INTRODUCTION: Sleep disorders are one of the most common disorders in women in the climacteric period.The emotional state, the daily life and the functioning of the women in this period are negativelyaffected.Despite the numerous studies on sleep problems in women in the menopausal period, the number of studies investigating the difference between menopausal turnover, menopausal and post-menopausal periods, which constitute the climacteric period, is limited.In this study, women in the climacteric period were divided into three groups as premenopausal, menopausal and postmenopausal, then sleep quality, severity of insomnia, excessive daytime sleepiness, sleep apnea risk, and accompanying anxiety and depression findings were assessed.The aim of this study was to determine whether there is any difference according to these data between the groups.
METHODS: Totally 152 women who were in the age range of 45-59 years and weredetermined in the climacteric period, also without hormone replacement therapy, any surgical menopause history, have the education level and mental status that can fill the questionnaire and the scale given for evaluationwere volunteered to fill in the informed consent form and participated to the study.The cases were divided into three groups as premenopausal, menopausal and postmenopausal.The Pittsburgh Sleep Quality Scale (PSQS), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Berlin Questionnaire (BQ), Beck Anxiety (BA) and Beck Depression (BD) scales were used in all cases.It was aimed to determine whether there is any difference between the three groups in terms of sleep quality, insomnia severity, daytime sleepiness and accompanying anxiety and depression.
RESULTS: A large proportion of women in all groups had poor sleep quality, a significant number of daytime sleepiness and clinical insomnia, and depression and anxiety in about two thirds.Although sleep quality was found worse in the postmenopausal period comparing to other climacteric periods, there was no significant difference between the groups. Amoderate increase in daytime sleepiness was most commonin women in postmenopausal period as well as subthreshold insomnia,moderate or severe clinical insomnia. Premenopausal, menopausal and postmenopausal women were not significantly different in terms of OSAS risk.
DISCUSSION AND CONCLUSION: Sleep disorders and depressive symptoms increase in climacteric women, especially in postmenopausalperiod. Women in the postmenopausal period should be given priority in terms of sleep problems and depressive mood,effective treatment of sleep disorders and accompanying depression should be planned and implemented without delay in these women.

INTRODUCTION: Atopic dermatitis (AD) is the most common dermatologic disease of infancy. In this case, food allergy is usually responsible. In our study, we wanted to examine the relationship between AD and eosinophil and IgE.
METHODS: Our work was done in 128 (64 AD and 64 Control) children aged between 2-12 months. Our work was done in retrospective file scanning. Complete blood count, total IgE level, food allergy skin tests and specific immunoglobulin E tests were evaluated in patients with AD. For the control group, full blood count results were obtained from the same number of patients in the same age range.
RESULTS: A positive correlation was found between the presence of eosinophilia and allergy test positivity in AD group (p <0.01). Twenty-two of 64 patients with atopic dermatitis were found to have positive allergy skin tests and / or specific IgE values.
There were 10 cases of milk allergies among patients who had positive allergy tests. There were milk and egg allergy associations in 7 of these patients. Egg allergy was found in 5 of these patients. IgE levels (p <0.001), eosinophil percentage (p = 0.001) and absolute eosinophil counts (p = 0.005) were higher in allergic skin test positive patients in the atopic dermatitis group.
DISCUSSION AND CONCLUSION: Eosinophil and IgE elevation in those with AD clinical manifestations may be a marker that can be used for predicting positivity in food allergy tests. The first choice in the dietary elimination diet for AD should be milk. If there is not enough clinical improvement with the milk diet; milk should be tried to be confirmed with the egg diet.

