Clarithromycin regresses endometriotic implants in rat endometriosis model.

The aim of this study was to investigate the effect of clarithromycin in rat endometriosis and its association with matrix metalloproteinase-9 (MMP-9) expression. After surgical induction of endometriosis, 27 rats were randomised into three groups. Size of endometriotic implants were evalutated and rats in group I (n = 9) were given 100 mg/kg/day of oral clarithromycin, rats in group II (n = 9) were given single 1 mg/kg s.c. injection of leuprolide acetate and rats in group III (n = 9) were not given any medication for 21 days. At the end of 21 days of medication, remaining 23 rats were sacrificed to evaluate morphological and histological features of implants. There was a significant difference between the groups in implant volumes (p = 0.004) before and after medication. Regression of implants were significantly higher in groups I and II than that in control group (p = 0.009 and p = 0.011, respectively). After medication, in group I the implant volume decreased from 62 (12-166) mm(3) to 26 (3-87) mm(3) (p = 0.012) and in group II the volume decreased from 224 (76-1135) mm(3) to 62 (26-101) mm(3) (p = 0.028). There was a significant difference between groups in histopathological score (p = 0.024). The epithelial immunohistochemical score of MMP-9 was significantly lower in group II than that in control group (p = 0.014). In conclusion, clarithromycin regresses endometriotic implants in rats, but not via MMP-9.

Factors affecting pregnancy outcome of intrauterine insemination cycles in couples with favourable female characteristics.

The aim of the presented study is to determine the effect of different sperm parameters on the pregnancy rate of intrauterine insemination (IUI) cycles in women with favourable fertility characteristics treated for infertility. Medical records of 212 infertile couples who had undergone a total of 253 cycles were reviewed retrospectively. Inclusion criteria for women were age <35 years, antral follicle count >5, FSH <15 IU/ml, and at least one patent tube documented by HSG or laparoscopy. Clinical pregnancy rates were achieved as 15.8% per cycle, and 18.8% per couple. Woman's age, partner's age, total number of motile sperm (TMS) and motility, significantly influenced pregnancy rate. Pregnancy rate was the highest when women were aged <25 and TMS >10 × 10(6). Partner's age significantly affected the pregnancy rate per cycle in women aged <30 years and TMS >10 × 10(6). Woman's age (OR: 5.4 95% CI: 1.2-24.3) and TMS (OR: 0.06 95% CI: 0.003-0.89) were predictor variables as regards to pregnancy. Pregnancy rate was the highest in IUI cycles when woman was <25 years old, TMS was >10 × 10(6), and morphology was >4%. Male age was found to be another determining factor for IUI success, even if they had a normal spermiogram.

Does the localisation of tumour at stage I endometrial endometrioid adenocarcinoma have an impact on invasion of the tumour and individualisation of the surgical procedure?

OBJECTIVE: To detect whether the localisation of the tumour has an impact on the dissemination of the tumour and whether or not surgical procedures should be individualized according to the localisation of the tumour. MATERIAL METHOD: 106 clinically surgically stage I endometrial endometrioid carcinoma cases treated multi-institutionally at Gulhane Military Medical Academy (GATA) and Dr. Zekai Tahir Burak (ZTB) Women's Health Education and Research Hospital Gynecologic Oncology Units in the last five years were evaluated retrospectively. The tumours localised near the internal cervical os and not invading the cervical canal were accepted as lower uterine segment (LUS) localisation and the corporal location as upper uterine segment (UUS) localisation. RESULTS: Tumour localisation was more frequent in the upper segment than LUS (85.9% vs 14.1%). There was no statistically significant difference between only endometrial and only serous invasion rates. Myometrial invasion less than one-half was significantly higher in the UUS group than the LUS group (p < 0.05). Lymph vascular space involvement rate was significantly higher in the LUS group (60%, 9/15) than the UUS group (23 %, 21/91), (p < 0.01). Positive peritoneal cytology rate was 20% (3/15) in the LUS group and 6.6% (6/91) in the UUS group (p > 0.05). CONCLUSION: Patients with LUS involvement should be considered as high-risk patients. Thus more expanded surgery must be taken into consideration. In this study a limitation was the low number of patients with LUS involvement. Larger prospective studies are necessary to confirm our results.

Hysterectomy with preservation of both ovaries does not result in premature ovarian failure.

This study investigated ovarian function and adnexial pathology following total abdominal hysterectomy with preservation of both ovaries compared with that in a control group. Data from 29 patients who had undergone total abdominal hysterectomy at age < or =40 years and 42 menopausal patients with no previous ovarian pathology were evaluated retrospectively. The mean (+/- SD) age of menopause was 49.7 +/- 1.5 years in the total abdominal hysterectomy group and 50.1 +/- 1.3 years in the control group; this difference was not statistically significant. The incidences of cyst and hydrosalpinx were 31% and 6.9%, respectively, in the total abdominal hysterectomy group and 44.8% and 0%, respectively, in the control group. The increased incidence of cysts in the total abdominal hysterectomy group was statistically significant. In conclusion, patients who undergo total abdominal hysterectomy without oophorectomy do not experience premature menopause. Preservation of the ovaries may avoid the disadvantages of hormone replacement therapy at the expense of a higher risk of developing adnexial pathology.

Treatment of incidental adnexal masses at cesarean section: a retrospective study.

