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OBJECTIVE: The aim of this study is to evaluate the outcomes of gonadotropin-releasing hormone agonist treatment for ovarian cysts, which are developed during tamoxifen use due to breast cancer. STUDY DESIGN: This was a retrospective cohort study including the patients who were under tamoxifen treatment due to stage I-III breast cancer and who were administered leuprolide acetate for ovarian cysts with low malignancy risk between 2012-2020. RESULTS: Leuprolide acetate was administered to a total of 16 patients with ovarian cysts. The median age was 39.5 (33-52), the median size of the ovarian cyst was 42.5 (39-79) mm, and the median duration of tamoxifen use was 22 (7-36) months. Leuprolide acetate was administered at doses of 3.75 mg for 1 month at 10 (62.5%) patients, 7.5 mg in two months at 3 (18.75%) patients, and 11.25 mg in three months at 3 (18.75%) patients. Ovarian cysts were regressed after treatment at 13 patients, while 3 patients underwent surgery. CONCLUSION: Leuprolide acetate can be used as an option in the treatment of ovarian cysts that develop in breast cancer patients under tamoxifen therapy. [ABSTRACT FROM AUTHOR]

Non-endometrioid endometrial carcinoma seems to be less common with a poor prognosis. Due to the lack of standard treatment options and worse survival rates of non-endometrioid endometrial carcinoma, we aimed to investigate these patients inclusively. In total, 492 women with endometrial cancer who were treated in a gynecologic oncology center were examined. Patients with a final histopathologic diagnosis of non-endometrioid endometrial carcinoma were evaluated in respect of demographic characteristics, prognostic aspects, and survival outcomes. We identified 94 patients with the histopathologic results of non-endometrioid endometrial carcinoma. The performance of the systematic lymphadenectomy and adjuvant treatment rate were 96.9% and 92.6%, respectively. Recurrence of the disease was detected in 32 (34%) women and disease-related mortality occurred in 28 (29.8%) women. Multivariate Cox proportional regression analyses determined tumor size, adnexal involvement, and lymphovascular space invasion as independent predictors of overall survival. Larger tumor size, adnexal, and lymphovascular space invasion are important factors in determining prognosis in non-endometrioid endometrial carcinoma patients according to our findings. Besides, high rates of surgical staging and adjuvant chemotherapy and radiation therapy may contribute to improved survival outcomes; in addition to having potential advantages of providing prognostic information. Therefore, a multidisciplinary therapeutic approach should be planned from the early stages for all patients in this group. Nevertheless, comprehensive prospective studies are necessary to optimize the treatment strategies and support successful treatment modalities. [ABSTRACT FROM AUTHOR]

Introduction: To assess the rate of disease control and survival after adjuvant treatment in patients with uterine papillary serous (PSC) and clear cell carcinoma (CCC) and compare the results between these two subtypes. Methods: The medical charts of 199 patients with de novo uterine PSC or CCC who underwent radiotherapy (RT) following surgery between 2001 and 2019 in three radiation oncology departments were retrospectively evaluated. Adjuvant treatment was decided by a multidisciplinary tumor board. All patients were planned to undergo adjuvant 4–6 cycles of chemotherapy with external beam RT (EBRT) and/or vaginal brachytherapy (VBT). Results: Median age was 63 years for all, 64 years for PSC, and 59 years for CCC, respectively. Complete surgical staging was applied in 98% of patients. Histopathologic subtype was PSC in 142 (71%) and pure CCC in 57 (29%) patients, respectively. FIGO stage was I in 107 (54%), II in 35 (18%), and III in 57 (28%) patients, respectively. Lympho‐vascular space invasion and positive peritoneal cytology (PPC) were present in 42% and 10% of patients, respectively. All patients but 23 (12%) underwent adjuvant chemotherapy. Median follow‐up was 49.5 months for all patients, 43.9 months for patients with PSC, and 90.4 months for patients with CCC, respectively. During follow‐up, 20 (10%) patients developed pelvic recurrence (PR) and 37 (19%) developed distant metastasis (DM). PSC subtype increased the PR and DM rates, although the latter not statistically significant. The 5‐year overall survival and disease‐free survival rate was 73% and 69% for all patients, 71% and 66% for patients with PSC, and 77% and 75% for patients with CCC, respectively. The difference was more prominent in patients with stage ≥ IB disease. In multivariate analysis, advanced age and PPC significantly decreased all survival rates. Conclusion: PSC has a worse prognosis than CCC with regard to pelvic and distant recurrence with a trend for decreased survival rates. Therefore, a more aggressive therapy is needed for patients with uterine PSC, particularly in patients with stage ≥ IB disease. [ABSTRACT FROM AUTHOR]

