Does Programmed Cell Death 1 Ligand (Pd-L1) Expression Predict Recurrence in Women With Endometrioma?

The study aimed to evaluate whether there is a difference in the expression of programmed cell death 1 ligand (PD-L1) in the cell lining of endometrioma between cases with and without recurrent disease. Additionally, we sought to assess the effect of cyst size and serum CA125 level on the expression of PD-L1 staining. The pathological specimens were immunohistochemically stained for PD-L1 in women who underwent surgery for endometrioma. All patients were evaluated to confirm if their endometriomas had recurred or not. A total of 36 patients who underwent surgery for endometrioma were included. The study population was divided into two groups according to their recurrence status. The study group (having recurrence) (n=12) and the control group (having no recurrence) (n=24) were compared regarding their demographic and clinical characteristics and PD-L1 staining. PD-L1 staining and the intensity of PD-L1 staining did not differ between the patients with and without recurrence. No variable, including parity, cyst size, serum CA125 level, and PD-L1 staining, was found to be significant in determining recurrence. No significant difference was found between the groups with and without PD-L1 staining in terms of cyst size and serum CA125 level. Although we have shown that PD-L1 expression could not be used for the prediction of recurrence, further studies are needed to assess this issue and to guide the development of new immunotherapeutic agents on this basis.

Comparison of transumbilical and periumbilical median incisions in ovarian cancer surgery

Objective: The umbilicus is traditionally circumvented while performing a vertical midline abdominal incision. There is a gap in knowledge pertaining to avoiding the umbilicus. Our aim was to investigate whether a transumbilical (TU) or periumbilical (PU) midline incision conferred any advantage to the patient. Material and Methods: This was a retrospective cohort study of patients undergoing ovarian cancer surgery with a midline incision, from the pubic tubercle to the xiphoid. All surgery was performed by the same team of gyneacological oncologists. Patients were classified into two groups according to the midline incision used, TU or PU. The primary endpoint was the incision wound complication rate. Results: TU and PU midline incisions were performed in 54 and 68 patients, respectively. There were no differences between the two groups in terms of patient characteristics and operative details. The two groups had comparable rates of complications, including wound infection (7.4% vs. 10.3%, p=0.75), deep surgical site infection (11.1% vs. 4.4%, p=0.18), evisceration (3.7% vs. 4.4%, p=0.99) and incisional hernia (33.3% vs. 33.8%, p=0.99). Conclusion: Our findings suggest that circumventing the umbilicus during laparotomy did not have any advantage. Future prospective randomized trials are warranted to validate this finding.

The effect of adenomyosis on endometrial cancer: a university hospital-based cohort study.

Endometrial cancer (EC) can coexist with gynaecological diseases including adenomyosis which can be defined as the location of endometrial cells within the myometrium. Our aim was to clarify the impact of adenomyosis on the clinical and survival outcomes of EC. We included the patients who underwent an operation for EC and had concurrent adenomyosis in this retrospective cohort study. All clinicodemographical and tumour characteristics with survival outcomes of the patients were analysed comparatively. A total of 763 patients who met the eligibility criteria were included. Of those, 591 patients in the non-adenomyosis group and 172 patients in the adenomyosis group were examined. Disease-specific survival (DSS) was significantly prolonged while progression-free survival (PFS) was not affected by the presence of adenomyosis (p = .004 vs. p = .161). However, adenomyosis did not remain as an independent prognostic factor for EC in multivariate analysis (p = .341). These patients with coexistent adenomyosis and EC have better clinicopathological characteristics and less advanced tumour. Although adenomyosis is associated with prolonged DSS, it has no prognostic importance for survival outcomes of the patients with EC.IMPACT STATEMENTWhat is already known on this subject? Endometrial cancer (EC) can coexist with other gynaecological diseases including uterine adenomyosis. Adenomyosis is typically diagnosed by the pathological evaluation of the uterus following hysterectomy, although diagnosis is possible with imaging methods However, the coexistence of adenomyosis and EC is controversial in the literature.What do the results of this study add? To the best of our knowledge, our study is the largest study performed at a single university hospital. All potential confounding factors including clinicodemographical characteristics of the patients, examination of histopathology slides by the experienced gynaecological pathologists, evaluation of all included factors that may affect the survival outcomes of EC by multivariate analysis were examined. Although adenomyosis is associated with prolonged disease-specific survival (DSS), it has no prognostic importance for survival outcomes of the patients with EC.What are the implications of these findings for clinical practice and/or further research? Women having coexistent adenomyosis and EC should be informed about the impact of adenomyosis on the survival outcomes of EC.

