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Objective: : To investigate the effect of challenging factors on laparoscopic hysterectomy trends within twenty-four years. Population and Method: : This was a trend analysis study of 7558 women who underwent hysterectomy for benign indications between 1995-2018 in Bursa Uludag University Hospital, Turkey. A trend analysis of obesity, previous laparotomy (>= 3) and uterine specimen weight (>= 500 g) was applied for abdominal hysterectomy (TAH), vaginal hysterectomy (VH), and laparoscopic hysterectomy (TLH) rates in this period. The primary outcome was laparoscopic hysterectomy trends throughout the years. We measured the effect of obesity, previous laparotomies and large uterus on TLH trends as secondary outcomes. Results: : The ratio of TLHs to all hysterectomies was 2.4% in 1995 and 44.7% in 2018 which increased 33 times higher over 24 years. The percentage of obese patients in TLH cases increased from 1% to 37%, the rate of patients who had three or more previous laparotomy in TLH cases increased from 0% to 32.2%, and the percentage of patients who had more than 500 g uterus specimen in laparoscopic hysterectomy cases increased from 0% to 32.8%. Conclusion: : Laparoscopic hysterectomy trends are increasing in challenging cases. Obesity, previous surgeries, and large uteruses are no longer a limiting factor for laparoscopic hysterectomy. (C) 2019 Elsevier Masson SAS. All rights reserved.

In recent decades, there has been a trend towards an increase in the incidence of hormone-dependent diseases and tumors in the organs of the reproductive system, in which the structure of hyperplastic processes of the endometrium occupies an important place.The aim of the study was to improve the quality of diagnostics of endometrial hyperplastic processes by realizing new differential diagnostic determinants using hysteroscopy and elastography.Material and methods of investigation. 162 women with endometrial pathology aged 18 to 45 years were examined. Diagnostic search was conducted using ultrasound with subsequent hysteresisectoscopy or separate curettage of the uterine mucosa and cervical canal.Results of the study and their discussion. The authors have shown that the introduction of sonoеlastography and hysteroscopy allows to determine the tactics and stages of patient management, to conduct screening diagnostics and dispensary observation.Conclusions: The transvaginal ultrasound study has a high sensitivity of 79.1%. The addition of а sonoеlastography to the ultrasound study method in the diagnosis of hyperplastic endometrial processes makes it possible to increase the diagnostic sensitivity to 89.6%, and hysteroscopy to 95.5%., В последние десятилетия сохраняется тенденция к росту частоты гормонозависимых заболеваний и опухолей органов репродуктивной системы, в структуре которых важное место занимают гиперпластические процессы эндометрия.Цель исследования - улучшить качество диагностики гиперпластических процессов эндометрия путем реализации новых дифференциально-диагностических детерминант с применением гистероскопии и эластографии.Материал и методы исследования. Обследовано 162 женщины с патологией эндометрия в возрасте от 18 до 45 лет. Диагностический поиск проводился при использовании ультразвукового исследования с последующим выполнением гистерорезектоскопии или раздельного выскабливания слизистой матки и цервикального канала.Результаты исследования и их обсуждение. Авторами показано, что внедрение соноеластографии и гистероскопии позволяет определить тактику и этапность ведения больных, проводить скрининговую диагностику и диспансерное наблюдение.Выводы. Трансвагинальное ультразвуковое исследование имеет высокую чувствительность - 79,1%. Дополнение ультразвукового исследования соноеластографией при диагностике гиперпластических процессов эндометрия позволяет повысить диагностическую чувствительность до 89,6%, а гистероскопии - до 95,5%., У останні десятиліття зберігається тенденція до зростання частоти гормонозалежних захворювань і пухлин органів репродуктивної системи, в структурі яких важливе місце займають гіперпластичні процеси ендометрія.Мета дослідження - поліпшити якість діагностики гіперпластичних процесів ендометрія шляхом реалізації нових диференційно-діагностичних детермінант з застосуванням гістероскопії та еластографії.Матеріал і методи дослідження. Обстежено 162 жінки з патологією ендометрія у віці від 18 до 45 років. Діагностичний пошук проводився при використанні ультразвукового дослідження з подальшим виконанням гістерорезектоскопії або роздільного вишкрібання слизової матки та цервікального каналу. Результати дослідження та їх обговорення. Авторами показано, що впровадження соноеластографії та гістероскопії дозволяє визначити тактику і етапність ведення хворих, проводити скринінгову діагностику та диспансерне спостереження.Висновки. Транспіхвове ульразвукове дослідження має високу чутливість - 79,1%. Доповнення ультразвукового дослідження методикою соноеластографії при діагностиці гіперпластичних процесів ендометрія дозволяє підвищити діагностичну чутливість до 89,6%, а гістероскопії - до 95,5%.

