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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 The Biochemical and Histologic Effects of Adnexal Torsion and Early Surgical Intervention to Unwind Detorsion on Ovarian Reserve: An Experimental Study(Sage Publications Inc, 2013) Ozler, Ali; Turgut, Abdulkadir; Soydinc, Hatice Ender; Sak, Muhammet Erdal; Evsen, Mehmet Siddik; Alabalik, Ulas; Basarali, Mustafa KemalObjective: The aim of the present study was to determine to what extent ovarian reserves are affected by ischemia-reperfusion injury, evaluating the number of growing follicles and the serum levels of the ovarian hormones. Study Design: Thirty female fertile adult Wistar albino rats, weighing 200 to 220 g, were previously numbered to randomization, and then randomly divided into 3 equal groups (n = 10): sham, torsion, and detorsion groups. In 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. Results: The mean number of preantral and small antral follicles in detorsion group were lower than those of the sham group (P < .01). After torsion, anti-Mullerian hormone (AMH), estradiol, and inhibin B levels decreased significantly compared to the preoperative and postoperative periods (P = .003, P = .032, and P = .014, respectively). In detorsion group, only AMH levels were found to decrease significantly following the 3-hour ischemia and 3-hour reperfusion (P < .05). Conclusion: After adnexal torsion, a significant decrease in ovarian reserve has been detected for the first time in this study. Additionally, the results of this study suggest that conservative surgery alone is insufficient to protect ovarian reserve.Öğe Can aquaporins be used as diagnostic and prognostic markers for uterine smooth muscle tumours?(Taylor & Francis Ltd, 2017) Alabalik, Ulas; Turkcu, Gul; Keles, Ayse Nur; Ibiloglu, Ibrahim; Ozler, Ali; Urakci, Zuhat; Buyukbayram, HuseyinGenerally, uterine leiomyosarcoma is easily diagnosed. However, uterine smooth muscle tumours which show atypical histological features and unusual growth patterns may mimic malignancy and may not be easily diagnosed. In this study, our aim is to show the expressions of Aquaporin3, Aquaporin7 and Aquaporin9 in uterine smooth muscle tumours, and to investigate if aquaglyceroporins can be used as diagnostic and prognostic markers to start rapidly an appropriate treatment for patients with these tumours in order to extend the survival time. We determined that there had been 74 patients diagnosed with uterine smooth muscle tumours. We divided patients into four groups based on the diagnosis: bizarre leiomyoma, smooth muscle tumour of uncertain malignant potential, leiomyosarcoma and leiomyoma. Aquaporin3, Aquaporin7 and Aquaporin9 were detected by using monoclonal anti-Aquaporin3, anti-Aquaporin7 and anti-Aquaporin9 antibodies, respectively. In leiomyosarcoma group, we observed a statistically significant relation of Aquaporin3 expression with survival time, grade, stage, mitotic index and Ki-67 score. A significant relation of both Aquaporin7 and Aquaporin9 expressions with survival time, grade, stage was not statistically detected in leiomyosarcoma group. The decrease of Aquaporin3 expression can be used as important diagnostic and prognostic marker. Aquaporin7 and Aquaporin9 expressions cannot be used as diagnostic and prognostic markers.Öğe Effect of Caffeic Acid Phenethyl Ester on Intra-Abdominal Adhesion in Rats(Karger, 2013) Turgut, Abdulkadir; Sak, Muhammet Erdal; Turkcu, Gul; Ozler, Ali; Soydinc, Hatice Ender; Evsen, Mehmet Siddik; Evliyaoglu, OsmanBackground: To determine the impact of caffeic acid phenethyl ester (CAPE) on abdominal adhesion formation after laparotomy. Methods: Forty female rats were allocated into four distinct groups on which laparotomy alone; laparotonny with traumatization of the uterine horns; laparotomy, traumatization of the uterine horns and intraperitoneal irrigation with saline, and laparotomy, traumatization of the uterine horns and intraperitoneal irrigation with CAPE were performed. After sacrifying the animals on the 14th postoperative day, histopathological examination and biochemical analysis were conducted to evaluate the formation of abdominal adhesions and antioxidant status. Results: In the CAPE group, total adhesion scores were significantly lower than