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Öğe Addition of parity to the risk of malignancy index score in evaluating adnexal masses(Elsevier Taiwan, 2014) Yavuzcan, Ali; Çağlar, Mete; Özgü, Emre; Üstün, Yusuf; Dilbaz, Serdar; Özdemir, İsmail; Kumru, SelahattinObjective: The aim of our study was to evaluate the individual contribution of parity when incorporated as another parameter into the four risk of malignancy indices (RMI 1-4) to differentiate noninvasive benign lesions from invasive malignant ovarian lesions. Materials and methods: After calculating RMI 1-4 for each patient included in this study, the resulting RMI scores were further multiplied by the parity score (P) of each patient to calculate the RMI parity (RMIP) score. Results: A cutoff value of 300 for RMIP 1 yielded 95.0% specificity, 97.4% negative predictive value (NPV), 88.5% sensitivity, and 79.3% positive predictive value (PPV) and performed better than RMI 1 in the preoperative diagnosis of invasive malignant lesions. RMIP 2 with a cutoff value of 400 yielded 95.0% specificity, 97.4% NPV, 88.5% sensitivity, and 79.3% PPV, and it also performed better than RMI 2. A cutoff value of 400 for RMIP 3 provided 97.5% specificity, 97.5% NPV, 88.5% sensitivity, and 88.5% PPV and performed better than RMI 3. However, a cutoff value of 400 for RMIP 4 provided 90.0% specificity, 97.3% NPV, 88.5% sensitivity, and 65.7% PPV but did not perform better than RMI 4 in the preoperative diagnosis of invasive malignant lesions. Conclusion: RMIP 1-3 scales were more reliable tools for the preoperative diagnosis of invasive adnexal masses compared with the traditional RMI 1-3 scales. Copyright (C) 2014, Taiwan Association of Obstetrics & Gynecology. Published by Elsevier Taiwan LLC. All rights reserved.Öğe Adneksiyal torsiyon yönetimi(2014) Erkal, Neslihan; İsenlik, Bekir Sıtkı; Çağlar, Mete; Sahillioğlu, Birsen; Kumru, SelahattinAmaç: Adneksiyal torsiyon tanısı alan hastaların klinik, uygulanan operasyon ve patoloji bulgularının değerlendirilmesiYöntemler: Ocak 2009 ile Mart 2013 tarihleri arasında kliniğimize başvurup adneksiyal torsiyon tanısı alan 14 hasta retrospektif olan çalışmamıza dahil edildi. Klinik bulgular, operasyon bulguları, patoloji sonuçlarını içeren bilgiler toplandı.Bulgular: 16-56 yaş arası olan hastaların ortalama yaşı 28,110,5 idi. Bütün hastalara ultrasonografi yapıldı ve adneksiyal kitle bütün hastalarda saptandı. Ortalama kitle boyutu 8,042,96 cm idi. Bütün hastalarda alt abdominal ağrı, bulantı ve kusma şikayeti mevcuttu. 6 hastaya laparoskopi, 8 hastaya laparatomi uygulandı. 7 (50,0%) hastaya detorsiyon ve kistektomi yapıldı. Biri ilk trimesterda, diğeri üçüncü trimesterda olan 2 hamile hastaya kistektomi ve detorsiyon uygulandı (biri laparoskopi ile). Bir hastada hidrosalpinkse bağlı izole tubal torsiyon izlendi ve laparoskopik salpenjektomi uygulandı. İki hastada paratubal kist nedeniyle tubal torsiyon izlendi. Birine laparoskopik detorsiyon ve kistektomi, birine laparotomi ile salpenjektomi yapıldı. En sık görülen patoloji seröz kistadenomdu. (28,6 %). Sonuç: Adneksiyal torsiyon daha çok üreme çağında görülen nadir jinekolojik acillerdendir. Hızlı tanı ve konservatif yaklaşım ile over ve tubaları korumak gelecekteki fertiliteyi korumak için önemlidir.Öğe Anormal uterin kanamalı hastalarda endometrium kanseri ve benign endometrial patoloji tanısı alanların hematolojik parametrelerinin karşılaştırılması(2014) Yavuzcan, Ali; Çağlar, Mete; Erdem, Havva; Oktay, Murat; Üstün, Yusuf; Dilbaz, Serdar; Kumru, SelahattinAmaç: Çalışmamızın amacı 40 yaş ve üstünde anormal uterin kanama (AUK) şikayeti bulunan hastalarda evre 1 ve evre 2 endometrium kanseri tanısı alanlar ile benign endometrial patoloji tanısı alanların ortalama trombosit hacmi (MPV), nötrofil/lenfosit oranı (NLR) ve trombosit/lenfosit oranı (PLR) değerlerini karşılaştırmaktır. Yöntem: Çalışmamıza Temmuz 2012-Temmuz 2013 tarihleri arasında Düzce Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı’na AUK ön tanısıyla histeroskopi, dilatasyon küretaj yada endometrial biopsi ile endometrial örnekleme yapılan hastalar dahil edilmiştir. Hastalara ait bilgiler retrospektif olarak hasta dosyaları incelenerek elde edilmiştir. Bulgular: Hastaların ortalama yaşı 