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Background Agenesis of the corpus callosum (ACC) is the most frequent commissural malformation of the brain. It continues to be an important cause of the pregnancy termination associated with the central nervous system (CNS). Objective The aim of the study is to provide a comprehensive assessment of fetuses with diagnosis of complete ACC, as well as postnatal neurodevelopmental outcomes. Methods The data of 75,843 fetuses were screened for evaluation of complete ACC between 2003 and 2017, and a total of 109 cases with complete ACC were included in the study. ACC was considered isolated when no additional anomalies were detected, and ACC was considered complex when additional anomalies were present. Results The prevalence of complete ACC was 9.4 per 10,000 live births, and the incidence was ranged from 1.8 to 16.6 per 10,000 person-years. Patients with isolated ACC had a significantly higher survival when compared with patients with complex ACC (97.4%, n = 38/39 vs. 68.8%, n = 22/32, P = 0.001).The most important cause of death were congenital heart disease and/or respiratory failure during neonatal period. Developmental and intellectual disabilities were significantly higher in the complex ACC cases (P < 0.001). Postnatal neurodevelopmental outcomes were completely normal in 79.4% of cases with isolated ACC. Conclusions Isolated complete ACC is usually associated with a favorable outcome. The most important prognostic factors are the presence or absence of associated congenital anomalies.

This historical cohort study aimed to assess the relationship between antenatal maternal C-reactive protein (CRP) level and neonatal outcome preterm premature rupture of membranes (PPROM). We reviewed the records of 70 singleton pregnancies with PPROM between 24 and 34 weeks. Maternal CRP levels of neonates with respiratory distress syndrome, neonatal sepsis, grade 3-4 intraventricular haemorrhage and stage 2-3 necrotizing enterocolitis, perinatal mortality were compared with those without these complications. Administration of corticosteroid, tocolysis for two days and prophylactic antibiotics (intravenous ampicillin/sulbactam, and oral azithromycin) were the standard management protocol. The mean age at PPROM was 29 weeks 2 days (±3 weeks), the mean age at birth was 30 weeks 5 days (±20 days). CRP levels were not different between groups. Uni/multivariate analysis showed that maternal CRP levels were not related with neonatal outcomes. Neonatal complications in PPROM are related with the degree of prematurity and maternal WBC counts.

Objective: This study aimed to ultrasonographically determine the presence of short and long umbilical cords in full-term, uncomplicated pregnancies before delivery.Methods: A total of 681 pregnant women aged between 18 and 35 years who had a single pregnancy and an intact amniotic membrane, and who were past the 37th week of gestation, were included. Umbilical cord lengths were ultrasonographically evaluated using a new method, and were compared with postnatal umbilical cord length.Results: The mean index values for short, normal, and long umbilical cords were 2.96, 5.36, and 6.98, respectively. The cut-off index value for a short umbilical cord was 3.75 and the sensitivity and specificity were calculated as 67 and 97%, respectively, for a value ≤3, and as 92 and 80%, respectively, for a value ≤4. The cut-off index value was 6.25 for a long umbilical cord and the sensitivity and specificity were calculated as 75 and 78%, respectively, for a value ≥6, and as 85 and 64%, respectively, for a value ≥6.5.Conclusions: Calculation of the umbilical cord length index is a new ultrasonographic method that can be easily used to predict short and long umbilical cords during routine amniotic fluid evaluation in full-term pregnancies.

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

Objective This prospective study was designed to compare ultrasound and autopsy findings on fetal urinary system malformations in second trimester terminations of pregnancy to evaluate the degree of agreement of such findings. Methods From January 2003 to October 2012, a total of 308 second trimester terminations of pregnancy were performed because of fetal malformation diagnosed through second trimester ultrasound examination at a tertiary referral center. Result Among 308 second trimester fetuses with congenital anomalies, 62 (20.1%) had urinary anomalies. Ultrasound and fetal autopsy findings were in full agreement for urinary system malformations in 45 (72.6%) of 62 cases. In six (9.7%), autopsy confirmed the malformations detected by ultrasound but showed additional lesser urinary anomalies. In 10 (16.1%) cases, autopsy revealed major urinary anomalies not determined by ultrasound. In one case (1.6%), ultrasound reported bilateral renal agenesis; however, autopsy revealed a horseshoe kidney. The ultrasound screening sensitivity was 83.8%, and specificity was 99.5%. Conclusion The results showed that prenatal ultrasound achieved a high accuracy in diagnosing fetal urinary malformations. However, fetal autopsy occasionally adds valuable information to prenatal ultrasound findings. © 2014 John Wiley & Sons, Ltd.

