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Öğe Donmuş embriyo transferi yapılan hastalarda D Vitamini düzeylerinin gebelik sonuçlarına etkisi(Kocaeli University, 2023) Köle, Merve Çakır; Köle, Emre; Görgülü, Gökşen; Candan, Barış; Güllüoğlu, Ahmet; Doğer, Emek; Aksoy, LaleAmaç: Donmuş embriyo transferi yapılan infertil hastalarda 25-OH vitamin D’nin gebelik sonuçlarına etkisini değerlendirmek. Yöntem: Kocaeli Üniversitesi Tıp Fakültesi Hastanesi, Üremeye Yardımcı Teknikler Merkezinde prospektif -tek kör olarak yürütülen bu çalışmada donmuş embriyo transferi (DET) yapılması planlanan 276 infertil olgunun serum 25-OH vitamin D düzeyleri tedavi başlangıcında elde edildi. 25-OH-D vitamini seviyelerinin yetmezlik seviyesinde düşük olduğu olgular (Öğe OP-14 Fetal right ventricular diverticulum a case report(2023) Güllüoğlu, Ahmet; Deniz, Alparslan; Köle, Emre; Çalışkan, Eray; Hasanova, İlahaAim We report the case of 27 years old age Turkish lady G2 P1 at 20 weeks of gestations, double test was normal, attended for routine prenatal ultrasound screening a four chamber ultrasound of the heart with right ventricular diverticulum associated with pericardial effusion. Case A 27 years old age woman at 20 weeks of gestation, came for routine second trimester ultrasound screening. Ultrasound revealed four chambers of the heart with right ventricular outpouching (right ventricular diverticula or aneurysm) associated with pericardial effusion, no other anomalies. She was explained about the ultrasound findings and referred to pediatrics cardiology, fetal cardiac echo was done, confirmed the ultrasound findings and the diagnosis of fetal right ventricular diverticulum with pericardial effusion with no other cardiac malformations. She was followed up by ultrasound at 22 weeks of gestations, which revealed same findings but the pericardial effusion increased. Follow up ultrasound at 24 weeks of gestations the fetus was intrauterine death. Discussion By reviewing literature the overall prenatal prognosis of ventricular diverticula is favorable even if associated with pericardial effusion, hence conservative management may be a reasonable option, unless there is risk of impending rupture, cardiac temponade or significant lung compression and subsequently pulmonary hypoplasia. Our case was with right ventricular diverticulum and pericardial effusion and no other cardiac malformations and the choice of conservative management was opted but the fetus died at 24 weeks of gestation. Among the therapeutic options fetal pericardiocentesis to decompress the fetal thorax to allow lung expansion and reduction of systemic venous pressure leading to reduction in the risk of pulmonary hypoplasia but the risk is considered too high especially in isolated ventricular diverticulum with pericardial effusion as pulmonary hypoplasia usually resolve with corticosteroid therapy and pericardial effusion disappears progressively in most of the cases. Conclusion The prognosis is good in isolated cases. The 10 years survival rate for the patients with ventricular diverticula is approximately 80% while the 4 years survival rate for patients with congenital ventricular anuerysm is approximately 30%. However complications include rupture, arrhythmia, thrombus formation, heart failure and infective endocarditis, therefore, monitoring is required.Öğe OP-15 Case report pulmoner embolism during pregnancy(2023) Güllüoğlu, Ahmet; Köle, Merve Çakır; Deniz, Merve ErolObjective Thrombosis is limited to the deep veins of the lower extremities in most cases during pregnancy. In this case, a rare arterial embolism (in the left anterior tibial artery) was observed. A 36-year-old 33-week pregnant woman patient with a history of G3P2 2*CS was admitted into ALKU Hospital due to dyspnea and tachycardia. Pulmonary embolism is a mortal condition seen in 1/7000 pregnancies. There is clinical evidence of DVT in 70% of women who develop pulmonary embolism. Case A 36-year-old 33-week-old pregnant woman applied to the emergency department with complaints of high fever, left flank pain and shortness of breath. Patient’s vitals: TA:135/70 mmHg, Pulse:170/min, Fever:39C, Spo2:91. Laboratory results were: D-dimer: 10520 ng/ml, Procalcitonin: 2.68 ng/dl. Celestone(1x2 amp), Rocephin(1 gr IV), Diltiazem(100cc/hour) were applied to the patient. Oxygen was started