¿Evita la antibioterapia biopsias de próstata en pacientes con valores elevados de PSA? / Does Antibiotherapy Prevent Unnecessary Prostate Biopsies in Patients With High PSA Values?

Introducción: Investigamos si la antibioterapia tiene algún papel en el PSA total (tPSA), PSA libre (fPSA) y fPSA/tPSA en pacientes con PSA superior a 2,5ng/ml. También si tiene alguna relación con la tasa de diagnóstico de cáncer de próstata. Material y métodos: Un total de 108 pacientes mayores de 50 años con síntomas del tracto urinario inferior y PSA>2,5ng/ml fueron incluidos en este estudio. Se dio antibioterapia a todos los casos durante tres semanas. Luego se tomó biopsias con guía ultrasonográfica a todos los pacientes. Antes y después de la antibioterapia se les aplicó los cuestionarios International Prostate Sypmtom Score (IPSS) y National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) y se comparó los valores de tPSA, fPSA y fPSA/tPSA en sangre. Resultados: Las variaciones de tPSA, fPSA y fPSA/tPSA antes y después de la antibioterapia no mostraron diferencias estadísticamente significativas (p>0,05). Cuando excluimos el adenocarcinoma de próstata se hallaron diferencias estadísticamente significativas en las puntuaciones del IPSS y NIH-CPSI en todos los casos. Conclusiones: La administración de antibioterapia a pacientes con niveles de PSA superiores a los valores de corte no produjo un cambio significativo en la decisión de realizar biopsias de próstata con aguja. Se debería considerar realizar biopsias de próstata sin antibioterapia previa en los pacientes con PSA elevado cuando no exista una sospecha de prostatitis (AU)

Introduction: We investigated if antibiotherapy has any role on total PSA (tPSA), free PSA (fPSA) and fPSA/tPSA ratio in patients with tPSA higher than 2.5 ng/ml. We also analyzed if it has any relation with prostate cancer diagnosis rate. Material and Methods: A total 108 patients older than 50 years of age with lower urinary system sypmtoms and tPSA >2.5ng/ml were included in this study. Antibiotherapy was given to all the cases for three weeks. After that, transrectal ultrasound-guided prostate biopsies were taken from all the patients. Before and after antibiotherapy, "The International Prostate Symptom Score" (IPSS) and "National Institutes of Health Chronic Prostatitis Symptom Index" (NIH-CPSI) questinories are performed and serum tPSA, fPSA and fPSA/tPSA values were obtained. Results: TPSA, fPSA and fPSA/tPSA ratio alterations prior to and after antibiotherapy did not show any statistically significant difference (p>0.05). When prostate adenocarcinoma was excluded, an statistically significant decrease was found in IPSS and NIH-CPSI scores for all cases. Conclusions: Antibiotherapy given to patients with PSA levels higher than threshold value has not led to significant change in prostate needle biopsy decision. Prostate biopsy should be considered without trying antibiotherapy in patients with high PSA values if a suspicion of prostatitis does not exist (AU)

[Does antibiotherapy prevent unnecessary prostate biopsies in patients with high PSA values?]. / ¿Evita la antibioterapia biopsias de próstata en pacientes con valores elevados de PSA?

INTRODUCTION: We investigated if antibiotherapy has any role on total PSA (tPSA), free PSA (fPSA) and fPSA/tPSA ratio in patients with tPSA higher than 2.5ng/ml. We also analyzed if it has any relation with prostate cancer diagnosis rate. MATERIAL AND METHODS: A total 108 patients older than 50 years of age with lower urinary system sypmtoms and tPSA >2.5ng/ml were included in this study. Antibiotherapy was given to all the cases for three weeks. After that, transrectal ultrasound-guided prostate biopsies were taken from all the patients. Before and after antibiotherapy, "The International Prostate Symptom Score" (IPSS) and "National Institutes of Health Chronic Prostatitis Symptom Index" (NIH-CPSI) questinories are performed and serum tPSA, fPSA and fPSA/tPSA values were obtained. RESULTS: TPSA, fPSA and fPSA/tPSA ratio alterations prior to and after antibiotherapy did not show any statistically significant difference (p>0.05). When prostate adenocarcinoma was excluded, an statistically significant decrease was found in IPSS and NIH-CPSI scores for all cases. CONCLUSIONS: Antibiotherapy given to patients with PSA levels higher than threshold value has not led to significant change in prostate needle biopsy decision. Prostate biopsy should be considered without trying antibiotherapy in patients with high PSA values if a suspicion of prostatitis does not exist.

