Follicular phase serum and follicular fluid glycodelin measurements in gonadotropin-releasing hormone (GnRH)-antagonist assisted reproduction cycles: A prospective cohort study.

PURPOSE: To establish the serum pattern for glycodelin and to investigate the possible correlations of serum and follicular fluid (FF) glycodelin with clinical pregnancy in gonadotropin-releasing hormone (GnRH)-antagonist controlled cycles. MATERIALS AND METHODS: A prospective observational study conducted with 80 infertile couples who received a GnRH-antagonist controlled cycle. Glycodelin levels were measured in FF, day 2-3, and ovarian pick-up (OPU)-day serum samples. RESULTS: There were no significant differences in serum glycodelin concentrations in either the early follicular phase or the preovulatory phase, and in FF glycodelin concentrations between clinically pregnant and non-pregnant patients. OPU-day serum glycodelin was found to be significantly higher than early follicular serum glycodelin level in all patients whether pregnancy occurred or not. CONCLUSION: Although day 2-3 and OPU-day measurements of serum glycodelin levels were not significant in predicting clinical pregnancy, the pattern of serum glycodelin seems different in GnRH-antagonist controlled cycles than natural and GnRH-agonist controlled cycles.

The role of laparoscopy in the management of infertility.

The advancement of new perspectives in assisted reproductive technology (ART) through the use of modern infertility evaluation techniques has led clinicians to reassess how infertility should best be treated. The usefulness of laparoscopy in the diagnostic work-up of infertile patients or in patients who are unresponsive to fertility treatments is debatable. The purpose of this review is to define the role of laparoscopy in the management of infertility, which is one of the most controversial aspects of reproductive medicine. To the best of our knowledge, laparoscopy is currently not a routine step in the evaluation of infertile women; every patient and clinical condition must be assessed individually. In this review, we investigated the effectiveness and the utility of laparoscopy as a diagnostic and therapeutic tool in the management of infertility. Various topics and parameters in ART will be discussed based on the evidence that is currently available.

Surgical intervention for adnexal masses during pregnancy.

We aimed to evaluate the influence of surgical intervention on gestational and neonatal outcomes in women who underwent elective surgery in the second trimester of gestation because of an adnexal mass. We retrospectively reviewed the hospital records of women who underwent elective surgery for adnexal masses in the second trimester of gestation between 2006 and 2012. The ages of the women ranged between 17 and 33 years. Eight women underwent a laparotomy, and one woman, who aborted on the day of the operation, underwent a laparoscopy. Dermoid cysts, cystadenoma and borderline ovarian tumours were present in four, two and two of the women, respectively. Eight women had no complications after surgery and delivered healthy newborns at term. We concluded that elective surgery on an adnexal mass in the second trimester of gestation is safe for both the mother and the fetus.

The relationship between urogenital symptoms and climacteric complaints.

OBJECTIVE: To evaluate the relationship between urogenital symptoms and climacteric complaints, including anxiety, depression, somatic, vasomotor and sexual subscores according to the Greene Climacteric Scale (GCS). METHODS: We retrospectively reviewed the records of 1278 patients and the 908 patients who fulfilled the inclusion criteria were included in the study. The relationships were evaluated between GCS and vaginal symptoms, including vaginal pain, dyspareunia, itching, discharge, burning, dryness, and postcoital bleeding, and urinary symptoms, including dysuria, frequency, nocturia and incontinence, by using univariate and multivariate analyses. RESULTS: Among vaginal symptoms, somatic and sexual scores and, among urinary symptoms, anxiety and somatic scores were found to be the most associated factors. Of the vaginal symptoms, the highest odds ratios for somatic score and sexual score were found to be 2.21 (95% confidence interval (CI) 1.69-2.88, p < 0.001) and 2.08 (95% CI 1.70-2.56, p = 0.029), respectively. Multivariate logistic regression analyses for urinary symptoms revealed that the highest odds ratios for anxiety, somatic, depression and sexual scores were 1.53 (95% CI 1.20-1.95, p = 0.001), 1.92 (95% CI 1.38-2.66, p = 0.01), 1.47 (95% CI 1.11-1.94, p = 0.007), and 1.28 (95% CI 1.06-1.55, p < 0.001), respectively. CONCLUSIONS: There is a strong relationship between urogenital symptoms and GCS subscores. Therefore, clinicians should be aware of urogenital problems in the presence of severe climacteric symptoms and this may provide earlier treatment for urogenital complaints.

