Uncommon Presentation of Triploidy: A Case Report.

A 28-year-old woman presented in her first pregnancy was admitted with severe hyperemesis gravidarium. Increased nuchal translucency with cardiac anomaly and omphalocele at the first trimester was observed at the ultrasound examination. Chorionic villus biopsy confirmed triploidy. The combination of type I and type II triploidy patterns were seen together in the second trimester of the pregnancy. Although the symptoms due to increased human chorionic levels occured, at the pathologic investigation there were no molar changes in the placenta. Here we report a case of uncommon presentation of triploidy.

A Huge Mature Cystic Teratoma in a Nulliparous Patient.

Here we report a case of a giant mature cystic teratoma of the ovary in a 38-year-old nullipaous woman. The patient presented with abdominal distension and abdominal pain. Laparotomy and cystectomy yielded satisfactory results. Histologic evaluation confirmed a benign cystic teratoma of the ovary. The patient underwent surgery for rupture of corpus luteum six years ago and no gross lesion was seen at the operation. This case demonstrates that dermoid cysts can grow to enormous sizes within a short duration.

Prenatal diagnosis of torcular herophili thrombosis: report of 2 cases and review of the literature.

Prenatally diagnosed thrombosis of the torcular herophili is very rare, and it is sometimes misdisgnosed due to unfamiliarity. Sonography with color Doppler imaging is the key imaging modality for prenatal diagnosis of torcular herophili thrombosis. Typical prenatal sonographic findings include a well-defined triangular anechoic collection in the occipital region and an echogenic structure within the collection, which represents the thrombus. Fetal magnetic resonance imaging is usually used as an adjunctive modality for prenatal diagnosis, as it confirms the diagnosis by providing more precise anatomic information and better characterization of the lesion. We present 2 cases of thrombosis of an ectatic torcular herophili with serial sonographic and magnetic resonance imaging examinations, as well as a review of the literature regarding the prenatal diagnosis of torcular herophili thrombosis.

Isolated fetal liver calcifications.

Hepatic calcification in the fetus is considered an uncommon occurrence and the clinical significance is not fully known. We describe five cases with isolated hepatic calcification. The causes and postnatal outcome of the fetal liver calcifications detected by ultrasound imaging are discussed. Isolated fetal liver calcifications with no aneuploidy and infection have a good prognosis.

Intrahepatic cholestasis of pregnancy: correlation of preterm delivery with bile acids.

BACKGROUND/AIMS: The aim of this study was to determine the incidence, obstetrical and fetal complication rates of intrahepatic cholestasis of pregnancy in patients managed actively around 38 weeks and evaluate the correlation of these results with liver function tests and bile acids. MATERIAL AND METHODS: In this cohort study 3710 women were booked for delivery, of which 32 pregnant women were diagnosed as intrahepatic cholestasis of pregnancy. All data concerning obstetric- medical history, laboratory results, symptom onset time, pruritus degree, treatment response, and delivery time and infants information were recorded in the study protocol. Statistical analyses were conducted with SPSS 12.0 version and correlations were assessed by Spearman Rank correlation analysis. RESULTS: The incidence of intrahepatic cholestasis of pregnancy was 0.86%. The symptoms appeared around 32 weeks. 16.6% multiparas had a previously affected pregnancy and 21.8% of intrahepatic cholestasis of pregnancy patients had family history of intrahepatic cholestasis of pregnancy. Symptom onset varied according to season (p<0.05). Most patients (69.5%) were diagnosed in winter and the beginning of spring. There were no reported cases of clinical maternal jaundice, bleeding tendency or stillbirth. Pruritus was decreased by ursodeoxycholic acid treatment. Total bile acids tended to be higher in patients with preterm delivery (r=0.409, p=0.038). CONCLUSION: Total bile acids are correlated with preterm delivery. An attempt to deliver at around 38 weeks may improve perinatal outcome.

Comparison of the effects of hormone therapy regimens, oral and vaginal estradiol, estradiol + drospirenone and tibolone, on sexual function in healthy postmenopausal women.

