EFFECT OF INSULIN RESISTANCE ON THE OCCURRENCE OF PREGNANCY IN WOMEN TREATED EMPIRICALLY FOR UNEXPLAINED INFERTILITY.

CONTEXT: The detrimental effects of hyperinsulinemia on human ovaries during follicular development process have been shown in various studies, particularly in women with polycystic ovary syndrome. To our knowledge there is no study regarding the effect of insulin resistance (IR) on the intrauterine insemination (IUI) success in women with unexplained infertility (UEI). OBJECTIVE: To evaluate the effects of IR on the occurrence of pregnancy among infertile women undergoing ovulation induction (OI) with IUI for UEI. DESIGN: Prospective cohort study. SUBJECTS AND METHODS: 173 patients who met the criteria for UEI and under the age of 35 were included in this study. All women underwent OI with IUI and, subsequently, they were divided into two groups based on the presence of pregnancy. Data reviewed for analysis were demographic, clinical, and laboratory features. RESULTS: There were 37 (21.4%) cycles with pregnancy and 136 (78.6%) cycles without pregnancy. Median infertility duration was significantly lower in the pregnant group when compared with non-pregnants (p=0.018). The mean number of previous cycles per patient was also lower in this group (p=0.028). No significant differences were found between the groups in terms of other variables. Levels of insulin, fasting glucose and HOMA-IR were also similar between the two groups. CONCLUSIONS: IR calculated by using HOMA-IR index has no positive or negative effect on the occurrence of pregnancy in women undergoing OI therapy with IUI for UEI.

Factors affecting recurrence after surgery for ovarian mature cystic teratoma.

We aimed to evaluate the risk factors for recurrence of surgically managed ovarian mature cystic teratoma (MCT). A total of 178 women with MCT managed surgically at our clinic were included in this retrospective study. The cases were followed for a minimum of 34 months. Risk factors recorded were age, gravidity, diameter of MCT, tumour markers, bilaterality, operation time and recurrence time. One hundred forty-one women (79.2%) underwent laparoscopy and the other thirty-seven patients (20.8%) underwent laparotomy. The mean age of patients with cyst recurrence was significantly lower than that of patients without recurrence (p = 0.02). There was a significantly lower median gravidity and parity in this group. The capacity of younger age, lower gravidity and parity in predicting the recurrence of ovarian MCT was analysed using receiver operating characteristic curve analysis. The cut-off value of age, number of gravidity and parity was 26, 1 and 0, respectively. In conclusion, younger age and lower gravidity and parity were predictive of recurrence due to a more conservative approach in young and nulliparous patients. Therefore, we suggest regular follow-up visits during the postoperative period, especially for younger patients and those with lower numbers of gravidity and parity.

Relation of red cell distribution width to the presence and severity of endometriosis.

AIM: Although the exact pathogenesis of endometriosis is not known, it is proposed to be a chronic inflammatory disease. The asso- ciation between red cell distribution width (RDW) and inflammation is well established. Therefore, in the present study, the authors aimed to investigate the association between presence and severity of endometriosis and RDW. MATERIALS AND METHODS: Fifty endometriosis patients and 48 controls were included in the study. The endometriosis group was categorized in two subgroups as mild-to-moderate (n = 35) and moderate-to-severe disease (n = 15). CA-125 and RDW values of all participants were measured. RESULTS: Both RDW (17.7 ± 2.2 vs 14.9 ± 1.5, p < 0.001) and CA-125 (50.6 ± 35.1 vs 27.9 ± 4.8) levels were significantly higher in the endometriosis patients when compared to the control group. Moreover the authors found a significant positive correlation between RDW and CA-125 levels (r: 0.495, p < 0.001). CONCLUSION: The present study results demonstrated that RDW levels were significantly increased in endometrio- sis patients and associated with the severity of endometriosis.

Local differences in the position of the mental foramen.

The mental foramen has been reported to vary in position in different ethnic groups. Repeated failures during injections and operative procedures involving the mental foramen suggest the presence of local differences in a given population. The aim of the present study was to investigate possible local differences of the mental foramen in Eastern Anatolian individuals in the Turkish population. The present investigation is based on the examination of 70 adult mandibles. The study consisted of three measurements, to include the relations of the mental foramen to the following: 1) the lower teeth; 2) the body of mandible; 3) the mandibular symphysis and posterior border of the ramus of the mandible. The most common position of the foramen was in line with the longitudinal axis of the second premolar tooth (relation IV), at the midpoint of the mandibular body height and at 1/3.5 of the distance from the mandibular symphysis to the posterior border of the ramus. Local differences of the mental foramen may occur in a population. Prior to surgery knowledge of the most common location of the foramen peculiar to a local population may enable effective mental block anaesthesia to be provided.

