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Biomedical subjects

Ali Ayhan

Publications and source records attributed to Ali Ayhan.

At least 19 recordsLinked to original sources
PubMed2007

Comparison of the effects of tibolone and estrogen therapy on hemostasis in surgical menopause: a randomized, double-blind, placebo-controlled study.

OBJECTIVE: To examine the effects of unopposed estrogen (E) and tibolone therapy on coagulation and natural anticoagulant systems in surgical menopause. DESIGN: A randomized, double-blind, placebo-controlled study. SETTING: University hospital clinic in Turkey. PATIENT(S): Ninety healthy surgically postmenopausal women. INTERVENTION(S): Ninety surgically postmenopausal women were randomized into three groups: unopposed conjugated ET (0.625 mg/d, group 1), tibolone (2.5 mg/d, group 2), and identical tablets of placebo (group 3). MAIN OUTCOME MEASURE(S): Effects on parameters in the clotting cascade at baseline and after 24 weeks of treatment. RESULT(S): After 6 months, fibrinogen, lipoprotein (a), and factor VIIa were decreased, and activated partial thromboplastin time was increased significantly in the ET group compared with in the placebo group. However, tibolone significantly decreased only the serum levels of factor VIIa and factor IX and prolonged the activated partial thromboplastin time, compared with placebo group. In addition, conjugated ET caused a significantly greater decrease in serum fibrinogen level than did tibolone. CONCLUSION(S): Neither E nor tibolone therapy led to activation of coagulation in the surgically menopausal women. Both preparations changed the overall hemostatic balance to a more fibrinolytic state.

Antithrombin III↗
PubMed2006

The value of preoperative platelet count in the prediction of cervical involvement and poor prognostic variables in patients with endometrial carcinoma.

OBJECTIVE(S): To evaluate the relationship between preoperative platelet counts and prognostic factors extensively, among endometrial cancer patients, especially with respect to cervical involvement. METHODS: One-hundred fifty-five patients with endometrial carcinoma, who underwent surgery as the initial treatment consisting peritoneal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, systematic pelvic-paraaortic lymphadenectomy, and omentectomy were retrospectively analyzed. RESULTS: There were no differences with respect to age, histological type (endometrioid vs. non-endometrioid), depth of myometrial invasion, peritoneal cytology, LVSI, and lymphatic metastasis. However, advanced stage (stages III and IV), poorly differentiated tumor grade (grade 3), the presence of cervical and adnexal involvements were associated with significantly higher median preoperative platelet counts. Accepting 325.000/microl platelet count as a threshold value, multivariate analysis revealed cervical involvement (P=0.008; OR=1.84, 95% CI:1.17-2.89) and presence of high grade histology (P=0.014; OR=2.23, 95% CI:1.18-4.23, for grade 3 disease) to be significantly associated with higher platelet count. At a cut-off value of 326.000/microl, 42.3% sensitivity and 82.8% specificity for the prediction of cervical involvement was observed under receiver operator characteristic curve method. CONCLUSION(S): Higher preoperative platelet counts, even in conditions with normal range (150.000-400.000/microl), may reflect poor prognostic factors such as cervical involvement and high grade among patients with endometrial carcinoma. Also, the higher platelet count should be taken into consideration for the necessity of radical hysterectomy.

Endometrial Neoplasms↗
PubMed2006

Radical reoperation for invasive cervical cancer found in simple hysterectomy.

OBJECTIVE: To evaluate the patients with invasive cervical cancer found in simple hysterectomy and who were subjected to radical parametrectomy and upper vaginectomy with therapeutic lymphadenectomy. METHODS: Twenty-seven patients who underwent the radical parametrectomy and upper vaginectomy with therapeutic lymphadenectomy procedure from 1986 to 2004 were retrospectively reviewed. RESULTS: The mean age at the time of diagnosis was 49.85 (range 38-72). The histopathological diagnoses were SCC, adenocarcinoma, adenosquamous carcinoma, endometroid carcinoma, and anaplastic carcinoma in 70.4%, 11.4%, 7.4%, 7.4%, and 3.7% of patients, respectively. Operative complications occurred in only five patients (18.5%). Following radical surgery, residual disease was found in 10 patients (37.03%). The lymph node involvement rate was 22.2% (6 patients). The recurrence rate was 7.4% (2 of 27 patients). The overall disease-free survival rate was 88.67%. The overall survival rate was 88.89%; it was significantly lower in the presence of the following factors: anaplastic carcinoma, vaginal apex metastasis, and pelvic lymph node metastasis. CONCLUSION: This series suggests the excellent overall survival of patients that underwent radical surgery. We recommend the surgical treatment of such selected patients in experienced centers only with expert surgeons and primary adjuvant radiotherapy may be recommended in selected patients.

