Jtgga 4 2 110 165

V. Türk-Alman Jinekoloji Derne¤i ve II.
Reproductive Medicine Tart›flmal› Konular ve Çözümler Ortak Kongresi POSTER

V. Kongress der Deutsch-Türkischen Gynäkologengesellschaft II. Internationaler Kongress für Reproduktionsmedizin SUNUMLARI
Pine Beach A2 Salonu
POSTER SUNUMLARI
POSTER PRESANTATIONS
V. Türk-Alman Jinekoloji Derne¤i ve II. Reproductive Medicine Tart›flmal› Konular ve Çözümler Ortak Kongresi POSTER
Vol 4(2) 2003 17 May›s 2003 Cumartesi
POSTER SUNUM B‹LD‹R‹ ÖZETLER‹
P-001 P-003
EKTOP‹K GEBEL‹⁄‹N TEDAV‹S‹NDE TEK DOZ METOTREKSAT PACKING TO CONTROL PERSISTENT HEMORRHAGE AFTER
KULLANIMININ ETK‹NL‹⁄‹ HYSTERECTOMY FOR HEMOSTASIS
E. Yermez, Ü. SekŸ, M. Yamazhan, G. UÛurel Aydar, ‚. Üspahi M. Erman Akar, E. Þeker ArÝ, B. TÝrak
SSK Ege Do¤umevi ve Kad›n Hastal›klar› Hastanesi, ‹zmir Akdeniz Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, Antalya
Amaç: Ektopik gebelik olgular›nda, metotreksat tek doz kullan›m›n›n dolay›s›yla da no- Our case was a 35-year old female patient, gravida 3 para 2 abortus 1 presented at
noperatif bir yöntemin etkinli¤ini daha önce yap›lan çal›flmalarla karfl›laflt›rarak araflt›r- 16 weeks of gestation with provocated abortus. She had been referred to the emer-
makt›r. Gereç ve Yöntem: Çal›flma kriterlerine uyan 60 hasta, Stovall ve arkadafllar›n›n gency service with the signs and symptoms of septic shock. She was hospitalized in
tek doz metotreksat protokolüne göre sa¤alt›lm›flt›r. Sonuçlar retrospektif olarak analiz the Intensive Care Unit with the preliminary diagnosis of septic abortion plus dis-
edilmifltir. Uygulanan protokol: ‹zleme bafllama günü, hCG >2000 mIU/ml ve gestasyo- seminated intravascular coagulation (DIC). The source of infection was decided to
nel kese yok ise D&C yap›lmam›fl, hCG <2000 ise D&C uygulanm›flt›r. Rutin olarak, tam be removed, which eventually would be hysterectomy. Eventually, an abdominal
kan say›m›, karaci¤er fonksiyon testleri, üre, kreatinin, kan grubu ve Rh tayini tap›lm›flt›r. hysterectomy was performed. She had 10 units of fresh frozen plasma and 6 units
Bulgular: Altm›fl hastadan, 49’u baflar›yla metotreksalle tedavi edilmifltir. On hastada, of platelet transfusion. The hemorrhage could not be controlled and eventually the
cerrahi uygulanm›flt›r. On bir hastadan, 2’si metotreksat tedavisinin 1. haftas›n›n sonunda pelvic cavity was packed with two surgical compresses. In the first postoperative
tedaviden çekildi. Bu 2 hasta, metotreksat›n 2. dozu yerine elektif cerrahiyi tercih ettiler. day, platelet level remained below 20 000 in spite of 16 units of platelet transfusion.
‹ki hasta cerrahi tedavinin daha kesin sonuç verdi¤ini düflünürek opere oldular. Bu 2 has- The packing was removed via relaparotomy 24 hours after its application, and it
tada elektif cerrahi metotreksat tedavisinin bir komplikasyonu sonucu uygulanmam›flt›r. was observed that only very little blood was oozing in pelvis. In the second post-
Metotreksat baflar› oran› %81.6’d›r. Sonuç: Hasta say›m›z›n az olmas› bu konuda çekin- operative day, 8 more units of platelets were transfused and the platelet count was
celer oluflturabilir ancak yine de bu konuda yap›lan genifl serili çal›flmalarla karfl›laflt›r›l- elevated to 31 000. In the third postoperative day, no more dopamine infusion was
d›¤›nda, ektopik gebeli¤in tek doz metotreksat ile baflar›yla tedavi edilebilece¤i görülmüfl- necessary. No more platelet transfusion was necessary and the platelet count was
tür. Tüm bunlar göz önüne al›nd›¤›nda, çal›flmada ortaya ç›kan baflar› oran›, bu tedavinin elevated to 72 000 by the sixth postoperative day. The improvement in platelet
uygulama alan›n›n geniflletilmesi konusunda cesaretlendirmifltir. Sonuçta, ektopik gebe- count continued, and the patient was discharged from the intensive care unit by the
likte bir tedavi yaklafl›m› olarak, metotreksat kullan›m› yeni bir geliflmedir. Yeni çal›flma- eighth postoperative day. An early resort to hysterectomy when conservative mea-
lar ile uygun doz verilme intervalleri ve uygulama flekilleri daha da gelifltirilecektir. sures fail, will minimize maternal morbidity and mortality. In case of continuous
bleeding after hysterectomy, pelvic packing proved to be effective.
P-002
P-004
REPRODUCTIVE OUTCOMES OF WOMEN WITH UNICORNUATE
POSTPARTUM DEPRESSION: A COMPARISON BETWEEN
UTERUS: REPORT OF A LARGE RETROSPECTIVE STUDY
OBSTETRIC STAFF AND GENERAL POPULATION
M. Erman Akar1, D. Bayar2, S. YÝldÝz2, B. YŸksel2, Z. YÝlmaz2

M. Erman Akar1, E. Yapar Eyi2
1
Akdeniz Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, 1
Akdeniz Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD,
Antalya Antalya
2
Zekai Tahir Burak Kad›n Sa¤l›¤› E¤itim ve Araflt›rma Hastanesi, Ankara 2
Zekai Tahir Burak Kad›n Sa¤l›¤› E¤itim ve Araflt›rma Hastanesi, Ankara
Objective: This study was undertaken to report the incidence and reproductive The aim of this study is to evaluate the pregnancy outcomes among obstetric staff
impact of unicornuate uterus on women desiring to conceive during their reproduc- in Turkey’s biggest maternity hospital and to examine the influence of gestational
tive years. Material and Methods: A total of 1782 patients who had HSG and and puerperal complications on subsequent postpartum depression. This is a
laparascopy or laparatomy to ascertain the uterine morphology were compiled retro- prospective study on the pregnancy outcomes of obstetricians (80), nurses (137),
spectively. The incidence and reproductive outcomes of the uterine anomalies were housewives (100) and women with other occupations. Postpartum depression was
investigated. Results: 55 cases were diagnosed as unicornuate uterus. The rudimen- evaluated by Edinburgh Postnatal Depression scale. Obstetric staff tend to have
tary horn had a cavity in 10/54 cases. 6/10 cases had communicating, 4/10 had non- higher depression scores compared with general population (p<0.000). There was
communicating horn. Hematometra of the rudimentary horn was found in two cases. no significant difference in low birth weight and preterm labor rates. Gestational
Ectopic pregnancy with rupture of the rudimentary horn was detected in 3 cases. and puerperal complications were significantly associated with increased risk for
Rudimentary horn was removed in these five cases. 55 women had at least two year postnatal depression (p<0.000, p<0.002). Screening for postpartum depression is
follow up. In all, 38 women had 65 pregnancies; 28% miscarried; 17 women did not appropriate and feasible for clinical practice and increases the rate of identification
conceive during the follow up period. The reproductive performance of women with of women suffering from this serious, common, treatable disorder.
unicornuate uteri was quite low, with a mere live birth rate of 29,2%. Conclusion:
Reproductive performances in women with unicornuate uterus is fairly impaired.
Prematurity is still a threatening problem and needs meticulous prenatal care.
Hematometra with pelvic cyclic pain and the high frequency of ectopic pregnancy in
women with unicornuate uterus with the communicating rudimentary horn is an indi-
cation for the removal of the horn with its tube once the diagnosis is confirmed.
111
POSTER V. Türk-Alman Jinekoloji Derne¤i ve II. Reproductive Medicine Tart›flmal› Konular ve Çözümler Ortak Kongresi
SUNUMLARI V. Kongress der Deutsch-Türkischen Gynäkologengesellschaft II. Internationaler Kongress für Reproduktionsmedizin
P-005 P-007
EVALUATION PREVALENCE OF ANEMIA IN PREGNANT WOMEN LE‹OM‹YOM ÖN TANISIYLA YAPILAN OPERASYONLARDA

AND ITS RELATION WITH MATERNAL AGE AND GESTATIONAL AGE POSTOPERAT‹F UTER‹N SARKOM SIKLI⁄I
N. Asnafi, S. Sina A. Haberal, F. KayÝk•ÝoÛlu, S. YiÛitbaßÝ, E. …ztŸrkoÛlu, N. …ztŸrk,

D. ‚avußoÛlu
Babol Medical University, Persia
SSK Ankara Do¤umevi ve Kad›n Hastal›klar› E¤itim Hastanesi, Ankara
Introduction: Goal of this study is the detection of prevalence of anemia in preg-
nant women and then, its relation with maternal age and gestational age. Method Amaç: Uterin leiomiyom ön tan›s›yla opere edilen hastalarda uterin sarkom s›kl›¤›-
and Material: The pregnant women who had visited the Yahyanejad Hospital’s n›n ve sarkom aç›s›ndan riskli olan grubu tan›mlayabilecek klinik özellik ve labo-
obstetrics O.P.D. clinic, during 6 months of 2001 (March-August), had studied by ratuvar testlerinin belirlenmesi. Gereç ve Yöntem: Hastanemiz jinekoloji klini¤in-
randomized sampling, and the related data have analyzed by SPSS. T test and de 1 Ocak 2002 ile 31 Aral›k 2002 tarihleri aras›nda, miyoma uteri nedeniyle yap›-
ANOVA and X2 variance analyzer. Result: The mean age of cases was 24.6±5 lan 679 total abdominal histerektomi ve miyomektomi retrospektif olarak incelen-
years old that about 66.2% of them were in the 20-30 years age group. The mean di. Hastalar›n yafllar›, baflvuru semptomlar›, preoperatif laboratuvar tetkik sonuçla-
Hb of cases was 12.6±1.6 and 20 of all 214 cases had anemia (9.4%). Maternal age r› ve intraoperatif bulgular kaydedildi. Postoperatif kesin patoloji sonuçlar›na göre
had no relation with anemia prevalence (p>0.05) but there was a significant relation leiomiyosarkom, endometriyal stromal sarkom, mikst mezodermal tümör s›kl›¤› he-
between gestational age and prevalence of anemia (p=0.012) with the higher rate of sapland›. Bulgular: Uterin leiomiyom ön tan›s›yla opere edilen 679 hastan›n yaflla-
occurrence in the 3rd trimester. The first visit time of the most cases was in the 15th r› 18-69 aras›nda idi. Olgular›n üç tanesinde leiomiyosarkom (%0.44), bir tanesin-
trimester of pregnancy (44.4%). Conclusion: Due to higher prevalence of anemia de endometriyal stromal sarkom (%0.15) ve bir tanesinde de karsinosarkom
in 3rd trimester, it is highly advisable to start iron replacement therapy from 2nd (%0.15) saptand›. Toplam sarkom s›kl›¤› %0.74 olarak belirlendi. Hastalar›n uterin
trimester and so checking of maternal HCT levels at early 3rd trimester. sarkom s›kl›¤›n›n yaflla beraber art›fl gösterdi¤i görüldü. ‹ntraoperatif üç vakada sar-
komu düflündüren bulgular mevcuttu. Toplam befl uterin sarkom olgusundan bir ta-
nesine evresi nedeni ile postoperatif kemoterapi verildi. Sonuç: Leiomiyom ile be-
lirti benzerli¤i nedeniyle sarkomun preoperatif tan›s› zordur. Ultrasonografik gö-
P-006 rüntüleme ve endometriyal örneklemenin tan›da de¤eri s›n›rl›d›r. Özellikle postme-
nopozal hasta grubunda, leiomiyom ön tan›s› ile konservatif tedavi planlanan has-
FETAL TRANSSEREBELLAR ÇAP VE SAKRUM UZUNLU⁄UNUN talarda, preoperatif de¤erlendirme detayl› yap›lmal›, sarkom olas›l›¤› ak›lda tutul-
GEBEL‹K YAfi TAY‹N‹NDEK‹ YER‹ mal› ve postoperatif patoloji sonucu yak›ndan takip edilmelidir.
Z. Gen•, M. BerkkanoÛlu, S. Atar, C. Mutaf, C. Ark P-008
SSK Bak›rköy Do¤umevi Kad›n ve Çocuk Hastal›klar› E¤itim Hastanesi,

POSTOPERAT‹F VAJ‹NAL KUBBE SELLÜL‹T‹NDE ETK‹L‹
‹stanbul
FAKTÖRLER
Amaç: Bu çal›flmam›zdaki temel amac›m›z, güncel ultrasonografik ekipman›m›zla

ve kendi popülasyonumuzda fetal transserebellar çap (TSÇ) ile sakrum uzunlu¤u- A. Haberal, F. KayÝk•ÝoÛlu, E. SobacÝ, S. YarkÝn, N. …ztŸrk, E. †nlŸbilgin,
nun (SU) ele al›n›p, bu iki ölçümün gebelik yafl› tayinindeki yerini ve birbirine olan F. HalÝcÝ, F. Al
üstünlüklerini araflt›rmakt›. Yöntem ve Gereç: Çal›flma, antenatal izlem poliklini-
¤ine baflvuran 17-40. gestasyonel haftalar aras›ndaki 134 gebede yap›ld›. Her biri üç SSK Ankara Do¤umevi ve Kad›n Hastal›klar› E¤itim Hastanesi, Ankara
defa tekrarlanmak üzere fetal SU ve TSÇ ölçülerek ortalamalar kaydedildi. Toplam
4 gebede TSÇ, 3 gebede ise SU ölçülemedi. 2 gebede hem sakrum, hem de transse- Amaç: Vajinal kubbe sellülitinde etkili olabilecek faktörler prospektif olarak arafl-
rebellar çap ölçümü yap›lamad›. Sonuç olarak, 134 gebenin 125’inde bu ölçümler t›r›ld›. Gereç ve Yöntem: Benign endikasyonlar nedeniyle histerektomi planlanan
yap›labildi. ‹lk olarak, ölçümlerle elde edilen verilerin tan›mlay›c› analizi yap›ld›. 43 olgu çal›flmaya dahil edildi. Birinci kuflak sefalosporin ile profilaksi ve abdomi-
Sonraki ad›mda, incelenen parametreler aras›ndaki korelasyon katsay›lar› hesaplan- nal kesi yeri ve vajinal antisepsi sonras›, total abdominal histerektomi uygulanan ve
d›. Son olarak TSÇ ve SU gestasyonel yafl› tahmin etme güçleri karfl›laflt›r›ld›. Bul- vajinal kubbe kapal› olarak oluflturulan tüm hastalardan, preoperatif vajinal ve pos-
gular: Çal›flma grubundaki gebelerin son âdet tarihine (SAT) göre gebelik haftala- toperatif kubbe kültürleri al›nd›. Operasyon süresi, intraoperatif kanama miktar› ve
r› 17 ile 40 aras›nda de¤iflmekte olup, ortalama gebelik haftas› 29.02 (SD 5.38) ola- toplam hastanede kal›fl süresi kaydedildi, postoperatif febril ve enfeksiyöz morbidi-
rak bulundu. Fetal TSÇ ölçülen en küçük de¤eri 16 mm, en büyük de¤eri 53 mm ve te takibi yap›ld›. Bulgular: Hastalar›n yafl ortalamas› 45.5 idi. Hastalardan
ortalamas› 33.26 (SD 8.56) olarak hesapland›. Fetal SU’nun ise ölçülen en küçük %61’inin alafranga, %39’unun alaturka tuvalet kulland›¤›, %37.2’sinin tuvalet ka-
de¤eri 16 mm, en büyük de¤eri 42 mm ve ortalamas› 28.50 (SD 5.49) olarak bulun- ¤›d› ve %35 olgunun vajinal dufl al›flkanl›¤› oldu¤u ö¤renildi. Menstrüasyon döne-
du. 17-40 gebelik haftalar› aras›nda sakral büyüme lineer olarak bulundu. 17-40 minde %55 olgunun bez, %39 olgunun hijyenik ped ve %6 olgunun pamuk kullan-
gestasyonel haftalarda, SU ile SAT aras›nda çok kuvvetli derecede anlaml› korelas- d›¤› saptand›. Postoperatif bir olguda abdominal kesi yeri enfeksiyonu ve bir olgu-
yon vard› (R=0.972). TSÇ ile SAT aras›nda çok kuvvetli derecede anlaml› korelas- da da vajinal kubbe hematomunu takiben enfeksiyon gözlendi. Preoperatif vajinal
yon vard› (R=0.936). SU ile TSÇ aras›nda da çok kuvvetli derecede anlaml› kore- kültürlerde en s›k izole edilen mikroorganizma Gardnerella vaginalis, sonra s›ray-
lasyon vard› (R=0.927) (p<0.001). Sonuç: ‹lk antenatal vizite geç baflvuran gebe- la Candida ve E. coli idi. Postoperatif vajinal kubbe kültürlerinde birinci s›rada E.
lerde CRL’den yararlanma olas›l›¤› bulunmamaktad›r. Bu durumda di¤er paramet- coli görüldü ve bu sonuçlar›n tuvalet temizli¤inde ka¤›t kullanmayan hasta grubu-
releri desteklemek aç›s›ndan sakrum uzunlu¤u veya transserebellar çap ölçümü fay- na ait oldu¤u saptand›. Preoperatif ve postoperatif kültürler karfl›laflt›r›ld›¤›nda sa-
dal› olabilir. dece 4 olguda (%9.3) ayn› patojenin postoperatif dönemde persiste etti¤i gözlendi.
Sonuç: Postoperatif morbiditenin önlenmesinde, titiz bir cerrahi teknik ve antibiyo-
tik profilaksisi yan›nda, vajinal antisepsinin önemi büyüktür.
112
P-009 P-011
CORRELATION BETWEEN FETAL SEX AND PROLIFERATIVE CELL DOES MANUAL REMOVAL OF THE PLACENTA EFFECT OPERATIVE
ACTIVITY IN TROPHOBLASTS OF FULL TERM HUMAN PLACENTA BLOOD LOSS DURING CESAREAN SECTION?
WITH REGARD TO HUMAN CHORIONIC GONADOTROPHIN IN
PERIPHERAL MATERNAL BLOOD AND CORD BLOOD IN NORMAL M. Gšl1, A. BaloÛlu2, L. Ova2, ‚. AydÝn2, U. Yensel2, L. KarcÝ2
PREGNANCIES 1
Dokuz Eylül Üniversitesi T›p Fakültesi, Kad›n Hastal›klar› ve Do¤um AD,
1 2 2 2 2 2 ‹zmir
M. Gšl , B. Tuna , E. DoÛan , B. GŸlekli , M. BaÛcÝ , U. SaygÝlÝ , 2
Atatürk E¤itim ve Araflt›rma Hastanesi, 1. Kad›n Hastal›klar› ve
M. KoyuncuoÛlu2
Do¤um Klini¤i, ‹zmir
1
Dokuz Eylül Üniversitesi T›p Fakültesi, Kad›n Hastal›klar› ve Do¤um AD,
‹zmir Objective: We tried to determine if manual removal of the placenta cause signifi-
2 cant amount of blood loss than spontaneous removal of the placenta in cesarean sec-
Dokuz Eylül Üniversitesi T›p Fakültesi, Patoloji AD, ‹zmir
tion. Material and Methods: The study included 200 pregnant women with nor-
mal pregnancies and with healty newborns, who were meeting the same criteria.
Objective: Fetal gender has a significant effect on maternal serum HCG levels. In the pre- They were divided into two subgroups of 100 patients in each group. Manual
sent study we evaluated the influence of fetal gender on the trophoblast cell activity in removal of the placenta was applied in Group – I (Study Group), while spontaneous
human placenta, with regard to maternal serum and cord blood HCG levels. Material and removal was applied in Group – II (Control Group). The operative blood loss was
Methods: Thirty-four uncomplicated, singleton, term pregnancies; 17 had male and 17 calculated in both groups during the surgery. Also postoperative 24 and 48 hours
had female fetuses. Human chorionic gonadotropin was measured in maternal peripheral hemoglobin levels were assessed. Results: Manual removal of the placenta did not
blood and cord blood. Trophoblast cell activity was measured by using immunohisto- cause significant operative blood loss during surgery than spontaneous removal.
chemistry for Ki-67 antigen. Results: Although it was not significant, the HCG levels in Although it was not statistically significant, spontaneous removal of the placenta
maternal serum and cord blood were higher in pregnant women with female fetuses than caused more operative blood loss. Hemoglobin levels decreased at 24 and 48 hours
in those carrying male fetuses. There were no sex difference in Ki-67 immunostaining of postoperatively in each group. But there was no significant decrease in hemoglobin
trophoblast cells. However there was a linear correlation between trophoblast cell activi- levels between the groups. Conclusion: Manual extraction of the placenta is not
ty and maternal serum (r= 0.43, P= 0.04) and cord blood (r= 0.52, P= 0.03) HCG levels. associated with a significantly greater risk of operative blood loss than spontaneous
Discussion: The difference in maternal serum and cord blood HCG levels with regard to placental removal. Also postoperative hemoglobin levels do not decrease signifi-
fetal gender is not associated with trophoblast cell activity in human term placenta. Fetal cantly in manual removal of the placenta than spontaneous removal.
sex difference has no effect on the regulation of trophoblast cell proliferation. However,
maternal serum and cord blood HCG levels could be related to placental proliferation.
P-012
P-010
ORAL KONTRASEPT‹F KULLANAN VE KULLANMAYAN YET‹fiK‹N
ACCURACY OF FROZEN SECTION DIAGNOSIS IN OVARIAN KADINLARIN BES‹N TÜKET‹M DURUMLARININ VE BAZI
TUMORS: IS THERE A CHANGE IN THE COURSE OF TIME? ANTROPOMETR‹K ÖZELL‹KLER‹N‹N KARfiILAfiTIRILMASI
M. Gšl1, A. BaloÛlu2, S. YiÛit3, M. DoÛan3, ‚. AydÝn3, U. Yensel3 G. Samur, E. YÝldÝz, G. Akbulut, A. Kuyumcu, H. …zel, E. Okut
1
Dokuz Eylül Üniversitesi T›p Fakültesi, Kad›n Hastal›klar› ve Do¤um AD, Hacettepe Üniversitesi Styo Beslenme ve Diyetetik Bölümü, Ankara
‹zmir
2
Atatürk E¤itim ve Araflt›rma Hastanesi, 1. Kad›n Hastal›klar› ve Amaç: Bu çal›flma oral kontraseptif kullanan ve kullanmayan yetiflkin kad›nlar›n
enerji-besin ö¤esi tüketim durumlar›n› ve beden kitle indeksi, bel/kalça oranlar› ara-
Do¤um Klini¤i, ‹zmir
3
s›ndaki muhtemel farkl›l›klar› saptamak amac›yla yap›lm›flt›r. Yöntem: Çal›flmaya,
Atatürk E¤itim ve Araflt›rma Hastanesi, Patoloji Klini¤i, ‹zmir Ankara’da yaflayan 20-60 yafl grubu yetiflkin kad›nlar aras›ndan tabakal› örneklem
yöntemi ile seçilen 2000 kad›n kat›lm›flt›r. Araflt›rmada bireylerle ilgili genel bilgi-
Objective: The aim of the present study was to determine the accuracy of frozen sec- ler (OCA kullan›m durumu), beslenme al›flkanl›klar› soruflturma yöntemi ile saptan-
tion diagnosis of ovarian tumors, and to examine the variation in accuracy rates of m›flt›r. Beslenme durumlar›n›n de¤erlendirilmesinde bir günlük besin tüketimi al›n-
diagnosis, in the course of time with the relevant literature. Material and Methods: m›flt›r. A¤›rl›k, boy, bel çevresi ve kalça çevresi ölçümleri yap›lm›flt›r. Bulgular:
A retrospective study of 221 ovarian biopsy results, between January 1, 2000 to Çal›flmaya kat›lan kad›nlar›n %54.1’nin BK‹ de¤erlerinin 25’in üzerinde oldu¤u be-
August 31, 2002 was examined to determine the accuracy of frozen section diagno- lirlenmifltir. Beden kitle indeksleri (BK‹) ortalamas› OCA kullanan kad›nlarda
sis. Also we searched for all published studies from 1979 through 2002 regarding the (n=308) 26.79±0.29 kg/m2 iken, kullanmayan kad›nlarda (n=1692) 26.02±0.11
accuracy rates of frozen section diagnosis of ovarian tumors, and tried to review and kg/m2 olarak bulunmufltur (p<0.05). Bel/kalça oranlar› (B/K) de¤erlendirildi¤inde
compare the accuracy data of these investigations in relation with time. Results: OCA kullanan ve kullanmayan kad›nlar aras›nda önemli bir farkl›l›k bulunmam›fl-
Histopathologic examination results of frozen section biopsies were concordant with t›r (p>0.05). Besin tüketim durumlar› incelendi¤inde, gruplar aras›nda enerji ve
paraffin section results in 92% of all cases. The sensitivity for benign, malignant, and makro besin ö¤eleri tüketimi aç›s›ndan istatistiksel olarak önemli bir farkl›l›k bu-
borderline ovarian tumors were 98%, 88.7%, and 61% respectively. There were 5 lunmam›flt›r (p>0.05). Bu araflt›rma sonuçlar›na göre besin tüketim durumlar›nda
(2.2%) false positive (overdiagnosed) and 13 (5.4%) false negative (underdiagnosed) önemli farkl›l›k olmamas›na ra¤men OCA kullanan kad›nlarda a¤›rl›k ve beden kit-
cases. Frozen section examination of mucinous tumors demonstrated high underdiag- le indekslerinin daha yüksek oldu¤u gösterilmifltir.
nose rates (20%). Review of the published studies in relation with time, revealed no
significant variation in accuracy rates of frozen section diagnosis for benign and
malignant ovarian tumors. Altough previous studies and our data revealed low accu-
racy rates of frozen section diagnosis for borderline ovarian tumors, neverthless an
increasing rate of accuracy seems to be with advancing years. Conclusion: Frozen
section evaluation in identifying a malignant or benign ovarian tumor is accurate
enough for the correct diagnosis. Altough we had more improvement in the correct
diagnosis of borderline ovarian tumors in the course of time, the accuracy rates are
still low. We should gain much more experience, and technical development in deal-
ing with the frozen section diagnosis of borderline ovarian tumors.
113
P-013 P-015
‹NTRAS‹TOPLAZM‹K SPERM ENJEKS‹YONU ‹LE ELDE ED‹LEN THE ROLE OF DYNAMIC ASSAYS OF SERUM INHIBIN A AS
GEBEL‹KLERDE ‹K‹NC‹ TR‹MESTER MATERNAL SERUM ALFA FETO PREDICTORS OF OVARIAN RESPONSE AND VERY EARLY
PROTE‹N, HUMAN KORYON‹K GONADOTROP‹N VE ESTR‹OL PREGNANCY IN IVF PROGRAMMES
KONSANTRASYONLARININ DE⁄ERLEND‹R‹LMES‹
S. YaltÝ, B. GŸrbŸz, C. FÝ•ÝcÝoÛlu, H. Sezer, S. ‚elik
B. GŸrbŸz, S. YaltÝ, C. FÝ•ÝcÝoÛlu, H. Sezer, S. ‚elik
Zeynep Kamil Kad›n ve Çocuk Hastal›klar› E¤itim ve Araflt›rma Hastanesi
Zeynep Kamil Kad›n ve Çocuk Hastal›klar› E¤itim ve Araflt›rma Reprodüktif Endokrinoloji ve IVF Klini¤i, ‹stanbul
Reprodüktif Endokrinoloji ,IVF Klini¤i, ‹stanbul
Objective: The study was designed to examine whether dynamic measurement of
Amaç: ‹ntrasitoplazmik sperm enjeksiyonu (ICSI) ile elde edilen tekil gebeliklerde serum inhibin A were correlated with the ovarian response to stimulation in invitro
ikinci trimester maternal serum total human koryonik gonadotropin (HCG), alfa- fe- fertilization programme and to see if serum inhibin A levels obtained at varying
to protein (AFP) ve unkonjuge estriol (uE3) konsantrasyonlar›n›n de¤erlendirilme- times during treatment were of value in predicting pregnancy. Study design: A
si. Gereç ve Yöntem: ICSI ile tekil gebelik elde edilen 24 olguda 16-20. gebelik total of 40 patients undergoing invitro fertilization treatment were studied. Plasma
haftalar› aras›nda serum AFP, uE3 ve HCG konsantrasyonlar› ölçülerek MoM de- concentrations of inhibin A were studied on day of human chorionic gonadotrophin
¤erleri hesapland›. De¤erler ayn› zaman diliminde spontan gebe kalarak hastanemiz administration, follicle aspiration day, 5 and 12 days after invitro fertilization
laboratuvar›nda üçlü tarama testi yapt›ran 82 tekil gebenin sonuçlar› ile karfl›laflt›- embryo transfer. Serum samples were also collected 12 days after invitro fertiliza-
r›ld›. Bulgular: Çal›flma ve kontrol gruplar› aras›nda anne yafl› ve kilosu, gebelik tion embryo transfer for beta human chorionic gonadotrophin pregnancy testing.
haftas›, sigara al›flkanl›¤› aç›s›ndan fark yokken çal›flma grubunda parite daha yük- The samples were divided into non-pregnant (n=24) and pregnant (n=16) groups,
sekti. ICSI gebeliklerinde HCG, AFP ve uE3 için MoM de¤erleri s›ras›yla 1.42 ± the pregnancies were followed and outcomes determined. Results: Plasma concen-
0.04, 0.99±0.04 ve 1.00±0.01 olarak saptand›. AFP ve uE3 MoM de¤erleri kontrol trations of inhibin A on the day of human chorionic gonadotrophin administration,
grubu ile benzer iken, total HCG MoM de¤eri kontrol grubundan anlaml› olarak da- follicle aspiration day, 5 days after embryo transfer were not different between
ha yüksekti. Hiçbir olguda tarama pozitifli¤i saptanmad›. Kromozomal anomalili pregnant or nonpregnant patients. Only inhibin A concentrations 12 days after
bebek do¤umu, fetal ve neonatal ölüm tespit edilmedi. Sonuç: ICSI ile elde edilen embryo transfer were significantly lower in non-pregnant women than in women
tekil gebeliklerde artm›fl HCG seviyeleri fazla say›da embriyo transferi ve corpus with ongoing pregnancies (p=0.001). Inhibin A concentrations were not signifi-
luteum oluflumuna, ICSI uygulamas›na ba¤l› maternal hormonal çevreye veya di¤er cantly different between singleton and multipl pregnancies in the ovarian stimula-
faktörlere ba¤l› olabilir. HCG düzeyindeki bu art›fl Down’s Sendromu aç›s›ndan tion protocol. Inhibin A serum concentrations were significantly correlated with
yanl›fl pozitif tarama sonuçlar›na neden olabilir. Yard›mc› üreme teknikleri ile elde mature and retrieved oocytes number. Conclusion: 12 days after embryo transfer
edilen gebeliklerde en ideal Down’s Sendromu tarama testi için ileri çal›flmalara ih- serum inhibin A concentrations could be of value to help predict whether the infer-
tiyaç vard›r. Anahtar Kelimeler: Alfa-feto protein , unkonjuge estriol, total human til patient would have pregnancy or not. Key words: Inhibin A, in vitro fertilization
koryonik gonadotropin, ICSI
P-014 P-016
SEVERE RIGHT UPPER QUADRANT PAIN IN PREECLAMPSIA IVF OLGULARINDA FOL‹KÜL SIVISI VE SERUM HORMON
ASSOCIATED WITH GALLBLADDER WALL THICKENING CAN BE PARAMETRELER‹N‹N DE⁄ERLEND‹R‹LMES‹
MANAGED BY SIMPLE ANTISPASMODICS
S. YaltÝ, B. GŸrbŸz, C. FÝ•ÝcÝoÛlu, Z. ‚olak
F. YazÝcÝoÛlu, S. Kelek•i, M. AygŸn, O. …zyurt
Zeynep Kamil Kad›n ve Çocuk Hastal›klar› E¤itim ve Araflt›rma Hastanesi
Süleymaniye Maternity Hospital, Perinatology Unit, ‹stanbul Reprodüktif Endokrinoloji ve IVF Klini¤i, ‹stanbul
Objective: To find out whether the severe right upper quadrant pain in preeclamp- Amaç: Folikül s›v›s›nda hormon seviyelerinin gebelikle iliflkileri ve farkl› stimülas-
tic patients with or without ultrasonographic changes resembling an acalculous yon protokollerinin folikül s›v›s›ndaki hormon seviyeleri üzerine etkisinin araflt›r›l-
cholecystitis can be managed by simple antispasmodic medication as used in biliary mas›d›r. Gereç ve Yöntem: Temmuz 2001-Ekim 2001 tarihleri aras›nda IVF mer-
colic. Materials and methods: 3 cases of preeclampsia with severe epigastric pain kezimize baflvuran 36 infertil olgu çal›flmaya dahil edildi. Çal›flmaya kat›lan tüm
and abnormal (>5 mm) thickening of the gallbladder wall and 3 cases with normal hastalara uzun protokol GnRH-a uyguland› ve hastalar r FSH veya HMG ile indük-
thickness during abdominal ultrasonography received a standart IV dose of anti- lendi. Üçten fazla 18 mm’nin üzerinde folikül oluflumu sa¤land›ktan sonra 10 000
spasmodic medication (Hyoscine – N – Butylbromure, 20 mg). Pain relief and IU HCG ovulasyon uyar›ld›. Otuz alt› saat sonra, tüm oositler transvajinal olarak
changes in gallbladder wall thickness were noted. Findings: All patients had imme- topland›. Oosit aspirasyon günü serum ve folikül s›v›s› örne¤i al›nd›. Toplanan fo-
diate relief of the severe right upper quadrant pain. All 3 patients with increased likül s›v›lar›nda FSH, LH, E 2, PG, Prolaktin, BhCG, testosteron, serumda FSH,
gallbladder wall thickness had concomittant decrease in the thickness. In the three LH, BhCG seviyeleri ölçüldü. Bulgular: HMG ve FSH ile tedavi edilenler grubun-
other cases with normal values, the thickness remained unchanged. Conclusion: da serum ve folikül s›v›lar›nda hormon seviyelerinde anlaml› fark bulunmad›. Ge-
Severe right upper quadrant pain in preeclamptic patients with or without abnormal belik olmayan grupta, folikül s›v›s›nda testosteron seviyesi, gebelik olan gruba gö-
ultrasonographic appearance of the gallbladder wall can be managed by simple anti- re anlaml› ölçüde yüksek bulundu. Sonuç: Folikül s›v›s›n›n steroid içeri¤i gebeli¤i
spasmodic medication. We speculate that the true mechanism in these cases might predikte etmede faydal› bulunmam›flt›r. Anahtar kelimeler: Folikül s›v›s›, steroid,
be a pathological contraction of the sphincter of Oddi leading to a painful high pres- gonadotropin, in vitro fertilization
sure state of the whole biliary tree.
114
P-017 P-019
THE EVALUATION OF SECOND TRIMESTER DOWN’S SYNDROME PREOPERATIVE SERUM VASCULAR ENDOTHELIAL GROWTH
TRIPLE SERUM SCREENING TEST IN INTRAUTERINE FACTOR (VEGF) IN OVARIAN MASSES
INSEMINATION PREGNANCIES
H. Mete TanÝr1, S. …zalp1, …. Yal•Ýn1, …. ‚olak2, A. Ak•ay2, T. Þenses2
B. GŸrbŸz, S. YaltÝ, H. Sezer, S. ‚elik
1
Osmangazi Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um
Zeynep Kamil Women and Children Education and Research Hospital Anabilim Dal›, Eskiflehir
2
Reproductive Endocrinology and Infertility Unit, ‹stanbul Osmangazi Üniversitesi T›p Fakültesi Biyokimya Anabilim Dal›, Eskiflehir
Objective: To evaluate second trimester maternal serum total human chorionic Objective: To assess the value of serum VEGF in the preoperative management of
gonadotrophin (HCG) , alpha-feto protein (AFP) and unconjugated estriol (uE3) ovarian mass. Materials and Methods: A prospective cohort study was conducted
concentration in singleton pregnancies conceived from intrauterine insemination on 40 premenopausal and 23 postmenopausal patients with ovarian masses.
(IUI). Study design: Second trimester (16-20 weeks) maternal serum levels of Patients’ ages, serum Ca-125 levels, serum VEGF levels and preoperative tumor
AFP, uE3 and total hCG were measured and expressed as multiples of median volumes were determined. Laparoscopy or laparotomy were undertaken as to obtain
(MoM) values in 28 patients conceiving singleton pregnancy by IUI. The results the final pathologic result. Follicular cysts, corpus luteum cysts and endometriomas
were compared with those of 82 naturally occuring singleton pregnancies who had were grouped as non-neoplastic masses (group I). Serous or mucinous cyctadeno-
serum screening at 16-20 weeks at the same laboratory over the same period of mas, dermoid tumors, fibromas were allocated into neoplastic benign ovarian mass
time. Results: There were no significant differences between the study and control (group II). Primary malignant ovarian neoplasms were assigned as neoplastic-
groups in maternal body weight, age, gestational week and habitus of cigarette malign group (group III). Results: Among postmenopausal cases, serum Ca-125
smoking. The median levels of the triple markers were 1.03±0.66 MoM for hCG, levels were 113.5±20 IU/ml, compared to those in premenopausal cases (85.8±16.0
1.09±0.32 MoM for AFP and 1.06±0.01 MoM for uE3 in the IUI pregnancies. The IU/ml, p=0.05). Serum VEGF values among pre- and postmenopausal ovarian
values of hCG, AFP and uE3 were not significantly different from that in controls. masses were 46.2±6.7 pg/ml and 68.2±7.9 pg/ml, respectively (p=0.04). Serum
No women were found to be screen positive. In neither group were chromosomal VEGF levels in endometriomas (56.5±1.5 pg/ml) were higher compared to those of
abnormalities detected and no fetal or neonatal deaths were recorded. Conclusion: follicular or corpus luteum cysts (30.6±2.8, p=0.05). Tumor size was larger in non-
Based on our findings, IUI did not significantly affect the results of maternal serum endometriotic, non-neoplastic cysts (10.1±2.0cm), compared to endometriomas
Down’s syndrome screening. Key words: Alpha-feto protein, unconjugated estriol, (6.4±0.6cm, p<0.01). Serum VEGF levels of group III were higher than other
total human chorionic gonadotrophin, IUI groups (p<0.001). In discriminating benign or malign nature of the mass, with a
VEGF cut-off value of 68.7 pg/ml, sensitivity (Se), specificity (Sp), positive (PPV)
and negative likelihood ratios (NPV) were 92.3%, 88.0%, 3.3 and 0.1, respective-
ly. For serum Ca-125 cut-off value of 102 IU/ml, Se, Sp, PPV, NPS were, 76.9%,
P-018 76.0%, 3.2 and 0.3. Area under curve (AUC) for serum VEGF and Ca-125 values
were, 0.938 and 0.769, respectively (p=0.02). Among postmenopausal group,
EIN NEUES NICHTOPERATIVES VERFAHREN ZUR BEHANDLUNDER AUC’s for serum VEGF and Ca-125 were detected as 0.902 and 0.873, respective-
ly (p=0.14). Conclusion: Serum VEGF has a preoperative value in determining the
HARN- STRESSINKONTINENZ DER FRAU - DIE
nature of ovarian mass.
IMPLACEMENTTHERAPIE MIT ZUIDEX G
R. F.
P-020
Berlin
VAJ‹NAYA DO⁄MUfi ENDOMETR‹YAL POL‹P: OLGU SUNUMU
Einführung Bei der IMPLACEMENTTHERAPIE mit ZUIDEX wird das Implantat
submukös in die Harnröhre injiziert. Es bewirkt eine Unterfütterung des Gewebes H. KÝran1, G. KÝran1, M. Alanur GŸven1, S. Bakariß2
und somit die Besserung oder Beseitigung der Inkontinez. Material und
Methoden: Zwischen September 2002 und Januar 2003 haben wir 7 Frauen im 1
KSÜ T›p Fakültesi Kad›n Hastal›klar› ve Do¤um Anabilim Dal›, Konya
Alter von 53 und 89 Jahren mit ZUIDEX – IMPLACER – VERFAHREN durchge- 2
KSÜ T›p Fakültesi Patoloji Anabilim Dal›, Konya
führt. Bei allen Patienten wurde vorher Urinanalyse, Zystoskopie,
Perinealsonographie, Stresstests durchgeführt. 4 Patientinnen wurden urody-
namisch kontrolliert. ZUIDEX ist ein steriles Gel, dessen Bestandteile Endometriyal polipler, endometriumdan kaynaklanan, de¤iflik boyutlarda pedinkül-
Dextranomermikropartikel und stabilisierte, nicht animalische Hyaluronsäure ein lü veya sesil tümöral oluflumlard›r. Uterusun en s›k görülen polip türüdür. Büyük-
compatibles und biologisch abbaubares Implantat ergeben. Unsere erste Erfahrung lükleri 1-2 mm’den, uterusun içini tamamen dolduracak boyutlara kadar ulaflabilir.
bei 7 Patientinnen zeigt folgendes Bild: - sehr gute Akzeptanz bei Patientinnen - Sapl› endometriyal polipler uzayarak servikal kanaldan d›flar›ya ç›kabilirler. Çok
einfache Durchführung des Verfahrens - Verfahrensdauer durchschnittlich 9 Min. - nadir olarak, introitustan sarkt›klar› görülmüfltür. Olgumuz 66 yafl›nda ve 21 y›ld›r
Kontinenz 85.7% (6 von 7 Patientinnen) - Besserung 14.3% (1 von 7 Patientinnen) menopozda olup, vajinal kanama nedeniyle departman›m›za baflvurmufltur. Jineko-
- Versager 0 - Komplikationen k e i n e Die Patientinnen wurden jeweils 24 Std., lojik muayene ve tetkikler sonucunda, vajinaya do¤mufl endometriyal polip tan›s›
nach 7 Tagen und nach 1 Monat kontrolliert. Dabei wurde ein Pad-Test durchge- konulmufltur. Anahtar Kelimeler: Endometriyal polip, postmenopozal kanama.
führt, Restharn wurde mit Ultraschall kontrolliert. Schlusswort Die IMPLACE-
MENT – THERAPIE mit ZUIDEX ist ein einfaches Verfahren, nicht invasiv,
geeignet für leichte bis mittelschwere Harn-Stressinkontinenz der Frau in jedem
Alter. Sie ist eine ideale Alternative nach Versagen von konservativen Therapien
und traditionellen und minimalinvasiven Inkontinenzoperationen. Sie ist ambulant
durchführbar ohne Vollnarkose bei sehr guter Akzeptanz und sehr guten
Ergebnissen.
115
P-021 P-023
ANKARA ZÜBEYDE HANIM DO⁄UMEV‹ VAKUM EKSTRAKS‹YON A THREE-YEAR AUDIT OF THE MANAGEMENT OF ECTOPIC
UYGULAMALARI: 303 OLGUNUN ANAL‹Z‹ PREGNANCY
R. Tuncer, S. KÝß, D. Uygur, S. Erdin•, S. Erkaya N. …ztŸrk Turhan, N. Carda Se•kin, Ü. Ünegšl
Ankara Zübeyde Han›m Do¤umevi, Ankara Fatih University, Faculty of Medicine, ‹stanbul
1997-2000 y›llar› aras›nda 303 olguya vakum ekstraksiyonla operatif do¤um yapt›- Objective: To audit the management of ectopic pregnancy over a three years peri-
r›ld›. Vakum uygulamalar› 4 y›ll›k çal›flma süresi boyunca gerçekleflen 26.414 do- od. Material and method: The medical records of 40 women diagnosed and hos-
¤umun %1.1’ini oluflturmaktad›r. Bu süre içerisinde sezaryen do¤um h›z› %29.8 pitalised with ectopic pregnancy from 1999 to 2002 at Fatih University Hospital
olarak bulunurken, 15 olguya obstetrik forseps uygulamas› yap›ld›¤› gözlendi. Va- were evaluated retrospectively. Results: Mean age of women was 29.3. The most
kum uygulamalar›nda ortalama yafl 24.9, ortalama parite 0.6 olarak bulundu. Do- common presenting symptom was abdominal pain (67.5%) and most frequent phys-
¤um s›ras›nda 290 (%95.7) olgu term, 2 olgu postterm, 11 olgu ise s›n›rda preterm ical finding was abdominal tenderness (97.5%). The prevalence of smoking was
idi. Bebek a¤›rl›¤›na göre 27 bebek 4000 gr üzerinde, 6 bebek ise 2000-2500 gr ola- 60%. Past histories of laparotomy and previous ectopic pregnancy were 37.5% and
rak bulunurken 270 (%89.1) bebek 2500-4000 gr aras›nda idi. Yüz k›rk dokuz 17.5% retrospectively. 52.5% of the patients were using a contraceptive method.
(%49.1) olguda ilerlemeyen eylem, 135 (%44.5) olguda fetal distress, 10 olguda The most common contraceptive methods were coitus interruptus (25%) and
maternal hastal›k ve 6 olguda malpozisyon nedeniyle vakum uygulan›rken 3 olgu- intrauterine device (20%). In 65% of the cases, the ectopic pregnancy was located
da profilaktik uygulama yap›ld›. Vakum uygulamas›n›n baflar›s›z kald›¤› 9 (%2.9) in the right tuba uterina and in 35% was located in left tuba uterina. 10 women
olgudan 6’s›nda vakum uygulamas›n› takiben forseps uygulamas› ile vajinal do¤um (25%) was followed-up with expectant management, 9 women (22.5%) received
baflar›labilirken 3 olguda sezaryen do¤um yapt›r›ld›. Maternal komplikasyonlar ola- single-dose methotrexate. 21 women (52.5%) were treated surgically. In two cases
rak 48 (%15.8) olguda derin vajinal laserasyon, 7 olguda kan transfüzyonu, 4 olgu- (22.2%) single-dose methotrexate therapy failed and required a second dose of
da servikal laserasyon, 3 olguda epizyotomi aç›lmas›, 2 olguda puerperal infeksiyon methotrexate. 66.7% of the surgically treated cases underwent laparotomy and
gözlendi. Bir olguda uterus rüptürü ve 1 olguda uterin atoni nedeniyle toplam 2 33.3% of the cases underwent laparoscopy. Conservative tubal surgery was per-
(%0.7) olguda postpartum histerektomi operasyonu yap›ld›. Neonatal komplikas- formed in 28.5%. There was no complication and none required further surgery.
yonlar olarak 36 olguda belirgin caput succedaneum, 26 olguda düflük APGAR sko- Conclusion: Although expectant management and methotrexate therapy are effec-
ru, 12 olguda mekonyum aspirasyonu, 6 olguda anoksik do¤um, 5 olguda sefal he- tive and safe options for women with ectopic pregnancy, the majority of women
matom, 3 olguda bafl saçl› derisinde laserasyon, 3 olguda neonatal konvülsiyon, 2 still undergo surgical management as a consequence of late admission to hospital.
olguda omuz distosisi gözlendi. Bir (%0.3) olguda neonatal ex gözlendi. Vakum
ekstraksiyon nispeten az uygulanmakla birlikte forsepse göre daha çok tercih edilen
bir metoddur ancak ciddi maternal ve fetal komplikasyonlara neden olabilir.
P-024
PLASENTAL ‹NVAZYON ANOMAL‹L‹ B‹R OLGUDA KONSERVAT‹F

YAKLAfiIM
P-022
B‹LATERAL TEKA LUTE‹N K‹ST‹ VE PREEKLAMPS‹ ‹LE KOMPL‹KE A. Aker ‚Ýrpan, N. …ztŸrk Turhan, F. Bolkan
GEBEL‹K
Fatih Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, ‹stanbul
T. Usta1, N. NumanoÛlu1, B. …zdemir1, H. Aslan2, B. SÝdal2 Plasental invazyon anomalileri ço¤unlukla tedavi fleklinin histerektomi oldu¤u na-
1
dir görülen obstetrik problemlerdir. Konservatif yaklafl›mla tedavi ve takip etti¤imiz
SSK Vak›f Gureba E¤itim Hastanesi, ‹stanbul bir olguyu sunuyoruz. 31 yafl›nda hastada, 39. gestasyonel haftada normal vajinal
2
SSK Bak›rköy Do¤umevi, ‹stanbul do¤um sonras› plasentas›n›n ayr›lmamas› üzerine genel anestezi alt›nda yap›lan el-
le halas baflar›l› olmad›. Uterotonik ajanlar eflli¤inde keskin küretaj sonras› plasen-
Amaç: Teka lutein kistleri maternal hipotroidi, yard›mc› üreme tekni¤i sonras›, ço- tal materyal gelmemesi üzerine yap›lan ultrasonografik incelemede plasentan›n ute-
¤ul gebelik, molar gebelik, hidrops fetalis’te s›k görülmesine karfl›n normal gebe- rin fundusta miyometrium içerisine 113x70 mm’lik bir kitle halinde invaze oldu¤u
likte daha nadir görülmektedir. Yaz›n›n amac› normal gebelikte nadir görülen teka gözlendi. Vajinal kanaman›n oksitosikler ile kontrol alt›na al›nmas› ve hastan›n da
lutein kistlerinin, olgu nedeniyle klinikte yap›lan takibinin irdelenmesidir. Olgu histerektomiyi kabul etmemesi üzerine hasta t›bbi takip amac› ile gözlem alt›na
Sunumu: Yirmi alt› yafl›ndaki hasta, gebelik ve bilateral kas›k a¤r›s› nedeniyle anal›nd›. Postpartum 1. gün tekrar keskin küretaj denendi ancak ultrasonografik bul-
tenatal poliklini¤ine baflvurdu. Yap›lan ilk ultrasonografisinde (USG) 17 haftal›k gular de¤iflmedi. Do¤umdan iki saat sonra 3979 mIU/ml olan b-hCG düzeyi post-
tek, canl›, gross anomali saptanmayan gebelikle beraber, her iki over normalden bü- partum 1. hafta 709 mIU/ml, 2. hafta 191 mIU/ml’ye geriledi ve 4. haftada s›f›rlan-
yük (sa¤:85.1-46.2 mm, sol:67.5-38.9 mm) ve multipl kistler izleniyordu. Maternal d›. Postpartum 4. haftada ani bafllayan bilateral kas›k a¤r›s› ve vajinal kanama ile
serum human koryonik gonadotropin (hCG) >100.000 mIU/Ml, CA-125, CA-15.3, baflvuran hastan›n plasentas› spontan olarak att›. Ultrasonografik incelemede uterus
CEA ise normal de¤erlerdeydi. Normal gebelik ve bilateral teka lutein kisti tan›s›y- 68x65x60 mm boyutlar›nda, miyometriyum düzenli ve endometriyum çift duvar ka-
la takibe al›nd›. 21. gebelik haftas›nda (g.h.) bilateral kistlerin boyutlar›nda azalma l›nl›¤› 15 mm idi. Cerrahi tedavi gerektiren ve dramatik komplikasyonlarla sonuç-
saptand›. 28. g.h.’de üç haftal›k geliflme gerili¤ine, hipertansiyon, proteinüri, oligo- lanabilen plasental invazyon anomalilerinde her ne kadar bu vakada oldu¤u gibi çok
hidramni, plasentada 3-4 cm’lik lakünler eklenmesi üzerine hasta yat›r›larak takibe nadiren konservatif yaklafl›m ile baflar›l› olunabilse de komplikasyonlara karfl› ha-
al›nd›. On befl günlük hospitalizasyon sonucunda, oligohidramni, doppler USG bul- z›rl›k ve donan›m sa¤lanmal› ve takip ve tedavileri acil ameliyathane ve yo¤un ba-
gular›nda bozulma nedeniyle sezaryenle, 6/8 apgarl›, 1130 gr., erkek bebek do¤ur- k›m olanaklar› olan birimlerde yap›lmal›d›r.
tuldu. Konjenital anomali, plasental patoloji ve annede postpartum komplikasyon
saptanmad›. Annenin do¤umdan sonra yap›lan kontrollerinde overlerin boyutlar› ve
hCG de¤eri normal düzeylerdeydi. Tart›flma: Genelde spontan regresyon göster-
mesi nedeniyle, normal gebelikle beraber seyreden teka lutein kistlerinin tan›nma-
s›, hastaya gereksiz cerrahi giriflim yap›lmas›n› engeller.
116
P-025 pik gebelik erken tan›s›nda kullan›lacaksa hangisinin daha etkin olaca¤›n› de¤erlen-
dirmek için ROC e¤rileri çizilerek her üç testin prediktif güçleri karfl›laflt›r›lm›flt›r.
EP‹TELYAL VE NONEP‹TELYAL MAL‹GN OVER TÜMÖR Bulgular: CK için ROC e¤risine göre saptanan s›n›r de¤er 45 IU/l bulundu. Buna
göre sensitivite %86, spesifisite %31, PPD %55, NPD %70 saptand›. Östradiol için
OLGULARINDA 17 YILLIK DENEY‹M‹M‹Z
s›ras›yla 225 pg/ml, %100, %68, %75 ve %100 bulunmufltur. Progesteron için s›ra-
s›yla 13 ng/ml, %95, %81, %84 ve %94 olmaktad›r. Östradiol ile CK aras›nda ve
Ü. ArÝkan, D. ArÝkan, F. Karatepe, S. Bozkurt progesteron ile östradiol aras›nda istatistiksel olarak anlaml› fark varken (p de¤er-
leri 0.024 ve 0.0082), progesteron ile CK aras›nda ileri düzeyde anlaml› fark sap-
SSK ‹stanbul E¤itim Hastanesi II. Kad›n Hastal›klar› ve Do¤um Klini¤i, ‹stanbul tanm›flt›r. Sonuçlar: Ektopik gebeliklerde CK düzeyi normal gebeliklerden yüksek,
östradiol düzeyi anlaml› olarak düflük bulunmufltur. Ektopik gebelik tan›s›nda PGN
Amaç: Epitelyal ve nonepitelyal malign over tümörlerin retrospektif olarak de¤erlen- tayini, CK ve östradiole göre daha prediktiftir.
dirilmesi. Gereç ve Yöntem: 1985-2003 y›llar› aras›nda klini¤imize baflvuran ve takip
etti¤imiz 158 malign over tümörlü hasta histolojik tipleri, evre, uygulanan cerrahi ve
adjuvan tedavi göz önüne al›narak retrospektif olarak de¤erlendirildi. Bulgular: Olgu-
lar›n %61’i 50 yafl ve üzerindeydi. Yüz yirmi yedi (%80) olguda malign epitelyal over P-028
tümörü, 27’sinde (%17) ise nonepitelyal over tümörü mevcuttu. Epitelyal over tümör-
lerinin ço¤unlu¤unu 48 (%30) olgu ile seröz tümörler oluflturmaktayd›. Olgular›n 78’i PRENATAL DIAGNOSIS OF MECKEL-GRUBER SYNDROME: A CASE
(%49) evre I, 18’i (%12) evre II, 28’i (%18) evre III ve 34’ü (%21) evre IV olarak tes- REPORT
pit edildi. Altm›fl (%38) hastaya geniflletilmifl histerektomi+apendektomi+ omentekto-
mi +BLND operasyonu uyguland›. Yirmi dokuz (%18) olgu ise inoperable olarak ka-
bul edildi ve laparotomi esnas›nda sadece biyopsi al›nd›. Yüz dtuz iki (%83.5) olguya B. Dane, C. Dane, A. ‚etin
postoperatif adjuvan kemoterapi, 6 (%3.7) olguya radyoterapi uyguland›. Sonuç: Er-
ken tan›s› güç oldu¤u ve büyük ço¤unlu¤u ileri evrede yakaland›¤›ndan mortalite ora- Haseki E¤itim ve Araflt›rma Hastanesi Kad›n Hastal›klar› ve Do¤um Klini¤i,
n› yüksek olan malign over tümörlerine bu çal›flmayla tekrar de¤inmek istedik. ‹stanbul
Introduction: Meckel-Gruber syndrome is a rare and lethal autosomal recessive dis-

order characterized by occipital encephalocel, postaxial polydactyly and bilateral dys-
P-026 plastic cystic kidneys. Finding at least two of the three features of the classical triad,
in the presence of normal karyotype makes the diagnosis . Case Report: A twenty-
INTRAVAGINAL PGE (2) TABLETS COMPARED TO INTRAVAGINAL year-old woman with 20 weeks amenorrhea. The ultrasound scan revealed bilateral
PGE (2) INSERT enlarged cystic kidneys, occipital encephalocele, six digits. There was oligohydram-
nios. The fetal urinary bladder was not visualised. The pregnancy was terminated.
Post-mortem examination of the fetus revealed a large abdomen, a head with occipi-
G. ArÝkan, C. Benedicic, J. Haas tal encephalocel, bilateral clubfeet and six digits in all the four limbs . Autopsy
revealed bilateral large cystic dysplastic kidneys . Urinary bladder and both ureters
Department of Obstetrics and Gynecology, University of Graz, Austria were identified. Discussion: According to different authors, the incidence varies
between 0.07-1.1:10.000 live births. The reported incidence of renal disorder in this
Objective: To compare the efficacy and safety of intravaginal PGE tablets (Prostin) syndrome varies from 95% to 100%. Occipital encephalocel is present in 60% to
with PGE2 insert (Propess) in cervical ripening and induction of labour. Design: This 80%. Post-axial polydactyly is present in 55% to 75%. A karyotype study should be
was a retrospective analysis of patients with single pregnancy, intact membranes and a obtained when Meckel syndrome is suspected, to exclude chromosomal disorders. If
viable fetus who required cervical ripening at > 40 weeks` gestation. 52 patients meet- the diagnosis is made before viability, termination can be offered.
ing the criteria between 1998 and 2000 received Prostin and 49 meeting the criteria
between 2000 and 2002 received Propess. Results: The Prostin and Propess groups
were similar in patient characteristics and delivery outcome. Cervical ripening within
24 h was achieved in the Propess group in 75% as compared to 49% in the Prostin
P-029
group. The application-delivery-interval was shorter in the Propess group compared to
the Prostin group (median 17 hours, range 2 to 147 hours versus median 33 hours,
range 6 to 257 hours, P <0.05). A smaller number of applications was observed in the A RARE CAUSE OF SEVERE DYSPAREUNIA - POST OSTEOMALACIC
Propess group (1 versus 1.5, P <0.00). Both methods proved to be safe in cervical prim- CONTRACTED PELVIC OUTLET
ing. Although caesarean section rate in the Propess group was higher (25% vs. 10%),
the differences in mode of delivery were not significant. Conclusion: Both C. Dane1, B. Dane1, C. Kural2, M. Erginbaß2, A. ‚etin2
prostaglandin E2 agents are safe and effective in achieving cervical ripening; however
the vaginal insert demonstrated a shorter application-delivery interval. The hospital 1
Haseki E¤itim ve Araflt›rma Hastanesi Kad›n Hastal›klar› ve Do¤um
stay was consequently shorter, contributing to cost effectiveness.
Klini¤i, ‹stanbul
2
Haseki E¤itim ve Araflt›rma Hastanesi Ortopedi ve Travmatoloji Klini¤i,
‹stanbul
P-027
Introduction: In this case, the patient was presented with the diagnosis of pelvic
EKTOP‹K GEBEL‹⁄‹N ERKEN TANISINDA SERUM KREAT‹N K‹NAZ, deformity, which is rarely seen due to osteomalacia. Case Report: In this case
ÖSTRAD‹OL VE PROGESTERONUN DE⁄ER‹ report, we presented a 28 years old applied with the complaint of severe dyspareu-
nia with the obstruction at the pelvic outlet. A three dimensional CT scan reported
multiple pseudo fractures on the bilateral ischion arms and related deformities.
F. MimaroÛlu, C. Dane, B. Dane, E. Kalli, A. ‚etin Bilateral ischion arm resection was performed considering an obstruction at the
pelvic outlet. After one year, when seen at her last control, she had become preg-
Haseki E¤itim ve Araflt›rma Hastanesi, Kad›n Hastal›klar› ve Do¤um nant with normal coition way. Discussion: Osteomalacia related to the deficiency
Klini¤i, ‹stanbul of vitamin D depends on many factors. In our 28 years old female patient the main
factor was established as frequent periods of pregnancy accompanied with failure
Amaç: Ektopik gebelik ile normal intrauterin gebeliklerdeki kreatin kinaz (CK), in intake. During pregnancy the rate of osteomalacia is as high as %1-10 in China
östradiol (E2) ve progestron (PGN) de¤erlerinin karfl›laflt›r›larak, ektopik gebeli¤in and as %1-3 in India. In literature, only a few reports about pelvic outlet obstruc-
erken tan›s›nda yerinin araflt›r›lmas›. Gereç ve Yöntem: Çal›flmaya laparotomi ile tion related to osteomalacia were established only one case but was treated with sur-
tan› konulmufl 22 ektopik gebelik hastas› ve son âdet tarihlerine göre 8 hafta ve al- gical resection was found. Since the other cases could let a sexual intercourse, only
t›nda olan 22 normal gebelik vakas› al›nm›flt›r. CK ve E2, PGN düzeylerinin ekto- the deliveries have been performed with cesarean section.
117
P-030 P-032
PRIMARY RETROPERITONEAL LIPOSARCOMA BEN‹GN VEYA MAL‹GN ADNEKS‹YEL TÜMÖRLER‹N AYRIMINDA

