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Appendix mucinous cystadenoma mimicking a right adnexal mass
(Cukurova Univ, Fac Medicine, 2016) Kafadar, Mehmet Tolga; Kosem, Bahadir; Kirtis, Emine; Kosus, Nermin; Kosus, Aydin
Appendix mucocele is a mass formed by the dilatation of appendix lumen due to abnormal mucinous secretions. It develops as a result of epithelial proliferation, mucinous secretion, and luminal dilatation on the background of mucosal hyperplasia, mucinous cystadenoma, or mucinous cystadenocarcinoma. Appendix mucinous cystadenoma is the most common type that may have different clinical presentations. The preoperative diagnosis remains difficult and the pathology is usually detected during laparotomy. Despite concerns about the rupture risk of appendix mucoceles, laparoscopic surgery has been increasingly used for its treatment. Perforation of a lesion and spread of its contents into abdominal cavity produces a condition known as pseudomyxoma peritonei. In this paper we report a case of 75-year-old woman who was taken to the operating room to be operated for a right adnexial mass and but ultimately underwent laparoscopic appendectomy after detecting an appendix mucocele in laparoscopic exploration.
Can either oral glucose challenge test or oral glucose tolerance test parameters predict gestational diabetes mellitus?
(Springer India, 2017) Yildirim, Melahat; Kosus, Aydin; Kosus, Nermin; Hizli, Deniz; Akcal, Banu; Kosger, Hatice
This study aims to evaluate the relationship between the glucose challenge test (GCT) levels and any of the oral glucose tolerance test (OGTT) parameters (fasting plasma glucose (FPG), 1-, 2-, or 3-h plasma glucose levels) and their effect on predicting gestational diabetes mellitus (GDM). This analysis was carried out as a retrospective study at Obstetrics and Gynecology Clinic of Turgut A-zal University Hospital. Oral GCT were conducted on patients who are at 24-29 weeks' gestation. The study participants with positive GCT results underwent a 3-h, 100-g OGTT, and the resulting values were evaluated using Carpenter and Coustan diagnostic criteria to determine the gestational glucose tolerance status of patients. The data obtained from both tests (GCT, FPG, 1-, 2-, 3-h OGTT values) were analyzed to observe the effect of each group on predicting GDM. Although all of the GCT and OGTT values were found to be statistically significant (p < 0.001) in determining GDM, the 2-h values of OGTT detected almost all GDM cases with a very high sensitivity level (94.5 %). The 1-h values on the other hand identified 87.6 % of GDM (p < 0.001). The GCT value with the highest sensitivity and specificity for predicting GDM was calculated as 154.50 mg/dl (sensitivity and specificity rates were 79.2 and 72.8 %, respectively). A 2-h OGTT glucose level can detect GDM with 94.5 % sensitivity. This result can guide clinicians to evaluate the patients with GDM.
CRP, HbA1c, lipid, and biochemical parameters and their relation with maternal visceral adipose tissue and subcutaneous fat tissue thickness
(Tubitak Scientific & Technological Research Council Turkey, 2016) Duran, Muzeyyen; Kosus, Aydin; Kosus, Nermin; Turhan, Nilgun
Background/aim: The aim of this study was to find whether maternal visceral tissue (VAT) or subcutaneous fat tissue (SCFT) thicknesses are associated with CRP, HbA1c, lipid, and biochemical parameters in the first trimester of pregnancy. Materials and methods: Ninety pregnant women were enrolled. Body mass index (BMI), VAT, and SCFT were measured. The best cutoff points for grouping subjects were found to be 4 cm for VAT and 2 cm for SCFT. Venous blood samples were collected. Results: VAT was higher than 4 cm in all cases with high BMIs. High CRP and HbA1c were found in 45.5% and 18.2% of cases with VAT over 4 cm, respectively. Conclusion: Besides overall obesity, VAT thickness is the most important parameter. Decreasing obesity may prevent pathologies caused by inflammation during pregnancy as well as decrease the risk for future metabolic and cardiovascular disorders.
