Wos Açık Erişimli Yayınlar
Permanent URI for this collectionhttps://hdl.handle.net/11727/10754
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Item What is the predictive value of preoperative CA 125 level on the survival rate of type 1 endometrial cancer?(2021) Baran, Safak Yilmaz; Alemdaroglu, Songul; Durdag, Gulsen Dogan; Simsek, Seda Yuksel; Bolat, Filiz Aka; Kose, Fatih; Celik, Husnu; 0000-0001-5874-7324; 0000-0003-4335-6659; 0000-0003-3191-9776; 0000-0002-0156-5973; 32979897; AAI-8400-2021; AAK-7016-2021; G-4827-2016; AAL-1923-2021Background/aim: To investigate the utility of preoperative serum cancer antigen 125 (CA 125) levels in type 1 endometrial carcinoma (EC) as a marker for determining poor prognostic factors and survival. Material and methods: All patients with endometrial cancer, who had been treated between 2012 and 2020, were retrospectively reviewed, and finally, 256 patients with type 1 endometrium carcinoma were included in the study. The relationship between the clinicopathological characteristics, CA 125 level, and survival rates were analyzed. The cut-off value for the preoperative serum CA 125 level was defined as 16 IU/L. Results: The median serum CA 125 levels were significantly higher in patients with deep myometrial invasion, lymph node metastasis, lymphovascular space invasion, cervical stromal and adnexal involvement, advanced stage, positive peritoneal cytology, recurrence, and adjuvant therapy requirement. Serum CA 125 cut-off values determined according to clinicopathologic factors ranged from 15.3 to 22.9 IU/L (sensitivity 61%-77%, specificity 52%-73%). The disease-specific survival rate was significantly higher in patients with CA 125 levels < 16 IU/L (P = 0.047). Conclusion: The data showed that choosing a lower threshold value for the CA 125 level (16 IU/L) instead of 35 IU/L, could be more useful in type 1 EC patients with negative prognostic factors.Item Prevention of preterm delivery by cervical cerclage; a comparison of prophylactic and emergency procedures(2021) Simsek, Seda Yuksel; Simsek, Erhan; Durdag, Gulsen Dogan; Alemdaroglu, Songul; Baran, Safak Yilmaz; Kalayci, Hakan; 0000-0003-3191-9776; 0000-0002-1505-5288; 0000-0002-5064-5267; 0000-0003-4335-6659; 0000-0001-5874-7324; 32517429; AAK-7016-2021; AAI-9594-2021; AAI-8400-2021Objective: Prophylactic or emergency type cervical cerclage procedures are being used for treatment of cervical insufficiency. The aim was to review and compare the outcomes of these cerclage types and identify factors affecting outcomes. Material and Methods: Retrospective review of seventy-five patients in whom transvaginal cervical cerclage procedures were performed over a seven-year period in a tertiary referral center. Results: Twenty seven of 75 (36%) patients were in the emergency cerclage group and 48 (64%) of them were in the prophylactic group. Mean body mass index (BMI), hospitalization time and gestational week at cerclage were significantly higher, whereas latency period was significantly shorter for the emergency group. Mean gestational ages at delivery were 35.6 +/- 4.5 and 33.6 +/- 5.9 weeks in the prophylactic and emergency groups, respectively (p=0.117). Delivery rates under 34th gestational week were 20.8% and 37.0% in the prophylactic and emergency groups, respectively (p=0.175). Birthweight, and delivery >= 34th gestational week was higher in the prophylactic group, whereas complication rate was higher in the emergency group, but these differences were not significant. High BMI was associated with more deliveries before 34-week in the prophylactic group. Pre-cerclage cervical length was shorter in patients who delivered before 34 gestational weeks at delivery. Conclusion: Prophylactic and emergency cerclage procedures have comparable results regarding gestational week at delivery. High BMI and low pre-cerclage cervical length may have adverse effects on success of cerclage procedures.Item Prognostic factors of endometrial cancer in elderly patient group and their effects on survival(2021) Alemdaroglu, Songul; Durdag, Gulsen Dogan; Baran, Safak Yilmaz; Simsek, Seda Yuksel; Yetkinel, Selcuk; Yaginc, Didem Alkas; Guler, Ozan Cem; Celik, Husnu; 0000-0003-4335-6659; 34585068; AAI-8400-2021OBJECTIVE: The objective of the study was to investigate the prognostic factors of the elderly group and their effects on survival by examining the histopathological features, surgical treatment protocols, and treatment modalities of patients diagnosed with endometrial cancer (EC). METHODS: The records of 397 EC patients who completed their treatment and follow-up at a single center between 2012 and 2019 were evaluated retrospectively. The patients were evaluated in two groups as <70 years old (n: 301; 75.8%) and >70 years old (n: 96; 24.2%). Following the