Comparison of gait and sagittal plane arm swing between individuals with adolescent idiopathic scoliosis and healthy individuals.

Arm swing and energy consumption play an important role in the realization of an effective gait. However, research on arm swing and energy consumption during gait in individuals with adolescent idiopathic scoliosis (AIS) is limited. The aim of this study was to investigate the spatiotemporal characteristics of gait, arm swing angles in the sagittal plane, energy consumption in individuals with AIS, to compare them with their healthy peers in this regard. 26 diagnosed with AIS and 21 healthy were included in this study. Evaluation measures were based on the Cobb angle, axial trunk rotation, trunk symmetry, sagittal curve measurements, spatiotemporal characteristics of gait with the GAITRite electronic walkway, sagittal plane arm swing with two video-camera recordings, and energy consumption. There were a decrease in right- sided sagittal arm swing, an increase in energy consumption, in left-side step time and right-side double support time in the scoliosis group compared to the control group. The other spatiotemporal characteristics of the gait were similar in both groups. The evaluation of arm swing, energy consumption, and gait of individuals with AIS may contribute to the development of rehabilitation programs by better identifying the deficiencies of individuals with AIS.

Do obesity and age effect the clinicopathological features and survival outcomes in premenopausal women with endometrial cancer?

PURPOSE: The purpose of this study was to review the effect of age and body mass index (BMI) on the prognosis, demographic characteristics, and pathological features of patients diagnosed with endometrial cancer, specifically before menopause. MATERIALS AND METHODS: Patients that were diagnosed with endometrial cancer before menopause, were screened retrospectively. Between 1999 and 2011, 163 patients were identified while 40 were excluded. Patients were classified into three groups according to age (under 40 years, between 40-45 years, more than 45 years) and BMI (normal weight group, overweight group, and obese weight group). Demographical characteristics, histopathological features (Stage, grade and histology of the tumor, the presence of myometrial and/or lymphovascular invasion, history of diabetes mellitus, history of hypertension, hormonal contraception method, smoking, parity, infertility, family history, and recurrences) and survival rates were compared among the groups. RESULTS: In total, 123 patients with a mean of 65.0 months follow up were enrolled into the study. The majority of the patients had endometrioid type in all age-related subgroups. Advanced stage endometrium cancer (Stage 2 and greater) was seen more commonly in the group of patient over 45 years of age against the other age-related subgroups (27.9% vs. 8% vs. 3.3%). Ratio of myometrial invasion more than 50% and occurrence of well-differentiated tumor were seen with a similar ratio among the age-related subgroups. Ratio of nulliparity and infertility were found statistically significant in the group of patients under 45 years of age against the group of patients over 45 years of age (p = 0.001, p = 0.03). The five-year estimated disease-free survival rates of women under 40 years of, women with an age between 40-45 years, and women over the age of 45 years were calculated as 73%, 95%, and 87%, respectively (p = 0.152). Concerning the histopathological features, there were no statistical differences between weight related subgroups. Comorbid conditions (hypertension and diabetes mellitus) were found as statistically high in the obese patients' group (43.5%-25.8%). In contrast to comorbid conditions, nulliparity and infertility histories were observed more often within the normal weight group (55.6%-38.5%). Mean disease-free survival time was calculated as 155.81 months in the normal weight group; 114.691 months in the overweight group, and 144.677 months in the obese group. Five-year disease-free survival rate was calculated as 91%, 81%, and 87%, respectively (p = 0.452). CONCLUSION: Women with premenopausal cancers generally exhibit early and favorable histopathological symptoms. Although advanced stage endometrium cancer incidence was detected to be higher in the premenopausal endometrium cancer patients aged above 45 years compared to other age subgroups. A significant difference in terms of survival rates between these groups was not reached. In the same manner, the authors did not find a significant difference in survival rates among different weight subgroups of premenopausal endometrium cancer patients. As a secondary result, the authors discovered that diabetes mellitus and hypertension play a key role in patients with a BMI above 30 kg/m2 and nulliparity and infertility play a key role in patients with a BMI below 25 kg/m2 in the development of premenopausal endometrial cancer.

A deceiving disease in women for clinicians: peritoneal tuberculosis.

