The overlooked association between lower urinary tract dysfunction and psychiatric disorders: a short screening test for clinical practice.

INTRODUCTION: Lower urinary tract dysfunction (LUTD) often presents with other associated comorbidities such as urinary tract infections, constipation, fecal incontinence, and vesicoureteral reflux. However, the psychiatric conditions that can be associated with LUTD tend to go unnoticed. The evaluation, diagnosis, and treatment of LUTD and psychiatric disorders in children are difficult and time-consuming. Moreover, there is currently no accepted consensus on this subject. OBJECTIVE: In this study, the authors aimed to investigate the relationship between the subgroups of both LUTD and psychiatric disorders. STUDY DESIGN: LUTD were divided into 4 groups by using voiding dysfunction symptom score (VDSS), bladder diary, and uroflowmetry/electromyography (UF/EMG) test. A short screening test for psychological problems was used to detect psychiatric disorders accompanying each LUTD group. In terms of psychiatric disorders, the patients were divided into two groups: externalizing and internalizing disorders. RESULTS: A total of 156 children were diagnosed with LUTD. Seventy-six patients had overactive bladder (OAB), 53 had dysfunctional voiding (DV), 14 had primary bladder neck dysfunction (PBND), and 13 had underactive bladder (UAB). Psychiatric disorder was detected in 46 children (29.4%). Of these, 32 had an externalizing and 14 had an internalizing disorder. In terms of age, externalizing disorders were more common in children aged between 6 and 11 years (87.5%), whereas internalizing disorders were seen equally in both age groups. Among these, attention deficit hyperactivity disorder (ADHD) was the most common psychiatric disorder (16.1%). The LUTD groups with the most frequent psychiatric disorders were UAB (53.8%), PBND (35.7%), and OAB (28.9%). DISCUSSION: Most of the studies investigating the relationship between the lower urinary tract and psychiatric disorders so far have been concerned with the lower urinary tract symptom (LUTS) (such as nighttime or daytime incontinence) and ADHD. However, the present study was performed according to the LUTD classification, which is primarily based on VDSS, bladder diary, and UF/EMG tests. Furthermore, psychiatric disorders were classified into their subgroups. The results have shown that around a quarter of children with LUTD also had comorbid psychiatric disorders. The relationship between LUTD and psychiatric disorders constitutes a critical point. Identifying this association can contribute to the comprehensive diagnosis and treatment for these patients. CONCLUSIONS: LUTD and psychiatric disorders can be seen together, and this can be detected by the short screening test for psychological problems. Therefore, the authors think that patients who applied with LUTS should undergo this short test along with the routine urinary system examination and tests.

OVERTREATMENT AND HYPOGLYCEMIA PREVALENCE IN GERIATRIC PATIENTS WITH TYPE-2 DIABETES IN THE TURKISH POPULATION.

OBJECTIVE: To determine the prevalence of over-treatment and hypoglycemia in Turkish type-2 diabetes patients and to identify the risk factors. METHODS: Patients ≥ 65 years, having a minimum 5 years of type-2 diabetes, were included in the study. Patients' body mass index, mean HbA1c level, disease onset and medications related with their co-morbidities were recorded. Over-treatment is defined as the use of non-metformin therapies despite having HbA1c levels < 7%. A history of hypoglycemia episodes in the last three months and patients' home blood glucose measurements were recorded. Factors relating to hypoglycemia and over-treatment were analyzed. RESULTS: After applying criteria, 755 patients were included in the study: 728 patients (96.4%) had at least one comorbidity. 257 patients (34%) were found to have HbA1c levels < 7%. 217 of them (84.4%) were using non-metformin therapies. 497 patients (65.8%) were using insulin. The over-treatment prevalence in the ≥ 65 years group was 28.7%. The over-treatment ratio in ≥ 80 years group was 28.2%. Hypoglycemia prevalence in the last three months was 23.3%. It was 22.7% for patients ≥ 80 years. Mean age, disease duration, body mass index, insulin usage and doses were found to be significantly different in over-treated patients compared to the others. CONCLUSIONS: This study showed that despite recent guidelines, there is still a considerable amount of over-treated geriatric patients who are at risk of hypoglycemia and related morbidity and mortality. Insulinization rate was high. Physicians should not avoid de-intensifying the treatment of geriatric patients who have multiple co-morbidities.

