İzzet Yücesoy

Misoprostol 50 μg Sublingually versus Vaginally for Labor Induction at Term: A Randomized Study

Objective: To compare the efficacy of misoprostol 50 µg vaginally and 50 µg sublingually for labor induction at term. Materials and Methods: One hundred and sixty women were randomized to receive misoprostol 50 µg vaginally (n = 80) or 50 µg sublingually misoprostol (n = 80). The doses were given every 4 h (maximum 6 doses). Primary outcome measure was number of cesarean deliveries. Induction to delivery time, delivery within 24 h, the number of misoprostol doses given; the need for oxytocin augmentation, tachysystole and uterine hyperstimulation rates and neonatal outcomes were secondary outcome measures. Results: The mean induction to delivery time was 748 ± 379 min in the vaginal group and 711 ± 425 in the sublingual group (p = 0.56). The number of women delivering within 24 h was 73 (91.3%) in the vaginal group and 74 (92.5%) in the sublingual group (p = 0.78). The mean number of misoprostol doses required was significantly higher in the sublingual group (1.9 ± 1.2) compared with the vaginal group (1.1 ± 0.4; p < 0.001). More women in the sublingual group experienced tachysystole (n = 14, 17.5%) compared with the vaginal group (n = 3, 3.8%; p = 0.005). Seven cases (8.8%) in the vaginal group and 12 cases in the sublingual group (15%) required emergent cesarean delivery for fetal heart rate abnormalities (p = 0.22). Other neonatal outcomes including umbilical artery pH, Apgar scores and intensive care unit admission were similar in the two groups. Conclusion: Sublingual misoprostol is as efficacious as vaginal misoprostol for induction of labor. More frequent tachysystole is observed with misoprostol 50 µg sublingually, but neonatal outcomes are similar.

Comparative efficacy and safety of vaginal misoprostol versus dinoprostone vaginal insert in labor induction at term: a randomized trial

ObjectiveTo compare efficacy and safety of vaginal misoprostol (PGE1 analog) with dinoprostone (PGE2 analog) vaginal insert for labor induction in term pregnancies.Study designA total of 112 women with singleton pregnancies of ≥37xa0weeks of gestation, and low Bishop scores underwent labor induction. The subjects were randomized to receive either 50xa0μg misoprostol intravaginally every 4xa0h to a maximum of five doses or a 10xa0mg dinoprostone vaginal insert for a maximum of 12xa0h. Time interval from induction to vaginal delivery, vaginal delivery rates within 12 and 24xa0h, requirement of oxytocin augmentation, incidence of tachysystole and uterine hyperstimulation, mode of delivery, rate of cesarean section due to fetal distress and neonatal outcome were outcome measures. Student’s t test, Chi square test, Fischer’s exact test were used for statistical analysis.ResultsTime interval from induction to vaginal delivery was found to be significantly shorter in misoprostol group when compared to dinoprostone subjects (680xa0±xa0329xa0min vs. 1070xa0±xa0435xa0min, Pxa0<xa00.001). Vaginal delivery rates within 12xa0h were found to be significantly higher with misoprostol induction [nxa0=xa037 (66%) vs. nxa0=xa025 (44.6%); Pxa0=xa00.02], whereas vaginal delivery rates in 24xa0h did not differ significantly between groups [nxa0=xa041 (73.2%) vs. nxa0=xa036 (64.2%); Pxa0=xa00.3]. More subjects required oxytocin augmentation in dinoprostone group [nxa0=xa035 (62.5%) vs. nxa0=xa020 (35.7%), Pxa0=xa00.005] and cardiotocography tracings revealed early decelerations occurring more frequently with misoprostol induction (10.7 vs. 0%, Pxa0=xa00.03). Tachysystole and uterine hyperstimulation, mode of delivery, rate of cesarean sections due to fetal distress and adverse neonatal outcome were not demonstrated to be significantly different between groups (Pxa0=xa01, Pxa0=xa00.5, Pxa0=xa00.4, Pxa0=xa00.22, Pxa0=xa00.5).ConclusionUsing vaginal misoprostol is an effective way of labor induction in term pregnant women with unfavorable cervices, since it is associated with a shorter duration of labor induction and higher rates of vaginal delivery within 12xa0h. Misoprostol and dinoprostone are equally safe, since misoprostol did not result in a rise in maternal and neonatal morbidity, namely, tachysystole, uterine hyperstimulation, cesarean section rates and admission to neonatal intensive care units as reported previously in literature.

