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    18F-FDG PET-CT and USG/CT in benign and malignant ovarian tumors with postoperative histopathological correlation
    (Studio K, 2011) Kuyumcuoglu, Umur; Irfan, Guzel Ali; Celik, Yusuf; Erdemoglu, Mahmut; Komek, Halil
    Objectives: The role of F-18-FDG (F-18 fluorodeoxyglucose) PET/CT** (Positron emission tomography) in the diagnosis, treatment and follow up of benign and malignant ovarian tumors had been investigated previously. The objective of the following study was to evaluate the predictive value of PET/CT in benign and malignant ovarian tumors and compare with computerized tomography and post-operative pathology. Materials and methods: In this retrospective study a total of sixty nine cases with benign or malignant pelvic masses underwent laparotomy at our clinic. Postoperative pathology of the patients was recorded and PET/CT results were compared with ultrasonography, computerized tomography and postoperative pathology. Results: The ROCs and AUCs values four predictors were shown in Figure 1. The AUCs (95 % CI) values calculated for CA 125, ultrasonography (USG), PET/CT and CT were as follows: 0.855(0.752-0.958), 0.703(0.540-0.866), 0.681(0.514-0.848) and 0.631(0.463-0.799) respectively. CA 125 has the highest AUC value in order to predict the malignant potential of the patient. USG has the highest AUC value between the imaging techniques, following PET/CT and CT. Conclusion: According to this study among four modalities that distinguish malignant potential preoperatively; CA 125 is the best parameter. USG and PET provide similar benefits in detecting malignant ovarian masses preoperatively. Both of these parameters are superior to CT. Combination of CA 125, USG and PET/CT may be useful in detecting malignant ovarian masses preoperatively, resulting in less invasive surgeries. **F-18-FDG (F-18 fluorodeoxyglucose) PET/CT will be used as the PET/CT, later in this article.
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    Are maternal and fetal parameters related to perinatal mortality in HELLP syndrome?
    (Springer Heidelberg, 2011) Guzel, Ali Irfan; Kuyumcuoglu, Umur; Celik, Yusuf
    We designed this retrospective study to evaluate the association between maternal and fetal parameters and perinatal mortality in hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. In this retrospective study, 152 pregnancies complicated with HELLP syndrome were evaluated. Risk factors recorded were maternal age, gravidity, gestational age (weeks), systolic and diastolic blood pressure, platelet count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), fetal weight, and Apgar scores. The association of these factors with perinatal mortality was determined. Statistical analyses were performed using the Chi-square (chi (2)) test with Yates' correction, the Student's t test, logarithmic transformation, and the logistic regression method. Ninety-two (60.52%) patients had mild preeclampsia, 46 (22.2%) had eclampsia, and 14 (15.2%) had severe preeclampsia. The fetal mortality rate was higher in eclamptic and severe preeclamptic patients (P = 0.029). No correlation was found between maternal age, laboratory values (platelet count, ALT, AST, and LDH), or systolic and diastolic blood pressure and fetal morbidity. According to the logistic regression model, fetuses with prematurity, low birth weight, and low Apgar scores (Apgar score 1 a parts per thousand currency sign 3 and Apgar score 5 a parts per thousand currency sign 5) were found to be at significant risk for perinatal mortality (P < 0.001). The odds ratios (95% CI) were 3.0 (2-5), 3.42 (1.82-6.41), 0.62 (0.44-0.86) and 4.66 (2.04-10.63), respectively. Maternal laboratory and clinical parameters were not associated with fetal mortality. Fetal prematurity, low birth weight, and low Apgar scores were significantly associated with fetal mortality. The HELLP syndrome and severe preeclampsia may be life threatening to the mother; therefore, the accepted treatment is expeditious delivery. Our study indicates that prevention of prematurity must be the main priority for the fetus in pregnancies complicated by the HELLP syndrome. This can be efficaciously achieved using glucocorticoid therapy for lung maturity and ensuring that delivery is at an experienced hospital with a multidisciplinary approach including a neonatal intensive care unit.
