Publications by authors named "Ali Haberal"

91 Publications

Complications of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: An evaluation of 100 cases.

Int J Gynaecol Obstet 2021 May 26. Epub 2021 May 26.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Baskent University School of Medicine, Ankara, Turkey.

Objective: To evaluate the perioperative outcomes and complications of patients with peritoneal carcinomatosis who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods: This retrospective study included 100 patients operated on between 2016 and 2020. Patients' characteristics, including age, comorbidities, chemotherapy history, treatment failures, cancer type, histology, platinum sensitivity, and perioperative complications, were documented. Perioperative complications were classified according to the Clavien-Dindo classification.

Results: Median age was 58 years and median follow-up time was 16 months. Eighty-six (86%) patients had ovarian cancer; 11 (11%) experienced grade III-IV complications, and the only relevant factor was the presence of multiple metastasis (P = 0.031). Seven patients (7%) had surgical-site infection; in multivariant analyses, only ostomy formation was found as an independent risk factor for surgical-site infection (odds ratio [OR] 14.01; 95% confidence interval [CI] 1.36-143.52; P = 0.024). Fifteen (15%) patients experienced elevated serum creatinine after surgery and the median time to creatinine elevation was 5 days postoperatively (range 3-15 days). In multivariant analyses, only age of of 58 years or more was found as a significant factor for the elevation of serum creatinine (OR 6.96; 95% CI 1.42-32.81; P = 0.014).

Conclusion: Our results showed that the presence of multiple metastases increased the risk of grade III-IV complications and age of 58 years or more was the leading risk factor for renal complications. However, we could not find a relation between postoperative complications and oncologic outcomes. HIPEC seems to be a safe approach in experienced hands.
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http://dx.doi.org/10.1002/ijgo.13767DOI Listing
May 2021

Prognostic value of the number of the metastatic lymph nodes in locally early-stage cervical cancer: squamous cell carcinoma versus non-squamous cell carcinoma.

Arch Gynecol Obstet 2021 Mar 27. Epub 2021 Mar 27.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey.

Purpose: To clarify the prognostic value of the number of metastatic lymph nodes (mLNs) in squamous and non-squamous histologies among women with node-positive cervical cancer.

Methods: One hundred ninety-one node-positive cervical cancer patients who had undergone radical hysterectomy plus systematic pelvic and para-aortic lymphadenectomy followed by concurrent radiochemotherapy were retrospectively reviewed. The prognostic value of the number of mLNs was investigated in squamous cell carcinoma (SCC) v (n = 148) and non-SCC (n = 43) histologies separately with univariate log-rank test and multivariate Cox regression analyses.

Results: In SCC cohort, mLNs > 2 was significantly associated with decreased 5-year disease-free survival (DFS) [hazard ratio (HR) = 2.06; 95% confidence interval (CI) 1.03-4.09; p = 0.03) and overall survival (OS) (HR = 2.35, 95% CI 1.11-4.99; p = 0.02). However mLNs > 2 had no significant impact on 5-year DFS and 5-year OS rates in non-SCC cohort (p = 0.94 and p = 0.94, respectively). We stratified the entire study population as SCC with mLNs ≤ 2, SCC with mLNs > 2, and non-SCC groups. Thereafter, we compared survival outcomes. The non-SCC group had worse 5-year OS (46.8% vs. 85.3%, respectively; p < 0.001) and 5-year DFS rates (31.6% vs. 82.2%, respectively; p < 0.001) when compared to those of the SCC group with mLNs ≤ 2. However, the non-SCC group and the SCC group with mLNs > 2 had similar 5-year OS (46.8% vs. 65.5%, respectively; p = 0.16) and 5-year DFS rates (31.6% vs. 57.5%, respectively; p = 0.06).

Conclusion: Node-positive cervical cancer patients who have non-SCC histology as well as those who have SCC histology with mLNs > 2 seem to have worse survival outcomes when compared to women who have SCC histology with mLNs ≤ 2.
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http://dx.doi.org/10.1007/s00404-021-06030-wDOI Listing
March 2021

Nulliparity and postmenopausal status are independent factors of malignancy potential of endometrial intraepithelial neoplasia in polyps.

Int J Gynaecol Obstet 2021 Mar 15;152(3):433-438. Epub 2020 Dec 15.

Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey.

Objective: To estimate the risk of concurrent endometrial cancer in endometrium when endometrial intraepithelial neoplasia (EIN) is found within an endometrial polyp and to identify the possible predictive factors for concurrent endometrial cancer.

Methods: Histopathologic data of women who underwent hysteroscopy for resection of endometrial polyps at Ankara Baskent University Hospital, between 2011 and 2019 were screened. Patients whose polypectomy report was EIN in a polyp, and who had a final report of the hysterectomy specimen were included. Patients were divided into two groups according to the presence of concurrent cancer in the hysterectomy material: group 1, concurrent cancer present and group 2, concurrent cancer absent. Statistical analyses were performed using SPSS.

Results: A total of 4125 women underwent hysteroscopy for the resection of endometrial polyps. Of those women, 161 (3.9%) were diagnosed as having EIN and 115 met the criteria. The rate of concurrent endometrial cancer was 28.6% (33/115). According to multivariate analysis, nulliparity (odds ratio [OR] 0.38; 95% confidence interval [CI] 1.04-3.67; p = 0.036) and postmenopausal status (OR 0.64; 95% CI 0.42-0.98; p = 0.042) were found to be independent factors significantly associated with concurrent endometrial cancer.

Conclusion: The incidence of concurrent cancer is higher in postmenopausal or nulliparous women when EIN is detected in a polyp.
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http://dx.doi.org/10.1002/ijgo.13448DOI Listing
March 2021

The prognostic value of lymph node ratio in stage IIIC cervical cancer patients triaged to primary treatment by radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy.

J Gynecol Oncol 2020 Jan 24;31(1):e1. Epub 2019 Jun 24.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey.

Objective: The aim of this study was to determine the prognostic value of lymph node ratio (LNR) in women with 2018 International Federation of Gynecology and Obstetrics stage IIIC cervical cancer.

Methods: In this retrospective dual-institutional study, a total of 185 node-positive cervical cancer patients who had undergone radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy were included. All of the patients received adjuvant chemoradiation after surgery. LNR was defined as the ratio of positive lymph nodes (LNs) to the total number of LNs removed. The patients were categorized into 2 groups according to LNR; LNR <0.05 and LNR ≥0.05. The prognostic value of LNR was evaluated with univariate log-rank tests and multivariate Cox regression models.

