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Yayın Abdominal surgical approach to a case of complete cervical and partial vaginal agenesis(National Library of Medicine, 2005) Gürbüz, Ayşe; Karateke, Ateş; Haliloğlu, BernaObjective: To construct a uterovaginal canal in a patient with a complete cervical agenesis and partial vaginal agenesis. Design: Case report. Setting: Zeynep Kamil Women's and Children Hospital. Patient(s): A 15-year-old woman presented with lower abdominal pain. On examination, partial vaginal agenesis with a 4-cm vagina was noted. A pelvic ultrasonography revealed hematometra and the absence of a cervix. Intervention(s): Surgical therapy included creation of an ostium by making 1.5-cm midline vertical hysterotomy incision, trimming away the fibrous tissue at the distal portion of uterus, and attaching the proximal end of the vagina to the uterus by the abdominal route. A stent was left in place for 2 weeks. Main outcome measure(s): Pelvic ultrasonography and clinical follow-up evaluation. Result(s): Regular menstrual periods were observed for 6 months beginning at the first month. The follow-up pelvic ultrasonography was normal. Conclusion(s): Cervicoplasty attaching the mucosal lining of the endometrium to that of the vagina permits the creation of a patent cervical canal with short stenting time.Yayın A case of microglandular adenocarcinoma of the endometrium(National Library of Medicine, 2005) Karateke, Ateş; Haliloğlu, Berna; Atay, Vedat; Gürbüz, Ayşe; Kir, GözdeBackground: Microglandular adenocarcinoma is a rare type of endometrium carcinoma and had some potential diagnostic problems with difficulties in discriminating from some malign and benign lesions of cervix. Case report: A 70-year-old woman misdiagnosed as cervical adenocarcinoma was referred to our clinic, and the lesion was ultimately evaluated as microglandular adenocarcinoma in repeat of endometrial curettage specimen. Postoperatively, histopathologic examination of specimen revealed grade 1 microglandular adenocarcinoma. To our best knowledge, this is the twelfth case of uterine carcinoma simulating microglandular hyperplasia in the literature. Conclusion: Because microglandular adenocarcinoma can be confused with benign lesions like microglandular hyperplasia and malignant lesions of cervix, we aim to discuss the clinical, demographic and immunohistochemical characteristics of the patients with microglandular adenocarcinoma useful in differential diagnosis.Yayın Comparison of TVT and TVT-O in patients with stress urinary incontinence: short-term cure rates and factors influencing the outcome. A prospective randomised study(Wiley, 2009) Karateke, Ateş; Haliloğlu, Berna; Cam, Çetin; Sakallı, MustafaBackground: Recently, mid?urethral slings have been commonly used in treatment of patients with stress urinary incontinence (SUI). Aims: To investigate tension?free vaginal tape (TVT) and tension?free obturator tape (TVT?O) for surgical treatment of SUI for cure rates (primary endpoint), complications and factors influencing cure rate (secondary endpoints). Methods: One?hundred and sixty?four patients were included in the study (n = 81 for TVT, n = 83 for TVT?O). The cure rates, complications, preoperative and postoperative urodynamic evaluation, Q?tip test, the Turkish version of Incontinence Impact Questionnaire (IIQ?7) and Urogenital Distress Inventory (UDI?6) scores were recorded. At three and 12 months, the patients were evaluated regarding outcome measures. Results: The cure rates were similar in TVT and TVT?O groups, 88.9% versus 86.7% respectively. Mean operative time was significantly shorter in TVT?O group (P = 0.001). The cure rate was significantly higher in both groups in patients with urethral hypermobility when compared with those with no hypermobility (P = 0.001). Conclusions: The TVT and TVT?O procedures appear to be equally effective for the treatment of SUI. Also, urethral hypermobility seems to be a factor influencing cure