Duygu Kara Bozkurt

Intramuscular Abdominal Wall Endometriosis Treated by Ultrasound-Guided Ethanol Injection

Abdominal wall endometriosis (AWE) is a rare condition that usually develops in a surgical scar resulting from a Caesarean section. While commonly seen in the cutaneous and subcutaneous fat tissue at the Caesarean scar level, its intramuscular localization is quite rare. Its treatment options consist of the excision of the lesion and/or hormonal therapies, although wide surgical excision is the treatment of choice in the literature. Wide surgical excision may create a defect in the abdominal wall and may increase the risk of hernia formation and mesh complications. This case report describes the clinical and radiological findings and treatment modalities of endometriosis that have appeared in the rectus abdominis muscle of a 25-year-old patient at the Caesarean scar level. Sclerotherapy may be used for endometrioma. We present a new and alternative treatment method using ultrasound-guided intralesional ethanol injection for AWE. Compared with the complications of surgical excision, the complications of sclerotherapy by ethanol are at a more acceptable level. Sclerotherapy by ethanol injection may be an alternative treatment to surgery for AWE.

Impact of Endometrioma Resection on Eutopic Endometrium Metabolite Contents Noninvasive Evaluation of Endometrium Receptivity

The aim of this study was to determine whether endometrioma resection alters most commonly defined endometrial metabolites, lactate (Lac), N-acetylaspartate (NAA), creatine 1 (Cr1), creatine 2 (Cr2), and choline (Cho) during the window of implantation. Twenty patients with uni- or bilateral endometrioma and 7 patients having nonendometriotic benign ovarian cyst were included. Midluteal phase magnetic resonance spectroscopy analysis of eutopic endometrium was performed before surgery. Second spectrum of endometrium was obtained 3 to 5 months after laparoscopic endometrioma resection. Pre- and postoperative endometrial peaks of Lac, NAA, Cr, and Cho were measured in units and denominated in parts per million (ppm). Compared to preoperative peak values, significantly decreased NAA, Lac, and Cr1 signals were noted in patients undergoing endometrioma surgery. Nearly 5-fold decline in the NAA signal occurred after endometrioma surgery (1.94 ± 3.24 vs 0.37 ± 0.55). Likewise, 2.5-fold decline in Lac signals was noted after endometrioma resection (2.81 ± 2.64 vs 1.06 ± 1.88). Both uni- and bilateral endometrioma affected endometrium signals the same. The peak intensity of Cho, Cr1, Cr2, NAA, and Lac did not alter significantly after nonendometriotic cyst surgery. Endometrioma surgery straightens endometrial NAA, Lac, and Cr1 peaks, suggesting improvement in endometrial receptivity.The aim of this study was to determine whether endometrioma resection alters most commonly defined endometrial metabolites, lactate (Lac), N-acetylaspartate (NAA), creatine 1 (Cr1), creatine 2 (Cr2), and choline (Cho) during the window of implantation. Twenty patients with uni- or bilateral endometrioma and 7 patients having nonendometriotic benign ovarian cyst were included. Midluteal phase magnetic resonance spectroscopy analysis of eutopic endometrium was performed before surgery. Second spectrum of endometrium was obtained 3 to 5 months after laparoscopic endometrioma resection. Pre- and postoperative endometrial peaks of Lac, NAA, Cr, and Cho were measured in units and denominated in parts per million (ppm). Compared to preoperative peak values, significantly decreased NAA, Lac, and Cr1 signals were noted in patients undergoing endometrioma surgery. Nearly 5-fold decline in the NAA signal occurred after endometrioma surgery (1.94 ± 3.24 vs 0.37 ± 0.55). Likewise, 2.5-fold decline in Lac signals was noted after endometrioma resection (2.81 ± 2.64 vs 1.06 ± 1.88). Both uni- and bilateral endometrioma affected endometrium signals the same. The peak intensity of Cho, Cr1, Cr2, NAA, and Lac did not alter significantly after nonendometriotic cyst surgery. Endometrioma surgery straightens endometrial NAA, Lac, and Cr1 peaks, suggesting improvement in endometrial receptivity.

Intrauterine Temporomandibular Joint Dislocation: Prenatal Sonographic Evaluation

Congenital temporomandibular joint (TMJ) diseases are very rare disorders and are usually diagnosed in childhood. Developmental disorders of the TMJ such as hypoplasia, hyperplasia, and aplasia of the TMJ compartments are characterized by TMJ dysfunction. In childhood, these patients experience recurrent dislocation, pain, and malocclusion. We present the case of a 25-week fetus with unilateral TMJ dislocation with fluid retention in the joint diagnosed by ultrasonography. To the best of our knowledge, this is the first case of TMJ dislocation diagnosed by ultrasonographic evaluation during the prenatal period.

