Management of intra-abdominally translocated contraceptive devices, is surgery the only way to treat this problem?

This study was a multi-centre retrospective review of patients with uterine perforation caused by intrauterine contraceptive devices (IUDs). A total of 15 patients were registered, in a seven year period. Among them, five were asymptomatic and the rest were symptomatic. Asymptomatic patients were managed conservatively, except in one case in which the patient requested surgery because she also wanted a tubal ligation. Symptomatic patients all underwent surgery. All the surgeries were elective and all the surgical procedures were initiated laparoscopically. There were seven complications in the surgically managed group: conversion to laparotomy (n = 3), bowel injury (n = 2), bladder injury (n = 1), and wound infection (n = 1). Mild and severe adhesions (81.8%), and abscess (18.1%) formation related to translocated IUD (TIUD) were observed during surgery. All the patients were uneventful at 1 to 5 years of follow-up. A TIUD, by causing adhesions, complicates future laparoscopic surgery and increases the likelihood of conversion to laparotomy. While surgery is indicated to prevent TIUD-induced adhesive complications, it may also be the cause of both adhesions and complications, resulting in a vicious cycle. Some asymptomatic women, especially elderly patients with comorbidities, may not need or may be better managed without treatment. Impact statement In this study we try to find an answer for the question of "Should removal of a translocated intrauterine contraceptive device (TIUD) routinely be performed even if patients are asymptomatic?" From only the theoretical point of view there were some reports supporting conservative management in asymptomatic patients. The other studies addressing this issue were case reports including few patients with a short-term follow-up. The novelties of the present study include multi-centre design, detailed clinical and surgical information about the patients and the long period of follow-up. Most clinicians have limited experiences in managing TIUD because perforation is a rare event. So it can be difficult to know exactly what the surgeon will encounter intraoperatively. We undertook this study with the aim of providing a perspective about patients with TIUD for those faced with this situation. This is a descriptive study reporting 15 cases of TIUDs and management. Asymptomatic patients were managed conservatively, and symptomatic patients were operated. There are important implications resulting from this study that in asymptomatic patients leaving the IUD in place may be a reasonable option, mostly as the risk of surgical intervention is quite high with a high rate of complications with surgical management.

The diagnostic value of frozen section for borderline ovarian tumours.

Borderline ovarian tumours (BOTs) are characterised histologically by a low degree of cellular proliferation and nuclear atypia in the absence of infiltrative growth or stromal invasion. Surgical treatment has been a crucial component of BOT therapy. Surgical decisions are established intraoperatively via the frozen section. We evaluated the accuracy of frozen section diagnosis. The rate of correct diagnosis, underdiagnosis and overdiagnosis of BOTs with frozen sections was 78%, 17% and 5%, respectively. The sensitivity and positive predictive values for the diagnosis of BOTs with frozen sections were 82.3% and 93.3%, respectively. The positive likelihood ratio was 0.82 (95% CI: 0.85-0.96). The histological classification of BOTs had a significant effect on the accuracy of diagnosis (p = 0.001). Frozen section diagnosis is not suitable to be considered as the gold standard for a definitive diagnosis. Clinicians should be aware that using frozen sections is insufficient for the accurate staging of BOTs.

Is Cryotherapy Friend or Foe for Symptomatic Cervical Ectopy?

OBJECTIVE: To evaluate the success rates and clinical outcomes of cervical cryotherapy applied to cervical ectopy for symptomatic relief. SUBJECTS AND METHODS: A total of 124 women who underwent cryotherapy for symptomatic treatment of cervical ectopy were included in this study. Indications for treatment were: abundant leucorrhoea (n = 114), post-coital bleeding (n = 22), recurrent cervicitis (n = 30) and pelvic pain (n = 12). Cryotherapy consisted of the use of carbon dioxide at -89°C to destroy the ectopic columnar epithelium by freezing, and it was transmitted to the ectopy through a flat cryoprobe. No routine anaesthesia or analgesia was administered. All patients were questioned about the status of their symptoms after 6 weeks of treatment. RESULTS: The highest success rate was obtained in patients with abundant leucorrhoea (n = 102; 89.5%), while the lowest success rate was achieved in subjects with pelvic pain (n = 7; 58%). After treatment, no severe complications were observed, except for hydrorrhoea for a few days. Success rates were 9 times lower in patients who had 3 or more cervicitis episodes per 6 months. CONCLUSION: In this study, the success rate of cryotherapy was highest in patients with abundant leucorrhoea and lowest in patients with pelvic pain and recurrent cervicitis. Hence, we recommend that clinicians perform the procedure in such patients without much delay.

