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OBJECTIVE: Resistin is a potent regulator of glucose homeostasis which is thought to oppose the action of insulin in peripheral tissues. The aim of this study was to determine changes in resistin levels in gestational diabetes mellitus (GDM). MATERIAL AND METHOD: Twenty women with GDM (mean age 32.28 +/- 5.01 years old, and gestational age 32.2 +/- 4.8 weeks) matched with 22 non diabetic pregnant women (NGDM) (mean age 30.30 +/- 4.5 years old, and gestational age 34.8 +/- 3.5 weeks) were included in the study. Body mass index (BMI) was calculated. Serum resistin levels were measured and insulin resistance was calculated with HOMA-IR. The Mann Whitney U test was used for statistical analysis. RESULTS: BMI was 33.8 +/- 6.2 kg/m2 in the GDM group and 28.4 +/- 6.2 kg/m2 in the NGDM group (p = 0.04). Serum resistin levels were 8.7 +/- 2.1 ng/ml in the GDM group and 8.1 +/- 2.5 ng/ml in the NGDM group. Mean resistin level was not different between the two groups. HOMA-IR in GDM was higher than in the NGDM group (13.2 +/- 12.2 vs 5.8 +/- 5.1, p = 0.02, respectively). CONCLUSION: Although mean BMI in GDM was higher than in NGDM and insulin resistance in GDM was more marked than in NGDM, serum resistin levels in GDM were not found to be any different from NGDM.

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In a prospective case-control study, we compared the amniotic fluid amino acid levels in non-immune hydrops fetalis (NIHF) and normal fetuses. Eighty fetuses underwent amniocentesis for different reasons at the prenatal diagnosis unit of the Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University. Forty of these fetuses were diagnosed with NIHF. The study included 40 women each in the NIHF (mean age: 27.69 ± 4.56 years) and control (27.52 ± 5.49 years) groups, who had abnormal double- or triple-screening test values with normal fetuses with gestational ages of 23.26 ± 1.98 and 23.68 ± 1.49 weeks at the time of sample collection, respectively. Amniotic fluid amino acid concentrations (intra-assay variation: 2.26-7.85%; interassay variation: 3.45-8.22%) were measured using EZ:faast kits (EZ:faast GC/FID free (physiological) amino acid kit; Phenomenex, USA) by gas chromatography. The standard for quantitation was a mixture of free amino acids from Phenomenex. The levels of 21 amino acids were measured. The mean phosphoserine and serine levels were significantly lower in the NIHF group, while the taurine, α-aminoadipic acid (aaa), glycine, cysteine, NH(4), and arginine (Arg) levels were significantly higher compared to control. Significant risk variables for the NIHF group and odds coefficients were obtained using a binary logistic regression method. The respective odds ratios and 95% confidence intervals for the risk variables phosphoserine, taurine, aaa, Arg, and NH(4) were 3.31 (1.84-5.97), 2.45 (1.56-3.86), 1.78 (1.18-2.68), 2.18 (1.56-3.04), and 2.41 (1.66-3.49), respectively. The significant difference between NIHF and control fetuses suggests that the amniotic fluid levels of some amino acids may be useful for the diagnosis of NIHF.

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OBJECTIVE: The aim of the study was to determine the risk factors and perinatal outcomes of umbilical cord prolapse (UCP). MATERIAL AND METHODS: This study was performed at Dicle University between January 2000 and December 2008 on 79 cases in which deliveries were complicated by umbilical cord prolapse. RESULTS: 0.36% of all deliveries were complicated by umbilical cord prolapse. The presentation of the fetuses were as follows: vertex, breech and transverse lie and foot presentation. Thirty-four (43%) fetuses with UCP had a fetal weight of < or = 2500 g as compared with nine (9%) for fetuses in the control group (p < 0.05). Mothers in the study group were 1.3 times more likely to be multiparas than the control group (p = 0.16) Cesarean section was performed in 76 cases (96.2%) and there were nine (11.3%) perinatal deaths. CONCLUSION: Umbilical cord prolapse is a risk factor of perinatal morbidity and mortality. Fetal weight < or = 2500 and abnormal fetal presentation are associated with increased risk of umbilical cord prolapse. Cesarean section resulted in a significantly decreased risk of perinatal mortality.

