Publications by authors named "Mehmet Ali Vardar"

28 Publications

  • Page 1 of 1

PALM-COEIN classification system of FIGO vs the classic terminology in patients with abnormal uterine bleeding.

Ginekol Pol 2021 Mar 23. Epub 2021 Mar 23.

Cukurova University, Adana, Turkey.

Objectives: To evaluate the FIGO's novel classification system versus the classic terminology in patients with abnormal uterine bleeding.

Material And Methods: A retrospective study was carried out between August 2015 and September 2019 in the Health Sciences University Gazi Yaşargil Training and Research Hospital. The pathology reports of the patients were classified according to the PALM-COEIN method and were compared with classical terminology. The operated patients with fibroids reported in the pathology results were classified as subgroups of fibroids.

Results: Evaluation was made of a total of 515 women with abnormal uterine bleeding. According to the classical terminology, 137 (26.6%) patients were defined with hypermenorrhea, 74 (14.4%) with menorrhagia, 57 (11.1%) with metrorrhagia, and 246 (47.8%) with menometrorrhagia. In the PALM-COEIN classification system, polyps were determined in 84 (16.3%) cases, adenomyosis in 228 [diffuse adenomyosis: 196 (38.1%), local adenomyosis: 32 (6.2%)], leiomyoma in 386 [submu-cous: 161 (31.1%), other types: 225 (43.9%)], and malignancy and hyperplasia in 47 (9.1%).

Conclusions: The classical terminology for abnormal uterine bleeding is insufficient in terms of etiological pathologies in non-pregnant women of reproductive age. The widespread use of this novel system for the abnormal uterine bleeding classification will provide a more useful communication between physicians and researchers.
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http://dx.doi.org/10.5603/GP.a2021.0011DOI Listing
March 2021

Clinicopathologic characteristics and prognosis comparison of the uterine high grade endometrial carcinomas.

Ginekol Pol 2021 Mar 10. Epub 2021 Mar 10.

Department of Obstetrics and Gynecology, Çukurova University, School of Medicine, Adana, Turkey.

Objectives: Grade 3 endometrioid adenocarcinomas (G3 EAC), type two endometrial carcinomas (Type 2 EC), and also uterine carcinosarcomas (UCS) are considered as high-grade endometrial adenocarcinomas. The aim of this study was to compare the clinicopathologic features and survival of patients with UCS, G3 EAC, Type2 EC.

Material And Methods: We included two hundred and thirty-five patients in this study. Patients were divided into three groups according to the type of tumor as uterine G3 EAC (group 1, n = 62), Type 2 EC (serous, clear and mixed types; group 2, n = 93), and UCS (group 3, n = 80). We compared the groups according to age, initial symptom, surgical approach, stage, myometrial invasion (MI), lymph node invasion (LNI), lymphovascular space invasion (LVSI), adjuvant therapy, and survival. When comparing the survival outcomes the Kaplan-Meier analysis was performed.

Results: The groups were similar according to age, menopausal status, nulliparity, initial symptoms, stage, LVSI, and LNI. Positive cytology was determined significantly more in group 3. There was a significant difference between the groups in terms of myometrial invasion degree. Optimal cytoreduction was similar among the groups. The primary adjuvant treatment was chemotherapy for UCS and Type2 EAC whereas radiotherapy was the main adjuvant treatment for G3 EAC. There were no significant differences among the groups according to overall survival (OS) (p = 0.290).

Conclusions: Although the survival difference among the groups can not be revealed, these patients have different clinical and pathological features and they should be considered as different groups.
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http://dx.doi.org/10.5603/GP.2020.0184DOI Listing
March 2021

Prognostic factors and survival outcomes of women with uterine leiomyosarcoma: A Turkish Uterine Sarcoma Group Study-003.

Curr Probl Cancer 2021 Feb 9:100712. Epub 2021 Feb 9.

Department of Gynecologic Oncology, Ankara State Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.

To assess the clinicopathological features, prognostic factors, and survival rates associated with uterine leiomyosarcoma (uLMS). Databases from 15 participating gynecological oncology centers in Turkey were searched retrospectively for women who had been treated for stage I-IV uLMS between 1996 and 2018. Of 302 consecutive women with uLMS, there were 234 patients with Federation of Gynecology and Obstetrics (FIGO) stage I disease and 68 with FIGO stage II-IV disease. All patients underwent total hysterectomy. Lymphadenectomy was performed in 161 (54.5%) cases. A total of 195 patients received adjuvant treatment. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 42% and 54%, respectively. Presence of lymphovascular space invasion (LVSI), higher degree of nuclear atypia, and absence of lymphadenectomy were negatively correlated with DFS, while LVSI, mitotic count, higher degree of nuclear atypia, FIGO stage II-IV disease, and suboptimal surgery significantly decreased OS. LVSI and higher degree of nuclear atypia appear to be prognostic indicators for uLMS. Lymphadenectomy seems to have a significant effect on DFS but not on OS.
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http://dx.doi.org/10.1016/j.currproblcancer.2021.100712DOI Listing
February 2021

Low-grade endometrial stromal sarcoma: A Turkish uterine sarcoma group study analyzing prognostic factors and disease outcomes.

Gynecol Oncol 2021 03 27;160(3):674-680. Epub 2020 Dec 27.

Department of Gynecologic Oncology, Saglik Bilimleri University Ankara City Hospital, Ankara, Turkey.

Objective: To investigate factors associated with refractory disease, recurrence, or death as well as disease-free survival (DFS) and overall survival (OS) in low-grade endometrial sarcoma (LGESS).

Methods: A multi-institutional, retrospective study was conducted in a total of 124 patients, who received a curative-intent surgery. The exclusion criteria were as follows: i) history of any other invasive disease; ii) neoadjuvant therapy; iii) fertility sparing surgery; iv) a different diagnosis after review of the slides.

