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The Ovaries and the Adnexa
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Kuhan Rajah, Dimitrios Mavrelos
The presence of ovarian dermoid cysts is associated with an increased risk of ovarian torsion, which may be compounded by ovarian stimulation and pregnancy [32]. Patients should be informed of the risk and asked to report any relevant symptoms immediately.
EMQ Answers
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
P Laparoscopic ovarian cystectomyIn this patient, the clinical features are in keeping with torsion. However, the fact that the pain is still intermittent will suggest that tissue vascularity is not yet compromised. If an ovarian cystectomy is not performed, the cyst will continue to undergo torsion unless it is fixed. (Damigos et al. An update on the diagnosis and management of ovarian torsion. The Obstetrician & Gynaecologist 2012; 19: 229–236)
Adnexal masses in the neonate, child, and adolescent
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Lisa Allen, Nathalie Fleming, Julie Strickland, Heather C. Millar
The size of ovarian cysts does affect the likelihood of ovarian torsion, being significantly higher in fetal ovarian cysts larger than 40 mm compared to those smaller than 40 mm, with an odds ratio of 30.8 (95% confidence interval 8.6–110).24
The effect of medical ozone therapy in addition to ovarian detorsion in ischemia reperfusion model
Published in Journal of Obstetrics and Gynaecology, 2022
Sema Süzen Çaypınar, Sema Karakaş, Cihan Kaya, Damlanur Sakız, Salim Sezer, Murat Ekin
Adnexal torsion is a common gynecological emergency in reproductive-age women, with a reported incidence of 2.7% (Hibbard 1985). Torsion of the adnexal structures can result in massive parenchymal congestion, infarcts, and haemorrhagic necrosis after arterial and venous blockade (Vijayalakshmi et al. 2014). The diagnosis of ovarian torsion could be obscure due to non-specific symptoms such as nausea, vomiting, and abdominal pain. Nevertheless, the early diagnosis is essential since it may cause detrimental effects on ovarian reserve (Bayer and Wiskind 1994). The recommended management is the detorsion of the adnexal pedicle in patients with fertility desire (Kaya et al. 2014). However, detorsion alone may increase the risk of thrombosis, infection, and leaving an undiagnosed malignancy (te Velde et al. 1998; Ozler et al. 2013).
When is it too late? Ovarian preservation and duration of symptoms in ovarian torsion
Published in Journal of Obstetrics and Gynaecology, 2022
Katherine Adams, Emma Ballard, Akwasi Amoako, Akram Khalil, David Baartz, Kevin Chu, Keisuke Tanaka
Eighty-six women were identified as having surgically proven ovarian torsion in the 10-year study period (Table 1). All women were admitted via the emergency department. The mean age was 36.1 years (SD 14.2), with a range between 18 and 78 years. Seventy patients (81%) were pre-menopausal with twenty-five (34.7%) being nulligravida. Nine patients (10.5%) were pregnant at the time of diagnosis with a mean gestation of 13 weeks, and 2 patients (2.3%) were within 6 weeks postpartum. Thirty-seven patients (43.0%) had a history of previous abdominal surgery. One or more risk factors for ovarian torsion were identified in thirty-seven patients (43.0%), including previous ovarian torsion, previous ovarian cyst, polycystic ovarian syndrome and endometriosis. There were no cases of ovarian hyperstimulation syndrome.
TLR4/NF-κB/TNFα and cAMP/SIRT1 signaling cascade involved in mediating the dose-dependent effect of cilostazol in ovarian ischemia reperfusion-induced injury
Published in Immunopharmacology and Immunotoxicology, 2022
Marwa M. M. Refaie, Maram El-Hussieny, Sayed Shehata
Ovarian torsion is a serious gynecological emergency during the reproductive period. Rotation of the ovary around its axis with or without tubal rotation result in blood flow disturbances followed by dangerous consequences such as bleeding, adhesion, thrombophlebitis, sepsis, and even death [1]. Urgent diagnosis and management is mandatory to keep the ovarian function and rescue the patient [2]. The first step is de-torsion of the ovaries with restoration of arterial blood flow and venous drainage. Unfortunately, this is accompanied with gushing of huge amounts of free radicals with oxidative tissue injury which play an essential role in ovarian ischemia reperfusion (OIR) induced damage [3]. In addition, induction of oxidative stress is accompanied with release of pro-inflammatory cytokines including tumor necrosis factor α (TNFα) and activation of toll-like receptors (TLRs) protein family which contribute in mediating any ovarian injury followed by stimulation of more inflammatory/apoptotic cascades with final up-regulation of caspase family of apoptotic proteins. OIR is a very complicated pathological disorder initiated with deprivation of oxygen supply followed by excessive production of free oxygen radicals expanding to an inflammatory response and terminated with apoptosis and cell death [4,5].