Endometroid type endometrial cancer after surgery: unravelling the interplay of sleep, fatigue, and psychological well-being.

BACKGROUND: Endometrioid carcinoma, originating in the endometrium glandular cells, is often detected early and treated by surgery. However, post-treatment life quality remains poorly studied, explicitly focusing on sleep quality, fatigue, and depression. METHODS: In this cross-sectional, observational study, 147 female patients with endometrioid-type endometrial carcinoma were evaluated using standardised tools-Pittsburgh Sleep Quality Index (PSQI), Fatigue Assessment Scale (FAS), and Beck Depression Inventory (BDI). Patients were categorised based on sleep quality and depression levels. The study employed correlation and regression analyses to examine the relationships among these variables. RESULTS: No correlations were found between sociodemographic or lifestyle variables and sleep quality, fatigue, or depression (P > 0.05). A strong correlation was identified between PSQI and FAS (r = 0.623; P < 0.001), PSQI and BDI (r = 0.291; P < 0.001), and FAS and BDI (r = 0.413; P < 0.001). Fatigue and tumour grade were potential predictors of poor sleep. Sleep quality and depression predicted fatigue, while only fatigue was a predictor for depression. Radiotherapy and external radiation rates were notably higher in the mild depression group. CONCLUSIONS: Our study suggests an imperative for integrated multi-disciplinary approaches that focus on medical and psychological aspects of patient care to enhance long-term well-being and quality of life.

Prevalence of Candida albicans in High-Risk Human Papillomavirus-Positive Women: A Study in Diyarbakir Province, Turkey.

The human papillomavirus (HPV) is a significant public health concern due to its association with the development of cervical cancer. Although inflammation caused by Candida spp. has been shown to facilitate oncogenesis, the interactions between HPV and Candida spp. remain unclear. This study aimed to determine the prevalence and genotype distribution of HR-HPV infection HR-HPV-positiveCandida albicans in HR-HPV-positive individuals in Diyarbakir province in Turkey. Cervical samples were taken from 350 participants aged 20-69 years who applied to Diyarbakir Gazi Yasargil Training and Research Hospital, Gynecology and Obstetrics Clinic. For detection of HPV presence and HR-HPV genotyping, PCR/direct cycle sequencing was used. E6/E7 mRNA expression of HPV-16, -18, -31, -33, and -45 was determined by type-specific real-time NASBA assay (NucliSENS EasyQ(®)HPV v1.1). The presence of Candida albicans in cervical specimens of HR-HPV-positive women was investigated by RAPD-PCR and culture methods. Results. Of the 350 women who participated in the study, 24% were HPV positive and 10.5% were found to be HR-HPV positive. HR-HPV positivity was most frequently detected in the age range of 40-49 years. Among HR-HPV-positive women, C. albicans was found in 59.4%. Conclusion. The most frequent HR-HPV genotype was HPV16, followed by HPV31. Of women who tested positive for HR-HPV, C. albicans was discovered in 59.4%. C. albicans infection may occur when the immune system is weakened or the balance of the vaginal flora is disturbed, increasing tissue damage in the vaginal area and the risk of carcinogenesis of HR-HPV. Therefore, knowing the presence of Candida infection in HR-HPV-positive women is essential to plan the treatment and prevent the risk of secondary disease.

Does ovarian preservation have an effect on recurrence of early stage low-grade endometrial stromal sarcoma?

