Mehmet Emin Soysal

The Efficacy of Levonorgestrel-Releasing Intrauterine Device in Selected Cases of Myoma-Related Menorrhagia: A Prospective Controlled Trial

Background/Aims: To determine the efficacy of levonorgestrel-releasing intrauterine device (LNG-IUD) insertion in menorrhagic patients who have at least one type II myoma according to the European Society of Hysteroscopy. The primary outcome measures were menstrual blood flow reduction and increase in hemoglobin values. The secondary outcome measures were hysterectomy rates and patient satisfaction. Methods: In menorrhagic women (documented by a validated pad scoring system) with a myomatous uterus <380 ml at ultrasonography, LNG-IUD was inserted after the diagnostic triage. Patients were evaluated at 3, 6 and 12 months after the insertion. The primary outcome measures were compared to those of a matched group of historical controls that underwent thermal balloon ablation (TBA). Results: Following LNG-IUD insertion, statistically significant decreases in menstrual blood flow and increases in hemoglobin values were noted. LNG-IUD insertion was found to be as effective as historical controls of TBA applications. Conclusion: This prospective controlled trial demonstrates the effectiveness of LNG-IUD in this setting and equivalent results are obtained as compared to TBA.

Thermal balloon ablation in myoma-induced menorrhagia under local anesthesia.

Objective: Our purposes were to compare the impact of surgery on menstrual blood flow reduction and on the increase in hemoglobin values as primary endpoints at 12 months, and operating time, complication rates, postoperative pain scores at 12 h and surgically induced amenorrhea rates at 12 months as secondary endpoints after roller ball endometrial ablation or thermal balloon ablation for myoma-induced menorrhagia. Materials and Methods: Menorrhagic women (documented by a validated pad scoring system) over 40 years of age, with a mobile myomatous uterus smaller than 12-week pregnancy, were enrolled in a prospective randomized trial to compare endometrial roller ball ablation and thermal balloon ablation after pharmacological endometrial thinning. One year after surgery, primary and secondary endpoints in both groups were compared. Results: Forty-five subjects underwent endometrial thermal balloon ablation under local anesthesia and 48 underwent endometrial roller ball ablation under general anesthesia. Statistically significant but similar decreases in mean pictorial blood assessment score and increases in mean hemoglobin values were noted for both groups at 12 months. Those who underwent endometrial roller ball ablation had experienced significantly more intraoperative complications. Conclusion: Thermal balloon ablation under local anesthesia for myoma-induced menor- rhagia provided both significant and statistically similar reductions in menstrual blood flow and increases in hemoglobin values with no intraoperative complication compared to roller ball endometrial ablation.

Prenatal diagnosis of epignathus causing acute polyhydramnios

Fetal teratonias complicate pregnancies with an incidence of I : 20 000 to 1 : 40 000 live births (1 ) . Although teratomas are the most common congenital neoplasms, epignathus (oropharyngeal teratoma) is a much rarer type and carries a grave prognosis ( 2 3 ) . These lesions are frequently unresectable and infants born with these lesions usually die secondary to respiratory compromise (4). This report describes the accurate prenatal diagnosis of epignathus with ultrasound examination done for the evaluation of acute polyhydramnios at gestational week 26 and discusses the obstetrical management.

Transvaginal sonographic diagnosis of ovarian endometrioma

Objective: To assess the efficacy of transvaginal sonography (TVS) in differentiating endometriomas from other adnexal masses. Methods: One thousand thirty‐five adnexal masses undergoing laparoscopy or laparotomy were evaluated prospectively using TVS. Masses diagnosed as endometrioma according to their sonographic appearance were divided into two groups: those with a round shape, regular margins, thick walls and homogeneous, low‐level echoes (group A); or those with irregular margins, internal septations and an anechoic appearance (group B). Results: The sensitivity of TVS in diagnosing endometriomas was 86.50% and the specificity 99.11%. The positive predictive value (PPV) and the negative predictive value of the test were calculated to be 91.45% and 98.14%, respectively. By using the criteria determining group A, the PPV of the test increased to 97%, whereas group B had a lower PPV (70.85%). Conclusion: We propose that the accuracy of TVS in diagnosing endometriomas may be beneficial in various clinical conditions.

