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Öğe Abdominal wall endometriosis: a case series and review of the literature(Old City Publishing Inc, 2016) Basaranoglu, Serdar; Agacayak, Elif; Deregozu, Aysegul; Yilmaz, Deniz; Acet, Mustafa; Tunc, Senem Yaman; Evsen, Mehmet Siddik[Abstract Not Available]Öğe Acupuncture Enhances Chances of Pregnancy in Unexplained Infertile Patients Who Undergo A Blastocyst Transfer in A Fresh-Cycle(Springer, 2019) Coksuer, Hakan; Barut, Mert Ulas; BozkurT, Murat; Agacayak, Elif; Sak, Sibel; Demir, Mustafa; Caliskan, ErayObjectiveTo analyze the effects of acupuncture on in vitro fertilization patients with unexplained infertility.MethodsWe retrospectively analyzed the charts of a total of 302 cycles performed in 273 patients attending Assisted Reproductive Technology (ART) Centre from August 2013 to August 2016. During the study period, embryo transfer with acupuncture (Acupuncture group, 46 cases) and without acupuncture (Control group, 42 cases) were applied. Prior to embryo transfer, the following points were used in the acupuncture group: Neiguan (CX 6), Diji (SP 8), Taichong (Liv 3), Baihui (Gv 20), and Guilai (S 29). These sessions were carried out two times before and after embryo transfer in a single day. In addition, auricular acupuncture was also performed at ear points, including ear point 55 (Shenmen), ear point 58 (Zhigong), ear point 22 (Neifenmi) and ear point 34 (Naodian). The biochemical pregnancy rate and clinical pregnancy rate after transplantation were compared between two groups.ResultsThe clinical pregnancy rate in the acupuncture group was higher than that in the control group [60.9% (28/46) vs. 33.3% (14/42), respectively, P<0.05]. Likewise, the live birth rate in the acupuncture group was also higher than that in the control group [71.7% (33/46) vs. 31.0% (12/42), P<0.01).ConclusionAdministration of acupuncture on the day of embryo transfer dramatically improved fertility results in women who underwent in vitro fertilization/intra-cytoplasm sperm injection for reproduction.Öğe Amniotic fluid paraoxonase-1 activity, thyroid hormone concentration and oxidant status in neural tube defects(Wiley-Blackwell, 2016) Sak, Sibel; Agacayak, Elif; Tunc, Senem Yaman; Icen, Mehmet Sait; Findik, Fatih Mehmet; Sak, Muhammet Erdal; Yalinkaya, AhmetAimThe aim of this study was to investigate the potential association between neural tube defects and paraoxonase-1 activity in amniotic fluid. We studied total oxidant status, total antioxidant capacity, paraoxonase-1 activity and thyroid hormone amniotic fluid concentration in fetuses with neural tube defects. MethodsThe present study was performed at the Department of Obstetrics and Gynaecology and the Department of Clinical Biochemistry of Dicle University between September 2011 and June 2013. The study group included 37 amniotic fluid samples from pregnant women (16-20 weeks of gestation) with fetuses affected by neural tube defects. The control group consisted of 36 pregnant women who were diagnosed with a high-risk pregnancy according to first or second trimester aneuploidy screening and were later confirmed on amniocentesis to have genetically normal fetuses. ResultsAmniotic fluid paraoxonase-1 activity and total oxidant status were significantly higher (P = 0.023, P = 0.029, respectively) whereas free T4 was significantly lower (P = 0.022) in fetuses with neural tube defects compared with control subjects. In fetuses with neural tube defects, amniotic fluid paraoxonase-1 activity correlated positively with total oxidant status (r = 0.424**, P = 0.010), and amniotic fluid total antioxidant capacity correlated positively with free t4 (r = 0.381*, P=0.022). ConclusionThis is the first study in the literature to show an association between paraoxonase-1 activity and thyroid hormone concentration and neural tube defects.