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Öğe Comparison of "sandwich chemo-radiotherapy" and six cycles of chemotherapy followed by adjuvant radiotherapy in patients with stage IIIC endometrial cancer: a single center experience(SPRINGER HEIDELBERG, 2013) Dogan, Nasuh Utku; Yavas, Guler; Yavas, Cagdas; Ata, Ozlem; Yilmaz, Setenay Arzu; Celik, CetinTo compare "sandwich chemo-radiotherapy" with six cycles of chemotherapy followed by adjuvant radiotherapy with respect to tolerability and acute toxicity. Twenty-five women with surgically staged IIIC endometrial cancer were included. Treatment consisted of either three cycles of paclitaxel (175 mg/mA(2)) and carboplatin (AUC 6) on a q21-day schedule followed by irradiation (45-50.4 Gy) or six cycles of the same chemotherapy followed by radiotherapy. Acute toxicity related to either chemotherapy or radiotherapy was evaluated. Median age was 61.5 years (range 36-83 years). Eleven patients had sandwich chemo-radiotherapy, and the other 14 patients had 6 cycles of chemotherapy followed by radiotherapy. Three out of the five patients who could not complete all the cycles in the sandwich chemo-radiotherapy group had pelvic and para-aortic radiotherapy. Acute radiotherapy related grade 1-2 gastrointestinal system (GIS) and genitourinary system (GUS) toxicities were observed in 72.8 and 63.6 % of patients, respectively, for sandwich group. Undesired treatment breaks in the course of radiotherapy were observed in six patients for sandwich chemo-radiotherapy and in one patient receiving six cycles of chemotherapy followed by radiotherapy. All the patients who had undesired treatment breaks in the sandwich chemo-radiotherapy group had pelvic and para-aortic radiotherapy. Sandwich chemo-radiotherapy seems to be more toxic particularly for patients who had pelvic and para-aortic irradiation. Therefore, it might be more convenient to delay radiotherapy after six cycles of chemotherapy for patients with the indication of pelvic para-aortic radiotherapy.Öğe Diagnostic efficacy of diffusion-weighted MRI for pre-operative assessment of myometrial and cervical invasion and pelvic lymph node metastasis in endometrial carcinoma(WILEY-BLACKWELL, 2014) Koplay, Mustafa; Dogan, Nasuh Utku; Erdogan, Hasan; Sivri, Mesut; Erol, Cengiz; Nayman, Alaaddin; Karabagli, PinarIntroduction: To determine the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) for the pre-operative assessment of patients with endometrial carcinoma and to assess myometrial and cervical invasion as well as pelvic lymph node metastasis. Methods: Fifty-eight women who underwent surgery for histopathologically confirmed endometrial carcinoma were included in the current study. Prior to surgery, patients were evaluated using pelvic DW-MRI and gadolinium-enhanced T1-weighted imaging (Gd-T1WI). Gd-T1WI was evaluated together with T2-weighted images. DW-MR images were obtained in the axial plane using echo-planar spin-echo pulse sequences with different b factors. Endometrial carcinomas were observed as areas of increased intensity on DW-MRI images, and their intensity was compared with the surrounding hypo-intense myometrium. Pre-operative DW-MRI and Gd-T1WI results were compared with post-operative histopathological findings that served as reference standards. Results: The sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and diagnostic accuracy of DW-MRI for differentiation between superficial myometrial invasion and deep myometrial invasion were 85%, 89%, 81%, 92% and 88%, respectively. The sensitivity, specificity and diagnostic accuracy rates were 82%, 91% and 89.6% for cervical invasion and 100%, 96% and 96.5% for pelvic lymph node metastasis, respectively. The sensitivity, specificity, PPV and NPV, and diagnostic accuracy of Gd-T1WI for differentiation between superficial myometrial invasion and deep myometrial invasion were 85%, 81.5%, 71%, 91% and 83%, respectively. The sensitivity, specificity and diagnostic accuracy were 73%, 89% and 86% for cervical invasion, respectively. Conclusions: These findings suggest that DW-MRI may be a good diagnostic tool with high sensitivity and specificity for assessing myometrial invasion and detecting tumour extension. We suggest that DW-MRI should be considered as a routine part of the pre-operative pelvic MRI in all patients with endometrial carcinoma.