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Öğe Amniotic fluid amino acid levels in non-immune hydrops fetalis: a case-control study(Assoc Bras Divulg Cientifica, 2011) Erdemoglu, M.; Kuyumcuoglu, U.; Guzel, A. I.; Celik, Y.; Kale, E.In a prospective case-control study, we compared the amniotic fluid amino acid levels in non-immune hydrops fetalis (NIHF) and normal fetuses. Eighty fetuses underwent amniocentesis for different reasons at the prenatal diagnosis unit of the Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University. Forty of these fetuses were diagnosed with NIHF. The study included 40 women each in the NIHF (mean age: 27.69 +/- 4.56 years) and control (27.52 +/- 5.49 years) groups, who had abnormal double-or triple-screening test values with normal fetuses with gestational ages of 23.26 +/- 1.98 and 23.68 +/- 1.49 weeks at the time of sample collection, respectively. Amniotic fluid amino acid concentrations (intra-assay variation: 2.26-7.85%; interassay variation: 3.45-8.22%) were measured using EZ: faast kits (EZ: faast GC/FID free (physiological) amino acid kit; Phenomenex, USA) by gas chromatography. The standard for quantitation was a mixture of free amino acids from Phenomenex. The levels of 21 amino acids were measured. The mean phosphoserine and serine levels were significantly lower in the NIHF group, while the taurine, a-aminoadipic acid (aaa), glycine, cysteine, NH(4), and arginine (Arg) levels were significantly higher compared to control. Significant risk variables for the NIHF group and odds coefficients were obtained using a binary logistic regression method. The respective odds ratios and 95% confidence intervals for the risk variables phosphoserine, taurine, aaa, Arg, and NH(4) were 3.31 (1.84-5.97), 2.45 (1.56-3.86), 1.78 (1.18-2.68), 2.18 (1.56-3.04), and 2.41 (1.66-3.49), respectively. The significant difference between NIHF and control fetuses suggests that the amniotic fluid levels of some amino acids may be useful for the diagnosis of NIHF.Öğe The association of preoperative thrombocytosis with prognostic factors in malign ovarian tumor(I R O G Canada, Inc, 2010) Kuyumcuoglu, U.; Guzel, A. I.; Celik, Y.; Erdemoglu, M.Purpose We assessed the association of preoperative thrombocytosis with prognostic factors in malign ovarian tumor Methods Over a five-year period, cases treated for ovarian cancer were randomly assigned The data were collected from gynecological oncology. radiation oncology, medical oncology and pathology departments Statistical analyses were carried out by using the statistical packages for SPSS 12 0 for Windows (Chicago, IL. USA) Survival was analyzed by the method of Kaplan and Meier. using log-rank (Mantel-Cox) analysis Results 51 cases with ovarian cancer were evaluated Cases with thrombocytosis were found to have greater CA-125 levels, more advanced stage disease, more ascites and shorter periods of survival Conclusion Thrombocytosis is a poor prognostic factor in ovarian cancer As reported previously, it is associated with aggressive tumor biology Thus, preoperative thrombocytosis can be a used as a marker of poor outcomesÖğe The clinical significance of HPV screening in premalignant cervical lesions(7847050 Canada Inc, 2010) Kuyumcuoglu, U.; Hocaoglu, S.; Guzel, A. I.; Celik, Y.Purpose We evaluated the clinical significance of human papilloma virus (HPV) screening in premalignant cervical lesions Methods This prospective study was performed at Dicle University, School of Medicine, Department of Obstetrics and Gynecology. from January 2009 to June 2009 A total of 60 cases were evaluated Thirty cases had premalignant cervical lesions The prevalence of HPV was analyzed by polymerase chain reaction and types determined by Hybrid Capture II The cases that had premalignant cervical lesions were evaluated with colposcopy Statistical analyses were carried out by using the statistical packages for SPSS version 12 0 for Windows (Chicago. IL, USA) Results Of all the cases. those with premalignant cervical lesions had higher prevalence of HPV DNA The cases that had high oncogenic HPV type had more abnormal colposcopic