Comparing the effects of intrauterine progestin system and oral progestin on health-related quality of life and Kupperman index in hormone replacement therapy.

AIM: The aim of this study was to compare the effects of intrauterine-system-releasing 20 µg daily of levonorgestrel (LNG IUS) plus 1 mg 17 beta-estradiol daily, orally with combined oral pill containing 1 mg 17 beta-estradiol/2 mg drospirenone daily as hormone replacement therapy, on health-related quality of life (HRQoL) and climacteric symptoms in postmenopausal women. MATERIALS AND METHODS: A 6-month prospective clinical trial was conducted at the Department of Obstetrics and Gynecology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey. Ninety postmenopausal women were accepted to be part of the study. The Euro Quality of Life-5 Dimensions (EQ-5D) and Euro Quality of Life Visual Analogue Scale (EQ VAS) indexes for HRQoL and Kupperman indexes were compared between two groups of patients. RESULTS: Kupperman indexes of both treatment groups decreased gradually over 6 months, but indexes decreased significantly more in the group with intrauterine-system-releasing 20 µg daily of levonorgestrel. Elevations were observed in EQ-5D indexes and VAS values of both groups. EQ VAS values significantly increased in the group on intrauterine progestogen system. Similar changes were observed in the EQ-5D indexes of both groups. CONCLUSION: A hormone replacement therapy regimen that includes an intrauterine progestin system decreased climacteric symptoms and increased HRQoL in postmenopausal women during a follow-up period of 6 months. The extent of the relief of symptoms was greater in this group than in women receiving oral combined hormone replacement therapy. It seems therefore that the intrauterine progestin system could represent a method of choice for endometrial suppression in women using estrogen replacement therapy with distinct advantages over systemically administered progestogens, which have been the subject of considerable debate as reported in the recent literature.

Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis.

OBJECTIVE: The purpose of the present study was to compare the current diagnostic clinical and laboratory approaches to women with vulvovaginal discharge complaint. The secondary outcomes were to determine the prevalence of infections in our setting and to look for the relation between vulvovaginal infections and predisposing factors if present. METHOD: Premenopausal women applying to our gynecology outpatient clinic with vaginal discharge complaint were enrolled prospectively into the study. Each patient evaluated clinically with direct observation of vaginal secretions, wet mount examination, whiff test, vaginal pH testing and chlamydia rapid antigen test. Each patient also evaluated microbiologically with vaginal discharge culture and gram staining. Clinical diagnosis was compared with the microbiological diagnosis (the gold standard). Diagnostic accuracy was measured with sensitivity, specificity, positive (ppv) and negative predictive values (npv). RESULTS: 460 patients were included in the study. 89.8% of patients received a clinical diagnosis whereas only 36% of them had microbiological diagnosis. The sensitivity, specificity, ppv, npv of clinical diagnosis over microbiological culture results were 95, 13, 38, 82%, respectively. The most commonly encountered microorganisms by culture were Candida species (17.4%) and Gardnerella vaginalis (10.2%). Clinically, the most commonly made diagnoses were mixed infection (34.1%), bacterial vaginosis (32.4%) and fungal infection (14.1%). Symptoms did not predict laboratory results. Predisposing factors (DM, vaginal douching practice, presence of IUD and usage of oral contraceptive pills) were not found to be statistically important influencing factors for vaginal infections. CONCLUSION: Clinical diagnosis based on combining symptoms with office-based testing improves diagnostic accuracy but is insufficient. The most effective approach also incorporates laboratory testing as an adjunct when a diagnosis is in question or treatment is failing.

The effects of menopausal uterine fibroids on the prognosis of endometrium cancer.

OBJECTIVE: This study aimed to evaluate any potential associations between uterine leiomyomas and endometrial cancer. MATERIALS AND METHODS: This is a retrospective study of 153 female patients who have been operated because of endometrial carcinoma in our hospital between 2012 and 2017. Data were collected from hospital records. Study participants were divided into two groups according to the presence and absence of leiomyomas. These two groups were compared in terms of histopathological adenocarcinoma type, nuclear and histological grades, disease stage, para-aortic lymph node involvement, and myometrial invasion. For data analysis, Statistical Package for Social Sciences 15.0 software package was used. Comparison between the two groups was made using the chi-square test, and each variable was tested with the Student's t-test for statistical significance. RESULTS: No statistically significant differences were found between the groups with respect to age, tumor type, myometrial invasion, nuclear grade, or histological grade (p>0.05 for all). A significant difference was found between leiomyomas presence and lymph node metastases. The lymph node metastases were more common in patients without uterine leiomyomas (20.55%) than in those with them (5%; p=0.004). Analysis using the Federation of Obstetrics and Gynecology stages for the presence of leiomyomas indicated that the mean stages were 1A and 1B in patients with and without uterine leiomyomas, respectively (p=0.002). CONCLUSION: Uterine leiomyomas did not adversely affect the prognosis of patients with endometrial carcinoma. Moreover, lymph node involvement was less common, and stages were lower in patients with leiomyomas.

