The importance of ß-hCG values in prediction of the effectiveness of single dose methotrexate therapy in tubal ectopic pregnancy.

OBJECTIVES: To investigate the importance of ß-hCG values on the day of onset and on the fourth and seventh day after treatment in the effectiveness of treatment in tubal ectopic pregnancies treated with a single dose of methotrexate (MTX). MATERIAL AND METHODS: One hundred sixty-two patients with tubal ectopic pregnancy treated with a single dose MTX treatment were retrospectively evaluated. ß-hCG values and changes on Days 0, 4 and 7 of the MTX treatment successful group and the unsuccessful group were analyzed. RESULTS: MTX treatment was successful in 125 (77.2%) and unsuccessful in 37. When the ß-hCG values on Days 0, 4 and 7 were compared in pairs, the differences between groups were statistically significant (p < 0.001). The mean ß-hCG value was 783.0 in the MTX successful group and 1802.0 in unsuccessful group (p < 0.001). There was a 21.6% decrease in ß-hCG values between Days 0 and day 4 in the MTX successful group and a 25.7% increase in the MTX unsuccessful group (p < 0.001). On Days 0, 4 and 7, ROC curve analysis's values are , respectively; 755/939/486 for cut off, 86.49/83.78/94.59% for sensitivity and 48.80/69.60/72.36% for specificity. CONCLUSIONS: Success rates of single-dose MTX treatment increase in tubal ectopic pregnancies with low initial ß-hCG value. Patients with a decrease in ß-hCG value and/or a cut-off decrease of 20% or more on the fourth day of treatment can be called for weekly ß-hCG monitoring without the need for close follow-up. The change in ß-hCG between Day 0 and Day 4 can be used to predict the efficacy of treatment.

The predictive value of the first trimester combined test for gestational diabetes mellitus.

OBJECTIVES: To investigate the predictive importance of first trimester combined test markers pregnancy-associated plasma protein-A (PAPP-A), human chorionic gonadotropin ß (ß-hCG) and nuchal translucency (NT) for gestational diabetes mellitus (GDM). MATERIAL AND METHODS: Pregnant women which both first trimester combined test and GDM screening were performed during antenatal follow-up were included in this retrospective case-control study. The cases were divided into two groups as GDM screening positive and negative. Demographic, clinical and laboratory data of both groups were compared. Predictive tests were applied to the first trimester combined test data for the detection of GDM. RESULTS: A total of 378 patients, 171 (45.2%) in the control group and 207 (54.8%) in the GDM group. The age (control: 30.9 ± 5.2; GDM: 30.5 ± 5.1; p = 0.844) and NT (control: 1.254 ± 0.289; GDM: 1.319 ± 0.299; p = 0.074) data of the groups were statistically similar. MoM PAPP-A (GDM:0.967 ± 0.685; ontrol:1.191 ± 0.624; p < 0.001) and MoM f-ßhCG (GDM: 0.9 ± 0.602; control: 1.103 ± 0.746; p = 0.001) levels of the GDM group were lower than the control group. In the binary logistic regression model, MoM PAPP-A and MoM f-ßhCG variables were found to be effective on GDM. In the ROC analysis of these variables, the MoM PAPP-A (0.654) had the highest area under the curve. According to the optimum cut-off point (≤ 0.885) of the MoM PAPP-A, we found a sensitivity of 66.7% and a specificity of 65.50% for predicting GDM. CONCLUSIONS: Our study showed that serum PAPP-A and f-ßhCG MoM values, which are among the first trimester combined test parameters, can be used in the early pregnancy period for the prediction of GDM.

The Value of Preoperative CA 125 Levels in Prediction of Myometrial Invasion in Patients with Early-stage Endometrioid- type Endometrial Cancer.

