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The October 30, 2020 Earthquake caused unexpectedly significant damage in İzmir considering its distance to the city. This paper evaluates the recorded ground motions, summarizes the performance of structures affected from the earthquake with emphasis on the reasons of damage. A detailed damage assessment was carried out by the Earthquake Engineering Research Center of Middle East Technical University to compile data on the damage of RC and masonry buildings. It was observed that majority of the damage was concentrated in the Bayraklı district due to its peculiar soil properties where many 7-10 story mid-rise RC buildings suffered heavy damage and collapse. The level of amplified ground motions combined with deficiencies of apparently non-code compliant buildings exacerbated the damage. The main reasons of damage were mainly attributed to the presence of soft stories, lack of proper detailing, poor construction quality, presence of heavy overhangs, and hence significant lack of code-compliance in essence. The influence of infill walls on seismic performance of deficient and inadequate buildings was clearly seen in this earthquake. This paper also discusses seismic code requirements in effect and their influence on the observed building performance. The recorded ground motions were compared with the code spectra to evaluate the performance of the buildings. The code response spectra were found to be well above the recorded ground motion spectra at the sites where significant damage was observed.

This paper presents forced and ambient vibration tests on a six-storey precast concrete frame building, a structural system that has not often been the focus of such tests in spite of its widespread use. Precast buildings come with semi-rigid connections so their idealisation requires good knowledge of the construction practice for those connections and their details. Structural system dynamic properties are identified for the first three translational modes along each axis of the building and for the first three torsional modes. The study shows that the three-dimensional finite-element structural model for the building is capable of replicating the measured in situ dynamic properties. In the small displacement elastic range, the finite-element modelling of precast concrete frame systems is not very different from their cast-in-place counterparts but an extrapolation to the large displacement range requires empirical confirmation.

Study Objective To evaluate whether the presence of an ultrasonographic visible isthmocele has an impact on the chance of pregnancy in women undergoing embryo transfer. Design Age-matched retrospective study. Setting Private-assisted reproductive center. Patients The study included a total of 150 patients with a history of cesarean delivery with 75 isthmocele cases and 75 controls. All patients underwent embryo transfer from January 2017 through June 2018. The diagnosis of isthmocele was based on transvaginal ultrasound assessment. Isthmocele was defined as an anechoic indentation on the previous cesarean scar at the midsagittal plane, with a depth of >1 mm. Interventions Embryo transfer. Measurements and Main Results The groups were similar in patient and treatment characteristics. The live birth rate was 44% in the isthmocele group and 46.7% in the control group (odds ratio [OR] 0.89; 95% confidence interval [CI], 0.47–1.71; p = .743). The clinical pregnancy rates were 49.3% and 50.7%, respectively (OR, 0.94; 95% CI, 0.50–1.79; p = .870). The miscarriage rate was greater in the isthmocele group (8%) than in the control group (4%); however, it did not reach statistical significance (OR, 2.09; 95% CI, 0.50–8.67; p = .302). The multiple pregnancy rate was similar between the groups (8% vs 5.3%, respectively; OR, 1.54; 95% CI, 0.41–5.70; p = .513). The groups were also similar in ectopic pregnancy rates (p = .560). These outcomes remained similar when adjusted for potential confounders on the regression analysis. Conclusion Isthmocele does not seem to have a significant impact on the chance of pregnancy in assisted reproductive treatment settings. However, the embryo transfer procedure may be more difficult in the presence of an isthmocele.

PURPOSE: To compare outcomes between daily intramuscular progesterone (IMP) and daily vaginal progesterone (VP) gel plus weekly intramuscular hydroxyprogesterone caproate (IMHPC) for luteal phase support (LPS) in single, autologous euploid frozen-thawed blastocyst transfers (FBTs) following artificial endometrial preparation (EP). METHODS: The retrospective cohort study included 767 single, autologous FBTs from 731 patients between January 2015 and March 2018. LPS was performed either with IMP (100 mg/day) or with VP gel (90 mg, twice daily) plus IMHPC (250 mg/week). Oral estrogen was prescribed in combination of both regimes. Oral estrogen was discontinued following the visualization of fetal cardiac activity on ultrasound and progesterone at 10 weeks of gestation. The primary outcome was live birth rate. The secondary outcomes included implantation, clinical pregnancy, and multiple pregnancy rates. RESULTS: Patient characteristics did not differ in LPS regimes. Of 767 FBTs, 608 had IMP (100 mg/day) for LPS and 159 had VP gel (90 mg, twice daily) plus IMHPC (250 mg/week) for LPS. The live birth rate was 51.8% and 50.3%, respectively (p = 0.737, OR 0.94, 95%CI 0.66–1.33). The implantation rate was 62.7% and 64.2%, respectively (p = 0.730, OR 1.06, 95%CI 0.74–1.53). The clinical pregnancy rates were also similar in both groups (59.5% vs. 61.6%, respectively, p = 0.631, OR 1.09, 95%CI 0.76–1.56). CONCLUSIONS: We did not observe significant differences in the rates of live birth, implantation, and clinical pregnancy between daily IMP and daily VP gel plus weekly IMHPC for LPS in single, autologous euploid FBTs after artificial EP.