Öğe Early surgical abortion: Safe and effective(INFORMA HEALTHCARE, 2013) Kara, Fatih; Dogan, Nasuh Utku; Bati, Serap; Demir, Senay; Durduran, Yasemin; Celik, CetinObjectives To evaluate patients' characteristics and complications of surgical abortion performed at an early gestation, compared to later gestations. Methods A total of 4310 women with unintended pregnancies attending the family planning unit of a government maternity hospital in Konya, Turkey, were included retrospectively. Abortions were carried out from 6 weeks' up to 10 weeks gestation. Results The gestational age in 62% of the cases was between 6 weeks and 6 weeks + 6 days. Only 8.5% of the 4310 women had used a modern contraceptive method, and 16% had had a surgical abortion for an unplanned pregnancy previously. These women were younger, had more siblings, and a shorter time had elapsed since their last pregnancy when compared to women who never had an abortion. There were four failures (0.09%). The rate of retained products of conception (RPCs) was 1.9% in women aborted between six and six(+6) weeks' gestation, and 6.2% (p < 0.001) in those aborted later. Women who had had a surgical abortion previously more often had RPCs than those who never had (16% vs. 1%, respectively, p < 0.001). Of the 151 women with RPCs, 65 (43%) had been using an intrauterine device prior to surgical abortion. Conclusion Early surgical abortion (at six-six(+6) weeks' gestation) generates few complications. Delaying surgical abortion until a somewhat later gestation causes complication rates (particularly RPCs) to increase.Öğe Ectopic Pregnancy in a Cesarean Section Scar: Successful Management Using Vacuum Aspiration under Laparoscopic Supervision-Mini Review of Current Literature(HINDAWI LTD, 2016) Koplay, Mustafa; Dogan, Nasuh Utku; Sivri, Mesut; Erdogan, Hasan; Dogan, Selen; Celik, CetinA cesarean scar ectopic pregnancy (CSEP) is a fairly uncommon presentation wherein the conceptus is implanted deep in the myometrium and at the exact scar site of the previous cesarean section. There are various CSEP management options that range from medical treatment to surgical interventions such as dilatation and curettage, laparoscopic excision, resection by laparotomy, or, sometimes, a combination of these modalities. Establishing a diagnosis of CSEP can be challenging. Given the relatively rare incidence of CSEP, its management is controversial and current standards of therapy have been derived from data obtained from a limited number of patients. Herein, we present transvaginal ultrasonography (TVUS) imaging findings and management strategies used in a case of CSEP along with the short review of current literature.Öğe The effect of long interpregnancy interval on labor characteristics and pregnancy outcomes: A tertiary maternity hospital experience(DRUNPP-SARAJEVO, 2012) Dogan, Nasuh Utku; Cicek, Mahmut Nedim; Uygur, Dilek; Dogan, Selen; Erol, NidaObjective: We evaluated effect of long interpregnancy intervals (IPI) on the length of labor and perinatal outcomes. Materials and methods: In this retrospective study, 249 women with uncomplicated vaginal delivery were divided into three groups (Nulliparous women was first group, multiparous women with IPI shorter than 3 years second group and women with IPI longer than 6 years the last group). Results: Nulliparous women had longer total delivery time than multiparous women (p< 0.01). But admission to NICU (p = 0.30) and meconium stain rates (p= 0.74) were similar. Total delivery time meconium stain and NICU admission rates for multiparous women in short IPI group (<3 years) were similar to women with a longer IPI (> 6 years). But more women in longer IPI group needed oxytocin augmention (p=0.031). Conclusion: Multiparous women with prolonged IPI might be evaluated in the same way as women with shorter IPIs with favorable perinatal outcomes. But obstetrician should be more cautious with the potential risks of labor augmentation with oxytocin in this group of patients.