The association between ischaemia-modified albumin levels in umbilical vein and intrauterine growth restriction.

Intrauterine growth restriction (IUGR) is one of the most common problems in obstetrics. Ischaemia-modified albumin (IMA), a product deriving from albumin as a result of the modification by oxidative free radicals in response to hypoxia, was previously used as a marker of ischaemia in acute coronary syndrome. We performed this study to determine whether umbilical venous IMA levels are associated with IUGR. A total of 40 pregnancies with IUGR were compared with 40 of normal fetal development. Blood samples were obtained from the umbilical vein after delivery. IMA levels in the IUGR group were higher than in the control group (78.74 ± 6.87 vs 74.43 ± 7.84 U/ml, respectively, p = 0.011). An elevated IMA level was associated with IUGR (OR: 1.079, 95% CI: 1.000-1.163, p = 0.049). We suggest that IMA, which was formerly proved to arise in ischaemic conditions, may also be a valuable marker in perinatal hypoxia and IUGR detection.

Dilatation of the cervix at non-labour caesarean section: Does it improve the patients' perception of pain post-operatively?

Our aim was to determine the effect of cervical dilatation at non-labour caesarean section on post-operative pain and maternal morbidity. This prospective, randomised, single-blinded trial was conducted from March 2013 to February 2014. In all, 199 patients were enrolled in the study: 102 in non-dilated group and 97 in cervical dilatation group. Based on Visual Analogue Scale, there were no significant differences between the two groups on post-operative 8th, 24th and 48th hour pain scores. We observed thinner endometrial cavity thickness, shorter operation time and shorter hospitalisation duration in cervical dilatation group. However, change in haemoglobin concentrations and puerperal fever rates were found to be comparable between the groups. In conclusion, intra-operative cervical dilatation does not seem to benefit in terms of post-operative pain, change in haemoglobin concentrations or puerperal fever.

Essure microinsert hysteroscopic tubal sterilization: eight-years follow-up results.

OBJECTIVES: To evaluate the effectiveness and reliability of microinsert hysteroscopic sterilization method at short- and long-term. MATERIALS AND METHODS: In the period between January 2004 and December 2005, 34 patients who submitted to the present gynecology outpatient clinic seeking for permanent contraception and accepted tubal sterilization with microinsert method were included in this prospective, interventional study. RESULTS: Bilateral microinsert placement was successful in 28 (87.5%) of 32 patients that underwent the procedure. In all of the 30 patients (100%) in whom the placement procedure was attempted, bilateral tubal occlusion was documented by hysterosalpingogram (HSG) including the two patients in whom unilateral placement was carried out. First three procedures were performed under general anesthesia. Local or general anesthesia was not administered in any other cases (97.5%). The mean visual analogue scale score for pain felt during the procedure was 3.1. The mean procedure time was 11.5 ± 4.88 (5-22) minutes, the average time from beginning the procedure to discharge of the patients was 41.7 ± 18.5 (15-94) minutes. One intrauterine pregnancy was detected in one of the patients nine months after cessation of the alternative contraceptive period. This patient was excluded from the follow-up. At short-term all patients rated their microinsert-wearing tolerance as good or excellent. At eighth year, three patients were lost to follow-up. Mean follow-up time was 83.4 ± 15.0 (36-103) months. During 2,420 woman-months of follow-up, no other pregnancies were detected. Almost all of the patients were happy with the procedure and recommended it to a friend. CONCLUSION: Essure microinsert is a safe, effective, minimally invasive sterilization method which can be performed in outpatient settings without any anesthesia requirement. It appears to be a good alternative to laparoscopic tubal sterilization. The procedure time and the time to discharge are brief. Patient tolerance during the procedure and at long-term is very good.

Borderline epithelial ovarian tumors: a single center experience.

AIM: To evaluate the clinical outcomes of the patients treated for borderline ovarian tumor (BOT). MATERIALS AND METHODS: In this retrospective study, records of the patients between November 2001 and December 2012 who underwent surgery and whose final pathological diagnosis were BOT were retrieved. RESULTS: During the study period, 78 patients were diagnosed as BOT. The patho- logical diagnoses of the tumors were serous in 26 (33.3%) and mucinous in 52 patients (66.6 %), respectively. Accuracy of frozen section diagnosis was observed in 63 of 89 patients (70.7%). Sixty-eight women (87.1%) underwent complete staging procedure. According to final pathological diagnoses, Stage IA, IB, and IC were found in 52 (67%), five (6.5%), and seven (9%) patients, respectively. FIGO Stages IIC and IIIC were found in one case in each (1.25%). Remaining 12 patients were classified as unstaged (15%). The median follow-up time was 63 months. The authors observed only one recurrence (1.3%) and that patient died of disease. CONCLUSION: The survival rate in patients with BOTs confined to the ovary is excellent. Surgical staging procedure can be omitted in the patients with grossly apparent Stage I mucinous tumors.

