Role of serum renalase levels in predicting the presence of metabolic syndrome in patients with polycystic ovary syndrome.

OBJECTIVE: This study was designed to compare the serum renalase levels of polycystic ovary syndrome (PCOS) women with and without metabolic syndrome (MS) and those of healthy non-PCOS women. MATERIALS AND METHODS: Seventy-two patients diagnosed with PCOS and age-matched 72 healthy non-PCOS were included in the study. The PCOS group was divided into two groups as having metabolic syndrome or not. General gynecological and physical examination findings and laboratory results were recorded. Renalase levels in serum samples were determined using Enyzme-Linked ImmunoSorbent Assay method. RESULTS: Mean serum renalase level was significantly higher in PCOS patients with MS compared with both PCOS patients without MS and healthy controls. Additionally, serum renalase correlates positively with body mass index, systolic and diastolic blood pressure, serum triglyceride and homeostasis model assessment-insulin resistance values among PCOS women. However, systolic blood pressure was found to be the only significant independent factor that can affect the serum renalase levels. A serum renalase level of 79.86 ng/L had a sensitivity of 94.7% and specificity of 46.4% in discriminating PCOS patients with metabolic syndrome from healthy women. CONCLUSIONS: Serum renalase level increases in women with PCOS in the presence of metabolic syndrome. Therefore, monitoring the serum renalase level in women with PCOS can predict the metabolic syndrome that may develop.

Prediction of uterine dehiscence via machine learning by using lower uterine segment thickness and clinical features.

BACKGROUND: With the global increase of cesarean delivery rates, the long-term effects of cesarean delivery have started to become clearer. One of the most prominent complications of cesarean delivery in recurrent pregnancies is uterine rupture. Assessing the risk of uterine rupture by accurately predicting dehiscence is very important to prevent untimely operations and/or maternal and fetal complications. OBJECTIVE: This study aimed to assess whether machine learning can be used to predict uterine dehiscence by using patients' ultrasonographic findings, clinical findings, and demographic data as features. Hence, we investigated a potential method for preventing uterine rupture and its maternal and fetal complications. STUDY DESIGN: The study was conducted on 317 patients with term (>37 weeks' gestation) singleton pregnancies and no medical complications or medications that may affect uterine wound healing. Demographics, body mass indices, smoking and drinking habits, clinical features, past pregnancies, number and history of abortions, interdelivery period, gestational week, number of previous cesarean deliveries, fetal presentation, fetal weight, tocography data, transabdominal ultrasonographic measurement of lower uterine segment full thickness and myometrium thickness, and lower uterine segment findings during cesarean delivery were collected and analyzed using machine learning techniques. Logistic regression, multilayer perceptron, support vector machine, random forest, and naive Bayes algorithms were used for classification. The dataset was evaluated using 10-fold cross-validation. Correct classification rate, F-score, Matthews correlation coefficient, precision-recall curve area, and receiver operating characteristic area were used as performance metrics. RESULTS: Among the machine learning techniques tested in this study, the naive Bayes algorithm showed the best predictive performance. Among the various combinations of features used for prediction, the essential features of parity, gravidity, tocographic contraction, cervical dilation, dilation and curettage, and sonographic thickness of lower uterine segment myometrium yielded the best results. The second-best performance was achieved with sonographic full thickness of lower uterine segment added to the base features. The base features alone could classify patients with 90.5% accuracy, whereas adding the myometrium measurement increased the classification performance by 5.1% to 95.6%. Adding the full thickness measurement to the base features raised the classification performance by 4.8% to 95.3% in terms of correct classification rate. CONCLUSION: The naive Bayes algorithm can correctly classify uterine dehiscence with a correct classification rate of 0.953, an F-score of 0.952, and a Matthews correlation coefficient value of 0.641. This result can be interpreted as indicating that by using clinical features and lower uterine segment ultrasonography findings, machine learning can be used to accurately predict uterine dehiscence.

