The Prevalence of Trigeminal Neuralgia in Turkey: A Population-Based Study

OBJECTIVE

Population-based studies on the prevalence of trigeminal neuralgia (TN) worldwide are rare and the epidemiology of TN in Turkey is unknown. The aim of this study is to determine the prevalence of TN in Turkey.

METHODS

We conducted a cross-sectional, population-based, descriptive epidemiological study in Ereğli, Turkey. Participants over the age of 18 were screened using a self-assessment form, and potential patients were identified by a 'neuroscreening team'. Suspected patients were invited for a clinical examination and evaluated by a senior neurologist. Any required imaging was carried out at a university hospital.

RESULTS

Data were collected from a total of 9605 participants, after the exclusion of 247 individuals who refused to participate. Seven suspected patients were invited to a public health center for clinical evaluation. One patient was diagnosed with SUNCT (Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing) and one patient was diagnosed with post-herpetic neuralgia. A definite diagnosis of TN was confirmed in five participants. The crude prevalence was found to be 52.1/100.000. The mean age of cases was 62.2 ± 8.3 years and the female/male ratio was 4/1. TN was classified as 'symptomatic' in one patient with multiple sclerosis. The other four cases were diagnosed with classical TN. Right side involvement was identified in three cases (60%), whereas left side involvement was seen in two cases (40%).

DISCUSSION

This study establishes the prevalence of TN in Turkey for the first time. The prevalence rate is low when compared with other international studies.

Air pollution, a possible risk factor for multiple sclerosis

OBJECTIVE

Studies focusing attention on the effects of environmental pollution on the etiology of multiple sclerosis (MS) are on the increase. The aim of this study was to determine MS prevalence in a city home to an iron and steel factory which causes air pollution.

METHODS

The study was designed as a cross-sectional, population-based, descriptive epidemiologic study. Ereğli city, which has an iron and steel factory and proven air pollution, was screened. Additionally, Devrek city, which is a rural and clean city, located 40 km away from Ereğli was assigned and results were compared. A validated questionnaire was used for screening. McDonald 2010 criteria were used to diagnose cases.

RESULTS

32 261 people were screened in Ereğli, and 21 963 people were screened in Devrek. In total, 41 patients were diagnosed with clinical definite MS. Crude prevalence was found to be 96.1/100 000 in Ereğli and 45.5/100 000 in Devrek. The mean age of patients was 39.8, and the female/male ratio was 1.9.

CONCLUSION

The results of this study indicate a more than double MS prevalence rate in the area home to an iron and steel factory when compared to the rural city. This supports the hypothesis that air pollution may be a possible etiological factor in MS.

The overlooked association between lower urinary tract dysfunction and psychiatric disorders: a short screening test for clinical practice

INTRODUCTION

Lower urinary tract dysfunction (LUTD) often presents with other associated comorbidities such as urinary tract infections, constipation, fecal incontinence, and vesicoureteral reflux. However, the psychiatric conditions that can be associated with LUTD tend to go unnoticed. The evaluation, diagnosis, and treatment of LUTD and psychiatric disorders in children are difficult and time-consuming. Moreover, there is currently no accepted consensus on this subject.

OBJECTIVE

In this study, the authors aimed to investigate the relationship between the subgroups of both LUTD and psychiatric disorders.

STUDY DESIGN

LUTD were divided into 4 groups by using voiding dysfunction symptom score (VDSS), bladder diary, and uroflowmetry/electromyography (UF/EMG) test. A short screening test for psychological problems was used to detect psychiatric disorders accompanying each LUTD group. In terms of psychiatric disorders, the patients were divided into two groups: externalizing and internalizing disorders.

RESULTS

A total of 156 children were diagnosed with LUTD. Seventy-six patients had overactive bladder (OAB), 53 had dysfunctional voiding (DV), 14 had primary bladder neck dysfunction (PBND), and 13 had underactive bladder (UAB). Psychiatric disorder was detected in 46 children (29.4%). Of these, 32 had an externalizing and 14 had an internalizing disorder. In terms of age, externalizing disorders were more common in children aged between 6 and 11 years (87.5%), whereas internalizing disorders were seen equally in both age groups. Among these, attention deficit hyperactivity disorder (ADHD) was the most common psychiatric disorder (16.1%). The LUTD groups with the most frequent psychiatric disorders were UAB (53.8%), PBND (35.7%), and OAB (28.9%).

