The Role of Adenomyosis in the Pathogenesis of Preeclampsia.

INTRODUCTION: Adenomyosis can cause defective deep placentation. Preeclampsia is known to be associated with abnormal placentation. The aim of this study was to compare the presence of adenomyosis on magnetic resonance imaging in patients with and without history of preeclampsia in order to investigate the possible role of adenomyosis in the pathogenesis of preeclampsia. MATERIALS AND METHODS: This prospective, randomized study consisted of patients with (n = 35) and without (n = 34) history of preeclampsia. Direct (submucosal microcysts, adenomyoma and cystic adenomyoma) and indirect (maximal thickness of junctional zone, ratio of maximal thickness of junctional zone to myometrial thickness, junctional zone differential, focal thickening of junctional zone, globally enlarged uterus and non-uniform junctional zone contours) signs of adenomyosis were assessed by pelvic magnetic resonance imaging. RESULTS: The prevalence of adenomyosis was found to be more common in patients with preeclampsia und fetal growth restriction compared to patients without fetal growth restriction (94.4 vs. 64.7 %; p = 0.041), respectively. There was a strong association between maximal thickness of junctional zone (9 vs. 13 mm, p = 0.005), ratio of maximal thickness of junctional zone to myometrial thickness (0.42 vs. 0.66, p = 0.001) and junctional zone differential (3 vs. 5 mm, p = 0.02) and late-onset preeclampsia. CONCLUSIONS: Presence of adenomyoma is more common in patients with preeclampsia complicated with fetal growth restriction. Indirect signs of adenomyosis detected on pelvic magnetic resonance imaging might have a role in the pathogenesis of late-onset preeclampsia.

What are the best surgical techniques for caesarean sections? A contemporary review.

The aim of this study was to evaluate the reported techniques used in caesarean sections in order to form a general perspective of the procedural options for this frequently performed operation. The PubMed database and Cochrane Reviews were searched separately with the key words 'caesarean', 'abdominal entry', 'abdominal incision', 'uterine repair', 'peritoneal repair', 'closure of abdominal incision', 'suture materials', 'extraction of the placenta' and 'review'. Reviews, meta-analyses and prospective randomised trials were included in this review. In conclusion, although caesarean delivery is a very common operation, standardised and globally accepted techniques for caesarean section have not been described. The best surgical techniques for this operation are still unknown. Although the long-term follow-up results from two large, prospective, randomised studies are pending, further research is needed to establish an evidence-based, standardised approach for caesarean sections.

Quality of life in women with gynecologic cancer in Turkey.

AIM: The management of gynecological cancer patients mainly aims at prolonging survival but modern therapy focuses on good survival combined with a good quality of life (QoL). The aim of this study was to evaluate QoL and identify its associated factors in Turkish women with gynecologic cancer. METHOD: The study included 119 women diagnosed with endometrial, cervical, ovarian or vulvar cancer and treated at the Gynecologic Oncology Department of Celal Bayar University Faculty of Medicine. The data were collected between January and June 2011. QoL was measured with EORTC QLQ-C30 version 3.0. Relationships between clinical and socio- demographic characteristics and QoL scores were analyzed using the Mann-Whitney U, Kruskal Wallis and t-tests. RESULT: Global health status, physical and role function scores were found higher in women under the age of 60 years. Role function scores were found lower, and emotional and social scores were found to be higher in single women than in married women. Physical scores were found higher in women who had graduated from secondary school or above. Women with ovarian cancer had the highest while women with cervical cancer had the lowest global health score (65.3 ± 24.7 and 43.0 ± 24.1, respectively). Women with endometrial cancer were found to have better role function, and social well being than those with vulvar, cervical or ovarian cancer. Global, physical, role function, cognitive and social scores were found higher in women who had been treated with surgery. CONCLUSION: Gynecological cancer and treatment processes cause significant problems that have negative effects on physical, emotional, social and role function aspects of QoL. Health care providers play a key role in the identification and treatment of the complications of cancer therapy. Minimizing the effect of the symptoms of gynecologic cancer may positively impact on patient QoL.