An Investigation of Protective Effects of Litium Borate on Blood and Histopathological Parameters in Acute Cadmium-Induced Rats.

This study was carried out to determine the protective effects of lithium borate (LTB) on blood parameters and histopathological findings in experimentally induced acute cadmium (Cd) toxicity in rats. Twenty-eight male Wistar albino rats were used, weighing 200-220 g, and they were randomly divided into four groups, including one control and the following three experimental groups: a Cd group (0.025 mmol/kg), a LTB group (15 mg/kg/day orally for 5 days), and a LTB + Cd group (15 mg/kg/day orally for 5 days and Cd 0.025 mmol/kg by intraperitoneal injection on the fifth day). All the rats in the study were anesthetized with ketamine at the end of the sixth day, blood was taken from their hearts, and then the rats were decapitated. The values in the control and LTB group were usually close to each other. White blood cell (WBC), neutrophil %, and C-reactive protein (CRP) levels increased in the Cd and LTB + Cd groups while lymphocyte and monocyte levels decreased in a statistically significant manner, in comparison to the other groups. It was determined that the levels of red blood cells (RBCs), hematocrit (Htc), and hemoglobin (Hb) did not change in the groups. The levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the Cd and LTB + Cd groups significantly increased, in comparison to the other groups, while the glucose, alkaline phosphatase (ALP), albumin (ALB), and total protein (TP) levels decreased. According to histopathological findings in the control and LTB groups, the liver and kidney tissues were found to have normal histological structures. In the Cd group, severe necrotic hemorrhagic hepatitis, mild steatosis, and mononuclear cell infiltration were detected in the liver. In the LTB + Cd group, degeneration and mild mononuclear cell infiltration were found in the liver. Regarding the kidney tissue in the Cd group, severe intertubular hyperemia in both kidney cortex and medulla, as well as degeneration and necrosis in the tubulus epithelium, was observed. In the LTB + Cd group, mild interstitial hyperemia and mononuclear cell infiltration was detected. Resultantly, it can be said that LTB at this dose has non-toxic effects and some beneficial effects for liver and kidney damage caused by acute Cd toxicity.

Biomarkers of airway and systemic inflammation in obese asthmatic paediatric patients

Background: It is thought that airway inflammation is more common in obese asthmatic patients because inflammation is harder to control and does not respond well to glucocorticoid treatment. Objective: This study's aim was to investigate the effect of obesity on airway and systemic inflammation in children with asthma and to identify the biomarkers that play a role in this inflammation. Methods: The study included patients aged 6-16 years who were diagnosed with asthma in the paediatric allergy outpatient clinic of Bagcilar Training and Research Hospital in Turkey. Complete blood count parameters were compared between three groups: obese asthmatic (n = 43), obese non-asthmatic (n = 45), and non-obese non-asthmatic (control group, n = 30). Levels of high-sensitive CRP (hs-CRP), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), and matrix metalloproteinase-9 (MMP-9), and 25(OH)-vitamin D were compared between the groups. Results: No statistically significant differences were observed in 25(OH)-vitamin D, NGAL, OPN, hs-CRP, and MMP-9 levels between groups. There was a statistically significant negative correlation between FEV1/FVC and NGAL and MMP-9. Conclusion: This is the first study to investigate levels of hs-CRP, NGAL, OPN, MMP-9, and 25(OH)-vitamin D in obese asthmatic children. Larger studies with sputum and BAL examinations are required to determine the potential of biomarkers for identifying inflammation in obese asthmatic children (AU)

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Biomarkers of airway and systemic inflammation in obese asthmatic paediatric patients.