Our goal was to address the safety of major gynaecologic cancer surgery without routine preoperative COVID-19 testing in the COVID-19 era. The databases of seven gynaecologic cancer centres were searched in order to identify all consecutive gynaecologic cancer patients undergoing major surgery between March 11, 2020 and May 15, 2020 for this retrospective, case-control study. The case group consisted of patients with histopathologically confirmed gynaecologic cancers, and each case was matched with two counterparts who had undergone primary surgery before the COVID-19 pandemic. The case and the control groups were compared in terms of length of hospital stay, admission to the intensive care unit (ICU), intraoperative and postoperative complications. During the study period, 154 women with gynaecologic cancer undergoing major surgery were identified. Although the case group had more co-morbidities compared to the control group (103/154 vs. 178/308, respectively; p =.04), the median length of hospital stays, the rate of ICU admission, intraoperative complication rates and postoperative complication rates were similar in the two groups. Gynaecologic cancer surgery may be performed safely in the COVID-19 era with similar rates of ICU admission, intraoperative and postoperative complications compared to the patients operated before the COVID-19 pandemic. What is already known on this subject? Many societies have announced their guidelines about the surgical management of gynaecologic cancer patients during the COVID-19 pandemic. However, most of them are not evidence-based and mostly on expert opinions. What do the results of this study add? The main findings of this retrospective, case-control study indicate that the short-term (30 day) outcomes of gynaecologic cancer patients undergoing major surgery in the COVID-19 era are similar to those who had been operated before the COVID-19 pandemic. The length of hospital stays, the rates of admission to the ICU, intraoperative and postoperative complications were comparable between women undergoing major gynaecologic cancer surgery in the COVID-19 era and the women who had been operated before the pandemic. What are the implications of these findings for clinical practice and/or further research? We can suggest that definitive surgery may be performed for gynaecologic cancer patients in the COVID-19 era if the resources permit and appropriate precautions such as social distancing, isolation and the use of personal protective equipment are taken. [ABSTRACT FROM AUTHOR]

To investigate the effect of coffee consumption on bowel motility on postcaesarean patients. This study is designed as a prospective randomized trial. Patients who are operated between dates June 2017-July 2017 are assessed for eligibility. We included patients who are operated under elective conditions. Leading exclusion criterias were; emergency caesarean section, patients diagnosed with inflammatory bowel disease, chronic constipation, irritable bowel syndrome and who had previous bowel or endometriosis surgery. Simple randomization scheme is used. Patients allocated to intervention group drank 65 cc Turkish coffee at postoperative 4 th and 12 th hour; control group patients drank warm water starting from postoperative 4th hour. Time to first flatus, presence of stool passage and nausea, vomiting are questioned and recorded. Sixty five patients' data was available for final analysis. General characteristics of control and intervention group patients were similar regarding mean age, body mass index (BMI), operation time, type of anesthesia, postoperative analgesic requirement . Mean time to first flatus was 17.7±6.1 and 13.0±5.7 hours respectively for control and intervention group (p:0.004). Number of patients whose stool passage assured before discharge were 7 (22.6%) in control and 3 (8.8%) in intervention group (p:0.174). There was not any patient who had nausea and vomiting in both groups. Postoperative coffee consumption is a cheap, attainable and safe practice that can be utilized to expedite gastrointestinal motillity during postcaesarean period. [ABSTRACT FROM AUTHOR]

