Comparison of laparoscopic lateral suspension and laparoscopic sacrocolpopexy with concurrent total laparoscopic hysterectomy for the treatment of pelvic organ prolapse: a randomized controlled clinical trial.

INTRODUCTION AND HYPOTHESIS: We compared the outcomes of women who underwent laparoscopic lateral suspension with concurrent total laparoscopic hysterectomy (LLS-TLH) with those of women who underwent laparoscopic sacrocolpopexy with concurrent total laparoscopic hysterectomy (LSC-TLH) for apical and/or anterior vaginal wall prolapse. METHODS: Eighty women underwent LLS-TLH or LSC-TLH operations. According to the Pelvic Organ Prolapse Quantification System (POP-Q), women with symptomatic pelvic organ prolapse of stage 2 or higher apical and/or anterior compartment prolapse were enrolled in the study. The objective cure rate according to the POP-Q system was the primary (objective) outcome. The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Patient Global Impression of Improvement (PGI-I) questionnaire scores were the secondary (subjective) outcomes. The primary and secondary outcomes were evaluated at 1 year after surgery. RESULTS: The primary and secondary outcomes indicated significant improvements in both groups (p < 0.05). The objective cure rate was 92.5% for apical and 78.6% for anterior compartment prolapse in the LLS-TLH group; the respective rates were 100% and 74.1% in the LSC-TLH group. The subjective cure rate was 87.5% for the LLS-TLH group and 90% for the LSC-TLH group. No statistically significant differences between groups were found in the objective cure rate, subjective cure rate, or ICIQ-VS, ICIQ-SF, or PGI-I scores at 1 year (p > 0.05). CONCLUSIONS: LLS-TLH can serve as a safe, effective, and feasible alternative to LSC-TLH, with low complication rates and similar short-term objective and subjective outcomes.

The impact of timing for estrogen supplementation in polycystic ovary syndrome patients undergoing primed in vitro maturation.

OBJECTIVE: This study aims to determine the effects of early and late onset estrogen supplementation on the immature oocyte retrieval, fertilization and clinical pregnancy rates in follicle stimulating hormone (FSH) and human chorionic hormone (hCG) primed in vitro maturation (IVM) cycles of the patients with polycystic ovary syndrome (PCOS). METHODS: This is a retrospective analysis of 161 patients with PCOS who underwent FSH and hCG primed IVM. Group 1 included 120 patients who received early onset estrogen supplementation while group 2 consisted of 41 patients who had late onset estrogen supplementation in primed IVM cycles. Immature oocyte (germinal vesicle and/or metaphase I) retrieval and fertilization rates were the primary outcomes, whereas clinical pregnancy and live rates were the secondary outcomes. RESULTS: Group 1 patients had significantly higher body mass index and more previous IVF attempts (p = 0.001 and p = 0.008, respectively). All of the retrieved oocytes from the PCOS patients were either germinal vesicle or metaphase I oocytes and there were no metaphase II oocytes among the retrieved oocytes. Both groups had statistically similar numbers of metaphase I and fertilized oocytes (p > 0.05 for both). However, group 1 patients had significantly lower number of germinal vesicle oocytes but significantly higher number of metaphase II oocytes (p = 0.001 for both). Both groups had statistically similar fertilization (85.0% vs 78.0%), clinical pregnancy (49.2% vs 43.9%) and live birth (37.5% vs 39.0%) rates (p > 0.05 for all). CONCLUSION: Early onset estrogen supplementation appears to improve the quality of retrieved immature oocytes and contribute to the maturation of oocytes in stimulated IVM cycles.

Hair Transplantation in Burn Scar Alopecia After Combined Non-Ablative Fractional Laser and Microfat Graft Treatment.