Does vitamin E prevent tubal damage caused by smoking? A light microscopy and animal study
(Elsevier Science Bv, 2014) Duran, Muzeyyen; Ustunyurt, Emin; Kosus, Aydin; Kosus, Nermin; Turhan, Nilgun; Hizli, Deniz; Sarac, Gulce Naz
Objective: To assess the histomorphological effects of smoking on the cilia of fallopian tubes in mice and the effect of vitamin E on the negative effects of smoke. Study design: Eighteen 12-14 week-old Swiss albino type female mice were randomly divided into three groups, each consisting of six mice: Group A: control group; Group B: mice exposed to cigarette smoke; Group C: mice exposed to cigarette smoke together with vitamin E. Groups B and C were exposed to cigarette smoke for 10 weeks. After 10 weeks, tubal excision was performed in all animals. Histopathologic examination of excised tubal tissue was conducted under light microscopy. Results: The number of cilia was significantly lower in Group B. Although not statistically significant, the median number of cilia in Group C was measured to be higher than in Group B but lower than in Group A. Conclusion: Based on the results, it can be concluded that smoking decreases tubal cilia numbers. Supplementation by vitamin E may treat or at least help to slow down the decrease in number of cilia caused by smoking; therefore it could be used therapeutically in the treatment of smoking-related tubal damage. Crown Copyright (C) 2014 Published by Elsevier Ireland Ltd. All rights reserved.
Effect of combined oral contraceptive use on serum 25-hydroxy vitamin D levels and ultrasound parameters in patients with polycystic ovary syndrome
(Taylor & Francis Ltd, 2016) Kalem, Mueberra Namli; Hizli, Deniz; Kamalak, Zeynep; Kosus, Aydin; Kosus, Nermin; Turhan, Nilgun; Kafali, Hasan
Purpose: To investigate if there is an effect of combined oral contraceptive (COC) use on serum 25-hydroxy vitamin D [25(OH)D] levels in patients with polycystic ovary syndrome (PCOS). Methods: PCOS was defined by the 2003 Rotterdam criteria. All patients with PCOS were treated with a COC containing 0.035 mg ethinylestradiol and 2 mg cyproterone acetate for 6 months. Serum 25(OH)D levels, HOMA-IR, ovarian volume and antral follicule count were measured before and after the treatment. Results: The median 25(OH)D levels were 9.40 (range 4.40-24.50) mu g/l and 7.00 (5.00-13.50) mu g/l before and after COC use, respectively. Serum 25(OH)D levels decreased after the treatment; however, the difference was not statistically significant (p = 0.055). Conclusion: This study seems to be the first prospective trial revealing the effect of COC use on serum 25(OH)D levels in women with PCOS. Although the decrease in serum 25(OH)D levels in patients with PCOS with the use of COC alone, did not reach to statistically significance level after 6 months treatment with COC.
Effect of Underlying Infertility Factors on Second Trimester Serum Screening Results
(Sci Printers & Publ Inc, 2014) Kosus, Nermin; Kosus, Aydin; Duran, Muzeyyen; Turhan, Nilgun O.
OBJECTIVE: To determine whether assisted reproductive technologies (ART) alone or an underlying cause of infertility has any effect on second trimester serum screening results. STUDY DESIGN: Second trimester serum screening results of ART pregnancies of women with polycystic ovary syndrome (IVF-P group) were compared with those of women who underwent ART dike to male factor infertility (IVF-M group) and of women who conceived spontaneously. RESULTS: Comparison of the groups for a-fetoprotein, beta-hCG, and beta-hCG multiples of the median (MoM) revealed a significant difference between the IVF-M and control groups. Comparison of groups for unconjugated estriol (uE(3)) and uE(3) MoM levels revealed a statistically significant difference between the IVF-P versus the control groups. CONCLUSION: It seems advisable to use a population of ART pregnancies, preferably divided by type of treatment and the etiology of the infertility, when establishing median curves for second trimester serum screening markers.
