Husnu Celik

Use of a single preoperative dose of misoprostol is efficacious for patients who undergo abdominal myomectomy.

OBJECTIVE To investigate the effectiveness of a single preoperative dose of misoprostol in abdominal myomectomies. DESIGN Placebo-controlled randomized prospective study. SETTING Department of obstetrics and gynecology in a university hospital. PATIENT(S) Twenty-five women with symptomatic uterine leiomyomas. INTERVENTION(S) Among patients undergoing abdominal myomectomies, an hour before the operation women in the study group (n = 13) were given a single dose of vaginal misoprostol (400 microg); those in the control group (n = 12) were given placebo. MAIN OUTCOME MEASURE(S) Intraoperative blood loss, duration of operation, duration of postoperative hospitalization, and the need for blood transfusion were compared between the control and study groups. RESULT(S) Blood loss, operation time, and need for postoperative blood transfusion were significantly reduced in the group given vaginal misoprostol. No difference was observed among patients in terms of the time of hospitalization. CONCLUSION(S) A single preoperative dose of vaginal misoprostol is a simple, reliable method for reducing intraoperative blood loss and need for postoperative blood transfusion after abdominal myomectomies.

Treatment of symptomatic uterine leiomyoma with letrozole

Uterine leiomyomas are the most common benign tumours of the female genital tract, often necessitating hysterectomy. The most common symptoms are dysmenorrhoea, menorrhagia, infertility and abortion. Ovarian hormones seem to play an essential role in pathogenesis, and deprivation of ovarian oestrogen causes leiomyomas to shrink significantly. The purpose of this study was to evaluate the effects of the non-steroidal aromatase inhibitor letrozole on uterine leiomyomas and on bone metabolism. A prospective, open clinical trial was conducted in a university-based hospital. Sixteen premenopausal women with symptomatic uterine leiomyomas were treated with letrozole 5 mg/day orally for 3 months. The main outcome measures of uterine and uterine leiomyoma sizes, serum FSH, LH, oestradiol concentrations, ovarian volumes and myoma-related symptoms were noted at baselines and once a month during treatment. Lumbar spine bone mineral density and biochemical markers of bone metabolism were studied at the beginning and at the end of 3 months. Letrozole significantly decreased uterine leiomyoma sizes (P < 0.01) and promptly benefited women with heavy menstrual bleeding associated with leiomyomas without changing bone mineral density. Aromatase inhibitors may represent a new generation of medications for the treatment of leiomyoma and associated symptoms. Larger clinical trials are needed, however, to fully evaluate their safety and efficacy.

Lymphatic mapping and sentinel node biopsy in gynecological cancers: a critical review of the literature

Although it does not have a long history of sentinel node evaluation (SLN) in female genital system cancers, there is a growing number of promising study results, despite the presence of some aspects that need to be considered and developed. It has been most commonly used in vulvar and uterine cervivcal cancer in gynecological oncology. According to these studies, almost all of which are prospective, particularly in cases where Technetium-labeled nanocolloid is used, sentinel node detection rate sensitivity and specificity has been reported to be 100%, except for a few cases. In the studies on cervical cancer, sentinel node detection rates have been reported around 80–86%, a little lower than those in vulva cancer, and negative predictive value has been reported about 99%. It is relatively new in endometrial cancer, where its detection rate varies between 50 and 80%. Studies about vulvar melanoma and vaginal cancers are generally case reports. Although it has not been supported with multicenter randomized and controlled studies including larger case series, study results reported by various centers around the world are harmonious and mutually supportive particularly in vulva cancer, and cervix cancer. Even though it does not seem possible to replace the traditional approaches in these two cancers, it is still a serious alternative for the future. We believe that it is important to increase and support the studies that will strengthen the weaknesses of the method, among which there are detection of micrometastases and increasing detection rates, and render it usable in routine clinical practice.