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.

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.

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

Antenatal sonographic diagnosis of rhizomelic chondrodysplasia punctata depends on recognization of the combination of rhizomelic bone shortening and epiphyseal stippling. This is the only report of prenatal ultrasonographic diagnosis of bilateral cataracts in a fetus with rhizomelic chondrodysplasia punctata (type 1). Also, this is the first report of severe rhizomelic limb shortening, and bilateral cataracts prior to the recognization of epiphyseal stippling. Copyright (C) 2005 S. Karger AG, Basel.

BACKGROUND: Our main aim was to investigate the effects of melatonin (ME), possibly the most powerful free-radical scavenger, on the prevention of i.p. adhesion formation in rat uterine horn. Our secondary aim was to determine whether different methods of administration of ME were beneficial. METHODS: Animals were randomly assigned into seven groups, each consisting of 13 rats. Measured serosal injury was created using a standard technique. While control and two sham groups were not given ME, two of the remaining four groups were given a single dose of 10 mg/kg (2 mg) of ME i.p. immediately after injury and 30 min prior to injury respectively. In the two other groups, ME treatment was continued daily for 5 days. All animals were killed 2 weeks after surgery and adhesions were determined and scored by a examiner blinded to the test. RESULTS: The extent, severity and total scores of adhesion were found to be significantly reduced in all of the ME treatment groups when compared with control and sham groups. There were no statistically significant differences between the treatment groups. CONCLUSIONS: This study showed that even single dose ME therapy was effective in the prevention of post- operative i.p. adhesion formation.

Objective: The aim of this study was to evaluate the effects of hypertension and obesity on endometrial thickness. Study design: Forty obese women with hypertension (Group 1), 28 non-obese women with hypertension (Group 2), 58 obese women (Group 3), 56 nonobese healthy women (Group 4), totally 182 postmenopausal women were included in this prospective study. All patients were examined, and Papanicolaou cervical smear was performed after interview. Endometrial thickness was measured in the anterior-posterior diameter by vaginal ultrasonography. The data were analysed with one-way analyses of variance (ANOVA), Scheffe and 2 tests. P < 0.05 was accepted as statistically significant. Results: Endometrial thickness in obese women with or without hypertension were significantly greater than in non-obese women with or without hypertension (P < 0.05). There was no statistical difference between nonobese hypertensive women and control group regarding endometrial thickness measurement (P > 0.05). Conclusion: Obesity has been found to increase endometrial thickness independently. Hypertension may increase the endometrial thickness if it is combined with obesity. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

The aim of this study was to present our experience with 5 cases of fetal schizencephaly in terms of prenatal diagnostic features, and postnatal outcome. The database of prenatal diagnosis unit was searched for antenatally diagnosed cases with schizencephaly. Maternal characteristics, ultrasonography, prenatal-postnatal magnetic resonance imaging (MRI) findings, and postnatal outcome were noted. Of 5 cases, 2 had definitive prenatal diagnoses on ultrasound and 3 cases were diagnosed by fetal MRI. All cases had cerebral cortical migration anomalies including polymicrogyria, subependymal heterotopia, and lissencephaly, and 2 cases had additional extracranial malformations. Three cases showed regression of the cerebral clefts on follow-up postnatal MRIs. Three cases had moderate to severe psychomotor retardation, and 1 case needed repeated ventriculoperitoneal shunt operation due to hydrocephaly. Prenatal diagnosis of schizencephaly with ultrasonography is not straightforward and required further evaluation with fetal MRI. Additional cerebral anomalies worsen the prognosis of schizencephaly.

