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Biomedical subjects

O Taskin

Publications and source records attributed to O Taskin.

30 records · Page 2Linked to original sources
PubMed1996

Effectiveness and Long-Term Safety of Prolonged Gosereline and Tibolone in Women with Endometriosis

Gonadotropin-releasing hormone (GnRH) agonists are widely administered to treat endometriosis, but generally are not prescribed for more than 6 months since they are associated with vasomotor symptoms and bone loss. A GnRH agonist and steroid add-back therapy can be given for longer times without flare-up or significant hypoestrogenic symptoms. We examined the efficacy and safety of a weak estrogenic steroid, OD14, with prolonged goserelin treatment in seven regularly menstruating women (age 26-33 yrs) with laparoscopically diagnosed, symptomatic endometriosis. The women received goserelin 3.65 mg subcutaneously/month and 2.5 mg OD14 2.5 mg/day beginning in the fourth cycle for 18 to 20 months. The frequency and severity of hot flushes, sweating, irritability, loss of libido, nervousness, and sleeplessness were scored by the women on a scale of 0 to 6 and compared. Samples of blood and urine were obtained to measure serum estradiol (E2) levels, lipids, and urinary calcium:creatinine (Ca:Cr) ratios at the start of treatment and monthly thereafter. The vasomotor scores, serum E2 levels, and urine Ca:Cr ratios were consistent with the hypoestrogenism induced by goserelin (24.2 &plusmn; 3.1, 18.5 &plusmn; 7.2 pg/ml, and 0.063 &plusmn; 0.008, respectively). The decreases in vasomotor scoring with regard to hot flushing, sweating, and urinary Ca:Cr ratios were significant after adding OD14 (14.8 &plusmn; 2.2, 0.031 &plusmn; 0.005, p <0.05), whereas E2 levels remained below 40 pg/ml (23.1 &plusmn; 8.2 pg/ml, p >0.05) throughout therapy. The increased low-density:high-density lipoprotein ratio with goserelin improved with OD14, remaining at the lower limit of normal. Thus, OD14 add-back to GnRH agonist therapy enabled us to extend medical therapy of endometriosis longer than 6 months, preventing hypoestrogenic side effects, and with adequate suppression endometriosis symptoms.

Journal Article↗
PubMed1996

Insulin-like growth factor binding proteins in peritoneal fluid of women with minimal and mild endometriosis.

This prospective cohort study was carried out in a university-based infertility clinic to determine the profile of insulin-like growth factor binding proteins (IGFBPs) in patients with mild endometriosis and no obvious mechanical factor contributing to infertility. A total of 26 patients with minimal and mild endometriosis and 10 controls contributed peritoneal fluid at surgery. The variety, expression and levels of IGFBPs were determined by radio-immunoassay and Western ligand blots (WLBs) with quantitation by laser densitometer. A 27 kDa species was significantly lower and 31 kDa species tended to be lower in patients with endometriosis as determined by quantitative laser densitometer. The levels of IGFBP-3 detected by radioimmunoassay and by WLB were correlated in the control group and in the patients with endometriosis in the follicular phase but not in patients with endometriosis in the luteal phase. The level of 27 kDa species seen on WLBs did not appear to correspond to IGFBP-1 determined by radioimmunoassay and IGFBP-3 levels in luteal phase endometriosis patients also departed from values determined by radioimmunoassay. These discrepancies suggest a complex system to control levels of IGF in the peritoneum involving multiple binding proteins and proteases. The IGFBPs of patients with endometriosis may contribute to reproductive dysfunction and be able to serve as markers.

Adult↗
PubMed1996

Laparoscopic vaporization of diaphragmatic endometriosis in a woman with epigastric pain: a case report.

BACKGROUND: Endometriosis has been observed in 8-15% of reproductive age women and is commonly found in pelvic and nonpelvic organs. Despite its widespread prevalence, the etiology remains obscure. CASE: A 22-year-old woman with intractable epigastric and pelvic pain who was treated previously by laser ablation for pelvic and diaphragmatic endometriosis was referred to our clinic. The patient received leuprolide acetate for six months, but the symptoms did not improve. Second-look laparoscopy revealed deep endometriotic spots involving both the diaphragms, exactly in the line of the left ventricle. With visualization, endometriosis was excised in total with the help of hydrodissection and CO2 vaporization. CONCLUSION: As in pelvic endometriosis, therapy for extrapelvic endometriosis consists of surgical and hormonal manipulation following the diagnosis. The importance of extreme caution, meticulous surgery and cardiothoracic consultation when treating the diaphragmatic surface cannot be overemphasized.