Dorsal vein rupture after practice of taqaandan, necrotising cavernositis, penile reconstruction, urethroplasty and penile prosthesis implantation.

Penile fracture is an uncommon and emergent urologic condition defined as traumatic rupture of the corpus cavernosum secondary to a blunt trauma of the erect penis. Tunica albuginea is thinned and stretched in the erect state, and a transverse tear in the corpus cavernosums may occur by a buckling force. However, penile dorsal vein tears may mimic penile fracture. Also, corporeal infection and purulent cavernositis are associated with trauma, cavernosography, priapism, intracavernosal injection therapy and penile prosthesis.

Do ureteral catheterisation procedures affect sexual functions? A controlled prospective study.

The use of ureteral stents is a common procedure in urology practice. We investigated whether the use of double-J stent had an effect on sexual functions or not. One hundred and seventy-seven cases were included in the study. Unilateral double-J stent was placed during ureteral stone treatment in one hundred and eight of these cases. Sixty-nine cases were included as the control group. 'International Index of Erectile Function' (IIEF) and 'Female Sexual Function Index' (FSFI) questionaries were assessed before and 4 weeks after the intervention in all patients. When total IIEF and subdomains of IIEF scores of men and total FSFI and subdomains of FSFI scores of women whom double-J stent was placed were evaluated before and after the procedure, there was statistically significant reduction in patient's scores. In the control group, any statistically significant alteration in patient's score was not observed in men and women. Sexual functions are negatively affected in both women and men whom ureteral stents are placed. To reduce these problems specific to urinary system owing to stents, new treatment strategies and new studies that lead to improvements in the material and design of stents are required.

Resistin may not associate with gestational diabetes mellitus although insulin resistance.

OBJECTIVE: Resistin is a potent regulator of glucose homeostasis which is thought to oppose the action of insulin in peripheral tissues. The aim of this study was to determine changes in resistin levels in gestational diabetes mellitus (GDM). MATERIAL AND METHOD: Twenty women with GDM (mean age 32.28 +/- 5.01 years old, and gestational age 32.2 +/- 4.8 weeks) matched with 22 non diabetic pregnant women (NGDM) (mean age 30.30 +/- 4.5 years old, and gestational age 34.8 +/- 3.5 weeks) were included in the study. Body mass index (BMI) was calculated. Serum resistin levels were measured and insulin resistance was calculated with HOMA-IR. The Mann Whitney U test was used for statistical analysis. RESULTS: BMI was 33.8 +/- 6.2 kg/m2 in the GDM group and 28.4 +/- 6.2 kg/m2 in the NGDM group (p = 0.04). Serum resistin levels were 8.7 +/- 2.1 ng/ml in the GDM group and 8.1 +/- 2.5 ng/ml in the NGDM group. Mean resistin level was not different between the two groups. HOMA-IR in GDM was higher than in the NGDM group (13.2 +/- 12.2 vs 5.8 +/- 5.1, p = 0.02, respectively). CONCLUSION: Although mean BMI in GDM was higher than in NGDM and insulin resistance in GDM was more marked than in NGDM, serum resistin levels in GDM were not found to be any different from NGDM.

Amniotic fluid amino acid levels in non-immune hydrops fetalis: a case-control study.

