Cihan Kaya

Comparison of serum anti-Müllerian hormone levels in normal weight and overweight-obese adolescent patients with polycystic ovary syndrome.

OBJECTIVE To evaluate serum concentration of anti-Müllerian hormone (AMH) in adolescent patients with polycystic ovary syndrome (PCOS) with respect to body mass index (BMI), and to investigate the relationship with clinical, metabolic and hormonal parameters. STUDY DESIGN Fifty-eight adolescent girls (29 normal weight and 29 overweight-obese) diagnosed with PCOS and 28 apparently healthy girls (controls) were enrolled in the study. BMI was calculated in all cases. Serum AMH, hormonal and metabolic parameters were compared between patients with PCOS (normal weight and overweight-obese) and controls. RESULTS Serum AMH did not differ between patients with PCOS and controls (p=0.283), and no correlation was found between BMI and AMH. A significant positive correlation was found between 2-h plasma glucose on 75-g oral glucose tolerance test and AMH (R=0.364, p=0.005). HOMA-IR index and insulin were significantly higher in overweight-obese patients with PCOS than in controls, but no significant difference was found between controls and normal-weight patients with PCOS. CONCLUSIONS AMH was not found to be a reliable predictor for the presence of PCOS, and serum AMH did not differ between obese and non-obese adolescent patients with PCOS.

Genitourinary symptoms in patients with adenomyosis

Introduction and hypothesisAdenomyosis causes problems in women, including dysmenorrhea and abnormally heavy and prolonged menstrual bleeding; however, its etiology is unknown. We hypothesized that urinary symptoms are frequent in patients with adenomyosis and that they affect the patients’ quality of life.MethodsWe conducted a pilot study from September 2011 to December 2011. Ninety-one patients with an ultrasound diagnosis of uterine adenomyosis comprised the study group (adenomyosis group). Ninety-four women with a normal-appearing uterine myometrium on ultrasound comprised the control group. Patients filled out two validated questionnaires, the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Patients also underwent a pelvic examination and urinary symptoms were recorded. Groups were compared using the nonparametric Mann–Whitney U test, chi-square test, and Fisher’s exact test.ResultsThe frequency of urinary symptoms was significantly higher in the adenomyosis group than in the control group (P = 0.0001), including stress urinary incontinence, urgency, daytime frequency, urge urinary incontinence, and dyspareunia. Total UDI scores were significantly higher in the adenomyosis group than those in the control group (P < 0.0001), as were IIQ scores of questions regarding social relations (P < 0.05).ConclusionsOur results suggest that urinary tract dysfunction is associated with adenomyosis and that urinary symptoms may affect patients’ quality of life.

A randomized controlled study of the efficacy of misoprostol and hyaluronic acid in preventing adhesion formation after gynecological surgery: a rat uterine horn model.

OBJECTIVE To investigate the effect of misoprostol in the reduction of adhesion formation after gynecological surgery. STUDY DESIGN A double blind, randomized controlled experimental study was designed. Twenty-one female Wistar Hannover rats were divided into three groups as control, misoprostol and Hyalobarrier(®) groups. A uterine horn adhesion model was created. After anesthesia induction, 1.5-2cm injuries were made to the each uterine horn by cautery. The control group received no special medications except for the standard surgical procedure. The misoprostol group received 10μcg/kg misoprostol in addition to the standard surgical procedure, and the Hyalobarrier(®) group received 1cm(3) ready-for-use Hyalobarrier(®) gel intraperitoneally in addition to the standard surgical procedure. After 14 days from the first surgical procedure, adhesion scores were evaluated. RESULTS The extent (p<0.001), severity (p<0.001), degree (p<0.001) and total adhesion score (p<0.001) values of the control group were statistically higher than the values of misoprostol and Hyalobarrier(®) groups. The inflammation score value of misoprostol group was statistically lower than control and Hyalobarrier(®) groups (p<0.001). CONCLUSION In this study, we have found a new therapeutic potential of misoprostol that may be useful in preventing pelvic adhesion and reducing inflammation scores.

