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Background: Intrauterine adhesions are usually detected incidentally during routine obstetric ultrasound and remain one of the reasons for concern for both clinicians and patients.Objective: Our ob...

Background The aim of this case series was to present the ultrasonographic findings, clinical features, management, and outcome of multiple pregnancies with complete hydatidiform mole and coexisting fetus (CHMCF). Methods Sonographic features and obstetrical and perinatal outcomes of seven cases with CHMCF were analyzed retrospectively. Results A total of seven cases was included in the analysis. Six cases were twins and one case was quadruplet. The mean ± SD maternal age was 25.3 ± 1.9 years (median: 25; range: 23–29). The mean gestational age at diagnosis was 16.1 ± 4.6 weeks (median: 17; range: 11–23). Two pregnancies were achieved by ovulation induction. Two couples opted for pregnancy termination. Four pregnancies resulted in fetal loss between the 11th and 23th week of gestation. One pregnancy ended with the preterm delivery of a live-born neonate at 34 weeks due to pre-eclampsia. One patient developed persistent trophoblastic disease, which was treated by hysterectomy. The mean ± SD time for β-human chorionic gonadotropin clearance was 3.7 ± 0.5 weeks (median: 4; range: 3–4) in the six patients without persistent trophoblastic disease. Conclusions Spontaneous fetal loss is the most likely outcome for CHMCF. However, on the basis of our experience, we recommend carefully monitored continuation of pregnancy as long as maternal complications are not present or are controllable. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42:465–471, 2014

backgound: Currently, there is no ideal agent to prevent adhesion formation. We have shown that sildenafil, a phosphodiesterase-5 (PDE-5) inhibitor, reduces post-operative adhesion formation by vasodilatation and increases fibrinolytic activity. Here, we evaluated whether tadalafil, a long-acting PDE-5 inhibitor, decreases post-operative adhesion reformation in rats. materials and methods: Standardized lesions were created in Wistar albino rats by cauterization of uterine horns and abrasion of adjacent peritonium. The extent and severity of adhesions were scored on the 14th post-operative day and adhesiolysis was performed at the second laparotomy. Animals were then assigned randomly into two groups. The study group (n ¼ 11) received 10 mg/kg oral tadalafil by gavage 60 min before the second laparotomy and daily for 14 days afterwards. Controls (n ¼ 11) received the same volume of tap water for 14 days by gavage. Animals were killed 15 days after adhesiolysis and adhesions were scored blind during the third laparotomy. results: Basal adhesion scores at the time of the second laparotomy were comparable in the study and control groups. Scores for the extent of adhesion reformation in the study and control groups did not differ [median 1 (range 0 –3) versus median 2 (range 1 –3); P: 0.81] but tadalafil reduced the respective severity scores [median 0.5 (range 0 –1) versus median 1 (range 0.5 –1); P: 0.02] and total scores [median 2 (range 0 –4) versus median 2.5 (range 1.5– 4); P: 0.042]. conclusions: Oral administration of tadalafil during the perioperative period reduces intra-abdominal adhesion reformation in rats.

Objective To evaluate idiopathic hirsutism etiology via molecular studies testing peripheral and local aromatase and 5α-reductase expression. Design Assessment of the expression of messenger RNA (mRNA) for type 1 and 2,5α-reductase isoenzyme gene ( SDR5A1, SDR5A2 ) and aromatase ( CYP19A ) in dermal papillae cells and peripheral blood mononuclear cells. Setting University hospital. Patient(s) 28 untreated idiopathic hirsute patients and 20 healthy women (controls). Intervention(s) Human skin biopsies and peripheral venous blood. Main Outcome Measure(s) SDR5A1, SDR5A2, CYP19A gene expression in skin biopsies and peripheral blood. Result(s) A statistically significant reduction of SRD5A1, SRD5A2 , and CYP19A gene expression was found in the dermal papillae cells and peripheral blood mononuclear cell between the study and control group. Conclusion(s) Further study, including protein expression and enzyme activity assays, are warranted to characterize the paradoxically low gene expression levels of local 5α-reductase and aromatase in women with idiopathic hirsutism.

