The protective effect of letrozole in a rat ovarian ischemia-reperfusion injury model

INTRODUCTION: Torsion of the ovary is a surgical emergency. Future fertility is an important question for choosing the most appropriate treatment strategy as radical or conservative. Conservative treatment includes detorsion of the twisted ovary and after detorsion, the ischemic injury in ovary increases with reperfusion. During the detorsion process, abundant amounts of reactive oxygen species (ROS) are produced. ROS causes cellular injury by attacking cellular membranes through the peroxidation of polyunsaturated fatty acids and causing cellular death. Letrozole is a nonsteroid aromatase inhibitor that blocks estrogen production in all tissues, increases gonadotropin secretion and induces follicular development. METHODS: In this study, rats are divided into 5 groups including 8 rats in each group; control group, ischemia group, ischemia and letrozole group, ischemia-reperfusion group, ischemia-reperfusion and letrozole group. For each group Malondialdehyde (MDA) levels were measured, degree of ischemia and number of follicles were recorded by histopathological examination. Endometrial thicknesses were also measured. RESULTS: In the ischemia and ischemia-reperfusion groups, MDA levels and grade of ischemia were significantly decreased with letrozole. Ovarian follicle numbers were higher and endometrial thickness was lower in the letrozole used groups. DISCUSSION AND CONCLUSION: Letrozole can be protective on ovarian ischemia-reperfusion injury and this effect will be related to hypoestrogenic environment by inhibition of aromatase activity, antiinflammatory effects and increased blood flow to the ovary by letrozole

The effects of the association of placenta previa and placenta accreta on the short-term maternal morbidity

Objective: We aimed to compare the effects of placenta previa (PP) and placenta accreta (PA) on the short-term maternal morbidity alone and together. Methods: The data of the patients who were diagnosed with PP, PA or placenta previa accreta (PPA) which includes both of them between January 2010 and December 2018 in a tertiary reference center were analyzed retrospectively. The records of the patients were compared between 3 groups for age, gravida, parity, week of gestation, previous cesarean section, history of curettage and myomectomy, gestational complications, placental location, hospitalization at hospital and intensive care unit, decreased level of hemoglobin, blood product transfusions, procedures to control bleeding and complications. Results: Six out of 192 patients were excluded from the study as they delivered in other hospitals, and the data of 186 patients were analyzed. There were 141 (75.8%) patients with PP only, 9 (4.8%) patients with PA only, and 36 (19.4%) patients with PPA. The erythrocyte transfusion was significantly higher in PPA patients than PP patients (p<0.001). The possibility for the transfusion of any blood product was lower in PP group than other groups. While the rate of hospitalization at intensive care unit was higher in PPA group, the number of hospitalization day at hospital was significantly lower in PP group than PA (p=0.042) and PPA (p<0.001) groups. Urinary complication was observed less in PP patients. The hysterectomy rate was higher in PPA patients with than PP and PA patients (p=0.004). Conclusion: The rates of maternal morbidity and hysterectomy increase when PP and PA are together compared to the cases where they are alone

. Laparoscopic management of uterine prolapsus in a patient with ureteral kinking.

Objective: To show how uterine prolapsus in a patient with ureteral kinking could be safely managedwith a laparoscopic pectopexy.Design: Stepwise demonstration of the technique with narrated video footage.Setting: Anatomical support of the uterus is provided primarily by the pelvic diaphragm and thenby the cardinal and sacrouterine ligaments . Compression of the ureters due to uterine prolapse,and bilateral hydronephrosis is not a common clinical condition . Uterus-sparing procedures aims tocorrect apical prolapse by attaching the lower uterus or cervix to a support structure [1]. Advantagesof uterus-sparing prolapse correction techniques are a shorter operative time and less blood loss, butother advantages remains unproven. Laparoscopic pectopexy is an effective and alternative procedurefor women with pelvic organ prolapse. This promosing surgical technique cold be an alternativeto sacrocolpopexy procedure [2]. In this case report, we present the successful management oflaparoscopic pectopexy in a woman with ureteral kinking and hydronephrosis due to uterine prolapse.Interventions: Laparoscopic approach to an advanced pelvic organ prolapse with several keystrategies to maintain anatomic correction:1. Suspension of cervix uteri to pectineal ligament2. Vaginal evaluation of adequacy of the pectopexy3. Correction of ureteral kinkingConclusion: Advanced pelvic organ and bladder could be managed with laparoscopic conservative surgery.</p

