Publications by authors named "Yunus Aydın"

75 Publications

Surgical treatment and outcomes of intramedullary tumors by minimally invasive approach.

J Clin Neurosci 2021 Apr 25;86:26-31. Epub 2021 Jan 25.

Acıbadem Healthcare Group, Fulya Hospital, Dikilitaş Mahallesi, Hakkı Yeten Cd. No.: 23, Beşiktaş, İstanbul, Turkey.

Intramedullary tumors are uncommon neoplasms which, without treatment, can cause neurologic morbidity or mortality. The goal of the treatment is complete surgical resection with a minimally invasive approach while preserving neurological status and also spinal stability. Out of 1972 patients with tumors of the spinal canal treated between 1994 and 2017, 168 intramedullary tumors of 417 intradural tumors have been presented. All patients had undergone one surgical resection. The mean age is 43 ± 12 years (range 11-67 years). Tumors were subdivided into 4 groups: cervically located-tumors (n = 43), cervicothoracic-region-tumors (n = 32), thoracic-region-tumors (n = 57), and lumbosacral-region-tumors (n = 36). The mean follow-up time was 37 ± 29 months. Gross-total resection rate was higher in cervical located intramedullary tumors compared to the thoracic intramedullary tumors. Cervical intramedullary tumors showed better postoperative functional outcome than the thoracic intramedullary lesions. In intramedullary tumors, extending more than 3 spinal segments, postoperative worsening was significantly increased. A minimally invasive approach (the bilateral decompression via unilateral hemilaminectomy) was used to remove the tumor while preserving spinal stability. Perioperative permanent morbidity was very low. Intramedullary tumors should be surgically treated as soon as neurological symptoms appear. Patients with thoracic intramedullary tumors and tumor extension of more than three segments were at a higher risk for permanent morbidity. The minimally invasive approach allowed complete removal of the intramedullary tumors, and adequate preservation of vertebral stability while providing a good postoperative course.
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http://dx.doi.org/10.1016/j.jocn.2021.01.001DOI Listing
April 2021

Diagnosis and Treatment of Transforaminal Epidural Steroid Injection in Lumbar Spinal Stenosis.

Sisli Etfal Hastan Tip Bul 2020 24;54(3):327-332. Epub 2020 Aug 24.

Fulya Hospital, Acıbadem Healthcare Group, Istanbul, Turkey.

Objectives: Transforaminal epidural steroid injection reduces the low back-leg pain and enables daily activities of the patients. In this study, we aim to evaluate the treatment of transforaminal epidural steroid injection for lumbar spinal stenosis, which was mainly performed for lumbar disc herniation and share our diagnostic experience for lumbar spinal stenosis which is treated surgically.

Methods: In our study, 37 patients were included who were treated by transforaminal epidural steroid injection for Grade B lumbar spinal stenosis in our clinic between June-2014 and June-2018. We evaluated the patients at the second weeks, third/sixth months and one year after the treatment by Oswestry-Disability-Index and Visual-Analogue-Scale and followed up for surgical treatment after one year.

Results: The mean low back and leg pain Visual Analogue Scale was 5.1±0.3 before the transforaminal epidural steroid injection procedure, and it was 2.7±0.1 after two weeks. It was 2.8±0.2, 3.1±0.1 at three and six months after procedure, respectively. The improvement of low back-leg pain mean Visual-Analogue-Scale is statistically significant at two weeks, three and six months after transforaminal epidural steroid injection procedure, respectively. The mean Oswestry-Disability-Index was 29.6±0.4 before the transforaminal epidural steroid injection procedure, and it was 14.1±0.3 after two weeks. It was 15.3±0.5, 24.4±0.2 at three and six months after procedure, respectively. The improvement of Oswestry-Disability-Index is statistically significant at two weeks, three-six months.

Conclusion: The transforaminal epidural steroid injection is safe procedure for non-surgical treatment of lumbar spinal stenosis and this procedure may be preferred support to the indication of the surgical treatment of level of lumbar spinal stenosis.
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http://dx.doi.org/10.14744/SEMB.2020.89983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729724PMC
August 2020

Surgical Outcomes of Extraforaminal Microdiskectomy by Midline Incision for Far-Lateral Lumbar Disk Herniation.

J Neurol Surg A Cent Eur Neurosurg 2021 Jan 6;82(1):27-33. Epub 2020 Nov 6.

Acibadem Healthcare Group, Fulya Hospital, Istanbul, Turkey.

Background:  Far-lateral lumbar disk herniation (FLDH) is defined as a disk herniation located laterally to the medial wall of the pedicle. The aim of our study is to describe the extraforaminal microdiskectomy by midline incision for FLDH, which does not include laminotomy-partial facetectomy, and to evaluate mid-term surgical outcomes.

Methods:  107 patients who underwent surgery for FLDH by midline incision for the first time between 2012 and 2017 were included in our study. The assessment of neurological status of the patients was done by physical examination, preoperative Oswestry Disability Index (ODI), Visual Analog Scala (VAS) scores, and magnetic resonance images. They were then followed-up postoperatively and at 12 months with VAS and ODI tests.

Result:  58 (54.2%) patients were male and 49 (45.8%) were female. The mean age at the time of surgery was 55.0 ± 8.6 years. The mean ODI scale score was 32.4 ± 6.2 preoperatively, 11.4 ± 2.1 early postoperatively, and 9.7 ± 2.2 in late postoperative follow-up (statistically significant,  = 0.001). The average VAS was 7.51 ± 1.1 preoperatively, 2.74 ± 0.7 early postoperatively, and 0.68 ± 0.08 in late postoperative follow-up (statistically significant,  = 0.001). The average operative time was 41 ± 7 (37 to 58) minutes.

Conclusions:  The extraforaminal microdiskectomy without laminotomy by midline incision is a minimally invasive approach for FLDH. Our technique allows a sufficient and safe decompression of the neural structures, and thus results in a significant reduction of the symptoms and disability.
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http://dx.doi.org/10.1055/s-0040-1714367DOI Listing
January 2021

Minimally Invasive Open Surgical Approach and Outcomes for Carpal Tunnel Syndrome.

Sisli Etfal Hastan Tip Bul 2019 26;53(3):247-251. Epub 2019 Aug 26.

Acibadem Healthcare Group, Fulya Hospital, Neurosurgery, Istanbul, Turkey.

Objectives: The most common peripheral neuropathy is carpal tunnel syndrome. The present study aims to describe our minimally invasive open surgical approach for carpal tunnel syndrome and evaluate surgical outcomes.

