Human papillomavirus genotype distribution and E6/E7 oncogene expression in Turkish women with cervical cytological findings.

BACKGROUND: Infection with certain human papillomavirus (HPV) genotypes is the most important risk factor related with cervical cancer. The objective of the present study was to investigate the prevalence of HPV infection, the distribution of HPV genotypes and HPV E6/E7 oncogene mRNA expression in Turkish women with different cervical cytological findings in Mersin province, Southern Turkey. MATERIALS AND METHODS: A total of 476 cytological samples belonging to women with normal and abnormal cervical Pap smears were enrolled in the study. For the detection and genotyping assay, a PCR/direct cycle sequencing approach was used. E6/E7 mRNA expression of HPV-16, 18, 31, 33, and 45 was determined by type-specific real-time NASBA assay (NucliSENS EasyQ(®)HPV v1.1). RESULTS: Of the 476 samples, 106 (22.3%) were found to be positive for HPV DNA by PCR. The presence of HPV was significantly more common (p<0.001) in HSIL (6/8, 75%) when compared with LSIL (6/14, 42.9%), ASC-US (22/74, 29.7%) and normal cytology (72/380, 18.9%). The most prevalent genotypes were, in descending order of frequency, HPV genotype 66 (22.6%), 16 (20.8%), 6 (14.2%), 31 (11.3%), 53 (5.7%), and 83 (4.7%). HPV E6/E7 oncogene mRNA positivity (12/476, 2.5%) was lower than DNA positivity (38/476, 7.9%). CONCLUSIONS: Our data present a wide distribution of HPV genotypes in the analyzed population. HPV genotypes 66, 16, 6, 31, 53 and 83 were the predominant types and most of them were potential carcinogenic types. Because of the differences between HPV E6/E7 mRNA and DNA positivity, further studies are required to test the role of mRNA testing in the triage of women with abnormal cervical cytology or follow up of HPV DNA positive and cytology negative. These epidemiological data will be important to determine the future impact of vaccination on HPV infected women in our region.

Role of luteal phase support on gonadotropin ovulation induction cycles in patients with polycystic ovary syndrome.

OBJECTIVE: To evaluate the effect of luteal phase progesterone support on pregnancy rates in women with polycystic ovary syndrome (PCOS) who were treated for clomiphene citrate-resistant anovulatory infertility with ovulation induction and intrauterine insemination (OI/ IUI). STUDY DESIGN: This randomized study included 110 clomiphene citrate-resistant PCOS patients. All patients underwent ovulation induction with recombinant follicle-stimulating hormone and intrauterine insemination, up to 3 cycles, and were randomized into 2 groups: (1) luteal support with progesterone or (2) a control group. The main outcomes were clinical pregnancy rates and live birth rates per cycle. RESULTS: Demographic data were not different between the study and control groups. Cycle characteristics were found to be homogeneous between groups. A total of 38 pregnancies were achieved (15.5% pregnancy rate per cycle). The clinical pregnancy rate and live birth rate per cycle in progesterone supported cycles were 18.9% and 16.8%, respectively. CONCLUSION: There might be a clinical benefit of luteal progesterone supplementation on OI/IUI cycles for women with PCOS. Although we did not reach a statistically significant difference between the 2 groups, luteal-supported cycles demonstrated a 6.7% higher clinical pregnancy rate and 6.1% higher live birth rate.

Effect of surgical staging on 539 patients with borderline ovarian tumors: a Turkish Gynecologic Oncology Group study.

