The effect of folate on ischemia/reperfusion injury in a rat adnexal torsion model

Purpose The ischemia/reperfusion (I/R) injury of ovaries in adnexal torsion may have inadvertent consequences. Many agents have been studied in terms of their ability to prevent reperfusion damage to ovaries in suspected cases. In this study, folic acid, known to have antioxidative properties, was investigated to determine whether it played a role in the prevention of I/R damage in a rat ovarian torsion model.Methods In this experimental study, 40 female adult Wistar-Albino rats were randomly divided into fve groups as control, ischemia, I/R, Fol2 (2 mg/kg folic acid), and Fol4 (4 mg/kg folic acid). In the Fol2 and Fol4 groups, folic acid was intra peritonelly administered 30 min before reperfusion. Blood samples were obtained from the tails of each rat at the second hour of reperfusion.Results The total oxidant status (TOS), total antioxidant status, cystatin C and folic acid levels of the fve groups were investigated. Folic acid in 2 mg/kg dose could moderately increase the serum folic acid concentration (15.75–19.95 ng/ml, p0.05), although there was no statistical diference in TOS levels (p=0.07). Folic acid in 4 mg/kg dose, could signifcantly increase the serum folic acid concentration (15.75–37.65 ng/ml). However, it did not signifcantly reduce the level of cystatin C (0.18–0.19 µg/L, p>0.05), and did not improve oxidative stress injury (76.05–130.58, p>0.05).Conclusion Folic acid in 2 mg/kg dose might improve the ovarian I/R injury though this was not statistically signifcant. Further studies are required to reach a defnitive conclusion about the protective efect of folic acid in I/R injury

The histopathological results of vestibulectomy specimens in localized provoked vulvodynia in Turkey

Introduction: Localized Provoked Vulvodynia (LPV) is a gynecological disease that is difficult to manage. Despite the wide spectrum of pathophysiological mechanisms and treatment modalities, there is limited success in the management of this disease. Surgical treatment is usually performed as the last resort. We aimed to investigate the histopathological results of 38 women with LPV who underwent surgical vestibulectomy. Methods: of the 55 women that were diagnosed with LPV and underwent vulvar vestibulectomy, 38 patients with complete histopathological results were included in this retrospective study. Results: in 14 patients, the pathological reports revealed Low-Grade Squamous Intraepithelial Lesions (LGSIL) (36.8%) whereas for 21 cases (55.2%), the findings were concordant with vestibulitis. The remaining three patients (7.8%) were diagnosed with lichen simplex chronicus. Conclusion: the presence of LGSIL in the surgical specimens of LPV cases is noteworthy. In this group of patients, surgical excision may contribute to the prevention of progression into high-grade lesions. The relationship between Human Papilloma Virus (HPV) infections and LPV should be further investigated

Menstrual cycle variability of ca 72-4 in healthy women

Objectives: CA 72-4 is not approved as a tumormarker but has been used as an adjunct marker in gynecological practice. The study aims to evaluate the menstrual cycle variability of CA 72-4 in a population of healthy women. Design and methods: Forty apparently healthy regularly menstruating subjects were included in the crosssectional study designed in the University Obstetrics and Gynecology outpatient clinic. Venous blood samples from each participant were collected twice: first at the follicular phase (2nd–5th days of the menstrual cycle) for FSH, estradiol, CA 125, CA 72-4 and the other at the luteal phase (21st-24th days of the menstrual cycle) for progesterone, CA 125 and CA 72-4 levels. Results: CA 72-4 values were similar in follicular and luteal phase of the menstrual cycle in apparently healthy regularly menstruating subjects (1.15 U/mL (0.2–5.4) vs 1.15 U/mL (0.56–6.3); p= 0.326 respectively). Ovulatory or smoking status did not have an effect on CA 72-4 values (p N 0.05). Conclusion: This first clinical study about the menstrual cycle variability of CA 72-4 revealed that the menstrual cycle does not have a significant impact on CA 72-4 values and that it can be measured at any time during the menstrual period

A new practical surgical technique for hymenoplasty: primary repair of hymen with vestibulo-introital tightening technique

