Bilateral Torsion Research Articles

The Role of Mannitol and Vitamin D in Ovarian Ischemia/Reperfusion Injury in Rats with Acute Abdominal.

This study was designed to investigate the effects of vitamin D and mannitol in an experimental rat ovarian torsion model. Thirty-two female Wistar albino rats were randomly classified as group 1: (sham), group 2: (detorsion), group 3: (detorsion + mannitol), group 4: (detorsion + vitamin D) and group 5: (detorsion + mannitol + vitamin D) (for each group n = 8). All groups were subjected to bilateral adnexal torsion for 2 h except for group 1. Bilateral adnexal detorsion was performed in all groups except for group 1. Groups 3 and 5 intraperitoneally received the injection of mannitol at a dose of 0.3 mg/kg 30 min before detorsion. Also, the group's 4 and 5 orally received vitamin D in a dose of 500 IU/kg/day for two weeks before torsion. Total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) and proliferating cell nuclear antigen (PCNA) levels were analyzed. According to the histopathological analyses, ovarian tissue damage and follicle counting were evaluated. TOS, OSI and histopathologic score values of ovarian tissue were significantly lower in group 5 than groups 2, 3 and 4 (p < 0.05). The PCNA level was significantly higher in group 5 than in groups 2, 3 and 4 (p < 0.05). A strong negative correlation was found between OSI and PCNA in groups 2, 3, 4 and 5 (r = -0.92, p = 0.01; r = -0.98, p < 0.0001; r = -0.98, p < 0.0001 and r = -0.96, p = 0.0002, respectively). The numbers of primordial follicles in group 5 (p < 0.001) and primary follicles in group 4 (p < 0.001) were significantly higher when compared to group 2. Based on the results of this study, it could be suggested that combination treatment of mannitol with vitamin D is more effective in reversing tissue damage induced by ischemia-reperfusion (I/R) injury in the ovarian torsion model than administration of only an agent.

Dance-specific eligibility of vocational ballet students - examinations at a governmental training institution for classical ballet

During their training, pre-professional ballet students are confronted with physical stresses comparable to those of competitive sports. In competitive sports, there are mandatory and binding aptitude tests to ensure that the growing athlete meets the requirements. In ballet, there are no such mandatory examinations preceding the start of training. For adult professional dancers, musculoskeletal ideals could be isolated from the dance medicine literature. However, only a few studies describe musculoskeletal characteristics of pre-professional ballet students. It is neither known at what age a student should meet the ideal measurements for an adult nor what deviations from the ideal can be considered normal. This study aims to describe sociodemographic and musculoskeletal characteristics of pre-professional ballet students and discusses to what extent they already meet or deviate from dance-specific eligibility criteria for adult professional ballet dancers. In this study, n = 414 female and n = 192 male students of John Cranko School (JCS) were seen by an experienced orthopaedist and dance physician. Mean age was 13.9 years (SD 3.5, range 5-22 years). Their medical history was taken (age; nationality; start of ballet/training) and a physical examination was performed (height/weight; symmetry of shoulder girdle, spine, waist triangles; pelvic tilt; tibial torsion; range of motion of base of index finger joint, spine, hips, ankle and base of great toe joint). Subsequently, the results of this study were compared with suitability criteria for adult professional ballet dancers that had been isolated from the dance medicine literature for a previous article. Examinees were from 49 different nations. 34.6% of the female subjects (≥16 years) were between 165 and 170 cm and 33.3% of the male subjects (≥18 years) were between 178 and 185 cm tall. 45.0% of those examined showed low body weight (<10th percentile, BMI <18.5 kg/m²). The trunk of 61.0-84.8% of those examined was erect and symmetrical. 25.2% had scoliosis. Half (53.5%) were found to have a bilateral external rotation of the hips of at least 60°, and 68.7% had a bilateral internal rotation between 20 and 50°. 87.3% exhibited a bilateral tibial torsion between 15 and 40°. A bilateral en dehors of 90° was calculated for 25.0%. In 9.1% of those examined, the upper ankle joints presented a dorsiflexion of at least 25°, and in 70.2%, a plantarflexion of at least 70° was seen. In 88.0%, the metatarsophalangeal joint of the great toe was 90° (f) and 80° (m) on both sides. The results of this study showed that pre-professional ballet students fulfil many characteristics of adult professional ballet dancers. High values already among young age groups suggest a ballet-specific selection. Nevertheless, not all students fulfil the theoretical "ideal measurements" for professional classical ballet. These anatomical limits should be considered individually in training to protect the growing pre-professional ballet dancer. The high ballet-specific anatomical demands, but especially the large number of students with a low body weight, underline the necessity of mandatory aptitude tests at the beginning and regular check-ups in the course of training to avert compensatory mechanisms and their consequential damage and to screen for eating disorders and disorders of eating behaviour.

