Biomedical subjects

Ali Haberal

Publications and source records attributed to Ali Haberal.

At least 19 recordsLinked to original sources

PubMed2006

A randomized comparison of transobturator tape and Burch colposuspension in the treatment of female stress urinary incontinence.

This study was performed to compare the efficacy of transobturator tape (TOT) and Burch colposuspension in the treatment of female stress urinary incontinence (SUI). This is a prospective randomized single blind study of 100 women diagnosed as with urodynamic SUI who were randomized either to TOT procedure (n = 49) or Burch procedure (n = 51). The outcome was evaluated at 1 and 2 years. The mean operation time and hospital stay were significantly shorter in the TOT group compared to Burch group (p < 0.001). Procedure-related complications and postoperative voiding problems including postoperative urinary retention, de novo voiding difficulties and de novo urge incontinence were similar in the two groups. Both the subjective and objective cure rates of SUI at 1 year were 85.7 and 87.5%, respectively, in the TOT group. This was similar to subjective and objective cure rates at one year of 84.3% (p = 0.8) and 80.3% (p = 0.4) in the Burch group, respectively. At the end of 2 years, 32 patients were available in the TOT group and 31 patients were available in the Burch group for analysis. Both the subjective and objective cure rates of SUI at 2 years were 87.5 and 87.5% in the TOT group which was similar to the 87% (p = 0.9) and 83.8% (p = 0.6) in the Burch group, respectively. TOT procedure results in similar cure rates of SUI at 1 and 2 years compared to Burch procedure. The TOT procedure has a shorter operative time and length of hospital stay.

Adult↗

PubMed2006

Comparison of efficacy and complications of IUD insertion in immediate postplacental/early postpartum period with interval period: 1 year follow-up.

OBJECTIVE: This study aimed to compare immediate postplacental (IPP) and early postpartum (EP) intrauterine device (IUD) insertions with interval (INT) IUD insertions with respect to efficacy and complications. METHODS: The study group consisted of 268 women in whom the following TCu 380A IUD insertions were performed: 84 IPP (less than 10 min), 46 EP (10 min to 72 h) and 138 INT (more than 6 weeks). The women were followed up 8 weeks, 6 months and 12 months after insertion. Complications and pregnancies encountered at the end of 1 year following IPP, EP and INT insertions were compared. The chi-square test and Fisher's Exact Test were used for the evaluation of the data. RESULTS: Complications developed in 40.4% of the women in the IPP group, in 74.4% of the women in the EP group and in 19.2% of the women in the INT group (p<.001). Although no statistically significant difference was found between the groups for uterine perforation and infection (p>.001), there was a statistically significant difference between the groups in the incidence of complete and partial expulsion according to the time of IUD insertion. The overall cumulative pregnancy rate and frequency of pregnancy were found to be higher (p>.05 for both), which are both insignificant for the EP group (2 of 43 women), as compared with the INT (4 of 130 women) and IPP groups (2 of 84 women), and pregnancy rates at 1 year for all groups was 3.1% (8 of 257 women). CONCLUSION: IPP and EP insertion of the TCu 380A IUD is an effective and convenient procedure, and expulsion rates in these groups are higher than in the INT group. Further studies are necessary to determine the cause of the higher expulsion rates and to find ways to reduce such rates.

Adolescent↗

PubMed2006

Effects of levonorgestrel-releasing intrauterine system on glucose and lipid metabolism: a 1-year follow-up study.

PURPOSE: This prospective study aimed to assess the possible effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) on serum lipids and fasting blood glucose levels over a period of 1 year. METHODS: Forty-eight premenopausal women, attending our gynecology clinic with the complaint of menorrhagia, were enrolled in the study. Systolic and diastolic blood pressures were recorded. Serum concentrations of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and fasting plasma glucose (FPG) levels were tested before (pretreatment group) and 1 year later following insertion (on-treatment group). Baseline mean parameters were compared with mean parameters at 1 year for statistical significance using paired samples t-test. RESULTS: Thirty-three (68.75%) women were eligible for control in the on-treatment group. Mean age of the patients was 44.34+/-7.59 years. The study results showed that mean FPG level was significantly increased, whereas mean diastolic blood pressure was significantly decreased. Although mean systolic blood pressure tended to decrease and HDL-C concentrations to increase, these changes from baseline levels were insignificant. There were no significant changes in mean TG, TC, VLDL, LDL, AST and ALT. DISCUSSION: The only significant unfavorable effect observed was an increase in FPG level. Since it did not rise to risky values, but alerted us for the high risk patients for glucose intolerance before insertion. The LNG-IUS can be regarded as being safe in their effects on lipid metabolism, blood pressure and liver function tests.

