Diagnostic and prognostic values of preoperative serum levels of YKL-40, HE-4 and DKK-3 in endometrial cancer.

OBJECTIVE: The objective of this study is to determine the efficiency of YKL-40, HE-4 and DKK-3 levels in early diagnosis of patients with endometrial cancer and in the pre-operative estimation of the prognostic parameters such as stage, grade and the extension of the disease. METHODS: In this prospective study, 50 patients diagnosed with endometrial cancer and 50 women as a control group, who applied to Dokuz Eylul University and Ege University Faculties of Medicine, Obstetrics and Gynecology Clinics between May 2011-May 2012 were included. CA125, HE-4, YKL-40 and DKK-3 serum levels were measured by ELISA and compared between two groups. The relation between serum levels and histopathological results, extension of disease and prognostic factors were analyzed. RESULTS: Preoperative serum CA125, HE-4 and YKL-40 levels were significantly higher in endometrial cancer group (p<0.001). Serum HE-4 levels were significantly higher in advanced stages (p=0.004). When we examined early stage patients, YKL-40 levels were significantly higher in non-endometrioid histology compared with endometrioid adenocarcinoma (p=0.022). We also examined the relation between the markers and prognostic factors. Different from other markers, HE-4 levels were significantly higher in endometrial cancer patients who had lymphovascular space involvement, lower uterine segment involvement, endocervical stromal involvement, and deep myometrial invasion. CONCLUSION: YKL-40 and HE-4 were significantly higher in patients with endometrial cancer. HE-4 seems to be superior to YKL-40 in discriminating early and advanced stages. Additionally, HE4 is significantly correlated with prognostic factors. HE-4 and YKL-40 may be successful in early determination of endometrial cancer and in detection of high risk subsets before surgery.

Tumor-free distance from outermost layer of cervix is of prognostic value in surgically treated cervical cancer patients: a multicenter study.

OBJECTIVE: This study aimed at determining if tumor-free distance (TFD) from outermost layer of cervix predicts surgicopathologic factors and outcome in surgically treated cervical cancer patients. MATERIALS AND METHODS: One hundred sixteen surgically treated cervical squamous cell carcinomas between 1991 and 2010 with FIGO stage IB/2A were identified and re-evaluated histologically regarding the TFD. TFD was defined as the distance between outermost layer of cervix and deepest cervical stromal invasion. Depth of invasion (DOI) and TFD were expressed as continuous variables and compared with traditional surgicopathologic variables and survival to determine their prognostic significance. RESULTS: The mean DOI was 10.3 mm and the mean TFD was 4.2 mm. The most common stage was IB1 (60 patients, 51.7 %). The mean number of removed pelvic lymph nodes was 32.2 (median 30; range 8-78). Positive pelvic lymph nodes were found in 27 (23 %) of the patients. Sixty-eight patients had lymphovascular space involvement (LVSI). Sixty-eight patients (59 %) received postoperative radiotherapy where the following items were present: tumor diameter >4 cm, positive lymph nodes, LVSI and positive surgical margins. With the median follow-up of 53 months (3-219 months); 14 patients had local and 13 patients had distant metastases (5 of the patients had both at the time of recurrence). With logistic regression analysis, TFD was a predictor of pelvic lymph involvement (p = 0.028) and LVSI (p = 0.008) while DOI was a predictor of LVSI (p = 0.044). In Cox regression analysis, increased TFD was associated with improved disease-free survival (DFS) (p = 0.007). DFS curves (for TFD cut off value 2.5 mm) according to Kaplan-Meier were found to be statistically significant (log rank test = 0.002). CONCLUSION: The results indicate that TFD is predictive of pelvic lymph node involvement, LVSI and patient outcome in surgically treated cervical cancer patients. However, prospective measurement of TFD is still necessary to determine its value in clinical practice.

The role of endometrial thickness for detecting endometrial pathologies in asymptomatic postmenopausal women.

BACKGROUND: The aim of the present study was to evaluate the significance of endometrial sampling in asymptomatic, bleeding-free postmenopausal women who have endometrial thickness greater or equal to 5 mm. METHODS: A retrospective review was conducted of all women who underwent transvaginal ultrasonography between January 2000 and March 2009 in a menopause clinic, who were found to have an endometrial thickness of at least 5 mm and who were subjected to endometrial sampling. RESULTS: Five hundred and thirty asymptomatic postmenopausal women underwent ultrasonographic evaluation with subsequent endometrial sampling. The mean endometrial stripe thickness was 8.7 mm (range: 6-26). Five cases of adenocarcinoma (0.9%) and 65 (12.2%) cases of simple/complex atypical hyperplasia were diagnosed. CONCLUSIONS: In this study, 106 investigations were performed to detect one case of adenocarcinoma. Although this is a high number per case detection of endometrial adenocarcinoma, considering the rising incidence of endometrial cancer, large prospective trials with surrogate criteria for asymptomatic women are needed to investigate the importance of thickened endometrial stripe in postmenopausal women.