BACKGROUND: It is thought that airway inflammation is more common in obese asthmatic patients because inflammation is harder to control and does not respond well to glucocorticoid treatment. OBJECTIVE: This study's aim was to investigate the effect of obesity on airway and systemic inflammation in children with asthma and to identify the biomarkers that play a role in this inflammation. METHODS: The study included patients aged 6-16 years who were diagnosed with asthma in the paediatric allergy outpatient clinic of Bagcilar Training and Research Hospital in Turkey. Complete blood count parameters were compared between three groups: obese asthmatic (n=43), obese non-asthmatic (n=45), and non-obese non-asthmatic (control group, n=30). Levels of high-sensitive CRP (hs-CRP), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), and matrix metalloproteinase-9 (MMP-9), and 25(OH)-vitamin D were compared between the groups. RESULTS: No statistically significant differences were observed in 25(OH)-vitamin D, NGAL, OPN, hs-CRP, and MMP-9 levels between groups. There was a statistically significant negative correlation between FEV1/FVC and NGAL and MMP-9. CONCLUSION: This is the first study to investigate levels of hs-CRP, NGAL, OPN, MMP-9, and 25(OH)-vitamin D in obese asthmatic children. Larger studies with sputum and BAL examinations are required to determine the potential of biomarkers for identifying inflammation in obese asthmatic children.

Atorvastatin has no effects on kidney tissues of wistar albino rats in the long-term Intake: an electron microscopic Study / Atorvastatina no niene efectos sobre los tejidos renales de ratas wistar albinas en el consumo a largo plazo: un estudio de microscopia electrónica

In this study, we evaluated the ultrastructural findings of kidney with systemic administration of different doses of atorvastatin in a rat model. Statins may have anti-inflammatory effects that would play a role in preventing the cellular damage. The aim of this study was to investigate how atorvastatin could play a role in kidney tissues. Forty adult male Wistar albino rats (200­250 g) were randomly divided into 4 groups of ten rats each (A1, A2, A3 and Control). Three different doses of atorvastatin were used to determine the effects on kidney tissues during 90 day period. The kidneys of A1 (0.1-mg group), A2 (0.5-mg group) and A3 (1-mg group) group were excised and the tissues were examined after the 90 days by transmission electron microscopy. Despite increasing the dose of atorvastatin intake, the histological structures of atorvastatin groups were appeared normal in the same period. In conclusion, long-term use of atorvastatin was not found to have an adverse effect on kidney tissue.

En un modelo de rata, se evaluaron los hallazgos ultraestructurales del riñón provocados por la administración sistémica de diferentes dosis de atorvastatina. Las estatinas pueden tener efectos anti-inflamatorios que desempeñan un importante rol en la prevención del daño celular. El objetivo de este estudio fue investigar cómo la atorvastatina podría desempeñar un papel en los tejidos del riñón. 40 Ratas Wistar albinas Adultas (200-250 g) machos fueron divididas aleatoriamente en cuatro grupos de 10 ejemplares cada uno (A1, A2, A3 y Control). Tres diferentes dosis de atorvastatina se utilizaron para determinar los efectos sobre los tejidos del riñón durante un período de 90 días. Los riñones de los grupos A1 (0,1 mg), A2 (0,5 mg) y A3 (1 mg) fueron extirpados a los 90 días y los tejidos examinados por microscopía electrónica de transmisión. A pesar de haberse aumentado la dosis de ingesta de atorvastatina, las estructuras histológicas se asemejaron al grupo normal del mismo período. En conclusión, el uso de atorvastatina en un plazo prolongado, no produce efecto negativo sobre el tejido renal.

Effects of atorvastatin on smoking-induced alveolar injury in rat lungs.

