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Öğe A comparison of treatment modalities in 69 patients with endometriosis and/or endometrioma and review of the literature(OrtadogŸu Reklam Tanitim Yayincilik Turizm Egitim Insaat Sanayi ve Ticaret A.S., 2015) Ağaçayak Elif; Akdeniz N.; Sak S.; Palanci Y.Objective: Treatment of endometriosis and/or endometrioma are much disscussed subject nowadays. In this study, our aim; was to compare treatment methods laparoscopy, laparotomy and combined treatment (surgery+medical) applied at our clinic of endometriosis and/or endometrioma with current literature knowledge, following postoperative pregnancy, pain, recurrence and CA-125 level. Material and Methods: A total of 69 patients who had endometriosis and/or endometrioma was observed intraoperatively and patients who had been referred with a diagnosis of chronic pelvic pain, infertility or endometrioma to Dicle University Faculty of Medicine, Obstetrics and Gynecology Department between June 2006 and June 2008 were included in the study. Data were obtained retrospectively scanning hospital records. Treatment to patients in our clinic were recorded. Pre-treatment and post-treatment pain history, levels of CA-125, CA15-3, CA19-9, history of infertility and ultrasonographics findings were recorded. Post-treatment outcomes relevant to pregnancy were determined. Among those who had become pregnant after treatment, the rates of spontaneous pregnancies, pregnancies due to ovulation induction and those due to IVF (in vitro fertilization) were determined. Results: Among 69 patients presenting to our outpatient clinic with complaints of chronic pelvic pain, infertility and endometrioma who were diagnosed with endometriosis and/or endometrioma intraoperatively, 40 underwent laparoscopy, 16 underwent laparotomy and 13 received combined treatment. In terms of age group, patients who had undergone laparotomy were significantly older (p=0.002). The study showed that pregnancy rates among the three patient groups after treatment and follow-up were not significantly different. Pregnancy rates of spontaneous, due to ovulation induction, in vitro fertilization when evaluated separetely were significantly higher pregnancy rates of spontaneous in laparoscopic group (p=0.036). Among the tumor markers, CA-125 had significantly decreased after treatment in all three groups (p<0.05), but CA-125 was observed more significant decreased laparoscopy group (p<0.001). Conclusion: In this study, among the three methods applied at our clinic, laparoscopy stands out due to higher spontaneous conceival rates and lower post-treatment CA-125 levels. Therefore we can say that a particular method should be chosen as a priority by the surgeon of laparoscopy in infertile patients. Copyright © 2015 by Türkiye Klinikleri.Öğe Diploid karyotype partial mole coexisting with live term fetus-Case report and review of the world literature(Via Medica, 2012) Sak M.E.; Soydinc H.E.; Evsen M.S.; Sak S.; Firat U.A partial molar pregnancy of diploid karyotype coexisting with live term fetus is a rare entity. Most instances of partial mole are triploid and only a few cases of diploid partial moles with term delivery have been reported. Here, we report a case of partial mole concomitant with a 37-week live fetus. Postpartum karyotype of the placenta and the fetus revealed both as 46XX. Histological examination of the placenta showed a partial hydatidiform mole. We discuss the diagnosis based on presenting clinical picture and proper management of signs and symptoms of partial molar pregnancy coexisting with live term fetus and diploid karyotype, coupled with a review of the literature. © Polskie Towarzystwo Ginekologiczne.Öğe The immunohistochemical and ultrastructural evaluation of pericytes in human full term placentas of gestasyonal diabetes mellitus(Acta Medica Mediterranea, 2013) Deveci E.; Söker S.; Turgut A.; Aktaş A.; Ayaz E.; Sak S.; Şeker U.Pericytes, vessel wall plays a stabilizing role in the regulation of blood flow in the microcirculation. The purpose of this study is based on non-diabetic pregnancies complicated by gestational diabetes pregnancies to investigate the morphological structure of pericyte cells. In this study, as a control group human placental tissues from normotensive pregnancies was collected from diabetic wome at 28-35 weeks of gestation. Pericytes with smooth alpha-actin positive cells, endothelial cells, and painted like a belt was surrounded. Pericytes, capillary plexus and endothelial cells of large vessels in the mesenchyme around the middle shows desmin positive reaction. Placental microvessels examined by transmission electron microscopy showed many pericytes. Placentas of gestational diabetes group, heterochromatin nucleus hypertrophy, dilatation of endoplasmic reticulum, mitochondria cristae in length, shortening was observed thickening of the filamentary structure. The contractile function of the barrier formed by endothelial cells, pericytes and can increase the contractions were considered.Öğe Internal iliac artery ligation for severe postpartum hemorrhage(Via Medica, 2012) Evsen Mehmet S.; Sak M.E.; Soydinc H.E.; Basaranoglu S.; Bakir C.; Sak S.; Gul T.Objective: To evaluate the outcomes of bilateral internal iliac artery ligation (IIAL) in severe postpartum hemorrhage (PPH). Design: Multi-center, retrospective study. Methods: The study was performed from January 2005 to December 2010, at the Obstetrics and Gynecology Clinic, Dicle University Medical Faculty and Maternity Hospital, Diyarbakir, Turkey. Life-threatening cases of severe postpartum hemorrhage, which could not be controlled with conservative medical and surgical treatments and finally managed with IIAL, were retrospectively evaluated. Results: Totally 53 patients who underwent IIAL procedures were included in the study. All patients were hemodynamically unstable. The mean shock index and transfused units of blood were 1.17±0.46, 5.49±3.04, respectively. Uterine atony was the leading cause of severe postpartum hemorrhage and the need for IIAL. Coagulopathy developed in 26 (49.1%) patients during the postoperative follow-up period. Uterus was preserved in 17 (32.0%) cases. Three patients died of complications and/or morbidity associated with hemorrhage. Conclusion: Serious PPH is most frequently associated with uterine atony and IIAL should be considered in cases with severe PPH unresponsive to other treatment modalities. If, in the antenatal period, patients have risk factors of postpartum hemorrhage, they must be transferred to appropriate centers to prevent a possibly fatal outcome. © Polskie Towarzys two Ginekologiczne.Öğe Translocated intrauterine contraceptive device: Experiences of two medical centers with risk factors and the need for surgical treatment(2013) Ender Soydinc H.; Siddik Evsen M.; Çaça F.; Erdal Sak M.; Zeki Taner M.; Sak S.OBJECTIVE: To present experiences of 21 patients with a translocated intrauterine contraceptive device (IUD) who required surgical treatment and to discuss the diagnosis, surgical management, and complications of such cases. STUDY DESIGN: The cases of 21 patients who were hospitalized with the diagnosis of translocated IUD and had surgical treatment were analyzed retrospectively. RESULTS: The mean age of the patients was 25.7 (range, 20-35). Of the 21 patients, 17 (81%) were in puerperium. IUDs were inserted by trained midwife nurses in 17 cases (81%). Severe lower abdominal pain was reported by 16 patients (76%) during the insertion procedure. At the time of diagnosis, 13 patients (62%) presented with lower abdominal pain. Surgical treatments included laparoscopic surgery (67%), laparotomy, colpotomy, and hysteroscopy. All of the removed IUDs were TCu-380A models. The most frequent complication due to translocation of the IUD was pelvic abscess (38%). CONCLUSION: The incidence of IUD translocations was significantly high in the puerperal period and for insertions performed by educated midwife nurses. Uterine perforation must be taken into consideration when there are complaints of unusually severe abdominal pain during the insertion procedure. Surgical treatment is necessary because of the potential complications of extracavitary IUDs. © Journal of Reproductive Medicine®, Inc.