Relation of Preoperative Thrombocytosis between Tumor Stage and Grade in Patients with Endometrial Cancer

OBJECTIVE We aimed to evaluate the predictive value of preoperative thrombocytosis for postoperative tumor stage and tumor grade in patients with endometrial cancer. MATERIALS AND METHODS This was a retrospective study carried out in our gynecologic oncology department between January 2000 and December 2011. We reviewed the medical charts of 190 patients diagnosed with endometrial carcinoma and underwent complete staging procedure. The clinicopathologic characteristics of the patients such as; age, gravidity, parity, menopausal status, body mass index, co-morbidities (diabetes, hypertension etc.), stage, grade, histological subtype, depth of myometrial invasion, peritoneal washing cytology and preoperative platelet count were recorded. Endometrioid adenocarcinomas were graded according to the FIGO classification. Blood samples for the measurement of platelet count were obtained 3 days prior to the surgery. Thrombocytosis was defined as a platelet count of 300×10(9)/L. P values less than 0.05 derived from two-tailed tests were considered statistically significant. RESULTS The mean age of the study population was 55.4 (range 33-80) years. The mean gravidity was 3.8 (range 0-12) and the mean parity was 3.32 (range 0-11). 108 (56,8%) patients were with body mass index of >30 kg/m(2). The mean platelet count among women was 288, 6±90.7×10(9)/L (range 105-772×10(9)/L). The majority of the patients were with early stage diseases during the surgeries. 170 (89.5%) of the patients had stage I to II disease, and 20 (10.5%) of them had stage III to IV disease. There were no statistical significance between thrombocytosis and age, gravidity, parity, BMI, cancer grade and stage, histological subtype of the tumor, depth of invasion, cervical involvement, intrauterine tumor volume and peritoneal washing cytology. CONCLUSION We found that preoperative platelet count was not correlated with the stage or grade of endometrial cancer.

Management of intractable postpartum haemorrhage in a tertiary center: A 5-year experience

Background: The purpose of this study is to describe treatment alternatives to prevent postpartum hysterectomy after failure of conventional therapies. Prevention of hysterectomy was the main outcome studied. Materials and Methods: This is a retrospective study of 19 patients diagnosed to have intractable postpartum hemorrhage and not managed with medical treatment who were subsequently treated with operative interventions in our unit between January 2004 and January 2009. The cases were identified by review of medical records. Results: In the period under review, a total of 17,341 deliveries were conducted, out of which 19 women were managed for intractable PPH. The incidence of severe PPH unresponsive to standard medical treatment was 0.1%. The mean maternal age was 33.5±3.4 years (range 27–39 years). The mean gestational age was 38.3±1.3 weeks (range 37–41 weeks). Organ preserving surgery methods were utilized in all the patients with a success rate 78.9%. The mean duration of surgery was 95 minutes (range 50–130 minutes) and the mean hospital stay was for 5 days. The mean transfused blood volume was 2.4 units as packed red cells. Among these 19 cases, 4 cases were resorted to hysterectomy. Conclusions: In the presence of uncontrolled hemorrhage, this simple procedure should be tried before other complex treatment alternatives are undertaken. Our case series suggests that the combination of uterine artery ligation with B-Lynch sutures might be the best surgical approach because it preserves future fertility better than other methods and avoids high operative risks and morbidity.

Identification of patients at risk for preeclampsia with the use of uterine artery Doppler velocimetry and copeptin.

Abstract Purpose: To investigate the relationship between maternal copeptin levels and uterine artery Doppler examination and progress of preeclampsia. Materials and methods: A cross-sectional study was designed with women those were screened at 20 + 0 – 24+  6 weeks’ gestation between May 2014 and August 2014. The obstetric records of all normotensive women were examined. Uterine artery Doppler velocimetry results and serum copeptin levels were measured. The patients were divided into two groups according to normal (n = 67) and abnormal uterine artery Doppler (n = 21) findings. Results: Maternal age was significantly lower in group 1 (n = 21, 23.9%) than in group 2 (n= 67, 76.1%) (p < 0.05). We found no differences in maternal characteristics, birth weight, gestational age at delivery and copeptin levels between the two groups. Maternal serum copeptin levels were higher in women who subsequently developed preeclampsia. There was also a significant correlation between copeptin levels and the presence of preeclampsia. (p = 0.002). Conclusions: Copeptin levels are significantly higher in patients who develop preeclampsia.

