Evaluation of the feasibility of a new method for performing chorion villus sampling.

OBJECTIVE: This study aimed to evaluate the usefulness and safety of a new method for taking a placental biopsy. METHODS: The procedures were performed using the traditional single needle technique (group 1) or the new method (group 2). In group 2, the piston was fixed in a simple metallic clip and the negative pressure was maintained in a continuous manner which was controlled with a three-way stopcock. RESULTS: Multiple uterine insertion was necessary in 14 cases (32.6%) in group 1 and five (11.9%) in group 2 (p < 0.05). The amount of chorionic tissue obtained was significantly higher in group 2 (19.1 +/- 15.0 mg vs. 33.9 +/- 17.4 mg p < 0.05). The abortion rates did not differ in either group. CONCLUSION: While using this technique, the operator is capable of performing the procedure without any assistance and of applying constant negative pressure only in the placenta. The advantageous outcomes are probably related to the size as well as the incessant fashion of the vacuum force.

Fraser syndrome.

In a consanguineous marriage, a woman at 32 weeks' pregnancy presented with intrauterine growth retardation and bilateral renal agenesis. Fraser syndrome (cryptophthalmus syndactyly syndrome) was diagnosed based on cryptophthalmos, atresia of meatus acusticus externus in auricula, syndactyly, hypoplastic larynx, hypoplastic left lung, agenesis of urinary system and aberrant pancreas in duodenum. The syndrome is inherited as a recessive trait and the risk of recurrence is 25%.

Pregnancy outcomes in young Turkish women.

STUDY OBJECTIVE: We documented adolescent pregnancies that were thought to be at high risk for increased obstetric complications. DESIGN, SETTING, PARTICIPANTS: This study covered 442 pregnant women who were under 19 years of age and who delivered in Cukurova University, School of Medicine, Department of Obstetrics and Gynecology between January 1, 1993 and December 31, 1997, retrospectively. RESULTS: The patients' mean age was 18.24 years and their mean gestational age was 38.2 weeks. The newborns' mean birthweight was 3093.05 g and their mean birth height was 45.75 cm. Apgar score in the 1st minute was 6.79 and at the 5th minute 8.37. Cesarean section rate was 28.5%. The most common causes were pregnancy-induced hypertension (PIH) and breech delivery. There were 32 stillborns and 5 early neonatal deaths. The most frequent obstetric complications were PIH (14.5%), preterm delivery (7.0%), and low birthweight (< 2000 g) (10.2%). The pregnant adolescents with obstetric problems (44.4%) had poor obstetric results. CONCLUSIONS: Adolescent pregnancies are considered high risk with many obstetric complications and poor obstetric results. To decrease the complications adolescent pregnancies must be followed-up as high risk pregnancies, especially in developing countries where socioeconomic factors are more pronounced.

Labial fusion in a pubertal girl: a case report.

An 18-year-old virgin, pubertal girl was treated for abnormal menses and dysmenorrhea. She had no history of trauma, sexual infection, or abuse. Occlusion of the introitus of the vagina had been first diagnosed 10 years earlier. The patient presented with fusion of the labia minora in the midline, posteriorly. Her physical examination, ultrasonographic laboratory examination, and intravenous pyelogram were all normal. Following surgical treatment, she had no problems at the time of postoperative follow-up.

Is it essential to perform complete paraaortic lymph node dissection if no metastases have been shown in the lower part of the aorta?

One hundred and twenty eight patients with cervical carcinoma underwent pretherapy staging laparotomy between the years 1991 and 1994. Adopting a transperitoneal approach nodal dissection was performed from the aortic bifurcation to the level of the renal artery. Specimens were segregated into those inferior to and superior to the origin of the inferior mesenteric artery (IMA) then sent for pathologic examination. Of the 15 histologically malign node samples inferior to the IMA, none were associated with neoplasia in the groups of node samples taken from above the IMA. Of the 5 malignant nodal samples taken from above the IMA, all had concurrent neoplastic changes in the specimens taken from below the IMA. An intraoperative complication rate of 8.7% was encountered in the lower nodal dissections. This was compounded by a resultant 7.7% complication rate with nodal dissection above the IMA. As a result of our findings we feel confident in omitting upper paraaortic lymph node (PALN) dissection in the absence of malignant findings in the inferior paraaortic lymph node at frozen section.

Copper, zinc, and magnesium tissue and serum levels in patients with cervical carcinoma.

Serum and cervical tissue copper (Cu), zinc (Zn) and magnesium (Mg) levels were determined by atomic absorption spectrophotometry in 65 women with cervical carcinoma and compared with levels in 30 healthy women. The patients mean serum Cu level (184.8 +/- 12.3 mugr/dl) was significantly higher than the control group (p < 0.05). However, in relation to the control group, the differences in Mg, Zn and Cu levels in cancerous tissues of patients with cervical carcinoma were not statistically significant (p > 0.05). There was also no significant difference between FIGO Stage I and IIA patients according to their serum and tissue concentrations of these trace elements. We concluded that serum and tissue copper, zinc and magnesium determinations have no use in cervical carcinoma management.

[Incidence of Mycoplasma and group B streptococci in the genitourinary system of pregnant women and their effect on pregnancy]. / Gebe kadinlarin genitoüriner sistemlerinde Mycoplasma ve B grubu streptokoklarin insidansi ile gebelige etkileri.

This study included 59 pregnant women and their mature infants born in term in order to establish the incidence of potential microorganisms that may transmit through the birth canal to infant and the evidence for vertical transmission in pregnancy. Using isolation studies based on selective methods, it was found that U.urealyticum had the highest incidence with 26 (44%) and Diphtheroid was isolated from 19 (32.2%), Staphylococcus from 17 (28.8%), M.hominis from 16 (27.1%), group B Streptococcus from 8 (13.6%) of genital canal specimens, respectively. It was also found that E.coli with a carriage rate of 6 (50%), M.hominis with 4 (25%) and Diphtheroid with 4 (21%) were transmitted through the birth canal to infant and colonized the conjunctiva and face of infant at birth.

