Intra-ovarian stem cell transplantation in management of premature ovarian insufficiency: towards the induced Oogonial Stem Cell (iOSC).

The specialized resident-stem cells in gonads are tasked with restorating damaged ovarian cells following injury to maintain sequential reproductive events. When we talk about premature ovarian insufficiency (POI) we accept the existence of decreased stem cell and their regenerative abilities. The present study was to explain how restorating damaged ovarian cells following injury to maintain sequential reproductive events in evidence-based medicine indexed in PubMed and Web of Science. The exact mechanism is unclear stem cells transfer may improve compromised ovarian function and fertility outcome in women with POI. Soluble factors secreted by stem cell may rescue impaired mitochondrial function in oogonial stem cells, enhance metabolic capacity of resident stem cells, induce local neovascularization in the ovary, and activate gene shifting between transferred stem cells and germ cell precursors. This review may provide insight into how stem cells show some of their beneficial effects on compromised ovarian microenvironment and germ cell niche and paves the way for clinical trials for improving ovarian function of women with POI. We also had the opportunity to share our hypothesis about the design and development of induced oogonial stem cell (iOSC) and its use in POI.

Malignant Brenner tumor of the ovary: analysis of 13 cases.

OBJECTIVE: Most Brenner tumors are benign, with only 1% being malignant. In this study we report on 13 cases with malignant Brenner tumor of the ovary and discuss the clinical, demographic and histologic features. METHOD: Thirteen patients with malignant Brenner tumor of the ovary who were treated at Selçuk University Gynecology Department over a 6-year period from January 2004 to December 2010 were retrospectively analysed from hospital electronic medical records. Clinical and pathologic findings were reported. RESULTS: The median age of the study population was 55.69 ± 11.81 years (range 43-79 years). Most of the patients presented with abdominal pain (6/13, 46.2%). The mean size of the ovarian tumors was 9.19 ± 1.34 cm (range 4-16.5 cm). Six patients (46.2%) were in stage III, five (38.5%) in stage I, and two (15.4%) in stage IV. Ten patients (76.9%) received chemotherapy. The mean follow-up was 38.38 ± 23.25 months (range 5-84 months). During follow-up, recurrence was detected in 7 patients (53.8%). The mean recurrence time was 23.8 ± 14.46 months (range 11-48 months). CONCLUSION: In our study, we found that diagnosis was at an advanced stage, and recurrence rate was high. The mainstay of treatment is surgical resection, but the exact regimen and benefit of adjuvant therapy remain unknown.

Ovarian cancer during pregnancy.

OBJECTIVE: To evaluate the clinical features, pregnancy outcome, and treatment of patients with ovarian cancer diagnosed during pregnancy. METHODS: The present study was a retrospective review of 11 cases of ovarian cancer detected during pregnancy. The women were treated and followed up at Selçuk University, Meram Faculty of Medicine, Konya, Turkey, during 2006-2010. RESULTS: Approximately half the patients were asymptomatic (5 [45.5%]) and diagnosed during cesarean delivery (6 [54.5%]). The histopathologic tumor categories comprised malignant epithelial ovarian tumor (4 [36.4%]), borderline tumor (4 [36.4%]), malignant germ cell tumor (2 [18.2%]), and sex cord stromal tumor (1 [9.1%]). Nine (81.8%) tumors were classified as stage I. Conservative surgery was performed in 10 (90.9%) patients. A patient with stage IIIC serous papillary adenocarcinoma underwent hysterectomy with bilateral salpingo-oophorectomy. A patient with dysgerminoma in stage IV died on follow-up. Three infants were born premature; they were followed up in the neonatal intensive care unit with satisfactory outcomes. CONCLUSION: Early diagnosis and appropriate treatment are crucial for patients with ovarian cancer diagnosed during pregnancy. Tumor staging is possible during pregnancy, but the appropriateness of surgery needs to be considered carefully. Ideally, the treatment strategy should be discussed and structured on an individual basis.