INTRODUCTION: Sexual dysfunction is more prevalent in postmenopausal women. AIMS: To prospectively evaluate and compare the effects of hormone therapy (HT) regimens, oral and vaginal estradiol, estradiol + drospirenone and tibolone, on sexual function in healthy postmenopausal women. METHODS: The study included 169 consecutive healthy postmenopausal women, and the women were divided into two groups: 111 women received HT, and 58 women received no treatment and served as a control group. As an HT, 23 women with surgically induced menopause received oral 17-beta estradiol. The rest of the women with natural menopause were prospectively randomized: 22 received oral 17-beta estradiol + drospirenone daily, 42 received oral tibolone, and 24 received vaginal 17-beta estradiol. Sexual function was evaluated with a detailed 19-item questionnaire, the female sexual function index, including sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. MAIN OUTCOME MEASURES: The differences in sexual function were compared before and 6 months after the treatment in all women. RESULTS: Total sexual function score increased from 19.81 +/- 7.15 to 22.9 +/- 6.44 in the HT group and decreased from 21.6 +/- 8.69 to 17.6 +/- 5.7 in the control group, revealing a significant difference from baseline to post-treatment between the two groups (P = 0.000). The highest improvement in total score and arousal was achieved with the oral 17-beta estradiol (P = 0.000 and P = 0.000, respectively). The highest improvement in lubrication was achieved with the oral and vaginal 17-beta estradiol groups (P = 0.000). The highest improvement in orgasm was achieved with the tibolone group (P = 0.000). The highest improvement in pain was achieved with the oral and vaginal 17-beta estradiol groups (P = 0.000). CONCLUSIONS: HT provided significant improvement in sexual function compared to women receiving no treatment, and therefore, HT regimens should be suggested for improvement in sexual functioning of postmenopausal women.

Prevalance of Chlamydia trochomatis, Ureaplasma urealyticum and Mycoplasma hominis infections in the unexplained infertile women.

OBJECTIVE: To prospectively investigate the prevalence of Chlamydia trachomatis (CT), Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU) in the cervical canal and pouch of Douglas in unexplained infertile women and compare it to healthy controls in the Turkish population. MATERIALS AND METHODS: A total of 31 women presenting with a history of infertility [n = 24 (77%) primary infertility, n = 7 (23%) secondary infertility] between 20 and 38 years of age and 31 women willing to have tubal ligation between 30 and 41 years of age were consecutively included into this study. Specimens were taken from intra-abdominal washings and from the cervical canal. CT, MH and UU were detected with polymerase chain reaction (PCR). RESULTS: Results of 62 women were analyzed. None of the participants met the criteria for salpingitis during laparoscopy. The most common infection in the cervical canal in both groups was UU, which was detected in 13 cases of infertile patients and 11 controls (P = 0.602). Cervical chlamydial and mycoplasmic infection was detected in one case each in infertile and control patients. Neither MH nor UU were obtained from the pouch of Douglas in both groups. Only CT was present in peritoneal fluid of an infertile woman who had also a concomitant chlamydial infection in the cervical canal. CONCLUSION: Demonstration of cervical colonization of CT by PCR may be a promising method for the detection of asymptomatic pelvic infection in patients with unexplained infertility. However, screening for MH and UU is not cost-effective due to similar low rates of detection.

Comparison of cervical volume and cervical length to predict preterm delivery by transvaginal ultrasound.

The objective of this study was to evaluate predictive value of cervical volume and length measurement for preterm delivery in low-risk pregnancies by transvaginal ultrasound. Two hundred fifty pregnant women were underwent ultrasound examination at 22 weeks of gestation by transvaginal route. Cervical length, width, and anteroposterior diameters were measured and cervical volume was calculated. All subjects were observed until term. Predictive values of cervical length and cervical volume were calculated and compared with predict preterm delivery. Preterm delivery occurred in 18 patients (7.2%). Mean cervical length and volume were statistically different between term and preterm delivered patients ( P = 0.001). Areas under curves were 0.913 for cervical volume and 0.923 for cervical length; this difference was not statistically significant ( P = 0.289). Sensitivity of cervical volume was 73.3% for 32-mL cut-off value with 12.85% false-positive rate and cervical length had 80% sensitivity at the 33.15-mm cut-off value with 12.7% false-positive rate. Cervical volume measurement by two-dimensional ultrasound did not add any benefit compared with the cervical length measurement for prediction of preterm delivery.

Excision of endometriotic cyst wall may cause loss of functional ovarian tissue.

Management of ovarian cysts is still controversial especially when dealing with endometriomas. Cyst excision was accepted surgical method by many centers; however, relationship between the excision and the loss of functional ovarian tissue is still uncertain.

The effect of inducible nitric oxide synthase on postoperative adhesion formation in rats.

