Netrina-1 en sangre como biomarcador para la detección del cáncer de endometrio / Serum Netrin-1 as a biomarker for Endometrium Cancer detection

RESUMEN Investigar la relación de la netrina-1 preoperatoria con factores clinicopatológicos y pronósticos importantes y los niveles de corte adecuados en pacientes con cáncer de endometrio. En este estudio prospectivo y observacional, el grupo de casos y el de controles se seleccionaron entre las pacientes que acudieron a la Clínica de Oncología Ginecológica. Se extrajeron 4 mL de sangre venosa en un tubo de bioquímica de cada paciente durante el período preoperatorio. Los valores de netrina para predecir la presencia de malignidad se analizaron mediante el análisis de la curva ROC (receiver operating characteristics). El valor de corte se calculó según el índice de Youden. En el estudio, el valor de corte de malignidad según el nivel de netrina fue determinado en 645,50 mg/dL en el análisis ROC (utilizando el índice de Youden). La probabilidad de malignidad en individuos con valores de netrina superiores a este punto de corte fue del 78,2% (IC 95%: 0,680 a 0,884). La sensibilidad de la netrina para mostrar la probabilidad de malignidad en este valor de corte fue del 87,5% y la especificidad del 63,6%. La netrina-1 puede ser un biomarcador potencial para la detección del cáncer de endometrio y la evaluación de su pronóstico.

ABSTRACT To investigate the relationship of preoperative netrin-1 with important clinicopathological and prognostic factors and appropriate cut-off levels in patients with endometrial cancer. In this prospective, observational study, the case and control group were selected among patients who applied to the Gynecological Oncology Clinic. Four mL of venous blood was drawn into a biochemistry tube from each patient during the preoperative period. Netrin values in predicting the presence of malignity were analyzed using ROC (receiver operating characteristics) curve analysis. The cut-off value was calculated according to the Youden index. In the study, the cut-off value of malignancy according to the netrin level was determined as 645.50 mg/dL in the ROC analysis (using the Youden index). The probability of malignancy in individuals with Netrin values above this cut-off was 78.2% (95% CI 0.680-0.884). The sensitivity of netrin in showing the probability of malignancy at this cut-off value was 87.5%, and the specificity 63.6%. Netrin-1 can be a potential biomarker for endometrial cancer detection and prognosis evaluation.

Does hypericin boost the efficacy of high-power laser? A preliminary experimental study on rats / A hipericina aumenta a eficácia do laser de alta potência? Um estudo preliminar e experimental em ratos

CONTEXT AND OBJECTIVE: Lasers are widely used in treating symptomatic benign prostatic hyperplasia. In current practice, potassium titanyl phosphate (KTP) lasers are the most common type of laser systems used. The aim here was to evaluate the rapid effect of high-power laser systems after application of hypericin. DESIGN AND SETTING: Experimental animal study conducted in the Department of Urology, Gülhane Military Medical Academy, Ankara, Turkey, in 2012. METHODS: Sixteen rats were randomized into four groups: 120 W KTP laser + hypericin; 120 W KTP laser alone; 80 W KTP laser + hypericin; and 80 W KTP laser alone. Hypericin was given intraperitoneally two hours prior to laser applications. The laser incisions were made through the quadriceps muscle of the rats. The depth and the width of the laser incisions were evaluated histologically and recorded. RESULTS: To standardize the effects of the laser, we used the ratio of depth to width. These new values showed us the depth of the laser application per unit width. The new values acquired were evaluated statistically. Mean depth/width values were 231.6, 173.6, 214.1 and 178.9 in groups 1, 2, 3 and 4, respectively. The most notable result was that higher degrees of tissue penetration were achieved in the groups with hypericin (P < 0.05). CONCLUSIONS: The encouraging results from our preliminary study demonstrated that hypericin may improve the effects of KTP laser applications. .

