Eyüp Ekici

The effects of hormone replacement therapy on uterine fibroids in postmenopausal women

OBJECTIVE To evaluate and compare the effects of two different modalities of hormone replacement therapy (HRT) on the size of uterine fibroids. DESIGN Randomized clinical study. SETTING The Menopause Center of a public hospital. PATIENTS Postmenopausal women with small asymptomatic uterine fibroids were selected. INTERVENTIONS One group was treated with 50 micrograms transdermal E2 plus 5 mg medroxyprogesterone acetate (MPA) continuously, whereas the second group was given 0.625 mg conjugated equine estrogen plus 2.5 mg MPA continuously. MAIN OUTCOME MEASURE The size of the uterine fibroids was measured before and after the first year of HRT. RESULTS At the end of the first year on HRT, the size of the uterine fibroids was re-evaluated sonographically and no significant difference was found with the oral group, whereas there was a significant increase in the transdermal group. CONCLUSION Hormone replacement therapy with 50 micrograms transdermal E2 plus 5 mg MPA increases the size of the uterine fibroids.

Prenatal diagnosis of epignathus causing acute polyhydramnios

Fetal teratonias complicate pregnancies with an incidence of I : 20 000 to 1 : 40 000 live births (1 ) . Although teratomas are the most common congenital neoplasms, epignathus (oropharyngeal teratoma) is a much rarer type and carries a grave prognosis ( 2 3 ) . These lesions are frequently unresectable and infants born with these lesions usually die secondary to respiratory compromise (4). This report describes the accurate prenatal diagnosis of epignathus with ultrasound examination done for the evaluation of acute polyhydramnios at gestational week 26 and discusses the obstetrical management.

Transvaginal sonographic diagnosis of ovarian endometrioma

Objective: To assess the efficacy of transvaginal sonography (TVS) in differentiating endometriomas from other adnexal masses. Methods: One thousand thirty‐five adnexal masses undergoing laparoscopy or laparotomy were evaluated prospectively using TVS. Masses diagnosed as endometrioma according to their sonographic appearance were divided into two groups: those with a round shape, regular margins, thick walls and homogeneous, low‐level echoes (group A); or those with irregular margins, internal septations and an anechoic appearance (group B). Results: The sensitivity of TVS in diagnosing endometriomas was 86.50% and the specificity 99.11%. The positive predictive value (PPV) and the negative predictive value of the test were calculated to be 91.45% and 98.14%, respectively. By using the criteria determining group A, the PPV of the test increased to 97%, whereas group B had a lower PPV (70.85%). Conclusion: We propose that the accuracy of TVS in diagnosing endometriomas may be beneficial in various clinical conditions.

Iniencephaly: sonographic-pathologic correlation of 19 cases.

During a four year period (1991-1994), 19 cases of iniencephaly were evaluated at our institution. Associated cranial malformations include anencephaly in 15 (79%), and posterior encephalocele in 5 (26.3%) of the cases. Other associated malformations include diaphragmatic defects with a accompanying hernia, omphalocele, gastrointestinal malformations, cardiovascular and genitourinary malformations, single nostril, facial cleft, spina bifida, hypoplastic lungs, club foot and single umbilical artery. No single causative agent for this group was identified. A brief review of the literature is included regarding categorization of these malformations and also a discussion of the embryological basis for these lesions and possible etiological factors.

Transvaginal sonographic findings of chronic ectopic pregnancy

Chronic ectopic pregnancy is not precisely defined in gynecologic and sonographic texts. The diagnosis of this enigmatic clinical condition is frequently not made until laparotomy. In the present retrospective study, we evaluated the transvaginal sonographic findings of cases who were diagnosed as chronic ectopic pregnancy intraoperatively and/or postoperatively. The incidence of chronic ectopic pregnancy was found to be 20.3% (62/305) of all ectopic pregnancies. Of these 62 cases, 55 had transvaginal sonographic examination. On transvaginal sonographic examination, all 55 cases of chronic ectopic pregnancy had a complex adnexal mass with an empty uterus and only 18 (32.7%) had simple fluid in the pelvis/cul-de-sac. In the majority of cases (82.7%, n = 48), there was a non-homogeneous echo pattern within the adnexal mass. Of 55 cases, 30 had color Doppler flow examination, of whom none had color Doppler flow imaging on the wall of the mass or within the mass. There was a negative quantitative beta human chorionic gonadotropin (beta-hCG) assay (i.e. 0 mIU/ml) in only 4 cases. Based on this study, we concluded that chronic ectopic pregnancy is not a rare clinical entity and should be considered in differential diagnosis among patients presenting with an adnexal mass and an overt clinical picture. Transvaginal sonography is sensitive in diagnosing chronic ectopic pregnancy, but not specific. The combined use of transvaginal ultrasonography and beta-hCG assay increases diagnostic accuracy. However, it should be kept in mind that a negative beta-hCG value does not rule out chronic ectopic pregnancy.

