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Biomedical subjects

O Gökmen

Publications and source records attributed to O Gökmen.

At least 19 recordsLinked to original sources
PubMed2002

Ovarian fibrosarcoma with five-year survival: a case report.

A 45-year-old postmenopausal woman, Gravida6, Para4, Abortus0, Dilatation x Curhetage2, came to the gynaecology department with pelvic pain. The tumor had arisen in the right ovary and measured 15 x 12 x 7 cm. Its cut surface varied from grey-white with a whorled appearance and showed areas of haemorrhage. Histologically the tumor was densely cellular, composed of spindle cells, diffusely involved the entire ovarian stroma with no normal ovarian structures remaining. Tumor cells had hyperchromatic nuclei with prominent nucleoli. There was moderate pleomorphism and the number of mitotic figures was an average of 6 per 10 high power fields. In the immunohistochemical study, the tumor was negative for desmin, muscle-specific actin, estrogen, progesterone receptors and CD31, but was positive for vimentin. A low proliferation index with Ki-67 was determined. The patient has shown no evidence of recurrent disease for five years.

Abdominal Pain↗
PubMed2001

Fetal survival despite unrecognized uterine rupture resulting from previous unknown corporeal scar.

Cesarean scar rupture of a gravid uterus with unknown corporeal scar is common. Our case was a 35 year woman, gravida 2, para 1 presented at 38 weeks gestation. She was admitted to our hospital for routine follow up. She had no signs or symptoms of labor. However eight hours after the initial examination, she came back to hospital with the signs of shock and acute abdomen. Immediately she was referred to surgery. Intraoperatively a complete rupture of the classical corporeal incision was observed, but the fetus was enclosed within the anterior lying plasenta. The fetus was delivered with one minute apgar score 3, and five minute apgar score 8. According to this case, we conclude that spontaneous uterine rupture of the classical uterine scar can be observed even without uterine contractions. So women with the possibility of previous classical uterine incision should be delivered once fetal maturity is documented.

Adult↗
PubMed2001

Prognostic importance of the nucleolar organizer region score in ovarian epithelial tumors.

OBJECTIVE: The score of the silver-stained nucleolar organizer region (AgNOR) is frequently found to be high in malignant tumors. We studied AgNOR in ovarian epithelial tumors diagnosed in our hospital between 1993 and 1998. MATERIALS AND METHOD: In our study 67 ovarian epithelial tumors (18 cystadenoma, 16 borderline type, 34 cystadenocarcinoma) were stained using the method previously described by Crocker. One-way ANOVA and logistic regression tests were used to find the statistical relationship between grade, recurrence, mortality rates and AgNOR scores in tumors (p values of <0.05 were considered statistically significant). RESULTS: The mean AgNOR scores of 28 mucinous and 39 serous ovary tumors were calculated. The lowest AgNOR score of 1.33 was found in cystadenomas and the highest AgNOR score of 4.92 was found in serous and mucinous cystadenocarcinomas. In addition the relationship between mortality rate, recurrence and AgNOR score in carcinomas were studied. CONCLUSION: AgNOR scores in carcinomas were found to be higher than adenomas, and the highest AgNOR score was found in grade-III carcinomas. This shows that the AgNOR score can be used as a prognostic index in malignancies.

Aged↗
PubMed2000

Increasing the daily dose of recombinant follicle stimulating hormone (Puregon) does not compensate for the age-related decline in retrievable oocytes after ovarian stimulation.

A prospective, randomized, double-blind, multicentre (n = 6) study was conducted to compare the influence of either a 150 or 250 IU daily fixed-dose regimen of recombinant follicle stimulating hormone (FSH, Puregon) on the number of oocytes retrieved and the total dose used in down-regulated women between 30 and 39 years of age undergoing ovarian stimulation. In all, 138 women were treated with recombinant FSH, 67 with 150 IU and 71 with 250 IU. The number of oocytes retrieved in the low-dose group was 9.1 compared to 10.6 in the high-dose group (not significant). In the 30-33 years of age class receiving the 250 IU dose, a surplus of 4.2 oocytes (14.8 versus 10.6) was found, whereas in the 37-39 age class nearly one oocyte more was retrieved in the 150 IU group (8.1 versus 7.4). The total dose used to reach the criterion for human chorionic gonadotrophin (HCG) administration was 1727 IU for the women treated with 150 IU daily and 2701 IU for the 250 IU treated women (P < 0. 001). No significant relationships were found between serum FSH concentrations as obtained in the early follicular phase and the number of oocytes collected, or the total dose. It is concluded that in women between 30 and 39 years of age, the decline in number of oocytes retrieved with increasing age cannot be overcome by augmenting the daily dose of recombinant FSH from 150 to 250 IU.

