The Role of Total Oxidant and Antioxidant Levels in Follicular Fluid in Unexplained Infertility.

BACKGROUND: Unexplained infertility is defined as the absence of any pathology in the basic evaluation performed in couples who cannot achieve pregnancy after 1 year of unprotected sexual intercourse. The results of tests examining the causes of infertility show no identifiable cause in almost 15% of couples. AIM: The aim of this study was to investigate the effects of reactive oxygen species (ROS) on pregnancy and embryos. METHODS: This study included 200 patients, aged between 20-44 years, with unexplained infertility, who had recurrent intrauterine inseminations failures and hence started in vitro fertilization (IVF)/intracytoplasmic sperm injection treatment. Some amounts of waste follicular fluid samples were collected by embryologists from the oocytes of these patients during the ovum pick-up procedure. Next, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) values were calculated in the biochemistry laboratory. RESULTS: In terms of pregnancy status, both follicular TOS and OSI values were not significantly different in patients with biochemical and clinical pregnancy, whereas TAS values were significantly higher in patients with pregnancy (P < 0.05). In terms of embryo quality, no significant difference was observed in TAS, TOS, and OSI values between grade 1 and 2 embryos, whereas pregnancy rates were significantly higher in patients who received grade 1 embryo transfer (P < 0.05). However, the follicular fluid TAS levels were significantly lower in smoking patients than in those who did not smoke; TOS and OSI levels were significantly higher. CONCLUSION: This study showed that exposure to oxidative stress might be a causative factor for infertility. In addition, ROS decreased the level of TAS by increasing OSI in the follicular fluid; thus, antioxidant supplementation might be a necessity.

Does BLOODCARE Powder Prevent Postoperative Chylous Ascites After Lymphadenectomy for Gynecological Malignancies?

OBJECTIVE: The aim of this study was to evaluate the effect of an intraoperative hemostatic cellulose agent (BLOODCARE powder [Life Line, Brno, Czech Republic]) on reducing the incidence of postoperative chylous ascites (PCA) after complete pelvic and para-aortic lymphadenectomy (PPALN) in patients with gynecological cancers treated with laparotomy. METHODS: This case control study reviewed 150 patients with gynecological cancer who underwent PPALN. In the study group (n = 75), BLOODCARE powder was applied below the left renal vein and bilateral obturator fossa. In the control group (n = 75), no sealant agent was used after the procedure, such as fibrin glue or a hemostatic cellulose agent. RESULTS: The demographic and surgical characteristics of the patients in both groups were similar. Chylous ascites occurred in 9 cases (6%). The incidence of PCA was lower in the study group (1 [1.3%] vs 8 [10.7%]; P = 0.03). Logistic regression analysis indicated that using BLOODCARE powder during the surgery independently protected against the development of PCA. CONCLUSIONS: Using BLOODCARE powder during retroperitoneal surgery may prevent PCA. This simple, effective agent should be used after PPALN for gynecological cancers.

Stage-III and -IV endometrial cancer: A single oncology centre review of 104 cases.

The objective of this study was to evaluate the clinicopathological characteristics, treatment and prognosis of advanced endometrial cancer (EC). Patients who underwent surgery for advanced EC between January 1995 and December 2012 were retrospectively reviewed. Patients with missing data, concurrent cancers or uterine sarcomas and those who did not undergo surgery were excluded. The effects of clinicopathological factors on progression-free survival (PFS) and overall survival (OS) were analyzed. A total of 104 patients were included. Most presented with endometrioid histology (74%) and stage-III disease (87.5%), and 76.9% underwent optimal cytoreduction. A multivariate analysis confirmed that lymphovascular space invasion (LVSI) is an independent poor prognostic factor for PFS [odds ratio (OR): 21.37, p = 0.005] and OS [OR: 8.09, p = 0.044]. Suboptimal cytoreduction is another independent poor prognostic factor for PFS [OR: 5.68, p < 0.001]. Our study demonstrated that LVSI and optimal cytoreduction are the most significant factors affecting the survival of advanced EC patients.

Comparison of the histopathological diagnoses of preoperative dilatation and curettage and Pipelle biopsy.

