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Allergic contact dermatitis is a common skin disease, which affects approximately 20% of the population. This reaction may present with several clinical manifestations. Erythema multiforme-like allergic contact dermatitis is a rare type of non-eczematous contact dermatitis, which may lead to difficulty in diagnosis.Essential oil of Laurus nobilis is widely used in massage therapy for antiinflammatory and analgesic effects. Laurus nobilis induced contact dermatitis has been reported in the literature but an erythema multiforme-like presentation is rare.

Objective: Reliability of first and second trimester screening tests largely depends on accurate estimation of maternal serum marker values. Reduced reliability could lead redundant invasive tests or misdiagnosis. Adjustments of serum marker values for confounding factors like insulin-dependent diabetes, maternal weight or maternal rhesus status are essential. We aimed to investigate whether isolated single umbilical artery alters first and second trimester test parameters or not., Methods: Routine detailed obstetric ultrasonographies performed were retrospectively screened for this study. Among spontaneously conceived singleton pregnancies, women who were found to have single umbilical artery without any additional structural anomalies or aneuploidies were selected. First and second trimester screening test results were accessible for 98 and 102 of the cases with isolated single umbilical artery, respectively., Results: Among first trimester screening test parameters, PAPP-A (pregnancy-associated plasma protein A) MoMs were found significantly higher in isolated single umbilical artery group. AFP MoMs were found significantly elevated in isolated single umbilical artery group in second trimester quadruple tests., Conclusion: Existence of single umbilical artery could alter the estimation of MoM values of maternal serum markers. Reliability of prenatal screening tests could be improved by adjusting these parameters in accordance with isolated single umbilical artery.

Objective: The aim of this study was to evaluate the effects of umbilical cord milking (UCM) on the need for packed red blood cell (PRBC) transfusion and hematologic and hemodynamic parameters in very-low-birth-weight infants., Methods: The infants were randomized into 2 groups: group 1 (UCM) and group 2 (control). The primary outcome was the number of PRBC transfusions during the first 35 days of life. The secondary outcome measures were the hemodynamic variables during the first 24 hours of life., Results: A total of 44 infants were included with 22 infants in each group. Two of 21 infants in group 1 and 4 of 21 infants in group 2 received transfusion in the first 3 days of life (P=0.384). The number and volume of PRBC transfusions were similar in both groups. However, the levels of hemoglobin (Hb) at the first and 24th hour of life were significantly higher in group 1. Phlebotomy volume was found as a statistically significant risk factor for the need for PRBC transfusion (P=0.005)., Conclusions: UCM in delivery room results in a higher Hb level in the first day of life. In these groups of infants, phlebotomy losses may impact the transfusion need.

Severe pelvic infections following ultrasound-guided transvaginal oocyte retrieval (TVOR) are rare but challenging. Ovarian abscess formation is one of the consequences and management of such cases as highly debated in pregnant patients. In this case report, an early fetal loss following laparoscopic management of ovarian abscess is described and possible etiologies are discussed.

Purpose: To identify prognostic predictors and spread patterns in adult ovarian granulosa cell tumors (OGCTs)., Methods: Available retrospective data of 108 OGCT patients managed at three centers between January 1, 1991 and December 31, 2010 were abstracted and analyzed., Results: Stage distributions at diagnosis for stage I, II and III OGCT were 84.3, 5.4, and 9.3 %, respectively. Optimal cytoreduction with no macroscopically visible disease was achieved in 99/108 (91.6 %) patients. The median disease-free interval to first recurrence was 61 months. The overall 5- and 10-year survival rates were 93.3 and 90.9 %, respectively. Disease recurred in 18 (16.6 %) patients, and 8 (7.4 %) patients died of their disease. The first recurrence sites included the pelvic peritoneum (n = 10), liver/liver-capsule (n = 5), rectosigmoid colon (n = 4), retroperitoneal lymph nodes (n = 3), omentum (n = 3), small bowel mesenterium (n = 2), and vaginal cuff (n = 2). Multiple-site recurrence was observed in 9/18 (50 %) patients. Secondary cytoreduction requiring extensive surgery was performed in 14 patients with an optimality rate of 71.4 %. The remaining four patients received only chemotherapy. Multivisceral approaches, including pelvic peritonectomy (n = 9; 64.2 %), rectosigmoid resection (n = 3; 21.4 %), and segmental liver capsule resection (n = 2; 14.2 %) were performed more frequently during the secondary surgery. Definitive retroperitoneal lymph node metastasis rates at the initial and recurrent settings were 5.1 % (3/58) and 21.4 % (3/14), respectively. Both stage and residual tumor status were significantly associated with recurrence in univariate and multivariate analyses., Conclusions: Stage and residual tumor status are predictors of recurrence. Pelvic peritoneal, nodal and hepatic involvement, and multiple-site spread patterns requiring extensive cytoreductive surgery are likely associated with recurrence of OGCTs.

