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Öğe Abdominal sacrohysteropexy in young women with uterovaginal prolapse - results of 20 cases(Sci Printers & Publ Inc, 2006) Demirci, Fuat; Özdemir, İsmail; Somunkıran, Aslı; Doyran, Gönül Duras; Alhan, Ali; Gül, BarışOBJECTIVE: To report the results of abdominal sacrohysteropexy with polypropylene mesh in young women who wish to retain their uteri following uterovaginal prolapse. STUDY DESIGN: Twenty young women underwent abdominal sacrohysteropexy and concomitant reconstructive surgery. The preoperative and postoperative protocols included a urogynecologic history, physical examination, voiding diary, 1-hour pad test, cough stress test, multichannel urodynamic studies and administration of a validated, prolapse-specific symptom inventory and quality of life instrument. RESULTS: Of the 20 patients with marked uterovaginal prolapse, 13 had urodynamic stress incontinence. Anterior and posterior vaginal wall prolapse and urodynamic stress incontinence recurred in 1 of 20 patients (5%) at a mean follow-up of 25 months. Nineteen patients stated that their sex life had improved, although 3 of them had dyspareunia. One patient was dissatisfied owing to persistent dyspareunia. The postoperative values on the symptom inventory and quality of life scores were significantly lower than the preoperative values. The low scores suggest satisfaction and no symptoms of prolapse. CONCLUSION: Abdominal sacrohysteropexy is effective and safe in the treatment of uterovaginal prolapse in women who wish to retain their uteri. It maintains a durable anatomic restoration, normal vaginal axis and sexual function. The success rate is excellent for correcting prolapse, and the complications are minimal.Öğe Can maternal height predict shorter cervical length in asymptomatic low-risk pregnant women?(Elsevier Science Bv, 2011) Albayrak, Mustafa; Özdemir, İsmail; Koç, Önder; Coşkun, EsraObjective: To evaluate the association between maternal height and cervical length in the first and second trimesters in low-risk asymptomatic pregnant women. Study design: Maternal height and cervical length of 146 asymptomatic women with singleton pregnancies at low risk for preterm birth were measured during the first and second trimesters. Preterm birth was defined as birth before <37 gestational weeks. Correlations between maternal height and cervical length measurements were determined using Pearson correlation analysis. The women were also divided into three groups based on height percentiles: <25% (Group I), 25-75% (Group II) and >75% (Group III). Cervical lengths were compared among groups. Correlations between cervical length and maternal height and statistically significant differences in cervical length among height percentile groups were the main outcomes. Results: Maternal height was positively but weakly correlated with first and second trimester cervical lengths (p = 0.047, r = 0.167 and p = 0.039, r = 0.197 respectively). The mean first trimester cervical lengths were significantly different between the groups (p = 0.04). There were no significant differences, however, in the mean second trimester cervical lengths among the three groups although the difference was close to significance (p = 0.06). Conclusion: Although our results indicate a relationship between maternal height and cervical length in our population, maternal height seems to have only limited value in identifying women to be screened for shorter cervical length in a low risk asymptomatic population. (C) 2011 Elsevier Ireland Ltd. All rights reserved.Öğe A case of primary Addison's disease with hyperemesis gravidarum and successful pregnancy(Elsevier Sci Ireland Ltd, 2004) Özdemir, İsmail; Demirci, Fuat; Yücel, Oğuz; Şimşek, Enver; Yıldız, İdrisWe followed up a pregnant woman with Addison's disease diagnosed before conception. She presented with hyperemesis gravidarum. Throughout pregnancy, she received prednisone and the basic disease did not deteriorate during pregnancy. She was delivered by caesarean section due to breech presentation. The fetal prognosis was good.