Akgün Yildiz

Transvaginal sacrospinous colpopexy for marked uterovaginal and vault prolapse

Objective: The transvaginal sacrospinous ligament fixation technique was used as part of the vaginal repair procedure for marked uterovaginal prolapse, and in the treatment of vault prolapse. Method: Out of the 26 women treated with sacrospinous ligament suspension of the vaginal vault, 23 had marked uterovaginal prolapse and three had vault prolapse following hysterectomy. Patients with vault prolapse underwent posterior vaginal repair, obliteration of the enterocele sac and sacrospinous colpopexy. Patients with marked uterovaginal prolapse underwent vaginal hysterectomy with high ligation of the enterocele sac, anterior and posterior vaginal repair, and sacrospinous colpopexy. Bilateral salpingoopherectomy was added to the procedure in five patients. All patients were examined 6 weeks after the operation and, subsequently, on an annual basis. The mean follow‐up period was 2.6 years (1–5 years). Results: Out of the three patients with previous vault prolapse, none had recurrences. Out of the 23 patients with previous marked uterovaginal prolapse, only two had small cystocele, and one had small enterocele at 36 months following the operation. These patients were asymptomatic and did not need an operation. Vaginal vault prolapse was not observed in any of these patients. Two women had post‐operative urinary tract infection and five had buttock discomfort, which subsided after 2 months. No other intra‐ or post‐operative complications occurred. Conclusion: Transvaginal sacrospinous colpopexy can be performed together with vaginal hysterectomy, and anterior and posterior vaginal wall repair in patients with marked uterovaginal prolapse because of its high success in avoiding possible vault prolapse, and low intra‐ and post‐operative complication rates.

The changes in ovarian hormone levels and ovarian artery blood flow rate after laparoscopic tubal sterilization

OBJECTIVE To investigate the changes in serum ovarian hormone levels and ovarian artery blood flow rate by Doppler ultrasonography following laparoscopic tubal sterilization. METHODS Laparoscopic tubal sterilization have been performed on 13 voluntary subjects between the sixth and eighth days of the menstrual cycle. Serum ovarian hormone levels and ovarian artery blood flow rate, by Doppler ultrasonography, were determined 3 days before the operation, on the post-operative third day and on the post-operative third month. The results of 10 participants who finished the follow-up period were analyzed. RESULTS There were no statistically significant changes in serum levels of ovarian hormones after laparoscopic tubal ligation. The end-diastolic blood flow in ovarian artery was found to be decreased following tubal sterilization (8.7+/-2.8 and 7.4+/-1.8m/sec, respectively, P>0.05), while resistivity index (RI) increased after the operation (0.7+/-0.1 and 0.8+/-0.03, respectively, P>0.05). CONCLUSION There was no change in ovarian hormone levels after laparoscopic tubal sterilization. There is slight but statistically non-significant decrease in ovarian artery blood flow rate following tubal sterilization, signifying a local increase in vascular resistance.

Surgical Treatment of Urinary Stress Incontinence by a Suburethral Sling Procedure Using a Mersilene Mesh Graft

A suburethral sling procedure using a Mersilene mesh has been performed in 24 patients. Six patients had recurrent incontinence after an unsuccessful past operation. A postoperative follow-up was done for an average of 24 months. Twenty-three patients were free of symptoms, while only 1 patient had recurrent incontinence. The suburethral sling procedure can be applied to all patients, particularly for recurrent stress urinary incontinence, with reasonable cure rates when performed with a proper technique.

Bone loss rate in the lumbar spine: a comparison between natural and surgically induced menopause

Objective: To compare the bone loss between natural and surgically induced menopause by dual photon absorbsiometry (DPA) and quantitative computed tomography (QCT). Methods: The study group included 365 women, who were in menopause for at least 6 months. Of all patients, 272 became menopausal naturally and 93 surgically. Spinal bone mineral density (BMD) of the women was determined by DPA in 201 patients and by QCT in 164. Regression analysis was used to correlate BMD and months since menopause. Results: Measurements with DPA did not show any significant difference in bone loss between natural and surgical menopause patients, whereas in the group of patients of whom BMD is measured by QCT, a relatively increased bone loss rate is found in surgically induced menopause patients. Conclusions: Oopherectomized women seemed to suffer a relatively higher bone loss rate compared with natural menopause.

