Burak Ersak

Background/Objectives: Postpartum depressive symptoms have been associated with maternal functioning and mother–infant bonding (MIB). This study primarily examined the association between postpartum depressive symptom severity and MIB, estimated the proportion screening positive for probable postpartum depression (PPD), and explored relevant sociodemographic and psychosocial correlates. Methods: In this cross-sectional study, 212 mothers assessed at 4–24 weeks postpartum during April–June 2025 completed the Edinburgh Postnatal Depression Scale (EPDS) and Maternal Attachment Inventory (MAI). The primary adjusted analysis used linear regression with HC3 robust standard errors, including infant age and selected clinical and psychosocial covariates. Because 39.2% of MAI scores were at the maximum, Tobit, fractional-logit, and ordinal regressions were used as complementary sensitivity analyses, alongside exploratory spline assessments. Results: Forty-one mothers (19.3%) screened positive for probable PPD (EPDS ≥13). Each 1-point higher EPDS score was associated with a 0.20-point lower MAI score (95% CI: −0.26 to −0.15), approximately one MAI point per five EPDS points. Observed-scale estimates were similar across linear, Tobit, and fractional-logit models, although exploratory splines suggested possible nonlinearity at sparsely represented EPDS extremes. In exploratory adjusted analyses, stressful breastfeeding and nonbreastfeeding were associated with higher EPDS scores. Separately, only four of 69 unadjusted exploratory comparisons survived false-discovery-rate correction, all involving probable PPD screening status and breastfeeding or spousal support. Conclusions: Greater depressive symptom severity was associated with lower bonding scores, but the absolute difference was small and its clinical significance uncertain. The cross-sectional design precludes causal inference.

Background: Sentinel lymph node (SLN) mapping has become an established alternative to systematic lymphadenectomy for surgical staging in endometrial cancer. This study evaluated SLN mapping rates, anatomical distribution, factors associated with mapping failure, and perioperative outcomes in patients with early-stage endometrial cancer. Methods: This retrospective cohort study included patients with early-stage endometrial cancer who underwent SLN mapping during minimally invasive surgical staging between September 2022 and January 2025. Overall and bilateral SLN detection rates were calculated. Anatomical distribution of SLNs, factors associated with mapping failure (including a hemipelvis-level generalized estimating equation [GEE] analysis), and perioperative outcomes according to surgical approach were analyzed. Results: A total of 165 patients were included. The overall SLN detection rate was 96.4%, and bilateral mapping was achieved in 125 patients (75.8%). A total of 584 SLNs were removed, most commonly from the iliac basin. In the hemipelvis-level GEE analysis (330 hemipelves, 46 failures), ICG use (adjusted odds ratio [OR] 4.50, 95% confidence interval [CI] 1.07–18.83) and, in a sensitivity model, conventional laparoscopy compared with robotic surgery (OR 2.31, 95% CI 1.14–4.69) were associated with higher odds of mapping failure, whereas age and BMI were not. Operative time and intraoperative complication rates were comparable among laparoscopic, robotic-assisted, and vaginal natural orifice transluminal endoscopic surgery (vNOTES) procedures. Postoperative complication rates and length of hospital stay differed significantly across surgical approaches (both p = 0.002); post hoc pairwise comparison of complication rates showed that the difference was driven mainly by conventional laparoscopy compared with robotic-assisted surgery, whereas the small vNOTES group (n = 8) did not differ significantly from either approach and does not permit conclusions on its comparative safety. Conclusions: SLN mapping demonstrated high overall detection rates and acceptable bilateral mapping success in early-stage endometrial cancer. These findings support the feasibility of SLN mapping as a minimally invasive staging strategy in routine clinical practice.

Wandering spleen is a rare clinical entity characterized by abnormal displacement of the spleen from its normal anatomical position in the left upper quadrant. It may lead to serious complications such as torsion and infarction. Due to nonspecific clinical presentation, diagnosis can be challenging and imaging plays a crucial role. We present the case of a 20‐year‐old woman who presented with abdominal pain and was found to have a large pelvic mass initially suspected to be an ovarian germ cell tumor. Preoperative imaging demonstrated absence of the spleen in the left upper quadrant and a solid pelvic mass. Intraoperative findings revealed an ectopic spleen, which was confirmed histopathologically. This case highlights the importance of considering wandering spleen in the differential diagnosis of pelvic masses in young women, particularly when the spleen is not visualized in its normal location.

