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    Bone turnover and maternal 25(OH) vitamin D3 levels during pregnancy and the postpartum period: should routine vitamin D supplementation be increased in pregnant women?
    (ELSEVIER SCIENCE BV, 2011) Haliloglu, Berna; Ilter, Erdin; Aksungar, Fehime Benli; Celik, Aygen; Coksuer, Hakan; Gunduz, Tonguc; Yucel, Erdal; Ozekici, Umit
    Objective: To investigate the relationship between 25(OH) vitamin D3 levels and maternal bone turnover during pregnancy and lactation. Study design: Thirty pregnant women and 30 healthy non-pregnant controls were included the study. The pregnant women were examined in the 12th, 25th and 32nd gestational weeks and 6 weeks after delivery. The controls were examined once. Serum concentrations of 25(OH) vitamin D3, parathyroid hormone (PTH), cross-linked C-terminal telopeptide of type I collagen (CTX), calcium, and phosphate were measured. Results: In the 32nd week and the postpartum period, 25(OH) vitamin D3 deficiency rates were 13.3% and 333%, respectively. Serum 25(OH) vitamin 03 levels were below the detection limit in 10% and 33%, respectively, of the same subjects. In the control group, rates of 25(OH) vitamin D3 deficiency and "below detection limit" were 30% and 23%, respectively. While 25(OH) vitamin 03 and CTX levels were not correlated to each other in the first trimester, a negative correlation was found in the 2nd and 3rd trimesters and the postpartum period between 25(OH) vitamin 03 and CTX levels (r = -0.472, p = 0.048; r = -0.893, p < 0.0001, r = -0.881, p < 0.001, respectively). No correlation between 25(OH) vitamin D3 and CTX levels was found in controls. Conclusion: We consider that 25(OH) vitamin D3 supplementation of women could both decrease maternal bone resorption and lead to enhanced bone mass in offspring during later life. Since women are prone to 25(OH) vitamin D3 insufficiency, we suggest higher doses of 25(OH) vitamin D3 should be given to pregnant subjects. (C) 2011 Elsevier Ireland Ltd. All rights reserved.
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    Does urinary incontinence subtype affect sexual function?
    (ELSEVIER SCIENCE BV, 2011) Coksuer, Hakan; Ercan, Cihangir Mutlu; Haliloglu, Berna; Yucel, Mehmet; Cam, Cetin; Kabaca, Canan; Karateke, Ates
    Objective: Urinary incontinence (UI) may affect a woman's physical and psychological well-being in different aspects. The aim of this study was to compare the effects of urinary stress incontinence (USI), detrusor overactivity (DO) and mixed urinary incontinence (MUI) on sexual function. Study design: One-hundred and seventy urinary incontinent, sexually active women were included in this cross-sectional study. After urodynamic evaluation, participants were divided into three subgroups as USI (n = 61), DO (n = 55) and MUI (n = 54). Patients were matched according to age, parity and body mass index (BMI), rendering the sample size to 41 patients in each group. Turkish version short form of the Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire (PISQ-12) was filled out by each of the participants. Totally, 52 patients were excluded from the study (47 could not be matched and 5 incomplete questionnaire). Demographic characteristics of the participants, total and three domain scores of PISQ-12 were compared among three UI subgroups. Results: The study group was consisted of 38 (32.2%) DO, 41(34.7%) USI and 39(33.1%) MUI patients. Demographic characteristics of the patients were similar in three subgroups. Patients with a diagnosis of MUI had significantly lower mean PISQ-12 scores than the ones with USI and DO whereas patients with USI had lower mean PISQ-12 scores than patients with DO. Conclusion: Although urinary stress incontinence effects sexual function more than detrusor overactivity in terms of PISQ-12 scores, mixed urinary incontinence has the greatest impact on sexual function when compared with urinary stress incontinence and detrusor overactivity. (C) 2011 Elsevier Ireland Ltd. All rights reserved.
