Çetin Çelik

Assessment of myometrial invasion in endometrial cancer by transvaginal sonography, Doppler ultrasonography, magnetic resonance imaging and frozen section.

Objective: We aimed to compare the diagnostic performance of transvaginal sonography (TVS), magnetic resonance imaging (MRI), and intraoperative frozen section in the assessment of myometrial invasion and to evaluate intratumoral blood flow in any myometrial invasion with transvaginal Color Doppler ultrasonography (TV-CDU). Methods: This prospective study included 64 women consecutively diagnosed with endometrial carcinoma. The subjects were evaluated by TVS, MRI, and TV-CDU by 2 radiologists with a special training in gynecology. Intraoperatively, a frozen section was obtained and processed for interpretation by a blinded pathologist. Sensitivity, specificity, negative, and positive predictive values were calculated for each imaging modality and frozen section with regard to assessment of myometrial invasion. The intratumoral blood flow was evaluated by TV-CDU. Results: Transvaginal sonography, MRI, and frozen section showed no statistical significant differences in overall diagnostic performance for the preoperative and intraoperative assessment of any myometrial invasion, although frozen section seemed to be slightly superior to the imaging techniques. The positive rate of intratumoral blood flow was higher in deep myometrial invasion, but statistical significance was not obtained. The mean value of resistance index was significantly lower in the cases with deep myometrial invasion. Conclusions: Transvaginal sonography with concomitant TV-UCD is low-cost, easily performed, and repeated technique for particularly deep myometrial invasion. Because of its high costs and time-consuming, MRI may be recommended in the cases with poor quality of TVS. Because depending solely on imaging methods could lead to insufficient treatment schedules, intraoperative frozen section should also be performed for myometrial assessment.

Serum TNF-α, IL-6, lupus anticoagulant and anticardiolipin antibody in women with and without a past history of recurrent miscarriage

ObjectiveThe aim of the this study was to investigate Lupus Anticoagulan (LA), Anticardiolipin Antibody (ACA), Tumor Necrosis Factor-α (TNF-α) and Interleukin-6 (IL-6) serum levels in 40 pregnant and 20 nonpregnant.Materials and methodsThe women were divided into three groups. The first group consisted of 20 pregnant women of less than 20 gestational weeks and a past history of habitual abortion . The second group consisted of 20 non pregnant patients with a past history of habitual abortion. The third group consisted of 20 healthy non pregnant women. RESULT: LA was found in only one patient in the Group 2. ACA Ig G positivity were found 1 patient in the Group 1, 3 patients Group 2 and 1 patient in Group 3. Mean ACA IgG was highest in the Group 2. High serum TNF-α levels were found in the 12 (60%), 6(30%) and 2 (10%) women in the Groups 1, 2, and 3, respectively. Significant difference were found for TNF-α among the groups (P<0.05). The highest level of TNF-α was found in the Group 1 and the lowest in the Group 3. There were statistically significant differences for IL-6 among the three groups (P>0.05).ConclusionWe propose that cytokines especially TNF-α was found to be related to the pregnancy loss.

Can Myomectomy be performed during pregnancy

Objective: To evaluate the effectiveness, safety, complications and outcome of pregnancy after myomectomy performed during pregnancy. Material and Methods: Five pregnant women with myomas requiring operation because of severe abdominal pain were included in the series at the Department of Obstetrics and Gynecology, Selçuk University Faculty of Medicine between October 1, 1996 and February 24, 2001. The patients were controlled with ultrasonography and cardiotocography every month up to 32 gestational weeks and then every 2 weeks. Cesarean section was performed on all patients at 37–40 weeks. Complications and fetoneonatal outcome were recorded. Results: The mean age of the patients was 31.4 ± 3.5 years. The mean parity was 1.4 ± 1.6. The median gestational age at the time of myomectomy was 17.8 ± 3.4 weeks. The mean size of the myomas was 14.0 ± 3.8 cm. The main symptom of all patients was severe abdominal pain in spite of analgesic medication. The mean duration of the operation was 40.0 ± 7.9 min. The mean blood loss was 280.0 ± 83.6 ml. The mean number of myomas removed was 2.8 ± 1.3. Conclusion: Myomectomy during pregnancy can be performed if necessary.

