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Öğe Alteration of peripheral blood cells in tubal ectopic pregnancy(Studio K, 2013) Turgut, Abdulkadir; Sak, Muhammet Erdal; Ozler, Ali; Soydinc, Hatice Ender; Karacor, Talip; Gul, TalipObjectives: To investigate whether mean platelet volumes and leukocyte counts are altered significantly in patients with tubal ectopic pregnancy (TEP). Materials and Methods: Retrospective analysis of mean platelet volumes and leukocyte counts of 138 TEP patients, diagnosed between 2005 and 2012, and the control group consisting of 72 pregnants was performed. Patients with TEP were further subdivided into 2 subgroups composed of 72 ruptured and 66 non-ruptured cases. Statistical analysis was performed using the Kruskal-Wallis and the Mann-Whitney U tests. Results: Mean platelet volume was found to be larger in patients with TEP (whether ruptured or non-ruptured) when compared to controls (p=0.007). However, no significant difference could be observed between the ruptured or non-ruptured cases (p=0.89). With respect to leukocytosis, the TEP group with tubal rupture had significantly higher white blood cell numbers when compared to the non-ruptured TEP and the control groups (p=0.022 and p<0.001, respectively). Conclusions: Mean platelet volume seems to be higher in ectopic pregnancy and this finding evokes a possible role of increased platelet activity in the pathophysiology. Leukocytosis may occur more apparently in EP cases with tubal rupture. However, further prospective, controlled and with a larger sample size studies must be conducted to find clues on the correlation between the clinical entities and laboratory findings.Öğe Brucellosis in pregnancy(Royal Soc Medicine Press Ltd, 2011) Gulsun, Serda; Aslan, Selda; Satici, Omer; Gul, TalipThis study was undertaken in order to evaluate the effect of brucellosis in pregnancy. The serum agglutination test, Coombs and/or blood culture systems were used in the diagnosis of brucellosis. From July 2003 to September 2010, the clinical and delivery patterns of 40 healthy pregnant women were compared with 39 pregnant women who had brucellosis. There were no birth defects, anomalies or mortalities. We observed that brucellosis in pregnancy increases the incidence of preterm delivery (P = 0.01) and low birth weight (P = 0.001) from that seen in general deliveries. A cephtriaxone/rifampicin combination was found to be the most effective treatment in pregnant women infected with brucellosis (P = 0.004). Brucellosis in pregnancy has no effect on the incidence of congenital malformations or stillbirths. Preterm delivery and low birth weight can be seen as pregnancy outcomes in brucellosis. Appropriate antimicrobial therapy of brucellosis in pregnancy will reduce morbidity and prevent complications.Öğe Cesarean Scar Pregnancy Mimicking Malignant Tumor A Case Report(Sci Printers & Publ Inc, 2011) Soydinc, Hatice Ender; Evsen, Mehmet Siddik; Sak, Muhammet Erdal; Gul, TalipBACKGROUND: Ectopic pregnancy in cesarean scar is rare, however it is occurring with increasing frequency. These ectopic pregnancies can cause serious complications such as severe bleeding, uterine rupture, disseminated intravascular coagulation and maternal death. We present a case of cesarean scar pregnancy diagnosed during laparotomy with frozen section. CASE: A 26-year-old woman, gravida 3, para 3, was admitted to our gynecology clinic because of a 6-week history of irregular vaginal bleeding and anemia. A solid mass originating from the cervix was detected on ultrasound examination. Doppler ultrasound revealed an increase in blood supply. The case was managed by laparotomy. The solid mass was removed and the uterus preserved. CONCLUSION: Although ultrasound is useful in the detection of a typical scar pregnancy, ultrasound images can lead to a misdiagnosis, such as sarcoma or myoma, in some cases. Cesarean scar pregnancy should be considered in the differential diagnosis when an extremely vascularized and exophytic mass located in the isthmic region is detected. (J Reprod Med 2011;56:518-520)Öğe Comparison of hysterosalpingography and laparoscopy in the evaluation of infertile women(Saudi Med J, 2008) Sakar, Mehmet N.; Gul, Talip; Atay, Ahmet E.; Celik, YusufObjective: To compare tuboperitoneal factors of infertile women by hysterosalpingography (HSG) and laparoscopy. Methods: In this cohort study, 82 infertile cases were evaluated retrospectively by laparoscopy, 3 months subsequent to HSG in