Volkan Noyan

Transvaginal sacrospinous colpopexy for marked uterovaginal and vault prolapse

Objective: The transvaginal sacrospinous ligament fixation technique was used as part of the vaginal repair procedure for marked uterovaginal prolapse, and in the treatment of vault prolapse. Method: Out of the 26 women treated with sacrospinous ligament suspension of the vaginal vault, 23 had marked uterovaginal prolapse and three had vault prolapse following hysterectomy. Patients with vault prolapse underwent posterior vaginal repair, obliteration of the enterocele sac and sacrospinous colpopexy. Patients with marked uterovaginal prolapse underwent vaginal hysterectomy with high ligation of the enterocele sac, anterior and posterior vaginal repair, and sacrospinous colpopexy. Bilateral salpingoopherectomy was added to the procedure in five patients. All patients were examined 6 weeks after the operation and, subsequently, on an annual basis. The mean follow‐up period was 2.6 years (1–5 years). Results: Out of the three patients with previous vault prolapse, none had recurrences. Out of the 23 patients with previous marked uterovaginal prolapse, only two had small cystocele, and one had small enterocele at 36 months following the operation. These patients were asymptomatic and did not need an operation. Vaginal vault prolapse was not observed in any of these patients. Two women had post‐operative urinary tract infection and five had buttock discomfort, which subsided after 2 months. No other intra‐ or post‐operative complications occurred. Conclusion: Transvaginal sacrospinous colpopexy can be performed together with vaginal hysterectomy, and anterior and posterior vaginal wall repair in patients with marked uterovaginal prolapse because of its high success in avoiding possible vault prolapse, and low intra‐ and post‐operative complication rates.

Serum leptin levels in patients with polycystic ovary syndrome

OBJECTIVE To determine whether polycystic ovary syndrome (PCOS) is related to leptin dysregulation. DESIGN Prospective study. SETTING Department of Obstetrics and Gynecology in a university hospital. PATIENT(S) Fifty patients with PCOS (33 nonobese and 17 obese) and 32 control women (19 nonobese and 13 obese) were included in the study. INTERVENTION(S) Serum leptin levels were measured in patients with PCOS and the controls. Correlations between leptin levels and serum hormone levels (FSH, LH, free testosterone, androstenedione, DHEA-S and fasting insulin) were studied. MAIN OUTCOME MEASURE(S) Serum leptin levels and correlations between leptin levels and the hormonal parameters. RESULT(S) Mean serum leptin levels were not significantly higher in patients with PCOS compared to the control group. Leptin levels were found to be significantly higher in the obese subgroups both in patients with PCOS and in the control women. Leptin levels were found to be higher in obese patients with PCOS compared to obese controls; however, when the levels were evaluated again with covariance analysis excluding body mass index, there was no statistically significant difference. Leptin levels had a positive correlation with body mass index, both in patients with PCOS and the controls. CONCLUSION(S) Leptin levels were not higher in patients with PCOS compared to the control group; the leptin level was correlated with the amount of fat tissue not only in patients with PCOS but also in healthy women.

The changes in ovarian hormone levels and ovarian artery blood flow rate after laparoscopic tubal sterilization

OBJECTIVE To investigate the changes in serum ovarian hormone levels and ovarian artery blood flow rate by Doppler ultrasonography following laparoscopic tubal sterilization. METHODS Laparoscopic tubal sterilization have been performed on 13 voluntary subjects between the sixth and eighth days of the menstrual cycle. Serum ovarian hormone levels and ovarian artery blood flow rate, by Doppler ultrasonography, were determined 3 days before the operation, on the post-operative third day and on the post-operative third month. The results of 10 participants who finished the follow-up period were analyzed. RESULTS There were no statistically significant changes in serum levels of ovarian hormones after laparoscopic tubal ligation. The end-diastolic blood flow in ovarian artery was found to be decreased following tubal sterilization (8.7+/-2.8 and 7.4+/-1.8m/sec, respectively, P>0.05), while resistivity index (RI) increased after the operation (0.7+/-0.1 and 0.8+/-0.03, respectively, P>0.05). CONCLUSION There was no change in ovarian hormone levels after laparoscopic tubal sterilization. There is slight but statistically non-significant decrease in ovarian artery blood flow rate following tubal sterilization, signifying a local increase in vascular resistance.

Serum paraoxonase 1 activity, asymmetric dimethylarginine levels, and brachial artery flow-mediated dilatation in women with polycystic ovary syndrome

OBJECTIVE To evaluate endothelial function via serum asymmetric dimethylarginine (ADMA) levels, paraoxonase 1 (PON1) activity, and brachial artery flow-mediated dilatation (FMD) in women with polycystic ovary syndrome (PCOS). DESIGN Prospective case-control study. SETTING University hospital. PATIENT(S) Thirty patients with PCOS with a mean age of 24.33 ± 4.50 years and 30 healthy controls matched for body mass index (BMI) and age. INTERVENTION(S) Endothelial function was assessed biochemically with serum ADMA levels and serum PON1 activity and functionally with brachial artery FMD by ultrasonography. MAIN OUTCOME MEASURE(S) Serum ADMA levels, serum PON1 activity, brachial artery FMD, hormonal and biochemical parameters. RESULT(S) Patients with PCOS had higher levels of free testosterone and insulin, and higher waist-hip ratio and Ferriman Gallwey scores when compared with the controls. Fasting glucose and homeostasis model assessment of insulin resistance were not different between the groups. There was no statistically significant difference in ADMA levels between two groups. Serum PON1 activity and brachial artery FMD were statistically significantly lower in women with PCOS. There was negative correlation between ADMA and PON1 in patients with PCOS. CONCLUSION(S) Serum PON1 activity and brachial artery FMD, as markers of endothelial dysfunction and cardiovascular risk, were statistically significantly lower in women with PCOS compared with healthy controls matched for age and BMI. Endothelial dysfunction may be seen at earlier ages in patients with PCOS.

