Prognostic role of maspin expression in patients with cervical dysplasia and cervical cancer.

AIM: Mammary serine protease inhibitor (maspin) acts as a tumor suppressor through the inhibition of cancer cell invasion and metastasis. Paradoxically, maspin levels are increased in some types of malignant cells. The aim of this study was to investigate the maspin expression in cervical dysplasia and cervical cancer, and to analyze its' relation with survival. METHODS: Maspin expression was detected by immunohistochemistry using labeled streptavidin biotin method to determine cytoplasmic and nuclear maspin expressions in cervical intraepithelial neoplasia grade 1 (CIN1), cervical intraepithelial neoplasia grade 2 (CIN2), cervical intraepithelial neoplasia grade 3 (CIN3) and cervical cancer. RESULTS: A total of 89 patients with CIN (29 cases of CIN1, 30 cases of CIN2 and 30 cases of CIN3), and 27 patients with cervical cancer were included to the study. 7.8% of the patients with CIN had maspin staining positivity. On the other hand maspin staining was positive in 20 of 27 patients (74.1%) with cervical carcinoma (P = 0.001). Of these patients 20 (100%) had cytoplasmic, and 8 (40%) had nuclear maspin staining positivity. Cytoplasmic maspin immunoreactive scores were found to be significantly higher in carcinoma group when compared to the patients with CIN1/3 (respectively; P = 0.01, P = 0.02). No difference was noted for nuclear maspin expression. Significant overall survival advantage was detected for patients with nuclear maspin staining (P = 0.03). CONCLUSION: The current study shows that nuclear maspin expression is related with better overall survival in cervical cancer. Maspin staining can be a useful diagnostic marker to discriminate cervical intraepithelial neoplasia from cervical carcinoma.

A potential novel treatment strategy: inhibition of angiogenesis and inflammation by resveratrol for regression of endometriosis in an experimental rat model.

The aim of our study was to evaluate the effectiveness of resveratrol in experimentally induced endometrial implants in rats through inhibiting angiogenesis and inflammation. Endometrial implants were surgically induced in 24 female Wistar-Albino rats in the first surgery. After confirmation of endometriotic foci in the second surgery, the rats were divided into resveratrol (seven rats), leuprolide acetate (eight rats), and control (seven rats) groups and medicated for 21 d. In the third surgery, the measurements of mean areas and histopathological analysis of endometriotic lesions, VEGF, and MCP-1 measurements in blood and peritoneal fluid samples, and immunohistochemical staining were evaluated. After treatment, significant reductions in mean areas of implants (p < 0.01) and decreased mean histopathological scores of the implants (p < 0.05), mean VEGF-staining scores of endometriotic implants (p = 0.01), and peritoneal fluid levels of VEGF and MCP-1 (p < 0.01, for VEGF and p < 0.01, for MCP-1) were found in the resveratrol and leuprolide acetate groups. Serum VEGF (p = 0.05) and MCP-1 (p = 0.01) levels after treatment were also significantly lower in the resveratrol and leuprolide acetate groups. Resveratrol appears to be a potential novel therapeutic agent in the treatment of endometriosis through inhibiting angiogenesis and inflammation. Further studies are needed to determine the optimum effective dose in humans and to evaluate other effects on reproductive physiology.

The effect of captopril on endometriotic implants in a rat model.

OBJECTIVE: To determine the effects of captopril on experimentally induced endometriosis in a rat model. STUDY DESIGN: Twenty-four adult, mature female Wistar-Albino rats in which endometriotic implants were induced by transplanting autologous uterine tissue to ectopic sites on the peritoneum. After the endometriotic implants were formed surgically, the 24 rats were randomly divided into three groups. Group 1 (captopril group, eight rats) were given 50 mg kg(-1)d(-1) of oral captopril for 21 d. Group 2 (leuprolide acetate group, eight rats) were given a single 1 mg kg(-1) subcutaneous injection of leuprolide acetate. Group 3 (control) were given no medication and served as controls (eight rats). The surface area of the endometriotic implants and the score of histologic analysis. Also, VEGF and MCP-1 levels in peritoneal fluids and bloods were analyzed. RESULTS: At the beginning of the medical treatment, the mean surface areas of the endometriotic implants were comparable in all three groups. At the end of the treatment the mean implant surface area in the captopril group and leuprolide acetate group was less than that in the control group. Mean histopathological examination score for the implants post treatment was lower in the captopril and leuprolide acetate groups. Peritoneal fluids VEGF level in the captopril and leuprolide acetate groups was lower than that in the control group. The post-treatment MCP-1 level was also lower in the captopril and leuprolide acetate groups than in the control group. The serum VEGF and MCP-1 levels post treatment were significantly lower in the captopril and leuprolide acetate groups than in the control group. CONCLUSION: Administration of captopril reduced the size and progression of endometriotic lesions in a rat model.