Research question: Does the use of preimplantation genetic testing for aneuploidies (PGT-A) improve outcomes in couples with severe male factor infertility (SMFI)? Design: This retrospective cohort study included SMFI cases that underwent blastocyst transfer with/without PGT-A. Inclusion criteria were SMFI (azoospermia and sperm count

Can serum oestradiol concentrations on the day of progesterone initiation predict live birth rates in single, autologous vitrified-warmed blastocyst transfers following artificial endometrial preparation?This retrospective study included the first transfers of 468 patients with unexplained or tubal factor infertility who underwent freeze-all cycles using single, top-quality blastocysts after artificial endometrial preparation from January 2015 to January 2018. Patients were stratified into four groups based on serum oestradiol concentration percentiles on the day of progesterone initiation: Group 1 (25th percentile), Group 2 (25-50th percentile), Group 3 (51-75th percentile) and Group 4 (75th percentile). The primary outcome was live birth rate. The secondary outcomes were implantation, clinical pregnancy and multiple pregnancy rates. Receiver operating characteristic (ROC) curves were generated to evaluate serum oestradiol concentrations in predicting implantation, clinical pregnancy and live birth.Similar live birth rates of 51.6%, 55.1%, 54.9% and 56.4% for Groups 1, 2, 3 and 4, respectively, were found. The groups also showed similar implantation and clinical pregnancy rates. ROC analysis revealed that serum oestradiol concentrations on the day of progesterone initiation were not predictive for implantation (area under the curve [AUC] 0.490, 95% CI 0.445-0.554), clinical pregnancy (AUC 0.507, 95% CI 0.453-0.561) or live birth (AUC 0.514, 95% CI 0.461-0.566).Serum oestradiol concentration monitoring just prior to progesterone administration does not appear to be predictive for live birth rates in good prognosis patients undergoing single, autologous vitrified-warmed blastocyst transfer after artificial endometrial preparation. Therefore, the current practice of monitoring serum oestradiol concentration is not supported by this study.

The effect of autoclaved aerated concrete (AAC) infill walls on the structural system dynamics of a two-story reinforced concrete building is investigated using its finite element structural model, which is calibrated to simulate the acceleration-frequency response curves from its forced vibration test. The model incorporating the AAC infill walls by equivalent diagonal struts captures the increase in lateral stiffness of the building and the torsional motions induced due to the asymmetrically placed AAC infill walls. A higher strut width coefficient than in ASCE/SEI 41-06 is recommended to model the stiffness of the AAC infill walls in the elastic range.

The aim of this study was to investigate the relationship of cathepsin B, relaxin and anti-Mullerian hormone (AMH) in follicular fluid (FF) with pregnancy rates in infertility patients.Seventy-nine infertile couples who underwent ICSI were included in the study. The FF levels of cathepsin B, relaxin and AMH were measured using ELISA kits.The FF cathepsin B levels were statistically higher in pregnant patients compared with non-pregnant patients (0.20±0.13 versus 0.13±0.03; P0.001). There were statistically significant differences in the total number of oocytes (10.00±6.85 versus 5.96±3.94); the mean number of M2 oocytes (8.65±5.63 versus 4.58±3.36) between the pregnant and non-pregnant patients (P0.05). There were no significant correlations between pregnancy rates and relaxin and AMH (P0.05). The area under the curve of cathepsin B for prediction of pregnancy was 0.662 (p=0.024, 95% Confidence Interval 0.528-0.797).This study demonstrated that increased level of cathepsin B in FF significantly correlates with a better chance of clinical pregnancy. Further studies are needed to clarify the role of cathepsin B in the reproductive process of humans.

It has been documented that exogenously administered irisin (1010 fibronectin-type III domain-containing 5 [FNDC5]), which is a new polypeptide hormone, induces the browning of subcutaneous fat and thermogenesis. In this study, effects of physical activity and exogenous administration of irisin were investigated on parameters related with reproduction and metabolism in the high-fat diet-induced obesity model of the female C57BL/6J mice. Sixty mice were gathered at age approximately 5 to 6weeks and were divided into 3 groups. Control group remained sedentary. Irisin group remained also sedentary but intravenously received 1010 FNDC5-expressing adenovirus after 20 weeks. Exercise group performed treadmill after 6 weeks. All mice were sacrificed 22 to 23 weeks after the start of the study. There was a significantly greater Δ weight in the controls compared with the irisin and exercise groups ( P .05), whereas primary and secondary follicles per ovary were higher in the irisin and exercise groups compared with controls ( P < .05). Pharmacologic introduction of irisin may improve metabolic factors such as insulin sensitivity and obesity by promoting weight loss and consequently improving the reproductive potential.

Aim: The aim of this study is to evaluate the effects of number and size of antral follicles on ovarian reserve and subsequently in vitro fertilization (IVF) outcome. Material and Method: 44 patients treated with IVF in the Infertility Clinic of Zeynep Kamil Women’s and Children Disease Education and Research Hospital (Istanbul, Turkey) were prospectively included in this study. On the third day of menstrual bleeding, transvaginal ultrasound was performed. Antral follicle count (AFC) and antral follicle (AF) size were recorded in these patients. Group I as AF > 5mm and Group II as AF ≤ 5mm were defined. The patients underwent controlled ovarian hyperstimulation with rec-FSH following. Results: Our findings indicated that there was not a statistical difference in number of total oocytes ( 11.03± 6.59 vs. 13.71± 5.38), embryos (5.7± 4.46 vs. 7.29± 5.05) and pregnancy rates ( 76.7% vs. 71.4%) between groups according to antral follicle size (AF ≤5mm vs. AF >5 mm) . Under the area of ROC curve estimations for ovarian response revealed that antral follicle (AF) >5 mm had the largest area 0.675±0.083 (0.517-0.808). Discussion: There might be an association between AF that is larger than 5 mm in size and number of retrieved mature oocytes. Since AFC, is a routine screening test in any IVF center, we believe paying closer attention to the measurement of AFC that are larger than 5 mm in size might help clinicians to achieve more successful outcomes in terms of on embryo quality and pregnancy outcome in women undergoing an in vitro fertilization.

