Can the Pfannenstiel skin incision length be adjusted according to the fetal head during elective cesarean delivery?

Objective: The study aims to determine whether the Pfannenstiel skin incision can be adjusted according to the fetal head's occipitofrontal diameter (OFD) during primary cesarean delivery. Background: Eligible 114 nulliparous women delivered at term by cesarean section in which Pfannenstiel skin incision was performed according to the OFD of the fetal head between June 2017 and September 2021 were included. Excluded cases were non-vertex presentations, all emergency cesarean sections, severe preeclampsia, women in an active phase of the first stage of labor and second stage of labor, placenta previa and low-lying placenta, multiple pregnancies, and uncontrolled gestational diabetes mellitus. Results: Among 114 eligible nulliparous women, the mean OFD was 116.1 ± 7.2 (99-138) mm, and the measurement of the Pfannenstiel skin incision length, which was performed according to the OFD was found to be 122.8 ± 9.2 (100-155) mm. The difference between OFD and Pfannenstiel incision kept remained within 10 mm in 90 (82.5.2%), 10-20 mm in 17 (15.5%), and more than 20 mm in two women (1.8%). This technique was successful in 109 (95.6%) out of 114 women without extending the skin incision. In five women, skin incision needed to be extended up to 38 mm. In 10 women (8.7%), the rectus abdominis muscle was cut partially to deliver the fetal head. The mean fetal umbilical artery pH was 7.33 ± 0.05. No neonatal hypoxia was encountered in the study. Conclusion: Pfannenstiel skin incision can be adjusted according to the OFD with minimal margins of error. This technique may provide better cosmetic results by avoiding unnecessarily prolonged incisions with similar newborn outcomes. Clinical Trial Registration: Clinicaltrials.gov, identifier [NCT05632796].

Role of C-type natriuretic peptide in polycystic ovary syndrome.

OBJECTIVE: To evaluate serum C-type natriuretic peptide (CNP) and androgen concentrations in women with polycystic ovary syndrome (PCOS), and compare them with the healthy group. METHODS: The present study was carried out prospectively at the Near East University Hospital, between July 15, 2019 and September 1, 2020. Out of the 90 patients aged between 18 and 40 years old who were enrolled, the final study population consisted of 36 patients with PCOS and 30 healthy women. RESULTS: Body mass index, free androgen index, serum androstenedione, total testosterone, free testosterone, and CNP were significantly higher and serum sex-hormone-binding globulin level was lower in the PCOS group. CONCLUSION: We revealed that serum CNP levels are high in PCOS patients. The mechanism of the relationship between this increase and hyperandrogenism or anovulation is not known, but these findings provide a direction for new studies. CLINICALTRIALS: GOV: NCT04006171.

Investigation of allele frequencies of polymorphic variants in genes that are related to polycystic ovary syndrome.

OBJECTIVE: Polycystic ovary syndrome is a hormonal disorder that normally affects women of reproductive age in the range of 18-44 years. This study aimed to investigate the allelic frequencies of two polymorphisms, IRS rs18012781 and INSR rs1799817, which are suspected to be involved in polycystic ovary syndrome. METHODS: The samples were obtained from the patients admitted to the Near East University Hospital, Department of Gynecology and Obstetrics. The samples were divided into two groups: control and polycystic ovary syndrome groups. Blood samples were collected from 55 women in the control group and 65 samples from the patient group. DNA from whole blood was obtained. The allelic frequencies of single-nucleotide polymorphisms were determined using real-time PCR. Results were presented as the heterozygous and homozygous state of the single-nucleotide polymorphisms. RESULTS: There were no significant differences in the allelic frequencies of the single-nucleotide polymorphisms between the patient and control groups. Further statistical analysis investigating the INSR Tm using the Mann-Whitney U test value revealed that there was no difference in the homozygous and heterozygous state of INSR rs1799817. The result of this study showed that there was no statistically significant difference between the allelic frequencies of IRS1 rs1801278 and INSR rs1799817 between the patient and control groups. CONCLUSION: These single-nucleotide polymorphisms do not seem to modify the risk of polycystic ovary syndrome, and they cannot be used as a marker in clinical circumstances to evaluate the possible occurrence of polycystic ovary syndrome.

