Aim: This study aims to investigate the existence of any relationship between homocysteine levels and insulin resistance in Turkish women with polycystic ovary syndrome.Methods: A case-controlled, cross-sectional, observational study... more
Aim: This study aims to investigate the existence of any relationship between homocysteine levels and insulin resistance in Turkish women with polycystic ovary syndrome.Methods: A case-controlled, cross-sectional, observational study was undertaken in a total of 94 infertile Turkish women who required professional help in the Department of Infertility of Dr Zekai Tahir Burak Women's Health Research and Education Hospital. The correlation between serum homocysteine with age, body mass index, hormone profile, fasting insulin and glucose concentrations and insulin resistance were examined in patients with polycystic ovary syndrome and the results were compared to those of women with normal ovaries, who served as a control group.Results: The mean serum fasting glucose and insulin levels, thus insulin resistance index of women with polycystic ovary syndrome, were significantly higher than those of the control subjects. The mean serum homocysteine levels were significantly higher in women with polycystic ovary syndrome than those in the control group. A positive correlation was detected between the mean homocysteine, the insulin resistance index determined by homeostasis model assessment and the fasting insulin levels in polycystic ovary syndrome patients.Conclusions: Serum homocysteine levels are elevated in women with polycystic ovary syndrome, and this elevation is associated with the serum insulin level rather than androgen excess. The intense treatment of hyperhomocysteinemia in women with polycystic ovary syndrome might improve reproductive outcome and contribute to protection from cardiovascular risks.
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Objective The present study aims to compare anti-Mullerian hormone (AMH) with other ovarian reserve markers and to find a cut-off value of AMH for predicting ovarian response towards controlled ovarian hyperstimulation in an in vitro... more
Objective The present study aims to compare anti-Mullerian hormone (AMH) with other ovarian reserve markers and to find a cut-off value of AMH for predicting ovarian response towards controlled ovarian hyperstimulation in an in vitro fertilization (IVF) program. Materials and methods A prospective analysis was performed in 180 patients undergoing their first IVF trial, which is being conducted at a department of assisted reproduction in a tertiary medical center. The main outcome measures were determined as age and antral follicle count as well as the serum concentrations of follicle stimulating hormone, luteinizing hormone (LH), estradiol (E2), inhibin B and AMH. The predictive power of the aforementioned measures in specifying ovarian response was determined by means of discriminate analyses. Results As expected, day 3 LH levels were significantly high in the poor responder group. The poor responders had significantly lower antral follicle counts, retrieved oocyte number, and mature oocyte counts as well as day 3 AMH levels (5.8 ± 2.32 vs. 1.8 ± 0.80 ng/ml). There was a positive correlation with antral follicle count, basal AMH, E2 and follicle count on the day of HCG administration and negative correlation with age. The AMH level was addressed as the only significant factor in determination of mature oocyte number. A cut-off point for serum AMH concentration indicating the value of 2.97 ng/ml was found to predict the poor ovarian response with a sensitivity of 100.0% and a specificity of 89.6%. However, the same cut-off point was not as predictive for the non-conception circumstance. Conclusion The present study concludes that AMH is a promising biochemical marker for the prediction of ovarian response and that a cut-off point indicating the value of 2.97 ng/ml can be adopted for this prediction.
Research Interests: Prospective studies, Pregnancy, Humans, Female, Ovulation Induction, and 13 moreAssisted Reproduction, In Vitro Fertilization, Newborn Infant, Polycystic Ovary Syndrome, Ovarian Follicle, Adult, Prognosis, Fertilization in Vitro, Female Infertility, Luteinizing Hormone, Estradiol, Follicle stimulating hormone, and Predictive value of tests
Objective This study aims to identify the alterations in cervicovaginal flora after insertion of TCu 380A which is a popular type of copper IUD. Study design Among the women who visited the Department of Family Planning in our hospital... more
Objective This study aims to identify the alterations in cervicovaginal flora after insertion of TCu 380A which is a popular type of copper IUD. Study design Among the women who visited the Department of Family Planning in our hospital during 1 month, 100 subjects who preferred IUDs for contraception and who had no history of local or systemic antibiotic use were considered eligible candidates. Results Anaerobic colonies, especially Gram-positive cocci and Gram-negative bacilli were isolated at significantly higher rates after the insertion of TCu-380A. Aerobic colonies were isolated relatively less. Conclusions It can be suggested that copper IUD causes the predominance of anaerobic species in the cervicovaginal flora, which is consistent with the literature. This clinically insignificant condition can be attributed to the copper content or threads of the IUDs. Yet there is no evidence that the prevalance of pelvic infections is influenced by the use of IUDs.
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Background Endometrial cancer is the most common malignancy of the female genital tractus which is primarily seen in postmenopausal women. The purpose of this study is to investigate the relation between uterine histopathologic... more
Background Endometrial cancer is the most common malignancy of the female genital tractus which is primarily seen in postmenopausal women. The purpose of this study is to investigate the relation between uterine histopathologic alterations and sonographic findings in women diagnosed with endometrial cancer. Materials and methods A total of 120 women who were histologically diagnosed with endometrial cancer and who admitted to Gynecologic Oncology Department in the study center were eligible. The subjects were evaluated by Doppler ultrasonography (USG) coupled with a vaginal probe before surgery. After surgical staging was performed in all participants, the preoperative sonographic findings were compared with histopathologic information yielded from surgical specimens. Results The mean age of the study population was 53.1 years. About 85% of the subjects were postmenopausal. The mean endometrial thickness measured by transvaginal USG was found to be 25.6 ± 13.4 mm (range 6–88 mm). The diagnostic accuracy, sensitivity, specificity, positive and negative predictive values of transvaginal USG was, respectively, 69, 66, 72, 60 and 75%. In 37 (30.8%) patients, transvaginal USG could not correctly predict the depth of myometrial invasion. Myometrial invasion was underestimated in 17 cases (14.2%) and overestimated in 20 cases (16.7%). There was a significant negative correlation between the tumor grade and uterine artery blood flow. Conclusions The results of the present study determine that transvaginal USG has moderate sensitivity and moderate-to-high specificity which limit its use. However, endometrial thickness, myometrial invasion and resistance index values determined by Doppler USG can indicate the tumor grade allowing individualized treatment to be planned for endometrial tumors.
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Aim The present prospective study aims to investigate the serum concentrations of CA-125 in normal and preeclamptic pregnancies and thus to specify the clinical utility of this biochemical marker in prediction, diagnosis and follow up of... more
Aim The present prospective study aims to investigate the serum concentrations of CA-125 in normal and preeclamptic pregnancies and thus to specify the clinical utility of this biochemical marker in prediction, diagnosis and follow up of preeclampsia. Methods The present study reviews a total of 242 women with singleton pregnancy. These participants were categorized into three groups: control (n = 100), mild preeclampsia (n = 78) and severe preeclampsia (n = 64). The three study groups were statistically similar in aspects of maternal age, gestational age and body mass index. Results Serum CA-125 concentrations were found to correlate positively with systolic blood pressure (r = 0.345, p = 0.001), diastolic blood pressure (r = 0.379, p = 0.001), platelet count (r = 0.368, p = 0.001), serum levels of uric acid (r = 0.415, p = 0.001) and urine concentrations of protein (r = 0.357, p = 0.001). On the other hand, CA-125 levels correlated negatively with estimated fetal weight (r = −0.451, p = 0.001) and birthweight (r = −0.363, p = 0.001). When the cut-off point for serum CA-125 concentrations was accepted as 50 IU/ml, the sensitivity and specificity of this biochemical marker were, respectively, 93.7 and 88.0% for the detection of preeclamptic pregnancies. On the other hand, positive and negative predictive values for CA-125 were computed as 91.7 and 90.7%, respectively ( χ 2 = 30,184, p = 0.001). Conclusion The present study suggests that CA-125 is a biochemical marker which reflects the severity of the underlying inflammatory process in preeclampsia. Since it is much more available and relatively less expensive, it seems to be a promising test for screening preeclampsia. In accordance, the present study suggests 50 IU/ml as a cut-off point for CA-125 in screening preeclampsia.
