Kadın Hastalıkları ve Doğum Alanında Kök Hücre Uygulamaları

[No Abstract Available

Iatrogenic Port Site Parasitic Myoma; Case Report and Literature Review

Introduction: We report a case of iatrogenic parasitic myoma of the anterior abdominal wall and discuss the differential diagnosis, treatment, and prevention of complication with relevant literature. Case Report: A 33-year-old woman presented with anterior abdominal wall mass 3 years after initial laparoscopic myomectomy surgery. A mass with a 38 3 26 mm diameter was observed in the anterior abdominal wall at the site of inferior left side port of previous surgery. It was excised from the anterior abdominal wall outside of the peritoneum, below the fascia. The pathologic examination of the excised mass revealed cellular myoma. This case is the 4th port site parasitic myoma in literature. Conclusion: The risk of implantation and subsequent growth of minute myoma fragments should be kept in mind during morcellation procedures and, in order to avoid such complications, all fragments should be tracked during morcellation. The inspection of trocar sites after the removal of trocars for retained fragments would prevent such recurrences

Predictivity of fatty liver index for non-alcoholic fatty liver disease in lean females with polycystic ovary syndrome

Background: Fatty liver index (FLI) is a simple tool used to predict non-alcoholic fatty liver disease (NAFLD). The role of FLI in polycystic ovary syndrome (PCOS) for the prediction of NAFLD has not been elucidated. Methods: This case-control study was from January 2014 to January 2016. Anthropometric measurements, biochemical testing, and abdominal ultrasonography were performed in 83 premenopausal otherwise healthy women with PCOS and 58 controls. NAFLD was diagnosed by ultrasound. The predictivity of FLI for NAFLD in lean and overweight/obese females with PCOS was analyzed. Results: The γ-glutamyl transferase levels were significantly higher in the females with PCOS than in the controls (p = 0.001). In women with PCOS, FLI was significantly higher in females with NAFLD comparing to those without NAFLD (47.1 ± 33.6 vs. 16.9 ± 21.6; p = 0.001). For the PCOS group, Body Mass Index had the strongest relationship with FLI (p < 0.05, r = 0.908). FLI < 30 was calculated for all the lean females. The lean females with PCOS had a significantly higher rate of NAFLD (27.5%vs. 8.8%; p = 0.041) than lean controls. Conclusion: An FLI < 30 was not sufficient to rule out NAFLD in the lean PCOS patients. Keywords: Polycystic ovary syndrome; non-alcoholic fatty liver disease; fatty liver index

The Use of an Anterior Abdominal Wall Peritoneal Flap in the Laparoscopic Repair of Vesicouterine Fistula

Vesicouterine fistula (VUF) is a rare type of genitourinary fistula. Lower-segment cesarean section is the leading cause of VUF. Patients mostly present with the classical triad of menouria, amenorrhea, and urinary incontinence, with the history of a previous cesarean section. Conservative management with catheterization and open, laparoscopic, and robotic surgeries are the prescribed treatment options. We present the case of a 35-year-old woman who presented with cyclical menouria and urinary incontinence. After diagnosis of VUF by cystoscopy, the laparoscopic approach was chosen. During the procedure, we used anterior abdominal wall peritoneum and adjacent adipose tissue interposition for the first time, instead of omental interposition, because of the unavailability of omentum. The postoperative period was uneventful, and the procedure was successful. In conclusion, the laparoscopic approach is feasible and the anterior abdominal wall peritoneal flap can be used instead of omentum for tissue interposition when the omentum is not available

İntra Uterin İnseminasyon ile Ovulasyon İndüksiyonu yapılan infertil kadınlardaki yüksek sensitiviteli CRP ve Human Chaperonin 10 seviyesinin değerlendirilmesi

