Ismail Mert

Role of oxidative stress in preeclampsia and intrauterine growth restriction

Aim:  The aim of the present study was to evaluate the role of oxidative stress and DNA damage in preeclampsia and intrauterine growth restriction (IUGR).

Cardiovascular risk factors in polycystic ovary syndrome.

A total of 31 women with polycystic ovary syndrome (PCOS) and 31 healthy age/body mass index matched controls were compared for serum hormones, basal and oral-glucose stimulated glucose, insulin, homocysteine, high sensitive C-reactive protein (hsCRP) and lipid levels. The women with PCOS had significantly higher serum fasting insulin, homocysteine, total cholesterol and LDL cholesterol level than controls, whereas no differences were detected in serum fasting or OGTT 60th- and 120th-minute glucose concentrations, hsCRP, HDL cholesterol, VLDL cholesterol and triglyceride levels between PCOS and control women. Insulin resistance was found in 54.8% (17/31) of PCOS patients by glucose: insulin (G/I) ratio, whereas only 29.0% (9/31) of control women (p = 0.04). Multivariate linear regression analysis revealed that only waist/hip ratio was independent determinants of G/I ratio. PCOS is associated with some biochemical and clinical risk factors for cardiovascular disease. Therefore, patients with PCOS should undergo comprehensive evaluation for recognised cardiovascular risk factors.

Evidence of fetal central nervous system injury in isolated congenital heart defects: microcephaly at birth

OBJECTIVE We sought to ascertain the risk of reduced fetal brain growth in cases of isolated congenital heart defect (CHD) based on microcephaly at birth. STUDY DESIGN In a case-control study, head circumference was compared in 401 newborns with isolated CHD with 401 control subjects. Microcephaly was defined as head circumference below third percentile. The rates of microcephaly in multiple different categories of major CHD were ascertained along with logistic regression analyses to determine the specific types of cardiac defects that were significantly associated with microcephaly. RESULTS Isolated CHD in the fetus was associated with an increased risk of microcephaly as were tetralogy of Fallot, coarctation/aortic arch hypoplasia, and hypoplastic left ventricle syndrome. Tetralogy of Fallot odds ratio, 2.6; 95% confidence interval, 1.1-6.3; P < .04 and coarctation/aortic arch hypoplasia, odds ratio, 2.8; 95% confidence interval, 1.5-5.1; P < .001 were significant independent predictors of microcephaly. CONCLUSION The finding of microcephaly at birth in nonsyndromic CHD provides strong evidence in support of intrauterine hypoxic central nervous system damage. Potential changes in prenatal management including aggressive antepartum surveillance and earlier delivery warrant urgent consideration.

Vulvar/vaginal Melanoma: An Updated Surveillance Epidemiology and End Results Database Review, Comparison With Cutaneous Melanoma and Significance of Racial Disparities

Objective We aimed to compare the differences in demographic features, clinicopathologic features, and survival in patients with vulvar/vaginal melanoma versus cutaneous melanoma with a special emphasis on race. Materials and Methods Data were obtained from the Surveillance Epidemiology and End Results database from 1973 to 2008. Kaplan-Meier curves and Cox multivariate model were used for statistical analysis. Results Seven hundred sixty-two patients with vulvar/vaginal melanoma and 55,485 patients with cutaneous melanoma patients were included in the study. Twenty-eight patients of the vulvar/vaginal group and 334 patients of the cutaneous group were black (3.6% vs 0.6%, respectively). The median age at the time of diagnosis was 68 years in the vulvar/vaginal group and 52 years in the cutaneous group (P < 0.0001). Three hundred fifty patients (45.9%) in the vulvar/vaginal and 46,499 patients (83.8%) in the cutaneous group presented with localized disease (P < 0.0001), whereas 64 patients (8.4%) in the vulvar/vaginal group and 1520 patients (2.7%) in cutaneous group presented with advanced disease (P = 0.0081). The median survival of the black patients was 16 months in the vulvar/vaginal group and 124 months in the cutaneous melanoma group (P < 0.0001). The median survival in the nonblack population was 39 months in the vulvar/vaginal group compared to 319 months in the cutaneous melanoma group (P <0.0001). In multivariate analysis performed for patients between 1988 and 2008, age, stage, and positive lymph nodes were negative independent prognostic factors for survival in vulvar/vaginal melanoma; whereas age, race, stage, radiation therapy, and lymph node positivity were negative prognostic factors in cutaneous melanoma. Conclusion These findings emphasize that cutaneous and vulvar/vaginal melanomas have different clinicopathologic features and survival patterns.

