Eclampsia with neurological complications: a five-year experience of a tertiary centre.

PURPOSE: The neurological signs and symptoms in 107 pregnant women with eclampsia in the last five years at the Department of Obstetrics and Gynecology at the Yuzuncu Yil University School of Medicine are presented. MATERIALS AND METHODS: The medical records of 107 pregnant women with eclampsia in the Clinic of Obstetrics and Gynecology at the Yuzuncu Yil University consulted with neurology clinic from September 2005 to December 2010, were evaluated. RESULTS: The most common symptoms of the patients were seizure, headache, and seeing spots of light. Although neurologic examination was normal in 81 patients, 26 had pathological signs. The most common neurologic pathologic signs determined were alterations in consciousness. CONCLUSION: In eclamptic patients, brain scanning might reveal pathological results in spite of normal neurological examination. With neurological examination and brain scanning, it may be possible to diagnose and treat severe complications that may otherwise result in maternal mortality.

Rectal cancer and pregnancy: report of two cases.

Colorectal cancers are rare during pregnancy and the management is controversial and challenging. Prognosis is usually unfavorable due to late diagnosis since the presenting symptoms of colorectal cancer are attributable to the usual manifestations of pregnancy. Management depends on the patient's age and desire for future pregnancy, gestational age, cancer stage and religious principles. Thus, the treatment should be individualized. We present two cases of rectal cancer during pregnancy.

The relationship between clinico-biochemical characteristics and psychiatric distress in young women with polycystic ovary syndrome.

The relationship between clinico-biochemical characteristics and self reported psychological parameters in 42 women with polycystic ovary syndrome (PCOS) and 42 age-matched healthy controls was examined. The General Health Questionnaire was used (GHQ-12) to ascertain emotional distress and the Beck Depression Inventory (BDI) to determine depressive symptoms. Emotional distress, depressive symptoms, hirsutism score, body mass index (BMI), waist-to-hip ratio (WHR), luteinizing hormone/follicle-stimulating hormone ratio, serum total testosterone, dehydroepiandrosterone sulphate levels and the insulin resistance index were significantly greater in women with PCOS than in healthy women. The BDI and GHQ-12 scores of the women with PCOS were significantly higher than those of the control group (BDI, 11.69 +/- 9.49 vs 5.80 +/- 4.58; GHQ-12, 3.38 +/- 3.38 vs 1.54 +/- 1.97, respectively), and BMI and WHR were positively correlated with the BDI and GHQ-12 scores. Clinicians should be aware of the increased risk of emotional distress and depression in women with PCOS, especially those who are obese, and of the need to screen these patients for such symptoms.

Ovarian stimulation in obese and non-obese polycystic ovary syndrome using a low-dose step-up regimen with two different starting doses of recombinant follicle-stimulating hormone.

Sixty-seven infertile women with polycystic ovary syndrome (PCOS) were divided into two groups, obese and non-obese, according to their body mass index. Waist-to-hip ratio, insulin resistance, total testosterone and dehydroepiandrosterone sulphate levels were significantly elevated in obese, compared with non-obese, patients. Both groups were treated with a low-dose step-up protocol of recombinant follicle-stimulating hormone (rFSH) with a starting dose of 50 IU/day and, every third day, a 25-IU increase in the dose until the appropriate dose was achieved for each individual, up to a maximum of 175 IU/day. In the obese group only, repeat therapy commenced in the second ovulatory cycle in women who had not become pregnant, however a starting dose of 75 IU/day was then used, with incremental and maximum dose as before. The results of the starting dose of 75 IU/day rFSH were compared with the results of a 50 IU/day rFSH starting dose in the obese group. A starting dose of 50 IU/day rFSH in a low-dose step-up regimen was found to be effective, safe and well-tolerated for inducing follicular development in non-obese infertile women with PCOS. However, for obese PCOS patients, a starting dose of 75 IU/day rFSH is recommended.

Giant bladder leiomyoma presenting as a pelvic mass: a case report.

We present a rare case of bladder leiomyoma with an unusual presentation as a pelvic mass. Bladder leiomyomas are very rare tumors, compromising less than 0.43% of all bladder tumors. Magnetic resonance imaging showed a 16 x 13 cm mass covering the entire pelvis and extending up to the umbilicus. There was a 20 x 20 x 11 cm immobile mass originating from the bladder at laparotomy. The mass was removed by bladder-sparing surgery and was reported to be leiomyoma. We conclude that bladder leiomyomas should be preoperatively recognized as a cause of pelvic mass in order to make the possible diagnosis.

Ovarian hemangioma with elevated CA125 and ascites mimicking ovarian cancer.

We report a case of a very rare tumor of the ovary with an unusual presentation; an ovarian hemangioma with massive ascites and elevated CA125. A 57-year-old woman presenting with elevated CA125, massive ascites and a left solid adnexal mass of 60 x 47 mm, with calcification and increased blood flow at Doppler examination, was submitted to laparotomy. Frozen section was inconclusive and a staging procedure which complicated the patient was performed. Pathologic examination revealed cavernous hemangioma which is an extremely rare tumor of the ovary. Although it is very unusual, an ovarian hemangioma may present with ascites and elevated CA125 and the differential diagnosis from ovarian cancer should be considered.

Primary giant leiomyoma of the ovary--case report.