Results: A total of 138 patients (74.6%) had stage IIIC1 disease and 47 (25.4%) patients had stage IIIC2 disease. With a median follow-up period of 45.5 months (range 3-135 months), the 5-year disease-free survival (DFS) rate was 62.5% whereas the 5-year overall survival (OS) rate was 70.4% for the entire study population. The 5-year DFS rates for LNR <0.05 and LNR ≥0.05 were 78.2%, and 48.4%, respectively (p<0.001). Additionally, the 5-year OS rates for LNR <0.05 and LNR ≥0.05 were 80.6%, and 61.2%, respectively (p=0.007). On multivariate analysis, LNR ≥0.05 was associated with a worse DFS (hazard ratio [HR]=2.12; 95% confidence interval [CI]=1.15-3.90; p=0.015) and OS (HR=1.95; 95% CI=1.01-3.77; p=0.046) in women with stage IIIC cervical cancer.

Conclusions: LNR ≥0.05 seems to be an independent prognostic factor for decreased DFS and OS in stage IIIC cervical carcinoma.
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http://dx.doi.org/10.3802/jgo.2020.31.e1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6918892PMC
January 2020

Is the revised 2018 FIGO staging system for cervical cancer more prognostic than the 2009 FIGO staging system for women previously staged as IB disease?

Eur J Obstet Gynecol Reprod Biol 2019 Sep 6;240:209-214. Epub 2019 Jul 6.

Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.

Objective: The purpose of this study was to compare the prognostic value of the revised FIGO staging system with that of the 2009 FIGO staging system for women previously staged as IB disease.

Methods: Institutional cervical cancer databases of two high-volume gynecologic cancer centers in Ankara, Turkey, were retrospectively analyzed. Only women with 2009 FIGO stage IB1 or IB2 disease who underwent primary surgery were included. Survival curves were generated using Kaplan-Meier plots, and the log-rank test was used for survival comparisons. The Cox proportional hazards regression model was used to obtain hazard ratios (HRs) and 95% confidence interval (CI).

Results: Data from 425 women were analyzed. The 2009 FIGO stage IB2 (n = 131) disease was associated with a nearly three-fold increased risk of mortality when compared to the 2009 FIGO stage IB1 (n = 294) disease (HR: 2.72, 95% CI: 1.69-4.37; p < 0.001). Stage migration was observed in 372 (87.5%) patients, according to the revised FIGO staging system, leading to no significant difference in five-year overall survival rates between stage IB1 (n=53) and IB2 (n=127) disease (95.2% vs. 89.3%, respectively; p = 0.23),or between stage IB2 (n=127) and IB3 (n=95) disease (89.3% vs. 84.2%, respectively; p = 0.12). Similarly, there was no significant difference in five-year overall survival rates between stage IIIC1 (n=114) and IIIC2 (n=36) disease (79.0% vs. 67.2%, respectively; p = 0.34).

Conclusion: When compared to the 2009 FIGO staging system, the revised staging system has more sub-stages, which leads to fewer patients in each sub-stage, resulting in diminished statistical power.
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http://dx.doi.org/10.1016/j.ejogrb.2019.07.002DOI Listing
September 2019

Are There Any Predictors of Endometrial Premalignancy/Malignancy within Endometrial Polyps in Infertile Patients?

Gynecol Obstet Invest 2019 16;84(5):512-518. Epub 2019 Jul 16.

Department of Obstetrics and Gynecology, Baskent University School of Medicine, Ankara, Turkey,

Background: In the literature, there is no detailed analysis on the prediction factors for premalignancy/malignancy within endometrial polyps (EPs) in infertile patients. In this study, we aimed to determine the frequency of endometrial premalignancy/malignancy within EPs in infertile patients undergoing office hysteroscopic polypectomy and identify the factors that can potentially predict an endometrial premalignancy/malignancy within EPs.

Method: A total of 957 infertile patients undergoing office hysteroscopy were diagnosed with EPs between February 2011 and August 2018. Patients were divided into 2 groups according to the pathological examination of EPs as benign (Group 1; n = 939) and premalignant/malignant (Group 2; n = 18). The medical records of all patients included in the study were reviewed retrospectively.

Results: In this cohort, prevalence of endometrial premalignancy/malignancy within EPs was 18/957 (1.88%). On univariate analysis, age, polyp size, diabetes, hypertension, and causes of infertility did not differ between the 2 groups. On multivariate analysis, diffuse polypoid appearance of the endometrial cavity on office hysteroscopy (hazard ratio [HR] 4.1; 95% CI 1.576-10.785), duration of infertility, (HR 4; 95% CI 1.279-12.562), and body mass index (HR 7.9; 95% CI 2.591-24.258) were found to be independent predictors of endometrial premalignancy/malignancy within polyps in infertile patients.

Conclusion: When diffuse polypoid appearance of the endometrial cavity is detected in an infertile patient during office hysteroscopy, hysteroscopy-guided resection and endometrial curettage should be performed. The pathological specimen should be sent for histopathological evaluation to diagnose possible endometrial premalignancy/malignancy within polyps.
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http://dx.doi.org/10.1159/000501682DOI Listing
December 2019

Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer.

Int J Gynecol Cancer 2019 03 21;29(3):505-512. Epub 2019 Jan 21.

Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Ankara, Turkey.

Objective: The purpose of this study was to assess the prognostic significance of lymphovascular space invasion in women with low-risk endometrial cancer.

Methods: A dual-institutional, retrospective department database review was performed to identify patients with 'low-risk endometrial cancer' (patients having <50% myometrial invasion with grade 1 or 2 endometrioid endometrial cancer according to their final pathology reports) at two gynecologic oncology centers in Ankara, Turkey. Demographic, clinicopathological and survival data were collected.

Results: We identified 912 women with low-risk endometrial cancer; 53 patients (5.8%) had lymphovascular space invasion. When compared with lymphovascular space invasion-negative patients, lymphovascular space invasion-positive patients were more likely to have post-operative grade 2 disease (p<0.001), deeper myometrial invasion (p=0.003), and larger tumor size (p=0.005). Patients with lymphovascular space invasion were more likely to receive adjuvant therapy when compared with lymphovascular space invasion-negative women (11/53 vs 12/859, respectively; p<0.001). The 5-year recurrence-free survival rate for lymphovascular space invasion-positive women was 85.5% compared with 97.0% for lymphovascular space invasion-negative women (p<0.001). The 5-year overall survival rate for lymphovascular space invasion-positive women was significantly lower than that of lymphovascular space invasion-negative women (88.2% vs 98.5%, respectively; p<0.001). Age ≥60 years (HR 3.13, 95% CI 1.13 to 8.63; p=0.02) and positive lymphovascular space invasion status (HR 6.68, 95% CI 1.60 to 27.88; p=0.009) were identified as independent prognostic factors for decreased overall survival.

