Olgu Sunumu: Vulva’nın saplı, dev, agresif anjiyomiksomu

Agresif anjiyomiksom, hemen daima reprodüktif dönemde ortaya çıkan, kadın pelvik yumuşak dokularının nadir görülen ve yavaş gelişen neoplazisidir. Malign değildir ancak lokal agresif olup çoğunlukla nükseder. Yanlış tanı sıktır. Tedavide geniş eksizyon tercih edilir ancak gereksiz morbiditeye yol açmadan nüksü önleyecek derecede ekstirpasyon yapılmalıdır. 45 yaşında, sağ labium majör’den köken almış, hastanın yürümesinde güçlük yaratan, ağrısız olguyu sunuyoruz. Rezeke edilen tümör 4210 gr tartıldı. Cerrahi işlemin ayrıntıları sunuldu. Tanı mikroskopi ve immünokimya ile konuldu. Perine, vulva veya alt pelvis kaynaklı, iyi sınırlı kitlesi olan bir genç kadında, nadir olmasına rağmen anjiyomiksom düşünülmelidir.Aggressive angiomyxoma is a rare, slow-growing neoplasm of female pelvic soft tissues occurring almost exclusively in women of reproductive age. It is non-malignant but can be locally aggressive and frequently recurs. Misdiagnosis is frequent. Wide excision is the preferred method of treatment but the challenge is to perform the degree of extirpation necessary to prevent recurrence without causing unnecessary morbidity. We present a case of a 45-year-old woman who presented with a non-painful mass in the right labium majus which was causing her difficulty in walking. The resected tumour weighed 4210 g. Details of the operative procedure are given. Diagnosis was by microscopy and immunochemistry. Though rare, aggressive angiomyxoma should be considered in any young woman presenting with a well-defined mass arising from the perineum, vulva or lower pelvis

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

Herlyn-Werner-Wunderlich Sendromu (uterus didelphys, kör hemivajen ve ipsilateral renal agenezi) – vaka sunumu

Kör hemivajen ile beraber olan uterovajinal duplikasyon ve ipsilateral renal agenezi Herlyn-Werner-Wunderlich (HWW) Sendromu olarak tanımlanır. 17 yaşındaki hasta; 13 yaşında gördüğü ilk adetinden itibaren olan ve son bir yılda şiddeti artan sağ kasık ağrısı ve dismenore şikayetleri ile acil servise başvurdu. Ultrasonda; sağ pelvik kitle (5x5 cm), çifte endometrial eko ve hematokolpos tespit edildi. Yapılan magnetik rezonans görüntülemesi ve intravenöz pyelografisinde; sağ pelvik kitle, sağ böbrek agenezi, çifte uterus, ve hematokolposla beraber olan kör hemivajen tespit edildi. Yapılan diagnostik laparoskopide; kalın yapışıklıklarla olan sağ tubaovaryen abse ve çift uterus tespit edildi. Abse drene edildi ve yapışıklıklar açıldı. Hastaya antibiyotik tedavisi verildikten sonra tekrar opere edildi ve vajinal septum eksize edilerek pyokolpos drene edildi. Hastanın takiplerinde herhangi bir şikayeti olmadı. Bu sendromun erken ve doğru tespit ve tedavisi, bu problemi yaşayan hastaların refahını belirgin olarak artırabilir ve yaşanabilecek komplikasyonları engelleyebilir.Uterovaginal duplication with obstructed hemivagina and ipsilateral renal agenesis is referred to as the Herlyn-Werner-Wunderlich (HWW) syndrome. A 17 year old woman presented with right pelvic pain and dysmenorrhea, present since menarche at 13 and worsening over the past year. Ultrasound examination revealed a right pelvic mass (5x5 cm), double endometrial echoes, and hematocolpos. A right pelvic mass, agenesis of the right kidney, double uterus, and blind hemivagina with hematocolpos were detected by magnetic resonance imaging and intravenous pyelography. A right tubo-ovarian abscess with dense adhesions and a double uterus were observed on diagnostic laparoscopy. Adhesiolysis was carried out and purulent material irrigated. After a course of antibiotics, a vaginal septum resection was performed and the pyocolpos drained. She remained symptom free after four months of follow-up. Prompt and accurate diagnosis and treatment of this syndrome can significantly improve the lives of sufferers and prevent future complications

