The efficiency of hysterosalpingo-contrastsonography (HyCoSy) in the evaluation of tubal patency

Radiological hysterosalpingography (R-HSG) and laparoscopic hydrotubation are widely used for the evaluation of tubal patency in infertile patients. Both methods have advantages and disadvantages that limit their use. In this study, the efficiency of a new method (HyCoSy) in the diagnosis of tubal patency was evaluated by comparing it with the traditional methods (R-HSG and laparoscopic hydrotubation). In a total of 47 infertile patients HyCoSy was performed in the evaluation of tubal patency, between November 1996 and May 1997 at Akdeniz University, Department of Obstetrics and Gynaecology. In 18 of 47 patients, the traditional methods were also performed and the results were compared with HyCoSy. In this study laparoscopic hydrotubation was accepted as the 'gold standard'. In 36 fallopian tubes of 18 patients the clinical concordance of HyCoSy and laparoscopic hydrotubation was 86%, R-HSG and laparoscopic hydrotubation was 77%. In this study it was shown that in the evaluation of tubal patency the new method; HyCoSy is statistically comparable with the traditional methods. HyCoSy has the advantage of being easily repeatable compared with R-HSG and this may reduce false-positive results. Furthermore HyCoSy is a welltolerated and easily applicable method compared with R-HSG.

Pericardial cystic mass with fetal tachycardia

A pericardial cystic mass is a rare congenital anomaly and may be mistaken for other pericardial and pleural masses. A 31-year-old pregnant woman at 38 weeks of gestation presented with fetal pericardial cyst and fetal tachycardia, which were confirmed by transthoracal echocardiography after delivery. Tachycardia did not persist after delivery. The case is being followed up without any clinical problems at the pediatric cardiology clinic.

Misoprostol in second and early third trimester for termination of pregnancies with fetal anomalies

OBJECTIVES

To assess the effectiveness of a prostaglandin E1 analog, misoprostol, using different regimens compared with dinoprostone in termination of pregnancies in second and early third trimester complicated by either congenital fetal anomalies or intrauterine fetal demise.

METHODS

A retrospective review of 59 pregnancies between 15 and 30 weeks was performed which were terminated due to congenital fetal anomalies or intrauterine fetal demise. In group 1 (n=29) 400 microg oral and 600 microg vaginal misoprostol, in group 2 (n=12) 600 microg vaginal misoprostol and in group 3 (n=18) 0.5 mg dinoprostone gel were given for the termination of the pregnancies. All these groups were evaluated for demographic characteristics and delivery findings. Statistical analysis were performed by one-way ANOVA, Kruskal-Wallis and chi(2)-test.

RESULTS

No significant statistical difference was observed in terms of age, gravidity, parity, previous abortion, gestational week, frequency of prostaglandin usage, and birth weights among the three groups. The time intervals between the first administration and delivery were 20.3 h for oral vaginal misoprostol, 17.3 h for vaginal misoprostol and 22.5 h for the dinoprostone group (P=0.594). Evacuation rates after single doses were similar in all groups (83%, 73% and 72%, respectively). Uterine tachysystole was the only major side effect encountered in the oral-vaginal misoprostol group.

CONCLUSIONS

All three regimens yielded similar results for termination of pregnancies in second and third trimester. The major advantage of misoprostol was the cost.

The effect of platinum-based combination chemotherapy on the lymph nodes in advanced-stage epithelial ovarian cancer: does it decrease the incidence of lymph node involvement?

This paper aims to determine the impact of platinum-based combination chemotherapy on the lymph nodes in advanced-stage epithelial ovarian carcinoma. From 1997 to 2000, the patients in whom we performed lymphadenectomy before (group A) or after chemotherapy (group B) in the Department of Obstetrics and Gynecology, Akdeniz University School of Medicine were enrolled in this study. A total of 47 cases were included in the study. Twenty five cases had lymphadenectomy during the initial laparatomy and 22 cases during second-look procedures. Lymph node metastasis was detected in 14 (56%) patients in group A and in 10 (45.4%) cases in group B (P > 0.05). Platinum-based combination chemotherapy does not decrease significantly the incidence of involved lymph nodes in advanced-stage epithelial ovarian carcinoma.

