İnfertil kadınlarda antichlamydial IgG antikoru araştırılması ve infertilitedeki yeri

Konya bölgesinde infertil kadınlarda Chlamydia trachomatis enfeksiyonu sonucu oluşan spesifik antichlamydial IgG'lerin pre- valansı araştırıldı. Kontrol grubunu Konya Devlet Hastanesi Doğumevi'nde yeni doğum yapmış anneler oluşturdu. Spesifik antikorların varlığı, Selçuk Üniversitesi Tıp Fakültesi Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı İmmünoloji Laboratuvarı'nda ELISA yöntemi ile araştırıldı. Serumlarında çalışılan toplam 84 kadının 42'si infertil has ta, 42'si normal kontrol grubu olup, yaş ortalaması 30 idi. Kon trol grubunda antichlamydial antikor negatif iken, infertil grupta %12 oramnda idi. Pozitiflik en çok (4/31) 18-30 yaş grubunda bulundu. Literatür verileri ile karşılaştırıldığında sonuçların biraz düşük olması sexuel aktivitede toplumun sınırlamalarına ve çalışılan hasta grubu sayısının az olmasına bağlı olabileceği düşünüldü

The Investigation of Chlamydia Antigen and the Antimicrobial Susceptibilities of Mycoplasma and Ureaplasma from the Cervical Swap Specimens of Infertile Women

Mycoplasma, Ureaplasma and Chlamydia may cause asymptomatic infections. It is thought that these organisms might be responsible for infertility. The objective of this study is to evaluate presence of the Chlamydia antigen and the antibiotic susceptibility of Mycoplasma and Ureaplasma which were defined. Cervical swap specimens were obtained from 38 patients who applied for infertility and aged between 20 and 40. Specimens were studied for Chlamydia antigens by using Clearview Chlamydia MF (Unipath, Bedford, England) kits and for Mycoplasma and Ureaplasma by using Mycofast Screening Evolution 2 (International Microbio, Signes, France) kits. Mycoplasma was not isolated from any of the patients but Ureaplasma was isolated from 14 patients. All of these Ureaplasma isolates were resistant to lincomycine and trimethoprim-sulfamethoxazole. It was defined all isolates were sensitive to doxycycline and roxithromycin. Chlamydia antigens were not positive in infertile patients. Investigation of presence of Ureaplasma and usage of sensitive antibiotics in infertile patients will be useful for the treatment of these patient groups

Sezaryen Sonras� Kesi Yeri Enfeksiyonunu ÖNlemek İçIn Ciltalt� Rifamisin Sv Uygulanmas�.

Aim: The aim of this study was to compare the effect of Rifamycin SV application to subcutaneous tissue for prevention of post-caesarean wound infection with a traditional method used for preoperative antisepsis of skin; povidone-iodine and also to calculate cost of the treatment. Method: In this randomized prospective study, 1272 women were divided into two groups. Povidone-iodine was used for preoperative antisepsis and after closure of the skin in the first group. In the second group povidone-iodine was used in the same way but also subcutaneous tissue was irrigated with Rifamycin SV before closure of subcutaneous tissue. Result: Surgical site infection (SSI) was developed in 12 of 600 patients in the first group. All of them were superficial incisional SSI. In 2 cases wound was opened up to fascia. The overall rate of wound infection with pus was 2%. Total cost of 12 patients with SSI was $5386.In the 2nd group, SSI wasn’t develop in any of the 596 patients. Total cost of the rifamycin SV used for washing of subcutaneous tissue was$876.12. Conclusion: Rifamycin SV application to subcutaneous tissue during cesarian effectively prevents SSI. It decreases both cost and morbidity caused by wound infection.Amaç: Bu çalışmada sezeryan sonrası kesi yeri enfeksiyonunu önlemede Rifamisin SV ile geleneksel bir antisepsi yöntemi olan povidon iyotun cilt altı uygulamalarının etkinliklerinin ve tedavi maliyetlerinin kıyaslanması amaçlandı. Metod: Bu randomize prospektif çalışmada 1272 kadın iki gruba ayrıldı. Birinci gruptaki hastalara preoperatif ve postoperatif kesi yerine povidon iyot uygulandı. İkinci gruptaki hastalara ise povidon iyot antisepsisine ek olarak cilt kapılmadan önce cilt altına Rifamisin SV uygulandı. Bulgular: Birinci grupta 12/600 hastada kesi yeri enfeksiyonu saptandı. Bu enfeksiyonların tamamı yüzeyel enfeksiyondu. İki hastada cilt altı fasiaya kadar açıldı. Pürülan kesi yeri enfeksiyonu oranı %2 olarak tesbit edildi. 12 hastanın tedavi maliyeti 5386 dolar olarak hesaplandı. İkinci gruptaki 596 hastanın hiçbirinde kesi yeri enfeksiyonu gelişmedi. Cilt altı yıkamasında kullanılan Rifamisin SV nin toplam maliyeti ise 876.12 dolar olarak hesaplandı. Sonuç: Sezeryan sırasında cilt altına Rifamisin SV uygulanması kesi yeri enfeksiyonunu önlemektedir. Bu uygulama hem tedavi maliyetini hemde kesi yeri enfeksiyonuna bağlı morbiditeyi azaltmaktadır

