Mine Kiseli | T.C. Ufuk University (original) (raw)
Papers by Mine Kiseli
Aesthetic Surgery Journal
Pan African Medical Journal, 2020
Introduction: Localized Provoked Vulvodynia (LPV) is a gynecological disease that is difficult to... more Introduction: Localized Provoked Vulvodynia (LPV) is a gynecological disease that is difficult to manage. Despite the wide spectrum of pathophysiological mechanisms and treatment modalities, there is limited success in the management of this disease. Surgical treatment is usually performed as the last resort. We aimed to investigate the histopathological results of 38 women with LPV who underwent surgical vestibulectomy. Methods: of the 55 women that were diagnosed with LPV and underwent vulvar vestibulectomy, 38 patients with complete histopathological results were included in this retrospective study. Results: in 14 patients, the pathological reports revealed Low-Grade Squamous Intraepithelial Lesions (LGSIL) (36.8%) whereas for 21 cases (55.2%), the findings were concordant with vestibulitis. The remaining three patients (7.8%) were diagnosed with lichen simplex chronicus. Conclusion: the presence of LGSIL in the surgical specimens of LPV cases is noteworthy. In this group of patients, surgical excision may contribute to the prevention of progression into high-grade lesions. The relationship between Human Papilloma Virus (HPV) infections and LPV should be further investigated.
Aesthetic Surgery Journal, 2020
Background Hymenoplasty is distinct from other genital surgeries with its ethical and psychologic... more Background Hymenoplasty is distinct from other genital surgeries with its ethical and psychological issues. It is performed to narrow the vaginal opening to ensure vaginal bleeding with penetration. There are various kinds of techniques with different success rates. Objectives The authors sought to report a new hymenal reconstruction technique with vestibulo-introital tightening with the results of 145 procedures. Methods The new technique included a diamond-shaped incision to the vestibulum with the base in the posterior midline and superior corner 2 to 3 cm higher above the hymen. The angles were accommodated according to the degree of tightening, and the submucosal layer was closed from the apex downwards involving the vaginal mucosa. Results The satisfaction rate of the patients was 99.3%. No adverse events were observed. Conclusions Compared with previous techniques described, this hymenal reconstruction technique is an alternative with the advantage of low risk of loosening be...
Gazi Medical Journal, 2013
arasında yapılan vajinal doğum ile sezaryen doğum oranlarını ve sezaryen endikasyonları incelemek... more arasında yapılan vajinal doğum ile sezaryen doğum oranlarını ve sezaryen endikasyonları incelemek, sezaryen oranlarının artışı bilgisiyle Türkiye gerçeğine katkı sağlamak ve sezaryen oranlarının azaltılabilmesi için çözüm yolları aramaktır. Yöntemler: Çalışmaya 01.01.2009 ile 31.12.2012 tarihleri arasında Elazığ Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Bölümü'nde doğum yapmış hastalar dahil edilmiştir. Hastaların demografik özellikleri, gravida ve parite durumu, doğum haftası, doğum şekli, sezaryen endikasyonları, doğum ağırlıkları, yenidoğan cinsiyetleri hastane kayıtlarından retrospektif olarak tarandı. Yıllara göre sezaryen oranları ve sezaryen endikasyonları belirlendi. Bulgular: 2009-2012 yılları arasında gerçekleşen 13874 doğumun %55.6'sı (n=7720) normal spontan vajinal doğum, %44.4'ü (n= 6154) ise sezaryen ile doğum gerçekleşmiştir. Tüm doğumlar içindeki sezaryen endikasyonları incelendiğinde; 2391 (%17.2) hastanın mükerrer sezaryen, 387 (%2.7) hastanın makat prezentasyon, 1067 (%7.6) hastanın baş-pelvis uygunsuzluğu ve 1125 (%8.1) hastanın fetal distress, 279 (%2) hastanın makrozomi, kalan hastaların ise diğer nedenler (plasenta dekolmanı, kordon sarkması, çoğul gebelik, preeklampsi) ile sezaryene alındığı tespit edilmiştir. Yıllara göre sezaryen istatistiği incelendiğinde; 2009 yılında %41.6 (n=1491) hastaya, 2010 yılında %45,7 (n=1739) hastaya, 2011 yılında %43 (n=1499) hastaya ve 2012 yılında %43.7 (n=1225) hastaya sezaryen ile doğum uygulandığı saptanmıştır. Sonuç: Sezaryen oranlarımızdaki artış dünyadaki ve Türkiye'deki artış oranlarıyla paralellik göstermektedir. Artmış sezaryen oranlarının azaltılması hekim, hasta ve sağlık politikaları belirleyicilerinin işbirliği ile multidisipliner bir yaklaşım gerektiren stratejilere ihtiyaç duymaktadır.
Türk üreme tıbbı ve cerrahisi dergisi, 2023
Leiomyomlar kadın genital sisteminin en sık görülen iyi huylu tümörleridir. Myomektomi, fertilite... more Leiomyomlar kadın genital sisteminin en sık görülen iyi huylu tümörleridir. Myomektomi, fertiliteyi korumak için iyi bir seçenektir. Myomektomi, hem laparotomi (LT) hem de laparoskopi (LS) ile yapılabilmektedir. LS'de LT'ye göre psödokapsül liflerinin daha iyi korunduğu düşünülmektedir. Psödokapsülün korunması myometriumun sonraki fonksiyonelliği için önemlidir. Bu çalışmada LS ve LT myomektomi yapılmış olgularda, myomektomi spesmenlerinin myom psödokapsül kalınlıklarını karşılaştırmayı amaçladık. Gereç ve Yöntemler: Ufuk Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği'nde Ocak 2018 ve Aralık 2018 tarihleri arasında myomektomi yapılmış olan 121 hasta kaydından 34'ü zarf yöntemiyle seçilerek retrospektif olarak incelenmiştir. Kayıtlar; hastaların yaşları, vücut kitle indeksleri (VKİ), myomektomi endikasyonları, myom sayıları, myom çapları ve geçirilmiş abdominal cerrahi için tarandı. Laparoskopik ve laparotomik myomektomi grupları psödokapsül kalınlığı açısından karşılaştırıldı. Bulgular: Çalışmaya toplam 34 hasta dahil edildi. Bu hastaların 20'sine LT myomektomi (%58.8), 14'üne LS myomektomi (41.1%) yapılmıştı. LT ve LS myomektomi grupları arasında hasta yaşı, VKİ bakımından istatistiksel açıdan anlamlı fark izlenmedi. Myomektomi endikasyonlarının dağılımı da gruplar arasında benzerdi. Geçirilmiş abdominal cerrahisi olan hastaların oranı LT myomektomi grubunda, LS grubuna göre yüksekti (40.0% vs 7.1%; p:0.049, sırasıyla). Psödokapsül kalınlıkları, LT grubunda LS grubuna göre anlamlı olarak yüksekti (1.2 vs 0.75, p:0.013). Sonuç: Bu çalışma LT myomektomi yönteminde eksize edilen psödokapül kalınlığının LS'ye göre artmış olduğunu ve laparoskopide psödokapsülün daha yüksek oranda korunduğunu göstermiştir. Psödokapsülün korunmasının, post-operatif myometrial iyileşme ve bütünlük üzerindeki olumlu etkilerini doğrulayan daha geniş örneklem büyüklüğüne sahip prospektif çalışmalar gerekmektedir. Anah tar Ke li me ler: Leiomyom; uterin myomektomi; laparoskopi; laparotomi ABS TRACT Objective: Leiomyomas are common benign tumors of the female genital tract. Myomectomy is a feasible option for fertility preservation. Myomectomy can be performed with both laparotomy (LT) and laparoscopy (LS). So far it has been assumed that pseudocapsule fibers of myom are better preserved in LS compared to LT. Preservation of pseudocapsule is essential for the subsequent functionality of myometrium. In this study, we aimed to compare the pseudocapsule thicknesses of myomectomy specimens in LS and LT myomectomy. Material and Methods: Among 121 patient records who underwent myomectomy between January 2018 and December 2018 at Ufuk University Faculty of Medicine, Gynecology Clinic, 34 patients were selected randomly with the envelope method and evaluated retrospectively. Records were screened for age, body mass index (BMI), myomectomy indications, number of myomas, fibroid diameters, and previous abdominal surgery. LS and LT myomectomy groups were compared in terms of pseudocapsule thicknesses. Results: A total of 34 patients were included in the study. LT myomectomy was performed in 20 patients (58.8%), and LS myomectomy was performed in 14 (41.1%) patients. There was no significant difference between LT and LS myomectomy groups in terms of age and BMI. Distribution of myomectomy indications was also similar between groups. Pseudocapsule thicknesses were significantly higher in LT myomectomy group compared to LS group (1.2 vs 0.75, p:0.013). Conclusion: This study showed that pseudocapsule preservation was much better in laparoscopy. Prospective studies with larger sample sizes are needed to confirm the positive effects of this finding on post-operative myometrial recovery rates.
