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Öğe Clinical experience in pregnancies complicated by adnexal torsion(7847050 Canada Inc, 2016) Basaranoglu, S.; Agacayak, E.; Tunc, S. Y.; Icen, M. S.; Turgut, A.; Peker, N.; Evsen, M. S.Objective: The purpose of this study was to present data on clinical and operational management and postoperative outcomes of pregnancies complicated by adnexal torsion (AT). Materials and Methods: Twenty-four pregnant women who presented to the present clinic between January 2007 to December 2013 and were intraoperatively diagnosed with AT were included in this study. Demographic data such as age and data on obstetric history, gestational week, current trimester, previous gynecologic and non-gynecologic operations, type of surgery that was performed, average size, location and number of adnexal masses, surgical techniques that were employed, postoperative complications, and pathology results were investigated and noted. Results: In this study, 132 patients were operated due to AT, and the rate of pregnant women with AT was 18.2% (24/132). The mean age of the patients was 29.25 +/- 6.27 years, and the mean gestational week was 18.25 +/- 7. Eight patients were in their first trimester (33.3%) whereas 13 were in their second trimester (54.2%), and three were in their third trimester (12.5%) when they presented to the hospital. The mean AT size was 95.3 +/- 53.9 mm, as measured by ultrasonography. All the patients were operated by laparotomy. Regarding the types of abdominal incision, 13 patients (54.2%) had a Pfannenstiel incision, three patients (12.5%) had an infra-umbilical median incision, and eight patients (33.3%) had a pararectal incision. Duration of operation was significantly shorter in patients with pararectal incisions (p < 0.01) compared to those with Pfannenstiel and infra-umbilical median incisions. Regarding the types of treatment, ten patients (41.7%) underwent unilateral salpingo-oophorectomy (USO), eight patients (33.3%) underwent adnexal detorsion+cystectomy, and six patients (25%) underwent adnexal detorsion only. Conclusion: AT is a gynecologic emergency that requires early diagnosis and treatment, as it is capable of complicating the pregnancy. Determination of the current gestational week prior to the surgical intervention will assist and guide the surgeon in identifying the suitable type of surgery for a particular patient. Pararectal incision should be the incision of choice for a shorter duration of operation, which is crucial in pregnant women for reduced exposure to anesthesia.Öğe Comparison of long-term results of obliterative colpocleisis and reconstructive vaginal surgery including sacrospinous ligament fixation in patients with total genital prolapse(Wolters Kluwer Medknow Publications, 2022) Agacayak, E.; Bulut, M.; Peker, N.; Gunduz, R.; Tunc, S.; Evsen, M.; Gul, T.Background: Treatment of total genital prolapse in elderly patients is still controversial in terms of postoperative objective and subjective results. Aim: The present study aimed to compare the long-term objective and subjective cure rates of sacrospinous ligament fixation and Le Fort operation for treatment of total genital prolapse. Patients and Methods: Patients over the age of 60 with stage 3 or 4 pelvic organ prolapse that presented to the Obstetrics and Gynaecology Clinic of the Faculty of Medicine of *** University. The study sample consisted of 17 patients that underwent Le Fort operation and 29 patients that underwent sacrospinous ligament fixation. Data on duration of operation, intraoperative complications, duration of hospital stay, and differences between preoperative and postoperative estimated blood loss, postoperative complications, and relapse in the long term were obtained. Questionnaires exploring quality of life, incontinence, and pelvic floor disorders were applied to the patients. Results: As subjective cure rates, postoperative patient satisfaction (P = 0.001), regret rate (P = 0.038) and recommendation rate (P = 0.044), as well as postoperative questionnaire results, Pelvic Floor Impact Questionnaire and SF36 were found to be significantly better in the Le Fort group (respectively P = 0.039 and 0.042). As objective cure rates, there was no difference between the two groups in terms of postoperative cystocele, rectocele, and cystorectocele (P = 0.955) and postoperative recurrence of prolapse beyond the hymen (P: 0.893). Duration of operation and duration of hospital stay were found to be significantly shorter in the Le Fort group (respectively P = 0.032 and 0.012). Conclusion: Le Fort operation could be the intervention of choice in sexually inactive elderly patients with stage 3 or 4 pelvic organ prolapse.