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Elmas B, Simsek D, Dincgez B, Ozceltik G, Urun C, Akin HY. Could Birth Weight to Placental Weight Ratio Predict Postpartum Haemorrhage and Neonatal Intensive Care Unit Admission? J Coll Physicians Surg Pak 2022; 32:1557-1562. [PMID: 36474375 DOI: 10.29271/jcpsp.2022.12.1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the usability of the ratio of birth weight to placental weight [fetoplacental ratio (FPR)] in predicting postpartum haemorrhage (PPH) and neonatal intensive care unit (NICU) admission. STUDY DESIGN Prospective observational study. PLACE AND DURATION OF STUDY Bursa Yuksek Ihtisas Training & Research Hospital, Bursa, Turkey, between July 2020 and July 2021. METHODOLOGY Women who were supposed to have an uncomplicated delivery with a live, single, term pregnancy without any concomitant disease, were included in the study. Patients with PPH were accepted as the study group and patients without PPH were the control group. For NICU requirement, babies who were admitted to NICU were the study group, and babies who did not require NICU were the control group. The fetoplacental ratio was calculated by dividing the newborn weight to placental weight and evaluated in the prediction of NICU admission and PPH. RESULTS The number of patients included in the study was 812. Approximately 7% of women had postpartum haemorrhage. The FPR was found as an independent predictor for PPH by nearly 3.5 fold. Women who experienced PPH had heavier placenta and lower fetoplacental ratio. Patients whose babies were admitted to NICU also had lower FPR with statistically significant differences. CONCLUSION The fetoplacental ratio could be a promising predictor for PPH and NICU admission in the postpartum period. Since novel studies are needed using ultrasonographic measurements during antenatal surveillance to predict PPH or NICU admission. KEY WORDS Birth weight, Neonatal intensive care unit, Placental weight, Postpartum haemorrhage, Cesarean birth, Vaginal birth, Fetoplacental ratio.
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Affiliation(s)
- Burak Elmas
- Department of Obstetrics & Gynaecology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.,Department of Obstetrics & Gynaecology, Bursa Yuksek Ihtisas Training & Research Hospital, University of Health Sciences, Bursa, Turkey.,Department of Obstetrics & Gynaecology, Ege University School of Medicine, Izmir, Turkey.,Department of Obstetrics & Gynaecology, Ardahan State Hospital, Ardahan, Turkey
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Ozceltik G, Itil IM, Yeniel AO. Comparison of perioperative outcomes between colpocleisis with hysterectomy and colpocleisis without hysterectomy. J Gynecol Obstet Hum Reprod 2022; 51:102456. [DOI: 10.1016/j.jogoh.2022.102456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/23/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022]
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Ozceltik G, Simsek D, Hortu I, Yeniel AO, Itil IM. Transvaginal natural orifice transluminal endoscopic surgery for ectopic pregnancy. J Obstet Gynaecol Res 2022; 48:843-849. [PMID: 35075736 DOI: 10.1111/jog.15165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/11/2021] [Accepted: 01/13/2022] [Indexed: 02/05/2023]
Abstract
AIMS This study aims to describe our transvaginal natural orifice transluminal endoscopic surgery (vNOTES) technique for ectopic pregnancy that can be performed using conventional laparoscopic equipment with the addition of a self-constructed pessary port and to evaluate the safety, feasibility, and outcomes of the technique. METHODS This is a retrospective study evaluating outcomes of patients who underwent vNOTES for ectopic pregnancy (n = 21) between August 2019 and April 2021. RESULTS Twenty-one patients underwent vNOTES as intended without any intraoperative complications. Three patients (14.3%) were nulliparous, 16 patients (76.2%) had no history of vaginal delivery, and 13 patients (61.9%) had a history of at least one cesarean delivery. Eight patients (38.1%) had a history of previous abdominal surgery other than cesarean section. The mean duration of surgery was 43.4 ± 12.6 min. The mean visual analog scale scores for pain were 2.45 ± 1.13 at 2 h after surgery, 0.45 ± 0.83 at 12 h after surgery, and 0.18 ± 0.36 at 24 h after surgery. The median duration of postoperative hospital stay was 1 day (range, 1-2). There were no postoperative complications within 30 days after surgery. CONCLUSIONS vNOTES can be performed in an existing laparoscopy setup with the addition of a self-constructed pessary port. vNOTES is a safe and effective surgical treatment option for ectopic pregnancy, even in patients who have not had a vaginal delivery and have had multiple abdominal surgeries.