The prospective observation of women with uterus myoma being on operative treatment in gynecological department of the Tula oblast clinical hospital during 2011-2012 was implemented. The regular female donors of the department of transfusiology of the given medical institution were used as the comparison group. It is established that female contingent with uterus myoma has a complex of such predisposing medical social risk factors as lower motion activity, financial neediness, increased stress load, diet of lower quality and its limitations, increased liquid intake, inobservance of work and rest regime, with passive character of longer day rest, certain occupational hazards. The unfavorable effect of forced body position, electromagnetic radiation and psycho-emotional over-strain on development of uterus myoma is reliably established. According data of component analysis, possible complex prevention of uterus myoma is presented by higher level of intellectual strain during working activities, maintenance of work and rest regime, long-term day rest, regular intake of fruits and cultured milk food, availability of quality preferences in diet, regular exercises, frequent foot walks at clean air. The established characteristics of life-style and occupational hazards in women with uterus myoma testify their pathogenic involvement in development of disease and availability of opportunities of their usage in development of programs of individual prevention.

Der Einfluss des isopropanolischen Cimici­fuga-racemosa-Extrakts iCR auf Uterusmyome wurde an menopausalen Frauen mit klimakterischen Beschwerden untersucht. Die Studienpopulation entstammte einer randomisierten, kontrollierten (vs. Tibolon) Doppelblindstudie. Mit transvaginalen ­Ultraschallmessungen wurden die Tumordurchmesser (dreidimensional) gemessen und die Volumenanderungen im Vorher-­Nachher-Vergleich bestimmt. Nach 12-wochiger Therapie mit iCR (n=34) war das ­Volumen der Myome deutlich reduziert (-30,3 %) und signifikant unterschiedlich (p=0,016) zu der Zunahme von 4,7 % unter Tibolon (n=28). Die Responderrate (Volumenabnahme) lag fur iCR bei 70 % (Tibolon: 36 %). Die Confounder-adjustierte logistische Regression ergab eine 4,7-fach hohere Wahrscheinlichkeit, dass Myome unter iCR kleiner werden als unter Tibolon (p=0,008). Die Ergebnisse dieser Untersuchung weisen auf einen zusatzlichen Nutzen von iCR bei der Therapie klimakterischer Beschwerden von Patientinnen mit Myomen hin.

Premature ovarian insufficiency (POI) is a frequent pathology that affects women under 40 years of age, characterized by an early cessation of menses and high FSH levels. Despite recent progresses in molecular diagnosis, the etiology of POI remains idiopathic in most cases. Whole-exome sequencing of members of a Colombian family affected by POI allowed us to identify a novel homozygous donor splice-site mutation in the meiotic gene MSH4 (MutS Homolog 4). The variant followed a strict mendelian segregation within the family and was absent in a cohort of 135 women over 50 years of age without history of infertility, from the same geographical region as the affected family. Exon trapping experiments showed that the splice-site mutation induced skipping of exon 17. At the protein level, the mutation p.Ile743_Lys785del is predicted to lead to the ablation of the highly conserved Walker B motif of the ATP-binding domain, thus inactivating MSH4. Our study describes the first MSH4 mutation associated with POI and increases the number of meiotic/DNA repair genes formally implicated as being responsible for this condition. © The Author 2017. Published by Oxford University Press. All rights reserved.