To investigate fetuin-A concentrations and its association with metabolic and sonographic cardiovascular markers in women with polycystic ovary syndrome (PCOS) and healthy subjects.Thirty-five women with PCOS and 37 healthy control women were matched for body mass index (BMI) and age. Serum fetuin-A concentrations, and reproductive and adrenal hormones were measured, and insulin resistance and carotid intima media thickness (CIMT) were evaluated in both groups. The correlations between cardiovascular risk factors, CIMT and fetuin-A concentrations were tested.Mean fetuin-A concentrations were significantly elevated in the PCOS group compared with control subjects (101.2 ng/ml ± 33.55 vs. 82.5 ng/ml ± 32.65, P=0.019). CIMT was also higher in women with PCOS than in control subjects (0.51 ± 0.05 mm vs. 0.44 ± 0.05 mm, P0.01). Serum lipid parameters were correlated to serum fetuin-A concentrations in the PCOS group, but no correlation was found between fetuin-A and CIMT (rPCOS=0.244, pPCOS=0.158; rcontrol=-0.002, pcontrol=0.988).In this, the first study of fetuin-A concentrations in PCOS, the results showed that fetuin-A concentrations were increased in euglycemic patients with PCOS.

To determine whether the timing of embryo transfer (day 2 or day 3) affects pregnancy outcome in IVF patients, receiving single or double embryo transfer, 380 patients were included in this retrospective study. All patients underwent GnRH antagonist protocol. When stratified by number of transferred embryos, single embryo transfer (SET) patients undergoing a day 2 embryo transfer (ET) had similar biochemical pregnancy (25% vs 20.4%; p > 0.05) and clinical pregnancy (16.6% vs 14.6%; p > 0.05) rates to SET patients that were undergoing a day 3 ET. A similar observation was again noted in double embryo transfer (DET) patients undergoing a day 2 ET, with similar biochemical pregnancy (35% vs 29.8%; p > 0.05) and clinical pregnancy (25% vs 15.5%; p > 0.05) rates to DET patients undergoing a day 3 ET. Women, despite age, number of transferred embryos and ET timing, have similar reproductive outcomes. Shortening or lengthening the duration of in vitro culture provides no obvious benefit.

Abnormal uterine bleeding (AUB) is a substantial cause of ill health in women worldwide. In this study, our aim was to evaluate the effectiveness of endometrial ablation using a modified urologic resectoscope along with tranexamic acid in AUB. Sixty patients were enrolled in this study. All patients underwent resectoscopic surgery. Patients were randomly divided into two groups. Group 1 (n = 30) received 500 mg of tranexamic acid. Group 2 (n = 30) served as the control group and underwent surgery without the administration of tranexamic acid. Total pictorial blood loss assessment chart (PBAC) scores were significantly lower postoperatively (152.14 ± 9.65 versus 6.6 ± 0.90; P < 0.001). When stratified by the administration of tranexamic acid, the number of patients with a postoperative day 1 PBAC score ≤15 was higher in the tranexamic group (19 versus 13), whereas the number of patients with a post operative day 1 PBAC score >15 was lower in the tranexamic group (11 versus 17), but the differences were not statistically significant (P > 0.05). AUB is a complex disease that may need repeated treatments. In expert hands, the treatment rate of resectoscopic surgery seems acceptable. However, some patients may require additional interventions, like repeated surgery, hysterectomy, or a drug therapy in the long run. Introduction of tranexamic acid as a potential adjunct to rollerball endometrial ablation may present an interesting option that requires additional well-designed studies before firm conclusions can be made.

To evaluate the tear osmolarity and ocular surface changes in patients with polycystic ovary syndrome (PCOS).Forty-eight patients with recently diagnosed PCOS and thirty-three control volunteers were enrolled in this prospective, observational study. Ocular surface disease index (OSDI) score was calculated. Tear osmolarity was measured using the TearLab Osmolarity System (Tearlab, San Diego, CA, USA). All subjects also underwent the following ophthalmologic evaluation: Schirmer I test, tear-film breakup time (TBUT), ocular surface flourescein staining, and conjunctival impression cytology.Mean OSDI score was significantly higher in patients with PCOS than control subjects (P = 0.001). Tear osmolarity was similar in both groups (P = 0.404). There were no significant differences between groups in Schirmer I test results, TBUT, and ocular surface flourescein staining scores (P0.05). Compared to control group, a statistically significant squamous metaplasia was observed in temporal bulbar conjunctival impression cytology specimens in PCOS group (P = 0.032).In patients with recently diagnosed PCOS, tear volume and osmolarity are not affected but, conjunctival morphology may be affected, though on a limited scale.

The aim of the study was to evaluate the fatty acid-binding protein-4 (FABP4) and irisin concentrations in women with polycystic ovary syndrome (PCOS). Forty-nine women with PCOS, diagnosed according to Rotterdam criteria and 39 healthy women matched for body mass index (BMI) and age. Serum irisin and plasma FABP4 concentrations were measured in both groups. The association of irisin and FABP4 concentrations with metabolic parameters were also tested. Women with PCOS had significantly lower mean serum irisin concentrations than control subjects (158.5 ± 123.3 versus 222.9 ± 152.2 ng/ml, p 0.05). Concentrations of FABP4 in PCOS and control groups were not significantly different (10.5 ± 4.4 versus 10.9 ± 4.2 ng/ml, p 0.05). FABP4 concentrations were correlated with BMI, waist-hip ratio (WHR) and HOMA-IR (r = 0.57, p = 0.001; r = 0.26, p = 0.03; r = 0.26, p = 0.03, respectively). No associations between irisin and all the others parameters except serum levels of LH were found. Serum irisin concentrations of women with PCOS were lower compared to the controls. Moreover, there were no difference in plasma FABP4 concentrations between women with PCOS and controls.

