Ureterovesical junctional stenosis: a rarity.
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Constriction, Pathologic↗
Biomedical subjects
Munire Erman Akar
Publications and source records attributed to Munire Erman Akar.
Menstrual cycle-dependent changes in white-on-white visual field analysis of diabetic women.
AIM: To determine the effect of the menstrual cycle on white-on-white perimetry (WWP) tests of diabetic women. SUBJECTS AND METHODS: Left eyes of 129 normally menstruating women (81 type 1 diabetes mellitus (DM) with mild (n = 43) and severe (n = 38) non-proliferative diabetic retinopathy (NPDR), and 48 healthy control females) were included in the study. All subjects underwent complete ocular examination and WWP tests both in the follicular (7-10th day of the cycle) and luteal phases (days 3-7 before the bleeding) of two consecutive menstrual cycles. WWP was performed using Humphrey Field Analyzer II with SITA Standard, central 30-2 program. Mean sensitivity (MS) of points located at central 3, 9, 15, 21 and 27 degrees retinal locations (4, 12, 18, 24 and 16 points, respectively) were calculated in all menstrual phases. RESULTS: The mean age of diabetic patients with mild and severe NPDR and control subjects were 28.8 +/- 4.7, 30.1 +/- 5.9 and 29.4 +/- 5.1 years, respectively (p > 0.05). Their mean MS values were 30.7 +/- 1.0, 30.4 +/- 1.0 and 30.8 +/- 0.8 dB, respectively (p > 0.05). Diabetic patients with severe NPDR demonstrated significant decreases in mean MS values of peripheral 21 and 27 degrees visual field locations in the luteal phase (p < 0.05). However, changes in that of the locations within central 15 degrees visual field were non-significant (p > 0.05). Diabetic patients with mild NPDR and control subjects demonstrated no significant changes in mean MS values of any of the visual field locations (p > 0.05). CONCLUSION: Peripheral, rather than central, locations of central visual field of diabetic women with severe NPDR demonstrated a significant retinal sensitivity loss in the luteal phase. These findings should be taken into consideration during the clinical follow-up of diabetic women at risk of glaucoma and ocular hypertension.
Adult↗
Long-term fluctuation of retinal sensitivity during pregnancy.
BACKGROUND: We investigated the effect of pregnancy on the long-term fluctuation of retinal sensitivity in healthy women. METHODS: Candidates for the study were healthy women who were likely to become pregnant. A complete ocular examination of both eyes was performed in 41 women, and 1 eye each was chosen at random for the study. This initial examination included 2 sets of visual field measurements consisting of 5 individual measures done at least a day apart. After pregnancy, ocular examinations were repeated once between 10 and 15 weeks of gestation and once between 29 and 34 weeks. The mean threshold sensitivity (MS) of the visual field and the coefficient of variation of MS measurements for upper temporal, upper nasal, lower temporal, and lower nasal quadrants were calculated in each series. RESULTS: The visual field MS of the subjects increased significantly in the third trimester (p < 0.01). The coefficient of variation of the visual field MS measurements did not change significantly in the nasal quadrants. However, it decreased significantly in both upper and lower temporal quadrants. INTERPRETATION: Visual field MS and the reproducibility of MS measurements for temporal visual field increased significantly in the third trimester of the pregnancy. Further studies on the role of pregnancy-related ocular hemodynamic changes may provide insight into the etiopathogenesis of hormone-related processes.
Adult↗
Effect of the menstrual cycle on the optic nerve head in diabetes: analysis by confocal scanning laser ophthalmoscopy.