In a prospective case-control study, we compared the amniotic fluid amino acid levels in non-immune hydrops fetalis (NIHF) and normal fetuses. Eighty fetuses underwent amniocentesis for different reasons at the prenatal diagnosis unit of the Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University. Forty of these fetuses were diagnosed with NIHF. The study included 40 women each in the NIHF (mean age: 27.69 ± 4.56 years) and control (27.52 ± 5.49 years) groups, who had abnormal double- or triple-screening test values with normal fetuses with gestational ages of 23.26 ± 1.98 and 23.68 ± 1.49 weeks at the time of sample collection, respectively. Amniotic fluid amino acid concentrations (intra-assay variation: 2.26-7.85%; interassay variation: 3.45-8.22%) were measured using EZ:faast kits (EZ:faast GC/FID free (physiological) amino acid kit; Phenomenex, USA) by gas chromatography. The standard for quantitation was a mixture of free amino acids from Phenomenex. The levels of 21 amino acids were measured. The mean phosphoserine and serine levels were significantly lower in the NIHF group, while the taurine, α-aminoadipic acid (aaa), glycine, cysteine, NH(4), and arginine (Arg) levels were significantly higher compared to control. Significant risk variables for the NIHF group and odds coefficients were obtained using a binary logistic regression method. The respective odds ratios and 95% confidence intervals for the risk variables phosphoserine, taurine, aaa, Arg, and NH(4) were 3.31 (1.84-5.97), 2.45 (1.56-3.86), 1.78 (1.18-2.68), 2.18 (1.56-3.04), and 2.41 (1.66-3.49), respectively. The significant difference between NIHF and control fetuses suggests that the amniotic fluid levels of some amino acids may be useful for the diagnosis of NIHF.

Amniotic fluid amino acid levels in non-immune hydrops fetalis: a case-control study

In a prospective case-control study, we compared the amniotic fluid amino acid levels in non-immune hydrops fetalis (NIHF) and normal fetuses. Eighty fetuses underwent amniocentesis for different reasons at the prenatal diagnosis unit of the Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University. Forty of these fetuses were diagnosed with NIHF. The study included 40 women each in the NIHF (mean age: 27.69 ± 4.56 years) and control (27.52 ± 5.49 years) groups, who had abnormal double- or triple-screening test values with normal fetuses with gestational ages of 23.26 ± 1.98 and 23.68 ± 1.49 weeks at the time of sample collection, respectively. Amniotic fluid amino acid concentrations (intra-assay variation: 2.26-7.85 percent; interassay variation: 3.45-8.22 percent) were measured using EZ:faast kits (EZ:faast GC/FID free (physiological) amino acid kit; Phenomenex, USA) by gas chromatography. The standard for quantitation was a mixture of free amino acids from Phenomenex. The levels of 21 amino acids were measured. The mean phosphoserine and serine levels were significantly lower in the NIHF group, while the taurine, α-aminoadipic acid (aaa), glycine, cysteine, NH4, and arginine (Arg) levels were significantly higher compared to control. Significant risk variables for the NIHF group and odds coefficients were obtained using a binary logistic regression method. The respective odds ratios and 95 percent confidence intervals for the risk variables phosphoserine, taurine, aaa, Arg, and NH4 were 3.31 (1.84-5.97), 2.45 (1.56-3.86), 1.78 (1.18-2.68), 2.18 (1.56-3.04), and 2.41 (1.66-3.49), respectively. The significant difference between NIHF and control fetuses suggests that the amniotic fluid levels of some amino acids may be useful for the diagnosis of NIHF.

Umbilical cord prolapse in the southeast region of Turkey: evaluation of 79 cases.

OBJECTIVE: The aim of the study was to determine the risk factors and perinatal outcomes of umbilical cord prolapse (UCP). MATERIAL AND METHODS: This study was performed at Dicle University between January 2000 and December 2008 on 79 cases in which deliveries were complicated by umbilical cord prolapse. RESULTS: 0.36% of all deliveries were complicated by umbilical cord prolapse. The presentation of the fetuses were as follows: vertex, breech and transverse lie and foot presentation. Thirty-four (43%) fetuses with UCP had a fetal weight of < or = 2500 g as compared with nine (9%) for fetuses in the control group (p < 0.05). Mothers in the study group were 1.3 times more likely to be multiparas than the control group (p = 0.16) Cesarean section was performed in 76 cases (96.2%) and there were nine (11.3%) perinatal deaths. CONCLUSION: Umbilical cord prolapse is a risk factor of perinatal morbidity and mortality. Fetal weight < or = 2500 and abnormal fetal presentation are associated with increased risk of umbilical cord prolapse. Cesarean section resulted in a significantly decreased risk of perinatal mortality.

Pregnancy-related acute renal failure in the southeast region of Turkey: analysis of 75 cases.

