The effect of individual oocyte matched follicular fluid oxidant, antioxidant status, and pro- and anti-inflammatory cytokines on IVF outcomes of patients with diminished ovarian reserve.

Oocyte matched follicular fluid oxidant, antioxidant status, and pro- and anti-inflammatory cytokine levels were assessed to reveal a possible effect of local-intrafollicular levels of these markers on the individual oocyte with its quality, ability to achieve fertilization, further embryo development, and pregnancy. A cross-sectional study of infertile women with diminished ovarian reserve undergoing antagonist protocol in vitro fertilization (IVF); in the form of ICSI, and fresh single embryo transfer were included. When follicular fluid was collected, each ovarian follicle was aspirated independently, and each follicular fluid was collected into a separate test tube to match it with a single cumulus-oocyte complex obtained from the same follicle. Oocyte matched follicular fluid samples and blood specimens were taken from the participants. Relationships of total antioxidant status, total oxidant status, oxidative stress index, total thiol, interleukin (IL)-6, IL-8, and IL-10 levels of each follicle with oocyte grade, grade of transferred embryos, and pregnancy rate of a given follicle were assessed. A total of 23 infertile women with diminished ovarian reserve and 79 individual follicles of these women were assessed. Serum total oxidant status level of metaphase II (MII) group was significantly lower than non-MII group (P < .001). Follicular fluid IL-6 level of MII group was significantly lower than non-MII group (P = .005). Follicular fluid IL-8 value was significantly low with positive pregnancy results (P < .001). Serum oxidative stress status and follicular fluid pro-inflammatory cytokines were associated with IVF outcomes. This unique study might guide IVF practice with the aim of developing and establishing more effective therapeutic strategies and choosing embryos with more potential for success.

Effects of vitamin D supplementation on ovarian reserve markers in infertile women with diminished ovarian reserve.

ABSTRACT: The purpose of this study was to evaluate the effects of vitamin D supplementation on ovarian reserve markers, including serum anti-Mullerian hormone (AMH) level, follicle-stimulating hormone (FSH) level, and antral follicle count (AFC), in infertile women with diminished ovarian reserve and vitamin D deficiency.A prospective, nonrandomized, cross-sectional study was conducted. Women aged 18 to 41 years who were unable to become pregnant after 12 months of sexual intercourse and had normal tubal patency, partners with normal semen analysis, diminished ovarian reserve, and 25-hydroxyvitamin D [25(OH)D] deficiency were included. Eligible patients' AFC and serum levels of AMH, FSH, 25(OH)D, 1,25-dihydroxyvitamin D [1,25(OH)D], calcium, phosphate, alkaline phosphatase, and parathormone were assessed before and after administration of 300,000 IU of vitamin D ampules. Changes in the parameter values after vitamin D supplementation were compared with the initial levels.The study was conducted in 62 of the 142 participants. The AFC and AMH, 25(OH)D, 1,25(OH)D, phosphate (P < .01), and calcium levels (P < .05) were statistically significantly increased after vitamin D supplementation. Statistically significant decreases in FSH (P < .01) and alkaline phosphatase levels (P < .05) were observed after vitamin D supplementation. No statistically significant correlations were found between 25(OH)D level and AFC, 1,25(OH)D level, AMH level, and FSH level before and after supplementation (P > .05).As improvements in the ovarian reserve markers were obtained with vitamin D supplementation, vitamin D might be considered as a fertility treatment for patients with diminished ovarian reserve and vitamin D deficiency.

Variant type of leiomyomas: 13 years of experience in a single institution.

OBJECTIVES: Our understanding of a variant type of leiomyoma lags far behind of leiomyoma/leiomyosarcoma of the uterus. The rarity of variant type leiomyomas limits epidemiologic study, evidence-based guidance for diagnosis and treatment. We aimed to analyze clinical, pathologic and radiological features of variant type of leiomyomas in women who underwent surgical therapy for symptomatic disease in a tertiary center. We furthermore intended to put forth the recurrence patterns of variant type of leiomyoma after uterine-conserving therapies. MATERIAL AND METHODS: Pathology results and inpatient files of women undergoing surgery (vaginal or abdominal hysterectomy; total abdominal hysterectomy and bilateral salphingoopherectomy; abdominal myomectomy; polipectomy) for symptomatic disease and with a histologic diagnosis of variant type of leiomyoma were assessed. Patient gravida, parity, menopausal status, patient complaint, type of initial surgical procedure, size of neoplasms, number of mitosis, presence of atypia, and necrosis, MRI evaluation, recurrence and any subsequent therapy were documented. RESULTS: A total of 3275 patients' medical records were evaluated between 2005-2018. The study sample comprised of 185 women with a diagnosis of variant type of leiomyoma. The patients ranged from 23 to 79 years of age. One hundred thirty-five cases were postmenopausal and 50 cases were during the reproductive period. The most common presenting symptom was menometrorrhagia (38.9%). Four point nine percent of cellular leiomyoma, 14.2% of smooth muscle tumors of uncertain malignant potential (STUMP) and 4.7% of atypical leiomyomas were recurred with clinical follow-up. CONCLUSIONS: Clinicians should be aware of variant type leiomyomas and their associated clinical, imaging, and pathologic issues.