BACKGROUND: The purpose of this study was to examine and compare menstrual-cycle-dependent topographic changes in the optic nerve head of normally menstruating women with different grades of type 2 diabetes mellitus. METHODS: We studied the right eyes of 123 normally menstruating women (36 with severe nonproliferative diabetic retinopathy [NPDR], 42 with mild NPDR and 45 healthy subjects). All subjects underwent a complete ocular examination at baseline. At 4 hormonally distinct phases of the menstrual cycle (early follicular, late follicular, mid-luteal and late luteal), we analysed the topography of the optic nerve head, using a confocal scanning laser ophthalmoscope, and measured the serum levels of estradiol, progesterone and luteinizing hormone. RESULTS: We excluded from analysis the data for 8 patients with severe NPDR, 10 patients with mild NPDR and 15 control subjects who were lost to follow-up examinations during the menstrual cycle. The mean age and optic disc area did not differ significantly among the 3 groups. The duration of diabetes was significantly longer in the patients with severe NPDR than in those with mild NPDR (p < 0.05). The women with severe NPDR had a significantly increased neuroretinal rim area and a significantly decreased cup-shape measure, linear cup/disc ratio, cup/disc area ratio and cup area in the late luteal phase compared with the other phases of the menstrual cycle (p < 0.05). Those with mild NPDR or a normal retina had no significant topographic changes in the optic nerve head during the menstrual cycle. INTERPRETATION: Severe NPDR is associated with significant topographic changes in the rim and cup of the optic nerve head during the menstrual cycle. This must be considered in the evaluation of women with both diabetes and glaucoma. The normal fluctuations in serum sex hormone levels during the menstrual cycle of diabetic women seem to affect the optic nerve head more when the disease is advanced.
Adult↗
Effect of the menstrual cycle on standard achromatic and blue-on-yellow visual field analysis of women with migraine.
BACKGROUND: It has been postulated that migraine and glaucoma may have common vascular causative factors. Significant sex-based differences in the incidence of many important ocular conditions raise the possibility that estrogens may have direct effects on the eye. We performed a study to determine the effect of the menstrual cycle on standard achromatic automated perimetry (SAP) and short-wavelength automated perimetry (SWAP) (blue-on-yellow perimetry) of women with migraine. METHODS: Both eyes of 73 normally menstruating women (31 subjects with migraine and 42 healthy control subjects) were included in the study. Subjects underwent a complete ocular examination including SAP and SWAP in both the follicular phase (12th to 13th day of the cycle) and the luteal phase (1 to 2 days before the onset of bleeding) of two consecutive menstrual cycles.We performed visual field analysis using the Humphrey Field Analyzer II with the full-threshold central 30-2 program. Mean sensitivity was calculated for the superior temporal, inferior temporal, superior nasal and inferior nasal regions separately. RESULTS: Thirteen subjects were lost to follow-up (5 in the migraine group and 8 in the control group), leaving 26 subjects and 34 subjects respectively. There was no significant difference in mean age between the two groups (33.9 years [standard deviation (SD) 3.4 years] vs. 35.1 years [SD 3.3 years]). The mean duration of migraine was 7.6 (SD 3.1) years (range 3-14 years). In both groups, serum estradiol levels were significantly lower (p = 0.001) and serum progesterone levels were significantly higher (p < 0.001) in the luteal phase than in the follicular phase. In the control group, the mean sensitivity values with SWAP were significantly lower in the luteal phase than in the follicular phase (p = 0.04). A similar decrease was observed for the subjects with migraine with both SAP and SWAP (p = 0.01). There was no difference in regional mean sensitivity between the two phases with either perimetric test in the control group. For the subjects with migraine, there was no difference in regional mean sensitivity between the two phases with SAP. However, with SWAP, the mean sensitivity for the nasal visual field locations was significantly lower in the luteal phase than in the follicular phase (p = 0.01). INTERPRETATION: Our study provides further evidence of an effect of sex hormones on the visual field of women with migraine. In addition to assessment of intraocular pressure, menstrual cycle phases should be considered in women with migraine at risk for glaucomatous optic neuropathy.
Adult↗
Menstrual cycle-dependent differences between right and left visual hemifields in perimetry.
