Effect of pomegranate extract on vagina, skeleton, metabolic and endocrine profiles in an ovariectomized rat model.

AIM: Many women need estrogen therapy because of menopausal complaints. It is suggested that pomegranate plant has estrogenic effect. Aim of the study was to examine the effects of pomegranate seed extract on menopausal changes. METHODS: This study was conducted in an experimental environment with 23 Wistar Albino genus female rats. Sixteen rats were divided into two groups after ovariectomy. One group (SG) was fed with standard food and the pomegranate extract was added to drinking water of the other group (PG). Seven rats were identified as the sham group for the detection of basal values. At the end of 90 days, follicle stimulating hormone (FSH), estradiol, total cholesterol, high-density lipoprotein cholesterol (HDL)-cholesterol, low-density lipoprotein cholesterol (LDL)-cholesterol, triglyceride, tibial bone cortex thickness and vaginal epithelium thickness of the groups were compared. RESULTS: FSH, total-cholesterol and HDL-cholesterol levels were similar among the three groups (P > 0.05), while others were different (P < 0.05). In binary comparisons (PG vs SG), estradiol level (average ± standard deviation [SD]: 252 ± 43 vs 154 ± 26 pg/mL), tibial bone cortex thickness (58 ± 7 vs 40 ± 2 µm) and vaginal epithelium thickness (21 ± 7 vs 10 ± 4 µm) were significantly higher in PG. In PG, triglyceride levels (103 ± 26 vs 87 ± 41 mg/dL) were higher and LDL-cholesterol levels were lower (20 ± 8 vs 27 ± 8 mg/dL), but these differences were not significant. CONCLUSION: In rats fed with pomegranate extract, estradiol levels increased and tibial bone cortex thickness and vaginal epithelium thickness also increased. Pomegranate itself or its formulation extracts may be a support or an alternative to the main treatment modalities in the preservation of bone density and the treatment of vaginal epithelial atrophy.

Diagnostic value of signal peptide-CUB-EGF domain-containing protein 1 as an early and late biochemical marker in the ovarian torsion rat model.

AIMS: Signal peptide-CUB-EGF (epidermal growth factor-like protein) domain-containing protein 1 (SCUBE1) is an experimental marker of ischemia that has been previously studied both in rat models and humans. In this study, we aim to investigate the importance of SCUBE1 levels in ovarian torsion using an ovarian torsion model in rats. METHODS: A total of 18 Sprague-Dawley rats were equally divided into three groups. Group 1 (n = 6) was the Sham group and was only given a laparotomy procedure. Group 2 (n = 6) underwent bilateral ovarian torsion and ovarian ischemia lasting 8 h. Group 3 (n = 6) was subjected to bilateral ovarian torsion and ischemia lasting 24 h. Blood samples were collected from all three groups after the operations, and SCUBE1 levels were studied. Ovarian samples were collected, and microscopic evaluation was performed. The correlation of SCUBE1 levels and histopathological findings were investigated. RESULTS: The mean SCUBE1 level of group 3 was statistically higher than other groups (P < 0.01). Follicular degeneration and infiltration of inflammatory cells were, respectively, statistically significant in groups 2 and 3 (P = 0.002 and P = 0.045, respectively). CONCLUSION: SCUBE1 can be useful in diagnosing ovarian torsion during the first 24 h, but more randomized controlled studies are necessary in order to implement it in clinical settings.

The Role of Ischemia Modified Albumin and D-dimer as Early or Late Biochemical Markers in Ovarian Torsion.

OBJECTIVE: Our aim was to examine the potential roles of ischemia modified albumin(IMA) and D-dimer as reliable early diagnostic markers of ovarian torsion. MATERIALS AND METHODS: 24 Wistar albino rats were included and randomized into three groups. Control (sham) rats underwent laparotomy then bilateral ovaries removed for histopathological examination and concomitant blood sampling for IMA and D-dimer assays after 4 h. In the remaining groups, ovarian ischemia was achieved by rotating bilateral ovaries 1080° clockwise then blood samples were obtained and ovaries were removed after 4 h and 24 h. IMA and D-dimer levels as well as the histopathological injury scores were assessed in all groups. RESULTS: A statistically higher significant difference in D-dimer levels in the 4-h torsion group (Group 2) than the other groups (P = 0.001, P < 0.01). Despite absence of statistical significance, the difference in IMA levels between the groups was close to statistical significance (P = 0.064; P > 0.05); accordingly IMA levels were higher in the 24-h torsion group (Group 3), than in 4-h torsion (Group 2) or sham (Group 1) group. CONCLUSION: Our results suggest that D-dimer may represent a valuable acute marker of ovarian torsion. The cut-off value for D-dimer was 402 ng/ml. Although rats in Group3 had higher IMA than in other groups, the difference was only close to statistical significance. Also, increasing duration of torsion was associated with reduced D-dimer levels, while IMA levels exhibited an increase during the 24 h period. In contrast with previous studies, IMA appeared to be a potential marker in the long term rather than the short term.