BACKGROUND: Burn scar and alopecia on hair-bearing areas can severely affect the social life of patients. Unlike healthy skin, poor biological and mechanical properties of scar tissue in the recipient area can reduce the survival rate of hair graft following hair transplantation. OBJECTIVES: The authors sought to determine if combined non-ablative fractional laser (NAFL) and microfat injection could improve the survival rate of hair grafts on post burn scar. METHODS: Thirteen patients with alopecia resulting from burn scar in hair-bearing areas of the scalp and face were treated with combined NAFL and microfat graft and subsequent follicular unit extraction hair transplantation. Cicatricial alopecia occurred on the scalp, eyebrow, mustache, and beard areas. Patients were treated with 3 to 6 sessions of NAFL and 2 to 5 sessions of microfat graft injections, followed by 1 session of hair transplantation employing the follicular unit extraction technique. RESULTS: Hair transplantation was successfully performed with good to excellent results. The survival rate of transplanted follicular units ranged from 76% to 95% (mean, 85.04%), and the density success rate per square centimeter ranged from 76.9% to 95.2% (mean, 84.54%). All patients expressed high satisfaction with the results and no complication was encountered. CONCLUSIONS: Hair transplantation, after combined NAFL and microfat injection, is a promising treatment for post burn alopecia.

Quantitative measurements of celeration times and indexes in the ductus venosus spectral Doppler waveforms in normal fetuses.

Background Ductus venosus spectral waveform has two peaks and two nadirs: S, v, D and a velocities, which are obtained after to some extent of accelerations or decelerations throughout a cardiac cycle. It is aimed to define the actual celeration times and indexes and their relationships with the fetal heart rate (FHR). Methods The acceleration times and indexes were measured in 357 patients between 11 and 40 weeks of pregnancies with low risk. Results The FHR has a gradual increasing negative correlation from time for S to time for a with each of the cardiac times of phases according to the statistical analysis (correlations were minus 190, 269, 407 and 541 for S, v, D and a phase times, respectively). The acceleration aS and the deceleration Da have positive correlations with the FHR; however, the deceleration Sv and the acceleration vD do not correlate with the FHR. Conclusion The deceleration Da time and index are the main components for determining the FHR in fetuses. Therefore, the atrial contraction is the strongest component for determining the FHR in fetuses.

Pathology of cigarettes on the reproductive system and ameliorative effects of alpha lipoic acid: A rat model study.

Cigarette smoking (CS) has some detrimental effects that occur via oxidative stress (OS). The aim of this work was to demonstrate the pathological and immunohistochemical effects of CS and the protective effects of a strong antioxidant alpha lipoic acid (ALA) on CS-induced genital system changes in a rat model. Twenty-eight female rats were randomly allocated to three groups as control, CS-exposed, and CS-exposed and ALA-treated. Reproductive tract organs were collected for biochemical and pathological examinations. In the CS group, OS markers increased in the tissues of both the ovary and fallopian tubes. Decreased follicle numbers in the ovary, marked cilial loss in the fallopian tubes, and pathologic changes in the uterus were observed in the CS group. Positive calcitonin gene-related peptide (CGRP), caspase 3α, hypoxia-inducible factor 1α (HIF-1α), tumor necrosis factor-α (TNF-α) immunoreactions were observed in uterine tissues and HIF-1α immunoreactions in tubal and uterine epithelial cells of the CS group. ALA reversed all these findings effectively. CS has negative effects on the female reproductive system via HIF-1α in tuba uterina and HIF-1α, HIF-2α, TNF-α, caspase 3, and CGRP in the uterus, and ALA could protect against the negative effects of CS on the female reproductive system.

The impact of electromagnetic radiation (2.45 GHz, Wi-Fi) on the female reproductive system: The role of vitamin C.

