Polat Dursun

Women's knowledge about human papillomavirus and their acceptance of HPV vaccine

Objective: Recently, prophylactic human papillomavirus (HPV) vaccines were approved in the USA and Europe to protect against HPV‐related disease. However, there is ongoing debate about the acceptance of the HPV vaccine as a part of routine vaccine scheme. The aim of this study is to determine the baseline knowledge Turkish women have about HPV and prophylactic HPV vaccines.

Human papillomavirus (HPV) prevalence and types among Turkish women at a gynecology outpatient unit

BackgroundHuman Papillomavirus (HPV) is a well-known pathogen for lower genital tract neoplasias, yet little is known regarding HPV prevalence in Turkey. The aim of this study was to investigate the prevalence of HPV DNA and to determine HPV types distribution among women with normal and abnormal cytology.MethodsA total of five hundred seven (n = 507) women were retrospectively evaluated between 2004-2008. Conventional polymerase chain reaction was used to detect the presence of HPV types in cervicovaginal samples obtained from patients during gynecologic examination.ResultsOne hundred four (n = 104) of the women were excluded from the study because of the incomplete data and a total of 403 women were used for the final analysis. There were, 93 (23%) women with cytologic abnormality and 310 (77%) women with normal cytology. Overall, 23% of the women was HPV positive. The overall prevalence of HPV in women with abnormal Pap smears was 36% (93/403), of which in ASCUS 22%, LSIL 51% and HSIL 60%. Also, HPV DNA was positive in 20% of the women with normal cervical cytology. The most common HPV types in cytologically normal women were as follows; HPV 16 (36%), HPV 6 (22%) and HPV 18 (13%). The rate of other HPV types were as follows; HPV11 4.4%, HPV45 4.4%, HPV90 4.4%, HPV35 2.2%, HPV67 2.2%, HPV81 2.2%, and multiple type HPVs 8.9%. The most common HPV types in cytologically abnormal women were HPV 16 (35%), HPV6 (19%) and HPV18 (8%). The rate of multiple HPV infections in women with normal Pap test was 2.2%.ConclusionHPV prevalence and type distribution in this study were similar to that reported worldwide at least in our study population. Hovewer, HPV prevalence was more common compared with previous studies reported from Turkey. This might be related with methodology and hospital based patient accrual and high rate of women with abnormal cytology. Further population based prospective studies are needed to eliminate the drawbacks of our study and to determine nonhospital based HPV prevalence in Turkish women.

Lymphatic mapping and sentinel node biopsy in gynecological cancers: a critical review of the literature

Although it does not have a long history of sentinel node evaluation (SLN) in female genital system cancers, there is a growing number of promising study results, despite the presence of some aspects that need to be considered and developed. It has been most commonly used in vulvar and uterine cervivcal cancer in gynecological oncology. According to these studies, almost all of which are prospective, particularly in cases where Technetium-labeled nanocolloid is used, sentinel node detection rate sensitivity and specificity has been reported to be 100%, except for a few cases. In the studies on cervical cancer, sentinel node detection rates have been reported around 80–86%, a little lower than those in vulva cancer, and negative predictive value has been reported about 99%. It is relatively new in endometrial cancer, where its detection rate varies between 50 and 80%. Studies about vulvar melanoma and vaginal cancers are generally case reports. Although it has not been supported with multicenter randomized and controlled studies including larger case series, study results reported by various centers around the world are harmonious and mutually supportive particularly in vulva cancer, and cervix cancer. Even though it does not seem possible to replace the traditional approaches in these two cancers, it is still a serious alternative for the future. We believe that it is important to increase and support the studies that will strengthen the weaknesses of the method, among which there are detection of micrometastases and increasing detection rates, and render it usable in routine clinical practice.

Association between fertility drugs and gynecologic cancers, breast cancer, and childhood cancers

Ovulation‐inducing drugs have been widely used for various types of infertility since the beginning of 1960s and their use increases day by day parallel to the success achieved in fertility treatment. However, the researches performed in the last two decades have begun to discuss about the safety of these drugs and the risks associated with their use. Especially, the potential neoplastic effects of these drugs are increasingly questioned. The studies have discussed whether there is an association between the exposure to ovulation‐inducing drugs and the incidence of various cancers. Moreover, several studies have been performed to reveal whether there is an increased risk of childhood cancers in children conceived after fertility treatment. The point we reached through the available data is that the risk of breast, uterine and invasive ovarian cancers is not increased, but the risk of borderline ovarian tumors might increase after such a therapy. The risk of cancer has been found similar for children conceived after fertility treatment and those conceived naturally. It should also be kept in mind that cancers are overdiagnosed in infertile women population because of the close medical surveillance, which may also contribute to the early detection of cancers. Although it is still early to state the last words on this topic, the possible association should be addressed when obtaining an informed consent before starting treatment.

Nerve-sparing radical hysterectomy for cervical carcinoma

With the concept of the improvement of quality of life in the field of surgical oncology, recent studies have questioned the place of radical hysterectomy (RH) in the treatment of cervical carcinoma due to a high rate of long-term postoperative complications involving the pelvic autonomic nerve system. It has been demonstrated that RH frequently causes bladder dysfunction, anorectal mobility disorders, and sexual dissatisfaction in cervical cancer survivors due to surgical trauma involving the sympathetic and parasympathetic branches of the autonomous innervation of the pelvic organs. Nerve-sparing RH was first pioneered by Takashi Kobayashi in Japan and then other Japanese gynecologic surgeons introduced and improved this concept to Western countries. However, nerve-sparing RH has only become popular among gynecologic surgeons during the last two decades. Recently, European gynecologic surgeons modified this concept. Herein, a review of the evolution of nerve-sparing RH, a quick overview of long-term pelvic organ dysfunctions associated with RH, and the technical details of different authors and their oncological outcomes are presented. Today, the lack of randomized studies comparing the effectiveness and complications of RH with nerve-sparing RH is an important barrier to the widespread use of this concept. Nonetheless, while nerve-sparing RH still awaits prospective randomized trials in order to prove that its effectiveness is equal to or greater than that of conventional treatment modalities, and that is has fewer long-term complications, this surgical approach remains attractive for the patients and gynecologic oncologists based on the published results.

