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31. Zeynep Kamil Jinekopatoloji Kongresi Poster Bildiriler P12 Sezeryan sonrasında uterin kavitede unutulmuş plasenta olgusu:case report
(2013) Özler, Ali; Ağaçayak, Elif; Yaman, Senem Tunç; Turgut, Abdulkadir
[Abstract Not Available]
Adölesan gebelerin maternal ve fetal sonuçlarının değerlendirilmesi
(Dicle Üniversitesi Tıp Fakültesi, 2016) Ağaçayak, Elif; Alan, Bircan; Turgut, Abdülkadir; Karabel, Müsemma; Tunç, Senem Yaman; Çeter, Yasemin; Arslan, Necmi; Yalınkaya, Ahmet
Objective: In this study, our aim is to compare discussing maternal and fetal problems non-adolescent pregnancy with maternal and fetal problems in adolescent pregnancy that seen in hospital. Methods: 15-19 years of age (50 patients) and 20-23 years (96 patients) who gave birth at the Gynaecological and Obstetric Clinic under the Faculty of Medicine of Dicle University between January 2015-October 2015 were retrospectively evaluated. Age at birth, parity, blood pressure, pulse, gestational age, complications at birth, cesarean section indications, maternal biochemical parameters, patients with preeclampsia and preterm birth, maternal and fetal complications were recorded. Results: Total number of births between January 2015- October 2015 were 1715 patients in our clinic. 62 of them (3.6%) were observed in the adolescent group. Maternal blood transfusion needs were found to be significantly higher in the adolescent group (p=0.004). Fetal abnormalities and fetal intensive care needs were found to be significantly higher in the adolescent group (p=0.014, p=0.018). Conclusion: Adolescent pregnancies were high-risk pregnancies in terms of maternal anemia and blood transfusion requirements and because of adverse perinatal outcomes. Therefore, to reduce the adolescent pregnancy and to minimize perinatal complications should be done more extensive studies.
Analysis of sensitivity, specificity, and positive and negative predictive values of smear and colposcopy in diagnosis of premalignant and malignant cervical lesions
(Int Scientific Literature, Inc, 2015) Barut, Mert Ulaş; Kale, Ahmet; Kuyumcuoğlu, Umur; Bozkurt, Murat; Ağaçayak, Elif; Özekinci, Server; Gül, Talip
Background: This study aimed to examine the positive and negative predictive value in the diagnosis of premalignant and malignant lesions of cervical colposcopy, the sensitivity and specificity of smear, and to evaluate the correlation with histopathology of abnormal cytology and colposcopy. Material/Methods: The criteria for inclusion of patients with unhealthy cervix in the study were: Erosion, Chronic cervicitis, and Healed lacerations, Hypertrophied cervix, bleeding on touch, suspicious growth/ulcer/polyp on the cervix, and abnormal discharges from the cervix. Women with frank carcinoma cervix, pregnant females, patients with bleeding per vaginum at the time of examination, and those who had used vaginal medications, vaginal contraceptives or douches in the last 48 h of examination were excluded from the study. Demographic analysis was performed for 450 patients who were admitted to the clinic. Sensitivity, specificity, positive predictive value and negative predictive values of patients to identify cervical pathologies of smear and colposcopy were histopathologically calculated. The statistical software package SPSS 15.0 (SPSS Inc., Chicago, IL, USA) and Spearman's and Chi-Square tests were used for statistical analysis. Results: Sensitivity, specificity, PPD and NDP of smear were 0.57%, 0.76%, 0.26%, 0.92% respectively. Sensitivity, specificity, PPD and NDP of colposcopy were 0.92%, 0.67%, 0.52%, 0.96% respectively. A statistically significant correlation was found between abnormal cytology and histopathology, and abnormal colposcopy finding and histopathology. Conclusions: Women with clinical diagnosis of unhealthy cervix should be evaluated by cytology to detect any premalignant or malignant lesions. It was concluded that Pap smear, colposcopy and histopathology should be collectively evaluated to evaluate cervical findings in low socio-economic regions.
