Publications by authors named "Yavuz Aydin"

41 Publications

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries.

Obes Surg 2021 Jul 30. Epub 2021 Jul 30.

Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK.

Background: There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates.

Methods: We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020.

Results: Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country.

Conclusions: BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak.
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http://dx.doi.org/10.1007/s11695-021-05493-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323543PMC
July 2021

15 and 30 W Holmium:YAG Laser Lithotriptor in Ureteroscopic Lithotripsy: Which One Is More Effective and Safe?

J Laparoendosc Adv Surg Tech A 2021 Jul 5;31(7):839-842. Epub 2021 May 5.

Department of Urology, Bursa Uludag University, Bursa, Turkey.

Holmium:yttrium-aluminium-garnet (Ho:YAG) laser lithotripsy with ureteroscopy (URS) was a safe and successful treatment option for pediatric ureteral stones. We aimed to comparatively evaluate the outcomes of 15 and 30 W Ho:YAG laser lithotriptors in pediatric ureter stones. We retrospectively evaluated 55 children who underwent ureteroscopic laser lithotripsy to treat ureter stone size up to 15 mm between September 2009 and March 2020. Groups were formed according to the laser lithotriptor power 15 W (Group 15:  = 32), 30 W (Group 30:  = 23). The efficiency of laser lithotriptors was compared between the groups. The age, gender, and stone characteristics (longest stone diameter, density, location and multiple stones) were similar between the groups. In the postop first month, stone-free status was achieved in all cases except one child in Group 15. The median operative time was significantly shorter in Group 30 (40 minutes) than in Group 15 (52.5 minutes) ( = .010). Clavien-Dindo class (CDC) 2 complications occurred in 2 children in both groups ( = .597). Although ureteric stenosis was observed in 1 patient in Group 15, no ureteric stenosis was seen in Group 30 during follow-up (median 16.1 months). Length of hospital stay (LoHS) and stone-free rates were similar between groups. URS with 15 and 30 W Ho:YAG laser lithotriptors is an effective treatment option for pediatric ureteral stones with a high success rate and low complication rates. In brief, 30 W Ho:YAG laser lithotriptors should be preferred over 15 W lithotriptors due to their shorter operative time with similar success rate.
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http://dx.doi.org/10.1089/lap.2021.0090DOI Listing
July 2021

Monocyte-to-High-Density Lipoprotein Cholesterol Ratio Is Independently Associated With All-Cause Mortality in Deceased Donor Kidney Transplant Recipients.

Exp Clin Transplant 2021 Apr 16. Epub 2021 Apr 16.

From the Department of Urology, Faculty of Medicine, Uludag University, Bursa, Turkey.

Objectives: The primary objective of this study was to evaluate the impact of monocyte-to-high-density lipoprotein cholesterol ratio on all-cause mortality in deceased donor kidney transplant recipients.

Materials And Methods: This was a retrospective observational study in which all deceased donor kidney transplant recipients were included. Relevant data for analyses included clinical and demographic features, laboratory values, number of HLA matches, occurrence of delayed graft function, cold ischemia time, and survival status. Kaplan-Meier survival analysis and Cox proportional hazards analysis were performed to determine the effects of monocyte-to-high-density lipoprotein cholesterol ratio on all-cause mortality.

Results: Our study included 325 deceased donor kidney transplant recipients (43.1% females, mean age of 44.5 ± 11.2 years). Median value of monocyte-to-high-density lipoprotein cholesterol ratio was 14.0 (interquartile range, 9.94-21.03). The total median observation time was 227 weeks (range, 115-345 weeks). Twenty deaths (12.3%) occurred during the follow-up period in recipients with monocyte-to-highdensity lipoprotein cholesterol ratio below median value, whereas 47 deaths (29%) occurred in recipients with ratio above the median (P < .001). Log-rank test showed significantly higher mortality in the group with monocyte-to high density lipoprotein cholesterol ratio higher than median (P = .001). In the multivariate Cox model, delayed graft function, duration of dialysis, cold ischemia time, and monocyte-to-high-density lipoprotein cholesterol ratio group appeared as independent predictors of all-cause mortality.

Conclusions: Monocyte-to-high-density lipoprotein cholesterol ratio before kidney transplant seems to affect survival independently in deceased donor kidney transplant recipients.
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http://dx.doi.org/10.6002/ect.2021.0024DOI Listing
April 2021

PAPP-A concentrations change in patients with gestational diabetes.

J Obstet Gynaecol 2020 Feb 23;40(2):190-194. Epub 2019 Jul 23.

Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.

Our aim was to assess the relationship between gestational diabetes and glucose intolerance regarding maternal serum PAPP-A and free β-hCG concentrations in first trimester pregnancies. This study was conducted on 278 women between 18-45 years old with singleton pregnancies. The subjects were divided into four groups, according to their 50 and 100 g OGTT results. Group 1 was the Control Group, Group 2 with positive 50 g OGTT results, but negative 100 g, Group 3 had gestational diabetes after testing with 50 g OGTT (≥180 mg/dl) or with 100 g OGTT. Finally Group 4 was made of women with a one single high glucose level after testing with 100 g OGTT. These groups were analysed in terms of OGTT results. In the GDM group, serum PAPP-A concentrations were significantly lower when compared with the Control Group's ( = 0.015). There was either no significant differences regarding free β-hCG concentrations among the groups. GDM rate is 21.1%, the patients with GDM had significantly low concentrations of serum PAPP-A but their f β-hCG concentrations did not change. Our results are supported by several studies. However, we need greater numbered studies for exact results.IMPACT STATEMENT Pregnancy associated plasma protein A (PAPP-A) is produced by the placenta in pregnancy. PAPP-A cleaves insulin-like growth factor (IGF) binding proteins. It would appear to have a role in regulating IGF bioavailability in pregnancy. This is important as the IGF axis plays a critical role in fetal growth, and placental growth and function during pregnancy. Some studies have reported that PAPP-A levels were impaired among women who subsequently developed GDM. The patients with GDM had significantly low concentrations of serum PAPP-A but their free β-hCG levels did not change. By looking at PAPP-A concentrations, we can predict patients that will be gestational diabetic and take precautions to protect the babies health, such as their diet or exercise.
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http://dx.doi.org/10.1080/01443615.2019.1615041DOI Listing
February 2020

Bleeding Complications in Warfarin-Treated Patients Admitted to the Emergency Department.