Immediate repair of an incompletely transected obturator nerve during robotic-assisted pelvic lymphadenectomy.

Intraoperative injury of the obturator nerve may occur in gynecologic oncologic procedures when extensive pelvic side wall dissection is performed. In this case, we report an immediate repair of an incompletely transected obturator nerve during robotic-assisted pelvic lymphadenectomy. A 62-year-old gravida 3, para 3 woman was admitted to our clinic for postmenopausal bleeding. The result of an endometrial biopsy was complex endometrial hyperplasia with atypia, and a robotic-assisted laparoscopic hysterectomy was performed. A frozen section of the specimen revealed grade 1 endometrioid adenocarcinoma with >1/2 myometrial invasion. During the pelvic lymphadenectomy, the left obturator nerve was incompletely transected. The obturator nerve edges were oriented and reapproximated end-to-end with two 6/0 polypropylene sutures. The operation and console times were 244 and 223 minutes, respectively. The final pathologic finding was a stage IB endometrial adenocarcinoma. The number of the obtained lymph nodes was 38. Postoperatively, the patient did not exhibit any clinically apparent loss of adductor function or any other neurologic deficiency. Over 6 months of follow-up, the patient experienced no residual neuropathy or deficit in the left thigh. Robotic-assisted repair of a transected obturator nerve during surgery is feasible, and immediate repair of the damaged nerve may result in no neurologic deficit postoperatively.

Laparoscopic removal of an intrauterine device from the sigmoid colon.

Uterine wall perforation which is commonly seen through the posterior wall of the uterus is the most serious complication of an intrauterine device (IUD). We present a case of laparoscopic removal of an IUD from the sigmoid colon in a 31-years-old female who was admitted to hospital with a history of pelvic pain and abnormal vaginal bleeding for one month. The dislocated IUD was removed from the sigmoid colon of laparoscopic intervention without any complications. In conclusion, the treatment modality for the removal of a dislocated IUD is possible by laparoscopic surgery in selected patients where the dislocated IUD is accessible.

The evaluation of homocysteine level in patients with preeclampsia.

OBJECTIVES: The aim of the study was to evaluate the correlation between preeclampsia and blood plasma homocysteine levels. MATERIAL AND METHODS: The research was conducted in a group of 114 pregnant patients who were subdivided into three groups consisting of: 30 women with severe preeclampsia, 24 with mild preeclampsia, and 60 healthy pregnant controls. Patient data included age, parity body mass index (BMI), systolic and diastolic blood pressure, homocysteine, folic acid, vitamin B12, hematocrit, hemoglobin, blood urine nitrogen, uric acid and urine analysis. RESULTS: There were no differences in the demographic characteristics (age, gravidity and BMI) among the groups. Mean serum homocysteine level was significantly higher in the preeclamptic group as compared to controls (p<0.01). Mean homocysteine level in the control group was significantly lower than in the severe and mild preeclampsia groups, respectively (p<0.001 vs. p<0.05). There were no statistically significant differences in homocysteine levels between mild and severe preeclampsia groups (p>0.05). Although there were statistically significant differences among the three groups in terms of BUN, creatinine, AST ALT and LDH, no statistically significant differences in serum folic acid, vitamin B12 and hemoglobin levels were found. CONCLUSIONS: Plasma homocysteine levels are significantly elevated in patients with preeclampsia and are not correlated with disease severity

Significance of foamy histiocytes in cervical smears from postmenopausal women.

