The role of Meibomian glands on the development of dry eye disease in patients with unilateral pseudoexfoliation.

PURPOSE: To evaluate the Meibomian glands and presence of dry eye in patients with unilateral pseudoexfoliation. METHODS: The study included 32 patients with clinical pseudoexfoliation (PEX) in one eye and 30 controls. Schirmer and tear film break-up time (TBUT) tests were performed, along with a detailed ophthalmological examination, meibography and evaluation of areas of meibomian gland loss. Subjective symptoms were evaluated using the ocular surface disease index (OSDI). RESULTS: Schirmer test results for eyes with or without PEX were similar (10.438±4.47mm and 11.563±4.35mm, respectively), vs. 15.967±9.75mm in the control group. While measurements of TBUT were found to be similar in both eyes of the patient group (6.188±2.66s in eyes with PEX and 6.250±1.87s in eyes without PEX), this was 8.233±2.66s in the control group. Schirmer and TBUT test results were found to be significantly lower in both eyes of patients with unilateral pseudoexfoliation compared to control eyes. The rate of meibomian gland loss in the upper and lower eyelids in the patient group was found to be significantly higher than in the control group. Similarly, meiboscores of both eyelids in the control group were significantly lower than those in patient group; however, there were no differences between patient eyes with or without pseudoexfoliation. CONCLUSION: The patients with unilateral pseudoexfoliation had a significant loss of meibomian gland area in both eyes compared to the control group, and their meiboscore was higher. It should be considered that meibomian gland loss may be one of the causes of dry eye in patients with pseudoexfoliation.

Comparison of vision-related quality of life in primary open-angle glaucoma and dry-type age-related macular degeneration.

PurposeTo compare quality of life (QoL) in patients with primary open-angle glaucoma (POAG) and dry-type age-related macular degeneration (AMD) with similar best-corrected visual acuity.MethodsAge-, sex-, and visual acuity-matched POAG and dry AMD patients were included in the study. Each patient performed 24-2 and 10-2 SITA standard visual field tests. Contrast sensitivity was evaluated with CSV-1000 HGT instrument. The 25 item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was used to analyze QoL. Overall and subscale scores were converted to scores between 0 and 100, the higher scores indicating better vision-related QoL.ResultsOverall NEI-VFQ-25 scores were 86.44 and 84.66 in glaucoma and AMD groups, respectively (P=0.244). The highest scores were obtained in 'vision-related dependency' subgroup in glaucoma and 'color and peripheral vision' in AMD group, whereas the lowest scores were noted 'in peripheral vision' in both glaucoma and AMD patients. Glaucoma patients had significantly lower scores in ocular pain, color vision, and peripheral vision subgroups compared with the AMD group, whereas AMD patients had lower scores in near and distance vision activities, vision-related social activity, and dependency subgroups. Contrast sensitivity results and mean defect values showed correlation with NEI-VFQ-25 scores in both groups.ConclusionsGlaucoma and AMD patients with similar visual acuity experienced similar overall impairment in QoL. However, glaucoma patients described more difficulty with peripheral vision and ocular pain, whereas AMD patients complained more about near and distance vision and dependency items.

A successful management of a giant mucinous ovarian tumor with intraoperative controlled fluid aspiration.

BACKGROUND: The aim of this article was to present management of a giant ovarian mass. CASE REPORT: A 61-year-old patient was admitted with compliants of abdominal swelling and dyspnea. Ultrasound revealed a giant ovarian mass with dimesnions 47x43x30 cm. The patient underwent laparatomy and the cyst's content was aspirated before total cyst excision. The total weight of the mass was calculated to be 42.5 kg. Postoperatively, the patient was discharged on her postoperative seventh day. CONCLUSION: Giant ovarian cysts can be managed with controlled aspiration before total cyst excision.

Successful management of a second-trimester post-abortion hemorrhage with the Bakri balloon tamponade.

Hemorrhage after abortion is rare but it is a significant cause of abortion-related mortality and morbidity. Conservative management of hemorrhage is gaining popularity. The authors describe a case which a uterine tamponade balloon which was successfully used to control second-trimester post-abortion hemorrhage.

Is gynaecological laparoscopic surgery safe for elderly women? A comparison study.

