A successful management algorithm for vulvar abscess: A tertiary hospital experience.

AIM: To develop a treatment and management algorithm for vulvar abscess. METHODS: We evaluated the clinical findings and treatment modalities of patients hospitalized with vulvar abscess via a comprehensive literature review and a clinical study. Patients with a diagnosis of vulvar abscess (n = 28) between 2015 and 2019 in the gynecology clinic of our hospital were included in the clinical study. Each patient's age, obstetric history, body mass index, presence of concomitant diseases, abscess culture and size, mean length of hospital stay, treatment modalities, and recurrence rate were recorded. RESULTS: The mean age and body mass index of the patients were 47.7 ± 11.5 years and 30.3 ± 2.7 kg/m2 , respectively. Diabetes mellitus was the most common concomitant disease (60.7%, n = 17). The abscesses of 22 (78.5%) patients drained spontaneously. The abscess cavities of the remaining six (21.4%) patients were treated via incisional drainage. Gentamicin + clindamycin or levofloxacin + metronidazole were used as the primary antibiotic treatment. Hemovac drains were placed in four (14.2%) patients with abscess sites greater than 5 cm. By applying our treatment methods, 26 (92.8%) of our patients were discharged with full recovery, and two patients (7.2%) were referred due to uncontrolled diabetes mellitus. The recurrence rate of vulvar abscess was 0%. CONCLUSIONS: This is the first study in the literature to present a successful algorithm for the treatment and management of vulvar abscess. Our treatment methods shed light on the treatment and management of vulvar abscess.

The effect of anterior uterocervical angle and cervical length on the development of pelvic inflammatory disease.

This study aims to compare the uterine body longitudinal axis, uterine body transverse axis, uterine cervix longitudinal axis and anterior cervical axis angle measured ultrasonographically between women with pelvic inflammatory disease (PID) and healthy controls. Women aged 18-45 years with PID and healthy controls were included in the study. Demographic characteristics, uterine body long axis, uterine body transverse axis, uterine cervix long axis and anterior cervical axis angle of PID patients and healthy controls were evaluated. Gravida, parity, history of smoking were significantly higher in the PID group (n = 75) than the control group (n = 74). The uterine body longitudinal axis (p = 0.001) and transverse axis (p = 0.005) were significantly lower, and the cervix longitudinal axis (p < 0.001) and the anterior uterocervical angle (p < 0.001) were significantly higher in the PID group than the control group. Binary logistic regression analysis showed that uterine body (UTX) longitudinal axis (p = 0.005), uterine cervix longitudinal axis (p < 0.001) and UCA (p < 0.001) were significant predictors of PID. Uterine body longitudinal axis, uterine cervix longitudinal axis, and UCA can be associated to PID.

Diagnostic value of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in adnexal torsion cases.

AIM: To evaluate if the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) could be used to diagnose adnexal torsion. METHODS: A retrospective study reviewed medical records of women who underwent surgery due to an adnexal mass between January 2012 and December 2017 at a tertiary referral center in Turkey. According to the surgical findings, the women were divided into a torsion group and a control group. NLR and PLR were compared between women who had adnexal torsion and those who did not. RESULTS: A total of 201 women were included in the study: 67 in the torsion group and 134 in the control group. Mean WBC count (9584.0 ± 3080.8 vs. 6678.2 ± 1886.1 h/mm3 ), mean NLR (5.9 ± 4.3 vs. 2.1 ± 0.8), and mean PLR (210.5 ± 132.7 vs. 147.9 ± 48.7) were higher in the torsion group than in the control group (p < 0.001). According to the ROC curve analyses, the optimal cut-off value for NLR and PLR were 2.51 (sensitivity, 72%; specificity, 78%) and 154.4 (sensitivity, 61%; specificity, 64%) in the diagnosis of adnexal torsion, respectively. CONCLUSION: NLR and PLR have been found useful hematological markers for the diagnosis of adnexal torsion. NLR and PLR could be helpful in cases, which is difficult to make a definitive diagnosis with patients' symptom and the ultrasonographic examination.

Impact of Curcumin on Ovarian Reserve After Tubal Ligation: an Experimental Study.

