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The aim of this study was to assess whether serum markers would be useful as a new predictor of preterm birth in patients with spontaneous, late preterm labour. Patients diagnosed with late preterm labour were divided into preterm delivery (229 patients) and term delivery (178 patients) groups. The two groups were compared in terms of clinical characteristics and levels of serum markers (leukocyte subtypes, platelet, C-reactive protein [CRP], neutrophil to lymphocyte ratio [NLR] and platelet to lymphocyte ratio [PLR]), which were obtained at admission. The levels of leukocyte (p .001), neutrophil (p .001), CRP (p = .001), NLR (p .001) and PLR (p = .003) were significantly higher, whereas lymphocytes (p = .012) were significantly lower in the preterm delivery group, compared to the term delivery group. On multivariate regression analysis, NLR positive was the most powerful predictive variable (OR = 1.41; 95%CI: 1.32-1.51; p = .005). NLR had the highest area under curve (0.711; 95%CI 0.662-0.760) in predicting preterm birth and a NLR6.2 had the highest sensitivity (65.1%) and specificity (62.5%). High NLR at admission is an independent predictor of preterm birth in patients with spontaneous, late preterm labour. Impact statement What is already known on this subject: Preterm birth accounts for 5-12% of all births, and is a major factor associated with perinatal morbidity and mortality worldwide. However, more than 70% of preterm births occur at late preterm between 34

Objectives: The aim of this study is to evaluate the results of advanced stage (stage IIIB-IVB) ovarian cancer (OC) patients with intestinal metastasis, and to investigate the factors that affect survival. Material and methods: Patients who underwent cytoreductive surgery (CS) for FIGO stage IIIB-IVB OC with metastasis in the intestinal system, at Tepecik Research and Treatment Hospital between 2008–2014, were analyzed retrospectively. Patients with borderline ovarian tumor; those who had previously undergone radiation therapy and/or hysterectomy and patients having secondary or tertiary cytoreduction were excluded and 49 patients were included and analyzed in this study. Hysterectomy, bilateral salpingo-oopherectomy, pelvic and para-aortic lymph node sampling, resection of bulky lymph nodes and omentectomy were performed. Optimal cytoreduction was accepted as that which left residual tumor ≤ one cm maximum size. Results: The risk factors affecting OS interval were investigated according to Cox’ regression analysis. Optimality of the primary CS (P = 0.008 and HR = 5.202) and cancer stage (P = 0.016 and HR = 6.083) were found to be statistically significant factors. Conclusions: Achieving optimal CS is the most important aim for the general surgeon carrying out an intestinal resection procedure. Although resection procedures are superior in providing the desired optimal results when compared to excision surgery, their higher complication rates and subsequent lower quality of life must be taken into consideration when choosing either resection or excision methods; surgical intervention should always be kept to the minimum possible.

BACKGROUND To evaluate vaginal cuff closure times of a single-port laparoscopic hysterectomy using a newly developed Turkish-made laparoscopic needle holder (TMLNH) with a single-port laparoscopic hysterectomy using a laparoscopic needle holder with pistol handle (LNHPH). METHODS We retrospectively reviewed 68 patients who underwent single-port laparoscopic hysterectomy using a TMLNH (n = 38) or a LNHPH (n = 30). Patients' age, parity, body mass index, mean operating time, mean vaginal cuff suturing time, uterine weight, estimated blood loss, drop of hemoglobin level, return of bowel activity, hospital stay, conversion to multiport access, conversion to laparotomy, and postoperative and intraoperative outcomes were analyzed. RESULTS The TMLNH group had a shorter operative time ( P < .001) and a shorter vaginal cuff suturing time ( P < .001) compared with the LNHPH group during a single-port laparoscopic hysterectomy. There was no difference in intraoperative and postoperative complications. CONCLUSION The TMLNH facilitates vaginal cuff suturing and decreases operation time during a single-port laparoscopic hysterectomy. We proposed that the TMLNH is a promising technique for suturing and vaginal cuff closure in a single-port laparoscopic hysterectomy.