Hysteroscopic Outcomes in Our Clinic: 5 Years Experience

OBJECTIVE: The documentation of outcomes of hysteroscopic procedures carried out at Selcuk University, Meram Medicine Faculty, Obstetrics and Gynecology Department in 2002–2006 years. STUDY DESIGN: 248 patients that have undergone hysteroscopy were included into the study. Operative indications and results were detected retrospectively. RESULTS: There were 94 primary infertile patients, in 17 of these polypectomy, in 8 patients diagnostic hysteroscopy together with laparoscopy, in 47 patients uterine septum resection and in 22 patients hysteroscopic synechiolysis for Asherman’s syndrome were carried out. There were 118 secondary infertile patients who had hysteroscopy for diagnostic purposes together with laparoscopy in 15 patients, for septum resection in 40 patients who had uterine anomaly, for habitual miscarriages in 25 patients, for polypectomy in 18 patients, for synechiolysis in 20 Asherman’s syndrome patients. There were 7 patients with dysfunctional uterine bleeding and hysteroscopic endometrial ablation was performed for these patients. In 9 patients hysteroscopy was done to take out ectopic intrauterine device. In 8 patients hysteroscopic polyp extirpation and in 12 patients hysteroscopic sub-mucosal myomectomy was performed. Among 248 hysteroscopic procedure, 8 cases were complicated with uterine rupture, there were no other major complications related to procedure, so our complication rate was 3.2%. CONCLUSION: Hysteroscopic procedures can be carried out for several indications and do not have frequent severe complication risks. The mostly seen complication is uterine rupture. In our series we have detected only 8 uterine rupture (3.2%)

How To Manage Intrauterine Growth Restriction Associated With Severe Preeclampsia At 28-34 Weeks Of Gestation?

Aim: To propose optimal management of intrauterine growth restriction (IUGR) cases associated with severe preeclampsia at 28-34 weeks of gestation. Methods: Two hundred pregnant women with severe preeclampsia associated with growth restricted fetuses were followed with doppler velocimetry of umbilical artery between 28-34 weeks of pregnancy. Patients were grouped according to indications for termination of pregnancy, first group consisted of severely affected doppler velocity waveforms (n:100) and the second group consisted of those whose cardiotocography and biophysic profile were unfavorable (n:100). Groups were compared according to perinatal outcomes (cesarean rates, gestational age at delivery, birth weight, Apgar scores and demand for intubation and perinatal deaths). Results: The diagnosis to delivery interval is significantly higher in the second group (p<0.05), whereas there was no significant difference between groups regarding gestational age at delivery and parity (p>0.05). Apgar scores were lower in the first group (p<0.05), and there was increased demand for intubation. Perinatal deaths were also lower in the second group (p<0.05). Cesarean rate was significantly lower compared with first group (p<0.05). Conclusion: Assessment of doppler velocimetry alone may not be enough at decision for termination of pregnancy, biophysic profile and cardiotocography should be added to confirm exact time for delivery of a premature fetus and to improve perinatal outcomes

