The effectiveness of the double B-lynch suture as a modification in the treatment of intractable postpartum haemorrhage.

A broader range of more effective compression techniques are needed in the patients who have an intractable postpartum haemorrhage due to uterine atony despite medical treatment and B-Lynch sutures. The aim of this study was to report the outcome of a series of patients with haemorrhage who were managed by double B-Lynch suture. Fourteen patients who were treated in a tertiary hospital between July 2010 and February 2015 were included in the study. The intractable haemorrhage rate was 0.35% over 5 years (14/4000 births). Bleeding was controlled in all the patients with a double B-Lynch suture. The mean age of the patients was 24 ± 3.4 years. The mean estimated blood loss was 1696 ± 272.075 mL, and the mean transfusion rate was 4.2 ± 2.5 units. Pregnancy was observed in five patients at follow up. The double B-Lynch suture seems to be an effective and reliable solution to an intractable postpartum haemorrhage resulting from uterine atony and has no unfavourable impacts on fertility. It should be considered before the use of any aggressive surgical techniques such as a hypogastric artery ligation or a hysterectomy. This the first study to investigate the effectiveness of the double B-Lynch suture, and we showed that the hysterectomy and/or hypogastric artery ligation rate can be decreased by adding a second B-Lynch suture in cases where the medical treatment or a single B-Lynch has failed. Impact statement What is already known on the subject? Uterine atony is the most common cause of a primary postpartum haemorrhage. When a simple massage of the uterus and medication failed to manage this condition, various surgical solutions have been sought, including uterine compression sutures, uterine artery ligation, devascularisation of the uterus, internal iliac artery ligation and, ultimately, a hysterectomy. The B-Lynch suturing technique is particularly useful because of its simplicity of application, life-saving potential, relative safety and capacity for preserving the uterus and subsequent fertility. To-date, this suturing technique, when applied correctly, has been successful with no problems and no apparent complications. However in the cases of when it falls, usually a hysterectomy or a hipogastric artery ligation is preferred. What does this study add? A 'double B-Lynch suture seems to be an effective and reliable method in an intractable postpartum haemorrhage due to a uterine atony and has no unfavourable impact on fertility'. What are the implications of these findings for clinical practice? The double B-Lynch suture seems to be an effective, reliable and technically easy method. With this aspect, it might be considered before any aggressive surgical techniques, such as a hypogastric artery ligation and hysterectomy in selected cases.

Endocan is a predictor of increased cardiovascular risk in women with polycystic ovary syndrome.

PURPOSE: Endocan is a proteoglycan secreted mainly from endothelial cells. It has been implicated that there is a link between endocan and endothelial dysfunction. Polycystic ovary syndrome (PCOS) is a reproductive and metabolic disease associated with increased risk of cardiovascular events. The aims of this study were to ascertain whether circulating endocan levels are altered in women with PCOS, and whether there is an association between endocan and carotid intima media thickness (cIMT). MATERIALS AND METHODS: This cross-sectional study included 80 women with PCOS and 80 age- and BMI-matched controls without PCOS. Circulating endocan levels were measured using ELISA. Metabolic, hormonal parameters and cIMT were determined. 2-h oral glucose tolerance test (2-h OGTT) was performed on all women. RESULTS: Circulating endocan levels were significantly elevated in women with PCOS compared with controls (5.99 ± 2.37 vs. 3.66 ± 1.79 ng/ml, P < 0.001). Endocan levels positively correlated with BMI, homeostasis model assessment of insulin resistance (HOMA-IR), free androgen index (FAI), high-sensitivity C-reactive protein (hs-CRP), and cIMT in both PCOS and control groups. Endocan levels did not correlate with fasting blood glucose, 2-h OGTT, A1C and lipid parameters. Multiple linear regression analysis revealed that endocan is an independent predictor for cIMT (ß = 0.128, 95% CI = 0.118-0.138, P = 0.011). CONCLUSIONS: Circulating endocan levels are significantly higher in women with PCOS and endocan is independently associated with cIMT. Elevated endocan levels can be a predictor of increased cardiovascular risk in PCOS subjects.