Results: All patients underwent hysterectomy, 96% had bilateral salpingo-oophorectomy, and 65% had lymphadenectomy. Twelve (14.8%) of 81 patients undergoing lymphadenectomy had lymph node (LN) metastasis. Of those, 8 (9.8%) had pelvic LN metastasis whereas 4 (5.6%) had isolated paraaortic LN metastasis. Six of 8 (75%) patients with positive pelvic LNs had concurrent paraaortic LN metastasis. Among 124 patients, 3 patients (2.4%) had refractory disease following primary therapy. During a median follow-up of 45.5 months, 27 (22.3%) of 121 patients who achieved complete remission after primary therapy developed recurrence, and 10 patients (8.1%) died of disease. The 3-year DFS and OS were 76.9% and 93.8%, respectively. Stage was the sole independent prognostic factor in the whole cohort. When analyzing factors within subgroups of stage I and stage ≥II, there was no significant prognostic factor for stage I; however, lymphadenectomy and adjuvant chemotherapy were significantly associated with disease outcomes for stage ≥II. While lymphadenectomy was related with improved DFS, chemotherapy was associated with poor DFS and OS.

Conclusion: The risk of LN metastasis at pelvic as well as paraaortic lymphatic basins is not negligible to omit lymphadenectomy in stage ≥II LGESS. Moreover, lymphadenectomy provides significant DFS advantage in patients with extrauterine disease.
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http://dx.doi.org/10.1016/j.ygyno.2020.12.017DOI Listing
March 2021

Feasibility and rationale of a novel approach in advanced ovarian cancer surgery: Bat- shaped en-bloc total peritonectomy and total hysterectomy salpingo-oophorectomy with or without rectosigmoid resection (Sarta-Bat approach).

Gynecol Oncol 2021 Apr 21;161(1):97-103. Epub 2020 Nov 21.

Faculty of Medicine, Gynecologic Oncology Department, Cukurova University, Turkey.

Objective: To evaluate the feasibility of bat-shaped en-bloc total peritonectomy and total hysterectomy-salpingo-oophorectomy with or without rectosigmoid resection as a novel approach in advanced ovarian cancer surgery.

Methods: Advanced ovarian cancer patients with widespread peritoneal implants requiring total peritonectomy were the subject of the study. Thirteen cases were operated with Sarta-Bat approach between February 2019 and July 2020. Patients' clinical and surgical data were collected and statistically analyzed.

Results: Median age of the patients was 52 (40-65). Histopathology of the tumors were high-grade serous carcinoma in 12 (92.3%) and carcinosarcoma in one (7.7%) cases and all of them originated from the ovary. Eight (61.5%), two (15.4%) and three (23.1%) patients were stage 3c, 4a, and 4b, respectively. Upper abdomen was involved in all cases. Nine cases underwent primary cytoreductive and four cases interval cytoreductive surgery. Sarta-Bat approach was performed as en-bloc total peritonectomy, total hysterectomy bilateral salpingo-oophorectomy with rectosigmoid resection in three and without rectosigmoid resection in 10 cases. Final surgery resulted in complete cytoreduction (no macroscopic residual) in all cases, with acceptable grade 2-3 morbidity rates.

Conclusion: Sarta-Bat approach is a feasible and convenient technique for cytoreductive surgery of advanced ovarian cancer with disseminated peritoneal metastases.
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http://dx.doi.org/10.1016/j.ygyno.2020.11.011DOI Listing
April 2021

The impact of morbid obesity on survival of endometrial cancer.

Turk J Obstet Gynecol 2020 Sep 2;17(3):209-214. Epub 2020 Oct 2.

Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Adana, Turkey.

Objective: Morbid obesity is identified as patients with a body mass index more than 40 kg/m. Obesity is known as a risk factor for endometrial cancer due to the increase of the deposited estrogen. This study was conducted to evaluate the effect of morbid obesity on the survival of endometrial cancer.

Materials And Methods: The archival records and pathologic reports of patients with endometrial cancer who underwent surgery and were followed up in Çukurova University Gynecologic Oncology Center between January 1996 and December 2018 were reviewed, retrospectively. Data regarding body mass index and survival was reported in 520 patients. These patients were stratified into two groups according to their body mass index, <40 and ≥40 kg/m. The groups' clinic, pathologic features, and survival rates were compared.

Results: There were 146 patients in the morbidly obese group and 374 patients in the obese group. The mean age of the groups was 58.5 and 56.2 years, respectively. The mean follow-up time was 51.6 months. Comorbidities were significantly higher in the morbidly obese group. The five-year disease-free and overall survival rates were 78.3% and 85.3% in the morbidly obese group, and 81.6% and 90.1% in the obese group, respectively. Although the groups' clinical and pathologic features were homogeneously distributed, disease-free and overall survival rates were significantly different (p=0.053 and p=0.054, respectively).

Conclusion: Morbidly obese patients with endometrial cancer were associated with 2.7-fold increased risk of death and 1.7-fold increased risk of recurrence compared with those who had body mass index <40 kg/m. It is important to deal with the frequent comorbidities in this special group, which could be simply altered by lifestyle changes. Morbidly obese patients with endometrial cancer should be encouraged in lifestyle changes and consulted by dieticians and endocrinologists.
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http://dx.doi.org/10.4274/tjod.galenos.2020.83773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538820PMC
September 2020

Challenges on the morbidly obese endometrial cancer surgery: Laparotomy or laparoscopy, lymphadenectomy or no lymphadenectomy?

Ginekol Pol 2020;91(8):453-459

Çukurova University Medical Faculty, Obstetrics and Gynecology Department, Adana, Turkey.

Objectives: A considerable proportion of endometrial cancer patients are morbidly obese. Management of these cases is a serious dilemma. The aim of this study was to investigate the relevance of laparoscopic route and omission of lymphadenectomy as morbidity-reducing strategies in this special population.

