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Ali Haberal

Publications and source records attributed to Ali Haberal.

At least 37 records · Page 2Linked to original sources
PubMed2004

Angiomyolipoma of the uterus associated with tuberous sclerosis: case report and review of the literature.

BACKGROUND: Angiomyolipoma (AML) is a rare benign tumor that occurs most commonly in the kidney. Only a few cases have been described in the uterus. CASE: We describe a 32-year-old woman with tuberous sclerosis who presented with irregular bleeding. Preoperatively, the lesions were confused with leiomyoma on ultrasound. At laparotomy, multiple circumscribed subserosal and intramural purplish lesions on the corpus uteri were noted leading to a diagnosis of uterine angiomyolipoma with the histological and immunohistochemical findings. CONCLUSION: In contrast to other reported uterine angiomyolipoma cases, HMB-45 melanoma-specific antibody immunoreactivity is demonstrated in the present case. The histopathologic diagnosis as well as immunohistochemical analysis is discussed here with a review of the literature.

Adult↗
PubMed2004

Serum levels of prostate-specific antigen and androgens after nasal administration of a gonadotropin releasing hormone-agonist in hirsute women.

We aimed to determine whether ovarian suppression affects the production rate of prostate-specific antigen (PSA) in hirsute women. A total of 34 hirsute women who had a modified Ferriman-Gallwey (FG) score of > or = 7 and 14, non-hirsute women as the control group were recruited for this prospective controlled study. Serum samples for evaluation of basal hormones and PSA concentration were collected and were analyzed by commercial kits and chemiluminescent enzyme immunoassay. The hirsute women were given 400 microg/day nafarelin acetate for 3 months. Basal hormones, PSA levels and FG scores were then assessed. ANOVA and Tukey test were used to compare differences in means between the hirsute and the non-hirsute group at the beginning of the study. Student's t test, Tukey test and repeated measures variance analysis were used to evaluate differences in the study group and between the women with polycystic ovary syndrome (PCOS) and idiopathic hirsutism after gonadotropin releasing hormone (GnRH)-agonist administration. Statistical significance was assumed with a value of p < 0.05. PCOS and idiopathic hirsutism were diagnosed in 58.8% and 41.2% of 34 hirsute women, respectively. Age and body mass index (BMI) were similar in the hirsute and the control group (p > 0.05). FG scores in the PCOS group (20.3 +/- 1.7) were statistically similar to those of the group with idiopathic hirsutism (17.6 +/- 1.7) (p > 0.05). The non-hirsute women had significantly lower serum PSA concentrations than the hirsute group (p < 0.001). The basal mean level of PSA was 0.095 +/- 0.001 in the PCOS, 0.0061 +/- 0.009 in the idiopathic hirsute and 0.0040 +/- 0.004 ng/ml in the control group. No significant difference in the mean PSA levels was noted between the PCOS and the idiopathic hirsute subgroups before and after GnRH agonist treatment (0.0096 +/- 0.01 and 0.0051 +/- 0.032 ng/ml, respectively) (p > 0.05). FG scores, testosterone, 17alpha-hydroxyprogesterone and dehydroepiandrosterone sulfate levels were significantly decreased in the hirsute group following treatment (p < 0.001). PSA levels in hirsute women were higher than in non-hirsute women and independent of BMI, age and androgen deprivation. PSA concentration may be mediated through extragonadal sites and possibly through a long-standing hyperandrogenemic environment such as in PCOS and idiopathic hirsutism. Further investigation as to the significance of PSA in women with hirsutism and whether antiandrogens directly act to inhibit biosynthesis of PSA is warranted.

17-alpha-Hydroxyprogesterone↗
PubMed2004

A population-based risk factor scoring will decrease unnecessary testing for the diagnosis of gestational diabetes mellitus.

