Recurrent molar pregnancy: report of a case with seven consecutive hydatidiform moles

A case of seven consecutive hydatidiform moles is presented. All of her pregnancies revealed a molar pregnancy, 4 of which were demonstrated histopathologically. In the context of this study, the potential risk for malignant transformation and the obstetric outcome are highlighted. The literature regarding recurrent molar pregnancies is reviewed.     

Impact of piroxicam beta-cyclodextrin on the efficacy of the intrauterine device in a rat model.

OBJECTIVE: To elucidate the effect of piroxicam beta-cyclodextrin (PbetaCD), a non-steroidal anti-inflammatory drug (NSAID), on the efficacy of the intrauterine device (IUD) in a rat model. METHODS: Forty nulliparous female Wistar rats were allocated to one of four groups, comprising each 10 of these animals. Group I: neither IUD nor medication; group II: IUD, but no medication; group III: IUD and PbetaCD; and group IV: PbetaCD only. In groups II and III, a string of 3/0 silk suture of 2 cm long was transcervically placed in one of the horns of the bicornuate uterus of the rat. Rats in group III were treated during the 18 days following IUD placement with 3 mg/kg/day PbetaCD administered via a feeding tube; group IV received PbetaCD for the same length of time, but had no IUD inserted. The rats were then mated. Thereafter, vaginal smears were taken and assessed daily, in the early morning, for the presence of spermatozoa. The day when spermatozoa were detected was considered to be the first day of gestation. On gestational day 19, both uterine horns of all rats were evaluated for the presence and number of embryos. RESULTS: In group II, mean embryo counts in the horn with or without IUD were 1.0 +/- 0.2 and 4.5 +/- 0.3, respectively (p < 0.01). The comparison of group II with group I showed that the presence of an IUD in one horn did not affect the mean embryo counts in the contralateral horn (4.5 +/- 0.3 versus 5.1 +/- 0.9, p > 0.05). In groups II and III, mean numbers of embryos in the horn with IUD were 1.0 +/- 0.2 and 2.7 +/- 0.4, respectively (p < 0.01). No difference in the mean embryo counts was observed between group I (5.1 +/- 0.9) and IV (4.8 +/- 0.9; p > 0.05). CONCLUSIONS: The IUD had a contraceptive effect in the rat model. The IUD in one horn did not affect the number of embryos in the contralateral horn. In this model, IUDs appear to exert a local effect, i.e. counteracted by PbetaCD. This drug had no adverse effect on the fertility of rats without IUD in situ.     

Factors influencing mortality in spontaneous gastric tumour perforations

Spontaneous perforation of gastric cancer is a serious complication with a very high incidence of mortality. In order to evaluate the prognostic factors influencing mortality in patients with gastric tumour perforations and to clarify the optimal surgical treatment, the records of patients at one centre during a 5-year period were evaluated retrospectively. Between 1995 and 2000, 14 patients with perforated gastric cancer were operated on in the Emergency Surgical Unit of a Turkish Hospital. This figure represents 3% of all the patients with gastric cancer who were treated during the same period. The hospital mortality was 36% in patients with perforations. The duration of symptoms suggesting perforation and the presence of pre-operative shock were predictive factors of mortality. It was concluded that those patients with pre-operative shock and delayed diagnosis should be treated with extra caution to decrease mortality. Perforation and peritonitis must be treated initially and elective radical surgery delayed.     

Neuroprotective effects of tamoxifen on experimental spinal cord injury in rats

The aim of this study was to evaluate the effects of tamoxifen on tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β) levels and ultrastructural changes in rats with spinal cord injury. Rats were divided into four groups: control group (laminectomy only), trauma group (laminectomy + spinal trauma), tamoxifen group (laminectomy + spinal trauma + tamoxifen), and vehicle group (laminectomy + spinal trauma + vehicle). Spinal cords were extirpated at the T₇–T₁₂ level and tissue samples from the spinal cords were gathered for TNF-α and IL-1β measurements at 1 and 6 hours. Spinal cords harvested at 6 hours were evaluated for ultrastructural changes. TNF-α and IL-1β levels at 6 hours were significantly lower in the tamoxifen group than in the trauma group. Electron microscopic examination of tissue from the trauma group revealed gross cell deformities with widespread edema of all structures as well as severe edema in the neuropil. At 6 hours after trauma, these ultrastructural changes were less marked in the tamoxifen group. Our findings support a neuroprotective and restorative role for tamoxifen in the context of secondary pathological biochemical events after SCI.     