The effect of tubal sterilization with the Pomeroy technique and bipolar electrocauterization on the ovarian reserve and serum anti-Müllerian hormone levels in a rat model

OBJECTIVE To investigate the effects of tubal sterilization techniques on the ovarian reserve and serum anti-Müllerian hormone (AMH) levels in rats. STUDY DESIGN Wistar Hannover rats (n=21) were assigned to the following 3 groups (7 rats/group): Pomeroy technique, bipolar electrocauterization, and control. Pre- and postoperative serum AMH levels, ovarian damage and ovarian follicle counts were assessed. RESULTS Total ovarian damage was higher in the electrocauterization group than in the Pomeroy (p=0.008) and control (p<0.0001) groups. The large antral follicle count was higher in the Pomeroy group than in the electrocauterization (p=0.023) and control (p=0.003) groups. The electrocauterization group had a greater decrease in postoperative serum AMH levels than the Pomeroy and control groups (p=0.031). CONCLUSION Bipolar electrocauterization may have a negative effect on the ovarian structure and ovarian reserve compared to the Pomeroy technique.

Management of incidental adnexal masses on caesarean section

Background: The reported incidence of adnexal masses during pregnancy vary from 1 in 81 pregnancies to 1 in 8000 pregnancies. There is still a debate on management of incidental adnexal masses during the caesarean section concerning the risk of this additional procedure on postoperative morbidity and mortality. The aim of our study was to investigate the management of incidental adnexal masses which were observed during caesarean section in a tertiary health care centre. Materials and Methods: The medical records of the patients who had incidental adnexal masses during caesarean section at Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Department of Obstetrics and Gynecology from January 2006 to September 2011 were evaluated retrospectively. The data was processed with the SPSS 16.0 statistical software. Results: The number of total live births was 17341 and 6624 of them were done by caesarean section (31%). There were 38 cases of incidental adnexal masses which were discovered at caesarean section. The most common pathologic diagnosis of the masses were paraovarian–paratubal cysts with the rate of 23.7% (n=9). Cystectomy procedure during caesarean section did not alter the morbidity of the patient. Conclusions: In conclusion for detecting adnexal masses during pregnancy follow-up of growth rate of adnexal mass will be a useful reference during the observation period if ideally all pregnant women have a first-trimester ultrasound examination with regular adnexa check-up.

Transverse vaginal septum: a benign reason for elevated serum CA 19-9 and CA 125 levels.

Transverse vaginal septum is relatively rare anomaly, occurring in about 1 in 70,000 girls [1]. It is a developmental defect in the embryogenesis of the vagina that leads to incomplete fusions between the mullerian duct component and the urogenital sinus component of the vagina [2]. The patients complain about hydrocolpos, primary amenorrhea and cyclic pelvic pain due to the development of hematocolpos [3]. Tumor markers such as CA19-9 and CA125 are commonly used markers in the diagnosis of pelvic masses. CA19-9, a side branch of the Lewis blood group system, is a sialylated Lewis A antigen that is highly expressed by many adenocarcinomas of the digestive tract. The CA125 is expressed in coelomic epithelia such as mullerian epithelium, peritoneum, pleura and pericardium [4]. In the literature, transverse vaginal septum is not considered as a benign gynecological disorder that causes elevation of CA19-9 and CA125. By presenting this case, we wanted to mention about vaginal anomalies that cause elevation of tumor markers with a literature review.

Evaluation of cardiac risk marker levels in obese and non-obese patients with polycystic ovaries.

Abstract Objective: To compare cardiac risk markers such as asymmetric dimethyl arginine (ADMA), C-reactive protein (CRP), homocystein (Hcy), plasminogen activator inhibitor-1 (PAI–1), vascular endothelial growth factor (VEGF), angiopoietin-related growth factor 6 (ANGPTL6) in obese and non-obese patients with polycystic ovary syndrome (PCOS). Study design: Thirty obese (BMI >30 kg/m2) and 30 non-obese (BMI < 30 kg/m2) patients diagnosed with PCOS and 30 age-matched healthy controls were included in the study. The ages of subjects were varying between 18 and 30 years. Serum ADMA, CRP, Hcy, PAI-1, VEGF and ANGPTL6 levels were analyzed for each subject. Results: Serum ADMA, CRP, Hcy, PAI-1, VEGF and ANGPTL6 levels were significantly elevated in obese and non-obese women with PCOS in comparison to control subjects (p < 0.05). This elevation was more obvious in the obese PCOS group than in the other group. Conclusions: Cardiovascular risk markers such as ADMA, CRP, Hcy, PAI-1, VEGF and ANGPTL6 levels are elevated in women with PCOS.