Atorvastatin for ovarian torsion: effects on follicle counts, AMH, and VEGF expression.

OBJECTIVE(S): To determine if atorvastatin protects ovarian follicles against ischemia reperfusion (I/R) injury and to determine how anti-Müllerian hormone (AMH) and vascular endothelial growth factor-A (VEGF-A) expression is altered. STUDY DESIGN: This experimental study was conducted at the Baskent University Animal Research Laboratory. Forty-four rats were arbitrarily assigned into four groups of 11 rats each. The control group underwent a laparotomy. The atorvastatin group received atorvastatin (10mg/kg/day), by oral gavage 7 days before and 7 days after the sham operation. The torsion group had bilateral torsion and detorsion of the ovaries. The atorvastatin+torsion group received atorvastatin (10mg/kg/day) 7 days before and 7 days after the torsion/detorsion operation. At day 7, the animals were euthanized and their ovaries were removed. Ovarian follicles were counted, and AMH and VEGF-A expression was determined. The Kruskal-Wallis, χ(2), or Fisher's exact test were used when appropriate. RESULTS: Primordial follicles (p=0.001), VEGF-A expression (p=0.018) and vascularization (p=0.02) were significantly higher in the atorvastatin group compared to controls. Primordial (p=0.002), primary (p=0.001), and secondary follicles (p=0.001), AMH expression (p=0.001), and vascularization (p=0.001) were lower in the torsion group compared with the control group. Primordial follicles (p=0.001), AMH (p=0.001) and VEGFA expression (p=0.001), and vascularization (p=0.001) were significantly higher in the atorvastatin+torsion group compared to the torsion group. CONCLUSION(S): Atorvastatin increased the primordial follicle pool and vascularization and protected primordial follicles and vascular structures against I/R injury.

Emergent surgical treatment of radiation-induced enteropathies for patients with urogynecological and colorectal carcinomas.

AIM: The aim of this study is to describe our 10-year experience in patients with urogynecological and colorectal carcinomas with radiation enteropathy treated surgically as an emergency, and to reassess symptoms and mortality. PATIENTS AND METHODS: The study included 17 patients receiving emergency surgery for complications of radiotherapy. Data about the patients and outcomes of the treatment alternatives used were retrospectively analyzed. RESULTS: Of 17 patients, nine had colorectal cancer, six had gynecological cancer, and two had cancer of the urinary system. As an emergency, 12 patients had ileus only, one patient had intestinal fistulae and ileus, two patients had bleeding and ileus and two patients had perforation on admission. Seven patients underwent resection and anastomosis, two patients intestinal by-pass, four patients resection and ostomy and four patients bridectomy. Morbidity (75% for early complications and 100% for late complications) and mortality in the early postoperative period (25%) were higher in the patients undergoing bridectomy than in the patients undergoing other surgical methods. The rate of early and late complications (71.4% and 66.6%, respectively) was lower in the patients undergoing resection-anastomosis with a higher of quality life. Only 11 patients survived during a long follow-up period (64.7%). CONCLUSION: As the postoperative complication rate, overall and operative mortality of patients treated for radiation enteropaties as emergent surgery are high, specialists following this group of patients may favor removal of the pathologic tissue to avoid complications in the early and late postoperative period.

Infected tuboovarian hydatid cyst: a rare cause of tuboovarian abcess.

Pelvic hydatid cysts, although rare, must be considered when evaluating a pelvic mass in women living in an endemic area. The pelvis may become secondarily involved as a result of a rupture of the cyst in another location or be the only localization of the disease. If the cyst becomes secondarily infected, it may mimic a tuboovarian abscess. A 49-year-old multipara was admitted to the emergency department with the complaint of fever, generalized abdominal pain and distension. Abdominal ultrasound revealed a 4 cm cystic structure in the liver and the gynecological examination was normal. The patient's abdominal pain receded spontaneously, so she was prescribed albendazole and discharged from the hospital. Ten days later, she complained of pelvic pain, pressure and vaginal discharge. The uterus and adnexa were tender on pelvic examination. Ultrasound revealed an 8 cm uniloculated cyst with free floating internal echogenities located between the bladder and the uterus. At surgery a 10 cm right-sided tuboovarian mass was present. A germinative membrane was present inside the abscess and pericystectomy with unilateral salphingo-oophorectomy was performed.

Osseous metaplasia of the endometrium.

Osseous metaplasia of the endometrium is very rare finding, and usually these cases presented with secondary infertility. Other symptoms are pelvic pain, dyspareunia, menstrual irregularities, vaginal discharge and the passage of bony fragments in menstrual blood. Suspicious lesion could see by hysterosalpingography or by ultrasonography; however, conclusive diagnosis and treatment tool is hysteroscopy. The aetiology is unknown, but theories include retained fetal bone and osseous metaplasia of endometrial tissue. We present a patient with osseous metaplasia who had treated with hysteroscopy.

Antenatal diagnosis of sacrococcygeal teratoma--two different case reports.

Sacrococcygeal teratoma (SCT) is the most common fetal tumour. It may be readily diagnosed by two-dimensional ultrasonography in the early second trimester. Three-dimensional ultrasonography is recommended as a supplemental examination to obtain further detailed information for multidisciplinary management of SCT. In the following article we present two cases of sacrococcygeal teratomas which exhibited two different courses. In the first case, sacrococcygeal teratoma was diagnosed in the early second trimester. The condition of the fetus worsened during the follow-up and the parents opted for the termination of the pregnancy. The other one presented at a later gestational age. The baby was born alive, immediately operated upon and did well until the age of 1, when we checked her condition for the last time.