Prevalence and genotype screening of human papillomavirus among women attending a private hospital in Northern Cyprus: an 11-year retrospective study.

BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted pathogen both in men and women. Accumulating epidemiological evidence supports a strong association between HPV infection and cancer of the cervix, vulva, vagina, anus, and penis. Currently, data on the HPV prevalence and genotyping is lacking in Northern Cyprus, a region in which HPV vaccination is not freely accessible via the national immunization program. The aim of this study was to evaluate the HPV type-specific prevalence in women with and without cytological abnormalities living in Northern Cyprus. METHODS: A total of 885 women who presented to the Department of Gynecology and Obstetrics Clinic between January 2011 and December 2022 were included in the study. Samples were collected for cytology. Cervical specimens were investigated for the presence of HPV-DNA and genotyping of HPV was performed using real-time polymerase chain reaction (rtPCR). Cytological examination was interpreted according to the Bethesda system. RESULTS: Among all patients, overall high-risk HPV DNA prevalence was 44.3%. HPV-16 and HPV-18 positivity was found in 10.4% and 3.7% of women respectively, while other high-risk HPV (OHR-HPV) was the most frequent type of HPV (30.2%). The highest frequency of HPV infection was observed in the 30-55 age group (51.0%), followed by the < 30 age group (45.7%). Co-infection with two or more HPV types was observed in 17.0% of all positive samples, in which the prevalence of HPV-16 + HPV-18 was 2.3%, HPV-16 + OHR-HPV and HPV-18 + OHR-HPV was 12.0% and 5.1%, respectively. Among the screened patients, 37.5% had abnormal and 62.5% had normal cytology results. HR-HPV positivity was 65.7% and 34.0% in patients with abnormal and normal cytology. The highest incidence of HRC-HPV was OHR-HPV types (44.7%) in positive cytology cases. Among women with a cytology result of ASCUS, L-SIL, H-SIL and unspecified dysplasia, 52.1%, 67.6%, 97.5% and 75.6% were respectively infected with HR-HPV. CONCLUSION: The present study provides the latest epidemiological data related to HPV prevalence and genotype distribution among women living in Northern Cyprus. Considering the unavailability of free vaccination in the community, it is imperative to implement local HPV screening programs and provide guidelines on HPV prevention and measures during early school education.

Comparison of health-related quality of life of women undergoing robotic surgery, laparoscopic surgery or laparotomy for gynecologic conditions: A cross-sectional study.

OBJECTIVE: To assess and compare the health-related quality of life of women undergoing robotic gynecologic surgery, laparoscopic gynecologic surgery or laparotomy for benign and cancerous conditions. METHODS: Cross-sectional study design was used. The present study was carried out with 240 women, who underwent gynecologic surgery (robotic 48, laparoscopic 96, and laparotomy 96) in a tertiary care hospital. Instruments included a participant description questionnaire and Medical Outcomes Study Short Form-36. The data were collected 4 weeks after surgery, at the first postoperative visit of women to the clinic. Pearson χ2 test, one-way analysis of variance, and regression analysis were used to assess the data. RESULTS: Over half of the women in each group had surgery because of gynecologic cancer. All the subscale scores of Medical Outcomes Study Short Form-36 were significantly higher in the robotic group than the other surgical groups (P < 0.05). Women in the robotic group had better quality of life in terms of both the physical component and the mental component after surgery. CONCLUSIONS: Knowledge of health-related quality of life in the recovery period after surgery is important for healthcare providers to provide adequate preventive measures, information, and follow up.

Lower vitamin D levels during the second trimester are associated with developing gestational diabetes mellitus: an observational cross-sectional study.

