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Öğe Abdominal paravaginal defect repair in the treatment of paravaginal defect and urodynamic stress incontinence(Informa Healthcare-Taylor & Francis, 2007) Demirci, Fuat; Özdemir, İsmail; Somunkıran, Aslı; Gül, Özlem Kemik; Gül, Barış; Doyran, Gönül DurasWe evaluated the morbidity, complications and outcomes.in 42 patients who underwent abdominal paravaginal defect repair (PDR) for vaginal wall prolapse due to a paravaginal defect and the prolapse of other pelvic organs. Out of a total of the 42 patients, 32 underwent PDR and concomitant pelvic reconstructive procedures, and 10 patients underwent PDR plus anti-incontinence surgery and concomitant pelvic reconstructive procedures. The mean patient age was 44.5 years. The mean follow-up period was 40 months. One bladder injury and two hemorrhages occurred intraoperatively. The cure rate of anterior vaginal wall prolapse was 92.9%. Of the 20 patients with urodynamic stress incontinence (USI) who underwent PDR alone, the rate of recurrence of USI was 20%; however, there was no recurrence in the 10 patients who underwent PDR plus the anti-incontinence procedures. Paravaginal repair is a safe and effective procedure for the surgical correction of a paravaginal defect, but has limited applicability in the surgical correction of USI.Öğe Antenatal and delivery risk factors and prevalence of cerebral palsy in Duzce (Turkey)(Elsevier Science Bv, 2007) Öztürk, Ayhan; Demirci, Fuat; Yavuz, Taner; Yıldız, S.; Değirmenci, Yıldız; Döşoğlu, M.; Avşar, Y.This cross-sectional study aimed at investigating the prevalence and the etiological factors of cerebral palsy (CP) and comparing them with normal population within the rural and urban areas of Duzce province. Of the 102 children with cerebral palsy, 98 were associated with antenatal and delivery risk factors. The mean crude prevalence of cerebral palsy was 1.1 per 1000 live births. The children with CP were compared with 530 control subjects. The mothers of the children with cerebral palsy were significantly younger than the mothers of children in control group, and they had less parity and abortion. Preeclampsia, premature rupture of membranes, home births, prolonged labor, and twin pregnancies were significantly more common in the mothers of children with cerebral palsy, where no significant differences were found between the groups in terms of breech delivery, rate of cesarean births, gestational diabetes, and hemorrhage in late pregnancy. Birth asphyxia, liqueur with meconim stained, prolonged jaundice and neonatal seizure were also significantly more common in the group with cerebral palsy. Of the children with cerebral palsy, 78% were born at term, 20% were born with gestational ages of 32-36 weeks, 2% were born with gestational ages of 30-31 weeks. Nine percent of those children had a birth weight of >= 3000 g, 12.2% had a birth weight of 2500-2999 g, 33.7% had a birth weight of 1500-2499 g, and 5.1% had a birth weight of <= 1500 g. The causes of low prevalence of cerebral palsy were due to insufficient neonatal care, resulting in low survival in preterm and low birth weight children, and poor postnatal care of children with cerebral palsy. (c) 2006 Elsevier B.V. All rights reserved.Öğe A case of primary Addison's disease with hyperemesis gravidarum and successful pregnancy(Elsevier Sci Ireland Ltd, 2004) Özdemir, İsmail; Demirci, Fuat; Yücel, Oğuz; Şimşek, Enver; Yıldız, İdrisWe followed up a pregnant woman with Addison's disease diagnosed before conception. She presented with hyperemesis gravidarum. Throughout pregnancy, she received prednisone and the basic disease did not deteriorate during pregnancy. She was delivered by caesarean section due to breech presentation. The fetal prognosis was good. (C) 2003 Elsevier Ireland Ltd. All rights reserved.