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Öğe APPENDICEAL MUCOCELE MIMICKING A CYSTIC RIGHT ADNEXAL MASS(ELSEVIER TAIWAN, 2009) Balci, Osman; Ozdemir, Suna; Mahmoud, Alaa S.Objective: Appendiceal mucocele is formed by cystic dilatation, abnormal mucinous secretion and epithelial proliferation of the appendiceal lumen. Mucocele may be a finding in cases of benign or malignant neoplasms, and can lead to the development of pseudomyxoma peritonei. Case Report: A 71-year-old woman presented with a 3-day history of right lower abdominal pain radiating to her right thigh. A simple 5 x 7 cm cyst with smooth borders and a thick capsule was detected in the right adnexal area by transvaginal ultrasonography. Magnetic resonance imaging identified a 4 x 8 cm cystic lesion in the area of the right ovary. The patient was admitted to our clinic with an initial diagnosis of adnexal cyst, later found to be appendiceal mucocele. Conclusion: The signs and symptoms of appendiceal mucocele are not specific. Because of its anatomic position, it should be considered in the differential diagnosis of adnexal masses. [Taiwan J Obstet Gynecol 2009; 48(4):412-414]Öğe Assessment of ischemia-modified albumin level in patients with recurrent pregnancy loss during the first trimester(ELSEVIER, 2011) Ozdemir, Suna; Kiyici, Aysel; Balci, Osman; Goktepe, Halime; Cicekler, Humeyra; Celik, CetinObjective: The finding that ischemia-modified albumin (IMA) is increased in pre-eclamptic pregnancy suggests a role for IMA as a potential biomarker for abnormal placental development related to miscarriage. This study was undertaken to evaluate IMA levels in women with recurrent pregnancy loss (RPL). Study design: This case-control study was performed between March 2008 and September 2009, at the Department of Obstetrics and Gynecology of Meram School of Medicine. Serum IMA and albumin concentrations were assessed in 43 women with a history of two or more unexplained first trimester miscarriages (group 1), and 42 healthy pregnant women (group 2) in the first trimester. IMA, adjusted IMA and albumin concentrations were compared between the groups. Statistical analysis was performed using Student's t-test and Mann-Whitney U test. Results: IMA and adjusted IMA levels were significantly higher in women with RPL (1.11 + 0.08 and 1.09 + 0.09, respectively) compared to women in group 2 (0.88 + 0.10 and 0.88 + 0.11, respectively). Albumin levels in group 1 were significantly lower compared with group 2. There was a negative correlation between IMAand albumin levels in each group. Conclusion: Maternal IMA levels appear to be elevated in women with early RPL This finding may suggest that an abnormally high hypoxic intrauterine environment may be associated with abnormal placental development that contributes to early miscarriage. (C) 2010 Elsevier Ireland Ltd. All rights reserved.Öğe Balci technique for suspending vaginal vault at vaginal hysterectomy with reduced risk of vaginal vault prolapse(WILEY, 2011) Balci, Osman; Capar, Metin; Acar, Ali; Colakoglu, Mehmet CengizAim: The aim of this study was to evaluate the efficacy of a new technique of suspending the vaginal vault at vaginal hysterectomy (VH) for total uterine prolapse. Material and Methods: This prospective study included 65 patients (group 1) in whom VH was performed using the new technique and 110 patients (group 2) in whom VH was performed using the traditional method. Both groups were followed up for 4 years. The incidences of vaginal vault prolapse (VVP), total vaginal length (TVL) (location of vaginal cuff), intraoperative and postoperative complications and sexual function were compared. Results: There were no statistically significant differences between the two groups regarding age, parity, body mass index (BMI), blood loss, intraoperative and postoperative complications, and sexual function. One (1.5%) patient had VVP in group 1, whereas 12 (10.9%) patients had VVP in group 2. TVL in group 1 was 8.9 +/- 1.2 cm while in group 2 it was 5.9 +/- 0.8 cm. The operation times were 57 +/- 5 min and 76 +/- 9 min in group 1 and group 2, respectively. There was a statistically significant difference between the two groups regarding VVP (P = 0.022), TVL (P < 0.001) and operation time (P < 0.001). The two groups were also compared regarding anterior and posterior prolapse after 4 years: group 1 had less anterior and posterior prolapse (stage II or more) than group 2 (P = 0.041, P = 0.047), respectively. Conclusion: In this new technique, compared to the traditional technique, there was a lower incidence of VVP, greater TVL was achieved and the duration of the operation was shorter.