RESUMEN
OBJECTIVE: The aim of this study was to evaluate the usefulness of integrated 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (PET/CT) for the detection of para-aortic nodal status and to test whether PET/CT change management strategy in locally advanced cervical cancer (LACC) patients with negative conventional CT findings. MATERIALS AND METHODS: Sixteen locally advanced (FIGO stage IIB-IVA) cervical squamous cancer patients with negative conventional CT findings were eligible to enter this prospective study. All patients underwent firstly PET/CT scans then extraperitoneal surgical exploration for para-aortic lymphadenectomy. Based on histopathologic confirmation, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the PET/CT for para-aortic lymph node metastasis were estimated. RESULTS: The median age was 48.7 (range 42-67). The accuracy, sensitivity, specificity, PPV and NPV of the PET/CT were 75%, 50%, 83.3%, 50% and 83.3%, respectively. The treatment was modified in four of sixteen (25%) patients; four patients received EFRT in combination with cisplatin chemotherapy instead of standard pelvic field radiotherapy in combination with cisplatin chemotherapy. CONCLUSION: Our results, despite our study group is small, suggest that PET/CT is an effective imaging technique in the evaluation of LACC with negative CT findings. It may help planning the management especially selecting radiation field. However, larger controlled studies are needed to recommend PET/CT as an alternative to pre-treatment surgical staging.
Asunto(s)
Fluorodesoxiglucosa F18 , Ganglios Linfáticos/diagnóstico por imagen , Recurrencia Local de Neoplasia/diagnóstico por imagen , Radiofármacos , Neoplasias del Cuello Uterino/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Antígeno Ca-125/sangre , Femenino , Humanos , Metástasis Linfática , Persona de Mediana Edad , Recurrencia Local de Neoplasia/sangre , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Tomografía de Emisión de Positrones , Estudios Prospectivos , Tomografía Computarizada por Rayos X , Neoplasias del Cuello Uterino/sangre , Neoplasias del Cuello Uterino/patologíaRESUMEN
To compare the prevalence of cervical human papillomavirus (HPV) infection in Turkish women with normal Papanicolaou (Pap) smear and cervical intraepithelial neoplasia (CIN). In between March 2002 and November 2005, the study was designed as case-control study. Cytologic abnormalities in Pap smears were classified according to the Bethesda System (2001). Identification of the presence of HPV was carried out by the Hybrid Capture II test for all patients. To compare the groups, Chi-square test was used. A total of 1353 reproductive aged women were screened. Of them, 1344 (99.3%) had normal or class I Pap smear. Remaining nine cases (0.7%) had CIN at several degrees (five CIN I, three CIN II, and one carcinoma in situ). While all these nine cases with cervical pathologies had HPV, only 20 cases from the other group (1.5%) had HPV (chi(2) 466.1; P = 0.0001). This is the first study of the evaluation of the association between HPV and preinvasive cervical lesions in Turkish population. In spite of low general frequency (2.1%) of cervical HPV colonization in this population, a strong correlation was found between HPV and CIN.
Asunto(s)
Infecciones por Papillomavirus/epidemiología , Displasia del Cuello del Útero/epidemiología , Neoplasias del Cuello Uterino/epidemiología , Adulto , Femenino , Humanos , Infecciones por Papillomavirus/complicaciones , Prevalencia , Turquía/epidemiología , Neoplasias del Cuello Uterino/virología , Displasia del Cuello del Útero/virologíaRESUMEN
OBJECTIVE: To compare, using method type and application time, the demographic characteristics of women using hormonal contraceptive methods administered after abortion or during the interval period with those of intrauterine device (IUD) users. METHODS: The demographic characteristics of women to whom oral contraception (OC), monthly injection, depot medroxyprogesterone acetate (DMPA), or IUD were administered in the post-abortive and interval periods between January 1998 and September 2001 in our clinic, were evaluated with the help of a registration system based on the Microsoft Access software used in our clinic. Demographic characteristics recorded were: age, reproductive expectation, previous contraceptive method, education level, number of live children, number of induced and spontaneous abortuses. RESULTS: A total of 10 500 women were included in the study. Of these, 6601 women had taken a contraceptive method during the interval period, and 3899 women had taken a contraceptive method post-abortion. Only 4.6% of the cases were younger than 20 years, 48.3% were between 21 and 30 years, 37.2% were between 31 and 40 years and 9.9% were 41 years old or over. The DMPA-administered group contained the highest number of women > or = 41 years when compared to other groups (22.8%). In reproductive expectations, 65.8% of the cases wanted no more children; 1.3% wanted to have a baby within a 2-year period whereas 23.7% wanted a child after 2 years. The proportion of women wanting no more children was greatest in the DMPA-administered group (77.3%). No previous use of contraceptive methods was reported by 20.7% of women; 27% were using coitus interruptus. The education level of the women was as follows: 10% had no education, 58.3% had education to primary school level, 23.2% to secondary-high-school level and 2.1% to university level. The group of women who chose OC as their contraceptive method contained the highest proportion of university graduates (6.5%). Only 6.26% of the women had no children. The proportion of women in the DMPA-use group with three or more children was higher compared to that in other groups (33.2%). CONCLUSION: The evaluation of demographic characteristics plays an important role in counseling, and in the efficacy and continued use of contraceptive methods.
