Browsing by Author "Karaman, Erbil"

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Acoustic Radiation Force Impulse Elastosonography of Placenta in Maternal Red Blood Cell Alloimmunization: a Preliminary and Descriptive Study
(Soc Romana Ultrasonografe Medicina Biologie-srumb, 2017) Cetin, Orkun; Karaman, Erbil; Arslan, Harun; Akbudak, Ibrahim; Yildizhan, Recep; Kolusari, Ali
Aims: Maternal red blood cell alloimmunization is an important cause of fetal morbidity and mortality in the perinatal period, despite well-organized prophylaxis programs. The objective of the study was to evaluate placental elasticity by using Acoustic Radiation Force Impulse (ARFI) in Rhesus (Rh) alloimmunized pregnant women with hydropic and nonhydropic fetuses and to compare those with healthy pregnant women. Material and methods: This case-control and descriptive study comprised twenty-eight healthy pregnant women, 14 Rh alloimmunized pregnant women with nonhydropic fetuses, and 16 Rh alloimmunized pregnant women with hydropic fetuses in the third trimester of pregnancy. Placental elasticity measurements were performed by ARFI elastosonography at the day of delivery. The maternal characteristics and neonatal outcomes of the patients were also noted. Results: The highest mean placental ARFI scores were observed in Rh alloimmunized pregnant women with hydropic fetuses (1.13 m/s) (p= 0.001). Healthy controls and Rh alloimmunized pregnant women with nonhydropic fetuses had similar mean placenta ARFI scores (0.84 m/s, 0.88 m/s, respectively) (p< 0.05). Conclusions: Based on the present findings, the placenta becomes stiffer in Rh alloimmunized pregnancies complicated with hydrops fetalis. The increased placental ARFI scores may be a supplemental marker for adverse pregnancy outcomes, additional to Doppler evaluation of middle cerebral artery. This data should be confirmed with a large sample size and prospective studies by using serial measurements of ARFI elastosonography in maternal red blood cell alloimmunization.
Amniotic Fluid Levels of Selected Trace Elements and Heavy Metals in Pregnancies Complicated With Neural Tube Defects
(Wiley, 2020) Ovayolu, Ali; Ovayolu, Gamze; Karaman, Erbil; Yuce, Tuncay; Ozek, Murat A.; Turksoy, Vugar A.
The aims of this study were to determine the levels of trace elements and heavy metals, namely aluminum (Al), chromium (Cr), manganese (Mn), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), molybdenum (Mo), cadmium (Cd), tin (Sn), antimony (Sb), mercury (Hg), and lead (Pb), in the amniotic fluid of pregnant women, and to investigate their relationship with neural tube defects (NTDs). The study included 36 pregnant women whose fetuses were complicated with NTDs (study group) and 39 pregnant women with unaffected healthy fetuses (control group), who were matched for body mass index and gestational weeks. The amniotic fluid levels of trace elements and heavy metals were measured using inductively coupled plasma-mass spectrometry and compared between the two groups. Significantly lower mean levels of Zn and Mo and significantly higher levels of Al, Sn, Sb, and Hg in the study group than in the healthy control group were observed, which implied that these elements are possibly correlated with risk factors for the occurrence of NTDs. In contrast, there were no significant differences in the levels of Cr, Mn, Co, Ni, Cu, As, Cd, and Pb between the groups (P >= .05).
Amniotic Fluid Oxidant-Antioxidant Status in Foetal Congenital Nervous System Anomalies
(Sage Publications Ltd, 2018) Cim, Numan; Tolunay, Harun Egemen; Karaman, Erbil; Boza, Baris; Bilici, Mustafa; Cetin, Orkun; Sahin, Hanim Guler
Objective This study aimed to evaluate the oxidant-antioxidant status of amniotic fluid in pregnant women with foetal congenital malformations of the central nervous system. Methods We studied pregnant women with foetal congenital nervous system anomalies at 16-22 weeks' gestation (n=36). The control group (n=30) consisted of pregnant women at the same gestational age who underwent amniocentesis, resulting in a normal karyotype. We analysed glutathione, catalase, and malondialdehyde levels in amniotic fluid. Enzyme activation was measured by spectrophotometry. Results The demographic features of the groups were similar in terms of age, parity, body mass index, and gestational weeks. We detected lower glutathione and catalase levels in the foetal congenital anomaly group than in the control group. We detected higher malondialdehyde levels in the foetal congenital anomaly group than in the control group. Conclusion In the organism, the rate of formation of free radicals and their rate of removal are balanced, and this is called oxidative balance. As long as oxidative stability is achieved, the organism is not affected by free radicals. This fact should be kept in mind to avoid any type of teratogenic agent that could lead to congenital disorders.
