Placental-site trophoblastic tumor. Principles of diagnosis, clinical behaviour and treatment

PubMedID: 7556286Placental site trophoblastic tumor (PSTT) is a rare form of the gestational trophoblastic disease (GTD). Seventy four cases have been reported in the English literature up to now. Based on all this data, the death rate is 20% in PSTT. There are many unknown aspect of PSTT on the principles of diagnosis and on the management as well. In this paper, all of the literature related to PSTT has been reviewed and according to these data, diagnosis, clinical behavior and therapy of PSTT have been discussed

A comparative study of the analgesic effect of patient-controlled morphine, pethidine, and tramadol for postoperative pain management after abdominal hysterectomy

PubMedID: 18165596We designed this prospective, randomized, double-blind study to compare the analgesic effectiveness and side effects of IV patient-controlled morphine, pethidine, and tramadol for postoperative pain management. One-hundred-twenty- six ASA physical status I or II patients undergoing abdominal hysterectomy were randomly allocated to receive IV-patient controlled morphine (M), pethidine (P), or tramadol (T) for postoperative analgesia. The cumulative analgesic consumption over 24 h was 25.7 ± 9.5 mg for morphine, 266 ± 90 mg for pethidine, and 320 ± 10 mg for tramadol. The average supplementary fentanyl dose used was significantly higher in group T than in groups M and P (P < 0.05). In conclusion, morphine, pethidine, and tramadol resulted in equivalent pain scores and side effects, but tramadol group T required more rescue analgesic doses of fentanyl. © 2008 by International Anesthesia Research Society

The prevalence of human papilloma virus infection among women who admitted to Çukurova University Faculty of Medicine hospital [Çukurova Üniversitesi Tıp Fakültesi Hastanesine başvuran kadınlarda genital human papilomavirus enfeksiyon prevalans]

Objective: Human papilloma virüs (HPV) is the major etiologic agent for cervical cancer. Cervical cancer is the second most prevalent cancer among women in the world. In this study, we aimed to investigate the prevalence of HPV infection among women admitted to Hospital of Çukurova University Faculty of Medicine. Material and Methods: A total number of 460 cervical smears were obtained from women aged between 20-68 years. Consensus polymerase chain reaction (PCR) assay using MY09/11 and GP5 + /6 + primers were used to detect HPV DNA. HPV DNA positive samples were further stratified as high risk (HR) and low risk (LR) by using HPVpU-1M/pU- 2R and HPVpU-31 B/pU-2R primers, respectively. HPV DNA positive samples were also genotyped for HPV 16, 18, 31 and 45, which are the most frequently detected genotypes in cervical cancer, by using type-specific PCR. Results: Twenty-four of 460 samples (5.2%) were positive for HPV DNA. Among the 24 HPV DNA positive women, 14 (3%) had single or multiple infection with HR HPV types, 10 (2.2%) had isolated LR HPV positivity. Among 24 women with HPV DNA positivity and aged ? 30 years, the most common HPV genotype was HPV 16 (33.3%), followed by HPV 45 (20.8%), HPV 18 and HPV 31 (4.2%), in rank order. Conclusion: The prevalence of genital HPV infection among women who admitted to Hospital of Çukurova University Faculty of Medicine was found as 5.2%. Epidemiological studies for HPV infection should be conducted to establish screening strategies for cervical cancer and to demonstrate the feasibility of HPV vaccination. © 2011 by Türkiye Klinikleri

Administration of preoperative gonadotropin releasing hormone agonist (buserelin) for uterine leiomyomas

This prospective, controlled study included 30 patients with uterine leiomyomas. 15 patients in the study group received intranasal form of Buserelin (GnRH-a) for a dosage of 900 µgr/day for 3 months and at the end of the therapy they underwent myomectomy. 15 patients in the control group underwent myomectomy immediately after they were diagnosed to have leiomyoma uteri. At the end of the third month of buserelin treatment, the mean total volume of the cases reduced 47.2% (p < 0.05). During the 3 months buserelin therapy, mean Hb levels of the cases rose from 10.2 ± 0.5 gr/dl to 13.4 ± 0.6 gr/dl (p < 0.05). Between the control and the study groups operation time was not significantly different. But intraoperative blood loss was significantly low in the buserelin treatment group comparing with the control group (p < 0.05). Especially in anemic, menorrhagic patients with leiomyoma uteri, administration of preoperative GnRH-a increases the haematological parameters of the cases and decreases tile intraoperative hemorrhage