In this study, we aimed to compare serum 25(OH)D levels in women with and without gestational diabetes mellitus (GDM), and to identify the serum 25(OH)D levels associated with GDM. We recruited 40 women with GDM and 40 healthy pregnant women, aged 20-40 years and in the second trimester, at Gulhane Education and Research Hospital. We excluded women with chronic diseases, preeclampsia, pre-GDM, multiple pregnancies, and those taking medications related to calcium or vitamin D metabolism. We took anthropometric measurements and blood samples during the second trimester. Of the 80 pregnant women, pre-pregnancy body mass index was significantly higher among the GDM group than the healthy group (26.4 ± 5.73 kg/m2 vs. 22.6 ± 3.56 kg/m2, p = .001). Serum 25(OH)D levels in women with GDM were significantly lower than those in healthy women (16.8 ± 9.90 ng/mL vs. 20.9 ± 8.16 ng/mL, p = .016). The prevalence of severe vitamin D deficiency was as high as 72.5% among women in the GDM group, with a 1.74-fold increased risk of deficient status. Levels of 25(OH)D lower than a cutoff value of 14.0 ng/mL were determined to be related to GDM. These study results suggest that maternal vitamin D deficiency in mid-pregnancy is significantly associated with development of GDM.

Anemia prevalence at the time of pregnancy detection.

OBJECTIVE: Anemia in the first trimester of pregnancy is the situation as described by the World Health Organization when the level of hemoglobin (Hb) is less than 11 g in 100 cc of blood. The prevalence of this problem is 18% in developed countries, whereas it is between 35-75% in developing countries. In this study, we aimed to determine the prevalence of anemia at the time of pregnancy detection. MATERIALS AND METHODS: A retrospective cross-sectional study was designed to determine the prevalence of anemia. A total of 5228 first trimester pregnant women were admitted to the study between 2012 and 2014. Hb levels of 11 to 9.5 g/dL, 9.5 to 8 g/dL, and less than 8 g/dL were considered as mild, moderate, and severe anemia, respectively. RESULTS: We detected mild, modarate, and severe anemia at rates of 16.64%, 3.07%, and 0.28%, respectively, in our population. The overall prevalence of anemia at the time of detection of pregnancy was 20.0%. CONCLUSION: Anemia is a significant risk factor for maternal mortality in developing countries. The prevalence of anemia at the time of pregnancy detection was 20% and this rate is close to those indicated in developed countries.

Arm reduced robotic-assisted laparoscopic hysterectomy with transvaginal cuff closure.

INTRODUCTION: The use of robotics for benign etiology in gynecology has not proven to be more beneficial when compared to traditional laparoscopy. The major concern regarding robotic hysterectomy stems from its high cost. AIM: To evaluate the clinical utility and effectiveness of one-arm reduced robotic-assisted laparoscopic hysterectomy as a cost-effective surgical option for total robotic hysterectomy. MATERIAL AND METHODS: A sample population of 54 women who underwent robotic-assisted laparoscopic surgery for benign gynecologic indications was evaluated, and two groups were identified: (1) the two-armed robotic-assisted laparoscopic surgery group (n = 38 patients), and (2) the three-armed robotic-assisted laparoscopic surgery group (n = 16 patients). RESULTS: An increased cost was observed when three-armed robotic surgery was employed for benign gynecologic surgery (p < 0.001). The cost reduction observed in the study group was primarily derived from one robotic arm reduction and vaginal closure of the cuff. This cost reduction was achieved without an increase in complication rates or undesirable postoperative outcomes. An estimated profit between $399.5 and $421.5 was made for each patient depending on the suture material chosen for cuff closure. Two-armed surgery resulted in an 18.6% reduction in procedure-specific costs for robotic hysterectomy. CONCLUSIONS: Two-armed robotic-assisted laparoscopic hysterectomy appears to be a cost-effective solution for robotic gynecologic surgery. This surgical solution can be performed as effectively as classical three-armed robotic hysterectomies for benign indications without the risk of increased surgical-related morbidities. This approach has the potential to be a widely preferred surgical approach in medical communities where cost reduction is one of the primary determinants of surgery type.

Plasma Free Fatty Acids in Hyperemesis Gravidarum Pregnancy.