rate of mid?urethral slings.Yayın Diabetes mellitus ve obezitenin postmenopozal dönemdeki kadınlardaki pelvik organ prolapsusu üzerine etkileri(Maltepe Üniversitesi, 2011) Çoksüer, Hakan; Haliloğlu, Berna; Ercan, Mutlu; Köse, Murat; Keskin, Uğur; Alanbay, İbrahim; Karaşahin, Emre; Kabaca, Canan; Karateke, AteşAmaç: Diabetes mellitus ve obezitenin postmenopozal dönemdeki kadınlarda pelvik organ prolapsusuna(POP) olan etkilerini değerlendirmeyi amaçladık. Yöntemler: 49-79 yaşları arasındaki POP bulunan 104 kadın grup I(non-diabetik ve non-obez) grup II(non-obez ve diabetik) grup III(obez ve non-diabetik) ve grup IV(obez ve diabetik) olmak üzere 4 gruba ayrılmıştır. Her bir grupta POP-Q (POP-Q) sistemi kullanılarak uterin prolapsus, sistosel ve rektosel varlığı değerlendirildi. Bulgular: Sağlıklı kadınlarla karşılaştırıldığında obezitenin ve diabetes mellitusun(DM) sistosel, rektosel ve uterin prolapsus progresyonuyla ilişkili olduğu saptanmıştır(p<0.001). Obezite olan gruplardaki uterin prolapsus evresi diyabetik gruplardan belirgin olarak daha ileri bulunmuştur( p<0.001). Sonuç: Obezite ve DM; POP için risk faktörü olarak görülmektedir. Obezite, uterin prolapsusu DM'den daha fazla etkilemektedir ve modifiye edilebilir bir risk faktörüdür. Dolayısıyla yeni tedavi stratejilerinin geliştirilmesi önem arz etmektedir.Yayın Does erythropoietin affect motility of spermatozoa?(Springerlink, 2010) Tuğ, Niyazi; Altunkaynak, Muhammed Eyüp; Aktaş, Ranan Gülhan; Kılıç, Ülkan; Yılmaz, Bayram; Cam, Cetin; Karateke, AteşIntroduction Erythropoietin, which is a hematopoietic growth factor, has been found to play a role in various physiologic processes within the body including testicular steroidogenesis and spermatogenesis. However, it is not known whether erythropoietin is also essential for the normal physiology of mature sperm cells. In this study, the effects of recombinant human erythropoietin beta (rEPO) on sperm motility were investigated. Materials and methods Samples of 37 volunteers (with total motile sperm count >5 × 106/ml and a total motility of >50% according to WHO criteria) were collected by masturbation following a 3–5 days period of abstinence. After morphometric analysis before and just after washing, samples were either used as control or treated with rEPO at concentrations of 0.1, 1, 10 or 100 mIU/ml, respectively. Control and treated tubes were incubated for 4 h at 37°C. Results Total motility, total progressive motility, slow forward and nonmotile sperm counts of 1, 10 and 100 mIU/ml rEPO groups were significantly improved. This effect was dose independent. Conclusion No significant effect was found at 0.1 mIU/ml concentration. These results suggest that supplementation of media used for sperm preparation techniques with erythropoietin might be beneficial. Further studies are needed to clarify the mechanism of action of erythropoietin on mature sperm cells.Yayın Does erythropoietin affect motility of spermatozoa?(Springerlink, 2009) Tuğ, Niyazi; Altunkaynak, Muhammed Eyüp; Kılıç, Ülkan; Yılmaz, Bayram; Cam, Cetin; Karateke, AteşErythropoietin, which is a hematopoietic growth factor, has been found to play a role in various physiologic processes within the body including testicular steroidogenesis and spermatogenesis. However, it is not known whether erythropoietin is also essential for the normal physiology of mature sperm cells. In this study, the effects of recombinant human erythropoietin beta (rEPO) on sperm motility were investigated.Yayın Erken doğum tehdidinde risk faktörlerinin belirlenmesi(Zeynep Kamil Kadın ve Çocuk Hastalıkları EAH, 2002) Demirbaşoğlu, Sema; Haliloğlu, Berna; Mülayim, Barış; Aksoy, Evrim; Karateke, AteşAmaç: Neonatal mortalitenin %83 ü preterm doğumlardan kaynaklanan nedenlere bağlıdır. Çalışmamızda erken doğuma yol açan risk faktörlerinin belirlenmesi amaçlanmıştır. Materyal Metod: Mayıs 2001 Aralık 2001 tarihleri arasında açıklanamayan nedenli erken doğum tehdidi tanısıyla interne edilen 112 olgu ve