CONTEXTO E OBJETIVO: Lasers são amplamente utilizados no tratamento de hiperplasia benigna de próstata sintomática. Na prática atual, lasers de fosfato de titanilo de potássio (KTP) são os tipos mais comuns usados dos sistemas. O objetivo foi avaliar o efeito rápido do sistema laser de alta potência após a aplicação de hipericina. TIPO DE ESTUDO E LOCAL: Estudo experimental animal, realizado no Departamento de Urologia, Academia de Medicina Militar de Gülhane, Ancara, Turquia, em 2012. MÉTODOS: 16 ratos foram divididos aleatoriamente em 4 grupos: 120W KTP laser + hipericina; 120W KTP laser somente; 80W KTP laser + hipericina; 80W KTP laser somente. Hipericina foi dada intraperitonealmente duas horas antes da aplicação do laser. As incisões a laser foram feitas através do músculo quadríceps dos ratos. A profundidade e a largura das incisões a laser foram avaliadas histologicamente e registradas. RESULTADOS: Para padronizar o efeito do laser foi utilizada a razão entre profundidade e largura. Estes novos valores nos mostraram a profundidade da aplicação do laser de largura por unidade. Os novos valores adquiridos foram avaliados estatisticamente. Os valores da média de profundidade/largura foram 231,6, 173,6, 214,1 e 178,9 nos grupos 1, 2, 3 e 4, respectivamente. O resultado mais notável foi atingir altos graus de penetração tecidual nos grupos com hipericina (P < 0,05). CONCLUSÕES: Os resultados promissores do nosso estudo preliminar mostraram que hipericina pode melhorar os efeitos das aplicações do laser KTP. .

Investigation of the efficacy of transobturator tape (TOT) surgery in stress urinary incontinence.

OBJECTIVE: To evaluate the safety and efficacy of transobturator vaginal tape (TOT) in the management women with stress urinary incontinence (SUI) and to analyze functional results and subjective cure rates at follow- up visits. METHODS: Eighty-three consecutive women with SUI underwent TOT procedure. Data related to operative time, pre- and post-operative complications were collected. Subjective cure was defined as the absence of any urine loss on physical activity. RESULTS: Mean age of the patients was 53.2 years, and 66.3% of the patients had pure SUI. The mean operative time was 24.96 min in cases of isolated SUI treatment. The mean hospital stay was 1.53±0.68 days. At a mean follow-up of 32.8 months, the median subjective cure rate was 68.7 percent. Bladder injury (8.4%) was the only short and long term complication of this procedure. CONCLUSION: TOT is a safe and effective procedure for SUI with a low rate of long- term complications. The short -term complication like bladder perforation may develop based on the experience of the surgeons or concomitant pelvic surgery.

Comparison of success rates of 'transvaginal aspiration and tetracycline sclerotherapy' versus 'only aspiration' in the management of non-neoplastic ovarian cysts.

AIM: To investigate the value of tetracycline sclerotherapy for management of recurrent or persisting non-neoplastic ovarian cysts in comparison to the aspiration without sclerotherapy. MATERIAL AND METHODS: Ninety-six patients with proven non-neoplastic ovarian cysts were randomized into two groups. Group 1 patients underwent cyst aspiration together with tetracycline sclerotherapy (n=48). Group 2 patients underwent only cyst aspiration without tetracycline sclerotherapy (n=48). Then, all patients were followed up monthly with ultrasonography for 12months. The procedure was considered to have failed if the recurring cyst, detected by ultrasound, was 4cm in size or greater. RESULTS: There were no differences between the two groups regarding demographic data, initial cyst volume and tumor markers. Recurrence rates within 12months were 14.6% in group 1 and 50% in group 2 (P<0.001). CONCLUSION: Based on the recurrence rates, we suggest transvaginal aspiration together with tetracycline sclerotherapy rather than only simple transvaginal aspiration in the management of non-neoplastic ovarian cysts.

Analgesic efficacy of forced coughing versus local anesthesia during cervical punch biopsy.

BACKGROUND/AIMS: To compare local anesthesia and forced coughing in terms of subjective pain perception during cervical punch biopsy. METHODS: In this randomized controlled trial, 114 patients (mean age: 38.9 ± 9.0 years) scheduled for colposcopically directed cervical punch biopsy were randomly assigned to local anesthesia (n = 39), forced coughing (n = 39) and control (n = 36) groups. Pain perception was measured on a 10-cm visual analog scale (VAS) during the insertion of the speculum, injection of the local anesthetic to the cervix and the taking of the first cervical biopsy, as well as for the overall pain perceived during the entire procedure. RESULTS: Experimental groups were similar in age, gravidity, parity and prior curettage. The pain score obtained during the first cervical biopsy was significantly lower if local anesthesia was applied (p = 0.016). Groups were similar in other pain subscores. The duration of the entire procedure was significantly longer (p < 0.001) in the local anesthesia group, while it was not significantly different in forced coughing patients compared to controls. CONCLUSION: Local anesthesia, but not forced coughing, provides significant pain relief during cervical biopsy. Based on similarity to control data in terms of pain relief and shortening of the operation, forced coughing per se seems related neither to pain relief nor a faster cervical biopsy.

