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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 Color Doppler assessment of ovarian arteries during the menstrual cycle(Partner Graf, 1998) Yücel, Neşe; Yücel, OğuzObjective: Color Doppler sonography was used to demonstrate physiology of ovarian haemodynamics during the menstrual cycle. Methods: Doppler measurements of ovarian arteries were performed in 20 cases with regular menstrual cycles in age ranging from 20 to 22 in cycle days 5-7 (early follicular phase), 11-13 (late follicular phase), 15-17 (early luteal phase), 26-28 (late luteal phase) using color Doppler ultrasound. Pulsatility index was assessed. Results: A marked increase in diastolic flow and a significant decrease in pulsatility index from late follicular phase were observed in the ovary carrying the dominant follicle and corpus luteum. In the inactive ovary, no cyclic changes were seen in the diastolic flow and in the values of pulsatility index. There was a significant difference between the value of pulsatility index of the active ovary and the inactive ovary in the late follicular, the early luteal and the late luteal phases (for active ovary 1.48 ± 0.35, 0.86 ± 0.13, 0.84 ± 0.15; for inactive ovary 2.50 ± 0.30, 2.71 ± 0.27, 2.54 ± 0.37, respectively) (p < 0.0005). Conclusions: We demonstrated the physiology of ovarian haemodynamics during the menstrual cycle. This will provide the possibility for studies of ovarian blood flow under pathologic conditions.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 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 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 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 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 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.Öğe Rupture of the pregnant uterus: A 9-year review(2005) Özdemir, İsmail; Yücel, Neşe; Yücel, OğuzObjective: To investigate the frequency of ruptured uterus, possible etiologic factors and fetomaternal outcomes. Study design: A retrospective chart view of all patients with ruptured uterus over a 9-year period from 1995 to 2003 was carried out. Relevant data relating to the clinical features, characteristics of labour, operative procedures, and fetomaternal outcomes were assessed. Results: During the study period there were 17 cases of ruptured uterus among a total of 117,095 deliveries, giving an incidence of 1 in 6,888 deliveries. Thirteen patients (76.5%) were multiparous and mean parity was 1.9. Uterine rupture occurred following vaginal delivery in ten patients. Caesarean delivery was performed in seven (41.2%) patients, of which five (29.4%) patients had a history of previous caesarean section. Abdominal hysterectomy was performed in 12 patients (70.6%), of which 9 (75.0%) were total and 3 (25.0%) were subtotal. The other five patients (29.4%) had suture repairs. In seven patients (41.2%), uterine rupture was associated with oxytocin use. There were one maternal and three perinatal (17.6%) deaths. Conclusion: Sudden fetal heart abnormalities in labouring patients should be taken as a potential sign of danger. Early diagnosis and immediate preoperative resuscitation are of great importance in cases of ruptured uterus. The fetomaternal outcomes can be improved with the experience and skill of the surgical team. © Springer-Verlag 2005.Öğe Transperineal versus transvaginal ultrasonographic evaluation of the cervix at each trimester in normal pregnant women(Blackwell Publishing, 2005) Özdemir, İsmail; Demirci, Fuat; Yücel, OğuzAims: To compare transvaginal and transperineal ultrasonography in the assessment of cervical length and cervical changes in normal gravid patients at each trimester. Methods: Transperineal and transvaginal ultrasonographic cervical length was measured on 104 asymptomatic pregnant women between 10 and 14, 20-24, and 30-34 weeks' gestation and the presence of a funnel was also noted. The study used the McNemar chi(2) test to assess the difference between two methods in their ability to obtain a measurement, and the Pearson correlation coefficient to determine the relationship between the paired transperineal and transvaginal cervical lengths. Results: Cervical length measurements were obtained by transvaginal ultrasonography in all 104 patients and by transperineal ultrasonography in 101 patients (97.1%) (P = 0.1). By gestational age, the greatest length discrepancy (2.8 mm) between the two ultrasonographic methods was found at 10-14 weeks (P < 0.001). At 20-24 and 30-34 weeks' gestation, the mean length differences were less than 1 mm (P < 0.01 and P = 0.337, respectively). Cervical funnelling was observed in 16 patients by both methods, whereas in two patients from the 20-24 week gestational age group, funnelling was observed by transvaginal ultrasonography and not by transperineal ultrasonography. Conclusions: Cervical length measurements by transperineal ultrasonography show good correlation with transvaginal ultrasonographic measurements and it is a satisfactory alternative to a transvaginal evaluation of the cervix throughout pregnancy.Öğe Ultrasonographic cervical length measurement at 10-14 and 20-24 weeks gestation and the risk of preterm delivery(Elsevier Ireland Ltd, 2007) Özdemir, İsmail; Demirci, Fuat; Yücel, Oğuz; Erkorkmaz, ÜnalObjective: To compare cervical length measurements at 10-14 and 20-24 weeks gestation in asymptomatic women with singleton pregnancies and to assess the measurements as a predictor of preterm delivery. Study design: In this prospective study, cervical length was measured in 152 asymptomatic women with singleton pregnancies using transvaginal ultrasonography at 10-14 and 20-24 weeks gestation. The primary outcome measure was spontaneous preterm, delivery before 35 weeks of gestation. The mean cervical length was calculated at both stages, and lengths were compared between the term and preterm groups. Results: The rate of spontaneous preterm deliveries was 10.5%. The mean cervical length at 10-14 and 20-24 weeks was 40.5 and 37.1 mm, respectively. The cervical length at 10-14 weeks was not significantly different between those who delivered at term (40.9 mm) and those who delivered preterm (38.6 mm). By contrast, the cervical length at 20-24 weeks was significantly shorter in the group that had preterm deliveries (28.4 mm) than in those who had term deliveries (37.8 mm) (P < 0.001). The cervical shortening was more apparent in the group that delivered prematurely (from 38.6 to 28.4 mm) than in that which delivered at term (from 40.9 to 37.8 mm). Conclusion: Cervical length measurement used to predict preterm delivery was found to be more predictive at 20-24 weeks. Cervical length measurement at 10-14 weeks was not reliable for predicting preterm delivery. The mean cervical length tapered gradually from the first to the second scan, and the more rapid cervical shortening was found to be associated with increased risk for preterm delivery. ((c) 2006 Elsevier Ireland Ltd. All rights reserved.