Agreement between colposcopy results using the Reid Colposcopic Index and histopathology.

OBJECTIVES: The aim of the study was to evaluate the diagnostic efficacy of colposcopy and to determine the strength of correlation between colposcopic impression using the Reid Colposcopic Index (RCI) and histopathology MATERIAL AND METHODS: This was a prospective cross-sectional study carried out at the colposcopy clinic of Bakirköy Dr Sadi Konuk Education and Research Hospital, Department of Obstetrics and Gynecology, between June 2011 and September 2011. A total of 105 women who met the selection criteria were included in the study. All women underwent colposcopy and the final diagnosis was made using RCI. Colposcopy-guided biopsy was obtained from the abnormal areas. In cases when colposcopy did not reveal any lesion, a four-quadrant biopsy from the squamocolumnar junction was taken, which served as the gold standard. RESULTS: According to the Reid scoring system, there were 60% of benign cases, whereas 27.6%, 5.7%, and 6.7% of the women were diagnosed with CIN 1, CIN 2, CIN 3, respectively As far as histologic results were concerned, 62.9% of the subjects were benign, whereas 25.7%, 3.8%, and 7.6% of the patients were diagnosed with CIN 1, CIN 2, CIN 3, respectively. The correlation between the Reid scoring system and histologic results was statistically significant (p > 0.05). CONCLUSIONS: The correlation between colposcopic lesions graded with RCI and histology was strong, particularly in women who had HGSIL on a Pap smear. Good correlation between colposcopic imaging using RCI and histopathology makes it a reproducible technique, easy to implement in colposcopy clinics.

Variant type of leiomyomas: 13 years of experience in a single institution.

OBJECTIVES: Our understanding of a variant type of leiomyoma lags far behind of leiomyoma/leiomyosarcoma of the uterus. The rarity of variant type leiomyomas limits epidemiologic study, evidence-based guidance for diagnosis and treatment. We aimed to analyze clinical, pathologic and radiological features of variant type of leiomyomas in women who underwent surgical therapy for symptomatic disease in a tertiary center. We furthermore intended to put forth the recurrence patterns of variant type of leiomyoma after uterine-conserving therapies. MATERIAL AND METHODS: Pathology results and inpatient files of women undergoing surgery (vaginal or abdominal hysterectomy; total abdominal hysterectomy and bilateral salphingoopherectomy; abdominal myomectomy; polipectomy) for symptomatic disease and with a histologic diagnosis of variant type of leiomyoma were assessed. Patient gravida, parity, menopausal status, patient complaint, type of initial surgical procedure, size of neoplasms, number of mitosis, presence of atypia, and necrosis, MRI evaluation, recurrence and any subsequent therapy were documented. RESULTS: A total of 3275 patients' medical records were evaluated between 2005-2018. The study sample comprised of 185 women with a diagnosis of variant type of leiomyoma. The patients ranged from 23 to 79 years of age. One hundred thirty-five cases were postmenopausal and 50 cases were during the reproductive period. The most common presenting symptom was menometrorrhagia (38.9%). Four point nine percent of cellular leiomyoma, 14.2% of smooth muscle tumors of uncertain malignant potential (STUMP) and 4.7% of atypical leiomyomas were recurred with clinical follow-up. CONCLUSIONS: Clinicians should be aware of variant type leiomyomas and their associated clinical, imaging, and pathologic issues.

The comparison of two methods in cervical smear screening - which method is better for smear adequacy rates?

OBJECTIVES: In the cervical smear screening test as a sample collection method for liquid-based thin layer cytology, classically the collecting device is placed into a liquid fixative solution and vigorously swirled or rotated ten times in the solution and the collection device is removed from the solution. In this study, a plastic smear brush was used as the collection device. After the cervical cell sample was obtained, the smear brush was detached from the stick and left in the solution and given to the laboratory. Our aim in the study is to examine whether smear inadequacy rates have decreased with the method used in the study compared to the classical method. MATERIAL AND METHODS: While the classical technique which the collecting device is placed into a solution and mixed and removed from the solution is defined as Method 1. The technique used in the study was defined as Method 2. The cervical smear screening test results obtained by two different methods in two consecutive time periods were analyzed. The two methods were compared using chi-square test in terms of smear inadequacy. RESULTS: A total of 2129 test results, including 1129 smears in Method 1 and 1000 smears in Method 2 were examined. The mean ages of the patients tested in both methods were similar (36 ± 6.1 and 37 ± 6.7). Abnormal test result rate was similar for Method 1 and Method 2 (5.8% vs 4.9%, respectively). The inadequate sample rate was higher in Method 1 than Method 2 (8.3% vs 2.1%, respectively). CONCLUSIONS: The study showed that leaving the smear brush in the solution is a better way to reduce the inadequacy sample rates. This result may guide clinicians about smear techniques.

