Management of adnexal torsion

Objective: To evaluate clinical findings, operative reports, the pathological results of patients with diagnosis of adnexal torsion. Methods: Fourteen patients with diagnosis of adnexal torsion who presented to our clinic between January 2009 and March 2013 were included in this retrospective analysis. Data including clinical findings, operative reports, the pathological results were recorded. Results: The mean age of the patients was 28.1 ± 10.5 with a range of 16 to 52 years. All patients underwent ultrasonography, and a pelvic mass appearance was detected in all cases. The mean diameter of the mass was 8,04±2,96 cm. All of the patients had lower abdominal pain, nausea and vomiting. Six patients were operated laparoscopically, while eight patients had laparotomy. Detorsion and cystectomy was performed in 7 (50.0%) of the patients. Two of patients were pregnant in operation time that treated by cystectomy and detorsion of the ovaries successfully in the first and third trimester (one by laparoscopy). There was one patient of isolated fallopian tube torsion due to hydrosalpinks treated by laparoscopic salpingectomy. Two of the patients had paratubal cyst and tubal torsion. Detorsion and cystectomy by laparoscopy and salpingectomy by laparotomy were performed for these patients respectively. The most common histopathology was serous cystadenoma (28,6%). Conclusion: Adnexal torsion is a rare gynecologic emergency of women and occur in reproductive ages mostly. Prompt diagnosis and conservative treatment is important for the safety of ovaries and fallopian tubes and future fertility. J Clin Exp Invest 2014; 5 (1): 7-1

İlk Trimester ve 24-28. Haftada Gestasyonel Diyabeti Olan ve Olmayan Hastalarda Ykl-40 Düzeyinin Karşılatırılması: Araştırma Makalesi

Objective: To elucidate whether the YKL-40 level in the first trimester is effective in predicting the development of diabetes in pregnant groups with and without gestational diabetes mellitus. Methods: All first-trimester pregnant cases between the ages of 18 – 35 years who applied to the obstetrics and gynecology outpatient clinic of Antalya Training and Research Hospital with a single pregnancy, who did not have additional diseases and fetal anomalies, were included in the study (n=250). An oral glucose tolerance test of 75 gr (OGTT) was performed weekly to diagnose GDM in all pregnant women 24 – 28. During the administration of OGTT, fasting venous blood was taken to check the level of YKL-40. Results: A total of 250 patients have been enrolled within the scope of this study. According to the results of OGTT, 18 individuals were diagnosed with GDM. Notably, while there was a difference in YKL-40 measurements in all patients, buts no difference in sub-group analysis. The differences between the first YKL-40, second YKL-40, and YKL-40 difference values of patients with and without GDM were evaluated. There was no statistically significant difference between the first, second, and YKL-40 difference values of patients with and without GDM (p>0.05). Conclusion: Regarding the results of this research, YKL-40 might be valuable in detecting low-grade inflammation in pregnant women. However, there is a need for larger-scale prospective randomized studies from the early period to the end of pregnancy to better and more accurately evaluate the relationship between insulin resistance and inflammation.Amaç: Gestasyonel diabetes mellitusu( GDM) olan ve olmayan gebe gruplarında ilk trimesterdeki YKL-40 düzeyinin diyabet gelişimini öngörmede etkili olup olmadığını aydınlatmayı amaçladık. Yöntem: Antalya Eğitim ve Araştırma Hastanesi kadın hastalıkları ve doğum polikliniğine tekil gebeliği bulunan, ek hastalığı ve fetal anomalisi olmayan 18 – 35 yaş arası tüm birinci trimester gebeleri çalışmaya alındı (n=250). GDM tanısı koymak  için 24 – 28 haftalık gebelere 75 gr oral glukoz tolerans testi (OGTT)  yapıldı. OGTT uygulaması sırasında, YKL-40 seviyesini kontrol etmek için açlık venöz kanı alındı. Bulgular: Bu çalışma kapsamında toplam 250 hasta çalışmaya alındı. OGTT sonuçlarına göre 18 kişiye gestasyonel diabetes mellitus tanısı konuldu. Trigliserid değerleri farklıydı (p<0.05); her iki grup da ikinci trimesterde artmış seviyeler gösterdi. Özellikle, tüm hastalarda YKL-40 ölçümlerinde bir fark varken, alt grup analizinde fark bulunamadı. GDM’u olan ve olmayan hastaların birinci YKL-40, ikinci YKL-40 ve YKL-40 değerleri arasındaki istatistiksel olarak anlamlı fark saptanmadı (p>0.05).  İkinci trimesterde trigliserit ve YKL-40 ölçümlerinde birinci trimestere göre artış gözlendi (p<0.05). Sonuç: Bu araştırmanın sonuçları, YKL-40’ın düşük dereceli inflamasyonun saptanmasında değerli bir biyobelirteç olacağıdır. Bununla birlikte, insülin direnci ile inflamasyon arasındaki ilişkiyi daha iyi ve daha doğru bir şekilde değerlendirmek için erken dönemden gebeliğin sonuna kadar daha büyük ölçekli prospektif randomize çalışmalara ihtiyaç vardır

