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PubMed | Kayseri Acbadem Hospital, Kayseri Education and Research Hospital of Medicine, Private Erciyes Hospital, Kayseri Military Hospital and Kayseri Memorial Hospital
Type: Journal Article | Journal: Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology | Year: 2016

Surgical abortion is one of the most frequently performed gynaecological procedures and its associated pain has always been a problem in gynaecology. Here we studied the analgesic efficacy of lidocaine spray and paracervical block (PCB) in patients undergoing first-trimester surgical abortion. A randomised double-blind placebo-controlled study was conducted on 108 women requesting pregnancy termination. The subjects were randomly assigned into four groups: Group 1 (PCB plus lidocaine spray) (n=27), Group 2 (PCB) (n=27), Group 3 (lidocaine spray) (n=27) and Group 4 (placebo) (n=27). Intra-procedural and post-procedural pain scores were measured with a standard visual analogue scale (VAS). The median VAS scores during procedure in placebo, lidocaine spray, PCB plus lidocaine spray and PCB groups were 8 (7-9), 5 (4-8), 4 (3-4) and 5 (3-5), respectively. The most effective method of pain relief during first-trimester abortion can be achieved through a combined use of PCB plus lidocaine spray. Therefore, lidocaine spray is a non-invasive complementary anaesthetic method versus traditional PCB for first-trimester surgical abortion.


PubMed | Kayseri Acbadem Hospital, Kayseri Education and Research Hospital of Medicine, Kayseri Military Hospital and Kayseri Memorial Hospital
Type: | Journal: SpringerPlus | Year: 2015

Hyperemesis gravidarum (HG) is a condition characterized by severe, intractable nausea and vomiting in early pregnancy. It affects about 0.3-2% of all pregnancies and is thought that HG is a multifactorial disease resulting from the combination of various unrelated conditions such as genetic, hormonal and psychiatric. Although there are studies investigating the relationship between anxiety, depression and HG; however, none have sufficiently clarified this link. The aim of this prospective case-control study was to investigate the possible relationship between depression and HG and compare the prevalence of depression disorders in pregnant women with and without HG. A prospective case-control study was performed at our tertiary referral centre between December 2013 and July 2014. The study group consisted of 78 pregnant women with HG and the control group consisted of 82 healthy pregnant women who never had experienced any nausea and vomiting. No study participants had any pre-pregnancy history of any psychiatric disorder including depression. Structured Clinical Interview for Diagnostic (SCID-I) and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) was used to evaluate symptoms of depression. Beck Depression Inventory (BDI) was administered to patients during the psychiatric interview and was evaluated by the same psychiatrist. The mean BDI scores in HG study and healthy control groups were 18.979.85 and 6.365.61, respectively (p<0.001). Among the 78 women in the HG study population, 42 (53.9%) of patients had moderate or severe depression disorder. Only 6.1% of patients in the control group had moderate or severe depression. In conclusion, the findings of this study indicated that psychological distress associated with HG was a direct consequence rather than a cause of HG. Therefore, patients with HG during pregnancy should be evaluated with respect to mood disorders as much as their medical conditions.


Acmaz G.,Kayseri Education and Research Hospital of Medicine | Aksoy H.,Kayseri Military Hospital | Ozoglu N.,Kayseri Education and Research Hospital of Medicine | Aksoy U.,Kayseri Education and Research Hospital of Medicine | Albayrak E.,Erciyes University
BioMed Research International | Year: 2013

The aim of the study was to investigate the analgesic efficacy of preoperative oral dexketoprofen trometamol, intravenous paracetamol, lidocaine spray, and paracervical block with ultracaine on curettage procedure. A total of 111 subjects with the request of pregnancy termination between 5 and 7 weeks of gestation were included in the study. The first group (control group) consisted of 20 participants without medication. The second group consisted of 25 participants receiving 2 puffs of lidocaine sprays on cervical mucosa. The third group consisted of 20 participants receiving oral 25 mg dexketoprofen trometamol. The fourth group consisted of 23 participants receiving 1000 mg intravenous paracetamol and the fifth group consisted of 23 participants receiving paracervical block with ultracaine. Paracervical block reduced pain score significantly in both intraoperative and postoperative periods. All analgesic procedures were significantly effective for reducing pain in postoperative period. Paracervical block may be the best method for reducing pain scores in intraoperative and postoperative periods during curettage procedure. All analgesic procedures such as lidocaine, paracetamol, ultracaine, and paracervical block with ultracaine can be used for reducing pain score in postoperative period. © 2013 Gökhan Açmaz et al.


