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Objective: To investigate the effectiveness of combining side-to-end anastomosis and vaginal NOSE (Natural orifice specimen extraction) surgery in colorectal endometriosis. Material and methods: We included 11 patients treated with laparoscopic side-to-end colorectal anastomosis and vaginal NOSE surgery between January 2019 and May 2021. We questioned the visual analog score (VAS) for pain symptoms, the short form-36 (SF-36) for health survey questionnaire, The Female Sexual Function Index (FSFI), EHP-5 for endometriosis health profile, The Hospital Anxiety and Depression Scale (HADS), OAB-V8 for overactive bladder symptoms and Constipation Severity Instrument (CSI). Results: VAS, EHP-5, and SF-36 scores were better at postoperative third and sixth months than preoperative values ( p Conclusions: Laparoscopic side-to-end anastomosis with vaginal NOSE surgery is feasible, scarless, and could be offered to patients with deep symptomatic bowel endometriosis.

Objective Congenital infections can cause newborn hearing loss. Although vertical transmission of coronavirus disease 2019 (COVID‐19) infection is theoretically possible, this has not been proven yet. To our knowledge, there is no previous report on whether COVID‐19 infection during pregnancy can cause congenital hearing loss. This paper aimed to find an answer to this question. Method This retrospective, single‐center study was performed between April 2020 and May 2021 at a tertiary care referral center in Turkey. A total of 422 pregnant women who had coronavirus infection during pregnancy were followed and 203 of them gave birth in our institution. Results of hearing screening tests of 199 newborns were assessed retrospectively. Results Of patients included in the study, 23 (11.6%) had the disease in the first trimester, 62 (31.2%) in the second trimester, and 114 (57.3%) in the third trimester. In the first hearing test performed on newborns, unilateral hearing loss was observed in 21 babies (10.5%). Hearing tests of these newborns were found to be normal in the second test performed 15 days later. Conclusion Considering the incidence of congenital hearing loss, the absence of hearing loss in our newborn population does not confirm the argument that coronavirus infection does not cause congenital hearing loss. This issue should be evaluated with larger patient series. In addition, it should be kept in mind that hearing loss can occur at later ages as well.

Introduction: Piriformis syndrome is an uncommon disease resulting from the piriformis muscle’s compression of the sciatic nerve. Pain and numbness in the buttocks and down the leg are the most common symptoms. This study analyzes the laparoscopic surgical treatment of piriformis syndrome. Methods: We report three cases of piriformis syndrome diagnosed in our hospital. The first case was a 40 years old woman with a 7-year history of intermittent low back pain and sciatica on her right side. Hyperesthesia and cutaneous allodynia were observed in the right sciatic nerve dermatome. The second case was a 30 years old woman with a 2-year history of sciatica on her left side. The third case was a 30 years old woman with a 2-year history of sciatica on her right side. All the patients underwent laparoscopic decompression surgery, which was performed to release the sciatic nerve or sacral nerve roots. Results: The patients were reexamined at the postoperative 3rd and 6th months. Their visual analog scale (VAS) scores were found to be decreased from 10/10, 9/10, and 7/10 to 0/10, 1/10, and 0/10, respectively. Conclusion: Due to the very few cases in the literature, pelvic piriformis syndrome is an exclusively clinical diagnosis. If the sciatica is refractory to conservative treatments, laparoscopic exploration and decompression surgery of the pelvic nerves and piriformis muscle could be an option.

The aim of the present study was to determine the incidence of unexpected gynaecological malignancies in patients undergoing hysterectomy for benign indications and to evaluate their clinical characteristics. Data from 6448 cases who had undergone hysterectomy for benign indications between the dates of 01.01.2008-01.01.2018 were recorded retrospectively from the database of the institution. The mean age of the cases with malignancy was 59.2 ± 9.66 (45-80) and 76,31% were (29/38) postmenopausal. The mean gravidity was 3.94 ± 1.73 and parity was 3.31 ± 1.45. Their mean BMI was 29.6 ± 4.26 kg/m

Aim: Endometriosis is a disease affecting women of fertile age, with an estimated more than 176 million women worldwide suffering from their symptoms, with no correlation between the degree and symptoms of the disease. Although the initial treatment in endometriosis is medical treatment, patients with severe symptoms are candidates for surgery as the last choice. We contribute to the literature by publishing our 15 cases and to discuss surgical treatment methods. Method: Patients operated due to the endometriozis in Kartal Dr Lutfı Kırdar Training and Research Hospital between January, 2019 and January, 2020 were evaluated. 15 patients were found according to the criteria. and discussed according to the literature. All patients’ age, body mass index, gravida, parity, medications, chronic diseases,, past surgical history, duration of diagnosis time, ultrasonograph results, clinical symptoms, physical examinations,surgical procedure, operation time, complications, hospital discharge time, preoperative and postoperative pain scores [10-cm visual analogue scale (VAS)] were analyzed Results: When the postoperative VAS scores were evaluated, it was found that the scores improved significantly compared to preoperative VAS scores. Intraoperatively, ureter damage in one patient and bowel damage in one patient were detected. Wound infection was detected as a postoperative complication in one patient. Conclusion: Operations performed by experienced teams in cases resistant to medical treatment in endometriosis benefit the patient, as well as operations performed by inexperienced hands may harm the patient. Therefore, we think that patients who need endometriosis surgery should be directed to experienced centers.