kontrol grubu olarak 55 gebe çalışmamıza dahil edilmiştir,Yayın Intestinal vaginoplasty: is it optimal treatment of vaginal agenesis? A pilot study. Surgical method of sigmoid colon vaginoplasty in vaginal agenesis(National Library of Medicine, 2006) Karateke, Ateş; Gürbüz, Ayşe; Haliloğlu, Berna; Kabaca, Canan; Köksal, NeşetThe outcome of 11 cases with vaginal agenesis who underwent intestinal vaginoplasties are presented. Patients were between 18 and 37 years old. Ileum vaginoplasty and sigmoid colon vaginoplasty were carried out in two and nine cases, respectively. Ileum necrosis at donor site requiring ileum resection and bilateral ileostomy encountered in one of the cases was the major complication. Mild stenosis responsive to finger dilatation had been detected in two women with sigmoid vaginoplasty. Excess mucous production, long operation time, and shortness of mesentery of ileum led us to abandon ileum vaginoplasty, and sigmoid colon vaginoplasty was performed in the following cases with vaginal agenesis. All of the neovaginas were patent and functional. We suggest sigmoid colon vaginoplasty as the treatment of choice because of its large lumen, thick walls resistant to trauma, adequate secretion allowing lubrication, not necessitating prolonged dilatation, short recovery time compared with ileum vaginoplasties; and in patients reluctance to prolonged use of dilatators or in those who experienced previous failure of the other treatment modalities.Yayın Metastatic ovarian carcinoma one year after surgical removal of colon carcinoma during pregnancy: a case report(Wiley, 2006) Gürbüz, A.; Kir, Gözde; Karateke, Ateş; Haliloğlu, Berna; Kabaca, CananColorectal carcinoma during pregnancy is a very rare event. We presented a woman with metachronous metastatic ovarian tumor existing 1 year after surgical removal of perforated sigmoid colon carcinoma encountered during cesarean section of woman of 36?week gestation for fetal distress. Pregnant women with suspicious abdominal mass should be evaluated for a possible colorectal carcinoma even in the absence of any other gastrointestinal symptoms associated with it and undergo rectal examination and sigmoidoscopy. In addition, as synchronous and metachronous ovarian metastases are common in these patients, ovaries must be evaluated carefully by bisection during operation for possible metastasis, and in women who do not have a desire for fertility, prophylactic oophorectomy seems an appropriate treatment modality for resecting synchronous metastasis and preventing future metastasis.Yayın The role of urethral hypermobility and intrinsic sphincteric deficiency on the outcome of transobturator tape procedure: a prospective study with 2-year follow-up(Springer Nature, 2009) Haliloğlu, Berna; Karateke, Ateş; Çoksuer, Hakan; Peker, Hakan; Cam, ÇetinIntroduction and hypothesis The aim of this study is to investigate the effect of intrinsic sphincter deficiency (ISD) and urethral hypermobility on the outcome of the transobturator tape (TOT). Methods Sixty-five women were divided into three groups: group I, ISD with hypermobile urethra (n=18); group II, ISD with fixed urethra (n=16); and group III, hypermobile urethra without ISD (n=31). Cure of stress urinary incontinence was defined if the patient had negative cough stress test. Cure and improvement rates were compared at 6, 12, and 24 months. Results The cure and improvement rates of groups I and III were similar at 6, 12, and 24 months (96.1% vs 96.6%, 96.1% vs 96.6%, and 87.5 vs %96.4%, respectively). Group II had the lowest cure and improvement rates (68.7%, 66.7%, and 66.7%, respectively). Conclusion A lack of urethral hypermobility may be a risk factor for TOT failure.Yayın Sacrocervicopexy and combined operations involving cases of total uterine prolapse. Case reports(Karger, 2004) Karateke, Ateş; Gürbüz, A.; Kir, Gözde; Haliloğlu, Berna; Kabaca, Canan; Mengüllüoğlu, MuratObjective: To determine the outcome of sacrocervicopexy and