Comparing the effects of intrauterine progestin system and oral progestin on health-related quality of life and Kupperman index in hormone replacement therapy.

AIM: The aim of this study was to compare the effects of intrauterine-system-releasing 20 µg daily of levonorgestrel (LNG IUS) plus 1 mg 17 beta-estradiol daily, orally with combined oral pill containing 1 mg 17 beta-estradiol/2 mg drospirenone daily as hormone replacement therapy, on health-related quality of life (HRQoL) and climacteric symptoms in postmenopausal women. MATERIALS AND METHODS: A 6-month prospective clinical trial was conducted at the Department of Obstetrics and Gynecology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey. Ninety postmenopausal women were accepted to be part of the study. The Euro Quality of Life-5 Dimensions (EQ-5D) and Euro Quality of Life Visual Analogue Scale (EQ VAS) indexes for HRQoL and Kupperman indexes were compared between two groups of patients. RESULTS: Kupperman indexes of both treatment groups decreased gradually over 6 months, but indexes decreased significantly more in the group with intrauterine-system-releasing 20 µg daily of levonorgestrel. Elevations were observed in EQ-5D indexes and VAS values of both groups. EQ VAS values significantly increased in the group on intrauterine progestogen system. Similar changes were observed in the EQ-5D indexes of both groups. CONCLUSION: A hormone replacement therapy regimen that includes an intrauterine progestin system decreased climacteric symptoms and increased HRQoL in postmenopausal women during a follow-up period of 6 months. The extent of the relief of symptoms was greater in this group than in women receiving oral combined hormone replacement therapy. It seems therefore that the intrauterine progestin system could represent a method of choice for endometrial suppression in women using estrogen replacement therapy with distinct advantages over systemically administered progestogens, which have been the subject of considerable debate as reported in the recent literature.

Cervical polyps: evaluation of routine removal and need for accompanying D&C.

OBJECTIVE: To estimate prevalence of malignancy and dysplasia in cervical polyps and to judge whether cervical polyps need to be removed routinely. Also to investigate if a cervical polyp is an indicator of endometrial pathology and to assess the necessity of performing dilatation and curettage (D&C). MATERIALS AND METHODS: We retrospectively reviewed hospital records of 4,063 cervical polyp cases. Patients' age, menopausal status and pathological findings were recorded. Descriptive statistics, Pearson's χ(2), Fisher's exact test were used for statistical analysis. P value of ≤ 0.05 was accepted significant. RESULTS: Among 4,063 cervical polyps, only 3 (0.1%) cases of malignancy were encountered which were metastasis from endometrium. There were also dysplastic (0.4%), metaplastic (2.1%), inflammatory (1%) changes. Accompanying endometrial pathologies were: endometrial cancer (0.3%), hyperplasia without atypia (1.3%), endometrial polyp (6.6%). There was statistically significant relation between menopausal status and malignancy of cervical polyps (P = 0.055) malignancy of endometrial cavity (P = 0.0001). CONCLUSION: Routine removal of cervical polyps, although not mandatory, seems clinically prudent because pathological evaluation is needed to confirm the diagnosis and to rule out other possibilities. 10.9% of postmenopausal patients and 7.8% of premenopausal patients were diagnosed with any endometrial pathology accompanying cervical polyp. Therefore, cervical polyps can be a sign of endometrial disease, especially in postmenopausal women with cervical polyp endometrium should be evaluated more carefully.

Raloxifene: is it really effective on mood changes in postmenopausal osteopenic women?