Öğe Cervical length changes during normal pregnancy by transvaginal ultrasonography(2004) Özdemir, İsmail; Demirci, Fuat; Yücel, Oğuz; Mayda, AtillaObjective: To evaluate the relationship between cervical length and gestational age in uncomplicated pregnancy in nulliparous versus multiparous women. Study Design: We studied a cross-sectional sample of 120 singleton pregnancies, including 58 nulliparous and 62 multiparous women. The ultrasonographic assessment of the cervix was performed between 10 and 12, 22 and 24, and 32 and 34 weeks of gestation. The inclusion criteria were ultrasonographic confirmation of gestational age by a combination of reliable last menstrual period and ultrasonographic measurements, absence of any risk factors for preterm birth, and an uncomplicated pregnancy with expected delivery after 37 completed weeks. If the cervical canal appeared curved, the canal length was measured in multiple linear segments. Means, SDs, and 95% confidence limits were reported for each study period. Student t test was used to compare the groups. Results: A linear relationship was found between cervical length and gestational age (R = 0.90; R2 = 0.85; P < 0.001). Cervical length actually shows a progressive, linear decrease throughout the investigated period of gestation. Although cervical length at each trimester was longer in multiparous than in nulliparous women there was no statistically significant difference between the two groups (P > 0.05). Conclusion: There is a spontaneous shortening in the pregnant cervix throughout gestation, whit a more shortening of the cervical length from the 22-24-week scan to the 32-34-week scan. Reference ranges for the trimesters might be more useful than a single cot-off value for more efficient early diagnosis and management of preterm labour.Öğe Comparison of colour Doppler indices of pelvic arteries in women with bilateral hypogastric artery ligation and controls(2005) Demirci, F.; Özdemir, İsmail; Şafak, Alp Alper; Özden, Selçuk; Somunkiran, AslıThe aim of this study is to compare the blood flows of bilateral uterine, ovarian and arcuate arteries in patients who underwent bilateral hypogastric ligation (BHL), with the controls having similar characteristics. The S/D, the RI and the PI were measured on uterine, arcuate and ovarian arteries in 7 women with BHL and compared with 10 controls. There were not significant differences between the Doppler indices of the two groups. In conclusion, our study suggests that BHL preserves pelvic function and fertility. © 2005 Taylor & Francis Group Ltd.Öğe Comparison of the diagnostic efficacy of the two rapid bedside immunoassays and combined clinical conventional diagnosis in prelabour rupture of membranes(Elsevier Science Bv, 2011) Albayrak, Mustafa; Özdemir, İsmail; Koç, Önder; Ankaralı, Handan; Özen, OrhanObjective: Diagnosis of prelabour rupture of membranes (PROM) may be challenging. Conventional diagnostic methods such as speculum examination, ferning pattern, and pH detection are not satisfactorily accurate. Two relatively new, commercially available rapid bedside immunoassay strip tests, for placental alpha microglobulin-1 (PAMG-1) and insulin-like growth factor binding protein-1 (ILGFBP-1), are alleged to be more accurate. We compared the diagnostic efficacy of PAMG-1 and ILGFBP-1 immunoassay tests and combined conventional clinical diagnostic methods in PROM. Study design: 167 pregnant women with signs and/or symptoms of PROM were prospectively evaluated with a combination of conventional clinical tests including speculum examination, nitrazine, ferning pattern, and pooling, in addition to PAMG-1 and ILGFBP-1 immunoassays. Differences in sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the diagnostic methods were compared. Results: Although the PAMG-1 assay was more accurate, the PAMG-1 immunoassay, ILGFBP-1 immunoassay, and combined conventional clinical diagnosis were, in fact, all highly accurate with no significant difference in sensitivity, specificity, PPV, NPV, or accuracy. Conclusion: Both rapid bedside strip tests may be used in clinical practice with similar efficacy in diagnosing PROM, particularly as a backup when diagnosis is still in doubt following a combination of conventional diagnostic methods. (C) 2011 Elsevier Ireland Ltd. All rights reserved.