Heterogeneity in recurrent complete hydatidiform mole: presentation of two new Turkish families with different genetic characteristics.

Subsequent pregnancy outcomes following complete hydatidiform moles (CHM) are usually favorable and the risk of a second CHM less than 2%. However, a small number of women have a rare autosomal recessive condition that predisposes them to CHM. Unlike typical CHM, that are androgenetic (AnCHM), the CHM in these women are diploid and biparental (BiCHM) with a contribution from each parent to the nuclear genome. To date most women with recurrent CHM have been found to have BiCHM and to have a wide variety of mutations in the causative gene, NLRP7. Our objectives were to genotype the molar tissue and identify the NLRP7 mutations in two unrelated Turkish women with recurrent CHM. Fluorescent microsatellite genotyping of molar tissue and screening of patient DNA for NLRP7 mutations was carried out in two women with five and four CHM respectively. The first case was confirmed to have BiCHM. In addition the patient was found to have a novel homozygous mutation in exon 8 of NLRP7. All CHM examined in the second case were AnCHM and no NLRP7 mutations were identified in DNA from the patient. This report describes a further individual with BiCHM and a novel mutation in NLRP7. A second patient with similar clinical history had no mutations in NLRP7 and is the first report of a patient with four CHM where the CHM are androgenetic. This study highlights the heterogeneity of recurrent CHM and the need to investigate women with recurrent molar pregnancies for appropriate clinical management.

A double-blind comparison of intrathecal S(+) ketamine and fentanyl combined with bupivacaine 0.5% for Caesarean delivery.

BACKGROUND: In this prospective, randomized, double-blind, controlled study, we investigated the sensory, motor and analgesic block characteristics of S(+) ketamine, fentanyl and saline given intrathecally (IT) in addition to 0.5% plain bupivacaine (10 mg) for spinal analgesia. METHODS: Ninety ASA I or II adult patients undergoing Caesarean section were randomly allocated to receive 1.0 mL of 0.9% saline in Group S (n = 30), 0.05 mg kg-1 of S(+) ketamine (1.0 mL) in Group K (n =30) or 25 microg (1.0 mL) of fentanyl in Group F (n =30) following 10 mg of plain bupivacaine 0.5% IT. We recorded onset and duration of sensory and motor block, time to reach the maximal dermatomal level of sensory block and duration of spinal analgesia. RESULTS: The onset time of sensory and motor block was significantly shorter in Groups K and F than in Group S (P < 0.014). Their duration was significantly longer in Group F than in Groups K and S (P < 0.009). The time to reach the maximal dermatomal level of sensory block was significantly shorter in Groups K and F than in Group S (P < 0.001). The duration of spinal analgesia was significantly longer in Group F than in Groups K and S (P < 0.001). CONCLUSION: In patients undergoing Caesarean section with spinal analgesia, the addition of S(+) ketamine (0.05 mg kg-1) IT to 10 mg of spinal plain bupivacaine (0.5%) led to rapid onset of both sensory and motor blockade and enhanced the segmental spread of spinal block without prolonging the duration of spinal analgesia, whereas fentanyl provided prolonged analgesia.

Clinical and mycological efficacy of single-day oral treatment with itraconazole (400 mg) in acute vulvovaginal candidosis.

This study aimed to investigate the effectiveness of single-day oral treatment with itraconazole in acute vulvovaginal candidosis (VVC). Vaginitis was demonstrated by both detection of yeast cells and pseudohyphae formation on microscopic examination of vaginal discharge and mycological culture as well as by the clinical signs and symptoms. Clinical and mycological examinations of the 52 patients were performed before, 1 week (short-term) and 4 weeks (long-term) after single-day oral treatment with itraconazole 200 mg b.i.d. The causative yeast fungi were: Candida albicans (76.9%), C. glabrata (9.6%), C. kefyr (9.6%) and C. krusei (3.9%), respectively. In short- and long-term examinations, clinical cure rates were found to be 61.5% and 90.4%, and mycological cure rates were 63.5% and 90.4%, respectively. Itraconazole was found to be 95.0% effective with C. albicans and 75.0% with other Candida species. It is concluded that treatment of acute VVC with itraconazole is safe and effective in the long-term.

Do parental smoking and history of allergy influence cord-serum IgE?

The associations between parental smoking habits during pregnancy, family history of allergy, and IgE levels in cord-serum IgE (cIgE) were investigated prospectively in 1251 infants. Mean cIgE levels were similar in infants with positive and negative family history of allergy (0.50 and 0.54 kU/l, respectively). In infants with a positive family history of allergy whose mothers smoked more than 10 cigarettes a day, however, the mean cIgE level was significantly higher (0.78 kU/l) than that in infants of nonsmoking mothers (p = 0.011). Similarly, the mean cIgE level was significantly higher in boys (0.61 kU/l) than in girls (0.51 kU/l) of nonsmoking parents (p = 0.03). However, in infants of smoking parents, there was no significant difference in the mean cIgE level between boys and girls. A total of 178 (14%) mothers and 477 (38%) fathers were current smokers, and in 128 (10%) cases, both parents were active smokers. The mean cIgE level tended to be slightly higher in infants of smoking mothers, especially when the mother consumed more than 10 cigarettes a day (0.63 vs 0.54 kU/l) (p > 0.05). Thus, cIgE levels were higher only in genetically prone babies whose mothers consumed more than 10 cigarettes a day.