Adult↗
PubMed1996

The Effects of Daflon on Pelvic Pain in Women with Taylor Syndrome

The syndrome of chronic pelvic pain without an obvious pathology has been described as pelvic congestion (Taylor) syndrome. It is frequently associated with continuous bilateral lower abdominal pain and dyspareunia. Pelvic examination reveals tenderness without induration or masses. Although their importance in the pathophysiology of pain is uncertain, prominent enlarged broad ligament veins are observed at laparoscopy. We evaluated the effects of daflon, a venomimetic agent that regulates the circulatory tonus of the venous system, on pelvic pain and investigated the role of enlarged veins in the pathophysiology of Taylor syndrome. Ten women (age 28-35 yrs) with chronic pelvic pain were diagnosed with the syndrome at laparoscopy. They all had prominent broad ligament and ovarian veins without other pathologies such as endometriosis to explain the etiology of pelvic pain. Five women were randomized in a double-blind fashion to receive daflon 500 mg twice/day for 4 months, and five a vitamin pill placebo; they were crossed over for another 4 months. They scored the frequency and severity of lower abdominal pain and dyspareunia on a scale from 0 to 6, and the results were compared with pretreatment values. At the end of the fourth month the frequency and severity of pelvic symptoms began to decrease with daflon compared with pretreatment and placebo. The mean scores were significantly less at the end of 4 months (9.3 &plusmn; 1.1 vs 4.2 &plusmn; 1.4, respectively, p <0.05). Based on our preliminary results, we conclude that venous dysfunction and stasis may be pathophysiologic components of pelvic pain in women with Taylor syndrome. Pharmacologic enhancement of venous tonus may restore pelvic circulation and relieve pelvic symptomatology.

Journal Article↗
PubMed1996

The Sensitivity of Low-Dose Oral Contraceptives in Differentiating Endometriosis in Patients with Pelvic Pain

We evaluated the effects of low-dose oral contraceptive (Desolett) in the management of pelvic pain, and its sensitivity in differentiating organic disorders such as endometriosis, in 96 women who were followed for at least 4 to 6 months. The 67 who still complained of pelvic pain with no improvement in severity, or who reported increase in symptoms after 4 to 6 months were examined by laparoscopy. All patients underwent laparoscopy in the follicular phase, under general anesthesia with the three-puncture technique. Fifty-six women (83.6%) were diagnosed as having endometriosis, 19 stage 1, 31 stage 2, and 6 stage 3 disease (American Fertility Society classification). Six (9%) had moderate to severe pelvic adhesions (2 Fitz-Hugh-Curtis syndrome) with no endometriotic implants. One (1.5%) had Taylor syndrome, and the others (6%) were free of disease. Unresponsiveness to low-dose oral contraceptives at the end of 4 to 6 months was highly sensitive and predictive of organic pelvic disorders such as endometriosis as the cause of pelvic pain. Therefore, we conclude that this therapy is effective in evaluating and treating women with obscure findings for particular disorders. In addition to managing mild to moderate endometriosis, it is effective in reducing the severity of midline pelvic pain of uterine origin, which may be of further benefit in pelvic pain of obscure etiology. Finally, a trial of oral contraceptives may be used as initial screening in women with chronic pelvic pain to reduce the number of unnecessary diagnostic and surgical interventions.

Journal Article↗
PubMed1995

Chronic ectopic pregnancy after clinically successful methotrexate treatment of ectopic pregnancy.

Persistent ectopic pregnancy, often a sequelae of conservative surgical procedures, is characterized by a residual trophoblastic activity site with rising or plateauing beta-human chorionic gonadotropin (hCG) titers after the initial treatment. Chronic ectopic pregnancy is a different entity which may be seen after expectant management of ectopic pregnancy and contains no active trophoblast with low or absent beta-hCG titers. A rare case with features of a chronic ectopic pregnancy, which followed successful methotrexate medical treatment of a persistent ectopic pregnancy, is presented.

Adult↗
PubMed1995

An incidental diagnosis of well-differentiated papillary mesothelioma in a woman operated on for recurrent endometriosis.

