Oksipital Ensefalosel

Encephalocele is a neural tube defect characterized by sac-like protrusions of the brain and the covering membranes through an opening in the skull. Encephalocele is less common than other neural tube defects. In this case we presented a 21 years old 20 weeks pregnant woman with fetal occipital encephalocele accompanying lemon sign, normal posterior fossa imaging and normal level of maternal serum alpha-fetoprotein (MSAFP).Ensefalosel beyin dokusunun kafa tasındaki bir açıklıktan dışarıya çıkmasıdır. Ensefalosel diğer nöral tüp defektlerine kıyasla daha az yaygındır. Bizim vakada ultrason görüntelemesinde oksipital ensefalosele eşlik eden limon belirtisi ve normal bir posterior fossa izlenmekle birlikte, normal düzeyde maternal serum alfafetoproteini (MSAFP) olan 21 yaşındaki 20 haftalık gebe sunulmaktadır

The effects of spermiogram parameters, hormone profile, endometrial thickness and other factors on pregnancy rates in infertile patients who underwent intrauterine insemination

Tıpta Uzmanlık TeziBu çalışmada 04 Ocak 2012 – 30 Aralık 2014 tarihleri arası Trakya Üniversitesi Tıp Fakültesi İnfertilite Polikliniği'ne başvuran ve ovulasyonun hormonal stimulasyonu ile birlikte intrauterin inseminasyon yapılan infertil hastalarda spermiogram, hormon profili, antral follikül sayısı, hCG uygulanan gün bakılan folikül (çap>10mm) sayısı ve endometrial kalınlık ölçümü ve diğer faktörlerin klinik gebelik oranına olan etkisini retrospektif olarak araştırmayı amaçladık. Toplam 201 olguya uygulanan 307 ovulasyon indüksiyonu ile birlikte uygulanan intrauterin inseminasyon sonucunda 55 klinik gebelik elde edildi. Olgu başına gebelik oranı % 28 ; siklus başına gebelik oranı % 18,1 olarak izlendi. Bu gebeliklerin 3 tanesi ikiz diğerleri tekil gebeliklerdi. İkiz gebeliklerde kullanılan ovulasyon indüksiyon ajanı gonadotropin olarak izlendi. Toplam 55 klinik gebeliğin 37 tanesinin birinci siklus sonrası, 9 tanesinin ikinci siklus sonrası, 7 tanesinin üçüncü siklus sonrası, kalan iki tanesinin ise 4 ve 5. sikluslarda elde edildiği belirlendi. Hastaların karakteristik özelliklerinden hasta yaşının, vücut kitle indeksinin, infertilite süresinin, infertilite nedeninin, menstrüasyonun üçüncü günü FSH, LH, E2 değerlerinin, toplam antral folikül sayısının, hCG uygulanan gün bakılan endometrial kalınlık değerinin ve Kruger katı ölçümüne göre bakılmış sperm morfolojisinin klinik gebelik elde edilemeyen hastalarla klinik gebelik elde edilen hastalar arasındaki farkları araştırıldı ve bu değerler açısından istatistiksel olarak anlamlı fark saptanmadı. Çalışmamızda gebe kalanlar ile kalamayanlar arasında yalnızca üç parametre anlamlı olarak farklı çıktı. Bunlar hCG uygulandığı gün bakılan folikül (çapı >10mm) sayısı, insemine edilen total motil sperm sayısı ve ovulasyon indüksiyonu protokolüydü (Klomifen sitrata karşı gonadotropin). Bu faktörler ile regresyon analizi yapıldığında anlamlı çıkan üç parametreden iki tanesinin [hCG uygulanan gün bakılan folikül (çap >10mm) sayısı ve insemine edilen total motil sperm sayısı] gebeliği bağımsız olarak belirlediği saptandı (sırasıyla p: 10mm) count and endometrial thickness on the day of hCG administration and other factors on pregnancy rates in infertile patients who were referred to Trakya University, Faculty of Medicine Infertility Clinic between 04.01.2012 and 30.12.2014 and underwent intrauterine insemination with ovulation induction. We studied a total of 307 cycles in 201 cases and observed 55 clinical pregnancies. The pregnancy rate per patient and cycle were %28 and %18,1 respectively. Among these clinical pregnancies three of them were twins and it was observed that gonadotropins were used as ovulation induction agent in these patients with multiple pregnancies. Among these 55 clinical pregnancies, 37 of them were obtained after first cycle, 9 of them after second cycle, 7 of them after third cycle and the rest 2 of them were obtained after fourth and fifth cycles. Among patients' characteristic features; patient age, body mass index, duration of infertility, type of infertility, FSH, LH, E2 levels on third day of menstruation, total antral follicle count, endometrial thickness value on the day of hCG administration and sperm morphology value according to Kruger Strict Criteria were evaluated between the patients with and without clinical pregnancy and no significant differences were observed. Between patients with and without clinical pregnancy we observed three factors showing significant difference which were follicle (diameter > 10mm) count on the day of hCG administration, inseminated total motile sperm count and ovulation induction protocol (Clomiphene Citrate vs. Gonadotropins). When regression analyses was done only two of these three factors (follicle (diameter > 10mm) count on the day of hCG administration and inseminated total motile sperm count) were found to have effect on pregnancy rate independently (p:<0,001 and p:0,01 respectively). As a result, intrauterin insemination is a method which should be attempted in appropriate cases that have an acceptable success rate. We suppose that there is a need for more studies to get ultimate results considering the few number of cases we have evaluated