AIM: To evaluate the relationship between pre-operative CA-125 levels and myometrial invasion in patients with early-stage endometrioid-type endometrial cancer. MATERIALS AND METHODS: Two-hundred and sixty patients were diagnosed with endometrial cancer between January 2007 and December 2012. Of these, 136 patients with stage 1 endometrioid histologic-type and documented pre-operative serum CA-125 levels were included in the study. Age, preoperative CA-125 level, histologic grade, surgical grade, and presence of deep myometrial invasion were recorded. Additionally, 16, 20, and 35 IU/ml cutoff values were used and compared to evaluate the relationship between pre-operative CA-125 levels and myometrial invasion. RESULTS: The average serum CA-125 level was 35.4±36.7 in patients with deep myometrial invasion, and 21.5±35.8 in cases without deep myometrial invasion. The relationship between the presence of deep myometrial invasion and CA-125 cut-off values (16, 20, 35 IU/ml) was statistically significant, although the correlation was weak (p<0.05). When the relationship between 16, 20 and 35 IU/ml CA-125 cut-off values and the presence of deep myometrial invasion was studied, specifity and sensitivity values were identified as: 0.60-0.68 for 16 IU/ml; 0.73-0.48 for 20 IU/ml; and 0.89-0.33 for 35 IU/ml. The sensitivity of 16 IU/ml cut-off value was higher when compared to other values. CONCLUSIONS: This study demonstrates that preoperative serum CA-125 values maybe used as a predictive test in patients with early stage endometrioid-type endometrium cancer, and as a prognostic factor alone. Further studies should be conducted to identify different CA-125 cut-off values in patients with low risk endometrial cancer.

Impact of prognostic factors on survival rates in patients with ovarian carcinoma.

PURPOSE: The aim of the present study was to invesitigate the impact of significant clinico-pathological prognostic factors on survival rates and to identify factors predictive of poor outcome in patients with ovarian carcinoma. MATERIALS AND METHODS: A retrospective chart review of 74 women with pathologically proven ovarian carcinoma who were treated between January 2006 and April 2011 was performed. Patients were investigated with respect to survival to find the possible effects of age, gravida, parity, menstruel condition, pre-operative Ca-125, treatment period, cytologic washings, presence of ascites, tumor histology, stage and grade, maximal tumor diameter, adjuvan chemotherapy and cytoreductive success. Also 55 ovarian carcinoma patients were investigated with respect to prognostic factors for early 2-year survival. RESULTS: The two-year survival rate was 69% and the 5-year survival rate was 25.5% for the whole study population. Significant factors for 2-year survival were preoperative CA-125 level, malignant cytology and FIGO clinical stage. Significant factors for 5-year survival were age, preoperative CA-125 level, residual tumor, lymph node metastases, histologic type of tumor, malignant cytology and FIGO clinical stage. Logistic regression revealed that independent prognostic factors of 5-year survival were patient age, lymph node metastasis and malignant cytology. CONCLUSIONS: We consider quality registries with prospectively collected data to be one important tool in monitoring treatment effects in population-based cancer research.

Anatomical and functional assessment of anterior colporrhaphy versus polypropylene mesh surgery in cystocele treatment.

OBJECTIVE: To compare the anatomical and functional results of traditional anterior colporrhaphy and polypropylene mesh surgery in cystocele treatment. STUDY DESIGN: Prospective study conducted in the Urogynecology Clinic of Etlik Zubeyde Hanim Maternity and Women's Health Teaching and Research Hospital between June 2006 and February 2007. Forty patients with stage II and III cystocele according to the Pelvic Organ Prolapse Quantification system were allocated by a computer programme to conventional or mesh surgery. Twenty patients each underwent anterior colporrhaphy (group I) or polypropylene mesh (Sofradim(®), Parieten) surgery (group II). Both groups were followed for 12 months. RESULTS: At the end of the 12th month, anatomical cure rates were 15/20 (75%) and 19/20 (95%) in groups I and II, respectively, and the difference between the two groups was statistically significant (p<0.05). De novo stress urinary incontinence developed in one patient in group I. Mesh erosion developed postoperatively in three cases (15%). CONCLUSION: In terms of anatomical cure rates, polypropylene mesh surgery was the more successful treatment option when compared with anterior colporrhaphy at the end of 1 year follow-up.

Preoperative serum CA 125 level in the prediction of the stage of disease in endometrial carcinoma.

