Tubal splenosis: unusual location of the spleen

İntroduction: Splenosis is defined as the autotransplantation of splenic tissue to abnormal locations after splenic injury. Heterotopic spleen can be found within the abdominal and pelvic cavities. We report a tubal splenosis case in a 48 year old woman who underwent splenectomy following a blunt trauma 41 years prior to presentation. Case report: A 48 years old gravida 3, para 3, was admitted to our gynecology clinic for pelvic pain, menstrual irregularities and abnormal bleeding. The patient had a six months history of sonographically detected 40 x 20 mm pelvic mass. She also had a blunt trauma and splenectomy history from 41 years ago. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Intraoperative exploration revealed a 40 mm sized suspicious mass immediately adjacent to the right fallopian tube. The histopathologic examination of the specimen reported normal splenic tissue with polymorphous small lymphocytes, granulocytes, and frequent hemosiderin laden macrophages. Discussion: Posttraumatic pelvic splenosis is a rare condition. Splenosis should be kept in mind as a differential diagnosis especially for patients with a history of posttraumatic splenectomy who are scheduled for pelvic mass surgery. Although most of the patients are diagnosed postoperatively, if preoperative diagnosis could be made, there is no medical indication for this normally functioning tissue to be resected

A case report of twin reversed arterial perfusion sequence with expectant management

Acardiac twin or TRAP (twin reversed arterial perfusion) sequence is a rare complication of monochorionic pregnancies. In these cases, the heart is either absent or non-functional. It’s controversial whether conservative management or therapeutic treatment is better in TRAP-sequence. In this case, we present a 19-years old, primigravida diagnosed with spontaneous monochorionic monoamniotic twin pregnancy at 7th week of gestation. One of the fetuses had a crown-rump length of 8 mm and fetal heart rate 122/minute while the other one had a crown-rump of 7 mm with no detected fetal heartbeat. At the 11th week of gestation, the acardiac twin continued growing despite the absence of the fetal heart beat and fetal extremities. The cranium could not be evaluated clearly. The diagnosis of TRAP sequence was confirmed by the reversed direction of flow observed in the umbilical artery. Since the patient and her husband did not want any intervention, no interventional diagnostic and treatment modalities were applied. Preterm labor started at the 32th week. Because the presentations were transverse and breech, pump and acardiac fetus, respectively, a cesarean delivery was performed. A healthy female baby, weighing 1650 gr with APGAR scores of 9-10, first and fifth minutes, respectively, was delivered along with the acardiac fetus which was 1550 gram in weight, fetal heart beat negative, with upper and lower extremity deformities. The uniqueness of the present case is that there was no significant difference in the weight of both twins. The acardiac twin was as large as the pump twin. Except for twenty days hospitalization because of neonatal respiratory distress syndrome, which was a consequence of preterm labor, there were no problems with the pump twin even though managed conservatively. In monochorionic twin pregnancies, when one of the twins is found to be fetal heartbeat negative and it continues to grow with concomitant structural abnormalities, the TRAP sequence should come to mind. If the acardiac fetus is small and the pump fetus has no complications, the conservative approach can be considered. Our goal should be to deliver the pump twin with minimal complications. To achieve this, follow-ups and treatment should be individualized for each patient, the pump fetus should be monitored closely

Morbidly adherent placenta and cesarean section methods. A retrospective comparative multicentric study on two different skin and uterine incision

Objectives: Morbidly adherent placenta (MAP) is one of leading causes of maternal mortality, with an increasing rate because of repeated cesarean sections (CS). The primary objective of this study is to compare two techniques of skin and uterine incisions in patients with MAP, evaluating the maternal fetal impact of the two methods. Retrospective multicentric cohort study.Material and methods: A total of 116 women with MAP diagnosis were enrolled and divided in two groups. Group one, comprised of 81 patients, abdominal entry was performed by Pfannenstiel skin incision plus an upper transverse lower uterine segment (LUS) incision (transverse-transverse), which was 2–3 cm above the MAP border, with the uterus in the abdomen. In group two, comprised of 35 patients, abdominal entry was performed by an infra-umbilical midline abdominal incision, by vertical-vertical technique, and the pregnant uterus was incised by a midline incision (vertical) from the fundus till the border of the MAP. Total surgery time, blood loss, blood product consumption, total hospital stay, cosmetic outcomes, and postoperative complications were investigated.Results: Total time of surgery was significantly shorter in group 1 (p < 0.05). Intraoperative blood loss was higher in group 2. Difference between preoperative and postoperative Hb and Htc levels were 3.30 ± 1.04 and 12.99 ± 5.07 respectively (p = 0.012; p = 0.033). The use of erythrocyte suspension (ES), fresh frozen plasma (FFP), and cryoprecipitate and thrombocyte suspension (TS) were found to be significantly lower in patients of group 1than vertical-vertical group (p = 0.008, p = 0.009, p = 0.001, p = 0.001, respectively). There was no difference in terms of total length of hospital stay between groups.Conclusions: In a subgroup of patients diagnosed for MAP, the transverse-transverse incision resulted in less bleeding, less blood and blood product use, and had better cosmetic results than vertical-vertical incision. Moreover, the total time of surgery, crucial for MAP patients, seems to be shorter also in transverse-transverse incision than in vertical-vertical incision

