Morgagni hydatids: a new factor in infertility?

PURPOSE: To evaluate the effect of Morgagni hydatid (MH) on infertility by comparing women known to be fertile and infertile with respect to MH frequency. METHODS: The study was conducted in Gaziantep University Faculty of Medicine with the precipitation of total 455 patients. The 240 of them were pregnant to whom planned cesarean section (C/S) and the other 215 were infertile one who have undergone diagnostic laparoscopy. Fertile Group (Group 1) consisted of women whom have become spontaneously pregnant without any kind of infertility management. These are planned to undergo C/S with different indications. Infertile group (Group 2) consisted of women diagnosed as unexplained infertility and planned to undergo diagnostic laparoscopy according to ASRM 2006 guidelines. The frequency, number, and the bilaterality of the MH were evaluated during the C/S in fertile group and diagnostic laparoscopy in infertile group. SPSS was used for statistical analyses. RESULTS: The MH frequency was higher in Group 2 than Group 1 (P < 0.05). The bilaterality of MHs were significantly higher in Group 2 than Group 1 (P < 0.05).The number of the MHs were significantly higher in Group 2 than Group 1 (P < 0.05). CONCLUSIONS: These findings suggest a possible effect of MH on fertility. The theory of MH disturbing tubal motility with respect to the pick-up and transport of ovum appears logical in this aspect.

Dicephalic parapagus conjoined twins: a rare second trimester sonographic diagnosis.

Conjoined twins are 1 of the rarest and most challenging congenital malformations. It occurs if twinning is initiated after the embryonic disc and rudimentary amniotic sac have been formed. We report a very rare case of dicephalic parapagus that was diagnosed by transabdominal sonography.

A case of Salmonella typhi endocarditis in pregnancy.

Infective endocarditis (IE) is an uncommon but life-threatening infection during pregnancy. Although there have been several reports of endocarditis caused by Salmonella typhi, to our knowledge it has not been reported as a cause of endocarditis during pregnancy. We report a case of 27-year-old pregnant woman with aortic valve IE caused by S. typhi, who had moderate mitral stenosis and aortic regurgitation. During pregnancy, fever, increase in sedimentation should always alert the physician about the possibility of IE, especially in the presence of predisposing clinical conditions. Whenever possible, transesophageal echocardiographic evaluation should be performed because transthoracic echocardiography might not always demonstrate vegetation as in the present case.

Premenarchal vulvar ulceration: is chronic irritation a causative factor?

OBJECTIVE: To study the common features of the young girls with vulvar ulcerations, and to help guide physicians caring for girls with this unusual condition. METHODS: In this retrospective study, ten patients who developed vulvar ulcerations and denied any kind of sexual contact or sexual abuse were identified. Patient information was collated from detailed history, physical, and laboratory examinations including age, menarchal status, type of clothing worn, whether history of oral aphthosis or previous vulvar ulcers had occurred, symptoms at the time of presentation, description of ulcer, laboratory studies including serologies, blood count, erythrocyte sedimentation rate, C-reactive protein, and biopsy results. RESULTS: Despite multiple evaluations, no patient had a specific medical cause identified to account for their vulvar ulcerations. None were diagnosed with Behcet's syndrome. Seven had bilateral vulvar ulcerations, which we attribute to the practice of wearing tightly fitted pants or polyester underwear frequently. No recurrences were documented in 6 months follow-up. CONCLUSION: Girls with vulvar ulcerations who have deny being sexually active should be thoroughly evaluated for infections, Behcet's disease, and other health problems, but, in addition, should be questioned about use of tight-fitting clothing in the perineal area. We hypothesize that chronic irritation because of tight clothing may play a role in causing vulvar ulcerations in this setting.

An extraordinary cause of vertebral fracture in pregnant woman: brucellosis.