BACKGROUND: To determine the effectiveness of a population-based risk factor scoring to decrease unnecessary testing for the diagnosis of gestational diabetes mellitus (GDM). METHODS: We formed a risk factor scoring over five, which questions maternal age, body mass index and first-degree relatives with a diagnosis of diabetes mellitus, a prior macrosomic fetus and adverse outcome during the previous pregnancies. All participants underwent a 50-g glucose challenge test (GCT) followed by a 100-g oral glucose tolerence test (OGTT). We opened the 50-g GCT envelope if the participant had a risk score > or = 1 and opened the 100-g OGTT envelope if the 50-g GCT value was > or = 7.2 mmol/l. After all patients delivered we also built other strategies and tested their detection rates. RESULTS: Fourteen patients (3.3%) were diagnosed as having gestational diabetes mellitus via a 100-g OGTT. None of the patients with a score of zero had gestational diabetes mellitus. Logistic regression analysis revealed that an increase in the score by one caused a three times increase in gestational diabetes mellitus risk (OR = 3, CI = 1.9-5). Compared with the universal screening, our strategy to screen if the risk score was > or = 1, followed by a 50-g GCT with a 7.2-mmol/l cut-off value, decreased the number of women to be screened by 30% and diagnosed all cases with GDM. Screening the patients with a score > or = 2 would have decreased the number of women to be screened by 63%, still diagnosing 85% of cases with GDM. Also, risk factor-based screening strategies cause a 50% and 53% reduction in the number of OGTT applied, respectively. CONCLUSION: A well integrated, population-based scoring will decrease the number of unnecessary testing but still diagnose 85-100% of GDM cases.

Adolescent↗
PubMed2004

Unsucessful labour induction in women with unfavourable cervical scores: predictors and management.

BACKGROUND: Misoprostol fails to induce labour in 5-20% of women at term. AIM: To analyse possible predictors of unsuccessful induction with 50 microg vaginal misoprostol and effectiveness and the safety of intracervical Foley catheter application in induction failures. METHODS: An observational study was conducted on 1030 women with singleton, live fetuses, vertex presentation, > 34 weeks of gestation and Bishop score < 5. Induction of labour with 50 microg vaginal misoprostol repeated every 6 h was attempted. Women without regular uterine contractions and cervical changes at the end of 24 h were considered to be unsuccessful, and a transcervical Foley balloon catheter was placed and inflated with 50 mL saline. Possible predictors of induction failures were analysed via logistic regression analysis. Neonatal outcomes and vaginal delivery achieved after Foley catheter were also determined. RESULTS: Induction was successful in 918 cases (89.1%) and Foley catheter was placed in 112 (10.8%) women. Increasing gestational age in weeks (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.68-0.88) and increasing Bishop score (OR 0.73, 95% CI 0.60-0.90) decreased the risk of failed induction. Failure rates were 16% (27/169) in post-term nulliparous women with Bishop score </= 1 and 40% (4/10) in preterm women with Bishop score </= 1. Foley catheter achieved vaginal delivery in 83% of these women without causing an increase in the adverse neonatal outcomes. CONCLUSION: When misoprostol induction fails, Foley catheter is a safe and effective method for cervical ripening. Foley catheter can be the first treatment of choice in post-term nulliparous women or preterm women with Bishop score </= 1.

Administration, Intravaginal↗
PubMed2003

Misoprostol for cervical ripening and labor induction in pregnancies with oligohydramnios.

The efficacy and safety of misoprostol for cervical ripening and labor induction in patients with oligohydramnios was investigated. 57 pregnancies with oligohydramnios and 58 cases with a normal amniotic fluid volume (controls) were enrolled in this prospective trial. All patients received 50 microg of intravaginal misoprostol every 5 h. Primary outcomes were: cesarean section rate; induction to delivery time; oxytocin augmentation; uterine hyperstimulation; meconium passage; fetal heart rate (FHR) changes; fetal distress requiring delivery, and Apgar scores. There were no differences in the mean time to delivery, cesarean section rate, oxytocin augmentation or Apgar scores. The mean induction to delivery time in oligohydramnios and control groups were, 11 h 43 min and 11 h 18 min, respectively (p > 0.05). FHR changes were observed in 26.3% of oligohydramnios group and 32.7% of control group (p > 0.05). There was no statistically significant difference in the cesarean section rate and the uterine hyperstimulation between the 2 groups. These data suggest that misoprostol can be used as an effective agent for cervical ripening and labor induction in pregnancies with oligohydramnios without increasing the risk for perinatal outcome, compared to those with normal amniotic fluid volumes.

Administration, Intravaginal↗
PubMed2003

Prediction of adverse outcome associated with vaginal misoprostol for labor induction.

OBJECTIVE: To identify predictors of adverse outcome in pregnant women at term receiving 50 microg of intravaginal misoprostol for labor induction. STUDY DESIGN: A prospective observational study was conducted of 720 pregnant women at term with an unfavorable cervix and a medical or obstetric indication for labor induction. All patients received 50 microg of intravaginal misoprostol every 4h up to three doses. The primary outcome measure was "adverse outcome" defined as: neonatal death, fetal acidemia and emergent cesarean delivery performed for non-reassuring fetal heart rate tracings. A stepwise logistic regression analysis was used to identify predictors of adverse outcome. RESULTS: Tachysystole (frequent uterine contractions) (odds ratio (OR), 3.7; 95% confidence interval (CI), 1.2-10.8) and fetal tachycardia (OR, 4.8; 95% CI, 1.4-16.2) were determined as significant predictors of adverse outcome. The specificity of the model was 94.2%, whereas the sensitivity was 20.4%. CONCLUSION: In the absence of tachysystole and fetal tachycardia, an uneventful delivery might be expected for women receiving 50 microg of intravaginal misoprostol.

