A hemophagocytic lymphohistiocytosis case with newly defined UNC13D (C.175G>C; p.Ala59Pro) mutation and a rare complication

Hemophagocytic lymphohistiocytosis (HLH) represents a severe hyperinflammatory condition with cardinal symptoms of prolonged fever, cytopenias, hepatosplenomegaly, and hemophagocytosis by activated, morphologically benign macrophages with impaired function of natural killer cells and cytotoxic T lymphocytes. A 2-month-old girl, who was admitted with fever, was diagnosed with HLH and her genetic examination revealed a newly defined mutation in the UNC13D (c.175G>C; p.Ala59Pro) gene. She was treated with dexamethasone, etoposide, and intrathecal methotrexate. During the second week of treatment, after three doses of etoposide, it was noticed that there was a necrotic plaque lesion on the soft palate. Pathologic examination of debrided material in PAS and Grocott staining revealed lots of septated hyphae, which was consistent with aspergillosis infection. Etoposide was stopped and amphotericin B treatment was given for six weeks. HLH 2004 protocol was completed to eight weeks with cyclosporine A orally. There was no patient with invasive aspergillosis infection as severe as causing palate and nasal septum perforation during HLH therapy. In immuncompromised patients, fungal infections may cause nasal septum perforation and treatment could be achieved by antifungal therapy and debridement of necrotic tissue. © 2015 Turkish Society of Hematology. All rights reserved

Four Hydatid Cysts in One Family: Is Family Screening Necessary?

Hydatid cyst is a parasitic infection mostly caused by Echinococcus granulosus. As transmission occurs from infected dogs, it is endemic in animal husbandry regions. Here four patients within the same family are presented. The first patient is a 10 year-old girl admitted with nausea, vomiting, and fever. On her physical examination, there were decreased respiratory sounds in the right lung, rales, and hepatomegaly. In the radiological examination, cysts were seen in both her lung and liver. After the confirmation of the diagnosis with a serological examination, surgical resection was performed, and albendazole treatment was given. On family screening, cysts were detected in the liver and spleen in her asymptomatic 6-year-old brother; in the lung, liver, spleen, and right kidney in her 33-year-old mother who had repeating abdominal pain; and in the liver and left kidney in her 33-year-old asymptomatic father. Hydatid cyst infection was serologically confirmed in all patients, and they were given albendazole and were surgically treated. In this case report, four patients in the same family and diagnosed as having hydatid cysts were presented. It was emphasized that once a hydatid cyst was diagnosed, family screening became important, in endemic regions in particular

Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study

PURPOSEThe clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions.METHODSThis retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson’s chi-squared test, the Fisher–Freeman–Halton test, and Fisher’s exact test were used for the statistical analyses.RESULTSThe overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes.CONCLUSIONADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision

Comparıson of the medical methods in cervical ripening

Amaç: Bu çalışmada, term gebelikte vajinal yol ile uygulanan misoprostol ile dinoprostonun servikal olgunlaşma ve doğum indüksiyonundaki etkinlik ve güvenilirliklerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya tıbbi ya da obstetrik nedenler ile doğum indüksiyonu planlanan, 37 ve daha büyük gebelik haftasında bulunan, bishop skoru uygun olmayan, baş prezentasyonda toplam 61 canlı tekil gebe dahil edildi. Gruplardan birine misoprostol 50 µg dozda, 4 saat ara ile, maksimum 4 doz; diğer gruba dinoproston 0.5 mg dozda, 12 saat ara ile, maksimum 2 doz uygulandı. Her iki gruptan elde edilen veriler, ki-kare testi ve daha nadir olaylar için Fisher’in kesin testi ile analiz edildi. Bulgular: İndüksiyon başlangıcından doğuma kadar geçen süre dinoproston grubunda 784.5 ± 90.9 dakika, misoprostol grubunda 833.8 ± 105.0 dakika bulundu (p=0.724). 24 saat içinde vajinal doğum oranı dinoproston grubunda, misoprostol grubundan yüksekti (%74.1 ve %57.1); ancak istatistiksel anlamlı bulunmadı (p=0.187). İndüksiyon ajanı dozu, oksitosin ile destekleme ihtiyacı, analjezi uygulamaları, doğum şekilleri ve yenidoğan sonuçları için iki grup arasında anlamlı fark saptanmadı. Sonuç: Her iki prostaglandin analogunun servikal olgunlaşma ve doğum indüksiyonundaki etkinlik ve güvenilirliklerinin benzer olduğu, miad gebelikte doğum indüksiyonunda birbirinin alternatifi olarak kullanılabileceği; maliyet göz önüne alınarak, daha ucuz olan misoprostolün tercih edilebileceği sonucuna varıldı.Objective: To compare the efficacy and safety of vaginal misoprostol with vaginal dinoprostone in term labor induction and cervical ripening. Material and method: The patients included in the study had medical or obstetric indication for induction of labor, had reached a gestational age of at least 37 weeks, had unfavourable bishop score and carried singleton pregnancies in cephalic presentation. Misoprostol at 50 µg dose, at every 4 hours, maximum 4 doses were applied to one group and; dinoproston at 0.5 mg dose, at every 12 hours, maximum 2 doses were applied to the other group. The data were analyzed statistically by Chi square test and Fisher’s exact test when applicable. Results: Intervals from application of initial dose to delivery time were 784.5 ± 90.9 minutes and 833.8 ± 105.0 minutes for the dinoprostone and misoprostol groups, respectively (p=0.724). More women in dinoprostone group were given birth vaginally within 24 hours, but this was not statistically significant (%74.1 vs %57.1, p=0.187). No significant differences were noted among the groups with regard to induction agent dose, oxytocin augmentation requirement and mode of delivery. The neonatal outcomes were not significantly different between two groups. Conclusion: Vaginal misoprostol has similar efficacy and safety as vaginal dinoprostone. One may be an alternative to the other in cervical ripening and labor induction. Misopristol, due to cost effectiveness can be prefered