Journal of Ovarian Research
Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by chronic ovulatio... more Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by chronic ovulation dysfunction and overabundance of androgens; it affects 6–20% of women of reproductive age. PCOS involves various pathophysiological factors, and affected women usually have significant insulin resistance (IR), which is a major cause of PCOS. IR and compensatory hyperinsulinaemia have differing pathogeneses in various tissues, and IR varies among different PCOS phenotypes. Genetic and epigenetic changes, hyperandrogenaemia, and obesity aggravate IR. Insulin sensitization drugs are a new treatment modality for PCOS. We searched PubMed, Google Scholar, Elsevier, and UpToDate databases in this review, and focused on the pathogenesis of IR in women with PCOS and the pathophysiology of IR in various tissues. In addition, the review provides a comprehensive overview of the current progress in the efficacy of insulin sensitization therapy in the management of PCOS, providing the latest evidenc...
Gynecologic and obstetric investigation, Jan 8, 2016
Our aim was to compare the therapeutic efficacies of norethisterone acid (NETA), tranexamic acid ... more Our aim was to compare the therapeutic efficacies of norethisterone acid (NETA), tranexamic acid and levonorgestrel-releasing intrauterine system (LNG-IUS) in treating idiopathic heavy menstrual bleeding (HMB). Women with heavy uterine bleeding were randomized to receive NETA, tranexamic acid or LNG-IUS for 6 months. The primary outcome was a decrease in menstrual bleeding as assessed by pictorial blood loss assessment charts and hematological parameters analyzed at the 1st, 3rd and 6th months. Health-related quality of life (QOL) variables were also recorded and analyzed. Twenty-eight patients were enrolled in each treatment group, but the results of only 62 were evaluated. NETA, tranexamic acid, and LNG-IUS reduced menstrual blood loss (MBL) by 53.1, 60.8, and 85.8%, respectively, at the 6th month. LNG-IUS was more effective than NETA and tranexamic acid in decreasing MBL. LNG-IUS was also more efficient than tranexamic acid in correcting anemia related to menorrhagia. Satisfactio...
Journal of Obstetrics and Gynaecology, 2021
The current study aimed to analyse and compare the vascularity of FIGO Type 4-7 leiomyoma specime... more The current study aimed to analyse and compare the vascularity of FIGO Type 4-7 leiomyoma specimens obtained from women with or without abnormal uterine bleeding (AUB). The records of 31 women who underwent myomectomy for FIGO Type 4-7 leiomyomas in a university hospital setting were analysed. Group I (n = 16) was composed of women that were symptomatic for AUB and group II (n = 15) consisted of asymptomatic cases. The myomectomy material(s) of each case were processed with CD34 staining and evaluated by Image J® software (Image J 1.52a, Wayne Rasband National Institutes of Health, Bethesda, MD). There was no statistically significant difference between the rates of vascular areas in the specimens of the two groups (p>.05). Although areas with large vessels were higher in group I compared to group II, the difference did not reach statistical significance (p>.05). AUB caused by FIGO Type 4-7 leiomyomas seems to be related to factors other than vascular density.Impact StatementWhat is already known on this subject? Uterine leiomyomas are the most common benign gynaecologic neoplasms with a prevalence of approximately 40% in women of reproductive age. They are most often asymptomatic but when symptomatic, abnormal uterine bleeding (AUB) is one of the most commonly observed symptoms. Although there are some hypothetical explanations, the exact pathogenesis underlying leiomyoma-associated AUB has not yet been elucidated. Almost a century ago, the vascular abnormalities of fibroids were hypothesised as one of the etiopathological factors correlated with clinical symptoms, such as AUB, and current data suggest that the vascular map of leiomyomas consists of an avascular core surrounded by a vascularised capsule. To our knowledge, there are no studies in the literature comparing the histopathological evaluation of the vascularity scores of FIGO Type 4-7 leiomyomas in symptomatic (with AUB) and asymptomatic (without AUB) women.What the results of this study add? The study revealed that there was no statistically significant difference between the vascularity scores of FIGO Type 4-7 leiomyomas excised from the symptomatic and asymptomatic women. Large vessel densities also did not statistically significantly differ between the two groups.What the implications are of these findings for clinical practice and/or further research? This study revealed that AUB caused by FIGO Type 4-7 leiomyomas was related to factors other than vascular density.
Paripex Indian Journal Of Research, 2016
Polycystic ovary syndrome (PCOS) is a common endocrine disease with metabolic, reproductive and p... more Polycystic ovary syndrome (PCOS) is a common endocrine disease with metabolic, reproductive and psychological consequences effecting reproductive age women. In addition to the clinical features of oligo-anovulation, infertility and hyperandrogenism, PCOS is closely interrelated with insulin resistance (IR) and hyperinsulinemia, with a high prevalence. IR is also suggested to have a role in the pathogenesis of PCOS. Post-receptor defects, as well as genetic susceptibility has been held responsible for underlying mechanisms of IR. Assessment of IR includes tests of fasting insulin and blood glucose levels. In especially obese women with PCOS, oral glucose tolerance tests are recommended for screening. To overcome IR, reducing body fat and weight with a healthy diet is the initial step. Therapeutic approach includes insulin-sensitizing agents. The prevention of long-term consequences of IR in PCOS, like cardiovascular disease, type 2 diabetes and endometrium cancer, through appropriate...
