Müfit Cemal Yenen

Metformin and oral contraceptive treatments reduced circulating asymmetric dimethylarginine (ADMA) levels in patients with polycystic ovary syndrome (PCOS)

There is a little information in literature about circulating asymmetric dimethylarginine (ADMA) concentrations in polycystic ovary syndrome (PCOS) and the results reported are discrepant. In this study, therefore, we aimed (1) to determine the circulating ADMA concentrations in 44 women with PCOS and 22 age- and BMI-matched healthy controls, (2) to evaluate its correlations with insulin resistance, gonadotrophins, and androgen secretion, and (3) to compare effects of metformin and ethinyl estradiol-cyproterone acetate (EE/CPA) treatments on circulating ADMA concentrations. In conclusion, our data indicate that circulating ADMA concentrations in non-obese, non-hypertensive and young women with PCOS are significantly higher than healthy controls and they improved by a 3-month course of metformin and oral contraceptive treatments.

Treatment of incidental adnexal masses at cesarean section: a retrospective study

In this study, we evaluated the management of incidental adnexal masses observed at the time of cesarean section in our clinic during January 1992 to January 2005. The number of total live births was 35,153 and 8330 of them were by cesarean section (23.69%). There were 68 cases of incidental adnexal masses greater than 5 cm (68/8330, 0.8%). All of the masses were removed at cesarean section. The pathologic diagnosis of the masses were as follows: benign—benign cystic teratoma 20 (29.4%), simple serous cyst 8 (11.8%), simple mucinous 9 (13.2%), endometrioma 3 (4.4%), cystadenoma 14 (20.6%), and paraovarian–paratubal cyst 13 (19.1%) and malignant—struma ovarii 1 (1.5%). Cystectomy procedure during cesarean section did not alter the morbidity of the operation. So, we recommend resection of such incidental adnexal masses at cesarean section to avoid possible surgical procedures in future for the patient, although there is controversial data in literature

Port-site Metastasis after Laparoscopic Extraperitoneal Paraaortic Lymphadenectomy for Stage IIb Squamous Cell Carcinoma of the Cervix

We report a case of port-site metastasis near the optic trocar site after extraperitoneal laparoscopic lymphadenectomy for cervical carcinoma. A 42-year-old woman with International Federation of Gynecology and Obstetrics clinical stage IIb squamous cell carcinoma of the cervix was evaluated with laparoscopic extraperitoneal paraaortic lymphadenectomy for staging. The aortic nodes were positive. The patient was treated with chemotherapy and radiotherapy. Then brachytherapy was performed. The patient was treated with 6 cycles of weekly topotecan. At month 12, a 4-cm left retroperitoneal mass was detected and excised. Pathologic examination showed an invasive squamous cell carcinoma with tumor-positive margins. Laparoscopic surgery for cancer may result in iatrogenic metastases at the port sites. But all of the port-site recurrence can not be explained by current factors leading to tumor metastases.

Metformin decreases circulating acylation-stimulating protein levels in polycystic ovary syndrome.

Aim. There are no studies that examine the circulating acylation-stimulating protein (ASP) levels in patients with polycystic ovary syndrome (PCOS). The present study was designed to determine the ASP levels in PCOS and to evaluate the effect of metformin on plasma fasting ASP concentrations. Methods. Twenty women with PCOS and 20 healthy controls matched for age and body mass index (BMI) were included in the study. We determined ASP and other biochemical parameters before and after treatment. Results. Baseline levels of plasma ASP, complement 3 (C3), waist-to-hip ratio (WHR), homeostasis model assessment–insulin resistance index (HOMA-IR), fasting insulin, triglycerides (TG) and very-low-density lipoprotein cholesterol (VLDL-C) were significantly higher in patients than in controls. After 3 months of metformin treatment, BMI, WHR, ASP, C3, fasting glucose, fasting insulin, HOMA-IR, total cholesterol, TG, VLDL-C and free testosterone decreased significantly, whereas apolipoprotein A-I and high-density lipoprotein cholesterol increased significantly. Conclusions. The major novel information of the present study is that ASP and C3 values are markedly increased in non-obese patients with PCOS, with a decrease evidenced with metformin treatment.