Öğe Assessment of oxidative stress markers in cord blood of newborns to patients with oxytocin-induced labor(Wiley, 2017) Karacor, Talip; Sak, Sibel; Basaranoglu, Serdar; Peker, Nurullah; Agacayak, Elif; Sak, Muhammet Erdal; Turgut, AbdulkadirAim: We aimed to measure the extent of oxidative stress experienced during labor by the neonates of pregnant women undergoing induced or spontaneous birth and to compare the effects of induced labor on fetalwell-being. Methods: Sixty-four healthy pregnant women referring to the Department of Gynecology and Obstetrics, Dicle University Medical Faculty between October 2010 and May 2011 were included in this comparative study. Pregnant women undergoing induced labor by oxytocin were group 1 and those without labor induction were group 2. Post-partum Apgar score was calculated at 1 and 5 min and measurements of weight and height of the neonateswere carried out. After the fetal cordwas clamped, 5 cm(3) blood was drawn into a plain tube without anticoagulant. The samples were centrifuged at 5000 r.p.m. for 5 min. Separated sera were transferred to Eppendorf tubes and were stored at -80 C degrees until the analysis time. Results: The complete blood counts and biochemistry results indicated that there were no statistically significant differences in regards to diseases between the two groups. Nitric oxide and asymmetrical dimethylarginine values of the two groups were not significantly different; however, there were statistically significant differences in the malondialdehyde, paraoxonase, total antioxidative status, and total oxidative status values of the two groups (respectively, P = 0.005, P = 0.006, P = 0.008, and P = 0.007). Conclusion: We observed that oxytocin-induced labor increases stress markers but does not affect Apgar scores. Oxidative stress in pregnant women may trigger antioxidative mechanisms. Prospective studies in larger cohorts are needed to better understand the impact of oxytocin-induced labor on pregnant women and neonates.Öğe Association of brain-derived neurotrophic factor and nerve growth factor gene polymorphisms with susceptibility to migraine(Dove Medical Press Ltd, 2016) Coskun, Salih; Varol, Sefer; Ozdemir, Hasan H.; Agacayak, Elif; Aydin, Birsen; Kapan, Oktay; Camkurt, Mehmet AkifMigraine is one of the most common neurological diseases worldwide. Migraine pathophysiology is very complex. Genetic factors play a major role in migraine. Neurotrophic factors, such as brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF), play an important role in central nervous system functioning, development, and modulation of pain. This study investigates whether polymorphisms in the BDNF and NGF genes are associated with migraine disease in a Turkish case-control population. Overall, 576 subjects were investigated (288 patients with migraine and 288 healthy controls) for the following polymorphisms: rs6265(G/A), rs8192466(C/T), rs925946(G/T), rs2049046(A/T), and rs12273363(T/C) in the BDNF gene, and rs6330(C/T), rs11466112(C/T), rs11102930(C/A), and rs4839435(G/A) in the NGF gene using 5'-exonuclease allelic discrimination assays. We found no differences in frequency of the analyzed eight polymorphisms between migraine and control groups. However, the frequency of minor A alleles of rs6265 in BDNF gene was borderline significant in the patients compared with the healthy controls (P=0.049; odds ratios [ORs] [95% confidence intervals {CIs}] = 0.723 [0.523-0.999]). Moreover, when the migraine patients were divided into two subgroups, migraine with aura (MA) and migraine without aura (MO), the minor TT genotype of rs6330 in NGF was significantly higher in MA patients than in MO patients (P=0.036) or healthy controls (P=0.026), and this disappeared after correction for multiple testing. Also, the rs6330*T minor allele was more common in the MA group than in the MO group or controls (P=0.011, ORs [95% CIs] = 1.626 [1.117-2.365] or P=0.007, ORs [95% CIs] = 1.610 [1.140-2.274], respectively). In conclusion, this is the first clinical study to evaluate the association between BDNF and NGF polymorphisms in migraine patients compared with health controls. Our findings suggest that the NGF rs6330*T minor allele might be nominated as a risk factor for developing aura in migraine disease. Our results should be considered as preliminary, and they need to be confirmed by future studies.Öğe Comparison of sVCAM-1 and sICAM-1 levels in maternal serum and vaginal secretion between pregnant women with preterm prelabour ruptures of membranes and healthy pregnant women(Taylor & Francis Ltd, 2019) Sak, Sibel; Barut, Mert; Incebiyik, Adnan; Agacayak, Elif; Kirmit, Adnan; Koyuncu, Ismail; Sak, MuhammetObjective: The study aims to evaluate the maternal serum and the vaginal fluid levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecular (sICAM-1) in pregnant women complicated by preterm prelabour ruptures of membranes (PPROM). Materials and methods: The prospective case control study included 34 pregnant women with PPROM and 34 healthy pregnant women. Patients with additional