TFEB inhibition induces melanoma shut-down by blocking the cell cycle and rewiring metabolism.

Melanomas are characterised by accelerated cell proliferation and metabolic reprogramming resulting from the contemporary dysregulation of the MAPK pathway, glycolysis and the tricarboxylic acid (TCA) cycle. Here, we suggest that the oncogenic transcription factor EB (TFEB), a key regulator of lysosomal biogenesis and function, controls melanoma tumour growth through a transcriptional programme targeting ERK1/2 activity and glucose, glutamine and cholesterol metabolism. Mechanistically, TFEB binds and negatively regulates the promoter of DUSP-1, which dephosphorylates ERK1/2. In melanoma cells, TFEB silencing correlates with ERK1/2 dephosphorylation at the activation-related p-Thr185 and p-Tyr187 residues. The decreased ERK1/2 activity synergises with TFEB control of CDK4 expression, resulting in cell proliferation blockade. Simultaneously, TFEB rewires metabolism, influencing glycolysis, glucose and glutamine uptake, and cholesterol synthesis. In TFEB-silenced melanoma cells, cholesterol synthesis is impaired, and the uptake of glucose and glutamine is inhibited, leading to a reduction in glycolysis, glutaminolysis and oxidative phosphorylation. Moreover, the reduction in TFEB level induces reverses TCA cycle, leading to fatty acid production. A syngeneic BRAFV600E melanoma model recapitulated the in vitro study results, showing that TFEB silencing sustains the reduction in tumour growth, increase in DUSP-1 level and inhibition of ERK1/2 action, suggesting a pivotal role for TFEB in maintaining proliferative melanoma cell behaviour and the operational metabolic pathways necessary for meeting the high energy demands of melanoma cells.

Penile skin length can be predicted before frenuloplasty during routine circumcision.

Background: One of the restricting factors for surgical treatment of congenital anatomical pathologies of the penis is the skin structure. Thanks to its structure, the penis is a flexible organ structure, and the treatment can be completed without the need for a free tissue graft. Length changes are obtained on the ventral side of the penis by frenuloplasty. Aims: Our study aims to attain an objective formula that could noninvasively predict these changes on the ventral side before the procedure. Patients and Methods: In our study, 52 patients who were admitted for routine religious circumcision were included, and penile ventral and dorsal skin and inner mucosa lengths were measured before and after frenuloplasty, which is a part of the normal routine circumcision procedure and performed via the "pull and burn" method. Stitches were done to prevent scar formation in the frenuloplasty area. The results were used to estimate the length changes to be obtained on the ventral side by performing a regression analysis of the patient's weight, height, ventral and dorsal inner mucosa, and outer skin lengths. Result: Following frenuloplasty, an increase was detected in the ventral surface ranging from 20% to 177%. This increase was found to be predictable with 62.5% precision (P < 0.01) using the formulation established by assessing the ventral inner mucosa length from pre-procedure values. No significant result was determined in the regression analysis of the patients' other measurements (P > 0.05). Conclusion: Penile length changes that would occur following frenuloplasty can be calculated using a noninvasive method. Frenuloplasty, which would be performed without any vascular change, could be helpful in the surgical planning of some penile surgeries. More studies should be conducted on older boys, in anatomic deviations, and moreover, to establish a reliable formulation.

The measurement of different diaper parameters for the evaluation of postcircumcision bleeding and their significance for the Infant's health.

