Kolorektal Kanserlerde Postoperatif İzlemde Nüks Metastaz Gelisimine Etkiyen Cerrahi, Histopatolojik ve Immünogenetik (Killer Immünoglobulin Like Reseptör ve Ligand Tiplendirilmesi) Özelliklerin Tanımlanması

To analyze the frequency of Killer Immunoglobulin Like Receptor (KIR) gene and their ligands (HLA Class I), 87 patients diagnosed with colorectal cancer and operated between 2005 and 2008 were enrolled into this study. 29 patients progressing within a median of five year follow-up period were compared with 58 cases that did not. Age, gender, clinical stage, tumor location, adjuvant therapy and recurrence location were similar between the groups. Among the cases without recurrence 2DL1, which is an inhibitory KIR, is observed significantly less frequent while activatory KIRs, 2DS2 and 2DS3, significantly more frequent. Therefore, a decrease in inhibition and an increase in activation, may lead to an antitumor immune response. Among the KIR ligands only A-Bw4 is observed significantly less frequently among non-recurrent patients. When KIR and KIR ligand association is examined, two KIR's who share the same ligand (group C1), 2DL2 (inhibitor) and 2DS2 (activator), frequently coexisted. Similarly inhibitory KIR-ligand combinations 2DL1-C2 and 2DL3-C1 are seen less frequnetly in the non-recurrent group while the activatory combination 2DS2-C1 and inhibitory combination 2DL2-C1 are shown to be more frequent in the non-recurrent group. Even though 2DS2 is seen less frequently in recurrent group, if recurrence occurs despite 2DS2, distant metastasis is more frequent than local recurrence. Our findings show for the first time in literature that in colorectal cancers, recurrence is association with the presence of activating KIR's and absence of inhibitory KIR's in the setting of their appropriate ligands.Antitümöral immün yanıtı belirleyen Killer Immunoglobulin Like Receptor (KIR) genleri ile onların ligandları olan HLA Class I moleküllerini incelemek amacıyla 2005-2008 yılları arasında kolorektal tümör tanısı ile kolon rezeksiyonu uygulanan 87 olgu araştırmaya alındı. Ortanca 5 yıl takip süresinde rekürrens gösteren 29 olgu ile nüks etmeyen 58 olgunun klinik ve KIR-ligand özellikleri karşılaştırıldı. Yaş, cinsiyet, klinik evre, tümör lokalizasyonu, adjuvan tedavi ve rekürrens lokalizasyonu açısından gruplar arasında bir fark olmadığı gözlendi. Rekürrens göstermeyen olgularda inhibitör KIR'lardan 2DL1 anlamlı olarak azalırken aktivatör özelliğe sahip 2DS2 ve 2DS3'ün anlamlı olarak arttığı gözlendi. Böylece inhibisyonun azalması ve aktivasyonun güçlenmesi ile antitümöral immün yanıtın arttığı düşünüldü. KIR ligandları incelendiğinde rekürrens göstermeyenlerde A-Bw4 ligandın daha nadir olduğu saptandı. KIR ve KIR ligand birlikteliğine bakıldığında rekürrens göstermeyenlerde ortak liganda(grup C1) sahip 2DL2 (inhibitör) ve 2DS2'nin (aktivatör) sıklıkla birlikte bulunduğu saptandı. Rekürrens göstermeyen olgularda inhibitör yöndeki 2DL1-C2 ve 2DL3-C1'in beraber görülme sıklığında azalma gözlenirken aktivasyon yönündeki 2DS2-C1 ve inhibitör yöndeki 2DL2-C1 beraber görülme sıklığında artış saptandı. Rekürrensin erken veya geç gelişmesini etkileyecek bir bulgu saptanmadı. 2DS2 her ne kadar rekürrens gösteren hastalarda daha az görülse de, 2DS2'ye rağmen rekürrens geliştiği takdirde uzak metastazın lokal rekürrensten daha sık oluştuğu saptandı. Bulgularımız, literatürde ilk kez kolorektal kanserlerde rekürrensin uygun ligandlarının varlığında aktive edici KIR'ların varlığı ve baskılayıcı KIR'ların azalması ile ilişkili olduğunu göstermektedir