Deneysel endometriozis tedavisinde farklı immünomodülatör ajanların etkinliği

Amaç: Deneysel peritoneal endometriozis oluşturulan ratlarda, levamizol, interferon alfa-2b ve löprolidin, peritoneal implantlara etkilerini araştırmayı amaçladık. Gereç ve Yöntemler: Vernon ve Wilson yöntemi ile 48 ratta peritoneal endometriozis oluşturuldu. Bu işlemden dört hafta sonra peritoneal implantlar histopatolojik olarak değerlendirildi ve ratlar dört gruba ayrıldı: a) birinci kontrol grubundakilere tek doz %0.9 salin solüsyonu, 1 ml, intraperitoneal; b) ikinci gruptakilere tek doz löprolid asetat, 1 mg/rat, intramüsküler; c) üçüncü gruptakilere tek doz interferon alfa-2b, 100.000 U, intraperitoneal ve son olarak d) dördüncü gruptakilere üç gün boyunca levamizol, 2 mg/rat, intraperitoneal, üç günlük aralarla altı hafta süreyle verildi. Ratlar altı haftalık ilaç uygulamaları sonunda sakrifiye edildiler. Endometriotik implantlar makroskopik ve histopatolojik olarak değerlendirildi. Mikroskopik değerlendirmeler, implantların bez ve stromalarının atrofilerine göre normal, hafif ve şiddetli atrofiye karşılık gelecek şekilde sırasıyla (+), (+ +) ve (+ + +) olarak skorlandı. Sonuçlar SPSS 10.0 paket programı kullanılarak, ?2 testi ile değerlendirildi. p0.05). Sonuç: Endometriozisin patogenezinde immünolojik faktörlerin rol oynadığına dair güçlü kanıt vardır. Tedavide immünomodülatör ilaçlardan fayda beklenebilir. Bu grup ilaçlardan interferon alfa-2b etkiliyken, levamizol etkisizdir. İleri çalışmalar bu hastalığı anlamaya yarayacak ve tedavisinde farklı immünomodülatör ajanların etkinliğini belirleyecektir.Objective: : We aimed to investigate the effects of levamisole, interferon alpha-2b and leuprolide on peritoneal implants in experimentally induced peritoneal endometriosis in rats. Material and Methods: Peritoneal endometriosis was induced in 48 rats by Vernon and Wilson’s method. Four weeks after this procedure, peritoneal implants were evaluated histopathologically, and rats were randomized to four groups treated respectively with: a) a single 1 mL intraperitoneal dose of 0.9% saline solution (control group); b) a single 1 mg intramuscular dose of leuprolide acetate; c) interferon alpha-2b, 100.000 U intraperitoneally; d) levamisole 2 mg intraperitoneally for 3 days, then 3 days rest, and continuing in this fashion over 6 weeks. Rats were sacrificed six weeks after the initiation of treatment, and endometriotic implants were evaluated macroscopically and histopathologically. Microscopic evaluations were scored as (+), (++), (+++) corresponding respectively to normal, mild or severe atrophy of the glands and stromas. Results were evaluated with chi-square test by SPSS 10.0 package program. A value of p 0.05). Conclusions: There is substantial evidence that immunologic factors play a role in the pathogenesis of endometriosis, and it could be expected that immunomodulator agents would be useful in its treatment. In this group of agents, interferon alpha-2b was effective, but levamisole was ineffective. Further studies will certainly bring more insight into this disease and will determine the effectiveness of different immunomodulator agents in its treatment

Obez ve obez olmayan postmenopozal hastalarda serum androjen seviyeleri ve endometrial kalınlığın karşılaştırılması

Amaç: Bu çalışmamızda, endometrial kalınlık ve serum androjen seviyelerinin obez ve obez olmayan hastalardaki farklılığı araştırılmıştır. Gereç ve Yöntemler: 32 obez olmayan (BMI5 mm had significant pathology. Conclusion: These results suggest that obesity may be a risk factor for endometrial carcinoma and other pathologies in post-menopausal women through an action on androgen concentrations

Accuracy of the 24-h urine protein excretion value in patients with preeclampsia: correlation with instant and 24-h urine protein/creatinine and albumin/creatinine ratios

The aim of this study was to determine the accuracy of the 24-h urine collection in preeclamptic pregnant women. This study included 65 singletons with preeclampsia and 53 singleton patients in a control-matched group. The ratio of inaccurate 24-h urine collection was measured by calculating expected urine creatinine excretion according to the proportion of pre-pregnancy weight and the lean body mass (LBM) of the patients. Comparisons were made between the accurately-collected 24-h urine protein excretion rates and the instant and 24-h urine protein/creatinine (P/Cr) and albumin/creatinine (A/Cr) ratios. Twenty-four-hour urine collection used to diagnose patients with preeclampsia was incorrectly collected 15–73.5% of the time among the patients and the control group. Instant and 24-h urine P/Cr and A/Cr ratios were correlated with total 24-h proteinuria among the patients in whom urine was collected correctly. Considering the 24-h urine P/Cr ratio, rather than the 24-h urine protein excretion value, is a better way to diagnose preeclampsia.IMPACT STATEMENT What is already known on this subject? Twenty-four-hour urine collection is considered as the gold standard of diagnosing proteinuria in preeclampsia, in case of the correctly collected. What do the results of this study add? Generally, in the literature the correctness of 24-h proteinuria is not questioned. However, it is actually quite important in daily practice to make the correct diagnosis of the proteinuria not to misdiagnose preeclampsia. What are the implications of these findings for clinical practice and/or further research? In this article, we aimed to show the importance of accurately collected 24-h urine in preeclampsia. We consider and advise to change the gold standard of this technique to 24-h protein/creatinine (P/Cr) ratio, in order to make correct diagnosis of the preeclampsia