Effects of curcumin on ovarian ischemia-reperfusion injury in a rat model
(Spandidos Publ Ltd, 2015) Eser, Ayla; Hizli, Deniz; Haltas, Hacer; Namuslu, Mehmet; Kosus, Aydin; Kosus, Nermin; Kafali, Hasan
Ischemia-reperfusion injury is a significant problem following reperfusion treatment for ovarian torsion. It is generally caused by reactive oxygen species-induced damage. Antioxidant agents, such as curcumin, may protect ovaries from this adverse effect. The aim of the present randomized, controlled study was to evaluate the short-term protective effect of curcumin on a rat model of ovarian ischemia-reperfusion injury. A total of 30 female Wistar albino rats, weighing 160-230 g, were divided into 2 groups depending upon the time of unilateral, left ovary ischemia/reperfusion (group 1, 2 h ischemia/2 h reperfusion and group 2, 4 h ischemia/4 h reperfusion). These groups were subdivided into 3 subgroups (sham, control and curcumin). The sham subgroups were not subjected to ischemia/reperfusion. Control and curcumin subgroups were performed under ischemia for 2 h plus 2 h reperfusion or 4 h ischemia plus 4 h reperfusion. Curcumin, 200 mg/kg, was intraperitoneally administered simultaneously with reperfusion to the curcumin subgroups. Serum nitric oxide (NO), NO synthase (NOS), xanthine oxidase (XO), total antioxidant status (TAS), total oxidant status (TOS) and histological scores were measured and compared between subgroups. For group 1, no significant differences were observed between NO, NOS, XO, TAS or TOS. The left ovary histological grade was significantly higher in the control and curcumin subgroups compared with the sham subgroup (P=0.036). For group 2, TOS was significantly higher in the control group compared with the sham and curcumin groups (P=0.023). However, TAS was also significantly higher in the control subgroup compared with the other 2 subgroups (P=0.005). Left ovary histological grade was significantly higher in the control and curcumin subgroups compared with the sham subgroup (P=0.038). No significant differences were observed between NO, NOS or XO between the group 2 subgroups. The results showed that curcumin exerted no major significant protective effect on ischemia-reperfusion injury in the rat ovary.
Factors affecting the rates of caesarean sections in cases with premature rupture of membranes (PROM) at term
(Taylor & Francis Inc, 2017) Kalem, Muberra Namli; Kosus, Aydin; Kamalak, Zeynep; Kosus, Nermin; Kalem, Ziya
The aim of this retrospective study was to investigate the factors affecting the rates of caesarean section in cases with premature rupture of membranes (PROM) in term pregnancies. Eighty-two term PROM patients who presented to Turgut Ozal University and Erzurum Nene Hatun Hospitals between 2012 and 2014 were included. The effects of demographics, nulliparity, active-latent phase durations, presence of meconium and chorioamnionitis, requirement of oxytocin and cervical dilation at the initial examination on C/S rates were assessed. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%. C/S rates did not change with other variables. We conclude that the factors increasing the risk for C/S in PROM at term group are not different from the non-term PROM.Impact statementThe aim of this retrospective study was to investigate the factors affecting the rates of caesarean section (C/S) in cases with premature rupture of membranes (PROM) in term pregnancies. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%.We conclude that the factors increasing the risk for C/S in PROM at term group, are not different from the non-term PROM groups.Currently, the PROM is considered the start of a pathological process in both term and preterm pregnancies and also considered to increase the rates of caesarean sections. Studies on the management of PROM at term have concentrated rather on whether to intervene for accelerating the labour or spontaneous monitorisation. As found by the studies like this one in the literature, the factors having an impact on C/S rates in the cases of PROM at term are similar to those of non-PROM patients at term, may prevent clinicians from taking an invasive or aggressive approach towards the cases of PROM at term.