Objective To assess the prevalence of pelvic kidneys during prenatal sonographic examinations in the second and third trimesters and to examine postnatal outcome. Methods Prenatal sonographic findings and postnatal follow-up data of fetuses with prenatal diagnosis of pelvic kidneys were analyzed. Routine (n = 10 079) and indicated (n = 17 732) second and third trimester scans were performed in 27 811 fetuses. A pelvic kidney was defined as one located within the fetal bony pelvis and in close approximation to the bladder. Postnatal evaluation consisted of renal ultrasound and/or dimercapto-succinic acid scan. Results A total of 36 newborns with postnatally confirmed pelvic kidneys were included in this analysis. Median gestational age at diagnosis was 25 weeks; half (18/36) were recognized after 24 weeks. The prevalence of pelvic kidneys in this cohort was 0.14%. Postnatally impaired renal function was present in 33% of the pelvic kidneys of children, but overall renal function remained normal. No serious complications occurred in the 31 fetuses with long-term follow-up, except in 1 case, which required nephrectomy due to multicystic dysplasia of the pelvic kidney. Conclusion Pelvic kidneys are common and can be easily detected prenatally. Prognosis is favorable in the vast majority of the cases. Copyright © 2011 John Wiley & Sons, Ltd.

Sacrococcygeal teratomas are very rarely diagnosed in the first trimester. Here we report a case of a presacral mass suggestive of a sacrococcygeal teratoma that was detected during the first trimester nuchal translucency thickness measurement at 12+1 week of gestation. Although the diagnosis was possible with conventional two-dimensional sonography, three-dimensional sonography facilitated prenatal counseling by providing more recognizable images to the parents. Postmortem examination of the fetus confirmed the presence of a type 2 benign immature teratoma.

Background The relationship between intrauterine device (IUD) use and anti-hepatitis C virus (HCV) status has not been investigated yet. The aims of this study were to compare anti-HCV seropositivity between IUD users and nonusers and to determine whether IUD use is an independent risk factor for anti-HCV seropositivity. Study Design This cross-sectional study included 302 married women who used either an IUD ( n =164) or did not use any form of modern contraception ( n =138). Statistical analysis was carried out using multiple logistic regression models. Results Most women were housewives and all indicated their husbands as the one and only lifetime sexual partner. None of the women have ever used intravenous drugs. There were no statistically significant differences between groups in any of the major risk factors for HCV exposure such as invasive dental procedures, parenteral injections, surgery and blood or blood product transfusions. Twenty-seven (8.9%) of the participants were anti-HCV-positive. Of these, 14 were IUD users and 13 were nonusers and there were no statistically significant differences between the two groups (p=.472). The most important risk factors for anti-HCV seropositivity were the number of deliveries (OR=1.41; 95% CI 1.07���1.86) and invasive dental procedures (OR=2.39; 95% CI 1.07���5.39). Conclusions IUD use is not associated with an increased incidence of anti-HCV seropositivity among monogamous women. The IUD may be an appropriate contraceptive option for women in stable monogamous partnership with HCV carriers and condom use should not be specifically recommended in this situation.

Splenogonadal fusion limb defect syndrome (SGFLD) is a very rare abnormality. We report on a case with prenatal sonographic findings of a fetus with postnatally diagnosed SGFLD syndrome. This is also the second case of prenatal ultrasonographic diagnosis of gastrointestinal malrotation associated with SGFLD. A 26-year-old primigravid woman was referred to our clinic because of nonvisualization of both fetal femoral bones at 20 weeks of gestation. A detailed sonographic examination showed complete bilateral absence of lower limbs, micrognathia, single umbilical artery and a rightsided stomach. Autopsy confirmed prenatal sonographic findings and additionally showed that the spleen was abnormally connected to the left gonad by a fibrous band. In conclusion, although all limbs and both sides were equally affected in most of the reported cases, SGFLD syndrome should be considered in cases with terminal limb defects of lower limbs. (c) 2009 Wiley Periodicals, Inc. J Clin Ultrasound 37:298-301, 2009; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcu.20557

This is a report of an intracerebellar hemorrhage in a severely growth-restricted fetus with pathological Doppler findings of the fetal and uteroplacental circulations. The diagnosis was made sonographically at 22 weeks of gestation and the natural course of the hemorrhage was followed. Interestingly, the final sonographic appearance of the posterior fossa was quite similar to that of the classic form of Dandy-Walker malformation: absence of the vermis and an enlarged fourth ventricle. However, careful sonographic examination showed that the enlargement of the fourth ventricle was actually caused by a porencephalic cystic lesion of the left cerebellar lobe. Pathological examination revealed complete absence of the vermis and cerebellar hypoplasia.