OBJECTIVE: The objectives of this study were to examine demographic and clinicopathologic characteristics and to determine the effects of primary surgery, surgical staging and the extensiveness of staging. METHODS: In a retrospective Turkish multicenter study, 539 patients, from 14 institutions, with borderline ovarian tumors were investigated. Some of the demographic, clinical and surgical characteristics of the cases were evaluated. The effects of type of surgery, surgical staging; complete or incomplete staging on survival rates were calculated by using Kaplan-Meier method. RESULTS: The median age at diagnosis was 40 years (range 15-84) and 71.1% of patients were premenopausal. The most common histologic types were serous and mucinous. Majority of the staged cases were in Stage IA (73.5%). 242 patients underwent conservative surgery. Recurrence rates were significantly higher in conservative surgery group (8.3% vs. 3%). Of all patients in this study, 294 (54.5%) have undergone surgical staging procedures. Of the patients who underwent surgical staging, 228 (77.6%) had comprehensive staging including lymphadenectomy. Appendectomy was performed on 204 (37.8%) of the patients. The median follow-up time was 36 months (range 1-120 months). Five-year survival rate was 100% and median survival time was 120 months. Surgical staging, lymph node sampling or dissection and appendectomy didn't cause any difference on survival. CONCLUSION: Comprehensive surgical staging, lymph node sampling or dissection and appendectomy are not beneficial in borderline ovarian tumors surgical management.

Extragastrointestinal Stromal Tumor during Pregnacy.

Extragastrointestinal stromal tumors (EGISTs) are mesenchymal neoplasms without connection to the gastrointestinal tract. Gastrointestinal stromal tumors (GISTs) and EGIST are similar according to their clinicopathologic and histomorphologic features. Both of them most often express immunoreactivity for CD-117, a c-kit proto-oncogene protein. The coexistence of GIST and pregnancy is very rare, with only two cases reported in the literature. In this paper, we presented the first EGIST case during pregnancy in the literature.

Hydatidiform mole in Turkey: results from six centers.

OBJECTIVE: To evaluate the clinical profile of gestational trophoblastic disease and to determine the incidence of hydatidiform mole (HM) from six centers in Turkey. STUDY DESIGN: A retrospective analysis of patients diagnosed with HM in six medical centers in Turkey from 2000 to 2010 was undertaken. Patients' age, gravidity, parity and abortion, presenting signs, histopathological results and their follow-up were recorded. RESULTS: From 2000 to 2010, 351,650 deliveries were recorded in six centers in Turkey, and 263 cases were diagnosed as HMs. Of the 263 patients the mean age was 28.2 years. The mean numbers of gravidity, parity and abortion were 2.6, 1.3 and 0.3, respectively. According to the medical histories, 3 (1.1%) patients had molar pregnancy previously and the presenting symptom was vaginal bleeding in symptomatic cases. After evacuation, histopathologic examination revealed complete mole in 175 (66.5%) patients and partial mole in 86 (32.6%) patients, and methotrexate was given as a prophylactic chemotherapy in 17 patients (6.4%) while 6 (2.2%) patients underwent hysterectomy procedure. CONCLUSION: According to the results the incidence of molar pregnancy is 0.7/1,000 deliveries. Because of its rarity, multicenter, community-based studies are needed to determine the real incidence.

Effect of cervical length on second trimester pregnancy termination.

AIM: To evaluate the value of sonographic measurement of cervical length as a predictor of abortion or delivery within 24 h by misoprostol in second trimester termination of pregnancy (TOP). MATERIAL AND METHODS: One hundred and sixty-three women underwent TOP between 14 and 26 weeks of pregnancy due to various indications. The primary outcome was abortion within 24 h. Cervical length was measured before transvaginal administration of misoprostol. The effects of cervical length, total misoprostol dose, parity, and gestational age at diagnosis on successful TOP were evaluated. RESULTS: One hundred and sixty-three women were eligible who met the inclusion criteria. TOP occurred in 80.5% of patients within 24 h. Parous women had shorter prolonged induction to expulsion period over 24 h (14.1% vs 28.6%, P = 0.061). Total misoprostol dose and history of abortion were parameters that affected induction to delivery period (P = 0.002 and P = 0.041). Using an optimum cutoff of 36 mm, 58.2% sensitivity and 68.2% specificity were obtained. In addition, positive and negative predictive values were 85.36% and 33.3%, respectively. Pregnant women whose preinduction cervical length was shorter than 36 mm had a shorter induction time and needed a lower total misoprostol dose to achieve TOP than women with a cervical length longer than 36 mm (P = 0.027 and P = 0.011, respectively). CONCLUSION: Transvaginal measurement of cervical length before administration of prostaglandin analogue was not correlated with successful TOP within 24 h. It cannot be used as a predictor in light of our findings.

