Evaluating the role of endometrial colour Doppler dynamic tissue perfusion measurements in in vitro fertilisation success.

The role of uterine receptivity and endometrial perfusion in in vitro fertilisation (IVF) remains unclear. In our prospective pilot study, we used a new dynamic tissue perfusion measurement method to evaluate this relationship in humans. A standard ovulation induction and embryo transfer method were applied to all the volunteers. On the day of embryo transfer, dynamic images of the uterus were recorded using colour Doppler ultrasound, and these images were uploaded onto PixelFlux Chameleon Software (GmbH, Münster, Germany). After determining the region of interest (ROI), the average velocity, intensity, and area values for all coloured pixels in the ROI, the tissue resistance index (RI) and the tissue pulsatility index were calculated. Endometrial thickness, morphology and dynamic endometrial perfusion parameters were compared between the clinically pregnant and non-pregnant groups. Endometrial thickness, morphology values and endometrial dynamic tissue perfusion measurements were similar between the groups. This study compared perfusion parameters between clinically pregnant and non-pregnant patients by accurately calculating endometrial tissue perfusion using standard software to establish its relationship with implantation success in IVF treatment.IMPACT STATEMENTWhat is already known about this subject? The relationship between IVF success, endometrial receptivity and perfusion is known. Clear valuations of endometrial receptivity require an endometrial biopsy which may cause endometrial damage to the actual IVF cycle. This problem has led researchers to conduct non-interventional studies. Studies have revealed the value of endometrial thickness, pattern and Doppler examination of endometrial uterine arteries in predicting the success of IVF treatment.What do the results of this study add? This prospective pilot study is the first one to use this programme in humans to evaluate uterine receptivity in IVF. Successful results can be obtained by using computer programmes in tissues where perfusion parameters cannot be measured using traditional colour Doppler ultrasonography. Revealing the relationship between tissue perfusion and IVF success will be more effective and accurate with the development of software technologies.What are the implications of these findings for clinical practice and/or further research? To increase the success of IVF treatment, current and new technological developments, as well as imaging methods should continue to be tested.

Long-term efficacy of the single-incision mini-sling procedure using surgeon-tailored mesh.

OBJECTIVES: To evaluate the long-term efficacy of a surgeon-tailored single-incision mini-sling procedure (SIMS) for the surgical treatment of stress urinary incontinence (SUI) in terms of objective cure rates, quality of life, and cost-effectiveness. STUDY DESIGN: This retrospective study included 93 women with pure SUI who underwent surgeon-tailored SIMS. All patients were evaluated with a stress cough test and quality of life questionnaire (Incontinence Impact Questionnaire [IIQ-7]) at 1 month, 6 months, 1 year, and last follow-up visit (4-7 years). Early and late (after 1 month) complication rates and the reoperation rate were also evaluated. RESULTS: Mean operative time and follow-up duration were 12 ± 2.5 min and 5.7 years (4-7 years), respectively. Objective cure rates determined by the stress cough test were 83.8%, 94.6%, 93.5%, and 91.3% at 1 month, 6 months, 1 year, and last follow-up, respectively. IIQ-7 scores improved at every visit compared to the preoperative value. There were no cases of hematuria, bladder perforation, or major bleeding requires a blood transfusion. CONCLUSION: Our results suggest that the surgeon-tailored SIMS procedure has high efficacy and low complication rates and offers a practical and inexpensive alternative to commercial high-cost SIMS systems.

Comparison of sexual function between women with iatrogenic and natural menopause.

INTRODUCTION: Menopause refers to the permanent cessation of menstruation resulting from the loss of ovarian activity. Studies have shown that menopause has an impact on the life quality of women as well as their sexual function. In this study, we sought to characterise the differences in the sexual function of women with iatrogenic menopause and those with natural menopause. METHODS: Data were collected from 300 women in this study. The Symptom Check List and the Female Sexual Function Index were the main data collection instruments. Forty-eight patients with a Symptom Check List score ≥0.5 were not included in the study. Therefore, we enrolled a cohort of 252 menopausal women at a tertiary care setting in Turkey. The independent sample t-test, one-way analysis of variance, Pearson correlation and logistic regression analysis were used in this study and p value of <0.05 was considered statistically significant. RESULTS: In our study, menopause women were divided into two equal groups based on the type of menopause (natural vs. iatrogenic). The iatrogenic group was further divided into 3 sub-groups; drug-induced 30 (12%), radiotherapy-induced 18 (7%) and surgical 78 (31%). No significant difference in sexual function between groups were observed with respect to mean scores for desire, arousal, lubrication, orgasm, satisfaction, pain and sexual function (p>0.05). CONCLUSIONS: Our results suggest that sexuality-specific problems during menopause are multifactorial and not solely attributable to biological or psychological factors. Our findings call for comprehensive interventions to address the psychological and biological effects of menopause in order to improve the life quality of women.