Background and Objectives: To compare the symptom severity and health quality outcomes of women who underwent laparoscopic and robotic myomectomy. Methods: This was a prospective nonrandomized cohort study. The Uterine Fibroid Symptom and Health Related Quality of Life Questionnaire was administered to 33 laparoscopic myomectomy and 31 robotic myomectomy patients before and year after surgery. Symptom severity and health quality scores were compared between the preoperative and postoperative periods for laparoscopic and robotic myomectomy procedures. Results: The mean age, operation time, estimated blood loss, body mass index, largest fibroid diameter, length of hospital stay, and number of fibroids removed were comparable for both groups (P > .05). Symptom severity scores decreased significantly for both laparoscopic and robotic myomectomy patients at year after surgery (P < .05), and health-related quality of life scores increased significantly in both groups at 1 year after surgery (P < .05). Improvement in symptom severity and health quality was higher in the laparoscopy group; however, this was not statistically different from the robotic myomectomy group (P > .05). Conclusion: Laparoscopic and robotic myomectomy provide significant reductions in fibroid-associated symptom severity and significant improvement in quality of life at 1 year after surgery. The rate of improvement was comparable for both procedures.

Objectives To present the complications of a twin pregnancy after first trimester myomectomy and to discuss the possible etiologic relationship. Case report A 44-year-old primigravida with a dichorionic-diamniotic twin pregnancy underwent myomectomy in another hospital at 12 weeks' gestational age. At 28 weeks the patient was referred to our unit because of ventriculomegaly and limb anomalies in the second twin. The patient underwent a Caesarean section at 37 weeks of gestation delivering twin A, a healthy female weighing 3235 g and twin B, a female weighing 2810 g with hydrocephalus and limb anomalies (clubfeet and hypoplasia of the nails and terminal phalanges). The placenta from twin A was normal, but in the placenta of twin B haemorrhage, thrombosis and infarction were noted. Conclusions Despite several reports of myomectomy in pregnancy without any problems for mother and fetus, the authors believe that myomectomy – especially in the first trimester – may be associated with the type of problems observed in the present case. The pathophysiological relationship between placental trauma and haemodynamic alterations as a possible cause of the malformations in twin B is discussed. Copyright © 2001 John Wiley & Sons, Ltd.

Prenatal hydrocephalus is one of the most common anomalies with heterogeneous etiology, frequently associated with extracranial malformations, chromosomal anomalies and variable degree of intellectual impairment In this paper, the common causes of fetal hydrocephaly, diagnostic criteria and prognostic variables are presented and discussed by comparing the literature and by presenting an own analysis of 155 cases of fetuses with fetal ventricolomegaly and follow-up.

A giant placental chorioangioma was diagnosed in a fetus at 22 weeks of gestation by prenatal ultrasound screening and color Doppler imaging. Although no signs of fetal hydrops and cardiac decompensation were observed, the situation of the fetus deteriorated rapidly and in utero fetal death occurred at 26 weeks, attributed to bleeding from ruptured sinusoids within the tumor. Prenatal diagnosis of chorioangioma and treatment modalities are discussed.

Women with epilepsy have a higher risk of having dysmorphic child. We report on a child exposed prenatally to valproate and carbamazepine presenting with severe bilateral upper limb defect and phenotypic features of fetal valproate syndrome. Anticonvulsant drugs can cause severe birth defects, especially when used in combination.

