Esra Kuscu

New rapid bed-side test to predict preterm delivery: phosphorylated insulin-like growth factor binding protein-1 in cervical secretions

Background.  Phosphorylated insulin‐like growth factor binding protein‐1 (phIGFBP‐1) is secreted by decidual cells and leaks into cervical secretions when fetal membranes detach from decidua. Our aim was to assess whether detection of phIGFBP‐1 in cervical secretions by a rapid bed‐side test could be used to predict preterm delivery in patients with regular uterine contractions.

Women's knowledge about human papillomavirus and their acceptance of HPV vaccine

Objective: Recently, prophylactic human papillomavirus (HPV) vaccines were approved in the USA and Europe to protect against HPV‐related disease. However, there is ongoing debate about the acceptance of the HPV vaccine as a part of routine vaccine scheme. The aim of this study is to determine the baseline knowledge Turkish women have about HPV and prophylactic HPV vaccines.

Human papillomavirus (HPV) prevalence and types among Turkish women at a gynecology outpatient unit

BackgroundHuman Papillomavirus (HPV) is a well-known pathogen for lower genital tract neoplasias, yet little is known regarding HPV prevalence in Turkey. The aim of this study was to investigate the prevalence of HPV DNA and to determine HPV types distribution among women with normal and abnormal cytology.MethodsA total of five hundred seven (n = 507) women were retrospectively evaluated between 2004-2008. Conventional polymerase chain reaction was used to detect the presence of HPV types in cervicovaginal samples obtained from patients during gynecologic examination.ResultsOne hundred four (n = 104) of the women were excluded from the study because of the incomplete data and a total of 403 women were used for the final analysis. There were, 93 (23%) women with cytologic abnormality and 310 (77%) women with normal cytology. Overall, 23% of the women was HPV positive. The overall prevalence of HPV in women with abnormal Pap smears was 36% (93/403), of which in ASCUS 22%, LSIL 51% and HSIL 60%. Also, HPV DNA was positive in 20% of the women with normal cervical cytology. The most common HPV types in cytologically normal women were as follows; HPV 16 (36%), HPV 6 (22%) and HPV 18 (13%). The rate of other HPV types were as follows; HPV11 4.4%, HPV45 4.4%, HPV90 4.4%, HPV35 2.2%, HPV67 2.2%, HPV81 2.2%, and multiple type HPVs 8.9%. The most common HPV types in cytologically abnormal women were HPV 16 (35%), HPV6 (19%) and HPV18 (8%). The rate of multiple HPV infections in women with normal Pap test was 2.2%.ConclusionHPV prevalence and type distribution in this study were similar to that reported worldwide at least in our study population. Hovewer, HPV prevalence was more common compared with previous studies reported from Turkey. This might be related with methodology and hospital based patient accrual and high rate of women with abnormal cytology. Further population based prospective studies are needed to eliminate the drawbacks of our study and to determine nonhospital based HPV prevalence in Turkish women.

Black cohosh and fluoxetine in the treatment of postmenopausal symptoms : A prospective, randomized trial

The objective of this study was to evaluate the efficacy of fluoxetine and black cohosh in the treatment of women with postmenopausal symptoms. A total of 120 healthy women with menopausal symptoms were recruited to this prospective study with a follow-up period of 6 mo. They were randomly assigned to 1 of 2 groups and were treated with fluoxetine or black cohosh. After entry into the study, patients were examined at the first, second, third, and sixth months of the treatment period. The women kept diaries in which they reported the daily number and intensity of hot flushes and night sweats. In addition, at the beginning and end of the third month, they completed questionnaires consisting of a modified Kupperman Index, Beck’s Depression Scale, and a RAND-36 Quality-of-Life Questionnaire. Statistically significant differences were noted in the Kupperman Index and Beck’s Depression Scale at the end of the third month in both groups compared with baseline values. In the black cohosh group, the Kupperman Index decreased significantly compared with that in the fluoxetine group by the end of the third month. On the other hand, in the fluoxetine group, Beck’s Depression Scale decreased significantly compared with that in the black cohosh group. Monthly scores for hot flushes and night sweats decreased significantly in both groups; however, black cohosh reduced monthly scores for hot flushes and night sweats to a greater extent than did fluoxetine. At the end of the sixth month of treatment, black cohosh reduced the hot flush score by 85%, compared with a 62% result for fluoxetine. By the sixth month of the study, 40 women had discontinued the study—20 (33%) in the fluoxetine group and 20 (33%) in the black cohosh group. Compared with fluoxetine, black cohosh is more effective for treating hot flushes and night sweats. On the other hand, fluoxetine is more effective in improvements shown on Beck’s Depression Scale.

