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Objective: To investigate the sleep quality in patients with polycystic ovary syndrome (PCOS) and to examine the effects of metabolic parameters on sleep disturbances. Material and Methods: The study included 50 patients diagnosed as PCOS and 51 normal healthy volunteers. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality. Index consists of 18 items and seven components and according to the index, the total scores of five or more indicate a poor sleep quality. After the sleep quality scores were determined, serum insulin, triglyceride, cholesterol, fasting glucose and androgen levels were recorded retrospectively and all parameters compared between groups. Results: The sleep quality was lower in the patients with polycystic ovary syndrome than in the healthy control group but this was not statistically significant (p>0.05). Serum dehydroepiandrosterone sulfate (DHESO4) and total testosterone level had a significant negative correlation with sleep duration and total PSQI scores. In addition, serum total testosterone level also had a significant negative correlation with sleep latency, sleep disturbance and subjective sleep quality. Besides, the patients with the poor sleep quality had significantly lower serum dehydroepiandrosterone sulfate and testosterone levels than those with a normal sleep quality (p

Objective: In most of the gynecological studies conducted using the Shear Wave Elastography (SWE) method in the literature, the menstrual cycle period was not taken into account. Current study, we aimed to describe the sonoelastographic features of normal myometrium and ovaries in healthy women and to define their variability during the different phases of the menstrual cycle using the SWE method. Material and methods: All cases were selected from individuals between the ages of 24-31, with regular menstrual cycles and no systemic disease. Each case was called in, 1-5th, 12-16th, 21-24th day of their menstrual cycles and was evaluated by B-mode imaging and SWE in pelvic ultrasonography. The relationship of menstrual phases with uterine and ovarian elasticity was investigated by comparing all measurements made in different menstrual phases. Results: No statistically significant difference was observed between the volume of right and left ovaries in terms (p> 0.05). There was no statistically significant difference in terms of elastography measurements obtained from the uterus, right and left ovaries for each menstrual phase according to Bonferroni Correction (p> 0.0163). Conclusion: Although there was a slight decrease in myometrial SWE measurements in the follicular phase, there was no significant difference regarding the SWE measurements of uterus and ovaries in early follicular, peri-ovulatory, and luteal menstrual stages. Further studies with a large number of participants are needed to suggest whether gynecological studies planned to be carried out with the shear wave elastography method should be planned in a specific menstrual phase.

Aim To evaluate the variation in tissue stiffness caused by the changes in ovarian volume and stroma in polycystic ovary syndrome (PCOS) using a novel method of ultrasonography, that is shear wave elastography (SWE). The current study also aimed to evaluate the potential applications of this method in predicting the metabolic and androgenic alterations in patients with PCOS. Methods The present study included 33 patients with PCOS. The blood samples for the metabolic and androgenic parameters and SWE values pertaining to the patients were obtained on the same day during the early follicular phase. The predictive ability of SWE to reflect the metabolic and androgenic abnormalities was evaluated using the receiver operating characteristic curve (ROC) analysis. Results The mean SWE value pertaining to the group with higher total testosterone levels was significantly lower, compared to the group with normal testosterone levels (p = 0.041). The ROC analysis revealed that the predictive potential of SWE was statistically significant in regard to the serum testosterone levels alone (area under the curve [AUC] = 0.755, 95% confidence interval [CI]: 0.573-0.938, p = 0.041). There was no significant relationship between the SWE values and metabolic parameters. Conclusions Based on the results of the present study, decreased SWE values appear to be associated with increased serum testosterone levels. However, the present study did not observe any significant relationship between the SWE values and metabolic parameters. SWE can be used as a practical and non-invasive method to predict the serum testosterone levels during the follow-up evaluations of the patients with PCOS.

The aim of this study was to investigate whether women giving preterm birth have joint hypermobility.The study included 44 women giving preterm birth (study group) and 48 women with the history of term birth (control group). After demographic data were recorded, the presence of joint hypermobility based on the Beighton diagnostic criteria and subgroup scores were noted down. Total Beighton scores were compared between the study and control groups.The total Beighton scores were significantly higher in the study group (It should be kept in mind that joint hypermobility detected during follow-up of pregnancy can be related to the risk of preterm birth. Informing pregnant women with joint hypermobility about the possibility of preterm birth could be helpful.