52.8111.47 yıl olarak bulunmuştur. Hastaların %37.1’si menopozdadır. Yapılan endometrial örneklemelerin sonucunda hastalardan 10 tanesinde (%14.2) endometrioid tip endometrial adenokarsinom, 1 tanesinde (%1.4) seröz papiller karsinom ve 1 tanesinde (%1.4) endometrial stromal sarkom tanısı konulmuştur. Hastaların 58 (%83) tanesinde non invaziv benign endometrial değişiklikler tespit edilmiştir. Endometrium kanseri saptanan ve saptanmayan hastalar arasında MPV,NLR ve PLR değerleri açısından istatistiksel olarak anlamlı farklılık tespit edilmemiştir (p0.148; p0.775 ve p0.942 sırasıyla). Sonuç: MPV, NLR ve PLR değerlerinin ileri evre endometrial malignitelerde yükseldiği ve prognostik bir faktör olarak kullanılabileceği bazı çalışmalarda gösterilmiştir. Ancak bu parametrelerin erken evre endometrium kanseri ve benign endometrial patoloji tespit edilen hastalar arasında gösterdiği değişimlerin net olarak ortaya konabilmesi için geniş kapsamlı yeni çalışmalara gerek duyulmaktadır.Öğe Clinical symptoms and diagnostic tools that are related to infertility and hydrosalpinx formation in women with advanced stage endometriosis complicated by endometrioma(Via Medica, 2013) Yavuzcan, Ali; Çağlar, Mete; Dilbaz, Serdar; Üstün, Yusuf; Özdemir, İsmail; Yıldız, Elif; Kumru, SelahattinObjectives: The study included patients suffering from stage III-IV endometriosis complicated by an endometrioma (DMA). We investigated the association between age, presence of dysmenorrhea/dyspareunia, preoperative CA 125 level, size of DMA on ultrasonographic exam and infertility as well as the risk of intraoperative detection of hydrosalpinx that was not suspected on pre-operative assessment. Materials and Methods: The study included patients with stage III-IV endometriosis complicated by DMA who underwent a laparoscopic or open surgery due to pre-diagnosis of infertility or adnexal mass. Results: Dysmenorrhea had statistically significant association with infertility (p=0.031). There was no statistically significant relation between age, dyspareunia, preoperative CA 125 level, size of DMA on ultrasonographic exam and infertility (p=0.203, p=0.561, p=0.561 and p=0.668, respectively). No statistically significant relation was found between age, CA 125 level, dysmenorrhea, dyspareunia and detection of an unilateral/bilateral hydrosalpinx, that was not suspected on pre-operative assessment (p=0.179, p=0.295, p=0.895, p=0.424, respectively). There was an association between DMA size (p=0.023) and detection of unilateral/bilateral hydrosalpinx. Conclusions: Patients who desire to have children but suffer from severe dysmenorrhea must be preoperatively informed about the possibility of having stage III-IV endometriosis. Infertile patients who are about to undergo an operation, especially due to a large DMA, may turn out to have hydrosalpinx. These patients should be informed preoperatively about the possibility of having salpingectomy or the proximal tubal surgery for improving fertilityÖğe Decorin: a possible marker for fetal growth restriction(Taylor & Francis Ltd, 2014) Çağlar, Mete; Yavuzcan, Ali; Göksu, Mehmet; Bülbül, Gül Alkan; İsenlik, Bekir Sıtkı; Üstün, Yusuf; Kumru, SelahattinThe aim of this study was to compare decorin (DCN) levels between pregnancies complicated by idiopathic fetal growth restriction (FGR) and uncomplicated pregnancies and to determine the relationship between DCN levels and clinical parameters. The study population consisted of two groups: control group consisted of 13 women with uncomplicated singleton pregnancies in the third trimester. Study group consisted of 14 singleton pregnancies complicated by idiopathic FGR who were admitted to the hospital for delivery in the third trimester of pregnancy. Maternal and fetal DCN levels were measured. Color Doppler flow assessments were performed. Relationship between DCN levels and clinical parameters was determined. Maternal DCN serum levels were significantly higher in complicated pregnancies by idiopathic FGR (p = 0.01). A statistically significant negative correlation was observed between maternal DCN serum levels and neonatal birth weight (r = -0.0506; p = 0.007). There was a significant correlation between umbilical artery (UA) DCN levels and UA S/D ratio (r = 0.512; p = 0.006) and UA RI (r = 0.405; p = 0.036). The risk of high DCN maternal serum levels (>7986.6 pg/mL) in pregnancy complicated by FGR was 8.25 times higher (RR = 8.25; 95% CI, 1.4-46.8). The results of our study showed that the presence of increased DCN levels in women with FGR could contribute to pathogenesis of the disease.