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Akkurt M.O.,Suleyman Demirel University of Turkey | Yalcn S.E.,Suleyman Demirel University of Turkey | Akkurt I.,Isparta Maternity And Childrens Hospital | Tatar B.,Suleyman Demirel University of Turkey | And 4 more authors.
Journal of the Turkish German Gynecology Association | Year: 2015

Objective: The aim of our study is to assess the risk factors for medical treatment failure and to predict the patients who will require the surgical therapy as well as to predict the factors affecting treatment success. Material and Methods: This was a cross-sectional study including 76 women with tubo-ovarian abscesses (TOA) who were either conservatively or surgically treated and were admitted to two gynecology units over a 4-year period. The demographic characteristics of the patients, gynecologic and obstetric histories, size and localization of abscesses were recorded. Gentamicin plus clindamycin treatment protocol was implemented for all patients. Ampicillin treatment was added in three patients with the positive culture of Actinomyces. Response to treatment was evaluated after 48–72 h. Patients who fail to respond to medical treatment required surgery or percutaneous drainage. We compared clinical and laboratory factors between the groups. Results: In surgery group, patients were significantly older than the others (44.9±5.4 versus 39.1±7.6 years). Fifty-six patients (74%) responded to antibiotics and 20 of the patients required surgical intervention. Patients treated with antibiotics were hospitalized for an average of 6.32±2.8 days versus 12.75±5.6 days for those who required surgery (p=0.021). Patients who were surgically treated had a mean size of TOA of 67.9±11.2 mm versus 53.6±9.4 mm for those treated with antibiotics alone (p=0.036). There were no significant differences between groups in laboratory parameters, except for initial white blood cell (WBC) counts. The complications of surgery included in descending order of frequency blood transfusions, surgical wound infections, bowel injury, and bladder injury. Conclusion: An increased size of pelvic mass, higher initial WBC counts, advanced age, and smoking were all associated with failed response to conservative treatment. It is important to identify the risk factors to distinguish patients who will respond to antibiotic therapy and those who will need a surgical treatment. Thus, the required early intervention can result in a reduction in the morbidity associated with TOA. © 2015 by the Turkish-German Gynecological Education and Research Foundation.


PubMed | Isparta Maternity and Childrens Hospital, Etlik Zubeyde Hanim Womens Health Research Hospital and Suleyman Demirel University of Turkey
Type: Journal Article | Journal: Journal of the Turkish German Gynecological Association | Year: 2015

The aim of our study is to assess the risk factors for medical treatment failure and to predict the patients who will require the surgical therapy as well as to predict the factors affecting treatment success.This was a cross-sectional study including 76 women with tubo-ovarian abscesses (TOA) who were either conservatively or surgically treated and were admitted to two gynecology units over a 4-year period. The demographic characteristics of the patients, gynecologic and obstetric histories, size and localization of abscesses were recorded. Gentamicin plus clindamycin treatment protocol was implemented for all patients. Ampicillin treatment was added in three patients with the positive culture of Actinomyces. Response to treatment was evaluated after 48-72 h. Patients who fail to respond to medical treatment required surgery or percutaneous drainage. We compared clinical and laboratory factors between the groups.In surgery group, patients were significantly older than the others (44.95.4 versus 39.17.6 years). Fifty-six patients (74%) responded to antibiotics and 20 of the patients required surgical intervention. Patients treated with antibiotics were hospitalized for an average of 6.322.8 days versus 12.755.6 days for those who required surgery (p=0.021). Patients who were surgically treated had a mean size of TOA of 67.911.2 mm versus 53.69.4 mm for those treated with antibiotics alone (p=0.036). There were no significant differences between groups in laboratory parameters, except for initial white blood cell (WBC) counts. The complications of surgery included in descending order of frequency blood transfusions, surgical wound infections, bowel injury, and bladder injury.An increased size of pelvic mass, higher initial WBC counts, advanced age, and smoking were all associated with failed response to conservative treatment. It is important to identify the risk factors to distinguish patients who will respond to antibiotic therapy and those who will need a surgical treatment. Thus, the required early intervention can result in a reduction in the morbidity associated with TOA.


Caglar G.S.,Ufuk University | Tasci Y.,Etlik Zubeyde Hanim Womens Health Research Hospital | Goktolga U.,Etlik Zubeyde Hanim Womens Health Research Hospital | Oztas E.,Ufuk University | And 3 more authors.
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2013

Objective: To evaluate umbilical cord blood ischemia-modified albumin (IMA) levels in cases of fetal distress (FD) and to explore fetal blood IMA levels regarding the route of delivery. Methods: Umbilical cord and maternal serum IMA concentrations were assessed in term 40 cases with cesarean section (CS) due to FD, 76 cases with elective repeat CS and 85 cases with noncomplicated vaginal delivery. Results: The maternal and umbilical cord IMA levels were significantly lower in vaginal deliveries when compared with CS cases either in FD or previous CS groups (p = 0.02). Although no statistically significant difference was found in IMA levels of CS groups (previous CS vs. FD), cord blood IMA levels tend to be higher in FD group. Neither demographic characteristics nor fetal outcome parameters were found to have any correlation with maternal IMA levels. However, umbilical cord IMA levels were found to be negatively correlated with 1th min Apgar scores (r = -0.143, p = 0.043). Conclusions: IMA seems to be responsive to hypoxic FD showing the highest levels in cases with severe fetal hypoxia. Higher levels of IMA in cases with elective repeat CS might indicate acute transient hypoxia and possible myocardial ischemia in these cases. © 2013 Informa UK, Ltd.