INTRODUCTION: Peritoneal tuberculosis (TB) is uncommon in developed countries, although there is an increase in incidence due to the patients with acquired immunodeficiency syndrome and in immigrants from countries with tuberculosis. The aim of the study was to identify characteristic features of peritoneal tuberculosis (TB), which may be useful for the clinical differential diagnosis and management of this deceiving disease. MATERIALS AND METHODS: For this retrospective study, 18 patients, who were diagnosed with peritoneal TB were identified after surgery. RESULTS: Initial presentation consisted of ascites, pelvic masses, and elevated levels of CA-125. All patients were initially misdiagnosed as ovarian carcinoma. Tissue biopsies obtained from laparoscopy or laparotomy revealed accurate diagnosis of peritoneal TB. CONCLUSION: Peritoneal TB should be included in the differential diagnosis ofascites and pelvic masses and can be accurately diagnosed by laparoscopic biopsy.

Implications of premature ovarian failure on bone turnover markers and bone mineral density.

INTRODUCTION: Premature ovarian failure (POF) is the cessation of ovarian function before the age of 40. The loss of ovarian function, whether premature or not, has an overwhelming impact on female skeletal health, leading to an increased risk of developing osteoporosis because of the lengthened time of exposure to reduced estrogen. The objective of this study was to compare the implications of premature ovarian failure on bone turnover markers and bone mineral density in patients under the age of 40. MATERIALS AND METHODS: Sixty-one patients with a diagnosis of POF were selected for this prospective study. Patients were divided into two groups according to age, patients < 30 years old (n = 30), and patients > or = 30 years old (n = 31). RESULTS: Between the two age sub-groups (< 30 and > or = 30 years old), there was a significant difference in menopause rating scale (MRS), lumbar spine t-score, N-telopeptides crosslinks (NTx), and serum bone specific alkaline phosphatase (bALP) between the two age groups (10.93 +/- 7.79 vs 17.38 +/- 8.62; -1.84 +/- 1.47 vs -1.06 +/- 0.93; 58.80 +/- 21.32 vs 41.1 +/- 11.37; 48.99 +/- 42.16 vs 23.76 +/- 10.08, respectively). CONCLUSION: It is apparent that bone mineral density (BMD) is commonly less in women with POF than normal healthy women. Therefore, measurement of BMD is warranted. At this time, it is not clear how often the tests should be carried out to evaluate BMD. Further prospective studies are required to establish guidelines. However, it seems reasonable to monitor women with POF yearly for the presence of any endocrine dysfunction and to assess BMD at periodic intervals.

Groin recurrence following stage IA squamous cell carcinoma of the vulva with negative nodes on superficial inguinal lymphadenectomy.

PURPOSE OF INVESTIGATION: Stage IA vulvar cancer with a depth of stromal invasion less than 1 mm is generally managed by wide local excision alone since there is less than 1% risk of lymph node involvement. CASE: A 62-year-old patient was admitted to a university hospital with a suspicious vulvar lesion. RESULTS: We present the first case of inguinal node and a possible contralateral pubic ramus recurrence following bilateral superficial inguinal lymphadenectomy and wide local resection for Stage 1A vulvar cancer. CONCLUSION: There is no evidence that extended radical surgery provides a better overall survival or reduces recurrence rate in Stage 1A vulvar carcinomas. Conservative vulvar resection and sentinel node dissection seem to be a rational choice. Nevertheless the disease may recur in the inguinal areas and frequently be lethal, therefore close surveillance and early attempts to treat the recurrent disease before infection and inflammation ensues should be the aim of current treatment strategies.

Factors affecting recurrence and disease-free survival in granulosa cell tumors of the ovary.

PURPOSE OF INVESTIGATION: To determine risk factors for prognosis and recurrence in ovarian adult-type granulosa cell tumor (GCT). METHODS: A retrospective review of GCT cases treated at our university hospital between 1991-2006. RESULTS: Of 39 patients with GCT, 82% had Stage I disease. The median follow-up period was 71 months. There were 12 cases of recurrence (30.8%) and seven of them had died of disease. The pelvis and liver were the most common sites of recurrence (8 and 3 patients, respectively). Interestingly lymph node recurrence was encountered in two patients. Estimated disease-free survival for five years was 82%. Stage and presence of residual tumor were calculated to be the only associated risk factors for recurrence and prognosis (p < 0.05). CONCLUSION: Recurrences in GCT might be associated with stage and presence of residual tumor during primary surgery. Although rarely present during diagnosis, lymph node metastasis might be more common in recurrent disease.

Conservative management of a patient with endometrial carcinoma desiring fertility: how to inform?

Conservative management of patients with endometrial cancer who desire fertility is becoming widespread in certain circumstances. A 36-year-old women desiring fertility with early-stage endometroid type adenocarcinoma of the endometrium was treated with 160 mg/d megestrol acetate for six months. After confirmation of a normal endometrial biopsy she became pregnant spontaneously. Following an uneventful pregnancy a healthy baby at term was delivered by cesarean section. Definitive surgery was performed. The risks and benefits of this thereupeutic approach are discussed and informing style of the patients emphasized.