DISCUSSION

Most of the studies investigating the relationship between the lower urinary tract and psychiatric disorders so far have been concerned with the lower urinary tract symptom (LUTS) (such as nighttime or daytime incontinence) and ADHD. However, the present study was performed according to the LUTD classification, which is primarily based on VDSS, bladder diary, and UF/EMG tests. Furthermore, psychiatric disorders were classified into their subgroups. The results have shown that around a quarter of children with LUTD also had comorbid psychiatric disorders. The relationship between LUTD and psychiatric disorders constitutes a critical point. Identifying this association can contribute to the comprehensive diagnosis and treatment for these patients.

CONCLUSIONS

LUTD and psychiatric disorders can be seen together, and this can be detected by the short screening test for psychological problems. Therefore, the authors think that patients who applied with LUTS should undergo this short test along with the routine urinary system examination and tests.

Greater occipital and supraorbital nerve blockade for the preventive treatment of migraine: a single-blind, randomized, placebo-controlled study

OBJECTIVE

Nerve injections have been used for the acute and preventive treatment of migraine in recent decades. Most of these injections focused on greater occipital nerve (GON) blockade. However, few studies were placebo controlled, and only a few of them investigated GON and supraorbital nerve (SON) blockade together. This study aimed to evaluate the efficacy of GON and SON blockade with local anesthetics for the preventive treatment of migraine without aura.

METHODS

Eighty-seven patients diagnosed with migraine without aura were included in the study. Patients were divided randomly. One group was injected with 1% lidocaine, the other group was injected with 0.9% saline. GON and SON injections were done bilaterally. The injections were repeated weekly for 3 weeks. Patients were followed up for 2 months to assess clinical response.

RESULTS

Seventy-one patients completed the study. After 2 months, the number of headache days decreased significantly from 12.8 ± 10.9 to 5.3 ± 7.4, and VAS decreased from 8.3 ± 1.0 to 5.5 ± 1.9 in the blockade group. The number of headache days decreased from 12.4 ± 10.3 to 7.5 ± 7.2 and VAS decreased from 8.2 ± 1.1 to 7.4 ± 1.3 in the placebo group. Response was seen in 65.1% of the patients in the blockade group (65.4% for episodic migraine, 64.7% for chronic migraine) and 28.6% of the patients in the placebo group. The difference was significant.

CONCLUSIONS

The results suggest that GON and SON blockade with lidocaine was more effective than the placebo in the prophylactic treatment of both episodic and chronic migraine.

Restless legs syndrome in type 2 diabetes mellitus

AIMS

This study aimed to investigate the prevalence of restless leg syndrome (RLS) in type-2 diabetes mellitus (DM) patients and to determine the risk factors.

METHODS

Patients were recruited from the Dr. Lütfi Kırdar Kartal Training and Research Hospital Diabetes Center. Patients between 18-80 years of age and meeting a minimum 5 years diagnosis of type-2 DM were included. All patients were examined by the same neurologist in terms of having RLS. The diagnosis was made according to the updated International Restless Legs Syndrome Study Group consensus criteria. Mimicking conditions such as myalgia, venous stasis, leg edema, arthritis, leg cramps, positional discomfort and habitual foot tapping were carefully investigated and excluded. Laboratory data, insulin use, family history and other related co-morbidities connected to RLS patients were recorded. RLS severity assessment was scored and recorded.

RESULTS

318 patients were included in the study. The prevalence of RLS in type-2 DM patients was found to be 28.3%. RLS prevalence in females was 33.3% and 20.6% in males. 39 patients (43.3%) had a family history of RLS. 43 patients with RLS had a co-morbidity link with RLS. Any co-morbidity linked to RLS was not seen in 47 patients. The prevalence rate of RLS in patients without co-morbidities was 17.1%. Mean duration of DM in patients with RLS was 15.6±6.7years while in DM patients without RLS was 13.7±6.3years. The relationship between RLS and the duration of diabetes was found to be statically significant. (p=0.025). 68 (75.6%) of patients diagnosed with RLS were treated with insulin. A statistical significance was found in the development of RLS and insulin usage (p=0.035).

