Pregnancy management and outcome after uterus transplantation.

Uterus transplantation is a novel approach in women whose uterus is absent or severely abnormal. However, it is still an experimental procedure that poses risks to both mother and baby. To date, 32 live births after uterus transplantation have been reported in peer-reviewed journals, with several maternal, fetal and neonatal complications. The most common complications were preterm delivery, hypertensive disorders and placenta previa. Four patients experienced episodes of transplant rejection during pregnancy. The appropriate management of complicated and non-complicated pregnancies following uterus transplantation is still unresolved. In this review, obstetric outcomes after uterus transplantation and optimal management during pregnancy are discussed in light of the available data. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Age and gender related changes in bronchial tree: a morphometric study with multidedector CT.

OBJECTIVE: The aims of this study are the identification of differences in the diameter, length, area and branching angles of the trachea and bronchi with gender and age, and the identification of trachea types by using MDCT images. PATIENTS AND METHODS: The thoracic MDCT images of 253 patients (0-74 years old, 142 male and 111 female) were evaluated. Tracheal diameter, tracheal cross-sectional area, diameter and length of bronchi, and several angles of the bronchial tree [e.g. subcarinal angles (SCA), interbronchial angles (IBA)] were measured. RESULTS: Average anteroposterior and transverse diameter of the trachea in adult patients were measured as 15.8 ± 2.9 mm and 17.5 ± 3.7 mm respectively. Average tracheal cross-sectional areas in adult patients were calculated as 160.7 ± 41.3 mm² in females and as 275.7 ± 57.3 mm² in males. Four types of trachea were identified as circular (68% in adults, 73% in children), oval (13%, 15%), rectangular (11%, 5%) and horseshoe shaped (8%, 7%). The average right and left SCA were calculated as 34.5º ± 8.1º and 38.1º ± 8.9º respectively. The average right and left IBA were calculated as 32.4º ± 7.7º and 35.2º ± 8.1º respectively. CONCLUSIONS: The findings of this study may be helpful during bronchoscopy and tube and stent application procedures. MDCT seems to be a convenient technique for the evaluation of the bronchial tree.

Adjuvant therapy for Stage IA uterine clear cell carcinoma with no myometrial invasion: a critical review of literature.

Uterine clear cell carcinoma (UCC) is an aggressive variant of endometrial cancer. Comprehensive surgical staging is strongly recommended for these patients as an upstaging to Stage 3-4 occur in 35-50% of patients. Stage 1A (no myometrial invasion) according to FIGO 1988 staging system are seen very rarely in patients. In most of the studies, regarding adjuvant treatment, clear cell carcinoma were all evaluated with papillary serous carcinoma (PSC). Studies on clear cell histology are low in number and also a limited number of patients were included. Proportion of patients with complete surgical staging, number of lymph nodes excised, and rate of omentectomy were all heterogenous and were not presented uniformly in studies. There is no concensus regarding adjuvant treatment for Stage 1A patients. Some authors suggest only close observation. Vaginal brachytherapy is also strongly recommended in some studies of this review. Multi-institutional studies with homogenous patient characteristics with homogeneous surgery is warranted.

Association of clinical androgen excess with radial artery intima media thickness in women with polycystic ovary syndrome.