Aim of this study - we have examined uterine pump disorder as a possible chain of infertility pathogenesis under adenomiosis, utilizing method of ultrasonic examination in saggital plane of the whole uterus and in a position fixed for 5 minutes.Material and methods. 152 patients with adenomyosis related infertility only or with concomitant myoma of uterus were examined. The control set consisted of women with male factor infertility only.Results. Uterine dysperistalsis has been revealed under adenomyosis in the form of dysperistalsis related waves, which are not observed with healthy women. In addition to dysperistalsis into all phases of cycle, hyperperistalsis (р, Цель исследования - исследование нарушения работы маточной помпы, как возможного звена патогенеза бесплодия при аденомиозе, с помощью ультрасонографии в сагиттальной проекции и фиксированным в течение 5 минут положением.Материалы и методы - обследовано 152 пациентки с бесплодием на фоне только аденомиоза или с сопутствующей миомой матки. Контрольную группу составили пациентки при наличии только мужского фактора бесплодия.Результаты - обнаружено нарушение маточной перистальтики при аденомиозе в виде дисперистальтических волн, не встречающихся у здоровых женщин. В группе с сопутствующей узловой миомой матки, кроме дисперистальтики во все фазы цикла, обнаружена гиперперистальтика (р, Мета дослідження - дослідження роботи маткової помпи, як можливої ланки патогенезу, за допомогою ультрасонографії в сагітальній проекції і фіксованим, протягом 5 хвилин, положенням.Матеріал і методи - обстежено 152 пацієнтки з безпліддям на фоні тільки аденоміозу чи з супутньою міомою матки. Контрольну групу склали пацієнтки при наявності лише чоловічого фактору безпліддя.Результати - виявлено порушення маткової перистальтики при аденоміозі у вигляді дисперистальтичних хвиль, що не зустрічаються у здорових жінок. У групі із супутньою вузловою формою міоми матки, окрім дисперистальтики у всіх фазах циклу, виявлена гіперперистальтика (р

Study objective To evaluate the long-term effectiveness of laparoscopic cryomyolysis as a minimally invasive technique for the treatment of symptomatic uterine myomas in menstruating women. Design Open, one-arm pilot study (Canadian Task Force classification II). Setting University-affiliated public hospital. Patients Twenty patients with symptomatic uterine myomas were treated with directed cryomyolysis. All had reported abnormal bleeding and/or pelvic pain/pressure and/or urinary frequency. Myoma diameters varied from 4 to 10 cm. Intervention One-year follow-up after laparoscopic-directed cryomyolysis. Measurements and main results Laparoscopic cryomyolysis was performed using the Her Option Cryoablation Unit (American Medical Systems, Minneapolis, MN). Patients were evaluated 1, 3, 6, 9, and 12 months after surgery. Power color Doppler ultrasound was performed preoperatively and postoperatively to demonstrate the effectiveness of the technique in reducing or eliminating the primary blood supply to the myomas, as well documenting regression of the myomas. All patients reported a high rate of satisfaction with the treatment including absence of symptoms 12 months after surgery, with no bleeding and no myoma-related symptoms, comparable with patients who underwent hysterectomy. Mean shrinkage of myoma volume increased until 9 months after surgery (59.5% ± 13.2%), reaching a steady mean-volume reduction of approximately 60% (61.9% ± 11.9%) 12 months after surgery. Conclusions Directed laparoscopic cryomyolysis appears to be an effective and safe technique for providing rapid symptom relief and at least 12 months’ effectiveness in the treatment of symptomatic uterine leiomyomas.

Background/Aims: To determine the efficacy of levonorgestrel-releasing intrauterine device (LNG-IUD) insertion in menorrhagic patients who have at least one type II myoma according to the European Society of Hysteroscopy. The primary outcome measures were menstrual blood flow reduction and increase in hemoglobin values. The secondary outcome measures were hysterectomy rates and patient satisfaction. Methods: In menorrhagic women (documented by a validated pad scoring system) with a myomatous uterus Results: Following LNG-IUD insertion, statistically significant decreases in menstrual blood flow and increases in hemoglobin values were noted. LNG-IUD insertion was found to be as effective as historical controls of TBA applications. Conclusion: This prospective controlled trial demonstrates the effectiveness of LNG-IUD in this setting and equivalent results are obtained as compared to TBA.

