Publications by authors named "Ahmet Mete Ergenoğlu"

41 Publications

Outcomes of antenatally diagnosed fetal cardiac tumors: a 10-year experience at a single tertiary referral center.

J Matern Fetal Neonatal Med 2020 Sep 20:1-6. Epub 2020 Sep 20.

Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.

Objective: The purpose of this study was to analyze the clinical and perinatal outcomes along with ultrasonographic characteristics of fetuses with a cardiac tumor.

Methods: The data were obtained retrospectively between January 2010 and December 2019 in a tertiary referral center. The Cardiovascular Profile Score (CVPS) was used for the diagnosis of heart failure. Clinical outcomes of the cases identified in the postnatal period were analyzed.

Results: Fourteen cases were evaluated with the fetal cardiac tumor. One case made the decision to terminate the pregnancy. Perinatal death was seen in 4 (30.7 %) cases out of 13 cases. In 3/14 (21.4%) cases, a solitary cardiac tumor was found while multiple cardiac tumors were found in 11/14 (78.6%) cases. All living cases 9/9 (100%) had the diagnosis of tuberous sclerosis complex (TSC). When the cases which survived were compared with the cases which died during the prenatal period, a significant difference in tumors' biggest diameters (16.44 ± 5.12 mm vs. 32.25 ± 9.28 mm; : .011, respectively) was found. No statistically significant difference was found in the number of the tumor(s) and heart failure.

Conclusion: Fetal cardiac tumors can have serious perinatal mortality. The cardiac tumor size was found to be associated with perinatal mortality. The survival is not different between the cases with solitary and multiple tumors and those with and without congestive heart failure.
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http://dx.doi.org/10.1080/14767058.2020.1822316DOI Listing
September 2020

Laparoscopic view of endosalpingiosis in a woman with dermoid cyst and endometriosis.

J Turk Ger Gynecol Assoc 2020 Jul 24. Epub 2020 Jul 24.

Ege University Faculty of Medicine Department of Obstetrics and Gynaecology, İzmir, Turkey.

Endosalpingiosis is, like endometriosis, the presence of cystic masses outside of the salpinx which contains fallopian tube epithelium. Endosalpingiosis can be seen on the surface of ovaries, tubal serosa, uterine serosa, myometrium, and also in the bladder. The main clinical features of endosalpingiosis are pelvic pain, adnexal mass which mimics cancer, and urinary symptoms. Herein, we reported a surgical video of endosalpingiosis in a woman with endometriosis and a dermoid cyst.
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http://dx.doi.org/10.4274/jtgga.galenos.2020.2020.0052DOI Listing
July 2020

The effect of surgical menopause after bilateral oophorectomy on hormonal changes, mucociliary clearance, and quality of life.

Eur Arch Otorhinolaryngol 2020 Oct 26;277(10):2793-2800. Epub 2020 Jun 26.

Department of Obstetrics and Gynecology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey.

Purpose: The removal of the ovaries for any reason causes surgical menopause. Hormonal changes that occur progressively over 5-10 years in natural menopause occur acutely in surgical menopause. Signs of estrogen deficiency appear suddenly and are permanent after this surgery. This study investigated the short- and long-term effects of estrogen deficiency occurring after surgical menopause on both nasal mucociliary activity and sinonasal symptoms.

Methods: This prospective study included women aged 20-45 years who were not in the menopause, who had a planned bilateral oophorectomy and who attended the Gynecology Clinic at the Faculty of Medicine at a university hospital between January 2018 and December 2019. The nasal mucociliary clearance time, and blood Estradiol (E2) and FSH levels were measured once in the preoperative period, and at the postoperative 3rd, 6th, 9, and 12th months. At the same times, the Sinonasal Outcome Test 22 (SNOT-22) was also applied.

Results:  The average age of the 47 patients was 41.2 ± 2.7. The mean serum estradiol levels of the women were 164.7 ± 63.4 pg/ml in the preoperative period, 14.8 ± 3.7 pg/ml at the postoperative 3rd month, 12.5 ± 3.5 pg/ml at the postoperative 6th month, 11.6 ± 3.0 pg/ml at the postoperative 9th month, and 11.1 ± 2.7 pg/ml at the postoperative 12th month. The mean FSH levels of the women were 9.4 ± 2.4 mIU/ml in the preoperative period, 60.5 ± 9.6 mIU/ml at the postoperative 3rd month, 61.9 ± 9.4 mIU/ml at the postoperative 6th month, 63.0 ± 9.3 mIU/ml at the postoperative 9th month, and 64.6 ± 8.7 mIU/ml at the postoperative 12th month. The changes in postoperative mean estradiol and FSH levels over a year were significant and consistent with menopausal symptoms (p < 0.001). The mean mucociliary clearance times were 12.6 ± 1.2 before menopause, 13.2 ± 1.7 at the postoperative 3rd month, 14.5 ± 1.7 at the postoperative 6th month, 17.5 ± 1.6 at the postoperative 9th month, and 19.4 ± 1.9 at the postoperative 12th month. The extension of the mean mucociliary clearance time over 1 year was significant (p < 0.001). The mean scores for the SNOT-22 were 17.3 ± 6.9 before the operation, 17.8 ± 6.0 at the postoperative 3rd month, 19.6 ± 6.9 at the postoperative 6th month, 23.4 ± 10.4 at the postoperative 9th month, and 36.1 ± 10.0 at the postoperative 12th month. The mean scores for rhinologic symptoms were 5.2 ± 1.9 (3-11) in the preoperative period, 5.7 ± 2.0 (3-12) at the postoperative 3rd month, 7.1 ± 2.3 (4-14) at the postoperative 6th month, 9.3 ± 3.3 (4-16) at the postoperative 9th month, and 11.9 ± 3.3 (6-18) at the postoperative 12th month. The 1-year change in the SNOT-22 scores was found to be significant (p < 0.001).

