Browsing by Author "Guvenal T."
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Item Effects of different postmenopausal hormone therapy regimens on cerebral blood flow and cognitive functions(2009) Guvenal T.; Durna A.; Erden O.; Guvenal F.; Cetin M.; Cetin A.Introduction: The purpose of this study was to compare the effects of different postmenopausal hormone therapy regimens, namely conjugated equine estrogens (CEE), CEE plus medroxyprogesterone acetate (MPA), tibolone, and raloxifene on cerebral blood flow and cognitive functions. Methods: A total of 64 healthy postmenopausal women admitted to the Department of Obstetrics and Gynecology, Cumhuriyet University, Turkey were included in this study. Patients were divided into five groups with respect to the treatment protocols: CEE 0.625 mg/day (n=13); CEE 0.625 mg/day + MPA 2.5 mg/day (n=14); tibolone 2.5 mg/day (n=11); raloxifene 60 mg/day (n=9); and control (n=17). The CEE group included only women with surgical menopause. Those who were on hormonal therapy, who had previously used hormonal therapy, who had neurological disorders, or who did not accept the longterm follow-up were excluded from the study. Demographic and clinic characteristics were recorded. Before starting the therapy regimens, cerebral blood flow was evaluated by internal carotid artery and middle cerebral artery peak systolic velocity, and pulsatility index measurements via Doppler ultrasonography. Cognitive functions were evaluated by the Standardized Mini-Mental Test. The mean follow-up period was 10.9±2.4 months, ranging between 8 and 16 months. After the follow-up period, the cerebral blood flow, and cognitive function of each woman was re-evaluated. Results: Demographic and clinical characteristics of the women were not significantly different between the study groups (P>0.05). There were no significant differences between the pretreatment and posttreatment values for cerebral blood flow indices and cognitive function scores in any of the study groups (P>0.05). Conclusion: Different postmenopausal hormone therapy regimens have not revealed any significant effects on either cerebral blood flow or cognitive function. © 2009 Springer Healthcare Communications.Item The availability of vaginal hysterectomy in benign gynecologic diseases: A prospective, non-randomized trial(Blackwell Publishing Asia, 2010) Guvenal T.; Ozsoy A.Z.; Kilcik M.A.; Yanik A.Objective: To determine whether vaginal hysterectomy can be performed in patients with benign gynecologic diseases regardless of uterine size, uterine mobility and previous pelvic surgery and to compare with abdominal hysterectomy. Study Design: Between 2003 and 2008, we compared 47 vaginal hysterectomies (VH) with 61 abdominal hysterectomies (AH). We excluded from the study the clinical conditions that mandate abdominal exploration and standard indications for VH such as uterovaginal prolapse. Large, immobile uterus and previous pelvic surgery were not accepted as a contraindication for VH. Demographic characteristics, primary diagnosis, uterine weight, operation time, intraoperative blood loss, complications, and hospital stay and cost in both groups were compared. Results: Groups were similar with respect to demographic features and primary indications. Mean uterine weight and mean operation time were similar in VH and AH groups (258.0 g vs 293.9 g and 93.7 min vs 101.4 min, respectively). Oopherectomy was performed in 44.7% of VH and in 83.6% of AH. Colporrhaphies and/or anti-incontinence surgery were performed in 15 patients in the VH group (31.9%). The intraoperative blood loss was lower in the VH group than the AH group (245.0 mL vs 408.6 mL, P < 0.001). Perioperative complications were increased with AHs. The mean hospital stay and operation cost in the VH group were significantly less than the AH group (P < 0.001). Conclusion: This study indicates that vaginal hysterectomy could be performed with less morbidity in patients with benign gynecologic diseases even in large, immobile uterus and previous