CONCLUSIONS

This is the first study which shows the RLS prevalence and risk factors in Turkish type-2 diabetes mellitus patients. The results indicated that RLS is much more frequent in DM patients even after excluding polyneuropathy than in general Turkish population. The duration of diabetes and insulin use are related to RLS.

Multiple sclerosis prevalence study: The comparison of 3 coastal cities, located in the black sea and mediterranean regions of Turkey

The prevalence of multiple sclerosis (MS) has significantly increased all over the world. Recent studies have shown that Turkey has quite a high prevalence. The aim of this study is to estimate prevalence in the Mediterranean and Black Sea regions of Turkey and to compare the results.This study was designed as a door to door survey in 3 cities. One is located in the Mediterranean region (South), 2 are located in the Black Sea region (North). A previous validated form was used for screening in the field. The patients were examined first in the field, then in the regional health facility. McDonald criteria were used for the diagnosis.In total, 26 patients were diagnosed with MS. The prevalence was found to be 18.6/100,000 in Artvin (Black Sea region), 55.5/100,000 in Ordu, (Black Sea region), 52.00/100,000 in Gazipaşa (Mediterranean region). The female/male ratio was 2.25.This study is the first prevalence study which was conducted in the Mediterranean City (South) of Turkey. The prevalence rate was found to be higher than expected in the Mediterranean city of Gazipaşa. The results showed that the prevalence varies from region to region. Latitude difference was not observed.

Stroke prevalence among the Turkish population in a rural area of Istanbul: A community-based study

Background

The population-based information on the prevalence of stroke from rural areas of Middle East countries including Turkey is unknown. Our aim is to evaluate the prevalence of stroke in those ⩾18 years in the Turkish population in a rural area of Istanbul.

Methods

A cross-sectional door-to-door study was conducted in a rural area of Istanbul between 1 March and 30 March 2013. A research protocol recommended by World Health Organization for developing countries was used. Each screening teams consisted of one neurologist, one local nurse, and five surveyors. Teams were trained about the survey and questionnaire. The patients, who claimed to have suffered a stroke, were examined, and the diagnosis was confirmed by a neurologist on site. The findings and medical records were documented.

Results

In total, 2906 people ⩾18 years were screened. 50 stroke cases were detected. 80% of those were found to have had an ischemic stroke, 14% of those were hemorrhagic cases, and 6% of those had an unclassified stroke type. The overall prevalence rate in those ⩾ 18 years was 1.7%. The male/female ratio was 0.92. Young (<45) stroke prevalence was found to be 0.6%.

Conclusion

This study was the first of its kind to show the stroke prevalence among Turkish population ⩾ 18 years in a rural area of Istanbul. When compared to other studies which investigate people ⩾45 years from Turkey, the result (in the same age group) was moderate high. The male/female ratio was low compared to many other studies.

Stroke Prevalence in a Coastal Town on the Black Sea Coast in Turkey: Community Based Study

BACKGROUND

This study aims to determine the stroke prevalence in Akçakoca which is a rural area in Turkey.

METHODS

The study was designed as a cross-sectional, door-to-door survey. The stroke questionnaire was completed by a trained team in the presence of the participants according to their answers. Based on the screenings, patients who had been diagnosed with stroke previously were reexamined by a neurologist and determined the prevalence values, risk factors, and stroke types.

RESULTS

A total of 3750 people over 44 years old were reached in the screenings. It was determined that 83 people had previously suffered a stroke. The prevalence rate of stroke in those above 44 years was found to be 2.2 (98% confidence level and ± 2% margin of error). 70 (84.3%) patients had suffered an ischemic stroke while 12 (14.5%) had suffered a hemorrhagic stroke. Male/female ratio was 1.1.

CONCLUSION

The results of this study give the prevalence rate of stroke among the Turkish population living in a rural area. Due to a lack of other similar studies, it is impossible to make any data comparison. However, the results of this study help shed light on the stroke prevalence rate.

Effects of multiple sclerosis and medications on menopausal age

Objectives

We aimed to determine whether multiple sclerosis (MS) and methylprednisolone and disease-modifying drugs have an effect on menopausal age.

Methods

A total of 86 patients and 98 healthy subjects were included in this study. The natural menopausal age of the patients and healthy subjects were compared. The cumulative dosages of methylprednisolone, beta interferons (IFNβs), and glatiramer acetate were calculated. The effects of the Expanded Disability Status Scale (EDSS), duration of the disease, and cumulative dosage of medications on menopausal age were evaluated.