Administration, Intravaginal↗
PubMed2003

Endometrial stromal sarcoma of the uterus: analysis of 25 patients.

OBJECTIVE: To analyze the prognostic factors in endometrial stromal sarcoma (ESS). METHODS: Prognostic factors and adjuvant treatment of endometrial stromal sarcoma in 25 patients were evaluated retrospectively. RESULTS: The mean age of the group was 43. In 58% of the patients, the presenting sign was vaginal bleeding. The median total survival was 55 months while the disease free survival (DFS) was 49 months. Disease recurred in eight patients, in three of whom tumors were confined to the pelvis. Seventeen patients were alive without disease. Four patients died because of the disease. The 5-year survival rate for patients with low-grade (LGESS) disease was 92%, and 85% in high-grade (HGESS) disease. CONCLUSION: In multivariate analyzes, tumor grading was the only prognostic factor in endometrial stromal sarcoma (P=0.0026).

Adolescent↗
PubMed2003

Oral misoprostol for the third stage of labor: a randomized controlled trial.

OBJECTIVE: To compare oral misoprostol with conventional oxytocics in the management of the third stage of labor. In a controlled trial, 1574 women were randomized into four groups, as follows: Group 1 received intravenous infusion of oxytocin 10 IU plus oral misoprostol 400 micro g, followed by two doses of oral misoprostol 100 micro g 4 hours apart; group 2 received oral misoprostol 400 micro g, followed by two doses of oral misoprostol 100 micro g 4 hours apart; group 3 received intravenous infusion of oxytocin 10 IU; and group 4 received intravenous infusion of oxytocin 10 IU plus intramuscular administration of methylergonovine maleate (Methergine) 0.2 mg. The incidence of postpartum hemorrhage and decrease in hemoglobin concentration from before delivery to 24 hours postpartum were the main outcome measures. RESULTS: The primary outcome measures were similar in groups 2 and 3. The incidence of postpartum hemorrhage was 9% in group 2, compared with 3.2% in group 1 and 3.5% in group 4 (P <.01, and P =.01, respectively). There were no significant differences among the four groups regarding hemoglobin concentrations. Significantly more women needed additional oxytocin in group 2, when compared with group 4 (5.9% versus 2.2%; P =.01). The proportion of women requiring additional methylergonovine maleate was 4.8% in group 2, compared with 0.7% in group 1 and 1% in group 4 (P <.01 and P =.01, respectively). CONCLUSION: Oral misoprostol alone is as effective as oxytocin alone for the prevention of postpartum hemorrhage; it is less effective than oxytocin plus methylergonovine maleate and oral misoprostol plus oxytocin.

Administration, Oral↗
PubMed2002

Erythropoietin prevents ischemia-reperfusion from inducing oxidative damage in fetal rat brain.

OBJECTIVE: The aim of this study was to show the effect of erythropoietin on ischemia-reperfusion-induced oxidative damage in fetal rat brain. METHODS: Fetal brain ischemia was induced by clamping the utero-ovarian artery bilaterally for 20 min, and reperfusion was achieved by removing the clamps for 30 min. The control group was made up of non-injured rats that were 19 days pregnant. In the ischemia-reperfusion group no treatment was given, while 0.4 ml of human serum albumin solution and 5,000 U/kg recombinant human erythropoietin (r-Hu-EPO) were administered in the vehicle and treatment groups 30 min before ischemia-reperfusion injury. Lipid peroxidation in the brain tissue was determined as the concentration of thiobarbituric acid-reactive substances (TBARS) for each fetal rat. A one-way analysis of variance and the post-hoc test were used for statistical analysis. RESULTS: TBARS increased to statistically significantly higher levels in fetal rat brain after ischemia-reperfusion injury than were found in the control group. Recombinant human erythropoietin prevented the increase in TBARS after ischemia-reperfusion injury. CONCLUSION: Recombinant human erythropoietin has been shown to have neuroprotective effect in intrauterine ischemia-reperfusion-induced fetal brain damage in rats.

Animals↗
PubMed2002

Sister chromatid exchange rate and alkaline comet assay scores in patients with ovarian cancer.