Background. The aim of this study was to measure the circulating levels of androgens in the third trimester of pregnancy and six weeks after delivery and to discuss androgen contribution in the pathogenesis of preeclampsia. Methods. Twenty-two preeclamptic and 20 normotensive women completed this prospective study. Blood samples were drawn in the third trimester (28-32 gestational weeks) and six weeks after delivery. Serum total testosterone ( T), free testosterone ( fT) dehydroepiandrosterone sulfate ( DHEAS), androstenodione ( A), sex hormone binding globulin ( SHBG) and estradiol ( E 2 ) levels were measured. The statistical analyses of the data were performed by using Wilcoxon Rank test within the groups, Student unpaired t test and Chi-square test between the groups with the SPSS program. Results. T and fT levels were found to be significantly higher ( p

Objective: To investigate the relationship between results of maternal thyroid function tests and endothelin levels in preeclamptic or eclamptic women. Methods: Thyroid hormones, TSH, and endothelin were measured in plasma or serum from 37 proteinuric, preeclamptic or eclamptic women and 20 normotensive, nonlaboring, pregnant women. Subjects were subdivided into four groups according to hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and birth weights of infants with respect to gestational age. Results: A significant decrease in concentrations of total thyroxine (T4) (13.76 ± 1.84 μg/dL versus 10.00 ± 1.48 μg/dL, P < .05), total triiodothyronine (T3) (180.58 ± 30.84 ng/dL versus 141.16 ± 27.31 ng/dL, P < .01), free T4 (1.45 ± 0.27 ng/dL versus 1.10 ± 0.21 ng/dL, P < .01) and free T3 (3.32 ± 0.56 pg/mL versus 2.41 ± 0.60 pg/mL, P < .01) and a significant increase in TSH (1.55 ± 0.89 μIU/mL versus 2.96 ± 1.07 μIU/mL, P < .05) and endothelin (2.31 ± 0.61 pg/mL versus 6.11 ± 1.41 pg/mL, P < .001) levels were observed in the preeclamptic-eclamptic group compared with the normotensive group. Also, women without HELLP syndrome and without small-for-gestational-age infants had elevated levels of thyroid hormones and decreased levels of TSH and endothelin compared with other subgroups, but stastical significance was reached only in total T4 (P < .05), TSH (P < .05), and endothelin (P < .001). Birth weights of infants born to preeclamptic or eclamptic women correlated positively with total T4 (P < .01) and total T3 (P < .01) and negatively with TSH (P < .01) levels. A more significant negative correlation was found in preeclamptic-eclamptics (P < .001) between birth weight and endothelin levels than in control subjects (P < .05). Endothelin levels in preeclamptic or eclamptic women correlated negatively with total T4 (P < .01), total T3 (P < .05), free T4 (P < .05), and free T3 (P < .05) and positively with TSH levels (P < .01) compared with control subjects. Conclusion: Moderate decreases in thyroid hormones with concomitant increases in TSH levels in maternal serum correlated with severity of preeclampsia or eclampsia and high levels of endothelin. Changes in results of thyroid function tests induced by preeclampsia or eclampsia might be consequences of the dysfunction in the hypothalamic-pituitary-thyroid axis, secondary to the disease itself.

The aim of the study was to determine, whether bladder weight changes in the menopause and whether there is any correlation between lower urinary tract symptoms and bladder weight or the duration of menopause. A total of 94 women (30 without gynecologic or obstetric complaints, 31 with menopause less than 5 years and 33 menopause of 5 years or longer) were entered into the study. Bladder weights were determined ultrasonographically. The International Prostate Symptom Score questionnaire was used to evaluate lower urinary tract symptoms. A negative correlation was found between bladder weight and the duration of menopause. There was no significant difference between the three groups in terms of overall symptom scores. However, urgency incontinence score was the highest in the early postmenopausal period. In addition, the postmenopausal women had a significant negative correlation between the duration of menopause and frequent voiding scores. It was concluded that, ultrasonographically measured bladder weight decreases with the duration of menopause. Detailed studies with larger numbers of older women are needed to determine clearly whether this decrease in bladder weight has more significant effects on lower urinary tract symptoms.