findings Conclusion Premalignant cervical lesions should be evaluated by cervical cytology. colposcopy, HPV DNA screening and cervical tissue sampling In this way, development of cervical cancer can be preventedÖğe Clinical significance of procalcitonin in cervico-vaginal secretions of women with preterm rupture of membranes(I R O G Canada, Inc, 2010) Kuyumcuoglu, U.; Kangal, K.; Guzel, A. I.; Celik, Y.Purpose: To compare vaginal fluid procalcitonin (PCT) concentrations in cases of preterm premature rupture of membranes (PPROM) and healthy pregnant women, and to determine whether the PCT concentrations are of value in the diagnosis of PPROM cases and clinical amnionitis. Methods: 50 cases with PPROM and 50 healthy pregnant women were enrolled in the study. In the PPROM group, analysis was conducted on PCT concentrations with reference to serum leucocytosis, serum C-reactive protein level and urine analysis, as well as to presence/absence of clinical amnionitis. Statistical analyses were carried out by using the statistical packages for SPSS 12.0 for Windows (SPSS Inc., Chicago, IL, USA). Results: Procalcitonin levels in the PPROM group were significantly higher than in cases of healthy pregnant women (1.17 vs 0.05 ng/ml; p < 0.001). In the PPROM group PCT concentrations between the patients with and without clinical amnionitis were comparable. Also, a significant correlation was observed between PCT and leucocytosis (r = 0.64; p < 0.001) and C-reactive protein (r = 0.90; p < 0.001). Conclusion: These findings suggest that the value of vaginal fluid PCT determinations can be useful for diagnostics of PPROM cases suspected of intrauterine infection.Öğe The Effect of Flurbiprofen as Prophylactic Analgesic before Hysterosalpingography(Sage Publications Ltd, 2010) Guzel, A. I.; Kuyumcuoglu, U.; Erdemoglu, M.Hysterosalpingography (HSG) is associated with pain during the four-step procedure. This prospective, double-blind, randomized, placebo-controlled study was conducted to investigate the effect of the analgesic flurbiprofen, administered prior to HSG, in 60 women. Thirty women were randomized to receive 100 mg of flurbiprofen, orally, 1 h prior to HSG and a further 30 women were randomized to receive placebo. Injection of contrast medium was more painful than the other steps in the HSG procedure in both groups; however, there was no significant between-group difference in terms of pain experienced in the individual steps of HSG. Pain scores at 5 and 30 min after the procedure were compared between the two groups. There was a significant decrease in the visual analogue scale pain score in the flurbiprofen-treated group compared with the placebo-treated group at both time points. Thus, the authors recommend flurbiprofen as a prophylactic analgesic to be administered before HSG procedures.Öğe Factors affecting maternal and perinatal outcomes in HELLP syndrome: evaluation of 126 cases(I R O G Canada, Inc, 2010) Erdemoglu, M.; Kuyumcuoglu, U.; Kale, A.; Akdeniz, N.Objectives. To ascertain the characteristics, clinical features. and maternal fetal outcome in HELLP (hemolysis elevated liver enzymes, low platelets) syndrome at a tertiary referral center Material and Methods This was a cross-sectional study carried out at Dicle University between January 2004 and December 2008 in which the charts of 126 cases were retrieved retrospectively and data analyzed descriptively Results Of all deliveries 0 9% were complicated by HELLP syndrome Of the cases with HELLP syndrome 79 (62 6%) had preeclampsia. 