Impact of Increased Activated Protein-C Resistance, Decreased Antithrombin III Activity and Hypocomplementemia on the Gestational Outcomes of Pregnancies with MTHFR Polymorphisms

OBJECTIVE

To evaluate the impact of increased Activated Protein C (APC) resistance, decreased antithrombin III activity and hypocomplementemia on the pregnancy outcomes of the patients with methylentetrahydrofolate reductase (MTHFR) polymorphisms.

METHODS

This study was composed of 83 pregnancies with MTHFR polymorphisms. Increased APC resistance, decreased antithrombin III activity and hypocomplementemia were accepted as risk factors for poor gestational outcome.

RESULTS

Having at least one risk factor resulted in significantly higher rates of "APGAR score of<7" at the first ten minutes (p=0.009). Composite adverse outcome rate was also higher in patients with at least one of the defined risk factors despite lack of statistical significance (p=0.241). Rate of newborn with an "APGAR score of<7" at first ten minutes was significantly higher at patients with hypocomplementemia (p=0.03).

CONCLUSION

Hypocomplementemia is a risk factor for poor gestational outcome in pregnancies with MTHFR polymorphisms.

GC-MS Based Metabolomics Analysis to Evaluate Short-Term Effect of Tumor Removal on Patients with Early-Stage Breast Cancer

In this study, it was aimed to demonstrate the short-term effect of breast cancer surgery and tumor removal on the metabolomic profiles of patients with early-stage breast cancer. This cohort consisted of 18 early-stage breast carcinoma patients who had breast cancer surgery to remove tumor and surrounding tissues. The blood samples obtained preoperatively and 24 h after surgery were used in this investigation. Gas chromatography-mass spectrometry (GC-MS) based metabolomic analysis was performed to determine the metabolites. The GC-MS-based metabolomics profile enabled the identification of 162 metabolites in the plasma samples. Postoperatively, glyceric acid, phosphoric acid, O-phosphocolamine, 2-hydroxyethyliminodiacetic acid, N-acetyl-D-mannosamine, N-acetyl-5-hydroxytryptamine, methyl stearate, methyl oleate, iminodiacetic acid, glycerol 1-phosphate, β-glycerol phosphate and aspartic acid were found to be significantly increased (P < 0.05 for all), whereas saccharic acid, leucrose, gluconic acid, citramalic acid and acetol were significantly decreased (P < 0.05 for all). Breast cancer surgery and tumor removal has an impact on the metabolomic profiles of patients with early-stage breast cancer. These findings can be used for understanding the pathogenesis of breast cancer biology and screening the success of the surgery.

Nuclear Deformability of Breast Cells Analyzed from Patients with Malignant and Benign Breast Diseases

Breast cancer is a heterogeneous and dynamic disease, in which cancer cells are highly responsive to alterations in the microenvironment. Today, conventional methods of detecting cancer give a rather static image of the condition of the disease, so dynamic properties such as invasiveness and metastasis are difficult to capture. In this study, conventional molecular-level evaluations of the patients with breast adenocarcinoma were combined with in vitro methods on micropatterned poly(methyl methacrylate) (PMMA) biomaterial surfaces that deform cells. A correlation between deformability of the nuclei and cancer stemness, invasiveness, and metastasis was sought. Clinical patient samples were from regions of the breast with different proximities to the tumor. Responses at the single-cell level toward the micropatterned surfaces were studied using CD44/24, epithelial cell adhesion marker (EpCAM), MUC1, and PCK. Results showed that molecular markers and shape descriptors can discriminate the cells from different proximities to the tumor center and from different patients. The cells with the most metastatic and invasive properties showed both the highest deformability and the highest level of metastatic markers. In conclusion, by using a combination of molecular markers together with nuclear deformation, it is possible to improve detection and separation of subpopulations in heterogenous breast cancer specimens at the single-cell level.

Impact of anti-thyroid peroxidase and anti-thyroglobulin antibodies on the gestational outcome of euthyroid pregnancies: A retrospective study

BACKGROUND

Thyroglobulin (anti-TG) and/or thyroid peroxidase (anti-TPO) autoantibodies are associated with higher rates of poor gestational outcomes.

OBJECTIVE

To demonstrate the impact of anti-TPO and anti-TG autoantibodies on the gestational outcomes of euthyroid pregnant women with a history of poor gestational outcome and thyroid gland disorders.

METHODS

This retrospective study included totally 75 euthyroid pregnant, 30 of women with high thyroid autoantibodies (Anti-TPO/Thyroglobulin-positive group) and 45 of them without autoantibodies (control group).

RESULTS

We could not demonstrate significant differences between two groups in terms of risk factors/co-morbidities, obstetric complications, gestational outcomes, and birth data (p> 0.05). However, enhanced miscarriage rates were observed among the Anti-TPO/Thyroglobulin-positive and control groups without significance (36.7% and 17.8% respectively, p= 0.116). High neonatal intensive care unit (NICU) admission rates were found for control and Anti-TPO/Thyroglobulin-positive groups (16.2% and 21.1%, respectively) (p= 0.720). Clinically, we compared the two groups in terms of the existence and the types of goiter (diffuse and nodular), and demonstrated that nodular goiter was statistically more frequent in the control group (40.0% vs. 8.7%, p= 0.015). Alongside, relatively high hereditary thrombophilia and type-2 diabetes mellitus rates were found in the Anti-TPO/Thyroglobulin-positive group (20.0% and 20.0%).