Krukenberg tumor in pregnancy is very rare and management of this condition is a dilemma for physicians. Moreover, the existence of a primary Krukenberg tumor is still in debate. Herein, we present a 29-year-old woman at 29 weeks of pregnancy, admitted with premature labor and revealed to have a signet ring cell ovarian tumor with an undetermined primary origin. A primary Krukenberg tumor or a Krukenberg tumor with an undetermined origin has not been previously reported in a pregnant patient. By virtue of the controversy, we are not eager to use the term 'primary Krukenberg tumor' for this case, although the possibility of the existence of this kind of tumor cannot be totally ignored., (© 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.)

Aim: To evaluate the long-term oncological and reproductive outcomes of patients aged 25 years and younger who were treated by fertility-sparing cytoreductive surgery (FSCS) plus adjuvant chemotherapy (ACT) or observation alone for malignant ovarian germ cell tumors (MOGCT)., Methods: Records of 42 eligible female patients treated for MOGCT between 1 May 1995 and 31 December 2010 at two centers were analyzed retrospectively. A telephone questionnaire was performed to gather reproductive and menstrual history., Results: One patient was treated without FSCS and two patients were lost to follow-up. The mean age of the remaining 39 patients was 18.4 ± 3.2 years. Eighteen of the tumors were histologically pure dysgerminomas (PD) and 21 were non-dysgerminomatous tumors (non-DT). Thirteen patients (33%) presented with stage II-III disease. Optimal cytoreduction was achieved in 34 of the 39 patients (87%). Systematic pelvic and para-aortic lymphadenectomy was performed in 31 of the 39 patients (79.5%). The frequency of lymph node metastasis was 29% (9/31). Twenty-seven patients (69.2%) received ACT. Disease recurred in six (15.3%) patients, all in the non-DT group. Four of six underwent secondary optimal FSCS followed by chemotherapy. Retroperitoneal nodal recurrence was detected in two of these four patients (50%). Four deaths occurred, three due to chemoresistant aggressive disease and one due to secondary acute myelocytic leukemia. The overall survival rates for patients with PD and non-DT were 100% and 81.4%, respectively. Twenty-three of 27 patients who received ACT continued their regular menses. Sixteen spontaneous pregnancies and one pregnancy by intrauterine insemination were achieved by 21 patients who attempted conception., Conclusion: Either primary or secondary FSCS followed by ACT seems to be a feasible and safe approach to preserving future fertility and hormonal function in young patients with MOGCT., (© 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.)

Cachexia presents with ongoing muscle wasting, altering quality of life in cancer patients. Cachexia is a limiting prognostic factor for patient survival and health care costs. Although animal models and human trials have shown mechanisms of motorprotein proteolysis, not much is known about intrinsic changes of muscle functionality in cancer patients suffering from muscle cachexia, and deeper insights into cachexia pathology in humans are needed. To address this question, rectus abdominis muscle samples were collected from several surgical control, non-cachectic and cachectic cancer patients and processed for skinned fibre biomechanics, molecular in vitro motility assays, myosin isoform protein compositions and quantitative ubiquitin polymer protein analysis. In pre-cachectic and cachectic cancer patient samples, maximum force was significantly compromised compared with controls, but showed an unexpected increase in myofibrillar Ca(2+) sensitivity consistent with a shift from slow to fast myosin isoform expression seen in SDS-PAGE analysis and in vitro motility assays. Force deficit was specific for 'cancer', but not linked to presence of cachexia. Interestingly, quantitative ubiquitin immunoassays revealed no major changes in static ubiquitin polymer protein profiles, whether cachexia was present or not and were shown to mirror profiles in control patients. Our study on muscle function in cachectic patients shows that abdominal wall skeletal muscle in cancer cachexia shows signs of weakness that can be partially attributed to intrinsic changes to contractile motorprotein function. On protein levels, static ubiquitin polymeric distributions were unaltered, pointing towards evenly up-regulated ubiquitin protein turnover with respect to ubiquitin conjugation, proteasome degradation and de-ubiquitination., (© 2013 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.)