Research Interests: Nonparametric Statistics, Birth Weight, Prospective studies, Pregnancy, Humans, and 14 moreBlood Pressure, Female, Young Adult, ROC Curve, Uric Acid, Adult, Analysis of Variance, Biological markers, Proteinuria, Reference Values, Platelet Count, Predictive value of tests, Pre Eclampsia, and Severity of Illness Index
Background The present review aims to increase the awareness of the gynecologists by analyzing all the case reports which refer to endometriosis presenting either with only ascites or with massive ascites with pleural effusion. Methods To... more
Background The present review aims to increase the awareness of the gynecologists by analyzing all the case reports which refer to endometriosis presenting either with only ascites or with massive ascites with pleural effusion. Methods To conduct the present review, the CENTRAL (in the Cochrane Library, current issue), MEDLINE (Silver Platter, from 1950 to 2010), and EMBASE (from 1950 to 2010) electronic databases were searched. As a result, all the publications based on the keywords relating to the review topic were acquired. Results Since the description of first case in 1954, endometriosis-related ascites was reported to occur in a total of 63 women who were aged between 19 and 51 years. Approximately 63.0% of the recruited women for whom ethnicity was specified were of African origin (29 out of 46). Of the 50 subjects with known obstetric history, 41 (82.0%) were nulliparous. Abdominal distention, anorexia/weight loss, abdominal pain, and menometrorrhagia were the most frequently encountered clinical symptoms, whereas pelvic mass was the most common physical finding. The serum concentrations of CA 125 were between 20 and 3,504 IU/ml for 19 women whose CA 125 levels were determined. Pleural effusion was also present in 38.1% of the reviewed subjects (24 out of 63). The clinical features of the women with endometriosis-related ascites and pleural effusion were similar to those of the women who had only endometriosis-related ascites. Conclusion Endometriosis-related ascites and/or pleural effusion refers to extensive disease with a high risk for recurrence which usually affects non-Caucasian, nulliparous women of reproductive age and leads to clinical symptoms resembling those of an ovarian malignancy. Therefore, clinicians should consider endometriosis in differential diagnosis of pelvic masses and also include endometriosis in diagnostic workup of ascites or pleural effusion.
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Aim: The present study aims to assign the reference values for nasal bone length (NBL) screened at 11–14 weeks of pregnancy in the Turkish population, determining whether the NBLs specified for Caucasians can be validated for Turkish... more
Aim: The present study aims to assign the reference values for nasal bone length (NBL) screened at 11–14 weeks of pregnancy in the Turkish population, determining whether the NBLs specified for Caucasians can be validated for Turkish people.Materials & Methods: The values of NBL were investigated in a total of 415 singleton fetuses that had Turkish parents and normal neonatal outcome. Sonographic measurements of NBL were done on a transabdominal midsagittal plane at 11–14 weeks' gestation. Regression analysis was used to assess the relationship between NBL and crown-rump length (CRL). Reference values, including the 5th, 50th and 95thpercentiles, were calculated for each gestational age.Results: The mean NBL was estimated to be 2.5 mm for 11–11+6/7 weeks, 2.9 mm for 12–12+6/7 and 3.4 mm for 13–13+6/7 weeks' gestation. The measurements of NBL showed a significant increase with CRL so that a linear and direct correlation was found between NBL and CRL (NBL = 0.267 + 0.043 × CRL, P < 0.001). Moreover, a significant and linear relationship was detected between NBL and gestational age (NBL = −3.858 + 0.537 × gestational age, P < 0.001).Conclusion: The measurement of NBL is found to be achievable in the majority of first trimester pregnancies. The reference range of NBL in normal Turkish fetuses is established so that basic data can be recorded for further studies related to NBL measurements in screening for various chromosomal abnormalities including Down syndrome within Turkish population.
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Aim The present case report describes colon injury subsequent to uterine penetration which is associated with the use of an intrauterine device (IUD). Case A 29-year-old multiparous woman, who presented with vague abdominal pain, had a... more
Aim The present case report describes colon injury subsequent to uterine penetration which is associated with the use of an intrauterine device (IUD). Case A 29-year-old multiparous woman, who presented with vague abdominal pain, had a TCu 380A inserted at her postpartum third month visit. The T-shaped segment of the IUD was found to be lodged within the lumen of a colon segment which was 60 cm far from the ileocecal valve. The vertical copper-bearing limb of the IUD extruded from the colon wall beyond the mesenteric edge and partially penetrated the fundal wall. After the affected colon segment was resected, an end-to-end anastomosis was made. Recovery period was uneventful. Discussion The incidence of uterine penetration is affected by the IUD type, the timing of insertion related to pregnancy termination, the position of uterus, insertion technique, the experience of the operator and the follow-up period. The location of missing IUDs can be determined by ultrasonography, X-ray or computed tomography imaging.
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Background The present study aims to investigate the predictive power of serum CA-125 and lactate dehydrogenase (LDH) for evaluating the outcome of first trimester pregnancies with beta human chorionic gonadotropin levels below... more
Background The present study aims to investigate the predictive power of serum CA-125 and lactate dehydrogenase (LDH) for evaluating the outcome of first trimester pregnancies with beta human chorionic gonadotropin levels below discriminatory zone (≤1,000 mIU/mL). Methods A total of 107 women with tubal ectopic pregnancies (30 ruptured and 77 unruptured), 105 women with normal intrauterine pregnancies and 100 women with intrauterine abortions were eligible for the study. Results Women with intrauterine abortion were found to have significantly higher CA-125 and LDH levels compared to women with ectopic and normal intrauterine pregnancies. Ruptured tubal pregnancies resulted in significantly higher CA-125 and statistically similar LDH levels compared with unruptured tubal pregnancies. Although CA-125 levels were found to be unrelated to gestational age in normal intrauterine normal and abortive as well as ruptured and unruptured ectopic pregnancies; LDH levels were directly correlated with gestational age in ruptured tubal ectopic pregnancies. Discussıon Consequently, the ability to determine the disintegration of ectopic trophoblastic or fetal tissues would be of great value in the management of hemodynamically stable patients with beta hCG levels below discriminatory zone. Intrauterine abortive pregnancies seem to yield high serum CA-125 concentrations combined with high LDH levels which indicate more extensive trophoblastic tissue damage than caused by intrauterine and ectopic pregnancies.
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Aim The present study aims to investigate the effects of betamethasone treatment on clinical outcome and laboratory data of pregnant women diagnosed with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Methods... more
Aim The present study aims to investigate the effects of betamethasone treatment on clinical outcome and laboratory data of pregnant women diagnosed with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Methods A prospective, randomized and placebo-controlled clinical trial was undertaken in a total of 60 pregnant women with HELLP syndrome who were treated at the perinatology department of the study center between January 2005 and February 2008. Betamethasone treatment (intramuscular injection of 12 mg in every 24 h) was given to 30 subjects while remaining 30 subjects received placebo. The treatment and control groups were compared in the aspects of clinical outcome and laboratory data. Results The alterations in platelet counts, alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase levels of women treated with betamethasone were statistically similar to those of the placebo group. Although there was a significant decrease in diastolic blood pressure values of control group (P = 0.04), alterations in systolic blood pressure values were statistically indifferent in both study groups. Hematological and metabolic complications occurred significantly less in women treated with betamethasone (P < 0.05). Interestingly, the percentage of women who received platelet transfusion was significantly higher in the control group (P < 0.005). No case of maternal mortality occurred. Conclusions The betamethasone treatment has ended up with insignificant alterations in clinical outcomes and laboratory data of women with HELLP syndrome except beneficial effects on metabolic complications and need for platelet transfusion. Further investigation is required to assess the efficiency of betamethasone in management of HELLP syndrome.
Research Interests: Nonparametric Statistics, Maternal Mortality, Prospective studies, Pregnancy, Humans, and 17 moreBlood Pressure, Female, HELLP Syndrome, Adult, Alanine Aminotransferase, Pregnant Women, Controlled Clinical Trial, Chi Square Distribution, Lactate dehydrogenase, Aspartate Aminotransferase, Aspartate Aminotransferases, Platelet Count, Glucocorticoids, Control Group, Systolic blood pressure, Alanine Transaminase, and Betamethasone
Aim Leptin is proposed to participate in the reproductive system of women by acting on either ovaries or hypothalamic-pituitary axis. The objective of the present study is to investigate the leptin concentrations in peritoneal fluid and... more
Aim Leptin is proposed to participate in the reproductive system of women by acting on either ovaries or hypothalamic-pituitary axis. The objective of the present study is to investigate the leptin concentrations in peritoneal fluid and serum samples of women diagnosed with primary infertility. Methods A prospective study was carried out in women who underwent laparoscopy within the diagnostic process of primary infertility between January 2005 and January 2007. Leptin concentrations were determined in blood samples obtained before surgery and in peritoneal fluid samples collected during laparoscopy. Results Peritoneal fluid was obtained from 112 subjects; 21 with unexplained infertility 28 with polycystic ovary syndrome (PCOS), 30 with bilateral tubal occlusion, and 33 with endometriosis. Subjects with PCOS have significantly higher body weights, BMI values and plasma leptin levels when compared to other study groups. Peritoneal fluid levels of leptin were significantly higher in the endometriosis group compared to other three study groups. A positive correlation was found between peritoneal fluid leptin levels and the endometriosis stage (r = 0.51, P = 0.01). However, plasma leptin levels were unrelated to the disease extent. Discussion It might be hypothesized that leptin may be an active factor in the pathogenesis of PCOS and endometriosis, which are two major causes of primary infertility. A mild leptin deficiency in peritoneal environment may interrupt follicular development and ultimately lead to PCOS. Leptin has angiogenic and mitogenic properties, which trigger inflammatory cytokines and eventually result in the development of endometriosis implants. Significantly, higher levels of leptin in peritoneal environments of endometriosis subjects strongly imply the important role of this common pathology.
