Undifferentiated pleomorphic sarcoma with focally rhabdomyosarcomatous differentiation of the ovary.

PURPOSE OF INVESTIGATION: Primary sarcomas account for of 2-3% of all female genital tract cancers and ovaries are unusual sites for sarcomas. The authors aimed to report a case of primary ovarian sarcoma. MATERIALS AND METHODS: A 46-year-old woman presented with abdominal pain and distention. Abdominal MRI revealed a 20-cm-sized complex mass in the right adnexa and ascites. Preoperative CA-125 was 289 U/ml. She underwent optimal debulking surgery and diagnosed with undifferentiated pleomorphic sarcoma with focally rhabdomyosarcomatous differentiation. RESULTS: The patient presented with severe abdominal pain and distention 32 days after the operation and recurrent disease was diagnosed. First cure of adjuvant chemotherapy was administered, but she died 15 days later. CONCLUSION: Coexistence of undifferentiated pleomorphic sarcoma and rhabdomyosarcoma shows highly aggressive behavior and its prognosis is extremely poor. To the best of the authors' knowledge, this is the second case report of the coexistence of these type tumors in the literature.

Virchow's node metastasis: an unusual presentation of ovarian cancer.

Ovarian primaries of supraclavicular metastases are extremely rare. The present study reports the case of a 64-year-old female with a left supraclavicular mass without any other symptoms. After performing a fine needle aspiration biopsy for pathological examination and positron emission imaging, she was diagnosed with FIGO Stage IV high-grade serous epithelial ovarian carcinoma. After three cycles of chemotherapy with paxlitaxel and carboplatin, complete response was achieved. There are only a few reports in literature that address patients with the initial symptom of left supraclavicular mass and final diagnosis of ovarian cancer. To the best of the authors' knowledge, this is the first report to describe the successful use of PET/CT to determine the primary site.

A current view of the role of epigenetic changes in the aetiopathogenesis of endometriosis.

The purpose of the study was to examine the role of epigenetic changes in the aetiopathogenesis of endometriosis. The analysis and review of the relevant current literature in English language related to the role of epigenetic changes in the aetiopathogenesis of endometriosis. Epigenetic changes are common denominators for hormonal, immunological and inflammatory aberrations which play a key role in the aetiopathogenesis of endometriosis. Many internal and external factors may cause the different running of the epigenetic mechanism. As yet fully unknown genetic factors may increase the sensitivity of the epigenetic mechanism to various internal and external factors. The breakdown of epigenetic regulation is the main factor initiating the pathogenetic mechanisms for endometriosis formation.

Endometrial stromal sarcoma with coexistent endometrioid adenocarcinoma in a woman with previous breast cancer: a preliminary case report.

Endometrial stromal sarcoma (ESS) is a rare neoplasm of the uterus. The authors report a case of low-grade ESS coexistent with endometrioid adenocarcinoma of the uterus in a woman with a previous history of breast cancer. To the best of their knowledge, such a case has not been reported to date.

Primary carcinoma of the neovagina: a case report.

We present a case of squamous cell carcinoma arising in the neovagina of a woman in whom we performed vaginoplasty 20 years before. To the best of our knowledge, this is the 23rd case of total carcinoma arising in the neovagina constructed because of vaginal agenesis, and the 3nd case of carcinoma arising in the neovagina performed without using a graft.

A stereological study of the effects of antidepressants on postmenopausal rat kidney.

Many factors can cause depression including genes (DNA), brain chemistry or stress. Antidepressant drugs affect the brain, heart, liver and kidney. We investigated the effects of the antidepressant drugs, amitriptyline (AMI) and paroxetine (PARO) on kidney. We used 24 adult female rats that were ovariectomized bilaterally 7 days before the experiment. The ovariectomized (OVX) animals and healthy control rats were divided into four equal groups for 4 weeks: control group, OVX control group (sham), AMI group and PARO group. Following the experimental period, the Cavalieri method was applied to sections of the kidney. PARO produced adverse effects on distal and proximal tubule volume, but AMI had no effect on the volume of distal and proximal tubules. Both PARO and AMI decreased the volume of Bowman spaces. PARO also damaged the kidney tubules and cells.

Efficacy of levamisole on experimental endometriosis.