Journal of Obstetrics and Gynaecology, 2021
Patients with polycystic ovary syndrome display increased levels of anti-Müllerian hormone. Froze... more Patients with polycystic ovary syndrome display increased levels of anti-Müllerian hormone. Frozen-thawed embryo transfer (FET) prevents ovarian hyperstimulation and results in better pregnancy outcome in PCOS patients. Therefore, we aimed to evaluate the effect of serum AMH levels on the pregnancy outcome of FET cycles in PCOS patients. 110 infertile women with PCOS who were recommended for embryo cryopreservation followed by FET. The patients' AMH levels were evaluated, and the age-related AMH percentiles were determined. The patients were then grouped according to AMH percentiles, namely, 75th-90th percentile (Group 1) and higher than the 90th percentile (Group 2).A total of 110 PCOS patients who conceived in Frozen Embryo Transfer (FET)-In-vitro Fertilisation (IVF) cycles were included in this study. The preterm delivery rates in FET cycles were higher in the group of PCOS patients with AMH levels greater than the 90th percentile than in patients in the 75th-90th percentile group (50% vs 28.8%, p = .024). In conclusion, PCOS patients with AMH levels higher than the 90th percentile had substantially higher preterm delivery rates than those with AMH levels at the 75th-90th percentile, suggesting the need for closer follow-up. Further studies are needed to elucidate the underlying mechanisms behind this correlation.IMPACT STATEMENTWhat is already known on this subject? The association of AMH levels with the risk of adverse pregnancy outcomes has been previously investigated. In women with PCOS, substantially elevated AMH levels were significantly associated with preterm birth.What do the results of this study add? Results showed that the PCOS patients with higher AMH levels and underwent assisted reproductive treatment demonstrated an increased risk of preterm labour than the PCOS patients with lower AMH levels.What are the implications of these findings for clinical practice and/or further research? In women with PCOS, substantially elevated AMH levels were significantly related to preterm birth, suggesting the need for closer follow-up in this population and the need for further studies to elucidate the underlying mechanisms behind this correlation.
The Journal of Maternal-Fetal & Neonatal Medicine, 2019
Introduction: Puerperal infection remains a significant cause of maternal morbidity and mortality... more Introduction: Puerperal infection remains a significant cause of maternal morbidity and mortality. Those infections occur more likely after Cesarean delivery (CD). Prophylactic antibiotics are administered at the time of CD to prevent complications. In addition to intraoperative prophylaxis; prescription of antibiotics during hospital discharge to prevent surgical site infections (SSI) is quite common. Purpose of this study is to determine the utility of prophylactic oral antibiotic prescription in a cohort of low-risk women undergoing CD.
Gynecologic and Obstetric Investigation, 2018
Background: Gastrin-releasing peptide (GRP) is thought to play a role in the metastatic process o... more Background: Gastrin-releasing peptide (GRP) is thought to play a role in the metastatic process of various malignancies. The more stable precursor of GRP, pro-GRP (ProGRP), has been shown to be secreted by neuroendocrine tumors. This study was designed to assess the validity of ProGRP as a diagnostic marker in endometrioid adenocarcinomas (EAs) of the endometrium. Methods: Thirty-seven patients with a diagnosis of EA, 23 patients with endometrial hyperplasia, and 32 age-matched controls with normal endometrial histology were recruited for this study. Serum ProGRP and cancer antigen 125 (CA125) values were compared between groups. Results: Median serum ProGRP levels were significantly higher in the cancer group compared to corresponding levels in both the hyperplasia and control groups (p = 0.008 and p < 0.001 respectively; endometrial cancer: 27.5 pg/mL; hyperplasia: 16.1 pg/mL; controls: 12.9 pg/mL). Age and endometrial thickness were positively correlated with ProGRP levels (r ...
Türk Üreme Tıbbı ve Cerrahisi Dergisi, 2017
Acta Oncologica Turcica, 2017
Önemi belirlenemeyen atipik skuamöz hücreler (ASC-US) tanısı koyduğumuz Papanicolau (PAP) smear ö... more Önemi belirlenemeyen atipik skuamöz hücreler (ASC-US) tanısı koyduğumuz Papanicolau (PAP) smear örneklerinin, tekrar üretilebilirliği, Bethesda tanı kriterlerinden hangilerini karşıladığı ve tanı kriterlerinin servikal histopatolojiye yansımasını araştırmayı planladık. Ayrıca Pap smear sonucu ASC-US olan hastaların servikal biyopsi örneklerinde p16 antikor varlığı araştırıldı. Yöntem ve Gereçler: Bölümümüzde 2006-2013 yılları arasında ASC-US tanısı konulan hastalardan servikal histopatolojik incelemesi yapılmış olan 33 hastayı çalışmamıza dahil ettik. Tüm Pap smear örnekleri iki patolog tarafından, aynı anda tekrar değerlendirildi. Her örneğin 2001 Bethesda ASC-US tanı kriterlerinden hangilerini karşıladığı ayrı ayrı belirlendi. Her biyopsi örneği p16 antikoru ile boyandı. Bulgular: Bölümümüzde Pap smear sonucu ASC-US olan raporların tekrar üretilebilirlik oranı %88 olarak bulundu. Bethesda'nın 4 tanı kriterinden herhangi biri için, CIN 1 ve malignite yönünden negatif vakalarda görülme sıklıkları bakımından anlamlı bir farklılığa rastlanamadı (p>0,05). Tüm ASC-US vakalarında örnek başına pozitif tanı kriteri sayısı ortalaması ise 2,7±0,9'dur. Malignite yönünden negatif olarak raporlanmış ve CIN olarak raporlanmış vakalarda ortalama kaç kriterin bir arada pozitif olduğu incelendi, istatistiksel olarak anlamlı bir farklılık olmadığı görüldü. ASC-US tanısı konulan vakaların histopatolojik örneklerinde p16 boyanma oranı %18 olarak bulundu. Çalışmamızda p16 immünohistokimyasal boyamanın CIN tanısı koymada duyarlılığı %46, özgüllüğü ise %100'dür. Tartışma ve Sonuç: Pap smear incelemelerinde Bethesda sistemi kullanılarak ASC-US tanısı konulan vakalarımızın %39'unda altta yatan bir servikal intraepitelyal neoplazi bulunduğu saptanmıştır. Bethesda ASC-US tanı kriterlerinden hiçbiri olası neoplastik değişiklikleri öngörmede tek başına diğer kriterlerden üstün değildir. ASC-US tanısı konulurken Bethesda tanı kriterlerinin her birinin varlığı ayrı ayrı araştırılmalı ve en az 2, tercihen 3 kriterin pozitif olması tercih edilmelidir. p16 antikorunun yalancı pozitiflik oranının oldukça düşük olduğu, bu sayede neoplazi potansiyeli taşıyan vakaların belirlenmesinin kolaylaştığı görülmüştür. İlerleyen yıllarda p16 boyanmasının sitopatolojiyle birlikte kullanılabilecek önemli bir tanısal araç haline geleceği düşünülmektedir.