Background: Evaluation of circumcision bleeding cannot depend on the visual change in the diaper. Diapers have different product features and absorbency capacities. The apparent changes in the diapers may vary according to their absorbent capacity and may not be in parallel with the amount of bleeding. Before significant visual difference occurs, the patient's hemodynamics may be impaired. Aim: Aim of the study is to evaluate better circumcision bleeding. Patients and Methods: Patients were divided into groups according to 12 different brand diapers of the same size, containing super-absorbent material. The study started by 15/01/2022, and finished by end of 01/03/2022. Diapers with concealed brands were soaked with blood with equal hematocrit value in 100 ml with increments of 5 ml. 252 images were obtained by taking 21 images of each diaper with the same method. The diapers were evaluated colorimetrically, and numerical values were obtained showing the color differences in red, green, and blue and saturation and lightness. Working groups were formed according to 12 different brands of diapers of the same size, containing super-absorbent material. Standard statistical tests were performed using obtained values. Result: : Dry diapers had different weights, volumes, and specific gravities; the diapers with the lowest unit weight were ranked ninth in terms of volume; the diapers with the highest specific gravity were ranked third in terms of thinness. There were significant differences in the blood on the diaper, and significant differences between some groups (p < 0.005); on the other hand, there was not any difference between some other groups (p > 0.05). There was a significant relationship in terms of Analysis of Variance (ANOVA) (P < 0.05 and P < 0.01). Visual graphic examination showed that linear but non-parallel color changes occurred. As the blood load increased, the visual and statistical differences between the diapers became more pronounced, and the curves diverged. Conclusion: Visual evaluation of the color change of the diapers may not give accurate results for bleeding follow-up. If necessary to use diapers after circumcision, it is more appropriate to prefer those with low absorbency capacity. Using fabric or cotton products in cases with bleeding risk may be recommended. If bleeding is suspected, hemogram control is the most appropriate option. Diaper manufacturers should warn consumers of the risk. In conclusion, we should be on the safe side for mortality and morbidity.

Effect of activated chlorhexidine and irritrol with photon-induced-photoacoustic-streaming and EDDY® on the dislocation resistance of biodentine.

Background: Irrigant activation techniques, which are more effective in anatomically complex areas, can be used to maximize irrigant efficacy. Aim: This in vitro study aimed to evaluate the efficacy of different agitation techniques on the dislocation resistance of Biodentine to the root canal dentin. Materials and Methods: Seventy single-rooted teeth divided into seven experimental groups (n = 10); Group I-Irritrol/Photon-induced-photoacoustic-streaming (PIPS), Group II-Irritrol/EDDY®, Group III- Irritrol/Syringe-needle-irrigation (SNI), Group IV-Chlorhexidine-gluconate (CHX)/PIPS, Group V-CHX/EDDY®, Group VI-CHX/SNI, Group VII-Saline. The midroot dentin slice was obtained from each tooth, and Biodentine was condensed with hand pluggers into the root canal lumen. The push-out bond strength values were measured using a universal testing machine. Each sample was categorized into one of the three failure modes: adhesive/cohesive/mixed. Scanning-Electron-Microscopy (SEM) was used to conduct the analyses, and the composition of Biodentine was analyzed using Energy-Dispersive Spectroscopy. The One-way ANOVA, post-hoc Tukey's test, and the Chi-square test were used for statistical analysis. Results: The push-out bond strength values of Biodentine showed that Group VII-Saline had a statistically significant difference (P = 0.002), however, the differences between the other groups were not statistically significant (P = 0.922). The percentages of the failure modes of the samples showed that there was a higher rate of mixed failure except for Group VII-Saline. SEM examination showed that Group VII-Saline had no open dentinal tubules, whereas the other groups, particularly the Irritrol groups, had open dentinal tubule areas. Conclusions: Within the scope of the study, using Irritrol or CHX as the final irrigation in the root canal treatment did not result in differences in the dislocation resistance of Biodentine to root canal dentin when PIPS and EDDY® were used.

Low-temperature atmospheric pressure plasma enhanced tooth whitening: the next-generation technology.