Background: Hymenoplasty is distinct from other genital surgeries with its ethical and psychological issues. It is performed to narrow the vaginal opening to ensure vaginal bleeding with penetration. There are various kinds of techniques with different success rates. Objectives: The authors sought to report a new hymenal reconstruction technique with vestibulo-introital tightening with the results of 145 procedures. Methods: The new technique included a diamond-shaped incision to the vestibulum with the base in the posterior midline and superior corner 2 to 3 cm higher above the hymen. The angles were accommodated according to the degree of tightening, and the submucosal layer was closed from the apex downwards involving the vaginal mucosa. Results: The satisfaction rate of the patients was 99.3%. No adverse events were observed. Conclusions: Compared with previous techniques described, this hymenal reconstruction technique is an alternative with the advantage of low risk of loosening because the tension on the hymen alone is decreased. Additional tightening of the introitus increases the satisfaction rates in some patients

The association between ischemia modified albumin and placental histopathology in uncomplicated term deliveries

Ischemia modified albumin (IMA) is a marker of ischemia elevated in different clinical conditions and its use for hypoxia in perinatology is of current interest. We aimed to investigate the association between maternal and cord blood IMA levels and placental histopathological findings in uncomplicated term deliveries. In this study, placental histopathological evaluation in uncomplicated deliveries that ended with healthy newborns revealed 80.6% vasculopathy. The results support the hypothesis that hypoxia exceeding the placental reserve ends with fetal compromise. Moreover, the presence of maternal vasculopathy in placenta is not correlated with maternal and fetal IMA levels

Clinical diagnosis and complications of paratubal cysts: review of the literature and report of uncommon presentations

Paraovarian or paratubal cysts (PTCs) constitute about 10 % of adnexial masses. Although they are not uncommon; they rarely cause symptoms and are usually incidentally found. Actual incidence is not known. The symptoms occur when they grow excessively, or in case of hemorrhage, rupture or torsion. Here, literature review reporting the incidence, presentation and complications of PTCs is performed. Uncommon presentations of PTCs in three different cases, a giant PTC, torsion of PTC and borderline paratubal tumor, are also reported and discussed. Ultrasonography, CT or MRI may be performed in preoperative evaluation; but none of these imaging techniques have specific criteria for diagnosis. So, in most cases misdiagnosis as an ovarian mass remains to be a problem. Paratubal cysts can become extremely big before causing symptoms. Torsion is another urgent issue regarding PTCs, necessiating urgent surgery for preservation of the ovary and the tube. Although malignancy is rare, borderline paratubal tumors have been reported in the literature

Atherogenic dyslipidemia, subclinical atherosclerosis, non-alcoholic fatty liver disease and insulin resistance in polycystic ovarian syndrome

Objective: We aimed to explore the relationship between insulin resistance (IR) and small dense lipoprotein (sd-LDL) particles, carotid intima-media thickness (CIMT) and non-alcoholic fatty liver disease (NAFLD) in young normal weight PCOS cases. Methods: This prospective, case-control study was designed in a University Hospital and 34 women with PCOS and 21 healthy controls were enrolled. Fasting plasma glucose, insulin, lipid (including sd-LDL particles) and hormone profiles, abdominal ultrasound and CIMT were evaluated. Results: IR was present in 68% of PCOS group while in none of controls. High density lipoprotein (HDL), very low density lipoprotein (VLDL), triglycerides (TG), and sd-LDL were higher in patients with IR (p<0.05). A positive correlation of sd-LDL with IR, VLDL and TG was found. A significantly higher rate of NAFLD and CIMT was found in PCOS. Totaltestosterone levels were weakly and positively correlated with CIMT (r=0.277, p=0.041). Conclusion: Insulin resistance and NAFLD are highly prevalent among young normal weight PCOS patients. When compared to controls levels of sd-LDL and CIMT are increased in PCOS. Insulin resistance is the key parameter for NAFLD and atherogenic dyslipidemia in PCOS. Hence, screening for NAFLD may be valuable for detection and prevention of liver disease. Higher levels of sd-LDL in insülin resistant PCOS cases necessiates treating PCOS for I

CRP at early follicular phase of menstrual cycle can cause misinterpretation for cardiovascular risk assessment

