Outcomes of Micro-Dissection TESE in Patients with Non-Mosaic Klinefelter's Syndrome without Hormonal Treatment.

BACKGROUND: Klinefelter syndrome (KS) is the most common sex chromosomal disorder in males and historically patients have been labeled as sterile. After the introduction of microdissection testicular sperm extraction (micro-TESE), successful sperm retrievals for intracytoplasmic sperm injection (ICSI) have been reported. MATERIALS AND METHODS: A retrospective study was undertaken on ten patients with non-mosaic KS undergoing micro-TESE for ICSI. The testicular volume and FSH and LH levels of each patient were measured. Karyotypes were confirmed by analyzing peripheral lymphocyte metaphases. Physical examination of the external genitalia was performed in all patients to rule out any co-existing anomaly. Micro-TESE was performed in order to investigate the presence of seminiferous tubules which may contain spermatozoa. When testicular spermatozoa were found in micro-TESE, ICSI was performed. Embryos were evaluated for further development. Fertilization was considered to have occurred after the visualization of the two pro-nuclei stage of the oocyte 24 hours after the intracytoplasmic injection of the motile spermatozoa. Pregnancy was confirmed by visualization of an intrauterine gestational sac under ultrasonographic examination. RESULTS: Testicular biopsy revealed motile spermatozoa in 6 of 9 patients (66.6 %). Fertilization rate per embryo-transfer was 40%. One patient was able to conceive and fathered a healthy boy weights 3410 g at the 39(th) week of gestation. CONCLUSION: Retrieval of testicular spermatozoa by micro-TESE is possible for azoospermic men with KS when assisted reproductive techniques are applied. For patients with KS who want to conceive, assisted reproductive techniques (ART) should be recommended.

Emergency peripartum hysterectomy: our 12-year experience.

OBJECTIVE: The aim of this study was to determine the incidence, indications and the risk factors and complications of emergency peripartum hysterectomy (EPH). METHODS: We analyzed retrospectively 44 cases of EPH performed at tertiary obstetric center between January 2001 and April 2013. Data related to demographics, reproductive histories, indications for EPH, and postoperative follow-up were obtained by analyses of hospital records. RESULTS: The overall incidence of EPH was 0.48 per 1,000 deliveries during the study period. The most common indications of EPH were abnormal placentation (50 %), uterine atony (36 %) and uterine rupture (9 %). All patients who underwent EPH with abnormal placentation had one or more previous cesarean sections (CS) except one. In our series, 24 cases (54 %) underwent total hysterectomy, most of which had the diagnosis of abnormal placentation (75 %), whereas subtotal hysterectomy was the choice of management of bleeding in cases with uterine atony (60 %). Maternal mortality was seen in 2 patients (4.5 %). The causes were disseminated intravascular coagulation in one and adult respiratory distress syndrome in the other patient. Perinatal mortality was observed in 7 patients (16 %). The causes for perinatal mortality were placental abruption in 4 and prematurity in 3 patients. CONCLUSIONS: In our series, abnormal placentation was the most common indication for EPH. The risk factors for EPH were previous CS for abnormal placentation and placental abruption for uterine atony and peripartum hemorrhage. Limiting the number of CS deliveries would bring a significant impact on decreasing the risk of EPH.

The effect of magnesium sulfate treatment on blood biochemistry and bleeding time in patients with severe preeclampsia.

OBJECTIVE: The objective of this study was to observe the effects of magnesium sulfate on various blood biochemical parameters and coagulation status of patients with preeclampsia. METHODS: During a period of 4 years, 50 patients with severe or mild preeclampsia progressing to severe preeclampsia were included in the cross-sectional study. Prothrombine (PT), activated limited thromboplastin time (aPTT), magnesium level, biochemistry parameters, systolic, and diastolic blood pressure (BP) were measured. These parameters were remeasured in the second hour of magnesium sulfate treatment. RESULTS: After magnesium sulfate therapy; creatinine levels are decreased (p < 0.05), bleeding time is increased and serum magnesium levels are increased (p < 0.01), systolic and diastolic BP values decreased significantly (p < 0.01). PT, aPTT, platelet levels, and coagulation time did not change after treatment. CONCLUSION: Magnesium sulfate infusion prolonged bleeding time in patients with severe preeclampsia. This is clinically important because it worsens the present condition and causes possible complications.

Acute abdomen due to rupture of Sertoli cell tumor.

PURPOSE: To present a rare case of Sertoli cell tumor that presents with acute abdomen. CASE: A 28-year-old patient with symptoms of acute abdomen has presented to our emergency department. Her examinations revealed a 12 x 10 cm heterogeneous mass in the right ovarian fossa. Laparotomy was carried out immediately. Frozen pathological study revealed a low-grade sex-cord stromal cell tumor. Right salpingo-oopherectomy was performed. During 2 years of follow-up, there was no evidence of disease. CONCLUSION: Although rupture of a malignant ovarian tumor is an infrequent cause of acute abdomen, it should be considered in the differential diagnosis of acute abdomen.

The effect of tubal sterilization through electrocoagulation on the ovarian reserve.

BACKGROUND: The study was conducted to compare the effects of tubal sterilization through electrocoagulation and the application of mechanical clips on the ovarian reserve. STUDY DESIGN: Eighty-eight patients in the reproductive period with the desire of tubal sterilization were included in the prospective, randomized study. The patients were divided into two groups by simple randomization as tubal sterilization through electrocoagulation group and the application of mechanical clips group. Day-3 serum follicle stimulating hormone, luteinizing hormone, estradiol, inhibin-B and antimüllerian hormone and Day-3 total ovarian volume measurements and anthral follicle counts of all patients in the preoperative and 10th postoperative months were compared both within and between the two groups. RESULTS: A significant difference between the postoperative 10th-month Day-3 total ovarian volumes and anthral follicle counts was detected between the electrocoagulation and mechanical clips application groups. CONCLUSION: Tubal sterilization by electrocoagulation is very likely to have an adverse effect on the ovarian reserve in the postoperative period.

Emergency peripartum hysterectomy in a tertiary Istanbul hospital.

OBJECTIVE: To evaluate the incidence, risk factors, indications, outcomes and complications of emergency peripartum hysterectomy performed after cesarean and vaginal deliveries. METHOD(S): We analyzed retrospectively 28 cases of emergency peripartum hysterectomy operations performed between February 2001 and February 2007 at the Istanbul Goztepe Training and Research Hospital, which is a teaching hospital operating under the Turkish Ministry of Health. The indications, risk factors and the associated complications were compared with control groups. Statistical analysis was performed using the STATA version 7.0 statistical package (Stata Corporation, College Station, TX, USA). RESULT(S): The overall incidence of emergency peripartum hysterectomy at our hospital is 0,37 in 1,000 deliveries. Abnormal placental adherence and uterine atony comprised 85% of the indications for peripartum hysterectomy. Postoperative maternal morbidity occurred in 15 cases (54%). Most had a febrile morbidity and depression. Seven patients underwent postpartum histerectomy due to consumptive coagulopathy. There was one maternal mortality (4%) and five perinatal mortalities (18%). The maternal death was due to consumptive coagulopathy after placental abruption. All patients had to receive blood transfusions. The median number of postoperative hospitalization days was 7. CONCLUSION(S): Peripartum hysterectomy is still a dramatic life-saving operation with high risks. The most common reason for abnormal placental adherence is previous uterine procedures.