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    Comparison of The Efficacy of Letrozole and Gonadotropin Combination Versus Gonadotropin Alone In Intrauterine Insemination Cycles In Patients With Unexplained Infertility
    (2020) Oğlak, Süleyman Cemil; Ege, Serhat; Otçu, Serap Mutlu Özçelik; Obut, Mehmet; Kahveci, Bekir; Yıldız, İsmail; Sakar, Mehmet Nafi
    This study aimed to determine the outcomes of combined treatment of letrozole (LTZ) with recombinant follicle -stimulating hormone (rFSH) in comparison with rFSH alone in intrauterine insemination (IUI) cycles.This study consisted of 86 patients who experienced 106 IUI cycle s. Patients were classified into two treatment groups:group I underwent a combination of LTZ plus rFSH, and group II received rFSH alone. Ovulation was triggered withhuman chorionic gonadotropin (hCG), and IUI performed 36 hours later. The number of follicles ?18 mm, endometrialthickness, required dose of FSH, duration of ovulation induction (OI), clinical pregnancy rates, multiple pregnancy rates,spontaneous abortion rates, and live birth rates were evaluated.The total required rFSH dose during the OI was significantly lower in the LTZ-rFSH combination group than the rFSHalone group (401.2±177.1 IU and 770.1±345.8 IU, respectively, p<0.001). The days of stimulation with rFSH were alsolower in the LTZ co-treatment group than the rFSH-alone group (5.2±1.3 days and 10.1±3.0 days, respectively, p<0.001).Clinical pregnancy rate was 17.0% in LTZ-rFSH group, and 15.2% in rFSH group (p>0.05).The combined use of LTZ with rFSH resulted in a lower required dose of rFSH, a similar and ac ceptable endometrialthickness at the day of hCG administration, and comparable pregnancy rate compared with rFSH alone
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    Eight-day methotrexate/folinic acid regime as single agent chemotherapy for low-risk gestational trophoblastic neoplasia: A retrospective study
    (Türkiye Klinikleri Yayınevi, 2022) Akgöl, Sedat; Oğlak, Süleyman Cemil; Tunç, Şeyhmus; Kahramanoğlu, Özge; Ölmez, Fatma; Kahramanoğlu, İlker; Budak, Mehmet Şükrü
    Objective: To evaluate the 8-day methotrexate (MTX)/folinic acid (FA) as a first-line chemotherapy regimen treatment in terms of complete regression of disease in women with low-risk gestational trophoblastic neoplasia (GTN). Material and Methods: All patients with low-risk GTN treated with an 8-day MTX/FA regimen were retrospectively included in the study. International Federation of Obstetrics and Gynecology and the modified World Health Organization Prognostic Scoring System were used to classify the risk of GTN. All women received diagnostic imaging evaluation before starting the treatment. The same MTX/FA regime was used repeating as a two-week cycle until normalization of the beta-human chorionic gonadotropin (ß-HCG), thus monthly ß-HCG follow-up was scheduled for up to 1 year. Results: Successful treatment was achieved in 56/66 (84.8%) patients. Nine (13.6%) women had resistance and 1 (1.6%) toxicity. The resistance patients were successfully treated with EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) protocol, whereas the patient who showed toxicity to the MTX/FA regime was successfully treated with actinomycin-D. Conclusion: Eight-day MTX/FA regime could be useful in low-risk GTN patients with good security margins. The toxicity rates in this protocol were determined as quite low. All resistance was treated successfully with the EMA-CO protocol.
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    Immunohistochemical analysis of vimentin and Zonula Occludens-1 in placentas of patients with PPROM
    (IMR Press Limited, 2024) Zaman, Fuat; Aşır, Fırat; Ermiş, Işılay Sezen; Tuncer, Mehmet Cudi; Deveci, Engin; Oğlak, Süleyman Cemil
    Background: We aimed to investigate the immunohistochemical staining of vimentin and zonula occludens-1 (ZO-1) expression in the placentas of pregnant women with preterm premature rupture of membranes (PPROM). Methods: Placentas of 25 healthy and 25 women with PPROM were fixed in 10% formaldehyde solution and further processed for paraffin wax tissue embedding. Demographic properties of patients were recorded. Placentas were histologically stained with hematoxylin-eosin and vimentin and ZO-1 expression immunostaining. Results: Vimentin expression was high in the decidual cells, fibroblasts, and connective tissue fibers in control group. Compared to control group, vimentin expression was decreased in the placental structures of PPROM group, where fetal membranes were degenerated and histologically irregular. Similar to vimentin expression, ZO-1 expression was also high in placental components of control group such as chorioamniotic membrane and amniotic epithelium. The PPROM group showed lower expression of ZO-1 expression in placental structures than in that of control. ZO-1 expression was significantly lowered in regions where fetal membrane integrity was weakened and lost. Conclusions: We suggest that ZO-1 and vimentin expression may show alteration in etiology premature rupture of membrane.