Results

The patients’ mean menopausal age was 45.3 ± 4.8 years and healthy subjects’ menopausal age was 46.8 ± 4.3 years, with no significant difference between the two groups. The cumulative dosage of methylprednisolone showed an effect on menopausal age. There was a significant inverse correlation between menopausal age and dosage of IFNβ-1b, while the disease duration and EDSS score showed no correlation with menopausal age.

Conclusions

We conclude that menopausal age is not affected by MS. However, long-term methylprednisolone and IFNβ-1b treatments may change menopausal age in a dose-dependent manner.

Stroke epidemiology in Karabük city Turkey: Community based study

Introduction

Stroke has been projected to increase in developing countries like Turkey. Information about the prevalence of stroke may uncover the etiology of stroke and overcome its impact burden. However, data is limited due to a lack of studies based in Turkey and neighboring regions. We aimed to investigate the prevalence and risk factors of stroke in the Turkish city of Karabük and to pave the way for future epidemiological studies in Turkey.

Methods

The study was designed as a cross-sectional, door-to-door survey. The questionnaire was completed by a trained team in the presence of the participants according to their answers. Patients who had been diagnosed with stroke prior to the survey were re-examined by a neurologist.

Results

3131 persons who were above 44 years old were screened. 129 of them were found to have had a stroke previously. The prevalence rate of stroke above 44 years was found to be 4.12% (98% confidence level and ± 2% margin of error). 72.1% of stroke patients had hypertension. Male/female ratio was 0.72.

Conclusion

This study showed a high prevalence rate of stroke in Karabük Turkey with a low male/female ratio when compared to other studies.

Botulinum toxin in the treatment of trigeminal neuralgia: 6-Month follow-up

BACKGROUND

Botulinum toxin type-A (BTX-A) has been successfully utilized to treat trigeminal neuralgia. In this study, through the use of a new technique, the efficacy of the injection of BTX-A to the maxillary and mandibular nerves was evaluated.

METHODS

A total of 27 patients were injected with 100 Units of BTX-A to the maxillary and mandibular nerves. Visual analogue scale score and pain frequency were assessed before treatment and at the first week, second month, and sixth month after treatment. Patients with ≥50% reduction in mean pain score at the second and sixth month were defined as responders.

RESULTS

A total of 27 patients were included in the study. BTX-A significantly reduced pain intensity and pain attack frequency at the first week, second month, and sixth month after treatment. At the second month, 74.1% of patients, at the sixth month, 88.9% of patients responded to treatment. Forty-four percent of patients did not experience any pain at the sixth month. The mean recurrence period was 87.7 ± 20.4. BTX-A was well tolerated and showed few treatment-related adverse events.

CONCLUSION

Injection to the maxillary and mandibular roots seems to be a highly effective method. In the event of recurrence, after each injection, the pain severity and attack frequency decreased.

The MRI findings of iris metastasis in patients with breast cancer

Breast cancer and lung cancer are the most common tumors that metastasize to iris. The metastasis of iris was generally diagnosed on ophthalmologic examination. In this case, we reported iris metastasis of patients with adenocarcinoma of breast cancer and MRI findings. We report a case of a 51-year-old. She was diagnosed breast cancer two years ago. After adjuvant chemotherapy, radiotherapy and trastuzumab, she was admitted to hospital with the complaints of headache on February 2012. The magnetic resonance imaging (MRI ) revealed multiple brain metastasis. Whole brain radiotherapy and palliative chemotherapy were applied to the patients. In follow-up, on ophthalmological examination, there was a solid lesion on iris. The orbital MRI was performed and it revealed the thickness on iris of left eye. After diagnostic procedure final pathological rewiev reported that invasive ductal carcinom metastasis. Iris metastasis may be considered by MRI findings following: The thickness on iris and contrast enhanced lesion. This reason may be resulted that the fine niddle aspiration biopsy for diagnosis of iris metastasis is not need.

Prevalence of multiple sclerosis: door-to-door survey in three rural areas of coastal Black Sea regions of Turkey

BACKGROUND

Little information exists on multiple sclerosis (MS) in Turkey. With a door-to-door survey in an urban part of Istanbul, we recently reported a prevalence rate of 101/100,000 population. We therefore investigated three rural areas of Turkey at the same latitude.