Why women request cesarean section without medical indication

Objective. To understand the reasons of the cesarean delivery on maternal request (CDMR) without medical indication would help to reduce the rates of unnecessary cesarean-delivery (CD). The objective of this study is to determine the basal knowledge of women regarding normal delivery (ND) and CD and also to assess their attitudes about CDMR, and to find out the reasons influencing those attitudes. Methods. The study included 400 women who completed a 45-item questionnaire that assessed their basal knowledge of ND, CD, and their attitudes and beliefs about the mode of delivery and CDMR. Results. Mean age of the study population was 32 ± 10.2 years (range 18–66). Majority of the women would choose the ND because of its ‘being completely natural’ (89%) and no anesthesia and operative risk related with ND (76%). Only 33% of the women indicated that ND might cause genital organ prolapse and/or stress urinary incontinence and just 26% and 24% of the women would choose CD to prevent pelvic organ prolapse and stress urinary incontinence, respectively. On the other hand, 50% and 54% of the women would indicate that they could choose CD in order to prevent labor pain and to minimize the risk of fetal distress during the labor. Furthermore, 47% of the women had an opinion that that CD could be performed by maternal request without medical indication. Educational level had no effect of CDMR although more educated women had more accurate knowledge about the some risk and benefits of ND and CD. Binary logistic regression analysis revealed that fear of labor pain (p = 0.02, OR: 15.0, CI: 0.494–0.966), maternal age (p = 0.01, OR: 6.3,CI: 1.00–1.05), and knowledge about the relation between the ND and pelvic organ prolapse/urinary incontinence (p < 0.001, OR: 4.8, CI: 0.549–0.966) were the independent prognostic variables for the CDMR . Conclusion. Although majority of the women had wrong idea or no idea about the risks and benefits of CD, nearly half of them indicated that women can always demand CDMR. This study shows that basal knowledge of the women should be improved by education.

Ascites and epithelial ovarian cancers: a reappraisal with respect to different aspects

Ascites is a common finding in patients with epithelial ovarian cancer (EOC). Clinico-pathologic correlations with respect to the presence of ascites, positive cytology and prognostic role of ascites, and the impact of ascitic volumes were not previously studied extensively. A total of 372 patients with EOC were retrospectively evaluated with respect to presence and amount of ascites, cytologic findings, and survival. Two groups were compared by using Chi-square, Students t and Mann-Whitney U, binary logistic regression, Kaplan Meier and Cox-regression analysis tests, where appropriate. Omental metastasis (P < 0.001; OR: 3.21, 95% CI = 1.945–5.297) and mean number of metastatic lymph nodes (P= 0.008; OR: 1.063, 95% CI = 1.016–1.112) were significantly related with presence of ascites. Evaluation of ascitic volume at different thresholds revealed lymphatic-omental metastasis, and also the disease stage to be significantly different among patient groups at lower threshold values and the positive cytology and high-grade diseases at higher threshold values. In conclusion, presence of ascites correlates with both the intraperitoneal and also the retroperitoneal tumor spread. Amount of ascites has different correlations with the clinico-pathologic factors depending on the thresholds chosen. At lower volumes, lymphatic and omental metastasis seems to correlate with the development of ascites. Once ascites develops, tumor grade seems to be important for larger ascites volumes. Neither the presence of ascites or its volume nor the cytologic positivity was an independent predictor of survival.

Posthysterectomy intestinal prolapse after coitus and vaginal repair

IntroductionTransvaginal bowel evisceration following either vaginal or abdominal gynecologic operations is a very rare complication. Furthermore, vaginal cuff rupture with the prolapse of the small bowel through the vagina during sexual intercourse after abdominal hysterectomy in a premenopausal woman is even more rare. However, regardless of the etiology, transvaginal evisceration requires prompt recognition and surgical intervention.Case report Here, we report a premenopausal woman who developed transvaginal bowel evisceration during the first postoperative intercourse.

Increasing women's choices in medical abortion: A study of misoprostol 400 μg swallowed immediately or held sublingually following 200 mg mifepristone

Objectives To assess the efficacy and acceptability of two misoprostol regimens (400 μg oral or sublingual) following mifepristone for medical abortion. Methods Women seeking abortion with gestations of 56 days or less since onset of their last menstrual period were offered medical abortion as an alternative to a surgical procedure. A total of 207 eligible and consenting women were given mifepristone (200 mg oral) and the option of taking 400 μg misoprostol either orally or sublingually two days later, with the option of home-use. Two weeks later, treatment success, satisfaction, and the frequency and acceptability of side effects were assessed. Results Most women (97.6%) opted for home use of misoprostol and almost three quarters selected the oral route. Overall efficacy, acceptability of side effects and satisfaction were high in both groups. The success rate was lower after sublingual than after oral administration but not significantly so (91.3% vs. 96.3%, p = 0.23, RR: 0.93, 95% CI = 0.85–1.02). The frequency and average duration of side effects in both groups were comparable except for pain/cramps and fever/chills, which were more frequently associated with the sublingual route. Conclusions This study re-emphasises the feasibility of integrating medical abortion into health services in Turkey and the potential to increase choices for women.

A third evaluation of tertiary cytoreduction

To evaluate the impact of tertiary cytoreductive surgery (TCS) on patient survival and to determine predictors of optimal TCS.