Methods: We included 217 patients who were operated in our clinic for carpal tunnel syndrome by minimally invasive open surgical approach. Visual Analogue Scale and Functional Outcome Scale scores were obtained preoperative, postoperative at one month and three months to determine surgical outcomes.

Results: The mean age of the patients was 55.4±12.8 years (32 to 69), 175 (80.6%) were women and 42 (19.4%) were men. The assessment of carpal tunnel syndrome's etiology showed that 189 (%87.1%) of the cases were idiopathic, 19 (8.8%) had hypothyroidism, 5 (2.3%) had rheumatoid arthritis and 4 (1.8%) were due to pregnancy. The average improvement of VAS between preoperatively and late postoperatively was 5.41±1.05. The average improvement FOS was 17.44±3.06. They were statistically significant.

Conclusion: The minimally invasive open surgical approach for carpal tunnel syndrome (an average of 1 cm skin incision) is performed with local anesthesia and successful surgical outcomes are achieved.
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http://dx.doi.org/10.14744/SEMB.2019.94759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192267PMC
August 2019

Cranio-Orbital Tumors: Clinical Results and A Surgical Approach.

Sisli Etfal Hastan Tip Bul 2019 27;53(3):240-246. Epub 2019 Aug 27.

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

Objectives: In this study, we aimed to share the surgical approaches and clinical experiences of cranio-orbital tumors, which are surgically difficult anatomies.

Methods: A total of 22 orbital tumors with extraorbital-transcranial pathology between January 2004 and December 2017 were retrospectively reviewed. Information was obtained from hospital, operation and outpatient records for this study. Preoperative demographic data, ophthalmologic examination findings, clinical and radiological findings were recorded. All patients had cranial magnetic resonance and cranial computerised tomography examinations at this time. The location of the tumor, its size and its relation to neighboring structures were recorded in the light of these examinations.

Results: The lateral approach was performed in 12 cases. The lateral approach was performed with frontotemporal craniotomy. Because of the lateral inferior location of the tumor in three of 12 cases, zygoma osteotomy was added to classical osteotomy. In 10 cases, the anterior approach was applied and the frontal craniotomy was found sufficient in seven cases. In three cases subfrontal craniotomy was added to classical craniotomy.

Conclusion: The findings obtained in this study suggest that high resection rates can be achieved with appropriate surgical intervention in orbital tumors requiring a transcranial surgical approach. The most important factor in surgical planning is the location of the tumor. The size of the tumor and the expectation of the percentage of surgical removal are the other important factors. In our series, it has reached high excision ratio in most cases with low complication rate, good visual field and eye movements results.
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http://dx.doi.org/10.14744/SEMB.2018.82698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192274PMC
August 2019

Letter: Contralateral Minimally Invasive Laminectomy for Resection of a Synovial Cyst: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2020 06;18(6):E258-E259

Vocational School of Health Services Acıbadem Mehmet Ali Aydınlar University Istanbul, Turkey.

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http://dx.doi.org/10.1093/ons/opaa046DOI Listing
June 2020

Does multifollicular development and number of intermediate follicles contribute to the effect of luteal phase support with vaginal progesterone gel in intrauterine insemination cycles?

Gynecol Endocrinol 2020 Jan 25;36(1):72-76. Epub 2019 Jun 25.

Obtetrics and Gynecology, Eskisehir Osmangazi Universitesi, Eskisehir, Turkey.

Luteal phase deficiency as a result of multifollicular development which produces supraphysiological progesterone and estradiol levels and benefit of luteal phase support have been proven in assisted reproductive technique (ART) treatment. But, there were some controversial results in intrauterine insemination (IUI) cycles whether luteal phase support (LPS) with progesterone have an impact on pregnancy outcome. To assess the efficacy of vaginal progesterone gel in the gonadotropin-induced IUI cycles, this retrospective data analysis compared the luteal phase support and control group in terms of clinical pregnancy (CPR) and live birth rates (LBR). In subgroup analysis, multifollicular and monofollicular growth were analyzed separately. In total, after exclusion criteria, 380 IUI cycles were analyzed, cycles were grouped as LPS(+) and LPS(-) with 190 and 190 cycles, respectively. CPR and LBR were comparable between groups (11.6% vs. 10.5,  = .74 and 8.9% vs. 8.4%,  = .75 respectively). Although multifollicular growth demonstrated higher pregnancy outcomes than monofollicular growth, intermediate follicles (14-16 mm) had a positive impact on pregnancy outcome in monofollicular growth like multifollicular subgroup. We found no difference in CPR and LBR according to the luteal phase vaginal progesterone gel. Nevertheless, multifollicular cycles and also monofollicular growth cycles with two and more intermediate follicles may have benefit LPS in gonadotropin-induced IUI cycles.
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http://dx.doi.org/10.1080/09513590.2019.1631277DOI Listing
January 2020

Laparoscopic management of a low-lying tailgut cyst: a rare case.

J Obstet Gynaecol 2019 Nov 7;39(8):1181-1183. Epub 2019 May 7.

Department of Obstetrics and Gynecology, Saglik Hospital , Denizli , Turkey.

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http://dx.doi.org/10.1080/01443615.2019.1587601DOI Listing
November 2019

Ultrasound-Guided Microsurgical Excision for Brachial Plexus Schwannomas: Short-Term Clinical Study.

Turk Neurosurg 2019 ;29(4):594-597

Acibadem Mehmet Ali Aydinlar University, Vocational School of Health Services, Istanbul, Turkey.

Aim: To describe the ultrasound-guided microsurgical excision technique and to evaluate the surgical outcomes of brachial plexus schwannomas.

Material And Methods: Eleven patients who underwent ultrasound-guided microsurgery for small ( < 3 cm) brachial plexus schwannomas between 2013 and 2017 were included in our study.

Results: The mean age of the patients was 45 years (range: 30-68 years), with six tumors localized on the right and five on the left side. There were no perioperative or postoperative complications. No postoperative deficits were observed in the patients.

Conclusion: Surgeons can safely and completely excise most of the benign ( < 3 cm and non-palpable) brachial plexus tumors by the ultrasound-guided microsurgical excision technique.
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http://dx.doi.org/10.5137/1019-5149.JTN.25575-18.3DOI Listing
October 2019

Surgical outcome and efficacy of lumbar microdiscectomy technique with preserving of ligamentum flavum for recurrent lumbar disc herniations.