Characteristics of suicidal attacks in pregnancy; a multicenter study.

BACKGROUND: Maternal death, fetal death and suicidal attack (SA), each one of these topics are an important public health problem. A suicide attack attempt during pregnancy includes all these important issues together and requires additional attention. Some factors may show regional differences such as suicidal method, distribution of attempts according to the gestational week and the most common preferred drugs. The predetermination of these variables may allow taking preventive measures and advantages can be gains on maternal-fetal health. METHODS: The data of pregnant women who were admitted to 3 different university hospital emergency departments in same city between 2015 and 2020 after a SA was investigated. SAs features and distribution of attacks based on variables such as age, gravidity and gestational week etc. was recorded. In addition, obstetric/non-obstetric injuries and pregnancy outcomes was also analyzed. RESULTS: The mean age of 78 cases was 26.9 ± 6.4 (17-44) years. SAs were detected most frequently in the 1st trimester (42.3%) and at least in the 3rd trimester (20.5%). The most preferred SA method (89.7%) was high-dose drug intake. The most commonly preferred drugs were paracetamol, iron/folic acid replacement therapy drugs and antidepressants. CONCLUSIONS: Pregnant women are at risk of SA, especially in the first trimester. Contrary to popular belief, 75% of pregnant women who have SA do not have a known psychiatric disease diagnosis before. Therefore, psychiatric evaluation should be a part of routine pregnancy follow-up examination, especially in the first trimester. In this way, pregnant women which have increased risk factors for SA such as alcohol addiction, unwanted pregnancy, and depressive mood can be detected early. In this special patient group, the most commonly SA method is high-dose drug intake. Knowing the high dose treatments for frequently used drugs such as paracetamol by emergency physicians and obstetricians, educating medical staff about treatments can save additional time for mother and fetus and can be a life saver approach.

Cervical dysplasia after renal transplantation: A retrospective cohort study.

OBJECTIVE: Since the first days of organ transplantation, it has been accepted that solid transplant recipients have a high risk of developing cancer. Chronic immunosuppression and environmental factors play a role in cancer development in recipients. In the present study, we tried to evaluate the cumulative incidence of cervical dysplasia after renal transplantation, risk factors for disease development, and the time until high-grade dysplasia occurred. MATERIALS AND METHODS: A total of 50 patients with renal transplantation who presented for gynecologic follow-up was included in the study. The medical records of the patients were reviewed until the last clinical visit, their demographic characteristics, transplant history, gynecologic history, and gynecologic examination results (cervical cytology and histology reports) were reviewed. RESULTS: Of the 50 women in the study population, 29 (58%; 95% confidence interval: 8.8-15.9) developed cervical dysplasia after the first transplant at a median follow-up of 7.8 (range: 4.6-12.9) years. Twenty-one women with benign cervical cytology before transplantation had evidence of low-grade intraepithelial lesions + after transplant (47% of these were within 2 years after transplant). During the follow-up, 8 women (18.2%) were diagnosed as having high-grade intraepithelial lesions + (within 5 years after transplantation). CONCLUSION: Renal transplant patients were found to have higher abnormal cervical cytology and histology rates than the normal population.

A rare tumor metastasis of bilateral lung: Epithelioid trophoblastic tumor.

A 44-year-old female patient with a history of a gestational trophoblastic tumor surgery was referred to our clinic upon detection of cystic-cavitary lesion showing slow progression in both lungs. It was decided to perform bilateral surgery in the patient for diagnosis and treatment purposes; first, left upper lobectomy and one month later, right lower lobectomy were applied. Histopathological examination results of the specimens obtained during both operations reported an "epithelioid trophoblastic tumor" metastasis. Aspergilloma was also noted in the tumor in left upper lobe at the same time. Epithelioid trophoblastic tumors, a very rare member of gestational trophoblastic tumors, can achieve distant organ metastasis. Surgical treatment remains important in these cases, which are mostly resistant to chemotherapy.