Cesarean Scar Endometriosis; A Case Report
Endometriosis is defined as the ectopic settlement of the endometrial stroma and the glands outside the uterine cavity. Scar endometriosis is a rare form of this disease with increasing incidence. The prevalent complaints are menstruation related nodule, pain and sometimes bleeding, in the area of surgical incision. The definitive therapy is surgery which requires attention to some points. In this case report, we examined the case of painful tumor emerging 22 months after cesarean section in the site of surgical incision, with an emphasis on the important points of surgery.

INTRODUCTION: The purpose of the present this study is to evaluate β-human chorionic gonadotrophin(β-hCG) and creatinine levels in the vaginal fluid regarding to diagnosis of premature rupture of membranes (PROM).
METHODS: This study was conducted on 150 pregnant women in the third trimester (28–40 weeks). The patients were grouped as: (1)PPROM group (75 cases) and (2) intact membranes as control group (75cases). Three milliliters of sterile normal saline was inserted into the posterior fornix of the vagina and then vaginal fluid was aspirated.Creatinine and β-hcg levels in the vaginal fluid was measured β-hcg and creatinine levels were compared between the two groups.
RESULTS: The mean vaginal fluid level in groups 1 and 2 were 0,60 ±0,72(0,37) and 0,22 ±0,11(0,2) for creatinine and β-Hcg was positive in 411,69±605,65(146) and 12,71±24,63(3,9) respectively. There was a statistically significant difference regarding to mean creatinine and β-hCG levels between two groups (P value < 0.001). Sensitivity,specificity, PPV, NPV and accuracy were all 66,67%,96%,%94,3,74,3% and 81,3% for creatinine and 94,6%,82,6%,84,52%,93,94% and 88,67% for β-hCG in detecting PROM with a cut‐of value of 0.21 mg/dl for creatinine and 16 mIU/ml for β-hCG.
DISCUSSION AND CONCLUSION: Measuring of β -hcg level in vaginal fluid is accurate, cheap and simple methods in the diagnosis of PROM. Also, measuring of Creatinine level is a simple and accurate method with a lower sensitivity and accuracy than for β–hcg.

INTRODUCTION: Endometrial carcinomas are divided into two groups roughly: Endometrioid (Type I) and NVon-endometrioid (Type II). The majority of the endometrial carcinomas are of endometrioid type and, this type of carcinoma is associated with hyperplasia which is formed due to unopposed estrogen.In this study, our purpose is to reveal the expression status of the PTEN, MLH1, ARID1A and β-catenin, biomarkers in all types of endometrial hyperplasia (EH) and endometrioid endometrial carcinoma (EC).
METHODS: We conducted a retrospective study with 202 cases including 82 EC cases, 71 simple EH cases without atypia, 16 complex EH cases without atypia, 9 simple atypical EH cases, 24 complex atypical EH cases which were diagnosed at Istanbul Civilization University Göztepe Training and Research Hospital. 10 normal endometrial tissues were used for the purpose of control.
RESULTS: In our study, loss of PTEN ratio was 61%, loss of ARID1A ratio was 52,4%, loss of MLH1 ratio was 40,2% in patients with EC. These ratios were 87,5%, 41,7%, 20,8%, respectively in patients with atypical complex EH and 12,7%; 4,2%; 1,4% in patients with simple EH without atypia.
DISCUSSION AND CONCLUSION: In the light of these findings it has been demonstrated that PTEN, ARID1A and MLH1 have a role in the transition from simple EH to atypical complex EH, and also MLH1 has a role in the transition from aytpical complex EH to EC.

Antenatal dönemde ultasonografinin yoğun kullanımı, intrauterin hayatta fetal anatominin ayrıntılı olarak değerlendirilebilmesi, fetal over
kistlerinin tanı insidansının artmasına neden olmuştur. Bu durum, fetal/neonatal over kistlerinin tespiti, takibi ve tedavisinde yakın perinatal
ve postnatal “sonografik” izlemin önemini vurgulamaktadır. Çalışmamızda, antenatal izleminde saptanan fetal over kistinin, takip döneminde
spontan regresyonu ve postnatal dönemde de sonografik olarak normal değerlendirilen ultrasonografi (USG) bulguları tartışılmıştır.