Gut satiety hormones and hyperemesis gravidarum
(Springer Heidelberg, 2015) Kosus, Aydin; Kosus, Nermin; Usluogullari, Betul; Hizli, Deniz; Namuslu, Mehmet; Ayyildiz, Abdullah
Hyperemesis gravidarum (HG) is described as unexplained excessive nausea and vomiting during pregnancy. Some gut hormones that regulate appetite may have important role in etiopathogenesis of HG and weight changes during pregnancy. In this study, levels of gut satiety hormones were evaluated in pregnant women with HG. Methods This prospective case-control study was conducted in 30 women with HG and 30 healthy pregnant women without symptoms of HG. Fasting venous blood samples were taken from all subjects for measurement of plasma gut hormone levels; obestatin (pg/mL), peptide YY (PYY), pancreatic polypeptide (PP) and cholecystokinin (CCK). Results Plasma PYY and PP levels were significantly higher in HG group. The most important parameter in diagnosis of HG was plasma PP level. Simple use of PP level led to the diagnosis 91.1 % of HG cases correctly. The single most important parameter in the prediction of HG was also PP level. Conclusion Anorexigenic gut hormones might have important role in etiopathogenesis of hyperemesis gravidarum and weight changes during pregnancy.
Hyperemesis gravidarum and its relation with maternal body fat composition
(Taylor & Francis Inc, 2016) Kosus, Aydin; Eser, Ayla; Kosus, Nermin; Usluogullari, Betul; Hizli, Deniz
The objective of this study was to determine if maternal body fat composition and body mass index were associated with hyperemesis gravidarum (HG) in the first trimester of pregnancy. Healthy pregnant women (n=30) without nausea and vomiting (control group) and women with HG (n=54; study group), all with singleton pregnancy at 6-14weeks gestational age, were included. Body mass index was measured before and during pregnancy. Visceral adipose tissue (VAT) and subcutaneous fat thickness were measured during pregnancy. Comparison of the groups revealed that VAT and pre-pregnancy body mass index but not subcutaneous fat thickness were significantly higher in the HG group versus controls. VAT and pre-pregnancy body mass index predicted 83.8% and 67.1% of HG cases, respectively. VAT and pre-pregnancy body mass index were correlated with the development of hyperemesis gravidrum and hence could be considered as predictive markers for HG.
Is There a Relationship Between Pelvic Organ Prolapse and Tissue Fibrillin-1 Levels?
(Korean Continence Soc, 2015) Eser, Ayla; Unlubilgin, Eylem; Hizli, Fatih; Acar, Muradiye; Kamalak, Zeynep; Kosus, Aydin; Kosus, Nermin
Purpose: Pelvic organ prolapse is a multifactorial disorder in which extracellular matrix defects are implicated. Fibrillin-1 level is reduced in stress urinary incontinence. In Marfan syndrome, which is associated with mutations in Fibrillin-1, pelvic floor disorders are commonly observed. We hypothesize that Fibrillin-1 gene expression is altered in pelvic organ prolapse. Methods: Thirty women undergoing colporrhaphy or hysterectomy because of cystocele, rectocele, cystorectocele, or uterine prolapse were assigned to a pelvic prolapse study group, and thirty women undergone hysterectomy for nonpelvic prolapse conditions were assigned to a control group. Real-time polymerase chain reaction was conducted on vaginal tissue samples to measure the expression of Fibrillin-1. Expression levels were compared between study and control groups by Mann-Whitney U test with Bonferroni revision. Results: Fibrillin-1 gene expression was not significantly lower in the study group than in the control group. Similarly, no significant correlation between Fibrillin-1 levels and grade of pelvic prolapse was found. Age over 40 years (P = 0.018) and menopause (P = 0.027) were both associated with reduced Fibrillin-1 levels in the pelvic prolapse group, whereas the delivery of babies weighing over 3,500 g at birth was associated with increased Fibrillin-1 expression (P = 0.006). Conclusions: The results did not indicate a significant reduction in Fibrillin-1 gene expression in pelvic prolapse disorders; however, reduced Fibrillin-1 may contribute to increased pelvic organ prolapse risk with age and menopause. Increased Fibrillin-1 gene expression may be a compensatory mechanism in cases of delivery of babies with high birth weight. Further studies are needed for a better understanding of these observations.
Is there any effect of demographic features on development of hyperemesis gravidarum in the Turkish population?
