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1.
Gynecol Minim Invasive Ther ; 10(1): 30-36, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33747770

RESUMO

OBJECTIVE: Vaginal-assisted laparoscopic sacrohysteropexy (VALH) is a new modified form of uterine-sparing prolapse surgery using a combined vaginal and laparoscopic approach. We aimed to compare 1 year efficacy and safety of VALH and vaginal hysterectomy with vaginal vault suspension (VH + VVS) in the surgical treatment of apical pelvic organ prolapse (POP). MATERIALS AND METHODS: Women who requested surgical treatment for stage 2-4 symptomatic uterine prolapse were recommended to participate in one year-long randomized study between July 2017 and January 2019. POP Quantification (POP-Q) examination and validated questionnaires such as International Consultation on Incontinence Questionnaire Vaginal Symptoms (IVIQ-VS) survey, Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire Short Form (IIQ-7), and Patient Global Impression of Improvement (PGI-I) were recorded at baseline and 12 months after surgery. The main primary outcome measure was apical prolapse recurrence. Secondary results were duration of surgery, pain score, blood loss, postoperative hospital stay, and quality of life scores related to prolapse. RESULTS: There were 15 women in VALH and 19 women in the VH + VVS group. ICIQ-VS score, ICIQ-QOL, UDI-6, and IIQ-7 scores were improved for both groups. According to the PGI-I scores, 80% of subjects in the VALH group, and 100% in the VH + VVS group, were "very much better" or "much better" with their prolapse symptoms at their 1-year follow-up. There was no reoperation or operation-related complication in both groups. CONCLUSION: VALH and VH + VVS have similar 1-year cure rates and patient satisfaction.

2.
Int Ophthalmol ; 41(7): 2339-2346, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33728491

RESUMO

PURPOSE: To examine the retinal, peripapillary, choroidal microvascularization and the choroid thickness (CT) of the patients with polycystic ovary syndrome (PCOS) using optical coherence tomography angiography (OCT-A) and compare the results to measurements obtained from healthy controls. METHODS: In total, 47 eyes of 47 patients recently diagnosed with PCOS and 47 eyes of 47 age-matched healthy women were included in this study. An RT XR Avanti instrument with AngioVue software was used for the OCT-A imaging using 6 × 6 mm macular and 4.5 × 4.5 mm optic nerve head scans. Quantitative vessel density results of superficial capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillaries (RPC); flow area and flow density of choriocapillaris; and foveal avascular zone (FAZ) area were analyzed. CT was evaluated by using the measurements obtained from the subfoveolar area. RESULTS: No significant differences were detected between the groups for any of vessel density results for the SCP, DCP, and RPC as well as the FAZ area. The difference in the choriocapillaris flow area and flow density between the groups was not statistically significant. The choroid was significantly thicker in women with PCOS than in the healthy group (p = 0.002). CONCLUSION: Retinal and choroidal microvascularization was comparable between the women who were evaluated early after diagnosed with PCOS and age-matched healthy controls. Choroid was found thicker in patients with PCOS than in healthy women. OCT-A, as a new and noninvasive imaging method, may help in understanding the effect of PCOS on the posterior segment of the eye.


Assuntos
Síndrome do Ovário Policístico , Tomografia de Coerência Óptica , Corioide/diagnóstico por imagem , Feminino , Angiofluoresceinografia , Humanos , Síndrome do Ovário Policístico/diagnóstico , Síndrome do Ovário Policístico/diagnóstico por imagem , Vasos Retinianos/diagnóstico por imagem
3.
J Invest Surg ; 34(11): 1185-1190, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32633168