J Clin Med Res 2019 Feb 5;11(2):106-113. Epub 2019 Jan 5.

Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey.

Background: Increased use of warfarin for the treatment and prophylaxis of many diseases has increased the frequency of adverse events. Emergency departments (EDs) are the first places where early interventions for bleeding and other complaints related to warfarin use are performed. This study assessed the characteristics of patients receiving warfarin and the risk factors for bleeding complication among those admitted to the ED.

Methods: Patients admitted to the ED for any reason other than trauma during a 1-year period were retrospectively reviewed. The study population consisted of 96 patients who had received warfarin and had an international normalized ratio (INR) ≥ 3. Patient demographics and medical history were recorded.

Results: The mean age of the patients (female, 52.1%) was 64.9 ± 14.5 years. Fatigue was the most common presenting complaint (61%). At least one major and/or minor bleeding event had occurred in 32 (33.3%) of the patients. Patients with (n = 32) and without (n = 64) bleeding complications did not significantly differ with respect to age, sex, reason for warfarin initiation, duration of warfarin use, concomitant diseases, and concurrent medications. There were also no significant differences in the distribution of patient admissions in terms of season at presentation, INR level, and weekly warfarin dose.

Conclusions: While the parameters evaluated in this study did not significantly differ among warfarin-treated patients, they may nonetheless pose a risk of bleeding. Further large-scale and long-term studies that take into account biological variation are required to precisely identify the risk factors for bleeding.
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http://dx.doi.org/10.14740/jocmr3669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340679PMC
February 2019

Plasma human leukocyte antigen-G (HLA-G) in patients with thyroid cancer

Turk J Med Sci 2017 08 23;47(4):1263-1266. Epub 2017 Aug 23.

Background/aim: A number of tumor markers detected in the serum or pathological specimens using immunohistochemical methods are used for early detection of malignancies and postoperative follow-up. Human leukocyte antigen-G (HLA-G) is a nonclassic HLA class I molecule. Recent studies suggested a relationship between HLA-G positivity and the stage or the phenotype of the malignancy. In this study, the relationship between serum HLA-G positivity and thyroid cancer was investigated. Materials and methods: Fifty patients with thyroid cancer and 45 healthy volunteers were included in this study. Serum HLA-G levels were measured using ELISA. Results: HLA-G was positive in only 3 out of 50 patients with thyroid cancer (2 papillary, 1 follicular type). On the other hand, HLA-G was positive in 20 out of 45 healthy subjects (P < 0.001). The prevalence of detectable levels of serum HLA-G was independent of sex and age in the whole study population. No correlation was found between serum HLA-G value and thyroid hormone profile, neither in papillary thyroid cancer nor follicular thyroid cancer patients. Conclusion: In this study, serum HLA-G was significantly less common in patients with thyroid cancer than in healthy controls.
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http://dx.doi.org/10.3906/sag-1611-25DOI Listing
August 2017

Coexistence of idiopathic granulomatous mastitis and erythemanodosum: successful treatment with corticosteroids

Turk J Med Sci 2017 11 13;47(5):1590-1592. Epub 2017 Nov 13.

Background/aim: Idiopathic granulomatous mastitis (IGM) is a rare, chronic inflammatory disease of the breast. Erythema nodosum (EN) is a rare extramammary manifestation of IGM. The purpose of this study is to determine the clinical and demographic characteristics of 11 IGM and EN patients and to evaluate the efficacy of methylprednisolone treatment. Materials and methods: In our series, ten patients had EN bilaterally, whereas one patient had a lesion of the right pretibial area. The mean age of the patients was 35.5 years (range: 29-45 years). IGM and EN were diagnosed by the necessary serological, microbiological, radiological, and histopathological examination. After diagnosis, methylprednisolone was started in the first week at 0.8 mg/kg daily for treatment. The weekly dose was tapered to 0.1 mg/kg daily over 8 weeks.Results: We started with the treatment of methylprednisolone, and in all our cases the initial response was excellent. In 2 weeks the IGM symptoms had markedly declined, while signs of EN disappeared completely. Patients were followed for an average of 60 months after treatment. None of the 11 patients had recurrence.Conclusion: We herein report a rare series considering IGM cases complicated by EN. Few such cases have been reported in the literature. We advocate for an initial trial of methylprednisolone treatment, which proved to be very successful in our patients.
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http://dx.doi.org/10.3906/sag-1611-100DOI Listing
November 2017

Eleven patients with primary thyroid lymphoma: a single center experience

Turk J Med Sci 2017 11 13;47(5):1322-1327. Epub 2017 Nov 13.

Background/aim: Primary thyroid lymphoma (PTL) is a very rare thyroid malignancy. It should be diagnosed and treated immediately and accurately. Our aim was to evaluate the diagnostic methods and treatment results for patients with PTL.Materials and methods: We retrospectively evaluated the records of 11 patients with PTL from 2009 to 2015, diagnosed at our institute. Age, sex, stage, histopathologic type, presence of Hashimoto's thyroiditis, diagnostic methods, treatment types, and recurrence were examined.Results: Six patients were female, 5 were male, and the median age of the patients was 61 years (range: 15-76 years). All patients had a large palpable mass in the neck. Fine needle aspirate (FNA) biopsy was performed in all patients; however, it was useful only in the diagnosis of 7 patients. Excisional and surgical biopsy was performed in 4 patients. All patients had non-Hodgkin B-cell lymphoma, including 9 cases of diffuse large B-cell lymphoma (DLBCL), and 2 patients had mucosa-associated lymphoid tissue (MALT) lymphoma. Recurrence was observed in one patient. Median survival was 34 months.Conclusions: The preferred option for the diagnosis of PTL should be FNA biopsy, and the treatment should be decided on according to whether the disease is limited to the thyroid gland or not, its histological type, and its stage.
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http://dx.doi.org/10.3906/sag-1611-91DOI Listing
November 2017

Diagnosis of Polycystic Ovary Syndrome: AMH in combination with clinical symptoms.