Conclusions: Age ≥60 years and positive lymphovascular space invasion status appear to be important prognostic parameters in patients with low-risk endometrial cancer who have undergone complete surgical staging procedures including pelvic and para-aortic lymphadenectomy. Lymphovascular space invasion seems to be associated with an adverse prognosis in women with low-risk endometrial cancer; this merits further assessment on a larger scale with standardization of the lymphovascular space invasion in terms of presence/absence and quantity.
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http://dx.doi.org/10.1136/ijgc-2018-000069DOI Listing
March 2019

Impact of lymph node ratio on survival in stage IIIC endometrioid endometrial cancer: a Turkish Gynecologic Oncology Group study.

J Gynecol Oncol 2018 Jul 13;29(4):e48. Epub 2018 Mar 13.

Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.

Objective: The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in women with stage IIIC endometrioid endometrial cancer (EC).

Methods: A multicenter, retrospective department database review was performed to identify patients with stage IIIC pure endometrioid EC at 6 gynecologic oncology centers in Turkey. A total of 207 women were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 2 groups: LNR1 (≤0.15), and LNR2 (>0.15). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models.

Results: One hundred and one (48.8%) were classified as stage IIIC1 and 106 (51.2%) as stage IIIC2. The median age at diagnosis was 58 (range, 30-82) and the median duration of follow-up was 40 months (range, 1-228 months). There were 167 (80.7%) women with LNR ≤0.15, and 40 (19.3%) women with LNR >0.15. The 5-year progression-free survival (PFS) rates for LNR ≤0.15 and LNR >0.15 were 76.1%, and 58.5%, respectively (p=0.045). An increased LNR was associated with a decrease in 5-year overall survival (OS) from 87.0% for LNR ≤0.15 to 62.3% for LNR >0.15 (p=0.005). LNR >0.15 was found to be an independent prognostic factor for both PFS (hazard ratio [HR]=2.05; 95% confidence interval [CI]=1.07-3.93; p=0.03) and OS (HR=3.35; 95% CI=1.57-7.19; p=0.002).

Conclusion: LNR seems to be an independent prognostic factor for decreased PFS and OS in stage IIIC pure endometrioid EC.
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http://dx.doi.org/10.3802/jgo.2018.29.e48DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5981100PMC
July 2018

Impact of lymph node ratio on survival in stage III ovarian high-grade serous cancer: a Turkish Gynecologic Oncology Group study.

J Gynecol Oncol 2018 Jan;29(1):e12

Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.

Objective: The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in patients with stage III ovarian high-grade serous carcinoma (HGSC).

Methods: A multicenter, retrospective department database review was performed to identify patients with ovarian HGSC at 6 gynecologic oncology centers in Turkey. A total of 229 node-positive women with stage III ovarian HGSC who had undergone maximal or optimal cytoreductive surgery plus systematic lymphadenectomy followed by paclitaxel plus carboplatin combination chemotherapy were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 3 groups: LNR1 (<10%), LNR2 (10%≤LNR<50%), and LNR3 (≥50%). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models.

Results: Thirty-one women (13.6%) were classified as stage IIIA1, 15 (6.6%) as stage IIIB, and 183 (79.9%) as stage IIIC. The median age at diagnosis was 56 (range, 18-87), and the median duration of follow-up was 36 months (range, 1-120 months). For the entire cohort, the 5-year overall survival (OS) was 52.8%. An increased LNR was associated with a decrease in 5-year OS from 65.1% for LNR1, 42.5% for LNR2, and 25.6% for LNR3, respectively (p<0.001). In multivariate analysis, women with LNR≥0.50 were 2.7 times more likely to die of their tumors (hazard ratio [HR]=2.7; 95% confidence interval [CI]=1.42-5.18; p<0.001).

Conclusion: LNR seems to be an independent prognostic factor for decreased OS in stage III ovarian HGSC patients.
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http://dx.doi.org/10.3802/jgo.2018.29.e12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709522PMC
January 2018

Comparison of three different risk-stratification models for predicting lymph node involvement in endometrioid endometrial cancer clinically confined to the uterus.

J Gynecol Oncol 2017 Nov;28(6):e78

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey.

Objective: To compare the clinical validity of the Gynecologic Oncology Group-99 (GOG-99), the Mayo-modified and the European Society for Medical Oncology (ESMO)-modified criteria for predicting lymph node (LN) involvement in women with endometrioid endometrial cancer (EC) clinically confined to the uterus.

Methods: A total of 625 consecutive women who underwent comprehensive surgical staging for endometrioid EC clinically confined to the uterus were divided into low- and high-risk groups according to the GOG-99, the Mayo-modified, and the ESMO-modified criteria. Lymphovascular space invasion is the cornerstone of risk stratification according to the ESMO-modified criteria. These 3 risk stratification models were compared in terms of predicting LN positivity.

Results: Systematic LN dissection was achieved in all patients included in the study. LN involvement was detected in 70 (11.2%) patients. LN involvement was correctly estimated in 51 of 70 LN-positive patients according to the GOG-99 criteria (positive likelihood ratio [LR+], 3.3; negative likelihood ratio [LR-], 0.4), 64 of 70 LN-positive patients according to the ESMO-modified criteria (LR+, 2.5; LR-, 0.13) and 69 of the 70 LN-positive patients according to the Mayo-modified criteria (LR+, 2.2; LR-, 0.03). The area under curve of the Mayo-modified, the GOG-99 and the ESMO-modified criteria was 0.763, 0.753, and 0.780, respectively.

Conclusion: The ESMO-modified classification seems to be the risk-stratification model that most accurately predicts LN involvement in endometrioid EC clinically confined to the uterus. However, the Mayo-modified classification may be an alternative model to achieve a precise balance between the desire to prevent over-treatment and the ability to diagnose LN involvement.
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http://dx.doi.org/10.3802/jgo.2017.28.e78DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641528PMC
November 2017

Effects of the morbid obesity and skin incision choices on surgical outcomes in patients undergoing total abdominal hysterectomy.

Turk J Obstet Gynecol 2016 Dec 15;13(4):189-195. Epub 2016 Dec 15.

Etlik Zübeyde Hanım Women's and Children's Health Education and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey.

Objective: This study aimed to evaluate the effect of obesity on surgical outcomes in patients who underwent gynecologic surgery.

Materials And Methods: In total, we evaluated 132 patients who underwent total abdominal hysterectomy with or without salpingo-oophorectomy for benign gynecologic procedures at our tertiary referral gynaecology clinic.