Results of the pregnancies with HELLP syndrome.

In this study, clinical features, developing complications, and results of thirty-six patients, which were followed up in our Obstetrics and Gynecology and Nephrology departments between 1997 and 2001, with the diagnosis of HELLP syndrome were searched retrospectively. The mean age of the cases followed up with diagnosis of HELLP syndrome were 30.2 ± 5.9 (17–46) years. HELLP syndrome was diagnosed on average in the 32.6 ± 4.8th (23–41) week of gestations. Seventy percent of the cases were with severe preeclampsia and 30% of the cases were with mild preeclampsia. Eleven cases (30%) were nullipara and twenty-five cases (70%) multipara. The average of arterial systolic blood pressure of the cases were 161.6 ± 26 mmHg, and that of diastolic blood pressure was 98.5 ± 16.8 mmHg. In thirteen cases (36%) acute renal failure (ARF), six cases (17%) placenta detachment, two cases disseminate intravascular coagulation (DIC), one case Adult Respiratory Distress Syndrome (ARDS) were developed. In seven cases (19%) intrauterine dead fetuses were detected. In twenty-three cases by cesarian section (64%), in thirteen cases by induction (36%) the pregnancies were terminated in 72 h after diagnosing HELLP syndrome. Birth weights of eleven babies (30%) were below 1500 g. Five of the eleven babies were dead in the neonatal period. Six of the thirteen patients who had ARF were given hemodialysis. Two patients died because of the development of ARF + DIC and ARDS. No predicting factors for the development of HELLP syndrome could be detected, but severe preeclampsia. Therefore we think that preeclamptic pregnancies must be followed up very closely and if HELLP syndrome develops, termination of the pregnancy would be proper as soon as possible.

Compared effects of surgical and natural menopause on climacteric symptoms, osteoporosis, and metabolic syndrome

To compare the effects of surgical (ie, earlier) and natural (ie, later) menopause on climacteric symptoms, osteoporosis, and metabolic syndrome.

The clinical value of preoperative and intraoperative assessments in the management of endometrial cancer.

Objective: In this study, we aimed to investigate the diagnostic accuracy of preoperative assessment and frozen-section analysis (FSA) in endometrial cancer by comparing postoperative histopathology. Methods: A total of 72 consecutive patients with endometrial cancer were included in this study. Comprehensive surgical staging was performed in all patients. After abdominal hysterectomy, the uterus was investigated for FSA. For preoperative analysis, histological grade and histological subtypes were investigated. In FSA, all the specimens were reviewed for histological subtype, histological grade, depth of myometrial invasion, lymphovascular space invasion (LVI), and cervical involvement. These results were compared with final histopathology. Data were statistically analyzed. Results: The accuracy of preoperative examination was 95.8% (69/72) for histological type and 90% (65/72) for histological grade. In the frozen section, the accuracies of histological grade and subtype were found to be 92% and 98%, respectively. However, histological grade had 43% sensitivity in preoperative and intraoperative assessments. Myometrial invasion and LVI were correctly diagnosed in 93% and 94% of the cases, respectively. The risk assessment was correctly determined in 63 (87%) of 72 patients. Five patients were underclassified, and there was no lymph node invasion in these patients after final histopathology. Lymph node invasion was higher in patients with grade 3 classification, deep myometrial invasion, positive cervical involvement, and LVI. Conclusions: Frozen-section analysis is a feasible method for the management of the patients with endometrial cancer. However, preoperative and intraoperative assessment of histological grade has lower sensitivity in endometrial cancer.

Management and outcomes of adnexal masses during pregnancy: A 6-year experience

Aim:  To demonstrate adnexal masses detected during gestations in a 6‐year period.

