Comparison of long-term results of obliterative colpocleisis and reconstructive vaginal surgery including sacrospinous ligament fixation in patients with total genital prolapse.

Background: Treatment of total genital prolapse in elderly patients is still controversial in terms of postoperative objective and subjective results. Aim: The present study aimed to compare the long-term objective and subjective cure rates of sacrospinous ligament fixation and Le Fort operation for treatment of total genital prolapse. Patients and Methods: Patients over the age of 60 with stage 3 or 4 pelvic organ prolapse that presented to the Obstetrics and Gynaecology Clinic of the Faculty of Medicine of *** University. The study sample consisted of 17 patients that underwent Le Fort operation and 29 patients that underwent sacrospinous ligament fixation. Data on duration of operation, intraoperative complications, duration of hospital stay, and differences between preoperative and postoperative estimated blood loss, postoperative complications, and relapse in the long term were obtained. Questionnaires exploring quality of life, incontinence, and pelvic floor disorders were applied to the patients. Results: As subjective cure rates, postoperative patient satisfaction (P = 0.001), regret rate (P = 0.038) and recommendation rate (P = 0.044), as well as postoperative questionnaire results, Pelvic Floor Impact Questionnaire and SF36 were found to be significantly better in the Le Fort group (respectively P = 0.039 and 0.042). As objective cure rates, there was no difference between the two groups in terms of postoperative cystocele, rectocele, and cystorectocele (P = 0.955) and postoperative recurrence of prolapse beyond the hymen (P: 0.893). Duration of operation and duration of hospital stay were found to be significantly shorter in the Le Fort group (respectively P = 0.032 and 0.012). Conclusion: Le Fort operation could be the intervention of choice in sexually inactive elderly patients with stage 3 or 4 pelvic organ prolapse.

Clinical experience in pregnancies complicated by adnexal torsion.

OBJECTIVE: The purpose of this study was to present data on clinical and operational management and postoperative outcomes of pregnancies complicated by adnexal torsion (AT). MATERIALS AND METHODS: Twenty-four pregnant women who presented to the present clinic between January 2007 to December 2013 and were intraoperatively diagnosed with AT were included in this study. Demographic data such as age and data on obstetric history, gestational week, current trimester, previous gynecologic and non-gynecologic operations, type of surgery that was performed, average size, location and number of adnexal masses, surgical techniques that were employed, postoperative complications, and pathology results were investigated and noted. RESULTS: In this study, 132 patients were operated due to AT, and the rate of pregnant women with AT was 18.2% (24/132). The mean age of the patients was 29.25 ± 6.27 years, and the mean gestational week was 18.25 ± 7. Eight patients were in their first trimester (33.3%) whereas 13 were in their second trimester (54.2%), and three were in their third trimester (12.5%) when they presented to the hospital. The mean AT size was 95.3 ± 53.9 mm, as measured by ultrasonography. All the patients were operated by laparotomy. Regarding the types of abdominal incision, 13 patients (54.2%) had a Pfannenstiel incision, three patients (12.5%) had an infra-umbilical median incision, and eight patients (33.3%) had a pararectal incision. Duration of operation was significantly shorter in patients with pararectal incisions (p < 0.01) compared to those with Pfannenstiel and infra-umbilical median incisions. Regarding the types of treatment, ten patients (41.7%) underwent unilateral salpingo-oophorectomy (USO), eight patients (33.3%) underwent adnexal detorsion+cystectomy, and six patients (25%) underwent adnexal detorsion only. CONCLUSION: AT is a gynecologic emergency that requires early diagnosis and treatment, as it is capable of complicating the pregnancy. Determination of the current gestational week prior to the surgical intervention will assist and guide the surgeon in identifying the suitable type of surgery for a particular patient. Pararectal incision should be the incision of choice for a shorter duration of operation, which is crucial in pregnant women for reduced exposure to anesthesia.

Serum levels of the adipokines, free fatty acids, and oxidative stress markers in obese and non-obese preeclamptic patients.