Conclusion: After bilateral oophorectomy, menopausal hormonal values were acutely high in women. At the 1-year postmenopausal follow-up, the mean scores for the SNOT-22 had increased significantly. In other words, quality of life decreased in parallel with prolonged nasal mucociliary clearance time.
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http://dx.doi.org/10.1007/s00405-020-06164-8DOI Listing
October 2020

Evaluation of complement system proteins C3a, C5a and C6 in patients of endometriosis.

Clin Biochem 2020 Jul 20;81:15-19. Epub 2020 Apr 20.

Faculty of Medicine, Department of Medical Biochemistry, Ege University, Bornova, Izmir 35100, Turkey. Electronic address:

Background: Endometriosis is a disease that shows auto-immune and chronic characteristics, suggesting a role for proteins mediating immune interactions in its pathophysiology. The aim was to evaluate C3a and C5a for their role in inflammatory responses and C6 as the down-stream interactor following our previous findings on C5 mRNA expression changes in endometriosis [1].

Methods: Sera from 71 endometriosis patients and 77 women without endometriosis were taken. While the samples were taken only once from the controls, the patient samples were taken before, in 1st and in 7th days after laparoscopy. Levels of complement proteins C3a, C5a and C6 were measured with ELISA assays. MPV (Mean Platelet Volume), CRP (C-Reactive Protein) and NLR (Neutrophil-to-Leukocyte Ratio) were also analyzed from the retrospective data.

Results: C6 levels of early-stage patients at postoperative 1st day were significantly higher than controls. Patients with high MPV measurements had significantly higher C3a (p < 0.0001) and C6 (p < 0.05) levels than controls at all times of measurement.

Conclusions: C6, an integral component of the membrane attack complex (MAC), could play a role at early disease-stage. The changes in levels of complement proteins and their relation to high MPV levels suggest a broader area of interplay for immune interactors in endometriosis. Although a bigger and longitudinal study design is needed to obtain more accurate results to evaluate these proteins as potential biomarkers, an important role of complement system within the pathophysiology of endometriosis is apparent.
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http://dx.doi.org/10.1016/j.clinbiochem.2020.04.005DOI Listing
July 2020

Protective effect of oxytocin on a methotrexate-induced ovarian toxicity model.

Arch Gynecol Obstet 2020 05 7;301(5):1317-1324. Epub 2020 Apr 7.

Department of Physiology, Demiroglu Bilim University School of Medicine, Istanbul, Turkey.

Purpose: Although cancer predominantly affects people at older ages, a substantial number of patients, like breast cancer patients, are diagnosed before they have completed their families or even before giving birth. Furthermore, cytotoxic chemotherapy may be required in addition to treat cancer survivors. The present study was conducted to investigate the protective effect of oxytocin (OT) on methotrexate (MTX)-induced ovarian toxicity in rats.

Methods: Eighteen adult female Sprague-Dawley rats were used in the study. All rats were divided randomly into three groups. The control group (n = 6) received no treatment. The remaining 12 rats received a single dose of 20 mg/kg of MTX. Half of the rats (n = 6) were treated with 1 mg/kg/day of saline, and the other half (n = 6) were treated with 160 µg/kg/day of OT for 21 days. Then, blood samples were collected for biochemical analysis, and an ovariectomy was performed for histopathological examination.

Results: Plasma malondialdehyde (MDA) and transforming growth factor-β (TGF-β) levels were significantly lower in the MTX + OT group compared to the MTX + saline group (p = 0.000036 for MDA; p = 0.0044 for TGF-β). AMH levels were also significantly higher in the MTX + OT group than in the MTX + saline group (p = 0.000036). The ovarian fibrosis percent was also notably lower in the MTX + OT group than in the MTX + saline group (p = 0.000036).

Conclusion: On the basis of these findings, OT is a promising agent for ameliorating harmful effects of MTX on rat ovaries in an experimental model.
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http://dx.doi.org/10.1007/s00404-020-05534-1DOI Listing
May 2020

Can we rely on blind endometrial curettage for complete removal of focal intrauterine lesion? A prospective clinical study.

J Gynecol Obstet Hum Reprod 2020 Apr 1;49(4):101696. Epub 2020 Feb 1.

Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.

Objective: To investigate the diagnostic and therapeutic efficiency of dilatation-curettage (D&C) combined with aspiration curettage for endometrial pathology compared to hysteroscopy alone in this study.

Material And Methods: A total of 143 patients who have suspicion of endometrial mass like lesion, increased endometrial thickness (>5-mm at menopause and/or endometrial thickness upper than 5-mm in patients under tamoxifen treatment due to breast cancer during 2-D transvaginal ultrasonography examination) were enrolled. All patients underwent procedures in order of hysteroscopy, D&C plus aspiration and second look hysteroscopy. Data for age, menopausal status, tamoxifen treatment, endometrial histology, hysteroscopy and D&C findings were recorded and statistically analyzed.

