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Öğe Comparison of the effects of ovarian cauterization and gonadotropin-releasing hormone agonist and oral contraceptive therapy combination on endocrine-changes in women with polycystic ovary disease(Amer Soc Reproductive Medicine, 1996) Taskin, O; Yalcinoglu, AI; Kafkasli, A; Burak, F; Ozekici, UObjective: To study the effects of laparoscopic ovarian cauterization and combination of long-acting GnRH agonist (GnRH-a) and oral contraceptive (OC) therapy on endocrine changes in women with clomiphene citrate (CC)-resistant polycystic ovary disease (PCOD). Design: Prospective, randomized. Setting: University-based infertility clinic. Patients: Seventeen women with CC-resistant PCOD were included randomly in the study to either laparoscopic ovarian cautery or GnRH-a and OC therapy for 3 months. Main Outcome Measures: Serum concentrations of LH, FSH, androstenedione (A), T, and sex hormone-binding globulin (SHBG) were determined before each therapeutic approach and during the follicular phase of first menstrual cycle after the cessation of each treatment. Results: The mean. serum concentrations and the clinical profiles were similar in both groups. Both groups showed significant changes in LH, FSH, A, T, and SHBG compared with pretreatment levels. There were no significant differences in the final concentrations of LH, FSH, and A between the two study groups after each treatment, whereas T and SHBG levels were significantly different in the goserelin and OC group. The decrease in LH and increase in SHBG serum concentrations were greater in the goserelin and CC-treated women [-59% and +5.9% versus -70% and +13.5%, respectively]. Although the SHBG concentration increased in both groups, the serum SHBG concentration of the goserelin and OC group was significantly higher than the other group. Conclusion: Both therapeutic modalities revealed similar effects on the endocrine profiles in women with CC-resistant PCOD. Considering the invasiveness, cost, and potential complications of laparoscopic ovarian cauterization, noninvasive medical treatment with GnRH-a and OC combination may be more effective in restoring the optimal follicular environment in women with PCOD.Öğe The effects of hormone replacement therapy on echocardiographic basic cardiac functions in postmenopausal women(Oxford Univ Press, 1998) Taskin, O; Gökdeniz, R; Muderrisoglu, H; Korkmaz, ME; Uryan, I; Atmaca, R; Kafkasli, AThis prospective study was designed to investigate the effects of hormone replacement therapy (HRT) on systolic and diastolic functions. Twenty-eight non-smoking, healthy postmenopausal women who had not received any kind of HRT for at least three years within the onset of menopause were included in the study. Ail patients received 0.625 mg conjugated oestrogens and 2.5 mg medroxyprogesterone acetate as daily HRT regimen. Their basic systolic and diastolic functions were investigated echocardiographically using standard positions and windows before and 6 months after initiation of HRT, The means of age, weight and length of postmenopausal period were 49.3 +/- 5.8 years, 63.5 +/- 8.7 kg and 46.3 +/- 7.1 months, respectively, Heart rate and systolic and diastolic pressures were similar during the pre- and post-treatment periods. After 6 months of HRT, the mean left ventricular end-systolic and end-diastolic volumes were decreased significantly (71.3 +/- 16.4 versus 56.3 +/- 22.8 mi, 144.5 +/- 26.1 versus 111.7 +/- 24.0 mi, respectively, P <0.05), Left ventricular ejection fraction was increased (45.1 +/- 6.2% versus 54.8 +/- 4.1%, P < 0.05), Improvement in diastolic function was significant compared with the pretreatment period (E/A 0.90 +/- 0.2 versus 1.10 +/- 0.4, deceleration time 238 +/- 36.8 versus 201 +/- 24.2 ms, respectively, P < 0.05), Based on our preliminary results, we conclude that besides the known favourable effects on women's lives, HRT may also improve cardiac performance and age-related dysfunctions. The present results further suggest that oestrogens exert many direct effects on the cardiovascular system, other than the metabolic changes related to lipoproteins.Öğe Epithelioid trophoblastic tumor of the endocervix: A case report(Academic Press Inc Elsevier Science, 2002) Meydanli, MM; Kucukali, T; Usubutun, A; Ataoglu, O; Kafkasli, ABackground. It is difficult to recognize epithelioid trophoblastic tumor (ETT) as a trophoblastic disease because of its rarity and growth pattern simulating a carcinoma. Case report. A 36-year-old woman with stage IB1 squamous cell carcinoma of the uterine cervix and a high serum beta-human chorionic gonadotropin (beta-hCG) level underwent radical hysterectomy with pelvic and para-aortic lymphadenectomy. However, light microscopic findings and immunohistochemical studies with pan-cytokeratin, epithelial membrane antigen, inhibin-alpha, beta-hCG, and human placental lactogen revealed ETT of the endocervix. The patient is alive with no evidence of disease 12 months after surgery. Conclusion. Before the patient is resorted to radical surgical interventions for assumed cervical carcinoma, ETT should be ruled out in women of reproductive age with endocervical tumors and elevated serum beta-hCG levels. (C) 2002 Elsevier Science (USA).