The present study investigated the effects of applied continuous 2.45 GHz electromagnetic radiation (EMR), which might cause physiopathological or morphological changes in the ovarian, fallopian tubal, and uterine tissues of rats. We proposed that the addition of vitamin C (Vit C) may reduce these severe effects. Eighteen female Sprague Dawley rats were randomly divided into three groups with six animals in each: Sham, EMR (EMR, 1 h/day for 30 days), and EMR + Vit C (EMR, 1 h/day for 30 days 250 mg/kg/daily). Total oxidant status (TOS) and oxidative stress index (OSI) levels increased ( p = 0.011 and p = 0.002, respectively) in the EMR-only group in ovarian tissues. In all tissues, TOS and OSI levels significantly decreased in the Vit C-treated group in ovarian, fallopian tubal, and uterine tissues ( p < 0.05). Anti-müllerian hormone levels significantly increased in the EMR group ( p < 0.05) and decreased in the Vit C-treated groups. Estrogen (E2) levels were unchanged in the EMR group, as the differences were not statistically significant. Immunohistochemical examination of the ovaries revealed significant increases in Caspase-3 expressions in the epithelial cells of the EMR group ( p < 0.05). In the EMR group, hyperemia was observed in uterine tissues. Also, Caspase-3 and Caspase-8 were significantly increased in the EMR group ( p < 0.001). Caspase-3 was significantly diminished with Vit C application in the ovarian and uterine tissues ( p < 0.05). Caspase-8 was significantly diminished only in uterine tissues ( p < 0.05). These results indicate that prolonged EMR exposure induced physiopathological changes in the ovarian, fallopian tubal, and uterine tissues due to oxidative damage. Under the conditions of this study, Vit C may have protective effects on female reproductive system against oxidative damage.

The association between serum ghrelin levels and large-for-gestational-age fetuses in patients with gestational diabetes mellitus.

We aimed to determine the relationship between serum ghrelin levels and large-for-gestational-age (LGA) fetuses in patients with gestational diabetes mellitus (GDM). A case-control study was conducted in 32 women with GDM and LGA fetuses (GDM + LGA group), 35 women with GDM and appropriate-for-gestational-age (AGA) fetuses (GDM + AGA group), 32 women with normal glucose tolerance (NGT) and LGA fetuses (NGT + LGA group), and 31 women with NGT and AGA fetuses (NGT + AGA group). All participants were recruited at the time of GDM diagnosis between 24 and 30 weeks of pregnancy. Participants also underwent ultrasonographic examinations. Serum ghrelin levels were significantly higher in GDM + LGA and GDM + AGA groups than in the NGT + AGA group. In the univariate model, biparietal diameter, head circumference, abdominal circumference (AC), femur length and ghrelin values were significant predictors of LGA fetuses. In the multivariate model, only AC remained as a predictor of LGA fetuses.

Comparison of thyroid function tests and blood count in pregnant women with versus without gestational diabetes mellitus.

AIM: The aim of this study was to compare thyroid function and complete blood count parameters in pregnant women with versus without gestational diabetes mellitus (GDM). METHODS: A total of 269 pregnant women patients with (n = 110, GDM group) or without (n = 159, non-GDM group) GDM were included in this study. Data on age, rate of cesarean section, birthweight of neonate, hemogram, and thyroid function tests were collected. Multivariate analysis was performed to determine factors predicting increased risk of GDM. RESULTS: Rate of cesarean section (70.9 vs 57.2%, P = 0.022), median (max-min) age (33.0 [26.0] vs 26.0 [20.0] years, P < 0.001), platelet count (246.7 ± 68.3 vs 227.8 ± 64.2 ×103 /µL, P = 0.021) and thyroid-stimulating hormone (1.3 [97.6] vs 1.0 [4.1] µIU/mL, P = 0.028) were significantly higher in the GDM than in the non-GDM group; whereas mean platelet volume (10.4 [5.3] vs 10.6 [5.6] fL, P = 0.031) and free triiodothyronine (FT3) (2.9 [3.6] vs 3.1 [3.0] pg/mL, P < 0.001) levels were significantly lower in the GDM than in the non-GDM group. Older age (odds ratio, 1.281; 95% confidence interval, 1.182-1.389, P < 0.001) and lower FT3 levels (odds ratio, 0.295; 95% confidence interval, 0.149-0.586, P < 0.001) were independently associated with increased risk of GDM. CONCLUSION: Our findings revealed that lower FT3 levels and older age predict the likelihood of developing GDM in euthyroid pregnant women, with no influence of other thyroid hormones or blood counts on the risk of GDM.