Tasci Y.,Etlik Zubeyde Hanim Womens Health Research Hospital | Karasu Y.,Etlik Zubeyde Hanim Womens Health Research Hospital | Erten O.,Etlik Zubeyde Hanim Womens Health Research Hospital | Karadag B.,Etlik Zubeyde Hanim Womens Health Research Hospital | Goktolga U.,Etlik Zubeyde Hanim Womens Health Research Hospital
Journal of the Turkish German Gynecology Association | Year: 2012

Dichorionic twin pregnancy discordant for fetal anencephaly is a serious condition that threatens the normal co-twin's life by causing polyhydramniosis, preterm labor and sudden death of one or both of the fetuses. We report a case of dichorionic twin pregnancy discordant for fetal anencephaly delivered at the 32 nd week of gestation because of preterm labor and nonreassuring fetal monitoring. The aim of this case report is to summarize management options in this situation. © 2012 by the Turkish-German Gynecological Education and Research Foundation.


Dede H.,Etlik Zubeyde Hanim Womens Health Research Hospital | Kandemir O.,Etlik Zubeyde Hanim Womens Health Research Hospital | Yalvac S.,Etlik Zubeyde Hanim Womens Health Research Hospital | Karcaaltincaba D.,Etlik Zubeyde Hanim Womens Health Research Hospital | Kiykac S.,Etlik Zubeyde Hanim Womens Health Research Hospital
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2010

We report three maternal deaths which might be in possible association with the use of intravaginal dinoprostone for cervical ripening and induction of labor. All cases occurred at our institution between January 2006 and December 2007. Uterine atony and profuse bleeding followed by disseminated intravascular coagulation (DIC), characterized by severe hypofibrinogenemia developed shortly after delivery of the first two patients. The third patient developed respiratory symptoms in the active labor followed by hemodynamic changes manifested by tetanic uterine contractions and fetal heart rate decelerations. Cardiac arrest developed in all patients shortly after the occurrence of symptoms with no response to any medical intervention. The pharmacologic induction of labor with dinoprostone may be in association with increased risk of maternal death because of increased risk of postpartum DIC and amnionic fluid embolism. Further investigations seem to be needed. © 2010 Informa UK Ltd.


Muberra K.,Etlik Zubeyde Hanim Womens Health Research Hospital | Yasemin T.,Etlik Zubeyde Hanim Womens Health Research Hospital | Nurettin B.,Etlik Zubeyde Hanim Womens Health Research Hospital | Zuhal I.,Etlik Zubeyde Hanim Womens Health Research Hospital | Berna D.,Etlik Zubeyde Hanim Womens Health Research Hospital
Journal of Obstetrics and Gynaecology Research | Year: 2010

We report a case of bilateral and primary tubal carcinoma associated with granulomatous inflammation and long-standing primary infertility. A 38-year-old woman with a 17-year history of primary infertility presented with lower abdominal pain and granulomatous inflammation in the endometrial biopsy. Bilateral adnexal masses measuring 4 and 6 cm in size were detected and the serum cancer antigen 125 level was 141 IU/ml. Laparoscopic surgical exploration and frozen section on the resected tubes revealed bilateral fallopian tube adenocarcinoma and then a staging laparotomy was performed. Histopathological examination showed a primary bilateral Grade 2 tubal serous adenocarcinoma of Stage 1b associated with granulomatous salpingitis. Primary fallopian tube carcinomas in young women are extremely rare gynecological tumors that are infrequently diagnosed prior to surgical exploration and their cause is unknown. A definitive diagnosis could be made on the histopathological examination in our case with the evidence of chronic pelvic inflammation. Our findings suggest that chronic pelvic inflammation may play a role in carcinogenesis in the tubes of infertile women. © 2010 Japan Society of Obstetrics and Gynecology.