BACKGROUND: Smoking is one of the most serious health care issues worldwide, as one third to one half of all people who smoke eventually use tobacco habitually. Chronic smoke exposure causes airway and lung parenchymal inflammation and the destruction of alveolar cell walls. Statins may have anti-inflammatory effects that would play a role in preventing the cellular damage associated with smoking. OBJECTIVE: The aim of this study was to investigate whether atorvastatin protects against smoking-induced inflammation in alveolar epithelial type I (ATI) and type II (ATII) cells in the lungs of rats. METHODS: Adult male albino Wistar rats (200-250 g) were randomly divided into 3 groups and exposed to cigarette smoke 8 hours per day for 15 days. During that 15-day period, the 2 treatment groups received atorvastatin 0.5 or 1.0 mg/kg/d in 2 mL of methyl cellulose solution and the control group received 2 mL of methyl cellulose solution alone, all via nasogastric catheter. After the 15 days, the lungs were excised and the tissues were examined by transmission electron microscopy. RESULTS: Thirty rats were divided into 3 groups of 10 rats each. All rats survived the 15 days. In the atorvastatin 0.5-mg group, no changes were found in the ATI cells or in the blood-air barrier. In the atorvastatin 1.0-mg group, we observed hyperplasia in the common basal membranes. Hypertrophy, mitochondrial crystolysis (MC), and intracytoplasmic edema (ICE) were detected in the ATI cells in the 1.0-mg group, while chromatin condensation, atrophic appearance, cell shrinkage, and cyto-plasmic vacuolization were observed in the ATII cells. The rough endoplasmic reticulum (rER) tubules of the ATII cells appeared spiral-shaped. In the control group, minimal ICE was detected in the ATI cells. However, microvillus deformation, pseu-dopod formation, edema, mitochondrial swelling, and MC were observed in the ATII cells. We also observed MC, several pinocytic vesicles, and normal rER tubules in the endothelial cells of the control group. CONCLUSIONS: The administration of atorvastatin 0.5 mg/kg/d was associated with some attenuation of lung injury caused by smoke inhalation in these rat lungs. However, atorvastatin 1.0 mg/kg/d was associated with lung damage. Future studies are needed to evaluate the dose-response relationship of atorvastatin to smoking-induced alveolar damage.

Association of apolipoprotein E genotype and cerebrovascular disease risk factors in a Turkish population.

The purpose of the present study was to investigate the predictive role of apolipoprotein E genotypes for stroke-related risk factors in the Turkish population. Among 100 stroke patients and 30 healthy subjects included in the study, most frequent Apo E genotype was epsilon3/3, compatible with polymorphic distribution of Asian population. VLDL and triglyceride levels in epsilon2/4(+) subjects were higher than in epsilon2/4(-) patients. HDL and homocysteine levels were higher in epsilon4/4 (+) subjects than in epsilon4/4 (-) stroke patients. These results suggest that ApoE polymorphism in this population was not associated with any other demographic or clinical variables except for lipid profiles and homocysteine levels.

Surgery of carotid body tumour: 14 cases in 7 years.

OBJECTIVE: The goal was to review our experience in the management of carotid body tumours. MATERIAL AND METHODS: A retrospective study was performed of patients in whom carotid body tumour was diagnosed between 1998 and 2005. Data were retrieved from hospital discharge files. RESULTS: Fourteen patients were operated on. There were five patients in Shamblin class I, 4 in class II, and 5 in class III. Duplex examination was performed in all patients. Computerized tomography scans were performed in eight (57%) patients and magnetic resonance imaging scans in five patients (36%). Angiography was performed in all patients, preoperative embolization was attempted in 5 (36%). The blood loss for these patients was not less than for those without embolization. Three patients (21%) had postoperative cranial nerve deficits. All the deficits resolved. The internal carotid artery was injured in two patients and the external carotid artery was injured in three patients (36%). No stroke occured. CONCLUSION: Surgical resection is the treatment of choice for carotid body tumours. Observation of these tumours is not recommended because progressive growth is associated with increased risk of neurological deficits. Early surgical management is recommended to avoid neurological deficit due to a Shamblin class III tumour. We also do not recommend embolization.

The adsorption of basic dye (Astrazon Blue FGRL) from aqueous solutions onto sepiolite, fly ash and apricot shell activated carbon: kinetic and equilibrium studies.

In this study, sepiolite, fly ash and apricot stone activated carbon (ASAC) were used as adsorbents for the investigation of the adsorption kinetics, isotherms and thermodynamic parameters of the basic dye (Astrazon Blue FGRL) from aqueous solutions at various concentrations (100-300 mg/L), adsorbent doses (3-12 g/L) and temperatures (303-323 K). The result showed that the adsorption capacity of the dye increased with increasing initial dye concentration, adsorbent dose and temperature. Three kinetic models, the pseudo-first-order, second-order, intraparticle diffusion, were used to predict the adsorption rate constants. The kinetics of adsorption of the basic dye followed pseudo-second-order kinetics. Equations were developed using the pseudo-second-order model which predicts the amount of the basic dye adsorbed at any contact time, initial dye concentration and adsorbent dose within the given range accurately. The adsorption equilibrium data obeyed Langmuir isotherm. The adsorption capacities (Q0) calculated from the Langmuir isotherm were 181.5 mg/g for ASAC, 155.5 mg/g for sepiolite and 128.2 mg/g for fly ash at 303 K. Thermodynamical parameters were also evaluated for the dye-adsorbent systems and revealed that the adsorption process was endothermic in nature.

