Dermatomyositis Flare-Up Following the SARS-CoV-2 Vaccine: A Case Report and Literature Review.

Dermatomyositis is a rare auto-immune inflammatory myopathy of unknown etiology. Several environmental factors, including vaccines, have been identified as potential triggers in genetically susceptible individuals. Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the development of vaccines (mRNA and vector-based) has been the most effective tool in reducing the incidence, hospitalization rates, and mortality of COVID-19. However, among individuals with immune dysregulation and auto-immune conditions, unique challenges may arise with immune stimulation. We present a case of a dermatomyositis flare-up following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. A 40-year-old Hispanic female presented to the emergency department with shortness of breath, muscle pain and weakness, and skin rash for two days. She had been recently diagnosed with dermatomyositis six months prior based on clinical presentation, laboratory investigations, and characteristic muscle biopsy findings. She had been on treatment with mycophenolate mofetil, prednisone, and hydroxychloroquine since. She reported receiving the second dose of the BNT162b2 COVID-19 vaccine one day prior to the onset of symptoms. Physical examination revealed erythematous plaques over her cheeks, upper chest, and arms, in addition to Gottron papules on her hands. She had reduced proximal muscle strength and scattered dry crackles bilaterally on lung auscultation. Her laboratory investigations were remarkable for elevated erythrocyte sedimentation rate, C-reactive peptide, creatinine kinase, and troponin T. The SARS- CoV-2 PCR test was negative. CT scan of the chest showed evidence of pneumonitis. A diagnosis of the dermatomyositis flare-up potentially secondary to the SARS-CoV-2 BNT162b2 vaccine was established. The patient was admitted and treated with pulse steroids and intravenous immunoglobulin. She responded well to therapy and was discharged home four days later. There have been several reports of a new onset of dermatomyositis following the SARS-CoV-2 vaccine which highlights the need for further large-scale studies to estimate the prevalence of such adverse effects. The benefits of the SARS-CoV-2 vaccine outweigh the risks even among patients with auto-immune and rheumatologic conditions; however, it is important for clinicians to recognize the possibility of occurrence of such events in order to manage patients appropriately.

Using Google Trends for Evaluation of Public Interest in Female Genital Aesthetic Procedures.

BACKGROUND: Genital aesthetics is a treatment that is increasing in popularity. OBJECTIVE: To clarify public interest in genital aesthetic procedures among women between 2004 and 2022. MATERIALS AND METHODS: In total, 12 terms including labiaplasty, vaginoplasty, perineoplasty, laser vaginal rejuvenation, labia cosmetic surgery, vaginal cosmetic surgery, vaginal tightening, genital bleaching, hymenoplasty, clitoroplasty, labiaplasty cost, and vaginal laser were reviewed. To evaluate public attention to female genital aesthetic procedures between January 1, 2004, and January 1, 2022, three 6-year periods were compared about the abovementioned 12 terms. RESULTS: Public attention to labiaplasty and hymenoplasty was significantly higher in 2010 to 2016 than in 2004 to 2010 and 2016 to 2022. Vaginoplasty, laser vaginal rejuvenation, and labia cosmetic surgery terms were researched significantly less in 2010 to 2016 and 2016 to 2022 than in 2004 to 2010 (p = .001). Public interest in vaginal tightening and labiaplasty cost significantly increased from 2004 to 2022. Finally, the term vaginal laser was researched most between 2016 and 2022 (p = .001). CONCLUSION: This study found that public attention to labiaplasty cost and vaginal tightening continuously increased between 2004 and 2022. In addition, public interest in the term vaginal laser significantly increased after 2016. By contrast, vaginoplasty, laser vaginal rejuvenation, and labia cosmetic surgery terms were researched significantly less after 2010.

Secondary Hypertension Due to Underlying Takayasu Arteritis.