CONCLUSION

Thyroid autoantibody positivity is likely a risk factor for early pregnancy loss and NICU admission.

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.

Relationship of Cholelithiasis and Urolithiasis with Methylenetetrahydrofolate Reductase Polymorphisms

AIM

To investigate the relationship of cholelithiasis and urolithiasis with Methylenetetrehydrofolate Reductase (MTHFR) polymorphism(s) in patients with poor obstetric history to search whether they are risk factors for adverse pregnancy outcome.

MATERIALS AND METHOD

This study is consisted of 94 patients with poor obstetric history. Patients were evaluated in terms of the presence of cholelithiasis and urolithiasis in association with MTHFR polymorphism(s). Additional laboratory tests including homocysteine measurements were also performed. ROC analysis for assessing the performance of blood homocysteine level in predicting the presence of cholelithiasis and urolithiasis were also performed.

RESULTS

Patients were divided into three groups such as cholelithiasis group (n = 9, 9.6%), urolithiasis group (n = 18, 19.1%) and control group (n = 67, 71.3%). Groups did not differ in term of age and Beksac obstetrics index (BOI) which is "[living child+(π/10)]/gravidity." The rate of the presence of MTHFR polymorphisms were 88.9% (8/9), 88.9% (16/18) and 43.3% (29/67) in cholelithiasis, urolithiasis and control groups respectively. Median homocysteine levels were found to be 13.1, 11.6 and 7.2 micromol/lt for the groups respectively. Statistically significant differences were found for MTHFR polymorphism rates and homocysteine levels (<0.001 for both). According to ROC analysis, 10.9 mcmol/L (88.9% sensitivity, 89.6% specificity) and 9.25 mcmol/L (83.3% sensitivity, 73.1% specificity) were determined to be cutoff values of homocysteine for cholelithiasis and urolithiasis respectively.

CONCLUSION

More frequent MTHFR polymorphisms are observed in women with a clinical history of gall or renal stones. Thus, screening of these patients may be benefical for the approprate management of their subsequent pregnancies.

Location and Frequency of Residual Breast Tissue after Mastectomy

Introduction

Residual breast tissue after mastectomy is a problem since breast cancer can arise from it. The aim of this study was to investigate the incidence and location of residual breast tissue following modified radical mastectomy.

Methods

111 consecutive breast cancer patients who underwent mastectomy were enrolled in this study. During surgery, after removal of the breast tissue and before skin closure, a 1-cm² tissue sample was obtained from each quadrant under the skin flaps. These samples were evaluated histopathologically for the presence of any residual breast tissue.

Results

Residual breast tissue was detected in the tissue samples of 12/111 (10.8%) patients. 4 of these patients had residual breast tissue in all 4 quadrants. 6 patients had residual tissue in a single quadrant. With 9 positive biopsy results, the upper medial quadrant was the most frequently involved location. The other quadrants had 6 positive biopsy results each. At the end of a median of 20 months of follow-up, none of these patients developed breast cancer recurrences.

Conclusion

Mastectomy has a high probability of residual breast tissue being left behind. Physicians should be aware of this and act accordingly when planning surgical or follow-up treatment.

Undifferentiated Embryonal Sarcoma of the Liver in an Adult Patient

An undifferentiated embryonal sarcoma of the liver (UESL) is a rare and highly malignant mesenchymal neoplasm that is uncommonly observed in adults. We report a case of UESL found in a 26-year-old female. Our case was initially regarded as a type II hydatid cyst and then a malignant mass in radiological studies. The patient underwent nonanatomic liver resection. There were postoperative complications, but they were handled successfully. The patient received taxol-cisplatin-ifosfamide chemotherapy protocol and is disease-free after six years. Although UESL is exceedingly rare in adults, it must be considered while evaluating large hepatic masses since curative resection has an excellent prognosis.

Giant retroperitoneal dedifferentiated liposarcoma

INTRODUCTION

Liposarcoma is the most frequent type of retroperitoneal sarcomas. Dedifferentiated liposarcoma is the least common subtype and is an extremely rare tumor.

CASE REPORT

We present the case of a 53-year-old male who was referred with a giant retroperitoneal mass. The patients' mass was deemed unresectable by the previous institution and received chemotherapy with no benefit. We macroscopically removed the 38x32 cm mass with right nefrectomy. Pathological examination revealed dedifferentiated liposarcoma.

CONCLUSION

Surgery is the gold standart in the treatment of retroperitoneal sarcomas. Giant masses present a challenge for the surgeon with possible major vascular injuries and multiorgan resections. Therefore it is important for these patients to be referred for surgery without delay.

