Prognostic significance of omental disease and the role of omentectomy in non-endometrioid endometrial cancer

Objectives: Non-endometrioid endometrial cancers (non-EEC) have different management from endometrioid endometrial cancers. The purpose of this study was to investigate the prognostic significance of omental disease and the role of omentectomy in non-endometrioid endometrial cancer and discuss the current literature with the findings. Material and methods: The study included two hundred-three patients with non-EEC who underwent surgical treatment and follow-up between January 1996 and December 2018 in a University Hospital Gynecologic Oncology Center. The patients were divided into three groups according to whether omentectomy was performed and the presence of omental metastasis. The patient’s demographics, clinical characteristics such as stage, grade, histopathologic type, lymphovascular space invasion (LVSI), myometrial invasion, lymph node involvement, and survival outcomes were compared between the groups. Results: The study included 203 patients. Twenty-five patients (12%) had omental metastases. LVSI was reported in 57.3%, 88.0%, and 43.2% of the non-omentectomy, no-omental metastasis, and omental metastatic groups, respectively (p = 0.001). The 5-year disease-free survival (DFS) and overall survival (OS) rates according to the tumor grade, peritoneal cytology, and lymphadenectomy were also compared and were found to be statistically similar. The five-year OS rates were 70.6% for the group without omental metastases and 16.2% for the group with omental metastases, respectively (p = 0.001). In the group of omentectomy, the five-year DFS rates were 62.2% in cases without omental metastasis and 13.0% in cases with omental metastasis (p = 0.001). The five-year OS rates of 86.3% and DFS rates of 80.0% in the group without omentectomy. Conclusions: In non-endometrioid tumors, the survival rate was better in the group that did not undergo omentectomy. Based on these results, we can say that omentectomy may not be necessary for non-endometrioid tumors whose omentum is found to be normal in intraoperative visual examination

Challenges on the morbidly obese endometrial cancer surgery: Laparotomy or laparoscopy, lymphadenectomy or no lymphadenectomy?

Objectives: A considerable proportion of endometrial cancer patients are morbidly obese. Management of these cases is a serious dilemma. The aim of this study was to investigate the relevance of laparoscopic route and omission of lymphadenectomy as morbidity-reducing strategies in this special population. Material and methods: Endometrial cancer patients’ archival records were retrospectively reviewed and cases with body mass index ≥ 40 kg/m2 were selected. A comparative evaluation of their characteristics and survival rates were performed. Firstly, according to the surgical approach; laparoscopy or laparotomy, and then regarding to performing lymphadenectomy or not. Results: There were 146 patients enrolled in this study. Whereas, significantly higher postoperative complications and longer hospital stays were determined in the laparotomy compared to laparoscopy groups. Five years disease-free and overall survival were not significantly different (83.6% vs 70.7%, p = 0.184 and 83.9% vs 86.6%, p = 0.571, respectively). On the other hand, operation length, postoperative hospitalization time, both intraoperative and postoperative complications were significantly lower in the non-lymphadenectomy compared to the lymphadenectomy groups. However, five-years disease-free and overall survival were not significantly different (77.3% vs 81.3%, p = 0.586 and 87.5% vs 78%, p = 0.479, respectively). Conclusions: Laparoscopic approach and omission of lymphadenectomy are worthy policies in the morbidly obese endometrial cancer patients

Clinicopathological Features and Prognostic Factors of the Uterine Sarcomas.

