Rahime Tuncer

Hacettepe University, Engüri, Ankara, Turkey

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Publications (12)18.88 Total impact

  • D Uygur · S Kiş · R Tuncer · F S Ozcan · S Erkaya ·
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    ABSTRACT: Our goal was to identify risk factors associated with umbilical cord prolapse and to review the perinatal outcome of cases of cord prolapse. During the study years 77 cases were identified retrospectively. Associations between cord prolapse and potential risk factors were evaluated by means of the odds ratio. Of the 77 fetuses with umbilical cord prolapse 9.1% had a fetal weight of < 2500 gas compared with 9.4% for fetuses in control group (P > 0.05). The umbilical cord prolapse occurred in association with vertex presentation 66 times (85.7%), breech presentation nine times (11.7%) and transverse presentation two times (2.6%). The occurrence of breech presentation among the control cases was 2.6%, and that of transverse lie was 1.7% (P < 0.01). Case mothers were 1.6 times more likely to be multiparas compared with the control group (P < 0.01). The perinatal mortality rate was 39/1000. Our study showed that abnormal fetal presentation and multiparity are associated with an increased risk of umbilical cord prolapse. The association of risk of cord prolapse with low birth weight was statistically insignificant (P > 0.05). We suggest that the cesarean delivery decreased the risk of perinatal mortality among cases of cord prolapse.
    International Journal of Gynecology & Obstetrics 08/2002; 78(2):127-30. DOI:10.1016/S0020-7292(02)00140-6 · 1.54 Impact Factor
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    ABSTRACT: Evan's syndrome was initially diagnosed in a 26-year-old pregnant patient. Following the introduction of high dose steroid therapy, the patient developed possible disseminated gonococcal infection which was followed by preterm labor and abruptio placentae. A cesarean delivery was performed at the 34th week of pregnancy following platelet infusion. While the infant survived, the mother had delayed postpartum hemorrhage.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 01/2002; 100(1):100-1. DOI:10.1016/S0301-2115(01)00430-4 · 1.70 Impact Factor
  • Rahime Tuncer · Dilek Uygur · Saime Kis · Sertaç Kayin · I Bebitoglu · Salim Erkaya ·
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    ABSTRACT: A 35-year-old woman was diagnosed to have cervical pregnancy of 10.2 weeks duration. Methotrexate therapy was not chosen due to the presence of active tuberculosis. Since the patient had gradually increasing vaginal hemorrhage, she was taken to the operating room. A dilatation and curettage could not control the hemorrhage. A laparotomy was performed and the uterine arteries were ligated. A cervical hysterotomy was also performed to evacuate the products of conception. There was active bleeding in the cervix although no products of conception were observed. Two purse string sutures were placed, but the persistence of profuse bleeding despite these measures necessitated total hysterectomy.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 01/2002; 100(1):102-4. DOI:10.1016/S0301-2115(01)00415-8 · 1.70 Impact Factor
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    ABSTRACT: A retrospective analysis of 36 patients with metastatic nodes out of 209 consecutively managed patients with a clinically stage I endometrial cancer was carried out. Of the 1023 lymph nodes removed, 154 nodes were found to be metastatic. The mean number of the involved nodes was 4.27 (range: 1-29). Of the 154 positive nodes, 3 had nodal diameters < or = 3 mm (1.9%), 84 had diameters of 4-10 mm (54.6%), 60 had diameters of 11-20 mm (39.0%) and 7 had diameters more than 20 mm (4.5%). With increasing lymph node size, the frequency of tumoral involvement varies from 1.0% in nodes < or = 3 mm to 63.6% in nodes bigger than 20 mm. In terms of patients, nine of them were found to have a single metastatic node ranging from 6 mm to 10 mm in diameter. In the remaining 27 patients with multiple metastatic nodes, the biggest nodes encountered were 6-10 mm in 4 (14.8%), 11-20 mm in 17 (62.9%) and more than 20 mm in 6 (22.2%) patients. Since mere sampling of the lymphatic tissue directed particularly to the enlarged nodes may not show the true incidence of positive nodes, a complete lymphadenectomy is advocated in order to obviate an understaging problem.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 05/1995; 60(1):61-3. DOI:10.1016/0028-2243(95)02072-1 · 1.70 Impact Factor