OBJECTIVE: To determine the significance of the presence of foamy histiocytes (FH) in postmenopausal cervicovaginal smears for the detection of endometrial carcinomas (EC). STUDY DESIGN: Endometrial sampling was performed over 6 months in 53 of 102 cases that presented with postmenopausal FH, benign endometrial cells (BEC), FH with BEC (FH + BEC), and atypical endometrial cells (AEC), resulting in a total of 41,150 cervicovaginal smears. The control group consisted of 58 cases with a cytologic diagnosis of a normal smear (NS). RESULTS: There were 0 (0%), 1 (4.54%), 2 (13.33%), 2 (33.33%), and 5 (50.00%) cases of EC diagnosed on histopathologic evaluation in patients with NS (n = 58), BEC (n = 22), FH (n = 15), FH + BEC (n = 6), and AEC (n = 10), respectively. The sensitivities and specificities of the cytologic diagnoses of FH, FH + BEC, and AEC for the detection of EC were 81.7 and 100%, 93.6 and 100%, and 92.1 and 100%, respectively. CONCLUSION: The cytologic diagnoses of FH and FH + BEC had reasonably high sensitivities and specificities for the diagnosis of EC by cervicovaginal smear. Additional studies are needed.

Comparison of robotic-assisted laparoscopic myomectomy outcomes with laparoscopic myomectomy.

PURPOSE: This study aimed at comparing short-term outcomes of patients who underwent robotic-assisted laparoscopic myomectomy and laparoscopic myomectomy. METHODS: From January 2008 to August 2010, prospective data including 15 consecutive patients who underwent robotic-assisted myomectomy (RALM) with the da Vinci surgical system were recorded. These cases were compared with a retrospective cohort of 23 patients who underwent laparoscopic myomectomy (LM). Patient demographics, fibroid characteristics and peri-operative data (operative time, anesthesia time, set-up time, console time for robotic cohort, Estimated blood loss (EBL), length of hospital stay, conversion to laparotomy and operative complications were collected in both groups. RESULTS: Mean operative time for the robotic group was 138.73 ± 39.51 min compared with 140.57 ± 38.17 min for the laparoscopy group (p = 0.887). No significant differences were noted between RALM versus LM for hospital stay (1.67 ± 0.58 vs. 1.87 ± 0.67 days, p = 0.369) and EBL (101.33 ± 39.84 vs. 119.78 ± 43.70 ml, p = 0.549). The numbers, size and location of myomas removed for two groups were similar. None of the cases in both groups required conversion to laparotomy. There were no significant intra-operative and post-operative complications in either group. CONCLUSION: RALM appears to provide the same surgical outcomes when compared with traditional laparoscopic myomectomy.

Robotic-assisted sacrocolpopexy/sacrocervicopexy repair of pelvic organ prolapse: initial experience.

PURPOSE: To present the short-term surgical outcomes of robotic-assisted sacrocolpopexy and sacrocervicopexy. METHODS: Between January 2009 and September 2010, 12 patients underwent robotic-assisted pelvic organ prolapse repair including six sacrocolpopexy and six sacrocervicopexy. Patients' demographics, surgical procedures, operative and postoperative complications, hospital stay, conversion to laparotomy, time data including all operative times and estimated blood loss (EBL) were recorded. RESULTS: All surgeries were completed robotically with no conversion to laparotomy. The average operative time for the robotic-assisted sacrocolpopexy (RASCP) was 150.5 ± 29.6 min (range 114-189) and the mean console time was calculated as 123.6 ± 34.2 min (range 84-166). The averages of the dissection and the suturation time were 34.8 ± 24.3 min (range 13-72) and 63.3 ± 21.8 min (range 28-95), respectively. The mean length of hospitalization was 2.8 ± 0.7 days (range 2-4) and the mean EBL was calculated as 12.5 ± 4.1 ml (range 10-20). There was one intraoperative complication. The mean age and body mass index of the patients underwent robotic-assisted sacrocervicopexy were 38.1 ± 6.5 years (29-47) and 28.4 ± 5.8 kg/m(2) (18.6-34.4), respectively. The mean operating times were calculated as follows: set-up time was 25.6 ± 4.0 min, docking time was 3 ± 0.8 min, dissection time was 28.6 ± 7.7 min, suturation time was 70.8 ± 10.9 min and console time was 123.1 ± 23.6 min. There were no recurrences during the follow-up period (12 months) in both groups of the patients. CONCLUSION: The use of the robotic system during pelvic organ prolapse repair is feasible, safe and may support the surgeon during dissection and suturing at the level of sacral promontory.

