Interrater reliability of modified visual mri rating scale assessing atrophy and white matter changes.

Background and purpose:

Cortical atrophy and white matter changes are common findings on magnetic resonance imaging among elderly. Several visual scales have been proposed to evaluate these changes using neuroimaging. We have recently proposed a scale (Modified Visual Magnetic Resonance Rating Scale) recently which allows us to evaluate atrophy, white matter hyperintensities, basal ganglia and infratentorial infarcts together. Our aim in this study was to evaluate the interrater reliability of magnetic resonance visual assessment using this scale between two neurologists and a radiologist. 

Randomly selected 30 patients in different ages who underwent brain magnetic resonance imaging between January 2014 and March 2015 were included. Axial T1, coronal T2, and axial FLAIR sequences were visually scored by two neurologists and one radiologist separately. Sulcal, ventricular and medial temporal lobe atrophy, periventricular and subcortical white matter hyperintensities, basal ganglia and infratentorial infarcts were graded according to our scale. The interrater reliability and internal consistency analysis were evaluated by using intraclass correlation coefficient and Cronbach’s alpha tests. 

The interrater agreements vary between good to excellent. The interrater correlations are moderate to excellent. Interrater correlations were excellent between two neurologists, especially on ventricular atrophy, medial temporal atrophy, basal ganglia infarcts, infratentorial infarcts. When assessing ventricular atrophy, interrater correlations between individual raters were higher than sulcal atrophy. We found good correlations between neurologists and radiologist, and excellent correlations between the two neurologists for medial temporal atrophy. We found excellent interrater correlations between neurologists and radiologist for white matter hyperintensities.

Our scale is a reliable tool assessing both atrophy and white matter hyperintensities with a good interrater reliability. Ventricular atrophy seems to be a more reliable marker than sulcal atrophy when assessing the atrophy on neuroimaging of a patient with memory decline. We think that the total score of the scale will also guide us in clinical practice.

Modified Visual Magnetic Resonance Rating Scale for Evaluation of Patients with Forgetfulness.

BACKGROUND: As cognitive impairment increases with age, sulcal atrophy (SA) and the enlargement of the ventricles also increase. Considering the measurements on the previously proposed visual scales, a new scale is proposed in this study that allows us to evaluate the atrophy, white matter hyperintensities (WMHs), basal ganglia infarct (BGI), and infratentorial infarct (ITI) together. Our aim of this study is to propose a practical and standardized MRI for the clinicians to be used in daily practice. METHODS: A total of 97 patients older than 60 years and diagnosed with depression or Alzheimer's disease (AD) are included. Cranial MRI, Mini Mental State Examination (MMSE), detailed neuropsychometric tests, and depression scales are applied to all patients. The SA, ventricular atrophy (VA), medial temporal lobe atrophy (MTA), periventricular WMH (PWMH), subcortical WMH (SCWMH), BGI, and ITI are scored according to the scale. The total score is also recorded. RESULTS: The average age of the patients was 74.53, and the mean MMSE score was 22.7 in the degenerative group and 27.8 in the non-degenerative group. Among the patients, 50 were diagnosed with AD. All parameters significantly increased with age. In the degenerative group, SA, VA, MTA, PWMH, SCWMH, and total scores were found to be significantly higher. Sensitivities of VA, PWMH, SCWMH, and total scores, as well as both sensitivity and specificities of MTA score, were observed to be high. When they were combined, sensitivities and specificities were found to be high. CONCLUSION: The scale is observed to be predictive in discriminating degenerative and non-degenerative processes. This discrimination is important, particularly in depressive patients complaining of forgetfulness.