Bilateral Congenital Diaphragmatic Hernia: A Rare Case Report
(2014) Özer, Mehmet; Turgut, Abdulkadir; Ağaçayak, Elif; Özler, Ali; Tunç, Senem Yaman
Konjenital diyafragma hernisi nedeni bilinmeyen, oldukça nadir görülen bir doğumsal anomalidir. Diğer anomaliler ile ilişkisi ve farklı klinik desenleri ile çeşitli nedenleri olabileceğini düşündürmektedir. Konjenital diyafragma hernisi 2.500 canlı doğumda 1 görülür. Olguların% 85'inde defekt [1] sol taraflıdır. Konjenital diyafragma hernisi vakalarının çoğu sporadiktir. Ailesel konjenital diyafragma hernisi, tüm vakaların sadece % 2' sini [2] oluşturur, oldukça nadirdir. Bu konjenital anomali hemen hemen her zaman doğum öncesi ultrasonografik muayene ile tanınabilir. Tedavisi ile sonuçlar herninin derecesine göre değişkenlik gösterir. Bilateral konjenital diyafragma hernisi kötü prognozile, nadir bir doğumsal anomalidir. Biz sağ taraflı konjenital diyafragma hernisi operasyon sırasında keşfedilen bilateral konjenital diyafragma hernisi olgusu sunulmuştur. Diyafragmatik defekt onarıldı ve bir prolen örgü abdominal kompartman sendromu önlemek için karın yara yerleştirildi. Hasta yine de ameliyat sonrası ciddi pulmoner hipertansiyon nedeniyle öldü. Öncelikle olgu sınırlı sayıda olup bilateral konjenital diyafragma hernisi, son derece nadirdir. CDH hasta bakımı yenidoğan ve cerrahlar için çok zordur. Olgumuzu sunmamızın amacı özellikle bilateral konjenital diyafragma hernisi olan hastaların tedavi ve sonuçlarını değerlendirmektir
Borderline ovarian tumors: clinical characteristics, management, and outcomes - a multicenter study
(BioMed Central Ltd., 2016) Gökçü, Mehmet; Güngördük, Kemal; Aşıcıoğlu, Osman; Çetinkaya, Nilüfer; Güngör, Tayfun; Pakay, Gonca; Ağaçayak, Elif
Background: The optimal surgical management and staging of borderline ovarian tumors (BOTs) are controversial. Institutions have different surgical approaches for the treatment of BOTs. Here, we performed a retrospective review of clinical characteristics, surgical management and surgical outcomes, and sought to identify variables affecting disease-free survival (DFS) and overall survival (OS) in patients with BOTs. Methods: A retrospective review of ten gynecological oncology department databases in Turkey was conducted to identify patients diagnosed with BOTs. The effects of type of surgery, age, stage, surgical staging, complete versus incomplete staging, and adjuvant chemotherapy were examined on DFS and OS. Results: In total, 733 patients with BOTs were included in the analysis. Most of the staged cases were in stage IA (70.4 %). In total, 345 patients underwent conservative surgeries. Recurrence rates were similar between the conservative and radical surgery groups (10.5 % vs. 8.7 %). Furthermore we did not find any difference between DFS (HR = 0.96; 95 % confidence interval, CI = 0.7-1.2; p = 0.576) or OS (HR = 0.9; 95 % CI = 0.8-1.1; p = 0.328) between patients who underwent conservative versus radical surgeries. There was also no difference in DFS (HR = 0.74; 95 % CI = 0.8-1.1; p = 0.080) or OS (HR = 0.8; 95 % CI = 0.7-1.0; p = 0.091) between complete, incomplete, and unstaged patients. Furthermore, receiving adjuvant chemotherapy (CT) for tumor stage ≥ IC was not an independent prognostic factor for DFS or OS. Conclusions: Patients undergoing conservative surgery did not show higher recurrence rates; furthermore, survival time was not shortened. Detailed surgical staging, including lymph node sampling or dissection, appendectomy, and hysterectomy, were not beneficial in the surgical management oF BOTs.
