Long term sexual outcomes of Mayer Rokitansky Küster Hauser Syndrome patients after Uncu-modified Davydov procedure.

Background: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome has an incidence of 1 in 4000. The absence of the vagina and uterus results in sexual dysfunction and infertility. The first-line treatment is vaginal dilatation. There exists a number of second-line surgical options including the Uncu-modified Davydov procedure. Objective: To determine the complication rate, anatomical outcomes, and long-term sexual outcomes of MRKH syndrome patients after Uncu-modified Davydov procedure. Materials and Methods: Patients with MRKH syndrome who underwent paramesonephric remnant-supported laparoscopic double-layer peritoneal pull-down vaginoplasty (aka Uncu-modified Davydov procedure) between January 2008 and December 2021. The procedure involves laparoscopic circular dissection of the pelvic peritoneum followed by pulling down, through the opened vaginal orifice, and suturing the vaginal cuff with the support of uterine remnants. The long-term complication rate, anatomical outcomes, and sexual function outcomes (as measured by Female Sexual Function Index (FSFI)) were ascertained. Main outcome measures: Main Outcome Measures: The long-term complication rate, anatomical outcomes and FSFI survey results. Results: A total of 50 patients with MRKH syndrome underwent the Uncu-modified Davydov procedure between Jan 2008- Dec 2021. There were four perioperative complications: three bladder injuries (6%) and one rectal serosa injury (2%). Four long-term postoperative complications were identified: one vesicovaginal fistula (2%), one recto-vaginal fistula (2%), and two vaginal stenoses (4%). All patients were physically examined at least one year after surgery. The mean vaginal length was 8.4 + 1.9 cm. The mean FSFI score was 31.5 + 3.9 (minimum score of 24, maximum score of 36). Conclusion: Conclusion: The Uncu-modified Davydov procedure has been demonstrated to be a safe and effective treatment option with high female sexual function index scores for patients with MRKH syndrome. What is new?: The long-term complication rate, anatomical and sexual outcomes of Uncu-modified laparoscopic peritoneal pull-down vaginoplasty were reported in this study. The results indicated that the surgical approach could be used in selective MRKH patients who failed first-line self-dilatation therapy.

Chemotherapy plus radiotherapy vs. radiotherapy alone in high-risk endometrioid endometrial carcinoma.

OBJECTIVE: Adding chemotherapy to radiotherapy in patients with high-risk endometrioid endometrial cancer (EEC) remains controversial, particularly in stages I-II. We aimed to investigate the effect of treatment modalities on survival in high-risk EEC patients. PATIENTS AND METHODS: Patients with high-risk EEC were evaluated retrospectively between 2010 and 2019. Patients who did not receive adjuvant treatment were excluded. We included seventy patients and formed two groups: patients who received radiotherapy (RT) alone and those who received chemotherapy and radiotherapy (CT and RT). RESULTS: The median follow-up time was 60.3 months (8.0-143.5). 38.5% of the patients had relapsed. Recurrence-free survival (RFS) rates were 97. 1%, 68.3% , and 60.8% at 12-, 36-, and 60-month, respectively. Overall survival rates were 97.1%, 80.6%, and 72.6% at 12-, 36-, and 60-month, respectively. Hematological adverse events and neuropathy were more common in the CT and RT group than in the RT group. Multivariate Cox regression analysis for RFS revealed that the FIGO stage and treatment modalities were statistically independent factors (p=0.031 and p=0.040, respectively). Stage stratified log-rank test revealed that adding chemotherapy improved RFS in patients with stage III (p=0.020) but not in stage I-II disease (p=0.725). The number of chemotherapy cycles administered (≤4 vs. >4) did not affect survival in all patients and stage III disease (p=0.497, and p=0.436, respectively). CONCLUSIONS: Adding chemotherapy to radiotherapy may be considered in high-risk stage III EEC. Further studies are needed to determine the optimal duration of chemotherapy.

Change in the ovarian environment after hysterectomy with bilateral salpingectomy: is it the technique or surgery itself?