28 (22 2%) had eclampsia and 19 (15 2%) had a diagnosis of HELLP syndrome The values of significant biochemical parameters (mean SI)) were documented as ALT (alanin aminotransferase) 224 42 IU/I and ALP (after birth) 140 +/- 22. AST 379 +/- 23 IU/I and AST(I) 215 +/- 51. LDH (lactate dehydrogenase) 1418 +/- 67 IU/I and LDH(I) 875 +/- 16. together with the hematological parameters as platelet count (86 12 K/UI). urine protein (3 + in urine test stick) and albumin levels (2 +/- 0 9 g/dl) Eighty-six (68 25%) of the patients required albumin replacement Thirty-one (24 6%) cases welt: nullipara and 95 (75 4%) multipara. of which 32 women (25 4%) were in Class I. and 94 (74 6 %) in Class II of complete HELLP syndrome Regular antenatal examination was accomplished in a very small number of patients (12 25%) Fifty-eight (46 03%) patients requited transfusions with blood or blood products and 12 (9 5%) underwent laparotomy due to major intraabdominal bleeding. Magnesium sulphate to prevent convulsions and corticosteroids (12 mg betametazone) to enhance fetal lung maturity were administered Forty-four (34 9%) cases had vaginal delivery and 82 (65.1%) cesarean section: another 18 (14 2%) were with in utero stillbirth Fifteen babies (11 9%) died. 26 (20 63%) developed placental abruption. 14 (11 11%) acute renal insufficiency, and 13 (10.31%) postoperative subcutaneous hematomas Maternal mortality occurred in ten cases (7 93%) Conclusion HELLP syndrome is a pathology associated with a high incidence of maternal and perinatal complications Laboratory parameters in cases with HELLP syndrome are not efficient in detecting perinatal results. but can be used as risk denominators in evaluating maternal complications Therefore, lot patients with HELLP syndrome. standard antenatal follow-up protocols should be applied in order to obtain early diagnosis and improve the speed of transfer to obstetric departments with expertise in this fieldÖğe Is pregnancy over 45 with very high parity related with adverse maternal and fetal outcomes?(I R O G Canada, Inc, 2009) Kale, A.; Kuyumcuoglu, U.; Guzel, A.Objective: To examine whether very high parity and age over 45 years are related with adverse maternal and fetal outcomes. Study Design: This study was carried out at the Department of Obstetrics and Gynecology from January 1, 2007 to December 31, 2007. Sixty-one pregnant women were enrolled in this prospective study. Mothers were classified in two groups: the study group (n = 23) included women with very high parity over 45 years of age (age > 45 and >= 10 previous live births), and a control group (n = 38) included women with high parity between 40-45 years of age (between 40-45 years and 5-9 previous live births). Hypertensive disorders complicating pregnancy, preterm labor, breech presentation, cesarean section ratio, mean APGAR scores, birthweight, fetal sex, fetal macrosomia, and early neonatal death were compared within groups. Results: Six (26%) patients in the study group and 12 (31.5%) patients in the control group had hypertensive disorders of pregnancies (p > 0.05). Twelve (52.1%) patients in the study group and 22 (57.8%) patients in the control group had preterin labor (p > 0.05). One (4%) patient in the study group and two (5.2%) patients in the control group had breech presentation during delivery (p > 00.5). Twelve (52.1%) patients in the study group and 21 (55.2%) patients in the control group had cesarean operations (p > 0.05). Mean APGAR scores (at 1 min and 5 min), mean birthweight, fetal sex ratio, fetal macrosomia ratio, and early neonatal death ratio due to prematurity were not statistically significant in the study group as compared with the control group. Conclusion: It is generally assumed that women with advanced age have an increased risk for complications during pregnancy. However, prospective population-based studies do not exist and available publications give conflicting views. Based on our results, we hypothesized that cases aged 45 or over with very high parity are not always related with adverse maternal and fetal outcomes.Öğe Pelvic packing method (after two laparotomies): a salvage procedure to control intractable pelvic hemorrhage after vaginal hysterectomy: a case report(I R O G Canada, Inc, 2008) Kale, A.; Kuyumcuoglu, U.Background: Hysterectomy is one of the most commonly performed operative procedures in the world and hemorrhage continues to be a serious complication of both obstetrical and gynecologic surgeries. The pelvic packing technique is a useful alternative to control pelvic bleeding when standard measures fail. Case: A 45-year-old premenopausal women with a history of pelvic pain and obstructive voiding Symptoms underwent vaginal hysterectomy. Intraabdominal bleeding persisted after surgery and relaparotomy was performed. After routine Surgical techniques failed to achieve adequate hemostasis, a pelvic packing technique was Successfully used to tamponade the pelvic bleeding. Conclusion: When traditional methods of controlling pelvic hemorrhage fail, pelvic packing can be used as an Unusual method for intractable pelvic hemorrhage. We Successfully used the pelvic packing technique in a premenopousal patient with intractable hemorrhage after vaginal hysterectomy and this technique saved the patient's life.