Frequency of a persistent yolk sac and its relationship with the gestational outcome.

OBJECTIVES: This study aimed to determine the frequency of a persistent yolk sac in pregnancies at 12 to 13 weeks and to investigate whether a persistent yolk sac is associated with an adverse gestational outcome. METHODS: This study reviewed a total of 282 women who had normal singleton pregnancies with a gestational age of 12 weeks to 13 weeks 6 days and who were consecutively admitted to the study center for first-trimester screening (for chromosomal abnormalities) between April 2010 and February 2011. A persistent yolk sac has been defined as a yolk sac that has achieved a diameter of 5.6 mm or greater without losing its internal pressure at the 12th week of pregnancy or later. RESULTS: A persistent yolk sac was detected by sonography in 25 pregnancies. The average diameter of the persistent yolk sacs ± SD was 6.3 ± 0.2 mm (range, 5.6-8.0 mm). The frequency of a persistent yolk sac in pregnancies at 12 weeks was significantly higher than that at 13 weeks (P = .017). A persistent yolk sac was not associated with adverse perinatal outcomes, including abnormal sonographic findings, isolated structural defects, poor obstetric outcomes, and perinatal mortality. CONCLUSIONS: Although yolk sacs mostly disappear toward the end of the first gestational trimester, they may sometimes persist even to the 13th week of gestation. The persistence of the yolk sac seems to be unrelated to an adverse perinatal outcome.

A systematic review: endometriosis presenting with ascites.

BACKGROUND: The present review aims to increase the awareness of the gynecologists by analyzing all the case reports which refer to endometriosis presenting either with only ascites or with massive ascites with pleural effusion. METHODS: To conduct the present review, the CENTRAL (in the Cochrane Library, current issue), MEDLINE (Silver Platter, from 1950 to 2010), and EMBASE (from 1950 to 2010) electronic databases were searched. As a result, all the publications based on the keywords relating to the review topic were acquired. RESULTS: Since the description of first case in 1954, endometriosis-related ascites was reported to occur in a total of 63 women who were aged between 19 and 51 years. Approximately 63.0% of the recruited women for whom ethnicity was specified were of African origin (29 out of 46). Of the 50 subjects with known obstetric history, 41 (82.0%) were nulliparous. Abdominal distention, anorexia/weight loss, abdominal pain, and menometrorrhagia were the most frequently encountered clinical symptoms, whereas pelvic mass was the most common physical finding. The serum concentrations of CA 125 were between 20 and 3,504 IU/ml for 19 women whose CA 125 levels were determined. Pleural effusion was also present in 38.1% of the reviewed subjects (24 out of 63). The clinical features of the women with endometriosis-related ascites and pleural effusion were similar to those of the women who had only endometriosis-related ascites. CONCLUSION: Endometriosis-related ascites and/or pleural effusion refers to extensive disease with a high risk for recurrence which usually affects non-Caucasian, nulliparous women of reproductive age and leads to clinical symptoms resembling those of an ovarian malignancy. Therefore, clinicians should consider endometriosis in differential diagnosis of pelvic masses and also include endometriosis in diagnostic workup of ascites or pleural effusion.

Unusual form of superficial spreading squamous cell carcinoma of cervix involving the endometrium, bilateral tubes and ovaries: a case report with literature review.

OBJECTIVE: Although the majority of metastatic ovarian tumors arise within the female genital tract, squamous cell carcinoma of the cervix is a rare form of metastases to the bilateral ovaries by endometrial and transtubal spreading. CASE: A 53-year-old woman was referred to the oncology clinic with postmenopausal bleeding. On vaginal examination, a 3 cm tumor arising from the cervix was inspected. Multiple cervical biopsies and endocervical curettage revealed large cell, non-keratinized squamous cell cervix carcinoma. Radical hysterectomy and bilateral salpingo-oophorectomy were performed. Bilateral pelvic and para-aortic lymph nodes were also removed. The final pathology report revealed endometrial, focal myometrial, bilateral tubal mucosal, fimbrial and bilateral ovarian squamous cell carcinoma involvement. Pelvic and para-aortic nodes were free from metastases. CONCLUSION: Although the incidence of ovarian metastases of adenocarcinoma of the cervix is significantly higher, squamous cell carcinoma may also metastasize to the ovaries by endometrial and transtubal spreading in the absence of lymph node involvement. Especially in young patients for whom preservation of the ovaries is supposed, gross intraoperative inspection of the radical hysterectomy specimen and endometrium should be done and ovaries should be evaluated carefully.