Concomitant use of transvaginal sonography and Doppler indices improve diagnosis of adenomyosis

Abstract This study was planned to investigate whether measuring of Doppler indices with TV-DUS improved the diagnosis of adenomyosis. Preoperative Doppler indices of subjects with a preliminary diagnosis of adenomyosis were compared with the histopathological results of excised specimens. Sensitivity, specificity and positive/negative predictive values (PPV, NPV) of the measured indices were also calculated. Sensitivity, specificity, PPV and NPV and positive and negative likelihood ratios (LR+) and (LR−) of TV-US in the diagnosis of adenomyosis were found to be 70.8%, 62.1%, 40.4%, 85.4%, 1.96 and 0.47, respectively. Sensitivity, specificity, PPV, NPV, LRu2009+u2009and LRu2009−u2009in the diagnosis of adenomyosis following the addition of TV-DUS were found to be 90%, 94.2%, 81.8%, 97%, 15.5 and 0.10, respectively. Concomitant use of TV-US and TV-DUS improved correct diagnosis of adenomyosis with high sensitivity.

Prenatal radiation exposure

Pregnant women may be exposed to nonionizing, ionizing radiation and contrast media via diagnostic or therapeutic procedures and workplace exposure. When computed tomography or magnetic resonance imaging is performed on a pregnant woman, the effects of exposure to radiation, high magnetic fields and contrast media, which can be risky for a fetus, should be considered. Nonionizing radiation that is not significantly risky for a fetus includes microwave, ultrasound, radio frequency and electromagnetic waves, while ionizing radiation that can be teratogenic, carcinogenic or mutagenic includes particles and electromagnetic radiation. The effects of radiation are associated with the level of exposure and stage of fetal development. Organogenesis (two to seven weeks after conception) and the early fetal period (eight to fifteen weeks after conception) are the most sensitive stages for a fetus. Noncancerous health effects have not been determined at any stage of gestation with less than 50 mGy (5 rad) exposure dose of ionizing radiation. Higher exposure levels may lead to spontaneous abortion, growth restriction, and mental retardation. The risk of cancer is increased regardless of the dose. Although the use of iodinated contrast media is generally thought to be safe during pregnancy, the risk of fetal hypothyroidism should be considered and it should be used only when necessary. The use of gadolinium-based contrast media during pregnancy is controversial because of the lack of clinical data. The purpose of this article is to review the existing literature regarding the prenatal radiation exposure and to discuss fetal risk of radiation.

Severe ovarian hyperstimulation syndrome in spontaneous pregnancy treated successfully with cabergoline

Ovarian hyperstimulation syndrome (OHSS) is a relatively common complication in infertile patients treated with exogenous gonadotropins. Ovarian hyperstimulation in spontaneous pregnancies is a rare but possible. The pathogenesis of spontaneous OHSS is not well known. Risk factors for OHSS are young age, polycystic ovaries, low body mass index, high gonadotropin dose, increased estradiol and human chorionic gonadotropin levels, multiple pregnancy, OHSS history, molar pregnancy and hypothyroidism. In this report we present a case of severe spontaneous OHSS with a brief summary of the literature. She was hospitalized and treated in the clinic with the diagnosis of severe OHSS accompanying spontaneous pregnancy.

Prenatal diagnosis of fetal acrania using two and three dimensional ultrasound

Malformations of the central nervous system are one of the most common congenital anomalies of the fetus. In this report we aimed to summarize a case of fetal acrania diagnosed in the first trimester and the use of two and threedimensional ultrasound in early diagnosis of the disease.

The second case of Horn Kolb Syndrome in the same woman in Turkey, diagnosed prenatally at 16 weeks of pregnancy

Background Acheiropodia is a rare form of skeletal dysplasias. It is characterized by the amputation of the upper and lower extremities and with aplasia of the hands and feet. Acheiropodia formerly was known as a disease affecting only people of Brazilian ancestry. The first case out of Brazil was reported from our clinic in 2012. In the present report, we summarize the second case of acheiropodia, which was diagnosed prenatally in the same patient. Case

Investigating the Relationship Between Persistent Reflux Flow on the First Postoperative Day and Recurrent Varicocele in Varicocelectomy Patients

Background The aim of this study was to investigate the presence of persistent reflux flow on the first postoperative day using color Doppler sonography (CDS) in patients who had undergone sub-inguinal varicocelectomy, and to research the relationship between persistent reflux flow and recurrent varicocele. Methods A total of 54 patients were included in the study. Ages of the patients were between 21 and 38 years (mean 27.3 ± 7.6). All patients were evaluated four times with CDS: preoperatively, first postoperative day, 3 months postoperative, and finally 6 months after the operation. Results Preoperative venous diameters were measured between 3 and 5.5 mm; mean vein diameters were 3.8 ± 0.7 mm for the left side and 3.4 ± 0.4 mm for the right side. Mean duration of reflux was 3.5 ± 0.3 seconds on the left side and 2.9 ± 0.7 seconds on the right side. First postoperative day persistent Valsalva-induced reflux flow was seen in 10 patients (18%). Mean venous diameter was measured 1.8 ± 0.9 mm. Three months after the operation, Valsalva-induced reflux flow was seen in two patients (3%) in whom reflux was not seen on the first postoperative day. After 6 months, venous diameters larger than 2 mm at rest and the occurrence of reflux during the Valsalva maneuver were considered to be a recurrence. Six months after the operation, 12 patients had recurrent varicocele. Detecting persistent reflux with CDS on the first postoperative day was found to be 85% sensitive and 100% specific for showing recurrence. Conclusion Valsalva-induced persistent reflux flow investigated with CDS on the first postoperative day can be used to show success of the surgery and is also an indicator of recurrence in varicocelectomy patients.