Öğe Bilateral adnexal torsion due to postmenopausal hydatidiform mole(WILEY-BLACKWELL, 2011) Ozdemir, Suna; Balci, Osman; Gorkemli, Huseyin; Koyuncu, Tuba; Turan, GulayOccurrence of gestational trophoblastic neoplasia (GTN) and adnexal torsion is rare in postmenopause. We report a 58-year-old postmenopausal woman with adnexal torsion caused by hydatidiform mole. The patient was admitted to our clinic complaining of acute abdominal pain, nausea and vomiting lasting one day. Ultrasonography showed an enlarged uterus including hypo/hyperechogenous cystic areas in the endometrial cavity and bilateral adnexal masses. beta-HCG level was investigated and determined as 157.000 IU/l, because of the suspicion of GTN in ultrasonography. Doppler sonography revealed enlarged left adnexa with absence of vascular flow. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. beta-HCG decreased to normal ranges in the fourth postoperative week. The resected uterus contained an endometrial, cystic, grapelike tumor. The ovaries were enlarged bilaterally with necrotic appearance. Histopathology revealed complete hydatidiform mole and theca lutein cysts. To our knowledge, the present case is the first hydatidiform mole associated with bilateral adnexal torsion caused by theca lutein cysts in postmenopausal period.Öğe Comparison of induction of labor with vaginal misoprostol plus oxytocin versus oxytocin alone in term primigravidae(TAYLOR & FRANCIS LTD, 2011) Balci, Osman; Mahmoud, Alaa S.; Acar, Ali; Colakoglu, Mehmet C.Objective. To compare the efficacy and complications of intravaginal misoprostol application before starting oxytocin infusion with oxytocin infusion alone for labor induction in term primigravidae pregnancies with low-Bishop score. Methods. This randomized study included 101 primigravidae women with singleton pregnancies >38 weeks and a Bishop score of <6. Group 1 (50 patients) received a 50-mu g dose of intravaginal misoprostol, with an oxytocin infusion started 3 h later. Group 2 (51 patients) received only an oxytocin infusion for labor induction. The time from induction to delivery, the route of delivery and complications were analyzed. Results. The mean time from induction to delivery was 10.4 +/- 2.1 h in Group 1 and 13.7 +/- 3.4 in Group 2 (p < 0.001). The rates of vaginal delivery, Apgar scores at 1st and 5th min, placental abniption, and postpartum hemorrhage were similar between the two groups. Conclusion. Intravaginal application of 50-mu g misoprostol before starting oxytocin infusion is a more effective method of labor induction than oxytocin infusion alone in term primigravidae pregnant women with low-Bishop scores.Öğe Does tenaculum application to the cervix during intrauterine insemination affect pregnancy rates?(TAYLOR & FRANCIS AS, 2009) Balci, Osman; Acar, Ali; Colakoglu, Mehmet CengizIntrauterine insemination (IUI) consists of sperm cell extraction from seminal plasma and artificial transfer into the uterine cavity. We investigated whether tenaculum application to the cervix during IUI affects pregnancy rates. A prospective study was done on 468 primary infertile women. Recombinant follicle stimulating hormone was used in ovulation induction. The women were divided randomly into Group 1 (n = 236) and Group 2 (n = 232) without and with tenaculum application to the cervix, respectively. After IUI, a five-minute sagittal plane uterine ultrasound scan was done in all cases. Uterine contraction was recorded. The women were evaluated for pregnancy rates. Uterine contraction was significantly higher in Group 2 (p < 0.001). In all, 24 patients in Group 1 (10.7%) and 38 in Group 2 (17.6%) achieved pregnancy (OR = 1.78, 95% CI 1.03-3.08; p = 0.038). Tenaculum application to the cervix increases immediate uterine contraction, but higher pregnancy rates may be obtained.