Husnu Caglar

Mode of delivery and pelvic floor muscle strength and sexual function after childbirth

To investigate the respective roles of the mode of delivery and strength of pelvic floor muscles in the sexual function of women.

Migration of an intrauterine contraceptive device to the sigmoid colon: a case report

Background: Copper T intrauterine devices (IUDs) remain the mainstay of family planning measures in developing countries, but have been associated with serious complications such as bleeding, perforation and migration to adjacent organs or omentum. Although perforation of the uterus by an IUD is not uncommon, migration to the sigmoid colon is extremely rare. Here, we report a case of migration of an IUD to the sigmoid colon. Case report: A 40-year-old woman who had an IUD (Copper T), inserted 1 month after delivery, presented, 7 months later, with secondary amenorrhea and transient pelvic cramps. Clinical findings and ultrasonographic examinations of the patient revealed an 8-week pregnancy, while laboratory tests were normal. Transvaginal ultrasonography also visualized the IUD located outside the uterus, near the sigmoid colon, as if it were attached to the bowel. The pregnancy was terminated at the patients wish; a diagnostic laparoscopy was performed concomitantly, which showed bowel perforation owing to the migration of the IUD. The device, which was partially embedded in the sigmoid colon, was removed via laparoscopy; however, because of bowel perforation, laparotomy was performed to open colostomy. Conclusion: This case report highlights the continuing need for intra- and postinsertion vigilance, since even recent advances in IUD technique and technology do not guarantee risk-free insertion.

Hormone receptor expressions and proliferation markers in postmenopausal endometrial polyps

Background/Aims: Endometrial polyps are quite common in the general population, they have a significant role in postmenopausal bleeding, and the pathogenesis is unclear. The aim of this study was to investigate proliferation markers and expression of estrogen and progesterone receptors in endometrial polyps in postmenopausal women. Methods: Endometrial polyps were removed by hysteroscopy from 36 women who presented with postmenopausal bleeding. None were using hormonal therapy. The control group consisted of 16 inactive-atrophic postmenopausal endometrial specimens removed at hysterectomy. Immunohistochemistry was used to demonstrate expression of estrogen and progesterone receptors and the cell growth and apoptosis markers, Ki67, bcl-2, c-erbB-2. Results: In both the glandular epithelium and stroma of endometrial polyps, estrogen and progesterone receptors, Ki67 and bcl-2 showed significantly more positive staining than the inactive endometrium from the control group. There was no difference in expression of c-erbB-2 between the two groups. Conclusions: Estrogen may have a role in the development of postmenopausal endometrial polyps, either by direct stimulation of localized proliferation or by stimulation of proliferation via other pathways, such as activation of Ki67 or through inhibition of apoptosis via bcl-2. c- erbB-2 is unlikely to play any role in development of these lesions.

Use of DNA hybridization test for diagnosing bacterial vaginosis in women with symptoms suggestive of infection.

The purpose of this study was to evaluate a DNA hybridization test (Affirm VPIII) as an alternative to Gram stain for the rapid diagnosis of bacterial vaginosis in women with clinical signs of vaginal infection. Vaginal specimens were collected from 321 symptomatic women, and analyzed for bacterial vaginosis by both Gram stain using Nugent criteria and DNA hybridization test. Sensitivity, specificity, positive predictive value, and negative predictive value of the DNA hybridization test were determined using the Gram staining as the standard for diagnosis of bacterial vaginosis. Of the 321 patients, 115 (35.8%) were Gram positive for bacterial vaginosis and 126 (39.2%) were negative. 80 patients (25.0%) demonstrated intermediate Gram staining that was also considered negative. The Affirm system detected G. vaginalis in 107 (93.0%) of 115 vaginal specimens positive for bacterial vaginosis diagnosed by Gram stain. Compared to the Gram stain, DNA hybridization test had a sensitivity of 87.7% and a specificity of 96.0%. Positive and negative predictive values of the DNA hybridization test were 93.0% and 92.7%, respectively. In conclusion, Affirm VPIII hybridization test correlated well with Gram stain and may be used as a rapid diagnostic tool to exclude bacterial vaginosis in women with genital complaints.

Immunohistochemical detection of transforming growth factor-α, epidermal growth factor, and vascular endothelial growth factor expression in hyperstimulated rat ovary

Objective.  The aim of the present study is to figure out the immunohistochemical expression of transforming growth factor‐α (TGF‐α), epidermal growth factor (EGF), and vascular endothelial growth factor (VEGF) in hyperstimulated rat ovaries.

Sexual life following total abdominal hysterectomy.

