Suat Dede

Smooth muscle fraction of the round ligament in women with pelvic organ prolapse: a computer-based morphometric analysis

Our objective was to compare the collagen and muscle content of the round ligament of uteri in women with pelvic organ prolapse. We evaluated the tissue samples obtained from the round ligaments of 22 patients with uterine prolapse who underwent vaginal hysterectomy (group A, study) and from 26 patients with no pelvic relaxation in whom total abdominal hysterectomy was performed for benign reasons (group B, controls). Morphometric analysis was performed on histologic cross-sections of the round ligament. Sections from each sample were stained with hematoxylin and eosin and Masson’s trichrome methods. A computer system was used for morphometric measurements. We used independent samples t-test or Mann-Whitney U test to investigate the difference between the two groups. It was found that the smooth muscle fraction of the round ligament in women with uterine prolapse was significantly decreased compared with that of healthy control subjects and concluded that decreased smooth muscle content may be an important pathogenetic factor in uterine prolapse.

Laparoscopic management of ovarian dermoid cysts: a review of 47 cases.

Background Mature cystic teratomas, often referred to as dermoid cysts, are the most common germ cell tumors of the ovary. In the recent years, transvaginal sonographic diagnosis of ovarian dermoid cysts together with laparoscopic approach have greatly improved the treatment of this benign lesion. We retrospectively reviewed the outcome of laparoscopic surgery for suspected ovarian dermoid cysts. Patients and Methods The preoperative findings, operative techniques and post-operative complications were retrospectively reviewed in women who underwent laparoscopic surgery for dermoid cysts, between January 2000 and May 2003. Results In 47 women aged 21 to 53 years (median, 38.8 years), 93.6% had a unilateral cyst with a diameter of 17 to 108 mm (median, 51 mm). Clinical presentations were pain (62%), abnormal vaginal bleeding (21%) and ovarian torsion (2%), whilst 17% were diagnosed incidentally during routine examination. Surgery included cystectomy (57%), total (36%) or partial oophorectomy (6.4%) and laparoscopy-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy (2%). During the cyst extraction, minimal spillage occurred in 42.5% of the cases and none developed chemical peritonitis. In 2 patients, conversion to laparotomy (4.3%) was required, one for sigmoid colon injury and one for malignant ovarian tumor detected via frozen section. The median operating time was 80 minutes (range, 35–180 minutes). Conclusion Using strict adherence to guidelines for preoperative clinical assessment and intra-operative management, laparoscopic treatment of dermoid cysts appears to be a safe procedure.

Lyophilised hMG versus rFSH in women with unexplained infertility undergoing a controlled ovarian stimulation with intrauterine insemination: a prospective, randomised study

Purpose. To compare the efficacy of lyophilised urinary hMG (HP-hMG) with recombinant FSH (rFSH) in women with unexplained infertilıty undergoing a controlled ovarian hyperstimulation with intrauterine insemination (IUI). Methods. Forty-nine consecutively seen women with unexplained infertility were randomised to a controlled ovarian hyperstimulation with IUI cycle either with rFSH or HP-hMG. The outcome was compared by independent samples t-test. Results. The mean patient age and duration of infertility were not different (29.5 ± 5.7 and 4.9 ± 2.7 years in rFSH; 28.8 ± 3.2 and 6 ± 4.2 in HP-hMG group) (p = 0.6 and p = 0.2). The mean body mass index (BMI) and basal hormones were similar. Total dose of gonadotropin used (710 ± 236 vs. 636 ± 185 IU) and duration of the cycles (9 ± 2.1 vs. 8.3 ± 2.3 days) showed no significant difference (p = 0.2). Number of follicles, serum oestradiol (E2), and the endometrial thickness on the day of hCG were comparable. Two singletons in each group were obtained. Conclusions. These data suggest that HP-hMG and rFSH may be equally suitable in mild ovarian stimulation for unexplained infertilıty. Further data derived from larger study population are needed to determine whether higher amounts of two gonadotropins in this subgroup might produce any benefits or unfavourable effects.

Estradiol supplementation in intracytoplasmic sperm injection cycles with thin endometrium

Objective: To evaluate the efficacy of estradiol supplementation starting on the day of human chorionic gonadotrophin (hCG) in patients with thin endometrium in intracytoplasmic sperm injection (ICSI) cycles. Methods: A total of 117 consecutive patients with the endometrial thickness on the hCG day ≤8 mm were rewieved. Estradiol supplementation was given in 57 patients and the remaining 60 patients were accepted as control group. Estradiol supplemented (ES) group received estradiol hemihydrate 4 mg/day started on the day of hCG. Luteal phase was supported using the vaginal progesterone gel in both groups. Clinical pregnancy rate, implantation rate, miscarriage rate, endometrial thickness on the day of oocyte pick-up and on the day of embryo transferred were accepted as main outcome measures. Results: There were no statistical differences in terms of clinical pregnancy rate (28.1% vs. 23.3%), implantation rate (16% vs. 10.4%), miscarriage rate (21% vs. 31.6%), endometrial thickness on the oocyte pick-up day (8.5 ± 1.8 vs. 8.4 ± 1.4, mm) and embryo transferred day (9.6 ± 2.9 vs. 10.3 ± 2.4, mm) in the ES group vs. control group. Conclusion: Estradiol supplementation starting on the hCG day for the patients with thin endometrium does not provide any benefit on the pregnancy outcome in ICSI cycles.