Türk Üreme Tıbbı ve Cerrahisi Dergisi, 2017
Is to evaluate the impact of body mass index (BMI) levels on pregnancy outcomes in high-responder... more Is to evaluate the impact of body mass index (BMI) levels on pregnancy outcomes in high-responders undergoing assisted reproductive technology (ART). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Total of 120 high responders was allocated to the study. High response was defined as having high serum AMH levels (>4 ng/ml). Subjects were divided into three groups according to their BMI values; normal weight 57 (BMI 18.5-24.9 kg/m 2), overweight 42 (25-29.9 kg/m 2) and obese 21 subjects (BMI ≥30 kg/m 2) were compared for pregnancy outcomes and Ovarian Hyperstimulation Syndrome (OHSS) rates. Gonadotropin starting dose was fixed to 150 IU/day in antagonist co-treated cycles for all subjects. R Re es su ul lt ts s: : A total of 120 cycles were evaluated. In patients with BMI ≥30 kg/m 2 , the total gonadotropin use was significantly higher (p<0.001) and number of retrieved oocytes was significantly lower (p=0.001) when compared to other groups. In normal weight patients, significantly higher numbers of mature oocytes and 2PN embryos were obtained when compared with other groups (p<0.001). Other parameters including number of good quality embryos available for transfer, implantation, biochemical, clinical pregnancy and OHSS rates were similar between all groups. C Co on nc cl lu us si io on n: : Our results did not reveal a significant effect of BMI on the ART outcomes of high responder infertile women. Although higher BMI was correlated with less number of retrieved oocytes, it did not resulted with a negative impact on pregnancy outcomes. Another interesting finding was the trend to a less OHSS incidence with the increase in BMI of high responder patients. K Ke ey y W Wo or rd ds s: : AMH, BMI, high responder, OHSS, pregnancy Ö ÖZ ZE ET T A Am ma aç ç: : Yardımla üreme teknikleri (YÜT) uygulanan yüksek ovaryen yanıtlı olgularda, farklı beden kitle indeksinin (BKİ), gebelik sonuçları üzerine etkisini incelemek. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Farklı BKİ değerlerine sahip toplam 120 yüksek ovaryen yanıtlı olgu çalışmaya dahil edildi. Yüksek yanıt kriteri olarak olgudaki serum AMH değerinin >4 ng/ml olması kabul edildi. BKİ değerlerine göre olgular 3 gruba ayrıldı: normal kilolu 57 olgu (BKİ 18,5-24,9 kg/m 2), fazla kilolu 42 olgu (BKİ 25-29,9 kg/m 2), obez 21 olgu (BKİ >30 kg/m 2), gebelik ve ovaryen hiperstimulasyon sendromu (OHSS) oranları açısından karşılaştırıldı. B Bu ul lg gu ul la ar r: : Obez grupta, hem kullanılan gonadotropin dozu hem de toplanan oosit sayısı, diğer 2 gruba göre anlamlı olarak daha az saptandı (p<0,05). Fertilizasyon, gebelik oranları ve diğer parametreler açısından gruplar arasında farklılık saptanmadı. S So on nu uç ç: : YÜT uygulaması yapılan yüksek yanıtlı olgularda, BKİ değerlerinin, YÜT sonuçlarına belirgin etkisinin olmadığı ortaya konulmuştur. Obez olgularda toplanan oosit sayısının az olmasının yanında, gebelik oranlarında farklılık saptanmamıştır. OHSS oranlarının, BKİ arttıkça bir miktar azaldığı gözlenmiştir.
Journal of Obstetrics and Gynaecology, 2016
Uterine incarceration during pregnancy is a rare complication with an incidence of 1 in 3000 preg... more Uterine incarceration during pregnancy is a rare complication with an incidence of 1 in 3000 pregnancies (Gibbons and Paley, 1969). Anatomic displacement of the growing uterus may cause adjacent organ distortion, with variable symptomatology. Common symptoms presented are abdominal pain, rectal pressure and urinary complaints such as retention or incontinence (Gardner et al. 2013). Early and accurate diagnosis for avoiding the devastating perinatal complications is critical. Here, we discuss the feasibility of ventro-fixation during pregnancy in cases of uterine incarceration to resume safe gestation and improve the chances of vaginal delivery.
Gynecology Obstetrics & Reproductive Medicine, 2016
Uterine compression sutures may be life and fertility saving interventions in management of uteri... more Uterine compression sutures may be life and fertility saving interventions in management of uterine atony. However, unintended long-term outcomes may occur and there is scarce literature about management. Herein, management of long-term adverse outcomes (synechia, pelvic pain and pelvic collection) of three different cases who had to be treated by uterine compression sutures is reported with review of the literature.
The Journal of Maternal-Fetal & Neonatal Medicine, 2016
To determine urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels and creatinine cle... more To determine urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels and creatinine clearance values in women with different degrees of asymptomatic hydronephrosis during pregnancy. A total of 44 pregnant women with different degrees of hydronephrosis and 46 without hydronephrosis were consecutively enrolled in this prospective study. Basic serum and urine parameters, uNGAL levels, and creatinine clearance values were evaluated. All results were compared between the two groups. Regression analysis was used to determine independent predictors, which were mostly related to hydronephrosis. Demographic data, basal laboratory parameters, and creatinine clearance values were similar, whereas significantly higher uNGAL levels were detected in women with hydronephrosis compared to those without hydronephrosis (45.3 versus 33.2 ng/mL, respectively) (p = 0.004). An increasing trend in uNGAL levels was detected with increasing degrees of hydronephrosis; as it was not statistically significant (p = 0.163). Linear regression analysis revealed that the parameter of "pelvic diameter" was found as a significant independent factor influencing uNGAL concentrations (β = 0.289; 95% CI: 0.522-3.061; p = 0.006). Other independent variables were not found to influence uNGAL concentrations (p > 0.05). The results obtained from this study indicate a significant increase of urinary concentration of NGAL in the presence of asymptomatic maternal hydronephrosis. This impact is likely to be more profound in those with severe hydronephrosis although this has not been specifically investigated. This theory needs to be validated in larger populations.
Gynecology Obstetrics & Reproductive Medicine, 2016
OBJECTIVE: To investigate the peripheral blood components, neutrophil/lymphocyte ratio (NLR) and ... more OBJECTIVE: To investigate the peripheral blood components, neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratios (PLR) in cervical cytological abnormalities. STUDY DESIGN: We retrospectively analyzed 185 cases with abnormal and 303 cases with normal cervicovaginal smears (CVS) with blood count profile, from a total number of 9286 patients. RESULTS: Abnormal CVS results consisted of 137 (72%) ASC-US, 16 (8%) ASC-H, 19 (10%) L-SIL, 4 (2%) H-SIL and 9 (4%) AGUS. NLR and PLR of abnormal CVS group were higher than control group (p<0.001). The lymphocyte count was significantly lower in abnormal CVS cases (p<0.001). The number of patients with neutrophilia (neutrophils ≥70% of the total leukocytes) was similar among two groups (p>0.05). CONCLUSION: Neutrophilia is not observed in cervical preinvasive lesions whereas it is common in cervical cancer. In this study, absence of increased neutrophil counts and presence of lymphopenia in patients with abnormal cervical cytology, may indicate an early measure in cervical pathologies.
Gynecologic and obstetric investigation, Jan 19, 2016
To document alterations in Anti-Müllerian hormone (AMH) levels with different energy doses by mon... more To document alterations in Anti-Müllerian hormone (AMH) levels with different energy doses by monopolar cautery in ovarian drilling (OD) in rats. Forty Wistar rats were randomly divided into 4 groups that each contained 10 animals. Group A was the Sham group. Groups B, C and D were intervention groups to which OD was applied by monopolar cautery, with 20, 60 and 120 J/ovary, respectively. The total amount of energy was calculated using the following formula: energy (J) = power (W) × duration (s) × number of punctures. The pre- and postoperative AMH levels for Groups A, B and C were not statistically and significantly different according to the Bonferroni correction (p > 0.0125). However, the postoperative AMH levels were significantly lower than the preoperative AMH levels in Group D (1.25 ng/ml (1.07-2.05) vs. 0.40 ng/ml (0.30-0.72); p = 0.012). AMH is a promising marker that can be used for the individualization of the energy dose to increase OD success, but the relationship be...