Surgical treatment of low-grade endometrial stromal sarcoma consists of hysterectomy. The role of oophorectomy is yet to be established. We aimed to examine the effect of preserving the ovaries on the pattern of recurrences in patients with stage I disease. Thirty-four patients with stage I low-grade endometrial stromal sarcoma were retrospectively analysed. Based on ovarian preservation the whole cohort was divided into two groups. Recurrence (liver, lung, groin and bone) was detected in 4 (11.8%) cases. No significant differences in overall survival or disease-free survival (DFS) were observed between the ovarian preservation and bilateral salpingo-oophorectomy (BSO) groups. Subset analysis revealed no significant difference in DFS between the ovarian preservation and BSO groups in the premenopausal arm. And also, the performance of pelvic (n = 2) or para-aortic lymphadenectomy (n = 6) or adjuvant hormonal therapy did not alter DFS significantly. The 5-year DFS rate for the group which received adjuvant radiotherapy was 62.5 and 94.4% for those which did not (p = .014). Preserving the ovaries had no adverse effect on the recurrence of stage I disease.IMPACT STATEMENTWhat is already known on this subject? Due to the rarity of the disease and the common postoperative diagnosis, only retrospective studies have been reported on low-grade endometrial stromal sarcoma. This disease is commonly diagnosed in premenopausal patients during the early stage. There is no consensus on preserving the ovaries, particularly in young patients, due to the tumour's hormonal characteristics and the risk of late recurrences.What do the results of this study add? Ovarian preservation had no effect on the recurrence of stage I low-grade endometrial stromal sarcoma. Lymphadenectomy and adjuvant hormonal treatment had no effect on DFS, and adjuvant radiotherapy decreased DFS in the current study.What are the implications of these findings for clinical practice and/or further research? Ovarian preservation should be considered, to prevent the negative effects of surgical menopause, particularly in young patients.

Life quality of endometrioid endometrial cancer survivors: a cross-sectional study.

Endometrial cancer is the most common gynaecologic malignancy in developed countries with increasing incidence worldwide. A total of 201 patients were enrolled and a cross-sectional study was performed using the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) and Female Sexual Functioning Index (FSFI) after the approval by an institutional review board (University of Health Sciences, Tepecik Education and Research Hospital, Turkey, March 13, 2019, Approval no. 2019/4-27). Morbidly obese patients (body mass index (BMI) ≥40 kg/m2) had lower physical functioning scores compared to non-obese (BMI < 30 kg/m2; p = .008) and non-morbidly obese patients (BMI < 40 kg/m2; p = .011). The overall sexual dysfunction rate was high (94.5%). No significant sexual function differences were observed among the study groups.IMPACT STATEMENTWhat is already known on this subject? Previous efforts to assess the influence of obesity and BMI on endometrial cancer patient quality of life have indicated that obesity adversely affects physical function and the effects of obesity on sexual function remains vague. In addition, the influence of patient age, surgical approach, adjuvant therapy type and time after diagnosis on quality of life and sexual function have not been clearly defined.What do the results of this study add? Increased BMI is associated with impaired physical function in endometrial cancer patients. However, BMI does not appear to affect sexual function in this population.What are the implications of these findings for clinical practice and/or further research? After endometrial cancer treatment, lifestyle interventions aimed at weight loss should be implemented to improve the quality of life.

Cervical carcinosarcoma presented in advanced stage after high grade cervical displasia.

OBJECTIVE: Cervical carcinosarcomas (Malignant Mixed Mullerian Tumour [MMMT] ) are very rare neoplasms. Fewer than 100 cases were documented until recently. Because of the rarity, etiologic factors, prognosis and treatment modalities are unclear. A 53 year-old woman presented with postmenauposal vaginal bleeding and abnormal cervical cytology. Cervical biopsy followed by loop electrosurgical excision procedure (LEEP) and cold knife conisation (CKC) was documented as cervical intraepithelial neoplasia III (CIN III). Without follow-up, two years later, the patient was referred with a cervical 6,5 cm mass invading vagina, parametriums and rectum. Biopsy was reported as cervical carcinosarcoma with squmous carcinoma and homologous sarcoma component. Neoadjuvant chemotherapy provided partial response. Subsequently external beam whole pelvis radiotherapy with chemotherapy and brachytherapy was applied. In despite of the treatment, the patient developed sistemic recurrence and died of disease within 10 months. In previous reports most of the patients were in early stage and had better prognosis than uterine carcinosarcomas. Here in we present a case who had a history of high-grade cervical displasia and presented at advanced stage, managed with neoadjuvant chemotherapy and definitive chemoradiotherapy.