the Department of Gynecology and Obstetrics, Medical School of Dicle University, Diyarbakir, Turkey, between March 2004 and April 2006. The findings of HSG and laparoscopy were compared. Results: Out of the 82 infertile women, pathological findings were observed in 45.1% by HSG, and 54.9% had no pathological finding. On laparoscopic evaluation, however, pathological findings were observed in 65.85%, and 34.15% had no pathological findings. The pathological findings were detected by laparoscopy in 20 of the 45(44.4%) patients who had no pathological findings by HSG, and no pathological findings were detected by laparoscopy in 3 of the 37 (8.1%) patients who had pathological findings by HSG. Laparoscopy revealed no pathological findings in 6 of the 35 patients who had tubal pathology by HSG. The sensitivity of HSG was 63%, specificity was 89.3%, and the positive predictive value was 92%, with a 55% predictive value, and the accuracy ratio was 72%. Conclusion: Laparoscopy is a superior method for the research of tubal and pelvic pathologies in the evaluation of infertility. However, HSG is a more economical and elementary method suitable for evaluation of endometrial and tubal pathologies, and laparoscopy is an appropriate method for examining the external part of tubae, fimbriae, the relation of tuba and ovary, endometriosis, adhesions, tuberculosis, and other pathologies. Therefore, these 2 methods are not alternative, but complementary.Öğe Evaluation of the relationship between insulin resistance and recurrent pregnancy loss(Via Medica, 2011) Celik, Nazan; Evsen, Mehmet Siddik; Sak, Muhammet Erdal; Soydinc, Ender; Gul, TalipObjective: To investigate insulin resistance in patients with recurrent pregnancy loss (RPL). Design: Single center, case-control, prospective study. Methods: The study was performed at the Obstetrics and Gynecology Clinic at the Dicle University Medical Faculty from May to October 2009. 64 study subjects who had RPL were compared to 64 controls. Both groups were compared with fasting glucose, fasting insulin, fasting glucose/fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) index values to assess insulin resistance. Results: No significant differences in age and BMI index were found between the study and control subjects (p>0.005). The mean number of abortions was 3.04 in the study and 0.2 in the control group (p<0.001). The mean fasting glucose value was 100.84 in the study group, and 89.67 in the control group (p<0.001). Also, the mean fasting insulin value was 15.51 in the study group and 7.17 in the control group (p =0.001). The mean glucose/ insulin ratio was 12.24 in the study group and 28.27 in the control group (p =0.017), and the mean HOMA-IR value was 4.16 in the study group and 1.62 in the control group (p =0.002). Conclusion: Compared with the control group, patients with RPL were more likely to have insulin resistance.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 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.Öğe Intrauterine pregnancies conceived in the presence of intrauterine devices (IUD): a single center experience(E-Century Publishing Corp, 2018) Karacor, Talip; Basaranoglu, Serdar; Peker, Nurullah; Guler, Oguz; Aydin, Edip; Deregozu, Aysegul; Gul, TalipAim: This study aims to investigate the clinical and perinatal outcomes of pregnancies occurring in the presence of an intrauterine device (IUD). Material and Method: A total of 132 women diagnosed as having pregnancies complicated by IUDs in situ with visible strings were retrospectively examined during a period of six years. Twenty-nine women who chose to keep their IUDs in situ during pregnancy were included in Group 1 whereas 103 women who had their IUDs removed during pregnancy were included in Group 2. Results: Age, parity, frequency of IUD insertion at a maternity hospital and frequency of IUDs located within the uterine corpus were significantly higher in women who retained their IUDs compared to women who had their IUDs removed (p=0.02, p=0.04, p=0.02 and p=0.01, respectively). Although women who retained their IUDs had a significantly higher frequency of perinatal complications, they had a higher gestational week at delivery as well as higher Apgar scores at both 1 and 5 minutes (p=0.01, p=0.02 and p=0.02, respectively). Gestational age at preterm delivery was significantly lower in women who retained their IUDs during pregnancy (31.4 +/- 6 weeks vs. 33.0 +/- 4 weeks, p=0.01). Conclusion: Although removing IUDs with visible strings during pregnancy may increase the abortion risk, retaining them is also associated with adverse perinatal outcomes such as preterm premature rupture of membranes and preterm delivery. If an IUD located within the uterine cavity is retained during pregnancy, it may act as a filter allowing pregnancies to reach term.