Ahmet Cem Iyibozkurt

Effects of Long-Term Oral Hormone Replacement Therapy on Plasma Nitric Oxide and Beta-Endorphin Levels in Postmenopausal Women

Objectives: The aim of this study is to evaluate the relationship between plasma nitric oxide (NO) and β-endorphin levels in women using hormone replacement therapy (HRT) for 12 months. Material and Methods: Our study group was composed of 55 patients who were in at least their second postmenopausal year. Of the 55 patients, 25 were in the control group. All 30 women in the study group received 2 mg 17β-estradiol + 1 mg norethisterone acetate tablets daily for 12 months. Plasma NO and β-endorphin levels were measured both before and after the study period and possible relationships were analyzed. Results: There was a significant increase in both β-endorphin (p = 0.0001, 10.93 ± 2.25 vs. 14.85 ± 2.49) and NO (p = 0.0001, 19.79 ± 4.01 vs. 27.83 ± 10.27) levels measured after the study in the HRT group. A correlation was seen between the increments in β-endorphin and NO levels in the HRT group. Conclusion: Continuous combined HRT raises both plasma NO and β-endorphin levels and a close relationship was found between the two molecules after therapy. We postulate that the increment in these molecules may explain some of the beneficial effects of HRT on cognitive function and mood.

Genetic variants of SDF-1 and CXCR4 genes in endometrial carcinoma

In this study, we aimed to investigate a possible association between the Stromal cell-derived factor-1 (SDF-1) and CXCR4 polymorphisms and the risk of developing endometrial carcinoma. SDF-1 3′A and CXCR4 gene polymorphisms was performed by polymerase chain reaction (PCR) and restriction fragment length polymorphism in 139 healthy individuals and 113 patients with endometrial carcinoma. In our study groups SDF-1 3′A AA genotype frequency was higher in patients that of controls and individuals who had AA genotype showed a 2.6-fold increased risk for endometrial cancer. The carriers of CXCR4 T allele were higher in patients compared with controls and individuals who had TT genotype had a 2.5-fold high risk for endometrial carcinoma. Our finding suggest that there was no significant association between the (SDF-1) and CXCR4 polymorphisms and endometrium cancer risk. Further studies in a larger population are needed to better elucidate the role of (SDF-1) and CXCR4 gene polymorphisms in the risk of endometrial carcinogenesis. To the best of our knowledge, this is the first study to show such an association.

Clinicopathologic and survival analyses of synchronous primary endometrial and epithelial ovarian cancers

The aim of the study was to describe clinicopathologic characteristics, survival outcomes and the factors associated with recurrence in patients diagnosed with synchronous primary endometrial and epithelial ovarian cancers.

Role of diffusion weighted MRI in the differential diagnosis of endometrial cancer, polyp, hyperplasia, and physiological thickening

Our purpose was to evaluate the role of diffusion-weighted imaging (DWI) in the diagnosis of various common pathologies of the uterine cavity, by comparing them with contrast-enhanced MRI findings. One hundred sixty-four patients with lesions in endometrial cavity were included in the study. The patients were grouped in four (one malignant and three benign groups). We have observed that the differences of the apparent diffusion coefficient, b1000q, and Cq values between various common benign and malignant lesions were statistically significant (P<.001). However, the differences of the values between benign groups were not statistically significant (P>.05). Alternatively, endometrial polyp groups signal intensity on DWI was different than the other groups.

Combination of adjuvant chemotherapy and radiotherapy is associated with improved survival at early stage type II endometrial cancer and carcinosarcoma

The aim of this study was to describe the impact of postoperative adjuvant treatment modalities and identify risk factors associated with recurrence and survival rates in women diagnosed with early stage type II endometrial cancer and carcinosarcoma.

Aggressive Angiomyxoma of the Pelviperineum: Surgical Treatment through a Perineal Incision

Aggressive angiomyxoma is a rare benign tumor of the pelvic soft tissue in women of reproductive age. The tumor is locally infiltrative and tends to recur. Herein is presented a case report of aggressive angiomyxoma that was totally excised using a transperineal approach. A 35-year-old woman had an aggressive angiomyxoma of the vulva and pelvis, with swelling of the right labium majus pudendi. Three years previously, she had undergone incomplete excision of the same type of pelviperineal mass via the transabdominal route. After a complete workup, a transperineal minimally invasive approach was used to excise the 20-cm mass filling the right side of the pelvis. Histopathologic findings were consistent with a diagnosis of aggressive angiomyxoma. Although often misdiagnosed as various other benign genital disorders, angiomyxoma usually is manifested as a soft nontender mass. After a thorough examination and full radiologic workup, a small transperineal incision may be sufficient for complete removal of the tumor.

