Could soluble L1 cell adhesion molecule (sL1CAM) in serum be a new biomarker for endometrial cancer?

OBJECTIVES: The aim of this study is to evaluate the place of serum soluble L1 cell adhesion molecule (sL1CAM) level in the diagnosis of endometrial cancer and its relationship with clinicopathological features. MATERIAL AND METHODS: This cross-sectional study was performed with 146 patients who underwent endometrial biopsy and whose pathology results were reported as benign endometrial changes (n = 30), endometrial hyperplasia (n = 32) or endometrial cancer (n = 84). The sL1CAM level between the groups was compared. The relationship between clinicopathological features and serum sL1CAM was evaluated in patients with endometrial cancer. RESULTS: The mean serum sL1CAM level in patients with endometrial cancer was significantly higher than in patients without cancer. The sL1CAM value was statistically significantly higher in the group with endometrial cancer, than the group with endometrial hyperplasia (p < 0.001) and the group with benign endometrial changes (p < 0.001). There was no statistically significant difference in terms of sL1CAM between the group of patients with endometrial hyperplasia and the group of patients with benign endometrial changes (p = 0.954). sL1CAM value in type 2 endometrial cancer was statistically significantly higher than Type1 (p = 0.019). High sL1CAM level in patients with type 1 cancer was associated with poor clinicopathological features. However, no correlation was observed between clinicopathological features and serum sL1CAM level in type 2 endometrial cancers. CONCLUSIONS: Serum sL1CAM may be an important marker for evaluating the diagnosis and prognosis of endometrial cancer in the future. There may be a relationship between increased serum sL1CAM level in type 1 endometrial cancers and poor clinicopathological features.

Cervical versus endometrial injection for sentinel lymph node detection in endometrial cancer: a randomized clinical trial.

OBJECTIVE: To evaluate the relationship between pelvic/para-aortic sentinel lymph node status and two different injection sites of 99m-technetium (99mTc)-labeled phytate in patients with endometrial cancer. METHODS: This was a randomized controlled trial involving 81 patients with endometrial cancer. In the cervical group (n=40), injections of 99mTc were performed at the 3 and 9 o'clock positions of the uterine cervix. In the endometrial group (n=41), 99mTc was injected into the fundal endometrium using a transcervical catheter. Sentinel lymph nodes were detected through pre-operative lymphoscintigraphy and intra-operatively using a handheld gamma probe. All patients underwent complete pelvic and para-aortic lymphadenectomy procedures. Pathologic ultra-staging was performed with immunostaining for cytokeratin in sentinel lymph nodes after routine hematoxylin and eosin histological examinations. The primary endpoint was the estimation of detection rates, sensitivity, false-negative rates, negative predictive value, and analysis of the distribution of pelvic and para-aortic sentinel lymph nodes. RESULTS: The rate of detection of at least one sentinel lymph node, sensitivity, and the negative predictive value was 80%, 66.6%, 96.6% for the cervical group and 85%, 66.6%, 96.9% for the endometrial group, respectively. False-negative sentinel lymph nodes were detected in one patient from each group . There was no significant difference between the groups in terms of total sentinel lymph node count, sentinel pelvic lymph node count, and pelvic bilaterality, but the para-aortic sentinel lymph node count was significantly higher in the endometrial group (p<0.001). Ultra-staging examination of the pelvic sentinel lymph nodes revealed isolated tumor cells in one patient from each group. CONCLUSION: Transcervical endometrial tracer injection in endometrial cancer revealed similar pelvic but significantly higher para-aortic sentinel lymph node detection.

BCL-2 and PAX2 Expressions in EIN which Had Been Previously Diagnosed as Non-Atypical Hyperplasia.

