Endometrioma is the most common form of endometriosis and is a sign of wide-spread disease in symptomatic patients. Medical treatment options can be successful in endometrioma smaller than 1 cm, but ineffective for growing and symptomatic endometriomas. Conservative surgical interventions that preserve fertility, such as laparoscopic removal or destruction of endometriotic tissue or aspiration of cystic content are typically used to treat the condition. One of the most frustrating aspects of endometrioma treatment is disease recurrence. The underlying mechanisms explaining recurrence are uncertain. Several risk factors have been evaluated in order to predict recurrence after cystectomy. In looking at the results overall, our study can conclude that the presence of greater cyst dimension, higher CA-125 level, presence of preoperative symptoms of non-cyclic pelvic pain, dysmenorrhoea and adhesion extension may be associated with recurrent endometrioma. In clinical practice, identification of risk factors for recurrence helps clinicians to inform patients. Impact statement What is already known on this subject: Endometrioma is the most common form of endometriosis and is a sign of wide-spread disease in symptomatic patients. One of the most frustrating aspects of endometrioma treatment is disease recurrence. Several risk factors have been evaluated in order to predict recurrence after cystectomy. However, the risk factors have not been precisely defined. What the results of this study add: This study aimed to investigate the contribution of possible risk factors to the recurrence of endometrioma after laparoscopic surgery. In looking at the results overall, our study can conclude that the presence of greater cyst dimension, higher CA-125 level, adhesion extension, presence of preoperative symptoms of non-cyclic pelvic pain and dysmenorrhoea may be associated with recurrent endometrioma. What the implications of these findings are for clinical practice and/or further research: In clinical practice, identification of risk factors for recurrence helps clinicians to inform patients. Detection of preoperative risk factors would be helpful in counselling patients on their future prognosis. This may also increase treatment success by providing accurate preoperative treatment planning and by assisting the scheduling of postoperative follow-ups.
Objective:To investigate whether there were any differences in the quality of life, sexual function, and self-esteem of patients who underwent total laparoscopic hysterectomy (TLH) (n=42) and total abdominal hysterectomy (TAH) (n=42).Materials and Methods:All premenopausal patients who underwent TLH or TAH because of benign uterine disorders were enrolled. The sexual function and quality of life status were assessed preoperatively and 6 months postoperatively using three standardized validated questionnaires: the Arizona Sexual Experiences Scale (ASEX), the Symptom Checklist-90-Revised (SCL-90-R), and the Rosenberg Self-Esteem Scale (RSES).Results:Preoperative ASEX, SCL-90-R and RSES scores were not different among the hysterectomy subgroups. The postoperative SCL-90-R scores were also not different among the hysterectomy subgroups. The postoperative RSES scores were significantly lower (p<0.05) than the preoperative scores for all procedures (indicating improved self-esteem) but did not differ among the groups. The postoperative ASEX scores were significantly decreased (p<0.01) as compared with the preoperative scores (indicating improved sexual function). When the average score of each item of the ASEX score was compared in both groups, significant differences were observed in sexual drive and arousal in the laparoscopy group (p<0.01).Conclusion:Women undergoing TLH for benign uterine disease may have better outcomes related to certain sexual function parameters than women undergoing TAH.
