The management of adnexal masses in premenopausal patients: a ten-year retrospective study at a single center.

PURPOSE OF INVESTIGATION: To distinguish adnexal masses as benign and malignant, and to thereby identity the suitable surgical method for these masses, in premenopausal women, by retrospectively evaluating over a ten-year period, the diagnostic parameters, such as serum CA 125 and transvaginal ultrasonography (TVS), in combination with the presence of ascites in the abdomen. MATERIALS AND METHODS: The study was conducted with 255 premenopausal patients diagnosed with adnexal masses who had been admitted to the Gaziantep University Faculty of Medicine, Clinic of Gynecology and Obstetrics, between January 2003 and January 2013. Data collected from these patients included age, menopausal state, information regarding the presence of ascites, ultrasound findings, and serum CA 125 levels. RESULTS: The mean age of the women included in the study was 32.79 ± 8.11 (range: 18-51) years. Based on the criteria mentioned above, 152 patients were treated by laparoscopy based on a strong suspicion of benign mass, while 103 patients were treated by laparotomy, based on a strong suspicion of malignant mass. CA 125 values did not have a significant effect on malignancy risk. Based on the TVS results, three malignant masses were reported postoperatively in the patient group strongly suspected to have benign masses, while five benign masses were reported postoperatively in the patient group strongly suspected to have malignant masses.An evaluation of the present diagnostic method showed that the TVS has a positive predictive value (PPV) of 94.19% in identifying malignant masses, and a negative predictive value (NPV) of 98.22% in identifying benign masses. CONCLUSION: TVS and CA 125, along with an evaluation of menopausal status and ascites, can be an effective approach for diagnosing adnexal masses, and also for determining the proper surgical method to follow.

Assessment of ß-hydroxydeoxyguanosine levels in patients with preeclampsia: a prospective study.

PURPOSE OF INVESTIGATION: To determine the levels of 8-hydroxydeoxyguanosine (8-OHdG) in preeclampsia (PE) using (enzyme-linked immunosorbent assay (ELISA) method. MATERIALS AND METHODS: Twenty-two pregnant women with severe PE, 18 pregnant women with mild PE, and 40 healthy pregnant women, all between 25 and 41 weeks of gestation, were enrolled in this prospective controlled study. 8-OHdG levels in maternal serum were measured using ELISA method. RESULTS: The authors observed no statistically significant difference in 8-OHdG levels between the mild-severe PE and control groups (p = 0.208). CONCLUSION: The present results do not support the concept that 8-OHdG has a role in the etiopathogenesis of PE.

Evaluation of sialic acid levels in patients with hydatidiform mole: a preliminary study.

PURPOSE OF INVESTIGATION: This study aims to investigate whether hydatidiform mole (HM) disease with malignant potential is significantly associated with increased sialic acid (SA) levels. MATERIALS AND METHODS: A total of 114 women were enrolled in this study. Patients were divided into three groups including HM (Group 1, n = 34), control group including non-pregnant healthy patients (Group 2, n = 42), and another control group including healthy pregnant patients within 12 weeks of gestation (Group 3, n = 38). Serum-free SA levels were measured. RESULTS: There was a statistically significant difference in serum-free SA levels among the groups (p ≤ 0.001). Patients with HM had significantly higher levels compared to the control groups. CONCLUSION: The present study results showed that there was a significant correlation between HM and serum SA level.

Do high levels of CA 19-9 in women with mature cystic teratomas of the ovary warrant further evaluation?

PURPOSE: To evaluate the serum levels of tumor markers (particularly CA 19-9) in patients with ovarian mature cystic teratomas (MCT) with respect to age, size, bilaterality, menopause, presence of adhesions, complications and the postoperative levels. METHODS: We evaluated clinical characteristics and tumor markers of 157 patients with MCT of the ovary operated at our clinic. RESULTS: CA19-9 was the only tumor marker with a mean serum level (46.95 +/- 101.11 U/ml) above the cut-off value and the elevated rate was 33.1%. Tumor size, presence of adhesions and CA 125 levels were significantly higher in patients with elevated CA 19-9. Bilaterality rate was 10.8%. The most common complication was torsion (6.4%). CONCLUSION: We suggest that elevated levels of CA 19-9 may be expected in MCTs of the ovary and that they will probably be decreased postoperatively. Therefore, postponing evaluation of other possible sources of CA 19-9 elevation in asymptomatic and young patients is more common sense.