The clinical importance of polyp size measurement through two-dimensional saline infusion sonohysterography prior to hysteroscopic resection in predicting premalignant and malignant endometrial lesions.

OBJECTIVE: To evaluate the clinical importance of endometrial polyp size measured using saline infusion sonohysterography (SIS) before performing a hysteroscopic resection in predicting premalignant/malignant lesions. METHODS: A retrospective observational study analysis was conducted of 365 patients, who underwent SIS, in a reference hospital. The longest plane of the polyp size was taken as base. Polyps were classified as benign, premalignant, or malignant. RESULTS: The rates of premalignant and malignant lesions were 7.4% and 0.9%, respectively. The mean polyp size was 17.7 ± 0.5 mm in benign patients and 23.7 ± 1.8 mm in premalignant/malignant individuals (P < 0.001). In the group of polyps that were 0-10, 10-20, 20-30, and >30 mm, premalignancy/malignancy rates were 0.0%, 4.8%, 13.3%, and 18.8%, respectively. The cut-off value for polyp size to be able to predict lesions was calculated as 22.5 mm (sensitivity: 63%, specificity: 80%) on receiver operating characteristics curve analysis (P = 0.001, area under the curve 0.732). The power of the study was calculated as 90.86%. CONCLUSION: During the female reproductive years, endometrial polyps smaller than 10 mm, as measured in SIS, can be followed. However, when the polyp size is 22.5 mm or more, especially in postmenopausal women, treatment should be planned.

Could the Long-Term Oncological Safety of Laparoscopic Surgery in Low-Risk Endometrial Cancer also Be Valid for the High-Intermediate- and High-Risk Patients? A Multi-Center Turkish Gynecologic Oncology Group Study Conducted with 2745 Endometrial Cancer Cases. (TRSGO-End-001).

This study was conducted to compare the long-term oncological outcomes of laparotomy and laparoscopic surgeries in endometrial cancer under the light of the 2016 ESMO-ESGO-ESTRO risk classification system, with particular focus on the high-intermediate- and high-risk categories. Using multicentric databases between January 2005 and January 2016, disease-free and overall survivals of 2745 endometrial cancer cases were compared according to the surgery route (laparotomy vs. laparoscopy). The high-intermediate- and high-risk patients were defined with respect to the 2016 ESMO-ESGO-ESTRO risk classification system, and they were analyzed with respect to differences in survival rates. Of the 2745 patients, 1743 (63.5%) were operated by laparotomy, and the remaining were operated with laparoscopy. The total numbers of high-intermediate- and high-risk endometrial cancer cases were 734 (45%) patients in the laparotomy group and 307 (30.7%) patients in the laparoscopy group. Disease-free and overall survivals were not statistically different when compared between laparoscopy and laparotomy groups in terms of low-, intermediate-, high-intermediate- and high-risk endometrial cancer. In conclusion, regardless of the endometrial cancer risk category, long-term oncological outcomes of the laparoscopic approach were found to be comparable to those treated with laparotomy. Our results are encouraging to consider laparoscopic surgery for high-intermediate- and high-risk endometrial cancer cases.

Comparison of robotic-assisted surgery outcomes with laparotomy for endometrial cancer staging in Turkey.