Results: Initial hysteroscopy revealed focally growing endometrial lesion in 96 patients. Second look hysteroscopy showed persistent focal lesion in 77 patients (80 %) after D&C plus aspiration. Endometrial blind curettage failed to diagnose 42 % (25/60) of endometrial polyps, none of submucous myomas as well as 27 % (3/11) of premalignant and malignant endometrial lesions. The sensitivity, specificity, overall accuracy, positive predictive value and negative predictive value of hysteroscopy were found as 84.1 %, 83.3 %, 83.9 %, 93.8 %, and 63.8 %, respectively.

Conclusions: Hysteroscopy showed significant superiority in the diagnosis and definitive treatment of endometrial pathologies specifically in focally growing endometrial lesions compared to D&C plus aspiration.
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http://dx.doi.org/10.1016/j.jogoh.2020.101696DOI Listing
April 2020

Antenatal Findings of Keratitis-Ichthyosis-Deafness Syndrome.

J Obstet Gynaecol Can 2020 04 14;42(4):504-506. Epub 2019 Aug 14.

Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.

Background: Keratitis-ichthyosis-deafness (KID) syndrome is a congenital ectodermal disorder characterized by keratitis, ichthyosis, and deafness. This syndrome affects multiple systems and can be fatal.

Case: A 34-year-old G2, P1 woman was admitted to the Ege University School of Medicine in Izmir, Turkey because of a rapid increase in abdominal circumference at 32 weeks gestation. Fetal anatomic screening revealed complete chorioamniotic separation, hypoplasia of the cerebellar vermis, and dysmorphic facial findings such as frontal bulging. After the delivery, the baby's whole body had granular thickened skin. Bilateral dry eye, corneal edema, and bilateral retinopathy of prematurity were diagnosed.

Conclusion: This case report highlights the importance of prenatal diagnosis through ultrasonography and magnetic resonance imaging. This is the first case report that has antenatal ultrasonographic features in the literature.
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http://dx.doi.org/10.1016/j.jogc.2019.06.005DOI Listing
April 2020

Pelvic floor muscle function and symptoms of dysfunctions in midwifes and nurses of reproductive age with and without pelvic floor dysfunction.

Taiwan J Obstet Gynecol 2019 Jul;58(4):505-513

School of Physiotherapy, Dokuz Eylul University, Izmir, Turkey. Electronic address:

Objectives: This study aims to compare pelvic floor muscle (PFM) functions in midwifes and nurses of reproductive age with and without pelvic floor dysfunction (PFD) and investigate the relationship between PFM function and the number, type and symptoms of PFDs.

Materials And Methods: 82 midwifes and nurses of reproductive age with (n = 51) and without PFD (n = 31) participated in the study. PFM function was assessed by digital palpation using PERFECT scale. Gynecological examination, ultrasonography, disease-specific questionnaires, questions and tests were used to assess symptoms of PFD. PFD was assessed in terms of risk factors, urinary incontinence, fecal incontinence, pelvic organ prolapse (POP), pelvic pain and sexual dysfunctions.

Results: Power parameter of PERFECT scheme was significantly lower in subjects with PFD compared to Non-PFD group (p = 0.002). 41% of the subjects with Power 5 PFM strength in PFD group were diagnosed as stage 1 POP, 5.8% as stage 2 POP, 15.7% of urge incontinence, 23.3% of stress incontinence and 10.5% of mixed incontinence. Both urinary incontinence and POP were detected in 15.7% of them. Among all subjects, incontinence symptoms decreased whereas POP and sexual function did not change as PFM increased. PFM strength was negatively correlated with the number of PFD (p = 0.002, r = -0.34). The type of dysfunction did not correlate with PFM strength (p > 0.05).

Conclusion: PFM strength only affects of urinary incontinence sypmtoms among all PFDs in midwifes and nurses of reproductive age. PFM strength may not be the main factor in the occurrence of PFDs as pelvic floor does not consist solely of muscle structure. However, it strongly affects the number of dysfunctions. Therefore, PFM training should be performed to prevent the occurrence of extra dysfunctions in addition to the existing ones even if it does not alter the symptoms.
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http://dx.doi.org/10.1016/j.tjog.2019.05.014DOI Listing
July 2019

The effects of uterine size with or without abdominal obesity on spinal block level and vasopressor requirement in elective cesarean section: a prospective observational study

Turk J Med Sci 2019 Feb 11;49(1):50-57. Epub 2019 Feb 11.

Background/aim: Hypotension is a serious complication caused by spinal anesthesia that places both the mother and fetus at increased risk. We aimed to investigate the effects of uterine size with or without abdominal obesity on sensory block level of pregnant women receiving spinal anesthesia.

Materials And Methods: This study included 125 term parturients who underwent cesarean section. Motor and sensory block characteristics, the distance between the symphysis pubis and the fundus (SPF), the distance between the symphysis pubis and the xiphoid (SPX), newborn and placental weights, adverse effects, and doses of ephedrine were recorded.

Results: Sensory block level and ephedrine dose were significantly correlated with the SPX and the combined newborn and placenta weights (P < 0.05). The incidence of hypotension was related to the SPX and the combined newborn and placenta weight (P < 0.05). There was no correlation between the SPF and sensory block level or ephedrine dose. The sensory block level was higher for patients who had greater SPX values and higher combined newborn and placenta weights. The incidence of hypotension and the ephedrine dose were also higher in these subjects.

