Expression of laminin-1 and matrix metalloproteinase-9 in benign and malignant endometrium.

BACKGROUND: Laminin-1 and matrix metalloproteinase (MMP)-9 may play roles in the progression from benign to malignant endometrium, so we aimed to investigate their levels of expression in these tissues. METHODS: This case-control study was conducted at a tertiary care center between January 2014 and December 2016. Paraffin blocks of 50 specimens of benign endometrium with proliferative (n = 20), secretory (n = 11), and atrophic (n = 5) endometrium; simple endometrial hyperplasia without atypia (n = 12); and endometrial polyp (n = 2) histology and 49 specimens of malignant endometrium with endometrioid (n = 40), serous (n = 7), clear cell (n = 1), and undifferentiated (n = 1) types were immunostained with laminin-1 and MMP-9 antibodies and assessed for basement membrane continuity for laminin-1 and the percentage and intensity of MMP-9 expression in epithelial cytoplasm. RESULTS: : Laminin-1 continuity in the basement membrane was higher in benign (92%) compared to malignant (16.3%) endometrium (p < 0.0001) without any difference between the subgroups within each group (p > 0.05). All atrophic endometria and endometrial polyps and 23.5% of low grade endometrioid and none of the other endometrial cancers showed uninterrupted basement membrane staining with laminin-1. All cases in malignant endometrium expressed MMP-9 with either low or high immunoreactivity while none of the cases in benign endometrium showed a high staining with MMP-9 (p < 0.01). Proliferative and hyperplastic endometrium together with grade 1 endometrioid cancer expressed MMP-9 better than the atrophic endometrium (p < 0.05). The immunoreactivity with MMP-9 increased gradually from secretory to hyperplastic endometrium and serous carcinoma (p < 0.05). MMP-9 expression in all types of cancers except grade 1 endometrioid and clear cell compared to proliferative endometrium was significantly higher (p < 0.05) and increased from proliferative to grade 2 endometrioid, grade 3 endometrioid, serous and undifferentiated endometrial carcinoma. DISCUSSION: Gradual increments in MMP-9 expression and basement membrane laminin-1 discontinuity may indicate progression from normal to hyperplastic and to low- and high-grade cancerous endometrium.

Use of in vitro assays to assess the potential cytotoxic, genotoxic and antigenotoxic effects of vanillic and cinnamic acid.

Vanillic acid (VA) found in vanilla and cinnamic acid (CA) the precursor of flavonoids and found in cinnamon oil, are natural plant phenolic acids which are secondary aromatic plant products suggested to possess many physiological and pharmacological functions. In vitro and in vivo experiments have shown that phenolic acids exhibit powerful effects on biological responses by scavenging free radicals and eliciting antioxidant capacity. In the present study, we investigated the antioxidant capacity of VA and CA by the trolox equivalent antioxidant capacity (TEAC) assay, cytotoxicity by neutral red uptake (NRU) assay in Chinese Hamster Ovary (CHO) cells and also the genotoxic and antigenotoxic effects of these phenolic acids using the cytokinesis-blocked micronucleus (CBMN) and the alkaline comet assays in human peripheral blood lymphocytes. At all tested concentrations, VA (0.17-67.2 µg/ml) showed antioxidant activity but CA (0.15-59.2 µg/ml) did not show antioxidant activity against 2,2-azino-bis (3-ethylbenz-thiazoline-6-sulphonic acid) (ABTS). VA (0.84, 4.2, 8.4, 16.8, 84 and 168 µg/ml) and CA (0.74, 3.7, 7.4, 14.8, 74, 148 µg/ml) did not have cytotoxic and genotoxic effects alone at the studied concentrations as compared with the controls. Both VA and CA seem to decrease DNA damage induced by H2O2 in human lymphocytes.

Plasma total oxidant and antioxidant status after oral glucose tolerance and mixed meal tests in patients with polycystic ovary syndrome.

