Evaluation of dynamic thiol-disulfide balance in preinvasive lesions of the cervix.

PURPOSE: This study aimed to determine the potential clinical use of dynamic thiol-disulfide balance in cases with preinvasive lesions of the cervix. METHODS: One hundred and sixteen patients with high-grade squamous intraepithelial lesion, 100 patients with low-grade squamous intraepithelial lesion, and 110 healthy controls were enrolled in the study. A fully automated colorimetric system was used to determine the levels of thiol-disulfide parameters. The ischemia-modified albumin, total oxidant-antioxidant capacity, and oxidative stress index of the retrieved cases were further analyzed. RESULTS: Native thiol and total thiol levels are significantly lower in the high-grade squamous intraepithelial lesion group according to control group (p: 0.004 and 0.015, respectively). Disulfide level is significantly increased in the high-grade squamous intraepithelial lesion group compared to control group (p: 0.004). Oxidative stress index levels in high-grade squamous intraepithelial lesion group were observed as significantly higher according to the control group (p: 0.014). Ischemia-modified albumin levels in the high-grade squamous intraepithelial lesion group were observed as significantly higher compared to the control group (p: 0.020). Disulfide levels are positively correlated with risk type of Human papillomavirus (r: 0.420, p < 0.001). CONCLUSION: The analysis of dynamic thiol-disulfide balance revealed considerable oxidative damage in patients with Human papillomavirus-related cervical precursor lesions compared to women with ordinary cytology specimens. Therefore, investigation of thiol-disulfide balance with presented method represents a new promising test for early diagnosis and management of women at high risk for cervical cancer.

Bilateral uterine artery coagulation in laparoscopic hysterectomy for benign disease in uteri more than 1000 g.

AIM: We aimed to evaluate the efficacy of bipolar uterine artery coagulation in laparoscopic hysterectomy for uteri larger than 1000 g. METHODS: Data from 674 patients who underwent laparoscopic hysterectomy were retrospectively analyzed. Among those, 75 patients with uteri weighing more than 1000 g were included. The clinical and surgical outcomes of patients with large uteri were compared according to bipolar uterine artery coagulation performance status. RESULTS: The mean difference in intraoperative blood loss between the groups of patients with uterine artery occlusion and without uterine artery occlusion was statistically significant (89.26 ± 65.52 vs 227.94 ± 124.65 mL; P < 0.001). The hemoglobin decrease was also significantly lower in the patients with uterine artery occlusion (0.46 ± 0.23 vs 1.21 ± 0.79 g/dL; P < 0.001). CONCLUSION: When performing laparoscopic hysterectomy of uteri weighing over 1000 g, the occlusion of the bilateral uterine arteries at the point of exit from the internal iliac arteries using bipolar coagulation at the beginning of the operation reduces intraoperative hemorrhage and hemoglobin decrease.

Assessment of thiol disulfide balance in early-stage endometrial cancer.

AIM: We carried out this research to assess thiol disulfide balance in patients with early-stage endometrial cancer. METHODS: Fifty-seven endometrial cancer patients and 60 age-matched healthy subjects volunteered for this study. Thiol disulfide parameters and the ratios of these parameters were examined using a colorimetric system. We also evaluated total antioxidant capacity, total oxidant capacity and oxidative stress index. RESULTS: Subjects with endometrial cancer had statistically significantly lower serum native thiol and total thiol levels (224.2 [122.8-267.5] and 270.5 [171.6-323.2], respectively) than healthy subjects (281.35 [213.45-358.9] and 339.55 [274.1-425.95], respectively) (P = 0.001, P < 0.001). Subjects with endometrial cancer had statistically significantly higher serum disulfide/native thiol and disulfide/total thiol ratios (12.22 [8.77-17.61] and 9.82 [7.46-13.02], respectively) than healthy subjects (8.9 [6.79-16.35] and 7.36 [5.9-12.32], respectively) (P = 0.038, P = 0.028). Disulfide/native thiol ratio appeared to be strongly and positively correlated with the stage of endometrial cancer (r = 0.827, P < 0.001). CONCLUSION: This is an initial report related to thiol disulfide balance in endometrial cancer patients. We believe that oxidative stress contributes both to the evolution and to the progression of the disease. We conclude that deterioration of thiol disulfide balance due to oxidative stress is likely to contribute to the etiopathogenesis of endometrial cancer.