Results: The non-morbid obese group [body mass index (BMI) <40 kg/m] included 94 patients, and the morbid obese group (BMI ≥40 kg/m) included 38 patients. The perioperative outcomes of the groups were compared. The mean operative time was significantly longer for morbid obese patients than non-morbid obese patients (p<0.05). Estimated blood loss, the need for blood transfusion, postoperative hemoglobin values, and the need for an intraabdominal drain were similar between the groups. Early and late postoperative complications were significantly more frequent in the morbid obese group than the other group (p<0.05, for each). Early postoperative complications in patients who underwent vertical skin incision were significantly more frequent than in patients who underwent pfannenstiel incision (p<0.05). Late complications were comparable between the two types of skin incision.

Conclusion: Morbid obesity significantly increases the mean operative times and the postoperative complication rates of abdominal hysterectomy operations.
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http://dx.doi.org/10.4274/tjod.67864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558291PMC
December 2016

Factors associated with survival after relapse in patients with low-risk endometrial cancer treated with surgery alone.

J Gynecol Oncol 2017 Sep 16;28(5):e65. Epub 2017 Jun 16.

Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Faculty of Medicine, University of Health Sciences, Izmir, Turkey.

Objective: To determine factors influencing overall survival following recurrence (OSFR) in women with low-risk endometrial cancer (EC) treated with surgery alone.

Methods: A multicenter, retrospective department database review was performed to identify patients with recurrent "low-risk EC" (patients having less than 50% myometrial invasion [MMI] with grade 1 or 2 endometrioid EC) at 10 gynecologic oncology centers in Turkey. Demographic, clinicopathological, and survival data were collected.

Results: We identified 67 patients who developed recurrence of their EC after initially being diagnosed and treated for low-risk EC. For the entire study cohort, the median time to recurrence (TTR) was 23 months (95% confidence interval [CI]=11.5-34.5; standard error [SE]=5.8) and the median OSFR was 59 months (95% CI=12.7-105.2; SE=23.5). We observed 32 (47.8%) isolated vaginal recurrences, 6 (9%) nodal failures, 19 (28.4%) peritoneal failures, and 10 (14.9%) hematogenous disseminations. Overall, 45 relapses (67.2%) were loco-regional whereas 22 (32.8%) were extrapelvic. According to the Gynecologic Oncology Group (GOG) Trial-99, 7 (10.4%) out of 67 women with recurrent low-risk EC were qualified as high-intermediate risk (HIR). The 5-year OSFR rate was significantly higher for patients with TTR ≥36 months compared to those with TTR <36 months (74.3% compared to 33%, p=0.001). On multivariate analysis for OSFR, TTR <36 months (hazard ratio [HR]=8.46; 95% CI=1.65-43.36; p=0.010) and presence of HIR criteria (HR=4.62; 95% CI=1.69-12.58; p=0.003) were significant predictors.

Conclusion: Low-risk EC patients recurring earlier than 36 months and those carrying HIR criteria seem more likely to succumb to their tumors after recurrence.
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http://dx.doi.org/10.3802/jgo.2017.28.e65DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540724PMC
September 2017

Prognostic factors and treatment outcomes in surgically-staged non-invasive uterine clear cell carcinoma: a Turkish Gynecologic Oncology Group study.

J Gynecol Oncol 2017 Jul;28(4):e49

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey.

Objective: To assess the prognosis of surgically-staged non-invasive uterine clear cell carcinoma (UCCC), and to determine the role of adjuvant therapy.

Methods: A multicenter, retrospective department database review was performed to identify patients with UCCC who underwent surgical treatment between 1997 and 2016 at 8 Gynecologic Oncology Centers. Demographic, clinicopathological, and survival data were collected.

Results: A total of 232 women with UCCC were identified. Of these, 53 (22.8%) had surgically-staged non-invasive UCCC. Twelve patients (22.6%) were upstaged at surgical assessment, including a 5.6% rate of lymphatic dissemination (3/53). Of those, 1 had stage IIIA, 1 had stage IIIC1, 1 had stage IIIC2, and 9 had stage IVB disease. Of the 9 women with stage IVB disease, 5 had isolated omental involvement indicating omentum as the most common metastatic site. UCCC limited only to the endometrium with no extra-uterine disease was confirmed in 41 women (73.3%) after surgical staging. Of those, 13 women (32%) were observed without adjuvant treatment whereas 28 patients (68%) underwent adjuvant therapy. The 5-year disease-free survival rates for patients with and without adjuvant treatment were 100.0% vs. 74.1%, respectively (p=0.060).

Conclusion: Extra-uterine disease may occur in the absence of myometrial invasion (MMI), therefore comprehensive surgical staging including omentectomy should be the standard of care for women with UCCC regardless of the depth of MMI. Larger cohorts are needed in order to clarify the necessity of adjuvant treatment for women with UCCC truly confined to the endometrium.
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http://dx.doi.org/10.3802/jgo.2017.28.e49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447148PMC
July 2017

Effect of maternal and neonatal interleukin-6 - 174 G/C polymorphism on preterm birth and neonatal morbidity.

J Matern Fetal Neonatal Med 2018 Apr 23;31(8):1009-1015. Epub 2017 Mar 23.

f Department of Obstetrics and Gynecology , Faculty of Medicine, Başkent University , Ankara , Turkey.

Objective: The aim of this study was to analyze maternal and neonatal interleukin 6 (IL-6) (-174 G/C) polymorphism and to determine effect on preterm birth and neonatal morbidity.

Study Design: One hundred and sixty-four mothers (100 term births, 64 preterm births) and 183 newborn infants who were 100 healthy term and 83 preterm babies followed in newborn intensive care units were evaluated. PCR-RFLP was performed for IL-6 (-174 G/C) genotyping.

Results: The rate of GG genotype in mothers of term and preterm infants were 54% (n = 54/100), 75% (n = 48/64), respectively (p > .05) and the rate of GC + CC genotype was 46% (n = 46/100) and 25% (n = 16/64) in mothers giving term and preterm birth (PTB), respectively (p < .05). Additionally, the rate of GG genotype was 65% (n = 65/100) and 81.9% (n = 68/83) in term infants and preterm infants, respectively. GC + CC genotype was 35% (n = 35/100) in term infants and 18.1% (n = 15/83) in preterm infants (p < .05). The effect of IL-6 (-174) GC + CC genotype on PTB was statistically significant.

Conclusion: The IL-6 174 G/C gene polymorphism was significantly different between mothers who were giving to term and preterm birth. The presence of polymorphism is protective against preterm birth and was not associated with neonatal outcome.
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http://dx.doi.org/10.1080/14767058.2017.1304911DOI Listing
April 2018

The immediate effect of vaginal and caesarean delivery on anal sphincter measurements.

J Int Med Res 2016 Aug 28;44(4):824-31. Epub 2016 Jun 28.

Department of Obstetrics and Gynaecology, Gazi University, Ankara, Turkey.