In recent years, the development of new surgical techniques in uterus myoma treatment have reduced operative trauma significantly. Our objective was to present operative technique-vaginal myomectomy, making a prospective clinical study where we have evaluated the operative and postoperative period after intentive diagnosis. The result of our study shows the feasibility of myomectomy by entering the peritoneum through the posterior vaginal fornix, using traditional and cheap surgical instruments and thus avoiding the trauma of laparatomy, minimal operative blood loss, reduced operating time and postoperative recovery. In our opinion, vaginal myomectomy could be useful for the treatment of selected cases with fundal or posterior wall uterine myomas.

In the present study, an ileal leiomyoma encountered in a captive zebra (Equus burchelli) was reported. A 29-year-old, female zebra was found dead in the Bursa zoo. According to the referring veterinarian the most prominent clinical signs were intermittent colic (responsive to analgesics) and constipation. At post mortem examination, abdomen was severely distended. A firm, multilobular, well vascularized and encapsulated tumoural mass, 12 cm in diameter, embedded into the proximal part of the ileum wall, and protruded from the serosal surface was found. The cut section of the mass had whorled appearance, pale yellow to white in colour, and had no sign of coagulation necroses and haemorrhages. In the microscopical examination, it was observed that tumoural mass consisted of interlacing bundles of well-differentiated, haphazardly arranged, and smooth muscle cells. Mitotic figures were not common. Immunohistochemically, neoplastic cells were stained strongly with alpha smooth muscle actin and the mass was diagnosed as leiomyoma. Bu çalışmada Bursa hayvanat bahçesinde ölü olarak bulunan 29 yaşlı, dişi bir zebrada karşılaşılan ileal leiomyoma olgusu sunulmaktadır. Alınan anemnezde hayvanın genel durumunun iyi olduğu ancak aralıklı kolik (ağrı kesicilerle hafifletilen) ve kabızlık şikayetinin bulunduğu bildirilmiştir. Postmortem muayenede karın duvarının aşırı gergin olduğu görüldü. İleumun proksimalinde 12 cm çapında, bağırsak duvarına gömülü ve serozal yüzeyden dışarıya çıkıntı yapan, nodüler görünümlü, bağ doku kapsülü ile sınırlandırılmış, fibroelastik kıvamlı, iyi vaskularize olmuş bir kitleye rastlandı. Kitlenin kesit yüzü açık sarı-beyaz renkteydi ve iç içe geçmiş kas demetlerini andıran yapılar mevcuttu. Mikroskobik incelemede kitlenin gelişi güzel dizilmiş ve yer yer birbirleri içerisine girmiş düz kas hücrelerinden oluştuğu görüldü. Mitotik figürler yaygın değildi. Kesitlere uygulanan Crossman boyama yöntemi ile kitleyi oluşturan hücrelerinin, bağırsak duvarındaki kas tabakası ile benzer boyanma özelliği gösterdiği tespit edildi. İmmunohistokimyasal olarak tümör hücrelerinin alpha smooth muscle actin ile pozitif olarak boyandığı görüldü ve tümör leiomyoma olarak teşhis edildi.

This report describes a case of multicentric intrahepatic biliary cystadenoma observed in a 13-year-old, male, Irish setter dog. The dog had a history of chronic inappetence, weight loss, intermittent icterus, and diarrhoea. In the ultrasonographic examination of the abdominal organs, 5 spherical masses were found in various liver lobes. The largest mass was 12 cm in diameter and was located on the quadrate lobe. It had spongy consistency and had several cystic structures, 3 mm-2.5 cm in diameter, on the cut surface. While this mass bulged through the normal outline of the liver, smaller masses were engraved within the liver parenchyma. Histopathologically, cystic glandular structures lined by cubical to columnar epithelial cells were observed. Immunohistochemically, tumoural cells stained positively with anti-cytokeratin 7 and anti-cytokeratin 19 antibodies. We report herein a rare case of multicentric biliary cystadenoma in an Irish setter dog with histopathological and immunohistochemical findings.

