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Biomedical subjects

T Aksu

Publications and source records attributed to T Aksu.

At least 19 recordsLinked to original sources
PubMed2006

Elevated second trimester serum homocysteine levels in women with gestational diabetes mellitus.

OBJECTIVE: Our aim was to investigate the association between total serum homocysteine, vitamin B12 and folate levels in pregnant women with gestational diabetes mellitus (GDM), glucose intolerance and compare them with those of glucose tolerant pregnant women. MATERIALS AND METHODS: Serum homocysteine, vitamin B12 and serum folate levels were prospectively measured in a total of 223 pregnant women who were grouped according to their status of glucose tolerance as gestational diabetes (abnormal 1-h and 3-h glucose tolerance test; n = 30), glucose intolerant (abnormal 1-h, but normal 3-h glucose tolerance test; n = 46) or normal controls (normal 1-h glucose test; n = 147). RESULTS: Mean serum homocysteine concentration of women in gestational diabetes, glucose intolerants and normal controls at 24-28 weeks of gestation was 9.0 +/- 3.1, 8.1 +/- 2.5 and 7.4 +/- 1.6 micromol/l, respectively. The only statistically difference in homocysteine levels was observed between women with gestational diabetes and normal controls (P < 0.01). However, no difference was observed for vitamin B12 and folate levels. CONCLUSION: Second trimester serum homocysteine concentrations are higher among women with GDM, as compared to normal controls.

Adult↗
PubMed2005

Quantitative telomerase activity in malignant, benign and normal gynecological tissues.

OBJECTIVE: The aim of this study was to evaluate quantitative telomerase activity in malignant, benign and normal gynecological tissue samples by using the Telomerase-PCR ELISA kit, and to determine a cut-off level for malignancy by this quantitative method. MATERIALS AND METHODS: Fifty gynecological tumors, 27 benign gynecological disorders and 29 normal tissues were analyzed by the Telomerase-PCR ELISA kit. All tissues were confirmed by a pathologist. A ROC (receiver operator characteristic) curve was drawn to determine a threshold level best discriminating malignant tissues from benign pathologies and normal tissues. Telomerase activity was compared in malignant, benign and normal tissues. RESULTS: The mean level of telomerase activity of the malignant tumor samples (1.03 +/- 0.53 units) was significantly (p < .001) higher than the normal tissues (0.13 +/- 0.07 units) and benign pathologies (0.37 +/- 0.25 units). The cut-off point to differentiate malignant samples from benign samples was set at 0.42 units, where the sensitivity was 93.8% and the specificity was 89.3%. Positive predictive value was 84% and negative predictive value was 89.3%. There was a significant difference in telomerase activity between malignant, benign and normal tissues within each histological group. CONCLUSION: In this preliminary study, the telomerase-PCR ELISA method was found to have a high sensitivity and specificity to differentiate malignant gynecological tissues from benign tissues.

Biomarkers, Tumor↗
PubMed2004

Nuchal cord type B associated with an excessively long umbilical cord as a cause of stillbirth: a case report.

Nuchal cord (NC) is defined as the umbilical cord being wrapped 360 degrees around the fetal neck. It is one of the most common complications of the umbilical cord and any pregnancy might be complicated with a nuchal cord. If a nuchal cord occurs in a pregnant woman with decreased fetal movements, it should be considered to be at high risk, particularly for fetuses with multiple nuchal cords. We report a case in breech presentation with an excessively long umbilical cord (190 cm) which was complicated with five nuchal loops around the fetal neck and resulted in intrauterine death at the 37th week of pregnancy.

Adult↗
PubMed2003

Oncologic and reproductive outcome after fertility-saving surgery in ovarian cancer.