RESUMO

AIM: To compare the results of conventional laparoscopic (CL) and vaginal natural orifice transluminal endoscopic surgery (vNOTES) techniques for the treatment of benign adnexal pathologies. MATERIALS AND METHODS: The study consisted of 114 patients who underwent CL or vNOTES for oophorectomy, ovarian cystectomy, or ectopic pregnancies. The medical and surgical data of the study population in terms of age, gravidity, parity, body mass index (BMI), duration of surgery, size of the mass, decrease in hemoglobin/hematocrit levels, the presence of complications, and visual analogue scale (VAS) pain scores at the 6th and 24th hours were analyzed. RESULTS: Both groups of patients (CL and vNOTES) had a similar mean age (42.22 ± 12.05 vs. 42.38 ± 13.06), mean BMI (27.51 ± 4.96 kg/m2 vs. 29.63 ± 7.86 kg/m2), and mean mass size (53.17 ± 24.41 vs. 48.93 ± 32.33) (the p-value was nonsignificant for all comparisons). According to the logistic regression propensity score match model, the duration of surgery was significantly shorter in the vNOTES group (48.33 ± 33.12 min) compared to the CL group (72.23 ± 43.63 min) (p = .04). Postoperative hospital stay was significantly shorter in the vNOTES group (38.4 ± 14.91 hours) compared to the CL group (48 ± 17.82 hours) (p = .03). Postoperative 6th- and 24th-hour VAS pain scores were significantly lower in the vNOTES group (p = .003 and .03, respectively). CONCLUSION: As an alternative to CL, vNOTES seems to be a promising approach for the treatment of a variety of adnexal pathologies.


Assuntos
Laparoscopia , Cirurgia Endoscópica por Orifício Natural , Estudos Transversais , Feminino , Humanos , Tempo de Internação , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Gravidez , Vagina/cirurgia
4.
J Obstet Gynaecol ; 41(3): 434-438, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32530343

RESUMO

Hysterectomy is one of the most frequent gynaecological procedures performed for various uterine pathologies. There are several approaches for conducting hysterectomies, including abdominal, vaginal, laparoscopic and robotic. Recently, natural orifices transluminal endoscopic surgery (NOTES) has emerged as an alternative approach for conducting hysterectomies. In this study, we aimed to compare the results of total laparoscopic hysterectomy (TLH) and vaginally assisted-NOTES (vNOTES) hysterectomy procedures for the treatment of benign gynaecological diseases. Ninety-nine patients, who underwent conventional TLH or vNOTES hysterectomies, were included in this study. The operation time, presence of per/postoperative complications, visual analogue scale (VAS) scores at postoperative sixth and 24th hours, and the duration of hospital stays were all analysed. The duration of surgery was significantly shorter in the vNOTES hysterectomy group (79.56 ± 32.54 min) compared to the TLH group (120.67 ± 38.35 min) (p: < .001). Also, postoperative hospital stays were significantly shorter in favour of the vNOTES hysterectomy group (44 ± 16.47 h) compared to the TLH group (57.86 ± 21.31 h) (p: .002). These results indicate that vNOTES hysterectomy can be a promising approach for treating a variety of different uterine pathologies and, furthermore, that it can be an alternative to TLH.Impact statementWhat is already known on this subject? A hysterectomy can be done in a variety of different ways, such as abdominal, laparoscopic, vaginal, and robotic. Even though the standard practice guidelines recommend that a vaginal hysterectomy (VH) should be the first choice of treatment, it can be challenging in cases of non-descendent and large uteruses. In such cases, NOTES hysterectomy can be an alternative option.What do the results of this study add? The study has shown that vNOTES is associated with a shorter operation and briefer postoperative hospitalisation time, in comparison to TLH.What are the implications of these findings for clinical practice and/or further research? This study speculates that vNOTES is an approach which may offer better outcomes than a conventional laparoscopy. Further randomised controlled trials with larger sample sizes, however, should be conducted in order to establish the place of vNOTES in hysterectomy surgeries.


