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ObjectiveTo 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.MethodsThis 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.ResultsThe 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 (pConclusionTranscervical endometrial tracer injection in endometrial cancer revealed similar pelvic but significantly higher para-aortic sentinel lymph node detection.

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 10.36 cm. 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.

Introduction/Background Endometrial carcinoma is the most common gynecological malignancy in developed countries. Myometrial invasion and lymph node metastasis are important prognostic factors for endometrial cancer. Although lymphadenectomy is part of the full staging procedure, it is known to be associated with increased complication rates and increased comorbidity with prolonged operation time. For this reason, it is important that biomarkers that can predict preoperative myometrial invasion and lymph node metastasis and which can predict poor prognosis can be used. These biomarkers can help in the adjustment of surgical treatment by identifying patients with advanced disease that will benefit from a wide range of surgical procedures but can also help to prevent over-treatment in low-risk patients. In this context, serum L1CAM examination seems promising in endometrial cancer. Methodology Between January and April 2019, 80 patients with endometrial cancer and 37 control patients were included in the study. Blood samples obtained from the patients were diluted and measured by the spectrophotometric microelisa method with HUMAN L1CAM/CD171. Data were evaluated by IBM SPSS Statistics 20.0 statistical data program and p-value Results It was found that serum L1CAM values were significantly higher in endometrial cancer patients than in the control group (p: 0.000). Although serum L1CAM levels were higher in patients with myometrial invasion and lymph node metastasis, statistically significant results could not be obtained. Conclusion In this study serum L1CAM measurements were not found to be significantly different in high-risk endometrial cancer patients. We believe that serum L1CAM examination may be effective in the diagnosis of endometrial cancer, but further studies with more patients on low risk and high-risk differentiation should be considered. Disclosure Nothing to disclose.

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.

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 (

To compare the efficacy of repeated doses of 100 microg vs. 200 microg misoprostol given sublingually for induction of second trimester abortion.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.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).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.

To integrate intermittent fetal pulse oximetry (FPO) to intrapartum fetal assessment and reduce the rate of caesarean sections.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.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).Intermittent FPO in misoprostol induced deliveries decreases both total caesarean rate and the caesarean rate due to non-reassuring FHR patterns.

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.

Purpose. To determine whether spectral Doppler measurements obtained from bilateral uterine, arcuate, radial, and spiral arteries in early gestation correlate with adverse pregnancy outcome. Methods. One hundred five pregnant women underwent transvaginal Doppler sonographic examination of uteroplacental circulation at 6–12 weeks' gestation. Resistance index (RI) and pulsatility index (PI) of bilateral uterine, arcuate, radial, and spiral arteries were measured. Diameters of gestational sac (GS) and yolk sac, crown–rump length (CRL), GS–CRL difference, and GS/CRL ratio were also recorded. Correlation was made with pregnancy outcome. Results. Sixteen women developed adverse pregnancy outcome. In these women, right uterine artery PI and RI were significantly higher than in women with normal obstetrical outcome. Spiral artery PI and RI values were also higher, but the difference was not statistically significant. GS–CRL difference, GS/CRL ratio, and yolk sac diameters were significantly lower in this group. Conclusion. Transvaginal Doppler examination can detect hemodynamic changes in uteroplacental circulation associated with subsequent adverse pregnancy outcome. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007

Fragile histidine triad (FHIT), a candidate of tumor suppressor protein, expression was examined on paraffin-embedded specimens in proliferative, secretory, hyperplastic, and neoplastic human endometrium by immunohistochemistry. The results of FHIT immunoreactivity in endometrial carcinomas were compared with prognostic indicators as well as with p53 overexpression. Forty-four cases of endometrial carcinoma, 30 normal functional (15 proliferative, 15 secretory), and 24 hyperplastic endometrium (12 without atypia, 12 with atypia) specimens were studied using polyclonal FHIT antibody. The streptavidin-biotin-peroxidase detection system was used, and the intensity and the distribution of immunoreactivity were evaluated semiquantitatively. There were no significant differences in FHIT expression in the proliferative, secretory, hyperplastic, either with or without atypia, or carcinomatous endometria. No significant difference in FHIT expression of endometrial carcinomas was detected when prognostic parameters or p53 overexpression were considered. Loss or reduced FHIT expression was not found to predict disease-free or cumulative survivals. This study showed that loss or reduction in FHIT protein expression is present in normal functional and hyperplastic endometria as well as in neoplastic endometrium. FHIT protein seems not to be involved directly in endometrial carcinogenesis, but rather, it regulates cell proliferation both in physiologic and in pathologic conditions of endometrium.