in the control and saline groups. The CAPE group displayed less inflammation, giant cell formation, fibrosis and fibroblastic activity than the control group. On the other hand, the control group displayed higher total adhesion scores. Conclusion:The results of this study indicate that the administration of CAPE may have beneficial effects for the prevention of abdominal adhesion formation after laparotomy. Further clinical studies are mandatory to explore the actual therapeutic potential of CAPE. Copyright (C) 2013 S. Karger AG, BaselÖğe 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 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 the Protective Effects of CoQ10 on Ovarian I/R Injury: An Experimental Study(Karger, 2013) Ozler, Ali; Turgut, Abdulkadir; Goruk, Neval Yaman; Alabalik, Ulas; Basarali, Mustafa Kemal; Akdemir, FatihBackground: The aim of this study was to investigate the protective effects of coenzyme Q(10) (CoQ(10)) on ovarian ischemia/reperfusion injury in an experimental rat adnexal torsion model. Methods: 48 female adult Wistar albino rats, weighing 220-250 g, were randomly equally divided into six groups (n = 8): sham, torsion, detorsion, sham+CoQ(10), torsion+CoQ(10), and detorsion+CoQ(10) groups. Bilateral adnexal torsion was performed for 3 h in all groups, except the sham and sham+CoQ(10) groups. Bilateral adnexal detorsion was performed on the detorsion and detorsion+CoQ(10) groups. CoQ(10) was injected intraperitoneally 30 min before the sham operation, torsion, and detorsion. Results: The torsion and detorsion groups had significantly higher histologic evaluation scores, as well as higher MDA levels, TOS values, and oxidative stress index values than the sham group. A strong correlation between total histologic evaluation scores for ischemia/reperfusion injury and the oxidative stress index was found. The mean oxidant marker levels and histopathologic scores for the ovarian tissue significantly decreased after using CoQ(10), which is a potent antioxidant. Conclusions: Conservative surgery (detorsion) was found to provide inadequate protection to ovarian tissue. The results of this study suggest that CoQ(10) could be useful for the protection of ovarian tissue before conservative surgery. (C) 2013 S. Karger AG, BaselÖğe Human Placental Macrophages (Hofbauer Cells) in Severe Preeclampsia Complicated by HELLP Syndrome Immunohistochemistry of Chorionic Villi(Sci Printers & Publ Inc, 2013) Evsen, Mehmet Siddik; Kalkanli, Sevgi; Deveci, Engin; Sak, Muhammet Erdal; Ozler, Ali; Baran, Ozlem; Erdem, ElifOBJECTIVE: To evaluate Hofbauer cells in the placentas of women diagnosed with HELLP syndrome. STUDY DESIGN: The present study compared 20 patients with HELLP syndrome and 20 control patients with respect to demographics, hematological parameters and the presence of Hofbauer cells in placental samples. CD-68 antibody was used for immunohistochemical examination. The total number and size of Hofbauer cells were measured in the placental villi, and the proportion of Hofbauer cells relative to the vascular structure was also compared between groups. RESULT: The patient and control groups were similar according to baseline obstetric characteristics. White blood cell counts in patients with HELLP syndrome and the control group were 15,139 4,169 and 10,806 2,888, respectively, and were significantly increased among patients with HELLP syndrome (p < 0.001). Hofbauer cell numbers in the placental villi of patients with HELLP syndrome were significantly elevated in comparison to normotensive controls (p = 0.046). The proportion of Hofbauer cells in the placental villi according to proximity to the vascular structure were 3.85 +/- 1.66 in the HELLP group and 1.75 +/- 1.12 in controls (p < 0.001). Sizes of the Hofbauer cells were not statistically different between groups. CONCLUSION: Increased Hofbauer cells may be associated with increased inflammation or may have an adaptive mechanism at the fetal site of the placenta in patients with HELLP syndrome.