Öğe Maternal and fetal plasma adenosine deaminase, xanthine oxidase and malondialdehyde levels in pre-eclampsia(Wiley, 2005) Karabulut, AB; Kafkasli, A; Burak, F; Gozukara, EMThe aim of this study was to evaluate maternal-fetal plasma adenosine deaminase, xanthine oxidase (ADA, XO) activity and malondialdehyde (MDA) levels and the relationship between them in pre-eclampsia. Maternal and umbilical cord whole blood samples were taken from 29 pre-eclamptic and 33 normal pregnants. The plasma ADA, XO activities as well as MDA levels were assayed by spectrophotometric methods. MDA levels and ADA, XO activities were found to be higher in maternal and fetal plasma in pre-eclamptics than in normal pregnancy. The differences were statistically significant between groups (p < 0.05). Increased maternal-fetal plasma XO and ADA activities, its a marker of immunological disorder, may be related to the pathogenesis of pre-eclampsia. In addition, increased MDA levels may be a reflection of increased oxidative stress in pre-eclamptics and their fetuses. Copyright (c) 2004 John Wiley & Sons, Ltd.Öğe Postmenopausal endometrial cancer screening(I R O G Canada, Inc, 2004) Güven, MA; Pata, Ö; Bakaris, S; Kafkasli, A; Mgoyi, LObjective: The aim of this study was to correlate,the body mass index with transvaginal sonographic measurement of endometrial thickness in a cohort of postmenopausal women who were admitted for endometrial cancer surveillance. Material and Methods: Transvaginal sonographic measurement of endometrial thickness was performed in 97 postmenopausal women who attended the gynecology clinic for endometrial cancer screening with no history of hormone replacement therapy and correlated with body mass index. Baseline characteristics including age, years since menopause and body mass index were recorded for each subject. The relationship between transvaginal sonographic endometrial thickness and baseline characteristics was assessed in each. Results: Body mass index was significantly correlated with years since menopause (r = 0.292, p = 0.004) and age (r = 0.243, p 0.01) but not with endometrial thickness (r = -0.07, p = 0.454). Endometrial thickness versus time since menopause correlation was found to be significant (r = 0.274, p = 0.03) in patients with a body mass index lower than 30. Conclusion: The present findings indicate that endometrial thickness does not differ with body mass index in the screening of postmenopausal women for endometrial cancer.Öğe Priming effect of misoprostol on estrogen pretreated cervix in postmenopausal women(Tohoku Univ Medical Press, 2005) Atmaca, R; Kafkasli, A; Burak, F; Germen, ATMisoprostol, which is a prostaglandin E1 analogue, is effectively used in cervical priming in women both for labor induction and for gynecological procedures. Although its efficacy is well documented in reproductive age women, during postmenopausal period this efficacy is limited probably due to estrogen deficit. Our objective is to evaluate if estrogen deficit in postmenopausal women is important for the effect of misoprostol on cervical ripening before diagnostic procedures. In this study, 45 patients were randomly allocated to estrogen or placebo group. The study group received local estrogen cream and other group received chlindamycine phosphate cream as placebo. The patients were given oral misoprostol 24 and 12 hours before the procedure for uterine cavity evaluation. Cervix was dilated by using Heagar dilator up to 6 mm. Data were analyzed by Student t-test, Mann-Whitney's U-test, chi-square test and paired samples t-test where appropriate. Basal cervical widths for the estrogen and placebo groups were 4.4 +/- 0.7 and 3.7 +/- 0.7 mm, respectively (p < 0.01). Mean time required for dilatation of cervix was 44.4 +/- 16.2 seconds for the estrogen group and 61.4 +/- 18.3 seconds for the placebo group (p < 0.01). As a conclusion, misoprostol treatment alone is not effective to get cervical priming in postmenopausal women, and as shown in our study, pretreatment with local estrogen overcome the failure. To get a beneficial effect of misoprostol on cervical ripening, estrogenic activity is necessary and when pretreated with local estrogen, misoprostol ameliorates cervical priming in postmenopausal women. (c) 2005 Tohoku University Medical Press.