The Role of Adenomyosis in the Pathogenesis of Preeclampsia

INTRODUCTION

Adenomyosis can cause defective deep placentation. Preeclampsia is known to be associated with abnormal placentation. The aim of this study was to compare the presence of adenomyosis on magnetic resonance imaging in patients with and without history of preeclampsia in order to investigate the possible role of adenomyosis in the pathogenesis of preeclampsia.

MATERIALS AND METHODS

This prospective, randomized study consisted of patients with (n = 35) and without (n = 34) history of preeclampsia. Direct (submucosal microcysts, adenomyoma and cystic adenomyoma) and indirect (maximal thickness of junctional zone, ratio of maximal thickness of junctional zone to myometrial thickness, junctional zone differential, focal thickening of junctional zone, globally enlarged uterus and non-uniform junctional zone contours) signs of adenomyosis were assessed by pelvic magnetic resonance imaging.

RESULTS

The prevalence of adenomyosis was found to be more common in patients with preeclampsia und fetal growth restriction compared to patients without fetal growth restriction (94.4 vs. 64.7 %; p = 0.041), respectively. There was a strong association between maximal thickness of junctional zone (9 vs. 13 mm, p = 0.005), ratio of maximal thickness of junctional zone to myometrial thickness (0.42 vs. 0.66, p = 0.001) and junctional zone differential (3 vs. 5 mm, p = 0.02) and late-onset preeclampsia.

CONCLUSIONS

Presence of adenomyoma is more common in patients with preeclampsia complicated with fetal growth restriction. Indirect signs of adenomyosis detected on pelvic magnetic resonance imaging might have a role in the pathogenesis of late-onset preeclampsia.

Effect of Pirfenidone on Vascular Proliferation, Inflammation and Fibrosis in an Abdominal Adhesion Rat Model

AIM

To study the efficacy of pirfenidone for prevention of postoperative adhesion formation in an adhesion rat model.

MATERIALS AND METHODS

Eighteen female Wistar rats were subjected to right-sided parietal peritoneum and right uterine horn adhesion model. Rats were randomized into three groups: group 1 (control) (closure of midline abdominal incision without any agent administration), group 2 (closure of incision after intraperitoneal administration of pirfenidone), and group 3 (closure of incision and only oral administration of pirfenidone for 14 days). Relaparotomy was performed 14 days after the first surgery. Effect of pirfenidone on adhesion formation was assessed on light microscopy by scoring vascular proliferation, inflammation, fibrosis, and collagen formation in the scarred tissue. Effect of pirfenidone on inflammation was assessed by measurement of transforming growth factor-β and interleukin-17 levels in scarred tissue.

RESULTS

The degree of vascular proliferation (1.32 ± 0.39 versus 2.34 ± 0.46, p < 0.001), inflammation (1.60 ± 0.70 versus 2.60 ± 0.52, p < 0.01), and fibrosis (1.50 ± 0.53 versus 2.40 ± 0.52, p < 0.01) were less prominent in group 2 compared to group 1, respectively. Only vascular proliferation was found to be less prominent in group 3 compared to group 1 (1.60 ± 0.42 versus 2.34 ± 0.46, p < 0.01). Intraperitoneal and oral administration of pirfenidone reduced tissue levels of inflammatory markers (TGF-β and IL-17) in parietal and visceral peritoneum compared to control group. Intraperitoneal administration of pirfenidone compared to oral administration was more effective in reducing tissue levels of inflammatory markers.

CONCLUSION

Pirfenidone is an effective agent on the prevention of postoperative vascular proliferation, inflammation and fibrosis in scarred tissue particularly with intraperitoneal administration.

What are the best surgical techniques for caesarean sections? A contemporary review

The aim of this study was to evaluate the reported techniques used in caesarean sections in order to form a general perspective of the procedural options for this frequently performed operation. The PubMed database and Cochrane Reviews were searched separately with the key words 'caesarean', 'abdominal entry', 'abdominal incision', 'uterine repair', 'peritoneal repair', 'closure of abdominal incision', 'suture materials', 'extraction of the placenta' and 'review'. Reviews, meta-analyses and prospective randomised trials were included in this review. In conclusion, although caesarean delivery is a very common operation, standardised and globally accepted techniques for caesarean section have not been described. The best surgical techniques for this operation are still unknown. Although the long-term follow-up results from two large, prospective, randomised studies are pending, further research is needed to establish an evidence-based, standardised approach for caesarean sections.

Comparison of Subcuticular Suture Materials in Cesarean Skin Closure

Aim. Comparison of the rate of wound complications, pain, and patient satisfaction based on used subcuticular suture material. Methods. A total of 250 consecutive women undergoing primary and repeat cesarean section with low transverse incision were prospectively included. The primary outcome was wound complication rate including infection, dehiscence, hematoma, and hypertrophic scar formation within a 6-week period after operation. Secondary outcomes were skin closure time, the need for use of additional analgesic agent, pain score on numeric rating scale, cosmetic score, and patient scar satisfaction scale. Results. Absorbable polyglactin was used in 108 patients and nonabsorbable polypropylene was used in 142 patients. Wound complication rates were similar in primary and repeat cesarean groups based on the type of suture material. Skin closure time is longer in nonabsorbable suture material group in both primary and repeat cesarean groups. There was no difference between groups in terms of postoperative pain, need for additional analgesic use, late phase pain, and itching at the scar. Although the cosmetic results tended to be better in the nonabsorbable group in primary surgery patients, there was no significant difference in the visual satisfaction of the patients. Conclusions. Absorbable and nonabsorbable suture materials are comparable in cesarean section operation skin closure.