Analyses of Interleukin-6, Presepsin and Pentraxin-3 in the Diagnosis and Severity of Late-Onset Preeclampsia
(Taylor & Francis Ltd, 2022) Ovayolu, Ali; Turksoy, Vugar Ali; Ovayolu, Gamze; Ozek, Murat Aykut; Dogan, Ilkay; Karaman, Erbil
Introduction: The etiology/pathophysiology of preeclampsia remains an enigma. Maternal inflammation (humoral and cellular) is a key factor in the etiology of late-onset preeclampsia (L-PrE). Presepsin is split out from the phagocytes membranes after phagocytosis. It is known as a novel inflammation marker. To our knowledge, this is the first study in literature in English to investigate maternal blood concentrations of presepsin in preeclampsia and healthy pregnant women. Methods: We examined maternal plasma interleukin-6, presepsin and pentraxin-3 concentrations in pregnant women with (n = 44) and without L-PrE (n = 44). These three inflammatory markers concentrations measured using enzyme-linked immunosorbent assays were compared. Results: The mean maternal age and gestational age at sampling are similar in the both groups (p >= .05). Interleukin-6, presepsin and pentraxin-3 concentrations differed between the groups (p < .05). There was no difference between the three inflammatory markers concentrations in patients with mild (22 patients) and severe (22 patients) preeclampsia in L-PrE (p >= .05). A significant discriminative role of interleukin-6, presepsin and pentraxin-3 for presence of L-PrE, with cutoff values of 39.74 pg/mL, 309.88 mg/L and 34.96 ng/mL, respectively, were reported in a ROC curve analysis. When the patients with and without small for gestational age infants (12 patients and 76 patients, respectively) were compared, it was determined that there was no differences between the interleukin-6, but there were differences between the presepsin and pentraxin-3 concentrations (p = .016, p = .008, respectively). Conclusion: Lower concentrations of interleukin-6/presepsin and higher concentrations of pentraxin-3 were associated with the development of preeclampsia. Further investigations of inflammatory/immunity markers in pregnancy are required and may ultimately lead to novel therapeutic approaches to treat complications of pregnancy.
Analyses of Maternal Plasma Cadmium, Lead, and Vanadium Levels in the Diagnosis and Severity of Late-Onset Preeclampsia: a Prospective and Comparative Study
(Taylor & Francis Ltd, 2022) Ovayolu, Ali; Turksoy, Vugar Ali; Gun, Ismet; Karaman, Erbil; Dogan, Ilkay; Turgut, Abdulkadir
Introduction: Cadmium, lead, and vanadium, important pollutants produced from anthropogenic activities, have been suggested to be embryotoxic and fetotoxic in many studies. However, the causes of preeclampsia are little known and heavy metals merit further investigation. We tested whether late-onset preeclampsia (L-PrE) was associated with exposure to these metals. Methods: This study was designed to determine maternal plasma cadmium, lead, and vanadium concentrations in women with L-PrE (n = 46) compared with those of normotensive women (n = 46). The concentrations of the metals were measured using inductively coupled plasma-mass spectrometry and compared. Results: The groups were matched for maternal age, gestational age, and gravidity (p >= 0.05). Vanadium concentrations differed between the groups (p = 0.007). In contrast, there were no significant differences in the concentrations of cadmium and lead between the groups (p >= 0.05). There was no difference between the concentrations of the metals in patients with mild (n = 23) and severe (n = 23) preeclampsia in L-PrE (p >= 0.05). A significant discriminative role of vanadium for the presence of L-PrE, with a cutoff value of 1.84 mu g/L, was found in ROC curve analysis. When the patients with and without small-for-gestational-age infants were compared (n = 12, and n = 80, respectively), it was determined that there were no differences between cadmium, lead, and vanadium concentrations (p >= 0.05). Conclusion: Lower levels of vanadium might be associated with the development of L-PrE. Our findings require further investigation in other populations.