Öğe Comparison of costs and efficacy of intravenous and orally disintegrating ondansetron tablet as a prophylactic antiemetic therapy in major gynecologic operations(2005) Demiraran, Yavuz; Özdemir, İsmail; Akbay, Buket Kocaman; Hayıt, Feray; Demirci, FuatObjective: The aim of the study is to compare the antiemetic efficacy and costs of oral rapid disintegrating ondansetron tablets and intravenously administered ondansetron in patients undergoing major gynecologic surgery. Materials and Methods: Anesthesia was induced with thiopenthone, vecuronium and fentanyl. Nitrous oxide and sevoflurane were used to maintain anesthesia. Patients were prospectively randomized into three groups of 30 patients each, receiving either ondansetron 8 mg intravenously or saline infusion only or oral rapid disintegrating tablets of 8 mg ondansetron. The patients were evaluated for nausea and vomiting at 1st, 5th, 10th, 20th, 30th, 60th, and 120th minutes and 6th hours postoperatively. Results: There were no significant differences in adverse effects between placebo group, intravenous ondansetron group and oral ondansetron group (P>0.05). The incidence rates of nausea, vomiting and the need of metoclopropamide were higher in placebo group than intravenous and oral ondansetron groups (P<0.05). Conclusion: Postoperative nausea and vomiting are common during recovery from general anesthesia. Both oral and intravenous forms of ondansetron are efficacious in the prevention of this postoperative nausea and vomiting. Orally disintegrating tablets are inexpensive and may be administered more easily than the intravenous form of ondansetron. Therefore, oral ondansetron tablet may be an alternative to intravenous ondansetron infusion for postoperative nausea and vomiting after major gynecologic operations.Öğe Comparison of saline infusion sonohysterography and hysteroscopy findings in patients with abnormal uterine bleeding(2005) Alhan, Ali; Özdemir, İsmail; Somunkıran, Aslı; Demirci, Fuat; Yücel, Oğuz; Bahçebaşı, TalatObjective: To establish the accuracy of saline infusion sonohysterography and hysteroscopy in diagnosing uterine pathology in women with abnormal uterine bleeding. Materials and Methods: A total of 39 women with abnormal uterine bleeding were recruited for the study and underwent transvaginal ultrasonography followed by saline infusion sonohysterography. During hysteroscopy, resection of the focal intracavitary lesion was performed. Endometrial sampling was obtained from all patients. Results: Sonohysterographic and hysteroscopic evaluation revealed 25 and 24 endometrial polyps, 7 each submucous myomas, 3 and 1 endometrial hyperplasia, 1 each synechia, and 3 and 6 normal findings, respectively. Comparison of histopathologic findings with other diagnostic tests revealed that hysteroscopy demonstrated a sensitivity of 97%, specificity of 72%, positive predictive value of 94%, negative predictive value of 83% and total sensitivity of 92%. Sonohysterography showed sensitivity of 97%, specificity of 29%, positive predictive value of 86%, negative predictive value of 85% and total sensitivity of 85%. Conclusion: In comparison with hysteroscopy, sonohysterography is a cheaper and easier procedure for detecting endometrial pathologies such as endometrial polyps and submucous myomas with its highly diagnostic value.Öğe Does postoperative misoprostol use induce intestinal motility? A prospective randomised double-blind trial(Wiley, 2007) Demirci, Fuat; Somunkıran, Aslı; Gul, Özlem Kemik; Demiraran, Yavuz; Özdemir, İsmail; Gül, Özgür BarışBackground: Misoprostol has been shown to increase colonic activity and decrease colonic transit time in chronic constipation patients. Aims: The aim of this prospective, randomised, double-blind study was to examine the effectiveness of rectally administered misoprostol on inducing intestinal motility after gynaecological surgery. Methods: Eighty women who underwent hysterectomy were divided randomly into three groups. Group A received misoprostol 200 mu g rectally while group B received 400 mu g rectal misoprostol after surgery before leaving the operating room. Patients in group C received no drugs. Bowel sounds in four quadrants were checked every hour and possible side-effects of misoprostol like nausea, vomiting, and distension were evaluated. The time interval between surgery and flatus pass and the need of analgesics were noted. Statistical analyses were done with Mann-Whitney U-test and chi(2) tests where available. Results: The time between surgery and presence of bowel sounds in four quadrants were similar in all groups (2.7 +/- 1.6, 2.9 +/- 1.2, 2.8 +/- 1.3 h, for groups A, B, and C, respectively). No difference was observed in flatus pass time. The incidence of nausea was significantly increased in group B compared to controls (P < 0.01). Additional analgesic need was significantly higher in groups A and B when compared to controls (P < 0.05 and P < 0.01, for groups A and B, respectively). Conclusion: Rectally administered misoprostol does not improve intestinal motility in the early postoperative period and thus, it is not effective in providing early oral food intake. On the contrary, it causes distention that requires additional analgesics and vomiting that naturally limits oral diet intake.