J Assist Reprod Genet 2014 Feb 18;31(2):213-20. Epub 2013 Dec 18.

Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Cerrahpasa School of Medicine, Istanbul University, Kizilelma Caddesi, No: 35/1, Fatih, 34300, Istanbul, Turkey,

Purpose: We assessed the utility of using anti-Müllerian hormone (AMH) and clinical features of polycystic ovary syndrome (PCOS), polycystic ovarian morphology (PCOM), oligo/amenorrhea (OA), and hyperandrogenism (HA) for diagnosing PCOS, and compared their diagnostic accuracy with those of classical diagnostic systems.

Methods: A total of 606 females were admitted to a university hospital with menstrual irregularities or symptoms of hyperandrogenism were enrolled in this cross-sectional study. Fasting blood samples were collected. Pelvic and/or abdominal ultrasonography and clinical examination were performed. Patients were evaluated for the presence of PCOS according to conventional diagnostic criteria. The diagnostic performance of using serum AMH levels alone and in various combinations with the clinical features of PCOM, OA, and HA were investigated.

Results: For the diagnosis of PCOS, the combination of OA and/or HA with AMH showed 83% sensitivity and 100% specificity according to the Rotterdam criteria; 83% sensitivity and 89% specificity according to the National Institutes of Health (NIH) criteria; and 82% sensitivity and 93.5% specificity according to the Androgen Excess Society (AES) criteria.

Conclusions: The serum AMH level is a useful diagnostic marker for PCOS and is correlated with conventional diagnostic criteria. The combination of AMH level with OA and/or HA markedly increased the clinical scope for PCOS diagnosis and can be introduced as a possible objective criterion for the diagnosis of this disease.
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http://dx.doi.org/10.1007/s10815-013-0149-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933601PMC
February 2014

Relation of antimullerian hormone with the clinical signs of hyperandrogenism and polycystic ovary morphology.

Gynecol Endocrinol 2014 Feb 16;30(2):130-4. Epub 2013 Dec 16.

Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Cerrahpasa Medical Faculty .

The relation of antimullerian hormone (AMH) levels with the clinical and biochemical markers of polycystic ovary syndrome (PCOS) could be different. A total of 463 PCOS patients were evaluated in this cross-sectional study. Groups were constructed according to polycystic ovarian morphology (PCOM) and menstrual cycle-length. The relation of serum AMH with androgenic hormones, menstrual cycle-length and clinical signs of PCOS were investigated. A powerful positive relation was found between the PCOM and AMH levels (odds ratio = 2.49). There was a negative correlation between age and AMH level (p < 0.001, r[correlation coefficent] = -0.155). Positive correlations were found between luteinizing hormone (LH) and AMH (p < 0.001, r = 0.25) and also between cycle length and AMH (p < 0.01, r = 0.27). We found a negative week correlation between AMH and follicle-stimulating hormone (FSH) (p = 0.01, r = -0.19). After controlling main androgenic hormones, AMH was found to be correlated with the Ferriman-Gallway score (p = 0.03, r = 0.18). There was a positive relationship between hirsutism and AMH (odds ratio = 1.43), but no correlation between AMH and other parameters of clinical hyperandrogenism like hair-loss, acne and seborrhea were identified. The strongest relation was presented between the AMH levels and PCOM. Also, cycle-length correlated well with the AMH levels. The relationship between hirsutism and AMH is found to be independent from androgenic hormones.
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http://dx.doi.org/10.3109/09513590.2013.867320DOI Listing
February 2014

Comparison of computed tomography- and positron emission tomography-based radiotherapy planning in cholangiocarcinoma.

Onkologie 2013 19;36(9):484-90. Epub 2013 Aug 19.

Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey.

Introduction: The aim of this study was to compare computed tomography (CT)- and positron emission tomography (PET)/CT-based gross tumor volume (GTV) delineation and its subsequent expansion to the planning target volume (PTV), and to analyze the resultant doses of 3-dimensional conformal radiotherapy (3D-CRT) to critical organs.

Methods: 15 patients with unresectable extrahepatic cholangiocarcinoma (EHCC) were enrolled into this study. PTVCT-based plans were initially made, and then PTVPET-CT-based plans were created using the same beam angles and isocenter. The dosimetric parameters analyzed included GTVCT, PTVCT, GTVPET-CT and PTVPET-CT. Prescribed and delivered radiation doses to target volumes and delineated organs at risk were also compared.

Results: Mean GTV and PTV were significantly reduced in the PET/CT-based plan compared to the CT-based plan; the mean reductions of GTV and PTV were 28.7% and 15.2%, respectively. The mean value for GTVPET/GTVCT mismatch was 49.5 ± 28.9%, and that for GTVCT/GTVPET was 95.9 ± 19.5%. The mean value for PTVPET-CT/PTVCT mismatch was 21.9 ± 7.0% and that for PTVCT/PTVPET-CT was 39.1 ± 9.2%. Liver doses were significantly reduced (17.1%) in the PET/CT-based plan compared to the CT-based plan; the doses received by at least 30% and 50% of the liver were 30.0%, and 27.3%, respectively.

Conclusion: The potential benefit of PET/CT is the reduction in geographic misses and regional treatment failures associated with CT-based planning.
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http://dx.doi.org/10.1159/000354630DOI Listing
May 2014

Elevated serum levels of anti-Müllerian hormone can be introduced as a new diagnostic marker for polycystic ovary syndrome.

Acta Obstet Gynecol Scand 2013 Dec 15;92(12):1369-74. Epub 2013 Oct 15.

Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Objective: To determine the possible role of anti-Müllerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS) with a larger population of women and to evaluate its role as a new diagnostic marker.

