Adenomyotic cyst of the uterus associated with pelvic pain: A case report

Adenomyotic cysts of the uterus are extremely rare and this case report is to document an adenomyotic cyst of the uterus associated with pelvic pain. A 27-year old nulliparous patient admitted to the hospital with the complaint of dysmenorrhea, dyspareunia and pain in the right pelvic region for the last 3 months. Transvaginal ultrasonographic examination revealed a 50 × 36 mm intramural cystic lesion on the right region of the corpus uteri. Hysteroscopic examination showed that it did not deteriorate the endometrial cavity. During laparatomy dissection of the uterine wall revealed 5 cm cystic lesion that was excised circumferentially protecting the surrounding myometrial tissue. The definitive pathology report came out as adenomyotic tissue. Imaging techniques are critical in differential diagnosis of adenomyotic cysts and to choose the appropriate intervention. Medical therapy or surgical intervention like excision of the cyst or hysterectomy may be the choices of treatment. J Clin Exp Invest 2014; 5 (1): 100-10

Can transvaginal ultrasonographic evaluation of the endocervical glandular area predict preterm labor among patients who received tocolytic therapy for threatened labor: a cross-sectional study

Objective: Increased neonatal morbidity and mortality rates resulting from preterm delivery(PTD) remain as a problem despite increasing evidence about the physiology of uterinecontractility process. More predictive signs of preterm labor detected on prenatal ultrasonographylike the presence of cervical gland area (CGA) on transvaginal ultrasonography can bea reassuring finding among patients with threatened labor risk.Methods: In this prospective study, 85 pregnant patients at 24–34 weeks of gestation whoattended to our high risk pregnancy clinic for threatened labor between March 2011 and March2012 have been examined by transvaginal ultrasonography to evaluate CGA located around theendocervical canal. Following discharge, the gestational week at birth, birth weight and birthroute of patients have been recorded.Results: Among patients with a cervical length (CL) 530mm and 30mm measuredby transvaginal ultrasonography on admission, 82.4% of the patients with a short cervixexhibiting echolucent endocervical glandular area and 42.3% of the patients with short cervixexhibiting echogen endocervical glandular area on sonography delivered at term (p¼0.013).Conclusion: The presence of CGA detected on transvaginal ultrasonography especially whencombined with the evaluation of CL during the management of patients with threatenedlabor can be a reassuring sign for actual probability of PTD

Elli beş yaşındaki bir kadında ki-67 ekspresyonu olmamasının düşük malign potansiyeli yansıttığı muhtemel olarak wolffian kaynaklı dişi adneksial tümör

Female adnexial tumors of probable Wolffian origin (FATWO) are rare tumors derived from the remnants of the mesonephric duct. These tumors generally exhibit a low malignant potential, but recurrence and or metastasis is possible during the course of the disease according to the tumors’ possible malignant potential. We report a case of FATWO without estrogen and progesterone receptors and with negative immunostaining for Ki-67 (a proliferation marker) as a probable low-malignant-potential tumor. A 55-year-old woman presented with a complaint of heavy menstrual bleeding and pelvic pain. Preoperative ultrasonographic evaluation revealed an intramural uterine leiomyoma of 4 cm in diameter and a right adnexial solid mass measuring 5 cm in diameter. Following total abdominal hysterectomy and bilateral salpingo-oophorectomy, immunostaining based on the labeled streptavidin-biotin method was performed on sections from representative blocks of paraffin-embedded tissues sampled from the mass, revealing a low mitotic index with negative Ki-67 immunostaining. Immunohistochemical staining with promising new markers and pathological investigation of the entire tumor are needed to determine the malignant behavior of an individual FATWO. Ki-67 is a helpful marker for determining Wolffian duct tumors’ potential malignant behavior

Is there an association between liver type fatty acid binding protein and severity of preeclampsia?

Objective The aim of this study was to estimate the level of liver fatty acid binding protein (LFABP) in women with preeclampsia. Method A case–control study was conducted in 90 pregnant women who were divided into the following three groups: normal pregnancy (n = 30), mild–moderate preeclampsia (n = 30), and severe preeclampsia (n = 30). Maternal blood samples were obtained during an antenatal clinic visit in normal pregnant women, and at the time of diagnosis in women with preeclampsia. Serum LFABP levels were measured by the quantitative sandwich enzyme immunoassay technique. Results Serum LFABP level was significantly higher in severe and mild–moderate preeclampsia groups than normal pregnancy group (1,709.90 ± 94.82, 1,614.93 ± 118.22, and 1,532.36 ± 140.98 pg/ml, respectively; p\0.001). In multivariate analysis, the severity of preeclampsia was correlated with LFABP level [unadjusted odds ratio (95 % confidence interval), 1.008 (1.003–1.012), p\0.001 and LDH 1.063 (1.029–1.099), p\0.001]. Conclusion Maternal serum LFABP level appears to be correlated with the severity of the preeclampsia and can be used to confirm the diagnosis

Maternal demir eksikliği anemisinin derecesi ile f etal neonatal hipoksemi arasındaki ilişki: Kesitsel bir çalışma