Öğe The effect of different preparations of hormone therapy on tumor necrosis factor-alpha levels in women with surgical menopause(Taylor & Francis Ltd, 2008) Somunkıran, Aslı; Coşkun, Abdurrahman; Demirci, Fuat; Yücel, OğuzThe aim of the present prospective controlled study was to examine the influence of 17 beta-estradiol and tibolone on tumor necrosis factor-alpha (TNF-alpha) levels in healthy women with surgical menopause. Forty-five surgically menopausal women were included in the study. Thirty women were randomized to receive tibolone 2.5 mg or 17 beta-estradiol 2 mg daily for 16 weeks. Fifteen surgically menopausal women who refused hormone therapy served as controls. Serum was collected from the subjects at baseline and at the end of the study for TNF-alpha assay. Neither tibolone nor 17 beta-estradiol showed a significant influence on TNF-alpha level at the end of 16 weeks in comparison with baseline. Although tibolone induced a trend toward decreased level of TNF-alpha (3.30 +/- 0.42 vs. 2.56 +/- 1.94 mu g/dl), this was non-significant. The slight increase observed in TNF-alpha level in the control group was also insignificant (3.60 +/- 1.20 vs. 4.10 +/- 0.70 mu g/dl). Overall, these results demonstrate no significant effects of either tibolone or 17 beta-estradiol on circulating TNF-alpha level in surgically menopausal women. However, the significant difference achieved between the tibolone and control group after treatment is promising and needs to be investigated in trials with longer treatment periods.Öğe The effect of ethinyl estradiol-cyproterone acetate treatment on homocysteine levels in women with polycystic ovary syndrome(Springer Heidelberg, 2008) Gül, Özgür Barış; Somunkıran, Aslı; Yücel, Oğuz; Demirci, Fuat; Özdemir, İsmailObjective Women with polycystic ovary syndrome (PCOS) have multiple risk factors for cardiovascular disease. The cardiovascular risk marker homocysteine (Hcy) is elevated in women with PCOS. This prospective study investigated the effect of oral contraceptives containing ethinyl estradiol-cyproterone acetate (EE-CA) on serum Hcy levels in women with PCOS. Study design A total of 30 women with PCOS were enrolled in this prospective study. The diagnosis of PCOS was made according to the criteria of the Rotterdam PCOS consensus workshop group. All women took oral contraceptives containing EE/CA (35 mu g/2 mg) for 3 months. Serum samples for Hcy, lipid profile and hormones were obtained during the early follicular phase (days 3-5) of the spontaneous or progestin-induced bleeding at baseline, and after the third treatment cycle. Results Three months of EE-CA therapy significantly decreased the Hcy levels from 55.97 +/- 16.04 to 54.03 +/- 16.15 (P = 0.01). A significant correlation was observed between the Hcy and total and free testosterone levels (r = 0.44, P = 0.015 and r = 0.46, P = 0.001 respectively). Conclusions Although the decrease in Hcy levels with EE-CA therapy was statistically significant, further studies are necessary to determine the clinical benefit of this treatment.Öğe Gastric cancer in pregnancy(Elsevier Sci Ireland Ltd, 2003) Özdemir, İsmail; Pehlivan, Mevlüt; Demirci, Fuat…Öğe A new, simple, safe, effective and cost-effective procedure for genuine stress incontinence: Midurethral polypropylene sling(Wiley, 2003) Demirci, Fuat; Özdemir, İsmail; Yücel, Oğuz; Alhan, AliWe developed a cost-effective procedure for genuine stress incontinence (GSI) that has the advantages of the tension-free vaginal tape (TVT). The midurethral polypropylene sling procedure (MPS) is carried out under local anaesthesia. A self-fashioned sling (7.5 x 1 cm) was created from a polypropylene mesh with two lengthening polypropylene sutures at the ends. The sutures are carried through the rectus fascia using a needle and the sling is placed around the urethra. Ten patients underwent the MPS and were followed up for a mean of 6.2 months. All patients were cured. The short-term results of the MPS were comparable to those of the TVT. The procedure costs approximately US$9. We conclude that the MPS can be considered as an alternative to the TVT procedure.