Ozyurt S.,Kayseri Education and Research Hospital of Medicine | Aksoy H.,Kayseri Military Hospital | Gedikbasi A.,Istanbul Kanuni Sultan Suleyman Education and Research Hospital of Medicine | Yildirim G.,Istanbul Kanuni Sultan Suleyman Education and Research Hospital of Medicine | And 3 more authors.
Archives of Gynecology and Obstetrics | Year: 2015

Purpose Here we aimed to evaluate the incidence of obstetric anal sphincter injuries in spontaneous primigravid deliveries with mediolateral episiotomy beyond 36 gestational weeks. Methods We performed a prospective, randomized controlled study including 201 primigravid women that delivered vaginally. Anal sphincter anatomy and integrity was evaluated before hospital discharge in all cases with transvaginal sonography (5–9 MHz) (Siemens Sonoline G50 and Voluson 730 Expert). The vaginal ultrasound probe is placed in the fourchette of the vaginal introitus to obtain the transverse section of the anal sphincter. Results In the cases with sphincter defect, mean gestational week and second stage of labor were prolonged significantly (p = 0.039 and p < 0.0001, respectively). The mean perineal body distance in cases with sphincter injury, as detected by sonography, 2.18 ± 0.33 cm, is compared to 2.31 ± 2.43 cm in cases without injury. There was a significant difference between the two groups (p = 0.0142). Shoulder dystocia was significantly higher in cases with sphincter injury, compared to cases without injury (p = 0.011). No clinical findings were reported in 11.5 % of cases (Sonography findings 1A;, 1B;) and 3.5 % of cases had clinical and sonographic findings (Sonography findings 2A;, 2B;). “Occult tears” were considered as those cases not detected clinically, but detected by sonography (11.5 % of all cases). Two months after examination, a moderate incontinence (Wexner continence scale) was found in 71.5 % of cases with overt sphincter tear, which was significantly different to the nonovert sphincter tear group. Multiple logistic regression analyses for sphincter injuries identified prolonged second stage of labor and shoulder dystocia as two independent risk factors. Conclusion Here, we found that only a portion of anal sphincter injuries can be detected after physical examination, with many of cases of “occult tears” escaping notice. These cases of occult anal sphincter injury are detectable by sonography with transperineal use of a vaginal probe. Based on these findings, we propose that this technique is convenient for obstetric, gynecologic and proctologic evaluation of sphincter anatomy. © Springer-Verlag Berlin Heidelberg 2015.


Aksoy H.,Kayseri Military Hospital | Ozyurt S.,Kayseri Education and Research Hospital of Medicine | Aksoy U.,Kayseri Education and Research Hospital of Medicine | Acmaz G.,Kayseri Education and Research Hospital of Medicine | And 2 more authors.
International Journal of Surgery Case Reports | Year: 2014

INTRODUCTION: Ovarian torsion (OT) is a rare cause of acute abdominal pain that requires prompt recognition and treatment during puerperium. Diagnosis of OT can be challenging due to nonspecific clinical features and uncommon objective findings. The management of OT is often delayed because of diagnostic uncertainty. Early and timely recognition and prompt intervention are crucial to preserve ovarian function and to minimize morbidity. PRESENTATION OF CASE: We report a 29-year-old postpartum woman who presented to the emergency department (ED) with severe right flank pain, nausea and anorexia initially considered as renal colic. After further investigation, OT caused by large mucinous cyst was diagnosed. Right-sided salpingo-oophorectomy was performed due to hemorrhagic ovary and huge cystic mass causing ischemic OT. DISCUSSION: OT is often diagnosed based on the clinical presentation, including severe, sharp, sudden onset of unilateral lower abdominal pain and tenderness with a palpable laterouterine pelvic mass and nausea/vomiting. Emergency surgical intervention should be performed if OT is suspected to confirm the diagnosis and uncoil the twist to prevent ovarian damage. CONCLUSION: In conclusion, emergency physicians should be aware of the possibility of OT in postpartum women. Therefore, early and timely surgical intervention should be undertaken. © 2014 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd.


Acmaz G.,Kayseri Education and Research Hospital of Medicine | Aksoy H.,Kayseri Military Hospital | Albayrak E.,Erciyes University | Baser M.,Erciyes University | And 3 more authors.
Asian Pacific Journal of Cancer Prevention | Year: 2014

Aim: To evaluate precancerous lesions such as hyperplasia and endometrial polyps in obese postmenopausal women. Materials and Methods: Women who were referred with abnormal uterine bleeding in postmenopausal period or the presence of endometrial cells on cervical cytology in our department were investigated. Anthropometric measurements such as height, weight, body mass index, waist/hip ratio and endometrial thickness were compared between a precancerous lesion (hyperplasia and endometrial polyp) group and a pathologically normal group. Results: We detected statistically significant thickening of endometrium in patients with precancerous lesions. Moreover patients with precancerous lesions had higher body mass index than the pathologically normal group. Conclusions: We found elevated precancerous lesion rates in overweight and obese women in the postmenopausal period, of interest given that the prevalence of obesity is increasing in most parts of the world. Although screening for endometrial cancer is not recommended for the general population, in high-risk populations like obese postmenopausal women, it may be very important.