PURPOSE: Insulin resistance (IR) and increased oxidative stress (OS) are the characteristics of polycystic ovary syndrome (PCOS). In this study, we aimed to evaluate the effects of oral glucose tolerance (OGTT) and mixed meal tests (MMT) on plasma total oxidant (TOS) and total antioxidant status (TAS) in patients with PCOS and the relationship between these parameters and IR, calculated via homeostasis of model assessment-IR (HOMA-IR) and Matsuda's insulin sensitivity index (ISI) derived from OGTT and MMT. METHODS: Twenty-two patients with PCOS, and age- and body mass index (BMI)-matched 20 women as controls were enrolled into the study. Five-hour OGTT and MMT were performed on different days, and before and after these tests, plasma TOS and TAS levels were investigated. IR was calculated with HOMA-IR and Matsuda's ISI. RESULTS: HOMA-IR levels were higher in patients with PCOS, compared to controls, while Matsuda's ISI derived from OGTT and MMT was higher in controls. Plasma TOS levels before OGTT and MMT were higher in patients with PCOS than controls, while TAS levels were similar. After OGTT, plasma TOS levels became decreased at 5th hour, when compared to baseline values in PCOS group. Likewise, the same decrement was found in controls, but the decrement was not significant. After OGTT and MMT at 5th hour, no changes were observed in TAS levels, compared to baseline. CONCLUSION: Matsuda's ISIs derived from OGTT and MMT can be used instead of each other, and interestingly, we found a decrease in TOS levels after OGTT in patients with PCOS.

Analgesia and respiratory function after laparoscopic cholecystectomy in patients receiving ultrasound-guided bilateral oblique subcostal transversus abdominis plane block: a randomized double-blind study.

BACKGROUND: Transversus abdominis plane (TAP) block has been shown to ameliorate postoperative pain after abdominal surgery. Postoperative pain-associated respiratory compromise has been the subject of several studies. Herein, we evaluate the effect of oblique subcostal TAP (OSTAP) block on postoperative pain and respiratory functions during the first 24 postoperative hours. MATERIAL/METHODS: In this double-blind, randomized study, 76 patients undergoing laparoscopic cholecystectomy were assigned to either the OSTAP group (n=38) or control group (n=38). Bilateral ultrasound-guided OSTAP blocks were performed with 20 ml 0.25% bupivacaine after induction of general anesthesia. Both the OSTAP and control groups were treated with paracetamol, tenoxicam, and tramadol as required for postoperative analgesia. Visual Analog Scale (VAS) pain scores (while moving and at rest), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR), arterial blood gas variables, and opioid consumption were assessed during first 24 h. RESULTS: VAS pain scores at rest and while moving were significantly lower in the OSTAP group on arrival to PACU and at 2 h postoperatively. The total postoperative tramadol requirement was significantly reduced at 0-2 h and 2-24 h in the OSTAP group. Postoperative deterioration in FEV1 and FVC was significantly less in the OSTAP group when compared to the control group (P<0.01 and P<0.05, respectively). There were no between-group differences in arterial blood gas variables. CONCLUSIONS: After laparoscopic cholecystectomy, OSTAP block can provide significant improvement in respiratory function and better pain relief with lower opioid requirement.

Controversial clinical practices for patients with preeclampsia or HELLP syndrome: a survey.

BACKGROUND: Considerable controversy continues to surround the management of severe preeclampsia and HELLP syndrome. Experts, researchers, and those published in the field were surveyed about their specific practices. MATERIALS AND METHODS: An extensive literature search was undertaken to identify the cohort of authors with recent publications on the subjects of preeclampsia (2009-2012) and HELLP syndrome (2005-2012). Online surveys were sent to all authors using the email addresses found in their publications. RESULTS: Surveys were delivered by email to 363 authors of preeclampsia publications and 91 authors of HELLP syndrome publications. Completed surveys were received from 61 (13.4%) of the group. Except for consensus about the indication of corticosteroids for the enhancement of fetal lung maturation, there was considerable variation in corticosteroid practice and anesthesia techniques. CONCLUSIONS: A marked diversity in practice characterized the clinical care rendered by experts in the field of preeclampsia and HELLP syndrome. Thus, there is an urgent need for well-designed and executed prospective clinical trials to improve the evidence for best consensus practice in this area of obstetrical medicine.

Usefulness of admission gamma-glutamyltransferase level for predicting new-onset heart failure in patients with acute coronary syndrome with left ventricular systolic dysfunction.