What are the probable predictors of urinary incontinence during pregnancy?

Objectives. The frequency, predisposing factors and impact of urinary incontinence (UI) on quality of life (QoL) during pregnancy were investigated. Materials and Method. A preliminary cross-sectional survey was studied among pregnant women between January and July of 2014. A total of 132 pregnant women were recruited using a questionnaire form for sociodemographic features, the Turkish version of the International Consultation on Incontinence-Short Form (ICIQ-SF), for the characteristics of UI and Wagner’s Quality of Life scale to assess impact on QoL. p < 0.05 was set significant. Results.Urinary incontinence was present in 56 out of 132 pregnant women (42.4%, UI-present group): mean age, 26.7 ± 5.4y(p = 0.780); median height, 160 cm (min–max: 153–176, p = 0.037); median BMI, 28.7 kg/m2(min–max: 22.4–50.0, p = 0.881); urine leakage occurred per week once (n = 18, 32.1%), twice or thrice (n = 8, 14.3%); per day few times (n = 14, 25%), once (n = 5, 8.9%) and always (n = 8, 14.3%) with mainly a small amount of urine leakage (n = 33, 58.9%) or a moderate (n = 4, 7.1%). There were statistically significant relationships between QoL scores and frequency of UI (p = 0.002) or amount of leakage (p = 0.002). Impact on QoL scores ranged from mild (n = 33, 58.9%), moderate (n = 4, 7.1%) to severe (n = 4, 7.1%) levels in daily life. UI impacted the daily life activities of women by making them less likely to undertake activities outside their homes (23.2%), by affecting their working performance and friendships (8.9%), their daily home activities (7.1%), their general health status (12.5%), their sexual relations (12.5%), by making them more nervous or anxious (10.7%) and by the need to wear pads or protectors (25%). ANOVA, Tukey, and Tamhane tests as the minimal important difference model yielded significant relevance between statistical analyses and clinical outcomes by using standard deviations (p = 0.001, 0.001 and 0.005 respectively). The following features favored the occurence of UI: Age (OR = 0.845, 95% CI [0.268–2.669]), being a housewife (OR = 1.800, 95% CI [0.850–3.810]), anemia (OR = 0.939, 95% CI [0.464–1.901]), parity (OR = 0.519, 95% CI [0.325–0.829]), miscarriage (OR = 1.219, 95% CI [0.588–2.825]) and living in rural areas (OR = 1.800, 95% CI [0.887–3.653]). Height (p = 0, 037), educational status (0.016), miscarriage (0.002), parity (0.006) and place of living (0.020) were significant factors. Conclusions.Many pregnant women are suffering from UI, which warrants a significant public health consideration in the region. Age, height, being a housewife or graduation level higher than primary school, living in rural, parity, miscarriage, and anemia were the factors in favor of the onset of UI. The authors plan a health promotion program in the region according to the results in order to provide information to health caregivers, especially family physicians, and to educate women about the predictors of UI and pelvic floor exercises for primary prevention and secondary relief of UI during and after pregnancy and provide some hygienic supplies to the poor in this aspect

Prevalence of cervical cytological abnormalities in Turkey

Objective: To evaluate retrospectively the prevalence of cervical cytological abnormalities in patient records obtained from healthcare centers in Turkey. Method: Demographic characteristics and data on cervical cytological abnormalities were evaluated from patients who underwent flap tests in healthcare centers in 2007. Results: Data were collected from 33 healthcare centers totaling 140 334 patients. Overall, the prevalence of cervical cytological abnormalities was 1.8%; the prevalence of ASCUS, ASC-H, LSIL, HSIL, and AGC was 1.07%, 0.07%, 0.3%, 0.17%, and 0.08%, respectively. The prevalence of preinvasive cervical neoplasia was 1.7% and the prevalence of cytologically diagnosed invasive neoplasia was 0.06%. Conclusion: The abnormal cervical cytological prevalence rate in Turkey is lower than in Europe and North America. This might be due to sociocultural differences, lack of population-based screening programs, or a lower HPV prevalence rate in Turkey