Investigation of allele frequencies of polymorphic variants in genes that are related to polycystic ovary syndrome

SUMMARY OBJECTIVE: Polycystic ovary syndrome is a hormonal disorder that normally affects women of reproductive age in the range of 18-44 years. This study aimed to investigate the allelic frequencies of two polymorphisms, IRS rs18012781 and INSR rs1799817, which are suspected to be involved in polycystic ovary syndrome. METHODS: The samples were obtained from the patients admitted to the Near East University Hospital, Department of Gynecology and Obstetrics. The samples were divided into two groups: control and polycystic ovary syndrome groups. Blood samples were collected from 55 women in the control group and 65 samples from the patient group. DNA from whole blood was obtained. The allelic frequencies of single-nucleotide polymorphisms were determined using real-time PCR. Results were presented as the heterozygous and homozygous state of the single-nucleotide polymorphisms. RESULTS: There were no significant differences in the allelic frequencies of the single-nucleotide polymorphisms between the patient and control groups. Further statistical analysis investigating the INSR Tm using the Mann-Whitney U test value revealed that there was no difference in the homozygous and heterozygous state of INSR rs1799817. The result of this study showed that there was no statistically significant difference between the allelic frequencies of IRS1 rs1801278 and INSR rs1799817 between the patient and control groups. CONCLUSION: These single-nucleotide polymorphisms do not seem to modify the risk of polycystic ovary syndrome, and they cannot be used as a marker in clinical circumstances to evaluate the possible occurrence of polycystic ovary syndrome.

Comparison of stromal thickness and doppler findings in polycystic ovary syndrome and healthy women with ultrasonographic evidence of polycystic ovaries? A cross-sectional study.

The purpose of the study was to compare the ovarian stromal blood flow and stromal thickness (ST) of polycystic ovary syndrome (PCOS) patients, with healthy women with polycystic ovarian morphology (PCOM) and normal ovarian morphology (NOM). A total of 220 participants were recruited and the three study groups were determined by diagnostic criteria (PCOS n = 106, PCOM n = 68, NOM n = 46). Clinical, hormonal and ultrasonographic measurements of ovaries were assessed and compared. PCOS patients showed statistically higher androgen levels, insulin resistance, hirsutism score, ovarian ST and stromal blood flow compared to PCOM and NOM. The correlation between free androgen index (FAI) and ST was measured. FAI was significantly highly correlated with left ovarian ST (0.83; p < .001) and right ovarian ST (0.83; p < .001). According to the results of this study, the ovarian ST which can be considered as ultrasonographic indicator of FAI, can be used in PCOS diagnosis. Also, it can be suggested that there is no statistically significant difference in ovarian ST and doppler findings between healthy women with PCOM or NOM. ROC analysis was used to measure diagnostic utility of ST. Impact StatementWhat is already known on this subject? Although it is known that ovarian stromal blood flows and stromal thickness are increased in PCOS disease compared to healthy women, they are not included in the diagnostic criteria.What the results of this study add? In the results of this study, it was determined that ovarian stromal blood flow and stromal thickness were increased in PCOS patients, as previously reported in the literature. In addition, these ultrasound measurements were found to be increased in PCOS patients compared to healthy women with PCO morphology, and stromal thickness measurements were strongly correlated with the free androgen index in PCOS patients.What the implications are of these findings for clinical practice and/or further research? Ovarian ST and/or S/A ratio may be an ultrasonograpic indicator of FAI, and may be used in PCOS diagnostic criterias. In the future, it can be revealed whether they vary in patients with different components of the syndrome, by examining these parameters in different PCOS phenotypes.