Öğe Congenital sialoblastoma (embryoma) associated with premature centromere division and high level of alpha-fetoprotein(John Wiley & Sons Ltd, 2005) Özdemir, İsmail; Şimşek, Enver; Sılan, Fatma; Demirci, FuatSialoblastoma is a rare, locally aggressive, and potentially malignant perinatal salivary tumor that predominantly affects the parotid glands. To date, 29 cases of sialoblastoma have been reported. We report a further case of sialoblastoma diagnosed at 37 weeks of gestation presenting with novel findings that are the premature centromere division and a high level of alpha-fetoprotein.Öğe Cord blood lipoprotein profile after magnesium sulphate treatment in pre-eclamptic patients(Wiley, 2006) Yavuz, Taner; Yavuz, Özlem; Özdemir, İsmail; Afşar, YılmazAim: To determine lipoprotein metabolism alterations in magnesium-exposed neonates of women with pre-eclampsia. Methods: The study group comprised seven singleton neonates of women with pre-eclampsia at term and treated with magnesium sulphate. Controls were 26 neonates of uncomplicated pregnancies of term delivery. Total serum magnesium concentrations were analysed by the photometric colour method. Total serum cholesterol, triglycerides and high-density lipoprotein cholesterol ( HDL-C) levels were determined by enzymatic colour methods, while apoprotein ( apo)A-I and apo B values were measured by immunoturbidimetry. Low-density lipoprotein cholesterol ( LDL-C) levels were calculated by Friedewald's formula. Very-low-density lipoprotein cholesterol levels, total cholesterol/HDL-C, apo B/apo A-I, LDL-C/apo B, LDL-C/HDL-C, and HDL-C/apo A-I ratios were determined by calculation. Results: Magnesium levels of magnesium-exposed neonates were found to be 1.6 times higher than those of controls. Magnesium-exposed neonates had lower serum apo A-I levels, and they had higher apo B/apo A-I and HDL-C/apo A-I ratios when compared to controls. Conclusion: The lipoprotein profile became more atherogenic in magnesium-exposed neonates as it may be a potential risk factor of cardiovascular heart disease.Öğe Dilatasyon ve küretajda propofol ile birlikte kullanılan tramadol, diklofenak ve fentanil’in etkinliklerinin karşılaştırılması(2006) Demirakan, Yavuz; Somunkıran, Aslı; Sezen, Gülbin; Kocaman, Buket; Hayıt, Feray; Özdemir, İsmailObjektif: Küretaj operasyonlarında postoperatif ağrı, derlenme ve sedasyon düzeyi ile intravenöz anestetik ilaç kullanımı ve hemodinamiye etkileri açısından diklofenak, tramadol ve fentanilin karşılaştırılması amaçlandı. Planlama: Randomize prospektif klinik çalışma. Ortam: Üniversite hastanesi Hastalar: Fraksiyone küretaj planlanan 63 hasta Girişim: Hastalar 3 gruba ayrıldı. Grup 1’de indüksiyondan 30 dk önce im diklofenak 1 mg/kg, grup 2’de indüksiyondan 15 dk önce iv tramadol 1 mg/ kg, grup 3’de indüksiyonda iv fentanil 1 μg/ kg dozunda uygulandı. İndüksiyon için propofol 2 mg/ kg ile yüz maskesi uygulanarak % 50 hava ve O2 ile devam edildi, idame ihtiyacı olduğunda propofol indüksiyon dozunun % 20 si olarak tekrarlandı. Değerlendirme Parameteleri: Peroperatif ve postoperatif SKB, DKB, OKB, KAH ve SpO2 kaydedildi. Postoperatif olarak 1, 5, 15, 30 ve 120. dakikalarda; Visual Analog Skala 0-10 cm, sedasyon skoru 0-4 puan, Aldrete derlenme skoru 1-10 puan arasında değerlendirildi. SONUÇ: İndüksiyon için fentanil kullanılan grupta indüksiyon öncesi tramadol ya da diklofenak kullanılan gruplara göre anlamlı olarak daha az propofol ihtiyacı izlendi ( p= 0.012 ve p=0.013). YORUM: Fentanil kullanımı, tramadol ve diklofenak kullanımına göre propofol tüketimini azaltmıştır. Buna rağmen, postoperatif ek analjezik ihtiyacının daha az olması ve narkotik analjezik olmamaları nedeniyle tramadol ve diklofenak’ın daha avantajlı olduğunu düşünmekteyiz.