In this case-control study, we aimed at analyzing the effect of pelvic and paraaortic lymphadenectomy on intraoperative and postoperative morbidity and mortality rates in a series of elderly patients (age ≥ 65 years) with gynecologic malignancies. We examined preexisting medical conditions, surgical data, intraoperative and postoperative morbidity and mortality in 37 patients aged 65 years or older with endometrial and ovarian carcinoma who underwent pelvic and paraaortic lymphadenectomy. Control group consisted of patients between 60 and 64 years with similar malignancies. The number of patients with hypertension (P= 0.03), minor (P= 0.01) and major cardiac problems (P= 0.03), chronic obstructive lung disease (P= 0.02), and history of cerebrovascular disease (P= 0.04) were significantly higher in the study group than that in control. The median operative time was significantly shorter (160 min) in the study group than that (191 min) in control (P= 0.004). There were no significant differences between the groups with regard to blood loss, intraoperative and postoperative blood transfusion, preoperative and postoperative hemoglobin levels, yielded lymph nodes, and postoperative stay. Minor and major intraoperative and postoperative complications were not different between the groups. In these elected elderly patients, we demonstrate that pelvic and paraaortic lymph node dissection can be performed with an acceptable morbidity and mortality. We should perform pelvic and paraaortic lymphadenectomy in the older aged patients and advanced aged should not be considered a contraindication.

Objective. To investigate the prognostic value of Ku70 protein expression in patients with endometrial cancer and to examine the correlation between Ku70 expression and established prognostic factors.Methods. Ku70 immunoreactivity was determined by an immunohistochemical technique in a series of 81 patients with stages I-III primary endometrial carcinoma. The prognostic value of Ku70 expression was also studied in 74 patients who had been followed for at least I year or until death.Results. The median percentage of Ku70 expression was 80%. The established clinicopathological prognostic factors for endometrial carcinoma were not associated with Ku70 expression. Although disease-free survival was significantly higher in patients with lower levels than median value of Ku70 (P < 0.05), overall survival was not different. In the univariate analysis, Ku70 expression did not show significant prognostic value for overall survival. The multivariate analysis also showed that Ku70 expression was not related to patient's outcome (P = 0.51, relative risk = 0.27, 95% confidence interval = 0.10-1.92).Conclusions. Our results suggest that Ku70 expression may not be a prognostic marker in endometrial carcinoma patients. However, disease-free survival was significantly higher in patients with low percentage of Ku70-positive tumor cells. More studies are needed to evaluate the correlation between Ku70 and survival in patients with endometrial cancer. (C) 2004 Published by Elsevier Inc.

OBJECTIVE:The aim of this study was to investigate the predictive value of serum CA-125 levels to ability of optimal primary cytoreduction in patients with advanced epithelial ovarian carcinoma.METHODS:Preoperative serum CA-125 levels were determined by a commercial enzyme immunoassay kit in a series of 92 patients with stage IIIC epithelial ovarian carcinoma. The abilities of various cutoff value of CA-125 to predict suboptimal cytoreductive surgery were determined. A receiver operating characteristic curve was used to find the most clinically useful CA-125 cutoff value.RESULTS:Optimal cytoreduction was obtained in 48 patients (52%) using the diameter of the largest residual tumor nodule less than 1 cm. Receiver operating characteristic curve showed that the most clinically suitable CA-125 cutoff value was 500 U/ml. Forty-seven patients (51%) had preoperative serum CA-125 levels below 500 U/ml. Of these patients, optimal cytoreductive surgery was performed in 36 (77%). Of the 45 patients with serum CA-125 levels greater than 500 U/ml, optimal cytoreductive surgery was achieved in 12 (27%). True- and false-positive rates were 73 and 23%, respectively.CONCLUSIONS:Although our results showed that preoperative serum CA-125 levels might predict the optimal resectable patients, larger prospective studies are needed to prove its predictivity. Gynecologic oncologists should evaluate the sum of all criteria until more data are available.

