Biomedical subjects

Sefa Kelekci

Publications and source records attributed to Sefa Kelekci.

14 recordsLinked to original sources

PubMed2006

Addition of human chorionic gonadotropin to clomiphene citrate ovulation induction therapy does not improve pregnancy outcomes and luteal function.

In a randomized prospective study, 125 women with World Health Organization class II anovulation received 50 mg of clomiphene citrate alone (group A, n = 65) or 50 mg of clomiphene citrate plus hCG (group B, n = 60) in a total of 125 cycles during natural intercourse-advised cycles. There were no statistically significant differences between groups regarding pregnancy outcomes and midluteal P levels, but luteal phase length was longer in group A.

Abortion, Spontaneous↗

PubMed2006

Randomized study on the effect of adding oxytocin to ethacridine lactate or misoprostol for second-trimester termination of pregnancy.

OBJECTIVE: To compare effectiveness of misoprostol and ethacridine lactate with or without oxytocin in second-trimester medical abortions. SUBJECTS AND METHODS: A randomized prospective study. A total of 388 women with genetic indications for termination of pregnancy at 13-24 weeks of gestation were recruited. Group I (n=85) were treated with extra-amniotic ethacridine lactate, 10 ml instilled per gestational week, to a maximum of 200 ml. Group II (n=93) were treated with misoprostol administered intravaginally (200 microg), followed by 100 microg of oral misoprostol 4 hourly for 24 h. Group III (n=102) were treated with a combination of ethacrine lactate and oxytocin. An initial dose of 6 mU/min oxytocin was given, followed by additional 6 mU/min doses every 20 min. Group IV (n=96) were treated with a combination of misoprostol and oxytocin administered in a similar way as in group III. The main outcome measures were time to induce abortion, side effects, and failure/success rates. RESULTS: The mean time to induce abortion was 14.2+/-3.6, 13.2+/-3.4, 10.8+/-2.6, and 9.9+/-2.4 h in groups I, II, III, and IV, respectively (p<0.001). Addition of oxytocin to ethacridine lactate did not decrease the risk of prolongation of induction beyond 24 h but use of oxytocin with misoprostol did reduce the risk of induction beyond 24 h (OR: 0.46, 95%CI: 0.21-1, p<0.05). The occurrence of minor side effects was similar in all groups. CONCLUSION: Addition of oxytocin to ethacridine lactate or misoprostol significantly decreases the length of time to induce abortion without supplementary side effects.

Abortifacient Agents↗

PubMed2005

Hormonal and ovarian stromal blood supply changes after laparoscopic tubal sterilization: a prospective controlled study.

OBJECTIVES: The purpose of this study is to determine if the effects of tubal sterilization (TS) by laparoscopy have any risk of a subsequent significant decrease in ovarian reserve and vascular support within the ovary by means of stromal artery Doppler study, and to compare the results with matched paired controls. DESIGN: Between February 2002 and January 2005, 148 healthy volunteers were enrolled sequentially, 74 undergoing laparoscopic TS (study group) and 74 age-, parity-, body mass index-matched women were recruited as a control group. The main outcome measurements were blood levels of follicle-stimulating hormone (FSH), luteinizing hormone and E2, ovarian volume, number of antral follicles and Doppler study of ovarian stromal artery pulsatile index (PI) and maximum velocity (Vmax) on the third day of the cycle immediately before, and 1 and 12 months after the surgical intervention. RESULTS: There were significant elevations in both serum FSH levels and PI values observed 1 month after TS, compared to the preoperative levels (p < .05), and also when compared to controls. However, there were no significant elevations at 12 months postoperation in both study and control groups. The other outcome measurements did not show any significant differences between the two groups. CONCLUSIONS: Tubal sterilization by laparoscopic electrocoagulation does not cause any decrease in ovarian reserve or ovarian stromal blood supply, except an early postoperative increase in FSH and PI.

Adult↗

PubMed2005

Misoprostol moistened with acetic acid or saline for second trimester pregnancy termination: a randomized prospective double-blind trial.