Relations of Platelet Indices with Endometrial Hyperplasia and Endometrial Cancer.

BACKGROUND: Platelets are blood elements thought to play a role in the immune system and therefore tumor development and metastasis. Platelet activation parameters such as mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) can be easily evaluated with the whole blood count and have been studied as markers of systemic inflammatory responses in various cancer types. Our aim in this study was to evaluate the correlation between endometrial pathologies and MPV, PDW and PCT. MATERIALS AND METHODS: A total of 194 patients who presented to our clinic with abnormal vaginal bleeding were included in our study. The patients were divided into 3 groups (endometrial hyperplasia, endometrial cancer, control) according to their pathology results. The groups were compared for MPV, PDW, and PCT values obtained from the blood samples taken on endometrial biopsy day. RESULTS: The endometrial cancer patients were the oldest group (p=0.04). There was no significant difference between the three groups in terms of white blood cell count (WBC), platelet count (PC), and hemoglobin (Hb) level. The highest MPV (p<0.001), PDW (p=0.002), and PCT (p<0.001) levels were in the endometrial cancer group, and the lowest levels were in the control group. CONCLUSIONS: The easy evaluation of platelet parameters in patients who are suspected of having endometrial pathology is a significant advantage. We found MPV, PDW, and PCT to be correlated with the severity of endometrial pathology with the highest values in endometrial cancer. Studies to be conducted together with different laboratory parameters will further help evaluate the diagnosis and severity of endometrial cancer and precursor lesions.

Evaluation of uterine artery recanalization and doppler parameters after bilateral uterine artery ligation in women with postpartum hemorrhage.

AIM: The evaluation of the uterine artery recanalization rate and color Doppler parameters during follow-up after bilateral uterine artery ligation (BUAL) for postpartum hemorrhage (PPH) related to uterine atony. MATERIAL AND METHOD: A total of 40 female patients who underwent BUAL for PPH related to uterine atony and 96 females who gave birth without complication at Hatay Obstetrics and Gynecology Hospital between January 2009 and December 2012 (48 months) were included in the study. The patients' uterine artery recanalization rate and all subjects' color Doppler ultrasonographic parameters (PI, RI, PSV and EDV) were evaluated at the 6th and 12(th) months. RESULT: No statistically significant difference was found between the age, obstetric history (gravida and parity), BMI, type of delivery, birth weight and gestational age when the demographic data of the groups were evaluated. The patient group UtA recanalization rate was 32.5% and 37.5% for the left and right UtA respectively at the 12-month follow-up. No statistically significant difference was found in the comparison of 6- and 12-month right and left uterine artery diameters and color doppler parameters of the patient group (UtA diameters P=0.322 and P=0.787, RI index P=0.390 and P=0.094, PI index P=0.949 and P=0.374, PSV P=0.335 and P=0.085, EDV P=0.173 and P=0.418, respectively). However, right and left ovarian volume was found to significantly increase during follow-up in patient group (P<0.001 for both right and left ovary). On the other hand, a statistically significant difference was found between the patient group and the control group in the comparison of the 6- and 12-month right and left uterine artery values (6th month; P<0.001 for both UtA diameters, RI, PI, PSV, EDV; 12(th) month; P<0.001 for right UtA diameter, RI, PI, PSV, EDV and P=0.002 for left UtA diameter). A statistically significant difference was found only in right ovary volume in the 6th month evaluation of the patient and control group ovary volumes (P=0.011). DISCUSSION: The recanalization rate and isolated uterine blood supply during low-term follow-up are low following the BUAL technique. The evaluation of future fertility results will be helpful in determining the reliability of this procedure in a definite manner.

Relation of platelet distribution width (PDW) and platelet crit (PCT) to preeclampsia.