Myomectomy during pregnancy performed because of the acute abdominal pain related to intramural leiomyomata

Three cases who underwent intramural myomectomy during pregnancy because of severe acute abdominal pain resistant to the medical therapy were reported. It is concluded that the surgical management of myoma during pregnancy is safe in carefully selected patients if conservative management of pain due to carneous degeneration of myoma fails

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

PubMedID: 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: R0) 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 intra-abdominal 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 laparoscopic 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 R0 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 CO 2 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 CO 2 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. © 2017 Elsevier Inc

Heterogeneity in recurrent complete hydatidiform mole: Presentation of two new Turkish families with different genetic characteristics

PubMedID: 20870286Subsequent pregnancy outcomes following complete hydatidiform moles (CHM) are usually favorable and the risk of a second CHM less than 2%. However, a small number of women have a rare autosomal recessive condition that predisposes them to CHM. Unlike typical CHM, that are androgenetic (AnCHM), the CHM in these women are diploid and biparental (BiCHM) with a contribution from each parent to the nuclear genome. To date most women with recurrent CHM have been found to have BiCHM and to have a wide variety of mutations in the causative gene, NLRP7. Our objectives were to genotype the molar tissue and identify the NLRP7 mutations in two unrelated Turkish women with recurrent CHM. Fluorescent microsatellite genotyping of molar tissue and screening of patient DNA for NLRP7 mutations was carried out in two women with five and four CHM respectively. The first case was confirmed to have BiCHM. In addition the patient was found to have a novel homozygous mutation in exon 8 of NLRP7. All CHM examined in the second case were AnCHM and no NLRP7 mutations were identified in DNA from the patient. This report describes a further individual with BiCHM and a novel mutation in NLRP7. A second patient with similar clinical history had no mutations in NLRP7 and is the first report of a patient with four CHM where the CHM are androgenetic. This study highlights the heterogeneity of recurrent CHM and the need to investigate women with recurrent molar pregnancies for appropriate clinical management. © 2010 Elsevier Ltd. All rights reserved.This work was supported by a grants from the Cancer Treatment and Research Trust

Is it essential to perform complete paraaortic lymph node dissection if no metastases have been shown in the lower part of the aorta?

PubMedID: 7641738One hundred and twenty eight patients with cervical carcinoma underwent pretherapy staging laparotomy between the years 1991 and 1994. Adopting a transperitoneal approach nodal dissection was performed from the aortic bifurcation to the level of the renal artery. Specimens were segregated into those inferior to and superior to the origin of the inferior mesenteric artery (IMA) then sent for pathologic examination. Of the 15 histologically malign node samples inferior to the IMA, none were associated with neoplasia in the groups of node samples taken from above the IMA. Of the 5 malignant nodal samples taken from above the IMA, all had concurrent neoplastic changes in the specimens taken from below the IMA. An intraoperative complication rate of 8.7% was encountered in the lower nodal dissections. This was compounded by a resultant 7.7% complication rate with nodal dissection above the IMA. As a result of our findings we feel confident in omitting upper paraaortic lymph node (PALN) dissection in the absence of malignant findings in the inferior para-aortic lymph node at frozen section

Dysfunctional uterine bleeding and other menstrual problems of secondary school students in Adana, Turkey

PubMedID: 11173019Study Objective: We documented such menstrual disorders as dysfunctional uterine bleeding (DUB): dangerous health problem during adolescence. Design, Setting, Participants: We gave a questionnaire containing 29 questions about menstruation to 3000 secondary school students in Adana, Turkey. Results: The mean age of the students was 15.8 years; their menarche age was 12.9 years. Irregular periods were observed in 26.7% of the cases, 62.2% had at least one irregular bleeding in their lives, 11.3% visited a gynecologist for irregular bleeding, and 4.5% were treated for it. Dysmenorrhea occurred in 38.7% of the students. Forty-one percent used pain killers during their menstruation; half of them received the drugs from their family, and the other half received them over-the-counter without a prescription. Almost half (46.6%) of the girls experienced premenstrual problems. Most of the students (71.4%) discussed their menstrual problems with their mothers. Among the school girls, 15.8% claimed that there was a correlation between school examinations and irregular menses. Conclusion: The questionnaire's results show that such menstrual disorders during adolescence as DUB are common but neglected. Medical staff who specialize in adolescent gynecology must address the problem