Does asporin have a role in polycystic ovary syndrome? A pilot study.

OBJECTIVE: Asporin is secreted by theca cells in the mouse ovaries and is an effective marker at the gonadotropin-independent stage in secondary follicle development. It has an inhibitory effect on transforming growth factor beta and bone morphogenic proteins, which are involved in androgenesis process. Our aim was to compare serum asporin levels of polycystic ovary syndrome and control groups and examine the relationship between asporin and hyperandrogenism. METHODS: A total of 60 patients, i.e., 30 polycystic ovary syndrome group and 30 controls, were included in the study. The demographic characteristics, hormonal status, and serum asporin levels of patients were evaluated and compared for each group. In addition, polycystic ovary syndrome patients were analyzed according to the presence of hyperandrogenism. Receiver operating characteristic curve analysis was performed for asporin levels in order to distinguish polycystic ovary syndrome patients from controls. RESULTS: Body mass index, serum asporin and androgen levels, free androgen index, and insulin resistance values were statistically significantly higher in polycystic ovary syndrome group. Serum asporin levels were statistically significantly higher in hyperandrogenic polycystic ovary syndrome patients compared to non-hyperandrogenic polycystic ovary syndrome women (p=0.010). Receiver operating characteristic curve analysis was done for serum asporin levels to distinguish between polycystic ovary syndrome patients and healthy controls (area under the curve=0.676, standard error: 0.070, 95%CI: 0.539-0.812, p=0.019, 63.3% sensitivity, and 70% specificity). CONCLUSION: The elevation of serum asporin levels in patients with polycystic ovary syndrome may be associated with the pathogenesis of this syndrome, or it may be the consequence of the disease. This relationship may be explained through the androgen mechanism.

Does asporin have a role in polycystic ovary syndrome? A pilot study

SUMMARY OBJECTIVE: Asporin is secreted by theca cells in the mouse ovaries and is an effective marker at the gonadotropin-independent stage in secondary follicle development. It has an inhibitory effect on transforming growth factor beta and bone morphogenic proteins, which are involved in androgenesis process. Our aim was to compare serum asporin levels of polycystic ovary syndrome and control groups and examine the relationship between asporin and hyperandrogenism. METHODS: A total of 60 patients, i.e., 30 polycystic ovary syndrome group and 30 controls, were included in the study. The demographic characteristics, hormonal status, and serum asporin levels of patients were evaluated and compared for each group. In addition, polycystic ovary syndrome patients were analyzed according to the presence of hyperandrogenism. Receiver operating characteristic curve analysis was performed for asporin levels in order to distinguish polycystic ovary syndrome patients from controls. RESULTS: Body mass index, serum asporin and androgen levels, free androgen index, and insulin resistance values were statistically significantly higher in polycystic ovary syndrome group. Serum asporin levels were statistically significantly higher in hyperandrogenic polycystic ovary syndrome patients compared to non-hyperandrogenic polycystic ovary syndrome women (p=0.010). Receiver operating characteristic curve analysis was done for serum asporin levels to distinguish between polycystic ovary syndrome patients and healthy controls (area under the curve=0.676, standard error: 0.070, 95%CI: 0.539-0.812, p=0.019, 63.3% sensitivity, and 70% specificity). CONCLUSION: The elevation of serum asporin levels in patients with polycystic ovary syndrome may be associated with the pathogenesis of this syndrome, or it may be the consequence of the disease. This relationship may be explained through the androgen mechanism.

Comparison of subscription access and open access obstetrics and gynecology journals in the SCImago database.