Pelvic Hydatic Cyst Mimicking An Ovarian Neoplasm: A Case Report

Hydatid disease is a zoonotic infection that affects a large number of and animals especially in livestock producing countries like Turkey. A case of pelvic echinococcal cyst is presented, which gives the apperance of a malignant ovarian neoplasm. Patient’s past history of hepatic surgery gave a clue, that it could be echinococcosis, but since the reports were lost, we could not confirm our suspicion. Although their localization in the pelvis is rare, echinococcal cyst should be kept in mind in the differentia ldiagnosis of pelvic masses, especially in patients of endemic regions

Investigate the relationship between the microbiota awareness in first trimester and high risk pregnancy in Turkish women: cross-sectional study

Abstract Background It is suggested that pregnancy risks may be related to microbial dysbiosis, and it is known that knowledge on this subject is reflected in behaviors. The purpose of this study was to investigate whether microbiota awareness in the first trimester of pregnancy is associated with pregnancy-related risks. Methods Within the scope of the study, the microbiota awareness scale was administered to 426 individuals in the first trimester of pregnancy, and information on any diagnosis related to high-risk pregnancy, gestational age, birth weight, and birth height of the newborn was obtained from their file records. Results The mean total microbiota awareness score of individuals was 61.38 ± 11.00 (26.00–91.00). The microbiota awareness score (56.85 ± 11.65) was found to be lower in individuals diagnosed with high-risk pregnancy (p < 0.05) than in healthy subjects (63.64 ± 9.94). Moreover, in individuals with high-risk pregnancies, a positive correlation was found between the microbiota awareness score and newborn birth weight and height (p < 0.05). Conclusion The poor microbiota awareness level in pregnant women is associated with high-risk pregnancy and neonatal growth status

The Effect of B - Lynch Compression Suture on Fertility Potential

OBJECTIVE: To investigate the potential complications like intrauterine synechia and tubal occlusion following B- lynch suture which was used to control the postpartum hemorrhage. STUDY DESIGN: Between December 2010 and December 2011 at the Department of Obstetrics and Gynecology, Rize Education and Reseach Hospital, 8 patients underwent B lynch suture for postpartum hemorrhage that was intractable to medical treatment and needed blood transfusion. These patients were called at 3. month of postpartum period. Uterine cavity and tubal patency was evaluated with hysterosalpingography and hysteroscopy. RESULTS: Early postpartum hemorrhage was controlled with B- lynch suture in all patients. In hysterosalpingographic and hysteroscopic inspection; uterine cavities were normal with bilateral tubal free passages in all patients. CONCLUSION: B- lynch suture was found to be an effective fertility preserving alternative to emergency postpartum hysterectomy in reproductive age women

Assessment of Nuchal Translucency Nasal Bone and Ductus Venosus Flow in the First Trimester: Pregnancy Outcomes

OBJECTIVE: To report the first trimester prenatal obstetric ultrasonography findings and pregnancy outcomes. STUDY DESIGN: This study was designed as a retrospective cohort one. Seven-hundreds twelve (n=712) singleton pregnant women attending to Simav –Kütahya Government Hospital between January 2008 and December 2011 for the routine first trimester screening and standard obstetric ultrasound examination were enrolled retrospectively. Pregnancy outcomes of these pregnancies were reported. RESULTS: The nasal bone was present in 704 (98.8%), absent in 4 (0.6%) and was not clearly evaluable in 4 (0.6%) patients. Blood flows in ductus venosus (DV) were normal in 609 (85.5%), reversed in 15 (2.1%) and not measurable in 88 (12.4%) of fetuses. We had 4 fetuses with cardiac anomaly. Among these 4 fetuses, we noted NT≥3.5 mm in 3 fetuses, absence of nasal bone in 3 fetuses and abnormal DV flow in 2 fetuses. We had 3 fetuses with Down syndrome. Among these 3 fetuses, we noted NT≥3.5 mm in 1 fetus, absence of nasal bone in 1 fetus and abnormal DV flow in 1 fetus. CONCLUSION: We reported our first trimester standard obstetric ultrasonographic results and pregnancy outcomes. We noted that the prenatal diagnosis of cardiac anomalies and Down syndrome may be possible via assessment of NT and DV flow

Brenner Tumor Found Incidentally in a Hysterectomised Patient: A Case Report

Brenner tümörü tüm over neoplazilerinin %1,5-2'sini oluşturur. Over yüzey epiteli veya pelvik mezotelin transisyonel metaplazisinden kaynaklanır. Vakaların %30'unda başka bir epitelyal over neoplazisi ile birliktelik vardır. Çoğunlukla insidental olarak patolojik incelemede tanı alır. Bu olgu sunumunda benign bir sebeple postmenopozal dö- nemde histerektomi uygulanan hastalarda salpingoooferektomi uygulama kararının gerekliliği araştırıldı.Brenner tumors are uncommon neoplasms of the ovary accounting for 1.5-2% of all ovarian neoplasms. They arise from ovarian surface epithelium or pelvic mesothelium through transitional metaplasia. In 30% cases an association with another epithelial ovarian neoplasm is observed. They are usually diagnosed incidentally in pathologic examination. This case report emphasis on the decision to perform an elective bilateral salpingo-oophorectomy (BSO) at the time of a hysterectomy for a benign condition in postmenopausal women