Background: Liver function tests change after liver mobilization.Aim: Evaluate the fluctuation of aminotransferase levels after liver mobilization forgynecologic cancers and determine the effect of liver metastasectomy on this change.Materials and Methods: We retrospectively evaluate the patients who underwent livermobilization for gynecologic cancers from 09/2019 to 10/2022. Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and bilirubin serum levels were monitored.Results: 69 patients were enrolled in the study. Liver function tests (LFTs) immediatelytended to increase following surgery. ALT levels peaked at the postoperative 6 th hour(median: 119.5 U/L; range: 13-762) and AST peaked in the 2 nd hour after the surgery(median: 204 U/L; range: 11-717). Both ALT and AST tended to normalize on the 6 thpostoperative day (24/28 U/L). Liver tumor resection was performed on 26 patients.Liver metastasectomy caused high both AST and ALT levels (p=0.013 and p=0.022,respectively) on the 2 nd postoperative day. This effect continued especially in ALT fromthe 2 nd day to the 10 th postoperative day. Subsequently, both groups became similar.Liver metastasectomy caused higher AST and ALT on the 2 nd postoperative daycompared with the non-metastasectomy group.Conclusion: Both liver mobilization and liver metastasectomy procedures areassociated with a transient increase in LFTs. Although liver mobilization in itself causeshigh LFTs in the immediate postoperative period, this effect is more significant in livermetastasectomy. High LFTs returned to normal values within 2 weeks in both twogroups. Fluid replacement and avoidance of hepatotoxic drugs can prevent theaggravation of the clinical course.

Background: To identify prognostic factors related to survival in patients with early-stage cervical cancer treated with radical surgery in six high-volume gynecologic oncology centers in Turkey. Methods: This retrospective analysis examined a cohort of 612 patients diagnosed with cervical cancer who underwent type II/III radical hysterectomy and pelvic lymphadenectomy, with or without para-aortic lymphadenectomy at six gynecologic oncology centers. A total of 537 patients between 1993 and 2023 were included. According to the 2009 FIGO staging system, 411 patients (76.5%) were stage IB1, 76 (14.2%) were stage IB2, 40 (4.7%) were stage IIA1, and 10 (1.9%) were stage IIA2. Patients underwent either type II or type III radical hysterectomy with pelvic lymphadenectomy, with para-aortic lymphadenectomy performed in 93.1% of cases. Among the 537 patients, 258 (48%) underwent type II radical hysterectomy and 279 (52%) underwent type III. Univariate and multivariate analyses of 5-year overall survival (OS) and 5-year disease-free survival (DFS) were performed. Results: In the entire cohort, 258 (48%) patients underwent radical surgery alone, while 279 (52%) patients underwent radical surgery followed by adjuvant therapy. The 5-year DFS and 5-year OS rates were 85.3% and 98.4%, respectively. In the multivariate logistic analysis, lymph node metastasis was identified as an independent prognostic factor for DFS and OS. Conclusions: Lymph node metastasis was the most important prognostic factor for survival in this large multicenter Turkish cohort. These findings highlight the prognostic value of nodal status, stromal invasion, margin status, and LVSI, while underscoring the importance of tailored adjuvant treatment strategies.