PURPOSE: To evaluate the effect of the menstrual cycle and gender on right and left visual hemifields in healthy subjects. METHODS: One randomly selected eye from each of 42 healthy normally menstruating women and of 37 men with no systemic and ocular problems, other than refractive error, were included in the study. Subjects underwent complete ocular examination and standard acromatic perimetric (SAP) and short-wavelength automated perimetric (SWAP) analysis in both follicular (7th to 10th day of the cycle) and luteal phases (days 3 to 7 before the menstrual bleeding) of the menstrual cycle. Visual field analysis was performed using Model 750 Humphrey Field Analyzer II (Carl Zeiss Meditec, Dublin, CA, USA) with full-threshold, central 30-2 program. RESULTS: The mean age of female (n = 42) and the male subjects (n = 37) were 35.2 +/- 3.1 years and 34.8 +/- 2.9 years, respectively (p = 0.58). Neither females nor males showed any statistically significant differences in the right and left hemifield tests with SAP (both p values > 0.05). However, using SWAP, in luteal phase of female subjects, left hemifield sensitivity was significantly less than (with a mean of 0.47 dB) right hemifield. In follicular phase, there was no significant interhemifield difference (p > 0.05). Male subjects did not show any significant differences between the sensitivity of the two hemifields with SWAP tests. CONCLUSIONS: There has been a significant difference between the mean SWAP sensitivity of right and left visual hemifields in luteal phase of the menstrual cycle. In case of a suspected hemifield difference, SAP rather than SWAP may be used to confirm suspected neurological defects as SAP is not affected by the menstrual cycle.
Adult↗
Luteal phase support in assisted reproductive technology.
PURPOSE OF REVIEW: The purpose of this review is to discuss luteal support in assisted reproduction and to provide an evidence-based overview of the current options available. RECENT FINDINGS: The luteal phase has been found to be defective in virtually all of the stimulation protocols used for in-vitro fertilization. Common mechanisms such as supraphysiological levels of estradiol, decreased output of luteinizing hormone, inhibition of the corpus luteum and asynchronization of estradiol and progesterone may be involved in insufficient function of the corpus luteum in assisted reproductive technology. SUMMARY: Gonadotropin releasing hormone agonist undoubtedly provides benefits in stimulated cycles, however it also has adverse effects, inhibition of the corpus luteum together with supraphysiological hormonal profiles finally leading to luteal phase defects. Luteal phase support with human chorionic gonadotropin or progesterone after assisted reproduction results in increased pregnancy rates. The role of luteal phase support in these cycles has also been recently elucidated. Use of human chorionic gonadotropin for luteal phase support is associated with a marked increase in the risk of ovarian hyperstimulation syndrome, therefore progesterone is the preferred choice. Data on the benefits of estrogen supplementation are conflicting. Among the routes of progesterone administration, reductions in pregnancy rates are noted on oral administration. In spite of a lack of statistical significance, the intramuscular route seems to be more beneficial than the vaginal route when considering rates of ongoing pregnancy and live birth. Further clarification is needed on the ideal dose, the optimal route and the duration of progesterone administration in assisted reproduction.
Administration, Intravaginal↗
Uterine artery embolization to control bleeding after myomectomy.
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Adult↗
Emergency peripartum hysterectomy.
OBJECTIVE: To review the incidence, indications, risk factors, and complications associated with emergency peripartum hysterectomy. STUDY DESIGN: We analyzed retrospectively 38 cases of emergency peripartum hysterectomy operations performed between January 1996 and June 2001 at Zekai Tahir Burak Women's Health Research and Education Hospital. The indications, risk factors and the associated complications were noted. Standard tests were used to calculate odds ratios (ORs) and their 95% confidence intervals (CI). RESULTS: Thirty-eight cases of postpartum hysterectomy were performed. All of these cases were referred to our center from rural areas. The rate of peripartum hysterectomy was 1/3736 deliveries. The main indications for hysterectomy were placenta accreata, uterine rupture and uterine atony. There were four maternal deaths. CONCLUSION: Peripartum hysterectomy is a necessary life saving operation. Timely operation minimizes the morbidity and mortality.
Adult↗
Menstrual cycle dependent changes in blue-on-yellow visual field analysis of young diabetic women with severe non-proliferative diabetic retinopathy.