The rate of ovarian tumour diagnosis in reproductive age woman has increased parallel to the improvements in diagnostic methods and regular gynaecological visits. Because of this organ saving surgical procedures for the preservation of reproductive and endocrine functions have gained more interest. Conservative surgical approaches for ovarian tumours after surgical staging include cystectomy, unilateral salpingo-oophorectomy and unilateral salpingo-oophorectomy plus contralateral cystectomy. Ovarian tumours diagnosed in young ages tend to be low-stage low-grade malignancies. This not only enables but also necessitates preserving the fertility of women who have not completed their family. In invasive ovarian cancer, fertility saving surgery is confined to early-stage and low-grade disease. But, it also had been reported in advanced stages (up to Stage IIIc). Candidates for those procedures were selected according to the FIGO stage, grade, ploidy state, histological subtypes and patients' desire. Adjuvant chemotherapy is necessary for high-risk patients. The rate of recurrence following conservative and radical surgical procedures in low-stage and low-grade tumours are 9% and 11.6%, respectively; and disease-free and overall survival rates do not differ significantly. Prognosis of borderline ovarian tumours is excellent. Five and 20-year survival rates are 95% and 80%, respectively. Management of borderline tumours has evolved significantly in the last few decades. In contrast to invasive ovarian cancer, borderline tumours can be operated on conservatively at all stages. Chemotherapy is rarely prescribed even in advanced stages. Eighty percent of malignant germ cell tumours are diagnosed less than 30 years of age, and 70-75% of patients have Stage I disease. Conservative surgery is generally used in malignant germ cell tumours even in advanced stages. The relation between ovulation induction and tumour recurrence is not consistent in the literature. Spontaneous pregnancy rates following fertility saving surgery has been reported as 60-88%. Because of this over-treatment of these patients for fertility should be avoided. Briefly, fertility saving surgery can be performed safely in germ cell, borderline and early stage epithelial ovarian tumours in selected cases. Any increment in the rate of tumour recurrence following ovulation induction has not yet been demonstrated. Menstrual irregularities caused by chemotherapy are transient. The congenital malformation rate of ovarian cancer patients is slightly higher than that of the normal population, but no significant difference has been observed between patients who received or did not receive chemotherapy.

Adult↗
PubMed2002

Surgical stage III endometrial cancer: analysis of treatment outcomes, prognostic factors and failure patterns.

OBJECTIVE: The purpose of this study was to evaluate the survival estimates of stage III endometrial cancer patients, and also to detect the prognostic factors and failure patterns. MATERIALS AND METHODS: Sixty-eight surgical Stage III endometrial cancer patients treated at Hacettepe University Hospital were included. All patients underwent surgical staging procedures consisting of peritoneal cytology, infracolic omentectomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy and complete pelvic-paraaortic lymphadenectomy. By surgical staging 26 (38%) patients had Stage IIIA and 42 (62%) patients had Stage IIIC disease. The mean resected lymph node number was 26 (median, 25; range, 15-58). RESULTS: The median age was 60 years (range, 38-77), and the median follow-up period was 62 months (range, 36-90 months). The 5-year disease free survival rate was 58% and the 5-year overall survival rate was 64%. These figures for Stage IIIA were 60% and 68%, respectively; and for Stage IIIC they were 57% and 62%, respectively. No significant survival difference was detected between Stage IIIA and IIIC (p = 0.60 for disease-free survival and p = 0.48 for overall survival). High grade and positive peritoneal cytology predicted poor survival in both univariate (p = 0.004 and p = 0.006, respectively) and multivariate (p = 0.05 and p = 0.04, respectively) analysis. Twenty-eight patients (41%) had recurrence with a median time of 23 months (range, 10-54 months). Nine patients (13%) had only local, 13 patients (19%) had only distant and six patients (9%) had both local and distant relapse. CONCLUSION: Surgical staging is important in the management of Stage III endometrial cancer, and the main problem is still distant failure. In multivariate analysis high grade and positive peritoneal cytology predicted poor survival significantly.

Adult↗
PubMed1998

Benign epithelial ovarian tumors.

Two hundred and twelve patients with benign epithelial ovarian tumors managed consecutively at Hacettepe University Hospital between 1974-1994 were analyzed retrospectively. Benign epithelial tumors constituted 9.5% (212/2216) of all ovarian tumors and 28.5% (212/743) of the primary epithelial ovarian tumors during the study period. Of the patients with benign epithelial tumors, 104 (49.0%) had serous, 94 (44.3%) had mucinous and the remaining 14 (6.7%) had Brenner tumors. The surgical procedures varied from cystectomy to total abdominal hysterectomy according to the age of the patient. Bilaterality was encountered in 12.8% of serous and 10.6% of mucinous tumors. Ovarian carcinoma occurred synchronously in two patients. In two patients, serous cystadenoma was detected in the preserved ovaries following 3 and 7 years of initial conservative surgery, respectively. Serous tumors were relatively more common constituting approximately one half of the cases. Most of the patients presented with an abdominopelvic mass.

Adolescent↗
PubMed1996

Serous surface papillary carcinoma.

Three cases of serous surface papillary carcinoma of the abdominopelvic peritoneum are presented. All of the patients were subjected to a relatively homogeneous management consisting of primary surgery and cisplatin based chemotherapy regimen. The second look procedures of two patients were found to be negative. Although these tumors are known to have a poor prognosis, aggressive surgery and cisplatin based chemotherapy seem to have promising results.