Effect of deep infiltrative endometriosis surgery and surgical method on sexual function in females - Turkish Journal of Obstetrics and Gynecology

Background and Objectives: Human papillomavirus (HPV) is one of the most prevalent sexually transmitted illnesses. HPV is responsible for genital condyloma lesions. A durable and effective systemic treatment regimen has not been established for HPV-related infections. In the present study, our purpose was to evaluate the role of active hexose correlated compound (AHCC) in preventing relapse in patients who underwent cauterization for condyloma accuminata. Materials and Methods: A total of 244 individuals admitted to our hospital between January 2019 and June 2022 were diagnosed as having condyloma acuminata, and those who underwent condyloma cauterization were evaluated retrospectively. We included 133 individuals who met the criteria. Patients who received AHCC were scheduled for follow-up examinations at regular intervals every three months. Patients were divided into two groups and analyzed based on whether they did or did not use AHCC. Results: The average age of AHCC non-users was significantly greater than that of AHCC users (p < 0.01). The number of condylomas and the maximum condyloma diameter of AHCC users before treatment were found to be significantly higher than in AHCC non-users (p = 0.006 and p = 0.004, respectively). Among participants with recurrence, the number and diameter of condylomas in AHCC users were significantly lower than in AHCC non-users (p = 0.019 and p = 0.042, respectively). Conclusions: Although the usage of AHCC is not expected to help prevent recurrence after the cauterization of condylomata acuminate in all patients, physicians may consider AHCC as a nutritional supplement and supportive therapy in the absence of other systemic treatments. Consequently, the duration of AHCC support necessary to optimize the effect of AHCC use on relapse prevention requires further evaluation on the basis of both target IFN-β levels and HPV infection status.

OBJECTIVE: Our study aimed to examine the function of triglyceride/glucose (TyG) index, TyG-BMI, HOMA-IR, and conventional lipid ratios in determining IR in women with PCOS and to evaluate whether the TyG index is a clinical marker for IR. STUDY DESIGN: A total of 171 individuals with PCOS and 93 control patients who were admitted to our gynecology clinic between January 2018 and January 2024 were evaluated retrospectively. BMI, FBG, QUICKI, HOMA-β, HOMA-IR, FSH, LH, TyG-BMI, TyG, LDL-C, HDL-C, TG, TC, and fasting insulin levels of all patients were retrieved from the hospital database and evaluated retrospectively. RESULTS: The TyG index was significantly higher (8.35±0.44) in the PCOS group compared to the control group (8.23±0.36) (p=0.04). The PCOS group had a significantly higher TyG-BMI index (217.93±46.2) than the control group (199.16±42.4) (p=0.026). The PCOS group had a substantially higher TC/HDL-C ratio (4.52±1.36) than the control group (3.94±1.62) (p=0.016). The PCOS group had a significantly higher TG/HDL-C ratio (2.75±1.18) than the control group (2.15±1.12) (p=0.008). CONCLUSION: According to our research, the TyG index and TyG-BMI demonstrated a strong predictive power in identifying impaired insulin sensitivity in female PCOS patients. The TyG index can serve as a potential surrogate marker for calculating IR in female PCOS patients, as TG and glucose tests are both commonly performed and cost-effective. Further large-scale prospective and epidemiological studies are needed to validate these findings.

Objective: To evaluate the role of serum inflammatory markers in determining colposcopy indications more accurately, reducing unnecessary colposcopy requests, and preventing overtreatment. Materials and Methods: In our study, the data of 218 patients who were followed up in our hospital's oncology outpatient clinic between April 2017 and November 2023 and who underwent colposcopy and biopsy for suspected cervical lesions due to Papanicolaou smear test abnormalities or the presence of human papillomavirus were evaluated retrospectively. The parameters of patients with and without cervical lesions were compared. Patients with cervical lesions were compared according to lesion type. Results: Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio levels were significantly higher in the cervical lesions (+) group compared with the cervical lesions (−) ( p < 0.001 and p < 0.001, respectively). Systemic immuno‐inflammation index and systemic inflammatory response index levels were significantly higher in the cervical lesions (+) group compared with the cervical lesions (−) group ( p < 0.001 and p < 0.001, respectively). Mean platelet volume level was significantly lower in the cervical lesions (+) group compared with the cervical lesions (−) group ( p < 0.001). In the group with cervical lesions, no significant relationship was found between the severity of the cervical lesions and serum inflammatory marker levels. Conclusion: According to the results of our study, although there were significant differences between the serum inflammatory marker levels of patients with and without cervical lesions, their importance in predicting cervical lesions could not be clearly demonstrated. The importance of serum inflammatory markers should be evaluated in prospective studies with larger patient numbers and longer follow‐up periods.