Effect of adenomyosis on prognosis of patients with endometrial cancer.

OBJECTIVE: Our goal was to contrast the prognoses of patients with endometrial cancer who had adenomyosis against those that did not. METHODS: All patients who had received surgical staging for hysterectomy-based endometrial cancer had their medical data retrospectively examined. The analysis covered 397 patients, who were split into two groups depending on the presence of adenomyosis. Comparisons were made between patients covering type of surgery, histopathology, endometrial cancer stage, lymphovascular space invasion, presence of biochemical or histochemical markers, adjuvant therapy, presence of adenomyosis in the myometrial wall, and outcomes in terms of overall survival and disease-free survival. RESULTS: There is no statistically significant difference in the 5-year disease-free survival or overall survival rates between endometrial cancer patients with and without adenomyosis. This is based on comparisons of tumor stage, tumor diameter, histological type and grade of tumor, myometrial invasion, lymphovascular space invasion, and biochemical markers that affect the course of the disease. The median follow-up times were 61 months for the adenomyosis-positive group and 56 months for the group without adenomyosis. CONCLUSION: Coexisting adenomyosis in endometrial cancer has no bearing on survival rates and is not a prognostic factor.

Neoadjuvant chemotherapy in patients with stage IVB uterine serous carcinoma: a Turkish multicentric study.

The aim of this study was to evaluate the prognostic factors for and determine the effect of neoadjuvant chemotherapy (NACT) on oncologic outcome in stage IVB pure serous endometrial carcinoma patients who received taxane and platinum. Forty-two patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage IVB uterine serous carcinoma were enrolled from six gynecologic oncology centers and a study group was created. The study group had a 2-year disease-free survival (DFS) of 32% and 2-year disease-specific survival (DSS) of 73%. On univariate analysis; lymphadenectomy (not performed vs. performed), paraaortic lymph node metastasis (positive vs. negative) and number of metastatic lymph node count (≤5 vs. >5) were found to have statistical significance for DFS (p < 0.001, p = 0.026 and p = 0.044, respectively). Adnexal metastasis (positive vs. negative) and type of cytoreductive surgery (maximal vs. optimal and suboptimal) had statistical significance for DSS (p = 0.041 and p = 0.015, respectively). Receiving NACT did not affect DFS and DSS in stage IVB uterine serous carcinoma patients. As our sample size was small, precise conclusions could not be made for suggesting the use of NACT in advanced stage uterine serous carcinoma. For more accurate results, more randomized controlled studies are needed in this patient group.IMPACT STATEMENTWhat is already known on this subject? Endometrial carcinoma is the most common type of gynecologic tract malignancies and usually it is diagnosed at early stages. Although the favorable prognosis, uterine serous carcinoma (USC), one of the rarest subtypes, has a poorer prognosis when compared to other histological subtypes. USC has a propensity to spread beyond pelvis. Due to this aggressive behavior, surgical intervention could not be feasible in advanced stage disease.What do the results of this study add? Our study evaluated the prognostic factors that affect survival in advanced stage USC patients. Also we investigated that neoadjuvant chemotherapy (NACT) could improve oncologic outcomes. Performing lymphadenectomy, presence of paraaortic lymph node and adnexal metastasis, number of metastatic lymph nodes and type of cytoreductive surgery improved survival in advanced stage USC patients. However, NACT did not have a statistical significance as a predictor for disease-specific survival (DSS) and disease-free survival (DFS).What are the implications of these findings for clinical practice and/or further research? Maximal surgical effort should be performed in advanced stage USC according to our results. On the other hand, NACT had no impact on DSS and DFS rates. For this reason, we could not be able to suggest the routine use of NACT in advanced stage USC. But more randomized controlled trials are warranted for confirmation of our results.

A new and more effective feticide technique in late termination of pregnancy: potassium chloride injection into the interventricular septum of the fetal heart.