INTRODUCTION: To analyse the cytology and pathology results of HPV 16 or HPV 18 positive patients referred to our clinic as part of the national screening program.
METHODS: Data of patients with HPV 16 or HPV 18 positive who were referred to our Gynecologic Oncology Clinic between January 2014 and May 2017 were retrospectively reviewed. All patients underwent colposcopy. The highest grade lesion obtained from biopsy, endocervical curettage or excisional procedure results was accepted as the final pathology.
RESULTS: The mean age of the 720 patients included in the study was 41.96 ± 8.67, and the parity average was 2.39 ± 1.58. One hundred and thirty-two of them (18.3%) were menopausal, and 588 (81.7%) were premenopausal. The smear results of 138 patients could not be reached. Reached smear results were; normal or inflammation in 39 patients (55.3%), insufficient in 36 patients (5%), ASCUS in 91 patients (12.6%), LGSIL in 36 patients (5%), ASC-H in 11 patients (1.5%), HGSIL in 4 patients (0.6%), and AGC in 6 patients (0.8%). Distribution of abnormal smear results that cause CIN 2+ lesion in the final pathology were; ASCUS: 23 (25.3%), LGSIL: 13 (36.1%), ASC-H: 6 (54.5%), HGSIL: 4 (100%) and AGC: 2 (33.3%). More CIN 2+ lesions were detected in cases with abnormal cytology than those with normal cytology who are positive for HPV 16 or 18, and this difference was statistically significant (48 (32.4%) vs 60 (15.1%), OR: 2.7 ), p<0.01). The smear test was reported negative in 60 (55.6%) patients with CIN 2+, and three patients (75%) of the invasive cancers.
DISCUSSION AND CONCLUSION: Our results support the idea of performing colposcopic evaluation even if the cytology is normal in HPV 16 or 18 positive patients.

INTRODUCTION: Metabolic disorders can increase the risk of endometrial diseases and endometrial cancer. Patients with metabolic syndrome are at risk for endometrial pathologies. Advising routine gynecological examination even to the patients with metabolic syndrome having no gynecological complaints may be helpful in early diagnosis.
METHODS: 120 patients diagnosed with metabolic syndrome in the Internal Diseases Outpatient Clinic were examined for endometrial diseases in the Gynecology Clinic. Data were analyzed using SPSS 16 statistical software, and Chi-square test was performed. p<0.05 was considered as statistically significant.
RESULTS: 36 patients had undergone a diagnostic curettage. There was no endometrial cancer in any patient. The rate of endometrial hyperplasia without atypia was found significantly increased in the patient group with abnormal uterine bleeding when compared to the patient group with menopause having postmenopausal bleeding and an increased endometrial thickness (p=0.001).
DISCUSSION AND CONCLUSION: Endometrial pathology was diagnosed in 15% of the patients with metabolic syndrome. It was concluded that the question of whether routine gynecological examination of metabolic syndrome patients is required in clinical practice could be answered by further studies including larger patient groups.

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INTRODUCTION: Hypogastric artery ligation (HAL) is a life-saving procedure for severe postpartum haemorrhage (PPH). It should be performed as fast as possible when needed. In this study, a single surgeon’s experience in HAL for controlling PPH was presented.
METHODS: Cases in whom HAL performed in emergency setting by the same surgeon in between 2015 and 2018 were included in this retrospective cohort study. The technnique of the procedure was the same for all cases. Data were extracted from hospital’s records.
RESULTS: A total of 6 patients were included into the analysis. Indications for HAL were as follows: uterine atony in 3 (50%) cases, placenta previa in 2 (33.3%) cases and ablatio placenta in one case (16.7%). There were no intraoperative complication. The success rate of HAL was 83.3%, as one of the 6 patient underwent re-laparotomy. Within a median follow-up time of 13 months, only one patient attempted to concieve and succeeded.
DISCUSSION AND CONCLUSION: HAL is an effective procedure for the management of PPH. Entering to the retroperitonneum directly over the hypogastric artery may fasten the procedure.