The significance of fetal sacral length in the ultrasonographic assessment of gestational age.

OBJECTIVE: The present study aims to establish a more sensitive nomogram of fetal sacral length measurements, as well as to specify the accuracy of fetal sacral length for the ultrasonographic assessment of gestational age. METHODS: The present study investigated a total of 2,184 pregnant women who were referred for routine pregnancy follow-up. All of the reviewed women had uncomplicated singleton pregnancies without known structural and chromosomal fetal anomalies. RESULTS: A statistically significant linear relationship was established between sacrum length and gestational age [gestational age = 4.49 + 0.92 × sacrum length (r = 0.98, R (2) = 0.96)]. The rate of increase in sacrum length of fetuses with a gestational age of < 28 weeks was formulated as [gestational age = -0.05 + 1.01 × sacrum length (r = 0.96, R (2) = 0.98)], while the same formula was [gestational age = -0.09 + 1.32 × sacrum length (r = 0.94, R (2) = 0.96)] for fetuses with a gestational age of ≥ 28 weeks. On the other hand, a statistically significant correlation was found to exist between biparietal diameter (r = 0.68, P = 0.001), head circumference (r = 0.590, P = 0.001), femur length (r = 0.719, P = 0.001) and sacrum length (r = 0.696, P = 0.001). However, the same statistically significant correlation exists between abdominal circumference and the other sonographic measurements (r = 0.223, P = 0.375). CONCLUSIONS: The fetal sacral length appears as an easily acquired and valuable parameter, which directly and strongly correlates with gestational age and other biometrical measurements. Therefore, fetal sacral length may be utilized as a complementary tool in both the evaluation of fetal growth and prediction of gestational age. Further research is required to determine the significance of fetal sacral length in prenatal follow-up.

The significance of fetal maxillary length in the first trimester screening for trisomy 21.

OBJECTIVE: The present study aims to specify the significance of fetal maxillary length by establishing a nomogram for a Turkish population and by investigating its relationship with the ultrasonographic and biochemical parameters which are commonly used to screen trisomy 21 in the first trimester of pregnancy. METHODS: The present observational study investigates 1,308 Turkish women who had 11- to 14-week-old singleton healthy pregnancies. Fetal crown-rump length (CRL), nuchal translucency (NT), nasal bone length (NBL) and maxillary length are measured by ultrasonography and maternal serum concentrations of pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (HCG) are determined. RESULTS: A positive and significant correlation was detected between the fetal maxillary length and gestational age (r = 0.309, P < 0.001) as was the case with fetal CRL (r = 0.357, P < 0.001) and NBL (r = 0.487, P < 0.001). Although there was a significant and positive correlation between fetal maxillary length and maternal serum PAPP-A levels (r = 0.201, P < 0.001), a significant and negative correlation was found between fetal maxillary length and the maternal serum concentrations of free beta-HCG (r = -0.238, P < 0.001). Fetal maxillary length increased in accordance with the advancing gestational age and increasing CRL. Maternal serum PAPP-A concentrations and fetal CRL and NBL were addressed as independent predictors of fetal maxillary length. CONCLUSIONS: The length of fetal maxillary bone is a promising biometrical parameter which can be reliably and efficiently used to screen trisomy 21 in first trimester. Fetal maxillary length is also found to correlate with gestational age, CRL, NBL and PAPP-A significantly. It would be rational to use a combination of nasal and maxillary bone length measurements in case serum concentrations of PAPP-A or beta-HCG cannot be assessed.

Fertility outcome after conservative surgery for borderline ovarian tumors: a single center experience.