diseases, a smoking habit and vaginal bleeding, as well as those using antibiotics, during the study period were not included in the study. Cervicovaginal fluid and serum samples were taken during the patients' admission. The demographic data, maternal serum and vaginal fluid sVCAM-1 and sICAM-1, C reactive protein (CRP) and leukocyte counts were noted for all pregnant women included in the study. The sVCAM-1 and sICAM-1 levels were measured by enzyme-linked immunosorbent assay kits. Results: In pregnant women with PPROM, the serum leukocyte (mean +/- SD =11.41 +/- 1.067 versus 9.18 +/- 1.56, p < .0001), serum sVCAM-1 (median 771.20 versus 704.60 ng/ml, p < .001), sICAM-1 (mean +/- SD 213.10 +/- 35.59 ng/ml versus 188.11 +/- 37.35 ng/ml, p = .06), vaginal sVCAM-1 (median 208.00 versus 140.20 ng/ml, p = .014) and sICAM-1 (mean +/- SD 32.32 +/- 6.49 ng/ml versus 24.87 +/- 6.79 ng/ml, p < .001) values were found to be significantly higher in pregnant women with PPROM than in healthy pregnant women. A positive and significant correlation was observed between the leukocyte count and the vaginal sVCAM-1 level (r = 0.850; p < .001). Conclusion: To the best of our knowledge, this is the first study evaluating the levels of sICAM-1 in maternal serum in pregnant women with PPROM. The maternal serum and vaginal fluid sVCAM-1 and sICAM-1 levels can be used as biochemical markers supporting the PPROM diagnosis because of the increase in both maternal serum and vaginal fluid sVCAM-1 and sICAM-1 levels in pregnant women with PPROM.Öğe Copper and ceruloplasmin levels are closely related to the severity of preeclampsia(Taylor & Francis Ltd, 2020) Sak, Sibel; Barut, Mert; Celik, Hakim; Incebiyik, Adnan; Agacayak, Elif; Uyanikoglu, Hacer; Kirmit, AdnanObjective: The aim of this study was to investigate the maternal serum concentrations of copper (Cu) and ceruloplasmin (CP) in patients with mild preeclampsia, severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and to determine their association with the severity of the disease. Methods: This study was carried out at the largest tertiary care health center in the southeast region in Turkey and Department of Obstetrics and Gynecology, Dicle University Hospital. A total of 179 pregnant women, including 58 healthy pregnant women and 71 mild preeclampsia, 26 severe preeclampsia, and 24 HELLP syndrome cases classified according to the American College of Obstetricians and Gynecologists? 2013 guidelines were included in this prospective study. Blood samples were taken from all the pregnant women to evaluate the serum Cu and CP levels. The Cu level was determined via atomic absorption/emission spectroscopy, while the serum CP level was assessed with a nephelometric assay using an automatic image analyzer. Spearman?s rank correlation tests were used to determine the correlations between the serum levels of the antioxidative markers and the preeclampsia severity. Results: The mean???SD of the Cu was 81.2???11.84 ?g/dl in the mild preeclampsia cases and 160.2???20.89 ?g/dl in the severe preeclampsia cases (p?Öğe Cytogenetic screening in couples with Habitual Abortions(Elsevier Masson, Corporation Office, 2019) Sak, Sibel; Incebiyik, Adnan; Hilali, Nese Gul; Agacayak, Elif; Uyanikoglu, Hacer; Akbas, Halit; Sak, Muhammet ErdalObjective: Habitual abortion (HA) is defined at least three consecutive pregnancy losses. One of the etiologic causes is parental chromosomal anomalies. In this study, we aimed to that investigate the effect of parental chromosomal abnormalities on HA. Methods: The cytogenetic results of patients with at least three abortions referred to our university hospital between January 2010 - March 2017 were evaluated. A total of 1154 couples with HA were analysed. Peripheral lymphocyte cultures incubated for 72 h were used for karyotype analysis via the Giemsa banding technique. Results: Of a total 1154 couples (2308 patients) 37 female (3.2%) and 17 male (1.47%) had abnormal karyotypes. Reciprocal translocation carriage (n = 26; 1.12%) was the most commonly detected structural anomaly, followed by X chromosome mosaicism (n = 16; 0.69%), Robertsoniantransiocation (n = 9; 0.38%), Chromosomal inversion (n = 6; 0.26%). Chromosomal polymorphisms, which are considered minor chromosomal changes, were detected in 221 (9.57%) individuals. Conclusion: Our study exhibits that chromosomal analysis in patient with HA is an appropriate approach to elucidate the aetiology of HA. Data from cytogenetic screening can be used in guiding couples planning future pregnancies and in prenatal diagnosis of chromosomal anomalies in the foetus. (C) 2018 Published by Elsevier Masson SAS.