Effects of selective and non-selective cyclooxygenase (COX) inhibitors on postoperative adhesion formation in a rat uterine horn model.

OBJECTIVE: To investigate the effects of cyclooxygenase (COX) inhibitors including celecoxib, indomethacin, and nimesulide on postoperative adhesion formation. MATERIAL AND METHODS: Forty-eight female Wistar-Albino rats were randomly divided into four groups: control (saline solution), celecoxib, indomethacin, and nimesulide groups. The uterine horns of rats were traumatized with unipolar electrocautery. Drugs of each group and saline in the control group were insillated on travmatized areas of horns as intraperitoneally. After three weeks, the extent and severity of adhesions with a standardized scoring system were evaluated. RESULTS: The extent and severity of postoperative adhesions were significantly reduced in nimesulide group compared with the control group. The extent but not severity of adhesions in rats given indomethacin was significantly reduced. Celecoxib showed no significant reduction in the extent and severity of adhesions. CONCLUSION: Nimesulide is more effective than the other COX inhibitors in the prevention of postoperative adhesions in rats.

Correlation between birth weight, leptin, zinc and copper levels in maternal and cord blood.

Leptin and zinc are involved in the regulation of appetite. Copper is a trace element regulating the functions of several cuproenzymes that are essential for life. To evaluate the relationship between zinc and copper status and the leptin system in humans, we examined whether leptin concentrations in the mother and the newborn correlate with the weight of mother, placenta and newborn. A total of 88 pregnant women at 38-42 weeks' gestation were studied. All infants were categorized as small for gestational age (SGA) (n = 16), average for gestational age (AGA) (n = 59) or large for gestational age (LGA) (n = 13). Leptin, zinc, and copper levels were measured in maternal and cord serum at birth. Maternal BMI and placental weight of the LGA groups were significantly higher than those of the SGA and AGA groups. Cord and maternal leptin levels of the SGA groups were significantly lower than those of the AGA and LGA groups. Maternal serum leptin levels were positively correlated with BMI and maternal zinc levels in all groups. Cord serum leptin levels of all groups were positively correlated with birth weight and placental weight. Birth weight was negatively correlated with maternal and cord copper level of all groups. Umbilical leptin concentrations of SGA newborns correlated with leptin concentrations of their mothers. In all pregnancies, birth weight increases in association with increase in cord leptin level. Our results suggest that maternal zinc but not copper level has an effect on maternal serum leptin levels. The increase in copper level in both maternal and cord blood may contribute to restriction in fetal growth.

Correlation between birth weight, leptin, zinc andcopper levels in maternal and cord blood

Leptin and zinc are involved in the regulation of appetite. Copper is a trace elementregulating the functions of several cuproenzymes that are essential for life. Toevaluate the relationship between zinc and copper status and the leptin system inhumans, we examined whether leptin concentrations in the mother and the newborncorrelate with the weight of mother, placenta and newborn. A total of 88 pregnantwomen at 38-42 weeks’ gestation were studied. All infants were categorized as smallfor gestational age (SGA) (n=16), average for gestational age (AGA) (n=59) or largefor gestational age (LGA) (n=13). Leptin, zinc, and copper levels were measured inmaternal and cord serum at birth. Maternal BMI and placental weight of the LGAgroups were significantly higher than those of the SGA and AGA groups. Cord andmaternal leptin levels of the SGA groups were significantly lower than those of theAGA and LGA groups. Maternal serum leptin levels were positively correlated withBMI and maternal zinc levels in all groups. Cord serum leptin levels of all groupswere positively correlated with birth weight and placental weight. Birth weight wasnegatively correlated with maternal and cord copper level of all groups. Umbilicalleptin concentrations of SGA newborns correlated with leptin concentrations of theirmothers. In all pregnancies, birth weight increases in association with increase in cordleptin level. Our results suggest that maternal zinc but not copper level has an effecton maternal serum leptin levels. The increase in copper level in both maternal andcord blood may contribute to restriction in fetal growth (AU)

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Correlation between birth weight, leptin, zinc and copper levels in maternal and cord blood

