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Biomedical subjects

A Ayhan

Publications and source records attributed to A Ayhan.

At least 109 records · Page 6Linked to original sources
PubMed1995

Malignant tumors metastatic to the ovaries.

One hundred sixty-eight patients treated at Hacettepe Hospital between 1969-1993 with metastatic ovarian tumors constituted 21.5% of all malignant ovarian neoplasms. Primary tumors were endometrial (51), breast (27), colorectal (18), and stomach cancer (17), lymphoma (14), sarcoma of the uterus (13), undetermined (11), tumors of the appendix (6) and ileum (4), carcinoma of the cervix (4), and gestational trophoblastic neoplasia (3). Overall 5-year and median survivals were 20.0% and 26.8% months, respectively. While worse prognoses were seen in gastric cancer and undetermined tumors followed by colorectal cancer, best survival figures were observed in endometrial cancer patients. A trend toward a better survival was seen with the advancement of the operation from bilateral salpingooophorectomy, and/or biopsy to total abdominal hysterectomy, bilateral salpingooophorectomy, total omentectomy, pelvic and paraaortic lymphadenectomy with debulking. Multivariate analysis identified the primary site, grade, laterality of involvement, type of surgery and adjuvant therapy status as significant prognostic parameters. Maximal surgical effort followed by adjuvant therapy might at least have some short term survival benefit in certain types metastatic to the ovaries.

Adult↗
PubMed1995

Results of treatment in 182 consecutive patients with genital fistulas.

OBJECTIVES: To evaluate genital fistulas with the aim of improving strategies to prevent them. METHOD: An institutional, retrospective, clinical analysis. One hundred eighty-two patients with genital fistulas managed consecutively between 1970 and 1993 were analyzed. RESULTS: About 60% of all fistulas were attributable to obstetric traumas whereas gynecologic surgery constituted only 24.7% of cases. The contribution of gynecologic surgery increased from 11.1% in 1970-75 to 60.6% in 1988-93. Approximately half of the patients had vesico-vaginal fistulas. Of the 45 patients with fistulas occurring following gynecologic surgery, 19 had undergone simple hysterectomy and eight had undergone radical hysterectomy. All cesarean sections had been performed after failed labor. Hysterectomy was performed due to myoma in nine patients, endometrial hyperplasia in two patients and pelvic relaxation in eight patients. As regards management of fistulas, the transvaginal approach was chosen in the vast majority of patients. The overall success rate after the primary repair of fistulas was 91.5% (162/177). Fifteen patients with failure of the primary repair were subjected to repeat repairs. The second repair was successful in 11 patients but the remaining four needed further repairs. The maximum was seven repairs to a recto-vaginal fistula before a satisfactory result could be achieved, which had initially occurred after a cesarean section. CONCLUSION: Although the results of reparative surgery are promising, it would be more useful to encourage national measures to prevent in particular obstetric trauma.

Adult↗
PubMed1995

Tumor status of lymph nodes in early endometrial cancer in relation to lymph node size.

A retrospective analysis of 36 patients with metastatic nodes out of 209 consecutively managed patients with a clinically stage I endometrial cancer was carried out. Of the 1023 lymph nodes removed, 154 nodes were found to be metastatic. The mean number of the involved nodes was 4.27 (range: 1-29). Of the 154 positive nodes, 3 had nodal diameters < or = 3 mm (1.9%), 84 had diameters of 4-10 mm (54.6%), 60 had diameters of 11-20 mm (39.0%) and 7 had diameters more than 20 mm (4.5%). With increasing lymph node size, the frequency of tumoral involvement varies from 1.0% in nodes < or = 3 mm to 63.6% in nodes bigger than 20 mm. In terms of patients, nine of them were found to have a single metastatic node ranging from 6 mm to 10 mm in diameter. In the remaining 27 patients with multiple metastatic nodes, the biggest nodes encountered were 6-10 mm in 4 (14.8%), 11-20 mm in 17 (62.9%) and more than 20 mm in 6 (22.2%) patients. Since mere sampling of the lymphatic tissue directed particularly to the enlarged nodes may not show the true incidence of positive nodes, a complete lymphadenectomy is advocated in order to obviate an understaging problem.