Zinc and homocysteine levels in polycystic ovarian syndrome patients with insulin resistance.

In this study, our objective was to evaluating the value of serum zinc levels as an etiologic and prognostic marker in patients with polycystic ovarian syndrome. We conducted a prospective study, including 53 women with polycystic ovarian syndrome and 33 healthy controls. We compared serum zinc levels, as well as clinical and metabolic features, of the cases. We also compared serum zinc levels between patients with polycystic ovarian syndrome with insulin resistance. Mean zinc levels were found to be significantly lower in patients with polycystic ovarian syndrome than healthy controls. Multiple logistic regression analysis of significant metabolic variables between polycystic ovarian syndrome and control groups (serum zinc level, body mass index, the ratio of triglyceride/high-density lipoprotein cholesterol, and homocysteine) revealed that zinc level was the most significant variable to predict polycystic ovarian syndrome. Mean serum zinc levels tended to be lower in patients with polycystic ovarian syndrome with impaired glucose tolerance than patients with normal glucose tolerance, but the difference was not statistically significant. In conclusion, zinc deficiency may play a role in the pathogenesis of polycystic ovarian syndrome and may be related with its long-term metabolic complications.

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

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

NLF2 gene expression in the endometrium of patients with implantation failure after IVF treatment.

The aim of this study was to analyze the expression of microfibril-associated protein 2 (MFAP2), microfibril-associated protein 5 (MFAP5) and nuclear localized factor 2 (NLF2) genes in patients with repeated IVF failure and compare with fertile population. Total RNA was isolated from 38 patients (repeated implantation failure, group 1, n=22; fertile patients, group 2, n=16). mRNA expression levels were measured quantitatively using real-time polymerase chain reaction. Our results showed that mRNA expression of NLF2 significantly decreased in the infertility group as compared to control group (P=0.023). In addition a marked decrease was observed in the expression of MFAP2 in women with repeated implantation failure. In conclusion, NLF2 gene expression levels and differences in MFAP2 and MFAP5 gene expressions (albeit being insignificant) between infertile group and control group draw attention to a genetic basis under implantation failure.

Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy in postmenopausal bleeding.

OBJECTIVE: To compare the diagnostic accuracy of transvaginal sonography (TVS), saline infusion sonohysterography (SIS) and hysteroscopy (HS) with respect to pathological diagnosis in the detection of uterine cavity abnormalities associated with abnormal uterine bleeding among postmenopausal women. METHODS: Being a prospective, investigator-blind trial, the present study was conducted on 137 postmenopausal women, with abnormal uterine bleeding, admitted to the Department of Obstetrics and Gynecology of Istanbul Bilim University, Florence Nightingale Hospital and Fertigyn Woman Health and IVF Center. After TVS, all patients underwent SIS using Cook Soft 500 IVF transfer catheter and HS, consecutively. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated to compare the diagnostic accuracy of TVS, SIS and HS. RESULTS: Most commonly encountered endometrial lesions were polypoid lesion (38.0%) and hyperplasia (28.4%) among our study population consisting of 137 women (mean age 61.6 ± 9.6 years) in their postmenopausal stage. Overall sensitivity rates were 70.0% for TVS, 89.6% for SIS and 92.3% for HS, while the overall specificity rates were 50.0, 77.3 and 80.7%, respectively. HS had PPV of 96.2% and NPV of 65.3%, whereas PPV was determined to be 80.9 versus 95.3% and NPV was 35.4 versus 58.3% for TVS and SIS, respectively. CONCLUSIONS: As an easy to perform, safe and well-tolerated procedure yielding high diagnostic accuracy, saline infusion SIS via this catheter seems to be superior to TVS and very close to HS. It may be used as the primary method for the detection of uterine abnormalities among postmenopausal women with abnormal uterine bleeding.

Prevalence of human papillomavirus (HPV) and HPV-16 genotyping by real-time PCR in patients with several cervical pathologies.

