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...

INTRODUCTIONLeiomyoma of the uterus is the most common type of tumor affecting the female pelvis and arises from uterine smooth muscle. The size of leiomyomas varies from microscopic to giant; giant myomas are exceedingly rare. We report an unusual case of a large, cystic, pedunculated uterine leiomyoma mimicking a primary malignant ovarian tumor on sonography and CT.PRESENTATION OF CASEA 58-year-old postmenopausal nulliparous woman presented with a history of lower abdominal pain and distension for a period of approximately 12 months. The patient's personal history revealed difficulty in walking, tiredness and recent weight gain of approximately 25 kg. Sonography and CT examination showed a large mass that filled the abdomen. A preoperative diagnosis of a primary malignant ovarian tumor was made. The patient underwent laparotomy, total hysterectomy and bilateral salpingo-ooferectomy. The histology revealed a leiomyoma with extensive cystic degeneration.DISCUSSIONThe current established management of uterine fibroids may involve expectant, surgical, or medical management or uterine artery embolization or a combination of these treatments. A surgical approach is preferred for management of giant leiomyomas.CONCLUSIONPedunculated leiomyomas should be considered in the differential diagnosis of a multilocular and predominantly cystic adnexal mass.

The recurrence of myoma was relatively low following CM. Subsequent pregnancy is protective for recurrence of myoma without increased adhesion formation and obstetric complications.

MS during pregnancy was not associated with adverse maternal and perinatal outcomes except UTI, low 1-min Apgar scores, and decreased breastfeeding rates.

Objective: The reasons why endometriosis is more aggressive and invasive in some patients are unknown. Despite the importance of population-based clinically defined risk factors in the prediction of recurrence, biochemical markers obtained from the patient are more valuable for prediction on an individual basis. Therefore, the discovery of significant potential biomarkers could be useful to clinicians for shedding light on the pathogenesis of endometriosis and in the monitoring recurrence. Materials and Methods:This study included 50 patients who underwent surgery for ovarian cysts that were diagnosed as endometrioma. The age of the patients, stage of the endometriosis, diameter and localization of endometriomas, type of surgery, and pre-and postoperative cancer antigen 125 (CA125) levels were compared between patients with and without recurrence. The archived pathology slides were stained with Ki-67 and anti-urocortin antibodies for reevaluation. By comparing the pathology parameters of the patients with and without recurrence, the association between these parameters and recurrence was investigated.Results: The median Ki-67 proliferation index of the patients with recurrence (7.5±6.5) was statistically significant compared with that of the patients without recurrence (1±4) (p=0.003). The urocortin epithelial staining intensity and percentage were not found to be statistically significant in comparison. A statistically significant difference was determined between postoperative CA125 median levels of patients without recurrence (10±17.6) and those of patients with recurrence (29.9±18.1) (p=0.003). Conclusion:The Ki-67 proliferation index may be useful for predicting prognosis and recurrence risk.Keywords: Endometriosis, Ki-67 proliferation index, urocortin ÖZ Amaç: Endometriozisin bazı hastalarda neden daha agresif ve invaziv olduğunun nedenleri bilinmemektedir. Klinik olarak belirlenen risk faktörleri populasyon bazında rekürrens prediksiyonunda değerli olmasına rağmen kişi bazında prediksiyonda hastadan elde edilen biyokimyasal markerlar daha değerlidir. Bu nedenle, rekürrens açısından anlamlı potansiyel biyomarkerların keşfi endomeriozis patogenezine ışık tutabileceği gibi rekürrens takibinde klinisyenlere yardımcı bir parametre olarak kullanılabilir.Gereç ve Yöntem: Çalışmamıza over kisti nedeniyle cerrahi geçiren ve patolojik inceleme sonucunda endometrioma tanısı konmuş 50 hasta dahil edildi. Olguların yaş, endometriozis evresi, endometrioma çapı ve lokalizasyonu, cerrahi tipi, preoperatif ve postoperatif CA 125 düzeyleri kaydedildi. Olguların arşiv patoloji preparatları Ki 67 ve anti-urocortin antikor ile boyandı. Patolojik parametreler nüks olan olgular ile olmayanlarda kıyaslanarak bu parametrelerin rekürrens ile ilişkisi araştırıldı.Bulgular: Nüks olan olguların Ki67 İndeks medyanı (7,5±6,5) nüks olmayan olguların Ki67 İndeks medyan değerinden (1±4) daha büyük olup, istatistiksel olarak anlamlıydı (p=0,003). Olguların nüks olma durumu ile ürocortin epitel boyanma yoğunluğu ve yüzdesine göre da...