We aimed to evaluate the clinical efficacy of r-LH supplementation to r-FSH in patients with suboptimal response to ovarian stimulation undergoing assisted reproduction with GnRH-a downregulation and stimulation with r-FSH. One-hundred thirty-seven patients were included in the study; among them 52 showed normal ovarian response to stimulation and composed the control group (Group 1), and 85 showed suboptimal response to stimulation and were divided into two groups. For Group 2 (n = 50), 75 IU/L r-LH was added to the treatment, for Group 3 (n = 35) r-FSH dose was increased by 75 IU/L. IVF results were compared between the groups. Implantation rates were 34.8% in control group, and 36.1% and 15% in LH supplementation group and increased-dose r-FSH group, respectively. Implantation rates were statistically significantly higher in Groups 1 and 2 compared to Group 3 (p < 0.02). Pregnancy rate was noticed in 64.7% of Group 1, 57.8% of Group 2 and at 32.4% of Group 3. Pregnancy rate was significantly higher in Group 2 than Group 3 (p < 0.05). r-LH supplementation is an option for improving IVF outcome in patients with suboptimal ovarian response to ovulation induction with r-FSH during GnRH agonist down-regulation. Particularly, r-LH is recommended as it may have a beneficial action on implantation in selected group.

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: This paper describes a case of fibroleiomyoma seen in the vagina of a cow, diagnosed on the basis of macroscopic, microscopic and immunohistochemical findings. A five year-old female, Simmental and Brown Swiss crossbreed cow presented with six neoplastic masses located on the vaginal wall. The masses were surgically removed through the vaginal route and were firm and well demarcated. Microscopic examination showed that the non-encapsulated neoplastic nodules consisted of the admixture of smooth muscle and connective tissue. Immunohistochemical examination revealed strong focal positive reactions for smooth muscle actin and vimentin, but no positive reaction for CD 68. The tumour reported here was considered benign because of the lack of clear pleomorphism, invasivness, multinuclear giant cells and atypia, and low mitotic activity.

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The purpose of this study was to compare postoperative pain and neuropathy after primary caesarean sections with either blunt or sharp fascial expansions. A total of 123 women undergoing primary caesarean sections were included in the study. The sharp group had 61 patients, and the blunt group had 62. In the sharp group, the fascia was incised sharply and extended using scissors. In blunt group, the fascia was bluntly opened by lateral finger-pulling. The primary outcome was postoperative pain. The long-term chronic pain scores were significantly lower in the blunt group during mobilisation (p = .012 and p = .022). Neuropathy was significantly more prevalent in the sharp group at both 1 and 3 months postoperatively (p = .043 and p = .016, respectively). The odds ratio (OR) and 95%CI for postoperative neuropathy at 1 and 3 months were as follows; OR 3.71, 95%CI 0.97-14.24 and OR 5.67, 95%CI 1.18-27.08, respectively. The OR for postoperative pain after 3 months was 3.26 (95%CI 1.09-9.73). The prevelance of postsurgical neuropathy and chronic pain at 3 months were significantly lower in the blunt group. Blunt fascial opening reduces the complication rate of postoperative pain and neuropathy after caesarean sections. Impact statement What is already known on this subject? The anatomic relationship of the abdominal fascia and the anterior abdominal wall nerves is a known fact. The fascia during caesarean sections can be opened by either a sharp or blunt extension. Data on the isolated impact of different fascial incisions on postoperative pain is limited. What do the results of this study add? The postoperative pain scores on the incision area are lower in the bluntly opened group compared to the sharp fascial incision group. By extending the fascia bluntly, a decrease in trauma and damage to nerves was observed. What are the implications of these findings for clinical practice and/or future research? The lateral extension of the fascia during caesarean sections must be done cautiously to prevent temporary damage to nerves and vessels. The blunt opening of the fascia by lateral finger pulling might be a preferred method over the sharp approach that uses scissors. We included only primary caesarean cases, however, comparisons of blunt and sharp fascial incisions in patients with more than one abdominal surgery should be explored in future studies.

