The effect of treatment on pregnancy outcomes in women with one elevated oral glucose tolerance test value.

OBJECTIVE: The aim of the study was to evaluate whether dietary intervention could reduce maternal and perinatal morbidity in pregnancies with one elevated 100 g oral glucose tolerance test (OGTT) value. MATERIAL AND METHODS: The study was conducted among patients with positive 50 g glucose challenge test (GCT) and one elevated 100 g OGTT value. Plasma glucose value of 140 mg/dL was used as the threshold to define an abnormal GCT result. Carpenter and Coustan criteria were used to evaluate the OGTT results. Seventy-four women with normal GCT values comprised group I. Ninety-nine women with one elevated 100 g OGTT value who were given a caloric diet and 102 women with one elevated OGTT value in group III who received antenatal care with no special diet were randomly assigned to groups II and III, respectively. All women were followed up until the end of pregnancy. Poor maternal outcome was defined as: cesarean delivery performed due to cephalopelvic disproportion, failure to progress or fetal distress, preeclampsia, and/or preterm labor. Poor perinatal outcome was defined as: small for gestational age, large for gestational age or admission to a neonatal intensive care unit. The groups were compared in terms of maternal and perinatal outcomes. RESULTS: The rates of macrosomia and large for gestational age incidence were significantly higher in group III as compared to groups I and II. When we examined the multivariate effects of the risk factors considered to be predictive of poor maternal outcomes, group III was the only statistically significant risk factor (OR=3.90, 95% CI:1.95- 7.84; p=<0.001). In terms of poor perinatal outcome, one elevated OGTT value (group III) was the only significant risk factor (OR=2.92, 95% CI:1.56-5.46; p=<0.001). CONCLUSION: Women with one elevated OGTT value benefit from a structured program of diet therapy aimed to reduce adverse maternal and perinatal outcomes.

Maternal plasma total antioxidant status in preterm labor.

AIM: To investigate the role of oxidative stress and antioxidant status in preterm labor. METHODS: Twenty-five cases diagnosed with preterm labor were included in the study group, whereas 25 women with uncomplicated pregnancies at similar stages of pregnancy were included in the control group. Total antioxidant status was measured in maternal plasma using a Hitachi 911 auto analyzer and a total antioxidant status kit (Randox Laboratories, UK) in mmol/L. RESULTS: Mean serum antioxidant status were lower in patients (1.002 ± 0.177 mmol/L) than in controls (1.258 ± 0.147 mmol/L) (P < 0.001). CONCLUSION: Women with preterm labor have decreased total antioxidant status compared with uncomplicated pregnancies in similar gestational weeks. Future work should clarify whether decreased total antioxidant status precedes preterm labor in a prospective cohort study.

Predictive power of sexual hormones and tumor markers in endometrial cancer.

OBJECTIVE: The purpose of the present study was to investigate the predictive power of sexual hormones and tumor markers in endometrial cancer. METHODS: A total of 135 healthy women were prospectively compared with 135 women who had histopathologically confirmed endometrial cancer. Both the groups of women were matched by age and body mass index. RESULTS: When compared with healthy controls, women with endometrial cancer had significantly higher serum levels of CA-125, CA 19-9, prolactin and thyroid-stimulating hormone, whereas significantly lower serum concentrations of alpha-fetoprotein, CA 15-3, follicle-stimulating hormone and luteinizing hormone (LH). Tumor stage correlated positively and significantly with serum levels of prolactin, CA-125 and CA 19-9 as did tumor grade with serum concentrations of LH, estradiol, prolactin and CA-125. Serum CA-125 levels >35 U/ml were found to have a sensitivity of 42.2%, specificity of 87.4%, positive-predictive value of 77.0% and negative-predictive value of 60.2%. Besides endometrial cancer could be diagnosed with 16.3% sensitivity, 100.0% specificity, 100.0% positive- and 54.4% negative-predictive values with serum prolactin levels >30 ng/ml. CONCLUSIONS: Because serum concentrations of CA-125 can be elevated in various malignancies, it is obvious that it is neither specific nor accurately diagnostic for endometrial tumors. What is more, the distinct effects of physiological factors on prolactin secretion shadow the credibility of this hormone in early diagnosis of endometrial tumors. Thus, either prolactin or CA-125 is far from being utilized as the sole entity for screening endometrial cancer. Therefore, both parameters should be regarded as the components of a biochemical screening panel that is to be developed in future.

Malign mural nodules associated with serous ovarian tumor of borderline malignancy: a case report and literature review.