OBJECTIVE: This study sought to compare the efficacy and outcomes of fetal intracardiac intraventricular and interventricular septal potassium chloride (KCl) injections during the induced fetal demise process in a cohort of pregnant women with severe fetal abnormality who opted for late termination of pregnancy (TOP). MATERIALS AND METHODS: This study consisted of 158 pregnant women who requested late TOP for severe fetal abnormality between 22 and 36 weeks of pregnancy. Participants were randomly assigned with the simple randomization procedure to one of two feticide procedure groups: the intraventricular KCl injection group and the interventricular septal KCl administration group. We studied the clinical outcomes of both the feticide procedures. RESULTS: The median total dose of strong KCl was significantly lower in the interventricular septal KCl administration group (3 mL) than in the intraventricular KCl injection group (5 mL, p < 0.001). The median time to reach asystole and the median total duration of the procedure was significantly shorter in the interventricular septal KCl administration group (42 s and 85 s, respectively) than in the intraventricular KCl injection group (115 s and 150 s, respectively, p < 0.001). We detected a statistically significant correlation between the gestational week at feticide and the total dose of KCl (r = 0.705, p < 0.001), time to reach asystole (r = 0.653, p < 0.001), and total duration of the procedure (r = 0.683, p < 0.001). CONCLUSION: KCl administered directly into the interventricular septum induces immediate and permanent fetal cardiac asystole with a 100% of success rate without comprising maternal safety. We did not observe any maternal complications related to the procedure in our cases. Since the consequences of failed feticide procedure are challenging for both parents and healthcare providers, and providers are also concerned about potential legal implications regarding an unintended live birth, it is crucial to guide a strict protocol to confirm permanent fetal cardiac asystole.

Remediation of Cadmium Stress in Strawberry Plants Using Humic Acid and Silicon Applications.

(1) Background: Strawberry plants are strongly affected by heavy-metal-contaminated soils, which affects plant growth, yield and fruit quality. The aim of this work was to study the effects of a combination and individual application of silicon (Si) and humic acid (HA) on growth and development of Rubygem strawberries exposed to cadmium (Cd) in greenhouse conditions. (2) Methods: Morphological, physiological and biochemical parameters, including minerals in roots and leaves were determined. (3) Results: Cd stress in strawberry plants decreased plant fresh and dry weight; leaf stomatal conductance; leaf relative water content and chlorophyll content; number of leaves; leaf area; leaf N, P and K levels; and root P, N, Mg, K and Ca contents. Cd increased membrane permeability, leaf temperature, proline levels and lipid peroxidation. Si and HA individual applications to strawberries mitigated the negative effect of Cd stress on biochemical, physiological, morphological and minerals parameters by decreasing membrane permeability, leaf temperature, proline levels and lipid peroxidation. (4) Conclusions: Our findings highlighted that applications of Si, HA and Si + HA were effective in conferring Cd tolerance in strawberry plants by upregulating their many morphological, physiological and biochemical properties and reducing Cd stress.

Serum autotaxin levels correlate with the severity of pruritus in intrahepatic cholestasis of pregnancy.

PURPOSE: This study aimed to examine autotaxin (ATX) concentrations in the serum of pregnant women complicated with intrahepatic cholestasis of pregnancy (ICP) and compare them with individuals with uncomplicated healthy pregnancies. METHODS: This prospective case-control study took place with 83 pregnant women. The study group included 43 pregnant women presenting with a singleton pregnancy diagnosed with ICP in their third trimester of pregnancy. The diagnostic power of the ATX variable was examined by receiver operating characteristic analysis, and the cut-off value calculated according to the Youden index was summarized with the related sensitivity and specificity points. RESULTS: The mean serum concentration of maternal ATX was significantly higher in the ICP cases (8.91 ± 2.69 pg/mL) compared to the pregnant women in the control group (3.59 ± 1.39 ng/mL, p < 0.001). According to the Youden index, a 5.80 ng/mL cut-off value of serum ATX concentrations can be used to diagnose ICP with 97.7% sensitivity and 97.5% specificity. A significant highly positive correlation was found between maternal serum ATX levels and maternal serum total bile acid levels (r = 0.633 and p < 0.001) and itch intensity, which was objectified by the visual analog scale score (r = 0.951 and p < 0.001). CONCLUSION: Maternal serum ATX levels were significantly increased in ICP patients as compared with healthy pregnant women. Also, serum ATX activity was highly correlated with the itch intensity. We consider that ATX might represent a robust, accurate, and reliable circulating biomarker to diagnose ICP.