A Child with Severe Bilateral Tibia Vara: Treatment with Computer-Assisted Gradual Correction Utilizing Hexapod External Fixator

A 7-year-old obese boy presented to the Paediatric Orthopaedic clinic with a complaint of worsening bilateral knee bowing. He was initially seen for the same problem in another hospital at the age of 3. The bowing of the leg was associated with pain over the lateral aspect of both knees. He was able to walk but unable to run or participate in sports due to the deformity and knee pain. On examination, the child had a waddling gait and lateral thrust due to severe bilateral genu varus. The range of motion of bilateral knee joints was 0 to 110 degrees. The knee intercondylar distance was markedly increased and there was bilateral tibial torsion. No limb length discrepancy and neurovascular examination was normal. The radiograph revealed features of infantile tibia vara (Blount disease). Bilateral proximal tibia temporary hemiepiphysiodesis was attempted but no correction of the deformity was achieved due to implant failure. His parents were then counseled to let him undergo gradual deformity correction surgery using a ring external fixator (hexapod system). The bilateral varus deformity was corrected after 4 months, and the patient was able to walk normally.

78. Management of Asynchronous, Recurrent, Bilateral Pre-Menarchal Ovarian Torsion

78. Management of Asynchronous, Recurrent, Bilateral Pre-Menarchal Ovarian Torsion

Hypertrophic osteopathy in a dog associated with chronic lung lobe torsion

AbstractA 6‐year‐old, male, neutered, crossbreed dog was presented with a history of lethargy, chronic cough, right thoracic limb lameness, bilateral distal thoracic limb swelling and non‐healing skin wounds. Computed tomography showed bilateral forelimb irregular periosteal reaction and chronic right cranial lung lobe torsion, with secondary bronchiectasis. The affected lung lobe was surgically excised, the right radius was biopsied, and postoperative antimicrobial therapy was prescribed. Histopathology and bacterial culture confirmed chronic lung lobe torsion, associated bacterial bronchopneumonia, and right radial hypertrophic osteopathy. Two months after starting treatment, the respiratory signs resolved and the soft tissue swelling and lameness markedly improved. To the authors’ knowledge, this is the first case report describing hypertrophic osteopathy suspected secondary to chronic lung lobe torsion in a dog.

Sildenafil as a Salvage Treatment for Ovarian Torsion: A Rat Model

OBJECTIVE: In this study, we aimed to investigate the effect of sildenafil, acting as an anti-oxidant on the ischemic rat ovarian torsion model by pointing out ovarian reserve via AMH levels which is the best marker for oocyte pool.STUDY DESIGN: This study is an experimental animal study conducted according to the principles of the Declaration of Helsinki. Twenty-seven rats were assigned into three groups, each consisting of nine individuals. Group 1: Sham operation (laparotomy only) was performed. Group 2: The torsion group had bilateral torsion and detorsion of the ovaries. Group 3: In Sildenafil and torsion group the rats received 0.7 mg/kg sildenafil (Viagra, Pfizer, New York, ABD) intraperitoneally one hour before torsion and detorsion operation. One month after the initial operation, blood was drawn via the intra-cardiac route, and serum antimullerian hormone (AMH) concentrations were studied.RESULTS: The mean weights of the rats were similar 224 g, 229 g, and 222 g for groups 1, 2, and 3 respectively. Only one rat from Group 2(T/D) died during the experiment leaving eight rats for analysis. The mean value for AMH was 24.9227±12.19124 ng/ml and the mean value for weight was 226.22±19.200. The differences in AMH groups were not statistically significant (p=0.873)CONCLUSIONS: As a result, as is shown in our study, the ovarian reserve may not be influenced by ischemia developed by ovarian torsion or any influences could not change AMH levels. Sildenafil which was given to the rats before detorsion to protect against reperfusion ischemia was found to be ineffective on ovary reserve according to AMH assessment.