Background. This study was conducted to investigate the effectiveness of vaginal natural orifice transluminal endoscopic surgery (vNOTES) gynecologic scarless surgery in benign and malignant class 2 and class 3 obese patients. Materials and methods. The class 2 and class 3 obese women undergoing vNOTES scarless surgery for benign and malign indications at a tertiary referral medical center between January 2019 and April 2021 were retrospectively analyzed and surgical outcomes were measured. Results. In this study, 81 class 2 and class 3 obese patients underwent gynecological procedures using vNOTES scarless surgery. Of the 81 operations, 55 of the class 2 obese patients with benign pathologies, and 26 of the class 3 obese patients had malign pathologies. No conversion to conventional laparoscopy or even laparotomy was needed in any of the procedures. All of the surgeries were performed by the same surgeon (Prof. Dr Ahmet Kale). vNOTES scarless surgery was performed on 26 class 3 obese patients with malign pathologies. Of the 26 class 3 obese patients, 22 of the class 3 obese patients with early-stage endometrial carcinoma had very high mean body mass index 41.5 kg/m2 (range 20.6–56) and 4 of the class 3 obese patients had ascites with unknown cause and diagnosed with peritoneal carcinomatosis. The mean postoperative pain VAS scores of class 2 obese patients undergoing vNOTES scarless surgery with benign pathology at 6, 12, and 24 h were 3.19, 1.11, and .66, respectively, and the mean postoperative pain VAS scores of class 3 obese patients underwent vNOTES scarless surgery with malign pathology at 6, 12, and 24 h were 3.30, 1.76, and 1.03, respectively. Conclusion. vNOTES scarless surgery is an alternative surgical method for diagnosis and treatment not only in benign obese cases, but also in severely obese patients with early stage endometrial cancer and patients had with ascites with unknown cause. In the near future, vNOTES scarless surgery will become more preferable by experienced surgeons in benign and malignant obese cases as it has increased satisfaction with esthetic results such as less pain, and improved postoperative quality of life in the short and long term.

Aim To evaluate the efficacy and reliability of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) technique in making the diagnosis of ascites with unknown cause. Methods Seven patients with ascites with unknown cause and diagnosed with vNOTES between November 2018 and May 2019 were analyzed retrospectively. The following data were collected retrospectively: body mass index, age, parity, previous abdominal or pelvic surgery, total operating time, perioperative complications and visual analog scale scores for evaluation of postoperative pain. After general anesthesia and disinfection, a 2-3 cm incision was made in the posterior fornix of the vagina. In all of the vNOTES procedures, a handmade glove port system comprised of a glove-wound retractor NOTES port was used. Results Transvaginal natural orifice transluminal endoscopic surgery for diagnostic peritoneoscopy was successfully performed in seven patients. Following postoperative pathological examination; three patients were established to have peritoneal carcinomatosis, one patient abdominal tuberculous, one patient ovarian fibroma, one patient ovarian mature cystic teratoma and one patient stomach cancer. In 1-year follow-up period after vNOTES procedure, no adverse events occurred in patients. Conclusion In making histological diagnosis of ascites with unknown cause, vNOTES is a feasible, safe and efficient technique. Due to its high performance in diagnosis, this technique helps to initiate treatment early in some diseases in addition to preventing unnecessary treatment and examination in benign diseases. Besides, via obtaining a detailed and enlarged image of abdominal cavity, this procedure also guides the clinician in the evaluation of the suitability of patient for operation.

AIM The study objective was to compare intraoperative and early postoperative outcomes among patients who underwent hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (and single-port lararoscopy for presumed benign gynecologic disorders). METHODS We retrospectively reviewed 40 patients who underwent single-port laparoscopic hysterectomy and 20 patients who underwent hysterectomy via natural orifice transluminal endoscopic surgery. Patients' age, body mass index, history of previous delivery and surgery, total operation time (from skin incision to closure), intraoperative and postoperative complications conversion to another surgical procedure, drop of hemoglobin level, postoperative pain at 1 and 18 h, average hospital stay, and clinical outcomes were analyzed. RESULTS Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery was superior to single-port hysterectomy concerning the length of hospitalization (p

Purpose In December 2019, the COVID‐19 pandemic started in China and spread around the World. Operations were postponed in most surgical clinics to reduce the risk of contamination and increase the number of beds available in hospitals. We investigate whether elective gynaecologic surgery is safe or not under safety measures. Methods A total of 765 patients were operated on electively between 15 March and 30 October 2020 at our inpatient gynaecology clinic. We took the SARS‐CoV‐2 Reverse Transcriptase (RT) Polymerase Chain Reaction (PCR) test of the nasopharyngeal swab before and after the surgery. Patients were questioned for COVID‐19 symptoms by phone calls on the 7th, 15th, 30th and 60th days postoperatively. Results The average age of patients was 45.6 ± 11(19‐81). Sixty‐two (8.1%) operations were performed due to gynaecologic malignancies. Three patients (0.39%) were detected as SARS‐CoV‐2 RT PCR positive within 7 days after surgery. The patients did not need ICU admission or any further treatments. Conclusion Our study offers a novel perspective on elective surgery during a pandemic. The risk assessment of patients should be meticulously done and substantiated on objective variables. According to our study, in a carefully selected patient population, operating under appropriate precautions, elective gynaecologic surgical procedures during the two peaks of the COVID‐19 pandemic do not pose a risk to the patients.

Objective: The rate of bladder injury during laparoscopic hysterectomy (LH) is three-fold higher than that of ureter injury and is an important problem for gynecologists. The aim of the present study was to present the results of laparoscopic repair of bladder injuries produced during LH procedure. Methods: Patients who underwent LH for benign indications between November 2018 and January 2020 were evaluated retrospectively. Medical records of all patients with bladder injury were reviewed and their causes of injury, incidence, treatment and follow-up were evaluated. Results: Eight patients were established to have bladder injury while undergoing LH. All bladder injuries were recognized during operation. Bladder injury occurred during laparoscopic sharp and blunt dissection of uterovesical area in seven patients and during suprapubic trochar insertion in one patient. All bladder injuries were repaired laparoscopically. No major complications were encountered during or after operation. Bladder catheters were removed 7–10 days after surgery. Conclusion: It was demonstrated that laparoscopic repair of bladder injury, which is a feared complication of LH, can be carried out successfully be gynecologists experienced in endoscopic surgery.