Post-recurrence survival analysis of patients with pulmonary recurrence from gynaecologic cancers: a multi-institutional analysis of 122 patients.

In this retrospective study, patients with epithelial gynaecologic cancer with pulmonary recurrence (PR) were evaluated from five national gynaecologic oncology clinics. Patients with a diagnosis of primary endometrial, ovarian/fallopian tube/peritoneal, cervical or vaginal/vulvar tumours who developed an initial PR were included in the study A total of 122 patients were included in the study. The median follow-up time after recurrence was 7.5 (range, 1-84) months. The 2-year PRS was 48% in the main cohort. The risk of death was more than seven times higher in patients who did not receive salvage chemotherapy compared with those who did (hazard ratio: 7.6, 95% CI: 3.0-18.9; p < .001). When squamous cell carcinoma was compared with the other tumour types, the risk of death increased more than three times (hazard ratio: 3.7, 95% CI: 1.4-9.6; p = .007).IMPACT STATEMENTWhat is already known on this subject? Pulmonary recurrence (PR) from gynaecologic malignancies is rare and can cause major clinical problem. Therefore, defining the clinical and pathologic characteristics and recurrence patterns are essential.What the results of this study add? This study demonstrates non-squamous subtype and salvage chemotherapy at PR were associated with improved survival.What of these findings for clinical practice and/or further research? To the best of our knowledge, our study is the largest study to investigate the clinico-pathologic characteristics, recurrence patterns, treatment options, and post-recurrence survival (PRS) in patients with PR from epithelial gynaecologic cancers. Future research should examine the underlying causes of these findings.

The effect of medical ozone therapy in addition to ovarian detorsion in ischemia reperfusion model.

This study aimed to investigate the protective effect of ozone therapy on ovarian reserve, number of ovarian follicles, ovarian morphology in a rat ischaemia reperfusion (IR) injury model. Twenty-four, Wistar Hannover rats were included. The rats were divided into three groups as control, detorsion-only, and ozone therapy + detorsion groups. There was a statistically significant difference in the follicular damage and inflammation scores between the study groups (p = .019, p = .002, respectively). The highest AMH decrease was observed in the detorsion-only group (p = .012). The total damage score was higher in the detorsion-only group than the ozone therapy + detorsion group. Preantral, small and large antral follicle numbers were less in the detorsion-only group than the ozone therapy + detorsion group. The highest postoperative day 7 TAS level was in the ozone therapy + detorsion group. TOS levels did not differ significantly between the study groups. The combination of the ozone therapy with ovarian detorsion is more effective in protecting the ovarian reserve than ovarian detorsion-only.Impact StatementWhat is already known on this subject? Adnexal torsion is a common gynecological emergency in reproductive-age women. The recommended management is the detorsion of the adnexal pedicle in patients with fertility desire.What do the results of this study add? The combination of the medical ozone therapy with conventional surgical ovarian detorsion is more effective in the protection of the ovarian reserve compared to surgical ovarian detorsion.What are the implications of these findings for clinical practice and/or further research? This study speculates that medical ozone therapy in addition to conventional surgical ovarian detorsion could preserve ovarian reserve and function if confirmed in further clinical studies.

The effect of omentectomy on the blood levels of adipokines in obese patients with endometrial cancer.