Endometrial Neoplasms↗
PubMed1995

The effect of the pineal gland on liver regeneration in rats.

BACKGROUND/AIMS: We investigated the influence of pinealectomy on liver regeneration after partial hepatectomy in rats. METHODS: Thirty rats were allocated into four groups as follows: group 1 in which no operation was done (control), group 2 in which only midline scalp incision and craniotomy was performed (sham operation), group 3 in which pinealectomy was performed and group 4 in which the rats underwent pinealectomy and pineal transplantation. Eight weeks later all the rats underwent 70% hepatectomy. RESULTS: Hepatic regenerative capacity was observed 24 h after PH by bromodeoxyuridine incorporation into DNA and the mitotic index of hepatocytes. The bromodeoxyuridine labeling indices were 45.4, 35.8, 19.9 and 36.8 in groups 1, 2, 3 and 4, respectively. The mitotic indices of the same groups were 31.2, 28.7, 8.3 and 13.4, respectively. Both the bromodeoxyuridine labeling and mitotic indices were significantly lower in the pinealectomized rats than in the control and sham operation groups. CONCLUSIONS: These results suggest that the pineal gland stimulates liver regeneration after partial hepatectomy in rats.

Animals↗
PubMed1995

Malignant germ cell tumors of the ovary: Hacettepe hospital experience.

BACKGROUND: To determine the most important prognostic factors in patients with malignant germ cell tumors of the ovary. METHODS: Age, histologic type, tumor size, stage, treatment mode, type of surgery of 67 patients with malignant germ cell tumors managed consecutively were evaluated retrospectively using multivariate analysis. RESULTS: The overall survival rate was 60.6%. This figure was 78.5% for dysgerminoma, 53.3% for immature teratoma, 12.0% for endodermal sinus tumor, 33.3% for mixed germ cell tumor and 100.0% for others. The patients with endodermal sinus tumor had significantly poorer survival than other groups. Among the factors analyzed for survival histologic type was found to be the most significant predictor for survival. CONCLUSIONS: Finding of histologic type as the strongest independent risk factor may be evaluated in correlation with the literature that these tumors have historically been investigated as dysgerminomatous and nondysgerminomatous tumors. Furthermore, endodermal sinus tumors had long been known for poor survival. Based on this data, despite advent of staging and effective chemotherapy, prognosis still is basically related to histologic type and histology of tumor should be taken into account while comparing results.

Adult↗
PubMed1994

Trends in maternal mortality at a university hospital in Turkey.

OBJECTIVE: To highlight recent trends in maternal mortality in Hacettepe University Hospital. METHOD: A retrospective clinical analysis of 117 maternal deaths between 1968 and 1992. RESULTS: The overall maternal mortality ratio was 180/100,000 (108/59,993). In terms of 5-year periods, the maternal mortality ratio declined from 417.7 in 1968-72 to 73.7 in 1988-92. Infection was the most common cause of death (59.8%), followed by cardiac disease (8.5%) and hemorrhage (8.5%). Infection related deaths were either due to septic abortion (75.7%) or puerperal sepsis (24.3%). While 73.9% of all deaths were due to infection in 1968-72, this figure contributed only 9.1% of the deaths in 1988-92. When infection, hemorrhage, cardiac disease ad toxemia are investigated together, percentages of their contribution varies from 95.7% in 1968-72 to 54.5% in 1988-92 period. CONCLUSIONS: Maternal mortality ratios are decreasing significantly in our institution. An another promising finding is the further reduction in direct causes especially in recent years. However, an improvement in the care of pregnant women is necessary to continue this declining trend.

Abortion, Septic↗
PubMed1994

Is routine appendectomy beneficial in the management of ovarian cancer?