OBJECTIVES: To evaluate the safety and effectiveness of the plasma pencil (PP) device in conjunction with H2 O2 gel. The purpose of this study was to determine whether LTAPP delivered using the PP would enhance the tooth-whitening process while causing no thermal threat. METHODS: The study consisted of thirty extracted human teeth that were randomized into two groups: Group I received LTAPP plus 36% H2 O2 gel at 10, 15 and 20 min and Group II received 36% H2 O2 gel only at the same time intervals. Tooth surface temperature was measured periodically throughout the experiment using a non-contact thermometer. Digital photographs were taken pre- and post-treatment and transferred to Adobe Photoshop for comparison, using the CIELAB Color Value System. Only L* (lightness) values were evaluated in this study. Data were analysed using descriptive statistics and t-test at the 0.05 level. RESULTS: The results revealed a statistically significant difference in mean CIE L* values after exposure to LTAPP plus 36% H2 O2 gel, compared with 36% H2 O2 only, in the 10- and 20-min groups (P = 0.0003 and 0.0103, respectively). The temperature in both treatment groups remained under 80°F throughout the study, which is below the thermal threat for vital tooth bleaching. CONCLUSION: Utilizing PP device in conjunction with 36% H2 O2 safely accelerates and enhances the tooth-whitening process.

Influence of several fibre-reinforced composite restoration techniques on cusp movement and fracture strength of molar teeth.

AIM: To compare mean cusp movement in molar teeth with endodontic access and mesial-occlusal-distal (MOD) cavities before and after restoration with several fibre-reinforced composite restoration techniques under loading and to evaluate the effect of restoration technique on fracture strength. METHODOLOGY: Reference points were marked at the mesial cusp ridges of extracted human mandibular molar teeth. Digital images were taken under loading (300 N) using a stereomicroscope (Leica MZ16A; Wetzlar, Germany). Three-dimensional (3D) distances between the reference points were recorded (Leica, Stereo-Explorer, 2.1) as controls. Standard MOD cavities were prepared and restored as follows (n = 10), group 1: composite restoration (Clearfil AP-X; Kuraray, Tokyo, Japan); group 2: cavity lined with polyethylene fibre (Ribbond, Ribbond Inc., Seattle, WA, USA) in combination with flowable resin (Protect-Liner F; Kuraray, Tokyo, Japan) before composite restoration; group 3: polyethylene fibre inserted on occlusal surface of the tooth from buccal to lingual after finishing the composite restoration; group 4: missing walls were restored with composite resin and inner surfaces of the axial walls were then reinforced with polyethylene fibre placed circumferentially before the composite restoration. The restored teeth were re-loaded, digital images were re-taken and the 3D distance between the reference points was recorded in µm. Comparisons of the restoration techniques, the effectiveness of restoration for each group were analysed statistically (Kruskall-Wallis, paired-samples t-test). The teeth were then loaded until failure (5 mm min(-1) ), the data were recorded (N) and analysed statistically (Kruskall-Wallis test). RESULTS: A significant difference occurred amongst the groups in terms of cusp movement (P = 0.018). All the groups revealed a decrease in inter-cuspal width when compared to their initial records. The mean values of these decreases were as follows: group 1 17.6 (P = 0.003), group 2 6.7 (not sig), group 3 6.6 (not sig) and group 4 0.85 (not sig) µm. No significant difference was found amongst the fracture strength values (P = 0.22). In group 1, 90% of the fractures were non-restorable, whereas in group 3 100% of the fractures were restorable. CONCLUSIONS: Regardless of restoration technique, fibre reinforcement of composite restorations decreased cusp movement in molar teeth with MOD and endodontic access cavities but did not affect fracture strength.

The influence of prenatal counselling on postpartum contraceptive choice.

This study tested the hypothesis that individual counselling in the third trimester would increase postpartum contraceptive use to a greater extent than only providing an educational leaflet. A total of 180 third trimester pregnant women of mean age 28.3 years who were attending Marmara University Hospital for prenatal care were enrolled. One-third were randomly allocated to receive prenatal contraceptive counselling and the remaining two-thirds (control group) received an educational leaflet. Participants were followed-up at 6 - 9 months postpartum. The majority of subjects (91.5%) wanted to use contraception after delivery but 26.7% did not know which method to use. At follow-up, 79.6% of all women had begun a postpartum contraceptive regime and 68.7% were using a modern contraceptive method. Overall, there was no statistically significant difference in postpartum contraception use between the control and intervention groups in this study population. It is, therefore, concluded that prenatal counselling was not superior to educational leaflets for increasing the use of effective and modern postpartum contraception.