OBJECTIVE: To investigate the blood levels of adipokines in obese patients with endometrial cancer who have and have not undergone omentectomy. METHODS: Between September 2017 and September 2019, the study recruited 54 patients with endometrial cancer. Measurements were taken of blood levels of human leptin, perilipin-1, adiponectin, adipolin, resistin, visfatin, and estrone preoperatively and postoperatively before adjuvant therapy or at the end of one month. The serum samples were separated by centrifugation for 10 mins at 3,000 revolutions/min, then stored at -80 °C until assay. RESULTS: In this prospective study, a total of 54 endometrial cancer patients were analyzed in two separate groups according to the omentectomy status. Comprehensive staging surgery with omentectomy and without omentectomy was performed in 26 patients and 28 patients, respectively. The age, body mass index, body fat index, waist circumference, and skin thickness values of the patients with and without omentectomy were found to be similar. No statistically significant difference was determined between the patients with and without omentectomy in respect of the blood level of the adipokines measured preoperatively. A strong statistically significant correlation was determined between the pre and postoperative levels of Human Leptin (p = 0.002), perilipin-1(p = 0.001), adipolin (p < 0.001), adiponectin (p < 0.001), resistin (p = 0.001), visfatin (p < 0.001), and estrone (p = 0.004) (r = -0.43, -0.47, 0.75, 0.84, -0.47, - 0.58, -0.41, respectively) CONCLUSIONS: Omentectomy affected the postoperative blood levels of adipokines in obese patients with endometrial cancer. As omentectomy may have some positive effects on metabolism in these patients, it may be considered during endometrial cancer surgery due to the possible positive metabolic effects.

Perioperative goal-directed fluid management using noninvasive hemodynamic monitoring in gynecologic oncology.

BACKGROUND: Intraoperative fluid management is important for the prevention of perioperative morbidity and mortality. Our study aimed to investigate the perioperative feasibility and benefits of Goal-Directed Fluid Management (GDFM) using noninvasive hemodynamic monitoring in gynecologic oncology patients with acute blood loss and severe fluid loss. We assessed the effects of GDFM on hemodynamics, organ perfusion, complications, and mortality outcomes. METHODS: This randomized prospective study included 104 patients over the age of 18 years, including 56 patients with endometrial cancer and 48 patients with ovarian cancer who had open surgery. The anesthetic approach was standardized for all patients. We compared the perioperative results of the subjects who were randomized into GDFM (n = 51) and Liberal Fluid Management (LFM) (n = 53) groups using a computer program. RESULTS: The median perioperative crystalloid replacement (2000 vs. 2700; p < 0.001) and total volume of fluid (2260 vs. 3200; p < 0.001) were lower in the GDFM group compared to the LFM group. The hemodynamic findings and the HCO3 and lactate levels of the GDFM group did not significantly change perioperatively. The heart rate, mean arterial pressure, and HCO3 levels of the LFM group decreased and serum lactate levels increased perioperatively. The hospitalization rate in ICU (7.8% vs. 28.3%; p = 0.010), rate of patients with comorbidity conditions indicated in ICU (2% vs. 17%; p = 0.024), and rate of complications (17.6% vs. 35.8%; p = 0.047) were lower in the GDFM group compared to the LFM group. CONCLUSION: The amount of intraoperatively administered crystalloid solution and complication rates were significantly lower in gynecologic oncologic surgery patients who received GDFM. Besides, hemodynamic findings, and lactate levels of the GDFM group did not change significantly during the perioperative period.

Comparison of vNOTES technique with conventional laparoscopy in gynecological emergency cases.

BACKGROUND: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has emerged as a minimally invasive approach. This study aimed to evaluate the feasibility and surgical outcomes of the vNOTES method and compare it with conventional laparoscopy (CL) in gynecological emergency cases. MATERIAL AND METHODS: A retrospective study was conducted to compare vNOTES with CL regarding pre-/intra-/postoperative outcomes. The women who were operated on for emergency indications such as ectopic pregnancy, ovarian torsion, ovarian cyst rupture and acute abdominal pain were evaluated. Patients' age, gravidity, parity, medical/surgical history, height, weight, blood pressure, heart rate, pre-/postoperative hemoglobin and hematocrit levels, the quantity of aspirated hemoperitoneum, visual analog scale (VAS) pain scores six and 12 h postoperatively, duration of surgery and hospital stay were recorded. RESULTS: The study was conducted with 90 women. Sixty of them underwent CL, while 30 women had vNOTES. The vNOTES group had a significantly shorter duration of surgery -28.5 min (15-48 min) vs. 77 min (29-155 min), respectively, p < .001), shorter hospital stay - 32 h (11-125 h) vs. 38 h (12-201 h), respectively, p = .007), lower VAS scores after 6 h - 5 (4-7) vs. 6 (2-8), respectively, p < .001), and after 12 h - 2 (1-3) vs. 2 (1-5), respectively, p < .001) and a lower dose of postoperative analgesic administration - 2 (2-3) vs. 3 (1-5), respectively, p < .001) than the CL group. CONCLUSION: vNOTES surgeries can be considered an alternative technique to CL by providing shorter surgery duration, lower postoperative pain scores, shorter hospital stays and better cosmetic outcomes.