Assessment of circulating betatrophin concentrations in lean glucose-tolerant women with polycystic ovary syndrome.

The aims of the current study were to investigate the betatrophin levels in lean glucose-tolerant women with polycystic ovary syndrome (PCOS), and to explore the relationships between these levels and antropometric, hormonal and metabolic parameters. The study population consisted of 50 lean (body mass index [BMI] < 25 kg/m2) women diagnosed with PCOS using the Rotterdam criteria, and 60 age- and BMI-matched healthy controls without any features of clinical or biochemical hyperandrogenism. Before recruitment, glucose tolerance was evaluated in all of the subjects using the 2-h 75 g oral glucose-tolerance test, and only those exhibiting normal glucose tolerance were enrolled. Serum betatrophin levels were significantly higher in women with PCOS (median 322.3; range 44.7-1989.3 ng/L) compared to the controls (median 199.9; range 6.2-1912.9 ng/L; p = .005). In the control group, no significant correlation was evident between betatrophin levels and clinical or biochemical parameters. In the PCOS group, betatrophin levels were positively correlated with prolactin levels (r = .286, p = .046) and negatively correlated with BMI (r = -.283, p = .049), waist/hip ratio (r = -.324, p = .023), and low-density lipoprotein cholesterol levels (r = -.385, p = .006). Impact statement What is already known on this subject: Several studies have suggested that primary alteration in beta-cell function is a pathophysiological feature of PCOS, and insulin resistance is the most significant predictor of beta-cell dysfunction independent of obesity. Betatrophin is a circulating protein that is primarily expressed in the liver in humans. Early experimental investigations demonstrated that overexpression of betatrophin significantly promoted pancreatic beta-cell proliferation, insulin production and improved glucose tolerance. Few studies have investigated the association between PCOS and betatrophin. However, in contrast to our study, the authors included overweight/obese patients and glucose tolerance was not evaluated before recruitment. What the results of this study add: Our results showed that serum betatrophin levels were significantly higher in lean glucose-tolerant PCOS women than in age- and BMI-matched healthy controls. What are the implications of these findings for clinical practice and/or further research: Elevated betatrophin levels in PCOS women, in the absence of obesity and glucose intolerance, may reflect a compensatory mechanism in order to counteract metabolic syndrome-related risk factors.

Validation of Revised FIGO Staging Classification for Cancer of the Ovary, Fallopian Tube, and Peritoneum Based on a Single Histological Type.

OBJECTIVE: This study aimed to evaluate the prognostic significance of revised International Federation of Gynecology and Obstetrics (FIGO2013) staging classification for cancer of the ovary, fallopian tube, and peritoneum in patients exhibiting high-grade serous histology. METHODS: Clinical records of patients with high-grade serous carcinoma who underwent primary surgery between 2007 and 2012 were reviewed retrospectively. Patients were reclassified according to the FIGO2013 criteria. Progression-free survival (PFS) and overall survival (OS) were calculated for each stage using Kaplan-Meier estimates and compared with the log-rank test. RESULTS: In total, 125 patients were included in the analysis. The distribution of the study cohort according to the revised classification was as follows; stage I, 6 patients; stage II, 9 patients; stage III, 85 patients; and stage IV, 25 patients. Median follow-up time was 36 months (95% confidence interval [CI], 3-110). The median PFS and OS were 14 months (95% CI, 12.4-15.6) and 60 months (95% CI, 47.0-72.9), respectively. Both PFS and OS were significantly different among stages I, II, III, and IV (P < 0.01). Subgroup analyses for stage III disease also revealed significant differences in survival. The median PFS for stages IIIA1, IIIB, and IIIC was 56, 46, and 16 months, respectively (P < 0.01), and the median OS was 104, 95, and 60 months, respectively (P = 0.03). The outcomes of patients with stage IV disease differed slightly but nonsignificantly according to new substages. The median PFS for stages IVA and IVB was 12 and 6 months, respectively (hazard ratio, 1.16; 95% CI, 0.48-2.79; P = 0.72), and the median OS was 41 and 24 months, respectively (hazard ratio, 1.62; 95% CI, 0.58-4.55; P = 0.35). The study sample was insufficient in size for subgroup analyses in stages I and II. CONCLUSIONS: The revised FIGO2013 staging system is highly prognostic for discriminating outcomes of patients with high-grade serous carcinoma across stages I to IV, in subgroups of stage III, but not in subgroups of stage IV.