Asunto(s)
Anticonceptivos Orales/administración & dosificación , Acetato de Medroxiprogesterona/administración & dosificación , Aborto Espontáneo , Adulto , Anticoncepción , Preparaciones de Acción Retardada , Demografía , Servicios de Planificación Familiar , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intramusculares , Embarazo , Índice de Embarazo , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , TurquíaRESUMEN
OBJECTIVE: To determine the factors affecting the pregnancies with intrauterine devices. DESIGN AND METHODS: The intrauterine device (IUD) locations in pregnancies with IUDs referring to SSK Aegean Maternity Hospital were determined by ultrasonography (USG) in a 6 year period. Three hundred and eighteen pregnancy cases (pregnancy group) were observed together with intrauterine devices. All intervally applied IUDs were CeT380A. All demographic characteristics of the cases together with determination of IUD localizations were recorded, and these cases were compared with 300 cases (control group) using CuT380A and under routine follow-up in our clinic. RESULTS: Ultrasonographic examination revealed IUD dislocation in 64% of 318 cases, whereas only 11% of the control group had dislocated IUDs. The difference between two groups was statistically significant. Especially in cases where the pregnancy group was less than 20 years old, IUD dislocations were recorded in 87.5%. The statistical analysis revealed a significant correlation in the distribution of IUD pregnancies according to years. When the demographic characteristics of two groups were compared, no statistically significant correlation was observed between the demographic characteristics and pregnancies with IUDs. There were 89 cases (27.9%) who decided on the continuation of IUD pregnancies. Unfortunately, 40% of these cases resulted in abortion. Only in 27% of 56 cases after IUD extraction because of IUD dislocation was miscarriage recorded. Meanwhile, 77% of the 26 cases with IUD left in the uterine cavity presented with miscarriage. Of the total of 36 miscarriages, 33% were =6 weeks pregnancy, and 27% were over 10 weeks. CONCLUSION: IUD dislocation is a significant factor affecting IUD pregnancies. The fact that dislocation is most common in the first year reveals the necessity for more frequent controls in this period.
Asunto(s)
Dispositivos Intrauterinos , Embarazo no Planeado , Aborto Espontáneo/epidemiología , Adulto , Estudios de Evaluación como Asunto , Femenino , Humanos , Dispositivos Intrauterinos/estadística & datos numéricos , Nacimiento Vivo/epidemiología , Embarazo , Complicaciones del Embarazo/diagnóstico por imagen , Complicaciones del Embarazo/epidemiología , Turquía/epidemiología , UltrasonografíaRESUMEN
OBJECTIVES: To determine the effect of oral versus vaginal misoprostol on cervical dilatation in first-trimester intrauterine evacuation or menstrual regulation (MR). DESIGN AND METHODS: A total of 120 patients were randomly assigned to a double-blind prestudy. Four groups, each consisting of 30 cases, were administered one of four regimens: 200 microg misoprostol orally, 200 microg misoprostol intravaginally, placebo orally, or placebo intravaginally, 10 h before MR, respectively. Age, number of births and abortions, birth methods, date of last delivery and last abortion were recorded. The gestational age was determined by ultrasonography. Prior to MR, data regarding the time of the application of the drug, the presence of placenta in the cervical canal, the degree of cervical dilatation, the duration of MR and patients' complaints were recorded. The MRs were performed by the same physician. The statistical analyses were evaluated with the chi(2) test and Fisher's exact test in the Aegean University Science Faculty Department of Statistics. RESULTS: In the oral misoprostol group, four patients had cervical bleeding and one had intracervical placenta. In the intravaginal misoprostol group, cervical bleeding was observed in seven patients and intracervical placenta was recorded in four cases. Cervical bleeding was observed in one case and intracervical placenta was also observed in one case in the oral placebo group. Cervical dilatation reached 8 mm in seven patients in the oral misoprostol group and in three patients in the intravaginal group, with none in the placebo group. Symptoms such as pelvic pain, headache and nausea were observed in 11 cases in the oral and 14 cases in the vaginal misoprostol groups. CONCLUSIONS: Different methods of misoprostol administration may not be equivalent in terms of efficacy and side-effects. Therefore, we decided to extend the study to include more patients so as to achieve statistically significant results.