The relationship between PAX2 and another anti-apoptotic gene, BCL-2, has been shown in a limited number of studies. The aims of this study are to investigate the value of PAX2 and BCL-2 expressions in lesions which have been defined as nonatypical hyperplasia in terms of detecting EIN and to evaluate the relations of these proteins in EIN. For this purpose, 108 cases of non-atypical endometrial hyperplasia diagnosed from 2006 to 2011 were re-evaluated. Immunohistochemical studies with PAX2 and BCL-2 were performed in 20 cases with EIN and 34 cases with benign hyperplasia. The mean BCL-2 immunohistochemistry scores of benign hyperplasia and EIN cases were 4.06 ± 1.04 and 4.63 ± 2.03, respectively. The mean BCL-2 score of EIN cases was significantly higher than benign hyperplasia (p = 0.021). The mean PAX2 scores of benign hyperplasia and EIN cases were 4.32 ± 1.07 and 2.19 ± 2.34, respectively. The mean PAX2 scores of EIN cases were significantly lower than benign hyperplasia (p = 0.001). BCL-2 expression was increased compared to normal endometrium in 66.7% of EIN cases, and PAX2 expression was decreased in 73.3%. Consistent with this, in 60% of cases, BCL-2 expression was increased compared to normal endometrium, while PAX2 expression was decreased. BCL-2 and PAX2 protein expression changes occur in early phases of endometrial tumorigenesis. These changes are often seen as a simultaneous increase in BCL-2 expression and decrease in PAX2 expression.

Malignant tumors associated with ovarian mature teratoma: A single institution experience.

OBJECTIVE: The aims of this study are to present demographical features of cases diagnosed with malignant tumor associated with ovarian mature teratoma and to analyze histopathological features and clinical follow up of these tumors. STUDY DESIGN: Single-institution retrospective charts were reviewed to identify all cases of ovarian mature teratoma diagnosed from 1998 to 2015. Clinicopathological parameters that were analyzed include age, tumor size, tumor stage, histological type, laterality, IOC diagnosis and whether or not patient has received adjuvant chemotherapy. RESULTS: A total of 218 ovarian mature teratoma cases were identified during the study period. Of the 218 ovarian mature teratoma specimens, eight (3.7%) exhibited malignant tumors. The average age for cases of malignancy associated with ovarian mature teratoma was 44.6 years. The average size of tumors was 10.36cm. On final pathology, histological types of tumors were as follows: two cases each of squamous cell carcinoma and papillary thyroid carcinoma; one case each of mucinous adenocarcinoma, metastatic adenocarcinoma, sebaceous carcinoma and oligodendroglioma. Only one patient with Stage IIB tumor died of disease. One patient was alive with metastatic disease two months after initial diagnosis. Mean and median follow-up times were 64.1 and 49 months, respectively. CONCLUSION: An ovarian mass that has characteristics of a teratoma in a postmenopausal patient should alert for malignancy -regardless of tumor size. IOC is a valuable tool for the detection of malignancy and should be requested to determine the modality of surgical approach.

Prediction of tumor grade and stage in endometrial carcinoma by preoperative assessment of sonographic endometrial thickness: Is it possible?

OBJECTIVE: To evaluate preopertive accuracy of endometrial thickness for assesment of histologic grade and stage of endometrial carcinoma and also determining a cut-off value for the determination of grade of endometrial carcinoma. MATERIALS AND METHODS: Clinical data of 105 patients who underwent surgical staging with endometrial carcinoma were reviewed retrospectively. Preoperatively endometrial thickness were recorded and correlated with pathologic information. RESULTS: A statistically significant correlation was found in between endometrial thickness and grade of the disease (r=0.746, p=0.001). Besides, no correlation was found between endometrial thickness and stage (r=0.153, p=0.119). The endometrial thickness at 9 mm revealed the optimal sensitivity and specificity (93.33 and 26.2, respectively) for turning through grade1 to grade 2 with 68.2% positive predictive value and 66.7% negative predictive value. We indicated the endometrial thickness at 27 mm as the optimal value with sensitivity and specificity (27.27 and 95.65, respectively) for turning through grade 2 to grade 3 with 66.7% positive predictive value and 77.5% negative predictive value. CONCLUSION: In conlusion, sonographic evaluation of the endometrial thickness is economical, simple and can be used as a prognostic tool for endometrial cancer grading. The operating team may have the chance to get prepared before the operation and may have the chance to inform the patient about the operation.

