Pinar Solmaz Hasdemir

Lymphovascular space invasion and cervical stromal invasion are independent risk factors for nodal metastasis in endometrioid endometrial cancer

The purpose of this study was to investigate the potential roles of pathological variables in the prediction of nodal metastasis in women with endometrioid endometrial cancer (EC).

Effect of Pirfenidone on Vascular Proliferation, Inflammation and Fibrosis in an Abdominal Adhesion Rat Model.

ABSTRACT Aim: To study the efficacy of pirfenidone for prevention of postoperative adhesion formation in an adhesion rat model. Materials and Methods: Eighteen female Wistar rats were subjected to right-sided parietal peritoneum and right uterine horn adhesion model. Rats were randomized into three groups: group 1 (control) (closure of midline abdominal incision without any agent administration), group 2 (closure of incision after intraperitoneal administration of pirfenidone), and group 3 (closure of incision and only oral administration of pirfenidone for 14 days). Relaparotomy was performed 14 days after the first surgery. Effect of pirfenidone on adhesion formation was assessed on light microscopy by scoring vascular proliferation, inflammation, fibrosis, and collagen formation in the scarred tissue. Effect of pirfenidone on inflammation was assessed by measurement of transforming growth factor-β and interleukin-17 levels in scarred tissue. Results: The degree of vascular proliferation (1.32 ± 0.39 versus 2.34 ± 0.46, p < 0.001), inflammation (1.60 ± 0.70 versus 2.60 ± 0.52, p < 0.01), and fibrosis (1.50 ± 0.53 versus 2.40 ± 0.52, p < 0.01) were less prominent in group 2 compared to group 1, respectively. Only vascular proliferation was found to be less prominent in group 3 compared to group 1 (1.60 ± 0.42 versus 2.34 ± 0.46, p < 0.01). Intraperitoneal and oral administration of pirfenidone reduced tissue levels of inflammatory markers (TGF-β and IL-17) in parietal and visceral peritoneum compared to control group. Intraperitoneal administration of pirfenidone compared to oral administration was more effective in reducing tissue levels of inflammatory markers. Conclusion: Pirfenidone is an effective agent on the prevention of postoperative vascular proliferation, inflammation and fibrosis in scarred tissue particularly with intraperitoneal administration.

Endometriosis associated with relapsing ascites and pleural effusions

Case report We present a case of 32-year-old woman with a two-month history of complaints of abdominal distension and shortness of breath. She had a history of primary infertility diagnosed at the age of 27, along with recurrent ascites and pleural eff usions. She underwent laparoscopy at an outside hospital three years ago, which showed generalised adhesions in pelvic area, and no tubal passage was obtained. Biopsy taken from a suspicious peritoneal side revealed endometriosis. Pleural biopsy for the aetiology of the eff usion revealed non-diagnostic benign cytology and nonspecifi c pleural infl ammation. She was subsequently referred to our hospital with a presumptive diagnosis of ovarian malignancy, secondary to endometriosis. Physical examination on admission revealed massive ascites complicated with an umbilical hernia and decreased breathing sounds on both lung fi elds. Abdominal ultrasonography confi rmed the presence of ascites. A pelvic sonogram showed a normal sized uterus, along with a normal right ovary (43 41 mm in size), a heteroechogenic cyst in the left ovary (34 38 45 mm) and a large amount of peritoneal fl uid. Serum CA125 was 41.7 U/ml (normal range 0 to 35) and CA19-9, AFP, CEA, CA15-3 levels were normal. Abdominal and thoracic MRI showed two cystic masses in the right ovary (40 and 45 mm in diameter), a multiloculated cystic mass in the left ovary (75 mm in total size), massive ascites in full abdomino-pelvic sites, no lymphadenopathy and bilateral pleural eff usion (Figure 1). She had been on leuprorelin acetate therapy for one month at the time of referral to our centre. Paracentesis was the preferred treatment in the presence of a higher morbidity risk of operation, for both diagnostic purposes and relief of symptoms. A total of 2,500 cc of haemorrhagic fl uid was removed, with signifi cant symptom relief. Cytology was consistent with endometriosis. Peritoneal tuberculosis was ruled out. Pleural eff usion was thought to be secondary to the ascites. She continued on leuprorelin acetate therapy for six months, with complete resolution of her symptoms and disappearance of the endometriomas. On follow-up, bilateral ovarian cysts recurred with symptoms, two months aft er cessation of the leuprorelin acetate. Subsequently, she was placed on dienogest therapy for the last three months with resolution of her symptoms and persistence of ovarian cysts.

Adnexal Torsion with Dystrophic Calcifications in an Adolescent: A Chronic Entity?

Intermittent pelvic pain caused by ovarian cysts in adolescence may be due to torsion or partial torsion of the ovary. We present a case of 18-year old adolescent with symptomatic left ovarian torsion with calcifications demonstrated by pelvic MRI and ultrasonography prior to surgery. The pathologic investigation demonstrated dystrophic calcifications. We speculated that the pattern of the intermittent pain in the story of the patient and the dystrophic calcifications in pathologic investigation which is thought that it might have been potentially developed as a result of chronic hypoxia due to intermittent partial torsions over a period of two years.

Analysis of clinical and pathological characteristics, treatment methods, survival, and prognosis of uterine papillary serous carcinoma.