OBJECTIVES: Our aim was to determine whether there is a relationship between admission gamma-glutamyltransferase (GGT) and subsequent heart failure hospitalizations in patients with acute coronary syndrome. STUDY DESIGN: We selected 123 patients with newly diagnosed acute coronary syndrome of ejection fraction (EF) <45%. Patients were followed 15±10 months, and the relationship between admission GGT level and hospitalization because of heart failure during the follow-up was examined. RESULTS: Twenty-three (18.7%) patients were hospitalized during the follow-up of 15±10 months. Receiver operating characteristic (ROC) curve analysis showed that the cut-off point of admission GGT related to predict hospitalization was 49 IU/L, with a sensitivity of 81.7% and specificity of 65.2%. Increased GGT >49 IU/L on admission, presence of hypertension and hyperlipidemia, left ventricular ejection fraction (LVEF), right ventricular dysfunction, moderate-to-severe mitral regurgitation, alanine aminotransferase level, and antiplatelet agent usage were found to have prognostic significance in univariate Cox proportional hazards analysis. In multivariate Cox proportional-hazards model, increased GGT >49 IU/L on admission (hazard ratio [HR] 2.663, p=0.047), presence of hypertension (HR 4.107, p=0.007), and LVEF (HR 0.911, p=0.002) were found to be independent factors to predict new-onset heart failure requiring hospitalization. CONCLUSION: Hospitalization in heart failure was associated with increased admission GGT levels. Increased admission GGT level in acute coronary syndrome with heart failure should be monitored closely and treated aggressively.

Chorionic villus sampling and the risk of preeclampsia: a systematic review and meta-analysis.

OBJECTIVE: To perform systematic review and meta-analysis to evaluate the risk of preeclampsia after chorionic villus sampling (CVS). DATA SOURCES: A systematic search of PubMED and Web of Science from inception through August 2010, and bibliographies of review articles and eligible studies were performed. METHODS OF STUDY SELECTION: Six studies reported the risk of preeclampsia after CVS. All of the identified studies were retrospective and included in analysis. TABULATION, INTEGRATION, AND RESULTS: Reporting quality of the identified studies according to quality assessment scale for methodology in retrospective clinical reporting was moderate. Pooling was performed in two strata for control: (1) patients without any invasive prenatal diagnostic procedure served as control group: no significant difference was found in the odds ratio (OR) of preeclampsia (OR 0.79, 95% CI 0.38-1.64), severe preeclampsia (OR 0.49, 95% CI 0.04-5.78), gestational hypertension (OR 0.76, 95% CI 0.46-1.26), all pregnancy-induced hypertensive disorders (OR 0.80, 95% CI 0.46-1.41) between CVS and control groups. (2) Patients with amniocentesis combined with patients without any invasive prenatal diagnostic procedure served as control group: no significant difference was found in the OR of preeclampsia (OR 0.76, 95% CI 0.37-1.53), severe preeclampsia (OR 0.83, 95% CI 0.14-4.85), all pregnancy-induced hypertensive disorders (OR 0.92, 95% CI 0.55-1.53) between CVS and combined control groups. CONCLUSION: None of the included studies were randomized prospective trials designed to investigate the effect of CVS on preeclampsia. Accordingly, this review is limited by the heterogeneity, small number and retrospective nature of the available studies. CVS does not seem to increase the risk of preeclampsia or other pregnancy-induced hypertensive disorders. However, randomized prospective trials that are designed to investigate the risk of preeclampsia after CVS are needed to make a definite conclusion.

Effects of oxidized regenerated methylcellulose on lymphocyst formation and peritoneum in gynecologic cancer patients.

HYPOTHESIS: The role of oxidized regenerated methylcellulose (ORC) in the lymphocyst formation after systematic lymphadenectomy. METHODS AND STUDY DESIGN: This was a retrospective case-control study. Patients with gynecologic cancer who underwent systematic lymphadenectomy from May 2000 to April 2006 were considered. Retroperitoneal "no closure" method was performed in all patients. Two groups were identified according to ORC use. The lymphocysts were evaluated via ultrasonography/computed tomography/magnetic resonance imaging between the third and sixth months after surgery. RESULTS: The overall lymphocyst incidence was found to be 75 (29.8%) of 252, and lymphocyst incidence in the ORC and control groups was 45 (30%) of 150 and 30 (29.4%) of 102, respectively. The mean (SD) total number of extracted lymph nodes in the ORC group was 27.5 (10.6), which was significantly higher than that in the control group (22.1 [10.8]; P = 0.001). Duration of drain was significantly longer in the ORC group (P = 0.028). However, when confounding variables were included into the binary logistic regression analysis for the prediction of the duration of drains, only the stage of disease predicted the duration of drains. CONCLUSIONS: Use of ORC does not seem to affect lymphocyst formation. Oxidized regenerated methylcellulose use does not affect the duration of drains, hence ORC does not seem to pose a stimulatory effect on the peritoneum.

Prenatal diagnosis of Jarcho-Levin syndrome in combination with inguinoscrotal hernia.