The comparison of two methods in cervical smear screening - which method is better for smear adequacy rates?

OBJECTIVES: In the cervical smear screening test as a sample collection method for liquid-based thin layer cytology, classically the collecting device is placed into a liquid fixative solution and vigorously swirled or rotated ten times in the solution and the collection device is removed from the solution. In this study, a plastic smear brush was used as the collection device. After the cervical cell sample was obtained, the smear brush was detached from the stick and left in the solution and given to the laboratory. Our aim in the study is to examine whether smear inadequacy rates have decreased with the method used in the study compared to the classical method. MATERIAL AND METHODS: While the classical technique which the collecting device is placed into a solution and mixed and removed from the solution is defined as Method 1. The technique used in the study was defined as Method 2. The cervical smear screening test results obtained by two different methods in two consecutive time periods were analyzed. The two methods were compared using chi-square test in terms of smear inadequacy. RESULTS: A total of 2129 test results, including 1129 smears in Method 1 and 1000 smears in Method 2 were examined. The mean ages of the patients tested in both methods were similar (36 ± 6.1 and 37 ± 6.7). Abnormal test result rate was similar for Method 1 and Method 2 (5.8% vs 4.9%, respectively). The inadequate sample rate was higher in Method 1 than Method 2 (8.3% vs 2.1%, respectively). CONCLUSIONS: The study showed that leaving the smear brush in the solution is a better way to reduce the inadequacy sample rates. This result may guide clinicians about smear techniques.

Predictive Value of Hematological Inflammatory Markers in Endometrial Neoplasia

Objective: To investigate the predictive role of neutrophil lymphocyte ratio (NLR) and the platelet lymphocyte ratio (PLR) as hematological inflammatory markers in cases of endometrial hyperplasia and cancer. Material and Method: This retrospective study was performed between 2005-2015 with 247 cases of 83 endometrial adenocarcinoma (group 1), 64 of endometrial hyperplasia (group 2) and 100 controls (group 3) who underwent a curettage due to abnormal uterine bleeding and had a normal histopathology in our tertiary clinic. The cases were chosen from patients without chronic diseases, that do not have infection or medication that could affect the systemic inflammatory response. Preintervention blood parameters were taken into account. The neutrophil/ lymphocyte and platelet/lymphocyte ratios were and statistical comparisons of the groups were conducted. Results: The age distribution of 247 patients was between 26 and 85 years, and the mean age was 48.8 ± 8.92.The median age was 54 in group 1, 46 in group 2 and 45 in group 3. The age was significant between group 1 and the other groups (p=0.001). Some 71% of the cases were premenopausal and 29% were postmenopausal, the latter being significantly more frequent in group 1 (62.7%; p=0.001). Of the cases with endometrial hyperplasia, 42 (65.6%) had simple and 22 (34.4%) have atypical-complex lesions. The median NLRs in groups 1, 2, and 3 were 2.15, 2.10, and 1.92, respectively, with median PLRs of 135.1, 134.0 and 145.6. There was a statistically significant difference between the NLR measurements of the cases from different groups (p=0.048; p<0.05). The NLR value for the endometrial adenocarcinoma group was significantly higher than for the control group (p=0.033; p<0.05). The optimum cut-off value was calculated to be ≥4, at which sensitivity was 20.5%, specificity 99%, positive predictive value (PPV) 94.4% and negative predictive value (NPV) 60%. Conclusion: The value of NLR ≥4 has predictive significance in distinguishing endometrial pathologies before intervention in patients with abnormal uterine bleeding. Simple, cheap and easy-to-perform, the NLR can be used as a potential hematological marker for endometrial malignancy.

Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: Clinicopathologic-Sonographic Characteristics, Follow-Up and Recurrence.

BACKGROUND: Uterine smooth muscle tumor of uncertain malignant potential (STUMP) is rare tumor, and regarded as sub-classification in uterine smooth muscle tumors between benign and malignant criteria. In this study, we evaluated characteristics of cases with STUMP diagnosis in a 10-year period. METHODS: We retrospectively evaluated medical records of patients with histopathological STUMP diagnosis in Istanbul Training and Research Hospital, a tertiary center. We analyzed preoperative demographic, clinical features and postoperative follow-up. Preoperative sonographic data were re-evaluated. RESULTS: The mean age was 42 years. One patient was postmenopausal, and five patients were premenopausal. All of them had a complaint of meno-metrorrhagia. We re-evaluated preoperative sonographic images of patients, and defined 83.3% as well-defined margins, 66.7% hyperechoic, 100% heterogeneous, 66.7% non-cystic, 50% calcification and 66.7% acoustic shadowing. Pathologic features showed mean number of mitosis 8, mild atypia 66.7%, and necrosis 33.3%. In a 24-year-old unmarried female patient with myomectomy, we detected recurrance of tumor in sonographic and MRI studies after 11 months, and confirmed the diagnosis via tru-cut biopsy. There was no relevance between sonographic findings and atypia, necrosis and mitosis. The recurrence was not in relationship with mitosis, degree of atypia and necrosis. We found no relevance between tumor diameter and mitosis, atypia, necrosis and recurrence. CONCLUSIONS: STUMP is classified as an intermediate form, histopathologically so calling it benign or malignant for sure is not possible. Singulary, solidity, hyperechogenicity, heterogenecity and features of acoustic shadowing and margins can guide us to preoperative sonographic diagnosis. Recurrence/metastasis after many years from operation can be seen, and those patients should be followed long term.

Angiographic Embolization in the Treatment of Puerperal Hematoma.

Puerperal hematoma is one of the life threatening obstetrical emergencies. Surgical ligation of bleeding vessel may not always be possible for the patients who were hemodynamically unstable, hence pelvic arterial angiography may be preferred as the first line treatment modality for these cases. Pelvic arterial angiography and embolization is a safe, tolerable, and minimally invasive treatment modality in the diagnosis and treatment of pelvic hemorrhage. We present a case of puerperal hematoma after a normal spontaneous delivery treated with bilateral iliac arterial embolization.

An Infected Urachal Cyst in an Adult Woman.

The urachus is an embryologic remnant which degenerates after the birth. Defective obliteration of the urachus leads to urachal abnormalities. An infected urachal cyst is one of the urachal abnormalities and this pathology is rare in adult women. We report a case of 33-year-old woman with pelvic pain and dysuria who was diagnosed with infected urachal cyst. Infected urachal cyst is a rare pathology in adult women and this pathology should be considered in the differential diagnosis of acute abdomen.

Histopathological correlation of squamous cell abnormalities detected on cervical cytology.

OBJECTIVE: To investigate the correlation between cytology and cervical biopsy in patients with squamous cell abnormality on cervical cytology. MATERIAL AND METHOD: The cervical smears diagnosed in our clinic between 2005-2008 were reviewed retrospectively. Cases which exhibited squamous cell abnormality (n: 374) were evaluated. RESULTS: The mean age was 45.15±10.78. In the cytopathological results, 256 (68.4%) ASC-US, 21 (5.6%) ASC-H, 31 (8.2%) LSIL, 48 (12.8%) HSIL, and 8 (4.8%) invasive carcinomas were diagnosed. Histopathological results were 213 (57%) nonneoplastic, 85 (22.7%) CIN I, 14 (3.7%) CIN II, 34(9.0%) CIN III and 28 (7.5%) invasive squamous cell carcinomas. Including all squamous cell abnormalities, the sensitivity of the smear test in CIN I and higher grade lesions was 56.95% and the false positivity was 43.04%. Excluding ASC-US and ASC-H lesions, the sensitivity of the smear test was 77.31% and the false positivity was 22.68%. After evaluating cervical cytohistopathological correlation, the positive predictive value was found to be 100% in invasive carcinoma, 62% in HSIL and 38% in LSIL. CONCLUSION: As the grade of cytopathological result increases, the correlation between biopsy and the smear test also increases. The high sensitivity of the cervical smear test for high-grade lesions shows that it is an effective screening test.