OBJECTIVE: To evaluate whether a preoperative serum CA-125 level in patients with endometrial carcinoma can provide additional information in determining the stage of disease, and which cutoff value is optimal in this respect. STUDY DESIGN: Retrospective chart review of 147 women with pathologically proven endometrial carcinoma who were treated between January 1999 and May 2009. The associations of preoperative CA-125 levels with the tumor stage, histologic type and grade, and the lymph node positivity were examined. To determine the values of cutoff point levels for serum tumor marker CA-125, the levels of 20 IU/ml and 35 IU/ml were compared. RESULTS: High CA-125 levels significantly correlated with advanced stage and lymph node metastases. The ROC curve determined that the best cutoff value was 20 U/ml. The sensitivity and specificity of a CA-125 cutoff level of 20 U/ml were 75% and 69.51%, respectively, with a positive predictive value of 80.6% and negative predictive value of 84.9%. CONCLUSION: The current study suggests that measurement of preoperative CA-125 is a clinically useful test in endometrial carcinoma patients. CA-125 appears to be a significant independent predictor of the advanced stage of the disease as well as lymph node metastases. The results complement a growing body of literature that supports the relationship between CA-125 level and stage of disease but more studies are needed to establish the appropriate cutoff level for serum CA-125 in this respect.

Efficacy of electrosurgical bipolar vessel sealing for abdominal hysterectomy with uterine myomas more than 14 weeks in size: a randomized controlled trial.

OBJECTIVE: To compare electrosurgical bipolar vessel sealing with conventional suturing during abdominal hysterectomy. METHODS: This was a randomized controlled prospective study. A total of 88 patients with myoma uteri larger than 14 weeks in size were divided into two groups: group A (44 patients who were administered the LigaSure vessel sealing system during surgery) and group B (44 patients who were administered conventional sutures during surgery). Total abdominal hysterectomy was performed in all patients. Hemoglobin reduction, operation time, hospital stay and visual analogue scale parameters of patients in both groups were compared. SPSS 16.0 was utilized in statistical analyses. The outcomes with a 95% confidence interval and a p value of less than 0.05 were regarded as significant. RESULTS: When the two groups were compared, it was observed that the LigaSure device significantly reduced the operation time (p < 0.05). Nevertheless, no statistically significant difference was determined in hemoglobin reduction, hospital stay and visual analogue scale parameters between the two groups. CONCLUSION: In myoma uteri cases larger than 14 weeks in size, LigaSure vessel sealing is a secure and comfortable method for surgeons to achieve shorter operation times in abdominal hysterectomy.

Cofactors in human papillomavirus infection and cervical carcinogenesis.

OBJECTIVE: This study aimed to identify the effect of various risk factors as the promoters of HPV infection, and to identify which HPV-positive women may have an increased risk of developing cervical cancer. METHODS: Smear preparations were examined and classified according to the Bethesda system. HPV-DNA detection and genotyping was carried out using polymerase chain reaction combined with reverse hybridization line-probe assays. Age, smoking habit, age at first sexual intercourse, number of sexual partners, number of term births, contraceptive method, progesterone therapy, history of sexually transmitted diseases, history or existence of warts and existence of cervical infection were recorded. RESULTS: 642 women (96 women with abnormal cervical cytology and 546 women with normal cytology) provided cervical samples. Smoking habit, number of sexual partners, number of term births, history of sexually transmitted diseases, history or existence of warts and existence of cervical infection were identified as the promoters of HPV infection. History of sexually transmitted diseases, history or existence of warts and existence of cervical infection were identified as cofactors affecting progression from HPV infection to cervical cancer. Neither of contraceptive methods studied was related to HPV infection or coexistence with malign transformation to cervical cancer. CONCLUSION: Information gathered from this study could be used to prioritize limited screening and treatment services to woman who have specific characteristics that may put them at an increased risk of HPV infection. Additionally, by identifying which women have a higher risk of cervical cancer; it may be possible to reduce the number of unnecessary colposcopies.

Comparision of Burch colposuspension and colporraphy anterior-Kelly plication operations for effectiveness and influence on life quality.