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Obesity is an important factor that might reduce fecundity. In order to determine the underlying physiological mechanisms and risk factors, the obesity-fecundity association is investigated in relation to parity, menstrual cycle... more
Obesity is an important factor that might reduce fecundity. In order to determine the underlying physiological mechanisms and risk factors, the obesity-fecundity association is investigated in relation to parity, menstrual cycle regularity, smoking habits, and age. This was a retrospective cohort study of 22,840 women who gave birth between January 2006 and January 2007 in the Dr Zekai Tahir Burak Women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Health Research and Education Hospital. Age, parity, prepregnancy body mass index (BMI) values, time to pregnancy data related to smoking, and reproductive, medical, and gynecological history were obtained from the medical records. Fecundity was reduced for overweight and obese women compared with optimal weight women, and this reduction was more evident for obese primiparous women. Fecundity remained reduced for overweight and obese women with normal menstrual cycles. Obese and overweight women were found to smoke significantly more than the optimal weight group. Obesity was found to be associated with reduced fecundity for all weight-adjusted groups of women and persisted for women with regular cycles. Weight loss should be encouraged initially during the treatment of infertile overweight and obese women.
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Background Thrombocytosis has been reported in a variety of solid tumors, including certain gynecologic cancers such as endometrial, vulvar, and cervical cancers. The present study aims to determine the incidence of thrombocytosis in... more
Background Thrombocytosis has been reported in a variety of solid tumors, including certain gynecologic cancers such as endometrial, vulvar, and cervical cancers. The present study aims to determine the incidence of thrombocytosis in women with epithelial ovarian tumors and to evaluate its association with clinical and pathologic prognostic factors. Material and methods Between January 2001 and December 2006, 292 patients were diagnosed with epithelial ovarian tumors, and they underwent primary surgical treatment and subsequent platinum-based chemotherapy at the Gynecologic Oncology Department of the study center. The medical records of these patients were evaluated retrospectively. Results Of the 292 women with epithelial ovarian tumors undergoing primary surgical exploration, 124 (42.5%) had thrombocytosis, indicating platelet counts >400 × 109/l. Patients with thrombocytosis were found to have statistically higher levels of preoperative CA-125 levels, more advanced stage disease, higher grade tumors, and shorter periods of survival. Thrombocytosis is a significant negative prognostic factor for survival in patients with epithelial ovarian tumors. Conclusions Thrombocytosis is frequently detected in preoperative evaluation of women diagnosed with epithelial ovarian tumors. The data obtained by the previous and present studies suggest that thrombocytosis is associated with factors reflecting a more aggressive tumor biology, and predicting poor survival in women with epithelial ovarian tumors. However, these data are limited by the retrospective nature of the studies and do not confirm a casual relationship between thrombocytosis and tumor behavior. Molecular studies investigating the expression of platelet secretory factors are required to clarify the differences among data provided by the literature.
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Background The management of delayed delivery in a triplet pregnancy is described. Case A 25-year-old woman with an in vitro fertilization pregnancy aborted the presenting fetus at 19th gestational week. As she decided to carry on,... more
Background The management of delayed delivery in a triplet pregnancy is described. Case A 25-year-old woman with an in vitro fertilization pregnancy aborted the presenting fetus at 19th gestational week. As she decided to carry on, cervical cerclage, tocolysis and antimicrobial prophylaxis were performed. The remaining fetuses survived until 29th gestational week. Conclusion Prolongation of multiple pregnancies after the abortion of presenting fetuses is a possible approach, which is especially justified in women with a history of infertility.
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Objective The purpose of the present study was to investigate the predictive power of sexual hormones and tumor markers in endometrial cancer. Methods A total of 135 healthy women were prospectively compared with 135 women who had... more
Objective The purpose of the present study was to investigate the predictive power of sexual hormones and tumor markers in endometrial cancer. Methods A total of 135 healthy women were prospectively compared with 135 women who had histopathologically confirmed endometrial cancer. Both the groups of women were matched by age and body mass index. Results When compared with healthy controls, women with endometrial cancer had significantly higher serum levels of CA-125, CA 19-9, prolactin and thyroid-stimulating hormone, whereas significantly lower serum concentrations of α-fetoprotein, CA 15-3, follicle-stimulating hormone and luteinizing hormone (LH). Tumor stage correlated positively and significantly with serum levels of prolactin, CA-125 and CA 19-9 as did tumor grade with serum concentrations of LH, estradiol, prolactin and CA-125. Serum CA-125 levels >35 U/ml were found to have a sensitivity of 42.2%, specificity of 87.4%, positive-predictive value of 77.0% and negative-predictive value of 60.2%. Besides endometrial cancer could be diagnosed with 16.3% sensitivity, 100.0% specificity, 100.0% positive- and 54.4% negative-predictive values with serum prolactin levels >30 ng/ml. Conclusions Because serum concentrations of CA-125 can be elevated in various malignancies, it is obvious that it is neither specific nor accurately diagnostic for endometrial tumors. What is more, the distinct effects of physiological factors on prolactin secretion shadow the credibility of this hormone in early diagnosis of endometrial tumors. Thus, either prolactin or CA-125 is far from being utilized as the sole entity for screening endometrial cancer. Therefore, both parameters should be regarded as the components of a biochemical screening panel that is to be developed in future.
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Purpose The present study aims to determine whether sonographic endometrial pattern can be addressed as an early indicator for tubal ectopic pregnancy and related tubal rupture in case ultrasonography reveals no adnexal mass and maternal... more
Purpose The present study aims to determine whether sonographic endometrial pattern can be addressed as an early indicator for tubal ectopic pregnancy and related tubal rupture in case ultrasonography reveals no adnexal mass and maternal serum beta human chorionic gonadotropin (HCG) level is below the discriminatory zone (≤1,000 mIU/mL). Methods The study evaluated the endometrial features of 441 naturally conceived and asymptomatic first trimester (99 tubal ectopic, 138 failing and 264 normal intrauterine) with maternal serum beta HCG levels ≤1,000 mIU/mL and indeterminate sonographic findings. Results Tubal ectopic, failing intrauterine and normal intrauterine pregnancies are statistically similar in aspect of endometrial thickness. However, trilaminar endometrial pattern was significantly less frequent in failing and normal intrauterine pregnancies but significantly more frequent in ruptured tubal pregnancies. Also the relative risk of tubal rupture is significantly higher in case of trilaminar endometrial pattern. Trilaminar endometrial pattern has a sensitivity of 21.2%, specificity of 93.9%, positive predictive value of 50.0% and negative predictive value of 80.5% for distinguishing tubal ectopic pregnancy. Moreover, the sensitivity, specificity, positive and negative predictive values of the same pattern are computed to be 60.0, 95.7, 85.7 and 84.6%, respectively, in the prediction of ruptured tubal pregnancy. Conclusions Sonographic appearance of endometrium may be used to predict tubal pregnancy when ultrasonography shows no adnexal mass and maternal serum HCG ≤1,000 mIU/mL. That is, trilaminar pattern may indicate tubal pregnancy and warn about a possible related rupture in case of previous ectopic pregnancy or pelvic surgery.
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Objective The present study aims to compare the clinical and reproductive outcomes of women who have undergone lymph node dissection with those who have not and to discuss the indications for retroperitoneal evaluation in the treatment of... more
Objective The present study aims to compare the clinical and reproductive outcomes of women who have undergone lymph node dissection with those who have not and to discuss the indications for retroperitoneal evaluation in the treatment of borderline ovarian tumors. Methods The present study investigated 123 women who were finally diagnosed with borderline epithelial ovarian tumors at the study center between January 1999 and January 2009. A total of 68 patients (55.3%) were found to have a complete surgical staging procedure. Results The patients who underwent complete lymph node dissection were significantly younger than those who did not have lymphadenectomy. Thus, the ratio of postmenopausal women was significantly higher among those in whom retroperitoneal evaluation was performed. As expected, the intraoperative blood loss was significantly more and the hospital stay was significantly longer in patients who underwent complete lymph node dissection. Also, the non-serous borderline ovarian tumors were significantly more frequent in the latter patient group. However, overall and disease-free survival spans were found to be statistically similar for both study groups as well as the recurrence rate. Conclusions Retroperitoneal evaluation can be spared in every woman with borderline ovarian tumor unless she is to undergo complete surgical staging procedure because of high recurrence risk, advanced stage disease or personal choice.