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    ABSTRACT: This study includes 183 patients with clinical stage I endometrial carcinoma. All patients had standard surgical staging procedure including peritoneal cytology, total abdominal hysterectomy, bilateral pelvic and paraaortic lymphadenectomy. The factors analysed for recurrence were age, menopausal state, cell type, grade, mitotic activity, myometrial invasion, lymphovascular space invasion, cervical involvement, microscopic vaginal metastases, adnexal metastases, peritoneal cytology, concomitant endometrial hyperplasia and pelvic and paraaortic node metastases. The overall recurrence rate was 14.2% (26/183). Of the 26 patients with recurrence, 11 had local and 13 had distant metastases. In the remaining two patients (7.7%), both local and pelvic metastases were observed. Of the factors analysed, age, grade, mitotic activity, myometrial invasion, lymphovascular space invasion, microscopic vaginal metastases, adnexal involvement and pelvic and paraaortic nodal metastases were found to be significant predictors of recurrence. After multivariate analysis, advanced age (RR = 1.05), marked mitotic activity (RR = 3.11), pelvic and/or paraaortic nodal metastases (RR = 6.37) were chosen as the most important determinants of recurrence. In terms of surgical pathological stages, recurrence risk reaches up to 45.4% for stage IIIC disease. Using surgical pathological parameters, it is possible to predict recurrence but because of high rate of distant failures it still seems hard to improve survival of this group. Detection of a substantial risk of recurrence even in stage IA/B grade 1 group warrants adjuvant therapy in all patients after primary surgery.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 01/1995; 57(3):167-70. DOI:10.1016/0028-2243(94)90294-1 · 1.70 Impact Factor
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    Ali Ayhan · Z.Selçuk Tuncer · Rahime Tuncer · Kunter Yüce ·
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    ABSTRACT: A retrospective analysis of 136 patients with ovarian carcinoma subjected to appendectomy as a part of surgical procedure was carried out to assess the importance of appendectomy in patients with ovarian cancer. Of the 136 patients studied, 94 had epithelial and 38 had non-epithelial type of primary ovarian carcinoma. In the remaining 4 patients, the primary operation was performed with an intraoperative diagnosis of ovarian carcinoma but the final pathological examination revealed appendiceal carcinoma metastatic to ovaries. The overall appendiceal involvement in the study group with primary ovarian cancer was found to be 32.5% (43/132). This figure was 15.7% and 39.3% for non-epithelial and epithelial tumors, respectively. Involvement of the appendix ranged from 8.8% for patients with stage I disease to 46.0% for patients with stage III-IV disease. Four of the appendices found to be inflamed during the surgical explorations were later reported as acute appendicitis. The frequent occurrence of metastatic disease in the appendix in patients with ovarian cancer suggests routine appendectomy is appropriate for staging early cases and for contributing to maximal cytoreduction in advanced cases.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 11/1994; 57(1):29-31. DOI:10.1016/0028-2243(94)90106-6 · 1.70 Impact Factor
  • A. Ayhan · R. Tuncer · Z.S. Tuncer · K. Yüce · T. Küçükali ·
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    ABSTRACT: This study includes 183 patients with clinical stage I endometrial cancer subjected to peritoneal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and para-aortic lymphadenectomy and omental biopsy during a 12-year period in a single institution. The factors analyzed were age, menopausal state, cell type, grade, mitotic activity, myometrial invasion, lymphovascular space invasion, cervical involvement, microscopic vaginal metastases, adnexal metastases, peritoneal cytology, presence of concomitant endometrial hyperplasia and lymph node status. The overall incidences of pelvic and para-aortic lymph node metastases were found to be 15.3% (28/183) and 9.3% (17/183), respectively. In five of 17 patients (29.4%) with para-aortic nodal metastases, pelvic nodes were free of tumor. The most significant prognostic factors for positive pelvic and/or para-aortic nodes were found to be the depth of myometrial invasion, grade of tumor and age.
    International Journal of Gynecological Cancer 10/1994; 4(5):306-309. DOI:10.1046/j.1525-1438.1994.04050306.x · 1.95 Impact Factor
  • A Ayhan · F Bilgin · Z.S. Tuncer · R Tuncer · A Yanik · H.A. Kişnisçi ·
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    ABSTRACT: To highlight recent trends in maternal mortality in Hacettepe University Hospital. A retrospective clinical analysis of 117 maternal deaths between 1968 and 1992. The overall maternal mortality ratio was 180/100,000 (108/59,993). In terms of 5-year periods, the maternal mortality ratio declined from 417.7 in 1968-72 to 73.7 in 1988-92. Infection was the most common cause of death (59.8%), followed by cardiac disease (8.5%) and hemorrhage (8.5%). Infection related deaths were either due to septic abortion (75.7%) or puerperal sepsis (24.3%). While 73.9% of all deaths were due to infection in 1968-72, this figure contributed only 9.1% of the deaths in 1988-92. When infection, hemorrhage, cardiac disease ad toxemia are investigated together, percentages of their contribution varies from 95.7% in 1968-72 to 54.5% in 1988-92 period. Maternal mortality ratios are decreasing significantly in our institution. An another promising finding is the further reduction in direct causes especially in recent years. However, an improvement in the care of pregnant women is necessary to continue this declining trend.