BACKGROUND: This study was conducted to evaluate the efficacy and side effects of a new regimen of 800 microg misoprostol administered intravaginally every 6 h up to a maximum of three doses in 24 h for second trimester pregnancy termination. METHODS: A total of 66 women seeking termination of second trimester pregnancy (30 fetal structural anomaly, six chromosomal abnormality and 30 fetal death) were randomly assigned to one of two treatment groups: (i) intravaginal misoprostol moistened with 3 ml of 5% acetic acid in group A (n = 33); or (ii) intravaginal misoprostol moistened with 3 ml of saline in group B (n = 33). RESULTS: The overall median (range) induction-abortion interval was 10 h (2-46) [10 h (4-35) in 36 live fetuses and 9 h (2-46) in 30 dead fetuses, P = 0.515]. All of the patients in both groups aborted within 48 h (100% success rate). The median (range) induction-abortion interval revealed a significantly faster delivery time (P < 0.001) in group A [8 h (2-24)] than in group B [14 h (3-46)]. CONCLUSIONS: This new regimen of 800 microg of vaginal misoprostol every 6 h for a maximum of three doses in 24 h was an effective alternative method for second trimester abortion. In addition, misoprostol moistened with acetic acid was significantly more effective than misoprostol moistened with saline.

Abortifacient Agents, Nonsteroidal↗

PubMed2005

Incomplete healing of the uterine incision after caesarean section: Is it preventable?

OBJECTIVE: To find out whether a change in suturing technique might affect the healing of the uterine scar after caesarean section (CS). STUDY DESIGN: In this randomised prospective study, 78 term pregnant patients delivered by CS were allocated to two different suturing techniques either including or excluding the endometrial layer. The integrity of the uterine incision was checked by ultrasound 40-42 days after the operation. Any deviation from the full thickness apposition of the anterior uterine wall (with the ratio: [anterior wall thickness/(anterior wall thickness+height of the wedge shaped defect)]<1) was considered to represent incomplete healing. Both groups were then compared in terms of the frequency of incomplete healing. Chi square and Student's t-test were used where appropriate. A logistic regression model was used to adjust for confounding factors. RESULTS: The frequency of incomplete healing was significantly lower in the group treated by full thickness suturing (44.7% versus 68.8%); (OR: 2.718; CI: 1.016-7.268). Similarly the mean values for the incomplete healing ratio were 0.77+/-0.17 and 0.86+/-0.17 (p = 0.03) in split and full thickness groups, respectively. After adjusting for other confounding factors the suture technique still remained as a significant determinant of the incisional healing (p = 0.04). CONCLUSION: By selecting full thickness suturing technique one may significantly lower the incidence of incomplete healing of the uterine incision after CS.

Cesarean Section↗

PubMed2005

Multiple repeat caesarean section: is it safe?

OBJECTIVE: We aimed to evaluate the obstetric outcome of patients without obstetric risks, who had two or more previous caesarean sections (C/S) prior to the current pregnancy, which was managed by caesarean section in our obstetric department. METHODS: We studied the case notes of 602 women who had a repeat caesarean section in our unit between May 2002-June 2003. We then compared the two groups: (1) those who had two or more previous caesarean sections and (2) those who had only one previous caesarean section. RESULTS: In the study group, while dense intraperitoneal adhesions were present in 3.6% of the patients, they were not found in control group. This difference was statistically significant (P < 0.05). Uterine wound separation rate was 1.9% in the study group and none of the patients in control group had uterine wound separation, which was statistically significant also (P < 0.05). There was no statistically significant association between Apgar scores and number of previous caesarean sections. Postoperative complication rates did not differ between the two groups (P > 0.05). CONCLUSION: Patients without any obstetric risks, with two or more previous caesarean sections had significantly more dense adhesions and uterine wound separations in the current caesarean section compared to patients with one previous caesarean section. But, maternal and fetal mortality and morbidity in women who have two or more previous caesarean sections did not differ from the patients with one previous caesarean section.

Adult↗

PubMed2005

Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding.

OBJECTIVE: To compare the diagnostic accuracy and acceptability of transvaginal sonography (TVS), saline infusion sonography (SIS), and office hysteroscopy (OHS) for detecting intracavitary abnormalities in women with or without abnormal uterine bleeding (AUB). DESIGN: Prospective double-blind study. SETTING: Zekai Tahir Burak Women's Health Education and Research Hospital, Gynecology Clinic (Ankara, Turkey). PATIENT(S): A total of 26 women with AUB and 24 women without AUB were enrolled in this study. INTERVENTION(S): Transvaginal sonography, SIS, and OHS were performed on women scheduled for hysterectomy. MAIN OUTCOME MEASURE(S): Sensitivity, specificity, and positive and negative predictive values of TVS, SIS, and OHS to detect intracavitary abnormalities (with histopathologic findings used as the gold standard), duration of procedure, and pain scores. RESULT(S): The sensitivity and specificity of TVS, SIS, and OHS in detecting intracavitary abnormalities were 56.3% and 72%, 81.3% and 100%, and 87.5% and 100%, respectively. The prevalence of endometrial polyps was not different in women with and without AUB. Saline infusion sonography was less painful than OHS (pain scores of 4.3 and 7.2, respectively). CONCLUSION(S): The diagnostic accuracy of SIS was equal to that of OHS in diagnosing intracavitary abnormalities. Moreover, SIS was less painful than OHS for patients.