A retrospective analysis of 136 patients with ovarian carcinoma subjected to appendectomy as a part of surgical procedure was carried out to assess the importance of appendectomy in patients with ovarian cancer. Of the 136 patients studied, 94 had epithelial and 38 had non-epithelial type of primary ovarian carcinoma. In the remaining 4 patients, the primary operation was performed with an intraoperative diagnosis of ovarian carcinoma but the final pathological examination revealed appendiceal carcinoma metastatic to ovaries. The overall appendiceal involvement in the study group with primary ovarian cancer was found to be 32.5% (43/132). This figure was 15.7% and 39.3% for non-epithelial and epithelial tumors, respectively. Involvement of the appendix ranged from 8.8% for patients with stage I disease to 46.0% for patients with stage III-IV disease. Four of the appendices found to be inflamed during the surgical explorations were later reported as acute appendicitis. The frequent occurrence of metastatic disease in the appendix in patients with ovarian cancer suggests routine appendectomy is appropriate for staging early cases and for contributing to maximal cytoreduction in advanced cases.

Appendectomy↗
PubMed1994

Risk factors for recurrence in clinically early endometrial carcinoma: an analysis of 183 consecutive cases.

This study includes 183 patients with clinical stage I endometrial carcinoma. All patients had standard surgical staging procedure including peritoneal cytology, total abdominal hysterectomy, bilateral pelvic and paraaortic lymphadenectomy. The factors analysed for recurrence were age, menopausal state, cell type, grade, mitotic activity, myometrial invasion, lymphovascular space invasion, cervical involvement, microscopic vaginal metastases, adnexal metastases, peritoneal cytology, concomitant endometrial hyperplasia and pelvic and paraaortic node metastases. The overall recurrence rate was 14.2% (26/183). Of the 26 patients with recurrence, 11 had local and 13 had distant metastases. In the remaining two patients (7.7%), both local and pelvic metastases were observed. Of the factors analysed, age, grade, mitotic activity, myometrial invasion, lymphovascular space invasion, microscopic vaginal metastases, adnexal involvement and pelvic and paraaortic nodal metastases were found to be significant predictors of recurrence. After multivariate analysis, advanced age (RR = 1.05), marked mitotic activity (RR = 3.11), pelvic and/or paraaortic nodal metastases (RR = 6.37) were chosen as the most important determinants of recurrence. In terms of surgical pathological stages, recurrence risk reaches up to 45.4% for stage IIIC disease. Using surgical pathological parameters, it is possible to predict recurrence but because of high rate of distant failures it still seems hard to improve survival of this group. Detection of a substantial risk of recurrence even in stage IA/B grade 1 group warrants adjuvant therapy in all patients after primary surgery.

Age Factors↗
PubMed1994

Loss of heterozygosity at the bcl-2 gene locus and expression of bcl-2 in human gastric and colorectal carcinomas.

The loss of heterozygosity (LOH) at the bcl-2 gene locus and the expression of the bcl-2 gene were examined in gastric and colorectal carcinoma cell lines and carcinoma tissues. LOH at the bcl-2 locus was detected in 24% (4/17) of gastric and 60% (6/10) of colonic carcinomas, all of which were well differentiated adenocarcinomas, whereas LOH was not seen in poorly differentiated ones. On the other hand, 24% (5/21) of poorly differentiated stomach cancers overexpressed bcl-2 gene, whereas no overexpression was detected in well differentiated stomach cancer. Three gastric and three colorectal carcinoma cell lines, all of which were derived from poorly differentiated adenocarcinomas, expressed considerable levels of bcl-2 mRNA and protein. These results suggest that LOH at the bcl-2 locus is frequently associated with well differentiated adenocarcinomas of the stomach and colon, and bcl-2 overexpression has implications for the development of poorly differentiated adenocarcinomas of the gastrointestinal tract.

Adenocarcinoma↗
PubMed1994

The influence of tocolytic therapy on serum digoxin-like immunoreactive substance concentration.