We evaluated the free fatty acids differences in plasma between hyperemesis gravidarum(HG) and healthy pregnant in first trimester pregnancy. OBJECTIVE: We aimed to compare the plasma levels of DHA, AA and EPA, between HG patients and healthy pregnant women. DESIGN: Fifty-two pregnants were involved in the study. Twenty-six pregnants of them were HG as study group, and twenty-six pregnants were enrolled as healthy pregnant women at the similar gestational age. The saturated fatty acids C14, C15, C16, C18, C20, C22, and C24; the omega-3 fatty acids eicosapentaenoic acid, (EPA) and docosahexaenoic acid, (DHA); the omega-6 fatty acids linoleic acid, arachidonic acid (AA), and homo-gamma-linolenic acid; and the omega-9 fatty acids oleic acid, erucic acid, and nervonic acid were analysed by gas chromatography. RESULTS: Statistically differences was not seen between the groups with maternal age, gestational age, or plasma levels of EPA, DHA, and AA. Statistically significant difference was seen between the groups with plasma levels of C20 and C22(p<0.05). C20 was declined but C22 was rised in the HG patients. CONCLUSION: EPA, DHA, or AA, which related to placental and fetal neural development are not changing from Hyperemesis gravidarum.

Cytohistological discrepancies of cervico-vaginal smears and HPV status.

OBJECTIVES: Discrepancies between abnormal cervical cytology or high-risk human papillomavirus (HR-HPV) status (cytolo-gy negative/HPV positive) and subsequent histological findings are a common occurrence. After using co-testing, the dis-crepancies between the HR-HPV status and cervical cytology have become an issue. In this study, we aimed to determine the characteristics of women with a discrepancy between histology and cytology/HR-HPV status, in terms of diagnosis, review and identification. MATERIAL AND METHODS: A total of 52 women, patients of the University Hospital between 2013-2015, with cytohistologi-cal or HR-HPV status discrepancy were recruited for the study and retrospectively analyzed. The cytological samples were liquid-based Pap smears, classified according to the 2001 Bethesda system. The HR-HPV status was identified using the Hybrid Capture 2 HR-HPV DNA assay. The histological samples were obtained by cervical biopsy as well as large loop exci-sion of the transformation zone (LLETZ). RESULTS: A cytohistological discrepancy was demonstrated in patients with (-)cytology/HR-HPV(+), ASCUS, LSIL, ASC-H, HSIL, AGC-NOS: 17.3%, 23.07%, 26.9%, 9.5%, 17.3% and 5.7%, respectively. When the degree of atypia in cytology increases, the concurrency of cervical cytology with biopsy also increases. A positive HR-HPV co-test result (19/24, 79.1%) was observed in nearly all CIN2 ≥ (+) cases. Our study emphasizes the significance of HR-HPV testing to determine CIN2 ≥ (+) cases, even in the presence of a normal cytological result. CONCLUSIONS: In case of cytohistological or HR-HPV discrepancies, a careful review of the HR-HPV status and the degree of cytological atypia should be performed before further intervention.

Factors associated with survival after relapse in patients with low-risk endometrial cancer treated with surgery alone.

