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Öğe Analysis of adnexal masses which are operated in gynecologic oncology clinic(2018) Erdem, Baki; Peker, Nuri; Seyhan, Niyazi Alper; Aşocıoğlu, Osman; Temel Yüksel, İlkbal; Ülker, Volkan; Akbayır, ÖzgürObjective: Abnormal adnexal masses are a common gynecologic problem that affects women of all ages. Although many of these masses are benign, the primary aim of diagnostic evaluation is to exclude malignancy. In this trial, we aimed to analyze adnexal masses that are referred and operated in our gynecologic oncology clinic. Methods: A total of 1,152 patients operated in our clinic due to suspicious malignancy between 2004 and 2017 were included in this trial. Patient data from the database of the gynecologic oncology clinic were analyzed retrospectively. Results: Among all included patients, benign pathological results were determined in 529 (45.92%) patients, whereas malignant and borderline tumors were determined in 505 (43.83%) patients and 118 (10.24%) patients, respectively. The median cancer antigen 125 level in the malignancy group was 150 (7-15,554) IU/mL, whereas that in the benign and borderline groups, it was 19 and 29 IU/ mL, respectively. Conclusion: Many benign masses imitate ovarian cancer. Although some of them can be separated, preoperative careful examination and histological examination are the established diagnostic procedures.Öğe Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia?(Elsevier Science Bv, 2018) Erdem, Baki; Aşıcıoğlu, Osman; Seyhan, Niyazi Alper; Peker, Nuri; Ülker, Volkan; Akbayır, ÖzgürBackground: This study investigated the frequency of high-risk cancer types in hysterectomy material obtained from patients who were diagnosed with atypical endometrial hyperplasia (AEH) by endometrial sampling. Materials and methods: A total of 227 patients with AEH were retrospectively included in the study. Hysterectomy material was examined as both perioperative frozen section (FS) and paraffin-embedded permanent section (PS). Grade III tumors, grade II tumors larger than 2 cm, over 50% myometrial invasion, cervical involvement, and serous or clear cell histology were considered high-risk. Results: In final pathology, 57 (25.1%) patients had endometrial cancer and 7 (3%) patients had high-risk cancer. Overall analysis of FS/PS agreement yielded a Cohen's Kappa (K) coefficient of 0.420 (moderate agreement). There was moderate (K=0.526) agreement between FS and PS in detecting tumor grade, and good agreement (K=0.653) in evaluation of myometrial invasion. Conclusion: High-risk endometrial cancer can coexist with AEH. It should be remembered that despite pre-operative and FS examinations, these high-risk tumors can be overlooked until final pathology.Öğe Cesarean myomectomy: Is it a safe procedure?(Gazi Univ, Fac Med, 2017) Peker, Nuri; Demir, AhmetObjective: To determine whether myomectomy during cesarean section causes an increase in intraoperative and postoperative complications. Materials and methods: A total of 55 patients who had undergone myomectomy during cesarean and a total of 55 patients who undergone only cesarean section in our clinic between January 2010 and December 2013 were retrospectively reviewed. Results: Mean change in hemoglobin level was 1.72 +/- 0.56 and 1.59 +/- 0.63 in the patients that underwent cesarean myomectomy and the patients that underwent cesarean section only, respectively, and no significant difference was found between the two groups. The incidence of hemorrhage was 5.44% and 5.35%, respectively, and no hysterectomy was required in any patient in both groups. The mean length of postoperative stay was 2.26 +/- 0.57 and 2.089 +/- 0.34 days, respectively, and no significant difference was found. Blood transfusion was required in 6 patients, with 3 patients in each group. Conclusion: Myomectomy during caesarean section is a safe procedure and does not increase the incidence of intraoperative and postoperative complications.