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Objective:The aim of our study is to assess the risk factors for medical treatment failure and to predict the patients who will require the surgical therapy as well as to predict the factors affecting treatment success. Material and Methods:This was a cross-sectional study including 76 women with tubo-ovarian abscesses (TOA) who were either conservatively or surgically treated and were admitted to two gynecology units over a 4-year period. The demographic characteristics of the patients, gynecologic and obstetric histories, size and localization of abscesses were recorded. Gentamicin plus clindamycin treatment protocol was implemented for all patients. Ampicillin treatment was added in three patients with the positive culture of Actinomyces. Response to treatment was evaluated after 48-72 h. Patients who fail to respond to medical treatment required surgery or percutaneous drainage. We compared clinical and laboratory factors between the groups. Results:In surgery group, patients were significantly older than the others (44.9±5.4 versus 39.1±7.6 years). Fifty-six patients (74%) responded to antibiotics and 20 of the patients required surgical intervention. Patients treated with antibiotics were hospitalized for an average of 6.32±2.8 days versus 12.75±5.6 days for those who required surgery (p=0.021). Patients who were surgically treated had a mean size of TOA of 67.9±11.2 mm versus 53.6±9.4 mm for those treated with antibiotics alone (p=0.036). There were no significant differences between groups in laboratory parameters, except for initial white blood cell (WBC) counts. The complications of surgery included in descending order of frequency blood transfusions, surgical wound infections, bowel injury, and bladder injury. Conclusion:An increased size of pelvic mass, higher initial WBC counts, advanced age, and smoking were all associated with failed response to conservative treatment. It is important to identify the risk factors to distinguish patients who will respond to antibiotic therapy and those who will need a surgical treatment. Thus, the required early intervention can result in a reduction in the morbidity associated with TOA. (J Turk Ger Gynecol Assoc 2015; 16: 226-30) Keywords: Antibiotic therapy, pelvic abscess, surgery, tubo-ovarian abscesses Received: 01 July, 2015 Accepted: 06 August, 2015 Available Online Date: 02 November, 2015 The evaluation of risk factors for failed response to conservative treatment in tubo-ovarian abscesses Material and MethodsThis was a cross-sectional study including 76 women with TOA who were either treated conservatively (group 1) and surgically (group 2) and were admitted to two gynecology units over a 4-year period. The study was subject to local ethics committee's approval, and written informed consent was obtained from patients who participated in this study. All authors and the study protocol have complied with the World Medical Association Declaration of Helsinki regarding the ethical conduct of research involving human subjects. In this study, some of t...

Although increased TOA size, fever at admission, and parity were associated with increased odds of patients with TOA requiring surgical treatment, ultrasonographic TOA morphology was not.

Aim: To evaluate the treatment of endometrial hyperplasia (EH) with different progestins. Methods: Eighty-two women with simple EH without atypia were included. Patients were offered oral progestagens and were randomized to one of three options for 3 months: medroxyprogesterone acetate (MPA, 10 mg/day), lynestrenol (LYN, 15 mg/day) and norethisterone (NET, 15 mg/day) for 10 days per cycle. Patients were reevaluated after treatment. Women diagnosed with proliferative and nonatypical EH at the second curettage were offered the same progestins for another 3 months. The primary outcome of the study was the proportion of women requiring further treatment. Results: Of the 82 women, 46 (56.1%) received MPA (23.2%), LYN (13.4%) and NET (19.5%) therapy for another 3 months at the end of the first 3 months of treatment. The patients receiving MPA showed resolution in 36.7% of the cases versus 37% in the NET group. The highest resolution rate (56%) was observed in the LYN group, although there was no statistically significant difference between progestins regarding the proportion of women requiring further treatment (χ² = 2.608; p = 0.271). Conclusion: It seems that the efficacies of oral progestins are similar at these dosages in simple EH without atypia.

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