Background: Uterine lipoleiomyoma is a rare and specific type of leiomyoma with a considerable amount of adipocytes., Aims: The aim of the study was to investigate the clinical, pathological and immunohistochemical features of lipoleiomyoma of the uterine corpus, and review its histogenesis and differential diagnosis from other neoplastic and non-neoplastic lesions in order to obtain a detailed profile of this somewhat uncommon lesion., Study Design: Descriptive study., Methods: This study is a retrospective analysis of 70 consecutive women with 76 lipoleiomyomas, who underwent surgery mainly for uterine leiomyoma and gynecological carcinomas between January 2000 and April 2013. Clinical and pathological information was obtained from medical records. Immunohistochemistry was applied in selected cases. Parametric methods were used to compare clinical and pathologic features., Results: The patients ranged in age from 34 to 77 years (mean 55.49 years). Lipoleiomyomas ranged from 0.5 to 55 cm in diameter (mean 5.50 cm). Typical macroscopic and microscopic features were noted. Sixty-nine (90.7%) tumors were in the uterine corpus and five (6.5%) were in the cervix. One broad ligament tumor and one retroperitoneal tumor were also studied. No tumors displayed cytologic atypia, mitosis, necrosis, calcification, or other degenerative changes. Immunohistochemically, the adipose tissue element was positive for vimentin, desmin, S100 protein, estrogen (ER), progesterone (PR), and Ki-67. Among patients with lipoleiomyomas, 53 cases (75.7%) had different types of lesions associated with hyperestrogenic status, such as adenomyosis, endometriosis, endometrial hyperplasia, and polyps, complex atypical endometrial hyperplasia, and gynecologic carcinomas. The follow-up period ranged from one to eight years (mean 4.6 years). There were no recurrences or tumor-related fatalities., Conclusion: In the present study, the lipoleiomyomas were seen more frequently in patients with adenomyosis, endometriosis, endometrial hyperplasia, polyps, and various gynecologic carcinomas. Lipoleiomyoma of the uterus seems to have a benign clinical course. © 2014, Trakya University Faculty of Medicine.

Psammocarcinoma is a rare type of serous carcinoma arising from the ovaries or the peritoneum. Histopathologically, it has large deposits of psammoma bodies, invasion to surrounding tissues, and low-grade cytologic atypia. Biologic behavior is similar to borderline serous tumors with a favorable survival time. Primary surgical debulking with complete resection of the tumor should be the main surgical approach, while the benefit of postoperative chemotherapy remains unknown. A new case of primary peritoneal psammocarcinoma with survival after an initial diagnosis of 5.5 years is presented with a literature review.

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Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:28:38Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:32:20Z : No. of bitstreams: 1 2-s2.0-84874582462.pdf: 2646107 bytes, checksum: 198eeb5a410105f90919e96a3ab88e1b (MD5) Made available in DSpace on 2014-05-27T11:28:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-03-04 Background: Uterine Leiomyomas (ULs) are the most common benign tumours affecting women of reproductive age. ULs represent a major problem in public health, as they are the main indication for hysterectomy. Approximately 40-50% of ULs have non-random cytogenetic abnormalities, and half of ULs may have copy number alterations (CNAs). Gene expression microarrays studies have demonstrated that cell proliferation genes act in response to growth factors and steroids. However, only a few genes mapping to CNAs regions were found to be associated with ULs. Methodology: We applied an integrative analysis using genomic and transcriptomic data to identify the pathways and molecular markers associated with ULs. Fifty-one fresh frozen specimens were evaluated by array CGH (JISTIC) and gene expression microarrays (SAM). The CONEXIC algorithm was applied to integrate the data. Principal Findings: The integrated analysis identified the top 30 significant genes (P