Öğe Immune mechanisms and the role of oxidative stress in intrahepatic cholestasis of pregnancy(Termedia Publishing House Ltd, 2014) Ozler, Ali; Ucmak, Derya; Evsen, Mehmet Siddik; Kaplan, Ibrahim; Elbey, Bilal; Arica, Mustafa; Kaya, MuhsinIntroduction: The purpose of this study was to investigate levels of inflammatory cytokines such as interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha) and neopterin and oxidative stress status in patients with intrahepatic cholestasis of pregnancy (ICP) as well as their potential role in the pathophysiology. Material and methods: Thirty patients with ICP (Group 1) and 30 healthy pregnant women (Group 2) were included in this prospective case-control study. Levels of IL-6, TNF-alpha and neopterin were determined in both of the groups. Total anti-oxidant status (TAS) and total oxidative stress (TOS) levels were determined by means of a fully automated Erel method. Oxidative stress index (OSI) was calculated as the ratio of TOS to TAS. Results: There was no significant difference between the groups in IL-6 and TNF-alpha levels (p = = 0.105 and p = 0.722, respectively). The mean neopterin level was significantly higher in Group 1 compared to Group 2 (2.34 +/- 0.77 and 1.57 +/- 0.38, respectively, p = 0.001). In addition, TAS, TOS and OSI levels were significantly higher in Group I (p = 0.004, p = 0.001 and p = 0.001, respectively) compared to Group 2. Discussion: Intrahepatic cholestasis of pregnancy is an inflammatory disorder in which maternal immune reaction may play a role. Interleukin 6 and TNF-alpha, which are some of the markers of humoral reaction, act as an indicator of abnormal reaction rather than acute-phase reaction in ICP. Further clinical trials and supportive placental findings are needed on the role of cytokines in cellular and humoral immune reactions during the symptomatic period and delivery to better understand the role of immune mechanisms in the aetiology of ICP.Öğe Increased psychological trauma and decreased desire to have children after a complicated pregnancy(Galenos Yayincilik, 2013) Tan, Pinar; Evsen, Mehmet Siddik; Soydinc, Hatice Ender; Sak, Muhammet Erdal; Ozler, Ali; Turgut, Abdulkadir; Bez, YasinObjective: Information about fertility desire and psychological sequelae after high-risk pregnancies are scarce in the literature. The aim of the present study is to investigate the psychological effects of high-risk pregnancies. Material and Methods: The patients who had a history of severe preeclampsia, eclampsia or major hemorrhage during the peripartum period were enrolled as the study group and compared with the control subjects with respect to fear about new pregnancy, anxiety/depression and post-traumatic stress disorder (PTSD) scores. The study was carried out by submitting a questionnaire form to the participants. Numbers of planned children before and after the last delivery were evaluated in both groups. Results: Fear about a new pregnancy was found to be significantly higher in the study group compared with the controls. There were no statistically significant difference between the two groups in terms of anxiety and depression. In terms of re-experience and avoidance in PTSD was significantly higher in the study group, however no significant difference was found for hyper-arousal. Conclusion: Fear regarding new pregnancy is high and planning more children is decreased after high-risk pregnancies and PTSD symptom scores were higher after high-risk pregnancies.Öğe Leptin expression in proliferative, secretory and hyperplastic endometrial tissues(Galenos Yayincilik, 2011) Ozler, Ali; Kuscu, Naci Kemal; Temiz, Peyker; Kandiloglu, Ali Riza; Koyuncu, Faik MumtazObjective: The goal of this study was to detect endometrial leptin expression in proliferative and secretory phases and then to compare the results with that of hyperplastic endometrium. Material and Methods: Seventeen proliferative, 23 secretory phase and 18 hyperplastic endometrial tissues diagnosed in our hospital between 2002 and 2007 were included in the study. These samples were stained with leptin antibody using an immunohistochemical method. Endometrial glandular and surface epithelium and stroma were evaluated for staining distribution and intensity. Conclusion: Staining intensity seen in early proliferative phase samples (2.33 +/- 0.51) increased significantly throughout the middle (2.40 +/- 0.54) and late phases (2.83 +/- 0.40) (p<0.05). Early secretory phase samples had the least staining intensity (1.42 +/- 0.53), while it increased significantly in later periods (2.38 +/- 0.51) (p<0.05). There was no difference in staining intensity among proliferative, secretory and hyperplastic tissues (p>0.05). Conclusion: Although endometrial leptin expression was observed in a differential manner throughout the whole menstrual period, no difference was seen in endometrial hyperplasia. We consider that leptin does not play a role in hyperplastic transformation of the endometrium.