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.

Complications of radical hysterectomy: clinical experience of 115 early stage cervical cancers

We evaluated the clinical experience of 115 women with early stage cervical cancer who had been operated in our Gynecologic Oncology Clinic. Of these, 85 were in stage I, and 30 in stage II. Intraoperative complications occurred in 16 patients including 3 cases concerning bladder, 1 ureter, 1 aorta, 5 v.cava inferior, 1 internal iliac a., 3 internal iliac v., 1 obturator nerve and 1 rectovaginal septum hematoma formation. Postoperative complications were observed in 38 patients. These were 14 bladder dysfunctions, 10 lymphocyst formations, 6 urinary infections, 12 wound infections, 3 pelvic infections, 2 eviscerations and 1 incisional hernia. However, no death occurred due to intraoperative or postoperative complications. Pelvic lymph node metastases were observed in 32 patients of whom 17 had only unilateral involvement, most often in the obturator region. Para-aortic lymph node metastases were diagnosed in 4 patients, all of whom were in stage II.

The utilization of immunohistochemical prognostic factor in endometrial adenocarcinoma: is it cost effective?

This study investigated the relation between immunohistochemical prognostic factors and clinical stage and histopathological grade in endometrial adenocarcinoma. Twenty-seven patients with a mean age of 61 (38-74), who underwent radical surgery due to endometrial adenocarcinoma in our hospital between 1983-1998, were re-evaluated. For clinical staging FIGO criteria were used. Histopathological differentiation of the tumor was graded as good (grade 1), moderate (grade 2), and poor (grade 3). Estrogen and progesterone receptors, c-erb B2, UEA 1, Ki-67, PCNA and p53 were studied as immunohistochemical prognostic factors. There were no patients in stages IA and IIIB. Among the prognostic factors, PCNA was the most significantly stained marker, followed by c-erb B2, estrogen and progesterone receptors, regardless of the clinical stage and histopathological grade of the tumor. The least positivity was achieved with Ki-67. There was no significant difference when each prognostic factor was analysed with respect to clinical stage and histopathological grade. In our study no significant relation was found between the prognostic factors and the clinical stage and histopathological differentiation of the tumor. Therefore the cost effectiveness of the utilization of these factors should be reconsidered.

Partial hydatidiform mole with diploid karyotype in a live fetus

Even though most instances of partial mole are triploid, only a few cases of diploid partial moles have been reported. Prognosis of partial mole is usually better than the complete mole as few cases of partial moles progress to persistent trophoblastic disease. However, the nature and the risks of diploid partial moles are not well established and they seem to be a distinct clinical entity. Here we report a case of partial mole presenting with a 22 weeks live fetus and preeclampsia. Fetal blood sampling was performed for cytogenetic analysis which revealed a diploid (46XY) karyotype. No progression to malignant gestational trophoblastic disease occurred.

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.

Emergency hysterectomy in modern obstetric practice. Changing clinical perspective in time

OBJECTIVE

Emergency hysterectomy in obstetric practice is generally performed in the setting of life-threatening hemorrhage. A retrospective review based on hospital data of 67 patients undergoing emergency peripartum hysterectomy over 10 years was undertaken.

METHODS

Comparison of two different time periods regarding the incidence and the indications of obstetric hysterectomies was made.

RESULTS

The number of patients with hysterectomy in the first 5 years of the study period (1985-1989) was 43 and during the last 5 years (1990-1994) it was 24. The incidence of hysterectomy during 1985-1989 was 1 in 2495 deliveries and the most common indication for hysterectomy was uterine atony (42%) followed by placenta accreta (25.5%) and uterine rupture (21%). On the other hand, the incidence of hysterectomy during 1990-1994 was 1 in 4228 deliveries and the ranking of indications of hysterectomy was slightly different from group 1 as mostly placenta accreta (41.7%) followed by uterine atony (29.2%). The maternal mortality rate was 4.5% in this series.

CONCLUSION

This study showed that over the last decade the incidence of emergency hysterectomy in obstetric practice has declined in our clinic due to availability of high standard obstetric care and more liberal use of cesarean section at risk deliveries, better controlled use of oxytocin and internal iliac artery ligation.

The significance of birth weight difference in discordant twins: a level to standardize?

OBJECTIVE

To evaluate the significance of different degrees of birth weight discordance in twin pregnancies.

DESIGN

Population based study.