Laparoscopic salvage procedures for adnexal torsion in pediatric and adolescent patients during the COVID-19 pandemic: a retrospective cohort study

BackgroundEarly management for adnexal torsion increases likelihood of ovarian/tubal salvage. The Coronavirus disease of 2019 (COVID-19) pandemic poses delays from symptom-onset to intervention. The primary objective was to evaluate rates of ovarian salvage and tubal salvage following ovarian torsion and adnexal torsion during the COVID-19 pandemic in a pediatric and adolescent gynecology population.MethodsThis was a retrospective quality improvement cohort study of pediatric and adolescent gynecology patients at a single children’s hospital who underwent laparoscopy for suspected ovarian torsion/adnexal torsion between March 2020 to March 2021. Descriptive statistics and t-tests were utilized.ResultsThere were 50 suspected adnexal cases in 47 patients. All underwent laparoscopy, revealing 39 adnexal torsion occurrences in 36 patients and 1 patient with recurrent adnexal torsion three times. All underwent pre-operative COVID-19 testing. Mean age was 13.9 ± 2.6 years for adnexal torsion cohort. Menarche was achieved in 88% (n = 44) and 12% (n = 6) were pre-menarchal. The primary outcome was ovarian salvage and tubal salvage rates, which were 97.4% (n = 38) and 89.7% (n = 35), respectively. Secondary outcomes assessed factors contributing to the primary outcome or operative delays. The mean age of menarche was 11.2 years (salvaged) and 12.5 years (non-salvaged) (p = 0.04). There were no differences in mean pain duration or mean COVID-19 testing time between groups. Left, right and bilateral adnexal torsion occurred in 42% (n = 21), 32% (n = 16), and 4% (n = 2) respectively. The most common pathologies were paratubal cyst (n = 17, 34%) and benign ovarian cyst (n = 16, 32%).ConclusionsOvarian salvage and tubal salvage rates were 97.4% and 89.7%, respectively during the time frame studied. These salvage rates during the study period are comparable to previous rates in a pre-COVID cohort at our institution. Institutional and departmental quality and safety initiatives likely contributed to this outcome.

A medical and literature undescribed case of acute abdomen - Consequences of bilateral torsion of the adnexa: Case report

ntroduction: Torsion is the turning of the adnexa around its axis. It accounts for 3% of all gynecological emergencies. It also happens during pregnancy, as much as 20-25% of all torsions. It most often occurs in pathologically altered ovaries, 60-80% of cases. Causes in pregnancy are more often benign than in nonpregnant women. The diagnosis is established by clinical picture, physical and ultrasound examination. Due to the specificity of pregnancy, it is more difficult to diagnose, especially in the third trimester. Torsion is treated surgically by laparoscopy or laparotomy. Options are detorquation or removal of the necrotic adnexa. Case report: We report the first case of bilateral adnexal torsion in the third trimester of pregnancy. A 32-year-old pregnant woman came to our institution in the 28th week of a spontaneous twin pregnancy with pain in the right hemiabdomen and an episode of vomiting. After clinical, laboratory and ultrasound evaluation, as well as artificial maturation of fetal lungs, cesarean section and bilateral adnexectomy were successfully performed. Pathohistological findings showed infarction and necrosis of the adnexa. Conclusion: Torsion of the adnexa is not uncommon in pregnancy, with 20-25% of all torsions occurring in pregnant women. Torsion of the adnexa should be considered in the differential diagnosis of pain in pregnancy, especially if it is accompanied by nausea, vomiting and fever.

