Tolgay Tuyan Ilhan

Relations of Serum Visfatin and Resistin Levels with Endometrial Cancer and Factors Associated with its Prognosis

BACKGROUND The aims of this study were compare the serum visfatin and resistin levels between endometrial cancer (EC) patients and controls and evaluate their power to predict prognosis. MATERIALS AND METHODS This prospective study was conducted between March 2013 to June 2014 on the Gynecologic Oncology Department of the University of Selcuk, Konya, Turkey. A total of 42 EC patients and 42 controls were included and assessed for differences in serum visfatin and resistin levels, along with prognostic factors. RESULTS Endometrial cancer patients had significantly higher visfatin levels than control s (p: 0.011), associated with deep myometrial invasion (p: 0.019). In contrast the serum level of resistin did not significantly differ between EC patients and controls (p: 0.362). However, high resistin level in EC patients was associated with increase lymph node metastasis (p: 0.009). On logistic regression analysis, we found that serum visfatin elevation was associated with risk of myometrial invasion (OR: 1,091; 95%CI: 1.021- 1.166; p: 0.010) and serum resistin with risk of lymph node metastasis (OR: 1.018; 95%CI: 1.000- 1.035; p: 0.046). For myometrial invasion prediction, a serum visfatin level greater than 26.8 ng/mL demonstrated a sensitivity and specificity of 66.6 % and 96.4%, respectively. For lymph node metastasis prediction, the best cut-off for serum resistin level was 599ng/mL. A serum resistin level greater than this demonstrated a sensitivity and specificity of 87.5% and 77.1%, respectively. CONCLUSIONS Our data suggest that serum visfatin is elevated in patients with EC and serum visfatin and resistin levels could be used to predict the risk of advance stage lesions.

Effect of the percentage of body fat on surgical, clinical and pathological outcomes in women with endometrial cancer

This study used the measure of percentage of body fat (%BF) to define obesity and evaluated the effect of percentage of %BF on clinical, surgical and pathological features in women with endometrial cancer.

Effect of drainage on postoperative pain after laparoscopic ovarian cystectomy

Abstract The aim of this prospective study was to investigate the effect of drainage on postoperative shoulder and abdominal pain after uncomplicated laparoscopic ovarian cystectomy (LOC). Allocation to drain or not to drain was non-randomised. There were 55 patients with drainage and 56 patients without drainage. Postoperative shoulder and abdominal pain was assessed using a 10-point visual analogue scale. Postoperative hospital stay in the drainage group was longer than the non-drainage group (p = 0.040). Postoperative shoulder pain scores at 6 h and 24 h were similar between the drainage and non-drainage groups (p = 0.376 and p = 0.847, respectively). Postoperative abdominal pain was higher in the drainage group at 6 h (p = 0.009), but was similar at 24 h (p = 0.097) between the groups. These data suggest that for LOC, drainage may not be useful to prevent postoperative shoulder pain and also increases postoperative abdominal pain and length of hospital stay.

The role of human epididymis secretory protein E4 in patients with endometrial cancer and premalignant endometrial lesions

abstract We evaluated the concentrations of human epididymis secretory protein E4 (HE4) and Ca-125 in relation to clinicopathologic features in patients with endometrial cancer and premalignant endometrial lesions. Women with abnormal uterine bleeding (n = 167) who underwent endometrial sampling were divided into four groups. Group 1: endometrial cancer (n = 68), group 2: atypical endometrial hyperplasia (n = 12), group 3: endometrial hyperplasia without atypia (n = 39) and group 4: controls (n = 48). Women with endometrial cancer exhibited higher concentrations of HE4 levels than controls (91.4 pmol/L vs. 46.2 pmol/L, p < 0.001). HE4 levels were significantly higher in patients with lymphatic involvement, deep myometrial invasion, lymphovascular space involvement and non-endometrioid histology (p < 0.001). The sensitivity, specificity, positive and negative predictive values for HE4 in detecting endometrial cancer were 72.7%, 84.4%, 80% and 78.4%, respectively. Preoperative HE4 levels are more elevated in women with endometrial cancer than those with benign endometrium as well as in women with prognostic high-risk factors with endometrial cancer. HE4 may be used as an additional marker in combination with other clinicopathologic features for planning the treatment.

Primary Ovarian Malignant Mixed Mullerian Tumour: A Case Report and Brief Review of Literature

Malignant Mixed Mullerian Tumour of the Ovary (OMMMT), also referred to as carcinosarcoma is a very rare tumour accounting for less than 1% of all ovarian cancers. Due to the rarity of OMMMT, little is known about the disease course and outcome of women with these tumours. It is important to evaluate because of its aggressive behaviour with extremely unfavourable prognosis. These tumours are composed of both malignant epithelial and mesenchymal elements. Current data in the literature is still limited to small case series and case reports, therefore, its optimal treatment is somewhat controversial. In the current report, we introduce a case of OMMMT which was successfully treated with Platinum-based combination chemotherapy after optimal cytoreductive surgery. The clinical manifestations, pathologic characteristics, diagnosis and management of these tumours are reviewed here. Although the most effective treatment is currently unknown, optimal cytoreductive surgery and platinum-based chemotherapy appears to improve the outcomes. Despite the aggressive nature of this tumour and its poor response to the treatment, management works best when cancer is found early. The stage of the disease is the most important prognostic factor. Therefore, the crucial question is how to diagnose the cancer at earlier stages rather than seeking the optimal treatment.