evaluation of histopathological features and treatment protocols, independent risk factors influencing survival were investigated with the Cox regression model. RESULTS: The incidence of non-endometrioid histology (16.3% vs. 32.3%, p: 0.001), high-grade tumors (50.5% vs. 69.8%; p: 0.001), and >50 myometrial invasion (19.6% vs. 36.5%, p: 0.003) in the >70 age group was more frequent than that in the <70 age group. The independent risk factors on overall survival in the >70 age group were determined as non-endometrioid histology (HR: 5.9; 95% CI: 1.4- 24.7) and lymph node metastasis (HR: 6.4; 95% CI: 1.6-25.0). In the <70 age group, non-endometrioid histology (HR: 11.3; 95% CI: 4.0-32.0) was identified as the only independent risk factor affecting 5-year survival. CONCLUSION: EC, with non-endometrioid histology, which is observed at a higher rate in elderly patients despite equal surgery and adjuvant therapy, is the primary factor that affects survival.Item The clinical outcomes of ovarian cancer in patients with brain metastasis(2021) Simsek, Seda Yuksel; Guler, Ozan Cem; Durdag, Gulsen Dogan; Sari, Sezin Yuce; Gultekin, Melis; Yildiz, Ferah; Celik, Husnu; Erbay, Gurcan; Onal, Huseyin Cem; 0000-0003-3191-9776; AAK-7016-2021Objective: To present the clinical characteristics and treatment outcomes of patients with ovarian cancer with brain metastasis. Methods: This study was designed as a retrospective observational study. Patients' data were obtained from hospital records. Patients who were diagnosed with brain metastatic ovarian cancer in two tertiary referral centers between 2012 and 2020 were included in the study. Results: In total, there were 56 patients diagnosed as having brain metastatic ovarian cancer. The median age was 56 years, 91% of patients were at an advanced stage at initial diagnosis. The median time from the initial diagnosis to brain metastasis was 34.0 months. Sixty-seven percent of patients were determined as having multiple brain metastatic lesions. Whole brain radiotherapy (WBRT) , stereotactic radiosurgery (SRS) and combined approach were utilized as primary treatment. The 1 and 2-year survival rates were 38% and 17%, respectively. Patient age and tumor histology were found to be significant prognostic factors that impact the survival in univariate analyses. The 1-year survival of patients aged younger than 55 years was 49.2%, and 28.2% for patients aged over 55 years (p = 0.04). Patients with nonserous histology had significantly longer one year overall survival compared to serous histology (61.4% vs 29.8%) (p= 0.01). Conclusion: The brain is one of the rarest locations for ovarian cancer metastasis. Radiotherapeutic approaches are the mainstay of treatment but survival rates are low. Age and tumor histology were determined as significant parameters that affected survival rates.Item The efficacy of dydrogesterone use to suppress premature luteinizing hormone surge on cycle outcomes in controlled ovarian stimulation(2021) Durdag, Gulsen Dogan; 33389927Objective: Progestins are used as an alternative to gonadotropin releasing hormone (GnRH) antagonists to suppress premature luteinizing hormone (LH) surge and a flexible protocol has been defined recently. The aim of this study was to compare the efficacy of flexible protocols with dydrogesterone and GnRH antagonist in suppressing LH surge. Material and Methods: This retrospective, case-control study, was conducted in an infertility unit of a tertiary university hospital. A daily dose of 40 mg dydrogesterone was compared with GnRH antagonist (GnRHant) in controlled ovarian hyperstimulation cycles between July 2018 and July 2019. Dydrogesterone was started when the leading follicle was 12 mm or serum estradiol was over 300 pg/mL. A subgroup analysis of poor responder patients was also performed. Results: In total there were 105 subjects aged between 23 and 41 years, 52 in the dydrogesterone group and 53 in the GnRHant group. Duration of pituitary suppression was longer in dydrogesterone group. Premature ovulation was observed in 11.5% (6/52) and 0% in the dydrogesterone and GnRHant groups, respectively. However, collected oocyte counts and metaphase II oocyte counts were found to be similar between the groups. The six patients with premature ovulation were in poor responder subgroup. Conclusion: Dydrogesterone can be used as an alternative to antagonist regimen in patients where embryo transfer is not planned in the same cycle. However, flexible regimen may not be appropriate in patients with diminished ovarian reserve, as advanced follicular maturation and delayed suppressive effect of oral progesterone may cause premature ovulation. Randomized controlled trials in particular patient groups are required to determine the most effective minimum dose and time of application