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Öğe Isolated single umbilical artery: Implications for pregnancy(Yuzuncu Yil Universitesi Tip Fakultesi, 2020) Sakar, Mehmet Nafi; Oğlak, Süleyman Cemil; Demir, Süreyya; Gültekin, Hüseyin; Demir, BülentThis study aimed to evaluate whether the presence of an isolated single umbilical artery (iSUA) is associated with a dverse perinatal outcomes. Fifty-one patients with iSUA and 54 controls were enrolled in the case-control study. Demographic characteristics and perinatal outcomes were recorded. All patients had normal umbilical artery (UMA) Doppler findings, and their de tailed ultrasound weeks were between 18 and 23 weeks. The birth weights of the babies in the iSUA group were significantly lower than the control group (2898.82±434.56 g vs 3143.70±419.09 g, p=0.004). In the iSUA group, oligohydramnios (7.8% vs 0%), preterm premature rupture of membranes (PPROM) (3.9% vs 0%), preterm delivery (9.8% vs 3.7%), small for gestational age (SGA) (11.8% vs 3.7%) and neonatal intensive care unit (NICU) (2% vs 0%) admission rates were higher than control group, but there was no statistical significance (p>0.05). But the total adverse pregnancy outcomes were observed in 35.3% (18/51) of cases with iSUA is higher than controls 7.4% (4/54) (p=0.001). In our study, iSUA is found to be associated with low newborn weight. In the iSUA group, oligohydramnios, PPROM, preterm delivery, SGA, and NICU admission rates were high, but there was no statistical significance. But the total adverse pregnancy outcomes were higher in the iSUA group. These results indicate that close follo w-up is essential to prevent and manage adverse perinatal outcomes in iSUA patients. © 2020, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.Öğe PP-06 Unicornuate uterus accompanied by unilateral tubal-agenesis in pregnancy a case presentation(2023) Kel, Serem; Kuşcu, Nur; Demir, Süreyya; Şahin, Abdülbaki; Süha, Emine İrem; Duaran, Mehmet Nuri; Demir, BülentObjective Fusion of the Müllerian ducts occurs during weeks 6-11 of pregnancy. Disruptions in this fusion process can lead to Müllerian duct anomalies. Among these anomalies, unicornuate uterus is the most common and is associated with pregnancy complications such as preterm labor. In this case presentation, we aim to present a patient with a diagnosis of unicornuate uterus and pelvic kidney, accompanied by unilateral tubal-ovarian absence, who gave birth at our clinic. Case A 26-year-old, G2P0A1 woman presented to the clinic at 33+4 weeks of gestation with high blood pressure. Upon reviewing the patient’s medical history, it was revealed that her first pregnancy ended in a miscarriage during the first trimester, and pelvic ultrasound detected an ectopic pelvic kidney. Further inquiry into the patient’s family history indicated that her mother also had an ectopic pelvic kidney. The patient was being followed up in our clinic with the threat of preterm delivery due to high blood pressure and contractions in the non-stress test .Considering the potential risk of preterm birth, the patient was administered two doses of betamethasone 24 hours apart for lung maturation. As high blood pressure and uterine contractions persisted during follow-up, a decision was made for delivery. The patient underwent a cesarean section. A live baby weighing 2180 grams with an 8-10 APGAR score and umbilical cord blood gas pH of 7.40 was delivered. Intraoperatively, a unicornuate appearance of the uterus without a rudimentary horn was observed, and the left fallopian tube and ovary were not seen. No complications arose during the operation. The patient was discharged on the third postoperative day. Conclusion Mullerian duct anomalies are observed in approximately 1-5% of the general population. The prevalence increases to around 13-25% in patients with a history of recurrent