Self-Application of Complementary and Alternative Medicine by Patients with Gynecologic Cancer

Objectives: In this study we aimed to determine the epidemiology and demographic data on complementary and alternative medicine (CAM) use along with the medical/surgical treatment modalities in patients with gynecologic cancers in Turkey. Materials and Methods: A cross-sectional study was designed to determine demographic data on CAM use of patients with gynecologic cancers who had medical and/or surgical treatments. Semistructured questionnaires were used for collecting data from 126 patients. Results: When the CAM use ratio of patients was evaluated with respect to demographic characteristics, patients using any type of CAM were younger and more educated, and there were no significant differences between the patients who used and who did not use any type of CAM with respect to geographical region. There were no significant correlations between the use of CAM and the type of malignancy, treatment modality and time period after diagnosis. Conclusion: There is critical concern about the probable serious risks associated with non-educated CAM practitioners. Therefore, informed and educated healthcare professionals should inform and help in relieving patients in a more professional and multidisciplinary way.

A Turkish Gynecologic Oncology Group study of fertility-sparing treatment for early-stage endometrial cancer.

To analyze the results of fertility‐sparing treatment of early‐stage endometrial cancer (EC) in patients treated at Turkish gynecologic oncology centers, and to present a review of the literature.

Comparison of four malignancy risk indices in the detection of malignant ovarian masses

Objective The aim of this study was to evaluate the ability of four risk of malignancy indices (RMI) to detect malignant ovarian tumors. Methods This is a prospective study of 100 women admitted to the Department of Obstetrics and Gynecology of Gulhane Military Medicine Academy for surgical exploration of pelvic masses. To diagnose malignant ovarian tumors, the sensitivity, specificity, negative and positive predictive values and diagnostic accuracy of four RMIs (RMI 1, RMI 2, RMI 3, and RMI 4) were obtained. Results In our study we found that there is no statistically significant difference in the performance of four different RMIs in discriminating malignancy. We think that malignancy risk indices is more reliable than the menopausal status, serum CA-125 levels, ultrasound features and tumor size separately in detecting malignancy. Conclusion We concluded that any of the four malignancy risk indices described can be used for selection of cases for optimal therapy. These methods are simple techniques that can be used even in less-specialized gynecology clinics to facilitate the selection of cases for referral to an oncological unit.

Effectiveness of nursing interventions to increase pap smear test screening

The purpose of this study was to determine the effect of a three-stage nursing intervention to increase Turkish womens participation in Pap smear testing. Knowledge and beliefs about cervical cancer screening and barriers to Pap smears also were explored. In a quasi-experimental study in a target population of 2,500 women, 237 completed pre-test measures to inform the intervention, and an educational brochure was distributed to all 2,500. As a result, 510 women (20.4%) accepted free Pap smears. Of the remaining 1,990 women, 417 were randomly selected for telephone interviews, 302 participated, and 158 of these (52.3%) participated in free Pap smear testing. Of the 144 who did not have Pap smears after participating in telephone interviews, 54 were then interviewed face-to-face, and 20 (37.0%) decided to accept free Pap smears. A total of 668 women had accepted free Pap smears by the end of the intervention period.

HPV Types in Turkey: Multicenter Hospital Based Evaluation of 6388 Patients in Turkish Gynecologic Oncology Group Centers Türkiye'deki HPV Tipleri: Türk Jinekolojik Onkoloji Grubuna Üye Merkezlere Başvuran 6388 Hastanin Retrospektif Analizi

