A new method used in laparoscopic hysterectomy for uterine manipulation: uterine rein technique.

The aim of this study is to define a new method of manipulating the uterus during laparoscopic hysterectomy. A total laparoscopic hysterectomy (TLH) with the newly defined technique was performed in 29 patients between July 2016 and July 2017. In this new technique, the uterus was bound from uterine corpus and fundus like a bridle with polyester tape, to allow abdominal manipulation. The technique was successfully performed at the first attempt in 93.1% of cases. It was repeated in two cases (6.9%) since the polyester tape departed away from the uterus at the first attempt. The mean application time was 11.2 min. The vaginal manipulator was not required in any of the cases. There were no intraoperative complications. In conclusion, this method has the advantages of not requiring any vaginal manipulator, reducing the number of people required during operation, permitting a near maximum manipulation of the uterus in all three dimensions, and giving the control of these manipulations directly to the surgeon. On the other hand, the technique also has some inadequacies which should be discussed and improved on in the future. Impact of statement What is already known on this subject? In a laparoscopic hysterectomy, manipulation of the uterus is essential for anatomical dissection of the regions and completion of the operation without complications. An ideal uterine manipulator is defined as inexpensive, as convenient, fast and suitable for injecting solutions, removing the need for an assistant and most importantly offering the most suitable range of motion. In this study, we describe a new and different technique (rein technique) allowing the abdominal manipulation of the uterus in a laparoscopic hysterectomy and discuss the advantages and disadvantages of this method. What do the results of this study add? The procedure was easily accomplished in most patients. We did not need to use an extra uterine manipulator in any of the cases. What are the implications of these findings for clinical practice and/or further research? In conclusion, the rein technique of uterine manipulation is effective and safe.

Robotic Sigmoid Vaginoplasty in an Adolescent Girl With Mayer-Rokitansky-Kuster-Hauser Syndrome.

BACKGROUND: Sigmoid vaginoplasty has carved a niche for itself in reconstructive genitoplasty. We describe the successful use of a robotically assisted sigmoid vaginoplasty in an adolescent girl with Mayer-Rokitansky-Kuster-Hauser syndrome. CASE: An 18-year-old girl was referred to our hospital with the complaint of primary amenorrhea. She was thoroughly evaluated and magnetic resonance imaging was done, which revealed absence of a vagina and uterus but bilateral normal ovaries. Because cytogenetic analysis was "normal 46,XX" karyotype, Mayer-Rokitansky-Kuster-Hauser syndrome was diagnosed. She was successfully managed by the use of robot-isolated sigmoid colon segment for vaginal replacement and robot-sewn colon-colon anastomosis. A follow-up was done at the 3rd and 6th months, which revealed a large capacious vagina even without self-dilatation. CONCLUSIONS: The robotic approach is feasible and can produce satisfying postoperative outcomes and might be a minimally invasive technique in future vaginoplasty surgery.

The effect of ethanol sclerotherapy of 5 minutes duration on cyst diameter and rat ovarian tissue in simple ovarian cysts.

OBJECTIVES: To examine the effect of 95% ethanol sclerotherapy (EST) administered over 5 minutes on cyst diameter and ovarian tissue in experimentally induced simple ovarian cysts in a rat model. MATERIALS AND METHODS: In order to induce ovarian cysts, unilateral total salpingectomy was performed in regularly menstruating adult female Wistar albino rats (n=20) between 12 and 14 weeks of age and weighing between 200 and 220 g. One month after the procedure, the abdominal cavity was opened and 14 rats (70%) were found to have developed macroscopic cysts. Rats with macroscopic cysts (n=14) were assigned into two groups in a prospective and single-blinded manner: group 1 (G1) (n=7), control rats; and group 2 (G2) (n=7), 5-minute EST 95% group. Cyst diameter was measured and recorded for each rat. In G2, after whole cyst fluid was aspirated the cystic cavity was irrigated with 95% ethanol, approximately equal to half of the aspirated cyst volume, after which an interval of 5 minutes was allowed and same amount was re-aspirated and the abdominal cavity was closed. One month after this procedure, abdominal cavities were reopened and intra-abdominal adhesion scoring was performed in both groups. Cyst diameter was measured for each rat, and the right ovary was removed, fixed in 10% formaldehyde, and transported to the laboratory. A histologic assessment of the ovarian tissues was performed under light microscopy following staining with hematoxylin and eosin. Mann-Whitney U-test was used for statistical analysis. A P-level less than 0.05 was considered significant. RESULTS: In comparison with G1, there was a statistically significant reduction in the mean ovarian cyst dimensions in G2, while there were no significant differences between the two groups with respect to total number of follicles. Again, a significant increase in apoptotic activity and germinal epithelial degeneration was observed in G2 as compared to G1. The two groups were similar in terms of adhesion formation. CONCLUSION: Although 95% EST results in a reduction in the size of simple ovarian cysts, this effect seems to be achieved at the expense of ovarian tissue injury.