OBJECTIVE: To evaluate the effect of iNOS on adhesion formation and to assess whether inhibition of iNOS expression affected adhesion formation according to adhesion maturation days. STUDY DESIGN: Forty Wistar Albino rats were subjected to standardized lesion by cecal abrasion and parietal peritoneal defect and were randomly divided into four groups. Group I (control) received no treatment; groups II-IV received N-acetyl-cystein (NAC) 15 mg/100 g per day intramuscularly on days 4-14, 0-14 and 0-3, respectively, after surgery. On the postoperative 14th day adhesion score, tissue iNOS expression, inflammatory cell reaction (ICR) and tissue fibrosis score were determined. RESULTS: Inflammation score of groups I and II was lower than that of groups III and IV (P < 0.05). Adhesion scores and tissue fibrosis of group II were significantly lower than that of the other groups (P < 0.001). CONCLUSION: iNOS inhibition during the first 3 days postoperatively caused a delay in the resolution of inflammatory cell reaction. On the other hand, when inhibited after the first 3 days, adhesion formation and fibrosis were reduced both clinically and histopathologically.

The effect of carbohydrate intolerance on neonatal birth weight in pregnant women without gestational diabetes mellitus.

BACKGROUND: There is still no consensus on screening, threshold levels and treatment of gestational diabetes mellitus. Furthermore, the importance of a positive 50-g glucose screening test in patients who had a negative 100-g oral glucose tolerance test remains controversial. We investigated the impact of the 50-g glucose screening test results on neonatal outcome in pregnant women with uncomplicated pregnancies, who had no risk factors according to ACOG criteria. PATIENTS AND METHODS: Three hundred eighty-six pregnant women with singleton pregnancies were prospectively screened with 50-g glucose challenge test between 24 and 28 weeks. If the test result was >140 mg/dl, a 100-g 3-hour oral glucose tolerance test was performed. Patients with a positive screening test, but not diagnosed as gestational diabetes mellitus constituted the study group, and patients with a negative screening test constituted the control group. Cesarean rates, neonatal birth weights and complications were compared between these groups. RESULTS: The cesarean delivery rates were not statistically different between the study and control groups (8.3% vs. 6.4%, P>0.05). The rates of macrosomic births were 10.0% in the study group, and 6.4% in the control group (P>0.05), but the mean birth weight (3451.67 +/- 355.70 g) in the study group was significantly higher than the mean birth weight (3296.29 +/- 365.14 g) in the control group (P=0.003). Neonatal hypoglycemia and hyperbilirubinemia was also encountered more often in babies of pregnant women with a positive 50-g glucose challenge test but negative 100-g glucose tolerance test. CONCLUSION: Because of similarities with gestational diabetes mellitus on the basis of perinatal outcomes, the non-diabetic pregnant women with 50-g glucose screen test result over 140 mg/dl but a negative 100-g OGTT should be followed closely.

Is stress urinary incontinence a familial condition?

BACKGROUND: Stress urinary incontinence (SUI) is a common problem of multifactorial origin. Some authors have claimed that it has a familial predisposition. This study was undertaken to investigate the prevalence of SUI among first-degree relatives of 154 women who had been operated on for this disorder and of 100 women without SUI. METHODS: This report is concerned with a questionnaire-based, case-control study. A total of 154 women who had undergone operations for SUI and 100 women who denied having SUI were included. A comparison was made of 413 first-degree relatives of incontinent women and 372 first-degree relatives of continent women according to the demographic characteristics, obstetric and gynecologic history and risk factors for SUI. The prevalence of SUI was investigated among the relatives. Furthermore, the characteristics of the women who had SUI operation were compared according to the continence state of their families. RESULTS: The prevalence of SUI was 71.4% among mothers and 24.6% among sisters of operated women compared with 40.3% among mothers and 11.6% among sisters of continent women (p < 0.05). Furthermore, the age at which symptoms began was significantly lower in the members of the 'incontinent families' (p < 0.001). CONCLUSIONS: The relatives of incontinent women displayed a higher prevalence of SUI than the relatives of continent women. Although this condition has a multifactorial origin, the familial aggregation of SUI and the appearance of symptoms at younger ages in women with a family history of SUI suggest that heredity may play a significant role.

The prevalence of stress urinary incontinence among women operated on for abdominal wall hernias.

The high co-occurrence of an abdominal wall hernia (AWH) and stress urinary incontinence (SUI) suggests that there is a common factor in the etiopathogenesis of these disorders in these patients.

Treatment of a cervical viable pregnancy with a single intraamniotic methotrexate injection: a case report.

INTRODUCTION: Cervical pregnancy is a rare condition, constituting <1% of all ectopic pregnancies. CASE REPORT: We report here, the successful management of a viable 7 weeks gestation cervical pregnancy. Feticide with 2 ml of potassium chloride 15% was performed under the guidance of transvaginal ultrasonography. Then 70 mg methotrexate (50 mg/m(2)) was injected through this spinal needle in to the amniotic cavity. Also serial changes in the color Doppler imaging after the methotrexate injection were emphasized.

Ovarian function and vascular resistance after tubal sterilization.