Pitfalls in diagnosis and management of distal vaginal agenesis: 10-year experience at a single centre.

OBJECTIVE: To discuss common pitfalls in diagnosis and management of distal vaginal agenesis, and summarize 10 years of experience among 11 patients using an interposition full-thickness graft and fibrin glue. STUDY DESIGN: Eleven patients with distal vaginal agenesis were evaluated and managed with an interposition full-thickness graft to bridge the gap between the upper vagina and the introitus. Associated renal abnormalities and complications including infection, total lack of skin graft take, stress urinary incontinence, partial graft loss, vaginal stricture and graft uptake were all investigated. RESULTS: The mean age of the patients was 12.91 (standard deviation 1.22) years. All patients had primary amenorrhoea, cryptomenorrhea, and cyclical or constant pelvic pain. None of the patients had associated urological abnormalities, and there were no cases of infection, total lack of skin graft take, stress urinary incontinence, partial graft loss or vaginal stricture. Graft uptake was 100% in 10 of the 11 patients. Four patients have subsequently married and report a satisfactory sex life. CONCLUSION: Accurate diagnosis of distal vaginal agenesis and careful pre-operative set-up, including evaluation of associated anomalies, bowel preparation, available vaginal stents and a multidisciplinary approach for the potential need for grafts, may be key to success.

An analysis of hysteroscopy experience over a seven-year period.

PURPOSE OF INVESTIGATION: Over the years, hysteroscopy has been increasingly performed for various gynecological disorders. In this study, we present a review of hysteroscopic procedures performed over a 7-year period. METHODS: Five hundred and eighty hysteroscopic procedures performed at the Department of Gynecology and Obstetrics, University of Gaziantep, Turkey from 2002 to 2009 were reviewed particularly highlighting the preoperative indications, postoperative diagnoses and complications associated with the procedure retrospectively. RESULTS: The most common indication for diagnostic hysteroscopy was infertility followed by AUB. The most common pathologies for referal to operative hysteroscopy were uterine septum, endometrial polyps, Asherman's syndrome, submucous myomas, and other uterine anomalies. The complication rate was 0.86% of the total hysteroscopies. False passage and uterine perforation were the most common acute complications. No late complications occurred. CONCLUSION: Our data is consistent with reports from other studies supporting that hysteroscopy is a safe and effective minimally invasive procedure with a low rate of complications with certain surgical principles.

Good prognosis for primary ovarian pure nongestational choriocarcinoma using the EMA/CO regime.

Nongestational choriocarcinoma of the ovary is a rare germ cell tumor with a worse prognosis than gestational choriocarcinoma. In this report we present a case of nongestational chroriocarcinoma where the EMA/CO regime was applied. The clinical features, management, and outcome are discussed.

Uterine myoma in pregnancy: report of 19 patients.

PURPOSE OF INVESTIGATION: To evaluate the effect of pregnancy on uterine myoma and the effect of uterine myoma on the pregnancy prospectively. METHODS: Prospective evaluation of 19 pregnant women with uterine myomas was done between January 2005 and February 2008 at the Gynecology and Obstetrics Department Gaziantep University. The number and changes in size of the uterine myomas during pregnancy, and perinatal complications were documented. RESULTS: Totally 37 fibroids in 19 pregnant women were observed. Neither enlargement of myomas nor serious perinatal complications were observed. CONCLUSION: We suggest that in contrast with the general opinion there is not much effect of pregnancy on uterine myoma size, and most cases are not affected by the presence of uterine fibroids resulting in severe perinatal complications. Expectant management may be an option for uterine myomas determined before gestation.

A rare case of low-grade endometrial stromal sarcoma with myxoid differentiation and atypical bizarre cells.

Endometrial stromal sarcoma (ESS) is a rare mesenchymal tumor with characteristic histological appearances, consisting of diffuse infiltrate of small uniform endometrial stromal cells with a multinodular arrangement and distinct vascular pattern. Less common variants of ESS include "mixed endometrial stromal and smooth muscle tumors", "endometrial stromal tumors resembling ovarian sex cord tumors" and "endometrial stromal neoplasms with endometrial glands", and "aggressive endometriosis". Rarely do endometrial stromal tumors have a prominent fibrous or myxoid appearance which causes confusion and possible misdiagnosis as myxoid leiomyosarcoma. In this report we present a very unusual subtype of ESS in a 32-year-old woman. The tumor revealed atypical pleomorphic bizarre cells which were stained positive only with vimentin and CD10 in an abundant myxoid matrix. A low-proliferative rate was established with MIB-1 staining. To our knowledge such appearance has not been previously reported.