The aim of this case series was to present the ultrasonographic findings, clinical features, management, and outcome of multiple pregnancies with complete hydatidiform mole and coexisting fetus (CHMCF).Sonographic features and obstetrical and perinatal outcomes of seven cases with CHMCF were analyzed retrospectively.A total of seven cases was included in the analysis. Six cases were twins and one case was quadruplet. The mean ± SD maternal age was 25.3 ± 1.9 years (median: 25; range: 23-29). The mean gestational age at diagnosis was 16.1 ± 4.6 weeks (median: 17; range: 11-23). Two pregnancies were achieved by ovulation induction. Two couples opted for pregnancy termination. Four pregnancies resulted in fetal loss between the 11th and 23th week of gestation. One pregnancy ended with the preterm delivery of a live-born neonate at 34 weeks due to pre-eclampsia. One patient developed persistent trophoblastic disease, which was treated by hysterectomy. The mean ± SD time for β-human chorionic gonadotropin clearance was 3.7 ± 0.5 weeks (median: 4; range: 3-4) in the six patients without persistent trophoblastic disease.Spontaneous fetal loss is the most likely outcome for CHMCF. However, on the basis of our experience, we recommend carefully monitored continuation of pregnancy as long as maternal complications are not present or are controllable.

The objective of the study was to compare intracytoplasmic sperm injection (ICSI) outcome and gonadotropin doses between obese women with PCOS and non-obese patients with PCOS. This follow-up study represents ICSI outcomes in obese women with PCOS (BMI ≥ 30 kg/m(2)) compared with non-obese women with PCOS (BMI 30 kg/m(2)). Obese (n = 18) and non-obese (n = 26) women with PCOS underwent long protocol pituitary suppression, ovarian stimulation and ICSI with fresh embryo transfer. Obese patients with PCOS required higher doses of gonadotropin (2994 IU vs 1719 IU; p 0.001). Miscarriage rate was significantly higher in obese women compared with the non-obese women with PCOS (60% vs 6.7%, p = 0.002). Our results are valuable for counselling couples before initiation of assisted reproduction techniques (ART).

A 33-year-old woman with a history of surgically treated papillary thyroid carcinoma was inadvertently given radioactive iodine when she was 16 weeks pregnant. Sonographic examination revealed fetal thyroid hypoplasia, and cordocentesis confirmed fetal hypothyroidism at 22 weeks. The pregnancy was terminated at 24 weeks. We report the first case of fetal thyroid hypoplasia diagnosed by ultrasound and cordocentesis. (C) 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:506-508, 2010; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/jcu.20737

To evaluate the protective effect of GnRH agonist for the prevention of ovarian reserve during treatment with paclitaxel and cisplatin.Experimental study.University-based research laboratory.Seventy female Wistar-Albino rats.Each group consisted of 10 rats. Group 1 served as controls. Groups without GnRH agonist (groups 2, 3, and 4) were administered paclitaxel and cisplatin, respectively; the remaining groups (groups 5, 6, and 7) were given the same regimens with GnRH agonist. The GnRH agonist (leuprolide acetate; 2.5 microg/d subcutaneously for 5 weeks) was started four weeks before chemotherapy to achieve anovulation. Paclitaxel (7.5 mg/kg) and cisplatin (5 mg/kg) were administered intraperitoneally on the 28th day as a single dose.One week after the chemotherapy, the animals were euthanized and primordial, primary, secondary, and tertiary follicle counts were evaluated.Primordial, primary, and tertiary follicle counts in group 5 (paclitaxel plus GnRH agonist) and tertiary follicles in groups 2 and 3 had not decreased, but there was a significant decrease in other treatment groups compared with controls (P0.05). Binary comparison between all groups demonstrated that the primordial follicle count in group 5 was comparable to those of the controls.Paclitaxel plus GnRH agonist treatment may be an appropriate option for patients deserving further fertility in the preservation of primordial follicles.

Breakage of a needle during medical interventions is unusual. When fracture occurs it is usually due to inappropriate needle selection, excessive resistance offered by the tissue as well as poor op...