Parietal peritoneal closure versus non-closure at caesarean section: which technique is feasible to perform?

Abstract Objective: To evaluate short-term effects of closure versus non-closure of the parietal peritoneum at caesarean section. Methods: A randomized controlled study of women undergoing caesarean section was conducted at the obstetrics department of a research and education hospital between October 2010 and May 2011. Patients were randomly assigned to have closure of parietal peritoneal layer (Group I, n = 55), and non-closure of parietal peritoneal layer (Control, Group II, n = 55). Intra-operative and post-operative outcomes were compared between the groups. Results: Groups were similar for baseline characteristics. Although there was statistically significant difference between Group 1 and Group 2 in terms of time to oral intake and mobilization time [12 (8–12) versus 8 (8–10) h; p < 0.001; 12 (8–12) versus 8 (8–10) h; p < 0.001]; the other variables, such as drop in hemoglobin concentration, estimate of blood loss, intra-operative additional sutures, operating time and time to passage of flatus [1.13 ± 0.86 versus 1.41 ± 0.82 g/dL; 487.9 ± 217.01 versus 544.87 ± 237.64 mL; 0 (0–1) versus 0 (0–1); 30.8 ± 7.63 versus 31.6 ± 10.38 h; 18.2 ± 6.04 versus 18.2 ± 4.23 h, p > 0.05] were not statistically different between Group 1 and Group 2. Conclusions: Closure of the parietal peritoneum has no benefit over non-closure of parietal peritoneum and non-closure is associated with rapid post-operative recovery.

Evaluation of pain during hysterosalpingography with the use of balloon catheter vs metal cannula

Abstract Our aim was to investigate the use of a balloon catheter device in comparison with metal cannula for hysterosalpingography (HSG) in terms of patient comfort. A total of 168 patients were randomised for HSG either with a balloon catheter (n = 83) or metal cannula (n = 85). Scores of pelvic pain during insertion of the devices, injection of the contrast medium and 1 h after the procedure were evaluated using the Wong Baker Faces Pain Rating Scale; complications and reinsertion rates were also noted. The pain scores were significantly lower in the balloon catheter group (p < 0.001). The reinsertion rate of metal cannula was higher (8.2% vs 2.4%) as well as the incidence of nausea being the most common short-term adverse effect (14.1% vs 1.2%) in the metal cannula group (p = 0.002). Performing HSG with a balloon catheter is advantageous for decreasing the pain and side-effects related to the procedure, when compared with the use of a metal cannula.

Does 75 IU difference improve the cycle performance in poor responders? Comparison of daily 375 versus 450 IU gonadotrophin doses.

Objective. To compare the efficacy on the cycle performance of 375 versus 450 IU/day gonadotrophin on the microdose flare-up protocol in poor responders. Study design. A total of 91 poor responder patients who were treated with the microdose flare-up protocol were enrolled in this study. Group 1 (n = 40) was stimulated with 375 IU/day gonadotrophin. Group 2 (n = 51) was stimulated with 450 IU/day gonadotrophin. Main outcome measurements were accepted as the results of controlled ovarian hyperstimulation, implantation, clinical pregnancy, and live birth rates. Results. Baseline characteristics are similar between the two groups. Higher number of oocyte cumulus complexes and lower total gonadotrophin requirement were noted in Group 1 compared with Group 2. Number of metaphase II oocytes and implantation rates were similar between the groups. A trend toward higher clinical pregnancy and live birth rate was observed in Group 1 but these results did not reach statistical significance. Conclusions. Total gonadotrophin costs are lower using the 375 IU/day gonadotrophin compared to the 450 IU/day in poor responders. Additional 75 IU/day does not give any improvement neither embryology nor pregnancy outcomes.

Total Laparoscopic versus Vaginal Hysterectomy: The experience of a Training Hospital

Objective: To compare the operative outcomes of total laparoscopic hysterectomy (TLH) and vaginal hysterectomy (VH) in a training and research hospital. Material and Methods: Retrospective data analysis of all women who underwent either TLH or VH at gynecology unit for benign pathologies between January, 2012 and June, 2015 were conducted. Hysterectomies for desensus uteri were excluded. Groups were compared regarding operation time, change in hemoglobin value, intraoperative complications, postoperative complications and length of hospital stay. Results: During the study period, 120 patients underwent TLH and 192 patients underwent VH. Indications for surgery except desensus uteri were myomas (n= 55), endometrial hyperplasia (n= 43), dysfunctional uterine bleeding (n= 37), adenomyosis with chronic pelvic pain (n= 13), and adnexal mass (n=6). Operation time was shorter for VH in comparison with TLH (108 ± 38.3 minutes versus 151 ± 41.5; p < 0.001). Delta hemoglobin was smaller for TLH in comparison with VH (1.7 ± 0.98 versus 2.8 ± 1.03; p < 0.001). Intraoperative complications and postoperative complications were comparable (p = 0.16 and p= 0.25; respectively). Postoperative hospital stay was shorter in TLH group compared to VH group (p < 0.001). Conclusion: Although VH is the suggested approach for the removal of uterus in literature, this study showed the non-inferiority of TLH against VH.