METHODS

The same survey methods were used for total populations of two rural areas (Kandıra and Geyve) near Istanbul, and for half the population of Erbaa, all near 40° north latitude on the Black Sea coast.

RESULTS

In Kandıra, 5 of 8 suspects were diagnosed as having MS among 8,171 screened, resulting in a prevalence rate of 61/100,000. Geyve with 7 MS cases in 17,016 screened had a prevalence of 41/100,000, and Erbaa with 15 MS cases in 28,177 screened one of 53/100,000. Together they showed a prevalence of 51/100,000. Of the 27 patients, 20 were women; 25 had definite and 2 possible MS, the former all with abnormal laboratory findings. Average ages were 30.5 years at onset and 39.1 years at diagnosis. Clinical features and course were typical of European MS.

CONCLUSION

These findings indicate that Turkey is a high-risk MS area, similar to most regions of Mediterranean Europe, where all recent increases are likely due to (undefined) environmental factors.

Epidemiology of restless legs syndrome in Turkish adults on the western Black Sea coast of Turkey: A door-to-door study in a rural area

OBJECTIVE

To determine the prevalence and clinical presentation of restless legs syndrome (RLS) in Turkish population living in Kandira, a town located on the Black Sea coast of Istanbul.

METHODS

This study was designed as a descriptive, cross-sectional, door-to-door field study. A total of 2111 people aged 18 years and over were selected for the study. The criteria suggested by the IRLSSG (International Restless Legs Syndrome Study Group) were used in the assessment of RLS. All the suspected subjects underwent neurological examination.

RESULTS

The prevalence of RLS was found to be 3.4% of Turkish population aged over 18. Female:male ratio was 3.5:1. The prevalence reached peak point (8.3%) in the 58- to 67-year-old group. Prevalence of DM, anemia and polyneuropathy in RLS patients was 13.9%, 8.3% and 4.2%, respectively.

CONCLUSION

RLS prevalence is relatively low, but increases with age in both genders in this Turkish population. Although it has negative effects on daily life, it is not well recognized by the population.

Prevalence of essential tremor: a door-to-door survey in Sile, Istanbul, Turkey

The aim of this study was to determine the prevalence of essential tremor (ET) in a Turkish population living in Sile, a rural town located on Black Sea coast of Istanbul. This study was designed as a descriptive cross-sectional field study. People aged 18 years and over were selected for the study. Tremor surveillance questionnaire was applied by door-to-door visits. Subsequently, all subjects who answered the questionnaire had a standard tremor examination. Diagnosis was made based on Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) diagnosis and clinical evaluation scale. A total of 2227 people was screened. The prevalence of ET was found to be 3.09% (95% Cl=2.42-3.91%) in Turkish population aged over 18 years. The prevalence of ET increased by age in both genders.

Living alone following first-ever stroke: a prospective study in Turkey identifying the risk factors and evaluating their effects

INTRODUCTION

The incidence of stroke, death, and dependency rates shows variability between countries and ethnic groups. The cost of management of stroke is extremely high. Thus, determination of controllable risk factors is important. The aim of this study was to evaluate the risk factors and the effects of risk factors on death rates, dependency, and stroke recurrence in hospitalised patients having first-ever stroke.

METHOD

A total of 100 patients admitting to our hospital during the period April 2002 to March 2003 inclusive who were diagnosed as stroke according to WHO criteria were included in this study and evaluated prospectively.

RESULTS

The mean age of the patients was 66.7 +/- 9.9 years and 60% was male. 76 of the patients had ischaemic stroke; 24 had hemorrhagic stroke. The death rates were 12% in the first 28 days and 26% in 6 months. The best predictors of death rate in 6 months were stroke severity, living alone, and prestroke dementia. Stroke severity was also the best predictor for dependency. Peripheral atherosclerosis, pre-stroke dementia, and stroke severity were the best predictors for recurrent stroke.

CONCLUSION

Living alone may be an important predictive factor for survival, although its importance has been underestimated.