Clinical analysis of emergency peripartum hysterectomies in a tertiary center.

OBJECTIVE: To investigate the incidence, indications, complications, and risk factors associated with increased mortality and morbidity of emergency peripartum hysterectomy (EPH). MATERIALS AND METHODS: The authors retrospectively analyzed 48 cases of EPH performed within six-year interval at Ondokuz Mayis University Hospital. EPH was defined as the operation performed for life-threatening hemorrhage which could not be controlled with conservative treatment modalities within 24 hours of a delivery. RESULTS: The incidence of EPH was 5.03 per 1,000 deliveries. The most common indication for EPH was abnormal placental adherence (n = 22, 45.8%), followed by uter- ine atony (n = 19, 39.6%). All the patients with placenta accreta had a history of repeat cesarian section (CS) and placenta previa.Total hysterectomy was performed in almost all of the patients (n = 47, 97.9%). All women required blood transfusions. Maternal morbidity was significant, with bladder injury (31.3%) and disseminated intravascular coagulation (18.7%) among the most common complications. There were one maternal (2.1%) and five neonatal deaths (10.4%). CONCLUSION: Since most of the EPH cases are associated with prior cesarean delivery, decision of the first CS should be made for true obstetrical indications.If conservative treatments fail to control massive obstetrical bleeding, blood products and an experienced obstetrician should be ready to perform EPH to decrease the maternal mor- bidity and mortality.

Primary carcinoma of the neovagina: a case report.

We present a case of squamous cell carcinoma arising in the neovagina of a woman in whom we performed vaginoplasty 20 years before. To the best of our knowledge, this is the 23rd case of total carcinoma arising in the neovagina constructed because of vaginal agenesis, and the 3nd case of carcinoma arising in the neovagina performed without using a graft.

Topical testosterone versus clobetasol for vulvar lichen sclerosus.

OBJECTIVE: To compare the effects of topical testosterone and clobetasol treatments on symptoms remission and recurrence rates in patients with vulvar lichen sclerosus (LS). METHODS: A retrospective review of the records showed that, of 140 patients with biopsy-proven vulvar LS, 80 were treated with applications of testosterone propionate 2% in petrolatum and 60 with clobetasol 17-propionate 0.05%. RESULTS: The response rates after 6 months were 77.5% for patients treated with testosterone and 91.7% for those treated with clobetasol (P=0.02). The recurrence rates were 20% and 6.7% in the 2 groups, respectively (P=0.02). Premenopausal patients had higher remission rates and lower recurrence rates than postmenopausal patients (P>0.05). Considering whole patients, low remission rates and high recurrence rates were observed in patients who had had a hysterectomy (P>0.05). CONCLUSION: Treatment of LS with a corticosteroid provided excellent remission rates. In this study, clobetasol 17-propionate 0.05% was superior to testosterone for both remission induction and maintenance therapy.

Medical treatment of vulvar squamous cell hyperplasia.

OBJECTIVE: To evaluate symptomatic response and recurrence rates of graduated topical fluorinated corticosteroid in patients with vulvar squamous cell hyperplasia. METHODS: Nine hundred seventy-six patients with biopsy-proven vulvar squamous cell hyperplasia from 1990 to 2003 were reviewed in this retrospective study. All patients were treated with graduated topical fluorinated corticosteroid. Data were obtained from hospital records. Symptomatic remission and recurrence rates were noted following six months local therapy. RESULTS: The mean age was 42.55+/-10.93 (15-85). The remission rate was 93.8% in six months. The remission rate was non-significantly higher in postmenopausal patients than that in their premenopausal counterpart (94.9% vs 93.0%, p=0.15). The disease recurred in 6.9% of patients. Of the patients that suffered recurrence 47.5% had persistent disease initially. The patients with following factors older ages (>40 years), postmenopausal period had significantly higher recurrence rates. Four patients with recurrent disease and six patients with persistent disease in the form of vulvar intraepithelial neoplasia I-II or atypical squamous hyperplasia, were treated with skinning vulvectomy. CONCLUSION: Corticosteroid in the treatment of vulvar squamous cell hyperplasia yielded excellent response rates. In the evaluation of patients without symptomatic relief, the first step should be a vulvar biopsy to exclude the presence of atypical components.

