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Nukleer radyasyonlarin enerji olcumlerinde spektrometrenin karakteristiklerinin belirlenmesi son derece onemlidir. Gelen gama isinlarinin enerjisine bagli olarak, detektorden elde edilen pulslar, puls yuksekligi analizi (Puls Height Analysis-PHA) metoduyla cok kanalli analizorde (Multi Channel Analyzer-MCA) gama spektrumlari olarak gozlenir. MCA’de kanal basina dusen gama enerjilerini belirlemek icin dedektorun enerji kalibrasyonunun ve enerjileri birbirine yakin pikleri ayirt edebilme yetenegi olan enerji cozunurlugunun bilinmesi gereklidir. Bu calismada, gama isinlari icin yuksek verime sahip olan NaI(Tl) detektorunun enerji kalibrasyonu ve enerji cozunurlugu 137 Cs, 60 Co, 22 Na, 133 Ba standart gama isini kaynaklarinin puls yuksekligi spektrumlari olculerek elde edilmistir.

Purpose To assess the relationships between mucosal thickness, T1-weighted, T2-weighted signals and restricted diffusion on magnetic resonance imaging (MRI) with the degree of symptoms in patients with incidentally detected inflammatory sinonasal disease. Materials and methods Conventional and diffusion-weighted MRI of 100 patients with incidental sinonasal mucosal thickening were prospectively evaluated. There were 53 men and 47 women, with a mean age of 44.6 years ± 15.17 (SD) (range: 18–81 years). Correlations between quantitative values (T1-signal, T2-signal and apparent diffusion coefficient [ADC]) and three different quality of life questionnaires (chronic sinusitis survey, sinonasal outcomes test-22 and nasal obstruction and septoplasty effectiveness scale [NOSE]) were searched using the Spearman correlation test. Results The mean SNOT-22 score was 35.81 ± 20.36 (SD) (range: 0–83), CSS score was 4.64 ± 3.42 (SD) (range: 0–14), and NOSE score was 5.91 ± 4.84 (range: 0–18). All patients (100%) had maxillary sinus involvement. Ethmoidal sinus involvement was present in 57% of patients, frontal sinus involvement in 33% and sphenoidal sinus involvement in 27%. Morphologically, 40 patients (40%) had septal deviation, 41 (41%) had maxillary sinus retention cyst and 78 (78%) had hypertrophy of the conchae. No correlations were found between morphological abnormalities, quantitative values and patient scores in none of the questionnaires. Conclusion Incidental morphological abnormalities or restricted diffusion of the paranasal sinuses on MRI do not correlate with the degree of symptoms in patients with incidentally detected inflammatory sinonasal disease.

Study Objective To evaluate the use of a technique consisting of culdocentesis followed by saline solution–enhanced pelvic ultrasonography in cases suspect for ectopic pregnancy in which an accurate diagnosis could not be made using routine transvaginal ultrasound. Design Retrospective clinical study (Canadian Task Force classification III). Setting Academic medical center. Patients Twenty patients with an initial diagnosis of pregnancy of unknown location. Interventions In 20 patients with symptoms of early pregnancy and serum quantitative human chorionic gonadotropin concentration, ectopic pregnancy could not be confirmed or ruled out. Transvaginal ultrasound-guided culdocentesis was performed, and 300 to 400 mL of normal saline solution was injected into the posterior cul-de-sac and pelvis. Transvaginal ultrasound was repeated with particular attention to the floating fallopian tubes Measurements and Main Results Using this technique, a tubal pregnancy was visualized in 15 of 20 patients, and ectopic pregnancy was ruled out in 5 patients. In all patients, appropriate management was provided according to the final diagnosis, and consisted of either methotrexate, laparoscopic salpingostomy or salpingectomy, or expectant management in patients with abnormal intrauterine pregnancies. Conclusion Ultrasound-guided culdocentesis followed by saline solution–enhanced pelvic ultrasound can be considered as a diagnostic tool in patients with suspected ectopic pregnancy in whom other methods fail to demonstrate this diagnosis.