Adult↗

PubMed2005

Psychological effects of tibolone and sequential estrogen-progestogen therapy in perimenopausal women.

OBJECTIVE: To investigate changes in psychological symptoms before and after continuous tibolone treatment and sequential estrogen-progestogen therapy in perimenopausal women. METHODS: In this prospective, randomized, controlled study, perimenopausal women were randomly allocated to treatment with either tibolone 2.5 mg/day for 28 days (n = 28), or 0.625 mg conjugated equine estrogens (CEE) for 25 days plus 5 mg medroxyprogesterone acetate (MPA) daily on days 16-25 (n = 33). The differences in Beck's depression scores and serum lipid profiles before and after 1 year of treatment with both regimens were compared. RESULTS: Both groups were similar with respect to demographic characteristics. The differences in Beck's depression scores before and after treatment were statistically significant in the tibolone group (21.3 vs 17.1, p = 0.038) and also in the group receiving standard sequential estrogen-progestogen treatment (15.7 vs. 13.0, p = 0.040). In the sequential estrogen-progesterone group, a statistically significant increase was measured in high-density lipoprotein (HDL)-cholesterol levels after treatment (49.1 vs. 56.8 mg/dl, p = 0.023). CONCLUSION: Tibolone is as effective as sequential estrogen-progesterone therapy in alleviating the psychological symptoms of the perimenopause. In addition, CEE + MPA induces favorable changes in HDL-cholesterol.

Depressive Disorder↗

PubMed2005

Ovarian reserve and ovarian stromal blood supply after tubal ligation by the Pomeroy technique: comparison with controls.

OBJECTIVE: To determine if women who undergo tubal sterilization by the Pomeroy technique have any risk of a subsequent significant decrease in ovarian reserve and vascular support inside the ovary, by means of stromal artery Doppler ultrasonography. METHODS: Between March 2000 and September 2004, 108 healthy volunteers underwent mini-laparatomic tubal ligation using the modified Pomeroy technique (study group). As a control group, 102 age-matched women were recruited. The main outcome measurements were blood levels of follicle-stimulating hormone (FSH), luteinizing hormone and estradiol, ovarian volume, number of antral follicles and Doppler indices of the ovarian stromal arteries on the third day of the cycle immediately before, 1 month and 12 months after the surgical intervention. RESULTS: In the study group and control group, results of the main outcome measurements immediately before, 1 month and 12 months after the surgical intervention did not show any significant difference except one. There was a significant elevation of FSH levels after 1 and 12 months, which was statistically significant (p < 0.05) in the study group. CONCLUSION: The 12-month follow-up of patients suggests that there is neither a decrease in ovarian reserve nor an adverse effect on the blood supply of ovarian stroma after tubal sterilization by the modified Pomeroy technique. A significant elevation of FSH levels was observed at 1 and 12 months after the operation.

Adult↗

PubMed2005

Cardiac rhabdomyoma with tuberous sclerosis: a case report.

BACKGROUND: Rhabdomyomas are the most common benign cardiac neoplasms occurring in the fetus and neonate, with most of them identified within the first year of life. Cardiac rhabdomyomas are frequently associated with tuberous sclerorosis. CASE: A 25-year-old, pregnant woman with no remarkable personal or family history was referred to us for a suspected fetal cardiac anomaly. Ultrasonographic examination of the fetus revealed multiple solid masses consistent with rhabdomyoma in the ventricular septum and ventricular wall. No other anomalies could be detected. Postnatal echocardiography confirmed the presence of cardiac rhabdomyoma, and periventricular subependymal multiple hamartomas were diagnosed by postnatal magnetic resonance imaging. CONCLUSION: When fetal cardiac rhabdomyoma is diagnosed, careful evaluation of other fetal structures, including brain and renal parenchyma, should be performed to search for signs of tuberous sclerosis.

Adult↗

PubMed2004

Nasal bone measurement during the 1st trimester: is it useful?