The aim of this study was to evaluate the effects of tubal ligation (TL) via modified Pomeroy method on ovarian reserve and to determine the role of curcumin (Curcuma longa [Indian saffron]) against ovarian reserve decrement after TL. Forty-eight albino Wistar rats were randomly divided into four groups: (1) Control group: a sham operation was performed (n = 12), (2) Tubal ligation group: TL was performed (n = 12), (3) TL+DMSO group: 1 mL/day dimethyl sulfoxide was used for 50 days after TL, (4) TL+Curc group: 100 mg/kg/day curcumin dissolved in DMSO was administrated for 50 days after TL. Pre-operatively and on post-operative day 50, blood samples were collected for AMH evaluation, and oophorectomy was performed for histological and immunohistochemical examinations of ovaries in all groups. No difference in the basal AMH levels was found among the groups (p = 0.249). Compared to the basal, AMH levels were lower in the control, TL, and TL+DMSO groups (p = 0.003, p = 0.004, and p < 0.001, respectively) but not different in the TL+Curc group (p = 0.503) on post-operative day 50. No significant differences in the number of primary, preantral, antral, atretic follicles, and corpus luteum among the groups (p > 0.05) were found. The percentage of granulosa cells stained for caspase-3 in antral follicles and the corpus luteum was higher in the TL+Curc group than in the control and TL groups ([antral follicles; p < 0.01 for both groups], [corpus leteum; p = 0.009 and 0.002 for the control and TL groups, respectively]). It seems that TL does not decrease ovarian reserve and curcumin might have a positive effect on ovarian reserve in the setting of TL.

Assessment of minimally invasive surgical skills of pre-medical students: What can we learn from future learners?

OBJECTIVE: Knowledge of baseline laparoscopic and robotic surgical skills of future learners is essential to develop teaching strategies that best fit them. The objectives of this study are to determine baseline laparoscopic and robotic skills of high school and college students and compare them to those of current obstetrics and gynecology residents. MATERIAL AND METHODS: A cross-sectional (Class II-2) pilot study. Laparoscopic and robotic surgical skills of college and high (secondary) school students were evaluated using simulators and compared to those of obstetrics and gynecology residents. In addition, questionnaire data were collected regarding video game playing and computer use. RESULTS: A total of 17 students, both high school (n=9) and college (n=8), in addition to 11 residents, completed the study. Overall, students performed comparably to the residents in simple exercises (p>.05). However, students took significantly longer time to complete complex exercises (p=.001). Finally, students played video games significantly more than residents (p<.001). CONCLUSION: Future learners may have a different background skill set. This difference may be related to improved hand-eye coordination, possibly due to playing video games. The results of this pilot study should spur more research into surgical teaching strategies.

Face presentation at term: a forgotten issue.

AIM: To determine factors associated with face presentation of term fetuses delivered. METHODS: Of 34,480 consecutive, term deliveries of uncomplicated pregnancies within a 3-year period, all live, singleton term fetuses with cephalic presentation in which no lethal anomalies occurred that were diagnosed with a face presentation were studied. Factors that may have contributed to the etiology of the presentation including age, parity and fetal size were evaluated. Ultrasonographic evaluation was recorded. RESULTS: Fifty cases were diagnosed with an incidence of 0.14%. Parity was not associated with face presentation. Birthweight of 4000 g or more indicated an increased risk of approximately 2.9-fold, whereas fetuses weighing 3000-3499 g were found to have a relatively decreased risk of face presentation when compared with the general obstetrics group (P = 0.015 and 0.001, risk ratio = 2.948 and 0.450, respectively). With physical examination, only 70% were diagnosed correctly. CONCLUSION: Face presentation is a rare event and birthweight more than 4000 g was found to be associated with face presentation. Parity is not an associated factor.

Human papillomavirus, vaccines, and protection from cervical cancer.

Current published data makes clear the relationship between genital human papillomavirus (HPV) infection and cervical cancer. Although there is an opportunity for screening programs that could obviate the disease, cervical cancer still remains the second most common cancer among women worldwide. The subtypes HPV 16 and 18 affect the anogenital tract mucosal surfaces, and accounts for nearly 70% of all cervical cancers, and 90% or more of anal cancer cases. When the 493,000 new cases of cervical cancer and 274,000 deaths per year are taken into consideration, the importance of treatment and prophylaxis modalities for HPV can clearly be recognized. With the molecular and epidemiological studies that have focused on the oncogenicity and immunobiological structure of HPV, the main strategy is to develop prophylactic and therapeutic vaccines. Here, recent data concerning HPV infections and vaccination is discussed.

Superior ovarian nerve (SON) transection leads to stunted follicular maturation: a histomorphologic and morphometric analysis in the rat model.