CONTEXTE: Dans la mesure où les manifestations de déficience cognitive ont tendance à augmenter avec le vieillissement, on constate aussi une augmentation de l'atrophie des sillons du cortex cérébral et de l'élargissement des ventricules cérébraux. En tenant compte des mesures propres à des échelles visuelles utilisées antérieurement, cette étude entend proposer une nouvelle échelle nous permettant d'évaluer en même temps des cas d'atrophie ainsi que la présence d'hyperdensités de la substance blanche, d'anomalies des ganglions de la base et d'infarctus affectant l'étage sus-tentoriel (infratentorial infarcts). L'objectif de cette étude est donc de proposer un examen d'IRM pratique et standardisé pouvant être utilisé quotidiennement par les cliniciens. MÉTHODES: Nous avons inclus dans cette étude 97 patients âgés de plus de 60 ans qui étaient soit atteints de dépression, soit de la maladie d'Alzheimer. Tous les patients recrutés ont été soumis à des examens d'IRM crâniens, au test de Folstein (ou MMSE), à un ensemble de tests neuro-psychométriques approfondis et à des échelles diagnostiques permettant d'évaluer la dépression. L'incidence de l'atrophie des sillons du cortex cérébral, de la région ventriculaire, du lobe temporal médian, des régions péri-ventriculaire et sous-corticale et de la substance blanche qu'elles contiennent, d'anomalies affectant les ganglions de base et d'infarctus à l'étage sus-tentoriel a été ainsi mesurée selon notre échelle. Le score total obtenu a aussi été enregistré. RÉSULTATS: L'âge moyen des patients était de 74,53 ans. Leur score moyen au test de Folstein était de 22,7 dans le cas du groupe de patients atteints d'une maladie dégénérative et de 27,8 dans le cas du groupe de patients n'étant pas atteints par ce type de maladie. Fait à noter, cinquante patients avaient reçu un diagnostic de maladie d'Alzheimer. Tous les paramètres évalués ont augmenté de façon notable avec l'âge. Ainsi, tant les scores obtenus dans le cas de l'atrophie des sillons du cortex cérébral, de celle affectant le lobe temporal médian, la région ventriculaire, la région péri-ventriculaire, la région sous-corticale que les scores totaux se sont révélés nettement plus élevés au sein du groupe de patients atteints d'une maladie dégénérative. La sensibilité des scores totaux et des scores évaluant l'atrophie des régions vasculaire, péri-vasculaire et sous-corticale, de même que la sensibilité et la spécificité des scores évaluant l'atrophie du lobe temporal médian, se sont révélées élevées. Lorsque combinées, la sensibilité et la spécificité sont apparues élevées. CONCLUSIONS: Notre échelle possède un caractère prédictif en ce qu'elle permet d'établir une distinction entre les processus dégénératifs et les processus non-dégénératifs. Cette capacité est particulièrement importante dans le cas de patients dépressifs qui se plaignent de perte de mémoire.

Amniotic fluid proteomic signatures of cervical insufficiency and their association with length of latency.

PROBLEM: Cervical insufficiency is a precursor of preterm birth. Treatment with emergency cervical cerclage is contraindicated in the presence of intra-amniotic infection. Detecting infection with Gram stain and culture of amniotic fluid lacks sensitivity. Proteomic profiling of amniotic fluid in cervical insufficiency may help identify pregnancies best suited for emergency cerclage. METHOD OF STUDY: Thirty-two pregnant women underwent amniocentesis for routine genetic testing (n = 22) or after diagnosis of cervical insufficiency (n = 10). The proteomic profiles of the amniotic fluid samples were compared in a cross-sectional fashion, including sub-analyses of women with cervical insufficiency and latency periods of <1 week and >1 week post-diagnosis. RESULTS: Mean gestational age at diagnosis of cervical insufficiency was 21.4 weeks (95% CI 20.6-22.1). Proteomic analysis yielded 40 (7.2%, P < 0.05) differentially expressed proteins between women with delivery <1 week (n = 6) vs. >1 week (n = 4). Women who delivered <1 week had activated inflammatory response (z = 2.3, P = 6.71E-09), chemotaxis of immune cells (z = 2.9, P = 2.01E-08), and inhibited bacterial growth (z = -2.2, P = 5.82E-05). A multivariate model of eight biomarkers positively associated with cases of <1 week latency and distinguished cases from controls (97.8%, cross-validation accuracy 92.7%, P = 0.0009). CONCLUSION: In this pilot study, significant differences in the amniotic fluid proteomic profiles in cases of cervical insufficiency compared to genetic amniocentesis were observed. Proteomic signatures were predictive of achieving latency > 1 week after diagnosis of cervical insufficiency. These preliminary findings suggest that proteomic analysis may be of value in predicting outcome following cervical insufficiency and warrants further validation in larger studies.