METHODS

Three hundred and eighty-four twin gestations over 20 weeks of gestation during a two-year period ending in 31.12.1995 were retrospectively analyzed. Twins were stratified into six categories according to the percent difference in infant birth weight. The difference in percents was calculated from the larger twin; (Birth weight of larger twin--Birth weight of smaller twin)/Birth weight of larger twin and multiplied with 100. The relationship between different categories and the subsequent perinatal and neonatal outcomes was assessed.

RESULTS

Among 384 pairs thirteen patients were identified to have single fetal demise and fourteen patients were documented to have dead fetuses of both twin pairs. Of 357 twin gestations studied 137 (38.4%) had discordance of < 10% and 36 experienced discordance of > 30% (10.1%). The frequency of low APGAR score (< 7) in women with > 30% discordance was higher than that of < 10% group (16.7% vs. 9.5%). Intensive care for infants was required in 30 infants with > 30% birth weight discordance (41.7%) and in 24 cases with < 10% birth weight discordance (8.8%). Thirty-three percent of cases with discordance of > 30% experienced neonatal mortality whereas the corresponding figure for patients with < 10% discordance was 1.5%.

CONCLUSION

We postulate that definition of discordant growth in twin gestations should be categorized with respect to gestational week since the level of discordance prejudicing fetal or neonatal jeopardy may vary in different stages of pregnancy.

Conservative management of twin pregnancies with one dead fetus: is it safe?

BACKGROUND

Fetal death in one of the twins is unusual and the management issue of such a condition is not straightforward.

METHODS

We reviewed the outcomes of nine twin pregnancies with one dead fetus in whom follow-up period exceeded 3 weeks.

RESULTS

The twinning frequency was 8.9 per thousand deliveries and the frequency of subsequent antepartum death of one fetus was found to be 3.8%. The preterm birth rate was 45.5% and the survival rate was 90.1%. The perinatal mortality rate was 12%. Maternal clotting disorder was observed in one patient and treated successfully with heparin.

CONCLUSIONS

We suggest that these patients are best managed conservatively unless further hazard to the fetus or mother appears.

Endocrinological and clinical analysis of hyperprolactinemic patients with and without ultrasonically diagnosed polycystic ovarian changes

In the present study we aimed to identify the relationship of hyperprolactinemia and polycystic ovarian changes. We retrospectively analyzed the endocrinological and clinical features of 79 hyperprolactinemic patients detected during a 3-year period ending in March 1995. Patients who had hypothyroidism, macroprolactinoma and drug-induced hyperprolactinemia were excluded from the study. Among 61 hyperprolactinemic patients, 41 (67.2%) had ultrasonographically diagnosed polycystic ovaries (PCO). Prolactin levels in the PCO and non-PCO groups were 32.8 +/- 5.8 and 36.7 +/- 5.1 ng/dl, respectively, which was a significant difference (p < 0.05). Hirsutism was associated with hyperprolactinemia in 55.7% of the patients and was found to be more frequent in the PCO (58.8%) than the non-PCO group (41.2%). The mean Ferriman Gallwey scores and both total and free testosterone levels were significantly higher in the PCO group in comparison to the non-PCO group. In addition, a significantly higher body mass index was detected in patients with PCO. We documented a frequent association between hyperprolactinemia and polycystic ovarian changes and suggested that hyperprolactinemia in PCO is most likely related to a pathologic-endocrinologic milieu.

Low dose ketoconazole is an effective and a relatively safe alternative in the treatment of hirsutism

Efficacy, clinical and hormonal effect of ketoconazole in 400 mg/day dose was tested in a prospectively-designed study. Twenty four patients with hirsutism according to the Ferriman and Gallwey score (> 8) and elevated blood androgen levels were administered 400 mg/day ketoconazole for 6 months. Basal and posttherapy early follicular phase androgens and biochemical parameters were evaluated. In 22 patients significant improvement and in 2 slight improvement was seen in subjective complaints. No side-effects were observed in these patients other than 2 cases of pruritus (transient), 2 mild gastric upset and 1 mastodynia. All patients completed the study. Low dose ketoconazole seems to be effective in the treatment of hirsutism with relatively few side-effects but still should be reserved as an alternative choice due to the potential for deleterious hepatic effects.

Reproductive outcome after metroplasty

OBJECTIVE

To evaluate the impact of abdominal metroplasty for symmetric uterine anomalies on reproductive performance.