Digoxin-like immunoreactive substance (DLIS) has been proposed to have a role in what seems to be the timely onset of labor. The relationship between the DLIS in patients with preterm labor and the success of tocolytic therapy with ritodrine and nifedipine has been studied. Using a commercially available radioimmunoassay kit, DLIS levels were determined in a total of 47 women with preterm labor and in 30 control. Tocolysis was successful in 37 of 47 women, in 20 of whom nifedipine and in 17 ritodrine was the tocolytic agent. Mean DLIS concentration was higher in patients with preterm labor. Moreover, DLIS levels were found to be decreased by successful tocolysis as could be observed from the values before initiation of tocolytic therapy and on the 3rd day of tocolysis for both nifedipine (0.268 +/- 0.198 vs. 0.220 +/- 0.210 ng/ml) and ritodrine (0.250 +/- 0.176 vs. 0.196 +/- 0.147 ng/ml; Wilcoxon test, p < 0.05).

Adult↗
PubMed1994

Granulosa cell tumor of the ovary. A clinicopathological evaluation of 60 cases.

The patients with granulosa cell tumor of the ovary constituted 7.6% (60/780) of all ovarian malignancies treated at our Institution. The mean age of patients at diagnosis was 53.1. The most frequent symptom was abnormal vaginal bleeding. Of the 60 patients, 36 had stage I, 2 had stage II, 16 had stage III and 6 had stage IV disease. Endometrial hyperplasia and adenocarcinoma were detected in 18 and 3 patients, respectively. Lymph node metastasis was detected in only one of 18 patients subjected to lymphadenectomy. Recurrent disease was observed in 3 of 36 patients with stage I disease. The overall 5-year survival was found to be 85.0% (51/60). This figure varied from 100.0% to 63.6% according to the stage. In patients with stage I disease, surgery with and without adjuvant therapy achieved the same 5-year survival rate. In advanced stage, 5-year survival rate dropped from 90.0% with no gross residual disease to 25.0% with residual disease more than 2 cm. In patients with stage I disease, surgery only seems to be the treatment of choice. In advanced stage, since residual disease after surgery effects survival significantly, an aggressive surgical approach is advocated.

Adenocarcinoma↗
PubMed1994

Primary carcinoma of the fallopian tube: a study of 8 cases.

Eight patients with primary tubal carcinoma of the fallopian tube are presented. These patients constituted 0.3% of all gynecological malignancies encountered during the period the study was conducted. The most common symptom was abnormal vaginal bleeding (4 patients). All patients but one had extra tubal disease at the time of surgery. No patient was operated with a preoperative diagnosis of tubal cancer. All patients were subjected to primary surgical therapy. As adjuvant therapy, radiotherapy (3 patients) and chemotherapy (5 patients) were given. Only three patients are living with a mean survival of 30 months.

Adult↗
PubMed1994

Pregnancy outcome after hydatidiform mole, initial and recurrent.

Pregnancy outcome after complete and partial hydatidiform mole was evaluated in 170 patients. Of the 170 patients, 143 became pregnant a total of 250 times. Patients with incomplete hydatidiform mole had 232 subsequent pregnancies that resulted in 169 (72.8%) term deliveries, 30 (12.9%) spontaneous abortions, 7 (3.0%) induced abortions, 6 (2.6%) stillbirths, 13 (5.6%) preterm deliveries, 6 (2.6%) recurrent moles and one (0.4%) ectopic pregnancy. Of the subsequent pregnancies in patients with partial hydatidiform mole, full-term delivery, spontaneous abortion and recurrent mole occurred in 10 (55.6%), 5 (27.8%) and 3 (16.7%) of the patients, respectively. Among the 9 patients with recurrent hydatidiform mole, viable term pregnancy was achieved in 4. Even patients with recurrent hydatidiform mole can be assured that they can have a normal subsequent pregnancy.

Adult↗
PubMed1993

Increased expression of p34cdc2 and its kinase activity in human gastric and colonic carcinomas.