Investigation of the effects of unilateral total salpingectomy on ovarian proliferating cell nuclear antigen and follicular reserve: experimental study.

OBJECTIVE: We aimed to investigate the effects of unilateral total salpingectomy procedure on ovarian follicular reserve, apoptosis, and proliferating cell nuclear antigen (PCNA) staining in this study. STUDY DESIGN: Fourteen female Wistar Albino rats of 12 weeks were randomly divided into two groups. Abdomen midline incision was conducted under general anesthesia. Group 1(G1) (n=7): Group in which only the abdomen was opened and closed, Group 2(G2) (n=7): Group that underwent right total salpingectomy. After 1 month, abdomens of all rats were opened. Ovaries were macroscopically evaluated. Right ovarian tissue was quickly removed, fixed in 10% formaldehyde, and paraffin blocks were prepared.' The existence of fibrosis was identified with the usage of light microscope. Follicles were microscopically classified and counted. The prevalence of cytoplasmic immune staining and TUNEL staining was scored semi-quantitatively. STATISTICAL ANALYSIS: SPSS 17.0 software was used for the statistical analysis of data. First, Kruskal-Wallis variance analysis was conducted, and then Mann-Whitney U test was utilized for inter-group dual comparisons for parameters found as p<0.05. RESULTS: While the number of CL was found out dramatically high, secondary follicle count was found out to be significantly low in G2. Also in G2, although the number of atretic follicle and fibrosis were found out significantly increased, and the score of the angiogenesis was found to be significantly decreased in CL. When compared PCNA immunoreactivity in granulosa cells with the control group, there was a significant decrease in G2. When compared the malondialdehyde (MDA) immunoreactivity with G1 a significant increase was established in G2. Apoptosis score of ovarian follicles in granulosa cells was significantly higher in G2. CONCLUSIONS: In this experimental study, the decrease in the ovarian reserve and PCNA staning of granulosa cells, an increase in apoptosis, fibrosis and the number of atretic follicles in unilateral total salpingectomy operation were analyzed in rats. We found out significantly higher MDA staining rates in G2 in comparison to in G1. According to the study, the unilateral total salpingectomy procedure can damage to the same side ovarian tissue by means of the ischemia and reperfusion injury at the ovarian tissue.

Clinical efficacy of low dose flutamide plus Diane-35 in the treatment of idiopathic hirsutism and polycystic ovary syndrome.

OBJECTIVE: Idiopathic hirsutism (IH) or polycystic ovary syndrome (PCOS) are the most common causes of hirsutism which affects 5-10% of all women. The aim of this study was to evaluate the efficacy of flutamide plus diane 35 in the treatment of idiopathic hirsutism and polycystic ovary syndrome. MATERIALS AND METHODS: 26 polycystic ovary syndrome and 24 idiopathic hirsutism patients were evaluated. Fifty patients were divided into two groups according to their diagnosis: idiopathic hirsutism or polycystic ovary syndrome. All patients received 125 mg Flutamide once a day and Diane 35 tablets for 21 days of each month, for 12 months. We measured hirsutism scores and hormonal levels of all patients. Evaluations were done before treatment, in the 6th and 12th months of therapy. RESULTS: There were no significant differences in Ferriman-Gallwey scores at the beginning and at the end of the therapy between the IH and PCOS groups. The decreases in Ferriman-Gallwey scores were significant in both groups in the 6th and 12th month of therapy. Combined treatment significantly decreased total and free testosterone, DHEAS and significantly increased SHBG levels in both groups and additionally decreased levels of LH, androstenodione and LH/FSH ratio in the polycystic ovary syndrome group. CONCLUSION: Combined treatment was effective and safe in the treatment of hirsutism. Combined regimens have additional effects on the treatment of hirsutism.