The aim of this study was to evaluate the efficacy and safety of gynaecological laparoscopic surgery in an elderly group, by comparing the operative outcomes of the elderly group with those of the younger group. We analysed retrospective data of 121 women who underwent laparoscopic surgery for benign gynaecological disease. Women aged > 60 years were compared with women aged between 30 and 50 years who had the same operation. We evaluated body mass index, comorbidities, number of previous abdominal surgeries, operating time, haemoglobin change, postoperative complications, hospital stay and return of bowel activity. There were no significant differences between the elderly and a matched younger group in number of previous abdominal surgeries, operating time, ASA score distribution, changes in haemoglobin level, hospital stay and postoperative complications (p > 0.05). Laparoscopic surgery can be safely performed in elderly patients with benign gynaecological disease, and surgeons should not hesitate to perform laparoscopic surgery in elderly patients.

Is laparoscopic surgery safe in patients with an elevated shock index due to ruptured ectopic pregnancy?

PURPOSE: To evaluate the effectiveness of laparoscopic surgery in patients with elevated shock index (SI), which is a unique determinant of acute hemorrhage. MATERIALS AND METHODS: A retrospective chart review of all patients treated for ectopic pregnancy (EP) in the present gynaecology department between January 2007 and March 2011 was performed. For each measurement of heart rate (HR) and systolic blood pressure (SBP), a SI was calculated by dividing HR by SBP (normal, 0.5 - 0.7). RESULTS: One hundred sixty patients were selected as SI above 0.7. There were 111 (69.4%) patients in the laparotomy group and 49 (30.6%) patients in the laparoscopy group. The postoperative hemoglobin (Hb) level was 8.46 +/- 1.56 (g/dl) in the laparotomy group and 9.37 +/- 1.52 (g/dl) in the laparoscopy group, with lower postoperative levels in the laparotomy group. The mean duration of postoperative hospital stay was 2.37 +/- 0.74 days in the laparotomy group and 2 +/- 0.84 days in the laparoscopy group. CONCLUSION: The availability of suitable operative equipment, nursing teams, and advanced laparoscopic skills, all justify operative laparoscopy for the surgical treatment of EP in women with elevated SI.

Serum adiponectin levels in high school girls with polycystic ovary syndrome and hyperandrogenism.

OBJECTIVE: To compare the serum adiponectin levels together with metabolic and hormonal parameters among teenage girls at the early onset of polycystic ovary syndrome (PCOS) and hyperandrogenism with controls. DESIGN: Prospective study. SETTINGS: Education and research hospital, outpatient gynecological endocrinology clinic. PARTICIPANTS: Four hundred seventy-nine teenage girls from a school of nursing were interviewed for the signs and symptoms of PCOS. Among them, 42 cases who had a definitive diagnosis of PCOS with hyperandrogenism based on Rotterdam diagnostic criteria were recruited for the study and other causes of hyperandrogenemia had been excluded. The controls were recruited from regularly cycling healthy teenage girls from the same high school of nursing; none of those who agreed to join the study met any of the diagnostic criteria for PCOS (n = 44). INTERVENTIONS: Cases were selected as group I: PCOS with body mass index (BMI) < 25 kg/m² (n = 20), group II: PCOS with BMI > 25 kg/m² (n = 22), group III: Controls with BMI < 25 kg/m² (n = 21) and group IV: Controls with BMI > 25 kg/m² (n = 23). Serum adiponectin, metabolic and hormonal parameters were compared in PCOS patients with BMI matched controls. MAIN OUTCOME MEASURES: Difference of serum adiponectin levels, metabolic and hormonal parameters between teenage girls with PCOS and controls. RESULTS: Serum adiponectin levels were not significantly different in group I and group II. Serum adiponectin levels were significantly decreased in group I and group II compared with both control groups (III and IV). CONCLUSION: Serum adiponectin levels were lower in teenage girls with PCOS and this reduction was independent from BMI.

Intravenous albumin versus hydroxyethyl starch for the prevention of ovarian hyperstimulation in an in-vitro fertilization programme: a prospective randomized placebo controlled study.

A prospective randomized placebo controlled clinical trial was carried out on 250 patients (cycles) considered at risk of developing OHSS in an IVF programme. Criteria for inclusion were: estradiol value of more than 3000 pg/ml or the presence of more than 20 follicles on the day of hCG administration. Patients were randomized by using a random table to receive either 20% human albumin 50 ml (n: 82); 6% hydroxyethyl starch (200/0.5) 500 ml (n: 85) or a placebo of 500 ml 0.9% NaCl solution (n: 83) over 30 min during oocyte collection. Groups were similar with respect to patients' age, estradiol levels on hCG day, body mass index, number of oocytes retrieved, number of embryos transferred and pregnancies (P>0.05). There was no severe OHSS in patients who received albumin and HES while four patients who received placebo developed severe OHSS. On the other hand moderate OHSS was encountered in four patients in the albumin group; five patients receiving HES; and 12 patients receiving placebo. There was a statistically significant difference in the incidence of moderate, severe and overall OHSS among groups (P values of <0.05, <0.05, and <0.01, respectively). Both HES and albumin significantly reduced the incidence of moderate, severe and overall incidence of OHSS. It is concluded that hydroxyethyl starch is a cheaper and safer alternative to Human Albumin in OHSS prevention.