A blind spot: Manchester Fothergill operation for cervical elongation without uterine descensus.

OBJECTIVE: To evaluate the anatomical results of Manchester Fothergill operation performed due to cervical elongation cases without uterine descensus and its effects on quality of life and sexual function. MATERIALS AND METHODS: Thirty-six women who underwent Manchester Fothergill operation for cervical elongation without uterine descensus were analyzed retrospectively. Pre- and postoperative Pelvic Organ Prolapse-Quantification (POP-Q) measurements, Prolapse Quality of Life (P-QoL) Questionnaire and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) scores were collected. RESULTS: There were significant improvements in POP-Q measurements, P-QoL Questionnaire and PISQ-12 scores postoperatively. There was no relationship between the change in POP-Q measurements and the changes in questionnaires scores. Reoperation was performed in only one patient due to anterior compartment prolapse. No serious complications were detected. CONCLUSION: Manchester Fothergill operation is an effective and safe surgical option in the surgical treatment of cervical elongation cases without uterine descensus. It provides anatomical improvement, increases the quality of life and improves sexual function in women.

The feasibility of the platelet count and mean platelet volume as markers of endometriosis and adenomyosis: A case control study.

INTRODUCTION: The aim of the study is to investigate the role of platelet count (PC) and mean platelet volume (MPV) in determining adenomyosis and endometriosis. MATERIAL AND METHODS: This was a retrospective case control study that included adenomyosis, endometriosis and control groups. The adenomyosis group included 84 women diagnosed between January 2013 and January 2015 based on hysterectomy specimen. The endometriosis group included 102 patients underwent diagnostic laparoscopy and confirmed by histopathologic examination. Lastly, the control group included 88 women had no medical problem and underwent tubal ligation. RESULTS: MPV (fl) was significantly lower in adenomyosis group (8.5) compared to endometriosis (9, p<0.05) and control groups (9, p<0.01). Modified platelet activity (MPV/PC) was significantly lower in adenomyosis group compared to control group (p<0.01). Bivariate logistic regression model was used to assess the odds ratio of risk factors and serum markers related to endometriosis and adenomyosis. Variables showing significant differences based on post-hoc Bonferroni test were included in the logistic regression model for comparison of each disease with the control group. MPV was not found to be a risk factor both for presence of endometriosis and adenomyosis after adjusting for demographic and clinical characteristics. DISCUSSION: Our study suggested that PC and MPV were not useful diagnostic markers for endometriosis or adenomyosis. Further research on how platelet indices and other inflammatory markers are related to inflammation might help better understand their potential as markers for these diseases.

Pure large cell neuroendocrine carcinoma of ovary: A rare clinical entity.

OBJECTIVE: Large cell neuroendocrine carcinoma (LCNEC) of the ovary is a rare tumour. Its pure form without any associated surface epithelial stromal or germ cell component is more rarely seen. Its prognosis is generally very poor even when the diagnosis is made at an early stage. We report a case of pure large cell neuroendocrine tumour of ovary. The patient was a 73-year-old woman with symptom of pelvic pain. Ultrasonography detected an abdominal tumour larger than 10 cm. She underwent an exploratory laparotomy with resection of the pelvic mass. After the surgery six cycles of chemotherapy (Etoposide and Cisplatin) were administered to the woman. She is still healthy after the last chemotherapy. Due to the rarity of the disease, few number of reported cases and the lack of systematic population based studies or registry data, we reported this case.

The impact of concurrent pelvic organ prolapse reconstructive surgery on midurethral sling procedure outcome.