Thiol-disulfide status of patients with cervical cancer.

AIM: The evaluation of dynamic thiol-disulfide homeostasis among patients with the cancer of the uterine cervix. METHODS: The study was conducted in 62 cervical cancer patients and 61 healthy women who had been followed up in an obstetrics and gynecology clinic between September 2018 and April 2020. Serum disulfide, native thiol, total thiol, ischemia modified-albumin, total antioxidant and oxidant capacities, and oxidative stress index values were measured in all participants. RESULTS: The mean plasma disulfide levels of the cervical cancer group was statistically significantly higher than that of the control group (25.79 ± 6.90 µmol/L, 22.31 ± 6.11 µmol/L, respectively) (P = 0.004). Plasma native thiol and total thiol levels were lower in cervical cancer patients (299.27 ± 99.05 µmol/L and 350.86 ± 102.72 µmol/L, respectively) compared to controls, but no statistically significant difference was observed (318.00 ± 93.75 µmol/L and 376.44 ± 98.51 µmol/L, respectively) (P = 0.284, P = 0.161). With respect to the ischemia modified-albumin level, no statistically significant difference was observed between two groups. There were statistically significant positive association between disulfide level and both the stage of cervical cancer (r = 0.278, P = 0.029) and total oxidant capacity level (r = 0.256, P = 0.046). CONCLUSION: Dynamic thiol-disulfide homeostasis may participate in the pathophysiological mechanisms of cervical cancer and may be a potential biomarker for early identification of cervical cancer in future.

Laparoscopic Resection of An Extragastrointestinal Stromal Tumor in the Presacral Area.

STUDY OBJECTIVE: To show a surgical video in which a retroperitoneal extragastrointestinal stromal tumor was resected with the laparoscopic approach in the presacral area. DESIGN: A case report (Canadian Task Force classification III). The local ethics committee waived the requirement for approval. SETTING: A very small proportion of extragastrointestinal stromal tumors (EGISTs) is located in the retroperitoneal region. There are insufficient data on the clinical and pathologic features and the long-term follow-up of these tumors [1]. There are a few cases reported in the presacral region in the literature. The gold standard treatment for EGISTs is complete surgical excision of the mass. If it is possible, en bloc excision with its surrounding tissue is very important [2]. PATIENT: A 53-year-old woman. The patient provided informed consent to use images and videos of the procedure. INTERVENTIONS: This is a step-by-step illustration for resection of a retroperitoneal EGIST in the presacral area. The patient was a 53-year-old, gravida 3, para 3 white woman. She presented with abdominal pain for 5 months. Magnetic resonance imaging showed a 4-cm diameter solid mass localized at the presacral area. Laboratory test results for tumor biomarkers were as follows: cancer antigen (CA) 125 = 40 U/mL (normal values <35 U/mL), CA 19-9 = 29 U/mL (normal values <37 U/mL), carcinoembryonic antigen = 2.1 ng/mL (normal values <3 ng/mL), and CA 15.3 = 18 U/mL (normal values <35 U/mL). Because of malignancy suspicion, gastroscopy and colonoscopy were performed and revealed no abnormality. The Papanicolaou smear and endometrial biopsy results were negative. After preparation of the patient, laparoscopy was performed. After placement of an 11-mm umbilical port and three 5-mm abdominal ports, the pelvis and abdomen were explored and revealed a 4-cm retroperitoneal mass in the presacral area. The peritoneum overlying the presacral mass was incised and the retroperitoneum explored. Given the proximity to the mass, left ureterolysis was performed. The mass was located on the left internal iliac vein and dissected carefully. The retroperitoneal attachments were resected, and the presacral mass was removed without any complications. In order not to widen the abdominal incisions, a posterior colpotomy was performed in the cul-de-sac at equal distances from the uterosacral ligaments. An Endobag (Covidien, Dublin, Ireland) was introduced through the 5-mm port site at the posterior colpotomy. The specimen was removed in the Endobag through posterior colpotomy. MEASUREMENTS AND MAIN RESULTS: The procedure was performed without any complications. The patient had an uneventful postoperative course and was discharged home on postoperative day 2. Pathology revealed a 4-cm retroperitoneal EGIST with negative margins. Immunohistochemistry measurements revealed hematoxylin-eosin; CD117; S100 positivity; and CD34, CD68, desmin, and DOG1 negativity. The cell type was mixed (spindle and epithelioid type). The mitotic rate was 1 to 2/50 high-power fields. The patient has been disease free since the completion of surgery. CONCLUSION: Laparoscopic complete resection of the retroperitoneal EGIST in the presacral area is successfully performed in this patient. The patient presented by us is an example showing that minimally invasive procedures can be used in the treatment of this type of tumor in the presacral area. The key point in this operation is to control the relationship of vascular structures and a ureter with a tumor in every step to avoid any injury.

