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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 The degree of fluid absorption during hysteroscopic surgery in patients pretreated with goserelin(Journal Amer Assoc Gynecologic Laparoscopists, 1996) Taskin, O; Yalcinoglu, A; Kucuk, S; Burak, F; Ozekici, U; Wheeler, JMStudy Objective. To assess the effects of pretreatment with the gonadotropin-releasing hormone analog goserelin on fluid absorption in patients undergoing hysteroscopic endometrial ablation. Design. Prospective, randomized, placebo-controlled study. Setting. A university-based clinic. Patients. Thirteen women with dysfunctional uterine bleeding who were scheduled for electrosurgical hysteroscopic ablation. interventions. Seven women were randomized to receive luteal phase goserelin 3.75 mg and six saline in the menstrual cycle approximately 10 weeks before surgery. Operative hysteroscopy was carried out with glycine 1.5% mixed with 2% alcohol medium under constant pressure as an irrigant. The amount of irrigant used, irrigant deficit, blood levels of albumin and ethanol, hematocrit, hemoglobin, changes in sodium levels, and central venous pressure were compared between the groups. Measurements and Main Results. All of the patients had an unsuccessful course of medical therapy for at least 3 months and a normal endometrial biopsy. The age, weight, and uterine size were similar between the groups. The mean volume of irrigant used and operating time were similar in both groups (4.18 +/- 0.2 vs 4.5 +/- 0.5 L, and 33.7 +/- 1.5 vs 37 +/- 2.1 min). Although operating time, volume deficit, decrease in protein level, and hematocrit were less in the goserelin than in the saline group, the differences were not statistically significant (p >0.05). The ethanol levels in blood, decrease in Na+, and irrigant deficit were significantly lower in the goserelin than in the saline group (17.4 +/- 3.8 vs 25.3 +/- 4.2 mg/ml, 6.7 +/- 1.2 vs 9.1 +/- 0.9 mEq/L, and 0.49 +/- 0.08 vs 0.66 +/- 0.05 L, respectively; p <0.05). Conclusion. Based on these results we conclude that in women undergoing hysteroscopic endometrial ablation, pretreatment with goserelin may decrease the absorption of hysteroscopic medium, prevent fluid overload, and improve the outcome possibly by causing hypovascularity and decreased endometrial growth.Öğe The effects of duration of CO2 insufflation and irrigation on peritoneal microcirculation assessed by free radical scavengers and total glutathion levels during operative laparoscopy(Journal Amer Assoc Gynecologic Laparoscopists, 1998) Taskin, O; Buhur, A; Birincioglu, M; Burak, F; Atmaca, R; Yilmaz, I; Wheeler, JMStudy Objective. To investigate the effects of peritoneal exposure to carbon dioxide (CO2) on peritoneal microcirculation and free radical scavenger (FRS) metabolism, and its role in potential adhesion formation after operative laparoscopy. Design. Randomized, controlled study (Canadian Task Force classification I). Setting. University-affiliated hospital. Patients. Twenty-eight women undergoing operative laparoscopy for adnexal masses. Intervention. For each patient, a 1 x I-cm sidewall peritoneal flap was excised at the end of laparoscopy and numbered randomly. Similar flaps obtained from 24 women immediately after entering the abdomen during laparotomy served as controls. Measurements and Main Results. Changes in glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH) levels were studied in homogenized peritoneal tissues. The duration of CO2 exposure and amount of CO2 used were correlated with levels of free radical scavengers and compared with controls. Mean CO2 exposure, amount of CO2 used, and CO2 pressure (15 mm Hg) was similar between low irrigation and irrigated laparoscopy (118.3 +/- 25 and 39.2 +/- 8.81 min and 125 +/- 20 and 44.5 +/- 6.81 min, respectively). The change in FRS levels was significantly correlated with duration and amount of CO2 exposure ( r = -0.92). Levels of GSH-Px, SOD, CAT, and GSH were significantly lower in the CO2 exposure group than in controls (0.57 els of GSH-Px, SOD, CAT; and GSH were significantly lower in the CO2 exposure group than in controls (0.57 mu mol, 1.8 ng, 48.5 mu mol, 1.5 nmol vs 0.8 mu mol, 2.6 +/- 0.4 ng, 79 mu mol, 3.6 nmol, respectively). Conclusion, Exposure to CO2 has adverse effects on peritoneal microcirculation and cell-protective systems, which are proposed mechanisms in adhesion formation. Avoiding long CO2 exposure and copiously irrigating the abdominal cavity throughout surgery may lessen these effects. The potential role of the peritoneal FRS system on postoperative adhesion formation and its relation to estrogen status mandates further studies.Öğe The effects of episiotomy and Kegel exercises on postpartum pelvic relaxation: A prospective controlled study(Mary Ann Liebert Inc Publ, 1996) Taskin, O; Wheeler, JM; Yalcinoglu, AI; Coksenim, STo evaluate the effects of episiotomy and Kegel exercises on symptoms and signs indicating postpartum pelvic relaxation, we prospectively studied 100 primigravidas consecutively enrolled from a homogeneous patient population. A control group was defined as the first 20 women requiring cesarean section prior to labor for accepted indications. The remaining four groups of 20 women each were treated as follows: no episiotomy or Kegel, episiotomy but no Kegel, episiotomy plus postpartum Kegel, and episiotomy plus antepartum Kegel. Research outcomes included the incidence and severity of pelvic relaxation determined by physicians blinded to group assignment and complaints of stress urinary incontinence. Fisher's exact tests were used for comparisons. Episiotomy alone was associated with decreased incidence of cystocele and rectocele, but there was no effect on degree of defects that occurred. Episiotomy plus antepartum Kegel produced no significant difference compared with cesarean controls for any defect of pelvic relaxation and, furthermore, was the only vaginal delivery group producing no third-degree defects. This study supports the use of episiotomy in most primigravidas and further suggests that teaching of Kegel exercises be included in antepartum patient instruction.