Effect of surgical staging on 539 patients with borderline ovarian tumors: a Turkish Gynecologic Oncology Group study.

OBJECTIVE: The objectives of this study were to examine demographic and clinicopathologic characteristics and to determine the effects of primary surgery, surgical staging and the extensiveness of staging. METHODS: In a retrospective Turkish multicenter study, 539 patients, from 14 institutions, with borderline ovarian tumors were investigated. Some of the demographic, clinical and surgical characteristics of the cases were evaluated. The effects of type of surgery, surgical staging; complete or incomplete staging on survival rates were calculated by using Kaplan-Meier method. RESULTS: The median age at diagnosis was 40 years (range 15-84) and 71.1% of patients were premenopausal. The most common histologic types were serous and mucinous. Majority of the staged cases were in Stage IA (73.5%). 242 patients underwent conservative surgery. Recurrence rates were significantly higher in conservative surgery group (8.3% vs. 3%). Of all patients in this study, 294 (54.5%) have undergone surgical staging procedures. Of the patients who underwent surgical staging, 228 (77.6%) had comprehensive staging including lymphadenectomy. Appendectomy was performed on 204 (37.8%) of the patients. The median follow-up time was 36 months (range 1-120 months). Five-year survival rate was 100% and median survival time was 120 months. Surgical staging, lymph node sampling or dissection and appendectomy didn't cause any difference on survival. CONCLUSION: Comprehensive surgical staging, lymph node sampling or dissection and appendectomy are not beneficial in borderline ovarian tumors surgical management.

Menstrual pattern and intrauterine adhesions after transuterine suture for postpartum hemorrhage.

OBJECTIVE: To describe menstrual abnormalities and intrauterine adhesions within 5 years after a transuterine compression suture and uterine devascularization with hypogastric ligation. STUDY DESIGN: Prospective clinical follow-up was conducted on 56 patients who underwent uterine devascularization with hypogastric ligation and transuterine suture. The main outcomes were to investigate intrauterine adhesions, menstrual pattern, and desire for subsequent pregnancy and fertility. RESULTS: Among 56 cases, abnormal placental implantation was diagnosed in 30 (53.6%) (Group 1), and uterine atony was diagnosed in 26 (46.4%) (Group 2). Before pregnancy, while 2/24 patients in Group 1 and 2/23 patients in Group 2 had menstrual irregularities, after pregnancy 8/24 patients in Group 1 and 9/23 patients in Group 2 had menstrual irregularities (p = 0.03 and 0.01, respectively). Hysteroscopic examination revealed normal findings in 16 patients in Group 1 (66.6%) and 20 patients in Group 2 (86.9%) (p > or = 0.05). Among patients who had desired a future pregnancy, 2 of 4 patients (50%) in Group 1 and 4 of 5 patients (80%) in Group 2 subsequently had achieved successful pregnancies. CONCLUSION: Transuterine compression suture and uterine devascularization with hypogastric ligation in managing postpartum hemorrhage appear to have achieved preserved fertility and, in most cases, menstrual regularity.

[In vitro biofilm formation and relationship with antifungal resistance of Candida spp. isolated from vaginal and intrauterine device string samples of women with vaginal complaints]. / Vajinal Yakinmasi Olan Kadinlarin Vajen ve Rahim Içi Araç Ipi Örneklerinden Izole Edilen Candida Türlerinin In Vitro Biyofilm Olusturma Özellikleri ve Antifungal Direnç ile Iliskisi.