    International Journal of Gynecology & Obstetrics 04/1994; 44(3):223-8. DOI:10.1016/0020-7292(94)90170-8 · 1.54 Impact Factor
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    A Ayhan · Z S Tuncer · R Tuncer · R Mercan · K Yüce ·
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    ABSTRACT: The patients with granulosa cell tumor of the ovary constituted 7.6% (60/780) of all ovarian malignancies treated at our Institution. The mean age of patients at diagnosis was 53.1. The most frequent symptom was abnormal vaginal bleeding. Of the 60 patients, 36 had stage I, 2 had stage II, 16 had stage III and 6 had stage IV disease. Endometrial hyperplasia and adenocarcinoma were detected in 18 and 3 patients, respectively. Lymph node metastasis was detected in only one of 18 patients subjected to lymphadenectomy. Recurrent disease was observed in 3 of 36 patients with stage I disease. The overall 5-year survival was found to be 85.0% (51/60). This figure varied from 100.0% to 63.6% according to the stage. In patients with stage I disease, surgery with and without adjuvant therapy achieved the same 5-year survival rate. In advanced stage, 5-year survival rate dropped from 90.0% with no gross residual disease to 25.0% with residual disease more than 2 cm. In patients with stage I disease, surgery only seems to be the treatment of choice. In advanced stage, since residual disease after surgery effects survival significantly, an aggressive surgical approach is advocated.
    European journal of gynaecological oncology 02/1994; 15(4):320-4. · 0.61 Impact Factor
  • A Ayhan · R Mercan · Z.S. Tuncer · R Tuncer · H.A. Kişnişçi ·
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    ABSTRACT: To determine the outcome and morbidity of pregnancies following cervical cerclage. Records were reviewed for 326 patients with 374 singleton pregnancies between 1980 and 1990. McDonald and Shirodkar procedures were carried out in 323 and 51 pregnancies, respectively. The procedure was classified as elective if based on past history (n = 330). In 44 pregnancies, cervical dilatation prompted operation. The overall fetal survival rate has increased from 17.7% to 79.1% after cervical cerclage. While the presence of cervical dilatation at suture placement had a prognostic value, the surgical technique, gestational age at suture placement and progestin therapy had no significant effect on survival. Premature rupture of membranes and chorioamnionitis were found to be the leading causes of morbidity. Cervical cerclage seems to the treatment of choice in patients with cervical incompetence. Only the presence of cervical dilatation at operation was found to have a prognostic value among the factors analyzed.
    International Journal of Gynecology & Obstetrics 10/1993; 42(3):243-6. DOI:10.1016/0020-7292(93)90218-L · 1.54 Impact Factor
  • A Ayhan · F Yanik · R Tuncer · Z.S. Tuncer · S Ruacan ·
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    ABSTRACT: To review the clinicopathological experience of patients with benign and malignant struma ovarii. A retrospective institutional analysis of 2 patients with malignant and 14 patients with benign struma ovarii, treated during a period of 20 years. The patients with struma ovarii constituted 1.0% of all ovarian neoplasms in our institution (16/1501). Four percent of the germ cell tumors were calculated to be of struma ovarii (16/382). The stages of the malignant cases were recorded as 1A and 1C. Besides detection at early stage, a biologically low grade tumor was encountered as well. Although 5 of the patients had goitre, none of them had hyperthyroidism. None of the patients had a bilateral tumor. However, in 2 patients, a serous cystadenoma and dermoid cyst were found in the contralateral ovaries. The preoperative and intraoperative diagnosis of malignant struma ovarii proved to be difficult since 2 patients subjected to radical surgery according to suspicious frozen section reports in this series later were found to be benign struma ovarii. The low metastatic potential and slow progression rate of malignant struma ovarii support conservative surgery especially in young patients who have not yet completed their families.
    International Journal of Gynecology & Obstetrics 09/1993; 42(2):143-6. DOI:10.1016/0020-7292(93)90628-A · 1.54 Impact Factor
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    ABSTRACT: This study includes 39 patients with squamous carcinoma of the vulva subjected to radical surgery. Stage, tumor description, cell type, lesion localization, lesion size, depth of invasion, grade, lymphovascular space invasion, number of mitoses, degree of stromal inflammatory reaction, and tumors in surgical margins were analyzed for groin metastasis. Of the factors analyzed, stage (P = 0.018), grade (P = 0.007) and depth of invasion (P = 0.001) were found to be the most important predictors of node metastasis. While a combination of factors permitted to define a low-risk group with 0% node metastasis, it seems hard to identify preoperatively those patients with no risk of nodal metastasis.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 02/1993; 48(1):33-6. DOI:10.1016/0028-2243(93)90050-M · 1.70 Impact Factor