Ultrasound-guided intrauterine insemination versus blind intrauterine insemination: a randomized controlled trial.

PURPOSE: This study was performed to determine the effects of ultrasound (US) guidance during intrauterine insemination (IUI) on pregnancy rate. MATERIALS AND METHODS: This study is a prospective randomized controlled trial which was performed in Women's Health Research and Education Hospital, Infertility Unit. The study enrolled 130 couples who were scheduled to undergo IUI. The couples were randomized according to a computer-generated list into two groups; 1) the ultrasound-guided IUI group included 64 couples (n = 64) treated for 99 cycles 2) blind IUI group included 66 couples (n = 66) treated for 104 cycles. All women underwent controlled ovarian stimulation before IUI. The study's main measurements were pregnancy rate per cycle; pregnancy rate per woman. RESULTS: The pregnancy rates were similar in both the ultrasound-guided (USG) (16.2%, 16/99) and non-ultrasound-guided (NUSG)(12.5%, 13/104) groups (p = 0.386). CONCLUSIONS: The present results suggest a routine ultrasound guidance during IUI is not essential as it does not increase pregnancy rates but it can be used in such cases to overwhelm some sort of difficulties.

Maternal and perinatal outcomes in women with placenta praevia and accreta in teaching hospitals in Western Turkey.

In this retrospective study, we investigated patient characteristics and fetal and maternal outcomes of placenta praevia and accreta at two tertiary hospitals in Istanbul. A total of 364 pregnancies complicated by placenta praevia with (n = 46) and without (n = 318) placenta accreta managed between January 2005 and December 2010 were reviewed. Among 364 women, 46 (12.6%) had placenta accreta and 318 (87.4%) had placenta praevia without accreta. The rates of curettage history and caesarean delivery were significantly higher in the group with placenta accreta. Furthermore, we found that emergency surgery had negative effects on maternal outcomes in the placenta praevia group. In addition, when accreta was suspected at ultrasound examination in women who had placenta praevia, the mean estimated blood loss during surgery was reduced significantly. If placenta praevia is detected, a careful ultrasound examination should be performed and the patient should undergo elective surgery at a tertiary referral hospital.

The prediction of para-aortic lymph node metastasis in endometrioid adenocarcinoma of endometrium.

The aim of this study was to assess factors associated with para-aortic lymph node metastasis in endometrioid adenocarcinoma. The data of 157 patients with endometrioid adenocancer, who underwent staging surgery, was reviewed retrospectively. A total of 23 patients (14.6%) had pelvic and 19 patients (12.1%) had para-aortic lymph node metastasis; 21% (4/19) of the patients with para-aortic lymph node involvement did not have pelvic lymph node metastasis. Para-aortic lymph node involvement was significantly more common in the presence of LVSI and pelvic lymph node metastasis, and pelvic lymph node metastasis was the only independent risk factor for para-aortic lymph node involvement. The sensitivity and NPV of positive pelvic lymph node in the prediction of para-aortic lymph node metastasis were found to be 78.9% and 97%, respectively. The corresponding rates for obturator and/or external iliac lymph node were 63.1% and 95%, respectively. In conclusion, although pelvic lymph node metastasis is the only independent risk factor for para-aortic lymph node involvement, negative pelvic lymph node is not enough to omit para-aortic lymph node dissection. On the other hand, intraoperative frozen section examination of obturator and/or external iliac lymph node to omit para-aortic lymphadenectomy might be a good option for the patients who have high medical risks for surgery.

Borderline epithelial ovarian tumors: a single center experience.

AIM: To evaluate the clinical outcomes of the patients treated for borderline ovarian tumor (BOT). MATERIALS AND METHODS: In this retrospective study, records of the patients between November 2001 and December 2012 who underwent surgery and whose final pathological diagnosis were BOT were retrieved. RESULTS: During the study period, 78 patients were diagnosed as BOT. The patho- logical diagnoses of the tumors were serous in 26 (33.3%) and mucinous in 52 patients (66.6 %), respectively. Accuracy of frozen section diagnosis was observed in 63 of 89 patients (70.7%). Sixty-eight women (87.1%) underwent complete staging procedure. According to final pathological diagnoses, Stage IA, IB, and IC were found in 52 (67%), five (6.5%), and seven (9%) patients, respectively. FIGO Stages IIC and IIIC were found in one case in each (1.25%). Remaining 12 patients were classified as unstaged (15%). The median follow-up time was 63 months. The authors observed only one recurrence (1.3%) and that patient died of disease. CONCLUSION: The survival rate in patients with BOTs confined to the ovary is excellent. Surgical staging procedure can be omitted in the patients with grossly apparent Stage I mucinous tumors.

