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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 BLOOD PRESSURE DIURNAL RHYTHM IS RELATED WITH HEMATOLOGICAL INDICES IN GESTATIONAL DIABETES MELLITUS PATIENTS(Carbone Editore, 2013) Soydinc, Serdar; Oylumlu, Mustafa; Yuksel, Murat; Turgut, Abdulkadir; Soydinc, Hatice EnderObjective: Gestational diabetes mellitus (GDM) is related with cardiovascular risk factors. Non-dipping blood pressure pattern and high mean platelet volume, which is an indicator of increased platelet activation, are associated with cardiovascular morbidity and inortality. The aim of our study is to determine circadian variation of blood pressure and to study the impact of hematological indices on blood pressure dipping and non-dipping patterns in patient with GDM. Material and methods: A total of 42 patients who were diagnosed with GDM and 33 patients with healthy pregnancies were included into the study. Patients' blood pressures were monitored and were grouped due to their blood pressure circadian pattern. If the blood pressure while sleeping decreased more than 10% from the blood pressure while awake, the patient was classified as a dipper. If the decrease was less than 10%. the patient was classified as a non-dipper. Biochemical and hematological parameters were measured and clinical features were recorded for all study groups. Results: Ambulatory blood pressures monitoring of two groups revealed that average systolic and diastolic blood pressures as well as the day-phase diastolic and night-phase systolic and diastolic blood pressures of GDM patients were significantly increased than those of the control group. Besides, control patients had a more significant decrease in night-phase systolic and diastolic blood pressures than GDM patients (p<0.001). There was no significant difference between hematological indices and dipping status, except for mean platelet volume (MPV). MPV in non-dippers was significantly higher than dippers one (p<0.001). Step-wise multivariate linear regression demonstrated that MPV and GDM can be used as independent predictors of non-dipping status. Conclusion: According to our results the circadian variation of blood pressure is impaired and MPV is increased in GDM patients. Increasing in MPV is associated with non-dipping status of blood pressure. It is possible that non-dipping status and increased MPV levels may be additional risk factors for increased cardiovascular disease events in gestational diabetes patients.Öğe Cesarean Scar Pregnancy Mimicking Malignant Tumor A Case Report(Sci Printers & Publ Inc, 2011) Soydinc, Hatice Ender; Evsen, Mehmet Siddik; Sak, Muhammet Erdal; Gul, TalipBACKGROUND: Ectopic pregnancy in cesarean scar is rare, however it is occurring with increasing frequency. These ectopic pregnancies can cause serious complications such as severe bleeding, uterine rupture, disseminated intravascular coagulation and maternal death. We present a case of cesarean scar pregnancy diagnosed during laparotomy with frozen section. CASE: A 26-year-old woman, gravida 3, para 3, was admitted to our gynecology clinic because of a 6-week history of irregular vaginal bleeding and anemia. A solid mass originating from the cervix was detected on ultrasound examination. Doppler ultrasound revealed an increase in blood supply. The case was managed by laparotomy. The solid mass was removed and the uterus preserved. CONCLUSION: Although ultrasound is useful in the detection of a typical scar pregnancy, ultrasound images can lead to a misdiagnosis, such as sarcoma or myoma, in some cases. Cesarean scar pregnancy should be considered in the differential diagnosis when an extremely vascularized and exophytic mass located in the isthmic region is detected. (J Reprod Med 2011;56:518-520)Öğe Circadian Variation of Blood Pressure Is Impaired in Normotensive Pregnant Women with Gestational Diabetes Mellitus(Taylor & Francis Inc, 2013) Soydinc, Hatice Ender; Davutoglu, Vedat; Sak, Muhammet Erdal; Ercan, Suleyman; Evsen, Mehmet Siddik; Kaya, Hasan; Oylumlu, MuhammedData about circadian blood pressure (BP) in normotensive patients with gestational diabetes mellitus (GDM) are lacking. Thus, we sought to compare dipper and nondipper circadian variation of BP profile between normotensive women complicated with GDM and normal pregnant women. Forty-two women with GDM and 33 normal uncomplicated pregnant women who met the entry criteria for the study were enrolled in the study. Twenty-four-hour noninvasive ambulatory blood pressure monitoring and echocardiography to measure the left ventricle mass index and diastolic parameters were performed. Nocturnal