Aesthetic Surgery Journal
Pan African Medical Journal, 2020
Introduction: Localized Provoked Vulvodynia (LPV) is a gynecological disease that is difficult to... more Introduction: Localized Provoked Vulvodynia (LPV) is a gynecological disease that is difficult to manage. Despite the wide spectrum of pathophysiological mechanisms and treatment modalities, there is limited success in the management of this disease. Surgical treatment is usually performed as the last resort. We aimed to investigate the histopathological results of 38 women with LPV who underwent surgical vestibulectomy. Methods: of the 55 women that were diagnosed with LPV and underwent vulvar vestibulectomy, 38 patients with complete histopathological results were included in this retrospective study. Results: in 14 patients, the pathological reports revealed Low-Grade Squamous Intraepithelial Lesions (LGSIL) (36.8%) whereas for 21 cases (55.2%), the findings were concordant with vestibulitis. The remaining three patients (7.8%) were diagnosed with lichen simplex chronicus. Conclusion: the presence of LGSIL in the surgical specimens of LPV cases is noteworthy. In this group of patients, surgical excision may contribute to the prevention of progression into high-grade lesions. The relationship between Human Papilloma Virus (HPV) infections and LPV should be further investigated.
Aesthetic Surgery Journal, 2020
Background Hymenoplasty is distinct from other genital surgeries with its ethical and psychologic... more Background Hymenoplasty is distinct from other genital surgeries with its ethical and psychological issues. It is performed to narrow the vaginal opening to ensure vaginal bleeding with penetration. There are various kinds of techniques with different success rates. Objectives The authors sought to report a new hymenal reconstruction technique with vestibulo-introital tightening with the results of 145 procedures. Methods The new technique included a diamond-shaped incision to the vestibulum with the base in the posterior midline and superior corner 2 to 3 cm higher above the hymen. The angles were accommodated according to the degree of tightening, and the submucosal layer was closed from the apex downwards involving the vaginal mucosa. Results The satisfaction rate of the patients was 99.3%. No adverse events were observed. Conclusions Compared with previous techniques described, this hymenal reconstruction technique is an alternative with the advantage of low risk of loosening be...
Gazi Medical Journal, 2013
arasında yapılan vajinal doğum ile sezaryen doğum oranlarını ve sezaryen endikasyonları incelemek... more arasında yapılan vajinal doğum ile sezaryen doğum oranlarını ve sezaryen endikasyonları incelemek, sezaryen oranlarının artışı bilgisiyle Türkiye gerçeğine katkı sağlamak ve sezaryen oranlarının azaltılabilmesi için çözüm yolları aramaktır. Yöntemler: Çalışmaya 01.01.2009 ile 31.12.2012 tarihleri arasında Elazığ Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Bölümü'nde doğum yapmış hastalar dahil edilmiştir. Hastaların demografik özellikleri, gravida ve parite durumu, doğum haftası, doğum şekli, sezaryen endikasyonları, doğum ağırlıkları, yenidoğan cinsiyetleri hastane kayıtlarından retrospektif olarak tarandı. Yıllara göre sezaryen oranları ve sezaryen endikasyonları belirlendi. Bulgular: 2009-2012 yılları arasında gerçekleşen 13874 doğumun %55.6'sı (n=7720) normal spontan vajinal doğum, %44.4'ü (n= 6154) ise sezaryen ile doğum gerçekleşmiştir. Tüm doğumlar içindeki sezaryen endikasyonları incelendiğinde; 2391 (%17.2) hastanın mükerrer sezaryen, 387 (%2.7) hastanın makat prezentasyon, 1067 (%7.6) hastanın baş-pelvis uygunsuzluğu ve 1125 (%8.1) hastanın fetal distress, 279 (%2) hastanın makrozomi, kalan hastaların ise diğer nedenler (plasenta dekolmanı, kordon sarkması, çoğul gebelik, preeklampsi) ile sezaryene alındığı tespit edilmiştir. Yıllara göre sezaryen istatistiği incelendiğinde; 2009 yılında %41.6 (n=1491) hastaya, 2010 yılında %45,7 (n=1739) hastaya, 2011 yılında %43 (n=1499) hastaya ve 2012 yılında %43.7 (n=1225) hastaya sezaryen ile doğum uygulandığı saptanmıştır. Sonuç: Sezaryen oranlarımızdaki artış dünyadaki ve Türkiye'deki artış oranlarıyla paralellik göstermektedir. Artmış sezaryen oranlarının azaltılması hekim, hasta ve sağlık politikaları belirleyicilerinin işbirliği ile multidisipliner bir yaklaşım gerektiren stratejilere ihtiyaç duymaktadır.
Türk üreme tıbbı ve cerrahisi dergisi, 2023
Leiomyomlar kadın genital sisteminin en sık görülen iyi huylu tümörleridir. Myomektomi, fertilite... more Leiomyomlar kadın genital sisteminin en sık görülen iyi huylu tümörleridir. Myomektomi, fertiliteyi korumak için iyi bir seçenektir. Myomektomi, hem laparotomi (LT) hem de laparoskopi (LS) ile yapılabilmektedir. LS'de LT'ye göre psödokapsül liflerinin daha iyi korunduğu düşünülmektedir. Psödokapsülün korunması myometriumun sonraki fonksiyonelliği için önemlidir. Bu çalışmada LS ve LT myomektomi yapılmış olgularda, myomektomi spesmenlerinin myom psödokapsül kalınlıklarını karşılaştırmayı amaçladık. Gereç ve Yöntemler: Ufuk Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği'nde Ocak 2018 ve Aralık 2018 tarihleri arasında myomektomi yapılmış olan 121 hasta kaydından 34'ü zarf yöntemiyle seçilerek retrospektif olarak incelenmiştir. Kayıtlar; hastaların yaşları, vücut kitle indeksleri (VKİ), myomektomi endikasyonları, myom sayıları, myom çapları ve geçirilmiş abdominal cerrahi için tarandı. Laparoskopik ve laparotomik myomektomi grupları psödokapsül kalınlığı açısından karşılaştırıldı. Bulgular: Çalışmaya toplam 34 hasta dahil edildi. Bu hastaların 20'sine LT myomektomi (%58.8), 14'üne LS myomektomi (41.1%) yapılmıştı. LT ve LS myomektomi grupları arasında hasta yaşı, VKİ bakımından istatistiksel açıdan anlamlı fark izlenmedi. Myomektomi endikasyonlarının dağılımı da gruplar arasında benzerdi. Geçirilmiş abdominal cerrahisi olan hastaların oranı LT myomektomi grubunda, LS grubuna göre yüksekti (40.0% vs 7.1%; p:0.049, sırasıyla). Psödokapsül kalınlıkları, LT grubunda LS grubuna göre anlamlı olarak yüksekti (1.2 vs 0.75, p:0.013). Sonuç: Bu çalışma LT myomektomi yönteminde eksize edilen psödokapül kalınlığının LS'ye göre artmış olduğunu ve laparoskopide psödokapsülün daha yüksek oranda korunduğunu göstermiştir. Psödokapsülün korunmasının, post-operatif myometrial iyileşme ve bütünlük üzerindeki olumlu etkilerini doğrulayan daha geniş örneklem büyüklüğüne sahip prospektif çalışmalar gerekmektedir. Anah tar Ke li me ler: Leiomyom; uterin myomektomi; laparoskopi; laparotomi ABS TRACT Objective: Leiomyomas are common benign tumors of the female genital tract. Myomectomy is a feasible option for fertility preservation. Myomectomy can be performed with both laparotomy (LT) and laparoscopy (LS). So far it has been assumed that pseudocapsule fibers of myom are better preserved in LS compared to LT. Preservation of pseudocapsule is essential for the subsequent functionality of myometrium. In this study, we aimed to compare the pseudocapsule thicknesses of myomectomy specimens in LS and LT myomectomy. Material and Methods: Among 121 patient records who underwent myomectomy between January 2018 and December 2018 at Ufuk University Faculty of Medicine, Gynecology Clinic, 34 patients were selected randomly with the envelope method and evaluated retrospectively. Records were screened for age, body mass index (BMI), myomectomy indications, number of myomas, fibroid diameters, and previous abdominal surgery. LS and LT myomectomy groups were compared in terms of pseudocapsule thicknesses. Results: A total of 34 patients were included in the study. LT myomectomy was performed in 20 patients (58.8%), and LS myomectomy was performed in 14 (41.1%) patients. There was no significant difference between LT and LS myomectomy groups in terms of age and BMI. Distribution of myomectomy indications was also similar between groups. Pseudocapsule thicknesses were significantly higher in LT myomectomy group compared to LS group (1.2 vs 0.75, p:0.013). Conclusion: This study showed that pseudocapsule preservation was much better in laparoscopy. Prospective studies with larger sample sizes are needed to confirm the positive effects of this finding on post-operative myometrial recovery rates.