Sacrospinous fixation for the prolapsed vaginal vault.

In 54 patients, transvaginal sacrospinous ligament fixation procedures were reviewed retrospectively. The mean operation time was 15 (12-45) min. The mean blood loss was 126 (110-175) cm3. The only intraoperative complication was a rectal laceration that was repaired primarily. The mean duration of follow-up was 28 (4-54) months. There were only 2 recurrent vaginal vault prolapses. There were 3 cases of cystocele (5.5%), 1 case of rectocele (1.8%), 5 cases of enterocele (9.2%), 3 cases of stress incontinence (5.5%), and 5 cases of dysparonia (9.2%). Sacrospinous ligament fixation can be used as an alternative treatment to vaginal hysterectomy in aged women with medical problems and young women suffering from genital descent with infertility. The procedure has the advantage of avoiding laparatomy, facilitating other vaginal repairs needed during the same operation, preserving vaginal function and shortening the time necessary for anesthesia and surgery.

Color Doppler ultrasonography in the earlier differentiation of benign molehydatidiforms from malignant gestational trophoblastic disease.

BACKGROUND: To find out the effectiveness of color Doppler ultrasonography of the uterine arteries in the differentiation of benign molehydatidiforms from malignant gestational trophoblastic disease. METHODS: Prospective study was performed in 32 women who were referred to the Oncology Department with the diagnosis of gestational trophoblastic disease. Uterine artery Doppler studies were made and resistance index for both uterine arteries were calculated. In the follow-up, twelve of these patients required chemotherapy (first group) and 20 of them were treated with only suction curettage (second group). Non parametric Mann Whitney U test was used for the statistical analysis. RESULTS: Median of the lowest uterine artery resistance index were 0.29 for the first group and 0.46 for the second group. Resistance index were significantly lower in the first group (alpha<0.001). Color Doppler study of the uterine arteries is helpful in the differentiation of benign molehydatiforms from malignant gestational trophoblastic disease.

Influence of anterior colporrhaphy with colpoperineoplasty operations for stress incontinence and/or genital descent on sexual life.

The effect of anterior colporrhaphy and colpoperineoplasty operation for stress incontinence and/or genital descent on sexual life was studied in 44 women. All sexually active cases prior to the operation for stress incontinence and/or genital descent were evaluated by interview and gynaecological examination immediately before and six months after the operation. Prior to the operation, 30 out of 44 patients (68.2%), found their sexual life unsatisfactory because of various reasons like urinary incontinence, genital descent, vaginal relaxation and urinary incontinence during intercourse. Postoperatively, 20 (66%) of these 30 patients improved, 4 (14%) showed no change and 6 (20%) deteriorated. Twelve of 14 (86%) patients who found their sexual life satisfactory before the operation described no change and 2 (14%) experienced deterioration postoperatively. Overall, 8 patients described deterioration postoperatively and all complained of dyspareunia. Colpoperineoplasty in combination with anterior colporrhaphy might cause dyspareunia in some patients. Colpoperineoplasty may increase the disturbances due to the atrophic changes related to menopause and should therefore be done selectively.

Urinary incontinence in women of reproductive age.

We investigated the prevalence and the consequence of urinary incontinence in the Turkish population, representing a composition of European and Asian populations. During a 12-month period, the standard urinary incontinence questionnaire was answered by 1,250 women of reproductive age who were admitted to the outpatient clinic with various gynecologic complaints, except for women whose main complaints were urinary incontinence. These patients were randomly selected by stratification according to the following five age-groups: 18-24, 25-29, 30-34, 35-39, and 40-44. The prevalence of incontinence was measured for each group. Urinary incontinence prevalence was 24.5%; in 6.6% the incontinence occurred at least once daily. The lowest prevalence was found in the younger age-groups (18-29 years) and the highest in 40-44 years of age. Two hundred and sixty-one incontinent women (85%) had never sought medical help. The results indicated that urinary incontinence was common among women of reproductive age and only few sought medical help. We suggest that more public education about women's urinary problems and more attention to this problem by physicians are the mainstays of management.