Impact of different hormone replacement therapy regimens on the size of myoma uteri in postmenopausal period: tibolone versus transdermal hormonal replacement system

OBJECTIVES

To assess the effect of different hormone replacement therapy regimens on myoma uteri in postmenopausal period.

METHODS

Totally 46 patients with 60 myomas attending to Department of Obstetrics and Gynecology, Akdeniz University School of Medicine between May 2000 and March 2001 because of postmenopausal symptoms and having myoma uteri were included in this study. These patients were randomized for tibolone and transdermal hormonal replacement therapy system. The patients who were taking hormonal replacement therapy, discontinued the treatments and lost for follow-up were excluded from the study. Impact of the treatments on the size of myoma uteri was evaluated 6 months after starting the therapy. Size of myomas were evaluated by transvaginal sonography before and 6 months after onset of the treatment.

RESULTS

Mean age was 57.3 (50-70) and mean gravida 3.6 (1-6) for all the patients. Although, increase in the size of myoma uteri was frequent in transdermal HRT, it was not statistically significant.

CONCLUSION

There are no statistical significant differences between tibolone and transdermal hormonal replacement therapy regimens in respect to increase in the size of myoma uteri.

Telomere-specific fluorescence in situ hybridization analysis of couples with five or more recurrent miscarriages

Fluorescence in situ hybridization analysis using telomere specific probes has been used to detect cryptic translocations in the chromosomal telomeric regions. This study was performed in five clinically normal couples who have had five or more spontaneous abortions and whose karyotypes were found to be normal using conventional cytogenetic techniques. Using the telomere specific probes, in one couple we determined a cryptic translocation between chromosome 3 and 10, and, in another couple, the signal in chromosome 20 was detected in another chromosome, which was probably a D group chromosome. Additionally, in the latter and also in two other couples, we observed a polymorphism. The approach will be helpful for screening cryptic translocations using telomere specific multiple probe sets in couples with recurrent miscarriages. As prenatal diagnosis will be available for these couples for future pregnancies, it will be possible to help these families to have healthy fetuses.

Toxicity of chemotherapeutical protocols in the treatment of uterine sarcomas (Vincristine, actinomycin D, Cyclophosphamide VAC versus ifosfamide)

OBJECTIVE

Uterine sarcomas are rare tumors which account for 1% of all genital tract malignancies. They have a poor prognosis with an overall survival of under 50% at 2 years. The benefit of chemotherapy is unclear and different chemotherapy protocols are used for the treatment of uterine sarcomas. But there is little experience about their toxicity because of the limited case series. So we compared VAC protocol and ifosfamiide for toxic effects.

MATERIAL AND METHOD

We reviewed 13 cases which were diagnosed as uterine sarcomas and treated with surgery plus chemotherapy at The Department of Obstetrics and Gynecology, Akdeniz University School of Medicine from 1990 to 1995. Data were obtained from patient files.

RESULTS

Mean age was 55.7 (range 38-70), 7 (53.8%) patients had malignant mixed mullerian tumors and 6 (46.1) had leiomyosarcomas. A total of 32 courses of chemotherapy were given -20 ifosfamide and 12 VAC therapy. Leucopenia, hepatic dysfunction and peripheral neuropathy were more frequent in the VAC group as 75%, 16.6%, versus 30%, 0%, 0%, in the iFosfamide group respectively. However, urothelial toxicity (35%) was more common in the ifosfamide group.

CONCLUSION

VAC protocol is more toxic for the liver, hematopoietic and peripheral neurologic system. On the other hand the major toxicity of ifosfamide was on the urinary tract. Ifosfamide may be a good choice with less toxicity than VAC therapy in the treatment of uterine sarcomas.