Analyses of Soluble Endoglin and Matrix Metalloproteinase 14 Using Enzyme-Linked Immunosorbent Assay in the Diagnosis and Assessment of Severity of Early- and Late-Onset Pre-Eclampsia
(Galenos Yayincilik, 2021) Ovayolu, Ali; Ovayolu, Gamze; Karaman, Erbil; Guler, Selver; Dogan, Ilkay; Yuce, Tuncay
Objective: Abnormal trophoblastic invasion and impaired placentation have a crucial role in the etiopathogenesis of preeclampsia (PrE). Trophoblastic cells are involved in invading the maternal decidua and remodelling of the spiral arteries with matrix metalloproteinase-14 (MMP-14). MMP-14 cleavage of endoglin releases its extracellular region, the soluble form of endoglin (s-ENG), into the maternal circulation. In PrE, there is a relationship between endothelial dysfunction and s-ENG concentration. The aim was to determine and compare the serum levels of s-ENG and MMP-14 in different groups of PrE patients and healthy subjects. Material and Methods: The study included 30 patients with late-onset preeclampsia (L-PrE) (group 1; gestational age >= 34 weeks), 33 patients with normal pregnancy (group 2; gestational age >= 34 weeks), 31 patients early-onset preeclampsia (E-PrE) (group 3; gestational age < 34 weeks), and 31 patients with normal pregnancy (group 4; gestational age <34 weeks). s-ENG and MMP-14 concentrations measured using enzyme-linked immunosorbent assays were compared. Results: In all groups, MMP-14 concentrations decreased with increasing gestational age. s-ENG concentrations were highest in the E-PrE group. In groups 1 and 3, 29 had mild PrE while 32 suffered severe PrE and s-ENG concentrations did not differ between mild and severe preeclampsia (p=0.133). However, there was a significant difference in MMP-14 concentration comparing mild with severe PrE (3.11 +/- 0.61 vs 3.54 +/- 1.00; p=0.047, respectively). There was no correlation between s-ENG and MMP-14 concentrations. Conclusion: MMP-14 and s-ENG concentrations can be predictive biomarkers for the diagnosis of PrE. Maternal serum MMP-14 concentration may be a biomarker for determining the severity of PrE.
Analysis of Factors Affecting Outcomes of Pregnancy Complicated by Echinococcus: an Algorithm for Approach and Management
(Springer Heidelberg, 2018) Celik, Sebahattin; Okyay, Ozan; Karaman, Erbil; Sert, Ozlem Z.; Cim, Numan; Okyay, Tuba Y.
The management of hydatid disease (HD) co-occurring with pregnancy remains a challenge for physicians. We aimed to determine factors that were related to fetal and maternal outcomes in HD complicated pregnancies and then develop an approach/treatment algorithm. All patients at the participating hospitals were first analyzed to determine whether they had HD. Only patients diagnosed with HD during the course of their pregnancy were included. Certain cyst-related factors (diameter, localization, increase in size, and viability) and certain pregnancy-related factors (treatments, gestational week, maternal co-morbidities, and delivery type) were investigated. Nonlinear principal component analysis (NPCA) was performed to determine the relationships between the categories of variables. Out of 12,926 pregnancies, 27 cases were diagnosed with HD. In 13 cases, each developed at least one fetal problem. Using Albendazol in first trimester, presence of an active cyst, increased diameter by more than 1 cm during pregnancy and a cyst diagnosed in the second trimester were associated with at least one fetal problem. According to the NPCA results, cyst diameter when first diagnosed was related to fetal outcomes; a cyst greater than 10 cm was associated with "at least one fetal problem". Cysts 5-10 cm in diameter were in a neutral position, while 2-5 cm in diameter were in the "no problems" group. HD mostly affects fetus. If cyst-related and pregnancy-related variables are optimal, close follow-up on a monthly is the best course of action. However, in high-risk conditions, percutaneous interventions or surgery should be considered.
Analysis of Uterine Rupture Cases at a Tertiary Referral Center: a Retrospective Study
(2016) Karaman, Erbil; Çim, Numan; Çetin, Orkun; Güler, Hnım Şahin; Alkis, İsmet; Kolusarı, Ali; Yildizhan, Recep