OBJECTIVE: While the relationship between platelet crit (PCT), platelet distribution width (PDW) and hypertension has been well-documented, data on the association between PCT, PDW and preeclampsia are scant at best. In our study we aimed to investigate the possible correlation of PCT and PDW with preeclampsia and disease severity MATERIAL AND METHODS: A total of 110 preeclamptic and 100 healthy pregnant women were included in the study Baseline PCT and PDW were measured using an automatic blood counterin the entire study population. RESULTS: While there were no significant differences between the preeclampsia group and the control group in terms of hemoglobin and platelet counts, the PDW, mean platelet volume (MPV), systolic and diastolic blood pressure, proteinuria, WBC and Hs-CRP levels were significantly higher in the preeclampsia group. In addition, PCT level was significantly lower in the preeclampsia group as compared to controls. Moreover subgroup analysis revealed that PDW and MPV levels were significantly increased in severely preeclamptic patients when compared to mildly preeclamptic patients. CONCLUSIONS: Our study results revealed that PCT and PDW levels were associated with both, the presence and severity of preeclampsia.

The effect of Ramadan fasting on fetal development.

OBJECTIVE: To evaluate the effects of Ramadan fasting on fetal development and outcomes of pregnancy. METHODS: We performed this study in Antakya State Hospital of Obstetrics and Child Care, between 28 June 2014 and 27 July 2014 (during the month of Ramadan). A total of two hundred forty healthy pregnant women who were fasting during Ramadan, were included in the groups. The three groups were divided according to the trimesters. The each group was consisted of 40 healthy pregnant women with fasting and 40 healthy pregnant women without fasting. For evaluating the effects of Ramadan on fetus, ultrasonography was performed on all pregnant women in the beginning and the end of Ramadan. We used the essential parameters for the following measurements: increase of fetal biparietal diameter (BPD), increase of fetal femur length (FL), increase of estimated fetal body weight (EFBW), fetal biophysical profile (BPP), amniotic fluid index (AFI), and umbilical artery systole/diastole (S/D) ratio. RESULTS: No significant difference was found between the two groups for the fetal age, maternal weight gain (kilogram), estimated fetal weight gain (EFWG), fetal BPP, AFI, and umbilical artery S/D ratio. On the other hand, a statistically significant increase was observed in maternal weight in the second and third trimesters and a significant increase was observed in the amniotic fluid index in second trimester. CONCLUSION: In Ramadan there was no bad fetal outcome between pregnant women with fasting and pregnant women without fasting. Pregnant women who want to be with fast, should be examined by doctors, adequately get breakfast before starting to fast and after the fasting take essential calori and hydration. More comprehensive randomized studies are needed to explain the effects of fasting on the pregnancy and fetal outcomes.

Malouf syndrome with hypergonadotropic hypogonadism and cardiomyopathy: two-case report and literature review.

Malouf syndrome is a very rarely encountered syndrome which was first diagnosed in 1985 upon the examination of two sisters, with findings of hypergonadotropic hypogonadism, dilated cardiomyopathy, blepharoptosis, and broad nasal base. Later on, Narahara diagnosed another sporadic case with the same findings. A survey of relevant literature leads us to three women cases in total. Here we present two cases of Malouf syndrome and literature review.

Does polycystic ovary syndrome itself have additional effect on apelin levels?

Objective. The present study was designed to compare serum levels of apelin between lean PCOS women and healthy women with regular menses. Study Design. A total of 30 lean patients with PCOS and 30 healthy subjects were included in this study. Serum apelin levels were compared between groups. Results. Serum apelin levels in lean PCOS patients were not significantly different from the control subjects. Conclusion. Our findings indicate that PCOS itself does not seem to change apelin levels. Further investigation on a large number of subjects will need to be conducted to prove the consistent or variable association in PCOS.

Evaluation of Mean Platelet Volume values in lean women with polycystic ovary syndrome.

OBJECTIVE: Mean Platelet Volume (MPV) is an important indicator of platelet activation. It is known that MPV increases in patients with coronory artery disease, diabetes mellitus, atherosclerosis and Polycystic ovary syndrome (PCOS). Our aim was to measure the MPV in lean patients with polycystic ovary syndrome. METHODS: The present study was designed to examine the platelet function by measuring MPV in non-obese women with PCOS. A total of 50 outpatients with PCOS were included. The control group consisted of 50 healthy subjects. Serum platelet, MPV, and white blood cell (WBC) levels were compared and evaluated retrospectively in all participants. These values were compared by statistical analysis. RESULTS: There were no statistically significant difference in between groups regarding MPV (p═0.357), WBC (p═0,414) and platelet (p═0,666). CONCLUSION: There are studies implying MPV increase in PCOS patients, in our patients MPV levels did not correlate with PCOS except for patients with obesity. We think that PCOS itself has no effect on MPV levels and obesity changes MPV levels.

