Conservative management of postmenopausal woman with prolonged use of the dislocated intrauterine device which was also unnoticed while hysterectomy

The objectives of this study are to identify and compare the treatment options of woman with uterine perforation caused by intrauterine device (IUD). A 74-years-old woman presented with irritable voiding symptoms and a dislocated IUD into the peritoneal cavity was discovered incidentally during radiologic imaging. While a Lippes loop IUD had been inserted 35 years previously, she had a history of hysterectomy 10 years after an IUD insertion. Not only the patient had forgotten the presence of the IUD, but also it was unnoticed during hysterectomy. Patient has remained asymptomatic for over the 25 years, with the prolonged use of dislocated IUD. The patient managed conservatively and no need for surgical intervention. Once a gynaecologist is faced with the dilemma of whether it is necessary to remove a dislocated IUD or not, patients should undergo an individualized management, balancing both risks and benefits of surgical intervention. Asymptomatic elderly patients with comorbidities may benefit from conservative management with close monitoring.

Cleft lip and cleft palate: a disease with multiple risk factors in a pregnant woman

Clefts of the lip and/or palate (CLP) are currently the most common craniofacial birth defects that arise as a result of failure of facial embryonic processes to fuse. CLP etiology, which involves both genetic and environmental factors, is highly complex; its molecular basis remains largely unknown. In the current study we present a case report of a woman with prenatal diagnosis of cleft lip and palate, who had multiple risk factors including genetics, advanced age, family history, antiepileptic drug usage, consanguineous marriage and smoking. Her previous child was born with CLP, and this also contributes. Data of our study supports the hypothesis of a multifactorial etiology for CLP

Endometrium Kanserli Hastalarda Preoperatif Tam Kan Sayımının Prognostik Parametreler ve Sağkalımla İlişkisi

Amaç: Çalışmamızda endometriyum adenokarsinomu tanılı hastalarda preoperatif tam kan sayımı parametrelerinin çeşitli klinikopatolojik prognostik parametrelerle ve sağkalım ile ilişkisi olup olmadığını değerlendirmeyi amaçladık.Gereç ve Yöntem: Ocak 2011-Aralık 2014 tarihleri arasında fakültemizde opere edilen ve endometrial adenokarsinom tanısı alan 144 hasta çalışmaya dahil edilmiştir. Hemogram parametrelerinden absolü beyaz küre sayısı BK , absolü platelet sayısı Plt hematokrit Hct , hemoglobin Hb değerleri yanı sıra absolü nötrofil sayısının absolü lenfosit sayısına bölümü olan NLR, absolü platelet sayısının absolü lenfosit sayısına bölümü olan PLR ve absolü monosit sayısının absolü lenfosit sayısına bölümü olan MLR oranlarının; tümör çapı, tümör derecesi, FIGO evresi, serviks invazyonu, pozitif lenf nodu sayısı, lenf nodunda ekstrakapsüler yayılım, lenfovasküler invazyon LVİ , myometrial invazyon derinliği gibi prognostik parametreler ve hastalıksız ve genel sağkalım süreleri ile olan ilişkisi istatistiksel metodlarla araştırılmıştır.Bulgular: Derece 3 tümöre sahip hastalarda BK sayısının derece 1 tümörlü hastalara göre anlamlı derecede düşük olduğu görüldü p=0.04 . LVİ olan olgularda PLR p=0.018 ve MLR p=0.028 LVİ olmayan hastalara göre daha düşük idi. Düşük evre olgularda evre I-II PLR, yüksek evreli olgulara göre evre II-III daha düşük tespit edildi p=0.03 . Tedavi öncesi bakılan tam kan parametreleri ile tümör çapı, serviks invazyonu, pozitif lenf nodu sayısı, lenf nodunda ekstrakapsüler yayılım, myometrial invazyon derinliği, hastalıksız sağkalım ve genel sağkalım arasında anlamlı bir ilişki saptanmadı p>0.05 .Sonuç: Endometriyum kanserinde tedavi öncesi tam kan sayımı parametrelerinin bir arada kullanılması, hastalığın prognozu ile ilgili fikir verebilir. Çalışmamızın sonuçlarının daha uzun takip süresine ve daha geniş olgu sayısına sahip çalışmalarla desteklenmesi gereklidi

Comparison of the Efficiency of Posterior Intravaginal Sling (PIVS) Procedure in Older and Younger Groups

The will reads: Know by all men these presents, that I Alexander Ketcham of Huntington, County of Suffolk and State of New York and Village of Fresh Pond… Image 1 of 1.https://digitalcommons.lmu.edu/tiersma_collection/2566/thumbnail.jp

Gynecologic Cancers in Pregnancy

The number of cancer diagnosis during pregnancy is increasing as a result of becoming widespread of screening tests and advanced pregnancy age. Gynecologic oncologists and oncologist make effort for medical and surgical treatments of cancer without any side effect on fetal well- being. In this review, the diagnosis, treatments and fetal effects of gynecologic cancers during pregnancy was discussed. [Archives Medical Review Journal 2015; 24(2.000): 211-227

Pelvic radiotherapy does not deteriorate the quality of life of women with gynecologic cancers in long‑term follow‑up: A 2 years prospective single‑center study