Comparison of IMA, YKL-40, EN-RAGE, and AIM levels in maternal blood and cord blood in patients with preeclampsia
(2023) Fındık, Fatih Mehmet; İçen, Mehmet Sait; Tunç, Senem Yaman; Gündüz, Reyhan; Ağaçayak, Elif; Evsen, Mehmet Sıddık; Satıcı, Ömer
Aim: Preeclampsia and severe preeclampsia are among the most significant causes of maternal mortality. Preeclampsia’s pathogenesis is not fully understood, and it is a disease with early diagnosis and treatment possibilities. In this study, we aimed to investigate the levels of IMA, YKL-40, EN-RAGE, and AIM in maternal and cord blood. The results will ideally shed light on preeclampsia’s pathogenesis and early diagnosis. Methods: The study was conducted with the following three groups: a severe preeclampsia group (group 1), a preeclampsia group (group 2), and a control group (group 3). IMA, YKL-40, EN-RAGE, and AIM levels were measured in all patients across the groups using blood taken from the mothers before delivery and from the cords during delivery. Statistically descriptive analyses were performed. Specifically, a one-way analysis of variance was performed on group variables, and a Tukey test was used to determine the differences between the groups. Results: The mean age was similar across all groups. The gestational week at delivery was low for the severe preeclampsia group (p=0.001). The IMA and YKL-40 levels in the maternal and cord blood were the same between the groups. The EN-RAGE levels in the maternal blood were found to be significantly higher in the control group (p=0.000). While the AIM levels in the maternal blood were high in the control group (p=0.001), they were significantly lower in the cord blood in the control group (p=0.029). Conclusion: EN-RAGE and AIM levels are parameters that can be used in the early diagnosis of preeclampsia and severe preeclampsia.
Could moesin be a new marker for indicating progression in endometrial cancer?
(Dove Medical Press Ltd., 2022) Ağaçayak, Elif; Keleş, Ayşenur; Değer, Uğur; Özçelik, Mehmet Şirin; Peker, Nurullah; Gündüz, Reyhan; Akkuş, Murat; Büyükbayram, Hüseyin
Aim: This study aims to determine an important parameter in progression from pre-invasive lesions of endometrium to endometrial cancer and also evaluate the effect of this parameter on the progression of endometrial cancer. Material and Method: In our study,30 patients with normal endometrial tissue (group 1), 56 patients who had endometrial hyperplasia without atypia (group 2), 36 patients who had endometrial hyperplasia with atypia (group 3), and 63 patients with endometrial cancer (group 4) were included. Age, parity, body-mass index, systemic diseases, and tumor markers of patients were evaluated. Expression levels of Ezrin, Radixin, and Moesin proteins were immunohistochemically evaluated in terms of frequency, intensity, and score value. Results: When we compared hyperplasia cases with or without atypia; frequency, and score value of ezrin expression and frequency, intensity, and score value of moesin expression was significantly higher in patients who had hyperplasia with atypia (p:0.000 p:0.001 p:0.003, p:0.032 p: 0.035 p:0.015 p:0.005, respectively). It was observed that the frequency and score value of moesin expression were significantly higher in patients with endometrial cancer when compared with patients who had hyperplasia with atypia (p:0.003 p:0.045). The frequency of moesin expression was significantly higher in patients who had postoperative mortality (p:0.030 p:0.039). Conclusion: Increased frequency of moesin expression in the preoperative period in patients with atypical hyperplasia should alert the surgeon in terms of malignancy. If the frequency of moesin expression increases in cases with endometrial cancer, the patient should be followed closely in terms of progression in the postoperative period.
The Diagnostic Accuracy of Endometrial Sampling in Endometrial Hyperplasia
(2017) Deregözü, Ayşegül; Karaçor, Talip; Acet, Mustafa; Gül, Talip; Evsen, Mehmet Sıddık; Ağaçayak, Elif; Hatirnaz, Safak
OBJECTIVE: Endometrial hyperplasia is a premalignant lesion characterized with hyperplastic changes in endometrial gland and stromal structures. Its incidence is not exactly known. This study evaluated the accuracy of endometrial sampling of the patients whose pathological results were endometrial hyperplasia and had undergone hysterectomy (paraffin sections). STUDY DESIGN: Patients that diagnosed with endometrial hyperplasia by endometrial biopsy and/or hysterectomy at Dicle University School of Medicine Department of Obstetrics and Gynecology between January 2006 and July 2014 were retrospectively evaluated. Sensitivity, specificity, and positive and negative predictive values of endometrial biopsy to predict postoperative hysterectomy result were calculated. Discrete results in endometrial sampling and hysterectomy were recorded separately. Statistical analyses were conducted with corresponding appropriate methods. RESULTS: Mean ages of pre and postmenopausal patients were 42.6±4.8 (28-50) and 57.7±7.7 (50- 79) years, respectively. For the efficiency of endometrial sampling to predict definite pathologic diagnosis, sensitivity was 71.9%, specificity was 87.5%, positive predictive value was 79.3%, and negative predictive value was 82.3%. When the accuracy of endometrial sampling with the pathologic diagnosis was evaluated, 38 patients had accurate (47.5%), and 42 patients had discrete (52.5%) results. CONCLUSION: The presence of atypia determines the treatment in patients with endometrial hyperplasia. Hysterectomy should not be the first option in endometrial hyperplasia patients without atypia, and medical treatment and curettage options should be considered. Experienced staff should perform and evaluate endometrial samplings. We consider that this will increase the success in diagnosis, and could change treatment options.