Assuntos
Histerectomia Vaginal/estatística & dados numéricos , Histerectomia/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Cirurgia Endoscópica por Orifício Natural/estatística & dados numéricos , Vagina/cirurgia , Adulto , Estudos Transversais , Feminino , Humanos , Histerectomia/métodos , Histerectomia Vaginal/métodos , Laparoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
5.
Asian J Endosc Surg ; 14(3): 346-352, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32967055

RESUMO

INTRODUCTION: Natural orifice transluminal endoscopic surgery has been used for gynecologic operations in recent years. The aim of the study is to describe our initial experience using vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) for apical pelvic organ prolapse repair. METHODS: After patients underwent vaginal hysterectomy, vNOTES sacrocolpopexy (n = 4) or vNOTES high uterosacral ligament suspension (n = 7) were performed to treat symptomatic apical pelvic organ prolapse. Sociodemographic and clinical characteristics, Pelvic Organ Prolapse Quantification results, and recorded surgical data (eg, duration of surgery, intraoperative complications, additional prolapse and incontinence surgeries) were obtained from patient files and the hospital's database. Information from postoperative follow-up visits, including complications and anatomical results, were also recorded. RESULTS: The mean age of the patients was 60.7 ± 9.1 years. The mean total operative time was 121.3 ± 22.7 minutes. The mean operative time for vaginal hysterectomy, vNOTES sacrocolpopexy, and vNOTES uterosacral ligament suspension was 46 ± 11.9, 65 ± 38, 25 ± 8.2 minutes, respectively. There were no intraoperative and postoperative complications observed. The mean postoperative 24-hour visual analog scale score was 3.5 ± 1.9 for vNOTES sacrocolpopexy patients and 3.2 ± 0.9 for vNOTES uterosacral ligament suspension patients. Only one patient in the vNOTES sacrocolpopexy group had a recurrence; she experienced stage 2 anterior compartment prolapse 8 months after surgery. CONCLUSION: As a treatment for apical pelvic organ prolapse, vNOTES is a feasible approach in both sacrocolpopexy and uterosacral ligament suspension.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Cirurgia Endoscópica por Orifício Natural , Prolapso de Órgão Pélvico , Vagina/cirurgia , Idoso , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Histerectomia Vaginal , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Prolapso de Órgão Pélvico/cirurgia , Estudos Retrospectivos , Técnicas de Sutura , Centros de Atenção Terciária , Resultado do Tratamento
6.
Gynecol Minim Invasive Ther ; 9(2): 69-73, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32676283

RESUMO

OBJECTIVES: Natural orifice transluminal endoscopic surgery (NOTES) has been performed in gynecology practice for the surgical treatment of ovarian cysts, uterine fibroids, ectopic pregnancies, adnexal masses, and pelvic organ prolapse. The aim of this study is to evaluate the intraoperative and postoperative outcomes of patients who underwent NOTES for gynecological diseases. MATERIALS AND METHODS: This study was a retrospective clinical study. The data of 50 patients who had been treated via NOTES procedure for benign gynecological indications such as ectopic pregnancy, adnexal mass, uterine fibroid, and treatment-resistant heavy menstrual bleeding during the time period between January 2016 and 2019 were included. All procedures were performed by a single surgeon (C.K.) using a self-constructed glove port, and a sealing device in addition to conventional laparoscopic (CL) equipment. Descriptive analysis of the patients' data was performed. RESULTS: The initial two of the adnexectomy procedures were performed via hybrid NOTES technic and four of them were performed via total vaginal NOTES technic. The remaining procedures, namely hysterectomies, adnexectomies, salpingectomies, and myomectomy were performed via vaginally assisted NOTES (VaNOTES) technic. The mean operation time for the hysterectomy ± bilateral salpingo-oophorectomy (BSO) and salpingo-oophorectomy patients was 85.25 min and 53.15 min, respectively. For those patients who underwent VaNOTES procedure, the median postoperative visual analog scale pain score at the 6thh was six and at the 24thh was two. The mean length of the hospital stay was 2.07 days in the hysterectomy ± BSO patients and 1.63 days in the salpingo-oophorectomy patients. CONCLUSION: The NOTES procedure is a feasible technic in regards to the duration of surgery, postoperative pain scores, and cosmetic outcomes.

