Amaç: Bu çalışmada gonad koruyucuların pediatrik hastalarda kullanımının etkinliği değerlendirildi. Hastalar ve yöntemler: Ekim 2011 -Şubat 2012 tarihleri arasında hastanemizde çekilen ardışık 675 hastanın (323 erkek, 352 kız; ort. yaş 6.8 yıl; dağılım 6 ay-17 yıl) 1137 pelvis röntgeni, gonad koruyucu kullanımı açısından, bir ortopedist, bir jenekolog ve bir pediatristten oluşan bir ekip tarafından değerlendirildi. Bulgular: İncelenen 1137 röntgenden 566'sında (%49.8) gonad koruyucu kullanıldığı ve bunlardan 506'sında (%44.5) anatomik mihenk noktalarının açık olduğu görüldü. Koruyucuların 104 (%9.1) röntgende doğru yerde olduğu belirlendi. Toplam 293 (%25.7) röntgende kısmi koruyucu olduğu, 109 (%9.6) röntgende ise tamamen yanlış yerleşimli olduğu gözlendi. On dokuz röntgen (%3.3) hatalı gonad koruyucu yerleşimine bağlı olarak tekrar çekildi. Erkek çocukların röntgenlerinin 193'ünde (%17) koruyucu kullanıldığı fakat bunların sadece 74'ünde (%6.5) koruyucunun doğru yerleştirildiği görüldü. Kız çocuklarının röntgenlerinin 373'ünde (%32.8) koruyucu kullanıldığı ve bunların sadece 30'unun (%2.6) tam olarak koruyucu özellikte olduğu görüldü. Sonuç: Pek çok pediatrik pelvis hastalığının tanısı için pelvik röntgenlerin gerekli ve vazgeçilmez olması göz önünde bulundurulduğunda, gonad koruyucuların kullanımı konusunda bu grafileri çeken teknik personelin daha iyi eğitilmesinin ve daha uygun koruyucu tasarımlarının geliştirilmesinin gerekli olduğunu düşünmekteyiz.Anahtar sözcükler: Gonad; çocuk; pelvis; radyasyon etkisi. Objectives:In this study, we evaluated the efficacy of using gonadal shielding in pediatric patients. Patients and methods: Between October 2011 and February 2012, 1137 pelvic X-rays of 675 consecutive patients (323 boys, 352 girls; mean age 6.8 years; range 6 month to 17 years) in our hospital were evaluated in terms of gonadal shielding use by a team including an orthopedist, a gynecologist and a pediatrician. Results: Gonadal shields were used in 566 (49.8%) pelvic X-rays of 1137 patients and important anatomical landmarks were left open in 506 (44.5%) of them. In 104 (9.1%) X-rays, the shields were placed in correct position. It was observed that a total of 293 (25.7%) X-rays were partially protective, while 109 (9.6%) X-rays were placed in a totally wrong position. Nineteen X-rays (3.3%) were repeated due to malposition of the gonadal shielding. In X-rays of boys, gonadal shields were used for 193 (17%); however only 74 (6.5%) of them were placed in correct position. In X-rays of girls, gonadal shields were used for 373 (32.8%); however only 30 (2.6%) of them were protective. Conclusion: If we take into consideration that use of pelvic X-rays is essential and indispensable for the diagnosis of many pediatric pelvic diseases, we believe that technicians who are responsible for taking these X-rays should be better trained on the use of gonadal shields and designs of gonadal shields should be improved.

Intrauterine devices (IUD) are frequently used as a family planning procedure in developing countries because they are easy to administer and governmental policies support their use in many countries. It is recommended that IUDs be removed or replaced after 10 years, but longer use is common, especially in developing countries. In some cases, rare infections such as pelvic inflammatory diseases, pelvic tuberculosis, or abdominopelvic actinomycosis related to IUD can develop. Pelvic actinomycosis is a rare disease and is often diagnosed incidentally during surgery. In recent years, there has been an increase in actinomycotic infections mostly due to long-term usage of IUD and forgotten intravaginal pessaries. It usually develops as an ascending infection. It is usually associated with non-specific symptoms such as lower abdominal pain, menstrual disturbances, fever, and vaginal discharge. The disease is sometimes asymptomatic. The rate of accurate preoperative diagnosis for pelvic actinomycosis is less than 10%, and symptoms and imaging studies sometimes mimic pelvic malignancy. This report details a case with abdominopelvic actinomycosis associated with an IUD presenting with highly elevated thromboctye count and small bowel perforation with abscess formation.

Study question Is there any effect of embryo migration on clinical pregnancy rate and live birth rate in fresh oocyte donation cycles? Summary answer Clinical pregnancy rate and live birth rate were not affected from embryo migration in any direction. What is known already Embryo transfer is the final crucial step to affect success rates and up to date there has been vast amount of studies to optimize embryo transfer for better implantation and increasing clinical pregnancy rate and live birth rate. Embryos are loaded on the catheter mostly in the order of air-embryo-air-medium. By doing so, we indirectly visualize embryo(s) via air bubbles and we rely on bubble position as a reflector of embryo position. In literature, there are no studies investigating whether there is any embryo migration after 60 minutes of embryo transfer and the effect of this migration on pregnancy outcomes. Study design, size, duration The study included fresh oocyte donation (OD) cycles of recipient women. In vitro fertilization (IVF) cycles, frozen-thawed embryo transfer cycles, cryopreserved-thawed OD cycles were excluded. Participants/materials, setting, methods The migration distance was assessed by ultrasound twice, one of them immediately after embryo transfer (ET) and the second one at 60th minutes of ET. All embryos were expulsed to 10-20 mm from the fundus. The first group consisted of patients whose embryos migrated towards fundus, second group with embryos remained between 10 and 20 mm from fundus and the third group including embryos migrated towards cervix. Three groups were compared for pregnancy outcomes. Main results and the role of chance A total of 611 fresh OD cycles were recruited in this study. At 60 minutes after ET; in 123 patients (20.1%) embryos were located nearer than 10 mm to the fundus (Group 1), in 476 patients (77.9%) embryos were located at same initial expulsed zone (Group 2) and in 12 patients (2%) embryos moved more away from fundal endometrium towards cervix (Group 3). In group1, there were 96 clinical pregnancies (CPR:78.0%) and 78 live births (LBR: 63.4%). In group 2, CPR and LBR were 72.1% (n = 343) and 66% (n = 314), respectively. In group 3, there were 8 clinical pregnancies (CPR:66.7%) and all had live birth (LBR:66.7%). There was no significant difference in terms of CPR and LBR between the groups. Limitations, reasons for caution Our study is the first to search the impact of embryo migration on live birth rate in fresh OD cycles with high number of patients. Although our population had sufficient number of participants with analyzing LBR; we believe prospective designed studies are required. Wider implications of the findings Our study reveals that the concept of embryo migration is a fact and almost 20% of embryos migrate, whether towards fundus or cervix. On the other hand, whether embryo stayed static or migrated, CPR and LBRs are high in freshOD cycles, independent from any possible migration. Trial registration number NCT044855669

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