Effect of pentoxifylline on immotile testicular spermatozoa.

PURPOSE: A model for differentiating live and dead sperm cells during intracytoplasmic sperm injection (ICSI) is proposed. METHODS: We used pentoxifylline, a phosphodiesterase inhibitor known to enhance sperm motility, to initiate motility in testicular spermatozoa. Ten immotile testicular sperm samples were divided into two parts for examination of sperm motility with and without pentoxifylline treatment at 30, 60, and 90 min. RESULTS: The samples without pentoxifylline remained immotile even after 90 min of incubation: the addition of pentoxifylline initiated sperm motility in all samples: 51.8 +/- 10.2, 64.4 +/- 9.4, and 70.8 +/- 8.9% (mean +/- SD) at 30, 60, and 90 min, respectively. CONCLUSIONS: That pentoxifylline may be used to differentiate live testicular spermatozoa during ICSI, which may improve fertilization and pregnancy rates, is suggested.

Effect of abnormal sperm head morphology on the outcome of intracytoplasmic sperm injection in humans.

The present study was designed to determine the efficacy of intracytoplasmic sperm injection (ICSI) using spermatozoa with abnormal head morphology in 17 cases with total teratozoospermia. A total of 160 oocytes were retrieved and 144 metaphase II oocytes were injected. The fertilization and cleavage rates were 50.7 and 93.2% respectively. Fertilization failure occurred in two couples. A total of 54 embryos were transferred and pregnancy rates per initiated and per embryo transfer cycle were 17.6 and 20.0% respectively, while the clinical pregnancy rates per initiated and embryo transfer cycle were 11.8 and 13.3%. The implantation rate was 3.7% (2/54). Out of two pregnancies achieved, one resulted in abortion in the first trimester. The ongoing pregnancy rates per initiated and embryo transfer cycle were 5.88% (1/17) and 6.6% (1/15) respectively. Although the implantation and ongoing pregnancy rates are very low, ICSI seems to be the only treatment modality in cases where teratozoospermia was total with 100% abnormal head morphology.

Minimally invasive treatment of live ectopic pregnancy.

Four cases of live ectopic (three tubal, one cornual) pregnancies managed by ultrasonographic puncture injection technique are described. The technique proves to be a practical, effective and conservative treatment.

Endometrium is not a reservoir for recurrent vaginal candidiasis.

The aim of this study was to determine whether the endometrium acts as a reservoir for Candida albicans in cases of recurrent vaginal candidiasis. Twenty-five women with documented history of recurrent vaginal candidiasis were enrolled in the study and endometrial samples were cultured for Candida albicans. Only two patients had positive cultures for Candida albicans. Therefore, we concluded that the endometrium is not a common reservoir for Candida albicans.

Pregnancies achieved with testicular and ejaculated spermatozoa in combination with intracytoplasmic sperm injection in men with totally or initially immotile spermatozoa in the ejaculate.