OBJECTIVES: To evaluate the effect of concurrent pelvic organ prolapse (POP) reconstructive surgery on midurethral sling (MUS) procedure outcome. MATERIAL AND METHODS: The present retrospective study included 300 women with urodynamically diagnosed stress urinary incontinence that underwent MUS procedures with or without concurrent POP reconstructive surgery. Patients were divided into four groups according to the performed surgery; 1) transobturator tape (TOT), 2) TOT with POP surgery (anterior colporrhaphy, posterior colporrhaphy and vaginal hysterectomy), 3) tension free vaginal tape (TVT), 4) TVT with POP surgery. Outcomes of surgeries for each group were evaluated postoperatively at the end of the first and sixth month by performing a cough stress test and also using the Incontinence Impact Questionnaire-7 (IIQ-7) and Urogenital Distress Inventory (UDI-6) questionnaires. Presence of a negative cough stress test was defined as "Cure". Multivariate regression was used to identify the parameters for surgical failure. RESULTS: Forty-two, 70, 49 and 139 women underwent isolated TOT, concurrent TOT and POP, isolated TVT and concurrent TVT and POP surgery, respectively. Postoperative UDI-6 score and postoperative cure rate were significantly higher in the only TOT group as compared to the TOT + POP group. However, in multiple regression analysis, women's age, parity, body mass index, menopausal status, preoperative urodynamic parameters, MUS types and presence of any concomitant POP reconstructive surgery were found to have no significant effect on surgical outcome. CONCLUSIONS: Concurrent POP reconstructive surgery including anterior colporrhaphy, posterior colporrhaphy and vaginal hysterectomy have no affect MUS procedure outcomes.

Pregnancy outcomes after transvaginal sacrospinous hysteropexy.

AIM: To evaluate the pregnancy outcomes in women who underwent transvaginal sacrospinous hysteropexy with the review of the literature STUDY DESIGN: 54 women who underwent transvaginal sacrospinous hysteropexy due to ≥grade 2 uterine prolapse during six-year period were identified from a computer based database. 8 of these who had pregnancy resulted in live birth subsequent to transvaginal sacrospinous hysteropexy were enrolled in this study. They were examined in case of pelvic organ prolapse recurrence and were questioned about their current self satisfaction status and PISQ-12 questionnaire. RESULTS: The median age of women was 36 years (range 29-43 years). All of the women were multiparous and there were no women with a previous cesarean section. All of the subsequent conceptions following operation occured spontaneously. The median time between hysteropexy and conception was 16 months (range 10-30 months). The pregnancies continued at least 37 weeks with only one preterm delivery (due to twin pregnancy). All 8 pregnancies were delivered by cesarean section. The median follow-up period after cesarean section was 45 months (range 7-60 months). Majority of women (7/8, 87.5%) were satisfied with current outcomes of sacrospinous hysteropexy and PISQ12 questionnaire scores revealed improvement in 87.5% (7/8) of women. CONCLUSION: Transvaginal sacrospinous hysteropexy is an appropriate surgical treatment method for symptomatic uterovaginal descensus in women who wish to preserve their uterine and future childbearing. And cesarean section is a reliable and satisfactory delivery route for women who underwent transvaginal sacrospinous hysteropexy.

Risk factors for postoperative urinary tract infection following midurethral sling procedures.

OBJECTIVE: To identify the potential risk factors for urinary tract infections following midurethral sling procedures. STUDY DESIGN: 556 women who underwent midurethral sling procedure due to stress urinary incontinence over a four-year period were reviewed in this retrospective study. Of the study population, 280 women underwent TVT procedures and 276 women underwent TOT procedures. Patients were evaluated at 4-8 weeks postoperatively and were investigated for the occurrence of a urinary tract infection. Patients who experienced urinary tract infection were defined as cases, and patients who didn't were defined as controls. All data were collected from medical records. Multivariate logistic regression model was used to identify the risk factors for urinary tract infection. RESULTS: Of 556 women, 58 (10.4%) were defined as cases while 498 (89.6%) were controls. The mean age of women in cases (57.8±12.9years) was significantly greater than in controls (51.8±11.2years) (p<0.001). The presence of menopausal status, previous abdominal surgery, preoperative antibiotic treatment due to urinary tract infection, concomitant vaginal hysterectomy and cystocele repair, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml were more common in cases than in controls. However, in multivariate regression analysis model presence of preoperative urinary tract infection [OR (95% CI)=0.1 (0.1-0.7); p=0.013], TVT procedure [OR (95% CI)=8.4 (3.1-22.3); p=0.000] and postoperative postvoiding residual bladder volume ≥100ml [OR (95% CI)=4.6 (1.1-19.2); p=0.036] were significant independent risk factors for urinary tract infection following midurethral slings CONCLUSION: Urinary tract infection after midurethral sling procedures is a relatively common complication. The presence of preoperative urinary tract infection, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml may increase the risk of this complication. Identification of these factors could help surgeons to minimize this complicationby developing effective strategies.