Role of diffusion-weighted MRI in the differential diagnosis of endometrioid and non-endometrioid cancer of the uterus

Background Many publications have examined the relationship between apparent diffusion coefficient (ADC) values and tumor grade in endometrial cancer. Nevertheless, none were designed to evaluate according to the histopathological type of endometrioid and non-endometrioid tumors. Purpose To evaluate the role of diffusion-weighted imaging (DWI) in the differential diagnosis of endometrioid and non-endometrioid cancer of the uterus, by comparing them with contrast-enhanced magnetic resonance imaging (MRI) findings. Material and Methods Institutional review board approval and informed consent were obtained. The MRI findings of 63 patients with endometrial cancer were retrospectively evaluated and divided into four groups: Grades I, II, and III endometrioid tumors, and non-endometrioid tumors. ADC values, DWI quotients (b = 1000 s/mm2), and post-contrast signal intensities between lesions and the myometrium (b1000q-Cq values) were evaluated. The one-way-ANOVA, student’s t-test, Kruskal–Wallis test, and receiver operating characteristic (ROC) analysis were used for statistical evaluation. Results Mean ADC values were 0.86 ± 0.14 in Grade I, 0.80 ± 0.7 in Grade II, 0.71 ± 0.14 in Grade III for endometrioid tumors, and 0.70 ± 0.12 in non-endometrioid tumors. There was a significant difference in ADC values between Grade I and Grade III (P = 0.006), and non-endometrioid tumors (P = 0.003). The difference was also significant between Grades I + II and Grade III (P = 0.009), and non-endometrioid tumors (P = 0.004). Besides, there was a significant difference between endometrioid and non-endometrioid tumors (P = 0.022). However, when considering b1000q (F = 0.640, P = 0.593) and Cq (χ2 = 6.233; P = 0.101), no significant difference was detected among the groups. Conclusion The difference in ADC values between the endometrioid and non-endometrioid tumors was statistically significant. However, the difference in DWI and contrast-enhancement findings were not statistically significant. Furthermore, the mean ADC values had an inverse relationship with tumor grade in the endometrioid cancer group.

Ovarian hyperstimulation syndrome in a patient with frozen–thawed embryo transfer and dichorionic diamniotic pregnancy

Ideal treatment outcome in assisted reproduction is optimum ovarian stimulation with minimal rate of severe ovarian hyperstimulation syndrome (OHSS) or multiple pregnancies. However, there is still no precise method to completely prevent severe OHSS, except by withholding the ovulation-inducing trigger of human chorionic gonadotropin (hCG) [1]. Individualization of treatment according to the speciWc risk factor and the speciWc response in the current cycle with the option of freezing all embryos, or transfer of only a single embryo, has the potential of reducing the risk and the severity of the syndrome in susceptible cases [2]. But, still in some situations, these strategies do not prevent ovarian hyperstimulation. We report a case in which cryopreserved and thawed embryo transfer in a spontaneous cycle led to ovarian hyperstimulation. Five weeks after the embryo transfer, the patient was admitted to the hospital with marked enlargement of the ovaries, ascites, and dyspnea. The diagnosis was OHSS and she was treated accordingly. A 32-year-old nulligravida nulliparous woman with a history of primary infertility for 12 years was admitted for assisted reproduction. She had oligomenorrhea with occasional ovulatory cycles and features of hyperandrogenism, and polycystic ovaries on the transvaginal ultrasound scan and was diagnosed with polycystic ovary syndrome, according to 2003 Rotterdam consensus criteria [3]. Her height was 167 cm, weight 64 kg, and body mass index (BMI) 23 kg/m. She had no other illnesses or operations. She had a history of three ovulation induction cycles with clomiphene citrate and intrauterine inseminations. Ovulation induction for assisted reproduction was performed using long protocol. Leuprolide acetate 1 mg was started on day 21 of the previous cycle and reduced to 0.5 mg on day 3 of the next cycle and ovulation induction was begun on day 3 with 150 IU recombinant FSH. The FSH and estradiol (E2) levels on day 3 were 6.7 mIU/ml and 16 pg/ml, respectively, and the duration of stimulation was 10 days. hCG was used for ovulation triggering; 30 follicles were aspirated and 27 oocytes were retrieved. Embryo transfer was performed on day 3 of oocyte retrieval. Three 8-cell embryos were transferred and 16 embryos were cryopreserved, but the -hCG on day 12 was negative. No ovarian hyperstimulation symptoms developed. Following this, two cycles of cryopreserved–thawed embryo transfer without ovulation induction was conducted 6 and 11 months after the Wrst negative result. Three cryopreserved embryos were thawed and transferred in each trial. In both of these cycles, transdermal 17estradiol and micronized progesterone were given for endometrial preparation; transdermal 17estradiol was started on day 1 of the cycle, micronized progesterone was added on day 14, and embryo transfer was performed on day 17. The appearance of the ovaries at the time of embryo transfer is documented in Fig. 1. The FSH and E2 levels on day 3 were 7.8 mIU/ml and 34 pg/ml; the FSH, LH, and E2 levels on day 14 were 8.0 mIU/ml, 7.1 mIU/ml, and 32 pg/ml, respectively. Micronized progesterone was continued for luteal phase support. The last cycle was successful, -hCG was positive on day 12 and a dichorionic diamniotic pregnancy was diagnosed at the transvaginal ultrasound scan 21 days after the embryo F. Gungor Ugurlucan (&) · A. C. Iyibozkurt · B. Baysal Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Atakoy 9-10. Kisim, B 7 Blok, Daire: 48, Atakoy/Bakirkoy, 34156 Istanbul, Turkey e-mail: fgungor@yahoo.com