The effect of diagnostic hysteroscopy performed before fresh and frozen-thawed embryo transfer in IVF cycles on reproductive outcomes

Objective: Hysteroscopy is frequently performed in infertile women and thought to improve pregnancy rates. The data obtained from studies investigating the effect of hysteroscopy in in-vitro fertilization (IVF) cycles is variable. We aimed to evaluate the effect of hysteroscopy on pregnancy outcomes of fresh and frozen-thawed embryo transfers (FET) performed during IVF cycles. Material and Methods: The data of the 765 patients, who had IVF treatment between January 2015 and July 2017 in an infertility center, were retrospectively analyzed. Of those, 586 (76.6%) patients underwent fresh embryo transfer, while 179 (23.4%) patients underwent FET. Hysteroscopy performed by a single experienced surgeon was scheduled two months before transfer. Hysteroscopy was performed in 101/586 (17.2%) in those undergoing fresh embryo transfer and 44/179 (24.6%) patients in the FET group. Pregnancy outcomes of the groups were compared respectively within their own group. Results: The mean age was similar in patients in the fresh and FET groups (p=0.365, respectively). There was no difference in the number of transferred embryos between the groups (p=0.218). In the fresh embryo group there were 246 pregnancies, of which 44 had undergone diagnostic hysteroscopy while 202 had not, (p=0.516) and 79 pregnancies in the FET group, of which 20 had undergone diagnostic hysteroscopy while 59 had not (p=0.711). There was no statistical difference according to pregnancy rate between the groups (p=0.538). Conclusion: Performing diagnostic hysteroscopy before fresh or FET does not improve the pregnancy rates.

Does visceral adiposity have an effect on the survival outcomes of the patients with endometrial cancer?

AIM: Endometrial cancer is the most common cancer of the female reproductive tract in the developed countries. There are many risk factors defined for the development of endometrial cancer, including obesity. We aimed to evaluate the significance of adiposity on the survival outcomes of the patients with endometrial cancer. METHODS: The patients diagnosed with endometrial cancer and underwent surgery between April 2009 and October 2017 were retrospectively reviewed. The visceral adipose tissue and subcutaneous adipose tissue volumes were measured at the level of umbilicus on single-slice magnetic resonance imaging. Visceral adiposity index was calculated. Patients were compared regarding their clinical, demographical, pathologic and survival characteristics. Patients divided into low visceral adiposity (≤0.265, group 1) and high visceral adiposity (>0.265, group 2). RESULTS: A total of 186 patients were included in this retrospective study. There was no significant difference in terms of the demographical, clinical and tumor characteristics of the patients, except age, menopausal status, subcutaneous adipose tissue and visceral adipose tissue. Although no significant difference in progression-free survival and disease-specific survival was noted between groups (P = 0.181), more patients in group 2 died because of endometrial cancer as statistically significant (P = 0.024). Disease-specific survival showed a significant difference between groups according to the log-rank test. CONCLUSION: Visceral adiposity tissue is a significant and reliable prognostic indicator for endometrial cancer prognosis. Women diagnosed with endometrial cancer should be informed about the deleterious effects of visceral adiposity on disease-specific survival.

Necrotizing Fasciitis Complicating Transobturator Tape Operation.