Amaç. Maternal kronik demir eksikliği anemisinin preterm eylem, düşük doğum ağırlığı ve intrauterin gelişme geriliği ile ilişkili olduğu bulunmuştur. Maternal aneminin doğum sırasında transplasental fetal oksijenizasyonu üzerine olumsuz etkileri henüz çalışılmış değildir. Yöntem. Spontan doğum eylemi başlayan, hemoglobin değeri 9,5gr/dL altında olan 16sı anemik toplam 32 term gebe çalışmaya dahil edilmiştir. Doğumdan hemen sonra arteriyel kord kanı örnekleri toplanmıştır. Neonatal Apgar skorları, doğum ağırlıkları ve umbilikal kord pH, PaO2, PaCO2, O2 saturasyonu ve HCO3 değerleri kaydedilmiştir. Bulgular. Anemik ve anemik olmayan hastaların ortalama hemoglobin değerleri sırasıyla 7,69±1,14gr/dL ve 10,5±0,67gr/dLdir. Anemik olmayan hastaların neonatal kord kanı PaO2 ve O2 satürasyonu değerleri anemik hastalardan anlamlı derecede daha yüksek bulunmuştur (PaO2 için 84,3 vs. 41,3mmHg ve O2 satürasyonu için %69,5 vs. %42,6 , sırasıyla). Anemik ve anemik olmayan hastaların kord kanı PaCO2, pH ve HCO3 değerleri arasında fark bulunamamıştır. Sonuç. Her ne kadar, 9,5gr/dLnin altındaki üçüncü trimester maternal hemoglobin seviyesi neonatal kord kanı PaO2 ve O2 satürasyonunda azalmaya sebep olsa da, ciddi anemi dışında genel olarak neonatal hipoksemiye yol açmaz. Maternal demir eksikliği anemisinin fetüsün transplasental oksij en transportu ve neonatal asit-baz dengesi üzerine muhtemel etkileri, neonatal hipokseminin yenidoğanın fizyolojik durumuna uzun ve kısa dönemli klinik etkilerinin araştırıldığı çalışmalarla açıklığa kavuşturulmalıdır.Aim. Chronic maternal iron deficiency anemia has been found to be related with preterm delivery, low birth weight and intrauterine growth retardation. The potential detrimental effects of maternal anemia on the transplacental fetal oxygen extraction during labor have not been investigated yet. Method. Upon the spontaneous initiation of delivery among 32 term pregnant women, half of them with hemoglobin values lower than 9.5gr/dL as anemic group, have been included to the study. Arterial cord blood samples have been collected immediately after delivery. Neonatal Apgar scores, birth weight and cord blood analysis of pH, PaO2, PaCO2, O2 saturation and HCO3 have been recorded. Results. The mean hemoglobin levels of the anemic and non-anemic patients were 7.69±1.14 gr/dL and 10.5 ±0.67gr/dL respectively. Neonatal cord blood PaO2 and O2 saturation of the non-anemic patients were significantly higher than anemic patients (84.3 vs. 41.3 mmHg for PaO2 and 69.5% vs. 42.6% for O2 saturation respectively). No significant difference in cord blood PaCO2, pH and HCO3 levels were found between anemic and non anemic ones. Conclusion. Although third trimester maternal iron deficiency anemia decreases neonatal cord blood PaO2 and O2 saturation levels; apart from severe ones, it does not result in neonatal hypoxemia generally. The possible effects of maternal iron deficiency anemia that can deteriorate transplacental oxygen transport to the fetus and neonatal acid-base status of the newborn should be clarified by further studies based on the short and long term clinical results of neonatal hypoxemia in the newborn s physiological state

Sociodemographic Findings in an Infertile Male Population

OBJECTIVE: This research aims to identify the sociodemographic features of serious spermatogenetic disorders in infertile males. STUDY DESIGN: A total of 585 infertile men were eligible. Infertile men with abnormal physical findings were compared to infertile men with normal physical findings. Infertile men with severe spermatogenetic abnormalities (azoospermia and oligoasthenoteratozoospermia) were compared to infertile men with other spermatogenetic disorders. RESULTS: The majority of the subjects revealed no surgery, chronic disease, trauma, drug use or gonadotoxic exposure that could be related to their infertility. Testicular atrophy which was the most common physical finding, was significantly related to trauma. Subjects with abnormal physical findings were more likely to have severe spermatogenetic abnormalities which were directly correlated to gonadotoxic agents, particularly heat exposure. CONCLUSION: This study claims that the previously established risk factors which are considered to be associated with infertility might influence less or interfere with male infertility in more subtle ways

Chromosome Abnormalities in Turkish Men with Primary Infertility

OBJECTIVE: The present study aims to identify the prevalence and types of chromosome anomalies among Turkish men with primary infertility. STUDY DESIGN: A case-control study was undertaken in 474 Turkish men with primary infertility and 450 phenotypically normal fertile men selected for the control group. RESULTS: Azoospermia is defined to be the most frequent spermiogram abnormality within infertile men, followed by oligoasthenoteratozoospermia. Chromosomal abnormalities were demonstrated to occur significantly more in azoospermic subjects (28.3%) compared to other infertile subjects (11.5%) and fertile men (0.8%). Klinefelter syndrome was detected to be the most frequent chromosomal abnormality with an overall rate of 10.5%. Azoospermia Factor (AZF) microdeletions occur statistically similar among azoospermic men (4.2%) and other infertile men (2.3%), with a total frequency of 3.2%. CONCLUSION: The high rate of chromosomal anomalies among infertile Turkish men strongly suggests the need for routine cytogenetic analysis prior to the application of assisted reproduction techniques