Synchronous bilateral ovarian torsion followed by recurrent unilateral torsion in a patient undergoing fertility treatment: A case report and literature review

BackgroundOvarian torsion (OT) is a gynaecological emergency and requires prompt recognition and treatment in order to prevent the loss of ovarian function. Patients who are undergoing fertility treatment are at an increased risk of developing OT. ObjectiveThe diagnosis of OT in patients undergoing fertility treatment can be challenging as they often present with abdominal pain and other non-specific symptoms. We highlight the importance of early diagnosis of suspected torsion and performed a literature review on cases of bilateral OT to review its presentation, investigation, and subsequent management.Case report: A 32-year-old nulliparous woman who was undergoing controlled ovarian stimulation presented with lower abdominal pain and was initially managed as ovarian hyperstimulation syndrome (OHSS). Her pain did not subside following conservative management and she proceeded to have a laparoscopy which demonstrated synchronous bilateral ovarian torsion (SBOT), both ovaries were detorted. Eight months later, she was preparing for her frozen embryo transfer (FET) cycle, patient again presented with significant right sided abdominal pain and was found to have a recurrent torsion of the right ovary which was again detorted successfully. ConclusionsClinicians should have a low-threshold to investigate and rule out OT in patients who present with lower abdominal pain, especially in those with additional risk factors for torsion. Patients with confirmed torsion can be successfully managed with detorsion of the ovaries. Further research is needed to determine the best management option for patients with recurrent torsion episodes.

Testicular decompression and tunica vaginalis flap in human acute testicular torsion: modified step-by-step technique description and preliminary outcomes.

To report the effects of a tunica vagina flap on testicular compartment syndrome. This single-arm clinical trial was conducted from September 2020 to October 2021. Consecutive patients with suspected testicular torsion within 24 hours of pain onset were included. Patients with past testicular torsion, bilateral torsion, or previous atrophy were excluded. The tunica vaginalis was opened, and the intratesticular pressure was measured before testicular retrieval from the scrotum and detorsion (P1), after detorsion (P2), and after transverse incision (P3). A tunica vaginalis flap was performed and a new intratesticular pressure was recorded (P4). The contralateral testicular pressure was recorded before fixation (Pc). The minimum follow-up period was 6 months. Fifteen patients were recruited from September 2020 to October 2021. Nine patients completed the follow-up. The median age (range) was 15 years (9-19). The mean P1, P2, P3, P4, and Pc (range) were 43, 60, 23, 20, and 14mmHg, respectively. The atrophy rate was 66.3% and the viability was 88.9%. No major complications were observed. The modified tunica vaginalis flap in acute testicular torsion decreased intratesticular pressure. Furthermore, normal testicular pressure can improve testicular preservation. It can also decrease testicular pressure to normal levels and preserve the testicular parenchyma. Testicular torsion causes orchiectomy in more than 80% of the cases after 24 hours of pain onset. Testicular detorsion only (P1-P2) showed a small difference in intratesticular pressure (median 4mmHg). Testicular incision (P2-P3) only demonstrated a major pressure decrease (median, 45mmHg). The final pressure after TVR was similar to the non-twisted testicle pressure (median, 1mmHg). Testicular salvage (88.9%) and atrophy (66.3%) rates were slightly higher than the previous literature reports, perhaps the initial learning curve of this novel technique.