Rectosigmoidectomy and Douglas Peritonectomy in the Management of Serosal Implants in Advanced-Stage Ovarian Cancer Surgery: Survival and Surgical Outcomes.

OBJECTIVE: This study aimed to evaluate the outcomes of rectosigmoid resection (RR) and Douglas peritonectomy (DP) on postoperative complications and survival in advanced-stage ovarian cancer surgery. METHODS/MATERIALS: Patients who underwent optimal cytoreductive surgery including RR and DP between January 2007 and January 2013 were included. Patients with deeper invasion into the muscularis and mucosal layer reported in pathology results and colon wall injury necessitating suturing or resection suggesting invasion of implants into the colon wall were excluded. The decision for RR or DP was made according to the surgical team and patients' preference. Resections were performed with the suspicion of colon wall invasion. The collected data were age, previous operations, preoperative cancer antigen 125 and albumin levels, surgical procedures, duration of surgery, tumor histology, recurrence, hyperthermic intraperitoneal chemotherapy, and length of hospital stay. Kaplan-Meir survival estimates were calculated and compared between the groups using the log-rank test. Cox proportional models were built to evaluate factors that affected disease-free and overall survival. RESULTS: Age, body mass index, preoperative cancer antigen 125 levels, albumin levels, and amount of ascites were similar between the groups. Neoadjuvant chemotherapy followed by interval debulking surgery was performed in 15% of both groups. End colostomy was performed in 23.7% of the RR group, and only 5.08% of the patients underwent diverting ileostomy procedures. There was no significant difference in terms of surgical complications between the groups. Recurrence occurred in the RR and DP groups at rates of 42% and 47%, respectively. Only primary debulking surgery had an effect on overall survival (odds ratio, 0.5; 95% confidence interval, 0.31-0.88). Overall survival and disease-free survival were similar in the RR and DP groups. CONCLUSIONS: Douglas peritonectomy showed similar survival and surgical outcomes to RR and provided shorter hospital stay and earlier admission to chemotherapy in the management of serosal implants during advanced-stage ovarian cancer surgery.

The prognostic significance of the heterologous component in uterine carcinosarcomas.

OBJECTIVE: Uterine carcinosarcomas are aggressive, rare biphasic tumors with malignant epithelial and malignant sarcomatous components. The prognostic significance of the presence of extrauterine sarcoma (heterologous component) is controversial. Therefore, the aim of this study was to investigate the effect of heterologous components in uterine carcinosarcomas on disease-free survival, overall survival, and other prognostic factors. METHODS: Clinical and histopathological data from patients treated for uterine carcinosarcoma in a tertiary cancer center in Turkey between July 2000 and January 2020 were collected. Independent risk factors affecting overall survival and disease-free survival were analyzed by univariate and multivariate Cox regression analyses. RESULTS: A total of 98 patients were identified. The median follow-up was 21.8 (1.2-233.1) months. In the multivariate analysis, the median overall survival and disease-free survival were 23.8 and 20.7 months in those with homologous mesenchymal components and 17.6 and 9.7 months in those with heterologous mesenchymal components, respectively. It was found that the presence of heterologous mesenchymal components significantly reduced both overall survival and disease-free survival (odds ratio [OR], 2.861; 95% confidence interval [CI] 1.196-6.841; p=0.018 and OR, 3.697; 95%CI 1.572-8.695; p=0.003, respectively). In addition, both lymphadenectomy and adjuvant radiotherapy were found to significantly increase overall survival and disease-free survival. Age was found to increase only disease-free survival. CONCLUSION: The results obtained in this study showed that the presence of heterologous components in uterine carcinosarcoma is a prognostic factor that adversely affects both overall survival and disease-free survival. Lymphadenectomy and adjuvant radiotherapy have beneficial effects on both overall survival and disease-free survival.

cERBB-2/Her-2 Neu Overexpression and Prognostic Significance in Uterine Carcinosarcoma.

