Computational modelling of wounded tissue subject to negative pressure wound therapy following trans-femoral amputation.

Proof-of-concept computational models were developed and applied as tools to gain insights into biomechanical interactions and variations of oxygen gradients of wounded tissue subject to negative pressure wound therapy (NPWT), following trans-femoral amputation. A macro-scale finite-element model of a lower limb was first developed based on computed tomography data, and distributions of maximum and minimum principal stress values we calculated for a region of interest (ROI). Then, the obtained results were applied iteratively as new sets of boundary conditions for a specific spatial position in a capillary sub-model. Data from coupled capillary stress and mass- diffusion sub-models were transferred to the macro-scale model to map the spatial changes of tissue oxygen gradients in the ROI. The -70 mmHg NPWT resulted in a dramatic change of a wound surface area and the greatest relative contraction was observed at -150 mmHg. Tissue lateral to the depth of the wound cavity revealed homogenous patterns of decrease in oxygenation area and the extent of such decrease was dependent on the distance from the wound surface. However, tissue lateral to the width of the wound demonstrated heterogeneous patterns of change, as evidenced by both gradual increase and decrease in the oxygenation area. The multiscale models developed in the current study showed a significant influence of NPWT on both macro-deformations and changes of tissue oxygenation. The patterns of changes depended on the depth of the tissue, the geometry of the wound, and also the location of tissue plane.

Comparison of the success of histopathological diagnosis with dilatation-curettage and Pipelle endometrial sampling.

The aim of this study is to compare collection of sufficient material and diagnostic accuracy of Pipelle biopsy with curettage and hysterectomy. A total of 82 cases with indications for endometrial biopsy for any reason and in which endometrial biopsy was performed with dilatation and curettage (D&C) and Pipelle aspiration biopsy, and 66 cases in which an indication for hysterectomy was established for any reason were included in the study. Histopathological findings were examined in the following six groups: normal; endometrial polyps; hyperplasia without atypia; hyperplasia with atypia; atrophy; and insufficient material. Descriptive statistical methods and McNemar's test were used. When the histopathological compatibility between Pipelle and D&C was considered (n=82), a diagnosis that was different from that obtained by D&C was obtained in 22 of the 63 cases (34%), in whom normal endometrial histology was found with a Pipelle biopsy specimen. It was observed that only 1 of 13 cases of endometrial polyps was diagnosed with Pipelle biopsy. Insufficient material was obtained in six cases (7%) with Pipelle biopsies and three cases (4%) with D&C. While Pipelle biopsies and D&C have a nearly equal level of success in widespread endometrial lesions, Pipelle biopsies provide limited diagnostic accuracy in cases with focal pathologies.

Placement of a vena cava filter in term pregnancy: case report and review of the literature.

During pregnancy there are hemostatic changes that may result in a hypercoagulable state producing thrombotic consequences. This condition may be aggravated in women who are carriers of congenital thrombophilic factors. These factors may increase obstetric complications such as miscarriages, fetal growth restriction, placental abruption and preeclampsia. Trombophilic factors may also cause venous thromboembolism, which is the leading cause of maternal morbidity and mortality. We report a case of a 22-year-old woman with factor V Leiden mutation, whose pregnancy was complicated with deep venous thrombosis requiring placement of a vena cava filter.

Effects of inherited thrombophilia in women with recurrent pregnancy loss.

PURPOSE OF INVESTIGATION: To evaluate the prevalence and effects of inherited thrombophilia caused by factor V Leiden, prothrombin G20210A and methylenetetrahydrofolate reductase (MTHFR) C677T mutations in women with recurrent pregnancy loss. METHODS: A study group of 97 women with recurrent miscarriages and a control group of 71 healthy pregnant women were included in the study. Genotype analyses for factor V Leiden, prothrombin G20210A and MTHFR C677T polymorphisms were performed by real-time polymerase chain reaction (RT-PCR). RESULTS: The frequency of factor V Leiden, prothrombin G20210A and MTHFR C677T mutations were similar in both the study and control group. There were eight patients (8.2%) who had more than one gene mutation in the study group and one patient in the control group (1.4%). This difference was not statistically significant. Study group patients (n = 97) were compared in terms of the number of miscarriages and the abortion week, in addition to being a carrier of factor V Leiden and MTHFR C677T gene mutations. No statistically significant correlation was found between being a factor V Leiden and MTHFR C677T mutation carrier with either the number of miscarriages or the abortion week. CONCLUSION: Factor V Leiden, prothrombin G20210A and MTHFR C677T gene mutations are not individually related with recurrent pregnancy loss. However, combined gene mutation status may be associated with recurrent miscarriages.

Effects of tamoxifen on tissue nitrite/nitrate levels and plasma lipid peroxidation in female rats.

PURPOSE OF INVESTIGATION: The effects of tamoxifen on lipid peroxidation and oxidant-antioxidant balance in an animal model were studied. METHODS: Twelve female adult rats were divided into two groups and DMSO and tamoxifen dissolved in DMSO were administered. Tissues taken from the brain, liver and ovary of rats were dissected. MDA, nitrite, nitrate levels and plasma LDL oxidation in brain, ovary and liver tissues were measured and compared. RESULTS: Induced LDL MDA levels were significantly lower in the tamoxifen group (p = 0.009). MDA levels in the liver were significantly lower in the tamoxifen group whereas nitrite levels were found significantly higher (p < 0.05). Brain and ovarian tissues demonstrated no significant difference with respect to MDA, nitrite and nitrate levels. CONCLUSION: Tamoxifen has no negative effects on lipid peroxidation in an animal model.

Retrospective analysis of hysteroscopic findings in breast cancer patients having adjuvant tamoxifen treatment.