Öğe Evaluation of factors affecting lymph node metastasis in clinical stage I-II epithelial ovarian cancer(Karger, 2018) Erdem, Baki; Yuksel, Ilkbal T.; Peker, Nuri; Ulukent, Suat C.; Asicioglu, Osman; Ozaydin, Ipek Y.; Akbayir, OzgurBackground: Systematic lymphadenectomy is useful for accurate staging of early-stage ovarian cancer and has obvious prognostic value. Accurate staging may prevent unnecessary postoperative chemotherapy. The aim of this study was to evaluate the rate of lymph node involvement and factors affecting it in clinically early-stage epithelial ovarian cancer (EOC; stages I, II). Patients and Methods: The study included 163 patients who underwent surgery at our hospital between January 2004 and April 2017 and who were diagnosed with early-stage EOC based on preoperative and intraoperative examination. Patient data were retrospectively analyzed. The rate of lymph node involvement and factors affecting it were analyzed. Results: Of 163 patients, 21 (12.9%) had lymph node metastasis, whereas 16 (16.3%) of 98 patients who underwent comprehensive lymphadenectomy had lymph node metastasis. According to the univariate results for patients undergoing any type of lymphadenectomy, the rate of positive lymph nodes was significantly higher (37.1%) in those with bilateral ovarian involvement (p < 0.001). The rate was significantly higher in patients with positive intraabdominal fluid cytology (25.9%; p < 0.001), serous histology (20.5%; p = 0.02), and grade 3 disease (33.3%; p < 0.001). In multivariate logistic regression analysis, the rate was significantly higher in patients with bilateral adnexal involvement (p = 0.012). The risk of positive lymph nodes was significantly higher in patients with grade 3 disease (p = 0.016). Conclusion: Comprehensive lymphadenectomy increases the detection rate for metastatic lymph nodes in patients with clinically early-stage EOC. The rate of lymph node involvement is significantly higher in grade 3 tumors, serous cytology, bilateral adnexal involvement, and positive intraabdominal fluid cytology. (C) 2018 S. Karger GmbH, FreiburgÖğe Is grand multiparity a risk factor for the development of postmenopausal osteoporosis?(Dove Medical Press Ltd, 2018) Peker, Nuri; Tosun, Ozge CelikerObjective: In this study, we investigated the relationship between the development of postmenopausal osteoporosis and parity. Materials and methods: The retrospective study included 129 postmenopausal women who were divided into three groups depending on the number of parity: Group I, <5; Group II, 5-9; and Group III, >= 10. The mean age of the subjects was 57.71 +/- 5.02 years. Results: No significant difference was found among the three groups regarding body mass index values, duration of menopause, mean thyroid stimulating hormone values and frequency of diabetes. Among the three groups, no significant difference was found in terms of the frequency of lumbar osteoporosis (p>0.05), whereas a significant difference was found regarding the frequency of femoral osteoporosis (p=0.012; p<0.05). Conclusion: It was revealed that femoral bone mineral density significantly decreased as the number of parity increased.Öğe Postpartum acute appendicitis(Gazi Univ, Fac Med, 2018) Peker, Nuri; Seçkin, Fatih Göksel; İpek, TurgutA 28-year-old woman, gravida 1 para 1, presented to the obstetrics department with pelvic pain and intermittent fever. Body temperature was 38.9 degrees C. Widespread abdominal sensitivity and rebound were observed on physical examination. C-Reactive Protein was elevated to 31.1 mg/dl and White Blood Cell count remained at 11,000/mm(3). The diameter of the appendix was measured as about 8.1 cm on Computed Tomography. Diagnostic laparoscopy was performed and appendectomy was done because of acute appendicitis. Postpartum appendicitis is a very rare condition and only a few cases have been reported in the literature however acute appendicitis has to be kept in mind in the differential diagnosis.