Adult↗
PubMed1999

Hormone replacement therapy and lipid-lipoprotein concentrations.

OBJECTIVE: To evaluate the links between hormone replacement therapy and lipid-lipoprotein concentrations (total cholesterol [T.Ch] triglycerids, high density lipoprotein cholesterol [HDL-C], low density lipoprotein cholesterol [LDL-C] and very low density lipoprotein cholesterol [VLDL-C]) in a total of 6416 postmenopausal women. STUDY DESIGN: Open prospective longitudinal study. Of the 2184 surgical postmenopausal women, 1102 received conjugated equine estrogen (CEE), and 1082 transdermal estradiol (TDE2). Of the 4232 natural postmenopausal women: 1073 received CEE+medroxyprogesterone acetate (MPA), 1068 CEE+dydrogesterone (DD), 1044 TDE2+MPA, 1047 TDE2+DD. Lipid-lipoprotein concentrations were evaluated by using a SPSS program at 1,2,3,4,5,6,7 years of therapy and cumulatively. RESULTS: Cumulative evaluation of the data on estrogen only replacement therapy revealed a significant decrease in T.Ch, LDL-C and VLDL-C, and an increase in HDL-C; however, the increase in HDL-C and triglycerids was significantly higher in CEE than TDE2 (P<0.01). Cumulative evaluation of the data on estrogen progestin hormone replacement therapy revealed a significant decrease in T.Ch, LDL-C and an increase in HDL-C for all; however, triglycerides and VLDL levels decreased in TDE2+MPA and TDE2+DD groups (P<0.05). CONCLUSION: Both the natural and surgical menopause patients were found to have more favorable lipid profiles after treatment with estrogen progesterone combined formulations and estrogen only replacement.

Adult↗
PubMed1999

Clinical assessment of EMA/CO induced DNA damage in peripheral blood lymphocytes of high-risk gestational trophoblastic tumor patients.

From 1989 to 1994, Etoposide, Methotrexate, Actinomycin-D, Cyclophosphamide, Vincristine, Folic acid (EMA/CO) regimen was administered to seven patients with high-risk gestational tumours according to the Bagshawe 1976 criteria. Peripheral blood lymphocytes were obtained from two of these seven high-risk gestational trophoblastic patients receiving the EMA/CO regimen, and damage levels of DNA during chemotherapy were assessed using SCGE (single cell gel electrophoresis) assay. Additionally, the efficacy, toxicity and clinical results of EMA/CO regimen were evaluated in patients with high-risk gestational trophoblastic tumours. Fever (71.4%), leukopenia (57%), increase in transaminase concentrations (57%), trombocytopenia (57%), and anemia (57%) were among the most frequent side-effects of the EMA/CO regimen. All these toxic effects were reversible and there was no need to stop the therapy. EMA/CO is highly effective in patients with high-risk gestational trophoblastic disease and its toxicity is predictable and reversible. Because of chemotherapy, DNA damage that is shown in peripheral blood lymphocytes, increases at the 8th day of the EMA/CO regimen. When DNA damage is higher in patients, the course of chemotherapy per each patient is shortened. When DNA damage is higher in the patients, the multisystem effects due to toxicity are more significant. The SCGE assay has many possibilities in such research and has proved to be a relatively simple, quick and sensitive technique.

Adult↗
PubMed1998

Effect of hysterectomy on ovarian blood supply and function.

Ovarian blood supply and function were assessed before and after hysterectomy in 43 patients and 30 healthy subjects (control group). Before the hysterectomy, transvaginal colour Doppler resistance index values of ovarian artery and hormonal levels were measured. Five days and 6 months after operation, all these measurements were repeated and compared with those of a control group. The sole hormone whose serum level decreased on the 5th postoperative day was oestradiol. Serum levels of all the other hormones remained unchanged 5 days and 6 months after the surgical operations. We also did not find any statistically significant difference between the preoperative, the postoperative and the control group resistance index of the ovarian arteries. We propose that the decision whether to preserve or remove the ovaries must be based on assessment of their functional status. Advantages and disadvantages of leaving ovaries intact should be carefully evaluated and the most useful approach applied to each patient on an individual basis.

Journal Article↗
PubMed1998

The significance of birth weight difference in discordant twins: a level to standardize?