Öğe Dört Farklı Malignite Risk İndeksinin (RMI 1-4) Endometrioma ve Matür Kistik Teratom AyırıcıTanısında Etkinliklerinin Değerlendirilmesi(2013) Yavuzcan, Ali; Çağlar, Mete; Üstün, Yusuf; Dilbaz, Serdar; Özdemir, İsmail; Özbilgeç, Sıtkı; Kumru, SelahattinAmaç: Adneksiyel kitlelerde bening-malign ayrımı için kullanılan Ca125 ve malignite risk indekslerinin (RMI 1, RMI 2, RMI 3 ve RMI 4) endometrioma (OMA) ve matür kistik teratomun preoperatif tanısındaki etkinliğini incelemektir. Gereç ve Yöntemler: Çalışmamıza adneksiyel kitle ön tanısı bulunan 83 hasta dâhil edilmiştir. Bulgular: Ca125 düzeyi, RMI 1, RMI 2, RMI 3 ve RMI 4 değerleri OMA'nın preoperatif tespitinde istatistiksel olarak anlamlı düzeyde öngörü gücüne sahiptir (p0.001; p0.002; p0.002; p0.001 ve p0.019 sırasıyla). Ca125 düzeyi ve tüm RMI 1-4 değerleri için % 95 güvenlik aralığında (% 95 CI) eğri altındaki kalan alan (AUC) anlamlı bulunmuştur. İstatistiksel olarak anlamlı olacak şekilde RMI 1 için cut off değeri 46 olarak hesaplanmıştır. RMI 1, OMA ayırıcı tanısında % 78.6 duyarlılık; % 76.8 özgüllük; % 40.7 pozitif kestirim gücü (PPV) ve % 94.6 negatif kestirim gücü (NPV) ile en başarılı indeks olarak saptanmıştır. OMA ayırıcı tanısında Ca125 için 18,5 iu/ml cut off değerinde; % 78.6 duyarlılık; % 71.0 özgüllük; % 35,5 PPV; % 94.2 NPV tespit edilmiştir. Ca125, RMI 1, RMI 2, RMI 3 ve RMI 4 değerlerinin matür kistik teratomun ayırıcı tanısında ve pozitif/negatif ayrımı yapmada istatistiksel olarak anlamlı etkisi saptanmamıştır (p0.386; p0.708; p0.626; p0.786 ve p0.203 sırasıyla). Sonuç: Çalışmamıza göre RMI 1 ve 3 ölçekleri OMA'nın preoperatif klinik tanısında Ca125'e göre daha etkin bulunsa da rutin tanı ve takipte güvenle kullanılabilmesi için daha kapsamlı çalışmalar gerekmektedir. Subjektif ve tecrübe bağımlı bir yöntem olmasına rağmen, USG'de patern tanıma metodu matür kisitk teratom ve OMA'nın preoperatif tanısında halen en etkin seçenek olarak gözükmektedirÖğe Düzce İlinde Nöral Tüp Defekti Saptanan Olguların Değerlendirilmesi(2013) Yavuzcan, Ali; Topuz, Seren; Çağlar, Mete; Dilbaz, Serdar; Üstün, Yusuf; Kumru, SelahattinAmaç: Nöral tüp defektleri (NTD) embriyoda nöral tüpün kapanmasındaki hatalar sonucu oluşmaktadır. Tüm dünyada NTD'lerin bütün formlarının insidansı 1000 canlı doğumda 1,4-2 arasındadır. Çalışmamızda NTD etiyolojisinde etkili olan faktörlerin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Mayıs 2010 ila Mayıs 2013 tarihleri arasında Düzce Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı'nda yaşamla bağdaşmayan NTD bulunması nedeniyle terminasyon yapılan hastalar ve Düzce Üniversitesi Tıp Fakültesi Çocuk Hastalıkları Anabilim Dalı'nda NTD tanısıyla tedavi verilen hastalar bu çalışmaya dâhil edilmiştir. Kontrol grubu olarak Düzce İlinde sağlıklı tek canlı bebek doğumu gerçekleşen hastalar alınmıştır. Çalışma grubunda 30 ve kontrol grubu da 30 hasta olarak belirlenmiştir. Her iki grup arasında yaş, prekonsepsiyonel/konsepsiyonel dönemdeki folik asit replasmanı, önceki gebelikte NTD öyküsü, meslek, eş mesleği,maternal eğitim düzeyi, kronik hastalık öyküsü, sigara/alkol kullanımı, prekonsepsiyonel dönem ile gestasyonel vücut kitle indeksi (VKİ) değerleri arasındaki fark karşılaştırılmıştır. Bulgular: NTD riskine karşı gebelikte verilen folik asit desteği önemli bir koruyucu etken olarak saptanmıştır (p0.018). Annenin eğitim düzeyinin artması ve babanın mesleği de NTD riskinde etkili olan diğer faktörlerdir (p0.012 ve p0.017). Sonuç: Ülkemizde NTD riskini etkileyen faktörlerin daha net ortaya konabilmesi için geniş kapsamlı ve randomize olarak yapılmış yeni çalışmalara gerek duyulmaktadırÖğe Effect of reproductive characteristics, body mass index, and anterior/posterior vaginal compartment defects on the short-term success of abdominal sacrocolpopexy(Taylor & Francis Inc, 2015) Çağlar, Mete; Erkal, Neslihan Boz; İsenlik, Bekir Sıtkı; Özdemir, Özgür; Yavuzcan, Ali; Üstün, Yusuf; Kumru, SelahattinObjective. Vaginal