Clinical and pathologic characteristics of serous carcinoma confined to the endometrium: a multi-institutional study.

The objective of this study was to analyze the clinical and pathologic factors in patients with uterine serous carcinoma confined to the endometrium. A total of 236 uterine serous carcinoma patients from the pathology databases of 4 large academic institutions were included in the study. Clinical and pathologic variables were analyzed, including patient demographics, tumor size (⩽2 vs. >2 cm), myometrial invasion, lymphovascular invasion, lymph node status, tumor location (endometrium vs. polyp), cervical involvement, lower uterine segment involvement, FIGO stage, pelvic washings, recurrence, overall survival, and progression-free survival. Of 236 patients, 55 (23%) had tumors limited to the endometrium. Forty-four patients (80%) had Stage IA tumors. The tumor was confined to a polyp in 17 (30.9%) patients. Twenty patients (36.4%) had tumor sizes >2 cm and 12 (21.8%) exhibited lymphovascular invasion. Only 3 patients (5.4 %) had cervical stromal involvement. Thirty-three (66%) patients underwent pelvic and para-aortic lymphadenectomy with 2 positive para-aortic lymph nodes identified. Seven (12.7%) patients had positive washings, whereas 8 patients (14.5 %) had disease recurrence. At a median follow-up of 46 months, there was no difference in overall survival (P=0.216) or progression-free survival (P=0.063) between patients with tumors confined to a polyp, patients with tumors confined to the endometrium, and patients with tumors present in both polyp and the endometrium. Uterine serous carcinoma with only endometrial involvement, even when confined to a polyp, can be associated with poor prognosis, further stressing the importance of complete surgical staging and adjuvant treatment in this setting.

Clear cell carcinoma arising in the abdominal wall: two case reports and literature review

Clear cell carcinoma originating in the abdominal wall is rare and usually develops within endometriotic implants in the scar. We describe 2 patients: a 42 year old with a 15 cm mass on the abdominal wall treated with neoadjuvant chemotherapy and excision and a 51 year old with a 6 cm abdominal mass treated with excision and adjuvant radiotherapy.

Management of squamous cell vulvar cancer: A review

Squamous cell vulvar cancer is a rare gynecologic malignancy. Standard treatment for early stage disease consists of wide radical excision of the primary tumor with inguinal–femoral lymphadenectomy or sentinel lymph node mapping/biopsy. Because of the general paucity of patients with advanced vulvar cancer, there is no standard therapy for advanced disease and therefore treatment should be individualized. Intergroup trials are needed to clarify the value of chemoradiation, neoadjuvant chemotherapy and targeted therapy in patients with advanced squamous cell cancer of the vulva to identify modalities with the best therapeutic index and lowest morbidity.

Serological investigation of the role of selected sexually transmitted infections in the aetiology of ectopic pregnancy

ABSTRACT Objectives To investigate the association between selected sexually transmitted infections (STIs) and the later occurrence of ectopic pregnancy. Methods A total of 125 women with ectopic pregnancy and 125 pregnant controls were recruited between January 2003 and February 2005 at Dr. Zekai Tahir Burak Women’s Health Education and Research Hospital, in Ankara, Turkey. Enzyme-linked immunosorbent assay was used to determine the prevalence of serum antibodies to Chlamydia (C.) trachomatis and to Herpes simplex virus (HSV)-2 IgG and, indirect immunofluorescence test was used to determine the prevalence of serum antibodies to Mycoplasma (M.) hominis and Ureaplasma (U.) urealyticum. Results The prevalence of C. trachomatis Ig G antibody in women with ectopic pregnancy (31/125; 25%) was significantly higher than in controls (12/125; 9.6%) (crude Odds Ratio [OR]: 3.1, 95% confidence interval [CI]: 1.51–6.38; p = 0.001). However, there was no significant association between C. trachomatis IgM; M. hominis IgG, IgM; U. urealyticum IgG, IGM; and HSV-2 IgG, and ectopic pregnancy. Conclusions Previous chlamydial infection plays an important role in the aetiology of ectopic pregnancy. There was no association between M. hominis, U. urealyticum and HSV-2 infections, and ectopic pregnancy.