PURPOSE: To evaluate the accuracy of dilatation and curettage (D&C) and Pipelle biopsy for the diagnosis of endometrial pathologies and determine whether the amount of endometrial tissue obtained using these techniques is sufficient for further histopathology of hysterectomy specimens. MATERIALS AND METHODS: Patients undergoing hysterectomy for various indications were evaluated via Pipelle endometrial biopsy or D&C from 2009-2011. A total of 267 women were included with 78 women enrolled in the Pipelle group and 189 in the D&C group. Uterine findings were grouped as normal, hyperplasia, focal lesion, atypia, and atrophy. Histological sections from the Pipelle biopsy or D&C specimens were compared to each other and hysterectomy specimens. RESULTS: The concordance rate between Pipelle biopsy and hysterectomy was 62% and between D&C and hysterectomy was 67%. The sensitivity of Pipelle biopsy and D&C for detecting hyperplasia was 41.7% and 45%, respectively, and for detecting atypia was 71.4% for both techniques. The sensitivity of detecting atrophic endometrial tissue was significantly higher in the D&C group at 80% compared to 37.5% in the Pipelle biopsy group (p = 0.030). All other parameters were similar in both groups. CONCLUSION: Pipelle biopsy and D&C were equally successful for diagnosing endometrial pathologies. Neither Pipelle biopsy nor D&C was adequate for detecting focal endometrial pathologies and endometrial hyperplasia. In contrast, both techniques were sufficient for the diagnosis of atypia. The Pipelle biopsy technique is a reasonable pre-hysterectomy procedure that is more economical, less invasive, and can easily be performed in multiple clinics.

Primary retroperitoneal mucinous cystadenocarcinoma during pregnancy.

Primary retroperitoneal mucinous cystadenocarcinoma (PRMC) is an extremely rare tumour. This case report describes the treatment and prognosis of a patient with PRMC during pregnancy. This is the third case of PRMC in a pregnant woman, worldwide. The patient was a 37-year-old woman presenting with a left mid-abdominal and pelvic semisolid, cystic mass at 29 weeks' gestation. At 30 weeks' gestation, she underwent an exploratory laparotomy, which revealed a solid tumour (22 × 13 × 11 cm) with an intact capsule extending from the inferior pole of the left kidney to the pelvic inlet in the left retroperitoneal area. The tumour had adhesions with the surrounding connective tissue and could be excised with its capsule intact. In conclusion, based on the limited information available, a PRMC with no visible dissemination excised with an intact capsule appears to have a good prognosis. Tumour excision may be adequate for treatment of PRMCs in the extragenital space and with no dissemination.

The effect of BMSCs on implantation mechanisms and pregnancy process in the experimental Asherman model.

OBJECTIVE: In this study, we aimed to investigate the role of bone marrow-derived mesenchymal stem cells (BMSC) on the molecular mechanisms involved in the removal of endometrial adhesions and the implantation process in the experimentally-created Asherman syndrome model in rats. MATERIALS AND METHODS: An experimental model chemical agent was used. Culture medium (CM), only BMSC, 48-hour culture medium (Niche), and BMSC+ niche were used as therapy. Each group was divided into two subgroups, and changes in the endometrial tissue were investigated by histochemical and immunohistochemical staining. RESULTS: The results of the study show that BMSCs exhibit therapeutic properties in endometrial damage, increase endometrial thickness and vascularization, and contribute to the implantation of embryos by reducing fibrous areas. These results are promising for the prevention of Asherman-induced infertility. CONCLUSIONS: It has been shown that BMSC and Niche applications can be helpful in preventing adhesion molecules in the mechanisms that cause infertility.

Assessment of efficacy of percutaneous epidural neuroplasty for lumbar stenosis and failed back surgery syndrome: effective and safe?

OBJECTIVE: Chronic, refractory low back and lower extremity pain is a common problem. There are many causes for persistent low back pain, including spinal stenosis (SS), disc herniation, facet disease, sacroiliac disease, adjacent segment disease, ligamentous disease, and failed back surgery syndrome (FBSS). FBSS and SS are common and often result in chronic, persistent pain and disability. After the failure of conservative treatments, percutaneous epidural neuroplasty (PEN) is often used in managing low back pain. PATIENTS AND METHODS: We retrospectively analyzed 117 patients who received PEN for FBSS and SS between January 2018 and January 2019. Clinical outcomes were assessed with the visual analogue scale (VAS) score and the Oswestry disability index (ODI). The follow-up period was 6 months. We aimed to evaluate the effectiveness of percutaneous epidural neuroplasty in managing chronic refractory low back and lower extremity pain secondary to FBSS and SS and to compare the differences between outcomes of SS and FBSS groups, before and after PEN. RESULTS: Mean VAS scores were 6.15 ± 1.25 preoperatively, 2.97 ± 1.5 after 1 month, 3.18 ± 1.65 after 3 months, and 3.83 ± 1.64 after 6 months of follow-up. Mean ODI scores were 49.91 ± 13.87 preoperatively, 30.19 ± 12.01 after 1 month, 31.61 ± 12.46 after 3 months, 34.58 ± 12.52 after 6 months of follow-up. CONCLUSIONS: Percutaneous epidural neuroplasty was shown to be a safe and effective treatment in managing refractory back/leg pain following FBSS and SS.

