Omer T. Yalcin

Isolated torsion of fallopian tube during pregnancy; report of two cases

Isolated torsion of fallopian tube is very uncommon during pregnancy. Predisposing factors for torsion are hydrosalpinx, prior tubal operation, pelvic congestion, ovarian and paraovarian masses and trauma. Although the most important clinical symptom is abdominal pain in lower quadrants, the diagnosis is usually established during the operation performed for acute abdomen and salpingectomy is almost always necessary. Two cases of torsion of fallopian tube during pregnancy, one with hydrosalpinx, the other with paratubal cyst are presented and symptoms and predisposing factors are discussed.

Vaginal intraepithelial neoplasia: treatment by carbon dioxide laser and risk factors for failure.

OBJECTIVE To evaluate the effectiveness of CO(2) laser ablation of vaginal intraepithelial neoplasia (VAIN) and to define prognostic factors. STUDY DESIGN Medical records of 24 patients with VAIN II or III, treated by CO(2) laser ablation from 1990 to 1998 were reviewed. The grade, location, and focality of the lesions, the age, follow-up period and menopausal status of the patients, the power and duration of laser ablation, the presence of concurrent cervical or vulvar neoplasia or previous hysterectomy were evaluated as possible prognostic factors. RESULTS Ablations of the VAIN were successfully accomplished in all of the patients with a mean period of 25.2+10.2 min, including additional simultaneous ablations of the cervix or vulva in eight (33.3%) patients. There was no early or late major complication. VAIN was completely eliminated in 17 (70.8%) patients after the first and in 19 (79.2%) patients after multiple episodes of ablation with a mean follow-up of 26.7+19.6 months. VAIN progressed to invasive vaginal carcinoma in one woman. None of the evaluated prognostic factors was found to be related to the persistence or recurrence. CONCLUSION CO(2) laser ablation was a safe and effective method for the treatment of VAIN. However, since no prognostic factor was defined, all patients should be closely evaluated for persistence, recurrence or progression to invasion.

The effects of severe cystocele on urogynecologic symptoms and findings

Background. To evaluate the effects of severe cystocele on lower urinary tract function.

Assessment of gestational trophoblastic disease by Doppler ultrasonography

OBJECTIVES To relate uterine artery blood flow characteristics to serum human chorionic gonadotropin (hCG) levels in patients with gestational trophoblastic disease (GTD). STUDY DESIGN Twenty-one patients with GTD were investigated by serum hCG titers and Doppler ultrasonography of uterine arteries. The relations between the Doppler indices and the serum hCG titers were evaluated by paired-t, Mann-Whitney U tests, and Pearsons correlation analysis. RESULTS Significant but weak negative correlations were observed between systole/diastole (S/D) ratios, resistance indices (RIs) and pulsatility indices (PIs) and the absolute values of serum hCG levels with correlation coefficients of -0.31, -0.37, and -0.33 (P < 0.05). However, the same Doppler indices had more significant and strong negative correlations with the logarithmic values of the serum hCG levels with correlation coefficients of -0.65, -0.58, and -0.63, respectively (P < 0.01). Five patients who received chemotherapy had significantly lower Doppler indices than those 16 patients with spontaneous regression (P < 0.001). CONCLUSIONS Uterine artery Doppler indices might be used for the surveillance of the patients with GTD.

Effect of cellular DNA content on the prognosis of epithelial ovarian cancers.

Objective: To assess the cellular DNA status of epithelial ovarian cancers with regard to clinicopathological findings and its effect on prognosis. Materials and Methods: Twenty-six consecutive patients with a diagnosis of epithelial ovarian cancer who had been treated by primary surgery and six courses of platinum-based chemotherapy were enrolled in this study. Second-look laparotomy (SLL) was performed in all cases following confirmation of the clinical remission state. Surgical stage, tumor grade, initial tumor volume, residual tumor volume, histopathologic differentiation, and SLL findings were analyzed in correlation with DNA ploidy and DNA index. DNA analysis was performed via DNA flow cytometry through paraffin-embedded tissue specimens. Results: Of 26 patients, flow cytometric studies revealed 16 aneuploidy cases (61.5%). DNA index values ranged from 1.1 to 1.82 (average 1.29 ± 0.28). The flow cytometry coefficient of variation mean value was set to 6.7. Taking the cutoff value of 1.2 for DNA indices, a fairly good correlation was detected between DNA ploidy and DNA indices (p < 0.001). The aneuploidy incidence was found to be high in advanced and poorly differentiated tumors (p < 0.05). There was statistically more residual tumor volume in aneuploid tumors during primary cytoreductive surgery and also higher recurrence rates following six courses of chemotherapy compared with diploid tumors (p < 0.05). No significant correlation was detected between the histopathologic subtypes and tumor volume (p > 0.05). Residual tumor volumes were larger in cases with DNA indices of 1.2 yielding higher residual tumor volume following surgery and being in good correlation with SLL results (p < 0.05). The mean survival rates of cases with aneuploid tumor and a DNA index of >1.2 were low compared to those with diploid tumors and DNA indices of <1.2 tumors (p < 0.05). Conclusion: DNA ploidy and DNA indices are important prognosticators for malignant epithelial ovarian tumors. They should be evaluated together with the patient’s clinical status and other prognostic factors.