Increased serum ghrelin in preeclampsia: is ghrelin a friend or a foe?

OBJECTIVES: To investigate maternal serum ghrelin levels in pregnancies complicated by preeclampsia and to explore the relationship between ghrelin level and disease severity. MATERIALS AND METHODS: This case-control study included 40 healthy pregnant women, 42 women with mild preeclampsia, and 40 women with severe preeclampsia. The groups were matched in terms of maternal and gestational age and body mass index. Serum ghrelin levels were measured via enzyme immunoassay. RESULTS: Serum ghrelin levels were significantly higher in women with mild and severe preeclampsia than in healthy controls (p < 0.001). Although serum ghrelin levels were somewhat higher in the severe compared to the mild preeclampsia group, the difference was not statistically significant (p > 0.05). In the control group, no significant correlation was observed between ghrelin level and any other parameter, but in the preeclampsia group, serum ghrelin levels were negatively correlated with uterine artery Doppler index values and both systolic and diastolic blood pressure (all p-values < 0.05). Multivariate stepwise linear regression analysis revealed that systolic blood pressure (ß = 0.493, p = 0.023) was independently associated with serum ghrelin level. CONCLUSION: Elevated blood ghrelin levels were correlated with disease severity in pregnancies complicated by preeclampsia.

Evaluation of circulating betatrophin levels in gestational diabetes mellitus.

Experimental data indicate that betatrophin plays a significant role in the regulation of lipid metabolism and glucose homeostasis. In recent years, considerable attention has focused on the relationship between betatrophin and diabetes mellitus in humans. This case-control study included 45 women diagnosed with gestational diabetes mellitus (GDM) and 45 pregnant healthy controls. The groups were matched for maternal and gestational age and body mass index. Serum betatrophin levels were significantly higher in women with GDM (median = 635.8 ng/L; range: 290-1841.6 ng/L) compared to control subjects (median = 320.1 ng/L; range: 94.6-936.8 ng/L; p = 0.001). No significant correlations were observed between serum betatrophin levels and clinical or biochemical parameters in the control group. However, in the GDM group, serum betatrophin levels were positively correlated with weight gain during pregnancy (r = 0.304, p = 0.042), systolic blood pressure (r = 0.394, p = 0.007), fasting insulin level (r = 0.348, p = 0.019), and homeostatic model assessment insulin resistance (HOMA-IR; r = 0.311, p = 0.038). Multivariate stepwise linear regression analysis revealed that fasting insulin levels (ß = 0.342, p = 0.022) and HOMA-IR (ß = 0.312, p = 0.037) were independently associated with serum betatrophin levels.

Pycnogenol prevents peritoneal adhesions.