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Objective The present study aims to specify the significance of fetal maxillary length by establishing a nomogram for a Turkish population and by investigating its relationship with the ultrasonographic and biochemical parameters which... more
Objective The present study aims to specify the significance of fetal maxillary length by establishing a nomogram for a Turkish population and by investigating its relationship with the ultrasonographic and biochemical parameters which are commonly used to screen trisomy 21 in the first trimester of pregnancy. Methods The present observational study investigates 1,308 Turkish women who had 11- to 14-week-old singleton healthy pregnancies. Fetal crown-rump length (CRL), nuchal translucency (NT), nasal bone length (NBL) and maxillary length are measured by ultrasonography and maternal serum concentrations of pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (HCG) are determined. Results A positive and significant correlation was detected between the fetal maxillary length and gestational age (r = 0.309, P < 0.001) as was the case with fetal CRL (r = 0.357, P < 0.001) and NBL (r = 0.487, P < 0.001). Although there was a significant and positive correlation between fetal maxillary length and maternal serum PAPP-A levels (r = 0.201, P < 0.001), a significant and negative correlation was found between fetal maxillary length and the maternal serum concentrations of free beta-HCG (r = −0.238, P < 0.001). Fetal maxillary length increased in accordance with the advancing gestational age and increasing CRL. Maternal serum PAPP-A concentrations and fetal CRL and NBL were addressed as independent predictors of fetal maxillary length. Conclusions The length of fetal maxillary bone is a promising biometrical parameter which can be reliably and efficiently used to screen trisomy 21 in first trimester. Fetal maxillary length is also found to correlate with gestational age, CRL, NBL and PAPP-A significantly. It would be rational to use a combination of nasal and maxillary bone length measurements in case serum concentrations of PAPP-A or beta-HCG cannot be assessed.
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Background The present study aims to characterize the women diagnosed with synchronous primary gynecological tumors with an emphasis on risk factors. Methods A total of 21 patients were identified with synchronous primary gynecological... more
Background The present study aims to characterize the women diagnosed with synchronous primary gynecological tumors with an emphasis on risk factors. Methods A total of 21 patients were identified with synchronous primary gynecological tumors between 2000 and 2006. Demographic, clinical and pathologic data were obtained from medical records and pathology reports. Results The majority of the study population (52.4%) was diagnosed with independent primary endometrial and ovarian tumors. The most common presenting symptoms were pelvic pain and abnormal vaginal bleeding. Tobacco use was significantly more frequent in women with synchronous cervical–ovarian tumors. There was no statistically significant difference in exogenous hormone use among patients with different synchronous tumors. Diabetes mellitus and hypertension were significantly more frequent in women with endometrial–ovarian tumors. Although the women with synchronous cervical–ovarian tumors were significantly younger and leaner, they had shorter survival periods. Conclusion Synchronous primary gynecologic tumors are usually detected in relatively older, overweight, multiparous and postmenopausal women with personal history of diabetes mellitus or hypertension. Synchronous primary tumors of endometrium and ovary are supposed to have better prognosis as they are diagnosed at early stage and low grade.
Research Interests: Survival Analysis, Turkey, Endometrial Cancer, Postmenopausal Women, Overweight, and 18 moreHumans, Diabetes mellitus, Tobacco Use, Female, Statistical Significance, Risk factors, Cervical Cancer, Synchronous, Aged, Middle Aged, Adult, Retrospective Studies, Ovarian Carcinoma, Age Factors, Risk Factors, Medical Records, Adenocarcinoma, and Cohort Studies
Objective The aim is to compare naturally conceived twins with twins conceived by assisted reproductive techniques (ART) by means of perinatal outcome, behavioural patterns and psychomotor development. Material and methods Three hundred... more
Objective The aim is to compare naturally conceived twins with twins conceived by assisted reproductive techniques (ART) by means of perinatal outcome, behavioural patterns and psychomotor development. Material and methods Three hundred and five spontaneous and 119 assisted twins were compared in aspects of behavioural patterns, mental and psychomotor development, as well as maternal and gestational age, foetal presentation, birth weight, sex, Apgar scores, perinatal complications, delivery route, and admission to neonatal intensive care unit (NICU) Results Although the maternal age was higher in assisted twins, the mean gestational age and birth weight of assisted twins were significantly less than those of spontaneous twins. The assisted twins did not differ from the naturally conceived twins in aspects of presentation, Apgar scores, admission to NICU and perinatal complications. However, caesarean section rate and the delivery rate of male foetuses were significantly higher in assisted twins. During the first year of life, retardation in mental and psychomotor development was more pronounced in assisted twins. Also assisted twins experienced behavioural problems and difficulties in parent-child interactions more frequently. Conclusions Although twins born to assisted pregnancies had significantly shorter duration of gestation and thus less birth weight, their perinatal outcome was similar to that of spontaneous twins. The mothers of assisted twins may be keener on getting intensive prenatal care, which might in turn help to diminish any possible maternal and foetal risks. However, assisted twins showed significantly retarded psychomotor and mental development and experienced problems with environmental factors more frequently during their first year.
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Introduction Primary ovarian leiomyosarcomas are rare gynecological tumors, which usually affect postmenopausal women. Materials and methods This short communication aims to remind this uncommon malignant pathology by describing a case... more
Introduction Primary ovarian leiomyosarcomas are rare gynecological tumors, which usually affect postmenopausal women. Materials and methods This short communication aims to remind this uncommon malignant pathology by describing a case and presenting a short review of the literature. Conclusion Unfortunately, these tumors are aggressive and have a poor prognosis.
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Objective The present study aims to document the experience of a single center on the reproductive outcome of a cohort of women who were treated with conservative surgery for borderline ovarian tumors and to specify whether their... more
Objective The present study aims to document the experience of a single center on the reproductive outcome of a cohort of women who were treated with conservative surgery for borderline ovarian tumors and to specify whether their fertility potential is associated with age, tumor histology and surgery type. Methods A total of 55 women who had undergone conservative surgery for borderline ovarian tumors between January 1999 and January 2009 were eligible. Recurrence rate, fertility outcome and the number of pregnancies were analyzed retrospectively. Results Among the study group, 11 women were not sexually active both at the time of surgery and during the follow-up period. Thus, a total of 44 patients attempted pregnancy after conservative surgery and 52.3% of them (23 out of 44) were able to conceive either spontaneously or by in vitro fertilization. The ability to conceive was shown to be associated with age, tumor histology and type of conservative surgery. As expected, the fertility potential correlated positively with decreasing age (correlation coefficient = 0.705, p = 0.001). Moreover, the existence of non-serous histology and the implementation of unilateral cystectomy were found to be associated with the ability to reach a clinical pregnancy (correlation coefficient = 0.585, p = 0.001 and correlation coefficient = 0.587, p = 0.001, respectively). Conclusions The primary treatment of borderline ovarian tumors refers to conservative surgery. Younger age, non-serous histology and unilateral cystectomy appear to be associated with favorable reproductive outcome in women who undergo conservative surgery for borderline malignancy of ovary.
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Objective The present study aims to compare anti-Mullerian hormone (AMH) with other ovarian reserve markers and to find a cut-off value of AMH for predicting ovarian response towards controlled ovarian hyperstimulation in an in vitro... more
Objective The present study aims to compare anti-Mullerian hormone (AMH) with other ovarian reserve markers and to find a cut-off value of AMH for predicting ovarian response towards controlled ovarian hyperstimulation in an in vitro fertilization (IVF) program. Materials and methods A prospective analysis was performed in 180 patients undergoing their first IVF trial, which is being conducted at a department of assisted reproduction in a tertiary medical center. The main outcome measures were determined as age and antral follicle count as well as the serum concentrations of follicle stimulating hormone, luteinizing hormone (LH), estradiol (E2), inhibin B and AMH. The predictive power of the aforementioned measures in specifying ovarian response was determined by means of discriminate analyses. Results As expected, day 3 LH levels were significantly high in the poor responder group. The poor responders had significantly lower antral follicle counts, retrieved oocyte number, and mature oocyte counts as well as day 3 AMH levels (5.8 ± 2.32 vs. 1.8 ± 0.80 ng/ml). There was a positive correlation with antral follicle count, basal AMH, E2 and follicle count on the day of HCG administration and negative correlation with age. The AMH level was addressed as the only significant factor in determination of mature oocyte number. A cut-off point for serum AMH concentration indicating the value of 2.97 ng/ml was found to predict the poor ovarian response with a sensitivity of 100.0% and a specificity of 89.6%. However, the same cut-off point was not as predictive for the non-conception circumstance. Conclusion The present study concludes that AMH is a promising biochemical marker for the prediction of ovarian response and that a cut-off point indicating the value of 2.97 ng/ml can be adopted for this prediction.