vault prolapse is caused by the loss of apical support in the cardinal-uterosacral ligament complex. Abdominal sacrocolpopexy (ASCP) is one means of repairing vaginal vault prolapse. In the present study, we investigated the effects of reproductive factors, body mass index (BMI), and anterior or posterior vaginal compartment defects on short-term outcomes of ASCP. Method. We retrospectively studied 70 women who had undergone ASCP between February 2012 and November 2012 in our clinic. Result. There were no significant differences in the complication rate among menopausal, nonmenopausal women, and grand multiparous patients. Operational success was not significantly affected by menopausal status. The long-term rate of grade >= 2 prolapse in the apical, anterior, or posterior vaginal wall after ASCP did not differ significantly by menopausal status. Correlation analysis showed that BMI was not associated with operational success in the early postoperative period in patients with vaginal prolapse and was not associated with the detection of grade >= 2 prolapse in apical, anterior, and posterior compartments after 1 year. Conclusion. ASCP should be the first-line treatment for obese/overweight, menopausal, or grand multiparous patients with additional anterior or posterior vaginal vault prolapse.Öğe Evaluation of mean platelet volume, neutrophil/ lymphocyte ratio and platelet/lymphocyte ratio in advanced stage endometriosis with endometrioma(2013) Yavuzcan, Ali; Çağlar, Mete; Üstün, Yusuf; Dilbaz, Serdar; Özdemir, İsmail; Yıldız, Elif; Kumru, SelahattinObjective: We compared the preoperative values of mean platelet volume (MPV) and peripheral systemic inflammatory response (SIR) markers (neutrophil/lymphocyte ratio and platelet/lymphocyte ratio) between patients with advanced-stage (stage 3/4) endometriosis having endometrioma (OMA) and patients with a non-neoplastic adnexal mass other than endometrioma (non-OMA). Material and Methods: Patients who underwent operations with the pre-diagnosis of infertility or adnexal mass and who underwent laparoscopic tubal ligation were included. Results: Haemoglobin levels, leucocyte count, platelet count, neutrophil count and lymphocyte count were not significantly different between patients with advanced stage endometriosis having OMA, patients with non-OMA and patients in the control group (p=0.970, p=0.902, p=0.373, p=0.501 and p=0.463, respectively). Patients with stage 3/4 endometriosis having OMA, patients with non-OMA and control patients were also not significantly different in terms of MPV (p=0.836), neutrophil/lymphocyte ratio (NLR) (p=0.555) and platelet/ lymphocyte ratio (PLR) (p=0.358). Preoperative cancer antigen 125 (Ca-125) levels were significantly higher in patients with OMA (p=0.006). Mean size of the OMAs was significantly lower than non- OMAs (p=0.000). Conclusion: It is very important to determine advanced stage endometriosis and OMAs during preoperative evaluation in order to inform patients and plan an appropriate surgical approach. We demonstrate that MPV, NLR and PLR values are not useful for this purpose in patients with advanced stage endometriosis that are proven to develop severe inflammation at either the cellular or molecular level. © 2013 by the Turkish-German Gynecological Education and Research Foundation.Öğe Evaluation of the outcomes of laparoscopic hysterectomy for normal and enlarged uterus (> 280 g)(Springer Heidelberg, 2014) Yavuzcan, Ali; Çağlar, Mete; Üstün, Yusuf; Dilbaz, Serdar; Kumru, SelahattinThe aim of this study was to evaluate intraoperative and postoperative outcomes of laparoscopic hysterectomy (LH) with routine intraoperative cystoscopy (CYS) for enlarged uterus (> 280 g). The patients, who underwent LH procedure in the Department of Obstetrics and Gynecology in Duzce University Faculty of Medicine between July 2012 and July 2013, were included in this study. Perioperative outcomes were compared between patients with and without enlarged uterus. Uterus weight of the operated patients ranges between 38 and 700 g. Mean uterus weight was 196.40 +/- A 142.32 g. Although we found longer operation time (148.75 +/- A 32.37 vs. 128.28 +/- A 27.58) and higher delta hemoglobin (2.98 +/- A 3.09 vs. 1.61 +/- A 1.29) in patients with enlarged uterus undergoing LH, these findings were not statistically significant (p = 0.077 and 0.058). No significant difference was found between the two groups in terms of need for insertion of pelvic drainage (p = 0.664), duration of bladder catheterization (p = 0.673), time of first postoperative flatus (p = 0.509) and the duration of hospitalization (p = 0.844). None of the patients had postoperative fever. The two groups were not significantly different in terms of postoperative body temperature (p = 0.736). In normal uterus group, 1 patient developed ureterovaginal fistula and 1 patient required re-operation. No major complication was observed in large uterus group. In our study, we compared the outcomes of LH in patients with large uterus measuring up to 700 g. and patients with normal uterus, and we achieved successful results by making minor changes in the operation technique and performing diagnostic CYS at the end of the operation.Öğe Factors Affecting Successful Labor Induction with Dinoprostone(Düzce Üniversitesi, 2014) Çağlar, Mete; Dilbaz, Serdar; Üstün, Yusuf; Özbilgeç, Sıtkı; Kumru, Selahattin; Yavuzcan, AliPurpose: The aim of this study was to examine the effect of maternal age, parity, gestationalage, fetal weight and fetal gender on the successful labor induction with dinoprostone vaginalovule. Methods: Patients undergoing induction of labor with dinoprostone in Düzce UniversityHospital, Department of Obstetrics and Gynecology between July 2012 and July 2013 wereincluded in this study. The controlled released dinoprostone ovules containing 10 mg wereplaced in the posterior fornix for the purpose of cervical ripening. Patients who gave birthvaginally within 24 hours of application of dinoprostone ovule were considered as successfullabor induction. Results: The induction of labor was successful in 41,9% of the patients (n = 13). Maternal age,gestational age, fetal weight and fetal gender showed no statistically significant differencebetween the group of successful induction and failed induction (p = 0.598 and p = 0.507, p =0.590 and p = 0.981 respectively). No statistically significant correlation was detected betweenthe parity and success of labor induction (p = 0.760, rr = 0.057). Multiparity rate was 38.8% inthe patients who were delivered vaginally and 46.1% among the patients with induction failure.Multiparity rate between the two groups showed no statistically significant difference (p =0.727). Conclusion: The controlled released dinoprostone ovule is a successful method of laborinduction. However, large-scale randomized clinical trials are needed in order to clearly exposethe factors that affect the success of this methodÖğe Ghrelins, obestatin, nesfatin-1 and leptin levels in pregnant women with and without hyperemesis gravidarum(Pergamon-Elsevier Science Ltd, 2013) Güngör, Sami; Gürateş, Bilgin; Aydın, Süleyman; Şahin, İbrahim; Kavak, Salih Burçin; Kumru, Selahattin; Özdemir, NazanObjectives: The goal of this study was to compare levels of acyl and des-acyl ghrelin, obestatin, nesfatin-1 and leptin in healthy gravidas to hyperemesis gravidarum (HG) patients. Design and methods: Twenty pregnant women with HG and twenty healthy pregnant women all of similar ages, BMI and all at similar pregnancy development comprised the study cohort. Fasting serum samples were obtained and measured for acyl and des-acyl ghrelin, leptin, obestatin and nesfatin-1. Results: Nesfatin-1 concentrations in the HG group were higher compared to the control group whereas; leptin concentrations during pregnancy were lower in the HG group as compared to the control group. The two groups did not differ with regard to acyl and des-acyl ghrelin and obestatin. Conclusion: This pilot study suggests a possible role of leptin and nesfatin-1, which might be involved in the pathology of the disease. (C) 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.