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Affiliation(s)
- Gokay Ozceltik
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Deniz Simsek
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Ismet Hortu
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ahmet O Yeniel
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ismail M Itil
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
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Ozceltik G, Hortu I, Itil IM, Yeniel AO. Vaginal approach versus laparoscopy for hysterectomy in transgender men. J Gynecol Obstet Hum Reprod 2021; 51:102286. [PMID: 34910989 DOI: 10.1016/j.jogoh.2021.102286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/14/2021] [Accepted: 12/06/2021] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVE To describe a vaginal approach combining vaginal hysterectomy (VH) with transvaginal natural orifice transluminal endoscopic surgery (vNOTES) bilateral salpingo-oophorectomy (BSO) for hysterectomy in transgender men and to evaluate the feasibility, safety, and surgical outcomes of this approach in comparison with laparoscopy. MATERIAL AND METHODS Retrospective cohort study comparing outcomes of the vaginal approach (n = 45) and laparoscopy (n = 45) in transgender men undergoing hysterectomy between May 2017 and June 2020. RESULTS There was one intraoperative complication (bladder injury) in the laparoscopy group, which was the reason for the only conversion from the initial surgical approach. All vaginal procedures were completed without any intraoperative complications or conversions. Patients in the vaginal approach group had shorter operative times compared to the laparoscopy group (median 60 [range, 30-130] vs median 85 [range, 63-179] minutes; P < 0.001). One patient in the vaginal approach group experienced late-onset intraabdominal bleeding and underwent reoperation on postoperative day 4 after failed expectant management. There were no reoperations in the laparoscopy group. Patients in the vaginal approach group experienced less pain at postoperative 12 h and 24 h (P values < 0.001 and < 0.001, respectively). Postoperative hospital stay was shorter in the vaginal approach group than in the laparoscopy group (median 2 [range, 1-7] vs. median 2 [range, 2-6] days; P < 0.001). There were no readmissions within 30 days after surgery in either group. CONCLUSION The vaginal approach combining VH with vNOTES BSO is a feasible and safe alternative to laparoscopy for hysterectomy in transgender men.
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Affiliation(s)
- Gokay Ozceltik
- From the Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir 35100, Turkey.
| | - Ismet Hortu
- From the Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir 35100, Turkey
| | - Ismail Mete Itil
- From the Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir 35100, Turkey
| | - Ahmet Ozgur Yeniel
- From the Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir 35100, Turkey
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Ozceltik G, Hortu I, Itil IM, Yeniel AO. Impact of transvaginal natural orifice transluminal endoscopic surgery on hysterectomy practice. J Gynecol Obstet Hum Reprod 2021; 51:102241. [PMID: 34626848 DOI: 10.1016/j.jogoh.2021.102241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVE To evaluate the impacts of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) on the hysterectomy route and concomitant adnexal surgery at the time of vaginal hysterectomy (VH). MATERIAL AND METHODS This retrospective study analyzed all hysterectomies performed for benign indications between 1 January 2017 and 31 December 2019. The period preceding the first case of VH and vNOTES BSO was considered as Pre-vNOTES. The period starting from the date of the first case was considered as Post-vNOTES. The rates per route of hysterectomy and the rate of concomitant adnexal surgery at the time of VH were compared between the two periods. RESULTS In hysterectomies performed by surgeons who implemented vNOTES, the proportion of the vaginal route increased from 40.1% to 94.3% (P-value < 0.001); the abdominal route decreased from 37.4% to 3.2% (P-value < 0.001); and the laparoscopic route decreased from 22.5% to 2.5% (P-value < 0.001). The rates of concomitant adnexal procedures performed at the time of VH also showed significant changes. While 39.7% of patients did not undergo any concomitant adnexal surgery during the Pre-vNOTES period, this rate dropped to 8.1% after the implementation of vNOTES (P-value < 0.001). Similarly, the rate of bilateral salpingectomy dropped from 49.3% to 14.2% (P-value < 0.001), whereas the rate of BSO increased from 6.8% to 75% (P-value < 0.001). CONCLUSION Implementation of vNOTES has led to a significant increase in the rate of VH and the rate of concomitant BSO at the time of VH.