Complications and outcomes of repeat cesarean section in adolescent women.

AIM: The evaluation of the effect of repeat cesarean sections in adolescent pregnancies on the morbidity, obstetric and perinatal results. MATERIALS AND METHODS: We reviewed the patient file and hospital records of patients who underwent at least one cesarean section among adolescent age group pregnant women who gave birth at our clinic between January 2010 and May 2013. The patients were divided into two groups as the patients who underwent the second cesarean section (116 patients) and those who underwent the third cesarean section (36 patients). The demographic data, maternal data and obstetric and perinatal results of the patients were evaluated. RESULTS: A significant difference was present between the patients in the evaluation of the total number of examinations during pregnancy (P = 0.001), total maternal weight gain during pregnancy (P = 0.006), and the first examination gestational age (P = 0.006) and all values were less favorable in the third cesarean group. The gestational week at birth (P < 0.001), birth weight (P < 0.001), and APGAR score (P < 0.001) in the group with the third cesarean section were statistically significantly lower than the second cesarean section. The third cesarean cesarean was found to cause a significant risk increase for placenta accreta risk in adolescent pregnancies (P = 0.042). CONCLUSION: The increasing number of cesarean sections in the adolescent group is seen to be a significant risk factor for low gestational week of birth, low birth weight and related morbidities. The most important reason for the increased morbidity with increasing cesarean sections in the adolescent age has been defined as placenta accreta.

Do clinical and laboratory parameters effect maternal and fetal outcomes in pregnancies complicated with hemolysis, elevated liver enzymes, and low platelet count syndrome?

OBJECTIVE: The aim of the study was to investigate whether the clinical features and laboratory parameters affect maternal and fetal outcomes in pregnancies complicated with HELLP syndrome. MATERIAL AND METHODS: The medical records of pregnant patients complicated with HELLP syndrome were analyzed retrospectively between June 01, 2003 and June 01, 2010. The demographic data, medical history, admission symptoms, clinical and laboratory findings and recovery time were evaluated. The adverse maternal outcomes including eclampsia, placental abruption, disseminated intravascular coagulation, postpartum hemorrhage, pulmonary complications, cerebral edema and visual loss were recorded. Fetal growth restriction, necessity for neonatal intensive care unit admission and perinatal mortality were recorded as an adverse fetal outcome. RESULTS: The incidence of HELLP syndrome was 0.52%. The mean age of the patients was 28.93±7.90 (range 17-45). HELLP syndrome was diagnosed on average in the 33.68±4.41(th) (ranged 24-40) week of gestation. Eighteen cases (40.9%) were nullipara and twenty-six cases (59.1%) multipara. The most common complications were eclampsia (40.9%) and abruption placenta (15.9%). Pregnancy was terminated within 48 hours in all patients. The rate of cesarean section was 90.9%. Perinatal mortality rate in HELLP syndrome was 31.8%. There was no maternal mortality. CONCLUSION: Neither clinical characteristics nor laboratory parameters was found effective for prediction of adverse maternal and fetal outcomes.

The diagnostic value of the Doppler ultrasonography in distinguishing the endometrial malignancies in women with postmenopausal bleeding.