Evaluation of the effects of gonadotropin-releasing hormone antagonist (GnRH-ant) and agonist (GnRH-a) in the prevention of postoperative adhesion formation in a rat model with immunohistochemical analysis

OBJECTIVE

To investigate the effects of GnRH antagonist (GnRH-ant) and agonist (GnRH-a) in the prevention of postoperative pelvic adhesions by a visual scoring system and immunohistochemical methods in a rat uterine horn model.

DESIGN

Controlled experimental animal study.

SETTING

Animal laboratory at an academic research environment.

ANIMAL(S)

Twenty-one Wistar albino rats.

INTERVENTION(S)

Rats were randomized into three groups. One week before the operation the rats received either GnRH-ant or GnRH-a or saline solution; they then underwent surgical laparotomy, and both uterine horns were traumatized by a scalpel. Three weeks later, all rats were sacrificed and extension and severity of the adhesions in each group were scored by a visual scoring system. Adhesion tissues were evaluated immunohistochemically for vitronectin and u-PAR.

MAIN OUTCOME MEASURE(S)

Scores of extend and severity of adhesions and staining of vitronectin and u-PAR.

RESULT(S)

The extent of adhesion scores were 1.85 ± 0.86, 0.78 ± 1.05, and 0.42 ± 0.64, and the severity of adhesion scores were 1.71 ± 0.91, 0.57 ± 0.85, 0.50 ± 0.75 for control, GnRH-ant, and GnRH-a groups, respectively. The extent and severity of adhesions were significantly lower in both GnRH-ant and GnRH-a groups when compared with the control group. Adhesion extent scores in the GnRH-a group were lower than in the GnRH-ant group, but this difference was not significant. vitronectin and u-PAR staining were significantly greater in both the GnRH-ant and GnRH-a groups than in the control group.

CONCLUSION(S)

GnRH-ant as well as GnRH-a reduced postoperative adhesion formation in a rat model. This finding was supported immunohistochemically by vitronectin and u-PAR staining.

Quality of life in women with gynecologic cancer in Turkey

AIM

The management of gynecological cancer patients mainly aims at prolonging survival but modern therapy focuses on good survival combined with a good quality of life (QoL). The aim of this study was to evaluate QoL and identify its associated factors in Turkish women with gynecologic cancer.

METHOD

The study included 119 women diagnosed with endometrial, cervical, ovarian or vulvar cancer and treated at the Gynecologic Oncology Department of Celal Bayar University Faculty of Medicine. The data were collected between January and June 2011. QoL was measured with EORTC QLQ-C30 version 3.0. Relationships between clinical and socio- demographic characteristics and QoL scores were analyzed using the Mann-Whitney U, Kruskal Wallis and t-tests.

RESULT

Global health status, physical and role function scores were found higher in women under the age of 60 years. Role function scores were found lower, and emotional and social scores were found to be higher in single women than in married women. Physical scores were found higher in women who had graduated from secondary school or above. Women with ovarian cancer had the highest while women with cervical cancer had the lowest global health score (65.3 ± 24.7 and 43.0 ± 24.1, respectively). Women with endometrial cancer were found to have better role function, and social well being than those with vulvar, cervical or ovarian cancer. Global, physical, role function, cognitive and social scores were found higher in women who had been treated with surgery.

CONCLUSION

Gynecological cancer and treatment processes cause significant problems that have negative effects on physical, emotional, social and role function aspects of QoL. Health care providers play a key role in the identification and treatment of the complications of cancer therapy. Minimizing the effect of the symptoms of gynecologic cancer may positively impact on patient QoL.

The availability of vaginal hysterectomy in benign gynecologic diseases: a prospective, non-randomized trial

OBJECTIVE

To determine whether vaginal hysterectomy can be performed in patients with benign gynecologic diseases regardless of uterine size, uterine mobility and previous pelvic surgery and to compare with abdominal hysterectomy.

STUDY DESIGN

Between 2003 and 2008, we compared 47 vaginal hysterectomies (VH) with 61 abdominal hysterectomies (AH). We excluded from the study the clinical conditions that mandate abdominal exploration and standard indications for VH such as uterovaginal prolapse. Large, immobile uterus and previous pelvic surgery were not accepted as a contraindication for VH. Demographic characteristics, primary diagnosis, uterine weight, operation time, intraoperative blood loss, complications, and hospital stay and cost in both groups were compared.

RESULTS

Groups were similar with respect to demographic features and primary indications. Mean uterine weight and mean operation time were similar in VH and AH groups (258.0 g vs 293.9 g and 93.7 min vs 101.4 min, respectively). Oopherectomy was performed in 44.7% of VH and in 83.6% of AH. Colporrhaphies and/or anti-incontinence surgery were performed in 15 patients in the VH group (31.9%). The intraoperative blood loss was lower in the VH group than the AH group (245.0 mL vs 408.6 mL, P < 0.001). Perioperative complications were increased with AHs. The mean hospital stay and operation cost in the VH group were significantly less than the AH group (P < 0.001).

CONCLUSION

This study indicates that vaginal hysterectomy could be performed with less morbidity in patients with benign gynecologic diseases even in large, immobile uterus and previous pelvic surgery.

Effects of selective and non-selective cyclooxygenase (COX) inhibitors on postoperative adhesion formation in a rat uterine horn model

OBJECTIVE

To investigate the effects of cyclooxygenase (COX) inhibitors including celecoxib, indomethacin, and nimesulide on postoperative adhesion formation.

