Deep vein thrombosis (DVT) is a common condition in which the approach to its diagnosis has evolved over the years. Currently, an algorithm strategy combining pre-test probability, D-Dimer testing and compression ultrasound imaging allows for safe and convenient investigation of suspected lower-extremity thrombosis. Patients with low pre-test probability and a negative D-Dimer test result can have proximal DVT excluded without the need for diagnostic imaging. The mainstay of treatment of DVT is anticoagulation therapy, whereas interventions such as thrombolysis and placement of inferior vena cava filters are reserved for special situations. The use of low-molecular-weight heparin (LMW) allows for outpatient management of most patients with DVT. The duration of anticoagulation therapy depends on whether the primary event was idiopathic or secondary to a transient risk factor. More research is required to optimally define the factors that predict an increased risk of recurrent DVT to determine which patients can benefit from extended anticoagulant therapy. DVT is also a serious problem in the antenatal and postpartum period of pregnancy. Thromboembolic complications are the leading cause of both maternal and fetal morbidity and mortality. The incidence of venous thromboembolism during normal pregnancy is six-fold higher than in the general female population of childbearing age. The treatment of DVT during pregnancy deserves special mention, since oral anticoagulation therapy is generally avoided during pregnancy because of the teratogenic effects in the first trimester and the risk of fetal intracranial bleeding in the third trimester. LMW heparin is the treatment of choice for DVT during pregnancy. If acute DVT occurs near term, interrupting anticoagulation therapy may be hazardous because of the risk of pulmonary embolism. In this situation, placement of a retrievable inferior vena cava filter must be considered. However, there is no consensus as to what the appropriate dose should be and whether anti-Xa levels need to be monitored. (J Turkish-German Gynecol Assoc 2011; 12: 168-75) Key words: Venous thrombosis, heparin, low-molecular-weight: heparin, anticoagulants, partial thromboplastin time, thromboembolism in pregnancy Received: 30 Junuary, 2011 Accepted: 25 May, 2011 Derin ven trombozları (DVT), teşhis yaklaşımlarının yıllar içinde büyük değişimler ve gelişmeler gösterdiği sık karşılaşılan bir durumdur. Son zamanlarda, pre-test probabilite, D-Dimer testi ve kompresyon ultrason görüntülemesini kombine eden bir algoritma stratejisi, alt ekstremite trombozlarından şüphelenilen olgularda hem güvenli hem de kullanışlı araştırma imkanı sağlamaktadır. Pre-test probabilitesi düşük, D-Dimer testi negatif olan hastalarda diagnostik görüntülemeye ihtiyaç olmadan, proksimal DVT dışlanabilir. DVT tedavisinin dayanak noktası antikoagü-lasyon tedavisidir, bununla birlikte tromboliz ve inferiyor vena cava filtreleri gibi girişimler özel durumlara mahsus tedavilerdir. Düşük moleküler ağırlıklı heparin kullanımı DVT'...

Prostate adenocarcinoma (PCa) is the most frequently diagnosed malignancy in the male population, with the most common sites for secondary lesions being the lymph nodes, bones, and lungs. Testicular metastases from PCa are very rare and mostly identified incidentally after therapeutic orchiectomy for advanced PCa or during autopsy. Here we present a case involving a 64-year-old man with biochemical recurrence of castrated oligometastatic PCa that presented as solitary testicular metastasis on Ga-PSMA ligand positron emission tomography/computed tomography.