The case presented involves a report of severe endometriosis with recurrent disabling dysmenorrhea associated with well-differentiated mesothelioma. Although the course of mesotheliomas is predominantly benign, the diversity of lesions, variable behavior, and resemblance, and association with endometriosis warrant thorough diagnostic investigation. Multiple biopsies and differential diagnoses are recommended in cases of peritoneal endometriosis.

Adult↗
PubMed1995

Laparoscopic repair of bladder injury and laceration.

The management of bladder injuries at laparoscopy is controversial. Some endoscopists believe in mandatory open repair, whereas others recommend laparoscopic cystotomy repair. We performed laparoscopy to treat two women with bladder injury, one with excision of a transmural nodule of bladder endometriosis, and the other with incidental cystotomy during adenexectomy in the presence of obliterative adhesions. After localizing the injury to the dome of the bladder remote from ureters, the edges of the injury were cleaned of damaged tissue and apposed in two layers using interrupted 4-0 polydioxanone endocorporeal sutures. The patients had an uneventful postoperative course, and neither experienced bladder function problems. We conclude that applying the already established tenets of bladder injury repair by laparotomy to laparoscopic procedures is acceptable in most endoscopic settings.

Adnexal Diseases↗
PubMed1994

High doses of oral contraceptives do not alter endometrial alpha 1 and alpha v beta 3 integrins in the late implantation window.

OBJECTIVE: To assess the effects of an emergency contraceptive agent on the distribution of integrin heterodimers during that part of the implantation window. DESIGN: Prospective, case-controlled study in a university-based Population Program. In the first ovulatory control cycle after the detection of LH surge, patients had endometrial sampling 11 days after the surge. In the next cycle the procedure was repeated 2 days after the administration of a postcoital contraceptive agent on day 9 after LH surge (100 g ethinyl E2 and 2 mg norgestrel). MAIN OUTCOME MEASURES: The effects of postcoital contraceptives on the expression of integrin heterodimers (alpha 1 and alpha v beta 3 subunits) reported to be unique to secretory phase was determined. RESULTS: All six specimens were consistent histologically with days 24 and 25 of the menstrual cycle by light microscopy. Using immunohistochemistry, strong membrane staining of endometrial glandular cells and superficial epithelium for both alpha 1 subunit and vitronectin (alpha v beta 3) receptor was observed in treatment and controls. No diminution of intensity or distribution was observed relative to pretreatment controls. CONCLUSIONS: There is no apparent change in the level of these two integrins in the human endometrium when high-dose oral contraceptives are given in the later stages of the implantation window. This suggests that the high doses of steroids used in emergency contraceptives may exert their effect through more complex mechanisms than endometrial cell surface changes.

Contraceptives, Oral↗
PubMed1994

In vitro comparison of four tocolytic agents, alone and in combination.

OBJECTIVE: To compare the tocolytic effects of magnesium sulfate, ritodrine, terbutaline, and nifedipine on human myometrial strips. METHODS: Myometrial strips were suspended in organ chambers for isotonic measurements and contracted with KCI. STrips from nonpregnant patients were used to obtain concentration-response curves. Myometrial strips from pregnant uteri were then exposed to the molar concentrations causing 50% relaxation in the nonpregnant tissues. RESULTS: In strips from nonpregnant patients, nifedipine was found to be the most potent tocolytic. Using strips from nonlaboring patients, nifedipine caused relaxation similar to ritodrine, and both were more effective than magnesium sulfate or terbutaline. Combinations were more effective than single agents. These agents were found to be equally less effective in myometrial strips from laboring patients. CONCLUSIONS: Nifedipine, alone or in combination, relaxes myometrial strips more effectively than the other agents studied. Myometrial strips from laboring patients are more resistant to inhibition, with none of the agents being superior.

Adult↗
PubMed1993

Term pregnancy after fallopian tube transposition.

A 28-year-old woman suffered from pelvic pain and secondary infertility. She previously had right salpingo-oophorectomy because of ruptured right cornual EP. She was found to have a normal appearing left fallopian tube that entered into a noncommunicating residual horn of the uterus. Microsurgical transposition of the left tube and tubouterine implantation was performed successfully. For cases in which tubocornual anastomosis of the transposed tube is impossible because of previous cornual resection, our technique remains an option.

Adult↗