A comperative study for short-term surgical outcomes of midurethral sling procedures in obese and non-obese women with stress urinary incontinence.

There is little data comparing the surgical outcomes of tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures in obese women. Therefore, we aimed to compare the surgical outcomes of TOT and TVT procedures among obese women with a diagnosis of stress urinary incontinence (SUI). One hundred and eighty-nine women who underwent TVT or TOT procedures due to pure SUI were included. Women in whom the body mass index (BMI) was ≥30 kg/m2 were considered as obese, while <30 kg/m2 were non-obese. And women with BMI ≥35 kg/m2 was defined as morbidly obese. At sixth month postoperative follow-up, neither the comparison of TVT and TOT results in obese women nor the comparison of TVT or TOT results between obese and non-obese women showed any significant differences in terms of objective and subjective cure rates, quality of life improvements, or intra/postoperative complications. TVT and TOT procedures also have similar effectiveness among morbidly obese women. We have concluded that TVT and TOT operations seem to be equally effective and safe surgical treatment procedures for female SUI regardless of BMI.

Association of clinical outcomes and complications with obesity in patients who have undergone abdominal myomectomy.

BACKGROUND: This study aimed to evaluate the association between complications and clinical parameters with obesity in 273 women who have undergone abdominal myomectomy during the study period. METHODS: The patients were classified into two groups according to body mass index (BMI) (≤30 kg/m(2) and >30 kg/m(2)). Demographic, preoperative and postoperative clinical parameters were evaluated. RESULTS: Demographic, preoperative and postoperative clinical parameters were evaluated. The results showed statistically significant differences between the obese and non-obese groups in terms of age, gravidity, diameter of fibroid (DOF), postoperative hemoglobin, duration of hospital stay, and complications. Patients in the obese group had greater DOF and complications such as hemorrhage, postoperative fever, wound infection and ileus (p < 0.05). CONCLUSION: Based on our results, we conclude that obesity adversely affects the clinical outcomes of patients who undergo abdominal myomectomy.

McCall Culdoplasty vs. Sacrospinous Ligament Fixation after vaginal hysterectomy: comparison of postoperative vaginal length and sexual function in postmenopausal women.

OBJECTIVES: To compare preoperative and postoperative vaginal length in sexually active postmenopausal women who underwent vaginal hysterectomy with McCall Culdoplasty or Sacrospinous Ligament Fixation and investigate whether these findings are correlated with sexual function. STUDY DESIGN: Fifty-eight sexually active postmenopausal women planned to undergo vaginal hysterectomy during the reconstructive surgical treatment of stage 2 or 3 uterine prolapse were included. They were classified into two groups according to their self-selections. Twenty-nine women underwent McCall Culdoplasty adjunct to hysterectomy while 29 women had Sacrospinous Ligament Fixation with hysterectomy. Vaginal length was measured before and after vaginal surgery at 6-week and 6-month follow-up. Sexual function were assessed by Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 form, preoperatively and 6 months postoperatively. RESULTS: It was found that McCall Culdoplasty and Sacrospinous Ligament Fixation adjunct to vaginal hysterectomy shortened vaginal length significantly. And, the decrease in vaginal length was greater in McCall Culdoplasty group compared to Sacrospinous Ligament Fixation group. However, preoperative and postoperative sexual function questionnaire scores were not correlated with vaginal lengths. CONCLUSION: McCall Culdoplasty or Sacrospinous Ligament Fixation adjunct to vaginal hysterectomy shortens vaginal length postoperatively. However these changes do not affect sexual function in postmenopausal women.