AimThe goal of this study was to evaluate the effect of total abdominal hysterectomy (TAH) on sexual lives of patients in the postoperative period.Materials and methodsEighty-six patients who accepted to participate a phone-questionnaire were recruited in the study after TAH or TAH + BSO. They were asked about sexual desire, pain during sexual intercourse, frequency and satisfaction of sexual intercourse at pre- and postoperative periods, and loss of “feeling a woman” in the postoperative period. Sexual desire, pain during sexual intercourse, loss of “feeling a woman” questions were answered as “yes” or “ no”, number of weekly sexual intercourse was recorded, and satisfaction was graded as no = 0, mild = 1 and complete = 2 points.ResultsWhile sexual desire and frequency were found to be significantly lower (p=0.026 and p=0.01 respectively), no difference was noted in dyspareunia and satisfaction. When the patients were divided into two groups according to the presence of endogenous or exogenous estrogen, no difference was seen between the two groups in the postoperative period.ConclusionWe concluded that the effect of TAH or TAH+BSO operations were mainly on sexual desire and the number of weekly intercourse, and estrogen in the postoperative period did not make any difference between the two groups.

Assessment of fetal cerebral arterial and venous blood flow before and after vaginal delivery or Cesarean section

To compare perinatal intracranial arterial and venous blood velocity changes between healthy term neonates delivered vaginally or by Cesarean section and to correlate these changes with cord blood gases and pH values at birth.

Assessment of the effectiveness of postmenopausal tibolone therapy on neural functions by measuring visual evoked potentials: a placebo-controlled study

OBJECTIVE To assess the effect of hormone replacement therapy on neural transmission in postmenopausal women using tibolone by a non-invasive, objective way. STUDY DESIGN In a randomised, 3 cycle, placebo-controlled study, neurovisual transmission in optic pathways were evaluated by measuring visual evoked potentials (VEP). After neuroophtalmologic examination, eligible subjects were randomised into two groups. Treatment group (n=38) were given tibolone 2.5mg daily continuously for 3 months and control group (n=20) were treated with placebo. A baseline VEP measurement before the treatment and then at the end of first, second and third month were obtained by the EMG-evoked system in the Department of Neurology, University of Celal Bayar, Manisa, Turkey. RESULTS Data from 31 women from treatment group and 16 from control group were available for evaluation. The mean P(100) latency values, which indicate the transition time period between the optic stimuli and electrical change recorded on the occipital area by the skin electrodes, have showed a significant decrease for the study group (from 100.39+/-0.58 to 97.90+/-0.65 ms, P<0.01) at the end of the first month of treatment according to the baseline values. This difference between two groups has remained constant during the study period. CONCLUSION The change in latency measurements of VEP, reflecting the functional status in optic pathways from retina to occipital cortex were significantly different in the treatment group than in that of control. We concluded that a facilitating effect of tibolone was observed on neurovisual transmission.

Giant mucinous cystadenocarcinoma: a case report.

Abstract We present a mucinous cystadenocarcinoma weighing 10 kg in a postmenopausal woman and the way how we managed the case.

Intrauterine‐diagnosed diastematomyelia

Diastematomyelia, which is also called split cord malformation, is a rare form of occult spinal dysraphism1–3. It occurs as a result of abnormal notochord development at days 15–18 of pregnancy3. An echogenic posterior focus in the axial view of the spinal canal is a specific prenatal sign of diastematomyelia4,5, and has been detected in 0.06% of 10 070 prospective ultrasonographic examinations4. A midline, sagittal osseous or fibrocartilaginous spur produces a complete or incomplete sagittal division of the spinal cord into two hemicords6. Along with isolated forms, complicated forms accompanied by other types of dysraphism, segmental abnormalities in vertebral bodies or visceral malformations may develop4. Prenatal ultrasonographic diagnosis of diastematomyelia can be made in the early second trimester of pregnancy7. Fetal magnetic resonance imaging (MRI), which allows for better assessment of spinal cord content, has been used in unclear cases to confirm sonographic findings and has revealed additional spinal cord abnormalities8–10. We present two cases of diastematomyelia detected by ultrasonography during the prenatal period and discuss the contribution of fetal MRI, which was used in one of these cases. In the first case, fetal ultrasound examination performed at 17 weeks’ gestation revealed a midline echogenic cleft at the thoracolumbar junction and a longitudinal division of the cord below the T12–L1 level. Intrauterine MRI at 32 weeks’ gestation showed the presence of an osseous sagittal cleft at the thoracolumbar junction and a low conus (Figure 1). There were no additional abnormalities and a diagnosis of isolated diastematomyelia was made. The second case involved a woman who, at 29 weeks’ gestation, was referred to our perinatology clinic with Type II diabetes mellitus. Glycosylated hemoglobin (HgA1c) was 9.82% and ophthalmoscopic findings were consistent with diabetic retinopathy. It was thought that she had non-regulated diabetes at the time of conception. Fetal ultrasound examination revealed a defect at the level of the L2–L3 vertebrae. A midline echogenic bony spur was observed along with a disorganization of the bony processes of the vertebral column and asymmetrical hemicords (Figure 2), suggesting the diagnosis of diastematomyelia. The woman was hospitalized for regulation of her diabetes but, at her request, she was discharged without full regulation. She declined fetal MRI. Postpartum evaluation revealed no other abnormality in the fetus. In our cases, diastematomyelia was directly visualized by the presence of two hemicords sonographically. In one case, fetal MRI did not show any additional Figure 1 Magnetic resonance image at 32 weeks’ gestation showing an osseous sagittal cleft (arrow) at the thoracolumbar level.