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    Comparison of the risk factors for adverse perinatal outcomes in adolescent age pregnancies and advanced age pregnancies
    (Studio K, 2012) Kuyumcuoglu, Umur; Guzel, Ali Irfan; Celik, Yusuf
    Objectives: To evaluate clinical outcomes of pregnancies in adolescent, advanced and reproductive women maternal age. Materials and methods: A total of 187 pregnant women were included into the study 51 (27.27%) were adolescent pregnancies, mean age 17.7 +/- 3.3 years (range, 14-18 years), 40 (21.29 %) advanced maternal age pregnancies, mean age 41.4 +/- 2.6 years (range, 39-50 years) and 96 (51.33 %), healthy controls, mean age 28.8 +/- 4.3 years (range, 19-37 years). The majority of the adolescent pregnant women were nulliparous, while all of the advanced age pregnant women were multiparous (mean gravidity 4.5 +/- 2.4; range, 6-12). Mean gravidity of the control group was 3.6 +/- 1.7 (range, 1-12). Results: There was statistically significant difference among the groups regarding demographic characteristics. According to the Bonferroni method, there was statistically significant difference among the three groups. Adverse fetal features were statistically different among the groups and the odd ratios were higher in the advanced maternal age group. The odds ratios (95% Cl) for lower Apgar scores (Apgar score 1 and 5) and low birth weight in adolescent maternal age and advanced maternal age group were as follows: 1.88 (127 - 2.78) vs. 2.46 (1.55 - 3.85), 2.17 (1.18 - 4.00) vs. 4.79 (3.02 - 6.69) and 1.39 (1.14 - 1.68) vs. 3.06 (1.59 - 5.88), respectively Gestational age at birth showed minimal risk for adolescent age group but no risk was noted in the advanced age group. Conclusions: The present study showed that pregnancies in adolescent maternal age, advanced maternal age and reproductive maternal age are different from each other in terms of clinical characteristics. According to this study advanced maternal age pregnancies are more risky and more likely to have adverse fetal outcome.
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    Dietary antioxidant levels in hyperemesis gravidarum: A case control study
    (Via Medica, 2011) Celik, Fatma; Irfan, Guzel Ali; Kuyumcuoglu, Umur; Celik, Yusuf
    Objectives: Dietary antioxidant intake decreases the risk of many diseases. Hyperemesis gravidarum (HG) is the most common eating disorder during pregnancy Therefore, the authors conducted this prospective and case control study to evaluate dietary antioxidant levels of women with HG and compare with healthy pregnant women. Material and Methods: This prospective case control study was conducted at a government hospital in the southeastern region of Turkey from February 2010 to May 2010. A total of 100 pregnant women were included into the study Dietary antioxidant levels (DAL) were measured according to the new 92-item antioxidant nutrient questionnaire developed by Satia et al (1). 50 women with HG and 50 healthy pregnant women were evaluated. Statistical analyses were carried out with statistical packages for SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, USA). Results: There were no statistically significant differences between the groups regarding the age of the patients, gestational age, educational status, body height and weight (p >.05). Vitamin E, E equivalent, vitamin C, carotene and vitamin A levels were significantly lower in women with HG (p <.05). The results of logistic regression method for these variables including odds ratio (95 % CI) were as follows: 10.07(1.52-66.51), 7.37(2.66-20.41), 4.26(2.66-20.41), 3.66(2.38-5.63) and 2.75 (1.56-4.85), respectively Conclusion: According to this study vitamin E, E equivalent, vitamin C, carotene and vitamin A levels of women may play a role in the pathogenesis of HG. Therefore, diet recommendations should be given by clinicians before pregnancy
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    Factors affecting the degree of hirsutism in patients with polycystic ovary syndrome
    (Springer Heidelberg, 2012) Guzel, Ali Irfan; Kuyumcuoglu, Umur; Celik, Yusuf
    To investigate the clinical features of patients with polycystic ovary syndrome (PCOS) and compare the patients with hirsutism to those without. In total, 304 consecutive females with PCOS were evaluated. The cases were divided into two groups of hirsute or non-hirsute. The risk factors recorded were age, age at menarche, body mass index (BMI), luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, prolactin, and total testosterone (tT) levels and hirsutism scores. Statistical analyses were performed using the Student's t test and logistic regression. Of all the cases, 224 were hirsute (hirsutism score a parts per thousand yen8). No significant difference was observed between the groups for age or age at menarche. BMI and hormone levels, including LH, FSH, estradiol and tT, were higher in hirsute patients than those in non-hirsute patients (p < 0.05). The logistic regression model showed that BMI, tT, LH, and estradiol were significant risk factors with odds ratios and 95% confidence intervals of 5.81 (2.22-15.18), 4.57 (2.34-8.90), 2.61 (1.73-3.94), and 2.29 (1.30-4.05), respectively. Hirsute patients with PCOS have different clinical characteristics from those that are non-hirsute in terms of BMI, LH, FSH, estradiol, and tT levels. We also determined the odds ratios of these different parameters. BMI was the most important risk factor for the degree of hirsutism.