Validation of a Turkish version of the burn-specific health scale.

The abbreviated Burn-Specific Health Scale (BSHS) is an instrument that measures physical, mental, social, and general health in burn survivors. This scale is composed of 80 items. The aim of this study was to determine the reliability and validity of a Turkish version of the BSHS (the BSHS-Turkish). The BSHS-abbreviated was translated and adapted for Turkish persons according to standard procedures. After a telephone interview with all eligible patients, the BSHS-Turkish was mailed to 103 burn patients. Fifty-three patients (51.46%) filled out both questionnaires; the second one was completed within 15 days of the first one. The mean time that it took to complete the questionnaire was 31.06 +/- 15.2 minutes (range, 3-60 minutes). The test-retest, internal reliability, and construct validity of the BSHS-Turkish were satisfactory according to intraclass correlation coefficient, Cronbach's alpha, and the Mann Whitney U test. The BSHS-Turkish is a reliable and valid instrument for determining the health status of Turkish patients with burns.

Bone loss during the acute stage following burn injury.

The aim of this study was to investigate the effect of burn injury on bone metabolism and bone densitometry in the early period. Twenty-one patients with >25% total body surface area (TBSA) burns and 20 healthy controls participated. TBSA burned, ambulation, and functional status were recorded. After 30 days, we measured bone mineral densities of the L1-L4 vertebrae, the left distal forearm, and the left proximal femur in the patients. At 1 and 4 weeks after the burn, changes in bone turnover were assessed in patients by changes in deoxypyridinoline levels in the urine and osteocalcin in the serum and compared with the values of control group. In patients, Z-scores < -1 were found in 71.42% of left distal forearm, 23.80% of left proximal femur, and in 42.85% of L1-L4 vertebrae measurements. No significant correlations existed between Z-scores and TBSA, Functional Ambulation Scale, or Functional Independent Measure. When compared with controls, there was no statistically significant decrease of osteocalcin (a marker of bone formation) levels in patients 1 and 4 weeks after burn injury. However, when compared with controls, a statistically significant difference was found regarding deoxypyridinoline (a marker for bone resorption) in patients 1 and 4 weeks after burn injury (P < .001 and P < .001, respectively). Decreases in bone mineral density occurred during the first month following burn injury, which seemed to be linked with increases in bone resorption during this period. No correlation existed between reduction in bone mineral density and functional status.

High-frequency sensorineural hearing loss in patients with ankylosing spondylitis: is it an extrarticuler feature of disease?

OBJECTIVE: The aim of this study was to investigate the ear involvement, especially at extended higher frequencies than those previously studied, in patients with ankylosing spondylitis (AS). PATIENTS AND METHODS: We prospectively evaluated 45 consecutive patients with AS. All patients underwent a complete physical examination of the ear, nose, and throat and an audiologic evaluation that included pure-tone audiometry at conventional and extended high frequencies, the determination of a speech discrimination score and the uncomfortable loudness level, and impedance audiometry. Thirty healthy volunteers were included as controls. RESULTS: The mean age of the patients was 39.6 +/- 9.1 years (range 19-63 years) and that of the controls was 10.6 +/- 8.1 years (range 1-30 years). There was no statistically significant difference between the two groups with respect to conventional frequency air conduction threshold and bone conduction threshold. There was a statistically significant difference at 14,000-16,000 Hz at extended high frequencies in 32 patients with AS (71.1%) versus 12 controls (40%). At 14,000-16,000 Hz, eight patients demonstrated a sensorineural hearing loss caused by extraspinal involvement. There was a significant difference between the patients with or without extraspinal involvement, and a positive correlation was noted between the duration of disease and the hearing level at 10,000-16,000 Hz. CONCLUSION: Sensorineural hearing loss, especially at extended high frequencies, is common in patients with AS and may be an extra-articular feature of that disease. A long duration of disease and extraspinal involvement are important parameters for ear involvement in patients with AS.