PURPOSE OF INVESTIGATION: To investigate the roles of adipokines, free fatty acid (FFA), and oxidative stress in obese and non-obese preeclamptic patients. MATERIALS AND METHODS: Gestational age-matched obese preeclamptic (n=32), non-obese preeclamptic (n=32), and non-obese normotensive healthy (n=32) pregnant women were included in the study. Serum insulin, insulin resistance, leptin, nesfatin, ghrelin, chemerin, FFA levels, total antioxidant status, total oxidant status, and oxidative stress index were determined. RESULTS: Leptin and nesfatin levels were significantly lower and ghrelin levels were significantly higher in the normotensive group as compared to the preeclamptic groups, while no difference was observed between obese and non-obese preeclamptic groups. Chemerin and FFA levels were significantly higher in obese preeclamptics as compared to non-obese preeclamptics and normotensive group. Total antioxidant status (TAS) levels were significantly higher in the normotensive group as compared to the preeclamptic groups, while no difference was observed between obese and non-obese preeclamptics. Total oxidative status (TOS) and oxidative stress index (OSI) levels were significantly lower in the normotensive group as compared to the preeclamptic groups, while no difference was observed between obese and non-obese preeclamptics. CONCLUSION: Serum levels of adipokines, TOS, and FFAs were significantly higher in pregnants with preeclampsia as compared to non-obese normotensive controls. Chemerin and FFA levels were significantly higher in obese preeclamptics as compared to non-obese preeclamptics.

Increased platelet count in severe peritoneal endometriosis.

OBJECTIVE: Platelet count (PC) is higher in chronic inflammatory diseases. The aim of this study was to evaluate the PC in patients with severe pelvic endometriosis. MATERIALS AND METHODS: Patients with advanced stage pelvic endometriosis were retrospectively evaluated in a tertiary center between January 2009 and December 2011. Patients with pelvic endometriosis were divided into two groups; advanced stage peritoneal endometriosis were classified as Group 1 (n = 28). Group 2 consisted of 29 patients which had ovarian endometrioma without clinically apparent peritoneal endometriosis foci. Group 3 included 51 women as control subjects. PC between the groups was tested by Student's t test. The mean values of three groups were analyzed by using one way ANOVA test followed post-hoc test Bonferroni. RESULTS: PC in patients with pelvic endometriosis were found to be higher from the control group (290 +/- 67 10(9)/1; 264 +/- 63 10(9)/1, respectively; p = 0.038). Patients with peritoneal endometriosis (Group 1) had significantly higher PCs compared with the healthy controls (309 +/- 65 10(9)/1; 264 +/- 63 10(9)/1; respectively; p = 0.011). CONCLUSION: Increased PC in advanced stage pelvic endometriosis may be a sign of increased systemic inflammation. The systemic inflammation may be more apparent in advanced stage peritoneal endometriosis.

Serum levels of androgens and prostate-specific antigen in endometriosis.

OBJECTIVE: The aim of the present study was to evaluate the levels of serum androgens and prostate-specific antigen (PSA) levels in patients with endometriosis. MATERIALS AND METHODS: Patients with Stage III/IV (advanced stage) endometriosis were compared to controls with respect to basal serum levels of total testosterone (T), free testosterone (fT), androstenedion (A), dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulphate (DHEA-S), and PSA in the early follicular phase of menstrual cycle for this prospective case control study. RESULTS: Level of T, fT, A, DHEA, and DHEA-S were higher in patients with endometriosis when compared to control subjects, but the difference was not statistically significant. The mean PSA level was 0.0074 +/- 0.0120 ng/ml in patients with endometriosis and 0.0059 +/- 0.0056 ng/ml in control group and there was no statistically significant difference between groups (p = 0.58). CONCLUSION: Serum basal androgens and PSA levels are higher in endometriosis group with respect to control but the differences are not statistically significant.

Placental expression of vimentin, desmin and ultrastructural changes in the villi in patients with HELLP syndrome.

OBJECTIVES: To examine placental expression of vimentin and desmin in relation to ultrastructural changes within the placental villi in cases of HELLP syndrome. STUDY DESIGN: Formaldehyde-fixed and paraffin-embedded specimens of 15 healthy pregnant and 13 Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, placentas were used for Harris hematoxylin staining, vimentin and desmin immunohistochemistry, and transmission electron microscopy (TEM). RESULTS: Increased of fibrinoid necrosis in vascular wall and the periphery of villi were observed in sections of the placentas with HELLP syndrome. Increased expression of vimentin in the intravillous area and increased expression of desmin on blood vessel wall, were seen in placentas of patients with HELLP syndrome when compared to placentas of healthy pregnant. CONCLUSIONS: Augmentation of intermediate filaments, desmin, vimentin may disturb normal movements of endothelial cells, and may display placental dysfunction that is unable to compensate the endothelial instability and the related hypertension in HELLP syndrome. Further studies are needed to get more definit results and also to compare HELLP syndrome with preeclampsia.