J Clin Neurosci 2019 May 1;63:43-47. Epub 2019 Mar 1.

Acıbadem Healthcare Group, Fulya Hospital, Istanbul, Turkey.

The reoperation for recurrent lumbar disc herniation (LDH) causes difficulties and low surgical outcome. The operation technique which was preferred in the first surgery has gained importance in reoperation for recurrent-LDH. The aim of our study is to evaluate the efficacy of lumbar microdiscectomy technique with preserving of ligamentum flavum (LF) for recurrent lumbar disc surgery. 149 patients were evaluated in two groups in our study, who were treated for single level recurrent-LDH in our clinic. The first group contains 86 patients who were treated by lumbar microdiscectomy without preserving LF during first surgery in other clinics, the second group contains 63 patients who were treated by lumbar microdiscectomy with preserving of LF during first surgery in our clinic. We investigated age, weight, gender, recurrence-time, level-side of recurrent-LDH, the surgical outcomes and hemorrhage, complications, operation-time. The mean-age was 45,9 ± 12,9, 44,1 ± 11,6 years and mean-weight was 73,4 ± 14,4, 77,3 ± 14,2 kg in two groups. 29 patients were treated for L3-4, 63 patients for L4-5, 57 patients were treated for L5-S1 recurrent LDH. The preoperative and follow-up back-leg pain Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) scores decreased significantly in all patients (p < 0,05). The average operation-time was 70,9 ± 5,2 and 42,3 ± 4,6 min and the average surgical hemorrhage was 91,1 ± 11,3 and 50,3 ± 7,4 ml in 1. group and 2. group respectively. Preserving of LF in first surgery is gaining importance for recurrent lumbar disc surgery with protected anatomical structures. Our technique decreases complication, operation time, surgical hemorrhage and provides good surgical outcomes in recurrent lumbar disc surgery.
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http://dx.doi.org/10.1016/j.jocn.2019.02.010DOI Listing
May 2019

Long-Term Clinical Outcome and Reoperation Rate for Microsurgical Bilateral Decompression via Unilateral Approach of Lumbar Spinal Stenosis.

World Neurosurg 2019 05 31;125:e465-e472. Epub 2019 Jan 31.

Acıbadem Healthcare Group, Fulya Hospital, Istanbul, Turkey.

Objective: To evaluate long-term outcome and reoperation rate for microsurgical bilateral decompression via unilateral approach of lumbar spinal stenosis, a common degenerative spinal disease of the lumbar spine.

Methods: In this observational prospective study, 918 patients were treated for single-level or multilevel lumbar spinal stenosis by bilateral decompression via unilateral approach between January 2002 and January 2016. Of 918 patients, 180 underwent microdiscectomy with decompression. Follow-up consisted of radiologic investigations, Oswestry Disability Index questionnaire, and 36-Item Short-Form Health Survey at 6 and 12 months postoperatively.

Results: There were 492 female patients (53.6%) and 426 male patients (46.4%) with a mean age of 63.83 ± 10.16 years (range, 43-79 years). Symptom duration was 4-49 months. Average follow-up time was 98 months (range, 25-168 months), and reoperation rate was 2.5%. Oswestry Disability Index scores decreased significantly (from 30.65 ± 7.82 to 11.32 ± 2.50 at 6 months and 11.30 ± 2.49 at 12 months), and 36-Item Short-Form Health Survey parameter scores demonstrated a significant improvement in the early and late follow-up results.

Conclusions: Bilateral decompression via unilateral approach for lumbar spinal stenosis allowed a sufficient and safe decompression of the neural structures, resulting in a highly significant reduction of symptoms and disability, acceptable reoperation rate, and improved health-related quality of life.
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http://dx.doi.org/10.1016/j.wneu.2019.01.105DOI Listing
May 2019

Midterm outcome of thoracic disc herniations that were treated by microdiscectomy with bilateral decompression via unilateral approach.

J Clin Neurosci 2018 Dec 9;58:94-99. Epub 2018 Oct 9.

Acıbadem Mehmet Ali Aydınlar University, Fulya Hospital, Department of Neurosurgery, Istanbul, Turkey.

Thoracic disc herniation (TDH) surgery carries risks of neurological worsening due to thoracic cord retraction injury. Multiple approaches have been developed aiming for resecting the disc herniations of the thoracic segment. We have conducted a prospective observational study to evaluate the mid-term outcome of thoracic microdiscectomy with bilateral decompression via a unilateral approach (BDUA). Patients were checked pre-operative, post-operative, and late follow-up by Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and radiological images. Twenty-three patients were treated for TDH by microdiscectomy with BDUA between January 2010 and January 2015. Nine patients were female, fourteen were male, and all of those mean age was 51,2 ± 8,3 (range 29-64 years). The mean follow-up time was 22,04 ± 8,59 months (range 13-58 m). The ODI and VAS scores decreased significantly in both postoperative and late follow-up evaluations. Microdiscectomy with BDUA for thoracic disc herniations allowed sufficient and safe decompression of the neural structures and resulted in a significant reduction of symptoms and disability.
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http://dx.doi.org/10.1016/j.jocn.2018.09.033DOI Listing
December 2018

A Prospective Study of Interbody Fat Graft Application With the Anterior Contralateral Cervical Microdiscectomy to Preserve Segmental Mobility.

Neurosurgery 2017 Oct;81(4):627-637

Clinic of Neurosurgery, Acibadem University, Acibadem Fulya Hospital, Istanbul, Turkey.

Background: Any surgical procedure aims at protecting mobile segments at the operated level, and the sagittal balance of the columna vertebralis. Interbody fusion has become an often applied technique in anterior cervical discectomy.

Objective: To indicate that a minimally invasive technique in which we use interbody fat graft placement showed great results and effectiveness, especially in patients who were suffering from cervical paramedian disc herniation.

Methods: In this study, 432 patients were observed from 2000 to 2013. All these consecutive patients had paramedian disc herniation. The initial 239 patients (group 1) underwent microdiscectomy without graft placement, whereas the remaining 193 patients (group 2) had a microdiscectomy with interbody fat graft insertion. The Neck Disability Index (NDI) and Short Form-36 (SF-36) were used to evaluate clinical outcomes. They were followed up for 5.3 years (range 2-13 years).

Results: Spontaneous radiological fusion was noticed in 12% of group 1 patients and none of the group 2 patients. It has been observed that the mean overall cervical curvature (C2-7) angles and segmental lordosis did not change significantly in late follow-up findings. During both early and late follow-ups, all patients indicated a decreasing NDI score, but in late follow-up, an improving SF-36 score.