Association between fertility drugs and gynecologic cancers, breast cancer, and childhood cancers

Ovulation‐inducing drugs have been widely used for various types of infertility since the beginning of 1960s and their use increases day by day parallel to the success achieved in fertility treatment. However, the researches performed in the last two decades have begun to discuss about the safety of these drugs and the risks associated with their use. Especially, the potential neoplastic effects of these drugs are increasingly questioned. The studies have discussed whether there is an association between the exposure to ovulation‐inducing drugs and the incidence of various cancers. Moreover, several studies have been performed to reveal whether there is an increased risk of childhood cancers in children conceived after fertility treatment. The point we reached through the available data is that the risk of breast, uterine and invasive ovarian cancers is not increased, but the risk of borderline ovarian tumors might increase after such a therapy. The risk of cancer has been found similar for children conceived after fertility treatment and those conceived naturally. It should also be kept in mind that cancers are overdiagnosed in infertile women population because of the close medical surveillance, which may also contribute to the early detection of cancers. Although it is still early to state the last words on this topic, the possible association should be addressed when obtaining an informed consent before starting treatment.

The effect of hysterectomy and bilaterally salpingo-oophorectomy on sexual function in post-menopausal women

OBJECTIVE To examine the effects of hysterectomy and bilaterally salpingo-oophorectomy (BSO) on Female Sexual Function Index (FSFI) in the post-menopausal women. METHOD This study included 92 women who underwent vaginal hysterectomy (VH) and BSO (n:37) and who underwent abdominal hysterectomy (AH) and BSO (n:55). Estrogen replacement therapy (ERT) was given 21 women who underwent VH and BSO and 28 women who underwent AH and BSO in pre- and postoperative periods. All patients were evaluated preoperatively and postoperative 6th month in terms of FSFI scores. RESULTS It was found that hysterectomies by abdominal or vaginal routes reduced FSFI scores significantly (P<0.05). The use of ERT were no effect on total score of FSFI in AH and BSO (P>0.05). ERT prevented deterioration of FSFI in women who underwent VH relative to preoperative values but AH. CONCLUSION Hysterectomy causes unfavourable effects on sexual functions at least in the first 6 postoperative months and this negative effect can not be repaired by estrogen replacement therapy in AH and BSO.

Comparison of the effects of the ligation of ascending branches of bilateral arteria uterina with tourniquet method on the intra-operative and post-operative hemorrhage in abdominal myomectomy cases

OBJECTIVE To compare the effects of ligation of the ascending branches of the uterine artery and tourniquet methods intra-operative and post-operative hemorrhage during abdominal myomectomy. METHODS Fifty-one cases with symptomatic myoma uteri were prospectively, randomly assigned to two single blind groups. Myomectomy was performed in Group 1 (n=26) by bilateral ligation of the ascending branches of the uterine artery and in Group 2 (n=25) by the intra-operative tourniquet method. Mann-Whitney U, Wilcoxon Rank and chi(2) tests were used in the comparison of the data. Spearman correlation analysis was used to determine the correlation between myoma enucleation, operation duration and blood loss (r(s), P, n). RESULTS Operation time, number of removed myoma nuclei, (P>0.05, Mann-Whitney U test), and febrile morbidity were similar in the two groups (P>0.05, chi(2) test). Intra-operative blood loss was lower in Group 1 (P<0.05, Mann-Whitney U test). In three cases from Group 2 post-operative hemorrhage occurred, and the laparotomy and bilateral ligation of the internal iliac arteries were performed in these cases. There was a positive correlation among myoma enucleation, operation duration and blood loss (r(s)=0.7, P=0.001, n=51). CONCLUSIONS Intra-operative blood loss is lower with bilateral ligation of the ascending branches of the uterine artery during myomectomy. The effect of ligation on hemorrhage continues in the post-operative period.

Homocysteine-induced enhancement of spontaneous contractions of myometrium isolated from pregnant women

Background.  Although many associations have been demonstrated between hyperhomocysteinemia and pregnancy complications, such as spontaneous abortion, preterm labor, preeclampsia and low birthweight, it is still not clear whether hyperhomocysteinemia is the cause or the consequence of these pregnancy complications. The aim of this study was to investigate the effects of homocysteine on the spontaneous contractility of isolated pregnant human myometrium.