Öğe Effect of the percentage of body fat on surgical, clinical and pathological outcomes in women with endometrial cancer(WILEY, 2015) Kerimoglu, Ozlem Secilmis; Pekin, Aybike; Yilmaz, Setenay Arzu; Yavas, Guler; Beyhekim, Fatma; Demirtas, Ayse Ayda; Dogan, Nasuh UtkuAimThis study used the measure of percentage of body fat (%BF) to define obesity and evaluated the effect of percentage of %BF on clinical, surgical and pathological features in women with endometrial cancer. MethodsBetween 2011 and 2013, bioelectrical impedance analysis and body size measurements of 94 patients whose endometrial biopsy revealed endometrial cancer were obtained. Patients were divided into two groups according to body mass index (BMI) (normal, <30kg/m(2); elevated, 30kg/m(2)), and also classified by %BF (normal, <32%; elevated, 32%). ResultsThe patients' mean age was 55.010.9 years. Mean %BF and BMI were 40.8%+/- 9.8% and 32.9 +/- 7.5, respectively. Eighty-three (88%) patients were obese according to %BF; 54 (57%) were obese according to BMI. Patients with elevated %BF were more likely to have less than 50% myometrial invasion (P=0.004). Significantly more para-aortic lymph nodes were retrieved in patients with normal %BF or BMI (P<0.001, P<0.001). Patients with elevated %BF had longer operating times (P=0.043) and were more likely to have stage I disease than patients with normal %BF (P<0.001). ConclusionEndometrial cancer patients with an elevated %BF are more likely to have stage I disease and less than 50% myometrial invasion than patients with normal %BF. Defining obesity by BF may provide better estimation of obesity prevalence in patients with endometrial cancer and further understanding the relationship between BF with endometrial cancer may give more information about the effects of obesity on endometrial cancer.Öğe Evaluation of Toll-Like Receptor Expression with Clinicopathologic Variables in Endometrium Cancer(YERKURE TANITIM YAYINCILIK HIZMETLERI AS, 2018) Bakbak, Berat Berrin Gencoglu; Ilhan, Tolgay Tuyan; Pekin, Aybike; Kerimoglu, Ozlem Secilmis; Yilmaz, Setenay Arzu; Kebapcilar, Aysegul; Dogan, Nasuh UtkuObjectives: Clinical evidence supports the association of toll-like receptor (TLR) with abnormal cell proliferation and cancer. In this study, we investigated the expression of TLRs 2, 4, 5, and 6 in healthy endometrium and endometrium cancer to study the relationship of these receptors' expression with carcinogenesis. Methods: Patients who had undergone a hysterectomy owing to endometrium cancer (group 1, 66 patients), endometrial hyperplasia (group 2, 14 patients), and other reasons besides endometrium cancer (group 3, 20 patients as controls) were included. The cases in the first group were classified by histological type of the cancer, stage, grade, and size of the tumor. In all the cases, expressions of TLRs 2, 4, 5, and 6 were assessed, and the relationship of these receptors with clinicopathologic signs was analyzed. For immunohistochemical staining, nuclear and cytoplasmic stainings were considered positive. A Chi-squared test was used to assess the correlation of the groups. A p<0.05 was considered significant. Results: The mean ages of patients in groups 1, 2, and 3 were 59.8 (range 33-83), 48.3 (range 40-59), and 53.4 (range 38-84) years, respectively. All types of TLRs were highly expressed in both types of endometrium cancer (groups 1 and 2). TLR expression was observed with a ratio of 87.9% in group 1, 100% in group 2, and 35% in group 3. There was a statistically significant association of TLR 2 among the three groups (p=0.000). TLR 6 expression in both group 1 and group 2 was significantly higher than that in the control group (p=0.000, p=0.000, respectively). In addition, TLR 6 was higher in cases with late-stage cancer (p=0.033). Regarding tumor grade and the size of the tumor, no association was found between TLR 2 and TLR 6. Conclusion: TLR 2 and TLR 6 were significantly more expressed in cases with endometrium cancer and endometrial hyperplasia. In addition, the presence of TLR 6 may indicate the presence of late-stage endometrial cancer.