Öğe Late postpartum eclampsia: report of two cases(Galenos Yayincilik, 2006) Demir, Blent; Gul, TalipObjective: To Present Two Cases with Late Postpartum Eclampsia. Case: In two women in whom the clinic and laboratory features fulfil the characteristics of preeclampsia, convulsions occurred on the forth and seventh postpartum day. These cases have been reviewed. Conclusion: To emphasize late postpartum eclampsia, which occurs over 48 hours after delivery, may not infrequently exist and may happen despite normal laboratory values.Öğe Level Of Belief In Sexual Myths Women With Infertility Treatment(Klinik Psikiyatri Dergisi, 2017) Ekmen, Betul Uyar; Ozkan, Mustafa; Gul, TalipObjective: Infertility is defined as failure of fetation in a couple at reproductive age with regular sexual intercourse at least for one year without any contraception method being used. Sexual myths are thoughts which people think they are true. Sexual myths are mostly exaggerated and false beliefs which have no scientific background. Lack of sexual knowledge and education, when combined with society's strict behaviour, taboos and restrictions about sexuality can lead to several sexual problems and sexual dysfunctions. The purpose of this study was to determine sexual myth belief level in infertile women. Method: Our study included 100 primer infertile and 78 fertile women. Participants had answered the questions of sociodemographic data form, Arizona Sexual Experience Scale -Woman form and sexual myths evaluation form. Results: The levels of belief on 9 sexual myths in 30 were significantly higher in infertile women compared to fertile women. We found that living in countryside, education, family type, blind date marriage, infertility and treatment duration have augmented belief on sexual myths. Conclusion: Belief on sexual myths has been found significantly higher in infertile women compared to fertile women. Especially low education has been found associated with higher belief levels for infertile women. It is important to get sexual education from right sources in the right time which is essential for a better sexual life and reduction in sexual myth belief levels.Öğe The Most Important Factors in Prognosis Of Obstetric Patients with Disseminated Intravascular Coagulation: A Tertiary Center Study(2020) Karacor, Talip; Dırıcan, Emre; Peker, Nurullah; Agacayak, Elif; Evsen, Gamze Akın; Icen, Mehmet Sait; Gul, TalipObjective: The aim of this study was to investigate the underlying causes of obstetrical disseminated intravascular coagulation (DIC) and to evaluate the laboratory and clinical signs affecting DIC-related morbidity and mortality in women diagnosed with obstetrical DIC in a tertiary referral hospital. Method: The retrospective study included women with DIC who either had a delivery at Dicle University Medical School Gynecology and Obstetrics Department or were referred to this department prior to delivery between May 2006 and May 2016. DIC scoring was performed using the DIC scoring system developed by the International Society of Thrombosis and Hemostasis (ISTH) in 2001. Results: A total of 82 women with obstetrical DIC were included in the study. The incidence of obstetrical DIC in our department was 0.41%. Overall mortality rate was 24% and mortality occurred in 8% of the patients with a DIC score of ?5 and in 12% of the patients with a score of >5 (p=0.043). Multiple logistic regression analysis indicated that increased INR (International Normalized Ratio) and ALT (Alanin Aminotransferaz) levels led to a significant increase in DIC-related mortality [OR: 1.803 (CI: 1.027-3.167), OR: 1.003 (CI: 1.001-1.005), respectively]. Conclusions: Obstetrical DIC may result in high mortality and morbidity. DIC scoring can be useful for predicting the prognosis and DIC-related mortality. INR and ALT is the most important laboratory parameter in DIC and also can affect mortality.