Histomorphologic and morphometric effects of peripubertal superior ovarian nerve (SON) transection were evaluated during adult life in rats. Twenty Sprague-Dawley rats were randomly divided into two groups: the SON-transected (SON-t) group (n = 10) and the sham-operated control group (n = 10). Total follicle development was not influenced; however, follicular maturation was seriously stunted by the procedure, as evidenced by significantly thinner theca interna and follicular wall.

A case of nephrogenic diabetes insipidus caused by partial bilateral ureteral obstruction due to advanced stage ovarian carcinoma.

Nephrogenic diabetes insipidus (NDI) secondary to chronic urinary tract obstruction is a rare condition. The exact cause is unknown; it is likely that increased collecting duct pressures cause damage to the tubular epithelium, resulting in insensitivity to the antidiuretic hormone (ADH). We report a case of NDI associated with ureteral obstruction caused by advanced stage ovarian carcioma in a 20-year-old girl. After debulcking surgery, massive polyuria continued. Several administrations of an ADH analog were ineffective in reducing urine output, suggesting a possible relationship of massive polyuria with NDI. Following oral administration of a thiazide diuretic, known to exert antidiuretic action in NDI, the urine output was dramatically reduced. This case suggests that ureteral obstruction due to ovarian mass may cause NDI and after the surgery thiazide diuretics are effective in reducing urine output in NDI with ureteral obstruction.

Is leptin a significant predictor of bone mineral density in postmenopausal Turkish women?

The objective of the present study was to investigate the relationship between leptin and bone mineral density in postmenopausal Turkish women. A total of 122 healthy postmenopausal women were enrolled in this cross-sectional study. Blood samples were obtained for analysis of serum leptin. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the lumbar spine, femoral neck and trochanter on the same day. Leptin levels was significantly correlated with BMD of L(1-4) (P = 0.04), but not of femoral neck (P = 0.13), and trochanter (P = 0.39). However, Z scores of L(1-4) (P = 0.009), femur neck (P = 0.009), and femur trochanter (P = 0.025) were positively correlated with leptin levels. In multiple linear regression analysis, leptin was not found to be a statistically significant independent predictor for BMD. Leptin was associated with BMD and Z scores at various body sites; however, it was not an independent predictor of BMD.

An unusual case of lingual alveolar soft part sarcoma during pregnancy.

OBJECTIVE: We report a case of alveolar soft part sarcoma (ASPS) of the tongue that presented in the third trimester of pregnancy. CASE REPORT: An 18-year-old, gravida 1, para 0, woman with ASPS of the tongue in the 31st week of pregnancy was described. Approximately 4 months after her first diagnosis, she was referred to our clinic for the delivery of her baby and additional treatment. At 32 weeks of gestation, a healthy male infant weighing 2,220 g was delivered by cesarean section. After an uneventful postoperative course, she was referred to the department of otorhinolaryngology and maxillofacial surgery for further investigation and treatment. CONCLUSION: ASPS of the tongue presenting in pregnancy is an extremely rare combination, and to our knowledge, this is the first reported case in the English literature. The diagnostic and therapeutic management of the pregnant patient with cancer, like ASPS, is especially difficult, because it involves both the mother and fetus.

Does hysterectomy affect ovarian function? Histopathologic evaluation and serum FSH, inhibin A, and inhibin B levels in an experimental rat model.

OBJECTIVE: To evaluate the effects of hysterectomy with ovarian conservation on ovarian histology, and FSH, inhibin A, and inhibin B plasma levels. STUDY DESIGN: Forty-five female Wistar albino rats were used in this study and randomly divided into two groups: hysterectomy (n=30) and sham-operated (n=15). Blood samples were collected before and after (50 and 100 days) abdominal hysterectomy from both groups to measure plasma levels of FSH, inhibin A, and inhibin B. All animals were sacrificed by decapitation to obtain ovaries for histological examination. For statistical analyses, Mann-Whitney U, Chi-square, Wilcoxon matched pairs signed rank sum tests, and two-sided variance analysis were used and statistical significance was defined as p<0.05. RESULTS: There was no difference in hormonal variables between groups when the time interval was considered completely [p>0.05 (for FSH p=0.962; for inhibin A p=0.321; for inhibin B p=0.476)]. In the hysterectomy group, the inhibin B level at postoperative day 50 was significantly lower than the control group (p=0.007) and at postoperative day 100, inhibin A concentrations were increased significantly when compared with the levels at both baseline and postoperative day 50 (p<0.001). Histopathologic evaluation of ovaries 100 days after hysterectomy showed that ovaries from the hysterectomy group had significantly fewer primary (p=0.01), preantral (p<0.001), and antral follicles (p<0.001), and significantly more corpora lutea (p<0.001), atretic (p=0.02), and cystic follicles (p=0.003). CONCLUSION: The results of this experimental rat model suggest that hysterectomy may affect ovarian function.

