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.

Distribution of tubal endometriosis

The incidence of tubal endometriosis was previously reported in a percentage of 4 to 11, but recent studies gave a prevalence up to 42.5 % which indicates the actual incidence of this disease is underestimated.  Some studies in recent literature suggested that endometrioma as well as left deeply infiltrating endometriosis are more likely to occur on the left side, compared to the right. According to Sampson's theory, the explanation for this left-side involvement is related to the presence of the…

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Endometriosis diagnosis and management based on the best available evidence from published literature

ESHRE, "European Society of Human Reproduction and Embryology" published a Guideline for the diagnosis and treatment of endometriosis in 2005 and then revised it in 2013. Based on new research and development there was a need to renew the last version of the ESHRE Guideline.  A core guideline development group was formed that included former members of the ESHRE guideline group and a subgroup of European experts who evaluate data coming from two patient representatives and five patient organizations. This group…

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Prevalence of endometriosis and adenomyosis by transvaginal ultrasound.

Women who present dyspareunia, dysmenorrhea, dysuria, dyschezia, chronic abdominal, and pelvic pain, and infertility would benefit from the early investigation. If the correct diagnosis of endometriosis and/or adenomyosis can be made in advance, early treatment will improve the quality of life in these patients. Transvaginal ultrasound is considered an accurate method for the diagnosis of endometriosis and adenomyosis as a first-line diagnostic method apart from its cost-effective nature. This retrospective cross-sectional study by Orlov et al. from the Department of…

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Planning surgery for recto-sigmoid endometriosis with 3D virtual models.

Efforts to reduce the high complication rate of rectosigmoid surgery in deeply infiltrated endometriosis are of great interest to gynecologists. 3D printing, currently used in various surgical specialties to support surgical planning and guide intraoperative procedures may be a way out. Borghese and colleagues from the Department of Medical and Surgical Sciences of the University of Bologne, Italy came up with the idea of using 3D models based on preoperative MRI segments of patients with recto-sigmoid endometriosis and comparing them…

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A French National Study Concerning The "Recovery Protocol" After Deep Infiltrating Endometriosis Surgery.

In recent years especially for complex surgeries, enhanced recovery after surgery (ERAS) programs have been implemented in several surgical specialties. This is based on a multimodal and multidisciplinary approach centered on the patient’s perioperative situation designed to improve patient management and reduce the hospital stay. In France, ERAS program guidelines for surgical procedures were published in 2016 by the French National Health Agency.  Deep infiltrating endometriosis (DIE) is a serious form of the disease, surgery for DIE can be complex and surgery may…

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A novel scoring tool to standardize surgical complexity for gynecologists.

The field of gynecologic surgery needs a more comprehensive, objective, and reproducible method for assessing and communicating surgical complexity than the current approach. Actually, there is no formal image-based system that allows surgeons to categorize and communicate the complexity of endoscopic hysterectomies. The aim of this study is to develop a system specifically for endoscopic hysterectomy through the creation of a novel scoring tool based on a review of surgical images.  Misal et al from the Department of Gynecology, Mayo…

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Algorithm for pain management in endometriosis

One of the debilitating symptoms of endometriosis is pain. Mostly due to delayed diagnosis and the high recurrence rate, even after the surgical and hormonal therapy pain control may not be sufficient causing the patient to suffer for decades.  Endometriosis-associated pain is caused by peripheral and central sensitization. Peripheral pain is due to the lesions themselves, and from the related nerve fibers.  This type of pain can be treated hormonally and surgically, as well as using analgesics. However, the continuous pain…

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Diaphragmatic endometriosis

Diaphragmatic endometriosis is a rare clinical condition that may show signs and symptoms like chest pain, right upper quadrant abdominal pain, shoulder pain, pleuritic pain, hemothorax, pneumothorax, hemoptysis, and thoracic endometriosis syndrome while the major part of the patients is asymptomatic (70%). The clinical diagnosis of this form of endometriosis is difficult due to the low sensitivity of imaging techniques and the lack of symptoms in most of the patients.  To reveal the feasibility, safety, and effectiveness of the minimally…

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Nerve-sparing technique for deep infiltrating endometriosis and its impacts on pelvic organ and sexual functions.

Deep infiltrating endometriosis and involvement of parametrium cause severe pelvic pain and dysfunction of some pelvic organs resulting in a reduction in women's quality of life. Although surgery for DIE aims to relieve pelvic pain, entering into the posterior parametrial spaces may also result in accidental pelvic nerve injury. Particularly for cases with posterior parametrial involvement, nerve-sparing excision surgery has recently been added to laparoscopic surgery in tertiary clinics, however, only a few cohort studies investigated the functional outcomes. Ianieri…

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A comparison of endometriosis Classifications: rASRM, EFI or Enzian?

None of the endometriosis classifications provide a clinically valuable system since the very first description of the disease in 1860. One unique terminology to describe the localization and the extension of the disease is needed, which should be the same for surgeons and imaging experts. A common language is essential due to the multidisciplinary aspect of the disease that involves radiologists, sonographers, gynecologists, and experts in gynecological, colorectal, and urological surgery.  One of the major classifications for endometriosis is rASRM …

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Evaluation of daily diary for endometriosis-related pain.

