Comparison of the effectiveness of topical silicone gel and corticosteroid cream on the pfannenstiel scar prevention — a randomized controlled trial

  Objectives: To compare the effects of topical silicone gel and corticosteroid cream for preventing hypertrophic scar and keloid formation following Pfannenstiel incisions. Material and methods: Fifty patients operated for benign gynecological diseases through primary Pfannenstiel incision were included. The wounds were randomly allocated to the treatment and control arms. In the treatment arm, the wounds were divided into two halves; one was treated with silicone gel and the other with methylprednisolone cream. No treat­ment was administered to the control group. Scars using the modified Vancouver Scar Scale (MVSS), patient satisfaction, and side effects were evaluated before and after (3rd month when treatment discontinued and 6th month) the treatment. Results: Thirty-nine patients (21 patients in the treatment group and 18 patients in the control group) completed the stu­dy. Intragroup comparisons of the 3rd month and 6th month scores of the MVSS revealed that the scores of all parameters (height, pigmentation, vascularity, pliability, and total MVSS score) significantly decreased at the 6th month evaluation as compared with the 3rd month evaluation in all groups (control, silicone, and methylprednisolone groups). Multiple group comparisons at the 6th month revealed that the most prominent improvements occurred in the methylprednisolone group in all MVSS parameters as compared with the control group and in the height, vascularity, and pigmentation parameters as compared with the silicone group. No side effects were experienced by the patients with either treatment and patient satisfaction was higher in the methylprednisolone group. Conclusion: The use of topical methylprednisolone cream in fresh wounds at the postoperative early period appears to be promising

Laparoscopic Sacral Uteropexy with Cravat Technique--Experience and Results

Objective The aim of the present study was to evaluate the safety and efficacy of a “Cravat’’ technique for the management of uterine prolapse in patients who want to preserve uterus, involving suspension of the uterus from the sacral promontory by using polypropylene mesh. Materials and Methods A prospective observational study between January 2011 and September 2013 was conducted. Prior to surgery, prolapse assessment was undertaken with Baden-Walker halfway system to grade the degree of prolapse at all sites. Patients with severe uterine prolapse (stage II-IV) who want to preserve uterus, were operated with Cravat technique. All patients were evaluated at 2 weeks and 6 weeks after surgery and followed for 6 months. Outcomes were evaluated objectively by vaginal examination using Baden-Walker halfway classification, and subjectively classifying patients as ‘very satisfied’, ‘satisfied’ and ‘not satisfied’ at the 6th month postoperatively. Results Sacral uteropexy was successfully performed by laparoscopy in 32/33 patients (one needed to be converted to laparotomy). Nine patients also had a concurrent procedure as colporaphy anterior, colporaphy posterior or transobturator tape. Postoperative recovery has been uneventful with subjective and objective cure rates were 96.9% and 93.9%, respectively at six month. One recurrence of total prolapse needed to be reoperated and two patients with sacrouteropexy still remained at stage 2 prolapse. There have been no cases of graft exposure, rejection or infection with a median follow-up of 23.9 months. Conclusions Laparoscopic sacral uteropexy with “Cravat technique” was found to be safe and simple procedure

Microdose Flare-up Gonadotropin-releasing Hormone (GnRH) Agonist Versus GnRH Antagonist Protocols in Poor Ovarian Responders Undergoing Intracytoplasmic Sperm Injection

Abstract Background: Microdose flare-up GnRH agonist and GnRH antagonist have become more popular in the management of poor ovarian responders (POR) in recent years; however, the optimal protocol for POR patients undergoing in vitro fertilization has still been a challenge. Methods: In this observational study design, two hundred forty four poor ovarian responders were retrospectively evaluated for their response to GnRH agonist protocol (group-1, n=135) or GnRH antagonist protocol (group-2, n=109). Clinical pregnancy rate was the primary end point and was compared between the groups. Student t-test, Mann Whitney U test and 2 -test were used to compare the groups. The p<0.05 was considered to show a statistically significant result. Results: The mean total gonadotropin doses were 3814±891 IU in group 1 and 3539±877 IU in group 2 (p=0.02). The number of metaphase-II oocytes (3.6±2.4 vs. 2.8±1.9, p=0.005) and implantation rates (27.8% vs. 18.8%, p=0.04) in group 1 and group 2, respectively were significantly different. The fertilization rate in group 1 and group 2 was 73% vs. 68%, respectively (p=0.5) and clinical pregnancy rate was 19.8% vs. 14.4%, respectively (p=0.13). Conclusion: The GnRH agonist microdose flare-up protocol has favorable outcomes with respect to the number of oocytes retrieved and implantation rate; nevertheless, the clinical pregnancy rate was found to be similar in comparison to GnRH antagonist protocol in poor ovarian responders. GnRH antagonist protocol appears to be promising with significantly lower gonadotropin requirement and lower treatment cost in poor ovarian responders

Coagulation tests at trigger day in patients with Factor V Leiden Mutation to predict implantation failure

Objectives: The aim of this study was to assess the predictive value of coagulation tests at trigger day in patients with isolated factor V Leiden mutation who underwent intracytoplasmic sperm injection cycle (ICSI). Study Design:  Ninety women with isolated factor V Leiden mutation underwent ICSI cycles with an indication of unexplained infertility. In all participants antagonist protocol was used for ovarian hyperstimulation and coagulation tests including activated partial thromboplastin time (APTT), partial thromboplastin time (PT), international normalized ratio (INR), serum fibrinogen and D-dimer levels at trigger day were determined to predict successful implantation. All the clinical parameters specific for the treatment and some patient characteristics were recorded for each participants. Results: There was no significant difference between groups with and without succesfull implantation in terms of age, body mass index, basal hormone levels (follicle stimulating hormone, estradiol, progesterone at day 3 and antimullerian hormone) (P > 0.05). Estradiol and progestrone levels at trigger day were comparable between groups  (P > 0.05). Groups had similar endometrial thickness at embryo transfer day (P > 0.05). Some ovarian stimulation characteristics including initial gonadotropin dose, number of follicles > 17 mm, number of oocytes harvested and number of embryos were similar between groups (P > 0.05). Although there was no significant difference between groups with regard to APTT and PT levels, INR level were significantly lower while D-dimer levels and fibrinogen were significantly higher in cases without implantation (P < 0.05). Conclusion: D-dimer, fibrinogen and INR levels were significant predictors for successful implantation in women with isolated factor V Leiden who underwent ovulation hyperstimulation