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    Effects of Hyperandrogenism on Tear Function and Tear Drainage in Patients with Polycystic Ovary Syndrome
    (SCI PRINTERS & PUBL INC, 2011) Coksuer, Hakan; Ozcura, Fatih; Oghan, Fatih; Haliloglu, Berna; Karatas, Serap
    OBJECTIVE: Polycys tic ovary syndrome (PCOS) is an endocrinopathy characterized by chronic anovulation and hyperandrogenism. Hormonal changes can affect ocular surface and tear functions. We evaluated dry eye symptoms, clinical tear film alterations, and tear clearance in patients with PCOS. STUDY DESIGN: Thirty-five women with PCOS and 22 healthy individuals were enrolled in the study. An ocular surface disease index (OSDI) questionnaire was administered, and after the routine ophthalmologic examination tear film breakup time (TB UT) and Schirmer tests were performed. Tear clearance was assessed via fluorescein dye disappearance test (FDDT). RESULTS: No difference was observed in Schirmer test between the groups, however OSDI scores were significantly higher (p=0.01) and TBUT was significantly lower (p=0.01) in PCOS patients than in the control women. FDDTs were not different between the PCOS and control subjects. CONCLUSION: Our findings suggest that patients diagnosed with PCOS should be advised to obtain an ophthalmic examination, especially for dry eye. (J Reprod Med 2011;56:65-70)
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    Evaluation of carotid wall thickness and vertebro-basilar system insufficiency in patients with obese polycystic ovary syndrome
    (WILEY, 2011) Coksuer, Hakan; Koplay, Mustafa; Oghan, Fatih; Haliloglu, Berna; Keskin, Nadi
    Aim: To investigate the risk of cardiovascular disease by measuring carotid intima-media thickness (CIMT) and to evaluate the diameters and blood flow volume of vertebral arteries using Doppler ultrasound and the possible contribution of hyperandrogenemia that exists in these patients. Material and Methods: We prospectively studied 64 Caucasian women aged 18-35 years (31 with polycystic ovary syndrome [PCOS] and 33 healthy controls). Patients were classified according to body mass index into obese (BMI > 27 kg/m(2)). All subjects were examined with ultrasound to measure CIMT and blood flow volume and diameters of vertebral arteries. Results: A significant difference between the two groups in CIMT (0.51 +/- 0.08 vs 0.39 +/- 0.02 mm, P < 0.001) and diameters of vertebral arteries (right, 3.03 +/- 0.37 vs 3.44 +/- 0.68 mm and left, 2.94 +/- 0.34 vs 3.33 +/- 0.63 mm, P < 0.05) were found, respectively. Right-left and total flow volumes of the vertebral arteries (VA) were significantly lower in the PCOS group than in the control group (P <= 0.001). Compared to the control group, diameters of right and left VA decreased (P < 0.05). Conclusion: The results of this study suggest that hyperandrogenemia in obese PCOS patients affects carotid and vertebro-basilar system arteries wall thickness. Pre-atherosclerotic vascular impairment with androgen excess should determine early examination of vertebro-basilar system with ultrasound. All patients with PCOS must be routinely examined using color Doppler ultrasound to measure CIMT carotid and vertebro-basilar arteries, and diameters and blood flow volume of vertebral arteries.
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    Intestinal vaginoplasty: seven years' experience of a tertiary center
    (ELSEVIER SCIENCE INC, 2010) Karateke, Ates; Haliloglu, Berna; Parlak, Onur; Cam, Cetin; Coksuer, Hakan
    Objective: To investigate the long-term effects of intestinal vaginoplasty in cases with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Design: Prospective study. Setting: Division of Pelvic Reconstructive Surgery, Department of Gynecology and Obstetrics, at a women's and children disease education and research hospital. Patient(s): Between 2003 and 2009, 29 patients with MRKH syndrome underwent intestinal vaginoplasty. Intervention(s): Two of the patients were treated with ileal and 27 with sigmoid vaginoplasty. Main Outcome Measure(s): The age, marital status, associated anomalies, method used for bowel transposition (isoperistaltic/antiperistaltic), type of abdominal incision, and intra-and postoperative complications were evaluated. Result(s): One of the patients for whom ileal vaginoplasty was performed had 40 cm ileal necrosis requiring bilateral ileostomy for 2 months. Introital stenosis was detected in 15 cases (79%) who were unmarried, while none of the married cases had introital stenosis. However, all patients responded to finger-dilatation. All married patients were sexually satisfied after operation. An intraluminal abscess developed in the proximal segment of the neovagina owing to stricture occurring above abdominoperineal tunnel 2 years after operation. In another patient who had a rudimentary uterine horn, hematometra developed 3 years after operation and treated with resection. Conclusion(s): In our experience, sigmoid vaginoplasty seems to be a favorable procedure which provides excellent long-term results for the patients with vaginal agenesis. (Fertil Steril (R) 2010;94:2312-5. (C) 2010 by American Society for Reproductive Medicine.)
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    Negative correlation between D-dimer and homocysteine levels during pregnancy and the postpartum period a prospective study
    (ELSEVIER SCIENCE BV, 2010) Haliloglu, Berna; Aksungar, Fehime Benli; Celik, Aygen; Ilter, Erdin; Coksuer, Hakan; Ozekici, Umit
    Objective There have been conflicting data about the role of increased levels of homocysteine (Hcy) on haemostatic system We aim to investigate prospectively the relation between serum Hcy levels and changes in haemostatic system in pregnancy and postpartum period Study design Sixty-eight healthy pregnant women were included in the study Blood samples were obtained in the 11th gestational week 25th gestational week 32nd gestational week and postpartum 4th week The haemoglobin levels white blood cell count (WBC) platelet count activated partial thromboplastin time (aPTI-) prothrombin time (PT) fibrinogen D-dimer Hcy vitamin B12 and folate levels were measured Results Serum Hcy levels were negatively correlated with D-dimer levels (r = -0 57 p < 0 0001) The highest levels of D-dimer (1046 62 +/- 322 01 ng/ml) were achieved in the third trimester and the lowest levels of serum Hcy (4 45 +/- 123 mmol/1) were detected in the same trimester In postpartum fourth week D dimer levels were decreased to normal levels (238 27 +/- 198 59 ng/ml) while the serum Hcy levels were reached to the highest levels (7 99 +/- 1 36 mmol/1) Conclusion The negative correlation between Hcy and D-dimer levels may be a compensatory mechanism to maintain the normal haemostatic balance in pregnancy Hence possible advantage of low Hcy levels in pregnancy may be to prevent undesired thrombosis (C) 2010 Elsevier Ireland Ltd All rights reserved