Abdullah Boztosun

The Efficacy of Bevacizumab, Sorafenib, and Retinoic Acid on Rat Endometriosis Model

Blood vessels are necessary for development and maintenance of the endometriosis and blood flow supplies oxygen and essential nutrient to the disease. Local angiogenesis is regulated by vascular endothelial growth factor (VEGF) and inhibitors of VEGF may be a novel therapeutic approach. We inducted endometriosis in 43 rats and they were randomly allocated into 4 groups. The rats in group I (control n = 11) were given no medication. The rats in group II (n = 11) were given bevacizumab. The rats in group III (n = 11) were given Sorafenib, and the rats in group IV (n = 10) were given retinoic acid (RA). Then groups were compared for microvessel density, VEGF, soluble tyrosine-kinase receptor, ovarian reserve, and treatment effectivity. All these medications were effective on endometriosis and we detected that volume of endometriotic implants were significantly decreased. Ovarian reserve was not affected from the medication, in addition RA have induced reproductive capacity.

The effect of ethanol sclerotherapy of 5 minutes duration on cyst diameter and rat ovarian tissue in simple ovarian cysts

Objectives To examine the effect of 95% ethanol sclerotherapy (EST) administered over 5 minutes on cyst diameter and ovarian tissue in experimentally induced simple ovarian cysts in a rat model. Materials and methods In order to induce ovarian cysts, unilateral total salpingectomy was performed in regularly menstruating adult female Wistar albino rats (n=20) between 12 and 14 weeks of age and weighing between 200 and 220 g. One month after the procedure, the abdominal cavity was opened and 14 rats (70%) were found to have developed macroscopic cysts. Rats with macroscopic cysts (n=14) were assigned into two groups in a prospective and single-blinded manner: group 1 (G1) (n=7), control rats; and group 2 (G2) (n=7), 5-minute EST 95% group. Cyst diameter was measured and recorded for each rat. In G2, after whole cyst fluid was aspirated the cystic cavity was irrigated with 95% ethanol, approximately equal to half of the aspirated cyst volume, after which an interval of 5 minutes was allowed and same amount was re-aspirated and the abdominal cavity was closed. One month after this procedure, abdominal cavities were reopened and intra-abdominal adhesion scoring was performed in both groups. Cyst diameter was measured for each rat, and the right ovary was removed, fixed in 10% formaldehyde, and transported to the laboratory. A histologic assessment of the ovarian tissues was performed under light microscopy following staining with hematoxylin and eosin. Mann–Whitney U-test was used for statistical analysis. A P-level less than 0.05 was considered significant. Results In comparison with G1, there was a statistically significant reduction in the mean ovarian cyst dimensions in G2, while there were no significant differences between the two groups with respect to total number of follicles. Again, a significant increase in apoptotic activity and germinal epithelial degeneration was observed in G2 as compared to G1. The two groups were similar in terms of adhesion formation. Conclusion Although 95% EST results in a reduction in the size of simple ovarian cysts, this effect seems to be achieved at the expense of ovarian tissue injury.

A new method used in laparoscopic hysterectomy for uterine manipulation: uterine rein technique

Abstract The aim of this study is to define a new method of manipulating the uterus during laparoscopic hysterectomy. A total laparoscopic hysterectomy (TLH) with the newly defined technique was performed in 29 patients between July 2016 and July 2017. In this new technique, the uterus was bound from uterine corpus and fundus like a bridle with polyester tape, to allow abdominal manipulation. The technique was successfully performed at the first attempt in 93.1% of cases. It was repeated in two cases (6.9%) since the polyester tape departed away from the uterus at the first attempt. The mean application time was 11.2 min. The vaginal manipulator was not required in any of the cases. There were no intraoperative complications. In conclusion, this method has the advantages of not requiring any vaginal manipulator, reducing the number of people required during operation, permitting a near maximum manipulation of the uterus in all three dimensions, and giving the control of these manipulations directly to the surgeon. On the other hand, the technique also has some inadequacies which should be discussed and improved on in the future. Impact of statement What is already known on this subject? In a laparoscopic hysterectomy, manipulation of the uterus is essential for anatomical dissection of the regions and completion of the operation without complications. An ideal uterine manipulator is defined as inexpensive, as convenient, fast and suitable for injecting solutions, removing the need for an assistant and most importantly offering the most suitable range of motion. In this study, we describe a new and different technique (rein technique) allowing the abdominal manipulation of the uterus in a laparoscopic hysterectomy and discuss the advantages and disadvantages of this method. What do the results of this study add? The procedure was easily accomplished in most patients. We did not need to use an extra uterine manipulator in any of the cases. What are the implications of these findings for clinical practice and/or further research? In conclusion, the rein technique of uterine manipulation is effective and safe.