Fibroblast growth factor-1 expression in the endometrium of patients with repeated implantation failure after in vitro fertilization.

BACKGROUND: An examination of the alterations in Fibroblast Growth Factor-1 (FGF-1) expression in a group of repeated implantation failure after in vitro fertilization (IVF) patients, when compared to fertile patients. PATIENTS AND METHODS: Study group consisted of 24 patients with repeated implantation failure and 29 fertile control patients. Endometrial samples received at the luteal phase were exposed to immunohistochemical staining for the fibroblast growth factor-1 (FGF-1) with antibodies. RESULTS: In the study group all patients have primary infertility (n = 24), and the average duration of infertility was 3.9 ± 1.3 years. The average recurrent IVF failure was 2.6 ± 0.6 attemps. There were no significant differences in the histological data according to the Noyes classification (p = 0.226) and age (p = 0.231) between the patients in the study and control groups (n=29). The control group was found to have more severe expression of FGF-1 (< 0.001) than the study group when endometrial glandular epithelial cells, stromal cells and vascular endothelial cells were evaluated. CONCLUSIONS: Endometrial glandular epithelial cells, stromal cells and vascular endothelial cells of the control and study group were evaluated and it was found that the control group displayed a stronger expression of the FGF-1 (< 0.001). The expression of FGF-1 in the IVF implantation failure group is less than in the fertile group, which suggests that growth factors such as FGF-1 are important maternal factors effecting implantation.

Effects of estrogen, estrogen/progesteron combination and genistein treatments on oxidant/antioxidant status in the brain of ovariectomized rats.

INTRODUCTION: The aim of this study was to investigate the antioxidative effects of estradiol (E), E plus progesteron (P) combination (E/P) and genistein (G) treatment in the brain of ovariectomized (OVX) rats. MATERIALS AND METHODS: Adult female Sprague-Dawley rats were divided into five groups, with each group including ten rats. Rats were anesthetized and bilateral ovariectomy was performed under general anaesthesia in all groups except for the sham operation group. Groups included: Sham-operated, control (OVX), estrogen treated group (OVX+ E), E/P combination group (OVX+E/P) and G treated group (OVX+G). Treatments were applied for 8 weeks. The total anti-oxidant status (TAS), total oxidant status (TOS), nitric oxide level (NO), glutathione peroxidase activity (GSH-Px) and oxidative stress index (OSI) were analysed in the brain tissue of rats from each treatment category. RESULTS: Ovariectomy lead to an increase in brain TOS and OSI levels compared to the sham group (p < 0.05). Also, ovariectomy resulted in a decrease in brain TAS levels compared to the sham group that approached statistical significance (p = 0.078). Significant decreases in TOS, OSI, GSH-Px and a significant increases in TAS and NO levels were observed in the E-treatment group compared to the control group (p < 0.001). The E/P combination group exhibited a significantly decreased TOS and OSI and significantly increased TAS and NO levels relative to the control group (p < 0.05). Genistein treatment resulted in a significant decrease in TOS and OSI compared to the control group (p < 0.05). CONCLUSIONS: Oxidative stress markers increase in the brain tissue of OVX rats. Conversely, estradiol, E/P and G supplementation decreases oxidative stress markers and increases antioxidant activity. Using G may prevent neural pathologies result in menopause-related oxidative stress.

Which factors may influence the duration of misoprostol-induced abortion in the second trimester?