Design: Cross-sectional study.

Setting: University hospital.

Population: A total of 570 women, with PCOS (n = 419) and without PCOS (n = 151).

Methods: Serum basal hormone; AMH, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and thyroid-stimulating hormone (TSH) levels were measured. Mean hormone levels were compared and the predictive value of serum AMH level was evaluated with the use of the receiver operating characteristic (ROC) curve analysis.

Results: No statistically significant differences were found between PCOS women and control groups in terms of age, body mass index and TSH levels. Differences between mean serum, FSH, LH and estradiol levels and LH/FSH ratio were found to be statistically significant (p < 0.001). Mean serum AMH level was higher in PCOS women than in controls (7.34 vs. 2.24 ng/mL, p < 0.001). The area under the ROC curve assay yielded a satisfactory result of 0.916 (95% confidence interval 0.897-0.935, p < 0.0001). The best compromise between 89.8% specificity and 80% sensitivity was obtained with a cut-off value of 3.94 ng/mL for PCOS diagnosis.

Conclusions: Serum AMH measurement is very valuable in the diagnosis of PCOS women. The serum AMH level in women with hyperandrogenism or oligo-anovulation could indicate the diagnosis of PCOS when reliable ultrasonography data are not available or when typical clinical and laboratory findings are not available. The serum AMH level is a new and useful diagnostic tool in PCOS diagnosis.
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http://dx.doi.org/10.1111/aogs.12247DOI Listing
December 2013

Serum levels of epidermal growth factor, transforming growth factor, and c-erbB2 in ovarian cancer.

Int J Gynecol Cancer 2012 Sep;22(7):1138-42

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

Objective: This study aimed to investigate serum levels of epidermal growth factor (EGF), transforming growth factor α (TGF-α), and c-erbB2 in patients with ovarian cancer.

Materials And Methods: In this retrospective cohort study, the study and control groups were composed of 43 women with a prediagnosis of ovarian cancer and 43 healthy women, respectively. Blood samples from all women were obtained and studied by enzyme-linked immunosorbent assay kits for EGF, TGF-α, and c-erbB2. After surgery of the study group, ovarian cancer was confirmed and compared with control group. Stage, grade, and histological types were defined after histopathologic examination, and subgroups were constructed and compared.

Results: Serum EGF, TGF-α, and c-erbB2 levels were significantly increased in study group compared with those in the control group (P < 0.001). There were no differences in serum levels of EGF, TGF-α, and c-erbB2 among all stages, grades, and histological types of ovarian cancer. If 47.90 pg/mL was selected as the cutoff value, EGF has an 80% sensitivity and a 65% specificity for detecting ovarian cancer. The cutoff value of 41,095.00 pg/mL for TGF-α has a 90% sensitivity and a 72% specificity for detecting ovarian cancer. The c-erbB2 level of 4.63 pg/mL as the cutoff value has an 83% sensitivity and a 76% specificity for predicting ovarian cancer.

Conclusions: Serum levels of EGF, TGF-α, and c-erbB2 may be used for diagnosing ovarian cancer.
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http://dx.doi.org/10.1097/IGC.0b013e31825b7dccDOI Listing
September 2012

Effects of amniotic and maternal CD-146, TGF-β1, IL-12, IL-18 and IFN-γ, on adverse pregnancy outcome.

J Matern Fetal Neonatal Med 2013 Jan 11;26(1):21-5. Epub 2012 Sep 11.

Department of Obstetrics and Gynecology, Cerrahpasa Medical Faculty of Istanbul University, Istanbul, Turkey.

Objective: Our aim was to determine the effects of maternal serum and amniotic fluid levels of cluster of differentiation 146 (CD-146), transforming growth factor (TGF)-β1, interleukin (IL)-12, IL-18, and interferon (IFN)-γ on intrauterine growth restriction and preterm labor.

Methods: In this retrospective cohort study, we included pregnant women who underwent amniocentesis at Istanbul University Cerrahpasa Medical School. Women were followed up to labor. The study group comprised 23 women with adverse pregnancy outcomes (intrauterine growth restriction and preterm labor), and the control group comprised 105 women with normal pregnancy outcome.

Results: The study group was further divided into two subgroups of preterm labor and intrauterine growth restriction. No significant differences were found for IL-12, IFN-γ, TGF-β1, or CD-146 levels in either plasma or amniotic fluid between the study and control groups. Serum IL-18 levels were similar, but the amniotic fluid level of IL-18 was significantly higher in the intrauterine growth restriction subgroup than that in the preterm labor subgroup and that in the control group (p < 0.01).

Conclusions: Increased IL-18 level in amniotic fluid may be a predictor for intrauterine growth restriction. IL-12, IFN-γ, TGF-β1, and CD-146 were not related to adverse pregnancy outcome.
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http://dx.doi.org/10.3109/14767058.2012.722712DOI Listing
January 2013

Bladder exstrophy.

Fetal Pediatr Pathol 2012 Aug 20;31(4):225-9. Epub 2012 Mar 20.

Istanbul University, Cerrahpasa School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Istanbul, Turkey.

Bladder exstrophy is a very rare congenital malformation in which the anterior wall of the bladder is absent, and the posterior wall is exposed externally. The differential diagnosis includes omphalocele, gastroschisis, and cloacal exstrophy. Ultrasound and Doppler examinations are the main diagnostic tools. Although mortality is low, termination of pregnancy should be discussed due to serious morbidities.
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http://dx.doi.org/10.3109/15513815.2011.650286DOI Listing
August 2012

Multiple fetal anomalies in association with topiramate and oxcarbezepine treatment.

Fetal Pediatr Pathol 2012 Jun 13;31(3):154-8. Epub 2012 Mar 13.

Department of Obstetrics and Gynecology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.

