Impact of laparoscopic ovarian detorsion on ovarian reserve.

AIM: The aim of this study was to evaluate ovarian reserve after laparoscopic ovarian detorsion in patients with ovarian torsion. METHODS: From February 2014 to September 2015, a total of 11 patients with ovarian torsion underwent laparoscopic detorsion. These 11 patients were eligible for study, and ovarian reserve was assessed on serum anti-Müllerian hormone (AMH) and by antral follicle count preoperatively, and in postoperative months 1 and 3. RESULTS: Mean patient age was 25.4 ± 5.5 years. Although mean antral follicle count on the operated side was slightly lower than on the contralateral side at 1 month postoperatively (P > 0.05), at 3 months postoperatively there was no difference in mean antral follicle count between the operated and contralateral sides (P > 0.05). There was no significant change in serum AMH level at 1 and 3 months postoperatively compared with the preoperative level (P > 0.05). CONCLUSIONS: Laparoscopic detorsion of twisted ovary is a safe procedure to preserve ovarian function, and does not impair ovarian reserve according to antral follicle count and AMH during the course of follow-up.

Evaluation of the diagnostic role of transvaginal ultrasound measurements of endometrial thickness to detect endometrial malignancy in asymptomatic postmenopausal women.

PURPOSE: To assess the diagnostic accuracy of endometrial thickness measurements of transvaginal ultrasound (TVUS) in asymptomatic postmenopausal women in the detection of endometrial malignancy. METHODS: A retrospective cohort study in a university hospital was undertaken with 276 consecutive asymptomatic postmenopausal women undergoing dilatation and curettage (D&C) and hysteroscopy for an incidental finding of thickened endometrium (≥4 mm) between 2003 and 2012. Different endometrial thickness cutoff values were tested on the basis of a pathologic report with carcinoma conditions (endometrial hyperplasia with atypia and endometrial carcinoma). RESULTS: The mean age of patients was 59.8 ± 9.0 years. The mean duration of menopause was 11.2 ± 8.9 years. The final pathology diagnoses included 107 (38.8 %) patients with polyps, 42 (15.2 %) with atrophic endometrium, 39 (14.1 %) with estrogen exposure, and 19 (6.9 %) with normal endometrium. With regard to carcinoma conditions, nine patients (3.3 %) had endometrial hyperplasia with atypia and eight patients (2.9 %) had endometrial carcinoma. The area under the ROC curve was 0.52 (95 % CI 0.44-0.57), which indicated a poor accuracy of endometrial thickness of TVUS for carcinoma conditions. CONCLUSIONS: Routine use of endometrial thickness measurement with TVUS does not seem to be an effective diagnostic tool for endometrial cancer because it has a low diagnostic performance in asymptomatic postmenopausal women. Further prospective studies are required to assess the endometrial thickness measurement with TVUS as a screening method in these women.

Recurrent pyoderma gangrenosum after cesarean delivery successfully treated with vacuum-assisted closure and split thickness skin graft: a case report.

We describe the case of a 32-year-old woman (gravidity: 4; parity: 2) who underwent cesarean delivery at 37 weeks of gestation and presented with dehiscence and infection of the surgical wound. She had a history of wound infection and dehiscence of the scar from a previous cesarean delivery and dehiscence in the dorsal side of her left hand at the site of intravenous catheterization. The patient was initially diagnosed with a skin infection and later with pyoderma gangrenosum. No evidence of any underlying disease was found. The lesions were treated with systemic corticosteroids and azathioprine, but the lesions were unresponsive to treatment. This complicated case of pyoderma gangrenosum after cesarean delivery, which initially mimicked wound infection, was successfully treated with vacuum-assisted closure and split-thickness skin graft. This synergistic approach with vacuum-assisted closure could be an important treatment option for aggressive and slow-healing lesions.

Is complete umbilical cord scanning possible at the second-trimester ultrasound scan?

