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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14288/3
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Publication Metadata only The clinical utility of a pulsed bipolar system and its electrosurgical device during total laparoscopic hysterectomy(Mary Ann Liebert, Inc., 2017) N/A; N/A; Mısırlıoğlu, Selim; Türkgeldi, Engin; Boza, Ayşen; Öktem, Özgür; Ata, Mustafa Barış; Urman, Cumhur Bülent; Taşkıran, Çağatay; Doctor; Faculty Member; Doctor; Faculty Member; Faculty Member; Faculty Member; Faculty Member; N/A; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; N/A; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; 329649; N/A; 102627; 232576; 12147; 134190Objective: The aim of this research was to evaluate the efficacy and safety of the PlasmaKinetic (PK) PKS OMNI (R) (Gyrus ACMI, Maple Grove, MN) sealing device in laparoscopic hysterectomy. Materials and Methods: For this retrospective observational study, 60 patients who underwent multiport total laparoscopic hysterectomy between January 2014 and January 2015 in a tertiary-care university-based teaching hospital and an academically affiliated hospital were included in this study. The PKS OMNI is a bipolar electrosurgical device that takes energy from a PK generator workstation G400. This pulsed wave system has two different modes; cutting (High Cut 1,2,3) and coagulation (Vaporization 1,2,3). Results: Records of 60 patients were analyzed. The median age was 50 (range: ages 40-84), median body mass index was 26kg/m(2) (range: 22-32kg/m(2)), and median parity was 2 (range: 1-8). The median total operation time was 100 minutes (range: 70-240 minutes), estimated blood loss was 80mL (range: 30-250mL), and uterine weight was 207g (range: 50-900g). Degree of Surgical Difficulty and postoperative pain scores at rest were evaluated with a visual analogue scale system, from 0 to 10, and the medians of these scores were 5 (range: 3-7) and 4 (range: 2-6), respectively. The median recovery time of bowel movement was 16 hours (range: 8-26 hours), median spontaneous urination time was 7 hours (range: 4-29 hours), and median postoperative mobilization time was 8 hours (range: 6-10 hours). Conversion to laparotomy was needed in 1 patient due to severe pelvic adhesions. The median duration of hospital stay was 2 days (range: 2-4 days). Vaginal cuff dehiscence was detected in 1 (1.7%) patient who engaged in sexual intercourse on the 122nd day after surgery. Cuff cellulitis in 1 (1.7%) patient and unexplained fever in 1 (1.7%) patient were the other recorded complications. The median follow-up time was 12 months (range: 6-17 months). Conclusions: The PKS OMNI is a novel, underused energy modality that promotes quick recovery and acceptable operation time with minimal blood loss.Publication Metadata only Adhesions and anti-adhesion systems highlights(Universa Press, 2019) Torres-De La Roche, L. A.; Campo, R.; Devassy, R.; Sardo, A. Di Spiezio; Hooker, A.; Koninckx, P.; Wallwiener, M.; De Wilde, R. L.; Urman, Cumhur Bülent; Faculty Member; School of Medicine; 12147The peritoneal and intrauterine cavities are lined by fragile membranes with a high-wound healing capacity, e.g. repairing the endometrium in its cyclical "injury and scar-free repair process" during menstruation. However, peritoneal and intrauterine fibrosis and adhesions can develop after surgical trauma through activation of molecular, immune and genetic mechanisms. During procedures with a high-risk of adhesions, the use of new peritoneal and intrauterine conditions in combination with anti-adhesion substances are promising measures to preserve peritoneal and endometrial function and avoid the most common complication of gynecological surgery. Highlights of adhesions and anti-adhesion prevention techniques in laparoscopic, laparotomic and hysteroscopic surgeries are discussed in this paper. Unfortunately, evidence is lacking to prove the superiority of one technique over its counterparts in terms of postoperative adhesions, such as instrumentation, type of energy, distending media, and intracavitary pressure. Additionally, there is limited evidence about the efficacy and outcomes of techniques and adjuvant measures used during adhesiolysis. The definition of a universal intrauterine adhesions classification scheme as well as a prognostic scoring system to identify women at high risk of postoperative adhesions are necessary for advising those who could benefit the most of the use of antiadhesion barriers.Publication