OBJECTIVE: Sister chromatid exchange (SCE) frequencies were studied in patients with different types of ovarian malignancies and in healthy volunteers. The level of DNA damage in patients with ovarian malignancy and control subjects has also been studied by alkaline single cell gel electrophoresis (SCGE), also known as the comet assay. PATIENTS AND METHODS: Peripheral blood was collected from 30 patients after histological confirmation of malignancy and 20 healthy female volunteers. The cells were evaluated according to their grade of damage. RESULTS: We found that the sister chromatid exchange frequencies of cancer cases were significantly greater than that of controls (P < 0.001). The frequency of exchange in chromosomal groups A, B, and C, which include chromosomes 1-12, was higher than that of the other chromosomal groups in both groups. Comparison of the results of the alkaline comet assay in patient and control subjects showed a significant difference in the number of damaged cells. The frequency of limited migrated and extensive migrated cells in the women with ovarian malignancies was higher than that of control women (P < 0.001). CONCLUSIONS: SCE and SCGE can be used successfully to monitor DNA damage in women with ovarian cancer.

Adult↗
PubMed2002

Metformin therapy improves ovulatory rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome.

OBJECTIVE: To evaluate the effect of metformin therapy on hyperandrogenism, insulin resistance, cervical scores, ovulation, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome (PCOS). DESIGN: Prospective, randomized, double-blind, placebo-controlled study. SETTING: Infertility clinic of a tertiary referral center. PATIENT(S): Fifty-six women with clomiphene citrate-resistant PCOS. INTERVENTION(S): Two cycles of oral metformin therapy (850 mg, twice daily) in group I and placebo therapy (twice daily) in group II. Clomiphene citrate (100 mg/day) on cycle days 3-7 of the second cycle in both groups. MAIN OUTCOME MEASURE(S): Insulin, T, DHEAS, FSH, LH, body mass index (BMI), waist-to-hip ratio, endometrial thickness, cervical score, ovulation, and pregnancy rates in clomiphene-induced cycles after metformin therapy. RESULT(S): Metformin therapy resulted in a significant decrease in total T, LH level, LH/FSH ratio, insulin resistance, and mean BMI. No difference in waist-to-hip ratio, DHEAS level, and fasting insulin level was observed. Clomiphene citrate induction resulted in higher ovulation rates and thicker endometrium in the metformin group than in the placebo group. There was higher cumulative pregnancy rate in the metformin group; however, there was no significant difference in the pregnancy rate between the two groups. CONCLUSION(S): Metformin therapy not only decreases hyperandrogenism and insulin resistance but also improves ovulation rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with PCOS.

Adult↗
PubMed2002

New rapid bed-side test to predict preterm delivery: phosphorylated insulin-like growth factor binding protein-1 in cervical secretions.

BACKGROUND: Phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) is secreted by decidual cells and leaks into cervical secretions when fetal membranes detach from decidua. Our aim was to assess whether detection of phIGFBP-1 in cervical secretions by a rapid bed-side test could be used to predict preterm delivery in patients with regular uterine contractions. STUDY DESIGN: In our prospective study, 36 women between 20 and 36 weeks of gestation with regular, persistent contractions (> 10/h) and 18 women between 20 and 36 weeks gestation without symptoms of preterm labor were assessed for the presence of cervical phIGFBP-1. Dacron swabs were applied to the cervix and assayed in 5 min by using immunochromotography, a new rapid bed-side test (actim partus test, Medix Biochemica, Kauniainen, Finland). Data analysis included one-way variance analysis (ANOVA), Student's t-test, chi-square and Fisher's exact test. RESULTS: Of the 36 patients with regular uterine contractions, 18 had a positive actim partus test and 18 had a negative test. Among the 18 patients with a positive test, only one delivered term and the other 17 patients delivered preterm (< 37 weeks). Among the 18 women with a negative test, only two delivered preterm (p < 0.05). Mean gestational age at delivery for patients with a positive and a negative test was 34.4 +/- 3.0 and 37.9 +/- 2.3 weeks, respectively (p < 0.05). Sensitivity, specificity, positive and negative predictive values of the rapid phIGFBP-1 test for preterm delivery was 89.5, 94.1, 94.4 and 88.9%, respectively. For delivery < 37 weeks, positive likelihood ratio was 15.2 (+/- 95% CI; range 2.6-102.5). When cervical phIGBP-1 assay was used to predict delivery within 7 days, sensitivity, specificity, positive and negative predictive values were 93.8, 85%, 83.3 and 94.1%, respectively. Positive likelihood ratio with +/- 95% CI was 6.25 (range 2.2-17.8). When patients were categorized according to cervical dilatation, the positive likelihood ratio of the test when the cervix was closed at 2 cm were 8.3 (1.3-55.3), 13.6 (2-91.4), 15.8 (2.3-106.3) and 1.5 (0.2-11.5), respectively, CONCLUSION: The presence of cervical phIGFBP-1 is predictive of preterm delivery < 37 weeks of gestation. Our study shows that cervical detection of phIGFBP-1 by immunochromotography is a rapid and easily applicable test that highly anticipates preterm delivery in patients at risk.