Öğe Identification of Clostridium septicum in a tubo-ovarian abscess: A rare case and review of the literature(Military Medical Acad-Ini, 2014) Yavuzcan, Ali; Çağlar, Mete; Dilbaz, Serdar; Kumru, Selahattin; Avcıoğlu, Fatma; Üstün, YusufIntroduction. Tubo-ovarian abscess (TOA) is a conglomerated mass of pelvic organs including the tube, the ovary, and the bowel. The most commonly isolated organisms from TOAs are Escherichia coli (E. cob) and Bacteroides species. Case Report. We reported a case of Clostridium septicum (C. septicum) infection from a ruptured TOA with atypical clinical features. Culture of intra-abdominal free fluid obtained during surgery yielded C. septicum. VITEK II (bioMerieux, France) automated system was used for advanced identification of the bacteria. Parenteral clindamycin in combination with an aminoglycoside was used. The patient was discharged 19 days after the surgery and was clinically asymptomatic 6 months after the surgery. Conclusion. The differential diagnosis of TOA caused by C. septicum can be difficult, due to the lack of the symptoms. Tissues infected with C. septicum can become necrotic. A combination of early, adequate antibiotic therapy and surgery is the key point of the treatment.Öğe Increased adhesion formation after gelatin-thrombin matrix application in a rat model(Springer Heidelberg, 2014) Çağlar, Mete; Yavuzcan, Ali; Yıldız, Elif; Yılmaz, Bayram; Dilbaz, Serdar; Kumru, SelahattinTo evaluate the effects of gelatin matrix and thrombin-based hemostatic sealant agents (gelatin-thrombin matrix) on postoperative adhesion formation in the rat uterine horn model. A total of fourteen female Wistar-Albino rats were used in our postoperative adhesion formation model. Both uterine horns were exposed by midline incision with sterile technique and each uterine horn was traumatized by bipolar electrocautery. Before closure of the abdomen, 0.9 % NaCl solution was administered intraperitoneally in the control group and the gelatin-thrombin matrix was applied on the traumatized areas on the uterine horns of the rats in the study group. At day 21 after the first surgery, the intraperitoneal macroscopic adhesion scores and the extent of fibrosis, inflammation scores, inflammatory cell activities, inflammation types of adhesion tissues, and the level of free oxygen radicals [malondialdehyde (MDA)] and antioxidant enzyme activity [superoxide dismutase (SOD) and glutathione S-transferase (GST)] in the uterine horn tissue were measured. There was no statistically significant difference between the two groups in terms of macroscopic adhesion scores (p = 0.064), MDA levels (p = 0.121), and GST activity (p = 0.360). However, there was statistically significant difference between the two groups in terms of the extent of fibrosis (p < 0.001), inflammation score (p = 0.001), inflammatory cell activity (p = 0.002), and SOD activity (p < 0.001). Gelatin-thrombin matrix was found to have increased the extent of fibrosis, inflammatory cell activity, and inflammation score, and reduced the activity of SOD, which acts to prevent cell damage.Öğe Influence of age, menopause, pelvic muscle exercises, urethral hypermobility and concomitant surgery on the outcomes after the transobturator tape procedure (factors effecting TOT outcomes)(Termedia Publishing House Ltd, 2013) Yavuzcan, Ali; Yıldız, Gazi; Üstün, Yusuf; Altıntaş, Raşit; Çağlar, Mete; Yıldız, Pınar; Kumru, SelahattinObjectives: We evaluated age, menopause, Q-tip and urinary stress tests performed on an outpatient basis before the transobturator tape (TOT) procedure, preoperative Kegel exercises, and vaginal surgeries performed concomitantly with the TOT procedure for their impact on symptomatic relief and complications in patients undergoing the TOT procedure. Aim of the study: Data including age, parity, menopausal status, concomitant vaginal surgery, complications, whether or not preoperative Kegel exercises were administered and urinary (cough) stress test and Q-tip test were performed, were retrieved from the patient charts and hospital records. Material and methods: The medical records of women, who underwent the TOT procedure for SUI in the Department of Obstetrics and Gynecology in Bucak State Hospital between January 2009 and November 2012 were reviewed. Results: No significant difference was observed between patients below and at or above 50 years of age in terms of success rate and complication rate (p = 1.00 and p = 0.351, respectively). There was a tendency for menopausal women to have a higher success rate (93.3% vs. 