The Association between the Preoperative Prognostic Nutritional Index and the Controlling Nutritional Status Score on Tumor Stage, Chemotherapeutic Response and Overall Survival in Ovarian Cancer.

This study aimed to investigate the association between preoperative prognostic nutritional index (PNI) and controlling nutritional status (CONUT) scores on the stage of ovarian cancer (OC), chemotherapeutic response, and overall survival (OS) in patients with OC.The data of the patients who operated due to OC between January 2015 and January 2020 in a tertiary referral hospital were recorded. The patients' basic characteristics, preoperative total cholesterol, albumin, lymphocyte count, tumor markers, disease stage, grade, chemotherapeutic response, OS, and progression-free survival were recorded. The PNI and the CONUT score were calculated.The mean PNI level was considerably higher in the early-stage group than the advanced-stage group (50.02 ± 6.8 vs. 46.3 ± 7.4, p = 0.005). The AUC was 63% for the cutoff point 45.98 of PNI, whereas the AUC was 42% for the cutoff point 1.5 of CONUT score in predicting early-stage disease. The PFS and OS were significantly higher in the high PNI group than the low PNI group (p = 0.01, p = 0.002, respectively).The patients with early-stage OC had significantly higher PNI levels and lower CONUT scores in our study population.

The Comparison of Transvaginal Natural Orifice Transluminal Endoscopic Surgery and Conventional Laparoscopy in Opportunistic Bilateral Salpingectomy for Permanent Female Sterilization.

STUDY OBJECTIVE: To compare the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) approach with conventional laparoscopy (CL) in opportunistic bilateral salpingectomy (BS) alone for permanent female sterilization as an opportunistic cancer prevention strategy. DESIGN: Prospective cohort study. SETTING: Two-centered tertiary hospitals. PATIENTS: Ninety-six women with a nonprolapsed uterus seeking definitive surgical permanent contraception. INTERVENTIONS: Patients were scheduled for BS and assigned to a study arm in a 2:1 fashion (CL:vNOTES allocation ratio) concerning patient's choice. MEASUREMENTS AND MAIN RESULTS: Patients were followed at their postoperative first week and first month. The visual analog score (VAS), Patient Global Impression of Improvement, and Female Sexual Function Index scales were used to assess the pain, patient satisfaction, and discomfort/pain after vaginal penetration, respectively. Patients who underwent to vNOTES had a significantly higher number of previous abdominal surgery (median difference, 1.97; 95% confidence interval [CI], 1.12-3.48; p = .016). Compared with CL, vNOTES was associated with lower 6-hour (rate ratio [RR], 0.63; 95% CI, 0.50-0.77) and 24-hour (RR, 0.33; 95% CI, 0.23-0.46) postoperative VAS scores and less amount of postoperative analgesics (RR, 0.54; 95% CI, 0.36-0.78). The slope of change in postoperative VAS scores was in a shorter time in the vNOTES group (RR, 0.47; 95% CI, 0.36-0.60). The rate of postoperative improvement was higher in the vNOTES group than the CL group at the postoperative first week (87.5% vs 68.2%, χ2 = 4.232, p = .032) and first month (96.9% vs 87.9%, χ2 = 2.091, p = .140). The rate of patients reporting postoperative decline in Female Sexual Function Index /pain scores (RR, 0.97; 95% CI, 0.47-1.96) was found to be similar in both of the study groups, and no postoperative complication was observed in either group. CONCLUSION: Women seeking permanent sterilization and who underwent BS for ovarian cancer risk reduction purposes had higher satisfaction, less postoperative pain, lower analgesic requirement, and similar surgical outcomes in the vNOTES group than the CL group, even in patients with previous surgeries and a nonprolapsed uterus. vNOTES approach could be the preferred method for the opportunistic BS in female sterilization.