Some endometriosis patient-reported outcomes elements have been previously developed in accordance with regulatory and best practice guidelines including Endometriosis Pain Daily Diary, the Endometriosis Symptom Diary, and Endometriosis Impact Scale. The aim of this study was to develop another content-valid instrument by modifying Dysmenorhea Daily Diary to form the Endometriosis Daily Diary. Guan et al. from Merck Research Laboratories, NJ, USA worked together with primary care physicians or gynecologists based in three US cities: Chicago, Baltimore, and Pittsburg. Eligible adult…

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The necessity of laparoscopy for unexplained infertility.

The standard for accepting a couple as "infertile" is the inability to conceive after 12 months of regular unprotected intercourse. When this condition is met, assessing the number of motile sperm in the male partner and certifying the patency at least in one tube in the woman partner becomes important. After confirming these criteria, we can talk about "unknown infertility". Additional clinical tests such as postcoital cervical mucus detection, endometrial biopsy, ovarian reserve assessment,  serum prolactin levels, immunological factor screening…

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Association of psoriasis and endometriosis

Psoriasis is an immune-mediated inflammatory skin disease characterized by scalpy, red, and well-demarcated skin plaques that are observed in 2-4% of the population. Approximately 30% of psoriatic patients additionally have joint pain, stiffness, and swelling called psoriatic arthritis. The mechanism for the chronic inflammatory nature of endometriosis and psoriasis, are both poorly understood.  Harris et al. from the University of Washington, Seattle, USA planned this prospective cohort study to measure the bi-directional relationship between endometriosis and psoriasis with psoriatic arthritis.…

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Envorinmental metals harmful for female reproductivity

Heavy metals exposure in a wide range of ways is one of the main causes of increased infertility. According to the 2003 National Health Survey, nearly every pregnant woman in the USA is exposed to at least 43 hazardous chemicals during their pregnancy period. Hazardous environmental chemicals affect women throughout preconception and prenatal periods and create adverse effects on reproductive health.  To draw attention to the increasing danger, Dutta et al. from Mahsa University, Malaysia penned an overview about underlining…

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From Spain: execution for endometriosis and chronic pelvic pain unresponsive to conventional therapies

The current conventional therapy for chronic pelvic pain for endometriosis is defined as either hormonal or non-hormonal medical treatment starting with combined oral contraceptives progestins or dienogest, and then gonadotropin-releasing hormone analogs and/or surgery. Although conventional therapies usually are successful, still one-fourth to one-third of the patients do not achieve pain relief, probably either due to intolerance or contraindications to the therapy. Pereira et al. from Puerta de Hierro University Hospital, Spain, conducted a retrospective study to evaluate the benefit of identifying…

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A study design to improve the patient-centeredness in endometriosis care.

It is well known that endometriosis causes impaired daily activity and productivity along with energy loss, fatigue, pelvic pain, deep dyspareunia, and further, infertility accompanies all these negative influences. The chronic nature of the disease forces clinicians to plan long-term care with frequent check-ups and long-lasting medical treatments. Patient-centeredness can be defined as “providing care that is respectful of and responsive to the individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions”. Currently, patient-centeredness in…

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An Overview on Treatment of endometriosis

There are different guidelines by different gynecological societies for the diagnosis and treatment of endometriosis, which is an extremely complex illness.  Kalaitzopoulos and Samartzis et al. from Switzerland worked on and compared six national and two international widely used guidelines to evaluate and compare the similarities and the differences between the guidelines. The results of the comparison and overview of six national (National German Guideline-S2k, Society of Obstetricians and Gynecologists of Canada, American College of Obstetricians and Gynecologists (ACOG), American Society of…

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Which one is more effective for the preservartion of postoperative ovarian reserve?

Although cystectomy is the most preferred treatment of endometrioma, it is still a matter of debate as it may cause a reduction in the quality and number of remaining follicles, especially important for women who are planning to conceive. Anti-Müllerian hormone (AMH) is a reliable serum marker to reveal the ovarian reserve and facilitates determining and selecting the operational approach for endometrioma. Preoperative GnRHa or DNG treatment is helpful in improving the pain symptoms, reducing the size of endometrioma, and…

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Evaluation of patient self-reported outcome measures for endometriosis.

Endometriosis symptomology is multifactorial and it changes over time based on the patient's life experience, perceptions, and medical treatment. These changes require the agility of adaptation for both clinicians and patients to respond properly. The documentation of the patient's specific centered pattern becomes important to adjust and create a patient-centered dashboard for endometriosis. The selected catalog of "patient-reported outcome measures" is a starting point for the integration of clinicians and patients who are dealing with endometriosis. Nicolas-Boluda et al., from…

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International definition and standardization for endometriosis

There is huge heterogeneity in classifications, subtypes, diagnostic and therapeutic interventions of endometriosis in published literature. The lack of a uniform and widely accepted terminology of the disease rose the necessity to argue and reach a common consensus with organizations, experts, and a working group of recognized international societies. Four international societies including AAGL, ESHRE, ESGE, WES started to work on the terms and definitions with their elected group members. All collected definitions were discussed and adaptations were made to give…

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