Objective: The aim of this study is to evaluate the effect of body mass index (BMI) before pregnancy on adverse perinatal outcomes. Material and Methods: This retrospective study was conducted with patients who delivered in Tepecik Training and Research Hospital between July 2014 and November 2014. The study population was consisted of singleton pregnancies monitored in our department. Patients with chronic systemic illnesses were excluded from the study. BMI was calculated by dividing body weight (kg) by the height (m) squared. The study population was categorized into four groups according to their BMI before pregnancy as follows: underweight (

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: The purpose of our study was too assess the diagnostic value of red cell distribution width and other inflammatory markers such as white blood cell count and mean platelet volume during the first trimester of gestation for predicting the subsequent development of preeclampsia.Material and Methods: A retrospective study was performed on 137 patients with preeclampsia and 150 normotensive pregnant women. Study group was assessed for presence of preeclampsia and the values of first trimester red cell distribution width, white blood cell count and mean platelet volume. The receiver operator curve was used to evaluate cut-off, sensitivity and specificity values.Results: The optimal cut-off points to predict preeclampsia were a white blood cell count 10200 cells/mm3 or higher with a sensitivity of 75.1% and specificity of 44.1%, a mean platelet volume 8.6fL or lower with a sensitivity of 62.5% and specificity of 64.4% and a red cell distribution width 15.3% or lower with a sensitivity of 31.2% and specificity of 79.7%.Conclusion: Regarding the association between first trimester red cell distribution width, white blood cell count and mean platelet volume, statistical analysis revealed that these markers were weak predictors of preeclampsia, Amaç: Bu çalışmanın amacı ilk trimester eritrosit dağılım genişliği, lökosit sayısı ve ortalama platelet hacmi gibi inflamatuar markerların sonradan gelişen preeklampsiyi belirlemedeki tanısal değerini belirlemektir.Gereç ve Yöntem: Preeklampsili 137 hasta ve 150 normal tansiyonlu hasta retrospektif olarak incelendi. Çalışma grubu preeklampsinin varlığına ve ilk trimester eritrosit dağılım genişliği, lökosit sayısı ve ortalama platelet hacmi açısından değerlendirildi. Eşik değeri, sensitivite ve spefisite değerlerini belirmek için ROC eğrisi kullanıldı.Bulgular: Preeklampsiyi öngörmede lökosit için optimal eşik değeri ≥10200 hücre/mm3, sensitivite %75.1 ve spesifisite %44.1; ortalama platelet hacmi için optimal eşik değeri ≤ 8.6fL, sensitivite %62.5 ve spesifisite %64.4; eritrosit dağılım genişliği için optimal eşikd eğeri %15.3, sensitivite %31.2 ve spesifisite %79.7 olarak belirlendi. Sonuç: İlk trimester eritrosit dağılım genişliği, ortalama platelet hacmi ve lökosit değerleri preeklampsiyi öngörmede zayıf öngörücü belirteçlerdir.

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

Adnexal torsion is an infrequent but significant cause of acute lower abdominal pain in women. While adnexal torsion is generally considered in premenopausal women presenting with acute abdominal pain and a pelvic mass, it is a rare cause of acute abdominal pain during postmenopausal period. The diagnosis of adnexal torsion is often challenging due to nonspesific clinical, laboratory and physical examination findings. Causes of adnexal torsion is also different in premenopausal and postmenopausal women. While a simple functional cyst is often the cause of torsion in premenopausal women, it is more rarely the cause in postmenopausal women. Adnexal torsion is a surgical emergency. The surgery of adnexal torsion is performed either via conventional exploratory laparotomy or laparoscopic surgery. Adnexal torsion in postmenopausal women should be considered not only in the setting of sudden onset pain, but also in long-term abdominal discomfort. In this article, we presented a case with adnexal torsion that rarely cause acute abdominal pain in postmenopausal women. [Cukurova Med J 2016; 41(1.000): 167-170]

[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.