Research Interests: Prospective studies, Pregnancy, Humans, Female, Ovulation Induction, and 13 moreAssisted Reproduction, In Vitro Fertilization, Newborn Infant, Polycystic Ovary Syndrome, Ovarian Follicle, Adult, Prognosis, Fertilization in Vitro, Female Infertility, Luteinizing Hormone, Estradiol, Follicle stimulating hormone, and Predictive value of tests
Objective This study aims to identify the alterations in cervicovaginal flora after insertion of TCu 380A which is a popular type of copper IUD. Study design Among the women who visited the Department of Family Planning in our hospital... more
Objective This study aims to identify the alterations in cervicovaginal flora after insertion of TCu 380A which is a popular type of copper IUD. Study design Among the women who visited the Department of Family Planning in our hospital during 1 month, 100 subjects who preferred IUDs for contraception and who had no history of local or systemic antibiotic use were considered eligible candidates. Results Anaerobic colonies, especially Gram-positive cocci and Gram-negative bacilli were isolated at significantly higher rates after the insertion of TCu-380A. Aerobic colonies were isolated relatively less. Conclusions It can be suggested that copper IUD causes the predominance of anaerobic species in the cervicovaginal flora, which is consistent with the literature. This clinically insignificant condition can be attributed to the copper content or threads of the IUDs. Yet there is no evidence that the prevalance of pelvic infections is influenced by the use of IUDs.
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Objective The present study aims to establish a more sensitive nomogram of fetal sacral length measurements, as well as to specify the accuracy of fetal sacral length for the ultrasonographic assessment of gestational age. Methods The... more
Objective The present study aims to establish a more sensitive nomogram of fetal sacral length measurements, as well as to specify the accuracy of fetal sacral length for the ultrasonographic assessment of gestational age. Methods The present study investigated a total of 2,184 pregnant women who were referred for routine pregnancy follow-up. All of the reviewed women had uncomplicated singleton pregnancies without known structural and chromosomal fetal anomalies. Results A statistically significant linear relationship was established between sacrum length and gestational age [gestational age = 4.49 + 0.92 × sacrum length (r = 0.98, R 2 = 0.96)]. The rate of increase in sacrum length of fetuses with a gestational age of <28 weeks was formulated as [gestational age = −0.05 + 1.01 × sacrum length (r = 0.96, R 2 = 0.98)], while the same formula was [gestational age = −0.09 + 1.32 × sacrum length (r = 0.94, R 2 = 0.96)] for fetuses with a gestational age of ≥28 weeks. On the other hand, a statistically significant correlation was found to exist between biparietal diameter (r = 0.68, P = 0.001), head circumference (r = 0.590, P = 0.001), femur length (r = 0.719, P = 0.001) and sacrum length (r = 0.696, P = 0.001). However, the same statistically significant correlation exists between abdominal circumference and the other sonographic measurements (r = 0.223, P = 0.375). Conclusions The fetal sacral length appears as an easily acquired and valuable parameter, which directly and strongly correlates with gestational age and other biometrical measurements. Therefore, fetal sacral length may be utilized as a complementary tool in both the evaluation of fetal growth and prediction of gestational age. Further research is required to determine the significance of fetal sacral length in prenatal follow-up.
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Background Endometrial cancer is the most common malignancy of the female genital tractus which is primarily seen in postmenopausal women. The purpose of this study is to investigate the relation between uterine histopathologic... more
Background Endometrial cancer is the most common malignancy of the female genital tractus which is primarily seen in postmenopausal women. The purpose of this study is to investigate the relation between uterine histopathologic alterations and sonographic findings in women diagnosed with endometrial cancer. Materials and methods A total of 120 women who were histologically diagnosed with endometrial cancer and who admitted to Gynecologic Oncology Department in the study center were eligible. The subjects were evaluated by Doppler ultrasonography (USG) coupled with a vaginal probe before surgery. After surgical staging was performed in all participants, the preoperative sonographic findings were compared with histopathologic information yielded from surgical specimens. Results The mean age of the study population was 53.1 years. About 85% of the subjects were postmenopausal. The mean endometrial thickness measured by transvaginal USG was found to be 25.6 ± 13.4 mm (range 6–88 mm). The diagnostic accuracy, sensitivity, specificity, positive and negative predictive values of transvaginal USG was, respectively, 69, 66, 72, 60 and 75%. In 37 (30.8%) patients, transvaginal USG could not correctly predict the depth of myometrial invasion. Myometrial invasion was underestimated in 17 cases (14.2%) and overestimated in 20 cases (16.7%). There was a significant negative correlation between the tumor grade and uterine artery blood flow. Conclusions The results of the present study determine that transvaginal USG has moderate sensitivity and moderate-to-high specificity which limit its use. However, endometrial thickness, myometrial invasion and resistance index values determined by Doppler USG can indicate the tumor grade allowing individualized treatment to be planned for endometrial tumors.
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Aim The present prospective study aims to investigate the serum concentrations of CA-125 in normal and preeclamptic pregnancies and thus to specify the clinical utility of this biochemical marker in prediction, diagnosis and follow up of... more
Aim The present prospective study aims to investigate the serum concentrations of CA-125 in normal and preeclamptic pregnancies and thus to specify the clinical utility of this biochemical marker in prediction, diagnosis and follow up of preeclampsia. Methods The present study reviews a total of 242 women with singleton pregnancy. These participants were categorized into three groups: control (n = 100), mild preeclampsia (n = 78) and severe preeclampsia (n = 64). The three study groups were statistically similar in aspects of maternal age, gestational age and body mass index. Results Serum CA-125 concentrations were found to correlate positively with systolic blood pressure (r = 0.345, p = 0.001), diastolic blood pressure (r = 0.379, p = 0.001), platelet count (r = 0.368, p = 0.001), serum levels of uric acid (r = 0.415, p = 0.001) and urine concentrations of protein (r = 0.357, p = 0.001). On the other hand, CA-125 levels correlated negatively with estimated fetal weight (r = −0.451, p = 0.001) and birthweight (r = −0.363, p = 0.001). When the cut-off point for serum CA-125 concentrations was accepted as 50 IU/ml, the sensitivity and specificity of this biochemical marker were, respectively, 93.7 and 88.0% for the detection of preeclamptic pregnancies. On the other hand, positive and negative predictive values for CA-125 were computed as 91.7 and 90.7%, respectively ( χ 2 = 30,184, p = 0.001). Conclusion The present study suggests that CA-125 is a biochemical marker which reflects the severity of the underlying inflammatory process in preeclampsia. Since it is much more available and relatively less expensive, it seems to be a promising test for screening preeclampsia. In accordance, the present study suggests 50 IU/ml as a cut-off point for CA-125 in screening preeclampsia.
Research Interests: Nonparametric Statistics, Birth Weight, Prospective studies, Pregnancy, Humans, and 14 moreBlood Pressure, Female, Young Adult, ROC Curve, Uric Acid, Adult, Analysis of Variance, Biological markers, Proteinuria, Reference Values, Platelet Count, Predictive value of tests, Pre Eclampsia, and Severity of Illness Index
Background The present review aims to increase the awareness of the gynecologists by analyzing all the case reports which refer to endometriosis presenting either with only ascites or with massive ascites with pleural effusion. Methods To... more
Background The present review aims to increase the awareness of the gynecologists by analyzing all the case reports which refer to endometriosis presenting either with only ascites or with massive ascites with pleural effusion. Methods To conduct the present review, the CENTRAL (in the Cochrane Library, current issue), MEDLINE (Silver Platter, from 1950 to 2010), and EMBASE (from 1950 to 2010) electronic databases were searched. As a result, all the publications based on the keywords relating to the review topic were acquired. Results Since the description of first case in 1954, endometriosis-related ascites was reported to occur in a total of 63 women who were aged between 19 and 51 years. Approximately 63.0% of the recruited women for whom ethnicity was specified were of African origin (29 out of 46). Of the 50 subjects with known obstetric history, 41 (82.0%) were nulliparous. Abdominal distention, anorexia/weight loss, abdominal pain, and menometrorrhagia were the most frequently encountered clinical symptoms, whereas pelvic mass was the most common physical finding. The serum concentrations of CA 125 were between 20 and 3,504 IU/ml for 19 women whose CA 125 levels were determined. Pleural effusion was also present in 38.1% of the reviewed subjects (24 out of 63). The clinical features of the women with endometriosis-related ascites and pleural effusion were similar to those of the women who had only endometriosis-related ascites. Conclusion Endometriosis-related ascites and/or pleural effusion refers to extensive disease with a high risk for recurrence which usually affects non-Caucasian, nulliparous women of reproductive age and leads to clinical symptoms resembling those of an ovarian malignancy. Therefore, clinicians should consider endometriosis in differential diagnosis of pelvic masses and also include endometriosis in diagnostic workup of ascites or pleural effusion.