pelvic surgery © 2010 Japan Society of Obstetrics and Gynecology.Item Effects of selective and non-selective cyclooxygenase (COX) inhibitors on postoperative adhesion formation in a rat uterine horn model(2010) Guvenal T.; Yanar O.; Timuroglu Y.; Cetin M.; Cetin A.Objective: To investigate the effects of cyclooxygenase (COX) inhibitors including celecoxib, indomethacin, and nimesulide on postoperative adhesion formation. Material and Methods: Forty-eight female Wistar-Albino rats were randomly divided into four groups: control (saline solution), celecoxib, indomethacin, and nimesulide groups. The uterine horns of rats were traumatized with unipolar electrocautery. Drugs of each group and saline in the control group were insillated on travmatized areas of horns as intraperitoneally. After three weeks, the extent and severity of adhesions with a standardized scoring system were evaluated. Results: The extent and severity of postoperative adhesions were significantly reduced in nimesulide group compared with the control group. The extent but not severity of adhesions in rats given indomethacin was significantly reduced. Celecoxib showed no significant reduction in the extent and severity of adhesions. Conclusion: Nimesulide is more effective than the other COX inhibitors in the prevention of postoperative adhesions in rats.Item Quality of life in women with gynecologic cancer in Turkey(Asian Pacific Organization for Cancer Prevention, 2011) Goker A.; Guvenal T.; Yanikkerem E.; Turhan A.; Koyuncu F.M.Aim: The management of gynecological cancer patients mainly aims at prolonging survival but modern therapy focuses on good survival combined with a good quality of life (QoL). The aim of this study was to evaluate QoL and identify its associated factors in Turkish women with gynecologic cancer. Method: The study included 119 women diagnosed with endometrial, cervical, ovarian or vulvar cancer and treated at the Gynecologic Oncology Department of Celal Bayar University Faculty of Medicine. The data were collected between January and June 2011. QoL was measured with EORTC QLQ-C30 version 3.0. Relationships between clinical and socio-demographic characteristics and QoL scores were analyzed using the Mann-Whitney U, Kruskal Wallis and t-tests. Result: Global health status, physical and role function scores were found higher in women under the age of 60 years. Role function scores were found lower, and emotional and social scores were found to be higher in single women than in married women. Physical scores were found higher in women who had graduated from secondary school or above. Women with ovarian cancer had the highest while women with cervical cancer had the lowest global health score (65.3 ±24.7 and 43.0±24.1, respectively). Women with endometrial cancer were found to have better role function, and social well being than those with vulvar, cervical or ovarian cancer. Global, physical, role function, cognitive and social scores were found higher in women who had been treated with surgery. Conclusion: Gynecological cancer and treatment processes cause significant problems that have negative effects on physical, emotional, social and role function aspects of QoL. Health care providers play a key role in the identification and treatment of the complications of cancer therapy. Minimizing the effect of the symptoms of gynecologic cancer may positively impact on patient QoL.Item Evaluation of the effects of gonadotropin-relasing hormone antagonist (GnRH-ant) and agonist (GnRH-a) in the prevention of postoperative adhesion formation in a rat model with immunohistochemical analysis(2011) Tamay A.G.; Guvenal T.; Micili S.C.; Yildirim Y.; Ozogul C.; Koyuncu F.M.; Koltan S.O.Objective: To investigate the effects of GnRH antagonist (GnRH-ant) and agonist (GnRH-a) in the prevention of postoperative pelvic adhesions by a visual scoring system and immunohistochemical methods in a rat uterine horn model. Design: Controlled experimental animal study. Setting: Animal laboratory at an academic