ULTRASONOGRAF‹K GÖRÜNTÜLEME, RENKL‹ DOPPLER
C. Dane1, B. Dane1, S. ArÝkan2, A. ‚etin2 SONOGRAF‹ VE B‹LG‹SAYARLI TOMOGRAF‹N‹N YER‹
1
Haseki E¤itim ve Araflt›rma Hastanesi Kad›n Hastal›klar› ve Do¤um
D. …ztŸrk, C. Dane, B. Dane, A. ‚etin
Klini¤i, ‹stanbul
2
Haseki E¤itim ve Araflt›rma Hastanesi Genel Cerrahi Klini¤i, ‹stanbul Haseki E¤itim ve Araflt›rma Hastanesi Kad›n Hastal›klar› ve Do¤um Klini¤i,
‹stanbul
Introduction: Retroperitoneal liposarcomas are usually slow to be recognized and
frequently may reach a very large size. Liposarcomas that extend retroperitoneally Amaç: Adneksiyel kitlelerin tan›s›nda bu üç yöntemin birbirlerine olan üstünlükle-
into the female pelvis represent a potential pitfall for gynecologists, who can mis- rini karfl›laflt›rmak ve postoperatif histopatolojik tan›lar› aras›ndaki iliflkiyi irdele-
diagnose them as adnexal masses. Case report: A 60-year-old woman presented mek. Gereç ve Yöntem: Adneksiyel kitle nedeniyle ameliyat edilecek 50 hastaya
with rapid abdominal enlargement. A computed tomography scan revealed a bulky ultrasonografi (USG), renkli doppler sonografi (RDS) ve bilgisayarl› tomografi
homogeneously enhancing retroperitoneal mass. At laparotomy, a giant lipomatous (BT) uyguland›. Adneksiyel kitleler kistik, kompleks ve solid görünüm aç›s›ndan
tumor that filled completely the abdominal cavity was found. The uterus and adnex- de¤erlendirildi. Vaskülarizasyon saptanan olgularda P.I. ve R.I. de¤erleri hesaplan-
ea appeared atrofic. The mass was near totally excised. The injury of colonic serosa d›. Postoperatif histopatolojik tan›lar ile üç görüntüleme bulgular› karfl›laflt›r›ld›.
was repaired. The surgical specimen weighed 7400 g and measured 35x20x7.5 cm. Bulgular: Basit kistlerin %100’ünün benign, kompleks kistlerin %60’›n›n malign
The histopathological diagnosis was dedifferentiated liposarcoma. The postopera- histopatolojiye sahip oldu¤u görüldü. Vaskülarizasyon saptanamayan olgular›n tü-
tive third day relaparotomy was performed because of the fecaloid material coming münün histopatolojisinin benign oldu¤u görüldü. Benign kitlelerin R.I. de¤erleri
from drains. At laparotomy, multiple colonic perforations were determined. The 0.68 ± 0.16, P.I. de¤erleri 1.41 ± 0.69, malign kitlelerin R.I. de¤erleri 0.48 ± 0.17
computed tomography scan performed 5 months after surgery showed a normal ve P.I. de¤erleri 0.78 ± 0.46 olarak hesapland›. Aralar›ndaki fark istatistiksel olarak
appearance. Discussion: When major tumor volume cannot be removed, inappro- anlaml› bulundu. R.I. için eflik de¤er 0.40 al›nd›¤›nda USG’nin, RDS’nin, BT’nin
priate resection of other vital structures should be avoided. The chemotherapy for sensitivitesi s›ras›yla %85, %38 ve %92 bulunurken spesifisitesi %89, %95 ve %81
retroperitoneal liposarcomas seems to be ineffective, and further studies are neces- saptanm›flt›r. Sonuçlar: Konvansiyonel ultrasonografi ve renkli doppler kombinas-
sary to clarify the role of radiotherapy for local control. Therefore, in retroperitoneal yonu en yüksek sensitivite ve spesifisiteye sahip olarak bulundu. Bu kombinasyona
liposarcoma an aggressive surgical management remains mandatory. tomografinin eklenmesinin sensitivite ve spesifisitede herhangi bir yükselmeye se-
bep olmad›¤›, bu üçlü kombinasyonun pelvik kitle teflhisinde do¤ru tan› oran›na ek
bir katk› sa¤lamayaca¤› anlafl›ld›.
P-031
ISOLATED TORSION OF THE FALLOPIAN TUBE: A CASE REPORT P-033
B. Dane, C. Dane, M. Semiz, A. ‚etin KOLLUM BOYU VE ‹NTERNAL OS AÇIKLI⁄ININ ABORTUSU

BEL‹RLEMEDEK‹ YER‹
Haseki E¤itim ve Araflt›rma Hastanesi Kad›n Hastal›klar› ve Do¤um Klini¤i,
‹stanbul Ü. Temiz, C. Dane, B. Dane, A. ‚etin
Introduction: Torsion of the fallopian tube is an infrequent but significant cause of Haseki E¤itim ve Araflt›rma Hastanesi Kad›n Hastal›klar› ve Do¤um Klini¤i,
acute lower abdominal pain in adolescent females that is difficult to recognize pre- ‹stanbul
operatively, although prompt diagnosis and timely surgical treatment are vital to
salvage the oviduct. Case report: A 17 years old virgin premenarcheal girl was
Amaç: Gebeli¤in 10. ve 12. haftas›nda transvaginal ultrasonografi ile ölçülen kol-
reported to surgery for a colicky right iliac fossa pain. Two months ago the patient
lum boyu ve internal os aç›kl›¤›n›n abortusu belirlemedeki de¤erinin araflt›r›lmas›-
had an appendectomy. Ultrasound scan showed normal ovaries. She was given
d›r. Gereç ve Yöntemler: Prospektif, randomize olarak 10. gebelik haftas›n›n alt›n-
spasmolitics and put on bed rest at home. After a transient improvement the pain
da olan 59 hasta üzerinde çal›flma planland›. Ultrasonografi ile orifisyum internum
worsened the week after and the patient vomited. At laparotomy, the right fallopi-
aç›kl›¤› ve serviks uzunlu¤u ölçüldü. Hastalar abortus ve erken do¤um tehdidi yö-
an tube was twisted completely, distended with blood, and necrotic, with a small
nünden izlendi. Bulgular: Takip edilen 59 hastan›n üç tanesinde 13. haftada, iki
fimbrial cyst. It was too late to salvage the tube and surgery ended up with excision.
hastada 14. haftada ve bir hastada 16. haftada abortus gerçekleflti. Dört tanesinde er-
Discussion: Isolated fallopian tube torsion is a rare clinical pathology. The mecha-
ken do¤um tehdidi geliflip, bu hastalar›n 52 tanesi terme ulaflt›. Gebeli¤in 12. hafta-
nism that leads to an isolated tube torsion is unknown, but previous tube ligation,
s›nda ortalama servikal uzunluk erken do¤um tehdidi geliflmeyenlerde 4.4 ± 5.5 cm,
abnormal tubal peristalsis are suspected. Isolated torsion of the fallopian tube
erken do¤um tehdidi geliflen olgularda 3.99 ± 5.5 cm olarak bulundu. Bu iki grup
should be considered in the female patient with acute lower abdominal and pelvic
aras›nda istatistiksel olarak anlaml› fark bulunmad›. Abortus geliflen hastalarda ser-
pain. Prompt surgical intervention may allow for definitive treatment before irre-
viks uzunluklar› di¤er olgularla karfl›laflt›r›ld›¤›nda anlaml› olarak k›sa saptand›. S›-
versible damage is done.
n›r de¤er olarak 40 mm al›nd›¤›nda sensitivite %66, spesifisite %75, PPD %23 ve
NPD %95 olarak bulundu. Gebeli¤in 12. haftas›nda ölçülen orifisyum internum
aç›kl›¤›n›n erken do¤um tehdidi geliflenlerle, abortus yapanlarda; terme kadar ula-
flanlardan farkl›l›k saptanmad›. Sonuçlar: Kollum boyunun k›sal›¤›n›n abortusla
sonuçlanacak olgular›n erken tan›s›nda yeri oldu¤u ortaya ç›km›flt›r. Fakat internal
os aç›kl›¤›n›n abortusla sonuçlanacak hastalar› önceden belirlemede yeri olmad›¤›
bulunmufltur.
118
P-034 P-036
KOLON ENDOMETR‹OMASI VE M‹YOMA UTER‹: OLGU SUNUMU INTRAVASATION OF OIL-BASE CONTRAST MEDIUM AS A
COMPLICATION OF HYSTEROSALPINGOGRAPHY
C. Dane, B. Dane, M. Erginbaß, A. ‚etin
S. …zkan, S. …zeren, A. ‚orak•Ý, E. ‚alÝßkan, J. Dal, Ü. YŸcesoy
Haseki E¤itim ve Araflt›rma Hastanesi Kad›n Hastal›klar› ve Do¤um Klini¤i,
‹stanbul Kocaeli Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um Klini¤i,
‹zmit
Girifl: Gastrointestinal sistem endometriozisin görülme s›kl›¤›, âdet gören kad›nlar-
da %3 ile %34 aras›nda de¤iflmektedir. En s›k rekto-sigmoid bölgede rastlanmakta- Hysterosalpingography (HSG) appears to be the basic diagnostic method to assess
d›r. Bu nedenle yap›lan kolon rezeksiyonu %1’den az görülmektedir. Bu vakada the reproductive tract of infertile females. It is frequently performed as an initial
uterus miyomatozus tan›s›yla ameliyat edilen ve rastlant›sal olarak bulunan kolon less invasive procedure when compared with laparoscopy or hysteroscopy. An oil-
endometriomas› sunulmufltur. Olgu sunumu: Klini¤imize 16 y›ll›k primer inferti- base or water soluble medium may be preferred to visualise the tract by this popu-
lite ön tan›s›yla baflvuran 34 yafl›ndaki hastada miyoma uteri saptand›. Çekilen his- lar radiographic technique. A rare complication with HSG is either lymhatic and/or
terosalpingografisinde tubalardan geçifl olmad›¤› görüldü. Yap›lan ameliyatta ute- venous intravasation with a risk of subsequent embolization. Proper timing of the
rusun büyüklükleri 2 ile 8 cm aras›nda de¤iflen, yaklafl›k 15 adet miyom nüveleriy- procedure and precise control of instillation pressure may provide extremely low
le dolu oldu¤u görüldü. Miyomektomi tamamland›ktan sonra sigmoid kolonda incidence of this complication. We report an experience of intravasation during
4x3x3 cm büyüklü¤ünde kitle saptand›. Sigmoid uç kolostomi ve Hartmann prose- HSG with oil-base medium while evaluating a 24 year old primary infertile patient
dürü uyguland›. Kitlenin frozen sonucu ‘endometriozis’ geldi. Histopatolojik ince- that was fortunately associated with no adverse sequelae.
lenmesinde mukozadan, serozaya kadar uzanan endometriozis odaklar› ve kas hi-
perplazisi saptand›. Hastaya postoperatif GnRH- analogu (Gosereline) 6 ay süreyle
verildi. Bu süre sonunda kolostomisi kapat›lan hastan›n halen problemi bulunma-
maktad›r. Tart›flma: Gastrointestinal sistem endometriozisinde segmental kolekto- P-037
mi oran› %0.1 ile %0.7 aras›nda de¤iflmektedir. Mukozal invazyon endometriozis-
te oldukça nadir olarak görülmektedir. Endometriozis, barsak duvar›nda fliddetli
FETAL SUPRAVENTRICULAR TACHYCARDIA ASSOCIATED WITH
fibrozise neden oldu¤u için barsak tümörlerinden makroskopik olarak anlafl›lama-
yabilir. ‹ntestinal sarkom, lenfoma ve karsinoid tümörlerde de mukoza tutulumu ol- HYDROPS: MANAGEMENT WITH FLECAINIDE
mad›¤›ndan endometriozisten ay›rt edilemez. Bu nedenle operasyon öncesinde ma-
ligniteden ay›rt edilemeyece¤i için rezeksiyon seçilecek yol olmal›d›r. S. …zkan1, A. ‚orak•Ý1, S. …zeren1, H. Ermiß2, E. ‚alÝßkan2,
N. HŸseyinoÛlu2, Ü. YŸcesoy2
1
Kocaeli Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve
P-035
Do¤um Klini¤i, ‹zmit
2
‹stanbul Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve
PREDICTION OF ADVERSE PREGNANCY OUTCOME BY ABNORMAL
Do¤um Klini¤i, ‹stanbul
SECOND TRIMESTER MATERNAL SERUM HUMAN CHORIONIC
GONADOTROPIN LEVELS Nonimmune hydrops fetalis is a heterogenous disorder with an incidence of 1 in
1500- 3800 associated with a wide variety of etiologic factors. Overall prognosis is
H. Keskin, F. Turkcapar, S. Kalyoncu, E. Aktepe Keskin, G. YŸcel, poor presenting a perinatal mortality of 50-98% absolutely depending on the under-
N. DanÝßman, T. Mungan lying fetal pathology. A 32 years old pregnant woman at 22 weeks of gestation was
diagnosed of a fetus with a significant pleural effusion and ascites. Supraventricular
Zekai Tahir Burak Women’s Health Education and Research Hospital, tachycardia diagnosed by M- mode echocardiography as the cause of fetal hydrops
was treated with Flecainide administration succesfully. We present our case with a
Ankara
review of literature. Key Words: Nonimmune, hydrops, fetalis, antiarrhytmic, ther-
apy
Aim: To investigate the relationship between adverse pregnancy outcomes and
unexplained elevations of midtrimester maternal serum human chorionic
gonadotropin (hCG) levels. Method: Between August 1999- June 2002, 990 preg-
nant, without chronic hypertension, undergoing between 16-20.weeks’ gestation
triple marker screening were enrolled in the study. 163 (16.5%) women with a hCG
level unexplained higher than 2.5 Multiples of the Median (MoM) were included in
the study group while 827 women with hCG level <2.5 MoM served as controls.
The main pregnancy outcome measures were preterm delivery (<37 weeks),
preterm premature rupture of membranes (PPROM), small for gestational age
(SGA) (≤10 percentile) and hypertensive disorders of pregnancy (pregnancy
induced HT-PIH-, mild preeclampsia, and severe pre-/eclampsia). Sensitivity,
specificity, positive predictive value (PPV), odds ratios (95% confidence interval)
were calculated. Results: Unexplained hCG levels (≥2.5 MoM) were associated
with an increased risk for mild preeclampsia OR:3.0 (1.31-6.88), and severe pre-
/eclampsia OR:4.26 (1.76-10.30) and for SGA OR: 2.16 (1.16-4.04). The sensitivi-
ties and specificities were 34.6% and 85.0% for mild preeclampsia; 43.0% and
85.0% for severe pre-/eclampsia; 29% and 84.2% for SGA groups. PPV were 6.2%,
6.2% and 9.2%, respectively. Women with elevated hCG levels showed not an
increased risk for preterm delivery, PPROM and PIH. In the preterm delivery group
sensitivity was %21.3, specificity 84.0%, PPV 8.0%, in the PPROM group 28.6%,
84.0% and 4.9%, respectively. In the PIH group these values were 28.6%, 85%, and
5.5%, respectively. Conclusion: Abnormal hCG levels in midtrimester appears to
be associated with subsequently developed preeclampsia and SGA.
119
P-038 P-040
ERFOLG DER ASS‹ST‹ERTEN REPRODUKT‹ON (ART): SPLENOSIS PRESENTING WITH ADNEXAL MASS: A CASE REPORT
IST SERUMLEPT‹N E‹N UNABHäNG‹GER PROGNOSEFAKTOR?
M. CeliloÛlu, E. DoÛan, S. KocoÛlu, E. SarÝhan
E. KšseoÛlu, K. Bock, S. Chari, K. Schulz
Dokuz Eylul University Faculty of Medicine Department of Obstetrics and
Philipps-Universität, Klinik für Gynäkologie, gynäkologische Gynecology, ‹zmir
Endokrinologie und Onkologie, Marburg, Deutschland
Abstract: A 21-year-old woman presenting with lower abdominal discomfort, dys-
Fragestellung: Das im Fettgewebe produzierte Serumleptin (SL) spielt nicht nur bei der menorrhoea and pelvic mass had been misdiagnosed as endometriosis. She had
Regulation des Körpergewichts eine zentrale Rolle, sondern ist auch ein Trigger für die post-traumatic splenic rupture and laparatomy history. Pelvic splenosis was diag-
Reifung der Genitalorgane und die Voraussetzung für eine erfolgreiche Reproduktion. nosed at laparatomy. Pelvic mass was removed and the other implants were left.
Ziel dieser Arbeit war die Untersuchung des prognostischen Stellenwertes von SL, Key words: Pelvic splenosis, endometriosis, adnexal mass
Body-Mass-Index und Alter im Hinblick auf die ovarielle Stimulierbarkeit sowie der
Veränderungen des Serumleptinspiegels und des Leptinspiegels der Follikelflüssigkeit
im Rahmen der ART. Material und Methode: Bei der Bestimmung der Leptin-/Östra-
diolkonzentration wurden konventionelle Radioimmunoassays verwendet. Die statistis- P-041
che Datenauswertung wurde mit dem SPSS-Programm durchgeführt. Ergebnisse: Der
Gonadotropinverbrauch zeigt bei Patientinnen über 40 Jahren eine Zunahme; bei WALLACE VE FRYDMAN EMBR‹YO TRANSFER KATETERLER‹N‹N
Adipositas wird zusätzlich eine Abnahme des maximalen Serumöstradiols am KULLANIMI ‹LE 3. VE 5. GÜNDE GERÇEKLEfiT‹R‹LEN EMBR‹YO
Auslösungstag beobachtet. Die Hypophysen-Suppression resultiert in einer Abnahme,
die ovarielle Stimulation verursacht eine Zunahme des SL-Spiegels. Das SL nimmt zwar TRANSFERLER‹N‹N KARfiILAfiTIRMALI DE⁄ERLEND‹R‹LMES‹
während der Stimulation zu, ist aber am Auslösungstag mit dem Serumöstradiol pro
Follikel negativ korreliert. Die Leptinkonzentration in der Follikelflüssigkeit ist niedriger A. Mumcu, B. Urman, K. YakÝn, S. Aksoy, C. Alataß, R. Mercan
als die im Serum. Diskussion: Bei der ART führen ein höheres Alter und Adipositas zu
schlechterer ovarieller Stimulierbarkeit und damit zu schlechteren Ergebnissen. Das SL VKV Amerikan Hastanesi, Üreme Endokrinolojisi ve Yard›mc› Üreme
kann aber derzeit nicht als ein weiterer unabhängiger Prognosefaktor der ovariellen Teknikleri Merkezi, Istanbul
Stimulierbarkeit angesehen werden. Die vermutete Interaktion zwischen dem
Fettgewebe und dem reproduktiven System wird bestätigt. Beim extrem erhöhtem
Amaç: Yard›mc› üreme teknikleri program›nda embriyo transferi için öncelikle yumuflak
Leptinspiegel zeigt sich eine Dysregulation dieses Regelkreises und lässt eine
transfer kateterleri tercih edilmektedir. Farkl› embriyo transfer kateterlerini karfl›laflt›ran
Schwellenwertbeziehung vermuten. Eine ovarielle Produktion des Leptins ist nicht
ve birbiriyle tezat sonuçlar ortaya koyan çok say›da çal›flma mevcuttur. Kateterin çeflidi,
anzunehmen. Somit bleibt das Ovar nur ein rezeptives Organ für die Leptinwirkungen.
ifllemin zorlu¤u, uterin kontraksiyonlar ve ultrasonografi alt›nda transfer gibi pek çok fak-
törün embriyo transferi sonucunu etkiledi¤i düflünülmektedir. Ancak embriyo transferinin
gerçeklefltirildi¤i döneme göre transfer kateterlerinin performans› ile ilgili veri bulunma-
P-039
maktad›r. Bu çal›flman›n amac›, en s›k olarak kullan›lan Wallace and Frydman embriyo
transfer kateterlerinin, 3. ve 5. günde gerçeklefltirilen embriyo transferleri aç›s›ndan per-
EVALUATION OF IMMUNITY AGAINST RUBELLA AMONG formanslar›n›n karfl›laflt›r›lmas›d›r. Gereç ve Yöntem: Retrospektif olarak yap›lan ince-
HIGHSCHOOL GIRLS IN URMIA CITY lemede dört y›l süre içerisinde gerçeklefltirilen toplam 3711 embriyo transferi de¤erlendi-
rilmifltir. Çal›flma grubunda yer alan 3130 hastada 3. günde, 581 hastada ise 5. günde emb-
F. Nanbakhsh, Sh. Salarilak, F. Bouromond, H. Mahaddesi, riyo transferi yap›lm›flt›r. Transferler s›ras›nda, embriyolar katetere yüklenmeden hemen
önce Wallace kateter ile yap›lan denemede kateter rahat geçifl gösterdi¤i taktirde embriyo
M.R. Taravati, F. Bahadori
transferi Wallace kateter ile, aksi taktirde ise Frydman kateter ile gerçeklefltirilmifltir. Has-
talar transfer dönemi ve kateter tipine dört gruba ayr›larak klinik sonuçlar aç›s›ndan kar-
Abstract: Rubella or German measles is a mild contagious disease in non-pregnant women fl›laflt›rma yap›lm›flt›r. Bulgular: Blastokist transferi yap›lan hasta grubunda ortalama ka-
but in pregnant affected mothers possibilities of fetus infection at 12th weeks of gestation is d›n yafl›, infertilite süresi ve elde edilen toplam oosit say›s› aç›s›ndan anlaml› farkl›l›k göz-
80%, at 13-14th weeks of gestation is 54% and by the end of the second trimester is 25%. lenmektedir. Yine bu grupta daha az say›da embriyo transfer edildi¤i saptanm›flt›r. Üçün-
At present no vaccination against rubella is being envisaged by the National Immunization cü günde transfer yap›lan grupta kateter tipleri aras›nda fark gözlenmemektedir
programme in Iran. Therefore screening young girls at their pre-marriage age is recom- (P=0.049). Buna karfl›n, Frydman kateter ile yap›lan blastokist transferlerinde klinik ge-
mended. Materials and Methods: Five hundred eighty nine highschool girls were selected belik oranlar›n›n anlaml› derecede düflük oldu¤u dikkati çekmifltir (p<0.0001). Sonuçlar:
randomly from Urmia’s highschool and then a questionnaire was filled up. Blood samples 3. gün embriyo transferinde her iki kateter ile elde edilen sonuçlar aras›nda anlaml› fark
were obtained, for anti-rubella IgGwas testing by using ELIZA. From 589 samples 437 bulunmamas›na karfl›n, 5. gün transferlerinde Frydman kateter ile elde edilen sonuçlar›n
studetns (74.2%) showed positive results, 89 students (15.1%) had negative results and 63 düflüklü¤ü dikkat çekmektedir. Bu sonuç, blastkist transferinin avantajlar› içerisinde öne
students (10.69%) had previously been vaccinated against rubella. Discussion: The results sürülen “uterine silencing” teorisi ile de çeliflmektedir. Bu durumun aç›klamas› kolay ol-
were indicating the screening of the girls before their marriage is necessary and vaccination mamakla birlikte baz› sebepler öne sürülebilir. Birincisi bu dönemde servikal mukus ve-
against rubella should become a part of the National immunization program. Key words: ya uterin kontraksiyon patternindeki de¤iflikliklerle birlikte, endometrium katetere ba¤l›
Rubella, immunity, ELIZA, highschool girls travmaya karfl› daha hassas olabilir. Di¤er bir düflünce ise, blastokist transferlerinde imp-
lantasyon dönemine çok yak›n bir zamanda transferin gerçekleflmesi endometriuma, rijid
Tablo: (P-041)
bir kateterin oluflturdu¤u travman›n tamiri için yeterli zaman b›rakmayabilir.
Wallace-3 Frydman-3 Wallace-5 Frydman-5
Ortalama kadÝn 32.6 31.6 31.5 30.4
yaßÝ (yÝl)
Ünfertilite 8.7 8.3 7.5 7.4
sŸresi (yÝl)
StimŸlasyon 10.36 10.19 10.6 10.4
sÝrasÝ (gŸn)
Oosit sayÝsÝ 10.35 10.92 15.5 16.7
Transfer edilen 3.5 3.6 2.8 2.9
embriyo sayÝsÝ
Embriyo skoru 9.5 9.8 - -
Klinik gebelik oranÝ 41.1% 39.2% 44.7% 33.8%
120
P-042 P-044
DOES THE DIFFICULTY OF EMBRYO TRANSFER AFFECT IN VITRO MAMMOGRAPHIC DENSITY CHANGES IN USERS OF DIFFERENT
FERTILIZATION OUTCOME POSTMENOPAUSAL HORMONE REPLACEMENT THERAPY (HRT):
TWO YEARS’ EXPERIENCE IN AN UNIVERSITY MENOPAUSE CLINIC
K. SofuoÛlu, N. Delikara, G. YÝldÝrÝm, E. Fu•ucu
H. Hassa, H. Mete TanÝr, A. YÝldÝrÝm, A. Ak•ay
Zeynep Kamil Hastanesi- Üremeye Yard›m Merkezi, ‹stanbul
Osmangazi University School of Medicine, Department of Obstetrics and
Objective: We aimed to assess the relation between the degree of embryo transfer Gynecology, Eskisehir
(ET) difficulty and success of in vitro fertilization (IVF) program. Materials and
Methods: Three hundred and two embryo transfer procedures were performed
Objective: To evaluate the breast density changes among current HRT users, non-users
between January 2000 and January 2002. Embryo transfer was classified as easy
and ex-users, respectively. Materials and Methods: Between August 2000 and March
(n:220), intermediate (n:34) or difficult (n:48). The transfer was considered difficult
2002, 522 postmenopausal women including current HRT users (n=162), past users (n=80)
if there was a need to use mallable catheter, if sounding or cervical dilatation was
and non-users (n=156) were enrolled in this retrospective study. Mammographic changes
needed or if blood was found outside of the catheter. The transfer was considered
was assessed among 3 different groups: 1- oral conjugated equine estrogen or 17-beta
intermediate if tenaculum was used or if the catheter met great resistance. Multiple
estradiol, E + medroxyprogesterone acetate/ noretindrone acetate, P, that was further sub-
logistic regression analysis was used for statistical consideration. Result(s): Easy
divided into continous cyclic and continous combined regimens. 2- transdermal E+P patch
and intermediate transfers resulted in a 1.41 fold higher pregnancy rate than diffi-
and 3- Tibolone group (2.5 mg/day). Any focal, multifocal or diffuse ductal density
cult transfer (p=0.04, 95 % Confidence Interval:1.00 – 1.98). Conclusion(s): This
increases, microcalcifications, were assigned as positive mammography findings, Results:
study shows that the degree of difficulty of embryo transfer has great importance
A total number of 78 women revealed pathologic mammographic findings (19%) includ-
for the success of IVF-ET treatment. Physicians should make all efforts to avoid
ing 21 women in non-HRT user; 26 women in ex-HRT users and 31 women in current
difficult embryo transfers. Key words: Embryo transfer, difficulty, in vitro fertil-
HRT users. Among ex-HRT users, oral E+P or E only regimens (61.5%) had the highest
ization, pregnancy rate.
breast density increase compared to E+P patch (15.4%) and tibolone group (23.1%).
Among oral regimens, those cases with E+P use (62.5%) had higher mamographic densi-
ty increase compared to those with only E regimen (37.5%, p=0.03). Among current HRT
users, 61.3% of cases with positive mammographic findings were on oral HRT, among
P-043 whom majority were using E+P combinations. Continous combined E+P regimen, in this
group, had higher number of cases with breast density increase (64.3%) compared to cyclic
HELLP SENDROMUNDA KLAS‹F‹KASYONA GÖRE BÖBREK combined cases (35.7%, p=0.02). Oral E only group had lower percentage of pathologic
FONKS‹YONLARININ KARfiILAfiTIRILMASI mammographic changes in comparison with oral E+P regimen (26.3% vs 73.7%, p<0.01).
Among current HRT users, tibolone users revealed lower percentage of pathologic breast
changes compared to oral E+P or E users (29.1 vs 61.3, p<0.01). Current E+P transdermal
A. Tezcan Germen, F. Burak, R. Atmaca, N. Kulak, A. KafkaslÝ
patch users (9.6%) had the lowest percentage of pathologic breast change (9.6%) compared
to two other groups. Conclusion: Based on the results of this retrospective study, one may
‹nönü Ünv. T›p Fak. Kad›n Hastal›klar› ve Do¤um AD, Malatya
conclude that current or ex-HRT users with oral continous combined E+P use are more
likely to result in breast density increase, compared to continous sequential forms.
Girifl: ‹lk kez Weinstein taraf›ndan tariflenen Hellp (hemoliz, karaci¤er enzimlerin- Tibolone, compared to continous combined E+P regimens, has shown lower percentage of
de yükselme, trombositopeni) sendromunda maternal-perinatal mortalite ve morbi- positive mammographic findings. Interestingly, in both ex- and current HRT users, lowest
dite artm›flt›r. Mortalitenin baflta gelen nedenleri; santral sinir sistemi patolojileri ve percentage of breast density increase among transdermal E+P patch users has called our
intrarenal vazospazm sonucu geliflen böbrek fonksiyonlar›nda bozulmad›r. Bu ça- attention.
l›flman›n amac› Hellp sendromlu hastalar› Missisipi klasifikasyonuna göre klasifiye
ederek hangi grupta böbrek fonksiyonlar›n›n daha fazla bozulaca¤›n› önceden belir-
leyebilmektir. Yöntem: Hellp sendromu tan›s› alm›fl 57 hasta Missisipi klasifikas-
yonuna göre üç gruba ayr›ld›. Tüm hastalar›n postpartum ilk 48 saatte kreatin kli- P-045
rensleri ve 24 saatlik idrar protein miktarlar› hesapland›. Her üç gruptaki olgular›n
böbrek fonksiyonlar› karfl›laflt›r›ld›. ‹statistiksel de¤erlendirme tek yönlü varyans
ART‹F‹SYEL AMN‹OTOM‹N‹N DO⁄UM EYLEM‹NE ETK‹S‹
analizi ile yap›ld›. Bulgular: 57 Hellp sendromlu hastadan 15 tanesi class I, 25 ta-
nesi class II ve 17 tanesi class III olarak s›n›fland›r›ld›. Kreatin klirensi ve total pro-
tein de¤erleri aç›s›ndan anlaml› fark sadece class I ve class III aras›nda bulundu. G. Ateßer,1, N. NurluoÛlu2, R. …zyurt2, …. Calay3, …. AkbayÝr3,
Class I’de class II ve özellikle class III’e göre kreatin klirensinde azalma, total pro- C. Ark3
tein miktar›nda artma saptand›. Sonuç: Hellp sendromu fliddetli preeklamptik her
1
100 hastan›n beflinde izlenmektedir. Bu hastalar›n Missisipi klasifikasyonuna göre SSK. ‹stanbul E¤itim Hastanesi, ‹stanbul
s›n›fland›r›lmas›n›n prognostik önemi vard›r ve en yüksek ölüm oran›n›n görüldü- 2
SSK Yenimahalle Do¤umevi, ‹stanbul
¤ü class I grubundaki hastalar›n böbrek fonksiyonunda daha belirgin bozulman›n 3
Cerrahpafla T›p Fakültesi, Bioistatistik Kürsüsü, ‹stanbul
oldu¤u sonucuna var›lm›flt›r.
Amaç: Artifisyel amniotomi zaman›, servikse ait bulgular ve oksitosinenfüzyonunun do-

¤um eylemi, do¤umun tipi, pospartum kanama, atefl, hastanede kal›fl süresi, FHR de¤i-
fliklikleri, mekonyum varl›¤›, 1 ve 5. dakika apgar skoru, yo¤un bak›m gereksinimi gibi
bulgulara etkisi araflt›r›lm›flt›r. Gereç ve Yöntem: Yafl ortalamas› 25+4,64, pariteleri
1,69+1,08 olan 85 gebede çal›flma yap›ld›. Yüksek risk tafl›mayan, fetusun baflla prezan-
te oldu¤u gebelerde çal›fl›ld›. Servikal aç›kl›k 3 cm aflt›¤›nda artifiyel amniotomi yap›ld›.
Bu hastalardan 54’üne oksitosin enfüzyonu da eklendi. Amnitomi sonras› FHR de¤iflik-
likleri, mekonyum tespiti, servikal aç›kl›k, tam aç›k oluncaya kadar geçen süre, tam aç›k
olufltan do¤uma kadar geçen süre, do¤umun tipi, postpartum bulgular ve yeni do¤an›n1
ve 5 inci dakika apgar skorlar›, restitüsyon gereksinimi belirlendi. Do¤um sonras› atefl,
enfeksiyon ve kanama bulgular› ve hastanede kal›fl süreleri saptand›. Bulgular Student?s
t ve X2 testleriyle de¤erlendirildi. Bulgular ve Sonuç: Artifisyel amnitomi s›ras›ndaki
servikal aç›kl›kla amnitomiden tam aç›k oluncaya kadar geçen süre, toplam travay süre-
si ve müdahaleli do¤um gereksinimi aras›nda tersine anlaml› bir iliflki gözlemlendi
(p<0.05). Servikal efesman ve seviye travay süresini de¤ifltirmiyordu. Oksitosin kullan›-
m› sonucu etkilemiyordu. Di¤er parametrelerle anlaml› bir iliflki gözlenmedi.
121
P-046 P-049
RECURRENT ECHINOCOCCAL DISEASE OF LIVER IN PREGNANCY: PRIMARY PELVIC HYDATID CYST IN A PATIENT WITH PREVIOUS
A CASE REPORT TOTAL ABDOMINAL HYSTERECTOMY AND BILATERAL
SALPINGO-OOPHORECTOMY
F. Dede, H. Dede, H. Arslanpen•e, M. Gšk•Ÿ, A. Haberal
F. Dede, M. Altay, M. Kocak, N. …ztŸrk, B. Dilbaz
SSK Ankara Maternity and Women’s Health Teaching Hospital, Ankara
SSK Ankara Maternity and Women’s Health Teaching Hospital, Ankara
The authors report a case of recurrent hepatic hydatid disease during each of three
consecutive pregnancies. A multiparous woman was found to have hepatic Primary pelvic hydatid disease is a rare condition presenting with various symptoms.
echinococcal cysts in the forty-second week of pregnancy. Her medical history We report a case of primary pelvic hydatid disease in a patient whose uterus and
revealed that she had hepatic hydatid disease during her previous pregnancies. ovaries were removed surgically. Total excision of the cyst was performed by opera-
Misoprostol was used for labor induction and after the delivery the patient was man- tive laparoscopy. Postoperative period was uneventful and the patient was treated with
aged percutaneously. Recurrence, significance and treatment options of this rare high doses of albendazole. Follow-up radiologic and sonographic investigation showed
echinococcal disease in pregnancy are also discussed. complete resolution, with no other diseased site. Hydatid disease should be considered
in the differential diagnosis of pelvic masses especially in the endemic regions.
P-047
P-050
IMPETIGO HERPETIFORMIS UNRESPONSIVE TO THERAPY
CA 125 YÜKSEKL‹⁄‹ ‹LE SEYREDEN ME‹GS’ SENDROMU:
H. Arslanpen•e, F. Dede, M. Gšk•Ÿ, O. Gelißen VAKA TAKD‹M‹ VE L‹TERATÜRÜN GÖZDEN GEÇ‹R‹LMES‹
SSK Ankara Maternity and Women’s Health Teaching Hospital, Ankara F. Atalay1, M. Atasever1, S. Demir2, J. Metindir1, S. AdanalÝ1
Impetigo herpetiformis is a rare pustular disorder affecting mainly pregnant women. 1

SB Ankara Onkoloji Hastanesi Jinekoloji Klini¤i, Ankara
We report a 16-year-old adolescent primigravida, who developed impetigo herpeti- 2
SB Ankara Onkoloji Hastanesi Patoloji Lab., Ankara
formis at 27 weeks gestation. She had pustular eruptions covering her whole body,
except palmoplantar and scalp regions with severe pruritus and pain. After negative
response to attempts of treatment with systemic steroids, IV fluids and antibiotics, Amaç: Benign over tümörü, asit ve plevral efüzyonun birarada olmas›yla tan›mlanan Me-
treatment was switched to cyclosporine, but no therapeutic effect could be achieved. igs’ sendromu over kanserini taklit etmesi nedeniyle önemli bir klinik tablodur. Kitlenin
Because of the deteriorating condition of the patient, early delivery decision was cerrahi olarak ç›kar›lmas›yla tüm bulgular normale döner. Fibroma, asit, plevral efüzyon
made. Her symptoms resolved after delivery and, at 20th postpartum day, her skin ve yüksek Ca 125 seviyeleriyle seyreden iki Meigs’ sendromu vakas›n› sunarak bu konu-
lesions were completely resolved. daki güncel literatürü gözden geçirmeyi amaçlad›k. Vaka 1. Elli sekiz yafl›nda postmeno-
pozal hasta pelvik kitle, asit ve plevral efüzyonla baflvurdu. Ca 125 137 IU/ml, pelvik ult-
rasonografide sa¤ over kökenli semisolid pelvisi dolduran kitle tespit edildi. Total abdo-
minal histerektomi+ bilateral salpingoooferektomi (TAH+BSO)+ omentektomi yap›ld›, 2
P-048 litre asit boflalt›ld›. Histopatolojik tan› fibrotekoma olarak rapor edildi. Vaka 2. Postme-
nopozal 65 yafl›nda hasta, kilo kayb›, akut asit oluflumu ve sa¤ plevral efüzyonla baflvur-
du. Ca 125’i 500 IU/ml’nin üzerinde ve abdominopelvik tomografide pelvisi dolduran 20
TANATOFOR‹K D‹SPLAZ‹N‹N SONOGRAF‹K TANISI
cm çap›nda kitle ve masif asit tespit edildi.TAH+BSO + omentektomi yap›ld›, 4.5 litre asit
boflalt›ld›. Histopatolojik tan› fibrom olarak rapor edildi. Postoperatif tüm bulgular gerile-
F. Dede, H. Arslanpen•e, M. Gšk•Ÿ, K. Altunay, O. Gelißen di.Ca 125 normal seviyeye indi. Sonuç: Over tümörlerinde preoperatif görüntüleme, tü-
mör mark›rlar› ve peritoneal sitoloji ile benign malign ay›r›m› kesin olarak yap›lamad›¤›
SSK Ankara Do¤umevi ve Kad›n Hastal›klar› E¤itim Hastanesi, Ankara için pelvik kitle, asit, plevral efüzyon ve yüksek Ca 125 seviyeleri ile baflvuran hastada
kemoterapi planlamadan önce tan› cerrahi ve histopatolojik olarak teyid edilmelidir.
Amaç: Nadir görülen ve ölümcül seyirli bir iskelet displazisi olan tanatoforik disp-
lazinin, 23. gebelik haftas›ndaki bir olguda ultrasonografik tan›s›n› sunmak. Olgu
sunumu: 23. gebelik haftas›nda prenatal ultrasonografi ile polihidramnios, ekstre-
mitelerde k›sal›k, dar toraks kafesi, femurlarda ciddi bombeleflme ve normal kafa-
tas› görünümü ile tan› konulan Tip I tanatoforik displazi (TD I) olgusu, prognoz
hakk›nda aile bilgilendirildikten sonra, intravajinal misoprostol uygulanarak termi-
ne edildi. Postpartum radyolojik ve morfolojik incelemeler ile tan› konfirme edildi.
Sonuç: Tanatoforik displazi prenatal ultrasonografi ile tan› konabilen, ölümcül se-
yirli bir iskelet sistemi displazisidir. ‹ki farkl› alt formu vard›r: k›sa, bombeleflmifl
femur tip I’de gözlenirken, yonca yapra¤› kafatas› ve düz femur tip II’de izlenmek-
tedir. Son y›llarda fibroblast büyüme faktörü reseptörü 3 (FGFR-3) gen mutasyonu
her iki alt tipte de tan›mlanm›fl ve tanatoforik displazi, genetik olarak homojen bir
iskelet displazisi olarak kabul edilmifltir. Anahtar kelimeler: Tanatoforik displazi,
ultrasonografi, prenatal tan›.
122
P-051 P-053
A RETROSPECTIVE ANALYSIS OF INTRAUTERINE FETAL DEMISE LAPAROSCOPIC SURGERY IN GYNECOLOGY: A RETROSPECTIVE

CASES AND ASSOCIATED RISK FACTORS IN A TERTIARY HOSPITAL ANALYSIS OF 395 PATIENTS WITH DIAGNOSTIC AND OPERATIVE
PROCEDURES
S. …zkan, S. …zeren, A. ‚orak•Ý, E. ‚alÝßkan, E. Coßkun, Ü. YŸcesoy
S. …zkan, S. …zeren, A. ‚orak•Ý, E. ‚alÝßkan, E. Coßkun, Ü. YŸcesoy
Kocaeli University, School of Medicine, Department of Obstetrics and
Gynecology, ‹zmit Kocaeli University, School of Medicine, Department of Obstetrics and
Gynecology, ‹zmit
Objective: To evaluate the clinical predictors of intrauterine fetal death and to elu-
cidate the etiology in order to determine the avoidable factors. Materials and Objective: To evaluate the clinical indications and associated complications of
methods: A retrospective study was conducted on all intrauterine fetal deaths laparoscopic (L/S) procedures in gynecology. Materials and methods: A retro-
occuring at Obstetrics and Gynecology Department of Kocaeli University, Medical spective study was carried on 395 diagnostic and operative laparoscopic cases per-
School from June 1997 to December 2002. We investigated the etiology of fetal formed between August 1997- September 2002 at Kocaeli University School of
deaths after the gestational age of 20 weeks, with fetal weight over 500 gr. We Medicine, Department of Obstetrics and Gynecology. Patient characteristics, clini-
described the sociodemographic and reproductive characteristics of mothers and cal indications and associated perioperative complications were reviewed. Results:
aimed to determine any avoidable etiologic factor. Results: There were 3599 deliv- The mean age of the patients was 32.124 and the mean hospital stay was less than
eries during the study period, of which 132 were stillbirths leading to a fetal death 2 days. Of the 395 procedures, 130 cases were diagnostic (32.91%) while operative
rate of 36.67%. The mean age of the patients at diagnosis, the mean gestational age L/S was performed in 265 patients (67.089%). The majority of the cases appeared
and the mean gravida were 27.8, 30.4, 2.590 respectively. Of the 79 multigravida to be primary infertility (n: 121, 30.63%) while secondary infertility cases made
patients 18 cases (22.7%) had a history of previous intrauterine death. The leading 9.367% of the patients with 37 cases. Chronic pelvic pain was the indication in 15
causes of intrauterine fetal demise were preeclampsia in 32 patients (24.24%), fol- cases, primary amenorrhea in 5 cases, secondary amenorrhea in 6 cases and habit-
lowed by neural tube defects in 20 cases (15.13%), abruptio placenta in 19 cases ual abortus in 6 cases. Types of L/S surgery performed were bilateral tubal ligation
(14.39%), Rh incompatibility in 13 cases (9.84%), IUGR, oligohydramnios in 11 (n: 105), adhesiolysis (n: 51), cauterization of endometriosis implants (n:39),
cases (8.33%), eclampsia in 7 cases (5.30%), HELLP Syndrome in 1.51% of the endometriotic cyst extirpation (n:28), cystectomy (n:26), L/S for ectopic pregnancy
cases. No significant antenatal cause could be identified in the majority of cases (n: 16), salpingooophorectomy (n:13). The mean operation time differed in the
(20.45%). Conclusion: We present this retrospective study to better determine the range of 30-120 minutes. Perioperative complications included 11 cases of conver-
factors leading to fetal demise and manage the patients under high risk category sion to laparotomy because of technical problems, dense intraabdominal adhesions,
with close antepartum surveillance so as to reduce these cases which are mostly unsuccesful L/S, incomplete hemostasis after myomectomy, 1 case of subcutaneous
attributable to preventable causes. Key words: Intrauterine, fetal, demise, etiology emphysema, 1 case of allergic reaction to methylene blue, 1 case of trocar site
bleeding, 2 cases of uterine perforation (cases of combined H/S and L/S).
Conclusion: L/S procedures seem to be treatment of choice for a number of indi-
cations in gynecology. Avoiding laparotomy, smaller incisions, less perioperative
P-052 discomfort, minimal tissue trauma, shorter hospital stay are well known advantages.
Nevertheless careful patient selection is mandatory to avoid potentially serious peri-
A RETROSPECTIVE EVALUATION OF 76 DIAGNOSTIC AND operative complications. Key words: Laparoscopy, diagnostic, operative, compli-
OPERATIVE HYSTEROSCOPIC PROCEDURES cation
S. …zkan, A. ‚orak•Ý, S. …zeren, E. ‚alÝßkan, E. Coßkun, Ü. YŸcesoy

