Are antral follicle count and serum anti-Mullerian hormone level, as reliable markers of ovarian reserve, affected by UV radiation?

ObjectiveWe aimed to assess whether ovarian reserve test including serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), anti-Mullerian hormone (AMH) levels, and antral follicle count (AFC) which are ovarian reserve markers are affected by ultraviolet (UV) radiation or not.MethodsWomen between the ages of 25 and 40 who served as flight crew constituted the study population in this prospective case-control study. Age-matched women having no risk factor for low ovarian reserve were selected as control group. Participants were compared according to age, duration in profession, and ovarian reserve markers.ResultsA total of 134 patients were included: 66 participants in study group and 68 participants in control group. Serum AMH levels and AFC were found to be significantly lower while serum FSH and E2 levels were significantly higher in the study group. This difference was found to be more significant, especially in the advanced age group. When the participants were classified according to their working time, lower ovarian reserve was observed in women with longer working time.DiscussionWorking for a while in the air and being closer to the sun have negative effects on ovarian functions. Preventive measures may be taken earlier in flight crew than those in the normal population to prevent the decline of ovarian functions and possible conceiving problems.

Comparison of two intraoperative examination methods for the diagnosis of sentinel lymph node metastasis in clinically early stage endometrial cancer: A Turkish Gynecologic Oncology Group Study (TRSGO-SLN-003).

OBJECTIVE: This study evaluated diagnostic accuracy of intraoperative sentinel lymph node (SLN) frozen section examination and scrape cytology as a possible solution for management of SLN positive patients. STUDY DESIGN: Clinically early-stage endometrial cancer patients who underwent SLN algorithm and intraoperative SLN examination were analyzed. Findings were compared with final pathology results and diagnostic accuracy of frozen section and scrape cytology were evaluated. RESULTS: Of the 208 eligible patients, 100 patients (48 %) had frozen section examination and 108 (52 %) had scrape cytology of the SLN. Intraoperative examination and final pathology were negative for metastasis in 187/208 (90 %) cases. The rest 21 cases had metastatic SLNs according to final pathology. 12 of 21 (57 %) metastases were classified as macrometastasis. Intraoperative examination of SLNs correctly identified 13 cases (true positive) and missed 8 cases (false negative). Five of 8 false negative cases had micrometastasis or isolated tumor cells. Considering identification of macrometastasis, sensitivity and negative predictive value were 85.71 % and 98.94 %, respectively, for the frozen section and 60.00 % and 98.15 %, respectively, for the scrape cytology. CONCLUSION: Frozen section examination of SLN has higher sensitivity in detecting macrometastasis compared to scrape cytology and it could help the surgeon in decision for further lymphadenectomy intraoperatively.

Perioperative Duloxetine for Pain Management After Laparoscopic Hysterectomy: A Randomized Placebo-Controlled Trial.

STUDY OBJECTIVE: To evaluate the effect of perioperative duloxetine on pain management in patients recovering from laparoscopic hysterectomy. DESIGN: A randomized placebo-controlled trial. SETTING: A university hospital. PATIENTS: Of 100 patients enrolled, 80 were randomized 1:1 to receive perioperative duloxetine (n = 40) or placebo (n = 40). INTERVENTIONS: Patients undergoing laparoscopic hysterectomy for benign conditions from November 2017 through March 2018 received 2 doses of 60 mg duloxetine or placebo 2 hours before and 24 hours after surgery. MEASUREMENTS AND MAIN RESULTS: The Quality of Recovery (QoR)-40 questionnaire was completed by participants after discharge. Study and control groups were compared in terms of questionnaire scores, opioid analgesic use, and hospital length of stay. The baseline characteristics of the groups were comparable; median total QoR-40 scores were 111 of 200 and 112 of 200 for duloxetine and the placebo group, respectively; the difference did not reach statistical significance (p = .91). Although the physical independence subcomponent of the recovery questionnaire was improved in favor of duloxetine, none of the subcomponents reached statistical difference between groups. The groups did not differ in terms of postoperative narcotic analgesic use and hospital length of stay (p >.05). CONCLUSION: Perioperative duloxetine did not reduce pain, need for narcotic analgesia, or hospital length of stay following laparoscopic hysterectomy.

Laparoscopic assisted robotic myomectomy of a huge myoma; Does robotic surgery change the borders in minimally invasive gynecology?

Today, the adoption of minimal invasive gynecologic procedures is expanding their routine use in clinical practice. Until recently, a diameter of 8 cm was the recommended maximal size for laparoscopic removal of fibroids. However, robot-assisted laparoscopy improved the capacity and the feasibility of the many gynecologic procedures. Here, we report a video of robotic myomectomy of a huge myoma.

Cervical premalignant lesions and their management.

Cervical cancer is the tenth most common cancer in women in developed countries that have national screening programs, while it is in the second line in underdeveloped countries. According to Ministry of Health registry data, cervical cancer is the eighth most common cancer among female cancers in Turkey. Today, the most effective screening for cervical cancer is to obtain smears from the cervix. Therefore, periodic screening programs are of great importance in identifying preinvasive lesions to prevent their progression to invasive cancer. Today, with the use of human papilloma virus (HPV) vaccine, screening programs have brought new insights into the prevention of cervical cancer. Management of preinvasive lesions has to be known by each obstetrics and gynecology specialist. Redundant procedures and treatments can be avoided by directing patients correctly at this step. Cancer phobia should not be created. Ablative or destructive treatments should not be done without histological diagnosis; hysterectomy, which has an equal risk of recurrence, should not be recommended.

The relation of increased uterine artery blood flow resistance and impaired trophoblast invasion in pre-eclamptic pregnancies.

OBJECTIVE: To assess the association between histopathologically confirmed vascular abnormalities developed during pre-eclampsia and abnormal arterial blood flows recorded during Doppler sonographies. MATERIALS AND METHODS: From pregnant women who attended our clinic between 01/03/2002 and 01/07/2002, a detailed medical history was obtained and routine biochemical blood tests, fetal ultrasonography and UA Doppler scans were performed. In addition, from pre-eclamptic and normal pregnant women who underwent cesarean sections, placental bed biopsies were taken. Thirty two pre-eclamptic [12 mild, 20 severe cases according to American College of Obstetricians and Gynecologists (ACOG) criteria] cases and as a control group 20 normal pregnancies were included in the study. In our study trophoblast invasion into decidual spiral arteries was observed in 75% of mild (9/12), and 55% of severe (11/20) pre-eclampsias. In the control group all the cases demonstrated trophoblast invasion in decidual spiral arteries. Trophoblast invasion in myometrial spiral arteries was noted in 50% (6/12) of mild and 25% (5/20) of severe pre-eclamptic pregnancies. It was seen in 16 cases out of 20 (80%) pregnancies. In the control group, decidual spiral artery invasion manifests significant differences (P<0.01) among groups studied. Invasion in decidual spiral arteries was seen in all normal pregnancies of the control group. There is not any significant difference between mild and severely pre-eclamptic groups (P>0.05). CONCLUSION: Doppler ultrasonography is not only a non-invasive method for evaluating fetal status in pre-eclamptic pregnancies, but it also correlates with partial trophoblastic invasion in spiral arteries, which contributes to the pathophysiologic mechanisms involved in pre-eclampsia.