28 research outputs found

    Predictive Utility of Systemic Immune Inflammation Index (SII) in Identifying Endometrial Carcinoma in Premalignant Endometrial Lesions

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    INTRODUCTION: It is important to detect endometrial cancer (EC) in endometrial intraepithelial neoplasia (EIN) patients. It was aimed to determine the role of systemic immune inflammation index (SII) in predicting concurrent EC in women with EIN. METHODS: In this retrospective study, 429 women with EIN divided into three groups according to final histopathologic results: benign(n=151), EIN(n=152), and EC(n=126). Demographic and clinical data, pathologic and laboratory result were collected. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and SII index were calculated and compared among groups. RESULTS: The SII, PLR and NLR values of benign, EIN and EC groups were compared and all values of EC group were the highest. The ROC analysis showed that although all markers had statistical significance, the AUC of SII was the highest. The SII score>0.67 (95%CI: 7.17-37.3) had a 16.35-fold, preoperative platelet count > 287 (95%CI: 1.91-6.2) had a 3.45-fold and age >49 years (95%CI: 1.97-5.92) had 3.42-fold increased risk for EC. DISCUSSION AND CONCLUSION: Although age and preoperative platelet count were found independent risk factors, SII was the strongest predictor for EC in women with EIN. SII can be used as a predictive marker for identifying concurrent EC or having risk for developing EC in women with EIN

    The relationship between Thiol/disulfide homeostasis and endometrial hyperplasia in patients with abnormal uterine bleeding/

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    Introduction: The role of oxidative stress and antioxidant capacity in the development of endometrial hyperplasia (EH) is controversial. Aim: The study aimed to evaluate Thiol/disulfide Homeostasis and ischemia modified albumin (IMA) levels in patients with EH without atypia. Materials and Methods: In this prospective case-control study, patients with EH without atypia (HP group) (n=28), patients with nonhyperplasia (proliferative/secretory/irregular proliferative/irregular secretory endometrium) (non-HP group) (n=28), and 28 healthy women (control group) were included. The patient's clinical characteristics, serum Thiol/disulfide parameters, and IMA levels were compared between groups. Results: A total of 84 patients were included in the study. Patients’ mean age, BMI, and mean native thiol (-SH-), total thiol (-SH-+-SS-), disulfide (-SS-), and IMA levels were similar among the three groups. The -SS- /-SH- ratio was higher in the HP group than the non-HP group. -SS- /-SH-+-SS- ratio was higher in the HP group vs. the other two groups. The -SS- /-SH-+-SS ratio was higher in the HP group vs. the non-HP group. -SH-/ -SH-+-SS- ratio was lower in the HP group than in the non-HP group. ET was greater in the HP group than in the non-HP and control groups. ET was also significantly greater in the non-HP group vs. in the control group. -SS-/-SH- ratio was found to be predictive with 64% sensitivity and 68% specificity for EH (area under curve = 0.672, p = 0.01). Conclusion and Suggestions: The dynamic thiol/disulfide balance shifted to the disulfide side in women with endometrial hyperplasia

    Medroxyprogesterone Acetate Plus Metformin to Prevent Persistent Endometrial Hyperplasia

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    OBJECTIVE: To determine the effect of metformin on treatment response in simple endometrial hyperplasia without atypia. STUDY DESIGN: In this study, we identified 134 women with simple endometrial hyperplasia without atypia. Seventy two of these women were administered cylic oral medroxyprogesterone acetate 10 mg/day for 3 months, 62 of these women were also receiving metformin 1000 mg/day due to preexisting insulin resistance and and all subjects underwent control endometrial sampling after treatment. All subjects were evaluated in terms of age, gravidity, parity, body mass index (BMI), menstrual cycle, luteal phase endometrial thickness, uterine fibroids, ovarian cysts, serum CA 125 levels, systemic disorders, cigarette smoking. All parameters and metformin were assessed for the effects on treatment success. RESULTS: Out of 72 women who were administered medroxyprogesterone acetate 10 mg/day for 3 months, 15 of them were diagnosed as endometrial hyperplasia in control endometrial sampling while only 5 women had persistent endometrial hyperplasia in group with receiving both medroxyprogesterone acetate 10 mg/day and metformin 1000 mg/day (P<0.05). Age, gravidity, serum CA125, BMI, pretreatment endometrial thickness were comparable between groups (P>0.05). CONCLUSION: Medroxyprogesterone acetate and metformin may be used as an adjunctive therapy for persistent endometrial hyperplasias especially in women with high body mass index