Demirci, Buket/0000-0002-3442-5061 WOS: 000559594800001 PubMed ID: 32283955 The aim of this study is to evaluate the effect of GnRH agonist or GnRH antagonist therapy on bleomycin-administered rats by examining ovarian follicle counts and AMH levels. A total of 30 female Wistar albino rats aged 4-6 months were randomly divided into 4 groups. First, an intramuscular injection of bleomycin (30 mg/m(2)) was administered to all except the control group on the 1st, 8th and 15th days. The control group (Group I) was administered 0.1 mL intramuscular saline on those days. The bleomycin group (Group II) was followed up without any further treatment. The bleomycin + GnRH agonist group (Group III) was administered subcutaneous GnRH agonist triptorelin (1 mg/kg) at the same time as the bleomycin injections. The bleomycin + GnRH antagonist group (Group IV) was administered 1 mg/kg cetrorelix acetate subcutaneously, concurrently with the bleomycin. Although AMH levels were lower in the bleomycin group than in all the other groups, there was no statistically significant difference between the groups in terms of AMH levels (p > .05). In the bleomycin + cetrorelix acetate and bleomycin + triptorelin groups, significantly higher primordial, secondary and tertiary follicle counts were determined compared to the bleomycin group (p < .001). In conclusion the harmful effects of bleomycin on ovarian reserve can be reduced by the simultaneous administration of GnRH agonist or GnRH antagonist.

Objectives: The success rate of methotrexate (MTX) therapy varies among tubal ectopic pregnancies. Common methylenetetrahydrofolate reductase (MTHFR) polymorphisms (C677T&A1298C) have been suggested to alter MTX effect. This study aimed to assess and compare MTX treatment failure rates with respect to MTHFR polymorphisms in trophoblasts of ectopic tubal pregnancies. Material and methods: A retrospective chart review of tubal ectopic pregnancies was conducted and 34 eligible cases were found. Paraffinized blocks of ectopic trophoblastic tissues were retrieved from the archives of pathology department. Common MTHFR polymorphisms were studied on microdissected trophoblastic tissues. Sixteen cases with history of failed MTX therapy (study group) and 18 control cases were compared for their pertinent clinical characteristics and common MTHFR polymorphisms (C677T&A1298) data. Results: In the study group, there were 8 (50%) C677T single nucleotide polymorphisms (SNP) and 9 (56.7%) A1298C SNP. Polymorphism rates were not found to be different between two groups for neither polymorphism (p > 0.05 for both). Number of compound heterozygotes was 3 (18.7%) in study group and 5 (27.7%) in controls (p = 0.693). In addition, MTHFR polymorphism presence seemed to have no effect on interval serum β-hCG concentration change in MTX-fail group (p=0.693). Conclusions: Our data implied that common MTHFR polymorphisms of ectopic trophoblastic tissue are not associated with MTX failure in patients with tubal pregnancies. Additionally, serum β-hCG concentration changes caused by MTX treatment and studied MTHFR polymorphisms are likely independent.

Abnormal vaginal bleeding in adolescent and young women is not a rare event and can be attributed mainly to anovulatory cycles, pregnancy-related bleeding, and endocrinological disorders in this age group. Cervical polyps commonly occur during the reproductive years, especially after the age of 40. Here we present a rare reason for vaginal bleeding and dysmenorrhea in a 20-year-old woman caused by endometriosis in a cervical polyp. Twenty-year-old patient admitted to Ege University Faculty of Medicine Gynecologic clinic due to vaginal bleeding and prolapsed lesion which was seen from introitus of the vagina. She had mental retardation and seizures since infancy. Her first menstrual bleeding occurred at the age of 14 and she had regular menstrual cycles. Gynecologic speculoscopy and bimanual examination could not be performed because the patient was sexually inactive and she did not accept the bimanual vaginal examination. Magnetic resonance imaging was performed. Multiple cervical polyps and genito-urinary system malformation were reported. Vaginoscopy with hysteroscope was performed and cervical polyp in 5 cm length was detected. Polypectomy was performed with operative hysteroscope without complication. No damage was occurred to hymen. Pathologic result was determined endometriosis in cervical polyp. Cervical polyp in young women is rare and endometriosis in cervical polyp is detected only in a few cases in literature. It is a reason of abnormal vaginal bleeding and dysmenorrhea. Vaginal masses that prolapse from the cervix should be examined precisely. Malignancies of the cervix, vagina and uterus should be kept in mind in patients with malformations and anomalies. We aimed to present this rare case and to show the feasibility of vaginoscopy with operative hysteroscope in sexually inactive patients. Pre-operative evaluations should be patient specific and care should be taken to avoid complications.