OBJECTIVE: To study the clinical profile, management and outcome of the patients with pregnancy-related acute renal failure (PRARF). METHODS: All patients with PRARF admitted between January 2006 and January 2009 were analyzed. RESULTS: The total number of women with PRARF was 75. Age range of women with PRARF was 21 to 46 years and 36% of the cases of PRARF were seen in the postpartum period. PRARF was caused by sepsis in 14.6%, toxemias of pregnancy in 75.2%, and hemorrhage of pregnancy in 12%. Postabortal sepsis was the cause in 14.6%. Dialysis was needed in 33.3%. Maternal mortality rate was 10.6%. CONCLUSIONS: Pregnancy-related acute renal failure is a major health problem and carries very high mortality and morbidity. Poor healthcare facilities and lack of antenatal healthcare clinics are major identified causes.

Factors affecting maternal and perinatal outcomes in HELLP syndrome: evaluation of 126 cases.

OBJECTIVES: To ascertain the characteristics, clinical features, and maternal fetal outcome in HELLP (hemolysis elevated liver enzymes, low platelets) syndrome at a tertiary referral center. MATERIAL AND METHODS: This was a cross-sectional study carried out at Dicle University between January 2004 and December 2008 in which the charts of 126 cases were retrieved retrospectively and data analyzed descriptively. RESULTS: Of all deliveries 0.9% were complicated by HELLP syndrome. Of the cases with HELLP syndrome 79 (62.6%) had preeclampsia, 28 (22.2%) had eclampsia and 19 (15.2%) had a diagnosis of HELLP syndrome. The values of significant biochemical parameters (mean +/- SD) were documented as ALT (alanin aminotransferase) 224 +/- 42 IU/I and ALT1 (after birth) 140 +/- 22, AST 379 +/- 23 IU/l and AST1 215 +/- 51, LDH (lactate dehydrogenase) 1418 +/- 67 IU/l and LDH1 875 +/- 16, together with the hematological parameters as platelet count (86 +/- 12 K/Ul), urine protein (3 + in urine test stick) and albumin levels (2 + 0.9 g/dl). Eighty-six (68.25%) of the patients required albumin replacement. Thirty-one (24.6%) cases were nullipara and 95 (75.4%) multipara; of which 32 women (25.4%) were in Class I, and 94 (74.6 %) in Class II of complete HELLP syndrome. Regular antenatal examination was accomplished in a very small number of patients (12.25%). Fifty-eight (46.03%) patients required transfusions with blood or blood products and 12 (9.5%) underwent laparotomy due to major intraabdominal bleeding. Magnesium sulphate to prevent convulsions and corticosteroids (12 mg betametazone) to enhance fetal lung maturity were administered. Forty-four (34.9%) cases had vaginal delivery and 82 (65.1%) cesarean section; another 18 (14.2%) were with in utero stillbirth. Fifteen babies (11.9%) died, 26 (20.63%) developed placental abruption, 14 (11.11%) acute renal insufficiency, and 13 (10.31%) postoperative subcutaneous hematomas. Maternal mortality occurred in ten cases (7.93%). CONCLUSION: HELLP syndrome is a pathology associated with a high incidence of maternal and perinatal complications. Laboratory parameters in cases with HELLP syndrome are not efficient in detecting perinatal results, but can be used as risk denominators in evaluating maternal complications. Therefore, for patients with HELLP syndrome, standard antenatal follow-up protocols should be applied in order to obtain early diagnosis and improve the speed of transfer to obstetric departments with expertise in this field.

Pregnancy and adnexal torsion: analysis of 20 cases.

OBJECTIVE: To study the clinical profile, management and outcome of pregnancy complicated by adnexal torsion. METHODS: All pregnancy cases complicated by adnexal torsion admitted between January 2001 and January 2009 were analyzed. RESULTS: The total number of pregnant cases was 20. Age range of pregnant women with adnexal torsion was 18 to 42 years. Of these cases 70% were seen in the first and second trimester. Seventy percent of cases were operated by the laparotomy route and 30% by laparoscopy. Salpingo-oophorectomy was performed in 70% of cases and detorsion in 30% of cases. Histopathologic examinations revealed five patients (25%) had serous cystadenoma, four patients (20%) mucinous cystadenoma, six patients (20%) dermoid cyst and five patients (25%) hemorrhagic cyst. CONCLUSIONS: Adnexal torsion as a differential diagnosis of acute abdomen in pregnancy should be considered and we recommend early surgical treatment that will save the adnexa.