combined operations in the treatment of uterovaginal prolapse in women with desire to preserving both uterus and fertility. Clinical Presentation and Intervention: Sacrocervicopexy with Prolene mesh and combined operations were performed in 3 women with total uterine prolapse because of the patient’s desire to retain fertility in 2 cases and refusal of hysterectomy in the 3rd patient. The 1st case was a 38-year-old woman, gravida 2, parity 1; the 2nd case a 42-year-old woman, gravida 3, parity 2, and the 3rd a 39-year-old woman, gravida 1, parity 1. Douglas pouch was obliterated with Moschcowitz operation. All of the women underwent sacrocervicopexy with Prolene mesh. The repair of a paravaginal defect and prophylactic Burch urethropexy were accomplished through entering Retzius’ space. Genital hiatus was narrowed via approximating levator muscles transvaginally. No serious intraoperative complications occurred and no recurrence was detected during the follow-up period. There was no postoperative complication except for some degree of pain in the 1st postoperative month in 1 case. Conclusion: The results indicate that sacrocervicopexy and repair of all concomitant defects in the pelvic floor are effective procedures in the treatment of uterovaginal prolapse in cases where there is a desire to retain fertility and uterus.Yayın Third trimester nonrecurrent fetal loss is associated with factor V Leiden and prothrombin gene mutations(National Library of Medicine, 2005) Karateke, Ateş; Haliloğlu, Berna; Gürbüz, AyşeObjective: To determine the role of factor V Leiden and prothrombin gene mutation in the pathogenesis of unexplained second and third trimester nonrecurrent fetal loss. Materials and methods: One hundred and fourteen women with unexplained nonrecurrent late fetal loss made up the study group, and 106 normal pregnant women with a history of delivery of at least one healthy fetus and no history of late fetal loss made up the control group. The study group was further divided into two subgroups: second (n = 36) and third (n = 78) trimester fetal loss. All women were tested for factor V Leiden and G20210A prothrombin gene mutations. Results: Twenty-one (18.4%) of the women in the study group and seven (6.6%) of the women in the control group were heterozygous carriers of factor V Leiden mutation (OR = 3.19). Eleven (9.6%) of the women in the study group and three (2.8%) of the women in the control group were heterozygous carriers of prothrombin gene mutation (OR = 3.66). In assessing with regard to trimesters, 18 (23%) factor V Leiden and 10 (12.8%) prothrombin gene mutations were present in the group of third trimester fetal loss (OR = 4.24 and OR = 5.04, respectively). Three (8.3%) factor V Leiden and one (2.7%) prothrombin gene mutation were detected in women with second trimester fetal loss (OR = 1.28 and OR = 0.40, respectively). Conclusion: Factor V Leiden and prothrombin gene mutations were associated with third trimester nonrecurrent fetal loss. These mutations should be screened in women with third trimester but not second trimester unexplained nonrecurrent late fetal loss.Yayın Urinary incontinence: prevalence and risk factors, association with anal incontinence and scope of incontinence in Turkish women(Mebas Medikal Basın Yayın San. ve Tic. Ltd. Şti, 2004) Gürbüz, Ayşe; Karateke, Ateş; Kabaca, Canan; Haliloğlu, Berna; Şahinoğlu, Zeki; Bilgin, ZümrütOBJECTIVE: To determine the prevalence and risk factors of urinary and anal incontinence and to assess women’s response and point of view to urinary incontinence. STUDY DESIGN: The prevalence of overall, stress, urge, mixed urinary incontinence and anal incontinence was assessed by a multichoice questionnaire form in 1021 patients who admitted to outpatient gynecology clinics of our hospital. RESULTS: Of the 1021 patients, 162(15.9%) reported urinary incontinence, comprising 79(48.8%) with stress, 50(30.9%) with urge and 33(20.4%) with mixed urinary incontinence. There were