Öğe Diagnosis of pre-eclampsia and assessment of severity through examination of the placenta with acoustic radiation force impulse elastography(Wiley, 2016) Alan, Bircan; Tunc, Senem; Agacayak, Elif; Bilici, AslanObjective: To assess the value of placental shear wave velocity (SWV) measurement by acoustic radiation force impulse (ARFI) imaging for the diagnosis of pre-eclampsia and to determine the relationship between the SWV and the severity of pre-eclampsia. Methods: A prospective study was performed at a center in Turkey between August 2014 and March 2015. The study included consecutive pregnant women in the second or third trimester diagnosed with pre-eclampsia and healthy pregnant women without pre-eclampsia of similar ages. Patients with pre-eclampsia were divided into two groups (severe or mild disease) on the basis of revised American College of Obstetricians and Gynecologists criteria. All patients underwent ARFI, and the SWV was measured at several placental locations. Results: Overall, 86 women were enrolled (42 with pre-eclampsia, 44 controls). Minimum, maximum, and mean SWV values were significantly higher in the pre-eclampsia group than in the control group (P < 0.001 for all). These values were also significantly higher among patients with severe pre-eclampsia than among patients with mild pre-eclampsia (P < 0.001 for all). Conclusion: Measurement of the placental SWV with ARFI imaging is a useful additional method for the diagnosis of pre-eclampsia and for determination of the disease severity. (C) 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.Öğe Effects of Adnexal Torsion on the Fallopian Tube in Rats A Histologic and Immunohistochemical Study(Sci Printers & Publ Inc, 2014) Tung, Senem Yaman; Agacayak, Elif; Yaman, Neval S.; Deveci, Engin; Kalkanli, Sevgi; Ozler, AliOBJECTIVE: To investigate histopathological and immunohistochemical changes in the Fallopian tube structure following ovarian torsion. STUDY DESIGN: Thirty fertile, female, adult Wistar albino rats, weighing 200-220 g, were randomly divided into 3 equal groups (n=10): sham, torsion, and detorsion. In the torsion and detorsion groups, bilateral adnexal torsion (3-hour ischemia) was carried out. Bilateral adnexal detorsion (3-hour reperfusion) was performed in the detorsion group. Fallopian tube sections were stained hematoxylin and eosin, periodic acid Schiff, Mallory-Azan and immunohistochernically-stained desmin, a smooth actin, and CD68 antibodies. RESULTS: In the sections of the ischemic group, degeneration of epithelium, loss of cilia, dilation of blood vessels, and hemorrhages were observed. Image analysis of the studied Fallopian section revealed a significant decrease in density of desmin in the torsion group. Moreover, strong positive cytoplasmic CD68 expression was observed in the torsion group. CONCLUSION: The use of effective antiinflammatory treatments may contribute to the conservative surgery in preservation of ovarian reserve and tubal structure.Öğe Effects of the treatment modalities in Bartholin's abscess(Edizioni Minerva Medica, 2016) Basaranoglu, Serdar; Agacayak, Elif; Deregozu, Ayseguel; Karakose, Yueksel; Acet, Mustafa; Koyuncu, Diler; Gumus, Ilknur I.BACKGROUND: Bartholin's abscess is a gynecological pathology commonly observed in the reproductive period. The etiology attributes this pathology to a wide range of factors. Even though there is more than one treatment option, there has yet to emerge a consensus regarding the ideal method. The present study aims to present patients operated on due to the presence of Bartholin's abscess. METHODS: The data pertaining to 15 patients that had applied to our clinic with various complaints and had been subject to silver nitrate treatment upon the diagnosis of Bartholin's abscess (group 1) and to 21 patients that had been subject to surgical excision after the same diagnosis (group 2) were reviewed retrospectively. The review was followed by the recording of age, gravidity, parity, presenting symptoms, mass sizes and locations, operative durations, and observed complications of the patients. The data thus compiled were evaluated through statistical analyses. RESULTS: In the specified timeframe, 36 patients were observed to have been operated upon, 15 patients to have been