PubMed | Erciyes University, Kayseri Education and Research Hospital of Medicine and Kayseri Military Hospital
Type: | Journal: BioMed research international | Year: 2014

The aim of the study was to investigate the analgesic efficacy of preoperative oral dexketoprofen trometamol, intravenous paracetamol, lidocaine spray, and paracervical block with ultracaine on curettage procedure. A total of 111 subjects with the request of pregnancy termination between 5 and 7 weeks of gestation were included in the study. The first group (control group) consisted of 20 participants without medication. The second group consisted of 25 participants receiving 2 puffs of lidocaine sprays on cervical mucosa. The third group consisted of 20 participants receiving oral 25 mg dexketoprofen trometamol. The fourth group consisted of 23 participants receiving 1000 mg intravenous paracetamol and the fifth group consisted of 23 participants receiving paracervical block with ultracaine. Paracervical block reduced pain score significantly in both intraoperative and postoperative periods. All analgesic procedures were significantly effective for reducing pain in postoperative period. Paracervical block may be the best method for reducing pain scores in intraoperative and postoperative periods during curettage procedure. All analgesic procedures such as lidocaine, paracetamol, ultracaine, and paracervical block with ultracaine can be used for reducing pain score in postoperative period. This trial is registered with NCT01947205.


PubMed | Acibadem Kayseri Hospital, Kayseri Education and Research Hospital of Medicine and Kayseri Military Hospital
Type: Journal Article | Journal: International journal of surgery case reports | Year: 2014

Ovarian torsion (OT) is a rare cause of acute abdominal pain that requires prompt recognition and treatment during puerperium. Diagnosis of OT can be challenging due to nonspecific clinical features and uncommon objective findings. The management of OT is often delayed because of diagnostic uncertainty. Early and timely recognition and prompt intervention are crucial to preserve ovarian function and to minimize morbidity.We report a 29-year-old postpartum woman who presented to the emergency department (ED) with severe right flank pain, nausea and anorexia initially considered as renal colic. After further investigation, OT caused by large mucinous cyst was diagnosed. Right-sided salpingo-oophorectomy was performed due to hemorrhagic ovary and huge cystic mass causing ischemic OT.OT is often diagnosed based on the clinical presentation, including severe, sharp, sudden onset of unilateral lower abdominal pain and tenderness with a palpable laterouterine pelvic mass and nausea/vomiting. Emergency surgical intervention should be performed if OT is suspected to confirm the diagnosis and uncoil the twist to prevent ovarian damage.In conclusion, emergency physicians should be aware of the possibility of OT in postpartum women. Therefore, early and timely surgical intervention should be undertaken.


PubMed | Kayseri Education and Research Hospital of Medicine
Type: Journal Article | Journal: Archives of gynecology and obstetrics | Year: 2015

Here we aimed to evaluate the incidence of obstetric anal sphincter injuries in spontaneous primigravid deliveries with mediolateral episiotomy beyond 36 gestational weeks.We performed a prospective, randomized controlled study including 201 primigravid women that delivered vaginally. Anal sphincter anatomy and integrity was evaluated before hospital discharge in all cases with transvaginal sonography (5-9MHz) (Siemens Sonoline G50 and Voluson 730 Expert). The vaginal ultrasound probe is placed in the fourchette of the vaginal introitus to obtain the transverse section of the anal sphincter.In the cases with sphincter defect, mean gestational week and second stage of labor were prolonged significantly (p=0.039 and p<0.0001, respectively). The mean perineal body distance in cases with sphincter injury, as detected by sonography, 2.180.33cm, is compared to 2.312.43cm in cases without injury. There was a significant difference between the two groups (p=0.0142). Shoulder dystocia was significantly higher in cases with sphincter injury, compared to cases without injury (p=0.011). No clinical findings were reported in 11.5% of cases (Sonography findings 1A, 1B) and 3.5% of cases had clinical and sonographic findings (Sonography findings 2A, 2B). Occult tears were considered as those cases not detected clinically, but detected by sonography (11.5% of all cases). Two months after examination, a moderate incontinence (Wexner continence scale) was found in 71.5% of cases with overt sphincter tear, which was significantly different to the non-overt sphincter tear group. Multiple logistic regression analyses for sphincter injuries identified prolonged second stage of labor and shoulder dystocia as two independent risk factors.Here, we found that only a portion of anal sphincter injuries can be detected after physical examination, with many of cases of occult tears escaping notice. These cases of occult anal sphincter injury are detectable by sonography with transperineal use of a vaginal probe. Based on these findings, we propose that this technique is convenient for obstetric, gynecologic and proctologic evaluation of sphincter anatomy.


PubMed | Kayseri Education and Research Hospital of Medicine
Type: Journal Article | Journal: Asian Pacific journal of cancer prevention : APJCP | Year: 2014

To evaluate precancerous lesions such as hyperplasia and endometrial polyps in obese postmenopausal women.Women who were referred with abnormal uterine bleeding in postmenopausal period or the presence of endometrial cells on cervical cytology in our department were investigated. Anthropometric measurements such as height, weight, body mass index, waist/hip ratio and endometrial thickness were compared between a precancerous lesion (hyperplasia and endometrial polyp) group and a pathologically normal group.We detected statistically significant thickening of endometrium in patients with precancerous lesions. Moreover patients with precancerous lesions had higher body mass index than the pathologically normal group.We found elevated precancerous lesion rates in overweight and obese women in the postmenopausal period, of interest given that the prevalence of obesity is increasing in most parts of the world. Although screening for endometrial cancer is not recommended for the general population, in high-risk populations like obese postmenopausal women, it may be very important.

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