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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 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 Costs and Efficacy of Intravenous and Orally Disintegrating Ondansetron Tablet as a Prophylactic Antiemetic Therapy in Major Gynecologic Operations(Galenos Yayincilik, 2005) Demiraran, Yavuz; Ozdemir, Ismail; Kocaman, Buket; Hayit, Feray; Demirci, FuatObjective: The aim of the study is to compare the antiemetic efficacy and costs of oral rapid disintegrating ondansetron tablets and intravenously administered ondansetron in patients undergoing major gynecologic surgery. Materials and Methods: Anesthesia was induced with thiopenthone, vecuronium and fentanyl. Nitrous oxide and sevoflurane were used to maintain anesthesia. Patients were prospectively randomized into three groups of 30 patients each, receiving either ondansetron 8 mg intravenously or saline infusion only or oral rapid disintegrating tablets of 8 mg ondansetron. The patients were evaluated for nausea and vomiting at 1st, 5th, 10th, 20th, 30th, 60th, and 120th minutes and 6th hours postoperatively. Results: There were no significant differences in adverse effects between placebo group, intravenous ondansetron group and oral ondansetron group (P>0.05). The incidence rates of nausea, vomiting and the need of metoclopropamide were higher in placebo group than intravenous and oral ondansetron groups (P<0.05). Conclusion: Postoperative nausea and vomiting are common during recovery from general anesthesia. Both oral and intravenous forms of ondansetron are efficacious in the prevention of this postoperative nausea and vomiting. Orally disintegrating tablets are inexpensive and may be administered more easily than the intravenous form of ondansetron. Therefore, oral ondansetron tablet may be an alternative to intravenous ondansetron infusion for postoperative nausea and vomiting after major gynecologic operations.Öğe Comparison of costs and efficacy of intravenous and orally disintegrating ondansetron tablet as a prophylactic antiemetic therapy in major gynecologic operations(2005) Demiraran, Yavuz; Özdemir, Ismail; Kocaman, Buket; Hayit, Feray; Demirci, FuatObjective: The aim of the study is to compare the antiemetic efficacy and costs of oral rapid disintegrating ondansetron tablets and intravenously administered ondansetron in patients undergoing major gynecologic surgery. Materials and Methods: Anesthesia was induced with thiopenthone, vecuronium and fentanyl. Nitrous oxide and sevoflurane were used to maintain anesthesia. Patients were prospectively randomized into three groups of 30 patients each, receiving either ondansetron 8 mg intravenously or saline infusion only or oral rapid disintegrating tablets of 8 mg ondansetron. The patients were evaluated for nausea and vomiting at 1st, 5th, 10th, 20th, 30th, 60th, and 120th minutes and 6th hours postoperatively. Results: There were no significant differences in adverse effects between placebo group, intravenous ondansetron group and oral ondansetron group (P>0.05). The incidence rates of nausea, vomiting and the need of metoclopropamide were higher in placebo group than intravenous and oral ondansetron groups (P<0.05). Conclusion: Postoperative nausea and vomiting are common during recovery from general anesthesia. Both oral and intravenous forms of ondansetron are efficacious in the prevention of this postoperative nausea and vomiting. Orally disintegrating tablets are inexpensive and may be administered more easily than the intravenous form of ondansetron. Therefore, oral ondansetron tablet may be an alternative to intravenous ondansetron infusion for postoperative nausea and vomiting after major gynecologic operations.Öğe Comparison of pubovaginal sling and burch colposuspension procedures in type I/II genuine stress incontinence(2001) Demirci, Fuat; Yücel, OğuzWe compared morbidity and success rate of pubovaginal sling with Burch colposuspension operations in Type I/type II genuine stress urinary incontinence (GSI). The study included patients who had no preoperative detrusor instability (DI), no recurrent GSI, no severe pelvic prolapsus and whose Valsalva leak point pressure (VLPP) values were higher than 90 cm water. Twenty three of free-rectus fascial sling and 23 of Burch colposuspension operations were performed randomly on the patients by a single surgeon. There was no statistical difference between patients in terms of age, BMI, parity, number of daily pads used and preoperative bladder neck mobility. Operation time, change in hematocrit, spontaneous voiding time, length of hospitalization and urinary infection were not different in 2 procedures. 