The association of preoperative thrombocytosis with prognostic factors in malign ovarian tumor.

PURPOSE: We assessed the association of preoperative thrombocytosis with prognostic factors in malign ovarian tumor. METHODS: Over a five-year period, cases treated for ovarian cancer were randomly assigned. The data were collected from gynecological oncology, radiation oncology, medical oncology and pathology departments. Statistical analyses were carried out by using the statistical packages for SPSS 12.0 for Windows (Chicago, IL, USA). Survival was analyzed by the method of Kaplan and Meier, using log-rank (Mantel-Cox) analysis. RESULTS: 51 cases with ovarian cancer were evaluated. Cases with thrombocytosis were found to have greater CA-125 levels, more advanced stage disease, more ascites and shorter periods of survival. CONCLUSION: Thrombocytosis is a poor prognostic factor in ovarian cancer. As reported previously, it is associated with aggressive tumor biology. Thus, preoperative thrombocytosis can be a used as a marker of poor outcomes.

The clinical significance of HPV screening in premalignant cervical lesions.

PURPOSE: We evaluated the clinical significance of human papilloma virus (HPV) screening in premalignant cervical lesions. METHODS: This prospective study was performed at Dicle University, School of Medicine, Department of Obstetrics and Gynecology, from January 2009 to June 2009. A total of 60 cases were evaluated. Thirty cases had premalignant cervical lesions. The prevalence of HPV was analyzed by polymerase chain reaction and types determined by Hybrid Capture II. The cases that had premalignant cervical lesions were evaluated with colposcopy. Statistical analyses were carried out by using the statistical packages for SPSS version 12.0 for Windows (Chicago, IL, USA). RESULTS: Of all the cases, those with premalignant cervical lesions had higher prevalence of HPV DNA. The cases that had high oncogenic HPV type had more abnormal colposcopic findings. CONCLUSION: Premalignant cervical lesions should be evaluated by cervical cytology, colposcopy, HPV DNA screening and cervical tissue sampling. In this way, development of cervical cancer can be prevented.

The effectiveness of sildenafil citrate in patients with erectile dysfunction and lower urinary system symptoms and the significance of asymptomatic inflammatory prostatitis.

We evaluated the effectiveness of sildenafil citrate on lower urinary system symptoms (LUTS) by using symptom score scales. We also evaluated whether or not the presence of asymptomatic inflammatory prostatitis had an effect on the alteration in the symptom scores. A total of 36 male patients were included in the study. For all the cases, 'International Prostate Symptom Score' (IPSS), 'National Health Institute Chronic Prostatitis Symptom Index' (NIH-CPSI) and 'International Index of Erectile Function' (IIEF-5) were investigated and the scores were calculated in the first visit. Sildenafil citrate was given for 30 days and at the second visit IPSS, NIH-CPSI and IIEF-5 scores were once more analyzed. Afterwards, the alterations of the scores between visits were statistically compared. Mean age of the 36 cases included in the study was 59.03±1.35. When the alterations in parameters of first visit and second visit were evaluated, we found a statistically significant increase in IIEF-5 and a statistically significant decrease in IPSS, IPSS-QOL (Quality of Life). In addition, when the cases were divided into two groups with and without asymptomatic inflammatory prostatitis, in the cases with asymptomatic inflammatory prostatitis, sildenafil citrate caused improvement only in ED, but had no effect on LUTS. Sildenafil citrate use in cases with LUTS and ED has an improving effect on LUTS as well as ED. However, in cases with asymptomatic inflammatory prostatitis, sildenafil citrate did not lead to an improvement in LUTS.

The effect of flurbiprofen as prophylactic analgesic before hysterosalpingography.