Reconstruction of the large defects that develop after pelvic exenteration with local flaps may result in higher morbidity because of poor perineal wound healing after pelvic radiation. A well vascularised reconstructive flap originating from distant non-irradiated areas is needed. We report two cases of pelvic exenteration and rectus abdominis myocutaneous flap procedure in patients with recurrent vulvar malignancies that had undergone external beam pelvic radiation and subsequently developed pelvic fibrosis, necrosis and fistulas. Both flaps were totally viable postoperatively; the abdominal wound healed without any complication, no perineal wound complications developed with a follow-up of nine months. In conclusions, rectus abdominis myocutaneous flap reconstruction seems to be an ideal option for the large defects resulting from exenteration operations in patients with previous perineal radiation.

Introduction: To evaluate the need for a prognostic classification system for obstetric fistula (OF) with the data obtained by a voluntarily action for OF repair in a regional hospital and Niger Africa. Material and methods: Obstetric fistula (OF) characteristics of 51 women with vesicovaginal fistula in a fistula campaign in Maradi Regional Hospital Niger were evaluated. Initial basic gynecological examination methylene blue (MBT) test and direct cystoscopy were used to describe the characteristics of the lesions. Demographic and clinical data were compared with the existing literature. Results: In 31 (60 %) cases were the sizes of the fistula greater than 4 cm. The urethra was circumferentially lost in 8 (15.7%) women. In 18 (35.3%) women the trigone was involved. Extensive fibrosis was present in 10 (19.6%) patients. Only in 11 (21.6%) patients without any obliterating scarring neither the trigone nor urethra were damaged. Five (9.8%) patients had severe infection. Five (9.8%) had multiple lesions. Thirty-four (66.6%) had a history of at least one previous attempt for fistula repair. A significant proportion of women were divorced or abandoned from their husband and socially isolated. Conclusions: A simple reproducible and universally accepted scientific classification or staging system for OF dealing with outcomes rather than anatomic landmarks should replace the present proposed classification systems for prognostic and ethical purposes.

Seismic fragilities are essential to earthquake loss estimation and performance-based earthquake engineering in regions of high seismicity. Construction practices for frames in regions of moderate seismicity are quite different, and such frames have received less attention in the literature. Fragilities for performance levels identified in recent seismic regulations are developed herein for reinforced concrete frames designed for gravity load in low-seismic regions using probabilistic non-linear finite element analysis. An examination of the contribution of uncertainties in material and structural parameters reveals that structural damping, concrete strength, and cracking strain in beam–column joints have the greatest impact on the fragilities of such frames. However, fragilities that incorporate these sources of uncertainty are only slightly different from those based solely on the uncertainty in seismic demand from earthquake ground motion, suggesting that fragilities that are developed under the assumption that all structural parameters are deterministic and equal to their median (or mean) values are sufficient for purposes of earthquake damage and loss estimation in regions of moderate seismicity. Confidence bounds on the fragilities are also presented as a measure of their accuracy for risk-informed decision-making, for prioritizing risk mitigation efforts in regions of low-to-moderate seismicity.

The infrequent nature of earthquakes in the Central and Eastern United States (CEUS), and the fact that none with intensity comparable to the New Madrid sequence of 1811-12 has occurred in the past century, have caused the earthquake hazard in the CEUS to be neglected until quite recently. The performance of reinforced concrete (RC) frames in the CEUS may be deficient if they are subjected to earthquakes that are believed to be plausible in the New Madrid Seismic Zone (NMSZ). This study presents a set of probability-based tools for seismic vulnerability and risk assessment of such gravity load designed (GLD) RC frames, and uses these tools to evaluate the seismic vulnerability of RC frames that are representative of the building inventory in Memphis, Tenn.—the largest population center close to the NMSZ. This evaluation indicates that traditional GLD RC frames have a substantial probability of suffering life-threatening damage or collapse in the event that they are subjected to earthquake demands stipulat...

Tunnel form buildings, owing to their higher construction speed and quality, lower cost, and superior earthquake resistance over that of conventional reinforced concrete buildings, have been widely used for mass housing, urban renewal, and post-earthquake reconstruction projects all over the world as well as in Turkey. However, there have been few dynamic tests performed on existing buildings with this structural system. This study investigates the dynamic structural properties of a typical nine-story reinforced concrete flat plate-wall building by forced vibration testing and develops its three-dimensional (3-D) linear elastic finite element structural model. The finite element model that uses the modulus of elasticity for concrete in ACI 318 predicts the natural vibration periods well. Mode shapes are also in good agreement with the test results. Door and window openings in the shear walls, and the basement with peripheral wall emerge as modeling considerations that have the most significant impact on structural system dynamic properties.

Objective: Laparoscopic surgery is the principal minimally invasive technique that is used for the treatment of gynecologic pathologies. The single-incision laparoscopic surgery (SILS) is another innovation in minimally invasive medicine. The cost of the procedure correlates with the fundamental materials used to access the abdominal cavity and utilize trocars. Material and Methods: We applied the single-incision tubal ligation procedure to three patients. A 15-20-mm vertical incision was made in the umbilicus. Two trocars were inserted through the same incision at different fascial regions after insufflation of the abdomen. A 5-mm bipolar cautery was introduced through the accessory trocar, and the mid-portion of the tubes was coagulated and cut bilaterally. Results: The postoperative periods of the three patients were uneventful. All patients were discharged on the day of surgery. No major or minor complications occurred. Conclusion: The cost for the abdominal access will drop about 82%. When we consider the low pricing for the tubal ligation procedure, the single-incision technique will be more applicable by this method. Moreover, patients will have the advantages of single-incision laparoscopic surgery with low cost. (J Turk Ger Gynecol Assoc 2015; 16: 30-1)