OBJECTIVE: The present study aims to document the experience of a single center on the reproductive outcome of a cohort of women who were treated with conservative surgery for borderline ovarian tumors and to specify whether their fertility potential is associated with age, tumor histology and surgery type. METHODS: A total of 55 women who had undergone conservative surgery for borderline ovarian tumors between January 1999 and January 2009 were eligible. Recurrence rate, fertility outcome and the number of pregnancies were analyzed retrospectively. RESULTS: Among the study group, 11 women were not sexually active both at the time of surgery and during the follow-up period. Thus, a total of 44 patients attempted pregnancy after conservative surgery and 52.3% of them (23 out of 44) were able to conceive either spontaneously or by in vitro fertilization. The ability to conceive was shown to be associated with age, tumor histology and type of conservative surgery. As expected, the fertility potential correlated positively with decreasing age (correlation coefficient = 0.705, p = 0.001). Moreover, the existence of non-serous histology and the implementation of unilateral cystectomy were found to be associated with the ability to reach a clinical pregnancy (correlation coefficient = 0.585, p = 0.001 and correlation coefficient = 0.587, p = 0.001, respectively). CONCLUSIONS: The primary treatment of borderline ovarian tumors refers to conservative surgery. Younger age, non-serous histology and unilateral cystectomy appear to be associated with favorable reproductive outcome in women who undergo conservative surgery for borderline malignancy of ovary.

Vascular endothelial growth factor +405 C/G polymorphism is highly associated with an increased risk of endometriosis in Turkish women.

OBJECTIVE: Endometriosis is a chronic gynecological disease characterized by the growth of hormonally responsive, endometrial tissue outside the uterine cavity. The present study aims to analyze two vascular endothelial growth factor (VEGF) polymorphisms (-460 C/T and +405 C/G) in Turkish women with and without endometriosis. STUDY DESIGN: A case-control study was undertaken at the Infertility Department of Zekai Tahir Burak Women's Health Care Education and Research Hospital. The single nucleotide polymorphisms, -460 C/T and +405 C/G, in the 5'-untranslated region of the VEGF gene were tested in 98 affected women and 94 women with no laparoscopic evidence of disease. Endometriosis was also confirmed histologically. Following genomic extraction of genomic DNA, genotyping of the -460 C/T and +405 C/G polymorphisms of the VEGF gene were performed by polymerase chain reaction and restriction fragment length polymorphism assay. Nominal data were evaluated by Pearson Chi-square or Fisher's Exact test, where applicable. Odds ratios and 95% confidence intervals were also calculated. A P value less than 0.05 was considered statistically significant. RESULTS: Demographic data were similar among groups. The genotype and allele frequencies of the -460 C/T polymorphism did not differ significantly between cases and controls. In contrast, the genotype (P < 0.001) and allele frequencies (P < 0.001) of +405 C/G polymorphism showed a significant difference between cases and controls. Regardless of the early or advanced stage, women with endometriosis showed a higher incidence of the +405 GC genotype and +405G allele when compared with the controls. CONCLUSIONS: These data suggest that VEGF +405 GC genotype and +405G allele may be associated with the risk of developing early and advanced stage endometriosis in the Turkish population.

Complete lymph node dissection: is it essential for the treatment of borderline epithelial ovarian tumors?

OBJECTIVE: The present study aims to compare the clinical and reproductive outcomes of women who have undergone lymph node dissection with those who have not and to discuss the indications for retroperitoneal evaluation in the treatment of borderline ovarian tumors. METHODS: The present study investigated 123 women who were finally diagnosed with borderline epithelial ovarian tumors at the study center between January 1999 and January 2009. A total of 68 patients (55.3%) were found to have a complete surgical staging procedure. RESULTS: The patients who underwent complete lymph node dissection were significantly younger than those who did not have lymphadenectomy. Thus, the ratio of postmenopausal women was significantly higher among those in whom retroperitoneal evaluation was performed. As expected, the intraoperative blood loss was significantly more and the hospital stay was significantly longer in patients who underwent complete lymph node dissection. Also, the non-serous borderline ovarian tumors were significantly more frequent in the latter patient group. However, overall and disease-free survival spans were found to be statistically similar for both study groups as well as the recurrence rate. CONCLUSIONS: Retroperitoneal evaluation can be spared in every woman with borderline ovarian tumor unless she is to undergo complete surgical staging procedure because of high recurrence risk, advanced stage disease or personal choice.

