Selma Oransay, MD
Dr. ORANSAY is 35 years experienced clinician in OB/ GYN. She worked in the main national maternity educational hospital of Turkey for 20 years than she moved to İstanbul and worked in private hospitals. Her published articles are mostly on topics of menopause and infertility. She is also experienced as a voluntary OB/GYN doctor in African healthcare program.
Peritoneal endometriosis and Peritoneal Immunity
The peritoneum is an important immune barrier where, under normal conditions, it is balanced. External stimuli cause pro-inflammatory responses. To bring balance to this undesired situation, anti-inflammatory factors come into play. However, in patients with endometriosis, cytotoxicity of T lymphocytes, cytokines secreted by T helper, and autoantibody produced by B lymphocytes are reduced due to fragmented endometrial tissues. The question is the role of the altered immune microenvironment in the peritoneum in explaining the peritoneal endometriosis and the infertility of…
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Elevated iron levels in "endometriosis pathogenesis"
The presence of abnormal levels of iron and ferritin in endometriotic lesions is likely due to repeated bleeding episodes. When red blood cells break down, the iron content is released, which can cause inflammation leading to damage to surrounding tissues. Iron-mediated oxidative stress is linked to subfertility, symptom severity, and possibly malignant transformation in patients with endometriosis. The evidence base in the literature about excess iron in endometriotic lesions and its possible effect on pathogenesis is large. However, there is no…
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A review for genetics of endometriosis.
There is an increased risk of developing endometriosis among first-degree relatives, which can raise suspicions of the role of genetic factors in endometriosis. Genome-wide association studies and next-generation sequencing have identified numerous genetic loci and variants relating to the disease. Dr. Chiorean et al. from the Department of Pathology of the County Clinical Hospital of Targu Mures, Romania, reviewed the genetic studies to date about endometriosis by 10 years of Pubmed research. This article was recently published in the journal…
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Is continuous hormonal treatment safe and healthy method for endometriotic patients?
One of the studies related to the search for new markers in pathophysiologic causes of endometriosis is circulating microparticles and their subset "tissue factor". In response to damage, activation, or apoptosis, these microparticles are found in human plasma, urine, saliva, and cerebrospinal fluid. Higher cMP levels are found in conditions where vascular dysfunction and inflammation are critical vital findings, such as cardiovascular disease, diabetes, preeclampsia, thrombotic disorders, and deep endometriosis. TF, also known as coagulation factor III, initiates the coagulation…
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A new classification called ENDOGRADE to rate surgical complexity in deep endometriosis.
Correlation with patient outcomes could not be identified in most endometriosis classification systems including the commonly used revised ASRM. Therefore, in addition to grading the depth and invasion pattern of the lesions, there is a need for a classification system to cover the operation time and perioperative outcomes. Crestani et al. from the Department of Obstetrics and Gynecology of Sorbonne University, France, developed a new grading system named "ENDOGRADE", in which the difficulties of surgical techniques are divided into four grades.…
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The compliance for post-surgical follow-ups after endometriosis surgery
. The patient's adherence to follow-ups after surgery is essential as it is the only way to evaluate the surgery's benefits in improving pain symptoms and recurrences, measuring the quality of life, and fertility outcomes. . Dr. Szabo and his team from the University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania, aimed to determine the postoperative outcomes of endometriosis patients by examining the follow-ups retrospectively using the electronic database of the Cirendo database, which compromise 15 institutions. .…
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"Transumblical single-port laparoscopy" for deep infiltrating endometriosis.
Deep infiltrating endometriosis patients have multi-system involvements, severe pelvic adhesions, and pelvic pain. Dyspareunia, dysmenorrhea, infertility, gastrointestinal symptoms, and lower urinary tract symptoms seriously affect their quality of life. Although hormonal therapy may be the first choice for treating endometriosis, surgical treatment should be recommended to remove the lesions, restore anatomy, and promote fertility in cases without response, intolerant, or who have severe intestinal and urinary tract stenosis. Compared to open surgery, laparoscopy has apparent advantages, such as less trauma,…
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Dienogest versus combined oral contraceptives treatment in postoperative endometriosis care
Dienogest is a synthetic progestin derivative, like oral contraceptives, used to prevent endometriosis recurrence after surgery. Randomized clinical trials verified a significantly higher reduction in endometriotic lesions, clinical symptoms, and improved quality of life obtained when dienogest was given to the patients instead of combined oral contraceptives. For this reason, the Chinese Medical Association Guidelines recommend using dienogest as a drug of choice to treat endometriosis. Zhang et al. from the Department of Pharmacology, China, compared the cost-effectiveness of dienogest…
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Postoperative outcomes of laparoscopic rectosigmoid resection for bowel endometriosis.
Rectosigmoid endometriosis comprises 80-85% of all bowel endometriosis cases and can be localized in the rectovaginal septum, uterosacral ligaments, retro-cervical region, and parametrium. Symptoms of rectosigmoid endometriosis include abdominal bloating, constipation-diarrhea, lower-back pain, dyschezia, and sometimes cyclic rectal bleeding. Minimally invasive surgical treatment has become the standard care of rectosigmoid endometriosis, which has a portfolio from rectal shaving to disc excision or techniques that combine transanal resection with concomitant laparoscopic rectal shaving. In cases with nodules more than 3 cm.…
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Pain Scoring System for Deep Endometriosis
The numeric pain scale is commonly used to interpret pain score values. According to the National Comprehensive Cancer Network guidelines, pain scores of 4-7 points indicate moderate, and 8-10 points indicate severe pain. Patients with a local pain score of 4 or higher should be addressed to the surgery and deserve drugs other than painkillers, preferably opioids. Pain scoring is an examination method to detect endometriosis-associated pain by pelvic examination alone. The uterus and surrounding regions can be divided into…
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Outcomes of improving chronic pelvic pain with "immersive digital therapeutics" at home.