Balci technique for suspending vaginal vault at vaginal hysterectomy with reduced risk of vaginal vault prolapse.

AIM: The aim of this study was to evaluate the efficacy of a new technique of suspending the vaginal vault at vaginal hysterectomy (VH) for total uterine prolapse. MATERIAL AND METHODS: This prospective study included 65 patients (group 1) in whom VH was performed using the new technique and 110 patients (group 2) in whom VH was performed using the traditional method. Both groups were followed up for 4 years. The incidences of vaginal vault prolapse (VVP), total vaginal length (TVL) (location of vaginal cuff), intraoperative and postoperative complications and sexual function were compared. RESULTS: There were no statistically significant differences between the two groups regarding age, parity, body mass index (BMI), blood loss, intraoperative and postoperative complications, and sexual function. One (1.5%) patient had VVP in group 1, whereas 12 (10.9%) patients had VVP in group 2. TVL in group 1 was 8.9 ± 1.2 cm while in group 2 it was 5.9 ± 0.8 cm. The operation times were 57 ± 5 min and 76 ± 9 min in group 1 and group 2, respectively. There was a statistically significant difference between the two groups regarding VVP (P = 0.022), TVL (P < 0.001) and operation time (P < 0.001). The two groups were also compared regarding anterior and posterior prolapse after 4 years: group 1 had less anterior and posterior prolapse (stage II or more) than group 2 (P = 0.041, P = 0.047), respectively. CONCLUSION: In this new technique, compared to the traditional technique, there was a lower incidence of VVP, greater TVL was achieved and the duration of the operation was shorter.

Management and outcomes of adnexal torsion: a 5-year experience.

PURPOSE: To discuss the surgical results of patients with diagnosis of adnexal torsion. METHODS: One hundred and fifty patients with diagnosis of adnexal torsion who presented to our clinic between January 2005 and December 2009 were included in this retrospective analysis. Data regarding age, gravidity, parity, size of mass, operation time, and duration of hospitalization were recorded and compared between the patients who had laparoscopy to those who had laparotomy. The pathological results of patients were also recorded. RESULTS: Fifty-eight patients were treated laparoscopically while 92 patients had laparotomy. The most frequent presenting symptom was pelvic pain (96%). Laparoscopy group consisted of young patients with low parity; operation and hospital stay time was shorter in laparoscopy group. Velocity loss in Doppler ultrasonography was noted in 81.3% of the patients. Of the laparotomy group 35 postmenopausal patients had hysterectomy and bilateral salpingo-oopherectomy, and staging surgery was done for 16 of them. The pathological finding was found to be malignant in four and borderline serous tumor in four patients. CONCLUSION: Laparoscopy is preferred for young patients who want to preserve their fertility. Because of high risk of malignancy in postmenopausal ovarian masses presenting with torsion; frozen section should be used. If not possible or not conclusive, staging surgery is more appropriate especially if there is suspicion of malignancy.

Diagnosis and management of intra-abdominal, mislocated intrauterine devices.

PURPOSE: To evaluate the predisposing factors, diagnosis and surgical treatment options of patients with intra-abdominal, mislocated intrauterine devices (IUDs). METHODS: The diagnosis and management of 18 patients with intra-abdominal, mislocated IUDs were analyzed in this retrospective study. RESULTS: Trained midwives inserted ten (55%) of the IUDs, while six (33%) were inserted by general practitioners and two (11%) by specialist gynecologists. Ten (55.5%) of the patients were diagnosed by gynecological examination and ultrasonography (USG); abdominal X-ray, in addition, was required in the other eight (44.4%). Eleven patients (61%) were managed by laparoscopy, whereas laparotomy was required in seven (39%). For all patients, laparoscopy was performed initially. No complication was encountered in any of the patients. CONCLUSION: Persons who insert IUDs should receive adequate training before certification, because inadequate pelvic examination before insertion and inexperience of the inserting person might be predisposing factors for uterine perforation. If IUD strings are not visible during gynecologic examination, USG should be tried to locate the IUD and pelvic X-ray used only when USG fails to locate the IUD. Laparoscopy can be the first choice for removal.

