Gestasyonel diyabetes mellitus, obezite ve travayın fetal vasküler yapıya etkisinin araştırılması

Amaç: GDM'li(Gestasyonel Diyabetes Mellitus'lu), obez ve normal doğum yapan gebelerde umbilikal ven intimasındaki VEGF (vaskuler endotelial büyüme faktörü) ekspresyonunun incelenmesi ve bu bulgularla gebelik sonuçları arasındaki ilişkiyi değerlendirmektir. Ayrıca maternal uterin arter, fetal umblikal arter ve fetal orta serebral arter (MCA) Doppler değerlerinin VEGF ekspresyonuyla ilişkisini araştırmaktır.  Yöntem: Çalışmaya, 37.-40. gebelik haftasında tekil gebeliği olan toplam 159 hasta alındı. Patoloji Anabilim Dalı'ndan 30 (%18,87) hastanın parafin bloklarının bulunamaması, 5 (%3,14) hasta dış merkezde doğum yapması ve 2 (%1,26) hasta preeklampsi tanısı alması nedeniyle çalışmadan çıkarıldı. Kalan 122 hasta 4 farklı gruba ayrıldı: GDM grubu (13 gebe), obezite grubu (13 gebe), travay grubu (50 gebe) ve kontrol grubu (46 gebe). Doğum öncesi gebelerin uterin arter, umbilikal arter ve fetal orta serebral arter Doppler değerlendirilmesi yapıldı. Aynı dönemde kan örneklerinden CRP ( C-reaktif protein) ve lipit profiline bakıldı. Doğum sonrası umblikal kord immünhistokimyasal inceleme için Patoloji Anabilim Dalı'na gönderildi. Bulgular: CRP değerlerinin ve VEGF skorunun gruplar arasındaki dağılımı istatistiksel olarak anlamlı saptandı (sırasıyla p=0,020 ve p=0,0001). Travay grubundaki VEGF'nin yüksek değerleri, kontrol, obezite ve GDM'li gruplara göre istatistiksel olarak anlamlı saptandı (p=0,0001). Obezite, VEGF değerlerini anlamlı olarak düşürmektedir (p=0,002). GDM de, VEGF değerlerini düşürmektedir, fakat etkisi istatistiksel olarak anlamlı bulunamadı. CRP'nin yükselmesi VEGF değerlerini etkilememekte, buna karşın HDL (High Density Lipoprotein) yükselmesi VEGF değerini anlamlı olarak düşürmektedir (p=0,043). Doppler bulguları ile VEGF değerleri arasında istatistiksel olarak anlamlı bir ilişki saptanmadı. Sonuç: VEGF artışının fetüs açısından koruyucu bir mekanizma olduğunu düşünmekteyiz. Riskli gruplardaki hastalara VEGF takviyesini yaparak, açıklanamayan fetal ölüm ve fetal malformasyonlar insidansı azaltılabilir. Objective: To assess the expression of VEGF (vascular Endothelial Growth Factor) of umbilical vein intima in patiaents with GDM (Gestational Diabetes Mellitus), obese patients and patients who delivered normally and to determine the relationship between these findings and pregnancy outcome. To investigate the relationship between VEGF expression and maternal uterine artery, umbilical artery and fetal middle cerebral artery Doppler velocimetry.  Method: 159 patients with singleton pregnancy who were between the 37-40th week of gestations included in the study. 30(%18,87) patients who cannot be found paraffin blocks in the Department of Pathology, 5(%3,14) patients who gave birth outside the hospital and 2 (%1,26) patients who received a diagnosis of preeclampsia were excluded from the study. The remaining 122 patients were divided into four groups: GDM group (13 patients), obesity group (13 patients), labor group (50 patients) and control group (46 patients). Before the delivery Doppler examination was performed to all patients. At the same time, maternal serum CRP (C-reactive protein) and lipid profile levels were measured. The umbilical cords after deliveries were sent to the Department of Pathology for immunohistochemistry examination.  Results: The distribution of CRP values and VEGF score was significantly found among the groups (p=0,020 and p=0,0001, respectively). Levels of VEGF were significantly higher in the labor group compared with the control, obesity and GDM groups (p=0,0001). Obesity significantly decreases the values of VEGF (p=0,002). GDM also decreases the values of VEGF but its influence was not significantly found out. The increasing values of CRP doesn't influence the VEGF score, in spite of this increasing of HDL levels (High Density Lipoprotein) significantly decreases the VEGF score (p=0,043). There was not significantly relationship between Doppler velocimetry and VEGF score. Conclusion: We think that the increasing value of VEGF is a protective fetal mechanism. So, we may reduce the incidence of unexplained fetal death and fetal malformations by reinforcement of VEGF in patients at risk groups

Clinicopatologic evaluation of pelvic masses with very high serum levels of CA 125