Is the Mean Platelet Volume a Predictive Marker of a Low Apgar Score and Insulin Resistance in Gestational Diabetes Mellitus? A Retrospective Case-Control Study

INTRODUCTION Gestational diabetes is defined as various degrees of glucose intolerance diagnosed or detected for the first time during pregnancy and is the most common metabolic complication of pregnancy. Early diagnosis and adequate treatment are important to prevent complications. Pre-eclampsia, polyhydramnios, fetalmacrosomia, and operative delivery are some of the complications seen in pregnant women diagnosed with Gestational Diabetes Mellitus (GDM). AIM The present study was designed to determine whether there was an association between Mean Platelet Volume (MPV) in predicting poor fetal outcome, insulin resistance, neonatal Apgar scores and gestational age for women with GDM. MATERIALS AND METHODS In this retrospective study, we enrolled 101 pregnant women with GDM together with a group of 138 healthy controls. MPV, insulin and homeostatic model assessment (HOMA-IR) values were measured at 24-28 weeks of the pregnancy. An independent samples t-test was used to compare MPV values. Multivariate linear regression models were used to establish relations between MPV values, HOMA-IR, insulin levels and Apgar score. RESULTS There was a significant positive correlation between MPV values, HOMA-IR and Insulin levels and a negative correlation with Apgar score at 1 min and 5 min in the GDM group (r=0.227, p=0.02; r=0.206, p=0.03; r=-0.485, p<0.001; and r=-0.399, p<0.001, respectively). In the multivariate logistic regression analysis, a high MPV value was most consistently associated with a low Apgar 1 min score (β=-0.387, p=0.003) in the GDM group. An MPV of >8.0 fL had a sensitivity of 82% and a specificity of 75% for the prediction of GDM. CONCLUSION We investigated the potential of MPV values in predicting low Apgar scores and insulin resistance in women with GDM.

Efficacy comparison of oral rosuvastatin versus oral progesterone and bevacizumab on regression of surgically endometriotic implants in rats

Abstract This study hypothesizes that oral rosuvastatin, oral dienogest and intraperitoneal bevacizumab might improve endometriosis in randomly selected female Wistar albino rats with surgically endometriotic implants. Thirty female Wistar albino rats with surgically endometriotic implants were randomized into three treatment groups: oral rosuvastatin (20 mg kg/day; oral rosuvastatin group 1; n = 10), oral progesterone (dienogest group 2; n = 10) and intraperitoneal bevacizumab (2.5 mg/kg of single intraperitoneal injection of bevacizumab; bevacizumab group 3; n = 10), for 10 days. Post-treatment variables were compared. The oral rosuvastatin group showed higher reduction for the glandular epithelium and uterine vessels of histopathological scores values than the oral progesterone group (both, p < 0.017, respectively). The median glandular epithelium and uterine vessels and histopathological scores values did not show a statistically significant difference between group 1 and group 3 (p > 0.017). Endometrial thickness values and uterine volume values were more significantly reduced in the oral rosuvastatin group than the oral progesterone group (both, p < 0.017, respectively). Moreover, endometrial thickness and uterine volume values were not different in groups wecompared with group 3 (p > 0.017). In conclusion, oral rosuvastatin and intraperitoneal injection of bevacizumab may cause more significant regression of surgically endometriotic implants in rats than oral progesterone medications.

Does lymphadenectomy have influence on postoperative body fluid distribution

OBJECTIVE We compared the fluid volume parameters in women undergoing gynaecological surgery for benign and malignant conditions before and after surgery using bioelectrical impedance vectors. STUDY DESIGN A total of 181 patients were enrolled. In all, 89 patients had surgery for benign conditions and 92 patients underwent oncological procedures, including lymph node dissection, for malignant diseases. Bioelectrical impedance analysis (BIA) parameters were measured on the day of hospitalisation before any treatment and at 24h and 1 month after the surgical intervention. The BIA parameters measured included extracellular water (ECW), intracellular water (ICW), and total body water (TBW). RESULTS TBW increased significantly 1 month after surgery in all cases (p<0,05 in both group). ECW was significantly higher (p<0.05) and ICW was significantly lower (p<0,05) in the malignant group than the benign group. CONCLUSION Radical gynaecological surgeries, including lymph node dissection, have a greater effect on body water distribution than surgeries performed for benign conditions.