Intensive use of ultrasonography in the antenatal period has led to the detailed evaluation of fetal anatomy and increment of incidence of the
fetal ovarian cysts diagnosis. This emphasizes the importance of close perinatal and postnatal “sonographic” monitoring for the detection, follow-up and treatment of fetal/ neonatal ovarian cysts. In our study; spontaneous regression in the follow-up period and ultrasonography (USG) findings that are treated as normal in postnatal period of a fetal ovarian cyst detected in antenatal monitoring are discussed

GİRİŞ ve AMAÇ: Asemptomatik postmenopozal kadınlarda, transvajinal ultrasonografiografi (TV-USG) ile endometrial kalınlık değerlendirmesinin, endometrium kanserinin erken tanısındaki etkinliğini ve endometrial kalınlıkla endometrium kanseri risk faktörleri arasındaki ilişkiyi retrospektif olarak araştırmayı amaçladık,
YÖNTEM ve GEREÇLER: S,B, İstanbul Eğitim ve Araştırma Hastanesi Menopoz Polikliniği’ne Haziran 2008- Ağustos 2009 tarihleri arasında rutin kontroller için başvuran asemptomatik postmenopozal kadınların, bilgisayar ve dosya kayıtları incelenerek retrospektif olarak yapıldı,
BULGULAR: Endometrial kalınlığı >5 mm bulunan 54 (%13,5) hastaya endometrial örnekleme yapıldı, Histopatolojik inceleme sonucunda, 1
vakada atipik kompleks hiperplazi (%0,3), 14 vakada endometrial polip (% 3,5), 7 vakada proliferasyon bulguları (% 1,8) ve 32 vakada (% 8) normal histolojik bulgular saptandı, Endometrial kalınlığı ≥ 5 mm olan postmenopozal hastalarda; diabetes mellitus, hipertansiyon ve yüksek vücut kitle indeksi istatistiksel olarak anlamlı derecede fazla bulundu, Daha önce hormon replasman tedavisi
alanlar ve sigara kullanan vakalarda endometrial kalınlık diğerlerinden istatistiksel olarak anlamlı derecede ince bulundu,
TARTIŞMA ve SONUÇ: Asemptomatik postmenopozal kadınlarda rutin TV-USG, kanser tarama yöntemi olarak anlamlı bulunmasa da postmenopozal riskli grubun tanımlanması ve takibinde invazif olmayan, tanıya yardımcı bir yöntemdir,

INTRODUCTION: We aimed to analyze the effectiveness of endometrial thickness evaluation by transvaginal ultrasonography in endometrial cancer diagnosis, and the relation between endometrial cancer risks and thickness.
METHODS: We investigated postmenopausal women who vizited our menopause clinic in between June 2008 and August 2009
RESULTS: We performed endometrial sampling to 54 patients whose endometrial thickness were over 5 mm. After histopathological examination
we found 1 patient had atypic endometrial hyperplasia, 14 patient had endometrial polyps, 7 patients had findings of endometrial proliferation and 32 patients had normal histological findings. Postmenopausal patients having endometrial thickness over 5 mm were found to have statistically higher incedence of diabetes and hypertension with increased body mass index. Endometrial thickness were found statistically thinner in patients who smoke and had previous hormonal treatment.
DISCUSSION AND CONCLUSION: Although routine transvaginal ultrasound examination in asymptomatic postmenopausal women were not found as significant in screening of cancer, it can help in prediction and definition of risk group as an noninvasive method.

INTRODUCTION: The present study aimed to assess the results of pregnant women who have been applied a 50-gram oral glucose tolerance test (OGTT) in the first and second trimesters and investigate this method's role in the diagnosis of gestational diabetes mellitus
METHODS: This retrospective study was performed on 153 pregnant women who were admitted to our hospital's antenatal clinics between March 2011 and August 2011. 50-gram OGTT was applied to the same pregnant women both in the 1st trimester (between 8th and 14th weeks) and second trimester (between 24th and 28th weeks); values of the test results were then compared.
RESULTS: GDM, diagnosed in 4.5% (7) in the first trimester (between 8th and 14th weeks) and 6.5% (10) second trimester, was detected in 11% (17) of 153 pregnant women in the present study. GDM, diagnosed in 41.2%(7 patients) in the first trimester and 58.8%(10 patients) second trimester. The mean fasting blood glucose level was 96 mg/dl in the GDM group and 83 mg/dl in the non-GDM group, with a statistically significant difference, which existed (p <0.05). The mean 50-gram OGTT value was 170 mg/dl in pregnant women diagnosed with GDM in the first trimester, and it was 140 mg/dl in those diagnosed in the second trimester, with this difference was considered statistically different (p <0.05).
DISCUSSION AND CONCLUSION: The half of patients was diagnosed with GDM in the early period of pregnancy. In the present study, 41.2% of cases were diagnosed in the 1st trimester and 58.8% in the 2nd trimester. In general, the patients diagnosed in the 1st trimester were those being under risk in terms of gestational diabetes mellitus. According to the present study, it is recommended that the pregnant women should be scanned for gestational diabetes mellitus in the early period.