(Tubitak Scientific & Technological Research Council Turkey, 2013) Kamalak, Zeynep; Kosus, Nermin; Kosus, Aydm; Hizli, Deniz; Ayrim, Aylin; Kurt, Gonca
Aim: To assess the effect of maternal demographic variables on development of hyperemesis gravidarum (HG) in pregnant Turkish women. Materials and methods: Two hundred consecutive women with HG were defined as the study group, and 200 consecutive pregnant women without any signs or symptoms of HG matched for age, parity, and gestational age were defined as the control group. Personal information, including lifestyle, educational level, occupation, and economic status were obtained via questionnaire. Results: The number of abortions was higher but parity was lower in the HG group. The time interval between 2 pregnancies was significantly shorter in the HG group than in the control group. HG developed in all women who had HG in a previous pregnancy. HG was significantly higher in women who graduated from high school or university. Level of monthly income and communication within the family have an effect on development of HG. Logistic regression analysis showed that the most important parameters for prediction of HG were education level, age at marriage, and previous history of abortus. Conclusion: Living conditions, life standards, communication, and experiences in previous pregnancies might affect development of HG.
Nail alterations during pregnancy: a clinical study
(Wiley-Blackwell, 2016) Erpolat, Seval; Eser, Ayla; Kaygusuz, Ikbal; Balci, Hatice; Kosus, Aydin; Kosus, Nermin
During pregnancy, cutaneous and appendageal alterations manifest and may cause concern in the subject. The nails may be affected by pregnancy. This study investigated the frequency and nature of nail changes occurring during pregnancy in 312 healthy, 18-40-year-old pregnant women in gestation weeks 16-40. After a routine obstetric examination at the obstetrics and gynecology clinic at the study institution, all subjects submitted to an examination of all fingernails and toenails. Only nail alterations that had developed during pregnancy were recorded. Any nail changes that had occurred before the start of gestation were not considered. Data were presented as percentages. The Shapiro-Wilk and chi-squared tests were used to make categorical comparisons. A P-value of < 0.05 was considered to indicate statistical significance. No nail pathologies were detected in 116 (37.2%) of the 312 subjects. The most commonly found nail change was leukonychia (24.4%). Ingrown toenail (9.0%) and onychoschizia (9.0%) represented the second most common nail changes. Rapid nail growth and subungual hyperkeratosis were observed in 6.7% and 4.2%, respectively, of subjects. When the alterations were evaluated according to gestational age, the most common nail pathology was leukonychia at both 14-28 weeks (16.3%) and 29-42 weeks (27.4%) of pregnancy. Leukonychia, onychoschizia, onycholysis, and brittle nail pathologies were frequently observed at 29-42 weeks of pregnancy (P = 0.047). A large proportion of nail changes that occur during pregnancy are benign and do not require treatment. However, these changes may cause significant cosmetic stress in women.
Relation between abdominal subcutaneous fat tissue thickness and inflammatory markers during pregnancy
(Termedia Publishing House Ltd, 2014) Kosus, Nermin; Kosus, Aydin; Turhan, Nilgun
Introduction: Subcutaneous abdominal fat thickness (SCFT) is important for predisposition to metabolic and cardiovascular diseases. Our aim was to evaluate maternal SCFT and metabolic changes (such as insulin resistance and high inflammatory markers) during pregnancy. Material and methods: A total of 92 pregnant women between 24-28 weeks of gestation were enrolled in the study. The SCFT was measured by ultrasonography and patients were divided into 2 groups according to thickness of maternal SCFT and body mass index (BMI). Groups were compared with each other for oral glucose loading test (OGL) results, and for haematological, biochemical and fetal biometric parameters. Results: After analysis of frequency for SCFT, the most appropriate cut-off value for grouping patients was found to be 15 mm for SCFT. In 48 cases SCFT was over 15 mm. High C reactive protein (CRP) was found in 47.9% (23) of cases with SCFT over 15 mm. Serum haemoglobin A(1c) (HbA(1c)) level was significantly correlated with SCFT thickness. The most important factors for determination of OGL level were found to be serum HbA(1c) level, BMI and SCFT In obese subjects (BMI >= 25 kg/m(2)), levels of inflammatory markers and SCFT thickness were higher. The CRP and gamma-glutamyltransferase (GGT) levels were significantly correlated with BMI and SCFT. Conclusions: High SCFT during pregnancy is associated with elevated inflammatory marker levels and HbA(1c). Pregnant women with thicker SCFT may be susceptible to the development of metabolic complications of pregnancy, such as gestational diabetes mellitus (GDM) and hypertension, as well as risk of future metabolic and cardiovascular disease.