Objectives: Monocyte/high density lipprotein (HDL) ratio (MHR) has been reported to be associated with obesity and polycystic ovarian syndrome (PCOS). In this study, it was aimed to evaluate whether there is a relationship between PCOS and MHR and inflammatory parameters, to investigate the relationship level of MHR and lymphocyte/monocyte ratio (LMR), which are easily accessible inflammatory and oxidative stress markers, with obese women with PCOS, and to determine the usability of MHR as a predictive marker for PCOS. Material and methods:The study included 64 PCOS-patients who were admitted to Gynecology clinics and 52 healthy women. Results:The mean MHR (12.5 ± 4.6) in the PCOS group was significantly higher than the control group (10.4 ± 4.0) (p = 0.01). In the examination performed by combining the groups PCOS and obesity status, the mean MHR value in the PCOS-obese group was significantly higher than all the other groups (p = 0.004). In the ROC analysis, the threshold value of 10.1 for MHR was found to have a sensitivity of 84.8% and specificity of 58.5% in determining the association between PCOS and obesity (AUC: 0.721; p < 0.001; LB: 0.628; UB: 0.814; CI 95%). Accordingly, the rate of those with MHR level of 10.1 and above was significantly higher in the PCOS group compared to the control group (67.2% vs 40.4%) (p = 0.001). In the logistic regression analysis, the determination is increased by 3,026 times (odds ratio; 1.401-6.535) in predicting the presence of PCOS in those with MHR value of 10.1 and above, and 7,576 times (Odds ratio; 2.652-21.646) in predicting the presence of PCOS + obesity. was found to be. Correlation analysis in PCOS patients revealed that the MHR value was negatively correlated with age (p = 0.001; r = -0.412), LMR (p = 0.003; r = -0.377), and total cholesterol [p = 0.018; correlation coefficient (r) = -0.302]. Conclusions:This study findings showed that MHR level is significantly related to PCOS, and especially MHR values above 10.1 may be a significant predictive marker for PCOS. Our study findings also show that an association of PCOS and obesity is a very important trigger on MHR.
Objective:The aim of this study was to review patients with tubal carcinoma who underwent surgery in our clinic due to primary carcinoma of the fallopian tubes, a very rare gynecologic malignancy.Materials and Methods:Sixteen patients who were diagnosed as having primary carcinoma of the fallopian tubes and underwent surgery in Zeynep Kamil Research and Training Hospital between January 2007 and December 2014 were included in the study. Demographic data such as age, gravidity, parity, menopausal condition, symptoms, adjuvant therapy, recurrence of tumor, as well as time and type of operation were extracted from patient epicrisis reports and oncology files. Patient information was extracted from the patients’ current files and phone calls were made with patients and their relatives.Results:The mean age of patients was 59.6 (range, 43-78) years. Seventy-five percent of the women were menopausal at admission; the mean menopause duration was 10 years (range, 1-20 years). None of the patients were nulliparous and mean parity was 4.3 (2-8). The most common presenting symptom was abdominopelvic pain, followed by abnormal uterine bleeding. The most common histopathologic type was high-grade serous carcinoma. The mean follow-up duration was 23.7 months (range, 2-53 months). During follow-up, recurrence was seen in 4 (25%) patients. One patient left the study during follow-up. The mean disease-free survival was 48 months. No relation was found between disease-free survival, age, stage, grade, and histologic type in univariate logistic regression analysis.Conclusion:Primary carcinoma of the fallopian tubes is a rare gynecologic tumor that is seen in older patients, has no specific signs, and usually cannot be diagnosed before surgery. Therefore, we think that large-series, multi-centered studies with long-term follow-up duration are needed to define its etiopathogenesis and treatment strategies for the disease.
Objective: This study aims to investigate the effect of prednisolone treatment on the pregnancy rates of in vitro fertilization (IVF) patients with positive thyroid autoantibodies. Methods: This study was conducted in the IVF unit of Gazi University Faculty of Medicine. It included 158 patients who underwent intracytoplasmic sperm injection using the long-term protocol of a gonadotropin-releasing hormone (GnRH) agonist that was positive for thyroid autoantibodies. Each test’s reference value was used as a positive measure of anti-thyroid peroxidase and anti-TG antibodies. On the day of oocyte intake, 44 of 158 patients were started on prednisolone, and the other 114 patients were followed up without medication. Results: In the control group, pregnancy did not occur in 67.5% of the patients; it was determined that 21.1% were pregnant, 5.3% had biochemical pregnancies, 4.4% had twin pregnancies, 0.9% had triplet pregnancies, and 0.9% had ectopic pregnancies. In the extended prednisolone group, pregnancy did not occur in 56.8% of the patients; it was determined that 36.4% of them were pregnant, 4.5% had twin pregnancies, and 2.3% had biochemical pregnancies. An increase in pregnancy rate was observed in the extended prednisolone group, while a statistically significant difference was found between the groups in terms of the mean values of prednisolone according to pregnancy status (p<0.05). It was thus determined that the rate of conception increased in the extended prednisolone group compared to the controls. Conclusion: There is a strong relationship between the presence of thyroid autoantibodies and poor IVF results. The coadministration of prednisolone can improve the clinical pregnancy rate in women affected by thyroid autoimmunity.
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