Amaç: Komplet veya inkomplet uterin rüptür gelişen vakaların risk faktörlerini, perioperatif maternal-fetal sonuçlarını ve yönetim şekillerini retrospektif olarak belirlemektir. Gereç ve Yöntem: Bu çalışmada 2012 ile 2016 yalları arasında kliniğimizde uterin rüptür tanısı alan 28 hasta retrospektif olarak incelendi. Analiz için demografik bilgileri, risk faktörlerinin detayları, rüptürün tipi, yönetim şekli ve perioperatif maternal-fetal sonuçları ele alındı. Verilerin analizi için SPSS (ver: 20) istatistik programı kullanıldı. Bulgular: Çalışma döneminde %0.86 oranında 28 uterin rüptür vakası olduğu görüldü. Vakaların yirmisi (%71) inkomplet rüptür iken sekizi (%29) komplet rüptür idi. Vakalardan sadece 8'i kliniğimizde gelişen rüptür vakaları iken geri kalan 20 vaka kliniğimize dışarıdan refere edilen hastalardan oluşmaktaydı. Önceki uterus cerrahisi 22 hastada (%78.5) en sık görülen sebep idi. Bu hastalardan 18'inde 2 yada daha fazla geçirilmiş sezeryan öyküsü vardı. Grandmultiparite ikinci en sık görülen sebep idi(8 hasta). Uterin rüptür bölgesinin primer onarımı en sık yapılan cerrahi girişim idi (28 hastanın 25'inde, %89.2). Ana perioperatif komplikasyon 4 hastada (%14.2) görülen mesane yaralanması idi. Maternal mortalite görülmedi. Komplet rüptür grubunda kan transfüzyon ihtiyacı, ortalama hastanede kalış süresi, önceki sezeryanla doğum fetal ölüm ve mesane yaralanması inkomplet rüptür grubuna göre daha fazla görülmekteydi (p<0.05). Sonuç: Bu çalışma obstetrisyenlerin geçirilmiş uterin cerrahi yada grand multiparite gibi risk faktörleri olan hastalarda uterin rüptür gelişebileceği konusunda dikkatli olmaları gerektiğinin doğrulamaktadır. Uterin rüptür yönetiminde hızlı tanı, erken transport, yeterli kan ürünü transfüzyonu ve tecrübeli cerrahi ekibin varlığı çok önemlidir
Association of Cord Blood Ischemia-Modified Albumin Level With Abnormal Foetal Doppler Parameters in Intrauterine Growth-Restricted Foetuses
(Taylor & Francis Ltd, 2021) Andic, Esra; Karaman, Erbil; Kolusari, Ali; Cokluk, Erdem
Objective: To investigate cord blood ischemia-modified albumin (IMA) levels in pregnancies with intrauterine growth restriction (IUGR) and to determine its association with abnormal fetal Doppler findings.Methods: Umbilical cord IMA levels were assessed in 34 pregnant women with IUGR and 32 pregnancies with normal fetal development. Associations of IMA with abnormal umbilical artery Doppler findings, preeclampsia, and oligohydramnios were investigated. IMA was measured using a colorimetric test based on a decrease in cobalt binding.Results: No significant between group differences in maternal age, body mass index, gravida, and parity were identified. The mean gestational age at delivery was earlier in the IUGR group than in the control group (35.73.2 versus 38.4 +/- 1.2, respectively). The mean cord blood IMA values for the IUGR group were significantly increased compared to those in the control group (0.565 +/- 0.22 versus 0.250 +/- 0.12, respectively, p=.001). There was a significant positive correlation between umbilical artery pulsatility index and IMA levels in the IUGR group. Patients with preeclampsia, oligohydramnios, and abnormal nonstress test results in the IUGR group had significantly higher IMA levels. Patients with systolic to diastolic ratios >3 and pulsatility index (PI) above the 95th percentile in the IUGR group had significantly higher cord blood IMA levels (p=.001 and p=.007, respectively).Conclusions: Cord blood IMA values may be a useful marker for perinatal asphyxia. Abnormal Doppler findings are associated with increased IMA levels in complicated pregnancies with IUGR.
Can Kinesio Taping Be a Novel Treatment Option for Emesis Gravidarum? a Randomized Preliminary Study
(2018) Karaman, Erbil; Kaplan, Şeyhmus; Şahin, Hanım Güler; Kolusarı, Ali; Alpaycı, Mahmut; Çetin, Orkun
This prospective, randomized study included 77 women divided randomly into two groups. To investigate the effect of Kinesio taping on nausea and vomiting in women with Emesis Gravidarum. The study group received standard medications as metaclopramide(10 mg) twice in a day and vitamin B6(30 mg) single dose in a day and was performed Kinesio taping on the stomach region over the abdomen, while the control group received only the standard medications for treatment of emesis gravidarum. The degree of nausea and vomiting was evaluated by a 10-cm visual analogue scale (VAS) and Pregnancy unique quantification of emesis (PUQE) scoring. There was no statistically significant difference between the two groups regarding mean of age, gravidity, parity, body mass index, gestational weeks at admission. Both groups showed a significant reduction in nausea and vomiting after the treatments. However, when considering the decrease in PUQE scores and VAS scores in groups from baseline at admission to the fifth day of treatment, the Kinesio tape group was significantly superior than the control group (p=0.048). This randomized, preliminary study demonstrates that Kinesio taping can be a useful and novel treatment option as supplement to the standard medication in the management of emesis gravidarum.
