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Objectives: To analyze intraoperative and postoperative complications according to Clavian-Dindo Classification (CDC) and evaluate the influence of clinicopathological features on the feasibility and safety of total laparoscopic hysterectomy (TLH) in patients that underwent surgery in a tertiary center. Material and methods: We retrospectively reviewed the database of 469 patients that underwent surgery for patients who underwent extra facial TLH from 2013 to 2020. Results: A total of 86 (18.3%) peri-postoperative complications were observed. The incidence of intraoperative complications was 2% (n = 10). The overall conversion rate to open surgery was 1.9% (n = 9). A total of 76 postoperative complications were observed in 61 patients (14.3%). The incidence of minor (Grade I [n = 16, 3.4%] and II [n = 42, 8.9%]) and major complications (Grade III [n = 15, 3.2%], IV [n = 2, 0.4%] and V [n = 1, 0.2 %]) were 12.3% and 3.8%, respectively. A higher BMI and performing surgery at the first step of learning are found to be associated with intraoperative and postoperative complications (p < 0.05). Postoperative complications related to having a history of the cesarean section, additional comorbidities, and uterine weight ≥ 300 g (p < 0.05). Conclusions: The implementation of TLH by experienced surgeons appears to have remarkable advantages over open surgery. However, the risk factor for complications should be taken into account by surgeons in the learning curve in selecting the appropriate patient for surgery.

Introduction: The aim of this study was to identify early changes in the Wnt/beta-catenin signaling pathway in high-risk human papillomavirus (HPV) infected cervicovaginal cells and to correlate these changes with cell proliferation, apoptosis, and autophagic processes. Methods: We evaluated 91 cervicovaginal smears of women with (n = 41) and without (n = 50) HPV-DNA. Smears were stained against beta-catenin, c-myc, secreted frizzled-related protein 4 (sFRP4), cleaved caspase-3, and the autophagy markers Beclin-1 and light chain 3B. In addition, sFRP-1, -2, -3, -4, -5 mRNA levels were determined by quantitative reverse transcription-PCR in primary keratinocytes and FaDu cells expressing HPV16-E6, -E7, or -E6E7. Results: Our data indicated that the Wnt/beta-catenin signaling is activated in HPV (+) cervicovaginal cells that can already be detected in cells with no obvious changes in cellular morphology (HPV [+]/cyto [−]). These cells also had significantly higher sFRP4 levels when compared to HPV-negative samples. In primary keratinocytes, sFRP4 was found to be absent and sFRP1 and sFRP2 to be repressed in the presence of HPV16-E6 and E7. Interestingly, sFRP4 is expressed in FaDu cells and can be upregulated in the presence of E6E7. Curiously, SFRP4 expression correlated with an increase in the level of autophagic markers in HPV (+)/cyto (−) smears. Conclusion: In conclusion, the activation of the Wnt/beta-catenin signaling pathway and upregulation of sFRP4, paralleled by an activation of the autophagic pathway may represent predisposing cellular factors early after HPV infection which need to be further determined in larger study.

Purpose: To evaluate the clinicopathological characteristics and surgical outcomes in patients with pure ovarian immature teratomas (POITs). Materials and Methods: In this multicenter study, a retrospective review was made of the databases of six Gynecology Oncology Departments in Turkey to identify patients with POITs who had undergone surgery between 1993 and 2019. Results: Evaluation was made of 48 patients with a median age at diagnosis of 22.5 years (range, 15-37 years). In 40 (83%) patients, stage I was determined and in eight patients, an advanced stage (IIIB, IIIC, and IVB) was determined. Tumors were found to be grade I in 17 (35.4%) cases, grade II in 12 (25%), and grade III in 19 (39.6%). Fertility-sparing surgery was applied to 42 (87.5%) patients and radical surgery to 6 (12.5%). The median follow-up was 60 months (range, 3-246 months). Recurrence was seen in seven patients, all with grade III tumors. In the final pathological examination of recurrent tumors, mature teratoma was reported in five patients, and immature teratoma in one patient. Salvage surgery was not performed in one patient as the tumor was unresectable and so a regimen of bleomycin, etoposide, and cisplatin (BEP) was administered. Conclusion: POITs are rare tumors seen at a young age, and benign or malignant relapse can be seen in these tumors. In this cohort, the malignant recurrence rate was 4.1%, and the benign recurrence rate was 10.4%. All the recurrences were in grade III tumors. Benign recurrences can be treated with surgery alone and the malignant group should be treated with surgery followed by chemotherapy.

Aggressive angiomyxoma is a type of mesenchymal tumor occurring predominantly in the pelvic and perineal region. The aim of our study was to reveal our experience with gonadotropin-releasing hormone (GnRH) treatment in patients with angiomyxoma and provide a comprehensive review of management.This study is a case-series including seven female patients diagnosed with aggressive angiomyxoma from a single institution, between 2012 and 2020. Follow-up after surgery was ranged between 2-45 months with an average of 17.6 months. Resection was performed in all patients without any complications, and five had received GnRH analogue (Goserelin acetate) therapy after surgery. Immunohistochemistry analyses showed positivity for smooth muscle actin and desmin in all cases, while both estrogen receptor (ER) and progesterone receptor (PR) positivity were identified in 6 patients. None of the seven patients had recurrence during follow up period.The mean treatment of aggressive angiomyxoma is surgery, and the use of GnHR analogues in cases with positive ER and PR may be effective in preventing recurrence.Aggressive Angiomyxoma, Gonadotropin-Releasing Hormone, Soft Tissue Neoplasm.PREMESSA: l’angiomixoma aggressivo è un tipo di tumore mesenchimale che si verifica prevalentemente nella regione pelvica e perineale. Lo scopo del nostro studio era di rivelare la nostra esperienza con il trattamento con ormone di rilascio delle gonadotropine (GnRH) in pazienti con angiomixoma e fornire una revisione completa della gestione. PAZIENTI E METODI: questo studio è una serie di casi che include sette pazienti di sesso femminile con diagnosi di angiomixoma aggressivo da un singolo istituto, tra il 2012 e il 2020. Il follow-up dopo l’intervento chirurgico è stato compreso tra 2 e 45 mesi con una media di 17,6 mesi. La resezione è stata eseguita in tutti i pazienti senza complicazioni e cinque avevano ricevuto una terapia con analogo del GnRH (Goserelin acetato) dopo l’intervento chirurgico. Le analisi immunoistochimiche hanno mostrato positività per l’actina e la desmina della muscolatura liscia in tutti i casi, mentre in 6 pazienti è stata identificata la positività sia del recettore degli estrogeni (ER) che del recettore del progesterone (PR). Nessuno dei sette pazienti ha avuto recidiva durante il periodo di follow-up. CONCLUSIONE: il trattamento medio dell’angiomixoma aggressivo è la chirurgia e l’uso di analoghi del GnHR nei casi con ER e PR positivi può essere efficace nel prevenire le recidive.