MATERIAL AND METHODS

Forty-eight female Wistar-Albino rats were randomly divided into four groups: control (saline solution), celecoxib, indomethacin, and nimesulide groups. The uterine horns of rats were traumatized with unipolar electrocautery. Drugs of each group and saline in the control group were insillated on travmatized areas of horns as intraperitoneally. After three weeks, the extent and severity of adhesions with a standardized scoring system were evaluated.

RESULTS

The extent and severity of postoperative adhesions were significantly reduced in nimesulide group compared with the control group. The extent but not severity of adhesions in rats given indomethacin was significantly reduced. Celecoxib showed no significant reduction in the extent and severity of adhesions.

CONCLUSION

Nimesulide is more effective than the other COX inhibitors in the prevention of postoperative adhesions in rats.

Effects of different postmenopausal hormone therapy regimens on cerebral blood flow and cognitive functions

INTRODUCTION

The purpose of this study was to compare the effects of different postmenopausal hormone therapy regimens, namely conjugated equine estrogens (CEE), CEE plus medroxyprogesterone acetate (MPA), tibolone, and raloxifene on cerebral blood flow and cognitive functions.

METHODS

A total of 64 healthy postmenopausal women admitted to the Department of Obstetrics and Gynecology, Cumhuriyet University, Turkey were included in this study. Patients were divided into five groups with respect to the treatment protocols: CEE 0.625 mg/day (n=13); CEE 0.625 mg/day + MPA 2.5 mg/day (n=14); tibolone 2.5 mg/day (n=11); raloxifene 60 mg/day (n=9); and control (n=17). The CEE group included only women with surgical menopause. Those who were on hormonal therapy, who had previously used hormonal therapy, who had neurological disorders, or who did not accept the longterm follow-up were excluded from the study. Demographic and clinic characteristics were recorded. Before starting the therapy regimens, cerebral blood flow was evaluated by internal carotid artery and middle cerebral artery peak systolic velocity, and pulsatility index measurements via Doppler ultrasonography. Cognitive functions were evaluated by the Standardized Mini-Mental Test. The mean follow-up period was 10.9+/-2.4 months, ranging between 8 and 16 months. After the follow-up period, the cerebral blood flow, and cognitive function of each woman was re-evaluated.

RESULTS

Demographic and clinical characteristics of the women were not significantly different between the study groups (P>0.05). There were no significant differences between the pretreatment and posttreatment values for cerebral blood flow indices and cognitive function scores in any of the study groups (P>0.05).

CONCLUSION

Different postmenopausal hormone therapy regimens have not revealed any significant effects on either cerebral blood flow or cognitive function.

The Effect of Glyceryl Trinitrate on Hypertension in Women with Severe Preeclampsia, HELLP Syndrome, and Eclampsia

OBJECTIVE

The goal of this study is to evaluate the effect of glyceryl trinitrate (GTN) in the management of hypertension in women with preeclampsia, eclampsia, and HELLP syndrome.

STUDY DESIGN

Fifty five women with preeclampsia, eclampsia, and HELLP syndrome administered GTN infusion for the management of hypertension were studied. Demographic, clinical, and perinatal outcome findings were collected for analyses. We recorded initial and maintenance doses of GTN, and duration of its use in prepartum and postpartum periods. We collected systolic and diastolic blood pressures (BPs) at admission and before the administration of GTN infusion. During the GTN infusion, we calculated average diastolic and systolic blood pressures 6 hours apart on the first day, 12 hours apart on the second day, and 24 hours apart on the third day.

RESULTS

Of 55 women, 24 with severe preeclampsia, 16 with HELLP syndrome, and 15 with eclampsia were included in this study. In severe preeclampsia group, GTN infusion significantly reduced systolic and diastolic BPs beginning from the second quarter and third quarter, respectively, of first day (p < 0.05). In the HELLP syndrome group, GTN infusion significantly decreased systolic and diastolic blood pressures beginning from the third quarter and second quarter, respectively, of the first day (p < 0.05). In the eclampsia group, GTN infusion significantly reduced systolic and diastolic blood pressures beginning from the third quarter and first quarter, respectively, of the first day (p < 0.05).

CONCLUSION

In women with severe preeclampsia, eclampsia, and HELLP syndrome, infusion of GTN can be used as an alternative agent to well-known drugs and causes no significant adverse effect to the mother and fetus.

Correlation between birth weight, leptin, zinc and copper levels in maternal and cord blood

Leptin and zinc are involved in the regulation of appetite. Copper is a trace element regulating the functions of several cuproenzymes that are essential for life. To evaluate the relationship between zinc and copper status and the leptin system in humans, we examined whether leptin concentrations in the mother and the newborn correlate with the weight of mother, placenta and newborn. A total of 88 pregnant women at 38-42 weeks' gestation were studied. All infants were categorized as small for gestational age (SGA) (n = 16), average for gestational age (AGA) (n = 59) or large for gestational age (LGA) (n = 13). Leptin, zinc, and copper levels were measured in maternal and cord serum at birth. Maternal BMI and placental weight of the LGA groups were significantly higher than those of the SGA and AGA groups. Cord and maternal leptin levels of the SGA groups were significantly lower than those of the AGA and LGA groups. Maternal serum leptin levels were positively correlated with BMI and maternal zinc levels in all groups. Cord serum leptin levels of all groups were positively correlated with birth weight and placental weight. Birth weight was negatively correlated with maternal and cord copper level of all groups. Umbilical leptin concentrations of SGA newborns correlated with leptin concentrations of their mothers. In all pregnancies, birth weight increases in association with increase in cord leptin level. Our results suggest that maternal zinc but not copper level has an effect on maternal serum leptin levels. The increase in copper level in both maternal and cord blood may contribute to restriction in fetal growth.