Material And Methods: Endometrial cancer patients' archival records were retrospectively reviewed and cases with body mass index ≥ 40 kg/m2 were selected. A comparative evaluation of their characteristics and survival rates were performed. Firstly, according to the surgical approach; laparoscopy or laparotomy, and then regarding to performing lymphadenectomy or not.

Results: There were 146 patients enrolled in this study. Whereas, significantly higher postoperative complications and longer hospital stays were determined in the laparotomy compared to laparoscopy groups. Five years disease-free and overall survival were not significantly different (83.6% vs 70.7%, p = 0.184 and 83.9% vs 86.6%, p = 0.571, respectively). On the other hand, operation length, postoperative hospitalization time, both intraoperative and postoperative complications were significantly lower in the non-lymphadenectomy compared to the lymphadenectomy groups. However, five-years disease-free and overall survival were not significantly different (77.3% vs 81.3%, p = 0.586 and 87.5% vs 78%, p = 0.479, respectively).

Conclusions: Laparoscopic approach and omission of lymphadenectomy are worthy policies in the morbidly obese endometrial cancer patients.
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http://dx.doi.org/10.5603/GP.2020.0077DOI Listing
January 2020

Prognosis Trend of Grade 2 Endometrioid Endometrial Carcinoma: Toward Grade 1 or 3?

Pathol Oncol Res 2020 Oct 2;26(4):2351-2356. Epub 2020 Jun 2.

Department of Obstetrics and Gynecology Faculty of Medicine, Çukurova University, 01330, Adana, Turkey.

Although the prognostic significance of grade in endometrial cancer is well known, grade 2 cases have not been evaluated separately in most of the previous studies. In this study, we aim to investigate whether the oncologic outcomes of grade 2 endometrioid endometrial carcinomas trend towards grade 1 or 3 tumors. Patients' records and pathological reports were reviewed retrospectively and eligible patients with endometrioid endometrial carcinoma were determined and distributed into 3 groups according to their 1988 International Federation of Gynecology and Obstetrics (FIGO) grade. Groups' characteristics and oncologic outcomes were compared. Differences between grades were tested with z-test and adjusted by Bonferroni method. Kaplan-Meier method was performed for the survival analysis. In total, 776 patients of endometrioid endometrial carcinoma were included in this study. Mean follow-up time was 52 ± 14 months. Patients' mean age was 56.3 ± 10.8 years. Even though grade 2 endometrioid endometrial carcinomas were different from both grade 1 and 3 in terms of the pathological features, survival analyses demonstrated that their oncologic outcomes trended towards grade 1. The grade was determined as an independent prognostic factor for overall survival (OS). The interobserver reproducibility will be improved among pathologists by combining FIGO grade 1 and 2 endometrioid endometrial carcinomas, while prognosis prediction is not likely to be affected.
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http://dx.doi.org/10.1007/s12253-020-00836-wDOI Listing
October 2020

Prognostic significance of programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) expression in uterine carcinosarcoma.

Eur J Obstet Gynecol Reprod Biol 2020 Jan 8;244:51-55. Epub 2019 Nov 8.

Cukurova University, Faculty of Medicine, Department of Obstetrics and Gynecology, Turkey.

Objective: The aim of this study was to evaluate the clinical and prognostic importance of programmed death-1 (PD-1) and/ or programmed death-ligand 1 (PD-L1) in uterine carcinosarcoma (UCS).

Study Design: Formalin-fixed, paraffin-embedded tissue samples from 59 cases with UCS were analyzed. PD-1 and PD-L1 expressions in tumor tissue and microenvironment were detected by immunohistochemistry. Clinical and pathological characteristics including age, stage, initial symptom, surgical approach, myometrial invasion, lymphovascular space invasion (LVSI), lymph node invasion, adjuvant therapy, and survival were evaluated. The Kaplan-Meier and Cox proportional hazards models were used to compare the outcomes and prognostic factors.

Results: PD-1 expression in tumor tissue and microenvironment was detected in 15 (25 %) and 18 (30 %) cases, respectively. PD-L1 expression in tumor tissue and microenvironment was detected in 15 (25 %) and 12 cases (20 %), respectively. PD-L1 expression in tumor was associated with longer survival and median survival was 38 and 15 months in cases with and without PD-L1 expressions, respectively (p = 0.019). Lymphovascular space invasion (LVSI) (p = 0.014), myometrial invasion (p = 0.008) and PD-L1 expression were found to be prognostic for UCS's. PD-L1 expression was found to be an independent good prognostic factor with Cox regression analysis (OR 3.9; 95 % CI: 1.4-11.0) for overall survival.

Conclusion: PD-1 and/or PD-L1 expression are important due to their expressions in one fourth of the cases with UCS and PD-1/PD-L1 blockade may be a new avenue in UCS.
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http://dx.doi.org/10.1016/j.ejogrb.2019.11.006DOI Listing
January 2020

Programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) expressions in type 2 endometrial cancer.

Arch Gynecol Obstet 2019 08 10;300(2):377-382. Epub 2019 May 10.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cukurova University, 01330, Saricam/Adana, Turkey.

Purpose: The aim of this study was to evaluate prognostic importance of programmed death-1 (PD-1) and/ or programmed death-ligand 1 (PD-L1) expressions in type 2 endometrial cancer. Study design Formalin-fixed, paraffin-embedded tissue samples from 53 cases with type 2 endometrial cancer were analyzed. One-third of our cases had serous adenocarcinoma (32%), 11 had clear cell (21%) and 25 had mixed-type adenocarcinoma (47%). PD-1 and PD-L1 expressions in tumor tissue and microenvironment were detected by immunohistochemistry. Clinical and pathological characteristics including age, stage, initial symptom, surgical procedure, myometrial invasion, lymphovascular space invasion (LVSI), lymph node invasion, adjuvant therapy, and survival were reviewed. The Kaplan-Meier and Cox proportional hazards models were used to evaluate the prognostic factors.