Conclusion: This surgical technique provides good direct decompression and preserves mobility at the treated level, while preventing disc collapse.
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http://dx.doi.org/10.1093/neuros/nyx056DOI Listing
October 2017

The effect of health-promoting lifestyle education on the treatment of unexplained female infertility.

Eur J Obstet Gynecol Reprod Biol 2016 Dec 2;207:109-114. Epub 2016 Nov 2.

Eskişehir Osmangazi University, Faculty of Medicine, Department of Gynecology and Obstetrics, Reproductive Endocrinology and Infertility, Eskişehir, Turkey.

Objective: This study aimed to reveal the 1) awareness, 2) improvements of a health-promoting lifestyle on women with unexplained infertility having at least one of the risk factors that have been indicated to negatively affect fertility (smoking, body mass index lower than 18.5kg/m and more than 25kg/m, over-exercising or not exercising at all, alcohol consumption, caffeine consumption of more than 300mg/day, and high levels of stress) by means of health-promoting lifestyle education, 3) the effect of this improvement on the result of assisted-reproduction treatment in terms of clinical pregnancy.

Study Design: 64 women diagnosed with unexplained infertility were divided into a group receiving Health-Promoting Lifestyle (HPL) education and a control group. 1) Risk Factors Questionnaire (BMI, Smoking, Alcohol, Stress, Exercise, Caffeine), 2) Depression, Anxiety and Stress Scale, 3) Health-Promoting Lifestyle Profile II. The health promoting lifestyle was given to the education group. The Risk Factors Questionnaire; Depression, Anxiety, Stress Scale and Healthcare-Promoting Lifestyle Profile II were also administered after the first-second-third month of education but before ART treatment.

Results: A statistically significant decrease was found in the average levels of four variables as; BMI (p<0.001)-stress (p<0.001)-caffeine consumption (p<0.001)-lower exercise levels (p<0.001). Moreover, the total number of risk factors that females had between the first and third interview decreased significantly. Clinical pregnancy rate after ART was 12 (46.1%) and 5 (19.2%) in education and control group consequently (p=0.02).

Conclusion: Health-promoting lifestyle education was found to be effective in reducing the lifestyle risk factors for infertility and increasing the success rates of assisted reproduction treatment by correcting these risk factors.
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http://dx.doi.org/10.1016/j.ejogrb.2016.10.050DOI Listing
December 2016

Computerized Tomography-Guided Stereotactic Biopsy of Intracranial Lesions: Report of 500 Consecutive Cases.

Turk Neurosurg 2017 ;27(3):395-400

Sisli Hamidiye Etfal Research and Training Hospital, Clinic of Neurosurgery, Istanbul, Turkey.

Aim: Computed tomography (CT)-guided stereotactic brain biopsy has been performed in our clinic since March 1998. In this prospective study, we examined the patient data undergoing stereotactic biopsy and the results of biopsies in 500 consecutive patients.

Material And Methods: Between the dates of March 1998 and January 2015, CT-guided stereotactic biopsies were performed by using the Leksell stereotactic frame system (Elekta Instruments EU, Sweden) in 500 patients. A total of 512 procedures were performed in patients consisting of 184 females (36.8%) and 316 males (63.2%), ages ranging from 3 to 81 years (mean 50.40±16.67).

Results: Conclusive histopathological diagnosis was not achieved in 17(3.3%) of 512 procedures. Of the others, 173 (33.8%) were high-grade gliomas, 103 (20.1%) were low-grade gliomas, 36 (7%) were malignant lymphomas, 34 (6.6%) were other types of brain tumors, 82 (16%) were metastasis and 67 (13.1%) were non-tumoral lesions. Complications were occurred in ten cases: 3 tumoral bleedings, 2 hypertensive cerebral hematomas, 2 peroperative convulsions, 1 epidural hematoma, 1 myocardial infarction and 1 brain edema. The patients who developed myocardial infarction and hypertensive thalamic hematoma died. The mortality was 0.4% and morbidity was 1.6% in 512 procedures.

Conclusion: CT-guided stereotactic biopsy is a reliable and a safe procedure in cases with intracranial lesions when histopathological diagnosis is required for the appropriate treatment.
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http://dx.doi.org/10.5137/1019-5149.JTN.16280-15.1DOI Listing
December 2017

Arachnoid cyst of the cerebellopontine angle causing isolated acute hearing loss, with literature review.

Acta Neurochir (Wien) 2015 Nov 2;157(11):1999-2001. Epub 2015 Sep 2.

Clinic of Neurosurgery, Acibadem Fulya Hospital, İstanbul, 34349, Turkey.

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http://dx.doi.org/10.1007/s00701-015-2563-9DOI Listing
November 2015

What is the Risk of Metabolic Syndrome in Adolescents with Normal BMI who have Polycystic Ovary Syndrome?

J Pediatr Adolesc Gynecol 2015 Aug 29;28(4):271-4. Epub 2014 Aug 29.

Midwifery Department of Nursing College, Eskisehir Osmangazi University, Eskisehir, Turkey.

Objective: The purpose of this study is to evaluate the effect of polycystic ovarian syndrome (PCOS) on the prevalence of metabolic syndrome (MBS) in adolescent girls with normal BMI.

Materials And Methods: Our study group consisted of 63 pubertal girls with a BMI less than 25 kg/m(2) who were referred to our center with signs of hirsutism or oligomenorrhea. The diagnosis of PCOS was based on the recent ESHRE/ASRM proposal and required that all 3 of the Rotterdam criteria for diagnosing PCOS in adolescents be met. The control group consisted of 159 pubertal girls matched for age and BMI. Glucose, insulin, testosterone, and sex hormone-binding globulin, free testosterone and all lipid parameters measured. For to diagnose the cases with MBS, modified Cook criteria were used and cases who had at least 3 of 5 criteria's were diagnosed as MBS.

Results: Girls with PCOS had higher blood pressure parameters (systolic/diastolic) (P < .01), fasting insulin (P = .007), low-density lipoprotein (P = .017), triglyceride (P = .045), total (P < .001) and free testosterone (P = .001) levels compared to control group. There were more cases who had at least 1 Cook criterion in girls with PCOS compared to the control group but the difference was not significant. However, there were more cases who had MBS in girls with PCOS compared to the control group (P = .02).