miscarriages. Unicornuate uterus is the most commonly encountered type among müllerian duct anomalies. The variation without a rudimentary horn accounts for approximately 35% of all unicornuate uteri. Kidney anomalies accompany approximately 40% of patients with unicornuate uterus. Patients with unicornuate uterus are often asymptomatic, and ultrasound alone might not be sufficient for diagnosis. Complications related to unicornuate uterus primarily manifest during pregnancy. Pregnant individuals with unicornuate uterus are at an increased risk of preterm birth, first and second-trimester miscarriages, intrauterine fetal death, and cesarean delivery. Pelvic kidney generally remains asymptomatic and is incidentally diagnosed. Its prevalence is approximately 1-10/10,000. In cases where a pelvic kidney is detected in female patients, the possibility of müllerian duct anomalies should be considered, and patients should be informed about potential pregnancy complications, especially in the context of such anomalies.Öğe PP-07 TAR Syndrome case report(2023) Kuşçu, Nur; Kel, Serem; Demir, Süreyya; Sungur, Müge Üstkaya; Öztürk, Menekşe; Duran, Mehmet Nuri; Demir, BülentObjective “Thrombocytopenia - absent radii Syndrome” (TAR) is characterized by hypo-megakaryocytic thrombocytopenia and bilateral absence of the radius bones despite the presence of both thumbs. It is rare and follows an autosomal recessive inheritance pattern. In individuals with TAR syndrome, skeletal, cardiac, gastrointestinal, hematological, renal, and genital abnormalities can also accompany the condition. Skeletal anomalies include varying degrees of ulnar hypoplasia, as well as hypoplasia of phalanges and carpal bones. Thumbs are always present. Thrombocytopenia improves with age and usually resolves by school age. It is associated with a deletion in the proximal region of the gene locus 1q21.1. The syndrome, first described in 1929, has an estimated prevalence of 0.42/100,000. In this case presentation, we aim to discuss the diagnosis and management of TAR syndrome. Case A 28-year-old woman, gravida 4, parity 1, abortion 1, was placed under routine pregnancy surveillance. During first-trimester screening, the absence of bilateral forearm segments and an increased nuchal translucency (3.8mm) were detected, prompting further monitoring. Amniocentesis was performed for the patient. In the second trimester, an obstetric ultrasound revealed the absence of the right forearm during upper extremity examination. Only a single bone consistent with the ulna was observed on the left side. Throughout the ultrasound examination, limited hand movement, significant wrist extension, and flexion contractures at the knees were noted. Additionally, there was pes equinovarus observed on the left foot. Differential diagnoses considered TAR syndrome, Roberts syndrome, and Fanconi syndrome. The amniocentesis yielded a normal fetal karyotype. At 40+1 weeks gestation by last menstrual period, the patient underwent a normal vaginal delivery with a birth weight of 3070g (19th percentile) and an 8-9 APGAR score. In the postnatal period, the infant was admitted to the neonatal intensive care unit due to a platelet count of 12000 and the presence of petechiae on the body. Absence of ulna and radius was observed on the right arm, while only a single bone consistent with ulna was seen on the left side. Postnatal microarray analysis was consistent with TAR syndrome. Conclusion TAR syndrome is an exceedingly rare condition. Prenatal diagnosis can be achieved through ultrasound evaluation of limb anomalies at around 16 weeks of gestation, combined with complete blood count and genetic analysis via cordocentesis. In neonates, when encountering thrombocytopenia and hemolytic anemia, TAR syndrome should be considered as a differential diagnosis.