PURPOSE: To investigate the diagnostic value of blood flow measurements in endometrial, myometrial and uterine vasculature by transvaginal Doppler ultrasonography in the differentiation of the neoplastic endometrial pathologies in women with postmenopausal bleeding. METHODS: 106 women who presented with postmenopausal bleeding were enrolled in a prospective cohort study. Endometrial thickness, pulsatility and resistance indices of the uterine, myometrial and endometrial vasculature, endometrial histopathology were measured by transvaginal Doppler sonography. Dilatation and curettage were performed for all women. Sonographic and histopathological results were evaluated. RESULTS: Endometrial malignancy was diagnosed in 24 of the patients (22.7%). Endometrial thickness was found to be higher in the patients with malign histopathology compared with the patients of benign histopathology. Statistically, uterine artery PI, RI, radial artery PI, spiral artery PI, and RI were also significantly lower in patients with malign histopathology. According to ROC curve analysis the endometrial thickness of 5 mm, uterine artery PI of 1.450, uterine artery RI of 0.715, radial artery PI of 1.060, and radial artery RI of 0.645 were defined as the cut-off points. In multivariate regression model, only uterine artery PI was identified as independent determinant of malignant endometrium. CONCLUSIONS: Blood flow of uterine artery and also myometrial and endometrial vasculature displayed lower impedance in patients with malignant endometrium, but these lower indices are not already adequate for using as diagnostic tests.

Synchronous primary cancers of the female reproductive tract in Turkish women.

OBJECTIVES: To evaluate the synchronous gynecologic cancers in Turkish women. MATERIALS AND METHODS: A population-based longitudinal cohort study was conducted using Izmir Cancer Registry (ICR) data on gynecologic cancer patients diagnosed in the period 1993 to 2005. The registry covers the 3.7 million population of Izmir and has been collecting data on cancer incidence and survival of cancer patients' since 1992. The ICR collects data on all new cases of cancer from all the hospitals (n = 22) in the city. RESULTS: A total of 4,185 women were identified with gynecologic cancer between 1993 and 2005, 1,526 with endometrial, 1,206 with cervical, 1,198 with ovarian, 115 with vulvar, 67 with other uterine ( sarcoma etc.), 33 with vaginal and 40 with other gynecologic cancers ( tuba uterina etc.). Fifty-five (1.3%) patients with invasive synchronous primary cancers were identified, 43 of these tumor pairs being endometrium-ovaries (81%), 66 of all lesions being endometrioid adenocarcinomas. CONCLUSIONS: Independent primary tumors of the endometrium and ovary are the most commonly encountered synchronous tumors of the female genital tractus with endometrioid adenocarcinoma as the most frequent component.

The positivity of Helicobacter pylori Stool Antigen in patients with Hyperemesis gravidarum.

OBJECTIVE: We aimed to investigate the possible association between Helicobacter pylori infection and Hyperemesis gravidarum. MATERIAL AND METHODS: Thirty-six pregnant women with Hyperemesis gravidarum with severe vomiting (more than 4 times a day), weight loss (≥3 kg), ketonuria and 36 pregnant women gestational age-matched, without nausea and vomiting attending our outpatient clinic for antenatal care were enrolled the study. Demographic data of the patients were registered. Blood samples for hemogram, serum electrolytes (sodium, potassium, chloride, and calcium), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), creatine, thyroid stimulating hormone (TSH), free T3-T4, total T3-T4, and urine samples for ketonuria, stool samples for HpSA were studied. The data of both groups were compared. RESULTS: Eight Hyperemesis gravidarum patients (22.2%) and 1 control patient (2.8%) were established HpSA positive and it was statistically significant (p:0.037). There was no significant difference between Hyperemesis gravidarum and control subjects in terms of age, gestational week, parity, educational level, socioeconomic status and smoking. There was anemia in 5 Hyperemesis gravidarum patients, 4 of them were HpSA positive. HpSA positivity was more prevalent in Hyperemesis gravidarum patients with anemia (p=0.003). Severe vomiting (more than 4 times a day), heartburn, epigastric pain, duration of hospitalization (more than 4 days) and weight loss (≥5 kg) were not correlated to HpSA positivity. CONCLUSION: The pregnant women with Hyperemesis gravidarum have a significantly higher prevalence of Helicobacter pylori compared with control subjects.

Prospective clinical study of the association between plasma level of free IGF-1 and myometrial invasion min patients with endometrial adenocarcinoma.