AIM This study aimed to evaluate the prognostic significance of adequate lymph node dissection (LND) (≥10 pelvic lymph nodes (LNs) and ≥ 5 paraaortic LNs removed) in patients with International Federation of Gynecology and Obstetrics (FIGO) stage II endometrioid endometrial cancer (EEC). METHODS A multicenter department database review was performed to identify patients who had been operated and diagnosed with stage II EEC at seven centers in Turkey retrospectively. Demographic, clinicopathological, and survival data were collected and analyzed. RESULTS We identified 284 women with stage II EEC. There were 170 (59.9%) patients in the adequate lymph node dissection (LND) group and 114 (40.1%) in the inadequate LND group. The 5-year overall survival (OS) rate of the inadequate LND group was significantly lower than that of the adequate LND group (84.1% vs. 89.1%, respectively; p = 0.028). In multivariate analysis, presence of lymphovascular space invasion (LVSI) (hazard ratio [HR]: 2.39, 95% confidence interval [CI]: 1.23-4.63; p = 0.009), age ≥ 60 (HR: 3.30, 95% CI: 1.65-6.57; p = 0.001], and absence of adjuvant therapy (HR: 2.74, 95% CI: 1.40-5.35; p = 0.003) remained as independent risk factors for decreased 5-year disease-free survival (DFS). Inadequate LND (HR: 2.34, 95% CI: 1.18-4.63; p

Surgical treatment of low-grade endometrial stromal sarcoma consists of hysterectomy. The role of oophorectomy is yet to be established. We aimed to examine the effect of preserving the ovaries on the pattern of recurrences in patients with stage I disease. Thirty-four patients with stage I low-grade endometrial stromal sarcoma were retrospectively analysed. Based on ovarian preservation the whole cohort was divided into two groups. Recurrence (liver, lung, groin and bone) was detected in 4 (11.8%) cases. No significant differences in overall survival or disease-free survival (DFS) were observed between the ovarian preservation and bilateral salpingo-oophorectomy (BSO) groups. Subset analysis revealed no significant difference in DFS between the ovarian preservation and BSO groups in the premenopausal arm. And also, the performance of pelvic (

Objective: To analyze the serum markers for the early diagnosis of intestinal anastomotic leak (AL) after the gyne-oncological operations. Methods: Between September 2017 and March 2021, patients with an intestinal anastomosis performed during the gyne-oncological surgeries were identified from a tertiary center in Turkey. As the local guideline of the clinic, all these patients were followed by measuring serum samples including procalcitonin (PCT) and C-reactive protein (CRP) on postoperative day (POD) 1 through the day of discharge or the day of re-operation for AL. Results: 12.5% (5/40) of the patients suffered an AL and 4 of them were re-operated. The mean albumin values on POD 3-4 and the mean platelet values on POD 1 were lower in the AL group (p0.05), median PCT values (ng/mL) on POD 8-10 were higher in the AL group compared with no leak group. The best cutt-off point for PCT on POD 9 was determined to be 0.11 ng/mL (AUC: 0.917, Sensitivity = %100.0, specifity = %66.7, positive predictive value = %66.7, negative predictive value = %100.0). Conclusion: Serum PCT and CRP concentrations were not found to be helpfull for the early diagnosis of AL in patients operated for gyne-oncological malignancies. Low levels of albumin and platelets in the first days after the operation may be clue for a possible AL.

Objective: We aimed to detect and compare group B streptococcus (GBS) colonization in pregnant women at third trimester using real-time polymerase chain reaction (real-time PCR) and culture methods. Methods: Vaginal swab specimens were taken for screening of GBS from 100 women between 35-37 weeks of gestation who were attending to antenatal outpatient unit of Obstetrics and Gynecology Department of Cerrahpasa Medical Faculty from May 2014 to September 2014. Results: Rates of GBS colonization was %5 and %7 by culture and real-time PCR methods, respectively. Using culture as the gold standard; sensitivity and specificity for real-time PCR were 100% and 97.9%, respectively. Any significant difference was not detected between GBS colonization with age groups, education levels, number of previous pregnancies, smoking habits, history of antibiotic use, and contraceptive method. Conclusion: Real-time PCR technique has proven to be as sensitive as the culture method. Also, real-time PCR may provide a rapid diagnostic tool for GBS detection potentially allowing a more effective intrapartum antibiotic prophylaxis and lower infant morbidity and mortality. However, the inability to use PCR test in every laboratory and its high cost creates a handicap.

Endometrial cancer is the most common gynaecologic malignancy in developed countries with increasing incidence worldwide. A total of 201 patients were enrolled and a cross-sectional study was performed using the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) and Female Sexual Functioning Index (FSFI) after the approval by an institutional review board (University of Health Sciences, Tepecik Education and Research Hospital, Turkey, March 13, 2019, Approval no. 2019/4-27). Morbidly obese patients (body mass index (BMI) ≥40 kg/m

Objective To investigate the clinicopathologic characteristics, prognostic factors, outcome, and treatment of the neuroendocrine carcinoma (NEC) of the endometrium. Materials and methods We retrospectively reviewed the clinicopathologic and survival data of 10 patients who underwent surgery for NEC. The patients were collected between 1999 and 2017 from four referral centers in Turkey. Results The median age of patients was 67 years (range: 34–75 years). The NEC of endometrium consist of 9 cases with small cell carcinoma (SC) NEC (two with mixed histotypes), and one with a large cell (LC) NEC. According to FIGO 2009 criteria, 70 % (7/10) of patients had advanced stage (III and IV) disease. All patients except one underwent surgical staging, eight patients received platinum-based chemotherapy (CTX) and of 6 those were additionally treated with radiotherapy (RT). Four patients died of disease ranging from 2 to 10 months and six were alive 12–72 months with no evidence of disease. In addition, 4 SC NEC cases raised in polypoid features had no evidence of disease from 24 to 72 months. Discussion NEC of the endometrium is a rare disease with poor prognosis, which frequently diagnosed in advanced stages. The main treatment modality was the administration of platinum-based CTX as an adjuvant to surgery or surgery and RT. Our result suggests that the polypoid feature of the tumor might be one of the best predictors for the prognosis of SC NEC.