Investigation of the effects of heparin and low molecular weight heparin on E-cadherin and laminin expression in rat pregnancy by immunohistochemistry

BACKGROUND

Heparin and low molecular weight heparin (LMWH) are used widely to improve the pregnancy outcome in women with thrombophilia, miscarriage, recurrent miscarriage and fetal death. This study was designed to investigate the effects of heparin and LMWHs, enoxaparin and tinzaparin, on E-cadherin and laminin expression in placental and decidual tissues in rat pregnancy.

METHODS

Wistar albino female rats (n = 48) were randomly assigned to four study groups (normal saline, heparin, enoxaparin and tinzaparin) in the preconceptional period. Tissue sections of placenta and decidua were immunohistochemically examined for the expression of E-cadherin and laminin.

RESULTS

E-cadherin placental staining score of heparin group was significantly lower and E-cadherin decidual staining score of heparin and enoxaparin groups were significantly lower than control group. There were no significant differences in placental and decidual laminin staining scores among the study groups.

CONCLUSIONS

Heparin and enoxaparin can reduce E-cadherin expression but not laminin expression in rat pregnancy. They might modulate trophoblast invasion. We suggest that this is the possible underlying mechanism involving in improvement of trophoblast invasion by the use of heparin and LMWH in patients with the history of miscarriage.

The role of cytoreductive surgery in nongenital cancers metastatic to the ovaries

OBJECTIVE

To investigate the role of cytoreductive surgery in patients with nongenital cancers metastatic to the ovaries.

PATIENTS AND METHODS

One hundred and fifty-four patients with nongenital cancers metastatic to the ovaries treated in Hacettepe University Hospital, Gynecologic Oncology Unit between 1982 and 2004 years were retrospectively evaluated. Data were obtained from patients' records and pathology reports. Demographic characteristics, prognostic factors, 5-year and median survivals were analyzed in all patients.

RESULTS

During study period, nongenital cancers metastatic to the ovaries constituted 9% of all malignant ovarian neoplasms. Primary cancers were breast (35), stomach (35) and colorectal (33) cancers, lymphoma (17), undetermined origin (16), appendix (7), ileum (4), pancreas (3), gallbladder cancer (2) and mesothelioma (2). Of patients, 67% were premenopausal and 33% were postmenopausal. Although most common presenting symptoms were abdominal distension with dyspeptic complaints in 46%, abdominal mass in 22%, and pressure symptoms in 8.4%, 15 patients (10%) were asymptomatic and were diagnosed in routine control examinations. Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO), omentectomy, and bilateral pelvic and para-aortic lymphadenectomy (BP-PALND) with cytoreduction were performed in 102 patients (66%), TAH + BSO + omentectomy in 21 patients (14%), TAH + BSO in 23 patients (15%), minimal surgical effort including BSO or biopsy in 8 patients (5%). Eighty-four percent of patients received adjuvant treatment according to the primary origins. Mean follow-up was 47.3 +/- 5.9 months. Overall, 5-year survival was 36% and median survival was 42 months. Comparison of median survival times for the primary sites showed a significant overall differences (P = 0.0001) and were as follows: breast 54 months, stomach 18 months, colorectal 48 months, lymphoma 181 months, unknown primary 16 months, appendix 18 months, ileum 40 months, pancreas 3 months, gallbladder 8 months and mesothelioma 20 months. Median survival time of patients who underwent cytoreductive surgery was 48 months, compared with 26 months for patients with suboptimal cytoreductive surgery (P = 0.0039). The 5-year survival rate was 47% and 23%, respectively. Multivariate analysis identified age, menopausal status, primary site, diffuse peritoneal involvement and type of operation as prognostic factors.

CONCLUSION

Presence of ovarian metastasis is associated with a poor prognosis in nongenital cancers. Surgery is essential for diagnosis of primary tumor and necessary for relief of symptoms. Cytoreductive surgery seems to have a beneficial effect on survival of selected patients, especially for patients with colorectal cancer metastatic to the ovary.

Comparison of effects of cyclooxygenase inhibitors on myometrial contraction and constriction of ductus arteriosus in rats

The aim of this study was to compare the tocolytic effect of a selective cyclooxygenase-2 inhibitor, DFU (5,5-dimethyl-3(3-fluorophenyl)-4-(4-methylsulphonyl)phenyl-2(5H)-furanone), indomethacin and nimesulide on myometrial strips isolated from rats in both lipopolysaccharide-induced preterm labour and term labour. We also compared the constrictor effects of DFU and indomethacin on the fetal ductus arteriosus. Myometrial strips were obtained from preterm and term labour Wistar albino rats and were mounted in organ baths for the recording of isometric tension. DFU, nimesulide and indomethacin significantly inhibited KCl-, oxytocin-, prostaglandin E(2)- and prostaglandin F(2 alpha)-stimulated contractions of myometrial strips isolated from rats in preterm and term labour. The E(max) value of indomethacin was significantly lower than those for DFU and nimesulide (P<0.05), with no change-log (10) EC(50) values. There was no significant difference between in -log (10) EC(50) and E(max) values of DFU and nimesulide for any of the tissues (P>0.05). In addition, there was no significant difference between -log (10) EC(50) and E(max) values for each of these three agents in myometrial tissues isolated from rats in preterm and term labour (P>0.05). Fetal ductus arteriosus was significantly constricted by DFU (10 or 100 mg/kg) in preterm and term rats, although DFU (10 or 100 mg/kg)-induced constriction ratios were significantly lower than those for indomethacin (P<0.05). These data demonstrate that DFU, a specific cyclooxygenase-2 inhibitor, could be considered as a new therapeutic agent for preterm labour. However, careful attention should be given to constriction of the fetal ductus arteriosus.