OBJECTIVE: To determine factors influencing overall survival following recurrence (OSFR) in women with low-risk endometrial cancer (EC) treated with surgery alone. METHODS: A multicenter, retrospective department database review was performed to identify patients with recurrent "low-risk EC" (patients having less than 50% myometrial invasion [MMI] with grade 1 or 2 endometrioid EC) at 10 gynecologic oncology centers in Turkey. Demographic, clinicopathological, and survival data were collected. RESULTS: We identified 67 patients who developed recurrence of their EC after initially being diagnosed and treated for low-risk EC. For the entire study cohort, the median time to recurrence (TTR) was 23 months (95% confidence interval [CI]=11.5-34.5; standard error [SE]=5.8) and the median OSFR was 59 months (95% CI=12.7-105.2; SE=23.5). We observed 32 (47.8%) isolated vaginal recurrences, 6 (9%) nodal failures, 19 (28.4%) peritoneal failures, and 10 (14.9%) hematogenous disseminations. Overall, 45 relapses (67.2%) were loco-regional whereas 22 (32.8%) were extrapelvic. According to the Gynecologic Oncology Group (GOG) Trial-99, 7 (10.4%) out of 67 women with recurrent low-risk EC were qualified as high-intermediate risk (HIR). The 5-year OSFR rate was significantly higher for patients with TTR ≥36 months compared to those with TTR <36 months (74.3% compared to 33%, p=0.001). On multivariate analysis for OSFR, TTR <36 months (hazard ratio [HR]=8.46; 95% CI=1.65-43.36; p=0.010) and presence of HIR criteria (HR=4.62; 95% CI=1.69-12.58; p=0.003) were significant predictors. CONCLUSION: Low-risk EC patients recurring earlier than 36 months and those carrying HIR criteria seem more likely to succumb to their tumors after recurrence.

Extraperitoneal lymph node dissection in locally advanced cervical cancer; the prognostic factors associated with survival.

OBJECTIVE: Surgical staging was recently recommended for the decision of treatment in locally advanced cervical cancer. We aimed to investigate clinical outcomes as well as factors associated with overall survival (OS) in patients with locally advanced cervical cancer who had undergone extraperitoneal lymph node dissection and were managed according to their lymph node status. MATERIAL AND METHODS: The medical records of 233 women with stage IIb-IVa cervical cancer who were clinically staged and underwent extraperitoneal lymph node dissection were retrospectively reviewed. Paraaortic lymph node status determined the appropriate radiotherapeutic treatment field. Surgery-related complications and clinical outcomes were evaluated. RESULTS: The median age of the patients was 52 years (range, 26-88 years) and the median follow-up time was 28.4 months (range, 3-141 months). Thirty-one patients had laparoscopic extraperitoneal lymph node dissection and 202 patients underwent laparotomy. The number of paraaortic lymph nodes extracted was similar for both techniques. Sixty-two (27%) of the 233 patients had paraaortic lymph node metastases. The 3-year and 5-year OS rates were 55.1% and 46.5%, respectively. The stage of disease, number of metastatic paraaortic lymph nodes, tumor type, and paraaortic lymph node status were associated with OS. In multivariate Cox regression analyses, tumor type, stage, and presence of paraaortic lymph node metastases were the independent prognostic factors of OS. CONCLUSION: Paraaortic lymph node metastasis is the most important prognostic factor affecting survival. Surgery would give hints about the prognosis and treatment planning of the patient.

The effect of anatomical placental location on the third stage of labor.

According to the lower uterine segment and trophotropism hypotheses of placental implantation, placentation occurs in uterine segments with a high blood supply. The present study was designed to determine the clinical implications of these hypotheses by assessing the dynamics of the third stage of labor. Two-hundred and ninety-two prospectively followed pregnant women were assessed at the time of delivery. The uterine locations of the placentas were determined according to the position of the main placental volume and mass under a sagittal view obtained using a centrally located ultrasonography probe. Depending on the location of the placental mass, the patients were assigned to three groups: anterior, posterior, and fundal. The placenta was located in the anterior, posterior, and fundal wall in 52.7% (154/292), 37.7% (110/292), and 9.6% (28/292) of cases, respectively. The duration of the third stage of labor was 6.26 ± 3.89, 6.47 ± 3.68, and 7.42 ± 3.67 min in the anterior, posterior, and fundal placental groups, respectively (P = 0.06). The placenta was separated peripherally in 25% (n = 73) of the patients in each group and centrally in 75% (n = 219). The delta hematocrit value (hematocrit change) was 2.99 ± 4.39, 3.15 ± 6.52, and 2.76 ± 3.04 in the anterior, posterior, and fundal groups, respectively (P = 0.99). This study showed that the location of the placenta did not affect the dynamics of the third stage of labor. Clin. Anat. 30:508-511, 2017. © 2017 Wiley Periodicals, Inc.