BACKGROUND AND OBJECTIVES:The aim of this study was to investigate whether systematic lymphadenectomy is necessary in suboptimally cytoreduced patients with stage III ovarian carcinoma. METHODS:Prognostic significance and the effect on survival of systematic pelvic and para-aortic lymphadenectomy were investigated retrospectively in 61 suboptimally debulked patients with stage III ovarian carcinoma. All patients received platinum-based chemotherapy after surgery; 51 patients had been followed for > or =1 year, or until death. Survival curves were calculated according to the Kaplan-Meier method and were evaluated by log-rank test. RESULTS:Most patients had stage IIIC disease (60.7%), poorly differentiated tumor (45.9%), and serous histological type (59%). Systematic pelvic and para-aortic lymphadenectomy was performed in 29 patients (47.5%). Lymph node metastases were found in 17 (58.6%) patients; the median number of metastatic nodes was 7 (5-10). Lymph node metastasis was significantly higher in patients with residual disease of >2 cm (P < 0.05). Both univariate and multivariate analyses showed that systematic pelvic and para-aortic lymphadenectomy was not a significant prognostic factor (P > 0.05). In lymph node-dissected patients, survival was significantly longer in patients with minimal residual tumor than in those with residual tumor size >2 cm (P = 0.005). CONCLUSIONS:Lymphadenectomy seems not to have an evident prognostic value and a benefit on survival in suboptimally debulked patients with stage III ovarian carcinoma.

One hundred and eighty four women who had corrective surgery for stress incontinence, genital prolapse or both were compared with two hundred and ninety women who had no surgery for these conditions. Patients and controls did not differ in terms of age, height, weight or body mass index. Younger age at first delivery (20.1±4.1 vs 22.8±4.9, p<0.000) and a smoking history (33.2% vs 23%, p<0.015) were found as risk factors for the study group. Women who underwent surgery had greater gravidity (4.85±2.9 vs 3.87±2.5, p<0.001), greater parity (3.03±1.9 vs 2.19±1.3, p<0.000), were less often nulliparous (2.2% vs 7.9%, p<0.008), less likely to have had a cesarean delivery (1.1% vs 9%, p<0.001) and more likely to have had a vaginal delivery (97.3% vs 85.9%, p<0.000) than the control group. The study group have had larger neonates on average (3800±416 vs 3373±637 gm’s, p<0.000) and had greater use of forceps or vacuum extractor for at least one delivery (17.9% vs 7.6%, p<0.001). Highly significant relationship was found between the risk of having corrective surgery and the number of children born vaginally. Women who had 4 or more vaginal deliveries had 11.7 times more risk of urinary incontinence or genital prolapse.

OBJECTIVES:Cancer antigen-125 (CA-125) is not a specific tumor marker and it is synthesized by normal and malignant cells of different origins. Recently it has been shown that various diseases are associated with increased CA-125 levels, especially in the presence of serosal fluid. The aim of this study is to investigate serum and fluid CA-125 levels in patients with different diseases.METHODS:A total of 133 patients and 23 healthy control cases were included in the study and divided into eight groups on the basis of disease and the presence of fluid in the serosal cavities. Serum and serosal fluid CA-125 levels were measured by a commercial enzyme immunoassay kit at the same time. Comparisons among the groups were made.RESULTS:Abnormal levels of serum CA-125 were observed in 76% of ovarian cancer patients; 96% in patients with ascites and 56% in patients without ascites. Moreover, elevated serum CA-125 levels were detected in 52% of patients with hepatic diseases, in 100% of patients with nongynecologic peritoneal carcinomatosis, and in 87% of patients with pleural effusion. Serum and fluid CA-125 levels were significantly higher in cases of ovarian cancer with ascites than in the other groups (P < 0.01). A positive correlation between serum CA-125 levels and ascites amounts was observed in cases of ovarian cancer with ascites (P < 0.01, r = 0.81). Furthermore, no correlation was observed between ovarian mass volume and serum CA-125 levels in ovarian cancer patients with stage I disease without ascites (P = 0.08, r = 0.48).CONCLUSIONS:Although CA-125 levels may be considered a sensitive tumor marker in patients with epithelial ovarian cancer, it was determined that high serum CA-125 levels were closely related to the presence of serosal fluids and serosal involvement, whatever the origin is. These results should be considered in the interpretation of CA-125 elevation in patients with ovarian cancer.