Primary leiomyoma of the ovary, which is of unknown origin, is an extremely rare tumor of ovary. We report a rare case of giant primary ovarian leiomyoma with an unusual presentation, ascites, elevated CA125 and discuss the preoperative imaging findings. A 45-year-old woman was referred for evaluation of an adnexal mass of 8 x 9 cm with ascites and elevated CA125 levels. Preoperative imaging studies were in accordance with fibroma/thecoma. At laparotomy total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Histological and immunhistochemical examination revealed primary ovarian leiomyoma.

Eight years' experience of uterine rupture cases.

Ruptured uterus is a serious obstetric emergency with a high maternal and perinatal mortality. It is a preventable and common obstetric problem in developing countries. The objective of this study was to review the incidence, methods of diagnosis and maternal and perinatal morbidity and mortality associated with uterine rupture. Case notes were reviewed for all patients with a ruptured uterus at Yüzüncü Yil University Medical Faculty Department of Obstetrics and Gynaecology from January 1995 to August 2003. Relevant data relating to the clinical characteristics of labour, operative procedures, maternal and perinatal outcome were assessed. There were 20 cases of ruptured uteri. The incidence was 0.40%. When patients referred from other hospitals were excluded, the revised ratio was 0.12%. There were 13 (65%) complete and seven (35%) incomplete ruptures. Nine (45%) cases occurred in patients with scarred uteri. Ten (50%) cases were grand multiparous. Subtotal abdominal hysterectomy was performed in five (25%) cases, total abdominal hysterectomy was performed in two (10%) cases and the remaining 13 (65%) cases had uterine rupture repair. There were two (10%) maternal deaths. Both of them were referred from other hospitals. There were seven (35%) perinatal deaths attributable to uterine rupture. Occurrence of uterine rupture is significantly associated with grand multiparity, scarred uterus, lack of antenatal care, unsupervised labour at home and low socioeconomic status of the patients. These factors are largely preventable.

Anxiety and depression before and after the menopause.

OBJECTIVE: Our purpose was to investigate the anxiety and depression at postmenopausal women. METHODS: We studied 32 postmenopausal and 32 premenopausal patients aged between 40-55 years in Kinrikkale University Medical Faculty Obstetric and Gynecology Department. We performed Beck depression scale and State Trait Anxiety Inventory (STAI) I and II on those patients. Blood samples were taken from each patient. We used student's t test, pearson correlation analysis. RESULTS: Beck depression test results were 21.3 +/- 6.7 and 15.1 +/- 5.6 in postmenopausal and premenopausal women respectively (p < 0.001). STAI-I were 50.4 +/- 9.1 and 47.5 +/- 8.5 in this 2 groups (p = 0.19) and STAI-II values were 47.5 +/- 9.1 and 45.4 +/- 7.5 (p = 0.33). We could not find a correlation between anxiety-depression and blood FSH, LH and E2 levels. We found a correlation between parity and depression (r = 0.423 p = 0.01). There were positive correlations between anxiety and depression tests (r = 0.489 p = 0.01 for STAI-I and r = 0.398 p) = 0.01 for STAI-II). CONCLUSION: Depression rate is significantly higher in menopausal women.

Anastomosis of the freshly divided uterine horns of rats with the CO2 laser vs. microsurgery.

We used the CO2 laser (group 1) and conventional microsurgery (group 2) for anastomosis of the freshly divided uterine horns of rats and compared the two methods. Each group was then compared with a control group in whom only exploration was carried out at laparotomy. Comparison was done regarding the clinical and histologic results. In addition, serum levels and tissue concentrations of alkaline phosphatase (ALP) and lactic dehydrogenase (LDH) were measured, and the three groups were compared. No significant difference was found between the mean adhesion scores of groups 1 and 2; however, when the control group was compared with the other groups, the differences were statistically significant. The tubal patency rates in groups 1 and 2 and the control group were 83.3%, 79.2% and 100%, respectively, and the pregnancy rates in those groups were 54.5% (6/11), 45.5% (5/11) and 100% (10/10). The differences in tubal patency and pregnancy rates between groups 1 and 2 were not significant, but when each was compared with the control group, the differences were significant. The mean scores for mucosal regeneration and disruption of the muscularis layer in group 1 were significantly lower than those in group 2. Serum levels and tissue concentrations of ALP and LDH in the control group were lower than in groups 1 and 2, and the differences between the control group and each of the other groups were significant; however, no significant difference was found between groups 1 and 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Turkey: pressures on employment, housing, education and health care.

PIP: High population growth rates in Turkey have exacerbated problems in the areas of employment, education, housing, and medical care. Rural unemployment has caused widespread migration to major cities, resulting in a deterioration of living conditions in these centers and increasing the demand for municipal services. Since 1940 population increases have consumed most of the rise in national income and hindered economic development. Employment opportunities have not kept pace with the excess supply of labor caused by population growth, especially in the modern industrial sector. Despite overall progress in increasing literacy, educational imbalances persist between regions, rural and urban areas, and males and females. Women with at least a primary school education have an average of 2.5 children compared with 5.2 children among illiterate women. Historically, large families have been encouraged by the Turkish government. From 1927-80, Turkey's population increased 350% to 45 million and is expected to reach 65-70 million by the year 2000. 38% of the population is currently under the age of 15 years, a fact that has implications for future population trends and economic development. The 1965 Population Planning Law gave responsibility for carrying out the country's family planning services to the Ministry of Health and Social Welfare. A 1983 law legalized abortion, which had been a major cause of maternal mortality, up to 10 weeks or longer if there is a risk to the infant or mother. 1600 physicians and 6800 other health personnel have been trained to provide contraceptive services. By 1981, 4 million people had been educated in family planning and maternal-child health. As a result of all these measures, a marked decrease in fertility has been noted since 1965.^ieng