Invasive squamous carcinoma of the vulva in women aged less than 40 years: report of two cases and a third case diagnosed during pregnancy.

PURPOSE OF INVESTIGATION: Invasive squamous cell cancer of the vulva (ISCC) is a rare disease in young patients and in pregnant women. The purpose of this paper was to investigate this type of cancer in women less than 40 years old and to present three cases, one which was diagnosed in the third trimester of pregnancy. METHODS: Three cases of invasive squamous cell cancer in women under age 40 among the retrospectively analyzed 52 vulvar cancer cases diagnosed between 1995-2002 were investigated. RESULTS: Women aged 25, 39 and 31, respectively, had Stage 1, 2 and 3 ISCC of the vulva. The first two cases had been spared by surgery and radiotherapy. The third patient was diagnosed during the last trimester of pregnancy. Although she was treated by radical surgery and postoperative radiotherapy, she had a recurrence in the inguinal region at 36 months, and died of disease 12 months later. CONCLUSION: Vulvar ISCC in young women may occur in association with or without predisposing factors. Although HPV-related type is predominant in the literature, keratinizing type of carcinoma may also be seen in this group of patients. Biopsy from suspected lesions is of paramount importance.

Malignant germ cell tumors of the ovary: a review of 41 cases and risk factors for recurrence.

OBJECTIVE: To review the outcome of treatment in patients with malignant ovarian germ cell tumors and to define the risk factors for recurrence. MATERIAL AND METHODS: Forty-one patients with malignant ovarian germ cell tumors were reviewed retrospectively. Survival time and survival rate were obtained. Risk factors such as stage, histological type, and type of operation were evaluated for reccurrence. RESULTS: Twenty-three (56%) had dysgerminomas, eight (19.5%) had mixed germ cell tumors, three (7.3%) had yolk sac tumors, three (7.3%) had immature teratomas, two (4.8%) had squamous cell carcinoma arising from a mature teratoma, one (2.4%) had embryonal carcinoma and one choriocarcinoma. Most of the cases (73%) were in Stage I. Twenty-nine patients (70.7%) underwent conservative surgery and 12 patients (29.3%) had at least bilateral salpingo-oophorectomy. Thirty patients were operated on optimally with surgical staging and 11 suboptimally. Seven patients (17%) had recurrence after remission. The overall survival time was 187 +/- 8.43 months for all cases, 195 +/- 8.49 for dysgerminoma and 161 +/- 10.96 for non-dysgerminoma cases with a median follow-up time of 98.52 (8-204) months. Non-dysgerminoma histologic type, being operated on suboptimally and radically, and advanced tumor stage have been found to be risk factors for recurrence. CONCLUSION: Regardless of histologic types and stages the prognosis of germ cell tumors are satisfactory with current therapeutic strategies.

Life-saving hysterectomy in choriocarcinoma: presentation of two cases.

BACKGROUND: Choriocarcinoma is a malignant tumor of the placenta. Life-saving hysterectomy was performed in two cases with choriocarcinoma who had profuse vaginal bleeding. CASE 1: A 25-year-old, gravida 3, para 1, woman was referred to our emergency clinic with the diagnosis of choriocarcinoma and massive vaginal bleeding. She had been transfused seven units of blood at the hospital where she was first admitted. Pelvic examination demonstrated heavy vaginal bleeding and a uterus equivalent to the size of 14 weeks of gestation. Her beta-hCG level was 560,000 mIU/ml. Despite four units of blood transfusion, she had a pulse rate of 130/min, arterial pressure of 90/60 mm/Hg and HCT of 19%. An emergency hysterectomy with vertical incision was performed. CASE 2: A 54-year-old, gravida 3, para 3, woman was referred to our clinic with heavy bleeding with the diagnosis of choriocarcinoma. She was scanned to look for possible metastases and pulmonary metastasis was detected. Chemotherapy was planned but as sudden vaginal bleeding began she was referred to the Gynecology Department. At pelvic examination a soft uterus the size of 20 weeks of gestation was palpated. The beta-hCG level was 554,700 mIU/ml. Due to hemodynamic instability and continuous vaginal bleeding an emergency hysterectomy was performed. CONCLUSION: Although chemotherapy is the cornerstone of treatment for choriocarcinoma, optimal treatment results may depend on the addition of surgery in selected circumstances. Hysterectomy is indicated in cases with life-threatening hemorrhage.

Pelvic actinomycosis mimicking ovarian malignancy: three cases.

