Publications by authors named "Zuat Acar"

6 Publications

  • Page 1 of 1

Role of serum organic solute transporter alpha/beta and sodium taurocholate cotransporting polypeptide in intrahepatic cholestasis of pregnancy.

Ginekol Pol 2021 Apr 12. Epub 2021 Apr 12.

Department of Gastroenterology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.

Objectives: This study aimed to assess the role of OST-α, OST-β and NTCP in patients with ICP, with a view to determine patients with severe prognosis and to minimize adverse fetal outcomes.

Material And Methods: Sixty-nine pregnant women diagnosed with ICP and 50 healthy women were included the study. Serum OST-α, OST-β and NTCP were measured using ELISA kits.

Results: The median OST-α levels were 176.3 pg/mL in women with ICP and 201 pg/mL in healthy subjects (p = 0.205). The median OST-β levels were found to be 51.17 pg/mL in patients with ICP and 40.9 pg/mL in controls (p = 0.033). Median NTCP levels were 519.7 ng/mL in the ICP group and 483.3 ng/mL in healthy women (p = 0.051).

Conclusions: This is the first study to evaluate serum levels of OST-α, OST-β and NTCP in patients with ICP. It is likely that OST-α, OST-β and NTCP contribute to the etiopathogenesis of ICP. Serum OST-α and OST-β levels can be used as diagnostic and monitoring markers of ICP, and the inhibition of these molecules could provide therapeutic benefit in ICP by reducing the circulation of enterohepatic bile acids.
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April 2021

Fetal cardiac tumors: prenatal diagnosis, management and prognosis in 18 cases

J Turk Ger Gynecol Assoc 2020 12;21(4):255-259

Clinic of Perinatology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey

Objective: To evaluate the long-term follow-up of patients with fetal cardiac tumors (FCTs), and to review the literature regarding advances in diagnosis and management of FCTs in the last decade.

Material And Methods: In this retrospective study, pregnant women referred to a single center maternal-fetal medicine unit between 2013 and 2018 for advanced ultrasonography, were reviewed. Pediatric cardiology counseling was offered to women whose fetuses had FCTs. All patients were evaluated according to revised diagnostic criteria for tuberous sclerosis complex (TSC). Medical treatment was administered to patients with FCTs ≥30 mm or if they were symptomatic. Everolimus therapy at a dose of 2x0.25 mg twice a week for three months was started in the postnatal period.

Results: Out of the 75,312 patients referred 18 (0.024%) were diagnosed with FCTs. Six were referred with fetal arrhythmias and the others were diagnosed with FCTs during routine follow-up. Ten patients (55%) with FCTs were diagnosed with TSC. All tumors were assessed to be rhabdomyoma. Mean tumor diameter in fetuses with TSC was significantly larger than those without TSC (29.8±14.1 mm versus 9.3±4.8 mm, respectively; p=0.004). All patients (n=2) who received medical therapy had a diagnosis of TSC and multiple FCTs and a reduction in tumor size occurred. Tumor size decreased in eight patients spontaneously during follow-up, but increased in one patient who had multiple locations but no TCS. No change in size was observed in the remaining seven cases. None of the fetuses died during the 1-5 year follow-up period.

Conclusion: Rhabdomyoma are usually multiple and associated with TSC. Rhabdomyomas with TSC are larger, but most regress spontaneously or respond well to medical treatment after birth, and have an excellent long-term prognosis.
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December 2020

Relationship between pruritus and autotaxin in intrahepatic cholestasis of pregnancy.

Gastroenterol Hepatol 2021 Feb 1;44(2):96-102. Epub 2020 Oct 1.

Tekirdag Namık Kemal University, Faculty of Medicine, Department of Radiology, Tekirdag, Turkey.

Objective: Intrahepatic cholestasis of pregnancy is a temporary, pregnancy-specific disease that resolves with delivery, characterized by itching (pruritus), as well as high transaminase and serum bile acid levels in the third trimester of pregnancy. Due to the effects of Autotaxin on the physiology of pregnancy, we aimed to investigate Autotaxin activity in patients with intrahepatic cholestasis of pregnancy.

Patients And Methods: Sixty-nine patients diagnosed with intrahepatic cholestasis of pregnancy and 20 healthy pregnant women were enrolled in the study. Fasting serum bile acid, pruritus intensity, serum parameters, gestational week of the patients at the time of diagnosis were recorded, and birth week and birth weight were monitored. Autotaxin serum level was measured enzymatically.

Results: The mean serum bile acid level (n=69; 38.74±35.92μmol/L) in patients with intrahepatic cholestasis of pregnancy (n=69) was detected to be higher than healthy pregnant women (n=20; 5.05±1.88μmol/L) (p<0.001). Weak correlation was detected between serum bile acid level and itch intensity (p=0.014, r=0.295), while no relation was detected between Autotaxin and itch intensity (p=0.446, r=0.09). Although mean Autotaxin (intrahepatic cholestasis of pregnancy: 678.10±424.42pg/mL, control: 535.16±256.47pg/mL) levels were high in patients with intrahepatic cholestasis of pregnancy, it was not statistically significant (p=0.157).

Conclusion: In our study, we observed that the serum Autotaxin level did not make a significant difference in patients with intrahepatic cholestasis of pregnancy compared to healthy pregnant women. These findings suggest that larger clinical studies are required to reveal the physio-pathological effects of Autotaxin on pregnancy.
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February 2021

Perinatal outcomes of intrauterine transfusion for foetal anaemia due to red blood cell alloimmunisation.

J Obstet Gynaecol 2020 Jul 29;40(5):649-653. Epub 2019 Aug 29.

