Vascular Effects of Estrogen and Progestins and Risk of Coronary Artery Disease: Importance of Timing of Estrogen Treatment

The effects of estrogen and progestins on the vascular wall have drawn major medical attention, and significant controversy over various studies has been developed. Several experimental and observational studies have shown cardioprotective effects; however, prospective randomized trials showed an increase in cardiovascular events in postmenopausal women on estrogen/medroxyprogesterone acetate treatment. The most significant parameter for cardiovascular benefit of estrogen seems to be the interval since the onset of menopause. In the early postmenopausal years, estrogen has beneficial effects on the vascular wall by inhibition of atherosclerosis progression, whereas in the late postmenopause, adverse effects like upregulation of the plaque inflammatory processes and plaque instability may develop. The effects of progestins on the cardiovascular system are not as clear and may differ according to the choice of progestins that is used. The aim of this review is to summarize the effects of estrogen and progestins on the vascular wall and their clinical implications

Spontaneous rupture of unscarred uterus at 27 weeks of gestation

Spontaneous rupture of a gravid uterus is a life-threatening obstetric emergency with high maternal mortality and morbidity, perinatal mortality and loss of future fertility as hysterectomy maybe inevitable in most cases. Most spontaneous uterine ruptures occur during labor in parturients with a scarred uterus. Rupture of unscarred uterus is a rare event involving 1/17,000 - 20,0000 and occur more frequently in older multiparous patients [1 - 3]. Here, we present a case of spontaneous rupture of uterus in a primigravid woman which was successfully repaired

ABRUPTIO PLACENTAE AFTER AMNIOREDUCTION IN TWIN-TO-TWIN TRANSFUSION SYNDROME (TTTS)

Twin-to-twin transfusion syndrome (TTTS) is a unique complication of monochorionic twin pregnancies. TTTS is the well-known cause of perinatal mortality and morbidity in monochorionic pregnancies. Fetoscopic laser ablation is the optimal treatment but in some selected cases amniodrainage can be performed. We hereby report a case of placental abruption after amniodrainage in a monochorionic diamniotic twin pregnancy. A 37-year-old gravida 4 para 3 who was 26 weeks pregnant was referred to our clinic for monochorionic diamniotic twin pregnancy. Ultrasonographic examination revealed that one of the twins has polyhydramnios while the other has oligohydramnios. The bladder of each twin was visualized separately. We suspected Quintero stage 1 TTTS. Amniodrainage is the appropriate treatment of choice at this time of pregnancy. We performed amniodrainage with a vacuum aspiration device. During the procedure, there was no bleeding in amniotic fluid and cardiac activity of both the twins was visualized. After 15 minutes, profused vaginal bleeding and uterine contractions started and was diagnosed with abruptio placentae and an emergency cesarean section was done. In monochorionic twin pregnancies complicated by TTTS, amniodrainage can be performed in selected cases. This procedure has some rare complications such as abruptio placentae, preterm delivery, and preterm rupture of membranes. These complications are not due to the amount and speed of draining the amniotic fluid but some randomized controlled studies are needed in this aspect

LARGE SCALE PRE-DIAGNOSIS OF TOXOPLASMA GONDII DNA GENOTYPING BY REAL-TIME PCR ON AMNIOTIC FLUID

The antepartum and peripartum maternal infections cause great problems complicating pregnancy. The early diagnosis of the maternal infections causing different pathologies in the newborns is of great importance. For an appropiate judgement, the early diagnosis of Toxoplasma gondii infections acquired during pregnancy is critical for an effective prevention. The common characteristics of these infections are that they may cause abortion, still birth, prematurity, intrauterin growth retardation, congenital malformations, infection of the newborn or normal term live-births. We report here the development of real-time PCR-based assay for detection of T gondii. Investigation of 300 specimens was carried out using B1 gene region specific primers and probes after the extraction of T gondii DNA. T.gondii DNA, was found in 4 (1.3%) out of 300 specimens. DNA was not found in the speciemens of the remaining 296 patients. Real-time PCR analysis significantly improves the detection of T gondii in amniotic fluid

Prenatal Incidence and Clinical Value of the Absence of 12th Ribs in a Population in a Setting of Detailed Second-Trimester Sonography

Objectives: We aimed to determine the incidence of the absence of the (last) 12th ribs in a population in a setting of detailed 2nd-trimester sonography using three-dimensional (3D) ultrasound and to assess whether or not this may be related to chromosomal aneuploidies. Methods: Prospectively, we counted fetal ribs for the absence of the (last) 12th ribs in singleton pregnancies of women who presented to our clinic for detailed 2nd-trimester sonography. The assessment was carried out using 3D ultrasound. Volume data sets were acquired with the 3D skeleton mode using the maximum intensity with X-ray-weighted rendering. If the 3D skeleton mode was not sufficient, volume contrast imaging with the OmniView bone mode was used. Results: The fetal ribs could be visualized in 97.01% of the 1,943 fetuses examined between 20 and 23 weeks' gestation. Timing the examination at 21, 22, or 23 weeks was found to be more successful than conducting it at 20 weeks. Twelfth ribs were found to be absent in 33 fetuses; 16 fetuses had 11 ribs unilaterally and 17 had so bilaterally. None of them had chromosomal abnormalities. Associated anomalies were present in 6 fetuses (18.2%); 2 of the anomalies were major and 4 minor. Conclusion: The incidence of absent 12th ribs in this mixed population was 1.75%. In the absence of additional anomalies, the prognosis is favorable