7.
Ginekol Pol ; 91(6): 295-300, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32627149

RESUMO

OBJECTIVES: To evaluate the rates of pain and mass recurrence of the patients over 40 years old with endometriosis who underwent ovarian cystectomy or uni/bilateral oophorectomy. MATERIAL AND METHODS: A retrospective study was conducted with 98 patients undergoing laparoscopic surgery for endometriosis in a tertiary referral center between the time period July 2015 and July 2019. All the patients followed every 3 months and requested to fill the Visual Analogue Scale (VAS) for evaluation of pelvic pain and an ultrasound scan was performed. The inclusion criteria for this study were as follows, patients with ages over 40, with regular menstrual periods, and who denied hysterectomy and any postoperative hormonal medical treatments. RESULTS: When the groups were compared in terms of age, body mass index, cyst diameter, CA-125 serum concentrations, preoperative and after surgical pelvic pain scores, mean follow up periods, postoperative hospital stay. However, each of the mean numbers of gravidity and parity were significantly higher than bilateral salpingo-oophorectomy (BSO) groups compared to the other groups (p = 0.04 and p = 0.03, respectively). The laterality, the recurrence rates, and the type of recurrence did not have a significant effect in the group comparison. CONCLUSIONS: The ovarian tissue preserving procedures could be offered for the women over 40 years old suffering from endometriosis with no significant increase in pain symptom or mass recurrence rates considering beneficial effects of estrogen on cardiovascular system, vasomotor symptoms, and bone mineral density.


Assuntos
Endometriose/cirurgia , Dor Pélvica/etiologia , Preservação de Tecido/estatística & dados numéricos , Adulto , Endometriose/complicações , Endometriose/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Dor Pélvica/terapia , Complicações Pós-Operatórias/diagnóstico , Recidiva , Estudos Retrospectivos
8.
Int Urogynecol J ; 31(12): 2617-2623, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32653969

RESUMO

INTRODUCTION AND HYPOTHESIS: Cervical elongation (CE) has not been clearly defined and has similar symptoms to pelvic organ prolapse. We aimed to evaluate the diagnostic value of preoperative POP-Q examinations, ultrasonographic measurements, and direct cervical length measurement with a Foley catheter in predicting CE on postoperative hysterectomy specimens. METHODS: Fifty-six patients who underwent vaginal hysterectomy for apical pelvic organ prolapse were included. The patients were divided into two groups based on the hysterectomy specimens' corpus/cervix ratio (CCR) as follows: the non-CE group, CCR > 1; the CE group, CCR < 1. The preoperative direct cervical length measurement was performed using 10-French Foley catheters. The recommended cutoff values and sensitivity/specificity analysis of the cervical measurements with Foley, ultrasound, and C-D measurements according to POP-Q were determined by the receiver-operating characteristic analysis. RESULTS: There were 13 patients (23%) in the non-CE group and 43 patients (76%) in the CE group. The mean cervical measurements with Foley catheter and ultrasound, C-D diameter, and postoperative cervix measurements were 49.4 ± 12.6 mm, 42.14 ± 9.4 mm, 41.4 ± 17.2 mm, and 49.5 ± 13 mm, respectively. Cervical measurement with a Foley catheter had 65% sensitivity and 62.5% specificity with a 47.5-mm cutoff value. Among these preoperative measurements, Foley catheter measurements were the most compatible with postoperative cervical measurements. There was no significant association between CE and age, body mass index, menopause duration, point C, and point D. CONCLUSION: Cervical length measurement with a Foley catheter may be preferred for estimation of CE.