to ensure treatment success.Item Reference values of the ductus venosus pulsatility index for pregnant women between 11 and 13(+6) weeks of gestation(2020) Kalayci, Hakan; Baran, Safak Yilmaz; Durdag, Gulsen Dogan; Yetkinel, Selcuk; Alemdaroglu, Songul; Ozdogan, Serdinc; Simsek, Seda Yuksel; Kilicdag, Esra Bulgan; 0000-0002-0942-9108; 0000-0003-4335-6659; 0000-0002-5064-5267; 0000-0002-2165-9168; 0000-0001-5874-7324; 0000-0002-1767-1527; 30157671; AAK-8872-2021; AAK-7016-2021; AAI-8400-2021; ABF-6439-2020; AAI-9594-2021; AAL-1530-2021Purpose: The ductus venosus pulsatility index velocity (DV PIV) has become a popular ultrasonographic measurement during the first trimester of pregnancy. The value of the DV PIV has been the topic of ongoing discussion in the literature, and its reference value in the normal population has not yet been established. Therefore, we aimed to determine a reference value for the DV PIV. Materials and Methods: We retrospectively evaluated our records of first-trimester ultrasonography performed between 2016 and 2017. Our inclusion criteria were as follows: singleton pregnancy; crown-rump length (CRL) between 45 and 84 mm; absence of structural abnormalities on the ultrasound examination; and absence of chromosomal abnormalities. Records of 820 patients were evaluated. According to the inclusion criteria, records of 458 patients were included in this study. All ultrasound examinations were performed by a single operator with the Voluson E8 (5- to 8-MHz 3 D transducer; General Electric Healthcare, Little Chalfont, UK) via the transabdominal route. Gestational weeks were designated according to CRL measurements at the beginning of the examination. Nuchal translucency (NT), nasal bone visualization (NB), tricuspid valve regurgitation (TR), "a"-wave pattern, DV PIV, S-wave (peak systolic velocity), D-wave (peak diastolic velocity), a-wave (atrial contraction in late diastole), and time-averaged maximum velocity (TAMXV) measurements were performed. To evaluate the DV Doppler images, a mid-sagittal view of the fetal profile was obtained. Color Doppler and pulse Doppler gate were used in the distal portion of the umbilical sinus, and at least three typical DV waveforms were detected. The SPSS 21.0 statistical program (IBM, Armonk, NY) was used to analyze variables. Results: The mean age, body mass index, CRL, gestational age, and NT values were 30.3 years (range, 18-45), 23.9 kg/m(2) (range, 15.5-46.6), 59.5 mm (range, 45-79), 12.3 weeks (range, 11.2-13.6), and 1.58 mm (range, 0.73-2.62), respectively. The median gravidity and parity were 2 (1-8) and 0 (0-4), respectively. The "a"-wave pattern was identified in all cases, but TR was not detected in any of the cases. Measurements of DV PIV with a Gaussian distribution were suitable according to the Shapiro-Wilk test (p = .252). The mean DV PIV was 0.98, and the fifth and 95th percentiles were 0.73 and 1.22 (+/- 2 SD), respectively. A statistical analysis of our cohort revealed that DV PIV values less than 0.73 and more than 1.22 were beyond the normal range. The mean S-wave, D-wave, a-wave, and TAMXV values were 31.18, 25.64, 8.68, and 22.72 cm/s, respectively. Conclusions: The value of DV PIV measurements is debated in the literature. Using our cohort, we defined the means and ranges of DV PIV. Determining the normal ranges of DV PIV could be helpful to anticipate congenital or chromosomal abnormalities. Further studies are needed to demonstrate the clinical importance of DV PIV, especially for patients with abnormal DV PIV measurements.Item Pregnancy of patients with idiopathic thrombocytopenic purpura: maternal and neonatal outcomes(2020) Kalayci, Hakan; Durdag, Gulsen Dogan; Baran, Safak Yilmaz; Simsek, Seda Yuksel; Alemdaroglu, Songul; Ozdogan, Serdinc; Kilicdag, Esra Bulgan; 0000-0003-4335-6659; 0000-0002-0942-9108; 0000-0002-5064-5267; 0000-0001-5874-7324; 0000-0002-1767-1527; 31397144; AAK-7016-2021; AAI-8400-2021; ABF-6439-2020; AAK-8872-2021; AAI-9594-2021Objective: Thrombocytopenia occurs in 7% of pregnant women. Along with other causes, idiopathic thrombocytopenic purpura (ITP), which is an autoimmune disease with autoantibodies causing platelet destruction, must be considered in the differential diagnosis. Antiplatelet antibodies can cross the placenta and cause thrombocytopenia in the newborn. The aim of our study was to assess the management of ITP in pregnancy, and to investigate neonatal outcomes. Material and Methods: This retrospective study was conducted in a tertiary center including 89 pregnant patients with ITP followed between October 2011 and January 2018. Patients were evaluated in two groups according to diagnoses of ITP and chronic ITP. Age, obstetric history, ITP diagnosis, and follow-up period, presence of splenectomy, platelet count during