[Obesity in the clinic room: diagnostics first, followed by effective treatment]. / Obesitas in de spreekkamer.

In clinical practice, relatively little attention is directed towards identifying underlying causes and contributing factors to weight gain in patients with obesity. However, recognising these "hidden fattening factors" is important as it can lead to more effective treatment strategies. In particular if underlying causes can be solved first, this could help to realise sustainable weight reduction. Besides the well-known lifestyle-related aspects, obesity may be caused or maintained by medication use, endocrine or hypothalamic disorders, monogenetic or syndromic diseases, and mental factors, which may require specific (medical) treatment. For lifestyle-related obesity, a combined lifestyle intervention (CLI) is a first step to combat obesity. This treatment comprises intensive guidance regarding healthy nutrition, physical activity, and behavioural psychology. In case of morbid obesity and insufficient effects of CLI after one year, weight-reducing medication or a bariatric intervention can be considered. This systematic strategy for diagnostics and treatment of obesity is illustrated by two clinical cases.

The evaluation of renal parenchymal scarring using static renal scintigraphy after percutaneous nephrolithotomy operations.

OBJECTIVE: To analyze whether operative techniques and other variables related to patient and renal stone characteristics affect potential renal parenchymal damage. MATERIALS AND METHODS: The study population comprised 64 patients who underwent percutaneous nephrolithotomy operations (PCNL). Data of the operated renal units, renal stone burden, route and number of entries, dilation techniques, duration of surgery, preoperative and postoperative glomerular filtration rate (GFR) and relative dimercaptosuccinic acid (DMSA) uptakes, as well as the changes in hemoglobin values, were recorded and analyzed for all patients. RESULTS: The mean age of the patients was 44 years. In 11 (17.1%) cases, renal cortical defects in the 3rd month were detected on DMSA scintigraphy. When the patients with and without renal cortical defect were compared regarding their preoperative and postoperative GFR values, no statistically significant difference was noticed between the groups (P > 0.05). Similarly, when postoperative relative DMSA uptakes were compared with preoperative relative DMSA uptakes of the same kidneys, no statistical significance was seen. When preoperative relative DMSA uptake values between groups with and without renal scarring were compared, no statistically significant difference was observed (P > 0.05). CONCLUSION: We did not observe any significant difference in scintigraphic parameters and GFR values. Hence, in the current trial, significant loss in renal function after PCNL operations was not observed. Thus, PCNL operations should be regarded as safe, but still, the risk of loss of kidney function should always be considered.

The safety and efficacy of ERCP in octogenarians: a comparison of two geriatric age cohorts.

BACKGROUND AND AIMS: The application of endoscopic retrograde cholangiopancreatography (ERCP) in the octogenarian population is limited. The aim of the study was to compare the clinical characteristics and outcomes of ERCP in octogenarian patients with non-octogenarian elderly patients. MATERIALS METHODS: A total of 1044 patients who underwent ERCP for the first time and are over the age of 65 were enrolled in this study. Data regarding demographic characteristics, medical history of patients, indications, technical success rate, final clinical diagnosis and complications were analyzed. 284 patients and 760 patients composed the octogenarian and non-octogenarian group, respectively. RESULTS: The mean ages in octogenarian and non-octogenarian groups were 83.99±3.85 and 71.50±4.27 years of age respectively. Both groups had similar values with regards to chronic concomitant diseases (96.6% vs. 96.5%). The most common indication of ERCP in the two groups was common bile duct stones. There was no significant difference in technical success and failure of cannulation in procedures of either group (p > 0,05). The duration of overall ERCP procedure was shorter in length in the non-octogenarian group in comparison to the octogenarian group (p = 0.004). The overall complication rate was similar in both groups (p > 0.177). The most common complication in either group was post-ERCP pancreatitis. CONCLUSIONS: ERCP is an effective and safe procedure in both octogenarian and non-octogenarian patients with naive papilla when performed by experienced endoscopists.