Paper 17: Decreased Glenohumeral External Rotation is associated with Elbow Injury in Adolescent Baseball Pitchers

Objectives: To compare bilateral standard glenohumeral range of motion, humeral torsion &amp; humeral torsion-corrected glenohumeral range of motion within and between healthy adolescent baseball pitchers &amp; adolescent baseball pitchers who have an injury to the throwing elbow. Secondarily, to analyze the relationship between humeral torsion angle and glenohumeral rotational motion in adolescent pitchers. Methods: Baseball pitchers aged 13-17 were prospectively enrolled into either a healthy group, if currently pitching in the community without complaint or injured group, if they presented to clinic for an elbow injury related to pitching. Bilateral standard glenohumeral internal &amp; external rotation was measured in degrees using a bubble goniometer with the scapulothoracic joint manually stabilized. Bilateral humeral torsion angles were measured using an Ultrasound &amp; bubble goniometer and were used to calculate humeral torsion-corrected glenohumeral range of motion. Parametric tests were used to compare values within and between groups for both the dominant and non-dominant extremities with significance defined as p&lt;0.05. Pearson’s correlation was used to evaluate the relationship between humeral torsion and standard glenohumeral motion in each group. Results: Twenty-nine healthy and twenty-five injured pitchers were enrolled with no difference in age or hand dominance between groups. The dominant shoulder of both the healthy (Table 2) and injured (Table 3) groups demonstrated a significant increase in humeral retrotorsion with increased standard glenohumeral external rotation &amp; GIRD. However, no difference in humeral torsion-corrected range of motion was present within groups. Injured pitchers displayed less standard &amp; humeral torsion-corrected external rotation of the dominant shoulder as well as less standard external rotation of the non-dominant shoulder compared to the healthy pitchers (Table 4). No difference in internal rotation measurements or humeral torsion was found between groups. A moderate correlation was found between ipsilateral humeral torsion angle and standard glenohumeral external (r=0.49) &amp; internal rotation (r=-0.58) in the dominant shoulder of healthy pitchers (Figure 1) but no correlation (r&lt; 0.3) was found between these measures in the dominant shoulder of injured pitchers. Conclusions: Both healthy &amp; injured adolescent baseball pitchers displayed dominant shoulder GIRD, external rotation gain &amp; retrotorsion of the humerus. In healthy pitchers, dominant glenohumeral motion was correlated to the humeral torsion angle suggesting that the osseous adaptation of humerus significantly contributed to these findings. However, this correlation was not found in the injured pitchers, suggesting that soft tissue factors played a larger role in the development of GIRD &amp; external rotation gain in this group. Additionally, injured pitchers displayed less standard glenohumeral external rotation of both shoulders and less humeral torsion-corrected external rotation of the dominant shoulder compared to healthy pitchers. This suggests a baseline difference in the soft tissue and/or structure of the pitchers’ shoulders between groups. Glenohumeral internal rotation and humeral retrotorsion were not associated with injury status in our study. Clinically, this study suggests that rehabilitation programs including modalities to improve external rotation may be of benefit for adolescent baseball pitchers with elbow injuries &amp; further research on the structural variations of the adolescent pitching shoulder is needed. [Table: see text][Table: see text][Table: see text]

Bilateral Testicular Torsion: A Systematic Review of Case Reports.

Bilateral testicular torsionis a rare but serious condition characterized by twisting both testicles around their respective spermatic cords, leading to reduced blood flow and potential loss of the testicles. Treatment of this condition may involve surgical detorsion of the affected testicles and fixation to prevent recurrence and, in some cases, removal of severely damaged testicles. In April 2023, a systematic review of case reports was performed to examine the presentation, clinical features, diagnostic process, and management of bilateral testicular torsion. Our search encompassed the following databases: PubMed, ScienceDirect, and Google Scholar. Out of 340 studies, only eight cases met our criteria. However, this review discusses bilateral testicular torsion symptoms, investigation, and outcome.

Effect of protection of enoxaparin against experimental ischemia/reperfusion injury in the rat ovary on in vitro fertilization outcomes.