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OBJECTIVE: To study the clinical profile, management and outcome of the patients with pregnancy-related acute renal failure (PRARF). METHODS: All patients with PRARF admitted between January 2006 and January 2009 were analyzed. RESULTS: The total number of women with PRARF was 75. Age range of women with PRARF was 21 to 46 years and 36% of the cases of PRARF were seen in the postpartum period. PRARF was caused by sepsis in 14.6%, toxemias of pregnancy in 75.2%, and hemorrhage of pregnancy in 12%. Postabortal sepsis was the cause in 14.6%. Dialysis was needed in 33.3%. Maternal mortality rate was 10.6%. CONCLUSIONS: Pregnancy-related acute renal failure is a major health problem and carries very high mortality and morbidity. Poor healthcare facilities and lack of antenatal healthcare clinics are major identified causes.

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OBJECTIVES: To ascertain the characteristics, clinical features, and maternal fetal outcome in HELLP (hemolysis elevated liver enzymes, low platelets) syndrome at a tertiary referral center. MATERIAL AND METHODS: This was a cross-sectional study carried out at Dicle University between January 2004 and December 2008 in which the charts of 126 cases were retrieved retrospectively and data analyzed descriptively. RESULTS: Of all deliveries 0.9% were complicated by HELLP syndrome. Of the cases with HELLP syndrome 79 (62.6%) had preeclampsia, 28 (22.2%) had eclampsia and 19 (15.2%) had a diagnosis of HELLP syndrome. The values of significant biochemical parameters (mean +/- SD) were documented as ALT (alanin aminotransferase) 224 +/- 42 IU/I and ALT1 (after birth) 140 +/- 22, AST 379 +/- 23 IU/l and AST1 215 +/- 51, LDH (lactate dehydrogenase) 1418 +/- 67 IU/l and LDH1 875 +/- 16, together with the hematological parameters as platelet count (86 +/- 12 K/Ul), urine protein (3 + in urine test stick) and albumin levels (2 + 0.9 g/dl). Eighty-six (68.25%) of the patients required albumin replacement. Thirty-one (24.6%) cases were nullipara and 95 (75.4%) multipara; of which 32 women (25.4%) were in Class I, and 94 (74.6 %) in Class II of complete HELLP syndrome. Regular antenatal examination was accomplished in a very small number of patients (12.25%). Fifty-eight (46.03%) patients required transfusions with blood or blood products and 12 (9.5%) underwent laparotomy due to major intraabdominal bleeding. Magnesium sulphate to prevent convulsions and corticosteroids (12 mg betametazone) to enhance fetal lung maturity were administered. Forty-four (34.9%) cases had vaginal delivery and 82 (65.1%) cesarean section; another 18 (14.2%) were with in utero stillbirth. Fifteen babies (11.9%) died, 26 (20.63%) developed placental abruption, 14 (11.11%) acute renal insufficiency, and 13 (10.31%) postoperative subcutaneous hematomas. Maternal mortality occurred in ten cases (7.93%). CONCLUSION: HELLP syndrome is a pathology associated with a high incidence of maternal and perinatal complications. Laboratory parameters in cases with HELLP syndrome are not efficient in detecting perinatal results, but can be used as risk denominators in evaluating maternal complications. Therefore, for patients with HELLP syndrome, standard antenatal follow-up protocols should be applied in order to obtain early diagnosis and improve the speed of transfer to obstetric departments with expertise in this field.

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OBJECTIVE: To study the clinical profile, management and outcome of pregnancy complicated by adnexal torsion. METHODS: All pregnancy cases complicated by adnexal torsion admitted between January 2001 and January 2009 were analyzed. RESULTS: The total number of pregnant cases was 20. Age range of pregnant women with adnexal torsion was 18 to 42 years. Of these cases 70% were seen in the first and second trimester. Seventy percent of cases were operated by the laparotomy route and 30% by laparoscopy. Salpingo-oophorectomy was performed in 70% of cases and detorsion in 30% of cases. Histopathologic examinations revealed five patients (25%) had serous cystadenoma, four patients (20%) mucinous cystadenoma, six patients (20%) dermoid cyst and five patients (25%) hemorrhagic cyst. CONCLUSIONS: Adnexal torsion as a differential diagnosis of acute abdomen in pregnancy should be considered and we recommend early surgical treatment that will save the adnexa.

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PURPOSE: We assessed the association of preoperative thrombocytosis with prognostic factors in malign ovarian tumor. METHODS: Over a five-year period, cases treated for ovarian cancer were randomly assigned. The data were collected from gynecological oncology, radiation oncology, medical oncology and pathology departments. Statistical analyses were carried out by using the statistical packages for SPSS 12.0 for Windows (Chicago, IL, USA). Survival was analyzed by the method of Kaplan and Meier, using log-rank (Mantel-Cox) analysis. RESULTS: 51 cases with ovarian cancer were evaluated. Cases with thrombocytosis were found to have greater CA-125 levels, more advanced stage disease, more ascites and shorter periods of survival. CONCLUSION: Thrombocytosis is a poor prognostic factor in ovarian cancer. As reported previously, it is associated with aggressive tumor biology. Thus, preoperative thrombocytosis can be a used as a marker of poor outcomes.