OBJECTIVE: To investigate the effect of raloxifene therapy on menopausal symptoms, depression and anxiety scores using Kupperman's Scale, Hamilton Depression Rating Scale (HDRS) and Beck Anxiety Rating Scale (BARS) in osteopenic postmenopausal women. METHODS: This was a prospective, randomised, parallel and open labeled clinical study. One-hundred thirty-two postmenopausal osteopenic women with natural menopause enrolled into the study. One-hundred twenty-four of them completed the study. Group I patients were treated with oral raloxifene (60 mg/day), Group II patients were treated with oral calcium supplementation (1000 mg/day) for 3 months. The patient's menopausal, depressive and anxiety symptoms were assessed by using Kupperman's Scale, HDRS and BARS, before and at the end of treatment. For statistical analysis unpaired t, ANOVA, RM-ANOVA, MANCOVA, Pearson correlation tests were used. Statistical significance level was established at p < 0.05. RESULTS: Baseline Kupperman's Scale, HDRS and BARS scores were not different among two groups. At the end of 3 months of therapy, there was improvement in menopausal symptoms, depression and anxiety scores within both groups. When we compared change of scores before and after the treatment; group I scores were better than group II scores. CONCLUSION: Our results suggest that raloxifene may have a positive effect on mood in osteopenic postmenopausal women.

Comparative study of a barbed suture, poliglecaprone and stapler in Pfannenstiel incisions performed for benign gynecological procedures: a randomized trial.

OBJECTIVE: To compare a novel barbed suture, poliglecaprone-25 suture and stapler in Pfannenstiel incisions performed for benign gynecological procedures. DESIGN: A randomized controlled non-inferiority trial with randomization in a 1:1:1 ratio. SETTING: Istanbul Dr. Lutfi Kirdar Kartal Research and Training Hospital, Department of Obstetrics and Gynecology. POPULATION: Patients between 18 and 45 years of age without prior lower abdominal incision and undergoing Pfannenstiel incisions for benign gynecological procedures. METHODS: A total of 117 female patients randomized into barbed (n = 39), poliglecaprone-25 (n = 39) and stapler (n = 39) groups according to suture type. Skin closure techniques were compared in terms of length of incision (cm), adverse events (wound dehiscence, incisional infection, seroma and hematoma), subjective pain scores, patient satisfaction and postoperative scar cosmesis. MAIN OUTCOME MEASURES. The difference between three suture materials in terms of postoperative incision pain, patient satisfaction and scar cosmesis. RESULTS: Skin closure techniques were similar in terms of length of incision (cm), adverse events and pain scores and Modified Hollander Cosmesis Score. Barbed (p < 0.001) and poliglecaprone-25 (p < 0.01) sutures were significantly better than staplers in terms of patient satisfaction. CONCLUSION: The three different methods of skin closure revealed comparable outcome except for a significant superiority of sutures to the stapler method in terms of patient satisfaction scores.

Effectiveness of short-term maintenance treatment with cabergoline in microadenoma-related and idiopathic hyperprolactinemia.

OBJECTIVE: This study aimed to determine the effectiveness of short-term maintenance treatment with cabergoline and to find out minimum effective dosage of cabergoline during maintenance treatment for patients with microadenoma-related and idiopathic hyperprolactinemia. STUDY DESIGN: Cabergoline was administered orally at a dose of 0.5 mg twice per week to 164 de novo hyperprolactinemic patients until serum prolactin level normalized. After this initial treatment phase, patients started on maintenance phase for which they were previously randomized. No maintenance treatment (Group I, n = 36) or cabergoline 0.5 mg (Group II, n = 46), 0.25 mg (Group III, n = 39), 0.125 mg (Group IV, n = 43) was administered twice per week for 8 weeks as maintenance treatment. Then, maintenance phase was finalized and patients were followed up for 6 months. Mean serum prolactin levels through maintenance treatment phase and follow-up period were assessed between groups and within groups. RESULTS: Except for group I, all the groups showed a similar pattern with fast decrease of serum prolactine level during maintenance phase and slower increase during the follow-up period. Notably, the average prolactin level was significantly lower at the last follow-up visit than at the diagnosis time in all of the groups. Stable normoprolactinemia of the groups at the end of follow-up period were 47.2, 37, 48.7, and 34.9%, respectively. CONCLUSIONS: The results indicate that short maintenance treatment in idiopathic and microadenoma-related hyperprolactinemia seems as effective as long maintenance treatment in the present study. But, further studies with larger study population and longer follow-up period are needed to make a decision about early treatment withdrawal. Also, during the maintenance treatment administration of medicine to patients should be tapered down to the lowest dose that will maintain prolactin levels normal.