To compare the effectiveness of hysterectomy and endometrial ablation in women with dysfunctional uterine bleeding.The Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding was a multicenter, randomized controlled trial. Eligible women were premenopausal with dysfunctional uterine bleeding and aged 18 years or older. Primary outcomes were problems that led the woman to seek care solved, bleeding, pain, and fatigue at 12 months. Additional outcomes included quality of life, adverse events, reoperation, and others at 24 months and up to 5 years.We randomly assigned 237 women between January 1998 and June 2001. Follow-up ended in June 2003. We completed 24 months of follow-up on 114 of 123 women assigned to endometrial ablation and 111 of 114 assigned to hysterectomy. Approximately 85% of women were aged younger than 45 years; 76.4% classified themselves as white, 18.6% as African American, less than 1% as Asian, 4.6% as American Indian, and 8.4% as Hispanic (classification within more than one category possible). Both endometrial ablation and hysterectomy were effective at 24 months in solving the problem that led women to seek care (84.9% compared with 94.4%), and in relieving bleeding, pain, fatigue, and other symptoms, although hysterectomy was more effective for bleeding. By 48 months, 32 of the 110 women initially receiving endometrial ablation required reoperation. Adverse events were more frequent with hysterectomy.Both endometrial ablation and hysterectomy are effective treatments in women with dysfunctional uterine bleeding. Hysterectomy (as the index surgery) was associated with more adverse events and a substantial number of patients receiving endometrial ablation had reoperation.ClinicalTrials.gov, www.clinicaltrials.gov, NCT00114088I.

BACKGROUND: Tubal ectopic pregnancy can be surgically treated by salpingectomy, in which the affected Fallopian tube is removed, or salpingotomy, in which the tube is preserved. Despite potentially increased risks of persistent trophoblast and repeat ectopic pregnancy, salpingotomy is often preferred over salpingectomy because the preservation of both tubes is assumed to offer favourable fertility prospects, although little evidence exists to support this assumption. We aimed to assess whether salpingotomy would improve rates of ongoing pregnancy by natural conception compared with salpingectomy.METHODS: In this open-label, multicentre, international, randomised controlled trial, women aged 18 years and older with a laparoscopically confirmed tubal pregnancy and a healthy contralateral tube were randomly assigned via a central internet-based randomisation program to receive salpingotomy or salpingectomy. The primary outcome was ongoing pregnancy by natural conception. Differences in cumulative ongoing pregnancy rates were expressed as a fecundity rate ratio with 95% CI, calculated by Cox proportional-hazards analysis with a time horizon of 36 months. Secondary outcomes were persistent trophoblast and repeat ectopic pregnancy (expressed as relative risks [RRs] with 95% CIs) and ongoing pregnancy after ovulation induction, intrauterine insemination, or IVF. The researchers who collected data for fertility outcomes were masked to the assigned intervention, but patients and the investigators who analysed the data were not. All endpoints were analysed by intention to treat. We also did a (non-prespecified) meta-analysis that included the findings from the present trial. This trial is registered, number ISRCTN37002267.FINDINGS: 446 women were randomly assigned between Sept 24, 2004, and Nov 29, 2011, with 215 allocated to salpingotomy and 231 to salpingectomy. Follow-up was discontinued on Feb 1, 2013. The cumulative ongoing pregnancy rate was 60·7% after salpingotomy and 56·2% after salpingectomy (fecundity rate ratio 1·06, 95% CI 0·81-1·38; log-rank p=0·678). Persistent trophoblast occurred more frequently in the salpingotomy group than in the salpingectomy group (14 [7%] vs 1 [INTERPRETATION: In women with a tubal pregnancy and a healthy contralateral tube, salpingotomy does not significantly improve fertility prospects compared with salpingectomy.FUNDING: Netherlands Organisation for Health Research and Development (ZonMW), Region Västra Götaland Health & Medical Care Committee.