Adult↗

PubMed2006

Risk factors and perinatal outcomes associated with umbilical cord prolapse.

OBJECTIVE: To utilize infant outcomes and to identify risk factors associated with umbilical cord prolapse. MATERIALS AND METHODS: Birth records of 80 cases with umbilical cord prolapse and 800 randomly selected controls were reviewed retrospectively. Statistical analysis was performed using logistic regression models. RESULTS: Prolapse of the umbilical cord complicated 0.47% (n=80) of all deliveries included in the study (n=16,874). Multiparity was more common in patients with umbilical cord prolapse (63.8-49.4%, P=0.014). Umbilical cord prolapse occurred in breech presentation in six cases (7.5%) and in transverse presentation in three of the cases (3.8%). The occurrence of breech presentation among the control cases was 1.0% and of the transverse lie was 0.1% (P<0.001). Fetuses with umbilical cord prolapse had lower fetal weight; particularly, fetal weight less than 2,500 g was a significant risk factor (3-2.4%, P<0.001). We also found that spontaneous rupture of membranes (OR=8.93; 95%, CI=4.16-19.14), Bishop score greater than 8 (OR=5.48; 95%, CI=3.21-9.34), and polyhydramnios (OR=21.0; 95%, CI=11.4-38.7) were risk factors for umbilical cord prolapse. The newborns that were delivered after umbilical cord prolapse graded lower Apgar scores less than 7 at 5 min (6.3-1.4%, P=0.002). CONCLUSION: Abnormal fetal presentation, multiparity, low birth weight, prematurity, polyhydramnios, and spontaneous rupture of membranes, in particular with high Bishop scores, are risk factors for umbilical cord prolapse. Early amniotomy increases the variable decelerations and hence increases the rate of cesarean section because of fetal distress, but it may prevent pregnant women from umbilical cord prolapse, which has a high mortality rate. However, large randomized trials are needed to prove that early amniotomy decreases the incidences of umbilical cord prolapse.

Adult↗

PubMed2006

Helicobacter pylori seropositivity and stool antigen in patients with hyperemesis gravidarum.

The objective of this paper is to investigate whether Helicobacter pylori is an etiologic factor in hyperemesis gravidarum. Thirty one patients with hyperemesis gravidarum and twenty nine pregnant controls without hyperemesis gravidarum were included in this prospective study. All pregnant women were examined both for Helicobacter pylori serum immunoglobulin G antibodies (HpIgG Ab), showing chronic infection, and Helicobacter pylori stool antigens (HpSA), showing active gastrointestinal colonization. Chi-square and Student t tests were used accordingly for statistical analysis. Helicobacter pylori seropositivity was 67.7% in the patients with hyperemesis gravidarum and 79.3% in the control group (chi(2) = 1.02, P = .31). HpSA was detected in 22.6% of patients with hyperemesis gravidarum, whereas 6.9% of patients in the control group. The difference was not statistically significant (chi(2) = 2.89, P = .08). In this study, no relation was found between Helicobacter pylori and hyperemesis gravidarum. The low social status of women in both groups could be one of the reasons for the high prevalence of Hp infection.

Adolescent↗

PubMed2006

Predictors of methotrexate treatment failure in ectopic pregnancy.