Is placebo as effective as estrogen regimens on vasomotor symptoms in women with surgical menopause?

OBJECTIVE: To evaluate the short-term effects of two hormone therapy (HT) regimens and placebo on the Greene Climacteric Scale (GCS) of women with surgical menopause following six months of treatment. METHODS: This 6-month, prospective, randomized, parallel-group, masked evaluator study compared the efficacy of once daily administration of 0.625 mg conjugated equine estrogen (group I), 3.9 mg transdermal 17beta-estradiol patch applied every week (group II) and placebo (group III). Mean GCS before and after six months of treatment in each group was compared. RESULTS: In groups I and II, vasomotor symptoms (p < 0.005, p < 0.05), somatic symptoms (p < 0.05, p < 0.05) and total score (p < 0.005, p < 0.01) significantly reduced from baseline values respectively, while the other subscores revealed no statistically important differences following six months of HT. In group III, vasomotor (p < 0.05), subscore and total score (p < 0.05) decreased significantly while other subscore reductions were not significant. CONCLUSIONS: Estrogen regimens and placebo seem to be effective in alleviating vasomotor symptoms. Additional larger prospective randomized studies need to be conducted in an aim to look at not only short-term but also long-term effects on climacteric symptoms, in comparison to both placebo arms and different dose and mode of HT use.

Cytokine and immune cell levels in peritoneal fluid and peripheral blood of women with early- and late-staged endometriosis.

OBJECTIVE: To investigate the level of cytokines and immune cells in the peripheral blood (PB) and peritoneal fluid (PF) of different stages of endometriosis. METHODS: A prospective study was conducted to include 97 women with (n 60) and without (n 37) histopathologically confirmed endometriosis. Based on rASRM classification, stage I/II and stage III/IV were categorized as early-and late-staged endometriosis. Prior to surgery, 10 ml of blood was withdrawn from antecubital vein and serum was obtained. Aliquots were made and stored at -70 degrees C until assayed for cytokines. PF was aspirated from the pouch of Douglas. Peripheral and PF samples were analyzed by ELISA in terms of IL-2, IL-4, IL-10 and IFN-gamma. Determinations of T helper, T suppressor, NK, and B cells were assessed by using cluster determinant-3 (CD-3), CD4, CD8, CD25, CD28, CD45, CD16, CD23 and antibodies against early T cell activation antigens such as CD45RA/CD45RO, CD-69 and late activation antigens such as HLA-DR. A multiparameter flow cytometry was applied to detect the cell activation antigen expression. RESULTS: In terms of cytokine levels in PB and PF's of control group and early- and late-staged endometriosis cases, no significant difference was depicted in the cytokine levels (p > 0.05). Levels of immune cells did not differ between three groups (p > 0.05). CONCLUSIONS: The result of this study did not show any significant difference in PB and PF cytokine and lymphocyte subgroups between normal and early- and late-staged endometriosis.

Apoptosis patterns in eutopic and ectopic endometrium, adhesions and normal-looking peritoneum from women with or without endometriosis.