Effects of Diazeniumdiolates (NONOates) and Methylene Blue on the Reduction of Postoperative Adhesion in Rats

We investigated the effects of spermine NONOate (SPER/NO), diethylenetriamine NONOate (DETA/NO) and methylene blue for preventing postoperative adhesion in a rat uterine horn model. Before operations, rats were randomly assigned into 6 groups, each composed of 12 rats. These were the sham, control, normal saline, SPER/NO, DETA/NO and methylene blue groups. Each rat was anesthetized with ketamine hydrochloride (40 mg/kg i.v.). The abdominal wall was shaved; the surgical site was scrubbed with povidone iodine and rinsed with sterile saline 3 times before surgery. Under sterile conditions, a 3-cm vertical midline incision was made in all groups. In the sham group, we closed the abdominal wall without any procedure. In the other groups, a 2-cm segment of each uterine horn was injured in 10 spots on the antimesenteric surface using unipolar cautery. Before the final abdominal closure, no adjuvant therapy was administered intraperitoneally to the rats in the control group; 2 ml of normal saline solution, 1% methylene blue solution, SPER/NO (0.5 mg/ml) and DETA/NO (0.1 mg/ml) were instilled into the uterine horns of the rats in the respective groups. The incision was closed with a running 4-0 monofilament delayed absorbable suture in a single layer of muscle and fascia in a running pattern, excluding the peritoneum, and in the covering layer of skin in an interrupted pattern, in all groups. Two weeks after the surgery, all animals were killed, second laparotomies were performed, and the extent and severity of adhesions were determined by a blinded examiner. The adhesion scores of the sham group were significantly lower than those of the other groups (p < 0.05). In the methylene blue, SPER/NO and DETA/NO groups, adhesion scores were significantly lower than in the normal saline and control groups (p < 0.05). However, there were no significant differences related to the extent and severity scores of adhesions between the methylene blue, SPER/NO and DETA/NO groups (p > 0.05). This study showed that SPER/NO, DETA/NO and methylene blue administered at the end of surgery reduced the adhesion formation in a rat uterine horn model.

Comparison of the effects of nimesulide and 5,5-dimethyl-3-(3-fluorophenyl)-4-(4-methylsulphonyl) phenyl-2(5H)-furanone (DFU) on contractions of isolated pregnant human myometrium

OBJECTIVE

To compare the effects of 5,5-dimethyl-3-(3-fluorophenyl)-4-(4-methylsulphonyl) phenyl-2(5H)-furanone (DFU) and nimesulide, selective COX-2 inhibitors, on the amplitude and frequency of KCl-, oxytocin-, and PGF(2alpha)-stimulated contractions of isolated pregnant human myometrial strips.

METHODS

Isolated myometrial strips were obtained from 20 pregnant women undergoing elective cesarean section. These strips were mounted in organ baths for recording of isometric tension. The effects of cumulative concentrations of nimesulide and DFU on KCl-, oxytocin-, and PGF(2alpha)-stimulated myometrial contractions were measured, and values for -log(10)EC(50) and mean maximal inhibition (E(max)) were compared. Nimesulide (10(-8) to 10(-4)M) and DFU (10(-8) to 10(-4)M) inhibited in a concentration-dependent manner the KCl-, oxytocin-, and PGF(2alpha)-stimulated contractions of myometrial strips, with a significant effect on the amplitude (10(-7) to 10(-4)M) and the frequency (10(-6) to 10(-4)M).

RESULTS

The inhibitor effect of DFU was more potent than nimesulide on KCl-, oxytocin-, and PGF(2alpha)-stimulated myometrial contractions, however, the inhibitor effects of nimesulide and DFU was much greater on KCl-stimulated contractions than on oxytocin- and PGF(2alpha)-stimulated myometrial contractions (P < 0.05). There was no significant difference between E(max) values of nimesulide and DFU in all tissues (P > 0.05).

CONCLUSION

DFU is a more potent inhibitor than nimesulide on KCl-, oxytocin-, and PGF(2alpha)-stimulated contractions of pregnant human myometrium. The inhibitor effects of nimesulide and DFU were predominantly on KCl-stimulated contractions.

An unusual cause of adnexal mass: fallopian tube schwannoma

BACKGROUND

Schwannoma is a well-defined, usually benign tumor arising from the Schwann cells in the nerve sheath. It can present in any location as a solitary mass; however, it is rarely found in the pelvis.

CASE

We report a 40-year-old female patient with a pelvic mass, which revealed tubal schwannoma after complete resection of the mass and uterus by laparotomy.

CONCLUSION

Schwannomas are thought to result from a proliferation of perineural cells. Although origin along the nerves of the retroperitoneal space is not uncommon, these tumors rarely present as pelvic masses.