Background: Primary sarcomas of the vulva are rare tumors that account for 1.8–3% of all vulvar malignancies. Malignant fibrous histiocytoma occurs infrequently on the vulva but nonetheless is the second most frequent sarcoma of this region. The purpose of this report is to review the diagnosis and therapy of this exceedingly rare tumor. Case: A 72-year-old woman was presented with a vulvar mass that was ultimately found to be a vulvar malignant fibrous histiocytoma. After surgical excision and 9 months of initial diagnosis, she returned with rapid localized progression and pulmonary metastases. Conclusion: Malignant fibrous histiocytoma arising in the vulva represents an example of vulvar sarcomas. Since the diagnostic criteria and natural history of this tumor still remain poorly defined, further case studies may be helpful to elucidate these issues as well as the optimal therapeutic approach of this heterogeneous group of malignancies.

Objective: The aim of the study was to determine the risk factors, prevalance, epidemiological parameters and maternal-perinatal outcome in pregnant women with hypertensive disorder. Materials and methods: A retrospective analysis was undertaken on 255 consecutive cases of hypertensive disorder in pregnancy who were managed at Kocaeli University, School of Medicine, Department of Obstetrics and Gynecology from June 1997 to November 2004. Demographic data involving age, parity, gestational week, clinical and laboratory findings were recorded from the medical files. Additionally delivery route, indications of cesarean section, fetal and maternal complications were determined. Statistical analysis was performed by SPSS programme using Kruskal Wallis nonparametric test, ANOVA (Analysis of variance) and chi-square tests. Results: Of 5,155 deliveries in our clinic during the defined period, 438 cases (8.49%) were managed as hypertensive disorder of pregnancy. Medical records of 255 cases could be avaliable. Of 255 cases, 138 patients (54.11%) were found to have severe preeclampsia while 88 cases (34.50%) were diagnosed as mild preeclampsia. Twenty-nine patients (11.37%) were suffering from chronic hypertension. Of 138 severely preeclamptic cases, 28 cases (11%) had eclamptic convulsion and another 28 patients (11%) were demonstrated to have HELLP syndrome. Intrauterine growth restriction, oligohydramnios, placental ablation were the obstetric complications in 75 (29.4%), 49 (19.2%), 19 (7.5%) cases, respectively. Additionally multiple pregnancy and gestational diabetes mellitus were noted in 5.9% (n:15) and 3.9% (n:10) of the patients. Delivery route was vaginal in 105 patients (41.2%) while 150 patients (58.8%) underwent cesarean section with the most frequent indication to be fetal distress in 69 cases (46%). Cesarean section rate seemed to be the lowest (48.3%) in chronic hypertensive women while the highest (63.8%) in severe preeclamptic patients. Maternal mortality occured in 3 cases (1.2%) and all of those cases were complicated with HELLP syndrome. Intracranial bleeding was the cause of maternal death in one case while the other two cases were lost due to acute renal failure and disseminated intravascular coagulation, respectively. Intrauterine fetal demise was recorded in 24 cases on admission. Ten fetuses died during the intrapartum period. Mean gestational age and birth weight were 28±3.5 and 1000±416 g, respectively in this group. In these ten women, five cases were diagnosed as HELLP syndrome, two were severely preeclamptic and three were eclamptic. Perinatal mortality rate was found to be 144/1,000 births Conclusion: Hypertensive disorder of pregnancy is associated with increased risk of maternal-perinatal adverse outcome. The complications of severe preeclampsia and eclampsia could be prevented by more widespread use of prenatal care, education of primary medical care personnel, prompt diagnosis of high-risk patients and timely referral to tertiary medical centers.