Breast milk is the most effective nutrient to support newborn’s growing. Besides its positive effects on baby’s development and mother’s health, breastfeeding is also agreed to be a means of communication among mother, baby and family. In recent years, World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) suggested that babies shoul
feed from breast in the first 6 months and they have emphasized that feeding must be completed fully. However, there are factors which prevent starting breastfeeding in early periods and maintaining it. These factors such as failure to breastfeed, type of delivery, condition of newborn and nipple fissures could originate from the mother or the newborn, or there could be other factors such as working life,
failure to provide skin contact, drug use, alcohol and tobacco use, sleep, father’s role, indifference of health personnel, diabetes, tuberculosis, HIV or breast cancer. In this review, studies regarding the factors that affect the start of successful breastfeeding and
its maintenance will be analyzed. The leadership, caretaking and educative acts of the nurses in maintenance and support of breastfeeding will be examined in line with the literature.

GİRİŞ ve AMAÇ: Surfaktan preparatları solunum fonksiyonlarını iyileştirerek respiratuar distres sendromuna bağlı komplikasyon ve ölüm oranlarını azaltmaktadırlar. Bu çalışmada poractant alfa ve beractant surfaktanın çok düşük doğum ağırlıklı yenidoğanlarda hayatın ilk haftasındaki ventilatör ve kan gazı parametreleri ve klinik seyir üzerindeki etkisi retrospektif olarak değerlendirildi.
YÖNTEM ve GEREÇLER: Yetmiş bir olgudan ilk grubu poractant alfa (Curosurf®) (200 mg/kg); diğer grubu ise beractant (Survanta®) (100 mg/kg) alanlar oluşturdu. İlk dozdan 6 saat sonra FiO2 ≥40 olacak şekilde oksijen desteği gerekenlere ek doz surfaktan (100 mg/kg) uygulandı.
BULGULAR: Grup 1’de (n: 33) 22 yenidoğan bir doz, 9 yenidoğan iki doz, 2 yenidoğan 3 doz surfaktan alırken, Grup 2’de (n: 38) 24 yenidoğan bir doz, 10 yenidoğan iki doz, 3 yenidoğan üç doz surfaktan almışdı. Grup 1’deki yenidoğanlar Grup 2’deki yenidoğanlara göre daha düşük tepe inspiratuar basınca ve FiO2’ye ihtiyaç göstermişti ve CO2 değerleri daha düşük seyretmişti. Mekanik ventilasyon ve toplam oksijen desteği süresi Grup 1’de daha azdı. Grup 1’de ölüm yüksek iken (%51-%36), intraventriküler kanama, bronkopulmoner displazi ve hastane yatış süresi daha kısaydı. Ancak tüm bu farklılıklar istatistiksel olarak anlamlı değildi.
TARTIŞMA ve SONUÇ: Her iki doğal surfaktan preparatı respiratuar distres sendromu tedavisinde kullanılabilir

INTRODUCTION: Various surfactants are used to improve lung function, and to decrease the morbidity and mortality associated with respiratory distress syndrome. We compared the effects of poractant alfa and beractant on gas exchange, ventilator requirements, and outcome in infants with respiratory distress syndrome.
METHODS: Seventy-one neonates were investigated. Group 1 received proctant alpha (Curosurf®) (200 mg/kg); whereas group 2 received beractant (Survanta ®)(100 mg/kg). Neonates who required FiO2 ≥40 after 6 hours received additional doses of surfactant (each of 100 mg/kg).
RESULTS: In group 2 (n: 38), 24 neonates received single dose, 10 received two doses, and 3 received three doses. One baby received four doses. In group 1, 22 neonates received one dose, 9 neonates received two doses, and 2 neonates received three doses. Infants
in group 1 (n: 33) required a lower peak inspiratory pressure and FiO2, and had lower CO2 levels than infants in group 2. Duration of mechanical ventilation and total oxygen therapy was lower in group 1. The incidences of intraventricular hemorrhage, bronchopulmonary dysplasia, and duration of hospitalization were lower in group 1 despite higher incidence of mortality (51% vs 36%). However, all these differences did not reach statistical significance.
DISCUSSION AND CONCLUSION: Both natural surfactant preparations can be used for the treatment of respiratory distress syndrome