Diagnosis of genital tuberculosis on menstrual blood during infertility explorations

[Abstract Not Available]WOS:000682779400041PubMed: 3409073

Iron deficiency anemia in adolescent pregnancy: investigation of its effects and the related factors

Introduction: Adolescent pregnancies and their maternal and fetal complications are a global health burden. Iron deficiency anemia is among the factors, which might contribute to these negative consequences. In this study, we aimed to evaluate the frequency of iron deficiency anemia among pregnant adolescents followed at the Düzce University Medical Faculty Hospital and to investigate its maternal and fetal effects. Methods: A total of 122 pregnant women under 19 years of age were included in this case-control study. The socio-economic characteristics, hematological status, and adverse maternal and perinatal outcomes possibly related to iron deficiency anemia were evaluated.Results: The incidence of anemia among the studied women was 29.5%, and 56.5% were receiving iron supplementation. Oral iron supplementation rate was 33.3% in the anemic group and 66.2% in the non-anemic group (p = 0.01). While the serum ferritin and hemoglobin levels were lower in the anemic group, iron binding capacity was lower in the non-anemic group, and the difference between the groups was statistically significant (p = 0.01, p = 0.01, and p = 0.02; respectively). Concerning adverse perinatal outcomes, preeclampsia was seen in 11.4% of the anemic group and 4.6% in the non-anemic group; the difference was statistically significant (p = 0.01). Conclusions: Iron deficiency anemia is a common problem in adolescent pregnancy. However, many anemic pregnant adolescents do not receive iron treatment. Positive effects on some maternal and perinatal outcomes can be achieved by administering iron supplementation to these women. Iron use should be increased to combat iron deficiency anemia during pregnancy

Evaluation of Effectiveness of Laser Assisted Hatching Pregnancy Rates on Fresh IVF / ICSI Cycles

Objectives: To investigate the effects of laser assisted hatching (LAHA) implantation rates, clinical pregnancies, and live births of the patients enrolled in a fresh in vitro fertilization and intracytoplasmic sperm injection-embryo transfer (IVF/ICSE-ET) program. Material and Methods: A total of 315 patients who underwent at least two unsuccessful ETs or had a baseline follicle-stimulating hormone (FSH) level of >= 10 mIU/mL and who underwent IVF/ICSE-ET at IVF Center. The patients were divided into two groups: patient group (n=100) who underwent LAHA and control group (n=215) who did not. The beta human chorionic gonadotropin (I3hCG) positivity, clinical pregnancies, and live births of both groups were compared. Results: There was no significant difference in the clinical pregnancy and implantation rates between the groups including those with an advanced maternal age or recurrent implantation failure. In the patients with elevated FSH levels (FSH >= 10 mIU/mL), these rates were significantly lower in the study group, compared to the control group. Conclusion: Our study results show that laser assisted hatching does not improve the biochemical, clinical, and take home baby rates in IVF / ICSI - ET patients.WOS:0005731050000012-s2.0-8509185329

PROOF OF CONCEPT OF A TREATMENT FOR HUMAN OOCYTE MATURATION ARREST;TRANSVAGINAL OVARIAN NEEDLE INJURY PRECEEDING LETROZOLE PRIMING IN VITRO MATURATION

76th Scientific Congress of the American-Society-for-Reproductive-Medicine -- OCT 17-21, 2020 -- ELECTR NETWORK[Abstract Not Available]Amer Soc Reprod MedWOS:00057935530153

Does Uterine Manipulator Type Affect Surgical Outcomes of Laparoscopic Hysterectomy?