Journal of Ovarian Research
Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by chronic ovulatio... more Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by chronic ovulation dysfunction and overabundance of androgens; it affects 6–20% of women of reproductive age. PCOS involves various pathophysiological factors, and affected women usually have significant insulin resistance (IR), which is a major cause of PCOS. IR and compensatory hyperinsulinaemia have differing pathogeneses in various tissues, and IR varies among different PCOS phenotypes. Genetic and epigenetic changes, hyperandrogenaemia, and obesity aggravate IR. Insulin sensitization drugs are a new treatment modality for PCOS. We searched PubMed, Google Scholar, Elsevier, and UpToDate databases in this review, and focused on the pathogenesis of IR in women with PCOS and the pathophysiology of IR in various tissues. In addition, the review provides a comprehensive overview of the current progress in the efficacy of insulin sensitization therapy in the management of PCOS, providing the latest evidenc...
Gynecologic and obstetric investigation, Jan 8, 2016
Our aim was to compare the therapeutic efficacies of norethisterone acid (NETA), tranexamic acid ... more Our aim was to compare the therapeutic efficacies of norethisterone acid (NETA), tranexamic acid and levonorgestrel-releasing intrauterine system (LNG-IUS) in treating idiopathic heavy menstrual bleeding (HMB). Women with heavy uterine bleeding were randomized to receive NETA, tranexamic acid or LNG-IUS for 6 months. The primary outcome was a decrease in menstrual bleeding as assessed by pictorial blood loss assessment charts and hematological parameters analyzed at the 1st, 3rd and 6th months. Health-related quality of life (QOL) variables were also recorded and analyzed. Twenty-eight patients were enrolled in each treatment group, but the results of only 62 were evaluated. NETA, tranexamic acid, and LNG-IUS reduced menstrual blood loss (MBL) by 53.1, 60.8, and 85.8%, respectively, at the 6th month. LNG-IUS was more effective than NETA and tranexamic acid in decreasing MBL. LNG-IUS was also more efficient than tranexamic acid in correcting anemia related to menorrhagia. Satisfactio...
Journal of Obstetrics and Gynaecology, 2021
The current study aimed to analyse and compare the vascularity of FIGO Type 4-7 leiomyoma specime... more The current study aimed to analyse and compare the vascularity of FIGO Type 4-7 leiomyoma specimens obtained from women with or without abnormal uterine bleeding (AUB). The records of 31 women who underwent myomectomy for FIGO Type 4-7 leiomyomas in a university hospital setting were analysed. Group I (n = 16) was composed of women that were symptomatic for AUB and group II (n = 15) consisted of asymptomatic cases. The myomectomy material(s) of each case were processed with CD34 staining and evaluated by Image J® software (Image J 1.52a, Wayne Rasband National Institutes of Health, Bethesda, MD). There was no statistically significant difference between the rates of vascular areas in the specimens of the two groups (p>.05). Although areas with large vessels were higher in group I compared to group II, the difference did not reach statistical significance (p>.05). AUB caused by FIGO Type 4-7 leiomyomas seems to be related to factors other than vascular density.Impact StatementWhat is already known on this subject? Uterine leiomyomas are the most common benign gynaecologic neoplasms with a prevalence of approximately 40% in women of reproductive age. They are most often asymptomatic but when symptomatic, abnormal uterine bleeding (AUB) is one of the most commonly observed symptoms. Although there are some hypothetical explanations, the exact pathogenesis underlying leiomyoma-associated AUB has not yet been elucidated. Almost a century ago, the vascular abnormalities of fibroids were hypothesised as one of the etiopathological factors correlated with clinical symptoms, such as AUB, and current data suggest that the vascular map of leiomyomas consists of an avascular core surrounded by a vascularised capsule. To our knowledge, there are no studies in the literature comparing the histopathological evaluation of the vascularity scores of FIGO Type 4-7 leiomyomas in symptomatic (with AUB) and asymptomatic (without AUB) women.What the results of this study add? The study revealed that there was no statistically significant difference between the vascularity scores of FIGO Type 4-7 leiomyomas excised from the symptomatic and asymptomatic women. Large vessel densities also did not statistically significantly differ between the two groups.What the implications are of these findings for clinical practice and/or further research? This study revealed that AUB caused by FIGO Type 4-7 leiomyomas was related to factors other than vascular density.
Paripex Indian Journal Of Research, 2016
Polycystic ovary syndrome (PCOS) is a common endocrine disease with metabolic, reproductive and p... more Polycystic ovary syndrome (PCOS) is a common endocrine disease with metabolic, reproductive and psychological consequences effecting reproductive age women. In addition to the clinical features of oligo-anovulation, infertility and hyperandrogenism, PCOS is closely interrelated with insulin resistance (IR) and hyperinsulinemia, with a high prevalence. IR is also suggested to have a role in the pathogenesis of PCOS. Post-receptor defects, as well as genetic susceptibility has been held responsible for underlying mechanisms of IR. Assessment of IR includes tests of fasting insulin and blood glucose levels. In especially obese women with PCOS, oral glucose tolerance tests are recommended for screening. To overcome IR, reducing body fat and weight with a healthy diet is the initial step. Therapeutic approach includes insulin-sensitizing agents. The prevention of long-term consequences of IR in PCOS, like cardiovascular disease, type 2 diabetes and endometrium cancer, through appropriate...