This study explores the relationship between clinical cardiovascular risk factors and clinical androgen excess, with direct comparison to radial artery intima media thickness (rIMT). rIMT of 91 patients with polycystic ovary syndrome (PCOS) were compared with 72 healthy women. Patients were divided into three groups with regard to body mass index (BMI). Group1 = 56 women (31 controls and 25 PCOS) with low BMI(18-22.49 kg/m(2)), Group2 = 36 women (15 controls and 21 PCOS) with normal BMI (22.5-24.99 kg/m(2)) and Group3 = 71 women (26 controls and 45 PCOS) with high BMI (25-30 kg/m(2)). rIMT was significantly higher in patients with PCOS (p = 0.007). rIMT was significantly higher group1 and group3 in patients with PCOS compared to controls (p = 0.007 and p = 0.042, respectively). There was a significant positive association between rIMT levels and fT in women with PCOS in group1 (r = 0.24, p = 0.04). rIMT levels correlated to fT levels in women with PCOS in group3 (r = 0.32, p = 0.03). Modified Ferriman-Gallwey (mFG) scores demonstrated a positive association with free testosterone, total testosterone, free androgen index, waist circumference (WC), LH levels, insulin levels, Homeostasis Model Assessment index(HOMA-IR), rIMT and a negative correlation with sex hormone binding globulin in group1 and group2. mFG scores demonstrated a positive association with free testosterone (r = 0.33, p = 0.029) in group3, but no association was found between mFG and WC, HOMA-IR in group3. Our findings indicate that clinical androgen excess may be associated with cardiovascular disease in patients with PCOS.

Anti-Müllerian hormone is associated with extrauterine involvement and stage of disease in patients with endometrial cancer.

Our aim was to evaluate serum levels of anti-Müllerian hormone (AMH) and also immunohistochemical (IHC) staining properties of AMH receptor type II (AMHRII) in patients with endometrial cancer (EC) and a control group. Preoperatively, serum levels of AMH were assessed and AMHRII expression was evaluated by immunohistochemistry in a benign and malignant group. AMH serum levels of the control group and EC patients were comparable. For EC patients, there was no difference with respect to the AMH levels and tumour stage; grade; histological type; deep myometrial invasion; lymphovascular space invasion or lymph node involvement. However, AMH levels in patients with extrauterine involvement were higher than patients with disease confined to the uterus. EC samples were more likely to be stained positive for AMHRII than benign lesions. Also, as the stage of the lesion worsens, the rate of IHC staining of AMHRII decreases. In conclusion, AMHRII is expressed in normal endometrial cells as well as endometrial cancer cells. AMH levels increase in EC, with extrauterine involvement at least in locally advanced disease. Also AMH expression decreases as the disease is staged-up.

Assessment of body composition with bioelectrical impedance analysis in pregnant women with hyperemesis gravidarum before and after treatment.

More than half of pregnant women suffer from nausea and vomiting, in 0.5-1% of the pregnant women, if nausea and vomiting are severe and persistent, condition can progress to hyperemesis. We evaluated the fluid volume parameters in pregnant women with hyperemesis gravidarum, before and after treatment using the bioelectrical impedance vectors. A total of 70 pregnant women who had weight loss exceeding 5% of pre-pregnancy body weight were recruited for the study in the first trimester. The measurement of multi-frequency bioelectrical impedance analysis parameters was performed on the day of hospitalisation before any treatment and after treatment at 24 h and 72 h with the same procedure. Total body water, extracellular water, intracellular water, and fat-free mass index increased after treatment at 24 h (P < 0.01). Also, the mean pregnancy-unique quantification of emesis and nausea score was significantly lower after treatment (11.3 ± 2.1 at enrolment, 5.1 ± 1.4 at 24 h and 4.3 ± 1.1 at 72 h) (P < 0.01), which correlated with the patients' clinical improvement and changes in hydration. In pregnant women with moderate-to-severe hyperemesis gravidarum, significant body composition changes occur and fluid replacement therapy performed during a short period of time, such as 24 h, provides improvement in body composition.

Effect of drainage on postoperative pain after laparoscopic ovarian cystectomy.

The aim of this prospective study was to investigate the effect of drainage on postoperative shoulder and abdominal pain after uncomplicated laparoscopic ovarian cystectomy (LOC). Allocation to drain or not to drain was non-randomised. There were 55 patients with drainage and 56 patients without drainage. Postoperative shoulder and abdominal pain was assessed using a 10-point visual analogue scale. Postoperative hospital stay in the drainage group was longer than the non-drainage group (p = 0.040). Postoperative shoulder pain scores at 6 h and 24 h were similar between the drainage and non-drainage groups (p = 0.376 and p = 0.847, respectively). Postoperative abdominal pain was higher in the drainage group at 6 h (p = 0.009), but was similar at 24 h (p = 0.097) between the groups. These data suggest that for LOC, drainage may not be useful to prevent postoperative shoulder pain and also increases postoperative abdominal pain and length of hospital stay.