Objective: This study evaluated the effects of vaginal and caesarean delivery on internal and external anal sphincter muscle thickness using translabial ultrasonography (TL-US).

Methods: This prospective cohort study enrolled nulliparous women who either had vaginal or caesarean deliveries. The thickness of the hypoechoic internal anal sphincter (IAS) and hyperechoic external anal sphincter (EAS) at the 12, 3, 6, and 9 o'clock positions at the distal level were measured before delivery and within 24-48 h after delivery.

Results: A total 105 consecutive women were enrolled in the study: 60 in the vaginal delivery group and 45 in the caesarean delivery group. The IAS muscle thickness at the 12 o'clock position in the vaginal delivery group was significantly thicker before compared with after delivery (mean ± SD: 2.31 ± 0.74 mm versus 1.81 ± 0.64 mm, respectively). The EAS muscle thickness at the 12 o'clock position in the vaginal delivery group was significantly thicker before compared with after delivery (mean ± SD: 2.42 ± 0.64 mm versus 1.97 ± 0.85, respectively).

Conclusions: There was significant muscle thinning of both the IAS and EAS at the 12 o'clock position after vaginal delivery, but not after caesarean delivery.
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http://dx.doi.org/10.1177/0300060516653066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5536623PMC
August 2016

Comparison of Therapeutic Efficacies of Norethisterone, Tranexamic Acid and Levonorgestrel-Releasing Intrauterine System for the Treatment of Heavy Menstrual Bleeding: A Randomized Controlled Study.

Gynecol Obstet Invest 2016 8;81(5):447-53. Epub 2016 Mar 8.

Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecology Clinic, Ankara, Turkey.

Background: Our aim was to compare the therapeutic efficacies of norethisterone acid (NETA), tranexamic acid and levonorgestrel-releasing intrauterine system (LNG-IUS) in treating idiopathic heavy menstrual bleeding (HMB).

Methods: Women with heavy uterine bleeding were randomized to receive NETA, tranexamic acid or LNG-IUS for 6 months. The primary outcome was a decrease in menstrual bleeding as assessed by pictorial blood loss assessment charts and hematological parameters analyzed at the 1st, 3rd and 6th months. Health-related quality of life (QOL) variables were also recorded and analyzed.

Results: Twenty-eight patients were enrolled in each treatment group, but the results of only 62 were evaluated. NETA, tranexamic acid, and LNG-IUS reduced menstrual blood loss (MBL) by 53.1, 60.8, and 85.8%, respectively, at the 6th month. LNG-IUS was more effective than NETA and tranexamic acid in decreasing MBL. LNG-IUS was also more efficient than tranexamic acid in correcting anemia related to menorrhagia. Satisfaction rates were comparable among the NETA (70%), tranexamic acid (63%) and LNG-IUS (77%) groups. QOL in physical aspects increased significantly in the tranexamic acid and LNG-IUS groups.

Conclusion: The positive effect of LNG-IUS on QOL parameters, as well as its high efficacy, makes it a first-line option for HMB.
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http://dx.doi.org/10.1159/000443393DOI Listing
April 2017

Adnexal Masses Treated Using a Combination of the SILS Port and Noncurved Straight Laparoscopic Instruments: Turkish Experience and Review of the Literature.

Minim Invasive Surg 2013 11;2013:836380. Epub 2013 Nov 11.

Department of Obstetrics and Gynecology, Baskent University, School of Medicine, Ankara, Turkey.

Objective. To report our experience treating adnexal masses using a combination of the SILS port and straight nonroticulating laparoscopic instruments. Study Design. This prospective feasibility study included 14 women with symptomatic and persistent adnexal masses. Removal of adnexal masses via single-incision laparoscopic surgery using a combination of the SILS port and straight nonroticulating laparoscopic instruments was performed. Results. All of the patients had symptomatic complex adnexal masses. Mean age of the patients was 38.4 years (range: 21-61 years) and mean duration of surgery was 71 min (range: 45-130 min). All surgeries were performed using nonroticulating straight laparoscopic instruments. Mean tumor diameter was 6 cm (range: 5-12 cm). All patient pathology reports were benign. None of the patients converted to laparotomy. All the patients were discharged on postoperative d1. Postoperatively, all the patients were satisfied with their incision and cosmetic results. Conclusion. All 14 patients were successfully treated using standard, straight nonroticulating laparoscopic instruments via the SILS port. This procedure can reduce the cost of treatment, which may eventually lead to more widespread use of the SILS port approach. Furthermore, concomitant surgical procedures are possible using this approach. However, properly designed comparative studies with single port and classic laparoscopic surgery are urgently needed.
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http://dx.doi.org/10.1155/2013/836380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836423PMC
December 2013

HPV types in Turkey: multicenter hospital based evaluation of 6388 patients in Turkish gynecologic oncology group centers.

Turk Patoloji Derg 2013 ;29(3):210-6

Department of Obstetrics and Gynecology, Başkent University, Faculty of Medicine, ANKARA, TURKEY.

Objective: To evaluate the prevalence of HPV DNA and cervical cytological abnormalities, to compare cervical cytology results and HPV DNA and to define HPV types distribution in a large series of Turkish women who have undergone HPV analysis in hospitals that are members of the Turkish Gynecological Oncology Group.

Material And Method: Between 2006 and 2010, a total of 6388 patients' data was retrospectively evaluated at 12 healthcare centers in Turkey. Demographic characteristics, cervical cytology results, HPV status and types were compared.

Results: The mean age of the patients was 38.9±10.2. Overall, 25% of the women were found to be HPV positive. Presence of HPV-DNA among patients with abnormal and normal cytology was 52% and 27%, respectively. There was significant difference with respect to decades of life and HPV positivity (p < 0.05). HPV was positive in (within the HPV (+) patients) 37%, 9%, 27%, 20%, 22%, and 41% of the ASCUS, ASC-H, LSIL HSIL, glandular cell abnormalities, and SCC cases respectively The most common HPV types in our study were as follows; HPV 16 (32%), HPV 6 (17%), HPV 11 (9%), HPV 18 (8%), HPV 31 (6%), HPV 51 (5%), HPV 33 (3%).

Conclusion: In this hospital based retrospective analysis, HPV genotypes in Turkish women with normal and abnormal cytology are similar to those reported from western countries. Further population based prospective multicenter studies are necessary to determine non-hospital based HPV prevalence in Turkish women.
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http://dx.doi.org/10.5146/tjpath.2013.01188DOI Listing
March 2014

Laparoendoscopic single-site surgery for acute adnexal pathology during pregnancy: preliminary experience.

J Matern Fetal Neonatal Med 2013 Sep 12;26(13):1282-6. Epub 2013 Apr 12.