This study was conducted to find out the group B streptococcus colonisation of pregnant women in Kocaeli, Turkey. A culture plus individualised high-risk-based antibiotic prophylaxis was compared with high-risk-based approach alone. The screening of women was performed via vaginal and anal cultures for group B streptococcus (GBS). The maternal GBS colonisation rate was found to be 6.5%. All colonised women or preterm labours with unavailable culture results until delivery received prophylactic antibiotics. Neonatal colonisation rate and early-onset neonatal sepsis due to GBS was 1/200. The unscreened 900 women received prophylactic antibiotics due to a risk factor-based approach. The neonatal colonisation rate was 17/900 (p = 0.1), and the rate of early-onset neonatal sepsis was 3/900 (p = 0.6). A culture plus individualised high-risk-based antibiotic prophylaxis provided an insignificant change in neonatal colonisation and early-onset neonatal sepsis with GBS when compared with high-risk-based approach alone.

P27 expression was examined on paraffin-embedded specimens in proliferative, secretory, hyperplastic and neoplastic human endometrium by immunohistochemistry. The results of p27 immunoreactivity in endometrial carcinomas were compared with clinicopathological indicators as well as with p53 expression. Thirty-eight cases of endometrial carcinoma, 30 normal functional (15 proliferative, 15 secretory), 24 hyperplastic endometrium (12 without atypia, 12 with atypia) specimens were studied by using monoclonal p27 and p53 antibodies. The streptavidin-biotin-peroxidase detection system was used and the intensity and the distribution of immunoreactivity was evaluated semiquantitatively. p27 expression was present both in the proliferative and secretory phases; the expression being stronger in the secretory period. In complex hyperplasia with atypia, p27 expression was even higher and it was significantly reduced in the endometrial carcinoma group (p0.05). No significant correlation was found between p27 expression and any of the clinicopathologic prognostic parameters (p0.05). Nuclear p53 expression was detected in 13 (34.2%) patients with endometrial carcinoma and was higher in non-endometrioid carcinomas and in tumors with increasing FIGO grade (p0.05). High expression of p53 was not found to be a significant prognostic indicator of survival (p0.05). No p53 expression was detected in the endometria with proliferation, secretion or hyperplasia either simple without atypia or complex with atypia. Surprisingly, tumors with absent/low p27 expression showed absent/low p53 expression. Our data suggest that p27 is necessary to control the proliferation of endometrium and its loss of expression seems to play a role in some aspects of endometrial carcinogenesis.

Intrauterine devices (IUDs) are the second most commonly used contraceptive method in the world. A number of mechanisms have been proposed by which IUDs could interfere with reproductive processes. In this study, the relationship between intrauterine devices and the risk of antisperm antibody (ASA) production in the absence of prior sensitization was investigated. Sixty-two IUD users (group 1) and 42 women with no contraceptive use as a control group (group 2) were included in the study. Six months after the IUD insertion, 4 women in group 1 and 2 women in group 2 with lower genital tract infections were excluded from the study. The sera of the remaining 58 women in group 1 and 40 women in group 2 were evaluated again for the presence of ASA. Twelve patients (20.7%) in group 1 and 12 patients (30.0%) in group 2 had ASA positivity. When we compared the ASA levels in the IUD group with those in the control group, there was no statistically significant difference (p>0.05). In summary, our data proved that copper-containing intrauterine devices in the absence of prior sensitization do not significantly affect immunity to sperm in sera of women.

For the prevention of postoperative adhesion formation, one of the most common causes of infertility, none of the adjuvants had been proven uniformly effective. In this study we evaluated the effectiveness of sodium carboxymethylcellulose (SCMC) and disodium cromoglycate (DSCG) in postoperative adhesion prevention in a rat uterine horn model. Thirty female Sprague-Dawley rats were used. After uterine horn abrasion, in 10 rats 10 ml 0.9% saline, in 10 rats 10 ml of 2% SCMC, and in 10 rats 10 ml DSCG were administered intraperitoneally. Two weeks later, all animals were sacrificed and adhesion formation was assessed. All the pieces of the peritoneum biopsies were stained with Luna’s mast cell stain to assess the mast cell degranulation. The mean adhesion scores were 2.1, 2.0 and 1.5 for saline, SCMC and DSCG groups respectively. There were no significant differences among all groups. In the pathologic examination, mast cell degranulation was less in the DSCG group than the other groups.