METHOD

A retrospective analysis of 24 patients who conceived following metroplasty for symmetric congenital anomalies during a 5-year period.

RESULTS

In patients with poor obstetric histories before surgery, the overall fetal survival rate increased from 2.5%, before treatment to 73.3% after treatment and 90.5% of women gave birth to a surviving infant. The remaining three patients suffering from infertility delivered a full-term infant after metroplasty. Antenatal complications occurred in 56.7% of the pregnancies.

CONCLUSION

Abdominal metroplasty clearly improves fetal survival particularly in women suffering from a history of poor obstetric outcome associated with symmetric malformations.

Threshold value of glucose screening tests in pregnancy: could it be standardized for every population?

We aimed to determine a threshold value that perfectly demarcates women at high risk for gestational diabetes mellitus (GDM) in the Turkish population. One thousand gravid women of 24 to 32 weeks of gestation were given 50 g, 1-hour glucose screening tests. A 100 g, 3-hour glucose tolerance test (GTT) was performed on all patients whose screening test plasma glucose value was 130 mg/dL or greater. The sensitivity and specificity of each screening test value was found, and the GDM rate of each value was calculated. Three-hundred-and-five patients were identified for GTT and 66 were shown to have GDM with two or more abnormal values in GTT. The incidence of GDM was found to be 6.6%. The maximum specificity and sensitivity were met at 140 mg/dL. However, this value underestimated 12% of patients with GDM, and the lowest value for a positive GTT appeared to be 134 mg/dL. We recommend a 135 mg/dL threshold for GTT since this threshold accurately diagnoses almost all women with GDM while eliminating unnecessary GTT.

Malignant degeneration of mature cystic teratomas

Malignant transformation of benign cystic teratoma is rare and the most common malignancy is squamous cell carcinoma. The diagnosis is rarely made preoperatively and the prognosis is usually poor. We report 4 cases with dermoid cysts showing malignant transformation, 3 with squamous carcinoma and 1 with adenocarcinoma. The patients were within the reproductive age and underwent surgical intervention with intraoperative evaluation. Frozen section identified 2 cases with malignant transformation and staging laparotomy was performed at the initial laparotomy. One of the remaining underwent reoperation following a pregnancy termination and the other refused further surgery. None had metastases and/or capsule invasion. One had tumour rupture during excision and received combined chemotherapy following surgery. Three of the patients remain well and 1 is lost to follow-up.

Anatomic distortion of clinically normal appearing fallopian tube: to what extent does it contribute to infertility?

We analyzed whether patent but anatomically deranged tubes were more commonly encountered in infertile women than in fertile women. The fertile group consisted of 100 women who were apparently normal with respect to fertility and the infertile group consisted of 100 infertile women with no certain etiology identified. The individual tubal structure was recorded at laparoscopy and the results of the two groups were then compared. Tubal pathology was found to be significantly higher in the infertile group; however, this marked difference arose from the contribution of a significantly higher frequency of peritubal pelvic adhesions because no difference was found between the two groups regarding anatomic variations of the fallopian tube. We conclude that tubal derangement which could only be identified with laparoscopy significantly contributes to infertility.

Urinary incontinence in women of reproductive age

We investigated the prevalence and the consequence of urinary incontinence in the Turkish population, representing a composition of European and Asian populations. During a 12-month period, the standard urinary incontinence questionnaire was answered by 1,250 women of reproductive age who were admitted to the outpatient clinic with various gynecologic complaints, except for women whose main complaints were urinary incontinence. These patients were randomly selected by stratification according to the following five age-groups: 18-24, 25-29, 30-34, 35-39, and 40-44. The prevalence of incontinence was measured for each group. Urinary incontinence prevalence was 24.5%; in 6.6% the incontinence occurred at least once daily. The lowest prevalence was found in the younger age-groups (18-29 years) and the highest in 40-44 years of age. Two hundred and sixty-one incontinent women (85%) had never sought medical help. The results indicated that urinary incontinence was common among women of reproductive age and only few sought medical help. We suggest that more public education about women's urinary problems and more attention to this problem by physicians are the mainstays of management.