Öğe PP-08 Meckel Gruber Syndrome a case report(2023) Kel, Serem; Kuşcu, Nur; Demir, Süreyya; Duran, Mehmet Nuri; Demir, BülentObjective Meckel-Gruber Syndrome is a rare fetal anomaly characterized by multiple anomalies that are inherited in an autosomal recessive manner and are incompatible with life. In our clinic, we aimed to present the findings of a fetus with Meckel-Gruber Syndrome, for which we conducted pregnancy termination. Case A 37-year-old patient with a history of G9P8Y7PPEX1 was referred to our center at 18+2 weeks of gestation due to cranial anomalies identified through a structural anomaly scan. Obstetric ultrasound revealed a single viable fetus consistent with 18+1 weeks of gestation. In intracranial evaluation, the fetus exhibited a single cavity in the lateral ventricles, thalamic fusion, absence of the cavum septum pellucidum, and alobar holoprosencephaly. A cystic hygroma with septations measuring 18x13 mm was observed in the fetal neck. Microcephaly and significant hypertelorism were also present. Ultrasonographic findings were suggestive of Meckel-Gruber Syndrome. Following the decision made by the board and with the consent of the family, the pregnancy termination was carried out. The fetus was aborted vaginally and weighed 110 grams, measuring 18 cm in length. Macroscopic examination of the fetus revealed micrognathia, hypertelorism, flattened nasal bridge, low-set ears, and encephalocele, consistent with female external genitalia. Autopsy examination of the fetus indicated an enlarged liver with absence of the gallbladder, spleen, and pancreas. Other internal organs appeared lithic in appearance. Conclusion Meckel-Gruber Syndrome is a rare fetal anomaly with an autosomal recessive inheritance pattern, occurring at a frequency of 1 in 13,250 to 140,000 births. It follows a severe and lethal course. While the classic triad includes cystic renal dysplasia, encephalocele, and polydactyly, the syndrome can also manifest with additional anomalies. Differential diagnoses should include Trisomy 13 and Smith-Lemli-Opitz syndrome, given their similar clinical presentations. Careful consideration is necessary in making a differential diagnosis due to the overlapping features with these two conditions. Definitive diagnosis requires autopsy, as karyotype analysis might yield normal results. The recurrence rate is 25%, underscoring the importance of prenatal diagnosis and monitoring. Mortality associated with this syndrome is 100%. Families should be counseled about the risk of mortality in the current pregnancy and the possibility of recurrence in subsequent pregnancies. First-trimester ultrasound evaluation between 11 and 14 weeks is strongly recommended for subsequent pregnancies.Öğe Primer Tuba Uterina Adenokarsinomu:Bir Olgu Sunumu(2016) Baş, Yılmaz; Kılınç, Nihal; Demir, Süreyya; Demir, BülentPrimer fallop tüp karsinomu ender bir tümör olup, kadın genital malign tümörlerinin %0,14-1,8'i oranında görülür. Elli iki yaşında, gebelik 9, parite 6 düşük 3 olan bir primer tuba karsinomu olgusu sunulmuştur. Hasta vajinal kanama ile başvurdu, jinekolojik muayenesinde pelvik kitle saptandı. Total abdominal histerektomi, bilateral salpingoooferektomi yapıldı. Histopatolojik olarak sol tubadan köken alan Stage Ia tuba uterina adenokarsinomu tespit edildi.Öğe Torsion of juvenile granulosa cell ovarian tumor(Elsevier Inc., 2022) Kurtuluş, Şenay; Demir, Bülent; Aylanç, NilüferJuvenile granulosa cell tumor (JGCT), which is one of the sex cord-stromal tumors of the ovary, is a rare malignancy of childhood. Juvenile type is a rare form that accounts for 5% of granulosa cell tumors. Isosexual precocious puberty is the most common presentation in prepubertal girls with juvenile granulosa cell tumors. Less frequently, they present with the complaint of a mass in the abdomen. We present an 8-year-old girl with a juvenile granulosa cell tumor who presented with sudden onset of abdominal pain and enlargement of the abdomen. She underwent exploratory laparotomy with right salpingo-oophorectomy and a complete mass resection was performed. Pathologic staging of the mass, which was diagnosed as juvenile granulosa cell tumor of the ovary, was determined as pT1c3, and our patient received four cycles of chemotherapy.