Objective: To investigate the perinatal outcomes of cases with idiopathic polyhydramnios., Study Design: Retrospective analysis of 160 singleton pregnancies that were under routine surveillance at the department of obstetrics from 2008 to 2010 was performed to assess perinatal outcomes. Finally, 59 cases were included as idiopathic polyhydramnios, and 101 cases were included as controls. Preterm delivery (<37 weeks), gestational age at birth, low birth weight (<2500 g), very low birth weight (<1500 g), macrosomia (>4000 g), 1- and 5-min APGAR scores <7, small for gestational age (SGA) fetuses, large for gestational age (LGA) fetuses, C-section rates, number of fetal distress, admission to neonatal intensive care unit (NICU) after delivery, neonatal death within the first 7 days, and deaths before the age of 1 year were selected as perinatal outcome variables., Result: Significantly higher preterm labors and low 1- and 5-min APGAR scores were noted in the idiopathic polyhydramnios group compared with the control group., Conclusion: Although perinatal outcomes are conflicting in literature, idiopathic polyhydramnios warrants close surveillance especially near term.

Objective: To analyze the results of fertility-sparing treatment of early-stage endometrial cancer (EC) in patients treated at Turkish gynecologic oncology centers, and to present a review of the literature., Methods: Thirteen healthcare centers in Turkey were contacted to determine if they were eligible to participate in the study. Centers that were eligible and agreed to participate were sent a database form to record the demographic characteristics, clinicopathologic findings, and follow-up results for their EC patients., Results: Eleven Turkish healthcare centers provided data on 43 EC patients. Mean duration of treatment was 5 months and mean follow-up was 49 months. In total, 35 (81.4%) patients were tumor free following primary progesterone therapy. Mean time from the end of progesterone therapy to pregnancy was 10.6 ± 4.3 months (range, 3-18 months). Two patients had tumor recurrence during follow-up. The pregnancy rate among the 31 women who actively sought pregnancy was 41.9% (n=13)., Conclusion: Conservative management of early-stage EC in women of reproductive age using oral progestins was effective and did not compromise oncological outcome. Pregnancy in the study patients was achieved spontaneously and artificially., (Copyright © 2012 International Federation of Gynecology and Obstetrics. All rights reserved.)

Objective: To compare follicular fluid concentrations of IGF-I, IGF-II, IGFBP-3, inhibin-B, VEGF, and AMH in women undergoing controlled ovarian hyperstimulation with a long-luteal GnRH agonist protocol or multiple-dose GnRH antagonist protocol., Study Design: A total of 80 cycles were included; long-luteal GnRH agonist group (n=40) and multiple dose GnRH antagonist group (n=40). All follicular fluid samples were obtained from mature follicles during oocyte retrieval. IGF-I and IGFBP-3 concentrations were measured by immunoradiometric assay. IGF-II, VEGF, AMH, and inhibin-B concentrations were measured by enzyme-linked immunosorbent assay., Results: There were no significant differences in the concentrations of the studied follicular fluid markers, cycle parameters, and treatment outcomes between GnRH agonist and GnRH antagonist protocols., Conclusions: The long-luteal GnRH agonist protocol and multiple-dose GnRH antagonist protocol seem to have similar effects on the follicular microenvironment in women undergoing controlled ovarian hyperstimulation., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: PAX2 is a member of paired box gene family and expressed during development of urogenital system. This study aimed to evaluate PAX2 expression pattern in hyperplastic and malignant endometrial tissues in comparison to non-pathological endometrial changes and to investigate the presence of any correlation between the PAX2 expression and tumor behavior., Methods: The study was performed on the archival material of 121 endometrial tissues including complex hyperplasia (n = 18), complex atypical hyperplasia (n = 20), and endometrioid type adenocarcinoma (n = 47) as study groups, and proliferative endometrium (n = 21) and atrophic endometrium (n = 16) as control groups. One representative block for each case was selected for immunohistochemical evaluation. Sections with 4μm thickness were cut from the blocks and incubated with PAX2 rabbit anti-human polyclonal antibody., Results: PAX2 nuclear staining was detected in all of the endometrial tissues. The mean percentages of PAX2 staining cells were 80.8, 96.7, 88.6, 92.7, and 99.2% with proliferative endometrium, atrophic endometrium, complex hyperplasia, complex atypical hyperplasia, and adenocarcinoma, respectively (Kruskal-Wallis; P < 0.001). The frequency of PAX2 staining increased as the pathology progressed in the manner of complex hyperplasia → complex atypical hyperplasia → adenocarcinoma. In cancer cases, there was no correlation between PAX2 expression levels and the stage, histological grade, myometrial invasion, and lymph node status., Conclusions: PAX2 is expressed in hyperplastic and malignant endometrium as well as proliferative and atrophic endometrium. As the neoplastic lesion progresses from a premalignant state to endometrial cancer, PAX2 expression increases. These findings suggest that PAX2 may contribute to the development of endometrial cancer.