Thyroid autoimmunity associated with recurrent aphthous stomatitis.

BACKGROUND: Recurrent aphthous stomatitis (RAS) is an autoimmune disorder characterized by the periodic appearance of aphthous lesions on the oral mucosa. TH1 cytokines plays a key role in the aetiopathogenesis. Autoimmune thyroid disease (ATD) is the most common autoimmune disease and is frequently accompanied by various other autoimmune diseases. OBJECTIVE: To investigate the frequency of ATD which has not been studied in the patients with RAS. METHODS: Ninety patients and 30 healthy volunteers were included into the study. The serum samples were assayed for thyroid stimulant hormone (TSH), free and total triiodothyronine (fT3, TT3), free and total thyroxine (fT4, TT4), thyroglobuline, anti-thyroid peroxidase antibody (anti-TPO) and anti-thyroglobuline antibody (anti-TG) levels. Thyroid ultrasonography was performed as well. RESULTS: In RAS patients, the fT3, TT3 levels were higher; whereas the fT4 levels were lower that the control group (P < 0.05). The anti-thyroid antibody was positive in 31.11% of the patients with RAS, and in only 10% of the individuals in the control group (P < 0.05). The mean anti-TG level was also higher in the RAS group. Ultrasonography revealed nodules in 28.8% of the patients with RAS and in 16.7% of the individuals in the control group (P < 0.05). The sT4 levels were lower and the TSH, anti-TPO and anti-TG levels were significantly higher in the RAS patients with thyroid nodules than the RAS patients without nodules (P < 0.05). DISCUSSION: These results may be related to either the advance age of the patients or the increased duration of the autoimmune activation which may affect the thyroid. CONCLUSIONS: The frequency of thyroid autoimmune-related problems was higher in patients with RAS. It would be worthy of searching autoimmune thyroid disorders in patients with RAS.

Quercetin prevents 2,3,7,8-tetrachlorodibenzo-p-dioxin-induced testicular damage in rats.

The protective effect of quercetin on 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-induced testicular damage in rats was investigated. Twenty-two rats were equally divided into four groups; first group was kept as control and given corn oil as carrier. In second group, TCDD was orally administered at the dose of 2 µ (kg week)(-1) for 60 days. In third group, quercetin was orally administered at the dose of 20 mg (kg day)(-1) by gavages, and in fourth group TCDD and quercetin were given together at the same doses. Although TCDD increased the formation of thiobarbituric acid reactive substances (TBARS) significantly, it caused a significant decline in the levels of glutathione (GSH), catalase (CAT), GSH-Px and CuZn-Superoxide Dismutase (CuZn-SOD) in rats. In contrast, quercetin significantly increased the GSH, CAT, GSH-Px and CuZn-SOD levels but decreased the formation of TBARS. In addition, sperm motility, sperm concentration and serum testosterone levels were significantly decreased but abnormal sperm rate and testicular damage were increased with TCDD treatment. However, these effects of TCDD on sperm parameters, histological changes and hormone levels were eliminated by quercetin treatment. Our results show that administration of TCDD induces testicular damage (oxidative stress, testes tissue damage, serum hormone level and sperm parameters), and quercetin prevents TCDD-induced testicular damage in rats. Thus, quercetin may be useful for the prevention and treatment of TCDD-induced testicular damage.

Beneficial effects of chrysin on the reproductive system of adult male rats.