The primary aim of this study is to evaluate the effects of previous abdominal surgery on the feasibility of performing and the safety of total laparoscopic hysterectomy (TLH).In this retrospective study, we analysed 62 laparoscopic hysterectomies which were performed at our institute between February 2011 and January 2013. We chose to perform laparoscopic surgery for all patients, including those who had previously undergone abdominal surgery. The patients were classified into two groups: Group 1 included patients with a history of abdominal surgery (n=24) and Group 2 included patients without a history of abdominal surgery (n=38).THE OPERATING PERIOD WAS COMPARED IN BOTH GROUPS: 184.43±51.0 min. for Group 1 and 195.41±64.1 min. for Group 2 (p=0.471). Postoperative hospital stay and blood loss was also compared. There was just 1 conversion from TLH to a laparotomy in both groups. None of the patients in Group 1 needed a blood transfusion, whereas 1 in Group 2 did.We found that operation time, postoperative hospital stay, blood loss, rate of operative complications or conversion rate to open surgery between patients with and without a history of abdominal surgery were comparable. Therefore, it appears that a history of abdominal surgery does not adversely affect the safety of TLH.Bu çalışmanın öncelikli amacı, daha önce geçirilmiş abdominal cerrahinin, total laparoskopik histerektomi (TLH) yapılabilirliği ve güvenliği üzerine etkisini değerlendirmektir.Bu retrospektif çalışmada, Şubat 2011 ve Ocak 2013 tarihleri arasında kurumumuzda gerçekleştirilen 62 TLH operas-yonun kayıtları incelendi. Laparoskopik cerrahiyi, geçirilmiş abdominal cerrahisi olsa da tüm hastalarda düşündük. Hastalar iki gruba ayrıldı. Grup 1 geçirilmiş abdominal cerrrahisi olanları, Grup 2 geçirilmiş abdominal cerrahisi olmayanları içerdi.Operasyon süresi her iki grupta da karşılaştırılabilirdi (184.43±51.0 dk. Grup1 ve 195.41±64.1 dk. Grup 2; p=0.471). İki grup arasında intraoperatif komplikasyon açısından anlamlı fark bulunmadı. Operasyon sonrası hastanede kalış süresi ve kan kaybı da karşılaştırılabilirdi. Her iki grupta da sadece 1 vakada laparotomiye geçiş yapıldı. Grup 1’de hiçbir hastada kan transfüzyonu ihtiyacı olmazken, Grup 2’de 1 hastada oldu.Çalışmamızda cerrahi geçirmiş ve geçirmemiş olan grup arasında, operasyon süresi, postoperatif kalış süresi, kan kaybı, operatif komplikasyon oranı veya açık cerrahiye geçiş oranı karşılaştırabilir bulundu. Sonuç olarak, abdominal cerrahi hikayesinin olması TLH nin güvenliğini olumsuz etkilememektedir.

cited By 17; The purpose of this study was to assess the ability of low-dose/low-frame fluoroscopy/angiography with a flat-panel detector angiographic suite to reduce the dose delivered to patients during uterine fibroid embolization (UFE). A two-step prospective dosimetric study was conducted, with a flat-panel detector angiography suite (Siemens Axiom Artis) integrating automatic exposure control (AEC), during 20 consecutive UFEs. Patient dosimetry was performed using calibrated thermoluminescent dosimeters placed on the lower posterior pelvis skin. The first step (10 patients; group A) consisted in UFE (bilateral embolization, calibrated microspheres) performed using the following parameters: standard fluoroscopy (15 pulses/s) and angiography (3 frames/s). The second step (next consecutive 10 patients; group B) used low-dose/low-frame fluoroscopy (7.5 pulses/s for catheterization and 3 pulses/s for embolization) and angiography (1 frame/s). We also recorded the total dose-area product (DAP) delivered to the patient and the fluoroscopy time as reported by the manufacturer's dosimetry report. The mean peak skin dose decreased from 2.4 ± 1.3 to 0.4 ± 0.3 Gy (P = 0.001) for groups A and B, respectively. The DAP values decreased from 43,113 ± 27,207 μGy m2 for group A to 9,515 ± 4,520 μGy m2 for group B (P = 0.003). The dose to ovaries and uterus decreased from 378 ± 238 mGy (group A) to 83 ± 41 mGy (group B) and from 388 ± 246 mGy (group A) to 85 ± 39 mGy (group B), respectively. Effective doses decreased from 112 ± 71 mSv (group A) to 24 ± 12 mSv (group B) (P = 0.003). In conclusion, the use of low-dose/low-frame fluoroscopy/angiography, based on a good understanding of the AEC system and also on the technique during uterine fibroid embolization, allows a significant decrease in the dose exposure to the patient. © 2010 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