A young female patient in her early 20s of Hispanic descent presented to the hospital with new-onset chest pain and uncontrolled hypertension. She was found to have blood pressure in the 200s/100s. She was evaluated for causes of secondary hypertension and underwent computed tomography angiography (CTA) of her abdomen to rule out fibromuscular dysplasia, which showed abnormal thickening of lower thoracic and abdominal aorta extending into both renal arteries causing stenosis. This finding led to further investigations, and she was found to have elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Magnetic resonance angiography (MRA) was done, which confirmed the findings of periaortitis in the vessels as described above. A diagnosis of Takayasu arteritis (TA) was made, and the patient was treated with high-dose steroids with significant improvement in her symptoms.

Ovarian incision enhances folliculogenesis: A rat model.

AIM: To determine whether performing incision on the surface of the ovarian cortex in rats advances follicular development. METHODS: Five to seven separate superficial incisions were performed on the surface of right ovaries of 6-7-month-old albino Wistar rats. Daily 40 IU of gonadotropins were administered for 14 days. On the 15th day, both ovaries of the rats were removed. The right (incised) ovaries were compared with the contralateral ovaries in terms of ovary's weight, numbers of primordial, primary, secondary and antral follicles, their mean percentages and mean Ki-67 proliferation indices. RESULTS: A total of 22 ovaries were evaluated, with 11 right ovaries (incised) and 11 left ovaries (non-incised). The mean weight of ovaries was greater in the right ovaries than in the left ovaries; however, no statistical difference was found between them (0.77 ± 1.22 vs. 0.22 ± 0.08 gr, P = 0.159). The numbers of secondary and antral follicle were statistically higher in the right ovaries than in the left ovaries (4.4 ± 1.5 vs. 2.1 ± 1.6, P = 0.003 and 18.6 ± 8.7 vs. 11.3 ± 7.5, P = 0.046, respectively). The right ovaries also significantly differed from the left ovaries in terms of mean percentages of primordial and antral follicles (P < 0.05 for both). The mean Ki-67 proliferation index had a marginal difference between the groups (P = 0.064). CONCLUSION: Performing incisions on the surface of the ovarian cortex in rats may advance the ovarian follicular development. Future animal studies may provide more evidence regarding potential benefits of mechanical stimulation to the ovaries.

Correlation between Overactive Bladder Syndrome and Severity of Coronary Artery Disease in Postmenopausal Women.

OBJECTIVE: To analyse the correlation of overactive bladder (OAB) and severity of coronary artery disease (CAD) by using Gensini score in postmenopausal women. STUDY DESIGN: Observational correlation study design. PLACE AND DURATION OF STUDY: Haseki Training and Research Hospital, Istanbul, Turkey, from January 2016 to January 2018. METHODOLOGY: Female patients in postmenopausal status, who had undergone coronary angiography due to CAD in tertiary academic care centre cardiology unit, were enrolled in the study. The Gensini score of each patient was calculated by two different cardiologists and the average score was taken. All participants filled the OAB-V8 questionnaire (Validated Turkish form). The participants were separated into two groups according to the severity OAB symptoms. Patients with OAB-V8 score ≥8, were included into OAB Group and patients with OAB-V8 score <8, were enrolled into group 2 Non-OAB Group. Two groups were compared according to patients' demographic characteristics, Gensini scores, OAB-V8 scores, blood test outcomes, urinary system ultrasound, and uroflowmetry findings. RESULTS: One hundred and two patients with OAB ≥8 score and 71 patients with OAB <8 score were compared. The median BMI was 28.7 (27.3-32.7) kg/m2 in OAB group and 27.5 (27.0-31.1) kg/m2 in non-OAB group (p=0.150). Additionally, OAB-V8 score and Gensini score were significantly higher in OAB group, compared to non-OAB group (25.0 (15.0-28.3) vs 4.0 (3.0-5.0), p<0.001 and 32.5 (27.8-42.7) vs. 10.0 (10.0-12.0), p<0.001, respectively). In blood chemistry, LDL level was the only marker found significantly different between groups and was significantly higher in patients with OAB (120.0 (90.0-148.5) mg/dl vs 97.0 (70.0-125.0) mg/dl, p<0.001). Multivariate regression analysis revealed that Gensini score ≥ 20 was an independent risk factor for presence of OAB. Additionally, LDL level ≥100 m/dl was the only other predictive factor for presence of OAB (2.8 times). CONCLUSION: The frequency of OAB significantly correlated to severe CAD in postmenopausal women. Moreover, as an additional finding, postmenopausal women with higher LDL levels faced OAB syndrome more frequently. Key Words: Atherosclerosis, Coronary artery disease, Gensini score, Menopause, OAB-V8 form, Overactive bladder.