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Affiliation(s)
- Gokay Ozceltik
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey.
| | - Ismet Hortu
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ismail Mete Itil
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ahmet Ozgur Yeniel
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
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Hortu I, Karadadas E, Ozceltik G, Tavmergen E, Tavmergen Goker EN, Yigitturk G, Erbas O. Oxytocin and cabergoline alleviate ovarian hyperstimulation syndrome (OHSS) by suppressing vascular endothelial growth factor (VEGF) in an experimental model. Arch Gynecol Obstet 2020; 303:1099-1108. [PMID: 33140116 DOI: 10.1007/s00404-020-05855-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/20/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Ovarian hyperstimulation syndrome (OHSS) is a life-threatening complication of ovarian stimulation in reproductive medicine. Here, we aimed to investigate the role of oxytocin (OT) and cabergoline in the prevention and alleviation of the OHSS in an animal model. METHODS Thirty-five female immature Wistar rats were randomly assigned to five groups. The control group (n = 7) received saline only for five consecutive days. Remaining twenty-eight rats received 10 IU of pregnant mare serum gonadotropin (PMSG) followed by 30 IU of human chorionic gonadotropin (hCG) to induce OHSS. Group 2 (n = 7) was managed with no additional intervention after the induction of OHSS. Group 3 (n = 7) received 100 μg/kg cabergoline 2 h before the PMSG injection for four consecutive days and 2 h before the hCG injection on the fifth day. Group 4 (n = 7) and group 5 (n = 7) received 80 μg/kg and 160 μg/kg OT after induction of OHSS, respectively. Oxytocin was administered 2 h before the PMSG injection for four consecutive days and 2 h before the hCG injection on the fifth day. Body and ovary weight, vascular permeability (VP), VEGF expression in the ovaries, and levels of VEGF in the peritoneal fluids were examined in all animals. RESULTS Cabergoline and OT reduced body weight, ovary weight, and VP compared to that of the OHSS group (p < 0.05). VEGF expressions in ovaries and peritoneal VEGF levels were decreased in cabergoline and OT groups compared to that of the OHSS groups (p < 0.001 for cabergoline and OT-80 μg/kg; p < 0.00001 for OT-160 μg/kg). However, there was no statistically significant difference in these parameters between the OT and cabergoline groups. CONCLUSION Both OT and cabergoline were active in the alleviation of OHSS through suppression of VEGF and VP. Overall, we conclude that OT is effective for downregulation for VEGF and improvement in vascular permeability in OHSS.