Treatment of recurrent vulvar Paget disease with imiquimod cream: a case report and review of the literature.

INTRODUCTION: Extra-mammary Paget disease is one of the rare neoplastic conditions of the skin. The most common site of involvement is the vulva and presents itself with erythematous plaques. Surgery is the most important treatment option. In the recent years, there are publications of the topical use of imiquimod cream in extra-mammary cutaneous Paget disease. We report the case of a woman with recurrent vulvar Paget disease, who underwent successful treatment with imiquimod cream. We also review the reports of other patients with vulvar Paget disease who were treated with topical imiquimod cream. CASE REPORT: A 65-year-old woman presented to the Oncology Outpatient Clinic with an itchy lesion in her vulva for 2 years. In the gynecologic examination, a hyperkeratotic erythematous lesion was found starting from the right labium to involve clitoris, with a size of 4 × 3 cm. Pathology result was reported as Paget disease. She was operated and wide vulvar excision was performed with a safety margin of 2 cm. Then recurrence two times occurred. Because she refused surgery, imiquimod cream 5% was applied for treatment. CONCLUSION: Imiquimod cream is an effective and safe therapeutic agent for both primary and recurring vulvar Paget disease.

Serum concentrations of CA-125 in normal and preeclamptic pregnancies.

AIM: The present prospective study aims to investigate the serum concentrations of CA-125 in normal and preeclamptic pregnancies and thus to specify the clinical utility of this biochemical marker in prediction, diagnosis and follow up of preeclampsia. METHODS: The present study reviews a total of 242 women with singleton pregnancy. These participants were categorized into three groups: control (n = 100), mild preeclampsia (n = 78) and severe preeclampsia (n = 64). The three study groups were statistically similar in aspects of maternal age, gestational age and body mass index. RESULTS: Serum CA-125 concentrations were found to correlate positively with systolic blood pressure (r = 0.345, p = 0.001), diastolic blood pressure (r = 0.379, p = 0.001), platelet count (r = 0.368, p = 0.001), serum levels of uric acid (r = 0.415, p = 0.001) and urine concentrations of protein (r = 0.357, p = 0.001). On the other hand, CA-125 levels correlated negatively with estimated fetal weight (r = -0.451, p = 0.001) and birthweight (r = -0.363, p = 0.001). When the cut-off point for serum CA-125 concentrations was accepted as 50 IU/ml, the sensitivity and specificity of this biochemical marker were, respectively, 93.7 and 88.0% for the detection of preeclamptic pregnancies. On the other hand, positive and negative predictive values for CA-125 were computed as 91.7 and 90.7%, respectively ( χ (2) = 30,184, p = 0.001). CONCLUSION: The present study suggests that CA-125 is a biochemical marker which reflects the severity of the underlying inflammatory process in preeclampsia. Since it is much more available and relatively less expensive, it seems to be a promising test for screening preeclampsia. In accordance, the present study suggests 50 IU/ml as a cut-off point for CA-125 in screening preeclampsia.

Extraovarian conditions mimicking ovarian cancer: a single center experience of 15 years.

OBJECTIVE: This study aims to review cases of extra-ovarian conditions that resembled ovarian malignancy and thus, to evaluate the distribution of primary pathology mimicking ovarian malignancy. METHODS: A retrospective review of women, with final pathology of extra-ovarian diseases mimicking ovarian malignancy, which were managed at Zekai Tahir Burak Women's Health Education and Research Hospital, from January 1995 to April 2010 was undertaken. RESULTS: Among the 2,210 women treated during the study period, extra-ovarian diseases accounted for 5.11% (113/2,210) of all the cases. Of the 113 extra-ovarian diseases, 42 (37.17%) were peritoneal tuberculosis, 25 (22.13%) were gastrointestinal malignancies, 20 (17.70%) were pelvic abscess, 8 (7.08%) were pelvic echinococcosis, 8 (7.08) were schwannoma and other retroperitoneal tumors, 4 (3.53%) were malignant lymphoma, 2 (1.77%) were chronic ectopic pregnancy, gossypiboma, and mesenteric cyst, respectively. CONCLUSION: Medical awareness of infectious diseases such as peritoneal tuberculosis, pelvic abscess, and pelvic echinococcosis in the differential diagnosis of ovarian malignancy is still lacking, especially in developing countries. In addition, in case of a pelvic mass, gastrointestinal and retroperitoneal tumors and malignant lymphoma should always be considered to avoid pitfalls in diagnosis and therapy.