Adenocarcinoma↗
PubMed2006

The role of reoperation in the management of endometrial carcinoma found in simple hysterectomy.

OBJECTIVE: To evaluate our experience in patients with endometrial cancer found in simple hysterectomy. METHODS: Forty patients treated for endometrial cancer after simple hysterectomy were evaluated, retrospectively. Twenty-one patients (Group 1) underwent surgical staging procedure while 19 patients were not subjected to complementary surgical staging procedure (Group 2). RESULTS: The mean age was 53.80 years. Residual disease following reoperation was found in only four patients (19.0%). The three of them who were considered Stage IC (two Grade 1, one Grade 2) were found to be Stage IIIC and one patient who was considered Stage IB (Grade 2) was found to be Stage IIIC. The overall recurrence rates in Groups 1 and 2 were 4.8% versus 10.5% (P > 0.05). The overall disease-free survival rates were 95.24% in Group 1 and 87.50% in Group 2 (P > 0.05). Considering the patients who received postoperative adjuvant radiotherapy (RT), the overall disease-free survival rates were 88.89% in Group 1 and 84.62% in Group 2 (P > 0.05). CONCLUSION: We believe that complementary surgical staging may have benefit in patients with incompletely staged endometrial carcinoma excluding Stage IA G1 cases, since the recurrence rate has rising and disease-free survival estimate has decreasing tendencies in incompletely staged patients than that in complementary surgically staged ones.

Adult↗
PubMed2006

Use of anti-thrombotic agents during chemotherapy for epithelial ovarian cancer.

The association between malignancy and venous thrombotic events is well established. However, arterial thrombosis among cancer patients is extremely rarely reported. There are several mechanisms of arterial thrombosis or embolism in malignancy. Important mechanisms in arterial thrombogenesis are shear stress-induced platelet aggregation and platelet-derived microparticles. Both of these are induced by major abdominal surgery. A major abdominopelvic surgery followed by adjuvant platinum-based combined chemotherapy is routinely performed for epithelial ovarian cancer which is the leading cause of death among all gynecologic malignancies. These patients have a greater risk of arterial thrombosis at the postoperative period. If the affected arteries are relatively larger, clinical findings will be evident due to limb ischemia or fatal organ infarctions. However, thrombosis of the small arteries disturbs the tissue circulation which is extremely important for the chemotherapeutic agents to reach the residual tumor cells. When the thrombosis of small arteries is prevented, these drugs will reach all of the residual macroscopic or microscopic tumoral tissues and so the prognosis of the patients may be improved. Therefore, we hypothesize that anti-platelet therapy with aspirin is needed to be initiated during the postoperative period of epithelial ovarian cancer patients and be continued as long as chemotherapy goes on. Such an approach might have a role in optimizing the oncological prognosis of these patients via increasing the effectiveness of cytotoxic therapy since some of the recurrences may be caused by some microscopic tumor foci which were not affected by cytotoxic drugs because of subclinical small arterial thromboses.

Antineoplastic Agents↗
PubMed2006

CYP1A1 gene polymorphism as a risk factor for cervical intraepithelial neoplasia and invasive cervical cancer.

OBJECTIVE: The purpose of this study was to evaluate the role of CYP1A1*3 gene polymorphism in the development of cervical cancer by comparing patients having cervical intraepithelial neoplasia (CIN) or invasive cervical cancer with control subjects. METHODS: CYP1A1*3 polymorphism was analyzed using an allele-specific PCR-based method. RESULTS: In the group of patients with CIN, the frequency of the Ile/Val and of any Val alleles was significantly higher than in the healthy control subjects (OR: 4.51; 95%CI = 2.42-8.43, and OR: 3.71; 95%CI = 2.03-6.78). In the CIN1 group, patients with Ile/Val and any Val genotypes were found to be significantly higher (OR: 10.53; 95%CI = 3.78-29.33 and OR: 8.38; 95%CI = 3.04-23.08). In the CIN2 group, patients with Ile/Val and any Val revealed a 4.06- and 3.23-fold higher risk than those with Ile/Ile (95%CI = 1.54-10.74 and 1.24-8.45). However, the variance in the group of patients with CIN3 did not reach statistical significance. Patients with cervical cancer were analyzed with respect to the histological diagnoses. In the adenocancer group, the estimated ORs with respect to the control subjects were 11.29 for Ile/Val (95%CI = 3.35-38.07) and 8.98 for any Val groups (95%CI = 2.69-30.01), with a statistical significance. Among the squamous cell cancer patients, Ile/Val and any Val were significantly higher than in controls (OR: 5.76; 95%CI = 3.13-10.59 and OR: 5.20; 95%CI = 2.91-9.28). Although Val/Val genotype did not reach a significant value, it was near significance with an OR of 3.03 (95%CI = 0.95-9.68). CONCLUSION: These results suggest that CYP1A1*3 gene polymorphism is linked to a propensity for cervical carcinogenesis and further series are needed to detect the exact role of this unique variation.