Öğe Long term outcomes of radical and conservative surgery for late diagnosed tubal pregnancies(Studio K, 2012) Ozler, Ali; Turgut, Abdulkadir; Evsen, Siddik Mehmet; Sak, Erdal Muhammet; Soydinc, Ender Hatice; Basaranoglu, Serdar; Celik, YusufObjective: To investigate long-term postoperative outcomes of conservative and radical surgery in ectopic tubal pregnancies, and evaluate the results of these techniques. Methods: A total of 145 patients that operated for tubal pregnancy between January 2006 and January 2009 were reviewed. Data on patient age, reproductive and surgical history history of ectopic pregnancies, serum hCG levels at the time of diagnosis and intraoperative observation were retrospectively obtained from hospital records. Telephone interviews were used to obtain information about exact postoperative time interval in which the patients were trying to get pregnant, and the time when they spontaneously became pregnant. Results: There was no significant difference in cumulative spontaneous intrauterine pregnancy rate for a 2-year of conception period subsequent to conservative (64.3%) and radical (58.3%) surgery (p=0.636). During the same time interval, the rates of development of ectopic pregnancy for the conservative and radical surgery groups were 17.9% and 4.2%, respectively (p= 0.093), The patients who developed ectopic pregnancy after conservative surgery had significantly higher levels of serum hCG levels (7413 +/- 3155 IU/L) compared with those of patients who not-developed ectopic pregnancy (3436 +/- 2668 IU/L) (p=0.007). Conclusion: In late-diagnosed cases with higher serum hCG levels, conservative treatment should not be the first choice. Indeed, our results suggested that the cumulative pregnancy rates are not significantly higher, and the risk of ectopic pregnancy recurrence may be increased with conservative surgery in late tubal pregnancies.Öğe Maternal plasma prolidase, matrix metalloproteinases 1 and 13, and oxidative stress levels in pregnancies complicated by preterm premature rupture of the membranes and chorioamnionitis(Galenos Publ House, 2012) Soydinc, Hatice Ender; Sak, Muhammet Erdal; Evliyaoglu, Osman; Evsen, Mehmet Siddi; Turgut, Abdulkadir; Ozler, Ali; Tay, HayrettinObjective: This study aimed to investigate the role of various biochemical markers in preterm premature rupture of membranes (PPROM) and in prediction of chorioamnionitis in patients with PPROM. Material and Methods: This case-control study included a total of 100 pregnant women at 26-34 gestational weeks. Of these women, 50 were healthy and 50 had PPROM. The biochemical markers in the maternal plasma including prolidase, matrix metalloproteinase (MMP) 1 and 13, total oxidative status (TOS), total antioxidant capacity (TAC), glutathione peroxidase (GPx), catalase (CAT), paraoxonase-1 (PON-1), tumor necrosis factor alpha (TNF-alpha), and high sensitive C-reactive protein (hsCRP) were assayed. These levels were compared between the PPROM and control groups and between women with or without chorioamnionitis in the PPROM group. Results: Compared to the control group, the levels of prolidase, MMP13, and TOS were significantly higher (p values < 0.001, 0.020, and 0.035, respectively) and those of TAC and PON-1 were significantly lower in the maternal plasma of the PPROM group (p values= 0.012 and < 0.001, respectively). The plasma prolidase and TOS levels were significantly higher (p values= 0.033 and 0.005, respectively) and the plasma TAC and PON-1 levels were significantly lower in women with chorioamnionitis as compared with the corresponding values in women without chorioamnionitis in the PPROM group (p values = 0.041 and 0.048, respectively). The multivariate logistic regression analysis observed that prolidase, TAC, and PON-1 were important markers for the presence of PPROM and prolidase and TOS were important markers for predicting chorioamnionitis. Conclusion: This study suggested that maternal plasma prolidase, TAC, and PON-1 may be useful for the diagnosis of PPROM, and prolidase and TOS may be used to predict chorioamnionitis in patients with PPROM.