Blood and semen paraoxonase-arylesterase activities in normozoospermic and azoospermic men.

Paraoxonase and arylesterase enzymes are corner stones of antioxidant defence. We aimed to compare azoospermic infertile men and normozoospermic individuals with respect to total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), paraoxonase and arylesterase levels in the blood and seminal plasma. Two-hundred consecutive infertility patients and voluntarily participated were included. In the normozoospermic group, TAS, PON, arylesterase values were statistically significantly higher when compared with those in the azoospermic group, while lower TOS and OSI levels were observed in the blood and seminal plasma of azoospermic group. In the semen analyses of normozoospermic group, the correlation between semen volume, sperm concentration, sperm motility and morphology and TAS, TOS, OSI, PON and arylesterase values was examined. A negative correlation was determined between semen volume and OSI. Levels of serum oxidative parameters were higher in the azoospermic group relative to normozoospermic group, but antioxidant parameters were lower than those of the normozoospermic group. Oxidative stress performs an essential role in the aetiology of male infertility by negatively influencing sperm quality and function. Assessment of blood and seminal plasma oxidative profiles might be an important tool to better evaluation of sperm reproductive capacity and functional competence.

Diabetes in Pregnancy.

OBJECTIVE: This guideline reviews the evidence relating to the diagnosis and obstetrical management of diabetes in pregnancy. OUTCOMES: The outcomes evaluated were short- and long-term maternal outcomes, including preeclampsia, Caesarean section, future diabetes, and other cardiovascular complications, and fetal outcomes, including congenital anomalies, stillbirth, macrosomia, birth trauma, hypoglycemia, and long-term effects. EVIDENCE: Published literature was retrieved through searches of PubMed and the Cochrane Library using appropriate controlled vocabulary (MeSH terms "diabetes" and "pregnancy"). Where appropriate, results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date limits, but results were limited to English or French language materials. VALUES: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). SUMMARY STATEMENTS: Recommendations It is recognized that the use of different diagnostic thresholds for the "preferred" and "alternative" strategies could cause confusion in certain settings. Despite this, the committee has identified the importance of remaining aligned with the current Canadian Diabetes Association 2013 guidelines as being a priority. It is thus recommended that each care centre strategically align with 1 of the 2 strategies and implement protocols to ensure consistent and uniform reporting of test results.

Le diabète pendant la grossesse.

OBJECTIF: La présente Directive passe en revue les données probantes liées au diagnostic et à la prise en charge obstétricale du diabète durant la grossesse. ISSUES: Les issues évaluées étaient les issues maternelles à court et à long terme, dont la prééclampsie, la césarienne, le diabète éventuel et d'autres complications cardiovasculaires et les issues fœtales, dont les anomalies congénitales, la mortinaissance, la macrosomie, le traumatisme de la naissance, l'hypoglycémie et les effets à long terme. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans PubMed et The Cochrane Library au moyen d'un vocabulaire contrôlé (termes MeSH « diabète ¼ et « grossesse ¼) appropriés. Le cas échéant, les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles. Aucune limite n'a été imposée en matière de date, mais les résultats ont été limités aux articles publiés en anglais ou en français. VALEURS: La qualité des résultats a été évaluée au moyen des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs (Tableau 1). DéCLARATIONS SOMMAIRES: RECOMMANDATIONS.

Perinatal Outcome in 1515 Cases of Prolonged Second Stage of Labour in Nulliparous Women.

OBJECTIVE: To examine perinatal outcomes among nulliparous women with a second stage of labour lasting more than three hours. METHODS: We conducted a retrospective review of all nulliparous women over a 14-year period who had a term, live, singleton, cephalic fetus ≥ 2500 g and who had a second stage of labour lasting at least three hours. Outcome measures included five-minute Apgar score < 7, cord arterial pH < 7.10, admission to the NICU, neonatal seizures, and neonatal death. Rates of serious long-term neurologic morbidity were also analyzed. Outcomes were compared with those of a similar cohort of women who delivered after less than three hours in the second stage. RESULTS: During the study period, 1515 women met the inclusion criteria. The majority of women (67%) delivered vaginally, after up to 10 hours in the second stage of labour. The overall rate of Caesarean section was low (15.7%). The rate of permanent neurologic impairment was 2.6 per 1000 deliveries. CONCLUSION: Among nulliparous women, 84% were spared a possibly difficult Caesarean section in the second stage of labour or a potentially difficult operative vaginal delivery by allowing a longer second stage. However, surviving neonates had a higher risk of permanent neurologic handicap. Our study indicates that the optimal management of the second stage of labour remains controversial.

