Role of 3D power Doppler sonography in early prenatal diagnosis of Galen vein aneurysm.

Vein of Galen aneurysm malformation (VGAM) is a rare congenital vascular anomaly. Although the cause of VGAM remains to be elucidated, the current hypothesis is persistence of the embryonic vascular supply, which leads to progressive enlargement and formation of the aneurysmal component of a typical VGAM. Here, we present a 36-year-old woman at 23 weeks' gestation (gravida 3, para 2) who was evaluated using 3D power Doppler sonography for the prenatal diagnosis of a vein of Galen aneurysm. Investigation using 3D power Doppler sonography allowed for a non-invasive yet diffuse and detailed prenatal assessment of VGAM. Thus, we suggest that prenatal sonography with 3D power Doppler may be an option in cases of VGAM.

The effects of GnRH analogs on serum and follicular fluid leptin levels and pregnancy outcomes in short protocols of assisted reproductive technology.

OBJECTIVE: To determine serum and follicular leptin levels in patients using gonadotropin releasing hormone agonist and antagonist in Assisted Reproductive Technology short protocol cycles and to evaluate pregnancy outcomes. MATERIAL AND METHODS: Patients randomly selected to join assisted reproductive technology cycles during February 2004-July 2004 were enrolled in this study. Group 1 consisted of 21 patients receiving r FSH+ GnRH agonists, whereas Group 2 consisted of 34 patients who received r FSH +GnRH antagonists. During the ovulation induction period 5 serum samples were collected (induction day 1, day 3 or antagonist starting day, human chorionic hormone day, oocyte pickup day, and twelfth day of embryo transfer). Follicular fluid samples were collected to be evaluated for leptin, estradiol, prolactin and luteinizing hormone. RESULTS: There was no difference in age, basal FSH, basal LH, and basal E2 between groups. Serum leptin levels were similar in both groups. Also, when each group's serum leptin levels were evaluated according to the presence of pregnancy, there was no significant difference in both groups. When follicle leptin levels were evaluated according to the existence of pregnancy, in both groups the follicle leptin levels were lower in pregnant participants but this difference was not statistically significant. When obesity is defined as body mass index over 26.5, there is a correlation between obesity and leptin levels in Group 2. CONCLUSION: Our results have shown that both agonists and antagonists have similar efficacy and effect in poor responder women. Leptin levels in either groups, whether pregnant or non-pregnant were not statistically different. This result shows the need for more studies on leptin in infertility.

How frequent are overactive bladder symptoms in women with urodynamic verification of an overactive bladder?

OBJECTIVE: To determine the relationship between overactive bladder symptoms and urodynamic verification of overactive bladder. MATERIAL AND METHODS: Between June 2011 and November 2011, 159 patients underwent urodynamics (UDS) at our urogynecology unit in the Ege University Hospital. Of these, 95 patients who complained of urgency, did not have any overt neurological diseases, bladder outlet obstruction and did not take any medication affecting the lower urinary tract function were evaluated. SPSS (ver. 15.0) was used to evaluate the data and the chi-square test and t test for independent samples were used for analysis. RESULTS: The mean age was found to be 54.5±12. Frequency was the most frequent symptom in women with overactive bladder (OAB) (82.1%), nocturia (57.8%) and (57.8%) urgency urinary incontinence followed in frequency. Detrusor over activity incidence was found to be 38.9%. There was no significant relationship between the presence of detrusor over activity (DOA) and OAB symptoms. Leak at urodynamics was found in 46.3% and there is no significant association with detrusor overactivity. Total bladder capacity was found to be significantly lower in women who had DOA (p=0.000). CONCLUSION: It appears that overactive bladder symptoms do not predict detrusor over activity. Urodynamic investigation is not mandatory in the initial management of women with only OAB symptoms.

Prenatal diagnosis of Cantrell pentalogy in first trimester screening: case report and review of literature.

Pentalogy of Cantrell is a heterogeneous and rare thoraco-abdominal wall closure defect with the estimated prevalence of 1/65.000 to 1/200.000 births. Supraumbilical midline wall defect (generally omphalocele), deficiency of the anterior diaphragm and diaphragmatic peritoneum, defect of the lower sternum and several intracardiac defects are the components of Cantrell pentalogy. Etiology is unknown but a defect on the lateral mesoderm during the early stage of pregnancy is the most accepted hypothesis. Nowadays both 2- dimensional (2D) and 3-dimensional (3D) sonography are commonly used in diagnosis. In our case, a fetus with 11 weeks of gestation was reported as Cantrell pentalogy during first trimester screening. Additionally, unilateral limb defect and lumbar lordoscoliosis were detected through 3D sonography. Pregnancy was terminated according to parental desire. Karyotype was 46 XY. Early diagnosis is feasible in the first trimester if ectopia cordis and omphalocele exist. Additionally, development in ultrasound technology provides us with better visualization and early diagnosis. Prognosis seems to be poor in patients with complete Cantrell syndrome and patients with associated anomalies. Termination is the choice of treatment. Early diagnosis gives us a chance to reduce maternal morbidity and mortality related to termination.