M. H. Ergeneli

Non-invasive early prenatal diagnosis using fluorescent in situ hybridization on transcervical cells: comparison of two different methods for retrieval.

OBJECTIVE We compared the efficiencies of uterine and endocervical lavage to retrieve fetal cells from first trimester pregnancies for further analysis with fluorescent in situ hybridization (FISH). STUDY DESIGN Transcervical cell (TCC) samples were collected at 7-10 weeks of gestations by uterine lavage (13 women) and by endocervical lavage (12 women) who were scheduled for volunteer termination of pregnancy. A sample of placenta was also obtained for cytogenetic analysis to confirm the sex or genotype in the end of the procedure. FISH was performed using probes for the chromosomes 18, X and Y in a three color hybridization protocol. The statistical analysis included chi(2)-analysis, and t-test. RESULTS Sufficient cells were obtained in 12 of the 13 (92.3%) in uterine lavage and 10 of the 12 (83.3%) in endocervical lavage group for FISH procedures for fetal sex prediction. The mean success rate of signal detection for FISH procedure was 91.7% (range 83-97%). Fetal sex was correctly predicted in 11 of 12 (91.6%) with uterine lavage and 8 of 10 (80.0%) in endocervical lavage and the difference was statistically insignificant. CONCLUSION This study demonstrated that there are available cells of fetal origin in the lower part of the uterus and these cells may be collected successfully as early as 7 weeks of the gestation. In addition, our results show that endocervical lavage method is as effective as uterine lavage. FISH has been successfully used to detect status of aneuploidy and sex of the fetus from TCC.

Silver nitrate for Bartholin gland cysts

The management of Bartholin cysts by inserting a silver nitrate stick into the cyst cavity was performed in 15 patients. The cyst wall was expelled in 14 (93%) with no recurrence in a year. The only complication was the cauterization of the surrounding mucosa (20%). This technique seems to offer benefit over conventional treatment modalities.

Atypical squamous cells of undetermined significance - Clinical experience in a Turkish university hospital

OBJECTIVE To assess the significance of atypical squamous cells of undetermined significance (ASCUS) in predicting the presence of underlying squamous intraepithelial lesion (SIL) of the uterine cervix, and to determine the best follow-up method for these patients. STUDY DESIGN We reviewed 76 cases with cervical smears that had been labeled ASCUS over a 41-month period, 64 of which were also examined colposcopically. RESULTS The 76 reported ASCUS cases represented 1.2% of all gynecologic cases diagnosed at our center during the same time period. Of the 64 patients who underwent colposcopy, 9 (14%) had low-grade SIL and 7 (11%) had high-grade SIL. CONCLUSION Based on this study, ASCUS on a cervical smear is a good marker for detecting underlying SIL, and immediate colposcopy and directed biopsy are the most appropriate follow-up procedures.

Malignant mixed mesodermal tumor arising in a benign cystic teratoma

The occurrence of sarcoma in a benign cystic teratoma is very rare. We report the first poorly differentiated, malignant mixed mesodermal tumor with a component of rhabdomyosarcoma to arise in a benign cystic teratoma of the ovary. The tumor was staged as FIGO IC due to capsule invasion. Although combination chemotherapy of cisplatin, ifosfamide and mesna, was instituted, the disease took a rapidly progressive course. After an unusual metastasis to the scapula was detected, the patient deteriorated and died in the forth postoperative month.

Endometrial response to unopposed estrogens remains unaltered in patients with chronic renal failure receiving hemodialysis

Most patients with chronic renal failure who are on maintenance hemodialysis are anovulatory and have menstrual abnormalities. This study was designed to determine the prevalence of organic causes of abnormal uterine bleeding in this group of patients exposed to unopposed estrogens. Eighteen patients with chronic renal failure and abnormal uterine bleeding underwent vacuum curettage. The histopathologic findings were compared with a group of 154 premenopausal women who had abnormal uterine bleeding without detectable organic causes. Excluding patients with secretory and atrophic endometrium, only 2 of 8 patients (25%) with chronic renal failure had endometrial lesions while 44 of 131 patients (33.6%) had either endometrial polyp, simple or atypical endometrial hyperplasia or endometrial carcinoma (p > 0.05). The uremic environment caused by chronic renal failure does not alter the endometrial responsiveness to unopposed estrogens and may lead to the development of endometrial lesions.