Cardiovascular Evaluation and Serum Paraoxonase-1 Levels in Adolescents With Polycystic Ovary Syndrome
(Taylor & Francis inc, 2020) Cetin, Mecnun; Tuncdemir, Perihan; Karaman, Kamuran; Yel, Servet; Karaman, Erbil; Ozgokce, Mesut; Komuroglu, Ahmet Ufuk
The aim of our study was to evaluate whether cardiovascular disease risks seen in adults with polycystic ovary syndrome (PCOS) develop in adolescents with PCOS using conventional Doppler echocardiography (CDE) and tissue Doppler echocardiography (TDE) or not. The other aim was to investigate the association of paraoxonase-1 (PON-1) level with cardiovascular parameters. 30 PCOS patients and 30 control patients were included in the study. All patients were evaluated with TDE and CDE. Paraoxonase-1 levels of both groups were studied. In CDE study, myocardial performance index (MPI) was higher in the PCOS group than in the control group (0.54 +/- 0.11, 0.50 +/- 0.12, p = .049, respectively). In the TDE study, early diastolic myocardial velocity (E)'/late diastolic myocardial velocity (A ') was lower in PCOS group than in the control group (2.07 +/- 0.08, 2.44 +/- 0.10, p = .008, respectively). PON-1 was higher in PCOS group than in the control group (26.81 +/- 3.05, 18.68 +/- 1.18, p = .011, respectively). Cardiovascular disease risks, which are among the long-term complications of PCOS, seem to begin from the early stage of PCOS. The high PON-1 level was thought to increase in response to increased oxidative stress in PCOS.Impact statement What is already known on this subject? Polycystic ovary syndrome (PCOS) is one of the most commonly seen endocrinopathy in the adolescent age group. PCOS has detrimental effects on the cardiovascular system in the adult population which is reported in many studies. What the results of this study add? The result of this study showed that cardiovascular effects, which are among the long-term complications of PCOS, seem to begin from the early stage of PCOS. And also, serum paraoxonase-1 level increases in response to the oxidative stress in the adolescent with PCOS.
A Case of Metastatic Esophageal Carcinoma in a Pregnant Woman With Radiologic Findings
(Premchand Shantidevi Research Foundation, 2016) Akdemir, Zulkuf; Karaman, Erbil; Arslan, Harun; Calli, Iskan; Akdeniz, Huseyin
The incidence of all malignant tumours during pregnancy is extremely rare and esophageal carcinoma ranges from 0.07 to 0.1% of all malignant neoplasms. The physiological changes during pregnancy frequently mask the complaints and symptoms related to the disease. The physical and physiological clinical conditions limit the diagnostic approaches. Therefore, the stage of cancer at the time of diagnosis is usually advanced. The management with cancer surgery and chemotherapy regimens must be modified in pregnant women in order to minimize fetal and maternal risks. Here, we report a very rare case of metastatic esophagus cancer in a 39-year-old woman with 28 weeks of pregnancy and aim to show the ultrasound (USG) and magnetic resonance imaging (MRI) findings with treatment and follow up management.
Çocuklarda Ovaryan Teratomlar: 7 Yıllık Deneyimimiz
(2020) Düz, Ebuzer; Beger, Burhan; Karaman, Erbil; Şimşek, Metin; Kızılyıldız, Baran Serdar
Amaç: Torsiyon ile ilişkili olarak kist içine kanama nedeniyle kitle görünümü oluşabilmektedir ve over dokusunun kanlanması radyolojik olarak net değerlendirilemeyebilir. Bu nedenle torsiyone ve torsiyone olmayan MKT’ lerin tanısı ciddi bir ikilem olmaya devam etmektedir. Gereç ve Yöntem: CRP yüksekliği torsiyonun eşlik etiği vakaların %40’ında anlamlı derecede yüksek(>5mg/l) bulundu. En sık yapılan cerrahi, 14 vakada uygulanan fertilite koruyucu kistektomi (%77) idi. Bulgular: Torsiyon olan ve olmayan ovaryan teratomların laboratuvar ve görüntüleme yöntemleri istatistiksel yöntemle karşılaştırıldı. Sonuçlar SPSS versiyon 24 kullanılarak istatistiksel olarak değerlendirildi. Normallik kontrolleri Shapiro-Wilk testi ile yapıldı. Gruplar bağımsız örneklem ttesti ile karşılaştırıldı. İstatistiksel anlamlılık p <0.05 idi. Sonuç: Prospektif ve çok sayıda hasta ile çalışmanın planlanması uygun olacaktır. Benign ovaryan kitlelerde ilk tercih fertilite koruyucu cerrahidir. CRP, WBC ve CA19-9 özellikle torsiyon vakalarında işaretleyici olabilir.
Comparison of Placental Elasticity in Normal and Pre-Eclamptic Pregnant Women by Acoustic Radiation Force Impulse Elastosonography
(Wiley-blackwell, 2016) Karaman, Erbil; Arslan, Harun; Cetin, Orkun; Sahin, Hanim Guler; Bora, Aydin; Yavuz, Alparslan; Akbudak, Ibrahim
AimThe aim of this research was to study and compare placental elasticity with acoustic radiation force impulse (ARFI) elastography in pre-eclamptic and normal pregnancies. MethodsA total of 107 singleton pregnancies in the third trimester (38 healthy control subjects, 34 patients with gestational hypertension, and 35 pre-eclampsia patients) were included in the study. ARFI elastography was used to determine the placental elasticity in the three predetermined regions of the placenta (the fetal edge, maternal edge, and central part of the placenta). The obstetrical data regarding grayscale and Doppler ultrasonography and perinatal outcomes were reviewed. A mean placental shear wave velocity cut-off value that predicts the presence of pre-eclampsia was determined. ResultsThe shear wave elasticity values in the pre-eclampsia group in all three regions were significantly higher than in the gestational hypertension and healthy control groups (P=0.001). The most significant difference was found in the peripheral edge of the placenta from the fetal surface in the pre-eclampsia group (P=0.001). ConclusionThe stiffness of the placenta determined by the ARFI technique is significantly higher in pre-eclampsia patients. ARFI elastography of the placenta might be used as a non-invasive and easy method in the diagnosis and evaluation of pre-eclampsia as a supplement to the already existing methods.