Background: Piriformis syndrome is an uncommon disease result from compression of the sciatic nerve by the piriformis muscle. Symptoms may include pain and numbness in the buttocks and down the leg. This study analyzes the laparoscopic surgical treatments of pelvic piriformis syndrome. Presentation: We report two cases of pelvic piriformis syndrome diagnosed in our hospital. The first case was a 40 years old woman with a 7-year history of intermittent low back and sciatalgia on her right side. The severity of the pain was 10/10 on the visual analog scale(VAS). Hyperesthesia and cutaneous allodynia were observed in the right sciatic nerve dermatome. The laparoscopic decompression surgery was performed to release the right sciatic nerve from the aberrant piriformis muscle. Postoperative 3 and 6 months follow-up, her VAS decreased to 0/10. The second case was a 30 years old woman with a 2-year history of sciatalgia on her left side. Her VAS was 9/10. The laparoscopic decompression surgery was performed to release the left sciatic nerve and left sacral nerve S2 dermatome from the aberrant piriformis muscle. Postoperative 3 and 6 months follow-up, her VAS decreased to 1/10. Conclusion: Due to the very few cases in the literature, pelvic piriformis syndrome is thought to be an exclusively clinical diagnosis. If the sciatica is refractory despite appropriate conservative treatments; laparoscopic exploration of the pelvic nerves and piriformis muscle and decompression surgery can be a good option. Keywords: Laparoscopy, pain, piriformis muscle syndrome, sacral nerve root, the sciatic nerve.

Aim The purpose of this study was to assess the feasibility and efficacy of transvaginal natural orifice transluminal endoscopic surgery (v-NOTES) staging surgery for extreme obese patients with early-stage type-1 endometrial cancer. Methods Study included cases of extreme obese patients with early-stage endometrial cancer who underwent v-NOTES between January 2019 and June 2019 at a tertiary referral medical center. The following parameters were noted: patient age, body mass index (BMI), operating time, conversion to conventional laparoscopy or laparotomy, any intraoperative or postoperative complications, estimated blood loss, pre- and postoperative hemoglobin levels, postoperative pain scores of the patients using visual analogue scale (VAS) at 6th, 12th and 24th h, length of hospital stay and final pathology report. Results Six cases of extreme obese patients with early-stage endometrial cancer underwent hysterectomy and bilateral salpingo-oophorectomy via the transvaginal NOTES. These six patients had a mean body mass index of 51.4 kg/m2 (SD = 6,13). No conversion to conventional laparoscopy or even laparotomy was needed in any of these patients. No adjuvant therapy was needed since all of the patients had early-stage endometrial carcinoma. Conclusion Given the increased risk of surgical morbidity and mortality associated with increasing BMI, it is paramount importance to establish safe surgical approaches to gynecological pathologies. We think that v-NOTES offers greater benefit to obese patients when performed by an experienced surgeon and v-NOTES is a safe, effective and feasible minimally invasive surgery in extreme obese patients with early endometrial cancer.

Objectives The purpose of this study was to determine whether there are any changes in cardiac function in fetuses with idiopathic polyhydramnios and also to evaluate the value of the myocardial performance index for prediction of adverse perinatal outcomes. Methods A prospective case-control study was conducted with a total of 134 fetuses between 24 and 40 weeks' gestation. Polyhydramnios was defined as an amniotic fluid index of greater than 24 cm. Seventy-three fetuses of healthy mothers were assigned as the control group whereas 36 fetuses with an amniotic fluid index of 24 to 34 cm constituted the nonsevere polyhydramnios group, and 31 fetuses with an amniotic fluid index of 35 cm or greater constituted the severe polyhydramnios group. Fetal echocardiography was performed to compare cardiac function parameters among groups. To determine which perinatal outcomes were independently associated with an increased myocardial performance index, a multivariate logistic regression analysis was performed. Results The myocardial performance index was significantly higher in polyhydramnios groups compared with controls (P < .001). Among fetuses with polyhydramnios, the myocardial performance index was significantly higher in severe polyhydramnios compared with nonsevere polyhydramnios (P = .003). An increased myocardial performance index in polyhydramnios was independently associated with nonreassuring fetal status (odds ratio, 2.12; 95% confidence interval, 1.41–4.53; P = .005), emergency cesarean delivery (odds ratio, 1.54; 95% confidence interval, 1.12–2.37; P= .025), and respiratory distress syndrome (odds ratio, 1.79; 95% confidence interval, 1.21–3.87; P = .012). Conclusions An increased myocardial performance index is an early indicator of adverse perinatal outcomes in pregnancies complicated by idiopathic polyhydramnios.