Assuntos
Medida do Comprimento Cervical , Prolapso de Órgão Pélvico , Colo do Útero/diagnóstico por imagem , Feminino , Humanos , Histerectomia Vaginal , Prolapso de Órgão Pélvico/diagnóstico por imagem , Prolapso de Órgão Pélvico/cirurgia , Gravidez , Ultrassonografia
9.
Arch Gynecol Obstet ; 301(6): 1553-1560, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32270331

RESUMO

PURPOSE: Our aim was to investigate the serum endocan levels and carotid artery intima-media thickness (CIMT) measurements of pre- and postmenopausal patients to clarify the relationship between the menopausal transition and endothelial injury. METHODS: This cross-sectional study was conducted on women who were premenopausal and postmenopausal between January 2019 and June 2019. The patients were divided into two groups according to premenopausal (n = 32) and postmenopausal (n = 32) status. Serum endocan levels were assessed by enzyme-linked immunosorbent assay (ELISA). CIMT ultrasonographic measurements were determined. Hormonal and biochemical parameters were measured. The validated Menopause Rating Scale (MRS) questionnaire was used on all women. RESULTS: Serum endocan levels were significantly higher in the postmenopausal group than in the premenopausal group (222.90 ± 121.00 ng/L and 146.62 ± 41.88 ng/L, p = 0.033, respectively). The mean CIMT was significantly higher in the postmenopausal group than in the premenopausal cohort (0.70 ± 0.14 mm and 0.58 ± 0.11 mm, p < 0.001, respectively). A positive correlation was found between body mass index (BMI), systolic blood pressure (SBP), abdominal circumference (AC), and CIMT and postmenopausal serum endocan levels. Serum endocan levels with a cutoff point of 141.14 ng/L identified women with significant CIMT levels with sensitivity of 73.8% and specificity of 77.3%. A positive correlation was found between CIMT and endocan and total MRS scores. CONCLUSION: Serum endocan levels were associated with CIMT during the menopausal transition period. Increased circulating endocan levels can be a predictor of cardiovascular risk in pre- and postmenopausal women.


Assuntos
Doenças Cardiovasculares/diagnóstico , Menopausa/sangue , Proteínas de Neoplasias/sangue , Pré-Menopausa/sangue , Proteoglicanas/sangue , Doenças Cardiovasculares/sangue , Espessura Intima-Media Carotídea , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco
10.
Turk J Med Sci ; 50(2): 455-463, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-31999406

RESUMO

Background/aim: Adnexal torsion is a common gynaecological emergency, and considered to be a problem mostly in reproductive-age women. To evaluatethe effect of metformin and detorsion treatment on reducing ovarian reserve in an ovarian torsion model. Materials and methods: Twenty-four nonpregnant, Wistar Hannover rats were included in the study. Animals were divided into 3 groups: the control group, the detorsion only group, and the metformin + detorsion group. The first group received only laparotomy. In the second group, ovaries were fixed to the abdominal wall after performing 360° ovarian torsion, followed by detorsion after a 3-h period of ischemia. The third group underwent the same torsion and detorsion procedures as the second group, and received 50 mg/kg metformin by gavage for 14 days. Ovarian damage scores, follicle counts, and AMH levels were evaluated. Results: The total damage score was significantly increased in the detorsion only group compared to the metformin+detorsion and control groups. Pre-operative/post-operative AMH decreases were statistically significant in negative direction in the detorsion only group when compared to the metformin+detorsion and control groups (P = 0.001). Conclusion: Metformin+detorsion treatment may be effective in protecting the ovarian reserve after ovarian torsion.