Öğe Follicle-stimulating hormone receptor gene polymorphisms in women with endometriosis(SPRINGER HEIDELBERG, 2015) Kerimoglu, Ozlem Secilmis; Yilmaz, Setenay Arzu; Pekin, Aybike; Nergiz, Suleyman; Incesu, Feyzanur; Dogan, Nasuh Utku; Acar, HasanThe purpose of this study was to evaluate the influence of the follicle-stimulating hormone (FSH) receptor poymorphisms Asn680Ser and Thr307Ala on endometriosis in Turkish women. Polymorphic analysis of the FSH receptor gene was performed in 100 patients with endometriosis and 100 controls. Genomic DNA was obtained from peripheral blood leukocytes and polymorphisms were investigated using restriction fragment length polymorphism analysis. There were no significant differences in genotype frequencies of FSH receptor gene between endometriosis patients and controls. When the patients were divided into two groups according to disease severity, we found that the patients with the SS (680 Ser/Ser) or AA (307 Ala/Ala) genotype were less likely to develop stage 3-4 endometriosis compared to the stage 1-2 endometriosis group (P = 0.004; OR: 0.177, 95 % CI 0.055-0.568 and P = 0.040; OR: 0.240, 95 % CI 0.061-0.938; respectively). The distributions of FSHR polymorphisms may not have an effect on endometriosis development but they are associated with the severity of the disease. The polymorphisms encoding SS at the position 680 and AA at the position 307 and the patients with the genotype that included alanine or serine were less likely to develop stage 3-4 endometriosis compared to the stage 1-2 endometriosis group.Öğe P-wave parameters and cardiac repolarization indices: Does menopausal status matter?(ELSEVIER IRELAND LTD, 2012) Dogan, Umuttan; Dogan, Nasuh Utku; Basarir, Ahmet Ozgur; Yildirim, Serkan; Celik, Cetin; Incesu, Feyzanur; Ozdemir, KurtulusBackground and purpose: Data regarding electrocardiographic characteristics of postmenopausal women are lacking. In this prospective, cross-sectional study, electrocardiographic P-wave parameters and cardiac repolarization indices of age-matched pre- and postmenopausal healthy women were compared. We hypothesized that menopausal status would have a significant effect on cardiac electrical activity and hence electrocardiography (ECG) recordings. Materials and methods: Twelve-lead ECG recordings were obtained from 125 consecutively recruited postmenopausal healthy women aged between 44 and 54 years. The control group consisted of 125 age-matched premenopausal women. P-wave parameters and cardiac repolarization indices were measured and compared with respect to menopausal status. Results: Demographic features of premenopausal and postmenopausal women were comparable. There were no significant differences between two groups regarding mean values of heart rate, maximum and minimum P-wave duration, P-wave dispersion, maximum and minimum QT interval, and QT dispersion. Mean values of QT interval obtained from lead V5 were also similar. Corrected values which were calculated according to Bazett and Fridericia formulas also did not differ between the groups. Mean values of Tpeak to Tend (TpTe) (p < 0.001) and corrected TpTe (p = 0.001) intervals obtained from lead V5 were significantly shorter in postmenopausal women when compared to those without menopause. Conclusion: Tpeak to Tend interval decreased significantly while QT intervals and P-wave parameters did not change in postmenopausal women when compared to premenopausal women. Association of these findings with changes in levels of sex steroids and their prognostic implications need to be elucidated with further studies. (C) 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.Öğe Pelvic radiotherapy does not deteriorate the quality of life of women with gynecologic cancers in long-term follow-up: A 2 years prospective single-center study(MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2017) Yavas, Guler; Yavas, Cagdas; Dogan, Nasuh Utku; Ilhan, Tolgay Tuyan; Dogan, Selen; Karabagli, Pinar; Ata, OzlemPurpose: To evaluate the emotional, sexual and health-related quality of life (HRQoL) concerns of the women with gynecologic malignancy treated with curative radiotherapy (RT). Patients and Methods: A 100 women with diagnosis of gynecologic malignancy were prospectively enrolled. HRQoL at baseline, at the end of RT and during follow-up was assessed using European Organization for Research and Treatment of Cancer QoL Questionnaire-C30 (EORTC QLQ-C30), EORTC QLQ-cervical cancer module 24, and Hospital Anxiety and Depression Scale. Results: The appetite loss, diarrhea, fatigue, dyspnea, insomnia, nausea and vomiting, pain scores, and sexual activity and sexual enjoyment scores were deteriorated after RT (P = 0.02 for pain scores and P < 0.001 for all other). Body image scores were higher in patients with endometrial cancer (P < 0.01). The emotional function, nausea and vomiting, body image and symptom experience scores were higher in patients who underwent chemotherapy (P = 0.04 and P = 0.01). All the complaints of patients improved during follow-up period. The global health status scores and the level of depression deteriorated in patients with locoregional recurrent disease and distant metastasis. The anxiety (P = 0.001) and depression (P = 0.007) levels were higher in basal and after-RT visits but then decreased through the subsequent follow-up visits. Conclusion: Although pelvic RT deteriorated HRQoL in patients with gynecologic malignancy, HRQoL improved during the follow-up period. The progressive disease had a negative impact on HRQoL.