Objective: The aim of this study was to identify the prevalence of anemia and predisposing factors contributing to anemia in pregnant women prior to delivery.Material and Methods: A retrospective case-control study was conducted on 1221 women who delivered between 37 and 42 weeks of gestation between July 2014 and January 2015. Data on the subjects’ socioeconomic and demographic characteristics, pregnancy outcomes, and hemoglobin levels within 24 h prior to delivery were collected. The study population was divided into two groups on the basis of the presence of anemia within 24 h prior to delivery. Anemia was defined as a hemoglobin level of 3 [odds ratio (OR) =1.82, 95% CI=1.24–2.96, p=0.002], illiterate (OR=2.23, 95% CI=1.35–3.45, p=0.001) and primary educational level (OR=2.01, 95% CI=1.28–3.39, p=0.008), household monthly income per person

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

To identify risk factors and etiologies leading to severe primary postpartum hemorrhage (PPH) in women with PPH. Women who experienced PPH within the first 24 h after delivery over a 3-year period were retrospectively evaluated. Patients were divided into two groups on the basis of severe PPH (n = 125) or non-severe PPH (n = 411). Risk factors and etiologies for severe PPH were explored using univariate and multivariate logistic regression analyses. PPH and severe PPH complicated 2.1 and 0.49 % of all deliveries, respectively. Previous cesarean delivery (OR = 3.15, 95 % CI = 1.02–10.3; p = 0.001), prolonged labor (OR = 3.62, 95 % CI = 3.21–4.03; p

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

AimThe aim of this study was to evaluate whether adenomyosis had an effect on myometrial tumor invasion, stage of the disease, and survival in endometrial cancer.MethodsEndometrial cancer patients encountered between 2007 and 2016 were identified from pathology records. Patients who underwent suboptimal surgical or medical treatment or with insufficient clinical or surgical data were excluded. Patients diagnosed as having concurrent adenomyosis constituted the study group. Control group patients were randomly selected in a paired design according to the tumor grades in the study group, and for each tumor grade, 4 times as many as patients were included. Tumor stage, histologic type and grade, myometrial invasion, lymphovascular space invasion, presence and location of the adenomyosis in myometrial wall, distance from endometrial line, tumor in adenomyosis, adjuvant treatment, and relapse were primary outcomes.Age, body mass index, medical comorbidities, and type of operation were also recorded. Univariate and multivariate Cox proportional hazards regression models were performed for overall survival.ResultsOf those 1242 endometrial cancer patients, 80 with concurrent adenomyosis were identified and compared with 320 patients without adenomyosis following a paired selection based on tumor grade. Higher rates of myometrial invasion, lymphovascular space invasion, tumor diameter, and adjuvant treatments were found in the nonadenomyosis group compared with adenomyosis group (P ≤ 0.001). In patients with adenomyosis, rates of early-stage disease and overall survival were significantly higher compared with the control group (P = 0.001 and 0.01, respectively).ConclusionsOur results showed that adenomyosis is significantly associated with lower stage in endometrial cancer that may suggest a possible limiting effect on endometrial cancer spread. In addition, despite similar rates in disease-free survival and endometrial cancer–related death, overall survival rate was significantly higher in the presence of adenomyosis and might be considered as a good prognostic factor for endometrial cancer.

Objective To investigate the clinicopathological characteristics, treatment, survival, and prognosis of endometrial cancer in women aged ≤40 years. Methods Women who underwent surgery for endometrial cancer at a single high-volume cancer center between January 1995 and December 2014 were retrospectively reviewed. Women aged >40, patients with missing data, and those who did not undergo surgical staging were excluded. Univariate and multivariate regression models were used to identify the risk factors for overall survival and progression-free survival. Results A total of 40 patients with endometrial cancer were assessed. The median age at diagnosis was 38 (range, 21–40) years, and most of the uterine tumors found were early-stage (85%), low-grade (67.5%), and endometrioid carcinomas (97.5%). The median serum cancer antigen 125 level was 10.9 IU/mL (range, 3–1284 IU/mL). Optimal cytoreductive surgery was achieved in 35 patients (87.5%). All patients underwent total abdominal hysterectomy, and 97.5% of the patients underwent hysterectomy plus bilateral salpingo-oophorectomy. Among the total group of 40 patients, 21 (52.5%) underwent pelvic and para-aortic lymph node dissection, and 15 (37.5%) underwent only pelvic lymph node dissection. Multivariate analysis confirmed that a cancer antigen 125 level ≥35 was the only independent prognostic factor for both progression-free survival (hazard ratio, 22.997; 95% confidence interval, 1.783–296.536; p = 0.016) and overall survival (hazard ratio, 22.541; 95% confidence interval, 1.75–290.364; p = 0,017). Conclusions Our study demonstrated that a cancer antigen 125 level ≥ 35 is the only independent prognostic factor for both progression-free survival and overall survival in patients aged ≤40 years with endometrial cancer.

