Relationship Between Lacrimal Bone Thickness and Lacrimal Sac in Chronic Dacryocystitis.

BACKGROUND: Chronic inflammation in the lacrimal sac may lead to thickening of the surrounding bony tissues. This study aimed to assess the thickness of lacrimal bone surrounding the lacrimal sac, and the thickness of maxilla, based on the presence of purulent secretion in the lacrimal sac in patients who underwent EDCR. MATERIAL AND METHODS: Lacrimal bone thickness and the maximum and midpoint maxillary bone thickness of 70 patients (mean age of 49.07 years) who underwent EDCR, were assessed along 3 planes (upper, middle, and lower) using CT of the paranasal sinus. The patients were divided into 2 groups: the 1 who had purulent secretion in the lacrimal sac during the intraoperative period (Group 1) and another who did not have purulent secretion (Group 2). RESULTS: No significant difference was detected between the 2 groups in terms of maximum and midpoint maxillary bone thickness. The increase in the thickness of lacrimal bone in Group 1 was statistically significant in all the 3 planes as compared to that in Group 2. Cutoff values for the thickness of the upper, middle, and lower plane of lacrimal bone were detected to be 0.710 mm, 0.685 mm, and 0.675 mm, respectively. CONCLUSION: The presence of purulent secretion in the lacrimal sac, along with the detected increase in the thickness of the lacrimal bone, as assessed by CT, offers an insight on the lacrimal sac before the surgery.

The association between homocysteine in the follicular fluid with embryo quality and pregnancy rate in assisted reproductive techniques.

PURPOSE: To investigate the association between follicular fluid homocysteine levels and embryo quality and pregnancy rates in patients undergoing assisted reproduction. METHODS: Fifty infertile women who were admitted to our clinic were enrolled in the study. Ovulation induction was performed by using GnRH agonist and gonadotropins. For each patient, homocysteine level in the follicular fluid was measured by using nephelometric method after the oocyte pick-up. The association between the homocysteine concentration in the follicular fluid and the oocyte-embryo quality, pregnancy rates and hormone levels were investigated. RESULTS: Mean ± SD Hcy was 9.6 ± 2.02 µmol/L and 14.9 ± 2.93 µmol/L in pregnant and non-pregnant women, respectively (p < 0.0001). There were no statistically significant differences between pregnant and non-pregnant women in mean age, duration of infertility, body mass index, the oocyte-embryo quality parameters, and hormone levels. Homocystein did not have any correlation with M2, late M2, and total number of oocytes, number of fertilized oocytes and transferred embryos, and embryo quality grade. Area under curve (AUC) of hcy for prediction of pregnancy failure was 0.922 (p = 0.0001, 95% Confidence interval 0.85-0.99). A threshold of 11.9 µmol/L of hcy had a sensitivity of 82%, specificity of 100%, positive predictive value of 100% and negative predictive value of 91.6% for prediction of pregnancy failure. The subgroup analysis in male factor infertility group (n = 28), showed that mean homocystein was 9.9 ± 2.44 µmol/L and 14.1 ± 2.72 µmol/L in pregnant and non-pregnant women, respectively (p = 0.002). CONCLUSION: Low follicular fluid homocysteine level is associated with a better chance of clinical pregnancy.

The Effect of Extranodal Extension on Survival in Laryngeal Carcinoma.

It is known that lymph node metastasis lowers the survival rates in laryngeal carcinoma. This study aimed to investigate the effect of extranodal extension in lymph node metastasis on survival. The demographic characteristics and histopathologic results of 81 patients who underwent total laryngectomy and neck dissection due to advanced larynx squamous cell carcinoma between 2011 and 2018 were reviewed retrospectively. The patients were divided into 3 groups by lymph node metastasis status as reactive lymph node (group 1), lymph node metastasis without detected extranodal extension (group 2), and lymph node metastasis with detected extranodal extension (group 3). Survival analysis was performed between these 3 groups. In the patient population with a mean age of 61.56 years consisting of 6 females and 75 males, demographic characteristics between groups were comparable. Overall survival (OS) rates were detected to be 81% in group 1, 69.2% in group 2, and 61.5% in group 3. Two-year OS rates were detected to be 66.7% in group 1, 46.2% in group 2, and 38.5% in group 3. Statistical difference was detected between group 1 and group 3 both for OS and 2-year OS (P = .014, P = .008, respectively). No statistical difference was detected between group 2 and group 1, and between group 2 and group 3. In this study, we found a negative effect of detecting neck lymphadenopathy metastasis and extranodal extension on survival in patients who underwent total laryngectomy and neck dissection due to advanced laryngeal carcinoma.