Öğe Misoprostol-induced termination of second-trimester pregnancy in women with a history of cesarean section: A retrospective analysis of 56 cases(Studio K, 2013) Turgut, Abdulkadir; Ozler, Ali; Goruk, Neval Yaman; Karacor, Talip; Yalinkaya, AhmetObjective: To assess the effectivity and safety of misoprostol induced termination of pregnancy in the second trimester in women with a history of previous caesarean section. Materials and Methods: Retrospective analysis of case records from the obstetrics and gynecology department of a tertiary care center between January 2009 and February 2012 was performed. Data derived from 219 women, who underwent a second trimester termination of pregnancy was analyzed in terms of demographics, clinical findings, laboratory and procedural data. The study group consisted of 56 women with a previous caesarean section and the control group was composed of 163 women without such a history Termination of pregnancies was conducted by administration of misoprostol at doses of 50-600 mcg intravaginally or by surgical evacuation in cases of failure of medical measures. Results: There was no statistically significant difference between two groups in terms of demographics such as age, menarche, number of pregnancies or live births, smoking habit and co-morbidities. Necessity for blood transfusion (p=0.05) and additional procedure for abortion (p=0.056) were found to be similar in both groups. However, laparotomy (p=0.004), uterine rupture (p=0.016), hysterotomy (p<0.001) were performed more frequently in the study group; while abortion was more likely to occur within 24 hours in the control group (p=0.031). Conclusion: Medical abortion must be carefully used for the termination of second trimester pregnancies in women with a history of CS. Increased possibility of uterine rupture and requirement of interventions such as laparotomy or hysterotomy is more likely in these patients.Öğe New inflammatory markers in pre-eclampsia: echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio(Taylor & Francis Inc, 2014) Oylumlu, Mustafa; Ozler, Ali; Yildiz, Abdulkadir; Oylumlu, Muhammed; Acet, Halit; Polat, Nihat; Soydinc, Hatice EnderBackground: Increased epicardial fat thickness (EFT) has been proposed as a new cardiometabolic risk factor. The neutrophil/lymphocyte ratio (NLR) has predictive and prognostic value in several cardiovascular diseases. The aim of this study was to explore the association between EFT and NLR in patients with pre-eclampsia. Methods: Hundred and eight pregnant patients with a mean age of 30.6 +/- 6.3 years were included in the study. Patients were divided into two groups based on the presence of pre-eclampsia. All participants underwent transthoracic echocardiography imaging, and complete blood counts were measured by an automated hematology analyzer. Statistical analysis was performed using the Chi-square, Mann-Whitney U, correlation and logistic regression tests, and receiver operating characteristic (ROC) analysis. Result: The mean EFT value of the pre-eclampsia group was significantly higher than the control group (6.9 +/- 0.6 versus 5.6 +/- 0.6; p < 0.001), and the NLR value of the pre-eclampsia group was also significantly higher than the control group (7.3 +/- 3.5 versus 3.1 +/- 1.1; p < 0.001). Multivariate analysis showed that increased levels of NLR and echocardiographic EFT are independent predictors of pre-eclampsia. In the receiver operating characteristic analysis, a level of EFT >= 6.2 mm and NLR >= 4.1 predicted the presence of pre-eclampsia with 77.8% sensitivity, 79.6% specificity and 83.3% sensitivity, 81.5% specificity, respectively. Conclusion: Unlike many other inflammatory markers and bioassays, NLR and echocardiographic EFT are inexpensive and readily available biomarkers that may be useful for risk stratification in patients with pre-eclampsia.