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Öğe Comparison of the demographic and clinical features of pregnant and non-pregnant patients undergoing appendectomy(2020) Koç, Cemalettin; Akbulut, Ahmet Sami; Çoşkun, Ebru İnci; Sarıcı, Barış; Yılmaz, SezaiAbstract: BACKGROUND: This retrospective study aims to compare the demographic and clinicopathological characteristics of the pregnant and non-pregnant patients who underwent appendectomy with a presumed diagnosis of acute appendicitis. METHODS: Between June 2009 and January 2019, 431 reproductive-aged of female patients underwent appendectomy with a presumed diagnosis of acute appendicitis. Patients were divided into two groups considering their pregnancy status: pregnant group (n=48) and non-pregnant group (n=383). Both groups were compared with respect to demographic, clinical and histopathological features. RESULTS: No statistically significant difference was found between pregnant and non-pregnant groups except total bilirubin level (p=0.019) and ultrasonographic findings (p=0.016). In the non-pregnant group, negative appendectomy and perforation rates were 26% and 10.5%, where these rates for the pregnant group were 20.8% and 4.2%. Sensitivity, specificity and accuracy rates of ultrasonography for the pregnant group were 50%, 100% and 58.5%, where these rates for the non-pregnant group were 67.3%, 57.9% and 65%. The pregnancy date was the first trimester in 52.1%, the second trimester in 29.2% and the third trimester in 16.7% of the pregnants. None of the term births (87.5%) resulted in neither a fetal nor a maternal complication. However, 12.5% of the preterm births resulted in neonatal mortality. CONCLUSION: Although not statistically significant, this study points out relatively lower rates of negative appendectomy and perforated acute appendicitis among pregnant patients, which is related to the overly attentive evaluation of pregnants admitted due to acute abdomen.Öğe Immunohistochemical profile in malignant ovarian tumors operated in our center and its discriminative importance(2020) Baloğlu, Demet; Çoşkun, Ebru İnci; Alan, Saadet; Yılmaz, Ercan; Yılmaz, Ercan; Kutlutürk, KorayAbstract: The aim of this study is to determine the correlation of histopathological subtype with frozen section examination and the importance of immunohistochemical analysis of ovarian malignancies which also include metastatic ones. This study is a retrospective study that have included 55 patients who have been operated for adnexial tumor and have the diagnosis of malignancy during surgery by frozen section or after surgery by final pathologic examination done by immunohistochemistry (IHC). The mean age of the patients with malignant ovarian tumor is 52.33 ± 15.5 years. When the pathologic diagnosis reports examined it has been found that 34 of 55 patients (61.8 %) have had epithelial type, 9 have had sex cord stromal tumor, 3 have had germ cell type and 9 of the patients have had metastatic ovarian cancer. Survival rates have been found as 70.6 % for epithelial ovarian cancer, 100 % for sex cord stromal tumors, 100 % for germ cell tumor and 44.4 % for metastatic tumors. Despite the rapid development in examination and imaging methods, histopathology is the pivotal issue in the diagnosis and also in sub-type diagnosis of pelvic mass lesions. The improvement is better in patients evaluated and operated in gynecologic oncology centers. The two important factor in this subject is the experience of the surgeon for maximum salvage from the tumoral burden and the well examination by frozen section the immunohistochemical methods for the discrimination of gastrointestinal tumors which can mimic ovarian primary tumors. Immunohistochemical methods have very important progression in diagnosis of cancer, its origin and subtypes and however IHC also could have a key role in treatment of cancer by targeted therapy.Öğe Is enoxaparin necessary to prevent adverse pregnancy outcomes in ethylenetetrahydrofolate reductase polymorphism positive recurrent pregnancy loss cases?