Objectif : Examiner les issues périnatales chez des nullipares ayant connu un deuxième stade du travail d'une durée supérieure à trois heures. Méthodes : Nous avons mené une analyse rétrospective, sur une période de 14 ans, portant sur toutes les nullipares qui ont accouché à terme d'un fœtus unique en présentation céphalique ≥ 2 500 g et qui ont connu un deuxième stade du travail d'une durée d'au moins trois heures. Parmi les critères d'évaluation, on trouvait un indice d'Apgar à cinq minutes < 7, un pH du sang artériel de cordon < 7,10, l'admission à l'UNSI, les convulsions néonatales et le décès néonatal. Les taux de morbidité neurologique grave à long terme ont également été analysés. Les issues ont été comparées à celles d'une cohorte semblable de femmes ayant accouché après un deuxième stade du travail d'une durée de moins de trois heures. Résultats : Au cours de la période d'étude, 1 515 femmes ont répondu aux critères d'inclusion. La majorité des femmes (67 %) ont connu un accouchement vaginal, et ce, même après un deuxième stade du travail dont la durée avait atteint jusqu'à 10 heures dans certains cas. Le taux global de césarienne était faible (15,7 %). Le taux de détérioration neurologique permanente était de 2,6 sur 1 000 accouchements. Conclusion : Quatre-vingt-quatre pour cent des nullipares ont pu, en permettant la prolongation du deuxième stade, éviter une césarienne qui aurait pu être difficile au cours du deuxième stade du travail ou encore un accouchement vaginal opératoire potentiellement difficile. Toutefois, les nouveau-nés ayant survécu ont été exposés à un risque accru de handicap neurologique permanent. Notre étude indique que la prise en charge optimale du deuxième stade du travail demeure un sujet controversé.

Assessment of Mean Platelet Volume in men with vasculogenic and nonvasculogenic erectile dysfunction.

Mean platelet (PLT) activation has an important role in the development of vascular diseases. In this study, we aimed to investigate the PLT volume in patients with vasculogenic and nonvasculogenic erectile dysfunction (ED) and compare it with the control group. Mean PLT volume (MPV) levels were measured in 50 patients with vasculogenic ED, in 30 patients who developed ED after radical prostatectomy (nonvasculogenic) and in 40 healthy controls. Ages were similar between the three groups. The diagnosis of ED was based on detailed sexual history, physical examination, laboratory assessment and color Doppler ultrasonography and is defined as the inability to attain or maintain a penile erection that is sufficient for successful vaginal intercourse. The results are given as mean ± s.d. of the mean. The mean age of the patients with vasculogenic ED, of patients with ED after radical prostatectomy and of the control group were 53.70 ± 12.39 (range 24-77), 54.60 ± 11.40 (range 43-61) and 53.85 ± 9.5 (range 30-73), respectively (P = 0.853). The MPV and PLT values were significantly higher in patients with vasculogenic ED than in patients with ED after radical prostatectomy and in control groups: 7.49 ± 1.4, 6.43 ± 1.19 and 6.85 ± 1.2 for MPV and 262.97 ± 68, 251.77 ± 78 and 252.89 ± 82 for PLT values, respectively (P = 0.033). The MPV and PLT values were not statistically significant in postprostatectomy ED patients and in control groups (P = 0.663). There was no significant difference among the three groups in terms of white blood cells and hemoglobin levels. PLT count and mean PLT volume were detected to be increased in patients with vasculogenic ED. This finding may suggest a role for PLT volume in the pathogenesis of vasculogenic ED.