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 Potential role of increasing number of sections in frozen section diagnosis of ovarian tumors(Old City Publishing Inc, 2016) Ayhan, Ali; Ozler, Ali; Dursun, Polat; Haberal, A. NihanObjective: To assess the accuracy of intraoperative frozen section of ovarian tumours at our institution and to identify the possible reasons for misdiagnosis. Study Design: Between January 2002 and August 2013, a total of 684 patients were included in the study. Frozen section diagnosis was compared with the final paraffin section diagnosis as the gold standard. The sensitivity, specificity, and positive and negative predictive values of frozen-section diagnosis were calculated for benign, borderline and malignant tumours. Clinicopathological parameters influenced by misdiagnosis were evaluated performing multivariate logistic regression analysis. Results: The overall accuracy was detected as 96.1%. Frozen-section diagnoses of 26 patients (3.8%) showed discordance. The specificity (99.7%) and PPV (99.4%) of frozen-section diagnosis was highest in the malignant category. In BOTs, diagnostic agreement was observed in 57 of 70 (81.4%) cases. The PPV (81.4%) was lowest for these patients. Tumour diameter of >= 10 cm (OR [95% CI]= 3.0 [1.1 to 8.2]; P=0.030) and mucinous histology (OR [95% CI]. 2.5 [1.0 to 6.2]; P=0.042) were significant predictors of misdiagnosis. With the increase in the number of sections, the accuracy rate of frozen section diagnosis was decreased. While not statistically significant (p=0.361). Conclusion: The number of sections is increased parallel to increase in tumor diameters. On the contrary, the diagnostic accuracy was no significantly increased with an increase in the number of sections. This discrepancy may be associated with falling tumor size per frozen section. A prospective study based on a certain tumour diameter per frozen section may better demonstrate the positive effect of the number of sections.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 Prolidase, Matrix Metalloproteinases 1 and 13 Activity, Oxidative-Antioxidative Status as a Marker of Preterm Premature Rupture of Membranes and Chorioamnionitis in Maternal Vaginal Washing Fluids(Ivyspring Int Publ, 2013) Soydinc, Hatice Ender; Sak, Muhammet Erdal; Evliyaoglu, Osman; Evsen, Mehmet Siddik; Turgut, Abdulkadir; Ozler, Ali; Yildiz, IsmailObjective: Etiology of premature preterm rupture of membranes (PPROM) is not yet completely known and chorioamnionitis is one of the most important complications of its. We aimed to evaluate whether prolidase, matrix metalloproteinases, oxidative-antioxidative status, and inflammation markers in vaginal washing fluid (VWF) were associated with etiology of PPROM and whether these markers could be used to predict chorioamnionitis in PPROM. Study Design: This prospective case control study enrolled fifty pregnant women with PPROM and 50 healthy pregnant women. The VWF samples were taken at the time of admission in the PPROM group and patients were followed for chorioamnionitis. Prolidase, matrix metalloproteinases, oxidative-antioxidative status, and inflammation markers in VWF were assayed. Results: VWF levels of prolidase, matrix metalloproteinases 1-13 (p<0.001), oxidative stress parameters, total oxidative stress (TOS) (p < 0.001) and oxidative stress index (OSI) (p = 0.002), and hs-CRP (p = 0.045) were significantly higher in the PPROM group than in the controls. Antioxidative status parameters, levels of paroxanase (PON-1) (p < 0.001) and total antioxidant capacity (TAC) (p < 0.001), were significantly lower in the PPROM group than in the controls. Mean VWF levels of prolidase (p < 0.001), metalloproteinases (p<0.05), and oxidative-antioxidative status parameters (p<0.05) were significantly different in women with versus women without chorioamnionitis in the PPROM group. Prolidase, MMP-13, TOS, TAC, and PON-1 were found as important predictors for chorioamnionitis in the PPROM group by the multivariate logistic regression analysis. When the ROC curve analysis for prolidase, MMP-13, TOS, TAC, and PON-1 were performed, all of them were statistically significant for area under the curve (areas under the curve were 0.94, 0.90, 0.80, 0.25, and 0.19, respectively). Conclusions: This study showed that collagen turnover mediators, especially prolidase, and increased oxidative stress are significantly associated with PPROM. Also, chorioamnionitis can be predicted with prolidase, MMP-13, TOS, TAC, and PON-1 in PPROM patients.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.