The relationship between unexplained elevated serum markers in triple test, uterine artery Doppler measurements and adverse pregnancy outcome.

OBJECTIVE: To investigate the relationship between adverse pregnancy outcomes and unexplained elevations of second trimester maternal serum human chorionic gonadotropin (hCG), alpha fetoprotein (AFP) levels and uterine artery Doppler measurements. METHODS: A total of 144 women between 16-20 weeks of gestation that applied to our clinic for triple test were enrolled into the study. Study group consisted of 84 pregnant women with hCG and/or AFP levels > or =2 MoM. Control group comprised of 60 pregnant women with hCG and AFP levels <2 MoM. Study group was further subdivided into 3 subgroups: Subgroup I; only AFP> or =2 MoM (n=30), subgroup II; only hCG > or =2 MoM (n=64) and subgroup III; both AFP and hCG > or =2 MoM (n=10). RESULT: Operative delivery rate (p = 0.0017), overall complication rate (p=0.0002), bilateral early diastolic notch presence rate (p = 0.015) were high and mean birth weight was low (p=0.045) in the study group. In subgroup I patients, low birth weight [LBW] (p = 0.0008), preterm delivery (p = 0.0001), preeclampsia (p = 0.003) and preterm premature rupture of membranes [PPROM] (p = 0.012) rates were high. In subgroup II patients, only small for gestational age baby [SGA] (p = 0.016) rate was high. In subgroup III patients LBW (p = 0.009), preterm delivery (p = 0.0001) and PPROM (p = 0.01) rates were high. According to Doppler velocimetry studies, bilateral early diastolic notch presence rate was high (p = 0.015) in the study group. CONCLUSION: Patients with high AFP levels and bilateral uterine artery diastolic notch presence, are candidates for pregnancy complications and these groups of patients should be followed up more intensively.

Do asymptomatic patients require routine hemoglobin testing following uneventful, unplanned cesarean sections?

OBJECTIVE: To determine the clinical usefulness of routine postoperative hemoglobin testing after unplanned, uneventful cesarean sections in low-risk women without any signs or symptoms of anemia and to identify possible risk factors for hemorrhage. MATERIALS AND METHODS: Retrospective analysis of the charts of all women who underwent non-elective and uneventful cesarean section over 12 months was performed and demographic data, estimated blood loss at surgery, pre- and post-operative hemoglobin values, postoperative symptoms suggesting anemia, and incidence of transfusion were tabulated. Statistical analysis was done with Student t test and Mann-Whitney U test. RESULTS: A total of 2,450 women were delivered during the study period among whom 743 of them (30.3%) underwent cesarean section. Among the cesarean sections, 421 (56.6%) were found to be unplanned and uneventful operations performed in low-risk women with no postoperative signs or symptoms for anemia. The mean preoperative hemoglobin of the low-risk asymptomatic women was 11.7+/-1.99 g/dl, whereas it was 11.24+/-1.99 g/dl, postoperatively (P<0.001). In 72% of the patients, there was a drop in hemoglobin concentrations, whereas 24.5% experienced an increase and 3.5% showed no change, postoperatively. Only one woman experienced a drop of greater than 30% in hemoglobin concentration. Since the woman did not show any signs of hemodynamic instability or symptoms of anemia, she was not transfused. CONCLUSION: Our findings suggest that routine hemoglobin testing following uneventful, unplanned cesarean section neither change postoperative management nor determine the patients requiring blood transfusion.

Transvaginal sonography, sonohysterography, and hysteroscopy for investigation of focal intrauterine lesions in women with recurrent postmenopausal bleeding after dilatation & curettage.