Evaluation of serum M30 and M65 activity in patients with stage-I endometrial cancer.

We aimed to analyse the prognostic value of serum oxidative stress parameters and apoptotic markers of serum M30/65 levels in endometrial cancer patients. Serum M30/65 levels and oxidative stress parameters were evaluated in 52 women with stage I endometrial cancer (n = 26) and a control group of healthy females (n = 26). The total antioxidant status (p = .002), oxidative stress index (p = .003) and serum M30/65 levels (p < .001) were significantly higher in women with stage-I endometrial cancer in comparison to the control group. Furthermore, serum M30/65 levels were significantly lower on postoperative day 8, compared to preoperative levels (p = .001 and p < .001, respectively), in the endometrial cancer group. Although impaired apoptotic activity plays a crucial role in the aetiopathogenesis of endometrial cancer, oxidative stress may be instrumental in malignant transformation. We concluded that measurement of M30/65 levels would be beneficial in the follow-up of women with endometrial cancer. Impact Statement What is already known on this subject: Although M30 has been evaluated as a marker of apoptosis in tissue samples from women with endometrial cancer (EC), no previous studies have simultaneously analysed serum M30 and M65 levels and oxidative stress in patients with stage-I EC. What the results of this study add: Total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI) and serum M30/65 levels were significantly higher in women with stage I EC in comparison to the control group. Furthermore, serum M30/65 levels were significantly lower on postoperative day 8, compared to preoperative levels, in the EC group. The fact that pre-operative M30/M65 levels were higher than the post-operative levels may be very important in early-stage EC What the implications are of these findings for clinical practice and/or further research: Although impaired apoptotic activity plays a crucial role in the aetiopathogenesis of EC, oxidative stress may be instrumental in malignant transformation. The fact that serum M30/M65 levels decreased in accordance with the reduction of post-operative tumour burden led us to conclude that measurement of M30/65 levels would be beneficial in the follow-up of women with EC.

Assessment of Apoptotic Activity Dysregulation and Oxidative Stress in the Development of Epithelial Ovarian Cancer: A Case-Controlled Descriptive Analysis.

AIM: In the present study, we aimed to assess whether oxidative stress and apoptotic activity play a role in the development of epithelial ovarian cancer (EOC). METHODS: The study group included patients with EOC (n = 26) and benign ovarian tumour (BOT) (n = 25), while 30 healthy women were employed as a control group. Venous blood samples were drawn to evaluate oxidative stress parameters and serum M30/M65 antigen levels before surgery. In addition, blood samples were taken for the second time on postoperative day 8 to analyse whether the postoperative tumour load was decreased. RESULTS: When the groups were assessed regarding oxidative stress, the highest values were detected in patients with EOC. Serum M30/M65 levels were found to be higher in patients with EOC when compared to the other groups (p < 0.001). A significant decrease was determined in the M30/M65 levels of serum samples taken on postoperative day 8 from the patients in the EOC and BOT groups (p < 0.001). CONCLUSION: Our results suggest that dysregulation of apoptotic activity could be effective in the development of ovarian tumoural tissue, whereas oxidative stress could be effective in malignant transformation.