Healthcare information on YouTube: Pregnancy and COVID-19.

OBJECTIVE: We aimed to analyze Turkish language videos on YouTube about Coronavirus and pregnancy. METHODS: YouTube was searched for the following keywords: "Coronavirus, gebelik," "Coronavirus, Hamilelik," "COVID-19, gebelik" and "COVID-19, hamilelik". All ranking data for each video was recorded, video sources and target audiences were analyzed. Videos were designated as "informative, "misleading" "personal experience" and "news update." The usefulness of the videos were analyzed by DISCERN score and the quality of the content was calculated by MICI score. RESULTS: Seventy-six videos had a total of 1.494.860 views, with 40.849 likes and 575 dislikes. The source of information in informative videos was physicians (73%), and news agencies (20%), and the majority of these targeted patients. The DISCERN score of videos was 2.9 ± 1, 1.6 ± 0.9, and 1.9 ± 0.9 respectively for respectively for the informative group, personal experience group, and news update group. The mean MICI score for informative videos was low and calculated as 5.3 ± 2.8. CONCLUSION: YouTube videos are easily accessible sources of COVID-19 information for pregnant women. The present study demonstrated that videos about pregnancy and COVID-19 have high view rates, but are generally low in quality and trustworthiness.

Effect of the COVID-19 pandemic on female sexual behavior.

OBJECTIVE: To evaluate the effect of the COVID-19 pandemic on female sexual behavior in women in Turkey. METHODS: An observational study using data from a previous study conducted prior to the pandemic. We compared frequency of sexual intercourse, desire for pregnancy, Female Sexual Function Index (FSFI) score, contraception type, and menstrual abnormalities among women during the pandemic with 6-12 months prior to the pandemic. Participants were contacted by telephone for questioning. RESULTS: Average frequency of sexual intercourse was significantly increased during the pandemic compared with 6-12 months prior (2.4 vs 1.9, P=0.001). Before the pandemic 19 (32.7%) participants desired to become pregnant, whereas during the pandemic it had decreased to 3 (5.1%) (P=0.001). Conversely, use of contraception during the pandemic significantly decreased among participants compared with prior (24 vs 10, P=0.004). Menstrual disorders were more common during the pandemic than before (27.6% vs 12.1%, P=0.008). Participants had significantly better FSFI scores before the pandemic compared with scores during the pandemic (20.52 vs 17.56, P=0.001). CONCLUSION: Sexual desire and frequency of intercourse significantly increased during the COVID-19 pandemic, whereas quality of sexual life significantly decreased. The pandemic is associated with decreased desire for pregnancy, decreased female contraception, and increased menstrual disorders.

Association of Severity of Lower Extremity Arterial Disease and Overactive Bladder Syndrome: A Cross Sectional Study.