This study aims to evaluate the accuracy of frozen section (FS) in mucinous borderline ovarian tumors (BOTs) and to examine the factors associated with misdiagnosis.In this retrospective study, cases diagnosed as mucinous BOTs by FS or final pathologic (FP) results were studied. The results of FS and FP were compared, and the factors associated with misdiagnosis were analyzed.Seventy-nine cases were examined. The median tumor diameter was 16 (6-50) cm, and 89.9 % of cases had tumors ≥10 cm. The overall agreement ratio between FS and FP was 79.7 %. Over-diagnosis and under-diagnosis rates were 3.8 % and 16.5 %, respectively. The sensitivity and positive predictive values were both 88.7 %. None of the underdiagnosed patients (13 cases) had recurrence during the 100-month median follow-up (9-222). Misdiagnosis was more common in tumors10 cm (p = 0.025). The under-diagnosis rate for tumors10 cm was 30.8 %. Tumor size10 cm was significantly associated with misdiagnosis in univariate and multivariate analyses (Odds ratio {OR} 4.92, 95 % Confidence Interval {CI} (1.08-22.45) p = 0.040; OR 5.17, 95 % CI (1.07-25.05) p = 0.041, respectively). Laterality and preoperative CA 125 levels were not associated with misdiagnosis.Tumor size10 cm is associated with misdiagnosis in mucinous BOTs. Laterality and CA 125 levels do not affect diagnostic accuracy. The evaluation of FS by gynecologic pathologists can help to increase the accuracy of FS.

Intrauterine device is one of the most preferred contraceptive methods. Rare complications such as uterine perforation were getting more common due to increased use of intrauterine device and could be seen either with mild manifestations or serious cases like bladder or intestinal damage. A 48-year-old patient who is consulted to our clinic because of a missed copper intrauterine device was presented. The intrauterine device was inserted 28 years ago, detected in pelvis incidentally by x-ray and extracted via laparotomy. Although device has been in abdomen for nearly three decades, we did not see any serious reaction or adhesion during surgery.Management of a patient with intrauterine device should be done carefully and following the instructions before insertion, regular examination at every visit are important.

Başlıca bulguları over kaynaklı kitle, asit ve CA 125 yüksekliği olduğu için over kanseri ön tanısı ile cerrahiye alınan 78 yaşındaki olgunun kesin tanısı ancak patoloji raporunun malign mezotelyoma olarak raporlanması üzerine konulabilmiştir. Öyküsünden yıllar önce yaşadığı yer nedeniyle asbeste maruz kaldığı düşünülen hastada kesin tanı ameliyat öncesi konulamamıştır. Over kanseri ile klinik tablo açısından benzerlikler gösterse de tedavileri ve sonuçları açısından aralarında farklılık bulunan bu malign peritoneal mezotelyoma olgusu ayırıcı tanıya yardımcı olması açısından sunulmuştur., A patient who had ovarian mass, ascites and elevated CA 125 levels was treated with presumptive diagnosis of ovarian cancer. After pathological examination, she was finally diagnosed as malign peritoneal mesothelioma. Although exposure to asbestos was considered, the diagnosis was not revealed before surgery. Despite similarity of clinical features, ovarian cancer and malign peritoneal mesothelioma have different treatment options and long-term outcomes. The aim of this case report is to describe the process of differential diagnosis between malign peritoneal mesothelioma and ovarian cancer.

OZET Amac: Ileri evre/rekuren over kanseri nedeniyle sitoreduktif cerrahi ve Hipertermik Intraperitonyal Kemoterapi (HIPEC) uyguladimiz hastalardaki peroperatif morbidite ve mortaliteyi arastirdik. Yontem: Ocak 2016-Aralik 2018 tarihleri arasinda HIPEC uyguladigimiz hastalarin elektronik dosyalari ve takipleri retrospektif olarak incelendi. Bulgular: Nihai patolojisi musinoz apandiks tumoru gelen 1 vaka dislandiginda peritonyal karsinomatozis nedeniyle toplam 18 hastaya ileri cerrahi ve HIPEC uygulandi. Hastalarin ortalama yasi 54,6 (aralik, 22-76 yas) idi. Median preoperatif CA125 degeri 64 U/ml (aralik, 6-4756 U/ml) idi. 3 hasta rekurens nedeniyle, 15 hasta (11 interval, 4 first-look cerrahi) ise primer olarak opere edildi. Hastalarin hepsine peritonektomi proseduru, 4 hastaya ise beraberinde barsak rezeksiyonu uygulandi. Ortalama operasyon suresi 323,5 dakika (aralik, 180- 495 dakika) idi. En sik gozlenen dahili morbidite, kan transfuzyonu (83.3%, 15/18); cerrahi morbidite ise yara yeri enfeksiyonu (%16.6, 3/18) bulundu. Hastalarin ortalama hastanede yatis suresi 10,3 gun (aralik, 5-32 gun) idi. Peroperatif mortalite gozlenmedi. Sonuc: HIPEC, yogun bakim kosullari iyi olan ve multidisipliner kliniklerde uygulandiginda peroperatif ciddi morbidite ve mortaliteye neden olmayan bir yontemdir. Anahtar Sozcukler: HIPEC; Peroperatif; Morbidite. ABSTRACT Objective: We investigated peroperative morbidity and mortality in patients who underwent cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for advanced stage/recurrent ovarian cancer. Methods: Between January 2016 and December 2018, electronic files and follow-up of patients who underwent HIPEC were reviewed retrospectively. Results: After one case of mucinous appendiceal tumor was excluded, a total of 18 patients underwent advanced surgery and HIPEC due to peritoneal carcinomatosis were detected. The mean age of the patients was 54.6 years (range, 22-76 years). The median preoperative CA125 value was 64 U/ml (range 6-4756 U/ ml). Fifteen patients (11 interval surgeries, 4 first-look surgeries) were operated primarily while 3 patients were operated due to recurrent disease. Peritonectomy procedure was performed in all patients and bowel resection was performed in 4 patients. The mean operative time was 323.5 minutes (range, 180-495 minutes). The most common medical morbidity was blood transfusion (83.3%, 15/18) while most common surgical morbidity was wound infection (16.6%, 3/18). The mean length of hospitalization was 10.3 days (range, 5-32 days). No peroperative mortality was observed. Conclusion: HIPEC is a method that does not cause severe morbidity and mortality when well intensive care conditions are applied in multidisciplinary clinics. Keywords: HIPEC; Peroperative; Morbidity.