Leptin and zinc are involved in the regulation of appetite. Copper is a trace elementregulating the functions of several cuproenzymes that are essential for life. Toevaluate the relationship between zinc and copper status and the leptin system inhumans, we examined whether leptin concentrations in the mother and the newborncorrelate with the weight of mother, placenta and newborn. A total of 88 pregnantwomen at 38-42 weeks’ gestation were studied. All infants were categorized as smallfor gestational age (SGA) (n=16), average for gestational age (AGA) (n=59) or largefor gestational age (LGA) (n=13). Leptin, zinc, and copper levels were measured inmaternal and cord serum at birth. Maternal BMI and placental weight of the LGAgroups were significantly higher than those of the SGA and AGA groups. Cord andmaternal leptin levels of the SGA groups were significantly lower than those of theAGA and LGA groups. Maternal serum leptin levels were positively correlated withBMI and maternal zinc levels in all groups. Cord serum leptin levels of all groupswere positively correlated with birth weight and placental weight. Birth weight wasnegatively correlated with maternal and cord copper level of all groups. Umbilicalleptin concentrations of SGA newborns correlated with leptin concentrations of theirmothers. In all pregnancies, birth weight increases in association with increase in cordleptin level. Our results suggest that maternal zinc but not copper level has an effecton maternal serum leptin levels. The increase in copper level in both maternal andcord blood may contribute to restriction in fetal growth (AU)

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The role of cytoreductive surgery in nongenital cancers metastatic to the ovaries.

OBJECTIVE: To investigate the role of cytoreductive surgery in patients with nongenital cancers metastatic to the ovaries. PATIENTS AND METHODS: One hundred and fifty-four patients with nongenital cancers metastatic to the ovaries treated in Hacettepe University Hospital, Gynecologic Oncology Unit between 1982 and 2004 years were retrospectively evaluated. Data were obtained from patients' records and pathology reports. Demographic characteristics, prognostic factors, 5-year and median survivals were analyzed in all patients. RESULTS: During study period, nongenital cancers metastatic to the ovaries constituted 9% of all malignant ovarian neoplasms. Primary cancers were breast (35), stomach (35) and colorectal (33) cancers, lymphoma (17), undetermined origin (16), appendix (7), ileum (4), pancreas (3), gallbladder cancer (2) and mesothelioma (2). Of patients, 67% were premenopausal and 33% were postmenopausal. Although most common presenting symptoms were abdominal distension with dyspeptic complaints in 46%, abdominal mass in 22%, and pressure symptoms in 8.4%, 15 patients (10%) were asymptomatic and were diagnosed in routine control examinations. Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO), omentectomy, and bilateral pelvic and para-aortic lymphadenectomy (BP-PALND) with cytoreduction were performed in 102 patients (66%), TAH + BSO + omentectomy in 21 patients (14%), TAH + BSO in 23 patients (15%), minimal surgical effort including BSO or biopsy in 8 patients (5%). Eighty-four percent of patients received adjuvant treatment according to the primary origins. Mean follow-up was 47.3 +/- 5.9 months. Overall, 5-year survival was 36% and median survival was 42 months. Comparison of median survival times for the primary sites showed a significant overall differences (P = 0.0001) and were as follows: breast 54 months, stomach 18 months, colorectal 48 months, lymphoma 181 months, unknown primary 16 months, appendix 18 months, ileum 40 months, pancreas 3 months, gallbladder 8 months and mesothelioma 20 months. Median survival time of patients who underwent cytoreductive surgery was 48 months, compared with 26 months for patients with suboptimal cytoreductive surgery (P = 0.0039). The 5-year survival rate was 47% and 23%, respectively. Multivariate analysis identified age, menopausal status, primary site, diffuse peritoneal involvement and type of operation as prognostic factors. CONCLUSION: Presence of ovarian metastasis is associated with a poor prognosis in nongenital cancers. Surgery is essential for diagnosis of primary tumor and necessary for relief of symptoms. Cytoreductive surgery seems to have a beneficial effect on survival of selected patients, especially for patients with colorectal cancer metastatic to the ovary.

Predictors of outcome after in situ anterior vaginal wall sling surgery.