Vaginal birth following unmonitored labor in patients with prior cesarean section

Following a previous cesarean section, trial labour followed by spontaneous birth is currently popular but is still debatable. In an effort to assess the risks of unmonitored labor, the outcomes of 165 patients with previous cesarean section who delayed coming to hospital were reviewed. Seventy-one patients were allowed to continue labor and 62 achieved successful vaginal delivery, a success rate of 87.3%. Sixty-one of 71 patients had an unknown uterine scar type prior to birth and, of these, 57 were delivered vaginally. The scar separation rate of this group was found to be 3.5% and the overall scar separation rate in our patients was 3.6%. Other than scar separation and febrile morbidity, no maternal morbidity or mortality was observed. The vast majority (98.4%) of infants delivered vaginally had 5-min Apgar scores of 7 or greater. We suggest that increasing the use of trial labor in patients with prior cesarean section, even in the presence of an unknown scar, may reduce the number of patients laboring in an unmonitored environment who wish to give birth vaginally.

Medical treatment of squamous hyperplasia and lichen sclerosus of the vulva

OBJECTIVE

To evaluate the efficacy of medical treatment in patients with lichen sclerosus (LS), squamous hyperplasia (SH) and lichen sclerosus with associated squamous hyperplasia.

METHODS

Forty-eight patients with non-neoplastic epithelial disorders of the vulva, SH in 23 (47.9%), LS in 20 (41.6%) and LS with associated SH in five (10.5%) were diagnosed and treated in our clinic. Patients with LS were treated with 2% testosterone ointment. Topical fluorinated corticosteroids was the treatment of choice in patients with SH. Patients with LS with associated SH were treated with topical fluorinated corticosteroid application followed by testosterone propionate ointment.

RESULTS

The clinical response rate of SH to first-line therapy was 95.6% with a correlation of 90.5% with histological reversal; this rate was 80% with a histological correlation of 81.3% in LS. The remission rates of SH and LS patients following a full course of therapy were 100% and 90%, respectively. In LS with associated SH patients, 90% responded to standard therapy with a remission rate of 100% after completion of a full course of therapy.

CONCLUSION

Medical therapy of lichen sclerosus and squamous hyperplasia was very effective with a good clinical and histologic correlation.

Chronic pelvic pain in adolescent women. Diagnostic laparoscopy and ultrasonography

OBJECTIVE

To evaluate the correlation of preoperative pelvic examination and ultrasonography with the laparoscopic findings in 45 adolescent women with chronic pelvic pain.

STUDY DESIGN

Between January 1, 1989, and December 31, 1992, 45 adolescent women underwent diagnostic laparoscopy following a detailed clinical workup for evaluation of chronic pelvic pain.

RESULTS

Thirty-five of 45 pelvic examination findings correlated with the laparoscopic findings. The predictive values of normal and abnormal findings at pelvic examination were 42.8% and 93.5%, respectively. Ultrasonography (US) correlated with laparoscopy in 39 of 45 cases. The predictive value of normal findings at US was 60%, and that of abnormal findings was 94.2%. When both pelvic examination and US were normal, 50% of cases were abnormal at laparoscopy. However, laparoscopy revealed abnormality in 100% of patients with abnormal pelvic examinations and abnormal US findings.

CONCLUSION

Clinical evaluation of chronic pelvic pain, when combined with US, is highly predictive but needs confirmation, best provided by laparoscopy.

Anastomosis of the freshly divided uterine horns of rats with the CO2 laser vs. microsurgery

We used the CO2 laser (group 1) and conventional microsurgery (group 2) for anastomosis of the freshly divided uterine horns of rats and compared the two methods. Each group was then compared with a control group in whom only exploration was carried out at laparotomy. Comparison was done regarding the clinical and histologic results. In addition, serum levels and tissue concentrations of alkaline phosphatase (ALP) and lactic dehydrogenase (LDH) were measured, and the three groups were compared. No significant difference was found between the mean adhesion scores of groups 1 and 2; however, when the control group was compared with the other groups, the differences were statistically significant. The tubal patency rates in groups 1 and 2 and the control group were 83.3%, 79.2% and 100%, respectively, and the pregnancy rates in those groups were 54.5% (6/11), 45.5% (5/11) and 100% (10/10). The differences in tubal patency and pregnancy rates between groups 1 and 2 were not significant, but when each was compared with the control group, the differences were significant. The mean scores for mucosal regeneration and disruption of the muscularis layer in group 1 were significantly lower than those in group 2. Serum levels and tissue concentrations of ALP and LDH in the control group were lower than in groups 1 and 2, and the differences between the control group and each of the other groups were significant; however, no significant difference was found between groups 1 and 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Preoperative assessment of myometrial invasion of endometrial carcinoma by transvaginal ultrasonography

Preoperative transvaginal ultrasonographic evaluation of myometrial invasion was performed in 33 patients with endometrial cancer and compared with histologic findings. TVU was remarkably precise in predicting deep myometrial invasion (accuracy 91.7%) but superficial myometrial invasion (sensitivity 20%). TVU was highly accurate in patients with tumours limited to the endometrium (sensitivity 100%) and the sensitivity of TVU in distinguishing nil or superficial versus deep invasion was 87.8%. TVU appears to be an efficient, economic, and practical tool for this purpose, however its limitation leads to more complex imaging techniques, especially in patients in whom preoperative irradiation or conservative management is planned.