Primary pure choriocarcinoma of the ovary in reproductive ages: a case report

Choriocarcinoma is an aggressive tumor with cyto- and syncytiotrophoblastic cells. It arises gestationally or nongestationally. Nongestational choriocarcinoma of the ovary can be pure or mixed with other germ cell tumors. Pure type is less frequent than mixed type and the diagnosis of nongestational choriocarcinoma of the ovary is very difficult in the reproductive period. A case of a 20-year-old woman with pure choriocarcinoma of the ovary is presented with a review of the literature and discussion of its origin.

Intravaginal naproxen in preterm labour: a preliminary study

In a preliminary study, the possibility that local inhibition of postaglandin formation may inhibit preterm labour was examined. An intravaginal cyclo-oxygenase inhibitor, naproxen sodium, 500 mg was used in cases of preterm labour. The gestational ages of the patients were between 27 and 34 weeks, and they included a triplet pregnancy unresponsive to beta-sympathomimetic therapy. Treatment with intravaginal naproxen sodium was associated with prolongation of pregnancy for more than 6 days in five out of seven patients. No untoward fetal or maternal side-effects were detected.

Induction of labor with intravaginal misoprostol versus intracervical dinoprostone

Sixty five pregnant women who had the indication for labor induction were randomized in a clinical trial to receive 100 micrograms intravaginal misoprostol or intracervical gel of 0.5 mg dinoprostone. The mean time from induction to delivery for the misoprostol group was 7.6 +/- 1.9 versus 8.2 +/- 5.9 (hours +/- SD) for the dinoprostone group. There were no significant differences between groups in gestational age, induced labor rates, type of delivery, fetal outcome and maternal complications. We found that intravaginal misoprostol tablet is as effective as intracervical dinoprostone for inducing second and third trimester labor.

Radionuclide hysterosalpingography with radiolabeled spermatozoa

OBJECTIVE

To evaluate the efficiency of radionuclide hysterosalpingography (HSG) by using 99mTc hexamethyl propyleneamine oxime (HMPAO)-labeled human spermatozoa in the assessment of fallopian tube patency in infertile couples.

DESIGN

Fifteen infertile female patients were inseminated with their husbands' radiolabeled spermatozoa immediately after cessation of menses.

SETTING

University-based academic hospital.

MAIN OUTCOME MEASURE(S)

The time course of radioactivity and scintigraphic images of the uterus and the parauterine tissues implying tubal patency were evaluated and compared by using laparoscopy and HSG.

RESULT(S)

We demonstrated Tmax (time to peak radioactivity at periovarian sites) for right and left tubes to be 6.74 +/- 2.66 and 5.91 +/- 2.93 minutes (means +/- SD), respectively. We also found 72% sensitivity and 75% specificity of spermatozoa labeled radionuclide HSG compared with laparoscopic findings for tubal patency.

CONCLUSION(S)

Radionuclide HSG with the husband's spermatozoa seems to be a potentially useful method of assessing patency of the fallopian tubes. The safety dose of this procedure is comparable to conventional HSG. However, more comparative studies are needed to evaluate advantages and disadvantages of this technique.

Immunologic evaluation of a neonate born to an immunosuppressed kidney transplant recipient

There are only a few reports about immunologic evaluation of neonates who have been exposed to immunosuppressive drugs during fetal life. We followed up immunoglobulins, T, B and natural killer (NK) cell levels in an infant of a kidney transplant recipient who has been exposed to cyclosporine, azathioprine, and prednisolone during his fetal life. B-cell percentage, absolute counts, and immunoglobulin levels were normal at birth, but IgG value was lower than our normal controls at 3 months and low normal at 6 months of age. Serum IgM levels were normal in all determinations, but IgA levels were lower than the control values during the follow-up period. B cell percentage and absolute counts were higher than the control values at 3 and 6 months. T-cell subpopulations were normal except for CD4+/CD8+ ratios that stayed high normal due to increased CD4+ cells. CD16+ (NK cells) absolute counts and percentages were below normal at birth and at 3 months. Clinically, increased susceptibility to infection was not observed during the follow-up period. More immunologic studies are needed on possible effects of in utero exposure to cyclosporine, azathioprine, and prednisolone.