Metin Kaba

Cervical cancer in a patient with uterus didelphys and obstructive hemivagina, ipsilateral renal anomaly (OHVIRA) syndrome

We report a rare case of cervical adenocarcinoma diagnosed and treated in a woman with uterine didelphys, obstructive hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome. A 49-year-old multiparous woman applied to our institution with menorrhagia and intermenstrual bleeding since 6 months. On pelvic examination, a grossly normal cervix was noted. A 7-cm firm mass was palpated in the left pelvic region extending to the vaginal level. Also, a 4-cm fluctuant mass was palpated on the left vaginal wall. On pelvic ultrasound, a 40-mm cystic mass with internal echoes resembling an endometrioma was visualized adjacent to the left superior vaginal wall. Upper abdominal ultrasound revealed left unilateral renal dysplasia, which was further confirmed by magnetic resonance imaging (MRI) (Fig. 1). Laboratory, pap-smear and endocervical curettage (ECC) results were normal. Endometrial biopsy taken with a pipelle endometrial sampling cannula was reported as endometrioid adenocarcinoma. Laparotomy was performed and peritoneal washings were obtained for cytology. Upon exploration, uterine didelphys (UD) with normal adnexa on both sides were discovered (Fig. 2). After complete resection of the uterus with bilateral tubes and ovaries, a blind vaginal stump on the left side was visualized. A brown-colored fluid was drained from the left vaginal lumen. There was a small opening between the left and right vaginal lumens. The operation was completed with bilateral pelvic-paraaortic lymph node dissection (LND) and omentectomy. Final pathology was reported as UD with a 10 9 8 mm well-differentiated primary endometrioid adenocarcinoma of the right cervix. Endometrial tissues on both uteruses were free of any tumoral involvement. Retroperitoneal lymph nodes, omentum and peritoneal cytology were negative for any tumoral spread. The patient was informed about the pathology results. Further treatment options including surgical treatment or chemoradiation were discussed. The patient preferred surgical treatment. Radical parametrectomy and proximal vaginectomy were performed. Postoperative follow-up period was uneventful. On pathological examination, bilateral parametria and vaginal tissues were free of tumor. The patient was consulted to the radiation oncology department of an affiliated hospital. Regular follow-up without adjuvant treatment was recommended, and she was discharged from the hospital. Short-term (15 months) follow-up visits were normal without any treatment related complications or signs of recurrence. Obstructive hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome (Herlyn–Werner–Wunderlich syndrome) is a rare type of congenital Mullerian anomaly (CMA), which is frequently associated with UD [1, 2]. This syndrome results from lateral fusion defect of the Mullerian ducts with asymmetric vaginal obstruction. The classical urinary manifestation of OHVIRA syndrome is ipsilateral renal agenesis. However, as in our case, dysplastic or duplicated kidneys have also been reported [3]. Women with CMA are generally diagnosed in adolescence or reproductive period. Symptoms and clinical findings vary greatly, depending on the present anomaly. The woman presented here did not report any symptoms M. Kaba T. Gungor E. Baser (&) B. Ozdal Department of Gynecologic Oncology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Talatpasa Bulvari, Samanpazari, Altindag, Ankara, Turkey e-mail: eralpbaser@gmail.com

Prevention of adhesion formation in Wistar-albino rats by increased bowel movements achieved with oral Ricinus oil use for 8 days postoperatively: an experimental study

OBJECTIVE Adhesion formation frequently occurs after abdominopelvic surgery and can cause significant morbidity for patients. Meticulous hemostasis, minimal access surgery and utilization of surgical adjuvants intraoperatively are clinically useful measures to minimize adhesion formation. We investigated the clinical efficiency of oral Ricinus oil treatment for 8 days postoperatively to decrease adhesion formation in this case-control study in a rat model. STUDY DESIGN Following computer-generated randomization, 24 female Wistar-albino rats were operated on, with 10 standard cautery lesions on the right uterine horn and two simple suture lesions on left uterine horn generated with absorbable material. Half (n=12) the rats received 0.13 g (0.2 ml) Ricinus oil emulsion (40 g/60 ml) via the oral route during the first 8 days postoperatively, and the remaining rats (n=11) were considered as controls. The extent, severity, degree, total adhesion scores and histopathological features of the adhesions were the main outcome measures. RESULTS The degree and total adhesion formation scores in the Ricinus oil group and control group revealed significant differences in adhesion extent and severity. The total adhesion scores of the Ricinus oil and control groups were 3.00 ± 2.21 and 5.18 ± 2.78 respectively (P<0.05). Differences in type of inflammation, extent of inflammation and vascularization were statistically insignificant for suture and cautery lesions individually (P>0.05). CONCLUSIONS Ricinus oil treatment following abdominopelvic surgery for the 8-day period that covers the completion of tissue healing process may be a promising, cheap and cost-effective treatment strategy for patients.