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Affiliation(s)
- Ismet Hortu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Bornova, 35100, Izmir, Turkey. .,Department of Stem Cell, Ege University Institute of Health Sciences, Bornova, 35100, Izmir, Turkey.
| | - Elif Karadadas
- Department of Biochemistry, Ege University School of Medicine, Izmir, Turkey
| | - Gokay Ozceltik
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Bornova, 35100, Izmir, Turkey
| | - Erol Tavmergen
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Bornova, 35100, Izmir, Turkey.,Department of IVF Research Center, Ege University School of Medicine, Izmir, Turkey
| | - Ege Nazan Tavmergen Goker
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Bornova, 35100, Izmir, Turkey.,Department of IVF Research Center, Ege University School of Medicine, Izmir, Turkey
| | - Gurkan Yigitturk
- Department of Histology and Embryology, Mugla Sıtkı Kocman University School of Medicine, Mugla, Turkey
| | - Oytun Erbas
- Department of Physiology, Demiroglu Bilim University School of Medicine, Istanbul, Turkey
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Ozceltik G, Yeniel AO, Atay AO, Itil IM. Simplified two-step technique for transvaginal natural orifice transluminal endoscopic surgery. Fertil Steril 2020; 114:665-666. [PMID: 32660724 DOI: 10.1016/j.fertnstert.2020.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/02/2020] [Accepted: 05/05/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe our simplified two-step technique for transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and to demonstrate the application of the technique. DESIGN Step-by-step description of the technique and demonstration of its application using surgical video footage from two different cases. SETTING Tertiary university hospital. PATIENT(S) Patient 1 was a 27-year-old G0P0 woman who presented with right lower quadrant pain. Transvaginal ultrasound scan revealed a right ovarian torsion. Patient 2 was a 25-year-old G3P2 woman. She presented with vaginal bleeding and left lower quadrant pain. Her serum β-human chorionic gonadotropin level was 28,313 U/L, and transvaginal ultrasound scan revealed an ectopic pregnancy in the left tube. The decision to perform vNOTES was made for both patients. INTERVENTION(S) As the first step, patients underwent diagnostic vNOTES. The patient was placed in lithotomy position under general anesthesia. By use of a 5-mm trocar with autoretracting blade, a colpotomy was performed on the posterior vaginal wall. Pneumoperitoneum was achieved, and the patient was placed in a Trendelenburg position. A 5-mm 30° rigid endoscope was introduced, and the diagnosis was confirmed. After the confirmation of the diagnosis, we proceeded to the second step. The colpotomy was enlarged with blunt dissection by using Metzenbaum scissors. A self-constructed pessary port was placed through the colpotomy, and pneumoperitoneum was achieved. The therapeutic procedure was then performed. Patient 1 underwent ovarian detorsion with a 5-mm laparoscopic grasper. After the ovary was detorsioned, a 5-mm bipolar instrument was used to achieve hemostasis. Patient 2 underwent left salpingectomy with a 5-mm advanced bipolar device. Hemostasis was verified, and the specimen was extracted through the colpotomy. Procedures ended with the closure of colpotomy with running resorbable sutures. MAIN OUTCOME MEASURE(S) Description of the technique and demonstration of its applicability in two common gynecological emergencies. RESULT(S) Both patients were treated successfully by vNOTES. The operating times were 25 minutes and 38 minutes for patient 1 and patient 2, respectively. Patients were discharged on postoperative day 1 without any complications. CONCLUSION(S) Our simplified two-step technique described and demonstrated in this video article is a feasible and practical approach to perform vNOTES. The first step allows the confirmation of the diagnosis and facilitates the colpotomy. The use of the self-constructed pessary port enables to perform surgery with already existing equipment without the need for specialized equipment and without increasing the costs.
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Affiliation(s)
- Gokay Ozceltik
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey.