OBJECTIVE: To compare the effects of total laparoscopic hysterectomy with bilateral salpingectomy (TLH-BS) and total abdominal hysterectomy with bilateral salpingectomy (TAH-BS) on ovarian function among women of reproductive age. STUDY DESIGN: One hundred and three patients with a diagnosis of benign uterine disorder were divided into two groups in this prospective longitudinal study. Patients who had never had sexual intercourse and patients with uterovaginal disproportion underwent TAH-BS (n=57), and the remaining patients (n=46) underwent TLH-BS. Ovarian function was assessed before and 6 months after surgery; ovarian volume was assessed by gray-scale ultrasonography, and levels of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), oestradiol (E2), anti-Mullerian hormone (AMH) and inhibin B were measured. RESULTS: Postoperative serum FSH, LH and inhibin B decreased significantly in both groups. Postoperative serum E2 did not change significantly. Postoperative serum AMH and ovarian volume decreased significantly in the TAH-BS group (p=0.016 and p<0.001, respectively), but not in the TLH-BS group. Significant differences were observed between the TLH-BS and TAH-BS groups with respect to change in FSH (p=0.012) and ovarian volume (p=0.001); between-group differences were not significant for changes in AMH and inhibin B. CONCLUSIONS: Although serum AMH did not change significantly in patients who underwent TLH-BS, ovarian aging commenced following both surgical procedures.

Clinical importance of placental membrane microscopic chorionic pseudocysts in preeclampsia.

OBJECTIVE: To determine the importance of placental membrane microscopic chorionic pseudocysts (MCP) in preeclamptic and normal placentas and evaluate the association between MCP and neonatal complications in preeclamptic patients. MATERIALS AND METHODS: In this prospective case-control study, microscopic examination of placentas was performed, including MCP count, in 33 preeclamptic and 35 normal control pregnant women from December 2008 to May 2009. The MCP were counted in placentas for each patient and modeled as a continuous variable to assess the difference between the two groups. RESULTS: The mean MCP count was similar for preeclamptic (7 ± 2) and control patients (7 ± 2; not significant). A weak positive correlation was noted between placental weight and MCP (r = 0.253; p ≤ 0.04). In the preeclamptic patients, mean MCP count was significantly higher for neonates that did not have neonatal respiratory distress syndrome (NRDS) (p ≤ 0.05) and who did not admitted to neonatal intensive care unit (NICU) than admitted to NICU (P ≤ .03). The risk for developing NRDS was 20.3-fold greater in neonates of preeclamptic patients who did not have than had MCP (odds ratio, 20.3 95% confidence interval, 1.0 to 48; P ≤ .05). The MCP count cutoff value was ≤ 1 for developing NRDS (sensitivity 83%; specificity, 70%). CONCLUSION: The absence of MCP was significantly associated with the development of NRDS in neonates. The MCP count was inversely associated with the risk of NRDS in newborns of high-risk pregnancies caused by preeclampsia.

Maternal adiponectin and visfatin concentrations in normal and complicated pregnancies.

OBJECTIVE: To evaluate the role of adiponectin and visfatin in the pathophysiology of pre-eclampsia (PE) and how their concentrations correlate with the severity of the disease and neonatal outcomes. STUDY DESIGN: A prospective case-control study was carried out in 52 preeclamptic and 28 healthy pregnant women during the third trimester. The maternal plasma concentrations of adiponectin and visfatin were determined. Neonatal outcomes were also recorded. RESULTS: Mean maternal plasma adiponectin concentrations in healthy pregnant women did not differ significantly from those of mild PE and severe PE groups. The plasma adiponectin levels of PE patients with small for gestational age (SGA) and those without SGA did not differ significantly, but the median plasma visfatin concentration of patients with SGA fetus was significantly higher if the patient was preeclamptic (p = 0.036). CONCLUSION: The severity of preeclampsia did not change the plasma levels of adiponectin and visfatin, but the median plasma visfatin concentration of patients with SGA fetuses were significantly higher if the patient was preeclamptic. Altered levels of adipocytokines strongly imply that the regulation of adipocytokines in PE is different and more complex compared to that in healthy pregnancy.

Polymorphisms of glutathione-s-transferase M1, T1, and P1 genes in endometrial carcinoma.