Adult↗
PubMed1994

Salpingoscopic findings in women with occlusive and nonocclusive salpingitis isthmica nodosa.

STUDY OBJECTIVE: To characterize ampullary endosalpingeal findings in women with occlusive or nonocclusive salpingitis isthmica nodosa. DESIGN: Prospective case study. SETTING: Obstetrics and Gynecology Department of a University Hospital. PATIENTS: Twenty women (38 tubes) with occlusive or nonocclusive salpingitis isthmica nodosa were studied. INTERVENTIONS: Salpingoscopy was performed during diagnostic laparoscopy in 20 women (38 tubes) with hysterosalpingographic evidence of salpingitis isthmica nodosa. MAIN OUTCOME MEASURES: Salpingoscopic findings were recorded and the patients were managed accordingly. RESULTS: Of the 38 tubes 10 appeared radiographically and laparoscopically normal. Two tubes were occluded distally. Of the 26 tubes with occlusive or nonocclusive salpingitis isthmica nodosa, 5 (19.2%) showed varying degrees of endosalpingeal abnormality. Patients with abnormal salpingoscopy were regarded as having bipolar tubal disease and were referred for assisted conception. The remaining patients were scheduled for microsurgical tubal reconstruction. CONCLUSIONS: One in five patients with proximal tubal disease may have ampullary endosalpingeal damage of varying degrees. However, the significance of this finding in relation to subsequent management strategies and fertility outcome is yet to be characterized.

Adult↗
PubMed1994

Results of Second-Look Laparoscopy Following Removal of Endometriomata

Despite widespread use of operative laparoscopy for removal of endometriomata, there are inadequate data regarding subsequent adhesion formation. We performed second look laparoscopy (SLL) within 6 months of laparoscopic endometriosis cystectomy in 21 infertile women. Mean age and mean duration of infertility were 30.5 &plusmn; 4.4 and 7.1 &plusmn; 4.9 years respectively. Cysts were removed with the following technique: incision of the ovarian cortex, cystoscopy (biopsy when necessary), and total stripping of the cyst capsule. All patients received postoperative suppressive therapy for 3 months. Total AFS score decreased significantly in all patients (34.1 &plusmn; 14.7 vs 12.3 &plusmn; 10.7; P<0.001). The adhesion score assessed at SLL improved in 3 (14.3%) remained the same in 13 (61.9%) and worsened in 5 (23.8%). Mean adhesion score at SLL was significantly less compared with adhesion score during cystectomy (7.1 &plusmn; 5.2 vs 8.7 &plusmn; 6.4; P=0.038). None of the patients had de novo adhesions. Adhesion scores were similar in women where ovarian cortical defect was left open or suture closed. Of the 21 women, 4 (19%) conceived within six months of SLL. In conclusion, laparoscopic removal of ovarian endometriomata was not associated with increased adhesion formation at SLL. Adhesions at SLL were mainly dependent upon adhesions at laparoscopic cystectomy.

Journal Article↗
PubMed1993

Immature teratoma of the ovary.

The clinicopathologic experience of 10 patients with immature ovarian teratoma is presented. The mean age of the patients was 22.1. Abdominopelvic mass was the presenting symptom in the majority of cases. Immature ovarian teratomas accounted for 4.0% of germ cell tumors and 2.1% of all ovarian neoplasms diagnosed in our institution. Of the patients, 6 had Stage I disease and 7 had grade I tumor. Unilateral tumor was encountered in the majority of patients. Adequate primary surgical-pathologic staging and multiagent chemotherapy seem to be the treatment of choice.

Adolescent↗
PubMed1992

Laparoscopic CO2 laser uterine nerve ablation for treatment of drug resistant primary dysmenorrhea.

Twenty women with drug-resistant primary dysmenorrhea were subjected to laparoscopic CO2 laser uterine nerve ablation. Menstrual pain assessed by a linear analog pain score showed a reduction of 33%, decreasing from 7.5 +/- 0.5 preoperatively to 5.0 +/- 1.7 postoperatively. The procedure was free of major complications and should be considered as a second-line therapeutic option in women who have failed medical treatment using nonsteroidal antiinflammatory agents or OCs.

Adult↗
PubMed1992

The effect of short-interval laparoscopic lysis of adhesions on pregnancy rates following Nd-YAG laser photocoagulation of polycystic ovaries.