PURPOSE: To evaluate the feasibility of umbilical cord scanning during the second-trimester sonographic examination, we looked at the method of scanning, the findings, and the time spent. METHODS: Five hundred forty-nine singleton pregnancies were evaluated at 18-23 weeks' menstrual age with two-dimensional sonography (US). Color Doppler US was used when needed. The umbilical cord was traced from the fetal insertion site to the placental insertion site. Fetal and placental sites of insertion; number of vessels; presence of knots, cysts, tumors, nuchal cords, or placental anomalies; time spent for scanning; and the use of color Doppler US were noted. RESULTS: The mean maternal age was 33.1 ± 4.1 years, and the mean menstrual age of the fetuses during scanning was 20.4 ± 2.4 weeks. The mean time spent for umbilical cord scanning was 41.5 ± 46.7 seconds. In one case (0.2%), the umbilical cord could not be scanned completely. Color Doppler US was needed in 125 (22.8%) of the scans. Scan results were positive in 153 (27.9%) cases. We observed six cases (1.1%) of a single umbilical artery, two (0.4%) umbilical cord knots, one (0.2%) umbilical cord hernia, and 104 (18.9%) nuchal cords. We also documented 27 (5.0%) marginal insertions, four placenta previa totalis (0.7%), four placenta previa marginalis (0.7%), and eight velamentous insertions (1.5%). CONCLUSIONS: Umbilical cord US scanning is feasible during the second trimester of pregnancy, and complete scanning can be performed in the majority of the cases. Color Doppler analysis may aid scanning when needed. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:249-253, 2015.

Persistent ascites resolving with gonadotropin-releasing-hormone-agonist 18 months after hospitalization for severe ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome (OHSS) is a life- threatening complication of controlled ovarian stimulation. One of the main symptoms of OHSS is ascites. Treatment is symptomatic with resolution of the symptoms over days to weeks. We report a case of severe OHSS with persistent ascites 18 months after the diagnosis. Persistent ascites secondary to OHSS was diagnosed and single dose leuprolide acetate depot 11.25 mg was administered. At follow-up, no ascites was observed.

Acute colonic pseudo-obstruction after hysterectomy in a patient with Friedreich ataxia.

Acute colonic pseudo-obstruction is a rare complication of gynecological surgery. Despite the complete description of this condition, diagnosis remains difficult and is often delayed. Due to delay in diagnosis and existence of serious comorbid illnesses, morbidity and mortality approaches higher levels. Early recognition of signs and symptoms of this condition and prompt accurate management are vital to prevent serious mortality. Here, we report a case of acute colonic pseudo-obstruction after total abdominal hysterectomy in a patient with known Friedreich ataxia.

Actions speak louder than words; pediatricians, gynecologists, nurses, and other mothers' perspectives on the human papillomavirus vaccine: an Istanbul multicenter study.

Introduction: Gynecologists and pediatricians have an essential duty to prevent cervical cancer. In this study, we compared the compliance of gynecologists (n = 22) and pediatricians (n = 49) with nurse/midwife (n = 66) and non-medical moms (n = 120) with regards to cervical cancer precautions. Methods: A questionnaire was used to gather data on their demographics, personal vaccination and screening practices, children's immunization status, and awareness of cervical cancer prevention. Results: The findings demonstrated that gynecologists and pediatricians were better than others at understanding the risk factors and prevention of cervical cancer. It was noted that compared to other groups, physician mothers and their offspring had higher vaccination rates (n = 13, 18.3%; n = 10, 29.4%, respectively). Medical professionals typically provided thorough and accurate answers to informational questions. More frequent Pap smear tests were performed by gynecologists. It was noted that mothers who worked as pediatricians and nurses/midwives neglected their own screening needs. Discussion: This questionnaire survey sought to ascertain Istanbul's health professionals' present opinions regarding HPV vaccination. Healthcare professionals should be the first to receive information on HPV vaccination and cervical cancer incidence reduction. The public could then readily use them as an example.

Recurrent obturator abscess with spontaneous expulsion of the mesh after transobturator tape operation.

The transobturator tape operation has been the most popular method of SUI surgery worldwide owing to its low complication rate and high success rate. However, erosions and abscesses secondary to transobturator tape have been observed. Here we report a 36-year-old woman referred to our unit with fever, persistent swelling in the left groin, difficulty in walking, and a tape that came through the vagina, 4 years after the transobturator tape operation. She had a history of ischiorectal abscess and rectovaginal fistula. A recurrent obturator abscess with fistula formation and spontaneous expulsion of the mesh was diagnosed. The patient underwent antibiotic therapy, incision through the fistula tract, drainage of the abscess, and removal of the necrotic material. Patients should be informed about risks of erosion and infection and that pain and foul smelling vaginal discharge might be the first signs of severe infectious morbidities after transobturator tape operation.

Randomized trial of graft materials in transobturator tape operation: biological versus synthetic.