OBJECTIVE: To investigate the polymorphism rates and possible roles of glutathione-s-transferase M1, T1, and P1 gene polymorphisms in the predisposition to endometrial cancer in Caucasian women. MATERIALS AND METHODS: Serum samples and medical records were collected from 53 Caucasian women with newly diagnosed endometrial cancer and 67 women of the same race without any known history of cancer. Multiplex polymerase chain reaction (PCR) analysis was used to assess glutathione-s-transferase M1 (GSTM1) and T1 gene polymorphisms. Polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) method was used in salvage of GSTP1 gene polymorphism. RESULTS: Frequencies of GSTM1 and GSTT1 null genotypes were not significantly different between the controls and patients with endometrial cancer (56.7% vs 52.8%, p = 0.671; 32.8% vs 26.4%, p = 0.574, respectively). The authors were not able to demonstrate any association between neither GSTP1 genotypes nor allele frequencies and endometrial carcinoma in the population studied (p = 0.310, p = 0.318, respectively). Moreover, no significant association could be demonstrated with GSTM1 and GSTT1 polymorphisms and clinical stages of endometrial cancer. Nevertheless, there was a significant difference between the frequencies of GSTP1 AA and GG genotypes in relation to Stage I disease when compared with advanced stages of endometrial carcinoma (p = 0.03). In addition, no association was found between polymorphisms of GST suspergene family and non-endometrioid type endometrial carcinomas. CONCLUSION: These results suggest that GSTT1, GSTM1, and GSTP1 polymorphisms are not associated with endometrial cancer in the Caucasian population.

Evaluation of the outcome benefit conferred by intensive surveillance strategies in women with early-stage endometrial cancer.

INTRODUCTION: The optimum follow-up regimen after treatment for early-stage endometrial cancer with curative intent is unknown. The National Comprehensive Cancer Network recommends a physical exam and vaginal cytology every three to six months for two years then at six to 12 month intervals with annual chest X-rays (CXR). However, there is debate as to whether intensive follow-up results in an improvement in outcomes for those with recurrent endometrial cancer. OBJECTIVE: To determine if intensive surveillance for recurrent cancer in women with early-stage endometrial cancer improves their outcomes. MATERIALS AND METHODS: The Roswell Park Cancer Institute tumor registry was used to identify patients with Stage I and II endometrial cancer initially diagnosed and treated over an 18-year period, who subsequently recurred. Clinico-pathological variables were abstracted. Patients were divided into two groups, depending on their mode of diagnosis of recurrent cancer: 1) routine screening, or 2) symptomatic. The outcomes between the two groups were compared. RESULTS: Fifty-two patients met inclusion criteria. Twenty-three patients were diagnosed via routine screening methods and 29 were symptomatic at presentation. Groups were equally represented with respect to age, stage, grade, adjuvant therapy, site of recurrence (local, distant), and time to recurrence (p > 0.05). Median survival time was 79 months for those diagnosed during routine screening and 80 months for symptomatic patients (p > 0.05). CONCLUSION: Pap smear and CXR appear to be of limited utility as the present study has shown that women diagnosed as a result of intensive surveillance did not have a better outcome than those who presented when symptomatic.

Polymorphisms in angiotensin-converting enzyme and glutathione s-transferase genes in Turkish population and risk for preeclampsia.

AIMS: This study was conducted to investigate whether insertion/deletion (I/D) polymorphism of angiotensin-converting enzyme (ACE) gene and polymorphisms in glutathione S-transferase (GST) M1 and T1 genes are associated with increased risk for preeclampsia. MATERIALS AND METHODS: Sixty-three patients with hypertensive disorder of pregnancy and 85 controls were evaluated in a prospective case-control study. All subjects were genotyped by polymerase chain reaction (PCR) followed by agarose gel electrophoresis. RESULTS: Allele frequencies of ACE gene I/D polymorphism were found significantly different between preeclampsia and the control groups (p = 0.001). Differences in genotype frequencies of ACE gene I/D polymorphism between the two groups were statistically significant (p = 0.004). Individuals homozygous for D allele were more likely to develop preeclampsia (OR = 2.29; 95% CI, 1.39-3.79), whereas heterozygous individuals were not at increased risk (OR = 0.92; 95% CI, 0.56-1.49), compared to individuals homozygous for I allele. The differences in frequencies of functional and null alleles of GSTM1 and GSTT1 genes between the two groups were not significant (p = 0.46 and p = 0.44, respectively). CONCLUSION: ACE gene DD genotype was found to be associated with increased risk of preeclampsia development, whereas the authors did not find any significant relationship with polymorphisms of the GSTM1 and GSTT1 genes and preeclampsia.