Journal of Obstetrics and Gynaecology, 2021
Patients with polycystic ovary syndrome display increased levels of anti-Müllerian hormone. Froze... more Patients with polycystic ovary syndrome display increased levels of anti-Müllerian hormone. Frozen-thawed embryo transfer (FET) prevents ovarian hyperstimulation and results in better pregnancy outcome in PCOS patients. Therefore, we aimed to evaluate the effect of serum AMH levels on the pregnancy outcome of FET cycles in PCOS patients. 110 infertile women with PCOS who were recommended for embryo cryopreservation followed by FET. The patients' AMH levels were evaluated, and the age-related AMH percentiles were determined. The patients were then grouped according to AMH percentiles, namely, 75th-90th percentile (Group 1) and higher than the 90th percentile (Group 2).A total of 110 PCOS patients who conceived in Frozen Embryo Transfer (FET)-In-vitro Fertilisation (IVF) cycles were included in this study. The preterm delivery rates in FET cycles were higher in the group of PCOS patients with AMH levels greater than the 90th percentile than in patients in the 75th-90th percentile group (50% vs 28.8%, p = .024). In conclusion, PCOS patients with AMH levels higher than the 90th percentile had substantially higher preterm delivery rates than those with AMH levels at the 75th-90th percentile, suggesting the need for closer follow-up. Further studies are needed to elucidate the underlying mechanisms behind this correlation.IMPACT STATEMENTWhat is already known on this subject? The association of AMH levels with the risk of adverse pregnancy outcomes has been previously investigated. In women with PCOS, substantially elevated AMH levels were significantly associated with preterm birth.What do the results of this study add? Results showed that the PCOS patients with higher AMH levels and underwent assisted reproductive treatment demonstrated an increased risk of preterm labour than the PCOS patients with lower AMH levels.What are the implications of these findings for clinical practice and/or further research? In women with PCOS, substantially elevated AMH levels were significantly related to preterm birth, suggesting the need for closer follow-up in this population and the need for further studies to elucidate the underlying mechanisms behind this correlation.
The Journal of Maternal-Fetal & Neonatal Medicine, 2019
Introduction: Puerperal infection remains a significant cause of maternal morbidity and mortality... more Introduction: Puerperal infection remains a significant cause of maternal morbidity and mortality. Those infections occur more likely after Cesarean delivery (CD). Prophylactic antibiotics are administered at the time of CD to prevent complications. In addition to intraoperative prophylaxis; prescription of antibiotics during hospital discharge to prevent surgical site infections (SSI) is quite common. Purpose of this study is to determine the utility of prophylactic oral antibiotic prescription in a cohort of low-risk women undergoing CD.
Gynecologic and Obstetric Investigation, 2018
Background: Gastrin-releasing peptide (GRP) is thought to play a role in the metastatic process o... more Background: Gastrin-releasing peptide (GRP) is thought to play a role in the metastatic process of various malignancies. The more stable precursor of GRP, pro-GRP (ProGRP), has been shown to be secreted by neuroendocrine tumors. This study was designed to assess the validity of ProGRP as a diagnostic marker in endometrioid adenocarcinomas (EAs) of the endometrium. Methods: Thirty-seven patients with a diagnosis of EA, 23 patients with endometrial hyperplasia, and 32 age-matched controls with normal endometrial histology were recruited for this study. Serum ProGRP and cancer antigen 125 (CA125) values were compared between groups. Results: Median serum ProGRP levels were significantly higher in the cancer group compared to corresponding levels in both the hyperplasia and control groups (p = 0.008 and p < 0.001 respectively; endometrial cancer: 27.5 pg/mL; hyperplasia: 16.1 pg/mL; controls: 12.9 pg/mL). Age and endometrial thickness were positively correlated with ProGRP levels (r ...
Türk Üreme Tıbbı ve Cerrahisi Dergisi, 2017
Acta Oncologica Turcica, 2017
Önemi belirlenemeyen atipik skuamöz hücreler (ASC-US) tanısı koyduğumuz Papanicolau (PAP) smear ö... more Önemi belirlenemeyen atipik skuamöz hücreler (ASC-US) tanısı koyduğumuz Papanicolau (PAP) smear örneklerinin, tekrar üretilebilirliği, Bethesda tanı kriterlerinden hangilerini karşıladığı ve tanı kriterlerinin servikal histopatolojiye yansımasını araştırmayı planladık. Ayrıca Pap smear sonucu ASC-US olan hastaların servikal biyopsi örneklerinde p16 antikor varlığı araştırıldı. Yöntem ve Gereçler: Bölümümüzde 2006-2013 yılları arasında ASC-US tanısı konulan hastalardan servikal histopatolojik incelemesi yapılmış olan 33 hastayı çalışmamıza dahil ettik. Tüm Pap smear örnekleri iki patolog tarafından, aynı anda tekrar değerlendirildi. Her örneğin 2001 Bethesda ASC-US tanı kriterlerinden hangilerini karşıladığı ayrı ayrı belirlendi. Her biyopsi örneği p16 antikoru ile boyandı. Bulgular: Bölümümüzde Pap smear sonucu ASC-US olan raporların tekrar üretilebilirlik oranı %88 olarak bulundu. Bethesda'nın 4 tanı kriterinden herhangi biri için, CIN 1 ve malignite yönünden negatif vakalarda görülme sıklıkları bakımından anlamlı bir farklılığa rastlanamadı (p>0,05). Tüm ASC-US vakalarında örnek başına pozitif tanı kriteri sayısı ortalaması ise 2,7±0,9'dur. Malignite yönünden negatif olarak raporlanmış ve CIN olarak raporlanmış vakalarda ortalama kaç kriterin bir arada pozitif olduğu incelendi, istatistiksel olarak anlamlı bir farklılık olmadığı görüldü. ASC-US tanısı konulan vakaların histopatolojik örneklerinde p16 boyanma oranı %18 olarak bulundu. Çalışmamızda p16 immünohistokimyasal boyamanın CIN tanısı koymada duyarlılığı %46, özgüllüğü ise %100'dür. Tartışma ve Sonuç: Pap smear incelemelerinde Bethesda sistemi kullanılarak ASC-US tanısı konulan vakalarımızın %39'unda altta yatan bir servikal intraepitelyal neoplazi bulunduğu saptanmıştır. Bethesda ASC-US tanı kriterlerinden hiçbiri olası neoplastik değişiklikleri öngörmede tek başına diğer kriterlerden üstün değildir. ASC-US tanısı konulurken Bethesda tanı kriterlerinin her birinin varlığı ayrı ayrı araştırılmalı ve en az 2, tercihen 3 kriterin pozitif olması tercih edilmelidir. p16 antikorunun yalancı pozitiflik oranının oldukça düşük olduğu, bu sayede neoplazi potansiyeli taşıyan vakaların belirlenmesinin kolaylaştığı görülmüştür. İlerleyen yıllarda p16 boyanmasının sitopatolojiyle birlikte kullanılabilecek önemli bir tanısal araç haline geleceği düşünülmektedir.