Objectives We aimed to determine if superb microvascular imaging (SMI) can predict response to uterine artery embolization (UAE) as compared with power Doppler ultrasound. Methods The blood flow and the volume of the dominant leiomyoma was evaluated by power Doppler ultrasonography (PDUS) and SMI 1 day before and 3 months after the UAE procedure. SMI and PDUS blood flow were classified to 4 grades of vascularity. The change in fibroid volume in Grades 0–2 (hypovascular group) was compared to the hypervascular Grade 3 group. Results Twenty‐eight women (mean age, 40.9 years; range, 33–53 years) were examined with PDUS and SMI before and 3 months after UAE. The volume reduction was statistically significantly higher hypervascular group (P < .05). When we accept 30% or more volume reduction as a good response to UAE, the positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of SMI were 100, 64, 73.6, 100, and 82.1%, respectively. There was excellent agreement between the two blinded observers in SMI measurements. Conclusions SMI, with its high reproducibility, provides further microvessel information than PDUS in uterine fibroids. It may be a useful tool in prediction of response to UAE treatment and improve counseling and patient selection for UAE versus medical or surgical treatment options.

We present a patient with persistent bilateral megalocystic ovaries following in vitro fertilization which was detected during cesarean section. A 24 year-old primigravida presented to our clinic at the 36(th) week of a twin pregnancy with labour pain and cervical dilatation. On ultrasound examination, 2 masses of 90×60 and 60×70 mm were seen in the right and left adnexal regions respectively. Her history showed that she had unexplained infertility for 4 years and had undergone IVF with gonadotropin releasing hormone (GnRH)-agonist stimulation. Two embryos were transferred. Twin pregnancy was detected on ultrasound examination. The patient was delivered by emergency caesarean section due to transverse presentations at 36(th) weeks of gestation. During the operation, both adnexae were markedly enlarged, the right ovary measuring about 15×18 cm and the left about 16×18 cm. There was minimal ascites in the abdominal cavity. Ovarian biopsy was performed and the final pathology report showed bilateral follicle cysts. The patient was discharged on the postoperative 4(th) day. The patient was seen 4 weeks later. She had no complaints and ultrasound follow-up revealed a normal size uterus and ovaries. We should keep in mind that hyperstimulated, enlarged ovaries and its complication may be seen in the late weeks of pregnancy, even at term, in cases of in vitro fertilization cases. Therefore, close follow-up of pregnant IVF patints is recommended whether they had OHSS or not, because ovarian torsion caused by hyperstimulated ovaries may be difficult to diagnose during pregnancy.

The aim of this study is to compare the diagnostic accuracy of transvaginal ultrasonography and hysteroscopy in the detection of intracavitary abnormalities that presented with abnormal uterine bleeding. Material and Methods: 216 women with uterine bleeding involve in this study. In this retrospective study, the diagnostic accuracy of transvaginal ultrasonography and hysteroscopy were compared to their corresponding pathology results in both prepostmenopausal (n:145) and postmenopausal (n:71) women. To compare these three methods more reliably, we used Kappa analyses. Results: In postmenopausal group with endometrial polyp and myomas; sensitivity of transvaginal ultrasonography is 68.2% to 40% dilatation & curettage, specificity is 33.3% to 97% and Kappa value is 0.016 to 0.407. Sensitivity of hysteroscopy is 97.7% to 40% dilatation & curettage, specificity is 74.1% to 100% and Kappa values is 0.75 to 0.553. Specificity of transvaginal ultrasonography is 98.3% to hysteroscopy, specificity of transvaginal ultrasonography is 98.1% to dilatation & curettage, sensitivity of hysteroscopy is 47.1% and specificity is 90.7% to dilatation & curettage and Kappa value is 0.411 with normal patients in the same group. Conclusion: In postmenopausal patients transvaginal ultrasonography has a high chance of detecting when there is an endometrial pathology. Transvaginal ultrasonography is not sensitive enough to use solely in order to exclude polyps and fibroids in abnormal uterin bleeding. Therefore, hysteroscopy can be applied even if transvaginal ultrasonography is normal in these patients.