Öğe A rare uterine malformation: asymmetric septate uterus(Elsevier Science Inc, 2018) Biler, Alper; Akdemir, Ali; Peker, Nuri; Sendag, FatihStudy Objective: To demonstrate a step by step surgical hysteroscopy technique in a patient with asymmetric uterine septum and transverse uterine septum that was not previously described in the literature.Öğe Sezaryen miyomektomi: Güvenilir bir yöntem midir?(TR- Dizin, 2017) Peker, Nuri; Demir, AhmetObjective: To determine whether myomectomy during cesarean section causes an increase in intraoperative and postoperative complications. Materials and methods: A total of 55 patients who had undergone myomectomy during cesarean and a total of 55 patients who undergone only cesarean section in our clinic between January 2010 and December 2013 were retrospectively reviewed. Results: Mean change in hemoglobin level was 1.72±0.56 and 1.59±0.63 in the patients that underwent cesarean myomectomy and the patients that underwent cesarean section only, respectively, and no significant difference was found between the two groups. The incidence of hemorrhage was 5.44% and 5.35%, respectively, and no hysterectomy was required in any patient in both groups. The mean length of postoperative stay was 2.26±0.57 and 2.089±0.34 days, respectively, and no significant difference was found. Blood transfusion was required in 6 patients, with 3 patients in each group. Conclusion: Myomectomy during caesarean section is a safe procedure and does not increase the incidence of intraoperative and postoperative complications.Öğe Yüksek dereceli skuamoz intraepitelyal lezyonun dışlanamadığı atipik skuamoz hücre anormalliği saptanan hastalarda servikal biyopsi sonuçlarının değerlendirilmesi(2018) Erdem, Baki; Peker, Nuri; Seyhan, Niyazi Alper; Ozaydin, Ipek Yildiz; Asicioglu, Osman; Ulker, Volkan; Numanoglu, Ceyhun; Akbayir, OzgurAmaç: PapSmear Test (PST) sonucu yüksek dereceli skuamoz intraepitelyal lezyonun dışlanamadığı atipik skuamoz hücre anormalliği (ASC-H) olarak saptanmış hastaların servikal biyopsi sonuçlarını sunmayı amaçladık.Gereç ve Yöntem: 2004-2016 tarihleri arasında jinekolojik onkoloji polikliniğine başvuran 7527 hastadan alınan pap smear test (PST) sonuçları retrospektif olarak incelendi. PST sonucu ASC-H olarak rapor edilen 201 hastayatanı amaçlı yapılan kolposkopi, servikal biyopsi, yapılmış ise Loop Electrosurgical Excision Procedure (LEEP) ve soğuk konizasyon patoloji sonuçları değerlendirildi.Bulgular: PST yapılan toplam 7527 hastadan 201'inde (%2,6) servikal sitoloji sonucu ASC-H olarak saptandı. Çalışmaya dahil edilen 197 hastanın kolposkopi ve punch biyopsi sonuçları değerlendirildiğinde, 107 (%54,3) hastada lezyon saptanmazken, 38 (%19,2) hastada servikalintraepitelyal neoplazi-1 (CIN1), 19 (%9,6) hastada servikalintraepitelyal neoplazi-2 (CIN2), 22 (%11,1) hastada servikal intraepitelyal neoplazi-3 (CIN3), 6 (%3) hastada karsinoma insitu (CIS) ve 5 (%2,5) hastada servikal karsinom saptandı. CIN2, CIN3 ve CISsaptanan 47 (%100) hasta, CIN1 saptanan 12 (%31,5) hasta, biyopsi sonuçları normal olmasına rağmen, malignite açısından şüpheli servikal görüntüye sahip 14 (%13) hasta olmak üzere toplam 73 hastaya servikal eksizyonel işlem uygulandı. Elli hastaya LEEP, 23 hastaya soğuk konizasyon uygulandı (Tablo 2). Eksizyonel prosedür uygulan ve biyopsi sonucu CIN3 olan üç hastada soğuk konizasyon sonrası patoloji sonucu skuamöz hücreli karsinom olarak rapor edildi.Sonuç: PST de ASC-H saptanan hastaların %26,3'ünde CIN2 ve üstü lezyon saptanması, aynı zamanda bu hastalarda Human PapillomaVirus (HPV) pozitifliğinin yüksek olması nedeniyle, bu hastaların kolposkopi ve servikal biyopsi ile değerlendirilmesinin preinvaziv lezyonların saptanması açısından önemli olduğunu düşünmekteyiz.