Relation between serum PAPP-A level and umbilical cord thickness during first trimester of pregnancy
(Taylor & Francis Ltd, 2014) Duran, Muzeyyen; Kosus, Aydin; Kosus, Nermin; Turhan, Nilgun O.
Purpose: To evaluate the relation between umbilical cord diameter versus pregnancy associated plasma protein-A (PAPP-A) level in first trimester women. Method: Cord diameter were measured and patients were divided into two groups according to frequency distribution analysis as below or above 3.7 mm for free loop diameter (FCD) and below or above 3.4 mm for cord measurement at umbilicus (ACD). Groups were compared with each other. Results: Strong correlations were found between ACD versus PAPP-A. Conclusion: By using strong correlation between ACD versus PAPP-A, it may be possible to reduce unnecessary amniocentesis due to false positive screening results.
Relationship between placental localisation, birth weight, umbilical Doppler parameters, and foetal sex
(Tubitak Scientific & Technological Research Council Turkey, 2014) Duran Erdolu, Muzeyyen; Kosus, Aydin; Kosus, Nermin; Dilmen, Gulcin; Kafali, Hasan
Background/aim: The aim of this study is to examine the relationship between placental localisation, birth weight, and foetal sex. It also evaluates umbilical artery Doppler parameters and their relationship with placental localisation. Materials and methods: This is a retrospective study of 500 healthy pregnant women who gave birth at our university. All women had undergone a detailed ultrasound and Doppler examination at 20-23 weeks. The ultrasonography results of the patients were examined retrospectively. Foetal biometry, birth weight, and umbilical artery Doppler parameters were recorded and compared according to placental localisation. Results: Birth weight was significantly higher in foetuses with anteriorly located placenta. The incidence of female foetuses was higher (62%) in relation to anteriorly located placentas, whereas male incidence was higher (51.9%) in relation to posterior placentas. A comparison of Doppler parameters between groups revealed significantly higher pulsatility index (PI) and resistance index (RI) values in posteriorly located placentas. Conclusion: Foetal sex might affect placental localisation. Doppler parameters and birth weight might also differ according to placental side. These factors should be taken into consideration during the evaluation of obstetric patients.
The Effect of Body Mass Index on Acne, Hirsutism and Menstrual Irregularity Symptoms in Turkish Adolescent Girls
(Gazi Univ, Fac Med, 2013) Hizli, Deniz; Kosger, Hatice; Hacivelioglu, Servet; Kosus, Nermin; Kosus, Aydin; Kamalak, Zeynep; Akcal, Banu
Purpose: The aim of the present study was to determine whether body mass index (BMI) influences polycystic ovary syndrome (PCOS) related symptoms such as acne, hirsutism and menstrual irregularity in a large healthy adolescent population. Methods: Self-administered questionnaires were distributed to all volunteer female students at 15 different secondary schools. The subjects' BMI, birthweight, age at menarche, pattern of menstrual cycle and presence of acne or hirsutism complaints were recorded. Subjects with BMI of = 18.4 kg/m 2, 18.5-24.9 kg/m(2), 25-29.9 kg/m(2) and > 30 kg/m(2) were defined as group 1, group 2, group 3 and group 4, respectively. The relation between BMI and the symptoms of acne, hirsutism and menstrual irregularity was analyzed. Results: A total of 1309 students filled the questionnaires properly and included in the study. Of these students, 314 were in group 1, 899 in group 2, 81 in group 3 and 15 in group 4. The median ages of participants were 16 years (range 13-20 years) and median age at menarche was 13 years (range of 11-16 years). A total of 106 (8.1%) participants reported various menstrual irregularity. Underweighed girls had significantly less acne (p= 0.001) and hirsutism problems (p<0.001) compared to normo weighed girls. Hirsutism incidence was significantly higher in overweighed girls than in normo weighed subjects (p<0.001). Conclusion: The present study provided the prevalence of PCOS related symptoms in population, including menstrual irregularity, acne and hirsutism according to BMI in a large adolescent population. Our results showed that menstrual irregularity was not significantly increased as BMI increased, however acne and hirsutism problems were significantly increased as BMI increased.