PurposeTo investigate the clinico-pathological prognostic factors and treatment outcomes in patients with ovarian yolk sac tumors (YST).MethodsA multicenter, retrospective department database review was performed to identify patients with ovarian YST who underwent surgery between 2000 and 2017 at seven Gynecologic Oncology Centers in Turkey.ResultsThe study group consisted of 99 consecutive patients with a mean age of 23.9years. While 52 patients had early stage (stage I-II) disease, the remaining 47 patients had advanced stage (stage III-IV) disease. Theuterus was preserved in 74 (74.8%) of the cases. The absence of gross residual disease following surgery was achieved in 76.8% of the cases. Of the 54 patients with lymph node dissection (LND), lymph node metastasis was detected in 10 (18.5%) patients. Of the 99 patients, only 3 patients did not receive adjuvant therapy, and most of the patients (91.9%) received BEP (bleomycin, etoposide, cisplatin) chemotherapy. Disease recurred in 21 (21.2%) patients. The 5-year disease-free survival (DFS) and overall survival (OS) in the entire cohort were 79.2% and 81.3%, respectively. In multivariate analysis, only residual disease following initial surgery was found to be significantly associated with DFS and OS in patients with ovarian YST (p=0.026 and p=0.001, respectively).ConclusionsOur results demonstrate the significance of achieving no visible residual disease in patients with ovarian YST. Fertility-sparing approach for patients with no visible residual disease affected neither DFS nor OS. Although high lymphatic involvement rate was detected, the benefit of LND could not be demonstrated.

Objective To evaluate the clinicopathological features and outcomes of patients undergone surgery for benign and metastatic adnexal masses during the surveillance of colorectal cancer (CRC). Methods A single institute retrospective study involving 90 patients diagnosed with CRC that undergone surgery at Hacettepe University Hospital between 2000−2018. Clinicopathological and survival data was obtained from hospital records. Results Elevated blood levels of CEA (HR, 1.23; 95 % CI: 1.03–1.24; p = 0.01), adnexal masses larger than 5 cm (HR, 3.296; 95 % CI: 1.527–7.076; p = 0.002), bilaterality of adnexal mass (HR, 2.200; 95 % CI: 2.464–11.969; p = 0.001) and high PCI score (HR, 0.150; 95 % CI: 0.044−0.479; p = 0.01) were found to be significantly associated with ovarian metastasis. There was a significant difference in overall survival (OS), with respect to complete and incomplete resection in adnexal surgery of ovarian metastasis (46.6 vs. 29.6 months; p = 0.004). The median survival time was 32.8 months for patients with ≤ 24 months interval time to adnexal metastasis surgery, and 48.5 months for patients with >24 months interval time to adnexal metastasis surgery (p = 0.001). Conclusion This study showed that numerous clinicopathological variables such as bilaterality and size of adnexal mass, serum blood levels of CEA and PCI score may have a significant impact on the prediction and management of ovarian masses diagnosed during CRC surveillance. Complete resection and interval time to adnexal surgery is significantly associated with OS.

This study was conducted to determine the changes in ovarian reserve markers after laparoscopic ovarian cystectomy (LOC).Prospective cohort study (Canadian Task Force classification II-2).University teaching hospital.Fifty 50 patients who underwent LOC were prospectively examined to determine the changes in serum markers of ovarian reserve, starting from 1 month before and 3 months after consecutive operations.Changes in serum markers were compared between the following groups: endometrioma cysts (n = 26) versus nonendometrioma cysts (n = 24), unilateral cystectomy (n = 38) versus bilateral cystectomy (n = 12), and bilateral endometrioma extirpation (n = 10) versus other cystectomy operations (n = 40).A significant change was noticed between the preoperative and postoperative antimüllerian hormone (AMH) levels (2.67 ± 2.67 ng/mL vs 1.84 ± 1.72 ng/mL, p .0001). Serum AMH levels were found to be significantly decreased in endometrioma (p = .002), nonendometrioma (p = .019), unilateral cystectomy (p = .001), bilateral cystectomy (p = .005), bilateral endometrioma (p = .011), and cysts other than bilateral endometrioma (p = .000) groups.The ovarian reserve was found to be diminished after LOC regardless of the presence of endometrioma that could be distinguishable by serum AMH levels.

Amaç: Urotensin II(UII) ve sistemi, birçok hastalığın (diyabet dahil) etyolojisinde rol oynar. Buçalışmada gestasyonel diabetes mellitusta (GDM) UII'yi değerlendirmek ve karşılaştırmayıdenedik.Yöntemler: Çalışmaya alınanotuzaltı gebe (GDM olmayan 15 kadın hasta 1. Grubu ve 21 GDM kadın hasta 2.Grubu oluşturdu). Üçüncü grup, yaşları eşleştirilmiş22 gebe olmayan sağlıklı bireyden oluşuyordu. Plazma UII seviyeleri çalışmanın başındabelirlendi. Doğum sonrası 12.hafta ikinci bir plazma UII düzeyi grup 1 ve 2'deki hastalardan ölçüldü.Bulgular: Hem GDMhem de GDM olmayan deneklerin Gestasyonel UII düzeyleri, gebe olmayan sağlıklı kontrolleregöre daha yüksekti (her ikisi için p=0,0001). GDM'li hastaların gestasyonel vepostpartum UII düzeyleri, GDM'li olmayan gebelere göre daha yüksekti ancak istatistikselolarak anlamlı değildi (p≥0.05). GDM'li olmayan kişilerde plazma UII konsantrasyonları,doğumdan sonra anlamlı olarak azaldı, ancak GDM'li kişilerde değişmedi (sırasıyla,p=0,036 ve p ≥0.05).Sonuç: GDMhastalarında doğumdan sonra anlamlı bir şekilde azalmayan plazma UIIkonsantrasyonlarının yüksek bulunması (GDM olmayan bireylerle karşılaştırıldığında),UII'nin ve sisteminin GDM patogenezinde rol oynayabileceğini göstermektedir. Bualanda daha ayrıntılı çalışmalara ihtiyaç vardır., Aim: Urotensin II(UII) and its system is implicated in the etiology of many diseases (including diabetesmellitus). We tried in this study to evaluate and compare UII levels ingestational diabetes mellitus (GDM).Methods: Thirty-sixpregnant women (15 non-GDM patients consisted group 1 and 21 GDM patientsconsisted group 2) enrolled in this study. The 3rd group consisted of age matched22 non pregnant healthy women. Plasma UII levels were determined at thebeginning of the study. After 12 weeks of delivery, a second plasma UII was determinedfrom group 1 and 2.Results: GestationalUII levels of both GDM and non-GDM patients were higher than non-pregnanthealthy controls (p=0.0001 for both). Both gestational and postpartum UIIlevels of GDM patients were higher than non-GDM patients but had not reached statisticalsignificance (P≥0.05). Plasma UII concentrations in non-GDM patients significantlydecreased after delivery but not in GDM patients (p=0.036 and p≥0.05,respectively).Conclusion: Thefinding of elevated gestational plasma UII concentrations in GDM patients whichdid not decrease significantly after delivery (in compare to non-GDM patients) showsthat plasma UII levels may have a role in the pathogenesis of GDM. Furtherdetailed studies are needed in this field.

