Publications by authors named "Murat Yayla"

28 Publications

  • Page 1 of 1

An ICP-MS Study for Quantitation of Nickel and Other Inorganic Elements in Urine Samples: Correlation of Patch Test Results with Lifestyle Habits.

Biol Trace Elem Res 2021 Feb 20. Epub 2021 Feb 20.

Cerrahpasa Medical Faculty, Department of Dermatology and Venerology, Istanbul University-Cerrahpaşa, 34098, Istanbul, Turkey.

Nickel (Ni) is a frequently used metal in the production of many products, and Ni exposure occurs in humans through food, inhalation, and skin. Studies reported Ni as the most common allergen diagnosed in the serial patch test. The main purpose of our study was to determine the concentration of Ni and other elements in the urine samples of individuals with Ni-sensitivity and to determine the effect of lifestyle habits on these variables. This study was conducted with 388 participants; additionally, both Ni patch test and inorganic analysis (for 24 elements) method in urine with inductively coupled plasma-mass spectrometry (ICP-MS) were applied to all participants. Ninety-two (23.7%) of the participants were found to have nickel sensitivity with a mean urine concentration of 4.475 μg/g creatinine (median=4.260; SD=2.527). The urine nickel concentration was significantly different between female and male participants (p =0.001). We found a significant correlation between Ni and other metals alongside various element pairs. The mean urine Ni concentration of the individuals with a positive Ni sensitivity test result was not different from that of the participants without Ni sensitivity (4.475 vs 4.256 μg/g creatinine, respectively; p = 0.068). The high accuracy, recovery, and repeatability data obtained from the analyses indicate that this study is efficient and appropriate for the quantitative determination of nickel and other elements in urine samples. Ni-containing objects and Ni-rich foods should be of concern for individuals with hypersensitivity reactions to the element.
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http://dx.doi.org/10.1007/s12011-021-02636-yDOI Listing
February 2021

Clinical management of coronavirus disease 2019 (COVID-19) in pregnancy: recommendations of WAPM-World Association of Perinatal Medicine.

J Perinat Med 2020 Nov;48(9):857-866

Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.

These guidelines follow the mission of the World Association of Perinatal Medicine, which brings together groups and individuals throughout the world with the goal of improving outcomes of maternal, fetal and neonatal (perinatal) patients. Guidelines for auditing, evaluation, and clinical care in perinatal medicine enable physicians diagnose, treat and follow-up of COVID-19-exposed pregnant women. These guidelines are based on quality evidence in the peer review literature as well as the experience of perinatal expert throughout the world. Physicians are advised to apply these guidelines to the local realities which they face. We plan to update these guidelines as new evidence become available.
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http://dx.doi.org/10.1515/jpm-2020-0265DOI Listing
November 2020

Elemental composition of green coffee and its contribution to dietary intake.

Food Chem 2017 Jan 29;215:92-100. Epub 2016 Jul 29.

İstanbul University, Institute of Forensic Sciences, Forensic Toxicology Laboratories, 34098 Cerrahpaşa, İstanbul, Turkey.

The concentration of twenty-seven elements (Li, Be, B, Mg, Al, P, K, Ca, Cr, Mn, Co, Ni, Cu, Zn, As, Se, Sr, Mo, Cd, Sn, Sb, Ba, Hg, Pb, Bi, Th, and U) in green coffee samples and their infusions were determined by using inductively coupled plasma-mass spectrometry (ICP-MS). Prior to analysis, green coffee samples were prepared by microwave digestion, while infusions were analyzed without any pre-treatment. The accuracy and precision of the proposed methods were verified by recovery experiments. Considering samples; K, Cu, and Al had the highest mean concentrations with 6714.5μgg(-1), 12.1μgg(-1), and 25.9μgg(-1) among major, trace and toxic elements, respectively. The impact of brewing type on leachability of elements was also studied and the results outlined that mean leachability of elements to Turkish coffee were greater than to mud coffee. Furthermore, dietary element intakes through green coffee consumption were also estimated. This is the first study presenting wide range of elements in green coffee brews and calculating dietary intakes.
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http://dx.doi.org/10.1016/j.foodchem.2016.07.176DOI Listing
January 2017

Quantitative lead determination in coating paint on children's outwear by LA-ICP-MS: a practical calibration strategy for solid samples.

Talanta 2015 Jan 4;132:222-7. Epub 2014 Sep 4.

Istanbul University, Institute of Forensic Sciences, Forensic Toxicology Laboratory, Cerrahpasa, 34303 Istanbul, Turkey.

