Should advanced age alone be considered a contraindication to systemic lymphadenectomy in gynecologic oncologic patients? A university hospital experience in Turkey.

In this case-control study, we aimed at analyzing the effect of pelvic and paraaortic lymphadenectomy on intraoperative and postoperative morbidity and mortality rates in a series of elderly patients (age >/= 65 years) with gynecologic malignancies. We examined preexisting medical conditions, surgical data, intraoperative and postoperative morbidity and mortality in 37 patients aged 65 years or older with endometrial and ovarian carcinoma who underwent pelvic and paraaortic lymphadenectomy. Control group consisted of patients between 60 and 64 years with similar malignancies. The number of patients with hypertension (P = 0.03), minor (P = 0.01) and major cardiac problems (P = 0.03), chronic obstructive lung disease (P = 0.02), and history of cerebrovascular disease (P = 0.04) were significantly higher in the study group than that in control. The median operative time was significantly shorter (160 min) in the study group than that (191 min) in control (P = 0.004). There were no significant differences between the groups with regard to blood loss, intraoperative and postoperative blood transfusion, preoperative and postoperative hemoglobin levels, yielded lymph nodes, and postoperative stay. Minor and major intraoperative and postoperative complications were not different between the groups. In these elected elderly patients, we demonstrate that pelvic and paraaortic lymph node dissection can be performed with an acceptable morbidity and mortality. We should perform pelvic and paraaortic lymphadenectomy in the older aged patients and advanced aged should not be considered a contraindication.

Use of boron waste as an additive in red bricks.

In boron mining and processing operations, large amounts of clay containing tailings have to be discarded. Being rich in boron, the tailings do not only cause economical loss but also pose serious environmental problems. Large areas have to be allocated for waste disposal. In order to alleviate this problem, the possibility of using clayey tailings from a borax concentrator in red brick manufacturing was investigated. Up to 30% by weight tailings addition was found to improve the brick quality.

Risk factors for pelvic surgery.

One hundred and eighty four women who had corrective surgery for stress incontinence, genital prolapse or both were compared with two hundred and ninety women who had no surgery for these conditions. Patients and controls did not differ in terms of age, height, weight or body mass index. Younger age at first delivery (20.1+/-4.1 vs 22.8+/-4.9, p<0.000) and a smoking history (33.2% vs 23%, p<0.015) were found as risk factors for the study group. Women who underwent surgery had greater gravidity (4.85+/-2.9 vs 3.87+/-2.5, p<0.001), greater parity (3.03+/-1.9 vs 2.19+/-1.3, p<0.000), were less often nulliparous (2.2% vs 7.9%, p<0.008), less likely to have had a cesarean delivery (1.1% vs 9%, p<0.001) and more likely to have had a vaginal delivery (97.3% vs 85.9%, p<0.000) than the control group. The study group have had larger neonates on average (3800+/-416 vs 3373+/-637 gm's, p<0.000) and had greater use of forceps or vacuum extractor for at least one delivery (17.9% vs 7.6%, p<0.001). Highly significant relationship was found between the risk of having corrective surgery and the number of children born vaginally. Women who had 4 or more vaginal deliveries had 11.7 times more risk of urinary incontinence or genital prolapse.

The effect of ascites, mass volume, and peritoneal carcinomatosis on serum CA125 levels in patients with ovarian carcinoma.

The aim of this study is to investigate the effects of ascites, ovarian mass volume, and peritoneal carcinomatosis on serum CA125 levels in patients with nonmucinous epithelial ovarian carcinoma. Serum CA125 levels were determined by a commercial enzyme immunoassay kit in a series of 98 patients with stage I-IV nonmucinous epithelial ovarian carcinoma. Amounts of ascites were determined in each patient with ascites. Ovarian mass volumes were calculated in 22 patients with stage I disease without ascites. Peritoneal carcinomatosis was detected in 35 ovarian cancer patients. Serum CA125 levels were compared among the patients with different clinical conditions. Serum CA125 levels were significantly higher in cases of ovarian cancer with ascites when compared with those without ascites (P < 0.01). Abnormal levels of serum CA125 were found in 80% of all patients; these abnormal levels were detected in 92% and 97% of the patients with ascites and with peritoneal carcinomatosis, respectively. A positive correlation between serum CA125 levels and ascites amounts was found in patients with ascites (P < 0.01, r = 0.74). However, there was no correlation between ovarian mass volumes and levels of serum CA125 in patients having stage I disease but no ascites (P = 0.5, r = 0.15). Our results showed that serum CA125 levels might be affected by the amount of ascites and the presence of peritoneal carcinomatosis but not with ovarian mass volume. However, these findings need to be confirmed in more and larger studies. These results may be beneficial in the management of ovarian carcinoma patients with elevated CA125 levels.

May cathepsin D immunoreactivity be used as a prognostic factor in endometrial carcinomas? A comparative immunohistochemical study.