Conclusion: MBS prevalence is higher in normal BMI adolescent girls with PCOS compared to age and BMI matched control group. So as clinicians, we must search for the MBS criteria's in girls with PCOS even if they have a normal BMI.
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http://dx.doi.org/10.1016/j.jpag.2014.08.011DOI Listing
August 2015

Effects of nasal continuous positive airway pressure therapy on partners' sexual lives.

Eur Arch Otorhinolaryngol 2016 Jan 10;273(1):133-7. Epub 2015 Feb 10.

Department of Obstetrics and Gynecology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey.

To assess sexual functioning in male and female partners before and after nasal continuous positive airway pressure (CPAP) therapy in men with obstructive sleep apnea (OSA). Twenty-one male patients with moderate to severe OSA and erectile dysfunction, and their female partner, were recruited into this prospective study. Males diagnosed with OSA were treated with nasal CPAP therapy for 12 weeks. Women were assessed for sexual functioning using the Female Sexual Function Index (FSFI), and for mood status using the Beck Depression Inventory (BDI), before and after their male partner underwent nasal CPAP therapy. Sexual functioning was assessed in men using the International Index of Erectile Function (IIEF), before and after nasal CPAP therapy. After nasal CPAP therapy for OSA in men, IIEF scores were significantly higher than pre-treatment scores. Total pre- and post-treatment IIEF scores (mean ± standard deviation) were 50.28 ± 15.88 and 65.42 ± 7.47, respectively, P < 0.01. Pre- and post-treatment FSFI scores in women were 21.54 ± 6.62 and 29.94 ± 3.76, respectively, P < 0.01. Pre- and post-treatment BDI scores in women were 14.61 ± 9.69 and 12.42 ± 8.92, respectively, P < 0.01. Following treatment of men with OSA, our data indicate benefits for nasal CPAP therapy on sexual functioning in both the male and female partners. Moreover, our findings indicate that improved sexual function in women after their male partner underwent nasal CPAP also had psychological benefits.
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http://dx.doi.org/10.1007/s00405-015-3546-4DOI Listing
January 2016

Early versus delayed oral feeding after cesarean delivery under different anesthetic methods--a randomized controlled trial anesthesia, feeding in cesarean delivery.

Ginekol Pol 2014 Nov;85(11):815-22

Objective: The aim of the study was to evaluate the safety and efficacy of early feeding after cesarean delivery under different anesthetic methods.

Study Design: Two hundred women with elective cesarean delivery were randomly assigned to early oral feeding (EOF) or routine oral feeding (ROF) groups. EOF patients were informed that they could begin taking fluids orally (regime I) as soon as 2 hours after the delivery and then gradually progress to solid foods (regime III), if tolerated. ROF patients were informed that they could start regime I right after bowel sounds were heard on examination and then gradually move on to regime III. Hospitalization time and total time to ambulation (primary outcomes), gasstool discharge time and onset of bowel sounds (secondary outcomes) were compared in groups A [EOF patients after regional anesthesia (n=49)}, B [EOF patients after general anesthesia (n=48)}, C [ROF patients after regional anesthesia (n=47)} and 0 [ROF patients after general anesthesia (n=48)].

Results: There were significant differences in primary and secondary outcomes between group A and the remaining groups, especially group D. The status of patients from group B was not better than group C. In fact, the latter were discharged home sooner and passage of gas, as well as initiation of regime I occurred earlier as compared to the former

Conclusions: Cesarean section under regional anesthesia and encouragement of oral feeding 2 hours after the operation should be recommended in order to acnieve postoperative recovery and early hospital discharge. Routine oral feeding (right after bowel sounds are heard on examination) after cesarean section under general anesthesia should be the last choice.
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http://dx.doi.org/10.17772/gp/1906DOI Listing
November 2014

Effects of dehydroepiandrosterone (DHEA) on follicular dynamics in a diminished ovarian reserve in vivo model.

Syst Biol Reprod Med 2015 Jun 11;61(3):117-21. Epub 2015 Feb 11.

Department of Obstetrics and Gynecology, Reproductive Medicine Unit .

The objective of this study was to determine whether there are changes in primary, primordial, and growing follicles after dehydroepiandrosterone (DHEA) administration in rats that have diminished ovarian reserve (DOR) due to 4-vinylcyclohexene diepoxide (VCD) application, and to examine the mechanism of the probable effect of DHEA on folliculogenesis. Two groups of Wistar rats were used. In Group A unilateral oophorectomy (eight rats) was carried out on day-0. The remaining study ovary was removed by relaparotomy after VCD (160 mg/kg, intraperitoneally) was administered for 15 days. In Group B unilateral oophorectomy (eight rats) was carried out on day-0. The remaining study ovary was removed by relaparotomy after VCD (160 mg/kg, intraperitoneally) administration for 15 days followed by DHEA (60 mg/kg body weight) daily for 45 days. Primordial, primary, and growing (secondary+antral) follicles were counted in 1,664 sections from 32 ovaries. In all three types of follicles (primordial, primary, and growing), the number of follicles significantly decreased in the study ovaries compared to the control ovaries in both Group A and Group B. In Group B, atresia rates were significantly lower in the study ovary compared to the control ovary in all of the follicular groups: primordial (p=0.02), primary (p=0.01), and growing (p=.027). To demonstrate the probable effects of DHEA on follicular dynamics, we also compared the study ovaries in both groups; the primordial (p=0.027), primary (p=0.031), and growing (p=0.04) number of follicles were significantly higher in Group B compared to Group A. In conclusion, our findings suggest that DHEA administration in DOR rats due to VCD results in a larger follicular pool. Decreased atresia may be one of the possible effects of DHEA in DOR cases. Whatever the mechanism, DHEA treatment potentially may be useful clinically as a means to increase the number of gonadotropin-responsive follicles for ovarian stimulation.
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http://dx.doi.org/10.3109/19396368.2015.1011353DOI Listing
June 2015

The role of perivitelline space abnormalities of oocytes in the developmental potential of embryos.

J Turk Ger Gynecol Assoc 2014 8;15(3):161-3. Epub 2014 Aug 8.

Department of Obstetrics and Gynecology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey.

Objective: In assisted reproductive technology (ART), high embryo quality is closely related to high-quality oocytes. Cytoplasmic maturation and extracytoplasmic maturation are the most important components in determining oocyte quality. One of the most important components of extracytoplasmic maturation is perivitelline abnormalities. The aim of this study is to determine the effect of perivitelline abnormalities on the development of high-quality embryos.