Unsedated transnasal versus conventional oral endoscopy in endoscopy naïve patients.

BACKGROUND AND STUDY AIMS: Unsedated transnasal upper endoscopy (TNE) has been suggested as a more comfortable and safer method than unsedated transoral endoscopy (TOE). However, the numbers of comparative trials are limited. The current study aimed to assess the tolerability, safety, and efficacy of TNE in endoscopy naïve patients. PATIENTS AND METHODS: The current study was designed as a randomized, prospective, parallel arm trial including all eligible patients referred for upper endoscopy. Patients were randomized with a 1:1 ratio to undergo either unsedated TOE using a standard endoscope or unsedated TNE using an ultrathin endoscope. Postprocedure, all patients were asked to complete a questionnaire to assess pain, discomfort, distress and tolerability using a 10 cm visual analog scale (VAS). Patients' expectations and future preferences were also determined by multiple choice questions. Endoscope insertion rate, procedure duration, and side-effects were recorded for each patient. RESULTS: Each group included 200 patients. With the exception of nasal pain, mean VAS scores were significantly lower in TNE patients when compared to TOE patients (p = 0.0001). 85% and 54.5% of patients in TNE and TOE groups, respectively, found the procedure better than expected (p = 0001). A repeat procedure was significantly more acceptable for TNE than TOE (82.4% and 60.5%, respectively). Endoscope insertion failed in 3.5% of TNE patients. Mild epistaxis was observed in 4% of TNE patients. CONCLUSION: Unsedated TNE was tolerated better in endoscopy naive patients than unsedated TOE in a large parallel arm trial.

Ultrathin endoscopy for gastrointestinal strictures.

BACKGROUND AND AIM: The assessment and treatment of advanced gastrointestinal (GI) strictures, which are defined as the inability to pass through the strictured segment with standard endoscopes, might require radiological work-up, repeated endoscopies and surgery. The aim of the present study was to assess the role of ultrathin endoscopy (UTE) for the evaluation and treatment of advanced GI strictures. METHODS: Patients in whom an initial diagnostic upper or lower endoscopy attempt was incomplete because of a tight stricture underwent a second procedure with a UTE (5.9 mm diameter) in the same session. An interventional endoscopic therapy was also carried out according to the etiology and nature of the stricture using the same UTE. Diagnostic and therapeutic outcomes were recorded and followed up prospectively. The study was conducted in a tertiary endoscopy center. RESULTS: During a one and half year study period, 62 patients (51 at upper and 11 at lower endoscopy) were detected with advanced GI stricture among 8456 diagnostic upper and 3815 lower endoscopy patients. A complete endoscopic examination was successful with UTE in 40 (78%) patients with upper and in nine patients (82%) with lower GI strictures. An interventional procedure was also carried out in 16 patients with the assistance of UTE. CONCLUSION: UTE is a useful tool for the evaluation of patients with advanced GI strictures. It provides a complete diagnostic endoscopy in most patients and gives an opportunity for therapeutic endoscopic procedures.

Influence of stone size, location and impaction on the success of ureteroscopic pneumolithotripsy.

This study was conducted on 336 patients that had undergone ureteroscopic pneumolithotripsy for ureteric stones between August 2005 and June 2008. Patient data were analyzed with respect to stone localization, size and impaction. All ureterorenoscopic procedures were performed under general anesthesia using a 9.5F rigid ureteroscope. A plain film of the kidney ureter bladder was performed on the first postoperative day and week 4 to evaluate treatment efficacy. Patient age was 42, 63+/-15 (14-77) yr. Mean stone size for all groups was 9.77+/-4mm (5-20 mm). A total of 336 patients were treated with ureteroscopic pneumolithotripsy, 129 female and 207 male. The overall initial success rate was 85.71%. The success rate of ureteroscopic pneumolithotripsy, proximal, middle and distal ureter, for Stone location, 76.54%, 85.48%, 90.74%, for Stone size (>10 mm) 54%, 77%, 88 % and for Stone impaction; 50%, 75,6%, 85,4% respectively. There was a statistically significant difference between stone free rates with respect to the proximal ureter stone, increasing stone size (>10 mm) and stone impaction (p<0.05) and a positive correlation with the operative complication rate. It is concluded that it is possible to achieve high success and low complication rates in pneumolithotripsy for distal ureteric stones. Nevertheless, the success rate decreases and complication rate increases with stone locations close to the proximal ureter. Complication rate increases with increasing stone size and/or impacted ureteral stones.