This prospective study was designed to compare ultrasound and autopsy findings on fetal urinary system malformations in second trimester terminations of pregnancy to evaluate the degree of agreement of such findings.From January 2003 to October 2012, a total of 308 second trimester terminations of pregnancy were performed because of fetal malformation diagnosed through second trimester ultrasound examination at a tertiary referral center.Among 308 second trimester fetuses with congenital anomalies, 62 (20.1%) had urinary anomalies. Ultrasound and fetal autopsy findings were in full agreement for urinary system malformations in 45 (72.6%) of 62 cases. In six (9.7%), autopsy confirmed the malformations detected by ultrasound but showed additional lesser urinary anomalies. In 10 (16.1%) cases, autopsy revealed major urinary anomalies not determined by ultrasound. In one case (1.6%), ultrasound reported bilateral renal agenesis; however, autopsy revealed a horseshoe kidney. The ultrasound screening sensitivity was 83.8%, and specificity was 99.5%.The results showed that prenatal ultrasound achieved a high accuracy in diagnosing fetal urinary malformations. However, fetal autopsy occasionally adds valuable information to prenatal ultrasound findings.

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.

A 28-year-old woman in whom a copper-T 280-A intra-uterine device (IUD) had been placed 6 months previously, presented complaining of urinary system infection and lower abdominal pain. Intra-vesical migration of IUD was confirmed by radiography and cystoscopy. Since 1966, 17 other cases of calculus formation among 41 cases of intra-vesical migration have been reported. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

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

BACKGROUND Our aim was to investigate the effects of metformin and letrozole on experimentally induced endometriosis in a rat model. METHODS Endometriotic implants were surgically formed, and 38 rats were randomly divided into four groups. Group 1 (control group, 8 rats) was given no medication. Group 2 (metformin group, 10 rats) was given 100 mg/kg/day of oral metformin. Group 3 (metformin group, 10 rats) was given 200 mg/kg/day of oral metformin. Group 4 (letrozole group, 10 rats) was given 0.1 mg/kg/day of oral letrozole. All rats continued to receive the treatment for 4 weeks and then were sacrificed to assess the size of implants and scores of adhesions. The histopathologic scores of implants in excised endometriotic foci were examined by a pathologist. RESULTS The mean surface area of endometriotic implants was similar in all groups before the treatment. Although the area was not reduced in controls, it was found to be significantly reduced in all treatment groups (44.50 +/- 23.37, 5.90 +/- 2.37, 4.30 +/- 1.33, 6.90 +/- 3.72 mm(2), respectively; P < 0.05). The effect was comparable between the treatment groups. The histopathologic assessment revealed that the histopathologic score of implants was lowest after 100 mg/kg/day metformin. Additionally, metformin reduced the severity of adhesions. CONCLUSIONS Metformin and letrozole caused a statistically significant regression of endometriotic implants. The effects of metformin on endometriotic tissue were at least comparable to letrozole.

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Objective The aim of the study was to compare the consistency of major/minor fetal anomalies detected by second trimester prenatal ultrasound examination with the findings in fetal autopsies following the termination of pregnancy (TOP) in the second trimester. Design In a 4-year long prospective study, 107 second-trimester TOP was performed due to fetal malformation diagnosed by second trimester-ultrasound examination at a tertiary referral center. Ultrasound findings were compared with fetal autopsy findings. Result Of the 107 cases with major fetal anomalies diagnosed by prenatal ultrasound, 49% had central nervous system anomalies, 23% had kidney and urinary tract anomalies, 11% had congenital heart disease. All of these major anomalies leading to TOP were confirmed by fetal autopsy (100% success rate in major anomalies). Overall success rate in prenatal ultrasound for major and minor anomalies was 77%. The percentage of additional minor anomalies detected in fetal autopsies was 20%. Three percent of the minor anomalies detected by prenatal ultrasonography could not be confirmed during autopsy. Chromosomal anomalies were detected in 9 (16%) out of 57 cases. Conclusion Evaluation of fetal autopsies following TOP enables diagnosis of pathologies undetected by prenatal ultrasound alone, leading to better preconceptional counseling for subsequent pregnancies. Copyright © 2007 John Wiley & Sons, Ltd.

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.

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.