We present a case of a woman who used topiramate (100 mg) and oxcarbazepine (300 mg) continuously during pregnancy. Multiple fetal anomalies including limp defects of the lower extremities, pericardiac fluid collection, cardiomegaly, cleft lip and palate, absent right kidney, and dysplastic left kidney were found by ultrasonography. Labor was induced and anomalies were confirmed by autopsy. The malformation rate after exposure to oxcarbazepine in utero as a monotherapy was calculated to be 2.4%, which is compatible with the malformation rate seen in the general population. Topiramate is teratogenic in mice, rats, and rabbits, but there are very few reports about its teratogenicity in humans.
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http://dx.doi.org/10.3109/15513815.2012.659378DOI Listing
June 2012

Hyberbaric oxygen increases atresia in normal & steroid induced PCO rat ovaries.

Reprod Biol Endocrinol 2012 Feb 6;10:11. Epub 2012 Feb 6.

Sisli Etfal Training & Research Hospital Obstetrics & Gynecology, Istanbul, Turkey.

Background: In this study, we investigated the effect of hyperbaric oxygen therapy (HBOT) on the morphology of estradiol valerate (EV) induced polycystic ovary (PCO) to find a new treatment modality for improvement of PCO.

Methods: The rats were divided into four groups. Group1, control; group 2, PCO group; group 3, PCO with HBOT group and group 4, normal ovary with HBOT. PCO was induced by a single intramuscular injection of 4 mg EV in adult cycling rats. Other rats with normal ovaries had oil injection as placebo. HBOT was applied to third and fourth groups for six weeks. Histopathologic evaluation of ovaries of all groups were performed & compared.

Results: Six weeks of HBOT was resulted in increase in follicular atresia, decrease in the number of primary, secondary, tertiary follicles and decrease in the number of fresh corpus luteum in normal rat ovary. HBOT on polycystic rat ovary, resulted in significant increase in atretic follicles which were already present.

Conclusions: HBOT of six weeks itself, changed ovarian morphology in favor of atresia both in PCO group and control group. This result of aggravated follicular atresia after HBOT on EV induced PCO may be due to long-term exposure in our protocol which with this state seems to be inapplicable in the improvement of PCO morphology.
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http://dx.doi.org/10.1186/1477-7827-10-11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395821PMC
February 2012

Hereditary thrombophilia, anti-beta2 glycoprotein 1 IgM, and anti-annexin V antibodies in recurrent pregnancy loss.

Am J Reprod Immunol 2012 Mar 22;67(3):251-5. Epub 2011 Nov 22.

Obstetrics and Gynecology, Istanbul University, Istanbul, Turkey.

Problem: We investigated the beta2-glycoprotein I and anti-annexin V antibodies as anti-phospholipid-cofactor antibodies; and factor V G1691A Leiden, prothrombin G20210A, and methylenetetrahydrofolate reductase (MTHFR) C677T mutations as hereditary thrombophilia in recurrent pregnancy losses (RPL).

Method Of Study: Study group consisted of 84 women with recurrent pregnancy loss and control group consisted of 84 women having at least one live birth.

Results: Methylenetetrahydrofolate reductase C677T homozygous mutation was detected in 28.5% of the study group and in 14.2% of the controls, and the difference was highly significant (P < 0.001). Heterozygous mutation of this gene was found in 64.3% of the study population and in 38.1% of the controls, and difference in heterozygous mutation frequency was also significant (P < 0.001). Both homozygous and heterozygous mutations of PT G20210A and factor V G1691A were not different between the groups. There was no significant difference in anti-annexin V levels and anti-beta2-gp 1 levels of the groups.

Conclusion: We concluded that both homozygous and heterozygous mutations of MTHFR C677T were related with RPL in Caucasian women.
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http://dx.doi.org/10.1111/j.1600-0897.2011.01092.xDOI Listing
March 2012

Remission of endometriosis by hyperbaric oxygen treatment in rats.

Reprod Sci 2011 Oct;18(10):941-7

Department of Obstetrics and Gynecology of Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

We designed this prospective, randomized controlled animal study to determine the effects of hyperbaric oxygen (HBO) on experimentally induced endometriosis in a rat model. Surgical induction of endometriosis was performed in 40, nonpregnant, female, Wistar-Albino rats at the Experimental Medicine Research Center of Istanbul University (DETAE). Four weeks later, the first and second laparotomies for volume measurement and peritoneal fluid (PF) collection were performed, and the rats were divided randomly into the study and control groups. The study group was exposed to HBO treatment for 6 weeks. Then, a third laparotomy was performed on all of the rats. The volume, histopathologic scores, Ki-67 labeling of the endometriotic implants, and the levels of tumor necrosis factor-α (TNF-α) in the PF were measured. The mean volume of the endometriotic implants in the study group was significantly lower than that of the control group at the end of the study (57.4 ± 12.5 vs 94.6 ± 17.2 mm(3)). The mean histopathological scores (1.60 ± 0.50 vs 2.42 ± 0.51), Ki-67 immunohistochemical scores (1.50 ± 0.51 vs 2.37 ± 0.49) of the endometriotic implants, and the TNF-α levels (5.33 ± 1.02 vs 8.16 ± 1.76 pg/mL) were significantly lower in the study group than in the control group. Hyperbaric oxygen treatment for 2 hours a day for 6 weeks resulted in significant remission of endometriosis in rats.
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http://dx.doi.org/10.1177/1933719111400635DOI Listing
October 2011

Plasma citrulline levels predict intestinal toxicity in patients treated with pelvic radiotherapy.

Acta Oncol 2011 Nov 24;50(8):1167-74. Epub 2011 Aug 24.

Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey.

Background: Radiotherapy (RT) for abdominal and pelvic malignancies often causes severe small bowel toxicity. Citrulline concentrations are known to decrease with intestinal failure. We thus evaluated the feasibility of plasma citrulline levels in predicting radiation-induced intestinal toxicity.

Material And Methods: Fifty-three patients (36 prostate cancer, 17 endometrial cancer) who received 45 Gy pelvic RT using conventional fractionation were prospectively evaluated. Patients with prostate cancer received an additional 25-30.6 Gy conformal boost. Plasma citrulline levels were assessed on day 0, mid- (week 3) and post-RT (week 8), and four months post-RT. Dose-volume histogram, citrulline concentration changes, and weekly intestinal toxicity scores were analyzed.

