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Selcuk S.,Zeynep Kamil Hospital | Cam C.,Zeynep Kamil Hospital | Asoglu M.R.,Zeynep Kamil Hospital | Karateke A.,Zeynep Kamil Hospital
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2012

Introduction and hypothesis: We evaluated the bother of concomitant anal incontinence (AI) in women with urinary incontinence (UI) who do not primarily report their anal symptoms. Methods: This prospective study assessed patients with complaings of primary UI without initially reporting anal symptoms. After urogynecological assessment, all patients were asked to complete the validated versions of the Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), Pelvic Floor and Incontinence Sexual Impact Questionnaire (PISQ-12), Wexner Incontinence Scale (WIS) score, and Beck Anxiety Inventory (BAI). Patients who scored nil in the WIS constituted the group of only UI, and patients with scores ≥1 were grouped as double incontinence (DI)., and the groups were compared. Results: Among 136 women, 69.1 % (94) had only UI, whereas 30.9 % (42) had DI. There were no differences in age, parity, body mass index (BMI), and prolapse status between patients with UI and those with DI, except menopausal status. Women with DI scored worse for IIQ-7, PISQ-12, and BAI questionnaires compared with women with UI. This difference was not statistically significant for IIQ-7 only. Conclusions: Our data show that concealed AI symptoms may contribute to the anxiety of the patient and even alter the perception of urinary symptoms. Actually, a significant number of women suffer from DI without reporting their anal symptoms, which results in underdiagnosing of concomitant AI. To prevent the suboptimal management of patients with lower urinary tract symptoms, standardized questionnaires for AI should be included in the evaluation of all patients with lower urinary tract symptoms. © 2012 The International Urogynecological Association.


Karateke A.,Zeynep Kamil Hospital | Tug N.,Zeynep Kamil Hospital | Sahin D.,Zeynep Kamil Hospital
Journal of the Turkish German Gynecology Association | Year: 2011

The differential diagnosis of metastatic ovarian malignant melanoma from primary ovarian tumors is a significant challenge, particularly if there is no obvious primary site. A 39-year-old patient with bilateral ovarian malignant melanoma presented as stage IV primary ovarian tumor, with metastases in the omentum and spleen. She underwent a total abdominal hysterectomy and bilateral salpingo-oopherectomy with infracolic omentectomy and splenectomy. The diagnosis on examination of frozen sections was inconclusive. The final diagnosis was made by immunohistochemistry. The sections showed positive staining with HMB-45, vimentin, S-100, and no staining for cytoceratin, inhibin, calretinin and caldesmon. After the operation, the MRI at the 14th postoperative day revealed metastatic lesions in the vertebrae, sacrum, bilateral humerus and femur and in the cerebral cortex, together with edema and hemorrhagic foci. The patient stayed in the intensive care unit for 12 weeks until her death due to cardio-respiratory arrest. This case highlights the clinical fact that metastatic malignant melanoma may mimic primary ovarian tumor with an occult or regressed primary. Both the standard pre-operative imaging modalities (such as CT, MRI) and the histo-pathologic examination of the frozen sections may be inconclusive in the differentiation of ovarian melanoma from epithelial ovarian malignancies. The final diagnosis could be established by immunohistochemistry. Intra-abdominal debulking surgery would not prolong the survival of metastatic ovarian melanoma because of the occult or rapid metastasis to the extra abdominal sites of the tumor. © 2011 by the Turkish-German Gynecological Education and Research Foundation.


Isik Kaygusuz E.,Zeynep Kamil Hospital | Cesur S.,Zeynep Kamil Hospital | Cetiner H.,Zeynep Kamil Hospital | Yavuz H.,Zeynep Kamil Hospital | Koc N.,Zeynep Kamil Hospital
Journal of Clinical and Diagnostic Research | Year: 2013

Aim: Sclerosing stromal tumor is a benign tumor of ovary. We aimed to review the clinical findings and immunohistochemical results of SSTs through the 7 diagnosed cases in our hospital. Material and Methods: As immunohistochemical, blocks were applied with estrogen receptor, progesterone receptor, inhibin, calretinin, melan-A, CD10, smooth muscle actin, desmine, vimentin, CD34, S-100, C-kit, cytokeratin, cytokeratin7. Results: Macroscopically, while 5 tumors had solid appearance, 2 tumors were composed of solid and cystic areas. All the tumors were in shape of ovarian masses with good limits. Microscopically, two types of cells were observed as fusiform fibroblast-like cells and theca-like cells with vacuolised cytoplasm. Immunohistochemical results: vimentin, smooth muscle actin, desmine, progesterone receptor, calretinin, inhibin were positive in all the cases; S-100, cytokeratin, cytokeratin7, estrogen receptor were negative in all the cases; CD-10 was positive in 2 cases; C-kit was positive in 5 cases; melan-A was positive in 4 cases. Conclusions: The significance of these tumors is that it is necessary to distinguish the histopathology in the frozen section in order to protect the other adnexa because of the characteristics to be observed at early ages (2nd and 3rd decades). Our findings support the conclusion that sclerosing stromal tumors are benign-character tumors that stem from over stroma and are hormonally active tumors because of the detected clinical and immunohistochemical results, although no hormonal effect that could be supported with laboratory tests was observed.