KEY WORDS

Dedifferentiated liposarcoma, Liposarcoma, Retroperitoneal sarcoma.

Spontaneously closed gastrocutaneous fistula becomes symptomatic after 30 years with pregnancy

Percutaneous endoscopic gastrostomy (PEG) is the standard procedure of choice for the provision of enteral nutrition in children who require long-term nutritional support. Removal of gastric tubes has a risk of causing gastrocutaneous fistula and this complication is dealt within childhood. The authors report a 34-year old woman who had a PEG procedure at the age of four years due to caustic esophageal injury and recovered without incident. Thirty years later she becomes pregnant and as her pregnancy progresses, her former fistula opening becomes more obvious and at the 34'h week of the pregnancy she' presents to the hospital with fistula. After a successful delivery, the fistula was evaluated and repaired surgically.

Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery: A New Predictive Statistical Model

INTRODUCTION

Although laparoscopic cholecystectomy is currently the standard treatment for benign gallbladder pathologies, some cases still require conversion to open cholecystectomy. Since open cholecystectomy has a significantly higher morbidity rate and a lengthier stay in the hospital compared with laparoscopic surgery, predicting this conversion would grant a great advantage in the management of cholecystitis. Therefore, in this study, we aimed to develop a predictive statistical model.

MATERIALS AND METHODS

Between August 2006 and January 2011, 1335 laparoscopic cholecystectomies were initiated at the General Surgery Department of Hacettepe University. One hundred four of these cases were started as laparoscopic surgeries, but converted to open cholecystectomies. In our study, we randomly chose 104 laparoscopically completed cases and compared them with the 104 converted cases. We used 31 parameters, including demographics, ultrasonographic findings, and laboratory values, to compare groups. These parameters were later included in a logistic regression analysis to create a statistical model that predicts conversion to open cholecystectomy.

RESULTS

Among the 1335 laparoscopically started cases, 104 (7.7%) were converted to open surgery. In our study, we found age, gender, ultrasonographic findings of acute cholecystitis, history of choledocolithiasis, history of abdominal surgery, and alkaline phosphatase (ALP) levels to be significant risk factors. By using a receiver operating characteristic curve, we found that the risk significantly increases after 55 years of age and an ALP over 80 IU/L.

DISCUSSION

Using four parameters-age, gender, history of abdominal surgery, and ALP-in our statistical model, we were able to predict the conversion from laparoscopic to open cholecystectomy with 70% sensitivity and 79% specificity.

Myomectomy during cesarean section and adhesion formation as a long-term postoperative complication

OBJECTIVES

We aimed to evaluate the incidence and features of postoperative adhesion related complications occurring following myolysis or myomectomy performed during cesarean section (C/S).

METHODS

This cross-sectional study consists of four groups of patients who underwent C/S: group I; myolysis is performed by electric cauterization for small superficial fibroids less than 2 cm. (n: 21), group II; myomectomy is performed for pedunculated fibroids (n: 18), group III; myomectomy is performed for intramural/subserous fibroids less than 5 cm. (n: 23), group IV control group (n: 19) who did not go through myomectomy Repeat C/S is performed to study subjects within 1-5 years. All cases are evaluated in terms of mild to moderate adhesions between omentum and uterus, mild to moderate adnexial area adhesions, mild to moderate incision area adhesions and surgical difficulty due to severe adhesions.

RESULTS

The incidence of adhesions of omentum and uterus (p= 0.278), mild to moderate adnexial area adhesions (p = 0.831), mild to moderate incision area adhesions (p= 0.804) were similar between the intervention groups (group I, II, and III) and the controls (group IV).

CONCLUSION

Cesarean myomectomy is a safe procedure and can be performed without significant postoperative adhesion formation.

Pregnancy-associated breast cancer: clinicopathological characteristics of 20 cases with a focus on identifiable causes of diagnostic delay

BACKGROUND

The primary objective of this study was to evaluate the clinicopathological characteristics of patients with pregnancy-associated breast cancer (PABC), with a special focus on diagnostic delays and the identifiable causes of diagnostic delays.

PATIENTS AND METHODS

Clinicopathological data of patients treated for PABC between 2003 and 2012 at Hacettepe University Hospital was retrospectively reviewed.

RESULTS

20 patients with PABC were included. The pathological examination revealed predominance of invasive ductal carcinoma (80%), grade III tumors (65%) and advanced-stage (III-IV) disease (75%). In 8 patients (40%), there was a diagnostic delay between occurrence of the presenting symptoms and the initiation of breast mass workup. For these 8 patients, the main identifiable causes of diagnostic delay were the attribution of disease-related symptoms to pregnancy or lactation in 5 (63%) and negligence of symptoms in 2 (25%).

CONCLUSIONS

PABC mostly presents with advanced-stage disease, and there can be a substantial diagnostic delay before these patients receive treatment. Preconceptional, gestational and postpartum examination of women of reproductive age should include a thorough breast examination and should provide adequate information regarding the physiological changes in breast tissue and the possible pathological symptoms.