PURPOSE: To determine the diagnostic accuracy of different diagnostic methods (blind dilatation & curettage (D&C), transvaginal ultrasonography (TVS), sonohysterography (SH), and hysteroscopy) compared with gold standard (hysteroscopic biopsy's histopathologic result) in diagnosis of focal intrauterine lesions of recurrent postmenopausal bleeding. METHODS: 36 postmenopausal women with recurrent vaginal bleeding after a normal D&C results were enrolled into the study. TVS, SH, hysteroscopy were performed on all patients. Outcomes of blind D&C, TVS, SH, and hysteroscopy were compared with results of gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LR) were calculated. RESULTS: Blind D&C sensitivity, specificity, PPV, and NPV were 47, 68, 57, 59%, respectively in comparison with gold standard. Blind D&C fails to diagnose 70% of all focal intracavitary lesions. TVS sensitivity, specificity, PPV, NPV were 63, 78, 89, 41%, respectively. SH yielded better results; with 93% sensitivity, 56% specificity, 86% PPV, and 71% NPV. Hysteroscopy sensitivity, specificity, PPV, and NPV were 100, 44, 84, 100%, respectively. CONCLUSIONS: In experienced hands, SH can be an initial evaluation method of uterine cavity for detecting focal lesions in women with recurrent postmenopausal bleeding.

Neoadjuvant chemotherapy followed by interval cytoreductive surgery in patients with unresectable, advanced stage epithelial ovarian cancer: a single centre experience.

BACKGROUND: Recent data has shown that the use of neoadjuvant chemotherapy (NAC) significantly reduces tumor burden before optimal cytoreductive surgery (CS) and is associated with an improved overall survival (OS). The aim of our study was to evaluate response to treatment and survival of patients with advanced epithelial ovarian cancer (EOC) who received NAC followed by interval cytoreductive surgery (ICS). METHODS: Fifty-two patients with advanced EOC treated with NAC followed by ICS were retrospectively analyzed. Response to NAC, progression-free survival (PFS), and OS were evaluated. By using univariate and multivariate analyses, the predicted survival rates by the factors were analyzed. RESULTS: Median age of patients at diagnosis were 62 years (range 33-77). The serous cell type was the most common histology (98%). The majority of patients (94%) received a combination therapy of paclitaxel and carboplatin. A median of four cycles of NAC was administered. At the end of NAC, the clinical complete response (CR) with normal clinical examination and normal serum CA 125 level was achieved in 40 patients (77%). Moreover, a radiological CR and a radiological partial response were obtained in 35 patients (67%) and in 16 patients (31%), respectively. ICS was considered standard in 45 (86%) patients. Optimal cytoreduction could be achieved in 43 of 52 patients (83%). After ICS, pathological CR was established in 15 of 52 patients (29%). At the median follow-up of 25 months (range 9-102), 2-year PFS and OS were 31 and 90%, respectively. The median PFS time was 13.3 months (SE 1.1, 95% CI 11-15) and the median OS time was 47.5 months (SE 5.8, 95% CI 36.1-59). The univariate analysis showed that optimal or suboptimal cytoreduction and perioperative blood transfusion were important prognostic factors on OS for patients who received NAC. Patients treated with optimal cytoreduction had significantly better median OS (52.5 months, 95% CI 45-60) than patients who underwent suboptimal cytoreduction (24.2 months, 95% CI 11.3-37) (P = 0.001). Furthermore, the cytoreduction type (optimal vs. suboptimal), surgical procedure (standard vs. non-standard), and perioperative blood transfusion were independent prognostic factors of OS by multivariate analysis (chi (2) = 9.28, P = 0.002, HR 0.28, 95% CI 0.003-0.37; chi (2) = 4.44, P = 0.035, HR 0.15, 95% CI 0.026-0.87; chi (2) = 9.24, P = 0.002, HR 0.75, 95% CI 0.014-0.79, respectively). CONCLUSIONS: This study demonstrates that NAC is associated with improved OS for patients with advanced EOC who received NAC followed by ICS. Additionally, our results showed that cytoreduction type, surgical procedure, and perioperative blood transfusion were independent prognostic indicators of OS for patients with advanced EOC who received NAC. Thereafter, NAC may be an alternative treatment to primary cytoreduction.

Awareness, knowledge and attitudes related to HPV infection and vaccine among non-obstetrician-gynecologist healthcare providers.