SodiumPhosphate (NaP) versus polyethylene glycol-electrolyte lavage solution (PEG-ELS) tolerability: a prospective randomized study in patients with gynecological malignancy.

PURPOSE: The aim of the study was to evaluate patient tolerability and compliance to two bowel cleansing agents (PEG-ELS and NaP) as well as to compare the cost effectiveness. METHODS: Three hundred and forty-three consecutive patients were randomized to receive either the standard 4 1 of polyethylene glycol and electrolyte lavage solution (PEG-ELS) or 90 ml of sodium phosphate (NaP). All patients were advised to be on a clear liquid diet one day before starting the bowel cleansing regimen and to take ornidazole orally (3 x 2 tablets) 24 hours before surgery. Patient tolerabilty and compliance to the regimens were assessed based on complaints of nausea, vomiting and the need of antiemetics. In addition completion of the regimens was evaluated in both groups. RESULTS: The need for antiemetics because of nausea and vomiting was statistically higher in the PEG-ELS group than the NaP group (p = 0.000). Regimen completion rate was statistically higher in the NaP group than in the PEG-ELS group (p = 0.000). NaP is more cost effective than PEG-ELS. CONCLUSION: NaP was rated superior to PEG-ELS in terms of patient tolerability, compliance, completion of the regimen and cost effectiveness and should be the first-choice treatment.

Adaptation process of the skin graft to vaginal mucosa after McIndoe vaginoplasty.

OBJECTIVE: There are many methods of treatment of vaginal agenesis. METHODS: In this study, patients who underwent McIndoe vaginoplasty were evaluated for development of vaginal mucosa. Vaginal pH measurements, smears, and punch biopsies were obtained from seven patients postoperatively at 3, 6, and 12 months after having McIndoe vaginoplasty. RESULTS: Neovaginal smears indicated no specific data for mucosal development at the 3rd and 6th month after the operation. However, Doderlein bacilli were determined at the 12th month. Histopathological examination of punch biopsies revealed dermal and subdermal thickening at the 3rd month, partial adaptation to mucosa at 6th month, and full adaptation to mucosa at 12th month. Also normal vaginal pH levels were recorded at the 12th month. CONCLUSION: As a result of the adaptation process, the split thickness skin graft acquired both histological and physiological characteristics of normal vaginal mucosa. Also, neovaginal epithelium was evaluated to be macroscopically similar to normal vaginal mucosa, 12 months after the operation.

Role of dietary habits on fetal anomaly development: review of 315 consecutive fetal anomaly cases.

OBJECTIVE: This study aimed to investigate and speculate on the dietary habits and certain environmental factors of the Southeast Anatolia region which are thought to be related with fetal anomaly development. MATERIALS AND METHODS: Patients admitted to Gaziantep University Faculty of Medicine Obstetrics and Gynecology Department with fetal anomalies between January 2003 and June 2007 were evaluated. Three hundred and fifteen patients with intrauterine fetal anomaly were detected. The number of total deliveries during this period were 7,554. Twenty-eight of the patients were above the age of 35. According to the history of patient, mean gravidity was 6.6 (1-13), consanguineous marriage rate was 25%, previous abnormal rate was 15%, and previous missed abortion was 35%. Eighty-eight percent of patients were of low sociocultural status. The frequency of daily dietary habits, especially tea consumption, red chili pepper consumption and eating barbecued meat were questioned with the anamnesis. RESULTS: Total fetal anomaly incidence was found to be 4.17%, neural tube defects 1.37%, renal anomalies 0.54%, non-immune fetal hydrops 0.46%, cystic hygroma 0.39%, central nervous system anomalies 0.36%, chromosomal anomalies 0.17%, gastrointestinal system anomalies 0.147%, sacrococcygeal teratoma 0.12%, cardiac anomalies 0.09%, and respiratory system anomalies 0.049%. Mean daily tea comsumption during pregnancy was 8 cups/day. Mean frequency of eating barbecued meat was 4 times/week. Mean chili pepper consumption was 10 g/day. CONCLUSION: In this study, four times higher overall fetal anomaly incidence appeared to be strongly correlated with Southeast Anatolia region's dietary habits. In the future monitoring women's dietary habits should have an important role in the prevention of fetal anomaly development.

