Biomedical subjects

M A Vardar

Publications and source records attributed to M A Vardar.

15 recordsLinked to original sources

PubMed2003

Efficacy of gemcitabine in heavily pretreated advanced ovarian cancer patients.

Single agent gemcitabine was used in recurrent epithelial ovarian cancer patients after standard treatment with debulking surgery and platin-paclitaxel based chemotherapy. Response rates and toxicity results were evaluated retrospectively. Gemcitabine was given in 1000 mg/m2 intravenous infusion over 30 minutes at 1, 8, 15 days of every 28 days. Clinical response was evaluated with clinical findings, serum CA 125 levels, and computerized tomography. Twenty-two patients--ten as second-line, 11 as third-line, and one as fourth line--received gemcitabine. Seven patients received six courses, nine cases three, five cases two and one case one course of treatment. There were four (18.2%) partial and two (9.1%) complete responses with an overall response rate of 27.3%. Stable disease was also observed in three more cases. The progression-free interval was found to be a median of three months. Grade 3-4 neutropenia was seen in two (9.1%) and grade 3-4 thrombocytopenia was seen in four (18.2%) cases. Pancytopenia was observed in one (4.5%) patient. There was no grade 3-4 non-hematological toxicity. Antitumoral activity is encouraging in heavily pretreated ovarian cancer patients. A short progression-free interval is noticeable in responding cases. Toxicity is mainly hematologic and moderate.

Adult↗

PubMed2001

Central nervous system involvement in gestational trophoblastic neoplasia.

OBJECTIVE: To evaluate characteristics of patients with central nervous system (CNS) lesions of gestational trophoblastic disease and determine prognostic and therapeutic implications applicable to management. METHODS: Nine patients among 56 cases of malignant gestational trophoblastic neoplasia (GTN) were analyzed prospectively in a single institution between the years 1990 and 1997 with at least two years of follow-up. Brain metastases were documented by physical exam and computed tomography scan or magnetic resonance imaging. In terms of therapy, all of the patients received an etoposide, methotraxate, actinomycin, cyclosphamide and vincristine (EMA-CO) regimen for 5 to 9 courses. To prevent unexpected intracranial hemorrhage, all patients received radiation therapy. No intrathecal chemotherapy was given. Remission was defined as three weekly beta-hCG levels below assay sensitivity (<5 mIU/ml). RESULTS: The mean age of the patients at diagnosis was 29.6 years. While two of the patients initially presented with symptoms related to cranial involvement, five were diagnosed during routine investigation for metastasis in malignant GTD and the remaining two developed cerebral metastases during the therapy. Besides central nervous system involvement, six had additional lung, two had hepatic and splenic and one had pelvic metastases. Overall survival was 66.6%. Two patients had a fulminant clinical course and were lost one month after initial diagnosis. CONCLUSION: Early diagnosis via computed tomography of the head and beta-hCG serum testing along with aggressive, multiagent intervention (EMA-CO) have greatly improved patient prognosis of this once highly fatal condition.

Adult↗

PubMed2000

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

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

Adolescent↗

PubMed2000

Pregnancy outcomes in young Turkish women.

STUDY OBJECTIVE: We documented adolescent pregnancies that were thought to be at high risk for increased obstetric complications. DESIGN, SETTING, PARTICIPANTS: This study covered 442 pregnant women who were under 19 years of age and who delivered in Cukurova University, School of Medicine, Department of Obstetrics and Gynecology between January 1, 1993 and December 31, 1997, retrospectively. RESULTS: The patients' mean age was 18.24 years and their mean gestational age was 38.2 weeks. The newborns' mean birthweight was 3093.05 g and their mean birth height was 45.75 cm. Apgar score in the 1st minute was 6.79 and at the 5th minute 8.37. Cesarean section rate was 28.5%. The most common causes were pregnancy-induced hypertension (PIH) and breech delivery. There were 32 stillborns and 5 early neonatal deaths. The most frequent obstetric complications were PIH (14.5%), preterm delivery (7.0%), and low birthweight (< 2000 g) (10.2%). The pregnant adolescents with obstetric problems (44.4%) had poor obstetric results. CONCLUSIONS: Adolescent pregnancies are considered high risk with many obstetric complications and poor obstetric results. To decrease the complications adolescent pregnancies must be followed-up as high risk pregnancies, especially in developing countries where socioeconomic factors are more pronounced.