Synchronous tumors of the female genital tract: a 20-year experience in a single center.

OBJECTIVE: To evaluate the clinicopathological characteristics and the clinical outcome of synchronous malignant neoplasms of the female reproductive tract. MATERIAL AND METHODS: Patients who were operated and diagnosed with synchronous malignant tumor of the genital system (n = 25) at the Dokuz Eylul University Department of Obstetrics and Gynecology Gynecologic Oncology Unit between 1992 and 2012 were included into this study. Recurrent, metastatic and metachronously detected tumors were not included. Age at diagnosis, parity menopausal status, hormone use, presenting sign or symptoms and the clinical outcomes were evaluated. RESULTS: 20 of 25 patients had endometrial-ovarian cancer. The mean age at diagnosis was 53,6 years. The most common presenting symptom was abnormal uterine bleeding. The median follow-up duration for all patients was 69 months. Overall survival for all patients was 87 months and 81 months for patients with endometrial-ovarian cancer 5-year survival rate was 73% for all patients and 68% for patients with endometrial-ovarian cancer. CONCLUSIONS: Endometrial-ovarian cancer togetherness is the most common in synchronous gynecologic malignancies. They occur at a younger age and have more favorable prognosis than metastatic primary gynecologic tumors.

Reproducibility of endometrial intraepithelial neoplasia diagnosis is good, but influenced by the diagnostic style of pathologists.

Endometrial intraepithelial neoplasia (EIN) applies specific diagnostic criteria to designate a monoclonal endometrial preinvasive glandular proliferation known from previous studies to confer a 45-fold increased risk for endometrial cancer. In this international study we estimate accuracy and precision of EIN diagnosis among 20 reviewing pathologists in different practice environments, and with differing levels of experience and training. Sixty-two endometrial biopsies diagnosed as benign, EIN, or adenocarcinoma by consensus of two expert subspecialty pathologists were used as a reference comparison to assess diagnostic accuracy of 20 reviewing pathologists. Interobserver reproducibility among the 20 reviewers provided a measure of diagnostic precision. Before evaluating cases, observers were self-trained by reviewing published textbook and/or online EIN diagnostic guidelines. Demographics of the reviewing pathologists, and their impressions regarding implementation of EIN terminology were recorded. Seventy-nine percent of the 20 reviewing pathologists' diagnoses were exactly concordant with the expert consensus (accuracy). The interobserver weighted κ values of 3-class EIN scheme (benign, EIN, carcinoma) diagnoses between expert consensus and each of reviewing pathologists averaged 0.72 (reproducibility, or precision). Reviewing pathologists demonstrated one of three diagnostic styles, which varied in the repertoire of diagnoses commonly used, and their nonrandom response to potentially confounding diagnostic features such as endometrial polyp, altered differentiation, background hormonal effects, and technically poor preparations. EIN diagnostic strategies can be learned and implemented from standard teaching materials with a high degree of reproducibility, but is impacted by the personal diagnostic style of each pathologist in responding to potential diagnostic confounders.

Tumor budding and E-Cadherin expression in endometrial carcinoma: are they prognostic factors in endometrial cancer?

OBJECTIVE: To evaluate the prognostic value of tumor budding (TB) in endometrioid (EEC) and non-endometrioid endometrial cancers (NEEC) and to determine its correlation with expression of E-cadherin. METHODS: Ninety-five patients with primary endometrial carcinoma were examined statistically. All patients were diagnosed, treated, and given follow-up care at Dokuz Eylul University Faculty of Medicine. Tumor budding detected by either H&E-stained sections and anticytokeratin-staining C11. The tissue block with the largest invasive front was chosen for budding counting and immunostaining. E-cadherin expression was examined by immunohistochemistry using the primary antibodies against to it. RESULTS: Tumor budding was low-grade in 73 and high-grade in 22 cases. E-cadherin expression loss was identified in 48 patients. The high-grade TB was significantly higher in patients with advanced stage and deep myometrial invasion (p=0.032 and 0.018, respectively). E-Cadherin expression was significantly lower in NEECs than EECs (p=0.032). The negative expression of E-cadherin was associated with advanced stage and poor differentiation (p=0.001 and p=0.024, respectively). We determined that tumor budding adversely correlated with the presence of E-cadherin expression but not statistically significant. Based on the results of multivariate analysis, TB has an independent impact on cumulative overall survival. We found no statistically significant difference between E-cadherin expression and survival. CONCLUSIONS: TB is associated with undifferentiated tumor, advanced stage and decreased postoperative survival in endometrial cancer. It might be a valuable prognostic clinicopathologic factor which can be applicable in routine examination.

