calcification, a teratoma of the fallopian tube should be considered.

Nodular endometriosis: dynamic MR imaging.

PURPOSE: In this study we aimed to investigate the value of contrast enhanced dynamic MR imaging (DMI) in the diagnosis of nodular abdominal endometriosis. SUBJECTS AND METHODS: Fourteen patients with surgically and pathologically proven endometriosis were examined with DMI. The patients were 22-54 years old (mean age 30.8 years). The dynamic MR studies of these patients were retrospectively reviewed by two radiologists who were aware of the clinical data. Nodular masses showing enhancement were evaluated for size, margins, and signal intensity on T1- and T2-weighted MR sequences. The protocol was tailored to selectively determine the diagnostic utility of signal intensity time course analysis for the behavior of nodular endometriosis and endometrial tissue, in DMI. Contrast-enhanced DMI was performed and the time-intensity curves of the lesions and the uterine endometrial tissue of each patient were compared. Mean enhancement values were calculated. Each DMI was evaluated for signal intensity value. RESULTS: In 8 (57%) of 14 patients, we found endometriosis in the abdominal wall. All patients with abdominal wall endometriosis had pelvic surgical operation history. Diameter of nodular endometriosis determined in the abdominus muscle ranged between 3 and 40 mm. Of eight cases, five had only one lesion and three had multiple lesions. Remaining 6 (43%) cases had deep pelvic endometriosis located in the uterosacral ligaments (n = 3), rectosigmoid (n = 2), and rectovaginal septum (n = 1). Diameter of pelvic endometriosis ranged between 9 and 53 mm. Noncontrast mean signal intensity of endometriosis and endometrial tissue were 280 +/- 73 and 216 +/- 20, respectively. The mean values of both endometriosis and normal endometrial tissue were calculated for each patient examined with five-slice DMI. All of the curves showed significant correlation. The lesion showed significant enhancement in the course of time similar to the endometrial tissue in all patients. CONCLUSION: Our study was inspired from the fact that endometriosis is the ectopic endometrial tissue and we thought that endometrial tissue and endometriomas should have similar vascularity. In this way imaging with MR, getting the time-intensity curves and experiencing the correlation between the endometriosis and endometrial tissue may support the diagnosis in the cases with suspected endometriosis. This first study shows that the ectopic nodular endometriosis can easily be identified with dynamic MRI. It may be used to differentiate nodular endometriosis from the other pathologic conditions of abdominal wall and pelvis.

Urinary calcium excretion in severe preeclampsia and eclampsia.

Urinary calcium levels in women with mild preeclampsia, severe preeclampsia and eclampsia were evaluated in this study. We collected 24-h urine samples from 35 mild preeclamptic (Group 1), 30 severe preeclamptic (Group 2), and 17 eclamptic patients (Group 3). The control group (Group 4) consisted of 35 healthy pregnant women. Serum levels of total calcium and creatinine, and urinary calcium were measured. These values were compared in the four groups. The mean maternal age and parity were similar in all groups. There were no statistically significant differences in the serum levels of total calcium and creatinine (p > 0.05). Urinary calcium excretion in patients with preeclampsia and eclampsia was significantly lower than in controls (p < 0.0001). Urinary calcium levels between mild preeclampsia and severe pre-eclampsia, and severe preeclampsia and eclampsia were similar (p > 0.05), but were lower in eclampsia than in mild preeclampsia (p < 0.05). In conclusion, urinary calcium excretion is reduced in patients with severe preeclampsia or eclampsia. However, the decrease in urinary calcium excretion cannot be used to identify the severity of preeclampsia, or to predict impending eclampsia.