Studies have shown that virtual reality can effectively treat acute pain experienced by burn victims, during labor, dental surgery, or for chronic musculoskeletal, neuropathic, and cancer pain. Considering the effectiveness of treating chronic pelvic pain at home, Merlot et al. from Franco European Multidisciplinary Endometriosis Institute, Bordeaux, France, conducted a prospective, double-blind, randomized, controlled trial to evaluate the efficacy and safety of virtual reality treatment at home. Patients were advised to use the treatment ("Endocare") or control starting on the first…
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Outcomes of chronic pelvic pain after niche repair
Rapidly increasing cesarian section rates in recent years increased the cesarian scar defects and the development of "isthmoceles". Isthmocele is a myometrial lesion located around the isthmic portion of the uterus that is a myometrial discontinuity or hypoechoic triangle in the myometrium of the anterior uterine wall at the site of hysterotomy. It is generally caused by the improper closure of the muscular layer of the uterus and is also described as the "niche" of the uterus. Isthmoceles are generally…
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Menopause-management strategies for women with endometriosis.
Menopausal hormonal therapy is the most effective treatment for menopausal symptoms, such as hot flushes, sweating, sleep disturbances, mood changes, and joint pain. Approximately 75% of all women experienced some degree of these symptoms, while 2-4% were diagnosed with endometriosis. Menopausal hormonal therapy consists of estrogen therapy alone or combined with progestins, while a synthetic preparation of tibolone may be another option. Jackson et al., from the Department of Gynecology and Reproductive Medicine of Karolinska University Hospital, Sweden, build five hypothetical…
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Limitations of current surgical classification systems for endometriosis.
Many classification systems for endometriosis have been developed since the 1970s, and in a 2021 review, more than 20 of those systems were identified. The best-known and most frequently used are rASRM (revised American Society of Reproductive Medicine), the Enzian classification for deep endometriosis, EFI (endometriosis fertility index), and AGGL (American Association of Gynecologic Laparosopists classification systems. Except for EFI, the most commonly used systems are based on the anatomical location, the number, and depth of the endometriotic lesions. The above…
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Endometriosis and Progesterone Resistance
Progesterone resistance is the unresponsiveness of endometrium with subsequent dysregulation of the progesterone signaling pathway, and endometrial gene works. Progestins, on the other hand, are the first-line treatment choice, especially for long-term treatment of endometriosis. In the clinics, one-third of the patients with endometriosis do not respond to progesterone appropriately, which means they suffer from progesterone resistance. To summarize the evidence and mechanism of progesterone resistance, Dr. Ping Zhang and Dr. Guoyun Wang from the Cheelo College of Medicine and…
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When to start ART after laparoscopic treatment of endometriosis?
Laparoscopy combined with histopathologic confirmation of endometriosis is the reference standard for diagnosing endometriosis. Additionally, laparoscopic surgery is considered the most effective way to approach infertility induced by endometriosis. The surgical factors influencing the outcome of treating the infertility of women with endometriosis are still controversial. In their study, Tahmasbi Rad t al. from the Department of Obstetrics and Gynecology of the University of Frankfurt, Germany, aimed to find the factors that influence the time until pregnancy after the laparoscopic…
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The effect of glucocorticoid use on clinical pregnancy rates
The preference to use glucocorticoids such as dexamethasone, prednisone, and methylprednisolone, along with IVF-ET cycles is due to the diminishing inflammatory response and suppressing immunity. Thus, while autoimmune diseases are suppressed with glucocorticoid administration, the success rate in the implantation phase of IVF-ET cycles increases based on its effect on natural killer cells and cytokines. Dr. Yaxuan et al. from the Department of Clinical Medicine at Anhui Medical University, Hefei, China, conducted a comprehensive meta-analysis using PRISMA guidelines after a…
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The cost-effectiveness of different GnRH agonist regimes for progestogen-resistant endometriosis.
Surgical and medical treatments are currently used to treat the pelvic pain caused by endometriosis. Respected guidelines recommend using progestins with or without estrogens as first-line medical treatment due to their safety, effectiveness, inexpensive, and tolerability. However, one-third to one-quarter of patients who don't respond to these agents need second-line medications such as GnHR agonists or GnRH antagonists. All those agents induce varying degrees of hypoestrogenic state to cause inactivity of endometriotic lesions and positively impact pelvic pain symptoms. Pseudo-menopausal…
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Ultrasonographic findings predicting parametrial deep endometriosis
Transvaginal ultrasonographic evaluation is the primary imaging technique to rule out deep endometriosis. Although the International Deep Endometriosis Analysis Group (IDEA) published a consensus to standardize the nomenclature of ultrasonographic pelvic examination in women with suspected deep endometriosis, parametrial deep endometriosis has not been described and classified. Only a few studies that detected the accuracy of Transvaginal Ultrasonography examination for parametrial endometriosis mentioned some indirect signs that correlated deep endometriosis presence, such as uterine adenomyosis, ovarian endometriomas with "kissing ovaries" sign, and…
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Surgery for Deep Endometriosis
In recent years, minimally invasive surgery has gained popularity, providing the best results in gynecologic cancers and deeply infiltrated endometriosis. With the help of a high-definition camera displayed on a TV monitor, the small structures are enlarged 4-7 times and create visibility for detailed dissection of tissues. Based on several key reports, the National Comprehensive National Negatively impacted and changed the guidelines on managing cervical cancer. These guidelines recommend an open laparotomic approach to cancers instead of minimally invasive surgery.…
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