Management of ovarian cysts by laparoscopic extracorporeal approach using single ancillary trocar.

OBJECTIVE: This prospective study aimed to evaluate an alternative laparoscopic extracorporeal approach for the treatment of benign ovarian cysts. MATERIALS AND METHODS: The initial study population included 243 patients diagnosed with benign ovarian masses. Two patients with suspected malignancies and 21 patients with technical difficulties secondary to severe, dense pelvic adhesions were excluded from the study, and the final study population, therefore, comprised 220 patients. A primary 10-mm trocar was inserted, followed by a second incision on the side of the cyst and the introduction of an ancillary 5-mm trocar. The cystic content was aspirated using a needle. The capsule was held using an endograsper inserted through the ancillary trocar. The capsule was extracted from the abdomen. The 5-mm trocar and the endograsper were removed from the abdomen simultaneously. The capsule was completely detached. Homeostasis was performed and the ovary was then released. RESULTS: The mean duration of the operation was 20 +/- 5 minutes. The size of the cysts ranged from 5 cm to 15 cm (mean, 8.4 +/- 2.6 cm). The pathologies of the cysts were simple cyst in 86 cases, endometrioma in 68, serous cyst in 57, mucinous cyst in eight and borderline in one. The perioperative complication rate was 2.27%. CONCLUSION: This technique does not require the use of two or more ancillary trocars or widening of the trocar incision. The duration of surgery can be shortened considerably and complete excision of the cystic capsule can be performed. Homeostasis was achieved using 3-0 polyglactin sutures. No electrocoagulation was required.

An incidental coexistence of Mayer-Rokitansky-Kuster-Hauser syndrome with pelvic ectopic kidney and perirenal endometrioma.

In this case report, a Mayer-Rokitansky-Kuster-Hauser syndrome with pelvic ectopic kidney and a perirenal cyst with endometrial tissue inside is demonstrated. A 17 year old patient admitted with primary amenorrhea. Pubertal stages were completed. In pelvic ultrasonography; uterus could not be detected, a 6 x 11 cm sized cystic lesion was seen on the right adnexal area. A centrally located 5.5 x 9 cm sized ectopic pelvic kidney was detected. Hormones and tumor markers were normal. Laparoscopy was planned. In the laparoscopic observation, uterus and both tubes could not be detected, ovaries were normal. There was a 6 x 7 cm sized cyst located in the retroperitoneal area, the origin of the cyst could not be identified. Laparatomy was considered, retroperitoneal space was entered, an 8 x 11 cm sized smooth contoured perirenal cyst adjacent to the pelvic kidney was detected. Cyst was extirpated. The pathology result was reported to include endometrial tissue and hemorrhage inside.

Evaluation of the results of cordocentesis.

OBJECTIVE: To evaluate the results of cordocentesis carried out in our clinic at Meram Medicine Faculty of Selcuk University in Konya, Turkey. MATERIALS AND METHODS: Cytogenetic results and complication data were obtained by cordocentesis from 250 pregnancies performed in our clinic. RESULTS: Adequate amount of cord blood was taken 98% of the time, the successful culture rate was 92.8%, and none of the 18 cases in which no proliferation was detected in the culture accepted a new intervention. Cordocentesis was performed in 14 cases (5.6%), because no results were obtained from amniocentesis carried out for various indications. According to cytogenetic evaluation, chromosomal abnormality was detected in 12 cases (5.17%), including four cases of trisomy 21, four cases of trisomy 18, one case of trisomy 13, one case of triploidy (69,XXX) and two cases of chromosomal inversion. Of the 250 cordocentesis cases, there were 12 (4.8%) cases of fetal loss, including four cases of rupture of membranes, four cases of abdominal pain and vaginal bleeding and four cases of a spontaneous abortus. In 53 (21.2%) cases, cordocentesis was performed because of hydrops fetalis; and of the total 12 losses, six were in this group. The fetal loss rate was 11.32% in the hydrops fetalis group. CONCLUSION: If cordocentesis is carried out by highly skilled physicians and optimal culture conditions are available, cordocentesis is an invasive prenatal diagnostic and therapeutic procedure that is performed secondary to amniocentesis with high accuracy and safety. In cases of hydrops fetalis in which cordocentesis is carried out, fetal loss is more likely to occur.