The impact of different 75 g oral glucose tolerance test target ranges within normal limits on neonatal outcomes: A validation study.

OBJECTIVE: To investigate the impact of different 75 g glucose tolerance test (OGTT) target ranges within normal limits on neonatal outcomes, thus to investigate the validity of 75 g OGTT thresholds. MATERIALS AND METHODS: The normal 1-hour and 2-hour ranges of 75 g OGTT levels of 110 pregnant women with no gestational diabetes mellitus (GDM) were further divided into three different sub-groups; for the 1 hour as group 1 (<120 mg/dL), group 2 (120-140 mg/dL), group 3 (>140 mg/dL) and for the 2 hour as group 1 (<120 mg/dL), group 2 (120-135 mg/dL), and group 3 (>135 mg/dL). RESULTS: For the 1-hour results, there was no statistically significant difference between groups in terms of age, body mass index, multiparity, neonatal hypoglycemia, hyperbilirubinemia, neonatal intensive care unit admission, birth weight, and LGT rates; however, the rate of small-for-gestational-age (SGA) infants was significantly higher in group 2 compared with those in group 3. For the 2-hour results, statistically similar results were found between the groups. CONCLUSION: A 2-hour 75 g OGTT has reliable threshold values for GDM screening. However, because there are still adverse neonatal outcomes in women with OGTT results below the current thresholds and the number of SGA fetuses is higher in the glucose range 120-140 mg/dL of the first hour, the validity of the 75 g OGTT thresholds still needs further investigation.

Low-grade endometrial stromal sarcoma with retroperitoneal metastases: an unusual case report.

BACKGROUND: Endometrial stromal sarcoma (ESS) is an uncommon malign neoplasm, and its occurrence outside the uterus is extremely rare in the absence of metastasis or extension of a primary uterine neoplasm. When arising in the pelvis or abdominal cavity, ESS is associated with uterine adnexa or serosal surface of various organs. CASE: We present the case of a 46-year-old woman with lower abdominal pain and regular menstruation who underwent laparotomy after a diagnosis of pelvic mass mimicking a right adnexial tumor. Exploration of the pelvis revealed a retroperitoneal mass of 15 cm in diameter in the right illiac fossa without accompanying pelvic or paraaortic lymphadenopathy. Uterus and ovaries were bilaterally normal in size. The pathology showed low-grade ESS of the uterus with direct spread to retroperitoneum without serosal metastases. CONCLUSION: This case shows that despite its well-known good prognostic nature, low-grade ESS may behave as an aggressive malignancy.

Is it necessary to do retroperitoneal evaluation in borderline epithelial ovarian tumors?

OBJECTIVE: Borderline epithelial ovarian tumors have good prognosis without any adjuvant therapy. The advantage of aggressive surgical staging, especially retroperitoneal lymph node sampling is questionable in patients with borderline ovarian tumors. We designed this study to evaluate the necessity of retroperitoneal pelvic and para-aortic lymph node dissection in the treatment of borderline epithelial ovarian tumors. STUDY DESIGN: From 1998 to 2007, 57 women who were diagnosed with borderline epithelial ovarian tumor in our hospital were prospectively accrued and evaluated; 27 of them (47.3%) had full surgical staging procedure including para-aortic and pelvic node dissection. Student's t-test was used to compare follow-up times. RESULTS: Median follow-up time was 54.6 (12-96) months for all patients in the study. There was one recurrence of disease, which was in the complete staging group. Follow-up times of patients were not statistically different between lymph node evaluated and non-evaluated groups (p = 0.10). We did not find any metastasis in lymph nodes in 27 women who had complete surgical staging procedure. CONCLUSION: Patients with borderline epithelial tumors who had full surgical staging procedure do not have survival advantage over those who had no lymph node evaluation and yet were patients with malignant ovarian tumors.

Imperforate hymen: a new benign reason for highly elevated serum CA 19.9 and CA 125 levels.

Imperforate hymen is a urogenital tract anomaly that represents the most frequent congenital malformation of the female genital tract. CA 19-9 and CA 125 are widely used as tumor markers, however several benign conditions are also known to increase serum CA 19-9 and CA 125 levels. According to classical textbook knowledge, imperforate hymen is not listed under the benign conditions that increase serum CA 19-9 and CA 125 levels. In this case report we describe a relation between imperforate hymen and elevated serum CA 19-9 and CA 125 levels.