TEZ9099Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2012.Kaynakça (s. 70-84) var.ix, 85 s. : res. ; 29 cm.Amaç: Uterin sarkomlar, uterusun; nadir, malign ve agresif seyirli tümörleridir.Bu çalışmanın amacı, son yirmi yıl boyunca kliniğimizde tedavi edilen uterin sarkomlu hastaların, retrospektif olarak, klinik ve patolojik özelliklerini değerlendirmek ve prognozu etkileyen faktörleri araştırmaktır. Gereç ve Yöntem: Kliniğimizde Mart 1991- Mart 2011 tarihleri arasında opere edilen ve düzenli takipleri yapılan 132 uterin sarkom hastasının arşiv dosyaları, klinik ve patolojik kayıtları incelendi. Hastaların klinik özellikleri, operasyon bilgileri, patolojik bulguları, adjuvan tedavileri ve takip bilgileri irdelendi ve sağkalıma etkileri araştırıldı. Kaplan-Meier ve Cox regression testleri kullanılarak, hastalıksız ve toplam sağkalım analizleri yapıldı. Tüm testlerde istatistiksel önem düzeyi p=<0,05 olarak alındı. Bulgular: Hastaların 70'i leiomyosarkom, 33'ü karsinosarkom, 12'si endometrial stromal sarkom, 9'u undiferansiye endometrial sarkom, 5'i adenosarkom ve 3'ü botroid rabdomyosarkom histopatolojisine sahip idi. Hastaların yaş ortalaması 53,7±12,6 (17-78) olarak bulundu. Hastaların yaklaşık 2/3'ü postmenopozal dönemde, 1/3'ü premenopozal dönemde idi. Vajinal kanama, hastaların en sık başvuru nedeni (% 68,9) olarak tespit edildi. Tüm vakalara cerrahi uygulandı ve çoğuna (% 88) cerrahi prosedür olarak total abdominal histerektomi + bilateral salpingooferektomi yapıldı. Hastaların ortalama takip süresi 36 ay (4-198) idi. Toplam sağkalım medyanı 37 ay (% 95 GA, 28-45), iki ve beş yıllık toplam sağkalım oranları sırasıyla % 65 ve % 36 olarak bulundu. Hastalıksız sağkalım medyanı ise 29 ay (% 95 GA, 18-40), iki ve beş yıllık hastalıksız sağkalım oranları da sırasıyla % 59 ve % 33 olarak hesaplandı. Sonuç: Multivaryant analizlerin sonucunda, yaş, evre, lenfovasküler alan invazyonu ve lenfadenektomi hastalıksız sağkalımı etkileyen bağımsız faktörler olarak bulunurken; evrenin, toplam sağkalımın tek bağımsız prognostik faktörü olduğu saptandı.Objective: Uterine sarcomas, are rare, malignant and aggressive tumors of the uterus. In this study we aimed to evaluate retrospectively the clinical and pathologic features and to investigate the prognostic factors of the uterine sarcoma patients who were treated in our department in the last 20 years. Material and Methods: The archive files, medical and pathological records of the 132 uterine sarcoma patients who were operated on and regularly followed up in our clinic between March 1991 - March 2011 were reviewed. Clinical features, operation characteristics, pathological findings, adjuvant therapies and follow-up data of the patients and their effects on survival were investigated. Analysis of disease-free survival and overall survival were calculated using Kaplan-Meier and Cox regression tests. P value was taken <0.05 for the statistical significance level among all results. Results: Seventy of the patients were diagnosed with leiomyosarcomas, 33 with carcinosarcomas, 12 with endometrial stromal sarcomas, 9 with undifferentiated endometrial sarcomas, 5 with denosarcomas and 3 of the cases with botryoid rhabdomyosarcomas. The average of the patients' age was 53,7±12,6 (17-78). About 2/3 of the patients were in the postmenopausal and 1/3 of them in the premenopausal period. Vaginal bleeding was detected as the most common reason for patients'admission (68,9%). All cases underwent surgery and a procedure of total abdominal hysterectomy + bilateral salpingo-oophorectomy was performed for most of them (88%). The mean duration of follow-up was 36 months (4-198). The 2 and 5 years total survival rates were 65% and 36% respectively, with a median time of 37 months (95% CI, 28-45). The 2 and 5 years disease-free survival rates were 59% and 33% respectively, with a median time of 29 months (95% CI, 18-40). Conclusion: As a result of multivariate analysis; while age, stage, lymphovascular space invasion and lymphadenectomy were found to be independent prognostic factors affecting disease-free survival, only stage was detected as independent prognostic factor for overall survival

Thrombocytopenia in Pregnancy

Trombositopeni gebeliklerin %7-10'unda saptanan, trombosit sayısının düşüklüğüyle karakterize bir durumdur. Gebelikte görülen trombositopenin en sık sebebi gestasyonel trombositopenidir. Bu hastalarda trombositopeni genelde hafif olduğundan semptom görülmez. Tanı çoğunlukla bağ dokusu hastalıklarının,ilaç etkilerinin, obstetriyle ilişkili sebeplerin dışlanmasıyla konulur. Erken gebelik haftalarında görülen trombositopenin etyolojisinde en fazla otoimmun sebepler rol alır. Preeklampsi,HELLP sendromu gibi obstetriyle ilişkili nedenlere ikincil gelişen trombositopeniler ise her zaman akılda tutulmalıdır. Bu durumların varlığında çoğu zaman doğum gerçekleşmeden trombositopeni düzelmeyecektir. Klinisyen; tedavi gerektirmeyen trombositopenilerle, annenin fetusun hayatını tehdit eden ve bu nedenle acil ve ciddi bakım gerektiren trombositopeni sebepleri arasında ayırımı iyi yapabilmelidir.Thrombocytopenia, which is encountered in 7-10% of pregnancies is characterized with decreased number of thrombocytes. The most frequent cause of thrombocytopenia during pregnancy is gestational thrombocytopenia. These patients usually do not have symptoms due to mild thrombocytopenia. The diagnosis is usually established by excluding connective tissue disorders, drug effects and obstetric causes. The etiology of thrombocytopenia during early pregnancy is most frequently due to autoimmune causes. Thrombocytopenia secondary to obstetric causes like preeclampsia, HELLP syndrome should always be kept in mind. Under these circumstances the thrombocytopenia will not resolve unless pregnancy is terminated. The clinician should be able to distinguish between thrombocytopenia that does not require treatment and the causes that require emergent and serious medical interventions