Department of Obstetrics & Gynecology, School of Medicine, Baskent University, Ankara, Turkey.

Objective: To report the feasibility of laparoendoscopic single port surgical approach for the management of huge adnexal cysts and adnexal torsion during pregnancy. To discuss the optimal method of entry into the peritoneal cavity for pregnant patients.

Design: Two case report. METHOD AND PATIENT(S): Two pregnant patients with adnexal mass. First patient, suffering from persistent and progressive abdominal distention and pain on her 12th week of pregnancy, was diagnosed with an ovarian cyst in 18 cm diameter on left ovary. The other patient had IVF twin pregnancy and presented with left adnexal torsion on the 25th week of pregnancy.

Intervention(s): Single-port laparoscopic ovarian cystectomy on the 12th week of pregnancy in patient one and single-port left adnexectomy in a twin pregnancy on the 25th week of pregnancy in patient two.

Main Outcome Measure(s): Feasibility of single port laparoscopic intervention during pregnancy for adnexal mass.

Result(s): Complete resolution of the symptoms for both pregnant women after the surgeries. No fetal and maternal complication was diagnosed during both pregnancies.

Conclusion(s): Single port laparoscopy with open-entry technique is feasible and might be a better surgical option for the pregnant patients with adnexal pathology. However, further studies with larger sample size are needed to reach clear conclusion.
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http://dx.doi.org/10.3109/14767058.2013.783799DOI Listing
September 2013

A Turkish Gynecologic Oncology Group study of fertility-sparing treatment for early-stage endometrial cancer.

Int J Gynaecol Obstet 2012 Dec 24;119(3):270-3. Epub 2012 Aug 24.

Department of Obstetrics and Gynecology, Baskent University School of Medicine, Ankara, Turkey.

Objective: To analyze the results of fertility-sparing treatment of early-stage endometrial cancer (EC) in patients treated at Turkish gynecologic oncology centers, and to present a review of the literature.

Methods: Thirteen healthcare centers in Turkey were contacted to determine if they were eligible to participate in the study. Centers that were eligible and agreed to participate were sent a database form to record the demographic characteristics, clinicopathologic findings, and follow-up results for their EC patients.

Results: Eleven Turkish healthcare centers provided data on 43 EC patients. Mean duration of treatment was 5 months and mean follow-up was 49 months. In total, 35 (81.4%) patients were tumor free following primary progesterone therapy. Mean time from the end of progesterone therapy to pregnancy was 10.6 ± 4.3 months (range, 3-18 months). Two patients had tumor recurrence during follow-up. The pregnancy rate among the 31 women who actively sought pregnancy was 41.9% (n=13).

Conclusion: Conservative management of early-stage EC in women of reproductive age using oral progestins was effective and did not compromise oncological outcome. Pregnancy in the study patients was achieved spontaneously and artificially.
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http://dx.doi.org/10.1016/j.ijgo.2012.06.010DOI Listing
December 2012

Maternal-fetal proinflammatory cytokine gene polymorphism and preterm birth.

DNA Cell Biol 2012 Jan 17;31(1):92-7. Epub 2011 Jun 17.

Department of Medical Biology, Baskent University School of Medicine, Ankara, Turkey.

Association between maternal-fetal proinflammatory cytokine genotype and preterm birth was studied. Isolated genomic DNA from maternal and cord blood samples of 100 preterm and 101 term labors were used for TNFα (-238G/A, -308G/A), IL-1α (4845G/T), and IL-1β (-511C/T) genotyping. TNFα -238 GA genotype in term neonates was significantly higher than the premature neonates (p<0.05). Maternal-fetal TNFα -238 heterozygosity was associated with term labor (p<0.05). TNFα -308 GA and AA genotypes were associated with term labor (mothers and neonates, respectively; p<0.05 and p<0.001). The incidence of term labor was significantly increased in TNFα -308 GA genotype. If a -308GA carrier has a fetus with GG genotype, the incidence of preterm labor increases (p<0.01). The 4845 T allele was significantly higher in preterm mothers and neonates (p<0.001 and p<0.001). The effect of maternal-fetal genotype for the pregnancy outcome reveals that maternal 4845GG and GT genotypes increase term labor incidence, whereas fetal 4845 TT genotype was a significant independent risk factor for preterm birth (p<0.01). IL-1β -511 TT genotype was significantly higher in preterm neonates. The preterm labor risk was significantly increased in maternal -511 TT genotype and fetal CT genotypes, whereas with maternal -511 CT or TT genotypes or a -511 TT fetus, the incidence of term pregnancy increases (p<0.01).
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http://dx.doi.org/10.1089/dna.2010.1169DOI Listing
January 2012

Diagnostic accuracy and efficacy of color Doppler mapping for tubal patency.

J Obstet Gynaecol Res 2011 Jul 13;37(7):782-6. Epub 2011 Mar 13.

Infertility Unit, Department of Obstetrics and Gynaecology, Etlik Zubeyde Hanim Womens' Health Teaching and Research Hospital, Ankara, Turkey.

Aim: To evaluate the diagnostic accuracy of color Doppler mapping for tubal patency, comparing its results with those of hysterosalpingography (HSG) and laparoscopy.

Material And Methods: A prospective clinical study was conducted in 36 subfertile women who were offered laparoscopy after HSG evaluation. All infertile couples were evaluated with basic infertility procedures. After HSG assessment, laparoscopy was offered when evidence of either unilateral or bilateral tubal obstruction was observed. One day before the operation, transvaginal ultrasound scanning of the pelvis and color Doppler mapping were performed. The findings of sonography, HSG and laparoscopy were compared.

Results: Sixty-four of 72 fallopian tubes were evaluated and four patients were excluded from the analysis because of technical difficulties. The sensitivity of color Doppler mapping for detecting tubal patency was 76.2% with a specificity of 81.4%. The positive and negative predictive values were 66.7% and 87.5%, respectively. The concordance rate was 79.7%. The false positivity rate for color Doppler mapping and HSG were observed as 19% and 35%, respectively.

Conclusion: Color Doppler mapping as an adjunct to an abnormal HSG may decrease the need for laparoscopic intervention for the diagnosis of tubal disorders.
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http://dx.doi.org/10.1111/j.1447-0756.2010.01433.xDOI Listing
July 2011

Comparison of the efficacy of three progestins in the treatment of simple endometrial hyperplasia without atypia.

Gynecol Obstet Invest 2011 25;72(1):10-4. Epub 2011 Jan 25.

Gynecology Clinic, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.

Aim: To evaluate the treatment of endometrial hyperplasia (EH) with different progestins.