AMAÇ: Benign overian hastalıklarda, CA 125 nadir olarak 1000 U/mL üzerinde saptanır. CA 125 düzeyinin 1500 U/ml'un üzerinde saptandığı durumlarda bu değerin over kanseri için spesifitesi %99.1'e yükselir. Genel olarak, premenopozal ve postmenopozal kadınlarda, CA 125'in maligniteyi saptamada sensitivitesi ve spesifitesi yaklaşık olarak %78'dir. Bu nedenle yüksek CA 125 düzeyleri günümüzde hala overian kitlelerin malign ve benign ayırımında çelişkili sonuçlar ortaya çıkarmaktadır. Preoperatif CA 125 seviyesinin çok yüksek saptandığı durumlarda adneksiyel kitlelere yaklaşım nasıl olmalı ve benign patolojilerin de CA 125'i çok yüksek seviyelere çıkarabileceğini vurgulamak amaçlanmıştır YÖNTEMLER: Ocak 2005 yılından Ocak 2013'e kadar Dokuz Eylül Üniversitesi Biyokimya Anabilimdalı tarafından CA 125 değeri 450 U/ml'nin üzerinde saptanan 236 hastanın dosyası geriye dönük olarak incelenmiştir. 236 hastanın 67'sinde jinekolojik patoloji saptanmıştır. 67 hastanın 7'si endometrium kanseri, 4'ü serviks kanseri, 21'i peritonitis karsinomatoza ve 1 hasta myoma uteri nedeniyle dışlandıktan sonra çalışmaya 34 hasta dahil edilmiştir. 34 hastanın, operasyon öncesi CA 125 düzeyleri kaydedilmiş, yaş, menopoz durumu, menopoz süresi, tespit edilen kitlenin boyutu, yerleşim yeri, muayene bulguları, görüntüleme yöntemleri dosyalarından ve veri tabanlarından incelenerek kaydedilmiştir. BULGULAR: Analize alınan 34 hastadan, histopatolojik tanılarına göre10'unda (%29.4) benign over kisti, 24'inde (%70.6) malign over tümörü saptanmıştır. Benign olguların 8'inde (%80) endometriozis, 1 olguda (%10) dermoid kist ve 1 olguda (%10) seröz kist adenofibrom saptanmıştır. Benign over kisti saptanan hastaların ortalama serum CA 125 değeri 830.80±395 saptanırken( en düşük 877 ve en yüksek 1565), malign olgularda bu değer 2027.04±1649 ( en düşük 471 ve en yüksek 6702) olarak bulundu. Benign olgular, malign olgularla karşılaştırıldığında anlamlı olarak daha genç ve premenopozal dönemde saptandı. Vücut kitle indeksi de malign epitelyal over tümörü saptanan hastalarda anlamlı olarak yüksek bulundu. SONUÇ: Pelvik kitlelerin preoperatif olarak benign/malign ayrımının yapılması için bir çok tümör belirteci içeren bir çok skorlama sisteminin geliştirildiğinin, ancak tek başına over kanseri ile özdeş bir tümör belirtecinin bulunamadığını, bunların içinde en özgün ve duyarlı olanının CA 125 olduğunu, bunun pelvik muayene, pelvik ultrasonografi, menopoz durumu ile birleştirildiğinde doğruluk oranlarının daha da arttığı vurgulanmaktadır. Bu nedenle, pelvik kitlelerin ayırıcı tanısında preoperatif CA 125 seviyesi, hastanın özgeçmişi, ultrason bulguları, menopoz durumu ile birlikte değerlendirilmelidir. OBJECTIVE: In benign ovarian diseases, CA 125 is rarely over 1000 U/mL. When CA 125 level is over 1500 U/mL, the spesitificity for ovarian cancer rises to %99.1. In general, for both premenopausal and postmenopausal women, the sensitivity and specificity of CA 125 in predicting malignity is %78. In differentiating benign from malignant pelvic masses, CA 125 has limited specificity, so CA 125 has left room for improvement. In this study, our aim is to discuss the management of pelvic masses when preoperative CA 125 is extremely high and to show that CA 125 level can be elevated in benign diseases. METHODS: From January 2005 to January 2013, 236 patients who had serum CA 125 levels over 450 U/mL in Dokuz Eylul University Biochemistry Department were recorded retrospectively. 67 patients had gynecological disease. From these 67 patients,33 patients were excluded becasue 7 had endometrium cancer, 4 had cervix cancer, 21 had peritonitis carsinomatosa and 1 had myoma uteri. 34 patients were found eligible for the study. Preoperative serum CA 125 levels, age, menopausal status, menopause time, the size and the location of the pelvic mass, pelvic examinations, imaging records were conducted from patient files. RESULTS: : 34 patients were analyzed and according to hystopatological diagnosis, 10 women(%29.4) had benign ovarien cyst and 24 patients (%70.6)had malignant ovarian tumour. In benign cases, 8 (%80) patients had endometriosis, 1 (%10) patient had dermoid cyst and 1(%10) patient had serous cyst adenofibroma. In patients who had benign ovarian cysts, mean serum CA 125 level was 830.80±395( lowest 877, highest 1565), and in malignancy group, serum CA 125 level was değer 2027.04±1649 ( lowest 471, highest 6702). When benign cases were compared with malignant cases, women who had benign cysts were younger and mostly premenopausal. In addition, body mass index were found to be higher in malignant cases. CONCLUSION: In differantiating benign and malignant pelvic masses, there are several scoring systems which includes different tumour markers. CA 125 is the most sensitive and specific tumour marker for ovarian cancer, but still the predictive value is low. In conclusion, in the diagnosis of pelvic masses, preoperative CA 125 levels should be interpreted with patients'age, menopausal status, ultrasonography findings to improve the prediction value of CA 125 in malignant cases