P-054
Kocaeli University, School of Medicine, Department of Obstetrics and
Gynecology, ‹zmit MALIGNANT DEGENERATION OF OVARIAN DERMOID CYSTS:
A CLINICOPATHOLOGIC ANALYSIS OF TWO CASES
Objective: The following study analyses the hysteroscopic experience of a tertiary
center in regard to indications, incidence of complications and management of those
in 76 cases. Materials and methods: Seventy-six cases requiring diagnostic and ope- S. …zkan1, Ü. YŸcesoy1, K. YÝldÝz2, A. ‚orak•Ý2, S. …zeren2, E. ‚alÝßkan2
rative hysteroscopic (H/S) interventions between January 2000- December 2002 we-
1
re analysed retrospectively. Results: Of the 76 patients, 56 cases (73.68%) underwent Kocaeli University, School of Medicine, Department of Obstetrics and
operative hysteroscopy, 20 cases (26.31%) were diagnostic. The mean age of the pa- Gynecology, ‹zmit
2
tients was determined to be 41.03. Of the 56 operative procedures 34 cases were per- Kocaeli University, School of Medicine, Department of Pathology, ‹zmit
formed as H/S endometrial polyp resection (60.71%), 11 cases as submucous myoma
resection (19.64%). The number of patients requiring H/S for menometrorhagia and
Malignant transformation of an ovarian dermoid cyst (Mature cystic teratoma) is a
had H/S endometrial ablation was 5 (8.928%), operative H/S incidence for uterine
rare entity with a reported incidence of approximately 1-3%. Any of the constituent
malformation was 5.35%. 3 myoma uteri cases protruding into the vagina were ma-
tisssues of a dermoid cyst has the potential to undergo malignant transformation;
naged by H/S. Of the 20 diagnostic H/S procedures 12 (60%) were performed for in-
however squamous cell carcinoma is the most frequently recognised type. A 35 ye-
fertility, 4 (20%) were for secondary amenorrhea, 3 (15%) were for habitual abortus.
ars old woman was diagnosed of a right ovarian mass which was demonstrated to
We experienced 6 uterine perforations of which 4 cases required laparotomy; in 2 ca-
be a dermoid cyst associated with malignant degeneration of squamous cell carci-
ses bleeding was controlled without surgery. In one case that we suspected of perfo-
noma postoperatively. Additionally, the pathologic examination of another 38 ye-
ration, diagnostic L/S revealed no perforation. We had another case of water intoxi-
ars old female patient diagnosed of left ovarian mass was reported as sebaceous car-
cation in which the patient had to be followed in intensive care unit for 3 days.
cinoma originating from ovarian dermoid cyst (mature cystic teratoma). Upon revi-
Conclusion: Diagnostic and operative H/S procedures seem to be effective and safe
ew of literature and discussion of its origin we present two more cases of malignant
and H/S is becoming a standart method in diagnosis of abnormal uterine bleeding, fer-
degeneration in ovarian dermoid cysts herein. Key words: Ovarian, dermoid, cyst,
tility disorders, intrauterine lesions and uterine malformations. H/S complications can
malignant, degeneration
be further reduced by expert preoperative evaluation, increasing expertise and surgi-
cal skill. Key words: Hysteroscopy, diagnostic, operative, complication
123
P-055 P-057
EVALUATION OF THE SERUM LEVELS OF INSULIN, IGF-1, AND HEPATIC HYDATID CYST DURING PREGNANCY, A CASE REPORT
IGFBP-1 IN PREECLAMPSIA AND ECLAMPSIA
M. PilancÝ, D. …ztekin, …. …ztekin, A. ÜncebÝyÝk, H. CamuzcuoÛlu, Þ. TÝnar
M. Ünge•, H. GŸrsoy, Y. Kumtepe, S. KadanalÝ
Department of Obstetrics and Gynecology, Social Insurance Institution,
Atatürk University Medical Faculty Department of Obstetrics and Aegean Maternity and Women’s Health Teaching Hospital, ‹zmir
Gynecology, Erzurum
Hydatid disease is primarily disease of sheep and cattle. Affected human beings are
Objective: The purpose of this study was to investigate whether the serum concentra- accidental hosts who have ingested foods contaminated with eggs of Echinococcus
tions of insulin, insulin-like growth factor -1 (IGF-1), and insulin-like growth factor granulosus. A 30 year old, 20 week pregnant primigravid woman presented with
binding protein-1 (IGFBP-1) were altered in women with mild preeclampsia, severe right upper quadrant pain. Ultrasound revealed a cystic lesion in the left lobe of the
preeclampsia, and eclampsia. Materials and Methods: In this prospective study, we liver. Conservative management was carried out, no additional therapy was given
investigated 20 mild preeclamptic, 20 severe preeclamptic, and 20 eclamptic patient in and a healty fetus was delivered vaginally at term. No complications occured dur-
third trimester. The control group consisted of 20 healthy pregnant women. Data were ing pregnancy. Surgical management was planned 6 weeks after delivery. Key
analyzed using Kruskal Wallis test. Results: There were no significant differences in words: pregnancy, hydatid disease, liver
demographic factors and serum insulin concentration between study and control groups.
Serum IGF-1 levels in patient with eclampsia were 395.7± 242.8 ng/ml compared with
802.2 ±131.9 in controls, 569.1± 233.1 in mild preeclampsia, 560.6± 279.1 in severe
preeclampsia (p<0,001). The measured values of IGF-1 in mild preeclampsia and severe P-058
preeclampsia were lower compared with control groups (both p<0.01), but there were
no differences between mild and severe preeclamptic patients. Also, serum IGFBP-1 NORMAL INTRAUTERINE PREGNANCY PLUS A CERV‹CO-ISTHMIC
levels in patient with eclampsia were 468.9± 155.4 ng/ml compared with 249.3 ±110.3 ONE EMBEDDED IN A PREVIOUS CAESAREAN SECTION SCAR:
in controls, 263.4± 119.8 in mild preeclampsia, 318.5± 105.4 in severe preeclampsia
A VERY UNUSUAL CASE OF HETEROTOPIC TWIN PREGNANCY
(p<0,001). The serum levels of IGFBP-1 in severe preeclampsia were higher compared
with control groups (p<0.01), but there were no statistical differences between mild TREATED SUCCESFULLY WITH SELECTIVE FETICIDE OF THE
preeclampsia and other groups. Conclusion: When compared with normotensive ABNORMALLY LOCATED ONE
women, IGF-1 was lower, and IGFBP-1 was higher in preeclamptic and eclamptic
patients; these alterations were related to the severity of preeclampsia. These alterations F. YazÝcÝoÛlu1, S. Kelek•i1, S. Turgut2, O. …zyurt2, K. Savan2
can be used as a potential marker for the identification of developing eclampsia.
1
Perinatology Unit, Süleymaniye Maternity Hospital, ‹stanbul
2
Meltem Private Maternity Hospital
P-056
A heterotopic twin pregnancy with one of the fetuses located in upper fundus and
LEIOMYOMA OF THE SMALL INTESTINE PRESENTING AS A PELVIC MASS the other one inside a wedge shaped defect at the uterine incision scar of a previous
casearean section was diagnosed at 6 weeks and 6 days of pregnancy. A selective
feticide of the ectopic fetus was accomplished with intrathoracic injection of 0.5 ml
S. SadÝk, M. PilancÝ, G. UÛurel Aydar, A. KÝzÝlyar, A. …noÛlu, A. GŸler 7.5% KCl by the transvaginal route. Vivid vascularisation of the placental portion
remained easily demonstrable throughout the rest of pregnancy. Placental abrupti-
Department of Obstetrics and Gynecology, Social Insurance Institution, on with rupture of the membranes at 30 weeks and 2 days resulted in an emergency
Aegean Maternity and Women’s Health Teaching Hospital, ‹zmir caesarean section without any complications. The male baby weighing 1530 g at
birth was kept in the NICU for five days to be released in good health thereafter. To
Abstract: We present a challenging case of differential diagnosis of leiomyoma of best of our knowledge this is the first such case ever reported in the English litera-
the small intestine in a patient presented with a pelvic mass. This 41-year-old ture.
woman complained of hypermenorrhea and pelvic pain and diagnosed as pelvic
mass arising from left adnexal region. Laparoscopic surgery was performed as the
first management. As the pelvic mass was recognised that it had been originated
from small intestine, laparotomy was carried out for the resection of the mass from P-059
ileum. Primary reconstruction for ileum was performed. The frozen section
revealed benign result so no other procedure added during laparotomy. Pathologic TETRALOGY OF FALLOT WITH ABSENCE OF THE PULMONARY
comfirmation of the mass revealed leiomyoma of the ileum. Allthough this tumor VALVE : A CASE DETECTED DURING DETAILLED
group is rare, they can appear as pelvic masses and they must be differentiated from
ULTRASONOGRAPHY AT 20 WEEKS GESTATION
gynecologic disease. Preoperative CT and MRI of the abdomen should be helpful
in obtaining the diagnosis. Key words: Leiomyoma, small intestine, pelvic mass.
F. YazÝcÝoÛlu, S. Kelek•i, O. …zyurt, K. Savan
Perinatology Unit,Süleymaniye Maternity Hospital, ‹stanbul
A case of tetralogy of Fallot with absence of the pulmonary valve which is detect-
ed during detailled ultrasonography at 20 weeks of pregnancy is presented. A dilat-
ed horse riding aorta over a large ventricular septal defect, severe tricuspidal regur-
gitation, bidirectional flow and a liasing at the pulmonary valve and huge dilatation
of right and left pulmonary arteries with obstruction of the trachea were the main
findings. A cordocentesis revealed a normal 46 XY karyotype. The fetus was deliv-
ered by caesarean section at term. The neonatal echocardiography and intraopera-
tive diagnosis was the same as the prenatal diagnosis. Unfortunately the baby was
lost following a corrective opreration in the early neonatal period. The mother now
carries her second baby without any detected cardiac malformation at 20 weeks.
124
P-060 P-062
TUBEROUS SCLEROSIS: A CASE REPORT PROSPEKT‹F OLARAK ‹ZLENEN 176 ‹NTRAS‹TOPLAZM‹K SPERM
ENJEKS‹YONU BEBE⁄‹N‹N SONUÇLARI
S. Kelek•i, H. YazÝcÝoÛlu, A. ÞentŸrk
A. Aytoz, …. Turan, G. KÝlÝ•, H. ApaydÝn
Department of Perinatology, Suleymaniye Maternity Hospital for Research
and Training, Istanbul Ac›badem Sa¤l›k Grubu, ‹stanbul
Cardiac tumors are rare, with an incidence among patients of all ages of about 1 in Amaç: Intrasitoplazmik sperm enjeksiyonu (ICSI) sonras› do¤an bebeklerin takibi,
10 000. Rhabdomyomas are the most common benign cardiac neoplasms occurring konjenital malformasyon ve kromozom anomalisi oranlar›n›n belirlenmesi. Gereç ve
in the fetus and neonate, most of them identified within the first year of life. Cardiac Yöntem: Aral›k 1999 ile 2002 tarihleri aras›nda do¤an 176 bebe¤in prospektif ola-
rhabdomyomas are frequently associated with tuberous sclerosis. We present a case rak izlenmesiyle elde edilen veriler incelendi. Gebeli¤e ait bilgiler kad›n do¤um uz-
in which the prenatal diagnosis of primary intracardiac rhabdomyoma was made manlar› ve hastalardan, bebeklerin 2 yafl›na kadarki bilgileri çocuk doktorlar› ve ai-
and which was not clearly associated with tuberous sclerosis. leleriyle yap›lan görüflmelerden sa¤land›. Bebeklere ait karyotip sonuçlar› amniyo-
sentez materyalinden veya do¤um sonras› periferik kan incelemesinden elde edildi.
Fonksiyonel bozukluk ya da cerrahi giriflim gerektiren malformasyonlar majör ola-
rak kabul edildi. Bulgular: Yüz yirmi dört canl› do¤umun %62’si (78/124) tekiz,
P-061 %34’ü (43/124) ikiz, %2’si (3/124) üçüz gebeliklerden gerçekleflti. Do¤umlar›n
%24.2’si (30/124) prematürdü. Düflük ve çok düflük do¤um a¤›rl›kl› bebek oran› s›-
PRETERM EYLEM PRED‹KS‹YONUNDA ‹K‹NC‹ TR‹MESTER ras›yla %34 (59/172) ve %5 (9/172) olarak saptand›. Canl›, ölü do¤umlar ve termi-
TRANSVAJ‹NAL SERV‹KAL UZUNLUK ÖLÇÜMÜ nasyonlar gözönünde bulunduruldu¤unda perinatal mortalite oran› ‰62.5 (11/176)
olarak bulundu. Sekiz canl› do¤umda majör malformasyon (%4), karyotipi bilinen
57 bebekten birinde trizomi 21 saptand›. Sonuçlar: ICSI sonras› do¤an bebeklerin
G. ‚aÛlar, ‚. SoÛuk, L. Keskin, Þ. Kalyoncu, F. Avßar izlendi¤i çal›flmalarla karfl›laflt›r›ld›¤›nda, serimizde, prematürite, düflük ve çok dü-
flük do¤um a¤›rl›kl› bebek oranlar› literatürle benzerlik göstermekteydi ve do¤al yol-
Dr. Zekai Tahir Burak Kad›n Sa¤l›¤› E¤itim ve Araflt›rma Hastanesi, Ankara larla oluflan gebeliklerdekinden yüksekti (P=0.75, P=0.86, P=0.05). Perinatal morta-
lite oran› ise literatürdeki oranlardan yaklafl›k 3 kat yüksekti. Bu sonuç prematür be-
Amaç: Transvaginal ultasonografi (TVUSG) ile 20-24. gebelik haftalar›nda servikal beklerin takip ve tedavisindeki standardizasyon eksikli¤ine ba¤land›. Majör malfor-
uzunluk ölçerek, ikinci trimesterde yap›lan transvaginal servikal uzunluk ölçümünün masyon oran› da literatürde belirtilen oranlara yak›nd› (P=0.75).
preterm eylem aç›s›ndan riskli hasta grubunun tesbitindeki prediktif de¤erini araflt›rd›k.
Gereç ve Yöntem: Gebe poliklini¤inde ilk trimesterden itibaren takip edilen 120 has-
ta prospektif olarak düzenlenen çal›flma program›na al›nd›. Fetal anomalisi, maternal
medikal hastal›¤› (diabetes mellitus, hipertansiyon, tiroid hastal›¤› v.b.), servikal yet- P-063
mezli¤i olan, servikal sirkülaj veya konizasyon uygulanm›fl olan hastalar ve ço¤ul ge-
belikler çal›flmaya dahil edilmedi. Tüm hastalar›n maternal yafl›, son adet tarihi, gravi- ‹CS‹ UYGULAMALARINDA HCG GÜNÜ TV-USG ‹LE
da, parite ve obstetrik hikayede preterm do¤um öyküsü kaydedildi. Çal›flmaya dahil DE⁄ERLEND‹R‹LEN ENDOMETR‹YAL EKOJEN‹TE ‹LE GEBEL‹K
edilen ve preterm eylem belirtileri olmayan tüm hastalara 20-24. gebelik haftalar› ara-
s›nda ayn› araflt›rmac› taraf›ndan TVUSG ile, mesane bofl iken servikal uzunluk ölçü- ORANLARI ARASINDAK‹ ‹L‹fiK‹
mü yap›ld›. ‹statistiksel analizler ile pariteye ve do¤umda gestasyonel yafla göre orta-
lama servikal uzunluklar karfl›laflt›r›ld›. P<0.05 istatistiksel anlaml› kabul edildi. D. Duvan, P. ÞatÝroÛlu, D. AtabekoÛlu, D. Berker, D. ‚etinkaya
TVUSG ile yap›lan servikal uzunluk ölçümünün preterm eylem riski aç›s›ndan sensi-
tivite, spesifite, pozitif ve negatif prediktif de¤eri hesapland›. Bulgular: 120 hastan›n Ankara Üniversitesi Kad›n Hastal›klar› ve Do¤um, Ankara
ortalama maternal yafl› 25.38, gravida 2, parite 0, TVUSG yap›ld›¤›nda ortalama gebe-
lik yafl› 22 hafta, do¤umda ortalama gebelik yafl› 38 hafta idi. Hastalar›n 54 (%45)’i Amaç: Kontrollü ovaryan hiperstimülasyon uygulanan ‹CS‹ sikluslar›nda hCG günü
nullipar, 66 (%55)’s› multipard›. Olgular›n %14.2 (n=17)’sinde 37. gebelik haftas›ndan TV-USG ile de¤erlendirilen endometriyal ekojenite ile gebelik sonuçlar› aras›ndaki ilifl-
önce ve %85.8 (n=103)’inde 37. gebelik haftas›ndan ve sonra do¤um tesbit edildi. Or- kiyi de¤erlendirmek. Gereç ve Yöntem: Çal›flmaya long-protokolü ile kontrollü ovar-
talama servikal uzunluk (±standart sapma) 43.83 (±7.66) mm olarak bulundu. Preterm yan stimülasyon uygulanan 110 siklus dahil edildi. HCG günü transvajinal ultrasonog-
do¤um yapanlar ile termde do¤um yapan hastalar aras›nda 20-24. gebelik haftalar›nda rafi ile de¤erlendirilen endometriyum ekojenik görüntüsüne göre 4 ekojenik gruba s›n›f-
yap›lan ortalama servikal uzunluk ölçümleri aras›nda istatistiksel olarak anlaml› fark land›r›ld›. Bulgular: Gruplar›n demografik özellikleri ve kullan›lan stimülasyon rejim-
bulundu (p=0.012). Preterm ve term gruplar›n multiparite ve primipariteye göre orta- leri benzerdi, ovaryan cevap HCG günü endometriyum çift duvar kal›nl›¤› d›fl›nda grup-
lama servikal uzunluklar› karfl›laflt›r›ld›¤›nda istatistiksel anlaml› fark yoktu.(s›ras›yla lar aras›nda fark oluflturmuyordu (Grup 4’de EÇDK’l›¤› di¤er gruplardan anlaml› ola-
p=0.09,p=0.379). 30 mm’den az servikal uzunlukta pozitif prediktif de¤er %75, sensi- rak yüksekti). Gruplar›n embriyolojik verileri birbirine benzerdi. Gruplar›n her biri için
tivite %17.6, spesifite %99 ve negatif prediktif de¤er %87.9 iken 25 mm ve alt›ndaki gebelik oranlar› (Grup 1:%36,4, Grup 2:%40, Grup 3:%26,7, Grup 4:%42,1) ve implan-
servikal uzunlukta bu de¤erler s›ras›yla %100, %5.9, %100, %86.6 olarak saptanm›fl- tasyon oranlar› (Grup 1:%9,1, Grup 2:%11,4, Grup 3: %8,9, Grup 4:%10,5) hesaplan-
t›r. Sonuç: ‹kinci trimester TVUSG ölçümlerinde servikal kanal uzunlu¤u <30 mm d›. Sonuçlar: Gruplar aras›nda implantasyon ve gebelik oranlar› aç›s›ndan istatiksel
olan olgularda erken do¤um riskinin yüksek oldu¤unu görülmüfltür. olarak anlaml› bir fark saptanmad›. HCG günü TV-USG ile de¤erlendirilen endometri-
yal ekojenite ile implantasyon ve gebelik oranlar› aras›nda anlaml› bir iliflki yoktur.
125
P-064 ile leptin seviyelerinin korrelasyonu de¤erlendirildi. Bulgular: Serum leptin sevi-
yeleri 28-32 gebelik haftalar›nda, do¤umda ve kordda üç grupta aras›nda farkl›l›k
KONJEN‹TAL SERV‹KAL AGENEZ‹ göstermedi. 28-32 gebelik haftalar›nda ve do¤umda serum leptin seviyesi ile VK‹
aras›nda korelasyon saptanmad›. Gruplarda 28-32 hafta ve do¤umdaki leptin sevi-
yeleri aras›nda da fark saptanmad›. 50 gram glukoz yükleme testi normal ve
H. Turan, G. Beydilli, B. Aykan, B. Atasay, …. Kandemir, A. Haberal OGTT’si normal gebelerde yenido¤anlarda VK‹’nin kord leptin seviyesi ile kore-
lasyon gösterdi¤i izlenirken bu iliflki gestasyonel diyabetik gebelerde saptanmad›.
SSK Ankara Do¤um Ve Kad›n Hastal›klar› E¤itim Hastanesi, Ankara Yorum: Gestasyonel diyabetik gebeler ile di¤er gruplar aras›nda leptin seviyeleri
aç›s›ndan fark olmad›¤›, bu hormonun ölçümünün taramada kullanmak için uygun
Amaç: Konjenital servikal agenezide farkl› tedavi yaklafl›mlar›n›n sonuçlar›n› de- bir test olmad›¤› sonucuna var›lm›flt›r.
¤erlendirmek. Gereç ve Yöntem: 8 Konjenital Servikal Agenezili hasta klinik bul-
gular, seçilen tedavi yaklafl›m› ve sonuçlar aç›s›ndan retrospektif olarak incelendi.
Bulgular: 8 olgudan 6’s›nda komplet servikal agenezi, 2’sinde ise k›smi bir vajinal
agenezi ile birlikte olan servikal hipoplazi vard›. Tedavi yaklafl›m›nda ilk seçenek P-067
olarak 7 olguda uterovajinal kanalizasyon, 1 olguda medikal süpresyon seçildi. Ute-
rovajinal kanalizasyon uygulanan hastalardan 5’inde drenaj›n sa¤lanmas› zaman TUBAOVARYEN APSE OLGULARINDA R‹SK FAKTÖRLER‹ VE TEDAV‹
içinde baflar›s›z oldu¤u için ikinci bir müdahele gerekti. Bu hastalardan birine ab-
MODAL‹TELER‹N‹N DE⁄ERLEND‹R‹LMES‹
dominal histerektomi, 3’üne rekanalizasyon yap›ld›. Bir olguya ise medikal süpres-
yon uyguland›. Sonuçlar: Konjenital servikal agenezili hastalarda normal menstrü-
el kanaman›n sa¤lanmas›, siklik pelvik a¤r›n›n azalt›lmas› ve tart›flmal› da olsa fer- B. Demir, Ü. Arslanpen•e, D. GŸler, R. Dur, N. ‚etin, A. Erten, A. Haberal
tilitenin korunmas› amac›yla konservatif yaklafl›m için bir seçenek olarak kanalizas-
yon ve medikal süpresyon uygulanabilir. SSK Ankara Do¤umevi ve Kad›n Hastal›klar› E¤itim Hastanesi, Ankara
Amaç: Tubaovaryen apse tan›s› konulan olgularda, klinik bulgular, risk faktörleri,
laboratuar ve radyolojik bulgular ile tedavi (medikal ve/veya cerrahi) ve komplikas-
P-065 yon oranlar›n›n saptanmas›. Gereç ve Yöntem: 01.01.02- 31.12.02 tarihleri aras›n-
da tubaovaryen abse tan›s› ile hospitalize edilen 45 olgu de¤erlendirildi. Bulgular:
ENDOMETR‹OMALARDA SECOND LOOK LAPAROSKOP‹ Olgular›n ortalama yafl› 37.9 (21-47) y›l idi. Olgular›n %17’de geçirilmifl PID öy-
SONUÇLARIMIZ küsü, %40’da rahim içi araç kullan›m›, %33.3’de abdominal operasyon öyküsü,
%8.8’de yak›n zamanda geçirilmifl intrauterin müdahale öyküsü saptand›. 18 olgu-
da (%40) kas›k a¤r›s›, atefl ve ak›nt› flikayeti birlikte bulunurken, en s›k karfl›lafl›lan
M. Altay, S. Karadeniz, E. †nlŸbilgin, A. Haberal semptom kas›k a¤r›s› (%86) idi. Olgular›n % 64.4’de 38°C üzerinde atefl, %88.8’de
lökositoz saptand›. 33 olgu kombine antibioterapiyi takiben (%73.3) laparotomiye
SSK Ankara Do¤umevi ve Kad›n Hastal›klar› E¤itim Hastanesi, Ankara al›nd›. Operasyon dökümü total abdominal histerektomi:14 (%31.1), unilateral sal-
pingoooferektomi: 13 (%26.6), salpenjektomi: 5 (%11.1), drenaj: 4 (%8.8) idi. Pos-
Amaç: Endometrioma olgular›n› sekond-look laparoskopi ile de¤erlendirmek toperatif komplikasyon saptanmad›. Sonuç: Tubaovaryen apse olgular›nda temel
Gereç ve Yöntem: Hastanemizde endometrioma nedeniyle operatif laparoskopi hedef erken tan›, uygun medikal tedavi ve risk faktörlerinin ortadan kald›r›lmas› ol-
uygulanan ve 3 ay sonra sekond- look laparoskopi (ikinci bak› laparoskopisi) ile de- mal›d›r. Apse geliflen olgularda kombine antibioterapiyi takiben eksiksiz cerrahi
¤erlendirilen 24 hastan›n kay›tlar› retrospektif olarak incelendi. Bulgular: Çal›flma- komplikasyon ve nüks oranlar›n› azaltacakt›r.
ya al›nan hastalar›n 10’u (%41,7) primer infertil, 3’ü (%12,5) sekonder infertildi.
Hastalar›n 15’inde (%62,5) unilateral endometrioma, 6’s›nda (%25) bilateral endo-
metrioma mevcuttu. ‹lk laparoskopi s›ras›ndaki ortalama American Fertility Soci-
ety (AFS) skoru 40,35± 21,64 idi. Postoperatif dönemde 20 (%83,3) hastaya 3 ay P-068
süreyle Gonadotropin Releasing Hormone (GnRH) analogu verildi. Second-look la-
paroskopisinde (SLL) tespit edilen ortalama AFS skoru 15,61± 16,41 olarak bulun- RESULTS OF 154 PGD CYCLES IN POOR PROGNOSIS IVF/ICSI
du. Birinci ve ikinci laparoskopilerde tespit edilen AFS skorlar› karfl›laflt›r›ld›¤›nda,
PATIENTS
iki skor aras›nda istatistiksel olarak anlaml› fark bulundu (p< 0,0005; paired t test).
Sonuç: Endometrioma tedavisinde cerrahi ve medikal tedavinin kombine kullan›m›
ile iyi sonuçlar elde edildi¤i SLL ile gösterilmifltir. N. Er•elen, B. Balaban, A. IßÝklar, E. Tutar, C. Alataß, S. Aksoy, K. YakÝn,
A. NuhoÛlu, B. Urman
VKV American Hospital, Reproductive Endocrinology and Genetic

P-066 Departments, Istanbul
GESTASYONEL D‹YABET TARAMASINDA LEPT‹N‹N YER‹ Objective: Preimplantation genetic diagnosis (PGD) for aneuploidy was performed
between April 2001 and February 2003 on embryos of 154 patients undergoing IVF
T. EroÛlu Elmas, A. Ko•, B. Cengiz, E. Þimßek, B. …zmen, F. Sšylemez of indications advanced maternal age, repeated implantation failures or recurrent
spontaneous abortion. Materials and Methods: In 154 ICSI/PGD/ET cycles in
Ankara Üniversitesi Kad›n Hastal›klar› ve Do¤um AD, Ankara 805-days, three embryos were biopsied and one blastomere from each was fixed for
aneuploidy screening. MultiVysion PB (Vysis) hybridization kit was used for detec-
Amaç: Gestasyonel diyabet taramas›nda leptin seviyesi ölçümünün tarama testi tion of chromosomes 13, 16, 18, 21, 22 and X, Y. Normal embryos were transferred
olarak kullan›labilirli¤ini araflt›rmak. Gereç ve Yöntem: Çal›flmaya Haziran 2001- on day 5. Results: Of the 805 embryos, 548 (68%) were aneuploid and 257 (32%)
Ekim 2002 tarihleri aras›nda baflvuran 28-32. gebelik haftas›ndaki 55 gebe dahil were euploid. The aneuploidy rates for chromosomes 13, 16, 18, 21, 22 and XY
edildi. Çal›flmaya dahil edilen gebelerden 50 gram glukoz yükleme testi (screening) were 17%, 14%, 19%, 18%, 12% and 19% respectively. A total of 188 embryos
öncesi rutin uygulamalar için kan al›m› s›ras›nda leptin ölçümü için kan al›nd›. Glu- (mean 1.6; min:1, max:3) were transferred to 115 patients. Clinical pregnancy was
koz screening’i pozitif olanlara 100 gram’l›k oral glukoz tolerans testi (OGTT) uy- documented in 24 of 115 patients yielding a 20.8% pregnancy rate/ET. Implantation
guland›. Çal›flmaya kat›lan gebelerden do¤um eylemi s›ras›nda ve do¤umda umbli- rate per replaced 16% (30/188) respectively. Nine babies were delivered without
kal korddan leptin ölçümü için kan al›nd›. 28-32.gebelik haftalar›nda ve do¤umda any perinatal complications. Normal karyotypes of ongoing pregnancies was con-
maternal ve do¤umda fetal vücut kitle indeksleri (VK‹) hesapland›. Glukoz scre- firmed with either CVS or amniocentesis. There were no FISH errors. Conclusion:
ening’i negatif olanlar (29 hasta) ve pozitif olup 100 gram OGTT’si normal olan ge- A satisfactory pregnancy rate can be achieved and healthy newborns delivered
beler (23 hasta) ile gestasyonel diyabet saptananan gebelerde (23 hasta) 28-32 haf- through the implementation of PGD in a group of poor prognosis patients with
ta ve do¤umda maternal leptin seviyeleri, kord leptin seviyeleri karfl›laflt›r›ld›. VK‹ advanced maternal age, repeated implantation failures or RSA.
126
P-069 P-071
SSK ANKARA DO⁄UMEV‹ VE KADIN HASTALIKLARI E⁄‹T‹M EVALUATION OF ENDOCERVICAL CANAL WITH THE
HASTANES‹ ERKEN GEBEL‹K KL‹N‹⁄‹NDE ABORTUS ‹MM‹NENS ENDOCERVICAL BRUSH IN ENDOMETRIAL CARCINOMA
TANISI ‹LE YATAN HASTALARIN PER‹NATAL SONUÇLARININ
DE⁄ERLEND‹R‹LMES‹ A. Yaman1, G. Tulunay1, F. KayÝk•ÝoÛlu1, R. …calan1, C. Baykal1, M. Kšse1,
A. Haberal1, …. AtaoÛlu2
S. Dilbaz, B. Kataß, O. Tan, B. Kahraman, E. ‚alÝßkan, B. Dilbaz, A. Haberal 1
SSK Etlik Do¤umevi, Ankara
2
SSK Ankara Do¤umevi Ve Kad›n Hastal›klar› E¤itim Hastanesi, Ankara Gazi Üniversitesi T›p Fakültesi, Ankara
Amaç: Hastanemiz Erken Gebelik Klini¤ine (EGS) abortus imminens tan›s› ile ya- Objective: To determine the role of endocervical brush in the evaluation of cervi-
tan hastalar›n perinatal sonuçlar›n›n de¤erlendirilmesi. Gereç ve Yöntem: Ocak - cal canal involvement in patients with endometrial carcinoma. Methods: Between
Haziran 2002 tarihleri aras›nda klini¤imize abortus imminens tan›s› ile yat›r›lan 40 February, 2002 and November, 2002 fifty patients whose endometrium cancer were
hasta prospektif olarak incelendi. Tüm hastalar klini¤e kabul edildi¤i gün ultraso- diagnosed after endometrial biopsy were included in the study. Tissue samples were
nografi (USG) ile crown-rump length (CRL), fetal heart rate (FHR) ve subkoryonik obtained from endocervical canal by rotating the endocervical brush 5 to 7 turns
kanama alan› yönünden de¤erlendirildi. Hastalar›n USG’si günafl›r› tekrar edildi. with light pressure against the wall of the canal. The brush then cut from its shaft
Vajinal kanamas› azalan, en az 2 ölçümde subkoryonik kanama alan›nda büyüme and placed in 10% formalin to be evaluated histologically. Pain scores were record-
olmayan ve FHR’i normal olan olgular medikal tedavi verilmeden, yatak istirahati ed on four step Pain Intensity Scale. Results were compared with the histopatho-
ve cinsel iliflki yasaklanarak taburcu edildi. Daha sonra maternal ve fetal kompli- logic report of uterus after surgical removal. Results: One of two patients with
kasyonlar aç›s›ndan gebeli¤in ilerleyen dönemlerinde olgular takip edildi. Bulgu- endocervical involvement was diagnosed by brush (50%). Nine false positive
lar: Üç olguda ikiz gebelik tespit edildi (%7,5). Yirmi bir olguda subkoryonik ka- results were observed by brush. Sensitivity was 50%. Specificity was calculated as
nama alan› tespit edilmedi (%52.5). En büyü¤ü 55x18 mm ve en küçü¤ü 7x7 mm 81.25%. False positive rate was 18.75% and false negative rate 50%. Positive pre-
boyutlar›nda subkoryonik kanama alan› tespit edilen olgu say›s› 13 idi (%32.5). ‹ki dictive value was 10% and negative predictive value was 97.5%. Seventeen patients
olguda (%5) inkomplet abort geliflti ve kürete edildi. Takibi s›ras›nda preterm ey- (34%) hadn’t any complaint of pain. Thirty three patients complained only of mild
lem nedeniyle hospitalize edilen olgu say›s› 5 (%12.5) idi. Befl hastada (%12.5) er- pain. Conclusion: The endocervical brush appears to be a specific test for cervical
ken membran rüptürü geliflti. 23 olgu vajinal (%57.5), 15 olgu (%37.5) abdominal canal evaluation but yields a low positive predictive value.
yolla do¤um yapt›. Olgular›n 15’ i (%37.5) 3000 gr. ve alt› 23’ ü (57.5) 3000 gr. üs-
tü bebek do¤urdu. Sonuç: Gebeliklerin % 20 sinde ilk 20 hafta içinde vajinal kana-
ma gözlenir. Bu olgular gebeli¤in ilerleyen dönemlerinde geliflebilecek di¤er komp-
likasyonlar aç›s›ndan dikkatli de¤erlendirilmelidir. Preterm eylem ve düflük do¤um P-072
a¤›rl›kl› bebek do¤urma riskinin oldu¤u unutulmamal›d›r. Anahtar kelimeler:
Abortus imminens, perinatal sonuç UTERINE CARCINOSARCOMAS
N. …zgŸl, G. Tulunay, C. Baykal, N. Boran, R. …•alan, M. Kšse, A. …zfuttu

P-070
AMIFOSTINE HAS NO PROTECTIVE EFFECT DURING
Objectives: This study aimed to evaluate survival analysis of patients with uterine
CONCOMITANT CHEMORADIOTHERAPY GIVEN FOR CERVICAL carcinosarcomas. Materials and Methods: 30 patients treated at the SSK
CARCINOMA Maternity and Women’s Hospital between 1993 and 2002 were included in the
study in a retrospective manner. Treatment protocol consisted of surgery with adju-
G. Tulunay1, B. GŸltekin1, N. Boran1, N. …zgŸl1, C. Baykal1, E. …zyar2, vant radiotherapy and/or chemotherapy. Mean age of the patients was 62 (44-82).
Of the 30 patients, 16 were early stage (FIGO stage I) and 14 were advanced.
L. Atahan2, M. Þenyuva2, M. Kšse2
Univariate survival analysis by Kaplan-Meier method was carried out to determine
1 any difference between stages. Results: One year recurrence free survival in early
SSK Etlik Do¤umevi, Ankara and advanced stages were found as 40% and 0% respectively. Two years recurrence
2
Hacettepe Üniversitesi T›p Fakültesi, Ankara free survival was 20% in early stage. Two years overall survival was 50% for early
stage and 12.5% for advanced stages. Conclusion: Uterine carcinosarcomas have
Objective: This study aims to determine the protective effect of amifostine in cer- poor prognosis despite the treatment methods that are currently being used.
vical carcinoma patients treated by concomittant chemoradiotherapy containing cis-
platin. Materials and Methods: 198 cervical carcinoma patients of different stages
(85 patients of early stages, 111 patients of 2b-4a and 2 patients of 4b) were includ-
ed in the study during November 2000-October 2002. Patient selection was made
according to the inclusion criteria as; histologic subtype (adeno, squamous, and
adenosquamous carcinomas), evident local disease (paraaortic lymph node positiv-
ity shown with imaging techniques is neglected), WHO performance status 0-2,
adequate bone marrow, and unimpaired renal function tests. The dosing schedule
consisted of cisplatin (40 mg/m2 for pelvic lymph node positivity, 25 mg/m2 for
paraaortic lymph node positivity) and amifostine, 500 mg IV given prior to cisplatin
and 250 mg before every other day during radiotherapy fractions. Two groups are
compared according to WHO toxicity criterias for hematological toxicities (The
least values during treatment and fall in Hb, WBC and platelets), the total number
of cisplatin doses given and side effects of medications. Results: Both groups were
homogenous for age (p=0.469), histology (p=0.872) and stage (p=0.708). They
were statistically insignificant according to hematologic toxicities, number of trans-
fusions required during treatment, cycles of chemotherapy given and toxicities of
medications. No hypotension is observed in both arms. The only difference seen-
between two groups was diarrhea that was found more frequent in amifostine group
(p<0.001). Conclusion: The addition of amifostine to concomitant cisplatin and
radiotherapy is shown to have no benefit over cisplatin and radiotherapy alone.
127
Vol 4(2) 2003 18 May›s 2003 Pazar
P-073 P-075
VULVAR SCHWANNOMA: A CASE REPORT POL‹K‹ST‹K OVER SENDROMLU KADINLARDA SERUM LEPT‹N
DÜZEYLER‹
N. …zgŸl, R. …•alan, G. Tulunay, M. Kšse, Z. ErdoÛan
S. ‚imen, …. …ztekin, M. Gencer, E. Muluk, L. ‚amlÝ, F. Soylu
Atatürk E¤itim ve Araflt›rma Hastanesi, II. Kad›n Hastal›klar› ve Do¤um Kli-
Schwannoma is a solitary benign tumor of a peripheral nerve sheath. The most com- ni¤i, ‹zmir
mon localizations of schwannoma are head, neck, upper and lower extremities, pos-
terior mediastinum and retroperitoneum. But vulvar schwannoma is very rare. The-
se slow-growing neoplasm are rarely found in the female genital system and have Amaç: Bu çal›flmam›zda polikistik over sendromunda serum leptin seviyelerindeki
been reported in clitoris, vagina, cervix, uterus, fallopian tube, ovary and round or de¤ifliklikleri ve bu de¤iflikliklerin PCOS ile ba¤lant›l› di¤er hormonlarla olan ilifl-
broad ligament. Our patient was at the age of 26 with a 2 years history of a mass in kilerini araflt›rmay› amaçlad›k. Gereç ve Yöntem: Bu çal›flmaya 32 PCOS hastas›
the right side of the vulva. There was no associated ulceration, bleeding or pain. She ve kontrol grubunu oluflturan 32 sa¤l›kl› kad›n dahil edildi.Hastalar›n serum hor-
had no urinary, bladder, gastrointestinal or neurological problems. There was no fa- mon düzeyleri R‹A yöntemi ile saptand›. Bulgular: Reproduktif yafl grubundaki ka-
mily history of cancer, neurofibromatosis or hereditary disease. On physical exami- d›nlarda immunoreaktif leptin konsantrasyonlar› ölçüldü. BMI’si 25 kg/m2’nin al-
nation, patient was found to have a mass in the right labia majora area, measuring t›nda olanlar zay›f, üstünde olanlar obez olarak kabul edildi. Kontrol grubunda
8x7 cm. Vulvar mass was not fixed to any deep structures. Abdominal, pelvic and obezlerde, zay›flara oranla anlaml› ölçüde artm›fl leptin seviyeleri tespit edildi (P
rectal examinations were negative. There was no other evidence of virilism and va- <0,05). PCO’lu zay›f hastalarda kontrol grubundaki zay›flara oranla leptin seviye-
ginal ultrasound studies were also negative. Biopsy of the primary revealed vulvar leri daha yüksekti (P <0,05), ancak obez kontrol grubundakilere benzer ölçülerdey-
schawannoma. The mass was completely resected on April 2002. The postoperative di. PCOS’lu obez kad›nlarda PCOS’lu zay›flara ve kontrol grubundaki tüm hastala-
period was uneventful following simple excision which is the treatment of choice. ra oranla dolafl›mdaki leptin seviyeleri anlaml› ölçüde yüksek bulundu (P <0,05).
Our patient’s tumour was completely resected. The follow-up 11 months after the PCOS’lu hastalar›n yüksek bir bölümü hiperandrojenikti. Beklendi¤i gibi, PCOS’lu
surgery showed no evidence of tumour recurrence. hastalarda serbest testosteron seviyeleri (3.7 ± 0,2 pg/ml) anlaml› ölçüde yüksekti
(P = 0,008). Kontrol grubunda serum leptin seviyeleri ile insülin sensivite indeksi
aras›nda pozitif korelasyon mevcuttu (P <0,01). PCOS’lu gruptaki hastalar›n ço-
¤unlu¤undaki leptin seviyeleri kontrol grubu için olan %99’luk tahmini aral›kta idi.
Sonuç: Bu çal›flman›n sonuçlar› serum leptin seviyeleri ile BMI aras›nda daha ön-
P-074
ce gösterilmifl olan pozitif korelasyonu desteklemektedir. Ayr›ca PCOS’lu hastalar-
da artm›fl leptinin yüksek serbest testesteron seviyeleri ile ba¤lant›l› olabilece¤i dü-
IN VITRO FERT‹L‹ZASYON UYGULAMALARINDA hCG GÜNÜ flünüldü. Kontrol grubunda serum leptin seviyeleri ile insülin sensitivitesi aras›nda
ENDOMETR‹UM KALINLI⁄I VE GEBEL‹K OLASILI⁄I pozitif korelasyon saptand›.
Tekin H. Ü., AltÝnel F., Kendirci A., ‚arak M., …zekici †., Þahmay S.
Dr. Pakize ‹. Tarzi Hastanesi Yard›mla Üreme Merkezi-Dr. Halil ‹brahim P-076
Tekin
MAKROZOM‹K VE DÜfiÜK DO⁄UM A⁄IRLIKLI BEBEKLERDE
Amaç: ‹n Vitro Fertilizasyon (‹VF) uygulanan olgularda endometrium kal›nl›¤›n›n UMBL‹KAL KORD LEPT‹N DÜZEYLER‹
gebelik olas›l›¤› ile iliflkisi araflt›r›lm›flt›r. ‹VF olgular›nda USG ile ovülasyon taki-
binde majör kriterden biri olan endometrial kal›nl›k, pek çok faktörün etkisindedir. M. Gencer, …. …ztekin, S. ‚imen, E. Muluk, L. ‚amlÝ, F. Soylu
Endometrial kal›nl›k, yeterli folüküler matürasyon ve E2 salg›s›n›n önemli bir gös-
tergesidir. Bu nedenle, gebeli¤in oluflumunda rol oynayan temel faktörlerden biri Atatürk E¤itim ve Araflt›rma Hastanesi, II. Kad›n Hastal›klar› ve Do¤um
olup, gebelik tahmininde belirleyici kriterlerden biri olarak kabul edilebilir.
Klini¤i, ‹zmir
Gereç ve Yöntem: ‹VF uygulanan 429 olgunun hCG günü yap›lan TV/USG ile en-
dometrial kal›nl›k ölçümleri ve gebelik oranlar› retrospektif olarak de¤erlendirildi.
Çal›flmaya 21 ile 45 yafl›ndaki olgular al›nd›. Ultrasonografik ölçümler ayn› hekim Amaç: Bu çal›flmada amac›m›z, umblikal kord leptin düzeylerinin do¤um a¤›rl›¤›
taraf›ndan yap›ld›. Hastalar›n tümüne uzun protokol uyguland›. Ovülasyon indüksi- ile iliflkisini saptamak, fetal ve neonatal hayatta, nutrisyonel durum ile leptin düzey-
yonu için over rezervlerine uygun dozda hMG kullan›ld›. Dominant folikül çap› 21 lerinin iliflkisini araflt›rmakt›r. Gereç ve Yöntem: Bu çal›flmaya, sistemik hastal›¤›
mm’ye ulaflt›¤›nda hCG uyguland› ve endometrium kal›nl›klar› ölçüldü. Olgular en- olmayan (DM, hipertansif hastal›k, konnektif doku hastal›¤›, kardiak hastal›k, böb-
dometrium kal›nl›¤›na göre 3 gruba ayr›ld›: rek yetmezli¤i vb.) ve 37. gestasyonel haftadan sonra do¤um yapan gebelerin in-
I. Grup (endometrium 6-9 mm.) fantlar› dahil edilmifltir. Leptin incelemesi için kan örnekleri, do¤umdan sonraki ilk
II. Grup (endometrium 9-12 mm.) 5 sn. içinde umblikal korddan çift olarak klemplendikten sonra al›nd›. Sonuçlar›n
III. Grup (endometrium >12 mm,) istatistiksel de¤erlendirmesi SPSS 9.0 istatistik program› ile yap›ld›. Bebek a¤›rl›¤›
Bu gruplardaki gebelik oranlar› tespit edilerek endometrial kal›nl›kla korelasyonu ve leptin düzeyleri aras›ndaki iliflki ve anne yafl› ile leptin düzeyleri aras›ndaki ilifl-
karfl›laflt›r›ld›. ki korelasyon testi ile incelendi. Bulgular: Olgular do¤um a¤›rl›klar›na göre üç gru-
Bulgular: Çal›flmaya kat›lan 429 olgunun yafl ortalamas› 32.6 (21-45 yafl aras›) ba ayr›lm›flt›r. Grup I, do¤um a¤›rl›klar› 2500 gr. ve alt›nda olan 14 düflük do¤um
olup I. Grup 36 olguda 7 gebelik (%19); II. Grup 185 olguda 53 gebelik (%29) ve a¤›rl›kl› bebekten oluflmaktad›r. Grup II, do¤um a¤›rl›klar› 2500 ile 3500 gr. aras›n-
III. Grup 208 olguda 56 gebelik (%27) saptanm›flt›r. da olan, normal do¤um a¤›rl›kl› 15 bebekten oluflmaktad›r. Grup III, do¤um a¤›rl›k-
Tart›flma ve Sonuç: Çal›flmam›za endometriumu <6 mm ve >17 mm olan olgular› lar› 4000 gr. ve üstünde olan 15 makrozomik bebekten oluflmaktad›r. Umblikal kord
dahil etmedik. Sonuçlardan da anlafl›ld›¤› gibi II. ve III. Grup’ta I. Gruba göre ge- leptin düzeyleri ile do¤um a¤›rl›klar› aras›nda pozitif korelasyon vard›r (r=0,967,
belik oran› yüksektir. Bulgular›m›za göre, hCG günü endometrium kal›nl›¤› 9-12 p<0,0001). Grup I ile grup 2 aras›nda, umblikal kord leptin düzeyleri bak›m›ndan
mm olan II. Grup’ta ve endometrial kal›nl›¤› >12 mm olan III. Gnup’ta gebelik ola- anlaml› bir farkl›l›k vard›r (p<0.0001). Grup 3 ile grup 2 aras›nda, umblikal kord
s›l›¤›n›n daha yüksek oldu¤u gözlenmifltir. Endometrial kal›nl›¤› 6-9 mm olan I. leptin düzeyleri bak›m›ndan anlaml› bir farkl›l›k vard›r (p<0.0001). Sonuçlar: Ça-
Grup’ta gebelik oran› düflük bulunmufltur. Eflik de¤erden (9 mm) sonra endometri- l›flmam›z sonuçlar›na göre, plazma leptin seviyeleri makrozomik bebeklerdeart-
al kal›nl›k art›fl›yla gebelik oranlar› aras›nda paralellik saptanmam›flt›r. Bulgular›- makta, düflük do¤um a¤›rl›kl› bebeklerde azalmaktad›r. Düzeyleri ya¤ dokusu hac-
m›za göre, ‹VF olgular›nda hCG günü, endometrial kal›nl›¤›n 9 mm’yi aflmas› ge- mi ile direkt orant›l› olarak ç›km›flt›r. Leptinin, bebek do¤um a¤›rl›¤›n› belirleyen
belik olas›l›¤›n› art›ran göstergelerden biridir. ba¤›ms›z bir faktör oldu¤u ve fetal büyüme anormalliklerinde, antenatal takip için
kullan›labilecek de¤erli bir metabolik hormonal parametre oldu¤u inanc›nday›z.
128
Vol 4(2) 2003 18 May›s 2003 Pazar
P-077 P-079
GESTASYONEL DIABETES MELLITUS, BOZULMUfi GL‹KOZ SA⁄LIKLI POSTMENOPOZAL KADINLARDA FARKLI HORMON
TOLERANSI VE YALNIZ TARAMA TEST‹ POZ‹T‹F OLAN GEBELERDE REPLASMAN TEDAV‹LER‹N‹N SERUM CRP DÜZEYLER‹NE ETK‹S‹
PROGNOZUN KARfiILAfiTIRILMASI
S. ‚akmak1, …. …ztekin2, G. Demir3, S. ‚imen3, M. Gencer3,
O. Api, A. Karageyim KarßÝdaÛ, B. CengizoÛlu, U. Tiryaki …zyurt, O. †nal, L. ‚amlÝ3
M. Turan
1
Kumru Devlet Hastanesi, Ordu
2
KEAH Atatürk E¤itim ve Araflt›rma Hastanesi, II. Kad›n Hastal›klar› ve Do¤um
Klini¤i, ‹zmir
3
Amaç: Gestasyonel Diabetes Mellitus (GDM), Bozulmufl Glikoz Tolerans› (IGT) Silvan Devlet Hastanesi, Diyarbak›r
ve tarama testi pozitif olup 100 gr oral glikoz tolerans testi (OGTT) negatif olan ge-
belerin prognozunu karfl›laflt›rmak. Gereç ve Yöntem: 1997-2002 y›llar› aras›nda Amaç: Bizim bu çal›flmadaki amac›m›z hormon replasman tedavisinde konjuge est-
Perinatoloji poliklini¤imize baflvuran 723 gebenin kay›tlar› retrospektif olarak ince- rojen + medroksi progesteron asetat ve Tibolon’un serum CRP düzeyleri üzerinde-
lendi. Çal›flma parametrelerini tamamlayan 60 hasta pregestasyonel diabetes melli- ki etkilerinin karfl›laflt›r›lmas›d›r. Gereç ve Yöntem: Çal›flmaya en az bir y›ld›r do-
tus (PGDM), bozulmufl glikoz tolerans› (IGT) ve yaln›z tarama testi pozitif olan ¤al menapoz döneminde olan 75 olgu al›nm›flt›r. Hastalar rastgele 3 gruba ayr›ld›.
(YTP) gebeler olarak 4 gruba ayr›ld›. Olgular›n glikoz tolerans testleri modifiye Co- Örnek seçimi toplulu¤u 3 k›sma ay›rma sonras› basit randomize kura usulü ile ya-
ustan kriterlerine göre de¤erlendirilerek, GDM 100 gr OGTT ‘de 2 de¤er pozitif ol- p›ld›. 1.gruba (n=25) tibolon 2.5 mg tb/gün, 2. Gruba (n= 25) konjuge estrojen
ma, IGT yaln›z 1 de¤er pozitif olma olarak tan›mland›. Bu dört grup, prognostik pa- 0.625 mg + medroksiprogesteron asetat 5mg/gün, 3. gruba (n= 25) herhangi bir ilaç
rametreler olarak kabul edilen antenatal komplikasyonlar (preterm eylem ve do- verilmedi. Sonuçlar›n istatistiksel de¤erlendirmesi SPSS 10.0 program› ile yap›ld›.
¤um, erken membran rüptürü, makrozomi), do¤um a¤›rl›klar› ve do¤um haftalar› Analitik ifllemler student- t ve ANOVA testleri kullan›larak ki kare testi ile yap›ld›.
yönünden karfl›laflt›r›ld›. Bulgular ve Sonuçlar: Elli gram OGTT’si pozitif olan 54 Bulgular: KEE+MPA için ilk ve son CRP de¤erleri aras›nda anlaml› bir farkl›l›k
hastan›n 15’i (%28) GDM, 12’si (%22) ‹GT , 27’si (%50) YTP olarak de¤erlendi- vard›r (P<0,05). Tibolon için ilk ve son CRP de¤erleri aras›nda anlaml› bir farkl›l›k
rildi. Gruplar aras›nda yafl, gravida, parite, kötü obstetrik anamnez varl›¤› ve ante- bulunmufltur (P<0,05). Yap›lan ifllem sonucunda CRP de¤erlerinin artt›¤› gözlen-
natal komplikasyonlar aç›s›ndan anlaml› fark bulunmad›. PGDM grubundaki hasta- mifltir. Kontrol grubu için ilk ve son CRP de¤erleri aras›nda anlaml› bir farkl›l›k
lar›n ortalama do¤um haftalar› 34.6 ± 6.9 ve do¤um a¤›rl›¤› 2775 ± 1411 gr bulun- yoktur (P<0,05). Sonuçlar: Sonuçlar›m›z HRT sonras› serum CRP seviyelerinin
du. Di¤er 3 grubun ortalama do¤um haftas› 38.6 ± 5.4, do¤um a¤›rl›¤› ise 3450 ± anlaml› ölçüde yükseldi¤ini göstermektedir.Serum CRP seviyelerine bak›larak kar-
542 gr olarak bulundu. Aradaki fark ise istatistiksel olarak anlaml› bulunmad› diovasküler hastal›k riski yüksek bulunan hastalara HRT bafllamadan önce fayda
(p>0.05). PGDM ile di¤er tüm gruplar aras›nda ailede DM öyküsü yönünden an- zarar dengelerinin çok iyi de¤erlendirilmesi gerekti¤ini düflünmekteyiz.
laml› fark saptan›rken (OR :0,036 %95 güven aral›¤›:0,003-0,5); GDM, IGT ve
YTP gruplar› aras›nda bu parametre istatistiksel olarak farks›z bulundu. GDM gru-
bunun ortalama 50 gr OGTT sonucu 183 ± 24,65 mg/dl, IGT grubunun 158,17 ±
11,30 mg/dl ve YTP grubunun 154 ± 11,12 mg/dl olarak bulundu. GDM ve di¤er P-080
gruplar aras›ndaki fark istatistiksel olarak anlaml› bulunurken (p=0,003), IGT ve
GDM aras›nda fark bulunmad› (p>0,05). Tart›flma: Günümüzde PGDM veGDM
SA⁄LIKLI POSTMENOPOZAL KADINLARDA FARKLI HORMON
tan›s› alan gebeliklerin glisemik kontrolü diet ve/veya insülin tedavisi ile kontrol al-
t›na al›nabilmektedir. Befl y›ll›k olgular›m›z› inceledi¤imizde PGDM, GDM, IGT REPLASMAN TEDAV‹LER‹N‹N SOL VENTR‹KÜL FONKS‹YONLARI
ve YTP gebeliklerinin prognozunu benzer bulduk. Sonuç olarak 50 gr/100 gr OGTT ÜZER‹NDEK‹ ETK‹LER‹N‹N EKOKARD‹OGRAF‹K DE⁄ERLEND‹R‹LMES‹
ile hastalar›n kategorizasyonu uygun tedavinin verilmesini sa¤lamakta ve böylece
gebelik prognozunun iyileflmesine yard›mc› olmaktad›r. G. Demir1, …. …ztekin2, A. Keskin3, S. ‚imen3, L. ‚amlÝ3, F. Soylu3
1
Silvan Devlet Hastanesi, Diyarbak›r
2
P-078 Atatürk E¤itim ve Araflt›rma Hastanesi, II. Kad›n Hastal›klar› ve Do¤um
Klini¤i, ‹zmir
3
‹CS‹ UYGULAMALARINDA DÜfiÜK DOZ ASP‹R‹N VE/VEYA Atatürk E¤itim ve Araflt›rma Hastanesi, Kardiyoloji Klini¤i, ‹zmir
STERO‹D‹N ‹MPLANTASYON VE GEBEL‹K ORANLARINA ETK‹S‹
Amaç: Bu çal›flmadaki amac›m›z Hormon Replasman Tedavisi’nde (HRT) Konju-
ge Equine Estrogen (KEE) + Medroksiprogesteron Asetat (MPA) ve Tibolon’un
D. Duvan, P. ÞatÝroÛlu, U. Berker, D. ‚etinkaya, D. Þimßek, D. Kahraman Sol Ventrikül fonksiyonlar› üzerindeki etkilerini incelemek ve karfl›laflt›rmakt›r.
Gereç ve Yöntem: Çal›flmaya en az 1 y›ld›r do¤al menapoz döneminde olan 45
Ankara Üniversitesi Kad›n Hastal›klar› ve Do¤um, Ankara hasta al›nm›flt›r.HRT’ne bafllamadan önce ve sonras›nda sol lateral dekubitis pozis-
yonunda standart 2-D (iki boyutlu) ile LA (sol atrium), M Mode ile sol ventrikül
Amaç: ‹CS‹ uygulamalar›nda düflük doz aspirin ve/veya steroid tedavisinin implan- çaplar› (LVEDD:sol ventrikül end diastolik diameter, LVESD: sol ventrikül end
tasyon ve gebelik oranlar› üzerine etkisini araflt›rmak. Gereç ve Yöntem: Çal›flma- sistolik diameter) ve EF (ejeksiyon fraksiyonu), Doppler Ekokardiografik yöntem-
ya ‹CS‹ program›na al›nan ve embryo transferi aflamas›na ulaflm›fl toplam 186 sik- le E/A, DT, IVRT, ‹VCT, ET ve MP‹’i (myokard performans indeksi) ölçüldü. Bul-
lus dahil edildi. Çal›flmaya al›nan hastalar kontrollü ovaryan hiperstimülasyonu ta- gular: EF de¤erleri aç›s›ndan sonuçlar tibolon lehinde anlaml› görülmekle birlikte
kiben embryo transferi günü ald›klar› tedaviye göre 4 gruba randomize edildi. Te- çal›flman›n geneline bak›ld›¤›nda MPI aç›s›ndan gruplar aras›nda anlaml› farkl›l›k
davi gruplar› 1. Grup (41 hasta) 100 mg/gün aspirin, 2. Grup (50 hasta) 10 mg/gün bulunmam›flt›r (P<0,05). Sonuç: Sonuçlar›m›za göre HRT, yaflla ilgili olarak dias-
prednizolon, 3. Grup (56 hasta) aspirin+prednizolon ve 4. Grup (40 hasta) kontrol tolik disfonksiyonu geciktirmekte, hatta tersine çevirebilmektedir. HRT’nin bu
grubu olacak flekilde düzenlendi. Bulgular: Çal›flmaya kat›lan hastalar›n demogra- olumlu etkileri metabolik ve kardiovasküler sistemde gözlenen direkt ve indirekt et-
fik özellikleri, kullan›lan stimülasyon ajanlar›na verdikleri ovaryan cevaplar› ve kilerine ba¤l› olabilir. Ancak HRT’nin kardioprotektif etkileri konusunda daha faz-
embriyolojik verileri benzerdi. Gebelik oranlar› (Grup 1: %27, Grup 2: %38, Grup la randomize çal›flmaya ihtiyaç vard›r.
3: %28,6, Grup 4: %35) ve implantasyon oranlar› (Grup 1: %9,8, Grup 2: %13,3,
Grup 3: %9,3, Grup 4: %10,9) her bir grup için hesapland›. Sonuçlar: Gruplar ara-
s›nda implantasyon ve gebelik oranlar› aç›s›ndan istatiksel olarak anlaml› bir fark
saptanmad›. ‹CS‹ uygulamalar›nda transfer günü bafllanan aspirin ve/veya steroid
tedavisi implantasyon ve gebelik oranlar› üzerine etkili de¤ildir.
129
Vol 4(2) 2003 18 May›s 2003 Pazar
P-081 P-083
DOES ENDOMETRIAL THICKNESS PREDICT ICSI OUTCOME? THE ULTRASOUND CHARACTERISTIC OF VARICOSE DISEASE VE-
INS OF THE SMALL PELVIS (VDSP)
M. IßÝkoÛlu, K. …zgŸr
A. Volkov
Antalya IVF Center, Antalya
Medical University Department of Obstetrics and Gynecology _1, Rostov
Introduction: We performed this prospective study to determine whether the – on – Don, Russia.
endometrial thicknesses on the day of HCG administration (En1), 12 days after
embryo transfer (En2) and En2-En1 are predictive of pregnancy outcome in ICSI
Background: The ultrasound characteristics of VDSP can’t de found in modern lit-
cycles. Materials and Methods: Endometrial thicknesses of 118 patients were
erature. The sonographic evaluation of the small pelvis of 969 VDSP patients was
measured by transvaginal sonography (TvUSG). Endometrium was measured at
performed to determine ultrasound characteristics of VDSP. Method: Trustworthy
midsagittal plane while both the fundal and the cervical ends of the uterus were
visualization of VDSP was achieved in compilation with B-Mode sonography,
imaged. HCG assay was done 12 days after embryo transfer following En2 mea-
color Doppler velocity (CDV) and color Doppler energy (CDE). Results: 31% of
surement. Student-t and Mann Whitney tests were used for statistical analyses.
patients had the main type of VDSP in the form of tubular, branch structures. 46%
ROC curves were applied when appropriate. Results: 11 patients were excluded
of patients had loose type of VDSP in the form of cell, spongy, anechogene multi-
because of indefinite endometrial borders on TvUSG image. Clinical pregnancy
chamber formations. 23% of patients had the total type of VDSP. That was a com-
rate was 55.1% (59/107). Five patients had miscarriages, 54 pregnancies are ongo-
bination of the main and loose types of VDSP. The transabdominal B-Mode sonog-
ing. En1, En2 and En2-En1 values for pregnants vs. non pregnants were
raphy revealed varicosity plexus venous: uterovaginalis, pampiniformis ovary. By
11.8±2.4mm vs 12.0±2.0mm (p=0.66), 18.3±4.7mm vs 14.2±3.7mm (p<0.05) and
the measurement of the diameter of dilatation and localization of varicosity 3 types
2.61±0.37mm vs 4.46±0.58mm (p<0.05) respectively. En2 and E2-E1 values were
of VDSP were defined. The 1-st stage – the vein diameter is 55 mm (of every vein
significantly greater for the pregnants (p<0.05). En1, En2 and En2-En1 were all
plexus of a small pelvis); the 2-nd stage – the vein diameter is from 6 to 10 mm in
similar for ongoing and lost pregnancies (p=0.42, p=0.96 and p=0.65 respectively).
case of the total type of VDSP or in case of loose ecstasy plexus pampiniformis
An En2-En1 value of 3.75mm assured 74.6% sensitivity and 70% specificity for
ovary or plexus uterovaginalis; the 3-rd stage – the vein diameter more than 10 mm
predicting pregnancy. Conclusion: Although En2 and En2-En1 are useful for pre-
in case of the total type of VDSP or in case of the main type of parametric local-
dicting pregnancy, neither can be used for predicting miscarriages in ICSI pregnan-
ization. Conclusion: The sensibility of B-Mode sonography in diagnostics is
cies. Larger studies are needed for clarification of this issue.
92.4%, the specificity is 95%. In case of CDV and CDE using the mean of the
shown indices came up to 98.7%.
P-082
P-084
UTERINE SUBSEPTUS: A QUANTIFICATION IS LACKING
MEDIKAMENTÖSE THERAPIE DES INTRAUTERINEN RIESENPOLYPEN
K. …zgŸr, M. IßÝkoÛlu
‚. ‚ift•i1, Y. Wessels2, A. KŸpelioÛlu3
Antalya IVF Center, Antalya
1
Özel Bodrum Hastanesi, Bodrum
Introduction: We aimed to reveal mean cornual myometrial thickness (Cm) and 2
Köln Üniversitesi T›p Fakültesi, Köln
fundal midsagittal myometrial thickness (Fm) in infertile population to create a no- 3
vel point of view to the quantification of subseptus uteri. Materials and methods: 9 Eylül Üniversitesi, ‹zmir
79 women presenting for infertility treatment constituted the study group. Measure-
ment of the Fm and Cm by transvaginal sonography (TvUSG) and sonohysterog- Fallbericht: Bei einer 32 jaehrigen Nullipara, die sich wegen Metrorrhagie
raphy (SHG) was performed. Fm was measured at midsagittal plane while both the vorstellte, wurde mittels Vaginalsonographie eine homogen erscheinende Struktur
fundal and the cervical ends of the uterus were visualised on the screen. Cm was mit einem mittleren Durchmesser von 25 mm festgestellt, die das gesamte cavum
measured where the myometrium is the thinnest. Anomalies about fundal contour uteri ausfüllte. Erst wurde eine Probeküretage durchgeführt. ‹n der pathologischen
were excluded by careful imaging in both planes. Results: TvUSG measurements Aufarbeitung erwies sich das Material als sekretorisches Endometrium. Als sich in
for Fm and Cm were 11.9±2.3mm and 6.4±1.4mm respectively. Mean difference der Kontrollsonograpie das Fortbestehen des Prozesses zeigte wurde der Patientin
between Fm and Cm was 5.4±2.4mm. Fm and Cm values on SHG were die hysteroskopische Resektion angeraten. Mit dem Ziel die Dilatation der Zervix
11.4±2.3mm and 6.4±1.5mm respectively. Mean difference between Fm and Cm on zu erleichtern wurde 600mg Misopristol als Vaginaltablette verabreicht. Zu Beginn
SHG was 4.9±2.2 mm. TvUSG showed double-lumen appereance in 12.6% of the der Operation, waehrend der Spekulumeinstellung, wurde ersichtlich, dass der
patients at transvers section. Hysteroscopical exam of 38 correlated with TvUSG Polyp vor die Zervix prolabiert war. Durch Drehung um die eigene Achse liess sich
and SHG. Conclusion: Our data reveal the mean values of endometrial thickness. der Polyp problemlos entfernen. ‹n der anschliessend durchgeführten Hysteroskopie
The study is ongoing to reveal also the infertility treatment outcomes. These preli- fand sich kein Anhalt für eine Blutung. Schlussfolgerung: Für gestielte
minary data may provide a basis for larger prospective studies which aim to de- Riesenpolypen kann Misoprostol in der für einen Abort benutzten Dosis über einen
monstrate the effect of incision of subseptus in infertile population. aehnlichen Mechanismus eine Therapieoption darstellen, ohne dass invasive
Massnahmen notwendig werden.
130
Vol 4(2) 2003 18 May›s 2003 Pazar
P-085 vely. The medical records of all cases were reviewed meticulously, with particular
attention to the the presence initial history and demographic characteristics presu-
SYMPTOMS DISTRIBUTION AMONG INFERTILE AND FERTILE med to be related with endometriosis such as age, body mass index (BMI), age at
menarche, marrital status, educational level (primary school, high school or univer-
ENDOMETRIOSIS CASES WITH DIFFERENT STAGES AND
sity), type of profession (none, teacher, government officer, etc.) parity status, num-
LOCALISATION ber of abortions, presence of medical illness (diabetes, hypertension, gastrointesti-
nal, renal, and pulmonary problems), exercise and smoking status, lenght of lacta-
H. Hassa, H. Mete TanÝr, M. Uray tion, time period since last pregnancy, type of contraception use such as none, con-
dom, intrauterine device tubal ligation, oral contraceptives and traditional methods,
Osmangazi University School of Medicine, Department of Obstetrics and history of endometriosis, the presence of uterine anomaly, lenght of menstrual cycle
Gynecology, Eskiflehir and duration of menstrual flow. Statistical analysis of data included Pearson, Fis-
her’s exact chi-square tests (Yates’ correction, if necessary) for categorical data and
Student’s-t test for continous variables, respectively. Results: Mean age of the ca-
Objective: To evaluate patients symptomatology and relate them with different
ses was 23.1±0.4 years. Most of them were married (85.3%). Mean lenght of menst-
stages and location of endometriosis and also among fertile and infertile
rual cycle and duration of flow were 26.8±0.4 days and 5.4±0.1 days,respectively.
endometriosis cases. Materials and methods: Sixty-eight patients diagnosed with
Age at menarche of early-stage endometriosis (13.0±0.2 years) cases was found to
endometriosis included in this cross-sectional observational study, of whom 55 and
be lower compared to those with late-stage disease (13.9±0.2 years, p=0.004). Me-
13 cases were diagnosed by the visual findings under the guidance of laparoscopy
an age of fertile endometriosis group was high compared to infertile group
and laparotomy, respectively. All cases were categorised into early (stage I and II)
(33.7±1.2 vs 30.6±0.8 years, p=0.04). More cases in the fertile group had a BMI of
and late (stage III and IV) staged endometriosis and fertile and infertile endometrio-
20-25 kg/m2, compared to those of infertile (p=0.01). There were no differences de-
sis. The extent of endometriosis was further divided into peritoneal, ovarian
tected among two groups regarding menstrual factors, socioeconomic factors, state
endometriosis and ovarian + peritoneal endometriosis. The symptoms of dysmen-
of smoking, exercise, medical illness, period of lactation, time period since last
orrhea, deep dyspareunia, dyschezia or dysuria and also depressive mood state were
pregnancy. Conclusion: This first epidemiologic study has documented the patients
analysed among those different groups. Statistical significances for the difference in
profiles of our endometriosis cases during 2.5 years in a university clinic.
the frequency of symptoms in relation to disease stage and site were tested via
Pearson’s chi-square test. Results: Mean age of the cases was 23.1±0.4 years (18-
48). Most of the cases (n=46,67.6%) were early-staged endometriosis. Deep dys-
pareunia, dysuria and dyschesia were seen in 22%, 10% and 4% of total cases,
P-087
respectively. Specific signs included fixed adnexal mass (n=5), uterosacral pain
(n=10), pain in the pouch of Douglas (n=6), nodularity in the Pouch of Douglas
(n=3) and uterosacral ligaments (n=3), pain on the movement of the uterus (n=3), MEDICAL TREATMENT IN RUPTURED ECTOPIC PREGNANCY WITH
painful adnexal mass (n=4). Of 68 women, 27 (39%) reported infertility. In early- HEMODYNAMICALLY STABLE PATIENTS
staged endometriosis cases, infertility was encountered in 22 (77.5%) cases com-
pared to late-staged disease (n=6, 22.2%). Cases with symptomatology other than Y. Kumtepe, M. Ünge•, O. DŸndar, A. Aksoy, G. SaÛÝr, S. KadanalÝ
infertility constituted 77.9% (n=53) of total enrolled study group. Abnormal uterine
bleeding (menometrorrhagia) was observed in 3 cases, two of whom were early- Department of Obstetrics and Gynecology, Faculty of Medicine, Atatürk
staged endometriosis. Cyclic chronic pelvic pain was more relevant in late-staged
University, Erzurum
endometriosis (p=0.04). Cases admitted for pelvic pain of any duration were more
prevalent in fertile endometriosis (p=0.008). More cases in fertile group experi-
enced non-cyclic pelvic pain (p=0.04). Most cases admitted with pelvic pain and Objective: The aim of this study was to determine the success rate of methotrexate
infertility have revealed ovarian endometriosis (p=0.01). Infertility was highly treatment in hemodynamically stable patients with ruptured ectopic pregnancy.
observed in ovarian endometriosis compared to other two localisation (p=0.008). Design: Prospective clinical study based on determination of the effects of
Conclusion: Symptoms of endometriosis may predict, to some extent, the stage and methotrexate treatment on ruptured ectopic pregnancy patients. Patients and
localisation of the disease. Methods: This study was carried out on 161 patients with suspected tubal ectopic
pregnancy. All patients diagnosed with ectopic pregnancy were treated by
methotrexate if they had stable hemodynamia and fulfill the criteria of methotrex-
ate treatment. 46 patients were accepted as ruptured and 115 patients were accept-
P-086 ed unruptured ectopic pregnancy. Single dose (50 mg/m2) methotrexate was admin-
istered to 29 of 46 hemodynamically stable ruptured ectopic pregnancy patients and
CHARACTERISTICS OF ENDOMETRIOSIS IN THE INNER ANATOLIAN 88 of 115 patients with unruptured ectopic pregnancy patients. 18 patients were left
to expectant treatment. Weekly β-hCG measurement has been followed till β-hCG
REGION UNIVERSITY HOSPITAL OF TURKEY
level <10 IU/L in methotrexate-treated patients. Results: The success rate of
methotrexate treatment was determined as 62% (18 of 29 patients) in hemodynam-
H. Hassa, H. Mete TanÝr, M. Uray ically stable ruptured ectopic pregnancy patients. Methotrexate treatment was found
to be successful in 18 patients. Eleven patients were underwent laparoscopy since
Osmangazi University School of Medicine, Department of Obstetrics and onset severe abdominal pain and/or impaired hemodynamic parameters. The suc-
Gynecology, Eskiflehir cess rate of methotrexate treatment in unruptured ectopic pregnancy group was 81%
(71 of 88 patients). The mean times of the success rate of methotrexate treatment in
Objective: To determine the epidemiologic risk factors among fertile and infertile haemodynamically stable ruptured ectopic pregnancy group and unruptured ectopic
endometriosis cases with different stages. Materials and Methods: Sixty-eight ca- pregnancy group were 28±4.4 days (14 to 56 day) and 32±6.2 (7 to 63 day) days
ses visually diagnosed as endometriosis on surgery were enrolled in this cross-sec- respectively. Conclusion: Methotrexate treatment could be confidently preferred
tional study. The diagnosis was made by direct visualisation of typical lesions du- before surgery in ruptured but hemodynamically stable patients, since operative
ring laparoscopy or laparotomy. All cases were categorised into early (stage I-II) laparoscopy or laparotomy has a lot of side effects such as patient discomfort, high
and late (stage III-IV) staged and fertile and infertile endometriosis cases, respecti- surgery cost and anesthetic risks.
131
Vol 4(2) 2003 18 May›s 2003 Pazar
P-088 P-090
FETAL ‹NTRAVENTR‹KÜLER ARAKNO‹D K‹ST: OLGU SUNUMU MANAGEMENT OF HYPOPARATHYROIDISM DURING