Abstract Objective: To evaluate the prevalence of HPV DNA and cervical cytological abnormalities, to compare cervical cytology results and HPV DNA and to define HPV types distribution in a large series of Turkish women who have undergone HPV analysis in hospitals that are members of the Turkish Gynecological Oncology Group. Material and Method: Between 2006 and 2010, a total of 6388 patients’ data was retrospectively evaluated at 12 healthcare centers in Turkey. Demographic characteristics, cervical cytology results, HPV status and types were compared. Results: The mean age of the patients was 38.9±10.2. Overall, 25% of the women were found to be HPV positive. Presence of HPV-DNA among patients with abnormal and normal cytology was 52% and 27%, respectively. There was significant difference with respect to decades of life and HPV positivity (p < 0.05). HPV was positive in (within the HPV (+) patients) 37%, 9%, 27%, 20%, 22%, and 41% of the ASCUS, ASC-H, LSIL HSIL, glandular cell abnormalities, and SCC cases respectively The most common HPV types in our study were as follows; HPV 16 (32%), HPV 6 (17%), HPV 11 (9%), HPV 18 (8%), HPV 31 (6%), HPV 51 (5%), HPV 33 (3%). Conclusion: In this hospital based retrospective analysis, HPV genotypes in Turkish women with normal and abnormal cytology are similar to those reported from western countries. Further population based prospective multicenter studies are necessary to determine non-hospital based HPV prevalence in Turkish women Öz Amaç: Türkiyedeki HPV tiplerinin geniş bir seri ile ortaya konması amacı ile Türk Jinekolojik Onkoloji grubuna üye hastanelerde HPV analizi yapılan hastaların sonuçlarının retrospektif olarak değerlendirilmesi ve sitolojik anormalliklerdeki HPV tiplerinin belirlenmesi. Gereç ve Yöntem: 2006 ve 2010 yılları arasında 12 ayrı merkeze başvuran smear ve HPV analizi yapılan toplam 6388 hasta retrospektif olarak incelenmiştir. Hastaların demografik bilgileri, smear sonuçları, HPV tipleri online olarak toplanıp analiz edilmiştir. Bulgular:Ortalama hasta yaşı 38.9±10.2 idi. Tüm grup değerlendirildiğinde, %25 hastada HPV pozitif olarak saptandı. Anormal sitolojisi olanlarda HPV pozitifliği %57 iken normal pap testi olanlarda HPV pozitifliği %27 oranında tespit edildi. Hastaların yaşam dekadları ile HPV pozitifliği arasında anlamlı bir ilişki bulundu (p<0,05) HPV pozitifliği ASCUS, ASC-H, LSIL, HSIL, glandüler anormallikler ve skuamöz hücreli karsinom için sırasıyla %37, %9, %27, %20, %22, %41 idi. En sık görülen HPV tipleri sırasıyla HPV 16 (%32), HPV 6 (%17), HPV 11 (%9), HPV 18 (%8), HPV 31 (%6), HPV 51 (%5), HPV 33 (%3) idi. Sonuç:Bu hastane temelli retrospektif analizde HPV tipleri gelişmiş batı ülkelerinde rapor edilen tiplerle benzer olarak tespit edildi. Ülkemizdeki gerçek popülasyon temelli HPV prevalansı ve tiplerinin belirlenmesi için hastane temelli olmayan çok merkezli geniş sayıda hasta içeren serilere ihtiyaç vardır

Tension-Free Vaginal Tape for Surgical Relief of Intrinsic Sphincter Deficiency: Results of 5-year Follow-up

STUDY OBJECTIVE We evaluated effectiveness of tension-free vaginal tape application for surgical relief of intrinsic sphincter deficiency. DESIGN A prospective study (Canadian Task Force classification II-3). SETTING Tertiary center of medical faculty. PATIENTS We studied 47 patients. INTERVENTIONS Tension-free vaginal tape procedure, questionnaire form, stress test, cotton swab test, and functional bladder volume measurements. MEASUREMENTS AND MAIN RESULTS Patients were grouped as intrinsic sphincter deficiency according to American College of Obstetricians and Gynecologists criteria. Operative results were documented at 6, 12, 36, and 60 months after the procedure by using a questionnaire form and objective tests of stress test, cotton swab test, and mean bladder functional volume measurement. At first visit 6 months after procedure, 70% (n = 35) of patients were completely satisfied, 9 (18%) had improved urine control, and 5 (10%) had no change in urine control. Results were: 72% (n = 36), 12% (n = 6), and 14 (n = 7%) at the end of the first year, and 66% (n = 33), 20% (n = 10), and 14% (n = 7) at the end of the third year, respectively. The fifth years follow-up visit revealed 57.4% (n = 27 of 47) satisfaction, 17.02% (8 of 47) improved urine control, and 25.5% (12 of 47) no change in urine control. CONCLUSION Tension-free vaginal tape procedure is a safe and effective technique for patients who have exclusively intrinsic sphincter deficiency. Long-term results will clarify the value of this procedure in comparison with classic antistress surgical techniques.