Treatment of vaginitis.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of metronidazole 500 mg and miconazole nitrate 100 mg (Neo-Penotran, Embil Pharmacy Company, Istanbul, Turkey) in the treatment of vaginitis. METHOD: One hundred patients (mean age 26.5 years, range 18-50) with a clinical diagnosis of vaginitis entered this open, noncomparative study. Each patient inserted a Neo-Penotran pessary twice daily for 14 days. Assessments were carried out at the beginning of the study and 15 and 22 days after the start of therapy. Student's t-test was used for the statistical analysis. RESULTS: Out of 100 patients who were initially recruited to the study, 20 were subsequently excluded, leaving a total of 80 patients (80%) who completed the full course of treatment. Vaginitis was resolved in 75% of cases, it improved in 18% and was unchanged in 7%. The success rate for the treatment of trichomoniasis was 80%, 93.4% for bacterial vaginosis and 84.4% for candidal vaginitis. CONCLUSION: Neo-Penotran pessaries represent a novel and effective formulation for the treatment of common types of vaginitis and this pessary may also be of particular value in the treatment of resistant or recurrent vaginitis.

Vulvar syringoma exacerbated during pregnancy.

Although syringoma of the eyelids and the cheeks are well known and defined, vulvar syringoma is a rare clinical variant of this benign eccrine tumor. A case of syringoma of the vulva exacerbated during pregnancies with regression in the periods in between is presented. Histopathological examination showed typical features of syringomas. Only 20 patients with vulvar syringoma have been previously reported in the literature.

Demographic and epidemiologic features of female adolescents in Turkey.

OBJECTIVES: To determine the average menarcheal age and menstrual cycle pattern, prevalence of dysmenorrhea, frequency of smoking, alcohol and drug use, sexual education level, and the gynecologic problems in female adolescents in Turkey. METHODS: A questionnaire consisting of 43 questions were given to 13,665 high school girls between the ages 13-18 years. RESULTS: The results showed that average menarcheal age was 13.28 +/- 1.09 years and 77.8% of the girls had menstrual cycles between 20-35 days; 10,688 (78.1%) of the girls complained about pain during their menstruation and 25.6% frequently missed school for this reason. That notwithstanding, only 0.4% of the adolescents with dysmenorrhea had sought medical consultation. Out of 13,665 girls, 19.7% smoked cigarettes, 14.9% used alcohol, and 0.63% used other drugs. Although 50.8% of the students believed that their knowledge about sexuality was adequate, on evaluating the results, this was not confirmed. Girlfriends were found to be the most important source of sexual knowledge. The study indicated that 88.8% of the girls wanted to have sexual education at schools and 60.5% of those preferred to take such a lecture together with boys. The study also revealed that 10.5% of the girls previously consulted a gynecologist and menstrual disorders (26.1%) and dysmenorrhea (23.4%) were the most common complaints. The results showed that 68.7% of the girls preferred a woman gynecologist and 66.3% wanted to be alone with the doctor during examination. CONCLUSION: We provided data about demographic and epidemiologic features of Turkish female adolescents.

Intravenous gamma-globulin treatment in a patient with subacute sclerosing panencephalitis.

A 10-year-old boy with subacute sclerosing panencephalitis was treated with intravenous gamma-globulin and inosiplex and followed for 18 months. Clinical improvement, demonstrated by decreasing scores on the Neurologic Disability Index, was observed. There were no side effects. We recommend intravenous immune globulin as an alternative therapy in the treatment of subacute sclerosing panencephalitis.

Congenital ocular motor apraxia in two siblings.

Two siblings whose features met Cogan's classic description of congenital ocular motor apraxia were examined. There was first-degree consanguinity in the family. Each had an absence of voluntary and optically-induced horizontal eye movements and demonstrated classic head thrusting.

Polycystic ovaries in association with müllerian anomalies.

The polycystic ovary syndrome, whose etiopathogenesis is not clearly understood, has a wide spectrum of clinical presentations, and may co-exist with other pathologic conditions. In this study, we evaluated the prevalence of ultrasound-defined polycystic ovaries (PCO) in patients with müllerian anomalies (n = 167), and those without müllerian anomalies (n = 3165) from 1990 to 1994, in a population markedly composed of infertility patients. PCO were found in 50 (29.9%) patients in the study group, compared to 637 (20.1%) patients in controls (P < 0.01). Müllerian anomalies were further grouped according to the American Fertility Society (AFS) classification and it was found that patients with the septate uteri and bicornuate uteri malformations had a higher prevalence of PCO than the controls (P < 0.001, P < 0.05, respectively). Although a difference existed in the percentage of PCO in patients with unicornuate uteri and didelphic uteri compared to controls, this difference did not reach statistical significance (P > 0.05). We conclude that, as PCO are more prevalent in certain müllerian anomalies, an embryogenetic defect may also be involved in the etiopathogenesis of PCO.

The effect of smoking on sister chromatid exchange rate of newborn infants born to smoking mothers.