INTRODUCTION: In this pilot study, it was aimed to demonstrate the efficacy of double intrauterine insemination (IUI) in the controlled ovarian hyperstimulation (COH) cycles with multiple follicular development.
METHODS: Thirty-eight patients involved in IUI program, aged 20-35 years, underwent human chorionic gonadotropin (hCG) procedure in assisted reproductive techniques (ART), between March 2017 and March 2018, in the Gynecology and Obstetrics Clinics of a tertiary center. Thereafter, double IUI was performed at 18th and 36th hours; thirty-two patients, aged 22-35 years, received hCG, and a single IUI was performed at the 36th hour. Demographic characteristics of 70 patients were recorded from the hospital records; age, weight, height, previous history of pregnancy (gravida, parity), smoking habits, hormonal levels at the 3rd day of their menstrual cycle [follicle stimulating hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2)], prolactin, anti-Mullerian hormone (AMH), antral follicle count (AFC), type and duration of infertility.
RESULTS: A total of 70 infertile patients were included in the study between April 2017 and May 2018. Of those, 32 (45.7%) were in the single IUI group and 38 (54.2%) were in the double IUI group. When the median values of the dominant follicle number> 15 mm on the HCG day of the women in the second group were examined, they were found as 2.0 (1-3) and 2.0 (1.0-3.0) in the study and control group, respectively (p = 0.139).When the clinical pregnancy rates (%) of the women in the two groups were examined, they were found as 21.05% and 18.75% in the study and control group, respectively (p = 0.812).
DISCUSSION AND CONCLUSION: In the present study, it was observed that there was no significant difference between the clinical pregnancy rates of single and double IUI procedure during intrauterine insemination after ovulation induction with COH. Therefore, by considering the treatment costs, it is necessary to share the results with the patient in the cases of intrauterine insemination.

INTRODUCTION: Preoperative evaluation of adnexial masses is crucial for decision processes of preoperative preparation. It is also directly related to prognosis. In this study, we aimed to evaluate the performances of versions of Risk of Malignancy Index (RMI) and Assesment of Different Neoplasias in the Adnexa (ADNEX) model for diagnosis of malignancy.
METHODS: We retrospectively evaluated patients who applied with adnexial mass to our tertiary gynecolocial center between 1st of September, 2014 and 30th of July, 2016. Of 206 patients, 15 were excluded due to missing CA 125 and ultrasonograpic measurement and recurrent ovarian cancer diagnoses. 191 patients were included into the study. Demographic, ultrasonographic data and CA-125 values were all recorded and RMI I to IV scores and malignancy risk percents for ADNEX model were calculated. Three cut-off values for malignancy probabilites (5%, 10%, and 15%) were applied for ADNEX model. Results were compared to postoperative pathological diagnoses.
RESULTS: Sensitivity (SEN), specifity (SPE), positive predictive value (PPV), and negative predictive value (NPV) were 66%, 88.4%, 68.6%, and 87.1% for RMI I, 75.5%, 78.3%, 57.1%, and 89.3% for RMI II, 66%, 88.4%, 68.6%, and 87.1% for RMI III, and 67.9%, 90.6%, 73.5 and 88% for RMI IV. For ADNEX model, SEN, SPE, PPV, and NPV values were 98.1%, 46.4%, 41.3%, and 98.5% for cut-off value of 5%, 94.3%, 63%, 49,5%, and 96.7% for cut-off value of 10%, and 94.3%, 72.5%, 56.8%, and 97.1% for cut-off value of 15%.
DISCUSSION AND CONCLUSION: Results of versions of RMI were similar to those in the literature in terms of specifity, but lower in terms of sensitivity. Sensitivity and specifity values for ADNEX model were similar to those of the literature. Although sensitivity of ADNEX model were higher than those of versions of RMI, specifity values were lower. Future prospective studies could be performed to evaluate diagnostic perfomances of those indices and to develop newer indices in terms of better SEN and SPE.

INTRODUCTION: Pelvik egzenterasyon rekürren jinekolojik kanserlerde kür veya daha uzun sağkalım amacıyla uygulanan ultraradikal bir cerrahidir. Bu çalışmanın birincil amacı kliniğimizce pelvik egzenterasyon operasyonu uygulanan hastaların klinik özelliklerini, operatif ve postoperatif komplikasyon türlerini ve sıklığını tanımlamaktır. Kısa dönem ortalama sağkalım ve hastalıksız sağkalım rakamlarını belirlemek çalışmanın ikincil amacıdır.
METHODS: Kliniğimizde 2013-2017 yılları arasında Pelvik egzenterasyon yöntemi ile opere edilen 14 nüks serviks, endometriyum, vagina kanserli hasta retrospektif olarak incelenmiştir.
RESULTS: Hastaların 11 tanesi rekürren serviks kanseri 2 tanesi rekürren endometriyum kanseri 1 tanesi de rekürren vagina kanseri idi. Opere edilen hastaların ortanca yaş 52.5 olarak hesaplanmıştır. Hastaların çoğunluğu (%57) daha önce opere edilmeyen kemoradyoterapi ile tedavi edilen hastalardan oluşmakta idi. En sık uygulanan pelvik egzenterasyon tipi total pelvik egzenterasyon olup kraniokaudal sınıflamaya göre supralevator (Tip 1) egzenterasyondur. En sık postoperatif komplikasyon enfeksiyon, ortanca hastanede yatış süresi 17.5 gün hesaplanmıştır. Postoperatif cerrahi ihtiyacı olan hasta sayısı 2 (%14.2) olarak bulunmuştur. 2 yıllık ortalama sağkalım %57; 2 yıllık hastalıksız sağkalım %35 olarak saptanmıştır.
DISCUSSION AND CONCLUSION: Pelvik egzenterasyon operasyonunun yüksek komplikasyon rakamları ve hastane kalış süreleri olmak ile beraber jinekolojik tümörlerin rekürrens geliştiren bir grubunda tek küratif ve sağkalımı artırıcı cerrahidir yöntemdir