Assuntos
Hormônio Antimülleriano/sangue , Metformina , Torção Ovariana , Ovário , Animais , Modelos Animais de Doenças , Feminino , Procedimentos Cirúrgicos em Ginecologia , Metformina/farmacologia , Metformina/uso terapêutico , Torção Ovariana/tratamento farmacológico , Torção Ovariana/patologia , Torção Ovariana/cirurgia , Ovário/efeitos dos fármacos , Ovário/patologia , Ovário/cirurgia , Ratos , Ratos Wistar
11.
J Med Virol ; 92(8): 1290-1297, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31696950

RESUMO

PROBLEM: Objective studies that use validated questionnaires are needed to evaluate the changes in the sexual functions of women diagnosed with human papillomavirus (HPV) infection. METHOD OF STUDY: The study comprised 80 sexually active women diagnosed with a high-risk HPV infection. These patients were divided into four groups as follows: group 1, HPV 16/18-positive and normal cytology; group 2, HPV 16/18-positive and abnormal cytology; group 3, non-16/18 HPV-positive and abnormal cytology; and group 4, non-16/18 HPV-positive and normal cytology. The sexual functions and anxiety statuses of the patients were assessed via the Female Sexual Function Index (FSFI) and Beck anxiety inventory (BAI) questionnaires, respectively, at their first clinical visits and then 2 months later. RESULTS: There was no statistically significant difference among the study groups in terms of the overall FSFI and domain sub-scores at either of the visits. Women who tested positive for the high-risk HPV 16/18 strains had a significantly less sexual desire after being informed about the test results. Those with HPV 16/18 and normal cytology had significantly higher anxiety levels at their second than first visits. The BAI scores of the HPV 16/18-positive women (normal or abnormal cytology) at the second visit were significantly higher than those of non-16/18 HPV-positive women with normal cytology. There was no significant difference between the patients with normal and abnormal cytology results regarding the difference of BAI, overall and domain FSFI sub-scores at the first and second visits. The desire and lubrication domain scores of the HPV 16/18-positive patients significantly decreased after the first visit compared with those of the non-16/18 HPV-positive patients. CONCLUSION: HPV 16/18 positivity decreases women's total FSFI and desire domain sub-scores.


Assuntos
Ansiedade/etiologia , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/psicologia , Comportamento Sexual/psicologia , Displasia do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Ansiedade/psicologia , Feminino , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Humanos , Estudos Prospectivos , Inquéritos e Questionários , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal , Displasia do Colo do Útero/virologia
12.
Metab Syndr Relat Disord ; 17(6): 341-345, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31045476

RESUMO

Background: Metabolic syndrome (MetS) could lead to an increase in fatty tissue that could be seen as a radiolucent image depicting breast density (BD) by a mammogram. We aimed to investigate the association between MetS and its separate components with BD among naturally postmenopausal women. Materials and Methods: Data of 494 postmenopausal patients who were admitted to our outpatient clinic between December 2012 and July 2015 were retrospectively reviewed. A total of 279 patients were in the without MetS group and 215 patients were in the with MetS group. Average BD percentage of the left and right breasts were measured. Basic characteristics, laboratory, and mammography results between the without MetS and the with MetS groups were compared. Results: The mean age of the patients was 53.20 ± 6.67 years in the without MetS group and 55.41 ± 6.56 years in the with MetS group. There were 219 (78.5%) patients in the without MetS group and 187 (86.9%) patients in the with MetS group with lower BD. The without MetS group had significantly higher BD scores than those patients in the with MetS group (P = 0.02). In correlation analysis, there was a negative correlation between fasting plasma glucose (FPG), systolic and diastolic blood pressures, waist circumference (WC), and BD scores. However, there was a positive correlation between high-density lipoprotein (HDL) and BD score (P = 0.046). In multivariate logistic regression analysis, it is found that lower body mass index (BMI) and parity were significantly associated with higher BD (P = 0.002 and P = 0.001; respectively). Conclusion: The lower BMI and parity may be associated with higher BD in postmenopausal women. In addition, higher HDL and lower FPG, blood pressure, triglyceride, and WC may be correlated with higher BD.