Metastatic and synchronous ovarian involvement in low-risk endometrial cancer; clinicopathological analysis with detection of DNA mismatch repair deficiency

Objectives: This study aimed to investigate ovarian involvement in low-risk endometrial cancer, the associated risk factors, and impact on overall survival. We attempted to explore the differences in mismatch repair (MMR) deficiency between metastatic and synchronous ovarian tumoral involvement.Material and methods: This was a retrospective study of patients with low-risk endometrial cancer who were treated at a tertiary center between January 2006 and December 2019. The primary outcome measures were the incidence and risk factors associated with metastatic and synchronous tumoral involvement of the ovary. Overall, survival data were also analyzed. Metastatic and synchronous tumors were compared with each other in terms of MMR deficiency with IHC staining.Results: From a total of 360 low-risk endometrial cancer patients, 10 (2.8%) had ovarian metastasis and 12 (3.3%) had synchronous ovarian involvement. The median age of patients with metastasis was significantly lower than that of patients without ovarian involvement (49 vs 57 years, p = 0.004). Most patients in the metastatic group were in the &lt; 50 age group (p &lt; 0.001) and premenopausal period (p = 0.001). As a result of IHC staining performed on patients with ovarian involvement, MMR deficiency was found in six (60%) patients in the metastatic group and six (50%) patients in the synchronous group. No significant difference was found in overall survival between groups.Conclusions: Younger age and premenopausal status were risk factors associated with ovarian metastasis. Overall survival did not show differences between all groups, and MMR deficiency was similar between metastatic and synchronous groups

Tanısal laparoskopi sonuçları 8 yıllık deneyim

AMAÇ: Bu çalışmanın amacı kliniğimizde yapmış olduğumuz tanısal laparoskopi sonuçlarının değerlendirilmesidir. GEREÇ VE YÖNTEM: Haziran 2001 - Aralık 2008 tarihleri arasında kliniğimizde tanısal laparoskopi yapılan 93 hastanın kayıtları retrospektif olarak değerlendirildi. BULGULAR: Tanısal laparoskopi için en sık endikasyonlar sırasıyla infertilite (n=81, %87,1) ve kronik pelvik ağrıydı (n=12, %12,9). İnfertil hastaların 33.3’ünde (27/81) ve kronik pelvik ağrısı bulunan hastaların %58,3%’ünde (7/12) pelvik patoloji gözlenmiştir.Bütün vakalar içinde endometriosis ve adezyon görülme sıklığı sırasıyla %16,1 (n=15) ve %9,6’dı (n=9). SONUÇ: İnfertilite problemi ve kronik pelvik ağrısı bulunan has talarda tanısal laparoskopi sık kullanılmaktadır. Uzmanlık eğitim programlarına tanısal laparoskopinin dahil edilmesi klinik pratikte komplikasyon oranlarını düşürecektir.OBJECTIVE: The aim of this study was to evaluate the results of diagnostic laparoscopy examinations performed in our clinic. STUDY DESIGN: Hospital records of 93 patients, who had undergone diagnostic laparoscopy in our clinic between June 2001 and December 2008, were evaluated retrospectively. RESULTS: The most common indications for diagnostic laparoscopy were infertility (n=81, 87.1%) and chronic pelvic pain (n=12, 12.9%). Pelvic findings were noted in 33.3% (27/81) of infertile patients and 58.3% (7/12) of patients with chronic pelvic pain. The frequencies of endometriosis and adhesions were 16.1% (n=15) and 9.6% (n=9), respectively, among all cases. CONCLUSION: Diagnostic laparoscopy, used as the standard method for the assessment of patients with infertility and chronic pelvic pain, should be used more often in differential diagnosis. Inclusion of diagnostic laparoscopy in residency training programs would reduce the complication rates in future clinical practice