1. 1. The uterine fibroid is a benign neoplasm, and its mere presence should be no cause for surgery. 2. 2. Only incontrovertible reasons, such as hemorrhage, pain, pressure symptoms, signs of tumor degeneration, rapid growth, interference with the pregnant states, cosmetic, and marital purposes should indicate surgical intervention. 3. 3. Myomectomy, even multiple, whereby endocrine balance, menstruation, and reproductive possibility are preserved, should be preferable to hysterectomy. 4. 4. The preoperative, operative, and postoperative preparation, technique, and care, respectively, as herein outlined, have enabled us to perform successfully 900 consecutive myomectomies for the interstitial and submucous types of fibroids with complete control and/or prevention of infection. 5. 5. The objections by opponents of myomectomy such as hemorrhage, infection, adhesions, and tumor recurrence have been effectively overcome in our procedures. 6. 6. This paper is presented with the hope that the widespread use of myomectomy, as described, will merit its recognition as the procedure of choice in the surgical treatment of uterine fibroids.

Summary 1 The indications for surgical ti*eatmeiit of myomata of the uterus are discussed. 2 The scope of myomectomy is analysed. 3 The important details in technique are described. 4 A series of 66 cases are surveyed. There were 110 deaths and the results were satisfactory.

The aim of this study is to determine the immunohistochemical expressions of estrogen receptor, progesterone receptor, and Ki-67 proliferation marker in 8 extrauterine leiomyomas and to compare these values with their uterine counterparts. In all, 8 patients with extrauterine leiomyomas and 20 patients with uterine leiomyomas as a control group were studied. Sections were immunohistochemically stained with estrogen receptor, progesterone receptor, and Ki-67 antibodies. Labeling indices for estrogen receptor, progesterone receptor, and Ki-67 were found to be 33.05 % ± 31.70%, 14.18 % ± 18.80%, and 0.52 % ± 1.32% for extrauterine leiomyomas and 65.09% ± 26.65%, 32.53% ± 32.80%, and 0.37% ± 0.71% for uterine leiomyomas, respectively. The difference of labeling indices for progesterone receptor between uterine leiomyomas and extrauterine leiomyomas was statistically significant (P =.002). This study shows that increased expression of progesterone receptor is observed only in uterine leiomyomas during the reproductive period. However, it seems that additional factors to hormone receptors contribute to the development of extrauterine leiomyomas. © 2008 Sage Publications.

Objective: Lipoleiomyoma is a rare and easily recognized, benign uterine fatty tumor, composed of an admixture of mature adipocytes and smooth-muscle cells. They may associate with metabolic disorders and rarely reach giant size. Case: We report a case of symptomatic giant lipoleiomyoma of the uterine corpus that may be associated with diabetes mellitus and hypothyroidism. Conclusion: Lipoleiomyoma must be thought in the differential diagnosis of the giant uterine tumors and should be removed when diagnosed, because malignancy cannot otherwise be excluded. Also the peculiar features of this giant neoplasm, histogenesis, concomitant metabolic disorders and the diagnostic methods are discussed. © 2008 Springer-Verlag.