PURPOSE: To evaluate menstrual cycle dependent changes on blue-on-yellow visual fields of diabetic women, and to compare the results with those of healthy women. METHODS: Left eyes of 93 normally menstruating women were included in the study, comprising 45 with type-1 diabetes mellitus and severe non-proliferative diabetic retinopathy and 48 healthy controls. All subjects underwent baseline complete ocular examination and achromatic visual field analysis. Blue-on-yellow visual field tests (short-wavelength automated perimetry) were performed in both follicular (days 7-10 of the cycle) and luteal phases (days 3-6 before the bleeding) of two consecutive menstrual cycles. Visual field analyses were performed using Humphrey Field Analyser II with full threshold, central 30-2 program. Visual fields were divided into four regions: superior temporal, inferior temporal, superior nasal and inferior nasal. Visual field mean sensitivity (MS) was calculated for all regions separately. RESULTS: The mean ages of diabetic and control subjects were not significantly different (P > 0.05). Mean MS values of the diabetic group were significantly lower than that of the control group (P < 0.05). Control subjects did not demonstrate any menstrual cycle dependent changes in MS values (P > 0.05). However, diabetic women demonstrated a significant decrease in MS values in the luteal phase (P < 0.05). The decrease in MS was most marked in the nasal visual field (P < 0.05). CONCLUSION: Young diabetic women demonstrated a significant depression in visual field threshold sensitivity in the luteal phase of the menstrual cycle. Nasal visual fields are more prone to have menstrual cycle dependent threshold sensitivity depression. This should be taken into consideration in the clinical assessment of women with advanced diabetes who are at risk of glaucomatous optic neuropathy.
Adult↗
The effect of the menstrual cycle on optic nerve head analysis in healthy women.
PURPOSE: To determine the effect of the menstrual cycle on optic nerve head topographic analysis in normally menstruating, healthy women. MATERIAL AND METHODS: The study included single eyes selected randomly from each of 52 healthy women with regular menstrual cycles. All subjects underwent a complete ocular examination. Optic nerve head topographic analyses were performed using a confocal scanning laser ophthalmoscope, the Heidelberg Retinal Tomograph II (HRT II, software version 1.6). The analyses were repeated three times during the menstrual cycle: in the follicular phase (days 7-10 of the cycle), at ovulation, and in the late luteal phase (days 1-3 before menstrual bleeding). Serum oestradiol, progesterone and luteinizing hormone levels were measured at each menstrual phase. RESULTS: Fourteen subjects were excluded from the study. The mean age of the subjects (n = 38) was 25.6 +/- 3.7 years (range 21-34 years). Blood oestradiol levels were significantly lower in the late luteal phase (35.8 pg/ml) (p < 0.0001). The mean disc area of the subjects was 1.94 +/- 0.33 mm(2). The neuroretinal rim area decreased significantly during the luteal phase (p < 0.001). However, the linear cup : disc ratio, cup : disc area ratio and the cup area were significantly higher during the luteal phase (p < 0.001). CONCLUSION: These observations raise the possibility that sex hormone fluctuations which occur during a normal menstrual cycle in healthy women significantly alter neuroretinal rim area and cup variables of the optic nerve head. These findings should be taken into consideration in the clinical follow-up of young women with glaucoma.
Adult↗
Maternal deaths and their causes in Ankara, Turkey, 1982-2001.
This study was carried out to determine the incidence and causes of maternal deaths about a 20-year period at the Zekai Tahir Burak Women's Health Education and Research Hospital (ZTBWHERH), Ankara, Turkey. All maternal deaths from January 1982 to July 2001 were reviewed and classified retrospectively. Using a computer-generated list, 348 patients admitted to the Labour Department of ZTBWHERH during 1982-2001 were selected as controls. Medical records were reviewed for demographic data, history of antenatal care, route of delivery, referral history, and perinatal mortality. Cases and controls were compared, and standard tests were used for calculating odds ratio (OR) and 95% confidence interval (CI) for the association of demographic and delivery characteristics. During this period, there were 174 maternal deaths and 430,559 livebirths, giving a maternal mortality ratio of 40.4/100,000 livebirths. The mortality rate declined from 85.1/100,000 in 1982 to 11.6/100,000 in 2001. One hundred thirty (74.7%) deaths were due to direct obstetric causes and 24 (13.7%) were abortion-related, while 20 (11.4%) were due to indirect obstetric causes. The most common cause of direct obstetric deaths was pre-eclampsia/eclampsia, followed by obstetric haemorrhage and embolism. Abortion-related sepsis and haemorrhage, anesthesia-related deaths, obstetric sepsis, acute fatty liver of pregnancy, and ectopic pregnancy accounted for other causes of deaths. Cardiovascular disease was the leading indirect cause of death. Referral, lack of antenatal care, and foetal death at admittance were associated with 8-, 3-, and 6-fold increased risk of maternal mortality respectively (OR 8.89, 95% CI 5.7-13.8; OR 3.74, 95% CI 2.5-5.5; OR 6.38, 95% CI 3.1-13.1). Although maternal mortality ratios have declined at the hospital, especially in the past five years, the rate is still high, and further improvements are needed. The problem of maternal mortality remains multifactorial. Short-term objectives should be focused on improving both medical and administrative practices. Improving the status of women will necessarily remain a long-term objective.