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.

Our aim was to evaluate the prevalence of and risk factors for sexual dysfunction in infertile Turkish females.We interviewed 352 infertile and 301 fertile females in the Department of Obstetrics and Gynaecology at Tepecik Training and Research Hospital in Izmir, Turkey. The female sexual function index (FSFI) was used to assess the relationship between infertility and female sexual function.The mean age was similar between the infertile and control groups (29.2±4.3 vs. 28.7±4.0, respectively; p=0.120). The prevalence of sexual dysfunction in infertile females was higher than that in the fertile control group (32.9 vs. 17.2%, p0.001), and the total FSFI score (26.2±2.5 vs. 28.2±1.7) and the score on each domain of sexual function parameters were significantly lower in the infertile group than in the control group (all p0.001). Multivariate logistic regression analysis indicated that a duration of marriage and of infertility ≥3 years (odds ratio [OR] 3.79, 95% confidence interval [CI] 1.75-8.20, p=0.001; OR 3.18, 95% CI 1.54-6.55, p=0.002, respectively) and a history of previous infertility treatment (OR 3.07, 95% CI 1.63-5.76, p0.001) were risk factors for sexual dysfunction in infertile females.Female sexual dysfunction was higher in the infertile group than the fertile control group in this Turkish population. Duration of marriage and of infertility ≥3 years and a history of previous infertility treatment were the primary risk factors for sexual dysfunction in infertile females.

The purpose of this retrospective study was to compare our umbilical stalk elevation (USE) technique with the classic Veress needle (VN) technique in obese patients.The USE technique was performed on 40 patients. One control per case was randomly selected from among those undergoing the classic VN technique using a random number table. In USE technique, a 12 mm skin incision was created at the superior crease of the umbilical fold, and the underlying subcutaneous adipose tissue was bluntly dissected using the tip of a fine clamp until the umbilical stalk was isolated at the inferior and central part of the incision. Next, the umbilical stalk was covered and held by a towel clip, and the abdominal wall was elevated by upward traction. The VN was then inserted nearly perpendicular to the incision and turned toward the pelvis immediately after resistance to the needle had been lost. A post-hoc power analysis was performed.The number of attempts was significantly lower in the USE laparoscopy group than in the classic laparoscopy group (1.2 ± 0.4 vs. 2.1 ± 0.7, respectively; P0.001). The USE technique group had a slightly shorter abdominal entry time than did the classic technique group (328.52 ± 63.71 vs. 434.95 ± 124.10s; P0.001). Six (7.5%) failed insufflations occurred in our study (5 patients in the classic group vs. 1 patient in the USE group (P=0.10).Our novel USE technique can be an effective means of establishing pneumoperitoneum in obese patients undergoing gynecologic laparoscopic procedures.