PURPOSE: this study was planned to evaluate the prevalence of HPV (excepting type 16) and HPV 16 by real-time PCR in colposcopy patients and to interprete the results with age, age of first sexual intercourse (FSI), parity and Pap smear results. METHODS: one hundred and two colposcopy patients (50 and 52 of the patients were classified as colposcopy positive and negative, respectively) applying to Gynecology clinic were included. HPV (excepting type 16) and HPV 16 were detected by realtime PCR using the L1 region. Real-time nested amplifications of MY09/11 products were done by GP5+/GP6+ primers and Cyanine-5 labeled HPV and HPV 16 DNA specific probe after HPV DNA extraction by phenol chloroform isoamylalcohol. RESULTS: HPV (excepting type 16) and HPV 16 were positive in 12% and 18% of the colposcopy positive patients respectively. HPV (excepting type 16) and HPV 16 were positive in 5.7% and 3.8% of the colposcopy negative patients, respectively. CONCLUSION: there was a statistically significant difference between colposcopy positive and colposcopy negative patients comparing HPV 16 with total HPV positivity (p = 0.021 for type 16 and p = 0.010 for total HPV) but there was not a statistically significant difference between colposcopy positive and colposcopy negative patients when we compared HPV (excepting type 16) positivity (p = 0.314). In conclusion, HPV detection and typing may be helpful for cervical cancer screening and prevention.

Prevalence of human papillomavirus (HPV) and HPV-16 genotyping by real-time PCR in patients with several cervical pathologies

PURPOSE: this study was planned to evaluate the prevalence of HPV (excepting type 16) and HPV 16 by real-time PCR in colposcopy patients and to interprete the results with age, age of first sexual intercourse (FSI), parity and Pap smear results. METHODS: one hundred and two colposcopy patients (50 and 52 of the patients were classified as colposcopy positive and negative, respectively) applying to Gynecology clinic were included. HPV (excepting type 16) and HPV 16 were detected by realtime PCR using the L1 region. Real-time nested amplifications of MY09/11 products were done by GP5+/GP6+ primers and Cyanine-5 labeled HPV and HPV 16 DNA specific probe after HPV DNA extraction by phenol chloroform isoamylalcohol. RESULTS: HPV (excepting type 16) and HPV 16 were positive in 12 percent and 18 percent of the colposcopy positive patients respectively. HPV (excepting type 16) and HPV 16 were positive in 5.7 percent and 3.8 percent of the colposcopy negative patients, respectively. CONCLUSION: there was a statistically significant difference between colposcopy positive and colposcopy negative patients comparing HPV 16 with total HPV positivity (p = 0.021 for type 16 and p = 0.010 for total HPV) but there was not a statistically significant difference between colposcopy positive and colposcopy negative patients when we compared HPV (excepting type 16) positivity (p = 0.314). In conclusion, HPV detection and typing may be helpful for cervical cancer screening and prevention.

Effects of hormone replacement therapy on glucose and lipid profiles and on cardiovascular risk parameters in postmenopausal women.

OBJECTIVES: The aim of this study was to evaluate the effects of hormone replacement therapy (HRT) on carbohydrate and lipid metabolisms and cardiovascular risk parameters in healthy postmenopausal women. METHODS: Forty women receiving and 38 women not receiving HRT were included and baseline and sixth month blood pressure, weight, body mass index, waist/hip ratio, blood lipid profile, inflammatory markers (homocysteine, C-reactive protein (CRP) and fibrinogen), hemoglobin A1c (HbA1c) and insulin, and oral glucose tolerance test (OGTT) results were evaluated. RESULTS: The mean age was 52.6+/-4.9 and 52.2+/-5.0 years in the HRT and Control Groups, respectively. Whereas there was no change in the Controls, the weight, waist/hip ratio, and BMI increased and diastolic blood pressure decreased in the HRT patients. LDL-c, VLDL-c and lipoprotein (a) levels were significantly higher in the HRT Group in the sixth month; however, total cholesterol and LDL-c increased in the Controls but VLDL-c and lipoprotein (a) did not. CRP and homocysteine significantly increased and fibrinogen decreased, whereas in the Control Group no significant change was detected. A significant improvement in HbA1c and OGTT was found in both the groups, whereas a significant reduction was measured only in the HRT Group. CONCLUSIONS: In response to 6 months of HRT, there was an increase in weight, BMI, and waist/hip ratio as known cardiovascular risk factors, but no significant impact on lipid profile and glucose metabolism could have been clearly demonstrated. A mixed effect profile of HRT on the state of inflammation (increase in CRP and homocysteine, decrease in fibrinogen) was observed.

Vaginal evisceration after trauma unrelated to previous pelvic surgery.

