Laparoscopically-assisted vaginal hysterectomy for enlarged uterus: operative outcomes and the learning curve

Objectives: The aim of the study was to compare the effects of uterine size and surgeon experience on the surgical out­comes of laparoscopically-assisted vaginal hysterectomy (LAVH) for benign gynecological conditions. Material and methods: This was a retrospective analysis of 184 LAVH cases. All hysterectomies were performed by the same surgeon and divided into two groups, with uterine weight of < 280 g (group 1) and uterine weight of > 280 g (group 2). The groups were compared in terms of the effects of the uterine size and surgeon experience vs. the operative outcomes (operative time, change in hemoglobin levels, hospital stay, and perioperative complications). Results: No significant differences in mean age, parity, history of chronic systemic diseases and previous surgery history were observed between the two groups. However, operative time was significantly greater in group 2 as compared to group 1 (132.1 ± 42.7 minutes vs. 111.5 ± 30.4 minutes, p < 0.05). There were no differences in the hospital stay and perioperative complications between the two groups. One case of bladder injury occurred in each group and one patient underwent a second laparoscopic surgery for postoperative bleeding in group 2. Greater surgeon experience was demonstrated to be associated with decreased operative bleeding and, consequently, smaller differences between preoperative and postop­erative hemoglobin levels. Operative time was also reduced as the surgeon was getting more experienced but the effect did not reach statistical significance. Conclusions: Our study supports the thesis that LAVH is a safe and effective procedure for managing benign gynecologi­cal conditions. Despite increased operative time, LAVH can be safely performed for enlarged uterus in conjunction with increased surgeon experience

Cabergoline versus bromocriptine for symptomatic treatment of premenstrual mastalgia: a randomised, open-label study

Objective: To compare the effectiveness and side effects of cabergoline with bromocriptine for the symptomatic treatment of cyclic mastalgia as a part of the premenstrual syndrome

Dienogest reduces endometrioma volume and endometriosis-related pain symptoms

This study aimed to evaluate the efficacy and adverse effects of dienogest for the treatment of endometriomas. Dienogest (2 mg/day) was administered to patients with endometrioma continuously through the 6-month study period. The patients were prospectively examined on the efficacy and side effects at baseline, at third months, and sixth months of the treatment. Twenty-four out of 30 patients were able to complete the study. The mean volume of the endometrioma decreased significantly from 112.63 ± 161.31 cm³ at baseline to 65.47 ± 95.69 cm³ at a 6-month follow-up (−41%) (p = .005). The VAS score for pelvic pain decreased significantly from 7.50 to 3.00 (p < .001) at the sixth months of treatment. The most common side effects were menstrual irregularities. Laboratory parameters did not change during the study. Dienogest considered being effective for 6 months of use in decreasing the size of endometrioma, reducing endometriosis-associated pain with a favourable safety and tolerability profile.Impact statement What is already known on this subject? Laparoscopic excisional surgery for endometrioma is currently the most valid approach in the treatment of endometriomas. However, there are concerns about ovarian reserve damage during surgery. What do the results of this study add? Dienogest considered being effective in decreasing the size of endometrioma, reducing endometriosis-associated pain with a favourable safety and tolerability profile. Long-term use of dienogest in younger patients with endometriomas who are yet to give birth may reduce the possibility of surgery by reducing the size of the endometriomas and may preserve ovarian reserve. What are the implications of these findings for clinical practice and/or further research? Dienogest may reduce the incidence of infectious complications such as pelvic abscess after oocyte retrieval and the surgical procedures in infertile patients with endometrioma