We aimed to determine the value of maternal erythrocyte malondialdehyde levels in the prediction of preeclampsia. 110 healthy women were included in this prospective study. Maternal erythrocyte malondialdehyde levels were measured at each trimester of pregnancy (10-14, 20-25 and 30-35 gestational weeks). On follow-up, patients were assigned to two groups as normotensive women and preeclamptic patients. Preeclampsia had developed in eight (8.9%) of the 90 pregnant women who completed the study. Preeclamptic patients were diagnosed between 36 and 39 gestational weeks (36.8 +/- 1.0 weeks). Malondialdehyde levels of preeclamptic patients increased significantly in the third trimester (p < 0.05), while there was no difference between values of malondialdehyde in the first and second trimester. Malondialdehyde levels were significantly higher in the patients who developed preeclampsia than in those who did not in the third trimester (p < 0.05). With the use of the receiver operating characteristics (ROC) 35.98 nmol malondialdehyde/gm hemoglobin was found to be a cut-off value predictive for the development of preeclampsia in the third trimester. However, cut-off values in the first and second trimesters could not be found. The sensitivity, specificity, positive and negative predictive values were 89, 75, 29 and 98%, respectively. Preeclampsia risk was found to increase nearly 24 times in values above 35.98 nmol malondialdehyde/ gm hemoglobin. Our results showed that maternal erythrocyte malondialdehyde could predict patients within a few weeks prior to onset of clinical symptoms of preeclampsia in the third trimester. There is no evidence of enhanced early lipid peroxidation in pregnancies with late onset preeclampsia.

To measure maternal serum and amniotic fluid leptin concentrations in pregnant women diagnosed antenatally as having fetuses with a neural tube defect in the second trimester.Twenty pregnant women who had fetuses with a neural tube defect detected on ultrasonography (neural tube defect group) in the second trimester and 20 women who had abnormal triple screens indicating an increased risk for Down syndrome but had healthy fetuses (control group) were enrolled in the study. Amniotic fluid was obtained by amniocentesis, and maternal serum samples were taken simultaneously.The mean leptin levels in amniotic fluid (P.001) and maternal serum (P.05) of patients who had fetuses with a neural tube defect were found to be significantly higher than control group levels. The mean leptin levels in maternal serum of both groups were also higher than leptin levels in amniotic fluid (P.05 for the neural tube defect group and P.001 for the control group). Although there were significant correlations between maternal weight, weight gain, body mass index at the time of amniocentesis, and maternal serum leptin concentrations in both groups, a significant correlation between leptin concentrations in maternal serum and amniotic fluid was found only in the neural tube defect group (P.05).We found significantly higher leptin levels in both amniotic fluid and maternal serum of patients who had fetuses with a neural tube defect. We suggest that the main source of leptin in amniotic fluid of pregnant women who had fetuses with a neural tube defect is the leakage into amniotic fluid from cerebrospinal fluid. The increase of maternal serum leptin concentrations has been attributed to the transportation of amniotic fluid leptin to the maternal circulation.

Objective: To determine the long-term effects of estrogen replacement therapy on sex hormone binding globuline (SHBG) and free testosterone (fT) levels in surgical postmenopausal women. Study Design: Forty patients with surgical menopause were enrolled in this prospective study. The women were randomly divided into two groups. The first group received oral therapy (continuous conjugated equine estrogens (CEE) - 0.625 mg per day) and the second group received transdermal therapy (patches delivering continuous 17 beta -estradiol (E2) - 0.05 mg per day). Serum SHBG and fT levels were determined at baseline and after first and second years of treatment. Two-way repeated measures analysis of variance with Bonferroni adjusted post-hoc test and unpaired-t-test were performed for statistical analysis with SPSS program. Results: Serum SHBG levels increased significantly with oral CEE after first year of treatment (P < 0.05) and remained at this level for the next year. Transdermal therapy did not affect SHBG levels after first and second years (P < 0.05). Serum fT levels did not change significantly in either group at the end of the first or second years (P < 0.05) although there was a significant difference between the groups after 2 years (P < 0.05). Conclusion: Oral conjugated estrogens increased SHBG levels during therapy. This effect may balance the increased estrogen and androgen stimulation on breast tissue and may be more beneficial to the cardiovascular system in postmenopausal women. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.