Adult↗
PubMed2006

The role of secondary cytoreduction in the treatment of ovarian cancer: Hacettepe University experience.

OBJECTIVE: This study was undertaken to evaluate the role of secondary cytoreduction in patients with recurrent epithelial ovarian cancer. STUDY DESIGN: Secondarily, cytoreduced patients were retrospectively analyzed with respect to the clinicopathologic variables. RESULTS: A total of 64 patients were evaluated in this report. Multivariable analysis revealed 3 factors to be significant: optimal cytoreduction during primary (P = .003, odds ratio [OR]: 0.30; 95% CI: 0.14-0.66), secondary cytoreduction (P = .04, OR: 0.47; 95% CI: 0.22-0.99), and the endometrioid histologic type (P = .005, OR: 0.09; 95% CI: 0.02-0.48). Intrinsic factors of the tumors (grade, stage, age), size, and number of recurrent tumors were nonsignificant. CONCLUSION: Secondary cytoreductive surgery should be offered in selected recurrent epithelial ovarian cancer patients. Further prospective randomized series are needed to determine specific recommendations.

Adult↗
PubMed2005

What is the underlying cause of aneuploidy associated with increasing maternal age? Is it associated with elevated levels of gonadotropins?

Aneuploidy is the most common chromosomal abnormality and also is the leading cause of early fetal loss and serious mental retardations. Except for the advanced maternal age, there is no clearly established factor for the development of aneuploidy. On the other hand, advanced maternal age is well characterized with elevated gonadotropin levels due to the decreased ovarian reserve. Such high level gonadotropins are also seen physiologically in the adolescent period. Both age groups may have an increased risk for having a baby with chromosomal abnormality. On the other hand, high doses of gonadotropins are widely used in artificial reproductive technologies (ART). Low pregnancy and high abortion rates in ART practices may be explained by higher incidence of chromosomal abnormalities in the unfertilized oocytes maturated by high dose gonadotropins. Gonadotropins are also found to induce congenital malformations and chromosomal abnormalities in some animal studies. From this point of view, we hypothesized that gonadotropins might have a role in the development of aneuploidy. If this hypothesis is true, basal serum FSH levels may be used as a screening test in preconceptional period for assessment of the aneuploidy risk in low risk population. Furthermore, new ART protocols using low dose gonadotropins should be developed in order to improve pregnancy outcomes and possibly to prevent aneuploidy.

Age Factors↗
PubMed2005

Endodermal sinus tumor of the ovary: the Hacettepe University experience.

OBJECTIVE: The purpose of this study was to evaluate the treatment regimens used for patients with endodermal sinus tumors (EST), and also to examine the prognostic value of surgicopathological variables. STUDY DESIGN: Twenty-two patients treated for pure EST, and seven patients who had mixed germ cell tumors with EST components were included. Initial surgery consisting of surgical staging to achieve optimal debulking was the principal mode of therapy. Data were obtained from patients' files, a special gynecologic oncology database, and pathology records. RESULTS: The median age at the time of diagnosis was 18 (range 8-45). Sixteen patients had stage I (55%), and 13 (45%) had stage II-IV disease. As an adjuvant therapy 18 patients (62%) received platin-based chemotherapy, three patients (10%) had non-platin-based chemotherapy, four patients (14%) had radiotherapy, and four patients (14%) had combined radiotherapy plus non-platin-based chemotherapy. The 5-year disease-free and overall survival rates were 47 and 48%, respectively. Survival rates were dismal in patients with stage II-IV disease (P < 0.001). Platin-based chemotherapy achieved significant survival benefit (P = 0.03 and P < 0.001, respectively). Fertility-saving surgery had an overall survival no worse than those who underwent more extensive surgery. There was no significant survival difference with respect to age, histology, and tumor size. CONCLUSION: Fertility-sparing surgery with a postoperative platin-based combination chemotherapy should be the selected mode of treatment.