Background: Premenstrual syndrome (PMS) is defined as the disabling and cyclic occurrence of emotional and behavioral symptom complex during the latter half of the menstrual cycle. Although its etiology is unknown, it has been speculated that premenstrual syndrome is linked to a deficiency of central serotoninergic activity. Method: The study consisted of a double-blind, placebo controlled trial of fluoxetine at a dose of 20 mg/day or placebo for three menstrual cycles. The 440 women who appeared to meet the eligibility criteria were instructed to record the ‘Calendar of Premenstrual Experiences’ (CPE) scale for two complete menstrual cycles. Of 410 women who successfully completed two cycles of recording their symptoms daily only 35 met the criteria for PMS. These criteria included psychiatric interviews which were made before treatment. Thirty-five PMS patients were randomized into placebo or fluoxetine treatment groups. Results: Our study suggests that fluoxetine at a dose of 20 mg per day was significantly superior to placebo in alleviating the symptoms of PMS. The most common side effects were gastrointestinal irritability (15%), insomnia (11%) and sexual dysfunction (8.5%). Conclusion: Fluoxetine is an effective and well-tolerated drug and appears to have considerable promise in treating a range of symptoms in women with PMS.

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 40years (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 36months (range 1–120months). Five-year survival rate was 100% and median survival time was 120months. 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.

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. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 2010

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

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. (authors)

To compare the effectiveness of sublingual and vaginal misoprostol application for cervical ripening prior to manual vacuum aspiration (MVA) under local anaesthesia for voluntary termination of pregnancy between 7 and 10 weeks of gestation.Prospective randomized study in which 72 women were randomly assigned to administration of either 400 microg vaginal misoprostol 3 hours prior to or 200 microg sublingual misoprostol 2 hours prior to the surgical procedure. We took the preoperative cervical dilatation that was achieved as the main outcome measure. The duration of the procedure, intra-operative blood loss, pain perception before and during the operation, patients' satisfaction, side effects and duration of post-operative bleeding were secondary outcome measures.A similar pre-operative cervical dilatation was achieved in the sublingual and the vaginal groups (6.9 +/- 1.6 mm and 6.6 +/- 1.1 mm, respectively; p = 0.3). The duration of the operation, intra-operative blood loss, and patients' satisfaction did not differ between the two groups. Pain scores were significantly higher in the sublingual group than in the vaginal group, both after administration of misoprostol (p = 0.02) and during the procedure (p = 0.02). Nausea and vaginal spotting were significantly more frequent (p = 0.01 and p = 0.003, respectively), but post-operative bleeding significantly shorter (p = 0.003) in the sublingual group.Administration of 200 microg sublingual misoprostol 2 hours before suction curettage under local anaesthesia was as effective as 400 microg vaginal misoprostol 3 hours before that procedure with regard to achieving cervical dilatation. It resulted in higher pre-operative and intra-operative pain scores without changing patients' satisfaction.

Estrogen replacement therapy alters the lipid profiles favorably for delaying atherosclerosis in postmenopausal women. The effects of estrogen plus progesterone combination therapy on lipids are controversial. This study was designed to evaluate the effect of female sex hormones on lipids and lipoproteins and to clarify the influence of progesterone on the effect of estrogen in postmenopausal women. Of the 60 postmenopausal women admitted to our menopause clinic, 40 had intact uterus and received continuous 0.625 mg conjugated equine estrogen (CEE) plus 2.5 mg medroxyprogesterone acetate (MPA), whereas the remaining 20 were hysterectomized and received 0.625 mg CEE daily. To assess the alterations in lipids and lipoproteins during menopause, 45 healthy premenopausal women were investigated. Lipid and lipoprotein levels were assessed in each subject at baseline and at the 6th and 18th months of therapy. In menopause, a shift towards more atherogenic lipid and lipoprotein profiles than those of the premenopausal state was found. Following 18 months of treatment, both regimens reduced total cholesterol (TC) levels as compared with the baseline (6.4 vs. 6.9% in the CEE/MPA and CEE groups, respectively). The CEE group had a more pronounced increase in high-density lipoprotein (HDL) cholesterol than the CEE/MPA group (10.3 vs. 8.8%, respectively). Both groups displayed reduced TC, low-density lipoprotein (LDL) cholesterol and apolipoprotein-B (ApoB) concentrations, whereas triglycerides increased, with a greater tendency to increase in the CEE/MPA group at the end of the trial. Also, the lipoprotein (a) [Lp(a)] levels decreased significantly (27.6 vs. 24.5% in the CEE/MPA and CEE groups, respectively). This decrease was more pronounced in subjects with a relatively higher basal Lp(a) concentration. Both treatment regimens caused positive alterations in the lipid and lipoprotein profiles. This association might play a pivotal role in the postmenopausal increases in atherosclerotic diseases and cardioprotective effect of estrogen in postmenopausal women.