Adolescent↗

PubMed2000

Gestational trophoblastic disease: the significance of vaginal metastases.

PURPOSE: To evaluate patients with vaginal lesions in gestational trophoblastic disease and determine prognostic and therapeutic implications applicable to management. METHODS: Twelve patients among 75 cases of gestational trophoblastic neoplasia were analyzed retrospectively between 1990 and 1997. Vaginal metastases were documented by physical examination and biopsy. Two patients received MAC III regimen (5 and 7 courses), 4 patients received EMA-CO regimen for 2 to 11 courses, while 6 were administered methotrexate alone. Remission was defined as 3 weekly beta hCG levels below assay sensitivity (<5 mIU/ml). RESULTS: The mean age of the patients was 25.4 years. While 10 of the patients presented initially with hemorrhage and bloody leukorrhea, the remaining 2 were diagnosed during a routine study of hydatidiform mole. The sites of involvement were almost always the anterior distal vaginal wall. Five cases had additional lung and 1 case had lung, liver, spleen and brain metastases. Three of the patients who received methotrexate as monotherapy did not respond to therapy and were switched to EMA-CO. Overall survival was 91.6%. One patient died in the first month of the initial therapy. CONCLUSION: The presence of large vaginal metastases should be classified as a high-risk factor and these patients must be treated by multiple agent chemotherapy.

Adolescent↗

PubMed1999

Intraoperative assessment of depth of myometrial invasion in endometrial carcinoma.

OBJECTIVE: To evaluate the adequacy of intraoperative assessment of depth of myometrial invasion in patients with endometrial adenocarcinoma. METHODS: Of the 58 evaluable cases, depth of myometrial invasion was estimated by gross examination of fresh tissue by an experienced surgeon and a pathologist and on the frozen section by the same pathologist. This was compared with the depth of invasion on the final microscopic examination performed by another pathologist. RESULTS: The depth of invasion was accurately predicted by the surgeon in 89.7% of the patients, while the pathologist's accurate prediction rates on fresh tissue and frozen section were 86.2% and 91.4%, respectively. The accurate prediction rate gradually diminished for both the surgeon and the pathologist as the histologic grade increased. Frozen section examination was reliable in grade I cancer (100%), while gross examination of the surgeon and the pathologist had a significant error rate in predicting accurate depth of invasion (7.6%-33%). CONCLUSION: If frozen section shows that myometrial invasion in patients with grade 1 endometrial carcinoma is less than 1/3, lymphadenectomy may be omitted. In all other cases radical surgery and surgical staging is mandatory to avoid undertreatment.

Adenocarcinoma↗

PubMed1997

Results of cytogenetic investigation in adolescent patients with primary or secondary amenorrhea.

A cytogenetic study of 77 adolescent girls with primary or secondary amenorrhea was performed. A pathologic or male karyotype was found in 18 (26.4%) of 68 patients with primary amenorrhea. In 1 (11.1%) of 9 patients with secondary amenorrhea, 46,XX/47,XXX mosaicism was recovered. The importance of the cytogenetic investigations in patients with primary or secondary amenorrhea was discussed.

Adolescent↗

PubMed1995

Fraser syndrome.

In a consanguineous marriage, a woman at 32 weeks' pregnancy presented with intrauterine growth retardation and bilateral renal agenesis. Fraser syndrome (cryptophthalmus syndactyly syndrome) was diagnosed based on cryptophthalmos, atresia of meatus acusticus externus in auricula, syndactyly, hypoplastic larynx, hypoplastic left lung, agenesis of urinary system and aberrant pancreas in duodenum. The syndrome is inherited as a recessive trait and the risk of recurrence is 25%.

Abnormalities, Multiple↗

PubMed1995

Choriocarcinoma metastatic to the maxillary gingiva.