OBJECTIVE: There is not enough data in the literature regarding Her-2 overexpression in uterine carcinosarcomas or its association with the prognosis. The aim of this study was to determine the Her-2 overexpression rate in uterine carcinosarcoma and to evaluate its relationship with the prognosis. MATERIAL AND METHOD: Her-2 protein and gene status were evaluated by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), respectively, in hysterectomy specimens from 51 patients with uterine carcinosarcoma. RESULTS: Her-2 protein expression in the epithelial component was negative in 42 patients (score 0 in 33 cases, score (+1) in 9 cases), score (+2) in 7 patients and score (+3) in 2 patients. None of the patients had Her-2 protein expression within the sarcomatous component of the tumors. Her-2 gene was not amplified in epithelial or mesenchymal tumor areas according to the FISH method. There was no difference between the Her-2 overexpression negative and positive groups in terms of disease-free survival (DFS) and overall survival (OS). Her-2 overexpression was significantly higher in tumors of patients diagnosed at 65 years or older (p=0.046). CONCLUSION: In our study, no relationship could be shown between Her-2 overexpression and prognosis in uterine carcinosarcoma. More comprehensive studies are needed to illustrate the relationship between Her-2 overexpression and carcinosarcoma prognosis.

The effect of lymph node metastasis on overall survival and disease-free survival in vulvar cancer patients.

OBJECTIVES: To examine the effect of lymphadenectomy on survival in patients with squamous cell vulvar carcinoma. MATERIAL AND METHODS: Patients with squamous cell vulvar cancer who underwent surgery were retrospectively analyzed. All procedures were performed according to current recommendations/standard of treatment. The clinical and pathological features were examined. Sixty-eight patients were studied. The mean age was 64.7 ± 10.9 years. Twenty-three (33.8%) patients had nodal metastasis. Most patients (60.3%) were in stage IB. Adjuvant radiotherapy and chemo-radiotherapy were administered to 33.8% and 25% of the patients, respectively. The median follow-up time was 28.5 (4-183) months. Recurrence occurred in 18 (26.5%) cases. RESULTS: There was no significant difference between node-positive and node-negative patients in terms of age, number of dissected lymph nodes and recurrence. Tumor diameter was significantly higher in the metastatic group. Age and surgical margin positivity were independent prognostic factors for overall survival (OS). Surgical margin positivity and lymph node metastasis had no effect on disease-free survival (DFS). CONCLUSIONS: Our results showed that age and surgical margin positivity were independent prognostic factors for OS. Although surgical margin positivity increased the risk of recurrence in univariate analysis, it was not a significant factor affecting DFS. OS was significantly lower in patients with lymph node metastasis.

Effect of tumor size on the accuracy of frozen section in the evaluation of mucinous borderline ovarian tumors.

OBJECTIVE: This study aims to evaluate the accuracy of frozen section (FS) in mucinous borderline ovarian tumors (BOTs) and to examine the factors associated with misdiagnosis. METHODS: In this retrospective study, cases diagnosed as mucinous BOTs by FS or final pathologic (FP) results were studied. The results of FS and FP were compared, and the factors associated with misdiagnosis were analyzed. RESULTS: Seventy-nine cases were examined. The median tumor diameter was 16 (6-50) cm, and 89.9 % of cases had tumors ≥10 cm. The overall agreement ratio between FS and FP was 79.7 %. Over-diagnosis and under-diagnosis rates were 3.8 % and 16.5 %, respectively. The sensitivity and positive predictive values were both 88.7 %. None of the underdiagnosed patients (13 cases) had recurrence during the 100-month median follow-up (9-222). Misdiagnosis was more common in tumors <10 cm (p = 0.025). The under-diagnosis rate for tumors <10 cm was 30.8 %. Tumor size <10 cm was significantly associated with misdiagnosis in univariate and multivariate analyses (Odds ratio {OR} 4.92, 95 % Confidence Interval {CI} (1.08-22.45) p = 0.040; OR 5.17, 95 % CI (1.07-25.05) p = 0.041, respectively). Laterality and preoperative CA 125 levels were not associated with misdiagnosis. CONCLUSION: Tumor size <10 cm is associated with misdiagnosis in mucinous BOTs. Laterality and CA 125 levels do not affect diagnostic accuracy. The evaluation of FS by gynecologic pathologists can help to increase the accuracy of FS.