Comparison of tissue prolidase enzyme activity and serum oxidative stress level between pregnant women with placental abruption and those with a healthy pregnancy.

PURPOSE: Although placental abruption is an acute condition, it is thought that the underlying pathology is chronic vasculopathy. Collagen is one of the important components of vascular structure, and there is a correlation between collagen turnover and prolidase enzyme activity (PEA). Thus, our aim was to assess whether there is a difference in serum oxidative stress level and PEA between pregnant women with placental abruption and those with a healthy pregnancy. METHODS: The study group consisted of 36 pregnant women who underwent caesarean section with a diagnosis of placental abruption, while the control group comprised 36 pregnant women who underwent caesarean section due to obstetric reasons. Venous blood samples were drawn from all patients before caesarean section. In addition, tissue samples were obtained during caesarean section to evaluate tissue PEA. RESULTS: No significant differences in demographic characteristics were detected between groups (p > 0.05). Oxidative stress parameters, such as total oxidant status and oxidative stress index, were found to be significantly higher in the study group (p < 0.001). Placental tissue PEA was found to be significantly higher in pregnant women with placental abruption (557.21 ± 135.41 vs. 426.68 ± 131.57 U/g, p < 0.001). In addition, a significant positive correlation was detected between PEA and oxidative stress parameters (r = 0.332, p = 0.004). CONCLUSIONS: Our results indicated that elevated tissue PEA and serum oxidative stress levels are closely related to placental abruption. Thus, we think that increased collagen turnover may have a significant role in the aetiopathogenesis of placental abruption.

Does sildenafil have protective effects against ovarian ischemia-reperfusion injury in rats?

PURPOSE: The aim of this study was to evaluate the protective activity of sildenafil treatment against ischemia-reperfusion damage created experimentally in rat ovaries. METHODS: For this study, 42 female Wistar rats were used, and the rats were separated randomly into six groups consisting of seven rats each: sham, torsion, torsion-detorsion, torsion-detorsion + saline, torsion-detorsion + sildenafil 0.7 mg/kg and torsion-detorsion + sildenafil 1.4 mg/kg. With the exception of the sham group, an ovarian torsion procedure was implemented in all other groups for 2 h. Then, a detorsion procedure was implemented to the groups for 2 h, with the exception of the torsion group. Medications were given intraperitoneally, one-half hour before the detorsion procedure in the saline, 0.7 and 1.4 mg/kg sildenafil groups. Finally, 2 ml of blood samples was drawn for markers of oxidative stress, while the ovaries which were torsioned for the histological examination were extracted from all rats. RESULTS: According to the histopathological damage scores, the least damage was seen in the sham group and the most damage was seen in the torsion-detorsion group. The sildenafil treatment appeared to be effective in decreasing tissue damage; however, there were no differences between the dosages. Additionally, it was determined that the oxidative stress levels were higher in the torsion-detorsion group, while the sildenafil treatment caused a significant decrease in the oxidative stress levels. CONCLUSIONS: The results of the current study showed that the sildenafil treatment can be effective in preventing tissue damage and oxidative stress induced by the ischemia-reperfusion created in rat ovaries.

Myomectomy during caesarean: a retrospective evaluation of 16 cases.

AIM: To evaluate the results and complications of myomectomy carried out during caesarean section. MATERIALS AND METHOD: A retrospective study of 16 patients who underwent myomectomy concurrently with caesarean section in our clinic between January 2009 and September 2012 was conducted. The pre- and postoperative haemoglobin values, number, size and total volume of excised fibroid nodules, location of fibroids, duration of operation, and duration of hospital stay of all patients were retrospectively investigated. RESULTS: While the most common leiomyoma was transmural myoma, with ten cases encountered, the most common location was in the corpus anterior, where transmural myomas were seen in five patients. The volume of the excised leiomyomata ranged from 84 to 3.300 cm³. The average preoperative haemoglobin value of our patients was 11.4 g/dl, while the postoperative value was 10.3 g/dl. Of 16 patients included in the study, two required blood transfusions due to excessive bleeding. Uterine defects caused by the myomectomy were closed without problems in all patients, and no patient required a hysterectomy. The average time for the myomectomy and caesarean section procedure was 56.1 min. All patients were discharged without problems an average of 3.25 days after the operation. CONCLUSION: Myomectomy carried out during caesarean section is a trusted surgical intervention regardless of the size of leiomyomata.