Tasci Y.,Etlik Zubeyde Hanim Womens Health Research Hospital | Polat O.G.,Etlik Zubeyde Hanim Womens Health Research Hospital | Ozdogan S.,Etlik Zubeyde Hanim Womens Health Research Hospital | Karcaaltincaba D.,Etlik Zubeyde Hanim Womens Health Research Hospital | And 2 more authors.
Archives of Gynecology and Obstetrics | Year: 2014

Purpose: To evaluate the treatment of simple endometrial hyperplasia without atypia with different gestagens. Methods: Sixty premenopausal women with histologically documented endometrial hyperplasia without atypia were included in this prospective controlled study. Patients were randomized into two groups: Group I included 30 patients who received lynestrenol (LYN) in a dose of 15 mg/d, while Group II included 30 patients who received micronized progesterone (MP) 200 mg/d for 12 days per cycle for 3 months. Patients were reevaluated with endometrial curettage after treatment. MP and LYN regimens were compared to regression, resolution or persistence rates and metabolic parameters. Results: After 3 months of treatment in both groups, none of the cases progressed. In LYN group, the rate of resolution was observed to be higher compared to MP group (p = 0.045). LYN was found more effective inducing resolution in patients more than 45 years compared to MP (p = 0.036). When we compare both groups after 3 months of treatment, there was no statistically significant difference in BMI, total cholesterol, HDL, LDL and fibrinogen level between two groups. The rate of patients without any side effects was found to be similar in both groups (p = 0.5). Conclusion: LYN which is a synthetic progestin ensures better endometrial control compared to MP in simple hyperplasia without atypia in the patients of premenopausal age especially in ages more than 45 years. © 2014 Springer-Verlag.


PubMed | Etlik Zubeyde Hanim Womens Health Research Hospital
Type: Case Reports | Journal: The journal of obstetrics and gynaecology research | Year: 2010

We report a case of bilateral and primary tubal carcinoma associated with granulomatous inflammation and long-standing primary infertility. A 38-year-old woman with a 17-year history of primary infertility presented with lower abdominal pain and granulomatous inflammation in the endometrial biopsy. Bilateral adnexal masses measuring 4 and 6 cm in size were detected and the serum cancer antigen 125 level was 141 IU/ml. Laparoscopic surgical exploration and frozen section on the resected tubes revealed bilateral fallopian tube adenocarcinoma and then a staging laparotomy was performed. Histopathological examination showed a primary bilateral Grade 2 tubal serous adenocarcinoma of Stage 1b associated with granulomatous salpingitis. Primary fallopian tube carcinomas in young women are extremely rare gynecological tumors that are infrequently diagnosed prior to surgical exploration and their cause is unknown. A definitive diagnosis could be made on the histopathological examination in our case with the evidence of chronic pelvic inflammation. Our findings suggest that chronic pelvic inflammation may play a role in carcinogenesis in the tubes of infertile women.


Kinay T.,Etlik Zubeyde Hanim Womens Health Research Hospital | Tasci Y.,Etlik Zubeyde Hanim Womens Health Research Hospital | Dilbaz S.,Etlik Zubeyde Hanim Womens Health Research Hospital | Cinar O.,Etlik Zubeyde Hanim Womens Health Research Hospital | And 2 more authors.
Gynecological Endocrinology | Year: 2010

Objective.To investigate the effects of endometrial thickness measurements and serum hormone levels on the outcomes of GnRH antagonist down-regulated ICSI cycles. Study design.Forty consecutive infertile women undergoing controlled ovarian hyperstimulation with recombinant FSH and GnRH antagonists for ICSI were enrolled in this study. All patient's age, day 3 FSH, antral follicle count (AFC), serum E2 levels on day 3, E2 on stimulation day 5, E2 on day of hCG administration, endometrial thickness on the baseline (ETMBaseline), on day 5 of stimulation (ETMDay 5), on day of hCG administration (ETMhCG) and cycle outcomes were recorded. The outcomes of pregnant and nonpregnant women were compared. Results.Women's age was 33.6±4.9. Overall pregnancy rate was 45 (n=18), clinical pregnancy rate was 27.5 (n=11) and ongoing pregnancy rate was 20 (n=8). In pregnant women, baseline AFC was significantly higher compared with nonpregnant women (p=0.01). There was no significant correlation between ETMhCG and E2 level on the day of hCG, number of retrieved oocytes or patients' age. Conclusion.For achieving pregnancy, endometrial thickness on the day of hCG is not a determining parameter, and the only significant determinent is AFC in GnRH antagonist down-regulated ICSI cycles. © 2010 Informa UK, Ltd.


PubMed | Etlik Zubeyde Hanim Womens Health Research Hospital
Type: Case Reports | Journal: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians | Year: 2010

We report three maternal deaths which might be in possible association with the use of intravaginal dinoprostone for cervical ripening and induction of labor. All cases occurred at our institution between January 2006 and December 2007. Uterine atony and profuse bleeding followed by disseminated intravascular coagulation (DIC), characterized by severe hypofibrinogenemia developed shortly after delivery of the first two patients. The third patient developed respiratory symptoms in the active labor followed by hemodynamic changes manifested by tetanic uterine contractions and fetal heart rate decelerations. Cardiac arrest developed in all patients shortly after the occurrence of symptoms with no response to any medical intervention. The pharmacologic induction of labor with dinoprostone may be in association with increased risk of maternal death because of increased risk of postpartum DIC and amnionic fluid embolism. Further investigations seem to be needed.

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