OBJECTIVE: To assess the apoptosis rate in eutopic and ectopic endometrial stromal and glandular cells, normal peritoneum and adhesions in women with endometriosis. METHODS: A total number of 97 women with (n:60) and without (n:37) histopathologically confirmed endometriosis who underwent laparoscopy or laparotomy in the early follicular phase of the menstrual cycles for pain and infertility were included in this study. Stage I/II and stage III/IV were categorized as early staged and late-staged endometriosis. The endometrial samples were obtained with a Novack cannula from the corpus of the uterus. Normal-looking peritoneum, peritoneal implants and adhesions were sampled and fixed in formaldehyde for immunohistochemical staining with Bcl-2 and Bax. Tissue samples were fixed in formaldehyde for the assessment of apoptosis via terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) and M30 cytoDEATH antibody. RESULTS: The intensity of Bax staining of normal-looking peritoneum in early staged endometriosis was higher, compared to women with late-staged and women without endometriosis (P = 0.03). However, degree of Bcl-2 staining did not differ among early and late-staged endometriosis and women without endometriosis (P = 0.1). In terms of Bcl-2 and Bax staining in the stromal and glandular parts of the eutopic endometria, no significant differences were detected among three groups. In cases with early- and late-staged endometriosis the intensity of Bax and Bcl-2 stainings did not differ in both stromal and glandular parts of ectopic endometria. Number of cells with positive apoptotic signals assessed via TUNEL (P = 1.0) and M30 cytoDEATH antibody (P = 0.59) in normal-looking peritoneum did not differ between three groups. In addition, no difference in term of numbers of apoptotic cells obtained from adhesions was observed between three groups (for TUNEL, P = 0.29, for M30, P = 0.19). CONCLUSIONS: Apoptosis patterns did not differ in the eutopic and ectopic endometria as well as adhesions of women with or without endometriosis.

Effect of cigarette smoke and alpha-tocopherol (vitamin E) on fertilization, cleavage, and embryo development rates in mice: an experimental in vitro fertilization mice model study.

OBJECTIVE: The objective was to elucidate the effects of cigarette smoke per se or vitamin E on mice exposed to cigarette smoke, with regard to fertility and cleavage rates, and embryo development in an experimental in vitro fertilization (IVF) mice model. STUDY DESIGN: Female and male mice, weighing 18-25 g and aged 14-16 weeks, were separated and divided into cigarette smoke-exposed (SE) and non-smoke-exposed (NSE) groups. A specially designed cage with a cigarette smoking machine was constructed. The SE (20 cigarettes/day) group was put in the cage for 10 weeks. SE and NSE female and male mice were given 50mg/kg of vitamin E intraperitoneally for 10 weeks and were cross-mated thereafter so as to produce seven different subgroups of mice population as follows: group I-NSE male and female mice (control); group II-SE female mice and NSE male mice; group III-NSE female with SE male mice; group IV-SE male and SE female mice; group V-SE female mice treated with vitamin E and SE only male mice; group VI-SE only female and male mice treated with vitamin E; and finally group VII-vitamin E-treated SE male and female mice. Following superovulation with FSH, follicles of female mice were obtained via laparotomy under high-dose ether. Male mice testicles were retrieved via the same surgical procedure. Both gametes were obtained and used for IVF. Fertilization, cleavage rates, and day 3 embryo grading were assessed in four groups. RESULTS: With regard to fertilization rate, group II (36%) significantly differed from group I (85%, p=0.002), group III (68.7%, p=0.04), but not from group IV (20.6%, p=0.34). Taking embryo development rate into consideration, group II (32%) had a lower percentage of embryo development compared with group I (75%, p<0.01) and group III (62.5%, p<0.001), but not group IV (17.2%, p=0.42). Percentages of embryo cleavage, embryo development, and day 3 grade I embryos did differ among four of the groups (p>0.05). CONCLUSIONS: Fertilization and cleavage rates were mainly affected in the SE female mice population. The impact of vitamin E on fertilization, cleavage, and embryo development rates was not relevant among SE male and SE female mice.

Impact of piroxicam beta-cyclodextrin on the efficacy of the intrauterine device in a rat model.