Results: PD-1 expression in tumor tissue and microenvironment was detected in 22 (42%) and 28 (53%) cases, respectively. PD-L1 expression was detected in tumor and microenvironment in 8 (15%) and in 15 cases (28%), respectively. Expression of PD-1 and PD-L1 expressions in tumor area was associated with shorter survival (p = 0.006 and 0.001, respectively) but PD-1 and PD-L1 expressions in microenvironment were not found to be related with survival. PD-1 (p = 0.006) and PD-L1 expressions (p = 0.001) in addition to LVSI (p = 0.005), myometrial invasion (p = 0.015), lymph node involvement (p = 0.019), and suboptimal cytoreduction (p = 0.042), were found to be associated with poor prognostic indicators. PD-1 and PD-L1 expressions in tumor and lymph node involvement were determined as independent prognostic factors.

Conclusion: PD-1 and PD-L1 expressions in type 2 endometrial cancers were found to be poor prognostic indicators.
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http://dx.doi.org/10.1007/s00404-019-05180-2DOI Listing
August 2019

Laparoscopic surgery for low, intermediate and high-risk endometrial cancer.

J Gynecol Oncol 2019 Mar 16;30(2):e24. Epub 2018 Nov 16.

Department of Biostatistics, Cukurova University Faculty of Medicine, Adana, Turkey.

Objective: The aim of the present study was to compare the long-term outcomes of the laparotomy (LT) and laparoscopic surgery and to evaluate the results according to low, intermediate, and high-risk groups of endometrial cancer (EC).

Methods: We identified 801 patients with EC and these patients were classified as group 1, who underwent LT (n=515); and group 2, who underwent laparoscopy (LS) (n=286). Patient's demographics, clinical characteristics such as stage, grade, histopathologic type, lymphovascular space invasion, myometrial invasion, lymph node involvement, and risk groups, peri- and post-operative outcomes, and survival outcomes were compared between the groups according to risk classification. Survival outcomes were assessed using Kaplan-Meier method.

Results: The demographic characteristics of both groups were similar except age. Shorter hospital stay and fewer complications were observed in group 2. The overall survival (OS) were similar in the low, low-intermediate, high-intermediate and high-risk groups (p=0.269, 0.476, 0.078, and 0.085; respectively) for LS compared to LT. The covariate analysis revealed that the death and recurrence risks were approximately twice higher in the LT group than in the LS group (odds ratio [OR]=1.9; 95% confidence interval [CI]=1.2-3.1 for OS; OR=2.0; 95% CI=1.2-3.3 for disease-free survival).

Conclusion: The results of our study support the well-known positive aspects of LS as well as safe and effective use in cases of intermediate and high-risk EC.
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http://dx.doi.org/10.3802/jgo.2019.30.e24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393633PMC
March 2019

Prognostic value of pre-operative neutrophil/lymphocyte ratio, monocyte count, mean platelet volume, and platelet/lymphocyte ratio in endometrial cancer.

Eur J Obstet Gynecol Reprod Biol 2018 Jul 22;226:25-29. Epub 2018 May 22.

Cukurova University, Faculty of Medicine, Department of Obstetrics and Gynecology, Turkey.

Objective: Cancer-related inflammation is associated with poor long-term outcomes in various solid tumors. The aim of this study is to investigate the prognostic significance of pre-operative neutrophil lymphocyte ratio (NLR), monocyte count (MC), mean platelet volume (MPV), and platelet lymphocyte ratio (PLR) in endometrial cancer.

Study Design: In this study, 763 patients with endometrial cancer were evaluated, who were followed between January 1996 and February 2016. Preoperative values of NLR, MC, MPV, and PLR were evaluated in terms of clinico-pathologic prognostic factors and overall survival (OS).

Results: NLR, MC, and PLR were detected to be statistically significant with regard to advanced stage of the disease (p = 0.001, p = 0.02, and p = 0.001, respectively), but only MC was significant in terms of grade (p = 0.035). Higher NLR and PLR values were found to be associated with advanced stage of the disease, deep myometrial invasion, cervical involvement, lymphovascular space invasion (LVSI), and nodal involvement. When the cut-off value was considered as 3, sensitivity and specificity for NLR were found to be 68% and 69%, respectively, to predict lymph node metastasis. NLR was found as a prognostic factor for survival (p = 0.01). Age, the presence of comorbidity, stage, and cervical involvement were determined to be independent prognostic factors for OS in our cohort.

Conclusion: NLR was detected to be a prognostic factor for survival. Moreover, NLR and PLR are a predictive value for lymph node involvement and also for cervical invasion in endometrial cancer.
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http://dx.doi.org/10.1016/j.ejogrb.2018.05.028DOI Listing
July 2018

A novel technique: Carbon dioxide gas-assisted total peritonectomy, diaphragm and intestinal meso stripping in open surgery for advanced ovarian cancer (Çukurova technique).

Gynecol Oncol 2017 09 15;146(3):674-675. Epub 2017 Jul 15.

Cukurova University, Faculty of Medicine, Gynecologic Oncology Department, Turkey.

Objective: Most of the ovarian cancers are diagnosed at advanced stages. As peritoneal carcinomatosis increases, especially when it extends to the diaphragm and intestinal mesos, probability of obtaining complete cytoreduction is reduced. Complete cytoreduction (residue zero: R0) is one of the main factors affecting survival [1-3]. Here we present a novel technique of stripping the peritoneal surfaces as a part of cytoreductive surgery in such cases.