Atorvastatin causes regression of endometriotic implants in a rat model.

Endometriotic implants were induced surgically in female Wistar albino rats, which were randomly divided into three groups. The rats in group I (n=10) and group II (n=9) were given 2.5 mg/kg/day intraperitoneal and oral atorvastatin, respectively, for 28 days. Group III (n=9) was given no medication (control). The mean volume and weight of explants in group I were significantly lower (both P < 0.05) compared with group III. Histopathological score of the implants was significantly lower in groups I and II, when compared with group III (P < 0.01 and P < 0.05, respectively). There were significant reductions in explant concentrations of vascular endothelial growth factor and matrix metalloproteinase 9 in group I (P < 0.01 and P < 0.001, respectively) and group II (both P < 0.01) compared with group III while staining due to tissue inhibitor of metalloproteinase 2 was significantly higher in group I (P < 0.01) and group II (P < 0.01) compared with group III. Moreover, explant concentration of superoxide dismutase was significantly increased in groups I and II compared with group III (both P < 0.05). In conclusion, atorvastatin causes significant regression of endometriotic implants in rats. Moreover, intraperitoneal atorvastatin seems to be more effective than oral atorvastatin.

Cervical phosphorylated insulin-like growth factor binding protein-1 in prediction of preterm delivery.

BACKGROUND: The aim of this study was to evaluate the phosphorylated isoform of insulin-like growth factor binding protein-1 (phIGFBP-1) in endocervical secretions as a predictor of preterm delivery in symptomatic and asymptomatic pregnant women. METHODS: The study included 105 patients between 24 and 34 weeks' gestation with uterine contractions and 73 controls. Ph IGFBP-1 in cervical secretions was assessed in all patients by using a qualitative, immunochromatographic one-step dipstick test. Data analysis included Student's test, Chi-Square, Fisher's exact test and Kruskal Wallis variance analysis. RESULTS: Preterm birth rate was 19.04% (20/105) in the study group. Of the 25 patients with a positive phIGFBP-1 test, mean gestational age at delivery was 32.8+/-3.8, whereas of the 80 patients with a negative phIGFBP-1 test mean gestational age at delivery was 37.8+/-2.5, in the study group (P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value for phIGFBP-1 in symptomatic patients were 70, 87.05, 56 and 92.5%, respectively, while in asymptomatic patients they were 40, 82.35, 14.28 and 94.91%, respectively. CONCLUSIONS: The phIGFBP-1 in cervical secretions is a potential specific marker for preterm delivery occurring before 37 weeks. Also cervical detection of phIGFBP-1 by immunochromatography is a rapid and easily applicable test that highly predicts preterm delivery.

HPV types in Turkey: multicenter hospital based evaluation of 6388 patients in Turkish gynecologic oncology group centers.