Öğe A new technique in laparoscopic abdominal access (Evsen Method, Modified Veress Technique)(Via Medica, 2018) Evsen, Mehmet Siddik; Icen, Mehmet Salt; Findik, Fatih Mehmet; Tunc, Senem Yaman; Magacayak, Elif; Gul, TalipObjectives: The most important step in laparoscopic surgery is to safely establish the pneumoperitoneum, especially since approximately half of the complications occur during the initial entry into the abdomen. There is a distinct need to modify the available methods to reduce therate of adverse events in laparoscopic entry. In this study, a modified Veress technique (MVT) or Evsen method is introduced. The aim of this article was to present a modified Veress technique for establishing the pneumoperitoneum. Material and methods: The study was conducted at the Dicle University, Faculty of Medicine, Department of Obstetrics and Gynecology, from September 2016 to May 2017. A new laparoscopic entry technique was introduced and compared with the classical Veress technique. A total of 40 cases were included in the study. MVT and the classical Veress method were applied to 26 and 14 patients, respectively. Results: The pneumoperitoneum was established at the first attempt in 23 (88.5%) MVT patients and in 7 (50%) patients from the classical Veress method group. The number of insufflation attempts to establish a successful pneumoperitoneum was lower using MVT and the difference was statistically significant (p: 0.022). As far as time is concerned, a comparison between the groups revealed that the pneumoperitoneum was established in a statistically significantly shorter time using MVT (p < 0.00). Conclusions: The modified Veress technique proved to be superior to the classical Veress method for establishing the pneumoperitoneum. Using the new method, the pneumoperitoneum was established after fewer attempts and in a shorter time.Öğe Platelet profile in patients with gestational diabetes: a retrospective study(Galenos Yayincilik, 2012) Sak, Muhammet Erdal; Soydinc, Hatice Ender; Ozler, Ali; Evsen, Mehmet Siddik; Turgut, Abdulkadir; Sak, Sibel; Gul, TalipObjective: To assess and compare alterations in the morphology and function of platelets occurring in gestational diabetes and healthy pregnancies. Material and Methods: A retrospective study was performed of 77 pregnant women: 42 cases with gestational diabetes and 35 healthy controls. The two groups were compared in terms of demographics and platelet parameters derived from complete blood counts. Results: The mean platelet volume (p=0.001) and HbA1c (p<0.001) were significantly increased in the patients with gestational diabetes. The mean platelet volume was well correlated with the platelet distribution width (rs=0.404, p<0.001) and the platelet count (rs=0.355, p=0.002) Conclusion: The mean platelet volume and other platelet parameters may significantly aid the identification of diabetic pregnants at risk for vascular complications. The role and possible clinical relevance of these changes during diabetic pregnancy need to be investigated in further studies.Öğe PREDISPOSING FACTORS IN THE OCCURRENCE OF COMPLICATIONS AFTER VAGINAL HYSTERECTOMY(Galenos Yayincilik, 2013) Sak, Muhammet Erdal; Ozler, Ali; Sak, Sibel; Goruk, Neval Yaman; Karacor, Talip; Gul, TalipObjective: To investigate the predisposing risk factors in the occurrence of complications after vaginal hysterectomy. Material and methods: The data obtained from 223 patients, admitted to tertiary care center that underwent vaginal hysterectomy due to benign pathology between January 2006 and March 2012 were retrospectively analyzed. Chisquare test was used to evaluate variables in categorized groups. Results: Group variables occurred age, number of pregnancies and abortion, parity, stage according to pelvic organ prolapse classification (POP-Q), periods of hospitalization and urinary catheterization. The main complications were hemorrhage, febrile morbidity and vaginal vault prolapse. Advanced age (> 60), pelvic prolapse, long-term hospitalization and urinary catheterization, were predisposing factors for the presence of complications. Conclusion: Vaginal hysterectomy is a safe and effective method, although not completely devoid of intraoperative or postoperative complications. Advanced age (> 60), POP-Q stage 3-4 pelvic prolapse, prolonged hospitalization and urinary catheterization were seem to be predisposing conditions for the existence of complications. Appropriate preoperative planning and meticulous postoperative care may be helpful to reduce the rate of complications.