The effect of myomectomy on health-related quality of life of women with myoma uteri.

AIM: An equal consideration should be paid to improving health-related quality of life (HRQoL) in addition to successful medical outcome. Many studies have evaluated the effect of other methods rather than myomectomy on HRQoL, and have focused solely on the presence of myoma without regarding any concurrent pelvic pathology. METHODS: This study involved 80 patients with myomas and 75 controls. Domains of the Short Form - 36 (SF-36) questionnaire were evaluated pre- and postoperatively in 72 women with myomas. Furthermore, any correlations between myoma characteristics and SF-36 physical components (PC) and mental components (MC) were investigated. RESULTS: All SF-36 domains were lower in women with myoma uteri than in the control group, except for physical and social function. There was no correlation between PC and MC scores and the number, location and total volume of the myomas. However, fundal and posteriorly positioned myomas were related with the PC score, and posterior myomas with the MC score. Women with uteri over 200 cm(3) had significantly lower mean PC and MC scores. After myomectomy, all SF-36 domains were improved except for physical function and mental health. CONCLUSION: The findings from this study suggest that myomectomy improves HRQoL, and that myoma characteristics may modulate quality of life domains.

Insulin receptor substrate-2 gene polymorphism: is it associated with endometrial cancer?

OBJECTIVE: The G1057D polymorphism in the insulin receptor substrate-2 (IRS-2) gene has been reported to be associated with insulin resistance, obesity and type 2 diabetes. However little is known about its possible association with cancer. To investigate this association, we determined the distribution of its genotypes and frequency of alleles in endometrial cancer patients. METHODS: The study population consisted of 184 subjects: 44 patients with endometrial cancer and 140 controls without cancer. All the patients were primarily treated with surgical intervention. DNA was extracted from the leucocytes by high pure polymerase chain reaction (PCR) template preparation kit. Genetic polymorphism of IRS-2 G1057D was detected by using PCR-based restriction fragment-length polymorphism. RESULTS: For IRS-2 G1057D polymorphism, there was a significant difference in genotype distribution and allele frequency between endometrial cancer patients and controls (p < 0.001). The risk for endometrial cancer was 4.87 times higher in the individuals with the IRS-2 DD genotype compared to the GG genotype [95% confidence interval (CI): 1.74-13.63 p = 0.003]. Also individuals with the IRS-2 D allele had a significantly higher risk of endometrium cancer compared with individuals with the IRS-2 G allele, with a relative risk of 2.23 (95% CI: 1.36-3.67, p = 0.001) for cases compared with population controls. CONCLUSION: These results suggest that IRS-2 G1057D polymorphism may be associated with endometrial cancer.

Association of G1057D variant of insulin receptor substrate-2 with endometriosis.

OBJECTIVE: To investigate whether the insulin receptor substrate (IRS)-2 G1057D polymorphism is associated with the risk of endometriosis, and to evaluate potential correlation of IRS2 gene polymorphism with the stages of endometriosis. DESIGN: Case-control study. SETTING: Gynecology clinics in university hospital. PATIENT(S): Women with (n = 135) or without (n = 135) endometriosis. Afterward, the women with endometriosis were divided into two groups according to the stage: group 1 included 63 women in stages I-II, and group 2 included 72 women in stages III-IV. INTERVENTION(S): Genotyping by polymerase chain reaction-based restriction fragment-length polymorphism method. MAIN OUTCOME MEASURE(S): Genotype distribution of the G1057D polymorphism in the IRS2 gene. RESULT(S): The genotype distribution of the IRS2 G1057D polymorphism in the endometriosis group was significantly different from that of the control group (GG/GD/DD rates were 43.0%/39.3%/17.7% and 55.6%/36.3%/8.1% for the endometriosis and control groups, respectively). Further subgroup analyses according to the stage of endometriosis also revealed a positive association between the IRS2 DD genotype expression and stage III-IV endometriosis patients in the population studied. CONCLUSION(S): These results suggest that the IRS2 G1057D polymorphism may be associated with an increased risk for endometriosis.