Objective To investigate the incidence of retroperitoneal lymph node metastasis among patients with primary adult type granulosa cell tumor (AGCT) of the ovary. Study design Between January 1982 and February 2017, patients with a pathological diagnosis of AGCT were identified. Clinical and pathological data were obtained from database records. Results A total of 151 patients with primary AGCT were identified with a mean age of 47.8 years (range, 17–91 years). 98 patients (64.9%) had stage IA, 24 (15.9%) had stage IC, 4 (2.6%) had stage IIB, 2 (1.3%) had stage IIIB, 6 (4.0%) had stage IIIC disease according to International Federation of Gynecology and Obstetrics (FIGO) 1988 criteria. In the remaining 17 patients (11.3%), primary stage was not detected. In 134 (88.7%) patients, pelvic and para -aortic lymphadenectomy was performed at primary staging surgery depending on the frozen section analysis or at re-staging surgery following initial diagnosis. In these patients, six (4.5%) of them had pelvic or paraaortic lymph node metastasis. The median number of lymph nodes removed was 43 (range, 10–96 lymph nodes). Conclusion Lymph node metastasis in initially staged AGCT is rare. Routine pelvic and paraaortic lymph node dissection may be omitted in these patients.

To investigate clinicopathological characteristics and oncological outcome of women with microinvasive BOTs. A retrospective multicenter case–control study was conducted on 902 patients with BOT, who underwent surgery from January 2002 to December 2015 at six participating gynecologic oncology centers from Turkey. Among 902 patients, 69 had microinvasive BOT. For every patient with microinvasive BOT, two controls were randomly selected from another database based on decade of age and stage of disease at diagnosis. The clinical–pathological characteristics and oncological outcomes were compared between BOT patients with and without stromal microinvasion. Risk factors for poor oncological outcomes were investigated in a multivariate analysis model. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method. Patients with microinvasive BOT had a significantly higher rate of recurrence than patients without microinvasive BOT (17.4 vs 7.8%, OR 3.55, %95 CI 1.091–11.59, p = 0.03). Stage at diagnosis (stage I versus II/III) and type of surgery (cystectomy versus others) were found as other significant prognostic factors for recurrence in multivariate analysis (OR 8.63, %95 CI 2.48–29.9, p = 0.001 and OR 19.4, %95 CI 3.59–105.6, p = 0.001, respectively). Stromal microinvasion was found as a prognostic factor for significantly shorter DFS (26.7 vs 11.9 months, p = 0.031, log rank). However, there was no significant difference in OS between two groups (p = 0.99, log rank). Stromal microinvasion is significantly associated with decreased DFS. In addition, our study confirms that the risk of recurrence is higher in patients with microinvasive BOT.

To evaluate the patterns of lymphatic spread in epithelial ovarian cancer (EOC) macroscopically confined to the ovary and to determine risk factors for lymph node metastasis.All patients with clinically apparent stage IA/B/C EOCs who underwent staging surgery between January 2003 and February 2013 were retrospectively identified.Two hundred and thirty-six (n = 236) consecutive patients were operated for primary epithelial ovarian carcinoma. Sixty-two of these patients (26.2 %) who underwent a comprehensive staging procedure including pelvic and paraaortic lymphadenectomy were diagnosed with tumors confined to one or two ovaries (stage IA/B/C). Of these 62 patients, 17 (27.4 %) had upstaged disease and 8 (12.9 %) had lymph node metastasis. Tumor histology was serous in 25 patients (40.3 %), mucinous in 23 patients (37 %), endometrioid in 9 patients (14.5 %), and clear cell in 5 patients (8 %). Positive lymph node status was found in 20 % (5/25) of those with serous histology while this rate was only 8.1 % (3/37) in those with non-serous disease. Although the presence of ascites was not associated with an increased risk of lymph node involvement (p = 0.24), positive peritoneal cytology (p = 0.001) and grade 3 disease (p = 0.001) were significant predictors of lymph node involvement.All patients diagnosed with EOC macroscopically confined to the ovary should be considered for comprehensive staging surgery including pelvic and paraaortic lymphadenectomy.

Isolated tubal torsion is a very rare entity with a reported incidence of 1: 1.500.000. In postmenopausal period it is even more rare. In this case report we present a postmenopausal patient with subacute pelvic pain and adnexal mass whose definitive diagnosis at laparotomy was isolated tubal torsion. Until now, to our knowledge, only 3 cases of postmenopausal isolated tubal torsion has been described in the literature. One-month duration of symptoms indicating the subacute nature of torsion was also unique in this case. Intraoperatively, the right tube was twisted 7-8 times just beside a paratubal cyst which is in the form of a 10x8x8 cm hemorrhagic necrotic cystic mass. Total abdominal hysterectomy, bilateral salpingoophorectomy and appendectomy procedure was undertaken.

To evaluate the feasibility of ovarian preservation at the time of operation in patients with clinical stage I endometrial carcinoma. The data of 499 consecutive patients with clinical stage 1 endometrial cancer operated between January 2001 and December 2011 were retrospectively reviewed. Clinical and pathologic information and the intraoperative inspection findings of ovaries were evaluated to find the factors associated with the coexisting ovarian malignancy. The mean age of patients was 56.8 ± 9.8 years. Coexisting ovarian tumors were detected in 38 patients (7.6 %), and 28 (5.6 %) of them were malignant (12 metastatic and 16 synchronous primaries). Most of the patients were postmenopausal (n = 371, 74.3 %) and 60 (12 %) of the patients were at the age of 45 years or less. Coexisting malignancy was detected in 9 % (n = 11) of the premenopausal patients and in 5 % (n = 3) of the patients aged 45 years or less. Multivariate analysis revealed that serosal invasion, tubal involvement, and positive abdominal cytology were independent risk factors for coexisting ovarian malignancy. The sensitivity, specificity, positive predictive value and negative predictive value of the intraoperative examination for the diagnosis of benign/normal ovary was 99.6, 78.8, 98.5 and 92.9 %, respectively. The incidence of coexisting ovarian malignancy in clinical stage I endometrial carcinoma is low. Although occult metastasis cannot be excluded at all, careful intraoperative inspection of ovaries seems valuable for the prediction of co-existing ovarian malignancy.