PREGNANCY: CASE REPORT AND REVIEW OF THE LITERATURE
A. YŸksel, N. …zcan, S. BŸyŸkkurt, M. …zek
M. KazandÝ, T. ‚Ýrpan, F. Akercan, Ü. Ütil, G. GŸndem
Amaç: Fetal dönemde intrakranial kistik yap›lardan en s›k karfl›lafl›lan› koroid plek
sus kistidir (KPK). Araknoid kist fetal dönemde az say›da tan›mlanm›flt›r. Tan›mla- Ege Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, ‹zmir
d›¤›m›z olgu ise ilk kez intraventriküler yerleflimli araknoid kistin fetal dönemde ta-
n›mlanmas› ile ilgilidir. Olgu Sunumu: 20. gebelik haftas›na kadar hiçbir bulgusu
There is no established therapeutic regimen for treatment of hypoparathyroidism
saptanmayan fetusa bu haftada yap›lan ultrasonografide, sol lateral ventrikülde
during pregnancy. This is due particularly to uncertainty about the use of vitamin D
17x16x14 mm’lik kistik yap› izlendi ve KPK olarak de¤erlendirildi. Ancak 22. ge-
or its analogues, as in animal experiments teratogenic side-effects have been repor-
belik haftas›nda yap›lan kontrol ultrasonografisinde sol ventrikülü dolduran,
ted. Nevertheless, vitamin D or its analogues are required to control tetany predis-
23x31x20 mm’lik, koroid pleksusu arkaya do¤ru iten kistik yap› izlendi. Bu bulgu-
posing to abortion and preterm labour. We herein article the course of one preg-
larla tan› araknoid kist olarak düzeltildi. Ultrasonografide baflka bulguya rastlanma-
nancy in a hypoparathyroid woman treated with calcitriol (1,25(OH)2D3). Additi-
d›. Yap›lan karyotip analizi normal olarak sonuçland›. 26. gebelik haftas›nda yap›-
onally, we describe the outcome of pregnancy in ten women receiving calcitriol, re-
lan fetal magnetik rezonans görüntüleme (MRG) ile tan› do¤ruland›. Pediatrik be-
ported to the Drug Safety Department (DSD), Hoffmann-La Roche AG. A 24-year-
yin cerrahisi, pediatrik nöroloji konsültasyonlar› sonuçlar› ›fl›¤›nda aileye bilgi ve-
old hypoparathyroid woman receiving chronic treatment with calcitriol (0.25
rildi ve gebeli¤in devam›na karar verildi. Gebelik ilerledikçe kistik yap› da büyü-
mg/day) and calcium (1.5 g/day) was referred in the 6th week of her first pregnancy.
meye devam etti. 31. gebelik haftas›nda erken giriflimde bulunabilmek için erken
Calcitriol and calcium was continued, stabilizing serum calcium around 9 mg/dl .
do¤um karar› verildi. 2 ay boyunca bebek cerrahi giriflime haz›rlanana kadar subga-
To maintain normocalcaemia the calcitriol dose was increased to 0.5 mg/day during
leal rezervuar tak›ld›. Araknoid kist duvar› ventrikül içine drene olacak flekilde
the 29rd week and to 1 mg/day shortly before delivery of a healthy girl in the 38th
a¤›zlaflt›r›ld›. Al›nan doku örne¤i ile araknoid kist tan›s› do¤ruland›. Bebek flu anda
week. In eight of the ten pregnancies reported to the DSD no adverse effects of cal-
14 ayl›k ve sa¤ üst ekstremitesindeki fizik tedaviye cevap veren hafif spastisite d›-
citriol (0.25–3.25 mg/day) were seen and healthy babies were delivered.In two ret-
fl›nda sorunu yok. Tart›flma: ‹ntra uterin dönemde en s›k görülen KPK’d›r (%1). 13.-
rospectively reported cases, serious adverse events were described: premature clo-
18. gebelik haftalar›nda belirmeye bafllar ve 28. gebelik haftas›ndan kadar gerileme-
sure of the frontal fontanelle, and stillbirth in the 20th week due to complex fetal
ye bafllar. Ek ultrasonografik bulgu yoksa karyotip analizi gerektirmez. Araknoid
malformation respectively. However, in both cases the causative role of calcitriol
kist ise en s›k orta temporal fossa, interhemisferik fissür, suprasellar bölge ve pos-
administration remains highly questionable. We conclude that, during pregnancy,
teriör fossaya yerleflse de intrakranial kavite ya da spinal kanal›n içinde her yerde
management of maternal hypoparathyroidism with calcitriol and calcium is feasib-
görülebilirler. Literatürde boyutlar› gerilemeyen iki KPK olgusundan bahsedilmek-
le, if the 1,25(OH)2D3 concentrations are adapted to the physiological needs during
tedir. Bunlardan biri gerilememifl, di¤eri ise do¤umdan sonra bile büyümeye devam
pregnancy and serum calcium levels are kept in the lower normal range.
etmifltir. Tan›mlad›¤›m›z olgu ilk kez fetal dönemde saptanm›fl intraventriküler
araknoid kisttir. ‹ntraventriküler kistik kütle saptand›¤›nda 2-3 hafta sonra kistin bo-
yutlar›n›n yeniden de¤erlendirilmesi do¤ru bir tutum olacakt›r.
P-091
P-089 SURGICAL APPROACH TO ECTOPIC PREGNANCIES
PERS‹STAN SA⁄ UMBL‹KAL VEN (PSUV); B‹R ANOMAL‹ YA DA T. ‚Ýrpan, F. Akercan, M. KazandÝ, F. ÞendaÛ, S. YŸcebilgin, S. …zßener
VARYASYONUN PRENATAL TANISI VE L‹TERATÜRÜN SONUÇLARI
Ege Üniversitesi T›p Fakültesi, Kad›n Hastal›klar› ve Do¤um AD, ‹zmir
A. YŸksel, S. BŸyŸkkurt, H. Savaß

Objective: Our goal is to determine the factors that affect the surgeons’ choice bet-
ween laparotomy and laparoscopy for the surgical therapy of ectopic pregnancies,
Amaç: PSUV’in prenatal dönemdeki tan›s› ile ilgili deneyimlerimizi aktarmak ve since 1998 August, in our clinic. Materials and Methods: A retrospective study
literatürdeki bilgileri gözden geçirmektir. Gereç ve Yöntem: 01 Kas›m 1999 ve was performed to the case of ectopic pregnancies from August 1998 through Au-
31.Aral›k.2001 tarihleri aras›nda 6657 fetusa detayl› ultrasonografik inceleme ya- gust 2002. The laparotomy and laparoscopy surgical treatment groups were compa-
p›ld›. Bu gruptaki PSUV vakalar› geriye dönük olarak incelendi. PSUV tan›s› için red with student t test. Results: The database included 80 cases. The sixtyfive ca-
gerekli kriterler mideye yönelen portal ven, mide ile umbilikal ven aras›na yerlefl- ses (%81.25) had been treated with laparotomy and while the rest fifteen (%18.75)
mifl safra kesesi, umbilikal venin sa¤ portal ven ile birleflmesi olarak belirlendi. had been treated laparoscopically. When compared, the rate of acute abdomen was
PSUV tan›s› koyulan fetuslarda situs inversus olmad›¤› kontrol edildi. E¤er efllik significantly higher in laparotomy group (%90.76 59/65 laparotomy group- %33.33
eden anomali varsa veya baflka bir nedenden ötürü gerekiyorsa fetal kromozom ana- 5/15 laparoscopy group, p<0.01); the rate of the cases with hemoperitonium was al-
lizine yönelik invazif giriflim önerildi. Bulgular: Detayl› ultrasonografik inceleme so significantly higher in laparotomy group (%84.61 55/65 laparotomy group-
yap›lan 6657 fetusun sekizinde PSUV saptand› (%0,12). Ortalama tan› haftas› %33.33 5/15 laparoscopy group, p<0.01). The rate of cases that had a hCG level of
21,25±3,53’tü. Dört fetusa çeflitli nedenlerle amniyosentez yap›ld› ve tümünde nor- >1500 IU/ml was significantly higher in laparotomy group (%83.07 54/65 laparo-
mal karyotip saptand›. Bir fetusta tek umblikal arter, iki fetusta konjenital kalp ano- tomy group- %33.33 5/15 laparoscopy group, p<0,01). The rate of cases that had a
malisi, bir hepatik kalsifikasyon saptand›. Konjenital kalp anomalisi olan fetuslar- ectopic pregnancy mass diameter of >4cm was significantly higher in laparotomy
dan birinde spina bifida da vard›. Konjenital kalp anomalisi saptanan fetuslar aile- group (%96.92 63/65 laparotomy group- %40.0 6/15 laparoscopy group, p<0.01).
lerinin de onay› ile sonland›r›ld›. Di¤er dört fetusta ek ultrasonografik bulguya rast- The percent of cases with ampuller tubal ectopic pregnancies was %70.76 (46/65)
lanmad›. Ancak bunlardan birinde do¤um sonras› konjenital kalp anomalisine rast- for the laparotomy and %86.66 (13/15) for the laparoscopic cases; and the differen-
land›. Sonuç: ‹zole PSUV vakalar› genellikle olumlu fetal ve neonatal prognoz ile ces between two groups was not significant (p>0.01). Also the percent of cases with
birlikte olsa da; saptand›klar›nda baflta kardiyovasküler sistem olmak üzere tüm sis- extirpative surgery was %89.23 (58/65) for the laparotomy and %60.0 (9/15) for the
temler ultrasonografik olarak detayl› incelemeye al›nmal›d›r. Ek ultrasonografik laparoscopic cases; and the differences between two groups was not significant eit-
bulguya rastlan›l›rsa fetal karyotipleme önerilmelidir. her (p>0.01). Conclusion: At the ectopic pregnancy cases, the surgeons’ choice
between laparotomy and laparoscopy depends on the hemodynamic stability of the
patient, diameter and localization of ectopic pregnancy mass, and surgeons’ experi-
ence.
132
Vol 4(2) 2003 18 May›s 2003 Pazar
P-092 P-094
GEBEL‹⁄‹N ERKEN DÖNEM‹NDE M‹YOMEKTOM‹: OLGU SUNUMU ENFLAMASYON VE ASCUS SMEAR NET‹CES‹ OLAN OLGULARIN
KOLPOSKOP‹ VE KOLPOSKOP‹K B‹OPS‹ SONUÇLARININ
T. ‚Ýrpan, M. KazandÝ, S. …zßener, S. YŸcebilgin KARfiILAfiTIRILMASI
Ege Üniversitesi T›p Fakültesi, Kad›n Hastal›klar› ve Do¤um AD, ‹zmir S. Þahin, S. Sezgi, R. YÝldÝzhan, E. AdalÝ, M. EroÛlu, B. Tok
Gebelikde miyomlara s›k rastlan›r, insidans› %1,4’dür. Gebeliklerin 1/500’ünde Göztepe SSK E¤itim Hastanesi, ‹stanbul
miyomla ilgili bir komplikasyon mevcutdur. Gebelik esnas›nda tespit edilen solid pel-
vik tümörlerin ço¤u uterus miyomlar›d›r. Miyomlar submüköz, intramural, subseröz
Amaç: Enflamasyon ve ASCUS smear neticesi olan olgularda kolposkopi ve kol-
ve pedünküllü olabilirler; bunlar›n ço¤u asemptomatik kalmakla birlikde abortus, int-
poskopik biopsi neticelerinde displazi oran›n› araflt›rmak. Gereç ve Yöntem: Bet-
rauterin geliflme gerili¤i, malprezentasyon, bafl pelvis uygunsuzlu¤u, ablasyo plasen-
hesda sistemine göre benign ve ASCUS tespit edilen hastalardan 69’u çal›flma gru-
ta, erken do¤um tehdidi, sepsis, postpartum kanama ve endometrite neden olabilirler.
bumuzu oluflturdu. Çal›flmam›za kat›lan olgular›n 56’s› enflamasyon, 13’ü ASCUS
Pedünküllü subseröz myomlar torsiyone olup nekroza yol açabilirler. Miyomlu gebe-
smear neticesi olan hastalard›. Kolposkopik muayene ve tüm hastalardan gerçek in-
de sezeryanl› do¤um ve postpartum histerektomi riski artar. Bu komplikasyonlar
sidans› bulabilmek amac›yla servikal biopsi ve endoservikal kürtaj materyali örnek-
miyom lokalizasyonu ve büyüklü¤ü ile iliflkilidir, retroplesental miyomlar özellikle
lemesi yap›ld›. Bulgular: Olgular›m›z›n yafllar› ise 23 ila 72 aras›nda de¤iflmekte
yüksek risklidir.iGebelikte ve puerperyumda miyomlarda hemorajik infarkt nedeniy-
olup yafl ortalamas› 11.68’dir. Benign karakterdeki smeari olan hastalar›n kolpos-
le k›rm›z› veya karnöz dejenerasyon görülebilir, sonuçta lokal a¤r›, atefl ve palpasyon-
kopisinde (44.11) %26,8’i asetowhite alan göstermekte idi. Olgular›n yap›lan bi-
da hassasiyet oluflabilir; ve bu nedenle kimi zaman apandisit, ablasyo plasenta, ureter
yopsilerinde %10,7’sinde CIN I ve %1,7’sinde CIN II-III histopatolojik tan› netice-
tafl› veya piyelonefrit ile ay›r›c› tan›s› gerekebilir. Bu olguda 15 haftal›k gebelik +
si gelmifltir. ASCUS smear neticelerine sahip kad›nlar›n yap›lan kolposkopisinde
miyomu olan ve fliddetli kar›n a¤r›s› nedeniyle laparatomiye al›narak miyomektomi
%76,9 oran›nda asetowhite epitel gözlendi. Bu olgular›n yap›lan biyopsilerinde en
uygulanan bir olgu sunulmufl, gebeliklerde miyomektomi tart›fl›lm›flt›r.
fazla %30,7 metaplazi neticesi gelmifltir. %15,4 oran›nda CIN I ve yine %15,4 ora-
n›nda CIN II-III histopatolojik tan› sonucu gözlenmifltir. SONUÇLAR: Benign
smear neticesi olan kiflilerde orta ve yüksek dereceli displazik epitel gösteren olgu-
lar %2 oldu¤u için rutin smear kontrolleri yapmak ve smear al›n›fl tekni¤ini ve za-
P-093
man›n› do¤ru uygulayarak yanl›fl negatif sonuçlar› azaltmak gerek harcanan zaman
gerekse maliyet aç›s›ndan en do¤ru yaklafl›m olacakt›r. ASCUS tespit edilen olgu-
EFFECT ON LUTEAL SUPPORT WITH VAGINAL MICRONIZED lar bizim çal›flmam›zda vaka say›m›z›n azl›¤›na ba¤l› olarak literatüre göre daha
PROGESTERONE GEL IN ASSISTED REPRODUCTION yüksek orta ve yüksek dereceli displazik epitel oranlar› göstermektedir.
F. VanlÝoÛlu, S. Kahraman, G. KarlÝkaya, H. KaragšzoÛlu, M. AygŸn
Reproductive Endoctinology & Genetics Unit, Istanbul Memorial Hospital, P-095

Istanbul
GENETIC EVALUATION OF MEN WITH NONOBSTRUCTIVE
Introduction: This study was compared the efficacy of vaginal administration of pro- AZOOSPERMIA
gesterone and intramuscular administration of progesteron on biochemical, clinical
pregnancy and abortion rate in patients undergoing ART. Materials&Metod(s): Betwe- N. Er•elen1, H. Þimßek1, H. Coßkun1, F. KšroÛlu1, M. GŸltomruk1,
en April 2002 and November 2002 This retrospective study was realized in women un- E. Tutar1, B. Urman2
dergoing ICSI due to severe male factor infertility (n=150) which were divided into two
subgroups according to the administration of progesteron . Group I (n=75) in patients 1
Genetics Department, American Hospital, Istanbul
were received with vaginal progesterone gel, 90 mg once daily beginning on the eve- 2
Assisted Reproduction Unit, American Hospital, Istanbul
ning of oocyte retrieval and Group II (n=75) in patients were received with intramuscu-
lar progesterone, 75 mg once daily beginning on the evening of oocyte retrieval. In this
study, clinical pregnancy was defined as the presence of a gestational sac, irrespective Aim: Aproximately 20% of nonobstructive azoospermic subjects have chromoso-
of the presence of fetal heartbeats on ultrasonic examination. All patients used the same mal abnormalities and/or micro deletions of the Yq chromosome. In this study, we
protocol and transferred the same quality embriyos. Blood samples were performed on evaluated the karyotypes and the Y chromosome deletions of 79 men referred to our
day 12 after transferred embriyos to estimate the progesterone level. Results: Implan- clinic for nonobstructive azoospermia. Materials and Methods: Molecular Study:
tation rates in patients receiving vaginal progesterone gel were 22% (Group I) and in pa- Genomic DNA from seventy-nine patients was extracted from peripheral blood. To
tients receiving intramuscular progesterone were 20% (Group II). In Group I Biochemi- detect presence or absence of previously identified and mapped 18 sequence tagged
cal pregnancy rate was 58% and in Group II was 56%. In Group I Biochemical preg- sites, multiplex PCR was performed according to Y Chromosome Deletion
nancy loss was 14% and in Group II was 17%. In Group I Clinical pregnancy rate was Detection System, Version 1.1 (Promega). These 18 sequence-tagged sites were on
46% and in Group II was 44%. In Group I miscarriage rate was 16% and in Group II the AZFa, b, c and d regions of the long arm of the Y chromosome. Karyotype
was 19%. In Group I ongoing pregnancy rate was 37% and in Group II was 34%. In Analysis: 3 ml peripheral blood was withdrawn from 79 patients for whole-blood
Group I mean SD blood Progesteron level (ng.ml) was 11±1.4 and in Group II was cultures. Metaphase chromosomes were stained with standard G banding tech-
23±2.4 (p<.01). Conclusion(s): This study showed that vaginal progesterone gel is as niques and analyzed. Results: Deletion was detected at different parts of investi-
effective as intramuscular progesterone on biochemical, clinical and miscarriage rates gated regions on Y chromosome in seven out of seventy-nine (8.9%) patients. AzFa
and convenient luteal support in patients undergoing ART. region deletion was detected in 1.3% of cases where AzFb region was deleted in
5.1%. AzFc and AzFd regions were deleted in 7.6% cases separately. Klinefelter
syndrome was identified in 14 (17.7%) patients. Translocation t (1; 13) (q24, q10)
Table: (P-094) was seen in one patient with no deletion on Y chromosome. Of two patients identi-
Group I (n=75) Group II (n=75) p value fied as Y deletion positive, one was identified with 46, XY del(Y),q11.223 and the
other with 45 XO/46, XY del(Y)(q11)(70/53) mosaisizm. In the studied group,
Implantation rate(%) 22 22 NS chromosomal polymorphisms were detected in 9% patients, mostly including chro-
Biochemical preg. (%) 58 56 NS mosome 9. Conclusion: Evaluation of 79 men with nonobstructive azoospermia
Biochemical preg.loss (%) 14 17 NS revealed that 29% of these men had definable genetic defects (Y chromosome micro
deletions or karyotype abnormalities).
Clinical preg.(%) 46 44 NS
Ongoing preg.(%) 37 39 NS
Miscarriage rate(%) 16 14 NS
Progesterone 11±1.4 23±2.4 p<.01
mean±SD (pg/ ml)
133
Vol 4(2) 2003 18 May›s 2003 Pazar
P-096 P-098
ENDOMETR‹OZ‹S‹N MED‹KAL TEDAV‹S‹NDE TR‹PTOREL‹N VE ANORMAL UTER‹N KANAMALARDA SONOH‹STEROGRAF‹N‹N YER‹

DANAZOLÜN SEMPTOMLARI G‹DERME ÜZER‹NDEK‹ ETK‹NL‹KLER‹
VE KARfiILAfiTIRILMASI F. Karatepe, S. Bozkurt, D. ArÝkan, A. Þahin, M. Ekiz, R. AbalÝ
M. Solak Vatandost, T. …zkÝlÝ•, D. ArÝkan, S. Bozkurt SSK ‹stanbul E¤itim Hastanesi, ‹stanbul
SSK ‹stanbul E¤itim Hastanesi, 2. Kad›n Hastal›klar› ve Do¤um Klini¤i, Amaç: Anormal uterin kanamalar›n etiyolojisinin belirlenmesinde, sonohisterogra-
fi (SHG) nin oldukça etkin ve de¤erli bir tan› yönteminin oldu¤unun ortaya konma-
‹stanbul
s›. Gereç ve Yöntem: Anormal uterin kanama flikayetiyle baflvuran, yap›lan pelvik
ve ultra sonografi (USG) muayenesinde uterusa ve adnekslere ait kitle tespit edil-
Amaç: Çal›flmam›zda; endometriozisli kad›nlarda Triptorelin ve Danazol ajanlar›n›n meyen 30 hastaya, SHG ve hemen ard›ndan full küretaj (F/C) yap›lm›flt›r. SHG’de
semptomlar› giderme etkinliklerini ve birbirleri aras›ndaki üstünlüklerini araflt›rd›k. endometrial kavitede kitle tespit edilen hastalara daha sonra histeroskopi uygulan-
Gereç ve Yöntem: fiubat 1999-A¤ustos 2001 tarihleri aras›nda klini¤imizde lapa- m›flt›r. Çal›flman›n sonunda USG, F/C ve histeroskopi sonuçlar›, SHG sonuçlar›yla
roskopi ve laparatomi ile endometriozis oldu¤u kan›tlanm›fl 38 hasta çal›flmaya al›n- karfl›laflt›r›lm›flt›r. Bulgular: Anormal uterin kanamalar›n etiyolojisinin belirlenme-
d›. 28 hastaya 3,75 mg Triptorelin depot IM, 6 ay süreyle 28 günde bir verildi. Di- sinde, SHG’nin di¤er tan› metotlar› ile (USG, F/C, Histeroskopi) karfl›laflt›r›ld›¤›n-
¤er 10 hastaya ise günde iki kez 200 mg Danazol, 6 ay süreyle oral verildi. Tedavi da ortaya konan sensitivite, spesifisite, pozitif ve negatif prediktif de¤erleri s›ras›y-
öncesi ve sonras›; ana semptomlar (dismenore, disparoni, pelvik rahats›zl›k ve a¤r›) la; %94.1, %92.3, %94.1 ve %92.3 olarak bulunmufltur. Sonuç: SHG, transvaginal
ve jinekolojik muayene ile saptanan bulgular› (pelvik hassasiyet ve indurasyon) en- USG esnas›nda uterin kaviteyi de¤erlendirebilmek amac›yla,kavite içerisine salin
dometriozis skorlama sistemine göre yap›ld›. Bulgular: Triptorelin grubunda disme- s›v›s› verilerek gerçeklefltirilen bir tan› yöntemidir. Transvaginal USG, uterusa ait
noreden yak›nan hasta oran›nda % 50 azalma gözlenirken, bu oran pelvik a¤r›da kitlelerin ve endometrial anormalliklerin (artm›fl kal›nl›k, endometrial düzensizlik,
%28,6, disparonide %50 olarak bulundu. Danazol grubunda dismenorede %50, pel- fokal kal›nlaflma) tan›s›nda oldukça duyarl› olmakla birlikte, lezyonlar›n gerçek lo-
vik a¤r›da %30, disparonide %30 azalma gözlendi. Menoraji aç›s›ndan Triptorelin kalizasyonlar›n›n, boyutlar›n›n ve uterin kaviteyle olan iliflkilerinin belirlenmesinde
grubunda %25, Danazol grubunda %40 azalma görüldü. Adet düzensizli¤i Triptore- s›kl›kla yetersiz kalmaktad›r. SHG ise, miyometrium ve uterin kaviteye ait detayl›
lin grubunda tamamen düzelirken (%32,1 azalma) Danazol grubunda de¤ifliklik gö- bilgiler vermekte; USG’de endometriumun kal›n ve düzensiz gözüktü¤ü veya endo-
rülmedi. Her iki grubun tedavi bitiminde semptomlar›n azalma oranlar› karfl›laflt›r›- metrium s›n›rlar›n›n ve miyometriumla olan ay›r›m›n›n net olarak yap›lamad›¤› du-
l›nca benzer düzeyde etkili olduklar› bulundu. Tedavi sonras› gebelik saptanan 8 ol- rumlarda, altta yatan patolojiyi (hiperplazi, submuköz miyom, intrakaviter miyom,
guya da triptorelin uygulanm›flt›. Triptorelin grubunda fertilite oran› %38 bulundu. endometrial polip, fokal büyüme) net olarak ortaya ç›karmaktad›r. SHG, özellikle
Sonuç: Triptorelin ve Danazol endometriozisin ana semptomlar› olan dismenore, anormal uterin kanamalarda, uterin kaviteyi de¤erlendirmede oldukça yüksek bir
disparoni ve pelvik a¤r›y› gidermekte ayn› derecede etkilidir. Endometriozisli infer- sensitivite, spesifisite ve do¤rulu¤u olan bir görüntüleme yöntemidir. Ucuz, kolay
til olgularda, GnRH analo¤u verilerek gebelik flans› elde edilebilmektedir. uygulanabilir olmas›, invazif olmamas›, hastaya rahats›zl›k vermemesi de di¤er
avantajlar›d›r. SHG, anormal uterin kanamalar›n nedeninin araflt›r›lmas›nda etkili
bir yöntem olmas›n›n yan›nda, daha sonra uygulanacak cerrahi yaklafl›m›n seçilme-
sinde de yol gösterici olmaktad›r.
P-097
ANKARA ‹L MERKEZ‹NDE BULUNAN BEfi AÇSAP MERKEZ‹NE

BAfiVURAN 15 YAfi VE ÜZER‹ KADINLARDA STRES ‹NKONT‹NANS P-099
PREVALANSI
KÜRETAJ ESNASINDA KOPARAK KAYBOLAN KARMANN KANÜL
A. Biri1, E. Durukan2, I. Maral2, H. Biri3, B. TÝraß3, M. Bumin3 UCUNUN H‹STEROSKOP‹ YARDIMI ‹LE SUBVES‹KAL SAHADAN
ÇIKARTILMASI
1
Gazi Üniversitesi T›p Fakültesi, Kad›n Hastal›klar› ve Do¤um AD, Ankara
2
Gazi Üniversitesi T›p Fakültesi, Halk Sa¤l›¤› AD, Ankara F. YazÝcÝoÛlu, S. Kelek•i
3
Gazi Üniversitesi T›p Fakültesi, Üroloji AD, Ankara
Süleymaniye Do¤um ve Kad›n Hastal›klar› E¤itim ve Araflt›rma Hastanesi,
Amaç: Bu araflt›rman›n amac› Ankara il merkezinde bulunan befl Ana Çocuk Sa¤- ‹stanbul
l›¤› ve Aile Planlamas› Merkezi’ne baflvuran 15 yafl ve üzeri kad›nlarda stres inkon-
tinans prevalans›n›n saptanmas›d›r. Gereç ve Yöntem: Bu araflt›rma 17.01.2002 ile Endometrial örnekleme esnas›nda No:5 Karmann kanülü ile isthmus ön duvardan
31.01.2002 tarihleri aras›nda Ankara il merkezinde befl Ana-Çocuk Sa¤l›¤› ve Aile perforasyon yap›lan olguda kanülün ucundan 2 cmlik bir bölümün koptu¤unun an-
Planlamas› (AÇSAP) Merkezine herhangi bir nedenle baflvuran 15 yafl üzeri 3465 lafl›lmas› üzerine klini¤imize refere edildi. Ultrasonografide Douglas’ta mayi art›fl›
kad›n›n 2601’ine (%71.4) yüz yüze görüflme tekni¤i ile anket uygulanarak yap›l- d›fl›nda bir özellik saptanamayan ve kanül ucunun lokalizasyonu belirlenemeyen ol-
m›flt›r. Bulgular: ‹ncelenlerin %59.9’unda nokturi , %20.5’inde uriner inkontinas guya önce laparoskopi yap›ld›. Uterus serozas›n›n tümüyle intakt bulunmas› ve int-
saptanm›flt›r. Stres inkontinans prevalans› %16.1, urge inkontinans prevalans› ise raperitoneal kanama görülmemesi üzerine 5.5 mm’lik tan›sal histeroskopi düzene¤i
%12.8 olarak belirlenmifltir. Hem stres inkontinans ve urge inkontinans hem de ile ve distansiyon medyumu olarak glisin yerine serum fizyolojik kullan›larak per-
nokturi aç›s›ndan tüm yafl gruplar› aras›nda istatistiksel olarak anlaml› fark saptan- forasyon trakt› izlendi ve subvezikal sahada kalm›fl bulunan kanül ucu görüldü. Ta-
m›flt›r (p<0.05). Do¤um say›s›na göre stres inkontinas varl›¤›na bak›ld›¤›nda, nulli- kiben perforasyon trakt› Hegar bujileri ile 8 mm’ye kadar geniflletilerek 7.5 mm’lik
parlarda stres inkontinans oran› %9.4, primiparlarda %10.4, multiparlarda ise operatif histeroskopi düzene¤i subvesikal sahaya ithal edildi. Düzene¤in biyopsi ka-
%34.7’dir. Yap›lan do¤um say›s› artt›kça stres inkontinans görülme s›kl›¤› da art- nal›ndan yollanan 1 mm’lik punch biyopsi forsepsi ile kopuk parça direkt gözlem
maktad›r (p<0.05). Stres inkontinas aç›s›ndan birer risk faktörü olan sistemik has- alt›nda yakalanarak d›flar› al›nd›. Laparoskopik kontrolde tüm parametrial ve para-
tal›k varl›¤› ve geçirilmifl pelvik ameliyat hikayesi yönünden incelendi¤inde siste- vesikal sahalar›n distansiyon medyumu ile enfiltre oldu¤u görüldü. 1 gün sonra ya-
mik hastal›¤› olanlar ile olmayanlar aras›nda stres inkontinas görülmesi aç›s›ndan p›lan ultrasonografik kontrolde subvesikal sahada minimal mayi d›fl›nda bir özellik
istatistiksel olarak anlaml› bir fark vard›r (p<0.05). Pelvik operasyon geçiren ve ge- bulunmayan olgu flifa ile taburcu edildi.
çirmeyenler aras›nda da stres inkontinans varl›¤› yönünden istatistiksel olarak an-
laml› fark saptanm›flt›r (p<0.05).
134
Vol 4(2) 2003 18 May›s 2003 Pazar
P-100 P-102
COMPARISON OF TWO ART APPROACHES ON PATIENTS WITH CORRELATION OF MATERNAL SERUM CERULOPLASMIN WITH
TRANSIENT AZOSPERMIA NEONATAL OUTCOME IN PREECLAMPSIA
S. Sertyel, S. Kahraman, A. Kahraman, N. FÝndÝklÝ, S. †nal, H. Yelke, Y. †stŸn, Y. Engin †stŸn, Þ. ZeteroÛlu, M. GŸvercinci, M. KamacÝ
S. Melil
Yüzüncü Y›l University Faculty of Medicine, Gynecology and Obstetrics
Reproductive Endocrinology & Genetics Unit, Istanbul Memorial Hospital, Department, Van
Istanbul
Objective: Our aim is to evaluate the relation between maternal serum levels of
Introduction: Patients with transient azospermia have changing patterns of no or ceruloplasmin and fetal outcome in preeclampsia. Material and Methods: Forty
very low number of spermatozoa after an extensive examination in consecutive seven women with a diagnosis of preeclampsia were recruited into the study group
semen analyses. The aim of this study was to evaluate the embryo development and and eighteen women with normal ongoing pregnancy into control group. Maternal
clinical outcome in cycles where either ejaculated or testicular spermatozoa was venous blood samples obtained after the onset of labor were assayed for the deter-
used as a sperm source for such patients. Materials and Methods: 98 ICSI cycles mination of ceruloplasmin. Neonatal outcome variables included birth weight,
in which more than 5 mI oocytes were collected were retrospectively analyzed and Apgar scores (1.5 minutes), umbilical cord blood gases at birth, the length of neona-
grouped according to either ejaculated (Group I, n=43) or testicular (Group II, tal intensive care unit stay, respiratory distress syndrome and sepsis. Results:
n=55) spermatozoa used. For 5 patients, both approaches were applied on consecu- Maternal serum ceruloplasmin was higher in pregnant women with preeclampsia
tive cycles. After ICSI, embryos were cultured using sequential media until uterine compared with those of normal pregnancy (p<0.001). Maternal serum ceruloplas-
transfer and scored daily for embryo development parameters. Pregnancy was min was significantly and positively correlated with the length of the hospital stay
assessed by serum hCG assay and transvaginal ultrasonography. Results: Main of the neonate and negatively correlated with umbilical artery blood pH.
cycle parameters were similar for both groups. No significant difference in preg- Conclusion: An increased maternal serum ceruloplasmin can be used as a marker
nancy (40.0% vs. 51.9%) nor implantation rates (12.1% vs. 18.8%) was observed for predicting fetal acidemia.
for either ejaculated or testicular spermatozoa (p>0.05). Embryos in both groups
showed similar fertilization (59% vs. 63.1%) and cleavage rates; although, a signif-
icantly higher number of embryos were found to be arrested at prezygote stage in
Group II (p<0.01). In 5 patients on which both approaches were applied, 5 preg- P-103
nancies were obtained in 15 cycles. Conclusion: Unpredictable sperm recovery in
fresh ejaculates sometimes necessitates the application of testicular sperm extrac- ADOLESANLARDA DÜfiÜK DOZ ORAL KONTRASEPT‹FLER‹N VÜCUT
tion on patients with transient azoospermia. Our results showed that in these cases, A⁄IRLI⁄I ÜZER‹NE ETK‹S‹
both approaches can be alternatively applied. More data is needed to evaluate
whether there is any benefit for either of these approaches on certain patient char-
acteristics. L. Erkan, H. Aktan, H. ‚aÛlar
KADOMER Kad›n Hastal›klar› ve Do¤um Merkezi, ‹zmir
P-101 Amaç: Bu çal›flman›n amac›, genç kad›nlarda düflük dozlu bir oral kontraseptif (20
mg Ethinyl Estradiol ve 150 mg desogestrel) kullan›m›na ba¤l› geliflebilecek vücut
PELV‹K AKT‹NOM‹ÇES ENFEKS‹YONU a¤›rl›¤› (VA) de¤iflimlerini de¤erlendirmekti. Gereç ve Yöntem: Çal›flmaya Eylül
2001-May›s 2002 tarihleri aras›nda klini¤imize baflvuran 25 hasta dahil edildi. Has-
talar›n 15’ine kontraseptif amaçl›, 10’una non-kontraseptif (dismenore, siklus dü-
F. KayÝk•ÝoÛlu, M. AkgŸl, …. Demir, M. GŸneß, A. Haberal zensizli¤i, basit over kisti) amaçl› ilaç baflland›. 28 günlük siklusun ilk 21 gününde
20 mgEE/150mgDSG (Myralon tb) verildi.Çal›flmaya kat›lan olgular›n bafllang›ç
SSK Ankara Do¤umevi ve Kad›n Hastal›klar› E¤itim Hastanesi, Ankara kilolar› 56-70 kg aras›ndayd›. 6 ay boyunca her ay sonunda hastalar›n vücut a¤›rl›k-
lar› kaydedildi. Bu non-randomize çal›flmaya dahil edilen olgular›n hiçbiri daha ön-
Amaç: Pelvik aktinomiçes tan›s› alan olgular›n klinik ve labarotuar özelliklerini ir- ce OK kullanmam›fl olgulard›. Bulgular: 2 hasta 6 siklus tamamlamadan, çal›flma-
delemek. Gereç ve Yöntem: Hastanemiz jinekoloji klini¤inde 1 Ocak 2002 ile 31 y› yar›da b›rakt› ve bu hastalar çal›flma d›fl› b›rak›ld›. ‹lk siklus sonunda hastalar›n
Aral›k 2002 tarihleri aras›nda pelvik aktinomiçes tan›s› alan befl hasta incelendi. 18’inde(%78) VA küçük art›fl ve azalmalar fleklinde de¤iflti, ancak 6 siklus sonun-
Hastalar›n baflvuru yak›nmalar›, tan› yöntemleri, tedavi seçenekleri ve bu tedavile- da hastalar›n kilolar›, bafllang›ç kay›tlar›na göre, anlaml› de¤ifliklik göstermedi.5
re yan›tlar› gözden geçirildi. Bulgular: Hastalar›n yafllar› 32–52 aras›nda idi. Bir hastada (%22) kilo art›fl›, 4 hastada (%17) azalma izlendi. Di¤er 14 olgunun VA’da
hasta d›fl›ndaki dört olguda tan› an›nda R‹A bulunuyordu. Bir olguda enfeksiyona de¤ifliklik olmad›. Kilo art›fl› olan olgularda, ortalama 2.5±1 kg art›fl, kilo kayb›
ba¤l› sol hidronefroz saptand›. ‹ki hasta postoperatif tan›nabilirken, di¤er üç hasta- olan hastalarda ortalama 2.0±1 kg azalma saptand›. Olgular›n hiçbirinde gebelik
ya operasyon yap›lmadan tan› (ikisi servikal smear, biri endometrial biopsi) kona- oluflmazken, 2 olguda bafla¤r›s›, 1 olguda meme hassasiyeti, 1 olguda libido azal-
rak medikal tedavileri (Penisilin G) verildi. Medikal tedavi uygulanan hastalar ha- mas› yak›nmas› kaydedildi. Dismenore (%48), siklus düzensizli¤i (%91) ve sebore-
len sorunsuz izlenmektedir. Sonuç: R‹A bulunan hastalarda pelvik enfeksiyon ay›- ik cilt yap›s›nda (%43) düzelme saptand›. Yorum: Myralon®, adölesan dönem kul-
r›c› tan›s›nda aktinomiçes enfeksiyonu akla gelmelidir. Çevre dokulara infiltratif lan›c›lar› için, iyi tolere edilebilen, non-kontraseptif yararlar› olan ve vücut a¤›rl›¤›-
yay›lma özelli¤i gösterdi¤inden operasyon morbiditesini ortadan kald›rmak için ol- n›, anlaml› ölçüde de¤ifltirmeyen, iyi bir seçenektir.
gulara preoperatif tan› konmas› büyük önem tafl›r ve uzun süreli Penisilin G ile te-
davileri baflar›l›d›r. Medikal tedaviye yan›ts›z veya komplikasyonlu olgular operas-
yon aday›d›r.
135
Vol 4(2) 2003 18 May›s 2003 Pazar
P-104 body fat mass was positively correlated with fasting insulin and homeostasis model
assessment, equally; fat-free mass was inversely correlated. There was a positive re-
SPERM ELDE ED‹LEMEYEN ST‹MÜLE ICSI S‹KLUSLARINDA lationship between fat-free mass and estradiol. Conclusion: Homeostasis model as-
sessment revealed that tibolone and combined oral hormone replacement therapy
FOL‹KÜL ASP‹RASYONU C‹DD‹ OHSS’YE KARfiI KORUYUCU MU?
might have not any harmful effect on insulin sensitivity in healthy, obese, postme-
nopausal women.
I. TŸrk•Ÿoglu, C. Demirel, K. Aydos, C. †nlŸ
Ankara Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, Ankara

P-106
Amaç: Nonobstrüktif azospermi tan›s› ile testisten sperm ekstraksiyonu (TESE) ve
intrasitoplazmik sperm enjeksiyonu (ICSI) planlanan, ifllem günü TESE’de sperm OVARIAN ABSCESS DUE TO BRUCELLA MELITENSIS:
bulunamayan hastalarda folikül aspirasyonu yap›lmamas›n›n ciddi ovaryan hipers- A CASE REPORT STUDY
timulasyon sendromu (OHSS) oran› üzerine etkisini araflt›rmak. Gereç: Ocak 1999
ile Mart 2003 tarihleri aras›nda Ankara Üniversitesi T›p Fakültesi Kad›n Hastal›k-
lar› ve Do¤um Tüp Bebek Ünitesine nonobstrüktif azospermi tan›s› ile baflvuran V. Fenk•i, S. CevrioÛlu, M. YÝlmazer, E. SÝrthan
TESE ve ICSI planlanan, ovulasyon indüksiyonu yap›lan ve testis dokusunda sperm
bulunamayan hastalar›n eflleri çal›flmaya dahil edildi. Toplam 38 siklus de¤erlendir- Department of Obstetrics and Gynecology, School of Medicine,
meye al›nd›. Hastalar›n yafl›, indüksiyon öncesi ultrasonografide overlerde polikis- Kocatepe University, Afyon
tik görünüm varl›¤›, ovülasyon indüksiyonunun süresi ve toplam gonadotropin do-
zu, human koryonik gonadotropin (hCG) günü östradiol düzeyi, 15 mm’nin üzerin- Objective: To report a case of brucellar ovarian abscess that is a rare one. Methods:
deki folikül say›s› de¤erlendirildi. ‹statistiksel analiz ki-kare testi ile yap›ld›. A 25-year-old woman with ovarian abscess caused by Brucella melitensis was repor-
Yöntem: Retrospektif çal›flma. Bulgular: Hastalar›n ortalama yafl› 30.08 yafl (22- ted. Tumor markers, brucella antibody agglutination titre were measured. Sonograp-
42 yafl) idi. 38 hastan›n 7’sinde polikistik over görüntüsü mevcuttu. Hastalar›n hep- hic and computed tomographic appearances were evaluated. Operative laparoscopy
sine midluteal faz uzun gonadotropin salg›lay›c› hormon (GnRH) agonisti protoko- was performed. Cultures of blood, ascites, and a pus specimen obtained from the
lü ile ovulasyon indüksiyonu yap›ld› (Lucrin® 500 µgr/gün ve hMG/FSH 225 wall of the abscess during surgery were taken. Results: Ultrasonography and tomog-
IU/gün). Ortalama indüksiyon süresi 11.21 gün (7-16 gün) ortalama kullan›lan am- raphy revealed a right ovarian semisolid mass with regular borders, a few abdominal
pül say›s› ise 36.7 ampüldü (18-70 ampül). HCG günü ortalama östradiol seviyesi ascites and hepatosplenomegaly. The low resistance index was found by color Dopp-
2634.7 pg/ml idi (900- 3813.6 pg/ml). 15 mm’nin üzerindeki ortalama folikül say›- ler examination. The brucella antibody agglutination titre was positive. Abscess dra-
s› 7.03 (3-12) idi. Hastalar›n 3 tanesinde ciddi OHSS geliflti (%7.89). Ciddi OHSS inage was done by laparoscopy. Cultures of blood, ascites, and a pus specimen yiel-
geliflen hastalar›n hiçbirinde polikistik over görüntüsü mevcut de¤ildi. Hastalar›n ded Brucella melitensis. Patient received a 6-week course of oral doxycyline and ri-
hCG günü östradiol seviyeleri 927 pg/gün, 3813 pg/gün, 3813.6 pg/gün ve 15 fampicin and her clinical condition improved slowly. Conclusion: The possibility of
mm’nin üzerindeki folikül say›lar› s›ras› ile 5, 7 ve 12 idi. Sonuç: Ocak 1999-Mart ovarian abscess that could be lethal should be considered, in addition to rare brucel-
2003 tarihleri aras›nda folikül aspirasyonu yap›lan sikluslarda OHSS oran›m›z %3.6 lar genitourinary complications including unilateral or bilateral epididymo-orchitis,
olarak tespit edildi. Folikül aspirasyonu yap›lmayan sikluslarda OHSS oran› ise prostatitis, seminal vesiculitis, chronic salpingitis, and cervicitis.
%7.89 bulundu. Bu iki oran aras›nda istatistiksel olarak anlaml› bir fark tespit edil-
medi (p:0.2). Çal›flman›n sonucunda TESE’de sperm bulunamayan sikluslarda has-
talara invazif bir giriflim olan folikül aspirasyonu yap›l›p yap›lmamas›n›n ciddi
OHSS oran› üzerine etkisi olmad›¤› bulunmufltur. Bu sonucun daha de¤erli olabil- P-107
mesi için genifl çapta araflt›rmalara ihtiyaç vard›r.
HAEMOSTATIC SYSTEM IN HEALTHY POSTMENOPAUSAL WOMEN
WHO RECEIVED HORMONE REPLACEMENT THERAPY
P-105
M. YÝlmazer1, V. Fenk•i1, S. CevrioÛlu1, E. Ellidokuz2, T. Koken3
THE EVALUATION OF INSULIN RESISTANCE WITH HOMEOSTASIS
1
MODEL ASSESSMENT IN HEALTHY, OBESE, POSTMENOPAUSAL Kocatepe University, Faculty of Medicine, Department of
WOMEN USING TIBOLONE OR COMBINED ORAL HORMONE Obstetrics and Gynecology, Afyon
2
Kocatepe University, Faculty of Medicine, Department of Internal
REPLACEMENT THERAPY
Medicine, Afyon
3
Kocatepe University, Faculty of Medicine, Department of
V. Fenk•i1, S. Fenk•i2, M. YÝlmazer2, S. CevrioÛlu2, Y. Sermez2
Biochemistry, Afyon
1
Department of Obstetric and Gynecology, School of Medicine, Kocatepe
University, Afyon Objective: To determine short-term effects of 3 different hormone replacement the-
2 rapy (HRT) regimens on haemostatic system in healthy postmenopausal women.
Department of Endocrinology and Metabolism, School of Medicine,
Materials and Methods: This prospective, controlled study included 60 healthy
Pamukkale postmenopausal women. A total of 45 women received the following treatments for
3 months; transdermal 17-beta estradiol 50 mg/day plus continuous medroxypro-
Objectives: To evaluate insulin sensitivity with clinical use of homeostasis model gesterone acetate (MPA) 2.5 mg/day (n=10), tibolone 2.5 mg/day (n=14), and oral
assessment in healthy, obese, postmenopausal women receiving tibolone or combi- conjugated equine estrogen (CEE) 0.625 mg/day plus continuous MPA 2.5 mg/day
ned oral HRT. Methods: In this cross-sectional study 76 healthy, obese, postmeno- (n=21). Activated partial thromboplastin time (aPTT), prothrombin time (PT), INR,
pausal women were enrolled. 16 women were receiving tibolone, 33 subjects were and fibrinogen levels were evaluated in baseline and in 3-month serum samples.
using oral estrogen plus progesterone, and 27 subjects were not on treatment. Wa- Results: Baseline aPTT was decreased by 10.5% after tibolone treatment (p<0.05).
ist, hip, height, weight, blood pressure, estradiol, fasting insulin, and lipid fractions CEE+MPA did not change aPTT, whereas PT was increased by 7.8% (p<0.05).
were measured. Waist-hip ratio and body mass index were calculated. Homeostasis Transdermally-implemented HRT did not cause any significant change in haemos-
model assessment for insulin resistance and bioelectric impedance analyse for total tatic system (p>0.05). Additionally none of the given regimens caused any signifi-
body fat mass were used. Results: The lowest waist, waist/hip ratio, systolic blood cant effect on plasma fibrinogen levels and INR. Conclusion: This study confirms
pressure measurements, and triglyceride level were observed in tibolone group. that tibolone changes hemostasis parameters toward a more thrombotic profile in
Women receiving tibolone had significantly lower fat mass and higher fat-free mass short term treatment. Large randomized studies are needed in order to define the ef-
in comparison with women not on treatment. Homeostasis model assessment was fect of HRT on coagulation system.
significantly lower in both treatment groups compared with control group. Total
136
Vol 4(2) 2003 18 May›s 2003 Pazar
P-108 fragmented embryos did not increase significantly with increasing age (p=0.08).
The odds of fragmentation increased by 3% per year. The average number of
EMERGENCY PERIPARTUM HYSTERECTOMY embryos transferred decreased significantly (p=0.03) with age from approximately
2.1 at the age of 25 to approximately 1.8 at the age of 40. In a selected subgroup of
embryos all consisting of good quality embryos, a significant decrease was found in
M. Erman Akar1, E. SaygÝlÝ YÝlmaz2, Z. YÝlmaz2 implantation rate with increasing age (approx. 0.08/10 years, 95% CI: 1.6; +0.00,
1
p=0.05). Of the 78 pregnancies achieved in this study we found a significantly
Akdeniz Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, decreased ongoing pregnancy rate and a significantly increased abortion rate with
Antalya increasing age (p=0.03). The decrease in the rate of ongoing pregnancies was
2
Zekai Tahir Burak Kad›n Sa¤l›¤› E¤itim ve Araflt›rma Hastanesi, Ankara almost linear, decreasing by approximately 1.5% per year. Conclusion: We con-
clude that age has an impact throughout a woman s reproductive life and that it is
Objective: To review the incidence, indications, risk factors, and complications important to realize that the age-related decline in fertility may start already in the
associated with emergency peripartum hysterectomy. Materials and Methods: We late twenties and not in the mid-thirties as is generally assumed.
analyzed retrospectively 48 cases of emergency peripartum hysterectomy per-
formed at Zekai Tahir Burak Women’s Health Research and Education Hospital
between January 1996 and June 2001. Emergency peripartum hysterectomy was
defined as one performed for hemorrhage unresponsive to other treatment less than P-110
24 hours after delivery. Fisher exact test and Wilcoxon rank sum test were used for
analysis. Results: Forty eight cases of caesarean and post-partum hysterectomy HEMOD‹NAM‹S‹ STAB‹L OLMAYAN EKTOP‹K GEBEL‹KTE
were performed. The rate of peripartum hysterectomy was 1:2598 deliveries. LAPAROSKOP‹K YAKLAfiIM
Sixtyseven per cent of the hysterectomies followed Caesarean section. The main
indications for hysterectomy were ruptured uteri, uncontrollable haemorrhage from
atonic uteri, sepsis, disseminated intravascular coagulation, myoma uteri and mor- A. GŸrbŸz1, A. GedikbaßÝ2, A. Karateke1, M. MengŸllŸoÛlu3, H. Peker3
bidly adherent placenta. Thirteen of the patients had previous operation on the 1
uterus. The mean age of patients was 34.7± 3.9 years, the median parity was 6 and Zeynep Kamil Kad›n ve Çocuk Hastal›klar› Hastanesi, ‹stanbul
2
the mean gestational age was 36.9±2.01 weeks. There were 19 cases of caesarean SSK Bak›rköy Do¤umevi, ‹stanbul
3
hysterectomy. The leading indication for caesarean section was previous caesarean Kula Devlet Hastanesi, Manisa
section (89.5%), placenta previa alone (10.5%). It should be noted that 7 cases with
previous caesarean section also had placenta previa (41.2%). The main indications Amaç: Ektopik gebelik olgular›nda günümüzde alt›n ve art›k klasik yaklafl›m lapa-
for emergency hysterectomy were, abnormally adherent placenta -which was the roskopidir. Hemodinamik aç›dan stabil olmayan hastalarda ise pek çok cerrah›n ter-
leading indication (38.1%), followed by ruptured uterus (33.3%), haemorrhage and cihi laparotomidir. Gereç ve Yöntem: Preflok tabloda, adet rötar›, idrarda gebelik
uterine atony occurred in 14.3% of cases each, maternal complications occurred in testi (+), ultrasonografide bat›nda serbest mayi ve adneksiyal kitle bulgular› sapta-
42.9% of cases postoperatively. There were 4 cases of stillbirths and 2 cases of nan hastaya, gerekli haz›rl›klar›n acil flartlarda tamamlanmas›n› takiben laparosko-
neonatal deaths. The maternal morbidity was substantial as the mean number of pik segmental rezeksiyon yap›lm›flt›r. Operasyon s›ras›nda bat›ndan 1500 cc defib-
transfusions given was 15 units (range 7-24), and the mean hospitalization time was rine kan aspire edildi. Operasyon süresi 75 dakika tutmufltur. Bulgular: Anemi
15 days (range 11-29). Perinatal mortality was high and there were four maternal semptomlar›ndan dolay› (Hb:6.1gr/dl) 2 Ü eritrosit süspansiyonu transfüzyonu ve
deaths. Postoperative complications included urinary tract infection (2), vaginal genel durumunun düzelmesi üzerine, postoperatif 2. gününde, hasta kendi iste¤i ile
cuff cellulitis (3), wound infections (2), septic thrombophlebitis (2), acute tubular taburcu oldu. Sonuç: Ektopik gebeliklere operatif yaklafl›mda, günümüzde laparos-
necrosis (1) and wound hematoma (1). Conclusion: Peripartum hysterectomy is a kopik cerrahi deneyim ve olanaklar›n da artmas›na ba¤l› olarak, endikasyon s›n›rla-
necessary life-saving operation. Prevention of complications that give rise to emer- r›m›z geniflleyecektir. Anahtar kelimeler: ektopik gebelik, stabil olmayan hemodi-
gency hysterectomy should decrease maternal and fetal morbidity and mortality. nami, laparoskopi
P-109 P-111
EMBRYO QUALITY AND DEVELOPMENTAL POTENTIAL IS RÜPTÜRE OLMAMIfi RUD‹MENTER HORN GEBEL‹⁄‹: 2 OLGU SUNUMU
COMPROMISED BY AGE
A. GedikbaßÝ1, A. GŸrbŸz2, A. Karateke2, H. Peker2, M. MengŸllŸoÛlu3
M. Erman Akar, S. Kursun, A. YÝlmaz, O. TaßkÝn
1
SSK Bak›rköy Do¤umevi, ‹stanbul
Akdeniz Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, 2
Zeynep Kamil Kad›n ve Çocuk Hastal›klar› Hastanesi, ‹stanbul
Antalya 3
Kula Devlet Hastanesi, Manisa
Aim: The aim of this retrospective study was to assess whether and how the age of Amaç: Müllerian anomalilerin insidans› de¤iflik oranlarda (%0.1-3.8) bildirilmekle
the woman affects the quality and developmental potential of the oocytes and birlikte, rudimenter horn gebeli¤i yaklafl›k 1:100.000 s›kl›kta görülmektedir ve ekto-
embryos in an ART program. Materials and Methods: A total of 367 IVF cycles pik gebeli¤in oldukça nadir bir formu olarak, hastalar›n ancak %5’i preoperatif tan›
was included as a consecutive series of single transfers (n=254), dual transfers alabilmektedir. Gereç ve Yöntem: Hastanemizde son 4 y›ll›k dönemde ektopik gebe-
(n=89) and triple transfers (n=24), where all the transferred embryos in each cycle lik tan›s› alan ve tedavi edilen 233 hastan›n 2 tanesinde rüptüre olmam›fl rudimenter
were of identical quality score and identical cleavage stage. Results: We found a horn gebeli¤i tesbit edilmifltir. Her iki hastaya da laparotomi uygulanm›fl, ektopik ge-
highly significant decrease in oocyte recovery with increasing age with about one belik ile birlikte rudimenter horn ekstirpasyonu uygulanm›flt›r. Bulgular: Her iki has-
oocyte per 2.3 years (95% CI 1.8 years to 3.1 years, p<0.0001). Further, we found ta da baflar›l› bir operasyon geçirmifl, müllerian anomalileri konusunda bilgilendiril-
that the number of oocytes that cleaved declined significantly with increasing age mifl ve postoperatif 2. ve 4. günlerde taburcu edilmifllerdir. Sonuç: Nonkommunikan
with one per 3.7 years (95% CI 2.7 years to 5.5 years, p<0.0001). This decline was rudimenter horn ve bu lokalizasyonda oluflabilecek ektopik gebeliklerin erken tan›s›,
mainly due to the decline in number of oocytes retrieved as the ratio of aspirated maternal mortalitenin önlenebilmesi aç›s›ndan önemlidir. Anahtar kelimeler: Mül-
oocytes that cleaved with increasing age (approx. 0.04/10 year 95% CI: 0.10; lerian anomali, rudimenter horn gebeli¤i (Preoperatif USG görüntüleri ilave edilecek-
+0.009) was not significantly different (p=0.10). The percentage of transfers using tir)
137
Vol 4(2) 2003 18 May›s 2003 Pazar
P-112 P-114
UTERUS D‹DELF‹S, EfiL‹K EDEN ANOMAL‹LER VE GEBEL‹K: KAYIP RAH‹M ‹Ç‹ ARAÇ VAKALARININ DE⁄ERLEND‹R‹LMES‹
OLGU SUNUMU
A. GedikbaßÝ1, A. GŸrbŸz2, K. Zehir2 G. Tuncay, H. Aytan, …. TapÝsÝz, Þ. Kalyoncu, L. MollamahmutoÛlu
1
SSK Bak›rköy Do¤umevi, ‹stanbul Dr. Zekai Tahir Burak Kad›n Sa¤l›¤› E¤itim ve Araflt›rma Hastanesi, Ankara
2
Zeynep Kamil Kad›n ve Çocuk Hastal›klar› Hastanesi, ‹stanbul
Amaç: Rahim içi araçlar (R‹A) önemli kontrasepsiyon yöntemlerinden birisidir.
Çokça tercih edilmesi nedeniyle beraberinde getirdi¤i komplikasyonlar önem ka-
Amaç: Müllerian anomaliler s›n›flamas›nda (ASRM,1998) uterin anomaliler için
zanmaktad›r. Bunlar aras›nda pelvik enfeksiyonlara yatk›nl›k, ektopik gebelik,
uterus didelfis (class III) s›kl›¤› %5 olarak tahmin edilmektedir ve infertilite neden-
mensruel düzensizlik vb. yan› s›ra R‹A ‘n›n iplerinin görülememesi da söz konusu-
leri aras›ndad›r. Ayn› flekilde vajinal anomaliler için de s›n›flama getirilmifltir. Ge-
dur. Bu çal›flmada amac›m›z kay›p R‹A olgular›n›n ve uygulanan tedavi yöntemle-
reç ve Yöntem: N.K. 23 yafl›nda G3 P2 Y2 eski sezeryan do¤um, 36 haftal›k gebe-
rinin incelenmesidir. Gereç ve Yöntem: Ocak 1999-Ocak 2003 döneminde hasta-
lik, makat prezantasyon, oligohidroamniyos tan›s› ile yat›r›ld›. Uterin kontraksiyon-
nemiz Aile Planlamas› poliklini¤ine kay›p R‹A nedeniyle baflvuran spekulum mu-
lar›n tesbit edilmesi üzerine elektif flartlarda sezeryan ile 2420 gr, sa¤l›kl› bir erkek
ayenesi ile R‹A ipleri görünmeyen 234 vaka retrospektif olarak incelenmifltir. Has-
bebek do¤urtuldu. Operasyon s›ras›nda hastada uterus didelfis saptand› ve gebeli-
talar›n demografik verileri yan›nda kay›p R‹A’n›n bulunmas›nda yararlan›lan rad-
¤in sol uterin oluflumda oldu¤u görüldü; sa¤ uterus, tuba uterina ve over dokusunun
yodiagnostik yöntem ve R‹A’n›n ç›kar›lmas›nda kullan›lan teknik kaydedilmifltir.
retroperitoneal oldu¤u görüldü. Bulgular: Müllerian anomalisi konusunda bilgilen-
Bulgular: Hasta grubunun yafl ortalamas› 29.6 ±6.9 y›ld›r. K›rk sekiz ayl›k dönem-
dirilen hastaya 4 ay sonra histerosalpingografi çekildi. Sol müllerian yap›lara rad-
de baflvuran hastalardan R‹A’n›n lokalizasyonun tespiti amac›yla % 38,8 ‘ine(n=91)
yoopak madde geçiflinin yan› s›ra, radyoopak maddenin sol üretere de geçti¤i göz-
X-ray , % 33,7’sine(n=79) ultrasonografi uygulanm›flt›r. Yirmi dokuz hastada
lendi; sa¤ müllerian yap›lara görülemedi. Hastaya çekilen intravenöz piyelografi ve
(%12,3) her iki tetkikte yap›lm›flt›r. Olgular›n ço¤unda (n=131, % 55,9) R‹A rutin
renal ultrasonografilerde sa¤ böbre¤inin olmad›¤› tesbit edildi. Sonuç: Müllerian
dilatasyon ve küretaj, hook veya forceps ile ç›kar›lm›flt›r. Bu yolla al›namayan va-
anomalilerin insidans› ve fertilite üzerine etkisi de¤iflkenlik göstermekte olup, efllik
kalarda ofis histerekopi denenmifl ve böylece 71 (%30,3) hastada R‹A ç›kar›lm›flt›r.
eden anomaliler yönünden ileri araflt›rma gerektirmektedirler. Anahtar kelimeler:
Ofis histeroskopi ile baflar›l› sonuç al›namayan 12 hastada (%5,1) operatif histeros-
Müllerian anomali, uterus didelfis, gebelik
kopi ile kay›p R‹A al›nm›flt›r. R‹A’n›n ekstrauterin oldu¤u 13 hastaya laparoskopi
yap›lm›fl ve 11 hastadan (%4.7) R‹A al›nm›flt›r. Laparoskopi ile baflar›l› olunama-
yan 2 olguda R‹A laparotomi ile ç›kar›lm›flt›r. Sonuçlar: Y›ll›k olarak yaklafl›k
2500 R‹A uygulanan bir e¤itim araflt›rma hastanesi olarak kay›p R‹A durumunda
P-113
sistematik yaklafl›mla birçok vakada ameliyata gerek kalmaks›z›n sorunun çözüle-
bilece¤i aflikard›r.Literatürde sunulan çal›flmalara bak›ld›¤›nda çal›flmam›z genifl
MEKONYUM PASAJI ‹LE KOMPL‹KE GEBEL‹KLERDE FETAL serili araflt›rmalarla uyumlu görünmektedir.
ER‹TROPO‹ET‹N DÜZEYLER‹
G. Þahin1, Y. Engin †stŸn1, Y. †stŸn1, Þ. ZeteroÛlu1, H. Þahin2,