Comparison of Surgical Outcomes of Total Laparoscopic Hysterectomy and vNOTES Hysterectomy for Undescended-Enlarged Uteri.

AIM: This study aimed to compare the surgical outcomes of laparoscopic hysterectomy (LH) and vaginally assisted natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy procedures in women with undescended-enlarged uteri. MATERIALS AND METHODS: This cross-sectional study was conducted with 78 women who underwent LH (48 patients) or vNOTES hysterectomy (30 patients) for benign gynecological pathologies. The dimension of the uterus, operation time, intraoperative blood loss, the presence of peri-, postoperative complications, conversion to laparotomy, pre-, postoperative hemoglobin (Hb), and hematocrit (Hct) levels, postoperative hospital stay, total dose of postoperative analgesics, VAS scores at the postoperative 6th and 24th hours, and the final pathology reports were recorded. RESULTS: There was no significant difference between LH and vNOTES hysterectomy groups regarding age (47 vs. 47.5 years, p = 0.92), parity (2 vs. 2, p = 0.74), and BMI (30.8 vs. 28.2 kg/m2, p = 0.31). The patients in the vNOTES hysterectomy group had significantly shorter durations of surgery (45 vs. 160 min) and hospitalization (48 vs. 72 h) than the LH group (p < 0.001, p < 0.001, respectively). The 24th hour VAS score was lower (VAS score 2 vs. 3, p = 0.003) in favor of the vNOTES hysterectomy group. In matched group analysis, the 24th hour VAS score (2 vs. 3, p = 0.008), operation time (45 vs. 157, p < 0.001), and hospitalization (48 vs. 72, p < 0.001) were lower in the vNOTES hysterectomy group than the LH group. CONCLUSION: vNOTES hysterectomy provides favorable outcomes compared to conventional LH considering the shorter operation time, hospitalization, and lower 24th h VAS score.

Evaluation of HSP70 levels in ectopic pregnancy, abortus imminens and intrauterine pregnancy.

Aim: To assess the serum levels of HSP70 concentrations in ectopic pregnancy (EP) patients compared with abortus imminens (AI) patients and healthy controls. Materials & methods: Age-matched patients were divided into three groups, with 30 patients in each group: EP, AI and healthy intrauterine pregnancy groups. Blood samples were taken from the antecubital vein and kept for HSP70 analysis. Results: The HSP70 levels were higher in the EP group than in AI patients and healthy controls (p < 0.05). The area under the curve for the serum HSP70 assay reached a value of 0.81 for a cutoff point of 11.12 pg/ml, which identified women with EP. Conclusion: Serum HSP70 levels increased in women with EP compared with healthy controls and women with AI.

A pregnancy outside the uterus is called ectopic pregnancy. While diagnosing these patients, consecutive blood tests and serial vaginal examinations are used. Abortus imminens, which is in the differential diagnosis of ectopic pregnancy, means impending miscarriage or abortion. The aim of this study was to evaluate the relationship between HSP70 serum levels and pregnancies in which the exact location is unknown. Therefore, the study determined that HSP70 increased in ectopic pregnancy patients compared with abortus imminens and healthy patient groups.

Serum X-box-binding protein 1 levels in PCOS patients.