Laparoscopic treatment of recurrent ectopic pregnancy in the ipsilateral salpinx after ovulation induction and intrauterine insemination

AbstractObjectiveTo report a case of recurrent ectopic pregnancy in the ipsilateral salpinx after and intrauterine insemination treated by laparoscopy.Case reportA 33-year-old woman with unexplained infertility sought evaluation at our hospital due to pelvic pain after ovulation induction and intrauterine insemination. She had a history of a right salpingectomy. Transvaginal ultrasonography did not reveal an intrauterine pregnancy, but showed a suspected extrauterine gestational sac on the operated adnexal area with free fluid in the pouch of Douglas. The patient was diagnosed with a recurrent ruptured ectopic pregnancy and an emergency laparoscopy was performed.ConclusionRecurrent ectopic pregnancy in the ipsilateral fallopian tube is rare, but it is important to be suspicious of the diagnosis to prevent serious morbidity. This case also demonstrates transtubal or transperitoneal migration of the gametes because ovulation and ectopic pregnancy occurred on opposite sides

Effect of vascular endothelial growth factor on fetal vessels among obese pregnant women

Objective To determine the role of vascular endothelial growth factor (VEGF) in placental hypoperfusion in obesity. Methods the prospective study enrolled women with a first-trimester singleton pregnancy in Izmir, Turkey, between January and April 2011. Participants were divided into three groups: obese (body mass index [BMI, calculated as weight in kilograms divided by the square of height in meters] >30) with cesarean delivery; normal weight (BMI <30) with vaginal delivery (NVD); and healthy controls (BMI <30) with cesarean delivery. Before delivery, serum C-reactive protein (CRP), and uterine and fetal Doppler measurements were taken. VEGF was evaluated immunohistochemically from the umbilical cord. Results Overall, 109 women completed the study: obesity group (n=13, 11.9%), NVD group (n=50, 45.9%), and control group (n=46, 42.2%). Serum CRP was higher in the obesity group than in the control or NVD groups (P=0.009). VEGF score was highest in the NVD group (9.39 +/- 3.11), and lowest in the obesity group (4.58 +/- 2.78) (P<0.001). VEGF score decreased by 0.81 for each increase in BMI of 1 (P=0.002). Conclusions Maternal obesity was related to decreased VEGF expression. Although not supported by Doppler findings, decreased VEGF expression owing to maternal obesity might trigger endothelial dysfunction and inflammation

Effect of vascular endothelial growth factor on fetal vessels among obese pregnant women

Objective To determine the role of vascular endothelial growth factor (VEGF) in placental hypoperfusion in obesity. Methods the prospective study enrolled women with a first-trimester singleton pregnancy in Izmir, Turkey, between January and April 2011. Participants were divided into three groups: obese (body mass index [BMI, calculated as weight in kilograms divided by the square of height in meters] >30) with cesarean delivery; normal weight (BMI <30) with vaginal delivery (NVD); and healthy controls (BMI <30) with cesarean delivery. Before delivery, serum C-reactive protein (CRP), and uterine and fetal Doppler measurements were taken. VEGF was evaluated immunohistochemically from the umbilical cord. Results Overall, 109 women completed the study: obesity group (n=13, 11.9%), NVD group (n=50, 45.9%), and control group (n=46, 42.2%). Serum CRP was higher in the obesity group than in the control or NVD groups (P=0.009). VEGF score was highest in the NVD group (9.39 +/- 3.11), and lowest in the obesity group (4.58 +/- 2.78) (P<0.001). VEGF score decreased by 0.81 for each increase in BMI of 1 (P=0.002). Conclusions Maternal obesity was related to decreased VEGF expression. Although not supported by Doppler findings, decreased VEGF expression owing to maternal obesity might trigger endothelial dysfunction and inflammation