Öğe Effect of clomiphene citrate on ovarian, endometrial, and cervical histologies in a rat model(Karger, 2005) Özdemir, İsmail; Üstündağ, Nil; Güven, Aysel; Duran, Bülent; Demirci, FuatObjective: To examine the effect of clomiphene citrate ( CC) on the ovarian, endometrial, and cervical histologies in a rat model. Methods: The rats (n = 40) were randomly assigned to 4 treatment groups: CC 50 ( repetitive doses of 0.2 mg CC); CC 100 ( repetitive doses of 0.4 mg CC); CC 200 ( repetitive doses of 0.8 mg CC), and control ( repetitive doses of normal saline). Each study group received its CC dose intraperitoneally in 2 ml saline for 5 days and the controls received 2 ml saline only. Each treatment cycle was repeated six times. Six months later the rats were euthanized. Their ovaries, uterine horns, and cervices were removed and examined for histologic changes. Results: We found no significant difference in the number of follicles and corpora lutea of the study groups ( p >0.05). The numbers of granulosa, theca, and luteal cells of the CC 100 and CC 200 groups were significantly higher than those of the CC 50 group and controls ( p < 0.05). There was no important finding related to pre-malign and malign changes in ovarian, endometrial and cervical samples of the control and CC 50 groups. Focal atypia and atypical mitoses were noted in 2 cases of granulosa cells in the CC 100 and CC 200 groups. Conclusion: We did not find an association between the use of CC and ovarian, endometrial, and cervical neoplasms; nevertheless, we noticed an increase in granulosa, theca and luteal cells with high doses of CC, which may be a risk factor for granulosa, theca, and luteal cell tumors.Öğe Effects of tibolone on blood flow resistance and intima-media thickness of the carotid arteries: effect of time since menopause(Taylor & Francis Ltd, 2006) Somunkıran, Aslı; Yazıcı, Burhan; Demirci, Fuat; Erdoğmuş, Beşir; Özdemir, İsmailObjective The aim of this prospective study was to evaluate the effects of tibolone on carotid atherosclerosis in healthy postmenopausal women. Methods Twenty-five healthy postmenopausal women were included in the study. Patients received tibolone 2.5 mg daily for 6 months. Resistance indices of the common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA) and vertebral arteries, and intima-media thickness of the CCA were measured both at baseline and at the end of the study with ultrasonography. Results No significant differences were observed in the resistance indices of the CCA, ICA, ECA and vertebral arteries, as well as intima-media thickness of CCA at 6 months in comparison with baseline. Tibolone significantly improved the intima-media thickness of the CCA of women who were less than 18 months since menopause. Conclusion Overall, these results demonstrate no significant effects of tibolone on either intima-media thickness or blood flow resistance in the carotid arteries in postmenopausal women. However, the results suggest that tibolone may have a positive effect on the vascular system if commenced within 18 months since menopause; this warrants further investigation.Öğe Elektif sezaryen girişimlerinde intratekal hiperbarik bupivakain ile ropivakain'e eklenen sufentanil'in karşılaştırılması(2006) Hayıt, Feray; Demiraran, Yavuz; Sezen, Gülbin; Kocaman, Buket; İskender, Abdulkadir; Özdemir, İsmailAmaç: Bu çalışmada elektif sezaryen için sufentanil eklenen hiperbarik ropivakain ve bupivakain kombinasyonlarının intratekal verilmesinin motor ve duyusal blok özellikleri, anne ve bebek üzerine etkilerinin karşılaştırılması amaçlandı. Yöntem: Çalışma, ASA I-II, 18-40 yaşları arasında elektif sezaryen operasyonu geçirecek miadında 60 gebe kadında, prospektif ve randomize olarak planlandı. İntratekal olarak 30 gebeye 12.5 mg hiperbarik bupivakain+5 pıg sufentanil 3 mL serum fizyolojik içinde (Grup HBS) ve diğer 30 gebeye de 12.5 mg hiperbarik ropivakain+5 pıg sufentanil 3 mL serum fizyolojik içinde (Grup HRS) kullanıldı. Bulgular: HRS grubunda, HBS grubuna göre maksimum duyusal bloğa ulaşma süresi istatistiksel olarak anlamlı çıkmasa da daha kısa idi. İki segment regresyon süresi HRS grubunda, HBS grubundan daha kısa bulundu. Gruplar arası karşılaştırmada motor blok oluşma süresi ve motor blok kalkış süreleri HRS grubunda anlamlı daha kısa idi (p<0.05). Sonuç: Sezaryen ile gerçekleştirilen doğumlarda, intratekal hiperbarik bupivakain ve hiperbarik ropivakaine sufentanil ilavesinin güvenle kullanılabileceği kanısına varılmıştır.