Comparation of clinic and demographic specialities of benign and malign pathologies of endometrium

Aim. The objective of this study is to compare clinical and demographic data of benign and malign pathologies of endometrium and to describe risc factors for endomatrial carcinoma. Method. Eighty-eight patients which was hysterectomised in our clinic between 2006 and 2010 was included. Twenty eight of these has the diagnosis as ‘proliferative endometrium’, twenty nine as ‘hyperplasia of endometrium’, thirty-one as ‘endometrioid type of endometrial carcinoma’. Data were collected from patient files retrospectively. Results. Pregnancy and parity rate, presence of diabetes mellitus and smoking were not altered for groups. Endometrial thickness and presence of hypertension were significantly higher for carcinoma group. Endometrial carcinoma patients were generally postmenauposal and had younger menarche age. Discussion. Advanced age, early menarche, increased endometrial thickness, hypertension and postmenapouse are risk factors for endometrial carcinoma.

The evaluation of our intraoperative consultation results in ovarian lesions for five years

Aim. Intraoperative consultation has an important role in the diagnosis and treatment of ovarian masses. During surgery, the correct classification as benign, borderline or malignant (primary/metastatic) provides to appropriate surgical staging. This retrospective study was undertaken to determine the accuracy of intraoperative consultation results in ovarian lesions and to review the diagnostic problems that may be causing the error. Method. Between January 2007December 2011, the diagnoses of 246 intraoperative consultations applied to the ovarian lesions were examined retrospectively. Twenty-five out of 246 of these sections belonged to the same patient. Frozen section diagnoses were compared with paraffin section diagnoses. Results. The mean age of the patients was 46.7±16 (17-87). There was an agreement in diagnosis between frozen and paraffin section in 96.3%. The sensitivity of malignant cases, 96.9%, specificity was 100%. The positive predictive value of malignant cases was 100%, negative predictive value of benign cases was 100%. In series had no false positive, false negative rate was 6%. Diagnosis had been deferred in 2.4% of the cases. The incompatible diagnoses caused by limited sampling during intraoperative consultation. There were metastatic tumors in 3.7%, mixed type tumors in 2%. Conclusion. The concensus between the gynecologist and the pathologist is very important in intraoperative consultation process. In our series, the sensitivity and specificity of the frozen application in ovarian lesions were high, and the our results are reliable. It was concluded that increasing the number of samples for especially in large tumors will decrease the false-negative rate.

The effect of cell type on surgico-pathologic risk factors in endometrial cancer.

OBJECTIVE In this study the effect of histologic subtype as a surgicopathologic risk factor in endometrial cancer is evaluated. MATERIAL AND METHODS We evaluated 182 patients who underwent systematic lymphadenectomy up to the level of the renal vessels and at least 15 lymph nodes were dissected from the pelvic area and 10 lymph nodes from the para-aortic area. investigation of whether endometrioid and aggressive cell types (serous papillary cell and clear cell) affect the distribution of surgicopathologic risk factors among endometrial cancer cases was carried out. RESULTS Patients in the aggressive cell type group were older and the tumor size was significantly smaller. There was no difference between the two groups for the total number of dissected lymph nodes except for the external iliac area. Although the difference is not statistically significant, the total number of lymph nodes dissected in the aggressive group was less (54.3 vs 62.9, p=0.067) than that of the endometrioid cell type group. While the incidence of pelvic lymph node metastasis in the aggressive group was 59.1% the incidence was 15.6% in the endometrioid cell type group (p>0.001). The possibility of lymph node metastasis for aggressive cell type endometrial carcinoma in the para-aortic area was twice the endometrioid cell type group. It was found that the presence and type (stromal/glandular) of cervical invasion, depth of myometrial invasion and presence of lymphovascular space invasion were not affected by cell type. CONCLUSION Aggressive cell types significantly increase the adnexial and lymph node metastasis in endometrial cancer.