Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Differences fin Geographical Distribution and Risk Factors for Urinary Incontinence in Turkey: Analysis of 6,473 Women(2014) Dursun, Polat; Dogan, Nasuh Utku; Kolusari, Ali; Dogan, Selen; Ugur, Mete Gurol; Komurcu, Ozge; Altuntas, Baris; Gultekin, Murat; Celik, Nilufer Yigit; Karaca, Mehmet; Guzel, Ahmet Baris; Cim, Numan; Ege, Serhat; Koc, Onder; Yigit, Filiz Altinok; https://orcid.org/0000-0001-5139-364X; 24051428Objective: To assess the prevalence, types and risk factors for urinary incontinence (UI) and to evaluate the impact of incontinence on quality of life by using validated and objective questionnaires in the western and eastern parts of Turkey. Methods: In this multicenter observational study, 6,473 women from 38 cities in the western and eastern parts of Turkey were included. UI was assessed by ICIQ-SF (International Consultation on Incontinence Questionnaire Short Form) and IIQ-7 (Incontinence Impact Questionnaire). Results: The UI rate was 20.9% (10% for stress, 8.3% overactive bladder and 2.6% for mixed type). In all, stress incontinence was the most common type. The rate of UI in women residing in the west was higher than in women living in the east (p < 0.001). ICIQ scores were comparable in the two groups but women in the west scored higher in each item of the IIQ. Age >40 years (p < 0.001), number of siblings >5 (p < 0.001) and low educational status (p < 0.001) increased the rate of incontinence. In binary logistic regression analysis menopausal status, age >40 years, number of siblings >5, being overweight, region of residence, and educational status were associated with UI. Conclusion: The rate of UI in women residing in the western part of Turkey was higher than women living in the east. Residing in a different geographical region (in our case living either in the western or eastern part of Turkey) seemed to be an independent risk factor for UI. Moreover, UI deteriorates quality of life and more attention should be paid to this vulnerable population. (C) 2013 S.Karger AG, BaselItem The Effect of Captopril on Endometriotic Implants in A Rat Model(2014) Oktem, Mesut; Ozcan, Pinar; Erdem, Ozlem; Karakaya, Cengiz; Cenksoy, Cahit; Guner, Haldun; Karabacak, Onur; Dursun, Polat; 25090631Objective: To determine the effects of captopril on experimentally induced endometriosis in a rat model. Study design: Twenty-four adult, mature female Wistar-Albino rats in which endometriotic implants were induced by transplanting autologous uterine tissue to ectopic sites on the peritoneum. After the endometriotic implants were formed surgically, the 24 rats were randomly divided into three groups. Group 1 (captopril group, eight rats) were given 50 mg kg(-1) d(-1) of oral captopril for 21 d. Group 2 (leuprolide acetate group, eight rats) were given a single 1 mg kg(-1) subcutaneous injection of leuprolide acetate. Group 3 (control) were given no medication and served as controls (eight rats). The surface area of the endometriotic implants and the score of histologic analysis. Also, VEGF and MCP-1 levels in peritoneal fluids and bloods were analyzed. Results: At the beginning of the medical treatment, the mean surface areas of the endometriotic implants were comparable in all three groups. At the end of the treatment the mean implant surface area in the captopril group and leuprolide acetate group was less than that in the control group. Mean histopathological examination score for the implants post treatment was lower in the captopril and leuprolide acetate groups. Peritoneal fluids VEGF level in the captopril and leuprolide acetate groups was lower than that in the control group. The post-treatment MCP-1 level was also lower in the captopril and leuprolide acetate groups than in the control group. The serum VEGF and MCP-1 levels post treatment were significantly lower in the captopril and leuprolide acetate groups than in the control group. Conclusion: Administration of captopril reduced the size and progression of endometriotic lesions in a rat model. (C) 2014 Elsevier Ireland Ltd. All rights reserved.Item Oncofertility for Gynecologic and Non-Gynecologic Cancers: Fertility Sparing in Young Women of Reproductive Age(2014) Dursun, Polat; Dogan, N. Utku; Ayhan, Ali; 25090914; AAJ-5802-2021About ten percent of all female cancer survivors is younger than 40 years of age. For these young women the primary goal is to ensure the highest possibility of cure and to maintain the reproductive functions as well. Oncofertility is a new concept including both oncology and reproductive medicine. By