The effect of vaginal bleeding and non-spesific pelvic pain on pregnancy outcomes in subchorionichematomas cases
(Via Medica, 2019) Karaçor, Talip; Bülbül, Mehmet; Nacar, Mehmet Can; Kırıcı, Pınar; Peker, Nurullah; Ağaçayak, Elif
bjectives: To determine the clinical differences and factors affecting early pregnancy outcome in the first and early second trimester subchorionic hematoma cases. Material and methods: This study involved with the retrospective analysis and evaluation of 81 cases diagnosed with subchorionic hematoma. The patients were grouped according to the gestational periods, symptoms at the time of admission, ratio of surrounding hematoma to the gestational sac, and whether there was a pregnancy loss. The groups were compared according to the clinical features and pregnancy outcomes. Results: The ratio of surrounding hematoma to the gestational sac in the group with pregnancy loss was significantly higher (p = 0.002). When the cut-off value was 35.5%, it could determine the possibility of a complication in pregnancy with 70% sensitivity and 75% specificity. Nonspecific pelvic pain were significantly higher in the pregnancy loss group than in the other group. Logistic regression analysis was performed to determine the effect of these two parameters on the pregnancy outcome. Although the presence of non-specific pelvic pain is more in the group with pregnancy loss; there was no effect of on pregnancy outcome (p = 0.141). The risk of pregnancy loss increased 4.5 fold if the ratio of ScH to gestational sac was above 35% (p = 0.027). Conclusions: In the cases of subchorionic hematoma, we concluded that when the ratio of surrounding hematoma to the gestational sac increased and when it was accompanied by nonspecific pelvic pain, the hospitalization period of the patients increased and the ratio of pregnancy loss was higher.
Endometriozis ön tanılı 69 olgunun tedavi modalitelerinin karşılaştırılması
(2017) Ağaçayak, Elif; Akdeniz, Nurten
Çal mam z n amac Dicle Üniversitesi T p Fakültesi Kad n Hastal klar ve Do um klini inde endometriozis tedavisinde uygulanan tedavi modalitelerinin etkinlik, güvenirlilik aç s ndan kar la t r lmas d r. Çal mam zda endometriozis ön tan s yla tedaviye karar verilen 69 hastan n 40 na laparoskopi, 16 s na laparotomi, 13 üne kombine tedavi (preoperatif medikal tedavi veya postoperatif medikal tedavi) uyguland . Her 3 gruptaki olgular n da l m nda ya , medeni durumu, meslek, sigara kullan p kullanmad , ikayetleri, fertilite durumu, infertil hastalar n tedavi sonras gebelik durumu, gebelik olu anlar n hangi yöntemle gebe kald , tedavi öncesi ve sonras tümör belirteçleri, tedavi öncesi ve sonras USG ik bulgular kaydedildi. 3 grup aras nda ya da l m n n homojen olmad görüldü ve gruplar aras nda istatiksel olarak anlaml farkl l k oldu u tespit edildi (p=0.002). Laparotomik cerrahi grubu daha ileri ya taki hastalara, laparoskopik cerrahi daha genç hastalara uygulanm t . Gruplar aras nda tümör belirteçleri tedavi öncesi ve sonras kar la t r ld . CA 15-3 düzeyinde 3.grupta istatiksel olarak anlaml farkl l k izlendi (p=0.015). Gruplar aras nda medeni durum, meslek, sigara kullan p kullanmad , tedavi öncesi ve sonras a r ikayetinin durumu, tedavi öncesi infertilite ikayeti olanlar n gebelik durumu ve tedavi öncesi ve sonras USG bulgular aras nda istatiksel olarak anlaml bir farkl l k izlenmedi. Tedavi sonras gebelik olu anlar n gebelik meydana gelme yöntemi aç s ndan 1.grup lehine istatiksel olarak anlaml farkl l k oldu u izlendi (p=0.036).