Prevalence of hepatitis B surface antigen among pregnant women in a low-risk population

OBJECTIVES: To estimate the prevalence of chronic hepatitis B carriers among our lowrisk obstetric population and to determine the need for routine screening. METHODS: A group of 1224 pregnant women, admitted to Gazi University Medical Center, were screened for HBsAg using an enzyme‐immunoassay technique, and the obstetrical care records were reviewed. RESULTS: Fifty‐three patients were seropositive with a prevalence of 4.33% for HBV chronic carrier status in our obstetric population. CONCLUSIONS: Routine HBsAg screening is advisable in our antenatal population.

Seroprevalence of syphilis, human immunodeficiency virus type-1, and hepatitis B virus infections among pregnant women in Turkey

Recent data indicates that incidence of syphilis is increasing in many areas of the world with a w x rate as high as 3.9]15.8% 1 . Since risk of perinatal transmission of HIV-1 has been estimated to range from 13% to 40%, all pregnant women are encouraged to be tested for HIV-1 infection to reduce risk of perinatal transmission and to protect health personnel. There is no substantial data related to prevalence of syphilis and HIV-1 infections in recent years in Turkey. HBsAg-positive pregnant women are also at significant risk of Ž . transmitting hepatitis B virus HBV to their inŽ . fants particularly if they are ‘e’ antigen HBeAg positive. The objective of this study was to find prevalence of syphilis and HIV-1 infections and HBV carriers among pregnant women who applied for antenatal care in a low-risk population. A total of 3050 pregnant women were screened for syphilis, HBsAg and HIV-1 antibody at their

Bone mineral density in Turkish postmenopausal women.

OBJECTIVE: To determine the bone mineral density curve in Turkish postmenopausal women and to evaluate the efficacy of estrogen replacement therapy in the prevention of bone loss. METHOD: Spinal bone mineral density was measured using dual photon absorptiometry in 118 postmenopausal women, prospectively. Parity, previous and current use of estrogen preparations were correlated with BMD using Students t‐test and the χ2‐test. RESULTS: With a mean BMD value of 0.967 ± 0.013 g/cm2, 62.5% of our postmenopausal study population had a mean BMD value of < 1.0 g/cm2 and 33.7% were already osteoporotic (<0.9 g/cm2). Bone loss was faster and more intense in the surgically menopausal than in the naturally menopausal group (P < 0.05). Parity after the fourth delivery dropped the mean BMD value (P < 0.05). Previous and current use of estrogen treatment seemed to decrease bone mineral loss in the postmenopausal years. CONCLUSION: Our data stress the need for locally obtained normal BMD values in every country in the world. High parity, surgical menopause and duration of 5 or more years of natural menopause are risk factors for bone loss. Estrogen replacement diminishes the annual bone loss.

Ovarian wedge resection by minilaparatomy in infertile patients with polycystic ovarian syndrome: a new technique

OBJECTIVE To determine the effects of ovarian wedge resection by minilaparotomy in infertile patients with polycystic ovarian syndrome (PCOS). STUDY DESIGN One hundred and thirty-four anovulatory patients with PCOS, who were previously treated with clomiphene citrate and gonadotropins and did not conceive were operated via minilaparotomy with microsurgical principles and ovarian wedge resection was performed on each subject. Pregnancy rates and adhesion formation were investigated retrospectively. RESULTS A total of 121 pregnancies were achieved in 2 years (90%). One hundred and four patients conceived within the first 6 months (78%) and the remaining 17 patients conceived within 2 years (13%) following the operation. Sixty-eight patients had a second pregnancy later. In the post-operative period, 24 patients had cesarean delivery and 20 had diagnostic laparoscopy. Out of these 44 patients, only 5 of them were found to have minimal adhesions. CONCLUSION This technique offers high pregnancy rates and minimal adhesion formation. Ovarian wedge resection by minilaparotomy might be an alternative treatment approach in patients with PCOS who did not conceive with standard ovulation induction protocols.

