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Öğe Adhesion formation after microlaparoscopic and laparoscopic ovarian coagulation for polycystic ovary disease(Journal Amer Assoc Gynecologic Laparoscopists, 1999) Taskin, O; Sadik, S; Onoglu, A; Gokdeniz, R; Yilmaz, I; Burak, F; Wheeler, JMStudy Objective. To compare the effects of microlaparoscopy and decreased CO2 exposure on peritoneal microcirculation and potential adhesion formation after ovarian surgery with those of conventional operative laparoscopy. Design. Prospective, randomized study (Canadian Task Force classification I). Setting. Teaching hospital. Patients. Eighteen women with polycystic ovary disease. Interventions. Microlaparoscopic or laparoscopic ovarian coagulation of the ovaries. Measurements and Main Results. Approximately 10 to 12 coagulation points were applied to each ovary. Two to 3 weeks after the initial surgery second-look microlaparoscopy was performed to determine the extent of adhesions in both groups. The frequency of adhesion formation and changes in glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH) levels were studied in homogenized peritoneal tissues obtained during surgery in each group. Results. Clinical profiles were similar between groups. Mean exposure, amount, and pressure of CO2 were significantly less in the microlaparoscopy group (p <0.05). The laparoscopy group had significantly more adhesions than the microlaproscopy group (24% vs 48%, p <0.05). The GSH-Px, SOD, CAT, and GSH levels were significantly lower in the laparoscopy group (0.425 mu mol, 1.2 ng, 37.55 mu mol, and 0.9 nmol vs 0.755 mu mol, 2.1 ng, 625 mu mol, and 2.6 nmol, respectively). Conclusion. Reduced exposure to and amount of CO2 during microlaparoscopy may result in decreased adhesion formation compared with conventional laparoscopy. This effect may possibly be due to lack of or minimal adverse effects on peritoneal microcirculation and cell-protective systems, which are proposed mechanisms for adhesion formation and closely related to peritoneal injury. In addition, microlaparoscopy may be a cost-effective alternative to conventional laparoscopy.Öğe Cerebrospinal fluid nitric oxide level changes in preeclampsia(Elsevier Sci Ireland Ltd, 2003) Celik, O; Hascalik, S; Turkoz, Y; Hascalik, M; Gokdeniz, RObjective: The purpose of this study was to determine the level of nitric oxide (NO) metabolites, nitrite and nitrate in human cerebrospinal fluid (CSF) and serum and to assess whether there is any relationship among CSF, serum nitrate-nitrite levels and preeclampsia. Study design: Twenty-one preeclamptic and 27 healthy pregnant women as control group who underwent cesarean section (C/S) were included in the study. Before administering local anesthetic for spinal anesthesia, 2 ml CSF and 4 ml venous blood sample were taken. CSF and serum total nitrite, direct nitrite and nitrate levels were determined spectrophotometrically. Results: CSF total nitrite, direct nitrite and nitrate levels were significantly different between the two groups (21.00 +/- 1.68, 8.28 +/- 0.89 and 12.71 +/- 1.08 mumol/l, respectively versus 15.53 +/- 1.49, 5.57 +/- 0.39 and 9.96 +/- 1.45 mumol/l, respectively, P < 0.05). Significantly higher serum nitrate level was found (31.84 +/- 2.31 mumol/l) in the control group compared to the preeclamptic group serum nitrate level (25.06 +/- 2.02 mumol/l). Statistical comparisons were performed by the Mann-Whitney U-test. Conclusion: CSF-NO is significantly higher but serum NO is lower in preeclamptic group compared with control group may suggest independent regulation of NO in the two compartments. The determination of CSF-NO metabolites could be useful to clarify whether increased NO production is predominantly associated with poor perfusion of the brain in preeclampsia. (C) 2003 Elsevier Ireland Ltd. All rights reserved.Öğe Effectiveness of intravenous ephedrine infusion during spinal anaesthesia for Caesarean section based on maternal hypotension, neonatal acid-base status and lactate levels(Australian Soc Anaesthetists, 2002) Turkoz, A; Togal, T; Gokdeniz, R; Toprak, HI; Ersoy, OMaternal cardiovascular changes and neonatal acid-base status, including lactate levels, were assessed in 30 healthy women undergoing elective caesarean section under spinal anaesthesia. Patients were allocated randomly to receive IV ephedrine infusion (n = 15) (5 mg.min(-1)) immediately after the spinal injection or bolus administration of IV ephedrine (n = 15) (10 mg) in case of development of hypotension. Maternal and neonatal blood pressure, heart rate and acid-base status including lactate levels were compared between the groups. Systolic blood pressure in the bolus group was significantly lower when compared to the infusion group. Nausea was observed in one patient (6%) in the infusion group and nausea and vomiting were observed in 10 patients (66%) in the bolus group. Although umbilical arterial pH values were significantly lower in the bolus group, lactate levels were similar. In conclusion, ephedrine infusion prevented maternal hypotension, reduced the incidence of nausea and vomiting and led to improved umbilical blood pH during spinal anaesthesia for caesarean section.