PURPOSE: To compare the results of patients on whom staging was applied by robotic-assisted laparoscopic surgery and laparotomy for endometrial cancer. METHOD: The study included 10 patients who had undergone robotic-assisted endometrial staging (group 1) and 12 patients staged by open surgery (group 2). Demographical characteristics and operative outcomes of all patients were compared. Body mass index, age, previous abdominal surgeries, histopathologic characteristics, performed operative procedure, operation time, complications, hospitalization duration, estimated blood loss and number of resected lymph nodes were recorded for all patients. RESULTS: Mean age of the patients in the robotic surgery group was 55.7 years (37-66) and in the laparotomy group 56.4 years (47-75). Body mass index was calculated as 32.7 kg/m² (24.5-40.3) in group 1 and 30.3 kg/m² (25.9-35.8) in group 2. Total duration of operation was 234.6 min (137-300) and 168.5 min (102-232) in group 1 and 2, respectively. Mean duration of hospitalization in group 1 was 2.8 days (2-5) and in group 2 was 8.8 days (6-13). Estimates of blood loss were 95 ml (20-210 ml) in the robotic surgery group and 255 ml (80-420) in the other group. The mean number of resected lymph nodes was 42 (13-86) and 46.5 (26-107) in the robotic-assisted surgery group and laparotomy group, respectively. None of the cases in the robotic-assisted endometrial staging group required transition to laparotomy. CONCLUSION: Robotic surgery may be preferred over laparotomy with respect to the advantages observed in the duration of hospitalization, estimated amount of blood loss and complications. There was no significant difference between the two methods in terms of number of resected lymph nodes. Despite the limited number of patients in this study, these results are important as they represent the first data on robotic surgery in Turkey.

Turkey's experience of robotic-assisted laparoscopic hysterectomy: a series of 25 consecutive cases.

PURPOSE: To present the outcomes of the first 25 robotic-assisted hysterectomies from Turkey. METHOD: A total of 25 patients who underwent robotic-assisted hysterectomy (RAH) for benign conditions were included in the study. Patients' demographics, surgical procedures, operative and postoperative complications, hospital stay, conversion to laparotomy, time data including all operative times, uterus weight and estimated blood loss (EBL) were recorded. All hysterectomies were American Association of Gynecologic Laparoscopists type IVE. RESULTS: All hysterectomies were completed robotically with no conversion to laparotomy. The mean and range of the operating time were 104.1 and 47-176 min, respectively. The mean hysterectomy time was 40.5 min (range 14-77). The mean cuff incision time and cuff suturation time were 6.8 min (range 2-18) and 16.4 min (range 7-40), respectively. The mean set-up time was 30.4 min (range 17-41 min). The mean docking time was 4.3 min (range 2-9 min). The mean console time was 74.2 min (range 30-137). The mean and range of the anesthesia time were 133.8 min and 75-210 min, respectively. The averages of EBL and uterus weight were calculated as 38.2 cc and 221.9 g, respectively. Three complications occurred: one postoperative paralytic ileus and the others were peroperative vaginal cuff lacerations during the removal of the specimen through the vagina. CONCLUSION: Robotic-assisted hysterectomy (RAH) is feasible and safe for women with benign uterine pathologies, although it has limitations that may be overcome in the future.

Laparoscopy-assisted cystectomy for large adnexal cysts.