Results: Mean age was 63 years (range: 43-81 years) and mean baseline citrulline concentration was 38.0 ± 10.1 μmol/l. Citrulline concentrations were significantly reduced at week 3 (27.4 ± 5.9 μmol/l; p < 0.0001), treatment end (29.9 ± 8.8 μmol/l; p < 0.0001), and four months post-treatment (34.3 ± 12.1; p = 0.01). The following factor pairs were significantly positively correlated: Citrulline concentration/mean bowel dose during, end of treatment, and four months post-RT; dose-volume parameters/citrulline change groups; cumulative mean radiation dose/intestinal toxicity at end and four months post-RT; citrulline changes/intestinal toxicity during and end of RT. Citrulline concentration changes significantly differed during treatment according to RTOG intestinal toxicity grades (p < 0.0001). Although the citrulline changes differed significantly within RTOG intestinal toxicity grades (p = 0.003), the difference between Grade 0 and Grade 1 did not differ significantly at the end of the treatment. At four months after RT, no significant differences were apparent.

Conclusion: Citrulline-based assessment scores are objective and should be considered in measuring radiation-induced intestinal toxicity.
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http://dx.doi.org/10.3109/0284186X.2011.584557DOI Listing
November 2011

Late pregnancy associated plasma protein A levels decrease in preterm labor.

J Matern Fetal Neonatal Med 2011 Jul 11;24(7):923-7. Epub 2011 May 11.

Department of Obstetrics and Gynecology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Objective: The purpose of the present study is to evaluate late, 'at admission', Pregnancy-associated plasma protein-A (PAPP-A) levels as a predictor of preterm birth in women with complaints of preterm labor or preterm painful contractions.

Methods: Prospective cohort study of singleton gestations, 23-37 weeks, and symptoms of preterm labor. Primary end point was delivery < 37 weeks. Predictive PAPP-A values were calculated both for preterm delivery and threatened preterm delivery on receiver operator curve.

Results: In all, 41 women (38.3%) delivered before 37 weeks (Group 1); 32 women (30.7%) had symptoms of preterm labor but did not deliver preterm (Group 2); 31 women (29.7%) delivered term (Group 3, control). Mean PAPP-A levels in preterm-labor and its matched control were 33.4 ± 19.9 and 52.5 ± 25.4 mIU/ml, respectively, and difference was statistically significant (p = 0.003). Mean PAPP-A level in threatened preterm labor group was 47.6 ± 25.3 mIU/ml and difference was significant compared to preterm-labor, but not significant compared to control group (p = 0.028 and p = 0.74, respectively).

Conclusion: Late PAPP-A levels decreased in preterm labor, levels < 29.8 mIU/ml was associated with increased risk for preterm birth, supporting active management whereas cutoff value of 33.6 mIU/ml is useful for discrimination of preterm birth from threatened preterm birth reaching to term.
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http://dx.doi.org/10.3109/14767058.2010.531320DOI Listing
July 2011

PAPP-A levels of late pregnancy in preeclampsia and HELLP syndrome.

Arch Gynecol Obstet 2012 Jan 30;285(1):45-9. Epub 2011 Apr 30.

Obstetrics and Gynecology Department, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Purpose: To determine the relationship between pregnancy-associated plasma protein-A (PAPP-A) levels and preeclampsia and HELLP syndrome at last trimester and to investigate if the severity of preeclampsia would be associated with PAPP-A levels.

Methods: Four groups were constructed; mild-preeclampsia group consisted of 19 women, severe-preeclampsia group 17, HELLP group 5 and control group 32 women. All groups were matched strictly for gestational age at last trimester. Maternal blood samples for PAPP-A were collected as soon as the patients were diagnosed as preeclampsia or HELLP syndrome at last trimester and compared.

Results: Mean ages of participants, parity, gestational week, and fetal weights were similar. Mean PAPP-A levels were significantly higher in preeclampsia and HELLP groups compared to control group. PAPP-A levels were not different among mild-severe preeclampsia and HELLP groups. There was significant, positive and strong correlation between gestational age and PAPP-A level and also between fetal weight and PAPP-A levels (correlation coefficents = 0.83 and 0.78 respectively).

Conclusion: PAPP-A level at last trimester increases in all mild-severe preeclampsia and HELLP syndrome, but is not predictive for severity of preeclampsia or HELLP syndrome.
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http://dx.doi.org/10.1007/s00404-011-1912-zDOI Listing
January 2012

Factors affecting the accuracy of ultrasonographical fetal weight estimation in twin pregnancies.

J Matern Fetal Neonatal Med 2011 Sep 13;24(9):1168-72. Epub 2011 Jan 13.

Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Objective: To determine the factors affecting the accuracy of ultrasonographic weight estimation in twins.

Methods: 152 sets of twins delivered vaginally, were included. Effects of fetal weights, inter-twin weight discordance, chorionicity, early rupture of membranes, intrauterine growth restriction, and presentations of twins on errors of estimated fetal weights were evaluated. The primary measures of estimated fetal weight accuracy compared were mean-percentage-error and the standart deviation (SD) of percentage errors.

Results: Mean percentage errors for the first fetus (8.13 ± 6.82) and the second fetus (8.07 ± 6.88) were similar (p = 0.64). Random errors of both fetuses were also similar (p = 0.78). If one of the fetuses had IUGR, the percentage error and also the random error of that fetus would increase significantly. Different presentations and fetal gender combinations were similar for both types of errors of fetal weight estimation. A weak negative lineer relationship was found between the weight of the first fetus and its percentage error (r = -0.27, p = 0.04). A similar relation was present between the weight and percentage error of the second fetus (r = -0.29, p = 0.03). Percentage errors and also random errors of both fetuses were significantly higher if severe discordance was present between twins (p = 0.01 and p = 0.02, respectively).