PURPOSE: The aim of this study aim is to clarify the relationship between Overactive bladder syndrome (OAB) and severity of lower extremity ischemia by using Fontaine classification system. MATERIALS AND METHODS: Patients who were diagnosed with lower extremity arterial disease were enrolled into the study. The Fontaine score of each patient was taken and all patients completed the validated Turkish version of OAB-V8 questionnaire. Body mass index, serum creatinine, blood urea nitrogen, cholesterol and fasting plasma glucose levels were measured. The patients were divided into two groups. Patients with OAB-V8 score above 8 were enrolled into group 1 and patients with OAB-V8 score under 8 were enrolled into group 2. RESULTS: At the end of study period, 181 patients who met the  inclusion criteria were enrolled into the study.  Patients with OAB ? 8 score (n= 79) were compared with  patients with OAB < 8 score (n= 102). The mean age and the mean BMI were significantly higher in patients with OAB ? 8 (P = .001 and P = .001, respectively). Also, HDL- cholesterol level was found significantly lower in group 1 patients  (P= .001). Multivariate regression analysis showed that presence of Fontaine score ? class 2b, age ? 60 years, BMI ? 30 kg/m2 , and HDL-cholesterol levels < 60 mg/dL were predictive factors for OAB. CONCLUSION: The present study  demonstrated that incidence of OAB is higher in patients with severe lower extremity ischemic symptoms, older age, high BMI, and lower HDL-cholesterol level.

Comparison of Flexible Ureterorenoscopy and Mini Percutaneous Nephrolithotomy in the Management of Multiple Renal Calculi in 10-30 mm Size.

PURPOSE: To evaluate the efficacy and safety of flexible ureterorenoscopy (f-URS) and mini percutaneous nephrolithotomy (mini-perc) in the management of 10-30 millimeter multiple renal stones. MATERIALS AND METHODS: The charts of patients who underwent f-URS or mini-perc for multiple kidney stones between January 2011 and July 2015 were retrospectively analyzed. Patients with multiple 10-30-mm-sized renal stones were enrolled in the study. A total of 374 patients underwent mini-perc and 85 patients met the study inclusion criteria. In the same period, f-URS was performed in 562 patients, and 163 had 10-30-mm multiple renal stones. We selected 85 patients to serve as the control group from this cohort using propensity score matching with respect to the patient's age, ASA score, number, size, and location of stones to avoid potential bias between groups. RESULTS: The mean operation time and fluoroscopy screening time (FST) was significantly longer in the mini-perc group (P = .001 and P = .001, respectively). The mean hospitalization time was 76.9±38.7 hours in the mini-perc group and 25.0±27.7 hours in the f-URS group (P = .001). Post-operative complications, according to the Clavien classification system, were significantly more frequent in the mini-perc group (P = .003). The stone-free rate was 87% in the f-URS group and 83.5% in the mini-perc group (P = .66). CONCLUSION: Our study demonstrated that f-URS and mini-perc were effective treatment options for multiple renal stones 10-30 mm in size. However, f-URS was associated with a significantly lower complication rate, shorter operation time, shorter FST, and shorter hospitalization time.

Comparison of 4.8 Fr and 6 Fr ureteral stents on stent related symptoms following ureterorenoscopy: A prospective randomized controlled trial.

The effects of ureteral stent diameters on ureteral stent-related symptoms were evaluated by using Turkish-validated Ureteral Stent Related Symptoms Questionnaire (USSQ). Datas on 126 patients underwent uncomplicated flexible ureterorenoscopy and 62 patients underwent uncomplicated semirigid ureteroscopy surgery without stent insertion (group 3) were collected. Patients were randomized preoperatively in a double-blind fashion to 4.8 French (group 1) and 6 French (group 2) ureteral JJ stents groups. The first follow-up visit was done at one week after surgery for all groups. Stents were removed on the third postoperative week for stented groups. The second follow-up visit was done at one week after stent removal for group 1 and group 2, and four week after surgery for group 3. Preoperative characteristics, operation time and hospitalization times were similar in both groups. Total USSQ scores were 91.9, 103.0, 44.2 at first visit and 54.3, 58.7, 28.5 at second visit in group 1, group 2, and group 3, respectively. At both first and second visits, the group 2 had significantly higher USSQ scores than the group 1 (p = 0.01 and p < 0.001, respectively). Group 1 and 2 had higher scores than group 3 at both visits. Ureteral stents are associated with poor effects on patients' comfort and high USSQ scores. Using 4.8 Fr JJ stents improves stent-related symptoms and decreases the USSQ score more than 6 Fr JJ stents. Therefore, if ureteral stent is to be used after URS, we recommend using 4.8 Fr stent.