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    Homologous Type of Malignant Mixed Mullerian Tumor of the Uterus Presenting as a Cervical Mass
    (Elsevier Taiwan, 2009) Kuyumcuoglu, Umur; Kale, Ahmet
    Malignant mixed Mullerian tumors are composed of a mixture of sarcoma and carcinoma. The carcinomatous element is usually glandular, whereas the sarcomatous element may resemble normal endometrial stroma (homologous or so-called carcinosarcoma). Here, we present a homologous type of malignant mixed Mullerian tumor of the uterus that presented as a cervical mass. We describe a 55-year-old patient who had a cervical mass arising from the uterus. We performed total abdominal hysterectomy and bilateral salpingo-oophorectomy and surgical staging (including (peritoneal washings, suspicious areas or peritoneal surfaces sampled, infracolic omental sampling, pelvic and paraaortic lymph node sampling, and appendectomy). Carcinosarcomas of the uterine cervix are extremely rare, and when a postmenopausal woman with a cervical mass is admitted to the gynecology clinic, the physician should keep in mind that the mass might be a carcinosarcoma. [J Chin Med Assoc 2009;72(10):533-535]
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    Is Preeclampsia a New Risk Factor for Cochlear Damage and Hearing Loss?
    (Lippincott Williams & Wilkins, 2010) Baylan, Muzeyyen Yildirim; Kuyumcuoglu, Umur; Kale, Ahmet; Celik, Yusuf; Topcu, Ismail
    Objective: We investigated whether preeclampsia is a risk factor for cochlear damage and permanent hearing loss. Study Design: Prospective case-control study design. Setting: Academic tertiary medical center. Patients: Subjects included 40 patients with preeclampsia and 30 healthy pregnant women. Interventions: Otoscopic examinations and pure-tone audiometry, tympanometry, otoacoustic emissions (OAEs), and stapedial reflex tests were conducted for all subjects. Negative audiologic tests were reevaluated after the postpartum period. Statistical analyses were performed using chi(2) and binary logistic regression testing. Main Outcome Measures: We searched for signs of middle ear ventilation, damage of cochlea, and sensorineural hearing loss. Results: Eight patients from the preeclampsia group had 1 or more otological problems. Two patients from the control group were determined as having otological problems. Otoacoustic emissions of the right and left ears (p = 0.029, p = 0.044), hearing levels of right and left ear bone conduction (BC) at the 500-Hz frequency (right and left-BC 500), and left ear at the 2,000-Hz frequency (left-BC 2000) differed significantly between the preeclampsia and control groups (p = 0.040, p = 0.003, and p = 0.003). There was no significant difference in the OAEs between the right and left ears in the preeclampsia group (p < 0.05). The variables BC 500-left, BC 500-right, OAE-right, and OAE-left differed significantly between groups based on binary logistic testing. The odds ratio and 95% confidence intervals (95% CI) for these 4 risk variables were as follows: BC 500-left, 1.167 (1.044-1.306); BC 500-right, 1.117 (1.002-1.244); OAE-right, 0.642 (0.505-0.815); and OAE-left, 0.576 (0.475-0.698), respectively. Conclusion: Preeclampsia is a risk factor for cochlear damage and permanent hearing loss. Even if preeclampsia resolves after delivery, cochlear damage and permanent hearing loss remain unchanged in patients with preeclampsia.