Amaç: Embriyo implantasyonu başarılı gebeliğin en önemli adımlarından birisidir. Fetüs, uygun implantasyon için maternal immüniteden korunmalıdır ve maternal immünite modifikasyonu oldukça önemlidir. Düşük dereceli inflamasyonun indikatörü olan Yüksek sensiviteli CRP ve immünsüpresif Cp10 seviyelerini ovulasyon indüksiyonu ile intrauterin inseminasyon uygulanmış infertil kadınlardaki aşılama sonrası 2. Ve 8. günlerde değerlendirdik. Materyal Metod: 42 infertil hastada ovulasyon indüksiyonu uygulanmıştır. Başarılı ovulasyon indüksiyonu sonrası, IUI da yapılmıştır. Cp10 ve hsCRP seviyelerini ölçmek için IUI sonrası 2. Ve 8. Günlerde kan örnekleri alınmıştır. Gebe ve gebe olmayan grupların sonuçları karşılaştırılmıştır. Sonuçlar: IUI sonrası 8. Gündeki Cp10 değerleri gebe grupta daha yüksektir, ancak IUI sonrası 2. Gün değerleri ile karşılaştırıldığında aralarında bir fark bulunamamıştır. Hs CRP seviyeleri 2. Ve 8. Gün karşılaştırıldığında fark saptanmamıştır. Fakat gebe olmayan grupta Cp10 seviyeleri giderek düşmüştür. 2. Günden 8. Güne hs CRP seviyeleri, gebe ve gebe olmayan hastalarda belirgin farklılık göstermemiştir. Tartışma: CP10 seviyeleri fertilizasyonun erken aşamalarında daha yüksektir ve gebe kalan hastalarda giderek yükselirken gebe kalamayan hastalarda giderek düşmektedir.Aim: The implantation of embryo is one of the crucial steps of a successful pregnancy. The fetus should be protected from the maternal immune system, for the appropriate implantation. We investigated high-sensitive C-Reactive protein(hsCRP), that is an indicator of low-grade inflammation, and Chaperonin(Cp10), which has immunosuppressant capability levels in ovulation induction and intrauterine insemination(IUI) applied women, two and eight days after IUI. Materials and Method: The ovulation induction was maintained by clomiphene citrate or gonadotropines for 42 infertile patients. After successful ovulation induction, intrauterine insemination(IUI) was carried out. The blood samples were taken 2 and 8 days after IUI to evaluate Cp10 and hsCRP levels. The pregnant and non-pregnant groups? results were analyzed. Results: The Cp10 levels 8 days after IUI were higher in pregnant group whereas, there was no difference for the 2 days after levels between pregnant and nonpregnant group. The hsCRP levels were similar for both 2nd and 8th days when we compared pregnant and non-pregnant groups. The Cp10 levels increased from day 2 to day 8 in pregnant group. In contrast the Cp10 levels decreased in non-pregnant group. The change in hsCRP levels from day 2 to day 8 was not significant in pregnant and non-pregnant groups. Conclusions: The Cp10 levels were higher in early phases of fertilization and elevated through the preceding days of conception in pregnant patients while it decreased in non-pregnant patients with failed cycles

Pelvik organ prolapsusu olan hastalarda el kavrama Gücünün Değerlendirilmesi]

Aim: Pelvic organ prolapse(POP) is a common condition that is observed in 50% of parous women. Weakness of pelvic floor muscles is an important factor that leads to POP. The hand grip strength is related to total muscle strength and it could be used to evaluate one's general muscle strength. The Jamar hand dynamometer is a portable dynamometer that uses a strain gauge to measure hand grip strength. We hypothesized that general muscle strength would be impaired in patients with POP. Material and Method: Twenty patients with pelvic organ prolapse and twenty-one controls were recruited from the gynecology clinic of Namik Kemal University School of Medicine. The POP-Q classification was used to quantify the clinical severity of the prolapse. Hand grip strength was measured using a JAMAR hydraulic hand dynamometer. Results: The median pelvic organ prolapse score was 3 (1-4) in prolapse group. The mean Jamar scores of both groups were similar for the right hand, the left hand and the dominant hand (p=0.774, p=0.575 and p=0.707, respectively). The mean body fat percentage was 33.9 +/- 5.7 % in prolapses group and it was 38.9 +/- 7.4% in control group (p=0.021). Discussion: We found no difference in terms of general muscle strength between POP group and healthy controls. Our results showed that Jamar scores, which represented general muscle strength of body, did not related to pelvic organ muscle strength

Assessment of impaired glucose tolerance prevalence with hemoglobin A(1c) and oral glucose tolerance test in 252 Turkish women with polycystic ovary syndrome: a prospective, controlled study