this recently defined concept young women will have maximal chance to make an optimal decision without any significant impact and delay in oncologic outcome. Oncofertility concept could be applied for genital cancer as well as non-genital cancer of reproductive age. Currently sperm and embryo banking are the standard methods used for young patients with cancer whose future fertility is under risk. In contrary oocyte banking, ovarian tissue cryopreservation are all controversial procedures and still accepted as experimental by many authors although American Society of Reproductive Medicine (ASRM) consideres oocyte cryopreservation "no longer experimental". For genital cancers procedures for oncofertility depends on the type of the cancer and the treatment of choice. In this review the current data and concepts regarding oncofertility concept including the gynecologic oncologic perspective is reviewed. (C) 2014 Elsevier Ireland Ltd. All rights reserved.Item Gynecologic Oncologist Perspective About ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer(2017) Dursun, Polat; Ayhan, Ali; AAJ-5802-2021ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer was simultaneously published in 3 prestigious journals and is sure to have a huge impact on the clinical practice of gynecologic oncology community and other gynecologic cancer care providers. It is a tremendous report representative of great effort. Hovewer, as practicing gynecologic oncologists, endometrial carcinoma is the most common clinical entity encountered in our routine daily practice; as such, we find some of the report confusing and object to some of its findings, as detailed in this brief report. We also attempted to summarize the differences between the well-known NCCN guidelines and the ESMO-ESGO-ESTRO Consensus Conference guidelines and try to give the point of view of gynecologic oncologic perspective. It is obvious that differences in the management of endometrial carcinomas will continue to be debated by the scientific community.Item Cervical Carcinoma in a Renal Transplant Recipient: A Case Report(2016) Tuncer, Hasan Aykut; Kirnap, Mahir; Dursun, Polat; Ayhan, Ali; Moray, Gokhan; Haberal, Mehmet; https://orcid.org/0000-0002-5434-1025; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; 25807337; K-1760-2018; AAH-9198-2019; AAJ-5802-2021; AAE-1041-2021; AAJ-8097-2021A range of cancer types, at increased rates, is described in renal transplant recipients receiving immunosuppression. Aside from immunodeficiency, heightened medical surveillance for cancer, lifestyle, and other risk factors all play a role. Although the relation between cancer risk and degree of immunodeficiency might not be linear, and might be different for a wide range of cancer subtypes, human papillomavirus-related cancers in long-term transplant recipients may suggest the role of even modest immunosuppression, when present long enough. High-risk human papillomavirus types are recognized as the cause of cancer of the cervix. We report a 49-year-old female renal transplant recipient diagnosed with cervical squamous cell carcinoma, 5 years after the transplant. Based on this patient, we highlight difficulties in surgical approach and the importance of close clinical follow-up including regular gynecologic screening for cervical premalignant and malignant lesions.Item Risk Factors for Residual Disease After Cervical Conization in Patients with Cervical Intraepithelial Neoplasia Grades 2 and 3 and Positive Surgical Margins(2016) Ayhan, Ali; Tuncer, Hasan Aykut; Reyhan, Nihan Haberal; Kuscu, Esra; Dursun, Polat; 0000-0001-9852-9911; 0000-0002-5434-1025; 0000-0002-0992-6980; 27038228; AAK-4587-2021; K-1760-2018; AAJ-5802-2021; AAI-8792-2021Objective: To evaluate risk factors for the persistence of cervical intraepithelial neoplasia (CIN) grade >= 2 following repeat surgical procedures in patients with CIN grades 2 and 3 and positive surgical margins. Study design: This study included patients with CIN grades 2 and 3 and positive surgical margins following loop electrosurgical excision procedures (LEEP), who had undergone additional surgery between 2007 and 2014. Factors associated with CIN grade >= 2 on biopsy results after the second operation were assessed by multiple logistic regression analysis. Factors considered included patient age, parity, menopausal status, smoking, referral cytology, initial LEEP pathology, time interval between LEEP and surgical procedures, presence of disease on endocervical sampling, endocervical surgical margins, glands, disease surrounding >= 50% of the cervical circumference and