Factors influencing the postpartum length of hospital stay in eclamptic women.

OBJECTIVE: To determine which variables are associated with postpartum length of hospital stay in eclamptic patients. MATERIALS AND METHODS: The study sample comprised 98 eclamptic patients who were admitted to our perinatology unit during the period between January 1998 and May 2003. The study sample was divided into two postpartum length-of-stay groups: the short-stay group (1-3 days) consisted of 33 patients and the long-stay group (4 days and longer) consisted of 65 patients. The groups were compared with respect to the demographic characteristics, clinical and laboratory variables, and complications. RESULTS: The mean hospitalization periods for the short-stay and long-stay groups were 2.48 +/- 0.79 and 5.60 +/- 2.12 days, respectively ( p = 0.010). The mean prepartum follow-up period after the onset of eclampsia was longer in the long-stay group than in the short-stay group (12.11 +/- 27.63 vs. 5.08 +/- 6.08 hours). The proportion of patients receiving magnesium sulfate therapy longer than 12 hours was higher in the long-stay group ( p = 0.014). The long-stay group had higher diastolic arterial blood pressure than that of the short-stay group ( p = 0.006). The total cesarean delivery rate for the short-stay group was 48.5%, compared with 67.7% in the long-stay group ( p = 0.081). CONCLUSION: The duration of magnesium therapy, the timing, and the mode of delivery should be individualized to reduce the length of hospital stay in eclamptic patients.

Severe perineal lacerations in nulliparous women and episiotomy type.

OBJECTIVE: To determine the patient-related factors associated with severe perineal lacerations in nulliparous women and to evaluate the effect of episiotomy type on the risk of severe perineal tears. STUDY DESIGN: In all, 400 nulliparous women admitted in labor between June and December 2001 were prospectively enrolled. Maternal height, perineal length, fetal birth weight, fetal head circumference, and severe perineal lacerations (third and fourth degrees) were recorded. RESULTS: The rate of severe perineal lacerations was 2% (8/400); 3% with midline, 1% with mediolateral groups. In patients with severe lacerations, perineal length was significantly (p < 0.001) shorter and the head circumference of their babies in the midline significantly (p < 0.05) greater than normal, and birth weights were also significantly (p < 0.05) greater in the mediolateral group. A cut-off value for perineal length of 3.05 cm was found for severe lacerations in the midline group. CONCLUSION: If episiotomy is to be performed, it must be borne in mind that patients with a perineal length of < or = 3 cm have an elevated risk of severe perineal lacerations, and if clinical or ultrasound examination suggests that the fetal head is large, mediolateral episiotomy may be preferred. Otherwise, midline episiotomy must be considered.

Predictive value of maternal serum and vaginal interleukin-6 levels in preterm labor.

OBJECTIVE: The aim of the current study was to evaluate the predictive value of maternal serum and vaginal interleukin 6 (IL-6) levels for preterm delivery before 37 gestational weeks in patients with preterm labor and to determine the probable relationship between IL-6 concentrations and delivery interval. METHODS: In this prospective study, maternal serum and vaginal IL-6 levels were measured in 40 patients with the diagnosis of preterm labor between the 28th and 36th gestational weeks (study group) and in 20 pregnant women between the same gestational weeks attending the antenatal clinic with no complaints (control group). The gestational age at the time of admission and delivery, as well as the delivery interval, were evaluated and compared with the concentration of IL-6 on admission. RESULTS: There were no significant relationships between maternal serum concentrations of IL-6 and preterm delivery. Vaginal IL-6 levels were significantly higher in the study group as compared with the control group (P < .001). The optimal cut-off value for vaginal IL-6 (172 pg/mL) gave a sensitivity level of 73.9% (95% confidence interval [CI], 67-82%) at a specificity of 100% (95% CI, 91-100%) with positive and negative predictive values of 94.1% and 83.7%, respectively. In the study group, the interval from collection to delivery was significantly shortened when the maternal vaginal IL-6 levels increased. CONCLUSION: The ease of measurement, feasibility, cost-effectiveness, and success of identifying pregnancies at risk for preterm labor with vaginal IL-6 make this a useful biochemical marker for preterm labor and delivery.