Öğe Predictive value of second and third trimester fetal renal artery Doppler indices in idiopathic oligohydramnios and polyhydramnios in low-risk pregnancies: A longitudinal study(WILEY, 2015) Benzer, Nilgun; Pekin, Aybike Tazegul; Yilmaz, Setenay Arzu; Kerimoglu, Ozlem Secilmis; Dogan, Nasuh Utku; Celik, CetinAimIntermittent assessment of renal artery flow velocity waveforms during the early stages of pregnancy may help in predicting changes in amniotic fluid dynamics. The current study sought to determine the relation of renal artery and umbilical artery flow velocity waveforms with normal pregnancies and pregnancies complicated by either polyhydramnios or oligohydramnios. Material and MethodsRenal and umbilical artery Doppler values were evaluated at 22, 28 and 34 weeks' gestation in 300 low-risk pregnant women with singleton pregnancies. Pulsatility index (PI) and resistance index (RI) were recorded and the amniotic fluid volume was evaluated. Three groups were formed according to the amniotic fluid volume at birth. Group I consisted of 264 pregnant women with normal amniotic fluid, group II included 30 pregnant women with oligohydramnios and group III included six pregnant women with polyhydramnios. Doppler parameters were compared between the groups and within each group according to gestational age. ResultsRenal artery PI values were higher in group II than group I at 22 weeks, 28 weeks and 34 weeks. The PI value at 28 weeks' gestation was statistically significant (P=0.011). At 28 weeks' gestation, group II also had higher umbilical artery PI and RI values than group I. ConclusionAn increase in renal artery PI develops in early pregnancy before the development of oligohydramnios. In pregnancies developing polyhydramnios, renal artery PI was lower; however, our study included a small number of women with polyhydramnios.Öğe Prospective Assessment of Quality of Life and Psychological Distress in Patients With Gynecologic Malignancy A 1-Year Prospective Study(LIPPINCOTT WILLIAMS & WILKINS, 2012) Yavas, Guler; Dogan, Nasuh Utku; Yavas, Cagdas; Benzer, Nilgun; Yuce, Deniz; Celik, CetinObjective: Our aim was to evaluate the health-related quality of life (HRQoL) and psychological distress in patients treated with radiotherapy (RT) for gynecologic malignancy. Methods: Fifty-seven women with either cervical or endometrial cancer were prospectively enrolled. We assessed HRQoL at baseline (after surgery before RT), at the end of RT, and during follow-up (every 3 months thereafter) using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cervical Cancer Quality of Life Questionnaire 24 (EORTC QLQ-CX24), and Hospital Anxiety and Depression Scale. Results: We demonstrated changes in appetite loss (P = 0.03), nausea and vomiting (P = 0.02), and role function score (P = 0.003) domains of EORTC QLQ-C30. Only the mean body image score of EORTC QLQ-CX24 was significantly different during follow-up (P = 0.02). Type of surgery, histopathological diagnosis, and the menopausal and marital status of the patients affected baseline body image scores (P = 0.032, 0.004, and 0.019 and 0.005, respectively). Patients who underwent chemotherapy had higher baseline body image scores when compared with patients without any chemotherapy before RT (P = 0.028). All the complaints of patients except body image scores improved during the follow-up period. The baseline and follow-up anxiety and depression scores did not differ significantly. Conclusions: Although pelvic RT deteriorated HRQoL in gynecologic cancer, patients' improvement in HRQoL during follow-up was observed. Patients receiving RT could be reassured about the improvement of acute adverse effects in the course of treatment.