OBJECTIVES: The aim of this study is to compare the annual SJR and to evaluate the other parameters that show the scientific effect of journals in terms of open access (OA) or subscription access (SA) in the field of obstetrics and gynecology according to the SCImago database. MATERIAL AND METHODS: This study was conducted between September-December 2019 at Near East University. The SCImago Journal & Country Rank database was used to collect information about the journals. We evaluated and compared the changes in the one-year SJR (SCImago Journal Rank) and journal impact factor (JIF) of OA and SA journals. RESULTS: Data from 183 scientific journals in the field of obstetrics and gynecology from the period between 1999 and 2018 were evaluated, where 140 of these journals were SA and 43 were OA. The average SJR of OA journals in 1999 was 0.17, while it was 0.38 for SA journals. In 2018, these values were 0.31 and 0.78 for OA and SA journals, respectively. In the comparison of JIF, the average of the OA journals in 1999 was 0.09, while it was 0.66 for SA journals. In 2018, these values were 0.80 and 1.93 for OA and SA journals, respectively. CONCLUSIONS: Access to information has become easier due to technological developments and this will continue to affect the access policies of journals. Despite the disadvantages of predator journals, the rise of OA journals in terms of number and quality is likely to continue.

The importance of inflammation markers in polycystic ovary syndrome.

OBJECTIVE: This study aimed to examine inflammation markers in patients with polycystic ovary syndrome (PCOS) and to compare them with healthy women. METHODS: This prospective study was conducted by examining patients who applied to the Near East University Gynecology and Obstetrics Outpatient Clinic between January 2019 and January 2020. A total of 110 PCOS patients with 135 control groups were compared in terms of metabolism, hormonal factors, and inflammation markers. RESULTS: The neutrophil count, neutrophil-lymphocyte ratio (NLR), platelet, platelet-lymphocyte ratio (PLR), platelecrit (PCT), erythrocyte cell distribution width, platelet distribution width, mean platelet volume, and C-reactive protein (CRP) values were found to be statistically significantly higher in patients with PCOS. There was a positive correlation between inflammation markers and serum androgens. Also, a positive correlation was observed between inflammation markers and cardiovascular risk parameters. In receiver operating characteristic curve analysis, the most valuable parameter in distinguishing PCOS patients from healthy controls was serum CRP levels [areas under the curve (AUC)=0.928, 95%CI 0.894-0.963, p<0.001, 92.6% sensitivity, and 82.7% specificity]. CONCLUSIONS: Serum CRP, neutrophil count, and PCT and NLR levels are valuable markers that show the inflammatory process in PCOS patients.

Comparison of Anti-müllerian Hormone (AMH) and Hormonal Assays for Phenotypic Classification of Polycystic Ovary Syndrome.

OBJECTIVES: The aim is to compare the hormonal status and anti-müllerian hormone (AMH) levels of patients who have different polycystic ovary syndrome (PCOS) phenotypes, polycystic ovarian morphology (PCOM) and healthy women. MATERIAL AND METHODS: A total of 350 PCOS women, 71 women with PCOM and 79 healthy women with normal ovarian morphology (NOM) were observed. PCOS patients were divided into groups according to the phenotypes. Phenotype A- characterized by anovulation, hyperandrogenism and PCOM; phenotype B- defined as anovulation, hyperandrogenism; Phenotype C- identified as hyperandrogenism and PCOM; Phenotype D- outlined as anovulation and PCOM. AMH levels were compared for each group. RESULTS: Among 350 PCOS patients the highest number belonged to phenotype A (n = 117, 33.4%). The rest were distrubuted as follows: phenotype B (n = 89, 25.4%), phenotype C (n = 72, 20.6%), phenotype D (n = 72, 20.6%). Phenotype A (9.17 ± 4.56) had the highest mean AMH levels in our study. Comparison of AMH levels showed a statistically significant difference between phenotypes A and D. There was a statistically significant difference on comparison of AMH between NOM, PCOM and all PCOS phenotypes. CONCLUSIONS: Phenotype A is the most serious form of PCOS and these patients has all three features which are hyperandrogenism, anovulation and ultrasound findings of polycystic ovary (PCO). AMH reflects the severity of PCOS and patients with Phenotype A have higher AMH levels.