blood pressure dipping was calculated as follows: (awake BP - sleep BP) x 100/awake BP. Patients with a nocturnal reduction in average daytime systolic BP and diastolic BP of less than 10% were classified as nondippers. Left ventricle mass index was higher in normotensive pregnant women with GDM group than in normal pregnant subjects (101.98 +/- 24 g/m(2) vs. 90.67 +/- 15 g/m(2), P < .018). Significant nocturnal systolic and diastolic nondippings were observed in GDM groups compared with normal subjects. From diastolic variables, the mitral E velocity and isovolumetric relaxation time were compatible with diastolic dysfunction relaxation abnormalities (P = .003 and P = .015, respectively) in nondipper group. From all confounding factors, only E velocity (P = .002) and diagnosis of GDM (P < .001) were predictive of nondipper circadian variation. This study shows that (i) circadian BP is impaired in normotensive pregnant subjects with GDM, (ii) the left ventricle mass index is higher in pregnant subjects with GDM than in normal pregnant subjects who despite a 24-hour BP are within normal limits, and (iii) in nocturnal nondipper group, the tendency to having diastolic relaxation abnormalities is noted.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 Imperforate Hymen with Elevated Serum CA 125 and CA 19-9 Levels(Sci Printers & Publ Inc, 2013) Sak, Muhammet Erdal; Evsen, Mehmet Siddik; Soydinc, Hatice Ender; Sak, Sibel; Yalinkaya, AhmetOBJECTIVE: To report the clinical characteristics of 14 patients with imperforate hymen and their levels of tumor markers (CA 19-9 and CA 125). STUDY DESIGN: Fourteen patients with imperforate hymen who followed-up between September 2006 and September 2010 in the Department of Obstetrics and Gynecology, Dicle University School of Medicine, Diyarbakir, Turkey, were evaluated retrospectively. The clinical features and the management of the patients are discussed. RESULTS: The mean age of the patients was 13.8 years. All patients had primary amenorrhea and pelvic pain. The most common clinical symptoms were cryptomenorrhea in 14 patients, pelvic pain in 11, palpable abdominal mass in 6, voiding difficulties in 7, and defecation problems in 2. In 6 patients with palpable pelvic mass, the mean +/- standard deviation values of tumor markers were as follows: CA 125, 84.0 +/- 23.7 and CA 19-9, 162 +/- 189. One week after surgery we measured CA 125 and CA 19-9 levels once again. The postoperative mean CA 125 level was 13.8 +/- 3.6, and the mean postoperative CA 19-9 level was 17.5 +/- 3.5. Preoperative leziels of CA 125 and CA 19-9 were significantly higher than those of the postoperative period (p < 0.001 for both comparisons). Six patients were treated by T-shaped incision and 8 patients by a central surgical incision through the hymenal membrane. CONCLUSION: Diagnosis of imperforate hymen is very important before undergoing surgery in a different clinic. Many patients have seen several doctors before receiving a clear diagnosis and have had tumor markers evaluated because the presence of pelvic mass in patients suggests the possibility of a gynecologic malignancy. Imperforate hymen is one of the benign conditions that increase serum CA 125 and CA 19-9 levels and which is not listed in the classical medical textbooks. These markers are not needed for the diagnosis. (J Reprod Med 2013;58:47-50)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 Intrauterine blood transfusion in immune hydrops fetalis, corrects middle cerebral artery Doppler velocimetry very quickly(Assoc Basic Medical Sci Federation Bosnia & Herzegovina Sarajevo, 2012) Yalinkaya, Ahmet; Evsen, Mehmet Siddik; Celik, Yusuf; Sak, Muhammet Erdal; Soydinc, Hatice Ender; Taner, Mehmet ZekiThe aim of our study was to evaluate the middle cerebral artery velocimetry before and after intrauterine blood transfusion in immune hydrops fetalis. The current study was conducted in a tertiary research hospital, from February 2009 to January 2011. Nineteen intrauterine blood transfusions performed during the study period. The factors recorded were age of the mothers, gestational weeks, pre-transfusion fetal hematocrit and post-transfusion fetal hematocrit, and also middle cerebral artery peak systolic velocimetry (MCA-PSV) was detected and recorded before and after intrauterine transfusion. A control group of twenty two cases for normal MCA doppler velocimetry was also included to the study. During the study, a total of eleven rhesus isoimmunized pregnancies underwent intrauterine blood transfusions at our perinatal diagnose unit. Before transfusion seventeen severe and two moderate anemias were detected and mean