Lead is a hazardous compound that affects the central nervous system in people, particularly children, and may cause some reversible and irreversible diseases. Legal regulations try to prevent the exposure from products especially produced for children such as coating paints, jewelry, toys, bed linen, textile, etc. The aim of this study was to determine the lead levels of coating paints on children׳s outwear selling in district bazaar by laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) and to specify the percent of non-complying samples. Here we described the solid matrix calibration method and confirmed the results with the microwave-assisted acid digestion method. Both comparative methods were validated by analysis of the certified reference materials (NIST SRM-612 glass matrix, NIST SRM-2582 powdered paint and ERM-EC681k) and bias% for accuracy and RSD% for precision were calculated lower than 6.8% and 7.3%, respectively. The recovery ranges of laser ablation and microwave-assisted acid digestion method for Pb were found to be between 88.2-98.1% and 95.3-101.3%, respectively. The limits of detection values were determined as 0.162 mg kg(-1) for direct sampling in the ablation chamber and 0.002 ng mL(-1) for aqueous solutions. Correlation result of 16 samples (r=0.99) examined in both methods was satisfactory. In coating paint samples, 14.65% of 198 (n=29) did not comply with the 90 mg kg(-1) lead limit according to regulation. Validated quantitative laser ablation method may be preferred to quickly and reliably determine the Pb levels in other solid samples as well as coating paints.
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http://dx.doi.org/10.1016/j.talanta.2014.08.062DOI Listing
January 2015

Relationship between first trimester visualization of the intracranial translucency and spina bifida.

Arch Gynecol Obstet 2015 Mar 19;291(3):513-8. Epub 2014 Aug 19.

Obstetrics and Gynecology Department, Maternal Fetal Medicine Unit, Cerrahpaşa School of Medicine, Istanbul Universitesi, Istanbul, Turkey,

Purpose: To establish a reference range for the intracranial translucency (IT).

Methods: In this prospective study, we examined 596 singleton fetuses at 11-14 weeks of gestation using transabdominal ultrasonography. The distribution curves of the anterior-posterior diameter of the IT were established according to the gestational weeks, and the percentiles for 11-14 weeks of gestation were calculated. Regression analysis was performed to estimate the relationship between the anterior-posterior diameter of the IT and other fetal biometric parameters.

Results: The mean anterior-posterior diameter of the IT was 1.8 ± 0.4 mm. From 11 to 14 weeks of gestation, the IT diameter increased linearly with advancing gestation. The linear regression equation for the IT × crown-rump length (CRL) was IT = CRL × 0.0184 + 0.575 (R = 0.385, p < 0.001). The linear regression equation for the IT × biparietal diameter (BPD) was IT = BPD × 0.0532 + 0.632 (R = 0.346, p < 0.001). The linear regression equation for IT × gestational age (days) (GA) was ICT = GA × 0.024 - 0.339 (R = 0.25, p < 0.001). The linear regression analysis revealed significant correlations of the IT with CRL, BPD, and GA.

Conclusion: The IT increases linearly with increasing CRL, BPD, gestational age in weeks, and gestational age in days.
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http://dx.doi.org/10.1007/s00404-014-3410-6DOI Listing
March 2015

Ramadan fasting and pregnancy: implications for fetal development in summer season.

J Perinat Med 2015 May;43(3):319-23

Aims: In the Islamic religion, Ramadan is a month in the year that is passed by fasting. Healthy adult individuals are prohibited to eat, drink, and smoke from sunrise to sunset. In the present study, our aim was to assess the relation of Ramadan fasting with fetal development and maternal-fetal Doppler indices in pregnant women.

Methods: This is a prospective case-control study carried out in the month of Ramadan in 2013 (9 July-7 August). One hundred and six pregnant women at the second and third trimesters of pregnancy were enrolled into the study. The sample size of the fasting group was 83 and the non-fasting group sample size was also 83. Fetal biometric measurements, such as biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight, amniotic fluid index, and Doppler indices of both uterine and umbilical arteries were evaluated by gray scala and color Doppler ultrasound at the beginning and end of Ramadan.

Results: At the end of the Ramadan, increase in biparietal diameter, head circumference, and femur length showed a statistically significant difference from initial measurements (P<0.05). When fasting and non-fasting groups were compared separately, an increase in amniotic fluid index was statistically significant in the non-fasting group (P<0.05).

Conclusion: We demonstrated some adverse effects of Ramadan fasting on fetal development. In the Islamic religion, pregnant individuals have the privilege of not fasting; therefore, they should consider postponing fasting to the postpartum period, especially in the summer season. If they are willing to do so, an appropriate nutritional program should be recommended.
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http://dx.doi.org/10.1515/jpm-2013-0289DOI Listing
May 2015

Fetal demise due to cord entanglement in the early second trimester.

Proc (Bayl Univ Med Cent) 2014 Apr;27(2):143-4

Department of Gynecology and Obstetrics, Bahcesehir University, Istanbul, Turkey (R. Ergin); the Department of Gynecology and Obstetrics, International Hospital, Istanbul, Turkey (Yayla); and the Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey (A. Ergin).

