Suleyman Guven

Effect of endometrioma cystectomy on IVF outcome: a prospective randomized study

The study was conducted to investigate the effect of conservative surgery of ovarian endometriomas before an ICSI cycle. Ninety-nine patients with endometriomas who were referred to an intracytoplasmic sperm injection (ICSI) cycle were enrolled in the study. The patients were prospectively randomized into two groups; group I (49 patients) underwent conservative ovarian surgery before the ICSI cycle and group II (50 patients) underwent the ICSI cycle directly. The stimulation was started 3 months after the operation in group I and directly in group II. In the ovarian surgery group, stimulation was significantly longer (14.0 days in group I and 10.8 days in group II; P = 0.001), total recombinant FSH dose was significantly higher (4575 IU in group I and 3675 IU in group II; P = 0.001), and mean number of mature oocytes was significantly lower (7.8 in group I and 8.6 in group II; P = 0.032). There was no difference in terms of fertilization (86% in group I and 88% in group II), implantation (16.5% in group I and 18.5% in group II) and pregnancy rates (34% in group I and 38% in group II). Ovarian surgery resulted in longer stimulation, higher FSH requirement and lower oocyte number, but fertilization, pregnancy and implantation rates did not differ between the groups.

The effects of carbon dioxide pneumoperitoneum on ovarian blood flow, oxidative stress markers, and morphology during laparoscopy: a rabbit model.

OBJECTIVE To determine the effect of CO(2) pneumoperitoneum on the ovaries in an experimental pneumoperitoneum model. DESIGN Experimental controlled study. SETTING University hospital. PATIENT(S) Sixteen adult female conventional rabbits. INTERVENTION(S) Group I (8 rabbits) was not subjected to intra-abdominal pressure (IAP). In group II (8 rabbits), IAP insufflation was performed at 12 mm Hg. In total, 60 minutes of pneumoperitoneum and 10 minutes of reperfusion were maintained. Ovarian blood flow (OBF) was studied using laser Doppler flowmetry. The time points of OBF measurements were as follows: OBFbaseline, 10 minutes before insufflation; OBF30min, 30 minutes after pneumoperitoneum; OBF60min, 60 minutes after pneumoperitoneum; and OBFreperfusion, 10 minutes after pneumoperitoneum desufflation. Mean OBF changes during CO(2) pneumoperitoneum (OBFmean) were also assessed. MAIN OUTCOME MEASURE(S) Blood perfusion units, tissue malondialdehyde values, and histopathologic damage scores. RESULT(S) In group II, mean OBF values were significantly lower than in group I, especially for OBF30min, OBF60min, OBFreperfusion, and OBFmean. The mean tissue malondialdehyde value for group II was significantly higher than in the control group (104.48 +/- 20.07 nmol/g vs. 64.12 +/- 8.77 nmol/g, respectively). Compared with group I, in group II histologic specimens of the ovaries had higher scores for follicular cell degeneration, vascular congestion, hemorrhage, and inflammatory cell infiltration. CONCLUSION(S) Pneumoperitoneum, even at normal IAP levels, leads to significant oxidative stress-induced biochemical and histologic damage to the ovaries.

The novel ischemia marker ‘ischemia-modified albumin’ is increased in normal pregnancies

The aim of this prospective case‐control study was to determine the change in serum maternal ischemia‐modified albumin (IMA) during normal pregnancies. A total of 117 pregnant (first trimester (n = 24), second trimester (n = 34), and third trimester (n = 35)) and non‐pregnant healthy women (n = 23) were included. Maternal serum IMA, Malondialdehyde (MDA), and albumin levels were measured. Compared with non‐pregnant women, the cross‐sectional mean IMA levels in pregnant women were significantly increased, while the mean serum MDA and albumin levels were significantly decreased throughout pregnancy. Furthermore, a significant negative correlation between serum IMA and albumin levels (r = −0.354, p<0.001) was found, and there was a weak positive correlation between serum albumin and MDA levels (r = 0.334, p<0.001). Serum IMA, which has recently been developed as a clinical marker of ongoing myocardial ischemia, appears to be elevated in normal pregnancy. This may be due to the physiologic oxidative stress state of pregnancy.

Contribution of MRI to ultrasound in the diagnosis of fetal anomalies.

To evaluate the contribution of MRI to ultrasound (US) in the diagnosis of fetal anomalies.

Is there a correlation between tumor marker panel and tumor size and histopathology in well staged patients with borderline ovarian tumors