requirement for multiple sweeps on initial LEEP to excise a lesion. The forward likelihood ratio method was used and significance was set at p < 0.05. Results: Repeat surgical procedures were performed in 104 patients, 75 with CIN 2 and 29 with CIN 3, with 43 (41.3%) reported as normal or CIN 1. However, 57 (54.8%) patients had CIN >= 2 lesions and four (3.8%) had previously undiagnosed cervical cancer. Factors associated with CIN >= 2 lesions included requirement for multiple sweeps (vs. a single sweep; odds ratio [OR] 5.967; 95% confidence interval [CI] 2.183-16.311, p < 0.001) and involvement of >= 50% of the cervical circumference (vs. <50%; OR 5.073; 95% CI 1.501-17.146, p = 0.009). Conclusion: As lesions requiring multiple sweeps for excision and/or surrounding >= 50% of the cervical circumference during initial conization are associated with recurrent CIN >= 2 lesions, attention should be paid during resection to prevent margin positivity. If surgical margins are positive, however, repeat surgical procedures should be considered in patients with CIN 2 and CIN 3 lesions and these risk factors. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Item Evaluation of a New Oncogynecologic Training Program(2016) Tuncer, Hasan Aykut; Ozgul, Nejat; Kuscu, Esra; Dursun, Polat; Ayhan, Ali; 0000-0002-0992-6980; 0000-0002-5434-1025; 27465887; AAJ-5802-2021; AAI-8792-2021; K-1760-2018Objective The first cohort of Turkish fellows has begun to graduate from a newly accredited training program on gynecologic oncology. This study aimed to investigate the value of experience on the confidence of these fellows to perform surgical procedures. Methods We assessed the characteristics of 32 fellows, including the perceived adequacy of their fellowship training, the facilities of the clinics at which they were trained, and their levels of exposure and confidence in performing a total of 44 procedures. Exposure levels were performing, assisting with, observing, or no exposure. Confidence was assessed by asking whether they could perform each procedure. Correlation analysis was used to determine the link between exposure levels and confidence. Results The confidence of fellows to perform a surgical procedure increased with exposure to that procedure (r = 0.820, P < 0.001). Performing, assisting with, and observing a procedure created a sense of confidence in 97.2%, 54.1%, and 31.1% of fellows. The majority of fellows (>75%) had performed type 2 hysterectomy, total omentectomy, and pelvic and para-aortic lymphadenectomy. None of the fellows had ever performed a trachelectomy. Conclusions Efforts should be made in accredited systems for gynecologic oncology surgical training to provide more opportunities for trainees to perform surgical procedures, rather than assisting with and observing them.Item Potential Role of Increasing Number of Sections in Frozen Section Diagnosis of Ovarian Tumors(2016) Ayhan, Ali; Ozler, Ali; Dursun, Polat; Haberal, A. Nihan; 0000-0001-9852-9911; 27849334; AAK-4587-2021; AAJ-5802-2021Objective: To assess the accuracy of intraoperative frozen section of ovarian tumours at our institution and to identify the possible reasons for misdiagnosis. Study Design: Between January 2002 and August 2013, a total of 684 patients were included in the study. Frozen section diagnosis was compared with the final paraffin section diagnosis as the gold standard. The sensitivity, specificity, and positive and negative predictive values of frozen-section diagnosis were calculated for benign, borderline and malignant tumours. Clinicopathological parameters influenced by misdiagnosis were evaluated performing multivariate logistic regression analysis. Results: The overall accuracy was detected as 96.1%. Frozen-section diagnoses of 26 patients (3.8%) showed discordance. The specificity (99.7%) and PPV (99.4%) of frozen-section diagnosis was highest in the malignant category. In BOTs, diagnostic agreement was observed in 57 of 70 (81.4%) cases. The PPV (81.4%) was lowest for these patients. Tumour diameter of >= 10 cm (OR [95% CI]= 3.0 [1.1 to 8.2]; P=0.030) and mucinous histology (OR [95% CI]. 