Objective: C-reactive protein (CRP) is a well-known marker of infl ammation and infection in clinical practice. This study is designed to evaluate CRP levels in diff erent phases of menstrual cycle, which might end up with misleading conclusions especially when used for cardiovascular risk assessment. Methods: Twenty-seven women were eligible for the cross-sectional study. Venous blood samples from each participant were collected twice during the menstrual cycle. The fi rst sampling was held at 2nd to 5th days of the menstrual cycle for FSH, estradiol, CRP, and sedimentation, and the second was done at 21st to 24th days of the menstrual cycle for measurement of progesterone, CRP, and sedimentation values. Results: CRP values were signifi cantly higher in the early follicular phase compared to luteal phase (1.8 mg/L [0.3–7.67] vs. 0.7 mg/L [0.1–8.3], p < 0.001, respectively). In both phases of the menstrual cycle, sedimentation rate was similar (12.1 ± 6.7 vs. 12.3 ± 7.7; p = 0.717, respectively). Conclusions: CRP levels in early follicular phase of the menstrual cycle (menstruation) are signifi cantly higher than CRP levels in luteal phase of the same cycle. In reproductive age women, detection of CRP for cardiovascular risk assessment during menstruation might not be appropriate

Oral antibiotic prophylaxis in elective cesarean deliveries: pilot analysis in tertiary Care Hospital

Introduction: Puerperal infection remains a significant cause of maternal morbidity and mortal ity. Those infections occur more likely after cesarean delivery (CD). Prophylactic antibiotics are administered at the time of CD to prevent complications. In addition to intraoperative prophy laxis; prescription of antibiotics during hospital discharge to prevent surgical site infections (SSI) is quite common. Purpose of this study is to determine the utility of prophylactic oral antibiotic prescription in a cohort of low-risk women undergoing CD. Materials and methods: A prospective observational study was conducted between 2014 and 2018 at Ufuk University School of Medicine, Department of Obstetrics and Gynaecology. Total of 389 low risk elective cesarean deliveries were selected. All cases received intraoperative prophy laxis. In group I (157 subjects), no further antibiotics were given and in group II (232 cases), oral cephuroxime 500 mg was given during hospital discharge. Primary outcome was SSI. Secondary outcomes were endometritis and other infectious conditions. Results: Overall SSI rate was 2.5%. Only 2 SSIs were noted in group 1 (1.2%) compared to eight in group II (3.4%). There was no statistical difference in SSI rate between two groups. Secondary outcomes were also comparable. Conclusion: In this study, we failed to reveal any beneficial effect of oral antibiotic prescription during hospital discharge in low risk elective CDs. Therefore, use of oral antibiotics in addition to intraoperative prophylaxis should be questioned in terms of increased costs, emergence of bacterial resistance and long term effects on new born as a consequence of changes in gut microbiom

İleri yaşta dehidroepiandrosteron ile spontan gebelik: üç olgu sunumu ve literatür derlemesi

It has been reported recently that dehydroepiandrosterone (DHEA) supplementation in older patients with low ovarian reserve increases the response to infertility treatment. Three women of age >3S years with low ovarian reserve parameters including high FSH, low AFC have been treated with DHEA for various time intervals are reported here. They conceived spontaneously after a few months of treatment which resulted in healthy newborns. Although there are not many randomized controlled trials about the value of DHEA treatment in infertile patient population, previous case reports support that DHEA increases spontaneous pregnancy rates. Considering healthy livebirths of the relatively older age of the mentioned cases, DHEA might be improving also oocyte quality as an additional impact.Son yıllarda dehidroepiandrosteronun düşük over rezervli hasta grubunda infertilite tedavisine yanıtı arttırdığı saptanmıştır. Bu olgu serisinde, 35 yaşından büyük ve kötü over rezervi, yüksek 3. gün FSH’sı ve düşük antral folikül sayısı ile kanıtlanmış üç hastada kısa süreli dehidroepiandrosteron kullanımı ile spontan gelişen ve sağlıklı biçimde terme ulaşan gebelik olguları ve bu konudaki güncel literatür bilgileri gözden geçirilmektedir. Dehidroepiandrosteron ile yapılan çok geniş randomize çalışmalar bulunmasa da literatürdeki olgu sunumları ve burada sunulan vakalar, bu androjenin düşük over rezervli hastalarda spontan gebelik şansını arttırdığını kanıtlamaktadır. Gebeliklerin ileri anne yaşına rağmen sağlıklı canlı doğum ile sonuçlanmaları da oosit kalitesini iyileştirdiği fikrini desteklemektedir