Objective The purpose of this study was to investigate the clinicopathological characteristics, treatment methods, and prognostic factors in women with uterine papillary serous carcinoma (UPSC) and uterine clear-cell carcinoma (UCCC). Study design All patients who had undergone surgery for UPCS and UCCC between January 1995 and December 2012 were retrospectively reviewed. Patients with missing data, who did not undergo surgical staging and patients with mixed tumor histology were excluded. Multivariate regression models were used to identify the risk factors for overall survival (OS) and progression-free survival (PFS). Results A total of 49 UPSC and 22 UCCC women were included. The majority of the patients were at stage I [IA, 22 (31%) and IB, 18 (25.4%)]. Stages II, III, and IV were identified in 9 (12.7%), 13 (18.3%), and 9 (12.7%) of cases, respectively. Optimal cytoreduction was achieved in 71.8% of cases. Recurrences occurred in 16 patients (22.5%). The 5-year OS rates were 67% for UPSC; 76% for UCCC; 68% for both histology, respectively. Multivariate analysis pointed out that age>67 years (odds ratio (OR): 3.85, p = 0.009 and OR: 3.35, p = 0.014), >50% myometrial invasion (MI) (OR: 2.87, p = 0.037 and OR: 2.46, p = 0.046) and optimal cytoreduction (OR: 3.26, p = 0.006 and OR: 2.77, p = 0.015) were the independent prognostic factors for both PFS and OS. Conclusions Our study demonstrated that optimal cytoreduction, >50% MI, and age >67 years are the most significant factors affecting survival in women with UPSC and UCCC.

Objectives: The aim of our study is to determine whether first-trimester neutrophil-to-lymphocyte ratio (NLR) and plate­let-to-lymphocyte ratio (PLR) would be useful as new predictors of subsequent preeclampsia. Material and methods: Medical records of women with preeclampsia and healthy controls from a tertiary referral center were retrospectively evaluated. The two groups were compared in terms of clinical characteristics and first-trimester levels of hemoglobin, leukocyte, neutrophil, lymphocyte, platelet, NLR and PLR. Receiver operating characteristic curve (ROC) analysis was performed to identify the optimal NLR and PLR levels predicting preeclampsia. Results: Neutrophil (p < 0.001), platelet (p < 0.001), NLR (p < 0.001) and PLR (p < 0.001) levels were significantly elevated, whereas hemoglobin concentration (p = 0.003) was significantly lower in the group with preeclampsia as compared to the control group. On multivariate regression analysis, NLR (OR 1.43; 95% CI 1.21–1.76; p = 0.005) and PLR (OR 1.38; 95% CI 1.15–1.63; p = 0.008) were the most powerful predictive variables. The area under the ROC was 0.716 and 0.705 for NLR and PLR, respectively. The cut-off values of NLR ≥ 3.08 and PLR ≥ 126.8 predicted preeclampsia with the sensitivity of 74.6% and 71.8% and specificity of 70.1% and 72.4%, respectively. Conclusions: High NLR and PLR during the first trimester are independent predictors of subsequent preeclampsia.

Purpose Uterine papillary serous carcinoma (UPSC) is an atypical variant of endometrial carcinoma with a poor prognosis. It is commonly associated with an increased risk of extrauterine disease. The aim of this study was to investigate clinical and pathological characteristics, therapeutic methods, and prognostic factors in women with UPSC. Methods All patients who underwent surgery for UPSC at a single high-volume cancer center between January 1995 and December 2010 were retrospectively reviewed. Patients who did not undergo surgical staging and those with mixed tumor histology were excluded. Univariate and multivariate regression models were used to identify the risk factors for overall survival (OS) and progression-free survival (PFS). Results A total of 46 patients were included, the majority of whom having stage I disease (IA, 13 [28.2%] and IB, 12 [26.7%]). Stages II, III, and IV were identified in 5 (10.9%), 8 (17.4%), and 8 (17.4%) women, respectively. Optimal cytoreduction was obtained in 67.3% of patients. Recurrences developed in 8 (17.4%) patients. Multivariate analysis confirmed that lymphovascular space invasion (LVSI) (odds ratio [OR] 26.83, p = 0.003) was the only independent prognostic factor for OS, whereas LVSI and optimal cytoreduction were found to be independent prognostic factors for PFS (OR 6.91, p = 0.013 and OR 2.69, p = 0.037, respectively). The 5-year overall survival rate was 63%. Conclusions Our study demonstrated that LVSI is the only independent prognostic factor for OS, whereas LVSI and optimal cytoreduction are independent prognostic factors for PFS in patients with UPSC

[Purpose] The aim of this study was to evaluate whether the effect of pelvic floor exercises on pelvic floor muscle strength could be detected via ultrasonography in patients with urinary incontinence. [Subjects and Methods] Of 282 incontinent patients, 116 participated in the study and were randomly divided into a pelvic floor muscle training (n=65) group or control group (n=51). The pelvic floor muscle training group was given pelvic floor exercise training for 12 weeks. Both groups were evaluated at the beginning of the study and after 12 weeks. Abdominal ultrasonography measurements in transverse and longitudinal planes, the PERFECT scheme, perineometric evaluation, the stop test, the stress test, and the pad test were used to assess pelvic floor muscle strength in all cases. [Results] After training, the PERFECT, perineometry and transabdominal ultrasonography measurements were found to be significantly improved, and the stop test and pad test results were significantly decreased in the pelvic floor muscle training group, whereas no difference was observed in the control group. There was a positive correlation between the PERFECT force measurement scale and ultrasonography force measurement scale before and after the intervention in the control and pelvic floor muscle training groups (r=0.632 and r=0.642, respectively). [Conclusion] Ultrasonography can be used as a noninvasive method to identify the change in pelvic floor muscle strength with exercise training.