Occipital Encephalocele

Encephalocele is a neural tube defect characterized by sac-like protrusions of the brain and the covering membranes through an opening in the skull. Encephalocele is less common than other neural tube defects. In this case we presented a 21 years old 20 weeks pregnant woman with fetal occipital encephalocele accompanying lemon sign, normal posterior fossa imaging and normal level of maternal serum alpha-fetoprotein (MSAFP)

Unilateral Ovarian Leiomyoma in a 14-year-old Adolescent: A rare case report

Leiomyomas are benign mesenchymal tumors mostly seen in uterus. Uterin leiomyomas are one of the most common reasons of pelvic masses seen in women whereas ovarian leiomyomas are so rare that among all benign ovarian tumours it accounts only 0,5-1 %. It’s mostly seen between ages of 20-65 which premenopausal women consist %85 of them. In this case we wanted to present a 14 years old girl who was admitted to our clinic with a 6 months history of lower quadrant abdominal pain. In the ultrasonographic evaluation, there was a solid mass with uterin echogenity extending from posterior of uterus towards left adnexia with diameters of 6 cm x 5,5 cm. The origin of the tumor was unknown and could not be revealed with ultrasonography nor MRI until diagnostic laparoscopy was performed. Ovarian tumor was removed and the final pathology was compatible with leiomyoma. When we checked the literature there were only 5 cases of ovarian leiomyoma reported under age of 20 and mostly they had bilateral character. The youngest age reported was 13. Our case is the second youngest of all reported cases and it shows a unilateral character. The other important aspect of our case is that sometimes the imaging techniques can’t be adequate for detecting the origin of tumor