Novel NLRP7 mutations in familial recurrent hydatidiform mole: are NLRP7 mutations a risk for recurrent reproductive wastage?

OBJECTIVE: Familial recurrent hydatidiform mole is an exceedingly rare clinical condition. Affected women are predisposed to molar pregnancies of diploid, biparental origin rather than androgenetic origin. At present, NLRP7 and KHDC3L (C6orf221) are the only genes known to be associated with familial recurrent hydatidiform mole. This study investigated the genetic dispositions in two large Turkish families with recurring molar conceptuses. STUDY DESIGN: Copy number variation analysis was performed followed by NLRP7 gene sequencing. The finding of a mono-allelic condition in one family led to investigation of the adjacent NLRP2 gene and recently associated KHDC3L gene. Sampled molar tissues were genotyped using microsatellite markers. RESULTS: In one family, a homozygous single nucleotide insertion that caused a frameshift leading to an early stop codon, c.2940_2941insC (p.Glu981ArgfsX13), was identified in the affected sisters. In the other family, a heterozygous 60-kb deletion eliminating substantial portions of the NLRP2 and NLRP7 genes on one allele was found. Screening of NLRP2 and KHDC3L genes revealed no alterations that were considered to be pathological. Genotyping of six independent molar conceptions revealed that five were of diploid, biparental origin and one was of diandric, triploid origin. CONCLUSIONS: Two novel protein-truncating mutations in the NLRP7 gene were found to be associated with familial recurrent hydatidiform mole. Mutations in the NLRP7 gene causing recurrent biparental hydatidiform mole may also be associated with other forms of recurrent reproductive wastage.

Placental mesenchymal dysplasia: a rare clinicopathologic entity confused with molar pregnancy.

Placental mesenchymal dysplasia (PMD) is a rare placental abnormality characterised by placentomegaly and grape-like vesicles resembling partial mole by ultrasonography, but in contrast to partial mole can co-exist with a viable fetus. Although the karyotype is normal, the fetus is at increased risk for intrauterine growth restriction, intrauterine fetal demise or perinatal death and Beckwith-Wiedemann syndrome. Prenatal diagnosis is difficult and the final diagnosis is usually achieved by postpartum histological examination of the placenta. We present two recent cases of placental mesenchymal dysplasia with poor obstetric outcome. One fetus presented with reduced growth parameters, while the other fetus showed hepatosplenomegaly and early hydropic changes that appear to be associated with Beckwith-Wiedemann syndrome. In this report, the clinico-pathological features of two cases of PMD are discussed and the differentiation from a partial mole is highlighted. This study also supports the utility of cytogenetic ploidy analysis and p57KIP2 protein staining in the evaluation of pregnancies with PMD.

Characteristics and prognosis of ovarian metastatic tumors: review of a single-institution experience.

BACKGROUND: To evaluate the clinico-pathological characteristics and role of surgery in patients with ovarian metastasis. MATERIALS AND METHODS: Clinical data from 51 patients with pathologically confirmed ovarian metastasis were reviewed. RESULTS: Ovarian metastasis accounted for 14% of all malignant ovarian neoplasms (51/364). Of the 51 metastatic ovarian tumor cases, 24 originated from gynecologic malignancies, while 27 originated from non-gynecologic malignancies. Optimal cytoreduction was performed in 88% and 37% of patients with metastases of gynecologic and non-gynecologic origin, respectively. Patients with ovarian metastasis had a two-year survival rate in 82% of the gynecologic group and 70% of the non-gynecologic group (p = 0.35). The five-year survival rate of patients with non-gynecologic tumor origin (29%) was significantly worse (p = 0.04) than the survival rates of those with tumors of gynecologic origin (61%). In the non-gynecologic group, the five-year survival rates were significantly different between patients who were performed optimal cytoreductive surgery vs those without this procedure (42% and 20%, respectively; p = 0.04). CONCLUSION: Although complete surgical resection is not achievable in approximately two-thirds of patients with metastases of non-gynecological origin, optimal tumor cytoreduction appears to improve survival, which is statistically significant in all patients with ovarian metastatic tumors.