Prevalence of ß-thalassemia trait and abnormal hemoglobins in Sanliurfa Province in southeast Turkey.

Thalassemia is one of the most common hereditary disorders in Turkey, especially in the Mediterranean region of the country. The purpose of this study was to determine the frequency of the ß-thalassemia (ß-thal) trait and abnormal hemoglobins (Hbs) in couples who applied for premarital screening in Sanliurfa Province, in the southeastern region of Turkey, a province with the first reported incidence of ß-thal and abnormal Hbs. In the present study, in order to detect the prevalence of the ß-thal trait and abnormal Hbs in Sanliurfa Province, Turkey, a total of 37,962 couples who applied for premarital screening were analyzed. From January 2011 through March 2014, red blood cell (RBC) counts and Hb fractionation were carried out by a cell counter and high performance liquid chromatography (HPLC), respectively. The prevalence of ß-thal with high Hb A2 (>3.5%) values was found at rates of 2.44% (n = 1853) in Sanliurfa Province. Additionally, the abnormal Hb rate was 1.57% (1193/75,924), and Hb S (HBB: c.20T > A), Hb C (HBB: c.19G > A) and Hb D-Punjab (HBB: c.364G > C) were reported as 0.50, 0.38 and 0.69, respectively. This study is the first to establish the frequency of ß-thal and abnormal Hbs in Sanliurfa Province, which has the highest birth frequency. We report that the frequency of the ß-thal trait is at a high-risk level compared to other cities in Turkey. Due to the high risk of ß-thal in Sanliurfa Province, a premarital screening program would be of great value in informing parents about offspring with ß-thal.

Increased prolidase activity and oxidative stress in PCOS.

AIM: Matrix metalloproteinases (MMPs) have been considered to have a role in various pathological processes, including inflammatory response, cardiovascular disease and recently also in ovarian dysfunction. Since prolidase could be accepted as a matrix metalloproteinase, on the biochemical level, we aimed to evaluate serum prolidase activity and oxidative-antioxidative status in patients with polycystic ovary syndrome (PCOS) and healthy individuals. MATERIALS AND METHODS: Thirty-three PCOS patients and 28 healthy nonhyperandrogenic women were studied. Levels of prolidase activity, total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (T) and prolactin (PRL) were calculated. RESULTS: Levels of prolidase activities, total oxidant status, oxidative stress index, LH, PRL, and T were significantly higher in PCOS group than in the control group. Total antioxidant status levels were lower in PCOS group than healthy group, but it was not statistically significant. There was no significant difference between PCOS and control groups in term of FSH. CONCLUSION: Women with PCOS have increased serum prolidase activity and oxidative stress. It might be hypothesized that elevated serum prolidase activity and oxidative stress may be associated with increased cardiovascular risk in PCOS and/or menstrual irregularities associated with this syndrome.

Relationship between oxidative stress parameters and cystatin C levels in patients with severe preeclampsia.

BACKGROUND AND OBJECTIVE: Oxidative stress is believed to play a role in the development of preeclampsia (PE). It is known that an increased cystatin C level is also associated with PE. The aim of this study was to investigate the relationship between oxidative stress parameters and cystatin C levels in patients with severe PE. MATERIAL AND METHODS: Forty-four patients with severe PE and 40 healthy pregnant women were recruited for the study. All study subjects were divided into 2 groups: group 1 (n=44) consisted of patients with severe PE, and group 2 (n=40) included healthy pregnant subjects. Blood samples were obtained from all subjects in order to measure the cystatin C level, total antioxidant status, and total oxidant status. The oxidative stress index was calculated. RESULTS: The group 1 had significantly higher cystatin C, total oxidant status, oxidative stress index levels and lower total antioxidant status level as compared with the group 2 (P=0.001, P<0.001, P<0.001, P=0.036, respectively). The serum cystatin C level was significantly correlated with the oxidative stress index (r=0.609, P<0.001). CONCLUSIONS: The present study demonstrated that both oxidative stress and cystatin C levels were increased in patients with PE, and the increased cystatin C levels seem to be a consequence of oxidative stress.