Glucocorticoid effects on angiogenesis are associated with mTOR pathway activity.

Glucocorticoids (GC) often are administered during pregnancy, but despite their widespread use in clinical practice, it remains uncertain how GC exposure affects pro-angiogenic factors and their receptors. We investigated the effects of GC on vascular endothelial growth factor (VEGF), placental growth factor (PIGF), vascular endothelial growth factor receptor 1 (VEGFR1) and vascular endothelial growth factor receptor 2 (VEGFR2) protein and mRNA expressions and investigated the possible association of GC with the Akt/mTOR pathway. We incubated human umbilical vein endothelial cells (HUVECs) with a synthetic GC, triamcinolone acetonide (TA). TA administration caused decreased cellular and soluble VEGF and VEGFR1 protein expressions and increased soluble VEGFR2 expression. VEGF, VEGFR1 and VEGFR2 mRNA expressions were altered in a time and dose dependent manner. PIGF protein expression was unaffected by TA treatment, but PIGF mRNA expression decreased in a dose dependent manner after incubation for 48 and 72 h. Phospho-mTOR and phospho-Akt expressions were unaffected. Phospho-p70S6K and phospho-4EBP1 protein expressions and the vascular network forming capacity of HUVECs decreased in a dose dependent manner. We found that GC exert detrimental effects on angiogenesis by altering cellular and soluble angiogenic protein and mRNA levels, and vascular network forming capacities by the Akt/mTOR pathway.

The role of cytoreductive surgery in nongenital cancers metastatic to the ovaries.

OBJECTIVE: To investigate the role of cytoreductive surgery in patients with nongenital cancers metastatic to the ovaries. PATIENTS AND METHODS: One hundred and fifty-four patients with nongenital cancers metastatic to the ovaries treated in Hacettepe University Hospital, Gynecologic Oncology Unit between 1982 and 2004 years were retrospectively evaluated. Data were obtained from patients' records and pathology reports. Demographic characteristics, prognostic factors, 5-year and median survivals were analyzed in all patients. RESULTS: During study period, nongenital cancers metastatic to the ovaries constituted 9% of all malignant ovarian neoplasms. Primary cancers were breast (35), stomach (35) and colorectal (33) cancers, lymphoma (17), undetermined origin (16), appendix (7), ileum (4), pancreas (3), gallbladder cancer (2) and mesothelioma (2). Of patients, 67% were premenopausal and 33% were postmenopausal. Although most common presenting symptoms were abdominal distension with dyspeptic complaints in 46%, abdominal mass in 22%, and pressure symptoms in 8.4%, 15 patients (10%) were asymptomatic and were diagnosed in routine control examinations. Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO), omentectomy, and bilateral pelvic and para-aortic lymphadenectomy (BP-PALND) with cytoreduction were performed in 102 patients (66%), TAH + BSO + omentectomy in 21 patients (14%), TAH + BSO in 23 patients (15%), minimal surgical effort including BSO or biopsy in 8 patients (5%). Eighty-four percent of patients received adjuvant treatment according to the primary origins. Mean follow-up was 47.3 +/- 5.9 months. Overall, 5-year survival was 36% and median survival was 42 months. Comparison of median survival times for the primary sites showed a significant overall differences (P = 0.0001) and were as follows: breast 54 months, stomach 18 months, colorectal 48 months, lymphoma 181 months, unknown primary 16 months, appendix 18 months, ileum 40 months, pancreas 3 months, gallbladder 8 months and mesothelioma 20 months. Median survival time of patients who underwent cytoreductive surgery was 48 months, compared with 26 months for patients with suboptimal cytoreductive surgery (P = 0.0039). The 5-year survival rate was 47% and 23%, respectively. Multivariate analysis identified age, menopausal status, primary site, diffuse peritoneal involvement and type of operation as prognostic factors. CONCLUSION: Presence of ovarian metastasis is associated with a poor prognosis in nongenital cancers. Surgery is essential for diagnosis of primary tumor and necessary for relief of symptoms. Cytoreductive surgery seems to have a beneficial effect on survival of selected patients, especially for patients with colorectal cancer metastatic to the ovary.