GİRİŞ ve AMAÇ: Bu retrospektif kohort çalışmasının amacı; total prolapsus olgularında, LeFort operasyonu ile birlikte uygulanan transobturator tap TOT prosedürünün cerrahi sonuçlarının ve komplikasyonlarının değerlendirilmesidir.
YÖNTEM ve GEREÇLER: Bu retrospektif çalışmaya; 2011-2013 yılları arasında Baden-Walker evre III-IV pelvik organ prolapsusu olan ve stres üriner inkontinans (SÜİ), mikst üriner inkontinans (MÜİ) veya “gizli SÜİ” tanısı alan, 70 yaş üstü ve cinsel yaşam beklentisi olmayan 14 hasta dahil edildi. Tüm hastalara LeFort ve TOT operasyonu ile birlikte yüksek perineorafi operasyonu rutin olarak uygulanmıştır. Postoperatif tüm olgular 2. hafta, 6. hafta ve 3. ayda kontrollere çağrılarak ürojinekolojik muayeneleri yapıldı, operasyon başarısı, üriner disfonksiyon ve perioperatif komplikasyonlar kayıt edilerek değerlendirildi.
BULGULAR: Hastaların ortalama yaşı 77,3±4,5 (72-87) ve paritesi 7,1±2,4 (4-10) olarak bulunmuştur. Çalışma grubunda; 8 hastada (%57) MÜİ ve 2 hastada (%14) SÜİ bulguları mevcuttu. Dört (%29) hasta ise inkontinans şikayeti olmamasına rağmen prolapsusları redükte edildiğinde öksürük-stres testinde inkontinan (“gizli” SÜİ) olarak bulunmuştur. Hastalarda tekrar cerrahi girişim gerektiren veya uzun süreli aralıklı kateterizasyon gerektiren üriner retansiyon izlenmemiştir. Hastaların postoperatif dönem takiplerinde sadece 1 (%7) hastada de novo urge inkontinans izlenmiştir ve antikolinerjiklerle tedavi edilmiştir. Hastaların takiplerinde prolapsus tekrarı veya de novo SÜİ izlenmemiştir.
TARTIŞMA ve SONUÇ: Pelvik organ prolapsusu olan ve cinsel yaşam beklentisi olmayan yaşlı kadınlarda; LeFort ve TOT operasyonun yüksek perineorafi ile birlikte uygulanması oldukça etkin, güvenilir ve minimal invazif bir seçenektir. “Gizli” SÜİ olguların tespiti ve cerrahi yönetimi ile profilaktik TOT operasyonun bu olgulardaki yeri hakkında prospektif çalışmalara ihtiyaç vardır.

INTRODUCTION: The aim of this retrospective cohort study is to evaluate the surgical outcomes and complications of LeFort operation with concomitant transobturator tape TOT procedure in totally prolapsed cases.
METHODS: In this retrospective study; which is conducted between the dates 2011 and 2013, sexually-inactive fourteen patients, over the age of 70, who had Baden-Walker grade III-IV pelvic organ prolapse (POP) and diagnosed as stress urinary incontinence (SUI), mixt urinary incontinence (MUI) or “occult SUI” were enrolled. All patients had undergone LeFort and TOT procedure with high perineoraphy. In follow-up period; all cases were evaluated at the 2nd week, 6th week and 3rd month by urogynecological examination and surgical outcomes; urinary dysfunction and perioperative complications were recorded.
RESULTS: The median age was 77,3±4,5 years (range 72The median age was 77,3±4,5 years (range 72-87) and parity was 7,1±2,4 (range 4-10). In study group; 8 patients (57%) had complaint of MUI and 2 patients (14%) had complaint of SUI. Four patients (29%) without a complaint of stress incontinence, demonstrated leakage (“occult” SUI) with cough-stress examination during prolapse reduction. There was no urinary retention requiring chronic catheterization or surgical management.. There was only 1 (7%) postoperative de novo urgency in follow-up period and it was managed by anticholinergics. There was no postoperative de novo SUI or recurrence of prolapse.
DISCUSSION AND CONCLUSION: In older women who had pelvic organ prolapse and sexually-inactive; LeFort and concurrent TOT procedure with high perineoraphy, is highly effective, safety and minimally-invasive option. There is need for prospective studies in the detection and surgical management of “occult” SUI cases and the role of prophylactic TOT operation in these cases.