Öğe Endothelial nitric oxide synthase expression in leiomyoma and parental myometrium(Karger, 2000) Gokdeniz, R; Mizrak, B; Ozen, S; Bazoglu, NThe aim of this study was to determine the expression of endothelial nitric oxide synthase (eNOS) in leiomyomatous tissue as a possible mediator of the growth process. Nine patients had myoma enucleation during the follicular phase. The myomata and adjacent myometrial tissues were fixed in formol until study. Immunohistochemical localization of leiomyomatous and myometrial tissue eNOS expression was performed using specific monoclonal antibodies to eNOS. Statistical comparisons were made using the Mann-Whitney Wilcoxon rank-sum test for the expression of eNOS. The test was considered significant when p values were <0.05. Immunostaining for eNOS was seen in the cytoplasm of myometrial endothelial and smooth muscle cells in both tissue sections. eNOS expression was significantly higher in the smooth muscle cells of leiomyomata, compared to parental myometrium (p < 0.0005). The expression of eNOS in vascular endothelial cells was not different in the leiomyoma and myometrium (p > 0.05). To our knowledge, this is the first study to document marked expression of eNOS in leiomyomatous tissue, compared to parental myometrium. We also conclude that the mechanism(s) of the growth-promoting effect of estrogen on leiomyomata is mediated by more synthesis of NO. Copyright (C) 2000 S. Karger AG, Basel.Öğe GnRH agonist decreases endothelial nitric oxide synthase (eNOS) expression in leiomyoma(Elsevier Sci Ireland Ltd, 2000) Gokdeniz, R; Ozen, S; Mizrak, B; Bazoglu, NObjective: To define the effect of GnRH agonist (GnRHa) treatment on endothelial nitric oxide synthase (eNOS) expression in leiomyoma. As eNOS expression is more pronounced in leiomyoma compared to parental myometrium, we hypothesized that the mechanism(s) of tumor shrinkage by GnRHa may be due to decreased nitric oxide (NO) production in leiomyoma. Methods: Eleven patients with leiomyoma ware operated for myoma enucleation by laparatomy. Six of them were treated with GnRHa every 28 days, three times before the operation. The remaining five patients who had no treatment prior to operation formed the control group. flood was drawn from the patients before treatment and on the day of operation for the assay of serum estradiol (E-2). Immunohistochemical localization of eNOS expression in leiomyoma and myometrium in treated patients, and in leiomyoma in the control group, was performed using monoclonal antibodies specific to eNOS. Results: All treated subjects showed a significant reduction of fibroid volume at the end of therapy. eNOS-positive cells were localized primarily within the vascular endothelium and smooth muscle cells, but had weak expression in fibroid and myometrial muscle cells in the treated group. The immunoreactivity was similar for both the leiomyoma and myometrium (P > 0.05). In contrast to this, the control group had shown strong expression in leiomyoma muscle cells (P < 0.005) in addition to the vascular endothelium and smooth muscle cells. Conclusion: GnRHa-induced tumor shrinkage should be due to diminished eNOS expression, most probably by lowering estrogen secretion. (C) 2000 International Federation of Gynecology and Obstetrics.Öğe Increased nitric oxide production in the spermatic vein of patients with varicocele(Elsevier Science Bv, 2000) Ozbek, E; Turkoz, Y; Gokdeniz, R; Davarci, M; Ozugurlu, FObjective: To define the level of nitric oxide (NO) in the spermatic vein of patients with varicocele and its relation with male infertility. Materials and Methods: Following physical and color Doppler ultrasonographic examination, whole blood samples were drawn from a peripheral vein and a dilated varicocele vein from fourteen patients with clinically palpable varicocele (G2-3) before ligation. NO levels in the serum were determined as total nitrite by Greiss reaction and results were compared with Mann-Whitney U test. Results: NO levels in the internal spermatic vein were 36.05 +/- 8.92 mu mol/l, compared to 19.41 +/- 4.12 mu mol/l in the peripheral vein and the difference was statistically significant (p < 0.01). Conclusion: In view of our results, increased NO levels in the dilated varicocele vein might be responsible for spermatozoa dysfunction. Copyright (C) 2000 S. Karger AG, Basel.