Türk Üreme Tıbbı ve Cerrahisi Dergisi, 2017
Is to evaluate the impact of body mass index (BMI) levels on pregnancy outcomes in high-responder... more Is to evaluate the impact of body mass index (BMI) levels on pregnancy outcomes in high-responders undergoing assisted reproductive technology (ART). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Total of 120 high responders was allocated to the study. High response was defined as having high serum AMH levels (>4 ng/ml). Subjects were divided into three groups according to their BMI values; normal weight 57 (BMI 18.5-24.9 kg/m 2), overweight 42 (25-29.9 kg/m 2) and obese 21 subjects (BMI ≥30 kg/m 2) were compared for pregnancy outcomes and Ovarian Hyperstimulation Syndrome (OHSS) rates. Gonadotropin starting dose was fixed to 150 IU/day in antagonist co-treated cycles for all subjects. R Re es su ul lt ts s: : A total of 120 cycles were evaluated. In patients with BMI ≥30 kg/m 2 , the total gonadotropin use was significantly higher (p<0.001) and number of retrieved oocytes was significantly lower (p=0.001) when compared to other groups. In normal weight patients, significantly higher numbers of mature oocytes and 2PN embryos were obtained when compared with other groups (p<0.001). Other parameters including number of good quality embryos available for transfer, implantation, biochemical, clinical pregnancy and OHSS rates were similar between all groups. C Co on nc cl lu us si io on n: : Our results did not reveal a significant effect of BMI on the ART outcomes of high responder infertile women. Although higher BMI was correlated with less number of retrieved oocytes, it did not resulted with a negative impact on pregnancy outcomes. Another interesting finding was the trend to a less OHSS incidence with the increase in BMI of high responder patients. K Ke ey y W Wo or rd ds s: : AMH, BMI, high responder, OHSS, pregnancy Ö ÖZ ZE ET T A Am ma aç ç: : Yardımla üreme teknikleri (YÜT) uygulanan yüksek ovaryen yanıtlı olgularda, farklı beden kitle indeksinin (BKİ), gebelik sonuçları üzerine etkisini incelemek. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Farklı BKİ değerlerine sahip toplam 120 yüksek ovaryen yanıtlı olgu çalışmaya dahil edildi. Yüksek yanıt kriteri olarak olgudaki serum AMH değerinin >4 ng/ml olması kabul edildi. BKİ değerlerine göre olgular 3 gruba ayrıldı: normal kilolu 57 olgu (BKİ 18,5-24,9 kg/m 2), fazla kilolu 42 olgu (BKİ 25-29,9 kg/m 2), obez 21 olgu (BKİ >30 kg/m 2), gebelik ve ovaryen hiperstimulasyon sendromu (OHSS) oranları açısından karşılaştırıldı. B Bu ul lg gu ul la ar r: : Obez grupta, hem kullanılan gonadotropin dozu hem de toplanan oosit sayısı, diğer 2 gruba göre anlamlı olarak daha az saptandı (p<0,05). Fertilizasyon, gebelik oranları ve diğer parametreler açısından gruplar arasında farklılık saptanmadı. S So on nu uç ç: : YÜT uygulaması yapılan yüksek yanıtlı olgularda, BKİ değerlerinin, YÜT sonuçlarına belirgin etkisinin olmadığı ortaya konulmuştur. Obez olgularda toplanan oosit sayısının az olmasının yanında, gebelik oranlarında farklılık saptanmamıştır. OHSS oranlarının, BKİ arttıkça bir miktar azaldığı gözlenmiştir.
Journal of Obstetrics and Gynaecology, 2016
Uterine incarceration during pregnancy is a rare complication with an incidence of 1 in 3000 preg... more Uterine incarceration during pregnancy is a rare complication with an incidence of 1 in 3000 pregnancies (Gibbons and Paley, 1969). Anatomic displacement of the growing uterus may cause adjacent organ distortion, with variable symptomatology. Common symptoms presented are abdominal pain, rectal pressure and urinary complaints such as retention or incontinence (Gardner et al. 2013). Early and accurate diagnosis for avoiding the devastating perinatal complications is critical. Here, we discuss the feasibility of ventro-fixation during pregnancy in cases of uterine incarceration to resume safe gestation and improve the chances of vaginal delivery.
Gynecology Obstetrics & Reproductive Medicine, 2016
Uterine compression sutures may be life and fertility saving interventions in management of uteri... more Uterine compression sutures may be life and fertility saving interventions in management of uterine atony. However, unintended long-term outcomes may occur and there is scarce literature about management. Herein, management of long-term adverse outcomes (synechia, pelvic pain and pelvic collection) of three different cases who had to be treated by uterine compression sutures is reported with review of the literature.
The Journal of Maternal-Fetal & Neonatal Medicine, 2016
To determine urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels and creatinine cle... more To determine urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels and creatinine clearance values in women with different degrees of asymptomatic hydronephrosis during pregnancy. A total of 44 pregnant women with different degrees of hydronephrosis and 46 without hydronephrosis were consecutively enrolled in this prospective study. Basic serum and urine parameters, uNGAL levels, and creatinine clearance values were evaluated. All results were compared between the two groups. Regression analysis was used to determine independent predictors, which were mostly related to hydronephrosis. Demographic data, basal laboratory parameters, and creatinine clearance values were similar, whereas significantly higher uNGAL levels were detected in women with hydronephrosis compared to those without hydronephrosis (45.3 versus 33.2 ng/mL, respectively) (p = 0.004). An increasing trend in uNGAL levels was detected with increasing degrees of hydronephrosis; as it was not statistically significant (p = 0.163). Linear regression analysis revealed that the parameter of "pelvic diameter" was found as a significant independent factor influencing uNGAL concentrations (β = 0.289; 95% CI: 0.522-3.061; p = 0.006). Other independent variables were not found to influence uNGAL concentrations (p > 0.05). The results obtained from this study indicate a significant increase of urinary concentration of NGAL in the presence of asymptomatic maternal hydronephrosis. This impact is likely to be more profound in those with severe hydronephrosis although this has not been specifically investigated. This theory needs to be validated in larger populations.
Gynecology Obstetrics & Reproductive Medicine, 2016
OBJECTIVE: To investigate the peripheral blood components, neutrophil/lymphocyte ratio (NLR) and ... more OBJECTIVE: To investigate the peripheral blood components, neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratios (PLR) in cervical cytological abnormalities. STUDY DESIGN: We retrospectively analyzed 185 cases with abnormal and 303 cases with normal cervicovaginal smears (CVS) with blood count profile, from a total number of 9286 patients. RESULTS: Abnormal CVS results consisted of 137 (72%) ASC-US, 16 (8%) ASC-H, 19 (10%) L-SIL, 4 (2%) H-SIL and 9 (4%) AGUS. NLR and PLR of abnormal CVS group were higher than control group (p<0.001). The lymphocyte count was significantly lower in abnormal CVS cases (p<0.001). The number of patients with neutrophilia (neutrophils ≥70% of the total leukocytes) was similar among two groups (p>0.05). CONCLUSION: Neutrophilia is not observed in cervical preinvasive lesions whereas it is common in cervical cancer. In this study, absence of increased neutrophil counts and presence of lymphopenia in patients with abnormal cervical cytology, may indicate an early measure in cervical pathologies.
Gynecologic and obstetric investigation, Jan 19, 2016
To document alterations in Anti-Müllerian hormone (AMH) levels with different energy doses by mon... more To document alterations in Anti-Müllerian hormone (AMH) levels with different energy doses by monopolar cautery in ovarian drilling (OD) in rats. Forty Wistar rats were randomly divided into 4 groups that each contained 10 animals. Group A was the Sham group. Groups B, C and D were intervention groups to which OD was applied by monopolar cautery, with 20, 60 and 120 J/ovary, respectively. The total amount of energy was calculated using the following formula: energy (J) = power (W) × duration (s) × number of punctures. The pre- and postoperative AMH levels for Groups A, B and C were not statistically and significantly different according to the Bonferroni correction (p > 0.0125). However, the postoperative AMH levels were significantly lower than the preoperative AMH levels in Group D (1.25 ng/ml (1.07-2.05) vs. 0.40 ng/ml (0.30-0.72); p = 0.012). AMH is a promising marker that can be used for the individualization of the energy dose to increase OD success, but the relationship be...