Herein, we report the unique case of Brucella-related lumbar vertebral fracture in a first trimester pregnant woman. The unique effective treatment protocol for the infection is prolonged combined antibiotics and immobilization with follow-up, even in the presence of vertebral fracture related to spinal disease. With the accurate choice of anthiobitics (suitable, non-teratogenic and non-toxic for the fetus) therapeutic abortion is not indicated.

Bilateral femur fracture in a newborn: an extreme complication of cesarean delivery.

INTRODUCTION: Bilateral femoral fracture due to birth trauma which is extremely rare, can occur during cesarean section. MATERIAL AND METHODS: This case represents a newborn delivered by cesarean section for breech presentation who sustained bilateral subtrochanteric fracture of the femur. RESULT: The newborn was treated with immobilization in pelvipedal cast. CONCLUSION: It has been concluded that performing accurate delivery technique and immediate evaluation-orthopedic consultation of the newborn in the presence of forced obstetrical maneuver are important.

Is pregnancy loss after amniocentesis related to the volume of amniotic fluid obtained?

OBJECTIVE: The objective was to determine whether pregnancy loss after amniocentesis is related to the amount of amniotic fluid obtained during the procedure. STUDY DESIGN: The study enrolled 2,400 women, all in their sixteenth to twentieth week of pregnancy. A 22G spinal needle was inserted for amniocentesis. The amount of amniotic fluid obtained from 1,200 patients in Group 1 was 4 ml and from 1,200 patients in Group 2 was 20 ml. In Group 1, the amniotic fluid was analyzed with a quantitative fluorescent polymerase chain reaction technique, whereas in Group 2, conventional cytogenetic analysis was used. SPSS 16.0 (chi-square and t tests) was used for statistical analyses. RESULTS: In Group 1, postamniocentesis premature rupture of membranes (PROM) occurred in four patients (0.3%). There was one unintended fetal loss and postamniocentesis miscarriage rate was 0.08%. In Group 2, postamniocentesis PROM occurred in 12 patients (1%). Eight of these patients experienced fetal loss (0.67%). Fetal loss rates were higher in Group 2 compared with Group 1. These results did not show statistical differences between the groups according to chi-square test (P>0.05). CONCLUSION: Although statistical analysis denies the positive effect of obtaining small amounts of amniotic fluid to reduce fetal loss rates in patients after amniocentesis, six to eight times lower fetal loss rates based on the amount of fluid obtained cannot be undervalued.

Benign ovarian dermoid cyst complicated with rectal fistula formation: an unusual case.

BACKGROUND: Fistulation in benign cystic teratomas has not been commonly reported in the literature. We present a case of a benign ovarian dermoid cyst complicated with a recto-ovarian fistula. CASE REPORT: A 30-year-old nonpregnant woman admitted to the gynecological outpatient clinic because of lower abdominal pain and purulent diarrhea. Gynecological examination and ultrasonography revealed a 10-cm heterogeneous cystic mass in the left ovary. Abdominopelvic CT scan revealed a left ovarian mass (10 x 9 cm) thought to be a dermoid cyst, which was seen to penetrate the proximal part of the rectum. Left adnexectomy and low anterior rectum resection were performed. The pathological evaluation suggested benign ovarian dermoid tumor penetrating the rectum wall. CONCLUSION: Fistula formation by a dermoid ovarian cyst is not always related to malignant transformation of the cyst. In addition to factors such as torsion, infection, trauma, and chronic pressure during labor, spontaneous rupture of the dermoid cyst resulting in leakage of fluid could be the cause of fistula formation.

The potential of serum fetal DNA for early diagnosis of gestational trophoblastic disease.