Respiratory complaints and spirometric parameters of the villagers living around the Seyitomer coal-fired thermal power plant in Kütahya, Turkey

The aim of the study was to investigate the respiratory effects of the stack emissions of the Seyitömer coal-fired thermal power plant in the Kütahya Province of Turkey. The three villages that are located within 5 km around the power plant were investigated as our "Villages around Power Plant." Two villages which were similar to the Villages around Power Plant as far as climate, culture, and lifestyle were concerned and which were located more than 30 km away from the thermal power plant were investigated as our "Control Villages." The study design was based on the comparison of the respiratory complaints and the spirometric parameters of the individuals living in the two groups of villages. The study was carried out on individuals of 15 years of age and above living in these villages (277 of 302 individuals living in the Villages around Power Plant and 225 of 264 living in the Control Villages). Among the ones living in the Villages around Power Plant, 46.2% had complaints of chest tightness and 29.2% repeated coughing attacks present for more than one year, whereas these percentages were 28.0 and 20.4% in the Control Villages, the differences being statistically significant (P=0.001 and P=0.024, respectively). The complaint of productive coughing present for more than one year was not found to differ statistically significantly between the two groups of villages (P=0.0885). The means of the spirometric parameters of FEV1 and FEF25-75% were found to be statistically significantly lower in the individuals of the Villages around Power Plant compared to the individuals of the Control Villages (P=0.0001 and P=0.0001, respectively). When the spirometric parameters of nonsmokers were compared between the two groups of villages, FEV1, FVC, and FEF25-75% were found to be statistically significantly lower in the Villages around Power Plant compared to the Control Villages (P=0.0001, P=0.0001, and P=0.0001, respectively). No statistically significant differences of the spirometric measurements of current smokers were observed between the two groups of villages (P>0.05). The spirometric parameters revealed statistically significant adverse health effects of the Power Plant, this was particularly apparent v212nfor the nonsmokers. More specific tests to confirm the diagnosis of acute and chronic lung diseases can be suggested to be carried out in the area in further studies. Also follow-up studies can be recommended in the area to detect any new adverse health effects of the Power Plant.

Effect of pentoxifylline on immotile testicular spermatozoa

PURPOSE

A model for differentiating live and dead sperm cells during intracytoplasmic sperm injection (ICSI) is proposed.

METHODS

We used pentoxifylline, a phosphodiesterase inhibitor known to enhance sperm motility, to initiate motility in testicular spermatozoa. Ten immotile testicular sperm samples were divided into two parts for examination of sperm motility with and without pentoxifylline treatment at 30, 60, and 90 min.

RESULTS

The samples without pentoxifylline remained immotile even after 90 min of incubation: the addition of pentoxifylline initiated sperm motility in all samples: 51.8 +/- 10.2, 64.4 +/- 9.4, and 70.8 +/- 8.9% (mean +/- SD) at 30, 60, and 90 min, respectively.

CONCLUSIONS

That pentoxifylline may be used to differentiate live testicular spermatozoa during ICSI, which may improve fertilization and pregnancy rates, is suggested.

Minimally invasive treatment of live ectopic pregnancy

Four cases of live ectopic (three tubal, one cornual) pregnancies managed by ultrasonographic puncture injection technique are described. The technique proves to be a practical, effective and conservative treatment.

Endometrium is not a reservoir for recurrent vaginal candidiasis

The aim of this study was to determine whether the endometrium acts as a reservoir for Candida albicans in cases of recurrent vaginal candidiasis. Twenty-five women with documented history of recurrent vaginal candidiasis were enrolled in the study and endometrial samples were cultured for Candida albicans. Only two patients had positive cultures for Candida albicans. Therefore, we concluded that the endometrium is not a common reservoir for Candida albicans.

Effect of abnormal sperm head morphology on the outcome of intracytoplasmic sperm injection in humans

The present study was designed to determine the efficacy of intracytoplasmic sperm injection (ICSI) using spermatozoa with abnormal head morphology in 17 cases with total teratozoospermia. A total of 160 oocytes were retrieved and 144 metaphase II oocytes were injected. The fertilization and cleavage rates were 50.7 and 93.2% respectively. Fertilization failure occurred in two couples. A total of 54 embryos were transferred and pregnancy rates per initiated and per embryo transfer cycle were 17.6 and 20.0% respectively, while the clinical pregnancy rates per initiated and embryo transfer cycle were 11.8 and 13.3%. The implantation rate was 3.7% (2/54). Out of two pregnancies achieved, one resulted in abortion in the first trimester. The ongoing pregnancy rates per initiated and embryo transfer cycle were 5.88% (1/17) and 6.6% (1/15) respectively. Although the implantation and ongoing pregnancy rates are very low, ICSI seems to be the only treatment modality in cases where teratozoospermia was total with 100% abnormal head morphology.