Introduction: Non-stress test (NST) became the basic method to increase fetal survival rates during over 4 decades. Although the accuracy of fetal well-being assesmernt of the method still remains controversial. The basic goal is to predict fetal hipoxia and severe asphyixia and intervene before fetal death happens. On the other hand, prenatal outcome does not improve as desired due to discordance between NST findings and severity of fetal hipoxia. Aim: To determine the power of decision-making role of NST, via retrospective datas of cesarean deliveries indicated with fetal distress according to NST findings. Materials and methods: In Istanbul Medical Faculty Hospital, the datas of 590 cesarean deliveries indicated with fetal distres according to NST findings, between the dates of 2007-2009 were detected retrospectively. Cases were divided into two groups as preterm and term labors. The postpartum term datas selected were; birth weight, APGAR scores of 1st and 5th minutes, cord blood pH, pH, pO2, pCO2, HCO3, base excess (BE). As measuring the value of NST to predict fetal hipoxia, positive predictive value was calculated. As for APGAR scoring; positive and negative predictive values, spesificity, sensitivity were calculated. Result: NST was not found as effective as it was obtained. Only 30% of the cases were found hipoxic. Additionally between those fetuses with hipoxia, 38% had 1st minute APGAR score of 7 (cut-off value) and under. Although in cases with findings of uteroplacental insufficiency NST should give much valuable information, regarding to increase of unnecessary surgical procedures. On the other hand, concept of guideness of NST to operative labor seems to be logical considering medicolegal issues.

Objectives: To define the epidemiologic, clinical and laboratory risk factors associated with failed response to conservative antibiotic therapy in tubo-ovarian abscess (TOA). Material and methods: The charts of 108 patients, admitted with clinically and sonographically diagnosed TOA between 1988 and 2010 were reviewed. On admission, all patients were treated with broad-spectrum antibiotics, and were divided into two groups according to the response to medical treatment. 47 patients, responding to antibiotic therapy, constituted group A, whereas 61 patients who did not respond and were further treated by surgery, were included in group B. The groups were compared with respect to patient characteristics, clinical and sonographic presentation, laboratory findings. Results: There was no statistical difference between the mean age of patients (38±2,8) responding to medical therapy (group A) and the age of patients who did not respond (group B) (38±3,4)(p>0,05). The gravidity, parity, use of intrauterin device (IUD) and history of tubal ligation were similar between the groups (p>0,05). The size and bilaterality of TOA, evaluated sonographically were significantly increased in group B compared with group A (p=0,008 and p=0,002, respectively). On admisson, fever >38,0°C was determined in %32 of group B and %8 of group A (p=0,003.) The only laboratory finding differentiating between two groups was C-reactive protein (CRP), being significantly higher in group B (p=0,03). The duration of hospitalization was significantly shorter in group A (8,21 ± 1,9)(p

To evaluate maternal and fetal outcomes among women with hyperemesis gravidarum (HG). In a university hospital and a research and training hospital, a retrospective cohort study was conducted among women with singleton deliveries between 2003 and 2011. Maternal outcomes evaluated included gestational diabetes, pregnancy-induced hypertension, cesarean delivery. Neonatal outcomes also determined were 5-min Apgar score of less than 7, low birth weight, small for gestational age (SGA), preterm delivery, fetal sex, and stillbirth. There were no statistical differences in the mean of age, parity, the number of artificial pregnancy, and smoking between two groups. Infants from HG pregnancies manifested similar birth weight (3,121.5 ± 595.4 vs. 3,164 ± 664.5 g) and gestational age (38.1 ± 2.3 vs. 38.1 ± 2.6 weeks), relative to infants from the control group (p = 0.67 and 0.91, respectively). In addition, no statistical significant differences were found in the rates of SGA birth, preterm birth, gestational diabetes, pregnancy-induced hypertension, and adverse fetal outcome between two groups (p > 0.05). Cesarean delivery rates were similar in two groups (31.9% in hyperemesis group vs. 27% in control group, p = 0.49). Comparing the gender of the newborn baby and Apgar scores less than 7 at 5 min, there were no statistically significant differences between two groups (p = 0.16 and 0.42, respectively). Hyperemesis gravidarum is not associated with adverse pregnancy outcomes.

Objectives: To compare the efficacy, adverse effects and user satisfaction of roller-ball endometrial ablation (RBEA) and levonorgestrel intrauterin system (LNG-IUS) for the treatment of abnormal uterine bleeding (AUB). Methods: 58 women attending a university hospital clinic in Istanbul,Turkey were randomised to either surgical treatment using RBEA or medical treatment using a LNG-IUS (Mirena, Schering Healthcare). Pictorial bleeding assesment chart (PBAC) scores and hemoglobin levels were noted pre-insertion/operatively and again at one year post-insertion/operatively. Non-parametric tests (Mann-Whitney) and Pearson chi-square test were used for statistical analysis. Ethics Commitee approval was obtained for this study. Results: Hemoglobin levels were increased and PBAC scores were reduced in both groups after 1 year of treatment (p