at 4lt/min. Sinus tachycardia was seen on ECG and EF was 65% on ECO. No significant dilatation was observed in the right heart structures. Considering the clinical and laboratory evaluation of the patient, it was thought to be compatible with the preliminary diagnosis of pulmonary embolism. The patient was started on Clexane 2x0,6. Due to that the patient’s vital signs were unstable, the partial oxygen pressure was at the intubation limit, and the maternal-fetal tachycardia did not improve, the patient was taken to cesarean section. Postoperative vitals and general condition was good. As a result of thorax CT angiography, there were thickenings in the interstitial septas and frosted glass densities in the bilateral lungs, and the patient was transferred to the chest diseases service with a preliminary diagnosis of alveolar hemorrhage. There was an appearance compatible with thrombosis in the left tibial artery’s branch. On the 14th postoperative day, the patient’s vital signs were stable, the laboratory values were Troponin- negative(less than 0,04 ng/ml), D-dimer (less than 500 ng/ml) Procalcitonin:0.14 ng/dl. One week after discharge, the patient presents to the emergency department again with complaints of fever and flank pain. Sepsis was suspected in the patient who had fever(39C), tachycardia(130/min) and Spo2: 89. After further investigations(CT imaging), the Urinoma secondary to renal pelvis laceration due to nephrolithiasis was considered as the cause of sepsis. Double J stent was inserted to the patient by the urology team under cystoscopy. As soon as the patient’s urinoma and sepsis regressed after antibiotic therapy, the stent was removed on the postoperative 30th day. Discussion Considering similar complaints during pregnancy, sepsis and other pulmonary diseases of pregnancy must be ruled out. Urosepsis is a common cause of septic shock during pregnancy. Genitourinary tract infections can often be asymptomatic. It may be accompanied by nephrolithiasis. Conclusion The risk of thrombosis and pulmonary embolism increases during pregnancy and puerperium. Especially pregnant women with a history of thrombosis should be questioned and anticoagulant treatment should be started.Öğe Vajinal laksisite ve pelvik taban hasarı nedeniyle pelvik organ prolapsusu olan hastalarda preoperatif ve postoperatif dönemde VTİ cihazı ile vajinal duvar ve ligament basınçlarının değerlendirilmesi(Alanya Alaaddin Keykubat Üniversitesi, 2025) Güllüoğlu, Ahmet; Deniz, AlparslanÖZET Amaç: Bu çalışma, pelvik organ prolapsusu (POP) nedeniyle cerrahi uygulanan kadın hastalarda, cerrahinin vajinal ve pelvik destek dokular üzerindeki biyomekanik etkilerini Vajinal dokunsal görüntüleme (VTI) cihazı ile değerlendirmeyi amaçlamaktadır. Yöntem: Çalışmaya POP tanısı almış evre 1 ve üzeri prolapsusu olan 32 kadın hasta ve kontrol grubu olarak POP bulgusu olmayan 30 sağlıklı kadın dahil edilmiştir. Tüm hastalara preoperatif ve postoperatif 6. ayda VTI cihazı ile ölçümler yapılmıştır. VTI cihazı; doku direnci, kasılma gücü ve elastisite gibi pelvik yapıların fonksiyonel bütünlüğünü sekiz farklı ölçüm protokolü ile değerlendiren bir cihazdır. Ölçüm verileri istatistiksel analiz ile karşılaştırılmış, anlamlılık düzeyi p<0,05 olarak kabul edilmiştir. Bulgular: VTI ile ölçülen bazı vajinal duvar ve ligament basınç parametrelerinde postoperatif dönemde istatistiksel olarak anlamlı değişiklikler gözlenmiştir. Hasta grubu preoperatif ve postoperatif 6. ay ölçüm değerleri arasındaki fark kıyaslamasında P2max_a (-2,9 ve p<0,05), P2max_p (-2,0 ve p<0,05), 3P1_I (-1,2 ve p<0,05) ve Df_p ( 0,5 ve p<0,05) değerlerinde istatistiksel olarak anlamlı fark gözlenmiştir. Özellikle anterior ve posterior vajinal duvar ile uterosakral ve kardinal ligament bölgelerinde kasılma kuvveti, elastisite ve doku direncine ait verilerde cerrahi sonrası iyileşme görülmüştür. Sonuç: POP cerrahisi, yalnızca anatomik onarım sağlamakla kalmayıp pelvik yapıların fonksiyonel ve biyomekanik özelliklerinde de anlamlı iyileşme sağlamaktadır. VTI cihazı, cerrahi etkinliği objektif olarak değerlendirmek için güvenilir ve tekrarlanabilir bir araçtır. Bu çalışma, POP tedavisinde doku kalitesinin izlenmesinde VTI cihazının rolünü desteklemektedir. Anahtar Kelimeler: POP (Pelvik organ prolapsusu), VTİ (Vajinal Taktil Imaging), ligament basıncı, elastisite, doku direnci.