A rare metastatic lesion from a gestational trophoblastic neoplasm is presented in a 26-year-old woman. The first symptom and sign was mild pain and a mass in the gingiva. The diagnosis was established by gingival biopsy. The patient was treated with 6 courses of methotrexate, actinomycin D and cyclophosphamide (MAC) and has no evidence of disease 2 years after completion of therapy.

Adult↗

PubMed1995

Copper, zinc, and magnesium tissue and serum levels in patients with cervical carcinoma.

Serum and cervical tissue copper (Cu), zinc (Zn) and magnesium (Mg) levels were determined by atomic absorption spectrophotometry in 65 women with cervical carcinoma and compared with levels in 30 healthy women. The patients mean serum Cu level (184.8 +/- 12.3 mugr/dl) was significantly higher than the control group (p < 0.05). However, in relation to the control group, the differences in Mg, Zn and Cu levels in cancerous tissues of patients with cervical carcinoma were not statistically significant (p > 0.05). There was also no significant difference between FIGO Stage I and IIA patients according to their serum and tissue concentrations of these trace elements. We concluded that serum and tissue copper, zinc and magnesium determinations have no use in cervical carcinoma management.

Cervix Uteri↗

PubMed1995

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

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

Adult↗

PubMed1995

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

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

Aorta↗

PubMed1995

Human papillomavirus detection in cervical smears and cervical tissue excised by the Loop Electrosurgical Excision Procedure (LEEP). Diagnostic value of cytology, colposcopy and histology.

A study was performed on 176 patients with benign cervical lesions. Human papillomavirus (HPV) structural antigens which were stained with the immunoperoxidase staining were sought for in cervical smears and in cervical tissues excised by the loop electrosurgical excision procedure (LEEP). HPV infection was found in 16.4% of the patients. Furthermore, cytologic screening on Papanicolaou (PAP) smears, colposcopy, and histologic examinations of whole transformation zones excised by the LEEP were performed. The diagnosis of HPV was based on the positive immunoperoxidase staining of either the exfoliated cells or the cervical tissue. HPV was detected on 5.6% of the PAP smears. The reliability of cytologic colposcopic, and histologic diagnosis of HPV was investigated.

Antigens, Viral↗

PubMed1994

Etiology of serum CA-125 in patients with endometriosis treated with a gonadotrophin-releasing hormone agonist (Buserelin).

Fifty-six patients with pelvic endometriosis were treated with a buserelin dosage of 200 micrograms/day s.c. for 6 months. Scoring of the American Fertility Society (AFS) for endometriosis was performed by laparoscopy in all cases before and at the end of therapy. Serum CA-125 and estradiol levels were determined before the treatment, and monthly during therapy and follow-up (6 months; respectively). A slight positive correlation was found between serum CA-125 concentrations before treatment and AFS scores for adhesions only. Before treatment, serum CA-125 values also correlated slightly with total AFS scores of patients with adhesions. At the end of the 6-month therapy, no correlation was found between CA-125 concentrations and second-look AFS scores for implants and/or adhesions. Serum CA-125 and estradiol values were closely parallel to each other during and after therapy with the gonadotrophin-releasing hormone agonist buserelin. In conclusion, (1) adhesions may play a role in the elevation of serum CA-125 levels in endometriosis, and (2) a significant decrease in serum CA-125 values during the buserelin therapy may result from a rather different mechanism, such as ovarian suppression, other than the therapeutic effect of this agent.

Buserelin↗

PubMed1992

Role of Chlamydia trachomatis infections in infertility due to tubal factor.

The prevalence of IgG antibodies to C. trachomatis was determined in 185 infertile women who underwent laparoscopy, and 110 pregnant women with no known infertility problems. In addition, chlamydial antigens were evaluated by EIA in cervical samples taken from all subjects. Subjects with tubal infertility had the highest prevalence of chlamydial antigen and antibody (P less than 0.01). While the percentage of subjects with antigen and antibody positive was 11.6 per cent, those with antigen negative and antibody positive averaged 55.8 per cent among women with tubal related infertility. The results of our study provide additional support to the concept that infertility of tubal etiology often is a sequela of a previous chlamydial infection.

Adolescent↗