Sperm immobilization antibodies in infertile male sera decrease the acrosome reaction: a possible mechanism for immunologic infertility

OBJECTIVE

To study the effect of sperm-immobilizing antibodies from male sera on spontaneous and A23187-induced acrosome reactions (AR).

DESIGN

Swim-up spermatozoa obtained from three fertile donors were incubated with 13 sera with sperm-immobilizing antibodies obtained from infertile men and three control sera obtained from healthy fertile males. Sperm acrosomes were examined by staining with pisum sativum agglutinin labeled with fluorescein isothiocyanate (30 micrograms/ml; Sigma Chemical Co., St. Louis. MO) as spontaneous and A23187 (used at a final concentration of 10 microM; Sigma Chemical Co.) induced.

RESULTS

The incidence of spontaneous AR of spermatozoa incubated with antisperm antibody positive male sera (6.2 +/- 0.7) was significantly (P < 0.001) lower than that of spermatozoa incubated with control sera (10.7 +/- 0.5). And the incidence of A23187-induced and -inducible (incidence of induced minus spontaneous) ARs of spermatozoa incubated with sperm antibody-positive male sera (12.4 +/- 1.9 and 6.2 +/- 1.9) was significantly lower (P < 0.001) than that of spermatozoa incubated with control sera (31.0 +/- 0.5 and 20.3 +/- 0.9). Sperm-immobilizing antibody-positive sera decreased spontaneous, A23187-induced, and inducible ARs.

CONCLUSIONS

Sperm-immobilizing antibodies from male sera interfere with fertilization by inhibiting the AR.

Fertility with testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermic men

In non-obstructive azoospermia spermatozoa can usually only be isolated from the testicles, and thus the most promising treatment model is testicular sperm extraction (TESE). Hormone concentrations, testicular volume determinations and testicular biopsy results are not uniform enough to select potential candidates for successful TESE and intracytoplasmic sperm injection (ICSI) approaches in advance. The aim of this study was to assess the efficacy of using ICSI with testicular spermatozoa in cases of non-obstructive azoospermia and to compare the inclusion criteria and sperm existence in the testicles in sperm obtainable and non-obtainable groups. All men showed either complete or incomplete (n = 14) maturation arrest in spermatogenesis, severe hypospermatogenesis (n = 10) or Sertoli cell-only syndrome (n = 5) in their testicular biopsies. Only 14 out of a total of 29 men provided enough spermatozoa for the ICSI procedure, while no spermatozoa were found in the testicular samples of the remaining 15 men. Out of 123 oocytes obtained from 14 females, 101 were injected with the husbands' testicular sperm cells. Total fertilization failure was observed in three cases. Of 39 oocytes fertilized, 38 cleaved. The fertilization and cleavage rates were 38.6 and 97.4% respectively. The pregnancy rate was 20.7% per initiated cycle. In the group from whom spermatozoa were obtainable, the pregnancy rate was 42.9% per initiated cycle and 54.5% per embryo transfer. A total of six pregnancies were achieved, of which two were twins and four were singletons. One singleton pregnancy resulted in abortion in the first trimester. There was no statistical difference concerning the serum follicle stimulating hormone concentration, testicular volume and biopsy results in groups in which spermatozoa were obtainable or not. In conclusion, although the association of TESE with ICSI obtained pregnancies for some patients with non-obstructive azoospermia, further studies are needed to determine the inclusion criteria for successful TESE.

High implantation and pregnancy rates with testicular sperm extraction and intracytoplasmic sperm injection in obstructive and non-obstructive azoospermia

Thirty-two infertile couples with obstructive and non-obstructive azoospermia were included in this study. Testicular sperm extraction (TESE) was performed in 16 obstructive azoospermic cases where microsurgical sperm aspiration (MESA) or percutaneous sperm aspiration (PESA) were impossible because of totally destroyed epididymis and 16 non-obstructive azoospermia cases with severe spermatogenetic defect where the testicles were the only source of sperm cells. A total of 288 oocytes was obtained from 32 females and 84% were injected. The fertilization rates (FR) with 2 pronuclei (PN) and cleavage rate were 50.8 and 68.2% respectively. A total of 15 pregnancies was achieved (53% per embryo transfer), nine from the obstructive and six from the non-obstructive group. Four pregnancies resulted in clinical abortion (26.6%). The ongoing pregnancy rate was 39.2% per embryo transfer (ET) and 34.3% per started cycle. A high implantation rate was also achieved (26.6% in non-obstructive and 30% in obstructive azoospermia group). Using testicular spermatozoa in combination with ICSI in both obstructive and non-obstructive azoospermic groups, high implantation and pregnancy rates can be achieved.