Öğe Effect of pre-amniocentesis counseling on maternal pain and anxiety(WILEY, 2011) Balci, Osman; Acar, Ali; Mahmoud, Alaa S.; Colakoglu, Mehmet CengizAim: The aim of this study was to evaluate the levels of anticipated and perceived pain and anxiety in expectant mothers at the times of pre-counseling, post-counseling, and post-amniocentesis and to investigate the effect of pre-amniocentesis counseling on the level of pain and anxiety. Materials and Methods: This prospective study was carried out on 240 women with singleton pregnancies at mid-trimester. The maternal pain and anxiety levels associated with the procedure were evaluated using the visual analogue scale. Perceived pain and anxiety were assessed before and after counseling the pregnant woman about amniocentesis, and after amniocentesis. Results: Median anticipated pain levels before (pain 1) and after pre-procedure counseling (pain 2) were 5 and 4, respectively. The actual pain after the procedure (pain 3) was 3. Median levels of anxiety felt by the patients before (anxiety 1) and after pre-procedure counseling (anxiety 2) were 6 and 3, respectively, while the median anxiety after the procedure (anxiety 3) was 5. For the pain and anxiety measurements, the results for each of the comparison times were significantly different from the results for the other two comparison times (P < 0.001). Conclusion: Adequate pre-amniocentesis counseling effectively reduces the actual level of pain and anxiety felt by the mother undergoing mid-trimester amniocentesis.Öğe The efficacy of multiple-dose methotrexate treatment for unruptured tubal ectopic pregnancy and conversion rate to surgery: a study on 294 cases(ELSEVIER SCIENCE INC, 2010) Balci, Osman; Ozdemir, Suna; Mahmoud, Alaa S.; Acar, Ali; Colakoglu, Mehmet C.In this prospective study 294 patients diagnosed with ectopic pregnancy (EP) were treated with multiple-dose methotrexate (MTX) to determine the conversion rate to surgery. We concluded that multiple-dose MTX treatment had a low success rate, and the success rate was not related to initial b-hCG value; it was more related to the size of gestational mass before treatment. (Fertil Steril (R) 2010;93:2415-7. (C) 2010 by American Society for Reproductive Medicine.)Öğe Evaluation of Oxidative Stress in Women with Polycystic Ovarian Syndrome as Represented by Serum Ischemia Modified Albumin and Its Correlation with Testosterone and Insulin Resistance(JAPAN SOC INTERNAL MEDICINE, 2016) Beyazit, Fatma; Yilmaz, Nafiye; Balci, Osman; Adam, Magdi; Yaman, Selen TaflanObjective Ischemia-mediated oxidative stress and inflammation have been reported to be important contributors to the pathogenesis of polycystic ovary syndrome (PCOS). Ischemia-modified albumin (IMA) is a novel marker generated under ischemic and oxidative conditions and may reflect disease activity in distinct disease states. Therefore, we investigated whether the serum IMA levels are affected in infertile PCOS patients. Methods Forty-six patients with infertile PCOS, 30 patients with unexplained infertility, and 31 age-and body mass index (BMI)-matched controls were included in this cross-sectional study. Biochemical parameters, serum IMA levels, and their correlations with serum testosterone and insulin resistance were determined for each subject. Results In patients with infertile PCOS, the serum IMA levels were significantly elevated (p=0.003) compared with unexplained infertility patients and controls. A correlation analysis suggested that the IMA levels only correlated with the serum free testosterone levels in PCOS patients (r=0.43, p=0.028). Conclusion Elevations in the serum IMA levels in infertile PCOS patients may suggest a possible additional role of oxidative stress mechanisms in disease pathophysiology. Moreover, correlation between serum IMA and testosterone levels may influence the quality of oocytes via alterations in the balance of critical follicular fluid factors in the follicular microenvironment.