Jarcho-Levin syndrome is characterized by short trunk dwarfism associated with rib and vertebral anomalies. The syndrome encompasses a group of disorders with phenotypic and inheritance variations. Here we report a prenatally diagnosed patient with spondylocostal dysostosis (SCD) with accompanying congenital inguinoscrotal hernia. A 28-year-old pregnant women, gravida 4, para 3, was referred to our clinic with a diagnosis of wedging of fetal thoracal vertebra and kyphoscoliosis at 28 weeks of gestation. Upon evaluation, fetal vertebral wedging and kyphoscoliosis were confirmed with the addition of thoracic circumference below 3rd percentile, short thorax length, and mild pyelectasis. During follow-up, in utero inguinoscrotal hernia developed. Prenatal diagnosis of SCD is important to provide appropriate genetic counseling and to have an adequate setting for the delivery of the fetus.

Spinal balloon nucleoplasty: a hypothetical minimally invasive treatment for herniated nucleus pulposus.

Low back pain is the most common cause of disability under the age of 45. The annual incidence of back pain is estimated to be 5% and the lifetime prevalence is 80%. Majority of the patients with persistent symptoms are suffering from radiculopathy that is mainly caused by a herniated nucleus pulposus (HNP). HNP can heal spontaneously due to spontaneous resorption. Besides pressure nucleus pulposus, without any compression, may induce similar changes when applied epidurally to the nerve roots. Nevertheless, combination of chronic mechanical compression and application of nucleus pulposus causes a more pronounced nerve injury. When dual pathophysiology (pressure and inflammatory reaction), spontaneous resorption, and natural course of HNP are taken into account, any treatment modality that eliminates both the pressure and contact of the nucleus pulposus with the nerve root via creating extra time for healing to take place might prove beneficial. These requirements can be provided by spinal balloon nucleoplasty (SBN), which can be used in combination with other treatment modalities such as chymopapain injection. In this hypothetical method, epidural access to the subarachnoid space is established via epidural needles, thereafter a specially designed balloon tipped catheter is advanced. When the catheter is ideally placed with the help of CT or MRI, the balloon at the tip is inflated to relieve pressure and to prevent contact of the nerve root with HNP. The answer to the question, will SBN find a place in clinical practice? is obscure. But a homology can be established with uterine fibroid embolization, which has found clinical use in a period of 30 years approximately.

Prenatally diagnosed lethal type Larsen-like syndrome associated with bifid tongue.

Larsen syndrome is characterized by multiple joint dislocations, associated with a typical facial appearance and frequently other abnormalities. Both dominant and recessive patterns of inheritance have been reported. A lethal form of Larsen syndrome (Larsen-like syndrome) has been described as a combination of the Larsen phenotype and pulmonary hypoplasia. In this report, we present a 24-week-old female fetus with a possible prenatal diagnosis of thanatophoric dysplasia in whom postmortem examination revealed lethal type Larsen-like syndrome associated with bifid tongue, severe micrognathia and non-immune hydrops fetalis. These findings have not been reported previously in the lethal type Larsen syndrome.

Ascites is the primary cause of cancer antigen-125 (CA-125) elevation in systemic lupus erythematosus (SLE) patients with nephrotic syndrome.

Tumor markers or tumor antigens are used for the monitoring of the response to treatment, follow-up, and potentially for diagnosis and screening. However, use of CA-125 serum assay as a single diagnostic tool is restricted by the fact that it is also produced by normal epithelia, not only by the ovarian cancer cells. Systemic lupus eryhtematosus (SLE) and related systemic autoimmune syndromes are associated with elevation of CA-125. In this group of patients antigen elevation had been tried to be linked with SLE disease activity. Although not found to be related with the disease activity, CA-125 serum levels were found to be related with the presence of nephrotic syndrome in the English literature. Although particularly important, the presence of ascites was not taken into consideration during the statistical analysis of the relationship between CA-125 elevation and nephrotic syndrome in SLE patients. However most of the SLE patients with nephrotic syndrome would have had accompanying ascites secondary to protein loss. Ascites itself could induce elevation in CA-125 serum levels. With this in mind we can hypothesize that the development of ascites was the primary cause for the elevation of CA-125 in SLE patients with nephrotic syndrome rather than the nephrotic syndrome itself. Probably the presence of ascites was the cause of observed relationship. Most likely ascites was a confounding variable biasing the results and statistical analysis. Failure to control for the presence of confounding variables such as ascites might lead to bias in all clinical trials. Otherwise a causative role for nephrotic syndrome in the elevation of serum CA-125 level seems somewhat inconsequential.