OBJECTIVE: To elucidate the effect of piroxicam beta-cyclodextrin (PbetaCD), a non-steroidal anti-inflammatory drug (NSAID), on the efficacy of the intrauterine device (IUD) in a rat model. METHODS: Forty nulliparous female Wistar rats were allocated to one of four groups, comprising each 10 of these animals. Group I: neither IUD nor medication; group II: IUD, but no medication; group III: IUD and PbetaCD; and group IV: PbetaCD only. In groups II and III, a string of 3/0 silk suture of 2 cm long was transcervically placed in one of the horns of the bicornuate uterus of the rat. Rats in group III were treated during the 18 days following IUD placement with 3 mg/kg/day PbetaCD administered via a feeding tube; group IV received PbetaCD for the same length of time, but had no IUD inserted. The rats were then mated. Thereafter, vaginal smears were taken and assessed daily, in the early morning, for the presence of spermatozoa. The day when spermatozoa were detected was considered to be the first day of gestation. On gestational day 19, both uterine horns of all rats were evaluated for the presence and number of embryos. RESULTS: In group II, mean embryo counts in the horn with or without IUD were 1.0 +/- 0.2 and 4.5 +/- 0.3, respectively (p < 0.01). The comparison of group II with group I showed that the presence of an IUD in one horn did not affect the mean embryo counts in the contralateral horn (4.5 +/- 0.3 versus 5.1 +/- 0.9, p > 0.05). In groups II and III, mean numbers of embryos in the horn with IUD were 1.0 +/- 0.2 and 2.7 +/- 0.4, respectively (p < 0.01). No difference in the mean embryo counts was observed between group I (5.1 +/- 0.9) and IV (4.8 +/- 0.9; p > 0.05). CONCLUSIONS: The IUD had a contraceptive effect in the rat model. The IUD in one horn did not affect the number of embryos in the contralateral horn. In this model, IUDs appear to exert a local effect, i.e. counteracted by PbetaCD. This drug had no adverse effect on the fertility of rats without IUD in situ.

Effect of smoking on semen parameters of men attending an infertility clinic.

OBJECTIVE: To assess the effects of smoking on total sperm count, progressive sperm motility and sperm morphology among couples attending an infertility clinic. METHODS: A total of 223 sperm samples (126 smokers and 97 nonsmokers) from men attending an infertility clinic for routine infertility workup were compared on the basis of standard semen analysis. RESULTS: Cigarette smoking is negatively correlated with progressive motile sperm count (r = -0.1464, p = 0.042), but not with sperm concentration (p = 0.961), total motile sperm count (p = 0.890) and sperm morphology (p = 0.838). Furthermore, packages/ year (cumulative dose of cigarettes) did not correlate with any of the sperm parameters including sperm density (p = 0.976), total (p = 0.559) and progressive (p = 0.406) motile sperm count and sperm morphology (p = 0.449). CONCLUSIONS: Although the effect of smoking on male infertility remains inconclusive, smoking had an adverse effect on the progressive sperm motility, irrespective of total amount of cigarettes smoked per day.

Possible factors affecting the age at menopause among women in the central anatolian region of Turkey.

OBJECTIVE: We aimed to investigate the age at menopause and possible related factors in a Turkish population. STUDY DESIGN: In a three-year period, a retrospective analysis of 541 spontaneous menopause cases were evaluated. All postmenopausal women with spontaneous cessation of menses for > or = 12 months and serum FSH levels > 40 IU/l were included in the study. Sociodemographic status, reproductive and medical history, menopausal symptoms, and previous contraceptive and hormonal therapy use were assessed based on an interview using a standardized information system. Age at menarche, parity, menopausal age of mother and sister, history of lactation, physical activity, cigarette smoking, oral contraceptive use and body mass index (BMI) were assessed. RESULTS: Menopausal age of the enrolled cases was positively correlated with mothers and sisters' ages at menopause. Postmenopausal smokers had an earlier age at menopause compared to non-smokers. CONCLUSION: Cigarette smoking results in earlier menopause in the Turkish population. Menopausal ages of mothers and sisters clearly correlated with the age at menopause.

Comparison of clinical and laboratory characteristics of cases with polycystic ovarian syndrome based on Rotterdam's criteria and women whose only clinical signs are oligo/anovulation or hirsutism.