Fetal Midgut Volvulus with a Cystic Appearance, Accompanying a Sinus Rhythm and an Increased Peak Systolic Velocity without Anemia

A midgut volvulus rarely occurs in a fetus; however, when it does, it requires an immediate diagnosis and surgery. Thirty-week pregnant was referred to our clinic with a diagnosis of a fetal abdominal cystic mass and preterm labor. The initial ultrasound examination revealed a female fetus with a 55 × 50 mm cystic mass in the lower abdomen, which was preliminarily diagnosed as an ovarian cyst. There was a sinusoidal rhythm on cardiography. The middle cerebral artery peak systolic velocity was 60.4 cm/sec, compatible with 1.49 MoMs that suggested fetal anemia on Doppler examination. Uterine contractions were observed with tocography and maternal hydration was administered for tocolytic treatment. Despite hydration, uterine contractions continued and the infant was delivered. A newborn ultrasonographic evaluation revealed a 6 cm abdominal cyst, and plain abdominal radiographs revealed distended loops of the small bowel on the left side. Emergency surgery was performed. A midgut volvulus leading to dilatation and necrosis of the small bowel without anatomical causes was observed during laparotomy. The necrotic bowel loop was resected and an end-to-end anastomosis was performed. The newborn died due to multiorgan failure. Obstetricians should be familiar with the appropriate diagnosis and management of a fetal volvulus.

Perinatal outcomes and cost-effectivity of the assisted reproduction pregnancies with advanced age: A retrospective analysis

Abstract We demonstrated the IVF-ICSI results, perinatal outcomes and cost-effectivity of the patients with advanced age at a tertiary centre. A total of 456 patients categorised into two groups according to age: group 1 (n = 158) (≥39years) and group 2 (n = 298) (<39years) were analysed retrospectively. In addition, subgroup analysis was performed according to the 40 years cut-off. Clinical pregnancy rate was significantly different between the groups (p< .001). Preterm delivery (< 37 gestational week) and low birth weight (< 2500 g) were significantly higher in advanced aged women than youngsters (p< .001). Mean expense per cycle for hormonal stimulation of IVF-ICSI was 1058.9 and 723.5 USD in groups 1 and 2, respectively (p< .001). Mean expense per pregnancy was 9294.7 and 1874.8 USD in groups 1 and 2, respectively (p< .001). Our study showed that perinatal outcomes and cost-effectivity might be adversely affected with increasing age.

Placental Blood Drainage Shortens Duration of the Third Stage of Labor in Women Slowly Administered 20 IU Oxytocin

Objective: Prolongation of the third stage of labor may cause serious postpartum complications. Thus, timely expulsion of the placenta is essential for preventing complications of the third stage of labor. We conducted a prospective cohort study to determine the effect of placental cord drainage on the duration of the TSL in women administered intravenous oxytocin during this stage. Study Design: This was a prospective cohort study in which 112 low risk pregnant women were allocated to the study. There were 53 women in the placental cord drainage group, and 59 women in the cord clamping group without drainage. Immediately after fetal delivery, intravenous infusion of 20 IU oxytocin in 500 mL Ringers’ Lactate was started and infused within 2 hours in women in both groups. Outcome measures were the third stage duration and hemoglobin differences between admission and the postpartum sixth hour. Results: There were no significant differences between the two groups with regard to duration of stages 1 and 2 of labor, hemoglobin level on admission, and at the postpartum sixth hour, and hemoglobin differences between admission and the postpartum sixth hour. The median third stage duration in the study group was 3.40 (range: 0.35-16.20) minutes, and 5.10 (range: 2.30-11.00) minutes in the control group. This difference between the groups was statistically significant (p<0.01). Conclusion: Placental cord drainage reduces the third stage duration following vaginal deliveries in patients receiving intravenous oxytocin. Placental cord drainage is simple, does not require additional cost, and is applicable for every delivery.

Spontaneous Fundal Uterine Rupture in a Pregnant Woman at 32 Weeks Gestation who had Two Previous Cesarean Sections

Spontaneous uterine rupture during pregnancy can cause severe complications, even maternal and fetal demise. We report successful management of a spontaneous fundal uterine rupture in a 32 week pregnant who had undergone two previous cesarean sections due to preterm delivery. We explain causes of spontaneous uterine rupture and the management of this rare event in the presented case report.