Purpose: The aim of this study was to present the results of our experience with patients who underwent total laparoscopic hysterectomy (TLH). Materials and methods: During the time period between January 2013 and September 2014, 96 patients who had undergone total laparoscopic hysterectomy were evaluated retrospectively by reviewing patients’ medical records. Patient’s mean age, gravidity, parity, preoperative and postoperative hemoglobin levels, indications of hysterectomy, return rate of laparoscopy to laparotomy, laparoscopic technique (single or multiport), the need of blood transfusion, duration of operation, complications, length of hospital stay and uterine weights were evaluated retrospectively. Results: 88 of 96 patients who underwent TLH were operated with multiport technic, while 8 patients were operated with single port technique. 28 patients were evaluated by intraoperative frozen section. Pelvic lymph node sampling was performed in 4 of 28 patients since endometrioid endometrium adenocancer at frozen section was detected. Mean operation time was observed as 145.9±43.3 (60-260) minute. Return rate of laparoscopy to laparotomy was 6.2% (6 patients). Complications were as follows: sigmoid colon serosa damage 1 patient (1.0%), sigmoid colon perforation 1 patient (1.0%), vaginal cuff cellulitis 2 patients (2.0%), mild ileus 1 patient (1.0%), vesicovaginal fistula 2 patients (2.0%), hypoesthesia and loss of power at left arm 1 patient (1.0%). Total complication rate was detected as 8.3%. Conclusion: Laparoscopic hysterectomy is a minimally invasive procedure with a shorter postoperative recovery period and better cosmetic results when compared with laparotomy and that can be applied successfully in experienced hands.

Uterin leiomyosarkomun (ULMS) klinikopatolojik özelliklerini, tedavi yöntemlerini, sağkalım özelliklerini ve prognozunu değerlendirmek.Gereç ve Yöntem: Ocak 1998 ile Ekim 2012 arasında ULMS tanısıyla tedavi verilen tüm hastalar retrospektif olarak değerlendirildi. Dışlama kriterleri sonrasında toplam 37 kadın çalışmaya dahil edildi. Toplam sağkalım (TS) ve progresyonsuz sağkalım (PS) ile ilişkili risk faktörlerini belirlemek üzere tek değişkenli ve çok değişkenli analizler yapıldı.Bulgular: Hastaların çoğunda evre 1 hastalık mevcuttu (IA, n=9 (%24,3); IB, n=23 (%62,1)). Hastaların hepsine total abdominal histerektomi ve bilateral salpingo-ooforektomi yapıldığı görüldü. Ek olarak, sadece pelvik ve hem pelvik hem paraaortik lenfadenektominin sırasıyla 5 (%13,5) ve 8 (%21,6) hastada uygulanmış olduğu belirlendi. Adjuvan tedavi 27 (%72,9) hastaya uygulanmıştı. Adjuvan tedavi almayan hastalar evre 1 idi. Beş (%13,5) hastada rekürrens saptandı. Ortanca takip periyodu 71 (1-158 ay aralığında) ay olarak bulundu. Tüm hastalar için 5-yıllık PS ve TS oranları sırasıyla %68 ve %74 olarak belirlendi. Evre 1 ve >= evre 2 hastalarda 5-yıllık TS oranları sırasıyla %82 ve %27 idi. Çok değişkenli analizde evre 1 hastalık, PS (Odds oranı (OO) 10,955, %95 güven aralığı (GA) 1,686-71,181, (p=0,012)) ve TS (OO %57,429, 95 GA 3,287-1003,269, (p=0,006)) için tek bağımsız belirleyici olarak bulundu. Sonuç: ULMS'li hastalarda, ekstensif cerrahi, prognozla ilişkili değildir ve evre 1 hastalık sağkalım için tek bağımsız prognostik faktördür, To evaluate the clinicopathologic characteristics, treatment methods, survival, and prognosis of uterine leiomyosarcoma (ULMS). Materials and Methods: All patients with ULMS who were treated between January 1998 and October 2012 were retrospectively reviewed. A total of 37 women who met the inclusion criteria 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 patients had stage 1 disease (IA, n=9 (24.3%); IB, n=23 (62.1%)). All patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Additionally, only pelvic, and pelvic plus para-aortic lymphadenectomy was performed in 5 (13.5%) and 8 (21.6%) women, respectively. Adjuvant treatment was administered to 27 (72.9%) patients. Patients who did not receive adjuvant therapy had stage 1 disease. Recurrences occurred in 5 (13.5%) patients. The median follow-up period was 71 months (range 1-158 months). The 5-year PFS and OS rates were 68% and 74%, for all patients. The 5-year OS rates for women with stage 1 and >= stage 2 disease were 82% and 27%, respectively. Multivariate analysis confirmed stage 1 disease as the only independent predictor of both PFS (Odds ratio (OR) 10.955, 95% confidence interval (CI) 1.686-71.181, (p=0.012)) and OS (OR 57.429, 95% CI 3.287-1003.269, (p=0.006)).Conclusions: Extensive surgery is not associated with prognosis and stage 1 disease is the only independent good prognostic factor for survival in patients with ULMS

Aim The aim of this study was to investigate the impact of interpregnancy interval as a risk factor on multiple adverse perinatal outcomes. Material and Methods Interpregnancy intervals and confounding factors were determined for healthy pregnancies (controls [n = 357]) and for pregnancies complicated by adverse perinatal outcomes. Interpregnancy interval was categorized as

Introduction Chylous ascites is a rare form of ascites that results from accumulated lymph fluid in the peritoneal cavity caused by blocked or disrupted lymph flow through the major lymphatic channels. In the present study, our aim was to analyze the incidence, risk factors, diagnostic evaluation and management of chylous ascites after lymphadenectomy in gynecologic malignancies. Methods A total of 458 patients who had undergone staging surgery for gynecologic malignancies at our institution between January 2010 and December 2013 were retrospectively reviewed. After the exclusion criteria were applied, 399 patients were divided into 2 groups based on the presence (n = 36) or absence (n = 363) of chylous ascites. Results Among the 399 patients, 36 (9%) developed chylous ascites. The median time to onset was 4 days (range, 2–7 days). The analysis of the various features of lymphadenectomy showed that the number of para-aortic lymph nodes (PALNs) removed was significantly greater in the patients with chylous ascites (p 14 PALNs was a good predictor of chylous ascites. In all patients, chylous ascites resolved with conservative management. Conclusions Postoperative chylous ascites was strongly associated with the number of harvested PALNs. According to our findings, we suggest that conservative treatment should be the first step in managing patients with chylous ascites. Using an abdominal drain after surgery seems to be an effective diagnostic tool and treatment method for chylous ascites.

