Objective: Uterine perfusion, particularly the endometrial blood flow, may have an important role in endometrial receptivity. In order to assess the contribution of sub endometrial blood flow in the etiopathogenesis of unexplained infertility mid luteal-peri-implantation period spiral artery transvaginal color Doppler parameters were measured and compared with fertile controls. Material and Methods: Forty-two consecutive patients admitted toIzmir Katip Celebi University Ataturk Training and Research Hospital, Department of Obstetric and Gynecology with the diagnosis of unexplained infertility after standard diagnostic work up constituted the study group and they were compared with a fertile control group admitted to hospital with non specific gynecological complaints or for check-up in the same period. Mid luteal transvaginal color Doppler ultrasonography was applied to each patient by the same radiologist who was blind to the diagnosis of the particular patient and, RI (resistance index) and PI (pulsatility index) values were calculated.Results: There were no significant differences between the two groups, in respect to age, body mass index, basal hormonal and mid luteal progesterone levels (p>0.05). For the fertile control group, mid luteal-peri-implantation phase endometrial spiral artery mean RI values were calculated as 0.48±0.08 SD and mean PI values as 0.65±0.18 SD. For the study group, mean RI values were calculated as 0.54±0.07 SD, PI values were calculated as 0.80±0.16 SD. The differences for RI (p=0.009) and PI (p=0.004) were statistically significant. Conclusion:According to Doppler parameters, unexplained infertility patients have high impedance blood flow in spiral arteries which means that peri-implantation blood flow in these patient is lower than fertile controls. These findings suggest that endometrial perfusion may have an important contribution to etiopathogenesis of unexplained infertility. (J Turkish-German Gynecol Assoc 2012; 13: 169-71) Key words: Unexplained infertility, endometrial blood flow, endometrial receptivity, transvaginal ultrasonograhy, colored Doppler Received: 13 June, 2012 Accepted: 21 July, 2012 Amaç: Endometrial kan akımının, endometrial implantasyonda önemli rol oynadığı düşünülmektedir. Biz çalışmamızda subendometrial kan akımının açıklanamayan infertilitedeki önemini belirleyebilmek için mid-luteal-periimplantasyon dönemindeki kan akımını TVUSG doppler ile ölçerek fertil kontrol grubu ile karşılaş-tırdık. Gereç ve Yöntemler: Çalışmamıza İzmir Katip Çelebi ÜniversitesiAtatürk Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum Kliniği'ne infertilite nedeni ile başvurmuş ve yapılan tetkikler sonucunda açıklanamayan infertilite olarak tanı almış 42 hasta ile fertilite dışındaki jinekolojik şikayetler ile başvurmuş fertil hastaların midluteal dönemindeki endometrial kan akımı değerlendirildi. Ölçüm-ler; rezistans indeksi ve pulsatilite indeksi, hastaların hangi gruba ait olduğunu bilmeyen tek radyolog tarafından yapıldı. Abstract ÖzetOriginal Investigation ...

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Background: To determine the cut-off values of the preoperative risk of malignancy index (RMI) used in differentiating benign or malignant adnexal masses and to determine their significance in differential diagnosis by comparison of different systems. Materials and Methods: 191 operated women were assessed retrospectively. RMI of 1, 2, 3 and 4; cut-off values for an effective benign or malignant differentiation together with sensitivity, specificity, negative and positive predictive values were calculated. Results: Cut-off value for RMI 1 was found to be 250; there was significant (p<0.001) compatibility at this level with sensitivity of 60%, positive predictive value (PPV) of 75%, specificity of 93%, negative predictive value (NPV) of 88% and an overall compliance rate of 85%. When RMI 2 and 3 was obtained with a cut-off value of 200, there was significant (p<0.001) compatibility at this level for RMI 2 with sensitivity of 67%, PPV of 67%, specificity of 89%, NPV of 89%, histopathologic correlation of 84% while RMI 3 had significant (p<0.001) compatibility at the same level with sensitivity of 63%, PPV of 69%, specificity of 91%, NPV of 88% and a histopathologic correlation of 84%. Significant (p<0.001) compatibility for RMI 4 with a sensitivity of 67%, PPV of 73%, specificity of 92%, NPV of 89% and a histopathologic correlation of 86% was obtained at the cut-off level 400. Conclusions: RMI have a significant predictability in differentiating benign and malignant adnexal masses, thus can effectively be used in clinical practice.

ObjectiveThe goal of this study was to investigate the between cluster of differentiation 109 (CD109) expression and tumor diameter, invasion depth, tumor grade, presence of lymph-node metastasis, and overall survival in patients with vulvar squamous cell carcinoma, which is the most common type of vulvar cancer.MethodTwenty-six patients who underwent an operation for vulvar cancer between 1999 and 2009 in our clinic were included in this study. Immunohistochemical staining was performed on formalin-fixed and paraffin-embedded tissue.ResultTumor diameter was not found to be significantly associated with CD109 expression, intensity of cytoplasmic staining, or combined score (P = 0.325, P = 0.169, P = 0.352, respectively). Invasion depth and combined score were also not significantly correlated with CD109 expression (P = 0.324 and P = 0.174 respectively). There was a negative correlation between invasion depth and the intensity of cytoplasmic staining (P = 0.042). There was no significant correlation between tumor stage and CD109 expression, the intensity of cytoplasmic staining, and the combined score (P = 0.574, P = 0.389, P = 0.605, respectively). A significant positive correlation was observed between tumor grade and CD109 expression, the intensity of cytoplasmic staining, and the combined score (P = 0.003, P = 0.018, P = 0.008, respectively). No significant difference was found between the percentages of CD109 expression in patients with positive (48%) and negative (11%) lymph nodes (P = 0.058). The percentage of CD109 expression did not significantly differ in relation to overall survival (P = 0.483).ConclusionComprehensive and more extensive studies are needed to examine the relationship between CD109 expression and vulvar malignant lesions.

Gebelikte akut karın bugün en zorlu tanı ve tedavi ikilemlerinden biri olmaya devam etmektedir. Karın ağrısı obstetrik nedenlerle olabileceği kadar karın içi organlar nedeniyle de gelişebilmektedir. Gebelikte miyom dejenere olarak, saplı miyomun torsiyone olmasıyla veya kitle etkisine bağlı uterusun torsiyonuna yol açarak ağrıya yol açabilir. Bu olgu sunumunda eski sezaryenlı gebede gelişen karın ağrısının obstetrik bir acil mi yoksa cerrahi bir acil mi ayrımı yapılmasının zorluğu tartışılmıştır. Mukerrer sezaryenli G3 P2 olan 38 yaşında hasta, gebelik haftasında karın ağrısı ile başvurdu. Fizik muayenede batında yaygın hassasiyet mevcuttu. Ultrasonografi de her iki over normal olarak değerlendirildi. Plesanta dekolmanı ön tanısı ile sezaryen uygulandı. İntraoperatif gözlemde uterus sağ kornual yüze yakın ince pediküllü subserozal miyomun torsiyone olduğu tespit edildi. Hastaya sezaryen sırasında miyomektomi uygulandı.