Objective: The aim of this study is to invastigate the cycle outcomes and pregnancy rates in infertile patients treated with GnRH antagonist added gonadotrophins followed by intrauterin insemination (IUI).

Materials and Methods: This is a randomised controlled trial starting from may 2010 to may 2011, with the verdiction of Health Ministery Bakırkoy Gynecology and Obstetrics and Pediatrics Education and Research Hospital Ethics Commitee dated 12/06/2009 and numbered 254. We analysed the data on IUI cycles starting from may 2010 to may 2011 in 56 cycles of 47 patients diagnosed with unexplained infertility and polycyctic ovary syndrome (PCOS) with current guidelines (RCOG and Rotterdam Concensus 2003). All patients were treated with recombinant FSH in a low dose step up regimen starting on day 2-4. 25 women in the antagonist group, 0,25 mg per day GnRH antagonist was added when leading follicul reached the size of 14 mm in 30 cycles. In the control group there were 22 women treated with only recombinant FSH in 26 cycles. When at least one follicle reached a size of ?18 mm, ovulation was induced by hCG injection. IUI was performed 36 hours later.

Results: rFSH amount, number of follicules, E2 level in the hCG day and endometrial thickness were not significantly different between the antagonist group and the control group. Also there was statistically no difference in the induction period time. Mean early LH peak was observed in %3.3 of cases of antagonist group, while it was %34.6 in the control group, showing that the early LH peak was statistically lower in the antagonist group (p:0.002) but there was no statistical difference in the pregnancy rate for cycle between the two groups, as %10 in the antagonist and %7.7 in the control group (p:0.763).

Conclusion: Adding GnRH antagonist in cycles with rFSH followed by IUI has significant effect on early LH surge, but it does not increase pregnancy rates.

Objective: We investigated the association of normal endometrial cells (NECs), detected during Pap smear screening of pre- and post-menopausal women over 40 years with endometrial abnormalities.?

Methods: This study recruited 15 post-menopausal and 9 pre-menopausal cases, with NEC on Pap smear screening. Overall, 24 cases underwent endometrial biopsy by probe curettage. Obtained specimens were sent to pathology laboratory in individual containers after placing them in formaldehyde solution. All histopathological evaluations were performed by a single pathologist at the same pathology laboratory.

Results: Diagnoses made were hyperplasia without atypia in 8 (33.33 %), atrophic endometrium in 5 (20.83 %), endometrial polyp in 4 (16.66 %), proliferative endometrium in 3 (12.50 %), hyperplasia with atypia in 2 (8.33 %) and secretory endometrium in 2 cases (8.33 %), respectively. Polyp incidence was higher in postmenopausal women than those in premenopausal women (20.0 % vs. 11.1 %). Atypia was detected in overall 2 cases (8.3 %). Presence of NEC in Pap smear was associated with polyp or endometrial hyperplasia at a rate of 66.7% in postmenopausal women. This rate was 44.4 % in premenopausal cases. No cancer case was detected.

Conclusion: Presence of NECs on Pap smear of pre- and postmenopausal women over 40 years may be associated with endometrial abnormality. NEC in cervical smear should be considered and presence of possible endometrial abnormality in these women should be kept in mind.

Key words: cervical smear, endometrium, endometrial cells

Objective: Changes in perinatal management have led to improved survival of extremely low birth?weight (ELBW) infants in recent years.There have been concerns that the new survivors are at increased risk for neurodevelopmental disability. The Amiel-Tison Neurological Assessment (ATNA) is part of a set of three different instruments based on a neuro-maturative framework. Our aim was to look at neurodevelpmental outcomes by Amiel-Tison Neurological Assessment and to determine the relation betwen the risk factors at 12 to 24 months’ corrected age for infants of <37 weeks gestational age who were born in Suleymaniye Maternity Teaching Hospital between 2008-2009 years.?

Methods: Ninty seven infants between 26-37 weeks gestational age were evaluated for prenatal, natal and postnatal factors and examined according to Amiel-Tison Neurological Assessment scale. Demographic data of all infants were recorded. SPSS 17,0 was used for statistical analysis.?

Results: The median birth weight and gestational age of infants were 1382 gr (560-2480) and 31 weeks (26-37) respectively. While more than half of the babies were between 29-32 weeks (% 58), 22 % were below 28 weeks gestational age. Among the study population 43 % were males.According to ATNA scale 81.4 % of infants were normal. Insufficiency without disability was present in 12.4 % and insuffiency with disability was present in 6.2 % of the infants. ?There was not correlation between ATNA scale and gestational age, multiple gestation, administration of antenatal steroids and length of stay.??