Purpose: To compare the efficacy of clomiphene citrate (CC) and recombinant FSH (rFSH) protocols in ovarian stimulation (OS)/intrauterine insemination (IUI) cycles for couples with unexplained infertility or male subfertility., Methods: One hundred and eighty-nine patients with unexplained or male subfertility were randomized to treatment with 100 mg/day CC for 5 days (93 patients) or rFSH with starting dose of 75-100 IU daily (96 patients). The main outcome measurement was ongoing pregnancy rate (OPR)., Results: The number of preovulatory (≥ 17 mm) follicles on the day of hCG administration was significantly greater in the rFSH group than in the CC group (1.7 vs. 1.4, P = .01). Multifollicular growth was observed in 35.1% in the CC group and 54.8% in the FSH group (P = .01). The OPR per cycle was 9.6 and 15.6% for CC and rFSH groups, respectively (P = .31)., Conclusions: Recombinant FSH is superior to CC for enabling multifollicular development in OS/IUI cycles of unexplained and male subfertile couples. Although this finding did not lead to a statistically significant superiority of rFSH in terms of clinical outcomes, the presence of relative increase by 62.5% in OPR with rFSH may be regarded as a clinically significant trend.

The aims of this study are to determine the frequency of fibromyalgia syndrome (FMS) in patients with chronic cervical myofascial pain (CMP) and to investigate the FMS characteristics in CMP patients. Ninty-three patients with CMP and 30 age-matched healthy women were included in this study. Main outcome measures included visual analog scale (VAS), Beck Depression Inventory (BDI), and pain pressure thresholds. CMP patients were evaluated for the existence of FMS. The severity of FMS was assessed with total myalgic score (TMS) and control point score (CPS). Most common clinical characteristics of FMS were noted. Of the 93 CMP subjects, 22 (23.6%) patients fulfilled the classification criteria for FMS. Number of tender points were higher (p=0.0), while TMS (p=0.0) and CPS (p=0.0) values were lower in comorbid CMP and FMS patients than regional CMP group. There were statistically significant differences between regional CMP patients and comorbid CMP and FMS patients regarding presence of fatigue (p=0.0) and irritable bowel syndrome (p=0.022). There was no statistically significant difference between patient groups regarding VAS values (p>0.05). BDI values of the regional CMP were significantly lower than comorbid CMP and FMS patients (p=0.011). In conclusion, we found that nearly a quarter of CMP patients were comorbid with FMS, and psychological and comorbid symptoms were more prominent in comorbid patients. We thought that, these two syndromes might be overlapping conditions and as a peripheral pain generator or inducer of central sensitisation, MPS might lead to FMS or precipitate and worsen the FMS symptoms.

The purpose of this study was to investigate the effect of oral administration of a simple carbohydrate solution on splanchnic circulation and bacterial translocation in endotoxemia. Group 1 was sham control; group 2 was starved for 24 hours; in group 3, endotoxin was administrated at the end of starvation; in group 4, carbohydrate solution was administrated via orogastric route for 24 hours; and in group 5, carbohydrate solution was given and endotoxin was administrated at the end of 24 hours. Splanchnic blood flows were recorded and tissue samples were collected for microbiological analyses. There was a significant increase (P<.05) in the incidence of bacterial translocation in starvation. Endotoxemia decreased distal (P=.021) and midmesenteric (P=.046) flow in starved animals. Oral carbohydrate significantly increased ileal blood flow in starvation (P=.036) and endotoxemia (P=.008). In conclusion, oral carbohydrate solution prevents bacterial translocation during starvation and endotoxemia. The possible mechanism is the improvement in the mesenteric blood flow.

Background: Pregnancy in the rudimentary uterine horn is an extremely rare clinical condition. Treatment includes surgical removal of the rudimentary horn., Methods: A rudimentary horn pregnancy was reported that occurred after intrauterine insemination. Similar cases treated with laparoscopic surgery reported in the peer-reviewed journals were reviewed as well., Results: Pregnancy in the right rudimentary horn of 6-weeks gestational age was successfully treated with laparoscopic surgery., Conclusion: Laparoscopy is a feasible and safe method for treating rudimentary horn pregnancy.