Aim: We aimed to investigate possibility of different ovarian volume threshold and to study diagnostic thresholds for polycystic ovary in Turkish women, since the literature on this subject is very limited. Material and Method: Clinical study carried out Namik Kemal University School of Medicine, Tekirdag, Turkey.This case-control study included 132 patients with polycystic ovary syndrome (PCOS), diagnosed according to Rotterdam criteria and 75 controls. Comparison of ovarian volumes between PCOS patients and control group. Results: We found a mean ovarian volume of 9.44 ± 4.3 cm3 in PCOS cases and 7.63 ± 3.66 cm3 in control cases. The area under curve (AUC) for mean ovarian volume (MOV) was 0.633. The analysis showed that setting the threshold of MOV at 8.2 cm3 offered the best compromise between specificity (61.3%) and sensitivity (53.8%). Discussion: Optimum threshold of ovarian volume to distinguish the PCOS from normal women and the mean ovarian volume in Turkish PCOS patients remain beneath the criteria by Rotterdam.

Sex cord-stromal tumors account for 5% of ovarian tumors and 2% of malignant ovarian tumors. Steroid cell tumors (SCT), not otherwise specified (NOS), are rare sex cord-stromal tumors of the ovary and account for less than 0.1% of all ovarian tumors. We report a rare case of a post-menopausal woman presented with hirsutism, virilism and with findings of hyperestrogenism.Sex-cord hücreli tümörler, tüm over tümörlerinin %5 ‘ini, malign over tümörlerinin %2’sini oluşturmaktadır. Steroid hücreli tümörler nadir sex kord –stromal tümörler olup, tüm over tümörlerinin %0.1’ini oluşturmaktadır. Biz hirsutizm, virilizasyon ve hiperöströjenizm bulguları mevcut postmenapozal bir bayan olgusunu sunmak istedik.

Objective To investigate the effect of bladder distention before outpatient hysteroscopy (OH). Study design Initially, 120 eligible patients were approached, and a total of 102 patients were recruited into the randomised controlled trial. OH was completed successfully in 97 patients. Pain scoring (visual analogue scale) and the ease of cervical entry (Likert scale) were the primary outcome measures. The secondary outcome measures in this study were the duration of the procedure and patient acceptability (Likert scale). Result(s) Bladder distention before OH was related to easier cervical entry, a shorter procedural time and low pain scoring in patients who underwent the procedure with a full bladder. Conclusion(s) Bladder distention before OH significantly improved the pain score of patients and increases the feasibility of the hysteroscopy procedure.

Vesicouterine fistula (VUF) is a rare type of genitourinary fistula. Lower-segment cesarean section is the leading cause of VUF. Patients mostly present with the classical triad of menouria, amenorrhea, and urinary incontinence, with the history of a previous cesarean section. Conservative management with catheterization and open, laparoscopic, and robotic surgeries are the prescribed treatment options. We present the case of a 35-year-old woman who presented with cyclical menouria and urinary incontinence. After diagnosis of VUF by cystoscopy, the laparoscopic approach was chosen. During the procedure, we used anterior abdominal wall peritoneum and adjacent adipose tissue interposition for the first time, instead of omental interposition, because of the unavailability of omentum. The postoperative period was uneventful, and the procedure was successful. In conclusion, the laparoscopic approach is feasible and the anterior abdominal wall peritoneal flap can be used instead of omentum for tissue interposition when the omentum is not available.

Background and Objectives: The aim of this study was to compare the in vitro fertilization (IVF) outcomes of long gonadotropin-releasing hormone agonist (GnRH-a) and GnRH-antagonist (GnRH-ant) protocols in endometriosis patients who have undergone laparoscopic endometrioma resection surgery. To our knowledge, there is no study in the current literature that compares the effectiveness of long GnRH-a and GnRH-ant protocols in management of IVF cycles in endometriosis patients who underwent laparoscopic endometrioma resection surgery. Methods: Eighty-six patients with stage III to IV endometriosis who had undergone laparoscopic resection surgery for endometrioma were divided into 2 groups: those who had ovarian stimulation with a long GnRH-a protocol (n = 44), and those who had ovarian stimulation with a GnRHant protocol (n = 42). Results: The number of follicles on human chorionic gonadotropin injection day, duration of hyperstimulation, number of retrieved metaphase II oocytes, and total number of grade 1 embryos were statically significantly higher in the long GnRH-a protocol. There were no significant differences in positive beta-human chorionic gonadotropin pregnancy rates (25% vs 21.4%; P = .269) and ongoing pregnancy rates per patient (20.5% vs 19.1%; P = .302) between the 2 protocols. Conclusions: Long GnRH-a and GnRH-ant protocols both present similar IVF outcomes in patients with endometriosis who have undergone laparoscopic endometrioma resection surgery. A long GnRH-a protocol may lead to a higher number of embryos that can be cryopreserved, providing the possibility of additional embryo transfers without having to go through the process of ovarian stimulation again. Scientific Research Projects Coordination Unit of Istanbul UniversityIstanbul University [33502] An earlier version of this research was presented at the 29th Annual Meeting of the European Society of Human Reproduction and Embryology in London, 2013. This was made possible by funding from the Scientific Research Projects Coordination Unit of Istanbul University (#33502).