Methods: A 55year-old woman diagnosed with peritoneal carcinomatosis was considered appropriate for primary cytoreduction after assessment of her thorax-abdominopelvic tomography, which revealed resectable intra-abdominal disease. Upon laparotomy, omental cake adherent to pelvis-filling mass, disseminated implants on the diaphragm, meso of the descending colon and small intestine were observed. The mass invaded the rectosigmoid colon, uterus, adnexa and the bladder resulting in frozen pelvis. Palpable retroperitoneal pelvic and para-aortic lymph nodes were detected. On the other side, stomach, anti-mesenteric surfaces and mesentery root of the small bowel were tumor-free. Hence, upon these perioperative and preoperative imaging findings, complete cytoreduction was thought to be achievable. Therefore, primary cytoreduction was performed. Total omentectomy, hysterectomy with bilateral salpingo-oophorectomy, rectosigmoid low anterior resection and retroperitoneal lymphadenectomy were performed. With the assistance of an injector needle connected to the insufflator tube (as in laparoscopic surgery), carbon dioxide gas was blown into the right retroperitoneal area and subsequently peritoneum was rapidly stripped up to the right diaphragm. The same procedure was then applied to the diaphragm and meso of the bowels, respectively. Owing to this technique, total stripping of all involved peritoneal surfaces was clearly facilitated and R0 goal was reached.

Results: Gas insufflation caused convenient detachment of the peritoneal surfaces along their anatomical line which led to concluding the stripping procedures easily, rapidly and safely without bleeding. Thus, according to our experience, about 10 to 15min per procedure are saved in such cases. Potential complications of CO gas used here are not superior to those in transperitoneal or retroperitoneal laparoscopic procedures. During the operation, patient was followed-up for potential complications such as subcutaneous emphysema and CO gas embolism.Thus, hourly blood gas was monitored. Another potential complication is injury of the vessels while inserting the needle which can be avoided by cautious inserting under the peritoneal surfaces superficially and using transillumination. In case such injuries happen, tamponing is a sufficient measure. In our serial, no perioperative complications belonging to this technique were encountered. However, long term outcomes such as precise time difference, difference in blood loss, complication rates, adhesions, morbidity associated with this technique and its impact on survival of the patients with advanced ovarian cancer have yet to be investigated. Therefore, a prospective study to validate this technique's long-term usefulness has been initiated in our clinic.

Conclusion: We believe that this practical and effective technique will offer significant improvements in efforts to achieve complete cytoreduction.
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http://dx.doi.org/10.1016/j.ygyno.2017.07.132DOI Listing
September 2017

Does preoperative neutrophil to lymphocyte or platelet to lymphocyte ratios have a role in predicting borderline ovarian tumors?

J Ovarian Res 2016 Nov 8;9(1):78. Epub 2016 Nov 8.

Department of Pathology, Division of Gynecologic Pathology, Faculty of Medicine, Çukurova University, Adana, Turkey.

Background: to investigate the value of using preoperative neutrophil to lymphocyte and platelet to lymphocyte levels in the patients of borderline ovarian tumors.

Methods: During the period between January 2002 and December 2015, the pathology reports and archival files of the Gynecologic Oncology Department of Çukurova University Medical Hospital and the Gynecologic Oncology Department of Dumlupınar University, Evliya Çelebi Education and Research Hospital were retrospectively reviewed, and 144 patients of borderline ovarian tumor (as the study group) and 123 patients of serous cystadenoma (as the control group) were determined for eligibility in this study. Data regarding age, menopausal status, preoperative ultrasound findings, ca125 and complete blood counts were reviewed. Neutrophil to lymphocyte and platelet to lymphocyte ratios were calculated and these parameters were statistically compared between the groups.

Results: There was a statistically significant difference between the groups according to neutrophil count, platelet count, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio; in addition to age, ca125 and preoperative ultrasound findings.

Conclusions: It seems that neutrophil to lymphocyte and platelet to lymphocyte ratios are useful in predicting borderline ovarian tumors, preoperatively. However, further prospective studies are needed.
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http://dx.doi.org/10.1186/s13048-016-0283-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100210PMC
November 2016

GLUT-1 Expression in Proliferative Endometrium, Endometrial Hyperplasia, Endometrial Adenocarcinoma and the Relationship Between GLUT-1 Expression and Prognostic Parameters in Endometrial Adenocarcinoma.

Turk Patoloji Derg 2016 ;32(3):141-7

Department of Pathology, Cukurova University School of Medicine, ADANA, TURKEY.

Objective: Malignant cells show increased glucose uptake in in vitro and in vivo studies. This uptake is mediated by glucose transporter proteins. GLUT-1 is the most common transporter protein, and its expression is reported to be increase in many human cancers. The aim of this study is to determine the GLUT-1 overexpression in benign, hyperplastic, and malignant endometrial tissues, to evaluate the usefulness of GLUT-1 expression in endometrial hyperplasia, and to determine its role in the neoplastic progression to endometrioid type adenocarcinoma. We also aimed to analyze prognostic clinical parameters, predict prognosis, and survival.

Material And Method: We examined immunohistochemical expression of GLUT-1 in 91 cases of endometrial hyperplasia, 100 cases of endometrioid type adenocarcinoma, and 10 proliferative endometrial tissues. The percentage of positive cells and staining intensity were assessed in a semi quantitative fashion and scored (1+ to 3+).

Results: GLUT-1 immunoreactivity was not present in proliferative endometrium. Twenty-nine (31.9%) of 91 endometrial hyperplasia cases showed positive immunoreactivity, of which only six were cases of hyperplasia without atypia while 23 of them were cases with atypia. We found GLUT-1 positivity of 95% in endometrioid type adenocarcinoma. GLUT-1 overexpression was not significantly correlated with any of the clinicopathological parameters except histological grade in endometrioid adenocarcinoma; the survival was not found to be correlated with GLUT-1 expression.

Conclusion: GLUT-1 immunostaining may be useful in distinguishing hyperplasia without atypia from hyperplasia with atypia; GLUT-1 overexpression is a consistent feature of endometrioid adenocarcinoma. A correlation between GLUT -1 expression and tumor grade has been found, although other prognostic parameters and survival has no meaningful correlation.
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http://dx.doi.org/10.5146/tjpath.2015.01352DOI Listing
April 2017

A Single-Institution Radical Surgery Results in Stage IB2/IIA2 (Bulky) Cervical Cancer.