Early adverse emotional response to childbirth in Turkey: the impact of maternal attachment styles and family support.

Early adverse emotional response which is often detected in the form of depressive symptoms is a predictor of postpartum depression following the birth. The aim of our study is to highlight contextual and individual factors that have an impact on mothers' depressive symptoms during the early postpartum period. One hundred mothers participated in the study. Maternal depressive symptoms were screened by Edinburgh Postpartum Depression Scale (EPDS), and maternal anxiety level was assessed by State-Trait Anxiety Inventory (STAI) at early postpartum period (7-10 days). The Multidimensional Scale of Perceived Social Support (MSPSS) was used for the assessment of maternal social support. The Adult Attachment Scale (AAS) was used to determine the attachment style of the mother. The mean EPDS score of mothers who live in extended families is found to be significantly lower than others who live in nuclear families (extended families 7.13+/-7.39, nuclear families 11.77+/-5.96, p=0.006). Significant positive correlations were found between EPDS total scores and ambivalent attachment style group (r=.0436, p=.000), and avoidant attachment style group (r=.328, p=.001). The level of perceived family support also showed a negative correlation with EPDS total score (r=-.363, p=.000). The regression of EPDS total score with ambivalent attachment style and state anxiety level are positively predicted and the level of perceived family support and existence of wider social network negatively predict the EPDS total score in the first postpartum week. Maternal attachment patterns, living with the extended family and existence of family support have an important impact on early postpartum emotional adaptation. Early intervention strategies should count towards these individual and contextual factors when designing screening and preventive interventions for postpartum depression.

Providers' knowledge of, attitude to and practice of emergency contraception.

OBJECTIVES: Barriers to widespread use of hormonal emergency contraceptives (EC), such as lack of knowledge and prejudices held by health-care providers, still exist today. This study was initiated to evaluate the knowledge, attitudes and prejudices of family-planning (FP) providers. METHODS: This survey was conducted in FP units of primary-health-care centers in Istanbul. A total of 180 providers were interviewed in 80 units to whom a questionnaire was administered by face-to-face technique. RESULTS: One-hundred and fifty-two of the providers stated that they had heard of EC. The correct timing and dose interval of EC were known by 50% of them. The participants held the belief that EC caused abortion (39.4%), and that it was harmful for the fetus (31.1%). Other prejudices were the possibility of increased unprotected sexual intercourse (78.9%) and a tendency for men to give up condom use (75%); female providers were more prejudiced concerning these statements. The providers' tendency towards the provision of counseling was significantly related to their prejudices (p = 0.011, p = 0.033) and to the application rate (p = 0.000). Conclusion Providers need more detailed information about EC. During FP training courses, the providers should be encouraged towards counseling EC which would increase the application rate of the users and decrease their own prejudices.

The effects of iron deficiency on infants' developmental test performance.