The primary aim of this study is to evaluate the effects of previous abdominal surgery on the feasibility of performing and the safety of total laparoscopic hysterectomy (TLH).In this retrospective study, we analysed 62 laparoscopic hysterectomies which were performed at our institute between February 2011 and January 2013. We chose to perform laparoscopic surgery for all patients, including those who had previously undergone abdominal surgery. The patients were classified into two groups: Group 1 included patients with a history of abdominal surgery (n=24) and Group 2 included patients without a history of abdominal surgery (n=38).THE OPERATING PERIOD WAS COMPARED IN BOTH GROUPS: 184.43±51.0 min. for Group 1 and 195.41±64.1 min. for Group 2 (p=0.471). Postoperative hospital stay and blood loss was also compared. There was just 1 conversion from TLH to a laparotomy in both groups. None of the patients in Group 1 needed a blood transfusion, whereas 1 in Group 2 did.We found that operation time, postoperative hospital stay, blood loss, rate of operative complications or conversion rate to open surgery between patients with and without a history of abdominal surgery were comparable. Therefore, it appears that a history of abdominal surgery does not adversely affect the safety of TLH.Bu çalışmanın öncelikli amacı, daha önce geçirilmiş abdominal cerrahinin, total laparoskopik histerektomi (TLH) yapılabilirliği ve güvenliği üzerine etkisini değerlendirmektir.Bu retrospektif çalışmada, Şubat 2011 ve Ocak 2013 tarihleri arasında kurumumuzda gerçekleştirilen 62 TLH operas-yonun kayıtları incelendi. Laparoskopik cerrahiyi, geçirilmiş abdominal cerrahisi olsa da tüm hastalarda düşündük. Hastalar iki gruba ayrıldı. Grup 1 geçirilmiş abdominal cerrrahisi olanları, Grup 2 geçirilmiş abdominal cerrahisi olmayanları içerdi.Operasyon süresi her iki grupta da karşılaştırılabilirdi (184.43±51.0 dk. Grup1 ve 195.41±64.1 dk. Grup 2; p=0.471). İki grup arasında intraoperatif komplikasyon açısından anlamlı fark bulunmadı. Operasyon sonrası hastanede kalış süresi ve kan kaybı da karşılaştırılabilirdi. Her iki grupta da sadece 1 vakada laparotomiye geçiş yapıldı. Grup 1’de hiçbir hastada kan transfüzyonu ihtiyacı olmazken, Grup 2’de 1 hastada oldu.Çalışmamızda cerrahi geçirmiş ve geçirmemiş olan grup arasında, operasyon süresi, postoperatif kalış süresi, kan kaybı, operatif komplikasyon oranı veya açık cerrahiye geçiş oranı karşılaştırabilir bulundu. Sonuç olarak, abdominal cerrahi hikayesinin olması TLH nin güvenliğini olumsuz etkilememektedir.

The aim of this study was to evaluate the efficacy of vaginal misoprostol for cervical priming at doses of 200 mcg and 400 mcg, 12 to 15 hours before diagnostic office hysteroscopy (OH) without anesthesia in patients with infertility. Sixty infertile patients requiring a diagnostic office hysteroscopy for investigation of infertility were included in the study. The patients were randomly allocated into 3 vaginally administered misoprostol groups: (1) control group, (2) 200-mcg dose group, and (3) 400-mcg dose group. Misoprostol significantly facilitated the procedure of OH: cervical entry was easier; procedural time was shorter; baseline cervical width was larger; and pain scoring was lower in the misoprostol groups compared with the control group. Increasing the dose of misoprostol from 200 mcg to 400 mcg did not improve the effect on cervical dilation. Misoprostol is a promising analog to use for cervical priming before OH. Since doses of 200 mcg and 400 mcg vaginal misoprostol 12 hours before the OH both have proven to be effective regimens, 200 mcg may be preferred. However, before routine clinical usage, further research is needed through large, randomized, controlled trials powered to detect a difference in complications to determine whether misoprostol reduces complications in OH. Scientific Research Projects Coordination Unit of Istanbul UniversityIstanbul University [26324] An earlier version of this research was presented at the 42nd Annual Meeting of American Society of Reproductive Medicine in San Diego, 2012. This was made possible by funding from the Scientific Research Projects Coordination Unit of Istanbul University (grant 26324).

This study investigates copper (Cu) levels and vascular dysfunction in lean women with polycystic ovary syndrome (PCOS). 44 subjects with PCOS, diagnosed according to Rotterdam criteria, and 42 healthy subjects matched for body mass index and age. Comparison of serum Cu, homocysteine, carotid intima-media thickness (CIMT), brachial artery flow mediated dilation (FMD) was carried out between PCOS patients and the control group. Clinical study was done in Namik Kemal University School of Medicine. The CIMT and concentration of Cu in PCOS patients was significantly higher than the healthy controls. FMD levels in PCOS patients were significantly lower than those in controls. In PCOS patients, CIMT was correlated with estrogen and Cu levels. However, FMD was correlated with age and Cu levels. Among these contributing factors, Cu levels were correlated with a change in CIMT and FMD. CIMT and FMD in PCOS patients were related to Cu levels as well as several cardiovascular risk factors. Thus, increased Cu levels may be responsible for the increased risk of early vascular disease in women with PCOS.

Objective This study investigates human cartilage glycoprotein-39 (YKL-40) levels in patients with polycystic ovary syndrome (PCOS) and controls, and tests their relationship with metabolic and hormonal parameters. Design Clinical study carried out in a university hospital in Tekirdag, Turkey. Patients Eighty-five women with PCOS and normal glucose tolerance (NGT) and twenty-five women with PCOS and abnormal glucose tolerance (AGT), diagnosed according to Rotterdam criteria, and fifty-nine healthy women. Measurements YKL-40 levels, fasting hormone levels and metabolic parameters were investigated in all subjects. Results We showed increased YKL-40 levels in women with PCOS compared to controls. (152·57 ± 3·96 μg/l vs 98·16 ± 1·6 μg/l, P