Conclusions: IUGR, fetal weights, and inter-twin discordence are the factors affecting the accuracy of weight estimation by ultrasonography.
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http://dx.doi.org/10.3109/14767058.2010.545928DOI Listing
September 2011

Hyperreactio luteinalis with preeclampsia.

J Emerg Trauma Shock 2010 Jul;3(3):298

Obstetrician and Gynecologist, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Hyperreactio luteinalis (HL) is a condition associated with bilateral and, in rare cases, unilateral ovarian enlargement due to theca lutein cysts. HL is a benign condition, usually found incidentally at cesarean section, which can appear anaplastic and lead to unnecessary ovarian resection. A 24-year-old woman with 35 weeks of gestation attended with bilaterally enlarged ovaries. She had preeclampsia and preterm contractions. Due to breech presentation of baby and nulliparity and possible severe preeclampsia, she delivered by cesarean section. The ovaries had an anaplastic appearance and a biopsy was taken during cesarean section. Pathology revealed multiple benign theca lutein cysts. There are 51 reported cases of HL associated with a normal pregnancy in the literature. It is estimated that approximately 60% of the cases of HL is not associated with trophoblastic disease and occurs with normal singleton pregnancy. Only three of them were found to be associated with preeclampsia and this is the fourth case. HL may help explain the underlying cause of preeclampsia in these cases. There are multiple benign ovarian lesions in HL, which can mimic ovarian neoplasms. Accordingly, it is important to exclude these from the differential diagnosis via a wedge biopsy and frozen section to avoid unnecessary surgical excision.
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http://dx.doi.org/10.4103/0974-2700.66545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938501PMC
July 2010

Comparison of complications in second trimester amniocentesis performed with 20G, 21G and 22G needles.

J Perinat Med 2010 11 13;38(6):597-600. Epub 2010 Aug 13.

Perinatology Division of Obstetrics and Gynecology Department, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Aim: to compare short- and long-term complications of amniocentesis performed with 20G, 21G, and 22G needles.

Methods: this observational study included 793 pregnant women who underwent amniocentesis in the Perinatology Department of Cerrahpasa Medical Faculty, Istanbul University, Turkey. The patients were divided into three groups according to the needle size used for the procedure: 20G (Group 1), 21G (Group 2), and 22G (Group 3). The incidences of early and late complications were compared among groups.

Results: fetal loss rates did not differ among groups (Group 1=1.57%, Group 2=1.47%, Group 3=1.61%). Rates of vaginal bleeding (1.57%, 1.10%, and 0.81%, respectively), bloody amniotic fluid (2.32%, 6.23%, and 2.67%, respectively) and amniotic fluid leakage (1.57%, 1.10%, and 1.61%, respectively) were also similar among the three groups.

Conclusion: short- and long-term complications did not differ among amniocenteses performed with 20G, 21G, and 22G needles.
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http://dx.doi.org/10.1515/jpm.2010.105DOI Listing
November 2010

Protective effects of melatonin and octreotide against radiation-induced intestinal injury.

Dig Dis Sci 2011 Feb 23;56(2):359-67. Epub 2010 Jul 23.

Department of Radiation Oncology, Adana Research and Treatment Centre, Baskent University Medical Faculty, Adana, Turkey.

Purpose: To compare the protective effects of the potent antioxidants, melatonin and octreotide, against radiation-induced intestinal injury.

Methods: A total of 42 male 3-month-old Swiss albino mice (40 ± 10 g) were matched according to body weight and randomly assigned to one of six groups: control; radiation treatment (RT) only; melatonin only (15 mg/kg, i.p.); melatonin + RT; octreotide only (50 μg/kg i.p.); and octreotide + RT. Intestinal damage was induced by exposure to a single whole-body radiation dose of 8 Gy. All mice tolerated the experimental interventions, and no deaths were observed.

Results: Irradiation induced architectural disorganization, including inflammatory mononuclear cell infiltration, villitis, and desquamation with eosinophilic necrosis, and diminished mucosal thickness, crypt height, and villous height. In the melatonin + RT and octreotide + RT groups, the villous pattern was well preserved; desquamation at villous tips and edema was prominent, but necrosis was absent. The radiation-induced decrease in mucosal thickness was significantly reduced by pretreatment with melatonin (p < 0.001) or octreotide (p = 0.01), although the protective effect was significantly greater for melatonin (p = 0.04). Pretreatment with melatonin also preserved villous height (p = 0.009) and crypt height (p = 0.03); although a similar trend was observed for pre-irradiation octreotide, the differences were not significant.

Conclusions: Melatonin and octreotide potently protected against radiation-induced intestinal injury in mice, but melatonin was significantly more effective in preserving the histological structure of the intestines, a finding that warrants confirmation in clinical studies.
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http://dx.doi.org/10.1007/s10620-010-1322-2DOI Listing
February 2011

Cabergoline versus bromocriptine for symptomatic treatment of premenstrual mastalgia: a randomised, open-label study.

Eur J Obstet Gynecol Reprod Biol 2010 Jun 4;150(2):203-6. Epub 2010 Mar 4.

Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Objective: To compare the effectiveness and side effects of cabergoline with bromocriptine for the symptomatic treatment of cyclic mastalgia as a part of the premenstrual syndrome.

Study Design: 140 women with premenstrual mastalgia were enrolled in this randomised, open-label trial. Two groups were created (bromocriptine and cabergoline) and consisted of 61 and 67 patients respectively at the end of trial. Bromocriptine was administered 5 mg daily during second half of the menstrual cycle. Cabergoline was administered 0.5 mg weekly during the second half of the cycle. Relief of pain was evaluated using a visual analog scale (VAS). The mean percentage decrease in score for all patients in each group was calculated. A 50% or greater decrease at the end of the third month from the basal VAS score was accepted as a positive response to drug therapy. Data regarding side effects were collected systematically with review of a symptom diary.