subject to silver nitrate treatment (group 1) and 21 patients to have been subject to surgical excision (group 2). all operated patients were in the reproductive period. Mass locations tended to be in the right side in both groups (93.3% and 90.5%). No statistically significant difference was observed between the operated groups in mass sizes (P=0.892). The operative durations were significantly shorter among patients in Group 1 (P=0.001). Any increase in mass size and operative duration was observed to increase the risk of complications. CONCLUSIONS: increased mass size and extended operative duration are the two most important risk factors in the emergence of complications. it should be kept in mind that an effective course of treatment can be secured with minimum side effects through the performance of the operation in the shortest duration possible and with the use of suitable techniques. We are of the opinion that appropriate results can be achieved upon the consideration of minimally invasive treatment modalities in all aspects.Öğe Evaluation of obstetrical patients with disseminated intravascular coagulopathy - tertiary center experience(Taylor & Francis Ltd, 2016) Basaranoglu, Serdar; Evsen, Mehmet Siddik; Agacayak, Elif; Tunc, Senem Yaman; Yilmaz, Zulfikar; Yildirim, Yasar; Deregozu, AvSequiObjective: The purpose of the present study is twofold: (a) to investigate the etiology of disseminated intravascular coagulopathy (DIC) caused by obstetrical conditions and (b) to present parameters that can be used in predicting DIC-related mortality in obstetrical patients. Material and method: Obstetrical patients who had a delivery at or were referred (after delivery) to Obstetrics and Gynecology Clinic of Dicle University between July 2006 and December 2013 were retrospectively analyzed in this study. Those patients diagnosed with DIC were included in the study. Results: Fifty-six obstetrical patients carrying the diagnosis of DIC were included in this study. The overall mortality rate was 25% among these patients. More specifically, the mortality rate was 10.7% among patients with a DIC score <= 5 and 40.7% among those with a DIC score >5. Multiple logistic regression analysis resulted in the finding that international normalized ratio (INR) and urea were among those factors affecting mortality in obstetrical DIC [OR: 8.44 (CI: 1.9-36.8), OR: 1.05 (CI: 1.0-1.1), respectively]. Conclusion: DIC is a syndrome that might be caused by obstetrical conditions. It is associated with high mortality and morbidity rates. In obstetrical DIC, urea is the most important factor affecting mortality. In addition, we are of the opinion that DIC score might guide mortality predictions as a determinant of prognosis.Öğe Evaluation of postoperative sexual function in patients after trans-obturator-tape operation(Aves Press Ltd, 2016) Agacayak, Elif; Basaranoglu, Serdar; Yavuz, Mustafa; Tunc, Senem Yaman; Sak, Sibel; Turgut, Abdulkadir; Deregozu, AysegulIntroduction: In this study, we aimed to evaluate postoperative sexual function of patients, who had undergone colporraphy anterior and transobturator tape operation due to cystocele and stress urinary incontinence. Materials and Methods: In our study, 52 patients with cystocele and stress urinary incontinence that were admitted to Dicle University, School of Medicine, Department of Obstetrics arid Gynecology between January 2009 and January 2014, were included in the study. Patients with previous hysterectomy, patients who had rectocele repair during operation, patients in menopause were excluded from the study. Patients completed the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 before and after under going surgery. Results: Mean age of the patients in our study was 42.04 +/- 7.50, average body mass index of the patients was 30.1 +/- 3.7 kg/m(2). Average follow-up time was 31.5 +/- 11.3 months. 22 (42.3%) patients did not completely recovery the postoperative complaints. 2 (3.8%) patients had increased postoperative complaints. The positive correlation between postoperative complaints with dyspareunia was observed (r= 0.355 **p: 0.010). 5 (9.6%) patients developed postoperative complications. These complications, urinary comfortable inability in 2 (%3.8) patients, mesh erosion in 1(%1.9) patient, developed de novo urinary incontinence in 2 (%1.9) patients. The total result according to Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 was observed significant improvement in sexual function (p= 0.000). Conclusion: Urinary incontinence negatively affects the sexual life of women. We observed improvement in sexual function of women that had went transobturator tape operation for urinary incontinence.