Aim In order to assess the responsiveness of short forms of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) in a subset of women undergoing radical operations for gynecologic cancer. Materials and methods Women with cervical cancer without any abnormal urodynamic abnormalities who had undergone Class III hysterectomy were included in the study. All women underwent urodynamic investigation and completed the IIQ-7 and UDI-6 questionnaires pre-opera-tively and post-operatively in the sixth month. Twenty- eight patients were enrolled and general and subscale scores of the questionnaire were calculated in the study between February 2008 and September 2008. Results Class III hysterectomy was performed in 28 women with stage Ib cervical carcinoma. Scores of IIQ-7 and the irritative and obstructive subscales of UDI-6 in the sixth post-operative month were significantly higher than the pre-operative scores. The Cronbach’s a was 0.84. Cystometric parameters were in concordance with these changes in the questionnaire scores. Conclusion The IIQ-7 and UDI-6 questionnaires are sensitive to changes in patients who have undergone radical oncologic operations because their life impact of incontinence may be affected. Validated questionnaires are reasonable measures to detect these changes, which are confirmed by urodynamic findings. © Springer-Verlag 2010.

PubMed ID: 20397759, Objective. To evaluate the effects of early pelvic floor muscle training after vaginal delivery on sexual function. Design. Prospective randomized study. Settings. Urogynecology clinic of a tertiary medical center in Istanbul, Turkey. Population. Total of 75 primiparous women. Methods. Pelvic floor-muscle strength was assessed during rest and straining in primiparous women in their 4th postpartum month, after which the women were randomized into training (n=37) and control (n=38) groups. Patients were re-evaluated in the 7th postpartum month. Main outcome measures. Female sexual function and pelvic muscle strength scores. Results. Desire, pain and total female sexual index scores were significantly higher in the 7th month compared to 4th month in both groups (p < 0.05). However, sexual arousal, lubrication, orgasm, and satisfaction scores were improved in the 7th month in the training group (paired t-test, p < 0.001), but not significantly in the control group (p > 0.05). All domains except satisfaction were significantly higher in the training group compared with the controls. Pelvic floor-muscle strength was found to be increased in the 7th month in the training group (Wilcoxon rank test, Z=4.123, p < 0.001), whereas there was no significant difference between the 4th and 7th month measurements in the controls (p > 0.05). Conclusion. Pelvic floor-muscle training improves pelvic floor-muscle function, and starting after the puerperal period, exercise appears to have positive effects on female sexual function. © 2010 Informa UK Ltd.

[No abstract available]

To evaluate prospectively the rate of postoperative failure of McCall culdoplasty and the presence of a history of vaginal delivery of macrosomic infants as risk factors in patients with stage III or symptomatic stage II apical prolapse without any other pelvic floor defects.Patients with pelvic organ prolapse who underwent vaginal hysterectomy and McCall culdoplasty procedures were staged according to the POP-Q system before and after the operation (n = 70). POP-Q stages, age, gravidity, parity, body mass index (BMI), and the presence of diabetes mellitus in patients with or without history of vaginal delivery of macrosomic infants were analyzed. A birth weight of ≥4,000 g was accepted as macrosomia. Operative failure was defined as a postoperative POP-Q stage ≥ stage III of the apical segment. Follow-up period was 26.5 ± 6.37 months.Twenty-seven women had a history of macrosomic delivery and the remaining 43 did not. Postoperative failure was observed in 15 patients (44.4%) in the macrosomia group and in 3 patients (6.9%) in the control group. Postoperative failure was seen more frequently in the macrosomia group (Pearson's chi-square test, P = 0.000). No significant difference was found between the groups regarding age, gravidity, parity, BMI and the presence of diabetes mellitus.Failure of McCall culdoplasty occurs more frequently in patients with history of vaginal delivery of macrosomic infants, possibly due to direct pelvic floor damage. This technique should not be used in patients with a possible history of direct pelvic floor damage.

The purpose of this study was to evaluate whether the prophylactic administration of vaginal progesterone would reduce the preterm birth rate in high-risk population including singleton and twin pregnancies.This was a randomized, double blind, placebo-controlled study that included 150 high-risk pregnancies. Risk groups included prior spontaneous preterm birth, twin pregnancy, and uterine malformation. Micronized progesterone or placebo (100 mg) was administered daily by vaginal suppository between 24 and 34 weeks of gestation. We compared progesterone and placebo groups for incidence of preterm labor and preterm delivery. Data were compared by χ² analysis and Fisher exact test.There was a statistically significant difference in the rate of preterm labor between placebo and progesterone groups (45.7 vs. 25%, respectively; p0.05). More women delivered before 37 weeks in placebo group (57.2%) than in progesterone group (40%; p0.05). Administering progesterone also reduced the preterm birth before 34 weeks of gestation. The difference between placebo and progesterone group was statistically significant (24.3 vs. 8.8%; p0.05). However, there was no significant difference in neonatal death between placebo and progesterone groups.Prophylactic vaginal progesterone reduced the rate of preterm labor and preterm delivery in high-risk pregnancies.

Objective: To validate the Turkish translated version of short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Study design: After the test-retest reliability and internal consistency were established in a pilot study, 270 patients were enrolled and general and subscale scores of the questionnaire were calculated. All participants underwent the International Continence Society (ICS) prolapse score (POP-Q) and urodynamic assessment. Main scores and scores of Prolapse Quality of Life questionnaire (PQoL) and Incontinence Impact Questionnaire (IIQ-7) were compared between patients with incontinence ± prolapse and asymptomatic women. Results: 62.24% of the participants showed urodynamic abnormality and/or leakage with or without prolapse. 28.91% had prolapse stage 3 or higher diagnosed by the POP-Q system. PISQ-12 showed a high internal consistency (Cronbach's alpha was 0.89). For test-retest reliability Spearman's rho was 0.72-0.79 for all domains. The mean scores of PISQ-12 were significantly better in asymptomatic women compared with the incontinence ± prolapse group. Sexual function was negatively affected by prolapse and/or incontinence as assessed with PQoL and IIQ-7 questionnaires. Conclusion: The Turkish translated version of the PISQ-12 is a reliable, consistent and valid instrument to evaluate sexual functioning in women with urinary incontinence and/or pelvic organ prolapse. It is easy to understand that it may be easily administered and self-completed by the women. © 2009 Elsevier Ireland Ltd. All rights reserved.

