Bone metastasis in endometrial cancer: evaluation of treatment approaches by factors affecting prognosis.

OBJECTIVE: The purposes of this study were to present an endometrial cancer case with a first sign of bone metastasis, and to reveal factors affecting survival and the appropriate treatment methods for bone metastases. MATERIALS AND METHODS: A total of 101 case reports that presented with bone metastasis of endometrial cancer were reviewed in this study. RESULTS: Survival time in the patients without surgical treatment for bone metastasis was found to be 12 months (95% CI = 5.89 - 18.10) and 42 months in patients who underwent surgical treatment in addition to one or more of chemo-radio-hormonotherapies (95% CI = 16.58 - 67.41) (p = .006). Histological type of cancer, extra-osseous metastasis, and lack of surgery were the factors significantly affecting survival (p = 0.012, p = 0.002, and p = 0.038, respectively). CONCLUSION: Histological type and the presence of extra-osseous involvement are important prognostic markers in endometrial cancer patients with bone metastasis. It may be appropriate to implement combination therapies including surgery in the treatment of bone metastases.

Maternal colonisation with group B streptococcus and effectiveness of a culture-based protocol to prevent early-onset neonatal sepsis.

This study was conducted to find out the group B streptococcus colonisation of pregnant women in Kocaeli, Turkey. A culture plus individualised high-risk-based antibiotic prophylaxis was compared with high-risk-based approach alone. The screening of women was performed via vaginal and anal cultures for group B streptococcus (GBS). The maternal GBS colonisation rate was found to be 6.5%. All colonised women or preterm labours with unavailable culture results until delivery received prophylactic antibiotics. Neonatal colonisation rate and early-onset neonatal sepsis due to GBS was 1/200. The unscreened 900 women received prophylactic antibiotics due to a risk factor-based approach. The neonatal colonisation rate was 17/900 (p = 0.1), and the rate of early-onset neonatal sepsis was 3/900 (p = 0.6). A culture plus individualised high-risk-based antibiotic prophylaxis provided an insignificant change in neonatal colonisation and early-onset neonatal sepsis with GBS when compared with high-risk-based approach alone.

Antiproliferative effects and insulin-like growth factor-I expression in Balb-C 3T3 fibroblasts after treatment with somatostatin and gonadotropin-releasing hormone analogs.

The present study was aimed to compare antiproliferative effects of somatostatin (SS) and gonadotropin-releasing hormone analogs (GnRHa) on a fibroblast cell line. Proliferation index, cell count, viability of the cells and insulin-like growth factor-I (IGF-I) immunoreactivity were determined after treatment with either SS (100 microM/ml), GnRHa (35 nM/ml) or SS and GnRHa of Balb-C 3T3 mouse fibroblasts. It was found that the proliferation index, cell count, viability and IGF-I immunoreactivity were not affected by GnRHa treatment as compared with no treatment (p > 0.05). Application of SS to the fibroblasts resulted in a significant reduction in proliferation index, cell count, and IGF-I immunoreactivity as compared with GnRHa treatment and no treatment, but it had no effect on cell viability. The labelling index in SS-treated cells was significantly reduced as compared with combined treatment with SS and GnRHa. In conclusion, a direct effect of GnRHa on fibroblast cells in culture could not be demonstrated. SS had direct inhibitory effects on cell proliferation possibly via inhibition of IGF-I effects without affecting cell viability.

Factors affecting contraceptive use and behavior in Kocaeli, Turkey.

This study aimed to investigate contraceptive use and its determinants in Kocaeli, Turkey. A questionnaire was applied to 922 randomly selected sexually active women of reproductive age, in order to extract information concerning contraceptive use and sociodemographic factors affecting behavior and contraceptive use. Knowledge of at least one method was nearly universal. Intrauterine devices and withdrawal were the most commonly used methods. Illiterate women and housewives had less knowledge about some modern methods. The number of children (p < 0.001), nuclear type family (p < 0.05), and approval of family planning (p < 0.001) were the factors most predictive of contraceptive use. Husbands were involved in family planning via discussing family size (79.4%) and method (85.5%) 38.2% of males participated actively by using withdrawal or condom. Increasing the literacy of both male and female partners significantly increased both contraceptive use and the participation of husbands in family planning descision making. In conclusion, increasing the education level of couples and the status of women would result in increased contraceptive use in the future. Since the contraceptive behavior of women is influenced by their husbands' attitudes, family planning programs should be focused on the needs of both partners.

The effects of human amniotic membrane and fibrin sealant in the prevention of postoperative adhesion formation in the rabbit ovary model.

The study group consisted of 29 female, white New Zealand rabbits. The rabbits were randomized into 3 groups and a midline laparotomy was performed in order to make a 4-5 mm long lesion using a scalpel in both ovaries. In Group 1, both of the ovaries were left uncovered. In Group 2, the right ovaries were covered by human amniotic membrane graft. In Group 3, 0.1-0.2 mL of Tisseel solution was applied to the lesion in the right ovaries. No medication was applied to the left ovaries in any of the groups and thus this ovary acted as an individual control. After 2 weeks the adhesion scores were graded by relaparotomy in a blind manner. Fibrin sealant showed a significant reduction in postoperative adhesion formation compared with the amniotic membrane graft and control groups (p<0.001). Therefore, it can be concluded that fibrin sealant can be used as an adjuvant during reproductive surgery.