Gonadotropin-releasing hormone antagonist use in controlled ovarian stimulation and intrauterine insemination cycles in women with polycystic ovary syndrome.

OBJECTIVE: To observe the effects of ganirelix on controlled ovarian stimulation and intrauterine insemination (COS/IUI) cycles in women with polycystic ovary syndrome (PCOS). DESIGN: Prospective, randomized, controlled clinical study. SETTING: An academic clinical research center. PATIENT(S): Women with PCOS and anovulatory infertility undergoing COS/IUI. INTERVENTION(S): Recombinant FSH therapy was started on day 3. In women assigned to the control group (n = 47), treatment was continued up to the day of hCG administration. In patients assigned to receive GnRH antagonist (n = 42), ganirelix was added when the leading follicle was > or =14 mm. MAIN OUTCOME MEASURE(S): Pregnancy rates, serum E(2), P, and LH levels, and follicle numbers at hCG day, prevalence of premature luteinization, and cost of stimulation. RESULT(S): Serum E(2), P, and LH levels were significantly lower in the ganirelix group. Although premature luteinization and cycle cancellation was encountered less in the ganirelix group, the pregnancy rates per cycle were similar (15.4% vs. 10.7%). Patients would pay 6,153 dollars more for each pregnancy when using ganirelix. CONCLUSION(S): Gonadotropin-releasing hormone antagonist resulted in more monofollicular development, less premature luteinization, and less cycle cancellation in IUI cycles of patients with PCOS; however, the cost of stimulation increased without an improvement in pregnancy rates.

N-acetyltransferase 2 gene polymorphism in patients with cervical cancer.

The aim of the study was to evaluate the role of N-acetyltransferase 2 (NAT2) gene polymorphism in the development of cervical cancer by comparing patients having invasive cervical squamous cell carcinoma (SCC) with healthy control subjects. The study group consisted of 42 women with invasive cervical SCC and 50 control subjects. All of the patients were primarily treated with surgical intervention. Blood samples (5 mL) were obtained from the patients before surgery or during follow-up to 2 years after surgery. DNA was extracted from the leukocytes by a high pure PCR template preparation kit (catalog No. 1 796 828; Roche Diagnostics GmbH, Mannheim, Germany). NAT2*5A, NAT2*6A, and NAT2*7A/B polymorphisms of NAT2 were detected by using a LightCycler-NAT2 mutation detection kit in real-time PCR (catalog No. 3113914, LightCycler instrument; Roche Diagnostics GmbH, Mannheim, Germany). We found that the risk of cervical SCC was 9.045-fold higher in individuals with NAT2*5A mutant allele (95% confidence interval, 1.448-56.524; P = 0.018). The frequency of the NAT2*5A slow genotypes in the patients with cervical cancer (23.8%) was significantly higher compared with that in the control group (6%). Individuals with the NAT2*5A slow genotype had a significantly higher risk of cervical cancer compared with individuals with the NAT2*5A fast genotype (odds ratio, 7.469; 95% confidence interval, 1.673-33.350; P = 0.008). However, there was no significant association between the NAT2*6A and NAT2*7A/B fast or slow acetylator status and the development of cervical cancer. In conclusion, NAT2*5A slow acetylator genotype was found to be significantly higher in patients with cervical cancer. These results suggest that NAT2*5A gene polymorphisms in patients may be associated with genetic susceptibility to cervical cancer.

Use of Chinese herbal medicine 'meizitanc' in pregnancy: report of three cases.