Three synchronous primary tumors with different histology detected by ¹8F-FDG PET/CT.

The aim of this study is to present a patient with 3 primaries diagnosed with the ¹8F-FDG PET/CT study performed for the staging of endometrial cancer. Pathologic accumulations of the tracer were detected in both lobes of the thyroid gland, in the left lung and in the known primary of the uterus. A bilateral multifocal differentiated thyroid carcinoma and a peripheral carcinoid tumor in left lung were the final diagnosis as shown by histology. In conclusion, in this patient the PET/CT study performed for staging endometrial cancer demonstrated two new synchronous primary tumors. This is the second similar case but the first where all three primaries had entirely different histology.

Effect of mucinous differentiation in endometrioid type endometrial cancers on prognosis.

OBJECTIVES: To evaluate the influence of mucinous differentiation in endometrioid endometrial cancer regarding spread and prognosis. MATERIAL AND METHODS: Endometrioid endometrial cancer cases between 2015 and 2020 were collected retrospectively and divided into two groups according to the cytoplasmic mucin including. Prognostic factors and cancer spread related parameters were evaluated. RESULTS: A total of 219 patients were enrolled in this study. One hundred twenty-two (55.7%) were endometrioid and 97 (44.3%) were in the mucinous differentiated endometrioid catagory. Age was similar between the groups (59.3 vs 58.7, p = 0.62), however, grade 3 lesions were more frequent in endometrioid type endometrial cancer (8.7% vs 1.4%, p < 0.01). Poor prognostic factors including myometrial invasion, lymphovascular space invasion (LVSI), lymph node metastases, peritoneal cytology, endocervical involvement, and stage were not significantly different between groups (p = 0.23, p = 0.49, p = 0.40, p = 0.15, p = 0.17, p = 0.55). The median overall survival time of endometrioid and mucinous differentiated endometrioid type endometrial cancer patients was determined 88.5 and 96.8 months, respectively (p = 0.46). CONCLUSIONS: Mucinous differentiation in the endometrioid type of endometrial cancer does not seem to affect the prognosis in endometrioid endometrial cancer patients.

Frozen section diagnoses of 578 ovarian tumors made by pathologists with and without expertise on gynecologic pathology.

OBJECTIVE: Frozen section is an important diagnostic tool to determine the nature of the ovarian masses intraoperatively. The optimal surgical treatment can be achieved by classifying the masses as benign, borderline and malignant. The aim of this retrospective study was to evaluate the accuracy of frozen section diagnosis of ovarian neoplasms and to determine the effects of Gynecologic (Gyn) pathologist or non-Gyn pathologist on frozen section diagnosis. MATERIAL AND METHODS: Intraoperative frozen section diagnosis was retrospectively evaluated in 578 patients operated with the suspicion of ovarian neoplasms. We compared the results of frozen section diagnosis by Gyn pathologists (Group 1) and by non-Gyn (Group 2) pathologists. RESULTS: In 23 patients (3.9%), the tissues were other than ovary. No opinion could be obtained on frozen sections of 14 cases (2.4%). The sensitivities for benign, borderline and malignant tumors for frozen section diagnoses of Gyn pathologists were 99.7%, 89.5%, and 96.3% respectively. The corresponding specificities were 97.6%, 85% and 99%, respectively. Group 2 pathologists had sensitivities and specificities of 97%, 50%, 84.6% and 95.2%, 96.2% and 94.5% for benign, borderline and malignant tumors, respectively. The overall accuracy rate of frozen section was 97.1%. CONCLUSION: Intraoperative frozen section diagnosis has a high accuracy rate for ovarian pathologies. Those rates do increase even more if it is evaluated by the Gyn pathologists.

Collision tumor: serous cystadenocarcinoma and dermoid cyst in the same ovary.