Leydig cell tumors of the ovary are very rare, frequently associated with symptoms of virilization in postmenopausal patients. It is sometimes difficult to localize the tumor precisely even with modern imaging techniques. A 62-year-old patient presented with recent onset of rapidly progressive virilization including increased hirsutism, progressive balding, deepening voice and enlargement of the clitoris. Initial laboratory examination revealed a total serum testosterone level of 1330 ng/dL. Serum dehydroepiandrosterone sulfate, androstenedione and 17 hydroxyprogesterone levels were all within normal limits. Extensive pre-operative evaluations included transvaginal ultrasound, abdominal computed tomography and magnetic resonance imaging failed to localize the tumor. Therefore, selective ovarian venous hormonal sampling (SOVHS) was performed and they revealed that the total serum testosterone level was significantly higher in the left than in the right ovarian vein (7000 ng/dL vs. 225 ng/dL). A total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. Microscopic examination of the left ovary revealed a Leydig cell tumor. In conclusion, when the precise location of the tumor is not determined pre-operatively, SOVHS may be valuable to make accurate diagnosis.

Isolated fallopian tube torsion during pregnancy is a rare condition, and only 16 cases have been reported. In all but 1 case the right tube was affected. We report the second case of isolated left fallopian tube torsion during pregnancy.A 23-year-old primigravida presented at 22 weeks of gestation with left lower abdominal pain. Sonography depicted a simple cystic mass adjacent to the left uterine border. Laparotomy revealed torsion of the left hydrosalpinx together with a paraovarian cyst. The patient delivered a healthy infant at term after an otherwise-uneventful pregnancy.As the gravid uterus increases the risk for fallopian tube torsion, this condition should be included in the differential diagnosis of lower abdominal pain during pregnancy.

Objective Clinical features of the distal 10q trisomy syndrome consist of mental retardation, facial dysmorphism and renal and cardiac anomalies. The presence of a sacrococcygeal teratoma (SCT) in a fetus with distal 10q trisomy has not been reported yet. Methods A 33-year-old, G5, P2 woman with a singleton pregnancy was referred to our clinic at 24 weeks of gestation for further evaluation of a fetal sacral exophytic mass. Detailed fetal sonographic examination together with chromosomal analysis by amniocentesis was performed. Results The scan revealed a large SCT together with a persistent right umbilical vein, cardiomegaly, bilateral mild hydronephrosis and intrauterine growth retardation. The fetal karyotype showed distal 10q trisomy (10q24.3qter) distal monosomy 17 (p13pter). The fetus died after a preterm delivery at 28 weeks of gestation. Postnatal examination confirmed the prenatal findings and added the typical facial features of this syndrome, which consisted of prominent forehead, small nose with depressed nasal bridge, micrognathia and bow-shaped mouth. Conclusion This case provides further evidence of a possible association between chromosomal aberrations in SCTs. Copyright © 2007 John Wiley & Sons, Ltd.

Objective To compare the effectiveness of oral and vaginal misoprostol for preoperative cervical ripening in premenopausal women before hysteroscopic surgery. Design Placebo-controlled, double blind, randomized trial. Setting University hospital. Patient(s) Eighty-six premenopausal women eligible for operative hysteroscopy were recruited. Nine women were excluded from the study. Intervention(s) Patients were randomly assigned to receive 400 μg of misoprostol orally (n = 39) or vaginally (n = 38), 10–12 hours before operative hysteroscopy. Main Outcome Measure(s) Extent of initial cervical width, percentage of patients requiring cervical dilatation, duration of cervical dilatation and surgical procedure, complications during procedure, and associated side effects. Result(s) Mean cervical widths in the vaginal and oral misoprostol groups after treatment were 7.3 ± 1.6 mm and 6.0 ± 1.5 mm, respectively, which was a statistically significant difference. Time required for cervical dilatation (98.6 ± 88.7 s vs. 49.1 ± 34.9 s) and duration of surgery (14.5 ± 6 vs. 7.7 ± 4.0 min) was statistically significantly shorter in the vaginal misoprostol group. The percentage of women with an initial cervical width of 9 mm was statistically significantly higher in the vaginal misoprostol group (36.8% vs. 5.1%). Uterine perforation occurred in two patients in the oral misoprostol group and in none in the vaginal misoprostol group. Side effects were comparable between the two treatment groups. Conclusion(s) Vaginal administration of misoprostol is more effective than the oral route for preoperative cervical ripening in premenopausal women.