P-115
R. SŸrŸcŸ2
1
Yüzüncü Y›l Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, ‹ZOLE FETAL ASC‹D: ETYOPATOGENEZ- OLGU SUNUMU
Van
2
Yüzüncü Y›l Üniversitesi T›p Fakültesi Aile Hekimli¤i AD, Van P. Moroy, Þ. ‚elen, A. Sucak, G. Tuncay, T. Mungan
Dr. Zekai Tahir Burak Kad›n Sa¤l›¤› E¤itim ve Araflt›rma Hastanesi, Ankara
Amaç: Amnion mayisinde mekonyum varl›¤›n›n fetal eritropoietin ve kan gazlar›
ile iliflkisinin araflt›r›lmas›. Gereç ve Yöntem: Yedi ayl›k çal›flma döneminde do-
¤umlar› klini¤imizde gerçeklefltirilen, gebelik yafl› 37-41 hafta aras›nda olan 28 nor- Amaç: Fetal hidrotoraks ve/veya ascid sendromu çeflitli etyolojilere ba¤l› generali-
mal gebe (Grup 1) ve 25 mekonyumlu gebe (Grup 2) çal›flmaya dahil edildi. Umbi- ze cilt ödem, plevral effüzyon ve/veya ascid ile karakterizedir. Bu çal›flman›n ama-
likal arterden al›nan kan örneklerinden eritropoietin ve kan gaz› analizleri yap›ld›. c› izole ascid saptanan 6 vakan›n çeflitli yönleriyle de¤erlendirilmesidir. Gereç ve
Bulgular: Gruplar aras›nda maternal yafl, gravida, parite ve gebelik yafllar› aç›s›n- Yöntem: Bu çal›flmada hastanemiz perinatoloji ünitesinde Ocak 2000- Ocak 2003
dan anlaml› farkl›l›k saptanmad›. Mekonyumlu grupta umbilikal arter pH de¤eri an- tarihleri aras›nda saptanan alt› vaka de¤erlendirildi. Hastalarda nedene yönelik obs-
laml› olarak daha düflük (7.19±0.14’e karfl›l›k 7.35±0.05, p<0.001), SO2 daha dü- tetrik ultrasonografi, ekokardiografi uygulanarak de¤erlendirildi.Tüm olgular gene-
flük (p=0.003), pCO2 daha yüksek (p=0.001), baz excess daha fazla (p<0.001) ve tik olarak kordosentez yap›larak ve/veya do¤um sonras› post-mortem olarak de¤er-
laktat anlaml› olarak daha yüksek (p<0.001) bulundu. Birinci ve beflinci dakika AP- lendirildi. Bulgular: Hastanemize bu sürede gerçekleflen 38117 do¤um içinde 6
GAR skorlar› aras›nda da anlaml› farkl›l›k olup, her ikisi de mekonyumlu grupta da- izole ascid içeren olgu saptanm›fl olup, görülme s›kl›¤› binde 0,15 olarak hesaplan-
ha düflük olarak saptand› (p<0.05). Bebek do¤um a¤›rl›¤› birinci grupta m›flt›r. Olgular›n 3 tanesi immün hidrops fetalis+izole fetal ascid tan›s› al›rken 3 ta-
3498.29±420.18, ikinci grupta 3177.27±784.5 gram olarak saptand› (p=0.073). nesi non-immün hidrops fetalis + ascid olarak de¤erlendirilmifltir. Dört olgu efli ile
Umbilikal arter eritropoietin düzeyleri birinci grupta 32.25 (9.7-125) mIU/ml ve 3. dereceden akrabad›r. Hidrops fetalis bulgular›ndan, hidroselin 2 vakada fetal as-
ikinci grupta 124 (10.2-911) mIU/ml olarak saptand› (p=0.001). Sonuç: Amnion cide efllik etti¤i saptand›. Bir olguda kromozom anomalisi (Down sendromu), bir ol-
mayideki mekonyum varl›¤› fetal hipoksi ile iliflkilidir ve yüksek eritropoietin dü- guda bilateral clubfoot, clench hand ve fallot tetrolojisi ve di¤er bir olguda metabo-
zeyleri de olay›n kronik bir zeminde geliflti¤ine iflaret etmektedir. lik hastal›k (Arginino süksinik asidüri) saptand›. Sonuçlar: Literatürde izole ascid
patolojisi non immun olgularda bildirilmiflken , bu çal›flmada immun fetal hidrops
olgular›nda da gözlenebilece¤i izlenmifltir. Üç olguda etiyoloji belirlenirken üç ol-
guda etyoloji idiopatik olarak saptanm›flt›r. Etkilenmifl fetuslar›n cinsiyetleri aç›s›n-
dan de¤erlendirme yap›ld›¤›nda 4/6’s› (%66,6) erkek olarak gözlenmifltir. Literatür-
de etiyolojiye yönelik olarak belirtilen maternal metabolik hastal›klar (diabetes
mellitus gibi veya sistemik hastal›klar), hasta grubumuzda tespit edilmemifltir.
138
Vol 4(2) 2003 18 May›s 2003 Pazar
P-116 grupta iki hastada bafl a¤r›s›, bir hastada bulant› ve yedi hastada üç siklusta vücut
a¤›rl›klar›nda %5’ in üzerinde art›fl izlendi. Sonuç: Siklik mastalji, kad›nlar›n me-
OVARIAN CANCERS IN DIFFERENT AGE GROUPS COMPARISON meyle ilgili flikayetlerinin en s›k görülenidir. Mastalji tedavisinde gestajen, östro-
jen-gestajen kombinasyonu, sentetik prolaktin inhibitörleri, B6 ve E vitaminleri ve
FOR PROGNOSTIC FACTORS AND SURVIVAL
magnezyum kullan›lmaktad›r. Tüm bu yöntemlerin içinde Agnucaston®, klinik tab-
lonun kötüleflmesine neden olabilecek istenmeyen endokrin etkiler göstermez. Bu
K. Kepkep, Y. Tun•ay çal›flmada, effektif terapödik potansiyeli ve yan etki insidans›n›n düflük olmas› ne-
deniyle, mastodini tedavisinde hormonal ilaçlar›n yerine, Vitex agnus castus ekst-
Göztepe SSK E¤itim Hastanesi, ‹stanbul resinin ilk tercih olarak kullan›labilece¤i sonucu ortaya ç›km›flt›r.
Objective: To evaluate the distrubition of ovarian cancer in different age groups and
to compare with the prognostic factors and survival rate according to age groups.
Methods: A 10-year retrospective review of ovarian cancer was performed 432 P-118
patients who were diagnosed and treated at the Clinic of Obstetrics and Gynecology of
the SSK Göztepe and Okmeydan› Educational Hospitals, and Oncology Clinics of the UN‹LATERAL NONCOMM‹N‹KAN UTERUS D‹DELF‹S OLGUSU
SSK Okmeydan› Educational Hospital. Patients’ records were reviewed. To assess the
clinicopathologic profile (histological typing, grading and disease stage at diagnosis)
S. Kurt, E. ‚elik, Þ. TÝnar, D. …ztekin Can, E. Þahin, A. Uysal
and survival differences according to age, the patients was subdivided into three groups
(group1: < or = 30 years, group 2: 31-40 years, and group 3: > or = 41 years). Survival
SSK Ege Do¤umevi, ‹zmir
rates were calculated by the Kaplan–Meier method and differences among groups were
evaluated by the chi-square test. Results: The distrubition of the ovarian tumors in
group 1 by the histotype differs from that in group 3 women. Epithelial forms had Konjenital müllerian anomaliler %3.2’e kadar yükselen oranda görülmektedir.Bu
50.8% of all ovarian cancers in below the age of 30 years and 83% in above the age of anomaliler içinde uterus didelfis s›k görülenler aras›ndad›r. Bizim vakam›z kör bir
40 years, respectively. (59 and 331 patients of 432, respectively). Stage (p <0.05) and vajenle sonlanan uterus didelfis olgusudur. Hastam›z 24 yafl›nda olup 5 cm’lik pel-
grade (p<0.05) at initial diagnosis were found significant in different age groups. In vik kitle ön tan›s›yla hastanemize refere edilmifltir. Hasta do¤ufltan tek böbrekli ol-
group 1, low stage and well differentiated tumors were significantly more frequent than du¤unu ifade etmekte ve 2 y›l önce geçirilmifl sezeryan öyküsü bulunmaktad›r. Has-
group 3 (41% vs 25% and 51% vs 21%). Five year survival rates for the patients aged taya uterus didelfis tan›s› USG ve MRG görüntülemeleri ile konmufltur. Literatürde
30 years and younger, patients aged 31-40 and patients aged 41 years and older were bu olgularda çeflitli tedavi seçenekleri bulunmakla birlikte bizim vakam›zda laparo-
50.09%, 32.19% and 29.25%. Conclusion: Ovarian cancers in young women have a tomik hemihisterektomi uygulanm›flt›r. Tek tarafl› kitle tan›s›nda uterin anomaliler
more favorable prognosis because of a higher rate of early stage and low grade tumors. gözden kaç›r›lmamal›d›r. Uterin anomali tan›s›n›n konmas›nda USG ve MRG ol-
In contrast, patients over the age of 41 years are more likely to be initially diagnosed dukça faydal›d›r. Anahtar kelime: Uterus didelfis, Müllerian anomali
with advanced disease and significantly decreased survival rates. Therefore, periodical
and wide screening programes are important for earlier diagnosis and treatment and
better prognosis in women with ovarian cancers.
P-119
J‹NEKOLOJ‹K OPERASYON YAPILAN HASTALARDA PER‹TON

P-117 KAPATILMASININ POSTOPERAT‹F A⁄RI ÜZER‹NE ETK‹S‹N‹N
KARfiILAfiTIRILMASI
PREMENSTRUAL DÖNEMDE, S‹KL‹K MASTALJ‹N‹N SEMPTOMAT‹K
TEDAV‹S‹NDE V‹TEX AGNUS CASTUS EKSTRES‹ B. Duran, …. Erden, M. ‚etin, …. Balta, A. ‚etin
(AGNUCASTON[REG])
Cumhuriyet Üniversitesi, Sivas
Y. ArÝkan Onaran, G. Kurtay
Amaç: Jinekolojik operasyon yap›lan hastalarda periton kapat›lmas›n›n kapat›lma-
Ankara Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, Ankara yan hastalara göre postoperatif dönemde a¤r› skorunun ve kullan›lan analjezik mik-
tar›n›n karfl›laflt›r›lmas›. Gereç ve Yöntem: Bu çal›flma fiubat 2002 ile Mart 2003
Amaç: Bu çal›flmada, premenstrual mastalji flikayeti olan hastalar›n semptomatik tarihleri aras›nda opere olan 70 kad›n üzerinde yap›ld›. Operasyon hastalar periton
tedavisinde Agnucaston®’un etkinli¤i araflt›r›lm›flt›r. Gereç ve Yöntem: Ocak kapat›lm›fl (n = 30) ve periton kapat›lmam›fl (n= 40) olarak ikiye ayr›larak incelen-
2002-May›s 2002 tarihleri aras›nda, hastanemiz Jinekoloji poliklini¤ine, son 6 ay- di. Postoperatif a¤r› skoru de¤erlendirilmesi ameliyathanede 3 derecede Behavioral
da en az 3 siklus süresince ve her siklusta en az 3 gün mastalji flikayetiyle baflvuran Pain Score (BPS) ile, 15. dk’dan sonra hastalar›n a¤r› skorlar› toplam 8 zaman dili-
52 hasta, bilgilendirme ve onay formu imzalamalar›n› takiben çal›flmaya al›nd›. minde, istirahatte ve hareketle olmak üzere 10 derece üzerinden Visual Analog Ska-
Hastalar›n, çal›flma öncesi prolaktin, progesteron, estradiol, FSH ve LH serum dü- la (VAS) ile de¤erlendirildi. Tüm kad›nlar›n demografik özellikleri, a¤r› skoru ve
zeyleri ve bilateral meme ultrasonografileri normaldi. Randomize olarak ayr›lan analjezik miktarlar›n›n karfl›laflt›r›lmas›nda t testi ve Mann – Whitney U testi kulla-
hastalar›n ilk grubuna (n=27) üç siklus Agnucaston®, di¤er grubuna (n=25) mono- n›ld›. Bulgular: Periton kapat›lm›fl ve kapat›lmam›fl kad›nlar›n istirahat halindeki
fazik, çok düflük doz, kombine oral kontraseptif verildi. Çal›flmaya kat›lan hastala- VAS de¤erleri d›fl›nda istatistiki olarak anlaml› fark saptanmad›. Periton aç›k grup-
r›n meme a¤r›s› yo¤unlu¤u 0’dan (a¤r›s›z), 10 cm’ye (dayan›lmaz a¤r›) kadar olan ta ortalama istirahat VAS skoru 34,33 ± 7,96, kapal› grupta 38,53 ± 8,39 gibi an-
Vizüel Analog Skala’ya (VAS) göre kaydedildi. Bulgular: ‹lk siklus tedavi sonra- laml› fark bulundu. (p < 0,05 . t = 2,138). Sonuç: Jinekolojik bat›n operasyonlar›n-
s›, a¤r› yo¤unlu¤unda Agnucaston®’a ba¤l› ortalama düflüfl 23.6 mm (%27.5) iken, da periton kapat›lmas› postoperatif analjezik kullan›m›nda anlaml› bir fark yarat-
di¤er grupta 9.7 mm (%11.3) idi. ‹kinci siklustan sonra, Agnucaston ile mastalji or- mazken, postoperatif 30. dakikadan sonraki de¤erlendirmede istirahat VAS de¤er-
talama %38.2 oran›nda hafiflerken, östrojen-gestajen alan grupta bu oran %12.7 idi. leri periton aç›k grupta düflük ç›km›fl olup hastalar›n daha az a¤r› hissettikleri bu-
Çal›flman›n sonunda, Agnucaston kullanan hastalar›n %61.5’inde mastaljide iyilefl- lunmufltur.
me sa¤land›. Agnucaston® alan grupta hiçbir yan etkiye rastlan›lmazken, di¤er
139
Vol 4(2) 2003 18 May›s 2003 Pazar
P-120 P-122
PRETERM DO⁄UMUN SONOGRAF‹K SERV‹KAL UZUNLUK VE D‹YETE EKLENEN SOYA ISOFLAVONLARININ MENOPOZAL
‹NTERNAL SERV‹KAL OS D‹LATASYONU ÖLÇÜMLER‹ ‹LE SEMPTOMLAR ÜZER‹NE OLAN ETK‹S‹
PRED‹KS‹YONU
K. Ertekin, H. BozdaÛ, S. Eren
A. ArÝšz, A. Yazgan, A. Varolan, A. Aras, M. Ko•, Ü. Davas
Zeynep Kamil Kad›n ve Çocuk Hastal›klar› E¤itim ve Araflt›rma Hastanesi,
fiiflli Etfal Hastanesi 2. Kad›n Hastal›klar› ve Do¤um Klini¤i, ‹stanbul ‹stanbul
Amaç: Çal›flmam›zda 18-24.gebelik haftalar› aras›ndaki tekiz gebelerde sonografik Amaç: Alternatif tedavi modalitesi olarak, standardize edilmifl soya isoflavonlar›-
olarak uygulanan sevikal uzunluk ve internal os dilatasyonu ölçülerinin preterm do- n›n (Super Concentrated Isoflavones, Solgar, Türkiye) diyete eklenmesinin meno-
¤umlar›n prediksiyonu aç›s›ndan önemini de¤erlendirdik. Gereç ve Yöntem: 1 pozal flikayetler üzerine olan etkisini araflt›rmak. Gereç ve Yöntem: En az 12 ayd›r
Ocak 1999 ve 31 Aral›k 2001 tarihleri aras›nda rutin antenatal takip amac›yla gebe amenoresi olan ve menopozal flikayetleri bulunan, hormon replasman tedavisini ka-
izleme poliklini¤imize baflvuran, 18-24. gebelik haftalar› aras›nda tekiz gebeli¤i bul etmeyen 38 sa¤l›kl› kad›n çal›flmaya al›nd›. Kat›l›mc›lar›n diyetlerine 16 hafta
olan 300 gebe çal›flma grubuna al›nd›. Gebelerin 18, 20, 22 ve 24. haftalarda fetal süresince 38 mg/gün soya isoflavonlar› (Daidzain: 18 mg, Glycitein: 15 mg, Genis-
biyometrik ölçümleri yap›ld›ktan sonra servikal kanal uzunlu¤u ve internal os dila- tein: 5.5 mg) eklendi. Etkinli¤in de¤erlendirilmesi, çal›flman›n bafllang›c›nda ve so-
tasyonu oluflmufl ise bunun enlemesine ve boylamas›na ölçümleri yap›ld›. Servikal nunda Greene Climacteric Scale skorundaki de¤ifliklikler ölçülerek yap›ld›.
uzunluk s›n›r de¤eri 30 mm olarak al›nd›. Daha sonra bu gebeliklerin sonuçlar› kay- Bulgular: Menopozal semptomlardaki de¤ifliklikler soy isoflavonlar›n 16 haftal›k
dedildi. Yap›lan ölçümlerin istatistiksel analizleri SPSS 9.0, INSTAT ve Epi Info kullan›m› öncesi ve sonras›nda de¤erlendirildi¤inde; anksiyete semptom skoru
2000 programlar› ile yap›ld›. Bulgular: 18,20,22 ve 24. gebelik haftalar›nda ölçü- (10,52 ± 4,79/7,76 ± 4,59), depresyon semptom skoru (4,65 ± 3,44/3,34 ± 3.03), so-
len ortalama servikal uzunluk de¤erleri preterm do¤um yapan grupta term do¤um matik semptom skoru (7,47 ± 4,60/4,89 ± 3,89), vazomotor semptom skoru (4,34 ±
yapan gruba oranla daha k›sa bulundu (p<0.001) . Ayn› gebelik haftalar›nda sonog- 1,53/2,31 ± 1,59) ve seksüel disfonksiyon skoru (1,84 ± 1,15/1,52 ± 1,08) istatistik-
rafik olarak internal os dilatasyonu tespit edilen gebelerde preterm do¤um s›kl›¤› sel olarak ileri düzeyde anlaml› düflüfller göstermifltir (p<0,001). Sonuçlar: Bu ça-
tespit edilmeyenlere göre daha s›k bulundu (p<0.001). Sonuç: Servikal uzunluk s›- l›flman›n sonunda, günlük 38 mg soya isoflavonlar›n›n diyete eklenmesinin meno-
n›r de¤eri 30 mm olarak al›nd›¤›nda 18-24. gebelik haftalar›nda yap›lan servikal pozal semptomlar› anlaml› ölçüde azaltt›¤› bulunmufltur. Menopozal flikayetleri gi-
uzunluk ve internal os dilatasyonu ölçümlerinin preterm do¤umu önceden belirle- derdi¤i yönündeki bulgular, Super Concentrated Isoflavones’in postmenopozal dö-
mede tan› de¤eri oldukça yüksek biryöntem oldu¤unu gördük. nemdeki kad›nlarda geleneksel hormon replasman tedavilerine alternatif olarak kul-
lan›labilece¤ini düflündürmektedir.
P-121
P-123
11-14 HAFTALAR ARASI TR‹ZOM‹ TARAMA TEST‹N‹N ‹LER‹ YAfi
GEBELERDEK‹ ETK‹NL‹⁄‹N‹N ARAfiTIRILMASI POSTPARTUM ECLAMPSIA WITHOUT ANTENATAL PROTEINURIA
AND HYPERTENSION
A. Aras, A. Yazgan, A. Varolan, A. ArÝšz, M. Ko•, Ü. Davas
A. Biri, B. Bingšl, Y. Dingil, T. Nas, …. HimmetoÛlu
fiiflli Etfal Hastanesi 2. Kad›n Hastal›klar› ve Do¤um Klini¤i, ‹stanbul
Gazi Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um Klini¤i, Ankara
Amaç: Çal›flmam›zda 35 yafl üzeri gebelerde, 11-14 haftalar aras›, fetal nukal trans-
lusensi ölçümü ve anne yafl›n›n birlikte kullan›lmas› ile yap›lan trizomi 21 tarama Introduction: We report a woman with postpartum eclampsia on 10th hour who
testinin etkinli¤ini araflt›rd›k. Gereç ve Yöntem: Gebe izleme poliklini¤imize Ey- has no signs of hypertension and proteinuria during antenatal period Method:
lül 2000-A¤ustos 2002 tarihleri aras›nda baflvuran 168 gebelik çal›flmam›za al›n- Postpartum eclampsia without the classical pre-eclamptic signs of oedema, protein-
d›.11-14 haftalar aras› fetal nukal translusensi ölçümü yap›larak; anne yafl›, düzel- uria and hypertension is a rarely noticed complication of pregnancy.We managed
tilmifl gebelik haftas›, daha önce kromozomal anomalili do¤um ya da düflük hika- an eclamptic seizure of a 24 year old primipar pregnant woman and compared our
yesi ile birlikte View Point Software risk hesaplama program›nda de¤erlendiril- case with similar case reports from the literature. Results: We followed our patient
di.Trizomi 21 riski 1/300’ ün üzerine olan her gebeye karyotipleme önerildi. from the beginning of her pregnancy. Her arterial pressure never exceeded 120/70
Bulgular: Çal›flmam›za al›nan toplam 168 gebeli¤in 15’inde anne yafl› ve fetal and no proteinuria was reported.There was no complication during the labor and
translusensi ölçümünün birlikte kullan›m› ile trizomi 21 riski 1/300’ün üzerinde delivery. On the postpartum 10th hour her arterial pressure became 180/120 and she
saptand›. Bu 15 gebeli¤e invaziv giriflim önerildi. Böylece invaziv giriflim oran›m›z had a seizure. After stabilization and emergent management of the patient, we used
%8.92 olarak saptand›.Amniyosentez uygulanan 15 gebeli¤in 13’ünde kromozomal two different noninvasive methods to confirm the diagnosis; transcranial Doppler
anomali tespit edilmedi. ‹ki gebelikte trizomi 21 saptand›. Çal›flmaya al›nan ve tri- velositometry and magnetic resonance imaging. Concusion: Eclampsia may be
zomi 21 riski 1/300’den düflük bulunan 153 gebeli¤in do¤umdan sonra yap›lan ye- considered as the occurence of convulsions and /or coma in pregnant women with-
nido¤an muayenesinde trizomi 21 saptanmad›. Sonuç: 11-14 haftalar aras› anne ya- out an alternative identifiable cause.There are only a few reports in literature like
fl› ve fetal nukal translusensi ile yap›lan trizomi 21 tarama testi saptama oran›n yük- our case and all are reported to be as postpartum late eclampsia cases.
sek olmas›, invaziv giriflim oran›n› azaltmas›, yalanc› pozitif ve negatifli¤inin düflük
olmas› özellikleriyle etkin bir tarama yöntemi olarak gözükmektedir.
140
Vol 4(2) 2003 18 May›s 2003 Pazar
P-124 je, Schering) ve Grup 3 (düflük doz OKS tedavisi: 150 mg Desogestrel + 30 mg Et-
hinyl estradiol, Desolett tablet Organon)’e randomize olarak da¤›t›ld›. Grup 1 ve
EFFECTS OF ESTROGEN REPLACEMENT THERAPY ON HEARING 2’den birer hasta bulant›lar›n›n olmas› nedeniyle ilac› kullanamad›¤› için bekleme
tedavisi grubuna al›nd›. Hastalar bir sonraki menslerinin üçüncü günü TVUSG’ye
ça¤r›ld›. ‹lk kontrolde kisti sebat edenler sekiz hafta sonra tekrar kontrole ça¤r›ld›-
E. Bulgan KÝlÝ•daÛ, E. TarÝm1 , S. ErkanlÝ1, E. Aslan1, G. AßÝk1, F. KazancÝ1, lar. Bulgular: Gruplar aras›nda yafl, parite BMI ve bafllang›çtaki kist boyutlar› aç›-
H. Yavuz2, T. BaÛÝß1 s›ndan istatistiksel aç›dan anlaml› bir fark yoktu. 4 hafta sonraki kontrolde grup
1’de 22 hastan›n 12’sinde (%54,5), grup 2’de 20 hastan›n 12’sinde (%60), grup 3’te
Baskent University Faculty of Medicine, Department of Obstetrics and 20 hastan›n 11’inde (%55) kistin kayboldu¤u görüldü. Bekleme tedavisi ile OKS
Gynecology1 and Department of Oto-Rhinology2 kullananlarda kistin kaybolma oran› aç›s›ndan istatiksel anlaml› fark bulunamad›. 8
hafta sonra kontrole gelen 23 hastan›n 19’unde kistin persiste etti¤i görüldü. 12 haf-
Objective: To investigate how hormone replacement therapy affects hearing in tan›n sonunda grup 1’de 22 hastan›n 14’ünde (%63,6) , grup 2’de 20 hastan›n 15’in-
postmenopausal women. Study Design: This prospective study involved 109 post- de (%75), grup 3’te 20 hastan›n 14’ünde (%70) kistin kayboldu¤u görüldü. 8 ve 12
menopausal women. Twenty of the women were using estrogen replacement thera- hafta sonra yap›lan kontrollerde gruplar aras›nda kistin kaybolma oran› istatiksel
py (ERT group), 30 women were using hormone replacement therapy (HRT group), aç›dan anlaml› olacak flekilde farkl› bulunmad›. 12 hafta sonunda kisti sebat eden
and 59 had not received hormone therapy of any kind (control group). Otoscopic 19 hastaya laparoskopik kist eksizyonu uyguland›. Patoloji alt› hastada seröz kista-
examination revealed normal tympanic membranes in all 109 subjects. Each indi- denom, dört hastada endometrioma, iki hastada müsinöz kistadenom, bir hastada
vidual was tested with low- (250-2000 Hz) and high-frequency audiometry (4000- müsinöz kistadenofibrom, alt› hastada ise folliküler kist olarak rapor edildi. Sonuç:
16000 Hz). Duration of hormone therapy was recorded, and patient characteristics Benign over kistlerinin takibinde 20 mg estrojen içeren oral kontraseptifler daha
(age, type of menopause, time since onset of menopause), body mass index (BMI), yüksek doz içerenler kadar etkilidir. Bekleme tedavisi oral kontraseptif kullan›m›-
and hearing test results in the ERT, HRT and control groups were compared. na iyi bir alternatif olabilir, 12 haftal›k takibe ra¤men kaybolmayan kistlerde cerra-
Results: There were no statistically significant differences between the treatment hi önerilmesi gerekir.
(ERT and HRT group) and control groups with respect to age, BMI, or time since
onset of menopause. The mean time on HRT and ERT was 4.13±2.41 and
3.35±2.20 years respectively. The mean air conduction results at low frequencies
(250, 500, 1000, and 2000 Hz) in the ERT group were significantly higher than the P-126
corresponding findings in the control group (p<0.001) and than the HRT group
(p<0.001). When the same comparisons were made between the HRT group and the HORMON REPLASMAN TEDAV‹S‹ KULLANMAKTA OLAN
control group, none of the differences was statistically significant (p>0.05). The POSTMENOPOZAL HASTALARDA TEDAV‹Y‹ KESME
mean air-conduction results at high frequencies (4, 6, 8, 10, 12, 14, and 16 kHz) in
PROTOKOLLER‹N‹N KARfiILAfiTIRILMASI: HEMEN M‹? AZALTARAK MI?
the ERT group were significantly higher than the corresponding results in the HRT
group (p<0.008). ERT vs controls and HRT vs controls at high frequencies revealed
no significant differences (p>0.05). The mean bone conduction results in the ERT E. Aslan, S. ErkanlÝ, E. Bulgan KÝlÝ•daÛ, E. TarÝm, G. AßÝk, T. BaÛÝß
group were significantly higher than the corresponding findings in the control group
(p<0.016). Analysis of the same comparisons between the HRT-ERT and HRT- Baflkent Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD,
Control groups revealed no significant differences (p>0.05). Conclusion: Estrogen Ankara
replacement may slow down hearing loss in aging postmenopausal women; how-
ever, further studies of larger series are needed to confirm this, and the sites of hor- Amaç: Çal›flmam›zda hormon replasman tedavisi (HRT) kesme endikasyonu koy-
monal action must also be explored. du¤umuz hastalarda, azaltarak kesme ile hemen kesme prokolleri aras›nda menopo-
zal semptomlar›n (atefl basmas›, terleme) geri dönmesi aç›s›ndan bir fark olup olma-
d›¤›n› araflt›rmay› hedefledik. Gereç ve Yöntem: Çal›flmam›zda HRT kesme endi-
kasyonu koyulan 70 ard›fl›k hasta rank randomizasyon uygulanarak iki gruba ayr›l-
P-125 d›. Grup 1’de (n= 35) kullan›lan ilaç hemen kesildi, Grup 2’de (n=35) ilaç iki haf-
ta günafl›r› kulland›r›l›p bu sürenin sonunda tamamen kesildi. Bütün hastalar ilk vi-
BEN‹GN OVER K‹STLER‹NDE ULTRA DÜfiÜK DOZ ORAL zitte ilaç öncesi vazomotor semptomlar aç›s›ndan sorguland› ve ikinci ve dördüncü
KONTRASEPT‹FLER NE KADAR ETK‹L‹D‹R? hafta sonunda tekrar görüldü . Bu ziyaretlerde hastalar›n vazomotor flikayetleri bir
semptom skalas›na aktar›ld›. Semptomlar›n a¤›rl›¤› ve görülme s›kl›¤› kullan›larak
semptom skorlar› elde edildi. Skorlar yok, hafif, orta ve a¤›r olarak grupland›.
E. Bulgan KÝlÝ•daÛ, E. TarÝm, S. ErkanlÝ, E. Aslan, G. AßÝk, T. BaÛÝß
Bulgular: ‹kinci hafta sonunda; Grup 1 de 17 hastada semptom yokken (%48), 15
hastada hafif (%42.9), 1 hastada orta (%2,9), 2 hastada a¤›r semptomlar (%5,7) gö-
Baflkent Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, rüldü. Grup 2’de ise 16 hastada semptom yokken (%50), 13 hastada hafif (%40,6),
Ankara 2 hastada orta (%6,3), 1 hastada a¤›r semptomlar (%3,1) görüldü. Dördüncü hafta
sonunda ise; Grup 1’de 16 hastada semptom yokken (%48,5), 13 hastada hafif
Amaç: Benign over kistlerinin takibinde ultra düflük doz monofazik oral kontrasep- (%39,4), 2 hastada orta (%6,1), 2 hastada a¤›r semptomlar (%6,1) görüldü. Grup
tif (OKS) kullan›m›n›n etkinli¤ini araflt›rmak. Gereç ve Yöntem: Baflkent Üniver- 2’de ise 14 hastada semptom yokken(%45,2), 15 hastada hafif (%48,4), 2 hastada
sitesi Kad›n Hastal›klar› ve Do¤um Klini¤ine baflvuran mensin üçüncü gününde a¤›r semptomlar (%6,5) görüldü. Sonuç: Hormon replasman tedavisini hemen ya-
transvajinal ultrasonografide (TVUSG) 20 mm üzerinde kisti tespit edilen 62 hasta da azaltarak kesme protokolleri aras›nda ikinci ve dördüncü hafta sonunda semptom
çal›flma kapsam›na al›nd›. Hastalar Grup1 (bekleme tedavisi), Grup 2 (ultra düflük a¤›rl›¤› ve s›kl›¤› aç›s›ndan istatistiksel aç›dan anlaml› fark saptanmad›.
doz OKS tedavisi: 100 mg Levonorgestrel + 20 mg Ethinyl estradiol, Miranova dra-
141
Vol 4(2) 2003 18 May›s 2003 Pazar
P-127 P-129
B‹R‹NC‹ TR‹MESTERDE S‹TOMEGALOV‹RUS ENFEKS‹YONU VE ANORMAL UTER‹N KANAMALARDA ULTRASONOGRAF‹ VE