The Chinese herbal medicine 'meizitanc', known as 'LiDa Dai Dai Hua Jiao Nang' (Kunming Dali Industry and Trade, Kunming, Yunnan, China) has been used by many women to support weight loss, even though life-threatening side-effects and deaths have been reported. We report the outcomes of three cases of exposure to 'meizitanc' during early pregnancy. In the first case, the pregnancy continued after the patient stopped taking the drug and at 38 weeks of gestation, the patient delivered a healthy infant. However, in the second and third cases fetal cardiac activities were not detected on obstetric follow-up and both pregnancies were terminated due to missed abortion. To our knowledge, this is the first report of exposure to meizitanc during pregnancy. Although herbal medicines are presumed to be safe because of their natural origin, consumption of such products may be dangerous due to the content of undeclared drugs, adulteration with multiple substances and contamination with toxic metals.

Role of CYP2C19 polymorphisms in patients with endometriosis.

AIM: To investigate the association of CYP2C19 genotypes with endometriosis. METHODS: The study included 100 women who underwent laparotomy or laparoscopy: 50 patients with endometriosis diagnosed with surgery and histopathology, and 50 control subjects who had no evidence of endometriosis during exploratory laparotomy or laparoscopy. Genomic DNA of subjects was extracted from the whole blood using High Pure PCR template preparation kit. Genotyping of CYP2C19 polymorphisms were detected by using a LightCycler CYP2C19 mutation detection kit in a real-time PCR, and were compared between the two groups. RESULTS: Logistic regression analyses showed that the CYP2C19*2 heterozygote genotype was associated with a significantly increased risk of endometriosis. The odds ratio of endometriosis for the CYP2C19*2 heterozygote genotype was 3.165 (p = 0.023) compared with the control group. CYP2C19*3 genotype was detected as wild in all subjects in the endometriosis and control groups. CONCLUSION: Our results suggest that CYP2C19*2 heterozygote genotype has higher risk of developing endometriosis. Therefore, CYP2C19*2 allele gene polymorphisms may be associated with genetic susceptibility of endometriosis.

The association of mast cell density with myometrial invasion in endometrial carcinoma: a preliminary report.

It is known that cancer is not a single transformational event. It is rather a multistage process involving complex interactions with the surrounding cellular microenvironment. Mast cells accumulate at sites of tumor growth in response to numerous chemoattractants. Our aim was to investigate the relationship between mast cell density (MCD) and myometrial invasion in endometrial carcinomas. Immunohistochemistry was performed on 35 unselected consecutive hysterectomy specimens from patients with endometrial adenocarcinoma. C-kit-positive mast cell assessment was performed in the myometrium adjacent to tumor tissue. A mean number of or=16 mast cells was regarded as high mast cell density (H-MCD). A significant correlation (p=0.018, Pearson Chi-Square test) between H-MCD and the presence of myometrial invasion was demonstrated in endometrial carcinomas. H-MCD was found in 54% of all cases, and 94% of H-MCD cases had myometrial invasion, suggesting a role of mast cells or an interaction with tumor. Therapeutic modalities orientated to these cells or their microenvironment as a new target for adjuvant treatment might determine the prognosis in endometrial carcinomas.

The effect of myoma uteri and myomectomy on sexual function.

INTRODUCTION: This is a report about the effects of myoma uteri and myomectomy on sexual function in women. AIM: The aim of this article was to determine the effects of myoma uteri and myomectomy on sexual function in women. METHOD: The study was designed as a controlled clinical study in an academic clinical research center. The study patients consisted of 80 women with myoma uteri and 75 control women. Baseline characteristics and properties of the myomas were recorded. A validated questionnaire was used to determine pre- and postoperative sexual function in the patients. MAIN OUTCOME MEASURE: Female sexual function index (FSFI) scores of the women were recorded before and after surgery. RESULTS: Women with myoma uteri had lower FSFI pain and satisfaction scores than women without it, even after correction for possible confounders. Fundal and posterior myomas were associated with pain, whereas only posterior myomas were related to the overall FSFI scores. However, although there was no relation between the volume of the myomas and the FSFI scores, women with a uterine volume over 200 cm(3) had significantly lower mean FSFI satisfaction, pain, and total scores. The mean FSFI pain and total scores of the patients improved significantly after undergoing a myomectomy. CONCLUSIONS: The findings of this study suggest that a potential impairment of sexual function exists in women with myomas. This is mainly because of pain during sexual intercourse, although it does not seem to have an effect on either the arousal or orgasmic phases. Furthermore, the performance of a myomectomy may alleviate pain during intercourse, and thereby improve sexual function in the patients.