This study aimed to compare the frequency and risk factors of de novo urinary incontinence (UI) following abdominal and vaginal hysterectomies for benign disease.The study included patients without incontinence history who underwent abdominal or vaginal hysterectomy for benign indications. Incontinence statuses were assessed at least one year after hysterectomies. Data for age, body mass index (BMI), parity, mode of delivery, and the types of hysterectomy and postoperative UI were recorded.The study included a total of 196 patients with mean age of 52.8±11.4 years. Of these, 149 (76%) underwent abdominal hysterectomy (AH) and 47 (24%) had vaginal hysterectomy (VH). The mean follow-up period was 1.97±1.43 years. A total of 41 (20.9%) patients were diagnosed with UI after hysterectomy. De novo UI occurrence following AH and VH was similar(p0.05). Also, UI types were not significantly found different in either group (p0.05).This study showed that de novo UI occured frequently after hysterectomies. In addition, development and types of UI following AH and VH were comparable.Abdominal hysterectomy, Urinary incontinence, Vaginal hysterectomy.Lo studio ha lo scopo di confrontare i fattori di frequenza e di rischio dell’incontinenza urinaria de novo (UI) dopo isterectomia addominale e vaginale. Sono stati incluse pazienti sottoposte ad isterectomia addominale o vaginale per indicazioni di patologia benigna senza storia pregressa di incontinenza urinaria. La situazione di incontinenza è stata valutata almeno un anno dopo le isterectomie. Sono stati riportati i dati di età, indice di massacorporea (BMI), parità e tipo di parto, tecnica dell’isterectomia e tipi di UI postoperatoria. Sono state incluse nello o studio un totale di 196 pazienti, di età media di 52,8 ± 11,4 anni. Di queste pazienti, 149 (76%) sono state sottoposte ad isterectomia addominale (AH) e 47 (24%) ad isterectomia vaginale (VH). Il periodo medio di follow-up delle pazienti è stato di 1,97 ± 1,43 anni. Un totale di 41 (20,9%) pazienti sono state diagnosticate come affette da UI insorta dopo l’isterectomia. Le pazienti hanno presentato analoga incidenza di UI de novo sia dopo isterectomia per via addominale che per via vaginale (p0.05), analogamente senza differenze significative di UI nei due gruppi (p0,05). Lo studio ha dimostrato una elevata frequenza di incontinenza urinaria dopo isterectomia in modo paragonabile dopo l’adozione della via addominale e quella vaginale. Pertanto sembra importante la valutazione preliminare dei fattori di rischio e l’adozione di procedure preventive indipendentemente dall’approccio chirurgico.

Objective:Cesarean operation is very common and it is being performed increasingly all over the world. In this study, the effect of the number of cesarean deliveries on maternal and fetal health was evaluated.Materials and Methods:We included patients who underwent cesarean section in our clinic between October 2014 and October 2017, who had no additional disease, between 38 and 40 gestational weeks, and ages between 18 and 40 years. Postnatal records were retrospectively reviewed. Patients who had pregnancy complications such as pregnancy hypertension, gestational diabetes, oligohydramnios, polyhydramnios, or who had a dysmorphic appearing baby or with any genetic syndrome were excluded. Patients were divided into three groups according to the number of cesareans they had undergone. Group 1 consisted of patients with history of two cesarean deliveries, group 2 consisted of patients with 3 cesarean deliveries and group three consisted of patients with 4 or more cesarean deliveries. Groups were then compared to each other for their demographic data and maternal - fetal outcomes.Results:Mean age of the patients studied was 32.4 years [standard deviation (SD): 4.4], mean gestational week was 38 weeks and 2 days (SD: 0.55), and mean hospitalization duration was: 4.4 days (SD: 1.0). There was no significant correlation between the number of cesarean section and the parameters of birth weight, duration of hospital stay, and appearance, pulse, grimace, activity, and respiration scores.Conclusion:The history for the number of previous cesarean deliveries for a pregnancy may not seem to be correlated with increased maternal or fetal complications up to four previous cesarean deliveries. There is a need for future studies with even larger patients to support our findings.

Aim: The aim of this study was to determine the contribution of Shear Wave Elastography (SWE) to the diagnosis of polycystic ovarian syndrome (PCOS).Material and methods: Thirty-seven patients with PCOS diagnosis criteria were included in the study. Sixteen volunteer patients without hormonal disturbances and with normal menstrual cycles were evaluated as the control group. Gray scale ultrasonography (US) and SWE measurements in both ovaries were performed by a single radiologist who was blinded to the clinical and laboratory results.Results: The SWE measurements in PCOS group were 8.4±2.0 kPafor the right ovary and 9.4±3.9 kPa for the left ovary and in the control group 7.8±4.1 for the right ovary and 8.6±2.5 kPa for the left ovary. There was no statistically significant difference between the PCOS and the control group according to the SWE results (for right ovary p=0.356, for left ovary p=0.258, and total ovary p=0.293).Conclusions: The ovarian morphology isstill the most reliable imaging finding in the diagnosis of PCOS, although it is controversial especially among adolescents. Although the diagnostic efficacy of SWE is demonstrated in a variety of soft tissue lesions, we did not find any significant contribution of SWE to the diagnosis PCOS. Therefore, the promising value of elastography is yet to be defined for the diagnosis of PCOS.