In this study, the beneficial effect of chrysin, a natural flavonoid currently under investigation due to its important biological activities, on reproductive system of rats was investigated. Rats (n = 16) were divided randomly into two equal groups. Rats in control group were given corn oil as carrier. Chrysin was orally administered at the dose of 50 mg kg(-1) per day by gavages, and it was dissolved in corn oil for 60 days. Tissue thiobarbituric acid reactive substances (TBARS) and glutathione (GSH) levels, antioxidant enzyme activity (CAT, SOD and GSH-Px), sperm parameters (motility, concentration and abnormal sperm rate), reproductive organ weight (testes, epididymis, vesicula seminalis, prostate) and serum testosterone levels were determined in the rats. Our results indicated that chrysin significantly increased GSH, CAT, GSH-Px and CuZn-SOD levels, but did not change the formation of TBARS significantly. In addition, sperm motility, sperm concentration and serum testosterone levels significantly increased, whereas abnormal sperm rate significantly decreased with chrysin treatment. In conclusion, it is suggested that treatment with chrysin can positively affect the reproductive system in rats, and it can be used for the treatment of male infertility.

Adaptive support ventilation for faster weaning in COPD: a randomised controlled trial.

Adaptive support ventilation (ASV) is a closed-loop ventilation mode that can act both as pressure support ventilation (PSV) and pressure-controlled ventilation. Weaning with ASV shows promising results, mainly in post-cardiac surgery patients. The aim of the present randomised controlled study was to test the hypothesis that weaning with ASV could reduce the weaning duration in patients with chronic obstructive pulmonary disease (COPD) when compared with PSV. From among 435 COPD patients admitted to the intensive care unit (ICU) during a 20-month period, 97 were enrolled. Patients were assigned at random to either ASV or PSV as a weaning mode. Compared with PSV, ASV provided shorter weaning times (median 24 (interquartile range 20-62) h versus 72 (24-144) h, p=0.041) with similar weaning success rates (35 out of 49 for ASV and 33 out of 48 for PSV). Length of stay in the ICU was also shorter with ASV but the difference was not statistically significant. This study suggests that ASV may be used in the weaning of COPD patients with the advantage of shorter weaning times. Further studies are needed to investigate the role and potential advantages of ASV in the weaning period of different patient groups.

Role of exogenous melatonin on adriamycin-induced changes in the rat heart.

AIM: The protective effect of melatonin on adriamycin (ADM)-induced cardiotoxicity was investigated in the rat heart. Melatonin is a pineal hormone with free radical scavenging activity on oxidants; therefore it may decrease the ADM-induced oxidative stress and cardiotoxicity so that therapeutic efficacy might be enhanced. MATERIALS AND METHODS: Wistar rats in 4 groups were treated with saline (control), melatonin (MEL), adriamycin (ADM) and melatonin plus adriamycin (MEL+ADM). RESULTS: Adriamycin given at a single dose of 15 mg/kg significantly increased lipid peroxidation products as measured by thiobarbituric acid reactive substances (TBARS). Melatonin (5 mg/kg bw) given 2 days before and 7 days after ADM treatment reduced TBARS level. Adriamycin significantly reduced superoxide dismutase activity which was elevated by melatonin treatment. Additionally, ADM significantly increased catalase enzyme activity while melatonin normalized the ADM induced alteration in activity of catalase. CONCLUSIONS: The combined use of ADM and melatonin reduces the threat of cardiomyopathy. Melatonin seems to hold promise as a therapeutic treatment and can be recommended as an adjunct in antitumor therapy as a safe and effective protection against acute ADM-induced cardiotoxicity.

A new single-layer structure of MBene family: Ti2B.

In this manuscript, we have carried out a combined study of density functional theory and Monte Carlo (MC) simulations for a thorough examination of a single-layer (SL) Ti2B structure. On the basis of first-principles, spin-polarized density functional calculations, we showed that a free standing SL-Ti2B structure is dynamically and thermally stable. The atomic structure, phonon spectrum, electronic and magnetic properties of the SL-Ti2B structure are analyzed. In order to determine ground state, the structure of Ti2B is optimized for four types of spin oriented configurations, namely ferromagnetic (FM), antiferromagnetic Néel, antiferromagnetic Zigzag and antiferromagnetic Stripy and non-magnetic states. We found that the spin configuration FM corresponds to the ground state for SL-Ti2B. We also found that the Raman-active modes are softening in the antiferromagnetic cases. On the basis of these results, MC simulations show that the magnetic susceptibility, thermal variations of magnetization, and specific heat curves of Ti2B exhibit a phase transition between paramagnetic and FM phases at the Curie temperature of 39.06 K. While SL-Ti2B possess a little out-of-plane magnetic anisotropy, it has not any in plane magnetic anisotropy energy.

Ru(ii)-N-heterocyclic carbene complexes: synthesis, characterization, transfer hydrogenation reactions and biological determination.