The effect of methyldopa treatment on uterine, umblical and fetal middle cerebral artery blood flows in preeclamptic patients

Abstract The purpose of this study was to evaluate the efficacy of methyldopa in the treatment of preeclamptic patients. This study was performed on 24 preeclamptic women who were in between 25–36 weeks of gestational age. 24 healthy pregnant women were taken as control group. Before starting treatment, 24 preeclamptic patients were examined with Doppler ultrasound. Pulsatility index, resistance index, systolic/diastolic ratio of uterine, umblical and fetal middle cerebral arteries were measured. Preeclamptic patients were treated with totally 1 g methyldopa per day. After 7 d, patients were reexamined with Doppler ultrasound. The effect of methyldopa on uterine, umblical and fetal middle cerebral artery blood flows were detected. Only one control with Doppler ultrasound was done to the healthy pregnant women. Before methyldopa treatment to the preeclamptic women, pulsatility index (PI), resistance index (RI) and systolic/diastolic ratio (S/D) on uterine and umblical arteries were significantly higher than the control group. However, fetal middle cerebral artery (MCA) values were significantly lower than the control group. When Doppler results of preeclamptic patients before and after the methyldopa treatment were compared, no significant differences in terms of Pulsatility Index, Resistance IndexI and S/D ratio of umblical and fetal middle cerebral arteries were found. However, the results of uterine artery were significantly lower after the treatment in preeclamptic patients. Treatment with methyldopa lowered the uterine artery resistance in preeclamptic patients but did not effect the resistance of umblical and fetal middle cerebral artery.

Biological correlates of major depression and generalized anxiety disorder in women with polycystic ovary syndrome

OBJECTIVE We aimed to compare the levels of serum androgens in women with polycystic ovary syndrome (PCOS) who had a diagnosis of only major depressive disorder (MDD), only generalized anxiety disorder (GAD) or who had no psychiatric disorder, as determined by a structured clinical interview. Another objective of the study was to examine whether an association exists between these psychiatric diagnoses and insulin resistance or body mass index via a comparison among the study groups in terms of these parameters. METHOD This study was performed between March 2011 and February 2012. A total of 73 patients were included in the study. The study sample consisted of three groups: PCOS patients with only major depressive disorder (n=23), PCOS patients with only generalized anxiety disorder (n=20), and PCOS patients without any diagnosed psychiatric disorders (not diagnosed - ND group, n=30). RESULTS Significant difference was found among the three groups with regard to the serum levels of 17-OHP and DHEAS. When multiple comparisons were performed among the groups, 17-OHP levels were significantly higher in the MDD group than in the ND group. DHEAS levels were significantly higher in the MDD group and the GAD group than in the ND group. CONCLUSION The present study suggests that MDD and GAD appear to be associated with higher DHEAS levels.

Prospective assessment of quality of life and psychological distress in patients with gynecologic malignancy: a 1-year prospective study.

Objective Our aim was to evaluate the health-related quality of life (HRQoL) and psychological distress in patients treated with radiotherapy (RT) for gynecologic malignancy. Methods Fifty-seven women with either cervical or endometrial cancer were prospectively enrolled. We assessed HRQoL at baseline (after surgery before RT), at the end of RT, and during follow-up (every 3 months thereafter) using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cervical Cancer Quality of Life Questionnaire 24 (EORTC QLQ-CX24), and Hospital Anxiety and Depression Scale. Results We demonstrated changes in appetite loss (P = 0.03), nausea and vomiting (P = 0.02), and role function score (P = 0.003) domains of EORTC QLQ-C30. Only the mean body image score of EORTC QLQ-CX24 was significantly different during follow-up (P = 0.02). Type of surgery, histopathological diagnosis, and the menopausal and marital status of the patients affected baseline body image scores (P = 0.032, 0.004, and 0.019 and 0.005, respectively). Patients who underwent chemotherapy had higher baseline body image scores when compared with patients without any chemotherapy before RT (P = 0.028). All the complaints of patients except body image scores improved during the follow-up period. The baseline and follow-up anxiety and depression scores did not differ significantly. Conclusions Although pelvic RT deteriorated HRQoL in gynecologic cancer, patients’ improvement in HRQoL during follow-up was observed. Patients receiving RT could be reassured about the improvement of acute adverse effects in the course of treatment.