Perinatal asphyxia is associated with the umbilical cord nucleated red blood cell count in pre-eclamptic pregnancies.

Nucleated red blood cells are commonly present in the blood of newborns. Our objective was to investigate the value of umbilical cord nucleated red blood cell (NRBC) count in predicting fetal asphyxia in pre-eclamptic women. NRBCs were counted in umbilical cord blood samples of neonates born to 43 pre-eclamptic and 25 healthy pregnant women. Pre-eclamptic women were further subgrouped based on the presence or absence of intrauterine growth restriction. The NRBC count differed significantly between pre-eclamptic women with and without intrauterine growth restriction, and controls (26.3 +/- 7.5; 17.1 +/- 6.8; and 9.9 +/- 2.7; p < 0.001). A NRBC count of 18.5 or above could predict fetal asphyxia with a sensitivity of 94.4% and a specificity of 80.0%. The umbilical cord NRBC count is effective in predicting fetal asphyxia in pre-eclamptic women.

Peritoneal tuberculosis mimicking peritoneal carcinomatosis.

PURPOSE: The data of 11 peritoneal tuberculosis (TB) patients is discussed in an attempt to better understand this disease. METHODS: Nine patients with clinical features mimicking ovarian cancer and two with infertility were evaluated retrospectively. RESULTS: The mean age was 40.8 +/- 18.3 years. None had any past/family history of TB. Abdominal swelling and pain, appetite loss, nausea/vomiting, and primary infertility were the most common complaints. Chest X-ray suggested TB in one cachexic patient. Six patients had ovarian/primary peritoneal cancer on laparotomy. Laparoscopy was performed to determine therapeutic modality in one patient and for primary infertility in one patient. Three patients were not operated because of suspected TB in one and neoadjuvant chemotherapy in two with poor performance scores. They underwent peritoneal or omental biopsies; histopathology revealed caseous granulomatous TB lesions. Mycobacterium tuberculosis was identified in only two ascitic fluid cultures. CONCLUSION: Peritoneal TB should be suspected in endemic areas, especially in young patients considered to have peritoneal carcinomatosis.

A comparison of low-dose and high-dose protocols of vaginal misoprostol for second trimester termination of pregnancy.

Sixty patients were randomized to low-dose and high-dose groups, receiving a maximum total dose 1400 g of misoprostol by the vaginal route to compare the efficacy of the protocols for second trimester termination of pregnancy. Outcome measures to be compared between the groups were success rates, time to termination, blood loss, complications and side-effects. Yet time to termination was significantly shorter in the high-dose than in the low-dose group (923 +/- 571 vs 1307 +/- 828 min; p < 0.05). The distance between the internal cervical os and the placenta was positively correlated with the duration of the termination process (r = 0.508, p < 0.001). Induction to the fetal expulsion period is shorter with the higher dose without any significant increase in morbidity. A shorter distance between the internal cervical os and the placenta may forecast a shorter termination process.

A case with three primary tumors of the ovary, endometrium and gallbladder.

A case with three synchronous tumors is presented. A 52-year-old patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, bilateral pelvic and paraaortic lymph node dissection, and partial omentectomy for endometrial carcinoma accompanied by an adnexal mass. She further underwent cholecystectomy for a perioperative incidental suspicious nodule on the serosal surface of the gallbladder. Histopathology revealed a uterine endometrioid adenocarcinoma, a mucinous adenocarcinoma of the gallbladder, and an ovarian endometrioid carcinoma with a clear cell component. The progress of the patient until the time of death is discussed.

Efficacy of gemcitabine in heavily pretreated advanced ovarian cancer patients.