Transcervical intrauterine levobupivacaine or lidocaine infusion for pain control during endometrial biopsy
(Pulsus Group Inc, 2014) Kosus, Nermin; Kosus, Aydin; Demircioglu, Ruveyda I.; Simavli, Serap A.; Derbent, Aysel; Keskin, Esra Aktepe; Turhan, Nilgun O.
BACKGROUND: Endometrial biopsy is a common procedure for the investigation of many gynecological disorders including abnormal uterine bleeding, postmenopausal bleeding, abnormal cytology and infertility. Most women experience some degree of discomfort and pain during the procedure. Pain may occur during dilation of the cervix for insertion of the catheter and during endometrial biopsy, which further aggravates pain by inducing uterine contraction. Objectives: To determine pain levels during endometrial biopsy by comparing intrauterine instillation of levobupivacaine or lidocaine with placebo in a randomized, double-blinded trial in pre- and postmenopausal women. Methods: Ninety patients were allocated to either control or experimental groups before endometrial biopsy. The trial medication was intrauterine anesthesia, either 5 mL 0.9% saline (control group), or 5 mL 0.5% levobupivacaine or 2% lidocaine (experimental groups). Resident doctors used the same endometrial biopsy technique to minimize the risk of technical variation. All tissue specimens were sent for cytopathological examination. The pathologists, who were blinded to the study solution, analyzed all tissue specimens. The primary outcome measure was pain experienced during the procedure. Pain was assessed using a 10 cm visual analogue pain scale. All observed adverse effects were recorded until the patients were discharged. Results: Pain scores of the intrauterine lidocaine and levobupivacaine groups were found to be significantly lower than the control group. There was no difference between the levobupivacaine and lidocaine groups with regard to pain scores. There was a moderately positive correlation between pain scores and endometrial thickness. No complications were observed due to the procedure. Most of the biopsy results were proliferative and secretory endometrium. Insufficient material causing inconclusive results was observed mostly in the control group. Conclusion: Transcervical intrauterine topical instillation of levobupivacaine or lidocaine causes pain relief during endometrial biopsy. However, further studies are needed to evaluate the effectiveness of intrauterine anesthesia, to determine optimal concentration, volume and waiting time according to the type of local anesthetic agent, and to assess the applicability of the method to other intrauterine procedures.
Treatment of Ruptured Ovarian Endometrioma with Extremely High CA 125, Moderately High CA 19-9 and CA 15-3 Level
(Derman Medical Publ, 2013) Duran, Muzeyyen; Kosus, Aydin; Kosus, Nermin; Duvam, Candan; Kafali, Hasan
In this case report, a ruptured ovarian endometrioma with a very high CA-125 level, moderately elevated CA 19-9, and CA 15-3 levels is presented. A 20 years old patient, complaining from pelvic pain, 5 cm adnexial mass was detected on left side. Biochemical examination was revealed very high CA-125 value (2556IU/ml), moderately elevated CA 19-9 (134IU/ml), and CA 15-3 (65IU/ml) values. Laparoscopy was done and a ruptured ovarian endometrioma of 5 cm was seen during operation. After the total excision of the cyst, tumor markers fell rapidly. Very high CA-125 value, moderately elevated CA19-9, and CA 15-3 values can be seen in cases with ruptured endometrioma. In young patients, endometrioma must be considered firstly and laparoscopy should be applied instead of more invasive methods unless there was any finding or strong suspicion about malignancy.

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