Int J Gynecol Cancer 2016 10;26(8):1480-4

*Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Çukurova University, Adana; †Department of Obstetrics and Gynecology, Kirikkale Government Hospital, Kirikkale; and ‡Department of Biostatistic, Faculty of Medicine, and §Department of Pathology, Division of Gynecologic Pathology, Faculty of Medicine, Çukurova University, Adana, Turkey.

Objective: The aim of this study is to evaluate the results of radical surgery in patients with stage IB2 to IIA2 cervical cancer who were operated on at our center between 2002 and 2015.

Materials And Methods: Forty-seven cases of patients with stage IB2/IIA2 cervical cancer who underwent primary radical surgery between 2002 and 2015 were enrolled in this study. Patients' files and pathological reports were retrospectively reviewed. Surgical, pathological, and clinical variables were analyzed and their impact on survival period was researched. Disease-free survival and overall survival periods were determined using the Kaplan-Meier test. The P value was considered significant if less than 0.05.

Results: Type C2 radical hysterectomy with lymphadenectomy (5 pelvic, 42 pelvic and para-aortic) was performed for all of the 47 patients in accordance with the Querleu-Morrow classification. Thirty-three of the cases were stage Ib2 and 14 cases were IIa2. Five years of overall survival was 80%. Recurrence was noted in 10 (7 pelvic, 3 extrapelvic) patients. Adjuvant therapies were needed for 83% of the patients. A univariate analysis was made for all included variables in this research and, other than recurrence, none of them was found to be statistically significant on OS and DFS.

Conclusions: Although adjuvant therapies are often resorted to, primary radical surgery is also a reasonable treatment option for stage IB2/IIA2 cervical cancer, especially in young premenopausal patients when preserving ovarian functions is desired.
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http://dx.doi.org/10.1097/IGC.0000000000000786DOI Listing
October 2016

Primitive uterine neuroectodermal tumours: Two case reports.

Turk J Obstet Gynecol 2015 Sep 15;12(3):185-187. Epub 2015 Sep 15.

Çukurova University Faculty of Medicine, Department of Pathology, Adana, Turkey.

Primitive neuroectodermal tumor (PNET) arise from Kulchitsky cells and are rarely seen in the female genital tract. Differential diagnosis of PNET can be made based on immunohistochemical profiles and genetic analyses. Genital tract pNETs are very aggressive pathologies with different clinical and molecular manifestations and there are no standard guidelines for treatment. We aimed to present two cases of uterine PNETs with different symptomatology and clinical findings.
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http://dx.doi.org/10.4274/tjod.58295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558395PMC
September 2015

European Network of Gynaecological Oncological Trial Groups' Requirements for Trials Between Academic Groups and Industry Partners--First Update 2015.

Int J Gynecol Cancer 2015 Sep;25(7):1328-30

European Network of Gynaecological Oncological Trial Groups, Geneva, Switzerland.

The first version of ENGOT's Requirements for Trials Between Academic Groups and Industry Partners in Europe was published 2010. This first update integrates the experiences made by the ENGOT network and the cooperative group studies while performing, analyzing, and publishing -among others - three large phase III trials. Furthermore, progress in European legislation and its impact on clinical studies in Europe have been considered in this update process.
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http://dx.doi.org/10.1097/IGC.0000000000000478DOI Listing
September 2015

The clinical characteristics and outcomes of cases with pure ovarian clear cell, mixed type and high-grade serous adenocarcinoma.

Arch Gynecol Obstet 2015 Oct 9;292(4):923-9. Epub 2015 Apr 9.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cukurova University, 01330, Adana, Turkey,

Purpose: This study aimed to compare the clinical characteristics and outcomes of the cases with pure ovarian clear cell adenocarcinoma (OCCC), mixed type (clear plus serous or clear plus endometrioid or serous plus clear plus endometrioid) ovarian adenocarcinoma (MOC) and high-grade serous ovarian adenocarcinoma (HGSOC).

Methods: A retrospective comparison was conducted in 32 cases with pure OCCC, 23 cases with MOC and 28 cases with HGSOC followed between January 1999 and October 2011. Clinico-pathologic characteristics including histopathologic subtypes, age, stage, presence of ascites and/or peritoneal carcinomatosis, endometriosis and optimal cytoreduction, and also survival rates were compared in these three groups.

Results: The cases with pure OCCC were younger than the cases with MOC and HGSOC (p = 0.004). The median pre-operative CA-125 level was lower in the pure OCCC than in MOC and HGSOC (p = 0.006) (p = 0.001, p = <0.001, respectively). Bilaterality and peritoneal carcinomatosis were more frequently seen in the HGSOC group (p = 0.001, p < 0.001, respectively). The majority of the cases (65 %) had stage I or II disease in the pure OCCC group, but most of the cases in the HGSOC group had advanced stage disease (p < 0.001). Endometriosis was found in 16 cases (16/55, 29 %) in the OCCC group. No significant difference was detected with regard to the median survival rate among three groups (p = 0.517), while the stage of disease was found to be the only important factor for survival (p = 0.002).

Conclusion: Pure OCCC, MOC and HGSOC represent distinct clinical characteristics. Clinical characteristics of MOC are more similar to those of HGSOC.
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http://dx.doi.org/10.1007/s00404-015-3699-9DOI Listing
October 2015

Prognostic Significance of Retroperitoneal Lymphadenectomy, Preoperative Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Primary Fallopian Tube Carcinoma: A Multicenter Study.

Cancer Res Treat 2015 Jul 17;47(3):480-8. Epub 2014 Nov 17.

Department of Gynecologic Oncology, Ankara University School of Medicine, Ankara, Turkey.

Purpose: The purpose of this study is to evaluate the prognostic role of preoperative neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) and the need for para-aortic lymphadectomy in patients with primary fallopian tube carcinoma (PFTC).