| | - Ahmet Ozgur Yeniel
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Arif Onur Atay
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ismail Mete Itil
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
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Ozceltik G, Yeniel AO, Atay AO, Itil IM. Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Tubal Stump Pregnancy. J Minim Invasive Gynecol 2020; 28:750-751. [PMID: 32640294 DOI: 10.1016/j.jmig.2020.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To demonstrate a case of left tubal stump pregnancy successfully treated using our 2-step technique for transvaginal natural orifice transluminal endoscopic surgery (vNOTES). DESIGN Demonstration of the technique using surgical video footage. SETTING Tertiary university hospital. INTERVENTIONS A 27-year-old gravida 3 para 0 patient with a history of laparotomy, left salpingectomy owing to a ruptured tubal pregnancy, was referred to our hospital because of a pregnancy of unknown location. Her serum β human chorionic gonadotropin level was 8400 U/L, and a transvaginal ultrasound revealed an ectopic pregnancy in the left tubal stump. After discussing medical and surgical treatment options, the patient underwent a 2-step vNOTES approach. First, a diagnostic vNOTES was performed using a 5-mm trocar with autoretracting blade. After confirmation of the diagnosis, the trocar was removed, and the incision was enlarged with blunt dissection. A self-constructed pessary port was then placed through the enlarged colpotomy, and the ectopic pregnancy in the left tubal stump was excised using an advanced bipolar device. The colpotomy was closed with running resorbable sutures. The duration of the surgery was 36 minutes, and the patient was discharged on postoperative day 1 without any complications. CONCLUSION Tubal stump pregnancy is a rare form of ectopic pregnancy with an incidence of approximately 0.4% of all ectopic pregnancies [1]. Treatment options include conservative medical management using methotrexate and surgery. Successful surgical treatment using laparoscopy has been previously reported [1,2]. This case demonstrates that vNOTES may be a minimally invasive option for the surgical treatment of tubal stump pregnancy in selected cases.
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Affiliation(s)
- Gokay Ozceltik
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey.
| | - Ahmet Ozgur Yeniel
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Arif Onur Atay
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ismail Mete Itil
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey
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Hortu I, Ozceltik G, Sahin C, Akman L, Yildirim N, Erbas O. Granulocyte Colony-Stimulating Factor Prevents Ischemia/Reperfusion-Induced Ovarian Injury in Rats: Evaluation of Histological and Biochemical Parameters. Reprod Sci 2018; 26:1389-1394. [PMID: 30497339 DOI: 10.1177/1933719118816839] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Granulocyte colony-stimulating factor (G-CSF) is a glycoprotein commonly used in the field of medicine to treat neutropenia. Granulocyte colony-stimulating factor has also crucial roles in ameliorating the ischemia/reperfusion (I/R) injury in particular tissues. In this study, we aimed to investigate the protective effect of G-CSF on ovarian damage in experimental ovarian I/R injury. Thirty adult female rats were used. Rats were separated randomly into 5 groups; Group 1: sham group (abdominal wall was opened and closed surgically), Group 2: torsion group with 3-hour ischemia using vascular clips. Group 3: torsion + G-CSF group with 3-hour ischemia 30 minutes after the administration intraperitoneal (i.p.) of 100 µg/kg of G-CSF. Group 4: torsion-detorsion group with 3 hour ischemia and 3 hour reperfusion. Group 5: torsion-detorsion + G-CSF group with 3 hour ischemia followed by 100 µg/kg of G-CSF i.p. administration 30 minutes prior to 3 hour of detorsion/reperfusion. Ovarian tissue damage was scored on histopathology. Ovarian tissue malondialdehyde (MDA) was measured biochemically. In comparison with the sham group, both the torsion and torsion-detorsion groups had significantly higher scores for follicular degeneration, vascular congestion, edema, hemorrhage, and leukocyte infiltration (P < .05). When compared group torsion-detorsion + G-CSF to group torsion-detorsion, parameters aforementioned significantly decreased in group torsion-detorsion + G-CSF (P < .05). Granulocyte colony-stimulating factor has also decreased MDA levels notably both in the torsion + G-CSF and torsion-detorsion + G-CSF groups (P < .05, P < .01). Our experimental study suggests that G-CSF can be a novel agent for the treatment of ovarian I/R injury.
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Affiliation(s)
- Ismet Hortu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Gokay Ozceltik
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Cagdas Sahin
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Levent Akman
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Nuri Yildirim
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Oytun Erbas
- Department of Physiology, Istanbul Bilim University School of Medicine, Istanbul, Turkey
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