OBJECTIVE: To evaluate the feasibility and surgical outcome of laparoscopy-assisted surgery for large adnexal cysts. METHODS: From January 1998 to October 2007, 46 women underwent laparoscopy-assisted surgery for large adnexal cysts whose maximum diameter were between 10 and 20 cm, radiologic and laboratory features suggestive of benign disease. All the patients had a pre-operative ultrasound with or without computed tomography and CA-125 assessment. Patients' demographics, clinical and ultrasound features, CA-125 values, surgical procedures, operative and post-operative complications, estimated amount of blood loss (EBL), operative time, conversion to laparotomy and the pathological findings were recorded. RESULTS: Fourty-six consecutive patients underwent laparoscopy-assisted surgery over 9 years. The mean and range of the patients' age and body mass index were 34.1 +/- 6.3 and (21-45) years and 27.4 +/- 5.9 and (22-40), respectively. In all the patients, except one with borderline ovarian tumor, laparoscopy-assisted surgery was successful. There were no operative or post-operative complications. The mean and range of the operative time, EBL and hospital stay were 48.4 +/- 7.3 and (35-65) min, 55.0 +/- 28.9 and (25-150) mL, 1.49 +/- 0.50 and (1-3) days, respectively. The mean and range of the extracorporeal cystectomy time were 10.2 +/- 2.7 and (8-14) min. The surgical procedures performed were: ovarian and paraovarian cystectomy (n = 45), unilateral salpingo-oophorectomy, pelvic-paraaortic lymphadenectomy and omentectomy (n = 1). Pathologic findings included serous cystadenoma (n = 26), mucinous cystadenoma (n = 7), dermoid (n = 6), endometriosis (n = 6), and borderline ovarian tumor (n = 1). CONCLUSION: Laparoscopy-assisted surgery is feasible and safe for women with large benign adnexal cysts and result s in a short surgery time.

A conservative approach to unilateral ovarian torsion in a rat model.

OBJECTIVE: To determine whether surgical detorsion is effective in preventing surgical resection in a rat model of ovarian torsion. METHODS: This study was performed between July 2002 and May 2003 in the Department of Obstetrics and Gynecology of Gaziantep University Hospital, Gaziantep, Turkey. Fifty adult female rats were randomized into 10 groups. The right ovaries in the study groups were manually twisted under general anesthesia. The duration of ovarian torsion was 24, 48, 72, or 96 hours. Each group was also divided into 2 subgroups according to the time lapse following detorsion (24 or 72 hours). During autopsy, both ovaries from each animal were removed for histopathological examination. Tissue injury was graded from 0 (no injury) to 3 (necrosis). RESULTS: Follicle development was observed in all specimens. After 24 hours following detorsion, the histopathology scores of the twisted right ovaries were significantly higher compared to the untwisted left ovaries in groups with torsion periods of 48 (p=0.04), 72 (p=0.03), and 96 hours (p=0.04). The histopathology scores of the twisted right ovaries at 24 hours following detorsion were significantly higher than those at 72 hours following detorsion in all groups (p<0.05). CONCLUSION: The results show that conservative management by surgical detorsion in rats, even in those with a torsion period of 96 hours, can restore ovarian tissue viability. Furthermore, recovery observed in the twisted ovaries was better at 72 hours compared to that at 24 hours following detorsion.

Cephalopagus conjoined twins presented with encephalocele: diagnostic role of ultrafast MR imaging.

Conjoined twinning is a rare abnormality and cephalopagus is a very rare form of conjoined twins. We report a case of cephalopagus conjoined twins with encephalocele and omphalocele which diagnosed by ultrasonography and ultrafast magnetic resonance (MR) imaging at 24 weeks of the gestation. Ultrafast MR imaging can provide image quality superior to two dimensional ultrasonography and should be considered an adjunct to ultrasound for antenatal characterization of some anomalies. To the best of our knowledge, this is the first case of cephalopagus conjoined twins with encephalocele and omphalocele which diagnosed by ultrasound and ultrafast MR imaging.

Placenta percreta with concomitant uterine didelphys at 18 weeks of pregnancy: a case report and review of the literature.

AIM: The aim of this paper is to draw the attention of the clinicians on placenta percreta detected along with uterine anomalies in early second trimester. CASE PRESENTATION: A 35-year-old, gravida 2 parity 1 woman at 18 weeks of pregnancy was admitted to our emergency unit with abdominal pain. In ultrasound exam, a live fetus compatible with 18 weeks of gestation, hemoperitoneum and a solid mass adjacent to the uterus were detected. An emergent laparotomy was decided because of hemorrhagic shock findings. In the operation, uterine didelphys and an active bleeding area from placenta percreta on the anterior wall of the uterus where pregnancy was settled were detected. In the simultaneous vaginal examination two cervixes and a longitudinal vaginal septum were seen. Supracervical hemihysterectomy was performed. CONCLUSION: Placenta percreta is a rare clinical entity with an elevated perinatal mortality. Uterine anomalies are risk factors for placental adhesion anomalies. Clinical suspicion is vital for early diagnosis and timely management.