OBJECTIVE: To compare the outcome of outside-in biological and synthetic transobturator tape (TOT) operation, including subjective and objective success rates, urodynamics, and quality of life. MATERIALS AND METHODS: One hundred patients suffering from clinical and/or urodynamic stress urinary incontinence (SUI) were randomized into biological material TOT (PELVILACE® TO) or synthetic material TOT (ALIGN®TO Urethral Support System) groups. Preoperative and at 1 year postoperative urogynecological symptom assessment, 1-h pad test, 4-day bladder diary, stress test, Q-tip test, and urodynamics were performed. For the evaluation of quality of life, the King's Health Questionnaire, Urogenital Distress Inventory-6, Incontinence Impact Questionnaire-7, and Prolapse Quality of Life were used. RESULTS: There was no significant difference between the two groups regarding objective and subjective cure rates and quality of life. At 1-year follow-up, the subjective cure rate was 68 % in the biological material TOT and 70 % in the synthetic material TOT group. No perioperative complications developed. Groin pain developed in 2 patients in the biological TOT group and 1 patient had dehiscence in the periurethral incision, which healed with local estrogen. Two patients had transient urinary retention in the synthetic TOT group, 1 patient developed groin pain, and 1 patient had mesh erosion observed at the 1-year follow-up. CONCLUSION: Transobturator tape with biological material in the management of SUI has a rate of success and patient satisfaction similar to those of synthetic material at 1-year follow-up. Studies with longer follow-up and larger cohorts are necessary to evaluate possible autolysis and degradation of biological slings and a possible reduction in efficacy over time.

Diagnosis and management of vulvar Darier disease: A case report.

Darier disease is an autosomal dominant disorder with hyperkeratotic papules affecting primarily seborrheic areas of the upper chest, back, forehead, scalp, nasolabial folds, ears, and, less frequently, the oral mucosa. A typical eruption consists of keratotic and crusted skin-colored papules and plaques. Pruritus occurs in 80% of patients, and pain is rare. Lesions can be triggered by exposure to ultraviolet light, heat, or stress. Secondary infections of the lesions are a common complication. A definitive diagnosis is obtained by a biopsy showing histological features such as acantholysis, suprabasal clefts, and "corps rond and grains". Here we present a 37-year-old woman admitted to the gynecology department with pruritic lesions she had noticed on her vulva and perineum for three months. A vulvar biopsy led to the diagnosis of Darier disease. She was referred to the dermatology department and treated with oral acitretin since systemic retinoids are offered as the first-line treatment of the disease.

Management of cesarean heterotopic pregnancy with transvaginal ultrasound-guided potassium chloride injection and gestational sac aspiration, and review of the literature.

Cesarean scar pregnancy is one of the rarest forms of ectopic pregnancy, located in the scar from a previous cesarean section. There are few reports of such pregnancies, and there is no consensus about the best management. Herein is reported a case of cesarean heterotopic pregnancy, diagnosed at 6 weeks' gestation and successfully treated via transvaginal ultrasound-guided potassium chloride injection and gestational sac aspiration, with preservation of the intrauterine pregnancy.

The effects of posterior tibial nerve stimulation on refractory overactive bladder syndrome and bladder circulation.

AIM: We aimed to evaluate if posterior tibial nerve stimulation (PTNS) exerts its effects on overactive bladder symptoms through changes in bladder circulation. MATERIALS AND METHODS: Eighteen women who applied to Istanbul Medical Faculty with symptoms of urgency, frequency±urge incontinence and did not respond to anticholinergic treatment and behavioral modification were enrolled in the study. Weekly PTNS in 30-min sessions for 12 weeks was performed. Urogynecologic symptom assessment, 1-h pad test, bladder diary, King's Health Questionnaire (KHQ), and transvaginal Doppler ultrasonography were performed before and after treatment. RESULTS: Ten patients (55.5%) were cured, five (27.8%) improved, and no effect was observed in three (16.7%). No significant change was observed in systolic and diastolic flow rate, pulsatility index, resistive index, systolic/diastolic ratio and average flow rate. Significant decrease in frequency, urgency, urge incontinence, pad test results and increase in fluid intake was observed. There was a significant improvement in physical limitations and sleeping/energy domains of KHQ. No significant change was observed in urodynamics. CONCLUSIONS: PTNS does not have any effect on the bladder circulation despite positive effects on bladder diary, pad test, and quality of life in overactive bladder syndrome.

Successful pregnancy after presurgical uterine artery embolization in the management of a very large cervical myoma: A case report.