Polycythemia vera and pregnancy

The association of polycythemia vera and pregnancy is rare. Polycythemia vera is a clonal disorder involving hematopoietic stem cells and overproduction of phenotypically normal myeloid cell lines independent of physiologic stimulus w1x. A 24-year-old woman, gravida 1, was referred for prenatal care at 10 weeks of pregnancy. A diagnosis of polycythemia vera was made 2 years before the present pregnancy. Splenomegaly was found on physical examination. Her hemoglobin level was 15.9 gydl, hematocrit was 45.2%, and red blood cell count was 7.2=10.6yml. Platelet and white blood cell counts were 57.3=10 yml 3

Comparison of different treatment modalities for postmenopausal patients with osteopenia: hormone replacement therapy, calcitonin and clodronate

Objective To evaluate the effectiveness of hormone replacement therapy (HRT), clodronate, calcitonin and a clodronate plus calcitonin combination in postmenopausal patients with osteopenia. Methods One hundred postmenopausal patients with osteopenia, with bone mineral density (BMD) measurements at least one standard deviation below the mean value for young premenopausal subjects (T score <-1), were studied. They had no contraindications to HRT, clodronate or calcitonin use and were randomized to four different treatment groups. Patients in group I were treated with transdermal estradiol 50 μg/day and oral medroxyprogesterone acetate 10 mg/day during the last 12 days of the month; group II received oral clodronate 400 mg/day for 1 month out of every 3 months; group III received calcitonin nasal spray 100 IU/day; and patients in group IV were treated with oral clodronate 400 mg/day for 1 month out of every 3 months plus calcitonin nasal spray 100 IU/day. Elementary calcium 1000 mg/day was supplemented to patients in all groups. Spinal and femoral neck BMD measurements and markers of bone mineral metabolism were measured in each patient before treatment and 6, 12 and 18 months after treatment in 86 patients. Results Significant increases in mean lumbar spine BMD were found in the group receiving HRT, and at the end of 18 months there was a 2.69 ± 0.76% increase, compared with baseline. Mean femoral neck BMD also increased by 2.22 ± 0.57% in the HRT group; this was significantly different from baseline, resulting in a higher bone mass gain than in the other three groups. Increases in both lumbar spine and femoral neck BMD were found in patients treated with clodronate, although the only significant increase was observed in lumbar spine BMD at the end of 18 months. The mean changes in BMD were not significantly different, compared with the other groups, and at the end of 18 months there was a 2.20 ± 0.58% increase at the lumbar spine. The mean vertebral and femoral neck BMD did not change significantly throughout the study period in patients receiving calcitonin. At the end of 18 months, there was a 0.13 ± 0.52% decrease and a 0.11 ± 0.49% increase in mean lumbar spine and femoral neck BMD, respectively, compared with baseline. The combination of clodronate plus calcitonin increased mean lumbar spine and femoral neck BMD by 2.08 ± 1.05% and 1.46 ± 1.09%, respectively, at the end of 18 months, but these increases were not significantly different from those in the groups where these agents were used alone. Significant decreases in bone resorption and in markers of bone formation were observed in all groups. Conclusion HRT was found to be the most effective treatment regimen in postmenopausal patients with osteopenia, compared with clodronate, calcitonin and a clodronate plus calcitonin combination. Clodronate or calcitonin might be alternatives when HRT is contraindicated or refused by the patient, although calcitonin was found to be less effective. The clodronate plus calcitonin combination was not superior to either of these agents when used alone.