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Research Interests:
Aim: The present study aims to assign the reference values for nasal bone length (NBL) screened at 11–14 weeks of pregnancy in the Turkish population, determining whether the NBLs specified for Caucasians can be validated for Turkish... more
Aim: The present study aims to assign the reference values for nasal bone length (NBL) screened at 11–14 weeks of pregnancy in the Turkish population, determining whether the NBLs specified for Caucasians can be validated for Turkish people.Materials & Methods: The values of NBL were investigated in a total of 415 singleton fetuses that had Turkish parents and normal neonatal outcome. Sonographic measurements of NBL were done on a transabdominal midsagittal plane at 11–14 weeks' gestation. Regression analysis was used to assess the relationship between NBL and crown-rump length (CRL). Reference values, including the 5th, 50th and 95thpercentiles, were calculated for each gestational age.Results: The mean NBL was estimated to be 2.5 mm for 11–11+6/7 weeks, 2.9 mm for 12–12+6/7 and 3.4 mm for 13–13+6/7 weeks' gestation. The measurements of NBL showed a significant increase with CRL so that a linear and direct correlation was found between NBL and CRL (NBL = 0.267 + 0.043 × CRL, P < 0.001). Moreover, a significant and linear relationship was detected between NBL and gestational age (NBL = −3.858 + 0.537 × gestational age, P < 0.001).Conclusion: The measurement of NBL is found to be achievable in the majority of first trimester pregnancies. The reference range of NBL in normal Turkish fetuses is established so that basic data can be recorded for further studies related to NBL measurements in screening for various chromosomal abnormalities including Down syndrome within Turkish population.
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Aim The present case report describes colon injury subsequent to uterine penetration which is associated with the use of an intrauterine device (IUD). Case A 29-year-old multiparous woman, who presented with vague abdominal pain, had a... more
Aim The present case report describes colon injury subsequent to uterine penetration which is associated with the use of an intrauterine device (IUD). Case A 29-year-old multiparous woman, who presented with vague abdominal pain, had a TCu 380A inserted at her postpartum third month visit. The T-shaped segment of the IUD was found to be lodged within the lumen of a colon segment which was 60 cm far from the ileocecal valve. The vertical copper-bearing limb of the IUD extruded from the colon wall beyond the mesenteric edge and partially penetrated the fundal wall. After the affected colon segment was resected, an end-to-end anastomosis was made. Recovery period was uneventful. Discussion The incidence of uterine penetration is affected by the IUD type, the timing of insertion related to pregnancy termination, the position of uterus, insertion technique, the experience of the operator and the follow-up period. The location of missing IUDs can be determined by ultrasonography, X-ray or computed tomography imaging.
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Background The present study aims to investigate the predictive power of serum CA-125 and lactate dehydrogenase (LDH) for evaluating the outcome of first trimester pregnancies with beta human chorionic gonadotropin levels below... more
Background The present study aims to investigate the predictive power of serum CA-125 and lactate dehydrogenase (LDH) for evaluating the outcome of first trimester pregnancies with beta human chorionic gonadotropin levels below discriminatory zone (≤1,000 mIU/mL). Methods A total of 107 women with tubal ectopic pregnancies (30 ruptured and 77 unruptured), 105 women with normal intrauterine pregnancies and 100 women with intrauterine abortions were eligible for the study. Results Women with intrauterine abortion were found to have significantly higher CA-125 and LDH levels compared to women with ectopic and normal intrauterine pregnancies. Ruptured tubal pregnancies resulted in significantly higher CA-125 and statistically similar LDH levels compared with unruptured tubal pregnancies. Although CA-125 levels were found to be unrelated to gestational age in normal intrauterine normal and abortive as well as ruptured and unruptured ectopic pregnancies; LDH levels were directly correlated with gestational age in ruptured tubal ectopic pregnancies. Discussıon Consequently, the ability to determine the disintegration of ectopic trophoblastic or fetal tissues would be of great value in the management of hemodynamically stable patients with beta hCG levels below discriminatory zone. Intrauterine abortive pregnancies seem to yield high serum CA-125 concentrations combined with high LDH levels which indicate more extensive trophoblastic tissue damage than caused by intrauterine and ectopic pregnancies.
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Aim The present study aims to investigate the effects of betamethasone treatment on clinical outcome and laboratory data of pregnant women diagnosed with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Methods... more
Aim The present study aims to investigate the effects of betamethasone treatment on clinical outcome and laboratory data of pregnant women diagnosed with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Methods A prospective, randomized and placebo-controlled clinical trial was undertaken in a total of 60 pregnant women with HELLP syndrome who were treated at the perinatology department of the study center between January 2005 and February 2008. Betamethasone treatment (intramuscular injection of 12 mg in every 24 h) was given to 30 subjects while remaining 30 subjects received placebo. The treatment and control groups were compared in the aspects of clinical outcome and laboratory data. Results The alterations in platelet counts, alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase levels of women treated with betamethasone were statistically similar to those of the placebo group. Although there was a significant decrease in diastolic blood pressure values of control group (P = 0.04), alterations in systolic blood pressure values were statistically indifferent in both study groups. Hematological and metabolic complications occurred significantly less in women treated with betamethasone (P < 0.05). Interestingly, the percentage of women who received platelet transfusion was significantly higher in the control group (P < 0.005). No case of maternal mortality occurred. Conclusions The betamethasone treatment has ended up with insignificant alterations in clinical outcomes and laboratory data of women with HELLP syndrome except beneficial effects on metabolic complications and need for platelet transfusion. Further investigation is required to assess the efficiency of betamethasone in management of HELLP syndrome.
Research Interests: Nonparametric Statistics, Maternal Mortality, Prospective studies, Pregnancy, Humans, and 17 moreBlood Pressure, Female, HELLP Syndrome, Adult, Alanine Aminotransferase, Pregnant Women, Controlled Clinical Trial, Chi Square Distribution, Lactate dehydrogenase, Aspartate Aminotransferase, Aspartate Aminotransferases, Platelet Count, Glucocorticoids, Control Group, Systolic blood pressure, Alanine Transaminase, and Betamethasone
Aim Leptin is proposed to participate in the reproductive system of women by acting on either ovaries or hypothalamic-pituitary axis. The objective of the present study is to investigate the leptin concentrations in peritoneal fluid and... more
Aim Leptin is proposed to participate in the reproductive system of women by acting on either ovaries or hypothalamic-pituitary axis. The objective of the present study is to investigate the leptin concentrations in peritoneal fluid and serum samples of women diagnosed with primary infertility. Methods A prospective study was carried out in women who underwent laparoscopy within the diagnostic process of primary infertility between January 2005 and January 2007. Leptin concentrations were determined in blood samples obtained before surgery and in peritoneal fluid samples collected during laparoscopy. Results Peritoneal fluid was obtained from 112 subjects; 21 with unexplained infertility 28 with polycystic ovary syndrome (PCOS), 30 with bilateral tubal occlusion, and 33 with endometriosis. Subjects with PCOS have significantly higher body weights, BMI values and plasma leptin levels when compared to other study groups. Peritoneal fluid levels of leptin were significantly higher in the endometriosis group compared to other three study groups. A positive correlation was found between peritoneal fluid leptin levels and the endometriosis stage (r = 0.51, P = 0.01). However, plasma leptin levels were unrelated to the disease extent. Discussion It might be hypothesized that leptin may be an active factor in the pathogenesis of PCOS and endometriosis, which are two major causes of primary infertility. A mild leptin deficiency in peritoneal environment may interrupt follicular development and ultimately lead to PCOS. Leptin has angiogenic and mitogenic properties, which trigger inflammatory cytokines and eventually result in the development of endometriosis implants. Significantly, higher levels of leptin in peritoneal environments of endometriosis subjects strongly imply the important role of this common pathology.