Öğe Emergency peripartum hysterectomy: A 9-year review(2006) Yücel, Oğuz; Özdemir, İsmail; Yücel, Neşe; Somunkıran, AslıObjective: To determine the incidence, indications, risk factors, and complications of emergency peripartum hysterectomy. Study design: A retrospective study of the patients requiring an emergency peripartum hysterectomy of a 9-year period was conducted. Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment less than 24 h after delivery. Demographic and clinical variables were obtained from the maternal records. Results: There were 34 emergency peripartum hysterectomies out of 117,095 deliveries for a rate of 0.29 per 1,000. Of the 16 cases that were delivered by cesarean section, seven had a previous cesarean section and 18 cases were delivered vaginally, including two using vacuum extraction. Total hysterectomy was performed in 24 patients, and subtotal hysterectomy in ten patients. The indications for hysterectomy were uterine rupture (n = 12), placenta accreta (n = 10), uterine atony (n = 7), and hemorrhage (n = 5). There were two maternal deaths, six stillbirths, and two early neonatal deaths. Conclusion: This study identified surgical deliveries, uterine rupture, placenta accreta, and uterine atony as risk factors for emergency peripartum hysterectomy. The most common reason for abnormal placental adherence was a previous cesarean section. Multiparity and oxytocin use for uterine stimulation were among the risk factors for uterine atony that necessitated emergency peripartum hysterectomy. © Springer-Verlag 2006.Öğe Etiologic agents of cervicovaginitis in Turkish women(Saudi Med J, 2006) Öztürk, Cihadiye E.; Özdemir, İsmail; Yavuz, Tevfik; Kaya, Demet; Behçet, MustafaObjective: To investigate the distribution of microbiologic agents causing cervicovaginitis. Methods: We conducted the study between October 2002 and December 2004 in Abant Izzet Baysal University, Duzce School of Medicine Hospital, Turkey. The samples were obtained from the posterior vaginal fornix and cervix by swabs in 828 patients. Direct microscopic examination, culture and enzyme immune assay (EIA) methods were performed in all patients for diagnosis of microbiologic agents. Results: Gardnerella vaginalis (G. vaginalis) were diagnosed in 254 (30.7%) patients, Candida albicans (C. albicans) in 152 (18.4%), Candida glabrata (C. glabrata) in 36 (4.3%), Candida species in 52 (6.3%), Staphylococcus aureus (S. aureus) in 62 (7.5%), Streptococcus group B in 28 (3.4%), Escherichia coli (E. coli) in 42 (5.1%), Klebsiella species in 24 (2.9%), and Streptococcus group D in 8 (1%) patients in culture. Less frequent enterobacteria in 30 (3.6%) were: Pseudomonas species, Proteus species Enterobacter species, Hafnia alvei and Nonfermenter species. Neisseria gonorrheae (N. gonorrheae) was detected in one patient (0.1%) in culture. The Chlamydia trachomatis (C. trachomatis) antigen was detected by EIA methods in 130 (15.7%) patients and Trichomonas vaginalis (T vaginalis) was observed in 8 (1%) patients by direct microscopic examination. Conclusion: Performing the etiologic diagnosis of cervicovaginitis is necessary in order to take appropriate therapeutic and preventive measures. Therefore, we recommend G. vaginalis, C. albicans and C. trachoniatis should be investigated in patients having a diagnosis of cervicovaginitis in our population, since these were detected in a considerable number of cases. Additionally, C. glabrata and T vaginalis should be kept in mind as possible pathogens.Öğe Gastric cancer in pregnancy(Elsevier Sci Ireland Ltd, 2003) Özdemir, İsmail; Pehlivan, Mevlüt; Demirci, FuatA 27-year-old multigravida was examined on multiple occasions during pregnancy for mild epigastric discomfort. She was admitted to our clinic for the first time at 16 weeks of gestation and the diagnosis of hyperemesis gravidarum was made. Afterwards, she was readmitted with the complaints of loss of appetite, nausea, and vomiting. Those symptoms were interpreted as relevant with the pregnancy and the patient improved with the medical treatment. During the third admission at 28 weeks with the previous symptoms, a gastroscopy was performed showing ulcerous lesions in the antrum.