This study was an attempt to determine whether the hormonal and clinical profiles of polycystic ovarian syndrome (PCOS) or non-PCOS cases whose only admission signs were oligo/anovulation or hirsutism. This retrospective study comprised a total number of 118, age-matched, young Turkish women with initial admission signs and symptoms of menstrual disorders (MD) like oligo/anovulation or hirsutism. Of these, 66 cases were diagnosed as PCOS, based on 2003 Rotterdam criteria [presence of two of first three criteria such as oligo- and/or anovulation, signs of clinical hyperandrogenism (HA-c) and/or biochemical signs of hyperandrogenism (HA-b) and polycystic ovaries on ultrasonography after exclusion of specific identifiable disorders]. Fifty-two women were diagnosed as cases of oligo/anovulation or hirsutism before the era of PCOS Rotterdam's consensus criteria. These two PCOS and non-PCOS cases were evaluated in terms of body mass index (BMI), waist-to-hip ratio, serum FSH, LH, estradiol (E2), dehydroepiandrosterone sulphate (DHEAS), androstendione (A) 17 hydroxyprogesterone (17-HP), fasting insulin, C-peptide levels, sex hormone-binding globulin (SHBG) and finally, ultrasonographic ovarian morphology. PCOS cases with unilateral and bilateral polycystic ovarian morphology on ultrasound scan were analyzed based on Rotterdam criteria. No statistically significant difference was detected among two groups, in terms of BMI, waist-to-hip ratio, serum FSH, LH, E2, fasting insulin, C-peptide levels (P > 0.05). However, blood levels of DHEAS, A and 17-HP were higher, whilst SHBG levels were remarkably lower (P = 0.008) in PCOS cases. Among PCOS group, hormonal and clinical characteristics did not differ, irrespective or uni- or bilaterality of ovarian morphology on ultrasonographic scan. Percentages of cases with androgenic alopecia, oily skin/acnea and increased ovarian volume were higher in PCOS group; whereas Ferriman-Gallwey score >/= 8 were similar between two groups. Total but not free testosterone remained high in PCOS group (P < 0.01). In both PCOS and non-PCOS cases, a linear correlation was apparent between BMI and insulin levels (r (s )= 0.69 and 0.32, P < 0.05, respectively). Among PCOS group, MD + HA-b + HA-c (n = 40) was present in 60.6% of subjects, MD + HA-b (n = 12) in 18.2%, and MD + HA-c (n = 14) in 21.2%. The three phenotypes did not differ in mean BMI, waist-to-hip ratio and biochemical characteristics. To conclude, non-PCOS women with only sign or symptom of oligo/anovulation or hirsutism had a more favorable endocrine milieu. These cases should be followed in vigilance in an aim to confront the development of short- and long-term adverse effects of impending PCOS in the future. Furthermore, different phenotypes of PCOS cases were clinically or biochemically similar in characteristics.

Pelvic abscess in intrauterine device users.

OBJECTIVE: To assess the causality between pelvic abscess formation and intrauterine device (IUD) use through a clinical study in a hospital. METHOD: Sixty-two pelvic abscesses were retrospectively evaluated over a 7-year period. Patient records retrieved for the women enrolled in this study consisted of demographic characteristics, duration of IUD use and clinical management details. RESULTS: All the women were monogamous Muslim women without any suspicious sexual contacts, immunosupressive states, or drug use at the time of IUD insertion. In 10 cases (16.1%), a history of pelvic surgery was present. The mean age of the women was 36.1 +/- 2.3 years (range 19-50 years). Of the 62 women, 14 (22.6%) were current IUD users. The mean time interval for women using IUD prior to the diagnosis of pelvic abscess was 5.7 +/- 1.2 years (range 1-14 years). In all cases, a pelvic mass and abdominal pain constituted the referral signs and symptoms. All women received an initial antibiotic regimen comprising penicillin (24 mU/day), clindamycin (900 mg/day) and gentamycin (240 mg/day) in divided doses. In 38 cases (61.3%), medical treatment yielded a satisfactory clinical outcome, defined as a decreas in mass volume together with pain relief and a decrease in leukocytosis. Twenty-four cases (38.7%) underwent a subsequent surgical procedure, either laparotomy (n = 19) or laparoscopy (n = 5). The type of surgery ranged from abscess drainage to more radical approaches such as total abdominal hysterectomy and/or unilateral or bilateral salpingo-oophorectomy. There were no differences between those women responding to medical therapy and those who did not respond in terms of mean age, percentage of past pelvic surgery, gravidity, parity and the size of pelvic abscess. CONCLUSIONS: A substantial number of women with an IUD were diagnosed as having a pelvic abscess within a 7-year period at the university clinic. Despite current knowledge that pelvic inflammatory disease and pelvic abscess are rarely encountered in long-term IUD users, the presence of an IUD should be investigated in cases with an initial diagnosis of pelvic abscess based on clinical and ultrasonographic evaluation, demonstrating mostly acquisition via sexually transmitted disease.