Krukenberg carcinoma metastasized from stomach resembling mucinous cystadenocarcinoma of the ovary.

The ovaries are common site of metastasis in a variety of primary neoplasms. Multiple tumors such as breast, lung, and pancreas have been reported to metastasize to the ovary, however; the colon and stomach are the most common primary cancer sites that of ovarian metastasis. An ovarian mass mostly originates from its self-tissue, but sometimes it can be a metastasis of a gastrointestinal system tumor. Such cases are often misdiagnosed as primary ovarian cancers. A 42-year-old woman was admitted to our hospital with pelvic pain. She had a history of her complaints for two months. Bilateral large ovarian mass was detected in transvaginal ultrasound. Laparotomy was performed, the pathologist suggested inspection of the stomach after the frozen section analysis; therefore, an irregular mass on the stomach was detected. The general surgeon was attended to the operation, and an inoperative stomach tumor was reported by the general surgeon. After that due to the partial obstruction of jejunum, a gastrojejunostomy was performed. It is in fact difficult to distinguish between metastatic mucinous carcinomas and primary mucinous carcinomas of the ovary, due to the similar appearance of as cystic tumors on gross examination. The clinicians should be aware of the likely concomitant gastrointestinal system tumor when a large and bilaterally mass was detected on physical examination. This case also reminds that a systemic examination is necessary even if the large ovarian tumors suspicious of primary malignancy were noticed.

Preliminary Outcomes of a New, Safe, Tension-free Vaginal Tape Trocar.

The aim of this study is to introduce a new, safe, tension-free vaginal tape (TVT) trocar. Twenty-eight women with stress urinary incontinence who underwent a TVT procedure with a new trocar during a 6-month period were prospectively enrolled in this study. All the operations were performed by the same surgeon who developed the trocar. The trocar has two buttons, which make the tip of the device sharp or blunt. Median age of the study population was 52 years (range, 30-76 years), median number of vaginal deliveries was 3 (range, 1-10). And 57.1% of women were at menopause. Median body mass index was 30.0 kg/m² (range, 23.8-35.2 kg/m²). Preoperative median Valsalva leak point pressure was 78 cmH2O (range, 50-94 cmH2O), while the median maximum urethral closure pressure was 50 cmH2O (range, 14-74 cmH2O). Concomitant prolapse surgery was present in 23 women (82.1%). At the 6-month postoperative visit, objective and subjective cure rates were 89.3% for each. No serious intraopeartive or postoperative complication such as bladder, intestine, or major vessel injury occured. Only 3 women (10.7%) needed blood transfusion, and 2 women (7.1%) had postoperative voiding difficulty. Due to the modifiable tip, this new sling trocar seems safer than the conventional trocars. But large studies are necessary to prove this assumption. Due to the modifiable tip, this new sling trocar seems safer than the conventional trocars. But large studies are necessary to prove this assumption.

Spontaneous Membranous Dysmenorrhea in an Adolescent Girl: A Case Report and Literature Review.

BACKGROUND: Membranous dysmenorrhea is a rare entity. It involves the sloughing of the endometrium in 1 cylindrical or membranous piece, retaining the shape of the uterine cavity. Herein, we report the first case of spontaneous membranous dysmenorrhea in an adolescent girl. CASE: A 17-year-old girl was admitted to the emergency clinic with severe painful menstrual bleeding and passage of tissue via the vagina. Bloody endometrial tissue resembling the endometrial cavity expulsed from the vagina was seen on inspection. The pathologic diagnosis of the mass was membranous dysmenorrhea. SUMMARY AND CONCLUSION: To our knowledge, this is the first case of the spontaneous occurrence of membranous dysmenorrhea. The relationship between membranous dysmenorrhea and endogenous or exogenous progesterone should be investigated further. A review of the literature on membranous dysmenorrhea is presented.