Comparison of the Effectiveness of Single Dose Metotrexate Protocol and Combined Therapy of Letrazole and Single Dose Metotrexate in the Medical Management of Patients With Ectopic Pregnancy
(2022) Ayğar, Metin; Karaman, Erbil
Ektopik gebelikte tek başına tek doz metotreksat tedavisi ile tek doz metotreksat+letrozol tedavisinin başarısını karşılaştırmak, tedavi öncesi ve tedavi sonrası, β-hCG değişiminin, hemogram, biyokimya değerlerinin takibi, rüptüre veya medikal tedavi başarısızlığına bağlı cerrahiye gidişi değerlendirilip, çalışmamızdan elde edilecek bulgular ile erken dönemde kullanılabilecek alternatif tedavi seçeneklerini saptamak, bu tedavi seçenekleri ile maternal morbidite ve mortalitenin azalmasına, fertilitenin korunmasına katkıda bulunmak ve hastaların tedavi uyumlarını arttırıp, tedavi ve yatış maliyetlerini azaltmakır. Materyal – Metod Van Yüzüncü Yıl Üniversitesi Kadın Hastalıkları ve doğum kliniği'nde, Haziran 2021 ve Eylül 2022 tarihleri arasında obstetri ve jinekoloji polikliniklerine başvuran, ektopik gebelik tanısı konulan 60 hasta üzerinde yapılan prospektif bir çalışmadır. Bu amaçla çalışmaya dahil edilen 30 hastaya tek doz metotreksat tedavisi ve 30 hastaya tek doz metotreksat +letrozol tedavisi başlanmıştır. Ektopik gebelik tanısı konulan kişilerin β- HCG, hemogram, biyokimya değerleri bakıldıktan sonra, ciddi veya persistan karın ağrısı olmayan, β- HCG <5000 mIU/ml olan, fetal kardiyak aktivite izlenmeyen, ektopik kitle boyutu 3-4 cm'den küçük olan ve medikal tedaviye kontrendikasyonu olmayan 60 hasta çalışmaya dahil edildi. Çalışmanın sonunda tedavi sonrası kan parametrelerinde bozulma olanlar, rüptüre bağlı cerrahi tedavi gerektiren hastalar, medikal tedaviye yanıt alınamayan hastalar medikal tedaviye başarısızlık olarak değerlendirilmiştir. Bulgular Çalışmaya dahil edilen 60 hasta 2 gruba ayrıldı. Hastalar rastgele olarak sıralandı, tek sayılardaki hastalar yalnız metotreksat (MTX) tedavisi uygulanan (n=30) 1.grup, diğer çift sayılılar MTX+letrozol tedavisi uygulanan (n=30) 2. grup olarak belirlendi. MTX tedavisi uygulanan hasta grubunun yaş ortalaması 32,90±6,09 idi. MTX+letrozol tedavisi uygulanan hasta grubunun yaş ortalaması 29,00±4,73 idi. MTX grubunda β- hCG 7. gün 1010,53±1148,85, MTX+letrozol grubunda 927,50±1049,27 olarak bulundu. MTX+letrozol grubunda daha fazla düşme gözlenmiş olsa da istatistiksel olarak anlamlı bir fark bulunamadı. (p=0,771). MTX uygulanan grupta ALT 1. günde 14,37±4,93; MTX+letrozol uygulanan grupta 20,07±12,36 olarak bulundu aralarındaki fark istatistiki olarak anlamlıydı (p=0,022). MTX uygulanan grupta ALT 7. günde 20,20±19,25; MTX+letrozol uygulanan grupta 37,07±31,59 olarak bulundu aralarındaki fark istatistiksel olarak anlamlı bulundu (p=0,016). MTX uygulanan grupta AST 1. günde 16,60±4,49; MTX+letrozol uygulanan grupta 24,90±11,51 olarak bulundu aralarındaki fark istatistiki olarak anlamlıydı (p=0,001). MTX uygulanan grupta AST 7. günde 20,13±11,08; MTX+letrozol uygulanan grupta 40,37±34,07 olarak bulundu aralarında istatistiksel olarak anlamlı bulundu (p=0,003). MTX tedavisi uygulanan grupta β- hCG4.gün 1471,47±1379,46 ve 7.gün 1010,53±1148,85 olarak bulundu istatistiksel olarak anlamlı fark gözlemlendi (p=0,001). MTX+letrozol tedavisi uygulanan grupta β- hCG4.gün 1656,03±1544,69 ve β- hCG7.gün 927,50±1049,27olarak belirlendi, iki grup arası fark istatistiksel olarak anlamlıydı (p=0,001). Hastaların 4. ve 7. günler arasındaki β-hCG değişim yüzdesi, MTX tedavisi ugulananlarla MTX+letrozol uygulanan gruplar sırasıyla 36,98±25,94 ve 46,07±20,93 olarak bulundu. MTX+letrozol grubunda % bazında anlamlı olarak daha fazla düşme gözlenmiş olsa da istatistiksel olarak anlamlı fark bulunamadı (p=0,141). Yapılan çalışmamızda grup 2 de başlangıç β- hCG değerleri daha yüksek olmasına rağmen takiplerde 4. günden sonraki ölçümlerde daha hızlı ve keskin bir β- hCG düşüşü gözlemlendi. Sonuç MTX+letrozol tedavisinin MTX tedavisi ile aynı başarı oranına sahip olduğu görüldü. Ancak β- hCG değerlerindeki 4 ve 7. Gün düşüş oranlarının istatistiki olarak anlamlı izlenmemesine rağmen letrozol uygulanan grupta yüzdesel olarak daha keskin bir düşüş gözlemlenmiştir. Letrozol kullanılan grupta 7. Günde gözlenen karaciğer enzimlerinde yüksekliğin daha fazla olduğu görüldü ve bu sonuçla kullanılan ilaçların olası toksik etkilerinin göz önünde bulundurulması gerekmektedir.