A series of ruthenium(ii) complexes with N-heterocyclic carbene ligands were successfully synthesized by transmetalation reactions between silver(i) N-heterocyclic carbene complexes and [RuCl2(p-cymene)]2 in dichloromethane under Ar conditions. All new compounds were characterized by spectroscopic and analytical methods. These ruthenium(ii)-NHC complexes were found to be efficient precatalysts for the transfer hydrogenation of ketones by using 2-propanol as the hydrogen source in the presence of KOH as a co-catalyst. The antibacterial activity of ruthenium N-heterocyclic carbene complexes 3a-f was measured by disc diffusion method against Gram positive and Gram-negative bacteria. Compounds 3d exhibited potential antibacterial activity against five bacterial species among the six used as indicator cells. The product 3e inhibits the growth of all the six tested microorganisms. Moreover, the antioxidant activity determination of these complexes 3a-f, using 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-azinobis-3-ethylbenzothiazoline-6-sulphonic acid (ABTS) as reagent, showed that compounds 3b and 3d possess DPPH and ABTS antiradical activities. From a concentration of 1 mg ml-1, these two complexes presented a similar scavenging activity to that of the two used controls gallic acid (GA) and butylated hydroxytoluene (BHT). From a concentration of 10 mg ml-1, the percentage inhibition of complexes 3b and 3d was respectively 70% and 90%. In addition, these two Ru-NHC complexes exhibited antifungal activity against Candida albicans. Investigation of the anti-acetylcholinesterase activity of the studied complexes showed that compounds 3a, 3b, 3d and 3e exhibited good activity at 100 µg ml-1 and product 3d is the most active. In a cytotoxicity study the complexes 3 were evaluated against two human cancer cell lines MDA-MB-231 and MCF-7. Both 3d and 3e complexes were found to be active against the tested cell lines showing comparable activity with examples in the literature.

Pyelovenous fistula: a rare cause of hematuria.

A 72-year-old female who was admitted to our urology clinic with painless intermittent macroscopic hematuria existing for 3 months with no other voiding symptom was diagnosed with left pyelovenous fistula. Although a rare condition, pyelovenous fistula should be kept in mind when the cause of macroscopic hematuria cannot be diagnosed with routine radiological examinations, and retrograde pyelography should be the method of choice for the diagnosis in this rare condition.

Modulation of DMBA-induced biochemical changes by organoselenium compounds in blood of rats.

The protective role of two synthetic organoselenium compounds 1-isopropyl-3-methylbenzimidazole-2-selenone (SeI) and 1, 3-di-p-methoxybenzylpyrimidine-2-selenone (Sell) was examined against the 7,12-dimethylbenz[a]anthracene (DMBA)-induced changes in biochemical parameters in blood of rats. Albino Winstar rats (150-200 g body wt) were treated with single dose of DMBA (50 mg/kg body wt) and organoselenium compounds (25 micromol/kg) for 4 weeks at two days internal. Blood was taken from the anaesthetized rats ventricle from their hearts for biochemical analysis. Administration of DMBA resulted in elevation of urea, uric acid and creatinine levels as well as AST, ALT and LDH activities and decrease in levels of total proteins, albumin and globulin. SeI and SeII caused a significant (p<0.05) decrease in urea, uric acid and creatinine levels and alanine aminotransferase (ALT); aspartate aminotransferase; (AST) and lactate dehydrogenase (LDH) activities and significantly increased the levels of total protein and albumin (p<0.05). These organoselenium compounds are likely to be beneficial in human health.

What Are the Risk Factors for Lymphocyst Formation Apart From Lymphnode Dissection and Lymphnode Count in Gynecologic Malignancy?

Aim: Lymphocyst is one of the most common complications of lymphadenectomy and generally encountered during uro-gynecological oncology surgeries. We aimed to define the risk factors for formation of a lymphocyst in patients with various gynecological cancer types in whom a lymphadenectomy was performed. Methods: This retrospective study was performed on 206 patients. Of the 206 patients, 100 were diagnosed with a lymphocyst, and 106 were assigned to a control group. Laboratory findings and surgical characteristics of the patients were compared. Results: No differences were observed in age, pre-operative hemoglobin; platelet, white blood cell, and lymphocyte counts; or pre-operative albumin level (p = 0.315, 0.500, 0.525, 0.683, 0.740, and 0.97, respectively). A significant effect of the heparin dose × heparin days interaction and lymphocyst formation was observed (p = 0.002). Lymphocysts were most frequently detected in the ovarian cancer subgroup (49 %). Significant differences were detected between the groups in the percentages of patients who underwent CT only and RT only treatments (p = 0.001 and 0.002, respectively). The logistic regression analysis revealed a relationship between the LMWH dose × days interaction and formation of a lymphocyst (OR, 1.10; 95 % CI, 1.0-1.13; p = 0.01). Conclusion: The association between total LMWH dose administered and the formation of lymphocysts in patients with gynecological pelvic cancer was investigated for the first time. Significant relationship between heparin dose × days and lymphocyst formation was found. Although anticoagulation with LMWH is essential for preventing thromboembolism, it should be used appropriately to prevent other complications, such as bleeding and lymphocysts.