Öğe Perioperative complications in abdominal sacrocolpopexy and vaginal sacrospinous ligament fixation procedures(Springer London Ltd, 2007) Demirci, Fuat; Özdemir, İsmail; Somunkıran, Aslı; Topuz, Samet; İyibozkurt, Cem; Doyran, Gönül Duras; Gül, BarışThis study assessed perioperative complications in abdominal sacrocolpopexy and vaginal sacrospinous ligament fixation procedures. Perioperative complications were defined as any complication occurring during surgery or the first 6 weeks postoperatively. Forty-five patients underwent abdominal procedures (20 sacrohysteropexy and 25 sacrocolpopexy) and 60 patients underwent vaginal sacrospinous fixation. Of the 105 patients, 13 had vaginal vault prolapse. In the abdominal group, one bladder injury, four hemorrhages, and three wound dehiscences occurred. In the vaginal group, one rectal injury and one postoperative vaginal vault infection occurred. Major and minor complications were more frequent in the abdominal group than in the vaginal group. Blood loss was not significantly different. The operating time and hospital stay in the abdominal group were significantly longer than in the vaginal group. In conclusion, abdominal sacrocolpopexy had a higher rate of perioperative complications and longer hospital stay and operating time.Öğe Primary omental pregnancy presenting with hemorrhagic shock - A case report(Karger, 2003) Özdemir, İsmail; Demirci, Fuat; Yücel, Oğuz; Alper, MuratAbdominal pregnancy is a very rare and serious type of extrauterine gestation that accounts for approximately 0.003% of all ectopic pregnancies. Omental pregnancy, an extremely rare form of abdominal pregnancy, can be primary or secondary to a tubal pregnancy that aborts out of the fimbria and reimplants in the peritoneal cavity. We present an additional case of primary omental pregnancy at 12 gestational weeks presenting with symptoms of hemoperitoneum and acute abdomen. Copyright (C) 2003 S. Karger AG, Basel.Öğe Pure ovarian choriocarcinoma: a difficult diagnosis of an unusual tumor presenting with acute abdomen in a 13-year-old girl(Blackwell Munksgaard, 2004) Özdemir, İsmail; Demirci, Fuat; Yücel, Oğuz; Demirci, Elif; Alper, Murat…Öğe Transperineal versus transvaginal ultrasonographic evaluation of the cervix at each trimester in normal pregnant women(Blackwell Publishing, 2005) Özdemir, İsmail; Demirci, Fuat; Yücel, OğuzAims: To compare transvaginal and transperineal ultrasonography in the assessment of cervical length and cervical changes in normal gravid patients at each trimester. Methods: Transperineal and transvaginal ultrasonographic cervical length was measured on 104 asymptomatic pregnant women between 10 and 14, 20-24, and 30-34 weeks' gestation and the presence of a funnel was also noted. The study used the McNemar chi(2) test to assess the difference between two methods in their ability to obtain a measurement, and the Pearson correlation coefficient to determine the relationship between the paired transperineal and transvaginal cervical lengths. Results: Cervical length measurements were obtained by transvaginal ultrasonography in all 104 patients and by transperineal ultrasonography in 101 patients (97.1%) (P = 0.1). By gestational age, the greatest length discrepancy (2.8 mm) between the two ultrasonographic methods was found at 10-14 weeks (P < 0.001). At 20-24 and 30-34 weeks' gestation, the mean length differences were less than 1 mm (P < 0.01 and P = 0.337, respectively). Cervical funnelling was observed in 16 patients by both methods, whereas in two patients from the 20-24 week gestational age group, funnelling was observed by transvaginal ultrasonography and not by transperineal ultrasonography. Conclusions: Cervical length measurements by transperineal ultrasonography show good correlation with transvaginal ultrasonographic measurements and it is a satisfactory alternative to a transvaginal evaluation of the cervix throughout pregnancy.Öğe Vaginal removal of prolapsed pedunculated submucosal myoma during pregnancy(Health Communications Inc, 2007) Demirci, Fuat; Somunkıran, Aslı; Şafak, Alp Alper; Özdemir, İsmail; Demirci, ElifPedunculated submucosal myomas are generally associated with infertility and are most often encountered during the preconception period. This report describes a 38-y-old pregnant woman in whom a pedunculated submucosal myoma resulted in preterm labor and was successfully removed vaginally at 26 wk gestation. The procedure described here is simple and quick and can be performed during pregnancy, if necessary.