Conclusion: SPX values and combined newborn and placenta weights are more predictive of sensory block level than SPF values in parturients receiving spinal anesthesia.
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http://dx.doi.org/10.3906/sag-1804-167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350837PMC
February 2019

MicroRNA Expression Profile in the Prenatal Amniotic Fluid Samples of Pregnant Women with Down Syndrome.

Balkan Med J 2018 03 8;35(2):163-166. Epub 2017 Dec 8.

Department of Medical Genetics, Ege University School of Medicine, İzmir, Turkey.

Background: Down syndrome, which is the most common human chromosomal anomaly that can affect people of any race and age, can be diagnosed prenatally in most cases. Prenatal diagnosis via culture method is time-consuming; thus, genetic analysis has thus been introduced and is continually being developed for rapid prenatal diagnosis. For this reason, the effective use of microRNA profiling for the rapid analysis of prenatal amniotic fluid samples for the diagnosis of Down syndrome was investigated.

Aims: To evaluate the expression levels of 14 microRNAs encoded by chromosome 21 in amniotic fluid samples and their utility for prenatal diagnosis of Down syndrome.

Study Design: Case-control study.

Methods: We performed invasive prenatal testing for 56 pregnant women; 23 carried fetuses with Down syndrome, and 33 carried fetuses with a normal karyotype. Advanced maternal age and increased risk for Down syndrome in the screening tests were indications for invasive prenatal testing. The age of gestation in the study and control groups ranged between 17 and 18 weeks. The expression levels of microRNA were measured by real-time polymerase chain reaction.

Results: The expression levels of , and were significantly higher in the study group than in the control group.

Conclusion: The presence of significantly dysregulated microRNAs may be associated with either the phenotype or the result of abnormal development. Further large-scale comparative studies conducted in a variety of conditions may bring novel insights in the field of abnormal prenatal conditions.
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http://dx.doi.org/10.4274/balkanmedj.2017.0511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863254PMC
March 2018

Is overactive bladder microvasculature disease a component of systemic atheroscleorosis?

Neurourol Urodyn 2018 04 15;37(4):1372-1379. Epub 2017 Nov 15.

Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey.

Aims: To evaluate the relationship between overactive bladder (OAB) and systemic atherosclerosis in a cohort of women.

Methods: In this case-control study, we assessed atherosclerosis indicators, such as Framingham risk scores and carotid and femoral artery intima-media thickness, and evaluated possible bladder wall responses to atherosclerosis using endovaginal color Doppler ultrasound and the detection of urinary cytokines in women with OAB and in controls. Quantitative assessment of blood perfusion at the bladder neck was performed using a method that allows for the dynamic monitoring of flow in a predefined region of interest at every point of the cardiac cycle. The independent samples t-test was used to evaluate the relationship between OAB and the atherosclerotic findings when parametric conditions were met, and the Mann-Whitney U test was used when parametric conditions were not met. Kendall's Tau was used to assess the correlation between OAB severity and the atherosclerotic variables. P < 0.05 was considered statistically significant.

Results: There were 74 OAB patients and 73 controls; in total, 147 women were evaluated. We found that all atherosclerosis indicators were significantly associated with OAB and that there was a significant relationship between OAB and decreased bladder neck perfusion. Additionally, there were correlations of OAB severity with systemic atherosclerosis and impaired vascular perfusion of the bladder.

Conclusions: Decreased perfusion at the bladder neck, the Framingham scores in severe OAB, and the correlation between them suggest that OAB microvascular disease may be a component of systemic atherosclerosis rather than a separate process.
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http://dx.doi.org/10.1002/nau.23452DOI Listing
April 2018

Ovarian serous cystadenoma with ectopic adrenal tissue in a 65-year-old patient: A case report.

Int J Surg Case Rep 2017 27;33:89-91. Epub 2017 Feb 27.

Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.

Introduction: Ectopic adrenal tissue is a very rare entity in adult females, especially in the ovary, and is generally diagnosed incidentally during surgery. Although it can present at various sites during childhood, it becomes atrophic by adulthood due to normally functioning adrenal glands. Patients are predominantly asymptomatic; however, in some cases endocrine symptoms such as hypertension and fasciotruncal obesity due to hormonal activity can be seen or neoplastic transformation can appear.

Presentation Of Case: A 65-year-old patient with progressive pelvic pain and postmenopausal vaginal bleeding was evaluated by transvaginal ultrasound, which revealed bilateral adnexal masses measuring 5cm in size and a normal uterus with an increased endometrial thickness of 7mm. Initially the endometrial sampling result was reported as benign. The patient underwent abdominal hysterectomy and bilateral salpingo-oophorectomy and the pathological diagnosis was again benign, with serous ovarian cystadenoma being found in both ovaries. The pathologist also reported incidental ectopic adrenal tissue on the wall of the left ovarian cystadenoma.

Discussion: Ectopic adrenal tissue is infrequent in female genital organs especially at older ages. Only a few cases of ovarian ectopic adrenal tissue have been reported. To the best of our knowledge the present case is the fourth report in the English literature, and is of additional importance given the patient's age.

Conclusion: Ectopic adrenal tissues are generally asymptomatic and revealed incidentally during surgery; however some cases have demonstrated the risk of neoplastic transformation. Therefore, surgeons must be aware of this rare entity that bears the risk of malignancy, and should surgically remove all suspicious lesions.
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http://dx.doi.org/10.1016/j.ijscr.2017.02.045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5350495PMC
February 2017

Can We Predict the Presence and Severity of Intra-Abdominal Adhesions before Cesarean Delivery.