BACKGROUND: Vaginal evisceration is described as extrusion of intraperitoneal contents secondary to the disruption of the vagina. It is an extremely rare emergency condition. OBJECTIVES: To describe a very rare case of vaginal evisceration that occurred after blunt trauma in a patient with no prior pelvic surgery. CASE REPORT: This report describes vaginal evisceration in a 73-year-old female with no prior pelvic surgery, after blunt trauma. The patient was handled by the cooperation of gynecology and general surgery departments. An immediate surgery was performed after stabilization of the patient and no postoperative complications occurred. CONCLUSION: Whatever be the treatment approach, emergency management of vaginal evisceration is critical to the preservation of a viable bowel. Repositioning of viable bowels into the abdominal cavity and appropriate surgical repair are cornerstones of the treatment.

Recurrent mucinous cystadenoma: a laparoscopic approach.

The second most common epithelial tumor of the ovary is mucinous-type, and it constitutes 8-10% of all ovarian tumors. The recurrence of mucinous cystadenoma is very rare after complete excision. Only four such cases have been reported till date. The case presented in this report is the fifth, who had her initial surgery performed by gynecologic oncology team by laparotomy and was followed up by the same group. After recurrence at the same ovary, the patient underwent laparoscopic evaluation and unilateral salpingoophorectomy was performed. The final histopathological diagnosis was mucinous cystadenoma, just the same as the initial cyst.

Clinical significance of serum MMP-2 and MMP-7 in patients with ovarian cancer.

Matrix metalloproteinases (MMPs) are frequently expressed in malignant tumors and play an important role in tumor invasion and metastasis. The aim of this study was to evaluate role of serum MMP-2 and MMP-7 levels in patients with ovarian cancer. Serum levels of MMP-2 and MMP-7 were measured in 28 patients with ovarian carcinoma, 2 with borderline ovarian tumors, 10 with non-malignant gynecological disease and 30 healthy women by Enzyme-Linked Immunosorbent Assay (ELISA). Serum MMP-7 level was significantly (10.24+/-1.35 ng/ml) higher in the patients with ovarian malign tumors than healthy controls (3.29+/-1.64 ng/ml) (P<0.05). Postoperative levels of MMP-7 (7.68+/-1.17 ng/ml) were significantly lower in patients with malign ovarian tumors than those of preoperative level (10.24+/-1.35 ng/ml) (P<0.05). Serum MMP-2 levels were significantly lower in the patients with ovarian malign tumors (227.51+/-9.91 ng/ml) than those in the healthy controls (279.12+/-73 ng/ml) (P<0.05). There was no significant difference in serum levels of MMP-2 and MMP-7 in patients with benign ovarian disease when compared to healthy controls and patients with malignant disease (P>0.05). As a conclusion, MMP-7 can be a useful serum marker to show disease activity in malignant ovarian tumors.

CD105 expression is an independent predictor of survival in patients with endometrial cancer.

OBJECTIVE: The purpose of this study was to detect the prognostic value of CD105 (endoglin) and also to compare with CD34 and vascular endothelial growth factor (VEGF) in patients with endometrial adenocancer. METHODS: Ninety patients with endometrial carcinoma, who were treated at Gazi University Hospital, were included. Staging was performed according to the FIGO recommendations. Angiogenesis was estimated by using CD105 and CD34 and tested for possible significant relation with age, stage, histologic type, grade, depth of myometrial invasion, lymphovascular space invasion, lymph node metastasis, and overall survival (OS). In addition, VEGF staining intensity and distribution were analyzed with respect to all these variables. RESULTS: The mean age at the time of diagnosis was 57.7 years (range, 28-81 years). The mean microvessel density (MVD) for CD105 was 32.87+/-19.99, and it was 55.46+/-31.25 for CD34 (P<0.001). A significant correlation was noted between these two markers (r=0.257, P=0.02). The mean VEGF score was 4.13+/-1.73, and it was significantly correlated with MV counts determined by CD105 (r=0.291, P=0.006). It was not significantly related with CD34 (r=0.031, P=0.78). With respect to clinicopathological variables, none of the comparisons was found to be significant. The mean follow-up period was 60.5 months. To analyze the prognostic value of MVD, the patients were divided into three groups with respect to quartiles (or=75%). With CD105 staining, the 5-year OS rates for patients with the highest MVD count (>or=75%) were significantly poorer than the remaining two groups (P=0.01 for both). None of the comparisons for CD34 was significant. Survival analysis for VEGF was performed by grouping patients using staining characteristics. No significant difference was noted for OS. Multivariate analysis showed that MVD determined by CD105 correlated significantly and independently with OS (P=0.02). None of the remaining variables was significant in multivariate analysis. CONCLUSION: The current study showed that CD105 is an independent predictor of survival in patients with endometrial cancer. We recommend the use of this highly specific and prognosis-related antigen in further investigations.

Laparoscopic ultrasonography in the management of ovarian cysts.