Öğe The effects of estrogen/progesterone replacement therapy with or without low-dose testosterone on ischemia-reperfusion induced ventricular arrhythmias in ovariectomized rats.(Elsevier Science Inc, 1997) Taskin, O; Birincioglu, M; Olmez, E; Aksoy, T; Kilic, E; Wheeler, JM[Abstract Not Available]Öğe The effects of twisted ischaemic adnexa managed by detorsion on ovarian viability and histology: an ischaemia-reperfusion rodent model(Oxford Univ Press, 1998) Taskin, O; Birincioglu, M; Aydin, A; Buhur, A; Burak, F; Yilmaz, I; Wheeler, JMThis prospective controlled follow-up study was designed to examine the effects of adnexal torsion on long-term ovarian histology and radical scavenger (FRS) activity, and subsequent viability following the detorsion of twisted ischaemic adnexa, in a primate centre of a university clinic. Adnexal torsion/occlusion was created by twisting the adnexa three times and fixing on to the side wall or by applying vascular clips in cycling female rats at 70 days of age. Following an ischaemic period of 4 to 36 h, the twisted adnexas were surgically removed and fixed. In the second group of rats, following the above ischaemic periods, the torsion/occlusion were relieved by detwisting or removing the vascular clips. Then the animals were reperfused for a week and adnexas were extirpated. After both ischaemia and reperfusion, the removed adnexas were examined histologically and tissue concentrations of glutathione peroxidase, superoxide dismutase, catalase and glutathione were determined. Regardless of the ischaemia time, all the twisted adnexas were black-bluish in appearance. Despite the gross ischaemic-haemorrhagic features, histological sections revealed negligible changes, with intact ovarian structure similar to controls in 4-24 h groups. Though decreased compared with controls, the change in tissue concentrations of FRS was not significant in 4-24 h groups. Only the 36 h group showed prominent congestion on all sections and a significant decrease in all radical scavenger concentrations studied. While no longterm reperfusion injury was observed histologically in 4-24 h groups, the 36 h group ended with adnexal necrosis. Our findings support the importance of early diagnosis and conservative surgical management (detorsion) in adnexal torsion. Lack of histological changes and unimpaired FRS metabolism are consistent with the recent data that vascular compromise is caused by venous or lymphatic stasis in early torsion and that adnexal integrity is not correlated with gross ischaemic appearance, thus providing evidence of adnexal resistance against ischaemia.Öğe The effects of twisted ischemic adnexa managed by detorsion on ovarian viability and histology: An ischemia-reperfusion rodent model.(Amer Soc Reproductive Medicine, 1997) Taskin, O; Birincioglu, M; Aydin, A; Buhur, A; Burak, F; Wheeler, JM[Abstract Not Available]Öğe Endometrial Na+, K+-ATPase pump function and vasopressin levels during hysteroscopic surgery in patients pretreated with GnRH agonist(Journal Amer Assoc Gynecologic Laparoscopists, 1998) Taskin, O; Buhur, A; Birincioglu, M; Burak, F; Atmaca, R; Yilmaz, I; Wheeler, JMStudy Objective. To investigate the effects of gonadotropin-releasing hormone (GnRH) analog pretreatment on endometrial Na+, K+-adenosine triphosphatase (ATPase) pump function and peripheral blood vasopressin levels, and their role in fluid absorption and mechanisms of hyponatremia in patients undergoing hysteroscopic endometrial ablation. Design. Prospective, randomized, placebo-controlled study (Canadian Task Force classification I). Setting. University-affiliated hospital. Patients. Seventeen women with dysfunctional uterine bleeding. Intervention, Nine women received a GnRH analog and eight received saline approximately 6 to 8 weeks before hysteroscopic ablation by electrosurgery. Measurements and Main Results. Both before randomization and immediately before surgery, endometrial biopsy samples were obtained and numbered consecutively without patient identification. Operative hysteroscopy was performed with glycine 1.5% mixed with 2% alcohol. The amount of irrigant and irrigant deficit; blood levels of albumin and ethanol; hematocrit and hemoglobin; changes in sodium levels; and central venous pressure were compared. The Na+, K+-ATPase pump activity was significantly increased in the GnRH analog group compared with the saline group and correlated with decreased estradiol levels (0.4 +/- 0.08 vs 0.26 +/- 0.06 mu mol/min/ml). Vasopressin levels were significantly lower in the GnRH group (3.2 +/- 0.9 vs 7.6 +/- 1.7 mu mol/L). Mean volume of irrigant used and operating time were similar in both groups. Volume deficit, decrease in protein, and hematocrit were less in GnRH than in the saline group. Blood ethanol levels, decrease in sodium, and irrigant deficit were significantly lower in GnRH group. Conclusion. Pretreatment with GnRH analogs may prevent the adverse effects of estradiol on endometrial Na+, K+-ATPase and creates a protective mechanism against iatrogenic hyponatremia, which is more critical in women than men in case of absorption of irrigating fluid. Moreover, created hypoestrogenism may enhance Na+, K+-ATPase activity in brain as well as endometrium, thus decreasing women's susceptibility to hyponatremic complications and brain damage. Suppressed vasopressin levels may be protective against fluid absorption in GnRH analog-treated patients.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 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.