Purpose Uterine papillary serous carcinoma (UPSC) is an atypical variant of endometrial carcinoma with a poor prognosis. It is commonly associated with an increased risk of extrauterine disease. The aim of this study was to investigate clinical and pathological characteristics, therapeutic methods, and prognostic factors in women with UPSC. Methods All patients who underwent surgery for UPSC at a single high-volume cancer center between January 1995 and December 2010 were retrospectively reviewed. Patients who did not undergo surgical staging and those with mixed tumor histology were excluded. Univariate and multivariate regression models were used to identify the risk factors for overall survival (OS) and progression-free survival (PFS). Results A total of 46 patients were included, the majority of whom having stage I disease (IA, 13 [28.2%] and IB, 12 [26.7%]). Stages II, III, and IV were identified in 5 (10.9%), 8 (17.4%), and 8 (17.4%) women, respectively. Optimal cytoreduction was obtained in 67.3% of patients. Recurrences developed in 8 (17.4%) patients. Multivariate analysis confirmed that lymphovascular space invasion (LVSI) (odds ratio [OR] 26.83, p = 0.003) was the only independent prognostic factor for OS, whereas LVSI and optimal cytoreduction were found to be independent prognostic factors for PFS (OR 6.91, p = 0.013 and OR 2.69, p = 0.037, respectively). The 5-year overall survival rate was 63%. Conclusions Our study demonstrated that LVSI is the only independent prognostic factor for OS, whereas LVSI and optimal cytoreduction are independent prognostic factors for PFS in patients with UPSC

What are the best surgical techniques for caesarean sections? A contemporary review

The aim of this study was to evaluate the reported techniques used in caesarean sections in order to form a general perspective of the procedural options for this frequently performed operation. The PubMed database and Cochrane Reviews were searched separately with the key words ‘caesarean’, ‘abdominal entry’, ‘abdominal incision’, ‘uterine repair’, ‘peritoneal repair’, ‘closure of abdominal incision’, ‘suture materials’, ‘extraction of the placenta’ and ‘review’. Reviews, meta-analyses and prospective randomised trials were included in this review. In conclusion, although caesarean delivery is a very common operation, standardised and globally accepted techniques for caesarean section have not been described. The best surgical techniques for this operation are still unknown. Although the long-term follow-up results from two large, prospective, randomised studies are pending, further research is needed to establish an evidence-based, standardised approach for caesarean sections.

Comparison of Subcuticular Suture Materials in Cesarean Skin Closure.

Aim. Comparison of the rate of wound complications, pain, and patient satisfaction based on used subcuticular suture material. Methods. A total of 250 consecutive women undergoing primary and repeat cesarean section with low transverse incision were prospectively included. The primary outcome was wound complication rate including infection, dehiscence, hematoma, and hypertrophic scar formation within a 6-week period after operation. Secondary outcomes were skin closure time, the need for use of additional analgesic agent, pain score on numeric rating scale, cosmetic score, and patient scar satisfaction scale. Results. Absorbable polyglactin was used in 108 patients and nonabsorbable polypropylene was used in 142 patients. Wound complication rates were similar in primary and repeat cesarean groups based on the type of suture material. Skin closure time is longer in nonabsorbable suture material group in both primary and repeat cesarean groups. There was no difference between groups in terms of postoperative pain, need for additional analgesic use, late phase pain, and itching at the scar. Although the cosmetic results tended to be better in the nonabsorbable group in primary surgery patients, there was no significant difference in the visual satisfaction of the patients. Conclusions. Absorbable and nonabsorbable suture materials are comparable in cesarean section operation skin closure.

Hearing loss: An unknown complication of pre‐eclampsia?

The aim of this study was to determine whether pre‐eclampsia is a risk factor for cochlear damage and sensorineural hearing impairment.

The evaluation of last seven years maternal mortality in Manisa, Turkey

Objective: In this study, we aimed to evaluate the last 7-year rates of maternal mortality and the causes of maternal mortality in Manisa including Aegean region in the western part of the country. Study design: Maternal mortalities in Manisa determined by Maternal Mortality Commission were examined between January 1, 2006 and December 31, 2012. The classification of maternal mortality was performed as directly, indirectly, and incidentally. The annual rates and numbers of maternal deaths, causes of death, and demographic data were obtained from the records. Maternal mortality ratio is calculated as the number of women who die during pregnancy and childbirth, per 100,000 live births. Results: A total of 32 maternal deaths cases were reviewed between 2006 and 2012. A total of seven incidental maternal deaths of 32 were not evaluated. A total of five direct maternal deaths and 20 indirect maternal deaths were recorded. Maternal mortality rate (per 100.000 per live births) was 28.86 in 2006. This ratio decreased to 10.7 in 2012. Considering the leading causes of maternal death, the diseases of the circulatory system complicating the pregnancy and puerperium (28%) rank first. When direct maternal deaths are only evaluated, the most common cause was hemorrhage, which was followed by the disseminated intravascular coagulation. In all, six over eight (42%) maternal mortality in which delay model was detected were recorded as matched with third. Conclusion: In conclusion, an incentive to demand primary pregnancy advisory service is necessary for minimizing indirect maternal deaths and the need of medical staff must be fulfilled. Postpartum monitoring will be performed during the postnatal period especially in the first 24 h. Sensitivity must be showed for the training of medical staff that will perform emergency obstetric care when required.

Management of a Giant Border-line Malign Musinous Tumor of the Ovary in an Infertile Woman

though the vast majority of these tumors are benign (75%), borderline (atypical proliferative) types (10%) and carcinomas (15%) are also seen. It was thought that mucinous carcinomas of the ovary may develop from benign and mucinous borderline tumors.2 Mucinous borderline ovarian tumors (BOTs) are classified as gastrointestinal type (85%) and seromucinous type (15%), depending on their histological architecture and type of tumor cells. Seromucinous ovarian tumors are not common and their clinical behavior is not as aggressive as much as other types. The reported mortality rate with these tumors is low.2 There is slightly increased relationship between infertility and BOTs.3,4