Cam C.,Zeynep Kamil Hospital | Asoglu M.R.,Zeynep Kamil Hospital | Selcuk S.,Zeynep Kamil Hospital | Aran T.,Zeynep Kamil Hospital | And 2 more authors.
Archives of Gynecology and Obstetrics | Year: 2012

Objective This retrospective study investigates the effects of mediolateral episiotomy on the pelvic floor. Methods Premenopausal women suffering from urinary incontinence/genital prolapse who delivered only by vaginal route were enrolled into the study. History of diabetes, morbid obesity (BMI > 40 kg/m2), vacuum/forceps extraction, perineal lacerations that warranted repair during labor and any pelvic surgery were the exclusion criteria. Evaluation of the patients included pelvic organ prolapse quantification scores, presence of stress incontinence, urethral hypermobility, and questionnaires were obtained for overactive bladder and anal incontinence symptoms. These data obtained from patients with the history of mediolateral episiotomy were compared with those of patients with no episiotomy or any other pelvic injury that warranted surgical repair. Results Groups were identical by means of demographic data, POP-Q findings, signs and symptoms of the pelvic floor. However, in the MLE group, central defects on the anterior vaginal wall were less frequent. Conclusion According to the results of this retrospective study, MLE seems to prevent central defects on the anterior vaginal wall. Prospective randomized studies are needed to draw a sufficient conclusion. © 2011 Springer-Verlag.


Kaygusuz E.,Zeynep Kamil Hospital | Cetiner H.,Zeynep Kamil Hospital | Yavuz H.,Zeynep Kamil Hospital | Cesur S.,Zeynep Kamil Hospital | And 2 more authors.
Acta Endocrinologica | Year: 2014

Background. There is no immunohistochemical study to show luteinizing hormone receptor (LHR), estrogen receptor (ER) and progesterone receptor (PR) in the pregnant Fallopian tubes (FT). Objective. To study LHR, ER, PR expression in FT containing an ectopic pregnancy (EP) and during the menstrual phase. Design. Thirty FT were obtained from women diagnosed with EP and twenty FT collected by hysterectomy performed for benign diseases not affecting the tubes were included in this study. Assessment of immunohistochemical expression staining LHR, ER, PR in epithelium, smooth muscle cell and blood vessel endothelium in FT containing an EP and during the different phases of menstrual cycle. Results. In ectopic pregnancy group we found LHR expression in epithelium in 30 cases, muscle cell in 28 cases, and endothelium in 9 cases in FT. In menstrual cycle group we noted LHR expression in FT in epithelium in all cases, muscle cell in 4 cases. Conclusion. There is a significant difference in the proportions of the existence of LH receptor immunostaining in the muscle cells for ectopic pregnancy group as compared to the menstrual cycle groups (p < 0.001). Our findings may suggest that the women who have increased LH receptors on muscle cells in Fallopian tubes are at increased risk for having external pregnancy.


Cam C.,Zeynep Kamil Hospital | Selcuk S.,Zeynep Kamil Hospital | Asoglu M.R.,Zeynep Kamil Hospital | Tug N.,Zeynep Kamil Hospital | And 3 more authors.
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2011

Introduction and hypothesis The main aim of this study was to validate the Turkish translated version of the Wexner scale. Methods After establishing the test-retest reliability and internal consistency of the Turkish version of Wexner scale on 31 patients, total and subscale scores and anal manometric measurements of 60 participants were performed. Correlation between Wexner scale scores and manometric measurement values were analyzed and those values of patients with or without anal incontinence symptoms were compared. Results Of the 60 participants, 47 (78%) showed no signs or symptoms of anal incontinence. Wexner scale showed a high internal consistency (Cronbach's alpha=0.816). Total and each subscale score of Wexner scale showed strong correlation with resting and maximal squeeze pressures and between each other (p<0.005). The pressure values were significantly less in asymptomatic patients compared to patients with any degree of symptoms (p<0.05). Conclusion The Turkish translated version of the Wexner scale is a reliable, consistent, and valid instrument to evaluate anal functions in women with anal incontinence for Turkish speaking women. Total and subscale scores of the Wexner scale and anal manometric measurements showed significant correlation. © 2011 The International Urogynecological Association.