OBJECTIVE: Our aim was to compare the effectivenesses and influences on life quality rates of patients who underwent Burch Colposuspension or Colporaphy Anterior-Kelly Plication for the surgical treatment of stress urinary incontinence (SUI). MATERIALS AND METHODS: 81 patients who applied to Izmir Ataturk Training and Research Hospital 3rd Obstetrics and Gynecology Department between the dates of January 2006 and June 2007 with complaints of urinary leakage and were diagnosed as SUI were included to our study. 41 patients (50.6%) underwent Burch colposuspension and ColporaphyAnterior-Kelly Plication were applied to 40 patients (49.4%). Patients were reexamined after 6 months following discharge in terms of complications, stress test, patient complaints and life quality scores. RESULTS: The mean age of patients as well as the number of postmenauposal ones who underwent Colporaphy Anterior-Kelly Plication was significantly higher (p < 0.05). The difference of hospitalization was statistically insignificant between two groups (p = 0.413, p > 0.05). Also the differences for the 6th month postoperative stres test results were statistically insignificant (p > 0.05). Life Quality Inqury results differences were statistically insignificant (p > 0.05). Preoperative and postoperative scores of the patients were compared and convalescence was detected. This convalescence was statistically significant for each three tests (p < 0.05). DISCUSSION: In this study the success rates were 87.8% for the Burch procedure and 75% for Colporaphy Anterior-Kelly Plication. all of the patients had benefited from both operations according to life quality inquries. Besides the fact that the Burch procedure is the gold standart for SUI Colporaphy Anterior-Kelly plication might be chosen for the older patients with pelvic organ prolapse (POP). There were no significant differences in terms of complications. The results of our study were consistent with those of other publications. Currently Burch operation is the gold standard treatment modality for SUI. Use of life quality inquries proved to be useful in patients' convalescence follow-up.

Urinary ascites following total abdominal hysterectomy.

Intraperitoneal urinary bladder perforation should be in differential diagnosis of acute renal failure soon after gynecological surgery. We present a case of massive urinary ascites and acute renal failure in a patient who presented 1 week after a total abdominal hysterectomy for simple endometrial hyperplasia. Biochemical features of uremia occur as a result of intraperitoneal extravasation of urine from urinary bladder and reabsorbtion through the peritoneum. Since those were the doctors who first diagnosed the patient, nephrologists performed dialysis therapy. After that long interval urinary catheterization of the patient had been applied. Without surgical repair and with long interval uretral catheterization primary dramatic resolution was seen as we expected. Nephrologists and gynecologists should be aware of this condition since pseudorenal failure which may resolve without dialysis might be seen due to intraperitoneal uinary bladder rupture following gynecological operations.

Prevalence and risk factors for human papillomavirus DNA in cervical cytology.

OBJECTIVES: This study aimed to detect the presence and prevalence of HPV-DNA in the cervical swab samples obtained from patients with cervical cancer, premalignant cervical lesions and benign cervical smear results, and to identify the potential risk factors influencing this prevalence. STUDY DESIGN: Smear preparations were examined and classified according to the Bethesda system. HPV-DNA detection and genotyping was carried out using polymerase chain reaction combined with reverse hybridization line-probe assays. Age, smoking habit, age at first sexual intercourse, number of sexual partners, number of term births, contraceptive method, progesterone therapy, history of sexually transmitted diseases, history or existence of warts, existence of cervical infection and the history of circumcision of male sexual partners were recorded. RESULTS: Six hundred and forty-two women (96 women with abnormal cervical cytology and 546 women with normal cytology) provided cervical samples. Multiplex PCR testing revealed that prevalence of HPV-DNA was 38.9% in our study population. HPV-DNA was detected in 78.3% of the women with cervical cancer and 76.9% of the women with HGSIL. Abnormal cervical cytology was observed in 30% of HPV-DNA positive cases and in 5.4% of HPV-DNA negative cases. Our findings also indicate that smoking habit, number of sexual partners, history of sexually transmitted diseases, and abnormal cervical cytology were associated with HPV infection. With respect to parity, there was a decreased risk of HPV infection with the increase in the number of births. CONCLUSIONS: Estimates of the prevalence of HPV infection vary greatly around the world, so the factors that contribute to the rare occurrence of cervical cancer after HPV infection might also differ from country to country. Information gathered from this study could be used to prioritize limited screening and treatment services given to woman who have specific characteristics that may put them at an increased risk of HPV disease.