Laparoscopic removal of the cervical stump for a cervical solid mass in a patient with previous supracervical hysterectomy

The aim of this video article is to demonstrate a surgical tutorial in which a cervical mass was resected with laparoscopic removal of the cervical stump after supracervical hysterectomy (SCH). First, the dense adhesions due to previous operation were dissected. Then the dissection was continued carefully in order to identify bilateral ureters and iliac arteries. A cervical mass of nearly 4 cm was identified at the posterosuperior aspect. The mass was separated from surrounding tissue and removal of the cervical stump was performed. This is an exciting case, illustrating that minimally invasive procedures, such as laparoscopic removal of the cervical stump after SCH, can be used in the management of benign cervical tumor. The main feature of this operation was to check the relationship of tumor with adjacent structures, including ureters, bowel and vascular structures at every step to prevent unwanted injuries.

Decreased serum prolidase activity and increased oxidative stress in early pregnancy loss.

AIMS: To compare the levels of serum prolidase activity and oxidative stress markers including total oxidative status (TOS), total antioxidant capacity (TAC), lipid hydroperoxide (LOOH) and total free sulfhydryl (-SH) in healthy pregnant women without early pregnancy loss (EPL) and women with EPL. METHODS: Serum samples were obtained from 45 healthy first-trimester pregnancies and 45 pregnancies complicated with EPL. We have measured serum prolidase activity, TAC, TOS, -SH and LOOH levels spectrophotometrically. RESULTS: Serum prolidase, TAC and -SH levels were significantly lower in the women with EPL than in the women without EPL (p <0.001, p = 0.001, p < 0.001, respectively), whereas TOS and LOOH levels were significantly higher (p < 0.001, p = 0.004, respectively). Prolidase activity was negatively correlated with TOS and LOOH levels (r = -0.299, p = 0.004; r = -0.323, p = 0.002, respectively), while positively correlated with TAC and -SH levels (r = 0.232, p = 0.028, and r = 0.418, p <0.001, respectively) CONCLUSION: Findings of this study have shown that serum prolidase activity and oxidative stress are significantly associated with the presence of EPL, and the correlation between serum prolidase activity and the markers of oxidative stress was reflected in increased serum TOS and LOOH levels and decreased serum TAC and -SH levels.

Complete duplication of left and right external iliac vein: two case reports and review of the literature.

The femoral vein is named as external iliac vein as it progresses in the cranial direction. In the current case report, a rare variation of the left external iliac vein that was found incidentally during pelvic lymph node dissection in a 36-year-old woman is presented. We also found the same variation at the right side in a 55-year-old woman during laparoscopic pelvic lymph node dissection. Duplication of left external iliac vein throughout its entire length was detected during the operation of the patient with diagnosis of malignant ovarian serous tumor. The other patient with duplication of the right external iliac vein was diagnosed as stage IA, grade 3 endometrial cancer. These rare variations of external iliac veins are of great importance in gynecologic oncologic surgery and other operations requiring pelvic lymph node dissection. Here, we presented and discussed the importance of this variation with the photographs taken during the operation.

Massive Ascites and Pleural Effusion in Preeclampsia.

Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation and complicates approximately 2-8% of all pregnancies. Release of vasoconstrictive agents, endothelial damage, hyperpermeability of the capillaries and microangiopathic haemolysis involves the basic pathophysiology. It has variable clinical presentation. Here, we report a case of severe preeclampsia who developed postpartum massive ascites and pleural effusion. Primigravid patient was admitted to our clinic at 35 weeks of gestation with very high blood pressure. In biochemical analysis, Alanine aminotransferase (ALT) was 401 U/L, Aspartate aminotransferase (AST) was 292 U/L. An emergency caesarean section was performed because of fetal distress. On the 2nd post-operative day, abdominal distension and severe abdominal pain occurred. On the 3rd post-operative day, her abdominal distension increased and Ultrasonography (USG) revealed massive ascites. Abdominal drainage was performed and albumin infusion was administered. On postoperative day 4, she still had abdominal distension and concomitant respiratory distress. Computed Tomography (CT) showed ascites and bilateral pleural effusion. Her complaint regressed on the following days.