The goal of regenerative medicine is to repair, replace, or regenerate diseased tissues/organs in order to restore normal function. In this paper we will first discuss the general principle of regenerative medicine and the various techniques and approaches that have been used to replace or regenerate cells in diseased tissues and organs. Then, we will review different regenerative medicine approaches that have been used to treat specific diseased tissues and organs of the reproductive system in both animal and human experiments. It is clear from this article that regenerative medicine holds significant promise, and we hope that the review will serve as a platform for further development of regenerative medicine technologies for the treatment of inadequacies of the reproductive system.

Objective To describe a technique for frozen-banked ovarian tissue transplantation using robotic-assisted laparoscopy. Design Case study. Setting Academic tertiary care center. Patient(s) A 38-year-old patient in remission for non-Hodgkin lymphoma, whose ovarian tissue had been frozen for 3 years. Intervention(s) Robotic-assisted laparoscopic transplantation of thawed ovarian cortical tissue to the remaining ovary and peritoneum. Main Outcome Measure(s) Resumption of spontaneous menses, follicular development, and ovulation as demonstrated by ultrasound, and serum E 2 and P levels. Result(s) The patient experienced cyclic spontaneous menstruation 6 months after the transplantation. Ovulation was confirmed by ultrasound and serum E 2 and P levels at month 11 after surgery. Conclusion(s) Robotic-assisted laparoscopic surgery may be a good, minimally invasive alternative for the ovarian tissue transplantation procedure to restore ovarian function.

To report our experience of conservative treatment in four patients with cervical ectopic pregnancy.Case series.Academic medical center.Four women diagnosed with cervical ectopic pregnancy managed conservatively.Systemic methotrexate alone or combined with subsequent uterine artery embolization (UAE).Conservative management with decreased rate of serious complications.No hysterectomies were needed. One patient required subsequent intervention, UAE.Conservative treatment of cervical pregnancy might be successful with careful follow up and subsequent conservative interventions.

This preliminary report reviews our experience with 18 infertile patients with clomiphene-resistant polycystic ovary syndrome (PCOS). In the first treatment cycle, troglitazone was administered alone. During cycles 2-5, clomiphene was added with increments of 50 mg (up to 200 mg/day) if the previous cycle was anovulatory. Basal body temperature charts and serum progesterone were obtained to confirm ovulation. In a total of 66 treatment cycles, ovulation occurred in 44 (67%) and pregnancy in seven (11%). There were no significant changes in body weight, waist:hip ratio or liver enzymes during treatment. Troglitazone, alone or with clomiphene, induced ovulation in 15 of 18 patients (83%) and seven (39%) of them achieved pregnancy. This is the first report on ovulatory rates in clomiphene-resistant women with PCOS when troglitazone was used alone or with clomiphene. Recently, metformin and clomiphene were successfully used in women with PCOS. However, our patients represent a more resistant population of women with PCOS, with each patient serving as her own historical control by previous resistance to clomiphene. Although the pregnancy rate (39%) was promising for clomiphene-resistant women with polycystic ovary syndrome, it does not seem to have a definite advantage over gonadotrophins.

Objective To describe an early small bowel obstruction after robotic-assisted laparoscopic myomectomy with the Davinci system. Design Case report. Setting Academic medical center. Patient(s) Two days after a robotic-assisted laparoscopic myomectomy, a 35-year-old nulligravid African-American woman developed a small bowel obstruction due to retained myoma fragments that had implanted on and subsequently kinked loops of the small bowel. Intervention(s) The patient was managed conservatively for 4 days with bowel rest and IV hydration. Due to worsening clinical symptoms and supportive radiologic findings, exploratory laparotomy was performed to lyse adhesions and remove the implanted myoma pieces. Main Outcome Measure(s) Clinical resolution of small bowel obstruction symptoms. Result(s) No bowel resection was needed for this patient. Conclusion(s) Prompt recognition and operative treatment of the small bowel obstruction prevented the need for intestinal resection. To reduce the risk of ectopic implantation of myoma fragments, meticulous care should be taken to remove all remnants of morcellated tissue. Immediate postoperative complications, such as bowel obstruction, and long-term complications related to recurrent myomas may then be avoided.