Sexual function after surgery for stress urinary incontinence: vaginal sling versus Burch colposuspension.

OBJECTIVE: We prospectively investigated the effect of surgery for stress urinary incontinence (SUI) on sexual function and also compared preoperative and postoperative sexual functions according to vaginal or abdominal surgery for SUI. METHODS: The study included 94 women who underwent surgery for SUI, and the women were divided into two groups: 53 women had vaginal sling, and 41 women had Burch colposuspension. Female sexual function was evaluated with a detailed 19-item questionnaire, the female sexual function index (FSFI), including sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. In all women, sexual function was compared before and after surgery for SUI, and the differences in postoperative sexual functions were also compared between the women undergoing vaginal sling and Burch colposuspension. RESULTS: In all women, total sexual function score significantly decreased from 20.8 +/- 9 to 17.3 +/- 9.3 after surgery (P = 0.000). Total sexual function score decreased from 19.2 +/- 10 to 17.2 +/- 9.9 in the vaginal sling group and decreased from 23.6 +/- 6.2 to 17.6 +/- 7.7 in the Burch colposuspension group, revealing significant difference between the two groups (P = 0.011). Statistically significantly higher decreases in postoperative sexual desire (P = 0.014), arousal (P = 0.026), lubrication (P = 0.004), and orgasm scores (P = 0.008) were also observed in the Burch colposuspension group than in the vaginal sling group. Based on total score, postoperative sexual function improved in 13 women (24.5%) of the vaginal sling group and in 5 women (12.2%) of the Burch colposuspension group, remained unchanged in 15 (28.3%) and 10 (24.4%), respectively, and deteriorated in 25 (47.2%) and 26 (63.4%), respectively. CONCLUSION: Our findings show that sexual functions may be impaired after surgery for SUI. Burch colposuspension may deteriorate sexual functions much more than vaginal sling surgery in women. Therefore, women who will need surgery for SUI should be informed of the risk of deterioration of sexual function after surgery.

Comparison of the effects of hormone therapy regimens, oral and vaginal estradiol, estradiol + drospirenone and tibolone, on sexual function in healthy postmenopausal women.

INTRODUCTION: Sexual dysfunction is more prevalent in postmenopausal women. AIMS: To prospectively evaluate and compare the effects of hormone therapy (HT) regimens, oral and vaginal estradiol, estradiol + drospirenone and tibolone, on sexual function in healthy postmenopausal women. METHODS: The study included 169 consecutive healthy postmenopausal women, and the women were divided into two groups: 111 women received HT, and 58 women received no treatment and served as a control group. As an HT, 23 women with surgically induced menopause received oral 17-beta estradiol. The rest of the women with natural menopause were prospectively randomized: 22 received oral 17-beta estradiol + drospirenone daily, 42 received oral tibolone, and 24 received vaginal 17-beta estradiol. Sexual function was evaluated with a detailed 19-item questionnaire, the female sexual function index, including sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. MAIN OUTCOME MEASURES: The differences in sexual function were compared before and 6 months after the treatment in all women. RESULTS: Total sexual function score increased from 19.81 +/- 7.15 to 22.9 +/- 6.44 in the HT group and decreased from 21.6 +/- 8.69 to 17.6 +/- 5.7 in the control group, revealing a significant difference from baseline to post-treatment between the two groups (P = 0.000). The highest improvement in total score and arousal was achieved with the oral 17-beta estradiol (P = 0.000 and P = 0.000, respectively). The highest improvement in lubrication was achieved with the oral and vaginal 17-beta estradiol groups (P = 0.000). The highest improvement in orgasm was achieved with the tibolone group (P = 0.000). The highest improvement in pain was achieved with the oral and vaginal 17-beta estradiol groups (P = 0.000). CONCLUSIONS: HT provided significant improvement in sexual function compared to women receiving no treatment, and therefore, HT regimens should be suggested for improvement in sexual functioning of postmenopausal women.