OBJECTIVE: To determine the possible predictors of methotrexate treatment failure in ectopic pregnancy. STUDY DESIGN: Fifty-eight patients diagnosed with ectopic pregnancy were treated with methotrexate (50 mg/m2). Selected variables in the history of the patients, the signs and symptoms at the time of admission, transvaginal ultrasound findings and serum beta-human chorionic gonadotropin (beta-hCG) levels on day 1 and 3 were evaluated in a logistic regression model to predict treatmentfailure, defined as tubal rupture. RESULTS: Methotrexate treatment failed in 9 cases (15.5 %). Another 9 cases (15.5%) required a second dose of methotrexate, and no treatment failures were observed in these cases. The presence of subchorionic tubal hematoma in the ectopic gestation (OR = 22.9, CI = 2.7-194.7, p = 0.004), the presence of an embryo (OR = 24, CI = 2.1-269, p = 0.01) and day 1 serum beta-hCG level > or = 3,000 mIU/mL (OR = 27.1, CI = 2.1-342.5, p = 0.01) were the main predictors of treatment failure. Follow-up serum beta-hCG levels > or =3,500 mIU/mL (OR = 42.9, CI = 4.3-421) on day 3 were significant predictors of treatment failure. Follow-up risk score was calculated as > 4 on day 3 by adding day 3 serum beta-hCG level to the admission score. Only 1 treatment failure (2.4%) occurred in 42 patients with an admission score of nil. No treatment failure occurred in 39 patients whose follow-up score was nil. The increase in admission risk (OR = 32.1, CI = 3.8-270, p = 0.001) and follow-up risk (OR = 9.2, CI = 2.4-35.2) were significant predictors of treatment failure. CONCLUSION: Transvaginal ultrasound findings are as important as serum beta-hCG level on the first day of methotrexate treatment. In unruptured cases, day 3 serum beta-hCG level is important to reevaluate the decision to continuefollow-up or perform early surgery for increased risk of treatment failure.

Abortifacient Agents, Nonsteroidal↗

PubMed2005

Lobular carcinoma of the breast metastatic to the uterus in a patient under adjuvant anastrozole therapy.

This is the first report of breast carcinoma metastatic to the endometrium in a patient on adjuvant anastrozole therapy. We report a case of metastatic lobular carcinoma of the breast in a 63-year-old patient on adjuvant anastrozole therapy for 8 months. She was asymptomatic and metastatic endometrium was diagnosed after transvaginal ultrasound revealed suspicious findings along with elevated Ca 15-3 levels. As further work up showed no other metastatic sites her uterus was taken out along with her ovaries and pelvic lymph nodes. Uterine metastases should be kept in mind in asymptomatic patients on anastrozole therapy.

Anastrozole↗

PubMed2005

Color doppler flow analysis of uterine and ovarian arteries before and after tubal sterilization: electrocautery versus pomeroy.

BACKGROUND/AIM: To compare the changes in uterine and ovarian artery blood flow following laparoscopic sterilization via bipolar cautery with Pomeroy tubal ligation via mini-laparotomy in patients who had voluntary surgical sterilization. METHODS: Ninety consecutive fertile women applying for voluntary tubal ligation were recruited in this prospective study. Patients were allocated for either laparoscopic tubal ligation via bipolar electrocoagulation (group 1) or Pomeroy tubal ligation via mini-laparotomy (group 2) according to their preference. Color Doppler flow analysis of uterine and ovarian arteries were carried out on the 3rd day of the cycle prior to the procedure (D(0)), on the 3rd postoperative day (D(1)) and on the 3rd day of the cycle, 3 months (D(3)) following the surgery. The significance of difference between the three measurements was analyzed by using analysis of variance. RESULTS: Prior to surgery, the mean pulsatility index of the uterine artery, left and right ovarian arteries were 1.9 +/- 0.3, 1.8 +/- 0.3, 1.8 +/- 0.2 in group 1 and 1.8 +/- 0.08, 1.8 +/- 0.08, 1.8 +/- 0.07 in group 2, respectively. There was no statistically significant difference between group 1 and group 2 in terms of D(0) values (p > 0.05). 3rd postoperative day and 3rd month measurements of both uterine and ovarian arteries in group 1 and group 2 did not show any statistically significant difference from that of preoperative values (p > 0.05). CONCLUSION: No alternation in the flow of either ovarian or uterine arteries following tubal sterilization performed by bipolar electrocautery and Pomeroy's technique was determined both in the immediate postoperative period and 3 months after the surgery.

Adult↗

PubMed2005

Adjusted leptin level (ALL) is a predictor for hyperemesis gravidarum.