We aimed to evaluate the effects of ovulation induction on Ki67 expression and dysplasia scores of female rat ovaries. Twenty female Wistar rats were randomized either to receive 150 IU/kg human menopausal gonadotropin on estrous day 2 and 75 IU/kg human chorionic gonadotropin on the day of preestrous (induction group, n= 10) or saline as placebo on the corresponding days (control group, n= 10). After five estrous cycles bilateral oophorectomy was performed to compare the Ki67 expression and dysplasia score of the ovarian epithelium. The mean number of the cells that stained positive for Ki67 was 159.6 +/- 101.92 in the follicles, 283.4 +/- 42 in the corpus luteum, and 151 +/- 75.1 in the stroma of the study group compared to 41.8 +/- 35.6 (P= 0.03), 43.2 +/- 28.3 (P= 0.007), and 55.6 +/- 18.6 (P= 0.01), respectively, in the control group. The mean number and rate of cells that stained positive for Ki67 in the epithelium was significantly higher in the ovulation induction group (758 +/- 71 and 63 +/- 1.6%, respectively) compared to the control group (386 +/- 23, P < 0.001; and 60 +/- 1.1%, P < 0.001; respectively). The mean dysplasia score was significantly higher (9.6 +/- 1.3) in the study group compared to the control group (5.08 +/- 0.9, P < 0.001). Ovulation induction in rats resulted in increased Ki67 expression and dysplastic features in the ovarian epithelial cells.

Magnetic resonance (MR) imaging and MR angiography were used for the differential diagnosis and preoperative planning of a 17 weeks of age rudimentary horn pregnancy. A 26-year-old primigravida was referred to our hospital with a preliminary diagnosis of abdominal pregnancy. After an inconclusive ultrasound evaluation we were able to identify a rudimentary horn pregnancy, extent of the placental invasion, and the vascular supply via MR imaging and time of flight sequence MR angiography. The obtained data were also used for preoperative planning, which resulted in an uncomplicated, prerupture laparotomy for pregnancy termination and a healthy female.

Objective: To compare the efficacy of misoprostol 50 µg vaginally and 50 µg sublingually for labor induction at term. Materials and Methods: One hundred and sixty women were randomized to receive misoprostol 50 µg vaginally (n = 80) or 50 µg sublingually misoprostol (n = 80). The doses were given every 4 h (maximum 6 doses). Primary outcome measure was number of cesarean deliveries. Induction to delivery time, delivery within 24 h, the number of misoprostol doses given; the need for oxytocin augmentation, tachysystole and uterine hyperstimulation rates and neonatal outcomes were secondary outcome measures. Results: The mean induction to delivery time was 748 ± 379 min in the vaginal group and 711 ± 425 in the sublingual group (p = 0.56). The number of women delivering within 24 h was 73 (91.3%) in the vaginal group and 74 (92.5%) in the sublingual group (p = 0.78). The mean number of misoprostol doses required was significantly higher in the sublingual group (1.9 ± 1.2) compared with the vaginal group (1.1 ± 0.4; p < 0.001). More women in the sublingual group experienced tachysystole (n = 14, 17.5%) compared with the vaginal group (n = 3, 3.8%; p = 0.005). Seven cases (8.8%) in the vaginal group and 12 cases in the sublingual group (15%) required emergent cesarean delivery for fetal heart rate abnormalities (p = 0.22). Other neonatal outcomes including umbilical artery pH, Apgar scores and intensive care unit admission were similar in the two groups. Conclusion: Sublingual misoprostol is as efficacious as vaginal misoprostol for induction of labor. More frequent tachysystole is observed with misoprostol 50 µg sublingually, but neonatal outcomes are similar.