OBJECTIVE: To evaluate the prevalence of HPV DNA and cervical cytological abnormalities, to compare cervical cytology results and HPV DNA and to define HPV types distribution in a large series of Turkish women who have undergone HPV analysis in hospitals that are members of the Turkish Gynecological Oncology Group. MATERIAL AND METHOD: Between 2006 and 2010, a total of 6388 patients' data was retrospectively evaluated at 12 healthcare centers in Turkey. Demographic characteristics, cervical cytology results, HPV status and types were compared. RESULTS: The mean age of the patients was 38.9±10.2. Overall, 25% of the women were found to be HPV positive. Presence of HPV-DNA among patients with abnormal and normal cytology was 52% and 27%, respectively. There was significant difference with respect to decades of life and HPV positivity (p < 0.05). HPV was positive in (within the HPV (+) patients) 37%, 9%, 27%, 20%, 22%, and 41% of the ASCUS, ASC-H, LSIL HSIL, glandular cell abnormalities, and SCC cases respectively The most common HPV types in our study were as follows; HPV 16 (32%), HPV 6 (17%), HPV 11 (9%), HPV 18 (8%), HPV 31 (6%), HPV 51 (5%), HPV 33 (3%). CONCLUSION: In this hospital based retrospective analysis, HPV genotypes in Turkish women with normal and abnormal cytology are similar to those reported from western countries. Further population based prospective multicenter studies are necessary to determine non-hospital based HPV prevalence in Turkish women.

Protective effect of caffeic acid phenethyl ester (CAPE) on ischemia­ reperfusion injury in rat ovary / Efecto protector de ester feniletílico de ácido cafeico (CAPE) en la lesión por isquemia-reperfusión en ovario de rata

The aim of this study was to investigate the effects of caffeic acid phenethyl ester (CAPE) as a prophylactic agent on ischemia/reperfusion (I/R) injury in the rat ovary. A total of 28 Wistar rats were divided into 4 equal groups: (I) sham, (II) ischemia, (III) ischemia + reperfusion, and (IV) IR + CAPE. In groups I and II, ovary torsion was not performed and no drug was administered. In group III, 1 hour of ischemia and 2 hours of reperfusion were performed and no drug was given. Ovarian tissue concentrations of malondialdehyde were significantly higher in the torsion and detorsion groups compared with the sham and Cape groups (P<0.005). The detorsion group showed preantral ovarian follicles and luteal folicules around the blood vessels and positive expression of CD34. In the CAPE group the stromal vascular endothelium with weak expression of CD34 was detected in small areas, and the ovarian follicles and the corpus luteum showed negative expression of CD34. In the study, Biochemical and histopathological results of CAPE treatment was considered to torsion-detorsioned the model showed a protective effect against tissue damage.

El objetivo de este trabajo consistió en investigar los efectos del éster fenetílico del ácido cafeico (EFAC) como agente profiláctico en la lesión por isquemia/reperfusión (I / R) en el ovario de rata. Un total de 28 ratas Wistar se dividieron en 4 grupos iguales: (I) control, (II) isquemia, (III) isquemia + reperfusión, y (IV) IR + EFAC. En los grupos I y II, no se realizó torsión ovárica y no se administró ningún fármaco. En el grupo III, se provocó una hora de isquemia, dos horas de reperfusión y no se administró ningún fármaco. Las concentraciones de malondialdehído en los tejidos ováricos fueron significativamente mayores en los grupos de torsión y de destorsión, en comparación con los grupos sham y de EFAC (P <0,005). El grupo de destorsión mostró folículos ováricos preantrales y folículos lúteos alrededor de los vasos sanguíneos y expresión positiva de CD34. En el grupo EFAC el endotelio vascular estromal con expresión débil de CD34 se detectó en áreas pequeñas, y los folículos ováricos y el cuerpo lúteo mostraron expresión negativa de CD34. En el estudio, fueron considerados los resultados bioquímicos e histopatológicos del tratamiento EFAC en relación a la torsión-destorsión, desarrollando un modelo que mostró un efecto protector contra el daño tisular.

Predictive power of activin A levels in the prognosis of first trimester in vitro fertilization pregnancies.

BACKGROUND: The present study aims to determine the predictive power of activin A levels in the prognosis of first trimester pregnancies conceived by in vitro fertilization (IVF). METHODS: The study cohort included 23 biochemical, and 23 normal ongoing pregnancies conceived via IVF. Serum ß-human chorionic gonadotropin (ß-hCG), progesterone, and activin A levels were assessed 14 days after embryo transfer. RESULTS: Serum activin A levels were significantly lower in biochemical pregnancies compared to normal ongoing pregnancies (0.57 vs. 0.81 ng/mL, p<0.001). The ability of activin A to predict normal ongoing pregnancies at a cutoff level of 0.695 ng/mL gave a sensitivity of 91.3%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 92%. Significant correlation was found between ß-hCG and progesterone, ß-hCG and activin A, and progesterone and activin A. Activin A, ß-hCG, and progesterone were all found to be efficacious in prediction of early IVF pregnancies. CONCLUSIONS: The present study indicates that single measurement of activin A can be suggested as a marker for the progress and outcome of early pregnancies conceived via IVF. However, further large-scale studies are required to determine the efficacy and reliability of activin A in prediction of early pregnancies achieved by assisted reproductive techniques (ART).