Hysterosalpingography (HSG) is associated with pain during the four-step procedure. This prospective, double-blind, randomized, placebo-controlled study was conducted to investigate the effect of the analgesic flurbiprofen, administered prior to HSG, in 60 women. Thirty women were randomized to receive 100 mg of flurbiprofen, orally, 1 h prior to HSG and a further 30 women were randomized to receive placebo. Injection of contrast medium was more painful than the other steps in the HSG procedure in both groups; however, there was no significant between-group difference in terms of pain experienced in the individual steps of HSG. Pain scores at 5 and 30 min after the procedure were compared between the two groups. There was a significant decrease in the visual analogue scale pain score in the flurbiprofen-treated group compared with the placebo-treated group at both time points. Thus, the authors recommend flurbiprofen as a prophylactic analgesic to be administered before HSG procedures.

Clinical significance of procalcitonin in cervico-vaginal secretions of women with preterm rupture of membranes.

PURPOSE: To compare vaginal fluid procalcitonin (PCT) concentrations in cases of preterm premature rupture of membranes (PPROM) and healthy pregnant women, and to determine whether the PCT concentrations are of value in the diagnosis of PPROM cases and clinical amnionitis. METHODS: 50 cases with PPROM and 50 healthy pregnant women were enrolled in the study. In the PPROM group, analysis was conducted on PCT concentrations with reference to serum leucocytosis, serum C-reactive protein level and urine analysis, as well as to presence/absence of clinical amnionitis. Statistical analyses were carried out by using the statistical packages for SPSS 12.0 for Windows (SPSS Inc., Chicago, IL, USA). RESULTS: Procalcitonin levels in the PPROM group were significantly higher than in cases of healthy pregnant women (1.17 vs 0.05 ng/ml; p < 0.001). In the PPROM group PCT concentrations between the patients with and without clinical amnionitis were comparable. Also, a significant correlation was observed between PCT and leucocytosis (r = 0.64; p < 0.001) and C-reactive protein (r = 0.90; p < 0.001). CONCLUSION: These findings suggest that the value of vaginal fluid PCT determinations can be useful for diagnostics of PPROM cases suspected of intrauterine infection.

Is pregnancy over 45 with very high parity related with adverse maternal and fetal outcomes?

OBJECTIVE: To examine whether very high parity and age over 45 years are related with adverse maternal and fetal outcomes. STUDY DESIGN: This study was carried out at the Department of Obstetrics and Gynecology from January 1, 2007 to December 31, 2007. Sixty-one pregnant women were enrolled in this prospective study. Mothers were classified in two groups: the study group (n = 23) included women with very high parity over 45 years of age (age > 45 and > or = 10 previous live births), and a control group (n = 38) included women with high parity between 40-45 years of age (between 40-45 years and 5-9 previous live births). Hypertensive disorders complicating pregnancy, preterm labor, breech presentation, cesarean section ratio, mean APGAR scores, birthweight, fetal sex, fetal macrosomia, and early neonatal death were compared within groups. RESULTS: Six (26%) patients in the study group and 12 (31.5%) patients in the control group had hypertensive disorders of pregnancies (p > 0.05). Twelve (52.1%) patients in the study group and 22 (57.8%) patients in the control group had preterm labor (p > 0.05). One (4%) patient in the study group and two (5.2%) patients in the control group had breech presentation during delivery (p > 00.5). Twelve (52.1%) patients in the study group and 21 (55.2%) patients in the control group had cesarean operations (p > 0.05). Mean APGAR scores (at 1 min and 5 min), mean birthweight, fetal sex ratio, fetal macrosomia ratio, and early neonatal death ratio due to prematurity were not statistically significant in the study group as compared with the control group. CONCLUSION: It is generally assumed that women with advanced age have an increased risk for complications during pregnancy. However, prospective population-based studies do not exist and available publications give conflicting views. Based on our results, we hypothesized that cases aged 45 or over with very high parity are not always related with adverse maternal and fetal outcomes.

Risk of malignancy index for adnexal masses.