Urinary Incontinence Due to Urethral Coitus in a Multiparous Woman.

Urethral coitus in women with a normal vagina and introitus has very rarely been reported. We report the case of a 48-year-old gravida 5, para 5 woman with a history of urethral coitus complaining of urinary incontinence. To the best of our knowledge, our patient is the fifth reported case of urethral coitus with normal genitalia, and it might be accepted as the first reported case of urethral coitus in a multiparous woman.

Risk factors for adenomyosis, leiomyoma and concurrent adenomyosis and leiomyoma.

AIM: To evaluate the risk factors for adenomyosis, leiomyoma and concomitant adenomyosis and leiomyoma in patients with treatment-resistant menometrorrhagia. METHODS: A retrospective study was conducted on 129 women who underwent abdominal hysterectomy for treatment-resistant menometrorrhagia. The patients were divided into four groups according to the postoperative histopathology: concomitant adenomyosis and leiomyoma (n = 33), adenomyosis only (n = 26), leiomyoma only (n = 48) and controls (n = 22). Patients without any organic uterine pathology constituted the control group. RESULTS: Age at menarche was higher in the concomitant adenomyosis and leiomyoma group compared to the adenomyosis only group (P = 0.006). The mean age (P = 0.007), age at menarche (P = 0.001) and gravidity (P = 0.001) were higher in the concomitant adenomyosis and leiomyoma group compared to the leiomyoma only group. Preoperative hemoglobin was lower in the concomitant adenomyosis and leiomyoma, adenomyosis only, and leiomyoma only groups than the control group (P < 0.008). On receiver operating characteristic analysis, hemoglobin <10.9 mg/dL had a sensitivity and specificity of 77% and 70%, respectively, in discrimination of any uterine organic pathology, including adenomyosis only, leiomyoma only, and concomitant adenomyosis and leiomyoma, from the control group. Patients in the adenomyosis group were older (OR, 1.20; 95%CI: 1.05-1.50) and had a lower age at menarche (OR, 0.42; 95%CI: 0.19-0.89) than the other groups. CONCLUSIONS: Preoperative anemia may be a useful predictor of adenomyosis. Older patients, and patients who had a lower age at menarche, were also more likely to have adenomyosis.

Effect of pregnancy and delivery on urinary incontinence after the midurethral sling procedure.

INTRODUCTION AND HYPOTHESIS: To evaluate the continence status and to reveal the optimal delivery mode of women who had an infant after application of a midurethral sling to treat stress urinary incontinence. METHODS: Between January 2007 and January 2013, 12 women who delivered an infant after application of a midurethral sling were detected and demographic data, type of MUS, interval between MUS and delivery, mode of delivery, birth weight of the newborn, complications during pregnancy, and continence status after delivery were collected. Between 2000 and 2014, in 14 articles listed in Pubmed, the data of 54 patients who had delivered after successful midurethral sling application were included. Postpartum recurrence of urinary incontinence was evaluated according to delivery type in 54 patients. RESULTS: Mean age of 12 patients at the time of MUS was 33.1 ± 4.3 years old and the interval between MUS procedure and pregnancy was 30.2 ± 14.2 months. Four patients had a transvaginal tape (TVT; 33.3%) and 8 had transobturator tape (TOT) procedure (66.7%) and mean follow-up after MUS surgery was 52 ± 12.3 months. Seven women had cesarean section (CS; 58.3%) and 5 women delivered vaginally (41.7%). Nine women were continent during pregnancy (75%) and 10 were continent after delivery (83.3%). Among 54 women who were included in the review, 28 underwent CS (51.9%), 26 women delivered vaginally (48.1%), and 11 women had postpartum incontinence (20.3%). In the case of postpartum urinary incontinence, there was no statistically significant difference between the CS and vaginal delivery groups (14.3 vs 26.9% respectively, p = 0.32). In logistic regression, incontinence during pregnancy was a risk factor for postpartum incontinence (OR:5.5; 95% CI: 1.1-27.6, p = 0.036). CONCLUSION: Risk of postpartum SUI recurrence in women who underwent application of midurethral slings seems to be similar independent of delivery mode and incontinence during pregnancy may be a risk factor for postpartum incontinence.