Öğe Laparoscopic management of selected adnexal masses(Journal Amer Assoc Gynecologic Laparoscopists, 1999) Sadik, S; Onoglu, AS; Gokdeniz, R; Turan, E; Taskin, O; Wheeler, JMObjective. To investigate the significance, safety and intraoperative and immediate postoperative outcomes of laparoscopic management of adnexal masses thought to be at low risk for malignancy. Design. Prospective cohort study (Canadian Task Force classification II-2). Setting. Tertiary-care teaching hospital. Patients. Two hundred twenty women undergoing laparoscopic surgery for adnexal masses. Interventions. Laparoscopic treatment including cystectomy oophorectomy, adnexectomy, and peritoneal cytology, and, if necessary, frozen sections. A histologic diagnosis was obtained in every patient. Measurements and Main Results. Only one ovarian cancer and one borderline ovarian tumor were diagnosed by histologic examination, and both were managed by laparotomy. The remaining 218 patients had laparoscopy for benign adnexal masses. Conclusion. Operative laparoscopy with the finding of incidental ovarian malignancy is rare, as shown by pathologic examination. With appropriate preoperative evaluation, laparoscopic surgery is technically feasible, safe, and advantageous, with minimal morbidity, and should replace laparotomy in the management of most adnexal masses.Öğe Normal pregnancy outcome after inadvertent exposure to long-acting gonadotrophin-releasing hormone agonist in early pregnancy(Oxford Univ Press, 1999) Taskin, O; Gokdeniz, R; Atmaca, R; Burak, FFive infertile women exposed to long-acting gonadotrophin-releasing hormone agonist (GnRHa) during early pregnancy were studied to assess the risks of embryotoxicity on the outcome of their pregnancies. All the patients were diagnosed as stage 3-4 endometriosis following laparoscopy, Long-acting GnRHa (3.75 mg) was given in the first 3 days of their preceding menstrual period. Four of the five patients had two GnRHa injections and the last patient had three GnRHa injections. All patients were advised to use a barrier contraception (condoms) throughout the treatment period. Since all complained of no bleeding following the initial injections, human chorionic gonadotrophin (beta-HCG) concentrations were tested in order to rule out any pregnancy. Ultrasonographic examinations were commenced routinely and all patients had amniocentesis at 16-18 weeks gestational age. Genetic analysis revealed a normal karyotype in all fetuses. All five pregnancies progressed to term without complication, and normal healthy infants were delivered. Although there are still no clear answers concerning teratogenic and hormonal effects of GnRHa exposure in pregnancy, our data may suggest that luteal function, genetic structure and pregnancy outcome are not adversely affected by GnRHa, Since possible subtle effects on fetal endocrine organs cannot be disregarded, close monitoring is still needed in GnRHa-exposed pregnancies.Öğe Role of endometrial suppression on the frequency of intrauterine adhesions after resectoscopic surgery(Journal Amer Assoc Gynecologic Laparoscopists, 2000) Taskin, O; Sadik, S; Onoglu, A; Gokdeniz, R; Erturan, E; Burak, F; Wheeler, JMStudy Objectives. To evaluate long-term effects of operative hysteroscopy on the development of intrauterine adhesions (IUA), and to determine whether hypoestrogenism has a modulatory role in preventing IUA. Design. Prospective, randomized study (Canadian Task Force classification I). Setting. Tertiary-care teaching hospital. Patients. Ninety-five women requiring resectoscopic surgery. Intervention. Hysteroscopic surgery using the resectoscope and 1.5% glycine for uterine distention. Measurements and Main Results. indications for hysteroscopy were polyps (28 patients), solitary myoma (32), multiple myomata (20), and uterine septa (15). Patients in each group were randomized to endometrial suppression with danazol or placebo. Second-look office hysteroscopy with CO2 for uterine distention was performed after the First menses after surgery to assess the frequency, extent, and severity of IUA. The likelihood and severity of IUA depended on the pathology treated at initial surgery. Of women treated For polyps and uterine septa, in only one with septa (placebo group) developed IUA. Mild IUA Formation was present in 10 patients (31.3%) with solitary fibroids and 9 (45.5%) with multiple myomata. The frequency was similar in placebo- and danazol-treated groups with both solitary and multiple myomas (50% and 44.4% vs 50% and 55.6%). All IUA were lysed during second-look surgery except in one woman with multiple myomata who required repeat resectoscopy. Conclusion. Intrauterine adhesions are the major long-tern, complication of operative hysteroscopy, with frequency dependent on the pad,ology initially treated. Second-look office hysteroscopy is a cost-effective method of diagnosing and lysing IUA after resectoscopy.Öğe Tyrosine hydroxylase (TH) enzyme activity and adrenomedullin (AdM) level in ovariectomized rat tissues depend on tamoxifen(Federation Amer Soc Exp Biol, 2001) Dogru, MI; Yurekli, M; Kocagun, A; Gokdeniz, R[Abstract Not Available]