research environment. Animal(s): Twenty-one Wistar albino rats. Intervention(s): Rats were randomized into three groups. One week before the operation the rats received either GnRH-ant or GnRH-a or saline solution; they then underwent surgical laparotomy, and both uterine horns were traumatized by a scalpel. Three weeks later, all rats were sacrificed and extension and severity of the adhesions in each group were scored by a visual scoring system. Adhesion tissues were evaluated immunohistochemically for vitronectin and u-PAR. Main Outcome Measure(s): Scores of extend and severity of adhesions and staining of vitronectin and u-PAR. Result(s): The extent of adhesion scores were 1.85 ± 0.86, 0.78 ± 1.05, and 0.42 ± 0.64, and the severity of adhesion scores were 1.71 ± 0.91, 0.57 ± 0.85, 0.50 ± 0.75 for control, GnRH-ant, and GnRH-a groups, respectively. The extent and severity of adhesions were significantly lower in both GnRH-ant and GnRH-a groups when compared with the control group. Adhesion extent scores in the GnRH-a group were lower than in the GnRH-ant group, but this difference was not significant. vitronectin and u-PAR staining were significantly greater in both the GnRH-ant and GnRH-a groups than in the control group. Conclusion(s): GnRH-ant as well as GnRH-a reduced postoperative adhesion formation in a rat model. This finding was supported immunohistochemically by vitronectin and u-PAR staining. © 2011 American Society for Reproductive Medicine.Item A Turkish Gynecologic Oncology Group study of fertility-sparing treatment for early-stage endometrial cancer(John Wiley and Sons Ltd, 2012) Dursun P.; Erkanli S.; Güzel A.B.; Gultekin M.; Tarhan N.C.; Altundag O.; Demirkiran F.; Beşe T.; Yildirim Y.; Bozdag G.; Yarali H.; Simsek T.; Ozcelik B.; Ortaç F.; Taskin S.; Guvenal T.; Ozgul N.; Haberal A.; Vardar M.A.; Dede M.; Yenen M.; Altintas A.; Arvas M.; Ayhan A.Objective: To analyze the results of fertility-sparing treatment of early-stage endometrial cancer (EC) in patients treated at Turkish gynecologic oncology centers, and to present a review of the literature. Methods: Thirteen healthcare centers in Turkey were contacted to determine if they were eligible to participate in the study. Centers that were eligible and agreed to participate were sent a database form to record the demographic characteristics, clinicopathologic findings, and follow-up results for their EC patients. Results: Eleven Turkish healthcare centers provided data on 43 EC patients. Mean duration of treatment was 5 months and mean follow-up was 49 months. In total, 35 (81.4%) patients were tumor free following primary progesterone therapy. Mean time from the end of progesterone therapy to pregnancy was 10.6 ± 4.3 months (range, 3-18 months). Two patients had tumor recurrence during follow-up. The pregnancy rate among the 31 women who actively sought pregnancy was 41.9% (n = 13). Conclusion: Conservative management of early-stage EC in women of reproductive age using oral progestins was effective and did not compromise oncological outcome. Pregnancy in the study patients was achieved spontaneously and artificially. © 2012 International Federation of Gynecology and Obstetrics.Item Effect of surgical staging on 539 patients with borderline ovarian tumors: A Turkish Gynecologic Oncology Group study(2013) Guvenal T.; Dursun P.; Hasdemir P.S.; Hanhan M.; Guven S.; Yetimalar H.; Goksedef B.P.; Sakarya D.K.; Doruk A.; Terek M.C.; Saatli B.; Guzin K.; Corakci A.; Deger E.; Celik H.; Cetin A.; Ozsaran A.; Ozbakkaloglu A.; Kolusari A.; Celik C.; Keles R.; Sagir F.G.; Dilek S.; Uslu T.; Dikmen Y.; Altundag O.; Ayhan A.Objective The objectives of this study were to examine demographic and clinicopathologic characteristics and to determine the effects of primary surgery, surgical staging and the extensiveness of staging. Methods In a retrospective Turkish multicenter study, 539 patients, from 14 institutions, with borderline ovarian tumors were investigated. Some of the demographic, clinical and surgical characteristics of the cases were evaluated. The effects of type of surgery, surgical staging; complete or incomplete staging on survival rates were calculated by using Kaplan-Meier method. Results The median age at diagnosis was 40 years (range 15-84) and 71.1% of patients were premenopausal. The most common histologic types were serous and mucinous. Majority of the staged cases were in Stage IA (73.5%). 