Sexual functions and quality of life in women with tubal sterilization.

The aim of this study was to evaluate the sexual functions and quality of life of women who have undergone tubal sterilization after tubal surgery. In all, 90 active premenopausal women, who had undergone tubal sterilization at least 1 year ago and been admitted to four different hospitals, were included in the study group. A total of 100 women at a similar age range, admitted to the same four hospitals for routine health controls, were included in the control group. To obtain sexual function assessments, the patients were asked to fill out Female Sexual Function Index (FSFI) questionnaire. The participants were also asked to fill out Medical Outcomes Study Short Form (SF-36) questionnaire. All values were found to be lower in the tubal sterilization (TS) group and the differences between groups were statistically significant in domain except for pain and lubrication. Similarly, in the analysis of SF-36 scores, there were differences in comparison with the TS group in all domains. In the evaluation of the relationship of FSFI with educational level in the TS group, it was found that, while the educational level increased, all domain scores also increased, and this increase was statistically significant in all domains except pain. The termination of fertility, which is one of the important abilities of women, with tubal sterilization, may be a risk factor for female sexual dysfunction in people with low educational levels.

Polyorchidism: a three-case report and review of the literature.

The presence of more than two testes confirmed by histology is called polyorchidism. Polyorchidism is an extremely rare congenital anomaly with a few more than 100 cases reported in the literature. The majority of reported cases are asymptomatic patients, others present with cryptorchidism, hydrocele, varicocele, epididymitis, infertility, testicular malignancy and testicular torsion. Over a 2-year period, we encountered three patients who were found to have polyorchidism; two men presented with cryptorchidism and one with chronic scrotal pain. Physical examination of the first and the third patient revealed normal testes in the scrotal sac, the other scrotal sac was empty and small solid mass (atrophic left testes) was palpated in the inguinal canal. Ultrasonographic examination of the scrotum and inguinal region confirmed the findings of the physical examination. Ultrasonographic examination of the second patient revealed supernumerary testes within the scrotum. Orchiectomy was made on the first and third patients' supernumerary testes and ipsilateral inguinal high ligation was applied for herniorrhaphy. A conservative approach was preferred for the second patient, maybe preserving a potentially functional supernumerary testis to improve the capacity for spermatogenesis. The risk of malignancy justifies the removal of an atrophic and ectopic testis in polyorchidism. However, it would appear safe to preserve a viable intrascrotal supernumerary testis found incidentally at surgery, provided that the patient is followed-up in the long term.

Obstetrical and neonatal outcomes in obese parturients.

OBJECTIVE: Obstetrical risk is increased with maternal obesity. This prospective study was designed to simultaneously evaluate the outcomes in obese parturients and their newborns. METHODS: Patients with a body mass index (BMI) > or =35 were prospectively identified and compared to an equal number of normal weight parturients. Maternal and neonatal outcome measures were compared for the peripartum and neonatal period. RESULTS: We identified 580 obese parturients over a 6 month period and compared them to an equal number of normal weight parturients. The incidence of obesity in this population was 23%. Obesity was associated with increased rates of hypertension, diabetes, and cesarean section. Obese patients were more likely to develop postpartum complications. Neonatal outcomes were compared for infants > or =37 weeks gestation excluding multiple births (496 neonates in the obese group and 520 in the control group). The neonates of obese parturients were more likely to be macrosomic, have 1-minute Apgar scores of < or =7.0 and require admission to a special care unit. Sub-group analysis showed that negative outcomes for parturients and their neonates correlated with increasing BMI. Neonates born to obese diabetic parturients had the highest risk of poor outcomes. CONCLUSIONS: Maternal obesity confers increased risks for both the parturient and their newborn.