A trial of reducing adhesion formation in a uterine horn model.

For the prevention of postoperative adhesion formation, one of the most common causes of infertility, none of the adjuvants had been proven uniformly effective. In this study we evaluated the effectiveness of sodium carboxymethylcellulose (SCMC) and disodium cromoglycate (DSCG) in postoperative adhesion prevention in a rat uterine horn model. Thirty female Sprague-Dawley rats were used. After uterine horn abrasion, in 10 rats 10 ml 0.9% saline, in 10 rats 10 ml of 2% SCMC, and in 10 rats 10 ml DSCG were administered intraperitoneally. Two weeks later, all animals were sacrificed and adhesion formation was assessed. All the pieces of the peritoneum biopsies were stained with Luna's mast cell stain to assess the mast cell degranulation. The mean adhesion scores were 2.1, 2.0 and 1.5 for saline, SCMC and DSCG groups respectively. There were no significant differences among all groups. In the pathologic examination, mast cell degranulation was less in the DSCG group than the other groups.

Fluoxetine in the treatment of premenstrual syndrome.

BACKGROUND: Premenstrual syndrome (PMS) is defined as the disabling and cyclic occurrence of emotional and behavioral symptom complex during the latter half of the menstrual cycle. Although its etiology is unknown, it has been speculated that premenstrual syndrome is linked to a deficiency of central serotoninergic activity. METHOD: The study consisted of a double-blind, placebo controlled trial of fluoxetine at a dose of 20 mg/day or placebo for three menstrual cycles. The 440 women who appeared to meet the eligibility criteria were instructed to record the 'Calendar of Premenstrual Experiences' (CPE) scale for two complete menstrual cycles. Of 410 women who successfully completed two cycles of recording their symptoms daily only 35 met the criteria for PMS. These criteria included psychiatric interviews which were made before treatment. Thirty-five PMS patients were randomized into placebo or fluoxetine treatment groups. RESULTS: Our study suggests that fluoxetine at a dose of 20 mg per day was significantly superior to placebo in alleviating the symptoms of PMS. The most common side effects were gastrointestinal irritability (15%), insomnia (11%) and sexual dysfunction (8.5%). CONCLUSION: Fluoxetine is an effective and well-tolerated drug and appears to have considerable promise in treating a range of symptoms in women with PMS.

Efficacy of methotrexate and misoprostol for early abortion.

BACKGROUND: Medical termination of pregnancy (medical abortion) as an alternative to surgical abortion has many advantages since it does not require anesthetics and there is no risk of cervical laceration or uterine perforation. In the present study, we evaluated the efficacy of methotrexate and intravaginally administered misoprostol for early abortion. METHODS: The study population consisted of 32 women seeking abortion of a normal intrauterine pregnancy of 8 weeks or less documented by ultrasound. The dose of methotrexate was 50 mg/m2 intramuscularly and the dose of misoprostol was 800 micrograms intravaginally. The final outcome of treatment was evaluated on day 14 or 16, and an abortion was considered successful if pregnancy was terminated without a surgical procedure. RESULTS: Abortion occurred in only 23 (71.8%) of 32 women. There were 9 failures (28.1%); 3 were ongoing pregnancies (9.3%) and 6 were incomplete abortions (18.7%) requiring suction curettage. After the exclusion of treatment failures, the mean duration of vaginal bleeding was 16.3 +/- 2 days. No serious side effects occurred as a result of methotrexate and misoprostol treatment. CONCLUSION: The use of methotrexate and intravaginal misoprostol for the termination of pregnancy requires larger studies to determine the safety and efficacy of this medical abortion, a comparison with RU 486 in prospective controlled randomized trials is necessary.

PIP: Medical termination of pregnancy (medical abortion), as an alternative to surgical abortion, has many advantages since it does not require anesthetics and there is no risk of cervical laceration or uterine perforation. In the present study, the authors evaluated the efficacy of methotrexate and intravaginally administered misoprostol for early abortion. The study population consisted of 32 women seeking termination of a normal intrauterine pregnancy of 8 weeks or less documented by ultrasound. The dose of methotrexate was 50 mg/sq. m intramuscularly and the dose of misoprostol was 800 mcg intravaginally. The final outcome of treatment was evaluated on day 14 or 16, and an abortion was considered successful if pregnancy was terminated without a surgical procedure. Abortion occurred in only 23 (71.8%) of 32 women. There were 9 failures (28.1%); 3 were ongoing pregnancies (9.3%) and 6 were incomplete abortions (18.7%) requiring suction curettage. After the exclusion of treatment failures, the mean duration of vaginal bleeding was 16.3 +or- 2 days. No serious side effects occurred as a result of methotrexate and misoprostol treatment. The use of methotrexate and intravaginal misoprostol for the termination of pregnancy requires larger studies to determine the safety and efficacy of this type of medical abortion; a comparison with RU 486 in prospective controlled randomized trials is necessary.