Effects of fetal cardiac anomalies on ductus venosus and aortic isthmus doppler profiles

PurposeTo demonstrate the blood flow profiles of fetuses with cardiac anomalies at the level of Ductus venosus (DV) and Aortic isthmus (AI) to evaluate the effects of fetal cardiac anomalies on these profiles, and how these profile changes contribute to cardiac anomaly screening studies as a marker.MethodsDV and AI doppler studies were applied to 64 singleton pregnant women with fetal cardiac anomalies and 74 pregnant women with healthy fetuses. DV-PVIV (peak velocity index for veins) for DV and IFI (isthmic flow index) for AI were used.ResultsDV doppler studies in fetuses with cardiac anomalies and healthy fetuses did not show statistically significant difference. But the results of the AI doppler studies had statistically significant difference in the fetal cardiac anomaly group with the exception of cases with dilatation and regurgitation. When right-sided heart anomaly and the remaining cases were compared with the control groups, AI doppler results also showed lower IFI values.ConclusionsDV doppler studies in the second or third trimester may not be suitable as a screening test for congenital heart disease, but AI doppler studies might be considered as a supporting parameter. But further studies are needed for routine clinical use.

Microarray detection of human papilloma virus genotypes among Turkish women with abnormal cytology at a colposcopy unit.

OBJECTIVE There is a well-known association between human papilloma virus (HPV) and cervical neoplasia. The aim of this study was to investigate the types of HPV DNA and to compare the results with colposcopic findings among women with abnormal cytology. MATERIAL AND METHODS A series of 76 consecutive women attending the clinic with the usual referral indications (ASC-US or higher in Pap) were examined by the conventional diagnostic tools (PAP smear, colposcopy,punch biopsy) and subjected to HPV testing. For HPV genotyping, we used a commercially avaliable HPV DNA chip (Genomica-CLART) which is a PCR based microarray system.The HPV test detected 35types of HPV (HPV-6/-11/-16/-18/-26/-31/-33/-35/-39/-40/-42/-43/-44/-45/-51/-52/-53/-54/-56/-58/-59/-61/-62/-66/-70/-71/-72/-73/-81/-83/84/-85/-89). RESULTS Overall, 44.7% of all patients were HPV positive. HPV was positive in 35%, 51.9%, 77.7% of the ASCUS, LSIL and HSIL groups respectively and HPV 16 was the most prevalent type in all groups. 6 %of patients had mutiple infections. 57.8% of biopsy proven SILs were HPV positive. The most prevalent HPV type was HPV 16 (54.5%).Colposcopic assessment revealed pathologic findings in 94.7% of biopsy proven SIL cases. CONCLUSION Although it has been reported that the prevalence of HPV in the general population is lower than Western countries, and the prevalence and distribution of genotypes are smilar in patients with abnormal cytology. Further population based studies are needed to determine the prevalance and type distribution of HPV with normal and abnormal cytology in Turkish women. Despite the new technological progress in HPV virion, colposcopy is still very important diagnostic tool in the management of abnormal smears.