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    A New and Practical Aspartate Aminotransferase Test in Vaginal Washing Fluid for the Detection of Preterm Premature Rupture of Membranes
    (Karger, 2008) Kale, Ebru; Kuyumcuoglu, Umur; Kale, Ahmet; Guezel, Ali Irfan; Canoruc, Naime
    Objectives: To determine whether measurement of aspartate aminotransferase (Ast) and alanine aminotransferase (Alt) 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 36 and 48 pregnant patients between 26 and 36 weeks' gestation, respectively. Vaginal fluid Ast and Alt levels were measured in both groups. Results: Vaginal fluid Alt level was not statistically significant in the PPROM group as compared with the control group (p = 0.064). Vaginal Ast level was statistically significant in the PPROM (14.4 +/- 17.46 U/l) group as compared with the control group (3.08 +/- 7.8 U/l; p = 0.001). The optimal cutoff value of 3 IU/l for Ast gave a sensitivity level of 91% at a specificity of 83%, with positive and negative predictive values of 80 and 93%, respectively. Conclusion: Ast measurement from vaginal washing fluid appears to be a useful marker for the detection of PPROM. Copyright (C) 2008 S. Karger AG, Basel
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    Pregnancy-associated Aplastic Anemia: Case Report
    (Ekin Tibbi Yayincilik Ltd Sti-Ekin Medical Publ, 2010) Kale, Ahmet; Kuyumcuoglu, Umur; Fatmanur, Hancer
    Aplastic anemia in pregnancy is a rare condition with high maternal morbidity and mortality rates. Intensive hematological support during antenatal course remains the mainstay of the therapy. A successful obstetric outcome can be best accomplished with the clinical collaboration of the obstetrician and the hematologist. We present a patient with moderately severe aplastic anemia who was managed with intensive hematological support given repeatedly once in a month during pregnancy. She delivered a healthy infant by cesarean section.
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    Risk factors for postmenopausal osteoporosis: anthropometric measurements, age, age at menopause and the time elapsed after menopause onset
    (Informa Healthcare, 2009) Akdeniz, Nurten; Akpolat, Veysi; Kale, Ahmet; Erdemoglu, Mahmut; Kuyumcuoglu, Umur; Celik, Yusuf
    Objectives. The aim of this study was to determine, how much the anthropometric measurements and age affect the femur and vertebra T-scores by using correlation and regression analysis in postmenopausal women. Methods. Data of 540 healthy postmenopausal women were included in this analysis. Bone mineral density was determined by dual energy X-ray absorptiometry (DXA). The data of the patients related to height, weight, age, age at menopause were obtained from records, and body mass index (BMI) was calculated (BMI=W (kg)/H(m2)). Statistical analyses were performed with SPSS 15.0 for Windows (SPSS, Chicago, IL). Results. Mean age and standard deviation of 540 postmenopausal women was 59.38.4 years. The correlation coefficients among femur, vertebra T-scores, weight, the time elapsed after the menopause onset, age, BMI and height were found as follows, from higher to lower values with 0.465, 0.453, 0.411, 0.382, 0.232, respectively, and were statistically significant (p0.001). Conclusions. We determined the effects of the anthropometric measurements on osteoporosis from higher to lower influence as follows: weight, menopause age, age, BMI and height. Weight and menopause age of the patients were the major determinants for osteoporosis.
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    Vaginal douching practice and related symptoms in a rural area of Turkey
    (Springer Heidelberg, 2011) Guzel, Ali Irfan; Kuyumcuoglu, Umur; Celik, Yusuf
    Purpose To investigate vaginal douching habits and associated factors among women living in rural Turkey. Methods This study was performed in the gynecology department of a government hospital in a rural area of Turkey, from February to March 2010. The study included 393 women admitted to the gynecology clinic. The age, marital status, education, socioeconomic status, reason for vaginal douching, douching frequency, symptoms, and previous treatments were investigated. All of the subjects were asked about the use of, frequency, and reason for vaginal douching. Significant risk factors in the vaginal douching group and odds coefficients were found using binary logistic regression. Results The major symptoms of the subjects were itching and vaginal discharge. Of the 393 women, 317 (80.66%) performed vaginal douching and all of them had recurrent or treatment-resistant mixed agent vulvovaginitis. The majority of the women douched for ritual cleansing or washing before prayer (n = 278; 91.6%). The majority of the cases (n = 354; 90.1%) were of lower socioeconomic and educational status. The odds ratios and 95% confidence interval (CI) of the risk variables vaginal douching frequency, cervical motion tenderness, dyspareunia, and vaginal itching were 9.39 (2.07-42.48), 7.31 (2.08-25.64), 6.52 (2.26-18.78), and 1.46 (1.22-1.74), respectively. Conclusions In our region, vaginal douching is a common practice among women, especially those of lower socioeconomic and educational status. Clinicians should inform patients about the risks of vaginal douching to minimize the risks associated with this behavior.