Adolescent↗
PubMed2005

Reactive nodular fibrous pseudotumor involving the pelvic and abdominal cavity: a case report and review of literature.

There are several entities that can present with multiple nodular lesions within the peritoneal cavity, such as "disseminated peritoneal leiomyomatosis," "peritoneal fibrosis," "calcifying fibrous pseudotumor," and the recently described lesion of "reactive nodular fibrous pseudotumor of the gastrointestinal tract and mesentery." Here we present one such lesion in a 28-year-old woman with a history of dysmenorrhea and ergotamine use for migraine attacks. Intraoperative exploration of our patient disclosed numerous nodules located throughout the pelvic and abdominal peritoneum. Histopathologically, these lesions were fibrocollagenous nodules composed of sparse wavy spindle cells within hyalinized "keloid-like" collagen surrounded by an inflammatory infiltrate. Some of the nodules were associated with small foci of endometriosis. We believe this lesion is best described by the term "reactive nodular fibrous pseudotumor" and that endometriosis and the use of ergotamine derivatives may be contributing factors.

Adult↗
PubMed2005

Meigs' syndrome with highly elevated ca. 125 levels in a patient with Takayasu arteritis: a case report.

A 56-year-old post-menopausal woman presented with abdominal swelling and shortness of breath. An evaluation of abdomen and pelvis showed ascites and a solid mass. Serum CA-125 level was elevated (509 IU/ml). A computerized tomography-angiography was performed since the pulses of upper extremities could not be palpated. The patient was diagnosed to be suffering from Takayasu arteritis. The exploratory laparotomy revealed a fibroma of the ovary.

Angiography↗
PubMed2005

Lower expression of cyclooxygenase-2: is it associated with the development of borderline ovarian tumors?

Epithelial ovarian neoplasms can be divided into two major categories on the basis of their pathological and clinical behaviors: invasive ovarian tumors and borderline ovarian tumors. However, neither the etiology nor the pathogenesis of the borderline and invasive epithelial ovarian carcinomas has been understood completely. Borderline tumors are clearly more favaroble in terms of survival. The same pathological types can be seen both in borderline and invasive tumors. However; it is not clear if both diseases is a continuum of the same entity or are independent clinical entities. On the other hand, several in vivo and in vitro studies have demonstrated that overexpression of the cyclooxygenase-2 (COX-2) may have an important role in the development and the aggressive clinical behaviors of different malignancies. Furthermore, some recent studies have also revealed the overexpression of COX-2 in invasive epithelial ovarian carcinomas. In this manuscript, we propose that lower expressions of COX-2 may have a role in the development of borderline ovarian neoplasias, whereas higher levels have a role in the invasive epithelial ovarian cancers and this may be the basis for the clinical difference of both entities. To test this hypothesis; genetic, pathologic and epidemiologic studies may be performed. Patients with borderline tumors should be compared with the invasive counterparts in terms of COX mutations and expressions. Also, epidemiologic studies may reveal the role of COX inhibitors in the ovarian carcinogenesis. If this hypothesis is proven to be true, this may direct the clinicians to use prophylactic NSAIDs with or without combined oral contraceptives especially in high risk patients. Also, this hypothesis may enlight a new gene therapy targeting COX-2 gene in high risk patients for the development of EOC.

Apoptosis↗
PubMed2005

Lymphatic metastasis in epithelial ovarian carcinoma with respect to clinicopathological variables.