Objectives: Many surgeons use uterine manipulator (UM) during laparoscopic hysterectomy (LH). In this study, we aimed to compare the outcomes of LH operations performed by using partially reusable UM with the articulated system (artUM) and disposable (dUM) UM without articulation. Materials and Methods: A total of 99 patients underwent the LH operation. This study was carried out with 35 of those 99 Caucasian patients who met the inclusion criteria. Group 1 consisted for 7 LH operations using the articulated RUMI (R) II/KOH-Efficient (TM) (Cooper Surgical, Trumbull, CT, USA) system (artUM), while Group II consisted of 28 patients using old-type V Care (R) (ConMed Endosurgery, Utica, New York, USA) dUM as UM. Results: Mean operation time was found to be 157.1 +/- 42.0 min. The operation time was found statistically longer in Group 1, consisted of artUM used patients (P = 0.006 and P < 0.05). No statistically significant difference was found between two groups in terms of surgical results such as, delta hemoglobin value (P = 0.483 and P < 0.05), length of hospital stay (P = 0.138 and P < 0.05), and postoperative maximum body temperature (P = 0.724 and P < 0.05). Conclusion: The UM type did not alter the surgical outcomes except the operating time in our study. According to our results, the surgical technique is a more significant variable than instruments used in LH for normal size uterus. Further prospective, large-scale studies comparing various UM systems are mandatory.WOS:0006138361000032-s2.0-85100533544PubMed: 3374776

Relationship between adnexal mass and endometrial thickness in postmenopausal period

Endometrial cancer is the most common gynecological cancer. Increased postmenopausal endometrial thickness may be an indicator of endometrial cancer. Transvaginal ultrasound (TV-USG) is the primary imaging method for evaluating endometrial thickness in the postmenopausal period. The aim was to employ transvaginal ultrasonography in the evaluation of adnexal masses synchronously seen in postmenopausal women with increased endometrial thickness. The work was designed as a retrospective study. The medical records of 155 patients evaluated for increased postmenopausal endometrial thickness were examined. Ultrasonography had been performed on the women in the study for routine follow-up, postmenopausal hemorrhage, pelvic pain, pelvic mass on examination and family history of gynecological cancer. All patients had undergone endometrial evaluation with fractional dilatation and curettage (D & C) or pipelle endometrial sampling. Histopathological diagnosis was based on endometrial sampling results. Adnexal mass was present simultaneously in 17.4% (n = 27) of the women included in the study, while 82.6% (n = 128) had no gynecological pathology other than increased endometrial thickness. The endometrial thickness in the women with postmenopausal adnexal masses was greater than in those without adnexal mass (11.7 mm vs. 7.8 mm, p = 0.009). Non-atypical and atypical endometrial hyperplasia was more frequent in the group with postmenopausal adnexal mass (11.1% vs. 2.8%, 11.1% vs. 3.79, p = 0.03, p = 0.04, respectively). Final histopathological evaluation of patients operated on for adnexal masses revealed tubo-ovarian abscess in 1.9% (n = 1), benign ovarian tumor in 25.9% (n = 7) and malignant ovarian tumor in 11.1% (n = 3) of the patients. In postmenopausal women, adnexal masses can be seen simultaneously with increased endometrial thickness. In this regard, transvaginal ultrasound offers important opportunities for evaluation of both the endometrium and adnexa. Pre-surgery transvaginal ultrasound as well as multivariate serum markers may be used in evaluation models. [Med-Science 2018; 7(4.000): 848-51

In vitro maturation with letrozole priming: Can it be a solution for patients with cancerophobia? A pilot study

Objective: To investigate whether letrozole priming could be used efficiently in patients undergoing in vitro maturation (IVM) as compared with follicle-stimulating hormone (FSH) priming. Materials and Methods: This is a retrospective analysis of 63 patients who underwent IVM due to the high risk of Ovarian Hyperstimulation syndrome (OHSS) (n=39), cancerophobia (n=16), and desire for IVM after failed in vitro fertilization attempts (n=8). Forty-two patients received FSH priming and 21 patients received letrozole priming. Results: The patients who had FSH or letrozole priming were statistically similar with respect to age, body mass index, duration of infertility, basal antral follicle count, serum anti-Mullerian hormone levels, and IVM indications (p>0.05 for all). When compared with the FSH priming group, the number of germinal vesicle oocytes, metaphase 11 and fertilized oocytes were significantly higher (p=0.003, p=0.001, and p=0.016, respectively), but the number of metaphase I oocytes was significantly lower in the letrozole priming group (p=0.002). The patients who received FSH and letrozole priming had statistically similar rates of implantation (33.3% vs 37.0%, p=0.709), clinical pregnancy (31.5% vs 33.3%, p=0.848), twinning (1.9% vs 3.7%, p=0.611), and live birth (24.1% vs 29.6%, p=0.682). Conclusion: Potential indications for IVM include patients with increased risk for OHSS and contraindication for hyperestrogenism. Aromatase inhibitors can be used to preserve the fertility of patients with estrogen-sensitive cancers. Letrozole priming appears to be an efficient approach in patients who undergo IVM, with likely less cost than FSH priming.WOS:0005981573000032-s2.0-85109864641PubMed: 3334397