Pregnancy Outcome of Renal Transplant Recipients: Analysis of Nine Patients

OBJECTIVE: Pregnancy in renal transplant recipient was considered unsafe in the past. To date, these patients have successful pregnancy outcome. In this study, we aimed to analyze the outcome of pregnancy in kidney transplant recipients and the consequences on renal function. STUDY DESIGN: Retrospective analysis RESULTS: We found that the mean gestational age at delivery for patients were 35.22 weeks and 55.5% patients had preterm delivery and this result is higher than normal pregnant population. CONCLUSION: Pregnant women who renal transplant recipient have higher risk for preterm labor and hypertension compared normal pregnant women

Retrospective Evaluation Of Pregnant Women With Celiac Disease

Objective: To show celiac disease (CD) and its poor pregnancy outcome relationship, and to demonstrate the importance of a gluten-free diet together with low-dose low-molecular-weight heparin (LMWH) and low-dose corticosteroid (LDC) in the management of pregnancies with CD. Material and Methods: This study consisted of 2 groups of patients. Six patients with CD (control group) on a gluten-free diet were monitored during their first pregnancies within the framework of antenatal care program and their pregnancy outcomes were compared with eight poorly-treated pregnant patients with CD (study group) who were referred from other medical institutions. LMWH (enoxaparine 1x2000 Anti-XA IU/0.2 mL/day), and LDC (methylprednisolone 1x4 mg p.o/day) were used in the control group. Their obstetric histories and outcomes of their last pregnancies were compared. The patients’ obstetric risk levels were evaluated using the “Beksac Obstetrics Index” (BOI). Results: There were miscarriages in 50% of the study group. There were also 50% and 75% preterm deliveries in the control and study groups, respectively. The BOI of the study group was significantly worse than the control group (1.31 vs. 0.31±0.21, p<0.01). There were no statistically significant differences between age (24±4.7 vs 31.7±6 years, p=0.448), gestational day of birth (259.3±8.5 vs 246.6±24.3), birthweight (2691±698 vs 2262±359 g, p=0.394), and cesarean section rates (p=0.118). Conclusion: CD is a risk factor for adverse pregnancy outcome. Miscarriage and preterm labor are critical complications in pregnancies complicated by CD. A gluten-free diet is important in the treatment. LMWH and LDC seem to be helpful in the management of pregnant women with CD.PubMe

Surgical Management of Non-Obstetric Acute Abdomen During Pregnancy: A Retrospective Review of 24 Cases After 8-Years’ Experience

Objectives: Diagnosis and management of non-obstetric acute abdomen during pregnancy is a cause of concern both for the obstetricians and the general surgeons. A resistance against operation during pregnancy leads to unnecessary delay which may increase both maternal and fetal morbidity, even mortality. In this study we present our experience in surgical management of pregnant patients with non-obstetric acute abdomen. Study Design: Pregnant patients with acute abdomen requiring surgical exploration were enrolled from 2004 to 2012. Women were excluded from the analysis if the surgical procedure was obstetric in nature. Demographics, gestational age, symptoms, operative results, postoperative complications, pregnancy outcome and imaging studies were assessed. Results: There were 24 patients with a mean age of 28,25±3.51 years. Operations are often performed in the second trimester. Most common symptoms were abdominal pain (100%) and nausea (83%). Ovarian torsion and appendicitis were the most common etiologies causing non-obstetrical acute abdomen (33% and 25%, respectively). All patients tolerated surgery well, 11 of them had no postoperative complications, however 3 fetal losses, 4 preterm deliveries, 3 PPROM, 1 re-operation and 1 vaginal bleeding were observed. One patient died from acute respiratory distress syndrome in the 24th day of the surgery. Ultrasonography was performed in 22 patients, MR imaging was used in 11 patients. Sonographic findings were diagnostic in 59%, while MR was successful in assigning the correct diagnosis in 100%. Conclusions: The issue of surgical management of non-obstetric acute abdomen during pregnancy is an important concern for clinicians who care women. Prompt diagnosis and appropriate surgical approach are the cornerstones of the management. Due to the diagnostic limitations of ultrasonography, MR imaging has become increasingly popular and gave direction to management strategy

Pregnancy after Cancer Treatment and Pregnancy Associated Cancer: A Single Center Experience with 96 Cases