    Educational Status Number of Previous Contraceptive Failure Do not Effect the Women’s Contraceptive Preference After Surgical Abortion in Turkey

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    OBJECTIVE: The aim of this study was to investigate the determinants of the contraceptive preference of couples after surgical abortion result of contraceptive failure or no contraception. STUDY DESIGN: Study population consisted of 302 women who admitted to Dr. Sami Ulus Maternity and Women’s Health Teaching and Research Hospital family planning unit and underwent surgical abortion. All pregnancies were in their 5-10 th weeks of gestation. Gravida, parity, number of previous surgical abortions, living children number, last pregnancy status with current contraceptive method were recorded. RESULTS: Mean age, gravida, parity, number of previous surgical abortions and living children were 31.05±6.52 (19-46 years), 4.30±1.83 (1-11), 2.33±1.32 (0-7), 0.96±1.05 (0-5), 2.28±1.29 (0-7) respectively. There were 183 (60,6%) women with previous surgical abortions, mean number of surgical abortions were 1.59±0.6. Among these patients there were 82 (45%) patients using no contraceptive method and 55 (30%) women were using coitus interruptus. Condoms were being used only by 29 (16%) women. Oral contraceptives (OCS) were being used in 11 (6%) women. No association was observed between condom or OCS use and educational status (p=0.786) in these patients. Condom or OCS users a little bit younger but not reached statistical significance (p=0.071). Women with different contraceptive use were similar in terms of gravida, parity, interval from previous pregnancy (p=0.423, p=0.402, 0.467 respectively). No association was obtained between number of previous surgical abortion, current contraceptive use (p=0.386) and educational status (p=0.735). CONCLUSION: Our study suggests that educational status, number previous contraceptive failure or maternal age does not effect the contraceptive preference after surgical abortion

    Ductus Venosus Doppler S/D Value Adjusted Alfa Fetoprotein Levels to Decrease False Positive Rates

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    OBJECTIVE: Fetal liver is mostly perfused by umbilical vein via ductus venosus and AFP is synthesized and secreted from fetal liver. In this study we tried to determine the effect of ductus venosus and umbilical blood flow on serum AFP levels STUDY DESIGN: Sixty women with 16-20 weeks of gestation were enrolled for the study. Subjects were divided into two: AFP levels lower (n=46) and higher than 2 MomS MoMs (n=14). All participants underwent serum AFP, ductus venosus and umbilical artery Doppler Doppler S/D screening. Effect of ductus venosus and umbilical artery blood flow on serum AFP levels were analyzed. RESULTS: Ductus venosus (AUC=0.945, P<0.001) and umbilical artery Doppler S/D (AUC=0.803, P=0.001) values were predictor for low AFP levels. In regression analysis, Ductus venosus Doppler S/D (Beta coefficient= -0.442, P<0.001) and umbilical artery S/D (Beta coefficient= -0.291, P=0.011) values were significantly associated with the AFP levels (R2=0.60). DV and umbilical artery Doppler S/D values adjusted serum AFP levels remained significant but mean value of AFP in group with AFP>2 MoM became 1.98 MoM after adjustment. CONCLUSION: Our study revealed that Ductus venosus and umbilical artery S/D value adjusted serum AFP levels may have lower false positive rates

    Factor affecting lymph node metastasis in uterine papillary serous carcinomas: a retrospective analysis