OBJECTIVE: X-box binding protein-1 (XBP1) is a possible indicator of metabolic syndrome and diabetes. This study aimed to evaluate the relationship between serum XBP1 levels and polycystic ovary syndrome (PCOS). METHOD: A prospective observational study was conducted with 88 patients. The first group was defined as the control group with ovulatory and normal-BMI patients (n = 28). The second group comprised of nonobese PCOS patients (n = 30). The third group included overweight/obese patients with PCOS (n = 30). Fasting plasma glucose, serum lipids, follicle stimulating hormone, luteinizing hormone, total testosterone, dehydroepiandrosterone and XBP1 levels l were evaluated in all groups. RESULTS: There was a significant difference in XBP1 levels between the study groups, and higher levels were observed both in the nonobese and obese PCOS groups than in the healthy controls (p < .001). The median level of XBP1 was 73.7 pg/ml in the control group, 114.11 pg/ml in the nonobese PCOS group, and 151.61 pg/ml in the overweight/obese PCOS group. A cutoff level of XBP1 at 95.79 pg/ml level was determined with a significant AUC (area under the curve) level of 99% and high specificity and sensitivity rates to predict PCOS. Also, a significant positive correlation was observed between XBP1 levels and BMI, waist circumference, fasting plasma glucose and triglyceride levels (p < .05). CONCLUSIONS: XBP1 levels were significantly higher in PCOS patients, particularly in overweight/obese PCOS patients, than in the controls. Also, the parameters associated with metabolic syndrome were related to XBP1 levels.

Can pre-procedural MRI signal intensity ratio predict the success of uterine artery embolization in treatment of myomas?

Background/aim: Magnetic resonance (MR) images, signal intensity ratios calculated using region of interests (ROI) in T2W images by proportioning the dominant myoma to iliac muscle can aid patient selection and, thus, in achieving better outcomes with the uterine artery embolization (UAE) procedure. The present study investigates the association between the success of UAE treatment with signal intensity (SI) ratio of the dominant myoma to the iliac muscle in MR imaging performed prior to the procedure. Materials and methods: This is a retrospective study and included 30 patients who admitted to our clinic between February 2017 and July 2019 due to symptoms associated with myoma and who underwent MR imaging before and after UAE treatment. All patients, MR images obtained before UAE treatment and at the 12th month after the procedure were evaluated. In MRI, SI values were calculated by proportioning the dominant myoma to the iliac muscle using circular ROI in T1 weighted (W), T2W, and post-contrast T1W images. In the present study, 50% or more volumetric regression of the myoma with infarction of fibroids (loss of enhancement) at the 12-month follow-up MRI after the procedure was considered a successful procedure. Results: Myoma volumes calculated in MR images showed significant differences between the MRI performed before UAE procedure and the MRI performed at the 12th month after the procedure (p < 0.0001). SI ratio calculated from pre-procedure T2W MR images was found to be a significant determinant of 50% or more volumetric regression in the myoma after UAE procedure (p = 0.017), T1W, post-contrast T1W images were not statistically significant (p = 0.211). Conclusion: Our results indicate that SI ratio of the dominant myoma to the iliac muscle calculated using ROI in T2W images of MR studies performed before UAE procedure can predict the success of the procedure.

Effect of metformin and detorsion treatment on serum anti-Müllerian hormonelevels and ovarian histopathology in a rat ovarian torsion model

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.

Management of intractable postpartum haemorrhage in a tertiary center: A 5-year experience.

BACKGROUND: The purpose of this study is to describe treatment alternatives to prevent postpartum hysterectomy after failure of conventional therapies. Prevention of hysterectomy was the main outcome studied. MATERIALS AND METHODS: This is a retrospective study of 19 patients diagnosed to have intractable postpartum hemorrhage and not managed with medical treatment who were subsequently treated with operative interventions in our unit between January 2004 and January 2009. The cases were identified by review of medical records. RESULTS: In the period under review, a total of 17,341 deliveries were conducted, out of which 19 women were managed for intractable PPH. The incidence of severe PPH unresponsive to standard medical treatment was 0.1%. The mean maternal age was 33.5±3.4 years (range 27-39 years). The mean gestational age was 38.3±1.3 weeks (range 37-41 weeks). Organ preserving surgery methods were utilized in all the patients with a success rate 78.9%. The mean duration of surgery was 95 minutes (range 50-130 minutes) and the mean hospital stay was for 5 days. The mean transfused blood volume was 2.4 units as packed red cells. Among these 19 cases, 4 cases were resorted to hysterectomy. CONCLUSIONS: In the presence of uncontrolled hemorrhage, this simple procedure should be tried before other complex treatment alternatives are undertaken. Our case series suggests that the combination of uterine artery ligation with B-Lynch sutures might be the best surgical approach because it preserves future fertility better than other methods and avoids high operative risks and morbidity.