BACKGROUND: The aim of the study was to determine the role of laparoscopic ultrasonography in the management of ovarian cysts extirpated by means of endoscopic surgery. METHODS: Laparoscopic ultrasonography was used during endoscopic surgery in 14 consecutive patients with an adnexal mass. The diagnostic accuracies of transvaginal and laparoscopic ultrasonography were compared according to the final pathological diagnosis. Estimations of the exact location of the ovarian mass by means of laparoscopic visualization and laparoscopic ultrasonography were compared. The presence of residual tumor tissue after cyst extirpation was monitored with laparoscopic ultrasonography. RESULTS: Using laparoscopic ultrasound and transvaginal ultrasound the correct diagnosis was made in 12 of 14 (85.7%) and 9 of 14 (64.3%) patients, respectively (not significantly different). With laparoscopic visualization, the exact location of the ovarian tumor could be demonstrated in 57.1% (8/14) of the cases, while with laparoscopic ultrasonography precise visualization of the ovarian mass was achieved in all cases (not significantly different). Two patients were found to have residual tumor tissue in the ovary when laparoscopic ultrasonography was performed again after tumor extirpation. CONCLUSION: Laparoscopic ultrasonography seems to be useful in patients with an adnexal mass managed by endoscopic surgery, in terms of evaluating the internal characteristics and predicting the histological diagnosis of the ovarian cyst, deciding on the correct placement of the incision to prevent unnecessary trauma to the ovary, and evaluation of the ovary after cyst extirpation to expose any residual tumor tissue.

Laparoscopic burch colposuspension: comparison of effectiveness of extraperitoneal and transperitoneal techniques.

OBJECTIVE: To compare the effectiveness of two different laparoscopic colposuspension procedures: extraperitoneal approach using mesh fixed with tacks, and transperitoneal approach using sutures. STUDY DESIGN: We conducted a retrospective study of all patients (n = 64) who had undergone two different techniques of laparoscopic Burch colposuspension without additional surgeries over a 6-year period. Thirty-six women underwent laparoscopic transperitoneal colposuspension with using nonabsorbable sutures (group A), whereas 28 women underwent laparoscopic extraperitoneal colposuspension with using mesh and preperitoneal balloon dissection technique (group B). Cure rate was assessed by simple cystometry with a cough stress test in the standing position. Both groups were compared with regard to cure rates, operative time, length of hospital stay, complications, estimated blood loss, and total hospital charges. RESULTS: The mean times to follow-up were 25.7 months in the group A and 27.3 months in the group B (P = 0.082). At last follow-up, 33 of 36 (91.7%) patients in the group A and 23 of 28 (82.1%) patients in the group B were continent (P = 0.22). The other results were as follows for group A and B, respectively: average duration of surgery, 58.1 compared with 46.8 min (P = 0.001); average hospital stay, 2.05 compared with 1.57 days (P = 0.02); the intraoperative complication rate, 8.3% compared with 7.1% (P = 0.62). The total hospital charges for the group B were found significantly higher (US dollars 2,234 versus US dollars 1,348, P = 0.001). CONCLUSION: Although we found higher cure rates in laparoscopic colposuspension with the transperitoneal approach using sutures than the extraperitoneal approach using mesh fixed with tacks, there was no statistically significant difference between the two procedures. In comparison with extraperitoneal mesh technique, lower cost is the superiority of the transperitoneal suture technique.

Ovarian wedge resection by minilaparatomy in infertile patients with polycystic ovarian syndrome: a new technique.

OBJECTIVE: To determine the effects of ovarian wedge resection by minilaparotomy in infertile patients with polycystic ovarian syndrome (PCOS). STUDY DESIGN: One hundred and thirty-four anovulatory patients with PCOS, who were previously treated with clomiphene citrate and gonadotropins and did not conceive were operated via minilaparotomy with microsurgical principles and ovarian wedge resection was performed on each subject. Pregnancy rates and adhesion formation were investigated retrospectively. RESULTS: A total of 121 pregnancies were achieved in 2 years (90%). One hundred and four patients conceived within the first 6 months (78%) and the remaining 17 patients conceived within 2 years (13%) following the operation. Sixty-eight patients had a second pregnancy later. In the post-operative period, 24 patients had cesarean delivery and 20 had diagnostic laparoscopy. Out of these 44 patients, only 5 of them were found to have minimal adhesions. CONCLUSION: This technique offers high pregnancy rates and minimal adhesion formation. Ovarian wedge resection by minilaparotomy might be an alternative treatment approach in patients with PCOS who did not conceive with standard ovulation induction protocols.