In this report, we describe a rare cause of in utero fetal death, a complex entanglement of the umbilical cord around the fetal neck. At the 16th gestational week of pregnancy, routine fetal ultrasonography showed no fetal heartbeat. Thereafter, the fetus was delivered vaginally in the breech presentation. The neck was found to be encircled by multiple tight loops of the umbilical cord. Other than a thin and elongated neck, there were no dysmorphic features and no chromosomal abnormality on cytogenetic analysis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954675PMC
http://dx.doi.org/10.1080/08998280.2014.11929092DOI Listing
April 2014

Transvaginal sonographic evaluation of the cervix in asymptomatic singleton pregnancy and management options in short cervix.

J Pregnancy 2012 22;2012:201628. Epub 2012 Feb 22.

Department of Obstetrics and Gynaecology, Gole State Hospital, 34660 Ardahan, Turkey.

Preterm delivery (PTD), defined as birth before 37 completed weeks of gestation, is the leading cause of perinatal morbidity and mortality. Evaluation of the cervical morphology and biometry with transvaginal ultrasonography at 16-24 weeks of gestation is a useful tool to predict the risk of preterm birth in low- and high-risk singleton pregnancies. For instance, a sonographic cervical length (CL) > 30 mm and present cervical gland area have a 96-97% negative predictive value for preterm delivery at <37 weeks. Available evidence supports the use of progesterone to women with cervical length ≤25 mm, irrespective of other risk factors. In women with prior spontaneous PTD with asymptomatic cervical shortening (CL ≤ 25 mm), prophylactic cerclage procedure must be performed and weekly to every two weeks follow-up is essential. This article reviews the evidence in support of the clinical introduction of transvaginal sonography for both the prediction and management of spontaneous preterm labour.
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http://dx.doi.org/10.1155/2012/201628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317216PMC
June 2013

The nomogram of intracranial translucency in the first trimester in singletons.

J Turk Ger Gynecol Assoc 2012 1;13(3):153-6. Epub 2012 Sep 1.

Department of Gynecology and Obstetrics, International Hospital, İstanbul, Turkey.

Objective: Measurement of intracranial translucency (IT), which is a recent earlier recognizable sonographic marker, has been suggested for detection of spina bifida. In this prospective study we aimed to determine normative values of IT in the population of Turkish singleton pregnant women during the first trimester of pregnancy.

Material And Methods: Between January 2011 and July 2011, all consecutive singleton pregnant women were screened for intracranial translucency. Pregnancies were followed until birth. Pregnancies with any detected/suspicious anatomical or genetic fetal anomalies, biochemical abnormalities, increased nuchal translucency measurements, pregnancies of artificial reproduction techniques and anomaly detected at birth were set to be excluded from the data analyses. Mean±standard deviation, median and percentile values of intracranial translucency were calculated. Linear regression analyses were done between the length of intracranial translucency and gestational week and CRL.

Results: Data analyses included 201 fetuses. Median maternal age was 31 years. Median CRL was 62 mm. Median gestational week was 12.57 weeks. Median IT value for the first trimester was 1.7 mm (range 1.00-2.40). Calculated formulae are; IT (mm)=[0.237×Gestational Week)]-1.27, R(2)=0.302; p<0.001 and IT (mm)=[0.020×CRL (mm)]+0.44, R(2)=0.381; p<0.001). IT measurements increased with increasing CRL and advancing gestational weeks. During follow up none of the fetuses was found to have any anatomical abnormality or anomaly.

Conclusion: This study presents normative values of intracranial translucency in the first trimester screening of normal singleton pregnancies of the Turkish population. In accordance with previous reports, intracranial translucency increases linearly with advancing CRL.
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http://dx.doi.org/10.5152/jtgga.2012.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939232PMC
March 2014

Normative values of fetal nasal bone lengths of Turkish singleton pregnancies in the first trimester.

J Turk Ger Gynecol Assoc 2011 1;12(4):225-8. Epub 2011 Dec 1.

Department of Gynecology and Obstetrics, Göztepe Education and Research Hospital, İstanbul, Turkey.

Objective: Evaluation of nasal bone improves the performance of first-trimester screening for trisomy 21. In this retrospective study we aimed to determine normative values related to the measurement of nasal bone length of the Turkish population during the first trimester ultrasonographic fetal screening.

Material And Methods: Medical records of singleton pregnancies, whose first trimester fetal screening was performed between 2004 and 2010, were evaluated retrospectively. Pregnancies with any detected/suspicious anatomical or genetic fetal anomalies, biochemical abnormalities, increased nuchal translucency measurements, and pregnancies of artificial reproduction techniques were excluded from data analyses. Mean±standard deviation, median and percentile values of the length of nasal bone were calculated separately for 11(0-6), 12(0-6) and 13(0-6) gestational weeks.

Results: Nasal bone could be visualized in 99.6% of the included 1762 singleton pregnancies. In 16.5% of the cases nasal bones were only noted as present or absent. Mean maternal age was 29.67±4.50 years and mean gestational age was 12.54±0.61 weeks. Median values of nasal bone lengths were 1.7, 1.9, and 2.2 mm for 11(0-6), 12(0-6) and 13(0-6) gestational weeks respectively. Nasal bone length (NBL) increased linearly with advancing gestational age and CRL. NBL (mm)=[0.298xGestational Age (week)]-1.779, R(2)=0.318; p<0.001; NBL (mm)= [0.023 × CRL (mm)] + 0.520, R(2)=0.331; p<0.001.