Diagnostic problems in a case with mucometrocolpos, polydactyly, congenital heart disease, and skeletal dysplasia

Mucometrocolpos is the distention of the uterus and vagina caused by obstruction to the drainage of genital secretions. Although most cases of mucometrocolpos are sporadic, it may be part of an autosomal recessive condition, known as McKusick-Kaufman syndrome (MKS), including postaxial polydactyly and congenital heart disease as main findings. The diagnosis may be difficult when the presence of additional findings creates an overlap with other syndromes. We report on a female infant with mucometrocolpos, postaxial polydactyly, congenital heart disease, short limbs, short ribs, and chest constriction. The clinicopathological findings are described and discussed in the context of the phenotypic spectrums of MKS and mucometrocolpos concomitant with Ellis van Creveld syndrome.

Ritodrine Tocolysis and Neonatal Intraventricular-Periventricular Hemorrhage

Betamimetic drugs are commonly used for tocolytic therapy. To determine their potential role in periventricular-intraventricular neonatal hemorrhage (IVH), 103 preterm births with cranial ultrasonography results were evaluated for the history of betamimetic therapy. The study group was divided into three subgroups according to the cause of the preterm delivery: 44 patients were accepted as tocolysis failure (group A); 53 patients were too late for tocolysis (group B), and these latter cases were taken as controls for group A; for the remaining 6 patients, tocolysis was contraindicated due to fetomaternal reasons (group C), and these cases were not included in the analysis. In group A, 32 patients got ritodrine, 6 patients got combined therapy including ritodrine plus magnesium sulfate or nifedipine. When cases in group A who got ritodrine only or combined therapy are compared with the no-treatment group, no significant difference in neonatal IVH incidences could be found (p > 0.005). Ritodrine does not appear to affect the incidence of neonatal IVH.

Hyperreactio luteinalis masquerading as an ovarian neoplasm in a triplet pregnancy

Hyperreactio luteinalis is a non-neoplastic tumor-like ovarian lesion associated with pregnancy. Most patients are asymptomatic, with the ovarian enlargement being incidentally discovered at the time of cesarean section. It can simulate a neoplasm on clinical, gross and sometimes microscopic examination. We report a case of hyperreactio luteinalis in a patient, who was diagnosed as having polycystic ovary disease before conceiving a triplet pregnancy after three treatment cycles of human menopausal gonadotropin-human chorionic gonadotropin therapy, and discuss its pathogenesis.

First trimester fetal heart rate measurements by transvaginal ultrasound combined with pulsed Doppler : an evaluation of 1331 cases

The aim of this study is to present the cardiac activity measurements obtained from 1331 embryos and first trimester fetuses in whom the crown-rump length (CRL) measurements were between 2 and 60 mm, and to correlate the pattern of changes according to growth in body length, with an objective and reliable technique; transvaginal ultrasound combined with pulsed Doppler. Sonographic examinations were performed using a Combison 320-Kretz scanner with a 5-7.5 MHz vaginal probe with 240 degrees scanning angle, combined with a 4.5 MHz pulsed Doppler. As the embryo grows, the mean heart rate increases sharply, from 106.8 +/- 6.4 at a CRL of 2 mm to 178.3 +/- 7.0 at a CRL of 23 mm; followed by a plateau and a slight decline thereafter. Statistical analysis of the body length and corresponding heart rate revealed a relationship with a correlation coefficient of 0.61 (P < 0.01), whereas relationship between CRL < or = 23 and corresponding heart rate was striking with a correlation coefficient of .87 (P < 0.01).

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.