Metadata only First-trimester choroid plexus to lateral ventricle disproportion and prediction of subsequent ventriculomegaly(Wiley, 2023) Prasad, Smriti; Fabrizio, C. Di; Eltaweel, Nashwa; Khalil, Asma; N/A; Kalafat, Erkan; Faculty Member; School of Medicine; 197389Objective: ventriculomegaly can be associated with long-term neurodevelopmental impairment. The prenatal diagnosis of ventriculomegaly is most often made at the routine second trimester anomaly scan. The value of first trimester ultrasound has expanded to early diagnosis and screening of fetal abnormalities. The objective of this study was to assess the predictive accuracy of first trimester choroid plexus to head/ventricle ratios for development of ventriculomegaly at a later gestation. Methods: this was a case-control study of fetuses with isolated ventriculomegaly diagnosed after 16 weeks' gestation. The control group included normal fetuses (without ventriculomegaly). The exclusion criteria included aneuploidy, genetic syndromes or other brain abnormalities. Stored 2D first trimester ultrasound images were blindly analyzed offline and fetal biometry measured in axial view of the fetal head. The ratios of choroid plexus to lateral ventricle area (PA/VA), choroid plexus to lateral ventricle length (PL/VL), choroid plexus to lateral ventricle diameter (PD/VD), choroid plexus area to biparietal diameter (PA/BPD) and choroid plexus area to head circumference (PA/HC) were measured at 11-13+6 weeks' gestation. Intra- and inter-observer variability of these fetal head biometry parameters at 11-13+6 weeks' gestation were assessed in 20 normal fetuses using intra-class coefficients with 95% confidence intervals. The accuracy of first-trimester biometric measurements for prediction of ventriculomegaly was assessed using the area under the ROC curves (AUC). Results: the analysis included 683 singleton pregnancies; of which 102 fetuses were diagnosed with ventriculomegaly. The ventriculomegaly was mild in the majority (n=86; 84.3%) of cases, while it was severe in 16 (15.7%) fetuses. All first trimester fetal choroid plexus to ventricle/head ratios were significantly lower in the ventriculomegaly cases than in controls (p<0.05 all) with good inter- and intra-observer agreement (>0.95 for the majority of the fetal head biometry assessed). After adjusting for crown-rump length, both PL/VL ratio (AUC 0.87, 95% CI 0.73-0.98) and PA/VA ratio (AUC 0.90, 95% CI 0.82-0.98) showed good predictive accuracy for severe ventriculomegaly. PA/BPD ratio (AUC 0.73, 95% CI 0.54-0.90) had modest predictive ability, which was significantly lower than prediction using PA/VA ratio (P=0.003 and P=0.001, respectively). The predictive accuracy of PD/VD ratio was low with an AUC of 0.65 (95% CI 0.46- 0.84). Optimism adjusted AUC values obtained after cross-validation showed that PA/VA ratio offered the highest predictive accuracy with an AUC of 0.90 (95% CI: 0.82-0.98), followed by PL/VL ratio (AUC 0.87, 95% CI 0.73-0.98), PA/BPD ratio (AUC 0.73, 95% CI 0.54-0.90), and PD/VD ratio (AUC 0.65, 95% CI 0.47-0.84). Optimism-adjusted AUC values obtained after cross-validation showed that PA/VA ratio offered the highest predictive accuracy for mild ventriculomegaly with an AUC of 0.83 (95% CI 0.78-0.88), followed by PL/VL ratio (AUC 0.82, 95% CI 0.76-0.88), PA/BPD ratio (AUC 0.75, 95% CI 0.68-0.81), and PD/VD ratio (AUC 0.74, 95% CI 0.67-0.80). Calibration plots show both PA/VA and PL/VL ratios have good calibration CONCLUSION: First-trimester prediction of ventriculomegaly using fetal choroid plexus to ventricle ratios appears promising. Future prospective studies are needed to validate the predictive accuracy of these ultrasound markers as a screening tool for ventriculomegaly.Publication Metadata only Parasitic myomas and an adenomyoma obstructing the ureter after power morcellation of myomas and endometriotic nodule resection(Elsevier, 2016) Arslan, Tonguç; Aksu, Sertan; Urman, Cumhur Bülent; Ata, Mustafa Barış; Taşkıran, Çağatay; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; 12147; 182910; 134190Background: The use of power morcellation (PM) in abdominal and pelvic surgery has been discouraged and even banned in some institutions because of the risk of spreading malignant cells, although some authorities maintain that PM can be an appropriate tool for selected patients deemed to be at low risk of malignancy. Case: A 42-year-old woman developed parasitic myomas and an adenomyoma obstructing the right ureter after laparoscopic