Öğe A comparison of maternal outcomes in complicated vaginal and cesarean deliveries(7847050 Canada Inc, 2017) Agacayak, E.; Basaranoglu, S.; Tune, S. Y.; Icen, M. S.; Findik, F. M.; Sak, S.; Gul, T.Objective: The purpose of this study was to compare general characteristics, laboratory data, and maternal outcomes of patients who experienced complications in the first 24 hours after a normal vaginal delivery or cesarean section (C-section). This way, the authors intended to determine the results of complications in these patients. Materials and Methods: Data of patients referred from the peripheral care centers to the present tertiary care center in the first 24 hours after a vaginal delivery or C-section due to the presence of various complications were screened retrospectively from 2009 to 2013. Clinical and demographic characteristics, laboratory parameters, indications for C-section, mortality rates, maternal morbidities, surgical and medical treatments administered in the clinic, as well as operations performed in other care centers were noted. Results: A total of 330 patients were included in this study. Of these patients, 285 constituted the postoperative group (C-sections) whereas 45 constituted the postpartum (vaginal deliveries) group. There was no statistically significant difference between the two groups in demographic characteristics, results of laboratory parameters, maternal morbidity, and mortality rates. Requirement of hysterectomy and relaparotomy was significantly higher in the postoperative group. Conclusions: In the early follow-up, it was found that complicated C-sections and vaginal deliveries had similar results. However, it should also be mentioned that higher requirement of hysterectomy and relaparotomy emerged as an undesirable condition among the postoperative patients in this study. With this in mind, mode of delivery should be selected according to the overall health status of the patient and indications for C-section.Öğe The relationship between complete hydatidiform mole and serum Vitamin D level: a prospective case-control study(Verduci Publisher, 2022) Gunduz, R.; Deger, U.; Kaplan, I; Tepe, N. Bayramoglu; Tunc, S. Yaman; Icen, M. S.; Agacayak, E.OBJECTIVE: This study aimed to determine whether or not there was a relations-hip between complete hydatidiform mole (CHM) and serum Vitamin D level by comparing CHM patients with two control groups and to determi-ne whether or not Vitamin D deficiency is a risk factor for CHM. PATIENTS AND METHODS: This prospec-tive study included 30 patients diagnosed with CHM (case group), 30 patients in the first trimes-ter of a healthy pregnancy (control group), and 30 healthy non-pregnant subjects (control group). A record was made of serum 25-hydroxyvitamin D (25-OH D vitamin) levels, age, body mass index (BMI), gravida, parity, and the number of abortus. The serum 25-OH D vitamin levels were examined in each group and compared between groups. RESULTS: The 25-OH D vitamin level of all the patients in the study was determined as 11.16 +/- 8.64 ng/mL. No significant difference was determined between the groups in respect of 25 OH-D vitamin levels. When comparisons were made between the four subgroups according to the 25-OH-D level, no significant difference was determined between the CHM and control groups. When the patients were separated as obese and non-obese groups, no significant dif-ference was determined between the groups. CONCLUSIONS: Severe deficiency, deficien-cy, or insufficient levels of serum Vitamin D are not thought to be risk factors for CHM patients.Öğe Significance of growth differentiation factor 15 in primary ovarian insufficiency: inflammatory, biochemical, and hormonal correlates(I R O G Canada, Inc, 2017) Tunc, S. Y.; Goruk, N. Y.; Agacayak, E.; Icen, M. S.; Findik, F. M.; Kusen, H.; Evsen, M. S.Purpose: To investigate the levels of growth differentiation factor-15 (GDF-15) in primary ovarian insufficiency (POI) and to evaluate its correlation with hormonal, biochemical, and inflammatory indicators. Materials and Methods: This comparative, cross-sectional study was carried out in 60 cases consisting of 30 healthy controls (mean age: 29.2 +/- 5.0 years) and 30 patients with POI (mean age: 28.9 +/- 6.8 years). Two groups were compared in terms of serum levels of glucose, lipids, thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), GDF-15, and neutrophil-lymphocyte ratios (NLR). Correlation between GDF-15 and NLR with these variables was sought. Results: Serum levels of FSH (p < 0.001), LH (p < 0.001), NLR (p < 0.001) and TSH (p = 0.020) were increased significantly in POI group. In POI patients, a correlation was detected between levels of GDF-15 levels and PRL (p = 0.049). Conclusion: The authors suggest that NLR can serve as a promising marker for diagnosis and follow-up of POI, whereas GDF-15 seems not to have such a potential.