A Case of Distal Vaginal Agenesis Presenting with Recurrent Urinary Tract Infection and Pyuria in a Prepubertal Girl.

BACKGROUND: Isolated distal vaginal agenesis is a rare anomaly and mostly becomes symptomatic after menarche. We describe an unusual presentation of this anomaly in a prepubertal girl. CASE: An 11-year-old prepubertal girl presented with recurrent urinary tract infection, pyuria, and right-sided renal agenesis. The findings of perineal inspection, ultrasonography, and magnetic resonance imaging were consistent with a distal vaginal agenesis with pyometrocolpos. Discharging pyometrocolpos with dissection of the atretic portion and a pull-through vaginoplasty were performed. A cystoscopy showed no sign of a vesicovaginal or uterine fistula. SUMMARY AND CONCLUSION: This rare presentation of distal vaginal agenesis reminds us that congenital malformations of the female genital tract should be considered in patients with congenital anomalies of the urinary system and/or recurrent urinary tract infection, even during the prepubertal period.

Laparoscopic Outcomes of Adnexal Surgery in Older Children and Adolescents.

STUDY OBJECTIVE: To evaluate the outcomes of laparoscopic surgery for the treatment of adnexal pathology in older children and adolescents. DESIGN: A retrospective cohort review. SETTING: A tertiary academic center in Istanbul, Turkey. PARTICIPANTS: Pediatric and adolescent patients aged between 9 and 19 years (n = 69) who underwent laparoscopic surgery for adnexal pathology from January 2005 through September 2015. The patients who were pregnant or with non-gynecologic pathology detected during surgery were excluded from the study. INTERVENTIONS: Patients were divided into 2 groups according to their age. Group 1 consisted of 31 patients aged between 9 and 16 years and group 2 included 38 patients aged between 17 and 19 years. MAIN OUTCOME MEASURES: The indication for surgery, procedures performed, anesthesia time, length of hospital stay, pathology findings, and complication rates were evaluated. RESULTS: Ovarian cystectomy and adnexal detorsion with or without cystectomy were the most frequently performed. Ovary-sparing conservative surgery was possible for all patients, except those with gonadal dysgenesis and testicular feminization (n = 6), who underwent laparoscopic gonadectomy. The most common pathologic finding was mature cystic teratoma (30.2%), followed by benign paratubal cyst, and simple cysts of the ovary. Anesthesia time was shorter in group 2 (P = .018). The procedures performed, length of hospital stay, complication rate, and pathology findings were not significantly different between the 2 groups. CONCLUSIONS: Laparoscopic surgery can be successfully performed as an efficient, safe, and well tolerated procedure for treating a wide variety of adnexal pathology among children and young adolescents without any significant variation between different age groups.

Subcutaneous nodules are associated with cardiovascular events in patients with rheumatoid arthritis: results from a large US registry.

Subcutaneous nodules are the most common conspicuous extra-articular manifestation of rheumatoid arthritis (RA). Cardiovascular disease (CVD) is the leading cause of death in patients with RA. The objective of this study is to examine the possibility of a relationship between subcutaneous nodules and "first ever" cardiovascular disease event, i.e., myocardial infarction (MI), stroke, or cardiovascular death in a large registry-cohort of patients with RA. Patient information was collected from the CORRONA registry from October 2001 to September 2011. A total of 26,042 patients with RA were studied for the presence or absence of subcutaneous nodules. Cox proportional hazards regression models were constructed to estimate the hazard ratios (HR) for CVD events in relation to subcutaneous nodules at baseline. Three statistical models were used to examine the association between subcutaneous nodules and CVD: Model A adjusted for age and sex associated risk, model B adjusted for traditional CV risk factors, and model C adjusted for factors in models A and B plus underlying RA-specific measures. The definition of primary exposure was "subcutaneous nodules at baseline." A total of 3908 patients had subcutaneous nodules at baseline. Of the 566 total composite CVD events, 138 occurred in the group that had SCN at baseline. Incidence rate-ratio values (patients with subcutaneous nodules at baseline vs. no subcutaneous nodules at baseline) for composite CVD events, MI, stroke, and cardiovascular death were 1.55, 1.65, 1.37, and 1.68, respectively. Adjusted HR values (95 % CI) for composite CVD events based on "subcutaneous nodules-status at baseline" (primary exposure) were as follows: 1.35 (1.11-1.63) for model A, 1.25 (1.03-1.52) for model B, and 1.03 (0.831-1.277) for model C. Subcutaneous nodules were associated with increased CVD events in RA. This association persisted after adjusting for age, sex, and traditional CV risk factors.