Diagnostic efficacy of the preoperative lymphoscintigraphy, Ga-67 scintigraphy and computed tomography for detection of lymph node metastasis in cases with ovarian or endometrial carcinoma

BACKGROUND To investigate the diagnostic efficacy of preoperative lymphoscintigraphy (LS), Ga-67 scintigraphy (GS) and computed tomography (CT) for detection of lymph node metastasis in patients with endometrial or ovarian carcinoma. METHODS The results of preoperative LS, GS and CT used to detect lymph node metastasis were compared to the postoperative histopathological results of lymph node dissection materials of a total of 37 patients, including 16 patients with endometrial and 21 patients with ovarian carcinomas. The diagnostic efficacy of these methods for detecting lymph node metastasis were calculated. RESULTS When the results of all of the patients were taken into account, the preoperative LS, GS and CT were found to have sensitivities of 50%, 20% and 40% and specificities of 51.8%, 96.3%, and 92.6%, respectively, for detection of pelvic lymph node metastasis. The same methods had sensitivities of 27.3%, 27.3% and 72.7% and specificities of 88.5%, 88.5%, 84.6%, respectively, for detecting para-aortic lymph node metastasis in all patients. CONCLUSION These data suggested that although LS, GS and CT had relatively high specificity, low sensitivity of these imaging methods precluded their routine preoperative use for diagnosis of lymph node metastasis of ovarian or endometrial carcinoma.

Results of the anti‐incontinence operations and Kegel exercises in patients with Type II anatomic stress incontinence

BACKGROUND To evaluate the results of anti-incontinence operations and Kegel exercises in patients with pure type II anatomic stress incontinence. METHODS After evaluation by physical, genitourinary and urologically oriented neurological examinations, urogynecologic tests, perineal ultrasonography and cystometry, pure type II anatomic stress incontinence was diagnosed in 98 patients. Modified Pereyra and Burch operations were performed in 27 and 24 of the 51 (52.0%) patients, who had surgical treatments, respectively, while the remaining 47 (48.0%) patients were advised to perform Kegel exercise. The results of the treatment methods were evaluated subjectively by patient questionnaire and 24-hour urinary diary and objectively by one-hour pad test and stress test. RESULTS Fifty-one patients treated by anti-incontinence operations had 90.2% objective and 94.1% subjective complete successes (cure) with a mean follow-up of 13.7 months. These data were 8.5% and 14.9% respectively, for 47 patients treated by Kegel exercises with a mean follow-up of 12.8 months. Both the subjective and objective cure rates of surgical treatments were found to be significantly higher than those of Kegel exercises in patients with type II anatomic stress incontinence (p<0.01). Patients with good compliance to Kegel exercises had 20.7% subjective and 13.8% objective cures, however those with low compliance had only 5.6% subjective and no objective cures. CONCLUSIONS These data suggested that anti-incontinence operations were more effective than Kegel exercises for the treatment of patients with type II anatomic stress incontinence.

Recurrent Molar Pregnancy: Report of a Case with Seven Consecutive Hydatidiform Moles

A case of seven consecutive hydatidiform moles is presented. All of her pregnancies revealed a molar pregnancy, 4 of which were demonstrated histopathologically. In the context of this study, the potential risk for malignant transformation and the obstetric outcome are highlighted. The literature regarding recurrent molar pregnancies is reviewed.

Frequency and determinants of urogenital symptoms in postmenopausal Islamic women.

ObjectiveThe objective of this study was to evaluate the frequency of genitourinary symptoms and their relationships with several factors in a large cohort of postmenopausal women in Turkey. MethodsWe performed a cross-sectional study to review genitourinary complaints among 1,328 postmenopausal women; 1,071 of these women were enrolled in the study. They were questioned about their vaginal and urinary symptoms, and the relationships between these symptoms and their demographic characteristics were evaluated. ResultsThe most common vaginal and urinary symptoms were dryness (n = 358; 33.4%) and nocturia (n = 421; 39.3%), respectively. Cigarette smoking and regular exercise were not associated with any vaginal symptoms (P > 0.05), with the exception of an association between regular exercise and vaginal dryness (P = 0.026). Nocturia was more common in women older than 60 years (P = 0.001) and in obese women (P = 0.013). Based on multiple binary logistic regression analysis, lower educational status (primary school vs secondary school or higher) and higher parity were the factors most significantly associated with the appearance of at least three vaginal symptoms. Lower educational status was associated with vaginal pain (P = 0.002; odds ratio [OR], 1.75), itching (P < 0.001; OR, 1.23), and discharge (P = 0.011; OR, 1.46). Higher parity was associated with vaginal itching (P < 0.001; OR, 1.23), discharge (P = 0.07; OR, 1.18), and burning (P = 0.012; OR, 1.16). Body mass index (BMI) was the only factor that was significantly associated with the appearance of at least three urinary symptoms, with each one-unit increase in BMI increasing the risk of urgency (P < 0.001; OR, 1.06), nocturia (P < 0.001; OR, 1.06), and frequency (P = 0.009; OR, 1.04). ConclusionsWe identify associations between the frequency of genitourinary complaints and educational status, parity, and BMI. There is no association between regular exercise and urogenital symptoms. However, prospective studies are needed to evaluate the effects of regular exercise on urogenital symptoms. When examining postmenopausal women with risk factors for urinary and vaginal symptoms, clinicians should evaluate these symptoms more thoroughly to facilitate earlier treatment.

A new ultrasonographic method for evaluation of the results of anti-incontinence operations

Background. To evaluate the effectiveness of a new ultrasonographic method for discrimination of successful and failed anti‐incontinence operations.