Randomized trial of vaginal prostaglandin E2 versus oxytocin for labor induction in term premature rupture of membranes.

OBJECTIVE: The aim of this study was to compare the efficacy and safety of a prostaglandin E(2) (PGE(2)) vaginal insert with those of oxytocin for labor induction. The present study also examined whether its use reduces the rate of cesarean delivery in term pregnancies with premature rupture of membranes (PROM) and low Bishop scores. MATERIALS AND METHODS: A total of 240 women with singleton pregnancies at >or= 37 weeks, no prior uterine scar, vertex presentations, reactive nonstress tests, PROM for >or= 12 hours and Bishop scores of

Primary malignant melanoma of the female genital tract.

OBJECTIVE: Malignant melanoma, which has a highly malignant potential, is a tumor of the skin and mucosal membranes. Malignant melanomas of the female genital tract, including the vulva and vagina, are rare. Their overall prognosis is poor and is worse than that for cutaneous melanomas. CASE REPORTS: Clinical data for five patients with primary malignant melanoma are presented. Diagnosis was based on histologic and immunohistochemical examinations. Case 1 was a 58-year-old woman with mucosal lentiginous melanoma of the vulva. The other four patients, all of whom were over 40 years old, had vaginal melanomas. They were all treated with surgery, and three also received postoperative adjuvant therapy with interferon alpha-2b. Despite this, three of the patients died owing to widespread disease. CONCLUSION: Although malignant melanoma of the female genital tract is uncommon, elderly women should undergo regular gynecologic examinations and suspicious pigmented lesions should be biopsied. The use of immunohistochemical assays could markedly improve diagnosis. However, the prognosis for these tumors is poor, regardless of the treatment delivered, and they are associated with a high rate of recurrence and low long-term survival. Surgery is the best available treatment for controlling and potentially curing malignant melanomas.

The effects of iloprost, a prostacyclin analogue, in experimental ischaemia/reperfusion injury in rat ovaries.

Ovarian torsion is a surgical emergency affecting not only the ipsilateral ovary but also contralateral ovary. Although the conventional treatment is salpingo-oophorectomy, recent studies advocate detorsion. We hypothesized that iloprost, an analogue of prostacyclin with cytoprotective properties, may prevent the harmful effects of ischaemia-reperfusion injury in bilateral ovaries after unilateral ovarian torsion-detorsion in rat. In this study, 24 female Wistar-albino female rats were divided into four groups. Ovarian torsion was produced by applying vascular clamps to right ovaries. In Group I, bilateral oophorectomy was performed. In group II, bilateral oophorectomy was performed after a unilateral torsion period of 4h. In group III, bilateral ovaries were removed, following unilateral torsion-detorsion periods each lasted for 4h. Saline was injected i.p. 30 min before detorsion. In group IV, same experimental protocol, which was conducted in group III, was repeated. Iloprost was injected i.p. 30 min before detorsion instead of saline in group IV. Tissue levels of malondialdehyde (MDA) and nitric oxide (NO), which are the indicators for oxidative stress were determined and histopathological evaluation was performed in bilateral ovaries in all groups. The MDA and NO levels for ipsilateral ovaries of four groups were compared and no significant difference was found (p>0.05). The same comparison were done for the contralateral sides and no difference was seen either (p>0.05). In histological examination, iloprost produced improvement in I/R-induced alterations in ipsilateral and contralateral ovaries. In conclusion, these results showed that iloprost has beneficial effect on the histological appearances in both the ipsilateral and contralateral rat ovaries after unilateral torsion-detorsion.