Female sexual function after transobturator tape in women with urodynamic stress urinary incontinence.

We evaluate quality of life and sexual function before and after transobturator tape procedure (TOT) using the International Consultation on Incontinence Questionnaire (ICIQ -SF) and Female Sexual Function Index (FSFI). Between 2008 and 2013, 92 patients with stress urinary incontinence (SUI) underwent TOT procedure. A total of 81 patients were sexual active and enrolled in the study. All patients completed the Turkish translation ICIQ -SF and FSFI forms before and 1, 3, 6, 12 months after surgery. To evaluate the impact of incontinence and TOT success on sexual function, we compared patients that were dry after surgery and patients still incontinent and/or facing complication. All 81 patients completed the study protocol. The total FSFI score was 21.3 ± 7.9 and statistically significant when compare with preoperative total FSFI score (16.2 ± 7.9). The mean postoperative ICIQ -SF score (2 ± 2.9) was also significantly lower than the mean preoperative ICIQ -SF score (17.3 ± 1.8). Complications were encountered in 13 patients, including vaginal erosion (4 patients), de novo urge incontinence (4 patients), vesico-vaginal fistula (1 case), cysto-rectocele (1 case) and high postoperative residue requiring mesh excision (3 patients). Continent (n = 68) patients had a significantly better postoperative total FSFI and ICIQ -SF score against patients who had urine loss. Our study found a significant improvement of FSFI score and ICIQ -SF score after TOT operation in women with SUI. Additionally, urine loss due to complications was related with worsened FSFI score and ICIQ score compare with healthy patient's scores.

Management of bladder stones associated with foreign bodies following incontinence and contraception surgery.

AIM OF THE STUDY: To investigate success of endoscopic lithotripsy for bladder stone following stress urinary incontinance surgery and contraception surgery. MATERIALS AND METHODS: Charts of patients admitted in two centers between January 2006 and March 2013 were retrospectively reviewed and seven women were enrolled in our study. Patients demographic parameters including age, main complaint(s), previous surgery type, time to diagnosis were analyzed. Also operative time, hospitalisation lenght, perioperative and postoperative complication( s) were evaluated. RESULTS: Five patients had undergone tension free vaginal tape procedure and one patient had undergone transobturator tape procedure. Median age was 62 (50-71) years. In one patient bladder stone formed around an intrauterine device. Dysuria (85%), hematuria (57%) and recurrent urinary tract infection (57%) were the main complaints. The median diagnosis time was 44.1 months. Abdominal ultrasonography and non contrast enhanced computer tomography were performed for five and two patients respectively and diagnosis was confirmed cystoscopically. Endoscopic lithotripsy using Holmium laser lithotripter or pneumatic lithotripter was used for all cases. The mean operation time was 41.2 minutes (20-70) and success was 100%. There was no intraoperative complication. Only one patient had fever higher than 38ºC postoperatively and was treated by appropriate antibiotic. The median hospitalisation time was 1.57 day. CONCLUSION: In conclusion endoscopic lithotripsy is a safe and effective approach to manage bladder stone associated with mid-urethral synthetic slings and intrauterine devices.

Results of tension-free vaginal tape for recurrent stress urinary incontinence after unsuccessful transobturator tape surgery.