excision of multiple myomas and deep infiltrating endometriosis using PM. Laparoscopic excision of the parasitic myomas and removal of the adenomyoma relieved the obstruction of the ureter. Conclusion: Although there is reasonable concern about the use of PM spreading malignant disease, benign disease can also be spread by PM and can cause significant complications. Use of PM should be restricted as much as possible.Publication Metadata only Painful catamenial vulvar lesions misleading gynecologist(Sage Publications Ltd, 2022) Dikmen, Bahar Yılmaz; Yıldız, Şule; Bilir, Esra; Bulutay, Pınar; Türkgeldi, Engin; Ata, Mustafa Barış; Faculty Member; Researcher; Teaching Faculty; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 134205; N/A; 133565; 329649; 182910Endometriosis usually presents as cyclical pain in the pelvis but may also present as painful cutaneous lesions. Many diseases may mimic hidradenitis suppurativa (HS) since HS, a chronic inflammatory painful skin disease, is a clinical diagnosis. A 32-year-old woman presented with painful lumps on her vulva and groin accompanied with bloody discharge during menstruation. She was followed up with preliminary diagnosis of endometriosis. Previous excision without definitive diagnosis resulted in temporary relief. She was prescribed oral contraceptive pills that alleviated her symptoms but quitted due to headache. Surgical excision was performed for definitive diagnosis and therapeutic relief. Pathology report revealed HS. She was prescribed oral doxycycline. She responded well to the therapy and has symptom-free for the last 2 years. She delivered one healthy girl via cesarian section 2 years after the treatment. Endometriosis and HS should be included in the differential diagnosis when women present with menstrual painful lesions around external genitalia for diagnosis and treatment.Publication Metadata only Metabolic and carbohydrate characteristics of different phenotypes of polycystic ovary syndrome(Galenos Publ House, 2016) Çelik, Ebru; Türkçüoğlu, Ilgın; Karaer, Abdullah; Kırıcı, Pınar; Eraslan, Sevil; Taşkapan, Çağatay; Berker, Bülent; N/A; Ata, Mustafa Barış; Faculty Member; School of Medicine; 232576Objective: To compare the prevalence of various metabolic and cardiovascular risk factors and insulin resistance between polycystic ovary syndrome (PCOS) patients with or without hyperandrogenism. Material and Methods: This is a retrospective cross-sectional study involving women with PCOS as diagnosed according to the Androgen Excess (AE) Society definition (n=504) and women with normoandrogenemic PCOS (n=183). Anthropometrics, lipid profile, glucose, insulin, oral glucose tolerance test (OGTT), and reproductive hormone levels were evaluated. Results: Women with PCOS diagnosed according to the AE Society had a significantly higher prevalence of metabolic syndrome compared with the normoandrogenemic PCOS phenotype: odds ratio (OR) 2.95 [95% confidence interval (CI) 1.21–7.21]. There was no significant difference in the prevalence glucose intolerance test between the groups [OR: 2.15, 95% CI 0.71–6.56]. The prevalence of low high density lipoprotein (HDL)-cholesterol in the group under the AE-PCOS Society criteria was higher than that of the normoandrogenemic PCOS group [OR: 2.82, 95%CI 1.29–3.36]. Conclusion: The risks of metabolic syndrome and cardiovascular disease may vary among the phenotypes of PCOS based on the Rotterdam criteria. This new data may be of reference in informing women with PCOS, although further prospective studies are needed to validate this proposition.Publication Metadata only Sonographic demonstration of intracranial hemorrhage in a fetus with hydrops fetalis due to rh alloimmunization after intrauterine intravascular transfusion: a case report and review of the literature(Hindawi, 2018) Melekoğlu, Rauf; Kural, Hasim; N/A; Çelik, Ebru; Faculty Member; School of Medicine; 116631Intrauterine transfusion is the most common and successful intrauterine procedure for the treatment of fetal anemia due to red cell alloimmunization. Fetal intracranial hemorrhage is a very rare complication of intrauterine transfusion in patients with Rh(D) alloimmunization and it has been demonstrated only in a few case reports in the literature. Herein, we described a case of grade IV intraventricular hemorrhage that was diagnosed following the first intrauterine transfusion and reviewed the literature about the fetal intracranial hemorrhage that occurred after intrauterine intravascular transfusion procedure.