Intrauterin device (IUD) application is a widely used effective, safe and economic method for family planning. However IUD use may cause certain changes in vaginal ecosystem and may disturb microflora leading to increased colonization of various opportunistic pathogen microorganisms. The aims of this study were (i) to detect the biofilm production characteristics of Candida spp. isolated from vaginal and IUD string samples of women with IUDs, and (ii) to investigate the relationship between biofilm production and antifungal resistance. A total of 250 women (mean age: 34.4 ± 7.6 years) admitted to gynecology outpatient clinics with vaginal symptoms (discharge and itching) were included in the study. The patients have been implanted CuT380a type IUDs for a mean duration of 59.8 ± 42.4 months. Without removing IUD, string samples were obtained by cutting and simultaneous vaginal swab samples were also collected. Isolated Candida spp. were identified by conventional methods and API 20C AUX (BioMerieux, Fransa) system. Minimal inhibitory concentrations (MIC) of fluconazole, itraconazole and amphotericin B were determined by broth microdilution method according to the CLSI guidelines. Biofilm formation was evaluated by crystal violet staining and XTT-reduction assays, and the isolates which yielded positive results in both of the methods were accepted as biofilm-producers. In the study, Candida spp. were isolated from 33.2% (83/250) of the vaginal and 34% (85/250) of the IUD string samples, C.albicans being the most frequently detected species (54 and 66 strains for the samples, respectively). The total in vitro biofilm formation rate was 25% (21/83) for vaginal isolates and 44.7% (38/85) for IUD string isolates. Biofilm formation rate of vaginal C.albicans isolates was significantly lower than vaginal non-albicans Candida spp. (14.8% and 44.8%, respectively; p= 0.003). Biofilm formation rate of C.albicans strains isolated from vaginal and IUD string samples were found as 14.8% (8/54) and 45.5% (30/66), with a statistically significant importance (p< 0.001). However, no statistically significant difference was detected for biofilm formation rates of non-albicans Candida spp. when sample types were considered [44.8% (13/29) and 42.1% (8/19), respectively; p> 0.05]. Fluconazole resistance was significantly higher in biofilm-producing vaginal Candida spp. than those of nonproducers (52.4% vs. 16.1%; p= 0.001), however, itraconazole resistance was found similar in biofilmproducer and non-producer isolates (47.6% vs. 32.3%; p> 0.05). Resistance rates for both fluconazole and itraconazole were higher in biofilm-producers (39.5% and 52.6%, respectively), than those of non-producers (10.6% and 29.8%, respectively), representing a statistical significance (p= 0.002 and p= 0.03, respectively) for Candida spp. strains isolated from IUD string samples. The overall resistance rates of C.albicans and non-albicans Candida spp. against fluconazole, were determined as 15% and 54.2%, respectively, while those rates were 24.2% and 68.7%, respectively, against itraconazole. MIC value of amphotericin B for all of the Candida spp. isolates was ≤ 1.5 µg/ml. In conclusion, the data obtained from this study revealed that Candida spp. May lead to vaginal infections by inducing biofilm formation in IUD strings and these biofilms may be related to resistance to antifungal agents. Thus, women using IUDs should be followed-up periodically for the development of biofilms in their IUD strings.

Pathological characteristics and clinical outcome of uterine leiomyomas associated with pregnancy.

Classification of a uterine smooth muscle neoplasm as benign or malignant is straightforward in most of the cases. During pregnancy, hemorrhage, necrosis and various degenerative changes can complicate the diagnosis. In this study, we examined the histological features, clinical behavior and proliferatively related markers in gestational leiomyomas removed during cesarean section. From 2005 to 2008, 53 pregnant patients with leiomyomas were submitted to cesarean section in our institute. Degenerative and atypical changes were detected in 42 leiomyomas (61.7%). Seven leiomyomas had extensive areas of necrosis. All necrotic foci appeared in the form of hyaline type or infarct type necrosis. Cellular atypia was mild and focal in 18 leiomyomas. Atypia was associated with hyaline type necrosis in 3 cases. Mitotic activity was very low (<5/10 HPF) in one but all of the cases. Within a median follow-up of 38 months, none of the patients in our study with follow-up information had any evidence of residual disease or recurrence. Morphological features of leiomyomas removed during pregnancy include extensive hyalin type necrosis, hemorrhage and focal cellular atypia. The pathological management of gestational uterine leiomyomas may be performed successfully with a multivariate diagnostic approach. The proper clinical management of leiomyomas needs further studies to clarify the etiology and pathogenesis of this common disease.