The identification of the relationship between the perceived social support, fatigue levels and maternal attachment during the postpartum period.

OBJECTIVE: This study aims to determinate the relationship between social support perceived by women, fatigue levels and maternal attachment in postpartum period. METHODS: The sample of this descriptive study consists of 181 women who gave birth in the study period. The data was collected by the socio-demographic characteristics forms; "Multidimensional Scale of Perceived Social Support" (MSPSS); "Multidimensional Assessment of Fatigue Scale" (MAFS) and "Maternal Attachment Scale" (MAS) on the postpartum first days and 30-40th days. RESULTS: MSPSS scores of women who had university or higher education, employed, had their first pregnancy, have 12 months or less between two pregnancies, were found to be significantly higher than others. MAS scores of women at the end of the postpartum first month were significantly increased. MAFS scores of women at the end of the postpartum first month were significantly decreased. The correlation between the fatigue levels and maternal attachment levels at the end of the postpartum first month was found to be negative and significant. CONCLUSION: In the postpartum period, the care of the mother should include social support, maternal attachment and fatigue assessment. Mothers should be encouraged to use social support resources. The continuity of social support systems should be provided.

Effects of Levonorgestrel Intrauterine System on Patients with Female Sexual Dysfunction.

OBJECTIVE: To examine the effects of a levonorgestrel-releasing intrauterine device (LID) in patients with female sexual dysfunction and who were using this device for contraception. STUDY DESIGN: The results before device application and at the 6-month follow-up were compared using the female sexual function index (FSFI) test on a sample of 36 patients with female sexual dysfunction who had requested the use of the LID for contraception. RESULTS: The FSFI scores before the placement of an LID and at 6-month follow-up were determined to be 19.3±4.8 and 21.1±3.8 (p<0.001), respectively. In addition, the visual analog scale scores and menstruation duration were determined to be statistically significantly different before and after placement. When the FSFI subgroup evaluations were performed, the desire and arousal parameters before and after the application were determined to be statistically significantly different. CONCLUSION: The use of an LID for contraception resulted in positive effects in patients with female sexual dysfunction.

Safety, Efficiency, and Outcomes of Perineoplasty: Treatment of the Sensation of a Wide Vagina.

Background. The sensation of a wide vagina is a common problem for women after childbirth. As its etiology is unknown, there is no uniform management strategy. We hypothesized that, rather than vaginal laxity, the cause was level 3 pelvic support deficiency. Methods. This retrospective study compared preoperative and postoperative genital hiatus length, perineal length, and total vaginal length in patients treated with perineoplasty for the sensation of a wide vagina. A telephone survey was used to determine postoperative patient and male partner satisfaction rates. Results. Mean age of patients was 48 (26-68) years; mean body mass index (BMI) was 25.3 (17.6-33.2); and mean parity was 2.5 (2-5). Preoperative and postoperative genital hiatus, perineal length, and total vaginal length were 4.62 and 3.18 (p < 0.01), 3.06 and 4.04 (p < 0.01), and 9.43 and 9.43 (p = 0.882), respectively. At the 6-month follow-up, the success rate of the perineoplasty procedure was 87.9%; according to a visual analog scale, partner satisfaction rate was 92.6%. Ten percent (n = 4) of patients said they experienced dyspareunia during sexual intercourse at the introitus of the vagina. Conclusion. With low dyspareunia rates, low complication rates, high patient satisfaction, and satisfactory anatomical success, perineoplasty can be considered successful for treatment of the sensation of a wide vagina.

Risk of HSIL (CIN 2-3) on colposcopic biopsy is minimal in postmenopausal women with LSIL on cytology and a negative HRHPV test.