Breakthroughs in the Use of Inositols for Assisted Reproductive Treatment (ART).

It is well known that myo-inositol (MI) and D-chiro-inositol (DCI) are insulin-sensitizing agents, and MI is of proven utility in polycystic ovary syndrome (PCOS). In addition, MI plays a pivotal role in the physiology of reproduction, and has beneficial effects on the development of oocytes, spermatozoa, and embryos. By contrast, DCI has little effect on spermatozoa, but high concentrations in the ovary can negatively affect the quality of oocytes and the blastocyst. Overall, the evidence in the literature supports the beneficial effects of MI in both female and male reproduction, warranting clinical use of MI in assisted reproductive treatment (ART).

Smoking reduces ovarian stromal blood flow in polycystic ovary syndrome patients.

OBJECTIVES: The objective of the current research is to compare hormonal, metabolic and ovarian stromal blood flow outcomes in smoking versus non-smoking polycystic ovary syndrome (PCOS) patients. MATERIAL AND METHODS: 79 PCOS women (Group 1) and 79 healthy subjects (Group 2) were recruited. Both groups were subdivided according to their smoking habits. Ovarian stromal blood flow was assessed with pulsatility and resistance index for both ovaries and compared among smoking women. RESULTS: The smokers in the PCOS group had statistically significant higher levels of pulsatility and resistance index in both ovaries compared to nonsmoker PCOS patients (p < 0.001). Comparison of ovarian stromal blood flow indexes shows that pulsatility and resistance index for both ovaries is statistically significantly high in smoking healthy patients compared to the nonsmoking group (p < 0.001). There is a positive correlation between smoking and free androgen index (r = 0.866, p < 0.001) for PCOS patients and healthy women. CONCLUSIONS: Smoking reduces ovarian blood flow in PCOS patients and healthy subjects. Smoke components effect the vascular structure and form endothelial injuries that may reduce ovarian tissue perfusion. In this study, the positive correlation between smoking and free androgen index shows that the main effect of smoking on ovarian blood flow may be through androgen metabolism.

Experts' opinion on inositols in treating polycystic ovary syndrome and non-insulin dependent diabetes mellitus: a further help for human reproduction and beyond.

Introduction: This Experts' opinion provides an updated scientific support to gynecologists, obstetricians, endocrinologists, nutritionists, neurologists and general practitioners on the use of Inositols in the therapy of Polycystic Ovary Syndrome (PCOS) and non-insulin dependent (type 2) diabetes mellitus (NIDDM).Areas covered: This paper summarizes the physiology of Myo-Inositol (MI) and D-Chiro-Inositol (DCI), two important molecules present in human organisms, and their therapeutic role, also for treating infertility. Some deep differences between the physiological functions of MI and DCI, as well as their safety and intestinal absorption are discussed. Updates include new evidence on the efficacy exerted in PCOS by the 40:1 MI/DCI ratio, and the innovative approach based on alpha-lactalbumin to overcome the decreased therapeutic efficacy of Inositols in some patients.Expert opinion: The evidence suggests that MI, alone or with DCI in the 40:1 ratio, offers a promising treatment for PCOS and NIDDM. However, additional studies need to evaluate some still unresolved issues, such as the best MI/DCI ratio for treating NIDDM, the potential cost-effectiveness of reduced gonadotropins administration in IVF due to MI treatment, or the benefit of MI supplementation in ovulation induction with clomiphene citrate in PCOS patients.

The effect of myoinositol on ovarian blood flows in women with polycystic ovary syndrome.