Results: The positive response rates to treatment were similar (bromocriptine 66.6% and cabergoline 68.4%). The pain reduction rates for each month were also similar. Moreover, the pain reduction rate was maximum in the second month of treatment for both groups. Vomiting (28%), nausea (39%) and headaches (23%) recorded in the bromocriptine group were significantly more frequent than vomiting (4.5%), nausea (20.9%) and headache (6%) recorded in the cabergoline group (p=0.023, p=0.001, p=0.006 respectively). A difference in the rate of dizziness was not statistically significant (26.4% vs. 14.9%). There was no correlation between the baseline breast pain score and prolactin level but post-treatment pain reduction was well correlated with prolactin level.

Conclusions: Cabergoline is as effective as bromocriptine for the treatment of cyclic mastalgia but has minimal side effects compared to bromocriptine.
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http://dx.doi.org/10.1016/j.ejogrb.2010.02.024DOI Listing
June 2010

Comparison of conventional and CT-based planning for intracavitary brachytherapy for cervical cancer: target volume coverage and organs at risk doses.

J Exp Clin Cancer Res 2009 Jul 1;28:95. Epub 2009 Jul 1.

Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey.

Background: To compare intracavitary brachytherapy (ICBT) planning methods for cervical cancer, based on either orthogonal radiographs (conventional plan) or CT sections (CT plan); the comparison focused on target volume coverage and dose volume analysis of organs at risk (OARs), by representing point doses defined by the International Commission on Radiation Units and Measurement (ICRU) and dose volume histograms (DVHs) from 3D planning.

Methods: We analyzed the dosimetric data for 62 conventional and CT-based ICBT plans. The gross tumor volume (GTV), clinical target volume (CTV) and organs at risk (OAR)s were contoured on the CT-plan. Point A and ICRU 38 rectal and bladder points were defined on reconstructed CT images.

Results: Patients were categorized on the basis of whether the >95% isodose line of the point-A prescription dose encompassed the CTV (group 1, n = 24) or not (group 2, n = 38). The mean GTV and CTV (8.1 cc and 20.6 cc) were smaller in group 1 than in group 2 (24.7 cc and 48.4 cc) (P <0.001). The mean percentage of GTV and CTV coverage with the 7 Gy isodose was 93.1% and 88.2% for all patients, and decreased with increasing tumor size and stage. The mean D2 and D5 rectum doses were 1.66 and 1.42 times higher than the corresponding ICRU point doses and the mean D2 and D5 bladder doses were 1.51 and 1.28 times higher. The differences between the ICRU dose and the D2 and D5 doses were significantly higher in group 2 than in group 1 for the bladder, but not for the rectum.

Conclusion: The CT-plan is superior to the conventional plan in target volume coverage and appropriate evaluation of OARs, as the conventional plan overestimates tumor doses and underestimates OAR doses.
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http://dx.doi.org/10.1186/1756-9966-28-95DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711061PMC
July 2009

Comparison of rectal volume definition techniques and their influence on rectal toxicity in patients with prostate cancer treated with 3D conformal radiotherapy: a dose-volume analysis.

Radiat Oncol 2009 May 11;4:14. Epub 2009 May 11.

Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey.

Background: To evaluate the impact of four different rectum contouring techniques and rectal toxicities in patients with treated with 3D conformal radiotherapy (3DCRT).

Methods: Clinical and dosimetric data were evaluated for 94 patients who received a total dose 3DCRT of 70 Gy, and rectal doses were compared in four different rectal contouring techniques: the prostate-containing CT sections (method 1); 1 cm above and below the planning target volume (PTV) (method 2); 110 mm starting from the anal verge (method 3); and from the anal verge to the sigmoid flexure (method 4). The percentage of rectal volume receiving RT doses (30-70 Gy) and minimum, mean rectal doses were assessed.

Results: Median age was 69 years. Percentage of rectal volume receiving high doses (>or= 70 Gy) were higher with the techniques that contoured smaller rectal volumes. In methods 2 and 3, the percentage of rectal volume receiving >or= 70 Gy was significantly higher in patients with than without rectal bleeding (method 2: 30.8% vs. 22.5%, respectively (p = 0.03); method 3: 26.9% vs. 18.1%, respectively (p = 0.006)). Mean rectal dose was significant predictor of rectal bleeding only in method 3 (48.8 Gy in patients with bleeding vs. 44.4 Gy in patients without bleeding; p = 0.02).

Conclusion: Different techniques of rectal contouring significantly influence the calculation of radiation doses to the rectum and the prediction of rectal toxicity. Rectal volume receiving higher doses (>or= 70 Gy) and mean rectal doses may significantly predict rectal bleeding for techniques contouring larger rectal volumes, as was in method 3.
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http://dx.doi.org/10.1186/1748-717X-4-14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684071PMC
May 2009

An endometriotic vault fistula presenting with monthly bleeding after hysterectomy.

Arch Gynecol Obstet 2009 Dec 24;280(6):1011-4. Epub 2009 Mar 24.

Istanbul University, Turkey.

Introduction: The aetiology of endometriosis remains unknown. The clinical presentation of endometriosis can be highly variable, occurring in numerous potential locations outside the abdomen and associated with distinct complaints. Recurrence is common, though we present a very rare case of recurrence and complication.

Case Presentation: A 42-year-old caucasian woman was admitted to our unite with monthly vaginal bleeding lasting 3-5 days, beginning from 6 months after previous hysterectomy and right salpingo-oophorectomy surgery for myoma and endometrioma. We suspected of endometrioma of the left ovarium upon transvaginal ultrasonography, and diagnosed vault fistula from the endometriosis cyst to the vagina. We re-operated the patient using Pfannenstiel incision, and performed left-oophorectomy and fistula repairment. The Pouch of Douglas was obliterated and many bowel adhesions were present, indicating a stage IV endometriosis. According to our assessment, stage IV endometriosis had been present in the previous surgery.

Conclusions: Considering that the short-term endometriosis recurrence is higher in premenopausal age and in advanced stage of endometriosis, bilateral oophorectomy together with hysterectomy may be a better operational choice for these patients.
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http://dx.doi.org/10.1007/s00404-009-1020-5DOI Listing
December 2009
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