Öğe Pregnancy and adnexal torsion: analysis of 20 cases(I R O G Canada, Inc, 2010) Erdemoglu, M.; Kuyumcuoglu, U.; Kale, A.Objective. To study the clinical profile. management and outcome of pregnancy complicated by adnexal torsion Methods All pregnancy cases complicated by adnexal torsion admitted between January 2001 and January 2009 were analyzed Results The total number of pregnant cases was 20 Age range of pregnant women with adnexal torsion was 18 to 42 years Of these cases 70% were seen in the first and second trimester Seventy percent of cases were operated by the laparotomy route and 30% by laparoscopy Salpingo-oophorectomy was performed in 70% of cases and detorsion in 30% of cases Histopathologic examinations revealed five patients (25%) had serous cystadenoma. four patients (20%) mucinous cystadenoma. six patients (20%) dermoid cyst and five patients (25%) hemorrhagic cyst Conclusions Adnexal torsion as a differential diagnosis of acute abdomen in pregnancy should be considered and we recommend early surgical treatment that will save the adnexaÖğe Pregnancy-related acute renal failure in the southeast region of Turkey: analysis of 75 cases(I R O G Canada, Inc, 2010) Erdemoglu, M.; Kuyumcuoglu, U.; Kale, A.; Akdeniz, N.Objective: To study the clinical profile, management and outcome of the patients with pregnancy-related acute renal failure (PRARF). Methods: All patients with PRARF admitted between January 2006 and January 2009 were analyzed. Results: The total number of women with PRARF was 75. Age range of women with PRARF was 21 to 46 years and 36% of the cases of PRARF were seen in the postpartum period. PRARF was caused by sepsis in 14.6%, toxemias of pregnancy in 75.2%, and hemorrhage of pregnancy in 12%. Postabortal sepsis was the cause in 14.6%. Dialysis was needed in 33.3%. Maternal mortality rate was 10.6%. Conclusions: Pregnancy-related acute renal failure is a major health problem and carries very high mortality and morbidity. Poor healthcare facilities and lack of antenatal healthcare clinics are major identified causesÖğe Proposal of a diagnostic test for the detection of preterm premature rupture of membranes based on the determination of thyroid hormones in vaginal washing fluid(Karger, 2007) Kale, Ahmet; Kale, Ebru; Akdeniz, Nurten; Kuyumcuoglu, U.; Canoruc, N.Objectives: To determine whether measurement of total T3 (triiodothyronine), total T4 (thyroxine), free T3 (free triiodothyronine) and free T4 (free thyroxine) levels in vaginal fluid is useful for the diagnosis of preterm premature rupture of membranes (PPROM). Study Design: The PPROM group and normal pregnancy group consisted of 30 and 30 pregnant patients between 26 and 36 weeks' gestation, respectively. Vaginal fluid total T4, free T4, total T3 and free T3 levels were measured in both groups. Results: Vaginal fluid total T3 and free T3 levels were not statistically significant in the PPROM group as compared with the control group (p = 0.087, p = 0.123, respectively). Vaginal fluid total T4 and free T4 levels were significantly higher in the PPROM group as compared with the control group (p = 0.002, p < 0.000, respectively). The optimal cut-off value for total T4 (0.866 mu g/dl) gave a sensitivity level of 83.3% (65.3-94.3, 95% CI) at a specificity of 60.0% (40.6-77.3, 95% CI) with positive and negative predictive values of 67.6 and 78.3%, respectively. The optimal cut-off value for free T4 ( 0.079 ng/dl) gave a sensitivity level of 90% (73.4-97.8, 95% CI) at a specificity of 70.0% (50.6-85.2, 95% CI) with positive and negative predictive values of 75.0 and 87.5%, respectively. Conclusions: Total and free T4 measurements from vaginal fluids appears to be a useful marker of PPROM. Copyright (c) 2007 S. Karger AG, Basel.