Husnu Gorgen

Should Cesarean Scar Defect Be Treated Laparoscopically? A Case Report and Review of the Literature

Several obstetric complications due to inappropriately healed cesarean scar such as placenta accreta, scar dehiscence, and ectopic scar pregnancy are increasingly reported along with rising cesarean rates. Furthermore, many gynecologic conditions, including abnormal uterine bleeding, pelvic pain and infertility, are imputed to deficient cesarean scar healing. Hysteroscopy is the most commonly reported approach for the revision of cesarean scar defects (CSDs). Nevertheless, existing evidence is inadequate to conclude that either hysteroscopy or laparoscopy is effective or superior to each other. Although several management options have been suggested recently, the laparoscopic approach has not been thoroughly scrutinized. We present a case and reviewed the data related to the laparoscopic repair of CSDs and compared the hysteroscopic and laparoscopic management options based on the data from previously published articles. As a result of our analyses, the laparoscopic approach increases uterine wall thickness when compared with the hysteroscopic approach, and both surgical techniques seem to be effective for the resolution of gynecologic symptoms. Hysteroscopic treatment most likely corrects the scar defect but does not strengthen the uterine wall; thus, the potential risk of dehiscence or rupture in subsequent pregnancies does not seem to be improved. Because large uterine defects are known risk factors for scar dehiscence, the repair of the defect to reinforce the myometrial endurance seems to be an appropriate method of treatment.

Preoperative serum CA 125 level as a predictor for metastasis and survival in endometrioid endometrial cancer.

OBJECTIVE We wished to determine the relationship between preoperative serum CA 125 levels and the risk of metastatic disease, recurrent disease, and death in women with endometrial cancer. METHODS We reviewed the records of women with endometrial adenocarcinoma of all stages who underwent primary surgery. We abstracted multiple data variables, including demographic characteristics, serum CA 125 levels, postoperative histopathology results, progression-free survival, and overall survival rates. RESULTS The records of 97 women with endometrial carcinoma were analyzed. With a serum CA 125 cut-off level of 35 kU/L, the likelihood of disease-related death could be predicted with 70% sensitivity and 83% specificity; disease progression could be predicted with 60% sensitivity and 84% specificity; and lymph node metastasis could be predicted with 75% sensitivity and 84% specificity. There was a significant relationship between a serum CA 125 level ≥ 35 kU/L and depth of myometrial invasion, cervical stromal invasion, stage, frequency of recurrence, and disease-related death. Having deep myometrial invasion, cervical stromal involvement, positive peritoneal cytology, lymph node metastasis, disease recurrence, and disease-related death were each associated with significantly higher mean CA 125 levels. In women with serum CA 125 levels < 35 kU/L, five-year progression-free survival rates (88%) and overall survival rates (92%) were significantly better than in women with levels ≥ 35 kU/L (57% and 70%, respectively; P = 0.001 for both). CONCLUSION Serum CA 125 levels and extension of disease are highly correlated in women with endometrioid endometrial cancer, and elevated CA 125 levels predict a higher risk of disease recurrence and death.

The correlation of the antral follicle count and Serum anti-mullerian hormone.

OBJECTIVE To compare the value of the basal serum anti-Müllerian hormone (AMH) level with most of the established ovarian reserve tests. MATERIAL AND METHODS A total of 141 infertile women was studied prospectively. On cycle day 3, serum levels of AMH, inhibin B, estradiol (E), FSH and LH levels were measured, and the number of early antral follicles (2-6 mm in diameter) estimated at ultrasound scanning to compare the strengths of hormonal-follicular correlations. RESULTS The mean age of the participants was 29.18±5.54. The mean AMH and total AFC on day 3 were 2.23±1.90 ng/ml and 8.35±2.83, respectively. Serum AMH levels were more tightly correlated (p<0.001) with number of the early antral follicle count (r=0.467, p<0.0001) than age and serum levels of FSH (r=-0.400, p<0.001; r=-0.299, p<0.001 respectively). No correlation was detected between serum levels of inhibin B, E2, and LH (r=0.154, p=0.06; p=0.31; r=-0.085 and r=0.067, p=0.42) and AFC. CONCLUSION Serum AMH levels showed a strong correlation with AFC, and also this correlation is stronger than the other ovarian reserve parameters.