Does metoclopramide exposure alter endometrial receptivity and decrease pregnancy rates?

OBJECTIVE: The aim of this study was to investigate the effect of metoclopramide on endometrial receptivity with an immunohistochemical investigation of integrin ß3 expression in pregnant rats. MATERIALS AND METHODS: In the present study, the pregnant mice administrated by different doses of metoclopramide were used to explore the effect of metoclopramide on embryo implantation, especially on the endometrial receptivity. RESULTS: The statistical results showed that the number of implanted embryos was gradually declining along the increasing dose of metoclopramide. When the administrated dose of metoclopramide was 3 mg/kg per day, great changes were observed in the exposed uterine morphology and down-regulated integrin ß3 were also found in high dose metoclopramide-exposed mice. CONCLUSION: Metoclopramide exposure, especially in high doses may alter endometrial receptivity by effecting integrin expression on decidual tissue which can decrease pregnancy rates. This drug should only be recommended for use during pregnancy when benefit outweighs the risk.

A hidden reason for menopausal symptoms in premenopausal aged women: depression.

BACKGROUND: The relationship between depression and reproductive hormone changes in menopausal women is well konown but recent animal studies showed that depression can also cause changes in reproductive hormone levels. According to this, we aimed to eveluate the impact of depression on circulating follicle-stimulating hormone and estradiol levels in premenopausal women in terms of menopausal symptoms. MATERIAL-METHOD: A total of 120 premenoupausal women (age ranges 41-45) were divided into two groups as: study group consisted of patients (n = 60) with depression and the control group (n = 60) involved healthy women. Psychometric assessment of study group was done by the Turkish version of Structured Clinical Interview for DSM-IV Diagnosis.The presence of menopausal symptoms of all subjects was assessed by the Turkish version of Menopause Rating Scale and hormonal activity by estimating estradiol and follicle-stimulating hormone levels. RESULTS: Study group had significantly lower mean concentration of estradiol and higher intensity of menopausal symptoms than control group. Presence and severity of menopausal symptoms were not associated with follicle-stimulating hormone concentrations. CONCLUSION: The results of this study confirm the connection between menopausal symptoms and depression both on clinical and physiological level.The current study is unique in its ability to assess the effects of depression on menopausal symptoms in women as they are still reproductive.

Surgical Treatment of Scar Endometriosis Following Cesarean Section, a Series of 12 Cases.

It is difficult to conduct studies with larger series in rarely observed diseases. We report our experience in managing cesarean scar endometriosis (CSE) and emphasize the diagnosis and treatment options. The objective of our study is to review the clinical characteristics of CSE and to evaluate our surgical outcomes. We have collected and documented a case series of 12 patients who underwent surgical wide en bloc excision with surrounding clear margins for CSE. Patients' demographic features, symptoms, and clinical and operative findings were evaluated. The mean age was 34.6 years. Cyclical pain was documented in seven patients, while three patients presented with noncyclical pain. Menstrually-related enlargement of the nodule was observed in four patients, and only one patient had a complaint of dark brown leakage. The mean operation time was 26 min. The endometriotic lesions ranged from a diameter of 2 to 8 cm in size. Patients recovered completely, and no recurrence was observed. To prevent iatrogenic transplantation, additional attention is needed during surgery that exposes endometrial tissue. Complete wide excision of CSE is both diagnostic and therapeutic. To avoid unnecessary referrals, awareness of its typical clinical manifestations remains the mainstay for intervention. The most important issues to be considered during surgery is nonspreading endometriosis while manipulation.