OBJECTIVES: The aim of this study was to determine the effectiveness of the risk of malignancy index (RMI) and retrospective analysis of patients presenting with adnexal masses to our clinic for treatment. METHODS: Data of 137 women who had adnexal masses were included in the analysis. A simple algorithm called "risk of malignancy index" (RMI) reported by Jacobs includes menopausal status, ultrasound morphologic features and serum CA125 level. The RMI values were detected for each patient and analyzed to detect the relationship between benign and malign groups of the patients. Statistical analyses were performed with SPSS 15.0 for Windows (SPSS, Inc., Chicago, IL USA). Sensitivity and specificity was calculated for RMI in diagnoses of ovarian cancer by using receiver operating characteristic (ROC) analysis. RESULTS: A total of 137 patients with adnexal masses were operated on. Mean age and SD of 137 patients were 30.64 +/- 10.05. Fourteen patients (10.2%) had malignant disease and 123 patients (89.8%) benign pathology. ROC analysis of the RMI showed that the values of area under the curve were significantly high with a value of 0.883 (p < 0.001). CONCLUSION: The RMI is a simple scoring system and has a high sensitivity and specificity for the detection of malignant adnexal masses. Application of the RMI in clinical practice may provide a rational basis for specialists to treat patients with adnexal masses before diagnostic surgery.

Tragic results of suboptimal gynecologic cancer operations.

OBJECTIVE: The goal of this study was to analyze gynecological cancer patients who underwent suboptimal or failed surgeries with unsatisfactory and undesired results. STUDY DESIGN: During 1997-2007, 74 women were referred to our gynecological oncology service after suboptimal or failed surgeries for ovarian, cervix, endometrium and vulvar cancers. Medical records were evaluated retrospectively to determine the reasons of suboptimal surgery. RESULTS: Optimal cytoreduction was achieved in ten women (21.7%), 32 women (69.5%) had suboptimal surgical cytoreduction and four women (8.6%) had failed surgery, Seven patients were recurrences (3 had liver metastasis, 2 had pelvic metastasis, 2 had bladder metastasis); two patients died due to bladder metastasis, one patient died six days after surgery due to a pulmonary embolism in the suboptimal cytoreduction group, and one patient died due to ascites in the failed surgery group. Optimal surgery was achieved in three women (27.2%) and eight women (72.7%) had suboptimal surgery in the cervical cancer population. One patient had a recurrence with pelvic metastasis in the suboptimal group. Suboptimal surgery was achieved in one woman with vulvar cancer. Optimal surgery was achieved in seven women (43.7%) and nine women (56.2%) had suboptimal surgery in the endometrial cancer population. One patient died 11 days after surgery due to sepsis in the optimal surgery group. One patient died 21 months after primary surgery and the other patient had a recurrence with paraaortic lymph nodes, ascites and omental thickening in the suboptimal surgery group. The prognosis of 30 (65.2%) women in the ovarian cancer population, eight (72.7%) women in the cervical cancer group, 11 (68.7%) women in the endometrial cancer group, and one woman (100%) in the vulvar cancer population was unknown. The unknown cases of all genital cancers were missed during followup and we could not reach them using their phone or address information. CONCLUSION: If a gynecologist does not have enough experience or expertise about gynecological cancer operations, he or she must consider the possible harm that any surgical intervention might do, as the latin phrase "primum non nocere" means and should refer patients to a gynecological oncology center without performing any surgery. Optimal gynecologic surgery can only be carried out correctly when education becomes available throughout the world. Thus postgraduate fellowship programs should be considered urgently to extend the general gynecologists' surgical experience and expertise in developing and undeveloped countries.

Pelvic packing method (after two laparotomies): a salvage procedure to control intractable pelvic hemorrhage after vaginal hysterectomy: a case report.

BACKGROUND: Hysterectomy is one of the most commonly performed operative procedures in the world and hemorrhage continues to be a serious complication of both obstetrical and gynecologic surgeries. The pelvic packing technique is a useful alternative to control pelvic bleeding when standard measures fail. CASE: A 45-year-old premenopausal women with a history of pelvic pain and obstructive voiding symptoms underwent vaginal hysterectomy. Intraabdominal bleeding persisted after surgery and relaparotomy was performed. After routine surgical techniques failed to achieve adequate hemostasis, a pelvic packing technique was successfully used to tamponade the pelvic bleeding. CONCLUSION: When traditional methods of controlling pelvic hemorrhage fail, pelvic packing can be used as an unusual method for intractable pelvic hemorrhage. We successfully used the pelvic packing technique in a premenopousal patient with intractable hemorrhage after vaginal hysterectomy and this technique saved the patient's life.