Öğe Pregnancy and H1N1 infection in Southeast Turkey(J Infection Developing Countries, 2012) Soydinc, Hatice Ender; Celen, Mustafa Kemal; Yildiz, Bahri; Sak, Muhammet Erdal; Evsen, Mehmet Siddik; Gul, TalipIntroduction: H1N1 Influenza made a great impact a worldwide, as well as in Turkey, in 2009. Clinical experiences have shown that it had a more serious prognosis in pregnant women. In this report, we summarize the cases of 16 pregnant women with H1N1 Influenza. Methodology: The study included 16 pregnant women hospitalized in Dicle University Hospital with complaints of fever, sore throat, cough and myalgia between October and December 2009. The diagnosis of pandemic H1N1 Influenza was confirmed on nasopharyngeal specimens using real-time reverse-transcriptase polymerase chain reaction (RT-PCR) in all patients. Patients who had the same complaints but were not diagnosed as H1N1 Influenza were excluded. The epidemiological, clinical, diagnostic, and outcome features of the patients were recorded. Results: The median age of the patients was 27 years (range 18-41 years). The mean gestational age was 25.4 weeks (range 5-38 weeks). Two cases were twin pregnancy. Two cases had co-morbid diseases including asthma and anemia. The most frequent admission symptoms were fever in 13 cases (81%), cough in 12 cases (75%) and dyspnea in 6 cases (37,5%). Antiviral treatment (oseltamivir 75 mg p.o. bid) was applied in 15 cases. Four cases needed intensive care monitoring and two of them died (12.5%) because of severe respiratory insufficiency. Conclusion: Patients with late gestational age, the presence of co-morbid disease, and multiple pregnancy have poor prognosis. Immediate intervention with antiviral treatment is associated with reduced severity of the disease and duration of hospital stay.Öğe Pregnancy Associated with Brucellosis and Acute Viral Hepatitis: Course and Outcome (Co-infections in Pregnancy)(Kuwait Medical Assoc, 2011) Gulsun, Serda; Dorman, Vedat; Aslan, Selda; Gul, TalipObjective: To assess the outcome and course of pregnancies complicated by Brucellosis (BCS) and acute viral hepatitis (AVH) infections Design: Prospective study Setting: Diyarbakir State Hospital, Turkey Subjects: Eighty-eight pregnant women admitted to Diyarbakir State Hospital, Turkey Intervension: Serum agglutination test (SAT), Coombs anti-Brucella test and / or blood culture system were used in the diagnosis of BCS. Enzyme-linked immunosorbent assays (ELISA) and polymerase chain reaction (PCR) was used in the diagnosis of viral hepatitis. Main Outcome Measures: The clinical course and delivery pattern of 32 healthy pregnant women was compared with that of 32 pregnant women who had BCS and 24 pregnant women who were concurrently infected with BCS and AVH. Results: There was no maternal mortality. Preterm delivery occurred in 18.75% of the 32 pregnant women with BCS and 37.5% of 24 pregnant women with BCS and AVH (p = 0.004). The incidence of low birth weight was also significant between the two groups (p < 0.0001). Antepartum hemorrhage might be a warning sign of the occurrence of complications in pregnant women with BCS and AVH (p < 0.001). An important observation from the present study is that maternal BCS and AVH (even concurrent) had no effect on the incidence of congenital malformations or stillbirths; it did increase the incidence of prematurity and low birth weight over that seen in the general delivery population. Conclusion: In spite of the high complication rates, BCS and AVH in pregnancy are well-tolerated diseases even when they occur together.Öğe The protective effect of curcumin on ischemia-reperfusion injury in rat ovary(Elsevier Science Bv, 2013) Sak, Muhammet Erdal; Soydinc, Hatice Ender; Sak, Sibel; Evsen, Mehmet Siddik; Alabalik, Ulas; Akdemir, Fatih; Gul, TalipBackground: To evaluate the protective effects of curcumin in experimental ischemia and ischemia/reperfusion (I/R) injury of rat ovaries. Methods: Forty-eight female adult Wistar Albino rats were used. Rats divided into six groups and designed: Sham, Torsion, Detorsion, Sham + Curcumin, Torsion + Curcumin, and Detorsion + Curcumin. Except for the Sham and Sham + Curcumin group, all groups were performed to bilateral adnexal torsion for 3 h. Bilateral adnexal detorsion was implemented in the Detorsion and Detorsion + Curcumin groups. The injection of curcumin was intraperitoneally achieved 30 min before the sham, torsion and detorsion. Results: Total oxidant status levels (TOS), oxidative stress index (OSI) and histologic scores values of ovarian tissue were higher in the torsion and detorsion groups than the sham group (p < 0.05). There was a strong correlation between the total histologic scores of I/R injury and the OSI (r = 0.809, p < 0.001). By the use of curcumin, a significant decrease was established in the mean levels of oxidant markers and histopathologic scores of the ovarian tissues. Conclusions: Administration of curcumin is effective in reversing tissue damage induced by ischemia-reperfusion injury in ovarian torsion. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.Öğe Relaparotomy after initial surgery in obstetric and gynecologic operations: analysis of 113 cases(Via Medica, 2012) Sak, Muhammet Erdal; Turgut, Abdulkadir; Evsen, Mehmet Siddik; Soydinc, Hatice Ender; Ozler, Ali; Sak, Sibel; Gul, TalipCondensation: Even though relaparotomy is unavoidable in some cases, several measures such as careful surgical technique, meticulous hemostasis and aseptic conditions must be undertaken to prevent unnecessary interventions in obstetrics and gynecology. Objective: To assess the indications, procedures, risk factors and outcome for relaparotomy after obstetric and gynecological operations. Study Design: A retrospective observational study during a four-year period in a tertiary care center was performed. Demographics such as age, parity and indications for relaparotomy as well as outcome measures in terms of complications and mortality rates were assessed in 113 patients who had undergone a relaparotomy after the initial obstetric or gynecological surgery. Results: The overall incidence of mortality after relaparotomy was 3.5%. Leading indications for the initial operation included placental abruption in 10 cases (8.8%), followed by the HELLP syndrome and previous cesarean section both in 5 cases (4.4%), and postpartum atonia in 4 (3.5%). The most common operations performed initially were cesarean section in 78 cases (69.0%) and 31 hysterectomies (27.5%). Principal indications for relaparotomy were bleeding and hematoma in 80 cases (70.8%) and abscess in 10 cases (8.8%). The most frequently performed procedures at relaparotomy were drainage and resuturing of hematomas (n=42, 37.1%), hypogastric artery ligation (n=32, 28.3%), hysterectomy (n=31, 27.5%), and drainage of abscess (n=7, 6.2%). A second relaparotomy was performed in 4 cases (3.5%). Complications were encountered in 4 patients and 4 cases ended up with mortality. Conclusion: Hemorrhagic and infectious complications were the main indications for relaparotomy after obstetric and gynecologic surgeries. Cases with a history of placental abruption, HELLP Syndrome and previous cesarean section were under risk for relaparotomy. Despite favourable outcome, preventive measures such as careful surgical technique, meticulous hemostasis and aseptic conditions should be undertaken.Öğe Retrospective analysis of placenta accreta: management strategies - evaluation of 41 cases(Via Medica, 2012) Evsen, Mehmet Siddik; Sak, Muhamment Erdal; Soydinc, Hatice Ender; Caca, Fatma Nur; Obut, Mehmet; Gul, TalipObjective: The aim of the study was to evaluate maternal characteristics, surgical treatment options, and morbidity of patients with placenta accreta. Methods: We retrospectively reviewed the medical records of placenta accreta patients who were diagnosed and hospitalized between 2006 and 2010 at the Obstetrics and Gynecology Clinics of the Dicle University Hospital (Center A) and Maternity Hospital (Center B) in Diyarbakir, Turkey The data were retrieved from medical charts of both hospitals. Maternal demographic features, clinical outcomes, type of surgical intervention, and complications were evaluated. Results: The incidence of placenta accreta was 1/426 deliveries in Center A and 1/7573 deliveries in Center B over a 5-year period. Thirty-nine (95.1%) patients had placenta previa, and 32 (78.0%) patients had at least one previous cesarean delivery Hysterectomy was performed in 28 (68.3%) of 41 women with placenta accreta and uterine preservation was achieved in 13 (31.7%) of them. One (2.4%) maternal death occurred, Estimated blood loss was >2 liters and all patients required blood products transfusion. Conclusion: Placenta accreta is highly associated with the existence of placenta previa, especially in cases with previous cesarean delivery When placenta accreta is diagnosed or suspected, the patient should be referred to a tertiary center for optimum care, where the obstetrical team should include experienced pelvic surgeons who are capable of performing emergent hysterectomy internal iliac artery ligation, and uterine devascularization procedures.