pregnancy and after birth, treatment during pregnancy, route of delivery, weight and platelet count of newborn, sign of hemorrhage, and fetal congenital anomaly were assessed. Results: Considering the ITP and chronic ITP groups, no significant difference was seen with respect to parity, timing of delivery, preoperative and postoperative platelet counts, and hemoglobin values. Route of delivery, birth weight, APGAR scores, newborn platelet count, and congenital anomaly rates were also similar. The timing of treatment was different because patients whose diagnoses were established during pregnancy were mostly treated for preparation of delivery. Treatment modalities were similar. Conclusion: Probability of severe thrombocytopenia at delivery is higher in patients with ITP who are diagnosed during pregnancy when compared with patients who received prepregnancy diagnoses. ITP is an important disease for both the mother and newborn. Patients should be followed closely in cooperation with the hematology department.Item The Values of First-trimester Maternal Serum Markers in Predicting Poor Obstetric Outcomes(2019) Baran, Safak Yilmaz; Kalayci, Hakan; Durdag, Gulsen Dogan; Simsek, Seda Yuksel; Yetkinel, Selcuk; Simsek, Erhan; 0000-0001-5874-7324Introduction: The effects of pregnancy-associated plasma protein A (PAPP-A) and maternal serum free beta-human chorionic gonadotropin (beta-hCG), which are first trimester maternal serum markers, on assisting in the diagnosis of chromosomal abnormalities and perinatal outcome are discussed. The aim of the presented study was to investigate the predictive value of first-trimester PAPP-A and beta-hCG) levels in predicting poor obstetric outcomes. Methods: A total of 549 patients who underwent first trimester screening in Perinatalogy Outpatient Clinic of our hospital between January 2016 and March 2018 were included in this study. Patients with crown-rump length (CRL) measurements in the range of 45-84 mm, patients with singleton pregnancy and patients who delivered at 24 weeks or later were included in the study. CRL, nuchal translucency, mean uterine artery pulsatility index, PAPP-A and free beta-hCG levels were recorded. The 5th and 10th percentile values of PAPP-A and free beta-hCG levels were designated according to the literature. Results: There was no difference between PAPP-A percentile groups in terms of mean birth weight or gestational age at delivery. However, mean gestational age at delivery was lower in patients with free beta-hCG levels below 10th percentile. Preterm delivery was significantly higher in the group with PAPP-A levels below 5th percentile (p=0.049). Also, preeclampsia (PE) was higher in the group with free beta-hCG below 10th percentile (p=0.003). Conclusion: The risk poor obstetric outcome such as preterm delivery, low birth weight and PE may be associated with low PAPP-A and free beta-hCG levels. However, further studies are needed to explain the relationship between first trimester screening markers and neonatal outcomes.Item Reproductive outcomes of office hysteroscopic metroplasty in women with unexplained infertility with dysmorphic uterus(2018) Haydedeoglu, Bulent; Durdag, Gulsen Dogan; Simsek, Seda; Aytac, Pinar Caglar; Cok, Tayfun; Kilicdag, Esra Bulgan; 30202621Objective: The correlation between dysmorphic uterus and infertility still remains enigmatic. We evaluated the reproductive outcomes of metroplasty via office hysteroscopy in unexplained infertile women with dysmorphic uteri. Materials and Methods: In this retrospective cohort study, metroplasty via office hysteroscopy using a bipolar system was performed to 272 women with unexplained infertility with dysmorphic uteri from January 2013 to January 2016. Of all the patients, 162 had primary infertility, and 110 had secondary infertility. Results: In the primary infertility group, the clinical pregnancy rate was 45.68% (74/162) and the live birth rate was 38.9% (63/162), and in the secondary infertility group, the clinical pregnancy rate was 55.45% (61/110) and the live birth rate was 49% (54/110) after metroplasty. In the secondary infertility group, the miscarriage rate and especially the ectopic pregnancy rate declined dramatically [from 84.5% (93/110) to 9.8% (6/61) and from 15.5% (17/110) to 1.6% (1/61), respectively] (p<0.01). Conclusion: Reproductive outcome can be impaired by Mullerian anomalies, hence, infertile women with dysmorphic uteri should undergo hysteroscopy to improve reproductive outcomes. Our study demonstrated that office hysteroscopic metroplasty of a dysmorphic uterus might improve fertility, particularly in patients with unexplained infertility with dysmorphic uteri, which was an ignored factor previously. Office hysteroscopy is an alternative option in terms of non-invasive procedure.