OBJECTIVE: To evaluate the significance of different degrees of birth weight discordance in twin pregnancies. DESIGN: Population based study. METHODS: Three hundred and eighty-four twin gestations over 20 weeks of gestation during a two-year period ending in 31.12.1995 were retrospectively analyzed. Twins were stratified into six categories according to the percent difference in infant birth weight. The difference in percents was calculated from the larger twin; (Birth weight of larger twin--Birth weight of smaller twin)/Birth weight of larger twin and multiplied with 100. The relationship between different categories and the subsequent perinatal and neonatal outcomes was assessed. RESULTS: Among 384 pairs thirteen patients were identified to have single fetal demise and fourteen patients were documented to have dead fetuses of both twin pairs. Of 357 twin gestations studied 137 (38.4%) had discordance of < 10% and 36 experienced discordance of > 30% (10.1%). The frequency of low APGAR score (< 7) in women with > 30% discordance was higher than that of < 10% group (16.7% vs. 9.5%). Intensive care for infants was required in 30 infants with > 30% birth weight discordance (41.7%) and in 24 cases with < 10% birth weight discordance (8.8%). Thirty-three percent of cases with discordance of > 30% experienced neonatal mortality whereas the corresponding figure for patients with < 10% discordance was 1.5%. CONCLUSION: We postulate that definition of discordant growth in twin gestations should be categorized with respect to gestational week since the level of discordance prejudicing fetal or neonatal jeopardy may vary in different stages of pregnancy.

Adult↗
PubMed1998

Emergency hysterectomy in modern obstetric practice. Changing clinical perspective in time.

OBJECTIVE: Emergency hysterectomy in obstetric practice is generally performed in the setting of life-threatening hemorrhage. A retrospective review based on hospital data of 67 patients undergoing emergency peripartum hysterectomy over 10 years was undertaken. METHODS: Comparison of two different time periods regarding the incidence and the indications of obstetric hysterectomies was made. RESULTS: The number of patients with hysterectomy in the first 5 years of the study period (1985-1989) was 43 and during the last 5 years (1990-1994) it was 24. The incidence of hysterectomy during 1985-1989 was 1 in 2495 deliveries and the most common indication for hysterectomy was uterine atony (42%) followed by placenta accreta (25.5%) and uterine rupture (21%). On the other hand, the incidence of hysterectomy during 1990-1994 was 1 in 4228 deliveries and the ranking of indications of hysterectomy was slightly different from group 1 as mostly placenta accreta (41.7%) followed by uterine atony (29.2%). The maternal mortality rate was 4.5% in this series. CONCLUSION: This study showed that over the last decade the incidence of emergency hysterectomy in obstetric practice has declined in our clinic due to availability of high standard obstetric care and more liberal use of cesarean section at risk deliveries, better controlled use of oxytocin and internal iliac artery ligation.

Adult↗
PubMed1997

Endocrinological and clinical analysis of hyperprolactinemic patients with and without ultrasonically diagnosed polycystic ovarian changes.

In the present study we aimed to identify the relationship of hyperprolactinemia and polycystic ovarian changes. We retrospectively analyzed the endocrinological and clinical features of 79 hyperprolactinemic patients detected during a 3-year period ending in March 1995. Patients who had hypothyroidism, macroprolactinoma and drug-induced hyperprolactinemia were excluded from the study. Among 61 hyperprolactinemic patients, 41 (67.2%) had ultrasonographically diagnosed polycystic ovaries (PCO). Prolactin levels in the PCO and non-PCO groups were 32.8 +/- 5.8 and 36.7 +/- 5.1 ng/dl, respectively, which was a significant difference (p < 0.05). Hirsutism was associated with hyperprolactinemia in 55.7% of the patients and was found to be more frequent in the PCO (58.8%) than the non-PCO group (41.2%). The mean Ferriman Gallwey scores and both total and free testosterone levels were significantly higher in the PCO group in comparison to the non-PCO group. In addition, a significantly higher body mass index was detected in patients with PCO. We documented a frequent association between hyperprolactinemia and polycystic ovarian changes and suggested that hyperprolactinemia in PCO is most likely related to a pathologic-endocrinologic milieu.

Amenorrhea↗
PubMed1997

Conservative management of twin pregnancies with one dead fetus: is it safe?