Aims. To investigate whether there is a correlation between serum tumor markers panel (CA 125, CA 19‐9, CA 15‐3, and carcinoembryonic antigen (CEA)) and tumor size and histopathology in well staged patients with borderline ovarian tumors (BOTs). Methods. Four tumor markers (CA 125, CA 19‐9, CA 15‐3, and CEA) were analysed clinically in 60 well staged patients with borderline ovarian tumor, for this retrospective observational study. Results. Most patients had serous histology and early stage disease, and the mean age at the time of diagnosis was 40.70 years (range: 19–73). Twenty‐nine patients (48.3%) had high CA 125 levels (>35 U/l), 15 patients (25%) had high levels of CEA (>4 ng/ml), 12 patients (20%) had high levels of CA 19‐9 (>37 U/ml), and 9 patients (15%) had high levels of CA 15‐3 (>30 ng/ml) at the time of initial surgery. The positive rate of CA 125, CA 19‐9, CA 15‐3, and CEA in serous tumor were 57.9, 7.9, 7.9 and 15.8%, respectively. These figures were 31.8, 40.9, 27.3 and 40.9% in mucinous tumor. The positive rate of CA 125 in the serous group was statistically significantly higher than that in the mucinous group, while the positive rates for CA 19‐9 and CEA in mucinous histology was significantly higher than those in serous tumors. In case of grouping the tumor size as <4, 4.1‐10 and >10 cm, the mean serum levels of tumor markers had significantly increased by increasing tumor size (p<0.05 for CA 125, and CA 19‐9, p>0.05 for CA 15‐3, and CEA). Conclusion. The high levels of tumor markers, especially for CA 125 and CA 19‐9, may indicate the larger tumor size. The elevation of serum CA 125 may suggest serous tumors, while the high level of serum CA 19‐9 and CEA may indicate mucinous BOTs.

The Manchester operation for uterine prolapse

To evaluate the clinical characteristics, complications, and satisfaction scores of patients who underwent the Manchester operation.

Acute increase in plasma D-dimer level in ovarian torsion: an experimental study

BACKGROUND Torsion of the ovary is a rare but serious cause of gynecologic surgical emergency. Specific laboratory markers that support the preoperative diagnosis of ovarian torsion are not currently available in the clinical routine. The aim of this study was to investigate the diagnostic value of plasma D-dimer level as an early indicator of ovarian torsion in an experimental rat ovarian torsion model. METHODS Sixteen female adult Sprague-Dawley rats were used for this controlled experimental study. Eight rats in the sham operation group (Group I) underwent a surgical procedure similar to Group II but the ovary was not occluded. In Group II (eight rats), a torsion model was created by using atraumatic vascular clips just above and below the right ovary for a 2-h period of ischemia. Right ovaries were surgically removed at the end of the procedure in each group. Blood was sampled before and after operation to assess plasma D-dimer levels. The main outcome measure was ovarian histopathologic findings scores and plasma D-dimer levels. RESULTS There was no significant difference in pre-operative plasma D-dimer levels (0.5963 ± 0.2047 mg/l in Group I, 0.6344 ± 0.1348 mg/l in Group II, P = 0.815, Mann-Whitney U-test). However, mean plasma D-dimer value for Group II was significantly higher than that in the control group (1.2267 ± 0.3099 versus 0.6213 ± 0.2346 mg/l, respectively, Mann-Whitney U-test, P < 0.001), following 2 h of ovarian torsion. Ovarian tissue damage scores were also statistically significantly different among groups. CONCLUSIONS If the observations made in a rat model are extended to humans, plasma D-dimer measurement may be a valuable parameter in the early diagnosis of ovarian torsion.

Serum ischemia-modified albumin as a novel marker of ovarian torsion: An experimental study

OBJECTIVE To evaluate the effect of ovarian torsion on serum levels of ischemia-modified albumin (IMA) in an experimental model. STUDY DESIGN Sixteen female adult Sprague-Dawley rats were involved in the study. Rats were allocated randomly to group I or group II on the day of the experiment. Group I (eight rats) comprised the control (sham operated) group. In group II (eight rats), a torsion model was created by using atraumatic vascular clips just above and below the right ovary. At the end of a 3-h period of ischemia, the ovaries were removed. Blood was sampled before and after operation to assess serum IMA levels. Serum IMA levels (absorbance units) and histopathologic damage scores were evaluated. RESULTS Initial serum IMA levels were similar in both groups. After the operation, significant elevation was observed in group II in contrast to group I (0.191+/-0.034 and 0.277+/-0.089 ABSU, p=0.05). Histologic specimens of the ovaries in group II had higher scores of follicular cell degeneration, vascular congestion, hemorrhage and inflammatory cell infiltration than those in group I (p<0.001). CONCLUSIONS The elevated serum IMA levels observed in the ovarian torsion model seem to have a potential role as a serum marker in the early diagnosis of ovarian torsion.

Topical testosterone versus clobetasol for vulvar lichen sclerosus.

Objective: To compare the effects of topical testosterone and clobetasol treatments on symptoms remission and recurrence rates in patients with vulvar lichen sclerosus (LS). Methods: A retrospective review of the records showed that, of 140 patients with biopsy‐proven vulvar LS, 80 were treated with applications of testosterone propionate 2% in petrolatum and 60 with clobetasol 17‐propionate 0.05%. Results: The response rates after 6 months were 77.5% for patients treated with testosterone and 91.7% for those treated with clobetasol (P = 0.02). The recurrence rates were 20% and 6.7% in the 2 groups, respectively (P = 0.02). Premenopausal patients had higher remission rates and lower recurrence rates than postmenopausal patients (P > 0.05). Considering whole patients, low remission rates and high recurrence rates were observed in patients who had had a hysterectomy (P > 0.05). Conclusion: Treatment of LS with a corticosteroid provided excellent remission rates. In this study, clobetasol 17‐propionate 0.05% was superior to testosterone for both remission induction and maintenance therapy.

Serum IL-6 level may have role in the pathophysiology of unexplained infertility.

Problem  The aim of this study was to compare the serum levels of interleukin (IL)‐6 of women with unexplained infertility with fertile subjects.