Assuntos
Densidade da Mama/fisiologia , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etiologia , Pós-Menopausa/fisiologia , Adulto , Glicemia/metabolismo , Pressão Sanguínea , Índice de Massa Corporal , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/complicações , Obesidade/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Triglicerídeos/sangue , Circunferência da Cintura
13.
J Obstet Gynaecol Res ; 45(6): 1183-1189, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30907061

RESUMO

AIM: We aimed to compare the neutrophil-to-lymphocyte ratio (NLR) in tubo-ovarian abscess (TOA) patients who responded to medical treatment or who underwent surgical intervention due to medical treatment failure. METHODS: The files of the patients, hospitalized in our Obstetrics and Gynecology Department with TOA diagnosis between August 2015 and December 2017, were evaluated retrospectively. The conservative management group was comprised of 38 of the 81 patients (46.9%) who responded to sole medical treatment with the triple antibiotic regimen (gentamicin-clindamycin-ampicillin) and the surgical intervention group was comprised of 43 patients (53.1%) who did not respond to medical treatment and needed further surgery and/or interventional radiologic abscess drainage. Demographic and clinical data, imaging findings, and laboratory results including NLR were compared between two groups. RESULTS: There were statistically significant differences between the groups in terms of age, TOA diameter, white blood cell and neutrophil counts, and NLR levels (P < 0.05). The mean NLR was 7.4 ± 5.8 for the conservative management group and 10.3 ± 5.8 for the surgical intervention group (P = 0.004). The area under the curve (AUC) for NLR was 0.69 (threshold value was ≥6.97, 95% confidence interval, sensitivity 79.1%, specificity 57.9%). On multiple regression analysis, a significant correlation was identified between age, NLR and resistance to the medical treatment. CONCLUSION: Neutrophil-to-lymphocyte ratio and age are significantly higher in patients with medical treatment failure and NLR could be used as a novel marker in addition to white blood cell in the prediction of medical treatment failure in TOA patients.


Assuntos
Abscesso/sangue , Abscesso/terapia , Doenças das Tubas Uterinas/sangue , Doenças das Tubas Uterinas/terapia , Linfócitos , Neutrófilos , Doenças Ovarianas/sangue , Doenças Ovarianas/terapia , Falha de Tratamento , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Adulto , Fatores Etários , Antibacterianos , Doenças das Tubas Uterinas/tratamento farmacológico , Doenças das Tubas Uterinas/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Pessoa de Meia-Idade , Doenças Ovarianas/tratamento farmacológico , Doenças Ovarianas/cirurgia
14.
Turk J Obstet Gynecol ; 16(4): 271-273, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32231860

RESUMO

Heterotopic pregnancy occurs 1 in 30000 pregnancies. We present case of an acute abdomen caused by a ruptured ectopic component. Our patient had no known risk factors, which made the diagnosis even more challenging. Intrauterine pregnancy was desired by patient and her husband. A natural orifice transluminal endoscopic surgery (NOTES) procedure was performed, which is a next-generation minimally invasive procedure in this area. After the procedure, our patient was discharged one day after surgery with a viable intrauterine pregnancy.

17.
Arch Gynecol Obstet ; 294(5): 911-916, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-26980230

RESUMO

PURPOSE: Prevention of postpartum haemorrhage (PPH) is essential in the pursuit of improved health care for women. Oxytocin, the most commonly used uterotonic agent to prevent PPH, has no established the route of administration. In this study we aimed to compare whether the mode of oxytocin administration, i.e., intravenous and intramuscular administration, has an effect on the potential benefits and side effects. MATERIALS AND METHODS: A total of 256 women were randomised into two groups: intramuscular group (128) or intravenous group (128). RESULTS: Estimated blood loss during the third stage of labour was similar between the two groups (p = 0.572). Further there were no statistically significant difference was noted between the two groups in terms of the mean duration of labor, duration of the third stage of labor, manual removal of the placenta, need for instrumental delivery, need for blood transfusion, PPH ≥500 mL, PPH ≥1000 mL, or length of hospital stay. CONCLUSION: Using oxytocin by intravenous and intramuscular route has a similar efficacy and adverse effects.