OBJECTIVE: Three cases of pelvic actinomycosis initially diagnosed as pelvic malignancy and treated surgically are reported. CASES: The first case was a 38-year-old multiparous woman who was referred to our clinic because of bilateral ovarian solid masses. With the impression of ovarian carcinoma, a laparotomy was performed. During surgery adhesiolysis, total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, appendectomy, peritoneal washings, and peritoneal abscess drainage were performed. The second patient was a 37-year-old woman who presented with a left-sided fixed solid mass highly suggestive of pelvic malignancy. Both ureters were found to be dilated with hydronephrosis in the right kidney supporting the diagnosis of retroperitoneal fibrosis. Excision of the mass, colectomy and temporary diverting colostomy and stent insertion to the left ureter were performed. Colostomy repair was performed five months later. On the fifth day postoperatively, fascial necrosis developed so a Bogota-bag was placed on the anterior abdominal wall and left for secondary healing. The third patient was a 51-year-old postmenopausal woman incidentally diagnosed as having a pelvic mass while having been investigated for constipation and nausea. She had had a colostomy one year before and a reanastomosis two months after. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. In all cases, histopathologic staining of the specimens revealed chronic inflammation containing actinomycosis abscesses confirmed with microbiologic identification. CONCLUSION: Pelvic actinomycosis is an uncommon cause of a pelvic mass. However, it should be kept in mind in the differential diagnosis of pelvic masses, especially in the patients with a history of IUD use to avoid an unnecessary extensive surgical procedure.

Conservative treatment of an early ectopic pregnancy in a cesarean scar with systemic methotrexate--case report.

PURPOSE OF INVESTIGATION: Pregnancy implanted in a cesarean scar is rare, and is a life-threatening condition due to high risk of uterine rupture, hemorrhage, hysterectomy, and maternal mortality. CASE REPORT: We describe a 26-year-old woman who presented with five weeks of amenorrhea and a serum hCG level of 10,440 mIU/ml. Transvaginal sonography revealed a gestational sac of 15 x 11 mm containing a yolk sac located in a previous cesarean scar. She was successfully treated conservatively with multi-dose methotrexate. No side-effects were encountered. The serum hCG levels were undetectable in 58 days. The patient had normal menstrual cycles afterwards. CONCLUSIONS: In the view of increasing cesarean rates, healthcare professionals should be aware of the possibility of a scar pregnancy and the potentially life threatening sequelae. Early diagnosis by transvaginal sonography can improve outcome and minimize the need for emergent surgery. Conservative treatment with systemic methotrexate is an effective option in selected patients.

Cranial imaging spectrum in hypertensive disease of pregnancy.

OBJECTIVE: To determine cranial imaging findings in patients with severe preeclampsia, eclampsia and HELLP syndrome and the correlation between these findings and neurological symptoms. MATERIALS AND METHODS: CT or MRI findings of 120 patients diagnosed with severe preeclampsia, eclampsia and/or HELLP syndrome between January 1998 and December 2005 are presented. RESULTS: Pathological imaging findings were observed in 28.1% (n = 32) of the severe preeclampsia group, in 43.3% (n = 30) of the HELLP group, in 51.35% (n = 27) of the eclampsia group and in 61.9% (n = 21) of the eclampsia + HELLP group and in 45% of all patients. Thirty-five patients had specific pathology defined as ischemic lesions, edema, and perivascular microhemorrhage. Infarcts were found in seven, intracranial hemorrhage in seven, hydrocephaly in two, dural sinus thrombosis in two and a pineal cyst in one patient. Specific lesions were generally located in the posterior parietal and occipital lobes. Five patients died due to intracranial hemorrhage and one patient due to septic shock. CONCLUSION: A wide imaging spectrum from the ischemic lesion to severe intracranial hemorrhage can be detected in complicated cases of hypertensive diseases of pregnancy. It is essential to perform cranial imaging in patients with symptoms and neurological deficits.

Analysis of vaginal recurrences in stage I endometrial adenocarcinoma.

OBJECTIVE: To determine the risk of vaginal recurrence in Stage 1 endometrial cancer and treatment morbidity associated with different therapeutic approaches MATERIAL AND METHODS: Between 1995 and 2005, 341 patients with clinical Stage I endometrial cancer were treated at Istanbul Medical Faculty. One hundred and forty-four women were included in this study as the follow-ups and records were complete. The patients with no myometrial invasion received no further therapy following hysterectomy. When there was superficial myometrial invasion postoperative vaginal vault radiation was used, and if deep myometrial invasion was present, external pelvic radiation was given. RESULTS: Overall 5-year survival rate for all patients with Stage I disease was 80%. Nine patients (6.25%) developed recurrent disease, three of whom had vaginal recurrences. All three vaginal recurrences were small and diagnosed at routine follow-up exam within 51 months of primary therapy. CONCLUSION: This selective treatment protocol for patients with Stage I endometrial cancer avoided radiation entirely in 38% of the patients while achieving a very low rate of vaginal recurrence and good overall survival.