Purpose: To evaluate the emotional, sexual and health-related quality of life (HRQoL) concerns of the women with gynecologicmalignancy treated with curative radiotherapy (RT).Patients and Methods: A 100 women with diagnosis of gynecologic malignancy were prospectively enrolled. HRQoL at baseline,at the end of RT and during follow-up was assessed using European Organization for Research and Treatment of Cancer QoLQuestionnaire-C30 (EORTC QLQ-C30), EORTC QLQ-cervical cancer module 24, and Hospital Anxiety and Depression Scale.Results: The appetite loss, diarrhea, fatigue, dyspnea, insomnia, nausea and vomiting, pain scores, and sexual activity and sexualenjoyment scores were deteriorated after RT (P = 0.02 for pain scores and P < 0.001 for all other). Body image scores were higherin patients with endometrial cancer (P < 0.01). The emotional function, nausea and vomiting, body image and symptom experiencescores were higher in patients who underwent chemotherapy (P = 0.04 and P = 0.01). All the complaints of patients improved duringfollow-up period. The global health status scores and the level of depression deteriorated in patients with locoregional recurrentdisease and distant metastasis. The anxiety (P = 0.001) and depression (P = 0.007) levels were higher in basal and after-RT visitsbut then decreased through the subsequent follow-up visits.Conclusion: Although pelvic RT deteriorated HRQoL in patients with gynecologic malignancy, HRQoL improved during the follow-upperiod. The progressive disease had a negative impact on HRQoL

Management of intra-abdominally translocated contraceptive devices, is surgery the only way to treat this problem?

This study was a multi-centre retrospective review of patients with uterine perforation caused by intrauterine contraceptive devices (IUDs). A total of 15 patients were registered, in a seven year period. Among them, five were asymptomatic and the rest were symptomatic. Asymptomatic patients were managed conservatively, except in one case in which the patient requested surgery because she also wanted a tubal ligation. Symptomatic patients all underwent surgery. All the surgeries were elective and all the surgical procedures were initiated laparoscopically. There were seven complications in the surgically managed group: conversion to laparotomy (n = 3), bowel injury (n = 2), bladder injury (n = 1), and wound infection (n = 1). Mild and severe adhesions (81.8%), and abscess (18.1%) formation related to translocated IUD (TIUD) were observed during surgery. All the patients were uneventful at 1 to 5 years of follow-up. A TIUD, by causing adhesions, complicates future laparoscopic surgery and increases the likelihood of conversion to laparotomy. While surgery is indicated to prevent TIUD-induced adhesive complications, it may also be the cause of both adhesions and complications, resulting in a vicious cycle. Some asymptomatic women, especially elderly patients with comorbidities, may not need or may be better managed without treatment.Impact statement In this study we try to find an answer for the question of “Should removal of a translocated intrauterine contraceptive device (TIUD) routinely be performed even if patients are asymptomatic?” From only the theoretical point of view there were some reports supporting conservative management in asymptomatic patients. The other studies addressing this issue were case reports including few patients with a short-term follow-up. The novelties of the present study include multi-centre design, detailed clinical and surgical information about the patients and the long period of follow-up. Most clinicians have limited experiences in managing TIUD because perforation is a rare event. So it can be difficult to know exactly what the surgeon will encounter intraoperatively. We undertook this study with the aim of providing a perspective about patients with TIUD for those faced with this situation. This is a descriptive study reporting 15 cases of TIUDs and management. Asymptomatic patients were managed conservatively, and symptomatic patients were operated. There are important implications resulting from this study that in asymptomatic patients leaving the IUD in place may be a reasonable option, mostly as the risk of surgical intervention is quite high with a high rate of complications with surgical management

Hyperemesis Gravidarum and Helicobacter Pylori Stool Antigen Positivity

OBJECTIVE: Nausea and vomiting of pregnancy (NVP) is a common problem for patients during first trimester. The causes of this problem are multifactorial. Recent studies have shown association between hyperemesis gravidarum (HG) and Helicobacter Pylori infection. We aim to evaluate this association. STUDY DESIGN: Thirty-seven patients who were diagnosed HG were compared with 40 asymptomatic pregnant women. Direct stool antigen testing with using ELİSA (Enzyme Linked İmmunosorbent Assay) was performed. RESULT: Helicobacter pylori stool antigen was detected in 11 (27.5%) patients in control group. in HG group Helicobacter pylori stool antigen was detected in 8 (21.6%) patients. there were no statistically significant difference. CONCLUSION: Our study was unable to confirm association between HG and H. pylori. For elimination of genetic factors different population is should be evaluated

Cleft lip and cleft palate: a disease with multiple risk factors in a pregnant woman

Clefts of the lip and/or palate (CLP) are currently the most common craniofacial birth defects that arise as a result of failure of facial embryonic processes to fuse. CLP etiology, which involves both genetic and environmental factors, is highly complex; its molecular basis remains largely unknown. In the current study we present a case report of a woman with prenatal diagnosis of cleft lip and palate, who had multiple risk factors including genetics, advanced age, family history, antiepileptic drug usage, consanguineous marriage and smoking. Her previous child was born with CLP, and this also contributes. Data of our study supports the hypothesis of a multifactorial etiology for CLP. [Int J Reprod Contracept Obstet Gynecol 2015; 4(6.000): 2044-2046