Incidence and outcomes of eclampsia: a single-center 30-year study

Objective: We aimed to determine the incidence of eclampsia at Erciyes University Hospital which is a tertiary referral center situated at central Anatolia. Additionally, we investigated eclampsia-associated maternal and perinatal outcomes for the 30-year study period. Methods: A retrospective review was performed for all women who were diagnosed with eclampsia and admitted to the Erciyes University Medical School, Department of Obstetrics and Gynecology from January 1985 to December 2015. Improvement in management gained over time was determined by comparing the results of the years 2005–2015 with data which were already published from years 1985–1999 and 2000–2004. Results: Eclampsia prevalence was 289/46,928 (% 0.61). Maternal age at the time of diagnosis did not differ statistically; however, gestational age at diagnosis and birth weight decreased significantly throughout the years (p < 0.005). The perinatal mortality rate showed a slight decrease throughout the years (p = 0.238). Maternal mortality rate also decreased throughout the years; it was 1.7% in 2005–2009 and 0 % in 2010–2015 (p = 0.246). Conclusion: The prevalence of eclampsia cases has decreased over the years. Maternal mortality attributed to eclampsia has also declined. The early diagnosis and treatment of eclampsia have resulted in the increase of premature deliveries. The perinatal mortality rate showed a slight decrease throughout the years (p = 0.238); however, it is not at a desirable rate compared to developed countries

A Case of Dichorionic Twin Pregnancy Concordant for Bilateral Cleft Lip and Palate and Discordant for Spina Bifida; Schisis Association

Backround: The schisis theory suggests that neural tube defect (NTD), cleft lip and palate (CL/P), omphalocele and diaphragmatic hernia are associated to each other more frequently than at the expected random combination rates in a given fetus. However, it is unusual to see schisis-associated defects concordantly in dichorionic twin pregnancy with other schisis-associated and non-associated defects. In addition, the association of lower limb oligodactly with oral cleft and spina bifida has not been reported before. Case: A 24-year-old woman with twin gestation at 21 weeks was referred to our unit. At ultrasound examination, bilateral CL/P and single umbilical artery in male fetus, and bilateral CL/P and open lumbar spina bifida in female fetus were revealed. At autopsy, oligodactyly of both lower limbs was demonstrated in the female fetus. The parents had no family history of NTD and CL/P. There was no consanguinity, nor was the mother exposed to teratogens

The effect of parental 5,10-methylenetetrahydrofolate reductase 677C/T and 1298A/C gene polymorphisms on response to single-dose methotrexate in tubal ectopic pregnancy

Object: The aim of this study was to assess the effect of parental 5,10-methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms (677C/T and 1298A/C) on response to single-dose methotrexate (MTX) treatment in tubal ectopic pregnancy (TEP).Materials and methods: In this prospective cohort study, cases with unruptured TEPs were grouped into two according to their response to single-dose MTX treatment (Group 1: responsive, n:88; Group 2: unresponsive, n:21). The groups were compared with regard to baseline demographic and clinical parameters. As a main outcome measure, the independent effects of parental MTHFR gene polymorphisms on response to single dose MTX treatment were evaluated.Results: One hundred and nine unruptured TEP were included in the final analysis. The mean maternal age was 29.305.21 years, gravity 2 (min-max: 1-5), parity 1 (min-max: 0-4). The median serum beta-human chorionic gonadotropin (-hCG) was 1403.35MI/I (Q(1)-Q(3): 517-2564). The overall response rate was 81% (88/109). The groups were similar with respect to basic baseline demographic data and serum -hCG level. Binary logistic regression analysis showed that the presence of parental MTHFR677C/T and 1298A/C polymorphism were not independent factor predicting treatment success (p>0.05). The only independent factor for resistance to single dose MTX was the previous TEP (OR: 4.47 (1.18-16.9)).Conclusion: Parental MTHFR 677C/T and 1298A/C mutations do not predict the outcome of single dose intramuscular MTX treatment in unruptured TEP

F-18 fluoro-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in planning of surgery and sentinel lymph node screening in vulvar cancers

To determine the effectiveness of FDG-PET/CT in the assessment of inguinofemoral lymph node (IFLN) in patients with vulvar cancer by comparing FDG-PET/CT results, sentinel lymph node (SLN) screening with gamma probe, and the results of frozen section and definitive pathology in these lymph nodes

Postnatal outcome of isolated, nonprogressive, mild borderline fetal ventriculomegaly

Background This study aimed to evaluate postnatal outcome of fetuses affected by nonprogressive, isolated, mild (>= 10 and <= 12 mm) borderline ventriculomegaly (BVM)