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    The aim of this study was to investigate the risk factors for lymph node metastasis (LNM) in patients with uterine serous cancer (USC) who underwent systematic staging surgery. Eighty patients who were operated on for pure uterine serous papillary carcinoma between 2008 and 2020 in our clinic were retrospectively analysed. The effects of demographic information and clinicohistopathological characteristics of the included patients on LNM were examined. The median age of the patients included in the study was 64.3 and the tumour diameter was 3.8 cm. At the time of diagnosis, 65.8% of the cases were in the advanced stage, while 34.2% were in the early stage. There was no LNM in 42 (52.5%) of the cases, only pelvic in six (7.5%), only paraaortic LNM in four (5%) patients, and both pelvic and paraaortic LNM in 24 (30%) patients. When factors that may affect LNM were evaluated with multivariate analysis, lymphovascular space invasion (LVSI) and cytology positivity were found to be independent risk factors (p < 0.05). In addition, the rate of isolated paraaortic lymph node involvement in LNM positive patients is 5%, which is 100% associated with LVSI.Impact Statement What is already known on this subject? Uterine papillary serous carcinomas (UPSC) are an uncommon and aggressive histological subtype of endometrial cancer. The high risk of recurrence and tendency to migrate into the abdomen of these tumours is not always connected with lymph node and distant organ metastasis, tumour size, LVSI positive and depth of myometrial invasion. What do the results of this study add? Most patients with UPSC are diagnosed at an advanced stage. In this study, in which 80 patients with pure serous histology were evaluated retrospectively, and LVSI and peritoneal cytology positivity were found to be two important prognostic factors for lymph node metastasis. What are the implications of these findings for clinical practice and/or further research? In this study, cytology and LVSI positivity were identified as two predictive markers for LNM, and it is seen that cytology positivity still maintains its importance in these tumours with peritoneal spread. Furthermore, patients with isolated paraaortic lymph node involvement were shown to be LVSI positive, and isolated paraaortic LNM should be investigated in patients with LVSI positivity

    Does metoclopramide exposure alter endometrial receptivity and decrease pregnancy rates?

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    WOS: 000375027200028PubMed ID: 26421644Objective: The aim of this study was to investigate the effect of metoclopramide on endometrial receptivity with an immunohistochemical investigation of integrin beta 3 expression in pregnant rats. Materials and methods: In the present study, the pregnant mice administrated by different doses of metoclopramide were used to explore the effect of metoclopramide on embryo implantation, especially on the endometrial receptivity. Results: The statistical results showed that the number of implanted embryos was gradually declining along the increasing dose of metoclopramide. When the administrated dose of metoclopramide was 3 mg/kg per day, great changes were observed in the exposed uterine morphology and down-regulated integrin beta 3 were also found in high dose metoclopramide-exposed mice. Conclusion: Metoclopramide exposure, especially in high doses may alter endometrial receptivity by effecting integrin expression on decidual tissue which can decrease pregnancy rates. This drug should only be recommended for use during pregnancy when benefit outweighs the risk

    Retrospective Analysis Of Gestational Trophoblastic Neoplasia: Single Center Experience

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    This study aims to analyze the clinicopathologic characteristics and treatment outcomes of our patients with gestational trophoblastic neoplasia (GTN) and to present our real-life experience. A total of 32 patients with GTN diagnosed according to the FIGO 2002 criteria followed in Zekai Tahir Burak Women's Health Training and Research Hospital between 2011-2018 were included. Demographic features, treatment outcomes, and survival were analyzed retrospectively. The median follow up time was 32.1 (3.3-76.9) months. Of the 32 patients, 27 (84.4%) were defined as low-risk GTN (risk score = 7) according to the FIGO risk score. Seventeen (62.9%) patients with low-risk GTN achieved complete remission (CR) with single agent MTX. CR rate was 60% (12/20) in patients receiving weekly MTX and 71.4% (5/7) in MTX-FA eight-day regimen (p= 0.590). Of the 9 MTX resistant patients, 8 (88.8%) achieved CR with second-line Actinomycin D (ActD). Three (60%) out of the five high-risk GTN patients acquired CR with first-line EMA-CO (etoposide, MTX, plus ActD alternating with cyclophosphamide and vincristine). In the follow-up period one patient (3.1%) had recurrent disease. By the data cut off date, all of the patients were alive and CR could not be achieved in one (3.1%) patient. All patients with low-risk GM achieved CR with sequential therapies ultimately. Therefore, single agent MTX is a reasonable option in the initial treatment of low-risk GTN. Moreover, Actinomycin D is highly effective in patients with low-risk GTN who are resistant to MTX.WoSScopu
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