242 patients underwent conservative surgery. Recurrence rates were significantly higher in conservative surgery group (8.3% vs. 3%). Of all patients in this study, 294 (54.5%) have undergone surgical staging procedures. Of the patients who underwent surgical staging, 228 (77.6%) had comprehensive staging including lymphadenectomy. Appendectomy was performed on 204 (37.8%) of the patients. The median follow-up time was 36 months (range 1-120 months). Five-year survival rate was 100% and median survival time was 120 months. Surgical staging, lymph node sampling or dissection and appendectomy didn't cause any difference on survival. Conclusion Comprehensive surgical staging, lymph node sampling or dissection and appendectomy are not beneficial in borderline ovarian tumors surgical management. © 2013 Elsevier Inc.Item Multicenter analysis of gestational trophoblastic neoplasia in Turkey(Asian Pacific Organization for Cancer Prevention, 2014) Ozalp S.S.; Telli E.; Oge T.; Tulunay G.; Boran N.; Turan T.; Yenen M.; Kurdoglu Z.; Ozler A.; Yuce K.; Ulker V.; Arvas M.; Demirkiran F.; Bese T.; Tokgozoglu N.; Onan A.; Sanci M.; Gokcu M.; Tosun G.; Dikmen Y.; Ozsaran A.; Terek M.C.; Akman L.; Yetimalar H.; Kilic D.S.; Gungor T.; Ozgu E.; Yildiz Y.; Kokcu A.; Kefeli M.; Kuruoglu S.; Yuksel H.; Guvenal T.; Hasdemir P.S.; Ozcelik B.; Serin S.; Dolanbay M.; Arioz D.T.; Tuncer N.; Bozkaya H.; Guven S.; Kulaksiz D.; Varol F.; Yanik A.; Ogurlu G.; Simsek T.; Toptas T.; Dogan S.; Camuzoglu H.; Api M.; Guzin K.; Caliskan E.; Doger E.; Cakmak B.; Ilhan T.T.Background: To evaluate the incidence, diagnosis and management of GTN among 28 centers in Turkey. Materials and Methods: A retrospective study was designed to include GTN patients attending 28 centers in the 10-year period between January 2003 and May 2013. Demographical characteristics of the patients, histopathological diagnosis, the International Federation of Gynecology and Obstetrics (FIGO) anatomical and prognostic scores, use of single-agent and multi-agent chemotherapy, surgical interventions and prognosis were evaluated. Results: From 2003-2013, there were 1,173,235 deliveries and 456 GTN cases at the 28 centers. The incidence was calculated to be 0.38 per 1,000 deliveries. According to the evaluated data of 364 patients, the median age at diagnosis was 31 years (range, 15-59 years). A histopathological diagnosis was present for 45.1% of the patients, and invasive mole, choriocarcinoma and PSTTs were diagnosed in 22.3% (n=81), 18.1% (n=66) and 4.7% (n=17) of the patients, respectively. Regarding final prognosis, 352 (96.7%) of the patients had remission, and 7 (1.9%) had persistence, whereas the disease was mortal for 5 (1.4%) of the patients. Conclusions: Because of the differences between countries, it is important to provide national registration systems and special clinics for the accurate diagnosis and treatment of GTN.Item Endometriosis associated with relapsing ascites and pleural effusions(Informa Healthcare, 2015) Hasdemir P.S.; Ikiz N.; Ozcakir H.T.; Kara E.; Guvenal T.