Department of Perinatology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey.

The aim of this study was to evaluate the maternal and neonatal outcomes of patients who underwent intrauterine transfusion (IUT) for foetal anaemia due to red blood cell alloimmunisation and to determine the factors that affected the outcomes. All pregnancies that were treated with IUT due to Rh immunisation between January 2015 and June 2018 in the Kanuni Sultan Süleyman Training and Research Hospital, Department of Obstetrics and Gynaecology, were evaluated retrospectively. IUT due to non-Rh alloimmunisation, parvovirus B19 infection, chronic fetomaternal haemorrhage and foetal anaemia due to homozygous alpha-thalassemia were not included in the study. The perinatal and neonatal outcomes of the patients were retrospectively analysed. The gestational age, ultrasonography findings before and after IUT, laboratory results, complications related to IUT, and data on the newborns were recorded. The cases were divided into two groups, those with complication and those without complications, and their perinatal outcomes were compared. A total of 110 IUTs were performed in 42 foetuses. The survival rate after transfusion was 80.95%. Procedure-related complications were found in 12.7% of cases. There were no significant differences between the demographic and clinical characteristics of the patients with and without complications. The survival rate was lower and perinatal mortality was higher in foetuses with hydrops fetalis. IUT is a safe and effective procedure that can be used in the treatment of foetal anaemia in experienced centres. Survival rates can be increased by referring patients to experienced perinatology centres, by improving the IUT technique, and by reducing technique-related complications.Impact statement The predominant use of IUT is to treat foetal anaemia due to red blood cell alloimmunisation. Despite the decrease after anti-D immune globulin prophylaxis, Rh immunisation is still a major cause of foetal anaemia. However, foetal survival rates have increased with the use of IUT. The survival rates were increased after the development of a high-resolution ultrasound. Because foetal monitoring can be performed by ultrasonography, cord accidents and overload findings can be detected during transfusion, which allows for early interventions and increases survival rates.? The IUT procedure can be used in the treatment of foetal anaemia in experienced centres. After the technique was improved, the complication rates related to the procedure were decreased and foetal survival rates were increased. Further studies on the use of different IUT techniques will extend our findings.
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July 2020

Treatment of Vaginal Cuff Prolapses with Posterior Intravaginal Sling and Evaluation of Efficiency with International Consultation on Incontinence Questionnaire-Vaginal Symptoms Method in the Long Term: Preliminary Results.

Low Urin Tract Symptoms 2013 Sep 30;5(3):140-4. Epub 2012 Oct 30.

Department of Obstetrics and Gynecology, Diyarbakır Maternity and Children Hospital, Diyarbakır, TurkeyDepartment of Obstetrics and Gynecology, Çanakkale 18 Mart University, Çanakkale, Turkey.

Objectives: The aim of this study was to research the efficiency of posterior intravaginal sling (PIVS) procedure in vaginal cuff prolapse, together with possible complications, long-term effects and effects of the method on vaginal and sexual function and quality of life of patients. This retrospective study comprised 21 patients with vaginal cuff prolapse.

Methods: PIVS procedure was performed in 21 patients with vaginal cuff prolapse with quantification stages 2, 3, or 4 of pelvic organ prolapse. Patients were assessed according to the International Consultation on Incontinence Questionnaire-Vaginal Symptoms before and after operation.

Results: The average follow-up period was 24.6 months. The rate of surgical success was 100%, the rate of mesh erosion was 14.2% and the rate of dyspareunia was 33.3%. Vaginal symptom, sexual matter and quality of life scores were statistically significant in the postoperative period compared to the preoperative period (P = 0.001, P = 0.001, P = 0.001, respectively).

Conclusion: PIVS is an effective and reliable method of treating vaginal cuff prolapse. However, its complication profile is not yet at an acceptable level. We believe that the rate of mesh erosion will regress to a more acceptable level with the improvement of mesh technology and postoperative method. The necessary incontinence surgery is easily performed together with PIVS procedure. PIVS restores the vaginal and sexual functions of patients and increases their quality of life significantly.
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September 2013

Emergency cervical cerclage: effect on pregnancy outcome and mode of delivery.

J Matern Fetal Neonatal Med 2014 Jan 20;27(1):80-3. Epub 2013 Jun 20.

Department of Obstetrics and Gynecology, MH Diyarbakir Obstetrics and Gynecology Hospital , Diyarbakır , Turkey .

Aim: To evaluate the effectiveness of emergency cervical cerclage (ECC) and its effect on the mode of delivery.

Patients And Methods: Between April 2007 and July 2011 patients attending MH Diyarbakir Obstetrics and Gynecology Hospital and MH Seferihisar State Necat Hepkon Hospital who underwent ECC were included in this retrospective analysis.

Results: At the time of ECC, the mean gestational age, cervical length and cervical dilatation were 21.4 ± 2.2 weeks, 4.3 ± 0.8 cm and 11 ± 2.4 mm, respectively. The average time between the procedure and birth was 13.8 ± 4.9 weeks and this period was sufficient to maintain a viable pregnancy (p < 0.05). In this study, 12 patients (60%) were delivered vaginally and eight (40%) patients delivered with CS (40%). the difference was statistically insignificant (p = 0.371). Regarding the gestational age at time of delivery, 55% of patients delivered at 36 weeks, 70% at 32 weeks, and 80% of them delivered at 28 weeks. The total live birth rate was 90%.

Conclusion: ECC provides satisfactory time for the fetus to gain sufficient viability. Pregnancies with emergency cerclage show no difference in terms of birth method, whether cesarean or vaginal birth, and delivery type does not appears to be linked to ECC.
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January 2014