BACKGROUND: Fetal death in one of the twins is unusual and the management issue of such a condition is not straightforward. METHODS: We reviewed the outcomes of nine twin pregnancies with one dead fetus in whom follow-up period exceeded 3 weeks. RESULTS: The twinning frequency was 8.9 per thousand deliveries and the frequency of subsequent antepartum death of one fetus was found to be 3.8%. The preterm birth rate was 45.5% and the survival rate was 90.1%. The perinatal mortality rate was 12%. Maternal clotting disorder was observed in one patient and treated successfully with heparin. CONCLUSIONS: We suggest that these patients are best managed conservatively unless further hazard to the fetus or mother appears.

Embryonic and Fetal Development↗
PubMed1996

Diagnostic problems in a case with mucometrocolpos, polydactyly, congenital heart disease, and skeletal dysplasia.

Mucometrocolpos is the distention of the uterus and vagina caused by obstruction to the drainage of genital secretions. Although most cases of mucometrocolpos are sporadic, it may be part of an autosomal recessive condition, known as McKusick-Kaufman syndrome (MKS), including postaxial polydactyly and congenital heart disease as main findings. The diagnosis may be difficult when the presence of additional findings creates an overlap with other syndromes. We report on a female infant with mucometrocolpos, postaxial polydactyly, congenital heart disease, short limbs, short ribs, and chest constriction. The clinicopathological findings are described and discussed in the context of the phenotypic spectrums of MKS and mucometrocolpos concomitant with Ellis van Creveld syndrome.

Abnormalities, Multiple↗
PubMed1996

Plasma human chorionic gonadotropin levels after induced abortion.

In the present study, we evaluated the elimination time and the disappearance curve of maternal plasma hCG after induced abortion in 44 patients. The patients were divided into two groups: patients in group 1 had gestations at or at less than 8 weeks and group 2 consisted of patients with gestations at more than 8 weeks in whom sharp curettage was utilized. The entire group had a mean of 48,342 mIU/ml baseline level of maternal plasma hCG. After the evacuation of the uterine cavity, a rapid decrease of plasma hCG occurred within the first week, followed by a gradual decline until elimination was total. The mean disappearance time of plasma hCG was 30 days. The disappearance curve of hCG was found to be in a form similar to that described before. No significant difference was found between the two groups. We conclude that when the appropriate method is used for pregnancy termination, the time between the procedure and disappearance of hCG depends on the initial hCG value.

Abortion, Induced↗
PubMed1996

Causative factors in first trimester abortion failure.

OBJECTIVE: To evaluate the main contributors to failed first trimester abortions. PATIENTS AND DESIGN: Forty-two cases of unintentional continued pregnancy were detected among 23,000 termination procedures performed between 1989 and 1995. The patients were diagnosed either at follow-up visits or at the time of operation due to abnormal pelvic findings or discrepancy between the expected and obtained tissue. RESULTS: The failure rate was found to be 0.18%. Among the patients with failed abortion 8 patients had unsuspected anomalies; two of these patients conceived with an intrauterine device in position; 7 patients had uterine malposition (2 markedly anteverted and 5 markedly retroverted), and 2 patients had leiomyomas. No genital disorder was identified in the remaining 25 women. Among these 25 women, 10 had gestations beyond 8 weeks, for which suction curettage followed by sharp curettage was performed. Among the remaining 15 in whom only suction curettage was used for termination, 13 had less than 6 weeks of gestation at the time of pregnancy termination. CONCLUSION: When a termination fails, when scanty tissue is obtained, or when doubt exists about the termination, an extrauterine pregnancy must be ruled out and other causes of termination failure should be considered such as technical failure, uterine anomaly, or malposition.

Abortion, Induced↗
PubMed1996

Treatment of vaginitis.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of metronidazole 500 mg and miconazole nitrate 100 mg (Neo-Penotran, Embil Pharmacy Company, Istanbul, Turkey) in the treatment of vaginitis. METHOD: One hundred patients (mean age 26.5 years, range 18-50) with a clinical diagnosis of vaginitis entered this open, noncomparative study. Each patient inserted a Neo-Penotran pessary twice daily for 14 days. Assessments were carried out at the beginning of the study and 15 and 22 days after the start of therapy. Student's t-test was used for the statistical analysis. RESULTS: Out of 100 patients who were initially recruited to the study, 20 were subsequently excluded, leaving a total of 80 patients (80%) who completed the full course of treatment. Vaginitis was resolved in 75% of cases, it improved in 18% and was unchanged in 7%. The success rate for the treatment of trichomoniasis was 80%, 93.4% for bacterial vaginosis and 84.4% for candidal vaginitis. CONCLUSION: Neo-Penotran pessaries represent a novel and effective formulation for the treatment of common types of vaginitis and this pessary may also be of particular value in the treatment of resistant or recurrent vaginitis.

Adult↗