The Prevalence of Hydatids of Morgagni in Surgically Managed Patients with Gynecological Conditions

ABS TRACT Objective: To determine the prevalence of hydatid of Morgagni (HM) and describe its clinical features in patients with gynecological conditions. Material and Methods: A prospective study was designed to investigate the prevalence of HM. The patients who underwent diagnostic or surgical procedures like laparotomy and laparoscopy to visualize the fallopian tubes for malignant or benign obstetrical/gynecological conditions at a tertiary referral health care from January 2015 to October 2016 were included in the study. We defined HM based on the direct visualization of the tubes at the time of surgery. Results: A total of 1,361 patients, 1,066 (78.3%) premenopausal and 295 (21.7%) postmenopausal, were included in this study. The mean age was 39.3 ±14.7 years (range 18–80 years). The overall prevalence of HM was 17.2% (n = 235) and that in premenopausal and postmenopausal women was 18.9% and 11.5%, respectively. HM prevalence was significantly higher among premenopausal women compared to postmenopausal women (p = 0.003). The majority (~96%) of the HMs were ≤ 1 cm and in only three cases (0.2%) the HM exceeded 2 cm in diameter. Conclusion: A systematic examination and appraisal of the adnexa during pelvic surgery may help in accurately identifying such common cysts. The direct evaluation of the fallopian tubes seems to be the best method to determine the prevalence of HM since most cysts are < 1 cm in diameter. Since the prevalence of HM decreased after menopause, their development may be stimulated by hormones.

An extremely rare case of complicated appendicitis: in utero appendix with fistula formation

A 43-year-old G4P4 woman was referred to our gynaecology clinic from emergency department with a right lower quadrant pain, bilateral pelvic tenderness, fever and signs of peritoneal irritation. She had no nausea, diarrhoea, constipation or other changes in bowel or bladder habits. She reports a gradual onset of symptoms of lower unilateral abdominal discomfort and abdominal cramping for 3 days. Discomfort has gradually worsened and pain tends to be accentuated by motion but did not improve with resting. Bimanual exam revealed uterine and adnexal tenderness, as well as pain with cervical motion. No abnormal vaginal discharge was present and qualitative B-hCG was negative. Significant laboratory values on admission were an elevated white blood cell count of 18 600/mL with a left shift and a C-reactive protein value of 88 mg/L. Sonographic imaging study of the pelvis revealed a normal sized uterus and a thick-walled unilocular cystic mass as fluid-filled structure; folded onto itself to form an ‘S’ shape in the right adnexal area. There was no free fluid in the pouch of Douglas. Based on the clinical findings and imaging studies, pelvic inflammatory disease (PID) was highly probable. After failed antibiotic therapy, the patient was scheduled for surgery 4 days after hospitalization. Patient was fully informed of the procedures and the possible risks of hysterectomy. Under general anaesthesia, vagina and abdomen were prepped and draped in the standard fashion. A Pfannenstiel incision was made. Surgical exploration revealed dense adhesions between uterus and appendix. Bilateral adnexa were normal. The appendix formed an S-shaped configuration and was noted to be enlarged, inflamed and adherent to uterine surface in its longitudinal plane (Fig. 1). The distal part of the appendix was embedded deeply into the uterus (Fig. 1). Local abscess and inflammatory process involving the entire anterior uterine wall were noted (Fig. 2). There were severe destructive effects of inflammatory reactions penetrating all layers of the uterus and permanently damaged areas. Patient who did not desire childbearing underwent an appendectomy and total abdominal hysterectomy. Patients had an uneventful post-operative period and she was discharged on day 5 following surgery. No delayed complications related to treatment and/or infection occurred during 6-month follow-up. Septic complications of acute appendicitis (AA) still pose multiple problems. Known potential complications of untreated or delayed management of AA include appendiceal perforation, periappendiceal abscess formation, peritonitis, bowel obstruction and rarely septic thrombosis of mesenteric vessels. The inflammation in AA may sometimes be enclosed by the patients own defence mechanisms, by the formation of an inflammatory phlegmon or a circumscribed abscess. In such cases, symptoms are dependent on the localization of the abscess and are often nonspecific. Thus, the correct diagnosis is usually not established until direct visualization at the time of surgery. Utero-appendiceal fistula is an extremely rare condition and this is the second case reported thus far. The first one was reported by Parsons et al. They reported a case with clinical and radiological evidence of pelvic sepsis and a medical history of endometrial ablation. On physical examination of our patient, pelvic and abdominal tenderness, pain with cervical motion and fever were noted. Presenting symptoms are similar to those of PID. Traditionally, it has been felt that the pathophysiological progressive nature of appendicitis ultimately leads to perforation. Abscess caused by perforated appendicitis and involving the tissues surrounding may be a contributory factor in fistula formation. A risk of full thickness uterine damage after endometrial ablation might be