75%), this did not reach a statistical significance (p = 0.09). Urethral hypermobility did not significantly influence the success rate and complication rate (p = 0.694). Kegel exercises did not significantly influence the success rate and complication rate (p = 0.694). Vaginal surgeries performed concomitantly with the TOT procedure did not significantly influence complication rate (p = 0.454). Conclusions: The TOT procedure brings about the high success and low complication rates. Prospective, randomized, controlled studies on a larger number of patients are needed to clearly identify factors that would raise the success rate and reduce the complication rate.Öğe Irisin in idiopathic foetal growth restriction(Springer, 2014) Çağlar, Mete; Göksu, Mehmet; İsenlik, Bekir Sıtkı; Yavuzcan, Ali; Yılmaz, Musa; Üstün, Yusuf; Kumru, SelahattinPurpose The aim of the present study was to compare maternal serum and cord blood irisin levels in females whose pregnancies were or were not complicated by idiopathic foetal growth restriction. Methods A total of 30 subjects participated. The study group consisted of 15 female patients who were referred to our perinatology clinic for delivery because of foetal growth restriction developing in the third trimester. Fifteen females with uncomplicated singleton pregnancies constituted the control group. Irisin levels were assessed in maternal serum, as well as in serum from the umbilical vein and artery. Results The demographic features of the two groups were similar (p > 0.05). Gestational age at delivery and birth weight were higher in females with uncomplicated pregnancies (p = 0.001). Umbilical artery irisin levels were significantly lower in pregnancies complicated by foetal growth restriction compared to controls (p = 0.003). Umbilical artery irisin levels were positively correlated with foetal weight (p = 0.01) and foetal abdominal circumference (measured by ultrasonography) (p = 0.01). Maternal and umbilical vein irisin levels did not differ between the two groups (p > 0.05). Conclusions The data suggest that umbilical artery irisin levels were lower in pregnancies complicated by foetal growth restriction. Such lower irisin levels may contribute to the pathogenesis of this common condition, and metabolic syndrome may be a long-term consequence of idiopathic FGR.Öğe KOLPOSKOPİ UYGULANAN OLGULARIN SOSYODEMOGRAFİK ÖZELLİKLERİNİN SERVİKAL BİYOPSİ SONUÇLARIYLA KORELASYONU(Türk Jinekolojik Onkoloji Derneği, 2013) Çağlar, Mete; Derbent, Aysel U.; Pektaş, Mine Kanat; Erol, Onur; Özat, Mustafa; Kumru, SelahattinAmaç: Sunulan çalışma, servikal sitoloji anormalliği veya vulvar, vajinal ve servikal lezyon varlığı nedeniyle kolposkopi uygulanan olguların sosyodemografik özelliklerini ve sosyodemografik özelliklerinin kolposkopi sırasında alınan servikal biyopsi sonuçlarıyla korelasyonunu değerlendirmeyi amaçlamaktadır. Gereç ve Yöntem: Ocak 2011 ve Haziran 2012 tarihleri arasında, Antalya KETEM’nde, servikal sitoloji anormalliği veya vulvar, vajinal ve servikal lezyon varlığı nedeniyle kolposkopi uygulanan ve kolposkopi incelemesinin yeterli olarak kabul edildiği 301 kadın geriye dö- nük olarak değerlendirildi. Bulgular: Kolposkopi eşliğinde alınan servikal biyopsi sonucu normal olarak rapor edilen olgularla kıyaslandığında pre-invazif ve invazif servikal lezyon belirlenen olguların ortalama yaşı anlamlı olarak yüksekti (p=0.036). Bundan başka, pre-invazif ve invazif servikal hastalığı bulunan olgularda ortalama ilk koitus yaşı ve evli olma oranı anlamlı olarak daha düşüktü (sırasıyla p=0.001 ve p=0.002). Ayrıca, servikal patoloji saptanan olgularda düşük öğrenim düzeyi ve sigara alışkanlığı anlamlı olarak daha sık bulundu (sırasıyla p=0.040 ve p=0.044). Sonuç: Literatürle uyumlu olarak, sunulan çalışmada da, pre-invazif ve invazif servikal patoloji belirlenen kadınlarda ilk koitus yaşı- nın, evlilik oranının, sigara içmeme alışkanlığının ve yüksek öğrenim sıklığının daha düşük olduğu belirlenmiştir. Servikal biyopsi alınırken pre-invazif ve invazif serviks patolojileri için risk etkenleri mutlaka dikkate alınmalıdır.