Assuntos
Ocitocina/administração & dosagem , Hemorragia Pós-Parto/prevenção & controle , Administração Intravenosa , Adolescente , Adulto , Parto Obstétrico , Feminino , Humanos , Injeções Intramusculares , Hemorragia Pós-Parto/tratamento farmacológico , Gravidez , Adulto Jovem
18.
Gynecol Endocrinol ; 31(7): 531-5, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26340353

RESUMO

PURPOSE: The aim of this study is to evaluate the correlation between epicardial adipose tissue thickness and oxidative stress parameters in patients with polycystic ovarian syndrome. METHODS: The study included 35 patients with PCOS and 35 healthy women. Transthoracic echocardiography was used to measure the epicardial adipose tissue thickness (EATT) of all patients. For all patients, serum TOS, TAS, hs-CRP, and insulin levels were measured according to the literature, and the HOMA-IR values were calculated. Independent samples t-test, Pearson's correlation analysis, multivariate logistic regression analysis, and receiver operator characteristic curve (ROC) analysis were used in the statistical analysis. RESULTS: Between the patient group and the control group, EATT was significantly higher in the PCOS group compared to the control group (5.4 ± 1.4 mm and 3.9 ± 1.6 mm, respectively; p < 0.001). Similarly, TOS, TAS, and hs-CRP levels were significantly higher in the PCOS group compared to the control group (p < 0.01 for all). The correlation analysis showed a significant positive correlation between EATT and TAS and hs-CRP (r = 0.349, p < 0.01 and r = 0.352, p < 0.01, respectively). Multivariate regression analysis showed a significant correlation between PCOS and EATT, TAS, and diastolic blood pressure (p < 0.05 for all). CONCLUSIONS: Epicardial adipose tissue may play a major role in PCOS pathogenesis by leading to an increase in oxidative stress.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Estresse Oxidativo/fisiologia , Pericárdio/diagnóstico por imagem , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Ultrassonografia , Adulto Jovem
19.
Ginekol Pol ; 86(7): 537-40, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26376533

RESUMO

OBJECTIVES: The aim of the study was to evaluate the diagnostic efficacy of colposcopy and to determine the strength of correlation between colposcopic impression using the Reid Colposcopic Index (RCI) and histopathology MATERIAL AND METHODS: This was a prospective cross-sectional study carried out at the colposcopy clinic of Bakirköy Dr Sadi Konuk Education and Research Hospital, Department of Obstetrics and Gynecology, between June 2011 and September 2011. A total of 105 women who met the selection criteria were included in the study. All women underwent colposcopy and the final diagnosis was made using RCI. Colposcopy-guided biopsy was obtained from the abnormal areas. In cases when colposcopy did not reveal any lesion, a four-quadrant biopsy from the squamocolumnar junction was taken, which served as the gold standard. RESULTS: According to the Reid scoring system, there were 60% of benign cases, whereas 27.6%, 5.7%, and 6.7% of the women were diagnosed with CIN 1, CIN 2, CIN 3, respectively As far as histologic results were concerned, 62.9% of the subjects were benign, whereas 25.7%, 3.8%, and 7.6% of the patients were diagnosed with CIN 1, CIN 2, CIN 3, respectively. The correlation between the Reid scoring system and histologic results was statistically significant (p > 0.05). CONCLUSIONS: The correlation between colposcopic lesions graded with RCI and histology was strong, particularly in women who had HGSIL on a Pap smear. Good correlation between colposcopic imaging using RCI and histopathology makes it a reproducible technique, easy to implement in colposcopy clinics.


Assuntos
Colposcopia/métodos , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Biópsia/métodos , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Neoplasias do Colo do Útero/diagnóstico , Displasia do Colo do Útero/diagnóstico
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