BACKGROUND: Cystic tumors of ovary, whether benign, borderline, or malignant may be associated with mural nodule of various types, including sarcomas, sarcoma-like mural nodules (SLMN), and foci of anaplastic carcinoma. Cases of serous borderline ovarian tumor with mural nodules of mixed type are very rare. CASE: A 54-year-old woman referred with abdominal swelling. Imaging studies revealed a huge mass localized in pelvis and lower abdomen and grade 1-2 left renal hydronephrosis. Preoperative Ca-125 was 798 U/ml. In exploratory laparotomy there was a 16 cm mass adherent to lateral abdominal wall and intestines. Adhesiolysis and de-bulking surgery were performed including bilateral pelvic, para-aortic lymphadenectomy, appendectomy and omentectomy. Left ureter was found to be dilated because of the infiltration of distal part by the tumor, so distal ureteral resection and neoureterocystostomy were performed. Final pathology revealed borderline serous ovarian tumor with mural nodules which were consisted of SLMNs, multiple and sharply demarcated from the adjacent tumor, and sarcomatous nodules showing infiltrative appearance in metastatic regions. Mural nodules showed a positive reaction for vimentin and SMA but were negative for cytokeratin and also necrosis, hemorrhage, and 10-15 mitoses in 10 high power fields were noted. She had postoperative chemotherapy and follow-up is going on without metastases in her first year. CONCLUSION: The existence of sarcomatous nodules combined with the SLMN necessitates a careful histologic analysis for treatment and the determination of prognosis. However, too few cases of mixed type mural nodules have been published to warrant a conclusion regarding their prognosis.

Relationship between preterm labor and thrombophilic gene polymorphism: A prospective sequential cohort study.

OBJECTIVE: Premature labor is still the leading cause of infant mortality and morbidity worldwide. Multiple etiological factors including genetics and environment are held responsible for preterm birth. However, scientific data regarding the link between premature birth and genetics are limited. SUBJECTS AND METHODS: In this study, we included 50 women who had premature labor (group 1) but did not have any known risks for a premature delivery such as uterine anomaly, polyhydramnios, hypertension, and diabetes mellitus, and another 50 healthy women who had term labor as control (group 2). We compared these two patient groups for MTHFR C677T, MTHFR C1298T, prothrombin 20210A, factor V and ACE polymorphisms. RESULTS: We could not detect a statistical significance between groups for polymorphisms in MTHFR C677T, MTHFR C1298T, prothrombin 20210A, factor V and ACE polymorphisms. CONCLUSION: We investigated the relationship between premature and term labor and thrombophilic gene polymorphism. However, we found no associations with premature or term labor with the parameters included.

Skin graft failure mimicking abscess masking local recurrence of vulvar cancer: a case report.

BACKGROUND: Vulvar cancer is a rare gynecological malignancy and its local recurrence is even more uncommon. To date, no cases of recurrent vulvar cancer in split thickness graft area have been reported. We describe the first case of such recurrence. CASE: A 65-year-old G4P3013 presented with vulvar mass and itching. She had a 2 x 2-cm sized mass on clitoris and an ulcerated bulgy mass of 2 x 2.5 cm size was localized on left labia majora, of which a biopsy revealed invasive squamous cell carcinoma. She underwent a radical vulvectomy and bilateral inguinofemoral lymph node dissection via separate incisions. Her postoperative course was complicated by wound separation which was cored with a split thickness skin graft. Patient was advised to integrate her treatment with radiotherapy, but she refused it. Two months later, she consulted for a painful swelling in the operation field. The swelling resembled an abscess formation so it was drained and an outpatient antibiotic treatment was prescribed. At her second visit, it was noted that the above-mentioned lesion was persisting and so fine needle aspiration biopsy (FNAB) was performed and a local recurrence was retrieved beneath the graft failure. Then she underwent a wide local excision and adjuvant radiotherapy was initiated after patient's approval. CONCLUSION: Careful surveillance is warranted as squamous cell carcinoma recurrence can even occur beneath the split thickness skin graft, especially in conjunction with graft failure. And for high risk patients adjuvant radiotherapy is critically important for avoiding recurrences.

Tumor markers in mature cystic teratomas of the ovary.