Adult↗
PubMed2002

Preeclampsia disrupts the normal physiology of leptin.

This study was designed to examine the leptin levels of preeclamptic women and their offspring, to compare them with those of normal pregnant women and to search for a correlation between maternal and fetal plasma leptin levels and their anthropometric characteristics. Twenty-one preeclamptic women and their babies were enrolled into the study. Control group consisted of 21 normal pregnant women and their babies, whose birth weights, gestational ages, and genders match with those of babies born to preeclamptic women. Median maternal leptin concentrations of the preeclamptic group (15.3 ng/mL) were significantly higher ( p = 0.03) than the control group (10.4 ng/mL). However, fetal plasma leptin concentrations were not different ( p = 0.06) between the two groups. Fetal plasma leptin levels were correlated with birth weight, length, body mass index, gestational age, and fetal hematocrit levels in the control group. However, no correlation between leptin levels and these parameters was found in the preeclamptic group. Therefore, preeclampsia may be thought to disrupt normal leptin physiology.

Adult↗
PubMed2002

Is rectal misoprostol really effective in the treatment of third stage of labor? A randomized controlled trial.

OBJECTIVE: The purpose of this study was to compare misoprostol 600 microg intrarectally with conventional oxytocics in the treatment of third stage of labor. STUDY DESIGN: In a controlled trial, 1606 women were randomly grouped to receive (1) oxytocin 10 IU plus rectal misoprostol, (2) rectal misoprostol, (3) oxytocin 10 IU, and (4) oxytocin 10 IU plus methylergometrine. The main outcome measures were the incidence of postpartum hemorrhage and a drop in hemoglobin concentration from before delivery to 24 hours after delivery. RESULTS: The incidence of postpartum hemorrhage was 9.8% in the group that received only rectal misoprostol therapy compared with 3.5% in the group that received oxytocin and methylergometrine therapy (P =.001). There were no significant differences among the 4 groups with regard to a drop in hemoglobin concentrations. Significantly more women needed additional oxytocin in the group that received only rectal misoprostol therapy, when compared with the group that received oxytocin and methylergometrine therapy (8.3% vs 2.2%; P <.001). The primary outcome measures were similar in the group that received only rectal misoprostol therapy and the group that received only oxytocin therapy. CONCLUSION: Rectal misoprostol is significantly less effective than oxytocin plus methylergometrine for the prevention of postpartum hemorrhage.

Administration, Rectal↗
PubMed2002

Embolization of uterine artery in terminal stage cervical cancers.

Ligation of the hypogastric artery has been a standard and effective procedure in controlling massive bleeding in advanced cervical carcinoma. The authors wanted to demonstrate the selective use of embolization of hypogastric or uterine artery to achieve the same end result--the stoppage of vaginal bleeding. In a number of cases, surgical approach may not be appropriate either because of the critically ill patient or because of the highly deformed pelvic anatomy due to radiotherapy or to the recurrence of cancerous tissue. As an alternative therapy, we used selective embolization of the uterine artery in eight patients. In all the patients, embolization served to control bleeding. As the bleeding was brought under control, a gradual recovery of the patient was generally observed. The most common side-effect was temporary severe pain related to ischemia of tumoral tissue. Embolization may be regarded as an effective procedure, which can be used to control massive bleeding in selected cervical cancer patients.

Adult↗
PubMed2002

Laparoscopic conservation of the ovaries in cases with massive ovarian oedema.

Two women, one 27 years old (case 1) and the other 20 years old (case 2), were evaluated due to right lower quadrant pain. The lactate dehydrogenase level was increased in case 1 and the dihydroepiandostrone level was increased in both cases. Preoperative transvaginal ultrasonography revealed solid masses, but the tumour markers were within normal limits. At laparoscopy, oedematous ovaries were diagnosed in both cases. Untwisting of the ovaries and laparoscopic wedge resection combined with frozen section analysis resulted in conservation of the ovaries in both cases. The patients are symptom-free after 1 year of follow-up.

Adult↗