Conclusion: The present study presents normative values of nasal bone in the first trimester screening of normal singleton pregnancies of Turkish population. Nasal bone length increases with advancing gestational age and CRL.
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http://dx.doi.org/10.5152/jtgga.2011.56DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939254PMC
March 2014

Antenatal Bartter syndrome: analysis of two cases with placental findings.

Fetal Pediatr Pathol 2010 ;29(3):121-6

Department of Gynecology & Obstetrics, Haseki Training & Research Hospital, Istanbul, Turkey.

The prenatal diagnosis of Bartter syndrome can be based on the high chloride level in the amniotic fluid. Microscopic examination of the placenta in untreated cases showed extensive mineralization in the chorionic villi in previous studies. Two cases were presented at 26-29 weeks of gestation with severe polyhydramnios. The mothers were treated with Indomethacin, KCl, and serial amniocentesis in order to reduce the amniotic fluid volume and prevent fetal hypokalemia. The microscopic examination of the placenta revealed focal calcification and acute atherosis in placental vessels. The treatment with Indomethacin in the antenatal period can prevent severe nephrocalcinosis.
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http://dx.doi.org/10.3109/15513811003777276DOI Listing
August 2010

Maternal plasma fibronectin and advanced oxidative protein products for the prediction of preeclampsia in high risk pregnancies: a prospective cohort study.

Fetal Diagn Ther 2009 17;26(4):189-94. Epub 2009 Nov 17.

Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, Istanbul, Turkey.

Objective: To determine whether maternal plasma fibronectin and advanced oxidative protein products (AOPP) can be used for the prediction of preeclampsia in high-risk women.

Study Design: One hundred pregnant women at high risk of preeclampsia were enrolled in this prospective cohort study. Maternal plasma total fibronectin and AOPP levels were measured at 19-25 weeks of gestation. AOPP levels were also measured in 23 normal non-pregnant women. After delivery, the pregnant cohort was assigned to either the normotensive or preeclamptic group depending on their clinical course.

Results: Among the 78 pregnant women who completed the study, 19 (24.3%) developed preeclampsia between 36 and 39 (36.8 +/- 1.0) weeks of gestation. AOPP levels, which are significantly higher in normotensive pregnant women compared to nonpregnant controls (42.55 +/- 15.94 vs. 27.95 +/- 10.5; p = 0.0001) were not significantly different between normotensive and preeclamptic women (42.55 +/- 15.94 vs. 47.45 +/- 14.19 microM; p = 0.23). Plasma fibronectin levels were significantly higher in women who continued to develop preeclampsia rather than remain normotensive (383.68 +/- 19.07 vs. 227.65 +/- 97.39; p < 0.0001). ROC curve analysis shows that total fibronectin >or=360 mg/l is predictive for the development of preeclampsia. The sensitivity, specificity, positive and negative predictive values are 57, 92, 73 and 85%, respectively, with a likelihood ratio of 7.38.

Conclusion: Second trimester plasma concentrations of AOPP are not altered in women that develop pre-eclampsia later in pregnancy. However, total fibronectin levels are significantly increased and may be used to predict the onset of clinical symptoms of preeclampsia.
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http://dx.doi.org/10.1159/000259317DOI Listing
March 2010

Semilobar holoprosencephaly with associated cyclopia and radial aplasia: first trimester diagnosis by means of integrating 2D-3D ultrasound.

Arch Gynecol Obstet 2009 Oct 17;280(4):647-51. Epub 2009 Feb 17.

Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, Istanbul, Turkey.

Introduction: Holoprosencephaly (HPE) is commonly associated with facial malformations. We present a case of semilobar HPE associated with distal limb defect which was detected at 12 weeks of gestation.

Case: The fetus had a crown-rump length of 60 mm (12 weeks-4 days), had nuchal translucency thickness of 1.5 mm. Initial two-dimensional (2D) ultrasound revealed the absence of nasal bone, decreased BPD and abnormal profile. Transvaginal 2D ultrasound was effective in the detection of HPE (partially absence of the interhemispheric fissure, fused thalami, the choroid plexuses were not visualized bilateraly: absent 'butterfly' sign), cylopia, absence of the nose and unilateral radial aplasia. Three dimensional (3D) ultrasound provided a better visualization of the associated anomalies. The necropsy result confirmed the sonographic findings: the diagnosis was semilobar HPE, cyclopia, absence of the nose, and the absence of the radius and the thumb in the left arm.

Discussion: Transvaginal 2D sonographic examination is effective in detection of the cases with HPE at first trimester. Fetal morphological study through 3D ultrasound may facilitate the diagnosis of associated anomalies.
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http://dx.doi.org/10.1007/s00404-009-0975-6DOI Listing
October 2009

Umbilical cord thickness in the first and early second trimesters and perinatal outcome.