Pure nongestational choriocarcinoma of ovary

IntroductionPrimary ovarian choriocarcinoma arising presumably from a germ cell is extremely rare. Besides arising gestationally or nongestationally, it may be pure or mixed with other germ cell tumors like immature teratoma, dysgerminoma, polyembryoma.Case report and discussionWe present a case of a 22-year-old woman diagnosed with pure nongestational choriocarcinoma of the ovary with a review of the literature and discussion of its origin.

The effects of human amniotic membrane and fibrin sealant in the prevention of postoperative adhesion formation in the rabbit ovary model.

Summary: The study group consisted of 29 female, white New Zealand rabbits. The rabbits were randomized into 3 groups and a midline laparotomy was performed in order to make a 4–5 mm long lesion using a scalpel in both ovaries. In Group 1, both of the ovaries were left uncovered. In Group 2, the right ovaries were covered by human amniotic membrane graft. In Group 3, 0.1–0.2 mL of Tisseel solution was applied to the lesion in the right ovaries. No medication was applied to the left ovaries in any of the groups and thus this ovary acted as an individual control. After 2 weeks the adhesion scores were graded by relaparotomy in a blind manner. Fibrin sealant showed a significant reduction in postoperative adhesion formation compared with the amniotic membrane graft and control groups (p<0.001). Therefore, it can be concluded that fibrin sealant can be used as an adjuvant during reproductive surgery.

Preoperative evaluation of myometrial invasion in endometrial carcinoma: diagnostic performance of 3T MRI

PurposeTo evaluate the diagnostic accuracy of 3T MRI in preoperative staging of myometrial invasion.MethodsTwenty-eight women with histological diagnosis of endometrial carcinoma were included in this prospective study. After T2-W SS-TSE and DWI, dynamic series of T1-W THRIVE images were obtained (0–180xa0s) followed by a T1-W THRIVE sequence in the late phase (5thxa0min). For detection of deep myometrial infiltration: sensitivity, specificity, PPV, NPV, and accuracy were calculated on T2-W, postcontrast early arterial and late phase T1-W, and DWI. For the quantitative analysis of DWI, ADC values of the tumor were calculated and correlated with histologic grade. For the quantitative evaluation of dynamic series, SI-time curves were obtained and the maximum relative enhancement, wash-in rate, time-to-peak, and wash-out rate of masses and myometrium were compared.ResultsT2-W and early phase contrast-enhanced sequences obtained sensitivity 100xa0%, specificity 76xa0%, PPV 58xa0%, NPV 100xa0%, and accuracy 82xa0%; late-phase contrast-enhanced images obtained sensitivity 100xa0%, specificity 81xa0%, PPV 64xa0%, NPV 100xa0%, and accuracy 86xa0%; DWI obtained lower accuracy [sensitivity 71xa0%, specificity 62xa0%, PPV 38xa0%, NPV 87xa0%, and accuary 57xa0%] than T2-W and postcontrast images. The MRE of carcinomas were significantly lower than those of the myometrium. This analysis showed a significant improvement in tumor versus myometrium contrast during the late phase. On DWI, the mean ADC value of tumor was 1.02xa0±xa00.48xa0×xa010−3. There was no statistically significant correlation between tumor grades and ADCs.ConclusionsAs the 3T MRI scanner allows high-resolution images, accurate assessment of myometrial infiltration can be done especially with postcontrast late phase images.

Malignant Struma Ovarii: A Case Report

We present a case of a 40-yr-old woman diagnosed with a primary malignant struma ovarii. The patient was admitted with the complaint of pelvic pain and a large pelvic mass in the mid-portion of lower abdomen on gynecological examination. Pre-operative tumor markers and routine biochemistry were unremarkable. She was treated with total abdominal hysterectomy and right salpingo-oopherectomy. Post-operatively, she was diagnosed with a malignant struma ovarii through the usage of histopathological criteria similar to the guidelines for primary thyroid gland disease. The patient was subsequently performed left salpingo-oopherectomy and retroperitoneal pelvic lympadenectomy for re-staging. Although, left ovary and lymph nodes were histopathologically normal, she was offered thyroidectomy but she refused to accept the offer. Thyroglobulin level was monitored in the post-operative period. She is free of the disease for 18 months.