Öğe In vitro stability of pregnancy-associated plasma protein A(2005) Coşkun, Abdurrahman; Özdemir, İsmail; Yavuz, Özlem; Güler, Selver; Şahin, İbrahim E.Objective: Pregnancy-associated plasma protein A is produced in high concentration by trophoblasts during pregnancy and maternal serum assessment between 11 and 14 weeks of gestation has significant utility in screening for Down syndrome and other chromosomal anomalies. We aimed to investigate the in vitro stability of pregnancy-associated plasma protein A. Materials and Methods: Blood samples were collected from volunteer pregnant women and divided into two groups. The first and second groups were stored at +2 to +8°C for 7 days and at -20°C for 28 days, respectively. Pregnancy-associated plasma protein A was determined each day in the first group and each week in the second group. Results: There was no statistically significant difference between measurements in each group (p>0.05). Conclusion: We concluded that serum pregnancy-associated plasma protein A is stable for at least 7 days at +2 to +8°C and 28 days at -20°C, and could be preserved for up to one month in average laboratory conditions.Öğe In vivo evaluation of the genotoxic effects of clomiphene citrate on rat reticulocytes: a micronucleus genotoxicity(Karger, 2006) Duran, Bülent; Özdemir, İsmail; Demirel, Yeltekin; Özdemir, Öztürk; Çetin, Ali; Güven, AyselObjective: To determine the genotoxic effects of clomiphene citrate (CC) on rat reticulocytes in vivo. Methods: In this prospective, randomized, controlled study, rats were each assigned randomly to the CC 50, CC 100, CC 200, or control group and were given repeat doses of 0.16, 0.32 or 0.64 mg CC, or normal saline, respectively. Each study group received its CC dose in 2 ml of saline intraperitoneally for 5 days, while the control group received only 2 ml of saline. Each treatment cycle was repeated six times. Six months later, the rats were euthanized. Bone marrow tissues were removed, and pluripotent reticulocyte cells with micronuclei, nuclear buds, and binuclear abnormalities were analyzed using an in situ micronuclei assay under light microscopy. The proportion of micronucleated erythrocytes was measured. Results: Fewer cells with nuclear buds and binuclear abnormalities were detected in the CC 50 group and controls. The CC 100 and 200 groups had significantly (p < 0.05) more nuclear buds and binuclear abnormalities compared with the CC 50 group and controls in the cytogenetic analysis of bone marrow stem cells. Conclusion: In rats, the micronucleus genotoxicity assay suggests a dose-dependent CC effect on genomic instability in bone marrow stem cells in vivo.Öğe Interrelations among abnormal cardiotocograms in labor, arterial cord blood pH, base deficit and apgar scores in pregnancies(2005) Özdemir, İsmail; Yavuz, Taner; Yavuz, Özlem; Demirci, Furat; Somunkıran, AslıAmaç: Gebelerde fetal asidozu belirlemek için fetal kalp hızının klinik doğruluğunu değerlendirmek. Gereç ve yöntem: Doğum eylemindeki 38-40 gebelik haftaları arasındaki 55 gebe kardio-tokogram ile monitorize edildi ve doğumda umbilikal kordon gaz analizleri çalışıldı. Umbilikal kordon kan gazlan sonuçlarını ve neonatal bebeklerin durumlarını bilmeyen bir araştırmacı, fetal kalp atım traselerini değerlendirdi. Variabilite kaybı (amplitüd < 5 atım), variabilya da geç deselerasyon anormal kalp atım paterni olarak değerlendirildi. Umbilikal arter PH < 7.1,1. ve 5. dakika Apgar skorları < 7 ve umbilikal arter baz açığı > -14 değerleri fetal asidoz olarak değerlendirildi. Fetal kalp atım paternleri, umbilikal kan gazı, baz açığı ve Apgar skorları fetal asidozun prediksiyonu için çalışıldı. İstatistiksel değerlendirmede Ki-kare (Fisher's exact) test kullanıldı. P < 0.05 değeri istatistiksel olarak anlamlı kabul edildi. Bulgular: Anormal, fetal kalp traselerinin düşük Apgar skorun düşüklüğünü belirlemedeki sensitivite, spesifisite, pozitif ve negatif prediktif değerleri 1. dakika