Comparison of long-term results of obliterative colpocleisis and reconstructive vaginal surgery including sacrospinous ligament fixation in patients with total genital prolapse.

Background: Treatment of total genital prolapse in elderly patients is still controversial in terms of postoperative objective and subjective results. Aim: The present study aimed to compare the long-term objective and subjective cure rates of sacrospinous ligament fixation and Le Fort operation for treatment of total genital prolapse. Patients and Methods: Patients over the age of 60 with stage 3 or 4 pelvic organ prolapse that presented to the Obstetrics and Gynaecology Clinic of the Faculty of Medicine of *** University. The study sample consisted of 17 patients that underwent Le Fort operation and 29 patients that underwent sacrospinous ligament fixation. Data on duration of operation, intraoperative complications, duration of hospital stay, and differences between preoperative and postoperative estimated blood loss, postoperative complications, and relapse in the long term were obtained. Questionnaires exploring quality of life, incontinence, and pelvic floor disorders were applied to the patients. Results: As subjective cure rates, postoperative patient satisfaction (P = 0.001), regret rate (P = 0.038) and recommendation rate (P = 0.044), as well as postoperative questionnaire results, Pelvic Floor Impact Questionnaire and SF36 were found to be significantly better in the Le Fort group (respectively P = 0.039 and 0.042). As objective cure rates, there was no difference between the two groups in terms of postoperative cystocele, rectocele, and cystorectocele (P = 0.955) and postoperative recurrence of prolapse beyond the hymen (P: 0.893). Duration of operation and duration of hospital stay were found to be significantly shorter in the Le Fort group (respectively P = 0.032 and 0.012). Conclusion: Le Fort operation could be the intervention of choice in sexually inactive elderly patients with stage 3 or 4 pelvic organ prolapse.

A comparison of maternal outcomes in complicated vaginal and cesarean deliveries.

OBJECTIVE: The purpose of this study was to compare general characteristics, laboratory data, and maternal outcomes of patients who experienced complications in the first 24 hours after a normal vaginal delivery or cesarean section (C-section). This way, the authors intended to determine the results of complications in these patients. MATERIALS AND METHODS: Data of patients referred from the peripheral care centers to the present tertiary care center in the first 24 hours after a vaginal delivery or C-section due to the presence of various complications were screened retrospectively from 2009 to 2013. Clinical and demographic characteristics, laboratory parameters, indications for C-section, mortality rates, maternal morbidities, surgical and medical treatments administered in the clinic, as well as operations performed in other care centers were noted. RESULTS: A total of 330 patients were included in this study. Of these patients, 285 constituted the postoperative group (C-sections) whereas 45 constituted the postpartum (vaginal deliveries) group. There was no statistically significant difference between the two groups in demographic characteristics, results of laboratory parameters, maternal morbidity, and mortality rates. Requirement of hysterectomy and relaparotomy was significantly higher in the postoperative group. CONCLUSIONS: In the early follow-up, it was found that complicated C-sections and vaginal deliveries had similar results. However, it should also be mentioned that higher requirement of hysterectomy and relaparotomy emerged as an undesirable condition among the postoperative patients in this study. With this in mind, mode of delivery should be selected according to the overall health status of the patient and indications for C-section.

Serum levels of the adipokines, free fatty acids, and oxidative stress markers in obese and non-obese preeclamptic patients.

PURPOSE OF INVESTIGATION: To investigate the roles of adipokines, free fatty acid (FFA), and oxidative stress in obese and non-obese preeclamptic patients. MATERIALS AND METHODS: Gestational age-matched obese preeclamptic (n=32), non-obese preeclamptic (n=32), and non-obese normotensive healthy (n=32) pregnant women were included in the study. Serum insulin, insulin resistance, leptin, nesfatin, ghrelin, chemerin, FFA levels, total antioxidant status, total oxidant status, and oxidative stress index were determined. RESULTS: Leptin and nesfatin levels were significantly lower and ghrelin levels were significantly higher in the normotensive group as compared to the preeclamptic groups, while no difference was observed between obese and non-obese preeclamptic groups. Chemerin and FFA levels were significantly higher in obese preeclamptics as compared to non-obese preeclamptics and normotensive group. Total antioxidant status (TAS) levels were significantly higher in the normotensive group as compared to the preeclamptic groups, while no difference was observed between obese and non-obese preeclamptics. Total oxidative status (TOS) and oxidative stress index (OSI) levels were significantly lower in the normotensive group as compared to the preeclamptic groups, while no difference was observed between obese and non-obese preeclamptics. CONCLUSION: Serum levels of adipokines, TOS, and FFAs were significantly higher in pregnants with preeclampsia as compared to non-obese normotensive controls. Chemerin and FFA levels were significantly higher in obese preeclamptics as compared to non-obese preeclamptics.

Increased platelet count in severe peritoneal endometriosis.