Short-term intravaginal maximal electrical stimulation for refractive detrusor instability.

OBJECTIVES: To determine the efficacy of intravaginal maximal electrical stimulation for the treatment of refractive detrusor instability. METHODS: Thirty-five consecutive patients, treated by maximal electrical stimulation for pure refractive detrusor instability were evaluated subjectively by patient's questionnaires and 24-h urinary diary and objectively by 1-h standardized pad test and subtracted cystometry before and 1 week after the treatment. Paired-t and chi(2)-tests were used for the statistical analysis of the data. RESULTS: Thirty-one (88.6%) of the 35 patients were found to be either cured or improved, subjectively. The overall objective success rates based on the 1-h pad test and subtracted cystometry were 80.0% and 74.3%, respectively. The results of all subjective and objective assessment tests, except postvoiding residual urine volume, improved significantly after the treatment (P<0.01). No significant adverse effect related to the treatment was observed, except vaginal irritation noted only by 5 (14.3%) patients. CONCLUSION: Maximal electrical stimulation could offer a safe, non-invasive and effective treatment for patients with detrusor instability who respond poorly to other conservative therapies.

The effects of severe cystocele on urogynecologic symptoms and findings.

BACKGROUND: To evaluate the effects of severe cystocele on lower urinary tract function. METHODS: Urogynecologic evaluation composed of patient questionnaire, urinary diary, pad test, Q-tip test, perineal ultrasonography and cystometry was performed on 60 patients with reducible grade III or IV cystocele before and after reduction of the prolapsed organs. The data were analyzed by Paired-t and Chi-square tests and Pearson's correlation analysis. RESULTS: One-hour pad test revealed that 17 (28.3%) of the 60 patients with reducible severe cystocele had no demonstrable urinary incontinence, while 26 (43.3%) had mild and 17 (28.3%) had moderate or severe incontinence. However, all patients had moderate or severe incontinence after reduction with vaginal packing (p<0.001). The vaginal packing had no significant effect on the maximum bladder capacity, the intravesical pressure at maximum capacity and the frequency of detrusor instability (33.3%). Whereas, urine loss after 1-hour pad test, bladder neck mobility, straining Q-tip angle and PUVA increased significantly after reduction of the cystocele (p<0.01). CONCLUSIONS: As grade III or IV cystocele may mask the presence and severity of urinary stress incontinence, preoperative urogynecological evaluation should be done after reduction of the cystocele.

Factors affecting the selection of a reversible or an irreversible contraceptive method in a developing country.

OBJECTIVES: To evaluate the factors that may affect the selection of a reversible or an irreversible contraceptive method. METHODS: In an urban area of a developing country, demographic characteristics, educational and income levels, and previously used contraceptive methods were retrospectively reviewed for 3 years from the files of women who had chosen reversible or irreversible contraceptive methods. Student's t test and the chi2 test were used to analyze the data obtained from the two groups of women. RESULTS: Out of a total of 8078 women, 595 (7.4%) selected surgical sterilization, while 7483 (92.6%) preferred reversible methods such as intrauterine devices (38.1%), combined oral contraceptives (13.9%), condoms (40%) and Norplant (0.6%). Compared to those who preferred reversible methods, the women with surgical sterilization had a higher mean age (33.9 +/- 4.2 years versus 29.6 +/- 3.9 years), mean gravidity (3.8 +/- 0.9 versus 2.3 +/- 1.2) and mean number of living children (2.6 +/- 0.8 versus 2.1 +/- 1.1) (p < 0.01). These women had also higher rates of high-school education (37.3% versus 30.1%) and previous modern contraceptive use (78.1% versus 71.2%) (p < 0.01). None of the women with surgical sterilization, but 1770 (33.0%) of those who chose reversible methods, had fewer than two living children. CONCLUSIONS: These data suggest that irreversible contraceptive methods tend to be chosen by older women with higher educational levels, who have decided that their family is complete and who have at least two children.