The study aimed to investigate the protection of enoxaparin (E) against experimental ischemic (I) and ischemic-reperfusion (I/R) injury in rat ovaries on in vitro fertilization outcomes. In total, 56 adult female Sprague-Dawley albino rats were randomly assigned to 6 groups of 8 animals each: Sham, Ischemia, I/R, Sham+E, I+E, and I/R+E. Ischemia groups were subjected to bilateral adnexal torsion for 3 h. In contrast, I/R and I/R+E groups received subsequent detorsion for 3 h. Enoxaparin (0.5 mg/kg s.c.) was administered 30 min prior to ischemia (I+platelet-rich plasma) or reperfusion (I/R+I+platelet-rich plasma). Ovaries were stimulated through intraperitoneal injection of 150-300 internal units IU/kg pregnant mare serum gonadotropin. Anti-Müllerian hormone levels were measured before and after surgery in all groups. When the number of metaphase II oocytes was evaluated, statistically significant differences were observed between the I and I+E (p=0.001) and I/R and I/R+E (p=0.000) groups. When both I and I+E groups and I/R and I/R+E groups were compared, it was found that E application increased the number of fertilized oocytes. The number of embryos on the second day was higher in the I/R+E group than that in the I/R group. Statistically significant differences were found in the number of grade 1 embryos between the I/R and I/R+E groups (p=0.003). In comparing anti-Müllerian hormone values within the group, the highest decrease was observed in the I and I/R groups. Enoxaparin effectively minimizes ovarian damage and preserves ovarian reserve following ovarian torsion.

Protective effects of propolis on ischemia-reperfusion injury in a rat testicular torsion and detorsion model.

The torsion model of testis in a rat was adopted for evaluation of possible effects of propolis (Prop) on ischemia-reperfusion (IS/REP) injury. The healthy male Wistar rats (totally 24 animals) were randomized into four groups (n = 6) and animals experienced bilateral testicular torsions as follows: In sham group just, laparotomy was performed and in IS group, animals experienced a 3 hr period testicular IS. In IS/REP group, a 3 hr period of IS followed by a 3 hr period of testicular REP for left testis and a one-week testicular REP for right testis were done. In this group animals were gavaged by 1.00 mL normal saline 1 hr before the onset of IS. In IS/REP/ Prop group, the same procedures for IS/REP animals were followed as well as gavage of 1.00 mL Prop extract solution 1 hr before the onset of IS. Analyses of biochemistry, histology, inflammatory biomarkers and sperm parameters were carried out. In IS/REP/Prop group, nitric oxide synthase malondialdehyde, myeloperoxidase and 8-hydroxy-2 deoxyguanine in IS/REP/Prop group were significantly decreased and, superoxide dismutase, total glutathione, glutathione peroxidase, glutathione reductase and glutathione S-transferase were significantly increased compared to the other animals. In IS/REP/Prop group, seminiferous tubules (with normal spermatogenesis) showed all stages of spermatogenic cells with plentiful spermatozoa. Tubular deterioration and atrophy and spermatogenic cell loss in were seen in a limited extent. The mean concentrations of Interleukin-1 beta and tumor necrosis factor alpha in IS/REP/Prop were significantly decreased. Sperm quality was significantly improved by Prop in IS/REP/Prop group. It was concluded that Prop could be supportive in diminishing IS/REP injury in testicular tissue exposed to ischemia.

The Role of p-Coumaric Acid on Reproductive and Remote Organ Damages Created by Adnexal Torsion/Detorsion: Biochemical and Immunohistochemical A Study

Objective: We planned to search the effects of p-coumaric acid on ovary and lung injuries formed via bilateral adnexal torsion detorsion (T/D) in experimental rat model. Methods: 24 female, Sprague-Dawley rats were sorted out as 3 groups. Design of the groups was performed as sham (group I) and T/D (group II), p-coumaric acid+T/D (group III) groups. Sham group; abdomen area was applied incision and repaired with no T/D model application. T/D group; 3 h of torsion phase completed and then 3 h of detorsion stage was established. P-coumaric acid+T/D group; p-coumaric acid was administered at the dose of 100 mg/kg for 15 days by oral gavage and then, T/D model was performed. Following detorsion phase, rats were sacrificed, lung and ovarian tissues were excised for biochemical and immunohistochemical evaluations. Results: When it is compared to group I, oxidant parameters elevated significantly in group II (p&amp;lt;0.05) while the activity of antioxidant enzymes and TAS level decreased. On the other side, antioxidant enzyme activity raised and oxidant parameter levels diminished in group III compared to group II (p&amp;lt;0.05). Moreover, NF-kB, caspase 3 and LC3B protein expression levels increased in ovary and lung tissues of the group II. But NF-kB, caspase 3 and LC3B protein expression levels decreased in group III. Conclusion: As a consequence, p-coumaric acid acted a protective performance against ovary and lung injuries arising from adnexal T/D model in rats.