Objective Para-aortic lymph node dissemination in endometrioid endometrial cancer is uncommon, and systematic para-aortic lymph node dissection increases morbidity. The purpose of this study was to identify a subgroup of endometrioid endometrial cancer patients who did not require para-aortic lymphadenectomy. Study design All patients who had undergone surgery for endometrioid endometrial cancer between 1 January 1995 and 31 December 2012 were retrospectively reviewed. Patients with higher risk factors for nodal metastasis and inadequate lymphadenectomy were excluded. Para-aortic lymph node dissemination was defined as nodal metastasis when pelvic and para-aortic lymph node dissection was performed, when para-aortic lymph node recurrence occurred after negative para-aortic lymph node dissection or when para-aortic lymph node dissection was not performed. Multivariate logistic regression models were used to identify the pathological features as predictors for para-aortic lymphatic dissemination. Results A total of 827 patients were assessed, 516 (62.4%) of whom underwent pelvic and para-aortic lymph node dissection. Sixty-seven (13%) patients (37 with only pelvic, 26 with pelvic and para-aortic, and 4 with only para-aortic metastasis) had positive lymph nodes in the pelvic and para-aortic lymph node dissection group. Multivariate analysis confirmed positive pelvic nodes (odds ratio 20.58; p p =0.022) as independent predictors of para-aortic lymphatic dissemination. When these two factors were absent (in 83% of patients), the predicted probability of para-aortic lymph node metastasis was 0.1%. Conclusion Positive pelvic nodes and lymphovascular space invasion are highly associated with para-aortic lymph node metastasis. These markers may be useful for identifying those patients who require para-aortic lymph node dissection.

Aims The purpose of this study was to investigate the potential roles of pathological variables in the prediction of nodal metastasis in women with endometrioid endometrial cancer (EC). Materials and Methods Women who underwent surgery for endometrioid EC between 1995 and 2012 were retrospectively reviewed. Those who underwent prior neoadjuvant chemotherapy or radiotherapy and inadequate lymphadenectomy as well as those with nonendometrioid histology, synchronous cancers, International Federation of Gynecology and Obstetrics stage IV disease, gross uterine serosal and/or gross adnexal involvement were excluded. Lymph node dissemination was defined as occurring in the following circumstances: (i) when nodal metastasis with pelvic and/or para-aortic (P/PA) lymph node dissection (LND) was performed or (ii) when there was recurrence in the P/PA lymph nodes after a negative LND or when LND was not performed. Univariate and multivariate logistic regression models were used to identify the pathological predictors of lymphatic dissemination. Results A total of 827 women with endometrioid EC were assessed; 516 (62.4%) of whom underwent P/PA LND and 205 (24.8%) underwent P LND. Sixty-seven (13%) women in the P/PA LND group and 5 (2.4%) in the P LND group had positive lymph nodes. Multivariate analysis confirmed cervical stromal invasion (OR 4.04, 95% CI 2.02–8.07 (P

Objective: To examine our initial experience with robotic total hysterectomy and evaluate operation related outcomes. Materials and Methods: We retrospectively analyzed 16 consecutive patients who underwent robotic total hysterectomy between December 2015 and August 2016 in our clinic. Results: Robotic total hysterectomy was performed for benign indications in 13 (81.25%) patients, endometrial cancer in two patients (12.5%), microinvasive cervical cancer in one patient (6.25%). The mean age of patients was 48.7 ± 6.5 years, parity was 2.8 ± 1.7, body mass index was 28.2 ± 4.6 kg/m2, preoperative hemoglobin levels was 11.6 ± 1.0 g/dl, postoperative hemoglobin levels 10.3 ± 1.0 g/dl, operation time was 162.2 ± 39.4 minutes, docking time was 7.3 ± 3.3 minutes, console time was 147 ± 37.0 minutes, uterine weight was 178.8 ± 98.5 g and duration of hospital stay was 3.6 ± 1.8 days. Blood transfusion was administered to three patients in the postoperative period. One patient was converted to laparotomy because of poor visualization of pelvic structures by a large uterus. No intraoperative complication was encountered. Postoperative complications were limited to one patient with asthma who had fever on the first day following surgery. Conclusion: The results of robotic total hysterectomy is satisfactory for both patient and surgeon. Following the completion of the learning curve, robotic total hysterectomy could be an important alternative method for laparoscopic hysterectomy. However, the installation of robotic systems, operating and maintenance costs still remain as crucial limitations for the widespread use of robotic surgery.

The objective of this study was to evaluate the clinicopathological characteristics, treatment and prognosis of advanced endometrial cancer (EC). Patients who underwent surgery for advanced EC between January 1995 and December 2012 were retrospectively reviewed. Patients with missing data, concurrent cancers or uterine sarcomas and those who did not undergo surgery were excluded. The effects of clinicopathological factors on progression-free survival (PFS) and overall survival (OS) were analyzed. A total of 104 patients were included. Most presented with endometrioid histology (74%) and stage-III disease (87.5%), and 76.9% underwent optimal cytoreduction. A multivariate analysis confirmed that lymphovascular space invasion (LVSI) is an independent poor prognostic factor for PFS [odds ratio (OR): 21.37, p = 0.005] and OS [OR: 8.09, p = 0.044]. Suboptimal cytoreduction is another independent poor prognostic factor for PFS [OR: 5.68, p < 0.001]. Our study demonstrated that LVSI and optimal cytoreduction are the most significant factors affecting the survival of advanced EC patients. © 2015 Taylor & Francis Group, LLC.