Symptomatic anomalies and arthrotic formations of the axis vertebrae in eastern Anatolian people. A local investigation.

At the craniocervical junction, developmental anomalies of the axis may produce clinical symptoms by compressing the upper cervical cord during movements of the head and neck. The present study aimed at investigating several varieties and deformities of the axis on skeletal specimens of Eastern Anatolian origin. On 76 specimens, developmental anomalies and the variants of the second vertebrae (axis) were investigated. Hypoplasia of the dens axis in one specimen, the dens axis of a child with a bifid apex in another specimen and an arthrotic formation located on the apex of the dens in six axes were found. A bone protrusion narrowing the transverse foramen was also observed. The types of absence of the dens axis and clinical symptoms that may be caused by them are discussed. It was concluded that the frequency of arthrotic formations might reflect the possibility that the individuals suffered less commonly from neck pain due to arthrotic degeneration.

Symptomatic anomalies and arthrotic formations of the axis vertebrae in eastern Anatolian people. A local investigation

At the craniocervical junction, developmental anomalies of the axis may produce clinical symptoms by compressing the upper cervical cord during movements of the head and neck. The present study aimed at investigating several varieties and deformities of the axis on skeletal specimens of Eastern Anatolian origin. On 76 specimens, developmental anomalies and the variants of the second vertebrae (axis) were investigated. Hypoplasia of the dens axis in one specimen, the dens axis of a child with a bifid apex in another specimen and an arthrotic formation located on the apex of the dens in six axes were found. A bone protrusion narrowing the transverse foramen was also observed. The types of absence of the dens axis and clinical symptoms that may be caused by them are discussed. It was concluded that the frequency of arthrotic formations might reflect the possibility that the individuals suffered less commonly from neck pain due to arthrotic degeneration

Gingival enlargement in acromegaly.

In this study, we investigated gingival enlargement in patients with acromegaly as a component of the disease. Eleven patients (5 males, 6 females) were evaluated. Diagnosis was confirmed with typical clinical features and laboratory. Oral examinations were carried out by the same periodontist. During the examination, plaque index, gingival index, probing pocket depths, and gingival enlargement values were evaluated. Duration of the disease was between 0.2 and 13 yr. Seven patients had pituitary macroadenomas and four had microadenomas during their initial diagnosis. Only one patient was newly diagnosed. The other patients had previously undergone surgery. Gingival enlargement was found in eight patients. Seven patients with gingival enlargement also had prognathism, and one patient had prognathism associated with gingival enlargement. These findings demonstrate that acromegaly that results in overgrowth in various organs should be considered one of the causes of gingival enlargement.

Foramen jugulare: a local investigation and a review of the literature.

The jugular foramen varies in size and shape. Because of the variations and the surrounding structures, successful surgery is difficult in this region. For this reason, numerous studies have investigate the detailed anatomy of the foramen. The purpose of the present study is to investigate the possible local variations of the foramen jugulare. In this work, Eastern Anatolian skulls were examined in order to investigate the local variety. Extracranial opening of the foramen was only measured in diameters as maximum anteroposterior (AP) and mediolateral diameter (ML) of both right and left foramen. The height of the jugular fossa was taken as the dome height (DH). The results were in mm (right-left) as: AP (12.2-10.9); ML (13.7-12.3); DH (14-13.7). The present study suggested that local differences of the jugular foramen in relative size and shape might occur. These differences are probably peculiar to the region or probably the result of some particular clinical situation.

Successful treatment of cornual pregnancy by local injection of methotrexate under laparoscopic and transvaginal ultrasonographic guidance.

This report describes a woman with cornual pregnancy, documented by ultrasonography and laparoscopy, who was successfully treated with two doses of methotrexate under laparoscopic and ultrasonographic guidance. The serum beta human chorionic gonadotropin level was 20,000 mIU/ml and increased to 43,800 mIU/ml after the first methotrexate injection and to 44,400 mIU/ml after second injection and fell precipitously to nonpregnant levels within 27 days. No side effects were experienced by the patient.

Prophylactic vasopressin during laparoscopic salpingotomy for ectopic pregnancy.