Sister chromatid exchange (SCE) frequencies in lymphocytes of 21 smoking mothers and their 21 newborns were compared to those that of 10-infants whose mothers had never smoked and to those of 8 infants whose mothers were passive smokers and reported high exposure to tobacco smoke by living or working with smokers. Mothers in the first group also smoked throughout their pregnancy. Results confirm our earlier study on smoking effects reported for adults. Additionally, we saw that neonates have consistently lower SCE frequencies than adults.

Decreased retinal blood flow in retinitis pigmentosa.

OBJECTIVE: To determine alterations in retinal blood flow in retinitis pigmentosa (RP). DESIGN: Case-control study. SETTING: Ophthalmology department of a university-affiliated hospital in Elazig, Turkey. SUBJECTS: Ten patients (20 eyes) with typical RP and 22 age-matched volunteer subjects (22 eyes) with no history of ocular or systemic disease. MAIN OUTCOME MEASURES: Central retinal artery peak systolic and diastolic blood flow velocity (measured by means of colour Doppler imaging), resistance index and pulsatility index. RESULTS: The mean peak systolic and diastolic flow velocity values were significantly lower in the study group than in the control group (4.96 +/- 1.3 vs. 11.11 +/- 1.5 cm/s [p < 0.00001] and 2.15 +/- 0.4 vs. 3.40 +/- 0.9 cm/s [p < 0.0001] respectively). The mean resistance index value was significantly lower in the study group (0.55 +/- 0.05) than in the control group (0.71 +/- 0.06) (p < 0.0001), as was the mean pulsatility index value (0.94 +/- 0.18 vs. 1.45 +/- 0.36) (p < 0.00001). CONCLUSIONS: Decreased retinal blood flow is an important feature of RP.

Vaginal thrush and its management in pregnancy.

The frequency of vaginal thrush was determined in an unselected group of patients attending the antenatal clinic. Diagnosis was based on phase-contrast microscopy and culture. One hundred and two patients were initially included but only 98 completed this study. Thrush infection was detected in 25 (25%) patients. All 25 patients underwent treatment with one vaginal ovule containing 400 mg ketoconazole on each of three successive evenings. Thrush attack was eliminated in 23 (92%) cases. In view of the virtual absence of clinical symptoms, the recommendation to undertake general screening for thrush in pregnancy is discussed. The efficacy of treatment with ketoconazole ovules was studied and the results of treatment were reviewed after 4 and 8 weeks. Recurrence or re-infection has to be considered in pregnancy so that thrush treatment should sensibly be undertaken in the third trimester unless subjective symptoms indicate the need for earlier therapy.

Endocrinological, ultrasonographic and clinical findings in adolescent and adult polycystic ovary patients: a comparative study.

This study was performed to compare clinical and endocrine features and ultrasonographic data of adolescent (< or = 18 years old) and adult (> or = 19 years old) patients with ultrasound-diagnosed polycystic ovaries (PCOs) in our Reproductive Endocrinology outpatient clinic. The adolescent group included 35 PCO patients while 125 were in the adult group. Hirsutism was present in 64.7% of the adolescent group and in 49.6% of the adult group. Menstrual irregularities were detected as oligomenorrhea (42.8%), amenorrhea (20%) and irregular but normal cycles (17.4%) in the adolescent group; the figures for the adult group were 46.4, 8.8 and 23.2%, respectively. These differences were not statistically significant. The mean body mass index of the adult PCO group was significantly higher than the adolescent PCO group (p < 0.05). The endocrine features (estradiol, follicle stimulating hormone, luteinizing hormone (LH), prolactin, total testosterone, free testosterone, 17-OH progesterone, androstenedione, thyroid stimulating hormone, dehydroepiandrosterone sulfate (DHEAS)) and the ovarian volume of both groups were comparable. There was a significant positive correlation between ovarian volume and serum LH, total testosterone, free testosterone, androstenedione and DHEAS in both groups. We conclude that polycystic ovarian syndrome is a disorder with perimenarchal onset, the clinical, endocrine and ultrasound features of which will not change by age, although patients are prone to gain weight as they get older.

Oral rehydration of infants with hypernatremic dehydration due to acute gastroenteritis.

Twenty-five infants with hypernatremic dehydration due to acute gastroenteritis were given oral rehydration therapy (ORT). The patients received a glucose-electrolyte solution (such as that recommended by the World Health Organization) over six hours (2:1 rotating method). Twenty-three patients were successfully rehydrated within 48 hours after onset of therapy, while the two remaining patients attained normal serum Na+ levels within 72 hours. Acidosis was noted in 10 patients which disappeared in 24 hours.

Beta-ketothiolase deficiency. A case report.

A four-month-old boy with beta-ketothiolase deficiency is described in this report. Presenting symptoms and signs were vomiting, irritability and acidotic respiration. Laboratory investigations revealed hyperglycinemia, metabolic acidosis and ketosis. Subsequent urinary GC-MS analysis of the patient's urine sample showed the typical pattern of beta-ketothiolase deficiency. Our experience with this case indicates that accurate diagnosis and early treatment of inborn errors might be lifesaving.