için sırasıyla, % 100, % 90.2, % 44.4, % 100 ve 5. dakika için % 100, % 88.9, % 14.3 ve %100 bulundu. Anormal fetal kalp hızı paterninin umbilikal aıterpH'smm < 7.1 olmasını belirlemedeki sensitivite, spesifisite, pozitif ve negatif prediktif değerleri sırasıyla % 88.8, % 97.8,'% 88.9 ve % 97.8 bulundu. Anormal fetal kalp hızı paternlerinin umbilikal arter baz açığını belirlemedeki sensitivite, spesifisite, pozitif ve negatif prediktif değerleri sırasıyla, % 75.0, % 93.6, % 66.7 ve % 95.6 bulundu. Sontiç: Fetal kalp hızı monutörizasyonu fetal asideminin saptanmasında faydalı olsa bile, anormal trase varlığında operatif doğum oranlarında artışa . neden olmaktadır. Bu nedenle, obstetrisyen anormal trase yarlığında yüksek yalancı pozitiflik nedeniyle gereksiz sezaryen doğumlardan kaçınmalıdır.Öğe Intrathecal sufentanil (1.5?g) added to hyperbaric bupivacaine (0.5%) for elective cesarean section provides adequate analgesia without need for pruritus therapy(2006) Demiraran, Yavuz; Özdemir, İsmail; Kocaman, Buket; Yücel, OğuzPurpose: We compared the effects of different doses of intrathecal sufentanil when administered together with hyperbaric bupivacaine for elective caesarean section. Methods: This was a prospective, randomized, double-blind, controlled trial involving 100 pregnant women, American Society of Anesthesiologists (ASA) I-II, who were scheduled for elective caesarean section under spinal anesthesia. The patients were assigned to four groups according to the dose of sufentanil used: no sufentanil (group I; placebo) or 1.5, 2.5, or 5.0?g sufentanil (groups 2-4, respectively). In every group, the local anesthetic used was hyperbaric bupivacaine 0.5% (12.5 mg), and the total volume of the solution was 3.5 ml. The duration of complete analgesia, maternal side effects, and maternal/ fetal outcomes were recorded. The duration of complete analgesia was defined as the time from intrathecal injection to a vernal analogue score (VAS) of more than 0. Results: No patient experienced intraoperative pain. The duration of complete analgesia was prolonged in all groups receiving opioids. The duration of the analgesia and the 0- to 6-h intravenous analgesic requirements were similar in the sufentanil groups. Moreover, the sufentanil groups had longer durations of complete analgesia than the placebo group. Pruritus was more frequent in the 2.5- and 5-?g sufentanil groups than in the 1.5-?g sufentanil and placebo groups. There were no differences among the groups in umbilical cord blood gases on in neonatal Apgar scores. Conclusion: The addition of sufentanil 1.5 and 2.5?g to hyperbaric bupivacaine provided adequate anesthesia for caesarean delivery and good postoperative analgesia. In addition, the incidence of pruritus was significantly lower in the 1.5-?g sufentanil group when compared with that in the 2.5- and 5-?g groups. © JSA 2006.Öğe Isolated 17,20-lyase (desmolase) deficiency in a 46,XX female presenting with delayed puberty(Elsevier Science Inc, 2005) Şimşek, Enver; Özdemir, İsmail; Lin, Lin; Achermann, John C.Main Outcome Measure(s): Detailed biochemical, radiological, and molecular analysis, including pelvic ultrasound, basal steroid hormone analysis in serum and aspirated follicle fluid, serum steroid measurement after ACTH (Synachten) and human chorionic gonadotropin (hCG) stimulation, and molecular analysis of CYP17. Result(s): This girl with hypergonadotropic hypogonadism (LH 65 U/L, FSH 50 U/L) had a 46,XX karyotype, small uterus and enlarged cystic ovaries, and markedly delayed bone age (9 years). Basal (serum, follicular) and stimulated (serum) steroid hormone levels were consistent with isolated 17,20-lyase deficiency whereas relatively normal P and 17-hydroxyprogesterone concentrations were detected together with very low androstenedione, T, and E2 levels. Conclusion(s): Isolated 17,20-lyase deficiency should be considered in the differential diagnosis of hypergonadotropic hypogonadism in 46,XX females, and follicular fluid steroid analysis is a useful adjuvant test. Failure to detect mutations in CYP17 raises the possibility of a novel association of these phenotypes.