Gynecol Obstet Invest 2017 20;82(6):521-526. Epub 2016 Dec 20.

Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.

Aims: The study aimed to investigate whether we can predict the presence and severity of intra-abdominal adhesions before cesarean delivery using patient history, symptoms, and abdominal skin scar characteristics.

Methods: In this prospective study, 143 pregnant women with history of previous abdominal surgery were included and they delivered by cesarean. Preoperative abdominal scar characteristics and symptoms as well as intraoperative abdominal adhesions were evaluated using the Manchester Scar Scale, a symptomatology questionnaire and the More Comprehensive Adhesion Scoring Method, respectively.

Results: Patients with adhesions (n = 98) and without adhesions (n = 45) had similar baseline characteristics. In the adhesion group, abdominal scar scoring parameters were significantly increased. However, there was no significant correlation among total scar score, adhesion score, and symptom score.

Conclusion: Despite the availability of many proposed methods, accurate prediction of the severity of surgery-related adhesions is beyond our current abilities. Therefore, as healthcare providers, obstetricians should avoid unnecessary use of the cesarean approach. This approach is more effective, beneficial, realizable, and reasonable than the prediction of surgery-related adhesions.
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http://dx.doi.org/10.1159/000454767DOI Listing
July 2018

Which Should Be the Preferred Technique During Laparoscopic Ovarian Cystectomy.

Reprod Sci 2017 03 20;24(3):393-399. Epub 2016 Jul 20.

4 Department of Obstetrics and Gynecology, Faculty of Medicine, Acibadem University, Istanbul, Turkey.

The aim of the present study was to determine the long-term effects of different laparoscopic hemostatic techniques on ovarian reserve after ovarian cystectomy. Ninety patients with unilateral ovarian cysts were recruited and randomly distributed into 2 groups. Laparoscopic stripping cystectomy was performed in all patients. Afterward, cystectomy hemostasis was achieved via hemostatic suture or bipolar electrocoagulation. Serum levels of anti-Müllerian hormone (AMH) were determined preoperatively and postoperatively at 1, 3, and 12 months, and patients were evaluated for residual ovarian volume, antral follicle count, and pregnancy. The statistical difference was determined between the 2 groups in terms of AMH levels at 3 months (hemostatic suture group = 3.17 ± 3.40 vs bipolar electrocoagulation group = 2.38 ± 2.57, P = .006) and 12 months (hemostatic suture group = 3.71 ± 3.09 vs bipolar electrocoagulation group = 2.78 ± 2.85, P = .005). In addition, in the hemostatic suture group, there was no statistically significant difference between preoperative and postoperative AMH levels ( P = .165) and between the postoperative antral follicle count ( P = .779) and the residual ovarian volume ( P = .248), whereas in the bipolar electrocoagulation group, postoperative AMH levels were lower than preoperative levels ( P = .028) and postoperative residual ovarian volumes at 3 and 12 months were lower than those at 1 month ( P = .001). Nonetheless, pregnancy rates were not significantly different ( P = .546). Bipolar electrocoagulation is more destructive compared with hemostatic suture. However, the ovarian reserve does not decrease further during the follow-up period.
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http://dx.doi.org/10.1177/1933719116657195DOI Listing
March 2017

Prenatal Evaluation of MicroRNA Expressions in Pregnancies with Down Syndrome.

Biomed Res Int 2016 24;2016:5312674. Epub 2016 Mar 24.

Department of Medical Genetics, Faculty of Medicine, Ege University, 35100 Izmir, Turkey.

Background: Currently, the data available on the utility of miRNAs in noninvasive prenatal testing is insufficient in the literature. We evaluated the expression levels of 14 miRNAs located on chromosome 21 in maternal plasma and their utility in noninvasive prenatal testing of Down Syndrome.

Method: A total of 56 patients underwent invasive prenatal testing; 23 cases were carrying Down Syndrome affected fetuses, and 33 control cases carrying unaffected, normal karyotype fetuses were included for comparison. Indications for invasive prenatal testing were advanced maternal age, increased risk of Down Syndrome in screening tests, and abnormal finding in the sonographic examination. In both the study and control groups, all the pregnant women were at 17th and 18th week of gestation. miRNA expression levels were measured using real-time RT-PCR.

Results: Significantly increased maternal plasma levels of miR-3156 and miR-99a were found in the women carrying a fetus with Down Syndrome.

Conclusion: Our results provide a basis for multicenter studies with larger sample groups and microRNA profiles, particularly with the microRNAs which were found to be variably expressed in our study. Through this clinical research, the utility of microRNAs in noninvasive prenatal testing can be better explored in future studies.
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http://dx.doi.org/10.1155/2016/5312674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823505PMC
December 2016

Assessment of the effect of pelvic floor exercises on pelvic floor muscle strength using ultrasonography in patients with urinary incontinence: a prospective randomized controlled trial.

J Phys Ther Sci 2016 Jan 29;28(2):360-5. Epub 2016 Feb 29.

Department of Obstetrics and Gynecology, Ege Faculty, University of Medicine, Turkey.