Öğe Resistin may not associate with gestational diabetes mellitus although insulin resistance(I R O G Canada, Inc, 2011) Akdeniz, N.; Kuyumcuoglu, U.; Kale, A.; Arikan, S.; Kale, E.; Erdemoglu, M.Objective: Resistin is a potent regulator of glucose homeostasis which is thought to oppose the action of insulin in peripheral tissues. The aim of this study was to determine changes in resistin levels in gestational diabetes mellitus (GDM). Material and Method: Twenty women with GDM (mean age 32.28 +/- 5.01 years old, and gestational age 32.2 +/- 4.8 weeks) matched with 22 non diabetic pregnant women (NGDM) (mean age 30.30 +/- 4.5 years old, and gestational age 34.8 +/- 3.5 weeks) were included in the study. Body mass index (BMI) was calculated. Serum resistin levels were measured and insulin resistance was calculated with HOMA-IR. The Mann Whitney U test was used for statistical analysis. Results: BMI was 33.8 +/- 6.2 kg/m(2) in the GDM group and 28.4 +/- 6.2 kg/m(2) in the NGDM group (p = 0.04). Serum resistin levels were 8.7 +/- 2.1 ng/ml in the GDM group and 8.1 +/- 2.5 ng/ml in the NGDM group. Mean resistin level was not different between the two groups. HOMA-IR in GDM was higher than in the NGDM group (13.2 +/- 12.2 vs 5.8 +/- 5.1, p = 0.02, respectively). Conclusion: Although mean BMI in GDM was higher than in NGDM and insulin resistance in GDM was more marked than in NGDM, serum resistin levels in GDM were not found to be any different from NGDM.Öğe Risk of malignancy index for adnexal masses(Imr Press, 2009) Akdeniz, N.; Kuyumcuoglu, U.; Kale, A.; Erdemoglu, M.; Caca, F.Objectives: The aim of this study was to determine the effectiveness of the risk of malignancy index (RMI) and retrospective analysis of patients presenting with adnexal masses to our clinic for treatment. Methods: Data of 137 women who had adnexal masses were included in the analysis. A simple algorithm called risk of malignancy index (RMI) reported by Jacobs includes menopausal status, ultrasound morphologic features and serum CA125 level. The RMI values were detected for each patient and analyzed to detect the relationship between benign and malign groups of the patients. Statistical analyses were performed with SPSS 15.0 for Windows (SPSS, Inc., Chicago, IL USA). Sensitivity and specificity was calculated for RMI in diagnoses of ovarian cancer by using receiver operating characteristic (ROC) analysis. Results: A total of 137 patients with adnexal masses were operated on. Mean age and SD of 137 patients were 30.64 +/- 10.05. Fourteen patients (10.2%) had malignant disease and 123 patients (89.8%) benign pathology. ROC analysis of the RMI showed that the values of area under the curve were significantly high with a value of 0.883 (p < 0.001). Conclusion: The RMI is a simple scoring system and has a high sensitivity and specificity for the detection of malignant adnexal masses. Application of the RMI in clinical practice may provide a rational basis for specialists to treat patients with adnexal masses before diagnostic surgery.Öğe Tragic results of suboptimal gynecologic cancer operations(I R O G Canada, Inc, 2008) Kuyumcuoglu, U.; Kale, A.Objective: The goal of this study was to analyze gynecological cancer patients Who underwent Suboptimal or failed surgeries with unsatisfactory and undesired results. Study design: During 1997-2007, 74 women were referred to our gynecological oncology service after suboptimal or failed surgeries for ovarian, cervix, endometrium and vulvar cancers. Medical records were evaluated retrospectively to determine the reasons of suboptimal surgery. Results: Optimal cytoreduction was achieved in ten women (21.7%), 32 women (69.5%) had suboptimal surgical cytoreduction and four women (8.6%) had failed surgery, Seven patients were recurrences (3 had liver metastasis, 2 had pelvic metastasis. 