Pubovaginal sling procedures are being performed with increased frequency for stress urinary incontinence. The vaginal wall sling was introduced in 1989 by Raz et al., and its success rate has been reported as being 61%-100%. A number of recent studies have identified that some patient factors may influence the likelihood of a successful outcome. In the present study, we evaluated whether preoperative Valsalva leak-point pressure and urethral pressure profile can be used as predictors of success after surgery. We identified the preoperative characteristics of 58 women who underwent an isolated in situ anterior vaginal wall sling procedure by the same surgeon. Patients' ages, previous anti-incontinence procedures, hormone replacement status and previous hysterectomies were determined and patients underwent urodynamics, including cystometry, measurement of the Valsalva leak-point pressure and urethral pressure profile (maximal urethral pressure). After the vaginal wall sling procedure, success was defined as a significant improvement in stress urinary incontinence symptoms or no symptoms at all. The 58 women ranged from 41 to-71 years old (average 52.3) and average follow-up was 26 months (range 16-34). An anti-incontinence procedure had been done previously in 15% of cases. The success rate was 65.4% in patients with Valsalva leak-point pressure < 50 cmH2O and maximal urethral pressure < 30 cmH2O, but it was 90.6% in patients with Valsalva leak-point pressure 50 cmH2O or higher and maximal urethral pressure 30 cmH2O or more. Patients with Valsalva leak-point pressure 50 cmH2O or higher and maximal urethral pressure 30 cmH2O or more had a 90.6% success rate, and it was significantly higher than the success rate of patients with lower values for both parameters. We concluded that preoperative Valsalva leak-point pressure and maximal urethral pressure can be used to estimate the success rate of anterior vaginal wall sling procedures. When of these parameters are concurrently high, the outcome of surgery seems more favorable.

Survival and prognostic factors in patients with synchronous ovarian and endometrial cancers and endometrial cancers metastatic to the ovaries.

PURPOSE: To compare the survival and prognostic factors of patients with synchronous primary ovarian and endometrial cancers, and endometrial cancers metastatic to the ovaries. PATIENTS AND METHODS: Fifty-three patients with synchronous primary ovarian and endometrial cancer and 64 patients with endometrial cancer metastatic to the ovaries were evaluated. RESULTS: Mean follow-up time was 47.2 months (18-170 months). There was no statistical difference in age, gravidity and parity between the two groups. Abnormal vaginal bleeding was the most common symptom in both groups. All patients were subjected to a surgical staging procedure. Overall survival of the synchronous group was significantly higher than that of the metastatic group (98 +/- 12 vs 59 +/- 6 months; p = 0.048). The significant prognostic factors for synchronous cancers after multivariate analysis were age, stage of ovarian cancer, grade of endometrial cancer, and adjuvant therapy status. CONCLUSION: Patients with synchronous ovarian and endometrial cancers appear to have a good prognosis and should undergo primary surgical staging since the stage of tumors is a significant prognostic factor.

Beta-human chorionic gonadotropin and prolactin assays in cervicovaginal secretions as a predictor of preterm delivery.

OBJECTIVE: To evaluate and to compare the predictive value of cervicovaginal beta-hCG and prolactin levels in spontaneous preterm delivery. METHODS: The preterm labor group and normal pregnancy group consisted of 17 and 43 patients between 24 and 36 weeks' gestation, respectively. A single cervicovaginal beta-hCG and prolactin measurement were made in both groups. RESULTS: Cervicovaginal beta-hCG and prolactin levels were significantly higher in the preterm group when compared with those of the term delivery group (P=0.031, P=0.026, respectively). The optimal cut-off value for beta-hCG (27.1 mIU/ml) gave a sensitivity level of 87.5% (47.4-97.9; 95% C.I.) at a specificity of 65.4% (50.9-78.0; 95% C.I.) with positive and negative predictive values of 28% and 97%, respectively. The optimal cut-off value for prolactin (1.8 ng/ml) gave a sensitivity level of 50% (16.0-84.0; 95% C.I.) at a specificity of 96% (86.8-99.4; 95% C.I.) with positive and negative predictive values of 67% and 93%, respectively. CONCLUSIONS: Cervicovaginal beta-hCG measurement in patients with preterm labor may be used as a predictive test. Cervicovaginal prolactin is not a sensitive test compared with the beta-hCG test.