OBJECTIVE: To investigate the efficacy of levamisole on experimental endometriosis. METHODS: After the implantation of endometrial tissue on abdominal peritoneum, 40 rats were randomized to 1 of 4 equal intervention groups. Levamisole (2 mg/rat) was applied subcutaneously to group "L" once a week. Depot medroxyprogesterone acetate (3 mg/kg) was applied intramuscularly to group "M" twice at 4-week intervals. Leuprolide (0.075 mg/kg) was applied subcutaneously to group "G" twice at 4-week intervals. Saline (0.1 cm(3)/rat) was applied subcutaneously to group "C" once a week for 8 weeks. The efficacy of levamisole was determined by volume measurement and characterizing the histological structure of the implants. RESULT: Volume increase of the implants in group C (P<0.05), and volume decrease in groups M, G, and L was found (P<0.05, P<0.01, and P<0.01, respectively.) Stromal tissue and glandular activity were not different between groups L and G. CONCLUSION: Levamisole was found to be as effective as leuprolide in regression of the volume of endometriotic implants.

The comparison of effects of tibolone and conjugated estrogen-medroxyprogesterone acetate therapy on sexual performance in postmenopausal women.

OBJECTIVE: To compare the effects of two different postmenopausal regimens on sexual performance. METHODS: A single blind prospective clinical study was planned on fifty natural postmenopausal women with no absolute contraindication for hormone replacement therapy (HRT). A total of 25 women were randomized for tibolone therapy (group T) and the rest 25 for continuous conjugated estrogen (CE) 0. 625 mg plus medroxyprogesterone acetate (MPA) 2.5 mg (group E) for a year. Two women in group T and four women in group E were excluded from the study as they didn't attend the control visit. At baseline and after a year, sexual performance parameters (sexual desire, coital frequency, orgasm frequency, vaginal dryness/dyspareunia) and after therapy subjective well-being, vasomotor symptoms, and side effects were assessed by score method designed by us. RESULTS: Treatment with either preparation significantly improved subjective well-being, vasomotor symptoms and vaginal dryness. The rates of overall side effects between two groups were not found statistically different (P=0.84). Tibolone therapy increased sexual desire and coital frequency (P=0.001, P=0.014). CONCLUSIONS: Both tibolone and continuous combined CE/MPA effectively improve the findings of hypoestrogenism and subjective well being. Moreover, tibolone effectively increases sexual performance. It is seen that tibolone with acceptable androgenic side effects can be an appropriate selection for HRT in postmenopausal women with decreased sexual desire.

Analysis of the pregnancy-related deaths within the last two decades: a university hospital-based study from Turkey.

OBJECTIVE: To analyse the causes of pregnancy-related deaths at Ondokuz Mayis University Hospital. STUDY DESIGN: The death of a woman while pregnant or within 42 days of termination of pregnancy regardless of the cause of death, including accidental or incidental causes, was accepted as a 'pregnancy-related death'. Such deaths were evaluated in Ondokuz Mayls University Hospital in the years 1978-1997 inclusive. They were classified as direct obstetric, indirect obstetric, and accidental or incidental deaths. RESULTS: Eighty-seven pregnancy-related deaths were identified via hospital death records. Maternal mortality ratio was calculated to be 822.2 per 100,000 live births. Seventy seven percent of the deaths were due to direct obstetric causes; most commonly due to toxemia, infection and hemorrhage. CONCLUSION: Direct obstetric deaths, which are largely preventable with proper antenatal care and health services, are still problems in our country.

The rupture through posterior vaginal fornix of the posterior lower uterine segment.

Uterine rupture during labor, when it is in the immediate vicinity of the cervix, frequently extends transversely or obliquely. Usually the tear is longitudinal when it occurs in the portion of the uterus adjacent to the broad ligament. We report an unusual case of uterine rupture through posterior vaginal fornix of the posterior lower uterine segment.

Estimation of the amniotic fluid volume using the Cavalieri method on ultrasound images.

