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Öğe Assessment of CA-125 area under the curve as a prognostic factor in patients with ovarian cancer(Humana Press Inc, 2013) Uzunoglu, Sernaz; Aybatli, Aysun; Kaplan, Petek Balkanli; Cicin, Irfan; Sut, Necdet; Sayin, Cenk; Varol, FusunThe goal of this study was to evaluate the efficacy of CA-125 area under the curve (CA-125 AUC) as a prognostic factor following surgical treatment for ovarian cancer patients. A retrospective analysis was conducted on ninety-five patients with ovarian cancer who had primary treatment in a tertiary center between 2000 and 2010. After either optimal or cytoreductive surgery, all patients underwent adjuvant chemotherapy. CA-125 AUC was calculated for each patient that had a minimum of three CA-125 serum measurements during the treatment period. The mean age at diagnosis and mean survival were 53.9 years (range, 16-75 years) and 35.6 +/- 22.9 months (range, 3.1-95.4 months), respectively. The mean (and median) CA-125 AUC of patients of FIGO stages I, II, III, and IV was 53.0 (42.5), 58.06 (58.06), 97.8 (54.6), and 405.2 (149.3) IU/ml day, respectively (p = 0.004). The mean CA-125 AUC was 57.7, 410.1, and 636.3 IU/ml day for patients with a complete response, partial response, and no response/progressive disease to first-line chemotherapy, respectively (p < 0.001). The CA-125 AUC cut-off level for an overall survival of >= 5 years was 99.75 IU/ml day with a sensitivity of 90.9 % (95 % CI, 70.8-98.6) with 1.27 as positive likelihood ratio. Patients who suffer from ovarian cancer, with a lower CA125 AUC, have a better overall survival than those with a higher CA125 AUC. CA-125 AUC could be used as an independent factor for evaluating the treatment efficacy and chemotherapy response.Öğe The assessment of quality of life in female Turkish patients with overactive bladder(Wiley, 2012) Sut, Hatice Kahyaoglu; Kaplan, Petek Balkanli; Sut, Necdet; Tekbas, SerapThe objective of this study was to examine the quality of life in female Turkish patients with overactive bladder OAB). The investigation was conducted as a cross-sectional study between January and April 2010. Two hundred eighty female patients responded to the Overactive Bladder Validated Eight-Question Screener, the OAB disease-specific health-related quality-of-life scale OAB questionnaire OAB-q)) and the general quality-of-life scale EuroQol Five-Dimensional Questionnaire EQ-5D) for the study. Of the 280 patients, 38.9% was classified as having OAB. The mean age was 47.0 +/- 8.7. All of the quality-of-life domains coping, concern, sleep and social) and OAB-q total scores in women with OAB were significantly worse than in women without OAB P < 0.001 for all). Similarly, the EQ-5D(index) and EQ-5DVAS scores for women with OAB were significantly worse than for women without OAB P < 0.001 and P = 0.006, respectively). OAB-q and EQ-5D(index) scores in menopausal women were significantly lower than non-menopausal women P < 0.05) in patients with OAB. In conclusion, OAB negatively affects quality of life in Turkish women. However, many women's quality of life can be improved if the patients seek medical treatment. Thus, nurses should encourage the patients to seek medical support in order to cope with health-related quality-of-life problems.Öğe Delayed-interval delivery of an in vitro-fertilized triplet pregnancy with premature rupture of membranes in the second trimester(Springer Heidelberg, 2010) Yuce, Mehmet Ali; Aybatli, Aysun; Kaplan, Petek BalkanliThe incidence of multiple pregnancies is increasing with the availability of assisted reproductive techniques. Preterm labor and preterm rupture of membranes are major complications in such pregnancies. Preterm delivery of the first fetus is often followed by delivery of the remaining fetuses. However, conservative management in such circumstances might allow for fetal lung maturity in the remaining fetuses. We present a case of conservative management of an in vitro-fertilized triplet pregnancy with early loss of the leading triplet. A 33-year-old woman in the 21st week of a triplet pregnancy delivered her one of the fetuses, 4 days after the preterm rupture of membranes. To save the surviving fetuses, ligation of the umbilical cord at the cervical level was performed. Patient received antibiotics, tocolytics and corticosteroids after then. The second and the third fetuses were successfully delivered by cesarean section in the 28th week of pregnancy, 43 days after the first fetus was born. We can improve the life expectancy of the retained fetuses by conservative management using tocolytics, antenatal steroids to stimulate lung maturation and antibiotics following the delivery of the first fetus.