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    PALM-COEIN classification system of FIGO vs the classic terminology in patients with abnormal uterine bleeding
    (Via Medica, 2021) Kahveci, Bekir; Budak, Mehmet Şükrü; Ege, Serhat; Obut, Mehmet; Bağlı, İhsan; Oğlak, Süleyman Cemil; Vardar, Mehmet Ali
    Objectives: To evaluate the FIGO's novel classification system versus the classic terminology in patients with abnormal uterine bleeding. Material and methods: A retrospective study was carried out between August 2015 and September 2019 in the Health Sciences University Gazi Yasargil Training and Research Hospital. The pathology reports of the patients were classified according to the PALM-COEIN method and were compared with classical terminology. The operated patients with fibroids reported in the pathology results were classified as subgroups of fibroids. Results: Evaluation was made of a total of 515 women with abnormal uterine bleeding. According to the classical terminology, 137 (26.6%) patients were defined with hypermenorrhea, 74 (14.4%) with menorrhagia, 57 (11.1%) with metrorrhagia, and 246 (47.8%) with menometrorrhagia. In the PALM-COEIN classification system, polyps were determined in 84 (16.3%) cases, adenomyosis in 228 [diffuse adenomyosis:196 (38.1%), local adenomyosis:32 (6.2%)], leiomyoma in 386 [submucous:161 (31.1%), other types: 225 (43.9%)], and malignancy and hyperplasia in 47 (9.1%). Conclusions: The classical terminology for abnormal uterine bleeding is insufficient in terms of etiological pathologies in non-pregnant women of reproductive age. The widespread use of this novel system for the abnormal uterine bleeding classification will provide a more useful communication between physicians and researchers.
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    Prediction of posterior reversible encephalopathy syndrome (PRES) due to obstetric causes
    (Perinatal Medicine Foundation, 2023) Bozbay, Nizamettin; Bozbay, Özlem Polat; Ağaçayak, Elif; Oğlak, Süleyman Cemil; Avcı, Fazıl; Acar, Abdullah
    Objective: This study aimed to identify the demographic, laboratory, and clinical parameters that would help us identify patients at risk of posterior reversible encephalopathy syndrome (PRES) due to obstetric causes. Also, we analyzed the variables that might predict the development of obstetric-related PRES. Methods: This retrospective study examined a total of 274 hypertensive pregnant women diagnosed with preeclampsia (PE) and eclampsia from January 2010 to December 2017 at Dicle University Faculty of Medicine. Of these, 85 cases who underwent cranial imaging by mag-netic resonance imaging (MRI) or computed tomography (CT) were included in the study. Results: According to the cranial imaging results, 48 patients (56.47%) were reported as PRES (Group 1) and 37 patients (43.53%) were normal (Group 2). The incidence of patients diagnosed with PRES was found to be 17.51% when all PE and eclampsia patients were included. International Normalized Ratio (INR), and prothrombin time (PTT) values were significantly higher, and maternal age, gravida, parity, platelet (PLT), and albumin values were significantly lower in the PRES group compared to the cases in group 2 (p<0.05). As a predictor of PRES, INR values higher than 0.94 (sensitivity=75.0%, specificity=67.6%) and PTT values higher than 11.7 (sensitivity=75.0%, specificity=54.1%) were found to be significant factors. Conclusion: We consider that high INR, PTT, low PLT, low albumin, young age, early gestational week, low gravida, and parity parameters can help clinicians to predict and diagnose earlier PRES cases due to obstetric causes.
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    Prenatal diagnosis of fetal goiter and successful treatment with intraamniotic levothyroxine: a case report
    (Perinatal Medicine Foundation, 2024) Yalınkaya, Ahmet; Oğlak, Süleyman Cemil; Gündüz, Reyhan; Ağaçayak, Elif; Yayla, Murat
    Objective: Fetal goiter is rare and may cause polyhydramnios, fetal growth restriction, and congenital hypothyroidism. We aimed to report a rare case of fetal goiter complicated by polyhydramnios in a pregnant woman. Case(s): A 32-year-old woman with a 32-week pregnancy was referred to us because of polyhydramnios. Ultrasound examination revealed fetal asymmetric growth restriction and severe polyhydramnios. The fetal stomach was smaller, and pharyngeal dilatation and approximately 50x45 mm fetal neck mass (goiter) were observed. Also, mild hypothyroidism was detected in maternal thyroid function tests. In-utero treatment was initiated with 200 µg of levothyroxine injected into the amniotic sac. This treatment was repeated every 10 days for 2 doses following the initial dose. After levothyroxine treatment, fetal goiter and amniotic fluid volume completely recovered until birth. Conclusion: Fetal goiter can be successfully treated with an intraamniotic injection of levothyroxine. © 2024 Perinatal Medicine Foundation.