Summary: The study group consisted of 29 female, white New Zealand rabbits. The rabbits were randomized into 3 groups and a midline laparotomy was performed in order to make a 4–5 mm long lesion using a scalpel in both ovaries. In Group 1, both of the ovaries were left uncovered. In Group 2, the right ovaries were covered by human amniotic membrane graft. In Group 3, 0.1–0.2 mL of Tisseel solution was applied to the lesion in the right ovaries. No medication was applied to the left ovaries in any of the groups and thus this ovary acted as an individual control. After 2 weeks the adhesion scores were graded by relaparotomy in a blind manner. Fibrin sealant showed a significant reduction in postoperative adhesion formation compared with the amniotic membrane graft and control groups (p

Medical termination of pregnancy (medical abortion) as an alternative to surgical abortion has many advantages since it does not require anesthetics and there is no risk of cervical laceration or uterine perforation. In the present study, we evaluated the efficacy of methotrexate and intravaginally administered misoprostol for early abortion.The study population consisted of 32 women seeking abortion of a normal intrauterine pregnancy of 8 weeks or less documented by ultrasound. The dose of methotrexate was 50 mg/m2 intramuscularly and the dose of misoprostol was 800 micrograms intravaginally. The final outcome of treatment was evaluated on day 14 or 16, and an abortion was considered successful if pregnancy was terminated without a surgical procedure.Abortion occurred in only 23 (71.8%) of 32 women. There were 9 failures (28.1%); 3 were ongoing pregnancies (9.3%) and 6 were incomplete abortions (18.7%) requiring suction curettage. After the exclusion of treatment failures, the mean duration of vaginal bleeding was 16.3 +/- 2 days. No serious side effects occurred as a result of methotrexate and misoprostol treatment.The use of methotrexate and intravaginal misoprostol for the termination of pregnancy requires larger studies to determine the safety and efficacy of this medical abortion, a comparison with RU 486 in prospective controlled randomized trials is necessary.Medical termination of pregnancy (medical abortion), as an alternative to surgical abortion, has many advantages since it does not require anesthetics and there is no risk of cervical laceration or uterine perforation. In the present study, the authors evaluated the efficacy of methotrexate and intravaginally administered misoprostol for early abortion. The study population consisted of 32 women seeking termination of a normal intrauterine pregnancy of 8 weeks or less documented by ultrasound. The dose of methotrexate was 50 mg/sq. m intramuscularly and the dose of misoprostol was 800 mcg intravaginally. The final outcome of treatment was evaluated on day 14 or 16, and an abortion was considered successful if pregnancy was terminated without a surgical procedure. Abortion occurred in only 23 (71.8%) of 32 women. There were 9 failures (28.1%); 3 were ongoing pregnancies (9.3%) and 6 were incomplete abortions (18.7%) requiring suction curettage. After the exclusion of treatment failures, the mean duration of vaginal bleeding was 16.3 +or- 2 days. No serious side effects occurred as a result of methotrexate and misoprostol treatment. The use of methotrexate and intravaginal misoprostol for the termination of pregnancy requires larger studies to determine the safety and efficacy of this type of medical abortion; a comparison with RU 486 in prospective controlled randomized trials is necessary.

Primary ovarian choriocarcinoma arising presumably from a germ cell is extremely rare. Besides arising gestationally or nongestationally, it may be pure or mixed with other germ cell tumors like immature teratoma, dysgerminoma, polyembryoma.We present a case of a 22-year-old woman diagnosed with pure nongestational choriocarcinoma of the ovary with a review of the literature and discussion of its origin.

Background The purpose of this study was to compare fetal oxygen saturation by fetal pulse oximetry in parturients with and without epidural labor analgesia in a prospective case control study. Methods Fetal oxygen saturation values were compared in term pregnant women who received epidural analgesia (epidural group) with those in women who did not (control group). Mode of delivery, Apgar score, fetal oxygen saturation, cord blood gas analysis and fetal outcomes were also compared. Results A total of 150 pregnant women (75 in each group) gave written consent and were enrolled. The average fetal oxygen saturation during the first stage of labor (active phase) was 45.6 ± 8.1% for the epidural group and 45.9 ± 7.4% for the control group (NS); saturations for the second stage of labor were 44.9 ± 8.8% and 45.3 ± 6.7%, respectively (NS). In the epidural group, the duration of the first stage of labor was significantly longer (565 ± 217 min) than the control group (434 ± 222 min; P = 0.001). Cesarean delivery rates, neonatal cord blood gas analysis, Apgar scores, and neonatal outcomes were similar in the two groups. Conclusions Fetal oxygen saturation values are similar in the first and second stage of labor in the presence or absence of epidural labor analgesia.

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.

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.