AIM: To assess the effects of iron deficiency on developmental test scores in infants. METHODS: This prospective, single-blind, controlled clinical intervention study was made on 108 children aged 6-30 mo who applied to our paediatric outpatient clinic. The cases were classified as control (n = 31, haemoglobin > or = 11 g/dl, serum ferritin > 12 microg/l, MCV > or = 70 fl), non-anaemic iron deficiency (NAID, n = 40, haemoglobin > or = 11 g/dl, serum ferritin < or = 12 microg/l, MCV > or = 70 fl) and iron deficiency anaemia (IDA, n = 37, haemoglobin < 11 g/dl, ferritin < or = 12 microg/l, MCV < 70 fl) due to their anaemia status. In each group, MCV, haemoglobin and ferritin levels were measured, and Denver Developmental Screening Test (DDST) and Bayley Scales of Infant Development (BSID-I) were administered before and after a 3-mo follow-up. IDA and about half of the NAID subjects were treated with oral iron for 3 mo. RESULTS: Subjects with iron deficiency showed significantly lower developmental test scores both with BSID-I and DDST-II compared to their iron-sufficient peers (p < 0.05). After 3 mo of iron treatment, lower mental developmental test scores were no longer observed among the IDA and NAID groups whose anaemia and iron deficiency were also corrected. No significant differences were found between control NAID and control IDA groups on DGTT-II results after treatment. The difference in motor and mental developmental scores did not appear to depend on environmental and family factors considered in the analyses. CONCLUSION: These findings support the conclusions that iron deficiency may cause lower mental and motor test scores in infants and these adverse effects can be improved by iron therapy.

Occurrence of bilateral sacroiliitis and ossification of anterior spinal ligaments in the same patient.

Abstract Enthesopathy and ligament calcification may occur in both the degenerative and inflammatory types of diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis. Despite their fairly frequent occurence in rheumatic disease care settings, few reports of their presence in the same patient have appeared in the literature. In this report, we present the case of a male patient with chronic low back pain, who had both ossification of anterior spinal ligaments and bilateral sacroiliac joint ankylosis, and discuss the known pathogenesis of diffuse idiopathic skeletal hyperostosis.

Isokinetic measurement of trunk muscle strength in women with chronic low-back pain.

OBJECTIVES: To investigate the relationships among chronic low-back pain and obesity, total spinal range of motion, and trunk muscle strength. The short-term impact of trunk muscle strengthening exercises on this condition was also examined. DESIGN: A controlled, prospective study of trunk muscle strengths of patients with chronic low-back pain and the short-term impact of exercise on strength. The study group consisted of 25 female patients who had been experiencing low-back pain for at least 3 mo, and the control group included 20 age-matched women without known low-back trouble. The Davenport Index was used to calculate the body mass indexes of all subjects. The Oswestry Disability Questionnaire was used to assess pain in the study group. Full flexion and extension ranges of motion were measured, then isokinetic measurements of trunk muscles were performed at 60-, 120-, and 180-degrees/sec velocities. Isometric measurements were also recorded for both flexors and extensors at a 60-degree angle. RESULTS: Increased body mass index and decreased trunk muscle strength were found to be directly associated with chronic low-back pain (P < 0.05). After a 15-day standard trunk strengthening exercise program in the patient group, trunk muscle strength was found to be increased (P < 0.05). CONCLUSIONS: Obesity and decrease in trunk muscle strength are important factors in chronic low-back pain, and a trunk muscle strengthening program will be helpful in reducing the pain.

Is intestinal ischemia a risk of laparoscopy? An experimental study in rabbits.

BACKGROUND AND PURPOSE: In the literature, there are few reports documenting intra-abdominal organ necrosis following laparoscopic procedures. This experimental study was planned to investigate whether intestinal ischemia develops during laparoscopic procedures and if laparoscopy could cause intestinal necrosis. MATERIAL AND METHODS: Two experimental groups, each consisting of 10 adult New-Zealand rabbits, were used in this study. The first group comprised the study group which had pneumoperitoneum, the second group comprised the normal animals serving as the controls. A cervical tracheostomy was performed to achieve successful general anesthesia in both groups. In the study group, intraperitoneal CO2 insufflation was carried out and intraabdominal pressure (IAP) was adjusted so as not to exceed the arterial blood pressure. After 20 min high IAP period, the intraabdominal gas was aspirated. Five minutes later, samples of both small intestine and colon tissue were taken. In the control group, tissue samples were taken 25 min after anesthesia was achieved. Xanthine oxidase (XO) and malondialdehyde (MDA) levels were measured as indicators of intestinal ischemia and lipid peroxidation in the intestinal tissues. Statistical analysis was done to compare the XO and MDA levels of the small intestines and colons of both groups. RESULTS: The mean colonic XO levels were 1.323+/-1.17 and 0.217+/-0.27 (U/mg protein) in study and control groups, respectively. This difference was statistically significant (t = 2.60, p<0.05). The other comparisons with regard to XO and MDA levels were statistically not significant. CONCLUSION: Our results demonstrate that intraperitoneal CO2 insufflation in which intraabdominal pressure was adjusted to be lower than arterial blood pressure may affect oxygenization of the colon.