Predictive Value of Hematological Inflammatory Markers in Endometrial Neoplasia

Objective: To investigate the predictive role of neutrophil lymphocyte ratio (NLR) and the platelet lymphocyte ratio (PLR) as hematological inflammatory markers in cases of endometrial hyperplasia and cancer. Material and Method: This retrospective study was performed between 2005-2015 with 247 cases of 83 endometrial adenocarcinoma (group 1), 64 of endometrial hyperplasia (group 2) and 100 controls (group 3) who underwent a curettage due to abnormal uterine bleeding and had a normal histopathology in our tertiary clinic. The cases were chosen from patients without chronic diseases, that do not have infection or medication that could affect the systemic inflammatory response. Preintervention blood parameters were taken into account. The neutrophil/ lymphocyte and platelet/lymphocyte ratios were and statistical comparisons of the groups were conducted. Results: The age distribution of 247 patients was between 26 and 85 years, and the mean age was 48.8 ± 8.92.The median age was 54 in group 1, 46 in group 2 and 45 in group 3. The age was significant between group 1 and the other groups (p=0.001). Some 71% of the cases were premenopausal and 29% were postmenopausal, the latter being significantly more frequent in group 1 (62.7%; p=0.001). Of the cases with endometrial hyperplasia, 42 (65.6%) had simple and 22 (34.4%) have atypical-complex lesions. The median NLRs in groups 1, 2, and 3 were 2.15, 2.10, and 1.92, respectively, with median PLRs of 135.1, 134.0 and 145.6. There was a statistically significant difference between the NLR measurements of the cases from different groups (p=0.048; p<0.05). The NLR value for the endometrial adenocarcinoma group was significantly higher than for the control group (p=0.033; p<0.05). The optimum cut-off value was calculated to be ≥4, at which sensitivity was 20.5%, specificity 99%, positive predictive value (PPV) 94.4% and negative predictive value (NPV) 60%. Conclusion: The value of NLR ≥4 has predictive significance in distinguishing endometrial pathologies before intervention in patients with abnormal uterine bleeding. Simple, cheap and easy-to-perform, the NLR can be used as a potential hematological marker for endometrial malignancy.

Surgical management of squamous cell vulvar cancer without clitoris, urethra or anus involvement.

Vulvar cancers, which constitute 5% of all gynecologic cancers, are the fourth most common female genital cancers, preceded by uterine, ovarian and cervical cancers. The treatment methods employed for vulvar cancers have changed over the years, with previously applied radical surgical approaches, such as en bloc resection, being gradually suspended in favor of treatment approaches that require dissection of less tissue. While the removal of less tissue, which today's approaches have focused on, prevents morbidity, this method seems to result in higher risks of recurrence. It is therefore important that the balance between preventing the recurrence of the disease and forefending against postoperative complications and vulvar deformity be properly understood. As a working assumption, if patients with vulvar cancer are diagnosed at an early stage, properly evaluated and administered appropriate treatment, the most positive results can be obtained. This paper aims to highlight this assumption and demonstrate, through the provision of actual data, how to plan the treatment approach for patients who are diagnosed early. Statements extracted from the National Comprehensive Cancer Network (NCCN) Guidelines Version 1.2016 Sub-Committees on vulvar squamous cell carcinoma and articles by the European Society of Gynaecological Oncology (ESGO) regarding Vulvar Cancer Recommendations were used to obtain updated information.

Benign Pulmonary Metastasizing Leiomyoma of the Uterus.

Benign Metastasizing Leiomyoma (BML) is a rare disease which represents with multiple leiomyomatous lesions in many tissues and organs especially in lungs. These patients have been operated for leiomyoma of the uterus. Here we report a case of a 41-year-old woman who was evaluated in a thoracic surgery hospital for dyspnea and bilateral nodules in chest roentgenogram. She had no history of neoplasm, only myomectomy history of uterine leiomyoma 10 years ago. Biopsy and histopathological examination were consistent with pulmonary leiomyoma. The patient was reffered to our clinic and we performed a total abdominal hysterectomy for her multiple uterine leiomyomas. The final diagnosis was 'benign pulmonary metastasizing leiomyoma'. After this diagnosis, surgical castration was performed but two years later, repeat imaging showed progression in pulmonary lesions and progesterone therapy was administered to the patient. Patient has continued on this hormonal therapy to date and during the 5-years follow-up, the persisting lesions in both lungs regressed.