Primary malignant melanoma of the ovary: case report and review of the literature.

Ovarian malignant melanomas are extremely rare tumors. Most of them are secondary tumors and disseminated metastases are recognized at the time of diagnosis. Primary tumors are even more rare and usually associated with a teratoma. A 67-year-old female had a pelvic mass that was recognized on ultrasonography (USG) and physical examination. Intraoperative pathological consultation was reported as "pigmented solid ovarian tumor, probably compatible with malignant melanoma". Paraffin sections, and histochemical (Masson Fontana and Prussia blue) and immunohistochemical examination (S-100 and HMB-45) were also consistent with "malignant melanoma". This case was accepted as "Probably primary ovarian malignant melanoma" in lack of any other tumor focus on detailed clinical and radiological investigation, skin biopsies or pigmented lesions in medical history. It is reported for being an extremely rare tumor and its distinctive characteristics for differential diagnosis are emphasized.

Diagnostic accuracy of real-time 3D sonography in the diagnosis of congenital Mullerian anomalies in high-risk patients with respect to the phase of the menstrual cycle.

PURPOSE: To compare the diagnostic accuracy of 2-dimensional sonography (2DUS) and real-time 3-dimensional sonography (3DUS) in the diagnosis of congenital mullerian defects (CMD) with respect to the phase of the menstrual endometrium. METHOD: The accuracy of sonography was examined on 108 women by 2 gynecologists during the 1st 5 days after cessation of menstrual flow and then re-examined at the cycle days 20-24. Entrance criteria for the patients enrolled in the study were as follows: women who were referred to our center with a suspected Mullerian anomaly at hysterosalpingography, and women who were suspected to have a uterine anomaly at our hospital during infertility, dysmenorrhea, and recurrent abortion workup. First, 1 of the gynecologists performed the 2DUS, and afterwards the 2nd gynecologist performed the real-time 3DUS. Results from both examiners were compared and correlated with the definitive diagnosis obtained by MRI, laparoscopy, or hysteroscopy. The sensitivity and specificity values of 2DUS and real-time 3DUS for the diagnosis of CMD were calculated at follicular and luteal phases. RESULT: Among the 108 cases suspected to have CMD, the sensitivity and specificity values of real-time 3DUS were significantly higher in the follicular sensitivity, 94.7%, specificity, 75.0%, and luteal phases (sensitivity, 100%, specificity, 93.7%) when compared with 2DUS values (sensitivity of 30.2% and specificity of 78.1% in the follicular phase and sensitivity of 42.1% and specificity of 81.2% in the luteal phase). CONCLUSION: Real-time 3DUS is an accurate method that can be used for the diagnosis of congenital mullerian defects.

Reduction in caesarean delivery with fetal heart rate monitoring and intermittent pulse oximetry after induction of labour with misoprostol.

OBJECTIVE: To integrate intermittent fetal pulse oximetry (FPO) to intrapartum fetal assessment and reduce the rate of caesarean sections. METHODS: A randomised controlled trial using 37 weeks as a restriction point was conducted in 230 women induced with misoprostol. One hundred-fourteen were assessed with intermittent FPO plus fetal heart rate (FHR) monitoring (study group) and 116 were assessed with FHR monitoring alone (control group). The primary outcome measure was caesarean delivery rates. Secondary outcome measures included induction to delivery interval, number of emergency caesarean deliveries performed for fetal non-reassuring FHR patterns and neonatal outcomes. RESULTS: There was a reduction both in the overall caesarean deliveries (study n = 18, (15.7%); vs. control n = 31 (26.7%); p = 0.04), and the rate of caesarean deliveries performed for non-reassuring fetal status in the study group (study n = 11, (9.6%); vs. control n = 23 (19.8%); p = 0.03). Induction to delivery interval was similar in between the groups (759 +/- 481 min in group 1; vs. 735 +/- 453 min in group 2 respectively; p = 0.69). CONCLUSION: Intermittent FPO in misoprostol induced deliveries decreases both total caesarean rate and the caesarean rate due to non-reassuring FHR patterns.