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Obesity is an important factor that might reduce fecundity. In order to determine the underlying physiological mechanisms and risk factors, the obesity-fecundity association is investigated in relation to parity, menstrual cycle... more
Obesity is an important factor that might reduce fecundity. In order to determine the underlying physiological mechanisms and risk factors, the obesity-fecundity association is investigated in relation to parity, menstrual cycle regularity, smoking habits, and age. This was a retrospective cohort study of 22,840 women who gave birth between January 2006 and January 2007 in the Dr Zekai Tahir Burak Women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Health Research and Education Hospital. Age, parity, prepregnancy body mass index (BMI) values, time to pregnancy data related to smoking, and reproductive, medical, and gynecological history were obtained from the medical records. Fecundity was reduced for overweight and obese women compared with optimal weight women, and this reduction was more evident for obese primiparous women. Fecundity remained reduced for overweight and obese women with normal menstrual cycles. Obese and overweight women were found to smoke significantly more than the optimal weight group. Obesity was found to be associated with reduced fecundity for all weight-adjusted groups of women and persisted for women with regular cycles. Weight loss should be encouraged initially during the treatment of infertile overweight and obese women.
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Objective The present study aims to compare anti-Mullerian hormone (AMH) with other ovarian reserve markers and to find a cut-off value of AMH for predicting ovarian response towards controlled ovarian hyperstimulation in an in vitro... more
Objective The present study aims to compare anti-Mullerian hormone (AMH) with other ovarian reserve markers and to find a cut-off value of AMH for predicting ovarian response towards controlled ovarian hyperstimulation in an in vitro fertilization (IVF) program. Materials and methods A prospective analysis was performed in 180 patients undergoing their first IVF trial, which is being conducted at a department of assisted reproduction in a tertiary medical center. The main outcome measures were determined as age and antral follicle count as well as the serum concentrations of follicle stimulating hormone, luteinizing hormone (LH), estradiol (E2), inhibin B and AMH. The predictive power of the aforementioned measures in specifying ovarian response was determined by means of discriminate analyses. Results As expected, day 3 LH levels were significantly high in the poor responder group. The poor responders had significantly lower antral follicle counts, retrieved oocyte number, and mature oocyte counts as well as day 3 AMH levels (5.8 ± 2.32 vs. 1.8 ± 0.80 ng/ml). There was a positive correlation with antral follicle count, basal AMH, E2 and follicle count on the day of HCG administration and negative correlation with age. The AMH level was addressed as the only significant factor in determination of mature oocyte number. A cut-off point for serum AMH concentration indicating the value of 2.97 ng/ml was found to predict the poor ovarian response with a sensitivity of 100.0% and a specificity of 89.6%. However, the same cut-off point was not as predictive for the non-conception circumstance. Conclusion The present study concludes that AMH is a promising biochemical marker for the prediction of ovarian response and that a cut-off point indicating the value of 2.97 ng/ml can be adopted for this prediction.
Research Interests: Prospective studies, Pregnancy, Humans, Female, Ovulation Induction, and 13 moreAssisted Reproduction, In Vitro Fertilization, Newborn Infant, Polycystic Ovary Syndrome, Ovarian Follicle, Adult, Prognosis, Fertilization in Vitro, Female Infertility, Luteinizing Hormone, Estradiol, Follicle stimulating hormone, and Predictive value of tests
Background Thrombocytosis has been reported in a variety of solid tumors, including certain gynecologic cancers such as endometrial, vulvar, and cervical cancers. The present study aims to determine the incidence of thrombocytosis in... more
Background Thrombocytosis has been reported in a variety of solid tumors, including certain gynecologic cancers such as endometrial, vulvar, and cervical cancers. The present study aims to determine the incidence of thrombocytosis in women with epithelial ovarian tumors and to evaluate its association with clinical and pathologic prognostic factors. Material and methods Between January 2001 and December 2006, 292 patients were diagnosed with epithelial ovarian tumors, and they underwent primary surgical treatment and subsequent platinum-based chemotherapy at the Gynecologic Oncology Department of the study center. The medical records of these patients were evaluated retrospectively. Results Of the 292 women with epithelial ovarian tumors undergoing primary surgical exploration, 124 (42.5%) had thrombocytosis, indicating platelet counts >400 × 109/l. Patients with thrombocytosis were found to have statistically higher levels of preoperative CA-125 levels, more advanced stage disease, higher grade tumors, and shorter periods of survival. Thrombocytosis is a significant negative prognostic factor for survival in patients with epithelial ovarian tumors. Conclusions Thrombocytosis is frequently detected in preoperative evaluation of women diagnosed with epithelial ovarian tumors. The data obtained by the previous and present studies suggest that thrombocytosis is associated with factors reflecting a more aggressive tumor biology, and predicting poor survival in women with epithelial ovarian tumors. However, these data are limited by the retrospective nature of the studies and do not confirm a casual relationship between thrombocytosis and tumor behavior. Molecular studies investigating the expression of platelet secretory factors are required to clarify the differences among data provided by the literature.
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Background The management of delayed delivery in a triplet pregnancy is described. Case A 25-year-old woman with an in vitro fertilization pregnancy aborted the presenting fetus at 19th gestational week. As she decided to carry on,... more
Background The management of delayed delivery in a triplet pregnancy is described. Case A 25-year-old woman with an in vitro fertilization pregnancy aborted the presenting fetus at 19th gestational week. As she decided to carry on, cervical cerclage, tocolysis and antimicrobial prophylaxis were performed. The remaining fetuses survived until 29th gestational week. Conclusion Prolongation of multiple pregnancies after the abortion of presenting fetuses is a possible approach, which is especially justified in women with a history of infertility.
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Objective This study aims to identify the alterations in cervicovaginal flora after insertion of TCu 380A which is a popular type of copper IUD. Study design Among the women who visited the Department of Family Planning in our hospital... more
Objective This study aims to identify the alterations in cervicovaginal flora after insertion of TCu 380A which is a popular type of copper IUD. Study design Among the women who visited the Department of Family Planning in our hospital during 1 month, 100 subjects who preferred IUDs for contraception and who had no history of local or systemic antibiotic use were considered eligible candidates. Results Anaerobic colonies, especially Gram-positive cocci and Gram-negative bacilli were isolated at significantly higher rates after the insertion of TCu-380A. Aerobic colonies were isolated relatively less. Conclusions It can be suggested that copper IUD causes the predominance of anaerobic species in the cervicovaginal flora, which is consistent with the literature. This clinically insignificant condition can be attributed to the copper content or threads of the IUDs. Yet there is no evidence that the prevalance of pelvic infections is influenced by the use of IUDs.
Research Interests:
Objective The purpose of the present study was to investigate the predictive power of sexual hormones and tumor markers in endometrial cancer. Methods A total of 135 healthy women were prospectively compared with 135 women who had... more
Objective The purpose of the present study was to investigate the predictive power of sexual hormones and tumor markers in endometrial cancer. Methods A total of 135 healthy women were prospectively compared with 135 women who had histopathologically confirmed endometrial cancer. Both the groups of women were matched by age and body mass index. Results When compared with healthy controls, women with endometrial cancer had significantly higher serum levels of CA-125, CA 19-9, prolactin and thyroid-stimulating hormone, whereas significantly lower serum concentrations of α-fetoprotein, CA 15-3, follicle-stimulating hormone and luteinizing hormone (LH). Tumor stage correlated positively and significantly with serum levels of prolactin, CA-125 and CA 19-9 as did tumor grade with serum concentrations of LH, estradiol, prolactin and CA-125. Serum CA-125 levels >35 U/ml were found to have a sensitivity of 42.2%, specificity of 87.4%, positive-predictive value of 77.0% and negative-predictive value of 60.2%. Besides endometrial cancer could be diagnosed with 16.3% sensitivity, 100.0% specificity, 100.0% positive- and 54.4% negative-predictive values with serum prolactin levels >30 ng/ml. Conclusions Because serum concentrations of CA-125 can be elevated in various malignancies, it is obvious that it is neither specific nor accurately diagnostic for endometrial tumors. What is more, the distinct effects of physiological factors on prolactin secretion shadow the credibility of this hormone in early diagnosis of endometrial tumors. Thus, either prolactin or CA-125 is far from being utilized as the sole entity for screening endometrial cancer. Therefore, both parameters should be regarded as the components of a biochemical screening panel that is to be developed in future.