Bilateral Adnexal Torsion during the Third Trimester of Pregnancy

Acute pelvic pain during pregnancy can pose a problem for differential diagnosis. We report a case of bilateral adnexal torsion in the third trimester of pregnancy. Indeed, this diagnosis may go unnoticed in front of pelvic pain associated with a pregnancy and only an early management can avoid irreversible lesions due to ischemia, which may jeopardize the subsequent prognosis of fertility. Our patient is 28 years old, primiparous, with polycystic ovary syndrome, followed for a pregnancy stimulated by clomiphene citrate. She developed preeclampsia with intrauterine growth retardation during the follow-up of her pregnancy. She presented to the maternity emergency room with sustained uterine contractions at 36 weeks' gestation. The patient had a code red cesarean section for suspected retroplacental hematoma. Intraoperatively, no retroplacental hematoma was found but bilateral torsion of the adnexa with huge polycystic ovaries. Conservative treatment was recommended and the postoperative follow-up of the cesarean section was simple. Adnexal torsion is an emergency that should not be ignored in the presence of any acute pelvic pain in a pregnant woman.

The Effectiveness of Granulocyte Colony-Stimulating Factor (G-CSF) Against Experimental Ischemia-Reperfusion Injury in Rat Ovaries and Its Effect on In Vitro Fertilization Outcomes.

Local ischemic damage resulting from ovarian torsion is a common cause of decreased follicular activity and infertility. It was aimed to evaluate the effect of granulocyte colony-stimulating factor (G-CSF) protection on in vitro fertilization (IVF) results against experimental ischemic (I) and ischemic-reperfusion (I/R) injury in rat ovaries. The study consisted of 35 adult female Sprague-Dawley albino rats (sham, ischemia, I/R, I + G-CSF, and I/R + G-CSF) randomly assigned to 5 groups, each containing 7 rats. While bilateral adnexal torsion was applied to the ischemia groups for 3h, detorsion was applied to the reperfusion groups. Intraperitoneal 100IU/kg G-CSF was administered 30min prior to ischemia (I + G-CSF) or reperfusion (I/R + G-CSF). After ovulation induction (intraperitoneal 150-300IU/kg PMSG), the oocytes were collected and IVF was applied. Statistically significant differences were observed between the collected oocyte numbers in I and I + G-CSF, I/R, and I/R + G-CSF groups (P values were P = 0.001 for the I-I + G-SCF groups and P = 0.003 for I/R-IR + G-CSF, respectively). An increase in the number of MII oocytes obtained was observed in the I + G-CSF and I/R + G-CSF groups compared to the I and I/R groups. Grade 1 and grade 2 embryo numbers were statically different between the I/R and I/R + G-CSF groups (P values were P = 0.023 for grade 1 embryos and P = 0.045 for grade 2 embryos, respectively). G-CSF treatment was found to be effective in reducing I- and I/R-induced ovarian damage.

