Cihan Çetin

Unilateral Laparoscopic Tubal Reversal Versus IVF

BACKGROUND Tubal sterilization is one of the most important surgical techniques for sterilization. There is a dilemma for women who wish to undo this procedure in the choice between tubal reversal or in vitro fertilization (IVF). PATIENTS AND METHODS In this retrospective cohort study, 134 patients who had had tubal sterilization previously and wished to have another child were enrolled in this study. Primary outcome was clinical pregnancy. The outcomes of 58 women who had had laparoscopic unilateral tubal reversal (Group 1) were compared with those of 76 women who had had IVF (Group 2). RESULTS Clinical pregnancy rates were higher in the tubal reversal group (55.2% in Group 1 and 15.8% in Group 2). Ectopic pregnancy rates were similar (1.7% in Group 1 and 1.3% in Group 2) between the two groups. Clinical pregnancy rates were higher in all age, body mass index, and interval from ligation categories. CONCLUSIONS Laparoscopic unilateral tubal reversal is an important alternative to IVF. However, this is an advanced laparoscopic operation, and more surgeons skilled in this microsurgical operation are still needed.

Comparison of two misoprostol regimens for mid-trimester pregnancy terminations after FIGO's misoprostol dosage recommendation in 2012.

Abstract Objective: To compare the safety and efficacy of two misoprostol regimens for mid-trimester pregnancy terminations. Methods: Retrospective analysis of 263 cases of pregnancy terminations with misoprostol between 12 and 24 weeks was performed. Group 1 (total 129 patients) consisted of patients who were given 200 mcg vaginal misoprostol every 4 h until the abortion, whereas Group 2 patients (total 134 patients) were given misoprostol as in International Federation of Gynecology and Obstetrics’s (FIGO) 2012 recommendation. In case of a previous cesarean section doses were halved in both groups. Primary outcomes of the study were the time to abortion and the total drug dose used. Secondary outcome was the rate of complications. Results: Total dose and time to abortion did not differ between the groups. As for complications, one patient (%0.8) in group 1 developed HELLP syndrome and had hysterotomy. One patient (%0.8) in group 2 had uterine rupture and had total hysterectomy. Two patients in both groups considered failure of induction and terminated with surgery (hysterotomy). Groups did not show difference in induction failure rates. Conclusions: We respect the presence of dose recommendation stated by the FIGO and found similar results with our recent protocol. Other misoprostol regimens used worldwide should also be compared with this guideline in order to improve its efficacy.

Does preoperative neutrophil to lymphocyte or platelet to lymphocyte ratios have a role in predicting borderline ovarian tumors

Backgroundto investigate the value of using preoperative neutrophil to lymphocyte and platelet to lymphocyte levels in the patients of borderline ovarian tumors.MethodsDuring the period between January 2002 and December 2015, the pathology reports and archival files of the Gynecologic Oncology Department of Çukurova University Medical Hospital and the Gynecologic Oncology Department of Dumlupınar University, Evliya Çelebi Education and Research Hospital were retrospectively reviewed, and 144 patients of borderline ovarian tumor (as the study group) and 123 patients of serous cystadenoma (as the control group) were determined for eligibility in this study. Data regarding age, menopausal status, preoperative ultrasound findings, ca125 and complete blood counts were reviewed. Neutrophil to lymphocyte and platelet to lymphocyte ratios were calculated and these parameters were statistically compared between the groups.ResultsThere was a statistically significant difference between the groups according to neutrophil count, platelet count, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio; in addition to age, ca125 and preoperative ultrasound findings.ConclusionsIt seems that neutrophil to lymphocyte and platelet to lymphocyte ratios are useful in predicting borderline ovarian tumors, preoperatively. However, further prospective studies are needed.

Prenatal diagnosis of pectus excavatum

Pectus excavatum (PE) is the depression of the lower part of manubrium sterni and xiphoid process. The main problem of PE depends on the cardiopulmonary morbidity caused by the narrowing of the thoracic space. To date, prenatal diagnosis of this deformity has been reported only once and was associated with Down syndrome. We present another case which we diagnosed as PE during a second-trimester fetal anatomic scan. The pectus severity index is used for these patients in postnatal life; however, prenatal adaption of this index is reported for the first time in our case.