Purpose: The aim of this study was to evaluate the serum levels of omentin, osteoprotegerin and malondialdehyde levels in patients with polycystic ovary syndrome (PCOS).Material and Methods: This prospective case-control study included 31 patients with the diagnosis of PCOS and 33 healthy cases as a control group. Both groups were compared according to demographic characteristics, antropometric measurements, levels of biochemical parameters and serum levels of omentin, osteoprotegerin and malondialdehyde.Results: When compared with control group, patients in PCOS group were found to have statistically significantly lower age but have higher hirsutism score, fasting glucose level, total testosteron level, free androgen index, LH level and LH/FSH ratio. There was no statistically significant difference among PCOS and control groups in terms of serum omentin, osteoprotegerin and malondialdehyde levels.Conclusion: No significant change was shown in the levels of serum omentin, osteoprotegerin and malondealdeheyde levels in women with PCOS., Amaç: Serum omentin, osteoprotegerin ve malondialdehit düzeylerinin polikistik over sendromu (PKOS) hastalarındaki serum seviyelerinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Bu prospektif vaka kontrol çalışmasına PKOS tanısı almış 31 hasta ile sağlıklı kontrol grubu olarak değerlendirilen 33 olgu dahil edildi. Her iki grup demografik özellikleri, antropometrik ölçümleri, biyokimyasal parametrelerin seviyeleri ve serum omentin, osteoprotegerin ve malondialdehit düzeyleri açısından karşılaştırıldı.Bulgular: Kontrol grubu ile karşılaştırıldığında, PKOS grubundaki hastaların yaşları istatistiksel olarak anlamlı derecede daha düşük; hirsutism skoru, açlık glukoz seviyesi) total testosteron seviyesi, serbest androjen indeksi, LH seviyesi ve LH/FSH oranı ise anlamlı derecede daha yüksek bulundu. PKOS ve kontrol grubu arasında serum omentin, osteoprotegerin, ve malondialdehit düzeyleri açısından istatistiksel olarak anlamlı fark saptanmadı.Sonuç: Serum omentin, osteoprotegerin ve malondialdehit seviyeleri obez olmayan PKOS’lu kadınlarda anlamlı bir değişim göstermemektedir.

[Purpose] The aim of this study was to translate the Pregnancy Physical Activity Questionnaire, adapt it for use with Turkish subjects and determine its reliability and validity. [Subjects and Methods] The Pregnancy Physical Activity Questionnaire was translated into Turkish and administered twice at 7-14-day intervals to pregnant women to assess the test-retest reliability. Cronbach's alpha was used for internal consistency, and the inter-rater correlation coefficient was used to calculate the test-retest reliability. The Turkish Short Form 36 Health Survey (SF-36) and the International Physical Activity Questionnaire were used to estimate validity. [Results] The internal consistency during the first and third trimesters of pregnancy was excellent, with Cronbach's a values of 0.93 and 0.95, respectively. The mean interval between the two assessments was 11.1 +/- 2.1 days. The correlation coefficient between the total activity measured by the Turkish version of the Pregnancy Physical Activity Questionnaire and the International Physical Activity Questionnaire estimates of the total metabolic equivalent were fair to poor during the first, second, and third trimesters of pregnancy (r = 0.17, r = 0.17, r = 0.21, respectively). The Turkish version of the Pregnancy Physical Activity Questionnaire showed fair correlations with the Short Form 36 Health Survey physical component score (r = -0.30) and mental component score (r = -0.37) for the first trimester of pregnancy. [Conclusion] The Turkish version of the Pregnancy Physical Activity Questionnaire was found to be reliable and valid for assessing a pregnant woman's physical activity.

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

The purpose of this study was to compare the outcomes of interval debulking surgery after neoadjuvant chemotherapy (NAC/IDS) with primary debulking surgery (PDS) in patients diagnosed with advanced epithelial ovarian cancer (EOC).A total of 292 patients with IIIC and IV disease stages, who were treated with either NAC/IDS or PDS between 1995 and 2012 were retrospectively reviewed. The study population was divided into two groups: the NAC/IDS group (N=84) and the PDS group (N=208). Progression-free survival (PFS), overall survival (OS), and optimal cytoreduction were compared.The mean patient age was significantly higher in the NAC/IDS group (61.5±11.5 vs 57.8±11.1, p=0.01). Optimal cytoreduction was achieved in 34.5% (29/84) of the patients in the NAC/IDS group and in 32.2% (69/208) in the PDS group (p=0.825). The survival rates were comparable. The survival rate of patients who received optimal cytoreductive surgery in either the PDS or the NAC/IDS arm was significantly higher than that of patients who received suboptimal cytoreductive surgery (p0.01 and p0.01, respectively). Multivariate analysis confirmed the treatment method, amount of ascitic fluid, and optimal cytoreduction as independent factors for OS.There was no definitive evidence regarding whether NAC/IDS increases survival rates compared with PDS. NAC should be reserved for patients who cannot tolerate PDS or when optimal cytoreduction is not feasible.