MoM of MCA-PSV was 1.76 +/- 0.38 MoM. Post transfusion mean MoM of MCA-PSV in the patient group and control group were 1.08 +/- 0.22 MoM and 0.96 +/- 0.21 MoM, respectively. The mean MCA-PSV values were higher in RI fetuses than post transfusion and control group. In current study, we found that MCA-PSV is a valuable parameter in detecting fetal anemia requiring intrauterine transfusion and mean MCA-PSV values is higher than 1.5 MoM in fetuses with anemia. And also decrease in MCA-PSV just after transfusion in anemic fetuses showed the quick response of the fetus to correction of anemia. (C) 2012 Association of Basic Medical Sciences of FBIH. All rights reservedÖğe Massive Pulmonary Embolism with Mobile Right Atrial Thrombus in a Pregnant Patient Using Valproic Acid(Aves, 2012) Soydinc, Hatice Ender; Yuce, Murat; Sari, Emine; Yavuz, Sema; Sari, Ibrahim; Davutoglu, Vedat; Yigiter, RemziPulmonary embolism is a life threatening condition. Pregnancy is among the risk factors of pulmonary embolism. There is reluctance about using thrombolytics s during pregnancy due to potential teratogenic effects. Valproic acid is one of the most commonly used antiepileptic agents, hovewer, its use during pregnancy is controversial because of the teratogenic potential. Among adverse effects of valproic acid use, elevated liver enzymes, thrombocytopenia have been reported. Moreover, product literature warns that pregnant women using valproic acid should be monitored for low fibrinogen and platelets and the potential for bleeding. The present case report describes successful treatment of a massive pulmonary embolism with tissue plasminogen activator (t-PA), caused by a mobile right atrial thrombus in a 30-year-old first trimester pregnant women using valproic acid. This has not been reported previously. During follow-ups, she was free of any signs or symptoms and gave birth to a baby by spontaneous vaginal delivery. The baby was completely healthy without any problem or deformity.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 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 Partial Thrombus Resolution With Trofiban in a Pregnant Woman With Mechanical Prosthetic Mitral Valve Thrombosis(Sage Publications Inc, 2011) Akcay, Adnan Burak; Yuce, Murat; Akcay, Murat; Sen, Nihat; Soydinc, Hatice Ender; Davutoglu, VedatWe present a 15-week pregnant woman who developed mechanical mitral valve thrombosis on a fixed dose of enoxaparin therapy 60 mg twice daily. No reductions were observed in the thrombus size or mean mitral gradient on transesophageal echocardiography (TEE) with 1 week of unfractioned heparin therapy. As the thrombus on TEE imaging was hypermobile and fragile, in addition to a higher dose of enoxaparin (80 mg twice daily), trofiban infusion 0.20 mu g/kg per minute was administered for another 1 week. The thrombus on the valve was reduced in size, mobility and fragility of the thrombus diminished, and mean valve gradient decreased on TEE. As complete thrombus resolution was not observed and limitation of valve mobility continued, tissue plasminogen activator (tPA) was given to the patient. A complete thrombus resolution was observed on this therapy. The patient is presented for being the first case in literature whose valvular thrombus reduced with trofiban therapy.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 Pregnancy and H1N1 infection in Southeast Turkey(J Infection Developing Countries, 2012) Soydinc, Hatice Ender; Celen, Mustafa Kemal; Yildiz, Bahri; Sak, Muhammet Erdal; Evsen, Mehmet Siddik; Gul, TalipIntroduction: H1N1 Influenza made a great impact a worldwide, as well as in Turkey, in 2009. Clinical experiences have shown that it had a more serious prognosis in pregnant women. In this report, we summarize the cases of 16 pregnant women with H1N1 Influenza. Methodology: The study included 16 pregnant women hospitalized in Dicle University Hospital with complaints of fever, sore throat, cough and myalgia between October and December 2009. The diagnosis of pandemic H1N1 Influenza was confirmed on nasopharyngeal specimens using real-time reverse-transcriptase polymerase chain reaction (RT-PCR) in all patients. Patients who had the same complaints but were not diagnosed as H1N1 Influenza were excluded. The epidemiological, clinical, diagnostic, and outcome features of the patients were recorded. Results: The median age of the patients was 27 years (range 18-41 years). The mean gestational age was 25.4 weeks (range 5-38 weeks). Two cases were twin pregnancy. Two cases had co-morbid diseases including asthma and anemia. The most frequent admission symptoms were fever in 13 cases (81%), cough in 12 cases (75%) and dyspnea in 6 cases (37,5%). Antiviral treatment (oseltamivir 75 mg p.o. bid) was applied in 15 cases. Four cases needed intensive care monitoring and two of them died (12.5%) because of severe respiratory insufficiency. Conclusion: Patients with late gestational age, the presence of co-morbid disease, and multiple pregnancy have poor prognosis. Immediate intervention with antiviral treatment is associated with reduced severity of the disease and duration of hospital stay.