Effect of angiotensin II type 1 receptor blocker on osteoporotic rat femurs

BackgroundOsteoblasts and osteoclasts are known to express Ang II type I (AT1) receptor in cell cultures, suggesting the existence of local renin-angiotensin system (RAS) in bone. This study was designed to investigate the effects of losartan as AT1 receptor blocker on ovariectomized rats' femur.MethodsLosartan (5 mg/kg/day) was administered via oral gavage for 8 weeks. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry, while tensile and three-point bending tests were performed for evaluation of biomechanical properties of bone. The trabecular porosity was analyzed by scanning electron microscopy.ResultsThere was a significant decrease in BMD values of ovariectomized rats' femurs which were reversed by losartan treatment. According to tensile test results, ultimate tensile strength and strain values of losartan treated ovariectomized rats' femurs increased and decreased, respectively, when compared to that of ovariectomized animals. Losartan treatment also caused a significant recovery in flexural strength and modulus parameters regarding respective control values, which mean losartan treated ovariectomized rats' femur had more force tolerance until break than ovariectomized rats' femur. Quantitative microscopic analysis showed larger trabecular porosity in ovariectomized rats than control rat femurs and it was significantly decreased after losartan treatment.ConclusionBlockage of AT1 receptor increased strength, mass and trabecular connections of ovariectomized rat femurs. Therefore, it is tempting to speculate that drugs, including AT1 receptor blockers, may be used for the treatment of osteoporosis or reduction of its detrimental effects in the future.     

Effects of valproate on vestibular symptoms and electronystagmographic findings in migraine patients

OBJECTIVES: To investigate the effects of valproic acid on vestibular symptoms and electronystagmography (ENG) findings in patients with migraine-related vestibulopathy. METHODS: Thirty-seven patients with migraine (13 with vertigo, 13 with dizziness, and 11 without vestibular symptoms) were included in the study. Slow-released valproic acid (500 mg/d) was given for 3 months. Frequency of headache and vestibular symptoms in the first, second, and third months of the therapy were recorded and compared with the pretreatment values. The ENG findings were also evaluated before and 2 months after the therapy. RESULTS: We determined that prophylactic low-dose valproic acid decreased the frequency of headache and vestibular symptoms, although it does not cause any statistically meaningful change in ENG findings. CONCLUSIONS: Valproate can be used satisfactorily for patients with migraine who have vestibular complaints. Ineffectiveness of valproic acid on ENG findings can be clarified by the permanent effect of migraine on the vestibular system.     

Anatomical assessment of bile ducts of Luschka in human fetuses

Bile ducts of Luschka (also called subvesical or supravesicular ducts) can cause bile leakage during laparoscopic cholecystectomy, especially if surgery is carried out in ignorance of such variations. The aim of this study was to clarify the clinical anatomy of these ducts in human fetuses and frequency of the ducts locating near gallbladder fossa. Thirty-two fetal cadaver livers were dissected and the gallbladders were separated from the livers and ducts were investigated under a surgical microscope. All observed ducts were examined microscopically and connective tissue cords were excluded. Bile ducts of Luschka locating near cystic fossa were found in 7 of 32 fetuses (21.9%). Three of the seven ducts ran towards to liver segment 5 (S5); three ducts were found in the gallbladder fossa; and one duct ran towards to liver segment 4 (S4). Also it was found that three of the seven ducts drained into the subsegmental duct of S5, two ducts drained into the right hepatic duct, one duct drained into the right anterior branch bile duct, and one duct drained into the subsegmental duct of S4. Subvesical ducts running along the gallbladder fossa between the gallbladder and the liver parenchyma were found in a relatively high incidence in fetuses than adults. Awareness and knowledge about incidence of such ducts alerts the surgeon during laparoscopic cholecystectomy. Therefore morbidity due to bile leaks can be reduced.