BACKGROUND: To investigate the factors that may affect the time interval between induction and fetal expulsion in misoprostol-induced termination of second trimester pregnancy. MATERIALS AND METHODS: A retrospective analysis of second-trimester pregnancies terminated in the second trimester between October 2008 and 2010 was performed. Induction was done by administration of 400 mcg intravaginal misoprostol. The correlation between the duration of abortion and maternal, fetal, and clinical features were statistically analyzed with multivariate regression analysis. RESULTS: One hundred and seventy-five singleton pregnancies that met the inclusion criteria were evaluated. The average gestational age at the first induction was 18.3 weeks. The mean time interval between the first induction and expulsion was 37.2 +/- 21.3 (range 3 to 160) hours. Fetal expulsion occurred significantly at a later gestational age and those with a higher blood glucose level at admission. However, no correlation could be established between the duration of abortion and the number of pregnancies, deliveries, age, hemoglobin levels or platelet count. CONCLUSIONS: Misoprostol is safe and effective in induction of abortion during second-trimester pregnancies. The induction-to-abortion interval is longer in patients with hyperglycemia and advanced gestational age. Prospective, randomized studies are necessary to better understand the factors influencing the duration of abortion.

CD34 expression of chorionic villous in pre-eclamptic placenta: an immunohistochemical and ultrastructural study.

In this study, pre-eclampsia, proteinuria, and edema associated with hypertension in pregnancy were assessed at the Dicle University School of Medicine Department of Obstetrics and Gynecology Clinic. One group included 20 pre-eclamptic pregnant women with gestational age 20-35 weeks of pregnancy and the same in the control group that included; however, 20 normotensive pregnant women. Histochemistry, immunohistochemistry, and electron microscopy techniques were used. Histopathological examination of syncytial nodes and stromal cells were observed in the increase in hyperplasia and hyalinization. The evaluation immunohistochemical of chorionic villi, placenta, and hematopoietic stem cell markers showed a positive reaction with CD34. Ultrastructural examination showed endoplasmic reticulum dilatation, degeneration of mitochondria in endothelial cells, and capillary vessel edema.

Association between mean platelet volume and different phases of menstrual cycle in primary dysmenorrhea.

PURPOSE: Blood cells play a major role in homeostasis and inflammation. Primary dysmenorrhea (PD) involves the production of prostaglandins and leukotrienes, which cause inflammation in uterine tissue. Aim of this study was to investigate whether there is a relation between complete blood count parameters and PD during the menstrual cycle. MATERIALS AND METHODS: The study included 41 cases diagnosed as primary dysmenorrhea (mean age, 23.02 +/- 3.43 years) and 40 individuals who control subject (mean age, 23.76 +/- 3.13 years). Hematologic parameters were measured on menstrual phase (day 1-4), follicular phase (day 9-12), and luteal phase (day 21-23) during menstrual cycle. RESULTS: There were no statistically differences between hematological parameters of two groups except for mean platelet volume (MPV). MPV of PD and control groups at each phase of menstrual cycle were 7.71 vs 8.61 (p = 0.01); 7.66 vs 8.56 (p = 0.005); 7.75 vs 8.53 (p = 0.01), respectively. CONCLUSION: PD is associated with decreased MPV and platelets may be involved in the inflammatory process of PD.

Unusual case of extraovarian granulosa cell tumor.

We present a case of adult type extraovarian granulosa cell tumor in 22 years old woman. The pelvic and radiographic examination revealed right adnexial solid mass in patient who complaining from menstrual disregulation and pelvic pain. The patient underwent exploratory laparotomy which showed pelvic mass adjacent urinary bladder and fixed to the behind of pubic bone at pre-peritoneal area.

Risk factors for maternal mortality in eclampsia: analysis of 167 eclamptic cases.

BACKGROUND: The aim of this study was to evaluate risk factors associated with maternal mortality in patients with eclampsia. METHODS: The probable risk factors of maternal mortality including maternal age, length of hospital stay, gestational age, systolic and diastolic blood pressures; hematocrit, hemoglobin, platelet count, levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase were determined from patients' charts and Odds ratios (OR) of these factors were detected using by logistic regression analysis. RESULTS: According to logistic regression model, AST [OR, (95% Confidence Interval, CI): 7.39 (2.71-20.13)]; ALT [6.45 (2.42-17.16)]; postpartum diastolic blood pressure [4.58 (1.80-11.62)]; hematocrit [3.52 (1.86-6.65)]; hemoglobin [2.67 (2.01-3.55)] were found to be significant risk factors for maternal mortality. CONCLUSIONS: In eclamptic patients, close monitoring of particular laboratory values and blood pressure, and early intervention to alterations of certain variables will provide possibility for prevention against potential complications and subsequently decreasing mortality.