OBJECTIVE: Platelet count (PC) is higher in chronic inflammatory diseases. The aim of this study was to evaluate the PC in patients with severe pelvic endometriosis. MATERIALS AND METHODS: Patients with advanced stage pelvic endometriosis were retrospectively evaluated in a tertiary center between January 2009 and December 2011. Patients with pelvic endometriosis were divided into two groups; advanced stage peritoneal endometriosis were classified as Group 1 (n = 28). Group 2 consisted of 29 patients which had ovarian endometrioma without clinically apparent peritoneal endometriosis foci. Group 3 included 51 women as control subjects. PC between the groups was tested by Student's t test. The mean values of three groups were analyzed by using one way ANOVA test followed post-hoc test Bonferroni. RESULTS: PC in patients with pelvic endometriosis were found to be higher from the control group (290 +/- 67 10(9)/1; 264 +/- 63 10(9)/1, respectively; p = 0.038). Patients with peritoneal endometriosis (Group 1) had significantly higher PCs compared with the healthy controls (309 +/- 65 10(9)/1; 264 +/- 63 10(9)/1; respectively; p = 0.011). CONCLUSION: Increased PC in advanced stage pelvic endometriosis may be a sign of increased systemic inflammation. The systemic inflammation may be more apparent in advanced stage peritoneal endometriosis.

Expression of extracellular matrix metalloproteinase inducer (EMMPRIN) in the endometrium of patients with repeated implantation failure after in vitro fertilization.

AIM: To compare the immunohistochemical expression of extracellular matrix metalloproteinase inducer (EMMPRIN) in repeated implantation failure (RIF) patients with normal fertile controls. PATIENTS AND METHODS: The study group consisted of primary infertile patients with RIF and normal fertile controls between January 2011 and February 2013. Endometrial samples received at the luteal phase were exposed to immunohistochemical staining for EMMPRIN antibodies. EMMPRIN expression of endometrial glandular epithelial cells, stromal cells and vascular endothelial cells were evaluated. The main outcome measure was defined as immunohistochemical score with regard to the severity and extent of staining. RESULTS: The study group consisted of 26 primary infertile patients, whereas the control group consisted of 40 normal fertile controls. The fertile group was found to have stronger expression of EMMPRIN than the study group when endometrial glandular epithelial cells, stromal cells and vascular endothelial cells were evaluated with regards to the severity of staining (p < 0.001), the extent of staining (p < 0.001) and total staining score (p < 0.001). CONCLUSIONS: This is the first study showing low expression of EMMPRIN in the endometrial cells of the patients with RIF compared with fertile healthy controls. We suggest that reduced EMMPRIN expression in the human endometrium may lead to poor endometrial receptivity.

Effects of estrogen, estrogen/progesteron combination and genistein treatments on oxidant/antioxidant status in the brain of ovariectomized rats.

INTRODUCTION: The aim of this study was to investigate the antioxidative effects of estradiol (E), E plus progesteron (P) combination (E/P) and genistein (G) treatment in the brain of ovariectomized (OVX) rats. MATERIALS AND METHODS: Adult female Sprague-Dawley rats were divided into five groups, with each group including ten rats. Rats were anesthetized and bilateral ovariectomy was performed under general anaesthesia in all groups except for the sham operation group. Groups included: Sham-operated, control (OVX), estrogen treated group (OVX+ E), E/P combination group (OVX+E/P) and G treated group (OVX+G). Treatments were applied for 8 weeks. The total anti-oxidant status (TAS), total oxidant status (TOS), nitric oxide level (NO), glutathione peroxidase activity (GSH-Px) and oxidative stress index (OSI) were analysed in the brain tissue of rats from each treatment category. RESULTS: Ovariectomy lead to an increase in brain TOS and OSI levels compared to the sham group (p < 0.05). Also, ovariectomy resulted in a decrease in brain TAS levels compared to the sham group that approached statistical significance (p = 0.078). Significant decreases in TOS, OSI, GSH-Px and a significant increases in TAS and NO levels were observed in the E-treatment group compared to the control group (p < 0.001). The E/P combination group exhibited a significantly decreased TOS and OSI and significantly increased TAS and NO levels relative to the control group (p < 0.05). Genistein treatment resulted in a significant decrease in TOS and OSI compared to the control group (p < 0.05). CONCLUSIONS: Oxidative stress markers increase in the brain tissue of OVX rats. Conversely, estradiol, E/P and G supplementation decreases oxidative stress markers and increases antioxidant activity. Using G may prevent neural pathologies result in menopause-related oxidative stress.

Copper, ceruloplasmin and oxidative stress in patients with advanced-stage endometriosis.

AIM: To compare patients with advanced stage endometriosis with control patients without endometriosis with respect to serum Copper (Cu) and Ceruloplasmin (Cp) levels and oxidative stress markers in order to evaluate the importance of these parameters in the pathogenesis of endometriosis. PATIENTS AND METHODS: A total of 72 women who underwent laparoscopy or laparotomy for evaluation of infertility, pelvic pain, pelvic mass, tubal ligation or endometriosis were enrolled for this prospective clinical study. Patients were divided into two groups by visual diagnosis at surgery and histological confirmation of endometriosis: control patients (n=41) without endometriosis and study group (n=31) with stage III/IV (advanced stage) endometriosis. Serum Cu, Cp, total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), paraoxonase-1 (PON-1), malondialdehyde (MDA), triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were compared between the two groups. Correlations between Cu, Cp and oxidative stress markers were determined. RESULTS: Serum TOS, OSI, Cu, Cp, TG, TC, LDL were significantly higher, whereas TAS, PON-1 activity and HDL were significantly lower, in women with advanced-stage endometriosis than in control groups. There was no difference in serum MDA activities between the two groups. Positive correlations were found between Cu and TOS, Cu and OSI, Cu and Cp, while a negative correlation was found between Cu and PON-1 in the advanced-stage endometriosis group. Positive correlations were found between Cp and TOS, and Cp and OSI in the advanced-stage endometriosis group. CONCLUSIONS: Cu and Cp appear to be associated with the etiopathogenesis of and oxidative stress in endometriosis.