Aphasia: an early uncommon complication of ovarian stimulation without ovarian hyperstimulation syndrome

Thromboembolic disease associated with assisted reproductive techniques is extremely rare. A 21-year-old woman with primary infertility underwent an ovulation induction cycle with luteal long protocol. Twenty-four hours following oocyte retrieval, the patient complained of difficulty in speaking. On neurological examination, mild disorientation, motor aphasia, and right-sided hypoesthesia were noted. Brain computed tomography scanning without contrast revealed left parietal lob infarct. Brain magnetic resonance imaging (MRI), MRI angiography (MRA) and perfusion MRI demonstrated an occlusion of the posterior division of the left middle cerebral artery (MCA). Physical, ultrasound examinations and laboratory test evaluation failed to reveal ovarian hyperstimulation syndrome. Except for ovarian stimulation, no additional risk factors for stroke were shown. Following anticoagulation and speech therapy, the patient recovered completely within eight months. One year after the left MCA thrombosis, she conceived spontaneously and had an uncomplicated vaginal delivery of a live male infant weighing 2900 g at 38 weeks gestation. This case supports that ovulation induction and assisted reproductive techniques may be a newly recognized cause of cerebral infarction in otherwise healthy women.     

Sensitization to common allergens, especially pollens, among children with respiratory allergy in the Trakya region of Turkey

Asthma and allergic rhinitis are common problems in children and the causative pollen allergens vary according to the geographical area. The aim of this study was to investigate patterns of sensitization to common inhalant allergens, especially pollens, in Turkish children living in the Trakya region and to determine differences between rural and urban areas. Allergen skin testing was prospectively performed on 539 children aged between 4 and 17 years with respiratory allergy. The reaction was considered to be positive if the mean wheal diameter was at least 3 mm greater than that of the negative controls. We detected positive skin reactions in 420 (77.9%) children. Two hundred and eighty-one (52.1%) mite, 277 (51.4%) pollen, 174 (32.3%) mold, 65 (12.1%) animal dander, 12 (2.2%) cockroach and 6 (1.1%) latex skin sensitivities were detected. Among the pollen allergies 173 were cereal pollen (32.1%), 170 grass pollen (31.5%) and 144 tree pollen allergies (26.7%). The most common positive skin test among the pollens was to cultivated wheat (Titicum vulgare) (n = 116, 21,5%), followed by rye grass (Lolium perenne) and orchard grass (Dactylis glomerata). Positive skin reactions to Alternaria, to Candida albicans, and to all pollens except Ulmus competris, Pinus sylvetris, Platanus vulgaris and Tilia platyphyllos, were higher in children with allergic rhinitis than in those with asthma. In children from rural areas, allergic skin reactivity was found to be more common against Candida albicans, sheep dander and all pollens except Corylus avellana, Fraxinus excelsior, Populus alba, Pinus sylvetris, Platanus vulgaris and Chenopodium album, than in urban children. Although Trakya is close to Greece and other Mediterranean countries, this study suggests that the pollens, which sensitize children, are not similar.     

Factor V Leiden mutation and other thrombophilia markers in childhood ischemic stroke.

The aim of this study was to evaluate the association between ischemic childhood stroke and thrombophilia. The prevalence of thrombophilia risk factors in 30 unrelated children with ischemic stroke were compared with 33 age-matched control subjects. Patients and control group were tested for the presence of activated protein C (APC) resistance, antiphospholipid antibodies (APLA), increased factor VIII levels, and for the deficiency of protein C (PC), protein S (PS), and antithrombin. When APCR was detected in patients or in controls, factor V Leiden (FVL) mutation was also tested. Seventeen of 30 patients (56.6%) had at least one thrombophilia marker compared with only 5 of 33 control subjects (15.1%). Three children with ischemic stroke (10%) were affected with a combination of two or more thrombophilia markers whereas none of the children in the control group had a combination of risk factors. Seven of 30 children with ischemic stroke (23.3%) and one of 33 control subjects (3.03%) had APC resistance and in all of them FVL mutation were found. The prevalence of FVL mutation was higher among pediatric stroke patients than among control subjects (p < 0.05). None of the patients but one child from the control group (3.03%) had PS deficiency. Antithrombin and PC deficiencies and the presence of APLA and increased factor VIII levels were more frequent in the pediatric stroke patients than in controls but the difference was not statistically significant (p > 0.05). These data confirm that stroke in children is commonly associated with a combination of multiple risk factors and especially the prevalence of FVL mutation is increased in children with ischemic stroke compared with control subjects.     

Negative serology: could exclude the diagnosis of brucellosis?

Two cases of brucellar spondylodiscitis of the lumbar area were presented. Although both cases showed typical radiological changes, serological tests could not detect Brucella agglutinating antibodies. One of the patients was bacteremic and Brucella spp. was identified from blood culture. In the second patient needle biopsy was required for definite diagnosis. Although small, serologic tests have a certain rate of false negative results in brucellosis. Thus, a negative serology should not exclude the diagnosis of brucellosis, as it is demonstrated in the current cases.     

David's procedure for pulmonary artery aneurysm

Pulmonary artery aneurysm (PAA) is a rare entity with fatal complications. Its silent course contributes to large aneurysms with compression symptoms. We present a 39-year-old female idiopathic pulmonary arterial hypertension patient with a giant PAA causing severe pulmonary regurgitation (PR) and symptomatic left main coronary artery compression (LMCA). Since she had a failed LMCA stenting attempt, she underwent surgery. A valve-sparing David-like pulmonary trunk reconstruction and coronary artery bypass were performed. This case illustrates that David-like reconstruction procedure can be applied to the PAA with severe PR.     

兴趣在大学生学习中的作用与培养

在大学教学和学习中,学习兴趣是引导学生追求知识的最关键非智力因素之一,兴趣在目前的教育教学中受到越来越多的重视。本文主要论述了兴趣在大学生学习生活中的作用、个人应如何对待自身的兴趣以及作为教育工作者该如何引导和培养学生的学习兴趣,从而改善学习效果。     

In Her Own Words: Living with Urinary Incontinence in Sexual Life

Urinary incontinence (UI) is an extremely private, disturbing health issue with negative sexual effects for women. The aim of this study was to identify the feelings and experiences of women with UI effects on their sexual lives through a qualitative research method. Twelve Turkish women participated in this study. The mean age of them was 47.08 ± 6.12. Data was collected using both a demographic data form and a semi-structured interview form. Interview form was performed open-ended items which were designed to gather data on the experiences in sexual life, thoughts and perceptions of the participants about the impacts of UI on their sexual lives. Data was analysed by Colaizzi’s analysis method. The findings that attempt to describe how women with UI live their sexuality were presented under four themes such as experiences of women when the symptoms first occurred, feelings, negative effects on sexual functioning, behavior for coping with UI. Seven of the women described the feeling that the involuntary UI caused during sexual intercourse as “shameful.” The women reported that UI or the feeling of embarrassment during sexual intercourse has led to an inability to enjoy sexual intercourse by causing loss of sexual desire (five women), not having sexual intercourse (three women), and distraction (two women). There should be high degree awareness for UI and its sexual effects, not only by women but also by the healthcare staffs.