To investigate the postoperative pain intensity after laparoscopic gynecologic surgeries conducted with different pneumoperitoneal pressures. This study was designed as a single-blinded prospective randomized trial in a tertiary referral center. Patients who were scheduled to undergo laparoscopic surgery for benign gynecologic pathologies between dates August 2018 and December 2019 were included. Exclusion criterias were ; malign gynecologic diseases, lack of consent and conversion to laparotomy. Primary outcome measure was postoperative pain scores at 6th and 24th hour time point ; secondary outcome measures were shoulder tip pain and need for opioid type analgesic. The initial and intraoperative pressure for group 1 was 15 mm Hg, the initial pressure was 15 mm-Hg and intraoperative pressure was 12 mm Hg for group 2, and the initial and intraoperative pressure was 12 mm Hg for group 3. Visual analog score (VAS) surveys were performed in postoperative follow-ups for the 6th and 24th hours. The presence of shoulder tip pain and the postoperative opioid analgesic requirement was additionally evaluated. One hundred and seventy-one patients were investigated for per-protocol analysis. The mean 6th and 24th-hour VAS scores of the three study groups were 4.9;3.5; 5.0;4.1, and 5.3;4.3 respectively, for groups 1, 2, and 3 (p=0.506). The difference in shoulder tip pain rates was not statistically significant at each time point between the patient groups (p=0.829 and p=0.334, respectively). Opioid analgesic requirement was significantly higher in patients undergoing laparoscopic hysterectomy with 15 mm Hg intraabdominal pressure (p=0.004). Surgeons should take into account that high intraperitoneal pressures may cause more opioid analgesic requirement. Although pain scores and shoulder tip pain were comparable, opioid analgesic requirement is an important health issue. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of the study was to investigate the prognostic factors of the elderly group and their effects on survival by examining the histopathological features, surgical treatment protocols, and treatment modalities of patients diagnosed with endometrial cancer (EC). METHODS: The records of 397 EC patients who completed their treatment and follow-up at a single center between 2012 and 2019 were evaluated retrospectively. The patients were evaluated in two groups as <70 years old (n: 301; 75.8%) and >70 years old (n: 96; 24.2%). Following the evaluation of histopathological features and treatment protocols, independent risk factors influencing survival were investigated with the Cox regression model. RESULTS: The incidence of non-endometrioid histology (16.3% vs. 32.3%, p: 0.001), high-grade tumors (50.5% vs. 69.8%; p: 0.001), and >50 myometrial invasion (19.6% vs. 36.5%, p: 0.003) in the >70 age group was more frequent than that in the <70 age group. The independent risk factors on overall survival in the >70 age group were determined as non-endometrioid histology (HR: 5.9; 95% CI: 1.4-24.7) and lymph node metastasis (HR: 6.4; 95% CI: 1.6-25.0). In the <70 age group, non-endometrioid histology (HR: 11.3; 95% CI: 4.0-32.0) was identified as the only independent risk factor affecting 5-year survival. CONCLUSION: EC, with non-endometrioid histology, which is observed at a higher rate in elderly patients despite equal surgery and adjuvant therapy, is the primary factor that affects survival. [ABSTRACT FROM AUTHOR]

To examine the histopathological features and treatment modalities in patients with uterine sarcoma according to subgroups (uterine leiomyosarcoma, low grade/high grade endometrial stromal sarcoma, adenosarcoma, undifferentiated uterine sarcoma) and to determine the factors affecting mortality rates. We retrospectively evaluated patients diagnosed with uterine sarcoma in our center between March 2012 and December 2019. We compared the clinicopathological characteristics and treatment modalities of the subgroups and investigated the factors affecting mortality rates using logistic regression analysis. There was no difference between the subgroups in terms of age, body mass index, menopausal status, comorbidity, presenting complaint, primary diagnosis, surgical treatment protocol, adnexal and lymph node involvement and tumor size (p> 0.01). However, there were higher rates of hormone therapy administration in the low grade endometrial stromal sarcoma group (p: 0.000). There were comparable rates of local and distant metastases between subgroups, however, no difference was found between chemotherapy and radiotherapy protocols (p> 0.01). It was found that in all US groups, stage was the only parameter which affected mortality rates (OR: 15.7 (95% CI 2.8-29.6) p = 0.002). Stage is the most important factor affecting mortality in all uterine sarcomas. Despite their different histopathological features, subgroups do not have distinctive features such as demographic features, presenting complaints, primary diagnosis and surgical treatment protocols. [ABSTRACT FROM AUTHOR]

Objective This study aims to evaluate the effect of the COVID-19 pandemic and related restrictions on patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer. Methods We retrospectively evaluated ovarian cancer patients who underwent HIPEC following complete cytoreductive surgery performed during the outbreak of the COVID-19 pandemic in three different centers specializing in gynecological oncology. All patients who underwent cytoreduction plus HIPEC for a primary, interval, and recurrent surgery were evaluated. Primary outcomes was postoperative 30-day morbidity and mortality. The secondary outcome was infection of patient and/or related staff with COVID-19 during the perioperative or early postoperative period. Results We performed a total of 35 HIPEC procedures during the pandemic: 15 (42.9%) patients underwent primary/interval surgery, while 20 (57.1%) patients had recurrent disease. Grade 3-4 complications occurred in one patient (2.9%) (chronic renal failure), while mortality did not occur in any patient. Neither the patients nor related staff were infected with the coronavirus during the perioperative or early postoperative period. One patient, who was diagnosed with COVID-19 pneumonia on postoperative day 80 died from the infection. Another patient died on postoperative day 85 due to progressive ovarian cancer, a disorder in vital functions, and organ failure. Conclusion HIPEC during the COVID-19 pandemic seems a safe and feasible procedure, with acceptable morbidity and mortality rates. Careful selection of patients is important and precautions should be taken before the procedure. [ABSTRACT FROM AUTHOR]