OBJECTIVE: This study was designed to evaluate the awareness, knowledge and attitudes of healthcare providers related to HPV infection and vaccine. MATERIAL AND METHODS: A total of 311 healthcare providers working in specialties other than obstetrics and gynecology at the Dr. Lutfi Kirdar Kartal Education and Research Hospital as physicians (n=142) or non-physician healthcare providers (n=169) were included in the present study. A questionnaire developed by researchers based on literature and including items concerning socio-demographic features, awareness of HPV infection and vaccine, attitudes related to HPV vaccine and regular gynecological controls and knowledge about HPV infection was applied to participants via a face to face interview method. Each correct answer was scored as one to decide the level of knowledge and awareness. RESULTS: The frequency of parenthood was lower and the ratio of males was higher in the physician group compared to the non-physician group. Awareness of virus mediated cancer (p=0.01), human papilloma virus (p=0.0001), cervical cancer, HPV vaccine, and types of HPV vaccine was significantly higher in the physician group. While consent levels for vaccine administration for themselves were similar for physician and non-physician subjects, the frequency of subjects favoring vaccine administration for their offspring was significantly higher among physicians (p<0.001 for daughters, p<0.05 for sons). HPV-related level of knowledge in the physicians was significantly higher when compared to the non-physician staff (p<0.001). CONCLUSION: Physicians were more competent regarding the relation of HPV infection to cervical cancer and more aware of the presence and types of HPV vaccines which may lead to a higher degree of willingness for vaccination when compared with non-physician healthcare providers.

Primary ovarian adenomyoma in a woman with endometrial polyp: a case report and review of the literature.

BACKGROUND: An adenomyoma presenting outside the uterus is an extremely rare entity and only three cases of primary ovarian adenomyoma have been reported up to date. CASE REPORT: We report the fourth case of ovarian adenomyoma in a 45-year-old woman with an endometrial polyp. Transvaginal ultrasonography revealed a solitary endometrial polyp with an enlarged left ovary which appeared heterogenous with isoechoic and mildly hyperechoic pattern. CONCLUSION: Total abdominal hysterectomy and bilateral salpingo-oopherectomy was performed and histologic examination revealed an adenomyoma arising primarily in the ovary.

Low-grade endometrial stromal sarcoma with retroperitoneal metastases: an unusual case report.

BACKGROUND: Endometrial stromal sarcoma (ESS) is an uncommon malign neoplasm, and its occurrence outside the uterus is extremely rare in the absence of metastasis or extension of a primary uterine neoplasm. When arising in the pelvis or abdominal cavity, ESS is associated with uterine adnexa or serosal surface of various organs. CASE: We present the case of a 46-year-old woman with lower abdominal pain and regular menstruation who underwent laparotomy after a diagnosis of pelvic mass mimicking a right adnexial tumor. Exploration of the pelvis revealed a retroperitoneal mass of 15 cm in diameter in the right illiac fossa without accompanying pelvic or paraaortic lymphadenopathy. Uterus and ovaries were bilaterally normal in size. The pathology showed low-grade ESS of the uterus with direct spread to retroperitoneum without serosal metastases. CONCLUSION: This case shows that despite its well-known good prognostic nature, low-grade ESS may behave as an aggressive malignancy.

Is it necessary to do retroperitoneal evaluation in borderline epithelial ovarian tumors?

OBJECTIVE: Borderline epithelial ovarian tumors have good prognosis without any adjuvant therapy. The advantage of aggressive surgical staging, especially retroperitoneal lymph node sampling is questionable in patients with borderline ovarian tumors. We designed this study to evaluate the necessity of retroperitoneal pelvic and para-aortic lymph node dissection in the treatment of borderline epithelial ovarian tumors. STUDY DESIGN: From 1998 to 2007, 57 women who were diagnosed with borderline epithelial ovarian tumor in our hospital were prospectively accrued and evaluated; 27 of them (47.3%) had full surgical staging procedure including para-aortic and pelvic node dissection. Student's t-test was used to compare follow-up times. RESULTS: Median follow-up time was 54.6 (12-96) months for all patients in the study. There was one recurrence of disease, which was in the complete staging group. Follow-up times of patients were not statistically different between lymph node evaluated and non-evaluated groups (p = 0.10). We did not find any metastasis in lymph nodes in 27 women who had complete surgical staging procedure. CONCLUSION: Patients with borderline epithelial tumors who had full surgical staging procedure do not have survival advantage over those who had no lymph node evaluation and yet were patients with malignant ovarian tumors.