Lymph node metastasis in grossly apparent clinical stage Ia epithelial ovarian cancer: Hacettepe experience and review of literature

Background Lymphadenectomy is an integral part of the staging system of epithelial ovarian cancer. However, the extent of lymphadenectomy in the early stages of ovarian cancer is controversial. The objective of this study was to identify the lymph node involvement in unilateral epithelial ovarian cancer apparently confined to the one ovary (clinical stage Ia). Methods A prospective study of clinical stage I ovarian cancer patients is presented. Patient's characteristics and tumor histopathology were the variables evaluated. Results Thirty three ovarian cancer patients with intact ovarian capsule were evaluated. Intraoperatively, neither of the patients had surface involvement, adhesions, ascites or palpable lymph nodes (supposed to be clinical stage Ia). The mean age of the study group was 55.3 ± 11.8. All patients were surgically staged and have undergone a systematic pelvic and paraaortic lymphadenectomy. Final surgicopathologic reports revealed capsular involvement in seven patients (21.2%), contralateral ovarian involvement in two (6%) and omental metastasis in one (3%) patient. There were two patients (6%) with lymph node involvement. One of the two lymph node metastasis was solely in paraaortic node and the other metastasis was in ipsilateral pelvic lymph node. Ovarian capsule was intact in all of the patients with lymph node involvement and the tumor was grade 3. Conclusion In clinical stage Ia ovarian cancer patients, there may be a risk of paraaortic and pelvic lymph node metastasis. Further studies with larger sample size are needed for an exact conclusion.PubMedWoSScopu

Vaginal Birth or Cesarean Section: Recommendations of Women Who Delivered Via Both Methods

Aim: To determine which method is recommended by women who have delivered via both methods and their reasons for this recommendation. Material and Method: The study included 204 women, mean age was 42 +/- 7.6 years with history of both vaginal and cesarean delivery. A questionnaire was prepared about experiences with vaginal and caesarean delivery. Results: Reasons for cesarean section were maternal preference (40), and obstetric indications (164). Of the 204 women, 129 (63.2%) recommended vaginal delivery to other women. More participants who experienced difficult labor during vaginal delivery recommended cesarean delivery than those who considered their vaginal delivery "easy" (65.4% vs. 10.4%, p<0.01). Recommendation of cesarean section increased significantly with the level of education (p=0.011). The most frequent reason for recommend vaginal delivery was postpartum comfort (64.3%), for recommend cesarean delivery were easy labor (53.3%). Most women who delivered via cesarean section due to obstetric indications (69.6%) recommended vaginal route, whereas most who chose cesarean delivery (62.5%) recommended cesarean section. Discussion: Among women who had delivered via both methods, 63.2% of those recommended vaginal delivery due to primarily postpartum comfort. Patients who recommend cesarean section regarded it as easier primarily because of pain during vaginal delivery

Is the Loop Electrosurgical Excision Procedure Necessary for Minor Cervical Cytological Abnormalities?

Background: To investigate the indications of loop electrosurgical excision procedure (LEEP) and its overtreatment rates for the see and treat and three step strategies in cases of atypical squamous cells of undetermined cytology (ASC-US) and low grade intraepithelial neoplasia (LGSIL) cytology. Materials and Methods: We retrospectively analyzed colposcopy directed biopsy (CDB) and LEEP results of 176 paients with ASC-US or LGSIL cytologies who underwent colposcopic examination. Results: Initial cytologies were ASCUS in 120 women and LGSIL in 56. According to the see and treat approach immediate LEEP was performed for 38 women. Among the remaining 138 women, LEEP was performed for 32 whose CDB results revealed CIN2/3 lesions. In the see and treat group the recognition of CIN2/3 was found to be 39.4%. The overtreatment rate was 60% as compared to 25% in the three step group. In CDB group detection of CIN 2 or greater lesions increased with 3 or more biopsies. Conclusions: In patients with ASC-US/LGSIL cytologies CDB should be performed before LEEP to prevent overtreatment, with attention to all suspected areas and more than 2 biopsies taken

Placental elasticity on patients with gestational diabetes: Single institution experience

Background: Gestational diabetes is defined as glucose intolerance which is first recognized in pregnancy. Oral glucose tolerance test (OGTT) is the cornerstone in diagnosing gestational diabetes. Placental elasticity evaluation is relatively new concept and is principally used for research purposes. We aimed to find any relation between placental elasticity evaluation and patients of gestational diabetes diagnosed by 75 g OGTT. Methods: There were 91 patients took part in study, forming two groups as gestational diabetic patients (21 patients) and control group (70 patients). Elasticity of placenta was determined by acoustic radiation force impulse technology utilized by two blinded radiology specialists. Results: We were not able to find any correlation between 75 g OGTT values and placental elasticity measurements (p > .05). Also placental elasticity was not found to be significantly different in two groups (p > .05). Conclusion: Placental elasticity measurement on the 24th-28th weeks does not seem to be a marker for identification of gestational diabetes. Copyright (C) 2017, the Chinese Medical Association. Published by Elsevier Taiwan LLC