Dinc, Kemal; Issın, Gizem

Objectives: Ectopic pregnancy is a life-threatening condition; delaying treatment can result in mortality or serious complications. Identification of a biomarker that can predict tubal rupture may be helpful for guiding treatment. In this study, we evaluated the association between serum β-hCG, biochemical markers, Systemic Immunity-inflammation Index (SII) score, and the trophoblastic invasion stage. Material and methods: Tubal pregnancy was classified into three groups based on the depth of trophoblastic infiltration: stage I — limited to the mucosa; stage II — invaded the muscular layer, and stage III — invaded the serosa/subserosa of the tuba uterine. The association between groups, serum β-hCG, biochemical markers, and the SII score were assessed. Results: There was no significant difference between the groups, hemoglobin, platelet count, MPV, RDW, NLR or PLR values (p > 0.05). A ROC analysis was performed to evaluate the accuracy of serum β-hCG predictions for infiltration level. At a 95% confidence interval upper limit, cut-off value of the serum β-hCG that best predicted stage III trophoblastic infiltration, was 2799 mIU/mL, with 78.9% sensitivity, 53.8% specificity (positive predictive value was 71.4%, and a negative predictive value was 63.6%). Moreover, ROC curve analysis showed that The SII value of 792 was the best predictor of trophoblastic infiltration at stage III, with a sensitivity of 92.3% and a specificity of 63.1%. Conclusions: A linear relationship exists between depth of trophoblastic infiltration and serum β-hCG and the SII were observed. These findings suggested that the SII score can be used for predicting tubal ectopic pregnancy rupture

Yildiz, Caglar; Celik, Veysel Kenan; Kurt, Begum; Kapancık, Serkan; Kılıcgun, Hasan

Objectives: Since we assumed that endometriosis is a benign cell division disorder, our study was conducted to investigate the effects of the relationships between polyamine synthesis and angiogenesis in the formation of endometriosis. Material and methods: Thirty-five patients with endometriosis and 35 healthy female women were included in the study. The patient and the control groups were compared regarding the blood levels of agmatine, argininecarboxylase (ADC), ornithinecarboxylase (ODC), agmatinase, arginase, ornithine, and the vascular endothelial growth factor (VEGF). Results: There is a statistically significant difference between the patient and the control groups regarding the agmatinase, arginase and VEGF levels (higher in the patient group) (p < 0.05). There is no statistically significant difference between the patient and the control groups regarding the ODC, ornithine and the ADC levels (p > 0.05). There is a statistically significant difference between the patient and the control groups regarding the agmatine levels (higher in the control group) (p < 0.05). Conclusions: The increase in the serum levels of polyamine synthesis enzymes may contribute to the formation of endometriosis. It is anticipated that the study of the relationship between enzymes and molecules in the polyamine synthesis pathway and angiogenesis in patients with endometriosis will contribute to the literature.

Lakhno, Igor Victorovich; Uzel, Kemine

Objectives: The values of acceleration capacity and deceleration capacity are known to capture fetal neurological development. The fetal growth restriction was found to be featured by decreased variables of phase rectified signal averaging. We have speculated that acceleration capacity and deceleration capacity could be of use in the detection of antenatal fetal distress during fetal growth restriction. The study was focused on the detection of the accuracy of acceleration capacity and deceleration capacity in diagnosing fetal distress. Material and methods: In total, 124 pregnant women at 26–36 weeks of gestation were included in the study. The patients with appropriate to gestational age fetuses (n = 32) were enrolled in Group I. The patients with fetal growth restriction and an absence of fetal distress (n = 48) were observed in Group II. Lastly, the patients with fetal growth restriction and fetal distress (n = 44) were included in Group III. Fetal cardiosignals were obtained via non-invasive fetal electrocardiography. The maximally decreased acceleration capacity and deceleration capacity values were found in Group III. Results: A correlation was found between umbilical artery resistance index and acceleration capacity and deceleration capacity variables in all study groups. We have found that the application of phase rectified signal averaging in the antenatal period showed high sensitivity and specificity in fetal distress detection. Conclusions: Fetal acceleration capacity and deceleration capacity is a prospective option for the detection of fetal compromise during fetal growth restriction.

