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    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, Talat
    Objective: 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.
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    Evaluation of the effectiveness of fentanyl, tramadol and diclofenac in combination with propofol for dilation and curettage
    (Galenos Yayincilik, 2006) Demiraran, Yavuz; Somunkiran, Asli; Sezen, Gulbin; Kocaman, Buket; Hayit, Feray; Ozdemir, Ismail
    Objective: To compare the value of three agents in terms of providing postoperative analgesia in patients having dilation and curettages. Their effects on hemodynamic parameters were evaluated. Recovery and sedation properties were also assessed. Design: Prospective, randomized trial Setting: University hospital Patients: Sixty three patients who underwent fractional curettage. Interventions: Diclofenac 1 mg/kg intramuscularly 30 minutes before induction and tramadol 1 mg/kg intravenously 15 minutes before induction were given in group 1 and 2, respectively. The third group received fentanyl 1 mu g/kg intravenously for induction. Then, induction was provided with propofol 2 mg/kg and % 50 air and % 50 oxygen given with face mask. For anesthesia management 20% of the induction dose of propofol was used intermittently. Main outcome measures: Peroperative and postoperative haemodynamic parameters and SPO2 were recorded. Visual Analog Scale 0-10 cm, sedation score 0-4 point, Aldrete recovery scores 1-10 were assessed postoperatively at the 1, 5, 15, 30, and 120th minutes. Results: Peroperative and postoperative hemodynamic parameters showed no difference. The scores obtained by using Visual Analog Scale were also similar in all groups. There were no differences in sedation and Aldrete recovery scores in the three groups. On the other hand, propofol consumption was significantly lower in the fentanyl group when compared with the other two groups. Conclusion: Fentanyl usage decreased the amount of propofol when compared with diclofenac and tramadol administration. However, both tramadol and diclofenac were associated with lower amount of supplementary analgesic agents. They are both nonnarcotic analgesics. Therefore, preference of these two agents may be regarded more favorable.
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    Evaluation of the efficacy of rectalmisoprostol versus intravenous oxytocin for the prevention of postpartumhemorrhage
    (Galenos Yayincilik, 2006) Gul, Ozlem Kemik; Somunkiran, Asli; Ozdemir, Ismail; Yucel, Oguz; Demirci, Fuat
    Objective: 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.