PURPOSE: This study tested the ability of pycnogenol, an extract from the bark of the French maritime pine (Pinus pinaster), to prevent intra-abdominal adhesions. METHODS: Thirty female Wistar albino rats were separated randomly into three equal groups: Group (1) the control group, which underwent surgery, but was given no drug; Group (2) given 10 mg/kg of pycnogenol dissolved in normal saline intraperitoneally for 10 days after surgery; and Group (3) given 0.1 mL of normal saline for 10 days intraperitoneally after surgery. On post-operative day 10, all of the animals were killed and any adhesions were evaluated macroscopically and histopathologically. RESULTS: The macroscopic adhesion scores (mean ± SD) for Groups 1, 2, and 3 were 2.5 ± 0.53, 0.60 ± 0.70, and 2.0 ± 0.82, respectively. The macroscopic adhesion score was significantly lower in Group 2 than in Groups 1 and 3 (p < 0.001). All three components of the histopathological evaluation (inflammation, fibrosis, and neovascularization) were significantly lower in Group 2 than in Groups 1 or 3 (p < 0.001, p < 0.001, and p = 0.004, respectively). CONCLUSIONS: Pycnogenol was found to be effective at preventing surgery-related adhesions in an animal model.

Ultrasonography for the prediction of extension of trophoblastic infiltration into the tubal wall in ampullary pregnancy.

OBJECTIVE: Predictive factors of damage to the Fallopian tube may guide the treatment for patients with tubal pregnancy. The purpose of this study was to evaluate the predictive value of ultrasonographic findings in patients affected by ampullary pregnancy for the determination of the depth of trophoblastic infiltration into the tubal wall on histological examination. MATERIAL AND METHODS: 38 patients with ampullary pregnancy undergoing salpingectomy were enrolled into the study. The patients were divided into two subgroups depending on their transvaginal sonography (TVS) findings; either an ectopic gestational sac containing an embryo with cardiac activity or those with a tubal ring. The ampullary pregnancies were histologically classified according to the depth of infiltration of trophoblastic tissue into the tubal wall as follows: stage I: limited to mucosa; stage II: extension to the muscularis layer; stage III: complete infiltration of the tubal wall with or without rupture of the serosa. The association between findings on TVS and stage of trophoblastic invasion, serum beta-human chorionic gonodatropin (ß-hCG) levels was evaluated. RESULTS: Although there was no significant difference among two groups in terms of histological stage of trophoblastic infiltration (p = 0.257), patients in whom an embryo with cardiac activity had been identified were found to have higher percentage of stage II (47.8%) or stage III (8.7%) invasion. However, there was a significant difference in serum ß-hCG levels on the day of surgery among the two groups (p = 0.028). CONCLUSIONS: Ultrasonographic aspect of ampullary pregnancy is associated with depth of trophoblastic infiltration into the tubal wall and serum ß-hCG levels.

The impact of copper-containing and levonorgestrel-releasing intrauterine contraceptives on cervicovaginal cytology and microbiological flora: a prospective study.

OBJECTIVE: To compare vaginal microflora and cervical cytology before and after insertion of a copper-containing intrauterine device (Cu-IUD) or a levonorgestrel releasing-intrauterine system (LNG-IUS). METHODS: Between April 2009 and February 2011, all women requesting insertion of an intrauterine contraceptive for family planning or noncontraceptive indications were enrolled. One hundred and eight Cu-IUDs and 42 LNG-IUSs were placed. Cervical cytological and vaginal microbiological findings before insertion and after 12 months were recorded. RESULTS: With regard to cervical cytology, nonspecific inflammatory changes became more frequent (but not significantly so; p = 0.062) after one year of use of a Cu-IUD, whereas their prevalence remained unchanged among women fitted with a LNG-IUS. Colonisation by Candida spp. and mycoplasma infections were diagnosed significantly more often after one year of use of the Cu-IUD than at baseline. During the study period, women wearing a Cu-IUD complained significantly more frequently of vaginal discharge, pelvic pain, and increased menstrual flow. CONCLUSION: Use of a Cu-IUD - but not that of a LNG-IUS - was associated with an alteration of the vaginal flora and showed a trend towards a higher frequency of nonspecific inflammatory changes affecting cervical cytology.