Ata, Nahit; Kulhan, Mehmet; Kulhan, Nur Gozde; Turkler, Can

Objectives: An investigation of the importance of hematological inflammatory markers on the prognosis of first trimester pregnancies and their role in predicting threatened abortion and early pregnancy loss. Material and methods: This study was carried out in the Obstetrics and Gynecology Department of the Faculty of Medicine in our University between January 2018 and May 2019. Three-hundred individuals, 100 of them diagnosed with early pregnancy loss (EPL), 100 diagnosed with threatened abortion (TA) and 100 healthy control patients (HC), participated in the study. Results: There were no statistically significant differences in terms of hemoglobin, platelet, neutrophil count and NLR between the three groups. The RBC counts were significantly lower in EPL and TA compared to HC. Similarly, it was determined that the MPV value was significantly lower in EPL compared to HC. On the other hand, there was no difference in MPV between TA and HC. The PLR was higher in EPL and TA. Conclusions: MPV, RBCs and PLR values were strongly associated with first-trimester miscarriage. These economical and easily measurable platelet indices can be used to predict fetal losses.

Turkler, Can; Kulhan, Mehmet; Kulhan, Nur Gozde; Ata, Nahit; Sanci, Muzaffer; Ozeren, Mehmet

Objectives: Evaluation of the effect of lymphadenectomy in disease-free and overall survival on the low risk corpus cancer. Material and methods: Between 1994 and 2012, a total of 257 patients with endometrioid type, grade 1 or 2, myometrial invasion < 1/2, no intraoperative evidence of macroscopic extrauterine spread was treated surgically. Pelvic lymphadenectomy was performed in 184 cases, and not performed in 73 cases. Results: There was no difference between two groups about tumor sizes. Also lymphovascular space invasion and histologic grade of two groups were similar. Omission of LA did not worsen DFS and OS in early stage low risk corpus cancer. Conclusions: Patients who have low risk corpus cancer, can be treated optimally with hysterectomy only.

Nayki, Cenk; Gunay, Murat; Kulhan, Mehmet; Nayki, Umit; Cankaya, Murat; Kulhan, Nur Gozde

Objectives: The aim of this paper is to determine the oxidative-antioxidative status and levels of soluble interleukin-2 receptor (sIL-2R) in serum of patients with different types of HPV infections and to compare it with patients who are negative for HPV. Material and methods: A total of 80 women were divided into three groups as follows: Group 1 consisted of 25 women who were positive for HPV types 16 or 18; Group 2 consisted of 25 women who were positive for other types of HPV including type 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 or 68; Group 3 consisted of 30 patients who were negative for HPV as a control group. Serum sIL-2R and plasma oxidative stress index (OSI) were analyzed. Results: Serum sIL-2R levels were significantly higher in group 1 compared to group 2 and 3. OSI was found significantly increased in groups 1 and 2 compared to group 3. Also, we found a weak positive correlation between IL-2R and OSI. Conclusion: sIL-2R and oxidative stress may have a role in HPV infection, especially in case of high-risk types.

Kulhan, Mehmet; Kulhan, Nur Gozde; Nayki, Umit; Nayki, Cenk; Ulug, Pasa; Ata, Nahit; Toklucu, Hulya

Objectives: Appendicitis is the most common condition leading to an intraabdominal operation for a non obstetric problem in pregnancy and diagnosis of appendicitis is complicated by the physiologic and anatomic changes that occur during pregnancy. Although a surgical procedure carries the risk of fetal loss or preterm delivery, delay in diagnosis also increases the risk of complications in both mother and fetus. In this report we present our experience and analyze clinical characteristic and the pregnancy outcomes of appendicitis diagnosed incidentally during cesarean in the third trimester. Material and methods: The study population consisted of 23 pregnant women who were diagnosed incidentally with appendicitis during cesarean at Erzincan University Hospital between 2015 and 2016. Results: Appendectomy was performed on 23 patients during a caesarean section performed for any reason. The mean diameter of appendix was 7.82 ± 1.85 mm. The mean operation time was 67.39 ± 18.94 SD and antibiotic therapy was given to all patients. Postoperative complications were noted in 4 (17.4%) patients. Wound infection was seen in 4 (17.4%) patients, the other 19 patients revealed no postoperative complications. The mean of APGAR score of newborns in the postoperative period was 8.26 ± 0.86 SD and no complications were observed in both mothers and newborns. Histopathology of the specimen confirmed acute appendicitis in 23 (100%) cases. Conclusions: Acute appendicitis is a challenging diagnosis in the pregnant patient; however, early surgical intervention should be performed with any suspicion. The type of surgery depends on the surgeon's preference and experience.

