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

Inherited thrombophilia as a potential risk factor in the etiology of unexplained infertility

WOS: 000375156000006Objective: Unexplained infertility represents one of the most common diagnoses among infertile couples. In this study we investigated the impact of inherited thrombophilia as a risk factor in unexplained infertility. Material and Methods: In this study, genetic mutations of prothrombin gene G20210A, Factor V Leiden and methylene tetrahydrofolate reductase ( MTHFR) C677T, as well as D-Dimer levels were investigated in 25 women diagnosed with unexplained infertility and 25 healthy fertile women. Results: In the present study, among unexplained infertile women and the control group, MTHFR C677T, prothrombin G20210A mutations and D-Dimer levels did not have a statistically significant difference (p>0.05). Factor V Leiden mutation was not observed in either group. Conclusion: Currently, there still are unclear points in the etiopathogenesis of unexplained infertility. As a result of our findings, although we did not observe a significant association between hereditary thrombophilia and unexplained infertility, the presence of a number of studies with contradictory findings demands future research with large sample sizes to clarify this issue

Determination of Y Chromosome Microdeletions in Infertile Men at The Cukurova Region in Turkey

Purpose:Y Chromosome infertility is inherited in a Y-linked manner. Three different regions have been mapped on the long arm of the Y chromosome, named ‘’Azoospermic Factor’’ (AZFa, AZFb and AZFc) are involved in the control of spermatogenesis. Microdeletions in these gene loci may result in azoospermia or severe oligozoospermia. The aim of this study is to establish the prevalence of Y chromosomal microdeletions in infertile men at the Cukurova Region in Turkey. Material and Methods: We evaluated the frequency of Y chromosome deletions in 63 infertile men (38 azoospermic and 25 severe oligozoospermic) and 10 fertile men as a control group by using multiplex polymerase chain reaction (PCR) analyis. Plasma hormone concentrations of all patients including FSH, LH, testosterone, prolactin and leptin were measured by radioimmunoassay Results: Microdeletion frequency detected in all cases was 6.3% (4/63). The values for azoospermic group and severe oligozoospermic group were 7.8% (3/38) and 4% (1/25) respectively. Deletions were found at AZFb, AZFc and proximal AZFc/d regions in infertile group. However, no microdeletions were detected at the AZFa region. No deletions were found in the control group. FSH and LH levels were significantly elevated in azoospermic group than control and severe oligozoospermic groups (p:0.000). Prolactin levels were significantly elevated in azoospermic group than control group (p:0.000). Conclusion:Detection of Y Chromosome deletions in infertile males in routine clinical diagnosis may suitable for counseling prior to assisted reproduction. [Cukurova Med J 2013; 38(4.000): 723-733