Aims To evaluate the demographic, laboratory, clinical and imaging findings, surgical procedures and complications in women with final pathology results of pelvic tuberculosis (PT), pelvic echinococcosis (PE) or pelvic actinomycosis (PA) following exploratory surgery for suspicion of ovarian cancer. Methods Among 492 operations from January 2005 through January 2013, we retrospectively reviewed women with PT (n = 15), PE (n = 6), or PA (n = 5) mimicking ovarian cancer seen in an education and research hospital clinic. Results The mean ages of the women with PT, PE and PA were 34.2 ± 9.4, 39.1 ± 11 and 46.3 ± 3.6 years, respectively. The serum CA-125 was elevated in 14 (93%), four (67%) and four (80%) women, respectively. The average CA-125 levels were 242.8 ± 240, 104.3 ± 76.4 and 52.3 ± 18.6 IU/mL, respectively. The most common symptom was lower abdominal pain in 12 (87%), four (67%) and four (80%) women, respectively. The most common ultrasonography and computed tomography/magnetic resonance imaging finding was a pelvic mass in 11 (73%), six (100%) and five (100%) women, respectively. The most common surgical procedure was extensive adhesiolysis in 10 (67%), three (50%) and five (100%) women, respectively. Conclusions Pelvic tuberculosis, echinococcosis and actinomycosis must be included in the differential diagnosis of women suspected to have ovarian cancer with or without ascites and elevated CA-125 levels, especially in those living in endemic countries. During surgical exploration, frozen section analysis is important to avoid unnecessarily prolonged surgical procedures and retroperitoneal lymphadenectomy, which increases morbidity in women with these curable pelvic infectious conditions.

To determine whether urea and creatinine measurements in vaginal fluid could be used to diagnose preterm premature rupture of membranes (PPROM) and predict delivery interval after PPROM.A prospective study conducted with 100 pregnant women with PPROM and 100 healthy pregnant women between 24 + 0 and 36 + 6 gestational weeks. All patients underwent sampling for urea and creatinine concentrations in vaginal fluid at the time of admission. Receiver operator curve analysis was used to determine the cutoff values for the presence of PPROM and delivery within 48 h after PPROM.In multivariate logistic regression analysis, vaginal fluid urea and creatinine levels were found to be significant predictors of PPROM (p 0.001 and p 0.001, respectively) and delivery within 48 h after PPROM (p = 0.012 and p = 0.017, respectively). The optimal cutoff values for the diagnosis of PPROM were6.7 mg/dl for urea and0.12 mg/dl for creatinine. The optimal cutoff values for the detection of delivery within 48 h were19.4 mg/dl for urea and0.23 mg/dl for creatinine.Measurement of urea and creatinine levels in vaginal fluid is a rapid and reliable test for diagnosing and also for predicting delivery interval after PPROM.

Purpose Vulvar cancer is a relatively uncommon type of gynecologic cancer. The aim of this study is to analyze the treatment results and prognostic factors of vulvar cancer. Methods Forty-four vulvar cancer patients treated between 2000 and 2011 at the Department of Radiation Oncology, Ege University Faculty of Medicine, were retrospectively reviewed. External radiotherapy (RT) was applied with 6-18 MV linear accelerators with 1.8 Gy daily fractions with a median total dose of 50.4 Gy (45-59.4 Gy) for postoperative cases and 64.8 Gy (range 54-66 Gy) for definitive cases. Statistical analyses were performed with SPSS 13.0. Results Among 44 patients with a median age of 68 years (range 28-86), 14 (31.8%) were treated with curative and 30 (68.2%) were treated with postoperative RT or radiochemotherapy (RCT). According to International Federation of Gynecology and Obstetrics staging, 11 (25%) had stage IB, 10 (22.7%) had stage II, 6 (13.6%) had stage IIIA, 5 (11.4%) had stage IIIB, and 12 (27.3%) had stage IVA disease. Within a median of 24 months (range 6-135) of follow-up, 11 (27.3%) patients had local recurrence, 8 had regional recurrence, 2 had both local and regional recurrence, and 6 had distant metastases. Five-year locoregional, disease-free, and overall survival rates were 45%, 40%, and 54%, respectively. Older age, poor tumor differentiation, positive surgical margin, and lymphovascular space invasion were found to be important prognostic factors for disease-related outcomes. Conclusions Prognosis of vulvar cancer remains poor even with a multidisciplinary approach. Molecular prognostic factors need to be defined for individualized treatment options to achieve better treatment results.