What is the prevalence of abnormalities in glucose metabolism in patients with polycystic ovary syndrome (PCOS) and controls in a Turkish population? The total prevalence of glucose abnormalities in PCOS patients was 16.3 [impaired glucose tolerance (IGT) 14.3; type 2 diabetes mellitus (T2DM) 2] and was higher than in healthy subjects (IGT 8.5; T2DM 0, respectively). One of the most common markers of chronic glycemia is hemoglobin Alc (HbA(1c)). However, little is known about whether the use of HbA(1c) results in diagnosis of more cases of glucose intolerance in the PCOS population than the oral glucose tolerance test (OGTT) alone. This was a prospective study, including 252 women with PCOS and 117 control women without PCOS. The study was carried out in the gynecological outpatient department of Namik Kemal University Hospital, Turkey, between 2010 and 2012. Women with PCOS (n 252) were diagnosed according to Rotterdam criteria. The control group included 117 women (aged 1745 years) who were selected randomly. BMI of participants ranged between 15.6 and 47.9 kg/m(2). Patients with PCOS were comparable to controls in terms of age (24.8 versus 25.9 years, respectively) and had higher BMI (26.1 versus 24.9 kg/m(2), respectively). Of 252 patients with PCOS, 41 had glucose intolerance (IGT 14.3; T2DM 2) when compared with 10 of the 117 control patients (IGT 8.5; T2DM 0; odds ratios 2.08; P 0.045) during the OGTT. When an HbA(1c) value 5.6 was used to divide the total population, the prevalence of abnormal glucose metabolism was 7.9 in the patients with PCOS, below the value detected in the control patients (8.5), which showed that 20 of 41 patients with abnormal glucose tolerance would not have been diagnosed, if the HbA(1c) alone had been used. When compared with the OGTT results, HbA(1c) provided 52.4 sensitivity, 74.4 specificity, 67.1 positive and 60.9 negative predictive values with a threshold value of 5.6 in abnormal glucose tolerance. The receiver operating characteristic analysis suggested a threshold value of 5.35 in HbA(1c) (75.6 sensitivity and 52.6 specificity) for the prediction of abnormal glucose tolerance. This study did not involve weight-matched healthy subjects, which may cause a difference in prevalence of abnormal glucose metabolism between the groups, and the results are limited to an unselected population of patients who have the full PCOS phenotype. In addition, the incidence of T2DM among the first-degree relatives and 2-h insulin levels could not be reported in full. Further investigation of the efficacy of HbA(1c) for the prediction of abnormal glucose tolerance should be undertaken in long-term prospective studies and in different geographic populations. At present, the only way to reliably detect abnormal glucose metabolism in Turkish women with PCOS appears to be using the OGTT. No financial support. The authors have no competing interests to declare. Not applicable

Use of operative laparoscopy in single incision and natural orifice transvaginal surgery Response

[No Abstract Available

Re: Use of operative laparoscopy in single incision and natural orifice transvaginal surgery

[No abstract available

Alterations of Ionized and Total Magnesium Levels in Pregnant Women with Gestational Diabetes Mellitus

Background/Aims: The aim of this prospective study was to determine ionized and total magnesium (Mg) levels in pregnant subjects with and without gestational diabetes mellitus (GDM). Methods: Eighty-five women, 26-28 weeks pregnant, were recruited for routine oral glucose tolerance tests (OGTT); 45 had normal OGTT results and 40 were diagnosed with GDM. Electrolyte levels, including ionized and total Mg, were analyzed. Results: Gestational age and BMI were similar between the two groups (p = 0.800, p = 0.025). Multivitamin use was higher in the control group (p = 0.036). Fasting blood glucose was higher in the GDM group (p < 0.001). The median total Mg levels were 1.9 mg/dl (range 1.6-2.2) in the control group and 1.8 mg/dl (range 1.2-2.1) in the GDM group (p < 0.001). The median ionized Mg levels were 0.5 mmol/l (range 0.4-0.6) in the control group and 0.4 mmol/l (range 0.4-0.5) in the GDM group (p < 0.001). Conclusion: Our study revealed a relationship between low total and ionized Mg levels and GDM, as in type 2 diabetes mellitus (DM). The literature regarding type 2 DM and our findings suggest that Mg is the key ion in the pathophysiology of GDM. Low-dose Mg supplementation was not related to GDM; however, pharmacological doses in the various stages of pregnancy could be beneficial and should be investigated. (C) 2014 S. Karger AG, Base