We examined the expression of p34cdc2 and its kinase activity in human gastric and colonic carcinoma cell lines and carcinoma tissues and studied its relation with a tumor-suppressor gene product, p53. All the gastric and colonic cancer cell lines expressed p34cdc2 and showed its kinase activity at various levels. When the cells were arrested in mitotic metaphase by the use of nocodazole, p34cdc2 kinase activity was induced and p53 was apparently phosphorylated. Of 12 gastric carcinoma cases, 11 (91.7%) showed higher p34cdc2 kinase activity in tumor tissues than in corresponding non-neoplastic mucosa. The protein kinase activities in the individual cases were well correlated with the levels of p34cdc2 protein expression. A good correlation was also found between the expression of p34cdc2 and proliferating cell nuclear antigen (PCNA). Almost all the colonic carcinomas showed higher cdc2 kinase activity and increased p34 expression when compared with non-neoplastic mucosa. Interestingly, most of the gastric and colonic carcinomas having high cdc2 kinase activity expressed high levels of p53. These findings suggest that the increased p34cdc2 kinase activity might cause the development and proliferation of gastric and colonic carcinomas, partly through abnormal p53 accumulation.

Blotting, Western↗
PubMed1993

Reduced expression of nm23 protein is associated with advanced tumor stage and distant metastases in human colorectal carcinomas.

The nm23 gene, which encodes nucleoside diphosphate (NDP) kinase, is proposed as a metastatic suppressor gene. Loss of heterozygosity (LOH), and the expression of the nm23 gene were examined on matched sets of primary tumors and lymph node as well as distant metastases from colorectal carcinomas. Three (15%) of the 20 informative specimens examined showed LOH for the nm23 locus. nm23 was expressed in all the carcinomas as well as in nonneoplastic colonic mucosa at the mRNA and protein levels. Most of the carcinomas expressed the nm23 transcript at higher levels than the corresponding nonneoplastic colonic mucosa. By Western blotting, the level of nm23 protein expression in the tumors showed an inverse correlation with the tumor stage. Furthermore, distant metastatic tumors in the liver and lung showed reduced nm23 immunoreactivity in comparison with their primary tumor, although nm23 immunoreactivity was the same in the primary tumors and in local lymph node metastases. These results suggest that decreased nm23 expression may be associated with distant metastatic spread.

Adenocarcinoma↗
PubMed1993

Postconceptional cervical cerclage.

OBJECTIVE: To determine the outcome and morbidity of pregnancies following cervical cerclage. METHOD: Records were reviewed for 326 patients with 374 singleton pregnancies between 1980 and 1990. RESULT: McDonald and Shirodkar procedures were carried out in 323 and 51 pregnancies, respectively. The procedure was classified as elective if based on past history (n = 330). In 44 pregnancies, cervical dilatation prompted operation. The overall fetal survival rate has increased from 17.7% to 79.1% after cervical cerclage. While the presence of cervical dilatation at suture placement had a prognostic value, the surgical technique, gestational age at suture placement and progestin therapy had no significant effect on survival. Premature rupture of membranes and chorioamnionitis were found to be the leading causes of morbidity. CONCLUSION: Cervical cerclage seems to the treatment of choice in patients with cervical incompetence. Only the presence of cervical dilatation at operation was found to have a prognostic value among the factors analyzed.

Adult↗
PubMed1993

Struma ovarii.

OBJECTIVE: To review the clinicopathological experience of patients with benign and malignant struma ovarii. METHOD: A retrospective institutional analysis of 2 patients with malignant and 14 patients with benign struma ovarii, treated during a period of 20 years. RESULT: The patients with struma ovarii constituted 1.0% of all ovarian neoplasms in our institution (16/1501). Four percent of the germ cell tumors were calculated to be of struma ovarii (16/382). The stages of the malignant cases were recorded as 1A and 1C. Besides detection at early stage, a biologically low grade tumor was encountered as well. Although 5 of the patients had goitre, none of them had hyperthyroidism. None of the patients had a bilateral tumor. However, in 2 patients, a serous cystadenoma and dermoid cyst were found in the contralateral ovaries. The preoperative and intraoperative diagnosis of malignant struma ovarii proved to be difficult since 2 patients subjected to radical surgery according to suspicious frozen section reports in this series later were found to be benign struma ovarii. CONCLUSION: The low metastatic potential and slow progression rate of malignant struma ovarii support conservative surgery especially in young patients who have not yet completed their families.

Adolescent↗