Evaluation of definitive histopathological results of patients diagnosed with endometrial polyps: a tertiary care center experience
(Makerere University, Medical School, 2022) Gündüz, Reyhan; Ağaçayak, Elif; Okutucu, Gülcan; Alabalık, Ulaş; Evsen, Mehmet Sıddık
Background: Although endometrial polyps are generally benign, there are also risks of malignancy. Objectives: To determine the premalignancy and malignancy prevalence in patients diagnosed with endometrial polyps and to investigate factors affecting premalignancy and malignancy. Methods: In our retrospective study, patients who were diagnosed with endometrial polyp with endometrial samples and who underwent polypectomy by hysteroscopy or hysterectomy within one year were included. Results: Premalignant/malignant histopathological results were detected in 7 (2.8%) patients. There were no statistically significant differences in histopathological results and endometrial sampling indications between premenopausal and postmenopausal patients. Hysterectomy in patients with premalignant/malignant results and hysteroscopy in patients with benign results were found to be significantly different. There was not a statistically significant difference between patients with benign results and those with premalignant/malignant results in menopausal status, symptoms, status of hormone replacement therapy and endometrial polyp size. Conclusion: The possibility of premalignant/ malignant results in patients diagnosed with endometrial polyps should be kept in mind. The menopausal status, symptoms, sizes of endometrial polyps and whether or not the patient is on hormone replacement therapy should be considered while making the management plan. However, these should not be the decisive factors on their own.
The evaluation of diagnostic and clinical findings in grand multiparous patients with endometrial cancer
(Dicle Üniversitesi Tıp Fakültesi, 2013) Özler, Ali; Turgut, Abdulkadir; Ağaçayak, Elif; İçen, Mehmet Sait; Alabalık, Ulaş; Başaranoğlu, Serdar; Peker, Nurullah; Gül, Talip
Amaç: Bu çalışmanın amacı grand multipar, endometrium kanserli hastaların tanısal ve klinik özelliklerini diğer endometrial kanserli hastalar ile karşılaştırarak değerlendirmektir. Yöntemler: Kliniğimizde Ocak 2006-Ağustos 2012 tarihleri arasında endometrium kanseri nedeniyle opere edilen 34 hasta dahil edildi. Hastalar doğum sayısına göre üç gruba ayrıldı; Grup 1 (doğum yapmamış hastalar, n=8), Grup 2 (doğum sayıları 1’den 4’e kadar olan hastalar, n=14), Grup 3 (grand multipar hastalar, n=12). Grand multipar hastaların tanısal, klinik ve histopatolojik verileri diğer gruplardaki hastalar ile karşılaştırıldı. Bulgular: Grup 3 (grand multipar) hastaların yaş ortalaması diğer gruplara göre anlamlı yüksek bulundu. (p<0,05). Tüm gruplar tümörün myometrial invazyon derinliği açısından karşılaştırıldığında ise anlamlı bir farklılık tespit edilmedi (p>0,05). Grup 1, 2 ve 3’ deki Evre 1A tümörlü hastaların oranlarının sırasıyla %75, %64,2 ve %83,3 olduğu bulundu. Ayrıca, bütün grand multipar hastaların evre 1 tümöre sahip oldukları bulunmuştur. Sonuç: Sonuç olarak, grand multipar hastaların tanıları daha geç yaşlarda konmakta, fakat erken evrede ve endometrioid tip endometrial kanser tanılarını almışlardır. Son doğumdan itibaren geçen süre endometrial kanser riski üzerine etkili bir faktör olabilir.
Evaluation of factors affecting intrapartum cesarean section rates by comparing the data of patients with vaginal delivery: A retrospective case-control study
(Ortadoğu Reklam Tanıtım Yayıncılık, 2022) Gündüz, Reyhan; Ağaçayak, Elif; Sengi, Abdurrahman; Çalışır, Uğur; Gül, Talip
Objective: This study aimed to determine intrapartum cesarean section rates of our clinic as well as risk factors for intrapartum cesarean section. We also aimed to identify patients with risk factors beforehand and to reduce the intrapartum cesarean section rates and the complications that might occur due to intrapartum cesarean sections. Material and Methods: A total of 150 patients admitted to our clinic for vaginal delivery that ended up having intrapartum cesarean sections (case group) and 200 patients who had a vaginal delivery (control group) were included in our study retrospectively. Demographic, clinical, and neonatal results of the patients were compared. Results: Intrapartum cesarean section rate was determined to be 23% (150/654). The most common indication for intrapartum cesarean section was fetal distress (48%). We found that low gestational week at delivery, nulliparity, and polyhydramnios were independent risk factors for intrapartum cesarean section. We determined that gravidity and parity were not risk factors for intrapartum cesarean section. It was found that 1st minute APGAR scores of babies of patients with intrapartum cesarean section were significantly lower and that intrapartum cesarean section was an independent risk factor for this particular finding. Conclusion: The possibility of the intrapartum cesarean section should be considered in the labor follow-ups of patients with risk factors. We recommend hospital deliveries where the necessary conditions for the mother and fetus are met.