Experience with laparoscopy in nonpalpable testis.

AIM: The aim of this study was to investigate the feasibility and benefits of diagnosis and interventional laparoscopy in those paediatric patients with nonpalpable testes (NPT). PATIENTS AND METHODS: Between 1992 and 1999, 75 patients with NPT (mean age 3 years, range 6 months to 14 years) were treated. 86 testes were evaluated. RESULTS: According to the laparoscopic findings 4 groups of testes were identified: Vanishing testis (n = 32), low abdominal testis (< 2 cm to the internal ring) (n = 26), high abdominal testis (> 2 cm to the internal ring) (n = 24) and intersex patients (n = 4). Of the first group, 19 testes (one bilateral) had blind-ending spermatic cord and vessels and if an atrophic testicular tissue was identified, it was removed laparoscopically. For those with spermatic cord and vessels beyond the internal ring (13 testes), atrophic testes were removed through a high scrotal incision. 19 testes of the second group had a laparoscopy-assisted orchidopexy. In the same group a laparoscopic orchidopexy was performed on 7 testes. 24 testes in the 3rd group had a Fowler-Stephens (FS) stage 1 and 18 testes had a laparotomy performed for FS stage 2 procedure (laparotomy and orchidopexy) after 6 months. At laparotomy there was no evidence of testicular atrophy in all but one testis, which was removed and the FS stage 2 procedure was completed in 17 testes. The follow-up period was between 6 months and 4 years, and two more testicular atrophies were noted after FS stage 2. The results were satisfactory in 15 out of 18 testes (83%). In the intersex group, the patient with testicular feminization underwent laparoscopic orchiectomy. The other patient with bilateral nonpalpable testis was identified as having an uterus and two intraabdominally located gonads on laparoscopy and gonadal biopsies were obtained for diagnosis. Histology demonstrated bilateral ovotestes, confirming the diagnosis of a true hermaphrodite. CONCLUSION: We are of the opinion that laparoscopy decreases the number of laparotomies in NPT, allows a single-stage procedure in low abdominal testis, and facilitates clip ligation of the testicular artery in high abdominal testis. Laparoscopy also provides diagnostic and therapeutic options for vanishing testis and intersex patients.

Comparison of agonistic flare-up-protocol and antagonistic multiple dose protocol in ovarian stimulation of poor responders: results of a prospective randomized trial.

The management of poor responders in IVF has always been a big problem. The ideal approach has yet to be formulated. In this study we aim to compare two alternative stimulation protocols. A total of 48 poor responder patients described from previous cycles were included and grouped into two: group I consisted of 24 patients in 24 cycles in which leuprolide acetate (40 microg s.c. per day) was initiated on cycle day 2 followed by exogenous gonadotrophins on cycle day 3; group II consisted of 24 patients in 24 cycles in which ovarian stimulation included gonadotrophin-releasing hormone (GnRH) antagonist (cetrorelix, 0.25 mg daily during late follicular phase) administration. While only the oestradiol concentrations on the day of HCG were lower in group II compared with group I, the clinical pregnancy and implantation rates among groups did not show any significance. The impact of these two regimens in ovarian stimulation of poor responders seem to be same and to establish these results further randomized studies with larger sample sizes are required.