Examination of the effect of ovarian radiation injury induced by hysterosalpingography on ovarian proliferating cell nuclear antigen and the radioprotective effect of amifostine: an experimental study.

AIM: The aim of this study was to examine the effect of amifostine on cellular injury in the ovarian tissue induced by hysterosalpingography (HSG). METHODS: In total, forty 4-month old female Wistar Albino rats were assigned into 8 groups. Each group contained 5 rats. Group 1 (G1): rats were decapitated without any procedure. Group 2 (G2): rats were decapitated after 3 hours of total body irradiation. Group 3 (G3): rats were decapitated 3 hours after HSG procedure. Group 4 (G4): rats were decapitated 3 hours after HSG procedure performed 30 min after receiving amifostine 200 mg/kg intraperitoneally. Group 5 (G5): rats were decapitated after 1 month without any procedure. Group 6 (G6): rats were decapitated after 1 month of total body irradiation. Group 7 (G7): rats were decapitated 1 month after HSG procedure. Group 8 (G8): rats were decapitated 1 month after HSG procedure performed 30 min after receiving amifostine 200 mg/kg intraperitoneally. After rats were decapitated under general anesthesia in all groups, blood samples were obtained and bilateral ovaries were removed. One of the ovaries was placed in 10% formaldehyde solution for histological germinal epithelial degeneration, apoptosis and proliferating cell nuclear antigen scoring. The other ovary and blood sera were stored at -80°C. TNF-α, total antioxidant status, total oxidant status, and malondialdehyde levels were studied in tissue samples and anti-mullerian hormone levels in blood samples. RESULTS: At the end of the first month, there was significant ovarian germinal epithelium degeneration. Proliferating cell nuclear antigen immunoreactivity was significantly reduced in all other groups when compared with G1 and G5. CONCLUSION: In conclusion, amifostine could significantly reduce the ovarian cellular injury induced by HSG.

The prognostic significance of the heterologous component in uterine carcinosarcomas

SUMMARY OBJECTIVE: Uterine carcinosarcomas are aggressive, rare biphasic tumors with malignant epithelial and malignant sarcomatous components. The prognostic significance of the presence of extrauterine sarcoma (heterologous component) is controversial. Therefore, the aim of this study was to investigate the effect of heterologous components in uterine carcinosarcomas on disease-free survival, overall survival, and other prognostic factors. METHODS: Clinical and histopathological data from patients treated for uterine carcinosarcoma in a tertiary cancer center in Turkey between July 2000 and January 2020 were collected. Independent risk factors affecting overall survival and disease-free survival were analyzed by univariate and multivariate Cox regression analyses. RESULTS: A total of 98 patients were identified. The median follow-up was 21.8 (1.2-233.1) months. In the multivariate analysis, the median overall survival and disease-free survival were 23.8 and 20.7 months in those with homologous mesenchymal components and 17.6 and 9.7 months in those with heterologous mesenchymal components, respectively. It was found that the presence of heterologous mesenchymal components significantly reduced both overall survival and disease-free survival (odds ratio [OR], 2.861; 95% confidence interval [CI] 1.196-6.841; p=0.018 and OR, 3.697; 95%CI 1.572-8.695; p=0.003, respectively). In addition, both lymphadenectomy and adjuvant radiotherapy were found to significantly increase overall survival and disease-free survival. Age was found to increase only disease-free survival. CONCLUSION: The results obtained in this study showed that the presence of heterologous components in uterine carcinosarcoma is a prognostic factor that adversely affects both overall survival and disease-free survival. Lymphadenectomy and adjuvant radiotherapy have beneficial effects on both overall survival and disease-free survival.