Serum CA-125 is a good predictor of benign disease in patients with postmenopausal ovarian cysts.

AIM: To determine whether serum CA-125 levels, in addition to tumor size and ultrasonographic findings can help in differentiating benign ovarian cysts from malignant disease. METHODS: All postmenopausal women who had undergone explorative laporatomy for a preoperative diagnosis of an adnexal cyst between January 1999 and February 2006 were included if serum CA-125 levels were below 50 IU/ml. RESULTS: Ninety-three patients with ovarian cysts and serum CA-125 levels lower than 50 IU/ml were included. Seventy-five (80%) of the patients (53 unilocular, 22 multilocular) had ovarian cysts < 13 cm. Of 18 patients with ovarian cysts > 13 cm, seven had unilocular and 11 had multilocular cysts. All the patients (n = 77) with a serum CA-125 level < 35 IU/ml had benign histopathology regardless of the tumor size or ultrasonic features. Among 16 patients with CA-125 levels between 35 and 50 IU/ml, two with unilocular cysts > 13 cm and nine with multilocular cysts (3 < 13 cm, 6 > 13 cm) had borderline histopathology. CONCLUSION: We concluded that when unilocular ovarian cyst size is < 13 cm and serum CA-125 levels are below 35 IU/ml in a postmenopausal woman, the possibility of a benign etiology is most likely.

Effect of ascorbic acid on surgical stress response in gynecologic surgery.

Surgical stress may cause neural, endocrine, metabolic and humoral responses depending on the severity of the procedure. In this study, we aimed to study the effect of the preoperatively given ascorbic acid (AA), which is an antioxidant, and its role in the biosynthesis of neuropituitary hormones on the surgical stress response. Twenty-two American Society of Anaesthesiologists I and II patients ageing between 18 and 40, who have no endocrine and metabolic disease, and undergoing abdominal operation for non-malignant diseases were allocated to the study. These non-premedicated patients were divided into two groups in random: Group I, etomidate group; and Group II, AA plus etomidate group. AA was given to patients in Group II 20min before etomidate injection. After monitoring the patient, anaesthetic induction was applied by giving 0.3 mg/kg of etomidate, 2 microg/kg of fentanyl and 0.1 mg/kg of vecuronium. Anaesthesia was continued with 1-0.7% isoflurane and N2O/O2 (67 and 37%, respectively). Tramadol was given for the management of post-operative analgesia. Blood samples were obtained from all patients before the operation and at second, sixth, twelfth and twenty-forth hours after the beginning of operation for cortisol, adrenocorticotropic hormone (ACTH), osteocalcin, insulin and blood glucose level analyses. There was no statistically significant difference in cortisol, osteocalcin, insulin and glucose levels in both groups, when compared to the control levels. Whereas, patients in Group II had higher levels of cortisol than the control group at sixth hour, which were in normal limits, and there was no decrease in osteocalcin concentration. ACTH level was increased at the second and sixth hours, which was statistically significant, but at twelfth and twenty-forth hours, they were close to control group levels. As a result, we conclude that AA given before anaesthesia achieved by etomidate is not sufficient for the prevention of surgical stress response and that AA induction before anaesthesia should be preferred, particularly for the prevention of decrease in osteocalcin levels.

Changes in serum CA-125 levels after laparotomy?

There is no adequate data in the medical literature defining serum CA-125 levels after laparotomy. Therefore we designed this prospective study to evaluate the effects of laparotomy for hysterectomy on serum CA-125 levels. Ninety-four women (mean age 44.6 +/- 6.9 years) were included in the study between January, 2001 and April, 2003. Hysterectomies were performed in patients with chronic pelvic pain, dysfunctional uterine bleeding and myoma uteri. Mean serum CA-125 levels of the patients before and after laparotomy were 16.29 +/- 8.11 U/ml and 16.37 +/- 8.05 U/ml, respectively. The change in serum CA-125 levels prior to the operation was statistically insignificant when compared with the levels obtained at 24 hours after laparotomy (p > 0.05). We found that laparotomy for hysterectomy did not change the levels of CA-125 at the 24th hour after the operation, indicating either serum CA-125 levels are not correlated, at least within 24 hours, with peritoneal irritation or peritoneal irritation was minimal or absent in our operations.

Is there a change in serum CA-125 levels after laparoscopy?