Serum levels of neopterin, tumor necrosis factor-alpha and Interleukin-6 in preeclampsia: relationship with disease severity.

AIM: There are many studies evaluating the role of inflammation in the pathogenesis of preeclampsia. However, little is known about the relationship between the severity of inflammation and the severity of preeclampsia due to insufficient of studies reporting this matter. To investigate the maternal serum concentrations of IL-6, TNF-alpha and Neopterin in patients with mild preeclampsia and severe preeclampsia and HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome in preeclampsia and determine their association with the severity of the disease. PATIENTS AND METHODS: Patients, hospitalized with the diagnosis of preeclampsia between October 2011 and March 2012, were included in the study. The patients with preeclampsia were divided into three groups as mild preeclampsia, severe preeclampsia and HELLP syndrome. The control group was comprised of normotensive and uncomplicated pregnant women. The serum levels of IL-6, TNF-alpha and Neopterin (NEO) were determined, using enzyme-linked immunosorbent assay. Spearman's rank correlation tests were used for the correlations between the serum levels of inflammatory markers and the severity of preeclampsia. RESULTS: There was no observed significant difference among mean serum TNF-alpha and IL-6 levels of four groups (p > 0.05). The median serum concentration of NEO in subjects with mild preeclampsia of 14.1 nmol/L and severe preeclampsia of 14.8 nmol/L was significantly higher than that of 10.3 nmol/L in normotensive controls (p = 0.013; p = 0.000 respectively). In addition, the median serum concentration of NEO was detected to be highest in subjects with HELLP syndrome. The serum levels of NEO was well correlated with the severity of preeclampsia (r = 0.533, p = 0.000). CONCLUSIONS: The serum levels of NEO, an important marker of cellular immunity, associated with severity of disease in patients with preeclampsia.

The relationship between complete hydatidiform mole and serum Vitamin D level: a prospective case-control study.

OBJECTIVE: This study aimed to determine whether or not there was a relationship between complete hydatidiform mole (CHM) and serum Vitamin D level by comparing CHM patients with two control groups and to determine whether or not Vitamin D deficiency is a risk factor for CHM. PATIENTS AND METHODS: This prospective study included 30 patients diagnosed with CHM (case group), 30 patients in the first trimester of a healthy pregnancy (control group), and 30 healthy non-pregnant subjects (control group). A record was made of serum 25-hydroxyvitamin D (25-OH D vitamin) levels, age, body mass index (BMI), gravida, parity, and the number of abortus. The serum 25-OH D vitamin levels were examined in each group and compared between groups. RESULTS: The 25-OH D vitamin level of all the patients in the study was determined as 11.16±8.64 ng/mL. No significant difference was determined between the groups in respect of 25 OH-D vitamin levels. When comparisons were made between the four subgroups according to the 25-OH-D level, no significant difference was determined between the CHM and control groups. When the patients were separated as obese and non-obese groups, no significant difference was determined between the groups. CONCLUSIONS: Severe deficiency, deficiency, or insufficient levels of serum Vitamin D are not thought to be risk factors for CHM patients.

Evaluation of the relationship between preeclampsia and seropositivity of infectious disease in maternal plasma.

PURPOSE: The aim of the present study was to investigate the association between maternal infections and preeclampsia. MATERIALS AND METHODS: Fifty-four pregnant women with preeclampsia (study group) and 54 healthy pregnant women (control group) were enrolled in this study. Chlamydia pneumoniae (CP), Mycoplasma hominis (MH), Helicobacter pylori (HP), Cytomegalovirus (CMV), Herpes simplex virus type 2 (HSV-2), and Toxoplasma gondii (TG) antibodies were analyzed in the maternal plasma of all of the participants. RESULTS: There was no difference in the demographic data between groups. Maternal plasma seropositivity for CP IgM; MH IgA and IgG; HP IgM, IgA and IgG; TG, CMV and HSV-2 IgM and IgG were not significantly different between the preeclampsia and control groups. The seropositivity for CP IgG was significantly higher in women with preeclampsia versus the control women. CONCLUSIONS: Our results suggested that preeclampsia is associated with CP IgG seropositivity.