Pregnancy, due to its adaptive physiological changes, is a risk factor for deep vein thrombosis. Incidence of thromboembolic complications during pregnancy ranges from 0.76 to 1.72 per 1000 births. We present in this case report a pregnant woman with iliofemoral-popliteal deep vein thrombosis diagnosed at the 35 th week of her pregnancy, who was treated with vena cava blockage and thrombectomy followed by cesarean section. Unfortunately, a rethrombosis developed in the patient after three days. We determined that the a-v fistula was blocked and not working. We found additionally that the deep vein thrombosis was closing the iliac vein completely on the left side and the blockage descending down through the inferior vena cava inlet with MRI. The patient underwent insertion of a retrievable vena cava filter, two stent implantation to the venous narrowings and surgical iliofemoral venous thrombectomy with concomitant re-creation of a temporary femoral arterio-venous fistula. Anticoagulation therapy with enoxaparine was started after the operation. The patient was discharged with warfarin under control of the INR value, and also with additional compression therapy (compression stockings) from the clinic. Without jeopardizing the mother and the baby, planning a combined surgical procedure, with a multidisciplinary approach is the best way to eliminate the risks of serious complications such as pulmonary embolism and mortality. (J Turkish-German Gynecol Assoc 2012; 13: 139-41) Key words: Deep vein thrombosis, pregnancy, complications, thrombectomy, inferior vena cava Received: 13 September, 2011 Accepted: 20 November, 2011Gebelik, bu dönemdeki fizyolojik değişikliklere bağlı olarak, derin ven trombozu açısından bir risk faktörüdür. Gebelik sırasındaki tromboembolik komplikasyonların insidansı her 1000 doğumda 0.76 ila 1.72 arasında değişir. Biz bu olgu sunumunda, gebeliğin 35. haftasında iliofemoral-popliteal derin ven trombozu tanısı konan ve vena kava blokajı ve trombektomiyi takiben sezaryen seksiyo ile tedavi edilen bir gebeyi sunuyoruz. Ne yazık ki bu hastada üç gün sonra tekrar tromboz gelişti. Arterio-venöz fistülün tıkandığını ve çalışmadığını saptadık. Ayrıca MR görüntüleme ile sol tarafta iliak venin tamamen tıkandığını ve tıkanıklığın aşağıda inferior vena kavanın girişine kadar uzandığını tespit ettik. Hastaya çıkarılabilir vena kava filtresi yerleştirildi, venöz daralma bölgelerine iki stent yerleştirildi, cerrahi olarak iliofemoral venöz trombektomi yapıldı ve eşzamanlı olarak geçici femoral arteriovenöz fistül yeniden oluşturuldu. Operasyondan sonra enoxaparine ile antikoagulan tedavi başlandı. Hasta INR kontrolü altında warfarin ve ek olarak kompresyon tedavisi (kompresyon çorapları) ile klinikten taburcu edildi. Pulmoner emboli ve ölüm gibi ciddi komplikasyon risklerini, anne ve bebeğin hayatını tehlikeye atmadan, elimine etmenin en iyi yolu multidisipliner yaklaşımla kombine cerrahi işlemlerin planlanmasıdır. (J Turkish-German Gynecol Assoc 2012; 13: 139-41)

Objective: The aim of this study was to evaluate the success of intrauterine insemination (IUI) treatment, the factors affecting success, and current recommendations. Methods:This study was conducted by retrospectively investigating 300 cycles of IUI treatment performed in 183 patients between 2005 and 2009. The results of a single IUI treatment session performed 32 to 36 hours after a dose of 10,000 units of chorionic gonadotropin was administered to patients with unexplained infertility were analyzed. The patients were aged between 19 and 42 years with a median follicle-stimulating hormone test result of 7.15 mIU/L, a total motile sperm count exceeding 5 million/mL, and a follicle size of at least 15 mm with treatment. Results:The successful pregnancy rate with spontaneous coitus after clomiphene citrate (CC) treatment was 12.5% (13/104) The successful pregnancy rate with IUI after CC treatment was 11.7% (16/136), and the successful pregnancy rate with IUI after gonadotropin treatment was 23.4% (14/60). A total of 43/300 pregnancies were achieved and the overall success rate was 14.3%. When the results of the 43 pregnancies obtained were examined, 32 term pregnancies (10.7%) were achieved, there were 9 (3.0%) cases of abortus, 1 (0.7%) ectopic pregnancy, and 1 (0.7%) chemical pregnancy. Conclusion:CC is still the best agent for first-line treatment in couples with unexplained infertility. In cases refractory to gonadotropins, IUI promotes clinical success. IUI has the advantages of low cost, easy applicability and accessibility, low morbidity, and a significant success rate.

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