Objective: The aim of this study is to investigate our management of placental invasion abnormalities. Methods: A retrospective study was conducted on patients admitted to a tertiary referral center with a diagnosis of placental invasion abnormalities between 2011 and 2015. Risk factors and perinatal outcomes associated with placental invasion abnormalities were identified. Results: The overall incidence of placental invasion abnormalities during the 5-year period was 8.3/10000 deliveries, which showed an increasing trend. Ultrasonography and magnetic resonance imaging correctly identified placental invasion abnormality in 36.7% and 68.7% cases, respectively. Majority of patients (55.1%) with adherent placenta were diagnosed at the time of delivery. Of these patients, 22.4% underwent hysterectomy, 83.8% required at least one of the additional surgical procedures and 55% were transfused at least four units of packed red blood cell. Conclusion: Since placental invasion abnormalities are associated with significant morbidity, delivery should be scheduled in a tertiary center with appropriate expertise and facilities. J Clin Exp Invest 2016; 7 (1): 14-18 Key words: placenta accreta, placenta increta, placenta percreta, placental invasion abnormality

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.

Background: Evaluation of the cerebellum and vermis is one of the integral parts of the fetal cranial anomaly screening. Objectives: The aim of this study was to create a nomogram for fetal vermis measurements between 17 and 30 gestational weeks. Patients and Methods: This prospective study was conducted on 171 volunteer pregnant women between March 2013 and December 2014. Measurements of the fetal cerebellar vermis diameters in the sagittal plane were performed by two-dimensional transabdominal ultrasonography. Results: Optimal median planes were obtained in 117 of the cases. Vermian diameters as a function of gestational age were expressed by regression equations and the correlation coefficients were found to be highly statistically significant (P < 0.001). The normal mean (± standard deviation) for each gestational week was also defined. Conclusion: This study presents the normal range of the two-dimensional fetal vermian measurements between 17 and 30 gestational weeks. In the absence of a three-dimensional ultrasonography, two-dimensional ultrasonography could also be used confidently with more time and effort.

A 70-year-old woman presented with the complaint of vulvar itching. Physical examination revealed an ulcerative lesion (2.5 cm in diameter) in the left labium minus with widely spread white areas m...

Objective:To determine the impact of the chorion villus sampling (CVS) technique on adverse perinatal outcomes.Methods:In this case-control study, 412 women who underwent CVS at 11–14 weeks of gestation and 231 women who did not undergo any invasive procedure were retrospectively evaluated. The women in the CVS group were further divided into two groups according to the use of single-needle technique (n=148) vs. double-needle technique (n=264). The adverse outcomes were compared between controls and the two CVS groups, and regression analysis was used to determine the significance of independent contribution.Results:The rate of preeclampsia for the control group was 2.2%, for the double-needle group was 3% and for the single-needle group was 8.1%. CVS with single-needle technique was found to be an independent and statistically significant risk factor for preeclampsia [odds ratio (OR)=2.1, 95% confidence interval (CI); 1.4–2.7, P=0.008].Conclusion:The risk of preeclampsia after CVS appears to be increased with single-needle technique compared with double-needle technique.

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.

Objective: Malignant ovarian immature teratomas should be considered in differantial diagnosis of adnexal masses detected during pregnancy. This paper is reviewing the clinicopathologic and prognostic characteristics and therapeutic options for treatment of immature teratoma during pregnancy in the context of a case of pregnancy complicated with immature teratoma. Materials and Methods: A PubMed and Scopus search was conducted with the key words ‘ovarian immature teratoma’ and ‘pregnancy’ and all related published articles assessed. A total of 24 cases, included our case were included in the study. Age at presentation, clinical findings, histologic grades and stages, treatment options and the prognosis of both mothers and fetuses was analysed. Results: The median age of the patients in the published reports was 27.0± 4.2 ( range 21-36) years. The main presenting symptom was adnexal mass followed by abdominal or pelvic pain. Chemotherapy was added to the surgical treatment in 68.2% of the patients; a Bleomycin, Etoposide and Cisplatin protocol was the preferred treatment option. Prognosis for both mother and fetus were good. Conclusion: Immature teratoma during pregnancy should be treated immediately with surgery ± chemotherapy especially in high grade patients.

[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.