Granulomatous villitis formed by inflammatory cells with maternal origin: a rare manifestation type of placental toxoplasmosis.

We present a case of placental toxoplasmosis with granulomatous villitis. The patient was a 26-year-old gravida 1 female with the findings of intrauterine death at 16th week of gestation. The pregnancy was terminated. Pathological examination revealed an autolysed fetus and a placenta with necrotizing granulomas within the villous stroma. Encysted Toxoplasma gondii was rarely observed within the granulomas and serologic examination of the mother confirmed acute toxoplasmosis. A fluorocein in situ hybridization examination, using sex chromosome probes, revealed that the villous granulomas were formed by inflammatory cells, originated from the maternal immune system. In conclusion, T. gondii should be taken into consideration as a rare cause of placental granulomatous inflammation. To the best of our knowledge, this is the first case of granulomatous villitis due to toxoplasmosis, in which formation by maternal inflammatory cells has been demonstrated.

Differentiation of benign and malignant adnexal masses: value of a morphologic scoring system.

OBJECTIVE: The purpose of this study was to assess the value of conventional gray-scale ultrasonography, based on a morphologic scoring system, in the differential diagnosis of malignant and benign adnexal tumors. MATERIAL AND METHODS: A total of 58 adnexal masses in 51 patients were classified prospectively as suggestive of malignant or benign, on the basis of gray-scale ultrasonographic morphology. The results were correlated with histopathological diagnosis. RESULTS: Histopathology of 42 masses was found to be benign and 16 masses were found to be malignant. On gray-scale analysis 15 of 16 malignant masses were classified as suggestive of malignant and 37 of 42 benign masses were classified as suggestive of benign. The sensitivity, specificity, positive predictive value and negative predictive value are calculated as 93%, 88%, 75%, and 97%, respectively. CONCLUSION: Prediction of malignancy using gray scale ultrasonograhy based on a morphological scoring system was reliable (NPV = 97%, PPV = 93%). However further investigations about the assessment of adnexal masses with ultrasonography are needed

Laparoscopic evaluation of metastatic ovarian cancer: a case report.

UNLABELLED: OBJECTIVE AND CASE: Both noninvasive and invasive methods have limited value in the diagnosis of metastatic ovarian cancer. We present a case with the initial complaint of abdominal distention in whom primary and metastatic tumor sites were safely diagnosed by using laparoscopy: a gastric tumor with ovarian metastasis. DISCUSSION: Diagnostic laparoscopy by the open technique provides a safe and effective diagnostic option in patients with metastatic ovarian cancer.

Uterine artery embolization in a 10-week cervical pregnancy with coexisting fibroids.

A 36-year-old woman, gravid 3, para 1, abortus 1, was admitted to our department at 10 weeks and 4 days of gestation with the diagnosis of cervical pregnancy and multiple uterine fibroids. After admission she underwent angiographic embolization of bilateral uterine arteries followed by intraamniotic 70-mg methotrexate injection. Despite being given a second dose of methotrexate injection 1 week later, the gestational sac did not resolve spontaneously, thus vacuum evacuation and curettage of the cervical canal was required on the 15th day of embolization. The patient was discharged in good condition. She had no complaints by post-operative at month 11, except amenorrhea. Her uterine fibroids markedly decreased in size after the procedure. As a result, embolization of uterine arteries provided surgical evacuation of cervical pregnancy with minimal hemorrhage, and the patient's potential fertility was preserved, but a long-term amenorrhea was observed.

Spontaneous uterine rupture at an unusual site due to placenta percreta in a 21-week twin pregnancy with previous cesarean section.

Spontaneous uterine rupture is a rare, but serious complication of placenta percreta. This case report is about a spontaneous uterine rupture at an unusual site due to placenta percreta in a 21-week twin pregnancy with previous cesarean section. A 30-year-old, G3, P2 woman was referred to our unit in the 21st week of a twin pregnancy with acute abdomen. An emergency laparotomy was performed with the diagnosis of uterine rupture and intra-abdominal hemorrhage. A significant hemoperitoneum was found, with both fetuses freely floating in the peritoneal cavity. A large transverse rupture at the posterior isthmus wall was detected. Subtotal hysterectomy with preservation of both ovaries was performed. Pathological investigation of the uterus revealed placenta percreta.