Öğe An incidental coexistence of Mayer-Rokitansky-Kuster-Hauser syndrome with pelvic ectopic kidney and perirenal endometrioma(SAUDI MED J, 2008) Balci, Osman; Karatayli, Rengin; Capar, MetinIn this case report, a Mayer-Rokitansky-Kuster-Hauser syndrome with pelvic ectopic kidney and a perirenal cyst with endometrial tissue inside is demonstrated. A 17 year old patient admitted with primary amenorrhea. Pubertal stages were completed. In pelvic ultrasonography; uterus could not be detected, a 6x11 cm sized cystic lesion was seen on the right adnexal area. A centrally located 5.5x9 cm sized ectopic pelvic kidney was detected. Hormones and tumor markers were normal. Laparoscopy was planned. In the laparoscopic observation, uterus and both tubes could not be detected, ovaries were normal. There was a 6x7 cm sized cyst located in the retroperitoneal area, the origin of the cyst could not be identified. Laparatomy was considered, retroperitoneal space was entered, an 8x11 cm sized smooth contoured perirenal cyst adjacent to the pelvic kidney was detected. Cyst was extirpated. The pathology result was reported to include endometrial tissue and hemorrhage inside.Öğe INTRAVAGINAL FOREIGN BODIES PLACED IN THE VAGINA TO TREAT UTERINE PROLAPSE RETAINED FOR 35 YEARS(ELSEVIER TAIWAN, 2009) Balci, Osman; Goktepe, Halime; Mahmoud, Alaa S.; Acar, Ali[Abstract not Available]Öğe Management and outcomes of adnexal masses during pregnancy: A 6-year experience(WILEY-BLACKWELL, 2008) Balci, Osman; Gezginc, Kazim; Karatayli, Rengin; Acar, Ali; Celik, Cetin; Colakoglu, Mehmet C.Aim: To demonstrate adnexal masses detected during gestations in a 6-year period. Methods: A retrospective study of pregnancy with adnexal masses requiring surgery over a 6-year period at the Selcuk University Hospital, a tertiary referral center, between June 2000 and June 2006. Results: We detected 36 pregnancies with adnexal masses. The mean age of the patients was 26.6 years (range, 18-42). The mean gestational age at which adnexal masses were detected was 17 weeks (range, 5-36), and the mean gestational age at the time of surgery was 24 weeks (range, 6-41). Postoperative pathology results of the patients were functional ovarian cysts in 14 cases (41.1%), endometrioma in eight cases (23.5%), dermoid cyst in six cases (17.6%), serous cystadenoma in two cases (5.8%), mucinous cystadenoma in one case (2.9%), para-ovarian cyst in one case (2.9%), and borderline serous tumor in two cases (5.8%). Two patients operated on during the second trimester developed preterm birth risk (5.8%). Miscarriage occurred in only one patient (2.9%). Conclusion: In this report, we demonstrate a high rate of surgical intervention of adnexal masses at pregnancy which is secondary to the fact that our center works as a tertiary referral center. Most masses at pregnancies were benign in character and our malignity rate was low. We detected an acceptable complication rate due to surgery in pregnant women.Öğe Management and outcomes of adnexal torsion: a 5-year experience(SPRINGER HEIDELBERG, 2011) Balci, Osman; Icen, Mehmet S.; Mahmoud, Alaa S.; Capar, Metin; Colakoglu, Mehemet C.To discuss the surgical results of patients with diagnosis of adnexal torsion. One hundred and fifty patients with diagnosis of adnexal torsion who presented to our clinic between January 2005 and December 2009 were included in this retrospective analysis. Data regarding age, gravidity, parity, size of mass, operation time, and duration of hospitalization were recorded and compared between the patients who had laparoscopy to those who had laparotomy. The pathological results of patients were also recorded. Fifty-eight patients were treated laparoscopically while 92 patients had laparotomy. The most frequent presenting symptom was pelvic pain (96%). Laparoscopy group consisted of young patients with low parity; operation and hospital stay time was shorter in laparoscopy group. Velocity loss in Doppler ultrasonography was noted in 81.3% of the patients. Of the laparotomy group 35 postmenopausal patients had hysterectomy and bilateral salpingo-oopherectomy, and staging surgery was done for 16 of them. The pathological finding was found to be malignant in four and borderline serous tumor in four patients. Laparoscopy is preferred for young patients who want to preserve their fertility. Because of high risk of malignancy in postmenopausal ovarian masses presenting with torsion; frozen section should be used. If not possible or not conclusive, staging surgery is more appropriate especially if there is suspicion of malignancy.