BACKGROUND: Current cervical cancer screening guidelines recommend a 1-year follow-up period for patients with a postmenopausal low-grade squamous intraepithelial lesion (LSIL) who are test negative for high-risk human papillomavirus (HrHPV). The aim of this study was to assess whether such patients had an increased immediate risk of high-grade squamous intraepithelial lesion. METHODS: We assessed 54 HrHPV-negative women with postmenopausal LSIL in the Department of Obstetrics and Gynecology of our hospital between 2012 and 2013. All patients underwent liquid-based cytology and reflex HrHPV testing (for human papillomavirus [HPV] types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68). Colposcopic examination and guided biopsy were performed by the same gynecologist (MO). RESULTS: The average age of the patients was 53.1 ± 3.2 years. There were 33 patients (61%) with cervical intraepithelial neoplasia (CIN) grade 1 and 21 who were non-dysplastic. None of the patients was positive for CIN 2 or any other lesions. CONCLUSIONS: If the HPV test is negative, repeat cytology after 12 months is recommended by the American Society for Colposcopy and Cervical Pathology for cases of HrHPV-negative postmenopausal LSIL. We recommend reflex HPV testing as the best choice for patients who test positive for postmenopausal LSIL by Pap smear, in line with the literature. Diagn. Cytopathol. 2016;44:969-974. © 2016 Wiley Periodicals, Inc.

Are serum gamma-glutamyl transferase, high-sensitivity C-reactive protein, and ischaemia-modified albumin useful in diagnosing PCOS?

We assessed the serum levels of gamma-glutamyl transferase (GGT), high-sensitivity C-reactive protein (hsCRP) and ischaemia-modified albumin (IMA) in patients with polycystic ovary syndrome (PCOS). Fifty-three patients with PCOS were included in our study along with 40 women with no PCOS as the control group. The patients were divided according to their body mass index (BMI). GGT levels were significantly higher in the women with PCOS than the women in the control group (p < 0.05). They were also significantly higher in the PCOS women who were normoweight and overweight than the normoweight and overweight women in the control group (p < 0.001). There was no significant difference in the circulating levels of hsCRP and IMA between the women with PCOS and the controls or between the normoweight and overweight subgroups. GGT may be associated with the diagnosis of PCOS when the threshold is set at >15.5 U/L. With the application of this threshold, raised GGT levels had 83% sensitivity (95% CI 0.70-0.90) and 67.5% specificity (95% CI 0.52-0.79), for the diagnosis of PCOS. In our study, GGT levels were elevated in the PCOS patients independent of BMI and could thus be an important marker of PCOS.

Comparison of the Perioperative Outcomes of a Vessel Sealing Instrument-Assisted Technique with a Conventional Technique in Abdominal Myomectomy.

INTRODUCTION: In gynaecologic practice, LigaSure Precise(TM) is generally used in endoscopic and open surgeries, such as hysterectomy, adnexectomy, and cancer surgery. However, there is no case report or main research article where LigaSure Precise(TM) has been used for myomectomy. We want to compare a technique using a vessel sealing instrument with a conventional technique in abdominal myomectomy. MATERIALS AND METHODS: Fifty-five women who underwent abdominal myomectomy were divided two groups: (1) a vessel sealing instrument-assisted technique (24 patients); and (2) a conventional technique (31 patients) between January 2011 and December 2014 at the Department of Gynaecology and Obstetrics, Gulhane Military Medical Academy, Ankara, Turkey. The data for the operation times, the occurrence of perioperative complications, the hospitalization times, and changes in haemaglobin and haematocrit levels for the two techniques were collected and compared. RESULTS: The mean operation time was 48 minutes for the vessel sealing instrument-assisted technique and 54 minutes for the conventional technique. No statistically significant differences were determined for haemoglobin and haematocrit changes, hospital stay and perioperative complications. CONCLUSION: We did not find any difference in the occurrence of complications, changes in haemoglobin or haematocrit levels, or hospital stay. The vessel sealing instrument-assisted technique is feasible and effective in reducing operation times.

Using narrow-band imaging with conventional hysteroscopy increases the detection of chronic endometritis in abnormal uterine bleeding and postmenopausal bleeding.