OBJECTIVE: To study cell-free DNA (cfDNA) levels in patients with gestational trophoblastic disease (GTD) in order to test the hypothesis that cfDNA circulating in maternal plasma could provide early detection of GTD. MATERIALS AND METHODS: This study included 32 patients with GTD (complete mole and partial mole) and 30 non-GTD patients in the first trimester of pregnancy with no other medical problems. cfDNA levels in maternal serum were measured using polymerase chain reaction analysis on Y-chromosome-specific sequences. RESULTS: cfDNA was found as 327±367 pg on average in the control group and 600±535 pg in the GTD group. Within the GTD group, the partial mole group had an cfDNA average of 636±549 pg, and the complete mole group had an cfDNA average of 563±536 pg. Although there was a statistically significant difference between the GTD group and the control group in terms of cfDNA (p=0.02), there was no statistically significant difference between the complete mole group and the partial mole group (p=0.76). CONCLUSION: Non-parametric analysis of covariance in terms of cfDNA in GTD was performed, thereby increasing its power and revealing a significant difference compared with the control group. This indicates that maternal peripheral bloodstream cfDNA monitoring might be significant in the early diagnosis of GTD.

Vaginal adenosis successfully treated with simple unipolar cauterization.

Vaginal adenosis, without a history of diethylstilbestrol (DES) exposure, is a rare condition with an unclear etiology. A 24-year-old female presented with complaints of persistent vaginal discharge and dyspareunia. On examination, there were red, patchy, diffuse lesions on the vaginal wall and cervix. Histopathologic examination of the lesions revealed vaginal adenosis with chronic inflammation. Due to a poor response to metronidazole and tetracycline treatments, unipolar cauterization was performed with successful removal of the lesions.

The relationship of ceruloplasmin and neural tube defects.

OBJECTIVE: To compare the levels of ceruloplasmin (cp) in the amniotic fluids and maternal bloods of second trimester fetuses with and without neural tube defects (NTD). MATERIALS AND METHODS: 66 pregnant women were included in the study. Amniocentesis was performed in 32 women in a patient group diagnosed as NTD or anencephaly and 34 pregnants in a control group with positive Down Syndrome screening test. Maternal bloods were also taken. Cp was measured with Erel's ceruloplasmin measurement method. RESULTS: The cp levels of the amniotic fluid of patients and controls were not statistically different (p>0.05). The cp levels of the maternal bloods were not different in two groups (p>0.05). CONCLUSION: As an antioxidant, no relation was found between cp and NTD.

CA-125 and CRP are elevated in preeclampsia.

OBJECTIVE: To determine the relationship between the cancer antigen-125 (CA-125) and C-reactive protein (CRP) with preeclampsia and eclampsia. METHODS: The study group included 54 preeclamptic/eclamptic women, and 56 healthy pregnant women served as the control group. Mean arterial pressure (MAP) and albumin levels were used to monitor the severity of disease. CRP and CA-125 levels were determined. The cut-offs for CRP and CA-125 were 5 mg/L and 35 IU/ml. The t-test, Pearson correlation and ANOVA were used for statistical analysis. Values of p < 0.05 were considered to be significant. RESULTS: CRP and CA-125 parameters were significantly higher in the study group (p < 0.001), and were significantly higher in severe preeclampsia and eclampsia groups than in mild preeclampsia (p < 0.001). Significant correlations were found between CRP/MAP, CRP/albumin, CA-125/MAP and CA-125/albumin (p < 0.001). CONCLUSION: CRP and CA-125 are elevating markers in preeclampsia.

A rare mass formation of the vulva: giant cavernous hemangioma.

OBJECTIVE: Vulvar hemangioma is an extremely rare pathology in adult women causing sexual dysfunction, pain, and cosmetic problems requiring therapeutic intervention. MATERIALS AND METHODS: We present a case of an isolated giant vulvar cavernous hemangioma with a 2-year history that macroscopically seemed to be a vulvar varicosis but was actually detected at the end to be cavernous hemangioma in an adult patient with no history of other disease. RESULTS: The patient was treated with surgical excision because of progressive complaints. Histopathologic evaluation suggested cavernous hemangioma. CONCLUSION: Hemangiomas can undergo spontaneous involution; thus, treatment may be reserved for those lesions of functional or psychological concern. In this case, surgical correction was used both as a diagnostic method and as a therapeutic intervention because of progressive complaints such as pain, feeling of pressure, and sexual dysfunction.