The effects of oral contraceptives including low-dose estrogen and drospirenone on the concentration of leptin and ghrelin in polycystic ovary syndrome.

OBJECTIVE To evaluate short-term leptin and ghrelin concentrations in women with polycystic ovary syndrome (PCOS) who use low-dose oral contraceptives containing drospirenone. DESIGN Prospective study. SETTING Department of obstetrics and gynaecology in a university hospital. PATIENT(S) Twenty women with PCOS were enrolled in the study. INTERVENTION(S) A low-dose oral contraceptive containing ethinyl estradiol and drospirenone was given for three cycles. MAIN OUTCOME MEASURE(S) Serum androstenedione, free T, T, dehydroepiandrosterone sulphate, sex hormone-binding globulin, FSH, LH, E(2), lipid profiles, leptin, and ghrelin levels were measured in each subject. Insulin resistance was estimated by the homeostasis model assessment-insulin resistance (HOMA-IR). RESULT(S) While leptin concentrations did not change with therapy, ghrelin levels increased statistically. Baseline leptin concentrations were correlated positively with body mass index, waist-to-hip ratio, insulin, and HOMA-IR and negatively with ghrelin. After controlling for body mass index and waist-to-hip ratio in a partial correlation analysis, leptin levels were not correlated with these parameters. Ghrelin was inversely correlated with body mass index, waist-to-hip ratio, insulin, HOMA-IR, and free T. CONCLUSION(S) In patients with PCOS, an oral contraceptive containing ethinyl estradiol and drospirenone increases ghrelin levels but not leptin levels in a 3-month period. Ghrelin might be related to the metabolic and androgenic changes in patients with PCOS.

The association of androgenic sex steroids with serum lipid levels in postmenopausal women

Background.  The aim of the present study was to examine the correlations between androgenic sex steroids and serum lipid levels in postmenopausal women.

Comparison of microlaparoscopy and conventional laparoscopy for tubal sterilization under local anesthesia with mild sedation.

STUDY OBJECTIVE To compare tubal sterilization performed by microlaparoscopy and conventional laparoscopy. DESIGN Prospective, randomized trial (Canadian Task Force classification I). SETTING Gazi University School of Medicine. PATIENTS Twenty women undergoing surgical sterilization. INTERVENTION Ten sterilizations by conventional laparoscopy and 10 by microlaparoscopy. MEASUREMENTS AND MAIN RESULTS The techniques were comparable in quality of visualization, operating time, amount of drugs used for sedation and local anesthesia, and intraoperative pain scores. However, the postoperative analgesic requirement was significantly less in women treated by by microlaparoscopy. CONCLUSION Tubal sterilization by microlaparoscopy does not differ greatly from conventional laparoscopic sterilization.

Adenomatoid tumor of the uterus in a patient with chronic renal failure

A case of adenomatoid tumor of the uterus in a 34-year-old patient, who had received a renal transplant and was undergoing immunosuppresive therapy is presented. At surgery, there were a total of eight nodular intramural and subserous masses thought to be leiomyoma nodules, and tumor excision was unusually, hardly performed because the nodules were strictly adherent to the myometrium. All the specimens yielded the same pathological diagnosis - adenomatoid tumor. This case is unusual because of the multiple nodular pattern and its association with the immunocompromised status of the patient. Although adenomatoid tumors have not been shown to recur, we are in doubt in our case, because the uterus is still intact and the immunocompromised status of the patient might have a role in the extensive growth and also in the possibility of recurrence.

Change in retrobulbar circulation during menstrual cycle assessed by doppler ultrasound

Our purpose was to study the hemodynamic changes in the ophthalmic, central retinal and posterior ciliary arteries during the normal menstrual cycle and to relate the vascular changes to menstrual cycle. A total of 23 healthy women underwent serial color Doppler ultrasonography at least six times during a normal menstrual cycle, twice each in follicular, ovulatory and luteal phases. Pulsatility and resistance index and peak systolic velocity of the each arteries were assessed with color Doppler imaging. There was no statistical difference in any of the parameters during the menstrual cycle. This was supposed to be because generalized hormonal effects on heart rate, blood pressure, blood volume, cardiac output and on the diameter of the vessel cancel each other and this effect maintains the same ocular blood flow and perfusion during the menstrual cycle.

Laparoscopic intracorporeal ultrasound guidance during hysteroscopic adhesiolysis

We introduce a case of hysteroscopic adhesiolysis by the guidance of laparoscopic intracorporeal ultrasound (LIU) in a patient complaining of amenorrhea and infertility found to have total intrauterine synechia. Adequate intrauterine adhesiolysis was performed by resectoscope with a wire loop, coordinating images of the endometrial cavity, uterine wall and the tip of the hysteroscope. She had regular menses after the operation and follow-up hysterosalpingogram at 3 months demonstrated satisfactory surgical results, with no evidence of intrauterine adhesions. To avoid the possibility of inadvertent uterine perforation, complex intrauterine procedures can be easily performed by the guidance of endoscopic ultrasonography.