INTRODUCTION: Collision tumor means the coexistence of two adjacent, but histologically distinct tumors without histologic admixture in the same tissue or organ. Collision tumors involving ovaries are extremely rare. CASE: We present a case of 45-year-old parous woman with a left dermoid cyst, with unusual imaging findings, massive ascites and peritoneal carcinomatosis. The patient underwent cytoreductive surgery. The histopathology revealed a collision tumor consisting of an invasive serous cystadenocarcinoma and a dermoid cyst.

Ubiquitin-Proteasome Axis, Especially Ubiquitin-Specific Protease-17 (USP17) Gene Family, is a Potential Target for Epithelial-Mesenchymal Transition in High-Grade Serous Ovarian Cancer.

OBJECTIVES: To investigate gene expression differences and related functions between primary tumor, malignant cells in ascites, and metastatic peritoneal implant in high-grade serous ovarian cancer. METHODS: Biopsies from primary tumor, peritoneal implant, and ascites were collected from 10 patients operated primarily for high-grade, advanced-staged serous ovarian cancer. Total RNA isolation was performed from collected tissue biopsy and fluid samples, and RNA expression profile was measured. Messenger RNA expression profiles of 3 different groups were compared. Functional analyses of candidate genes were carried out by gene ontology and pathway analysis. RESULTS: There were significant differences in the expression of 5 genes between primary tumor and peritoneal implant, 979 genes between primary tumor and malignant cells in ascites, and 649 genes between peritoneal implant and malignant cells in ascites. Three commonly enriched gene ontology functions between "primary tumor and malignant cells in the ascites" and "peritoneal implant and malignant cells in the ascites" were protein deubiquitination, ubiquitin-dependent protein catabolism, and apoptotic processes. All genes related to these functions belonged to USP17 gene family. CONCLUSION: Gene expression difference between primary tumor and the peritoneal implant is not as much as the difference between primary tumor and free cells in the ascites. These results show that malignant cells in the ascites return into its genetic origin after they invade on the peritoneum. Significantly increased expression of DUB-enzyme genes, SNAR gene family, and ribosomal pathway genes in epithelial-mesenchymal transition suggests that this regulation is ubiquitin-proteasome dependent. Especially, this is the first study that offers USP17 as a potential target for epithelial-mesenchymal transition.

Predictability of myometrial, lower uterine segment and cervical invasion with 3D transvaginal ultrasonography and magnetic resonance imaging in endometrial cancer patients: a prospective cohort study.

AIMS: The objective of this study is to identify the diagnostic performance of three-dimensional transvaginal ultrasonography (3D-US) and magnetic resonance imaging (MRI) in detecting myometrial, lower uterine segment and/or cervical invasion in endometrial cancer patients. MATERIALS AND METHODS: In this prospective study, 40 patients diagnosed with endometrial cancer were performed 3D-US and MRI, preoperatively. Deep myometrial, lower uterine segment and cervical invasion were evaluated subjectively and results were compared with the final histology as a gold standard. RESULTS: Diagnostic accuracy of 3D-US for detecting deep myometrial, lower uterine segment and cervical invasion were 87.5%, 80% and 85%, respectively. The same results for MRI were 75%, 65% and 70%, respectively. For deep myometrial, lower uterine segment and/or cervical invasion in endometrial cancer, 3D-US had higher sensitivity, specificity, negative and positive predictive value and accuracy than MRI. The combination of these two imaging techniques had an increased sensitivity of detecting all parameters related with tumoral invasion but decreased specificity and the accuracy. CONCLUSION: 3D-US had better performance in detecting myometrial, lower uterine segment and/or cervical invasion than MRI in endometrial cancer patients. Combination of these techniques was not preferred according to this study.

The effect of nonsteroidal anti-inflammatory drugs on rat gastric mucosa. The role of endothelin.