OBJECTIVE: To investigate the effect of tubal sterilization (laparoscopic bipolar coagulation) on serum baseline follicle-stimulating hormone (FSH) and estradiol levels, ovarian volume, antral follicle counts and ovarian artery blood flow rate and to evaluate the correlation of these parameters. STUDY DESIGN: Nineteen women who underwent tubal sterilization with laparoscopic bipolar coagulation were enrolled in the study. Ovarian volume, antral follicle counts, serum hormone levels and ovarian artery resistivity index values were measured before and 1 year after the sterilization procedure on the third day of the menstrual cycle. RESULTS: Serum hormone levels, mean ovarian volume (MOV) and mean follicle counts (MFC), were not statistically significant before and 1 year after the operation (P > .05). The difference in ovarian artery resistivity index values was not statistically significant before and 1 year after the operation (P > .05). A significant correlation was observed between FSH, MOV and MFC before and after the operation (P < .05). No correlation was observed between MOV or MFC and resistivity index. CONCLUSION: Ovarian function and vascular resistance do not seem to be affected by laparoscopic bipolar tubal coagulation.

Polycythemia vera and pregnancy: a case report with the use of hydroxyurea in the first trimester.

Polycythemia vera (PV) is rarely associated with pregnancy. A 34-year-old patient treated with hydroxyurea for PV became pregnant and was referred to our clinic. At the patient's request, pregnancy was continued. The patient's hematocrit level remained below 45% without any treatment throughout her pregnancy, and a healthy male infant (without any congenital malformations or complications) was delivered at 37 weeks. This case report suggests that normal pregnancy and delivery is possible in patients with PV.

The effects of hormone replacement therapy type on pulmonary functions in postmenopausal women.

OBJECTIVE: To study whether hormone replacement therapy (HRT) or Tibolone has an effect on pulmonary function in postmenopausal women. METHODS: Seventy-five postmenopausal women without any risk factor for pulmonary disease were included in this randomized, prospective study. Fifty women had undergone natural menopause and 25 had had a hysterectomy/ooforectomy. Twenty-five natural menopause women were randomly allocated to two groups: 25 patients (Group I) were treated with Tibolone 2.5 mg/day, 25 patients (group II) with Estradiol Hemihidrate 2 mg+Norethindron Asetate 1 mg/day. Twenty-five induced menopause women were treated with 17 beta-estradiol 2 mg/day. Lung function tests including forced vital capacity (FVC), forced expiratory volume (FEV(1)), FEV(1)/FVC, forced expiratory flow rate over the 25-75% of the forced vital capacity volume (FEF(25-75%)), and peak expiratory flow rate (PEF) were evaluated at the beginning and 3 months after the treatment to assess the effects of HRT and Tibolone on respiratory function. RESULTS: Regardless of HRT types a significant difference was observed in FVC and FEV(1) after 3 months of the therapy (P=0.001, 0.0001, respectively). No significant difference was found between pre and post therapy values in the other parameters (P>0.05). CONCLUSIONS: We determined a significant increase in FVC and FEV(1) parameters of pulmonary functions after 3 months of the therapy regardless of HRT types. Therefore, we think that HRT regimens have modifying effects on pulmonary function in postmenopausal women.

[The effects of hormone replacement therapy in menopause on symptoms of anxiety and depression]. / Menopozda hormon yerine koyma sagaltiminin anksiyete ve depresyon belirtilerine etkisi.

OBJECTIVE: Replacement of deficient hormones (hormone replacement therapy, HRT) is the main treatment modality in menopause. There is no concensus among researchers as to how HRT influences psychiatric symptoms that might develop during menopausal period. In this study we aimed to explore the effects of HRT on symptoms of anxiety and depression comparatively by using either estrogen or tibolone. METHOD: Women with natural menopause who applied to the outpatient Clinic of Obstetrics and Gynecology Department were included in the study. Subjects (n=70) were randomized into two groups with one group to receive 17beta-estradiol and other group tibolon. All subjects were evaluated at baseline and after 3-months of HRT with Hamilton Anxiety Rating Scale (HARS) and Hamilton Depression Rating Scale (HDRS). RESULTS: Forty six of 70 patients completed the study. The 17beta-estradiol (n=23) and the tibolone (n=23) groups were similar with respect to age, education and occupational status. The time from onset of menopause was longer in the tibolon group. HARS and HDRS scores were significantly decreased after 3 months of HRT in both the 17beta-estradiol and the tibolone groups. The two drug regimens were not significantly different in this respect. CONCLUSION: HRT with 17beta-estradiol and tibolone improves symptoms of anxiety and depression in menopausal women.