STUDY OBJECTIVE: To evaluate the safety and efficacy of prophylactic mesosalpingeal vasopressin injection for hemostasis during laparoscopic salpingotomy for ectopic pregnancy. DESIGN: Prospective, randomized clinical study. SETTING: Reproductive endocrinology and endoscopic surgery clinic of a tertiary care hospital. PATIENTS: Forty women with ectopic pregnancy. INTERVENTIONS: Laparoscopic linear salpingotomy was attempted, with prophylactic mesosalpingeal dilute vasopressin injection in 20 patients (study group), and without vasopressin in 20 patients (control group). The two groups were similar with regard to age, size of ectopic pregnancy, gestational age, and initial beta-hCG values. A multipuncture operative laparoscopy technique was used in all cases and bipolar electrocoagulation was used for hemostasis. MEASUREMENTS AND MAIN RESULTS: The operating time was significantly shorter and the need for electrocoagulation was significantly less in the study than in the control group (p <0.05). Laparoscopic salpingotomy was performed successfully in 85% of study group patients compared with 70% of controls (p >0.05). Postoperative hysterogram revealed patency of the affected tube in 76.5% of women in the study group compared with 57.1% of controls (p >0.05). Possible complications of vasopressin, such as hypertension, bradycardia, and delayed bleeding, did not occur in any patient. CONCLUSIONS: Vasopressin use reduces both operating time and the need for electrocoagulation for hemostasis, which can have undesirable effects on the tube. Vasopressin was not associated with side effects in this relatively small sample.

The use of GnRH agonists in the treatment of endometriomas with or without drainage.

To assess the efficacy of GnRH-agonist therapy in the treatment of endometriomas with or without surgical intervention, 26 women with laparoscopically proven endometriomas larger than 3 cm were recruited to the study. Fourteen women with 19 endometriomas (5 bilateral), had drainage of endometrioma at initial laparoscopy. After the procedure, ovarian suppression was done with GnRH-a therapy for 6 months. The second group which consisted of 12 women, had 17 endometriomas. No surgical procedure was performed. They received only GnRH-a therapy for 6 months. On repeat laparoscopy, in the first group, the rates of decrease in ovarian AFS scores of endometriomas and complete resolution were found as 100% and 37% respectively. In the second group the response was only 18% (p < 0.0001). It was concluded that drainage of the cyst (surgical therapy) combined with postoperative GnRH-a suppression is a better treatment modality than the use of GnRH-a (medical therapy) alone for endometriomas.

Treatment of vaginitis.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of metronidazole 500 mg and miconazole nitrate 100 mg (Neo-Penotran, Embil Pharmacy Company, Istanbul, Turkey) in the treatment of vaginitis. METHOD: One hundred patients (mean age 26.5 years, range 18-50) with a clinical diagnosis of vaginitis entered this open, noncomparative study. Each patient inserted a Neo-Penotran pessary twice daily for 14 days. Assessments were carried out at the beginning of the study and 15 and 22 days after the start of therapy. Student's t-test was used for the statistical analysis. RESULTS: Out of 100 patients who were initially recruited to the study, 20 were subsequently excluded, leaving a total of 80 patients (80%) who completed the full course of treatment. Vaginitis was resolved in 75% of cases, it improved in 18% and was unchanged in 7%. The success rate for the treatment of trichomoniasis was 80%, 93.4% for bacterial vaginosis and 84.4% for candidal vaginitis. CONCLUSION: Neo-Penotran pessaries represent a novel and effective formulation for the treatment of common types of vaginitis and this pessary may also be of particular value in the treatment of resistant or recurrent vaginitis.

Rupture of the uterus.

OBJECTIVES: To investigate the frequency of ruptured uterus, possible etiologic factors and fetomaternal outcomes. METHODS: The birth records of 58262 deliveries at Dr Zekai Tahir Burak Women's Hospital from 1 January 1990 to 31 December 1992 were reviewed and the results compared with those of two previous studies reported from this hospital on the same subject. RESULTS: Forty uterine ruptures occurred between 1990 and 1992, with a frequency of 0.068% (1/1457). All occurred spontaneously but 10 (25%) had no previous surgery, whereas 30 followed previous cesarean section. There was no traumatic uterine rupture during this period. Fetal mortality was 32.5% and no maternal deaths were recorded. CONCLUSION: The rate of ruptured uterus has declined among our hospital population as etiologic factors responsible for the complication have been reduced.