Comparison of Topical Lidocaine Spray With Forced Coughing in Pain Relief During Colposcopic Biopsy Procedure: a Randomised Trial
(Taylor & Francis inc, 2019) Karaman, Erbil; Kolusari, Ali; Alkis, Ismet; Cetin, Orkun
Our objective was to compare the effectiveness of local lidocaine spray (LS) compared to forced coughing (FC) for relieving the pain during colposcopically guided cervical biopsies (CGBs). The study was a randomised study, which included patients with abnormal cervical cytologic results requiring a colposcopic biopsy procedure. The patients were randomly assigned to either the 10% LS or the FC groups before the biopsy procedure. As a primary outcome, the pain was assessed by using a 10cm visual analogue scale at the different steps during the procedure. Forty-four and 42 patients had CGBs using LS and FC, respectively. The age, parity, body mass index, history of previous curettage and vaginal delivery, smoking status and the number of biopsies were similar in both groups. The meanSD pain scores after the cervical biopsy were 3.251.4 and 4.41.3 in the LS and FC groups, respectively (p<.05). The operative time was longer in the LS than in the FC group (7.6 +/- 1.4 vs. 5.2 +/- 0.8, p: .004). No complication or adverse effect was observed in both groups. The present study showed that LS use can be recommended for pain relief during colposcopically directed cervical biopsy procedure with a superiority to the FC in the terms of pain and absence of any adverse reactions.Impact StatementWhat is already known on this subject? A colposcopic-guided cervical biopsy is a painful procedure and different techniques have been proposed to relieve this pain with conflicting results. Studies have demonstrated that a forced coughing is a good and easy method for relieving pain with some disadvantages. Local lidocaine spray (LS) is another option for pain relief during the biopsy procedure. However, no randomised study has compared these two methods yet.What the results of this study add? The results from this randomised study suggest that LS has superiority in terms of pain relief during the colposcopic biopsy procedure and has no adverse reactions.What the implications are of these findings for clinical practice and/or further research? The evidence from different studies showed some conflicting results regarding the pain relief methods during the colposcopic biopsy procedure. The local LS can be used in this procedure in routine clinical practice. However, further studies with larger samples and comparison of different methods are needed.
Conservative Management of Postpartum Hemorrhage
(Elsevier Taiwan, 2015) Karaman, Erbil; Alkis, Ismet; Han, Agahan; Ark, Hasan Cemal; Buyukkaya, Betul
The Diagnosis of Acute Appendicitis in Pregnant Versus Non-Pregnant Women: a Comparative Study
(Assoc Medica Brasileira, 2016) Aras, Abbas; Karaman, Erbil; Peksen, Caghan; Kiziltan, Remzi; Kotan, Mehmet Cetin
Objective: To investigate whether the diagnosis of acute appendicitis is affected by pregnancy or not. Method: A retrospective study with the analysis of the medical records of all women suspected of having appendicitis who underwent appendectomy at our hospital between June 2010 and March 2015 were reviewed. The patients were divided into two groups according to whether they were pregnant or not during the surgery: group I, pregnant women, and group II, non-pregnant women. Results: During the study period, 38 pregnant women and 169 non-pregnant women underwent appendectomy. The time from admission to the operation was not statistically different (2.17 +/- 1.47 days in group I vs. 1.98 +/- 1.66 day in group II; p=0.288). The pregnant group had longer hospital stay than the nonpregnant group (p=0.04). Ultrasonography (USG) was used as the first diagnostic modality in 36/38 patients in group I and 161/169 in group II. The non-visualized appendix on ultrasound was seen in 17 patients in group I and 51 patients in group II, which was not statistically different. Sensitivity and specificity of USG in diagnosis of acute appendicitis were 61.29 and 80.00% in group I, and 93.0 and 31.6% in group II, respectively. Conclusion: Although the diagnosis of appendicitis in pregnant women is not delayed, careful assessment of these patients suspected of having appendicitis should be encouraged when USG examination is normal or nondiagnostic.