First trimester fetal aortic Doppler for hemoglobinopathies

Objective: To evaluate fetal aortic Doppler for the prenatal diagnosis of hemoglobinopathies in the first trimester of pregnancy. Materials and Methods: Between January and November 2014, a total of 108 patients were enrolled in the study. The couples were carriers of either alpha/beta thalassemia, sickle cell disease or combined carriers of these and were admitted to Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology Prenatal Diagnosis Center. One hour before the chorionic villus sampling (CVS), patients were evaluated using fetal aortic Doppler. Pulsatility index, peak systolic velocity, and heart rate were noted. Results: There were no statistically significant differences in Doppler indices between different groups of CVS results when compared with the healthy controls. Conclusion: Fetal aortic Doppler investigation was found to be ineffective for the prenatal diagnosis of hemoglobinopathies.

Annular hymenotomy for imperforate hymen

Imperforate hymen is the most common obstructive anomaly of the female genital tract. Conventional surgical treatment for this condition is the cruciate incision made on the hymen. The aim of this study was to evaluate a novel technique that preserves virginity after hymenotomy using electrocautery.

A Rare Skin Lesion During Pregnancy: Localized Cutaneous Leishmaniasis

Leishmaniasis is an infectious disease that is spread by phlebotomine sand flies. These flies cause infections called cutaneous and/or visceral leishmaniasis in humans. In this paper, we present a pregnant patient who was diagnosed with localized cutaneous leishmaniasis, a localized form of the disease, and the treatment we applied to the patient. The patient was given systemic amphotericin-B treatment, however the immunosuppressive state of pregnancy and the diabetes of the patient complicated the treatment. Although the size of the lesion regressed during pregnancy, we could not completely cure the disease.

Gebelik ve Toksoplazma Enfeksiyonu

Toksoplazma gondii isimli bir protozoanin sebep oldugu toksoplazmozis enfeksiyonu gebelikte fetal anomalilere ve dusuk-olu dogum gibi olumsuz perinatal sonuclara yol acabildigi icin oldukca onemlidir. Ozellikle cig et, kontamine yiyeceklerle bulasan bu enfeksiyonun prenatal donemde uygun zamanda, dogru tani ve yonetimi ile ciddi norolojik sekel riski azaltilabilmektedir. Dolayisiyla gebe takibi yapan klinisyenlerin bu enfeksiyonu derinlemesine bilmesi onem arz etmektedir. Bu amacla makalemizde, toksoplazma enfeksiyonun prenatal donemde tanisi, komplikasyonlari ve tedavisini ozetlemeyi amacladik.

Renal angiomyolipoma during pregnancy: Case report and literature review

Renal angiomyolipoma is a rare tumor that can be either sporadic or found together with tuberous sclerosis or pulmonary lymphangioleiomyomatosis. These tumors are hormone sensitive and therefore tend to grow during pregnancy and their main complication is the risk of rupture. Optimal management is still controversial because there are very few cases reported in the literature. We expect that the case of our patient, who delivered her baby vaginally at 36 weeks of gestation and underwent definitive treatment (nephrectomy) thereafter, to further enhance the knowledge about the management of these rare tumors during pregnancy.

Predictive factors for latency period in viable pregnancies complicated by preterm premature rupture of the membranes

Objective: In this study, we aimed to evaluate some laboratory and clinical factors in the prediction of latency period for pregnant patients complicated with preterm premature rupture of the membranes. Materials and Methods: Sixty-five pregnant patients between 24 and 34 weeks of gestation, who were admitted to University of Çukurova School of Medicine Hospital with the diagnosis of preterm premature rupture of the membranes (PPROM) between January 01, 2013 and December 31, 2013, were included in this study. Serum CRP, procalcitonin, sedimentation rate, leukocyte count and cervical length (measured with transvaginal ultrasound) of patients were analyzed for the correlation with the latency period. Results: None of the parameters were found to be correlated with the latency period. However, patients with cervical length of <25 mm were found to have shorter duration of latency. Conclusion: Although preterm premature rupture of the membranes is thought to be either an infection-based disease or a disease increasing the risk of infectious complications, major infection markers are not found to be helpful criteria for the prediction of latency period. Patients with a cervical length of <25 mm can be expected to deliver earlier and, therefore, can be referred to a tertiary center earlier.