Sublingual misoprostol 100 microgram versus 200 microgram for second trimester abortion: a randomised trial.

OBJECTIVES: To compare the efficacy of repeated doses of 100 microg vs. 200 microg misoprostol given sublingually for induction of second trimester abortion. METHODS: One hundred and sixty-two women at 15-22 weeks' gestation were randomized to receive every 2 h either 100 microg (group 1; n = 81) or 200 microg (group 2; n = 81) misoprostol sublingually. The primary outcome measure was the abortion rate within 24 h. The secondary outcome measures were the induction-abortion interval, the total misoprostol dose required, and side effects of the regimen. RESULTS: There was no significant difference between the two groups with regard to the abortion rates within 12 h (43.2% in group 1 vs. 48.1% in group 2; p = 0.52; relative risk [RR]: 0.81; 95% confidence interval [CI]: 0.4-1.5) and 24 h (92.6% in group 1 vs. 91.4% in group 2; p = 0.77; RR: 1.11; 95% CI: 0.37-3.6). The induction-abortion intervals in the two groups were of similar length (885 minutes in group 1 vs. 912 minutes in group 2; p = 0.72). When the total dose of misoprostol was compared between the two groups, women belonging to group 2 on average had received significantly more misoprostol than those in group 1 (1274 +/- 592 microg [7 +/- 3 doses] vs. 614 +/- 432 microg [6 +/- 4 doses], respectively; p = 0.000). CONCLUSIONS: Sublingual administration of repeated doses of 100 microg misoprostol for abortion induction appears to be equally effective to that of repeated doses of 200 microg.

The effects of maternal anxiety prior to amniocentesis on uterine and fetal umbilical blood flow.

OBJECTIVE: To investigate the mothers' anxiety levels and determine its effect on fetomaternal circulation in pregnant women undergoing genetic amniocentesis. MATERIAL AND METHODS: A prospective case-control study was conducted regarding the assessment of maternal anxiety levels by means of the Spielberger State-Trait Anxiety Inventory in 60 pregnant women having genetic amniocentesis and 60 control cases having their early second trimester ultrasonographic screening, 30 minutes before and immediately after the procedure. Additionally, maternal-fetal hemodynamic changes and Doppler ultrasonographic measurements of fetoplacental circulation were recorded in both groups. RESULTS: The maternal anxiety state scores were found to be significantly higher in the amniocentesis group (p<0.001). Maternal heart rate was significantly higher in the amniocentesis group (p<0.05), while the fetal heart rate was significantly lower (p<0.05) compared to the control group. Uterine artery Doppler measurements were comparable in the two groups but umbilical artery resistance index (p<0.05) and S/D ratio (p<0.05) were significantly higher in the amniocentesis group. Regression analysis revealed that the time which elapsed from offering amniocentesis until it was performed is the main predictor of fetal umbilical artery S/D ratio measured prior to amniocentesis in the amniocentesis group (ß=0.66, p<0.001) and maternal anxiety state scores (ß=0.04, p=0.003) are the main predictors of fetal umbilical artery S/D ratio measured prior to amniocentesis or ultrasonography in the two groups. The education of the patient in years decreased (ß=-0.13, p=0.04), while the amniocentesis procedure (ß=1.44, p=0.02) and the time which elapsed in days from offering amniocentesis or ultrasonography up to its performance (ß=0.41, p=0.04) increased the S/D ratio measured after the procedures. CONCLUSION: Our study provides the evidence that maternal anxiety and its duration has effects on the fetal blood flow. Early booking and patient support may help to overcome undesired consequences of an invasive prenatal procedure.