OBJECTIVE: To investigate the role of endothelin on nonsteroidal anti-inflammatory drugs (NSAIDs) and selective cyclooxygenase-2 (COX2) enzyme inhibitors-induced effects on the gastric mucosa. METHODS: This study was carried out in the Department of Pharmacology Laboratory, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey during the period January to December 2002. In the first group a cyclooxygenase-1 (COX1) and COX2 enzyme inhibitor, indomethacin (25 mg/kg, subcutaneous injection (s.c), n=7), a selective COX2 enzyme inhibitor, NS398 (10 mg/kg, s.c) and normal saline were administered. In the second group, endothelin-1 (ET1) was administered (200 pmol/kg) alone, in the presence of an endothelin receptor antagonist bosentan, (100 mg/kg) and PGE1 [40 microg/kg, orally] with submucosal injection. In the third group, NS398 and indomethacin were applied in the presence of bosentan. In the fourth group, NS398 were applied in the presence of N (G)-nitro-l-arginine methyl ester (L-NAME) (10 mg/kg, s.c). RESULTS: Indomethacin caused gastric mucosal injury. The effect of NS398 on gastric mucosa did not differ considerably from that of the control group. Submucosal injection of ET1 caused a gastric damage, which could not be prevented by intragastric administration of bosentan, while pretreatment with PGE1 prevented ET1-induced ulcer. Pretreatment with bosentan did not attenuate indomethacin-induced gastric mucosal damage but it increased NS398-induced damage by 1.5 fold. Pretreatment with L-NAME increased NS398-induced gastric mucosal damage as bosentan did. CONCLUSION: These results suggest that neither endothelin-induced nor indomethacin-induced ulcer is completely receptor dependent. Cyclooxygenase-2 inhibitors caused ulcer in the presence of bosentan. Protective effects of gastric mucosal injury of COX2 inhibitors may be via endothelin receptor related nitric oxide release.

A new device to produce a standardized experimental fracture in the rat tibia.

OBJECTIVE: To develop and introduce a new device to produce a standardized closed experimental fracture in the rat tibia. METHODS: This study took place in the Research Laboratory, Medical Faculty, Dokuz Eylul University, in the year 2003. We include 20 healthy male white Wistar rats. After pinning both tibia of the rat intramedullary with the needle of a sterile injector without any incision, we tried to produce a fracture with the pendulum of the device, which was dropped in different angles in 9 rats. The tibial diaphysis of 14 rats in the main study were fractured at 60 degrees. After the fractures were confirmed radiologically, 4 tibia underwent pathological analysis to determine the degree of soft tissue damage and 24 tibia were examined in terms of histological fracture healing. RESULTS: Radiologically, this technique resulted in a transverse or short oblique bicortical fracture in the middle of the tibial diaphysis. The healing process was well adjusted with the classification of Allen. No noticeable soft tissue damage in the fracture region was demonstrated. CONCLUSION: This method of producing an easy and reproducible fracture in a standard fashion without displacement and minimal soft tissue trauma in laboratory animals with this simple apparatus make it a useful technique for bone healing studies.

Ovarian metastasis of Müllerian adenosarcoma of the cervix with sarcomatous overgrowth.

The aim of this study is to present a rare case of Müllerian adenosarcoma of the cervix with ovarian metastasis and sarcomatous overgrowth. A gravida 2, para 2 woman aged 32 years with vaginal bleeding was admitted to the gynecology department. A 3-4 cm polypoid mass protruding from the cervix was detected in a pelvic examination. Total abdominal hysterectomy and bilateral salpingoopherectomy was performed because of metastatic implants on the right ovary. The pathologic evaluation revealed Müllerian adenosarcoma of the cervix with sarcomatous overgrowth and ovarian metastasis. After surgery, the patient was planned to undergo chemo- and radiotherapy. This is the first cervical Müllerian adenosarcoma case mentioned in the literature with metastasis to the ovary in a young woman. There is no optimal management option for cervical adenosarcomas due to the rarity of this phenomenon. Nevertheless, even if the patient is young and imaging techniques do not elucidate metastatic disease, surgeons should evaluate the ovaries for the spread of tumor, especially if histology reveals sarcomatous overgrowth.

Diagnostic and Treatment Reproducibility of Cervical Intraepithelial Neoplasia / Squamous Intraepithelial Lesion and Factors Affecting the Diagnosis.