A CASE OF GASTROINTESTINAL STROMAL TUMOR PRESENTING AS A TUBOOVARIAN ABSCESS

A gastrointestinal stromal tumor (GIST) is a rare tumor of the gastrointestinal tract. Although stomach is the most frequent site of occurrence, GISTs can arise from anywhere in the gastrointestinal tract. The most common symptoms are vague and nonspecific abdominal pain or discomfort. We would like to present a GIST case with the complaint of acute abdominal pain and fever due to an accompanying complex adnexial mass. A 47-year-old female patient with sudden onset abdominal pain and fever applied at our clinic. A 8 cm diameter sized, complex, solid mass on the ultrasonografic examination was found. Her temperature was 38.6 degrees C and on her laboratory examination, leukocyte and CRP values were 27.400 and 254, respectively After an initial diagnosis of tuboovarian abscess, the patient was internalized. Abdominal CT revealed a solid lesion originating from small bowel resulting in signs of sepsis due to a closed perforation. Resection of the mass was performed and the postop pathology report was GIST. Patient had adjuvant imatinib therapy Although GIST's are mostly seen in stomach with vague symptoms, large sized GIST's which occur in the lower abdomen can be complicated and present as having a tuboovarian abscess clinic

Prenatal diagnosis of frontonasal dysplasia with anterior encephalocele Anterior ensefaloselin eşlik ettiǧi frontonazal displazinin prenatal tanısı

Frontonasal dysplasia is a rare congenital anomaly affecting the eyes, nose and forehead, and occurs sporadically in most of the cases. A 24-year-old woman was referred to our unit at 27 weeks gestation due to the preliminary diagnosis of encephalocele. The sagittal and axial sonography of the fetal face depicted a midline mass measuring 3.8 × 4.2 cm, projecting anteriorly between the fetal orbits and extending from the the upper aspects of the forehead to the nasal bridge, which was consistent with the frontal (anterior) encephalocele. There were prominent hypertelorism and two facial clefts, and the nostrils were extremely separated. Following genetic counseling, the couple requested termination of pregnancy. Fetal pathologic examination confirmed the diagnosis of frontonasal dysplasia and anterior encephalocele with no additional major malformation. The fetal karyotype was normal and no mutation in the ALX1 gene was found, excluding ALX1-related frontonasal dysplasia in the differential diagnosis. Fetuses with neural tube defect may suffer from associated syndromes and disorders, as with our case. The presence of frontonasal dyplasia should be considered when an anterior encephalocele is detected by ultrasonography

Fetal nasal bone assessment in first trimester Down syndrome screening

Objective: To evaluate the contribution of nasal bone assessment in the first trimester Down syndrome screening. Methods: The fetuses which underwent first trimester screening with nuchal translucency (NT) measurement were evaluated for the absence or presence of nasal bone according to the instructions described by the Fetal Medicine Foundation, London. Results: Among the 1,807 fetuses included in the study, 9 had trisomy 21. The detection rate of Down syndrome with NT measurement was 77.8% (7/9) with a false-positive rate of 4.5%. Incorporation of biochemical tests (PAPP-A, and free beta-hCG measurement) into the screening increased the detection rate to 88.9% (8/9) and decreased the false-positive rate to 3.6%. The prevalence of absent nasal bone was 7/1,798 (0.39%) in chromosomally normal fetuses, and 3/9 (33.3%) in Down syndrome fetuses. Sensitivity, specificity, positive predictive and negative predictive values of absence of nasal bone for trisomy 21 are 33.3% (CI: 0.12-0.64), 99.6% (CI: 0.99-0.99), 30% (95% CI: 0.11 0.53) and 99.7% (95% CI: 0.99-0.99), respectively. The positive likelihood ratio of absent nasal bone was 85.6 (95% CI: 26.2-279.5), and the negative likelihood was 0.67 (95% CI: 0.42-1.06). When nasal bone assessment was incorporated into the NT risk assessment or combined test, the detection rate of trisomy 21 was not changed, however, the false-positive rate decreased to 3.4 and 3%, respectively. Conclusion: The absence of fetal nasal bone has a high positive likelihood ratio for Down syndrome in the first trimester screening, and the presence of nasal bone may potentially lower the need for invasive testing. Copyright (C) 2008 S. Karger AG, Basel

Is Cystatin C a Promising Parameter to Determine Postnatal Outcome of Prenatally Diagnosed Infravesical Obstruction?

Purpose: We investigated the prognostic power of cystatin C to determine renal functional outcome in patients with prenatally diagnosed infravesical obstruction

Investigation of Preeclampsia Using Raman Spectroscopy

Preeclampsia is associated with increased perinatal morbidity and mortality. There have been numerous efforts to determine preeclampsia biomarkers by means of biophysical, biochemical, and spectroscopic methods. In this study, the preeclampsia and control groups were compared via band component analysis and multivariate analysis using Raman spectroscopy as an alternative technique. The Raman spectra of serum samples were taken from nine preeclamptic, ten healthy pregnant women. The Band component analysis and principal component analysis-linear discriminant analysis were applied to all spectra after a sensitive preprocess step. Using linear discriminant analysis, it was found that Raman spectroscopy has a sensitivity of 78% and a specificity of 90% for the diagnosis of preeclampsia. Via the band component analysis, a significant difference in the spectra of preeclamptic patients was observed when compared to the control group. 19 Raman bands exhibited significant differences in intensity, while 11 of them decreased and eight of them increased. This difference seen in vibrational bands may be used in further studies to clarify the pathophysiology of preeclampsia