Öğe Rare case of neuroendocrine small cell carcinoma of the endometrium with paraneoplastic membranous glomerulonephritis(Pensiero Scientifico Editor, 2003) Meydanli, MM; Erguvan, R; Altinok, MT; Ataoglu, O; Kafkasli, ASmall cell carcinomas are well-recognized tumors known to occur predominantly in the lung. These neoplasms are occasionally associated with a variety of paraneoplastic syndromes. Four cases of paraneoplastic glomerulopathy associated with small cell lung carcinoma have been reported. However, there have been no reports in the literature indicating an association between endometrial small cell carcinoma and paraneoplastic glomerulopathy. We report a case of neuroendocrine small cell carcinoma of the endometrium associated with membranous glomerulonephritis (MGN), which appeared to be a component of an unusual paraneoplastic syndrome. A 33-year-old multiparous woman presented with abnormal vaginal bleeding and abdominal bloating. Endometrial biopsy revealed neuroendocrine small-cell carcinoma of the endometrium. On the eighth day of hospitalization the patient suddenly developed renal failure. Renal biopsy revealed MGN, probably due to tumor-antigen-related immune complex deposition. Small cell carcinoma of the endometrium may be associated with paraneoplastic MGN. Medical staff should take into account the possibility of a preexisting glomerular injury when managing a patient with small cell carcinoma of the endometrium.Öğe Side effects of tamoxifen in oophorectomized rats(Karger, 1998) Kafkasli, A; Erdem, F; Müezzinoglu, B; Akbasak, B; Burak, F; Aksoy, T; Birincioglu, MObjective: Our objective was to evaluate the direct effect of tamoxifen citrate (TAM) on the endometrium, liver, breast tissue and the lipid profile in oophorectomized (OX) rats. Study Design: An experimental animal study. Material and Methods: Forty-one mature rats (33 OX) were randomly divided into four groups and received either TAM (0.4 or 0.8 mg/kg p.o.) therapy or placebo over 60 days as follows: (1) sham; (2) OX + TAM (0.4 mg/kg); (3) OX + TAM (0.8 mg/kg); (4) OX. All histological changes in the endometrium, liver and breast tissue were evaluated under the light microscope by comparing the TAM-treated groups with the OX and sham-operated groups. Blood total cholesterol and low-density lipoprotein cholesterol levels were also analyzed. Results: TAM-treated rats showed a significant reduction in body weight, blood cholesterol and low-density lipoprotein cholesterol levels, but the wet uterine weight was not affected. Estrogenic effects of TAM were not detected with either dosage on the endometrium. TAM-treated groups showed atrophic breast tissue. No histopathological changes were detected in the liver with TAM treatment. Conclusion: The data suggests that TAM may not act as an estrogen receptor agonist with the given dosage on the endometrium in OX rats. Two different doses of TAM do not cause histological changes in liver over 60 days of treatment.Öğe Uterine metastasis from infiltrating ductal carcinoma of breast in a patient receiving tamoxifen(Churchill Livingstone, 2002) Meydanli, MM; Karadag, N; Ataoglu, O; Kafkasli, AThe established relationship between tamoxifen and the development of endometrial cancer causes differential diagnostic problems between metastatic and primary uterine neoplasms. A 45-year-old woman underwent modified radical mastectomy because of left-breast cancer. She presented with abnormal vaginal bleeding 6 years later, while still on tamoxifen therapy. The endometrial curettage revealed undifferentiated adenocarcinoma. She underwent total abdominal hysterectomy, bilateral salphingoopherectomy as well as pelvic and periaortic lymphadenectomy. Microscopic examination revealed neoplastic cells which formed sheets and duct-like structures in the endometrium. The pattern was not that of a primary endometrial tumour and an immunohistochemical staining was performed using human breast gross cystic disease fluid protein-15 (GCDFP-15) which was found out to be positive in the tumour cells. A diagnosis of metastatic ductal carcinoma of the breast in the uterus was rendered. Uterine metastasis should be kept in mind in patients with a history of breast cancer who are on tamoxifen therapy. (C) 2002 Elsevier Science Ltd. All rights reserved.Öğe What should be done with patients who have abnormal GCT but normal GTT?(Medimond Publishing Co, 2004) Kafkasli, A; Karabulut, A; Kazezoglu, G; Kulak, N; Koçak, M; Yologlu, SThe aim of this study is to evaluate the carbonhydrate metabolism in pregnants with abnormal glucose challenge, but normal 100g-3-hour oral glucose tolerance test. Pregnants who were delivered at Ynonu University School of Medicine Department of Obstetrics and Gynecology and meet the criteria included the study. Group 1(n:6) gestational diabetes mellitus, Group 2(n: 8) Type 2 diabetes mellitus, Group 3(n: 10) plasma glucose levels were 140mg/dl f after glucose challenge test, but normal 100g-oral glucose tolerance test, Group 4(n:8) pregnants with normal glucose challenge test and have appropriate-for-gestational-age neonate as control group,Group 5(n:8) pregnants with normal glucose challenge test and have macrosomic neonate were included the study. Maternal blood was collected to evaluate the carbonhydrate metabolism by comparing the IGF-I,II and IGFBP-1,2,3 levels. IGF I-II and IGFBP1,2,3 measurements were done by RIA and IRMA technics respectively. Maternal plasma levels of IGF-II and IGFBP-1, -3 were found to be significantly higher than control group in gestational diabetics, type-2 diabetic pregnants, pregnants with abnormal glucose challenge test but normal 100g-oral tolerance test and pregnants with macrosomic infant (p<0.000, p<0.000, p<0.05, p<0.05).