A case of acromegaly in pregnancy: concomitant transsphenoidal adenomectomy and cesarean section.

The case of a 32-year-old woman at 29 weeks gestational age with acromegaly initially diagnosed in pregnancy is presented. During follow-up at 34 weeks of gestation, concomitant emergency cesarean section and transsphenoidal surgery were performed because of advancing vision loss. In tertiary centers, success in pregnancy can be made possible for a patient with acromegaly under the constant supervision of an obstetrician and neurosurgeon.

Effect of chorionic villus sampling on the occurrence of preeclampsia and gestational hypertension: An updated systematic review and meta-analysis.

OBJECTIVE: To perform a meta-analysis for an assessment of the risk of preeclampsia or gestational hypertension following chorionic villus sampling (CVS). DATA SOURCE: PubMed was systematically searched from its inception through January 2016. MATERIAL AND METHODS: Nine reports were identified. A pre-specified scale was used to assess their quality. TABULATION INTEGRATION AND RESULTS: We performed pooling into three subgroups with respect to the control group: A) Patients with no invasive prenatal diagnostic procedure served as a control group for comparison. The odds ratios for gestational hypertension (0.76, 95% CI 0.46-1.26), preeclampsia (0.83, 95% CI 0.42-1.67), and severe preeclampsia (0.49, 95% CI 0.04-5.78) or when hypertension categories were pooled (0.80, 95% CI 0.46-1.41) were not significantly different. B) Patients with midtrimester diagnostic amniocentesis and patients with no invasive prenatal diagnostic procedure were combined as a control group for comparison. The odds ratios for preeclampsia (1, 95% CI 0.46-2.18), severe preeclampsia (0.83, 95% CI 0.14-4.85), and pooled hypertension categories (1.07, 95% CI 0.63-1.84) were not significantly different. C) Patients with midtrimester diagnostic amniocentesis served as a control group. There was a significant difference in the odds ratio for preeclampsia between the CVS and amniocentesis groups (2.47, 95% CI 1.14-5.33). There was a marginal difference in the odds ratio for combined pregnancy-induced hypertension categories between the CVS and amniocentesis groups (1.61, 95% CI 1.02-2.53). CONCLUSION: The available data do not indicate an increased risk of preeclampsia or gestational hypertension following first trimester CVS. The heterogeneity and retrospective design of existing studies are limiting factors for our analysis and findings.

Simple handling of venous air embolism during abdominal myomectomy.

We report a case of venous air embolism during abdominal myomectomy. Although true incidence of venous air embolism is not known, in literature most of reported cases are belongs to sitting position craniotomies. Many of those are subclinical, and diagnostic methods have varying degrees of sensitivity and specificity. At time of suspicion, prevention of any subsequent air emboli is the cornerstone of treatment.

Anesthetic practices for patients with preeclampsia or HELLP syndrome: A survey.

OBJECTIVE: Substantial controversy exists regarding anesthetic management for patients with preeclampsia or hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. Experts, researchers, clinicians, and residents in Turkey were surveyed about their practices. MATERIAL AND METHODS: Questionnaires were distributed to attendees at a national conference, and they were filled out immediately. Anonymous 10-item paper surveys were administered to both residents and non-residents. Descriptive statistics were used in the analysis. Agreement among ≥75% of the respondents was considered a majority opinion. Surveys with missing responses were used to analyze the non-response bias. The Chi-square test was used for comparisons. A historical cohort of obstetricians-gynecologists was used for comparison with anesthesiologists. RESULTS: Of 339 surveys distributed, 288 were returned (84.9% response rate). Among the returned surveys, the completion rate was 96.1%. The job experience in years among clinicians and residents was 9±5 and 3±1, respectively. General anesthesia was still significantly preferred by 36.1% among patients with preeclampsia with platelet counts of ≥100,000/µL. Compared to obstetricians-gynecologists, anesthesiologists more often preferred general anesthesia. With platelet counts of <50,000/µL or eclampsia, most respondents preferred general anesthesia 94.4% for very low platelets and 89.5% for eclampsia. CONCLUSION: A preferential trend toward general anesthesia for patients with preeclampsia or HELLP syndrome exists among anesthesiologists in Turkey, particularly for patients with severe thrombocytopenia and/or eclampsia. There exists a need for well-designed and well-executed prospective clinical trials to provide evidence for the best consensus practice.