Background: Consecutive measurements of β-hCG levels and sonographic evaluation of adnexae are critical for choosing the optimal management in ampullar tubal ectopic pregnancies (EP). To select suitable patients for conservative approach, there is a need for an affordable and reliable marker for determining rupture risk. Evaluation of systemic inflammatory markers in combination with serum β-hCG levels and ultrasound might help to decide the appropriate treatment option. Objective: The purpose of the present study was to evaluate the diagnostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in determining the rupture risk in ampullar tubal EPs and to compare with intraoperative findings. Methods: A total of 142 patients who underwent surgery for tubal EP were included. Seventy-two patients were in the intraoperatively diagnosed tubal rupture group and 70 patients without rupture findings were included in the control group. Both groups were compared for inflammation markers, β-hCG levels, and sonographic findings. Results: Both NLR and PLR levels were found to be significantly higher in the tubal rupture group (4.62 ± 3.13 vs. 2.67 ± 1.43, 162.94 ± 63.61 vs. 115.84 ± 41.15, p < 0.01, respectively). According to the receiver operating characteristic analysis performed for the diagnostic performance of tubal diameter measurement, β-hCG, NLR, and PLR levels were significantly associated with histopathologically confirmed tubal rupture (p < 0.01). Conclusion: Systemic inflammatory markers are feasible and affordable tools for predicting tubal rupture risk in ampullar EPs and might be useful for determining surgery decision especially in low resource settings.

Our aim was to evaluate the presentation and diagnostic evaluation of patients with isolated tubal torsion and to evaluate the surgical approach to these patients. We also aimed to define the ultrasonographic diagnostic criteria. Five patients with isolated tubal torsion who were admitted to our gynecology department between January 2014 and January 2017 were evaluated and included in this study. All cases were diagnosed through ultrasonographic imaging alone. The preoperative findings of the patients were similar to those described in the literature. No further imaging modality was used for diagnosis and all patients were managed with laparoscopy. The clinical findings and ultrasonographic findings were consistent with literature. It may be difficult to preoperatively diagnose isolated tubal torsion, which is a rare clinical entity. Evaluation of these patients by an experienced sonographer and knowledge of the ultrasonographic findings of isolated tubal torsion may have vital preventive measures.

Cesarean scar ectopic pregnancies and molar pregnancies are two very rare obstetric pathologies. In both cases, serious morbidities are involved that require careful management. The coexistence of the two clinical conditions is far less common and there are a limited number of cases in the literature. In this case report, a 34-year-old patient with previous cesarean section was diagnosed as having a molar pregnancy in a cesarean scar through ultrasonography. The patient was asymptomatic at that time. Ultrasonography revealed a protruding mass at the cesarean section and her human chorionic gonadotropin level was measured as 59.705 mIU/mL. Due to the risk of severe bleeding, cesarean section scar excision and revision were performed via laparotomy after counselling the patient. Removal of all trophoblastic tissue was observed as a result of the frozen pathology and the operation was terminated. After the definite pathology result came as a complete molar pregnancy, the patient was followed up according to molar pregnancy follow-up protocols and cured completely. Despite the alternative treatment options (methotrexate application, curettage, uterine artery embolization) in such patients, the decision for surgery was made after counselling the patient. In this very rare clinical condition, patients should be closely monitored and the appropriate treatment option should be applied as soon as possible, taking into consideration the bleeding risks of both pathologies.

Female genital mutilation (FGM) is an unusual condition for our country. However, an increase in FGM in future days can be predicted with the increasing numbers of exchange students coming from African countries, migration of refugees and socioeconomic relations with the African countries. We want to share our experience of two FGM victims admitted to our clinic with the request of reconstructive vulvar surgery before their marriage. Both women had WHO Type III FGM. Physical examination findings and surgical reconstruction techniques were presented.

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Amaç: Erken evre uterin servikal kanser için radikal histerektomi yapılan hastalarda kemik nüksünün klinik, cerrahi ve patolojik özelliklerini sunmayı amaçladık. Gereç ve Yöntemler: Evre 1B-2A epitelyal servikal kanser için tip 3 radikal histerektomi ve pelvik ± paraaortik lenfadenektomi uygulanan 412 hastanın verileri gözden geçirildi. Çalışmaya ilk nüksde kemik nüksü olan 7 hasta (%1,7) dahil edildi. Bulgular: Ana kohortun ortanca takip süresi (n=412) 46 aydı (1-300 ay). Bu dönemde, 53 hastada (%12,9) nüks gelişti ve bu nükslerin %13,2'sinde (53) 7'sinde kemikte nüks gözlendi. Nüks zamanı 9 ila 45 ay arasında değişmekteydi. Nükslerin 5'i aksiyal iskelet, 2'si apendiküler iskeletteydı. Üç hastada lomber vertebra, 1 hastada torasik vertebra, 1 hastada sakral vertebra, 1 hastada lumbosakral omur ve 2 hastada sol femur saptandı. Dört hastada izole kemik nüksüne rağmen 3 hastada çoklu nüks vardı. Çoklu nüks olan hastalar 6-25 ay içerisinde öldüler. İzole kemik nükslerinin tümü aksiyal iskelette idi. İzole kemik nüksü olan 2 hastada kurtarma tedavisi ile tam klinik yanıt sağlandı. Sonuç: Servikal kanserlerde kemik nüksü tek olduğunda, salvage tedavisi ile tam klinik yanıt ve postoperatif uzun sağkalım sağlanabilir.

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