OBJECTIVE: To compare the maternal serum leptin level according to the gestational week and to assess the relationship between the adjusted serum leptin level and thyroid hormones. In order to obtain this objective a new parameter is developed: adjusted leptin level (ALL: maternal serum leptin level/gestational week). STUDY DESIGN: A prospective study was carried out at the early prenatal care unit, SSK Ankara Women's Health and Teaching Hospital. Fifty-four women with hyperemesis gravidarum (HG) and 42 pregnant women without HG as a control group were included to the study. The groups were compared for age, parity, body mass index, fasting serum TSH, free T3, free T4 and leptin levels. A new parameter; ALL was also calculated in each case. RESULTS: Gestational age and body mass index (BMI) were found significantly lower in the HG group than in the control group (p=0.001). ALL was significantly high in the HG group (p=0.009). Serum TSH, free T3, free T4 levels were significantly different in the HG group than in the control group (p=0.003, 0.013, 0.012, respectively). A significant positive correlation was found between ALL and BMI in the HG group (r=0.449 p=0.001). The maternal leptin level was also positively correlated with BMI in the HG group (r=0.313 p=0.025). CONCLUSION: Etiology of the hyperemesis gravidarum is multifactorial. However we can postulate the adjusted leptin level is a good predictor for hyperemesis gravidarum.

Adult↗

PubMed2005

Actinomyces infection in female genital tract.

OBJECTIVES: To analyze clinical and laboratory characteristics of patients with pelvic actinomyces. STUDY DESIGN: We studied five patients with pelvic actinomyces who were admitted between January 1, 2002 and December 31, 2002. The initial complaints, diagnostic methods, therapeutic alternatives and results of the therapies were examined. RESULTS: The ages of the cases varied between 32 and 52 years old. All five patients had been using an intrauterine device. Three cases had hydronephrosis due to infection. Two patients were diagnosed postoperatively while the other three cases were diagnosed with cervical smear and endometrial biopsy; penicillin G was administered to all. The patients are still under surveillance, and without any problems. CONCLUSION: In patients with an intrauterine device, actinomyces should be remembered in differential diagnosis of pelvic infections. Preoperative diagnosis is of the utmost importance in order to prevent morbidity of this infiltrative infection. Long-term penicillin therapy proved to be successful. Complicated or resistant cases to medical therapy should be candidates for surgical therapy.

Actinomycosis↗

PubMed2005

Comparison of oral and vaginal misoprostol for cervical ripening before manual vacuum aspiration of first trimester pregnancy under local anesthesia: a randomized placebo-controlled study.

The objective of this prospective randomized placebo-controlled study was to determine the effectiveness of 400 mug oral and 400 mug vaginal misoprostol administration for cervical priming 3 h prior to manual vacuum aspiration (MVA) under local anesthesia for voluntary termination of pregnancy before 10 weeks of gestation in comparison with placebo oral or placebo vaginal administration (n=40 in each group). Postmedication cervical dilatation was similar in the oral (mean, 6.6+/-1.5) and vaginal (mean, 7.2+/-0.8) misoprostol groups but significantly higher compared with the oral (mean, 3.4+/-0.2) and vaginal (mean, 3.6+/-1.9) placebo groups. Duration of the procedure was also significantly shorter in the misoprostol groups in comparison with their placebo counterparts. Preoperative bleeding and side effects were more common in the misoprostol groups, but none required medical intervention. Intraoperative bleeding was less in the vaginal misoprostol group compared with the placebo groups. There was no significant difference in terms of visual analogue scores during the procedure, patient satisfaction, days of postoperative bleeding and rate of postoperative complications among the groups. Cervical priming with misoprostol administered orally or vaginally 3 h before MVA for termination of pregnancy under local anesthesia facilitates the procedure by decreasing the need for cervical dilatation and by shortening its duration without improving patients' pain perception and satisfaction mainly due to side effects.

Abortifacient Agents, Nonsteroidal↗

PubMed2005

Intravenous versus oral iron for treatment of anemia in pregnancy: a randomized trial.