[Purpose] The aim of this study was to evaluate whether the effect of pelvic floor exercises on pelvic floor muscle strength could be detected via ultrasonography in patients with urinary incontinence. [Subjects and Methods] Of 282 incontinent patients, 116 participated in the study and were randomly divided into a pelvic floor muscle training (n=65) group or control group (n=51). The pelvic floor muscle training group was given pelvic floor exercise training for 12 weeks. Both groups were evaluated at the beginning of the study and after 12 weeks. Abdominal ultrasonography measurements in transverse and longitudinal planes, the PERFECT scheme, perineometric evaluation, the stop test, the stress test, and the pad test were used to assess pelvic floor muscle strength in all cases. [Results] After training, the PERFECT, perineometry and transabdominal ultrasonography measurements were found to be significantly improved, and the stop test and pad test results were significantly decreased in the pelvic floor muscle training group, whereas no difference was observed in the control group. There was a positive correlation between the PERFECT force measurement scale and ultrasonography force measurement scale before and after the intervention in the control and pelvic floor muscle training groups (r=0.632 and r=0.642, respectively). [Conclusion] Ultrasonography can be used as a noninvasive method to identify the change in pelvic floor muscle strength with exercise training.
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http://dx.doi.org/10.1589/jpts.28.360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792974PMC
January 2016

Comparison of three-dimensional ultrasound and magnetic resonance imaging diagnosis in surgically proven Müllerian duct anomaly cases.

Eur J Obstet Gynecol Reprod Biol 2016 Feb 29;197:22-6. Epub 2015 Nov 29.

Acibadem University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey.

Objective: To determine and compare the diagnostic accuracy of 3-dimensional ultrasound (3D US) and magnetic resonance imagining (MRI) in patients with surgically diagnosed Mullerian duct anomaly (MDA).

Study Design: Charts of patients with MDA were retrospectively evaluated. Patients who underwent both laparoscopic and hysteroscopic surgery and had 3D US and MRI examinations were included in the study. The diagnoses achieved via 3D US and MRI were compared with the surgical diagnoses to determine the diagnostic accuracy of these imagining techniques.

Results: Twenty-nine patients were included in the study. Three-dimensional ultrasound detected 28 out of 29 (96%) patients correctly. Only one patient was diagnosed with a uterine septum instead of uterine arcuatus. Magnetic resonance imaging detected 23 out of 29 patients correctly (79%). The Kappa indexes of the 3D US and MRI were 0.896 and 0.592, respectively.

Conclusion: Our results indicate that 3D US has a higher diagnostic accuracy level than MRI in evaluating MDA, especially when used in experienced hands. However, additional, well-designed studies are needed to better compare the diagnostic accuracy of the 3D US and MRI.
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http://dx.doi.org/10.1016/j.ejogrb.2015.11.010DOI Listing
February 2016

Innovative technique for enclosed morcellation using a surgical glove.

Obstet Gynecol 2015 May;125(5):1145-1149

Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.

Objective: To describe an innovative approach for enclosed morcellation using a surgical glove in multiport laparoscopic surgery.

Methods: Power morcellation was performed within an insufflated surgical glove in a completely enclosed manner between January and May 2014. The specimen was placed into the glove within the abdomen. The glove opening and thumb were exteriorized through the umbilical and left lower abdominal trocar incisions, respectively. The optical trocar and optic were inserted into the glove, which was then insufflated. The thumb tip was cut, and a power morcellator was inserted through this finger. The morcellation was accomplished within the completely enclosed glove. The thumb tip was closed, and the glove, containing residual specimens and bloody fluid, was removed from the abdomen through the umbilical incision. Thus, the risks of bag piercing and leakage during contained power morcellation were eliminated. Demographic and operative data were collected and analyzed for all cases.

Results: Thirty multiport laparoscopic myomectomy and morcellation procedures were performed during the study period. The median operative time was 85 minutes (range 60-140 minutes). The median morcellation preparation time, total morcellation time, and withdrawal time were 6 (range 4.5-14), 32 (range 15-55), and 1.2 (range 1-1.5) minutes, respectively. No intraoperative complications or bag ruptures were recorded.

Conclusion: With our innovative technique, a disposable latex glove can be used for an enclosed morcellation that avoids piercing the enclosure container within the abdominal cavity, thereby offering decreased risks related to bag perforation and leakage compared with previous contained power morcellation techniques.

Level Of Evidence: III.
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http://dx.doi.org/10.1097/AOG.0000000000000823DOI Listing
May 2015

Vaginal cuff dehiscence with bowel evisceration after robotic hysterectomy.

Turk J Obstet Gynecol 2014 Dec 15;11(4):249-251. Epub 2014 Dec 15.

Ege University Faculty of Medicine, Department of Obstetrics and Gynecology, İzmir, Turkey.

Vaginal cuff dehisence with bowel evisceration after hysterectomy is a very rare complication. However, the incidance of this complication appears to be increased with the widely used techniques of laparoscopic surgery especially with robotic hysterectomy. In this case report we aimed to evaluate the risk factors and treatment methods for this complication.
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http://dx.doi.org/10.4274/tjod.47640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558371PMC
December 2014

Increased expression of electron transport chain genes in uterine leiomyoma.

Ann Clin Lab Sci 2014 ;44(4):466-8

Department of Medical Biochemistry, Ege University Faculty of Medicine, Bornova, Izmir, Turkey

The etiology and pathophysiology of uterine leiomyomas, benign smooth muscle tumors of the uterus, are not well understood. To evaluate the role of mitochondria in uterine leiomyoma, we compared electron transport gene expressions of uterine leiomyoma tissue with myometrium tissue in six uterine leiomyoma patients by RT-PCR array. Our results showed an average of 1.562 (±0.445) fold increase in nuclear-encoded electron transport genes. These results might suggest an increase in size, number, or activity of mitochondria in uterine leiomyoma that, to our knowledge, has not been previously reported.
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June 2015

Recurrent brain tumor with hydrocephalus in pregnancy.