Evaluation of Maternal Hemorrhage in Placenta Accreta
(2016) Tunç, Senem Yaman; Gül, Talip; Alan, Bircan; Başaranoğlu, Serdar; Yalınkaya, Ahmet; Evsen, Mehmet Sıddık; Ağaçayak, Elif
OBJECTIVE: The aim of the present study is to provide a retrospective evaluation of placenta accretacases to identify the factors affecting the blood transfusion requirement, which stands as one of the mostimportant causes of maternal mortality and morbidity.STUDY DESIGN: A total of 110 patients who presented to the outpatient clinic of gynaecology and obstetrics of the Faculty of Medicine of Dicle University and were diagnosed with placental attachment before or during a caesarean section (C-section) between January 2006 and June 2015 were included inthis study. The patients' data were collected from the hospital's records.RESULTS: During the study period, 21674 births were realised and 110 (1/200) of these patients exhibited placenta accreta. 86 of these 110 patients (78,2%) received at least one unit of blood. The groupof patients that had received blood transfusion exhibited significantly higher values in age, parity, number of C-sections, length of stay (p = 0.003, 0.004, 0.024, 0.000, respectively). Multiple logistical regression analysis led to the identification of a significant association between the length of stay and theblood transfusion requirements (OR 95% Cl 2.005(1.213-3.314) p= 0.007).CONCLUSION: Patients of advanced age as well as grand multiparous patients and patients with a history of multiple repeat caesarean deliveries should be evaluated more carefully during pregnancy. Thesepatients should be referred to hospitals that provide multidisciplinary care and management before thedelivery or even at the early stages of pregnancy in an effort to decrease maternal mortality and morbidity rates..
Evaluation of patients with uterine perforation after intrauterine device placement and determination of risk factors: A retrospective case-control study
(Yuzuncu Yil University Faculty of Medicine, 2022) Gündüz, Reyhan; Ağaçayak, Elif; Dönmez, Dicle Akkılıç; Fındık, Fatih Mehmet; Evsen, Mehmet Sıddık; Gül, Talip
To determine the risk factors by evaluating patients with uterine perforation after intrauterine devices (IUD) placement. Also, it was to make suggestions and contribute to the literature in order to prevent uterine perforation after the IUDs placement and how we should behave when we encounter these patients.Twenty-two patients with uterine perforation after IUDs placement (patient group) diagnosed and treated at our clinic and 30 patients with IUDs in place in the uterine cavity (control group) were retrospectively ev aluated and compared. IUDs insertion by a midwife and during the breastfeeding and puerperal period significantly increased the frequency of uterine perforation after IUDs placement, while insertion during the menstrual period significantly reduced risk. Uterine perforation after IUDs placement were most frequently localized in the myometrium (54.5%) and the douglas (13.6%). Uterine perforation-related complications were absent in 59.1% of patients. Of patients, 40.9% underwent hysteroscopy, 18.2% laparoscopy. The diagnostic method was ultrasonography alone at a rate of 68.2%. IUDs could be inserted during menstruation where possible, and patients could be informed about the high risk of uterine perforation after IUDs placement associated with the breastfeeding and puerperal periods. We recommend that IUDs be inserted with ultrasonography in this period. Midwives should receive regular training in order to increase their knowledge and experience on this subject. We recommend ultrasonography as the primary d iagnostic method. Those with IUDs embedded in the myometrium can primarily undergo hysteroscopy, and those with IUDs in the abdomen can undergo laparoscopy or laparotomy.