OBJECTIVE: The aim of this study was to compare the efficacy of intravenous iron to oral iron in the treatment of anemia in pregnancy. METHODS: In this randomized open-label study, 90 women with hemoglobin levels between 8 and 10.5 g/dL and ferritin values less than 13 microg/L received either oral iron polymaltose complex (300 mg elemental iron per day) or intravenous iron sucrose. The iron sucrose dose was calculated from the following formula: weight before pregnancy (kg) x (110 g/L - actual hemoglobin [g/L]) x 0.24 + 500 mg. Treatment efficacy was assessed by measuring hemoglobin and ferritin on the 14th and 28th days and at delivery, and the hemoglobin on the first postpartum day. Adverse drug reactions, fetal weight, hospitalization time, and blood transfusions were also recorded. RESULTS: Hemoglobin values varied significantly with time between groups (interaction effect, P < .001). The change in hemoglobin from baseline was significantly higher in the intravenous group than the oral group at each measurement; the changes with respect to subsequent hemoglobin were significantly higher on the 14th (P = .004) and 28th (P = .031) days. Ferritin values were higher in patients receiving intravenous iron throughout pregnancy. No serious adverse drug reactions were observed. Fetal weight and hospitalization time were similar in the 2 groups. Blood transfusion was required for only one patient in the oral group. CONCLUSION: Intravenous iron treated iron-deficiency anemia of pregnancy and restored iron stores faster and more effectively than oral iron, with no serious adverse reactions.

Administration, Oral↗

PubMed2005

Analysis of retroperitoneal tumors operated on in a gynecology clinic.

AIM: To evaluate the patients with retroperitoneal tumors that presented as pelvic mass and were operated on in our gynecology clinic. METHODS: Records of 16 patients were analyzed retrospectively. RESULTS: All patients had a palpable mass on physical examination and abdominal pain was the most frequent symptom. The median diameter of the tumors was 15 cm. The postoperative histopathology of the patients was leiomyosarcoma in nine, retroperitoneal fibrosis in three, and paraganglioma, hamartoma, and dermoid cyst in three patients. All the tumors were excised almost completely. The incorrect preoperative diagnosis of the patients in this study is due to the presentation of the patients with non-specific symptoms and not considering the less common differential diagnosis of a pelvic mass. CONCLUSION: For clinical signs of vascular or rectal displacement, or where there is evidence of ureteric obstruction, retroperitoneal pathology should be kept in mind.

Adult↗

PubMed2005

Incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures.

AIM: To report 11 cases of incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures. The diagnostic approaches and therapies for incisional endometriosis are also evaluated. METHODS: Eleven patients who presented with a painful nodule that was increasing in size during menstruation on the scar of a previous gynecologic procedure were examined retrospectively. RESULTS: All patients presented with a palpable painful lesion, located on the cesarean section incision, perineal episiotomy incision or the vaginal cuff after hysterectomy. All masses were increasing during menstruation and all patients had been having cyclical pain that worsened during menstrual periods. The mean age of the patients was 28.2 years. The onset of symptoms was referred at variable intervals after surgery ranging between 2 and 11 years (mean: 5.72 years). Ultrasound examination confirmed hypoechoic mass septated with cystic and solid components in the abdomen without intra-abdominal communications. All endometriotic masses were completely excised under general anesthesia. The excised masses were sent for microscopic examination which confirmed the diagnosis of endometriosis. CONCLUSION: Incisional endometriosis seems to be common in women who have had a cesarean section, although it does occur after other procedures and de novo. It is suggested that caution is exercised during gynecologic procedures to avoid transplantation of endometrium to the anterior abdominal wall. The preferred management is to excise the lesion completely even if this necessitates fascial excision.

Adult↗

PubMed2005

Routine histopathologic analysis of product of conception following first-trimester spontaneous miscarriages.