To evaluate whether 4 gram myoinositol and 400 mcg folic acid(MYO) therapy has any effects on ovarian stromal blood flow by using pulsed and color Doppler at 3 months follow-up period in polycystic ovary syndrome (PCOS). One-hundred eighty patients were designed into six groups; Group 1: PCOS patients that received OCP containing 30 mcg ethinyl estradiol (EE) plus 3 mg drospirenone (DRP); Group 2: PCOS patients that received MYO; Group 3: PCOS patients that received no medication. Group 4: Healthy patients that received OCP; Group 5: Healthy patients that received MYO; Group 6: Healthy patients that received no medication. Resistance index (RI) and pulsatility index (PI) of both ovaries were assessed. There was a significant increase in RI and PI of both ovarian stromal blood flow women with PCOS who received OCP (Group 1, p < .001) and MYO (Group 2, p < .001). The rate of increment in both RI and PI values were similar for OCP users (Group 1) and MYO users(Group2) in PCOS patients. MYO therapy reduced ovarian vascularization in both PCOS and healthy users after 3 months and this decrease is especially noticeable in women with PCOS compared to healthy women. OCP therapy also reduced ovarian vascularization just like MYO therapy.

Corrigendum to "Different Effects of Myoinositol plus Folic Acid versus Combined Oral Treatment on Androgen Levels in PCOS Women".

[This corrects the article DOI: 10.1155/2016/3206872.].

Myo-inositol administration positively effects ovulation induction and intrauterine insemination in patients with polycystic ovary syndrome: a prospective, controlled, randomized trial.

Objective: The aim of the study is to investigate the effect of myo-inositol (MYO) on pregnancy rates of patients diagnosed with polycystic ovary syndrome (PCOS) who undergone controlled ovulation induction and intrauterine insemination (IUI). METHODS: A total of 196 infertile patients diagnosed with PCOS and admitted to Dokuz Eylul University Faculty of Medicine were included in the study between March 2013 and May 2016. The patients in group 1 (n = 98) were given 4 g MYO and 400 µg folic acid before and during ovulation induction. The patients undergone controlled ovarian hyperstimulation (COH) with recombinant FSH and IUI. The patients in group 2 (n = 98), were given recombinant FSH directly and 400 µg folic acid. The primary outcome measure of this study was the clinical pregnancy rate. RESULTS: In group 1, 9 patients conceived spontaneous pregnancy. During COH + IUI treatment three cycles were canceled in group 1 and 8 cycles in group 2. Total rFSH dose and cycle duration were significantly lower and clinical pregnancy rates were higher in group 1. The pregnancy rate for group 1 was %18.6 and for group 2 was %12.2. Conclusions: This study shows that MYO should be considered in the treatment of infertile PCOS patients. MYO administration increases clinical pregnancy rates, lowers total rFSH dose and the duration of the ovulation induction.

Different Effects of Myoinositol plus Folic Acid versus Combined Oral Treatment on Androgen Levels in PCOS Women.

Recently, myoinositol (myo-ins) and folic acid combination has gained an important role for treating Polycystic Ovary Syndrome (PCOS), in addition to combined oral contraceptives (COC). We aimed to examine myo-ins effects on anti-Mullerian hormone (AMH) levels and compare them with those ones obtained administering COC. In this prospective study, 137 PCOS patients, diagnosed according to Rotterdam criteria and admitted to the Reproductive Endocrinology and Infertility Outpatient Clinic at Dokuz Eylul University (Izmir, Turkey), were included. After randomization to COC (n = 60) and myo-ins (n = 77) arms, anthropometric measurements, blood pressure, Modified Ferriman Gallwey scores were calculated. Biochemical and hormonal analysis were performed, and LH/FSH and Apo B/A1 ratios were calculated. Data analysis was carried out in demographically and clinically matched 106 patients (COC = 54; myo-ins = 52). After 3-month treatment, increase in HDL and decreases in LH and LH/FSH ratio were statistically more significant only in COC group when compared with baseline (in both cases p > 0.05). In myo-ins group, fasting glucose, LDL, DHEAS, total cholesterol, and prolactin levels decreased significantly (for all p < 0.05). Progesterone and AMH levels, ovarian volume, ovarian antral follicle, and total antral follicle counts lessened significantly in both groups (for all p < 0.05). In PCOS treatment, MYO is observed more effective in reductions of total ovarian volume and AMH levels.