Materials And Methods: Ninety-one patients with a diagnosis of PFTC were identified through the gynecologic oncology service database of six academic centers. Clinicopathological, surgical, and complete blood count data were collected.

Results: In univariate analysis, advanced stage, suboptimal surgery, and NLR > 2.7 were significant prognostic factors for progression-free survival, whereas in multivariate analysis, only advanced stage and suboptimal surgery were significant. In addition, in univariate analysis, cancer antigen 125 ≥ 35 U/mL, ascites, advanced stage, suboptimal surgery, NLR > 2.7, PLR > 233.3, platelet count ≥ 400,000 cells/mm(3), staging type, and histological subtype were significant prognostic factors for overall survival (OS); however, in multivariate analysis, only advanced stage, suboptimal surgery, NLR > 2.7, and staging type were significant. Inclusion of pelvic and para-aortic lymphadenectomy in surgery showed significant association with longer OS, with a mean and median OS of 42.0 months and 35.5 months (range, 22 to 78 months), respectively, vs. 33.5 months and 27.5 months (range, 14 to 76 months), respectively, for patients who underwent surgery without para-aortic lymphadenectomy (hazard ratio, 3.1; 95% confidence interval, 1.4 to 5.7; p=0.002).

Conclusion: NLR (in both univariate and multivariate analysis) and PLR (only in univariate analysis) were prognostic factors in PFTC. NLR and PLR are inexpensive and easy tests to perform. In addition, patients with PFTC who underwent bilateral pelvic and para-aortic lymphadenectomy had longer OS.
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http://dx.doi.org/10.4143/crt.2014.058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4506112PMC
July 2015

The guidance of intraoperative frozen section for staging surgery in endometrial carcinoma: frozen section in endometrial carcinoma.

Pathol Oncol Res 2015 Jan 20;21(1):119-22. Epub 2014 May 20.

Pathology Department, Cukurova University, School of Medicine, 01330, Saricam, Adana, Turkey,

The objective of this study was to evaluate the reliability of an intraoperative frozen section during the endometrial carcinoma staging surgery procedure. The paraffin section reports of 291 cases with endometrial carcinoma were compared with intraoperative frozen section reports, which were diagnosed in the Pathology Department of Cukurova University, Medical Faculty between June 2006 and December 2012. The reports were reviewed for diagnostic accuracy of the frozen section in terms of histological subtype, grade, and myometrial invasion. Concordance values between frozen and paraffin section reports were 86, 84.3, and 91.6% for histological subtype, grade, and myometrial invasion, respectively. When collectively evaluated, two (0.7%) of 291 patients were inappropriately operated on due to frozen section reports. Intraoperative frozen section is a reliable guide for surgeons to evaluate the risk group of patients with endometrial cancer and prevent an unnecessary staging surgery operation.
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http://dx.doi.org/10.1007/s12253-014-9796-4DOI Listing
January 2015

Prognostic importance of survivin, Ki-67, and topoisomerase IIα in ovarian carcinoma.

Arch Gynecol Obstet 2014 Feb 22;289(2):393-8. Epub 2013 Aug 22.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cukurova University, 01330, Adana, Turkey,

Purpose: Stage, tumor grade and histological subtype determine the clinical behavior in ovarian tumors. Some additional factors are related to tumor cell biology and are the useful predictors for identifying the patients with poor prognosis. The aim of this study is to evaluate the prognostic significance of survivin, Ki-67 and Topoisomerase IIα (TOPO IIα) in epithelial ovarian cancer (EOC).

Materials And Methods: Seventy-three patients with EOC were included in this study. Survivin, Ki-67 and TOPO IIα expressions were studied by immunohistochemistry on formalin-fixed, paraffin-embedded tissue sections. Nuclear staining for all antibodies was scored on a three-tiered system and more than 10 % staining was accepted as expression. The relationship between the expressions of survivin, Ki-67, TOPO IIα and clinicopathological parameters including age, stage, grade, platinum resistance and survival was evaluated.

Results: Survivin, Ki-67 and TOPO IIα expressions were found in 20, 82 and 86 % of the tumors, respectively. Ki-67 and TOPO IIα expressions were found to be related to poor overall survival (p = 0.005, 0.004, respectively), while survivin expression was not associated with overall survival. There was no association between TOPO IIα and Ki-67 expressions and histological subtype, stage or grade. However, we found an important relationship between TOPO IIα expression and platinum resistance (p = 0.044). Platinum resistance was found to be an independent prognostic factor in EOC.

Conclusion: Ki-67 and TOPO IIα expressions were found to be related to poor overall survival, and TOPO IIα expression was found to be associated with platinum resistance.
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http://dx.doi.org/10.1007/s00404-013-3000-zDOI Listing
February 2014

Adenosine deaminase activity in patients with ovarian neoplasms.

Arch Gynecol Obstet 2012 Jul 7;286(1):155-9. Epub 2012 Mar 7.

Department of Obstetrics and Gynecology, Cukurova University, Adana, Turkey.

Purpose: The aim of this study was to investigate the serum and peritoneal fluid adenosine deaminase (ADA) activity in patients with benign and malignant ovarian neoplasms.

Methods: This is a prospective cross-sectional study performed in Cukurova University, Department of Gynecologic Oncology. Eighty-four patients with ovarian mass were included in this study within 13 months. The levels of serum and peritoneal fluid ADA levels were measured and compared in patients with benign and malignant ovarian neoplasms and also low- and high-grade malignant tumors.

Results: Serum and peritoneal fluid ADA levels were found to be significantly higher in patients with ovarian cancers as compared with benign ovarian tumors (p = 0.001). Additionally, ADA levels were found to be significantly different according to the histopathological subtypes and grade of ovarian cancers. However, there was no significant difference for ADA levels between the benign and low-grade malignant tumors. There was an important correlation between the peritoneal fluid and serum ADA levels.