AIM: To evaluate the histopathologic findings relating to tissue samples collected at surgical uterine evacuation in first-trimester spontaneous miscarriages. METHODS: In this retrospective study, histopathologic diagnosis of the tissue samples obtained via surgical uterine evacuation in patients who were admitted to the Early Pregnancy Clinic in a 12-month period with the diagnosis of incomplete miscarriage (n = 970), missed miscarriage (n = 406) and anembryonic miscarriage (n = 230) in the first trimester was recorded and compared with the presurgery diagnosis. RESULTS: Uterine evacuation was performed in cases of incomplete miscarriage (n = 970, 60.4%), missed miscarriage (n = 406, 25.2%) and anembryonic miscarriage (n = 230, 14.3%). Histopathologic examination revealed the product of conception in 1119 patients (69.7%), while partial hydatidiform mole was diagnosed in 33 patients (2.1%). Complete hydatidiform mole was detected in only seven cases (0.43%). Exaggerated placental site and placental site trophoblastic nodule was detected in two cases (0.12%). Decidual tissue without chorionic villi was reported in 272 patients (16.9%), raising the suspicion of presence of other pathology. CONCLUSIONS: By routine histopathologic assessment of products of first-trimester spontaneous miscarriages, important pathologies such as molar pregnancy and placental trophoblastic disease can be diagnosed. Histopathological assessment has great value in the identification of an ectopic pregnancy or infection when compared with clinical and laboratory findings.

Abortion, Incomplete↗

PubMed2005

Posterior sling (infracoccygeal sacropexy): an alternative procedure for vaginal vault prolapse.

This study of 30 patients evaluated the effectiveness and safety of the posterior sling (infracoccygeal sacropexy) in the surgical treatment of vaginal vault prolapse. The patients were reevaluated 3 months, 6 months and yearly postoperatively. Coexisting preoperative symptoms of pelvic pain, urgency, nocturia and 'obstructed' micturition feeling were followed-up. There was remarkable improvement in vault prolapse and in coexisting symptoms.

Aged↗

PubMed2004

Smooth muscle fraction of the round ligament in women with pelvic organ prolapse: a computer-based morphometric analysis.

Our objective was to compare the collagen and muscle content of the round ligament of uteri in women with pelvic organ prolapse. We evaluated the tissue samples obtained from the round ligaments of 22 patients with uterine prolapse who underwent vaginal hysterectomy (group A, study) and from 26 patients with no pelvic relaxation in whom total abdominal hysterectomy was performed for benign reasons (group B, controls). Morphometric analysis was performed on histologic cross-sections of the round ligament. Sections from each sample were stained with hematoxylin and eosin and Masson's trichrome methods. A computer system was used for morphometric measurements. We used independent samples t-test or Mann-Whitney U test to investigate the difference between the two groups. It was found that the smooth muscle fraction of the round ligament in women with uterine prolapse was significantly decreased compared with that of healthy control subjects and concluded that decreased smooth muscle content may be an important pathogenetic factor in uterine prolapse.

Adult↗

PubMed2004

Pregnancy outcomes and menstrual function after fertility sparing surgery for pure ovarian dysgerminomas.

MATERIALS AND METHODS: The medical records of 23 patients with pure ovarian dysgerminoma treated by conservative surgery at SSK Ankara Maternity Hospital between 1991 and 2001 were reviewed retrospectively. Pregnancy outcomes and menstrual function after conservative surgery were analyzed. RESULTS: Seven patients (30%) were incompletely staged and were assumed to be stage IA due to intraoperative findings. Fifteen patients (70%) were surgically staged. As a result 15 patients (65.2%) were diagnosed to be stage I while 2 patients (8.6%) were staged II and 6 patients (26%) were staged III. Wedge biopsy of contralateral ovary was performed in 17 patients (74%) and tumor was diagnosed in 2 (11.7%). Adjuvant chemotherapy was applied in 16 (70%) of the cases. BEP (bleomycin, etoposide, and cisplatin) was the most frequently used regimen (39%). Recurrences were seen in 3 (13%) patients. The sites of recurrences were contralateral ovary in all cases. Recurrences were treated with surgery and radiotherapy. None of the patients died of disease. Nine patients were sexually active. Five of these patients had prior live births. Three of the primiparous patients delivered after treatment. Five pregnancies occurred in 3 nulliparous patients at the time of primary surgery. Three of these reached term and healthy babies were delivered. One pregnancy was terminated at 18 weeks of gestation due to anencephaly and a dilatation and curettage was performed at 6th week in another patient. Menstrual problems occurred in 4 (17.3%) of the 23 patients. CONCLUSION: Fertility sparing treatments are safe in patients with pure ovarian dysgerminoma.

Adolescent↗