The efficacy of intracytoplasmic sperm injection (ICSI) employing testicular and ejaculated spermatozoa was assessed in 24 couples with totally or initially immotile spermatozoa. No criteria were employed in selecting which patients would be treated with testicular or ejaculated spermatozoa. The men were chosen at random. Testicular spermatozoa obtained by testicular sperm extraction were used in 14 and ejaculated spermatozoa were used in 10 of these couples. In all cases. asthenozoospermia was total in their basal semen sample. In 12 male partners, spermatozoa were totally immotile before and after Percoll gradient fractionation (totally immotile). In the remaining 12 men, spermatozoa initially showed a total absence of motility; however, some of the spermatozoa had showed very poor motility (0. 1%) after Percoll gradient fractionation and a 1.5-2.0 h incubation period (initially immotile). Of these 24 total asthenozoospermic males, 14 also had total teratozoospermia. The fertilization and cleavage rates in the testicular and ejaculated sperm groups were 53. 5 and 96.3 and 54.5 and 94.4% respectively. One cycle resulted in complete fertilization failure, and in 23 embryo transfer cycles a total of 10 pregnancies were obtained (41.6%). Eight pregnancies were achieved in the testicular sperm group, while only two pregnancies were obtained in the ejaculated sperm group. Four pregnancies, two from the ejaculated sperm group and two from the testicular sperm group, resulted in clinical abortions in the first trimester. Of the remaining six pregnancies, two have already resulted in healthy births and four pregnancies are now in the second or third trimester in the testicular sperm group. Using testicular spermatozoa in combination with ICSI can be an alternative mode of treatment in cases with totally or initially immotile spermatozoa in the ejaculate. Very low pregnancy rates have been obtained and no ongoing pregnancy has been achieved using ejaculated spermatozoa in these cases.

Sperm immobilization antibodies in infertile male sera decrease the acrosome reaction: a possible mechanism for immunologic infertility.

OBJECTIVE: To study the effect of sperm-immobilizing antibodies from male sera on spontaneous and A23187-induced acrosome reactions (AR). DESIGN: Swim-up spermatozoa obtained from three fertile donors were incubated with 13 sera with sperm-immobilizing antibodies obtained from infertile men and three control sera obtained from healthy fertile males. Sperm acrosomes were examined by staining with pisum sativum agglutinin labeled with fluorescein isothiocyanate (30 micrograms/ml; Sigma Chemical Co., St. Louis. MO) as spontaneous and A23187 (used at a final concentration of 10 microM; Sigma Chemical Co.) induced. RESULTS: The incidence of spontaneous AR of spermatozoa incubated with antisperm antibody positive male sera (6.2 +/- 0.7) was significantly (P < 0.001) lower than that of spermatozoa incubated with control sera (10.7 +/- 0.5). And the incidence of A23187-induced and -inducible (incidence of induced minus spontaneous) ARs of spermatozoa incubated with sperm antibody-positive male sera (12.4 +/- 1.9 and 6.2 +/- 1.9) was significantly lower (P < 0.001) than that of spermatozoa incubated with control sera (31.0 +/- 0.5 and 20.3 +/- 0.9). Sperm-immobilizing antibody-positive sera decreased spontaneous, A23187-induced, and inducible ARs. CONCLUSIONS: Sperm-immobilizing antibodies from male sera interfere with fertilization by inhibiting the AR.

Fertility with testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermic men.

In non-obstructive azoospermia spermatozoa can usually only be isolated from the testicles, and thus the most promising treatment model is testicular sperm extraction (TESE). Hormone concentrations, testicular volume determinations and testicular biopsy results are not uniform enough to select potential candidates for successful TESE and intracytoplasmic sperm injection (ICSI) approaches in advance. The aim of this study was to assess the efficacy of using ICSI with testicular spermatozoa in cases of non-obstructive azoospermia and to compare the inclusion criteria and sperm existence in the testicles in sperm obtainable and non-obtainable groups. All men showed either complete or incomplete (n = 14) maturation arrest in spermatogenesis, severe hypospermatogenesis (n = 10) or Sertoli cell-only syndrome (n = 5) in their testicular biopsies. Only 14 out of a total of 29 men provided enough spermatozoa for the ICSI procedure, while no spermatozoa were found in the testicular samples of the remaining 15 men. Out of 123 oocytes obtained from 14 females, 101 were injected with the husbands' testicular sperm cells. Total fertilization failure was observed in three cases. Of 39 oocytes fertilized, 38 cleaved. The fertilization and cleavage rates were 38.6 and 97.4% respectively. The pregnancy rate was 20.7% per initiated cycle. In the group from whom spermatozoa were obtainable, the pregnancy rate was 42.9% per initiated cycle and 54.5% per embryo transfer. A total of six pregnancies were achieved, of which two were twins and four were singletons. One singleton pregnancy resulted in abortion in the first trimester. There was no statistical difference concerning the serum follicle stimulating hormone concentration, testicular volume and biopsy results in groups in which spermatozoa were obtainable or not. In conclusion, although the association of TESE with ICSI obtained pregnancies for some patients with non-obstructive azoospermia, further studies are needed to determine the inclusion criteria for successful TESE.