INTRODUCTION: Endometrial carcinoma is a common malignancy of the female genital tract. There is a strong correlation between myometrial invasion and clinical prognosis. Increasing myometrial penetration is associated with an increasing risk of pelvic and para-aortic lymph node metastasis, adnexal metastasis, positive peritoneal cytology local vault recurrence, and hematogenous spread. The causal role for Insulin-like growth factor-1 and insulin in endometrial carcinogenesis is well supported and insulin and IGF system have mitogenic and antiapoptotic activity Endometrial cancer cell lines express high-affinity insulin receptors, consistent with there being a direct biological effect of insulin and IGF system on the growth and myometrial invasion of endometrial cancer cells. MATERIAL AND METHODS: Patients with endometrial carcinoma have been divided into three groups: tumor confined to the endometrium (stage IA, n:24), endometrial carcinoma with a minimal invasion (less than 50% of the myometrium; stage IB, n:32), and the control group (n:40). Demographic factors, estradiol and free IGF-1 plasma levels have been compared in all groups. RESULTS: Lower Free IGF-1 plasma levels were found in patients with myometrial invasion when compared to the patients without myomnetrial invasion. CONCLUSIONS: In the following work we have presented the current understanding of endometrial carcinoma, association between free IGF-1 plasma levels and myometrial invasion in patients with endometrial adenocarcinoma in terms of management and survival.

Residual and recurrent disease rates following LEEP treatment in high-grade cervical intraepithelial lesions.

INTRODUCTION: Loop electrosurgical excision procedure (LEEP) is a basic procedure in the conization performed on patients with CIN II/III. After excisional therapy, close follow up is essential for the earlier detection of residual and recurrent disease. The value of PAP-smear and HPV-DNA tests for investigation of residual and recurrent disease in patients diagnosed with high-grade intraepithelial lesion after LEEP treatment was purposed. MATERIALS AND METHODS: 42 patients were included in the study for whom epithelial cell anomalies were detected at PAP-smear screening. HPV-DNA test, colposcopy, cervical biopsy and endocervical curettage and then LEEP procedures were performed. The patients were followed with HPV DNA and PAP-smear tests in terms of recurrence and residual disease at 3-month intervals. RESULTS: HPV-DNA examination revealed that 36 patients (85.7%) were positive for high-risk HPV-DNA before treatment. Histopathological evaluation of LEEP materials revealed the presence of CIN I in 4 and CIN II/III in 38 patients. Surgical margin was positive in five patients. No sign of invasive cervical neoplasia was detected. The high-risk HPV DNA's persistence was observed in 11 (30.6%) of the 36 patients of whom HPV-DNA positivity had been detected before the treatment. HSIL was detected in four patients using PAP-smear on the third month examination. Positive LEEP surgical margins were found to be positively correlated both with HPV-DNA positivity detected during the follow-up examination and with the presence of residual disease in the follow-up PAP smear. CONCLUSION: LEEP is a basic procedure in the conization performed on patients with CIN II/III. In spite of high recurrence and residual disease rates, this kind of patients requires close monitoring. Follow-up with HPV and PAP-smear tests after LEEP treatment is of great importance in the detection of residual or recurrent disease.

The effect of body mass index value during labor on pregnancy outcomes in Turkish population (obesity and pregnancy outcomes).

PURPOSE: We investigated the relation between body mass index (BMI) value during labor and pregnancy outcomes in a group of Turkish population. METHODS: The data on 9,112 singleton pregnancies were reviewed retrospectively. Patients were classified into three groups according to their BMI values: normal (BMI 20-25 kg/m(2), n = 5,685, 62.4%), overweight (BMI 20-25 kg/m(2), n = 2,214, 24.3%) and obese (BMI >30 kg/m(2), n = 1,213, 33.3%). RESULTS: Gestational diabetes mellitus (P = 0.000), risk of delivering a baby >90th percentile (P = 0.000) and preeclampsia (P = 0.000) were increased in parallel with increased BMI. A statically significant difference was observed between the normal and obese groups in terms of the abdominal cesarean rates (P = 0.020). However, a significant difference was not observed in terms of preterm delivery (P = 0.846), birthweight <10th percentile (P = 0.484), placenta previa (P = 0.880), ablatio placenta (P = 0.499) and intrauterine death (P = 0.175) between the groups. CONCLUSIONS: Regardless of the gestation, BMI is a factor that affects the fetal and maternal outcomes. The obese and overweight women should be followed up carefully during the labor and delivery.