AIM: The aim of this study was to evaluate cure rate and mid-term results of tension-free vaginal tape for recurrent stress urinary incontinence after failed transobturator tape surgery. MATERIAL AND METHODS: Between January 2006 and December 2011, 42 women were enrolled in this study. Patient characteristics and operating parameters were recorded, and any complications were noted. All patients were followed up for at least 24 months after the second surgery. The Incontinence Impact Questionnaire and the Urinary Distress Inventory were used to identify satisfaction level. RESULTS: The mean age of the patients was 49.07 ± 8.6 years, and median period between transobturator surgery and the tension-free vaginal tape procedure was 12.8 (range 9.2-17.8) months. The cure rate was 83.3% and 76.2% at the first- and second-year follow-up visits, respectively. Intraoperative complications were transient and slight. Bladder injury in five patients and subcutaneous hematoma above the pubis in two patients were the most serious complications, but they were managed conservatively. We found the scores of the Incontinence Impact Questionnaire and Urinary Distress Inventory to be significantly lower at follow-up, compared to the preoperative assessment. De novo urgency was the most common complaint at follow-up and occurred in 11.9% of the women. CONCLUSIONS: We suggest that tension-free vaginal tape is a feasible surgical option for recurrent stress urinary incontinence. Further studies with larger patient numbers and longer follow-up periods are needed to support this finding.

Spontaneous retroperitoneal hematoma associated with anticoagulation therapy and antiplatet therapy: two centers experiences.

BACKGROUND: To analyze the characteristics of the patients with diagnosis of spontaneous retroperitoneal hematoma associated with anticoagulation therapy and antiplatet therapy. METHODS: From January 2006 to March 2013, 9 patients (6 from Haseki Training and Research Hospital - Urology Department and 3 from Istanbul Medical Faculty - Gynecology and Obstetric Department) were included in the study. Patients charts including sex, age, comorbidities, main complaint, and medication intake were examined. Also initial hemoglobin level, initial International Normalized Ratio level, red blood cells and fresh frozen plasma units transfused were evaluated. RESULTS: Median age was 60 year-old. Abdominal pain and flank pain were common symptoms. Eight patients were taking only anticoagulation therapy, 2 only antiplatet therapy and 1 both anticoagulation and antiplatet therapy. Median initial hemoglobin value was 9,0 g/dL and median International Normalized Ratio level was 3.2 Patients were evaluated by abdominal ultrasonography or abdominal computer tomography. Seven patients were treated conservatively. Only one patient died because of septic shock with a mortality ratio of 11%. CONCLUSION: Despite benefits of anticoagulation and antiplatet theraphy these agents have serious side-affects as retroperitoneal hemorrhage in elderly patients taking multi-drug medication.

Cervical priming before diagnostic operative hysteroscopy in infertile women: a randomized, double-blind, controlled comparison of 2 vaginal misoprostol doses.

The aim of this study was to evaluate the efficacy of vaginal misoprostol for cervical priming at doses of 200 mcg and 400 mcg, 12 to 15 hours before diagnostic office hysteroscopy (OH) without anesthesia in patients with infertility. Sixty infertile patients requiring a diagnostic office hysteroscopy for investigation of infertility were included in the study. The patients were randomly allocated into 3 vaginally administered misoprostol groups: (1) control group, (2) 200-mcg dose group, and (3) 400-mcg dose group. Misoprostol significantly facilitated the procedure of OH: cervical entry was easier; procedural time was shorter; baseline cervical width was larger; and pain scoring was lower in the misoprostol groups compared with the control group. Increasing the dose of misoprostol from 200 mcg to 400 mcg did not improve the effect on cervical dilation. Misoprostol is a promising analog to use for cervical priming before OH. Since doses of 200 mcg and 400 mcg vaginal misoprostol 12 hours before the OH both have proven to be effective regimens, 200 mcg may be preferred. However, before routine clinical usage, further research is needed through large, randomized, controlled trials powered to detect a difference in complications to determine whether misoprostol reduces complications in OH.