Öğe Effect of pelvic floor muscle exercise on pelvic floor muscle activity and voiding functions during pregnancy and the postpartum period(Wiley, 2016) Sut, Hatice Kahyaoglu; Kaplan, Petek BalkanliAimsThe aim of this study was to investigate the effects of pelvic floor muscle exercise during pregnancy and the postpartum period on pelvic floor muscle activity and voiding functions. MethodsPregnant women (n=60) were randomly assigned into two groups (Training [n=30] and Control [n=30]) using a computer-based system. Pelvic floor muscle strength was measured using a perineometry device. Urinary symptoms were measured using the Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and the Overactive Bladder Questionnaire (OAB-q). Voiding functions were measured using uroflowmetry and 3-day voiding diaries. Measurements were obtained at week 28, weeks 36-38 of pregnancy, and postpartum weeks 6-8. ResultsPelvic floor muscle strength significantly decreased during the pregnancy (P<0.001). However, pelvic floor muscle strength improvement was significantly higher in the Training group compared to the Control group (P<0.001). The UDI-6, IIQ-7, and OAB-q scores did not significantly change during weeks 36-38 of pregnancy in the Training group (P>0.05). However, UDI-6, coping, concern, and total scores of OAB-q were significantly decreased during weeks 36-38 of pregnancy in the Control group (P<0.05). The UDI-6 and OAB-q scores were significantly improved during postpartum weeks 6-8 (P<0.05). Voiding functions were negatively affected in both groups, decreasing during weeks 36-38 of pregnancy and improving during the postpartum period. ConclusionsPregnancy and delivery affect pelvic floor muscle strength, urinary symptoms, quality of life, and voiding functions. Pelvic floor muscle exercises applied during pregnancy and the postpartum period increase pelvic floor muscle strength and prevent deterioration of urinary symptoms and quality of life in pregnancy. Neurourol. Urodynam. 35:417-422, 2016. (c) 2015 Wiley Periodicals, Inc.Öğe Huge solitary primary pelvic hydatid cyst presenting as an ovarian malignancy: case report(Galenos Yayincilik, 2009) Aybatli, Aysun; Kaplan, Petek Balkanli; Yuce, Mehmet Ali; Yalcin, OmerHydatid disease is a zoonotic parasitic infection caused by Echinococcus granulosus. Echinococcus cysts are found mostly in the liver (60%) and lung (15%), but they can be located in any part of the body. However pelvic echinococcosis as the primary site is rarely seen. We report the case of a large echinococcal cyst localized in the lower pelvis. A 76-year-old woman was admitted to an emergency department with urinary retention for ten days. Ultrasonography and other imaging modalities revealed a mass with solid and cystic components in pelvic localization. This unusual presentation in an elderly postmenopausal woman was initially considered as an ovarian malignancy until surgical exploration and microscopic studies confirmed the diagnosis of echinococcosis. Antihelminthics were administered postoperatively and the patient is now being closely followed up. Gynecologists should be aware of the possibility of a primary hydatid cyst of the pelvic cavity and should be considered in the differential diagnosis of cystic pelvic masses, especially in areas where the disease is endemic.