To measure the feasibility of sentinel lymph node technique in endometrial cancer.The study was designed as a prospective non-randomized case-control trial. Between 2010-2011, in Istanbul University, Istanbul Medical Faculty, Gynecologic Oncology department, 26 patients who were preoperatively evaluated as endometrial cancer enrolled in the study. Patients' detailed informed consent and ethics committee approval were obtained. Sentinel lymph node (SLN) detection rate was determined as the primary outcome. Sensitivity, specificity, positive and negative predictive values and particularly false negative results were determined as secondary outcomes. As a technique of SLN, injection of methylene blue to the subserosal myometrium of the uterine fundus via 5 cc syringe following peritoneal aspiration cytology procedure was obtained. Surgery was made after injection for an average of 5 minutes due to the physiological spread of the blue dye. Then, the standard protocol of hysterectomy was performed and the retroperitoneum was opened to perform lymphadenectomy. The presence of lymph node regions, and presence of a sentinel node was recorded on the trial record form. Positive staining nodes were sent separately for pathological examination. In the course of the study due to insufficient rate of staining, the technique has been changed to cervical and multiple uterine injections.As the primary outcome, an SLN positivity rate of 23% in 6 patients with a total of 8 lymph nodes were found. The remarkable finding was that in the first technique, the rate was 1/16 (6%), while the second technique, 5/10 (50%), respectively. The difference is statistically significant (p=0.001). In endometrial cancer stage I and II, secondary outcomes for sensitivity, specificity, positive predictive value, negative predictive value were 23%, 0%, 100%, 43%, respectively. Because there were no metastatic lymph nodes found, false negative rate was 0%.SLN approach is not valuable enough to eliminate the need for lymphadenectomy. On the other hand, it facilitates scanning micrometastases and ultrastaging, while its clinical value has not yet been established. However, according to the recent pilot studies, it provides a means for assessing micrometastases for the medium-risk group for local recurrence.Sentinel lenf nodu tekniğinin endometriyum kanserinde uygulanabilirli ğini ölçmek.Prospektif non-randomize vaka kontrol çalış-ması olarak, 2010–2011 yılları arasında İstanbul Üniversitesi İstanbul Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Jinekolojik Onkoloji servisinde yapılan preoperatif değerlendirmesi endometriyum kanseri saptanan 26 olgu çalışmaya alındı. Çalışma için hastalardan aydınlatılmış onam formları ile etik kurul onayı alındı. Birincil sonuç olarak sentinel lenf nodu (SLN) saptanma oranı, sekonder sonuç olarak da yalancı negatiflik başta olmak üzere duyarlılık, özgüllük, pozitif ve negatif prediktif değerlerin saptanması belirlendi. SLN tekni- ği olarak periton yıkantı sitolojisini takiben uterus fundusta subserozal myometriyuma 5 cc injektör ile metilen mavisi verildi. Boya verilmesini takiben ortalama 5 dakika cerrahiye ara verilerek boya maddenin yayılması beklendi. Broad ligaman ve tubalar klempe edilerek tümör hücrelerinin mobilizasyonunun engellenmesi amaçlandı. Ardından standart histerektomi protokolü uygulandı. Retroperitoneum açılarak lenfadenektomi yapıldı. Çalışma formuna, çıkarılan lenf nodu bölgeleri ve varsa sentinel nodu varlığı kaydedildi. Pozitif boyanma gösteren lenf nodlarının patolojik incelemeye ayrıca gönderilmesi öngörüldü. Çalışmanın seyrinde boyanma oranı yetersiz görüldüğü için servikal ve multipl uterus injeksiyonu tekniğine geçildi.Primer sonuç olan SLN pozitifliği 6 hastada toplam 8 lenf nodu ile %23 oranında bulunmuştur. İlk teknikte oran 1/16 (%6) iken ikinci teknikte 5/10 (%50) olarak bulunmuştur. Aradaki fark istatistiksel olarak anlamlıdır (p=0.001). Sekonder sonuçlar olarak evre I ve II endometriyum kanserinde SLN tekniğinin duyarlılığı %23, özgüllüğü %0, pozitif prediktif değeri %100, negatif prediktif değeri %43 olarak bulunmuştur. Yalancı negatiflik değeri de pozitif lenf nodu bulunmad ığından %0’da kalmıştır.SLN yaklaşımı lenfadenektomi ihtiyacını bertaraf edecek kadar değerli olmamakla birlikte rutin pratikte tüm lenf nodlarına uygulaman ın mümkün görünmediği ve tedavi yönetiminde oturmuş bir yeri olmayan ancak pilot çalışmalarda elde edilen verilere göre nüks için orta risk grubu kabul edilen mikrometastaz incelemesine imkan vererek ultrastaging şansı yaratmaktadır.

Our aim was to determine the effect of cervical dilatation at non-labour caesarean section on post-operative pain and maternal morbidity. This prospective, randomised, single-blinded trial was conducted from March 2013 to February 2014. In all, 199 patients were enrolled in the study: 102 in non-dilated group and 97 in cervical dilatation group. Based on Visual Analogue Scale, there were no significant differences between the two groups on post-operative 8th, 24th and 48th hour pain scores. We observed thinner endometrial cavity thickness, shorter operation time and shorter hospitalisation duration in cervical dilatation group. However, change in haemoglobin concentrations and puerperal fever rates were found to be comparable between the groups. In conclusion, intra-operative cervical dilatation does not seem to benefit in terms of post-operative pain, change in haemoglobin concentrations or puerperal fever.

Background Ovarian fibromas/fibrothecomas are uncommon benign tumours of ovary. Due to their solid structure, these benign tumours are sometimes confused with malignant tumours during clinical evaluation. Aims To determine the clinico-pathological characteristics of ovarian fibroma/fibrothecoma and analyse the efficiency of risk of malignancy index (RMI) scoring system to distinguish malignancy among these tumours. Methods Between November 2001 and February 2012, women with a pathological diagnosis of ovarian fibroma/fibrothecoma were identified. Depending on the menopausal status, serum CA-125 level and ultrasonographic findings, RMI scores were calculated for each of the patients. Results During the study period, 43 ovarian fibroma/fibrothecoma (4.7%) were detected among 912 adnexal masses operated. The mean age of the women was 52.2 (range, 21–80 years). Upon calculating RMI scores, 33 women (76.7%) were classified as low risk and 10 women (23.3%) as high risk for malignancy. Sensitivity, specificity, positive predictive value and negative predictive value of the RMI scoring for identification of malignant lesions preoperatively were found as 0%, 76%, 0% and 97%, respectively. Final pathological diagnosis was ovarian fibroma in 13 (30%) women, fibrothecoma in 29 (67%) and fibrosarcoma in one woman (2%). Conclusion There are no specific markers for accurate preoperative diagnosis of ovarian fibroma/fibrothecoma. Moreover, according to our results, RMI scoring system does not aid clinicians in this issue either, with a high false-positive rate and very low sensitivity. Further studies with higher number of cases are needed to state clearly the role of RMI scores in preoperative discrimination of malignancy.