In this study, we evaluated the management of incidental adnexal masses observed at the time of cesarean section in our clinic during January 1992 to January 2005. The number of total live births was 35,153 and 8330 of them were by cesarean section (23.69%). There were 68 cases of incidental adnexal masses greater than 5 cm (68/8330, 0.8%). All of the masses were removed at cesarean section. The pathologic diagnosis of the masses were as follows: benign-benign cystic teratoma 20 (29.4%), simple serous cyst 8 (11.8%), simple mucinous 9 (13.2%), endometrioma 3 (4.4%), cystadenoma 14 (20.6%), and paraovarian-paratubal cyst 13 (19.1%) and malignant-struma ovarii 1 (1.5%). Cystectomy procedure during cesarean section did not alter the morbidity of the operation. So, we recommend resection of such incidental adnexal masses at cesarean section to avoid possible surgical procedures in future for the patient, although there is controversial data in literature.

Solitary splenic metastasis of squamous cell carcinoma of the uterine cervix: a case report and review of the literature.

A 45-year-old patient presented with complaints of vaginal bleeding and pelvic pain. Fractioned probe curettage was performed and reported as Stage IIa, grade 3, squamous cell carcinoma of the uterine cervix. The patient underwent radical hysterectomy type III, bilateral salpingo-oophorectomy, omentectomy, appendectomy, and pelvic para-aortic lymph node dissection according to our clinical protocol. Adjuvant radiation therapy was planned. A splenic mass of 8 cm in diameter was revealed on computed tomography at the end of the third year of the disease-free follow-up period. Fine needle aspiration biopsy was performed and reported as metastatic carcinoma correlated to the previous cervical cancer. Debulking surgery was performed. The patient died one year after the second surgical operation. Spleen metastasis in patients with squamous cell carcinoma of the uterine cervix is exceedingly rare. Nonetheless we recommend screening of all intra-abdominal organs including the spleen as a rare metastastic site in follow-up examination protocols.

Is adjuvant therapy necessary for peritoneal cytology-positive surgical-pathologic Stage I endometrial cancer? Preliminary results.

OBJECTIVE: To compare the clinical and laboratory findings between adjuvant therapy performed and not performed on peritoneal cytology-positive patients with cytology-negative cases of surgical-pathologic Stage I endometrial cancer. METHODS: Twelve peritoneal cytology-positive and 12 negative surgical-pathologic Stage I endometrial cancer cases were used in the study. Adjuvant radiotherapy was performed for six cytology-positive patients (group I); no adjuvant therapy was performed for six cytology-positive (group II) and 12 cytology-negative patients (control group). Pelvic examination, vaginal cytology, serum CA125 levels and routine blood tests were checked at two-month intervals for two years and at six-month intervals for the third year. Abdominopelvic computerized tomography was planned annually. RESULTS: There was no statistically significant difference among the three groups and no recurrence in any group. CONCLUSION: We do not recommend adjuvant therapy for cytology-positive patients if the tumor is confined to the uterus.

Hormone replacement therapy in postmenopausal women with benign fibrocystic mastopathy.

OBJECTIVE: To compare the effects of five different hormone replacement regimens on fibrocystic mastopathy in postmenopausal women. DESIGN: This was a randomized, prospective, clinical, case-control study. METHODS: Two hundred and twelve women with benign cystic mastopathy were studied. The largest diameters of the breast cysts were measured using ultrasonography at study entry. Forty-eight women were randomized to the control group and did not take any medication. One hundred and sixty-four women were randomized to the following study groups. Group I (n = 46) were given conjugated estrogen (0.625 mg/day) and medroxyprogesterone acetate (5 mg/day) continuously. Group II (n = 22) were given only conjugated estrogens (0.625 mg/day) continuously; these were hysterectomized women. Group III (n = 32) were given transdermal estrogen (50 microg/day) and medroxyprogesterone acetate (5 mg/day) continuously. Group IV (n = 32) were given only transdermal estrogen (50 microg/day) continuously; these were also hysterectomized women. Group V (n = 32) were given tibolone (2.5 mg/day) continuously. Hormone therapy was continued for 12 months. Every 3 months the women were rescanned using ultrasonography to determine cyst diameters and examine characteristics such as internal echogenicity, and thickness and regularity of the cyst wall. Statistical assessment used Students' t test and Friedman analysis. RESULTS: In the control group, there was no statistically significant change in cyst dimensions. However, tibolone was associated with a decrease in cyst dimensions which was statistically significant, but none of the other four hormone replacement therapy regimens caused any significant negative effect on the benign cystic mastopathy.

Pelvic-paraaortic lymphadenectomy in clinical Stage I endometrial adenocarcinoma: a multicenter study.

PURPOSE: To show the importance of complete surgical pathologic staging of clinical Stage I endometrial adenocarcinoma. METHODS: A total of 106 consecutive cases of clinical Stage I endometrial adenocarcinomas in two different centers were studied. RESULTS: We found an isolated paraaortic invasion in one patient without pelvic node invasion (0.94%). There were only three cases of pelvic lymph-node invasion (2.83%) and three cases of pelvic-paraaortic lymph-node invasion. CONCLUSION: We recommend complete lymphadenectom; the real stages of the cases can be determined more correctly and excessive treatments can be avoided.