Laparoscopic Nd-YAG laser photocoagulation of the ovaries was performed in 40 anovulatory women with clomiphene citrate-resistant polycystic ovary disease. Following this procedure, the subjects were randomly assigned to have either a second-look laparoscopy with lysis of adhesions within 3-4 weeks of the initial laparoscopy (N = 19) or expectant management (N = 20). One patient assigned to the laparoscopy group refused the procedure. Minimal and mild adhesions that did not distort the normal tubo-ovarian relationship were encountered in 13 patients (68%) in the second-look laparoscopy group; these adhesions were easily lysed using sharp or blunt dissection. The pregnancy rates over 6 months were similar in the two groups (47% in the second-look group and 55% in the expectant-management group; P greater than .05). These data suggest that early laparoscopic lysis of adhesions does not improve short-term conception rates following laparoscopic Nd-YAG laser photocoagulation of polycystic ovaries.

Adult↗
PubMed1991

The value of human menopausal gonadotropin treatment in patients with unexplained infertility.

The role of multiple ovulation with human menopausal gonadotropin (HMG) in the treatment of unexplained infertility is evaluated. Of a total 73 patients with unexplained infertility, 39 received four cycles of HMG, whereas, 34 were left untreated. Eight (20.5%) women conceived during HMG treatment, in comparison to only 1 (2.9%) in the control group (P less than 0.05). This study gives further credit to the value of HMG treatment for unexplained infertility.

Adult↗
PubMed1991

Evaluation of adhesion formation after laparoscopic treatment of polycystic ovarian disease.

The incidence and fertility effects of postoperative adhesion formation after laparoscopic ovarian electrocautery or laser photocoagulation of polycystic ovaries has not been adequately analyzed. Short-interval second-look laparoscopy appears to be a useful method for addressing this issue. Employing short-interval second-look laparoscopy 3 to 4 weeks after the initial laparoscopic intervention, we were able to demonstrate adhesions in 6 of 7 patients (85%) treated with ovarian electrocautery and 8 of 10 patients (80%) submitted to laser therapy. The adhesions were amenable to laparoscopic lysis in 12 of 14 patients (85%). The subsequent conception rates within 6 months of second-look laparoscopy that were 57% and 40% in the electrocautery and the Nd:YAG laser groups, respectively, may in part be attributed to the restoration of normal pelvic anatomy during this procedure.

Adult↗
PubMed1991

Complications and bilaterality of mature ovarian teratomas (clinicopathological evaluation of 286 cases).

Bilaterality, complications and associated pathology were reevaluated in 286 cases of mature teratoma of the ovary, treated in the last 25 years. Torsion was the most frequent complication, occurring in 22 (7.7%) patients. Rupture, infection and secondary malignant change were uncommon complications, occurring in 11 (3.8%), 7 (2.4%) and 1 (0.3%) patients, respectively. Both ovaries were evaluated histologically in 226 patients, 31 (13.7%) of whom were shown to have bilateral tumours, including 2 patients with tumour in the normally appearing ovary, contralateral to the gross tumour.

Adolescent↗
PubMed1991

Evaluation of the functional status of the fallopian tubes in unexplained infertility with radionuclide hysterosalpingography.

The functional status of the Fallopian tubes in patients with unexplained infertility (UI) was evaluated with radionuclide hysterosalpinography (RN-HSG). The rate of bilateral tubal occlusion with RN-HSG in women with UI (3/18 = 16.7%) was considerably higher than in a group of fertile and male-infertile women (0/28 = 0%), implying that a number of cases with UI might be associated with functional rather than anatomical tubal defects. RN-HSG is a simple, innocuous and potentially useful method for assessing functional tubal occlusion, and it might give a better understanding of the functional status of the tubes in UI.

Fallopian Tube Patency Tests↗
PubMed1991

Radionuclide hysterosalpingography. A simple and potentially useful method of evaluating tubal patency.

A prospective study was undertaken to evaluate the efficacy of radionuclide hysterosalpingography (RN-HSG) using 99mTc-labeled human albumin microspheres to assess the patency of the fallopian tubes in 36 women (72 tubes). The study group consisted of 20 women with proven fertility undergoing laparoscopic tubal ligation, 8 with male factor infertility and 8 with bilateral isthmic tubal occlusion. All RN-HSG scan results were correlated with the findings at laparoscopy when tubal patency was ultimately assessed with chromopertubation. The sensitivity and specificity of RN-HSG were 100% and 94.6%, respectively. The positive predictive value (probability of occlusion when RN-HSG was positive) was 84%, whereas the negative predictive value (probability of no occlusion when RN-HSG was negative) was 100%. RN-HSG is a simple and potentially useful method of assessing the patency of the fallopian tubes.

Albumins↗