Gum chewing reduces the time to first defaecation after pelvic surgery: A randomised controlled study.

Post-operative ileus is a major complication that increases the morbidity in patients who had abdominal surgery. Several different procedures have been used to manage bowel function, including adequate pain control, prokinetic drugs and supportive strategies. The present study aimed to assess the effect of chewing gum on bowel recovery in patients undergoing gynaecologic abdominal surgeries. A total of 137 patients were randomised into gum-chewing and control groups. Patients in the gum-chewing group began chewing gum at post-operative 3rd h and chewed gum thereafter every 4 h daily, for 30 min each time. All patients received the same post-operative treatment. Primary outcome measures were the time to first passage of flatus and time to first passage of stool. The secondary outcome measures included the first hearing of normal bowel sounds, nausea and the time until discharge from the hospital. Compared with the control group, the time interval between operation and first flatus was shorter in the gum-chewing group (median, 33 h vs 30 h). However, the difference was not significant (p = 0.381). The first defaecation time was significantly shorter in the gum-chewing group. The median time to first defaecation was 67 (20-105) h in the control group and 45 (12-97) h in the gum-chewing group (p < 0.01). Gum chewing is safe, well tolerated and it allows early defaecation after gynaecologic abdominal surgery.

Metastin levels in relation with hormonal and metabolic profile in patients with polycystic ovary syndrome.

OBJECTIVE: The aim of the present study was to evaluate serum concentrations of metastin in relation with hormonal and metabolic profile in patients with and without polycystic ovary syndrome (PCOS). STUDY DESIGN: The study was a clinical study. Eighty-three women with PCOS and 66 body mass index (BMI) matched controls were divided into two groups, based on BMI: overweight and obese (BMI≥25 kg/m(2)) and normal weight. (BMI<25 kg/m(2)) Hirsutism scores, hormonal and metabolic profile as well as metastin levels were evaluated in each subject. Blood samples were collected in the early follicular phase (between day 2 and day 5 of the menstrual cycle) at 9:00 AM, after an overnight fast. Circulating levels of LH, FSH, PRL, TSH, T, fT, DHEAS, 17-OH-P, sex hormone-binding globulin (SHBG), insulin, glucose, lipid profile and metastin were measured. RESULTS: Metastin levels were significantly higher in the PCOS group compared to controls (2.02 ng/ml versus 1.16 ng/ml, p<0.001). Metastin levels correlated significantly positively with luteinizing hormone (LH), total testosterone (T), dehydroepiandrosteronesulphate (DHEA-SO4) levels, modified Ferriman-Gallwey (mFG) scores and free androgen index (FAI); however, correlated negatively with sex hormone binding globulin (SHBG) levels (p<0.05). When overweight or obese (BMI≥25 kg/m(2)) and normal weight (BMI<25 kg/m(2)) women with PCOS were compared to body mass index (BMI) matched controls, higher metastin levels were also found in PCOS groups (1.94 ng/ml versus 1.18 ng/ml, and 2.06 ng/ml versus 1.08 ng/ml, p<0.05, respectively). CONCLUSIONS: These findings suggest that metastin levels were higher in women with PCOS as compared to controls regardless of BMI. Furthermore, metastin levels can be used as a specific marker for androgenic profile and this marker might play a role in the pathogenesis of PCOS.

Expression of cyclin A, cyclin E and p27 in normal, hyperplastic and frankly malignant endometrial samples.