Expectant management of functional ovarian cysts: an alternative to hormonal therapy

OBJECTIVE

We studied whether the administration of oral contraceptives facilitates the disappearance of spontaneously formed functional ovarian cysts.

METHODS

Eighty patients in whom ultrasonography revealed unilateral, mobile, unilocular, thin-walled ovarian cysts without internal echoes and greater than 30 mm but not exceeding 60 mm in diameter were enrolled into the study. Patients were randomized by stratification to receive a low-dose monophasic pill, a high-dose monophasic pill, a multiphasic pill or no therapy. Patients were re-evaluated after 5 weeks of therapy and at the end of therapy (10 weeks).

RESULTS

The mean ages and the mean cyst diameters of the patients for each group were not significantly different. We did not find a significant effect of oral contraceptive administration on the disappearance rate of functional ovarian cysts over that of expectant management.

CONCLUSION

We conclude that oral contraceptive therapy even with multiphasic pills is very effective in the management of functional ovarian cysts but expectant management achieves similar success rates and may be a good alternative to oral contraceptive therapy.

How does negative clinical evaluation of ovarian carcinoma after full course of chemotherapy correlate with second-look laparotomy findings?

Surgical reexploration was performed in 46 patients with epithelial nonmucinous ovarian adenocarcinoma requiring adjuvant chemotherapy whose initial therapy consisted of optimum debulking and surgical staging. All patients were placed on CAP (cisplatinum, Adriamycin, cyclophosphamide) chemotherapy for at least six courses until proved to be clinically disease free (mainly CA-125 below 35 U/ml and normal ultrasonography or computerized tomography). All women underwent second-look laparotomy (SLL) after completion of adjuvant therapy. We classified SLL findings in five categories, namely, no evidence of disease, cytological evidence of disease, histological evidence of disease, macroscopic evidence of disease (< 2 cm), and bulky tumor (> 2 cm). SLL demonstrated 14 (30%) patients with disease. Of these, five cases had histological evidence of disease and nine had macroscopic disease; however, we found no patient with persistent disease larger than 1.5 cm. No patient in stage I demonstrated disease at SLL. All cases with macroscopic disease and three cases with histological disease were initially in stage III. We found that about one third of cases who were clinically free of disease had persistent disease at the completion of chemotherapy. Hence, we conclude that routine SLL is still of importance in the management of patients with epithelial ovarian adenocarcinoma except those with stage I disease.

Malignant mixed müllerian tumor of the fallopian tube

Primary malignant mixed müllerian tumor of the fallopian tube is uncommon. Only 37 cases of malignant mixed müllerian tumor of the fallopian tube have been reported to date and of these only 16 contained heterologous components (mesodermal mixed tumor). This rarity made us report a case of malignant mixed müllerian tumor of the fallopian tube containing heterologous components which was operated on in our gynecologic oncology department. Postoperatively the patient was placed on six courses of adjuvant chemotherapy consisting of cis-platinum, adriamycin and cyclophosphamide (PAC). Second look laparotomy was performed after completion of chemotherapy. Presently, she is doing well, at two months follow-up, with no evidence of disease.

Accuracy of pipelle endometrial sampling in endometrial carcinoma

In this prospective study, we compared the histological results of Pipelle endometrial sampling (PES) with that of hysterectomy to examine whether endometrial sampling with the Pipelle device can accurately diagnose endometrial carcinoma. PES was performed in 26 patients with known endometrial carcinoma whose initial therapy consisted of hysterectomy. Discomfort and pain during the biopsy were reported to be mild by 22 patients, moderate by 3 patients and severe by only 1 patient. All of the samples were found to be adequate. Twenty-four of 26 PES confirmed endometrial carcinoma, a correlation of 95%, and the histological grade reported on PES agreed with that of hysterectomy specimens in 87.5% of the patients. On the other hand, the tumor grade in the specimens obtained at dilation and curettage correlated with hysterectomy specimens in 95% of the patients. We conclude that Pipelle is an accurate device in patients with endometrial carcinoma.