[No abstract available]Item Synchronous primary endometrial and ovarian cancers: A multicenter review of 63 cases(Wichtig Publishing Srl, 2016) Solmaz U.; Karatasli V.; Mat E.; Dereli L.; Hasdemir P.S.; Ekin A.; Gezer C.; Sayhan S.; Sanci M.; Guvenal T.Aims: To investigate clinicopathologic characteristics, therapeutic methods, and prognostic factors in women with synchronous primary endometrial and ovarian cancers (SEOCs). Methods: A retrospective review of 2 cancer registry databases in Turkey was conducted to identify patients diagnosed with SEOCs between January 1995 and December 2012. Patients with recurrent, metastatic, and metachronously occurring tumors were excluded. Multivariate logistic regression models were used to identify prognostic predictors for progression-free survival (PFS) and overall survival (OS). Results: The analysis included 63 women with SEOCs. Seventy-six percent of the patients had stage I endometrial cancer, and 60% of the patients had stage I ovarian cancer. Thirty-seven patients (58.7%) had endometrioid/ endometrioid histology. Optimal cytoreduction was obtained in 47 (74.6%) patients. Recurrence developed in 17 patients (27%). Multivariate analysis confirmed lymphovascular space invasion (LVSI) as an independent poor prognostic factor for OS (odds ratio [OR] 3.1, p = 0.045), whereas early-stage disease and optimal cytoreduction were found to be independent good prognostic factors for both PFS (OR 12.85, p<0.001 and OR 4.58, p = 0.004, respectively) and OS (OR 7.31, p = 0.002 and OR 2.95, p = 0.028, respectively). The 3- and 5-year OS rates were 74% and 69%, respectively. Conclusions: Our study demonstrated that optimal cytoreduction, early-stage disease, and LVSI are the most significant factors affecting survival in women with SEOC.Item The Role of Adenomyosis in the Pathogenesis of Preeclampsia(Georg Thieme Verlag, 2016) Hasdemir P.S.; Farasat M.; Aydin C.; Ozyurt B.C.; Guvenal T.; Pekindil G.Introduction: Adenomyosis can cause defective deep placentation. Preeclampsia is known to be associated with abnormal placentation. The aim of this study was to compare the presence of adenomyosis on magnetic resonance imaging in patients with and without history of preeclampsia in order to investigate the possible role of adenomyosis in the pathogenesis of preeclampsia. Materials and Methods: This prospective, randomized study consisted of patients with (n = 35) and without (n = 34) history of preeclampsia. Direct (submucosal microcysts, adenomyoma and cystic adenomyoma) and indirect (maximal thickness of junctional zone, ratio of maximal thickness of junctional zone to myometrial thickness, junctional zone differential, focal thickening of junctional zone, globally enlarged uterus and non-uniform junctional zone contours) signs of adenomyosis were assessed by pelvic magnetic resonance imaging. Results: The prevalence of adenomyosis was found to be more common in patients with preeclampsia und fetal growth restriction compared to patients without fetal growth restriction (94.4 vs. 64.7%; p = 0.041), respectively. There was a strong association between maximal thickness of junctional zone (9 vs. 13 mm, p = 0.005), ratio of maximal thickness of junctional zone to myometrial thickness (0.42 vs. 0.66, p = 0.001) and junctional zone differential (3 vs. 5 mm, p = 0.02) and late-onset preeclampsia. Conclusions: Presence of adenomyoma is more common in patients with preeclampsia complicated with fetal growth restriction. Indirect signs of adenomyosis detected on pelvic magnetic resonance imaging might have a role in the pathogenesis of late-onset preeclampsia. © Georg Thieme Verlag KG Stuttgart New York.Item Borderline ovarian tumors: A contemporary review of clinicopathological characteristics, diagnostic methods and therapeutic options(Zerbinis Publications, 2016) Hasdemir P.S.; Guvenal T.Borderline ovarian tumors (BOTs) differ from the epithelial ovarian malignancies with their excellent prognosis, curability with surgery, and being seen in relatively young ages. Thus, fertility sparing and conservative surgical approaches are currently recommended. Preoperative diagnosis of BOTs can be challenging because, clinical and ultrasonographic features might overlap with invasive carcinomas and sometimes with benign adnexal masses. Certain characteristics such as stage at diagnosis, age of the patient and histologic features are important while deciding the extensiveness and the type of surgery. Detailed evaluation of the entire abdominal cavity and sampling all suspected areas are imperative during operation. Frozen section is essential