The Effect of Patient Position During Mid-Urethral Sling Operations on the Postoperative Outcomes of Sling Success: a Randomized Clinical Study
(Karger, 2016) Han, Agahan; Karaman, Erbil; Alkis, Ismet; Ark, Hasan Cemal; Akca, Aysu; Numanoglu, Ceyhun; Tunca, Aysun Fendal
Aims: To determine and compare the effectiveness, peri- and postoperative outcomes of mid-urethral sling (MUS) operations for urinary incontinence, using 2 different patient positions during surgery. Methods: In this study, 146 patients underwent MUS surgery in a urogynecology clinic. Of them, 72 patients underwent the intraoperative surgical procedure of reverse trendelenburg patient positioning for tape adjustment (group 1) and the remaining 74 patients had the routine surgical procedure of MUS surgery (group 2). The primary outcome was the evaluation of postoperative urine leaks, using the stress test, and secondary outcomes were quality of life, using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF, Turkish version) and complication rates. Results: There were no significant differences in demographic variables between the 2 groups. The overall cure rates for incontinence in the lithotomy position was 97.22 and 85.13% for groups 1 and 2, respectively, in which group 1 had a statistically significant decrease in urine leak postoperatively (p < 0.05; OR 3.08, 95% CI 2.78-22.14). The postoperative ICQ-SF scores showed no significant difference between the 2 groups (p = 0.19). Conclusion: Applying a 45-degree reverse trendelenburg position for tape adjusting during MUS operation results in a greater objective cure rate compared with the typical dorsolithotomy position; however, there was no difference in the subjective outcome. (C) 2015 S. Karger AG, Basel
The Effect of Sublingual Misoprostol on Blood Loss in Abdominal Myomectomy, Abdulkadir Öktem, Md., Dissertation
(2023) Öktem, Abdulkadir; Karaman, Erbil
Amaç: Bu çalışmada abdominal myomektomi yapılan hastalarda preoperatif sublingual misoprostol kullanımının operatif kanama miktarı üzerine etkisinin incelenmesi amaçlandı. Yöntem: Randomize kontrollü olarak gerçekleştirilen bu araştırma; Van Yüzüncü Yıl Üniversitesi Dursun Odabaşı Tıp Merkezi Kadın Hastalıkları ve Doğum Kliniği'nde 21 Mart 2022 – 1Mart 2023 tarihleri arasında abdominal myomektomi yapılan 80 olgunun dâhil edildiği bir vaka-kontrol çalışmasıdır. Preoperatif sublingual 200 μg misoprostol uygulanan 40 olgu ve misoprostol uygulanmayan 40 kontrol grubu çalışmaya dahil edilmiştir. Bulgular: Gruplar arasında demografik, obstetrik ve myom özellikleri bakımından istatistiksel olarak anlamlı fark saptanmamıştır (p>0,05). Kontrol grubu ile karşılaştırıldığında olgu grubunda tahmini intraoperatif kan kaybı miktarı istatistiksel olarak anlamlı düzeyde daha az (629,33 ± 230,18 vs 445,38 ± 143,04 mL, p<0,001), intraoperatif sistolik kan basıncı ise anlamlı düzeyde daha yüksekti (p<0,001). Kontrol grubu ile karşılaştırıldığında misoprostol grubunda postoperatif 1.gün hemoglobin değeri (p = 0,044) ve postoperatif 2.saat (p = 0,003) ile 1.gün (p = 0,007) hematokrit değeri istatistiksel olarak anlamlı düzeyde daha fazlaydı. Ek olarak misoprostol grubunda postoperatif gaz çıkarma süresi daha kısa (p<0,001), postoperatif ateş ise daha yüksekti (p<0,001). Sonuç: Abdominal myomektomi operasyonunda preoperatif sublingual misoprostol kullanımı intraoperatif kan kaybı miktarını azaltmaktadır. Postoperatif hemoglobin ve hematokrit değerleri ise istenilen düzeylerde seyretmektedir. Anahtar Kelimeler: Abdominal myomektomi, sublingual misoprostol, intraoperatif kanama