Material And Methods: The study material consisted of 217 of 1154 oocytes from 98 intracytoplasmic sperm injection (ICSI) cycles undertaken due to male factor infertility. Only cycles with long gonadotropin-releasing hormone analogs combined with recombinant Follicle-stimulating hormone (rec-FSH) were included in study. We compared 105 metaphase-II oocytes that had dominantly perivitelline space abnormalities (large perivitelline space with or without granules) with 112 normal metaphase-II oocytes, based on the embryo grade determined by Alpha Scientists in Reproductive Medicine and the European Society of Human Reproduction and Embryology (ESHRE) Special Interest Group of Embryology. Normal metaphase-II oocytes were characterized by a round, clear zona pellucida; a small perivitelline space containing a single unfragmented first polar body; and a pale, moderately granular cytoplasm with no inclusions.

Results: The development rates of Grade I, II, and III embryos were 68.5%, 23.8%, and 7.7%, respectively, in the 105 oocytes with perivitelline abnormalities. The development rates of Grade I, II, and III embryos were 82.1%, 17.9%, and 0%, respectively, in the 112 morphologically normal oocytes. When compared with normal oocytes, Grade I (68.5% vs. 82.1%, p value; 0.019) and Grade III (7.7% vs. 0%, p value; 0.003) embryo development rates were significantly lower in oocytes that had perivitelline abnormalities.

Conclusion: It is important to analyze oocyte quality using multiple parameters, including the perivitelline space. Perivitelline space abnormalities might negatively affect embryo development in male factor-infertile couples that are stimulated with rec-FSH. Therefore, when choosing embryos for transfer, we must take into consideration the historical oocyte data.
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http://dx.doi.org/10.5152/jtgga.2014.13091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195326PMC
October 2014

Vaginal misoprostol versus a rectal nonsteroidal anti-inflammatory drug to reduce pain during Pipelle endometrial biopsies: a prospective, randomized, placebo-controlled trial.

Gynecol Obstet Invest 2014 16;78(4):230-4. Epub 2014 Jul 16.

Department of Obstetrics and Gynecology, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey.

Background: To evaluate and compare the efficacy of vaginal misoprostol and a rectal nonsteroidal anti-inflammatory drug (NSAID) on pain relief during Pipelle endometrial biopsies in a placebo-controlled randomized study.

Methods: One hundred and fifty-one women who had an indication for a Pipelle endometrial biopsy were randomized into three groups as follows: group 1, vaginal misoprostol; group 2, rectal NSAID, and group 3, control. After the procedure, the women were asked to record their pain severity on a visual analog scale. The secondary outcome of the study was patient acceptability, and vasovagal symptoms and analgesic requirements after the procedure were also recorded.

Results: There were no statistically significant differences in the demographic characteristics of the patients. The primary study outcome was the comparison of the median visual analog scale pain scores of groups 1 and 2 versus group 3 (controls); no statistically significant differences were found (p = 0.502). In addition, the patient acceptability (Likert scale), vasovagal symptoms and analgesic requirements after the procedure were similar among the groups (p = 0.204, 1 and 0.546, respectively).

Conclusion: Our study did not demonstrate a reduction in pain relief during Pipelle endometrial biopsies for patients receiving vaginal misoprostol or a rectal NSAID when compared to patients receiving placebo treatment.
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http://dx.doi.org/10.1159/000363748DOI Listing
August 2015

Follicular fluid and serum vascular endothelial growth factor, interleukin (IL)-1β and glycodelin concentrations: comparison between long-gonadotropin-releasing hormone (GnRH)-agonist and GnRH-antagonist cycles: a randomized controlled trial.

Gynecol Endocrinol 2014 Oct 13;30(10):734-8. Epub 2014 Jun 13.

Department of Obstetrics and Gynecology and.

In this randomized controlled trial, we aimed to examine whether differences exist among patients who underwent assisted reproductive technology treatment with a long-GnRH-agonist compared to a GnRH-antagonist protocol in terms of levels of follicular fluid (FF) and serum concentrations of vascular endothelial growth factor (VEGF), glycodelin and interleukin (IL)-1β on the day of oocyte pick-up (OPU). In 80 infertile couple with male factor or unexplained infertility, 40 women stimulated with GnRH-antagonist protocol and 40 women with the long-GnRH-agonist protocol. FF and blood serum samples were obtained simultaneously from 80 women during the OPU procedure and the concentrations of VEGF, IL-1β and glycodelin were measured with commercially available kits. Concentrations of FF VEGF, IL-1β and glycodelin were not significantly different in the long-GnRH-agonist and GnRH-antagonist groups, and neither were serum concentrations of VEGF, IL-1β and glycodelin. According to our results in at least, we can say that minor differences between these protocols in terms of clinical pregnancy do not depend on VEGF, glycodelin or IL-1β.
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http://dx.doi.org/10.3109/09513590.2014.929655DOI Listing
October 2014

Comparison of nonsteroidal anti-inflammatory drugs and misoprostol for pain relief during and after hysterosalpingography: prospective, randomized, controlled trial.

J Minim Invasive Gynecol 2014 Sep-Oct;21(5):762-6. Epub 2014 Mar 4.

Department of Obstetrics and Gynecology, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey.

Study Objective: To assess whether vaginal misoprostol or oral nonsteroidal anti-inflammatory drugs (NSAIDs) reduce pain during and 30 minutes after hysterosalpingography (HSG).

Design: Randomized prospective, controlled, parallel-group study (Canadian Task Force classification I).

Setting: University teaching hospital.

Patients: One hundred sixty-eight women with primary infertility who underwent HSG for evaluation of infertility.

Interventions: Patients were randomly assigned to 1 of 3 groups. Group 1 received 200 μg misoprostol vaginally 6 hours before HSG; group 2, 50 mg diclofenac potassium orally 45 to 60 minutes before HSG; and group 3, no medication. The primary outcome of the study was to evaluate the severity of pain during and 30 minutes after the procedure using a visual analog scale (VAS) ranging from 1 (very favorable) to 10 (very unfavorable). The secondary outcomes were to assess the rate of completion and the vasovagal effects including nausea, vomiting, sweating, weakness, syncope, hypotension, and bradycardia.