J Perinat Med 2008 ;36(6):523-6

Istanbul Goztepe Education and Research Hospital, Turkey.

Objectives: To study the association between thickness of the umbilical cord at 11+0 to 14+6 gestational weeks and perinatal outcome.

Methods: We studied 216 pregnant women between 11+0 and 14+6 weeks' gestation with singletons, intact membranes, normal volumes of amniotic fluid and a regular menstrual period. Patients with umbilical cord measurements below the 5(th) centile were defined as thin umbilical cord group and those between the 5(th) and 95(th) or above 95(th) centile were defined as non-lean umbilical cord group. Abortion or fetal demise, preeclampsia, mode of delivery, gestational age at delivery, birth weight, and 5-min Apgar scores were noted.

Results: A statistically significant difference existed between the mean gestational age, mode of delivery, birth weight and adverse perinatal outcome of the two groups. The relative risk of the adverse perinatal outcome in lean umbilical cords was 6.92 (2.71-17.67; 95% CI). The umbilical cord thickness correlated with birth weight (P<0.05).

Conclusions: Sonographic finding of a lean umbilical cord at 11+0 to 14+6 weeks' gestation should prompt the physician to strict monitoring of pregnancy.
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http://dx.doi.org/10.1515/JPM.2008.087DOI Listing
February 2009

Jarcho-Levin syndrome presenting as neural tube defect: report of four cases and pitfalls of diagnosis.

Fetal Diagn Ther 2007 24;22(6):416-9. Epub 2007 Jul 24.

Department of Perinatology, Clinics of Gynecology and Obstetrics, Haseki Education and Research Hospital, Istanbul, Turkey.

Jarcho-Levin syndrome (JLS) causes severe vertebral and thoracic deformity and has an autosomal-recessive mode of inheritance. Prenatal diagnosis may be difficult in some cases without the history of an affected baby. We present 4 cases of JLS with neural tube defects as the prominent finding. In 2 of them the deformity of the thorax was minimal and was not detected by ultrasonography. Rib anomalies were revealed with radiological and pathological examinations after the termination. The location of the vertebral defect may be the determinant factor for the severity of the thoracic deformity. The real recurrence risk could only be found out after postnatal examinations in cases with neural tube defects.
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http://dx.doi.org/10.1159/000106345DOI Listing
December 2007

Prenatal diagnosis of a fetus with androgen insensitivity syndrome (AIS).

Prenat Diagn 2007 Sep;27(9):856-7

Dicle University School of Medicine, Gynecology and Obstetrics, Turkey.

Objective: The aim of this study is to describe a fetus with androgen insensitivity syndrome diagnosed at mid-second trimester.

Case And Methods: Nuchal translucency was measured thick and double test was found higher. The patient referred to our center at 16(th) weeks of gestation. Fetal ultrasound examination and amniocentesis was performed.

Results: The nuchal translucency (NT) of fetus in present pregnancy was measured approximately 10 mm at 13 weeks and Down syndrome risk was calculated 1 in 10 by double test. On ultrasound examination; thick nuchal fold (NF) and short fetal limbs were found, and the fetus was seen a female and amniocentesis was performed. Three weeks later the fetal karyotype was reported normal as 46,XY. Thereupon the fetus reexamined for 2D and 4D ultrasound, and confirmed previous findings. The fetus was terminated at 19(th) weeks and seen a female phenotype. The fetal gonads removed in abdomen and testicles confirmed histopatologically.

Conclusion: In generally, diagnosis of AIS is most made postnatally. This is the second case in English literature, which diagnosed mid-second trimester. In this situation, the fetus with thick NT/NF and short limbs may be AIS, therefore appearance of fetal sex on ultrasound should be compared with genetic sex.
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http://dx.doi.org/10.1002/pd.1747DOI Listing
September 2007

Ultrasound screening for fetal major abnormalities at 11-14 weeks.

Acta Obstet Gynecol Scand 2007 ;86(6):666-70

Department of Gynecology and Obstetrics, Division of Perinatology, Haseki Training and Research Hospital, Istanbul, Turkey.

Background: This study was planned to evaluate the efficiency of the 11-14 week scan in detecting fetuses with major fetal structural abnormalities.

Methods: Some 1,290 pregnant women were submitted to a routine ultrasound scan between the 11th and 14th week after the detection of the fetal viability. The fetal anatomy was examined transabdominally, and in suspected cases transvaginally. Following the scans, the patients were examined in the second or third trimester of pregnancy. Fetal structural abnormalities classified as major and early onset were noted. Isolated choroid plexus cysts, cardiac defects not requiring treatment, mild ventriculomegaly, and mild renal pelviectasis in second trimester were not included.