Midurethral slings (MUSs) have been used successfully for the last 20 years in the treatment of stress urinary incontinence and accepted as the gold standard surgical procedure. High success rates and minimal invasiveness of surgery are among the most important advantages, but sometimes serious complications can occur during or after surgery. Although serious complications are rare after widely performed transobturator tape (TOT) operation, awareness, early diagnosis, and aggressive management are essential as they can progress with serious morbidity and mortality. In order to reduce the infectious complications after MUS procedures, in addition to sterility of the operating theater and the operating equipment, the type of mesh used and the preparation of the surgical site are crucial. We aimed to pre-sent the successful management of a case of necrotizing fasciitis in a TOT patient.

Is blood transfusion necessary in all patients with disseminated intravascular coagulation associated postpartum hemorrhage?

OBJECTIVE: The diagnosis of disseminated intravascular coagulation (DIC) in obstetrics is complicated owing to physiological changes, particularly during late pregnancy and the postpartum period. Therefore, a pregnancy-modified DIC score that includes only three components of the International Society on Thrombosis and Hemostasis (ISTH) DIC score has been constructed. Our aim was to determine how many blood-transfused postpartum women actually had the diagnosis of overt DIC according to the modified ISTH score and had the correct indications for blood transfusion. METHODS: We retrospectively analyzed 279 women who had received transfusion of at least two units of blood for postpartum hemorrhage. We used the modified ISTH score for DIC, which is based on platelet count, fibrinogen concentration, and prothrombin time (PT) differences. A total score of 26 points or higher indicated overt DIC, whereas a score lower than 26 points represented nonovert DIC. RESULTS: According to the modified ISTH score, 100 of the 279 patients (35.8%) had overt DIC, with a median DIC score of 37.0. Thirty-five percent of patients in the overt DIC group and 25.7% in the nonovert DIC group had received more than four units of blood. The levels of PT and activated partial thromboplastin time were higher, and the fibrinogen level was lower in patients with overt DIC. CONCLUSIONS: According to the modified ISTH score, we found that blood transfusion was unnecessary in 179 of the 279 postpartum women (64.1%). If this scoring system is used to determine which patients should be transfused, unnecessary transfusions and their related risks and complications will be prevented.

Evaluation of Biochemical Hyperandrogenism in Adolescent Girls with Menstrual Irregularities.

BACKGROUND: The aim of this study was to evaluate fertility hormone levels in adolescent girls and ten years older women with menstrual irregularities and with or without polycystic ovaries on ultrasound examination. The study population consisted of 276 patients aged 12-18 years and 469 patients aged 22-28 years who had menstrual irregularities with or without polycystic ovaries on ultrasound examination. METHODS: All subjects underwent a comprehensive medical assessment including documentation of the detailed history, physical and gynecological examination, measurement of the essential laboratory variables, and measurement of the fertility hormone levels. RESULTS: Within 745 patients (mean age: 21.4±4.8), 276 patients were aged 12-18 years (group 1) and 469 patients were aged 22-28 years (group 2). Dehydroepiandrosterone sulfate (DHEA-S) (237.7 (22.6-721.5) vs. 162.5 (2.4- 660.7) respectively; p<0.001) was significantly higher in group 1 than group 2. There were 74 subjects (26.8%) with LH/FSH ratio > 2 in group 1 and 74 subjects (15.8%) with LH/FSH ratio > 2 in group 2 (p<0.001). CONCLUSIONS: Biochemical hyperandrogenism is much more valuable in adolescents than in young adult women for the diagnosis of PCOS. Biochemical hyperandrogenism should be tested in adolescents with menstrual irregularities.

Do triple test results predict risk for neonatal hyperbilirubinemia?