Isobaric gasless laparoscopy and minilaparotomy have been used as more recent minimally invasive approaches to myomectomy. This randomized trial aimed to compare the surgical and immediate postoperative outcomes for myomectomy performed by isobaric gasless laparoscopy with those for minilaparotomy.A total of 100 patients with symptomatic uterine myomas requiring myomectomy were randomly allocated to the gasless laparoscopy group or the minilaparotomy group. The randomization procedure was based on a computer-generated list. The primary outcome was a comparison of the discharge times between the two procedures. A power calculation verified that more than 26 patients for each group was necessary to detect a difference of more than 24 h in discharge time with an alpha error level of 5% and a beta error of 80%. Continuous outcome variables were analyzed using the Student's t-test. Discrete variables were analyzed with the chi-square test or Fisher's exact test. A p value less than 0.05 was considered statistically significant.The mean discharge time was longer for minilaparotomy than for gasless laparoscopy (98.4 +/- 1.4 vs 52.8 +/- 1.6 h; p0.001). Gasless laparoscopy resulted in shorter times for canalization (21.6 +/- 1.1 vs 32 +/- 1.3 h; p0.05) and surgery (79.5 +/- 25.1 vs 103.5 +/- 24.9 min; p0.001). The intraoperative blood loss was less with gasless laparoscopy (154.2 +/- 1.2 vs 188.6 +/- 1.3 ml; p0.001). No intraoperative complications occurred, and no case was returned to the theater in either group. No conversion to standard laparotomy was necessary.Isobaric gasless laparoscopy and minilaparotomy can be suitable options for uterine myomectomy. Several surgical and immediate postoperative outcomes were significantly better in the gasless laparoscopy group than in the minilaparotomy group. However, further controlled prospective studies are required to confirm the results.

Objective The purpose of this study was to develop a minimally invasive, safe, and effective technique for managing symptomatic uterine myomas. Study design Twenty patients with symptomatic uterine fibroids were treated. All had complaints of abnormal bleeding and/or pelvic pain/pressure and/or urinary frequency. Myoma diameters were 4 to 8 cm. Power color Doppler imaging was performed preoperatively and postoperatively to determine the effectiveness of cryomyolysis in reducing or eliminating the primary blood supply, as well as regression of the myomas. Laparoscopic cryomyolysis was performed with use of the Her Option Cryoablation System (American Medical Systems Gynecology, San Diego, Calif). Patients were evaluated at 1, 3, and 6 months postoperatively. Results All patients were discharged within 24 hours of treatment. No intraoperative or postoperative complications occurred. Of the 20 patients treated, 19 had complete resolution of their complaints. Myomas regressed up to 80%, and major blood supply to the myomas was eliminated. Conclusion Directed laparoscopic cryomyolysis is an effective and safe technique for symptom relief from leiomyomas.

OBJECTIVE: To assess the quality of antibiotic prophylaxis for clean and clean-contaminated elective surgical procedures. DESIGN: A cross-sectional, country-wide survey. SETTING: Thirty-six hospitals in 12 cities in Turkey. PARTICIPANTS: Four hundred thirty-nine surgeons from 6 different specialties who performed selected procedures of interest. METHODS: A random sample of surgeons from different hospitals was selected. A standardized data collection form was used to record the type of procedure, the names, doses, timing of the first doses, and duration of antibiotics, important decisive factors, and problems in the management of prophylactic antibiotic use for surgical procedures. RESULTS: Fifty-five percent of surgeons addressed completed the survey. For clean-contaminated procedures, 6% of surgeons did not use antibiotic prophylaxis, whereas 88% used more than a single dose. Inappropriate antibiotics were chosen for 32% of procedures. In 39% of procedures, the first dose of antibiotics was not administered during induction of anesthesia. Duration of prophylaxis was longer than 24 hours in 80% and longer than 48 hours in 46% of all procedures. Only 112 surgeons (26%) were using definitely appropriate prophylaxis in all ways. Multivariate analysis revealed that surgeons in university hospitals (OR, 2.353; CI95, 1.426-3.884; P = .001) and general surgeons (OR, 4.986; CI95, 2.890-8.604; P < .001) used antibiotic prophylaxis more appropriately. Patients not covered by health insurance (OR, 0.417; CI95, 0.225-0.772; P < .001) were associated with inappropriate prophylaxis. CONCLUSION: Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.