Effectiveness of ultrasonographic parameters for documenting the severity of anatomic stress incontinence.

BACKGROUND: To assess the correlation between the severity of incontinence and some ultrasonographic parameters used to document the mobility of bladder neck. METHODS: The severity of the incontinence and mobility the bladder neck were evaluated by pad test and perineal ultrasonography respectively in 74 patients with pure anatomic stress incontinence. During perineal ultrasonography, distances from the bladder neck to the lower tip (A) and to the posterior midpoint of symphysis pubis (B) were measured at rest and during stress. The first bladder neck mobility was obtained by two caliper method (Mu). After superimposing the symphysis pubis of the frozen images, the bladder neck positions at rest and during stress were plotted on an x-y coordinate system by using computer programs and the corresponding X and Y values were calculated. The second bladder neck mobility was measured on this x-y coordinate system (Mc). Paired t-test and correlation analysis were used for statistical analysis of the data. RESULTS: The mean Mc was significantly higher than the mean Mu (p<0.01). Compared to the values at rest, the mean distance A did not change significantly; however, the mean distance B increased, and X and Y values decreased significantly during stress (p<0.01). The amount of urine leaked per hour had significant positive correlation with distance B-stress and Mc and significant negative correlation with Y-rest, X-stress and Y-stress (p<0.05-0.001). CONCLUSION: These data suggested that the bladder neck mobility was underestimated when it was measured by two caliper method and the absolute positions or mobility of the bladder neck measured by computer on an x-y coordinate system could effectively document the severity of the decreased support of bladder neck.

Second-look laparotomy; factors affecting the results and the prognosis.

OBJECTIVE: To define the factors which might effect the results of second-look laparotomy (SLL) and the prognosis of patients with negative SLL. METHODS: Fourteen (42.4%) of the 33 patients who underwent SLL for primary epithelial ovarian cancer had residual disease (positive SLL), while 19 (57.6%) of them had no evidence of disease (negative SLL); 13 (68.4%) of the 19 patients who were followed without any intervention, still had no evidence of disease, while 6 (31.6%) of them had clinical recurrences. The age of the patients, histopathological type, stage and grade of the cancers, type of chemotherapy and the effectiveness of the cytoreductive surgery were presumed as prognosticators and were compared in each group of patients. RESULTS: The age of the patients, histopathological type of the carcinomas and the type of combined chemotherapy were similar in patients with negative or positive SLL and those with recurrences or no evidence of disease during the follow-up after negative SLL (p>0.05). However, the groups of patients with negative SLL and those with no evidence of disease during the follow-up period had lower grade or stage of cancers and less frequent sub-optimal cytoreduction than the groups of patients with positive SLL and those with recurrences during the follow-up, respectively (p<0.05). CONCLUSION: SLL could be selectively performed in patients with high grade or high stage ovarian carcinoma or in those patients treated by sub-optimal cytoreduction.

Factors affecting the contraceptive choice in a developing country.

OBJECTIVES: To evaluate the factors affecting the contraceptive choice of women in a developing country. METHODS: Demographic characteristics, education and income level, previous and current contraceptive choices of the women from a maternity and a university hospital were retrospectively reviewed for 2 years. The data obtained from the two hospitals were analyzed by Student's t- and chi2-tests. RESULTS: Family planning services were offered to 651 and 7427 women in the university and the maternity hospital, respectively. Although the mean ages and income levels of the women in two centers were similar, the women in the university hospital had lower mean gravidity and mean number of living child, while they had higher education level and previous modern contraceptive use (P < 0.05-0.001). The women in the university hospital more frequently preferred combined oral contraceptive and surgical sterilization, while those in the maternity hospital chose condom and intrauterine device (P < 0.01-0.001). CONCLUSIONS: Women with higher education level had a lower number of pregnancies and living children due to more frequent use of previous effective contraception and they chose combined oral contraceptives and irreversible methods more frequently.