Öğe Laparaskopik HisterektomideTraneksamik Asit Kullanımı(2014) Yavuzcan, Ali; Çağlar, Mete; Üstün, Yusuf; Dilbaz, Serdar; Özkara, Atilla; Kumru, SelahattinAmaç: Bu çalışmanın amacı preoperatif dönemde traneksamik asit (TA) uygulanmasının laparaskopik histerektomide (LH) operasyon süresi, preoperatif-postoperatif dönem arasındaki hemoglobin (Hb) değişimi (delta Hb) ve hospitalizasyon süresi üzerine etkisini değerlendirmektir. Materyal-Metod: Adneksektomi dâhilya da hariç olmak üzere LH ile birlikte tanısal sistoskopi (CYS) işlemi yapılan hastalar çalışmaya dahil edilmiştir. Operasyonların hepsi aynı cerrah tarafından gerçekleştirilmiştir. Bulgular: TA kullanılan hastalar ile kullanılmayan hastalar arasında hasta yaşı ve uterin ağırlık açısından istatistiksel olarak anlamlı farklılık saptanmamıştır (p0,714 ve p0,955 sırasıyla). Ancak ortalama parite sayısı TA uygulanan grupta istatistiksel olarak anlamlı olacak şekilde düşük tespit edilmiştir (p0,006). Operasyonda TA uygulanan hastalar ile uygulanmayan hastalar arasında operasyon süresi (p0,962), delta Hb (p0,870) ve hospitalizasyon süresi (p0,759) açısından istatistiksel olarak anlamlı farklılık saptanmamıştır. Sonuç: Çalışmamızda TA uygulanmasının LHde operasyon sonuçları üzerine olumlu etkisi gösterilememiştir. Konvansiyonel olarak yapılan açık cerrahi işlemlerde kan kaybını azalttığı ispatlanmış olan TAnın minimal invaziv yöntemlerle yapılan operasyonlardaki etkinliğinin net olarak ortaya konabilmesi için geniş kapsamlı yeni araştırmalara gerek duyulmaktadır.Öğe Laparoskopik histerektomi sonuçlarımız: Tek merkez deneyimi(2014) Yavuzcan, Ali; Çağlar, Mete; Yıldız, Gazi; Dilbaz, Serdar; Üstün, Yusuf; Erişen, Onur; Kumru, SelahattinAmaç: Bu çalışmanın amacı temel demografik özellikleri benzer olan hastalardan oluşan, ilk 30 Laparoskopik histerektomi (LH) operasyonu ve daha sonra yapılan 62 adet LH operasyonunun perioperatif sonuçlarını karşılaştırmaktır. Yöntemler: Çalışmamıza Bucak Devlet Hastanesi Kadın Hastalıkları ve Doğum Kliniği ile Düzce Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı'nda Ocak 2012 ile Ekim 2013 tarihleri arasında opere edilen toplam 92 adet hasta dahil edilmiştir. Aynı cerrah tarafından LH operasyonu ilk defa uygulanmaya başlandıktan sonra yapılan ilk 30 hasta ile Grup 1 oluşturulmuştur. İlk 30 hastadan sonra opere edilen kalan 62 hasta ile Grup 2 oluşturulmuştur. Bulgular: Grup 1 ve Grup 2'deki hastalar arasında yaş, parite sayısı ve geçirilmiş pelvik cerrahi öyküsü oranı açısından istatistiksel olarak anlamlı farklılık tespit edilmedi (p0,813; p0,706 ve p0,410). Grup 1 ve Grup 2'deki hastalar arasında operasyon süresi (dk.), delta hb (gr/dl),hospitalizasyon süresi (gün) ve komplikasyon oranı açısından istatistiksel olarak anlamlı farklılık tespit edilmedi (p0,197; p0,085; p0,086 ve p0,353). Sonuçlar: Laparoskopik histerektomi günümüzde düşük komplikasyon oranları ve yüksek hasta memnuniyeti olan bir operasyon yöntemi olsa da artan cerrahi tecrübenin her zaman iyi peroperatif sonuçları garanti etmediği akılda tutulmalıdır.Öğe Maternal and umbilical cord copeptin levels in pregnancies complicated by fetal growth restriction(Taylor & Francis Ltd, 2015) Bülbül, Gül Alkan; Kumru, Selahattin; Erol, Onur; İsenlik, Bekir Sıtkı; Özdemir, Özgür; Çağlar, Mete; Aydın, SüleymanObjective: The aim of this study was to compare maternal and fetal serum copeptin concentrations in pregnancies complicated by isolated fetal growth restriction (FGR), and uncomplicated pregnancies, and to investigate relationships between copeptin levels and clinical parameters. Methods: Maternal and fetal serum copeptin levels were measured in 21 women with pregnancies complicated by isolated FGR and 20 women with normal pregnancies (control group). Doppler assessment of the uterine and umbilical arteries was performed in each patient. Results: Maternal serum copeptin levels were significantly higher in women with isolated FGR compared to controls (p = 0.042). In addition, maternal copeptin levels were inversely correlated with the uterine artery pulsatility and resistance indices and positively correlated with neonatal birth weight. Umbilical vein copeptin levels were significantly increased in neonates with adverse outcomes (p = 0.001). Conclusions: Increased maternal copeptin concentration may reflect a response to stress, thus serving as a compensatory mechanism in pregnancies complicated by FGR.