PURPOSE OF INVESTIGATION: To evaluate the effects of tamoxifen on the endometrium of breast cancer patients by hysteroscopy and endometrial sampling. METHODS: Thirty-seven breast cancer patients using tamoxifen underwent hysteroscopy because of postmenopausal endometrial thickening or abnormal uterine bleeding. Hysteroscopic findings were compared with histopathology and ultrasonographic measurement of the endometrium. RESULTS: Nineteen women showed endometrial abnormalities (51%) out of 37 patients. Negative and positive predictive values for hysteroscopy in detecting endometrial abnormalities were 100% and 94%, respectively. CONCLUSION: Endometrial surveillance is an important part of gynecological follow-up in breast cancer patients using tamoxifen and the liberal use of hysteroscopy aids in the diagnosis of abnormal endometrium.

Immunohistochemical expressions of p16 and p53 proteins in cervical intraepithelial neoplasia and in benign cervical tissue.

PURPOSE OF INVESTIGATION: To evaluate the immunohistochemical expressions of p16 and p53 in cervical intraepithelial neoplasia (CIN) and do a comparison with non-neoplastic cervical lesions. METHODS: Sixty cases diagnosed as CIN after histopathological examination and 25 controls diagnosed as chronic cervicitis were included in the study. Immunohistochemical expressions for p16 and p53 were evaluated and compared in all cases. The cases in the study were defined according to the Bethesda system. Of these, 31.8% (n = 27) had a low-grade squamous intraepithelial lesion (LGSIL), and 38.8% (n = 33) had a high-grade squamous intraepithelial lesion (HGSIL). RESULTS: There was a statistically significant difference between chronic cervicitis and CIN in terms of p53 and p16 expression levels (p = 0.001). On the other hand, the level of p16 expression was statistically different between LGSIL and HGSIL (p = 0.001), while there was no significant difference in terms of p53 expression. Among the HGSIL cases (n = 33), 91% had p16 expression, while 66.7% (n = 27) of the LGSIL patients had no p16 expression. In the chronic cervicitis group, 84% (n = 21) did not reveal any p16 expression, while 96% (n = 24) did not reveal any p53 expression. Various levels of p53 expressions were detected in 59.2% (n = 16) of CIN1 cases, 69.3% (n = 9) of CIN2 cases, and 90% (n = 18) of CIN3 cases. CONCLUSION: While p16 is useful in detecting high-grade cervical lesions, p53 is not a good biomarker for distinguishing high-grade lesions from low grade ones.

Grade 2 endometrioid adenocarcinoma arising from adenomyosis of the uterus: report of a case.

Adenomyosis is defined by the presence of endometrial tissue (glands and stroma) within the myometrium and malignant transformation of adenomyosis in premenopausal women with normal endometrium is extremely rare. Adenocarcinomas arising within adenomyosis need to be distinguished from endometrial carcinomas which arise from the eutopic endometrium, then extend into preexisting adenomyosis of the uterine wall. We report a case of grade 2 endometrioid adenocarcinoma arising from an adenomyotic focus in the uterus.

Relation between Doppler findings and perinatal outcomes in fetuses with intrauterine growth restriction.

PURPOSE OF INVESTIGATION: To find the relationship between fetal Doppler findings and perinatal outcomes in intrauterine growth restriction. METHODS: Eighty-two cases with a prenatal diagnosis of intrauterine growth restriction between November 2008 and July 2009 were included in this prospective study at Ege University School of Medicine. Fetuses were grouped according to Doppler parameters: those with normal Doppler findings (n = 43), and those with impaired arterial (n = 27) and venous systems (n = 12). RESULTS: Out of 82 growth restricted cases, 43 (52.4%) had normal Doppler findings, while 27 (32.9%) displayed impaired arterial parameters and 12 (14.6%) had impaired venous parameters. The mean first minute Apgar scores were 7.57 +/- 1.53 for the group with normal Doppler flows, 6.8 +/- 2 for the group with an impaired arterial system, and 4 +/- 1.94 for the group with an impaired venous system. Two cases from the normal Doppler flow group (n = 42), four cases from the impaired arterial flow group (n = 27), and 11 cases from the impaired venous flow group (n = 11) had fifth minute Apgar scores under 6. Evaluation of the umbilical artery blood gas revealed acidosis in two cases from the normal Doppler flow group (n = 42), three cases from the impaired arterial system group (n = 27), and five cases from the impaired venous system group (n = 11). CONCLUSION: A Doppler spectrum from normal to venous system impairment correlated with poor fetal outcomes including fetal acidosis, fetal mortality and morbidity, decreased Apgar scores at 1 and 5 min, and neonatal morbidity.

Placental growth factor: a putative screening test for gestational diabetes mellitus in first trimester.

PURPOSE OF INVESTIGATION: To evaluate placental growth factor as a screening test for gestational diabetes mellitus in the first trimester. METHODS: Sixty-seven pregnant women who were admitted to the outpatient clinic of Ege University Obstetrics and Gynecology Department consecutively for first trimester bioanalysis between May 2005 and February 2006 were included in the study. The cohort of patients underwent 50 g or 100 g oral glucose tolerance tests at the 24th week of pregnancy. Placental growth factor levels were analyzed by ELISA (human PGIF, ELIZA kit, Quantikine, R&D systems, USA) from the maternal blood collected at the time of first trimester screening. RESULTS: The study group of 15 patients with gestational diabetes were compared with a control group of 52 pregnant women with normal oral glucose tolerance tests. The level of placental growth factor was mean 35.79 +/- 16.79 pg/ml in the study group whereas it was mean 45,12 +/- 28.07 pg/ml in the control group. There was no significant difference between either group for placental growth factor maternal serum levels. CONCLUSION: Maternal placental growth factor serum levels are not useful in predicting gestational diabetes mellitus.