Kulhan, Mehmet; Kulhan, Gozde; Nayki, Umit; Nayki, Cenk; Ulug, Pasa; Sipahi, Mehmet; Yildirim, Yusuf

Objectives: We aimed to evaluate and compare the clinical and pathological features, diagnosis, treatment, and prognosis of uterine papillary serous carcinoma (UPSC) and clear-cell carcinoma (CC). Material and methods: Thirty-four patients who were operated on for UPSC and CC carcinoma at the Izmir Tepecik Research and Teaching Hospital, between January 1983 and December 2014, were included. Patients were evaluated for the following factors: Age, gravidity, parity, preoperative CA-125, tumor size, myometrial and lymphovascular invasion, lymph node tumor metastasis, presence of atypical cells in peritoneal cytology, pathology results, operation types, whether or not they received postoperative adjuvant therapy, prognosis, and death rate. Results: The stage of the disease was the main factor affecting disease-free and the overall survival. Cisplatin-based chemotherapy was partially effective in patients with postoperative recurrence, while postoperative adjuvant radiotherapy proved to be more effective in preventing relapse. Conclusion: The studied parameters generally were concordant with the literature but, due to the relatively small sample size, more comprehensive and multicenter studies are needed to generate valid results.

Kulhan, Gozde; Kulhan, Mehmet; Nayki, Umit; Nayki, Cenk; Ulug, Pasa; Akkaya, Emrah; Aldemir, Onur S.; Yildirim, Yusuf; Sipahi, Mehmet

Objectives: Our study aimed to determine the epidemiological characteristics and diagnostic and treatment protocols of primary vaginal carcinoma. Also, we compared the clinical and pathological features of primary vaginal carcinoma which intersect with cervical and vulvar carcinomas. Material and methods: Sixteen patients with primary vaginal carcinoma, admitted to the Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital between January 1983 and December 2012, were evaluated retrospectively. FIGO (International Federation of Gynecology and Obstetrics) Surgical staging was performed. The SPSS (Statistical Package for Social Sciences) program was used for statistical analyses. Results: The histological distribution of the 16 patients with primary vaginal carcinoma was as follows: 9 patients (56.3%) with squamous cell carcinoma (SCC), 5 (31.3%) with rhabdomyosarcoma, and 2 (12.5%) with adenocarcinoma. Conclusion: The stage of the disease was found the be the main factor affecting the survival.

Emirdar, Volkan; Nayki, Umit; Ertas, Ibrahim E.; Nayki, Cenk; Kulhan, Mehmet; Yildirim, Yusuf

Objectives: To determine the short-term effects of adjuvant or primary curative radiotherapy (RT) on the urinary system in women with gynecologic cancer. Material and methods: This is a prospective, concurrent cohort study including 55 patients with gynecologic cancer who were divided into three groups. Group 1 included 10 patients who were administered adjuvant RT following a radical hysterectomy (RH); Group 2 included 36 patients who were administered adjuvant RT following a type 1 hysterectomy and Group 3 included 9 patients who were administered primary curative RT. Urogynecologic assessments were carried out on patients before and six months after the treatment. Results: Compared to pretreatment, no significant differences were observed in any of the three groups after treatment in terms of incontinence, first urge to urinate, normal urge to urinate, severe urge to urinate and changes in residual urine volumes. There was a significant decrease in maximal vesical pressure after treatment in Group 1 and Group 3. The maximum detrusor pressure decreased significantly in Group 1. The post-treatment decline in bladder capacity in Group 1 and Group 2 was also significant. Conclusions: RH and pelvic RT cause lower urinary system dysfunction. Especially patients who receive primary curative RT and patients who are administered RT after RH, where more pelvic denervation occurs, are at higher risk due to high doses of RT.