INTRODUCTION: Ovulation induction and intrauterine insemination is the first line therapy chosen for infertile couples. In this study, we investigated the effect of endometrial thickness and endometrial pattern; examined on HCG day, on the success rate of OI-IUI performed in unexplained infertility cases on the day of HCG.
METHODS: In this study 101 couples and 132 IUI cycle who were diagnoses unexplained infertility were examined prospectively.
RESULTS: 22 successful pregnancy was achieved in 132 cycles, the rate of pregnancy was calculated as %16.6 per cycle and %21.7 per patient. There was no significant difference between clinically proved pregnancy-positive and negative outcome groups regarding FSH dosage, duration of stimulation, basal FSH level, basal E2, TPMSS, number of IUI cycle, follicle diameter. Infertility period was calculated as 2.1 ± 1.4 years, and 4.1 ± 2.3 years positive and negative outcome groups respectively. The difference was statistically significant (p < 0.05). The number of an antral follicle and follicle count on HCG day was significantly different on pregnancy positive group compared to pregnancy negative group (p< 0.05). Endometrial thickness was measured as 9.8±1.1 mm and 9.6±3.5 mm in groups with positive and negative outcomes respectively. There was no significant difference regarding endometrial thickness and endometrial pattern.
DISCUSSION AND CONCLUSION: There was no significant difference between pregnancy clinically proven and unproven groups in terms of endometrial thickness and endometrial pattern on the day HCG performed.

INTRODUCTION: Labor induction is imperative for 20-30% of all pregnancies, and is related to increased rate of C-section. In order to predict likelihood of the induction, cervix is evaluated manually and sonographically and Bishop Score is commonly preferred.
METHODS: 126 singleton pregnancies of 37-41 weeks, with cephalic presentation and no histrory of uterine surgery, were selected for birth induciton and included in this prospective obervational study. Age, gestational week, indication of birth induction, gravidity and parity, estimated fetal weight, delivery method, bishop socre, sonographicly measured cervical length were recorded.
RESULTS: C-section rate (%54.8) and vaginal delivery rates (%89.4) were higher in groups with bishop score less than 5 and greater than 5 respectively, Bishop score is a statistically significant method to foresee birth induction success. (p<0,001). Parity and delivery method were statistically significant in groups with different bishop score. In terms of cervical length with 25 mm cut off, vaginal delivery was dominant in both groups, (%69,6 and 59,6 respectively) and there was no significant difference between these groups. (p>0,05). Parity and vaginal delivery rates were similar in both groups of cervival length. In gap analysis there was no significant difference between 2 groups. With a cut off point of 25 mm, sensitivity of specificty of cerival length were reported as 52.3% and 58.5% respectively.
DISCUSSION AND CONCLUSION: Bishop score and parity were favorable predictors; whereas sonographic measurement of cervical length is an inadequate parameter to infer success rate of birth induction.