The Results of Diagnostic Laparoscopy Examinations - An 8 - Years Experience

OBJECTIVE: The aim of this study was to evaluate the results of diagnostic laparoscopy examinations performed in our clinic. STUDY DESIGN: Hospital records of 93 patients, who had undergone diagnostic laparoscopy in our clinic between June 2001 and December 2008, were evaluated retrospectively. RESULTS: The most common indications for diagnostic laparoscopy were infertility (n=81, 87.1%) and chronic pelvic pain (n=12, 12.9%). Pelvic findings were noted in 33.3% (27/81) of infertile patients and 58.3% (7/12) of patients with chronic pelvic pain. The frequencies of endometriosis and adhesions were 16.1% (n=15) and 9.6% (n=9), respectively, among all cases. CONCLUSION: Diagnostic laparoscopy, used as the standard method for the assessment of patients with infertility and chronic pelvic pain, should be used more often in differential diagnosis. Inclusion of diagnostic laparoscopy in residency training programs would reduce the complication rates in future clinical practice

Investigation of the relationship between umbilical cord morphometry and fetal and materyal parameters

Amaç: Kordon çapı ve boyu ile fetal ve maternal parametreler arasındaki ilişkiyi postpartum dönemde incelemek. Materyal ve Metod: Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Hastanesinde doğum yapmış 202 kadının maternal, plasental ve yenidoğana ait parametreleri, daha önceden hazırlanmış formlara doldurularak prospektif olarak incelendi. Bulgular: Maternal BMI ile kordon boyu arasında negatif korelasyon bulundu (p=0.045, r= -0.130). Umbilikal kord çapı yenidoğan boy, kilo, BMI ve göğüs çevresi ile pozitif korelasyon gösteriyordu. Umbilikal kord uzunluğu ile 5. dakika Apgar skoru arasında pozitif korelasyon vardı. Umbilikal kord uzunluğu plasenta santral kalınlığıyla pozitif korelasyon gösteriyordu. Umbilikal kord çapı tüm plasenta boyutları ve 5. dakika Apgar skoru ile pozitif korelasyon gösteriyordu. Umbilikal kord çapı ile uzunluğu arasında negatif korelasyon vardı (p=0.00, r=-0.227). Tüm istatistik sonuçları istatistiksel olarak anlamlı fakat zayıf korelasyon değerlerine sahiptir. Umbilikal kord morfolojisinin değerlendirilmesi önemlidir çünkü özellikle umbilikal kord çapındaki değişiklikler yenidoğan boyutlarını etkileyebilmektedir.Aim: To research the relationship between diameter and length of umbilical cord and fetal and maternal parameters, with respect to postpartum period. Materials and Methods: Maternal, placental and neonatal parameters of202 women who delivered singleton delivery was filled to forms prepared previously and researched prospectively. Findings: Negative correlation was determined between maternal BMI and umbilical cord length (p=0.045, r= -0.130). Diameter of umbilical cord showed positive correlation with weight, lenght, BMI and chest circumference of newborn. Positive correlation between umbilical cord length and 5. minute Apgar score was found. Umbilical cord length showed positive correlation with placental central thickness. Umbilical cord diameter showed positive correlation with all dimensions of placenta and 5. minute Apgar score. There was a negative correlation between umbilical cord diameter and umbilical cord length (p=0.00, r= -0.227). All test scores showed statistically significant but weak correlations with umbilical cord length and diameter. Evaluating of the umbilical cord morphometry is important because of changes in umbilical cord diameter may especially affect outcome of newborn