Is serum bilirubin level a predictor factor in parotid gland carcinoma?

INTRODUCTION: Bilirubin levels have been associated with risk of several malignancies. The association between pretreatment serum bilirubin levels and overall survival of patients with parotid gland carcinoma is unclear. OBJECTIVES: In this study, we assessed the effect of serum bilirubin levels to overall survival in malignant parotid tumors. METHODS: This study included a total of 35 patients, 15 female and 20 male. The mean age of these patients was 60.7±14.5 years. All patients who were diagnosed with parotid gland carcinoma and underwent total parotidectomy between 2008 and 2018, were retrospectively assessed. The relationship between the overall survival of patients and total bilirubin, direct bilirubin, and indirect bilirubin levels was estimated. The receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off points. RESULTS: Patients with low direct bilirubin, total bilirubin and indirect bilirubin had significantly longer overall survival than those with high levels. Cut-off values for total bilirubin, direct bilirubin and indirect bilirubin were detected as 0.545mg/dL, 0.175mg/dL and 0.435mg/dL, respectively. CONCLUSION: In our study, we observed that increased preoperative bilirubin levels are associated with reduced survival time in the postoperative period of patients with parotid gland carcinoma.

Identification of the first germline mutation in the extracellular domain of the follitropin receptor responsible for spontaneous ovarian hyperstimulation syndrome.

The receptors for follitropin (FSHR), thyrotropin (TSHR), and lutropin/chorionic gonadotropin (LHCGR) are the members of the glycoprotein hormone (GPH) receptors (GPHR) family. They present a bipartite structure with a large extracellular amino-terminal domain (ECD), responsible for high-affinity hormone binding, and a carboxyl-terminal serpentine region, implicated in transduction of the activation signal. Spontaneous ovarian hyperstimulation syndrome (sOHSS) is a rare genetic condition in which human chorionic gonadotropin (hCG) promiscuously stimulates the FSHR during the first trimester of pregnancy. Surprisingly, germline FSHR mutations responsible for the disease have so far been found only in the transmembrane helices of the serpentine region of the FSHR, outside the hormone binding domain. When tested functionally, all mutants were abnormally sensitive to both hCG and thyrotropin (TSH) while displaying constitutive activity. This loss of ligand specificity was attributed to the lowering of an intramolecular barrier of activation rather than to an increase of binding affinity. Here we report the first germline mutation responsible for sOHSS (c.383C>A, p.Ser128Tyr), located in the ECD of the FSHR. Contrary to the mutations described previously, the p.Ser128Tyr FSHR mutant displayed increase in affinity and sensitivity toward hCG and did not show any constitutive activity, nor promiscuous activation by TSH. Thus, sOHSS can be achieved from different molecular mechanisms involving each functional domains of the FSHR. Based on the structure of the FSHR/FSH complex and site-directed mutagenesis studies, we provide robust molecular models for the GPH/GPHR complexes and we propose a molecular explanation to the binding characteristics of the p.Ser128Tyr mutant.

Follicular fluid concentrations of vascular endothelial growth factor, inhibin A and inhibin B in IVF cycles: are they markers for ovarian response and pregnancy outcome?

OBJECTIVE(S): The aim of this study was to measure concentrations of vascular endothelial growth factor (VEGF), inhibin A and inhibin B in follicular fluid (FF) of women undergoing to in vitro fertilization (IVF) cycles and to determine their relationship with ovarian response and pregnancy. STUDY DESIGN: Follicular fluid was collected from 58 patients undergoing oocyte retrieval for IVF. Ovulation was induced with GnRH analogues and gonadotropins. Follicular fluids of mature follicles (>17 mm) were aspirated and pooled for each patient. Follicular fluid steroid hormone levels (E2, P) and VEGF, inhibin A, inhibin B concentrations were studied. The serum levels of E2, P and VEGF were also assessed on the day of the oocyte retrieval. These parameters and characteristics of the cycles were compared between the pregnant (group 1) and non pregnant (group 2) patients. RESULTS: The serum and FF VEGF levels were found to be significantly lower in the group in whom the pregnancy was achieved (P < 0.001). The FF inhibin A and FF inhibin B were found to be significantly higher in pregnant group (P < 0.001). However, age, day 3 FSH, dosage of gonadotropin administered, fertilization rate, sperm count, motile and morphologically normal sperm percentage were not significantly different in the two groups. There was an negative correlation between VEGF and number of follicles, number of oocytes, FF inhibin A, FF inhibin B. The number of oocytes retrieved, the fertilization rate were positively correlated with FF inhibin B and FF inhibin A. CONCLUSION: This study demonstrated that decreased FF VEGF, serum VEGF and elevated FF inhibin A and B are associated with better ovarian response and high pregnancy rate.