Cellular growth is under the control of certain molecules such as cyclins and cyclin dependent kinases. Dysregulation of these proteins disrupt cell cycle and may trigger malignant transformation. Cyclins and kinase inhibitors also play essential roles in endometrial cellular proliferation. But the exact roles of these mediators in the disease process is not clear. We evaluated expression of cyclin A, cyclin E and p27 in normal, hyperplastic and malignant endometrial samples assuming different expression patterns in physiological and pathological processes. A total of 75 patients with histopathological diagnosis of normal proliferative, hyperplastic or malignant endometrial samples were evaluated with different cellular proliferation markers, cyclin A, cyclin E and p27. For cyclin E, endometrial cancer samples had higher rate of immunoreactivity than normal proliferative and hyperplastic endometrial samples. Staining properties for cyclin A were comparable for three groups. However, p27 immunoreactivity decreased progressively as lesions progress from proliferative benign endometrium to frank carcinoma. Further large-scale studies with clinical follow-up will reveal the exact role of cyclins on endometrial carcinogenesis.

The effects of intrathecal morphine on patient-controlled analgesia, morphine consumption, postoperative pain and satisfaction scores in patients undergoing gynaecological oncological surgery.

OBJECTIVE: Gynaecological oncological surgery (GOS) includes a wide variety of surgical procedures and postoperative pain is a major concern. This study compared the impact of intrathecal morphine (ITM) plus patient-controlled analgesia (PCA) with PCA alone on morphine consumption, pain relief and patient satisfaction after GOS. METHODS: Sixty women undergoing GOS under general anaesthesia were randomized to receive either 0.3 mg ITM or placebo. On arrival at the postanaesthesia care unit each patient received a morphine PCA pump. The three primary outcome measures were pain, patient satisfaction scores evaluated using a 100-mm visual analogue scale and cumulative PCA morphine consumption. RESULTS: No significant differences were observed in the demographic data. Cumulative PCA morphine consumption was significantly lower in the ITM group compared with the control group. Fatigue scores were lower in the ITM group compared with the control group but did not reach statistical significance. Pain, sedation and patient satisfaction scores, and the rate of side-effects were similar for the two groups. CONCLUSIONS: Administering ITM in GOS could improve postoperative analgesia and reduce morphine consumption without serious side-effects.

Management of endometrial hyperplasia.

Endometrial hyperplasia is a commonly seen clinical entity. A great majority of patients present with abnormal uterine bleeding. Unopposed estrogen either from an endogenous or exogenous source is the most important etiologic factor. Etiologic evaluation and cause specific treatment is a must for these patients instead of direct biopsies and treatments. Clinical importance of this pathological entity is the underlying risk of carrying a concomitant genital cancer and the potential risk of progression to endometrial carcinoma during the follow-up. Despite to a great effort on research and a long history of the disease in the medical literature; we still do not have a practical and accurate system available to use during daily practice in order to differentiate the real precancerous lesions. Treatment of endometrial hyperplasia depends on the patient's age, fertility desire and the type of present hyperplasia. Progestagens are still the most commonly used medical treatment modality in these patients. Response rates are higher in cases without atypia. In selected cases, hysterectomy may be performed as a definitive treatment modality. In this review article current management of the endometrial hyperplasia is summarized in the light of associated literature.

The accuracy of frozen section analysis at hysterectomy in patients with atypical endometrial hyperplasia.

PURPOSE OF INVESTIGATION: To evaluate the accuracy of frozen section analysis in patients with atypical endometrial hyperplasia. METHODS: Women who underwent hysterectomy with frozen section analysis for atypical endometrial hyperplasia were identified. Frozen section evaluation aimed to give information about the presence of malignancy. Also, myometrial or cervical involvement was assessed in cases with malignancy to reveal the need for staging. Final pathological evaluation results were compared with intraoperative frozen section analyses. RESULTS: Twelve patients (34.3%) had endometrial cancer on final pathologic examination and eight required a staging procedure due to either myometrial invasion or cervical involvement; 75% of patients with endometrial cancer were successfully detected by frozen section analysis. Moreover, among women with cancer, frozen section examination revealed 75% of cases who required surgical staging. CONCLUSION: Frozen section analysis of hysterectomy specimens in patients with atypical endometrial hyperplasia is necessary to determine the presence of cancer and the need for surgical staging.