Methods: Eighty-two women with simple EH without atypia were included. Patients were offered oral progestagens and were randomized to one of three options for 3 months: medroxyprogesterone acetate (MPA, 10 mg/day), lynestrenol (LYN, 15 mg/day) and norethisterone (NET, 15 mg/day) for 10 days per cycle. Patients were reevaluated after treatment. Women diagnosed with proliferative and nonatypical EH at the second curettage were offered the same progestins for another 3 months. The primary outcome of the study was the proportion of women requiring further treatment.

Results: Of the 82 women, 46 (56.1%) received MPA (23.2%), LYN (13.4%) and NET (19.5%) therapy for another 3 months at the end of the first 3 months of treatment. The patients receiving MPA showed resolution in 36.7% of the cases versus 37% in the NET group. The highest resolution rate (56%) was observed in the LYN group, although there was no statistically significant difference between progestins regarding the proportion of women requiring further treatment (χ(2) = 2.608; p = 0.271).

Conclusion: It seems that the efficacies of oral progestins are similar at these dosages in simple EH without atypia.
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http://dx.doi.org/10.1159/000321390DOI Listing
February 2012

Comparison of levonorgestrel intrauterine system versus hysterectomy on efficacy and quality of life in patients with adenomyosis.

Fertil Steril 2011 Feb 12;95(2):497-502. Epub 2010 Nov 12.

Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecology Clinic, Ankara, Turkey.

Objective: To compare the levonorgestrel intrauterine system (LNG-IUS) with hysterectomy in patients with adenomyosis and to study the effects of both treatments on quality of life (QOL).

Design: Prospective randomized clinical trial.

Setting: Women's health teaching and research hospital.

Patient(s): Eighty-six patients (43 patients for each group) were enrolled, but only 75 women continued the study.

Intervention(s): Women interpreted as having adenomyosis on transvaginal ultrasound and magnetic resonance imaging were assigned to receive either LNG-IUS or hysterectomy.

Main Outcome Measure(s): Clinical measures of menstrual bleeding as number of used pads/day during menstruation, hemoglobin levels, and health-related QOL variables were assessed. Each woman was followed up for 1 year after treatment.

Result(s): LNG-IUS increased the hemoglobin levels at the sixth month and first year of the treatment to the comparable levels with hysterectomy. When pretreatment and post-treatment QOL scores of groups were compared, three of the five mean domain scores (physical, environmental, environmental-TR) were increased in patients treated with hysterectomy, while in patients managed with LNG-IUS, all five mean domain scores were increased.

Conclusion(s): It seems that LNG-IUS demonstrates significant and comparable improvements in hemoglobin levels to hysterectomy in treating adenomyosis-associated menorrhagia during the first year. Although both treatments lead to improvements in health-related QOL, LNG-IUS seems to have superior effects on psychological and social life. It may be a promising alternative therapy to hysterectomy.
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http://dx.doi.org/10.1016/j.fertnstert.2010.10.009DOI Listing
February 2011

Effect of strontium ranelate on fracture healing in the osteoporotic rats.

J Orthop Res 2011 Jan 19;29(1):138-42. Epub 2010 Aug 19.

Department of Orthopaedics and Traumatology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.

The aim of this study was to evaluate the effect of strontium ranelate (SrR) on fracture healing in the osteoporotic rat model. Forty female Sprague-Dawley rats aged 3 months were enrolled in the study. Osteoporosis was induced by bilateral ovariectomy and subsequent daily heparin injection started 1 week after surgery and lasted for 4 weeks. Osteoporosis was confirmed by a reduction of bone mineral density (BMD). Twenty of the osteoporotic rats were assigned to the SrR group and the remaining 20 to the control group. An open right tibial midshaft transverse fracture was created and then an intramedullary fixation was performed. SrR group was treated by 450 mg/kg/day SrR per oral. Six weeks after surgical induction of fracture, all animals were sacrificed. One animal from each group died after ovariectomy. Two tibiae from the control group failed to unite. SrR-treated group showed higher mechanical strength and fracture stiffness when compared to the control group (p = 0.006, p = 0.001, respectively). SrR-treated group had mature woven bone or predominantly woven bone compared with osteoporotic control group (p = 0.038). SrR-treated group's callus maturity was significantly higher than control group (p = 0.001). SrR is associated with better fracture healing in the osteoporotic rat model.
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http://dx.doi.org/10.1002/jor.21204DOI Listing
January 2011

Gestational diabetes and gestational impaired glucose tolerance in 1653 teenage pregnancies: prevalence, risk factors and pregnancy outcomes.

J Pediatr Adolesc Gynecol 2011 Apr 14;24(2):62-5. Epub 2010 Aug 14.

Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Hospital, Gazi University, Ankara, Turkey.

Study Objective: The aim of this study was to determine the prevalence of gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) in adolescent pregnancies, associated risk factors, and pregnancy complications.

Design: Retrospective study.

Settings: Community-based teaching hospital.

Participants: Results of 1653 pregnant women age ≤ 19 years in 2005-2007 were reviewed.

Intervention: All pregnant women screened with 50-g glucose challenge test (GCT) and patients with a GCT result ≥ 140 mg/dl underwent a 3-hour 100-g oral glucose tolerance test (OGTT).

Main Outcome Measures: GDM was diagnosed with at least two abnormal results and GIGT was diagnosed with one abnormal result. GDM and GIGT cases were evaluated for the presence of any associated risk factors and effects of presence of risk factors on pregnancy outcomes.

Results: The prevalence of GDM was 0.85% (95% CI, 0.41-1.29), GIGT was 0.5% (95% CI, 0.15-0.81) and GDM+GIGT was 1.35% (95% CI, 0.78-1.88) by Carpenter and Coustan criteria. 68% of patients had at least one of the risk factors including body mass index ≥ 25, family history of diabetes and polycystic ovary syndrome (PCOS). Only 9.1% (n = 2) of them required insulin for glucose regulation during pregnancy with 9.1% (n = 2) macrosomia rate. All patients were primiparous and cesarean delivery rate was 27.3% (n = 6). We could not find any effect of presence of risk factors on pregnancy outcomes in GDM and GIGT cases.

Conclusion: We demonstrated that GDM and GIGT are strongly associated with high BMI before pregnancy, PCOS, and family history of diabetes. Since GDM is a state of prediabetes, it is important to diagnose in adolescent pregnancies considering their life expectancy to take preventive measures to avoid diabetes mellitus.
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http://dx.doi.org/10.1016/j.jpag.2010.07.003DOI Listing
April 2011

Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: a prospective randomized study.

Acta Obstet Gynecol Scand 2010 Jul;89(7):889-95

Department of Obstetrics and Gynecology, Rize University, School of Medicine, Rize, Turkey.

Objective: To compare the success rates of single and multiple dose methotrexate protocols for the treatment of unruptured tubal ectopic pregnancy.