Although fibroids are the most common benign tumors of the uterus in women of reproductive age, cervical fibroids are rarely seen. Since cervical fibroids are located deep in the pelvis, the incidence of complications in surgery is high. Among these complications bleeding is the most common, due to poor access to myoma, difficulty in suturing and repair, and distortion of vital neighboring structures. Each case should be managed individually to minimize bleeding. To decrease bleeding in patients who wish to retain their fertility, intraoperative interventions include vasoconstrictors such as vasopressin and adrenaline, uterotonics such as oxytocin, misoprostol or ergometrines, uterine artery clamping, internal iliac artery balloon occlusion catheters, and tourniquets; preoperative interventions include gonadotropin releasing-hormone analogues and uterine artery embolization. We present a case of a 40-year-old woman who had a large cervical myoma and a desire for future fertility. To overcome technical difficulties and reduce intraoperative bleeding during myomectomy, presurgical uterine artery embolization was performed. The patient conceived spontaneously after the operation and a healthy baby was delivered by cesarean section.

Effects of Hormone Replacement Therapy on Low Bone Mineral Density in Adolescents and Young Women with Hypogonadism: Comparison of Oral and Transdermal 17 Beta-Estradiol Administration.

STUDY OBJECTIVE: To evaluate the effects of physiological dose 17 beta-estradiol (E2) replacement on low bone mineral density (BMD) and compare the results of oral and transdermal (TD) E2 administration in adolescents and young women with hypogonadism DESIGN, SETTING, AND PARTICIPANTS: We retrospectively reviewed the medical records of patients aged 15 to 24 years who were diagnosed with hypogonadism, who had begun receiving oral or TD E2 replacement, and whose initial dual-energy X-ray absorptiometry scan detected a lumbar spine BMD Z-score of -1 or lower between 2014 and 2018. The patients were divided into 2 groups according to the E2 route of administration as those who received 2 mg orally (Group 1) and 0.1 mg TD (Group 2). INTERVENTIONS: None MAIN OUTCOME MEASURE: BMD scans of the patients at baseline and repeated within 2 years after E2 replacement RESULTS: In total, 43 patients who met the inclusion criteria were included in the study. Two groups did not differ for BMD scores at baseline. A significant improvement in BMD was observed with physiological dose E2 replacement in both groups. Mean BMD Z-score increased by +0.7 (95% CI, 0.47-0.93) in response to TD E2 administration, compared with +0.41 (95% CI, 0.25-0.58) during oral E2 replacement (P = .037). CONCLUSION: We conclude that physiological dose E2 replacement, even within a short period of 2 years, has a significant beneficial effect on bone mass acquisition on the lumbar spine. Our study also demonstrates the possible superiority of TD E2 replacement over the oral route in increasing lumbar spine BMD.

Idiopathic primary ovarian insufficiency is associated with anogenital distance, a marker for prenatal environment.

OBJECTIVE: In a significant number of women diagnosed with primary ovarian insufficiency (POI), the underlying cause cannot be found. On the other hand, the ovarian reserve set prenatally has been shown to be affected by intrauterine nutrition, environmental and hormonal factors. We aimed to evaluate the relationship between anogenital distance (AGD), which is considered as a biomarker for prenatal hormonal environment, and idiopathic POI in adolescents and young women. STUDY DESIGN: This case control study was conducted between September 2018 and December 2019. The study group consisted of patients between the ages of 15-30, who developed POI following menarche without any identified genetic or iatrogenic cause. Controls were patients of the same age range who were having regular menstrual periods and were not diagnosed with polycystic ovary syndrome or endometriosis. Patients were excluded from the study if they were pregnant, had vaginal delivery or genital surgery. Distance between the anterior clitoral surface and the upper verge of the anus (AGDAC), and between the posterior fourchette and the upper verge of the anus (AGDAF) were measured in all subjects. RESULTS: In total, 37 POI patients and 44 controls were included in the study. Two groups were similar for demographic parameters such as age and body mass index (BMI). Shorter AGDAC and AGDAF measurements were found to be associated with idiopathic POI. CONCLUSION: Our results provide the first evidence of a strong association between shorter AGD measurements and the presence of idiopathic POI suggesting that prenatal environment may have role in the development of POI.

Sexual functions and quality of life of women over 50 years with urinary incontinence, lower urinary tract symptoms and/or pelvic organ prolapse.