Results: Twenty-four (1.86%) fetuses with various defects were identified, and 17 of these were diagnosed at the 11-14 week scan. The antenatal ultrasound detection rate of the fetuses with major anomalies was 95%, and 70% were detected in the first-trimester assessment. Four cardiac defects associated with genetic syndromes or requiring operation were included (0.31%) in this series. Two of the fetuses with cardiac defects (50%) had an increased nuchal translucency thickness. In this group, none of the fetuses with karyotype anomalies was born alive.

Conclusions: The first-trimester scan is important in routine antenatal care for early detection of fetal defects, and determination of the fetuses at risk of cardiac anomalies and genetic syndromes.
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http://dx.doi.org/10.1080/00016340701253405DOI Listing
September 2007

Sonographically diagnosed vault hematomas following vaginal hysterectomy and its correlation with postoperative morbidity.

Infect Dis Obstet Gynecol 2009 28;2009:91708. Epub 2007 Feb 28.

Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, 34019 Istanbul, Turkey.

Objective: Our aim is to investigate sonographically detectable vault hematomas after vaginal hysterectomy and its relation to postoperative morbidity.

Methods: We studied a group of 103 women who had undergone vaginal hysterectomy for benign causes apart from uterovaginal prolapse. Transabdominal ultrasound examinations were carried out 24 to 72 hours after surgery to assess the presence of vault hematomas. Ultrasound findings were correlated with clinical data and postoperative morbidity.

Results: The incidence of vault hematoma was found 19.4% in present study. In these patients, 40% (8/20) had fever while only 2.4% (2/83) of cases without vault hematoma suffered from fever. Out of all women having vault hematoma, 70% (14/20) had small-sized hematoma and 30% (6/20) had large-sized hematoma. Fifty percent of patients (3/6) with large-sized hematoma, as compared to only 35% (5/14) with small-sized hematoma, suffered from febrile morbidity. Large-sized hematomas drained by vaginally, while all small-sized pelvic hematomas managed by watchful expectancy successfully. The significant difference was found mean hemoglobin drop and postoperative stay in the hematoma group or without hematoma group.

Conclusion: Sonographic detection of vaginal vault fluid collection is common after hysterectomy, but such a finding rarely indicates additional treatment. Though febrile morbidity was more in cases with vault hematoma, the number of such patients was too small to be significant. Vaginal ultrasound examination should not be performed routinely after hysterectomy.
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http://dx.doi.org/10.1155/2007/91708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1847506PMC
October 2009

Successful full-term twin pregnancy in hemoglobin Brockton: a rare hemoglobinopathy--case report.

Fetal Diagn Ther 2007 15;22(4):282-4. Epub 2007 Mar 15.

Haseki Training and Research Hospital, Department of Gynecology and Obstetrics, Istanbul, Turkey.

Introduction: Hemoglobin Brockton is indicated by the hemolytic anemia, which is rare qualitative variant of aspect of the hemoglobinopathies. Hemoglobin disorders in pregnancy are associated intrauterine growth retardation, premature birth, and low birth weight. One of the unstable hemoglobinopathies, Hb Brockton associated with pregnancy has not been previously mentioned in the literature. In this case presentation and things to be done in case of a pregnant patient with rare hemoglobinopathy have been reviewed in reference to the literature.

Case Report: Twin pregnancy of a 26-year-old patient with Hb Brockton disorder which was diagnosed at the age of 11, and has led to minor hemolytic anemia crisis over the years, was observed. Due to decrease in hemoglobin level, 8 units of transfusion were made. A twin pregnancy continued without any problems until the 38th week when a caesarean section was performed due to breech-breech presentations. The hemoglobin pattern of the newborn was studied at birth and after 1 year; the variant in the mother was not found.

Discussion: During pregnancies with unstable hemoglobinopathy, observation of hemoglobin levels every 3 weeks and carrying out blood transfusions when below 8 g/dl can stabilize the pregnancy in terms of the development of the baby and the mother. Patients with hemoglobinopathy carry an increased risk for complications and should therefore seek medical care early in pregnancy and be managed by a multidisciplinary team of specialists.
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http://dx.doi.org/10.1159/000100791DOI Listing
July 2007

Prenatal diagnosis of Bartter syndrome with biochemical examination of amniotic fluid: case report.

Fetal Diagn Ther 2007 17;22(3):206-8. Epub 2007 Jan 17.

Department of Perinatology, Clinics of Gynecology and Obstetrics, Haseki Education and Research Hospital, Istanbul, Turkey.

Antenatal Bartter syndrome typically presents with marked fetal polyuria that leads to polyhydramnios and premature delivery. In our case, polyhydramnios was detected at 26 weeks of gestation and amniotic fluid chloride level was high. Serial amnion-drains were performed. During indomethacine treatment, fetal bradycardia developed. The mother was given daily oral potassium to maintain normal serum level and prevent fetal arrhythmias. After birth, hypokalaemic alkalosis, low chloride, hyper-reninemia and hyperaldosteronemia were detected.
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http://dx.doi.org/10.1159/000098719DOI Listing
May 2007

Prenatal diagnosis of Jarcho-Levin syndrome in the first trimester.