Tubal sterilization by laparoscopy and mini-laparotomy

Laparoscopic tubal sterilization was performed on 179 women using general anesthesia, and tubal sterilization via mini-laparotomy was performed in 52 cases using local anesthesia. The patients ranged in age from 25 to 41 years, with 73.2% between 31 and 40 years. The mean operative time of laparoscopy and mini-laparotomy were 14.2 and 11.6 minutes, respectively. Both the laparoscopy group and the mini-laparotomy group were found to be similar with regard to age, gravidity and number of abortions. Pelvic inflammatory disease (PID) was not observed in any patient during the follow-up period (3 months). Two wound infections were detected within the first week following mini-laparotomy, and these were treated on an out-patient basis by relevant antibiotics. Among the 179 patients in whom laparoscopic tubal sterilization was performed, tubal rupture occurred in 3 cases (1.67%) which were electrocoagulated easily, and unplanned laparotomy was performed in a patient in whom bowel injury during mini-laparotomy was suspected.

Pelvic inflammatory disease and intrauterine devices: prophylactic antibiotics to reduce febrile complications

In the present study, we tried to determine whether IUD insertion related PID and febrile complications could be prevented by prophylactic use of antibiotics. We studied 300 patients who were admitted to our family planning clinic for IUD contraception. Of these, 150 patients received prophylactic Doxycycline (group 1) and the second 150 received no therapy (group 2). Five cases experienced fever with or without leucocytosis and none required hospitalization. PID was observed in one woman in each group. Positive culture (gonorrhea) was obtained in one woman who was then treated by relevant antibiotics; the other woman required hospitalization for two days. The overall infection rates for group 1 and 2 were 2.1% and 2.9%, respectively and this difference was not significant. The incidence of PID infection and febrile complications was found to be very low for both groups when compared to other studies, suggesting that aseptic conditions with proper insertion reduce the risk of infection.

IUD (TCu380A) insertion following induced first trimester abortion

In this study, 110 women (study group) who received an IUD (TCu380A) immediately after induced legal first trimester abortion were compared with 90 women (group 1) who started another type of contraception following legal abortion. Additionally, 100 women (group 2) who had an interval IUD insertion, were compared with both. In the study group, 3 (2.7%) patients were found to have an infection which did not fulfill the diagnostic criteria described by WHO and were treated easily by relevant antibiotics. One of 90 patients (1.1%) in group 1 developed acute PID after induced abortion within 7 days. None of group 2 patients had either a suspicion of pelvic infection or infection within the follow-up period (3 months). Among the women in the study group, bleeding and pain were not found to be more frequent, intense or of longer duration when compared with the other groups. Spontaneous expulsion of an IUD occurred in 2 patients (1.8%) of the study group and in 1 patient (1%) of group 2. At the end of the follow-up period, the continuation rates of the study group, group 1 and group 2 were 96.3%, 86.6%, 99%, respectively.

Intraoperative evaluation of prognostic factors in stage I endometrial cancer by frozen section: how reliable?

The incidence of pelvic/paraaortic lymph node metastases is related to the grade of the tumor, the depth of myometrial invasion and the cervical involvement. These prognostic factors determine the initial surgery. Intraoperative evaluation and frozen section (FS) have been used for this purpose in order to identify patients requiring pelvic/paraaortic lymphadenectomy and adjuvant therapy, thereby eliminating routine lymphadenectomy with its complications. We used frozen section for this purpose and identified accurately 90% of patients requiring pelvic/paraaortic lymphadenectomy. The depth of myometrial invasion was accurately predicted in 90.6% and histologic grade in 91.9% of the patients; however, 60% of patients with cervical involvement were identified by FS. We recommend the use of frozen section as an inexpensive, simple and accurate way of estimating the poor prognostic factors.

Primary ovarian leiomyoma. A case report

A 32-year-old woman was admitted for termination of her 6-week pregnancy at her request. However, pelvic examination followed by transvaginal ultrasonography (TVU) revealed an adnexal mass complicating pregnancy and requiring surgical intervention that was carried out after termination of pregnancy. At laparotomy, left salpingo-oophorectomy was performed and histologic examination revealed a leiomyoma arising primarily in the ovary.