Öğe Evaluation of predisposing factors, diagnostic and treatment methods in patients with translocation of intrauterine devices(Wiley, 2015) Agacayak, Elif; Tunc, Senem Yaman; Icen, Mehmet Sait; Oguz, Abdullah; Ozler, Ali; Turgut, Abdulkadr; Basaranoglu, SerdarAimThe purpose of this study was to evaluate the diagnostic methods, predisposing risk factors and surgical treatment options in patients with translocation of intrauterine devices (IUD). Material and MethodsDiagnosis, predisposing factors and treatment of 34 patients with translocation of IUD was evaluated in this retrospective study. ResultsComplaints of pain during insertion and history of cesarean section were present in 70.5% and 58.8% of patients, respectively. IUD-related complications were detected in 52.8% of patients. Transvaginal ultrasonography was used to detect translocation of IUD in 55.8% of cases. Laparoscopy was performed in 55.8% of patients. ConclusionThere were high rates of history of cesarean section, insertion in the puerperal period and insertion by midwives in patients with translocated IUD. These may be predisposing factors for IUD translocation. The clinician who inserts the IUD should be experienced in this area and obtain sufficient information from the pelvic examination prior to insertion of the device. Gynecological examination should be conducted for a proper diagnosis of translocation of IUD. In the event that the IUD string is not visible in the gynecological examination, transvaginal ultrasonography should be performed. If the IUD is still not visible, then abdominal radiography should be performed. As soon as diagnosis of translocation of IUD has been established, surgical treatment should be planned. First treatment of choice should be laparoscopy.Öğe Evaluation of protein levels of autophagy markers (Beclin 1 and SQSTM1/p62) and phosphorylation of cyclin E in the placenta of women with preeclampsia(C M B Assoc, 2017) Yildiz, Dilara Akcora; Kandemir, Sevgi Irtegun; Agacayak, Elif; Deveci, EnginPreeclampsia is a severe multisystem disorder, and its pathophysiology is still not completely understood. Autophagy, a recycling process that maintains cellular homoeostasis during differentiation and development, is controversial regarding increased or decreased autophagic activity in preeclampsia. The aim of this study was to determine whether autophagy is increased in the placentas of women with preeclampsia by examining the protein levels of autophagy markers (Beclin 1 and SQSTM1/p62) and phosphorylation of cyclin E. For this purpose, placentas from preeclampsia (n=10) and control (n=10) pregnancies were included in this study. The protein expression of autophagy-related markers Beclin1, SQSTM1/p62 and phosphorylation status of cyclin E were detected by Western blot. Our data showed that the protein levels of both Beclin 1 and SQSTM1/p62 were significantly increased, while the phosphorylation level of cyclin E was significantly decreased in placentas with preeclampsia compared to those derived from controls. The results of this study suggest that the autophagic activity is perpetually increased in preeclampsia and cyclin E protein stabilisation might be involved in the induction of autophagy.Öğe Factors Affecting ICU Stay and Length of Stay in the ICU in Patients with HELLP Syndrome in a Tertiary Referral Hospital(Hindawi Ltd, 2022) Agacayak, Elif; Bugday, Rezan; Peker, Nurullah; Deger, Ugur; Kavak, Gonul Olmez; Evsen, Mehmet Siddik; Gul, TalipObjective. The study aimed to compare patients with HELLP syndrome who require intensive care and who do not require intensive care and evaluate the factors affecting the length of stay in the intensive care unit. Methods. Patients were divided into two groups as follows: requiring intensive care (group 1) and not requiring intensive care (group 2). The data of both groups were compared in terms of demographic characteristics, transfusion amounts, length of stay in the intensive care unit, maternal complications, and mortality. Results. 