Comparative morphological differences between umbilical cords from chronic hypertensive and preeclamptic pregnancies.

To compare morphological changes in the umbilical cords from chronic hypertensive and preeclamptic patients having normal or pathological umbilical artery Doppler ultrasonographic results. Umbilical cords from 34 normotensive, 31 chronic hypertensive and 70 preeclamptic women with normal and abnormal Doppler flow velocity waveforms (FVW) at 35-40 gestational weeks were studied. Morphological changes in the umbilical cords were examined on formalin-fixed, paraffin-embedded sections. The total umbilical cord area, total vessel area, and wall thickness of umbilical vessels were measured in systematic random samples using unbiased stereology methods. An ANOVA test was used for statistical analysis. In the chronic hypertensive and preeclamptic groups with normal Doppler FVW, the thickness of the umbilical cord vessels remained nearly constant, whereas both the total area and the lumen area were reduced. These changes correlate with the histopathological findings, suggesting a mainly vasoconstrictive effect. By contrast, analysis of the preeclamptic group with pathologic Doppler FVW showed a comparable reduction of all parameters of the umbilical cord. Histopathological findings were related to smaller, contracted smooth muscle cells of the vessel wall, which is suggestive of a predominant hypoplastic mechanism. As a result of reduced uteroplacental perfusion, fetal hypoxia and intrauterine growth retardation become unavoidable in preeclampsia. The histopathological changes in the umbilical cord between the chronic hypertensive and preeclamptic patients depend on the Doppler results. In conclusion, the umbilical artery Doppler FVW indices provide good values for predicting intrauterine growth retardation in preeclamptic patients.</p

Role of lymphadenectomy in disease-free and overall survival on low risk endometrium cancer patients

Objectives: Evaluation of the effect of lymphadenectomy in disease-free and overall survival on the low risk corpus cancer. Material and methods: Between 1994 and 2012, a total of 257 patients with endometrioid type, grade 1 or 2, myometrial invasion &lt; 1/2, no intraoperative evidence of macroscopic extrauterine spread was treated surgically. Pelvic lymphadenec­tomy was performed in 184 cases, and not performed in 73 cases. Results: There was no difference between two groups about tumor sizes. Also lymphovascular space invasion and histo­logic grade of two groups were similar. Omission of LA did not worsen DFS and OS in early stage low risk corpus cancer. Conclusions: Patients who have low risk corpus cancer, can be treated optimally with hysterectomy only

Gestational trophoblastic neoplasia after miscarriage with dilatation and curettage with normal histological findings

Gestational trophoblastic neoplasia may develop after a molar, term, ectopic pregnancy, or an abortion. The diagnosis of gestational trophoblastic neoplasia can be made solely based on changes in human chorionic gonadotropin levels without pathologic confirmation. It is important to distinguish molar pregnancy from that disease, as treatment for these entities differs. However, gestational trophoblastic neoplasia developing after a term or ectopic pregnancy, or an abortion may be difficult to diagnose, because there is no tissue confirmation. In such cases, the time between a previous pregnancy event and the current event, and an inconsistency between very high levels of human chorionic gonadotropin and the size of lesions in the uterine cavity may be warning signs of gestational trophoblastic neoplasia. The role of curettage in the treatment of the disease is limited. We present a case of gestational trophoblastic neoplasia that developed after an abortion, serving as a reminder illustration that gestational trophoblastic neoplasia can develop not only after molar pregnancies, but also after other pregnancy events

Applicability of fetal renal artery Doppler values in determining pregnancy outcome and type of delivery in idiopathic oligohydramnios and polyhydramnios pregnancies

Aims: To investigate the relationship between fetal renal artery Doppler results and pregnancy outcomes in patients with idiopathic abnormal amniotic fluid indices. Material and method: A total of 110 patients without signs of fetal distress were included in the study: 31 idiopathic oligohydramnios and 29 idiopathic polyhydramnios pregnancies (study group) and 50 normal pregnancies (controls). Doppler investigation of the umbilical artery (UA), middle cerebral artery (MCA), fetal descendant thoracic aorta (DTA) and fetal renal artery (RA) was performed in all patients. Fetal RA resistive index (RI) and pulsatile index (PI) values were measured. Values pertaining to type of birth, newborn weight and APGAR scores were compared. Results: Average patient age, gravidity and week of pregnancy were 25±4, 1.6, and 37.4±1, respectively. There were no statistically significant differences between the groups as far as UA S/D, MCA S/D, DTA S/D, DTA RI, DTA PI, and RA S/D measurements were concerned. However, in the oligohydramnios group RA RI and RA PI values were significantly higher than the other two groups. Birth weight in the polyhydramnios group and cesarean section rate due to fetal distress in the oligohydramnios group were significantly higher. Conclusions: In the oligohydramnios group, without affecting fetal distress parameters, Doppler USG evaluation identified an increase in the RA resistance. Also in that group, cesarean rate due to fetal distress during labor was significantly higher than in the remaining two groups. Due to the predictive potential of values of fetal renal artery Doppler of fetal outcome further large sample-sized studies on the subject ought to be carried out

Effects of coffee consumption on gut recovery after surgery of gynecological cancer patients: a randomized controlled trial

BACKGROUND: Paralytic ileus that develops after elective surgery is a common and uncomfortable complication and is considered inevitable after an intraperitoneal operation

DOES TIMING OF TREATMENT HAVE AN EFFECT ON SURVIVAL IN OVARIAN CARCINOMA?

Purpose: Optimal cytoreduction (CRS) is the main treatment modality in epithelial ovarian cancer (OC). Inoperable OC at the time of diagnosis may become eligible for CRS after neoadjuvant chemotherapy (NACT). We aimed to investigate the effect of the time between NACT-CRS and CRS-adjuvant chemotherapy on survival in OC patients.Material and Methods: Demographic and clinicopathological characteristics of sixty-nine patients with OC who underwent CRS after NACT between December 2009 and May 2020 were analyzed retrospectively.Results: The median age was 61.1, and the median overall survival (OS) was 75.8 months. The median time from the end of NACT to CRS was 6.53 weeks, and the median time from CRS to initiation of adjuvant therapy was 4.8 weeks. The mean OS was 123.4 months in patients with a NACT-CRS interval of 6.53 weeks or less, and it was 61.6 months in patients above this period (p>0.05). The OS was 75.7 months in patients with an interval between CRS and adjuvant therapy of 4.8 weeks or less and 55.1 months compared to those with 4.8 weeks or more (p>0.05).Conclusion: It was shown numerically, although not statistically significant, that a long time between NACT and CRS and CRS-adjuvant therapy had a negative effect on OS

The role of changes in systemic inflammatory response markers during neoadjuvant chemotherapy in predicting suboptimal surgery in ovarian cancer

Aim: The aim of this study was to investigate the possibility of using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and platelet count and their dynamic changes during chemotherapy to predict suboptimal interval debulking surgery (IDS) in stage IIIC-IVA serous ovarian cancer (OC)