Öğe Type-Specific Persistence/Clearance Results in Human Papillomavirus Infections in Turkish Women(2021) Şahin, Hacı Öztürk; Gürlek, Beril; Demir, Bülent; Sılan, FatmaOBJECTIVE: The persistence of high-risk human papillomavirus (HPV) infections, most of which are\rknown to be transient is of critical importance for the development of precursor lesions and cancer in the\rcervix. The aim of the present study is to investigate the persistence and clearance of genotype-based\rHPV infections and also some cofactors that could be effective in persistence.\rSTUDY DESIGN: Data of 115 patients whose human papillomavirus and genotype detection was made\rwith multiplex PCR (Polymerase chain reaction), and capillary electrophoresis were categorized as lowrisk HPV (LR-HPV)/high risk HPV (HR-HPV) and single/multiple HPV infections, and clearance/persistence data of two years were investigated.\rRESULTS: While 82 (71.3%) out of 115 patients (mean age 40.1 years) had a single HPV infection, the\rremaining had two or more HPV infections. Of all HPV infections, 81.5% (128/157) were HR-HPV.\rClearance rates of HPV infections during the first two years was 85.4% (134/157), persistence was 14.6%\r(23/157). The most frequently persisted HR-HPV genotypes were 31, 52, 68, 16, and 35, respectively. A\rstatistically significant difference was not found in HPV persistence with regard to the infection’s being\rsingle/multiple or LR/HR. A significant difference was not found between age groups and persistence.\rCONCLUSIONS: Of HPV infections, 85.4% are cleared during the first two years while the most frequently persisted HR-HPV genotypes were 31, 52, 68, 16, and 35, respectively. Being aware of population-based clearance/persistence results of type-specific infections may specify screening strategies.Öğe Ulipristal Asetatın Ratlarda Oluşturulan Cerrahi Endometriozise Etkisi(Mardin Artuklu University, 2022) Duran, Mehmet Nuri; Şahin, Hacı Öztürk; Kılınç, Nihal; Demir, BülentAmaç: Ulipristal Asetat'ın ratlarda oluşturulan endometriozis odakları üzerindeki etkisinin araştırılması hedeflendi. Gereç ve Yöntem: Çalışma, yaklaşık 280 gram ağırlığında 12 haftalık ratlarla yürütüldü. Otolog endometriozis modeli oluşturulduktan sonra, ulipristal asetat almayan gruba günlük oral salin, ulipristal asetat verilen gruba ise 4 hafta süreyle 0.5 mg/kg (0.125 mg/rat/gün) oral yolla verildi. Histopatolojik ve immünohistokimyasal değerlendirmeler için ektopik endometriyal dokular çıkarıldı. Boyama Hematoksilen-Eozin, Ki-67 ve Siklooksijenaz-2 ile yapıldı. Bulgular: Ektopik endometrium yüzey epitelinin Hematoksilen-Eozin Boyama skoru ulipristal asetat negatif grubunda 2,5 puan, ulipristal asetat pozitif grubunda 0,5 puan olarak bulundu. İmmünhistokimyasal değerlendirmede ektopik endometriyal yüzey epitelinin Ki-67 pozitifliği ulipristal asetat negatif grubunda %71.2, ulipristal asetat pozitif grubunda ise %31,7 olarak bulundu. Siklooksijenaz-2 pozitifliği ulipristal asetat negatif grubunda %67, ulipristal asetat pozitif grubunda ise %27 olarak tespit edildi. Sonuçlar: Hematoksilen-Eozin boyaması, ulipristal asetat negatif grubunun 2.5 (iyi-orta derecede korunmuş epitel) ve ulipristal asetat pozitif grubunun 0.5 (epitel nadiren var veya yok) olduğunu ortaya koydu. Ulipristal asetat pozitif grubunda Ki-67 ve Siklooksijenaz-2 immünohistokimyasal pozitiflik yüzdesinin ulipristal asetat negatif grubuna göre istatistiksel olarak anlamlı düzeyde azaldığı bulundu. Bu konuda daha fazla literatür verisine ihtiyaç vardır