Is leptin associated with diabetic retinopathy?

OBJECTIVE: In advanced stages of diabetic retinopathy, new blood vessels are formed based on undefined mechanisms. Recently, leptin was shown to possess an angiogenic action in vitro and to induce neovascularization in vivo. The aim of the present study was to investigate the relationship between plasma leptin levels and the severity of diabetic retinopathy. RESEARCH DESIGN AND METHODS: There were 70 patients with type 2 diabetes (age 47.9 +/- 9.7 years, BMI 26.4 +/- 3.3 kg/m2) who were seen in a retina outpatient clinic recruited and assigned to subgroups according to the stage of their diabetic retinopathy. There were 66 healthy volunteer subjects matched with the diabetic patients for age, BMI, and sex who served as control subjects (age 46.0 +/- 8.8 years, BMI 27.1 +/- 2.3 kg/m2). Fasting plasma leptin levels were measured. RESULTS: Plasma leptin level of the diabetic patients was not significantly different from the control subjects. In patients with proliferative diabetic retinopathy (n = 17), the mean plasma level of leptin (16.1 +/- 9.2 ng/ml) was significantly higher than that in patients with nonproliferative retinopathy (n = 20) (11.5 +/- 3.5 ng/ml, P = 0.039) or patients without retinopathy (n = 33) (5.8 +/- 3.7 ng/ml, P = 0.001). The mean leptin level in patients with nonproliferative diabetic retinopathy was also significantly higher than that in patients without retinopathy (P = 0.002). CONCLUSIONS: Our results show that the more advanced the diabetic retinopathy, the higher the plasma leptin levels, even after adjusting the leptin levels for BMI. The presence of such a positive correlation need not imply a causal relationship. Nevertheless, previously observed leptin-induced promotion of angiogenesis and neovascularization lends support to the possibility that leptin may play a role in the progression of human diabetic retinopathy to a proliferative phase. This possibility deserves further investigation.

Lymphovascular space invasion and positive pelvic lymph nodes are independent risk factors for para-aortic nodal metastasis in endometrioid endometrial cancer.

OBJECTIVE: Para-aortic lymph node dissemination in endometrioid endometrial cancer is uncommon, and systematic para-aortic lymph node dissection increases morbidity. The purpose of this study was to identify a subgroup of endometrioid endometrial cancer patients who did not require para-aortic lymphadenectomy. STUDY DESIGN: All patients who had undergone surgery for endometrioid endometrial cancer between 1 January 1995 and 31 December 2012 were retrospectively reviewed. Patients with higher risk factors for nodal metastasis and inadequate lymphadenectomy were excluded. Para-aortic lymph node dissemination was defined as nodal metastasis when pelvic and para-aortic lymph node dissection was performed, when para-aortic lymph node recurrence occurred after negative para-aortic lymph node dissection or when para-aortic lymph node dissection was not performed. Multivariate logistic regression models were used to identify the pathological features as predictors for para-aortic lymphatic dissemination. RESULTS: A total of 827 patients were assessed, 516 (62.4%) of whom underwent pelvic and para-aortic lymph node dissection. Sixty-seven (13%) patients (37 with only pelvic, 26 with pelvic and para-aortic, and 4 with only para-aortic metastasis) had positive lymph nodes in the pelvic and para-aortic lymph node dissection group. Multivariate analysis confirmed positive pelvic nodes (odds ratio 20.58; p<0.001) and lymphovascular space invasion (odds ratio 8.10; p=0.022) as independent predictors of para-aortic lymphatic dissemination. When these two factors were absent (in 83% of patients), the predicted probability of para-aortic lymph node metastasis was 0.1%. CONCLUSION: Positive pelvic nodes and lymphovascular space invasion are highly associated with para-aortic lymph node metastasis. These markers may be useful for identifying those patients who require para-aortic lymph node dissection.