ABSTRACT
Abstract Objective Previous studies investigating the association between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and recurrent pregnancy loss (RPL) risk has provided inconsistent results. The aim of our study was to assess the association between the ACE I/D polymorphism and risk of RPL. Methods All studies published up to January 30, 2018 on the association of ACE I/D polymorphism with RPL were identified by searching the PubMed, Web of Knowledge, and Google scholar databases. Results A total of 26 case-control studies with 3,140 RPL cases and 3,370 controls were included in themeta-analysis. Overall, there was a significant association between ACE I/D polymorphism and RPL risk under the allele model (I versus D: odds ratio [OR] = 0.538, 95% confidence interval [CI] = 0.451-0.643, p 0.001), the homozygote model (II versus DD: OR = 0.766, 95% CI = 0.598-0.981, p = 0.035) and the recessive model (II versus ID + DD: OR = 0.809, 95% CI = 0.658-0.994, p = 0.044). Subgroup analysis by ethnicity showed that there was a significant association between ACE I/D polymorphism and increased risk of RPL in Caucasian and West-Asian populations, but not in East-Asians. When stratified by number of recurrent miscarriages (RMs), a significant association between ACE I/D polymorphism and increased risk of RPL was detected in the group of studies with ≥ 2 RMs, but not in studies with ≥ 3 RMs. Conclusion Themeta-analysis suggests that ACE I/D polymorphism is associated with increased risk of RPL. The ACE I/D polymorphism may be a risk factor for RPL in Caucasian and West-Asian populations, but not in East-Asians.
Subject(s)
Humans , Female , Pregnancy , Abortion, Habitual/genetics , Peptidyl-Dipeptidase A/genetics , Polymorphism, Single Nucleotide , Case-Control Studies , INDEL MutationABSTRACT
OBJECTIVE: The aim of this study is to evaluate the results of neoadjuvant chemotherapy (NACT) and the impact of interval debulking surgery (IDS) on clinical outcomes of patients with advanced-stage ovarian cancer. METHODS: We performed a retrospective analysis on 92 patients with advanced ovarian cancer admitted to Vali-Asr Gynecologic oncology departments during 1996-2002. Comparison was made with results of neoadjuvant chemotherapy of 24 patients with unresectable advanced epithelial ovarian cancer treated with platinum- based NACT followed by IDS and clinical outcomes of 68 consecutive stage III and IV ovarian cancer patients treated with primary cytoreduction followed by platinum-based adjuvant chemotherapy. RESULTS: Primary cytoreductive surgery caused longer survival compared to neoadjuvant chemotherapy. Patients who underwent optimal interval debulking surgery (IDS) had a better progression free survival (PFS) (p=0.002) and overall survival (p=0.03) than those who did not. There were not significant differences between the two groups in complications of surgery. CONCLUSION: NACT followed by successful IDS can lead to high survival percentage in patients with chemoresponsive advanced ovarian cancer; although the result is more effective in those with optimal primary cytoreduction, we still got the same results with those with suboptimal primary cytoreduction.
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OBJECTIVE: Uterine sarcomas are rare and heterogeneous tumors with histopathological diversity characterized by rapid clinical progression and a poor prognosis. The aim of this study was to investigate clinical and histopathological characteristics together with treatment and outcome of Iranian patients with uterine sarcomas. MATERIALS AND METHODS: Records of 57 patients with histologically verified uterine sarcoma treated at the Vali-e-Asr Hospital were reviewed (1999-2004). RESULTS: The lesions were 19 leomyosarcoma (LMSs), 17 malignant mixed Mullerian tumors (MMMT), 16 endometrial stromal sarcomas (ESSs), 3 unspecified sarcomas, 2 rabdomyosarcomas. Median age at diagnosis was 50 (17-81) years. Clinical stages (based on FIGO) were 30 with stage I disease, 9 with stage II, 12 with stage III and 6 with stage IV. Only one patient did not undergo surgery and most cases with LMS and ESS were treated with simple total hysterectomy (STH). Forty patients (out of 57) received adjuvant radiotherapy. The median follow-up period was 19 (2-96) months and median disease free period was 16 (1-86) months. The overall survival rates after 1, 2, and 5 years were 71%, 58% and 52%, respectively. Survival was related to histological type of ESS (p=0.0018), grade I (p=0.0032) and early stage (p=0.045) significantly, but was not linked to postoperative irradiation. However, local recurrence rate was significantly improved after adjuvant radiotherapy. Twenty-one patients had relapse, 16 in the pelvic and 5 in extrapelvic sites. CONCLUSION: Based on the findings in this series, prognosis is dependent on histopathological subtype, grade and tumor stage. Adjuvant radiotherapy decreases local recurrence rate, but without significant impact on survival.
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AIMS: The prevalence of cervical cancer in a developing country, and diagnostic therapeutic value of knife conization for CIN, indications, cytopathologic results and complications of conization, were evaluated. METHODS: This retrospective- descriptive study concerned 44 cases that underwent conization. RESULTS: The age range of patients was 18-75 (mean=43), and parity ranges were from 0-10 (mean 4-5), ten cases were post-menopausal. The main indication was inability to visualize the entire T zone (19 cases) that was more prevalent in post-menopausal (5 cases and 14 cases premenopausal). The most common pap smear result was HSIL in 16 cases before conization. The most common colposcopic biopsy result was moderate dysplasia in 16 cases. Two cases had invasive cancer on colposcopic- biopsy: one of them had ASCUS in pap smear result and another one HSIL. The most common histologic result after conization was mild dysplasia in 23 cases. Four cases had invasive cancer in histology of the cervix with conization. Active hemorrhage occurred in 2 cases and urinary infection in 1 case after conization. CONCLUSIONS: Pap smear results in screening of cervical cancer are not reliable and colposcopy is more acceptable for LSIL and ASCUS. All gynecologist should develop the skill to perform accurate knife conization, because the classical indications for conization continue to be valid, and it has low risk of complications.