Evaluation of sexual function in women with hypogonadotropic hypogonadism using the female sexual function index (FSFI) and the beck depression inventory (BDI)
(International Scientific Information, Inc., 2018) Barut, Mert Ulaş; Çoksüer, Hakan; Sak, Sibel; Bozkurt, Murat; Ağaçayak, Elif; Hamurcu, Uğur
BACKGROUND: Hypogonadotropic hypogonadism (HH), or secondary hypogonadism, results from reduced secretion of gonadotropins, including follicle-stimulating hormone (FSH) and luteinizing hormone (LH), by the pituitary gland, resulting in lack of production of sex steroids. The aim of this study was to evaluate self-reported sexual function in sexually active women with and without HH using two evaluation methods, the Female Sexual Function Index (FSFI) and the Beck Depression Inventory (BDI). MATERIAL AND METHODS: The study recruited 88 women who attended an outpatient in vitro fertilization (IVF) clinic in Turkey for primary infertility, between August 2013 and August 2016. All patients were sexually active with an age that ranged from 20–41 years. Following an initial examination, including measurement of FSH and LH levels, all study participants were asked to complete the FSFI and BDI self-reporting questionnaires. Patients were divided into Group 1 (with HH) (N=42) and Group 2 (the control group) (N=46). RESULTS: Analysis of the patient responses to questions regarding their sexual function in the FSFI and BDI showed that of the 42 patients in Group 1 (the HH group), 27 patients (64.28%) reported sexual dysfunction; of the 46 patients in Group 2 (the control group) 14 patients (30.34%) reported sexual dysfunction. Analysis of the FSFI lubrication scores and orgasm scores showed a statistically significant difference between the two groups (both, p<0.01). CONCLUSIONS: Women with HH require both physical and psychological support to improve their sexual function, self-esteem, mental health, and quality of life.
Factors associated with complications of vaginal hysterectomy in patients with pelvic organ prolapse - a single centre's experience
(Via Medica, 2019) Peker, Nurullah; Aydın, Edip; Yavuz, Mustafa; Bademkıran, Muhammed Hanifi; Ege, Serhat; Karaçor, Talip; Ağaçayak, Elif
Objectives: The study aimed to examine the predisposing factors that play a role in the development of complications in patients undergoing vaginal hysterectomy. Material and methods: This retrospective analysis was performed on data provided from 239 patients who underwent vaginal hysterectomy due to uterine prolapse at a single centre between January 2008 and August 2018. Complications were defined according to Clavien-Dindo classification of complications. The patients were divided into two groups: with and without complications. We built a model using multivariable logistic regression to examine the relationships between complications and five candidate predictors. Results: Intra/postoperative complications developed in 30 patients, and the complication rate was found to be 12.5%. 87.2% of the reported complications were classified as Grade ≤2 according to Clavien-Dindo system. It was found that complications were associated with factors such as intraoperative concurrent salpingo-oophorectomy [Odds ratio (OR): 1.24 (1.1.1.4)], low preoperative haemoglobin [OR: 0.96 (0.94.0.98)], uterine weight [OR: 2.69 (2.62.2.76)], and long operation time [OR: 1.04 (1.02.1.07)]. History of pelvic surgery was not found to increase complication rate [OR: 1.11 (0.96.1.27), p = 0.13]. Our multiple logistic regression model correctly classified 74% of participants within the Receiver Operating Characteristic (ROC) curve. Conclusions: Preoperative anaemia, large uterus and concomitant adnexectomy were found to be factors associated with complications during and after vaginal hysterectomy for pelvic organ prolapse.
HISTOLOGICAL AND HISTOCHEMICAL EVALUATION OF NORMOTENSIVE AND PREECLAMPTIC PLACENTAS
(Rojan GÜMÜŞ, 2019) Erdogan, Gamze; Nergiz, Yusuf; Ağaçayak, Elif
The placenta plays a role in the pathophysiology of preeclampsia. Preeclampsia is more common in multifetal pregnancies than singleton pregnancies. In this study, we aimed to investigate the histopathology of normotensive and preeclamptic placentas and the localization of alkaline phosphatase activity. In our study, 10 normotensive and 10 preeclamptic, totally 20 placentas were obtained.Paraffin sections were stained with Hematoxylin-Eosin, Masson trichrome and PAS for histopathological examination.Remaining sections were then stained via Gomori’s method and micrographed under light microscope. Sections of the control group observed normal histologically structure.The alkaline phosphatase reaction was evident in the inner and outer membranes of the syncytiotrophoblasts. There was a significant increase in the number of syncytial knots, terminal villi and syncytial bridges in the preeclamptic placenta sections. Marked thickening of the trophoblast basal membranes were observed. Alkaline phosphatase reaction in preeclampsia group: The localization of alkaline phosphatase in the inner and outer membranes of the syncytiotrophoblasts was reduced. In placentas of preeclampsia group, a significant increase in syncytial knot, syncytial bridge were observed. The level of alkaline phosphatase enzyme in preeclamptic placentas was found to be lower compared to normotensive placenta.
Hysterosalpingography: a potential alternative to laparoscopy in the evaluation of tubal obstruction in infertile patients?