Karateke A.,Zeynep Kamil Hospital | Tug N.,Zeynep Kamil Hospital | Cam C.,Zeynep Kamil Hospital | Selcuk S.,Zeynep Kamil Hospital | Asoglu M.R.,Zeynep Kamil Hospital
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2011

Objectives: To assess the post-operative urinary incontinence states of pelvic organ prolapse cases operated on with concomitant trans-obturator tape (TOT) procedure. Study design: Urodynamic evaluation of 79 patients with pelvic organ prolapse, before and after operation, while reducing the prolapsed organs by ring forceps placed bilaterally on the anterolateral sulcuses avoiding urethral compression. According to urodynamic tests, 25 patients were diagnosed as having occult stress urinary incontinence. Results: Post-operative overactive bladder, stress urinary incontinence and mixed incontinence were found in three (12%), two (8%) and one (4%) patients of the occult stress urinary incontinence group, respectively. The corresponding numbers were six (11%), five (9%) and three (6%) in the continent group. No significant difference was found between the groups in terms of post-operative overactive bladder symptoms, stress urinary incontinence and mixed incontinence (Kruskal-Wallis test, X2 = 0.52, p = 0.820). Conclusions: This retrospective study suggests that a complete pre-operative urodynamic evaluation, including urodynamic tests at the time of POP reduction by placing ring forceps on the anterolateral sulcuses, is an efficient method for the diagnosis of occult symptomatic stress urinary incontinence (SUI). Prospective randomized studies are needed to establish the benefits and the risks of concomitant prophylactic surgery in patients with pelvic organ prolapse. © 2010 Elsevier Ireland Ltd. All rights reserved.


Kayatas S.,Zeynep Kamil Hospital | Asoglu M.R.,Zeynep Kamil Hospital | Selcuk S.,Zeynep Kamil Hospital | Sargin M.A.,Zeynep Kamil Hospital
Bulletin of the NYU Hospital for Joint Diseases | Year: 2012

Background: Pregnancy in patients with Wegener's granulamotosis (WG) is rare, and differential diagnosis of WG flare and preeclampsia is difficult. Case: A pregnant 35 year old with WG was referred with diagnosis of severe preeclampsia; caesarean section was performed. Intubation of the patient was difficult due to subglottic stenosis. Because of the clinical symptom, the case was considered preeclampsia, but p-ANCA of the patient was positive. In pregnancies with WG, differential diagnosis of WG flare-ups from preeclampsia should be made from clinical symptoms and laboratory findings. Serum ANCA titers are not useful in the differential diagnosis of WG flare-ups and preeclampsia because it may be positive in preeclampsia. Conclusion: Differential diagnosis of WG flare-up and preeclampsia should be made by clinical features. In the patients with subglottic stenosis, general anesthesia should not be preferred due to the probability of difficult intubation.


Tug N.,Zeynep Kamil Hospital | Ayvaci H.,Zeynep Kamil Hospital | Tarhan N.,Zeynep Kamil Hospital | Ozmisirci E.,Zeynep Kamil Hospital | And 2 more authors.
Archives of Gynecology and Obstetrics | Year: 2011

Introduction: It was aimed to investigate the effects of short-term maternal fasting on fetal biophysical profile (BPP) scores and obstetric doppler indices. Materials and methods: Thirty healthy uncomplicated singleton pregnancy cases were enrolled into the study. Results and conclusion: Fasting decreased BPP reversibly, but not to a level below 8/10. AFI, umbilical and MCA impedances were unchanged while pulsatility, resistance and systolic/diastolic values of uterine arteries were increased. © 2010 Springer-Verlag.


PubMed | Zeynep Kamil Hospital
Type: Journal Article | Journal: Iranian journal of reproductive medicine | Year: 2015

Submucous myomas may be associated with menorrhagia, infertility and dysmenorrhea.The aim of this study was to determine the long term effects of submucousal myoma resection on menorrhagia and infertility; also to detect whether the type, size, and location of myoma affect the surgical success.Totally 98 women referred to hysteroscopy for symptomatic submucousal fibroids (menorrhagia (n=51) and infertility (n=47)) between 2005- 2010 were enrolled in this historical cohort study Pregnancy rates and menstrual improvement rates were compared according to myoma characteristics (size, type and location).After a mean postoperative period of 2310 months in 51 patients with excessive bleeding, 13 had recurrent menorrhagia (25%). In Other 38 patients excessive bleeding was improved (75%). The improvement rates by location and myoma type: lower segment 100%, fundus 92%, and corpus 63%; type 0) 70%, type 1) 78%, type 2) 80%. The mean sizes of myoma in recurred and improved patients were 23.33 mm and 29.88 mm respectively. 28 of 47 infertile women spontaneously experienced thirty pregnancies (60%). Pregnancy rates according to myoma location and type: lower segment 50%, fundus 57%, and corpus 80%; type 0) 75%, type 1) 62%, type 2) 50%. The mean myoma size in patients who became pregnant was 30.38 mm; in patients who did not conceive was 29.95 mm.The myoma characetesitics do not affect improvement rates after hysteroscopic myomectomy in patients with unexplained infertility or excessive uterine bleeding.

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