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 The protective effect of curcumin on ischemia-reperfusion injury in rat ovary(Elsevier Science Bv, 2013) Sak, Muhammet Erdal; Soydinc, Hatice Ender; Sak, Sibel; Evsen, Mehmet Siddik; Alabalik, Ulas; Akdemir, Fatih; Gul, TalipBackground: To evaluate the protective effects of curcumin in experimental ischemia and ischemia/reperfusion (I/R) injury of rat ovaries. Methods: Forty-eight female adult Wistar Albino rats were used. Rats divided into six groups and designed: Sham, Torsion, Detorsion, Sham + Curcumin, Torsion + Curcumin, and Detorsion + Curcumin. Except for the Sham and Sham + Curcumin group, all groups were performed to bilateral adnexal torsion for 3 h. Bilateral adnexal detorsion was implemented in the Detorsion and Detorsion + Curcumin groups. The injection of curcumin was intraperitoneally achieved 30 min before the sham, torsion and detorsion. Results: Total oxidant status levels (TOS), oxidative stress index (OSI) and histologic scores values of ovarian tissue were higher in the torsion and detorsion groups than the sham group (p < 0.05). There was a strong correlation between the total histologic scores of I/R injury and the OSI (r = 0.809, p < 0.001). By the use of curcumin, a significant decrease was established in the mean levels of oxidant markers and histopathologic scores of the ovarian tissues. Conclusions: Administration of curcumin is effective in reversing tissue damage induced by ischemia-reperfusion injury in ovarian torsion. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.Öğe Pulmonary Balloon Valvuloplasty during Pregnancy(Hindawi Ltd, 2012) Oylumlu, Mustafa; Aykent, Kazim; Soydinc, Hatice Ender; Oylumlu, Muhammed; Ertas, Faruk; Ozer, Hasan Orhan; Sari, IbrahimWomen with valvular heart disease have an increased risk of adverse outcomes in pregnancy; however, with appropriate evaluation and treatment, most women can successfully bear healthy children. During pregnancy, pulmonary stenosis is generally well tolerated in the absence of other haemodynamically significant lesions. We present a case of amultiparous woman, who is pregnant with her sixth child, with a severe pulmonary stenosis. She presented with exertional chest pain and dyspnea. She was managed successfully with balloon valvuloplasty.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.Öğe Retrospective analysis of placenta accreta: management strategies - evaluation of 41 cases(Via Medica, 2012) Evsen, Mehmet Siddik; Sak, Muhamment Erdal; Soydinc, Hatice Ender; Caca, Fatma Nur; Obut, Mehmet; Gul, TalipObjective: The aim of the study was to evaluate maternal characteristics, surgical treatment options, and morbidity of patients with placenta accreta. Methods: We retrospectively reviewed the medical records of placenta accreta patients who were diagnosed and hospitalized between 2006 and 2010 at the Obstetrics and Gynecology Clinics of the Dicle University Hospital (Center A) and Maternity Hospital (Center B) in Diyarbakir, Turkey The data were retrieved from medical charts of both hospitals. Maternal demographic features, clinical outcomes, type of surgical intervention, and complications were evaluated. Results: The incidence of placenta accreta was 1/426 deliveries in Center A and 1/7573 deliveries in Center B over a 5-year period. Thirty-nine (95.1%) patients had placenta previa, and 32 (78.0%) patients had at least one previous cesarean delivery Hysterectomy was performed in 28 (68.3%) of 41 women with placenta accreta and uterine preservation was achieved in 13 (31.7%) of them. One (2.4%) maternal death occurred, Estimated blood loss was >2 liters and all patients required blood products transfusion. Conclusion: Placenta accreta is highly associated with the existence of placenta previa, especially in cases with previous cesarean delivery When placenta accreta is diagnosed or suspected, the patient should be referred to a tertiary center for optimum care, where the obstetrical team should include experienced pelvic surgeons who are capable of performing emergent hysterectomy internal iliac artery ligation, and uterine devascularization procedures.