Sexual function is important for health and quality of life. We evaluated effects of lower urinary tract symptoms (LUTS), urinary incontinence (UI) and coital incontinence, and/or pelvic organ prolapse (POP) on sexual functions and quality of life of women over 50 years of age. Secondary objectives were to compare rate of sexual activity, effects of type of UI and coital incontinence on sexual functions and quality of life among age groups. Female-Sexual-Function-Index (FSFI), Pelvic-Organ-Prolapse/Urinary-Incontinence Sexual-Function-Questionnaire-12 (PISQ-12), and King's-Health-Questionnaire (KHQ) were used for evaluation. Between 2013 and 2018, 1256 women were included. 565 women were 50-59 years (Group 1), 440 were 60-69 (Group 2), 251 were over 70 (Group-3). 763 women (60.7%) suffered from LUTS, 141 women (11.2%) suffered from POP only, and 352 women (28%) suffered from POP + LUTS. Younger women were more sexually active (p = 0.001). FSFI and PISQ-12 scores of women suffering from LUTS, POP + LUTS, and POP only were similar. Lubrication and orgasm scores were worse in Group 3 (p = 0.006 and 0.037). Type of UI did not affect FSFI and PISQ-12 scores. Coital incontinence was correlated with mixed UI in Groups 1 (p = 0.01) and 2 (p = 0.03). There was no association with coital incontinence and type of UI in Group 3. Coital incontinence had adverse effect in FSFI, PISQ-12 scores. In younger women, coital incontinence had an adverse effect on desire and arousal domains. KHQ scores were worse in women having LUTS in comparison to women suffering from POP only (p = 0.00) and were worse in Groups 1 and 2 (p = 0.002 and 0.013). KHQ scores were worse in women suffering from urge or mixed UI (p = 0.00). Coital incontinence had adverse effect in KHQ scores. In conclusion, aging, LUTS, UI, and coital incontinence have detrimental effects on sexual functions and quality of life. Urge or mixed UI have more adverse effects on quality of life. Quality of life is worse in younger women suffering from UI and coital incontinence.

Unique Diagnosis of Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) at the Time of First-Trimester Ultrasound Imaging.

BACKGROUND: Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is usually diagnose during adolescence due to pain-related symptoms; however, this syndrome can go unrecognized for several years, and unique presentations may occur later in life. CASE: We describe a 24-year-old-woman diagnosed with previously unknown OHVIRA syndrome and a 7-week intrauterine pregnancy in the obstructed side by the unique ultrasound image obtained during routine first-trimester ultrasonography. The patient was managed with single-stage vaginoplasty, and the rest of the pregnancy were uneventful. SUMMARY AND CONCLUSION: This report is unique in terms of showing that the pregnancy could develop in the uterine cavity on the side of the obstruction despite the blind hemivagina.

Atypical Presentation of Swyer Syndrome.

BACKGROUND: Swyer syndrome is a rare type of disorder of sex development and typically presents with delayed puberty and primary amenorrhea. We describe an unusual presentation of this condition. CASE: A 17-year-old female patient with typical thelarche and adrenarche presented with primary amenorrhea. Pelvic ultrasound showed normally developed uterus and bilateral ovoid hypoechoic structures suggestive of gonads. Laboratory investigations revealed highly elevated gonadotrophins with estradiol level within a range typical for a female of reproductive age and chromosome analysis showed a 46,XY karyotype. Histopathological examination of the gonadectomy specimens revealed gonadoblastoma and dysgerminoma with no functional ovarian or testicular tissue. SUMMARY AND CONCLUSION: This report reminds us the possibility of diagnosis of Swyer syndrome in the presence of normal pubertal development and normal sex steroid levels considered to be produced by gonadoblastoma.

The Impact of Early Postpartum Maternal Pertussis Vaccination on the Protection of Infants: A Randomized Clinical Trial.

BACKGROUND: Despite primary vaccination, infants under six months run a risk of infection with pertussis. OBJECTIVE: To determine the impact of early postpartum maternal pertussis vaccination on protecting infants from the disease. METHODS: All mothers (n=405) who gave birth to healthy term infants were educated on the cocoon strategy. The mothers who consented were immunized with the tetanus-diphtheria-acellular pertussis vaccine within the first three postpartum days. All infants received their pertussis vaccines according to the national schedule. The anti-pertussis IgG titers of infants of thirty vaccinated mothers were compared with those of thirty unvaccinated mothers. RESULTS: The pertussis antibody levels in the infants of vaccinated mothers were significantly higher than those of unvaccinated mothers at the mean infant age of 5.6 ± 1.2 months. Only 6 infants of vaccinated mothers exhibited pertussis-like symptoms, none of whom had positive pertussis PCR. Seventeen infants of unvaccinated mothers had pertussis-like symptoms, and 4 tested positive for pertussis PCR. CONCLUSION: Our results showed that maternal pertussis vaccination, administered within the first three postpartum days, may protect infants against pertussis in their first ten months.