OBJECTIVE: The purpose of this study was to evaluate the prognostic factors, and the patterns of lymphatic metastasis in EOC patients who were treated with systematic pelvic and paraaortic lymphatic dissection. METHODS: A total of 420 EOC patients was retrospectively evaluated. Clinical factors available were evaluated for a possible significance in terms of lymphatic metastasis and paraaortic involvement. RESULTS: Two-hundred and three patients were found to have lymphatic metastasis. In multivariable analysis, stage (P < 0.001), histology (P < 0.01 for serous; P = 0.02 for mixed, and P = 0.04, for Brenner), and Ca-125 level higher than 500 U/ml (P = 0.04) were found to be significantly related with the lymphatic involvement. Age and grade were significant factors for paraaortic metastasis both in univariable and multivariable analysis (P = 0.003 and P = 0.02, respectively). Most of the patients with unilateral tumors had contralateral pelvic and/or paraaortic metastasis. There were eleven patients with lymphatic metastasis in stage I-II disease, and five had paraaortic metastasis while an additional five patients had contralateral pelvic nodal metastasis. However, there was no lymphatic involvement in Stage IA, Grade I-II disease (0/63). Survival analysis revealed no significant difference by the number of metastatic lymph nodes. CONCLUSION: In multivariable analysis, lymphatic involvement was predicted independently by stage, histology, and Ca-125 level. In apparently stage I-II disease, a considerable part of patients were upstaged due to lymphatic involvement. Although routine systematic lymphadenectomy is suggested for patients with early stage disease, further series are needed for a definite regimen in patients with stage IA G1-2 disease since we did not detect any lymphatic involvement in this unique group.

Adult↗
PubMed2005

Primary cervical lymphoma: report of two cases and review of the literature.

BACKGROUND: Primary lymphoma arising from the female genital tract has been rarely encountered. Primary cervical lymphoma is even rarer in gynecologic oncology practice and accounts for approximately only 1% of extranodal lymphomas. In this article, two cases of cervical lymphoma are presented with a review of the available literature. CASE HISTORIES: A 51-year-old woman presented with abnormal vaginal discharge. On pelvic examination, cervix was apparently normal; however, a solid and mobile pelvic mass was palpated. Pap smear was reported as HSIL at another institution. Radiological evaluation revealed a cervical mass with a 3 cm diameter. Histopathological evaluation of LEEP material was reported as diffuse large B cell lymphoma. We performed abdominal hysterectomy plus bilateral salphingo-oopherectomy and the patient was treated with adjuvant 6 cycles of CHOP chemotherapy. A second case was a 49-year-old postmenopausal woman who had undergone a routine gynecologic follow-up examination without any complaint at another institution. Routine cytological smear revealed HSIL. Punch biopsy under colposcopic examination presented no remarkable pathology except for a benign inflammation. Due to discordance between cytology and histology, LEEP was performed under colposcopic examination, which revealed follicular lymphoma grade III. This patient was treated with 6 cycles CHOP chemotherapy without any surgery. CONCLUSION: Primary cervical lymphoma is a rare disorder. Although most reported cases in the literature have a normal Pap smear, some may represent with co-existent cytological abnormalities. Therefore, cervical lymphomas should be kept in mind in patients with cytological abnormalities.

Female↗
PubMed2005

Recurrence and prognostic factors in borderline ovarian tumors.

OBJECTIVE: The purpose of this study was to evaluate the survival estimates and clinico-pathological variables in patients treated for borderline ovarian tumors. METHODS: The patients treated for borderline ovarian tumors were evaluated retrospectively. Data were obtained from hospital records and special gynecologic oncology forms. RESULTS: Overall, 100 patients were evaluated. The mean age at the time of diagnosis was 41.7 (range, 19-84). Seventy one (71%) patients underwent surgical staging including 49 (49%) of them with comprehensive surgical staging, 22 (22%) with fertility-sparing surgery. Only 30 (30%) patients were unstaged. The histopathological diagnosis was serous, mucinous, and the other types of borderline ovarian tumor in 54 (54%), 39 (39%), and 7 (7%) of the patients, respectively. Seventy patients had stage IA (70%), 10 had stage IB (10%), 9 had stage IC (9%), 3 had stage IIIA (3%), and 8 had stage IIIC (8%) disease. The stage of only four patients in which disease confined to ovary was upgraded as stage IIIC following surgical staging procedure. The recurrence rate was found 3% (3). The overall disease-free survival rates of BOT in surgically staged (comprehensive, fertility-sparing surgery) and unstaged patients were 97.92%, 95.00%, and 96.30%, respectively. But, the overall tumor-free survival was significantly found to be decreased in cases of young age (<30 years old), performing fertility-sparing surgery and presence of micropapillary architecture or peritoneal implants. Overall survival rates of BOT in surgically staged (comprehensive, fertility-sparing surgery) and unstaged patients were 97.9%, and 100% and 100%, respectively. CONCLUSION: Low malignant potential ovarian tumors have excellent survival, and the patients can be treated safely by conservative surgery.

Adult↗