Iniencephaly: sonographic-pathologic correlation of 19 cases.

During a four year period (1991-1994), 19 cases of iniencephaly were evaluated at our institution. Associated cranial malformations include anencephaly in 15 (79%), and posterior encephalocele in 5 (26.3%) of the cases. Other associated malformations include diaphragmatic defects with a accompanying hernia, omphalocele, gastrointestinal malformations, cardiovascular and genitourinary malformations, single nostril, facial cleft, spina bifida, hypoplastic lungs, club foot and single umbilical artery. No single causative agent for this group was identified. A brief review of the literature is included regarding categorization of these malformations and also a discussion of the embryological basis for these lesions and possible etiological factors.

Ovarian hemangioma occurring synchronously with serous papillary carcinoma of the ovary and benign endometrial polyp.

Ann Saudi Med 28(2) March-April 2008 www.kfshrc.edu.sa/annals 128 Ovarian hemangiomas are extremely rare tum mors, most of which are asymptomatic and of the cavernous type.1 Considering the rich vasm cular supply of the ovary, the low incidence of ovarian hemangiomas is somewhat surprising. There are about 50 documented cases in the literature. The 12 described in Table 1 were associated with gynecologic tract dism ease including endometrial hyperplasia, endometrial carcinoma and endometriosis.1m34 Ovarian hemangiom mas have been reported in both adults and children and most of the reported cases have been unilateral and small.2,3 Although often an incidental finding at operam tion, ovarian hemangioma may rarely be associated with gynecologic cancers.4m8 The tumor in our case was an additional and incidental finding in a surgical specimen removed because of a serous papillary carcinoma involvm ing the left tuba and ovary.

Giant lipoleiomyoma of the uterine corpus

ObjectiveLipoleiomyoma is a rare and easily recognized, benign uterine fatty tumor, composed of an admixture of mature adipocytes and smooth-muscle cells. They may associate with metabolic disorders and rarely reach giant size.CaseWe report a case of symptomatic giant lipoleiomyoma of the uterine corpus that may be associated with diabetes mellitus and hypothyroidism.ConclusionLipoleiomyoma must be thought in the differential diagnosis of the giant uterine tumors and should be removed when diagnosed, because malignancy cannot otherwise be excluded. Also the peculiar features of this giant neoplasm, histogenesis, concomitant metabolic disorders and the diagnostic methods are discussed.

TWIN PREGNANCY WITH A FETUS AND A COMPLETE HYDATIDIFORM MOLE

Twin pregnancy with a normal fetus and gestational trophoblastic neoplasia as a co-twin is a rare entity. We are reporting such a case and discuss its management.

Laparoscopically assisted definitive treatment of severe endometriosis

The purpose of this study conducted between March 1996 and December 1999 was to identify the differences in the perioperative outcome of women undergoing definitive surgery for severe endometriosis either as laparoscopic assisted vaginal hysterectomy and salpingo-oophorectomy (LAVH+BSO) or as total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO). Study participants included 147 patients with known or suspected endometriosis causing pelvic pain and/or mass with no interest in further childbearing. Among these 90 of them were prospectively randomized to have the procedure either as LAVH+BSO (n = 45) or as TAH+BSO (n = 45). Results showed that laparoscopically-assisted definitive treatment took longer and resulted in a more significant fall in hemoglobin values. However those who underwent this procedure experienced less pain postoperatively during a vigorous cough both after 24 hours and 6 days required less narcotics were discharged earlier and experienced a quicker return to daily activities. With regards to tissue injury in terms of early postoperative C-reactive protein both techniques have the same results.