To examine the influence of obesity on the patient characteristics and clinicopathologic features of endometrial cancer, and to find how treatment and prognosis were affected by obesity in women with endometrial cancer.The data of 370 consecutive women operated for endometrial cancer were retrospectively reviewed. Patients were divided into three categories as25, 25-29.9 and ≥30 according to BMI. All patients underwent primary surgical treatment including total abdominal hysterectomy, bilateral oophorectomy and peritoneal cytology. Pelvic lymphadenectomy was carried out for all patients except for those with no myometrial invasion regardless of the tumor grade or for whom it was technically impossible. Paraaortic lymphadenectomy was performed when pre- and intraoperative assessments suggested non-endometrioid or grade 3 endometrioid cancer,50 % myometrial invasion and cervical involvement.Patients with a BMI (body mass index) of25 were significantly younger. Patients with a BMI of ≥30 were statistically less likely to have50 % myometrial invasion and more likely to have stage I disease. There were no significant differences in the incidences of positive pelvic and paraaortic lymph nodes and tumor grades between the three groups. Also, there were no differences in surgery type, the mean of removed pelvic and paraaortic lymph node number, hospital stay, blood loss and complications between the groups. The patients with a BMI of ≥30 had significantly longer operating time. There were no statistically significant differences in recurrences, the median number of months at recurrence or the site of recurrence between the three groups, as well as the 5-year overall and disease-free survival of patients. Multivariate proportional hazard models identified stage III and IV disease as significant covariates for mortality rates, while stage III and IV disease, hypertension and pelvic irradiation were identified as significant covariates for recurrence rates.Positive peritoneal cytology, deep myometrial invasion and stage II-IV endometrial cancer were significantly more common in patients with a BMI of25. There were no significant differences in tumor grade, surgical technique, surgical morbidity or adjuvant radiotherapy between the BMI groups. Recurrence and cancer-related mortality rates were not affected by the BMI.

Investigation of serum markers which could be used in the malignancy prediction of adnexal masses.Vascular endothelial growth factor (VEGF), interleukin 6 (IL-6), leptin, C-reactive protein (CRP), creatine-kinase-MB (CK-MB) and cancer antigen 15-3 (CA 15-3) levels were determined prospectively in serum samples that were obtained from patients who underwent surgery for an adnexal mass and who were referred to Istanbul University, Faculty of Medicine, Department of Obstetrics and Gynecology, between 2009 and 2011, and then were compared with the serum samples of completely healthy outpatient patients as a control group. Based onto the ovarian cancer status, cases were divided into four groups: 13 patients were included in the early-stage malignant group, 12 patients were included in the advanced-stage malignant group, 25 in the benign group and 19 in the healthy control group. Patients with only epithelial ovarian cancer were included into the cancer group. Ethics Commitee approval was obtained for this study. The budget was supported by the Istanbul University Scientific Research Projects Unit.RESULTS RELATED WITH SENSITIVITY, SPECIFICITY, POSITIVE PREDICTIVE VALUE (PPV), NEGATIVE PREDICTIVE VALUE (NPV) AND ODDS RATIO (OR), RESPECTIVELY, AND THE FOLLOWING VALUES WERE CALCULATED: 48%, 95%, 92%, 59% and +OR 9.6 -OR 0.5 for CA; 15-3; 52%, 75%, 72%, 55%, +OR 2.08 -OR 0.64 for leptin; 72%, 70%, 75%, 66% 2.4-0.5 for IL-6; 24%, 80%, 60%, 45%, 1.2-0.92 for VEGF; 68%, 30%, 55%, 43%, 0.97-1.06 for CRP; and 8%, 70%, 25%, 38%, 026-1.31 for CK-MB.CA 15-3, IL-6, Leptin, VEGF and CRP were effective in the prediction of benign and malignant masses; however they may be more suitable in selected cases as they have a limited use because of their inadequate potential regarding sensitivity and specificity.Adneksiyel kitlelerde malignite ayrımında kullanılabilecek serum markerlarının araştırılması.İstanbul Üniversitesi İstanbul Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı’nda 2009–2011 yılları arasında prospektif olarak, adneksiyel kitle endikasyonu ile opere olan hastalardan alınan serum örneklerinde vascular endotelial growth factor (VEGF), interlökin 6 (IL-6), leptin, C-reaktif protein (CRP), kreatin kinaz-MB (CK-MB) ile kanser antijeni 15-3 (CA 15-3) düzeyleri belirlendi ve kontrol grubu olan tamamen sağlıklı poliklinik hastalarının serum örnekleriyle karşılaştırıldı. Olgular over kanseri durumuna göre 4 grupta toplandı: 13 olgu erken evre malign, 12 olgu ileri evre malign, 25 olgu benign, 19 olgu sağlıklı kontrol grubunda yer aldı. Over kanseri grubunda sadece epitelyal over kanseri olan olgular çalışmaya dahil edildi. Çalışma için etik kurul onayı alındı ve bütçe ise İstanbul Üniversitesi Bilimsel Araştırma Projeleri Birimi tarafından desteklendi.Belirteçlerin duyarlılık, özgüllük, pozitif prediktif değer (PPD), negatif prediktif değer (NPD) ve odds ratio (OR) sonuçlarına bakıldığında CA 15-3 için sırasıyla %48, %95, %92, %59 ve +OR 9.6 −OR 0.5; leptin için sırasıyla %52, %75, %72, %55, +OR 2.08 −OR 0.64; IL-6 için %72, %70, %75, %66 2.4-0.5; VEGF için %24, %80, %60, %45, 1.2-0.92; CRP için %68, %30, %55, %43, 0.97–1.06; CK-MB için %8, %70, %25, %38, 026–1.31 değerleri hesaplandı.CA 15-3, IL-6, Leptin, VEGF ve CRP benign-malign over tümörü ayrımında etkin bulundu ancak duyarlılık ve özgüllükleri yeteri kadar kuvvetli olmadığı için rutinde kullanımı kısıtlı olup seçilmiş vakalarda kullanımı uygun olabilir.

WOS: 000345819100010 PubMed: 25551957 Objective: To investigate the incidence, indications, complications, and risk factors associated with increased mortality and morbidity of emergency peripartum hysterectomy (EPH). Materials and Methods: The authors retrospectively analyzed 48 cases of EPH performed within six-year interval at Ondokuz Maps University Hospital. EPH was defined as the operation performed for life-threatening hemorrhage which could not be controlled with conservative treatment modalities within 24 hours of a delivery. Results: The incidence of EPH was 5.03 per 1,000 deliveries. The most common indication for EPH was abnormal placental adherence (n = 22,45.8%), followed by uterine atony (n = 19, 39.6%). All the patients with placenta accreta had a history of repeat cesarian section (CS) and placenta previa.Total hysterectomy was performed in almost all of the patients (n = 47, 97.9%). All women required blood transfusions. Maternal morbidity was significant, with bladder injury (31.3%) and disseminated intravascular coagulation (18.7%) among the most common complications. There were one maternal (2.1%) and five neonatal deaths (10.4%). Conclusion: Since most of the EPH cases are associated with prior cesarean delivery, decision of the first CS should be made for true obstetrical indications conservative treatments fail to control massive obstetrical bleeding, blood products and an experienced obstetrician should be ready to perform EPH to decrease the maternal morbidity and mortality.