Protective effects of vitamin C and vitamin E against hysterosalpingography-induced epithelial degeneration and proliferation in rat endometrium.

AIM: The aim of this study was to examine the protective effects of vitamin C (VC) and vitamin E (VE) against hysterosalpingography (HSG)-induced epithelial degeneration and proliferation in rat endometrium. MATERIALS AND METHODS: A total of 28 female Wistar albino rats were randomized into four groups: G1 (n=7; abdomen was opened and closed), G2 (n=7; 0.1 mL Lipiodol [ethiodized oil] was administered to each uterine horn in conjunction with X-ray irradiation), G3 (n=7; 50 mg/kg of intraperitoneal (ip) VC was administered, followed by the administration of 0.1 mL of ethiodized oil into the uterine horns after 15 minutes), and G4 (n=7; 50 mg/kg of ip VE was administered, followed by the administration of 0.1 mL of ethiodized oil into the uterine horns after 15 minutes). After abdominal closure, rats in G2, G3 and G4 groups were exposed to whole-body X-irradiation three times with 2-minute intervals at a total dose of 15-20 mrad. Three hours after exposure, abdominal cavities of all the rats were reopened and uterine horns were removed. The right uterine horns were embedded into paraffin blocks after fixing in 10% formaldehyde for histopathological and immunohistochemical examination. Uterine horns on the other side were rapidly excised and stored at -80°C for the examination of expression of microRNAs (miRNAs) and oxidant, antioxidant, apoptotic and antiapoptotic gene expression using real-time polymerase chain reaction (RT-PCR) method. RESULTS: No differences were observed in terms of expression of miRNAs and oxidant, antioxidant, apoptotic and anti-apoptotic gene expression between the study groups. Congestion, epithelial degeneration and malondialdehyde immunoreactivity were significantly lower in G3 and G4 groups than in G2 group; no differences were observed between G1, G3 and G4 groups. Ki-67 immunoreactivity score was significantly higher in G2 group when compared with G1, G3 and G4 groups. Caspase-3 immunoreactivity was not statistically different between the groups. CONCLUSION: VC and VE may confer cellular protection against radiation injury induced by HSG in endometrial epithelium.

Efficacies of vitamin D and omega-3 polyunsaturated fatty acids on experimental endometriosis.

OBJECTIVE: The aim of this study was to investigate the effects of 1,25-dihydroxyvitamin-D3 (vitamin D) and omega-3 polyunsaturated fatty acids (omega-3 PUFA) on experimentally induced endometriosis in a rat model. MATERIALS AND METHODS: A prospective, single-blind, randomized, controlled experimental study was performed on 30 Wistar female rats. Endometriosis was surgically induced by implanting endometrial tissue on the abdominal peritoneum. Four weeks later, a second laparotomy was performed to assess pre-treatment implant volumes and cytokine levels. The rats were randomized into three groups: vitamin D group (42 µg/kg/day), omega-3 PUFA group (450 mg/kg/day), and control group (saline 0.1 mL/rat/day). These treatments were administered for 4 weeks. At the end of treatment, a third laparotomy was performed for the assessment of cytokine levels, implant volumes (post-treatment) and implants were totally excised for histopathologic examination. Pre- and post-treatment volumes, cytokine levels within the groups, as well as stromal and glandular tissues between the groups were compared. RESULTS: The mean post-treatment volume was statistically significantly reduced in the omega-3 PUFA group (p=0.02) and the level of the interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), vascular endothelial growth factor (VEGF) in the peritoneal fluid were significantly decreased at the end of treatment in the omega-3 PUFA group (p=0.02, p=0.03, and p=0.03, respectively). In the vitamin D group, only IL-6 levels were significantly decreased. In the histopathologic examination, the glandular tissue and stromal tissue scores of the implants were significant lower in the omega-3 PUFA group (p=0.03 and p=0.02). CONCLUSION: Omega-3 PUFA caused significant regression of endometriotic implants. Vitamin D has not been as effective as omega-3 PUFA on endometriosis.