Predictors of outcome after in situ anterior vaginal wall sling surgery

Pubovaginal sling procedures are being performed with increased frequency for stress urinary incontinence. The vaginal wall sling was introduced in 1989 by Raz et al., and its success rate has been reported as being 61%-100%. A number of recent studies have identified that some patient factors may influence the likelihood of a successful outcome. In the present study, we evaluated whether preoperative Valsalva leak-point pressure and urethral pressure profile can be used as predictors of success after surgery. We identified the preoperative characteristics of 58 women who underwent an isolated in situ anterior vaginal wall sling procedure by the same surgeon. Patients' ages, previous anti-incontinence procedures, hormone replacement status and previous hysterectomies were determined and patients underwent urodynamics, including cystometry, measurement of the Valsalva leak-point pressure and urethral pressure profile (maximal urethral pressure). After the vaginal wall sling procedure, success was defined as a significant improvement in stress urinary incontinence symptoms or no symptoms at all. The 58 women ranged from 41 to-71 years old (average 52.3) and average follow-up was 26 months (range 16-34). An anti-incontinence procedure had been done previously in 15% of cases. The success rate was 65.4% in patients with Valsalva leak-point pressure < 50 cmH2O and maximal urethral pressure < 30 cmH2O, but it was 90.6% in patients with Valsalva leak-point pressure 50 cmH2O or higher and maximal urethral pressure 30 cmH2O or more. Patients with Valsalva leak-point pressure 50 cmH2O or higher and maximal urethral pressure 30 cmH2O or more had a 90.6% success rate, and it was significantly higher than the success rate of patients with lower values for both parameters. We concluded that preoperative Valsalva leak-point pressure and maximal urethral pressure can be used to estimate the success rate of anterior vaginal wall sling procedures. When of these parameters are concurrently high, the outcome of surgery seems more favorable.

Survival and prognostic factors in patients with synchronous ovarian and endometrial cancers and endometrial cancers metastatic to the ovaries

PURPOSE

To compare the survival and prognostic factors of patients with synchronous primary ovarian and endometrial cancers, and endometrial cancers metastatic to the ovaries.

PATIENTS AND METHODS

Fifty-three patients with synchronous primary ovarian and endometrial cancer and 64 patients with endometrial cancer metastatic to the ovaries were evaluated.

RESULTS

Mean follow-up time was 47.2 months (18-170 months). There was no statistical difference in age, gravidity and parity between the two groups. Abnormal vaginal bleeding was the most common symptom in both groups. All patients were subjected to a surgical staging procedure. Overall survival of the synchronous group was significantly higher than that of the metastatic group (98 +/- 12 vs 59 +/- 6 months; p = 0.048). The significant prognostic factors for synchronous cancers after multivariate analysis were age, stage of ovarian cancer, grade of endometrial cancer, and adjuvant therapy status.

CONCLUSION

Patients with synchronous ovarian and endometrial cancers appear to have a good prognosis and should undergo primary surgical staging since the stage of tumors is a significant prognostic factor.

Use of methylene blue and N,O-carboxymethylchitosan to prevent postoperative adhesions in a rat uterine horn model

OBJECTIVES

To compare the anti-adhesion potential of 1% methylene blue (MB) solution and 2% N,O-carboxymethylchitosan (NOCC) gel in a rat uterine horn model.

DESIGN

Experimental animal study.

SETTING

University medical center.

ANIMAL(S)

Forty female Wistar albino rats randomized into four groups.

INTERVENTION(S)

We examined the effects of 1% MB solution and 2% NOCC gel to reduce the extent and severity of postoperative adhesions in a rat uterine horn model: no adjuvant therapy in control group, 2 mL of normal saline (NS) solution in NS group, 2 mL of 1% MB solution in MB group, and 2 mL of 2% NOCC gel in NOCC group was instilled onto uterine horns of the rats.

MAIN OUTCOME MEASURE(S)

Adhesions were scored according to their extent and severity.

RESULT(S)

The extent and severity scores of adhesions in MB and NOCC groups were significantly lower than those of control and NS groups. There was no statistically significant difference between the extent and severity scores of adhesions between MB and NOCC groups.

CONCLUSION(S)

These findings suggest that MB and 2% NOCC gel should be considered as an adjuvant in the prevention of postoperative intra-abdominal adhesions. Future experimental and clinical studies are required to find their optimal formulation and usage.

Histopathological changes in ovary and endometrium after tubal ligation: a rat model

BACKGROUND

To evaluate the histopathological effects of tubal ligation on ovary and endometrium in a rat model.

METHODS

Twenty-four female Wistar albino rats weighing 220-260 g were used. The rats were assigned randomly into tubal ligation and control groups. While tubal ligation was applied to the first group of rats, only a laparotomy was performed in the second group. Six weeks later, a second laparotomy was performed and uterine horns and ovaries of the rats in the two groups were excised for histopathological assessment. A pathologist blinded to the groups made histopathological examination including quantification of endometrial phases, presence of endometrial inflammation and counting the number of tertiary follicles and corpora lutea in each ovary.

RESULTS

We found no significant difference between tubal ligation and control groups related to the number of tertiary follicles and corpora lutea (p > 0.05). However, in the tubal ligation group, endometrial inflammatory infiltration was significantly higher than in the control group (p < 0.05).

CONCLUSION

Tubal ligation does not affect ovarian histology as an indicator of ovarian function. However, endometrial inflammation may occur after tubal ligation and lead to menstrual irregularities as an early complication.

Comparison of outcomes of three different surgical techniques performed for stress urinary incontinence

BACKGROUND

The aim was to compare the efficacy of Burch colposuspension, transvaginal four-corner bladder neck suspension (FCBNS) and the vaginal wall sling (VWS) procedures in patients with stress urinary incontinence.

METHODS

A retrospective analysis was performed on 88 patients who underwent Burch colposuspension (n = 20), FCBNS (n = 29) and VWS (n = 39) for stress urinary incontinence. Objective and subjective cure rates at 3 months and annually after the operation were the primary outcome measures.

RESULTS

The patients were similar in age, parity, menopausal status, grade of cystocel and preoperative residual urine volumes. Fourteen out of 20 (70%) patients showed improvement in the group undergoing Burch colposuspension, 29 out of 39 (74.4%) patients showed improvement in the FCBNS group, and 28 out of 29 (96.6%) patients showed improvement in the VWS group. The mean length of follow up was 3.8 years (range 3-5).