(2020) Sager, Hakan; Sancak, Muhammed Emin; Dinçgez Çakmak, Burcu; Öztaş, Sonay; Uzsezer, Begüm; Çoşkun, Ebru İnciAbstract: The association between methylenetetrahydrofolate reductase polymorphism and recurrent pregnancy loss is still under debate. Moreover, the use of enoxaparin to prevent adverse pregnancy outcomes is controversial in these patients. We aimed to analyse the effect of enoxaparin on pregnancy outcomes in recurrent pregnancy loss with only methylenetetrahydrofolate reductase gene polymorphism. A total of 339 pregnant women with recurrent pregnancy loss and methylenetetrahydrofolate reductase gene polymorphism between June 2017 and March 2019 were included. Patients were divided into two groups: enoxaparin plus folic acid (n=165) and folic acid group (n=174). Then, these groups were divided into subgroups: MTHFR A1298C homozygous (n=52), MTHFR A1298C heterozygous (n=141), MTHFR C677T homozygous (n=56) and MTHFR C677T heterozygous (n=90). Pregnancy outcomes were recorded and compared between two main group, and also between subgroups. There was no significant difference between enoxaparin plus folic acid group and only folic acid group according to delivery week (p=0.287), birthweight (p=0.677), miscarriage (p=0.372), stillbirth (p=0.585), live birth (p=0.246), preterm birth (p=0.700), anomaly (p=0.883), preeclampsia (p=0.656), intrauterine growth restriction (p=0.764), neonatal intensive care unit admission (p=0.820), APGAR 1st minutes<7 (p=0.729), APGAR 5th minutes<7 (p=1.000) and cesarean delivery (p=0.540). Furthermore there was no statistically significant difference with regard to delivery week, birthweight, miscarriage, stillbirth, live birth, preterm birth, anomaly, preeclampsia, intrauterine growth restriction, neonatal intensive care unit admission, APGAR 1st minute <7, APGAR 5th minute <7 and cesarean delivery between each subgroups. Contrary to the increasing trend of using empirical therapy with low molecular weight heparin in Turkey, we firstly demonstrated that there is no necessity to use enoxaparin to improve pregnancy outcomes both in homozygous and heterozygous methylenetetrahydrofolate reductase polymorphism related pregnancy loss cases. We suggest that only folic acid is enough for these cases.Öğe Vitronectin and prolactin levels of cervicovaginal irrigation liquid in preterm birth risk evaluation(2020) Çoşkun, Ebru İnci; Sezer, Salim; Dağ, İsmail; Yılmaz, Ercan; Ayanoğlu, Yavuz TahsinAbstract: Aim: The objective of this study is to determine the predictive role of cervical length, cervicovaginal irrigation liquid vitronectin and prolactin levels in preterm birth. Material and Methods: A total of 73 pregnant women between 24-34th gestational week were included and the study population was divided into two groups as: term birth group (n=54) and preterm birth(n=19). Birth weeks, weight and methods were noted. The irrigation fluid has been collected from posterior fornix and vitronectin levels are detected by Enzyme-linked-immunosorbent-assay method. Results: Vitronectin were higher in preterm group as compared to controls [90 (78-98) vs 16 (9-41) ng/ml, p<0.001]. Positive predictive value for vitronectin was 78 %, negative predictive value was 100 % and accuracy ratio was 91.8%. The sensitivity of vitronectin was 100 %, specifity was 89 % with a cut-off value of 59 ng/mL. Area under curve for vitronectin was 0.96 which was compatible with ‘perfect’. When average prolactin levels have been found as 0.14 ng/mL in term and 2 ng/mL in preterm birth group, cervical length have been found as 34.5 and 24.2 mm respectively. Cut-off value for prolactin has been found as 0.088 ng/dL. Positive predictive value was 58.3 % for prolactin and 51.5 % for cervical length. Negative predictive value was 89.8% for prolactin and 95 % for cervical length. Vitronectin was strongly positively correlated with prolactin levels while it was negatively correlated with cervical length (r=0.691 and r=-0.348 respectively). Conclusion: Many trials have been done to make the most accurate prediction of preterm delivery risk. By this study, it makes us think about that vitronectin could be a valuable marker for preterm birth, and also could be independent from the gestational week.