J Obstet Gynaecol Res 2015 Mar 20;41(3):464-7. Epub 2014 Oct 20.

Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.

Brain tumors during pregnancy are very rare. Diagnosis of this condition is difficult because the symptoms imitate pregnancy-related ailments. The management of this condition also presents challenges. This case report aims to present a successful treatment and delivery of a patient with recurrent brain tumor during pregnancy with hydrocephalus.
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http://dx.doi.org/10.1111/jog.12546DOI Listing
March 2015

Is there a relationship between age and side dominance of tubal ectopic pregnancies? --A preliminary report.

Ginekol Pol 2014 Sep;85(9):677-81

Objectives: To determine whether there exists a relationship between age and side dominance of tubal ectopic pregnancies.

Material And Methods: One hundred twenty patients were retrospectively analyzed. The sides of the tubal ectopic pregnancies were recorded on the basis of laparoscopy or laparotomy findings. Five age groups were created: 20-24, 25-29, 30-34, 35-39, and > or = 40 years.

Results: Of the patients who were > 30 years of age, 46 (69%) and 21 (31%) had tubal ectopic pregnancies on the right and left sides, respectively (p = 0.002). In the 35-39 years of age group, 17 of 20 patients (85%) had tubal ectopic pregnancies on the right, and 3 of 20 patients (15%) on the left side (p = 0.002). In the 30-34 years of age group, 26 of 39 patients (67%) and 13 of 39 patients (33%) had tubal ectopic pregnancies on the right and left sides, respectively (p = 0.037). In the > or = 40 years of age group, 3 of 8 patients (37%) had tubal ectopic pregnancy on the right side, while 5 patients (63%) on the left side (p = 0.48).

Conclusions: Patients who are between the age of 30-40 years have a right-sided dominance of tubal ectopic pregnancy however studies that involve larger numbers of subjects are needed to make definitive conclusions about women older than 40 years of age.
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September 2014

Coring-type laparoscopic resection of a cavitated non-communicating rudimentary horn under hysteroscopic assistance.

J Obstet Gynaecol Res 2014 Jul;40(7):1950-4

Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.

Non-communicating accessory uterine horns with an endometrial cavity are the most common and clinically significant unicornuate subtype of Müllerian duct abnormality. They are generally associated with symptoms of dysmenorrhea, dyspareunia, infertility, endometriosis, adhesions, and life-threatening cornual pregnancy. Treatment options include surgical resection of the rudimentary horn, hysteroscopic recanalization, and endometrial ablation. Currently, laparoscopic resection is the recommended treatment choice. Dissection of the rudimentary horn from the unicornuate uterus is the most challenging part of this procedure and may compromise the remaining unicornuate uterus wall. Here we describe a case of laparoscopic coring-type resection of a non-communicating functional rudimentary horn firmly attached to the unicornuate uterus, by using hysteroscopic assistance. The use of hysteroscopy, adjunct to laparoscopy, facilitates the coring-type resection and may strengthen the remaining myometrial scar.
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http://dx.doi.org/10.1111/jog.12449DOI Listing
July 2014

Do stages of menopause affect the outcomes of pelvic floor muscle training?

Menopause 2015 Feb;22(2):175-84

From the 1School of Physiotherapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey; 2Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Istanbul, Turkey; 3Department of Obstetrics and Gynecology, Tepecık Education and Research Hospital, Izmir, Turkey; 4Department of Obstetrics and Gynecology, Ege University, Izmir, Turkey; and 5School of Physiotherapy, Dokuz Eylül University, Izmir, Turkey.

Objective: The purpose of our study is to determine whether there is a difference in pelvic floor muscle strength attributable to pelvic floor muscle training conducted during different stages of menopause.

Methods: One hundred twenty-two women with stress urinary incontinence and mixed urinary incontinence were included in this prospective controlled study. The participants included in this study were separated into three groups according to the Stages of Reproductive Aging Workshop staging system as follows: group 1 (n = 41): stages -3 and -2; group 2 (n = 32): stages +1 and -1; and group 3 (n = 30): stage +2. All three groups were provided an individual home exercise program throughout the 12-week study. Pelvic floor muscle strength before and after the 12-week treatment was measured in all participants (using the PERFECT [power, endurance, number of repetitions, and number of fast (1-s) contractions; every contraction is timed] scheme, perineometry, transabdominal ultrasound, Brink scale, pad test, and stop test). Data were analyzed using analysis of variance.

Results: There were no statistically significant differences in pre-exercise training pelvic floor muscle strength parameters among the three groups. After 12 weeks, there were statistically significant increases in PERFECT scheme, Brink scale, perineometry, and ultrasound values. In contrast, there were significant decreases in stop test and 1-hour pad test values observed in the three groups (P = 0.001, dependent t test). In comparison with the other groups, group 1 demonstrated statistically significant improvements in the following postexercise training parameters: power, repetition, speed, Brink vertical displacement, and stop test. The lowest increase was observed in group 2 (P < 0.05).

