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Öğe Abnormal glucose challenge test and mild gestational diabetes(2008) Kafkasli A.; Sertkaya A.C.; Selcuk E.B.; Dogan K.; Burak F.; Yologlu S.Objective. The status of carbohydrate metabolism of pregnant women with positive glucose challenge test (GCT), but normal oral glucose tolerance test (OGTT) and their neonates are not defined clearly. Study Design. Pregnant women with normal GCT (n: 120), with abnormal glucose challenge test (AGCT) but normal OGTT (n: 67) and with gestational diabetes (GDM, n: 67) were included into the study. Insulin sensitivity was evaluated by fasting insulin level, homeostasis model assessment of insulin resistance index (HOMA-IR); quantitative insulin check index (QUICKI) and ISOGTT. Serum insulin and glucose values during OGTT were documented. Perinatal outcome and delivery modalities were compared. Results. Both GDM (31.6±5.9 yrs) and AGCT groups (29.0±4.0 yrs) were older than controls (28.1±4.9 yrs). Body mass index (BMI) was the predominant factor affecting both AGCT and GDM groups (OR: 3.78 and 5.97 respectively). Despite there was no significance between insulin indices; serum glucose and insulin values were similarly different; macrosomic infant and caesarean section rates were higher than controls in both GDM and AGCT groups in favor of gestational diabetics (6.6% vs. 18.9%; p=0.0001 and 20% vs. 27.7% p=0.0001 respectively). Conclusion. Pregnant woman with abnormal glucose challenge test have impaired carbohydrate metabolism as in gestational diabetics with a lesser severe degree.Öğe Abscess in adenomyosis mimicking a malignancy in a 54-year-old woman(2003) Erguvan R.; Meydanli M.M.; Alkan A.; Edali M.N.; Gokce H.; Kafkasli A.Background: Although there are a few reports describing abscess formation in endometriotic foci no report of abscess formation arising de novo within adenomyosis appears in the literature. Preoperative diagnosis of adenomyosis is frequently difficult because of non-specific signs and symptoms. Synchronous pelvic pathologies such as leiomyoma, endometrial polyp, endometrial hyperplasia, as well as endometrial cancer may cause differential diagnostic problems. Case: A 54-year-old postmenopausal woman complaining of inguinal pain, nightsweats and hot flashes is presented. Radiologic examinations of the pelvis revealed a 95 x 85 mm leiomyoma-like lesion including a 53 x 43 mm cystic space and 9 x 6 mm papillary formation within the uterus raising clinical suspicion of malignancy. A total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed accompanied by a frozen section diagnosis. The frozen section revealed an abscess formation arising in a focus of adenomyosis. The postoperative period of the patient was uneventful. Conclusion: The present case, to our knowledge, is the first report representing abscess formation in adenomyosis. Abscess arising within adenomyosis can strongly raise the suspicion of endometrial cancer, particularly if the patient is postmenopausal. If endometrial cancer cannot be ruled out with definitive histopathological diagnosis in the preoperative period, a frozen section becomes mandatory during surgical intervention.Öğe Acute abdomen in a case with noncommunicating rudimentary horn and unicornuate uterus.(2005) Atmaca R.; Germen A.T.; Burak F.; Kafkasli A.Unicornuate uterus with a rudimentary horn is the rarest congenital anatomic anomaly of the female genital system, causing many obstetrical and gynecologic complications. The frequency of this pathology is approximately 1/100 000. A rudimentary horn usually develops following insufficient development of mullerian ducts. These patients present with dysmenorrhea, dyspareunia, and chronic pelvic pain because of endometriosis and rarely with acute abdominal symptoms following distention and torsion of the noncommunicating rudimentary horn. The case of a patient referred for acute abdomen after distention of a noncommunicating rudimentary horn is presented herein.Öğe Anxiety, depression and sexual dysfunction in women with chronic pelvic pain(2006) Kaya B.; Unal S.; Ozenli Y.; Gursoy N.; Tekiner S.; Kafkasli A.In this article we compared healthy women with women having chronic pelvic pain (CPP) for the levels of depression, anxiety, and sexual dysfunction. A cross-sectional survey was conducted in the Obstetrics and Gynecology Outpatient Clinic and Family Planning Department of Inonu University Medical Faculty in Turkey. We examined 19 women with CPP and 25 healthy women between January 2000 and April 2000. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Spielberger Trait Anxiety Inventory (STAI), and the Golombok Rust Inventory of Sexual Satisfaction (GRISS) were used for psychological assessments. Women with CPP had significantly higher scores on the BDI and GRISS. While avoidance, dissatisfaction and non-sensuality subscale scores of the GRISS showed a positive correlation with depression and anxiety scores, the vaginismus subscale score had a positive correlation with the BAI scores. Our results indicated that there is a link between anxiety, depression and sexual dysfunction in women with chronic pelvic pain. Further studies are needed to characterize this link. © British Association for Sexual and Relationship Therapy.Öğe Effect of postpartum counseling on postpartum contraceptive use(2007) Engin-Üstün Y.; Üstün Y.; Çetin F.; Meydanli M.M.; Kafkasli A.; Sezgin B.Objective: The aim of this study was to evaluate the effect of postpartum counseling on postpartum contraceptive use. Methods: One hundred and forty-three women who delivered between 1 January 2004 and 31 September 2004 and counseled about postpartum contraception were included in the study. The participants were interviewed by telephone. Age, gravidity, parity, and mode of delivery of the participants were recorded. Their method of contraception before pregnancy, their decision on the contraceptive method after counseling and the method actually used were asked. Results: Just after postpartum counseling, 47 women (32.9%) decided to use the intrauterine device (IUD), 23 (16.1%) condoms, 16 (11.2%) progestin injections, 7 (4.9%) oral contraceptives, and 7 (4.9%) coitus interruptus for contraception. Thirty-six women (25.2%) did not decide on any method of use. At the time of the telephone interview the actual method used was learned. Fifty-one women (35.7%) were using coitus interruptus, 45 women (31.5%) condoms, and 14 (9.8%) the IUD. Sixteen women (11.2%) were reported as not using any methods. Conclusion: In spite of postpartum counseling, a high majority of the women appeared to use traditional and less effective contraceptive methods. © 2006 Springer-Verlag.Öğe Evaluation of cases with neural tube defects in an University Hospital in Eastern Anatolia(2007) Engin-Üstün Y.; Üstün Y.; Türkçüo?lu I.; Sezgin B.; Meydanli M.M.; Kafkasli A.AIM: To evaluate cases of neural tube defects detected at or referred to Inonu University Faculty of Medicine Gynecology and Obstetrics Department between 2004 and 2006. DESING STUDY: In this study, cases of neural tube defects detected at or referred to Inonu University Faculty of Medicine Gynecology and Obstetrics Department between 2004 and 2006 were evaluated. Cases were identified by a definitive prenatal radiology report. FINDINGS: There were 14 cases with spina bifida, 13 with anencepaly, 8 with spina bifida and hydrocephaly, 9 with spina bifida and acrani. Nine cases were primarily diagnosed and treated in our hospital whereas 35 were referred from other hospitals. During the study period, 3877 deliveries were performed in our clinic. When referrals from other hospitals were excluded, the incidence of neural tube defect was calculated as 2.3 per 1000 deliveries. Mean maternal age was 27.5±5.1 years and body mass index was 25.9±3.6 kg /m 2. Median gestational age at the time of diagnosis was 23 (13-41) weeks, gravida was 2 (1-9) and parity was 1 (0-6). Thirty four percent of cases were diagnosed in the third trimester and 63.6 % of cases were not under routine control. None of the patients used folic acid before of during the pregnancy. CONCLUSION: Folic acid supplementation and antenatal screening is mandatory for all pregnancies.