2.5 [1.0 to 6.2]; P=0.042) were significant predictors of misdiagnosis. With the increase in the number of sections, the accuracy rate of frozen section diagnosis was decreased. While not statistically significant (p=0.361). Conclusion: The number of sections is increased parallel to increase in tumor diameters. On the contrary, the diagnostic accuracy was no significantly increased with an increase in the number of sections. This discrepancy may be associated with falling tumor size per frozen section. A prospective study based on a certain tumour diameter per frozen section may better demonstrate the positive effect of the number of sections.Item The Preoperative Albumin Level Is an Independent Prognostic Factor for Optimally Debulked Epithelial Ovarian Cancer(2017) Ayhan, Ali; Gunakan, Emre; Alyazici, Irem; Haberal, Nihan; Altundag, Ozden; Dursun, Polat; https://orcid.org/0000-0003-0197-6622; 28875365; AAJ-5802-2021; W-9219-2019Purpose A low albumin level has been reported to be a prognostic factor for various cancers. The aim of this study was to determine the association between preoperative serum albumin level and survival in patients with epithelial ovarian cancer (EOC). Methods Records of 337 patients with EOC that underwent optimal cytoreductive surgery were retrospectively reviewed. Threshold albumin level was planned as 32.5 g L-1 due to the statistical analyses. Results Mean overall survival was 51.5 months. Area under the ROC curve was found statistically significant for the discriminative role of albumin for survival outcome (AUC = 0.857, 95% CI 0.813-0.90, P < 0.001). The best cut-off point for albumin was determined as 32.5 g L-1. The sensitivity rate, specificity rate, positive and negative predictive values, and accuracy rate for this cut-off level were found 67.2, 91.2, 81.2, 83.1, and 82.5%, respectively. Preoperative hypoalbuminemia was noted in 101 (30.0%) of the patients, of which 6.2% had an albumin level < 25 g L-1. The albumin level was independently and significantly associated with overall survival (HR 2.6; 95% CI 2.1-3.1; P < 0.001). Subgroup analysis showed that patients with an albumin level < 32.5 and >= 32.5 g L-1 had mean estimated overall survival of 40.6 and 96.0 months, respectively. Age, stage, and presence of ascites were the other independent significant factors. Conclusions The preoperative albumin level is an independent prognostic factor for overall survival in optimally debulked EOC patients. Further investigations about preoperative albumin level in prognostic models will contribute to the literature.Item A Call for New Communication Channels for Gynecological Oncology Trainees: A Survey on Social Media Use and Educational Needs by the European Network of Young Gynecological Oncologists(2017) Zalewski, Kamil; Lindemann, Kristina; Halaska, Michael J.; Zapardiel, Ignacio; Laky, Rene; Chereau, Elisabeth; Lindquist, David; Polterauer, Stephan; Sukhin, Vladislav; Dursun, Polat; https://orcid.org/0000-0002-4403-3707; 28187096; T-6723-2018Objective: The aim of the study was to assess patterns in the use of social media (SM) platforms and to identify the training needs among European gynecologic oncology trainees. Methods: In 2014, a web-based survey was sent to 633 trainees from the European Network of Young Gynaecological Oncologists (ENYGO) database. The 14-item questionnaire (partially using a 1-to 5-point Likert scale) assessed respondents' use of SM and preference for workshop content and organization. Descriptive analysis was used to describe the mean scores reported for different items, and the internal reliability of the questionnaire was assessed by Cronbach alpha. Results: In total, 170 ENYGO members (27%) responded to the survey. Of those, 91% said that they use SM platforms, mostly for private purposes. Twenty-three percent used SM professionally and 43% indicated that they would consider SM to be a clinical discussion forum. The respondents said that they would like updates on conferences and professional activities to be shared on SM platforms. Complication management, surgical anatomy, and state of the art in gynecologic oncology were identified as preferred workshops topics. The most frequently indicated hands-on workshops were laparoscopic techniques and surgical anatomy. Consultants attached a higher level of importance to palliative care education and communication training than trainees. The mean duration of the workshop preferred was 2 days. Conclusions: This report highlights the significance of ENYGO trainees' attachment to SM platforms. Most respondents expect ENYGO to use these online channels for promoting educational activities and other updates. Using SM for clinical discussion will require specific guidelines to secure professional and also consumer integrity. This survey confirms surgical management and the state of the art as important knowledge gaps, and ENYGO has tailored its activities according to these results. Future activities will further direct attention and resources to education in palliative care and molecular tumor biology.