Short protocol of gonadotropin releasing hormone agonist administration gave better results in long protocol poor-responders in IVF-ET

OBJECTIVE

To determine the effectiveness of a short protocol (SP) of gonadotropin-releasing hormone agonist (GnRH-a) administration in patients who already had undergone at least one in vitro fertilization (IVF) and embryo transfer (ET) treatment cycle with the long protocol (LP) and had shown poor results.

METHODS

One hundred and twelve patients were studied. The E2 levels, the number of preovulatory follicles, the number of oocytes retrieved and fertilized, the number of embryos cleaved, the fertilization rate and the number of embryos transferred were calculated.

RESULTS

The values for the mentioned parameters were significantly higher in the SP than those in the LP. So were the pregnancy rates per cycle and per ET (23.2% and 24.1%, respectively) in the SP significantly (p < 0.0001) higher than those in the LP (12.5% and 13.5%, respectively).

CONCLUSION

In cases who showed poor results to the LP, instead of repeating the same protocol the SP may be substituted. This strategy may not only improve the results, but also decrease the total cost of the IVF-ET treatment.

Effect of vaginal misoprostol application for cervical softening in pregnancy interruption before ten weeks of gestation

OBJECTIVE

To determine the effect of vaginal misoprostol application for cervical dilatation and to determine the time taken for pregnancy interruption.

METHODS

200 micrograms misoprostol and gyno-flor vaginal tablet, employed to create acidic milieu, were applied into the posterior fornix of 40 women with gestational age of 5 to 10 weeks. Placebo was applied vaginally to 20 women who made up the control group. All cases were examined 5 hours later. The cervical dilatation, presence of fetoplacental material in the vagina, extrauterine cervical bleeding and the time necessary for dilatation and suction curettage were investigated.

RESULTS

In 33 (82.5%) of the cases cervical bleeding, in 21 (52.5%) of the cases fetoplacental material on the cervix and/or in the vagina were detected in women of misoprostol group, while neither cervical bleeding nor fetoplacental material on the cervix and/or in the vagina was detected in the placebo group. In the misoprostol group the time taken for the operation was significantly (p < 0.005) shorter than that of the control group.

CONCLUSION

Vaginal application of misoprostol shortens the time needed for the termination of the gestation by its facilitating effect on cervical dilatation.

Two instead of three embryo transfer in in-vitro fertilization

The rational of transferring two instead of three embryos was studied through 468 in-vitro fertilization (IVF) treatment cycles in 287 couples. The quality of 1224 embryos was determined according to the fragmentation rate and the morphology as good (A) and poor (B). The influence of the number of embryos transferred (two or three) on the pregnancy rate when the same quality or combinations of good and poor quality embryos transferred was examined. When only good quality embryos were transferred the pregnancy rates in double (AA) and triple (AAA) embryo transfer were 40.5 (17/42) and 42.9% (30/70) respectively (not significant). When only poor quality embryos were transferred, the pregnancy rates in double (BB) and triple (BBB) embryo transfers were 11.0% (11/100) and 22.9% (16/70) respectively (P < 0.001). On the other hand, when good and poor quality embryos were transferred together as AB in double and as AAB and ABB in triple embryo transfer, the pregnancy rates were 36.8 (14/38) and 39.9% (59/148) respectively (not significant). There was no difference in the miscarriage rate between double and triple embryo transfers; 16.7 and 18.1% respectively. The multiple pregnancy rate was 14.3% for double embryo transfers and 32.4% for triple embryo transfers (P < 0.001). This study demonstrates that if there is at least one good quality embryo available for transfer, then double instead of triple embryo transfer will not yield a significantly lower pregnancy rate. The influence of the number of embryos transferred on the pregnancy rate became significant when only poor quality embryos were transferred.(ABSTRACT TRUNCATED AT 250 WORDS)