Associations between adipocyte fatty acid-binding protein and clinical parameters in polycystic ovary syndrome.

PURPOSE: We evaluated a possible association between serum adipocyte fatty acid-binding protein (A-FABP) levels and clinical parameters in women with polycystic ovary syndrome (PCOS). METHODS: Our study included 86 women: 49 with PCOS (study group), 37 with non-PCOS (control group). We recorded and analyzed age, body mass index [BMI = weight (kg)/height (m)(2)], waist circumference, and blood pressure and follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH, free testosterone (fT), dehydroepiandrosterone sulfate, 17-OH progesterone, insulin, glucose, triglyceride, high-density lipoprotein, low-density lipoprotein, very low density lipoprotein, HOMA-IR, and A-FABP levels. RESULTS: The mean BMI, waist circumference, and levels of serum LH, fT, LH/FSH, fasting insulin, and HOMA-IR were significantly higher in PCOS patients (p < 0.05). Pearson correlation analysis showed positive correlations of A-FABP levels with BMI and HOMA-IR levels and a negative correlation between A-FABP and fT levels. A ROC curve analysis found that BMI, waist circumference, and levels of fT, A-FABP, and HOMA-IR were discriminative parameters. CONCLUSION: Serum A-FABP levels may be a good prognostic marker in predicting metabolic syndrome and cardiovascular diseases in PCOS patients.

Pain experienced during and after office hysteroscopy with and without intracervical anesthesia.

We designed this study to evaluate if intracervical anesthesia reduces pain experienced during and after office hysteroscopy (OH). Two hundred women undergoing OH were randomized into two groups. Group I received intracervical anesthesia (10 ml %2 prilocaine), group II did not receive any anesthesia before procedure. The intensity of pain during procedure, 30 and 60 minutes later on visual analog scale (VAS) was assessed. Groups were similar in age, parity, previous number of vaginal delivery, or presence of menopausal status. The mean of pain scores during OH was less in group I (0.82 ± 0.11) than in group II (0.86 ± 0.09) and the difference was statistically significant (p = 0.04). But, the difference of mean pain scores 30 and 60 minutes after procedure between the groups were not statistially significant. In conclusion, intracervical anesthesia reduces pain experienced during OH, but this effect does not last longer.

Retention of fetal bones 8 years following termination of pregnancy.

Foreign bodies; in particular, fetal bones may present with a variety of clinical symptoms and signs including infertility, vaginal discharge, disparonia, pelvic pain, abnormal uterine bleeding. Many case reports were described post- abortal removal of retained fetal bone at varying time intervals from the previous (D&E), ranging from weeks to years. In our case, a 34-year-old woman presented with abnormal uterine bleeding and secondary infertility, her only pregnancy being a termination 8 years previously at 15 weeks' gestation. A transvaginal ultrasound revealed a normal-sized, normal-shaped uterus with an echogenic scarred endometrium. After then office hysterescopy revealed fragments of the immature bone. All the immature bones were removed by operative hysterescopy. Significant numbers of patients may have endometrial pathology; the differential diagnosis of such unusual findings on ultrasound examination includes intrauterine contraceptive devices, foreign bodies, calcified submucous fibroids and Asherman's syndrome, as well as rarities such as heterotopic bone. The presence of this pathology may be a causal or contributory factor to subfertilty, and will remain undetected if the endometrium is not routinely evaluated. Indeed, these cases highlight the advantage of performing a hysteroscopy at the same time as the more invasive laparoscopy and dye insufflation, in selected cases.