In this study, 683 patients with endometrial cancer (EC) after comprehensive surgical staging were classified into four risk groups as low (LR), intermediate (IR), high-intermediate (HIR) and high-risk (HR), according to the recent consensus risk grouping. Patients with disease confined to the uterus, ≥50% myometrial invasion (MI) and/or grade 3 histology were treated with vaginal brachytherapy (VBT). Patients with stage II disease, positive/close surgical margins or extra-uterine extension were treated with external beam radiotherapy (EBRT)±VBT. The median follow-up was 56 months. The overall survival (OS) was significantly different between LR and HR groups, and there was a trend between LR and HIR groups. Relapse-free survival (RFS) was significantly different between LR and HIR, LR and HR and IR and HR groups. There was no significant difference in OS and RFS rates between the HIR and HR groups. In HR patients, the OS and RFS rates were significantly higher in stage IB - grade 3 and stage II compared to stage III and non-endometrioid histology without any difference between the two uterine-confined stages and between stage III and non-endometrioid histology. The current risk grouping does not clearly discriminate the HIR and IR groups. In patients with comprehensive surgical staging, a further risk grouping is needed to distinguish the real HR group.Impact statementWhat is already known on this subject? The standard treatment for endometrial cancer (EC) is surgery and adjuvant radiotherapy (RT) and/or chemotherapy is recommended according to risk factors. The recent European Society for Medical Oncology (ESMO), European Society of Gynaecological Oncology (ESGO) and European Society for Radiotherapy and Oncology (ESTRO) guideline have introduced a new risk group. However, the risk grouping is still quite heterogeneous.What do the results of this study add? This study demonstrated that the current risk grouping recommended by ESMO-ESGO-ESTRO does not clearly discriminate the intermediate risk (IR) and high-intermediate risk (HIR) groups.What are the implications of these findings for clinical practice and/or further research? Based on the results of this study, a new risk grouping can be made to discriminate HIR and IR groups clearly in patients with comprehensive surgical staging. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the prognostic significance of adequate lymph node dissection (LND) (≥10 pelvic lymph nodes (LNs) and ≥ 5 paraaortic LNs removed) in patients with International Federation of Gynecology and Obstetrics (FIGO) stage II endometrioid endometrial cancer (EEC). Methods: A multicenter department database review was performed to identify patients who had been operated and diagnosed with stage II EEC at seven centers in Turkey retrospectively. Demographic, clinicopathological, and survival data were collected and analyzed. Results: We identified 284 women with stage II EEC. There were 170 (59.9%) patients in the adequate lymph node dissection (LND) group and 114 (40.1%) in the inadequate LND group. The 5‐year overall survival (OS) rate of the inadequate LND group was significantly lower than that of the adequate LND group (84.1% vs. 89.1%, respectively; p = 0.028). In multivariate analysis, presence of lymphovascular space invasion (LVSI) (hazard ratio [HR]: 2.39, 95% confidence interval [CI]: 1.23–4.63; p = 0.009), age ≥ 60 (HR: 3.30, 95% CI: 1.65–6.57; p = 0.001], and absence of adjuvant therapy (HR: 2.74, 95% CI: 1.40–5.35; p = 0.003) remained as independent risk factors for decreased 5‐year disease‐free survival (DFS). Inadequate LND (HR: 2.34, 95% CI: 1.18–4.63; p < 0.001), age ≥ 60 (HR: 2.67, 95% CI: 1.25–5.72; p = 0.011), and absence of adjuvant therapy (HR: 4.95, 95% CI: 2.28–10.73; p < 0.001) were independent prognostic factors for decreased 5‐year OS in multivariate analysis. Conclusion: Adequate LND and adjuvant therapy were significant for the improvement of outcomes in FIGO stage II EEC patients. Furthermore, LVSI was associated with worse 5‐year DFS rate in stage II EEC. [ABSTRACT FROM AUTHOR]

Abstract Although it does not have a long history of sentinel node evaluation (SLN) in female genital system cancers, there is a growing number of promising study results, despite the presence of some aspects that need to be considered and developed. It has been most commonly used in vulvar and uterine cervivcal cancer in gynecological oncology. According to these studies, almost all of which are prospective, particularly in cases where Technetium-labeled nanocolloid is used, sentinel node detection rate sensitivity and specificity has been reported to be 100%, except for a few cases. In the studies on cervical cancer, sentinel node detection rates have been reported around 80–86%, a little lower than those in vulva cancer, and negative predictive value has been reported about 99%. It is relatively new in endometrial cancer, where its detection rate varies between 50 and 80%. Studies about vulvar melanoma and vaginal cancers are generally case reports. Although it has not been supported with multicenter randomized and controlled studies including larger case series, study results reported by various centers around the world are harmonious and mutually supportive particularly in vulva cancer, and cervix cancer. Even though it does not seem possible to replace the traditional approaches in these two cancers, it is still a serious alternative for the future. We believe that it is important to increase and support the studies that will strengthen the weaknesses of the method, among which there are detection of micrometastases and increasing detection rates, and render it usable in routine clinical practice.