The efficacy, cost and patient satisfaction of classic versus office hysteroscopy in cases with suspected intrauterine space occupying lesions with 3-dimension ultrasound and abnormal uterine bleeding.

OBJECTIVE: The aim of this study is to compare the diagnostic efficacy, treatment effectiveness and cost of office hysteroscopy procedure with classic hysteroscopy in women suspected of having an intrauterine space occupying lesion, after being examined for abnormal uterine bleeding. MATERIAL AND METHODS: Among 544 cases admitted to our outpatient clinic due to abnormal uterine bleeding, 123 cases suspected of having an intrauterine space occupying lesion on 3D transvaginal ultrasound were included in the study. Patients were informed about classic and office hysteroscopy and asked to choose one of them. Fifty-seven cases preferred classic hysteroscopy and 66 cases preferred office hysteroscopy. The Visual analog scale was used to measure pain in office hysteroscopy cases while the Likert scale was used for patient satisfaction and cost was calculated in Turkish Lira. RESULTS: According to the histopathological examination, 65.9% of the cases (n=81) were diagnosed as polyp and 7.3% of the cases (n=9) were diagnosed as submucous leiomyoma. Mean operation time was 11±5.6 min. for office hysteroscopy and 42.6±18.4 min. for classic hysteroscopy (p<0.001). The level of pain before the operation was 0.3±0.1 (0-1), during the operation 2.8±2.5 (0-10) and after the operation 1.5±1.6 (0-8) in Office hysteroscopy cases. Among the Office hysteroscopy cases, 89.3% were very satisfied and 86.3% will advise other patients to have the procedure. Patients were evaluated at sixth month after the procedures and 92.4% of office hysteroscopy group and 96.4% of classic hysteroscopy group were symptom free. At sixth month of the office hysteroscopy procedure 83.3% of the cases were satisfied with the procedure and 81.8% would advice other patients to have the procedure. The mean cost of classic hysteroscopy was 3.6 times higher than the office procedure. CONCLUSION: Office hysteroscopy is a safe and satisfactory procedure for the patient and provides a fast "see and treat" option at a low cost as an out patient procedure without need for general anesthesia. It should be utilized as a first line diagnosis and treatment option.

The effect of copper intrauterine devices on the expression of mucin 1 and integrin ß1 in the luteal phase endometrium.

OBJECTIVE: To evaluate the effect of a copper intrauterine device on the expression of mucin- 1 (MUC1) and Integrin ß1 in the luteal phase endometrium. MATERIAL AND METHODS: 25 regularly menstruating women (25-35 years) who were willing to use copper intrauterine device contraception participated in this study. Endometrial sampling via a Pipelle canulla was performed on the 24(th) day of their cycle and repeated three months after insertion of TCu380A IUD. Immunohistochemical staining was performed for MUC1 and integrin ß1 in the endometrial sections. Staining intensity was graded under the conventional light microscope. RESULTS: The mean age of the study population was 32.8±5.3 years (25-35). MUC1 expression of the endometrial luminal epithelium cytoplasm and the luminal epithelium increased significantly after three months of IUD usage (p=0.01; p<0.001 respectively). Neither integrin ß1 expression of endometrial luminal epithelium cytoplasma nor of the endometrial stroma changed after three months of IUD usage (p=0.16; p=0.22 respectively). CONCLUSION: The increase of the embryo implantation inhibitor MUC1 synthesis may be responsible for the IUD's mechanism of action for pregnancy prevention. Integrin ß1 expression of the endometrial luminal epithelium cytoplasm and stroma are not affected by the use of copper IUD.

Fetal pulse oximetry: correlation with intrapartum fetal heart rate patterns and neonatal outcome.