AIM: A preliminary study was designed to evaluate whether a narrow-band imaging (NBI) endoscopic light source could detect chronic endometritis that was not identifiable with a white light hysteroscope. MATERIAL AND METHODS: A total of 86 patients with endometrial pathology (71 abnormal uterine bleeding and 15 postmenopausal bleeding) were examined by NBI endoscopy and white light hysteroscopy between February 2010 and February 2011. The surgeon initially observed the uterine cavity using white light hysteroscopy and made a diagnostic impression, which was recorded. Subsequently, after pressing a button on the telescope, NBI was used to reevaluate the endometrial mucosa. RESULTS: The median age of the patients was 40 years (range: 30-60 years). Endometritis was diagnosed histologically. Six cases of abnormal uterine bleeding (6/71, 8.4%, 95% confidence interval [CI] 0.03-0.17) and one case of postmenopausal bleeding (1/15, 6%, 95%CI 0.01-0.29) were only diagnosed with chronic endometritis by NBI (7/86, 8.1%, 95%CI 0.04-0.15). CONCLUSION: Capillary patterns of the endometrium can be observed by NBI and this method can be used to assess chronic endometritis.

Angular pregnancy.

Angular pregnancy is a rare condition in which the embryo is implanted in the lateral angle of the uterine cavity, medial to the uterotubal junction and round ligament, and causes life-threatening obstetric complications. It is important to differentiate this condition from interstitial and cornual pregnancy because they all result in emergency conditions. Although angular pregnancy can progress to term pregnancy, it may be associated with major obstetric complications such as uterine rupture, placental retention, postpartum hemorrhage, or may need further surgery and hysterectomy. This report describes a case of angular pregnancy from the 6th gestational week and continued until delivery in the 32nd gestational week. Sonographic findings, follow-up, and delivery concerns are described in this manuscript.

Comparison of nine morphological scoring systems to detect ovarian malignancy.

PURPOSE OF INVESTIGATION: The aim of this study was to prospectively compare the diagnostic performances of nine gray-scale sonographic prediction models to detect ovarian malignancy. MATERIALS AND METHODS: Clinical data of 322 women presenting with an adnexal mass were obtained and used in nine scoring systems. For each model a ROC curve demonstrating the capacity of the model to diagnose malignancy was constructed for all cases and for the subgroups of premenopause and postmenopause. The performance of each model was expressed as area under the ROC curve, sensitivity, and specificity. RESULTS: The area under the ROC curve, sensitivity, and specificity of these models in the present study varied between 0.737 and 0.929, 70.7% and 87.9%, 60.2% and 80.3%, respectively. CONCLUSIONS: This study has revealed the usefulness of morphological scoring systems to correctly discriminate between benign and malignant pelvic masses.

A modified technique to reduce spillage and the operative time in laparoscopic dermoid cyst excision.

INTRODUCTION: To determine whether controlled drilling, cyst excision, and removal in a bag can reduce the operative time and intraperitoneal spillage in dermoid cysts. MATERIALS AND METHODS: Laparoscopic dermoid cyst excision was performed in 45 women using a different technique: controlled drilling of dermoid cysts in a bag, excision of these cysts, and their removal in the same bag. RESULTS: The median age of the patients was 29.5 years (range, 18-42 years), the median size of the cysts was 55 mm (range, 30-100 mm), the median operative time was 40 minutes (range, 25-60 minutes), the median level of cancer antigen 19-9 was 28.5 U/mL (range, 1.2-127 U/mL), the median parity was 1 (range, 0-3), and the median hospitalization time was 1 day (range, 1-2 days). Twenty-five cysts were in the right ovary, and 20 were in the left ovary. In all cases, the dermoid cysts were ruptured with the controlled drilling. There was no intraperitoneal spillage of the cyst contents in the abdomen. No complication occurred intraoperatively or postoperatively. There was no recurrence 3 months after the operation. CONCLUSIONS: Controlled drilling, excision, and removal of a dermoid cyst inside the same bag seems to be a feasible method to prevent intraperitoneal spillage and to reduce the operative time.