Objective: The objective of our study was to compare the adnexal torsion patients in different age groups clinically and pathologically. Methods: Sixty-eight patients who had applied with pelvic pain and adnexal torsion diagnosis had been confirmed intraoperatively were included in the study. Patients were divided into three groups based on their ages as the adolescent period (Group 1), reproductive period (Group 2) and postmenopausal period (Group 3). Ages, history of torsion, history of past operations, periods between the date of hospitalization and operation, periods of hospital stay, adnexa as the localization of torsion and number of tours of torsion were examined in groups. Mass lesions found during the operation and pathologic consequences of such masses were examined retrospectively and compared. Results: No statistically significant differences in torsion history, past operations, WBC and platelet values, neutrophil/lymphocyte ratios, preoperative fever, preoperative nausea and vomiting and preoperative Doppler US findings between the groups included in the studies (p>0,05). Although not statistically significant, WBC values were higher in the postmenopausal patient group, and it was notable that symptoms including fever, nausea and vomiting were absent in this group. The adolescent age group was the group with the least confirmation of torsion diagnosis following the operation with 13 (52%) patients. Upon evaluation of the operations carried out on patients, it was seen that mostly fertility preserving approaches were preferred for adolescent and reproductive patients with 88%, while more radical methods such as USO (72.7%) and TAH+BSO (18.2%) were preferred in postmenopausal patients. Ovarian tissue with torsion without any pathologic findings is more frequent in the adolescent period as compared to other groups (48%). In the postmenopausal period however, some pathology was found in the entire portion of the adnexa with torsion. In the postoperative evaluation of the pathology results of patients, no significant differences were observed as regards the diameters of cysts (p:0,207). There are significant differences between the histopathological types. Conclusion: Although statistically significant differences have not been observed as regards the clinic al presentation and laboratory findings based on age groups; it must be kept in mind that a mass lesion can accompany the torsion and the pathology of this mass can vary. Torsion must be remembered in pelvic pain in the adolescent age group because of the indistinct clinical findings and inadequacy of imaging methods.

Sir,We have recently read the paper by Fisher et al.(1) evaluating the complementary and alternative medicine use by women with cyclic perimenstrual pain and discomfort.In their review, the authors have reported that cyclic perimenstrual pain and discomfort was widely experienced by women across cultures, and that the papers they reviewed clearly showed women used complementary and alternative medicine to treat a wide range of cyclic perimenstrual pain and discomfort.We were surprised to see that although they have mentioned almost all of the popular complementary and alternative medical approaches througout the world, such as vitamin/mineral supplements, evening primrose oil, herbal teas, acupuncture, massage, mind body therapies, yoga and meditation, they have not mentioned local heat applications as a remedy for especially cyclic perimenstrual pain.Hosono et al.(2) mentioned that warming the abdomen/ lumbar region is a well-known non-pharmacological remedy for dysmenorrhea which often has been recommended by mothers to their daughters, and hot baths and heating pads for pain relief have been used widely by teenagers, as much as 75 and 50%, respectively.Similarly, Potur and K€ om€ urc€ u (3) reported that the use of heat in different forms, for example as a hot bag, a towel or in a bottle, traditionally has been used to ease menstrual pain in many cultures, and has had a long history in common use and folklore. They concluded that local low-dose heat application would be an easy to apply noninvasive method that could be recommended to relieve menstrual pain, and since it did not require any special equipment or an expert's application in a clinical setting, would also be economic and time efficient.Newsweek magazine, in their issue of 29 April 2016 (4), shows a picture of a young woman holding a heat bag over her pelvic region for its topic on menstruation, showing the wide acceptance of the method all over the world.We believe, since the authors have already a large amount of data in their hands, that they may like to consider adding a search on the use of heat applications as a form of complementary/alternative medicine. Clearly, a large population of women all over the world are motivated to use local heat applications in many forms during their menstrual period.On the other hand, they might have deliberately omitted to include heat applications for perimenstrual pain, in which case it would have been informative for readers if they had mentioned their reasons in their manuscript. References 1. Fisher C, Sibbritt D, Hickman L, Adams J. A critical review of complementary and alternative medicine use by women with cyclic perimenstrual pain and discomfort: a focus upon prevalence, patterns and applications of use and users' motivations, information seeking and selfperceived efficacy. Acta Obstet Gynecol Scand. 2016;95:861-71. 2. Hosono T, Takashima Y, Morita Y, Nishimura Y, Sugita Y, Isami C, et al. Effects of a heat-and steam-generating sheet on relieving symptoms of primary dysmenorrhea in young women. J Obst...

No abstract

No abstract