OBJECTIVE: The objective of this study was to evaluate the serum levels of tumor markers in patients with ovarian mature cystic teratomas. METHOD: Retrospective study of 215 patients operated at Zekai Tahir Burak Women Health Education and Research Hospital between January 2001 and October 2006 was performed. RESULTS: The median age was 36 years (range 13-80). The mean tumor diameter was 7.7 +/- 4.6 cm (range 2-25). The mean serum CA 125 level was 26.2 +/- 29.9 U/mL (range 1.4-225, normal value <35), and the mean serum CA 19-9 level was 83.5 +/- 179.2 IU/mL (range 0.6-1,000; normal value <37). The elevated rate of CA 19-9, CA 125 was 39.6% (74/187) and 23.3% (50/215), respectively. The mean age of patients and the rate of bilaterality of tumors were similar in both patients with elevated CA19-9 and with normal CA 19-9 level (P > 0.05). The mean tumor size of patients with elevated CA 19-9 was greater than those with normal CA19-9 level (P = 0.01). CONCLUSION: Serum CA 19-9 has the highest positivity rate among other tumor markers in ovarian mature cystic teratomas. Elevated serum CA 19-9 levels are correlated with larger tumor size. But the diagnostic value of elevated CA 19-9 in patients with MCT would be poor if the test was used alone.

Colon penetration by a copper intrauterine device: a case report with literature review.

AIM: The present case report describes colon injury subsequent to uterine penetration which is associated with the use of an intrauterine device (IUD). CASE: A 29-year-old multiparous woman, who presented with vague abdominal pain, had a TCu 380A inserted at her postpartum third month visit. The T-shaped segment of the IUD was found to be lodged within the lumen of a colon segment which was 60 cm far from the ileocecal valve. The vertical copper-bearing limb of the IUD extruded from the colon wall beyond the mesenteric edge and partially penetrated the fundal wall. After the affected colon segment was resected, an end-to-end anastomosis was made. Recovery period was uneventful. DISCUSSION: The incidence of uterine penetration is affected by the IUD type, the timing of insertion related to pregnancy termination, the position of uterus, insertion technique, the experience of the operator and the follow-up period. The location of missing IUDs can be determined by ultrasonography, X-ray or computed tomography imaging.

Is leptin a significant predictor of bone mineral density in postmenopausal Turkish women?

The objective of the present study was to investigate the relationship between leptin and bone mineral density in postmenopausal Turkish women. A total of 122 healthy postmenopausal women were enrolled in this cross-sectional study. Blood samples were obtained for analysis of serum leptin. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the lumbar spine, femoral neck and trochanter on the same day. Leptin levels was significantly correlated with BMD of L(1-4) (P = 0.04), but not of femoral neck (P = 0.13), and trochanter (P = 0.39). However, Z scores of L(1-4) (P = 0.009), femur neck (P = 0.009), and femur trochanter (P = 0.025) were positively correlated with leptin levels. In multiple linear regression analysis, leptin was not found to be a statistically significant independent predictor for BMD. Leptin was associated with BMD and Z scores at various body sites; however, it was not an independent predictor of BMD.

An unusual case of lingual alveolar soft part sarcoma during pregnancy.

OBJECTIVE: We report a case of alveolar soft part sarcoma (ASPS) of the tongue that presented in the third trimester of pregnancy. CASE REPORT: An 18-year-old, gravida 1, para 0, woman with ASPS of the tongue in the 31st week of pregnancy was described. Approximately 4 months after her first diagnosis, she was referred to our clinic for the delivery of her baby and additional treatment. At 32 weeks of gestation, a healthy male infant weighing 2,220 g was delivered by cesarean section. After an uneventful postoperative course, she was referred to the department of otorhinolaryngology and maxillofacial surgery for further investigation and treatment. CONCLUSION: ASPS of the tongue presenting in pregnancy is an extremely rare combination, and to our knowledge, this is the first reported case in the English literature. The diagnostic and therapeutic management of the pregnant patient with cancer, like ASPS, is especially difficult, because it involves both the mother and fetus.

Does hysterectomy affect ovarian function? Histopathologic evaluation and serum FSH, inhibin A, and inhibin B levels in an experimental rat model.

OBJECTIVE: To evaluate the effects of hysterectomy with ovarian conservation on ovarian histology, and FSH, inhibin A, and inhibin B plasma levels. STUDY DESIGN: Forty-five female Wistar albino rats were used in this study and randomly divided into two groups: hysterectomy (n=30) and sham-operated (n=15). Blood samples were collected before and after (50 and 100 days) abdominal hysterectomy from both groups to measure plasma levels of FSH, inhibin A, and inhibin B. All animals were sacrificed by decapitation to obtain ovaries for histological examination. For statistical analyses, Mann-Whitney U, Chi-square, Wilcoxon matched pairs signed rank sum tests, and two-sided variance analysis were used and statistical significance was defined as p<0.05. RESULTS: There was no difference in hormonal variables between groups when the time interval was considered completely [p>0.05 (for FSH p=0.962; for inhibin A p=0.321; for inhibin B p=0.476)]. In the hysterectomy group, the inhibin B level at postoperative day 50 was significantly lower than the control group (p=0.007) and at postoperative day 100, inhibin A concentrations were increased significantly when compared with the levels at both baseline and postoperative day 50 (p<0.001). Histopathologic evaluation of ovaries 100 days after hysterectomy showed that ovaries from the hysterectomy group had significantly fewer primary (p=0.01), preantral (p<0.001), and antral follicles (p<0.001), and significantly more corpora lutea (p<0.001), atretic (p=0.02), and cystic follicles (p=0.003). CONCLUSION: The results of this experimental rat model suggest that hysterectomy may affect ovarian function.

