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    Chronic pelvic pain associated with pelvic congestion syndrome and the benefit of Daflon 500 mg: a review
    (Laboratoires Servier, 2009) Burak, Feza; Gunduz, Tonguc; Simsek, Mehmet; Taskin, Omur
    Chronic pelvic pain is common in women of childbearing age and causes disability and distress, which result in significant costs to health services. A specific diagnosis for the condition is often difficult because the pain may be of abdominal, neurogenic, or psychogenic origin, or may be caused by other pelvic conditions such as endometriosis, pelvic inflammatory disease, and ovarian cysts. Due to the possible interlinked factors, no diagnosis is made in 60% of patients.(1) The pathogenesis of chronic pelvic pain is poorly understood. The vascular hypothesis offers the most likely explanation for chronic pelvic pain, which is thought to arise from overdistension of the pelvic venous system in which blood flow is markedly reduced. In pelvic congestion syndrome (PCS), pelvic varices are seen in a significant proportion of patients and may be the underlying etiology of chronic pelvic pain.(1) Undetected severe diseases such as endometriosis, adhesions, interstitial cystitis, active chronic pelvic inflammatory disease, and irritable bowel syndrome may cause pain and should be excluded to confirm a diagnosis of PCS. Investigation using laparoscopy is controversial since it often reveals no obvious cause of pain. Complementary investigation uses selective ovarian venography, which is commonly recommended by gynecologists. Newer, noninvasive methods such as magnetic resonance imaging and duplex ultrasound are gaining favor for the diagnosis of pelvic varices. Using the example of micronized purified flavonoid fraction (MPFF, Daflon 500 mg, Servier, France), this review will provide an update on the diagnosis and management of PCS and on the benefits of MPFF 500 mg in the treatment of pelvic pain.
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    The impact of plasma SOCS3 levels and endometrial leukocytes on unexplained infertility
    (Tubitak Scientific & Technological Research Council Turkey, 2018) Ozkan, Zehra Sema; Deveci, Derya; Akpolat, Nusret; Ilhan, Fulya; Simsek, Mehmet; Timurkan, Huseyin
    Background/aim: To investigate the possible differences in endometrial leukocyte subtype distribution between women with unexplained infertility and normal fertile women and to determine whether there is a correlation between endometrial leukocyte counts and plasma cytokine levels in unexplained infertility. Materials and methods: This case-control study involved 79 infertile and 40 fertile women. Peripheral venous blood samples and endometrial samples were obtained on day 21 of the menstrual cycle. Plasma interleukin-4 (IL4), IL6, IL10, IL17, IL35, interferongamma (IFN-g), tumor necrosis factor-alpha (TNF-a), transforming growth factor-beta (TGF-b), and suppressor of cytokine signaling-3 (SOCS3) levels were determined by enzyme-linked immunosorbent assay. Endometrial CD8, CD56, and CD163 counts were detected by immunohistochemistry. Results: CD8 and CD56 counts were significantly higher, while CD163 count was significantly lower in infertile women than in fertile women. Plasma SOCS3, IL35, and IL4 levels of the infertile group were significantly lower than those of the fertile group (P < 0.01); the remaining cytokine levels were significantly higher in the infertile group than in the fertile group (P < 0.01). Conclusion: We observed aberrant cytotoxic immune activity in infertile women. The interaction between plasma SOCS3 levels and staining degree of endometrial leukocytes may be either the reason for or result of infertility leading to unavailability of the environment for implantation.