Does granulosa cell apoptosis have a role in the etiology of unexplained infertility?

OBJECTIVE(S): To compare granulosa cell apoptosis in patients with unexplained infertility and tubal factor. Accelerated granulosa cell apoptosis may be the cause of unexplained infertility. STUDY DESIGN: Setting was IVF-ET Unit of Cerrahpasa Medical Faculty, Istanbul University. GnRH analogs and gonadotropins were used for ovulation induction in patients with unexplained infertility (n=15) and tubal factor (n=15) undergoing in vitro fertilization and embryo transfer (IVF-ET) procedures. Following HCG injection and follicular aspiration, apoptosis of granulosa cells was assessed using the in situ DNA nick end labelling method and apoptosis rate was further determined by flow cytometry. Apoptosis rates were compared between two groups. Mann-Whitney's U-test and Student's t-test were used for statistics. RESULTS: Apoptosis rate was significantly higher in the unexplained infertility group (33.20 +/- 35.62% versus 10.10 +/- 17.23%). CONCLUSION(S): Granulosa cell apoptosis seems to have a role in the etiology of unexplained infertility.

An alternative treatment option in tubal ectopic pregnancies with fetal heartbeat: aspiration of the embryo followed by single-dose methotrexate administration.

OBJECTIVE: To present 13 cases of unruptured tubal ectopic pregnancies successfully treated with ultrasound-guided aspiration and local and systemic methotrexate (MTX) administration. DESIGN: Case series. SETTING: University hospital. PATIENT(S): Thirteen women with an unruptured tubal ectopic pregnancy. INTERVENTION(S): Transvaginal ultrasound-guided aspiration of the tubal ectopic pregnancy followed by MTX administration into the gestational sac (half of the calculated total dose of 25 mg/m(2)) and intramuscular injection (the remaining half of the calculated total dose of 25 mg/m(2)). MAIN OUTCOME MEASURE(S): Recovery of the patients, successful conservative treatment of the tubal ectopic pregnancies with preservation of the fallopian tubes. RESULT(S): Twelve (92%) of 13 women were successfully aborted, without need for salpingectomy or salpingostomy. CONCLUSION(S): Transvaginal ultrasound-guided aspiration of fetus followed by local and systemic methotrexate administration can be safely used to treat unruptured tubal ectopic pregnancies.

Expression and comparison of gap junction protein connexin 37 in granulosa cells aspirates from follicles of poor responder and nonpoor responder patients.

OBJECTIVE: To localize gap junction protein connexin 37 (Cx37) in granulosa cells obtained from aspiration of follicles, and to compare differences between poor responder and nonpoor responder patients in assisted reproductive technology. DESIGN: Prospective clinical study. SETTING: IVF unit of a university hospital. PATIENT(S): Seventy patients with various causes of infertility, undergoing an IVF treatment. INTERVENTION(S): Controlled ovarian hyperstimulation, serum hormone level measurements, ultrasonography scanning of ovarian follicles, oocyte retrieval after hCG administration and embryo transfer. MAIN OUTCOME MEASURE(S): Outcome of the IVF treatment and expression rate of Cx37 in granulosa cells. RESULT(S): Connexin 37 was expressed in the granulosa cells of all the patients. Connexin 37 rate in granulosa cells in the poor responder group was 81.32 +/- 35.86% (distribution: 2.95%-99.9%), while it was 88.98 +/- 23.73% (distribution: 6.30%-100.00%) in the nonpoor responder group. Connexin 37 rates between the two groups were not significantly different. CONCLUSION(S): Connexin 37 is expressed in the granulosa layer of follicles in the human ovary, and expression of Cx37 in granulosa cells was not different between poor responder and nonpoor responder patients.