Conclusions: Strength increase can be achieved at all stages of menopause with pelvic floor muscle training, but the rates of increase vary according to the menopausal stage of the participants. Women in the late menopausal transition and early menopause are least responsive to pelvic floor muscle strength training. Further studies in this field are needed.
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http://dx.doi.org/10.1097/GME.0000000000000278DOI Listing
February 2015

Effect of oxytocin treatment on explant size, plasma and peritoneal levels of MCP-1, VEGF, TNF-α and histopathological parameters in a rat endometriosis model.

Eur J Obstet Gynecol Reprod Biol 2014 Apr 3;175:134-9. Epub 2014 Jan 3.

Department of Obstetrics and Gynecology, Ege University, Bornova, Izmir, Turkey.

Objective: To determine the effects of oxytocin (OT) on surgically induced endometriosis in a rat model.

Study Design: Twelve female Sprague-Dawley rats were included. After the implantation and establishment of autologous endometrium onto the abdominal wall peritoneum, the rats were randomly divided into two groups, treated with intramuscular oxytocin (OT group, 160μgkg/day, n=6) or isotonic NaCl solution (control group, 1mLkg/day, n=6) for 28 days. To evaluate the therapeutic effects of OT, the explant volumes were calculated and the levels of vascular endothelial growth factor (VEGF), monocyte chemotactic protein-1, and TNF-α were measured in plasma and peritoneal fluid. Endometriotic explants were examined histologically by semiquantitative analysis.

Results: After treatment, the mean endometriotic explant volume was decreased in the OT group (p=0.016). The histopathological score and VEGF immunoexpression of endometriotic explants were significantly lower in the OT group (p=0.007) than in controls (p=0.000). Inflammatory cytokine levels in plasma and peritoneal fluid were considerably decreased in the OT group. Moreover, TUNEL immunohistochemistry clearly demonstrated more apoptotic changes in the mononuclear cells of the OT group compared with controls.

Conclusion: We suggest that oxytocin might be considered as a potential candidate therapeutic agent for endometriosis.
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http://dx.doi.org/10.1016/j.ejogrb.2013.12.034DOI Listing
April 2014

A novel technique for laparoscopic removal of the fallopian tube after ectopic pregnancy via transabdominal or transumbilical port using homemade bag: A randomized trial.

J Res Med Sci 2013 Sep;18(9):777-81

Department of Obstetrics and Gynecology, Ege University Medical Faculty, Izmir, Turkey.

Background: The purpose of this study was to evaluate the feasibility and surgical outcome of a novel technique for laparoscopic removal of the fallopian tube using a homemade retrieval bag through a 10-mm transumbilical or 5-mm transabdominal port.

Materials And Methods: A total of 40 women with ruptured ectopic tubal pregnancy were randomized into a 10-mm transumbilical group (n = 20) or a 5-mm transabdominal group (n = 20) according to the port used for specimen removal. Fallopian tube removal was performed using a new method based on the use of a homemade surgical glove as a retrieval bag.

Results: There were no differences in the demographic characteristics between the two groups. The specimen retrieval time was significantly shorter in the transumbilical group than in the transabdominal group. Post-operative pain scores, assessed using a visual analog scale, were similar between the groups. No cases of rupture of the homemade retrieval bag were observed.

Conclusion: The laparoscopic removal of the fallopian tube through the 10-mm umbilical port using a homemade retrieval bag is associated with shorter operative time than retrieval through a 5-mm abdominal port. The present results showed the feasibility and safety of our homemade retrieval bag and novel technique.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872586PMC
September 2013

Overexpression of complement C5 in endometriosis.

Clin Biochem 2014 Apr 5;47(6):496-8. Epub 2013 Dec 5.

Ege University School of Medicine, Department of Medical Biochemistry, Bornova, Izmir, 35100, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.clinbiochem.2013.11.020DOI Listing
April 2014

Prenatal diagnosis of infantile myofibromatosis of the lung: a case report and review of the literature.

J Clin Ultrasound 2013 Nov-Dec;41 Suppl 1:38-41. Epub 2013 May 20.

Department of Obstetrics and Gynecology, Ege University School of Medicine, Bornova, 35100, Izmir.

We present a case of infantile myofibromatosis of the lung detected at 32 weeks' gestation. The fetus was monitored with weekly ultrasound examinations measuring the mass size and amniotic fluid index. On day 2 after delivery, due to respiratory distress, an exploratory thoracotomy was undertaken and the mass was resected.
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http://dx.doi.org/10.1002/jcu.22059DOI Listing
July 2014

Massive secondary postpartum hemorrhage with uterine artery pseudoaneurysm after cesarean section.

Case Rep Obstet Gynecol 2013 4;2013:285846. Epub 2013 Apr 4.

Department of Obstetrics and Gynecology, Ege University, Faculty of Medicine, Bornova, 35100 İzmir, Turkey.

Uterine artery pseudoaneurysm is a rare but serious complication of cesarean section. If inadequately treated, it can lead to life-threatening postpartum hemorrhage. Herein, we report the case of a 28-year-old woman who developed secondary postpartum hemorrhage resulting from uterine artery pseudoaneurysm and cesarean scar dehiscence after cesarean section. Angiographic embolization is a safe and effective procedure for treating postpartum hemorrhage resulting from pseudoaneurysm in hemodynamically stable patients. However, uterine artery ligation may be the surgical procedure of choice for hemodynamically unstable patients when fertility preservation is desired.
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http://dx.doi.org/10.1155/2013/285846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638570PMC
May 2013