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Background Endometrial cancer is the most common malignancy of the female genital tractus which is primarily seen in postmenopausal women. The purpose of this study is to investigate the relation between uterine histopathologic... more
Background Endometrial cancer is the most common malignancy of the female genital tractus which is primarily seen in postmenopausal women. The purpose of this study is to investigate the relation between uterine histopathologic alterations and sonographic findings in women diagnosed with endometrial cancer. Materials and methods A total of 120 women who were histologically diagnosed with endometrial cancer and who admitted to Gynecologic Oncology Department in the study center were eligible. The subjects were evaluated by Doppler ultrasonography (USG) coupled with a vaginal probe before surgery. After surgical staging was performed in all participants, the preoperative sonographic findings were compared with histopathologic information yielded from surgical specimens. Results The mean age of the study population was 53.1 years. About 85% of the subjects were postmenopausal. The mean endometrial thickness measured by transvaginal USG was found to be 25.6 ± 13.4 mm (range 6–88 mm). The diagnostic accuracy, sensitivity, specificity, positive and negative predictive values of transvaginal USG was, respectively, 69, 66, 72, 60 and 75%. In 37 (30.8%) patients, transvaginal USG could not correctly predict the depth of myometrial invasion. Myometrial invasion was underestimated in 17 cases (14.2%) and overestimated in 20 cases (16.7%). There was a significant negative correlation between the tumor grade and uterine artery blood flow. Conclusions The results of the present study determine that transvaginal USG has moderate sensitivity and moderate-to-high specificity which limit its use. However, endometrial thickness, myometrial invasion and resistance index values determined by Doppler USG can indicate the tumor grade allowing individualized treatment to be planned for endometrial tumors.
Research Interests:
Purpose The present study aims to determine whether sonographic endometrial pattern can be addressed as an early indicator for tubal ectopic pregnancy and related tubal rupture in case ultrasonography reveals no adnexal mass and maternal... more
Purpose The present study aims to determine whether sonographic endometrial pattern can be addressed as an early indicator for tubal ectopic pregnancy and related tubal rupture in case ultrasonography reveals no adnexal mass and maternal serum beta human chorionic gonadotropin (HCG) level is below the discriminatory zone (≤1,000 mIU/mL). Methods The study evaluated the endometrial features of 441 naturally conceived and asymptomatic first trimester (99 tubal ectopic, 138 failing and 264 normal intrauterine) with maternal serum beta HCG levels ≤1,000 mIU/mL and indeterminate sonographic findings. Results Tubal ectopic, failing intrauterine and normal intrauterine pregnancies are statistically similar in aspect of endometrial thickness. However, trilaminar endometrial pattern was significantly less frequent in failing and normal intrauterine pregnancies but significantly more frequent in ruptured tubal pregnancies. Also the relative risk of tubal rupture is significantly higher in case of trilaminar endometrial pattern. Trilaminar endometrial pattern has a sensitivity of 21.2%, specificity of 93.9%, positive predictive value of 50.0% and negative predictive value of 80.5% for distinguishing tubal ectopic pregnancy. Moreover, the sensitivity, specificity, positive and negative predictive values of the same pattern are computed to be 60.0, 95.7, 85.7 and 84.6%, respectively, in the prediction of ruptured tubal pregnancy. Conclusions Sonographic appearance of endometrium may be used to predict tubal pregnancy when ultrasonography shows no adnexal mass and maternal serum HCG ≤1,000 mIU/mL. That is, trilaminar pattern may indicate tubal pregnancy and warn about a possible related rupture in case of previous ectopic pregnancy or pelvic surgery.
Research Interests:
Aim The present prospective study aims to investigate the serum concentrations of CA-125 in normal and preeclamptic pregnancies and thus to specify the clinical utility of this biochemical marker in prediction, diagnosis and follow up of... more
Aim The present prospective study aims to investigate the serum concentrations of CA-125 in normal and preeclamptic pregnancies and thus to specify the clinical utility of this biochemical marker in prediction, diagnosis and follow up of preeclampsia. Methods The present study reviews a total of 242 women with singleton pregnancy. These participants were categorized into three groups: control (n = 100), mild preeclampsia (n = 78) and severe preeclampsia (n = 64). The three study groups were statistically similar in aspects of maternal age, gestational age and body mass index. Results Serum CA-125 concentrations were found to correlate positively with systolic blood pressure (r = 0.345, p = 0.001), diastolic blood pressure (r = 0.379, p = 0.001), platelet count (r = 0.368, p = 0.001), serum levels of uric acid (r = 0.415, p = 0.001) and urine concentrations of protein (r = 0.357, p = 0.001). On the other hand, CA-125 levels correlated negatively with estimated fetal weight (r = −0.451, p = 0.001) and birthweight (r = −0.363, p = 0.001). When the cut-off point for serum CA-125 concentrations was accepted as 50 IU/ml, the sensitivity and specificity of this biochemical marker were, respectively, 93.7 and 88.0% for the detection of preeclamptic pregnancies. On the other hand, positive and negative predictive values for CA-125 were computed as 91.7 and 90.7%, respectively ( χ 2 = 30,184, p = 0.001). Conclusion The present study suggests that CA-125 is a biochemical marker which reflects the severity of the underlying inflammatory process in preeclampsia. Since it is much more available and relatively less expensive, it seems to be a promising test for screening preeclampsia. In accordance, the present study suggests 50 IU/ml as a cut-off point for CA-125 in screening preeclampsia.
Research Interests: Nonparametric Statistics, Birth Weight, Prospective studies, Pregnancy, Humans, and 14 moreBlood Pressure, Female, Young Adult, ROC Curve, Uric Acid, Adult, Analysis of Variance, Biological markers, Proteinuria, Reference Values, Platelet Count, Predictive value of tests, Pre Eclampsia, and Severity of Illness Index
Objective The present study aims to compare the clinical and reproductive outcomes of women who have undergone lymph node dissection with those who have not and to discuss the indications for retroperitoneal evaluation in the treatment of... more
Objective The present study aims to compare the clinical and reproductive outcomes of women who have undergone lymph node dissection with those who have not and to discuss the indications for retroperitoneal evaluation in the treatment of borderline ovarian tumors. Methods The present study investigated 123 women who were finally diagnosed with borderline epithelial ovarian tumors at the study center between January 1999 and January 2009. A total of 68 patients (55.3%) were found to have a complete surgical staging procedure. Results The patients who underwent complete lymph node dissection were significantly younger than those who did not have lymphadenectomy. Thus, the ratio of postmenopausal women was significantly higher among those in whom retroperitoneal evaluation was performed. As expected, the intraoperative blood loss was significantly more and the hospital stay was significantly longer in patients who underwent complete lymph node dissection. Also, the non-serous borderline ovarian tumors were significantly more frequent in the latter patient group. However, overall and disease-free survival spans were found to be statistically similar for both study groups as well as the recurrence rate. Conclusions Retroperitoneal evaluation can be spared in every woman with borderline ovarian tumor unless she is to undergo complete surgical staging procedure because of high recurrence risk, advanced stage disease or personal choice.
Research Interests:
Background The present review aims to increase the awareness of the gynecologists by analyzing all the case reports which refer to endometriosis presenting either with only ascites or with massive ascites with pleural effusion. Methods To... more
Background The present review aims to increase the awareness of the gynecologists by analyzing all the case reports which refer to endometriosis presenting either with only ascites or with massive ascites with pleural effusion. Methods To conduct the present review, the CENTRAL (in the Cochrane Library, current issue), MEDLINE (Silver Platter, from 1950 to 2010), and EMBASE (from 1950 to 2010) electronic databases were searched. As a result, all the publications based on the keywords relating to the review topic were acquired. Results Since the description of first case in 1954, endometriosis-related ascites was reported to occur in a total of 63 women who were aged between 19 and 51 years. Approximately 63.0% of the recruited women for whom ethnicity was specified were of African origin (29 out of 46). Of the 50 subjects with known obstetric history, 41 (82.0%) were nulliparous. Abdominal distention, anorexia/weight loss, abdominal pain, and menometrorrhagia were the most frequently encountered clinical symptoms, whereas pelvic mass was the most common physical finding. The serum concentrations of CA 125 were between 20 and 3,504 IU/ml for 19 women whose CA 125 levels were determined. Pleural effusion was also present in 38.1% of the reviewed subjects (24 out of 63). The clinical features of the women with endometriosis-related ascites and pleural effusion were similar to those of the women who had only endometriosis-related ascites. Conclusion Endometriosis-related ascites and/or pleural effusion refers to extensive disease with a high risk for recurrence which usually affects non-Caucasian, nulliparous women of reproductive age and leads to clinical symptoms resembling those of an ovarian malignancy. Therefore, clinicians should consider endometriosis in differential diagnosis of pelvic masses and also include endometriosis in diagnostic workup of ascites or pleural effusion.