Sinan Özalp

Health risks for early (=19) and late (=35) childbearing

Abstract. Both adolescents and women of advanced reproductive age comprise distinct groups of obstetrics patients. Each has special needs and is susceptible to different obstetric risks. Pregnant teenagers appear to be at increased risk for poor maternal weight gain, abortions, hypertensive disorders and delivery of low birthweight infants. Pregnant women over the age of 34 have an increased risk for a poor obstetric outcome as a result of an increased risk for chromosomal aneuploidies and their higher likelihood of having a chronic disease, such as chronic hypertension or diabetes mellitus, to complicate their pregnancies. This study emphasises the increased maternal and fetal risks for pregnancies at these extreme age groups in a retrospective way. Prepregnancy counselling is essential for these age groups in order for a woman to be able to make an informed decision regarding the timing of childbearing.

Maternal blood clot patch therapy: A model for postamniocentesis amniorrhea☆☆☆★

Persistent amniorrhea and extraamniotic fluid collection was observed after amniocentesis. After the drainage of extraamniotic fluid, maternal blood was given under ultrasonographic guidance to produce a clot patch. Amniorrhea was controlled within 12 hours and a healthy baby was delivered at term.

Peritoneal tuberculosis mimicking ovarian cancer.

OBJECTIVE To evaluate the characteristics of 20 patients diagnosed as tuberculous peritonitis (TBP) mimicking ovarian cancer during a 10-year period at a single center. STUDY DESIGN Among 612 operations for ovarian malignancy we retrospectively reviewed the surgical and pathological reports of 20 patients suspected preoperatively as having ovarian malignancy but whose pathological results revealed TBP, between 2000 and 2011 in a university clinic. Demographic characteristics, physical and pelvic examination, laboratory investigations and radiological imaging of the patients were evaluated retrospectively. RESULTS Diagnostic laparotomy, laparoscopy and ultrasound guided tru-cut biopsy were performed in 11, 2 and 7 of the 20 patients, respectively. The mean age of the patients was 37.5 ± 17.3 years (range 16-70 years). The most common symptoms were abdominal pain (n=14%, 70%) and abdominal distension (n=13%, 65%). Serum CA 125 was elevated in 16 (80%) cases and the average CA 125 level was 289 ± 186.2 IU/ml. During ultrasonographic imaging and CT scans, ascites and a pelvic mass were detected in 19 (85%) and 12 (60%) patients respectively. TBP was suspected in 7 (35%) patients and ultrasound guided tru-cut biopsy was preferred as a first-line approach. Surgery was performed in 11 patients (55%) and during exploration widespread miliary nodules (n=9%, 81%), widespread adhesion (n=5%, 45%), adnexal mass (n=8%, 72%) and caseous necrotic substance (n=4%, 36%) were observed. Patients underwent unilateral (n=3% 27%) or bilateral (n=4%, 36%) salpingo-oophorectomy in seven (63%) cases. CONCLUSION Since ovarian cancer is a serious condition and preoperative diagnosis of TBP is difficult, laparotomy is usually mandatory to distinguish these two entities. Ultrasound guided tru-cut biopsy is useful in selected patients and frozen section analysis avoids hazardous radical surgery at operation.

Differential expression of P16 and P21 in benign and malignant uterine smooth muscle tumors

PurposeThe diagnosis of benign and malignant uterine smooth muscle tumors depends on morphologic criteria such as nuclear atypia, coagulative tumor cell necrosis and mitotic activity. Most of these tumors are readily classifiable into benign or malignant categories using these criteria. However, the distinction between leiomyomas and leiomyosarcomas may at times be problematic. Hence, it would be useful to have additional markers which could help to distinguish these tumors. The aim of the study was to evaluate p16 and p21 expressions in uterine smooth muscle tumors and determine whether p16 and p21 have a potential value in the differential diagnosis of problematic cases. In addition, we evaluated whether the differential expression of p16 and p21 in uterine leiomyosarcomas correlated with tumor recurrence and patient survival.Methodsp16 and p21 expressions were investigated by immunohistochemistry from paraffin-embedded tissues in 53 cases of uterine smooth muscle tumors consisting of 15 cases of leiomyoma, 14 cases of atypical leiomyoma (leiomyoma with bizarre nuclei), 3 cases of smooth muscle tumor of uncertain malignant potential (STUMP) and 21 cases of leiomyosarcoma. Cases were evaluated with respect to both staining percentage and intensity.ResultsThere was a statistically significant difference in p16 and p21 staining percentage and intensity between leiomyosarcomas and the other groups. There was no difference in p16 and p21 expressions between leiomyomas, atypical leiomyomas (leiomyoma with bizarre nuclei) and STUMPs. Multivariate analysis showed that the tumor stage was the only independent significant prognostic factor for overall survival in leiomyosarcomas. Neither p16 nor p21 was correlated with disease-free or overall survival.ConclusionsOur findings suggested that p16 and p21 may be of value as an adjunct to conventional morphologic criteria in the assessment of problematic uterine smooth muscle tumors.

Platelet volume as a parameter for platelet activation in patients with endometrial cancer

The objective of this study was to use mean platelet volume (MPV) as a measure of platelet activation in patients with endometrial adenocarcinoma and healthy controls. There was a total of 310 patients with endometrial adenocarcinoma retrospectively evaluated and 250 healthy controls. Preoperative haemoglobin, platelet counts and mean platelet volume were evaluated and statistical tests were conducted to determine the differences among early and advanced disease groups and controls. Median haemoglobin (13.0 vs 13.3 g/dl) and platelet count (282,000 vs 280,000/μl) values were similar in patients with endometrial adenocarcinoma and healthy controls (p > 0.05). Subjects with endometrial cancer exhibited slightly higher MPV than the control group (8.4 fl vs 8.2 fl) (p = 0.048). In patients with advanced-stage endometrial cancer, haemoglobin was significantly lower (p < 0.05) and MPV was significantly higher (p < 0.05) than in either patients with early-stage endometrial cancer or the control group. It was concluded that MPV was found to be a marker for predicting advanced-stage endometrial cancers.

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.

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.

Effectiveness of ultrasonographic parameters for documenting the severity of anatomic stress incontinence

Background. To assess the correlation between the severity of incontinence and some ultrasonographic parameters used to document the mobility of bladder neck.

Induction of apoptosis and inhibition of cell proliferation by the cyclooxgenase enzyme blocker nimesulide in the Ishikawa endometrial cancer cell line

OBJECTIVES Endometrial cancer remains a leading cause of death in women and therefore the development of new therapies is essential. The present study evaluated the effects of nimesulide alone, cisplatin alone, and combination of cisplatin and nimesulide on an Ishikawa cell line with respect to cytotoxicity and induction of apoptosis in vitro. STUDY DESIGN Ishikawa cells were treated with increasing doses of nimesulide alone, cisplatin alone, and a combination of cisplatin and nimesulide. Subsequently their effects on cytotoxicity were investigated by MTT assay, while apoptosis was investigated by DAPI and JC-1 staining and caspase-3 colorimetric assays. RESULTS 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay showed that nimesulide alone and combination of cisplatin and nimesulide have growth inhibitory effect on Ishikawa cells. Nimesulide alone and the combination of cisplatin and nimesulide induced apoptosis. Apoptosis induced by nimesulide might be related to caspase-3 activation. CONCLUSIONS These results suggest that nimesulide treatment is as effective as cisplatin treatment in Ishikawa cells. The combination of cisplatin and nimesulide treatment is more effective than cisplatin alone in Ishikawa cells.