OBJECTIVE: Inter-observer differences in the diagnosis of HPV related cervical lesions are problematic and response of gynecologists to these diagnostic entities is non-standardized. This study evaluated the diagnostic reproducibility of "cervical intraepithelial neoplasia" (CIN) and "squamous intraepithelial lesion" (SIL) diagnoses. MATERIAL AND METHOD: 19 pathologists evaluated 66 cases once using H&E slides and once with immunohistochemical studies (p16, Ki-67 and Pro-ExC). Management response to diagnoses was evaluated amongst 12 gynecologists. Pathologists and gynecologists were also given a questionnaire about how additional information like smear results and age modify diagnosis and management. RESULTS: We show moderate interobserver diagnostic reproducibility amongst pathologists. The overall kappa value was 0.50 and 0.59 using the CIN and SIL classifications respectively. Impact of immunohistochemical evaluation on interpretation of cases differed and there was lack of statistically significant improvement of interobserver diagnostic reproducibility with the addition of immunohistochemistry. We saw that choice of treatment methods amongst gynecologists varied and overall concordance was only fair to moderate. The CIN2 diagnostic category was seen to have the lowest percentage agreement amongst both pathologists and gynecologists. We showed that pathologists had diagnostic "styles" and gynecologists had management "styles". CONCLUSION: In summary each pathologist had different diagnostic tendencies which were affected not only by histopathology and marker studies, but also by the patient management tendencies of the gynecologist that the pathologist worked with. The two-tiered modified Bethesda system improved diagnostic agreement. We concluded that immunohistochemistry should be used only to resolve problems in select cases and not for every case.

What does the Data of 354,725 Patients from Turkey Tell Us About Cervical Smear Epithelial Cell Abnormalities? - The Epithelial Cell Abnormality Rate is Increasing - Quality Control Studies and Corrective Activity are Musts.

OBJECTIVE: There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories. MATERIAL AND METHOD: In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire. RESULTS: The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08% in the total 354,725 smears and ranging between 0.3% to 16.64% among centers. The Atypical squamous cells /Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers. CONCLUSION: There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed.

Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study.

OBJECTIVE: To compare the results of total laparoscopic hysterectomy and total abdominal hysterectomy in morbidly obese women with early stage endometrial cancer. MATERIAL AND METHODS: This prospective study was conducted on 140 morbidly obese women with body mass indices ≥35 kg/m(2) and presenting with clinical stage 1 endometrial cancer. The patients underwent total laparoscopic hysterectomy (n=70) or total abdominal hysterectomy (n=70), bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and peritoneal washing. Age, parity, menopausal status, weight, height, medical problems, history of previous laparotomy, surgical procedure, operative time, estimated amount of blood loss, preoperative hematocrit, postoperative hematocrit, operative complications, conversion to laparotomy, need for intraoperative or postoperative blood transfusion, intraoperative and postoperative complications, secondary surgery, tumor stage, grade, histology, number of recovered lymph nodes, and visual pain scores of the patients were recorded. RESULTS: Postoperative complications were significantly higher in the laparotomy group. Hospital stay in the laparoscopy group was significantly lower than that in the laparotomy group. The visual pain scores were significantly higher in the laparotomy group on the first, second, and third postoperative days and on the day of discharge from the hospital. Resuming activity took a significantly longer time in the laparotomy group (34.70 days) than in the laparoscopic group (17.89 days). CONCLUSION: With the availability of skilled endoscopic surgeons, most obese women with early stage endometrial cancer can be safely managed by performing laparoscopy with an excellent surgical outcome, shorter hospitalization, less postoperative pain, and faster resumption of full activity.

Effects of betamethasone and thyroid releasing hormone on fetal lung maturation: an experimental and morphometric study.

OBJECTIVE: To determine the effects of betamethasone and thyroid releasing hormone (TRH) on morphologic fetal rabbit lung maturation when administered separately and in combination. MATERIAL AND METHODS: Twenty-five pregnant rabbits were divided into five groups. Study groups were as follows: TRH or betamethasone alone (between 24 and 27th days of gestation), TRH + betamethasone or betamethasone + TRH (second dose of drugs were added in the last 2 days), and the control. The pregnancies were terminated on the 27th day of gestation. Weights and volumes of the fetal lungs were determined and the results were compared. RESULTS: Mean lung weights in all treatment groups were significantly heavier than controls (P < 0.05). The differences between mean lung weights of TRH alone, TRH + betamethasone, and betamethasone alone groups were not statistically significant (P > 0.05), but the mean lung weight of betamethasone + TRH group was significantly lower than the other treatment groups (P < 0.05). Mean lung volume of TRH alone group was significantly higher than control group; however, there were no significant differences between other treatment groups and the control. No correlation was found between the lung weights and volumes in all groups (r = 0.1, P > 0.05). CONCLUSION: Only TRH alone treatment produced a significant increase in both fetal lung volume and weight compared to the control group. Administering TRH alone can lead to increased lung maturation. Combining TRH to corticosteroid treatment significantly decreased mean fetal lung weight, instead of an increase. According to these results combined used of these two substances probably counteract each others effect, instead of having a synergism.