Use of a levonorgestrel-releasing intrauterine device in the treatment of adenomyosis associated heavy menstrual bleeding.

OBJECTIVE: To evaluate the effects of a levonorgestrel-releasing intrauterine device in the treatment of adenomyosis associated with heavy menstrual bleeding. METHODS: The retrospective study was conducted at a tertiary referral hospital in Izmir, Turkey, and comprised data on adenomyosis patients who were implanted with a levonorgestrel-releasing intrauterine device for heavy menstrual bleeding between December 2004 and January 2008. After the insertion of the device, all patients were followed up by transvaginal ultrasonography and serum haemoglobin levels and menstrual patterns were determined at the 6th and 12th month. Data was analysed using SPSS 10. RESULTS: The mean age of the 42 women in the study was 43.2 +/- 0.8 years. At the sixth month, amenorrhoea, oligomenorrhoea, spotting and regular menstrual flow were 9.5% (n = 4), 7% (n = 3), 19% (n = 8), and 64% (n = 27), respectively. At the 12th month, the same parametres were 9.5% (n = 4), 7% (n = 3), 12% (n = 5), and 71% (n = 30), respectively. Haemoglobin levels had increased and endometrial thickness had decreased, and these differences were statistically significant (p < 0.001). CONCLUSION: The easy-to-use levonorgestrel-releasing intrauterine device can be added to the treatment options as a well-tolerated alternative in cases where a woman who has completed her fertility and does not request a hysterectomy has anaemia associated with adenomyosis.

The impact of thrombocytosis on clinicopathological prognostic factors and survival in patients with vulvar cancer.

PURPOSE: Reactive thrombocytosis in many solid tumors has widely been studied. In the present study we aimed to investigate whether thrombocytosis is a common and prognostic factor in women with vulvar cancer MATERIAL & METHODS: The preoperative platelet counts of 41 women, treated for vulvar cancer in our onco-gynecology center between March 1994 and January 2007, were retrospectively reviewed and correlated to clinical and pathological prognostic factors and 5-year survival. The chi-square or Fisher exact tests were used to compare categorical variables. P value < 0.05 was accepted for statistical significance. RESULTS: The mean age was 65.4 +/- 11.3 years (range 39-83y). All patients had squamous histology The mean platelet count was 335.42 x 109/L +/- 82.03 (range 142-1155x109/L). Thrombocytosis was detected in 8 (19.5%) patients. No correlation was found between thrombocytosis and grade (p = 0.65), LVSI (p = 0.82), tumor size (p = 0.73), depth of invasion (p = 0.18), lymph node metastasis (0.93), and FIGO stage (p = 0.78). The mean follow up time was 118.0 +/-43.1 months (range 60-213 months). At the end of the study period 14 patients (34.2%) had died, 8 (19.5%) had recurrence, 19 (46.3%) were disease-free. General 5-year survival was 68.3% (28/41). The 5-year survival rate for patients with thrombocytosis was 75.0% (6/8), which was not significantly different from the 5-year survival of patients with normal platelet counts (22/33; 66.7%) (p = 0.75). CONCLUSION: Our study showed that, overall, thrombocytosis was found in about 20% of patients with vulvar cancer and proved to be not linked to the best known prognostic factors and survival. Thus, disease stage and inguinofemoral lymph node status continue to be the best prognostic factors for this disease.

Borderline ovarian tumors: a study of 100 cases from a Tertiary Care Hospital.

AIM OF THE STUDY: The purpose of the study was to evaluate patients with borderline ovarian tumors. MATERIAL AND METHODS: Clinical features, treatment and survival status of 100 patients with borderline ovarian tumors were retrospectively evaluated between 1998 and 2007. RESULTS: Patients' mean age was 37.75 years (range: 15-72); 22 of them were postmenopausal. Histopathological diagnoses were serous, mucinous, endometrioid and clear cell in 54%, 41%, 2% and 3% of the patients, respectively; 70 patients had stage IA disease, 8 were at stage IB, 16 at stage IC, 2 at stage IIIA, 3 at stage IIIB and 1 at stage IIIC. Restaging laparotomies were performed on 19 patients; fertility-sparing surgery was performed on 52 patients; 2 patients received chemotherapy because of advanced-stage disease. All patients are currently alive. The 5-year disease-free survival rate for 71 cases was 100%. CONCLUSIONS: Borderline ovarian tumors have excellent prognoses, and fertility-conserving surgery can be performed in young patients with early-stage disease.

Prevention of infectious morbidity after elective abdominal hysterectomy.

OBJECTIVE: Our aim was to investigate whether posthysterectomy infectious morbidity could be reduced by intravaginal therapy before operations. MATERIALS AND METHODS: Women expected to undergo elective total abdominal hysterectomy were included. Vaginal flora was evaluated by preoperative Gram-stained vaginal smears up to Nugent's criteria. Study group were administered vaginal combination therapy including 500 mg metronidazole and 100 mg miconazole nitrate two times a day for 7 days. Control group were not given any preoperative vaginal therapy. Postoperative infectious morbidity was evaluated and compared. RESULTS: Ninety-five women in the study group and 97 women in the control group completed the study protocol. Women with abnormal flora had significantly more wound and vaginal cuff infections than the women with normal flora in the control group. Urinary infections were significantly higher in the study group (38.9 vs. 23.7 %) and vaginal cuff infections were significantly higher in the untreated control group (2.1 vs. 8.2 %). CONCLUSIONS: We concluded that postoperative vaginal cuff infections can be decreased by treating abnormal vaginal flora before elective abdominal hysterectomies.