14032 births in a tertiary center between 2011 and 2018 were evaluated in this study. During the study period, 342 patients were diagnosed with HELLP, and 32 (9.4%) of these were followed up in the intensive care unit. The length of stay in the intensive care unit was determined as 8.1 (7.2) days on average. Fresh frozen plasma, erythrocyte suspension, apheresis, and random thrombocyte transfusion were observed to be significantly more in group 1 patients. In the regression analysis, the most effective factor was found to be erythrocyte suspension and the length of stay in the intensive care unit was significantly longer in patients who had erythrocyte suspension transfusion. The receiver operating characteristic curve showed that the area under the curve value for erythrocyte transfusion was 70.6%. When the cutoff value of erythrocyte suspension was 450 (95% CI: 365-681) ml, the sensitivity was 43.8% and the specificity was 91.6%. Conclusion. We think that physicians should be careful that maternal morbidity and mortality may increase as the need for erythrocyte suspension transfusion increases in patients with HELLP syndrome. Minimum transfusion to hemodynamically stable patients can be more suitable in terms of morbidity and mortality in managing patients with HELLP syndrome requiring erythrocyte suspension transfusion. Precautions and measures should be taken in this regard.Öğe Fournier's Gangrene: A Summary of 10 Years of Clinical Experience(Int College Of Surgeons, 2015) Oguz, Abdullah; Gumus, Metehan; Turkoglu, Ahmet; Bozdag, Zubeyir; Ulger, Burak Veli; Agacayak, Elif; Boyuk, AbdullahWe aimed to present our clinical experience with FG treatment. Fournier's gangrene (FG) is a rare but serious disease characterized by progressive necrosis in the genitourinary and perineal region. The retrospective study included 43 patients. Patients were divided into 2 groups as survivors and nonsurvivors. Included in the analysis were data pertaining to demographics, predisposing factors, comorbidities, results of bacteriologic analyses, number of debridements, duration of treatment, FG Severity Index (FGSI) score, fecal diversion methods (trephine ostomy or Flexi-Seal Fecal Management System-FMS), and dressing methods (wet or negative aspiration system). In the nonsurvivor group, urea, WBC, and age were significantly higher, whereas albumin, hematocrit, platelet count, and length of hospital stay (LOHS) were significantly lower compared to the survivor group. Mean FGSI was lower in survivors in comparison with nonsurvivors (5.00 +/- 1.86 and 10.00 +/- 1.27, respectively; P < 0.001). We conclude that FGSI is an important predictor in the prognosis of FG. Vacuum-assisted closure (VAC) should be performed in compliant patients in order to enhance patient comfort by reducing pain and the number of dressings. Fecal diversion should be performed as needed, preferably by using FMS. The trephine ostomy should be the method of choice in cases where an ostomy is necessary.Öğe THE FREQUENCY AND THE TYPE OF DIFFERENT ETIOLOGICAL FACTORS IN PRIMARY AMENORRHEA(Carbone Editore, 2014) Agacayak, Elif; Icen, Mehmet Sait; Tunc, Senem Yaman; Evsen, M. Siddik; Kalkanli, Sevgi; Basaranoglu, SerdarAim: Primary anzenorrhea (PA) is defined as the absence of menarche by the age of 14 without the development of secondary sexual characteristics or lack of menstruation by the age of 16 despite the existence of normal growth with the appearance of secondary sexual characteristics. We carried out a retrospective study, with the purpose of establishing the frequency and the type of different etiological factors among patients with primary amenorrhea. Material and method: A total of 108 subjects, age ranged from 14 to 33 years were included in the study. A complete physical examination, blood tests for hormonal profile, pelvic ultrasonography and magnetic resonance imaging were performed to all patients. Besides, genotypic evaluations were also performed for the patients who got the indication. Results: Out of the 108 patients presenting with primary amenorrhea, 40 (37,0%) had gonadal dysgenesis, 25 (23,1%) had Mullerian agenesis and 14 (12,9%) patients had hypogonadotropic hypogonadism. The genotypic evaluation revealed that 77.5 % (n=31) of cases had normal chromosome composition whereas 22.5% (n=9) had chromosomal abnormalities. Conclusion: In conclusion, we have determined the 3 most common causes of primary amenorrhea are ovarian dysgenesis, Mullerian agenesis and hypogonadotropic hypogonadism; this data is compatible with the literature. Abnormalities in chromosomal analysis were determined in 22,5% of patients, which is also compatible with the literature. Determining etiology, in this large range of diseases may be confusing in clinical practice. During evaluation of patients with primary amenorrhea; these results should be kept in mind in order to establish an algorithm.