Abstract: Objective: To identify factors predictive of poor prognosis in women with stage III nonserous epithelial ovarian cancer (EOC) who had undergone maximal or optimal primary cytoreductive surgery (CRS) followed by six cycles of intravenous carboplatin/paclitaxel chemotherapy. Methods: A multicenter, retrospective department database review was performed to identify patients with stage III nonserous EOC who had undergone maximal or optimal primary CRS followed by six cycles of carboplatin/paclitaxel chemotherapy at seven gynecological oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. Results: A total of 218 women met the inclusion criteria. Of these, 64 (29.4%) patients had endometrioid, 61 (28%) had mucinous, 54 (24.8%) had clear‐cell and 39 (17.9%) had mixed epithelial tumors. Fifty‐five (25.2%) patients underwent maximal CRS, whereas 163 (74.8%) had optimal debulking. With a median follow‐up of 31.5 months, the 5‐year progression‐free survival (PFS) and overall survival (OS) rates were 34.8% and 44.2%, respectively. Bilaterality (hazard ratio [HR] 1.44, 95% CI 1.01–2.056; P = 0.04), age (HR 2.25, 95% CI 1.176–4.323; P = 0.014) and maximal cytoreduction (HR 0.34, 95% CI 0.202–0.58; P < 0.001) were found to be independent prognostic factors for PFS. However, age (HR 2.6, 95% CI 1.215–5.591; P = 0.014) and maximal cytoreduction (HR 0.31, 95% CI 0.166–0.615; P < 0.001) were defined as independent prognostic factors for OS. Conclusion: The extent of CRS seems to be the only modifiable prognostic factor associated with stage III nonserous EOC. Complete cytoreduction to no gross residual disease should be the main goal of management in these women. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in women with stage IIIC endometrioid endometrial cancer (EC). Methods: A multicenter, retrospective department database review was performed to identify patients with stage IIIC pure endometrioid EC at 6 gynecologic oncology centers in Turkey. A total of 207 women were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 2 groups: LNR1 (≤0.15), and LNR2 (>0.15). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models. Results: One hundred and one (48.8%) were classified as stage IIIC1 and 106 (51.2%) as stage IIIC2. The median age at diagnosis was 58 (range, 30-82) and the median duration of follow-up was 40 months (range, 1-228 months). There were 167 (80.7%) women with LNR ≤0.15, and 40 (19.3%) women with LNR >0.15. The 5-year progression-free survival (PFS) rates for LNR ≤0.15 and LNR >0.15 were 76.1%, and 58.5%, respectively (p=0.045). An increased LNR was associated with a decrease in 5-year overall survival (OS) from 87.0% for LNR ≤0.15 to 62.3% for LNR >0.15 (p=0.005). LNR >0.15 was found to be an independent prognostic factor for both PFS (hazard ratio [HR]=2.05; 95% confidence interval [CI]=1.07-3.93; p=0.03) and OS (HR=3.35; 95% CI=1.57-7.19; p=0.002). Conclusion: LNR seems to be an independent prognostic factor for decreased PFS and OS in stage IIIC pure endometrioid EC. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The purpose of this study was to determine the prognostic factors and patterns of failure in lymphovascular space invasion (LVSI)‐positive women with stage IIIC endometrioid endometrial cancer (EC). Methods: A multicenter, retrospective, department database review was performed to identify LVSI‐positive patients with stage IIIC endometrioid EC at five gynecological oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. Results: We identified 172 LVSI‐positive women with stage IIIC endometrioid EC during the study period; 75 (43.6%) were classified as Stage IIIC1 and 97 (56.4%) as Stage IIIC2. The median age at diagnosis was 59 years, and the median duration of follow up was 34.5 months. The total number of recurrences was 46 (26.7%). We observed 14 (8.1%) locoregional recurrences, 12 (7.0%) retroperitoneal failures and 20 (11.6%) distant relapses. For the entire study cohort, 5‐year progression‐free survival (PFS) was 67.4%, while the 5‐year overall survival (OS) rate was 75.1%. Grade 3 histology (hazard ratio [HR] 2.62, 95% confidence interval [CI] 1.34–5.12; P = 0.005), cervical stromal invasion (HR 2.33, 95% CI 1.09–4.99; P = 0.028) and myometrial invasion (MMI) ≥50% (HR 4.0, 95% CI 1.16–13.69; P = 0.028) were found to be independent prognostic factors for decreased OS. Conclusion: Uterine factors such as grade 3 disease, cervical stromal invasion and deep MMI seem to be independently associated with decreased OS in LVSI‐positive women with stage IIIC endometrioid EC. The high distant recurrence rate in this subgroup of patients warrants further studies in order to identify the most effective treatment strategy for those patients. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in patients with stage III ovarian high-grade serous carcinoma (HGSC). Methods: A multicenter, retrospective department database review was performed to identify patients with ovarian HGSC at 6 gynecologic oncology centers in Turkey. A total of 229 node-positive women with stage III ovarian HGSC who had undergone maximal or optimal cytoreductive surgery plus systematic lymphadenectomy followed by paclitaxel plus carboplatin combination chemotherapy were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 3 groups: LNR1 (<10%), LNR2 (10%≤LNR<50%), and LNR3 (≥50%). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models. Results: Thirty-one women (13.6%) were classified as stage IIIA1, 15 (6.6%) as stage IIIB, and 183 (79.9%) as stage IIIC. The median age at diagnosis was 56 (range, 18-87), and the median duration of follow-up was 36 months (range, 1-120 months). For the entire cohort, the 5-year overall survival (OS) was 52.8%. An increased LNR was associated with a decrease in 5-year OS from 65.1% for LNR1, 42.5% for LNR2, and 25.6% for LNR3, respectively (p<0.001). In multivariate analysis, women with LNR≥0.50 were 2.7 times more likely to die of their tumors (hazard ratio [HR]=2.7; 95% confidence interval [CI]=1.42-5.18; p<0.001). Conclusion: LNR seems to be an independent prognostic factor for decreased OS in stage III ovarian HGSC patients. [ABSTRACT FROM AUTHOR]