Prediction of preterm delivery among women with threatened preterm labor.

Background/Aims: To determine predictive values of fetal fibronectin and phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) in cervicovaginal secretions and ultrasonographic measurement of cervical length for delivery <35 weeks in patients with uterine contractions. Methods: Our study included 51 women between 24 and 35 weeks’ gestation with uterine contractions and 90 controls. Cervicovaginal samples were analyzed for presence of fetal fibronectin and phIGFBP-1. Cervical length was measured by transvaginal sonography. Results: Preterm birth rate was 19.6% (10/51) in the study group. Negative predictive values of fetal fibronectin, phIGFBP-1 and ultrasonographic cervical length <20 mm, and <25 mm for delivery <35 weeks were 91.9, 92.3, 91.1, and 90.5%, respectively. Positive predictive values were 50, 58.3, 100 and 66.7%, respectively. When results of fetal fibronectin/phIGFBP-1 test and ultrasonographic cervical length <25 mm were combined, specificity and positive predictive values of each test for delivery within 7 days increased. Conclusion: Fetal fibronectin and phIGFBP-1 tests have approximately equivalent ability to predict delivery <35 weeks’ gestation. An ultrasonographic cervical length measurement >20 mm or a negative fetal fibronectin/phIGFBP-1 test obtained from patients with uterine contractions at 24–35 weeks’ gestation may avoid overdiagnosis.

Intraoperative evaluation of prognostic factors in stage I endometrial cancer by frozen section: how reliable?

The incidence of pelvic/paraaortic lymph node metastases is related to the grade of the tumor, the depth of myometrial invasion and the cervical involvement. These prognostic factors determine the initial surgery. Intraoperative evaluation and frozen section (FS) have been used for this purpose in order to identify patients requiring pelvic/paraaortic lymphad‐enectomy and adjuvant therapy, thereby eliminating routine lymphadenectomy with its complications. We used frozen section for this purpose and identified accurately 90% of patients requiring pelvic/paraaortic lymphadenectomy. The depth of myometrial invasion was accurately predicted in 90.6% and histologic grade in 91.9% of the patients; however, 60% of patients with cervical involvement were identified by FS. We recommend the use of frozen section as an inexpensive, simple and accurate way of estimating the poor prognostic factors.

Nerve-sparing radical hysterectomy for cervical carcinoma

With the concept of the improvement of quality of life in the field of surgical oncology, recent studies have questioned the place of radical hysterectomy (RH) in the treatment of cervical carcinoma due to a high rate of long-term postoperative complications involving the pelvic autonomic nerve system. It has been demonstrated that RH frequently causes bladder dysfunction, anorectal mobility disorders, and sexual dissatisfaction in cervical cancer survivors due to surgical trauma involving the sympathetic and parasympathetic branches of the autonomous innervation of the pelvic organs. Nerve-sparing RH was first pioneered by Takashi Kobayashi in Japan and then other Japanese gynecologic surgeons introduced and improved this concept to Western countries. However, nerve-sparing RH has only become popular among gynecologic surgeons during the last two decades. Recently, European gynecologic surgeons modified this concept. Herein, a review of the evolution of nerve-sparing RH, a quick overview of long-term pelvic organ dysfunctions associated with RH, and the technical details of different authors and their oncological outcomes are presented. Today, the lack of randomized studies comparing the effectiveness and complications of RH with nerve-sparing RH is an important barrier to the widespread use of this concept. Nonetheless, while nerve-sparing RH still awaits prospective randomized trials in order to prove that its effectiveness is equal to or greater than that of conventional treatment modalities, and that is has fewer long-term complications, this surgical approach remains attractive for the patients and gynecologic oncologists based on the published results.