Chemotherapy of vulvar cancer: A review

SummarySquamous cell carcinoma of the vulva is a rare disease with good prognosis if diagnosed early. The standard primary therapy is surgery. Neoadjuvant radiation or chemotherapy has been used to achieve resectability of the tumor and to decrease the radicality of the surgery. Chemotherapy with platinum compounds, paclitaxel and targeted therapy (erlotinib) has shown activity. International collaborative trials are needed to identify the best therapeutic strategy for patients with squamous cell cancer of the vulva who are not candidates for primary surgery or concomitant chemoradiation. We review the various treatment options available to patients with advanced or recurrent squamous cell cancer of the vulva.ZusammenfassungDas Plattenepithelkarzinom der Vulva ist eine seltene Erkrankung mit guter Prognose bei frühzeitiger Diagnose. Die Standard-Primärtherapie ist die Operation. Eine neoadjuvante Bestrahlung oder Chemotherapie wird zur besseren Resektabilität des Tumors und Verminderung der Radikalität der Operation eingesetzt. Eine Chemotherapie mit Platin enthaltenden Substanzen, Paclitaxel, bzw. eine Targeted Therapie mit Erlotinib hat eine belegte Wirksamkeit.Internationale Multizenter-Studien werden allerdings benötigt, um die beste Therapie-Strategie für Patientinnen mit einem Plattenepithelkarzinom der Vulva, die nicht Kandidatinnen für eine Primär-Operation oder begleitende Chemo-Radiatio sind, festzulegen. Wir geben einen Überblick über die verschiedenen zur Verfügung stehenden Behandlungsoptionen für Patientinnen mit fortgeschrittenem oder rezidivierendem Plattenepithelkarzinom der Vulva.

Clinical/pathologic features and patient outcome in early onset endometrial carcinoma: A population based analysis and an institutional perspective from the Detroit metropolitan area, Michigan

OBJECTIVE Analyze tumor characteristics and outcomes in patients with endometrial carcinoma (EC)<40 years of age and compare them to the characteristics of patients ≥ 40 years of age. METHODS 10,700 patients (305 patients <40 years of age) diagnosed between 1988 and 2007 with EC from the Metropolitan Detroit Cancer Surveillance System (MDCSS), and 884 patients (42 patients <40 years of age) diagnosed between 1996 and 2008 with EC from our institutional database were identified. Differences in clinical and demographic variables by age (<40 vs. ≥ 40) were assessed for statistical significance by chi-square tests. Cox proportional hazards models were used to calculate adjusted hazard ratios (HR) and their 95% confidence intervals (95% CI) to assess the risk of death from all causes. RESULTS MDCSS based analysis: Patients<40 were more likely to present with low grade tumors (p<0.0001) and endometroid histology (p=0.0004) but less likely to undergo surgery (p=0.0007) or radiotherapy (p=0.0007). A multivariate analysis confirmed the significance of age, grade, and stage in all patients, and that of histologic type, surgery, and race in patients ≥ 40 as independent prognostic factors for overall survival. Institution based analysis: Patients<40 had a higher proportion of patients with BM I ≥ 30 (p=0.04), and presented with a higher frequency of well differentiated (p=0.04) endometrioid tumors (p=0.004) that are less prone to have deep myometrial invasion (p=0.008). CONCLUSION This study supports the hypothesis of a disease that is biologically and genetically heterogeneous among women of different ages and ethnicities.