Effects of erythromycin on pregnancy duration and birth weight in lipopolysaccharide-induced preterm labor in pregnant rats.

OBJECTIVE The aim of this study was to investigate the effects of erythromycin on pregnancy duration and on live birth weight in lipopolysaccharide (LPS)-induced preterm labor model in rats. STUDY DESIGN Total of 60 pregnant rats on day 16 of gestation was intraperitoneally injected with 25 microg/kg LPS. Animals were randomly divided into six groups and 20mg/kg (n=10), 40 mg/kg (n=10), 60 mg/kg (n=10), 80 mg/kg (n=10), and 100mg/kg (n=10) erythromycin and equal volume of physiological saline (n=10) were given intraperitoneally. Injection of LPS-to-vaginal bleeding interval, vaginal bleeding-to-delivery interval, LPS injection-to-delivery interval was monitored and live birth weight of neonates was determined. Statistical analysis was performed using Kruskal-Wallis, Mann-Whitney U-test and Spearman correlation analysis. RESULTS Intraperitoneal injection of erythromycin to LPS-administered rats caused significant increase in latent period, labor period, total period and live birth weight in a dose dependent manner. CONCLUSION These data shows that erythromycin causes prolongation of pregnancy period and increases live birth weight in LPS-induced preterm labor of pregnant rats.

Effects of tibolone on plasma homocysteine levels in postmenopausal women

OBJECTIVE To investigate the effects of tibolone on levels of plasma homocysteine, an independent risk factor for cardiovascular disorders, in postmenopausal women. DESIGN Prospective, randomized clinical study. SETTING University hospital. PATIENT(S) Postmenopausal healthy women. INTERVENTION(S) Tibolone (2.5 mg/d) or calcium (1250 mg/d) and conjugated equine estrogens (0.625 mg/d) plus medroxyprogesterone acetate (5 mg/d) were administered orally for 6 months. Blood samples were collected at the start and the end of therapy. MAIN OUTCOME MEASURE(S) Plasma homocysteine levels. RESULT(S) Administration of tibolone and calcium caused only a 4% decrease in plasma homocysteine levels compared with initial levels. In contrast, conjugated equine estrogens plus medroxyprogesterone acetate caused a 29% decrease in plasma homocysteine levels. CONCLUSION(S) Despite the reported beneficial effect of tibolone on the serum lipid profile, tibolone had no statistically significant effect on serum homocysteine levels in postmenopausal women. The possible cardiovascular protective role of tibolone might be unrelated to its effects on homocysteine levels.

Changes in serum obestatin, preptin and ghrelins in patients with Gestational Diabetes Mellitus.

OBJECTIVES The present study aims to establish the levels of acylated ghrelin, desacylated ghrelin, obestatin and preptin, during pregnancy and the postpartum period in pregnant women with Gestational Diabetes Mellitus (GDM) and healthy pregnancy women. DESIGN AND METHODS The study registered 20 pregnant women with GDM and 20 healthy pregnant women. Fasting venous blood samples were collected from all cases between weeks 24 and 28 of pregnancy and after 24h postpartum. Hormones were analyzed using ELISA method. RESULTS Serum acylated ghrelin (p:0.001), desacylated ghrelin (p:0.001), obestatin (p:0.006) and preptin (p:0.001) levels were all found statistically higher in both groups during the postpartum period, when compared to the pregnancy period. A positive correlation was established between desacylated ghrelin and acylated ghrelin (p:0.008), desacylated ghrelin and preptin (p:0.012) and preptin and insulin (p:0.039) in the GDM group during pregnancy. CONCLUSIONS The studied hormones (especially desacylated ghrelin and obestatin) are critical in GDM pathophysiology based on the comparison of measure after and before the delivery.