The purpose of our study was to compare the effects of cyclical versus continuous transdermal oestrogen replacement therapy on lipoprotein (a) (Lp(a)) and nitric oxide levels. The patients were randomly assigned into two groups. The first group received transdermal 17-beta oestradiol 50 mug/day for 21 days and the second group the same treatment on a continuous basis. Medroxyprogesterone acetate (10 mg/day orally) was added between the 14th and 25th days to each group. Lipoprotein (a) and nitric oxide levels were measured before the study and after six months. These values were compared using the Wilcoxon rank test within the groups and the unpaired t-test between the groups. Lipoprotein (a) levels decreased significantly in each group at the sixth month (p < 0.05). When compared between the groups, the decrease of lipoprotein (a) levels in the second group was more prominent at the sixth month (p < 0.05). Nitric oxide levels increased in each group after six months (p < 0.05). No difference in nitric oxide levels was observed between the groups before and after the therapy (p > 0,05). Continuous transdermal estradiol had a better effect on lipoprotein (a) levels than cyclical therapy The seven day pause in the 21-day administration did not affect nitric oxide levels negatively after six months.

Our objective was to determine the effectiveness of intraperitoneal single dose piroxicam and low molecular weight heparin (LMWH) on prevention of adhesion reformation in the rat uterine horn. This study was carried out in the Surgical Research Laboratory, at Erciyes University. A standard lesion was created by unipolar electrocautery in 72 uterine horns of 36 female Wistar-Albino rats. After 2 weeks, adhesion formation scores were determined and adhesiolysis was performed in the second-look laparotomy. Animals were then randomly assigned into three groups. Each group contained 12 animals: group 1 was the control group where no adjuvant was given; in group 2, 1 ml 50 U Axa IC/ml solution LMWH was applied to the horns postoperatively, and in group 3, 1 ml 2 mg/ml piroxicam solution was applied to the horns after adhesiolysis. Two weeks later the rats were killed and adhesion reformation was evaluated. The number of horns with adhesion formation and the cumulative scores were not significantly different among the three groups in the second-look laparotomies, but after third-look laparotomies, the number of horns with adhesion reformation, after calculating the extent, severity and total scores of adhesion reformation, was found to be significantly less in LMWH and piroxicam groups than in the control group. Also, the effectiveness of piroxicam was significantly greater in all scores of adhesion reformation than LMWH was. In conclusion, both LMWH and piroxicam doses reduce adhesion reformation in the rat uterine horn, but the effectiveness of piroxicam is significantly greater than that of LMWH.

The measurement of myocardial damage by newer, highly specific markers of myocardial damage is now possible, including cardiac structural proteins such as troponin T (TnT). In neonates of pre-eclamptic mothers, it identifies minor myocardial damage missed by other biochemical markers. The present study was designed to determine the diagnostic value of TnT concentrations in neonates of pre-eclamptic mothers. Fifteen neonates of pre-eclamptic mothers were studied (9 boys and 6 girls), and 17 healthy full-term neonates (9 boys and 8 girls) were selected as a control group. The serum TnT concentration in neonates of pre-eclamptic mothers (0.70 ng/ml) was significantly higher than that in the control group (0.10 ng/ml). In an echocardiographic study, the mean mitral peak velocity at an atrial contraction (A) value of 39 cm/s in neonates of pre-eclamptic mothers was significantly lower than that in the control group (53 cm/s), and the mean mitral peak velocity of early diastole to peak velocity of the atrial contraction (E/A) value (1.75) in neonates of pre-eclamptic mothers was significantly higher than that in the control subjects (1.23). In conclusion, our study demonstrated high levels of cardiac TnT, lower mitral A values and high mitral E/A values in neonates of pre-eclamptic mothers, presumably associated with mild myocardial damage in the neonates of pre-eclamptic mothers.