There is no adequate data in the medical literature defining serum CA-125 levels after laparoscopy. Therefore we designed this prospective study to evaluate the effects of laparoscopy on serum CA-125 levels. Eighty-two women (mean age 34.2 +/- 12.30 years) were included in the study between January, 2001 and April, 2003. Laparoscopies were performed in patients with chronic pelvic pain, dysmenorrhea, infertility, ovarian cysts and for tubal ligation. Mean serum CA-125 levels of the patients before and after the laparoscopic procedures were 13.96 +/- 4.86 U/ml and 14.02 +/- 4.96 U/ml, respectively. The change in serum CA-125 levels prior to laparoscopy was statistically insignificant when compared with the levels obtained at 24 hours after laparoscopic procedure (p > 0.05). We found that diagnostic laparoscopy or laparoscopic surgical procedures did not change the levels of CA-125 at the 24th hour after laparoscopy indicating either serum CA-125 levels are not correlated, at least within 24 hours, with peritoneal irritation or peritoneal irritation is minimal or absent in our operations.

[Evaluation of the knowledge and attitude of obstetric patients on epidural analgesia]. / Epidural analjezi konusunda obstetrik hastalarin bilgi ve davranislarinin degerlendirilmesi.

Epidural analgesia (EA) is one of the most commonly used techniques in obstetric analgesia. Our objective was to evaluate patients who experienced EA during labour as well as to find out their knowledge, attitude and behaviour in this matter, prospectively. Between 1997 and 2002, a questionnaire, "patient evaluation form for EA", was delivered to 190 obstetric patients. The patients were divided into two groups. In Group I there were 100 patients who were evaluated between 1997 and 1999, and Group II was comprised of 90 patients who were evaluated between 2000 and 2002. Demographic data of the patients were similar in both groups. The question "How have you been informed about EA?" was replied as "TV or newspaper" by 50% of the patients in Group I while the answer was "from someone who experienced it before" by 60% of the patients in Group II (p < 0.01). With these information about EA, 30% and 40% of the patients in Group I were found out to be worried about neural paralysis and some possible disorders related to their babies, respectively. However, 40% of the patients in Grup II worried about back pain and headache (p < 0.01). As a result, considering the mother candidates' high information rate from someone who experienced EA before (60%), interest to the labour analgesia will increase as the mothers are satisfied with the results of EA.

Paclitaxel/carboplatin versus cyclophosphamide/carboplatin in peritoneal carcinomatosis of the ovary.

The preceding platinum-based combination chemotherapy could possibly reduce tumor masses, allowing for adequate surgical debulking in advanced ovarian cancer. In this study, a total of 18 patients with peritoneal carcinomatosis of the ovary were evaluated between 1996 and 2003. All patients underwent open biopsy for the histopathologic confirmation of ovarian tumor. Forty-one percent of the patients (8/18) were administered six cycles of carboplatin/cyclophosphamide (CP) and the rest were administered six cycles of paclitaxel/carboplatin (TP) as a neoadjuvant chemotherapy (10/18). After six cycles of chemotherapy metastases to the peritoneum, Douglas' pouch, diaphragm, and liver serosa were higher in the CP group than the TP group (p < 0.05). All patients also had a better performance status (WHO performance status 0 or 1), but no statistical difference was observed between either group (p > 0.05). Optimal debulking surgery rates were significantly higher in the TP group (p < 0.05). In conclusion, we suggest paclitaxel/carboplatin in peritoneal carcinomatosis of the ovary as a neoadjuvant chemotherapy. However, large prospective, randomized studies should be performed in patients with peritoneal carcinomatosis of the ovary.

Prolonged stabilization of platinum/paclitaxel-refractory ovarian cancer with topotecan: a case report and review of the literature.

A combination of a paclitaxel and platinum analog is currently the standard first-line chemotherapy for women with ovarian cancer, with response rates of 20-37%. As patients who relapse have a poor prognosis and treatment options are limited, there is an urgent need to develop new agents with novel mechanisms of action for use as a second-line, non-cross-resistant chemotherapy in ovarian cancer. In this report, we describe a patient with platinum/paclitaxel-refractory ovarian cancer who received topotecan and reached long-term stabilization of her disease. The patient was administered 1.5 mg/m2 topotecan for five days in 17 cycles. She was also given granulocyte colony-stimulating factor (G-CSF) support to prevent severe granulocytopenia; no hematologic toxic effect was experienced. Her quality of life was good throughout the treatment, and also her daily activities were unaffected.