OBJECTIVE: The objective of our study was to evaluate our experience on pregnancies after cancer treatment and pregnancy-associated cancer. STUDY DESIGN: The clinical records of 96 pregnant women including previously received treatment for cancer and association of cancer with pregnancy who admitted to our department were enrolled between 2002 and 2012. Demographics, pregnancy outcomes, maternal and fetal complications, perinatal outcomes, cancer types and treatments performed were evaluated. RESULTS: The study group was consisting of 96 cases, 59 out of 96 were cancer survivors and 37 were pregnancy-associated cancer patients. Of those thirty seven, 25 were synchronous with the pregnancy and 12 were metachronic. Pregnancies resulted in 77 healthy newborns, 7 abortions and 12 medical terminations. The most common type of cancer was the breast cancer in 25 patients, followed by thyroid, leukemia, osteosarcoma, lymphoma and ovarian cancer. Patients were treated for their cancer with different modalities including surgery, chemotherapy and radiotherapy. We encountered maternal mortality in 8 cases, all occurred after delivery. CONCLUSIONS: Since management of a pregnancy of a cancer survivor and pregnant woman with cancer a hard work, multidisciplinary approach involving gynecologists, pediatricians, oncologists is essential. Interval between cancer and pregnancy and timing of initiation of therapy in cases of pregnancy associated cancer are important issues in the perspective of fetal/neonatal well-being

Pregnancy In Papillary Thyroid Cancer Survivors

Objective: To evaluate “papillary thyroid carcinoma-pregnancy” interaction among cancer survivors. Material and Methods: The clinical records of 8 pregnant women who received treatment for papillary thyroid cancer before their pregnancy were evaluated. Clinical features, pregnancy/perinatal outcomes and high-risk factors were compared with 45 controls who were randomly assigned from the institutional perinatal medicine database. Results: Patients in the cancer group were older than the control group (34.3 vs 29.8 years). The cesarean section rate was higher (62.5% vs 33.3%) and the APGAR scores at the 1st and 5th minutes were lower in the cancer group. Conclusion: Management of pregnancies with papillary thyroid cancer treatment and follow-up requires a multidisciplinary approach with careful antenatal care and perinatal surveillance. Patients who have received papillary thyroid cancer treatment can safely undergo pregnancy.PubMe

Pelvic Ectopic Adrenal Tissue Leading to Benign Gynecological Pathologies in a Mosaic Turner’s Syndrome Patient: A Case Report

Benign gynecological pathologies in patients with Turner’s syndrome were described in the medical literature. Herein, we present a 39-year-old woman with mosaic Turner’s syndrome (45,0X/46,X,i(X)q10) complaining about bleeding and persistent pelvic pain. In physical examination, she presented normal secondary sex development, normal breast, normal pubic and axillary hair. The external genitalia were also normal. Her laboratory examination showed elevated gonadotropin levels, decreased 17betaestradiol levels and normal plasma androgens and cortisol levels. At transabdominal ultrasonography multiple myoma and irregular thickening of the endometrium were suspected. At laparotomy, total abdominal hysterectomy and bilateral salpingectomy were performed. Histopathological examination revealed multiple leiomyoma, secretory endometrium and ectopically localized adrenal tissue. Since its known that both myoma uteri and secretory changes in endometrium develop primarily in woman of reproductive age and their growth is estrogen dependent, the source of estrogen in the present case was thought to be the ectopic adrenal tissue located just beneath the left salpinx. This seems to be the first report of the occurence of benign gynecological pathologies due to the ectopic adrenal tissue in a mosaic Turner’s syndrome patient without hormone replacement therapy

Fetal Cell Microchimerism; Normal and Immunocompromised Gestations in Mice

Objective: To compare fetal cell microchimerism in normal and immunocompromised gestations. Materials and methods: The study consists of two groups of mature female mice. In the control group and the immunocompromised study group, 5 mg of saline and cyclosporine were injected intraperitoneally, respectively. In the second step, all female mice were mated with “Actine-Luc (+) green fluorescent protein (GFP)” transgenic male mice. Immunohistochemical studies (ALPL-antiluciferase, cytokeratin-antiluciferase, and CD 105-antiluciferase) were carried out on maternal liver, skin, and lung tissues at 6–7th and 14–15th gestational days, and postpartum 3–4th, 12th, and 18–24 months. Results: GFP (+) cells were detected in maternal liver and skin but not in lung tissue. Liver was the most affected tissue. GFP was found to be more intense in the immunocompromised group. Conclusion: Fetal microchimerism was demonstrated in maternal liver and skin and found to be more intensive in the immunocompromised group