Bilateral torsion of an ovarian dermoid cyst in a nullipara, exploratory laparotomy, right ovariectomy and left cystectomy: A case report

Background: Ovarian torsion is a common gynecological emergency prompt diagnosis and treatment results in favourable outcome. This may be unilateral or bilateral in rare cases. However, bilateral Adnexal torsion (AT) is a gynecological emergency which occurs in approximately 2.7-3.5% of women of all ages globally. Aim: To present this uncommon clinical condition and offer management modality. Presentation of case: AC was a 28 -year- old nulliparous woman, who presented to our institution with a history of sudden onset of severe lower abdominal pain and nausea. On physical examination, she was acutely ill-looking, in mild painful distress, and her vital signs were within normal limits. On abdominal examination, there was no distension but there was lower abdominal tenderness, with muscle guarding. A pelvic examination revealed bilateral adnexal tenderness. Ultrasound examination showed a right ovarian cyst of size about 9 × 7 cm poor visualization of the left ovary. An impression of torsion of right ovarian dermoid cyst was made. She had exploratory laparotomy for ovarian torsion, right ovariectomy and left cystectomy. Her post-operative period was uneventful and was discharged in her 6th post-operative day in stable clinical state. Conclusion: We have presented 28-year-old nullipara who had bilateral ovarian and laparotomy with cystectomy. Prompt intervention of similar cases results in better prognosis.

The protective effect of cilostazol on experimental ischemia/reperfusion injury in rats ovaries on in vitro fertilization outcomes.

Objective:Ovarian torsion decreases ovarian reserve because of ischemic and reperfusion damage it causes. In this study, we investigated the protective effect of cilostazol (CIL) on experimental ischemia (I) and ischemic-reperfusion (I/R) damage in rat ovaries with in vitro fertilization (IVF) results.Materials and Methods:Forty-eight adult female Sprague-Dawley albino rats were randomly assigned to 6 groups with 8 animals in each group: Sham (S), I, I/R, S + CIL, I + CIL and I/R + CIL. The I groups were subjected to bilateral adnexal torsion for 3 h, while the I/R and I/R + CIL groups received subsequent detorsion for 3 h. Twenty-two mg/kg of CIL was given via oral gavage 30 min before surgery on the I (I+ CIL) or reperfusion (I/R + CIL) groups. Oocytes were collected before the IVF procedure and after ovulation induction with 150-300 IU/kg pregnant mare serum gonadotropin.Results:The metaphase oocytes reached their highest value of 4.73±0.96 in the S+ CIL group and reached their lowest value of 0.51±0.55 in the I/R group. There were statistically significant differences in the number of second-day embryos among the I, I+ CIL, and I/R and I/R+ CIL groups (p=0.000). When the groups were compared in terms of Anti-Müllerian hormone change, the highest decrease was observed in the I and I/R groups.Conclusion:CIL pretreatment before surgery has a protective effect against I and I/R in rats with ovarian torsion.

The effect of protection of platelet-rich plasma against experimental ischemia/reperfusion injury in the rat ovary on in vitro fertilization outcomes.

Ovarian torsion is a common cause of local ischemic damage, reduced follicular activity and infertility. This study aimed to investigate how well platelet-rich plasma (PRP) protects against experimental ischemic (I) and ischemia-reperfusion (I/R) injury in rat ovaries and its effect on in vitro fertilization (IVF) outcomes. Fifty-six adult female Sprague-Dawley albino rats were randomly assigned to six groups of eight animals each: Sham, Ischemia, I/R, Sham + PRP, I + PRP, and I/R + PRP. The remaining eight animals were used to prepare the PRP. The ischemia groups were subjected to bilateral adnexal torsion for 3h, while the I/R and I/R + PRP groups received subsequent detorsion for 3h. Intraperitoneal (i.p.) PRP was administered 30 min prior to ischemia (I + PRP) or reperfusion (I/R + PRP). The ovaries were stimulated through an intraperitoneal injection of 150-300 internal units of IU/kg PMSG. After ovulation induction, oocytes were taken from the ovaries, and IVF was performed. The number of MII oocytes reached the highest number with 4.63 ± 0.74 in the S group and had the lowest number with 0.50 ± 0.53 in the I/R group. There were statistically significant differences for the number of embryos obtained on the second day between the I and I + PRP groups and the I/R and I/R + PRP groups (p=0.000). In comparing anti-Müllerian hormone 1 (AMH1) and AMH2 values within the group, the highest decrease was observed in the I and I/R groups. PRP is effective in minimizing ovarian damage and preserving ovarian reserves following ovarian torsion.