14 yaşında bir adölesanda unilateral ovaryen leiomyom: Nadir bir olgu sunumu

Leiomyomlar sıklıkla uterusta rastlanan benin mezenkimal tümörlerdir. Uterin leiomyomlar kadınlarda görülen pelvik kitlelerin en sık nedenlerinden olsa da, over kaynaklı leiomyomlar oldukça nadir görülmekle birlikte bütün over kaynaklı benin tümörlerin yalnızca %0,5 ila %1'ini oluşturmaktadır. Genellikle 20-65 yaş grubunda görülmekte olup, %85'ini premenopozal dönemdeki kadınlar oluşturmaktadır. Bu olguda kliniğimize 6 aydır devam eden bilateral alt kadran karın ağrısı nedeniyle başvuran 14 yaşındaki bir kız çocuğunu sunduk. Ultrasonografik görüntülemede uterus arka duvar komşuluğundan sağ adneksiyal bölgeye uzanım gösteren, uterin ekojenitesi olan solid görünümde 6x5,5 cm boyutlarında bir kitle izlendi. Kitlenin kaynağının ultrason ve magnetik rezonans görüntüleme ile net belirlenememesi üzerine tanısal laparoskopi uygulandı. Sol over kaynaklı kitle laparotomi ile çıkarılıp patolojiye gönderildiğinde patoloji sonucu ovaryen leiomyom ile uyumlu çıktı. Bildirilen vakalar içinde 14 yaşında olarak en genç vakalardan biri olma özelliği yanı sıra 20 yaş altı olup, genelde rastlanandan farklı olarak unilateral karakter taşıması ile farklılık göstermektedir.Leiomyomas are benign mesenchymal tumors mostly seen in the uterus. Uterine leiomyomas are one of the most common reasons of pelvic masses seen in women whereas ovarian leiomyomas are so rare that among all benign ovarian tumors, it accounts only 0.51%. It is mostly seen between ages of 20 to 65 years which premenopausal women consist almost 85% of them. In this case, we aimed to present a 14-year-old girl who was admitted to our clinic with a six months history of bilateral lower quadrant abdominal pain. In ultrasonographic evaluation, there was a solid mass with uterine echogenity extending from the posterior side of the uterus towards to the right adnexial area with diameters of 6 cm x 5.5 cm. The origin of the tumor could not be evaluated with ultrasonography and magnetic resonance imaging. Therefore, diagnostic laparoscopy with an intention to excise was performed. The tumor arising from the left ovary was removed with laparotomy and the final pathology was compatible with ovarian leiomyoma. When we checked the literature our case is one of the youngest of all reported cases that was 14 years old and with unilateral feature differently from the most of the other published cases under age of 20

Cannabidiol as a potential novel treatment for endometriosis by its anti-inflammatory and anti-oxidative effects in an experimental rat model

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Cannabidiol as a potential novel treatment for endometriosis by its anti-inflammatory, antioxidative and antiangiogenic effects in an experimental rat model

Research question: Can cannabidiol (CBD) be used in the treatment of endometriosis for its anti-inflammatory, antioxidative and antiangiogenic effects? Design: Endometrial implants were surgically induced in 36 female Wistar albino rats. After confirmation of endometriotic foci, the rats were randomized into four groups. In the leuprolide acetate group, rats were given a single 1 mg/kg s.c. leuprolide acetate injection. The other groups were 5 mg/kg CBD (CBD5), saline solution and 20 mg/kg CBD (CBD20); daily i.p. injections were administered for 7 days. After 21 days, the rats were euthanised, and total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-a) measurements in blood and peritoneal fluid samples, and immunohistochemical staining for TNF-a, IL-6 and vascular endothelial growth factor (VEGF) of endometriotic tissues were evaluated. Results: Significant reductions in the endometriotic implant surface area (P = 0.0213), serum TOS (P = 0.0491), OSI (P = 0.0056), IL-6 (P = 0.0236), TNF-a (P = 0.0083) and peritoneal fluid OSI (P = 0.0401), IL-6 (P = 0.0205) and TNF-a (P = 0.0045) concentrations were observed in the CBD5 group when compared with the saline solution group. Compared with the saline solution group, increased TAS concentrations in serum (P = 0.0012) and peritoneal fluid (P = 0.0145) were found in the CBD5 group. The CBD5 and leuprolide acetate groups were similar regarding inflammatory and oxidative stress parameters of serum and peritoneal fluid samples. The CBD5 group showed significantly lower mean intensity in both surface epithelium and stromal cells for VEGF (both P = 0.002) and only in surface epithelium cells for IL-6 (P = 0.0108), when compared with the leuprolide acetate group. Conclusion: Due to its anti-inflammatory, antioxidative and antiangiogenic effects, CBD might be a therapeutic agent candidate for endometriosis.Department of Biostatistics ; Reakiro Company ; Bezmialem Vakif Universit