Öğe The investigation of tumoral angiogenesis with HIF-1 alpha and microvessel density in women with endometrium cancer(Galenos Yayincilik, 2012) Aybatli, Aysun; Sayin, Cenk; Kaplan, Petek Balkanli; Varol, Fusun; Altaner, Semsi; Sut, NecdetObjective: Hypoxia inducible factor 1 alpha (HIF-1 alpha) is a nuclear protein upregulated in response to reduced cellular oxygen concentration which therefore acts as a marker for hypoxia. The aim of this study was to determine tumoral angiogenesis with immunohistochemical markers in endometrium cancer and its relation with stage, grade, survival rates and other prognostic factors. Material and Methods: Using the database in our Gynecologic Oncology clinic, we selected 94 patients who were diagnosed with endometrial cancer and underwent primary surgery at our institution between 2001 and 2010. Tissue microarrays believed to demonstrate the optimum part of the tumor were reprepared from the paraffin blocks. Angiogenesis and microvessel density (MVD) were investigated with the aid of HIF-1 alpha and CD34 antibodies. Results: High expression of HIF-1 alpha was significantly more frequent in advanced grade endometrial cancers (p=0.044). HIF-1 alpha expression was highly correlated with CD34 expression in the tumor cells (p<0.001). However lack of relation among stage, overall survival rates and histological types were analyzed with HIF-1 alpha. When we compared HIF-1 alpha positive and negative cases with cervical, adnexial, lymphovascular and myometrial invasion, there was no difference between these groups. MVD was evaluated with CD34 and it was remarkable and significantly different on advanced grade tumors (r=0.268; p=0.009). A similar significant difference was observed between the high expression of CD34 and type II endometrial cancer histology (p<0.001). However, there was no relationship between the MVD and stage or survival rates. Conclusion: High expression of HIF-1 alpha is associated with tumoral angiogenesis in endometrial adenocarcinomas. Further studies targeting HIF-1 alpha for disrupting mechanisms essential for tumor growth in endometrium cancer will be significant investigations in the future.Öğe Neuromuscular Morphometry of the Uterine Ligaments and Vaginal Wall in Women With Pelvic Organ Prolapse(Wiley, 2011) Kaplan, Petek Balkanli; Usta, Ufuk; Inal, Hasan Ali; Tastekin, Tugba; Tokuc, BurcuAims: The aim of this study was to compare neuromuscular histomorphometry of the uterine ligaments and vaginal wall in women with and without pelvic organ prolapse. Methods: Biopsies were obtained from the round, uterosacral, and cardinal ligaments of the uterus and apical vaginal wall of women having pelvic organ prolapse repaired (stage >= II; prolapse group, 37) and the same location in patients with no prolapse (stage < II; control group, 47). Routine hematoxylin-eosin (H & E) staining and immunohistochemical staining for Protein Gene Product 9.5 (PGP 9.5) and smooth muscle alpha-actin were performed for all specimens. Results: Smooth muscle percentage of the uterosacral and cardinal ligaments were not significantly different in women with prolapse than in women without. In round ligament, mean smooth muscle percentage was lower than in women with normal support (81.63 +/- 8.2 vs. 51.63 +/- 16, P = 0.000). Mean distance of the smooth muscle fibers from surface epithelium of the vaginal epithelium of the women with prolapse were significantly higher than the control group (1.679 +/- 0.34 vs. 2.240 +/- 0.33, P = 0.000). PGP 9.5 stained area percentage of uterine ligaments and vaginal wall tissue samples were significantly lower in women with prolapse. Conclusions: Both total innervation of the anterior vaginal epithelium and uterine ligaments, and muscular percentage of the round ligament and vaginal wall were decreased in women with pelvic organ prolapse. Neurourol. Urodyn. 30: 126-132, 2011. (C) 2010 Wiley-Liss, Inc.