Combined oral contraceptives (COCs) are considered the first-line treatment for women with hirsutism. They diminish androgen release from the ovary and decrease plasma free testosterone levels by increasing sex hormone-binding globulin (SHBG) concentrations. COCs containing cyproterone acetate (CPA) and drospirenone (DRSP) have been proved effective for the treatment of acne and facial hirsutism. This study prospectively compared the clinical and biochemical efficacy of 3 mg DRSP/30 microg ethinyl estradiol (EE) and 2 mg CPA/35 microg EE combinations in a total of 91 patients with hirsutism. Individuals randomly received a cyclic combination of either DRSP/EE (n=48) or CPA/EE (n=43) for 12 months. Basal serum total testosterone, free testosterone, androstenedione, dehydroepiandrosterone sulfate and SHBG levels, as well as Ferriman-Gallwey scores, were determined before and after treatment. Both COCs achieved a similar effect on clinical hirsutism scores, in addition to serum androgen and SHBG levels, after completion of therapy. The percentage reductions in total hirsutism score (median % (min-max)) during therapy were 0.70 (0-0.58) vs. 0.57 (0.10-1.00) at 6 months (p = 0.028) and 0.80 (0-0.42) vs. 0.81 (0-0.75) at 12 months (p = 0.6) in the DRSP/EE and CPA/EE groups, respectively. In conclusion, the DRSP/EE combination is at least as effective as the CPA/EE combination in improving hirsutism scores.

Isolated fallopian tube torsion after menopause is a rare condition. Here we report the second case of isolated fallopian tube torsion in a post-menopausal woman. A 55-year-old post-menopausal woman presented with right lower abdominal pain. Sonography depicted a simple cystic mass adjacent to the right uterine border. Laparatomy revealed torsion of the right fallopian tube together with a paraovarian cyst. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. Histopathological examination revealed a simple paraovarian cyst with severe congestion, necrosis and hemorrhage. Tubal torsion Should be considered in the differential diagnosis of acute lower abdominal pain, even in post-menopausal women. (c) 2007 Elsevier Ireland Ltd. All rights reserved.

We report a prenatal diagnosis of a fetus with partial trisomy 7p. Ultrasonography at 28 weeks of gestation of a 27-year-old multigravid woman revealed a growth-retarded fetus with agenesis of the corpus callosum, enlarged left kidney, single umbilical artery, hypertelorism, depressed nasal bridge, frontal bossing, irregular maxiller alveolar composition, club feet, flexion deformity of the upper extremities and Epstein anomaly. Fetal karyotype was 46, XX, der(9) add(9p24), 16qh+. Our results indicated that the fetus had an unbalanced translocation, which resulted in duplication of the proximal segment of 7p. Maternal karyotype was (46, XX, t(7, 9)(p15.3, p24), 16qh+). Because fetal death occurred at 31 weeks of gestation, induction of labor was performed. An enlarged anterior fontanel and micrognathia were seen during fetal autopsy. Trisomy 7p is related to a well-known clinical picture with a dismal prognosis. Our report showed that the outcome of the affected pregnancy may also be poor. Detection of fetal chromosomal abnormality and parental translocations are essential for counseling of the parents. Copyright (c) 2007 S. Karger AG, Basel.

Objective We report on our experience in surgical treatment of patients with intra-abdominal intrauterine devices (IUDs). Material and Methods A total of 10 patients were retrospectively analyzed. Diagnosis was based on gynecologic examination, transvaginal sonography, and abdominal X-ray. Results All of the IUDs were inserted by trained midwives, either in the puerperal period ( n =3) or within 1 year after puerperium ( n =7). Five women were asymptomatic at the time of diagnosis, three were pregnant and two complained of pelvic pain. Eight patients were managed by laparoscopy, whereas laparotomy was required in two. Abscess formation was present in two cases. The postoperative course was uneventful in all patients. Conclusion A missing string during gynecologic examination is the first sign of an intra-abdominal IUD in all cases. Transvaginal sonography should be combined with abdominal X-ray to reach a definitive diagnosis. Laparoscopic treatment may be appropriate in most of the cases.