High implantation and pregnancy rates with testicular sperm extraction and intracytoplasmic sperm injection in obstructive and non-obstructive azoospermia.

Thirty-two infertile couples with obstructive and non-obstructive azoospermia were included in this study. Testicular sperm extraction (TESE) was performed in 16 obstructive azoospermic cases where microsurgical sperm aspiration (MESA) or percutaneous sperm aspiration (PESA) were impossible because of totally destroyed epididymis and 16 non-obstructive azoospermia cases with severe spermatogenetic defect where the testicles were the only source of sperm cells. A total of 288 oocytes was obtained from 32 females and 84% were injected. The fertilization rates (FR) with 2 pronuclei (PN) and cleavage rate were 50.8 and 68.2% respectively. A total of 15 pregnancies was achieved (53% per embryo transfer), nine from the obstructive and six from the non-obstructive group. Four pregnancies resulted in clinical abortion (26.6%). The ongoing pregnancy rate was 39.2% per embryo transfer (ET) and 34.3% per started cycle. A high implantation rate was also achieved (26.6% in non-obstructive and 30% in obstructive azoospermia group). Using testicular spermatozoa in combination with ICSI in both obstructive and non-obstructive azoospermic groups, high implantation and pregnancy rates can be achieved.

Short protocol of gonadotropin releasing hormone agonist administration gave better results in long protocol poor-responders in IVF-ET.

OBJECTIVE: To determine the effectiveness of a short protocol (SP) of gonadotropin-releasing hormone agonist (GnRH-a) administration in patients who already had undergone at least one in vitro fertilization (IVF) and embryo transfer (ET) treatment cycle with the long protocol (LP) and had shown poor results. METHODS: One hundred and twelve patients were studied. The E2 levels, the number of preovulatory follicles, the number of oocytes retrieved and fertilized, the number of embryos cleaved, the fertilization rate and the number of embryos transferred were calculated. RESULTS: The values for the mentioned parameters were significantly higher in the SP than those in the LP. So were the pregnancy rates per cycle and per ET (23.2% and 24.1%, respectively) in the SP significantly (p < 0.0001) higher than those in the LP (12.5% and 13.5%, respectively). CONCLUSION: In cases who showed poor results to the LP, instead of repeating the same protocol the SP may be substituted. This strategy may not only improve the results, but also decrease the total cost of the IVF-ET treatment.

Alternative treatment for bacterial vaginosis in pregnant patients; restoration of vaginal acidity and flora.

PIP: In Turkey, physicians treated 22 first-trimester pregnant women aged 20-34 exhibiting signs and symptoms of bacterial vaginosis with commercially available yogurt containing more than 100 million Lactobacillus acidophilus per ml and at a pH of less than 4.5. The treatment involved vaginal douching with a 10-ml syringe daily for 7 days and was repeated after a 1-week interval. The signs and symptoms used as criteria for bacterial vaginosis included subjective symptoms of foul-smelling discharge, vaginal pH more than 4.7, presence of clue cells in the vaginal discharge, and foul odor caused by the addition of 10% potassium hydroxide to the vaginal discharge (i.e., positive amine test). Cure was defined as the disappearance of 3 of the 4 criteria 4-6 weeks after completing the 2nd treatment and clinical improvement (i.e., patients' subjective feelings on 3rd day of treatment). All the women were considered clinically improved on the 3rd day of treatment. 4 weeks after the 2nd treatment, 20 (90%) women exhibited none of the criteria for bacterial vaginosis. At 6 weeks, 19 (86.4%) had no criteria. These findings suggest that commercially available yogurt may restore the microenvironment and pH of the vagina, thus representing a viable treatment of bacterial vaginosis. This treatment may be preferable during pregnancy, since the use of any drug during pregnancy should be minimized. It will reduce the likelihood of a premature delivery.^ieng