The aim of this study was to present our preliminary data about nasal bone measurements at 11-14 weeks of pregnancy. This study was conducted in our prenatal unit between 2000 and 2003. A total of 642 pregnant women (single pregnancies) were enrolled into the study. During the first trimester of pregnancy, crown-rump length, nuchal translucency thickness, and fetal nasal bone length measurements and ductus venosus Doppler images were evaluated. The distribution of absent or small nasal bones in both normal fetuses and in those having some pathological conditions was compared by statistical analysis. p < 0.05 was considered significant. Nasal bone evaluation was successful in 600 of 642 (93.4%) ultrasound examinations. The linear regression line showed a significant positive slope with increasing crown-rump length (r=0.54, p < 0.001). Absent or small nasal bones were more common in abnormal than in normal fetuses (p=0.007). It is clear that the fetal nasal bone is becoming a powerful tool in prenatal screening for aneuploidy. Larger studies to be performed in a low-risk population are needed to assess whether the measurement of the nasal bone length provides additional benefits beyond the assessment of the presence or absence of the nasal bone.

Adult↗

PubMed2004

Effect of tubal ligation on ovarian reserve and the ovarian stromal blood supply.

AIM: Our aim was to evaluate possible adverse effects of tubal ligation on ovarian reserve and ovarian stromal vascular support. METHODS: Ninety-one women who underwent tubal ligation, using a modified Pomeroy technique, were studied. The main outcome measurements were serum follicle stimulating hormone, luteinising hormone and oestradiol levels, ovarian volume, number of antral follicles and Doppler study of ovarian stromal artery on the third day of the menstrual cycle immediately before, 1 month and 12 months after the surgical intervention. RESULTS: Statistically significant elevation of follicle stimulating hormone levels was observed at 1 and 12 months after tubal ligation (P < 0.05). CONCLUSION: Doppler flow studies of the ovarian stromal arteries showed that there were no significant differences before and after tubal ligation.

Adult↗

PubMed2004

The efficacy of a hyaluronate/carboxymethylcellulose membrane in prevention of postoperative adhesion in a rat uterine horn model.

The current study was designed to investigate the efficacy of a hyaluronate/carboxymethylcellulose membrane for the prevention of post-operative adhesion in a rat uterine horn model. This is a prospective double-blinded controlled study. Nineteen injured uterine horns were treated with a hyaluronate/carboxymethylcellulose membrane as a barrier and 19 injured uterine horns without any treatment served as a control group. Two weeks later, second look laparotomies were performed in order to assess the degree of the adhesion. Total adhesion scores, histopathological analysis of inflammation process and vascularization of adhesions were compared with control group. P values of 5% or less were considered statistically significant. Animals treated with a hyaluronate/carboxymethylcellulose membrane had significantly reduced post-surgical adhesion scores when compared with control group. In histopathological examination, there was less vascularization in the treatment group. The types and extent of inflammation were similar in two groups. Clinically and histopathologically, a hyaluronate/carboxymethylcellulose membrane is effective in reducing postoperative adhesion formation in the rat uterine horn model.

Animals↗

PubMedDate not supplied

Glucose tolerance in pregnant women with vaginal candidiasis.

BACKGROUND: The use of traditional historic risk factors to identify gestational diabetes mellitus (GDM) will miss half of women with gestational diabetes mellitus. Our aim was to evaluate whether impaired glucose tolerance is a risk factor for vaginal candidiasis in pregnant women. PATIENTS AND METHODS: In a cross-sectional study, we compared the prevalence of impaired glucose tolerance in 64 pregnant women with vaginal candidiasis (positive microscopy) and 59 Candida-negative control subjects. Subjects underwent standardized 75-gram oral glucose tolerance testing between the 24th and 28th weeks of their pregnancies. Patients were included only if they had no known diabetes mellitus or historic risk factors for gestational diabetes mellitus, and had not been receiving antibiotic or steroid therapy. We compared glucose levels at fasting, 30 minutes, 60 minutes and 120 minutes, and perinatal and neonatal outcomes in the two groups. RESULTS: There were no statistical differences between cases and controls in demographic characteristics. Glucose concentrations were higher in pregnant women with vaginal candidiasis than in control subjects at fasting (89 vs. 84 mg/dL, P=0.021), 30 minutes (139 vs. 126 mg/dL, P=0.050), and 60 minutes (124 vs. 106 mg/dL, P= 0.018) after intake of 75 gram of glucose. The two groups did not differ in glucose level at 120 minutes after glucose administration. Gestational diabetes prevalence was 3.1% and 3.4% in the study and control group, respectively (P=0.274). CONCLUSION: The tolerance to glucose in pregnant women with vaginal candidiasis seems discretely impaired.

Adult↗