Öğe Histopathologic effects of meconium on human umbilical artery and vein: In vitro study(Parthenon Publishing Group Ltd, 1997) Kafkasli A.; Belfort M.A.; Giannina G.; Vedernikov Y.P.; Schaffner D.L.; Popek E.J.Objective: To determine the histopathologic effects of meconium on human umbilical artery and vein. Methods: Umbilical cords from six patients with uncomplicated, singleton, term gestations were obtained immediately after delivery. One centimeter segments from each cord were flushed, isolated, placed in either modified Krebs solution alone or modified Krebs solution with various concentrations (1%, 10%, or 25%) of fresh meconium, and then incubated at pH 7.2, temperature 37°C, PCO2 50-55 mmHg, PO2 40-45 mmHg for 1, 6, 12, or 24 h. The specimens were then fixed, stained, and examined under light microscopy. Results: Umbilical arteries exhibited focal vacuolation of the endothelium after exposure of the cord to meconium. Umbilical veins revealed: 1) endothelial loss proportionate to the meconium concentration at all intervals (P < 0.05), 2) increased density or focal absence of the internal elastic lamina, and 3) focal loss of myocyte nuclei. Rare nonpigmented macrophages and increased mast cells were identified in the Wharton's jelly. Conclusions: Exposure to meconium in vitro results in histopathologic changes in the umbilical artery and vein. © 1997 Wiley-Liss, Inc.Öğe The rates of seropositivity and seroconversion of Toxoplasma infection in pregnant women(2012) Do?an K.; Kafkasli A.; Karaman U.; Atambay M.; Karao?lu L.; Çolak C.Infections caused by Toxoplasma gondii are frequently asymptomatic in healthy adults, however they may be serious in pregnant women and immunocompromised patients. The aims of this study were to investigate the rates of seropositivity and seroconversion in pregnant women and newborn cord blood samples, and to evaluate those data in the view of relation to lifestyle and nutrition. A total of 312 pregnant women (mean age: 28.1 ±5.2 years) who were admitted to and followed by gynecology clinics of Inonu University Medical School Hospital, Malatya, Turkey were included in this observational and cross-sectional study. Anti-toxoplasma IgG and IgM antibodies in pregnants and newborn cord sera were screened by commercial ELISA and immunofluorescence antibody (BioTek; USA) methods. A total of 312 sera from pregnant women and 312 cord blood samples during delivery were collected. IgG seropositivity rate in pregnants was found as 37.5% (117/312), seroconversion was not determined in restrained pregnants and T.gondii IgM was found negative in all pregnants. Also in all newborns IgM was negative and IgG seropositivity was determined as 33.3% (104/312) in cord blood. There was a statistically significant relationship between IgG seropositivity and raw meat consumption (p< 0.001) and being engaged in agriculture (p< 0.005). It was concluded that toxoplasma antibodies should routinely be searched on the first visit of the pregnants and the seronegative cases should be trained about the preventive measures related to toxoplasmosis. The follow-up of toxoplasma seronegative cases during pregnancy can be achieved by only detecting the IgM class antibodies and this will also reduce the cost of screen test.Öğe Therapeutic effect of diasmin-hesperidin in primary dysmenorrhea(1997) Kafkasli A.; Buhur A.; Burak F.; Taskin O.Objective: To evaluate the effect of Flavinoid fraction; 450 mg Diasmin + 50 mg Hesperidin (DH), a venotrophic drug, in the treatment of the primary dysmenorrhea. Study Design: Thirty women, presenting with moderate (6 of 30, 20%) or severe (24 of 30, 80%) primary dysmenorrhea, were randomly divided into 2 groups. Each group received either DH tid or placebo for three months immediately after the onset of the menstrual flow and then each group was switched to the other regimen for the following three months. Ten point visual analogue scale was used to measure the pain of the patients. Statistical analysis was carried out by using student's t test, and chi square-test. Results: Pain scores were similiar in the placebo and the DH treated groups before treatment (7.5 ± 0.7 and 8.1 ± 0.2 respectively). Pain scores began to decrease one-hour following the DH administration and reduced to the lowest point at the third hour (from 5.5 ± 0.9 to 3.4 ± 0.9, p < 0.05). Satisfactory pain relief was detected in 90% of the patients. Meanwhile, pain scores in the placebo group did not change (7.8 ± 0.1 versus 7.6 ± 0.2, p > 0.05). The severity of the pain returned to pretreatment levels when the patients were switched to placebo. Conclusion: DH may be an effective drug for the treatment of primary dysmenorrhea in patients who can not use nonsteroidal anti-inflammatory drugs.