FETAL SONUÇLARI: VAKA SUNUMU ENDOMETR‹AL B‹YOPS‹N‹N KARfiILAfiTIRILMASI
H. A. TanrÝverdi, E. ‚Ýnar, A. Barut, †. Bayar, E. Kaya E. …zpak, G. Kurtay, A. Aktan, E. …ztaß
Karaelmas Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, Ankara Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve
Zonguldak Do¤um AD, Ankara
Fetal sitomegalovirus enfeksiyonu konjenital bir hastal›kt›r. En s›k rastlanan intra- Amaç: Anormal uterin kanamalar jinekoloji polikliniklerinde en s›k rastlan›lan
uterin enfeksiyondur. Toplumun büyük bir k›sm› bu virusle karfl›laflm›fl ve immün problemlerdendir. Reprodüktif ça¤daki kad›nlarda anormal uterin kanamalar s›kl›k-
oldu¤u için gebelikte bu virusle enfekte olma ihtimali ve bu enfeksiyonun takip la myometrial (myoma uteri) kaynakl›d›r. Biz bu çal›flmada anormal uterin kanama-
eden gebelikte nüks etmesi nadir rastlanan bir durumdur. Konjenital sitomegalovi- ya sebep olan endometrial patolojileri ve bu patolojilerde USG’deki endometrial
rus infeksiyonuna do¤umlar›n %0.2-2.2’sinde rastlanmakta ve infantlar›n %90-95’i kal›nl›k ölçümünün patoloji sonucuyla korrelasyonunu göstermeye çal›flt›k. Gereç
asemptomatik olarak dünyaya gelmektedir. Burada birinci trimesterde rutin antena- ve Yöntem: Çal›flmaya Aral›k 2002-Nisan 2003 tarihleri aras›nda jinekoloji polik-
tal takip s›ras›nda sonografide generalize cilt ödemi saptanan, tetkikinde sitomega- lini¤ine anormal uterin kanama nedeniyle baflvuran hastalardan endometrial patolo-
lovirus pozitifli¤i bulunan ve intrauterin ölüm ile sonuçlanan bir vaka sunulmakta- ji tespit edilen 60 hasta dahil edilmifltir. Tüm hastalarda serum _-hCG ölçümü ile
d›r. Vaka: Sonografide CRL de¤erine (24mm) göre 9 hafta 1 günlük, fetal kalp at›- gebelik ve USG ilede myoma uteri ekarte edilmifltir. Tüm hastalar›n USG’de endo-
m› pozitif (195/dk) olan, generalize cilt ödemi izlenen tek canl› embriyo saptand›. metrial kal›nl›klar› ölçülmüfltür. Daha sonra hastalara endometrial biyopsi yap›lm›fl-
Hastan›n yap›lan tetkiklerinde TORCH testlerinde sitomegalovirus IgG ve IgM po- t›r. Hastalar›n patoloji sonuçlar› ve endometrial kal›nl›k ölçümleri k›yaslanm›flt›r.
zitifli¤i, sitomegalovirus IgG aviditesi negatif (%47) olarak saptand›. Fetal cilt öde- Bulgular: Hastalar› patoloji sonuçlar›na göre normal (proliferatif endometrium,
mine neden olabilecek di¤er sebepler ekarte edildi. Bir hafta sonraki kontrol sonog- sekretuar endometrium, kronik endometrit) ve patolojik (endometrial polip, endo-
rafisinde devam eden generalize cilt ödemi bulunan, intrauterin ex embryo saptan- metrial hiperplaziler ve endometrium kanseri) olarak iki gruba ay›rd›k. 45 (%75)
d› ve gebelik tahliyesi yap›ld›. Bu çal›flmada gebelikte rastlanan sitomegalovirus en- hastada normal ve 15 (%25) hastada ise patolojik sonuç al›nm›flt›r. Normal patolo-
feksiyonunun seyri ve fetal komplikasyonlar tart›fl›lm›flt›r. ji sonucuna sahip grupta ortalama endometrium kal›nl›¤› 6.6 mm olarak bulunur-
ken, patolojik grupta 13.5 mm olarak saptanm›flt›r. Her iki grupta hastalar›n yafl or-
talamas› benzerdir (normal grupta 40.3, patolojik grupta 40.5). Sonuç: Anormal
uterin kanamaya sebep olan nedenlere bakt›¤›m›zda hastalar›n %75 ‘inde patoloji
P-128 sonucunda siklik endometrial de¤ifliklikler veya endometrial inflamatuar olaylar
saptand›¤›n› gördük. Hastalar›n %13’ünde basit endometrial hiperplazi, %7’sinde
FETAL RUBELLA SENDROMU: TANIDAK‹ ZORLUKLAR kompleks atipili ve atipisiz endometrial hiperplazi, %3’ünde endometrial polip ve
%2’sinde endometrium kanseri saptanm›flt›r. Hastalar›n USG ile yap›lan endomet-
rial kal›nl›k ölçümleride patoloji sonuçlar›yla korreledir. Sonuç olarak, USG ile ya-
H. A. TanrÝverdi, H. H. Sade, A. Barut, †. Bayar, E. Kaya p›lan endometrial kal›nl›k ölçümü anormal uterin kanamaya neden olan endometri-
al patolojiler ile ilgili olarak bizi yönlendirebilir.
Karaelmas Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um,
Zonguldak
Fetal Rubella sendromu konjenital bir enfeksiyondur. Fetal enfeksiyon virusun P-130
transplasental geçifliyle oluflmaktad›r. Enfeksiyonun s›kl›¤› ve fliddeti de¤iflkenlik
göstermekle birlikte mental retardasyon, konjenital katarakt, kalp defektleri ile ka- ‹NFERT‹L HASTA GURUBUNDA UTER‹N KAV‹TEN‹N
rakterizedir. Üreme ça¤›ndaki kad›nlar›n yaklafl›k %75-85’inin seropozitif oldu¤u DE⁄ERLEND‹R‹LMES‹NDE VAG‹NAL ULTRASONOGRAF‹ ‹LE
belirtilmektedir. Maternal kanda IgM seropozitifli¤i saptanmas› durumunda, mater-
nal kanda IgG aviditesinin bak›lmas› tan›da yard›mc› tetkiklerdir. Fetal enfeksiyo- SONOH‹STEROGRAF‹N‹N YER‹ VE H‹STEROSALP‹NGOGRAF‹ ‹LE
nun tan›s› için kordosentezle 21. gebelik haftas›ndan sonra fetal kanda Rubella an- KARfiILAfiTIRILMASI
tikorlar›n›n taranmas› gereklidir. Ancak, fetal kanda negatif IgM fetal enfeksiyonu
tamamen ekarte ettirmemektedir. Gebeli¤in ilk 12 haftas›nda enfeksiyonun fetüse A. …noÛlu, S. SadÝk, M. AlihanoÛlu, A. GŸler, D. AlihanoÛlu, G. UÛurel,
bulaflma oran› (%90) ve anomali riski çok yüksektir ve gebelik terminasyon endi-
H. GŸler, Þ. TÝnar
kasyonu bulunmaktad›r. Gebeli¤in 12.-16. haftalar› aras›nda fetüste etkilenme ola-
s›l›¤› %35-50 seviyesindedir ve prenatal tan› endikasyonu mevcuttur. E¤er fetal en-
SSK Ege Do¤umevi ve Kad›n Hastal›klar E¤itim Hastanesi, ‹zmir
feksiyon saptan›rsa riskler aileye anlat›lmal› ve istekleri do¤rultusunda gebeli¤in
sonland›r›labilece¤i belirtilmelidir. Klini¤imize rutin gebelik kontrolü amaçl› gelen
22 yafl›nda G:1 P:0 olan hastan›n transvajinal sonografisinde 11 hafta 4 günlük, can- Amaç: ‹nfertil hastalarda uterin kavitenin de¤erlendirilmesinde, sonohisterografi
l› bir embryo saptand›. Rutin tetkiklerinde bak›lan TORCH enfeksiyon parametre- (SIS) tekni¤inin yerini belirlemek. Gereç ve Yöntem: SSK Ege Do¤umevi ve Ka-
lerinden Rubella IgM ve Rubella IgG pozitifli¤i saptanm›flt›r. Aktif Rubella enfek- d›n Hastal›klar› E¤itim Hastanesi infertilite klini¤ine baflvuran 72 infertil hasta ça-
siyonunun teyit edilmesi amac›yla hariçteki bir laboratuardan da Rubella antikorla- l›flmaya al›nd›. Hastalara önce transvaginal ultrason, daha sonra SIS yap›larak so-
r› istendi. Hariçteki bir laboratuarda IgM negatif, Rubella IgG pozitif ve Rubella nuçlar kaydedildi, bu sonuçlar histerosonografi (HSG) bulgular› ile karfl›laflt›r›ld›.
IgG aviditesinin %84 olmas› üzerine hasta durumla ilgili bilgilendirildi. Hastan›n Tan›sal do¤rulu¤u operatif histeroskopiyle konuldu. Bulgular: Hastalar›n ortalama
iste¤i ile gebeli¤in devam edilmesine karar verildi. Gebeli¤in rutin takibinde her- yafl› 32,1 idi. Ortalama infertilite süreleri 4,7 y›l idi. Hastalar›n 51’inde (%70,8) ute-
hangi bir anormallik geliflmeyen hasta, 27. gebelik haftas›nda antenatal poliklini- rin bir patoloji tespit edilerek operatif histeroskopiye geçildi. 21 hastada kavite nor-
¤imzde halen takip edilmektedir. Bu vaka sunumunda Rubella taramas›n›n gebelik- mal olarak de¤erlendirildi. Do¤ru tan› oran› HSG’de %54, SIS’de %60 olarak be-
teki önemi ve laboratuvar tetkiklerinde karfl›lafl›labilecek çeliflkili sonuçlar tart›fl›l- lirlendi. SIS ve HSG beraber kullan›ld›¤›nda do¤ru tan› oran› %94,7’dir. Sonuç:
m›flt›r. SIS ve HSG’nin uterin kavitenin de¤erlendirmesinde birbirine üstünlükleri yoktur.
Beraber kullan›ld›¤›nda do¤ru tan› daha yüksektir.
142
Vol 4(2) 2003 18 May›s 2003 Pazar
P-131 P-133
KIRIKKALE ‹L‹NDE TAK‹P ED‹LEN GEBE KADINLARDA PR‹MER D‹SMENOREL‹ OLGULARDA UTER‹N ARTER KAN
PREEKLAMPS‹ PREVELANSI AKIMINDA D‹URNAL DE⁄‹fi‹KL‹KLER
M. Bayram, F. Sevin•, C. Soyer, G. …zer, B. U•ar H. ‚elik, B. GŸrateß, E. Sapmaz, C. ParmaksÝz, A. AltÝngŸl, S. †nal
K›r›kkale Ünivesitesi T›p Fakültesi, K›r›kkale F›rat üniversitesi T›p Fakultesi Kad›n Hastal›klar› ve Do¤um A B D. Elaz›¤
Amaç: Bölgemizdeki gebe kad›nlarda, preeklampsinin görülme prevelans›n›n ve Amaç : Primer dismenore olgular›nda uterin arter kan ak›m de¤iflimlerine gece-
ortaya ç›k›fl haftas›n›n belirlenmesi amaçland›. Gereç ve Yöntem: 2000-2003 y›l- gündüz fark›n›n araflt›r›lmas›. Gereç ve Yöntem: Bu çal›flma primer dismenore ta-
lar› aras›nda poliklini¤imize baflvuran birinci, ikinci ve üçüncü trimesterdeki 1200 n›s› konulan toplam 15 olgu üzerinde yap›ld›.Tüm olgular›n gündüz saat 12:00-
gebe çal›flmaya dahil edildi. Tüm gebelerin ayl›k izlemlerinde kan bas›nc›, vücut 14:00 ve gece saat 00:00-02.00 aras›nda ve transvaginal renkli doppler ile (HITAC-
a¤›rl›¤›, pretibiyal ödem, tam kan say›m›, karaci¤er ve böbrek fonksiyon testlerine HI EUB 525, 6.5 mHz) bilateral uterin arter Sistol/ Diastol oranlar› (S/D), Pulsati-
bak›ld›. Hipertansiyon saptanan gebelerde, günlük protein at›l›m›n› tespit amac› ile lite ‹ndeksi (PI) ve Rezistans ‹ndeks (RI) ölçümleri yap›larak elde edilen de¤erler
24 saatlik idrar topland›. Bulgular: Çal›flmaya dahil olan 1200 gebenin; yafllar› 24- karfl›laflt›r›ld›. ‹statistiksel de¤erlendirmede Wilcoxon Rank testi kullan›ld›. P <0.05
39 aras›ndayd› ve ortalama gravidalar› 3 idi. Bunlar içinde 22 preeklampsi vakas›, anlaml› kabul edildi. Bulgular: Gündüz saat 12:00-14:00 aras› yap›lan doppler öl-
ortalama 28. gebelik haftalar›nda tespit edildi. Bunlar›n %77,27’si hafif, %22,73’ü çümlerinde sa¤ uterin arter S/D: 3.47 ± 0.26, RI: 0.75 ± 0.16, PI: 2.46 ± 0.14, sol
fliddetli preeklampsi idi. Yap›lan takiplerde, kan bas›nçlar› hastalar›n %77,27’sinde uterin arter S/D: 3.34 ± 0.27, RI: 0.73 ± 0.27, PI: 2.44 ± 0.23 . gece saat 00:00-02.00
140/90-160/110 mmHg aras›nda, %22,73’ünde 160/110 mmHg’n›n üzerinde bulun- aras›nda yap›lan ölçümlerde sa¤ uterin arter S/D: 3.97 ± 0.26, RI: 0.94 ± 0.21, PI:
mufltur. 24 saatlik idrar analizinde proteinüri miktarlar› %22,73’ünde 300 mg/dl’nin 2.91 ± 0.27, sol uterin arter S/D: 3.94 ± 0.27, RI: 0.96 ± 0.23, PI: 2.96 ± 0.24 ola-
alt›nda, %68,18’inde 300-5000mg/dl aras›nda ve %9,09’unda 5000 mg/dl’nin üze- rak bulundu. Karfl›laflt›rmalarda uterin arter doppler indekslerinin gece saat 00:00-
rinde saptanm›flt›r. Bu hastalar›n di¤er parametrelerine bak›lacak olursa; ALT 02.00 aras› yap›lan ölçümlerde anlaml› olarak artm›fl oldu¤u bulundu (p <0.05). So-
%77,27’sinde normal, %27,73’ünde yüksek; AST %81,82’sinde normal, nuç: Bu çal›flmadaki bulgular›m›z dismenoreik olgularda çal›flma saatlerinin düzen-
%18,18’inde yüksek; BUN %95,45’inde normal, %4,45’inde yüksek; kreatinin lenmesinde bilimsel bir bak›fl aç›s› getirebilir.
%86,36’s›nda normal, %13,64’ünde yüksek; hemoglobin ve hematokrit %68,18’in-
de normal, %31,82’sinde düflük; trombosit %81,82’sinde normal, %18,18’inde dü-
flük bulunmufltur. Sonuçlar: K›r›kkale ilinde gebelikte preeklampsi prevelans›
%1,83 ve ortaya ç›k›fl› ortalama 28. gebelik haftas› olarak tespit edilmifltir. P-134
FETAL MAL‹GN SAKROKOKS‹G‹AL TERATOM: OLGU SUNUMU
P-132 Ü. Esinler, S. GŸven, B. KaramŸrsel, L. …nderoÛlu
MATERNAL D‹G‹TAL‹ZASYON ‹LE TEDAV‹ ED‹LEN NON‹MMUN Hacettepe Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD,
H‹DROPS FETAL‹S OLGUSU Ankara
H. ‚elik, C. ParmaksÝz, E. Sapmaz, B. GŸrateß, A. AltÝngŸl, F. YÝldÝz Sakrokoksigial Teratom (SKT) konjenital tümörlerin en s›k görülenidir. ‹nsidans›
1/35.000-1/40.000 aras›nda de¤iflmektedir. K›z fetuslarda erkeklere oranla 4 kat da-
F›rat Üniversitesi T›p Fakultesi, Kad›n Hastal›klar› ve Do¤um AD, Elaz›¤ ha fazla görülür. Prenatal dönemde tespit edilen SKT’lar›n %95’den fazlas›n› be-
nign tümörler (matür ya da immatür) oluflturur ve bunlar›n perinatal mortalitesi %67
dolaylar›ndad›r. Malign SKT’lar ise çok nadir olarak izlenir. 31 yafl›nda, G3P2,
31,2 hafta gebe iken klini¤imize baflvuran hastaya yap›lan antenatal USG’de sak-
Amaç: 20. gebelik haftas›nda tespit edilen ve maternal digitalizasyon ile tedavi edi-
rum bölgesinden eksternal olarak protrude olan (Tip 1 SKT), 15x15 cm boyutlar›n-
len nonimmun hidrops olgusunun sunulmas›. Olgu: R.T., 39 yafl›nda, G:9,P:7,
da kitle tespit edildi. Kitleye efllik eden polihidramniyos (Amniyotik S›v› ‹ndeksi:29
A:2,Y:7. 18. gebelik haftas›nda pelvik kitle torsiyonu nedeniyle acil flartlarda ope-
cm) d›fl›nda ek patoloji izlenmedi. Fetal kalp yetmezli¤i bulgular› olmad›¤› için be-
re edildi. Postoperatif gebelik takipleri s›ras›nda 20. gebelik haftas›nda fetal nonim-
tametazon 12 mg akci¤er matürasyonu için uyguland› ve elektif C/S planland›. Fa-
mun hidrops tespit edildi. Yap›lan incelemelerde fetal infeksiyonlar aç›s›ndan nor-
kat takiplerde fetal deselerasyonlar›n ve uterin hipertonisitenin olmas› nedeniyle ab-
mal ve karyotipi 46,XY olarak bulundu. Olguya maternal digitalizasyon uyguland›.
lasyo plasenta öntan›s› ile 31,4 hafta iken acil olarak C/S uyguland›. 2450 gram, 4
27 haftadan itibaren hidropsun azalmaya bafllad›¤› ve 32. haftada tamamen düzeldi-
apgarl›, k›z fetus do¤urtuldu. Retroplasental hematom varl›¤› ablasyo plasenta tan›-
¤i tespit edildi. Sonuç: Nonimmun hidrops fetalis, kardiovasküler, pulmoner, kro-
s›n› konfirme etti. Fetus postpartum 7. dakikada kardiopulmoner arrest nedeniyle ex
mozamal, hematolojik ve enfeksiyon hastal›klar›n› kapsayan heterojen gruptaki
oldu. Fetal umbilikal arter kan gaz› parametreleri normal olarak bulundu. Fetusun
hastal›klar›n bir sonucudur. Maternal digitalizasyon uygun vakalarda terapatik de-
otopsi incelemesinde kitle haricinde patoloji saptanmad›. Kitlenin histolojisi ise
¤ere sahiptir.
embriyonel karsinom odaklar› içeren malign teratom olarak tespit edildi.
143
Vol 4(2) 2003 18 May›s 2003 Pazar
P-135 siyon yüksekli¤i nedeni ile alfa-metil dopa 2x500 mg kullan›yormufl. Anjiografisin-
de LAD diagonal sonras›nda %60-70 darl›k saptanm›fl, nitrogliserin sonras› en faz-
OVAR‹AN D‹SGERM‹NOM VE GEBEL‹K: OLGU SUNUMU la %50 olunca iflleme son verilmifl. Ekokardiografide sol ventrikül fonksiyonlar›
normal s›n›rlarda, efor test negatif, EKG’de geçirilmifl anteroseptal MI bulgular›
vard›. Yap›lan ilk fetal ultrasonografik incelemesinde her iki bebe¤in ölçümlerinin
S. GŸven, E. GŸvendaÛ GŸven, D. Beishenova, N. YiÛit, M. Baßaran, 3 persentil alt›nda, umbilikal dopler çal›flmas›nda her iki bebekte redüstribüsyon ol-
Z. Tuncer du¤u saptand›. IUGR ve yüksek riskli gebelik tan›lar› ile servisteki izleminde dias-
tolik kan bas›nc› 90 mmHg üzerinde seyretmesi, spot idrar tetkikinde +++ proteinü-
Hacettepe Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, ri ve 24 saatlik idrarda 0.6 gram/lt proteinüri saptanmas› nedeni ile süperimpoze
Ankara preeklampsi tan›s› ile iv magnezyum sülfat tedavisi ile ek olarak akci¤er maturas-
yonu için tek doz steroid enjeksiyonu yap›lan hasta serviste izleme al›nd›. Hb 10.6
Amaç: Gebelikte over kanseri çok nadirdir. Over kanserlerinin sadece %2-5’i ge- gr/dl, trombosit 192.000/lt, ürik asit 7.9 (2-6 mg/dl), olup karaci¤er ve böbrek fonk-
belikte tan› al›r. Over kanseri ve gebelik 15.000-30.000 gebelikte bir görülür. Ovar- siyon testleri normal s›n›rlarda idi. ‹zleminde ara ara gö¤üs a¤r›lar› oldu ama EKG
yan disgerminom ile komplike olmufl 31 haftal›k gebe olgu sunulmufltur. Olgu su- ve kardiak enzim de¤erlendirilmelerinde akut patoloji saptanmad›. 30 hafta 6 gün
numu: 25 yafl›nda ilk gebeli¤i olan 31 haftal›k gebe hasta bel ve kar›n a¤r›s› flika- gebe iken tansiyonlar›n›n sürekli yüksek seyretmesi, fetal biyofizik profilde bozul-
yeti ile baflvurdu¤u klini¤imizde yap›lan ultrasonografik incelemesinde gebelik haf- ma nedeni ile acil sezaryen ile 1140 ve 1540 gram canl› erkek bebekler do¤urtuldu.
tas›na göre 5 persentil alt›nda IUGR ile uyumlu fetus ve fetusu bat›n içinde s›k›flt›- Her iki bebek 1 hafta yo¤un bak›m ünitesinde izlendikten sonra ek sorun olmadan
ran muhtemelen sa¤ adneksial kökenli ölçülemeyecek kadar büyük kistik solid kit- taburcu edildi. Sonuç: Gebeli¤i komplike eden geçirilmifl MI nadir olup gebelik ön-
le ve intraabdominal asit saptand›. Özgeçmiflinde diabet ve hipertansiyon da olan cesinde ventrikül fonksiyonlar›n›n de¤erlendirilmesi ile gebeli¤e izin verilebilir.
hastan›n izleminde 150/110 mmHg tansiyon ataklar› olmas›, spot idrar tetkikinde Hastam›zda muhtemelen altta yatan koroner arter hastal›¤› ve kronik hipertansiyon
++ proteinüri saptanmas› nedeni ile süperimpoze preeklampsi kabul edildi ve hasta ‹UGR geliflimine neden olmufltu. Bu tür riskli gebelerin kad›n do¤um ve kardiyolo-
serviste izleme al›nd›. Servise kabul edildi¤inde rutin tetkikleri yan›nda tümör mar- ji uzman›n›n oldu¤u 3. basamak sa¤l›k merkezlerinde takip edilmesi gereklidir.
kerlar› da istenen hastan›n kan biyokimyas›nda LDH’›n çok yüksek oldu¤u (3564
U/L) görüldü, tam kan say›m›nda L) say›m› dikkatFise anemi (Hb 9.8mg/dl) ve s›-
n›rda trombosit (160x103) çekiciydi. Kanama parametreleri subklinik bir dissemi-
ne intravasküler koagülasyonu ekarte ettiremese de karaci¤er fonksiyon testlerinin P-137
normal s›n›rlarda olmas› yan›nda periferik yaymas›nda hemoliz bulgular›n›n sap-
tanmamas› nedeni ile HELLP sendromu düflünülmedi. Serviste izlemin 3. günü VAJ‹NAL AKINTI fi‹KAYET‹ OLAN RAH‹M‹Ç‹ ARAÇ TAfiIYICISI
NST’de tekrarlayan derin deselerasyonlar› olan hasta akut fetal distress tan›s› ile se- KADINLARDA GEN‹TAL FLORA VE SEMPTOMLARDAK‹
zaryene al›nd›. 4/7/9 apgarl› 1550 gram canl› k›z bebek do¤urtuldu. Sa¤ overden
DE⁄‹fi‹KL‹KLER‹N SAPTANMASI
kaynaklanan 35x30 cm kistik solid kitle mevcuttu kitle vard›. Sezeryan ile birlikte
sa¤ unilateral salpingooferektomi, adezyolizis ve pelvik lenf nodlar›ndan biyopsi
yap›lan hastan›n tümör yata¤›ndan olan yayg›n kanama odaklar› kontrol edilerek B. Dilbaz1, E. ‚alÝßkan2, …. …zdeÛirmenci2, L. ‚akÝr2, S. Dilbaz2,
operasyona son verildi. Nihai patoloji disgerminom olarak rapor edildi. Kapsül d›- G. Aksu2, E. …ztaß2
fl›nda tümör olmas› fakat peritoneal implantlar›n olmamas› nedeni ile evre IC kabul
1
edildi. Sonuç: Disgerminom gebelikte en s›k görülen malign over tümörüdür. Has- SSK Ankara Do¤umevi ve Kad›n Hastal›klar› E¤itim Hastanesi, Ankara
tam›zda muhtemelen over tümörünün bas›s› ve plasentada yapt›¤› perfüzyon bozuk- 2
Kocaeli Üniversitesi Kad›n Hastal›klar› ve Do¤um AD, ‹zmit
lu¤u sonucu IUGR oluflumuna neden olmufltu. Gebelik haftas› nedeni ile bu hasta-
da en uygun yaklafl›m k›sa süreli de olsa zaman kazanmak olsa da izlemde tan› ko-
Amaç: Vajinal ak›nt› flikayeti olan rahimiçi araç tafl›y›c›s› kad›nlarda genital flora
nulan preeklampsi ve muhtemel HELLP sendromu ile kar›flan laboratuvar bulgula-
ve semptomlar› vajinal ak›nt›s› olan ancak rahim içi araç kullanmayan kad›nlarla
r› nedeni ile tan›sal bir sorun yaratm›flt›r.
karfl›laflt›rmak. Gereç ve Yöntem: Vajinal ak›nt› flikayeti ile aile planlamas› polik-
lini¤ine baflvuran 50 kad›n›n (grup 1) semptomlar›, vajinal kültürleri, taze yaymala-
r›, vajinal ak›nt› flikayeti olan ancak rahimiçi araç kullanmayan 30 vaka (grup 2) ile
karfl›laflt›r›ld›. Bulgular: Hastalar›n yafllar› ve pariteleri aras›nda anlaml› bir fark
P-136
yoktu. ‹ki grubun e¤itim seviyeleri benzerdi. Grup 1 olgular›n %34’ü, grup 2 olgu-
lar›n ise %36.7’si tütün kullan›yordu. Grup 1 olgular›n 3’ünde (%6) dismenore, iki-
GEÇ‹R‹LM‹fi M‹YOKARD ENFARKTÜSÜ SONRASINDA GEBEL‹K: sinde (%4) polimenore görülürken grup 2 olgularda bu semptomlara rastlanmad›,
OLGU SUNUMU ancak fark anlaml› de¤ildi (p>0.05). Postkoital kanama grup 1 olgular›n %12’sinde
gözlenirken, grup 2 olgular›n %3.3’ünde gözlendi (p=0.1). Grup 1 olgular›n 27’sin-
S. GŸven, E. GŸvendaÛ GŸven, T. Durukan de (%54) kokulu ak›nt› varken grup 2’nin tamam›nda kokulu ak›nt› vard› (p<0.001).
Grup 1 olgular›n ikisinde ak›nt› renksiz iken grup 2 olgularda renksiz ak›nt› yoktu.
Yap›lan taze yaymada grup 1 olgular›n 19’unda (%38) patolojik organizma gözle-
Hacettepe Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD,
nirken bu say› grup 2 olgularda %57 idi (=17, p=0.1). Vajinal kültürde üreme ise
Ankara grup 1 olgular›n %54’ünde, grup 2 olgular›n %23’ünde gerçekleflti (p=0.007). Grup
1 olgularda üreyen organizmalar 10 olguda (%20) kandida, 7 olguda (%14) gardne-
Amaç: Gebeli¤i komplike eden miyokard enfarktüsü çok nadirdir. Yaklafl›k rella vaginalis, kalan 10 olguda (%20) mikst enterik florayd›. Bu bulgular grup 2’de
10.000’de bir oran›ndan daha az görülür. Geçirilmifl miyokard enfarktüsü ile komp- s›ras›yla 5 kandida, 4 gardnerella vaginalis ve 8 mikst enterik florayd›. Sonuç:
like olmufl 30 hafta 6 gün ikiz gebelik olgusu sunulmufltur. Olgu sunumu: 38 ya- Semptomatik rahimiçi araç tafl›y›c›lar›ndan izole edilen patolojik mikroorganizma-
fl›nda Gravida 8, Para 5, Yaflayan 4 olan 26 haftal›k gebe hasta geçirilmifl miyokard lar›n da¤›l›m›, rahimiçi araç kullanmayan kad›nlarla benzerdir.
enfarktüsü, spontan ikiz gebelik nedeniyle klini¤imize baflvurdu. Özgeçmiflinden 3
ve 4 y›l önce toplam iki kez miyokard enfarktüsü nedeni ile hastanede yatt›¤›, 5 y›l-
d›r kronik hipertansiyon nedeni ile izlendi¤i ve izosorbid-mononitrat 1x40 mg, izo-
sorbid dinitrat 1x10mg, aspirin 1x100 mg kulland›¤› ö¤renildi. Son 2 ayd›r da tan-
144
Vol 4(2) 2003 18 May›s 2003 Pazar
P-138 P-140
THE EFFICACY OF DOUBLE VERSUS SINGLE INTRAUTERINE PREOPERATIVE AND POSTOPERATIVE CORRELATION OF
INSEMINATION IN PATIENTS WITH ABNORMAL SPERM HISTOPATHOLOGICAL FINDINGS IN CASES OF ENDOMETRIAL
MORPHOLOGY HYPERPLASIA
B. …zmen, C. Demirel, E. Simßek, K. Aydos, G. Vardar G. GŸndem1, F. ÞendaÛ1, M. KazandÝ1, F. Akercan1, L. Mgoyi1, M. Terek1,
O. ZekioÛlu2
Ankara Üniversitesi Kad›n Hastal›klar› ve Do¤um AD, Ankara
1
Ege University Faculty of Medicine Department of Obstetrics and
Objective: To compare the results of double versus single intrauterine insemination Gynecology, ‹zmir
(IUI) in patients with abnormal sperm morphology. Design: Prospective random- 2
Ege University Faculty of Medicine Department of Pathology, ‹zmir
ized comparison. Patients: Women undergoing IUI with their partner’s semen
whose morphology fell consistently below 14 % normal forms according to strict
Objectives: To determine the preoperative and postoperative correlation of
Kruger’s criteria. Intervention(s): Ovulation induction with clomiphene citrate,
histopathological findings in cases of endometrial hyperplasia. Material and
preparation of partner’s semen using wash and swim-up; with double (at 18.-42.
Methods: One-hundred and three patients with endometrial hyperplasia detected by
hours post hCG) or single (at 36. hour post hCG) intrauterine insemination.
surgical curettage performed due to various gynecologic pathologies were treated by
Result(s): The mean age was 28.5 and 30.6 in single and double insemination
hysterectomy. We compared retrospectively the histopathological diagnoses found
groups. The mean infertility period was 7 years in both groups. The pregnancy rates
on curettage with that found on hysterectomy specimen. The classification scheme
per cycle were %10 and %15.78 in double insemination and single insemination
endorsed by International Society of Gynecological Pathologists was used to classi-
group, respectively (p>0.05). The patients with morphology less than % 4 accord-
fy the endometrial hyperplasia. The histologic findings found on endometrial tissues
ing to Kruger’s strict criteria was % 63.15 in double insemination and % 77.5 in sin-
of curettage specimen were correlated with those found from hysterectomy materi-
gle insemination group. There was no statistical difference observed in pregnancy
als. Histopathologic evaluation was performed by a single skilled gynecologic
rates between two groups. Conclusion(s): Although there was not any statistical
pathologist. Results: A total number of 103 women 76 (73.8%) premenopausal and
difference in pregnancy rates between both groups, single intrauterine insemination
27 (26.2%) postmenopausal were found to have endometrial hyperplasia on
was slightly more efficient than double insemination in patients with abnormal
histopathological evaluation of endometrial tissues obtained by endometrial curet-
sperm morphology. Key words: Abnormal sperm morphology, intrauterine insem-
tage performed for evaluation of various bleeding abnormalities. These included, 94
ination.
patients with simple hyperplasia without atypia (91.3%), two patients with simple
hyperplasia with atypia (1.9%), five patients with complex hyperplasia without
atypia (4.9%), and two patients with complex hyperplasia with atypia (1.9%).
Histopathological evaluation of endometrial tissues obtained from hysterectomy
P-139
specimens (of patients diagnosed of having hyperplasia on curettage) revealed a
total number of 65 cases (63.1%) with endometrial hyperplasia, and thirty-eight
OVER KANSER‹NDE ERKEN REKÜRRENS‹N BEL‹RLENMES‹NDE cases (36.9%) were found to have various histopathological findings. The correla-
TELOMERAZ AKT‹V‹TES‹N‹N YER‹ tion between pre-operative and post-operative endometrial histologic findings were
found to be statistically insignificant (r = 0.105, p = 0.29). Among 94 patients who
B. …zmen1, F. Orta•1, A. TŸkŸn2, M. GŸngšr2, G. GŸmŸß2, were found to have simple hyperplasia without atypia on curettage specimens, were
found to have simple hyperplasia without atypia, 55.3%, simple hyperplasia with
B. AydÝnuraz2, E. Þimßek2, T. EroÛlu Elmas2, C. AtabekoÛlu2
atypia, 1.1%, complex hyperplasia without atypia 5.3%, secretory endometrium
1 9.6%, proliferative endometrium, 4.3%, disorganized proliferative endometrium,
Ankara Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD,
21.3%, corpus luteum persistency, 1.1%, basal endometrium, 1.1%, and endometri-
Ankara um cancer 1.1% on final hysterectomy specimens Conclusion: Postoperative diag-
2
Ankara Üniversitesi T›p Fakültesi Tibbi Bioloji ve Genetik, Ankara nosis of endometrial pathology might be different from that of preoperative, espe-
cially in cases with simple endometrial hyperplasia without atypia.
Amaç: Erken rekürrensin belirlenmesinde telomeraz aktivitesinin etkinli¤ini sapta-
mak. Gereç ve Yöntemler: Çal›flmada primer sitoredüksiyonu yap›lm›fl, first-line
kemoterapileri tamamlanm›fl ve second-look cerrahleri yap›lan 15 evre III ve IV
over kanser olgusu ile benign jinekolojik hastal›¤› olan 25 kontrol hastas›nda telo-
meraz aktivitesi de¤erlendirilmifltir. Telomeraz aktivitesi bat›n y›kama mayi yada
asit s›v›s›ndan çal›fl›lm›flt›r. Rekürrens için hastalar second-look sonras›nda bir y›l
süre izlenmifltir. Rekürrens gösteren vakalarda telomeraz aktivitesi di¤er vakalar ile
karfl›laflt›rlm›flt›r. Bulgular: Kontrol ve over kanserli olgular›n ortalama yafl› s›ras›
ile 39.04±10.50 ve 45.33±10.76 olarak hesaplanm›flt›r. Çal›flma sonunda 5 hastada
rekürrens gözlenmifltir. Telomeraz aktiviteleri de¤erlendirildi¤inde telomeraz akti-
vitelerinin da¤›l›mlar› homojen de¤ildir. Over kanserli olgular›n ve kontrol vakala-
r›n›n ortalama, ortanca telomeraz aktiviteleri s›ras› ile 54.65±69.05, 20.49 (ranj 0-
212.14) ve 27,65±32.49, 22.15 (ranj 0-135.15) olarak hesaplanm›flt›r. Rekürrens ve
over kanserli olgular›n telomeraz aktiviteleri ortalama, ortanca de¤erleri s›ras› ile
13.05±5.08, 8.43 (ranj 8.43-20.49) ve 75.46±77.22, 57.08 (ranj 0-212.14) olarak
hesaplanm›flt›r. Rekürrens olgular› ile hastal›ks›z over kanserli olgular yada kontrol
grubu aras›nda telomeraz aktiviteleri aç›ks›ndan bir fark bulunamam›flt›r (p>0.05).
Sonuç: Rekürrens olgular›n›n erken tespitinde telomeraz aktivitesi yerinin yoktur.
Rekürrens olgular›nda, karsinogenezde telomer d›fl› mekanizmalar rol oynuyor ola-
bilir. Anahtar kelimeler: Telomeraz aktivitesi, Ovaryen Kanser, Erken rekürrens
145
Vol 4(2) 2003 18 May›s 2003 Pazar
P-141 P-143
GENETIC ASPECTS OF HUMAN MALE INFERTILITY : THE MEIGS SYNDROME ASSOCIATED WITH GIANT GRANULOSA CELL
FREQUENCY OF CHROMOSOMAL ABNORMALITIES AND Y TUMOR OF THE OVARY: A CASE REPORT
CHROMOSOME MICRODELETIONS IN SEVERE MALE FACTOR
INFERTILITY S. ErkanlÝ, E. Aslan, E. KÝlÝ•daÛ, E. TarÝm, T. BaÛÝß, G. AßÝk, E. Kuß•u
A. Vicdan1, K. Vicdan2, S. GŸnalp3, A. Kence3, C. Akarsu3, A. IßÝk3, Baflkent University School of Medicine, Ankara
E. Sšzen3
Introduction: Sex cord-stromal tumors account for 5%-10% of all ovarian cancers;
1 most of these (70%) are granulosa cell tumors, which are low-grade malignancies
Middle East Technical University, Department of Biology, Ankara
2
with a relapse rate of 10%-33%. Meigs’ syndrome is an uncommon clinical entity
Ankara IVF Center, Ankara in which usually a benign ovarian fibroma is seen with ascites and hydrothorax.
3
Hacettepe University, IVF Department, Ankara Case Report: 47 years old, premenopausal virgin presented to our clinic with the
chief complaint of anorexia and diarrhea of approximately 3 weeks duration. Pelvic
The aim of this study is to detect the frequency and types of both chromosomal abnor- examination revealed an adnexal mass on the right side. Computerized tomography
malities and Y chromosome microdeletions in patients with severe male factor infer- scan showed adnexal mass up to the level of renal hilus, and bilateral pleural effu-
tility and fertile control subjects in Turkish population. The associations between the sion, uterus and left ovary were normal. Thoracentesis was negative for tumor cells.
type of genetic abnormality and clinical parameters including sperm concentration, Ca-125 was 553 U/ml, LDH was 502 IU/L. Laparotomy was performed where a
testicular histopathology, sperm retrieval by testicular sperm extraction were also right sided giant, partially necrotic ovarian mass, 150 cc of ascitic fluid admixed
evaluated. This study was carried out in 208 infertile and 20 fertile men. Of 208 with blood and bilateral double ureters were noted. No signs of metastatic disease
patients, 119 were azoospermic and 89 have had severe OAT. 17 out of 119 (14.3%) in the abdomen were found. The mass was excised and sent for frozen along with
azoospermic patients and 2 out of 89 (2.2%) patients with OAT had Y chromosome ascitic fluid. Pathologic diagnosis was granulosa cell tumor. Total abdominal hys-
microdeletions. Totally, 19 cases with a Y chromosome deletions were detected in terectomy, bilateral salpingooopherectomy, pelvic and paraaortic lymph node sam-
208 in infertile men, with a frequency of 9.1 %. The AZFc locus, mainly DAZ gene pling, omentectomy, and appendectomy were performed. No tumoral metastasis
cluster was the most frequently deleted region of the Y chromosome in our cases. 5 was found. In cross sections of the 30 x 28 x 13 cm right ovary, tumor cells showed
other cases among 119 azoospermic patients (4.2%) and 2 cases with OAT (2.2%) call-exner bodies and scant cytoplasm but no mitotic figures. Hydrothorax rapidly
also had a chromosomal abnormality, with a total chromosomal abnormality of seven dried up on excision, and postoperative follow-up was unremarkable. Conclusion:
(3.4%) among these 208 infertile men. Including Y chromosome deletions and a Being the third reported case of granulosa cell tumor of the ovary associated with
structural chromosome abnormality, a total genetic abnormality rate of 12.5% Meigs’ syndrome, this unique clinical entity should be considered in the diagnosis
(26/208) detected in our infertile male population. On the other hand, in 20 men with of ovarian tumors.
proven fertility, neither Y chromosome deletion nor chromosomal abnormality were
detected. No abnormality were found in the fathers of 5 cases with microdeletions.
Histologically, Y chromosome microdeletions and chromosomal abnormalities were
associated with various spermatogenetic alterations, including Sertoli Cell-Only syn- P-144
drome, maturation arrest and fibrosis or hyalinization, but no case with hyposper-
matogenesis was detected in these cases, whereas hypospermatogenesis occurred SENKRON‹ZE J‹NEKOLOJ‹K KANSERLERDE 17 YILLIK DENEY‹M‹M‹Z
more frequently in patients without a genetic abnormality suggesting that genetic
abnormality can be associated with more severe spermatogenetic failure in testis.
S. ‚imen, …. …ztekin, C. Tan, E. ÞentŸrk, L. ‚amlÝ, F. Soylu
Atatürk E¤itim ve Araflt›rma Hastanesi, II. Kad›n Hastal›klar› ve

P-142 Do¤um Klini¤i, ‹zmir
THE ROLE OF PERINEAL SONOGRAPHY IN THE EVALUATION OF Amaç: Bu çal›flma klini¤imizde yap›lan onkolojik cerrahi ameliyatlar›nda karfl›lafl-
PATIENTS WITH STRESS URINARY INCONTINENCE t›¤›m›z senkronize kanserlerin s›n›fland›r›lmas› ve prevalanslar›n›n hesaplanmas›
amac› ile gerçeklefltirilmifltir. Gereç ve Yöntem: Çal›flmay› gerçeklefltirmek üzere
klini¤imizde 1986-2003 y›llar› aras›nda jinekolojik kanser nedeni ile opere edilen
F. ÞendaÛ1, H. Vidinli1, M. KazandÝ1, Ü. Ütil1, N. Aßkar1, B. Vidinli2, hastalar›n dosyalar› retrospektif olarak incelenmifltir. Bulgular: Klini¤imizde bu
A. Pourbagher3 süre içinde over kanseri nedeni ile 105, serviks kanseri nedeni ile 95 ve endometri-
um kanseri nedeni ile 102 olgu olmak üzere toplam 302 hasta opere edilmifltir.Bu
1
Ege University Faculty of Medicine Department of Obstetrics and hastalar›n birinde (%0,3) servix ca + corpus ca, birinde (%0.3) serviks ca + tuba ca
Gynecology, ‹zmir + over ca + endometrium ca, 4 tanesinde (%1.3) ise over ca + endometrium ca,
2
Ataturk Education and Investigation Hospital, ‹zmir senkronize olarak tespit edilmifltir. Sonuçlar: Jinekolojik onkoloji vakalar› içerisin-
3 de daha çok endometrium ve over kanserleri birliktelik göstermektedir. Bu birlikte-
Ege University Faculty of Medicine Department of Radiology, ‹zmir
lik de¤iflik serilerde %14 ile %20 aras›ndad›r. Ancak senkronize tümör oluflumu çok
daha nadir görülmektedir. Endometrial tümör düflük grade’li ve myometrial invaz-
Objective: The aim of the study is to determine the role of perineal sonography in yon 1/2 den az ise metastatik potansiyel çok düflük olup ovarian tümör ba¤›ms›z ola-
diagnosis of stress urinary incontinence. Materials and Methods: Thirty patients rak kabul edilebilir. Tersi durumlarda ovarian tümör belirleyici olmaktad›r. Bilate-
with stress urinary incontinence and 17 age-matched control patients were included ralite ve multinodularite metastatik tümör lehinedir.
in the study. Perineal sonography was performed in both groups to evaluate the role
of this technique in the diagnosis of stress urinary incontinence. By using the pos-
terior edge of the symphysis pubis as a reference point, posterior urethra-vesical
angle (beta angle) and the angle between the vertical axis and urethral axis (alpha
angle) were measured at rest and on straining. Bladder neck mobility was evaluat-
ed only at the cephalocaudal plane by measuring the desensus diameter. Results:
Posterior urethro-vesical angle (beta angle) was found to be significantly different
between the study and control groups both at rest and on straining (p<0.05). The
angle between the vertical axis and urethral axis (alpha angle) was found to be sig-
nificantly different between study and control groups only on straining (p<0.05).
Cephalocaudal distance (desensus diameter) was longer in patients with stress uri-
nary incontinence (p<0.05). Conclusion: Perineal sonography has an important role
in diagnosing patients with stress urinary incontinence.
146
Vol 4(2) 2003 19 May›s 2003 Pazartesi
P-145 düzeyleri 11.36m IU/mL ile, FSH düzeylerinde oldu¤u gibi SCO+fokal spermato-
genez grubunda gözlenmifltir. Di¤er tüm gruplarda LH düzeyleri normal s›n›rlar
ABDOMINAL PREGNANCY WITH A VIABLE FETUS: A CASE REPORT içerisinde yer alm›flt›r. En düflük düzeyler s›ras› ile 6.94 nmol/L ve 7.94 nmol/L de-
¤erleri ile testiküler atrofi ve SCO+fokal matürasyon arresti gösteren olgularda göz-
lemlenmifltir.18±4.8 ml olarak kabul edilen normal testiküler hacim aral›¤›na en ya-
…. …ztekin, S. ‚imen, C. Tan, L. Erkan, L. ‚amlÝ, F. Soylu k›n grup 15.5 ml ortalama ile hipospermatogenez ve 15.3 ml ile matürasyon arresti
izlenen olgulard›r. Johnsen skorunun aktif spermatogenez izlenen grupta 7.35 orta-
Atatürk Education and Research Hospital, Obstetrics and Gynecology lama de¤eri ile en yüksek oldu¤u izlenmifltir. En düflük Johnsen skoru 1.4 ortalama
Clinics, Izmir de¤er ile testiküler atrofi olgular›nda bulunmufltur. Sonuç: TESE sonuçlar› ile kar-
fl›laflt›r›ld›¤›nda FSH düzeyinin spermatogenez hakk›nda de¤erli bir fikir verebil-
About 2% of all pregnancies are ectopic, accounting for 10% of all pregnancy-related mekten uzak gözüktü¤ü azoospermik olgular› ana s›n›flamalara dahil etmekte kul-
deaths. More than 95% of ectopic gestations occur within the fallopian tubes. Abdominal lan›labilirlik tafl›d›¤› söylenebilir. Testis volümü, FSH ile desteklense bile, sperma-
pregnancy, where implantation occurs within the peritoneal cavity, is much more uncom- togenez yönünde net bir fikir sa¤layamamaktad›r. Serbest testosteron düzeylerinin
mon. It has a worldwide incidence of 1:3300 to 1:10200 and occur for 1-4% of all ectopic spermatogenez ve primer testiküler hakk›nda bir fikir vermekten uzakt›r. Johnsen
pregnancies. Even more uncommonly does it reach an advanced stage of gestation, and skoru özellikle SCO ve testiküler atrofi söz konusu ise hücre bulmak yönünde gü-
a viable abdominal pregnancy with a successful outcome is a rare event indeed. venilir fikir vermemektedir.
Diagnosis of abdominal pregnancy is difficult and often missed. Signs and symptoms
such as abdominal pain, gastrointestinal symptoms, painful fetal movements, abnormal
presentations, uneffaced and displaced cervix, vaginal bleeding and palpation of a pelvic
mass distinct from the uterus, are considered suggestive of abdominal pregnancy. P-147
Abdominal pregnancy is a potentially life-threatening condition with high maternal-fetal
mortality and morbidity. Maternal and perinatal mortality rates of 0.5-18% and 40-95% PREMAL‹GN SERV‹KS LEZYONLARINDA SMEAR, YÖNLEND‹R‹LM‹fi
respectively, have been reported in the literature. This paper represents a 33 year old G2 B‹YOPS‹ VE N‹HA‹ PATOLOJ‹LER‹N KARfiILAfiTIRILMASI
P1 woman with a previously unrecognised abdominal pregnancy. Gestational age was
determined to be 33 weeks by dates and 34 weeks by sonography. Cesarean section was
performed because of fetal distress and a 43 cm. 2200 gr. healthy female infant was E. Þimßek, B. …zmen, B. AydÝnuraz, C. Ültemir, K. Kahraman,
delivered. Placenta was left in-situ without any attempt to remove. Methoteraxate was T. EroÛlu Elmas, Ü. DŸnder, F. Orta•
given to the patient. Although the baby lives, the mother has died because of uremia,
hepatic insufficiency and pancytopenia on the 17th postpartum day. Ankara Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, Ankara
Amaç: Premalign serviks lezyonlar›n›n tan›s›nda nihai patoloji ile smear ve kolpos-
P-146 kopik yönlendirilmifl biopsilerin korelasyonunu karfl›laflt›r›ld›. Gereç ve Yöntem:
Çal›flmaya Ankara Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um Anabi-
NON-OBSTRÜKT‹F AZOOSPERM‹K ‹NFERT‹L‹TEDE SERUM FSH, LH, lim Dal› Jinekoloji poliklini¤inde rutin al›nan Pap smear testi sonucu bir kez LSIL
TOTAL TESTOSTERON DÜZEY‹ VE TEST‹S VOLÜMÜ ‹LE TEST‹S ve HSIL ya da 2 kez üst üste ASCUS gelen hastalardan servikal biopsilerinde pre-
malign serviks lezyonu saptanan 30 hasta ve daha önce smear sonucu benign olan
DOKUSUNUN H‹STOPATOLOJ‹K MATÜRASYON BEL‹RTEC‹ OLAN
20 kad›n dahil edildi. Anormal smear sonucu olan hastalarda kolposkopik muayene
JOHNSEN SKORUNUN ICSI ‹Ç‹N GERM HÜCRE ELDE ETME ve yönlendirilmifl servikal biopsiler al›nd›. Serviks d›fl› patolojiler nedeniyle histe-
YÖNÜNDE PRED‹KT‹F DE⁄ER‹ rektomi geçiren 20 kad›nda rutin patolojik inceleme ile servikal doku örnekleri in-
celendi. Bulgular: Kolposkopi ve yönlendirilmifl biopsi için refere edilen hastala-
B. AydÝnuraz1, B. …zmen1, E. Þimßek1, L. Demirel1, C. †nlŸ1, K. Aydos2, r›n smear sonuçlar›nda %36,7’si ASCUS, %30,0’u L-SIL ve %33,3’ü ise H-SIL ne-
deniyle refere edilmiflti. Smear sonucu ASCUS ve L-SIL gelen 20 hasta ve smear
…. Tulunay3
sonucu H-SIL gelen 10 hastan›n biopsi sonuçlar›na göre da¤›l›m›na bak›ld›¤›nda
1 smear sonucu düflük dereceli gruptaki (ASCUS ve L-SIL) %25 hastada yüksek de-
Ankara Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, Ankara receli servikal intraepitelyal neoplaziye rastland›¤› görülmüfltür. Smeari yüksek de-
2
Ankara Üniversitesi T›p Fakültesi ‹nfertilite Teflhis ve Tedavi Merkezi, receli displazi lehine olan (H-SIL) hastalar›n hiçbirisinde düflük dereceli servikal
Ankara intraepitelyal neoplaziye rastlanmam›flt›r. Nihai patolojiler ile biyopsi materyalleri-
3
Ankara Üniversitesi T›p Fakültesi Patoloji AD, Ankara nin karfl›laflt›r›lmas›: biyopsi sonucu CIN I gelen hastalardan %15,4’ünde lokal ek-
sizyon veya histerektomi sonras› inceleme sonras› CIN II saptand›. Yine bu hasta-
lardan %23,1’inde ise nihai patoloji sonucu kronik servisit olarak de¤erlendirilmifl-
Amaç: Çal›flman›n amac› farkl› sebepleri olan nonobstrüktif azoospermik olgular-
ti. Biyopsisinde CIN II saptanan hastalardan %50’sinde nihai patoloji sonucu CIN
da primer histopatolojik tan› ,serum FSH-LH-total testosteron ve testis volümleri ile
III olarak de¤erlendirilmifltir. Hastalar›n %64,3’ünde biopsi sonucu ile nihai pato-
testis dokusunun matürasyon belirteci olan Johnsen skorlar›n› TESE sonuçlar› ile
lojinin uyufltu¤u bulunmufltur. %10,7 hastada nihai patoloji sonuçlar›n›n patolojik
birlikte de¤erlendirmek ve ICSI öncesi TESE’de hücre bulma yönünde olas› predik-
olmad›¤› görülürken bu hastalar›n tamam›n›n CIN I biopsi sonuçlar›na karfl›l›k kro-
tif de¤erleri ortaya koymakt›r. Gereç ve Yöntem: Çal›flmaya 2000 y›l› Kas›m ay›
nik servisit nihai tan›lar› ald›¤› görülmektedir. Kontrol grubundaki 20 hastan›n
ile 2001 y›l› Aral›k ay› aras›nda, çocuk sahibi olamama flikayeti ile baflvuran çift-
%10’unda nihai patoloji CIN I olarak rapor edilmifltir. Yorum: Premalign servikal
lerden yafllar› 23 ile 44 ars›nda de¤iflen 51 erkek hasta dahil edilmifltir. Hastalar›n
lezyonlar›n tan›s›nda kullan›lan smear az›msanmayacak oranda servikal patolojiyi
hepsinden biyopsi öncesinde bazal serum FSH, serum LH ve serum Total testoste-
oldu¤undan düflük gradeli olarak rapor etmekte iken; biyopsi, lokal eksizyon ve his-
ron düzeyleri için kan al›nm›fl ve skrotal USG ile testis volümleri ölçülmüfltür. So-
terektomi materyalleri aras›ndaki doku tan›lar›n›n ise tutarl›l›k gösterdi¤i gözlen-
nuçlar primer histopatoloji , Johnsen skorlar› ve TESE sonuçlar› ile karfl›laflt›r›lm›fl-
mektedir.
t›r. Bulgular: Gruplar içerisinde en yüksek ortalama FSH düzeyi SCO + fokal sper-
matogenez tan›s› alan grupta 26.06 mIU/mL de¤eri ile izlenmifltir. En yüksek LH
147
P-148 P-150
ACARDIAC ACEPHALIC TWIN GESTATION WITH TRANSPOSITION FACTORS ASSOCIATED WITH SEVERE PERINEAL LACERATIONS IN
OF GREAT ARTERIES IN PUMP TWIN NULLIPAROUS WOMEN AND THE EFFECT OF EPISIOTOMY TYPE
E. Þimßek, K. Kahraman, I. †stŸner, B. Cengiz, C. AtabekoÛlu, A. Ko• H. Aytan, …. TapÝsÝz, G. Tuncay, A. Avßar
Ankara Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, Ankara Dr. Zekai Tahir Burak Kad›n Sa¤l›¤› E¤itim ve Araflt›rma Hastanesi, Ankara
Background: Fetal acardia complicates less than 1% of monozygous twinning with Objective: To determine the patient-related factors associated with severe perineal
an overall prevalance of one in 35 000 birth. Associated major cardiac anomaly is lacerations in nulliparous women to whom midline and mediolateral episiotomies were
a peculiar finding that can preclude us from therapeutic intervention. Case: 20 years performed and to evaluate the effect of episiotomy type on the risk of severe perineal
old nullipar 27 weeks pregnant woman applied to our antenatal clinic. At her first tears. Materials and Methods: 200 mediolateral and 200 midline episiotomy per-
visit, routin antenatal tests were within normal limits. On ultrasonographic evalua- formed on 400 nulliparous women in labor who were admitted between June 2001-
tion; she was recognized to have carried a monochorionic monoamniotic twin ges- December 2001 were enrolled in this prospective study. Maternal height, perineal
tation. Acardiac acephalic mass was hidropic in appearence and had no upper limbs length, fetal birth weight, fetal head circumference, and severe perineal lacerations (3rd
and no cystic dilatations. Pump fetus’ ultrasonographic measurements were suitable and 4th degree) were recorded. Statistical analysis was accomplished using Chi-square
with 25 weeks of pregnancy with a cardiothoracic ratio of about 0.68 and its test and Mann-Whitney test. Results: Severe perineal laceration rate was 2% (8/400);
echocardiographic investigation revealed transposition of great arteries and consid- 3% with midline, 1% with mediolateral groups. Severely lacerated patients had signif-
erable pericardial effusion in pump twin. There were no evidence of hydramnios icantly short perineal lengths (p<0.001) and wide head circumferences (p<0.05) in
with amniotic fluid index being 13 cm. An analysis of color Doppler waveforms midline, and heavier birth weights in mediolateral group (p<0.05). A perineal length
confirmed arterial flow from placenta towards the acardiac mass. Family has not cut-off value of 3,05 cm. was found for severe lacerations for midline group. When two
been in favor of pregnancy to go on so then decided to induce therapeutic abortion. groups were united perineal length was found to be the only statistically significant fac-
Mother was hospitalized and applied 400 microgr oral and 800 microgr intravagi- tor associated with lacerations. Conclusion: Cases with a perineal length of ≤3 cm
nal prostaglandin 12 hours after oral dose. 27 hours later she delivered 620 gr have increased risk of severe perineal lacerations and should clinical or ultrasono-
female ex pump twin which was fallowed by 390 gr acardius acephalus mass and graphic estimation of fetal head to be large mediolateral episiotomy must be preferred.
the placenta. Karyotype analysis revealed a normal 46 XX karyotype in acardius Otherwise midline episiotomy must be the preferred procedure.
acephalus mass as well as in pump fetus. Autopsy performed on pump twin proved
transposition of great arteries with additional left thumb’s anomaly most probably
from the amniotic band syndrome. Comment : The presence of an acardiac fetus in
a twin pregnancy is a rare event occuring in one of every 35 000 pregnancies. It P-151
caries considerable amount of adverse pregnancy outcomes. Aneuploidy in acephal-
ic acardiac mass is reported to be common (50%) but rare in the normal twin . 26-34. GEBEL‹K HAFTALARI ARASINDA MULT‹GRAV‹D VE
Multiple anomalies are common and can affect all fetal organ systems. Cardiac
PR‹M‹GRAV‹D HASTALARIN TRANSVAJ‹NAL ULTRASONOGRAF‹ ‹LE
anomaly; the transposition of great arteries in our case is considered to be coinci-
dental anomaly without a genetic basis. SERV‹KAL UZUNLUK VE KALINLIKLARININ DE⁄ERLEND‹R‹LMES‹
B. Duran, Y. TimuroÛlu, N. Yurt•u, T. TimuroÛlu, T. GŸvenal, M. ‚etin
P-149 Cumhuriyet Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, Sivas
CLINICAL OUTCOMES OF EARLY POSTPLACENTAL INSERTION OF Girifl: Neonatal mortalite ve morbiditenin en önemli nedenlerinden biri preterm do-
INTRAUTERINE CONTRACEPTIVE DEVICES ¤umdur. Preterm do¤um tüm do¤umlar›n %8-14’ünü oluflturur. Preterm eylemin ve
do¤umun önlenmesinde yüksek riskli gebelerin erken tan›nmas› ön plandad›r. Obs-
tetrikte uterin serviks en az incelenen organlardan biridir. Modern obstetrikte servik-
Þ. ‚elen, P. Moroy, A. Sucak, A. Aktulay, N. DanÝßman
sin de¤erlendirilmesinde ultrasonografi kullan›lmaktad›r. Servikal de¤iflikliklerin
transvajinal ultrasonografi ile tespit edilmesi yüksek riskli hastalar›n ve preterm ey-
Zekai Tahir Burak Women Health Education and Research Hospital,
lemin erken tan›nmas›n› sa¤lamaktad›r. Bu araflt›rmada 26-34 haftal›k gebelik hafta-
Ankara lar› aras›nda bulunan multigravid ve primigravid hastalar aras›nda servikal uzunluk
ve servikal kal›nl›k aras›nda fark olup olmad›¤›n› araflt›rd›k. Gereç ve Yöntem:
Objectives: To assess the efficiacy and safety, thus advantages and disadvantages Cumhuriyet Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um poliklini¤ine
of early postplacental intrauterine device (IUD) insertion. Materials and Methods: fiubat 2002 – Mart 2003 tarihleri aras›nda baflvuran, son adet tarihine göre 26-34. ge-
IUDs were inserted within 10 minutes after postplacental expulsion in a term preg- belik haftalar› aras›nda bulunan 52 gebe kad›n çal›flmaya al›nd›. Ço¤ul gebelikler,
nancy both in vaginal and caesarean deliveries via a ring forceps. Of the 276 preterm eylem öyküsü, sigara al›flkanl›¤› olan gebeler çal›flmaya al›nmad›. Gebe has-
patients enrolled, 235 were included in the study. Recepients were scheduled for talar multigravid ve primigravid olarak iki gruba ayr›ld›. Her grubta 26’flar hasta yer
examination before hospital discharge; and at 6 weeks, at 6 months and at 12 ald›. Gebelerin yafl, parite, son adet tarihine göre gebelik haftalar›, obstetrik hikaye-
months after postplacental insertion. Results: The percentages of women returning leri, sorguland›. Gebelerin servikal uzunluklar› ve kal›nl›klar› transvajinal sonografi
for a follow up visit were 221 (94%), 210 (89%), 183 (78%) at 6 weeks, at 6 months (Shimadzu SDU-450, Omega Imaging, Cordova, USA) 7.5 MHz transvajinal prob
and at 12 months visits respectively. Among IUD acceptors, 74% of the cases had ile de¤erlendirildi. ‹statistiksel analiz χ2 testi, Man Whitney-U testi, ve korelasyon
vaginal deliveries and 26% had cesarian sectio deliveries. Continuation rates were testleri kullan›larak yap›ld›. Veriler oran veya ortalama ± standart hata olarak sunul-
relatively high being 87.6% and 76.3%, at 6 and 12 months after postplacental du. P < 0.05 olmas› anlaml› olarak kabul edildi. BULGULAR Araflt›rmaya al›nan 52
insertion of IUD. In this study, the 1- year cummulative expulsion rate with T Cu gebe hastan›n yafl ortalamalar› 27 ± 5.11 aras›ndayd›. Gebelik haftas› 26- 34 haftalar
380 A device was observed as 12.3% which may be regarded as a standard expul- aras›ndayd›. Primigravid grupta servikal uzunluk 40.5 ± 3.06 mm, servikal kal›nl›k
sion rate for immediate postplacental insertion of similar models of IUDs. 29.6 ± 3.0 cm iken multipar grupta ise servikal uzunluk 35.8 ± 2.8 servikal kal›nl›k
Conclusion: the evidences from this article suggest that immediate postplacental 29.7 ± 2.3 bulundu. Primigravid grupta gebelik haftas› 29.5 ± 2.9 multigravid grup-
insertion of Cu T 380 models is an effective, useful, safe, convenient and low-cost ta 30.7 ± 2.9 idi. ‹statistiksel analizde iki grup aras›nda servikal uzunlukta fark oldu-
procedure for early postpartum contraception. ¤u fakat servikal kal›nl›kta anlaml› bir fark olmad›¤› bulduk (p<0.005). Bu hastalar
gebelik sonuna kadar takip edildi. ‹ki gruptada preterm eylem ya da preterm do¤um
olmad›. Sonuç: Bir ve birden fazla do¤um yapm›fl olmak servikal uzunlu¤u k›salt-
makta fakat servikal kal›kl›kta anlaml› bir de¤ifliklik yapmamaktad›r. Biz de çal›fl-
mam›zda multipar hastalarda servikal uzunlu¤un k›sald›¤›n› bulduk.
148
P-152 P-154
TERM GEBEL‹KLERDE YÜZ PREZENTASYONU ‹LE ‹L‹fiK‹L‹ POSTMENOPOZAL ÖSTROJEN VEYA T‹BOLON TEDAV‹S‹N‹N P
FAKTÖRLER DALGA D‹SPERS‹YONU ÜZER‹NE ETK‹S‹
H. Aytan, …. TapÝsÝz, F. Anman, E. Toprak, Þ. Kalyoncu, M. Beßli, …. Pata1, N. Akkuß2, H. Pekdemir2, E. Tok1, A. Aktaß1, A. ‚amsarÝ1,
L. MollamahmutoÛlu M. Aban1
Dr. Zekai Tahir Burak Kad›n Sa¤l›¤› E¤itim ve Araflt›rma Hastanesi, Ankara 1
Mersin Üniversitesi Kad›n Hastal›klar› ve Do¤um AD, Mersin
2
Mersin Üniversitesi Kardioloji AD, Mersin
Amaç: Term gebeliklerde yüz prezentasyonu tespit edilip sezeryan ile do¤urtulan
infantlarda iliflkili faktörlerin araflt›r›lmas›. Gereç ve Yöntem: Ocak 2001-Ocak Amaç: P dalga süresi (PDS) ve P dalga dispersiyonu (PDD) sinüs uyar›s›n›n atri-
2003 y›llar› aras›nda Dr. Zekai Tahir Burak Kad›n Hastanesi risksiz gebelik bölü- umlarda yay›l›m›n› temsil eden yeni EKG parametreleridir. Uzam›fl PDS ve PDD’
münde meydana 18755 term do¤um retrospektif olarak incelendi. Anomalisi olma- nin atrial fibrilasyon riskini artt›rd›¤› üzerinde durulmaktad›r. Kad›nlarda AF erkek-
yan 50 adet yüz prezentasyonu tespit edilerek perinatal bilgileri dosyalardan al›nd›. lere göre daha az gözlenmekte ve oran menopozdan sonra eflitlenebilmektedir. Me-
Olas› etiyolojik faktörlerden yafl, parite ve fetal kilo incelendi. Ultrasonografik öl- nopozdaki kad›nlarda hormon replasman tedavisine ve tedavi seçene¤ine göre PDS
çümleri ve fetal monitorizasyon paternleri de¤erlendirildi. ‹statiksel analiz oran tes- ve PDD’de de¤iflim i ortaya koymak amaçland›. Gereç ve Yöntem: Kalpte ritm bo-
ti (p) kullan›larak yap›ld›. Bulgular: ‹nsidans %0.27 olarak bulundu. Ortalama an- zuklu¤u yapacak hastal›¤› olmayan 65 postmenopozal olgu çal›flma al›nd›. Olgular
ne yafl› 27.24 y›l, ortalama fetal a¤›rl›k 3356.8 gram idi. Primiparlar ile multiparlar randominize olarak iki gruba ayr›ld›. Bir gruba Tibolon di¤er gruba progestereon
aras›nda insidans aç›s›ndan anlaml› fark bulunamad› (p>0.05). Kabul muayenesin- içeren IUD uygulanarak oral 17 beta estradiol oral baflland›. Tüm olgulara tedavi
de vakalar›n %26’s› verteks, %2’si makat, %2’si de al›n gelifl olarak tespit edilmifl- öncesi, tedavinin alt›nc› ay›nda elektrokardiografi çekilerek P dalga süresinin mak-
ti. Mentum posterior, anterior, transvers pozisyon s›ras›yla %48, %24, %28 idi. 23 simum de¤eri (PD max), minimum de¤eri (PDmin), en uzun P dalgas› ile en k›sa P
hastaya ultrasonografi yap›lm›flt›. Sonografiyle vakalar›n %13’ünde yüz gelifl, dalgas› aras› fark al›narak PDD de¤erlendirildi. Tekrarlayan ölçümler için kovar-
%47.8’inde hiperekstansiyon tespit edilmiflti. Fetal kalp traselerinde 1 adet geç yans analizi kullan›larak ölçümler istatistiki olarak analiz edildi. Bulgular: P max,
(mentum-posteriorda), 2 adet ciddi variabl deselerasyon (mentum-posterior ve P min, PDD, kalp h›z› bak›m›ndan tedavi öncesi ve sonras› fark›n ilaç gruplar› ara-
transverste) tespit edildi. Tüm vakalar sezeryanla do¤urtuldu ve perinatal mortalite s›nda de¤iflim göstermedi¤i saptand›. P de¤erleri s›ras›yla 0.850, 0.820, 0.524,
olmad›. Sonuçlar: Bu çal›flmada maternal yafl, parite ve fetal kilonun ilgili faktör- 0.889 idi. Kombine yap›lan istatistiklerde ise P max, Pmin, Kalp h›z› bak›m›ndan
ler olmad›¤› bulunmufltur. Kesin tan› sonografi ile teyit edilmeli ve olas› anomali- fark bulunmazken, PDD’ in tedavi sonras› her iki grupta benzer oranda artt›¤› göz-
lerin olmamas› durumunda termdeki yüz prezentasyonlar› sezeryan ile do¤urtulma- lendi. P de¤erleri s›ras›yla 0.001, 0.916 idi. Sonuç: Postmenopozal östrojen ve Ti-
l›d›r. bolon tedavisi PDD’yi benzer oranda art›rmaktad›r.
P-153 P-155
OUTCOME OF ART AND PREIMPLANTATION GENETIC DIAGNOSIS OLGU SUNUMU: SERV‹KAL HETEROTOP‹K GEBEL‹⁄‹N
IN DOMINANTLY MACROCEPHALIC SPERM SAMPLES TRANSVAJ‹NAL ULTRASONOGRAF‹ EfiL‹⁄‹NDE ASP‹RASYONU ‹LE
BAfiARILI TEDAV‹S‹
S. Kahraman, S. Sertyel, A. Biricik, S. Melil, E. Dšnmez, N. FÝndÝklÝ,
S. †nal, H. Yelke, Y. Kumtepe
C. Akarsu, A. IßÝk, K. Vicdan
Reproductive Endocrinology and ART Unit, Istanbul Memorial Hospital,
Özel Ankara Tüp Bebek Merkezi, Ankara
Istanbul
Amaç: Bir olguda ICSI uygulamas›n› takiben meydana gelen heterotopik servikal
Objective: To evaluate the outcome of ART and preimplantation genetic diagnosis gebeli¤in transvajinal ultrasonografi (TVU) eflli¤inde aspire edilmesi. Intrauterin
in couples whose male partner was diagnosed as having spermatozoa with domi- gebeli¤in devam›na olanak sa¤lanmas›. Gereç ve Yöntem: TVU eflli¤inde 16 ga-
nantly macrocephal forms in their ejaculates. Materials&Methods: 59 patients uge aspirasyon i¤nesi ile servikse lokalize, yolk sak ve kalp at›mlar› izlenen gebe-
undergoing 71 cycles with more than 50% macrocephalic forms (50-100%) in their lik kesesinin aspirasyonu. Bulgular: Servikal gebelik komplikasyon geliflmeden
ejaculates (n=32) or testicular samples (n=27) were included in the study. Cycle baflar›l› bir flekilde geriledi. ‹ntrauterin gebelik termde sa¤l›kl› bir bebe¤in do¤u-
outcome was evaluated according to the source of spermatozoa (ejaculate or testic- muyla sonuçland›. Sonuç: Erken servikal heterotopik gebeli¤in TVU eflli¤inde as-
ular), concentration (num. of spermatozoa/ml of an ejaculate) and application of pirasyonu güvenle uygulanabilecek bir yaklafl›m olabilir.
PGD. Results: A significantly higher fertilization rate was observed with ejaculat-
ed spermatozoa than testicular spermatozoa (49.1% vs. 41.2%; p=0.03), although
both rates are lower when compared to standard ICSI cycles. No difference in cycle
outcome has been found with ejaculated spermatozoa having sperm concentration
either below or above the value of 1 million spermatozoa per ml. However once the
embryos were selected by PGD and transferred in 17 cycles, a 37.5% pregnancy
rate was achieved with the statistically higher implantation rate of 24.3% compared
to 54 non-PGD cycles (10,4%; p<0.01). Only one missed abortion was observed in
the PGD Group whereas 5 of the pregnancies resulted in abortion in non-PGD
cases. A 49.1% aneuploidy rate was found in 53 embryos analyzed. In 13 out of 53
embryos testicular spermatozoa was used and 9 were found to be abnormal (69.2%).
Conclusion: Our results show that if more than 50% macrocephalic spermatozoa is
detected in the sample, a higher fertilization rate may be obtained when ejaculated
spermatozoa is used as a sperm source, although this rate is below the standard fer-
tilization rate of ICSI cases. Application of PGD can increase the implantation rate
and decrease the abortion rate for such couples. Increased chromosomal abnormal-
ity rate suggests that there may be a link between sperm immaturity and chromoso-
mal status in patients with macrocephalic spermatozoa. Hence, PGD should be
offered for such cases.
149
P-156 P-158
TAMOKS‹FEN KULLANAN POSTMENOPOZAL DÖNEM ÖNCEDEN T‹P 1 DM TANISI ALMAMIfi VE KETOAS‹DOZA BA⁄LI
OLGULARINDA ENDOMETR‹AL DE⁄ERLEND‹RME ‹UMF GEL‹fiEN OLGUNUN SUNUMU
H. SabÝrlÝ, L. Erkan, L. ‚amlÝ, F. Soylu M. Þimßek, H. ‚elik, E. Sapmaz, C. ParmaksÝz, B. Kavak, A. ‚elik,
S. †nal, A. Erdin•
Atatürk E¤itim ve Araflt›rma Hastanesi, II. Kad›n Hast. ve Do¤um Kl. ‹zmir
F›rat Üniversitesi T›p Fakultesi Kad›n Hastal›klar› ve Do¤um AD, Elaz›¤
Amaç: Endometrium karsinomu için risk faktörü olarak kabul edilen Tamoksi-
fen’in endometrium üzerine etkilerini incelemek. Gereç ve Yöntem: Östrojen re- Amaç: Nadir olmas› nedeni ile 27. gebelik haftas›nda diyabetik ketoasidoza ba¤l›
septörü (+) meme karsinomu nedeniyle cerrahi tedavi sonras› 20 mg/gün dozunda ‹UMF geliflen olgunun sunulmas›. Olgu: 22 yafl›nda, Gebelik 1, Parite 0, Abortus 0
Tamoksifen kullanan ve yafllar› 46 ile 70 aras›nda de¤iflen (ort. 53), 24 kad›n olgu olan, önceden diyabet tan›s› almam›fl takipsiz gebe; fliddetli ketoasidotik koma ha-
de¤erlendirildi. Olgular›n 2’si (%8.3) pembe renkli vaginal ak›nt›, 5’i vaginal kana- linde baflvurdu. Ultrasonografide 27 haftal›k fetus, inutero mort idi ve polihidram-
ma (%20.8), 3’ü ise bat›n ultrasonografi incelemesinde uterin kavitede s›v› saptan- nios mevcuttu. Genel durumunun ve kan flekerinin stabillefltirilmesinin ard›ndan,
mas›, nedeniyle baflvurmufltu. 14 olgu ise (%58.3) primer hastal›¤› izleyen hekim- indüksiyon ile do¤urtulan olgu daha sonra insülin ba¤›ml› Tip 1 Diabetus Mellitus
lerce, genital kontrol amac›yla taraf›m›za refere edilen ve hiçbir genital yak›nmas› tan›s› ald›. Sonuç: Önceden diyabet tan›s› almam›fl gebelerde ketoasidozun ortaya
olmayan olgulard›. Tamoksifen, kullan›m süreleri 5 ay ile 39 ay aras›nda de¤iflmek- ç›kmas› çok nadir bir durumdur. Diyabeti yeni tan›mlanm›fl diyabetik ketoasidozlu
le beraber ortalama 20 ay olarak hesapland›. Olgular›n tümüne vaginal sonografi olgularda fetal mortalite yüksek orandad›r. Özellikle inutero fetal kay›pla gelen ve
uygulanarak, sagittal planda endometrium kal›nl›¤› de¤erlendirildi. Üst s›n›r 7 mm genel durumu kötü olan gebelerde diyabetik ketoasidoz düflünülmelidir.
olarak kabul edildi. Bu olgulardan 2’sine renkli vaginal ak›nt›, 5’ine vaginal kana-
ma, 5’ine uterin kavite s›v› ve 2’sine de 7 mm üzerinde endometrial kal›nl›k saptan-
mas› üzerine toplam 14 olguya endometrial doku örneklemesi uyguland›. Bulgular:
Yap›lan örnekleme sonucunda olgular›n hiçbirinde endometrial malignite saptan- P-159
mad›. Olgular›n 2’sinde endometrial polip saptan›rken di¤er olgularda ise endomet-
rial atrofi saptand›. Endometrial örnekleme yap›lan olgular›n tamam›na yak›n›n›n CORRELATION OF BECK DEPRESSION INVENTORY SCORES WITH
18 ay ve daha uzun süredir tamoksifen kullan›yor olmas› dikkat çekiciydi. Yorum:
Tamoksifen kullan›m› endometrium karsinomu için bilinen risklerden biridir ve PLATELET IMIPRAMINE BINDING SITES IN PREMENSTRUAL
risk, kullan›m süresi ile iliflkili olarak artmaktad›r. Bu nedenle tamoksifen kullanan SYNDROME
olgulara herhangi bir yak›nma ve semptomlar› olmaks›z›n 6 ayl›k aralarla endomet-
rial de¤erlendirme yap›lmal›d›r. Y. Engin †stŸn1, Y. †stŸn1, H. GŸrdal2, M. GŸngšr3, A. ‚anga3
1
Yüzüncü Y›l University Faculty of Medicine Gynecology and Obstetrics
Department, Van
P-157 2
Ankara University Faculty of Medicine Pharmacology Department,
MEDICAL AND SURGICAL MANAGEMENT OF ECTOPIC Ankara
3
PREGNANCIES Ankara University Faculty of Medicine Gynecology and Obstetrics
Department, Ankara
S. KÝlÝ•, G. Tuncay, S. Erdin•, D. Uygur, M. Ekin, S. BatÝoÛlu
Objective: The purpose of this study was first to investigate if premenstrual syn-
drome is associated with a reduction in platelet imipramine binding site and to
Zekai Tahir Burak Kad›n Hastal›klar› ve Do¤um Hastanesi, Ankara
investigate the possible relationship between platelet 3H-imipramine binding and
Beck depression inventory scores. Materials and Methods: Fifty-one patients at
Objective: Ectopic pregnancies are implantations occurring elsewhere than in the Ankara University Faculty of Medicine, identified as having PMS according to spe-
cavity of uterus. Commonly, extra uterine pregnancies occur in fallopian tube. The cific criteria were matched with healthy control group (n=28). The clinical charac-
aim of this study was to evaluate the treatment options of ectopic pregnancies. teristics recorded were age, body mass index, educational status. Imipramine bind-
Methods: Retrospective analysis performed on 179 patients diagnosed with ectopic ing was measured by saturation binding of [3H]-imipramine (19 Ci/mmol, Nycmed
pregnancy from March 2001 to July 2002. Results: A total of 179 cases of ectopic Amersham, Buckinghamshire, UK). The Beck Depression Inventory Form was
pregnancy were evaluated. A total 140 (78%) patients had stable vital signs and had completed. For statistical analysis; Student t test, Mann-Whitney U test and Pearson
no intra abdominal bleeding. 17 patients (9.5%) had ruptured fallopian tube and had correlation analysis were used. Results: Fifty-one patients met the criteria for par-
intraabdominal bleeding. Intraabdominal situations of 22 (12.5%) patients couldn’t ticipation. Bmax was found to be significantly lower in study group [264.6 (9.3-
be detected. Treatment options: 40 patients (22.3%) received primary surgical treat- 3484.5) fmol/mg protein versus 497.1 (0-4540.2)] (p= 0.011). Beck depression
ment with laparotomy, 106 patients (59.2%) received laparoscopy, 10 patients scores were significantly higher in study group compared with control group
(5.5%) converted laparoscopy to laporotomy, 40 patients (20.1%) received systemic (21.08±2.83 versus 11.21±3.02, p= 0.001). No correlation was found between
methotrexate, 4 patients failed methotrexate therapy and underwent laparotomy. platelet 3H-imipramine binding and Beck depression inventory scores (r=0.66,
Conclusion: Although methotrexate therapy is an effective and safe treatment p=0.682). Conclusion: We found a significantly lower number of [3H]-imipramine
option of ectopic pregnancy, in our hospital, the majority of the women still under- binding sites in patients with PMS compared to controls and no correlation between
go surgical treatment. Conservative management was an option but surgical treat- platelet 3H-imipramine binding and Beck depression inventory scores. Our finding
ment was done more often as a result of lately diagnosis. supports that PMS is not a subset of cycling affective disorder.
150
P-160 P-162
GEBEL‹KTE DEM‹R EKS‹KL‹⁄‹ ANEM‹S‹N‹ SAPTAMADA MATERNAL DOES PROLONGED BED REST AFTER INTRAUTERINE
SERUM FERR‹T‹N DÜZEY‹N‹N KULLANIMI INSEM‹NATION INCREASE PREGNANCY RATE
K. Kahraman, M. Sšnmezer, E. Þimßek, B. …zmen, C. Ültemir, L. Cengiz M. Delikara, K. SofuoÛlu, Z. ÞahinoÛlu, S. Eren
Ankara Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, Ankara Zeynep Kamil Kad›n ve Çocuk Hastal›klar› E¤itim ve Araflt›rma Hastanesi,
Istanbul
Girifl: Anemi, gebelikte rastlanan medikal hastal›klar›n en yayg›n nedenidir. Gebe-
likte görülen anemilerin yaklafl›k %75’inin nedeni demir eksikli¤i anemisidir. Objective: To compare the effects of 10 minutes of bed rest versus 20 minutes after
WHO verilerine göre, geliflmekte olan ülkelerde gebelik anemisinin prevalans› or- intrauterine insemination (IUI) on the pregnancy rate Design: Prospective random-
talama %56’d›r. Demir eksikli¤i anemisi ülkemiz için hala önemli bir halk sa¤l›¤› ized study. Patients: Two hundred twenty-four cycles in one hundred twenty seven
sorunudur ve maternal morbititenin en yayg›n nedeni olmaya devam etmektedir. patients with unexplained infertility. Intervention: All women were treated with
Amaç: Demir eksikli¤i anemisini saptamada kullan›lan paremetreler içerisinde de- clomiphene citrate and they were prospectively randomized either to remain in a
mir depolar›n›n serumdaki göstergesi olarak kabul edilen serum ferritin düzeyi ile supine position for 10 minutes following IUI (group I) or to remain 20 minutes after
maternal hemoglobin aras›ndaki iliflkiyi saptamak ve gebelikte hâlâ yayg›n bir mor- IUI (group II). Main Outcome Measure: Clinical pregnancy rate. Results: One hun-
bidite nedeni olmaya devam eden demir eksikli¤i anemisi insidans›n› azaltmaya yö- dred six women were included in the analysis. Group I consisted of 41 women (87
nelik, önleyici ve tedavi edici stretejilerin gelifltirilmesine yönelik çabalara katk›da cycles), and group II consisted of 65 (110 cycles). The pregnancy per cycle in group
bulunmak. Gereç ve Yöntem: Haziran 2001-Eylül 2002 tarihleri aras›nda antena- I (8%) was not significantly different than in group II (9.1%). Conclusion: This
tal poliklini¤imize baflvuran gebeler çal›flmaya dahil edildi. Gebelerin hemoglobin, study suggest that a 20 minutes of bed rest following IUI is not associated with
hematokrit, ferritin ve serum demir ba¤lama kapasitesine ait de¤erler ilk baflvuru increased pregnancy rate when compared with 10 min bed rest. We recommend that
an›ndan itibaren, her üç trimester için kaydedildi. Çal›flmaya 212 gebe ile baflland› 10 minutes bed rest after IUI is enough and prolongation of this period does not
ve bu gebelerin, bafllang›ç hemoglobin, hematokrit, ferritin ve serum demir ba¤la- increase pregnancy rate. Key words: Bed rest, intrauterine insemination, pregnan-
ma kapasitesi kaydedildi. ‹kinci trimesterde takiplere gelen ve gebeli¤i devam eden cy rate
173 gebe, üçüncü trimesterde ise 128 gebenin hematolojik parametreleri de¤erlen-
dirilmeye al›nd›. Bulgular: Ortalama ferritin düzeylerinde 12. gebelik haftas›ndan
sonra belirgin bir azalma (%37.54) izlenmifltir (p<0.001). Üçüncü trimester ferritin
düzeylerinde 2. trimestere göre belirgin bir art›fl olmakla birlikte,ilk trimestere gö- P-163
re azalma (%18.13) izlenmifltir (p<0.05). Ferritin seviyesi <15 µg/L olan gebelerin
her üç trimester için hemoglobin düzeyleri s›ras› ile; 11.53 µg/L, 10.28 µg/L ve OBSTETRIC AND PREGNANCY OUTCOME IN PATIENTS WITH
10.63 µg/L olarak bulundu. ‹lk trimester hemoglobin düzeyi <11 mg/dL olan 13 ge-
benin 9’unda ferritin düzeyi <15 µg/L, 4’ünde ise 15-30 µg/L olarak saptand›. ‹kin- GESTATIONAL DIABETES COMPARED WITH AGE MATCHED
ci trimesterde hemoglobin düzeyi <10.5 mg/dL olan 22 gebenin, 13’ünde ferritin CONTROLS
düzeyi <15 µg/L, 8’inde 15-30 µg/L, 1’inde >30 µg/L olarak saptand›. Üçüncü tri-
mester hemoglobindüzeyi <11 mg/dL olan 19 gebenin 10’unda ferritin seviyesi <15 C. Salman, P. Dursun, M. Baßaran, M. GŸltekin, S. Esin, T. Durukan,
µg/L, 8’inde15-30 µg/L,1’inde >30 µg/L olarak saptand›. Sonuç: Maternal serum
L. …nderoÛlu
ferritin düzeylerinin antenatal takip programlar› içinde rutin olarak taranmas›, gebe-
lik süresince geliflebilecek olan demir eksikli¤i ve sonras›nda geliflebilecek demir
Hacettepe University Faculty of Medicine, Department of Obstetrics and
eksikli¤i anemisinin tan›s›nda kullan›labilecek güvenilir bir testtir.
Gynecology, Ankara
Objective: To evaluate fetal and maternal outcome in singleton pregnancies comp-