OBJECTIVES: Presently, a design-based and practical method for measuring amniotic fluid volume (AFV) for routine clinical examinations has not been proposed. In this study we describe a new method, which combines the Cavalieri method with ultrasound imaging to estimate AFV. METHODS: We measured the AFVs of 14 women in the third trimester of pregnancy, and repeated our measurements three times for each woman. Parallel planimetric ultrasonographic images were obtained at every 2 cm along the longitudinal uterine axis. AFVs were calculated as the total of the multiples of the estimated cut surface areas by the section thickness. RESULTS: The mean estimated AFV was 380.5 cm3. The coefficient of error of each measurement was calculated and the mean was 0.108. The coefficient of correlation between the amniotic fluid index and our AFV estimations was 0.87. CONCLUSIONS: Design-based and efficient estimation of AFV is possible with the combination of consecutive ultrasound images and the Cavalieri method.

Pre-eclampsia associated with increased lipid peroxidation and decreased serum vitamin E levels.

OBJECTIVE: To evaluate lipid peroxidation and the serum levels of the antioxidant vitamin E in pre-eclampsia according to the disease severity. METHOD: Serum malondialdehyde (MDA) and vitamin E levels were measured in 18 pre-eclamptic, 15 eclamptic and 25 normotensive pregnant women in Ondokuz Mayis University Hospital. The correlation of these levels with the factors indicating disease severity was tested. Mann-Whitney U-test and correlation coefficients were used for the statistical analysis. RESULT: Both the pre-eclamptic and the eclamptic patients had higher MDA and lower vitamin E levels compared with control (P < 0.05); but these values were not significantly different from each other (P > 0.05). MDA levels were significantly correlated with the systolic and diastolic blood pressure (BP) and with serum uric acid levels. There was significant but negative correlation with the vitamin E levels. CONCLUSION: There is an imbalance between lipid peroxidation and serum vitamin E levels in pre-eclampsia and eclampsia. Increased lipid peroxidation is well correlated with the increase in systolic and diastolic BP measurements and serum uric acid levels.

Tibolone versus four estrogen replacement therapy protocols and plasma lipid levels in postmenopausal women.

OBJECTIVES: To compare tibolone therapy with four different estrogen replacement therapy protocols, with regard to the effects on plasma lipid profiles. METHODS: The plasma lipid levels of 178 postmenopausal women in five different therapy groups were compared with each other as well as their baseline levels with 6-month intervals during 2-year follow-up. Student's t-test, paired t-test and Pearson correlation analysis were utilized for statistical analysis. RESULTS: HDL cholesterol levels increased significantly from baseline in groups using oral estrogen (P<0.05) but a slight non-significant decrease was seen in tibolone therapy (P>0.05). LDL cholesterol levels significantly decreased at the end of the second year in oral estrogen and tibolone users (P<0.05). Triglyceride levels increased non-significantly with estrogen therapy (P>0.05), whilst decreased significantly in the tibolone group (P<0.05). CONCLUSION: Tibolone may be a good alternative to estrogen replacement therapy in postmenopausal women, as it has beneficial effects on LDL cholesterol and triglyceride levels, which play important role in atherosclerosis.

Primary-adenocarcinoma of Bartholin's gland: a case report.

Up to now, about 300 primary adenocarcinoma carcinomas of Bartholin's gland have been reported in the literature. A new case of a 57-year-old woman with primary carcinoma of Bartholin's gland is reported. The patient underwent radical vulvectomy and has been healthy for 18 months.

Comparison of connective tissue components in the uterine ligaments between women with and without pelvic organ prolapse.

AIM: Aim of the study was the comparison of the connective tissue components in the uterine ligaments between the women with and without pelvic organ prolapse. METHODS: This study included 15 postmenopausal women without pelvic organ prolapse who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for benign pathologies (control group) and 15 postmenopausal women who underwent vaginal hysterectomy because of pelvic organ prolapse (POP group). During the operation, samples for histological examination were taken from the cardinal and sacrouterine ligaments. The contents of collagen type I, collagen type III and elastin, and number and mitotic activity of fibroblasts in uterine ligaments were histopatholocially determined. RESULTS: The collagen type I content for the POP group was significantly higher than that of the control group. Collagen type III content, elastin content, and number and mitotic activity of fibroblasts were not significantly different between the control and POP groups. CONCLUSION: Collagen type I was found to be increased in the uterine ligaments of the POP group. The other connective tissue components did not differ between the two groups.