Serum TNF-alpha, IL-6, lupus anticoagulant and anticardiolipin antibody in women with and without a past history of recurrent miscarriage.

OBJECTIVE: The aim of the this study was to investigate Lupus Anticoagulan (LA), Anticardiolipin Antibody (ACA), Tumor Necrosis Factor-alpha (TNF-alpha) and Interleukin-6 (IL-6) serum levels in 40 pregnant and 20 nonpregnant. MATERIALS AND METHODS: The women were divided into three groups. The first group consisted of 20 pregnant women of less than 20 gestational weeks and a past history of habitual abortion . The second group consisted of 20 non pregnant patients with a past history of habitual abortion. The third group consisted of 20 healthy non pregnant women. RESULT: LA was found in only one patient in the Group 2. ACA Ig G positivity were found 1 patient in the Group 1, 3 patients Group 2 and 1 patient in Group 3. Mean ACA IgG was highest in the Group 2. High serum TNF-alpha levels were found in the 12 (60%), 6(30%) and 2 (10%) women in the Groups 1, 2, and 3, respectively. Significant difference were found for TNF-alpha among the groups (P<0.05). The highest level of TNF-alpha was found in the Group 1 and the lowest in the Group 3. There were statistically significant differences for IL-6 among the three groups (P>0.05). CONCLUSION: We propose that cytokines especially TNF-alpha was found to be related to the pregnancy loss.

A new retropubic suspension operation technique for transvaginal Burch operation, using newly developed equipment.

BACKGROUND: Genuine stress urinary incontinence is a very common pathologic condition among women. In order to operate this, different techniques have been introduced. Here, a new technique is described for the operation of genuine stress urinary incontinence with newly developed equipment. The present technique offers more advantages than previous techniques introduced by different authors. With this technique, the duration of operation and of the recovery period are both shorter than with previous techniques. All patients had symptoms and signs of stress urinary loss. We performed multichannel cystometry preoperatively to all patients. METHOD: A special valve is used with reflector having 97% reflection capacity for transvaginal burch operation technique. Twenty five women (n = 25) having genuine stress urinary incontinence were taken under transvaginal Burch bladder neck suspension operation with fixation of suspension sutures to the Cooper (iliopectineal) ligament. RESULTS: Following urodynamic workup 6 months after the surgery, one out of the 25 patients (4%) was diagnosed to have genuine stress incontinence, while one patient (4%) were diagnosed as having urinary stress incontinence and detrussor instability. One patient was found to be wet postoperatively due to only detrussor instability (4%). There were no significant differences pre- and postoperatively regarding capacity, residual volume, pressure rise on filling or standing, or maximal voiding pressure or peak flow rate.

Experience with vaginoplasty.

We did 27 vaginoplasties (7 gracilis musculocutaneous flaps, 8 pudendal thigh flaps, 12 full-thickness skin grafts) during the period 1994-2000. The preoperative assessment and postoperative follow up were done in collaboration with the gynaecologists. All patients had vaginal agenesis. With the gracilis flaps we found it difficult to achieve an adequate blood supply. With pudendal thigh flaps we achieved perfect innervation and a good contour, but they did tend to be hairy. With full-thickness skin grafts the innervation was not perfect, but the contour was good. Having compared the three operations during a follow up period ranging from 1-5 years we think that the full-thickness skin graft gives the best results.