Role of kisspeptin in polycystic ovary syndrome (PCOS).

OBJECTIVE: Due to the complex relationship between kisspeptin and the hypothalamic-pituitary-gonadal axis, the study was planned to measure the kisspeptin levels in polycystic ovary syndrome (PCOS) and to analyze the correlations between kisspeptin and PCOS-related reproductive, metabolic changes. METHODS: The study was designed as a prospective study in Dokuz Eylul University between December 2011 and September 2013. A total of 285 PCOS cases and 162 controls were recruited. After the antropometric measeruments and physcial examination, blood samples were taken for biochemical analysis. RESULTS: PCOS group's mean BMI was 24.32 ± 3.40 and for the control group, BMI value was 23.44 kg/m2 ± 4.08 (p = 0.351). PCOS patients' FSH level was 5.10 ± 2.01 mIU/L, LH value was 7.75 ± 4.31 mIU/mL, LH/FSH ratio was 1.70 ± 1.28, DHEAS value was 221.84 ± 105.02 mg/dl, total testosterone value was 50.51 ± 27.93 ng/ml, free testosterone value was 2.52 ± 1.05 pg/ml, SHBG was 63.74 ± 45.62 nmol/L, LDL was 102.56 ± 23.45 mg/dL, HDL value was 51.36 ± 12.15 mg/dL, total cholesterol value was 214.85 ± 39.27 mg/dL, triglyceride value was 112.95 ± 46.88 mg/dL, Apo A1 value was 171.30 ± 35.35 mg/dL, Apo B value was 71.08 ± 19.07 mg/dL, Apo B/A1 ratio was 0.42 ± 0.14, free androgen index was 13.77 ± 14.15, fasting glucose value was 80.68 ± 13.80 mg/dL, fasting insulin levels was 14.13 ± 9.11 µiU/mL, HOMA-IR index was 2.76 ± 2.34, AMH value was 5.93 ± 3:33 in ng/ml, and found to be significantly higher (p < 0.001). Leptin value was 9.71 ± 5.54 pg/ml and kisspeptin value was 1.92 ± 1.29 ng/ml, respectively. Kisspeptin and leptin levels showed no statistically significant difference with control group and PCOS group. In all PCOS patients, kisspeptin showed positive correlations between LH and leptin levels. CONCLUSION: In this study, kisspeptin had a positive correlation with LH and leptin levels in PCOS. In fact, the serum levels of kisspeptin and leptin does not differ statistically between PCOS and healthy women. There are limited data in the literature with regard to changes in kisspeptin levels and its relation with metabolic and hormonal disturbances.

Synchronous tumors of the female genital tract: a 20-year experience in a single center.

OBJECTIVE: To evaluate the clinicopathological characteristics and the clinical outcome of synchronous malignant neoplasms of the female reproductive tract. MATERIAL AND METHODS: Patients who were operated and diagnosed with synchronous malignant tumor of the genital system (n = 25) at the Dokuz Eylul University Department of Obstetrics and Gynecology Gynecologic Oncology Unit between 1992 and 2012 were included into this study. Recurrent, metastatic and metachronously detected tumors were not included. Age at diagnosis, parity menopausal status, hormone use, presenting sign or symptoms and the clinical outcomes were evaluated. RESULTS: 20 of 25 patients had endometrial-ovarian cancer. The mean age at diagnosis was 53,6 years. The most common presenting symptom was abnormal uterine bleeding. The median follow-up duration for all patients was 69 months. Overall survival for all patients was 87 months and 81 months for patients with endometrial-ovarian cancer 5-year survival rate was 73% for all patients and 68% for patients with endometrial-ovarian cancer. CONCLUSIONS: Endometrial-ovarian cancer togetherness is the most common in synchronous gynecologic malignancies. They occur at a younger age and have more favorable prognosis than metastatic primary gynecologic tumors.