Objective: To determine factors influencing overall survival following recurrence (OSFR) in women with low-risk endometrial cancer (EC) treated with surgery alone. Methods: A multicenter, retrospective department database review was performed to identify patients with recurrent "low-risk EC" (patients having less than 50% myometrial invasion [MMI] with grade 1 or 2 endometrioid EC) at 10 gynecologic oncology centers in Turkey. Demographic, clinicopathological, and survival data were collected. Results: We identified 67 patients who developed recurrence of their EC after initially being diagnosed and treated for low-risk EC. For the entire study cohort, the median time to recurrence (TTR) was 23 months (95% confidence interval [CI]=11.5-34.5; standard error [SE]=5.8) and the median OSFR was 59 months (95% CI=12.7-105.2; SE=23.5). We observed 32 (47.8%) isolated vaginal recurrences, 6 (9%) nodal failures, 19 (28.4%) peritoneal failures, and 10 (14.9%) hematogenous disseminations. Overall, 45 relapses (67.2%) were locoregional whereas 22 (32.8%) were extrapelvic. According to the Gynecologic Oncology Group (GOG) Trial-99, 7 (10.4%) out of 67 women with recurrent low-risk EC were qualified as highintermediate risk (HIR). The 5-year OSFR rate was significantly higher for patients with TTR ≥36 months compared to those with TTR <36 months (74.3% compared to 33%, p=0.001). On multivariate analysis for OSFR, TTR <36 months (hazard ratio [HR]=8.46; 95% CI=1.65- 43.36; p=0.010) and presence of HIR criteria (HR=4.62; 95% CI=1.69-12.58; p=0.003) were significant predictors. Conclusion: Low-risk EC patients recurring earlier than 36 months and those carrying HIR criteria seem more likely to succumb to their tumors after recurrence. [ABSTRACT FROM AUTHOR]

Objective: To investigate ghrelin and obestatin expression in serous ovarian tumours. Materials and methods: Preparations of deparaffinized blocks obtained from the pathology archives of a total of 47 previously diagnosed cases of benign serous tumour ( n = 20), borderline serous tumour ( n = 7) and malignant serous tumour ( n = 20) were subjected to immunohistochemical examination to find out ghrelin and obestatin expressions. Results: Mean ghrelin expressions decreased significantly in the benign group, relative to the malignant group ( p < 0.05), while there was no significant change in mean obestatin expression. It was established that rates of preparations with moderate and severe ghrelin and obestatin expression displayed a significant increase from benign to malignant ones ( p < 0.05). Conclusion: The fact that rates of preparations with severe expression correlated with an increase in malignancy suggests that ghrelin and obestatin may be effective in the malignant transformation in at least some cases. [ABSTRACT FROM AUTHOR]