CONCLUSION

In this study, the VWS procedure had a higher long-term cure rate of stress urinary incontinence when compared with the Burch colposuspension and the FCBNS procedures.

A placebo-controlled comparison of effects of repetitive doses of betamethasone and dexamethasone on lung maturation and lung, liver, and body weights of mouse pups

The aim of this study was to compare in vivo effects of single and repetitive doses of betamethasone (BETA) and dexamethasone (DEX) administered to pregnant mice on lung maturation and lung, liver, and body weights (LLBW) of their pups. One hundred and eighty gravid Swiss albino mice were randomly assigned to 1 of 6 groups (n = 30) and administered either BETA, DEX, or saline as a single dose at 14 d gestation or repetitive doses twice daily at 14 and 15 d gestation. All the study groups were then divided into three sets (n = 10). The mice in the second sets were redivided into three subsets randomly (including four, three, and three mice). All gestations in the first sets were terminated at 16.5 d gestation to observe the neonatal breathing pattern (scale to 0-5; 5 is unlabored breathing) of male and female pups whereas other sets had normal delivery. The pups in first, second, and third sets were killed for evaluation in the first set after the evaluation of breathing pattern, in the subsets of second set on postnatal d 1, 3, and 5, and in the third set on postnatal d 90. We recorded maternal body weights at 0 and 16.5 d gestation, and LLBW, the lung/body weight ratio of pups, sex, and the amount of live and dead births per litter. Pups exposed to BETA and DEX had significantly lower maternal weight compared with the saline groups. The death litter size was significantly higher in pups exposed to repetitive doses of DEX than the other treatments. Sex had no significant effect on breathing score and LLBW. Pups exposed to repetitive doses of BETA and DEX presented a higher breathing score than the other groups. The breathing score was significantly higher with BETA than DEX after their repetitive use. The LLBW were significantly less in the treatment groups, especially in the group exposed to repetitive doses of DEX. In conclusion, repetitive doses of BETA and DEX lead to increased fetal lung maturation, but this may be at the expense of fetal and neonatal growth. DEX is less potent in accelerating lung maturation than BETA but it causes more reduction in fetal and neonatal growth.

Reduction of Postoperative Adhesions by N,O-Carboxymethylchitosan and Spermine NONOate in Rats

BACKGROUND

Postsurgical adhesions can occur following virtually all types of surgery, resulting in serious clinical complications. Therefore, prevention of adhesions is an important goal of surgical practice. A rat uterine horn model was used to investigate the efficacy of N,O-carboxymethylchitosan (NOCC) and spermine NONOate (SPER/NO) alone and in combination in preventing adhesion formation.

METHODS

Sixty Wistar albino rats underwent bilateral uterine horn injury with a unipolar cautery. Study groups were as follows: (i) control group, no adjuvant therapy; and those with adjuvant applied, (ii) normal saline group, 2 ml of normal saline was given; (iii) NOCC group, 2 ml of 2% NOCC gel was given; (iv) SPER/NO group, 2 ml of SPER/NO (0.5 mg/ml) was given, and (v) NOCC plus SPER/NO group, 2 ml of 2% NOCC gel including SPER/NO (0.5 mg/ml) was given. After 14 days, all animals were euthanatized, and a standard adhesion scoring system including extent and severity scores was applied by a blinded examiner.

RESULTS

The extent score in NOCC plus SPER/NO group was significantly lower than those of control and normal saline groups (p < 0.05). The extent score in NOCC group was significantly lower than that of normal saline group (p < 0.05). The extent score in NOCC plus SPER/NO group was significantly lower than that of SPER/NO group (p < 0.05). The severity score was significantly lower in NOCC plus SPER/NO and NOCC groups than that of control group (p < 0.05). The severity score was significantly lower in NOCC plus SPER/NO group than that of SPER/NO group (p < 0.05).

CONCLUSIONS

Postoperative administration of NOCC gel and SPER/NO alone and especially in combination to the site of peritoneal injury reduces the formation of adhesions in the rat uterine horn model.

Effects of 5-nitro-2-(3-phenylpropylamino) benzoic acid, anthracene-9-carboxylate, and zaprinast on endothelin-1-induced contractions of pregnant rat myometrium

OBJECTIVE

The effects of 5-nitro-2-(3-phenylpropylamino) benzoic acid (NPPB), anthracene-9-carboxylate (9-AC) (chloride channel blockers) and zaprinast (an inhibitor of phosphodiesterase-5) on endothelin-1 (ET-1) induced contractions of pregnant rat myometrium were investigated in vitro.

METHODS

Isolated myometrial strips were obtained from pregnant rats, and the strips were mounted in organ baths for recording of isometric tension (n=8). The effects of 10(-7) to 10(-4)M NPPB, 10(-7) to 10(-4)M 9-AC, and 10(-7) to 10(-4)M zaprinast on 10(-8)M ET-1-induced contractions of pregnant rat myometrial smooth muscle were recorded.

RESULTS

NPPB and 9-AC increased the amplitude of ET-1-induced myometrial contractions, while decreasing the frequency, in a concentration-dependent manner. The amplitude of myometrial contractions were significantly increased by NPPB and 9-AC beginning from the concentration of 10(-6)M. The frequency of myometrial contractions were significantly decreased by NPPB and 9-AC beginning from the concentration of 10(-6)M. Zaprinast inhibited the amplitude and frequency of ET-1-induced myometrial contractions in a concentration-dependent manner. Zaprinast-induced decreases in amplitude and frequency of myometrial contractions reached statistical significance beginning from the concentrations of 10(-7)M and 10(-5)M, respectively.