Safety of clomiphene citrate: a literature review.

Clomiphene citrate (CC) is a nonsteroidal compound and induces ovulation indirectly. The wide usage of the CC raises a question; is it safe or not? In the light of this question, this review aimed to highlight all researches and insights into the association between the use of CC and risk of genotoxicity, cytotoxicity, embryotoxicity, teratogenicity and risk of different cancer types. We conducted a MEDLINE/PubMed, Scopus, Web of Science, Google Scholar search. After a careful screening process of all authors, 32 of these articles were considered as appropriate, and reviewed. Our evaluations showed that CC has genotoxic, cytotoxic, embryotoxic and teratogenic properties. There is no association between the use of CC and risk of ovarian, breast, uterine, cervix, endometrium, lung, colorectal cancer, and lymphoma. However, risk increased especially after 6 cycles of use and especially in nulligravid women. The use of CC should be restricted to 6 cycles. Moreover, malignant melanoma and thyroid cancer risk was found to be higher among CC treated women in almost all studies. Further works should be conducted especially in animal models to assess its risk features

Effect of reproductive characteristics, body mass index, and anterior/posterior vaginal compartment defects on the short-term success of abdominal sacrocolpopexy

WOS: 000369867400017PubMed: 25356618Objective. Vaginal vault prolapse is caused by the loss of apical support in the cardinal-uterosacral ligament complex. Abdominal sacrocolpopexy (ASCP) is one means of repairing vaginal vault prolapse. In the present study, we investigated the effects of reproductive factors, body mass index (BMI), and anterior or posterior vaginal compartment defects on short-term outcomes of ASCP. Method. We retrospectively studied 70 women who had undergone ASCP between February 2012 and November 2012 in our clinic. Result. There were no significant differences in the complication rate among menopausal, nonmenopausal women, and grand multiparous patients. Operational success was not significantly affected by menopausal status. The long-term rate of grade >= 2 prolapse in the apical, anterior, or posterior vaginal wall after ASCP did not differ significantly by menopausal status. Correlation analysis showed that BMI was not associated with operational success in the early postoperative period in patients with vaginal prolapse and was not associated with the detection of grade >= 2 prolapse in apical, anterior, and posterior compartments after 1 year. Conclusion. ASCP should be the first-line treatment for obese/overweight, menopausal, or grand multiparous patients with additional anterior or posterior vaginal vault prolapse

Safety of clomiphene citrate: a literature review

Clomiphene citrate (CC) is a nonsteroidal compound and induces ovulation indirectly. The wide usage of the CC raises a question; is it safe or not? In the light of this question, this review aimed to highlight all researches and insights into the association between the use of CC and risk of genotoxicity, cytotoxicity, embryotoxicity, teratogenicity and risk of different cancer types. We conducted a MEDLINE/PubMed, Scopus, Web of Science, Google Scholar search. After a careful screening process of all authors, 32 of these articles were considered as appropriate, and reviewed. Our evaluations showed that CC has genotoxic, cytotoxic, embryotoxic and teratogenic properties. There is no association between the use of CC and risk of ovarian, breast, uterine, cervix, endometrium, lung, colorectal cancer, and lymphoma. However, risk increased especially after 6 cycles of use and especially in nulligravid women. The use of CC should be restricted to 6 cycles. Moreover, malignant melanoma and thyroid cancer risk was found to be higher among CC treated women in almost all studies. Further works should be conducted especially in animal models to assess its risk features