Why women request cesarean section without medical indication

Objective. To understand the reasons of the cesarean delivery on maternal request (CDMR) without medical indication would help to reduce the rates of unnecessary cesarean-delivery (CD). The objective of this study is to determine the basal knowledge of women regarding normal delivery (ND) and CD and also to assess their attitudes about CDMR, and to find out the reasons influencing those attitudes. Methods. The study included 400 women who completed a 45-item questionnaire that assessed their basal knowledge of ND, CD, and their attitudes and beliefs about the mode of delivery and CDMR. Results. Mean age of the study population was 32 ± 10.2 years (range 18–66). Majority of the women would choose the ND because of its ‘being completely natural’ (89%) and no anesthesia and operative risk related with ND (76%). Only 33% of the women indicated that ND might cause genital organ prolapse and/or stress urinary incontinence and just 26% and 24% of the women would choose CD to prevent pelvic organ prolapse and stress urinary incontinence, respectively. On the other hand, 50% and 54% of the women would indicate that they could choose CD in order to prevent labor pain and to minimize the risk of fetal distress during the labor. Furthermore, 47% of the women had an opinion that that CD could be performed by maternal request without medical indication. Educational level had no effect of CDMR although more educated women had more accurate knowledge about the some risk and benefits of ND and CD. Binary logistic regression analysis revealed that fear of labor pain (p = 0.02, OR: 15.0, CI: 0.494–0.966), maternal age (p = 0.01, OR: 6.3,CI: 1.00–1.05), and knowledge about the relation between the ND and pelvic organ prolapse/urinary incontinence (p < 0.001, OR: 4.8, CI: 0.549–0.966) were the independent prognostic variables for the CDMR . Conclusion. Although majority of the women had wrong idea or no idea about the risks and benefits of CD, nearly half of them indicated that women can always demand CDMR. This study shows that basal knowledge of the women should be improved by education.

Maspin overexpression correlates with increased expression of vascular endothelial growth factors A, C, and D in human ovarian carcinoma

The vascular endothelial growth factor (VEGF) family, including VEGFA, VEGFC, and VEGFD, plays an essential role in the angiogenesis of both pathologic and nonpathologic conditions. Maspin belongs to the serpin superfamily and has been identified as a tumor suppressor because it inhibits motility, invasion, and angiogenesis. Few studies have compared maspin with VEGF in ovarian carcinoma. Therefore, we investigated the expression and correlation of maspin, VEGFA, VEGFC, and VEGFD with the tumorigenesis of the ovary and clinicopathologic variables. Using immunohistochemistry, we examined maspin, VEGFA, VEGFC, and VEGFD expression in 60 ovarian carcinoma tissues (35 serous papillary carcinomas, 18 endometrioid carcinomas, and 7 primary ovarian mucinous carcinomas). Staining of cells was scored as +2 if more than 50% of the cells were positive, as +1 if less than 50% of the cells were positive, and as negative if none of the cells stained positive. Overexpression of maspin, VEGFC, and VEGFD was significantly associated with high tumor grade (P<.001, P=.004, P<.001, respectively), clinical stage (P=.002, .01, and .001, respectively), the presence of ascites (P<.001, P=.03, and P=.001, respectively), and the presence of metastatic lymph nodes (P=.002, P<.001, and P<.001, respectively). Maspin was correlated with VEGFA (P=.01), VEGFC (P<.001), and VEGFD (P<.001). The VEGFA score was positively correlated with high tumor grade (P=.04), lymphovascular space invasion (LVSI) (P<.001), International Federation of Gynecology and Obstetrics (FIGO) stage (P=.009), maspin, VEGFC (P=.003), and VEGFD (P=.003), but it was not correlated with the presence of ascites and metastatic lymph nodes. Maspin, VEGFC, and VEGFD are expressed in ovarian tumors with a poor prognostic parameters, and seem to play a role in ovarian cancer angiogenesis, progression, and lymph node metastases. Our results indicate that in contrast to most other carcinomas, maspin expression is directly associated with the biological aggressiveness of ovarian carcinoma. These results may offer new insights regarding the role of maspin in ovarian cancer and might also affect the diagnosis and treatment strategies.

Elevated plasma homocysteine levels in gestational diabetes mellitus

Objective.  This prospective study investigated the occurrence of hyperhomocysteinemia in a population of patients with gestational diabetes. The aim was to determine whether elevated plasma homocysteine is associated with gestational diabetes in Turkish women.