Struma Ovarii, A Rare Form of Ovarian Tumor: Clinical Analysis of 6 Cases

OBJECTIVE: In this study, the analysis of clinical, epidemiological and biological features of 6 patients who had the diagnosis of struma ovarii postoperatively was presented. STUDY DESIGN: This study consists of 6 patients who admitted to Selcuk University, Faculty of Meram Medicine, Department of Obstetrics and Gynecology with several complaints and who were operated for pelvic mass and diagnosed as struma ovarii postoperatively. RESULTS: The mean age of patients was 52.5±8.38 years (41-63). 4 patients (66.7%) admitted with pelvic and abdominal pain. All patients had unilateral form of struma ovarii. Thyroid function tests and CA 125 levels were detected to be normal in examined patients. 2 patients did not have preoperative thyroid function tests. None of these patients had symptoms of thyrotoxicosis. Regarding surgical procedures, 1 patients (16.7%) had ovarian cystectomy, and 5 patients (83.3%) had total abdominal hysterectomy together with bilateral salphingooferectomy. CONCLUSION: Struma ovarii is a medical rarity and preoperative diagnosis is generally impossible. The diagnosis was confirmed only by pathologic findings. Clinicians should be aware of this diagnosis and include it in the differential diagnosis when a patient presents with signs and symptoms of ovarian malignancy

Management of Amniocentesis in High Risk Pregnancies and The Evaluation of the Results

OBJECTIVE: To evaluate amniocentesis results applied to high risk pregnancies in our clinic. STUDY DESIGN: In this study, we have perf ormed amniocentesis in 16th-24th weeks of 447 pregnancies who had previous history of chromosomally abnormal fetus, high risk in triple test screening, in which abnomal fetus was seen in ultrasonography, high maternal anxiety, and maternal age 35 years old and above. Cytogenetic analyses were applied to all specimens. RESULTS: Appropriate amount of amniotic fluid was obtained by 98.65%, the successful culture rate was 97.31%, cardocentesis was applied to only one case of 12 cases in which no prolif eration was detected in culture The cordocentesis result was 47XX+18. According to cytogenetic evaluation results, chromosomal abnormality was detected in 29 cases (6.65%). In 7 patients Trisomy 21, in 3 cases Trisomy 18, in one case Trisomy 13, in 3 cases triploidy (69,XXX), in one case mosaicism (46XY/47XYY), in 5 cases translocation, in 9 cases inversion type chromosomal abnormality was detected. After 447 amniocentesis, 5 (1.11%) fetal losses developed. In 2 cases the leakage of amniotic fluid, in one case premature rupture of membranes, in one case cramps and vaginal bleeding and in only one case spontaneous abortus was detected. When the maternal educational level of the cases were evaluated, it was f ound that about one half of the cases had high level education. CONCLUSIONS: If amniocentesis is carried out by highly skilled physicians and if optimal culture conditions are available, amniocentesis is avaluable invasive prenatal diagnosis method with high accuracy and safety, with minimal complications

Preventive effect of doxycycline sponge against bisphosphonate-related osteonecrosis of the jaws: an animal study

The aim of this study is to investigate the effect of doxycycline collagen sponge on bisphosphonate-related osteonecrosis of the jaw (BRONJ) and the level of serum biomarkers as an indicator of osteonecrosis. Twenty-four rats were divided into four groups. Animals in the control group were injected with saline and animals in Groups I, II and III were injected with zoledronate three times a week for eight weeks. After eight weeks, the following procedures were performed in each group. In Group I: extraction of maxillary first molar, in Group II: extraction of maxillary first molar and mucoperiosteal coverage was performed and in Group III: extraction of maxillary first molar and mucoperiosteal coverage with doxycycline collagen sponges was performed. At the end of 16 weeks, all animals were sacrificed. Serum collagen type I C-telopeptide (CTx), tartrate-resistant acid phosphatase (TRACP 5b) and alkaline phosphatase (ALP) levels’ analysis, clinical examination, histological and histomorphometrical analysis were performed. As a result no significant difference in CTx, TRACP 5b and ALP levels was observed between groups. Complete mucosal healing was observed in all animals in the control group and 66.7% of animals in Group III. The necrotic bone area in Group III was significantly lower than the other groups (p < 0.01). Statistically significant difference was observed between groups in terms of detached osteoclast number (p < 0.01). In conclusion, local application of doxycycline could have a positive effect in reducing the risk of BRONJ in rats