Long-term obstetric, perinatal, and surgical complications in singleton pregnancies following previous cesarean myomectomy: a retrospective multicentric study.

Objectives: The safety of cesarean myomectomy has been proven by previous studies. Our study aimed to reveal the long-term perinatal, obstetric, and surgical outcomes of cesarean myomectomy (CM) by comparing different CM techniques. Material and methods: This retrospective multicentric case-control study involved 7 hospitals and included 226 singleton pregnancies that underwent repeated cesarean section (CS) between 2015 and 2020. Among these pregnancies, 113 of 226 cases had CM (Group A), and 113 had only CS (Group B). Of the 113 cases in which CM was performed, 58 underwent endometrial myomectomy (EM) (Subgroup A1) and 55 underwent serosal myomectomy (SM) (Subgroup A2). The groups were compared in terms of obstetric, perinatal, and surgical outcomes, and fibroid recurrence, myomectomy scar healing rate, and adhesion formation were noted. Results: There was no significant difference between the groups in terms of maternal age, body mass index, gravidity, parity, and fibroid diameter in previous CS (p > 0.05). In the perinatal and obstetric evaluation of the groups, there was no significant difference between the groups in terms of neonatal weight, Apgar score, fetal growth restriction, preterm premature rupture of membranes, preterm delivery, hypertension in pregnancy, and diabetes mellitus (p > 0.05). The fibroid recurrence rate was 28.3%, and the myomectomy scar good healing rate was 99.1%. There was no difference between the groups in terms of CS duration, preoperative and postoperative hemoglobin levels, perioperative blood transfusion rates, febrile morbidity, and prolonged hospitalization (p > 0.05). In terms of adhesion formation, although the adhesion rate of the SM group was higher than that of the EM group, no statistically significant difference was detected between the groups. Conclusion: This study showed that in pregnancies following CM, obstetrical, perinatal, and surgical outcomes were unaffected. Obstetricians can safely use CM, either the trans-endometrial or serosal technique, as it is a safe and effective method with long-term results.

Complete chorioamniotic separation and persistence of a yolk sac associated with triploidy.

BACKGROUND: Triploidy is a highly lethal condition, and is thus very rarely observed in live births. It may result in significant medical risk to the pregnant woman. CASE: A 32-year-old multigravid woman presented for prenatal care. Ultrasound examination at 14+3 weeks of gestation revealed a viable fetus with appropriate fetal biometry, but with evidence of chorioamniotic separation (CAS) and persistence of the yolk sac. Two weeks later, repeat ultrasound showed a large multicystic placenta and early fetal symmetrical growth restriction with persistence of CAS and yolk sac, raising the suspicion of fetal aneuploidy. Amniocentesis showed a fetal karyotype of 69,XXX. The histology of the placental tissue was a partial hydatidiform mole. CONCLUSION: Persistence of chorioamniotic separation and yolk sac during the early second trimester cannot be considered a reassuring finding. In such cases, fetal karyotyping should be considered, especially when an additional abnormality is found.

Contexte : La triploïdie est une pathologie grandement mortelle; ainsi, il est très rare d'en constater la présence dans le cadre d'une naissance vivante. Elle peut en venir à constituer un risque médical considérable pour la femme enceinte. Cas : Une femme multigravide de 32 ans a sollicité nos services pour l'obtention de soins prénataux. L'examen échographique mené à 14+3 semaines de gestation a révélé la présence d'un fœtus viable qui présentaient une biométrie fœtale appropriée, tout en indiquant également des signes de séparation chorioamniotique (CAS) et la persistance du sac vitellin. Deux semaines plus tard, la tenue d'un deuxième examen échographique a révélé la présence d'un large placenta multikystique et d'un retard de croissance fœtal symétrique précoce, en plus d'indiquer la persistance de la CAS et du sac vitellin, ce qui nous a menés à soupçonner la présence d'une aneuploïdie fœtale. L'amniocentèse a indiqué la présence d'un caryotype fœtal 69,XXX. L'histologie du tissu placentaire a indiqué qu'il s'agissait d'une môle hydatiforme partielle. Conclusion : La persistance de la séparation chorioamniotique et du sac vitellin aux débuts du deuxième trimestre ne peut être considérée comme étant une constatation rassurante. Dans de tels cas, la tenue d'un caryotypage fœtal devrait être envisagée, particulièrement lorsque la présence d'une autre anomalie est constatée.