Objective: The purpose of this experimental study was to evaluate the effect of oral sildenafil on postoperative adhesion formation in rats. Study design: Thirty-two Wistar Albino rats were subjected to standardized lesion by cauterization of the uterine horn and abrasion of the adjacent parietal peritoneum. They were randomized to receive sildenafil at a daily dose of 15 mg/kg, 7.5 mg/kg and 3.75 mg/kg or placebo. Sildenafil was administered by gavage I h before the operation and daily for 5 days after the procedure. The extent and severity of adhesions were assessed on the 14th postoperative day., ObjectiveThe purpose of this experimental study was to evaluate the effect of oral sildenafil on postoperative adhesion formation in rats.Study designThirty-two Wistar Albino rats were subjected to standardized lesion by cauterization of the uterine horn and abrasion of the adjacent parietal peritoneum. They were randomized to receive sildenafil at a daily dose of 15mg/kg, 7.5mg/kg and 3.75mg/kg or placebo. Sildenafil was administered by gavage 1h before the operation and daily for 5 days after the procedure. The extent and severity of adhesions were assessed on the 14th postoperative day.Result(s)The severity but not extent of adhesions in rats given 15mg/kg sildenafil was significantly less when compared with the other groups (ConclusionSildenafil diminishes peritoneal adhesion formation in rat.

Objective: Our aim was to present a prenatally diagnosed case with Robinow syndrome in a consanguineous couple and discuss possible differential diagnosis in view of the literature. Methods: A 28-year-old pregnant woman gravida 2 para 1 was referred to the obstetric clinic of Kahramanmaras Sutcu Imam University presenting with a fetus having shortened upper and lower limbs at 33 weeks of gestation. Her medical history was unremarkable except for consanguinity. Prenatal ultrasonographic examination revealed a reduced humerus and femur length. Further, shortening of the forearm, frontal bossing, mild hypertelorism, reduced thoracic perimeter and hemivertebrae at the thoracic level were present. Results: Meticulous neonatal examination was performed following an uncomplicated vaginal delivery at 39 weeks of gestation. Distinct facial appearance in addition to the prenatal findings argued in favor of the diagnosis of Robinow syndrome. Additionally, radiological survey revealed and confirmed shortening of the upper extremities and thoracic hemivertebrae. Conclusion: We are documenting the case on the account of its rarity and additional features. The main approach in the differential diagnosis of Robinow syndrome should determine whether hemivertebrae is isolated or part of a syndrome or association.

Objective This study represents long term clinical and biochemical results and the response of different body parts to medical therapy with oral ethinyl estradiol/drospirenone combination in hirsute patients with or without polycystic ovary syndrom (PCOS). Design Prospective, open, controlled clinical study. Setting Outpatients at Erciyes University Medical School. Patient(s) Fifty women with moderate to severe hirsutism were recruited. Two women were lost to follow-up. Intervention(s) Women were treated with 3 mg of drospirenone and 30 μg of ethinyl estradiol for 12 cycles. Main Outcome Measure(s) Hirsutism was assessed at 6-month intervals using the Ferriman-Gallwey (F-G) scoring system. Serum FSH, LH, total and free testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), estradiol (E 2 ), and sex-hormone binding globulin (SHBG) levels at 6 and 12 months of therapy were compared with baseline values. Result(s) Total mean FG score declined by 67% and 78% after 6 and 12 months, respectively. Improvement was most prominent on the chest and abdomen, followed by the upper lip and chin. The lowest effect was observed on the back and arms. Serum levels of total and free T and A decreased, whereas SHBG levels increased significantly after 6 and 12 months when compared with baseline levels. Conclusion(s) Drospirenone/ethinyl estradiol combination exerts significant antiandrogenic activity and is effective in improving facial hirsutism. The beneficial effect is most obvious after six cycles and continues thereafter at a slower rate.