Background: Although many associations have been demonstrated between hyperhomocysteinemia and pregnancy complications, such as spontaneous abortion, preterm labor, preeclampsia and low birthweight, it is still not clear whether hyperhomocysteinemia is the cause or the consequence of these pregnancy complications. The aim of this study was to investigate the effects of homocysteine on the spontaneous contractility of isolated pregnant human myometrium.Methods: Myometrium samples obtained from women undergoing elective caesarean section were suspended in a jacketed organ bath containing Krebs' solution at 37 degrees C (pH 7.4), continuously gassed with 95% O2 and 5% CO2. After manifestation of spontaneous contractions under 2 g of resting tension, homocysteine was applied to the organ bath, and amplitude and frequency of contractions were evaluated at 20-min intervals. Statistical analysis of amplitude and frequency of the contractions was performed using the Kruskal-Wallis analysis of variance test.Results: Application of 0.1 mm homocysteine had no significant effect on either frequency (4.63 +/- 0.42 vs. 4.01 +/- 0.53 for the control period; p > 0.05) or amplitude (3.20 +/- 0.07 g vs. 3.15 +/- 0.07 g; p > 0.05) of spontaneous contractions, while 1 and 2 mm homocysteine significantly increased the frequency (8.54 +/- 0.62 vs. 3.9 +/- 0.44, p < 0.02, and 12.32 +/- 0.72 vs. 3.96 +/- 0.51, p < 0.001, respectively) of spontaneous contractions but caused only a modest change in amplitude (2.92 +/- 0.04 g vs. 2.87 +/- 0.05 g, p > 0.05, and 3.02 +/- 0.06 g vs. 2.93 +/- 0.05 g, p > 0.05, respectively).Conclusion: Results from this study indicate for the first time that homocysteine causes enhancement of spontaneous contractions of myometrium derived from pregnant women. [ABSTRACT FROM AUTHOR]

Objective: To investigate the use of omental graft following the repair of fistula between bladder and uterus (Youssef syndrome). Methods: Primary repair was performed on four women who had developed vesico-uterine/vesico-cervical fistula and infertility due to previous low segment caeserean between October 1997 and January 2001. An omental graft of 4 cm×3.5 cm was placed between bladder and uterus. Results: Repair was successful in all four patients. Complaints of amenorrhea, menouria and in three patients urine-type vaginal flux disappeared. Three patients did not want pregnancy, so contraceptives were administered. The fourth patient conceived after 4 months. Conclusions: This operation is both simple and effective. Fertility is recovered quickly. [Copyright &y& Elsevier]

: ObjectiveTo investigate the effectiveness of a single preoperative dose of misoprostol in abdominal myomectomies.: DesignPlacebo-controlled randomized prospective study.: SettingDepartment of obstetrics and gynecology in a university hospital.: Patient(s)Twenty-five women with symptomatic uterine leiomyomas.: Intervention(s)Among patients undergoing abdominal myomectomies, an hour before the operation women in the study group (n = 13) were given a single dose of vaginal misoprostol (400 μg); those in the control group (n = 12) were given placebo.: Main outcome measure(s)Intraoperative blood loss, duration of operation, duration of postoperative hospitalization, and the need for blood transfusion were compared between the control and study groups.: Result(s)Blood loss, operation time, and need for postoperative blood transfusion were significantly reduced in the group given vaginal misoprostol. No difference was observed among patients in terms of the time of hospitalization.: Conclusion(s)A single preoperative dose of vaginal misoprostol is a simple, reliable method for reducing intraoperative blood loss and need for postoperative blood transfusion after abdominal myomectomies. [Copyright &y& Elsevier]

: ObjectiveThe aim of this study was to investigate the effects of erythromycin on prostaglandin F2α (PGF2α)-induced contractions of isolated myometrial strips from non-pregnant rats.: DesignIn vitro pharmacological study.: SettingFirat University Faculty of Medicine.: SampleMyometrium samples were taken from 55 adult Wistar rats.: MethodsMyometrial strips were isolated from mature, non-pregnant Wistar rats. Isometric contractions of these strips were induced with 1 μM PGF2α. Effects of 0.01, 0.1, 0.2, 0.5 and 1 mM erythromycin on the frequency and amplitude of these PGF2α-induced contractions were recorded.: Main outcome measuresThe inhibition of prostaglandin F2α-induced contractions in vitro.: ResultsApplication of 0.01 mM erythromycin had no effect on either amplitude or frequency of contractions. However, 0.1, 0.2, 0.5 and 1 mM erythromycin decreased the frequency and amplitude of PGF2α-induced contractions. The inhibitory effect of erythromycin on amplitude was 27%, 38%, 54% and 83% (P < 0.05), and that on frequency was 10%, 16%, 32% and 61% (P < 0.05) at 0.1, 0.2, 0.5 and 1 mM concentrations, respectively.: ConclusionThe results of this study demonstrate that erythromycin inhibits PGF2α-induced contractions in rat myometrium. Because PGF2α-induced contractions have been suggested to be involved in the pathogenesis of primary dysmenorrhoea, effects of erythromycin in this clinical entity may present a new approach for the treatment. [Copyright &y& Elsevier]