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We report a phenotypically normal couple with repeated spontaneous abortions and without other clinical features. Clinical, hematological, biochemical, and endocrinological aspects of the couple did not reveal any abnormalities. The karyotype of the wife was normal (46,XX), while the husband was found to have an abnormal karyotype, 47,XY,+der(22)mat. The marker chromosome was familial and non-satellite. Although the potential risk of small supernumerary marker chromosomes for spontaneous abortions cannot be defined precisely, marker chromosomes, together with methods used for ascertainment, are also factors to be considered when investigating infertility consequences. Furthermore, identification of the origin of a marker chromosome may provide additional information for patient karyotype-phenotype correlations. Further studies, such as molecular analyses to identify the breakpoint, are necessary for investigating phenotype-genotype correlations and assessment of genetic risks for small secondary chromosomes. The cause of repeated spontaneous abortions in this couple might be the presence of this marker chromosome in the husband. Consequently, we recommended genetic counseling before further pregnancies.

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Hysterosalpingography (HSG) is associated with pain during the four-step procedure. This prospective, double-blind, randomized, placebo-controlled study was conducted to investigate the effect of the analgesic flurbiprofen, administered prior to HSG, in 60 women. Thirty women were randomized to receive 100 mg of flurbiprofen, orally, 1 h prior to HSG and a further 30 women were randomized to receive placebo. Injection of contrast medium was more painful than the other steps in the HSG procedure in both groups; however, there was no significant between-group difference in terms of pain experienced in the individual steps of HSG. Pain scores at 5 and 30 min after the procedure were compared between the two groups. There was a significant decrease in the visual analogue scale pain score in the flurbiprofen-treated group compared with the placebo-treated group at both time points. Thus, the authors recommend flurbiprofen as a prophylactic analgesic to be administered before HSG procedures.

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OBJECTIVES: The aim of this study was to determine the effectiveness of the risk of malignancy index (RMI) and retrospective analysis of patients presenting with adnexal masses to our clinic for treatment. METHODS: Data of 137 women who had adnexal masses were included in the analysis. A simple algorithm called "risk of malignancy index" (RMI) reported by Jacobs includes menopausal status, ultrasound morphologic features and serum CA125 level. The RMI values were detected for each patient and analyzed to detect the relationship between benign and malign groups of the patients. Statistical analyses were performed with SPSS 15.0 for Windows (SPSS, Inc., Chicago, IL USA). Sensitivity and specificity was calculated for RMI in diagnoses of ovarian cancer by using receiver operating characteristic (ROC) analysis. RESULTS: A total of 137 patients with adnexal masses were operated on. Mean age and SD of 137 patients were 30.64 +/- 10.05. Fourteen patients (10.2%) had malignant disease and 123 patients (89.8%) benign pathology. ROC analysis of the RMI showed that the values of area under the curve were significantly high with a value of 0.883 (p < 0.001). CONCLUSION: The RMI is a simple scoring system and has a high sensitivity and specificity for the detection of malignant adnexal masses. Application of the RMI in clinical practice may provide a rational basis for specialists to treat patients with adnexal masses before diagnostic surgery.

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The surface of naturally hydrophobic mineral pyrophyllite was modified to hydrophilic by treatment with prehydrolyzed N-(2-aminoethyl)-3-aminopropyltrimethoxysilane (APEO) coupling agent to prepare a novel and effective adsorbent for the removal of 4-nitrophenol (4-NP) from aqueous solutions. XRD, FTIR, and SEM analyses were used to characterize the surface modification. It was found that after the grafting procedure, heat treatment at 110 degrees C results in condensation reaction between the OH groups of the APEO molecule and the hydroxyl groups and/or oxygen atoms on the pyrophyllite surface and the adsorption of 4-NP by APEO-modified pyrophyllite involves interactions between dissociated 4-NP molecules and protonated amine groups of APEO molecules attached to the mineral surface. Adsorption equilibrium data for 4-NP adsorption on APEO-treated and untreated pyrophyllite were most satisfactorily fitted using the Freundlich adsorption isotherm and adsorption capacity was found to be 0.268 mg/g for modified pyrophyllite whereas it was only 0.105 mg/g for untreated pyrophyllite.