To examine the effect of antenatal betamethasone administration on Doppler parameters of fetal and uteroplacental circulation.Seventy-six singleton pregnancies that received betamethasone therapy were prospectively evaluated. Doppler measurements of pulsatility indices (PI) in fetal umbilical artery (UA), middle cerebral artery (MCA), ductus venosus and maternal uterine arteries were performed before (0 h) and 24, 48, 72 and 96 h after the first dose of betamethasone. Women with positive end-diastolic flow (EDF) in UA and those with absent or reversed EDF in UA were evaluated separately.Fifty-two women with EDF in UA and 24 women with absent or reversed flow in UA were examined. Administration of maternal betamethasone was followed by a significant decrease in the PI of the MCA at 24 h (PAntenatal administration of betamethasone is associated with significant but transient changes in the fetal blood flow. Hence, intensive surveillance of fetuses with Doppler ultrasonography is warranted following betamethasone therapy.

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.

OBJECTIVES Our aim was to evaluate the size of the fetal thymus by sonography in pregnancies with intrauterine growth restriction (IUGR) and to search for a possible relationship between a small fetal thymus and adverse perinatal outcomes. METHODS The transverse diameter of the fetal thymus was prospectively measured in 150 healthy and 143 IUGR fetuses between 24 and 40 weeks' gestation. The fetuses with IUGR were further divided according to normal or abnormal Doppler assessment of the umbilical and middle cerebral arteries and ductus venosus. Measurements were compared with reference ranges from controls. To determine which perinatal outcomes were independently associated with a small fetal thymus, a multivariate logistic regression analysis was performed. RESULTS Thymus size was significantly lower in IUGR fetuses compared to controls (P < .05). Among IUGR fetuses, thymus size was significantly smaller in IUGR fetuses with abnormal Doppler flow compared to normal flow (P < .05). A small thymus in IUGR fetuses was independently associated with early delivery (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.05-1.49; P= .023), respiratory distress syndrome (OR, 1.36; 95% CI, 1.09-1.78; P= .005), early neonatal sepsis (OR, 1.65; 95% CI, 1.11-2.42; P= .001), and a longer stay in the neonatal intensive care unit (OR, 1.33; 95% CI, 1.08-1.71; P = .017). CONCLUSIONS Intrauterine growth restriction is associated with fetal thymic involution, and a small fetal thymus is an early indicator of adverse perinatal outcomes in pregnancies complicated by IUGR.

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.

WOS: 000357874900016, PubMed ID: 25622588, Purpose The purpose of this study is to evaluate the prognostic role of preoperative neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) and the need for para-aortic lymphadectomy in patients with primary fallopian tube carcinoma (PFTC). Materials and Methods Ninety-one patients with a diagnosis of PFTC were identified through the gynecologic oncology service database of six academic centers. Clinicopathological, surgical, and complete blood count data were collected. Results In univariate analysis, advanced stage, suboptimal surgery, and NLR > 2.7 were significant prognostic factors for progression-free survival, whereas in multivariate analysis, only advanced stage and suboptimal surgery were significant. In addition, in univariate analysis, cancer antigen 125 >= 35 U/mL, ascites, advanced stage, suboptimal surgery, NLR > 2.7, PLR > 233.3, platelet count >= 400,000 cells/mm(3), staging type, and histological subtype were significant prognostic factors for overall survival (OS); however, in multivariate analysis, only advanced stage, suboptimal surgery, NLR > 2.7, and staging type were significant. Inclusion of pelvic and para-aortic lymphadenectomy in surgery showed significant association with longer OS, with a mean and median OS of 42.0 months and 35.5 months (range, 22 to 78 months), respectively, vs. 33.5 months and 27.5 months (range, 14 to 76 months), respectively, for patients who underwent surgery without para-aortic lymphadenectomy (hazard ratio, 3.1; 95% confidence interval, 1.4 to 5.7; p = 0.002). Conclusion NLR (in both univariate and multivariate analysis) and PLR (only in univariate analysis) were prognostic factors in PFTC. NLR and PLR are inexpensive and easy tests to perform. In addition, patients with PFTC who underwent bilateral pelvic and para-aortic lymphadenectomy had longer OS.