Objective: To investigate the effects of tibolone on levels of plasma homocysteine, an independent risk factor for cardiovascular disorders, in postmenopausal women.Design: Prospective, randomized clinical study.Setting: University hospital.Patient(s): Postmenopausal healthy women.Intervention(s): Tibolone (2.5 mg/d) or calcium (1250 mg/d) and conjugated equine estrogens (0.625 mg/d) plus medroxyprogesterone acetate (5 mg/d) were administered orally for 6 months. Blood samples were collected at the start and the end of therapy.Main Outcome Measure(s): Plasma homocysteine levels.Result(s): Administration of tibolone and calcium caused only a 4% decrease in plasma homocysteine levels compared with initial levels. In contrast, conjugated equine estrogens plus medroxyprogesterone acetate caused a 29% decrease in plasma homocysteine levels.Conclusion(s): Despite the reported beneficial effect of tibolone on the serum lipid profile, tibolone had no statistically significant effect on serum homocysteine levels in postmenopausal women. The possible cardiovascular protective role of tibolone might be unrelated to its effects on homocysteine levels. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the effects of erythromycin on pregnancy duration and on live birth weight in lipopolysaccharide (LPS)-induced preterm labor model in rats. Study design: Total of 60 pregnant rats on day 16 of gestation was intraperitoneally injected with 25 μg/kg LPS. Animals were randomly divided into six groups and 20 mg/kg (n=10), 40 mg/kg (n=10), 60 mg/kg (n=10), 80 mg/kg (n=10), and 100 mg/kg (n=10) erythromycin and equal volume of physiological saline (n=10) were given intraperitoneally. Injection of LPS-to-vaginal bleeding interval, vaginal bleeding-to-delivery interval, LPS injection-to-delivery interval was monitored and live birth weight of neonates was determined. Statistical analysis was performed using Kruskal–Wallis, Mann–Whitney U-test and Spearman correlation analysis. Results: Intraperitoneal injection of erythromycin to LPS-administered rats caused significant increase in latent period, labor period, total period and live birth weight in a dose dependent manner. Conclusion: These data shows that erythromycin causes prolongation of pregnancy period and increases live birth weight in LPS-induced preterm labor of pregnant rats. [Copyright &y& Elsevier]

Background: Despite the fact that preterm labor and birth account for the vast majority of neonatal morbidity and mortality the currently available treatment options are still far from satisfactory. The aim of this study was to investigate the effects of erythromycin on stretch-induced contractions of pregnant human myometrial strips, obtained at cesarean section.Method: Myometrial strips were suspended in an organ bath under 3 g tension and the effects of erythromycin (0.1, 0.2, 0.5, 1.0 mM) on stretch-induced isometric contractions were evaluated. Results were statistically analyzed using Kruskal Wallis analysis of variance and Wilcoxon Rank tests where appropriate.Results: Erythromycin caused a significant decrease in the peak amplitude, while causing an increase in frequency of stretch-induced myometrial contractions in a dose dependent manner in vitro.Conclusions: Results from this preliminary study suggest that erythromycin may have additional beneficial effects in infection related preterm labor cases, however, further studies are needed for clarifying the usefulness of erythromycin as a tocolytic agent. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The present study aims to establish the levels of acylated ghrelin, desacylated ghrelin, obestatin and preptin, during pregnancy and the postpartum period in pregnant women with Gestational Diabetes Mellitus (GDM) and healthy pregnancy women. Design and methods: The study registered 20 pregnant women with GDM and 20 healthy pregnant women. Fasting venous blood samples were collected from all cases between weeks 24 and 28 of pregnancy and after 24h postpartum. Hormones were analyzed using ELISA method. Results: Serum acylated ghrelin (p:0.001), desacylated ghrelin (p:0.001), obestatin (p:0.006) and preptin (p:0.001) levels were all found statistically higher in both groups during the postpartum period, when compared to the pregnancy period. A positive correlation was established between desacylated ghrelin and acylated ghrelin (p:0.008), desacylated ghrelin and preptin (p:0.012) and preptin and insulin (p:0.039) in the GDM group during pregnancy. Conclusions: The studied hormones (especially desacylated ghrelin and obestatin) are critical in GDM pathophysiology based on the comparison of measure after and before the delivery. [Copyright &y& Elsevier]

Abstract: Objectives: The goal of this study was to compare levels of acyl and des-acyl ghrelin, obestatin, nesfatin-1 and leptin in healthy gravidas to hyperemesis gravidarum (HG) patients. Design and methods: Twenty pregnant women with HG and twenty healthy pregnant women all of similar ages, BMI and all at similar pregnancy development comprised the study cohort. Fasting serum samples were obtained and measured for acyl and des-acyl ghrelin, leptin, obestatin and nesfatin-1. Results: Nesfatin-1 concentrations in the HG group were higher compared to the control group whereas; leptin concentrations during pregnancy were lower in the HG group as compared to the control group. The two groups did not differ with regard to acyl and des-acyl ghrelin and obestatin. Conclusion: This pilot study suggests a possible role of leptin and nesfatin-1, which might be involved in the pathology of the disease. [Copyright &y& Elsevier]