Comparison of a new technique with Deschamps ligature carrier for sacrospinous ligament fixation.

OBJECTIVE: A new technique for sacrospinous ligament fixation, which allows rapid and safe suture placement and automatic suture retrieval, is described and compared with Deschamps ligature carrier. METHOD: Sacrospinous ligament fixation was performed by Deschamps ligature carrier over 30 patients and the new procedure was applied over 27 patients. Patients were evaluated with respect to the operative time, blood loss and complications. RESULT: For the control group, it took 795 +/- 190.8 (480-1200) s for the placement of sutures. For the study group, it was 48.66 +/- 14.0 (32-90) s. Significant difference was found between the two groups in terms of time spent for suture placement, being shorter in the study group in which the new technique was used. CONCLUSION: The instrument described here seems to improve suture placement and retrieval during sacrospinous ligament fixation. It avoids the need for retractors reducing the risk of damage to the vessels and nerves in the area. It offers a quick and easy way of performing sacrospinous ligament fixation.

Serum leptin levels in women with uterine leiomyomas.

OBJECTIVE: The purpose of this study was to examine the influence of leptin in women with uterine myoma. MATERIALS AND METHODS: In this study, 38 women with myoma uteri and 30 normal women who applied to the Dr Zekai Tahir Burak Woman Health Research and Education Hospital's gynecology clinic were enrolled. Uterine leiomyomas were proved by pathology postoperatively. In all subjects, FSH, LH, E2, prolactin, hemoglobin, hematocrit, blood urea nitrogen, creatinine, fasting glucose, CA125, and leptin were examined, and body mass index (BMI) was calculated. Data were analyzed by Student's t test and Mann-Whitney U test. RESULTS: Although leptin level was higher in the myomatic women (5.73 +/- 4.08 ng/mL) than in the normal women, there was no statistically significant difference (p = 0.303). Also, no statistical difference in the ratios of leptin/BMI was found in both groups. A significant correlation was found between high E2 level and myoma uteri (p = 0.021). Hemoglobin levels were significantly lower in the myomatic women (p = 0.044). When we compared the leptin levels according to BMI, leptin levels were higher in patients who had BMI > 30 (p = 0.02). CONCLUSION: We did not find any significant difference in serum leptin levels between the two groups. But leptin may have an indirect role in the pathogenesis of uterine leiomyoma. So further research is needed to reveal the role of leptin in myoma uteri pathogenesis.

Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding.

OBJECTIVE: To compare the diagnostic accuracy and acceptability of transvaginal sonography (TVS), saline infusion sonography (SIS), and office hysteroscopy (OHS) for detecting intracavitary abnormalities in women with or without abnormal uterine bleeding (AUB). DESIGN: Prospective double-blind study. SETTING: Zekai Tahir Burak Women's Health Education and Research Hospital, Gynecology Clinic (Ankara, Turkey). PATIENT(S): A total of 26 women with AUB and 24 women without AUB were enrolled in this study. INTERVENTION(S): Transvaginal sonography, SIS, and OHS were performed on women scheduled for hysterectomy. MAIN OUTCOME MEASURE(S): Sensitivity, specificity, and positive and negative predictive values of TVS, SIS, and OHS to detect intracavitary abnormalities (with histopathologic findings used as the gold standard), duration of procedure, and pain scores. RESULT(S): The sensitivity and specificity of TVS, SIS, and OHS in detecting intracavitary abnormalities were 56.3% and 72%, 81.3% and 100%, and 87.5% and 100%, respectively. The prevalence of endometrial polyps was not different in women with and without AUB. Saline infusion sonography was less painful than OHS (pain scores of 4.3 and 7.2, respectively). CONCLUSION(S): The diagnostic accuracy of SIS was equal to that of OHS in diagnosing intracavitary abnormalities. Moreover, SIS was less painful than OHS for patients.