(Makerere University, 2021) Gündüz, Reyhan; Ağaçayak, Elif; Okutucu, Gülcan; Karuserci, Özge Kömürcü; Peker, Nurullah; Çetinçakmak, Mehmet Güli; Gül, Talip
Background: Evaluation of the fallopian tubes are important for infertile patients. The two most important diagnostic procedures used to evaluate tubal patency are hysterosalpingography and laparoscopy. Objectives: To asses the hysterosalpingography and laparoscopy results of patients diagnosed with infertility and investigate the diagnostic value of hysterosalpingography in patients with tubal factor infertility. Methods: The hysterosalpingography and laparoscopy results of 208 patients who presented to the Obstetrics and Gyne- cology Clinic at Dicle University, Faculty of Medicine between January 2014-January 2018 were retrospectively evaluated. Hysterosalpingography and laparoscopy results were compared with regard to the investigation of the presence of tubal obstruction and of the pelvic structures that could cause tubal obstruction. The specificity, sensitivity, positive, and negative predictive values of hysterosalpingography were computed. Results: The number of patients evaluated was 208. The ratio of primary infertile patients was 57.2% and 42.8% was secondary infertile. Hysterosalpingography was found to have a specificity of 64.6%, the sensitivity of 81.3%, the positive predictive value of 56.4%, and a negative predictive value of 86% in the determination of tubal obstruction. Conclusion: Patients with suspected tubal infertility can primarily be examined using hysterosalpingography in considera- tion of the invasive nature and the higher complication rate of laparoscopy.
İnfertil Çiftler İçin Tek veya Çift İntrauterin İnseminasyon (IUI): Çift IUI Klinik Gebelik Oranlarını Artırır mı?
(2018) Sak, Muhammet Erdal; Ağaçayak, Elif; Çelik, Hakim; Budak, Özcan; Barut, Mert Ulaş; Sak, Sibel
Amaç: Bu pilot çalışmada, çoklu foliküler gelişimi olan kontrollü ovarian hiperstimülasyon (KOH) sikluslarında çift intrauterin inseminasyon (IUI)'nin etkinliğini göstermeyi amaçladık.Gereçler ve Yöntem: Tersiyer bir merkezde Kadın Hastalıkları ve Doğum Kliniğinde Mart 2017 ile Mart 2018 tarihleri arasında yardımcı üreme teknikleri (YÜT) merkezinde IUI programına alınan 20 ile 35 yaş aralığında 38 hastaya hCG yapılmasından sonra 18. ve 36. saatte 2 kez IUI yapılmış ve kontrol grubu olarak 22 ile 35 yaş aralığında 32 hastaya human chorionic gonadotropin (hCG) yapıldıktan sonra 36. saatte 1 kez IUI yapılmıştır. Toplam 70 hastanın mevcut kayıtlardan hasta ile ilgili demografik özellikler; Yaş, kilo, boy, daha önceki gebelik öyküsü (gravide, parite), öyküsünde sigara alışkanlığı, hastaların adetin üçüncü gün hormon düzeyleri [ follicle stimulating hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2)], Prolaktin, Anti-Müllerian hormone (AMH), antral folikül sayısı (AFC), infertilite tipi ve süresi kayıt edildi.Bulgular: Çalışmada, nisan 2017-mayıs 2018 tarihleri arasında toplam 70 infertil hasta dahil edildi. Bunların 32 (%45.7)’sinin 1 kez IUI yapılmış grubunda iken, 38’i (%54.2) 2 kez IUI yapılmış grubunda olduğu izlendi.İki gruptaki kadınların HCG günü dominant Follikül sayısı >15mm değerleri bakımından median değerleri incelendiğinde, çalışma grubundaki 2.0(1-3), kontrol grubundakilerin ise 2.0(1.0-3.0) olarak bulundu (P=0.139).İki gruptaki kadınların Klinik gebelik oranı(%) değerleri bakımından değerleri incelendiğinde, çalışma grubundaki %21.05, kontrol grubundakilerin ise %18.75 olarak bulundu (P=0.812).Sonuç: Bu çalışmada KOH ile ovülasyon indüksiyonu sonrası intrauterin inseminasyon yapılan olgularda tek ve çift IUI yapılmasının klinik gebelik oranları arasında anlamlı bir fark olmadığı gözlenmiştir. Dolayısıyla intrauterin inseminasyon yapılan olgularda maliyet göz önünde tutularak sonuçları hastayla paylaşmak gerekir.

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