P-161 licated with gestational diabetes. Patients and Methods: We retrospectively evalu-
ated follow-up of 137 singleton pregnancies complicated with gestational diabetes
A CASE OF TRANSVERSE VAGINAL SEPTUM DIAGNOSED DURING (GDM) in Hacettepe University Faculty of Medicine, Obstetrics and Gynecology
department. Patients’ follow up forms and unit database were used to extract mater-
LABOR
nal age, age of delivery, fetal and maternal complication as variables.135 age cont-
rolled pregnant women with normal pregnancy follow-up were used as control gro-
Y. †stŸn, Y. Engin †stŸn, Þ. ZeteroÛlu, G. Þahin, M. KamacÝ up. Patients with risk factors for GDM were screened with 100 g OGTT in the first
antenatal visit, otherwise universal screening with 50 g GTT was used in 24-28 we-
Yüzüncü Y›l University Faculty of Medicine Gynecology and Obstetrics eks of pregnancy. 140 mg/dl and higher blood glucose levels were assumed positi-
Department, Van ve in 50 g test. Interpretations of 100 g OGTT test resuls were performed according
to criteria established by National Diabetes Data Group (2000). Insulin treatment
Objective: Transverse vaginal septum is the result of faulty canalization of the was started in patients who failed to respond dietary treatment. One-way ANOVA,
embryonic vagina. We described a case of transverse vaginal septum with a small Chi-square tests were used to compare groups. Significance level was set to 0.05.
central aperture diagnosed during labor. Case report: A 18-year-old girl at 28 we- Results: During the study period, 2875 pregnant women were screened for diabe-
eks of gestation presented to our obstetrics department complaining of symptoms of tes in our outpatients’ clinic. 137 (4.8%) patients were diagnosed as GDM. Among
preterm delivery. Pelvic and vaginal ultrasonography, gynecologic examination es- these 96 (70.1%) patients treated with diet only (Class A1) and in the remaining 42
tablished a diagnosis of transverse vaginal septum in mid-vagina. An incision in the (29.8%) patients insulin was added to the tretment (Class A2). Mean age of patients
vaginal septum made us see the head of the fetus in the vagina. Conclusion: The with GDM was 32.3±5.3 years. Mean gravida and parity in diabetic patients (Gra-
diagnosis of the transverse vaginal septum was confirmed during labor and excisi- vida: 2.9±1.3, Parity: 1.2±1.6) were significantly higher than controls (Gravida:
on of the septum prevented the uterine rupture. 2.4±1.3, Parity: 0.8± 0.9, p<0.05). There was no statistically significant differences
in respect to maternal age, gestational age, and fetal birtweights between GDM and
controls (p>0.05). Also, obstetric complication rates were similar in both groups
(p>0.05). Similarly, there was no significant difference observed between class A2
and class A1 groups. Conclusion: Obstetric outcome between GDM and normal
pregnancies were similar with respect to maternal and fetal complications.
151
P-164 P-166
A RETROSPECTIVE EVALUATION OF DIAGNOSTIC LAPAROSCOPY VAGINAL GLICERYL TRINITRATE OVULES FOR CERVICAL RIPENING
IN PATIENTS W‹TH CHRONIC PELVIC PAIN BEFORE LABOR INDUCTION ‹N POST-TERM PREGNANCIES:
A RANDOMISED PLACEBO CONTROLLED TRIAL
T. Aksu, P. Dursun, M. GŸltekin, M. Baßaran, C. Salman, T. GŸrer,
T. GŸrgan F. YazÝcÝoÛlu, …. ‚etin, S. Kelek•i, O. …zyurt, K. Savan
Hacettepe University Faculty of Medicine, Department of Obstetrics and Perinatology Unit, Süleymaniye Maternity Hospital, Istanbul
Gynecology, Ankara Objective: To test whether vaginal gliceryl trinitrate (GTN) ovules are better than
the placebo for cervical ripening and successful labor induction. Materials &
Objective: To determine the laparoscopic findings in patients with chronic pelvic pain. Methods: 70 women with an uncomplicated singleton post-term pregnancy were
Patients and Method: We evaluated 128 patients with chronic pelvic pain who randomised either to 500 mcg GTN or to placebo vaginal ovules. They received an
underwent diagnostic laparoscopy in Hacettepe University Faculty of Medicine, active management protocol as soon as they attained a Bishop’s of >6. The ripen-
Department of Obstetrics and Gynecology. Age, gravida, parity, number of trocar ports ing of the cervix and progress of labor were compared, as well as abnormal out-
use in laparoscopic procedures, operative findings, type of laparoscopic intervention, comes. Findings: 34 patients received placebo and 36 GTN ovules. Though the
presence and type of pelvic adhesions were the variables recorded from patients’ files time intervals between the first dose and amniotomy, onset of oxitocine infusion
and operative records of the department. Chi-square test was used for statistical analy- and delivery were all shorter in the GTN group, the differences were unsignificant.
ses. Significance level was set to p=0.05. Results: Mean age of patients was 31.6±7.7 But the maximum oxitocine infusion rate (12.4 ± 6.20 vs 9.19 ± 3.37 mIU/min;
with gravida 2.0±1.2 and parity 1.0±0.9. Overall visible organic pathology diagnosed p<0.05) and the total oxitocine dose (6.23 ± 4.24 vs 3.07 ± 1.73 U; p>0.0001) given,
in 75.8% of patients (97/128). Intraoperative findings were; no visible pathology (31, were significantly less in the study group. Conclusion: Total oxitocine dose need-
24.2%), endometriosis (46,36%), adhesions (27, 21.1%), simple ovarian cyst (13, ed for successful labor induction is significantly lower with the use of vaginal GTN
10.2%), chronic pelvic infection (2, 1.6%), myoma uteri (5, 3.9%), mullerian anomaly ovules prior to labor induction. But the total delivery time was not significantly dif-
(2, 1.6%), paraovarian cyst (1, 0.8%). Endometrioma cyst was observed in 18 of 46 ferent compared to placebo.
(39.1%) of patients with endometriosis. There was no operative intervention in 48.2%
of cases. Operative procedures in the remaining were; endometrioma cyst excision (16,
12.5%), adhesiolysis (14, 10.9%), cystectomy and adhesiolysis (13,10.2%), laparo-
scopic uterosacral nerve ablation (10, 7.8%), cystectomy (7, 5.5%), fenestration of sim- P-167
ple cyst (3, 2.3%). Conclusion: With the use of laparoscopy visible organic patholo-
gies could be detected in up to %75 of the cases with chronic pelvic pain. SUPRAVENTR‹KÜLER FETAL TAfi‹KARD‹: B‹R OLGU SUNUMU
Endometriosis and pelvic adhesions were the most common diagnoses.
A. Erdem, K. BayramoÛlu, …. BayramoÛlu, A. SaltÝk, M. Polat
Gazi Üniversitesi T›p Fak. Kad›n Hastal›klar› ve Do¤um AD, Ankara

P-165
27 yafl›nda gravida 1, parite 0 olan hasta, 36 hafta gebeli¤i mevcut iken d›fl merkez-
ESTROGEN-PROGESTERON RESEPTÖR POZ‹T‹FL‹⁄‹ GÖSTEREN
de yap›lan obstetrik muayenesinde fetal taflikardi saptanmas› üzerine klini¤imize re-
REKÜRREN VULVAR ENDOMETR‹OS‹S: OLGU SUNUMU fere edildi. Hastan›n yap›lan ultrasonografisinde gross fetal anomali mevcut de¤il-
di. Fetal ekokardiyografisinde 1. dereceden mitral ve trikuspit kapaklarda yetmez-
M. Sšnmezer, K. Kahraman, E. Þimßek, M. GŸngšr, G. Kurtay lik saptand›. Ventrikül at›m h›z› 240 at›m/ dk olarak tesbit edildi ve idyopatik sup-
raventriküler fetal taflikardi tan›s› ile medikal tedavi yap›ld›. Postpartum yenido¤a-
Ankara Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, Ankara n›n yap›lan fizik muayenesinde aritmi ve herhangi bir anomali saptanmad›. Fetal
kardiak aritmiler bradikardiler ve taflikardiler olmak üzere ikiye ayr›l›rlar. Kalp at›m
Girifl: Vulvar ve perineal alanda endometriotik lezyonlara oldukca nadir rastlan›l- h›z›n›n 120-160 at›m/dk d›fl›nda olmas› aritmi olarak adland›r›l›r. Ayr›ca fetal arit-
maktad›r. Bu alandaki lezyonlar s›kl›kla obstetrik ve/veya cerrahi bir travmay› taki- miler yap›sal kalp hastal›klar› ile beraber izlenebilece¤inden fetal ekokardiyografi
ben oluflmufl olan skar dokusu üzerinde geliflmektedir. Burada herhangi bir travma ile kardiyak yap›lar de¤erlendirilmelidir. Bu yaz›da bir olgu sunumu dolay›s›yla fe-
öyküsü bulunmayan bir genç k›zda tekrarlayan vulvar endometriosis lezyonu sunul- tal aritmi ile gelen bir gebede, etyoloji ve klinik yönetim ile geliflebilecek nonim-
mufltur. Bu olguda tan›y› kesinlefltirmek amac›yla estrogen ve progesteron reseptör- mun hidrops ve fetal distress gibi komplikasyonlar tart›fl›lm›flt›r. Fetal kardiyak ri-
lerinin varl›¤›, immün histokimya yöntemleriyle ortaya konulmufltur. Olgu: 19 ya- tim bozukluklar› fetal ekokardiografi için refere edilen hastalar›n %15’ini olufltur-
fl›nda virgine hasta, d›fl genitalyada özellikle âdet dönemlerinde ortaya ç›kan kaba- maktad›r.
r›kl›k, k›zar›kl›k ve kafl›nt› yanma flikayetleriyle baflvurdu. Jinekolojik muayenede
arka forflette 2x2 cm’lik aç›k k›rm›z› ve kirli beyaz renkte ciltten hafif kabar›k lez-
yon saptand›. Biobsi sonucunda lezyonun endometriosis eksterna oldu¤u anlafl›ld›.
Yap›lan immün histokimya incelemesinde epitel alt›nda gland yap›lar›n›n tümünde
kuvvetli (%100) nükleer estrogen reseptör (ER) ve progesteron reseptör (PR) varl›-
¤› gösterildi. Vulvada ki lezyon total olarak eksize edildikten 3 ay sonra ayn› böl-
gede benzer lezyonlar›n olufltu¤u izlendi. Yorum: Vulvar bölgede endometriotik
odaklar›n varl›¤› oldukça nadir görülmekle birlikte vulvar lezyonlar›n ay›r›c› tan›-
s›nda göz önünde bulundurulmas›n› gereklidir. Literatürde sunulan nadir olgular›n
büyük bir k›sm›nda geçirilmifl cerrahi ve/veya obstetrik travma öyküsünün varl›¤›
dikkati çekmektedir. Ancak bizim sundu¤umuz olguda oldu¤u gibi, epiteli intakt
olan olgularda endometrial hücrelerin implante olmas› teorik olarak mümkün olma-
sa da, bu olgularda gözden kaçan bir mikrotravmayla epitelyal bütünlük bozulmufl
olabilir. Bu lezyonlar› aç›klamaya yönelik olarak öne sürülmüfl teorilerden biride
multipotent çölomik hücrelerin endometrial hücrelere differansiye olmas› ile bu lez-
yonlar›n geliflebilece¤idir. Kuflkulu durumlarda lezyonda estrogen ve progesteron
reseptörlerinin varl›¤›n›n gösterilmesi ile tan›y› do¤rulamak mümkündür. Sonuç:
Vulvar alanda görülen endometriosis nadir bir durum olmakla birlikte, vulvar pato-
lojilerin ayor›c› tan›s›nda göz önünde bulundurmal›d›r. Tan›y› do¤rulamak için ER
ve PR pozitifli¤inin gösterilmesi ay›r›c› tan›da önem tafl›maktad›r.
152
P-168 P-170
PAIN COURSE IN UTERINE ARTERY EMBOLIZATION PR‹MER TUBA KANSER‹
Þ. ZeteroÛlu1, Y. †stŸn1, Y. Engin †stŸn1, M. ÞengŸl1, M. Harman2, M. Atasever, F. Atalay

M. KamacÝ2
SB Ankara Onkoloji Hastanesi Jinekoloji Klini¤i, Ankara
1
Yüzüncü Y›l University Medical Faculty Gynecology & Obstetrics
Department, Van Girifl: Kad›n genital kanserleri içinde en nadir görüleni %0.5 insidans ile tuba kan-
2
Yüzüncü Y›l University Medical Faculty Radiology Department, Van seridir. Ço¤u zaman laparatomi esnas›nda tan› konur. Etiyolojisi belli de¤ildir. Ol-
gu: 74 yafl›nda, 20 y›ld›r menopozda olan hasta kas›k a¤r›s›, fliflkinlik flikayetiyle
klini¤imize baflvurdu. Hastan›n jinekolojik muayenesinde sol adneksiyal kitle mev-
Objective: In this study, our aim was to determine whether the severity of post pro-
cuttu. Yap›lan abdominal tomografide sol over lokalizasyonunda kal›n duvarl›, hi-
cedure pain associated with uterine artery embolization (UFE) can be predicted and
poekoik, yo¤un dansiteli, yaklafl›k 6.5x5 cm boyutlar›nda kitle lezyonu tespit edil-
if the time course of pain can help us determining postoperative pain management.
di. Over tümörü ön tan›s›yla laparatomi yap›ld›. Laparatomide peritonitis karsino-
Materials and Methods: Twenty-one women with symptomatic uterine fibroid
matoza hali mevcuttu. Total abdominal histerektomi+ bilateral salpingoooferekto-
were recruited for the study. The procedure was performed in the angiography unit
mi+ omentektomi yap›ld›. Patolojik tan› seröz papiller karsinom olarak rapor edil-
under conscious sedation which was achieved with 50 mg aldolan. All patients re-
di. Tümör kütlesinin büyük k›sm› paratubal alanda olmakla birlikte tuba duvar› ve
ceived prophylactic intravenous antibiotics and analgesic, ibuprofen 600 mg. At the
lümeninde de tümör izlenmifltir. Bunun üzerine hastaya 6 kür paclitaxel+ cisplatin
completion of the procedure, all patients were given ibuprofen 600 mg orally every
verildi. Sonuç: Tuba maligniteleri ender rastlan›lan maligniteler olup, erken evrede
six hours. The patients were discharged with oral ibuprofen (600 mg 4 times daily).
tan› koymak zordur. Nadir görülen bir lokalizasyon oldu¤u için etiyolojik, tan›sal,
Pain scores were recorded along with the ibuprofen data, with patients asked to gra-
sa¤alt›m modelleri ve prognostik belirteçlerin yerleflmesinde daha genifl ve kapsam-
de their pain on scale of 1 to 10. Results: Twenty-one procedures were performed.
l› araflt›rmalara ihtiyaç vard›r.
The mean age was 43.04 ± 4.21 years (range 34-52) and median parity was 4 (0-6)
with a mean follow-up of 6 months. After the completion of embolization, cram-
ping was found to be increased for approximately 3 hours, had a plateau for 4-7 ho-
urs, and then decreased to a lower plateau at the 9th hour. Mean peak pain scores of
P-171
the patients seen at the 3rd hour was 4.95 ± 1.71 Conclusion: There is an increased
need for post-procedure pain control for UAE patients, especially in the first 6 ho-
urs after the procedure. FISTULA FORMATION AT THE TROCAR SITE: A LATE
COMPLICATION AFTER LAPAROSCOPIC SURGERY IN GYNECOLOGY
C. AtabekoÛlu, E. ‚etinkaya, M. Sšnmezer, F. Sšylemez

P-169
Ankara University Medical Faculty, Department of Obstetrics and
PREGNANCY FOLLOWING ENDOMETRIAL RESECTOSCOPIC Gynecology, Ankara
ABLATION: A CASE REPORT
Laparoscopy has become one of the most frequently performed procedures in gyne-
M. Altay, S. Karadeniz, T. …rnek, A. ‚il, A. Haberal cology since it has many advantages such as absence of a large surgical scar,
reduced postoperative pain, shorter hospital stay and reduced adhesion formation.
SSK Matern›ty and Womens Health Teach›ng Hosp›tal Although it is generally safe, it carries a risk of complication and failure as any
other surgical procedure. Pelvic abscess is an uncommon complication after
Objective: To present a case with pregnancy following endometrial resectoscopic laparoscopy in gynecology practice. A number of cases of postoperative abscess
ablation and discuss its incidence and complications. Materials and Methods: We and fistula formation through the abdominal wall due to retained gallstones during
presented a 43 year old premenopausal woman who had had endometrial resecto- laparoscopic cholecystectomy have been reported in the literature. We report a case
scopic ablation because of severe menometrorrhagia unresponsive to medical ther- of pelvic abscess and fistula formation at the trocar site 3 months after laparoscop-
apy. Eleven months after the operation she had to visit our hospital due to heavy ic adhesiolysis and cauterization of endometriotic implants. To our knowledge, this
bleeding. Her ß-HCG level was 68.9 mIU/mL, since her bleeding was scanty dur- is the first report of fistula formation at the trocar site after gynecologic
ing admission and her vital signs were normal, she was followed as outpatient. Her laparoscopy.
bleeding stopped and 1 week later her ß-HCG level was 1.23 mIU/mL. She was
thought to have a spontaneous abortion. The literature in English, relevant to
endometrial ablation and pregnancy were reviewed. Results: The incidence of
pregnancy following endometrial ablation is 0.7%. Most of these pregnancies will
end in abortion. Only about 1 in 4 of these pregnancies will reach term. The most
serious risk will be plasental penetration to myometrium and risk of death from
severe hemorrhage. Successfull planned pregnancies following endometrial abla-
tion are reported. Conclusion: The premenopausal women must be informed about
the risk of pregnancy and prevention methods after ablation. Concomittant tubal lig-
ation can be an option.
153
P-172 P-174
AÇIKLANAMAYAN ‹NFERT‹L‹TES‹ OLAN HASTALARA UYGULANAN ACCURACY OF ENDOVAGINAL US IN THE DIAGNOS‹S OF

KONTROLLÜ OVARYEN H‹PERST‹MULASYON VE ‹NTRAUTER‹NE ADENOMYOSIS
‹NSEM‹NASYON TEDAV‹S‹NDE GEBEL‹⁄E ETK‹ EDEN PROGNOST‹K
FAKTÖRLER A. Haberal, F. KayÝk•ÝoÛlu, E. SobacÝ, S. YarkÝn, B. Aykan
M. Erdem, A. Erdem, Y. Dingil, M. Polat SSK Maternity and Women’s Health Teaching Hospital, Ankara
Gazi Üniversitesi Kad›n Hastal›klar› ve Do¤um AD, Ankara Objective: To evaluate the accuracy of endovaginal US in diagnosis of adenomyo-
sis by using sonographic features and its interference by the presence of fibroids.
Materials&Methods: Forty-four consecutive women with benign gynecologic dis-
Girifl: Aç›klanamayan infertilite tedavisinde kontrollü ovaryen hiperstimulasyon
ease undergoing elective hysterectomy at our institution from June to September
(KOH) ve intrauterin inseminasyon (IUI) gebelik elde etme oranlar› en yüksek ve
2002 were included in the study. Age, body mass index (BMI), menstrual history,
en fazla tercih edilen tedavi yöntemidir. Bu çal›flmada KOH+IUI uygulanan aç›kla-
main presenting complaint were recorded. All patients underwent endovaginal US
namayan infertilite olgular›nda infertilite süresi, kad›n yafl›, endometriozis varll›¤›
preoperatively and the diagnosis was made during real-time examination. Uterine
gibi klinik de¤iflkenler ile sperm parametrelerinin gebelik oluflmas›na etkileri de¤er-
size, endometrial thickness, number and measurements of fibroids, myometrial
lendirilmifltir. Gereç ve Yöntem: Aral›k 1999- May›s 2001 tarihleri aras›nda Gazi
echo pattern, presence of myometrial cysts and asymmetry, localization and extent
Üniversitesi infertilite Merkezine baflvuran ve aç›klanamayan infertilite tan›s› alan
of adenomyosis were evaluated. Fibroids were further classified into 1-Multiple
67 hastan›n CC/hMG ve FSH stimulasyonu ile yap›lan 136 KOH+IUI siklusu ret-
Fibroids (MF) (at least 5-6 fibroids 3,4 or 5 cm in diameter) 2-Single Large Fibroid
rospektif olarak de¤erlendirildi. Sonuçlar: Hastalar›n %89’u primer %11’i sekon-
(SLF) (single fibroid at least 6 cm in diameter) 3- Fibroids of Unsignificant
der infertil idi. Yafl ortalamas› 29.4 ± 4.88 (21- 40), infertilite süresi ortalama 6.2 ±
Importance (UF) (no more than 3 fibroids of max. 2 cm in diameter) 4-No Fibroids
4.2 (1,5 – 16 y›l) olarak bulundu. Ortalama siklus say›s› 2.02 olarak hesapland›. To-
(NoF) (no fibroids present). Histological examination was performed by patholo-
tal 136 siklustan 31’i gebelikle sonuçland› (%22.8). Hasta bafl›na gebelik oran›
gists blinded to the clinical and sonographic findings. Three histologic categories of
%40,3 (27/67), hasta bafl›na canl› do¤um oran› %25.4 (17/67) olarak bulundu. 15
mild, focal and severe adenomyosis were identified. Results: The mean age and
gebelik abortus ile sonuçland›. Gebelik elde edilen hastalarda infertilite süresi (4.8
BMI of the patients were 46.8±5.5 and 31±5.7 respectively. Menometrorrhagia was
± 3.6 y›l vs 6.6 ± 4.2 y›l) daha k›sa oldu¤u (p<0.05) ancak yafl ve hormonal para-
the most common presenting complaint (%43) followed by pelvic pain (%33). The
metreleri aras›nda fark olmad›¤› gözlendi. Gebe kalan hastalar ile (4/15) ile gebe
prevalance of adenomyosis was % 27.2 (n=12). Ultrasound could detect adeno-
kalamayanlar (15/62) aras›nda endometriozis tan›s› oran› olarak fark olmad›¤› göz-
myosis in 9 out of 12 uteri correctly with a sensitivity and specificity of % 92.3 and
lendi. Tart›flma ve Sonuç: Aç›klanamayan infertilite olgular›nda gebelik sonuçla-
% 91.2 respectively. Presence of myometrial asymmetry and nonhomogeniety were
r›na dominant folikül say›s› ve sperm motilitesinin etki etti¤i gözlenmifltir. Bu so-
not significantly different between uteri with and without adenomyosis (p>0.05),
nuçlar KOH ve IUI sikluslar›nda gebeli¤i art›ran mekanizmalar oldu¤u düflünülen
however presence of myometrial cysts was statistically important in the diagnosis
birden fazla ovulasyon ve motil spermlerin fertilizasyon bölgesine ulaflmas›n›n ko-
(p=0.03). Histopathologic examination revealed 3 cases of mild and 9 cases of
laylaflt›r›lmas›n› teyid etmektedir.
severe adenomyosis. Uteri with severe adenomyosis contained NoF or UF while
each uteri with mild adenomyosis contained a SLF on ultrasound. Ultrasound was
able to detect all nine cases of severe adenomyosis but failed to detect cases with
mild adenomyosis. Conclusion: Ultrasonography is a valuable tool in detecting
P-173
adenomyosis with high sensitivity and spesificity, with myometrial cysts being an
important diagnostic feature, although mild type of adenomyosis, particularly when
POSTMENOPOZAL OVER K‹STLER‹N‹N DE⁄ERLEND‹R‹LMES‹ it is accompanied by an attention-receiving large fibroid may be a handicap in mak-
ing the diagnosis.
A. Erdin•, S. OÛuz, D. Uygur, O. Kaymak, E. Okyay, E. †stŸnyurt,
L. MollamahmutoÛlu
Zekai Tahir Burak Kad›n Sa¤l›¤› E¤itim ve Araflt›rma Hastanesi, Ankara
Amaç: Ultrasound teknolojisindeki geliflmelere paralel olarak günümüzde daha

fazla hasta postmenopozik dönemde over kisti tan›s› almaktad›r. Bu hastalar›n bir
k›sm› takip edilmekte bir ço¤u da ameliyat olmaktad›r. Biz klini¤imizde bu tan› ile
ameliyat olan hastalar› retrospektif olarak inceledik. Gereç ve Yöntem: Klini¤imi-
ze Ocak 1998 ile Ocak 2003 tarihleri aras›nda postmenopozik over kisti tan›s› ile
ameliyat olan 114 hasta retrospektif olarak incelendi. Bu hastalar›n ameliyat önce-
si ultrasonik incelemeleri, Ca 125,Ca 19-9 ve Ca 15-3 de¤erleri ameliyat türü, ame-
liyat esnas›ndaki ve sonraki patolojik tan›lar› karfl›laflt›r›ld›. Bulgular: Bu hastalar-
dan sadece üçünün patoloji sonucu malign olarak gelmifltir. Preoperatif USG rapo-
runda 5 cm’den küçük multilokule over kisti tan›s› alan 12 hastadan ikisi, 5 cm’den
büyük unilokule over kisti olarak de¤erlendirilen 53 hastadan biri ameliyat sonu-
cunda malign tan› alm›flt›r. 5 cm’den büyük multiloküle 29 hastan›n hepsi benign
olarak rapor edilmifltir. Tümör markerleri sadece 6 hastada yüksek ç›kmas›na kar-
fl›n, bu malign üç hastadan biri s›n›rda yüksek di¤eri ise tamamen normal de¤erler-
de bulunmufltur. Doppler incelemesi 23 hastaya uygulanm›fl, hepsi normal olarak
de¤erlendirilmifl, bu malign üç hastaya doppler incelemesi yap›lmam›flt›r.
Tart›flma: Menopozal yafl döneminde HRT als›n veya almas›n rutin kontroller es-
nas›nda pek çok hastada over kistlerine rastlanmakta, ço¤unlukla da operasyon ka-
rar› al›nmaktad›r. Ancak iyi bir ultrasonografik incelemeye (mutlaka doppler eflli-
¤inde) tümör markerleri da eklendi¤inde hasta s›k aral›klarla takip edilebilir veya
operasyon yap›lacak ise laparaskopik yaklafl›m tercih edilebir.
154
P-175 of delivery on short–term perinatal outcome, patients were divided in two groups by
parity. There were 560 primipares and 394 multipares in this 3-year period. The
TEKRARLAYAN ‹MPLANTASYON BAfiARISIZLIKLARINDA primary outcomes were perinatal mortality, neonatal morbidity and referrals to the
neonatal intensive care unit as a whole stratified by parity and mode of delivery.
ENDOMETR‹AL KOKÜLTÜRÜN EMBR‹YO GEL‹fi‹M‹ ÜZER‹NE ETK‹LER‹
Test of proportion was performed in statistical managament of data and the differ-
ences were evaluated by chi-square test. Results: Out of 35 560 deliveries in our
S. Sertyel, S. Kahraman, E. Dšnmez, N. FÝndÝklÝ, S. †nal, M. AygŸn hospital in the study period, there were 1157 singletion breech presentation
(3.25%). Preterm and intrauterine dead babies were excluded. All singletion breech
Memorial Hastanesi Reprodüktif Endokrinoloji & Genetik Merkezi, Istanbul presentation pregnancy at term (37-42 weeks) with a live fetus were 954. Caesarean
section was performed in 527 (94.11%) primiparas and in 257 (65.22%) multiparas.
Amaç: Endometrial kokültür, tekrarlayan yard›mc› üreme teknikleri (YÜT) uygu- There was a significant linear increase in the caesarean birth rate of primiparas over
lamalar› ile gebelik elde edilememifl, yavafl ve/veya kötü embriyo geliflimi gösteren a 3-year period, for each year it was 88.88%, 96.82% and 97.11%, accompanied by
olgularda konvensiyonel medyumlara karfl› alternatif bir yöntem olarak kullan›l- a modest linear increase for multiparas, 58.19%, 69.17% and 67.62%, respectively.
maktad›r. Tekrarlayan implantasyon baflar›s›zl›klar› (T‹B) olgular›nda da endomet- This was associated with a significant decline in neonatal mortality and referrals to
rial kokültür baflar› ile denenmektedir. Bu çal›flma klini¤imizde endometrial kokül- the neonatal intensive care unit. Conclusion: Caesarean section has gradually
türü gelifltirilmesi ve T‹B olgular›nda embriyo geliflimi üzerine etkilerini ve klinik become the preferred mode of delivery for term breech presentation, especially in
sonuçlar›n› araflt›rmak üzere planlanm›flt›r. Gereç ve Yöntem: Daha önce 2 ve üze- primipares. This change in trend may be influenced by maternal wishes and avoid
rinde YÜT ile gebelik elde edilmemifl 38 yafl alt›ndaki 15 infertil çift bu tedavi traumatic vaginal delivery for not having an experienced clinician. A trial of vagi-
program›na al›nd›. Âdetin 19-21 günlerinde pipel ile al›nan endometrial doku ör- nal delivery should be allowed in suitably selected cases before obstetricians lose
nekleri gerekli haz›rl›klar yap›larak kültüre edildiler ve dondurularak sakland›lar. the skills and confidence performing an assisted vaginal breech delivery.
YÜT ile elde edilen prezigotlar, çözülme sonras› kültüre edilen tek düzlemli otolog
endometrial hücreler üzerinde transfer aflamas›na kadar kültüre edildi. Günlük emb-
riyo geliflimi, klivaj oranlar› kontrol edildi. Bir önceki siklustaki konvensiyonel
medyumlardaki embriyo geliflimleri ile coculture içindeki geliflim karfl›laflt›r›ld›. P-177
Embriyo transferi yap›lan olgular›n klinik sonuçlar› de¤erlendirildi. Bulgular: Bul-
gular Tablo I’de özetlenmifltir. 5 olgunun embriyolar›na ayr›ca preimplantasyon ge- THE COMPARISON OF BIOCHEMICAL MARKERS OF BONE
netik tan› yap›ld›. Tüm olgularda embriyo transferi yap›ld› ve 6 adet gebelik elde TURNOVER BETWEEN PREECLAMPSIA AND HEALTHY PREGNANT
edildi (%40). Sonuçlar: Endometrial otolog kokültür, T‹B olgular›nda elde edilen
WOMEN
embryo kalitesinin ve geliflim h›z›n›n art›rmaktad›r. Bu etkileri sayesinde belirtilen
nedenler ile gebelik elde edilemeyen olgularda tercih edilecek bir yöntem olarak
kullan›labilir. Y. Kumtepe, H. Aksoy, M. Ünge•, B. Bšrek•i, S. Salman, S. KadanalÝ
Department of Obstetrics and Gynecology, Faculty of Medicine, Atatürk

University, Erzurum
P-176
Objective: The aim of this study was to compare the concentration of osteocalcin
CHANGING TRENDS IN THE MANAGEMENT OF SINGLETON (OC) and deoxypyridinoline (DPD) between healthy pregnant women and preec-
BREECH PRESENTATION AT TERM. A RETROSPECTIVE STUDY IN lampsia. Patients and Methods: The study involved 32 patients with preeclampsia
THE SSK GÖZTEPE EDUCATIONAL HOSPITAL OVER A 3-YEAR (Group-I, Study group) and 35 patients with healthy normotensive pregnant women
PERIOD. (Group-II, Control group) who were taken as the control group. OC was measured
to evaluate bone formation and DPD was measured to evaluate bone resorption to
compare between preeclampsia and healthy pregnant women. Osteocalcin and
Y. Tun•ay, C. Omurcan, …. Tok, K. GŸzin, E. Bilgi•, N. YŸcel deoxypyridinolin were measured by chemiluminescence method and results evalu-
ated as ng/ml for OC and nMDPD/mMC (C:creatinin) for DPD. Statistical differ-
SSK Göztepe Hastanesi, Istanbul ences between groups were determined using Mann-Whitney U test. Results are
given mean ± SD and P value < 0.05 was accepted as statistical significant. Results:
Objective: The aim of this study was to analyse term breech deliveries, with regard OC and DPD levels were significantly increased in women with preeclampsia com-
to the influence of the mode of delivery on the frequency of perinatal mortality and pared with healthy pregnant women. OC concentration was found 6.1±2.8 in
morbidity. Patients and Methods: A retrospective study including 954 term sin- preeclamptic group and 2.3 ± 2.0 ng/ml in control group (P<0.01). DPD concentra-
gletion (>or = 37 weeks gestation) pregnancies with frank or complet breech pre- tion determined as 29,1±26,0 nMDPD/mMC in preeclamptic group and 11.1±1.5
sentation delivered at a referral hospital, SSK Göztepe Educational Hospital, nMDPD/mMC in control group. Conclusion: Our results suggest that bone forma-
between January 1, 2000 and December 31, 2002. Patients records were identified tion and resorption is higher in preeclampsia than healthy pregnant women.
from the delivery database by each year period. To compare the effect of the mod
Tablo: (P-175)
KokŸltŸr grubu Konvansiyonel Medyum grubu P
Prezigot sayÝsÝ (N) 114 82

III. gŸn embriyo gelißimi (%)
Arest embriyo 11,3 22,4 ns
Blastomer sayÝsÝ (<6) p<0.01 31,1 53,3
Fragmantasyon (<15) 11,7 27,1 p<0.05
155
P-178 P-180
CAN HISTOLOGY OF TESTIS PREDICT SPERM RECOVERY BY PRIMARY PELVIC HYDATID DISEASE
MICRODISSECTION TESE IN PATIENT WITH AZOOSPERMIA?
T. AydoÛdu, E. ErdemoÛlu, P. Moroy, S. ZergeroÛlu, L. MollamahmutoÛlu
E. BakÝrcÝoÛlu, S. Kahraman, S. Sertyel, N. FÝndÝklÝ, E. Dšnmez, S. †nal,
H. Yelke Zekai Tahir Burak Kad›n Sa¤l›¤› Araflt›rma ve E¤itim Hastanesi, Ankara
Reproductive Endocrinology Unit, Istanbul Memorial Hospital, Istanbul Objectives: We present an extremely rare cyst of female genital tract simulating
ovarian cancer; primary pelvic cyst hydatid. Case: A 33 years-old woman admitted
to the hospital was found to have 3 cm semisolid fixed adnexial mass. She was
Introduction: Testicular sperm extraction (TESE) procedure has been widely used
taken to laparotomy and the cyst was totally removed without spillage. Her patho-
for obstructed or non-obstructed azoospermia (NOA) since intracytoplasmic sperm
logic examination revealed cyst hydatid disease. Conclusion: The case presented
injection (ICSI) was introduced as a therapy for severe male infertility. We report
here is unique in that she had no primary lesion of cyst hydatid in an other organ
an analysis of non-obstructive azoospermia patients operated with Microdissection
such as liver. The diagnosis was primary pelvic hydatid disease.
TESE (Micro-TESE) procedure. Material and Metods: 72 NOA patients who
underwent Micro-TESE operation were included in this study. All patients com-
pleted an evaluation including volume estimation by orchidometer, karyotype
analysis, Y chromosome microdeletions and serum levels determination of FSH and P-181
total testosterone. Out of 72 cases, 13 had orchidopexy (18%), 35 had testicular
biopsy (47%) and 21 had varicocelectomy (27%) operation. Testicular biopsies LAPAROSCOPY AND LAPAROTOMY IN THE MANAGEMENT OF
were taken for histological analysis while Micro-TESE was performed. Results: BENIGN OVARIAN MASSES
Fortytwo non-obstructive patients had successful sperm recovery out of 72 (58%).
At the time of the operation, 67 biopsies were taken as result of 40 patients were
F. AltÝntaßoÛlu, T. MÝzrak, S. Kayhan, G. Ko•un, S. Mun, A. Ege, C. Taner,
diagnosed germ cell aplasia (GCA) (60%), 17 patients were diagnosed maturation
arrest (MA) (25%) and 10 patients were diagnosed hypospermatogenesis (15%). All †. NaykÝ, G. Yeßilkaya
hypospermatogenesis cases had positive sperm retrieval while sperm retrieval rate
for GCA and MA were 57.5% and 35%, respectively. Statistical analysis did not Aegean Social Security and Maternity Teaching Hospital, Izmir
find age, testicular volume, FSH and Total Testosterone levels to have predictive
value for the presence of sperm. Conclusion: For non-obstructive azoospermic Objective: To evaluate the results of laparoscopy and laparotomy in the manage-
patients Micro-TESE is an effective sperm retrieval procedure. The homogeneity of ment of ovarian masses which are not suspected to be malignant. Materials and
tubular enlargement and higher testicular volume may have an effect on lower Methos: One hundred and six patients requiring surgical management of ovarian
sperm retrieval rate in MA group compare to GCA and hypospermatogenesis group masses were assigned to laparoscopy (n:52) or laparotomy (n:54). Inclusion criteria
by Micro-TESE technique. was cystic masses that were not suspected to be malignant with a diameter of <=10
cm in ultrasonographic measurements. All operations were performed by trainees
under the supervision of an experienced surgeon. Results: There were no differ-
ences in demogaphic characteristics between the two groups. Mean ovarian size in
P-179 the laparotomy group was 8.3 cm, mean ovarian size in the laparoscopy group was
8.1 cm. All of the ovarian masses were benign except two cases. Endometriotic
GRANÜLOSA HÜCREL‹ OVER TÜMÖRLER‹ cysts and dermoid cysts were the most common pathological findings in both
groups. Cystectomy was the most preferred operative management. Operation time
was not increased with the laparoscopic approach. Both two procedures (L/S and
K. GŸzin, Y. Tun•ay, S. Sezginsoy, N. YŸcel L/P) were associated with similar postoperative pain, analgesic requirement, hospi-
tal stay and recovery period. There were no life threatening intraoperative or post-
SSK Göztepe Hastanesi Kad›n Hastal›klar› ve Do¤um Klini¤i, ‹stanbul operative complications in both groups. Conclusiion: Operative laparoscopy and
laparotomy can be used in the management of benign ovarian masses satisfactorily.
Overin granülosa hücreli tümörleri, tüm over tümörlerinin %2-10’unu oluflturmak- Both two procedures have benefits over each other. Surgeon should select the pro-
tad›rlar. Fonksiyonel over tümörüdürler ve steroid seks hormonlar›, özellikle östro- cedure in which he feels more success and safety. Key Words: Ovarian masses,
jen salg›lard›klar›ndan en s›k gözlenen semptomu anormal vaginal kanamad›r. Has- laparoscopy, laparotomy
tanemizde Ocak 1999-Mart 2002 y›llar› ars›nda granülosa hücreli over tümörü tan›-
s› alan alt› olgu klinikopatolojik olarak incelendi. Olgular›n tan› ald›klar›nda yaflla-
r› 38-82 aras›nda idi. Olgular›n dördüne primer sitoredüktif cerrahi tedavi uygulan-
d›, bir olguya subtotal histerektomi yap›labildi. 38 yafl›ndaki hastaya yafl› ve opera-
tif evresi göz önüne al›narak unilateral ooferektomi yap›ld› fakat hastan›n postope-
ratif çocuk arzusunun olmad›¤›n› bildirmesi üzerine operasyondan iki ay sonra tek-
rar opere edilerek total histerektomi uygulanm›flt›r. ‹zlem süresince nüks görülme-
yen hastalar literatür ›fl›¤›nda de¤erlendirilmifltir.
156
P-182 P-184
ANGIOGENESIS IN HUMAN ENDOMETRIUM WITH INTRAUTERINE DIFFERENT DISTRUBUTIONS OF INTEGRINS IN ENDOMETRIUM IN