for the intraoperative diagnosis, despite the fact that the diagnostic value of frozen section is not as high as in invasive ovarian carcinomas. Routine appendectomy and/or contralateral ovarian biopsy in cases of isolated tumor with normal appearing appendix and/or contralateral ovary are not recommended. Conservative approach might improve the recurrence rate without worsening the overall survival. The exact role of laparoscopic surgery with its advantages and disadvantages in the treatment of BOTs needs to be confirmed with further studies.Item Vulvar Cancer with Bilateral Axillary Lymph Node Metastasis(Taylor and Francis Ltd, 2016) Hasdemir P.S.; Aras F.; Solmaz U.; Guvenal T.[No abstract available]Item What are the best surgical techniques for caesarean sections? A contemporary review(Taylor and Francis Ltd, 2016) Hasdemir P.S.; Terzi H.; Guvenal T.The aim of this study was to evaluate the reported techniques used in caesarean sections in order to form a general perspective of the procedural options for this frequently performed operation. The PubMed database and Cochrane Reviews were searched separately with the key words caesarean, abdominal entry, abdominal incision, uterine repair, peritoneal repair, closure of abdominal incision, suture materials, extraction of the placenta and review. Reviews, meta-analyses and prospective randomised trials were included in this review. In conclusion, although caesarean delivery is a very common operation, standardised and globally accepted techniques for caesarean section have not been described. The best surgical techniques for this operation are still unknown. Although the long-term follow-up results from two large, prospective, randomised studies are pending, further research is needed to establish an evidence-based, standardised approach for caesarean sections. © 2015 Taylor & Francis Group, LLC.Item Effect of Pirfenidone on Vascular Proliferation, Inflammation and Fibrosis in an Abdominal Adhesion Rat Model(Taylor and Francis Ltd, 2017) Hasdemir P.S.; Ozkut M.; Guvenal T.; Uner M.A.; Calik E.; Koltan S.O.; Koyuncu F.M.; Ozbilgin K.Aim: To study the efficacy of pirfenidone for prevention of postoperative adhesion formation in an adhesion rat model. Materials and Methods: Eighteen female Wistar rats were subjected to right-sided parietal peritoneum and right uterine horn adhesion model. Rats were randomized into three groups: group 1 (control) (closure of midline abdominal incision without any agent administration), group 2 (closure of incision after intraperitoneal administration of pirfenidone), and group 3 (closure of incision and only oral administration of pirfenidone for 14 days). Relaparotomy was performed 14 days after the first surgery. Effect of pirfenidone on adhesion formation was assessed on light microscopy by scoring vascular proliferation, inflammation, fibrosis, and collagen formation in the scarred tissue. Effect of pirfenidone on inflammation was assessed by measurement of transforming growth factor-β and interleukin-17 levels in scarred tissue. Results: The degree of vascular proliferation (1.32 ± 0.39 versus 2.34 ± 0.46, p < 0.001), inflammation (1.60 ± 0.70 versus 2.60 ± 0.52, p < 0.01), and fibrosis (1.50 ± 0.53 versus 2.40 ± 0.52, p < 0.01) were less prominent in group 2 compared to group 1, respectively. Only vascular proliferation was found to be less prominent in group 3 compared to group 1 (1.60 ± 0.42 versus 2.34 ± 0.46, p < 0.01). Intraperitoneal and oral administration of pirfenidone reduced tissue levels of inflammatory markers (TGF-β and IL-17) in parietal and visceral peritoneum compared to control group. Intraperitoneal administration of pirfenidone compared to oral administration was more effective in reducing tissue levels of inflammatory markers. Conclusion: Pirfenidone is an effective agent on the prevention of postoperative vascular proliferation, inflammation and fibrosis in scarred tissue particularly with intraperitoneal administration. Copyright © 2017 Taylor & Francis Group, LLC.