Single agent gemcitabine was used in recurrent epithelial ovarian cancer patients after standard treatment with debulking surgery and platin-paclitaxel based chemotherapy. Response rates and toxicity results were evaluated retrospectively. Gemcitabine was given in 1000 mg/m2 intravenous infusion over 30 minutes at 1, 8, 15 days of every 28 days. Clinical response was evaluated with clinical findings, serum CA 125 levels, and computerized tomography. Twenty-two patients--ten as second-line, 11 as third-line, and one as fourth line--received gemcitabine. Seven patients received six courses, nine cases three, five cases two and one case one course of treatment. There were four (18.2%) partial and two (9.1%) complete responses with an overall response rate of 27.3%. Stable disease was also observed in three more cases. The progression-free interval was found to be a median of three months. Grade 3-4 neutropenia was seen in two (9.1%) and grade 3-4 thrombocytopenia was seen in four (18.2%) cases. Pancytopenia was observed in one (4.5%) patient. There was no grade 3-4 non-hematological toxicity. Antitumoral activity is encouraging in heavily pretreated ovarian cancer patients. A short progression-free interval is noticeable in responding cases. Toxicity is mainly hematologic and moderate.

The effects of smiling or crying facial expressions on grip strength, measured with a hand dynamometer and the bi-digital O-ring test.

The effects of smiling or crying facial expressions on grip strength and the Bi-Digital O-Ring Test were evaluated in this study. Ten right-handed basketball players (age group 18-28) were included in the study. Grip strength was measured with a Riester hand dynamometer and the Bi-Digital O-Ring Test successively, after the players had looked at the drawing of a "crying face" for 5 seconds from a distance of 40 cm at the eye level. Immediately afterwards they were shown the drawing of a "smiling face" and were asked to grip with the same condition. Once all 10 players carried out this experiment, the order in which the drawings were shown was reversed. We then proceeded to measure the same variables, using the Bi-Digital O-Ring Test. The statistics obtained thereby were subjected to Pearsons correlation coefficient and paired t-test. Using a hand dynamometer and the Bi-Digital O-Ring Test, it was found that, in both tests, the "smiling face" drawing (first crying, then smiling face: with hand dynamometer, it increased from 8.34+/-0.97 kg to 9.18+/-0.9 kg; t=5.39,p=0.0001) increased the grip strength of the basketball players, and the "crying face" drawing (first smiling face, then crying face: with hand dynamometer it decreased from 9.35 +/- 0.90 kg to 8.51+/- 0.96 kg; t=9.81, p=0.0001) decreased the grip strength. Exposure to the smiling face drawing increased the grip strength, and exposure to the crying face decreased it, in every subject tested in this group. Similar effects were observed with the Bi-Digital O-Ring Test (first crying, then smiling: it increased from -2.80 +/- 1.13 to 2.20 +/- 1.32; t=33.54, p=0.0001; first smiling then crying: it decreased from 2.40 +/- 1.34 to -2.20 +/- 1.62; t = 15.06, p=0.0001).

Effect of prechemotherapy filgrastim on the bone marrow toxicity of topotecan.

PURPOSE: To investigate the efficacy and safety of single-dose filgrastim administered 24 hours prior to chemotherapy in the prevention of topotecan-related myeloid suppression. METHODS: No medication was given to 21 rats in group 1; 1.5 mg/m2/day topotecan was administered intraperitoneally for five days every three weeks to 21 rats in group II; a single dose of 5 microg/kg filgrastim was injected intraperitoneally 24 hours before the intraperitoneal administration of the same dose of topotecan to 21 rats in group III. After completion of six cycles of chemotherapy. the rats were decapitated and blood samples were immediately collected into citrated tubes for complete blood counts. RESULTS: White blood cell and lymphocyte counts in the control and the filgrastim + topotecan groups were similar (p > 0.05) and significantly higher than the counts in the topotecan group (p < 0.05). There was no difference in means of neutrophil, monocyte, eosinophil, basophil and erythrocyte counts among the groups (p > 0.05). CONCLUSION: Filgrastim administration prior to chemotherapy seems to be beneficial and further investigations are needed.

Association between HLA antigens and bladder tumors.

HLA antigen type was studied in 55 patients with transitional cell carcinoma of the bladder. The results showed high HLA-B5 and low HLA-BW35 frequencies. Histological grade, stage, and recurrence rate of tumors were also evaluated separately. The results were more significant in recurrent tumors.