OBJECTIVE To investigate the prognostic value of immunohistochemical detection of cathepsin D and the association between cathepsin D and established prognostic factors in endometrial carcinoma. METHODS Cathepsin D immunoreactivity was determined by an immunohistochemical technique in a series of 79 patients with surgical stage I-III primary endometrial carcinoma. RESULTS Of 79 tissue specimens, 48 (61%) showed a positive reaction for cathepsin D. A significant correlation between cathepsin D and histological grade was found (P < 0.05). The other established clinicopathological prognostic factors were not associated with cathepsin D. There was not any significant difference in prognosis between the positive cases and negative cases for cathepsin D (P > 0.05). In the univariate analysis cathepsin D immunoreactivity did not show significant prognostic value for overall survival (P > 0.05). The multivariate analysis also showed that cathepsin D was not related to patient outcome (P = 0.24, relative risk = 0.34, 95% confidence interval = 0.05-2.09). CONCLUSIONS Our results suggest that cathepsin D immunoreactivity may not be of prognostic value but more studies are needed to evaluate the relationship between its immunoreactivity in tumor cells and in other cells.

The aim of this study was to evaluate whether omentectomy, appendectomy, and peritoneal biopsy should be a routine part of staging surgery in endometrial carcinoma. Data of 97 patients who had been diagnosed with clinical stage I endometrial carcinoma were reviewed. Associations in the data obtained, pelvic and para-aortic lymph node status, depth of myometrial invasion, grade, and histology were investigated. The chi-square (chi (2)) test was used for statistical analysis.Of 97 patients, six (6%) had omental metastases, which was microscopic in four. There was a statistically significant relationship between omental metastasis and tumor grade (P < 0.01). Deep myometrial invasion was significantly more common in patients with omental metastases. Tumor was found in one of 55 appendectomy specimens (2%). Omentectomy may be included in surgical staging in patients with deeply invasive or grade 3 endometrial cancer because of the possibility of omental metastasis in spite of what appears to be stage I disease in laparotomy. In other cases, omentectomy and appendectomy and biopsies from peritoneal sites should be performed in the presence of grossly suspicious disease.

The aim of this study was to determine the frequency of apoptotic and mitotic cells in different grades of premalignant lesions and in different stages of squamous cell carcinoma (SCC) of the uterine cervix. The apoptotic and mitotic indices (A! and MI) of 55 H&E-stained sections of cervical intraepithelial neoplasia (CIN) and 30 SCCs were evaluated in light microscopy by a morphometric method. Twenty, 16, and 19 of 55 CIN cases were classified in CIN I, CIN II, and CIN III group, respectively. No apoptosis was observed in the normal epithelium next to the dysplastic mucosa. There was no statistically significant difference between CIN I and CIN II as well as CIN II and CIN III groups in terms of apoptotic and mitotic cell counts. Mitotic cell counts were found significantly higher in CIN III group when compared with CIN I and CIN II groups together. There was no statistically significant difference in the apoptotic and mitotic cell counts between nonkeratinizing and keratinizing types of SCC. In the SCC group, apoptotic cell counts did not show significant difference between tumor stages. But mitotic counts were significantly higher in advanced stage tumors. The SCC group showed significantly higher mitotic and apoptotic cell counts when compared with preneoplastic lesions. This study suggests that apoptotic function is not altered during progressive stages of dysplastic change in cervical epithelium, while proliferation is triggered only in late stages of dysplasia. Both apoptosis and mitosis are markedly increased in progression to malignancy in cervix epithelium. Mitotic cell counts may be helpful in predicting the extent of the disease in SCC. Resistance of cell death by apoptosis after invasion may accelerate the net growth of the tumor resulting in advanced disease.