Unilateral massive ovarian edema in a woman with polycystic ovaries.

Massive ovarian edema is a rare cause of ovarian enlargement in young women. We report the case of a 20-year-old woman with unilateral massive ovarian edema with findings on ultrasound of an enlarged policystic ovary and pedicle arterial and venous blood flow observed with color and pulsed wave Doppler examination. Massive ovarian edema can be managed conservatively and blood flow in the pedicle of the ovary is detected by color and pulsed wave Doppler examination.

First-trimester diagnosis of Robinow syndrome.

We present 2 cases with Robinow syndrome in a nonconsanguineous Turkish couple. The first case, second living child of the family, has all of the cardinal features of this syndrome including short stature, mesomelic shortening of forearms, frontal bossing, hypertelorism, anteverted nares, triangular mouth, hypoplastic genitalia and vertebral and costal anomalies. The second case was diagnosed with first-trimester ultrasonographic findings such as shortening of extremities and increased nuchal translucency thickness at 12 + 4 weeks of gestation, and the family wished to terminate this pregnancy. After abortion, we obtained findings such as typical face features, shortening of forearms, ambiguous genitalia suggesting Robinow syndrome with autopsy examination.

Unilateral massive ovarian edema and polycystic ovaries. A case report.

Massive ovarian edema is a rare cause of ovarian enlargement in young women. We report a case in a 20-year-old woman with unilateral edema associated with the ultrasound appearance of polycystic ovary disease. Arterial and venous blood flow in the pedicle was observed with color and pulsed wave Doppler examination. Conservative management was successful.

Prevention of postoperative adhesion formation in rat uterine horn model by nimesulide: a selective COX-2 inhibitor.

BACKGROUND: Pelvic surgery is one of the main causes of intraperitoneal (i.p.) adhesions that create various medical problems including pelvic pain, bowel obstructions and female infertility. A rat model was used to investigate the efficacy of nimesulide, a selective cyclooxygenase-2 inhibitor, in the prevention of adhesion formation. METHODS: Fifty Wistar-Albino rats underwent bilateral uterine horn injury with a unipolar cautery. Study groups were as follows: (i) control group, no adjuvant therapy; (ii) i.p. Ringer's lactate group, 2 ml Ringer's lactate solution was instilled i.p.; (iii) i.p. Ringer's lactate plus nimesulide group, 1 ml Ringer's lactate plus 1 ml nimesulide (0.5 mg/ml) were given i.p.; (iv) intramuscular (i.m.) nimesulide group, 1 ml i.m. nimesulide (0.5 mg/ml) was given preoperatively for 5 days; and (v) i.p. nimesulide group, 1 ml nimesulide (0.5 mg/ml) was instilled i.p. At the end of the study all animals were killed, and a standard adhesion scoring system was applied by a blinded examiner. RESULTS: The mean adhesion extent in study groups was as follows: 1.33 +/- 0.76 in control group, 1.40 +/- 0.90 in i.p. Ringer's lactate group, 0.75 +/- 0.70 in i.p. Ringer's lactate plus nimesulide group, 0.25 +/- 0.44 in i.m. nimesulide group and 0.31 +/- 0.70 in i.p. nimesulide group. The mean +/- SD adhesion severities of control, i.p. Ringer's lactate, i.p. Ringer's lactate plus nimesulide, i.m. nimesulide, and i.p. nimesulide groups were 0.58 +/- 0.35, 0.30 +/- 0.41, 0.27 +/- 0.3, 0.12 +/- 0.28 and 0.15 +/- 0.35 respectively. The lowest adhesions were found in the groups treated with nimesulide i.m. and nimesulide i.p. ( P < 0.05). CONCLUSIONS: This study showed that preoperative i.m. or postoperative i.p. administration of nimesulide to the site of injury reduced the formation of postoperative adhesions in a rat uterine horn model.