DEVICE INTRAUTERINE DEVICE USERS
S. Oru•1, S. Vatansever2, …. Karaer2, A. Gšker2, S. Cilaker2, G. Giray2 S. Oru•1, S. Vatansever2, …. Karaer2, F. EskicioÛlu2, B. NarlÝkuyu2
1
Celal Bayar University, Faculty Of Medicine, Department Of Obstetrics 1
Celal Bayar University, Faculty Of Medicine, Department Of Obstetrics
and Gynecology, Manisa and Gynecology, Manisa
2 2
Celal Bayar University, Faculty Of Medicine, Department Of Histology Celal Bayar University, Faculty Of Medicine, Department Of Histology
and Embryology, Manisa and Embryology, Manisa
Backgroud: Angiogenesis (formation of new blood capillaries developing from Backgroud: Many women in the world use intrauteine devices (IUDs) for contra-
pre-existing vessels) is induced in response to ischemic stimuli caused by inflama- ception and the use is increasing. Unschedulated breakthrough bleeding is a common
tion, wound repair, immune reactions and neoplasia. Angiogenesis is controlled side-effect of IUDs. The aim of this study was to investigate and evaluate immuno-
with several factors such as vascular endothelial factor (VEGF), von Willebrand histochemical distributions of different type of integrins in women using IUDs for
factor (factor VIII-related antigen) and CD34. The aim of this study was to investi- different time periods and in different phases of menstrual cycle. Materials and
gate and evaluate immunohistochemical distributions of angiogenetic factors in Methods: Pipelle endometrial biopsies were obtained from women using T Cu380A
women using IUD for different time periods and in different phases of menstrual IUD. The biopsies were collected from IUD users. The samples are classified
cycle. Materials and Methods: Pipelle endometrial biopsies were obtained from according to phase of menstrual cycle and IUD use time. All samples were fixed in
women using T Cu380A IUD. The biopsies were collected from IUD users. The % 4 paraphormaldehyde for 24 h and they were then embedded in paraffin blocks
samples are classified according to phase of menstrual cycle and IUD use time. All according the routine protocol. Five micron sections were taken and stained with
samples were fixed in % 4 paraphormaldehyde for 24 h and they were then embed- primer antibodies; anti-aV, anti-a3 and anti-b1 integrins to detect different distribu-
ded in paraffin blocks according the routine protocol. Five micron sections were tions of them. The intensity of integrins were graded as mild (+), moderate (++) and
taken and stained with primer antibodies; anti-VEGF, anti-F8 and anti-CD34 to strong (+++). Results: Immunoreactivity of aV integrin was detected in epithelial,
detect angiogenesis. The intensity of antibodies were graded as mild (+), moderate stromal and glandular compartments of endometrium in follicular phase in women
(++) and strong (+++). Results: The immunoreactivity of VEGF was not found dif- using IUD for 1-3 years, 3-5 years and more than 5 years. In contrast to that, aV
ferent in all groups but immunoreactivity was strong (+++). In addition, immunore- immunoreactivity was dramatically decreased in both luteal phase and perimena-
activity of F8 was detected in endothelial cells in follicular phase (+++), luteal pausal endometrium in women using IUD for 1-3 years, 3-5 years and more than 5
phase (++) and perimenopausal period in women using IUD for 1-3 years, 3-5 years years. While immunoreactivity of 3 integrin was detected in epithelial, stromal and
and more than 5 years. In contrast to that, CD34 immunoreactivity was observed in glandular compartments of endometrium in follicular and luteal phases in women
both follicular, luteal phases and perimenapausal endometrium in women using using IUD for 1-3 years, this immunoreactivity was decreased in 3-5 years and more
IUD for 1-3 years and 3-5 years. Immunoreactivity of CD34 was increased in IUD than 5 years IUD exposure. The immunoreactivity of b1 integrin was not found dif-
users more than 5 years. Conclusion: Angiogenesis was observed in endometrium ferent in all groups. Conclusion: The long term use of IUD effects distributions of
from all groups. While immunoreactivity of VEGF was constant in all groups, integrins, especially aV which is a special integrin for implantation stage.
immunoreactivities of F8 and CD34 were different according to phases.
P-185
P-183
OVER K‹ST‹ PRENATAL TANISI: B‹R OLGU SUNUMU
PR‹MER H‹POT‹RO‹D‹YE BA⁄LI SPONTAN OVARYEN
H‹PERST‹MULASYON: OLGU SUNUMU S. EserdaÛ, Y. Korkmaz, M. …zel, H. Yuvan•, M. Alan, T. Mungan,
N. DanÝßman
T. GŸvenal, Y. TimuroÛlu, N. Yurt•u, T. TimuroÛlu, B. Duran, M. ‚etin
Zekai Tahir Burak Kad›n Hastal›klar› ve Do¤um Arfl. ve E¤itim Hastanesi,
Cumhuriyet Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, Sivas Ankara
Spontan ovaryen hiperstimülasyon normal gebelikler ve endokrinopatiler sonucu Girifl: Fetal ovaryen kistler ultrasonografi ile teflhis edilebilir. Böbrek komflulu¤un-
geliflen nadir bir durumdur. Günümüze dek gebelikle birlikte olmayan primer hipo- da kistik yap› gözlenmesi ve difli genital organlar tan›mlamas›yla over kistinden flüp-
tiroidiye ba¤l› spontan ovaryen hiperstimülasyon geliflen yaln›zca iki olgu bildiril- helenmelidir. Burada, antenatal poliklini¤inde izledi¤imiz, ikinci trimestirde uE3
mifltir. Bu sunuda literatürdeki üçüncü olgu olarak primer hipotiroidi sonucu geli- yüksekli¤i olan ve ilk iki trimestirde sonografik bulgular› normal olan ancak üçüncü
flen ve tiroid hormon replasman› ile baflar›l› olarak tedavi edilen spontan ovaryen hi- trimestirde saptad›¤›m›z fetal ovaryen kistli bir olguyu sunuyoruz. Olgu sunumu:
perstimülasyon olgusu sunulmufltur. 32 yafl›nda antenatal poliklini¤imizde izlenen gebenin (G1PO) ikinci trimestir triple
testinde msAFP:1.56 mom, HCG:1.67 mom, uE3:3.54 mom idi. Gebe ayl›k takiple-
re al›nd›. 37 haftal›kken yap›lan sonografide fetal bat›nda 97X73 mm ve 67X32 mm
boyutlar›nda biloküle, seröz, homojen kistik kitle saptand›. Her iki fetal böbrek nor-
mal pozisyon ve büyüklükteydi. Pelvikaliksiyel sistem geniflli¤i normal s›n›rlarday-
d›. 40 haftal›kken elektif sezaryen ile 3350 gram erkek bebek do¤urtuldu. Postnatal
dördüncü günde yap›lan sonografide overden köken alan, sa¤da 31X19 mm ve sol-
da 75X47 mm over kistleri gözlendi. Bebek ayl›k takiplere al›nd›. Tart›flma: Fetal
ovaryen kistler, fetal intraabdominal kistlerin en s›k sebebidir. Ovaryen kistlerin ge-
liflimi hakk›nda tart›flmalar mevcuttur. Kist gelifliminde maternal ve plasental hor-
monlar›n fetal overler üzerine afl›r› stimülasyonu düflünülmektedir. Büyük kistler, re-
nal veya intestinal obstruksiyona ve distoziye sebep olabilirler. Ovaryen kistler rüp-
türe veya torsiyone olabilirler ve cerrahi tedavi gerekebilir. Triple testinde uE3 so-
nucu yüksek olan gebelerde, fetal pelviste kistik kitle saptanmas›na ilaveten cinsiye-
tin k›z olmas› halinde fetal ovaryen kisten flüphelenilmelidir. Kistin prenatal tan›s› te-
davi fleklini belirlemede ve intrapartum komplikasyonlar› önlemede önemli oldu¤u
için, gebeler ayl›k ultrasonografi takibine al›nmal›d›r.
157
P-186 P-188
PRUNE BELLY SENDROMUNUN PRENATAL TANISI B‹R OLGU SUNUMU: SCH‹S‹S ASSOS‹ASYONU- PRENATAL TANI VE
POSTMORTEM DE⁄ERLEND‹RME
N. DanÝßman, S. EserdaÛ, Y. Korkmaz, M. Alan, S. Ceylaner, D. Taner,
T. Mungan S. Ceylaner, S. EserdaÛ, Y. Korkmaz, H. Yuvan•, M. Alan, M. TuÛ,
T. Mungan, N. DanÝßman
Zekai Tahir Burak Kad›n Hastal›klar› ve Do¤um E¤t. ve Arfl. Hastanesi,
Ankara Zekai Tahir Burak Kad›n Hastal›klar› ve Do¤um E¤t. Arfl. Hastanesi,
Ankara
Girifl: Prune belly sendromu (PBS); abdominal kaslar›n hipoplazisi, genitoüriner
trakt anomalileri ve erkeklerde bilateral kriptorflidizm ile karakterizedir. Tan›n›n er- Schisis assosiasyonu, tan›mland›¤› 1981 y›l›ndan itibaren farkl› bir klinik durum
ken dönemde konmas›nda ve yönetiminde ultrasonografi önemlidir. Vaka sunu- olarak bilinmektedir. Schisis assosiasyonunda iki ya da daha fazla orta hat defekti
mu: 26 yafl›nda takipsiz gebe, 24. gebelik haftas›nda (G1P0) baflvurdu. Ultrasonog- bir arada görülmesiyle karakterizedir. Vaka sunumu: 17 yafl›nda ilk gebeli¤i olan
rafide, fetusun abdomenini dolduran 157x101x90 mm boyutlar›nda hipoekojenik antenatal takipsiz hasta 25 haftal›k gebelikle hastanemize baflvurdu. Özgeçmifl ve
kistik kitle, bilateral hidronefroz, hipoplazik toraks ve anhidroamn›os mevcuttu. soygeçmiflinde bir özellik yoktu. Yap›lan prenatal sonografide 22 haftal›k fetuste
Kistik kitleden 2500 cc s›v› aspire edildi. S›v›n›n hipertonik idrar oldu¤u tespit edil- acrani, 38x38 mm boyutunda omfalosel ve tüm spinal kanal boyunca spina bifida
di. 650 cc fetal idrarla amnioinfüzyon yap›ld›. Karyotip analizi 46XX’di. Anhidro- izlenmekteydi. Amniotik indeks:17 cm olarak ölçüldü. Do¤um indüklenerek fetus
amniosun devam etmesi nedeniyle gebelik termine edildi. Otopside; hipoplazik ak- tahliye edildi. Aileye genetik dan›flmanl›k verildi. Nekropside acrania, omfalosel,
ci¤erler, bilateral renal displazi, ileri derecede genifllemifl mesane mevcuttu. Fetu- spina bifida d›fl›nda ek bulgu izlenmedi. Cilt biyopsisinden yap›lan genetik incele-
sun iç ve d›fl genital organlar› geliflmemifl ve anüsü atrezikti. Bu bulgular PBS tan›- mede kromozomal yap› 46 XX idi ve yap›sal düzensizli¤e rastlanmad›. Tart›flma
s›n› do¤rulad›. Tart›flma: PBS 35000-50000 do¤umda bir görülür. Erkeklerde da- ve Sonuç: Czeizel 1981’de nöral tüp defekti ile oral yar›klar, omfalosel ve diafrag-
ha s›kt›r. Patogenezi tart›flmal›d›r. K›z PBS’lu vakalar›n kloakal malformasyon ne- matik herni birlikteli¤ine “schisis assosiasyonu” ad›n› vermifltir. Schisis defektleri
deniyle olufltu¤una dair görüfller vard›r. Vakam›zda PBS nedeni, kloakal malfor- blastojenik orjinli olan (nöral tüp defekti ve diafragmatik herni) ve olmayanlar (oral
masyona sekonder geliflen obstruktif üropatiden dolay›d›r. Ayr›ca PBS’a kas iske- yar›klar ve omfalosel) olarak ikiye ayr›lm›flt›r. Czeizel, en s›k anensefali-yar›k du-
let , gastrointestinal ve kardiyovasküler malformasyonlar efllik edebilir. Ultrasonog- dak birlikteli¤ini gözlemlemifltir. Orta hat defektleri sporadik oldu¤u gibi tek gen
rafide tespit edilen renal displazi ve pulmoner hipoplazinin ciddiyeti, fetal sa¤ kal›- mutasyonlar›n› da içerebilir. K›zlarda ve ikizlerde daha s›k bildirilmifltir. Schisis as-
m› etkileyen en önemli faktörlerdir . Erken intrauterin cerrahi tedaviler, renal hasa- sosiasyonunun rekürrensi, kardefllerde %3.7’dir. Bu rekürrensler s›kl›kla nöral tüp
r›n önlenmesine ve yeterli akci¤er geliflimine olanak sa¤lar. Sonuç: Ultasonografi- defekti ya da oral yar›klard›r. Sonuç olarak prenatal sonografi ile orta hat defekti
deki geliflmeler obstruktif üropatilerin erken prenatal tan›n›n konulmas›na ve teda- görülen vakalarda di¤er orta hat defektlerinin de s›k görüldü¤ü bilinmeli, baz› va-
vi modalitelerinin uygulanmas›na olanak sa¤lar. Renal displazi ve pulmoner hipop- kalarda genetik yatk›nl›k görülebilece¤inden, aileye bu yönde genetik dan›flmanl›k
lazi geliflimini önlemek için erken inutero cerrahi tadavilere uygun vakalarda bafl- hizmeti verilmelidir.
vurulabilinir.
P-189
P-187
B‹R OLGU SUNUMU: YARIK DUDAK- PRENATAL TANI VE YÖNET‹M
ROBINOW SENDROMUNUN PRENATAL TANISI
S. EserdaÛ, M. …zel, Y. Korkmaz, H. Yuvan•, M. Alan, T. Mungan
S. EserdaÛ, S. Ceylaner, Y. Korkmaz, H. Yuvan•, M. Alan, H. BayramoÛlu,
T. Mungan, N. DanÝßman Zekai Tahir Burak Kad›n Hastal›klar› ve Do¤um E¤t. ve Arfl. Hastanesi
Ankara
Zekai Tahir Burak Kad›n Hastal›klar› ve Do¤um Arfl. ve E¤t. Hastanesi
Ankara Girifl: Yüksek rezolüsyonlu ultrasonografi, fasiyal anomalilerin pek ço¤unun pre-
natal tan›nmas›na olanak sa¤lar. Ultrasonografiyle tan› konulmam›fl yar›k dudakl›
Girifl: 1969’da Robinow; mesomelik ekstremite k›sal›¤› , hemivertebra, genital hi- bebek do¤mas›, ailede emosyonel ve psikolojik strese neden olur. Postpartum dö-
poplaziyi içeren bir cücelik sendromu tan›mlam›flt›r. Karakteristik yüz görünümün- nemde yar›k dudakl› bebe¤in bak›m› yap›lmal› ve aileye psikolojik destek verilme-
den dolay›, ”fetal face” sendromu olarakda bilinir. Vaka sunumu: 29 yafl›nda, an- lidir. Vaka sunumu: Daha önce baflka bir merkezde takibi yap›lan gebe 30 hafta-
tenatal takibi olmayan gebe, 37 haftal›kken (G3P2) baflvurdu. Özgeçmifl ve soygeç- l›kken (G2P1Y1) antenatal poliklini¤imize baflvurdu. Anamnezinde ve obstetrik hi-
miflinde bir özellik yoktu. Ultrasonografide BPD=91 mm (37 hafta), FL=27.1 mm kayesinde bir özellik yoktu. Prenatal sonografide, 30 haftal›k tek canl› gebelik mev-
(18 hafta) ile genifllemifl lateral ventriküller, oksipital ensefalosel, hemivertebra, her cuttu. Fetusta, midline yar›k dudak d›fl›nda anatomik yap›sal bir bozuklu¤a rastlan-
iki femurda k›sal›k, clubfeet, hidrosel, penis yoklu¤u mevcuttu. Hasta spontan tra- mad›. Aileye genetik ve psikolojik dan›flmanl›k verilip plastik cerrahiye konsulte
vay› takiben 2850 gr, 31 cm, erkek bebek do¤urdu, ancak postnatal birinci saatte edildi. 39 haftal›kken spontan travay› takiben 3050 gr. erkek bebek do¤urtuldu. Be-
respiratuar distres nedeniyle bebek eks oldu. Fizik muayenede, bas›k burun kökü, be¤in fizik muayenesinde, midline 2.5 cm’lik yar›k dudak mevcuttu. Bebek, post-
midfasial hipoplazi, mezomelik ekstremite k›sal›¤›, club feet, k›sa bo, hidrosel, ape- natal üçüncü ay›nda opere edildi. Tart›flma ve Sonuç: Termdeki infantlar›n yakla-
ni mevcuttu. Kromozomal yap› normal 46XY idi. Radyolojik incelemede ise, me- fl›k 1/1000’inde izole fasial defektler gözlenmektedir. Birçok çal›flmada %16-33
somelik ekstremite k›sal›¤› ve hemivertebra izlendi. Otopside ayr›ca kalpte PDA ve aras›nda düflük prenatal tan› oran› bildirilmifltir. Yar›k duda¤›n tespiti daha kolayd›r
VSD gözlendi. Tart›flma: Robinow sendromu, fasial bulgular, kostavertebral ano- ve %38’e kadar tan› oran› bildirilmifltir. Etyoloji genelde multifaktöriyel olup akra-
maliler ve mesomelik ekstremite k›sal›¤› , erkeklerde normal skrotum ve testislerle ba evliliklerinde artmaktad›r. Ultrasonografi ile yar›k dudak tan›s› konulan vakala-
birlikte olan mikropenis, kad›nlarda ise hipoplastik labia minor ve klitoris ile karak- r›n, efllik edebilecek genetik ve yap›sal anomaliler ekarte edilerek, plastik cerrahiye
terizedir. Prenatal tan› ultrasonografi ile konabilir. Otozomal dominant veya resesif konsultasyonu uygundur. Prenatal tan› konulan vakalar›n ailelerinin 1/3’üne yeter-
kal›t›m mevcuttur. Radyolojik incelemede hemivertebra izlenebilir. Robinow send- li bilgi verilmektedir, oysa ki bütün aileler deformitenin ciddiyeti ve cerrahi sonra-
romlu hastalarda konjenital kalp anomalileri gözlenmektedir. Sonuç olarak prenatal s›ndaki tahmin edilen sonuç hakk›nda bilgilendirilmelidir. Böyle bir yaklafl›m aile-
dönemde yap›lan ultrasonografi ile saptanan, ekstremite k›sal›¤›na efllik eden geni- nin yar›k dudak hakk›ndaki psikolojik yaklafl›m›n› pozitif yönde etkilemektedir.
tal ve vertebral anomaliler varl›¤›nda Robinow sendromu düflünülmeli ayr›ca kardi-
ak anomaliler de taranmal›d›r. Robinow sendromunda genetik geçifl olabilece¤in-
den hastalara genetik dan›flmanl›k hizmeti verilmelidir.
158
P-190 P-192
PER‹TONEAL ONARIM VE ADEZYONUN ÖNLENMES‹ A RETROPERITONEAL PARAGANGLIOMA OBSTRUCTING THE

URETHER MIMICKING AN OVARIAN MASS: A CASE REPORT
…. Dilek
E. Kuß•u1, M. …ktem1, B. DedeoÛlu1, A. Haberal1, C. AygŸn2,
Suzan Sa¤l›k Hizmetleri, Gaziantep B. Bilezik•i3, B. Demirhan3
Gereç ve Yöntem: ‹nfertilite nedeniyle 1. grup hastalara laparotomik cerrahi ile 1

Baskent University, School of Medicine, Department of Obstetrics&
adezyolizis ve endometriotik implant eksizyonu takiben intraperitoneal olarak dek-
Gynecology, Ankara
sametazon 21-fosfat 8 mg/2ml ile diklofenak sodyum 75 mg/3 ml kar›fl›m› 1cm lez- 2
yona: 1ml olarak enjeksiyon yap›lm›fl, 2. ve 3. grup hastalara laparokopik veya la- Baskent University, School of Medicine, Department of Urology, Ankara
3
parotomik cerrahi yaklafl›mla yaklafl›mla adezyolizis ve endometriotik implant bi- Baskent University, School of Medicine, Department of Pathology,
polar-monopolar koterizasyonu uygulanm›flt›r. Hastalar›n postoperatif 6 aydaki de- Ankara
vam eden gebelik oranlar› ve gebelik sa¤lanamayanlar›n da ikincil laparoskopik
olarak AFS/adezyon skorlar› karfl›laflt›r›lm›flt›r. Bulgular: Endo1:16 has- A 75 -year -old woman G5, P5, was admitted to our hospital for further evaluation
ta,AFS:45.75 i)74-40/n:10, ii)38-26/n: 6. Endo2:8 hasta AFS:43.63 i)64-42/n: 5, of paroxysmal severe headache and back pain. The arterial blood pressure was
ii)37-24/n: 3. Endo3:11hasta AFS:48.27, i)77-42/n: 7, ii)38-30/n: 4;(p>0.05) top- 200/140 mmHg. A right adnexal mass obstructing the urether and grade II hydro-
lam 35 hastan›n postoperatif 6 aydaki devam eden gebelik oranlar› s›ras›yla nephrosis were detected by abdominal ultrasound sonography. Computed tomog-
%43.7(7/16), %37.5(3/8) ve %36.3(4/11), binominal p de¤erleri s›ras›yla raphy revealed a 4*4 cm contrast positive mass that was not ovarian origin and was
p=0.8,p=0.7 ve p=0.5(p>0.05) bulunmufltur. Gebelik sa¤lanamayanlar›n da ikincil not invaded the right urether. To make a certain decision, magnetic resonance
bak›fl laparoskopik adezyon skorlar› postop1:AFS:21.89, i)35-16, ii)22-12; postop (MRI) imaging was performed. MRI revealed a heterogeneous mass that was origi-
2:AFS:22.20, i)36-13, ii)23-11; postop 3:AFS:25, i)34-17, ii)33-14 ve postoperatif nated from right ovary. Renal artery doppler studies were normal in range. Under
skorlar›n farklar› minus1:27.56, minus2:24.80, minus3:26.71(p>0.05) olarak de¤er- these findings, there was not a proper consensus about the origin of the mass. Hen-
lendirilmifl olup anlaml› fark bulunmamaktad›r. Sonuçlar: Endometriotik implant ce surgery was suggested for the patient. Before surgery a retrograde percutaneous
ve adezyonlar›n cerrahi tedavisinde uygun yöntemin konvansiyonel tedavilere alter- nephrostomy was performed. Before the explorative surgery, patient has been eva-
natif olabilecek bipolar/monopolar koter kullanmadan yada sadece resistan hemos- luated to rule out metastatic ovarian tumor, upper and lower gastrointestinal endos-
taz› sa¤lamak amac› ile 40 geçmeden azami ölçülerde kullanarak, lezyonlar›n cold copic procedures were proceeded to investigate gastrointestinal pathology. GI seri-
knife eksizyonunu takiben tekrar adezyon oluflumunu inhibe etmek için diklofenak es were in normal, furthermore, mammography was normal. Tumor markers were
soyum ve deksametazon intraperitoneal infiltrasyonun laparatomik veya laparosko- normal in range. Later on, patient has undergone explorative surgery. Before the
pik yaklafl›mla uygulanmas›d›r. operation, patient has been re-examined under general anesthesia and gynecologic
oncologist has claimed that there was no adnexial mass. Operative findings revealed
that both of ovaries and uterus have been visulialized as normal and right adnexial
mass obstructing right urether has been originated as retroperitoneal. After dissec-
P-191 tion of visceral peritoneum, blue-violet color mass around right urether has been
dissected and specimen was processed in frozen section which reported as a benign
COMPARISON OF TWO DIFFERENT GLOBOZOOSPERMIA GROUPS vascular tissue. After frozen section, tissue was embedded into paraffin and 5 mm
IN THE INITIAL SEMEN SAMPLE sections were evaluated to ‘paraganglioma’.
S. Sertyel1, S. Kahraman1, E. Dšnmez1, N. FÝndÝklÝ1, S. †nal1, H. Yelke1,

S. Melil1, F. VanlÝoÛlu1, M. Benkhalifa2
P-193
1
Reproductive Endocrinology & Genetics Unit, Istanbul Memorial
Hospital, Istanbul THECOMA AND BILATERAL OVARIAN STROMAL HYPERPLASIA:
2
Advanced Technology Laboratories, Paris A CASE REPORT
Introduction: The aim of our study was to analyze and compare the ART outco- M. …ktem1, U. Kaya1, B. DedeoÛlu1, B. Bilezik•i2, E. Kuß•u.1
mes of cases which are grouped according to the prevalence of round-headed sper-
matozoa in the initial semen samples. Materials&Methods: According to the ro- 1
Baskent University, School of Medicine, Department of Obstetrics&
und-headed sperm concentration in the semen, 31 patients undergoing 41 cycles
Gynecology, Ankara
were classified into two groups: Group I consisted of 10 couples with 14 cycles with 2
sperm sample 70% globozoospermic forms (between 70 -100%). Group II included Baskent University, School of Medicine Department of Pathology,
patients with 27 cycles in which the male partner was diagnosed as severe teratozo- Ankara
ospermia and the abundance of round-headed forms were between 35-70%. Results
of semen characteristics and detailed morphological analysis in both groups were A 50 -year- old woman, G 3, P2 was presented with menorrhagia lasting 1 year.
compared. Intracytoplasmic Sperm Injection (ICSI) was performed in both groups Transvaginal sonography demonstrated a 57*54 mm leiomyomata at corpus uteri.
and embryo development profile were recorded for each embryo until the day of Bilateral adnexal sonograms were normal. The specimen obtained from endometri-
embryo transfer. Pregnancies were assessed by ultrasonography. Results: Statisti- al curettage showed proliferative endometrium. Abdominal hysterectomy was
cally significant differences were found in terms of spermatozoa having reduced ac- planned for the patient. At laparotomy, about 6 cm leiomyomata at corpus uteri and
rozomal content, macrocephalic head, multiple head as well as mid-piece defects in a 1*1.5 cm semisolid mass at left ovary were found. Right ovary and the other
group I (p<0.01). Low fertilization rate, which is a common finding for globozoos- pelvic organs were normal. Left oopherectomy was performed. The mass was
permia cases, were observed for both groups (21.3% and 39.9% for group I and gro- described as benign stromal tumour by frozen analysis. After then, total abdominal
up II respectively; p>0.05). No significant difference was found between these two hysterectomy and right oopherectomy were performed and operation was complet-
groups with respect to sperm concentration, motility, embryo developmental ability ed. Postoperative recovery was uneventful and the definitive histopathological diag-
on each day starting from prezygote stage until embryo transfer, pregnancy rates nosis was thecoma and bilateral ovarian stromal hyperplasia. We presented this case
and implantation rates (p>0.05). Conclusion: Although the degree of dominance because of the rare association of the thecoma with ovarian stromal hyperplasia.
may differ in different semen samples, once it is the dominant form, presence of ro-
und-headed spermatozoa can equally and negatively affect the ART outcome in
both groups.
159
P-194 P-196
YARDIMCI ÜREME TEKN‹⁄‹YLE ELDE ED‹LEN GEBEL‹KLERDE BAZAL TETK‹KLER‹ NORMAL OLAN PR‹MER ‹NFERT‹L OLGULARDA
OBSTETR‹K SONUÇLAR D‹AGNOST‹K LAPAROSKOP‹N‹N YER‹
M. TŸfek•i, H. Ozan, M. Karahasan, M. …zdil T. Var, …. LŸtfi TapÝsÝz, E. †stŸnyurt, S. KahyaoÛlu, B. YÝlmaz, H. Oral
Uluda¤ Üniversitesi, T›p Fakültesi Kad›n Hastal›klar› ve Do¤um Anabilim Dr. Zekai Tahir Burak Kad›n Sa¤l›¤› E¤itim ve Araflt›rma Hastanesi, Ankara
Dal›, Bursa
Amaç: Primer infertilite tan›s› ile takip edilen histerosalpingografi , ultrasonografi,
Amaç: Yard›mc› üreme teknikleri ile elde edilen gebeliklerin perinatal sonuçlar›n› bazal hormon düzeyleri normal olan ve male faktörü bulunmayan hastalarda diag-
belirlemek. Gereç ve Yöntem: Ocak 1999 – Ocak 2003 tarihleri aras›nda Uluda¤ nostik laparoskopinin yerini araflt›rmak. Gereç ve Yöntem: Nisan 2002- Nisan
Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um Klini¤i’nde do¤um yapan 2003 tarihleri aras›nda hastanemiz infertilite bölümünde diagnostik laparoskopi ya-
gebelerin kay›tlar› tarand›. Yard›mc› üreme yöntemleri (ART) ile gebelik sa¤lanm›fl p›lan primer infertil 50 hasta retrospektif olarak incelendi. Hastalar›n laparoskopik
olan 49 gebenin takip ve do¤um verileri incelendi. Bulgular: Yafl ortalamas› bulgular› ile birlikte laparoskopide patoloji tespit edilip operatif müdahale edilen
32,2±3.4 (27 – 41) olan gebelerin %24’ü 35 yafl üzerindeydi ve ortalama infertilite hastalar kaydedildi. ‹statistiksel analiz oran testi (p) kullan›larak yap›ld›. Bulgular:
süresi 10,0±4,6 (3–18) y›l idi. Olgular›n sadece %4.1’inde erkek faktörüne ba¤l› in- Hastalar›n yafl ortalamas› 29,8 ±5,7 olup ortalama infertilite süreleri 6,1 ±3,9 y›l
fertilite mevcut iken çiftlerin %65.3’üne ICSI uygulanm›flt›. Gebelerin %49’u tekil, idi.Laparoskopi öncesi 11 (%22) hastada; dismenore (n= 5, %10), disparoni (n= 2,
%46.9’u ikiz ve %4.1’i üçüz gebelikti ve %17.2’sine fetal redüksiyon uygulanm›fl- %4), lökore (n=2, %4), pelvik a¤r› (n= 1,%2) ve disüri (n=1, %2) semptomlar› mev-
t›. Gebelerin %37.9’unda erken do¤um tehtidi, %6.1’inde preterm membran rüptü- cuttu. Laparoskopide 30 (%60) hastada; pelvik adezyon (n=6, %12), endometriozis
rü, %13.8’inde gestesyonel diyabet, %3.4’ünde derin ven trombozu, %17.2’sinde (n=19, %38), pelvik iltihabi hastal›k (n= 3, %6), unilateral tubal oklüzyon (n=6,
preeklampsi ve %3.4’ünde maternal anemi gibi gebelik komplikasyonlar› geliflti. %12), bilateral tubal oklüzyon (n=4, %8), pelvik konjesyon (n=1, %2), polikistik
Ortalama do¤um haftas› 35.2±4.4 (22–41) olup, gebeliklerin %48’i 37. haftadan ön- over (n=5, %10), sa¤ hidrosalpinks (n=1, %2) tespit edildi. 13 (%26) hastaya ayn›
ce do¤um ile sonuçland›. Gebeliklerin %10.6’s› spontan vaginal do¤umla, %87.2’si seansta laparoskopik operatif müdahale yap›ld›. Sonuç: Primer infertilite tan›s› ile
sezaryenle ve %2.1’i operatif vaginal do¤umla sonland›r›ld›. Sezeryan ile dogum takip edilen histerosalpingografi, ultrasonografi, bazal hormon düzeyleri normal
yapan gebelerin %7.1’i eski C/S, %35.7’si primipar makat prezantasyon, %42.9’u olan ve male faktörü bulunmayan hastalara, aç›klanamayan infertilite tan›s› konma-
elektif, %7.1’i fetal distres ve %7.1’i fetal makrozomi nedeniyle C/S ile do¤urtul- dan önce diagnostik laparoskopinin yap›lmas›n›n baz› patolojilerin tan› ve tedavisi
du. Toplam 49 gebelik 70 canl› yeni do¤an ile sonuçland›. Ortalama bebek a¤›rl›¤› için gerekli oldu¤u kan›s›nday›z.
2414±894 gr (250–4300) olan bebeklerin %49’u k›z, %51’i erkekti. Tart›flma: Te-
kil gebeliklerle k›yasland›¤›nda fetal ve prinatal morbiditenin ikizlerde 3-6 kat,
üçüzlerde 5-15 kat artt›¤› ve yard›mc› üreme yöntemleri ile gebelik elde edilenler-
de spontan abort, ektopik gebelik, preterm do¤um,düflük do¤um a¤›rl›¤› ve perina- P-197
tal mortalitenin artt›¤› bildirilmifltir. Bizim merkezimizin verileri de bununla uyum-
lu olup fetal ve perinatal komplikasyon oranlar› özellikle ço¤ul gebeliklerde yüksek PREEKLAMPS‹ OLGULARDA RASGELE ‹DRARDA
bulunmufltur. Sonuç: Yard›mc› üreme teknikleri ile elde edilen gebeliklerde yüksek PROTE‹N/KREAT‹N‹N ORANI ‹LE GÜNLÜK PROTE‹N ATILIMI
fetal ve perinatal komplikasyon oranlar› nedeniyle bu olgular›n yak›n takibi gerek-
ARASINDAK‹ ‹L‹fiK‹
lidir.
R. Atakan AL, Ü. Dšlen, S. Yalva•, C. Baykal, O. Gelißen
P-195 SSK Ankara Do¤umevi ve Kad›n Hastal›klar› E¤itim Hastanesi, Ankara
EFFECT OF MELATONIN IN PREVENTION OF POSTOPERATIVE Objective: The aim of this study was to evaluate whether a random urinary protein-
ADHESION FORMATION IN RAT UTERINE HORN to-creatinine ratio is a predictor of significant proteinuria (300 mg/24 hour). Study
design: Pregnant patients with new onset hypertension in pregnancy who were
requested to collect 24-hour urine were recruited to the study. Random urine sam-
B. …z•elik1, S. Serin1, M. BaßbuÛ1, S. UludaÛ1, F. Narin2, M. Tayyar2 ples were collected before 24-hour urine collection. With the use of at least 300 mg
1
protein level in the 24-hour urine sample as the gold standard, the sensitivity and
Erciyes University Medical Faculty, Department of Obstetrics and specificity of the random protein-to-creatinine ratio for diagnosis of significant pro-
Gynecology, Kayseri teinuria were determined with the range of cutoffs. Results: A total of 151 patients
2
Erciyes University Medical Faculty, Department of Biochemistry, Kayseri completed the study. Thirty percent of study population had significant proteinuria.
There was a significant correlation between 24-hour urine and the protein-to-crea-
Objective: Our main aim was to investigate the effects of melatonin (ME), the most tinine ratio. The associations of maternal age, gestational age and 24-hour urine
powerful free-radical scavenger, on the prevention of intraperitoneal adhesion for- with the protein-to-creatinine ratio were not significant. The best cutoff of ≥0.25
mation in rat uterine horn. Our secondary aim was to determine whether different was a good predictor of significant proteinuria. Conclusion: The random urinary
methods of administration of ME were beneficial. Materials and Methods: Ani- protein-to-creatinine ratio is strongly correlated with the 24-hour total protein
mals were randomly assigned into seven groups, each consisting of 13 rats. Measu- excretion. A best cutoff ≥0.25 is a good predictor of significant proteinuria. Key
red serosal injury was created using a standard technique. While control and two words: Preeclampsia, pregnancy, proteinuria, protein-to-creatinine ratio, ROC
sham groups were not given ME, two of the remaining four groups were given a curve
single dose of 10 mg/kg (2mg) ME i.p. immediately after injury and 30 min prior
to injury respectively. In other two groups, ME treatment was continued daily for 5
days. All animals were sacrificed two weeks after surgery and adhesions were de-
termined and scored by a blind examiner. Results: The extend, severity and total
scores of adhesion were found to be significantly reduced in all of the ME treatment
groups when compared with control and sham groups. There were no statistically
significant differences between the treatment groups. Conclusion: In this study,
even single dose ME therapy was found effective in the prevention of postoperati-
ve intraperitoneal adhesion formation.
160
P-198 P-199
ORAL VE VAJ‹NAL M‹SOPROSTOL KULLANIMININ ETK‹NL‹KLER‹N‹N A SURVEY OF THE EFFECT OF RELAXATION TECHNIQUE ON
RANDOM‹ZE B‹R ÇALIfiMADA KARfiILAfiTIRILMASI LABOUR PAIN INTENSITY
R. Atakan Al, Ü. Dšlen, S. Yalva•, O. Gelißen, A. Haberal Sangestani Gita1, Bagharpoush Mahin2
SSK Ankara Do¤umevi ve Kad›n Hastal›klar› E¤itim Hastanesi Perinatoloji 1

M.S. in midwifery, University of Medical sciences, Faculty of nursing and
Ünitesi, Ankara midwifery, Hamadan, Iran (exhibitor)
2
M.S. in nursing, University of Medical sciences, Faculty of nursing and
Amaç: Oral ve vajinal misoprostol kullan›m›n›n etkinli¤ini ve güvenirli¤ini araflt›r-
midwifery, Hamadan, Iran
mak amac›yla prospektif randomize bir çal›flma düzenlendi. Yöntem: Toplam 142
gebe hastaya 50 mikrogram vajinal ya da 100 mikrogram oral misoprostol 3 saatte
bir verildi. ‹ndüksiyon-do¤um süresi, eyleme yard›m, hiperstimülasyon ve taflisistol Introduction: The delivery is a most important event in women’s life. Fear and
oran›, do¤um flekli ve neonatal sonuçlar iki grup aras›nda karfl›laflt›r›ld› (Tablo 1). worry about its pain could have negative effect on them. Some methods have been
Sonuçlar: Ortalama indüksiyon-do¤um süresi oral yolda 11,3±5 vajinal yolda suggested todecrease this pain. One of them is relaxation technique as a simple,
9,9±3,9 3 saat olarak bulundu ve bu istatistiksel olarak farks›zd›. Vajinal ve oral effective and useful for labour pain relife. Objective: This is a semiexperimental
yolda tetani oran› benzer iken (%5,4 vs %5,9) tafliflaksi oral yolda belirgin bir flekil- study in order to determine how relaxation method can affect on labour pain.
de daha yüksek oranda izlendi (%4,1 vs %25) (p=0,001). Synpitan ile eyleme yar- Materials and methods: 62 parturient women (31 in experimental group and 31 in
d›m oral yolda vajinal yoldan daha s›k uyguland› (%35,3 vs %18,9, p=0,045). the control group) by covenient sampling were surveyed. In the last two weeks of
Sezeryan oranlar› her iki grupta farks›z bulundu (%17,1 vs %13,7, p=0,61). Her iki pregnancy instructional classes were arranged only for the experimental group.
gruptada yenido¤an yo¤un bak›mda 24 saati aflan hospitalizasyon yoktu. Yorum: Then, the experimental group exercised the relaxation technique under the super-
Vajinal 50 mikrogram ve oral 100 mikrogram misoprostol do¤um eyleminin indük- vising investigator in all labour stages but the control group didn’t exercise (as rou-
siyonu amaç›yla her 3 saatte bir kullan›m› eflit etkinli¤e sahiptir. Ancak yüksek tine). The information were obtained by using the standard vision pain criteria
taflisistol oranlar› özellikle oral kullan›mda güvenlik aç›s›ndan sorun oluflturmak- (Mccaffery and Beebe, 1989) and the check list. Results: The results showed that
tad›r. in the exprimental group the labour pain gave reduction satisfactory. There was a
statistical expressive difference between pain intensity and behaviour reaction in
the first and second stages in the two groups by T student test. So, investigators
advise using of relaxation technique as a suitable, without side effect and a cheap
method for labour pain relief.
Tablo 1. Maternal ve neonatal demografik veriler. Veriler ortalama±Sd,
medyan (min-max) veya n(%) olarak sunulmufltur (ns= istatistiksel
olarak anlams›z, p<0.05). (P-198)
P-200
Vajinal Oral p
(n=74) (n=68)
EMBRYO DEVELOPMENT AND PGD OUTCOME IN
Anne yaßÝ 26±5 26±5 ns TRANSLOCATIONS
Gestasyonel yaß 40.7±1.1 41.0±1.2 ns
Bishop skoru 3 (1-5) 3(0-5) ns
N. FÝndÝklÝ, S. Kahraman, E. Dšnmez, A. Biricik, H. Berkil, S. Sertyel
Nulliparite 41 (56.0) 43 (64.8) ns
ÜndŸksiyon endikasyonlarÝ ns
Istanbul Memorial Hospital, Reproductive Endocrinology and ART Unit,
Post-term (³41 hafta) 37 (50.0) 39 (57.4)
IUGR 6 (8.1) 4 (5.9) Istanbul
Oligohidramniyon 17 (23.0) 13 (19.1)
DiÛer 14 (19.0) 12 (17.6) Objective: The effect of translocations on embryo development was evaluated and
Neonatal doÛum aÛÝrlÝÛÝ 3316±565 3366±475 ns results were compared in terms of embryo development with those of embryos
obtained from the standard ICSI cycles. Methods: In 23 translocation carriers with
34 cycles, fertilization, pronuclear morphology scoring (PMS), developmental
Tablo 2. ‹ndüksiyon sonuçlar› demografik veriler. Veriler ortalama±Sd, arrest, cleavage and blastocyst formation were compared with embryos obtained
medyan (min-max) veya n(%) olarak sunulmufltur (ns= istatistiksel from non-translocation cases undergoing ICSI (n=98 cycles). Sixteen patients with
olarak anlams›z, p<0,05). (P-198) reciprocal and seven patients with Robertsonian translocation were included. In 28
cycles PGD were performed on prezygotes (first and second polar body biopsy for
Vajinal Oral p female carriers; n=3) or on embryos having 7 or more blastomeres (blastomere
(n=74) (n=68) biopsy) for male carriers (n=25). Results: Irrespective of the type of translocation,
embryos developed from either female or male translocation carriers had a signifi-
Doz sayÝsÝ 1 (1-3) 2 (1-4)
cant impaired developmental growth profile. In translocation cases, a lower fertil-
<0,001
ization rate (63.7% vs. 71%; p<0.05), a higher rate of retarded embryo development
ÜndŸksiyon-doÛum zamanÝ 9.9±3.9 11.3±5.0 ns
(48.5% vs. 28.3%; p<0.01), and a lower rate of blastocyst formation (22.8% vs.
ÜndŸksiyon-doÛum zamanÝ 41.9%; p<0.01) were observed compared to embryos of non-translocation cases.
Nullipar 11.4±4.7 11.9±6.2 ns FISH analysis showed 70.9% abnormality rate for reciprocal translocations (n=64)
Multipar 8.5±2.9 10.0±4.4 ns and 55.0% for Robertsonian translocations (n=23) respectively. Conclusion:
Oksitosin ile eyleme yardÝm 14 (18.9) 24 (35.3) 0.02 Couples carrying a balanced translocation have a higher rate of slow growing and
Tetani 4 (5.4) 4 (5.9) ns arrested embryos during ART compared to embryos developed from non-translo-
Taßiflaksi 3 (4.1) 17 (25.0) 0.045 cation cases. This may either be due to the production of unbalanced translocation
c/s 13 (17.6) 10 (17.4) ns in gamete cells which may reflect the severity of the translocation and/or as a result
ÜndŸksiyon-doÛum zamanÝ <24 s - 3 (4.2) ns of other chromosomal abnormalities unrelated to translocated chromosomes or
micro aberrations. The probability of a poor embryo development pattern has to be
considered when the genetic counseling for translocation is given to couples.
161
P-201 P-203
EFFECTS OF HYPERTENSION AND OBESITY ON ENDOMETRIAL ENDOMETRIAL THICKNESS AND SEX STEROID RECEPTOR
TH‹CKNESS EXPRESSION IN PERIMENOPAUSAL WOMEN WITH ABNORMAL
UTERINE BLEEDING
S. Serin, B. …z•elik, M. BaßbuÛ, O. …zßahin, A. YÝlmazsoy, N. …zoÛul
A. BaloÛlu1, M. Gšl2, A. KÝlyar2
Department of Obstetrics and Gynecology, Medical Faculty, Erciyes
1
University, Kayseri ‹zmir Atatürk E¤itim ve Araflt›rma Hastanesi 1. Kad›n Hastal›klar› ve
Do¤um Klini¤i
2
Objective: The aim of this study was to evaluate the effects of hypertension and Dokuz Eylül Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um Klini¤i
obesity on endometrial thickness. Materials and Methods: Forty obese women
with hypertension (Group 1), 28 non-obese women with hypertension (Group 2), 58 Objectives: This study was conducted to evaluate the diagnostic value of transvaginal
obese women (Group 3), 56 non-obese healthy women (Group 4), totally 182 post- ultrasonographic measurement of endometrial thickness when combined with estrogen and
menopausal women were included in this prospective study. All patients were exa- progesterone receptor level detection in women with premenopausal bleeding. Material
mined and Papanicolaou cervical smear was performed after interwiev. Endometri- and Methods: A prospective investigational case control study. Fifty perimenopausal
al thickness was measured in the anterior-posterior diameter by vaginal ultrasonog- women with abnormal uterine bleeding for at least 3 months were recruited in the study
raphy. The data were 2 tests.‰analysed with one-way analyses of variance (ANO- group. Fifty premenopausal women who underwent hysterectomy regarding without any
VA), Scheffe and P<0.05 was accepted as statistically significant. Results: Endo- abnormal uterine bleeding, consisted of the control group. Endometrial thickness mea-
metrial thicknesses in obese women with or without hypertension were significantly surement by tranvaginal sonography of 50 patients in study and 50 patients in the control
greater than in non-obese women with or without hypertension (p<0.05). There was group was applied. Endometrial sampling of the study group was performed by fractional
no statistical difference between non-obese hypertensive women and control group curettage. Estrogen and progesterone receptor level assessment was performed with
regarding endometrial thickness measurement (p>0.05). Conclusion: Obesity has immunohistochemistry assay in both groups. Sonographic endometrial thickness measure-
been found to increase endometrial thickness independently. Hypertension may inc- ments and histopathological results of both groups were compared. For the assessment of
rease the endometrial thickness if it is combined with obesity. continues variables Independent Student’s t test was used. Spearmen correlation test was
used to correlate endometrial thickness and steroid receptor levels with histopathologic
results. Results: Trans-vaginal sonographic measurement of mean endometrial thickness
was greater in patients with hyperplasia and malignancy, than in patients with proliferative
P-202 and secretuar endometrium both groups Stromal and glandular levels of both progesterone
and estrogen receptor levels were found statistically lower in patients with endometrial car-
THE ROLE OF UTERIN MYOMAS ON INFERTILITY cinoma than in patients with endometrial hyperplasia in both groups. Conclusions: In
patients with perimenopausal bleeding whose endometrium thickness measurement is 7
mm or more, further investigations must be applied for the diagnosis. Evaluation of estro-
N. Kepkep1, C. †nlŸ2, H. Meden3, H. Kolb4 gen and progesterone receptor levels in the perimenopausal women may be considered as
1
a supplementary method to the sonographic measurement of endometrial thickness for the
Department of Gynecology and Obstetrics of Medicine Faculty of discrimination of endometrial carcinoma and endometrial hyperplasia.
Gaziantep University, Gaziantep
2
Department of Gynecology and Obstetrics of Medicine Faculty of Ankara
University, Ankara
3
Chefarzt der Frauenklinik des Diekoniekrankenhaus Rotenburg
(WÜMME) (Lehrkrankenhaus der Universitaet Göttingen) 27342,
Rotenburg
4
Chefarzt der Frauenklinik der Elbe Klinikum Stade 21682 STADE
Infertility is a problem observed in 10-20% of the couples in developed

countries. Uterine factors are considered responsible for 3-5% among the
female factors which are uterine anomalies, intrauterine adhesions, infec-
tions and myomas. The effects of myomas on infertility are controversial
issue in literature It is stated that 2% of all pregnancies coexist with
myomas and the rate of myomas has been found higher than the rate of
infertility in the populations. On the other hand, the size and localization of
myomas are said critical factors for infertility. We presented an infertile
woman who had multiple, intramural- submucous myoma nodules in criti-
cal localizations and size for the conservative surgery. After 14 months of
the performed myomectomies she conceived and finally gave birth a baby
by Cesarean delivery. The relationships between myomas and infertility
and the operation were discussed. The case showed us myomas can be a
causal factor upon infertility.
162
P-204 P-206
LAPAROSCOPIC REMOVAL OF A PERFORATED INTRAUTERINE COMPARISON OF THE EFFECTS OF ACARBOSE AND METFORMIN
DEVICE FROM THE RECTAL SEROSA. ON OVULATION IN CLOMIPHENE CITRATE RESISTANT
POLYCYSTIC OVARY SYNDROME
Y. ArÝkan, M. GŸngšr
S. Sšnmez, K. Savan, L. Yaßar, S. Ko•, A. AkgŸn
Ankara Üniversitesi T›p Fakültesi Kad›n Hastal›klar› ve Do¤um AD, Ankara
Assisted Reproductive Techniques Unit, Süleymaniye Maternity and
Objective: The purpose of this article is to present a case of IUD perforation of the Women’s Disease Research and Teaching Hospital, ‹stanbul
uterus to the rectum not being recognized for 11 years. A way of handling “ mislo-
cated “ IUD is outlined. Methods: An intra-abdominal IUD was removed laparo-
Introduction: Induction of ovulation is still a problem in clomiphene citrate (CC)
scopically from the serosa of the rectum of a 39-year-old gravida 3 para 2 woman,
resistant, hyperinsulinemic PCOS patients. Metformin has been widely used with
who had been diagnosed after 11 years with a “mislocated” IUD. The patient admit-
satisfactory results in this group of patients. But acarbose, an α-glucosidase
ted to our clinic with the desire of her IUD with lost strings be taken out. The patent
inhibitor, as to our knowledge, was not used in a comparative study for induction of
in whom conventional blind removal was not possible, was examined by pelvic
ovulation in CC-resistant patients. For this reason, this prospective, randomised,
ultrasonography, X-ray and hysteroscopy. Hysteroscopy comfirmed that the device
comparative study was conducted. Materials and Methods: Thirty CC-resistant
had perforated the fundal uterine wall. Then laparoscopy under general anesthesia
PCOS patients were randomised either to acarbose (group I) or metformin (group
was performed, indicating that the two flexible side arms and the copper-bearing
II) treatment. Group I received 300 mg/day acarbose and group II received 1700
rod had embedded into the serosa of the rectum just near the sigmoid colon with no
mg/day metformin for 3 months. Beginning from the third day of spontaneous or
mucosal lesion. No adhesions were found. The IUD was then removed and a soft
progestin induced cycle 100 mg of CC was administered for 5 days to every patient.
drain was left. After counselling, the patient requested sterilization, which was per-
BMI, LH/FSH ratio, fasting insulin and fasting glucose, total testosteron,proges-
formed at the same laparoscopy session by the bilateral bipolar coagulation of the
teron and estradiol ievels were recorded before and 3 months after the treatment. A
uterine tubes. A total of 325 cc serohemoragic fluid was drained without intestinal
serum progesteron concentration ≥ 8 ng/ml at cycle day 21 was taken as the evi-
component on the first two days. No major complications (intestinal or vessel
dence of ovulation. Transvaginal ultrasonography was used to measure endometri-
injuries) or minor problems occurred. The patient was discharged on the fourth day
postoperatively. Conclusions: The intrauterine device (IUD) was a very common al thickness and to count the number of mature follicles on days 8,10,12 and 14 of
form of birth control in Turkey. The most serious potential complication of IUD the cycle. Results: The fasting insulin levels, LH/FSH ratio and total testosteron
use, especially among women with “ mislocated “ IUDs, is uterine perforation. The levels reduced significantly in both groups (p<0.001) and progesteron levels on
incidence of intrauterine device perforation is 0.87 per 1000 insertions. The accept- cycle day 21 were significantly higher than pretreatment levels (p<0,001). Thirteen
ed treatment for displaced IUDs is surgical removal because of the putative risk of patients in group I and 12 patients in group II ovulated at the end of three months
adhesion formation or of damage to the intestine or urinary bladder. The migration (p<0,001). There was not a statistical significant difference in above mentioned
of an IUCD into the abdominal cavity is rare. A literature review spanning the past parameters between groups. BMI decreased significantly in acarbose group
20 years revealed 165 reported cases. The IUCD was located in the following sites: (p<0,01), however, it did not vary in metformin group (p>0,05) Conclusions: Both
omentum 45, rectosigmoid 44, peritoneum 41, bladder 23, appendix 8, small bowel acarbose and metformin therapy improved hormonal parameters and provided ovu-
two, adnexa one, iliac vein one. It is important that the possibility of uterine per- lation in CC-resistant PCOS patients. But effect of acarbose on reducing BMI was
foration be considered in anyone who has had a diagnosis of a lost IUD without ac- statistically significant than metformin.
tual confirmation that the IUD is no longer present in the cavity.
P-205
LAPAROSCOPIC MANAGEMENT OF OVARIAN DERMOID CYSTS: A

REVIEW OF 35 CASES
M. Ko•ak, B. Dilbaz, N. …ztŸrk, S. Dede, M. Altay, S. Dilbaz, A. Haberal
SSK Maternity and Women’s Health Teaching Hospital, Ankara
Objective: To review the outcome of laparoscopic surgery for suspected ovarian

dermoid cysts. Materials And Methods: Thirty-five women who underwent
laparoscopic surgery for dermoid cysts were reviewed between January 2000-
December 2002 for preoperative findings, operative technique and postoperative
complications. Results: Of the cases aged 21 to 49 years (median = 33.5) 94% had
an unilateral cyst, with a diameter between 17 to 108 mm (median =51). Clinical
presentations were pain (57%), abnormal vaginal bleeding (23%), incidental find-
ing (17%) and ovarian torsion (3%). Cystectomy, oophorectomy and laparoscopy
assisted vaginal hysterectomy with bilateral salpingoophorectomy were performed
in 74%, 22.5% and 4.5% of the operations, respectively. During the cyst extraction
within an endobag, minimal spillage occured in 86% of the cases, only one conver-
sion to laparotomy (3%) was required and none had developed chemical peritoni-
tis. All histologic examination of the cysts revealed a benign dermoid cyst that was
consistent with the initial diagnostic work-up (100%). The median operating time
was 80 minutes (range 35 -180) and only one case had an intraoperative complica-
tion. Conclusion: Using strict adherence to guidelines of preoperative clinical ass-
esment and intraoperative management, laparoscopic treatment of dermoid cysts
appears to be safe a procedure.
163
P-207 cases with pathological flow in the umbilical artery. In the LPV we
observed normal nonpulsatile forward flow in 9 cases, pulsatile forward
HIGH SINGLETON LIVE BIRTH RATE FOLLOWING CLASSICAL flow in 10 cases, and reversed flow in 9 cases. Reverse flow in the LPV
correlated significantly with an elevated resistance index of the umbilical
OVULATION INDUZTION IN ANOVULATORY INFERTILITY
arteries. This reversal could have major physiological implications:
Deoxygenated blood may be added via the LPV to the blood shifted
Marinus J. C. Eijkemans1, Babak I. Imani2, Annemarie G.M.G.J. Mulders2, through the DV and ultimately reach critical fetal organs. In extremis there
J. Dik F. Habbema1, Joop S.E. Laven2, Bart C. J. M. Fauser2 could be a waterhose effect, whereby more blood flows through the DV
than the UV that supplies it, creating suction in the LPV. The LPV is thus
Center for Clinical Decision Sciences, Department of Public Health1 and the watershed of the venous circulation of the fetus. It will be interesting to
Division of Reproductive Medicine, Department of Obstetrics and test in prospective studies, whether LPV blood flow reversal could be the
physiological basis for pathology associated with syndromes such as
Gynaecology2, Erasmus Medical Center, Rotterdam, The Netherlands
IUGR.
Background: Medical induction of ovulation using Clomiphene citrate

(CC) as first line and exogenous gonadotrophins as second line forms the
classical treatment algorithm in normogonadotrophic anovulatory infertili- P-209
ty. Because the chances of succes following classical ovulation induction
are not well established, a shift in first line therapy can be observed towards
FSH RECEPTOR POLYMORPHISMS AND ANOVULATION
alternative treatment options such as insulin sensitising agents, ‘high tech’
assisted reproductive technologies (notably IVF) or laparoscopic surgery of
ovaries. Our aim was to (1) reliably assess the probability of singleton live Joop S.E. Laven1, Annemarie G.M.G.J. Mulders1, Dwi A. Suryandari2,
birth following classical induction of ovulation and (2) evaluate whether Jšrg Gromoll2, Eberhard Nieschlag2, Bart C.J.M. Fauser1, Manuela Simoni2
individual patient characteristics assessed upon standardised initial screen-
ing can predict chances for success. Methods: Two hundred and forty con- Division of Reproductive Medicine, Department of Obstetrics and
secutive women visiting a specialist academic fertility unit with a history of Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands and
infertility, oligomenorrhea or amenorrhea, and normal follicle-stimulating
Institute for Reproductive Medicine of the University, Münster, Germany.
hormone (FSH) and oestradiol (E2) serum concentrations were prospec-
tively followed. The women were not treated before with ovulation induc-
ing agents. All patients commenced with CC. Patients who did not ovulate Objective: To assess the incidence of different FSH receptor (FSHR)
within 3 treatment cycles of incremental daily doses up to 150 mg for 5 genotypes in normogonadotropic anovulatory infertile women (WHO II)
consecutive days or ovulatory CC patients who did not conceive within 6 and normo-ovulatory controls, and to correlate them with baseline charac-
cycles, subsequently underwent gonadotrophin induction of ovulation teristics and ovarian responsiveness during ovulation induction. Design:
applying a step-down dose regimen. The main outcome measure was preg- Cross-sectional study. Setting: University Hospital. Patients: Thirty
nancy resulting in singleton live birth. Cox regression was used to construct normo-ovulatory controls were compared to 148 WHO II women.
a multivariable prediction model. Findings: Overall, 134 pregnancies end- Interventions: In WHO II patients and controls a standardized evaluation
ing in a singleton live birth occurred (56% of women). The cumulative including: cycle history, body mass index and transvaginal ultrasound scan-
pregnancy rate after 12 and 24 months of follow-up was 50% and 71%, ning of ovaries was performed. Fasting blood samples were obtained for
respectively. The multivariable Cox regression model contained the endocrine evaluation. Ovarian responsiveness to FSH in WHO II women
woman’s age, the insulin/glucose ratio and the duration of infertility and was assessed during ovulation induction and DNA was analyzed to deter-
predicted probabilities at 12 months lower than 30% for 25 out of 240 mine the FSHR genotype. Main Outcome Measures: The prevalence of
(10%) patients. Interpretation: Classical ovulation induction gives very FSHR polymorphisms, baseline serum FSH levels, amount of administered
good results in normogonadotrophic anovulatory infertility. Alternative FSH, duration of stimulation and ovarian response dose. Results: The
treatment options may not be indicated as first line therapy in these Thr/Thr 307 genotype was significantly less (52% vs 23%; P < 0.05) and the
patients, except for subgroups with poor prognosis. These women may be Ser/Ser 680 polymorphism was significantly more prevalent (40% vs 16%; P <
identified by initial screening characteristics. 0.05) in WHO II patients compared to controls. WHO II patients with the Ser/Ser
680 polymorphism presented with higher median FSH serum levels (5.2 IU/L;
range 2.4-9.7) compared to the Asn/Asn 680 (4.6 IU/L; range 1.4-5.8) and
Asn/Ser 680 (4.5 IU/L; range 1.8-9.7) variants (P < 0.05). However, ovarian
P-208 responsiveness to FSH was similar comparing different polymorphisms in
anovulatory women. Conclusions: WHO II patients exhibit a different
FSHR genotype compared to normo-ovulatory controls and although this
THE LEFT PORTAL VEIN IS THE WATERSHED OF THE FETAL
associated associated with increased baseline FSH serum levels altered
VENOUS SYSTEM ovarian sensitivity to exogenous FSH during ovulation induction could not
be established.
…. KÝlavuz1, K. Vetter2, T. Kiserud, P. Vetter
1
Unit of Prenatal Diagnosis, Clinic for Obstetrics, Vivantes Hospital
Neukoelln, Mariendorfer Weg 28, D-12051 Berlin
2
Klaus Vetter, Clinic for Obstetrics, Vivantes Hospital Neukoelln,
Mariendorfer Weg 28, D-12051 Berlin
Abstract
Critical fetal organs are preferentially supplied with oxygenated blood from
the umbilical vein (UV) by way of the ductus venosus (DV). Under normal
conditions a significant part of UV-blood flows steadily forward through
the left portal vein (LPV). Blood flow through the LPV could reverse,
however, in cases of absent or reversed enddiastolic flow in the umbilical
arteries. We tested when fetal blood flow reversal occurs by studying 28
164
P-210 P-211
BASAL HORMONAL EVALUATION: EVER INDICATED COMPARISON OF ICRODOSE FLARE-UP WITH GnRH STOP
PROTOCOL FOR IN VITRO FERTILIZATION IN POOR RESPONDER
A. Serta• BatÝoÛlu PATIENTS
The development of a sufficient number of follicles during ovulation induc- AygŸl Demirol, Timur GŸrgan
tion for ART is a very important step towards a successful outcome.
The selection of the drug regimen for ovulation induction is a crucial start-
CLINIC IVF Center, Ankara
ing point for women undergoing IVF. The recruitment of a sufficient num-
ber of follicles yields a larger number of oocytes and provides a good
choice of embryos for transfer. Age , basal FSH, basal E2, inhibin B, antral Objective: To compare the in-vitro fertilization (IVF) cycle performance
follicle count, dynamic tests such as clomiphene citrate challenge test and of microdose flare-up protocol with stop-GnRH agonist protocol in poor
gonadotrophin releasing hormone analogue test are used routinely to assess responder patients. Materials and methods: Eighty poor responder
ovarian reserve and the likelihood of response to ovarian stimulation. In patients prospectively randomized into two groups at the beginning of the
turn, this allows for careful counselling of women with regard to their IVF treatment cycle. The criteria for acceptance as poor responder was
chances of a successful outcome. Women with reduced ovarian reserve defined as previous at least two IVF cycle with < 3 oocytes retrieved, max-
have lower chances of achieving a pregnancy, so identification of this sub- imum serum estradiol level < 500 pg/ml. The patients in group I (n=40
group is important to tailor the drug regimen of each ART treatment cycle patients), microdose flare-up protocol group, started low dose oral contra-
to maximize follicular response. ceptive (Desolet; Organon, The Netherlands)on cycle day 3 of the previous
cycle for 21 days. On the second day of menstruation leuprolide acetate
BAZAL HORMONAL ‹NCELEME: END‹KASYONU VAR MI? (Lucrin, Abbott, France)was initiated with 40 µg s.c two times a day (12
hours apart) and HMG (Pergonal, Serono, Switzerland) started with 600 IU
per day on cycle day 5. The patients in goup II (n=40 patients), stop-GnRH
ART için yap›lan ovulasyon indüksiyonu s›ras›nda , gerekli say›da follikül anolog group, leuprolide acetate was initiated 500 µg per day on previous
geliflimi, baflar›l› bir sonuç elde etmenin çok önemli bir ad›m›n› oluflturur. cycle day 21 and stopped on the third day of the treatment cycle and HMG
Ovulasyon indüksiyonu için ilaç protokolu seçimi ,‹VF’e geçilecek hasta started in a dose of 600 IU per day. Doses adjusted according to the estra-
için en önemli hareket noktas›d›r. Yeterli say›da follikülün seçilmesi, çok diol level and follicular response individually with step down protocol.
say›da oosit ile embryo transferi için de iyi bir seçim olana¤› sa¤lar. Total 10.000 IU of HCG (Profasi, Serono) was administered when the lead-
Yafl, basal FSH, basal E2, basal antral follikül say›s›, klomifen sitrate chal- ing follicle reached > 16 mm in diameter. Following HCG administration,
lenge test ve Gonadotropin Releasing Hormon analog testi gibi dinamik 36 hours later, transvaginal USG-guided oocyte aspiration was performed.
testler, rutinde ovaryan reservi ve ovaryan stimülasyona muhtemel cevab› ICSI was performed for all cycles and embryos transferred on day 3.
de¤erlendirmede kullan›lmaktad›r. ‹lave olarak, hastalara baflar›l› sonuç Maximum four embryos transferred according to the patient characteristics.
olas›l›¤›na dair ciddi dan›flma verilmesini sa¤lar. Azalm›fl ovaryan reservi All patients in this study were managed and embryo transfers were per-
olan kad›nlarda daha düflük gebelik flans› oldu¤undan, bu grubun tan›mlan- formed by the same physician. Luteal suplemantation was given by
mas›, her ART tedavisinde folliküler cevab› en yüksek düzeye ç›karacak micronized progesterone vaginally (progestin, 600 mg/d, Koçak). Clical
ilaç protokolunun saptanmas› için önemlidir pregnancy was established with the visualization of gestational sac on
transvaginal USG. We used X2 test and p< 0.05 was considered as statisti-
cally significant. Results: Patients and cycle characteristics are shown in
Table I. Median ages, number of failed previous IVF cycles, basal FSH lev-
els in last three months were not different between the groups. Mean no of
total follicles, oocytes retrieved, MII oocytes and clinical pregnancy rates
were higher in Group I than Group II. Conclusion: The clinical outcome of
Microdose flare-up protocol was superior in comparison with GnRH stop
protocol in poor responder patients. But further randomized studies are
needed.
Table. Cycle performance in two groups (P-211)
Characteristics group I group II p value
No of patients 40 40
Age (years) 38 39.2 NS
FSH on day 3 (mIU/ml) 11.4 10.7 NS
No of HMG ampoules 72 68 NS
Duration of stimulation 14 12.3 NS
Cancellation rate (%) 5(12) 3(8) NS
No of total follicles (mean) 6 3.2 <0.05
No of total oocytes (mean) 5.1 3.1 <0.05
No of total M II oocytes 4.8 2.8 <0.05
Fertilization rates 82% 75% NS
No of embryos transferred 3.3 1.3 <0.05
No of grade I and II embryos 2.8 1 <0.05
transferred
Clinical pregnancy rates (%) 9(22) 3(8) <0.05
NS: non-significant
165

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