Measurements And Main Results: There was no statistically significant difference in the median (25%-75%) VAS pain scores between women administered vaginal misoprostol (median, 6.7 cm; range, 4.7-9 cm) and the control group (median, 6.7 cm; range, 4.6-8.8 cm) during the HSG. However, women in the NSAID group (median, 5.5 cm; range, 3-7.6 cm) reported less pain than did those in the misoprostol group (p = .009) and the control group (p = .03). At 30 minutes after HSG, there was no significant difference in the median VAS pain scores between patients administered NSAIDs (median, 2.3 cm; range, 1.4-4.2) or misoprostol (median, 2.3 cm; range, 1.2-4.4) and the control group (median, 2.2 cm; range, 1.3-4.4).

Conclusions: There is no benefit in terms of pain reduction with the use of misoprostol during HSG or at 30 minutes after the procedure. However, NSAIDs are associated with pain relief during the HSG procedure.
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http://dx.doi.org/10.1016/j.jmig.2014.02.014DOI Listing
June 2015

Incompletely Evaluated ART Leading to Ectopic Pregnancy and Cerebral Thrombosis.

Int J Fertil Steril 2013 Jul 31;7(2):138-41. Epub 2013 Jul 31.

Department of Obstetrics and Gynecology, Reproductive Medicine Unit, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey.

We presented a cerebral venous thrombosis case associated with lack of proper medical evaluation required for confirmation of suppression and exclusion of current pregnancy before starting assisted reproductive technology (ART) cycle. This is a case-report study about a 37-year-old woman who presented to emergency room with abdominal pain and tenderness. Initial human chorionic gonadotropin (hCG) value was 17616 IU/L. Endometrium was heteregenous and incompatible with a normal intrauterine pregnancy. She had a history of antagonist protocol/controlled ovarian hyperstimulation (COH) started 38 days ago in a different in vitro fertilization (IVF) center. Because of the fertilization failure, she had no embryo transfer. With ectopic pregnancy diagnosis, we made surgical exploration and observed a material which was consistent with ectopic pregnancy on the right tuba uterina. Partial salpingectomy was applied because of actively bleeding ectopic pregnancy. Two days after discharging from hospital; she presented to emergency room again with syncope and generalized tonic-clonic seizure. By cranial tomography generalized edema, cerebral venous thrombosis was established. Enoxaparine sodium 0.6 ml twice daily was administered. Six days after hospitalisation, she was discharged with normal neurological examination under phenytoin 200 mg daily and enoxaparine sodium 0.6 ml daily. Before ART treatment, clinicians must always rule out the likelihood of existing pregnancy by measuring estradiol, follicle stimulating hormone (FSH), and luteinizing hormone (LH). On the other hand, low-molecularweight heparine may be effective in cerebral venous thrombosis treatment. Therefore, intracerebral thrombosis is one of the rare mortal complications of ART.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850337PMC
July 2013

Factors predictive of clinical pregnancy in the first intrauterine insemination cycle of 306 couples with favourable female patient characteristics.

Hum Fertil (Camb) 2013 Dec 31;16(4):286-90. Epub 2013 Oct 31.

Department of Obstetrics and Gynecology, Eskisehir Osmangazi University School of Medicine , Eskisehir , Turkey.

The objective of this study was to evaluate the factors predictive of clinical pregnancy in the first superovulation/intrauterine insemination (SO/IUI) cycle of couples with favourable female characteristics. We analyzed retrospectively the first SO/IUI cycle of 306 infertile couples with mild male factor infertility and unexplained infertility. The women had a favourable prognosis in terms of ovarian reserve. Univariate logistic regression analyses identified body mass index (BMI) [odds ratio (OR) = 0.9, P = 0.014], sperm concentration [OR = 1.007, P = 0.007] and inseminating motile sperm count (IMC) [OR = 1.007, P = 0.032] as significant predictive factors of clinical pregnancy. Multivariate logistic regression analysis identified BMI [OR = 0.87, P = 0.008] and sperm concentration [OR = 1.008, P = 0.011] as significant factors. Pregnant and non-pregnant groups did not differ significantly in terms of the age and smoking status of the woman, duration and type of infertility, length of the stimulation, total gonadotropin dosage or antral follicle count. Of the female characteristics investigated, BMI was the most significant predictive factor of clinical pregnancy in the first SO/IUI cycle of couples with unexplained or mild male factor infertility and favourable female characteristics. In overweight women, weight loss should be advised before starting SO/IUI. Sperm concentration and IMC were significant male predictive factors for clinical pregnancy in the first SO/IUI.
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http://dx.doi.org/10.3109/14647273.2013.841328DOI Listing
December 2013

Sonographically guided core biopsy: a minimally invasive procedure for managing adnexal masses.

J Ultrasound Med 2013 Nov;32(11):2023-7

Department of Obstetrics and Gynecology, Eskisehir Osmangazi University School of Medicine, 26100 Eskisehir, Turkey.

Objectives: We hypothesized that sonographically guided core biopsy is an effective method for the differential diagnosis of adnexal masses and evaluated patients who underwent core biopsies in our gynecologic oncology department.

Methods: We reviewed the medical records of 55 patients who underwent sonographically guided core biopsies in our gynecologic oncology department between 2010 and 2013. Patients with suspected ovarian malignancies who were unsuitable for optimal debulking surgery and patients at risk for higher morbidity and mortality because of a poor performance status, suspected nongynecologic tumors, and peritoneal tuberculosis were indicated for sonographically guided biopsy.

Results: The indications for sonographically guided core biopsy were candidacy for suboptimal cytoreduction (n = 32 [58.2%]), a poor performance status (n = 11 [20.0%]), and suspected nongynecologic tumors (n = 12 [21.8%]). Histopathologic evaluations revealed primary ovarian tumors in 36 patients (65.5%). Tuberculosis was found to be the second most common disease (n = 8 [14.5%]) among the patients who underwent core biopsies. In 2 patients (3.6%), histologic examination revealed metastatic colorectal cancer.

Conclusions: Sonographically guided core biopsy may be preferred as a minimally invasive procedure for managing adnexal masses, particularly in patients with advanced ovarian cancer and high comorbidities who might benefit from neoadjuvant chemotherapy and in cases of suspected nongynecologic tumors, including pelvic tuberculosis.
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http://dx.doi.org/10.7863/ultra.32.11.2023DOI Listing
November 2013

A randomized study of simultaneous hCG administration with intrauterine insemination in stimulated cycles.

Eur J Obstet Gynecol Reprod Biol 2013 Oct 6;170(2):444-8. Epub 2013 Aug 6.