Adult↗
Menstrual cycle-dependent changes in visual field analysis of healthy women.
PURPOSE: To determine the effect of menstrual cycle phases on the visual field analysis of healthy females. MATERIAL AND METHODS: One randomly selected eye each of 59 healthy normally menstruating women, and of 54 men with no systemic and ocular problems, other than refractive error, were included in the study. Subjects underwent complete ocular examination, and standard achromatic perimetric (SAP) and short-wavelength automated perimetric (SWAP) analysis in both follicular (7th to 10th day of the cycle) and luteal phases (days 3-7 before the menstrual bleeding) of the menstrual cycle. Visual field analysis was performed using a Model 750 Humphrey Field Analyzer II (Humphrey Instruments Inc., San Leandro, Calif., USA) with full-threshold, central 30-2 program. Visual fields were divided into four regions as superior temporal, inferior temporal, superior nasal and inferior nasal, respectively. RESULTS: The mean age of female (n = 59) and the male subjects (n = 54) were 34.6 +/- 2.9 and 35.0 +/- 2.7 years, respectively (p = 0.49). SWAP tests demonstrated a significantly decreased mean MS value in the luteal phase (p < 0.05). However, it did not change significantly with SAP tests. Regional MS values of both SAP and SWAP tests were not different in both phases of the menstrual cycle (all p values >0.05). Mean perimetric test durations obtained with both SAP and SWAP were not different throughout the menstrual cycle (both p values >0.05). CONCLUSION: Clinicians should verify menstrual status when evaluating a suspected loss of visual field sensitivity in menstruating women. The findings of the present study suggest that the SWAP test may be more sensitive to determine subtle sex hormone-dependent changes in visual field analysis of healthy women.
Adult↗
Effect of pregnancy on intraobserver and intertechnique agreement in intraocular pressure measurements.
AIM: To evaluate the effect of pregnancy on intraobserver and intertechnique agreement for intraocular pressure (IOP) measurements. MATERIAL AND METHODS: Right eyes of 88 healthy women who were likely to become pregnant and of 94 healthy age-matched females were included in the study. Complete ocular examinations were performed on each eye. IOP measurements were obtained by Goldmann, Schiotz and non-contact tonometers (NCT) during 3-week exam periods before (within 6 weeks of conception) and during pregnancy (first, second and third trimesters) for pregnant cases, and in similar time intervals for control subjects. In each exam period, three readings with each of three separate tonometers were obtained, at least 1 day apart. Intraobserver and intertechnique agreements for IOP measurements were assessed. RESULTS: The mean visual acuity, keratometry and refractive error of both control and pregnant subjects did not change significantly during the study (all p values >0.01). In late pregnancy, pregnant cases demonstrated significant decreases in IOP measurements obtained with each of the three tonometers, and in intraobserver agreement with Goldmann and Schiotz tonometers (all p values <0.01). Intertechnique agreement of both Goldmann and Schiotz tonometers with NCT decreased significantly in the third trimester. Both intraobserver and intertechnique agreement in IOP measurements of control subjects were not found to change significantly during the study (all p values >0.01). CONCLUSION: IOP significantly decreased in the third trimester of pregnancy. Perfect intraobserver agreement in IOP readings of pregnant subjects was obtained with NCT. This may suggest that NCT is a viable option for IOP measurements during the follow-up of pregnant patients at risk for glaucoma.
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Partial recovery of the visual field scotoma upon early retinal photocoagulation and the medical therapy in a preeclamptic patient.
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Adult↗