Modulating interaction of glutathione-S-transferase polymorphisms with smoking in endometriosis.

OBJECTIVE: To evaluate the interaction of glutathione-S-transferase (GST) gene polymorphisms and smoking as a risk factor for endometriosis. STUDY DESIGN: The study group consisted of 150 women who were diagnosed by means of surgery and histopathology as having endometriosis. The control group consisted of 150 women who displayed no evidence of endometriosis during exploratory laparotomy or laparoscopy. We assessed the interaction of smoking and GSTM1 and GSTT1 polymorphisms in these patients. RESULTS: Logistic regression analyses showed that the GSTM1-null allele was associated with a significantly increased risk of endometriosis and smoking with a decreased risk of endometriosis separately. There was no association between endometriosis and the GSTT1-null allele. The interaction of smoking and GST polymorphisms showed a joint effect. We found that the GSTM1-null allele was more prevalent in active smoking endometriosis patients (63.4%) than in the controls (35.0%), and the difference was statistically significant. A similar tendency was also observed in the GSTT1 allele distribution. CONCLUSION: Genetic factors could modify the response to environmental pollutants in endometriosis.

Progressive cervical length changes versus single cervical length measurement by transvaginal ultrasound for prediction of preterm delivery.

BACKGROUND: To evaluate cervical length changes as predictors of preterm delivery. METHODS: Two hundred and fifty-seven pregnant women underwent transvaginal ultrasound examination at 16 and 24 weeks of gestation. Cervical length was measured and the difference between the 2 measurements was calculated. The sensitivity, specificity, positive predictive value and negative predictive value of cervical length and cervical length changes were calculated and these methods were compared by receiver-operating characteristic (ROC) curve analysis. RESULTS: Preterm delivery (before 37 weeks of gestation) occurred in 19 patients (7.4%). The mean cervical length was shorter in the preterm group, the area under the ROC curve for prediction of preterm delivery was 0.914, ultrasound had a sensitivity of 84.2% to predict preterm delivery with a false-positive rate of 18.5%, and the relative risk was 4.56 at the 34.3-mm cutoff value at 24 weeks of gestation. In contrast, a cervical length change on transvaginal ultrasound had a sensitivity of 73.3% to predict preterm delivery with a false-positive rate of 18.1%, and the relative risk was 4.08 at the 6.6-mm cutoff value. CONCLUSION: A single cervical length measurement obtained at 24 weeks of gestation can predict preterm delivery as accurately as cervical length change.

Self-application of complementary and alternative medicine by patients with gynecologic cancer.

OBJECTIVES: In this study we aimed to determine the epidemiology and demographic data on complementary and alternative medicine (CAM) use along with the medical/surgical treatment modalities in patients with gynecologic cancers in Turkey. MATERIALS AND METHODS: A cross-sectional study was designed to determine demographic data on CAM use of patients with gynecologic cancers who had medical and/or surgical treatments. Semistructured questionnaires were used for collecting data from 126 patients. RESULTS: When the CAM use ratio of patients was evaluated with respect to demographic characteristics, patients using any type of CAM were younger and more educated, and there were no significant differences between the patients who used and who did not use any type of CAM with respect to geographical region. There were no significant correlations between the use of CAM and the type of malignancy, treatment modality and time period after diagnosis. CONCLUSION: There is critical concern about the probable serious risks associated with non-educated CAM practitioners. Therefore, informed and educated healthcare professionals should inform and help in relieving patients in a more professional and multidisciplinary way.