Conclusion: The ATNA may be used in clinical setting and in research. Efforts to further decrease neonatal morbidity should continue to improve the outcomes of preterm children.

Key words: prematurity, Amiel-Tison neurological examination, perinatal risk factors

Objective: The aim of our study was to evaluate etiological factors leading to recurrent pneumonia in children and to determine their role in prognosis.?

Methods: Patients records of children hospitalized in Bakirkoy Maternity and Children’s Hospital between January 2005 and January 2009 with a diagnosis of pneumonia were evaluated retrospectively. Only recurrent pneumonia cases hospitalized with a defined etiology were included in the study. Age, sex, number of hospitalizations, underlying illnesses, growth retardation and mortality rates were evaluated.?

Results: Among 3650 patients hospitalized with a diagnosis of pneumonia during the four year period, 92 (2.5 %) cases with recurrent pneumonia were detected. Sixty-six patients with established etiological factors were included in the study. Mean age of the patients was 4.18 years and 53 % of them were male. Most common disorders asoociated with recurrent pneumonia were asthma 27.3%, neuromotor retardation 24.2%, gastroesophageal reflux (GER) 19.7% and congenital heart diseases 19.7 %. 19 cases (28.8 %) had episodes of pneumonia ?7 times and 28 cases (42.4 %) were hospitalised ? 5 times for pneumonia. Growth failure was detected in 40 patients (60.6 %). Mortality rate was 9.1 %.

Conclusion: An underlying illness could be detected in 71.7 % of patients, most commonly asthma and neuromotor retardation. Pneumonia attack rate and number of hospitalization were highest in patients with immune defficiency. Growth failure was most prominent in patients with neuromotor retardation and cystic fibrosis. Mortality rate was highest among patients with neuromotor retardation (25 %).

Key words: children, etiology, prognosis, recurrent pneumonia

Objective: To compare the prognosis in very low birth weight preterms being started late onset low protein and lipid feeding with early onset high protein and lipid feeding.?

Methods: Group 1 consisted of preterms with parenteral protein support after 2 days. This type of feeding was named as ‘late parenteral feeding’. In Group 2, protein supplement was started as 2 gr/kg/d in the first 24 hrs and increased to 3.5 gr/kg/d in the 2nd day, lipids were started as 1 gr/kg/dy in the first 24-48 hrs and increased to 4 gr/kg/d rapidly. This type of feeding was named as ‘early intense parenteral feeding’ Gestational weeks (GW), birthweights (BW), gender, timing, and duration of parenteral feeding, age at initiation of enteral feeding, catch-up time of age-matched birthweight, intake of breast milk enriching supplements, hospital stays, weight, height, and head circumference of newborns at discharge were recorded.

Results: 125 preterms were evaluated in Group 1 and 151 preterms in Group 2. There was no statistically significant intergroup difference regarding the method of delivery, birth weights and gender. Lipid supplements were given 46 % of the newborns in Group 1 and 89.5 % of Group 2. The catch-up time of birth weight, age at the begining of enteral feeding, timing of full enteral feeding, levels of calcium, alkaline phosphatase, protein, albumin and triglyceride levels were significantly different between groups. Duration of hospital stay, height, weight and head circumferences during hospital discharge were similar between groups.

Conclusion: Early intense parenteral feeding is especially very important for low birth-weight (< 1500 g) infants. The catch-up time of birth weight and time to switch to full enteral feeding were significantly short in the second group.

Key words: parenteral feeding, switching to enteral feeding

Among gynecological malignancies ovarian cancer is the leading cause of morbidity and mortality. However, an efficient screening test is still absent for asymptomatic women. But, sonomorphological signs appear to be important in distingushing benign and malignant adnexal masses especially in postmenopausal women. The major sonographic malignancy criteria are heterogenous echo, presence of septae, papillae, irregular borders, and free abdominal fluid. Together with these, absence of ovarian crescent sign is the single important sonographic malignancy criteria. Herein, we present a 60 year- old patient admitted with vaginal bleeding in which transvaginal ultrasonography detected a heterogenous adnexal mass without surrounding normal ovarian tissue.

Key words: ovarian cancer, ultrasonography, ovarian crescent sign

Multiple pterygium syndrome (MPS) is a rare congenital disorder characterized by abnormal facial appearance and skin folds on antecubital, cervical, popliteal, neck and interdigital areas and flexor contractures of joints. In this article, a patient with MPS was presented and the clinical features were discussed in the light of the literature. A newborn who had pterygium in his interdigital areas, both hands and popliteal regions and multipl joint contracture was evaluated. This patient is the first case with multiple features of the MPS syndrome in our hospital.

Key words: multiple pterygium syndrome, flexion contracture

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