The efficacy of bevacizumab, sorafenib, and retinoic acid on rat endometriosis model.

Blood vessels are necessary for development and maintenance of the endometriosis and blood flow supplies oxygen and essential nutrient to the disease. Local angiogenesis is regulated by vascular endothelial growth factor (VEGF) and inhibitors of VEGF may be a novel therapeutic approach. We inducted endometriosis in 43 rats and they were randomly allocated into 4 groups. The rats in group I (control n = 11) were given no medication. The rats in group II (n = 11) were given bevacizumab. The rats in group III (n = 11) were given Sorafenib, and the rats in group IV (n = 10) were given retinoic acid (RA). Then groups were compared for microvessel density, VEGF, soluble tyrosine-kinase receptor, ovarian reserve, and treatment effectivity. All these medications were effective on endometriosis and we detected that volume of endometriotic implants were significantly decreased. Ovarian reserve was not affected from the medication, in addition RA have induced reproductive capacity.

Evaluation of cervical cytological abnormalities in Turkish population.

INTRODUCTION: Cervical cancer is one of the most common female malignancy with high mortality rates in developing countries. Our purpose was to determine the prevalence of cervical cytologic abnormalities in population (strict Islamic religious area) and the detection rate of epithelial abnormalities by cervical cytology (CC). MATERIALS AND METHODS: A total of 32,026 conventional pap smear tests collected between January 2006 and January 2010 from three hospitals are retrospectively analyzed. RESULTS: Total of 900 (2.8%) cases had epithelial abnormalities. The numbers and rates of epithelial abnormalities were as the followings: Atypical squamous cell of undetermined significance (ASCUS; n=615 [1.9%]); atypical squamous cell suspicious for high-grade squamous intraepithelial lesion (ASC-H; n=27 [0.1%]); atypical glandular cell of undetermined significance (AGUS; n=73 [0.2%]); low- grade squamous intraepitelial lesion (LSIL; n=147 [0.5%]); high- grade squamous intraepithelial lesion (HSIL; n=35 [0.1%]); and squamous cell carinoma (SCC; n=3 [0.0%]). CONCLUSION: The prevalence of cervical cytological abnormality in our study was 2.8%. Recently, some conflicting results from the same population were published. More prospective studies with larger numbers are needed.

Serum levels of angiopoietin-related growth factor (AGF) are increased in polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a frequent reproductive and metabolic disorder associated with insulin resistance. Recently, angiopoietins were identified in the systemic circulation and have been designated angiopoietinlike proteins (ANGPTL). More recently, it is shown that angiopoietin-related growth factor (AGF, also called ANGPTL6) directly regulate lipid, glucose, and energy metabolism independent of angiogenic effects in animal studies. The aim of this study was to determine whether there is an association between AGF and PCOS. METHODS: The study included 55 [corrected] patients with PCOS and 30 healthy control women. We analyzed serum levels of AGF and other biochemical and anthropometric markers in all the subjects. RESULTS: This study showed that serum AGF levels were significantly higher in the subjects with PCOS (102.28 ng/mL) than those in the healthy control group (63.08 ng/mL; P < 0.001). Body mass index (24.33 vs 22.11 kg/m; P = 0.017), free testosterone (2.81 vs 2.17 pmol/L; P = 0.009), androstenedione (3.28 vs 2.92 nmol/L; P = 0.033), 17-hydroxyprogesterone (2.72 vs 2.09 ng/mL; P = 0.039), homeostasis model of assessment-insulin resistance (2.65 vs 1.9; P = 0.016), and fasting glucose (107.09 vs 96.18 mmol/L; P = 0.001) were found significantly higher in PCOS group than in control group. But there was no correlation between AGF and these parameters in PCOS group. In addition, no correlation between the AGF and other distinctive features of PCOS was found. CONCLUSIONS: Serum AGF levels were paradoxically increased in patients with PCOS in comparison with data of animal experiments. Further studies are needed to better elucidate the physiologic significance of circulating AGF in human disease.