Conclusions: Serum and peritoneal fluid ADA levels were found to be higher in malignant ovarian neoplasms. This finding may be useful to understand the biochemically characteristics of malignant ovarian tumors and ADA may be a useful biomarker in diagnosis and management of ovarian tumors.
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http://dx.doi.org/10.1007/s00404-012-2279-5DOI Listing
July 2012

Comparative analysis of CA 125, ferritin, beta-2 microglobulin, lactic dehydrogenase levels in serum and peritoneal fluid in patients with ovarian neoplasia.

Med Oncol 2012 Dec 25;29(4):2937-43. Epub 2012 Jan 25.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cukurova University, Adana, Turkey.

The aim of this study was to investigate the diagnostic role of the CA 125, ferritin, beta-2 microglobulin (β2 M), and lactic dehydrogenase (LDH) levels in serum and peritoneal fluid (PF) in patients with ovarian neoplasms. Using cross-sectional study design; serum and PF CA 125, ferritin, β2 M, and LDH levels were analyzed in 40 patients with benign ovarian neoplasms (Group 1) and 59 patients with malignant ovarian neoplasms (Group 2) which were evaluated surgically. Serum and PF levels of these markers compared between the groups. Diagnostic role of these markers were determined with receiver operating curve (ROC) analysis. Serum and PF CA 125, ferritin, β2 M, and LDH levels were statistically significant higher in patients with ovarian cancers as compared with benign neoplasms. Among these biomarkers, PF β2 M levels had highest sensitivity and specificity, 76.3 and 85%, respectively with the cut-off value: 2.3 mg/l. This study results indicates that especially PF β2 M and ferritin levels may be valuable for diagnosis of malignant ascites in patients with ovarian neoplasms.
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http://dx.doi.org/10.1007/s12032-012-0165-4DOI Listing
December 2012

A comparative study of the analgesic effect of patient-controlled morphine, pethidine, and tramadol for postoperative pain management after abdominal hysterectomy.

Anesth Analg 2008 Jan;106(1):309-12, table of contents

Department of Anaesthesiology, Cukurova University Faculty of Medicine, Adana, Turkey.

We designed this prospective, randomized, double-blind study to compare the analgesic effectiveness and side effects of IV patient-controlled morphine, pethidine, and tramadol for postoperative pain management. One-hundred-twenty-six ASA physical status I or II patients undergoing abdominal hysterectomy were randomly allocated to receive IV-patient controlled morphine (M), pethidine (P), or tramadol (T) for postoperative analgesia. The cumulative analgesic consumption over 24 h was 25.7 +/- 9.5 mg for morphine, 266 +/- 90 mg for pethidine, and 320 +/- 10 mg for tramadol. The average supplementary fentanyl dose used was significantly higher in group T than in groups M and P (P < 0.05). In conclusion, morphine, pethidine, and tramadol resulted in equivalent pain scores and side effects, but tramadol group T required more rescue analgesic doses of fentanyl.
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http://dx.doi.org/10.1213/01.ane.0000287815.32869.2aDOI Listing
January 2008

The use of a silicone-coated acrylic vaginal stent in McIndoe vaginoplasty and review of the literature concerning silicone-based vaginal stents: a case report.

BMC Surg 2007 Jul 10;7:13. Epub 2007 Jul 10.

Department of Plastic Surgery, Sutcu Imam University School of Medicine, Kahramanmaras, Turkey.

Background: Mc Indoe vaginoplasty is one of the mostly performed surgical interventions in Mullerian agenesis.

Case Presentations: We present our experience on the use of a new designed vaginal stent that was coated with silicone in two mullerian agenesis cases who had Mc Indoe vaginoplasty. Both full thickness and splitt thickness skin graft were used with the stent. No graft loss or hyperthrophic scarring which may be seen at the apex of neovagina after Mc Indoe vaginoplasty was observed during the follow-up period and adequate neovaginal depth were obtained in both of the patients.

Conclusion: We think that the incorporation of silicone to a vaginal stent for postoperative wound care improves skin graft take and decreases a possible constriction band formation in neovagina.
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http://dx.doi.org/10.1186/1471-2482-7-13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1947946PMC
July 2007

Non-puerperal inversion of the uterus caused by leiomyosarcoma: a case report and clinical management.

J Obstet Gynaecol Res 2007 Jun;33(3):402-6

Department of Obstetrics and Gynecology, University of Cukurova School of Medicine, Adana, Turkey.

Uterine inversion is a rare complication of the postpartum period, but it is an even rarer complication of the non-puerperal period. A 49-year-old nulliparous woman was admitted to the hospital with the following complaints: abnormal vaginal bleeding, pain, anuria and a mass protruding from the vulva. The mass was removed by twisting and a laparotomy was required for massive bleeding due to the inversion. The diagnosis of complete inversion was made during the laparotomy. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed and the pathological examination revealed a leiomyosarcoma. Uterine inversion in the non-puerperal period is an extremely rare event and it should be kept in mind that the cause of the inversion may be a malignant disease, like leiomyosarcoma.
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http://dx.doi.org/10.1111/j.1447-0756.2007.00546.xDOI Listing
June 2007

Tuba uterina leukemia inhibitory factor concentration does not increase in tubal pregnancy: a preliminary study.

Fertil Steril 2005 Feb;83(2):484-6

Department of Obstetrics and Gynecology, Kahramanmaras Sutcuimam University, Yoruk Selim Mah. Hastane Cad. No:32, Kahramanmaras 46050, Turkey.

The aim of the present study was to compare the levels of leukemia inhibitory factor (LIF) in the tubal ampullary region in normal and ectopic pregnancies and assess possible causative role of LIF in ectopic pregnancy. Although there was a tendency of increase in LIF concentrations in the ectopic pregnancy group, we were not able to determine a statistically significant difference between the two groups.
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http://dx.doi.org/10.1016/j.fertnstert.2004.09.014DOI Listing
February 2005