AIM: To determine how fetal pulse oximetry behaves in various cardiotocographic (CTG) tracings and correlates with neonatal outcome. PATIENTS AND METHODS: Pregnant women undergoing active labor with singleton pregnancies of 32-42 weeks were enrolled. CTG recordings were reassuring or nonreassuring (namely variable or persisting late decelerations). Pulse oximetry values during labor and changing throughout deceleration and recovery phases, duration and frequency of pulse oximetry recordings <30%, and neonatal outcome were determined. One-way anova, Tukey test, chi(2)-test and multiple logistic regression model were used for statistical analysis where appropriate. RESULTS: A total of 156 pregnant subjects were divided into three groups: reassuring fetal heart rate (FHR) patterns (group 1, n=78 [50%]), late decelerations (group 2, n=16 [10.3%]) and variable decelerations (group 3, n=62 [39.7%]). The initial and final pulse oximetry readings, pulse values in first stage of labor, the duration and the frequency of pulse oximetry recordings <30% were significantly different between groups (P<0.001, P<0.001, P<0.001, P=0.001, P<0.001). Fetal acidosis was significantly more frequent with late decelerations (23.1%, P=0.004). A multiple logistic regression model demonstrated that the initial pulse oximetry value during active labor was the most predictive variable of neonatal well-being (P<0.001). CONCLUSION: Decreased fetal pulse oximetry values, especially prolonged and recurrent recordings <30% are well-correlated with abnormal FHR patterns, indicating an association with fetal compromise and metabolic acidosis. Going through active labor with a lower initial value of FSpO(2) more frequently leads to an altered FHR pattern and subsequent adverse fetal outcome.

Cranial thromboembolism secondary to patent foramen ovale and deep venous thrombosis after cesarean section.

BACKGROUND: Paradoxical embolism via a patent foramen ovale (PFO) is a rare event in the puerperium as a cause of stroke. CASE: We report a 21-year-old, G4P3A1 woman with the symptoms of convulsion, stroke and unconsciousness 1 week after cesarean delivery. An infarction was detected in both frontal lobes, and echocardiography and MRI confirmed the PFO. Her follow-up course with low-molecular-weight heparin and then warfarin for 6 months was uneventful. CONCLUSION: Patients with an unexplained arterial event should be screened for PFO and possible paradoxical embolism.

Leiomyoma on the septum of a septate uterus with double cervix and vaginal septum: a challenge to manage.

OBJECTIVE: To describe the first case of a leiomyoma localized in the septum of a septate uterus that had cervical duplication and a longitudinal vaginal septum. DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A 43-year-old patient with primary infertility and complaint of menorrhagia. INTERVENTION(S): Laparotomy, adhesiolysis, myomectomy, and resection of the vaginal septum in the first operation. Hysteroscopic resection of the complete uterine septum in the second operation. MAIN OUTCOME MEASURE(S): Magnetic resonance imaging findings and two-step repair of the anomaly. Cervical length at second trimester. RESULT(S): Restoration of normal anatomy was achieved after correct diagnosis and a two-step operation procedure. A normal cervical length was measured at 26 weeks of gestation. CONCLUSION(S): Large leiomyoma at rare localizations in the presence of uterine anomalies is a diagnostic challenge, but with available diagnostic technology and appropriate operations, successful results can be obtained.

Three-dimensional ultrasonographic diagnosis and hysteroscopic management of a viable cesarean scar ectopic pregnancy.

Implantation of conception material within a cesarean section scar is an extremely rare form of ectopic pregnancy with devastating complications, such as uterine rupture and intractable bleeding. Both 2-D and 3-D transvaginal ultrasonographic devices are used adequately for precise diagnosis, but there is still a lack of consensus concerning management strategies. No therapeutic modality is suggested to be entirely efficacious and safe for preserving uterine integrity. We present here a 29-year-old woman with vaginal bleeding and a gestational sac with a viable embryo of 6 weeks of age that was implanted in a cesarean section scar. Serum beta-hCG levels were 16 792 mIU/mL. Following an unsuccessful treatment course of systemic methotrexate, the patient underwent operative hysteroscopy. Minimally invasive hysteroscopic resection of the ectopic gestational mass without major complication appears to be an alternative therapeutic approach with minimal morbidity and preservation of future fertility.