Öğe MANAGEMENT OF OVARIAN CYSTS BY LAPAROSCOPIC EXTRACORPOREAL APPROACH USING SINGLE ANCILLARY TROCAR(ELSEVIER TAIWAN, 2009) Capar, Metin; Balci, Osman; Acar, Ali; Colakoglu, Mehmet C.Objective: This prospective study aimed to evaluate an alternative laparoscopic extracorporeal approach for the treatment of benign ovarian cysts. Materials and Methods: The initial study population included 243 patients diagnosed with benign ovarian masses. Two patients with suspected malignancies and 21 patients with technical difficulties secondary to severe, dense pelvic adhesions were excluded from the study, and the final study population, therefore, comprised 220 patients. A primary 10-mm trocar was inserted, followed by a second incision on the side of the cyst and the introduction of an ancillary 5-mm trocar. The cystic content was aspirated using a needle. The capsule was held using an endograsper inserted through the ancillary trocar. The capsule was extracted from the abdomen. The 5-mm trocar and the endograsper were removed from the abdomen simultaneously. The capsule was completely detached. Homeostasis was performed and the ovary was then released. Results: The mean duration of the operation was 20 +/- 5 minutes. The size of the cysts ranged from 5 cm to 15 cm (mean, 8.4 +/- 2.6 cm). The pathologies of the cysts were simple cyst in 86 cases, endometrioma in 68, serous cyst in 57, mucinous cyst in eight and borderline in one. The perioperative complication rate was 2.27%. Conclusion: This technique does not require the use of two or more ancillary trocars or widening of the trocar incision. The duration of surgery can be shortened considerably and complete excision of the cystic capsule can be performed. Homeostasis was achieved using 3-0 polyglactin sutures. No electrocoagulation was required. [Taiwan J Obstet Gynecol 2009;48(4):380-384]Öğe PELVIC TUBERCULOSIS MIMICKING PERITONITIS CARCINOMATOSIS AND DIAGNOSED BY LAPAROSCOPY(ELSEVIER SINGAPORE PTE LTD, 2009) Balci, Osman; Karatayli, Rengin; Capar, Metin[Abstract not Available]Öğe Repeated in vitro Fertilization Failure and Its Relation with Thrombophilia(KARGER, 2009) Simur, Aynur; Oezdemir, Suna; Acar, Hasan; Colakoglu, M. Cengiz; Goerkemli, Hueyin; Balci, Osman; Nergis, SueleymanBackground: The objective of this study was to determine the prevalence of some thrombophilic factors and its relation to in vitro fertilization (IVF)-embryo transfer failure in women who had had three or more previously failed IVF-embryo transfer cycles. Methods: The study group included 51 consecutive women with three or more previously failed IVF-embryo transfer cycles (group 1). The control group included 50 women who conceived spontaneously with at least one uneventful pregnancy and no previous history of miscarriage. All women were tested for the presence of factor V Leiden, prothrombin (G20210A), and methylenetetrahydrofolate reductase (C677T) mutations. Results: A similar prevalence of factor V Leiden, prothrombin, and methylenetetrahydrofolate reductase mutations was found in both groups. At least one inherited thrombophilic factor was detected in 62.7% of women with repeated IVF failure and in 53.9% of women in group 2. No association between repeated IVF failure and these thrombophilic factors was found statistically. Conclusion: These data suggest that factor V Leiden, methylenetetrahydrofolate reductase and prothrombin gene mutation do not have a significant role in IVF-embryo transfer implantation failure. Copyright (C) 2008 S. Karger AG, Basel