The effect of ethanol sclerotherapy of 5 minutes duration on cyst diameter and rat ovarian tissue in simple ovarian cysts.

OBJECTIVES: To examine the effect of 95% ethanol sclerotherapy (EST) administered over 5 minutes on cyst diameter and ovarian tissue in experimentally induced simple ovarian cysts in a rat model. MATERIALS AND METHODS: In order to induce ovarian cysts, unilateral total salpingectomy was performed in regularly menstruating adult female Wistar albino rats (n=20) between 12 and 14 weeks of age and weighing between 200 and 220 g. One month after the procedure, the abdominal cavity was opened and 14 rats (70%) were found to have developed macroscopic cysts. Rats with macroscopic cysts (n=14) were assigned into two groups in a prospective and single-blinded manner: group 1 (G1) (n=7), control rats; and group 2 (G2) (n=7), 5-minute EST 95% group. Cyst diameter was measured and recorded for each rat. In G2, after whole cyst fluid was aspirated the cystic cavity was irrigated with 95% ethanol, approximately equal to half of the aspirated cyst volume, after which an interval of 5 minutes was allowed and same amount was re-aspirated and the abdominal cavity was closed. One month after this procedure, abdominal cavities were reopened and intra-abdominal adhesion scoring was performed in both groups. Cyst diameter was measured for each rat, and the right ovary was removed, fixed in 10% formaldehyde, and transported to the laboratory. A histologic assessment of the ovarian tissues was performed under light microscopy following staining with hematoxylin and eosin. Mann-Whitney U-test was used for statistical analysis. A P-level less than 0.05 was considered significant. RESULTS: In comparison with G1, there was a statistically significant reduction in the mean ovarian cyst dimensions in G2, while there were no significant differences between the two groups with respect to total number of follicles. Again, a significant increase in apoptotic activity and germinal epithelial degeneration was observed in G2 as compared to G1. The two groups were similar in terms of adhesion formation. CONCLUSION: Although 95% EST results in a reduction in the size of simple ovarian cysts, this effect seems to be achieved at the expense of ovarian tissue injury.

Investigation of the effects of unilateral total salpingectomy on ovarian proliferating cell nuclear antigen and follicular reserve: experimental study.

OBJECTIVE: We aimed to investigate the effects of unilateral total salpingectomy procedure on ovarian follicular reserve, apoptosis, and proliferating cell nuclear antigen (PCNA) staining in this study. STUDY DESIGN: Fourteen female Wistar Albino rats of 12 weeks were randomly divided into two groups. Abdomen midline incision was conducted under general anesthesia. Group 1(G1) (n=7): Group in which only the abdomen was opened and closed, Group 2(G2) (n=7): Group that underwent right total salpingectomy. After 1 month, abdomens of all rats were opened. Ovaries were macroscopically evaluated. Right ovarian tissue was quickly removed, fixed in 10% formaldehyde, and paraffin blocks were prepared.' The existence of fibrosis was identified with the usage of light microscope. Follicles were microscopically classified and counted. The prevalence of cytoplasmic immune staining and TUNEL staining was scored semi-quantitatively. STATISTICAL ANALYSIS: SPSS 17.0 software was used for the statistical analysis of data. First, Kruskal-Wallis variance analysis was conducted, and then Mann-Whitney U test was utilized for inter-group dual comparisons for parameters found as p<0.05. RESULTS: While the number of CL was found out dramatically high, secondary follicle count was found out to be significantly low in G2. Also in G2, although the number of atretic follicle and fibrosis were found out significantly increased, and the score of the angiogenesis was found to be significantly decreased in CL. When compared PCNA immunoreactivity in granulosa cells with the control group, there was a significant decrease in G2. When compared the malondialdehyde (MDA) immunoreactivity with G1 a significant increase was established in G2. Apoptosis score of ovarian follicles in granulosa cells was significantly higher in G2. CONCLUSIONS: In this experimental study, the decrease in the ovarian reserve and PCNA staning of granulosa cells, an increase in apoptosis, fibrosis and the number of atretic follicles in unilateral total salpingectomy operation were analyzed in rats. We found out significantly higher MDA staining rates in G2 in comparison to in G1. According to the study, the unilateral total salpingectomy procedure can damage to the same side ovarian tissue by means of the ischemia and reperfusion injury at the ovarian tissue.

