The significance of sonographically thickened endometrium in asymptomatic postmenopausal women

OBJECTIVE: To investigate the correlation between sonographic, hysteroscopic, and pathological findings in postmenopausal asymptomatic patients with sonographically thickened endometrium. METHODS: The records of postmenopausal patients who attended the Menopause Outpatient Clinic of a tertiary women's hospital in Ankara, Turkey between January 1, 2012 and December 15, 2013 were retrieved. A total of 266 postmenopausal women without vaginal bleeding underwent hysteroscopic evaluation and endometrial sampling. Patients whose pathological records indicated an endometrial thickness equal to or greater than 6 mm (double layer) on transvaginal ultrasonography without any symptoms were included in the study. RESULTS: The most frequently detected focal intrauterine lesions in asymptomatic women were endometrial polyps, which were diagnosed in 168 (63.1%) cases. Twenty-four (9%) patients were diagnosed as having simple hyperplasia, 4 (1%) atypical hyperplasia, and 8 (3%) endometrial adenocarcinoma. Two of the patients with adenocarcinoma were diagnosed based on endometrial polyps, and 6 cases showed endometrial hyperplasia on hysteroscopy, while histological examination showed endometrial carcinoma. CONCLUSION: We suggest 10.5 mm as the cutoff value for endometrial thickness and recommend hysteroscopy following dilatation and curettage to increase diagnostic efficacy and provide definitive treatment in asymptomatic postmenopausal women with thickened endometrium.

Only female age, and not blood type, is associated with ovarian reserve

Background: The association between blood types and ovarian reserve is investigated in this study

Materials and Methods: As an index of ovarian reserve, women with a follicle stimulating hormone [FSH] level of >/=10 mIU/ml in the early follicular phase were designated as having diminished ovarian reserve. In this prospective study, early follicular phase serum FSH and estradiol levels and blood types were evaluated in 500 patients who were admitted to the Infertility Department of Ministry of Health Etlik Zubeyde Hanim Women's Health Training and Research Hospital between January 2012 and June 2012. Women with serum FSH level <10 mIU/ml formed group I, and women with serum FSH >/=10 mIU/ml formed group II. The prevalence of blood types in each group and their association with ovarian reserve were analyzed

Results: Out of 500 patients, 438 women were in group I, while 62 women were in group II. There was no statistically significant difference among the two groups in terms of blood group proportions [p=0.69], this did not change after age adjustment [p=0.77]. The presence of A antigen [in A and AB blood type] [p=0.91], the blood type O [p=0.70], and the blood type B [p=0.51] were not statistically related to ovarian reserve after age adjustment. There was also no statistically significant correlation between rhesus factor and ovarian reserve after age adjustment [p=0.83]. The only factor that affected ovarian reserve was age of patients [p=0.006]

Conclusion: Blood groups do not constitute a risk or protective factor for ovarian reserve. Therefore, blood groups do not have any predictive value in evaluating ovarian reserve

Intraoperative complications of outpatient interval tubal sterilization at a teaching hospital in Turkey

To evaluate the intra-operative complications of outpatient interval tubal sterilization at a teaching hospital. The data of 461 patients who underwent interval tubal ligation ITL at the Family Planning Clinic of Ankara Etlik Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey between January 2002 and December 2005 were reviewed from a computerized database. The demographic characteristics, operative technique, and intra- and early postoperative complications of patients were evaluated. Only 11 patients had minilaparotomy for ITL. Laparoscopic ITL was performed using bipolar cautery. The cases who were hospitalized or who had a complication and/or an unplanned laparotomy were analyzed. The mean age of patients was 35.1 range: 21-51, gravidity was 4.6 range: 2-9, parity was 3.2 range: 2-7, and number of living children was 3.1 range: 2-6. Out of 461 patients, only 2 0.4% had complications related with general anesthesia. Two cases 0.4% had bleeding from the port-site, 3 cases 0.6% had meso-salpingeal and meso-ovarian bleeding, one had omental bleeding 0.2% and one case had bleeding 0.2% from the vaginal wall. There was only one 0.2% intestinal burn that required a laparotomy and segmental resection followed by end-to-end anastomosis. The mortality was nil, whilst the morbidity was found to be 2.1%, and all the complications were encountered in patients who had laparoscopic surgery. Outpatient tubal ligation is a convenient and safe procedure, and implementing endoscopic surgical techniques is necessary for correction of the complications

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 postoperative 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