significant differences regarding age, number of pregnancies and deliveries, route of delivery, duration of labor, infant birth weight, enuresis in childhood, enuresis nocturna, constipation, flatal and fecal incontinence between patients with and without urinary incontinence (p<0.05). In comparison of subgroups (stress, urge and mixed urinary incontinence) with patients without urinary incontinence, one by one, there were statistically significant differences concerning age, number of pregnancies and deliveries, route of delivery, and enuresis nocturna (p<0.05). Of the 1021 patients, 525(51.5%) reported flatal incontinence and 32(3.1%) reported fecal incontinence. The rates of flatal and fecal incontinence in patients with urinary incontinence were 65.4%(n=106) and 6.8%(n=11), respectively. Most of the women (66.1%) did not perceive urinary incontinence as a social or hygienic problem, however 84.6% of the patients with urinary incontinence did (p<0.0001). CONCLUSION: Ageing and obstetric events were the most prominent risk factors. According to our results, patients with urinary and anal incontinence could not yet seek for medical help. Education of population is important in order to avoid complications of incontinence.Yayın Vaginal agenezis olgularında uygulanan girişimler ve sonuçlarımız(Perinatoloji ve Endokrinoloji Derneği, 2004) Gürbüz, Ayşe; Karateke, Ateş; Haliloğlu, Berna; Kır Şahin, FigenAmaç: Konjenital vaginal agenezis nedeniyle uygulanan vaginoplasti operasyonlarını karşılaştırmak. Metod: Çalışmamıza Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesinde konjenital vaginal agenezis tanısı ile cerrahi girişim uygulanan 13 olgu dahil edildi. Bunlardan 8 olguya McIndoe yöntemi ile vaginoplasti, 1 olguya üretra ile rektum arası doku açılarak penil protez uygulanması, 2 olguya myokutanöz flep (pudendal-kasık bölgesinden alınan kas-deri flebi), 2 olguya ileum ile neovagen ve 1 olguya sigmoid kolon ile neovagen yapılmış idi. İleum ile neovagen yapılan olgulardan biri 6 yıl önce greft uygulanmadan üretra ile rektum arası doku açılarak penil protez uygulaması yapılan fakat yeni oluşturulan vagenin kapanması nedeniyle ileal vaginoplasti uygulanan olgu idi. Bulgular: En uzun operasyon süresi intestinal fleplerin kullanıldığı operasyonlarda idi (ileum için 267.5±35.4 dk,sigmoid için 260 dk). Deri grefti uygulanan operasyonların % 62.5 (5/8)'inde vaginal kısalma ve % 62.5 (5/8)'inde vaginal daralma mevcut idi. Myokutanöz flep uygulanan 2 olguda da vaginal daralma izlendi. İntestinal flep uygulanan hiçbir olguda vaginal daralma ve kısalma izlenmedi. İleal flep uygulanan olgulardan birinde aşırı vaginal sekresyon, diğerinde ise ileal rezeksiyona neden olan ileal nekroz izlendi. Sonuç: McIndoe yöntemi kozmetik olması ve major cerrahi girişime gereksinim duyulmaması nedeniyle avantajlı gözükmektedir. Ancak olgularımızın önemli bir kısmında uzun süreli dilatasyona isteksizlik nedeniyle neovagende kısalma ve daralma izlenmiştir. Bu nedenle bu yöntem ülkemiz koşullarında seçilecek tedavi yöntemi olarak gözükmemektedir. İntestinal flepler ise vagenin kısalmaması, uzun süre penil protez kullanmadan vaginal genişlik ve uzunluğun sağlanması, cinsel ilişkiyi kolaylaştıran mukus üretiminin olması, kötü kokunun olmaması, vagene benzeyen lümenli bir organ olmaları, ayrıca seksüel aktif olmayan olgularda aralıklı dilatasyona gereksinimduyulmaması nedeniyle çocukluk çağında uygulanabilmesi gibi pekçok avantaja sahiptir.Yayın Villoglandüler adenokarsinoma: diagnostik ikilem(Zeynep Kamil Kadın ve Çocuk Hastalıkları EAH, 2005) Gürbüz, Ayşe; Haliloğlu, Berna; Karateke, Ateş; Kabaca, Canan; Kır, GözdeVilloglandüler papiller adenokanser (CGPA) nispeten nadir görülen bir servikal adenokanser varyantı olup literatürde prognozunun çok iyi olduğu bildirilmektedir. Çalışmamımızda iki VGPA olgusu sunulmuştur. Olgularınızdaki klinik karara akın etkisi gözönüne alındığında VGPA'nın patolojşk ayırıcı tanısının daha ayrıntılı yapılması gerektiği kanaatindeyiz.