Ultrasonographic Assessment of The Fetal Foot Length for Gestational Age Estimation

OBJECTIVE: To describe the relationships between gestational age and ultrasonographic measurement of fetal f oot length. STUDY DESIGN: A total of 462 ultrasonographic measurements were performed to describe the relationship between gestational age and fetal foot length at the Zekai Tahir Burak Woman Health Education and Research Hospital. The nomogram of f etal foot length v ersus gestational age between 15-42 weeks was constructed f rom the fetuses of healthy singleton pregnancies. All patients had normal ongoing pregnancies and known last menstrual periods. RESULTS: A significant correlation was f ound between fetal f oot length and gestational age (r = 0.890, p < 0.0001). Our results suggested that f etal foot length was a reliable marker f or use in the assessment of gestational age. CONCLUSION: This parameter is particularly usef ul when other measurements do not accurately predict gestational age, for example, dysplastic limb reduction and abnormal fetal head structure

Sparing Saphenous Vein During Inguinal Lymphadenectomy in Patients with Vulvar Cancer: A Single Center Experience of 10 Years

OBJECTIVE: The present study aims to investigate the short-and long-term morbidity associated with the preservation of saphenous vein during inguinal lymphadenectomy in patients with vulvar cancer. STUDY DESIGN: A retrospective analysis was conducted in a total of 108 women who were diagnosed with vulvar cancer. The women undergoing preservation versus ligation of saphenous vein during inguinal lymphadenectomy were compared with respect to recurrence, disease-free survival, short and long term complications. RESULTS: Saphenous vein was spared in 88 inguinal incisions made in 51 women while saphenous vein was ligated in 101 inguinal incisions made in 57 women. When compared with those undergoing saphenous vein ligation, the short-term and long-term complications were significantly less frequent in women whose saphenous veins were spared (22.5% vs 42.4%, 12.7% vs 35.0% respectively; p<0.05). However local and lymphatic recurrence rates were comparable in women undergoing either preservation or ligation of saphenous vein during inguinal lymphadenectomy (19.3% vs 22.2%, 9.8% vs 10.5% respectively; p>0.05). The incidence of wound breakdown, local infection and chronic lymphedema were significantly lower in women undergoing saphenous vein preservation (0% vs 25.0%, 1.2% vs 38.3%, 11.6% vs 44.4% respectively; p<0.05). The existence of lymphatic involvement was found to be unassociated with the risk of acute or chronic lymphedema. CONCLUSIONS: The preservation of saphenous vein during inguinal lymphadenectomy reduces the incidence of short-term and long-term complications without affecting the risk of local recurrence. Depending on the experience of the surgeon, the surgical strategy should be individualized and optimized for each patient with vulvar cancer

Value of Post-transfer Day-12 Beta Human Chorionic Gonadotropin Levels for Pregnancy Outcome Prediction of Intracytoplasmic Sperm Injection Cycles

Background: Several markers were studied previously in order to predict the pregnancy outcome of assisted reproductive techniques; however, serum beta human chorionic gonadotropin was found to be the most predictive marker. Aims: To evaluate the value of serum beta human chorionic gonadotropin levels in discriminating biochemical and clinical pregnancies 12 days after embryo transfer, while determining the factors predicting ongoing pregnancy was established as the secondary aim. Study Design: Retrospective cross-sectional study. Methods: A total of 445 pregnant cycles were retrospectively analysed in 2359 embryo transfer cycles. Patients were divided into two groups according to the outcome of pregnancy: biochemical and clinical. Results: The cut-off value of beta human chorionic gonadotropin levels on day 12 in predicting clinical pregnancies was 86.8 IU/mL with 65.1% sensitivity and 74.7% specificity [CI: 0.76 (0.71-0.81). Receiver operating characteristic curve analysis revealed different cut-off values for embryo transfer days (57 mIU/mL for day 3 embryo transfer CI: 0.59-0.79 and 87 mIU/mL for day 5 embryo transfer, CI: 0.74-0.86). Subgroup analysis of clinical pregnancies revealed a significant difference between ongoing pregnancies and early fetal losses regarding duration of infertility (81.3±54.4 vs. 100.2±62.2 months), serum oestradiol on hCG day (2667.4±1276.4 vs. 2094.6±1260.5 pg/mL), number of transferred embryos (1.9±0.8 vs. 1.5±0.7) and the prevalence of diminished ovarian reserve as an indication (2.3% vs 12.2%). Conclusion: Beta human chorionic gonadotropin levels on day 12 following embryo transfer provide an important parameter for the prediction of clinical pregnancy; however, other stimulation parameters are indicated in the prediction of ongoing pregnancie