Design: Prospective randomized controlled trial.

Setting: Maternity and teaching hospital in Turkey.

Population: One hundred twenty women treated with methotrexate therapy for unruptured tubal ectopic pregnancy.

Methods: Sixty-two women received a single dose and 58 received a multiple dose methotrexate regimen.

Main Outcome Measures: Success rate of methotrexate therapy (women successfully treated with one injection and women who completed four doses).

Results: In the single dose group, treatment was considered successful in 50 women (80.6%), whereas in the multiple dose group, 52 women (89.7%) responded to treatment (p = 0.21; OR 0.90, 95%CI 0.77-1.05). The average number of days required for human chorionic gonadotropin (hCG) levels to fall below 5 mU/mL was longer in the single dose (22.3 +/- 7.6) compared with the multiple dose group (18.3 +/- 10.7) (p = 0.03). In the single dose group fewer or 17 women (24.7%) experienced side-effects compared to 28 (48.3%) of those who had multiple doses (p = 0.02, OR 0.57, 95%CI 0.35-0.92).

Conclusion: A multiple dose methotrexate regimen for the treatment of unruptured tubal ectopic pregnancy is not more effective than a single dose one. In addition, multiple doses may cause more side-effects, but the time for hCG levels to fall below 5 mU/mL is shorter.
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http://dx.doi.org/10.3109/00016349.2010.486825DOI Listing
July 2010

Effects of sildenafil and tadalafil on ischemia/reperfusion injury in fetal rat brain.

J Matern Fetal Neonatal Med 2011 Feb 14;24(2):317-23. Epub 2010 Jun 14.

Department of Obstetric and Gynecology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.

Objective: The aim of the present study was to evaluate the effects of phosphodiesterase type 5 (PDE5) inhibitory drugs, sildenafil and tadalafil, in ischemia/reperfusion (I/R)-induced oxidative injury in fetal rat brain.

Methods: Timed pregnant adult Wistar rats were randomly assigned to the following groups (n = 6 for each group): saline + none I/R (1), saline + I/R (2), sildenafil + none I/R (3); sildenafil + I/R (4), tadalafil + none I/R (5) and tadalafil + I/R (6). Fetal ischemia was induced by clamping the utero-ovarian artery bilaterally. Fetuses were delivered and 268 fetal rats were decapitated. Malondialdehyde (MDA) levels and, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were assessed in fetal brain tissue homogenates by spectrophotometric methods.

Results: In saline + I/R group, MDA levels were increased and, SOD and GSH-Px activities were decreased significantly comparing with saline + none I/R group. Both tadalafil and sildenafil treatment decreased the MDA levels significantly in ischemia/reperfusion groups, whereas this effect was significantly more potent with tadalafil. SOD levels were significantly decreased in all groups after I/R. Tadalafil seems to be more effective than sildenafil by means of increasing GSH-Px activity significantly after I/R.

Conclusion: Our results indicate some beneficial effects of PDE5 inhibitory drugs, especially tadalafil, on oxidative I/R injury in fetal rat brains.
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http://dx.doi.org/10.3109/14767058.2010.492061DOI Listing
February 2011

Can serum oestradiol be a predictor of quality of oocytes and embryos, maturation of oocytes and pregnancy rate in ICSI cycles?

Gynecol Endocrinol 2011 Apr 14;27(4):279-85. Epub 2010 Jun 14.

In Vitro Fertilization Clinic, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.

Our aim was to assess the influence of ratios of oestradiol (E2) to either number of follicles ≥ 14 mm on the day of human chorionic gonadotropin administration (E2/fol) or the number of oocytes retrieved (E2/o) during oocyte pick up and total serum E2 levels on the day of embryo transfer (ETE2) on the outcome of ICSI cycles. The assessed outcomes were number of oocytes retrieved (NRO), number of mature oocytes (NMO), number of fertilised oocytes (NFO), number of transferred embryos (NTE), qualities of oocytes (OQS), qualities of embryos (EQS) and pregnancy rates (PR). Two hundred and twenty-seven ICSI-ET cycles admitted to our IVF clinic during a 2-year period with normal ovarian reserve receiving long luteal GnRH agonist protocol were included. The E2/fol levels correlated positively with NRO (r = 0.202, p = 0.002), NMO (r = 0.199, p = 0.003) and NFO (r = 0.159, p = 0.018). However, we observed negative correlations between E2/o and NMO (r = -0.329, p <0.001), NFO (r = -0.219, p = 0.001), EQ5 (r = -0.203, p = 0.040). Oocyte quality scores were not affected from either E2/fol or E2/o levels. Implantation, clinical and ongoing PRs were comparable between groups categorised due to E2/fol, E2/o and ETE2. It seems that high E2/fol ratio may have beneficial effects on NRO, NMO and NFO while E2/o may adversely affect these parameters. Neither of the E2 levels is associated with pregnancy rates in women with normal ovarian reserve.
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http://dx.doi.org/10.3109/09513590.2010.491168DOI Listing
April 2011

The relationship between endometrial thickness and pregnancy rates in GnRH antagonist down-regulated ICSI cycles.

Gynecol Endocrinol 2010 Nov;26(11):833-7

Ministry of Health, Etlik Zubeyde Hanim Women's Health Research Hospital, Obstetrics and Gynecology, Ankara, Turkey.

Objective: To investigate the effects of endometrial thickness measurements and serum hormone levels on the outcomes of GnRH antagonist down-regulated ICSI cycles.

Study Design: Forty consecutive infertile women undergoing controlled ovarian hyperstimulation with recombinant FSH and GnRH antagonists for ICSI were enrolled in this study. All patient's age, day 3 FSH, antral follicle count (AFC), serum E2 levels on day 3, E2 on stimulation day 5, E2 on day of hCG administration, endometrial thickness on the baseline (ETMBaseline), on day 5 of stimulation (ETMDay 5), on day of hCG administration (ETMhCG) and cycle outcomes were recorded. The outcomes of pregnant and nonpregnant women were compared.

Results: Women's age was 33.6 +/- 4.9. Overall pregnancy rate was 45% (n = 18), clinical pregnancy rate was 27.5% (n = 11) and ongoing pregnancy rate was 20% (n = 8). In pregnant women, baseline AFC was significantly higher compared with nonpregnant women (p = 0.01). There was no significant correlation between ETMhCG and E2 level on the day of hCG, number of retrieved oocytes or patients' age.

Conclusion: For achieving pregnancy, endometrial thickness on the day of hCG is not a determining parameter, and the only significant determinent is AFC in GnRH antagonist down-regulated ICSI cycles.
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http://dx.doi.org/10.3109/09513590.2010.487591DOI Listing
November 2010
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