Abdominal Blockage of Iliohypogastric and Ilio-inguinal Nerves for Management of Post-Caesarean Pain: A Novel Method

Objective. The aim of this study was to compare pain relief after caesarean section achieved by an intra-abdominal iliohypogastric and ilio-inguinal (IHII) nerve block with levobupivacaine with that in patients given a placebo. Study design. A total of 60 healthy women scheduled for caesarean delivery under general anaesthesia were enrolled in the study. The patients were randomised to an abdominal IHII nerve block with levobupivacaine (levobupivacaine group) or administration of saline (placebo group). Instead of the classic percutaneous method; the block was administered intra-operatively from the peritoneal aspect. Scores on a visual analogue scale (VAS) at 2; 6; 12 and 24 hours; adverse effects; morphine consumption and success of blockage by a pinprick test were recorded.Results. In the levobupivacaine group; the pinprick test showed there to be successful bilateral block in 22 patients and unilateral block in 5; while the block failed in 3. No block was recorded in the placebo group. When morphine consumption at 12 and 24 hours were compared; consumption was found to be significantly low for both time points in the levobupivacaine group. VAS scores 2; 6 and 12 hours after the operation were also significantly lower in the levobupivacaine group.Conclusion. A block of the IHII nerves from inside the abdomen just before abdominal closure appears to be an effective and safe way of relieving pain after caesarean section

The evaluation of hypoxia-inducible factor 1 in N-nitro-L-arginine methyl ester preeclampsia model of pregnant rats.

OBJECTIVE: The objective of the study was to evaluate hypoxia-inducible factor 1 (HIF-1), which plays a major role in the stimulation of angiogenesis in placental tissues, by using immunohistochemical staining in preeclampsia model of rats, developed by N-nitro-L-arginine methyl ester (L-NAME) METHODS: Thirty pregnant rats were randomized into 2 groups (n = 15 in each group) on day 10 of gestation. L-NAME was given to rats in the study group by gavage. On days 0, 10, and 20 of gestation, rats were weighted, and urine protein values and blood pressures were measured. Hypoxia-inducible factor 1 expressions were assessed with immunohistochemical staining by using avidin-biotin peroxidase via selecting preparation. RESULTS: Systolic and diastolic blood pressures and urine protein value of L-NAME group on day 20 of gestation were found to be significantly higher than those obtained on days 0 and 10 of gestation in the same group and those obtained on day 20 of gestation in the sham group (P < 0.05). Maternal weight, number of fetuses, and mean fetal weight of rats in L-NAME group on day 20 of gestation were found to be significantly lower than those obtained from rats in the sham group (P < 0.05). Regarding HIF-1 expression of placental tissues, mild immunohistochemical staining was found in 2 rats (13.4%) and moderate in 13 rats (86.6%) in the L-NAME group. A significant difference was found in terms of HIF-1 positivity in the maternal placentas of both groups (P < 0.05). CONCLUSIONS: L-NAME preeclampsia model of pregnant rats is consistent with human preeclampsia in terms of hypertension, proteinuria, and intrauterine growth retardation; in addition, it also shows evidence of placental hypoxia findings.

Effect of thyroid hormone replacement therapy on ovarian volume and androgen hormones in patients with untreated primary hypothyroidism.