Gynecol Obstet Invest 2007 7;63(4):200-2. Epub 2006 Dec 7.

Haseki Education and Research Hospital, Department of Gynecology and Obstetrics, Istanbul, Turkey.

Introduction: Jarcho-Levin syndrome is a congenital segmental costo-vertebral deformation with multiple vertebral and numerical or structural rib abnormalities resulting in the 'crab-like' aspect of the chest. We describe an ultrasound antenatal diagnosis of the Jarcho-Levin syndrome with spina bifida during the first trimester of pregnancy.

Case Report: Prenatal ultrasonography showed shortened spine with marked kyphoscoliosis and spina bifida.

Conclusion: If a prenatal diagnosis of Jarcho-Levin syndrome is made before viability, the choice of pregnancy termination should be offered to the parents.
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http://dx.doi.org/10.1159/000097845DOI Listing
June 2007

Fertility after B-Lynch suture and hypogastric artery ligation.

Fertil Steril 2005 Aug;84(2):509

Department of Obstetrics and Gynecology, Haseki Education and Research Hospital, Istanbul, Turkey.

Objective: To report a case of successful pregnancy after hypogastric artery ligation and the B-Lynch brace suturing technique.

Design: Case report.

Setting: Education and research hospital.

Patient(s): A 22-year-old woman, whose first pregnancy was terminated by cesarean section owing to abruptio placenta and intrauterine fetal demise diagnosed at the 26th week of gestation, referred to our clinic for uterine atony.

Intervention(s): Hypogastric artery ligation and the B-Lynch brace suturing technique.

Main Outcome Measure(s): Clinical pregnancy and live birth.

Result(s): Two years after the surgery, the patient conceived spontaneously and delivered a healthy infant after an uneventful pregnancy.

Conclusion(s): This is the first reported case of successful pregnancy after hypogastric artery ligation and B-Lynch suturing technique. This life-saving therapeutic option for severe postpartum hemorrhage appears to be a safe procedure that does not impair subsequent fertility and pregnancy outcomes. The B-Lynch suturing technique seems to be simple and has the capability of preserving the uterus; therefore it may be considered as the first-line surgical treatment for uterine atony before considering hysterectomy.
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http://dx.doi.org/10.1016/j.fertnstert.2005.01.140DOI Listing
August 2005

Genital trauma in children: classification and management.

Urology 2005 May;65(5):986-90

Department of Pediatric Surgery, Dicle University School of Medicine, Diyarbakir, Turkey.

Objectives: To determine the severity and, accordingly, the treatment of genital trauma in a pediatric population.

Methods: A total of 116 children with genital trauma and anorectal injury were retrospectively reviewed. The severity of trauma was graded according to the genital injury score (GIS), which we developed as a genital trauma scoring system.

Results: The median age was 8 years. Of the 116 children, 80 were girls and 36 were boys. The etiology of the trauma was traffic road accident (53 patients), fall, sexual abuse, and gunshot wound. Sixty-one patients had additional organ injuries. The GIS was I for 25 children, II for 19, III for 32, IV for 23, and V for 17. In addition to the primary repair, colostomy was performed in 22 patients. The most frequent postoperative complication was wound infection. The postoperative complication rate was significantly greater in patients with an injury severity score greater than 15, severe contamination, prolonged delay (longer than 8 hours), and a GIS of IV or V.

Conclusions: The clarification of the mechanism and severity of the genital injury and associated organ injuries under general anesthesia may help in the appropriate classification. Primary repair should be the standard approach in genital trauma patients with a GIS of IV or less. Those with a GIS of V associated with severe contamination and prolonged delay require colostomy for improved outcome.
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http://dx.doi.org/10.1016/j.urology.2005.01.018DOI Listing
May 2005

The use of recombinant factor VIla in a primigravida with Glanzmann's thrombasthenia during delivery.

J Perinat Med 2004 ;32(5):456-8

Department of Obstetrics and Gynecology, Dicle University School of Medicine, Diyarbakir, Turkey.

Glanzmann's thrombasthenia is an inherited hemorrhagic disorder characterized by a severe reduction in, or absence of, platelet aggregation in response to multiple physiologic agonists due to qualitative or quantitative abnormalities of platelet glycoprotein IIb-IIIa. Glanzmann's thrombasthenia is characterized by potentially major mucocutaneous bleeding and prolonged bleeding time. Platelet counts, platelet morphology, prothrombin, and activated thromboplastin times are all within normal ranges in patients with Glanzmann's thrombasthenia. Pregnancy and delivery are rare in Glanzmann thrombasthenia patients and have been associated with immediate postpartum hemorrhage. We describe the peripartum management of a 31-year-old primipara with Glanzmann's thrombasthenia who underwent spontaneous vaginal delivery. Four units of single-donor platelets, two units of packed red blood cells, 36 microg/kg recombinant human coagulation Factor VIIa (rFVIIa) were given during peripartum management.
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http://dx.doi.org/10.1515/JPM.2004.147DOI Listing
January 2005

Maternal mortality in developing countries.