CONCLUSION

These data provide evidence that the ET-1-induced contractions of pregnant rat myometrial strips may be modulated by chloride channels. In addition, zaprinast effectively inhibited ET-1-induced contractions in pregnant rat myometrium.

Beta-human chorionic gonadotropin and prolactin assays in cervicovaginal secretions as a predictor of preterm delivery

OBJECTIVE

To evaluate and to compare the predictive value of cervicovaginal beta-hCG and prolactin levels in spontaneous preterm delivery.

METHODS

The preterm labor group and normal pregnancy group consisted of 17 and 43 patients between 24 and 36 weeks' gestation, respectively. A single cervicovaginal beta-hCG and prolactin measurement were made in both groups.

RESULTS

Cervicovaginal beta-hCG and prolactin levels were significantly higher in the preterm group when compared with those of the term delivery group (P=0.031, P=0.026, respectively). The optimal cut-off value for beta-hCG (27.1 mIU/ml) gave a sensitivity level of 87.5% (47.4-97.9; 95% C.I.) at a specificity of 65.4% (50.9-78.0; 95% C.I.) with positive and negative predictive values of 28% and 97%, respectively. The optimal cut-off value for prolactin (1.8 ng/ml) gave a sensitivity level of 50% (16.0-84.0; 95% C.I.) at a specificity of 96% (86.8-99.4; 95% C.I.) with positive and negative predictive values of 67% and 93%, respectively.

CONCLUSIONS

Cervicovaginal beta-hCG measurement in patients with preterm labor may be used as a predictive test. Cervicovaginal prolactin is not a sensitive test compared with the beta-hCG test.

Unilateral massive ovarian edema in a woman with polycystic ovaries

Massive ovarian edema is a rare cause of ovarian enlargement in young women. We report the case of a 20-year-old woman with unilateral massive ovarian edema with findings on ultrasound of an enlarged policystic ovary and pedicle arterial and venous blood flow observed with color and pulsed wave Doppler examination. Massive ovarian edema can be managed conservatively and blood flow in the pedicle of the ovary is detected by color and pulsed wave Doppler examination.

First-trimester diagnosis of Robinow syndrome

We present 2 cases with Robinow syndrome in a nonconsanguineous Turkish couple. The first case, second living child of the family, has all of the cardinal features of this syndrome including short stature, mesomelic shortening of forearms, frontal bossing, hypertelorism, anteverted nares, triangular mouth, hypoplastic genitalia and vertebral and costal anomalies. The second case was diagnosed with first-trimester ultrasonographic findings such as shortening of extremities and increased nuchal translucency thickness at 12 + 4 weeks of gestation, and the family wished to terminate this pregnancy. After abortion, we obtained findings such as typical face features, shortening of forearms, ambiguous genitalia suggesting Robinow syndrome with autopsy examination.

Unilateral massive ovarian edema and polycystic ovaries. A case report

Massive ovarian edema is a rare cause of ovarian enlargement in young women. We report a case in a 20-year-old woman with unilateral edema associated with the ultrasound appearance of polycystic ovary disease. Arterial and venous blood flow in the pedicle was observed with color and pulsed wave Doppler examination. Conservative management was successful.

Prevention of postoperative adhesion formation in rat uterine horn model by nimesulide: a selective COX-2 inhibitor

BACKGROUND

Pelvic surgery is one of the main causes of intraperitoneal (i.p.) adhesions that create various medical problems including pelvic pain, bowel obstructions and female infertility. A rat model was used to investigate the efficacy of nimesulide, a selective cyclooxygenase-2 inhibitor, in the prevention of adhesion formation.

METHODS

Fifty Wistar-Albino rats underwent bilateral uterine horn injury with a unipolar cautery. Study groups were as follows: (i) control group, no adjuvant therapy; (ii) i.p. Ringer's lactate group, 2 ml Ringer's lactate solution was instilled i.p.; (iii) i.p. Ringer's lactate plus nimesulide group, 1 ml Ringer's lactate plus 1 ml nimesulide (0.5 mg/ml) were given i.p.; (iv) intramuscular (i.m.) nimesulide group, 1 ml i.m. nimesulide (0.5 mg/ml) was given preoperatively for 5 days; and (v) i.p. nimesulide group, 1 ml nimesulide (0.5 mg/ml) was instilled i.p. At the end of the study all animals were killed, and a standard adhesion scoring system was applied by a blinded examiner.

RESULTS

The mean adhesion extent in study groups was as follows: 1.33 +/- 0.76 in control group, 1.40 +/- 0.90 in i.p. Ringer's lactate group, 0.75 +/- 0.70 in i.p. Ringer's lactate plus nimesulide group, 0.25 +/- 0.44 in i.m. nimesulide group and 0.31 +/- 0.70 in i.p. nimesulide group. The mean +/- SD adhesion severities of control, i.p. Ringer's lactate, i.p. Ringer's lactate plus nimesulide, i.m. nimesulide, and i.p. nimesulide groups were 0.58 +/- 0.35, 0.30 +/- 0.41, 0.27 +/- 0.3, 0.12 +/- 0.28 and 0.15 +/- 0.35 respectively. The lowest adhesions were found in the groups treated with nimesulide i.m. and nimesulide i.p. ( P < 0.05).

CONCLUSIONS

This study showed that preoperative i.m. or postoperative i.p. administration of nimesulide to the site of injury reduced the formation of postoperative adhesions in a rat uterine horn model.