BACKGROUND AND OBJECTIVES: Primary hypothyroidism may be associated with ovarian enlargement and/ or cyst formation. We evaluated the effect of thyroid hormone replacement therapy on hormonal changes, ovarian volume and sonographic appearance. DESIGN AND SETTING: Open, prospective study of women admitted to university gynecology clinic. PATIENTS AND METHODS: The study included 26 patients with untreated hypothyroidism who had polycystic (n=10) or normal-appearing (n=16) ovaries and 20 euthyroidic controls. Basal serum total testosterone, free testosterone, androstenedione, dehydroepiandosterone-sulfate, prolactin, estradiol, luteinizing hormone, follicle-stimulating hormone, free T3, free T4 and thyroid-stimulating horone, together with ovarian volumes, were determined and repeated after euthyroidism was achieved. RESULTS: Ovarian volumes of patients with hypothyroidism were significantly greater compared with controls, and their magnitudes diminished significantly during thyroid hormone replacement therapy. Hypothyroidic patients with polycystic ovaries had significantly higher serum free testosterone and dehydroepiandosterone-sulfate, but lower androstenodione levels compared with those who had normal-appearing ovaries. Serum total testosterone concentrations were significantly higher in hypothyroidic patients without polycystic ovaries, and thyroid hormone replacement therapy achieved a significant reduction in total as well as free testosterone. CONCLUSION: Severe longstanding hypothyroidism leads to increased ovarian volume and/or cyst formation. A decrease in ovarian volume, resolution of ovarian cysts and reversal of the polycystic ovary syndrome-like appearance, together with improvement in serum hormone levels, occurred after euthyroidism was achieved.

The effect of cell type on surgico-pathologic risk factors in endometrial cancer.

OBJECTIVE: In this study the effect of histologic subtype as a surgicopathologic risk factor in endometrial cancer is evaluated. MATERIAL AND METHODS: We evaluated 182 patients who underwent systematic lymphadenectomy up to the level of the renal vessels and at least 15 lymph nodes were dissected from the pelvic area and 10 lymph nodes from the para-aortic area. investigation of whether endometrioid and aggressive cell types (serous papillary cell and clear cell) affect the distribution of surgicopathologic risk factors among endometrial cancer cases was carried out. RESULTS: Patients in the aggressive cell type group were older and the tumor size was significantly smaller. There was no difference between the two groups for the total number of dissected lymph nodes except for the external iliac area. Although the difference is not statistically significant, the total number of lymph nodes dissected in the aggressive group was less (54.3 vs 62.9, p=0.067) than that of the endometrioid cell type group. While the incidence of pelvic lymph node metastasis in the aggressive group was 59.1% the incidence was 15.6% in the endometrioid cell type group (p>0.001). The possibility of lymph node metastasis for aggressive cell type endometrial carcinoma in the para-aortic area was twice the endometrioid cell type group. It was found that the presence and type (stromal/glandular) of cervical invasion, depth of myometrial invasion and presence of lymphovascular space invasion were not affected by cell type. CONCLUSION: Aggressive cell types significantly increase the adnexial and lymph node metastasis in endometrial cancer.

Pregnancy-associated changes in peripheral blood lymphocyte subpopulations and serum cytokine concentrations in healthy women.

OBJECTIVE: To investigate the effects of healthy pregnancy on peripheral blood T-cell subpopulations and serum T helper type 1 and 2 cytokines and transforming growth factor-beta1 concentrations. STUDY DESIGN: Thirty healthy, pregnant women (study group, mean+/-SD: 13+/-1.6 weeks of gestation) and 30 age-matched women with regular menstrual cycles (control group) participated in the study. Peripheral blood CD4+, CD8+ and CD16+56+ (natural killer) percentages and serum interferon-gamma, interleukin-10 and transforming growth factor-beta1 concentrations were measured by flow cytometry and enzyme-linked immunosorbent assay. RESULTS: In the study group, all pregnancies were maintained until term, no complications occurred, and the infants were delivered successfully. Although the percentage of CD4+ T cells was not significantly different between the 2 groups, the percentages of CD8+ T cells and natural killer cells were significantly increased (p < 0.05 for both), and the CD4+:CD8+ ratio was significantly decreased in the study group as compared to the control group (p < 0.05). Serum interferon-gamma concentrations were detectable in nonpregnant, nulliparous controls. However, pregnancy caused a severe decrease in serum interferon-gamma levels: they fell below the limit of detection. We also found increased serum interleukin-10 and transforming growth factor-beta1 concentrations in the study group in comparison to the control group (p < 0.05). CONCLUSION: Healthy pregnancy causes immune deviation by increasing CD8+ T and natural killer cells, serum interleukin-10 and transforming growth factor-beta1 concentrations and decreasing the CD4+:CD8+ ratio.