Öğe Honokiol Decreases intra-Abdominal Adhesion Formation in a Rat Model(Karger, 2015) Agacayak, Elif; Tunc, Senem Yaman; Icen, Mehmet Sait; Alabalik, Ulas; Findik, Fatih Mehmet; Yuksel, Hatice; Gul, TalipAim: The purpose of this study was to investigate the effectiveness of honokiol, a natural molecule that was shown to have antioxidant effects, in prevention of intra-abdominal adhesion formation in a rat model. Material and Method: This study was conducted on a total of 40 non-pregnant Sprague-Dawley rats, which were divided into 4 groups as follows: sham, control, saline, and honokiol groups. Both uterine horns of the rats in control, saline, and honokiol groups were exposed and a 2-cm segment of the anti-mesenteric surface of both uterine horns was traumatized by a scalpel. The saline group was administered 2 ml of saline/day intraperitoneally for 5 days after the operation. The honokiol group, on the other hand, was administered honokiol intraperitoneally at a dose of 1 mg/kg/day for 5 days after the operation. On postoperative day 14, 3 ml of intracardiac blood sample was taken from the rats for biochemical analyses, and the rats were sacrificed this way. Results: Adhesion and inflammation scores were significantly lower in the honokiol group compared with the saline and control groups (p < 0.008). Similarly, fibrosis score was significantly lower in the honokiol group compared with the saline group (p < 0.008). Conclusion: Honokiol was found to be effective in prevention of intra-abdominal adhesion formation in a rat model. However, larger studies are needed to shed light on the exact role of honokiol in intra-abdominal adhesion formation and to determine the molecular aspects of the promising results found in this study. (C) 2015 S. Karger AG, BaselÖğe Hypogastric artery ligation in postpartum haemorrhage: a ten-year experience at a tertiary care centre(Taylor & Francis Inc, 2021) Icen, Mehmet Sait; Findik, Fatih Mehmet; Akin Evsen, Gamze; Agacayak, Elif; Yaman Tunc, Senem; Evsen, Mehmet Siddik; Gul, TalipThis study investigated patients who underwent bilateral hypogastric artery ligation (BHAL) due to postpartum haemorrhage (PPH). Patients who underwent BHAL because of PPH following a conservative treatment were included in this study. Placental abnormalities were referred to as placenta accreta. A total of 130 BHAL procedures took place at the study hospital as a result of PPH. Of these, 39 (30%) were referred to the hospital. The rate of BHAL requirement was 62 out of 10,000 births. Among the 130 patients, the most frequent indication for BHAL was placenta accreta (58.5%). Haematological parameters were poorer among the referral patients. Four of the exitus patients (80%) were referral patients. The mortality rate among the referral patients was 10.25%, whereas this rate was only 1.01% among the patients who gave birth at the hospital. PPH is a life-threatening condition that requires immediate medical attention. BHAL, with its fertility-preserving features, is a good option that can be employed in all PPH patients. BHAL not only preserves patients' fertility, but it also gives them a higher chance of survival.IMPACT STATEMENT What is already known on this subject?PPH is a life-threatening condition. Due to the worldwide increase in caesarean sections, placenta accreta has also increased. BHAL is a vital treatment method for PPH. What do the results of this study add?Placenta accreta is one of the most common causes of PPH. Traditional hysterectomy rates can be reduced by replacing this treatment with BHAL in this group of patients. Without early intervention in PPH, a patient's mortality risk can increase by up to 10 times. As research and surgeons' experience grows, PPH can be controlled with treatments with less complex modalities without the need for BHAL. What are the implications of these findings for clinical practice and/or further research?The need for BHAL should be kept in mind when addressing PPH, especially in cases of placenta accreta. The need for hypogastric artery ligation, which is a more aggressive treatment for the surgical correction of the pathology, can be reduced as surgeons' experience increases. Early intervention and/or referral in cases of PPH is of great importance.