Objective: To evaluate the clinicopathological characteristics, treatment methods, survival, and prognosis of ovarian clear-cell carcinoma (OCCC).Material and Methods: All patients with OCCC who were treated between January 1998 and October 2012 were retrospectively reviewed. After the exclusion criteria, a total of 39 women were included in the present study. Univariate and multivariate analyses were used to identify the risk factors for overall survival (OS) and progression-free survival (PFS).Results: The majority of the patients were at stage I disease (n=21 [24.3%]). All patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Additionally only pelvic, and pelvic plus para-aortic lymphadenectomy was done in 8 (20.5%) and 19 (48.8%) women, respectively. Optimal cytoreductive surgery was achieved in 26 (66.7%) patients. Recurrences occurred in 11 (28.2%) patients. The median follow-up period was 51 months (range 4 – 132 months). The 5-year PFS and OS rates were 47% and 54%, for all patients. The 5-year OS rates for women with early (stage I and II) and advanced (stage III and IV) stage disease were 56.4% and 38.1%, respectively. Multivariate analysis confirmed optimal cytoreduction as the only independent predictor of OS [Odds ratio (OR) 21.212, 95% confidence interval (CI) 5.259–85.556, (p

Amaç: Gebeliğinde apendektomi yapılan hastaların gebelik sonuçlarının değerlendirilmesi.Gereç ve Yöntemler: 2010-2014 yılları arasında apendektomi yapılan hastalar retrospektif olarak incelendi. Tüm hastaların gebelik sonuçları üniversite kayıt sistemi ve telefon görüşmeleri ile takip edildi. Hastalar yaş, gebelik yaşı, klinik ve laboratuvar muayeneleri, görüntüleme çalışmaları, acil servis ve operasyon arasındaki ortalama zaman, ortalama operasyon süresi, gebelik sonucu ve apandiksin patoloji sonucuna göre değerlendirildi. Bulgular: Otuz dokuz hasta çalışmaya dahil edildi. Otuz dokuz hastanın 16'sı ilk, 15'i ikinci ve 8'i gebeliğin üçüncü trimesterindeydi. Üç hastaya laparoskopik apendektomi kalanlarına laparatomi yapıldı. Apendiksin patolojik değerlendirilmesinde, yedi hasta (17%) normal apendiks, dört hasta perfore apendiks, bir hasta nöro-endokrin tümor ve kalanları apandisit saptandı. Operasyon sonrası iki missed abortus meydana gelirken kalanları canlı doğum yaptı. Bunlardan altısı preterm ve otuz biri term doğum yaptı. On iki hasta vajinal yolla ve kalanları sezaryen yoluyla doğurtuldu. Yirmi hasta gebeliğin birinci yarısında (grup 1) ve 19 hasta gebeliğin ikinci yarısındaydı (grup 2). Gruplar arasında operasyon zamanı ve acile kabul ile operasyon arasındaki ortalama zaman aralığı açısıdan anlamlı farklılık yoktu. Sonuç: Gecikmiş operasyon ve negatif apendektomi olumsuz gebelik sonuçlarına neden olabilir. Şüpheli olgulardaki izlem tedavisi negatif apendektomi oranlarını düşürebilir; ancak aynı zamanda perforasyona neden olabilir. Bilgisayarlı tomografi ve manyetik rezonans görüntüleme, ultrasonografinin net olmadığı zaman düşünülmelidir. Erken doğum tehditini önlemek için tokolitik rejimler uygulanabilir. Doğum şekli için obstetrik endikasyonlar geçerlidir., Objective: To evaluate the pregnancy outcomes of patients who underwent appendectomy during pregnancy.Materials and Methods: Patients who underwent appendectomy between years 2010 and 2014 were retrospectively evaluated. All patients' pregnancy outcomes were followed-up by using university registry system and telephone interview. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, mean time interval between emergency department and operation, mean operative time, pregnancy outcome and pathologic results of the appendix.Results: Thirty-nine patients were included in the study. Sixteen of 39 patients were in the first, 15 of them in the second and 8 of them were in the third trimester of the pregnancy. Three patients underwent laparoscopic appendectomy and the rest underwent laparotomy. In pathologic evaluation of the appendix, seven patients (17%) had normal appendix, 4 patients had perforated appendix, one patient had neuro-endocrine tumor and rest of the patients had appendicitis. Two missed abortion occurred after operation, rest of the patients had live birth. Six of them were preterm and 31 had term birth. Twelve patients delivered through vaginal birth and the rest via caesarean section. Twenty patients were in the first half of the pregnancy (group 1) and 19 patients were in the second half of the pregnancy (group 2). There were no significant differences between the groups in operation time and mean time interval between emergency administration and operation. Conclusion: Delayed operation and negative appendectomy can cause adverse pregnancy outcomes. Expectant management in suspected cases may decrease negative appendectomy rates but can also lead to perforation. Computed tomography and MRI ought to be considered if ultrasonography is inconclusive. Tocolytic regimens can be administered to prevent threatened preterm labor. Obstetric indications were valid for delivery mode