Eskisehir Osmangazi University School of Medicine, Department of Obstetrics and Gynecology, Turkey. Electronic address:

Objective(s): To compare the clinical pregnancy rates between intrauterine insemination (IUI) simultaneously or 34-36 h following hCG injection in gonadotropin-stimulated IUI cycles.

Study Design: Randomized, prospective, controlled, study conducted in a university infertility clinic. Of 923 infertile couples, 220 couples with unexplained infertility or mild male factor infertility were included to the study. Before ovarian stimulation patients were randomized into two groups: IUI at 34-36 h after hCG injection (group I) (n=106) and IUI simultaneously with hCG administration (group II) (n=98). The primary outcome was clinical pregnancy rates.

Results: There was no significant difference between the groups according to baseline patient and cycle characteristics. Clinical pregnancy rates were 9.4% and 12.2% in group I and group II, respectively (p=0.523). Although group II had better outcomes there was no statistically significant difference in clinical pregnancy rates between the different timing methods: IUI simultaneously with hCG versus IUI at 34-36 h after hCG (odds ratio (OR)=1.35, 95% CI 0.53-3.42).

Conclusion(s): There is no difference in simultaneous use of hCG injection compared to cycles in which IUI is performed after 34-36 h following hCG injection. Prospective randomized trials with larger sample sizes or meta-analyses are required.
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http://dx.doi.org/10.1016/j.ejogrb.2013.07.022DOI Listing
October 2013

Effectiveness of vaginal misoprostol and rectal nonsteroidal anti-inflammatory drug in vaginoscopic diagnostic outpatient hysteroscopy in primarily infertile women: double-blind, randomized, controlled trial.

J Minim Invasive Gynecol 2013 Nov-Dec;20(6):880-5. Epub 2013 Jul 10.

Department of Obstetrics and Gynecology, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey.

Study Objective: To assess whether vaginally administered misoprostol or rectally administered nonsteroidal anti-inflammatory drug reduces pain during vaginoscopic diagnostic outpatient hysteroscopy in nulliparous infertile patients.

Design: Double-blinded, randomized, controlled trial (Canadian Task Force classification I).

Setting: Department of reproductive medicine at a university teaching hospital.

Patients: One hundred fifty-eight primarily infertile women who underwent outpatient hysteroscopy for evaluation of infertility.

Interventions: Patients were randomly assigned to 3 groups. Women in group 1 received 200 μg misoprostol vaginally at 6 hours before outpatient hysteroscopy and placebo tablets rectally at 60 minutes before the procedure. Women in group 2 received placebo tablets rectally at 6 hours before outpatient hysteroscopy and 100 mg diclofenac sodium rectally at 60 minutes before the procedure. Women in group 3 received placebo tablets vaginally at 6 hours before outpatient hysteroscopy and placebo tablets rectally at 45 to 60 minutes before the procedure. Patients were asked to record severity of pain, which was the primary outcome of the study, during the outpatient hysteroscopy procedure by using a visual analog scale ranging from 1 (very favorable) to 10 (very unfavorable). Secondary outcomes included procedural time from introduction of the hysteroscope through the external cervical os and visualization of the uterine cavity, patient acceptance recorded by the patient using a 5-point Likert scale, post-procedural analgesic requirements, and vasovagal effects.

Measurements And Main Results: Median (range) pain scores for the women in group 1 (4.75 [3.12-6.54]) and group 2 (5.01 [2.8-7.05]) were not significantly different from those in group 3 (4.15 [2.17-6.92]) (p = .57). There was also no significant difference in patient acceptance (Likert scale) (p = .67), vasovagal symptoms (p = .84), procedure time (p = .05), and post-procedural analgesic requirement (p = .71).

Conclusions: We were unable to demonstrate a benefit in pain reduction and patient acceptance with the use of vaginal misoprostol or rectal NSAIDs during vaginoscopic diagnostic outpatient hysteroscopy in nulliparous infertile women without a history of cervical stenosis. Trials investigating the optimal time for vaginal misoprostol premedication for pain relief in vaginoscopic outpatient hysteroscopy are needed. New interventions and/or drugs should be studied to decrease pain perception during vaginoscopic outpatient hysteroscopy.
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http://dx.doi.org/10.1016/j.jmig.2013.07.002DOI Listing
July 2014

Frequency and determinants of urogenital symptoms in postmenopausal Islamic women.

Menopause 2014 Feb;21(2):182-7

From the Departments of 1Obstetrics and Gynecology and 2Biostatistics, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey.

Objective: The objective of this study was to evaluate the frequency of genitourinary symptoms and their relationships with several factors in a large cohort of postmenopausal women in Turkey.

Methods: We performed a cross-sectional study to review genitourinary complaints among 1,328 postmenopausal women; 1,071 of these women were enrolled in the study. They were questioned about their vaginal and urinary symptoms, and the relationships between these symptoms and their demographic characteristics were evaluated.

Results: The most common vaginal and urinary symptoms were dryness (n = 358; 33.4%) and nocturia (n = 421; 39.3%), respectively. Cigarette smoking and regular exercise were not associated with any vaginal symptoms (P > 0.05), with the exception of an association between regular exercise and vaginal dryness (P = 0.026). Nocturia was more common in women older than 60 years (P = 0.001) and in obese women (P = 0.013). Based on multiple binary logistic regression analysis, lower educational status (primary school vs secondary school or higher) and higher parity were the factors most significantly associated with the appearance of at least three vaginal symptoms. Lower educational status was associated with vaginal pain (P = 0.002; odds ratio [OR], 1.75), itching (P < 0.001; OR, 1.23), and discharge (P = 0.011; OR, 1.46). Higher parity was associated with vaginal itching (P < 0.001; OR, 1.23), discharge (P = 0.07; OR, 1.18), and burning (P = 0.012; OR, 1.16). Body mass index (BMI) was the only factor that was significantly associated with the appearance of at least three urinary symptoms, with each one-unit increase in BMI increasing the risk of urgency (P < 0.001; OR, 1.06), nocturia (P < 0.001; OR, 1.06), and frequency (P = 0.009; OR, 1.04).

Conclusions: We identify associations between the frequency of genitourinary complaints and educational status, parity, and BMI. There is no association between regular exercise and urogenital symptoms. However, prospective studies are needed to evaluate the effects of regular exercise on urogenital symptoms. When examining postmenopausal women with risk factors for urinary and vaginal symptoms, clinicians should evaluate these symptoms more thoroughly to facilitate earlier treatment.
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http://dx.doi.org/10.1097/GME.0b013e3182937966DOI Listing
February 2014