Surgical management of 58 patients with placenta praevia percreta.

OBJECTIVE: The aim of this study is to present our experience with surgical management of placenta praevia percreta. METHODS: This study was conducted from January 2009 through March 2014 at Harran University Hospital and was a chart review of all patients who underwent caesarean hysterectomy with the placenta left in situ for placenta praevia percreta. RESULTS: The study group comprised 58 patients. All of the patients underwent ultrasound mapping of the placental area before surgery. Emergent caesarean hysterectomy was only performed in 9 patients; 49 patients underwent planned caesarean hysterectomy. Bilateral internal iliac artery ligation was performed in all cases. Four patients (6.9 %) had bladder damage, one patient (1.7 %) required cystotomy, and one patient (1.7 %) required re-operation because of postoperative hemorrhage. The mean operative time was 141.6 (range: 95-355) minutes. Only 17 (29.3 %) patients were administered more than four units of red blood cells. There was no ureteral damage or maternal death. Furthermore, there were no complications in 42 (72.4 %) patients. CONCLUSIONS: Caesarean hysterectomy for placenta praevia percreta is associated with increased maternal morbidity. However, preoperative diagnosis of placenta praevia percreta, ultrasound mapping of the placenta, and the presence of a multidisciplinary experienced team may decrease maternal morbidity and mortality. Moreover, the urinary system may be protected in the patients with placenta praevia percreta without serious morbidity.

Trophoblastic E-cadherin and TGF-beta expression in placenta percreta and normal pregnancies.

OBJECTIVE: This study aimed to evaluate whether trophoblastic transforming growth factor beta (TGF-ß) and E-cadherin expression levels have a role in placenta percreta (PP) aetiopathogenesis. METHODS: This study was carried out in the Obstetrics & Gynecology and Pathology Departments of Harran University Medicine School. Forty-four women who underwent caesarean section for PP and other obstetric reasons were included in this study. PP was defined as the detection of placental invasion during the histopathological examination of the hysterectomy specimen, which passes the uterine wall as a whole layer and involves the uterine serosa. Placental tissue samples were collected from all pregnant patients to evaluate TGF-ß and E-cadherin expression levels. RESULTS: No significant difference was found in demographic features, including age, gestational week, number of pregnancies and body mass index, among the groups. Immunohistochemical staining against E-cadherin, a cell adhesion molecule, showed significantly reduced staining in PP patients (p = 0.048). TGF-ß staining was also low in PP patients, but this difference was not significant (p = 0.107). CONCLUSIONS: The findings of this study suggest that a decrease in trophoblastic E-cadherin expression may have an important role in PP aetiopathogenesis.

Can circulating M30 and M65 levels be beneficial markers in the diagnosis and management of patients with complete hydatidiform mole?

OBJECTIVE: The objective of this study is to evaluate the prognostic value of M30 and M65 levels as markers of apoptotic activity and maternal serum oxidative stress in patients with complete hydatidiform mole (CHM). METHODS: In total, 68 pregnant women were included in the study. The study group included 34 pregnant with CHM, while 34 healthy pregnant were employed as a control group. Venous blood samples were drawn to assess the maternal serum oxidative stress and M30-M65 levels. In addition, a second blood sample was drawn from patients with CHM on day 8 after dilatation evacuation. RESULTS: Maternal serum oxidative stress and M30-M65 levels were found to be significantly higher in patients with CHM as compared with the control group. It was found that serum ß-subunit of human chorionic gonadotropin (ß-hCG) level had a significant positive correlation with M30-M65 levels in patients with CHM. In addition, serum M65 level was found to be as effective as ß-hCG in the identification of the patients with CHM. CONCLUSION: Our results indicated that oxidative stress and apoptosis may play significant roles in CHM development. In addition, it seems that serum M30-M65 levels can presumably be an ancillary laboratory test to ß-hCG in the diagnosis and follow-up of the patients with CHM.