Successful management of pelvic bleeding after caesarean hysterectomy by means of Foley catheter-condom balloon tamponade.

In this case report, we describe a 28-year-old woman with multipar gestation who developed postcaesarean atonia and severe pelvic haemorrhage which continued in spite of peripartum hysterectomy. A balloon tamponade tool was formed with Foley catheter and a condom, and was inserted into the pelvis through the vaginal cuff. The tampon was inflated up to 2200 mL and the pelvic tamponade was applied and bleeding was controlled. On the patient's incapability of urination, the volume of condom was decreased to 1800 mL and urination was achieved. seventy-two h postoperatively the Foley catheter-condom was removed through an abdominal incision. Pelvic bleeding ceased. After monitoring for a week, no postoperative fever, infection, pelvic abscess and haematoma were observed. Use of Foley catheter-condom as a pelvis pressure tampon tool may be a simple and effective method which can be easily used to control pelvic bleeding.

Impact of intracystic ethanol instillation on ovarian cyst diameter and adjacent ovarian tissue.

OBJECTIVE: To investigate the regression level of simple ovarian cyst size after local ethanol application and the damage level of adjacent ovarian reserve in rats. STUDY DESIGN: This study was conducted at Firat University Animal Laboratory with 18 mature (12-14 weeks old) female Wistar albino rats weighing 200-220g, with regular cycles. Ovarian cyst induction was performed with unilateral salpingectomy. Fourteen rats with ovarian cysts after a second laparotomy were divided into two groups as follows: Group 1 (n=7): cyst aspiration group, and Group 2 (n=7): intracystic 95% ethanol application group. One month after the cyst aspiration procedure a third laparotomy was performed. The cyst number and size were recorded for each rat. Right ovariectomy was performed and formalin-fixed/paraffin-embedded tissues were sectioned at 5µm thickness. Under light microscopy, ovarian total follicle reserve and fibrosis were evaluated with Masson trichrome staining and apoptosis was evaluated with TUNEL staining. The groups were compared with the Mann-Whitney U test and Wilcoxon Rank test. p<0.05 was considered significant. RESULTS: Ovarian cyst formation was observed in 85% (15/18) of rats. The mean diameter of ovarian cysts in Groups 1 and 2 were, respectively, 10.3mm and 10.1mm. After aspiration, there was no significant reduction in the cyst diameter (10.3mm vs 8.1mm), but after ethanol application the diameter significantly reduced (10.1mm vs 3.4mm, p<0.05). Mean ovarian follicle count in Group 2 was significantly lower than in Group 1 (25 vs 42, p<0.05), and mean fibrosis and apoptosis scores in Group 2 were significantly higher than in Group 1 (2.5 vs 0.9, p<0.05). CONCLUSION: Local ethanol application reduces cyst diameter but concomitantly decreases ovarian reserve due to increased fibrosis in rats. In humans, intracystic ethanol application should be performed cautiously.