The investigation of the factors affecting retroperitoneal lymph node metastasis in stage IIIC and IV epithelial ovarian cancer.

INTRODUCTION: The appropriate management of advanced ovarian cancer has been controversial in recent years. Lymphatic node involvement is known one of the most important prognostic factors in epithelial ovarian carcinomas. On the other hand in patients with advanced ovarian cancer involving the upper abdomen (with/without lymph node involvement) the evaluation of pelvic and para-aortic lymph nodes does not contribute to the staging and more importantly it does not improve overall-survival. MATERIALS AND METHODS: One hundred three patients underwent systematic pelvic and para-aortic lymphadenectomy in our clinic. Fifty-three patients with FIGO stage IIIC and IV epithelial ovarian tumor were included in the study. The numbers of positive lymph nodes in each patient were compared with the preoperative CA125 values, positivity/negativity of peritoneal washings and tumor types. Also we compared the patients with positive lymph nodes with patients with negative lymph nodes and investigate differences in CA125 levels, histological types, and cytology. RESULTS: No significant difference was observed between the patients' preoperative CA125 values and the number of positive lymph nodes. A significant relation was not determined between the positivity or negativity of peritoneal washings and the number of positive lymph nodes. As a number of positive lymph nodes were compared with the tumor types a significant difference was not observed. On the other hand, statistically, a significant relationship was found between patients with positive lymph nodes and patients with negative lymph nodes in terms of preoperative CA125 values, the positivity or negativity of peritoneal washings and histological types of tumors. DISCUSSION: We could not determine any effects of preoperative CA125 values, histological type of tumor and peritoneal cytology on the number of positive lymph nodes. Pelvic and para-aortic lymphadenectomy must be performed for us until the factors that affect nodal involvement will be described further in larger and more comprehensive studies.

Primary malignant melanoma of the vagina.

BACKGROUND: Primary vaginal melanoma is a rare, highly malignant, and poor prognostic disease. CASE: The 51-year-old patient with diagnosis of vaginal malignant melanoma was referred to our clinic. Since detection of pervasive brown lesions in the vagina total vaginectomy was performed. At pathological investigation melanoma was not determined. Immunotherapy was administered adjuvantly. Paraaortic lymph node metastasis was seen on the ninth month after total vaginectomy and the metastatic lymph nodes were excised. Cisplatin and tremozolamide chemotherapy was administered for six cycles after surgery. The patient is alive and disease-free at 18th month of the diagnosis of the disease. CONCLUSION: The impact of therapy on outcome of primary vaginal malign melanomas is poorly understood. Improved clinical outcomes were associated with surgical removal of gross disease whenever possible. Because of the low rate of lymph node metastasis, elective pelvic lymph node dissection is not mandatory. We presented a case of FIGO stage I primary vaginal malignant melanoma, which metastasized to the paraaortic lymph nodes 9 months after the primary operation.

Migration of an intrauterine device into the bladder: a rare case.

INTRODUCTION: Intrauterine device (IUD) application has been used for over 30 years and is a widely accepted contraception method among women because of its low-complication rates. The use of intrauterine devices may cause complications but migration of the IUD into an adjacent organ is rarely encountered. CASE: In the present report, we present a 26-year-old patient to whom IUD had been applied 2 years ago and whose examination performed due to pain and urinary complaints revealed migration of the uterine device into the bladder. CONCLUSION: Patients with pelvic pain and chronic irritative urinary symptoms whose vaginal examination and ultrasonography reveal a dislocated IUD should be carefully examined for the migration of the IUD into the bladder. In order to avoid this rare complication, patient should be evaluated physically and ultrasonographically for uterine position, thinness of the uterine wall and inflammatory disease before the insertion. The patient should be evaluated with sonography immediately after insertion and periodically.