OBJECTIVE: To investigate the prognostic value of immunohistochemical detection of cathepsin D and the association between cathepsin D and established prognostic factors in endometrial carcinoma. METHODS: Cathepsin D immunoreactivity was determined by an immunohistochemical technique in a series of 79 patients with surgical stage I-III primary endometrial carcinoma. RESULTS: Of 79 tissue specimens, 48 (61%) showed a positive reaction for cathepsin D. A significant correlation between cathepsin D and histological grade was found (P < 0.05). The other established clinicopathological prognostic factors were not associated with cathepsin D. There was not any significant difference in prognosis between the positive cases and negative cases for cathepsin D (P > 0.05). In the univariate analysis cathepsin D immunoreactivity did not show significant prognostic value for overall survival (P > 0.05). The multivariate analysis also showed that cathepsin D was not related to patient outcome (P = 0.24, relative risk = 0.34, 95% confidence interval = 0.05-2.09). CONCLUSIONS: Our results suggest that cathepsin D immunoreactivity may not be of prognostic value but more studies are needed to evaluate the relationship between its immunoreactivity in tumor cells and in other cells.

Omentectomy, peritoneal biopsy and appendectomy in patients with clinical stage I endometrial carcinoma.

The aim of this study was to evaluate whether omentectomy, appendectomy, and peritoneal biopsy should be a routine part of staging surgery in endometrial carcinoma. Data of 97 patients who had been diagnosed with clinical stage I endometrial carcinoma were reviewed. Associations in the data obtained, pelvic and para-aortic lymph node status, depth of myometrial invasion, grade, and histology were investigated. The chi-square (chi2) test was used for statistical analysis. Of 97 patients, six (6%) had omental metastases, which was microscopic in four. There was a statistically significant relationship between omental metastasis and tumor grade (P < 0.01). Deep myometrial invasion was significantly more common in patients with omental metastases. Tumor was found in one of 55 appendectomy specimens (2%). Omentectomy may be included in surgical staging in patients with deeply invasive or grade 3 endometrial cancer because of the possibility of omental metastasis in spite of what appears to be stage I disease in laparotomy. In other cases, omentectomy and appendectomy and biopsies from peritoneal sites should be performed in the presence of grossly suspicious disease.

Estrogen and progesterone receptor manipulations in castrated rat uterus models and the clinical adaptation.

To investigate the influence of tamoxifen, danazol and triptorelin (a GnRH agonist) on estrogen and progesterone receptors of rat endometrium, 44 castrated Sprague-Dawley rats were divided into four equal groups, and each group received either no treatment or one of the agents. After administration of the agents, estrogen and progesterone receptor levels, detected by immunohistochemical methods, were compared with the controls. Estrogen and progesterone receptors were significantly higher in the tamoxifen group than the controls (p<0.05), but this was not noticed in the triptorelin group (p>0.05). Receptor levels were higher in the danazol group than the controls, but it was significant only in the estrogen receptors. Among the 3 groups, receptor levels were higher than in the control group. There was not any correlation among the estrogen and progesterone receptor levels in all groups. Steroid receptor manipulations can be used in the treatment of gynecologic cancer, but further investigations are needed.

Relation between bone mineral content and clinical, hormonal and biochemical parameters in postmenopausal women.

We studied factors related to bone mass after a natural or surgical menopause in 73 healthy women attending the menopause clinic of a university hospital. In the natural menopause group we found inverse correlations between bone mineral density (BMD) vs. menopausal duration; BMD vs. body mass index (BMI) and BMI vs. inorganic phosphate (Pi), borderline correlations between weight vs. thyroxin (T4) and weight vs. luteinising hormone (LH) and a positive correlation between androstenedione (D4A) vs. urinary calcium (Uca). In the surgical menopause group we found some negative correlations (BMD vs. menopausal duration, BMI vs. Pi; BMI vs. dehydroepiandrosterone sulphate (DS), weight vs. DS and cortisol vs. Uca) and some positive correlations (BMD vs. free testosterone (fT), BMD vs. calcium (Ca), and BMD vs. Uca). We concluded that the serum hormone levels we measured were not useful markers of current bone mineral status.

Borderline ovarian tumours: retrospective analysis of twenty-one cases.

Twenty-one borderline ovarian tumour cases, diagnosed and treated in our oncology section between 1986 and 1996, were retrospectively analysed. Thirty-three percent of the cases had serous tumours and the rest (66.6%) were mucinous, 57.1% of the mucinous tumours were the intestinal type and the remaining 42.9% were the endocervical type. When all the cases were analysed, the average age was 45.4+/-18.6 years, the average follow-up period was 5.5+/-2.6 years. The preoperative average CA125 level was 55.1+/-51.9 U/mL, and for CA19.9 it was 48.2+/-47.8 U/mL. Of the patients 85.7% were stage I and 14.3% state III. There were not any significant differences between the serous, intestinal-type mucinous and endometroid-type mucinous tumours regarding tumour volumes (p>0.05). When serous and mucinous tumours were compared according to the tumour markers, CA125 levels were significantly higher in the serous tumours (p=0.04) and CA19.9 levels were significantly higher in the mucinous tumours (p=0.02). All of the patients are under our follow-up and are in remission, except one, who died in the third year of the treatment because of chronic renal failure unrelated to the ovarian pathology.