Transvaginal ultrasound-guided aspiration and instillation of hyperosmolar glucose for treatment of unruptured tubal heterotopic pregnancy.

OBJECTIVES: To report a case of tubal heterotopic pregnancy (HP) treated conservatively with transvaginal ultrasound-guided aspiration and instillation of hyperosmolar glucose. METHODS: Aspiration of the tubal ectopic pregnancy and hyperosmolar glucose instillation was performed with a 16-gauge needle under transvaginal ultrasound guidance. RESULTS: Unruptured tubal HP with positive cardiac activity was treated successfully without any further interventions, and intrauterine pregnancy has reached full-term without any complications. CONCLUSIONS: Early diagnosis of this life-threatening condition is the key to its successful treatment. Transvaginal ultrasound-guided aspiration and hyperosmolar glucose injection can be safely performed for the treatment of unruptured tubal HP.

Detection of an inguinal ovary at controlled ovarian stimulation that was successfully treated by repositioning.

OBJECTIVE: To report a rare case of an ectopic ovary placed in the inguinal canal that was detected while performing a controlled ovarian hyperstimulation (COH). DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A couple with primary infertility for 4 years was referred to our infertility clinic. The woman's medical history revealed a left inguinal operation at age 7. On vaginal ultrasound, only the right ovary could be seen. An infertility workup conducted for the man revealed teratospermia. The couple was subsequently admitted to the in vitro fertilization (IVF) program. While having a COH, the woman experienced a painful swelling in the inguinal area, and an ovarian image with follicular growth on the left inguinal region was observed with ultrasound. Afterward, surgery was performed, and the ectopic ovary in the left inguinal region was detected. INTERVENTION(S): Detection of an inguinal ovary with a controlled ovarian hyperstimulation procedure and surgical repositioning of the ectopic ovary. MAIN OUTCOME MEASURE(S): Controlled ovarian hyperstimulation, transabdominal ultrasound, transvaginal ultrasound. RESULT(S): The ectopic ovary was successfully repositioned with surgery. CONCLUSION(S): Patients must be closely monitored while performing COH. In patients who do not have a unilateral ovary, a painful inguinal mass should alert the physician to the possible presence of an ectopic ovary in the inguinal canal.

Comparison of transvaginal sonography, saline infusion sonography and hysteroscopy in the evaluation of uterine cavity pathologies.

AIMS: To determine whether performing transvaginal sonography (TVS) and saline infusion sonography (SIS) before hysteroscopy could reduce the number of diagnostic hysteroscopies performed for the evaluation of uterine cavity abnormalities. METHODS: Two hundred and twenty three women with suspected uterine cavity abnormalities were prospectively evaluated by TVS, SIS and hysteroscopy, and had histological evaluation of the endometrium with hysteroscopic biopsy or dilatation and curettage (D&C). One hundred and sixty five patients (74%) were premenopausal and 58 patients (26%) were postmenopausal. RESULTS: The positive predictive value (PPV) for endometrial polyps was 69% for TVS, 78% for SIS and 81% for hysteroscopy in premenopausal patients. In the postmenopausal group, TVS and SIS could detect only 24% of endometrial polyps, whereas 70% were diagnosed by hysteroscopy. The PPV for submucous fibroids was 47% for TVS, 81% for SIS and 77% for hysteroscopy in the premenopausal group. CONCLUSIONS: In premenopausal patients, SIS and hysteroscopy are equally accurate in the diagnosis of endometrial polyps and submucous fibroids. Hysteroscopy is the most accurate test for polypoid lesions in the postmenopausal group. Performing TVS, SIS and D&C could reduce the number of diagnostic hysteroscopies performed for the evaluation of uterine cavity abnormalities by 71.5% in premenopausal patients. However, this rate decreases to 40% in the postmenopausal group.

Infertility due to intrauterine residual fetal bone fragments.

A case of intrauterine retention of fetal bone diagnosed 8 years after termination of a pregnancy is presented. The patient had a history of hypermenorrhea infertility, and persistent vaginal discharge beginning after the abortion. Transvaginal sonography demonstrated an intrauterine foreign body. Curettage was performed, and fetal bone fragments were found within the removed materials.