Sublingual misoprostol 100 microgram versus 200 microgram for second trimester abortion: a randomised trial

Objectives To compare the efficacy of repeated doses of 100 μg vs. 200 μg misoprostol given sublingually for induction of second trimester abortion. Methods One hundred and sixty-two women at 15–22 weeks gestation were randomized to receive every 2 h either 100 μg (group 1; n = 81) or 200 μg (group 2; n = 81) misoprostol sublingually. The primary outcome measure was the abortion rate within 24 h. The secondary outcome measures were the induction-abortion interval, the total misoprostol dose required, and side effects of the regimen. Results There was no significant difference between the two groups with regard to the abortion rates within 12 h (43.2% in group 1 vs. 48.1% in group 2; p = 0.52; relative risk [RR]: 0.81; 95% confidence interval [CI]: 0.4–1.5) and 24 h (92.6% in group 1 vs. 91.4% in group 2; p = 0.77; RR: 1.11; 95% CI: 0.37–3.6). The induction-abortion intervals in the two groups were of similar length (885 minutes in group 1 vs. 912 minutes in group 2; p = 0.72). When the total dose of misoprostol was compared between the two groups, women belonging to group 2 on average had received significantly more misoprostol than those in group 1 (1274 ± 592 μg [7 ± 3 doses] vs. 614 ± 432 μg [6 ± 4 doses], respectively; p = 0.000). Conclusions Sublingual administration of repeated doses of 100 μg misoprostol for abortion induction appears to be equally effective to that of repeated doses of 200 μg.

Factors affecting contraceptive use and behavior in Kocaeli, Turkey.

This study aimed to investigate contraceptive use and its determinants in Kocaeli, Turkey. A questionnaire was applied to 922 randomly selected sexually active women of reproductive age, in order to extract information concerning contraceptive use and sociodemographic factors affecting behavior and contraceptive use. Knowledge of at least one method was nearly universal. Intrauterine devices and withdrawal were the most commonly used methods. Illiterate women and housewives had less knowledge about some modern methods. The number of children (p<0.001), nuclear type family (p<0.05), and approval of family planning (p<0.001) were the factors most predictive of contraceptive use. Husbands were involved in family planning via discussing family size (79.4%) and method (85.5%); 38.2% of males participated actively by using withdrawal or condom. Increasing the literacy of both male and female partners significantly increased both contraceptive use and the participation of husbands in family planning descision making. In conclusion, increasing the education level of couples and the status of women would result in increased contraceptive use in the future. Since the contraceptive behavior of women is influenced by their husbands attitudes, family planning programs should be focused on the needs of both partners.

Primary peritoneal clear cell adenocarcinoma associated with endometriosis.

To the Editor: Mourra and Bengrine-Lefevre recently published a case of thyroid transcription factor (TTF)-1-positive adenocarcinoma of the colon metastatic to the lungs. It is their observation that both the primary and metastatic tumor stained positive for TTF-1. In their discussion, the authors had highlighted that the antibody clone used was 8G7G1/1 and find this intriguing, as it has been reported earlier by Comperat et al that this clone was more specific for lung when compared with SPT24 clone. Recently, we have published a study comparing both antibody clones in a set of primary pulmonary and nonpulmonary tumors. In our study, 3 of 120 (2.5%) of the colonic adenocarcinomas were TTF-1 positive using both antibody clones. In addition, our study showed that both antibody clones detected the same cases of TTF-1-positive carcinomas of nonpulmonary origin including stomach, bladder, prostate, and salivary gland. SPT24 clone showed a higher detection rate only in pulmonary carcinoid and squamous carcinomas.

Efficacy of methotrexate and misoprostol for early abortion

BACKGROUNDnMedical termination of pregnancy (medical abortion) as an alternative to surgical abortion has many advantages since it does not require anesthetics and there is no risk of cervical laceration or uterine perforation. In the present study, we evaluated the efficacy of methotrexate and intravaginally administered misoprostol for early abortion.nnnMETHODSnThe study population consisted of 32 women seeking abortion of a normal intrauterine pregnancy of 8 weeks or less documented by ultrasound. The dose of methotrexate was 50 mg/m2 intramuscularly and the dose of misoprostol was 800 micrograms intravaginally. The final outcome of treatment was evaluated on day 14 or 16, and an abortion was considered successful if pregnancy was terminated without a surgical procedure.nnnRESULTSnAbortion occurred in only 23 (71.8%) of 32 women. There were 9 failures (28.1%); 3 were ongoing pregnancies (9.3%) and 6 were incomplete abortions (18.7%) requiring suction curettage. After the exclusion of treatment failures, the mean duration of vaginal bleeding was 16.3 +/- 2 days. No serious side effects occurred as a result of methotrexate and misoprostol treatment.nnnCONCLUSIONnThe use of methotrexate and intravaginal misoprostol for the termination of pregnancy requires larger studies to determine the safety and efficacy of this medical abortion, a comparison with RU 486 in prospective controlled randomized trials is necessary.