The purpose of this study was to identify possible changes in thyroid functions in newborn infants of preeclamptic women. Fifteen neonates (nine boys and six girls) of preeclamptic women and 17 healthy neonates (nine boys and eight girls) for the control group were included in the study. Serum thyroid-stimulating hormone (TSH), total triiodothyronine (TT3) and total thyroxine (TT4) levels and thyroid gland volumes were determined in both groups. Serum TSH and TT4 levels were not statistically different between the two groups. However, serum TT3 level was 79.22 +/- 40.19 ng/dl in the study group and 40.00 +/- 15.99 ng/dl in control subjects (p < 0.01). The mean right, left and total thyroid volumes were 1.3 +/- 1.2 ml, 1.2 +/- 1.1 ml and 2.4 +/- 2.3 ml in the study group and 0.6 +/- 0.2 ml, 0.6 +/- 0.2 ml, and 1.1 +/- 0.4 ml in the control group, respectively (p < 0.05). The mean thyroid volume/body weight was 0.9 +/- 0.09 ml/kg in the study group and 0.3 +/- 0.06 ml/kg in the control group (p < 0.05). In conclusion, we would like to stress that preeclampsia might be a cause of fetal and neonatal thyroid enlargement and elevated serum TT3 level.

The purpose of our study was to make a contribution to research in determining the least harmful progestogen dose for women who have not had their uterus removed. The study was an open comparative trial. The patients were consecutively assigned to two groups. The first group (n = 19) were given 0.625-mg conjugated equine estrogen plus 5-mg medroxyprogesterone acetate (MPA), and the second (n = 18) 0.625-mg conjugated equine estrogen plus 2.5-mg MPA. Serum total cholesterol (T-cholesterol), triglyceride, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels plus LDL-C/HDL-C values (atherogenic index) were measured before the study and again after 6 and 12 months. These values were compared with ANOVA and postANOVA tests (Scheffe) within the groups and with unpaired t-test between the two groups. The triglyceride serum levels in the first group were decreased in the 12th month compared to baseline levels. In addition, LDL-C/HDL-C values were significantly decreased in the 6th month, but these values slightly increased in the following 6 months. In the second group, T-cholesterol, triglyceride, LDL-C and atherogenic index were decreased in the 12th month when compared to baseline levels within the groups. This decrease was statistically significant (p0.05). There was no significant difference between the two groups (p0.05). Hormone replacement therapy with continuous 0.625-mg conjugated equine estrogen and 2.5-mg MPA had a better effect on lipid profiles than 0.625-mg conjugated equine estrogens and 5-mg MPA after 12 months of treatment.

Objective: To determine the effectiveness of hyaluronic acid (HA) and heparin [unfractioned heparin (UH) or low molecular weight heparin (LMWH)] combination in reducing adhesion formation in a rat uterine horn model. Study Design: Prospective, randomized, comparative study in a rat model was done in Surgical Research Laboratory, Erciyes University. A standard lesion was created by unipolar electrocautery in 120 uterine horns of total 60 female Wistar-Albino rats. Animals were then randomly assigned into four groups, each consisting of 15 animals: (1) control, no adjuvant given, (2) HA, 1 mi of 0.4% solution given onto each horn preoperatively; (3) HA, 1 ml of 0.4% solution given preoperatively plus 1 mi of UH given postoperatively; (4) HA, 1 mi of 0.4% solution given before injury plus 1 ml of LMWH given after injury. A second-look laparotomy was performed two weeks after surgery. The number of horns with adhesion was determined and a scoring system applied. Result(s): The number of horns without adhesion formation was significantly higher in HA plus UH (P

Objective: To compare the effects of continuous noncombined transdermal estradiol versus oral conjugated estrogen on serum sex hormone-binding globulin (SHBG) levels prior to and during the 10th and 22nd weeks of therapy in patients with surgical menopause. Study design: Open, comparative trial. Patients were consecutively assigned to three groups: group 1 (n=18) received continuous transdermal estradiol (0.050 mg/day), group 2 (n=18) continuous oral conjugated estrogens (0.625 mg/day), whereas group 3 (n=15) received no treatment. Serum SHBG levels were determined before treatment and after 10 and 22 weeks of treatment. Results: Serum SHBG increased significantly with oral conjugated estrogens at 10 (p0.05). Conclusion: Transdermal estrogen has no effect on SHBG, whereas oral conjugated estrogens causes a considerable increase. (C) 1997 Elsevier Science Ireland Ltd.