Analyses of atypical glandular cells re-defined by the 2006 Bethesda System: histologic outcomes and clinical implication of follow-up management.

BACKGROUND: To evaluate the histopathology and the long-term follow-up outcome of women who had atypical glandular cells on Pap smears. MATERIALS AND METHODS: All women with atypical glandular cells (AGC) who underwent colposcopic and histopathologic evaluation between January 2005 and October 2010 were reviewed. Patient data were examined up to October 2012, allowing for at least two years of follow-up for all patients. RESULTS: Forty-four women with AGC Pap test underwent histologic follow-up during the study period. Overall, upon reclassification of smears, 35 (79.5%) cases were diagnosed with AGC "not otherwise specified" (NOS) and nine (20.5%) with AGC "favour neoplasia". Seven out of nine patients (77.7%) with AGC "favour neoplasia" had significant pathology. On the other hand, only 11 out of 35 cases (31.4%) with AGC "NOS" had significant pathology. Significant correlation was found between AGC "favour neoplasia" smears and a significant pathology (p: 0.01). Of the 44 patients, 18 (40.9%) had significant pathology. Eight patients (18.2%) had low grade cervical intraepithelial neoplasia (CIN 1), four (9%) had high-grade cervical intraepithelial neoplasia (CIN 2/3), one (2.2%) had microinvasive squamous cell carcinoma of uterine cervix, one (2.2%) had cervical adenocarcinoma in situ, one (2.2%) had cervical adenocarcinoma, one (2.2%) had endometrial adenocarcinoma, and two (4.5%) had endometrial hyperplasia. CONCLUSION: Reporting AGC in the population is clinically significant due to the high prevalence of underlying preinvasive and invasive diseases (40.9%). The subtypes of the AGC category are significant predictor of such lesions.

Comparison of inguinal and laparoscopic approaches in the treatment of varicocele.

To determine the pros and cons of inguinal and laparoscopic varix ligation techniques, we reviewed 53 patients who underwent inguinal (n = 35) and laparoscopic (n = 18) varicocelectomy at two centers. Intraoperative complications were not observed in either of the groups. There was 1 recurrence and 1 persistence in the laparoscopically treated patients. The inguinal approach had the advantage of shorter operating time (19.1 versus 52.8 min), ability to ligate the external spermatic veins, and it could be performed as an outpatient procedure. However, the laparoscopic approach seemed superior for preserving the spermatic artery (88.8% versus 68.5%) and had lesser postoperative morbidity.

Renal cell carcinoma in a giant renal cyst. A case report and review of the literature.

A case of renal carcinoma in a giant solitary renal cyst is reported. Ultrasonography and CT showed an apparently benign left renal cyst except for wall irregularity. Cytological examination and fat analysis of the cyst content were negative but the fluid was haemorrhagic in nature. Frozen section of the cyst wall revealed malignancy and further histopathologic examination indicated renal cell carcinoma.

Systemic absorption of gentamicin in penile prosthesis operations.

Irrigation with antibiotic solutions is frequently used in penile prosthesis surgery to avoid infection. We carried out a prospective study to determine the degree of absorption of gentamicin after intracavernous irrigation in 10 patients who underwent penile implantation surgery. All obtained values were below the toxic level of 10 micrograms/ml and decreased gradually within a few hours. We concluded that highly concentrated gentamicin solutions could be used with safety for intracavernous irrigation.

Eosinophilic cystitis induced by mitomycin-C.

Eosinophilic cystitis is an unusual form of cystitis which is characterized by irritative voiding symptoms and haematuria. In the report herein two adult cases of eosinophilic cystitis treated with intravesical Mitomycin-C instillations for prophylaxis of bladder carcinoma are presented and the literature is reviewed.