[Purpose] The short-term effects of structured exercise on the anthropometric, cardiovascular, and metabolic parameters of non-overweight women diagnosed with polycystic ovary syndrome were evaluated. [Subjects and Methods] Thirty women with a diagnosis of polycystic ovary syndrome were prospectively randomized to either a control group (n=16) or a training group (n=14) for a period of 8 weeks. Anthropometric, cardiovascular, and metabolic parameters and hormone levels were measured and compared before and after the intervention. [Results] Waist and hip measurements (anthropometric parameters); diastolic blood pressure; respiratory rate (cardiovascular parameters); levels of low-density lipoprotein cholesterol, total cholesterol, fasting glucose, and fasting insulin; and the homeostasis model assessment of insulin resistance index (metabolic parameters) were significantly lower in the training group after 8 weeks of exercise compared to the baseline values. After exercise, the training group had significantly higher oxygen consumption and high-density lipoprotein levels and significantly shorter menstrual cycle intervals. The corresponding values for controls did not significantly differ between the start and end of the 8-week experiment. [Conclusion] Short-term regular exercise programs can lead to improvements in anthropometric, cardiovascular, and metabolic parameters of non-overweight women with polycystic ovary syndrome.

Aims To investigate clinicopathologic characteristics, therapeutic methods, and prognostic factors in women with synchronous primary endometrial and ovarian cancers (SEOCs). Methods A retrospective review of 2 cancer registry databases in Turkey was conducted to identify patients diagnosed with SEOCs between January 1995 and December 2012. Patients with recurrent, metastatic, and metachronously occurring tumors were excluded. Multivariate logistic regression models were used to identify prognostic predictors for progression-free survival (PFS) and overall survival (OS). Results The analysis included 63 women with SEOCs. Seventy-six percent of the patients had stage I endometrial cancer, and 60% of the patients had stage I ovarian cancer. Thirty-seven patients (58.7%) had endometrioid/endometrioid histology. Optimal cytoreduction was obtained in 47 (74.6%) patients. Recurrence developed in 17 patients (27%). Multivariate analysis confirmed lymphovascular space invasion (LVSI) as an independent poor prognostic factor for OS (odds ratio [OR] 3.1, p = 0.045), whereas early-stage disease and optimal cytoreduction were found to be independent good prognostic factors for both PFS (OR 12.85, pConclusions Our study demonstrated that optimal cytoreduction, early-stage disease, and LVSI are the most significant factors affecting survival in women with SEOC.

The aim of this study was to investigate the impact of interpregnancy interval as a risk factor on multiple adverse perinatal outcomes.Interpregnancy intervals and confounding factors were determined for healthy pregnancies (controls [n = 357]) and for pregnancies complicated by adverse perinatal outcomes. Interpregnancy interval was categorized as6, 6-11, 12-17, 18-23, 24-35 and ≥36 months. Adverse outcomes included spontaneous labor leading to preterm birth (n = 265), preterm premature rupture of membranes (n = 245), pre-eclampsia (n = 286), gestational diabetes (n = 302), abnormal placentation (n = 154), anemia (n = 314), congenital anomalies (n = 459), post-partum hemorrhage (n = 326) and small for gestational age (n = 168). Multivariate logistic regression analysis was performed to assess the association of each outcome with the interpregnancy interval categories.Spontaneous labor leading to preterm birth (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.13-1.97), preterm premature rupture of membranes (OR, 1.69; 95%CI, 1.28-2.39), congenital anomalies (OR, 1.38; 95%CI, 1.09-1.76) and small for gestational age (OR, 1.68; 95%CI, 1.14-2.34) were significantly associated with intervals of6 months. Among congenital anomalies, short interpregnancy interval represents an increased risk for cardiac defects (OR, 1.55; 95%CI, 1.09-5.46), neural tube defects (OR, 2.06; 95%CI, 1.32-7.64) and central nervous system anomalies (OR, 1.45; 95%CI, 1.12-3.65).Short interpregnancy interval is an independent risk factor for adverse perinatal outcomes.

Purpose: The purpose of this multicenter case–control study was to compare the demographic and clinical characteristics of patients with mucinous adenocarcinoma of the endometrium (MAE) and endometrioid endometrial carcinoma (EEC). Methods: A retrospective review of two cancer registry databases in Turkey was conducted to identify patients diagnosed with MAE between January 1996 and December 2012. Each patient was matched with a control EEC patient by age and tumor grade. Cases and controls were compared in terms of known risk factors for lymph node metastasis, disease-free survival (DFS), and overall survival (OS). Results: The analysis included 112 patients with MAE and 112 with EEC. No significant difference in baseline characteristics was evident between the two groups. Lymphovascular space invasion, deep myometrial invasion, cervical involvement, and tumor diameter did not differ significantly between the mucinous and endometrioid cases. Multivariate analysis confirmed that only mucinous histology (OR 2.2, 95 % CI 1.1–4.5; P = 0.02) was an independent predictor of lymph node involvement. Although the median DFS and OS tended to be better in the endometrioid group, the differences were not statistically significant. Routine appendectomy was performed in 52 (46.2 %) patients with MAE. No mucinous tumor of the appendix was identified. Conclusion: Routine appendectomy is not necessary when the appendix is grossly normal at the time of surgery for MAE. Although the DFS and OS of EEC and MAE patients were similar, the risk of nodal metastasis in MAE patients was greater than that in ECC patients, and we thus suggest to perform retroperitoneal lymphadenectomy (both pelvic and para-aortic) for patients with MAE during the initial operation. © 2014, Japan Society of Clinical Oncology.

Adenoma malignum (AM), also called ‘minimal-deviation adenocarcinoma’, is a rare variant of mucinous adenocarcinoma of the cervix (Doi et al. 1997), with a prevalence of approximately 1–3% among al...