Facial rejuvenation with staged injections of cryopreserved fat and tissue cocktail: clinical outcomes in the past 10 years.

BACKGROUND: Facial rejuvenation by autologous fat transfer is common in aesthetic plastic surgery. The main drawback is progressive resorption, requiring repeated harvesting and microfat grafting. OBJECTIVE: The authors present a method for cryopreservation of excess harvested fat and tissue to enable subsequent use of previously harvested excess material. METHODS: Fat grafts were harvested using a 50-mL syringe and a 3- or 4-mm cannula. A tissue "cocktail" composed of dermis, fascia, and fat was prepared from excised scar tissue, tissue from abdominoplasty, or tissue from reduction mammaplasty. Cocktail specimens were placed in sterile tubes, immersed in a liquid nitrogen tank (-196°C), and stored at -80°C. At 3- to 6-month intervals, repeated cryopreserved fat graft injections were performed. Patients were evaluated by comparing preoperative and postoperative photographs. RESULTS: Between 2000 and 2010, a total of 5199 cryopreserved fat or tissue injections were performed in 2439 consecutive patients (age range, 19-80 years). Nasolabial folds and lips were the most common injection sites. Clinical outcomes were satisfactory, and improved contour was achieved in most patients after repeated injections. CONCLUSIONS: Cryopreservation of excess tissue for future injection is promising since repetitive injections are often required after resorption of microfat grafts. In our study, the survival of cryopreserved tissue cocktail or fat was comparable to that of fresh fat grafts and is therefore an effective adjuvant method for facial rejuvenation.

Correlation of Preoperative Serum and Intraoperative Peritoneal Lavage Fluid Ca-125 Levels with Postoperative Tumor Histology in Patients with Endometrial Cancer: A Prospective-Controlled Study.

BACKGROUND: The role of Ca-125 in endometrial cancer is not fully known. Some authors have reported high Ca-125 levels in patients with recurrent or advanced endometrial cancer, whereas others have stated that Ca-125 levels and the advance of the disease were not correlated in endometrial cancer. This makes it inevitable for clinicians to search for different measurement methods or interpretation of the present tumor markers. The aim of this study was to evaluate the relationship between Ca-125 values of the serum and abdominal lavage fluid and postoperative histopathological parameters in patients with endometrial carcinoma. METHODS: The study included patients who were diagnosed with endometrial cancer in the Gynecology Clinic and were planned to undergo surgery. The correlations of clinicopathological parameters with preoperative values of Ca-125 measured from serum and abdominal lavage fluid were investigated. The Spearman correlation test was applied in the analysis of correlations of serum and abdominal lavage fluid Ca-125 values with postoperative tumor characteristics. RESULTS: The serum Ca-125 values were determined to be positively correlated with surgical stage, tumor diameter, and lymph node involvement (p = 0.03; p = 0.04; and p = 0.01, respectively). No correlation was determined between tumor grade and serum Ca-125 level. The level of Ca-125 in the abdominal lavage fluid was observed to be correlated with surgical stage and tumor grade, but not with tumor diameter or lymph node involvement (p = 0.01, p = 0.04, respectively). CONCLUSIONS: The value of Ca-125 in the abdominal lavage fluid has a positive correlation with the surgical stage and tumor grade in patients with endometrial carcinoma.