17 patients from both groups could be compared after one year. The bladder neck mobility of both groups were similar. One surgical failure, 1 DI, 1 severe cystocele and 1 enterocele were found in the Burch group while only 1 DI was found in the pubovaginal sling group. When pubovaginal sling operation was performed as the primary surgery on the patients with type I/II GSI, the morbidity, complications and 1 year success rate are the same as Burch procedure.Öğe Comparison of Saline Infusion Sonohysterography and Hysteroscopy Findings in Patients With Abnormal Uterine Bleeding(Galenos Yayincilik, 2005) Alhan, Ali; Ozdemipr, Ismail; Somunkiran, Asli; Demirci, Fuat; Yucel, Oguz; Bahcebasi, TalatObjective: To establish the accuracy of saline infusion sonohysterography and hysteroscopy in diagnosing uterine pathology in women with abnormal uterine bleeding. Materials and Methods: A total of 39 women with abnormal uterine bleeding were recruited for the study and underwent transvaginal ultrasonography followed by saline infusion sonohysterography. During hysteroscopy, resection of the focal intracavitary lesion was performed. Endometrial sampling was obtained from all patients. Results: Sonohysterographic and hysteroscopic evaluation revealed 25 and 24 endometrial polyps, 7 each submucous myomas, 3 and 1 endometrial hyperplasia, 1 each synechia, and 3 and 6 normal findings, respectively. Comparison of histopathologic findings with other diagnostic tests revealed that hysteroscopy demonstrated a sensitivity of 97%, specificity of 72%, positive predictive value of 94%, negative predictive value of 83% and total sensitivity of 92%. Sonohysterography showed sensitivity of 97%, specificity of 29%, positive predictive value of 86%, negative predictive value of 85% and total sensitivity of 85%. Conclusion: In comparison with hysteroscopy, sonohysterography is a cheaper and easier procedure for detecting endometrial pathologies such as endometrial polyps and submucous myomas with its highly diagnostic value.Öğe Comparison of saline infusion sonohysterography and hysteroscopy findings in patients with abnormal uterine bleeding(2005) Alhan, Ali; Özdemir, Ismail; Somunkıran, Aslı; Demirci, Fuat; Yücel, Oǧuz; Bahçebaşi, TalatObjective: To establish the accuracy of saline infusion sonohysterography and hysteroscopy in diagnosing uterine pathology in women with abnormal uterine bleeding. Materials and Methods: A total of 39 women with abnormal uterine bleeding were recruited for the study and underwent transvaginal ultrasonography followed by saline infusion sonohysterography. During hysteroscopy, resection of the focal intracavitary lesion was performed. Endometrial sampling was obtained from all patients. Results: Sonohysterographic and hysteroscopic evaluation revealed 25 and 24 endometrial polyps, 7 each submucous myomas, 3 and 1 endometrial hyperplasia, 1 each synechia, and 3 and 6 normal findings, respectively. Comparison of histopathologic findings with other diagnostic tests revealed that hysteroscopy demonstrated a sensitivity of 97%, specificity of 72%, positive predictive value of 94%, negative predictive value of 83% and total sensitivity of 92%. Sonohysterography showed sensitivity of 97%, specificity of 29%, positive predictive value of 86%, negative predictive value of 85% and total sensitivity of 85%. Conclusion: In comparison with hysteroscopy, sonohysterography is a cheaper and easier procedure for detecting endometrial pathologies such as endometrial polyps and submucous myomas with its highly diagnostic value.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 Doğum sonu kanamayı önlemede rektal misoprostol ve intravenöz oksitosinin etkinliklerinin karşılaştırılması(Galenos Yayincilik, 2006) Gül, Özlem Kemik; Somunkıran, Aslı; Özdemir, İsmail; Yücel, Oğuz; Demirci, FuatObjective: To compare the effectiveness of rectally administered prostaglandine E1 anolog misoprostol and parenterally oxytocin for the prevention of postpartum hemorrhage. Design: Prospective randomized trial Setting: University hospital Patients: 240 full term pregnant women who were in active labor. Interventions: 80 patients in group 1 received 200 mu g misoprostol rectally, 80 patients in Group 2 received 400 mu g rectally misoprostol, and the third group received a solution of 1000 ml 5% DRL + 10 IU oxytocin, immediately after the delivery of the fetus. Main outcome measures: Postpartum blood loss and potential side effects of misoprostol were evaluated. Results: No statistically significant difference was found among the three groups regarding the average blood loss (F=1.50, p=0.22). Average duration of the third stage of labor was similar in all groups (F=1.13, p=0.32). Hematocrit values were similar in the groups both before (F=3.28, p=0.52) and after the delivery and (F=1.84, p=0.16). Conclusions: No differences were found between rectallymisoprostol and oxytocin treatment for the prevention of postpartum hemorrhage. Nevertheless, misoprostol can be preferred in the prevention of postpartum hemorrhage because it does not require special storage conditions, can be used safely in hypertensive patients, can be stored for many years, it is resistant to heat and its side effects such as nausea and vomiting are low when used rectally.Öğe Düşük molekül ağırlıklı heparin, proksikam ve sisaprid' in intraabdominal adezyon üzerindeki etkileri(1998) Arıkan, Yüksel; Şenel, Mahmut Ferda; Akman, Ramazan Yavuz; Demirci, Fuat; Can, CevatAmeliyat sonrası karın içi yapışıklıkların oluşması sık görülen bir durumdur. Barsak peristaltizminin azalması, enflamasyon ve doku iskemisi sorumlu tutulan faktörlerdendir. Çalışmamızda kontrol grubundaki ratlara (Grup 1) batın eksplorasyonu yapıldıktan sonra herhangi bir ilaç verilmemiş, diğer gruplarda ise karın içerisi düşük molekül ağırlıklı heparin (DMAH, Grup 2), non-steroid antienflamatuvar proksikam (Grup 3) ve prokinetik ajan sisaprid (Grup 4) verilmiştir. Ondördüncü günde raflar sakrifiye edilerek karın içifibröz bant sayısı ve enflamasyonun şiddeti karşılaştırılmıştır. Kontrol grubunda 3/10 ratta fibröz band sayısı 3'ün altında bulundu. Proksikam ve sisaprid fibröz band oluşumunu önemli derecede etkilememişlerdir. DMAH verilen grupta ise 9/10 ratta fibröz band oluşumu 3'ün altında görüldü. Kontrol grubuna oranla bu fark istatistiksel olarak anlamlıydı (p<0.05). Ayrıca bu grupta enflamasyon şiddetinin derecesi kontrol grubuna oranla daha düşüktü (p<0.05). Düşük molekül ağırlıklı heparin'in adezyonu azaltması, bu ajanın mikfotrombüs oluşumunu engelleyerek kan akımının devamlılığını sağlamasına böylece yaralanma sahasında iskemiyi engellemesine bağlanmıştır.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 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 Long-term results of burch colposuspension(Karger, 2001) Demirci, Fuat; Yücel, Oğuz; Eren, Şadiye; Alkan, Akif; Demirci, Elif; Yıldırım, UzayThe study included 220 women who had undergone Burch colposuspension. Group I (65 women) was studied prospectively and the mean follow-up was 1.5 years. Group II (155 women) was studied retrospectively and the mean follow-up was 4.5 years. The cure rate was 87.7% in group I and 77.4% in group II. The cure rate was significantly higher following the primary procedure than the secondary procedure. At follow-up, late complications in 220 women were: cystocele in 18; rectocele in 32; enterocele in 35; dyspareunia in 6, and groin or suprapubic pain in 15. In group I, of the 11 women with detrusor instability preoperatively, 10 were cured and in 1 detrusor instability persisted postoperatively, Two women had de novo detrusor instability. In conclusion, the cure rate of Burch colposuspension is satisfactory, although it declines a little with time. Women who had previous anti-incontinence surgery have a greater probability of recurrence. The procedure elevates the bladder neck into the abdominal cavity and stabilizes it. Surgical failure is related to inadequate elevation and stabilization of the bladder neck. Copyright (C) 2001 S. Karger AG, Basel.Öğe The midurethral polypropylene sling for stress incontinence: 22-Month results of 81 patients(2005) Demirci, Fuat; Özdemir, İsmail; Alhan, AliObjective: The objective was to review a cost-effective procedure called the midurethral polypropylene sling (MPS) in the treatment of urodynamic stress incontinence (USI). Study design: A self-fashioned sling (7.5×1 cm) was created from a polypropylene mesh with two lengthening polypropylene sutures at the ends. The sutures are carried through the rectus fascia by a special needle carrier. The sling is placed around the urethra and its sutures are tied on the fascia. The procedure was performed on 81 patients. Of these patients, 73 had USI. The remaining 8 patients with uterine prolapse, who did not have USI, underwent the MPS prophylactically. Of 81 patients, 35 underwent the MPS alone, 46 underwent the MPS and abdominal or vaginal procedures. Results: Three patients had bleeding in excess of 300 ml necessitating a vaginal tamponade. One had hematoma and the other underwent a laparotomy. Urinary retention for more than 3 days was observed in 6 of the patients who had the MPS alone, in 7 of the patients who had both MPS and abdominal procedures, and in 13 of the patients who had MPS with vaginal procedures. The sling was cut in 3 patients due to persistent urinary retention. Of 73 patients with USI, 70 were completely cured (95.9%) at a mean of 22 months' follow-up. Conclusion: The cure rates and complications of the MPS were comparable to those of the tension-free vaginal tap (TVT) procedure for the treatment of USI. The procedure costs about US$ 9. We conclude that the MPS can be considered as an alternative to the TVT procedure. © Springer-Verlag 2005.Öğe A new, simple, safe, effective and cost-effective procedure for genuine stress incontinence: midurethral polypropylene sling(Wiley, 2003) Demirci, Fuat; Özdemir, İsmail; Yücel, Oğuz; Alhan, AliWe developed a cost-effective procedure for genuine stress incontinence (GSI) that has the advantages of the tension-free vaginal tape (TVT). The midurethral polypropylene sling procedure (MPS) is carried out under local anaesthesia. A self-fashioned sling (7.5 x 1 cm) was created from a polypropylene mesh with two lengthening polypropylene sutures at the ends. The sutures are carried through the rectus fascia using a needle and the sling is placed around the urethra. Ten patients underwent the MPS and were followed up for a mean of 6.2 months. All patients were cured. The short-term results of the MPS were comparable to those of the TVT. The procedure costs approximately US$9. We conclude that the MPS can be considered as an alternative to the TVT procedure.Öğe Perioperative complications in abdominal sacrocolpopexy and vaginal sacrospinous ligament fixation procedures(Springer London Ltd, 2007) Demirci, Fuat; Özdemir, İsmail; Somunkıran, Aslı; Topuz, Samet; İyibozkurt, Cem; Doyran, Gönül Duras; Gül, Özlem KemikThis study assessed perioperative complications in abdominal sacrocolpopexy and vaginal sacrospinous ligament fixation procedures. Perioperative complications were defined as any complication occurring during surgery or the first 6 weeks postoperatively. Forty-five patients underwent abdominal procedures (20 sacrohysteropexy and 25 sacrocolpopexy) and 60 patients underwent vaginal sacrospinous fixation. Of the 105 patients, 13 had vaginal vault prolapse. In the abdominal group, one bladder injury, four hemorrhages, and three wound dehiscences occurred. In the vaginal group, one rectal injury and one postoperative vaginal vault infection occurred. Major and minor complications were more frequent in the abdominal group than in the vaginal group. Blood loss was not significantly different. The operating time and hospital stay in the abdominal group were significantly longer than in the vaginal group. In conclusion, abdominal sacrocolpopexy had a higher rate of perioperative complications and longer hospital stay and operating time.Öğe Primary omental pregnancy presenting with hemorrhagic shock - a case report(Karger, 2003) Özdemir, İsmail; Demirci, Fuat; Yücel, Oğuz; Alper, MuratAbdominal pregnancy is a very rare and serious type of extrauterine gestation that accounts for approximately 0.003% of all ectopic pregnancies. Omental pregnancy, an extremely rare form of abdominal pregnancy, can be primary or secondary to a tubal pregnancy that aborts out of the fimbria and reimplants in the peritoneal cavity. We present an additional case of primary omental pregnancy at 12 gestational weeks presenting with symptoms of hemoperitoneum and acute abdomen.Öğe Pure ovarian choriocarcinoma: a difficult diagnosis of an unusual tumor presenting with acute abdomen in a 13-year-old girl(Blackwell Munksgaard, 2004) Özdemir, İsmail; Demirci, Fuat; Yücel, Oğuz; Demirci, Elif; Alper, MuratA 13-year-old girl before sexual debut presented with lower abdominal pain and a positive urine pregnancy test. On admission her face was very pale, and a physical examination revealed an acute abdomen with rigidity and tenderness. She was in intermediate shock. Ultrasound examination showed presence of fluid arising from the posterior cul-desac up to the liver, consistent with a possible hemoperitoneum, and identified a 68 78-mm mass in the right adnexa. Laboratory studies revealed the following values: white blood cells 12 109 /L, hemoglobin 5.2 g/L and hematocrit 0.16. Liver function results were within normal limits.