2 had bladder metastasis): two patients died due to bladder metastasis, one patient died six days after Surgery due to a Pulmonary embolism in the suboptimal cytoreduction group. and one patient died due to ascites in the failed surgery group. Optimal surgery was achieved in three women (27.2%) and eight women (72.7% had suboptimal surgery in the cervical cancer population. One patient had a recurrence with pelvic metastasis in the suboptimal group. Sub-optimal Surgery was achieved in one woman with vulvar cancer. Optimal surgery was achieved in seven women (43.7%) and nine women (56.2%) had suboptimal surgery in the endometrial cancer population. One patient died 11 days after surgery due to sepsis ill the Optimal surgery group. One patient died 21 months after primary surgery and the other patient had a recurrence with paraaortic lymph nodes, ascites and omental thickening ill file Suboptimal surgery group. The prognosis of 30 (65.2%) women in the ovarian cancer population, eight (72.7%) women in the cervical cancer group, 11 (68.7%) women in the endometrial cancer group. and one woman (100%) in the vulvar cancer population was unknown. The unknown cases of all genital cancers were missed during follow-up and we Could not reach them Using their phone or address information. Conclusion: If a gynecologist does not have enough experience or expertise about gynecological cancer operations. tic or she must consider the possible harm that any Surgical intervention might do, as the latin phrase primum non nocere means and should refer patients to a gynecological oncology center without performing all Surgery. Optimal gynecologic surgery call only be carried out correctly when education becomes available throughout the world. Thus postgraduate fellowship programs should be considered urgently to extend the general gynecologists' Surgical experience and expertise in developing and Undeveloped Countries.Öğe Umbilical cord prolapse in the southeast region of Turkey: evaluation of 79 cases(I R O G Canada, Inc, 2010) Erdemoglu, M.; Kale, A.; Kuyumcuoglu, U.; Akdeniz, N.; Guzel, A. I.Objective: The aim of the study was to determine the risk factors and perinatal outcomes of umbilical cord prolapse (UCP). Material and Methods: This study was performed at Dicle University between January 2000 and December 2008 on 79 cases in which deliveries were complicated by umbilical cord prolapse. Results: 0.36% of all deliveries were complicated by umbilical cord prolapse. The presentation of the fetuses were as follows: vertex, breech and transverse lie and foot presentation. Thirty-four (43%) fetuses with UCP had a fetal weight of <= 2500 g as compared with nine (9%) for fetuses in the control group (p < 0.05). Mothers in the study group were 1.3 times more likely to be multiparas than the control group (p = 0.16) Cesarean section was performed in 76 cases (96.2%) and there were nine (11.3%) perinatal deaths. Conclusion: Umbilical cord prolapse is a risk factor of perinatal morbidity and mortality. Fetal weight <= 2500 and abnormal fetal presentation are associated with increased risk of umbilical cord prolapse. Cesarean section resulted in a significantly decreased risk of perinatal mortality.Öğe Unusual presentation of a dermoid cyst that derived from the bladder dome presenting as subserosal leiomyoma uteri(I R O G Canada, Inc, 2008) Kuyumcuoglu, U.; Kale, A.Background: Dermoid cysts are benign neoplasms deriving from ectoderm and mesoderm and can be found in a variety of local Uterine leiomyomas are benign tumors that grow within the muscle tissue of the uterus. Only a few cases have been reported and cited in the literature on dermoid cysts of the urinary bladder, and can be confused with urogenital masses. This paper reports the first case of a dermoid cyst deriving from the bladder dome presenting as subserosal uterine leiomyoma. Case: A 44-year-old woman was admitted with a history of chronic pelvic pain. After gynecological examination and ultrasonography a subserous uterine myoma was suspected. Tumor resection was performed and the histopathological diagnosis was a dermoid cyst. Conclusion: To our knowledge this is the first case report of a woman with a dermoid cyst presenting as a Subserous uterine myoma.
