Metin Kaplan

Comparison of levonorgestrel intrauterine system versus hysterectomy on efficacy and quality of life in patients with adenomyosis

OBJECTIVE To compare the levonorgestrel intrauterine system (LNG-IUS) with hysterectomy in patients with adenomyosis and to study the effects of both treatments on quality of life (QOL). DESIGN Prospective randomized clinical trial. SETTING Womens health teaching and research hospital. PATIENT(S) Eighty-six patients (43 patients for each group) were enrolled, but only 75 women continued the study. INTERVENTION(S) Women interpreted as having adenomyosis on transvaginal ultrasound and magnetic resonance imaging were assigned to receive either LNG-IUS or hysterectomy. MAIN OUTCOME MEASURE(S) Clinical measures of menstrual bleeding as number of used pads/day during menstruation, hemoglobin levels, and health-related QOL variables were assessed. Each woman was followed up for 1 year after treatment. RESULT(S) LNG-IUS increased the hemoglobin levels at the sixth month and first year of the treatment to the comparable levels with hysterectomy. When pretreatment and post-treatment QOL scores of groups were compared, three of the five mean domain scores (physical, environmental, environmental-TR) were increased in patients treated with hysterectomy, while in patients managed with LNG-IUS, all five mean domain scores were increased. CONCLUSION(S) It seems that LNG-IUS demonstrates significant and comparable improvements in hemoglobin levels to hysterectomy in treating adenomyosis-associated menorrhagia during the first year. Although both treatments lead to improvements in health-related QOL, LNG-IUS seems to have superior effects on psychological and social life. It may be a promising alternative therapy to hysterectomy.

The Effect of Levonorgestrel Intrauterine System on Uterine Myomas: A 1-Year Follow-up Study

STUDY OBJECTIVE To assess whether levonorgestrel intrauterine system is an effective means of therapy in menorrhagia associated with myomas. DESIGN Prospective before and after study (Canadian Task Force classification II-1). SETTING Teaching and research hospital, a tertiary center. PATIENTS In all, 21 premenopausal women attending our gynecology clinic because of menorrhagia associated with uterine myomas were enrolled into the study. INTERVENTIONS Levonorgestrel-releasing intrauterine system use in uterine myomas. MEASUREMENTS AND MAIN RESULTS Patients with myomas greater than 4 cm were excluded. Clinical assessment tools of menstrual bleeding were measured both before (pretreatment) and 1 year after the insertion (posttreatment). A p value less than or equal to .05 was considered statistically significant for menstrual blood loss as a primary outcome and Bonferroni correction was done for secondary outcomes as 0.01. The mean age of the patients was 47.05+/-4.9 years. At 1-year follow-up, 5 women had had a hysterectomy. Four patients were amenorrheic. The duration of menstruation and the mean endometrial thickness were decreased 1 year after insertion; these decreases were not statistically significant (p=.034 and p=.204, respectively). While the mean number of pads used daily during menstruation decreased (p=.011), the hemoglobin level was increased (p=.001). A reduction in mean uterine volume and increase in ferritin levels were observed, but these changes did not reach statistical significance (p = .050 and p = .036, respectively). CONCLUSION The use of the levonorgestrel intrauterine system seems to be effective in reducing menorrhagia associated with myomas with improvement in hemoglobin levels.

Diagnostic accuracy and efficacy of color Doppler mapping for tubal patency.

Aim:  To evaluate the diagnostic accuracy of color Doppler mapping for tubal patency, comparing its results with those of hysterosalpingography (HSG) and laparoscopy.

Isolated tubal torsion: Successful preoperative diagnosis of five cases using ultrasound and management with laparoscopy

Our aim was to evaluate the presentation and diagnostic evaluation of patients with isolated tubal torsion and to evaluate the surgical approach to these patients. We also aimed to define the ultrasonographic diagnostic criteria. Five patients with isolated tubal torsion who were admitted to our gynecology department between January 2014 and January 2017 were evaluated and included in this study. All cases were diagnosed through ultrasonographic imaging alone. The preoperative findings of the patients were similar to those described in the literature. No further imaging modality was used for diagnosis and all patients were managed with laparoscopy. The clinical findings and ultrasonographic findings were consistent with literature. It may be difficult to preoperatively diagnose isolated tubal torsion, which is a rare clinical entity. Evaluation of these patients by an experienced sonographer and knowledge of the ultrasonographic findings of isolated tubal torsion may have vital preventive measures.

Beta-Human Chorionic Gonadotropin and Uterine Artery Doppler Measurements for the Prediction of Success of Single Dose Methotrexate Treatment in Tubal Ectopic Pregnancies

Objectives: To evaluate the impact of the uterine artery Doppler values and the change of β-Human chorionic gonadotropin (β-HCG) levels from day 0 to day 4 for prediction of the success of single dose methotrexate treatment in tubal pregnancy cases. Study Design: 50 patients with tubal pregnancy were included the prospective study. The location and size of ectopic pregnancy, bilateral uterine artery pulsed color doppler imaging was examined by ultrasonography and serum β-HCG levels were measured on day 0, 4, 7 of treatment. Success was defined as decrease of β-HCG level 15.04% on day 4, single-dose methotrexate therapy were 3.82 times more successful than the group without > 15.04% β-HCG decrease. However, no significant alteration of uterine artery Doppler measurements was determined on the same days. Conclusion: Reduction rate in the β-HCG level on day 4 of treatment can be used in determination the success of single-dose methotrexate therapy.