A novel technique: Carbon dioxide gas-assisted total peritonectomy, diaphragm and intestinal meso stripping in open surgery for advanced ovarian cancer (Cukurova technique)

WOS: 000409158200036PubMed ID: 28720378Objective. Most of the ovarian cancers are diagnosed at advanced stages. As peritoneal carcinomatosis increases, especially when it extends to the diaphragm and intestinal mesos, probability of obtaining complete cytoreduction is reduced. Complete cytoreduction (residue zero: RO) is one of the main factors affecting survival [1-3]. Here we present a novel technique of stripping the peritoneal surfaces as a part of cytoreductive surgery in such cases. Methods. A 55 year-old woman diagnosed with peritoneal carcinomatosis was considered appropriate for primary cytoreduction after assessment of her thorax-abdominopelvic tomography, which revealed resectable intraabdominal disease. Upon laparotomy, omental cake adherent to pelvis-filling mass, disseminated implants on the diaphragm, meso of the descending colon and small intestine were observed. The mass invaded the rectosigmoid colon, uterus, adnexa and the bladder resulting in frozen pelvis. Palpable retroperitoneal pelvic and para-aortic lymph nodes were detected. On the other side, stomach, anti-mesenteric surfaces and mesentery root of the small bowel were tumor-free. Hence, upon these perioperative and preoperative imaging findings, complete cytoreduction was thought to be achievable. Therefore, primary cytoreduction was performed. Total omentectomy, hysterectomy with bilateral salpingo-oophorectomy, rectosigmoid low anterior resection and retroperitoneal lymphadenectomy were performed. With the assistance of an injector needle connected to the insufflator tube (as in laparostopic surgery), carbon dioxide gas was blown into the right retroperitoneal area and subsequently peritoneum was rapidly stripped up to the right diaphragm. The same procedure was then applied to the diaphragm and meso of the bowels, respectively. Owing to this technique, total stripping of all involved peritoneal surfaces was clearly facilitated and RO goal was reached. Results. Gas insufflation caused convenient detachment of the peritoneal surfaces along their anatomical line which led to concluding the stripping procedures easily, rapidly and safely without bleeding. Thus, according to our experience, about 10 to 15 min per procedure are saved in such cases. Potential complications of CO2 gas used here are not superior to those in transperitoneal or retroperitoneal laparoscopic procedures. During the operation, patient was followed-up for potential complications such as subcutaneous emphysema and CO2 gas embolism.Thus, hourly blood gas was monitored. Another potential complication is injury of the vessels while inserting the needle which can be avoided by cautious inserting under the peritoneal surfaces superficially and using transillumination. In case such injuries happen, tamponing is a sufficient measure. In our serial, no perioperative complications belonging to this technique were encountered. However, long term outcomes such as precise time difference, difference in blood loss, complication rates, adhesions, morbidity associated with this technique and its impact on survival of the patients with advanced ovarian cancer have yet to be investigated. Therefore, a prospective study to validate this technique's long-term usefulness has been initiated in our clinic. Conclusion. We believe that this practical and effective technique will offer significant improvements in efforts to achieve complete cytoreduction. (C) 2017 Elsevier Inc. All rights reserved

Pregnancy and HIV Infection

Human Immunodeficiency Virus (HIV) enfeksiyonunun yönetimi hızlı şekilde değişim göstermeye devam etmektedir. Gelişmiş ülkelerdeki perinatal geçiş oranları, antiretroviral tedavi (ART) ve sezaryen doğumun planlanmasıyla %20-30'lardan, %1-2'lere kadar düşürülmüştür. Perinatal geçişin azaltılması için yapılan girişimler HIV ile enfekte kadınlar için uygulanan prenatal bakımı daha kompleks hale getirmiştir. Standart bakımın çok hızlı değişmesi ve HIV enfeksiyonu yaygınlığının giderek artması nedeniyle gebe takibi yapan klinisyenlerin bu konudaki güncel bilgilere sahip olması önemlidir. Bu nedenle makalemizde, HIV enfeksiyonunun prenatal dönemdeki seyri, tedavisi ve perinatal geçişin önlenmesi için alınacak tedbirleri özetlemeyi amaçladıkThe management of Human Immunodeficiency Virus (HIV) infection is progressing rapidly. In developed countries, the perinatal transmission rates have decreased from 20-30% to 1-2% with the use of antiretroviral therapy and cesarean section. Interventions for the prevention of prenatal transmission has made the prenatal care of pregnant patients with HIV infection more complex. Rapid development of standard care and continuing increase in the distribution of HIV infection has required clinicians taking care of pregnants to have current information. Therefore, in our review we aimed to summarize the prenatal course, treatment and preventive methods for perinatal transmission of HI