Öğe Neuromuscular Morphometry of the Vaginal Wall in Women With Anterior Vaginal Wall Prolapse(Wiley-Blackwell, 2010) Inal, Masan Ali; Kaplan, Petek Balkanli; Usta, Ufuk; Tastekin, Ebru; Aybatli, Aysun; Tokuc, BurcuIntroduction and Hypothesis: The aim of this study was to compare the changes in hystomorphometry and innervation of the anterior vaginal wall in women with and without anterior vaginal wall prolapse. Methods: Eighty-nine biopsy specimens were obtained from the anterior vaginal wall of women having a cystocele repaired (stage >= II; prolapse group, 49) and the same location in patients with no prolapse (stageÖğe Quality of life in women with infertility via the FertiQoL and the Hospital Anxiety and Depression Scales(Wiley-Blackwell, 2015) Sut, Hatice Kahyaoglu; Kaplan, Petek BalkanliThe aim of this study was to examine the relationships between quality of life, anxiety, and depression in female patients with infertility. This was a cross-sectional study with 89 women with infertility. Patients completed a questionnaire that included demographic data, the FertiQoL scale, and the Hospital Anxiety and Depression Scale. The average total FertiQoL score was 66.0 +/- 14.5. There were negative correlations between the treatment and core FertiQoL scores and the Hospital Anxiety-Depression subscale scores. The attempted conception duration was negatively correlated with the total and core (emotional, mind-body, and social subscales) scores of the FertiQoL. The number of in vitro fertilizations was negatively correlated with the total, core (mind-body subscale), and treatment (tolerability subscale) scores of the FertiQoL. In conclusion, infertility significantly reduces quality of life in women by increasing their anxiety and depression levels. Thus, healthcare professionals should consider quality of life with a holistic approach when examining and treating women with infertility.Öğe Single Dose Methotrexate in Treatment of Ectopic Pregnancy: Review of 32 Case(Galenos Publ House, 2011) Aybatli, Aysun; Kaplan, Petek Balkanli; Alicik, Mehmet; Sayin, Niyazi Cenk; Yuce, Mehmet AliObjective: To evaluate the efficacy of single dose intramuscular methotrexate in the treatment of ectopic pregnancy. Material and Methods: 32 patients who matched the inclusion criteria were enrolled. Success of treatment was defined as a resolution of ectopic pregnancy without performing surgical intervention. The cases in whom the treatment was successful and those that were not were compared for beta-hCG values and clinical features. Results: beta-hCG at diagnosis averaged 1293.9 mlU/ml. Of the 32 patients who received methotrexate, 26 were successfully treated. 23 patients (71.8%) received a single dose of methotrexate, 3 patients (9.3%) received an additional dose of methotrexate, 6 patients (18.7%) who had failed methotrexate required surgery for cure. The success rate of single-dose methotrexate was 79.3%. Conclusion: Our study shows that single dose systemic methotrexate treatment can be used as an option in unruptured pregnancies.Öğe Validation, cultural adaptation and responsiveness of two pelvic-floor-specific quality-of-life questionnaires, PFDI-20 and PFIQ-7, in a Turkish population(Elsevier, 2012) Kaplan, Petek Balkanli; Sut, Necdet; Sut, Hatice KahyaogluObjectives: The aim of the study was cultural adaptation, validation, and test for responsiveness of the short forms of the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) in a Turkish population. Study design: To evaluate their validity, questionnaires were applied to 248 women. The questionnaires were compared with prolapse stage according to the Pelvic Organ Prolapse Quantification (POP-Q) system. The responsiveness of the questionnaires was assessed in 103 women with prolapse who also completed the questionnaires after reconstructive surgical treatment, with standardized response mean (SRM), effect size (ES), and the Wilcoxon signed-rank test. Results: Cronbach alpha coefficients of the Turkish PFDI-20 and PFIQ-7 questionnaires were 0.908 and 0.830, respectively. Significant correlations were observed between the scores of the questionnaires with the vaginal examination findings. The PFDI-20 and PFIQ-7 scores were significantly improved after vaginal reconstructive surgery. Conclusions: Turkish translated versions of the PFDI-20 and PFIQ-7 are reliable, valid and responsive instruments for assessing symptom severity, impact on QoL in women with pelvic organ prolapse. They can be easily administered and self-completed by Turkish women. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
