title: Oxidative Stress during Ovarian Torsion in Pediatric and Adolescent Patients: Changing The Perspective of The Disease.
abstract: Among the different causes of gynecological acute pelvic pain, ovarian torsion represents a surgical emergency. It is a rare case in the pediatric/adolescent aged group that must be included in the differential diagnosis of any girl with abdominal pain or pelvic/abdominal mass. Current recommendations suggest that laparoscopic detorsion should be performed in order to preserve the integrity of the ovaries and fertility, although oophoropexy may be considered in case of severe necrosis. Nevertheless, maintaining the circulation of the ovary after detorsion deteriorates the tissue injury and leads to a pathologic process called ischaemia/reperfusion (I/R) injury, which is characterized by oxidative stress. During the detorsion process, an excess amount of molecular oxygen is supplied to the tissues, and reactive species of oxygen (ROS) such as superoxide radical (O2 (-)), hydrogen peroxide (H2O2), hydroxyl radical (OH•), as well as reactive nitrogen species (RNS) are produced in excess. ROS, RNS and their toxic products cause DNA damage and lipid peroxidation in the cellular and mitochondrial membranes, leading to cell death. In spite of attention on this topic, currently there is no shared and clear evidence about the use of anti-inflammatory and antioxidant agents to prevent I/R damage after laparoscopic ovarian detorsion. Considering this element, future research should aim to develop shared protocols for the clinical use (route of application, dosage and time of application) of antioxidants after laparoscopic management of this condition.
authors.affiliation: Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy.
authors.forename: Antonio Simone
authors.initials: AS
authors.lastname: Laganà
authors.affiliation: Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Vincenza
authors.initials: V
authors.lastname: Sofo
authors.affiliation: Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Francesca Maria
authors.initials: FM
authors.lastname: Salmeri
authors.affiliation: Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy.
authors.forename: Vittorio Italo
authors.initials: VI
authors.lastname: Palmara
authors.affiliation: Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy.
authors.forename: Onofrio
authors.initials: O
authors.lastname: Triolo
authors.affiliation: University of Belgrade, School of Medicine, Belgrade, Serbia; Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Milan Milosav
authors.initials: MM
authors.lastname: Terzić
authors.affiliation: University of Parma, Parma, Italy; Vicenza General Hospital, Vicenza, Italy.
authors.forename: Tito Silvio
authors.initials: TS
authors.lastname: Patrelli
authors.affiliation: Department of Gynecology and Obstetrics, University Clinical Center, Ljubljana, Slovenia.
authors.forename: Adolf
authors.initials: A
authors.lastname: Lukanovic
authors.affiliation: Department of Gynecology and Obstetrics, University Clinical Center, Ljubljana, Slovenia.
authors.forename: Eda Vrtcnik
authors.initials: EV
authors.lastname: Bokal
authors.affiliation: Department of Biomedical Sciences and Morpho-Functional Images, University of Messina, Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santoro
keywords: Adolescents; Antioxidants; Ischaemia/Reperfusion; Oxidative Stress; Paediatrics