Authors:
Murat Yayla

J Perinat Med 2003 ;31(5):386-91

Dicle University School of Medicine, Obstetrics and Gynecology Department, Diyarbakir, Turkey.

Of all health statistics mentioned by the World Health Organization (WHO), maternal mortality is unique in showing the largest discrepancy between developed and developing countries. Approximately 90% of maternal deaths (more than 0.5 million each year) occur in developing countries. Over the last century, almost all countries have accepted antenatal care principles. However, insufficiency of resources and lack of women's compliance were the main handicaps in developing countries and compelled these countries to apply various standard programs. Unfortunately, these programs are not sufficiently effective in the prevention and treatment of maternal mortality. Fixing the number (quantity) of antenatal visits and the static approach affect the "quality" of antenatal care. Bleeding, chronic anemia, hypertensive disorders, obstructed labor, unsafe abortions and infections are the main factors leading to maternal mortality. The majority of these factors are preventable. It is important to suspect the presence of any of these factors and to intervene promptly both during antenatal care and immediately after delivery. The evidence-based approach is a way of reaching this solution. Antenatal care is a concept that extends from pre-pregnancy to postpartum, leading to effective emergency care for unpredictable and predictable complications during pregnancy and childbirth. Worldwide policies are not always applicable to each country, coercing national policies. There is still a need for prospective randomized trials to clarify this concept and the relevant policies.
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http://dx.doi.org/10.1515/JPM.2003.059DOI Listing
March 2004

Antalya consensus on perinatal care: the report of the 2nd World Congress of Perinatal Medicine for Developing Countries, 1-5 October 2002, Antalya, Turkey.

J Perinat Med 2003 ;31(5):361-72

Department of Perinatology, Obstetrics and Gynecology, Cerrahpaşa Medical School, Istanbul.

The goal of antenatal care is to help the mother to maintain her well-being and achieve a healthy outcome for herself and her infant. Education about pregnancy, child-bearing and childrearing is an important part of antenatal care. Because of the perception that pregnancy is a physiologic event, even today lots of women do not seek medical care until a problem occurs during their pregnancy. There are still unacceptable differences in the extent of perinatal problems in developed and developing countries. Over the last century almost all countries have accepted antenatal care principles. However, insufficiency of resources and a lack of women's compliance have proved to be obstacles in developing countries and have compelled the application of various standard programs. Unfortunately, these programs are not sufficiently effective in preventing and treating maternal mortality. A safe pregnancy and delivery is a human right. Maternal mortality and morbidity should not be ranked with other diseases, because child bearing is not a disease. For this reason a global ethical consideration imposes an obligation upon society to avoid these almost totally preventable deaths. Ensuring access to family planning is an important way of decreasing maternal death. Maternal morbidity and mortality as well as perinatal mortality can be reduced through the synergistic effect of combined interventions, without first attaining high levels of economic development. These interventions include: education for all, universal childbirth, access to family planning services, attendance at birth by professional health workers, access to good quality care in case of complications, and policies that raise women's social and economic status and increase their access to property and the labor force.
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http://dx.doi.org/10.1515/JPM.2003.055DOI Listing
March 2004

Laparoscopy-assisted transinguinal extracorporeal gonadectomy in six patients with androgen insensitivity syndrome.

Fertil Steril 2003 Aug;80(2):429-33

Department of Obstetrics and Gynecology, Dicle University Medical School, Diyarbakir, Turkey.

Objective: To describe a new surgical technique to treat prophylactic gonadectomy in patients with androgen insensitivity syndrome.

Design: Prospective study. University hospital.

Patient(s): Six patients with androgen insensitivity syndrome.Laparoscopy-assisted transinguinal or suprapubic extracorporeal gonadectomy.

Main Outcome Measure(s): Accessibility, operation time, and cost-effectiveness.

Intervention(s): Laparoscopy-assisted transinguinal extracorporeal gonadectomy under general anesthesia was performed successfully, with no complications, in all patients as a one-day procedure. The operation times were 12 to 22 minutes (average, 16 minutes). Histopathologic examination revealed testicles in all cases. The cost of each operation was approximately dollar 500 to dollar 1000.

Conclusion(s): Laparoscopy-assisted transinguinal or suprapubic and extracorporeal gonadectomy has several advantages over laparotomy and operative laparoscopy, including short operating time, safety, simplicity, and cost-effectiveness.
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http://dx.doi.org/10.1016/s0015-0282(03)00666-6DOI Listing
August 2003

Aggressive angiomyxoma of the female pelvis and the labium.

Acta Obstet Gynecol Scand 2003 Mar;82(3):298-301

Departments of Obstetrics & Gynecology, Dicle University, Medical School, Diyarbakir, Turkey.

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http://dx.doi.org/10.1034/j.1600-0412.2003.00113.xDOI Listing
March 2003
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