INTRODUCTION: Primer kemoradyoterapi tedavisi almış ileri evre serviks kanserli hastalarda uterusa sınırlı rezidü tümör miktarının sağkalıma etkisini belirlemek ve bu tarz tümörlerde görüntüleme yöntemlerinin rezidü tümör saptamadaki başarısı saptamak
METHODS: İstanbul Universitesi İstanbul Tıp Fakültesi Jinekolojik Onkoloji Kliniğinde 2009 Nisan-2017 Mayıs ayları arasında opere edilen 31 hasta çalışmaya dahil edilmiştir. Bu hastaların klinikopatolojik özellikleri değerlendirilmiştir. Hastalar operasyon öncesi Magnetik Rezonans inceleme (MRI) ve/veya Pozitron Emisyon Tomografi (PET-BT) ile değerlendirilmiştir. Hastalar operasyon sonrası uterus materyalinde tümör miktarına göre i) rezidu tümör yok ii) rezidü tümör <10 mm iii) rezidü tümör > 10 mm olarak üç gruba ayrılmış ve hastalıksız sağkalım incelemesi yapılmıştır.
RESULTS: Ortanca yaş 54 olarak hesaplanmıştır. MRI rezidü tümör saptamada sensitivitesi %75 spesifitesi %50; PET-BT sensitivitesi %54.5 spesifitesi %50 olarak saptanmıştır. Bir yıllık hastalıksız sağkalım oranları rezidü olmayan, mikroskobik rezidü olan ve makroskobik rezidü olan hastalarda sırası ile %92.3, %80 ve %38.5 olarak tespit edildi.
DISCUSSION AND CONCLUSION: Irradiye serviks kanserinde rezidü tümör saptamada görüntüleme yöntemlerinin başarısı kısıtlıdır. Histopatolojik olarak saptanmış rezidü tümörün büyüklüğü arttıkça hastalıksız sağkalım rakamları azalmaktadır.

GİRİŞ ve AMAÇ: Metabolik hastalıklar endometrial hastalıklar ve endometrium kanseri riskini artırabilmektedir. Metabolik sendromlu hastalar endometrial patolojiler açısından risk altındadırlar. Tanı alan hastaları jinekolojik yakınması olmasa bile rutin olarak jinekolojik muayeneye yönlendirmek erken tanı için faydalı olabilir.
YÖNTEM ve GEREÇLER: Dahiliye polikliniğinde metabolik sendrom tanısı alan 120 hasta jinekoloji polikliniğinde endometrial hastalıklar açısından değerlendirilmiştir. Veriler SPSS 16 istatistik programında analiz edilmiş Ki kare(chisquare) testi uygulanmıştır. P<0.05 istatistiksel olarak anlamlı kabul edilmiştir.
BULGULAR: 36 hastaya probe küretaj yapılmıştır. Endometrial kansere rastlanmamıştır. Atipisiz endometrial hiperplazi anlamlı olarak anormal uterin kanaması olan grupta; postmenopozal kanama ve endometrial kalınlığı bulunan menopozlu hasta grubuna gore daha fazla bulunmuştur (p=0.001).
TARTIŞMA ve SONUÇ: Metabolik sendromlu hastaların %15’de endometrial patoloji tesbit edilmiştir. Hasta sayısı artırılarak yapılan çalışmalarla klinik pratikte metabolik sendromlu hastaların jinekolojik muayenelerinin rutin olarak yapılıp yapılmamasının tesbit edilebileceği kanaatine varılmıştır.

INTRODUCTION: Metabolic disorders can increase the risk of endometrial diseases and endometrial cancer. Patients with metabolic syndrome are at risk for endometrial pathologies. Advising routine gynecological examination even to the patients with metabolic syndrome having no gynecological complaints may be helpful in early diagnosis.
METHODS: 120 patients diagnosed with metabolic syndrome in the Internal Diseases Outpatient Clinic were examined for endometrial diseases in the Gynecology Clinic. Data were analyzed using SPSS 16 statistical software, and Chi-square test was performed. p<0.05 was considered as statistically significant.
RESULTS: 36 patients had undergone a diagnostic curettage. There was no endometrial cancer in any patient. The rate of endometrial hyperplasia without atypia was found significantly increased in the patient group with abnormal uterine bleeding when compared to the patient group with menopause having postmenopausal bleeding and an increased endometrial thickness (p=0.001).
DISCUSSION AND CONCLUSION: Endometrial pathology was diagnosed in 15% of the patients with metabolic syndrome. It was concluded that the question of whether routine gynecological examination of metabolic syndrome patients is required in clinical practice could be answered by further studies including larger patient groups.