Inguinal hernias commonly occur during infancy. They are approximately six times more common in males than in females. They are one of the most common surgical conditions in childhood. About 5-20% of inguinal hernias have the ovary or fallopian tube in the hernia sac. Surgical interventions during childhood may cause damage. Unawareness of this damage can cause infertility in future.Presentation of a case diagnosed as having tubal damage during laparoscopic operation because of primary infertility with a history of inguinal hernia during her childhood. Inguinal hernia repair caused tubal damage and bilateral tubal occlusion as a cause of primary infertility.Medical history is of great importance during infertility investigation and may reveal some unexpected conditions.

Iniencephaly is a rare but almost always lethal neural tube defect with the following cardinal features: occipital bone defect, partial or total absence of cervicothoracal vertebrae and fetal retroflexion. Iniencephaly is associated with malformations of the central nervous system, gastrointestinal and cardiovascular system. Prenatally diagnosed cases of iniencephaly are rare because careful and early ultrasonographic evaluation is necessary. The present cases of iniencephaly were found to carry associated malformations such as atrioventricular septal defect and club foot. We present an iniencephaly prenatally diagnosed by sonography, in which therapeutic abortion was induced, with a review of the published literature.

The aim of this study was to evaluate the criteria of endometrial thickness to detect retained products of conception following first trimester spontaneous abortion or elective pregnancy termination. This was a retrospective study on 116 patients who underwent uterine re-evacuation with a diagnosis of retained products of conception based on clinical and sonographic findings. Pathologic reports of samples obtained during re-evacuation were reviewed for the presence of gestational tissue. Endometrial thickness determined by transvaginal sonography and certain clinical features (gestational age and interval between initial curettage and re-evacuation, which may affect presence or absence of gestational tissue, parity, indication for initial curettage) were noted. The sensitivity and specificity of sonographic measurement of endometrial thickness for detecting retained products of conception were assessed. Histopathologic reports confirmed the diagnosis of retained products of conception in 66 of 116 patients (56.9%). Percentage of nulliparity and the time elapsed between initial curettage and re-evacuation were significantly high in patients with retained products of conception. The sensitivity and specificity of endometrial thickness greater than 13 mm for detecting retained products of conception were 85 and 64%, respectively. An endometrial thickness of 13 mm or more, detected by transvaginal sonography, has the best diagnostic efficiency for detection of retained products of conception following first trimester spontaneous abortion or elective pregnancy termination.

Objective To investigate whether retesting with the oral glucose tolerance test (OGTT) is useful and necessary for all women with polycystic ovary syndrome (PCOS). Design Follow-up study. Setting Tertiary medical center. Patient(s) Eighty-four women with PCOS and 45 healthy controls. Intervention(s) Peripheral venous blood sampling. Main Outcome Measure(s) We performed a 75-g 2-hour OGTT in women with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT) at the time of the first test with and without PCOS. Result(s) The average follow-up period for women with PCOS was 2.6 years (range, 2–4.17 years). Seventy-eight of these women had NGT at baseline, 11.5% converted to IGT, with an annualized incidence rate of 4.5%. Of those women with IGT at baseline (n = 6), 33.3% converted to type 2 diabetes mellitus, with an annualized incidence rate of 10.4%. In the healthy subjects, the average follow-up period was 2.6 years (range, 2–4.08 years). Forty-two of these women had NGT at baseline, 2.3% converted to IGT, giving a progression of 0.9% per year. Among the three women with IGT at baseline, 33.3% reverted to NGT, and 66.6% had persistent IGT. Conclusion(s) Conversion rates from NGT to IGT or type 2 diabetes mellitus were accelerated in women with PCOS compared with healthy subjects. Women with PCOS should be tested regularly for early detection of abnormal glucose tolerance. In addition, the interval for periodic rescreening should be determined by further studies involving more women with PCOS.

Objective: Evaluation of the problems encountered during a voluntarily fistula campaign in a regional hospital of Niger (Africa). Materials and Methods: Women underwent basic gynecological examination, methylene blue testing, and/or direct cystoscopy as necessary. According to their clinical condition, women were informed and surgical options offered as appropriate. Operations were performed under spinal or epidural anesthesia. Immediate postoperative outcomes were followed during the stay of the surgical team in the country. Results: A total of 62 women were examined and 11 had causes of incontinence other than obstetric fistula. In 9.8% of the women, severe local infection precluding any surgical intervention was evident. In 58.8% of patients, the trigonal region and/or urethra were irreversibly damaged. A proportion of patients (9.8%) with large lesions and intact urethra that were offered vaginal layered closure refused the intervention. Of the women that were operated on (21.6%), six underwent vaginal layered closure with Martius fat flap and five women underwent a combined abdomino-vaginal approach. Conclusion: It is extremely difficult to meet the needs of this global problem with short term programs and volunteers. Directing these efforts to specialist fistula centers and creating reliable scientific evidence should be the main goal. © 2010 Taiwan Association of Obstetric & Gynecology. World Health Organization United Nations Population Fund As a result, OF has surfaced as an issue of international public health concern with public health communities and initiatives sponsored by international institutions like the United Nations Population Fund, the World Health Organization, and the International Federation of Gynecology and Obstetrics [3].