PIP: Tumors of low malignant potential represent approximately 15% of epithelial ovarian tumors and tend to occur at a younger age than malignant neoplasia. This paper presents a retrospective analysis of the 21 borderline ovarian tumors diagnosed and treated at Dokuz Eylul University in Izmir, Turkey, in 1986-96. The average age at presentation was 45.4 +or- 18.6 years. The diagnosis was made by exploratory laparotomy and frozen section. 7 tumors (33.3%) were serous and 14 (66.6%) were mucinous. 8 borderline mucinous tumors (57.1%) were intestinal type and 6 (42.9%) were endocervical. The average preoperative cancer marker level was 55.1 +or- 51.9 U/ml for CA125 and 48.2 +or- 47.8 U/ml for CA19.9. CA125 levels were significantly higher in serous tumors (p = 0.04) while CA19.9 measurements were significantly higher in mucinous tumors (p = 0.02). 18 tumors (85.7%) were stage I and 3 (14.3%) were stage III. There were no significant differences in tumor volume between serous, intestinal-type mucinous, and endometroid-type mucinous tumors. Women with stage I tumors who wanted to preserve their fertility underwent unilateral salpingo-oophorectomy; total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed in the remaining cases. Women with stage III tumors received 6 rounds of first-line adjuvant chemotherapy followed by second-look laparotomy. 1 patient died in the third year of treatment as a result of chronic renal failure unrelated to the ovarian pathology; the remaining women, who have been followed an average of 5.5 +or- 2.6 years, are in remission.

Plasma endothelin-1 levels in Behçet's disease.

Plasma concentrations of endothelin-1 (ET-1), a vasoconstrictor peptide released from vascular endothelial and synovial cells, were measured by radioimmunoassay in 27 patients with Behçet's disease (BD) and 18 healthy controls. The plasma ET-1 concentrations were found to be significantly increased in patients with BD (121.15 +/- 11.6 fmol/dl) compared with the healthy subjects (89.37 +/- 8.03 fmol/dl p < 0.05). The elevation of ET-1 did not correlate with the disease duration, gender, ocular or articular involvement. Whether the elevated ET-1 level is a direct result of its increased synthesis from injured vascular endothelial cells or whether its presence in high concentrations may be responsible, together with other factors for both vascular and articular complications in patients with BD is uncertain.

Lipoprotein levels in patients with pregnancy induced hypertension.

The purpose of this prospective study was to investigate the levels of Lp(a), Apo(a), VLDL, LDL and HDL in 23 patients with pregnancy induced hypertension (PIH) and in 20 control. The Mann-Whitney U tests was used for comparisons between the two groups. Serum Lp(a) and Apo(a) levels were significantly raise in the PIH group (p < 0.05 and p < 0.05 respectively) and no significant correlations could be demonstrated for other lipoproteins.

Risk factors for Wolfe's dysplasia of mammograms in postmenopausal Turkish women.

OBJECTIVE: The aim was to ascertain whether menstrual, reproductive and hormonal risk factors for breast cancer are present in women with dysplastic mammographic patterns and to investigate possible trends towards breast cancer. METHOD: This prospective case-control study was designed in a university hospital. Thirty-two turkish postmenopausal women were evaluated for the associations between obesity, parity, age, age at menarche, age at menopause, total lactation period and dysplasic mammographic patterns. RESULTS: We found an increasing trend of dysplasia with increasing age at menarche. This association contradicts the well established one for breast cancer. The effects of parity and total lactation period on dysplasia were similar. Although nulliparity had some protective effects on dysplasia, relative risk (RR) increased to some extent with an increase in parity and lactation period. Later menopause and older age were associated with an increase risk of dysplasia, whereas an apparent protection was given by greater body mass index. CONCLUSION: Onset of the menopause increases the risk of dysplasia and the estrogenic milieu may have some role in the initiation and progression of dysplasia.

Oligohydramnios induced by maternal indomethacin therapy.

Indomethacin is a potent tocolytic agent used in premature labor. The most observed adverse effect was the constriction of ductus arteriosus, causing persistent fetal circulation postnatally. Until recently, decrease in amniotic fluid during treatment with indomethacin has been shown partly by subjective methods. In comparison with posttreatment results, using "amniotic fluid index", transient decrease in amniotic fluid was determined semi-quantitatively.

Subclinical amnionitis in patients with intact membranes in preterm labour.

Preterm delivery is the major obstetric and paediatric problem, being responsible for much perinatal morbidity and mortality. Subclinical amnionitis may cause preterm labour and delivery. The rate of subclinical bacterial infection of amniotic fluid was studied in 25 afebrile pregnant women with intact membranes in preterm labour. Specimens of amniotic fluid were collected by transabdominal amniocentesis. Serum and amniotic fluid lactic dehydrogenase (LDH) levels were assessed to determine their usefulness in making the diagnosis of subclinical amnionitis. Aerobic bacteria were isolated from 48% (12/25) of the specimens. Thus, subclinical amnionitis may play a substantial role in patients with intact membranes in preterm labour. However, transabdominal amniocentesis is not routinely indicated in similar asymptomatic patients because microbiological and especially LDH studies require further evaluation.