Journal of the Turkish German Gynecological Association最新文献

Currently, there is limited information available on the best course of action for advanced epithelial ovarian cancer (OC) with isolated extra-peritoneal disease in the cardiophrenic lymph nodes. Recently, there have been numerous reports of successful surgical removal of metastatic cardiophrenic lymph nodes in patients with OC, mostly during primary or interval cytoreduction procedures. However, the optimal management of isolated, extra-peritoneal cardiophrenic lymph node metastasis (ICLNM) remains unclear, since this clinical scenario is rather uncommon in OC and chemotherapy is so far the indicated treatment for patients with from advanced stage disease. We searched the English-language literature for cases of OC with ICLNM or recurrence, evaluating the feasibility and safety of surgical excision. From 2009 to 2022 only 11 cases were reported. In seven the tumor was of serous histology. ICLN was detected in five cases with primary disease and in the remaining six it was recurrence of OC. The primary disease was treated in 10/11 patients with primary cytoreduction while the other received systemic chemotherapy. The ICLNM was removed in all the patients, in 10 via video-assisted thoracic surgery and in one via transdiaphragmatic incision. Median follow-up was 10 months.

Objective: The aim of this study was to investigate the efficacy of injectable, platelet-rich fibrin (PRF) for the treatment of vaginal atrophy, also known as genitourinary syndrome of menopause (GSM), which may affect a third of a woman's lifespan.

Material and methods: This study included postmenopausal patients who had symptoms of genitourinary syndrome, such as vaginal burning, dryness, itching, and sexual dysfunction. Injectable platelet-rich fibrin (i-PRF) was applied to three areas on the posterior vaginal wall twice, one month apart. The genitourinary symptoms of the patients were evaluated using the female sexual function index (FSFI) and sexual life quality questionnaire before and one and six months after the procedure.

Results: Thirty-five patients were recruited with a mean age of 54.1±5.5 years. The analysis of the desire, arousal, lubrication, orgasm, satisfaction, pain, and total scores of the pre-procedural and post-procedural FSFI and sexual life quality questionnaire scores revealed significant improvements (p<0.001).

Conclusion: i-PRF treatment provided advantages such as safe and easy application, autologous material nature, absence of procedure-related complications or side effects, short procedure time, absence of the need for hospitalization, low cost, and a non-hormonal nature. These results suggest that injectable, PRF may be a promising treatment option in patients with symptoms of GSM. However, larger randomized controlled studies are needed to confirm and validate our findings.

There is a growing need for dental treatments in women during the puerperal period as a consequence of hormonal and physiological changes that occur. There are effective methods that dentists can apply while treating patients in the puerperal period and while ensuring the maintenance of treatment. The framework of these methods covers a wide range of subjects, from the examination and diagnosis process of the dentist to the treatment protocols and the oral hygiene motivation of the patient. This review focuses on restorative treatment protocols that dentists would apply to patients in the puerperal period and the maintenance of these treatments.

Objective: The aim was to find a cost-effective, more practical method to be used in the early gestational weeks as an alternative to the oral glucose tolerance test (OGTT) for predicting gestational diabetes mellitus (GDM). The method selected was adipose tissue measurements made in the first trimester.

Material and methods: The study was designed as a prospective, cohort study. Ultrasound images were used to calculate abdominal visceral (VAT) and subcutaneous adipose tissue (SAT) thicknesses of the first trimester pregnant women. Two groups were formed: those who were diagnosed with GDM and those who were not, based on the results of the OGTT performed in the same patients at 24^th-28^th weeks of gestation. Ultrasonographic records were examined and compared between these two groups using received operator characteristic curves and logistic regression analyses.

Results: A total of 292 pregnant women were included, of whom 21.2% were diagnosed with GDM. In the group diagnosed with GDM, SAT, VAT and total adipose tissue (TAT) values were significantly higher than the women who did not have GDM. Threshold values for SAT, VAT and TAT were 18 mm, 55 mm and 55 mm.

Conclusion: First trimester SAT, VAT and TAT measurements of pregnant women with GDM were significantly higher than those without GDM diagnosis. Although our results showed that adipose measurements cannot be an alternative to OGTT; they may be a powerful aid in identify at-risk pregnant women, suggesting to perform an early OGTT in the first trimester.

Objective: To assess the influence of basal serum levels of luteinizing hormone (LH), total testosterone (TT), and free testosterone (FT) on in vitro fertilization (IVF) success rates in patients with polycystic ovary syndrome (PCOS).

Material and methods: A retrospective cohort analysis of PCOS patients who underwent freeze-all, gonadotropin releasing hormone (GnRH) antagonist IVF protocols from January 2013 to December 2019. Patients were grouped based on median basal serum levels of LH, TT, and FT to compare their IVF outcomes.

Results: A total of 76 women with PCOS diagnosed as per the 2003 Rotterdam criteria were included. When analyzed by LH levels, groups had similar baseline characteristics except for higher mean ± standard deviation TT (1.4±0.9 vs. 1.9±0.9 nmol/L, p=0.02) and FT (0.6±0.5 vs. 0.9±0.5 nmol/L, p=0.03) in the elevated LH group. However, clinical pregnancy rates (CPR) (34.2% vs. 44.7%, p=0.35) and live birth rates (LBR) (21.0% vs. 31.6%, p=0.29) were not different. The group with lower TT had more previous pregnancies (0.9±1.2 vs. 0.3±0.7, p=0.02) and shorter infertility duration (2.3±2.0 vs. 3.7±2.7 years, p=0.04), but again CPR (46.8% vs. 42.8%, p=0.90) and LBR (37.5% vs. 25.7%, p=0.33) were similar. FT analysis revealed no significant differences in CPR (48.2% vs. 36.7%, p=0.36) and LBR (23.2% vs. 37.9%, p=0.22) despite higher TT (1.1±0.4 vs. 2.2±1.1 nmol/L, p<0.001) and LH (6.1±3.8 vs. 11.2±7.2 IU/L, p<0.001) in the high FT group.

Conclusion: Basal serum levels of LH, TT, and FT did not significantly affect IVF outcomes in patients with PCOS using GnRH antagonist, freeze-all protocols.

Stress urinary incontinence (SUI) is a fairly common disease among women. Synthetic meshes are frequently used in midurethral sling procedures due to the high long-term success rates. Because of the publications about vaginal mesh complications in recent years, urogynecologists are turning to techniques without mesh. The purpose of this video is to show that SUI can be treated without mesh complications by utilizing the meshless urethropexy technique. A 50-year-old woman applied to our urogynecology department with complaints of incontinence. Physical examination, stress test, Q-tip test, urine test and transperineal ultrasound performed. Post-void residual urine measured. The patient completed incontinence questionnaires: urogenital distress inventory-6, incontinence impact questionnaire-7. After discussing results SUI was diagnosed. Treatment options were offered to the patient. Due to mesh complications concern the patient preferred this approach and underwent urethropexy. The steps of meshless urethropexy technique was demonstrated in this video. SUI can be treated with this approach without worrying about mesh complications, but long-term results are needed.