OBJECTIVE: Neonatal jaundice is the most common condition that requires hospital admission and outpatient follow-up after discharge in neonates. The values of more than 17 mg/dL in term infants are accepted as neonatal significant hyperbilirubinemia. We aimed to define if there is any relationship between second trimester serum markers and neonatal severe hyperbilirubinemia to protect the neonates from its neurological damage. METHODS: Total 1372 pregnant women were enrolled who had done triple test between April 2014 and 2015 and then given birth at our hospital. Our primary outcome was neonatal significant hyperbilirubinemia. RESULTS: The mean age of our study population was 27.9±5.6. A total of 59 patients had babies with neonatal hyperbilirubinemia after exclusion of Rh incompatibility. We detected that the presence of in vitro pregnancy, maternal health problems or poor obstetric history had no effect on the risk for neonatal hyperbilirubinemia. Neonatal hyperbilirubinemia was related with low E3 levels. The ratios of AFP/E3 and hCG/E3 were the most helpful to predict the neonatal hyperbilirubinemia. CONCLUSIONS: According to our results, low E3 levels in the triple test result can be helpful to predict the development of the neonatal hyperbilirubinemia. However, this is a bit expensive and many developing countries may not afford it.

Risk factors for surgical site infection after hysterectomy.

INTRODUCTION: The aim of the study was to define the clinical and laboratory characteristics of patients who had surgical site infection (SSI) after hysterectomy. METHODOLOGY: This study was a retrospective cohort study. The patient data of 840 subjects who had undergone any type of hysterectomy and reported SSI after surgery were obtained from the archives of a tertiary referral center. The different types of hysterectomy procedures performed on these patients included total abdominal hysterectomy (TAH), laparoscopic hysterectomy (LH), and vaginal hysterectomy (VH). In addition, age, body mass index (BMI), preoperative and postoperative blood parameters, gravidity, and parity were also documented. RESULTS: TAH, LH, and VH were performed on 63.2% (n = 531), 21.6% (n = 181), and 15.2% (n = 128) of patients, respectively. Overall, SSIs were observed in 3.7% (n = 31) of all hysterectomy patients. Among them, 4.5% of TAH patients, 1.7% of LH patients, and 3.1% of VH patients had SSIs after the hysterectomy operation. Analysis of the data revealed that the patients with SSIs had significantly higher BMIs, lower preoperative hemoglobin, lower postoperative hemoglobin and hematocrit, and higher postoperative platelet counts compared to patients who did not have any SSIs. CONCLUSIONS: High BMI, blood loss during surgery, low hematocrit levels, and resulting anemia increased the incidence of SSI after hysterectomy. Among the different types of hysterectomy, LH was found to be relatively better than TAH and VH in preventing the occurrence of SSI.

Why do multiparous women with a history of vaginal delivery give birth by cesarean section?

OBJECTIVE: A cesarean section (C-section) is performed to deliver a baby through the mother's abdomen. In recent years, the rate of incidences requiring a C-section is steadily increasing all over the world. Advanced maternal age, chronic health problems, multiple pregnancies as a result of the development of assisted reproductive technologies, and an insufficient supplementary health network can be considered as the reasons why mothers and obstetricians prefer a C-section. Our study aimed to identify the risk factors for the need of C-section in women with a history of vaginal delivery. MATERIAL AND METHODS: 238 multiparous women with a history of vaginal birth at 37-42 gestational weeks were enrolled in our study. 110 women had underwent C-section. Control group was chosen randomly from women giving birth by vaginal route. RESULTS: Overall, 238 multiparous women with a history of vaginal delivery at 37-42 gestational weeks were enrolled in our study. The history of operative delivery, that of labor induction and presence of meconium and the indication of admission to the delivery room were different between groups. A lower Bishop score and biophysical profile, smaller gestational period, and lower birth weight were associated with the group requiring a C-section, whereas older age and a long time interval from the previous birth were associated with the group not requiring a C-section. CONCLUSION: A strategy involving either labor induction or not could be individualized for each patient to eliminate the risk factors for adverse outcomes. To identify criteria for the standardization of labor management, further studies are needed.