Comparison of pregnancy rates with intramuscular and vaginal progesterone use for luteal phase support in intracytoplasmic sperm injection cycles

Amaç: Gonadotropin releasing hormon analogları (GnRHa) kullanılarak kontrollü ovarian hiperstimulasyon yapılan in vitro fertilizasyon - intrasitoplazmik sperm enjeksiyonu-embriyo transferi sikluslarında, luteal faz desteği için intramuskuler progesteron ve vajinal progesteron karşılaştırmaktır. Gereç ve Yöntem: Çalışmaya kontrollü ovaryen hiperstimulasyon ile birlikte İn Vitro Fertilizasyon İntrasitoplazmik Sperm Enjeksiyonu - Embriyo Transferi yapılan 66 hasta dahil edildi. Oosit toplanmasının ertesi gününden başlayarak 32 hastaya vajinal (günlük 90 mg jel) ve 34 hastaya intramuskuler progesteron (günlük 50 mg) verildi. 20 mIU/mL ve üstü ?-hCG değeri pozitif olarak kabul edildi. ?-hCG pozitifligi, klinik gebelik ve canlı doğum iki grup arasında karşılaştırıldı. Bulgular: İn Vitro Fertilizasyon - İntrasitoplazmik Sperm Enjeksiyonu ve Embriyo Transferi yapılan kadınlarda oosit toplanması günü başlanarak günde bir kere vajinal progesteron jel(90 mg) verilmesi, günlük intramuskuler progesteron (50 mg) verilmesi ile benzer oranlarda ?-hCG pozitifliği, klinik gebelik ve canlı doğum oranları sağlamıştır. Sonuç: intramuskuler progesteron desteğinden sonra elde edilen sonuçlarla benzerdir. Vajinal yolla progesteron kullanımı hastalar tarafından da daha kolay tolere edilebilen bir metotturPurpose: This study aimed to compare the pregnancy rates of intramuscular and vaginal progesterone use for luteal phase support in in vitro fertilization intracytoplasmic sperm injection and embryo transfer cycles done with gonadotropin releasing hormone analogs. Material and Methods: Sixty six patients undergoing in vitro fertilization -intracytoplasmic sperm injection and embryo transfer with controlled ovarian hyperstimulation were included. Thirty two patients were supplemented with vaginal gel (90 mg daily) and thirty four patients with intramuscular progesterone (50 mg daily) starting at the day on oocyte retrieval. 20 mIU/mL or above was considered positive for ?-hCG. Positive ?-hCG, clinical pregnancy and live birth rates were compared among these groups. Results: In women undergoing intracytoplasmic sperm injection and embryo transfer, vaginal progesterone supplementation once a day beginning the day after oocyte retrieval resulted in comparable rates of positive ?-hCG, clinical pregnancy and live birth rates with women supplemented with intramuscular progesterone. Conclusion: The results of vaginal progesterone administration were similar with the results obtained with intramuscular progesterone. Vaginal progesterone use is a more tolerable method for patients

The role of anti-mullerian hormone for determining the ovarian reserve of IVF patients

WOS: 000399405200003Purpose: The puspose of this study was to find the level of effectiveness and reliability of AMH (anti-mullerian hormone) in indicating the over reserve of IVF patients in comparison with other reserve indicators used. Materials and Methods: The study included 89 infertile couples ages between 18 and 45. Basal serum FSH, LH, E2, prolactin, fT3, fT4 and TSH, AMH levels of female patients were measured in the 3rd day of menstruation. Ovary volume and AFC(antral follicle count) were determined through transvaginal ultrasound. In our study, all patients were subjected to long protocol with GnRH agonist. Oocyte numbers equal to or higher than 4 were included in the " good response" group and oocyte numbers lower than 4 were included in the "poor response" group. Afterwards, the results obtained were statistically compared with other parameters used for determination of ovarian reserve. Results. Significant differences were present between two groups in terms of age, serum FSH, AMH levels, hCG day E2 levels, number of antral follicles, hCG day follicle numbers and mature oocyte numbers. When the cutoff value for AMH was taken to be 0,24 ng/ml, sensitivity and specifity were determined to be 82.1% and 72.7% respectively. Conclusion: There is a strong relationship between serum AMH level and the ovarian response of the patients. Besides, AMH levels were determined to be in relation with the pregnancy rate