Objective: To review the antenatal sonographic findings and postnatal follow-up of fetuses with empty renal fossa (ERF) and normal amniotic fluid volume. Methods: Sonographic examinations of 13,705 fetuses were retrospectively analyzed and all fetuses with at least one ERF and normal antenatal amniotic fluid volume were included in this study. Results: Forty cases with antenatal ERF were diagnosed. Prenatal diagnosis consisted of pelvic kidney (n = 24), unilateral renal agenesis (n = 13), horseshoe kidney (n = 2) and crossed fused renal ectopia (n = 1). The prevalence of ERF in the low-risk population approximated 3.2‰. There was no serious renal complication during a mean follow-up period of 30 months except one case of crossed fused renal ectopia requiring hemodialysis. Conclusion: The underlying cause of ERF in the majority of cases with normal amniotic fluid volume is renal ectopia. Prenatal ultrasonography seems to be highly reliable in diagnosing these anomalies. Prognosis is favorable in the absence of additional extraurinary malformations.

Our purpose was to compare the efficacy of 25 microg and 50 microg intravaginally administered misoprostol tablets for cervical ripening and labor induction. Either 25-microg (n: 58) or 50-microg (n: 56) misoprostol tablets were randomly administered intravaginally to 114 subjects with an unripe cervix for labor induction. The physician was blinded to the medication. Intravaginal misoprostol was given every 4 h until the onset of labor. The mean Bishop score before misoprostol administration was 2.1 +/- 1.6 in the 25-microg group and 2.0 +/- 1.4 in the 50-microg group (p0.05). With the 25-microg dose the time until delivery was significantly longer (991.2 +/- 514.4 min vs. 703.12 +/- 432.6 min in the 50-microg group). The use of oxytocin augmentation was significantly higher in the 25-microg group (63.8%) than the 50-microg group (32.1%; p0.05). The proportions of patients with tachysystoles and hypersystoles were not significantly different between the two groups (19 and 6.9%, respectively, in the 25-microg group and 25 and 17.8%, respectively, in 50-microg group; p0.05). Overall, in the 25-microg group more women achieved vaginal delivery (79.3 vs. 60.7%; p0.05). The rate of cesarean sections due to non-reassuring fetal status was higher in the 50-microg misoprostol group (28.6 vs. 10.3%; p0.05). The number of neonates with a low 1-min Apgar score (7) was significantly higher in the 50-microg misoprostol group (26.8 vs. 8.6%; p0.05), but 5-min Apgar scores and umbilical artery blood gas values at the time of delivery were not significantly different between the groups (p0.05). One patient in the 25-microg group suffered a ruptured uterus. Intravaginal administration of 25 microg of misoprostol is a clinically effective labor induction regimen and has the least adverse effects and complications.

Objectives: Hypoplasia of the nasal bone is an important ultrasound marker for Down syndrome in the second trimester. Racial differences in fetal nasal bone length have been reported. However, there is no reference range for the fetal nasal bone length (NBL) in Turkish population. The aim of this study was to investigate the reproducibility of fetal NBL measurement in the mid second. trimester and to determine normogram for NBL between 19–23 weeks of gestation in the Turkish population. Methods: A total of 757 fetuses were evaluated between January 2009 and February 2010. Ultrasound measurements of NBL were performed on a strictly sagital plane with an insonation angle less than 30 degrees. The relationship between NBL and gestational age was determined and percentile values for each gestational week were calculated. The relationship between NBL and biparietal diameter was evaluated by Pearson correlation analysis. One way anova was used to assess the differences between the NBL and gestational age. Results: There was no significant relationship between NBL and biparietal diameter (r = 0.021 ve P = 0.634). The mean NBL was 5.7 mm ± 0.68 for 19–19+6/7 weeks, 6.1 mm ± 0.72 for 20–20+6/7 weeks, 6.4 ± 0.86 mm for 21–21+ 6/7 weeks, 6.5 mm ±1.01 for 22–22+6/7 weeks and 7.2 mm ± 0.98 for 23–23+6/7 weeks’ gestation. The measurements of NBL showed a significant increase with gestational age (P = 0.001). Conclusions: We have provided the normal reference range for NBL during the 19–23 weeks in Turkish population.