To investigate the influence of tamoxifen, danazol and triptorelin (a GnRH agonist) on estrogen and progesterone receptors of rat endometrium, 44 castrated Sprague-Dawley rats were divided into four equal groups, and each group received either no treatment or one of the agents. After administration of the agents, estrogen and progesterone receptor levels, detected by immunohistochemical methods, were compared with the controls. Estrogen and progesterone receptors were significantly higher in the tamoxifen group than the controls (p<0.05), but this was not noticed in the triptorelin group (p>0.05). Receptor levels were higher in the danazol group than the controls, but it was significant only in the estrogen receptors. Among the 3 groups, receptor levels were higher than in the control group. There was not any correlation among the estrogen and progesterone receptor levels in all groups. Steroid receptor manipulations can be used in the treatment of gynecologic cancer, but further investigations are needed.

Twenty-one borderline ovarian tumour cases, diagnosed and treated in our oncology section between 1986 and 1996, were retrospectively analysed. Thirty-three percent of the cases had serous tumours and the rest (66.6%) were mucinous, 57.1% of the mucinous tumours were the intestinal type and the remaining 42.9% were the endocervical type. When all the cases were analysed, the average age was 45.4+/-18.6 years, the average follow-up period was 5.5+/-2.6 years. The preoperative average CA125 level was 55.1+/-51.9 U/mL, and for CA19.9 it was 48.2+/-47.8 U/mL. Of the patients 85.7% were stage I and 14.3% state III. There were not any significant differences between the serous, intestinal-type mucinous and endometroid-type mucinous tumours regarding tumour volumes (p>0.05). When serous and mucinous tumours were compared according to the tumour markers, CA125 levels were significantly higher in the serous tumours (p=0.04) and CA19.9 levels were significantly higher in the mucinous tumours (p=0.02). All of the patients are under our follow-up and are in remission, except one, who died in the third year of the treatment because of chronic renal failure unrelated to the ovarian pathology.

Three cases with simultaneous neoplasms in multiple sites of female reproductive tract, followed up in our university clinic are reported.

Plasma concentrations of endothelin-1(ET-1), a vasoconstrictor peptide released from vascular endothelial and synovial cells, were measured by radioimmunoassay in 27 patients with Behçet's disease (BD) and 18 healthy controls. The plasma ET-1 concentrations were found to be significantly increased in patients with BD (121.15±11.6 fmol/dl) compared with the healthy subjects (89.37±8.03 fmol/dl p<0.05). The elevation of ET-1 did not correlate with the disease duration, gender, ocular or articular involvement. Whether the elevated ET-1 level is a direct result of its increased synthesis from injured vascular endothelial cells or whether its presence in high concentrations may be responsible, together with other factors for both vascular and articular complications in patients with BD is uncertain.

The purpose of this prospective study was to investigate the levels of Lp(a), Apo(a), VLDL, LDL and HDL in 23 patients with pregnancy induced hypertension (PIH) and in 20 control. The Mann-Whitney U tests was used for comparisons between the two groups. Serum Lp(a) and Apo(a) levels were significantly raise in the PIH group (p<0.05 and p<0.05 respectively) and no significant correlations could be demonstrated for other lipoproteins.

OBJECTIVE:The aim was to ascertain whether menstrual, reproductive and hormonal risk factors for breast cancer are present in women with dysplastic mammographic patterns and to investigate possible trends towards breast cancer.METHOD:This prospective case-control study was designed in a university hospital. Thirty-two turkish postmenopausal women were evaluated for the associations between obesity, parity, age, age at menarche, age at menopause, total lactation period and dysplasic mammographic patterns.RESULTS:We found an increasing trend of dysplasia with increasing age at menarche. This association contradicts the well established one for breast cancer. The effects of parity and total lactation period on dysplasia were similar. Although nulliparity had some protective effects on dysplasia, relative risk (RR) increased to some extent with an increase in parity and lactation period. Later menopause and older age were associated with an increase risk of dysplasia, whereas an apparent protection was given by greater body mass index.CONCLUSION:Onset of the menopause increases the risk of dysplasia and the estrogenic milieu may have some role in the initiation and progression of dysplasia.