Person: YOLDEMİR, AHMET TEVFİK
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YOLDEMİR
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AHMET TEVFİK
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Publication Metadata only Evaluation of sacroiliac joint MRI for pelvic venous congestion signs in women clinically suspected of sacroiliitis(SAGE PUBLICATIONS LTD, 2017) YOLDEMİR, AHMET TEVFİK; Cimsit, Canan; Yoldemir, Tevfik; Tureli, Derya; Aribal, Mustafa ErkinBackground: Pelvic congestion syndrome (PCS) is a commonly overlooked condition which is a potential cause of chronic pelvic pain. Magnetic resonance imaging (MRI) of the sacroiliac joint (SIJ) may demonstrate unexpected conditions that can mimic sacroiliitis (SI). Awareness of MRI-defined pelvic venous congestion (PVC) may help in identifying PCS, where vascular abnormality may be the sole manifestation of SIJ pain. Purpose: To detect incidental MRI-defined PVC in patients who underwent SIJ-MRI for presumed SI and define the variance of its incidence. Material and Methods: A total of 870 women who underwent SIJ-MRI were retrospectively evaluated. Incidental findings of PVC and other genitourinary and musculoskeletal system disorders were documented. Results: Of the 774 included patients, 37% demonstrated incidentally detected imaging findings related to the genitourinary system, musculoskeletal system, and PVC. The prevalence of MRI-defined PVC signs was higher in patients without SI than with SI. The prevalence of musculoskeletal disorders was higher in patients with SI whereas prevalence for genitourinary disorders was similar. Binary logistic regression analysis revealed a statistically significant correlation between SI-PVC and SI-genitourinary disorders but not between SI-musculoskeletal disorders pairs (P = 0.001, 0.001, and 0.057> 0.05). The probability of observing SI in SIJ-MRI is positively correlated with the absence of PVC or genitourinary disorders. Conclusion: Patients who underwent MRI for presumed SI demonstrated incidental PVC as well as other genitourinary and musculoskeletal findings. An awareness of these imaging findings can help identify PVC and may draw clinicians' attention to the possibility of PCS.Publication Metadata only Postmenopausal hyperandrogenism(TAYLOR & FRANCIS LTD) YOLDEMİR, AHMET TEVFİK; Yoldemir, T.Postmenopausal hyperandrogenism is a state of relative or absolute androgen excess originating from the adrenal glands and/or ovaries clinically manifested by the presence of terminal hair in androgen-dependent areas of the body, and other manifestations of hyperandrogenism such as acne and alopecia or the development of virilization. In such circumstances, physicians must exclude the possibility of rare but serious androgen-producing tumors of the adrenal glands or ovaries. Worsening of undiagnosed hyperandrogenic disorders such as polycystic ovary syndrome, congenital adrenal hyperplasia, ovarian hyperthecosis, Cushing syndrome and iatrogenic hyperandrogenism should be considered for differential diagnosis. Elevated serum testosterone not only causes virilizing effects, but also will lead to hypercholesterolemia, insulin resistance, hypertension and cardiac disease. An ovarian androgen-secreting tumor, which is diagnosed in 1-3 of 1000 patients presenting with hirsutism, comprises less than 0.5% of all ovarian tumors. Adrenal tumors, including non-malignant adenomas and malignant carcinomas, are less common than ovarian tumors but cause postmenopausal virilization. Measurement of serum testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate, androstenedione and inhibin B is necessary in postmenopausal women with the complaints and signs of hyperandrogenism. Some tests to discard Cushing syndrome should also be done. After an etiological source of androgen hypersecretion has been suspected, we recommend performing magnetic resonance imaging of the adrenal glands or ovaries. Medical management with gonadotropin-releasing hormone agonist/analogues or antagonists has been reported for women who are either unfit for surgery or in whom the source of elevated testosterone is unidentified.Publication Metadata only Assessment and management of B3 breast lesions with atypia: a focused review(TAYLOR & FRANCIS LTD, 2020) YOLDEMİR, AHMET TEVFİK; Ugurlu, M. U.; Yoldemir, T.; Gulluoglu, B. M.Breast lesions with atypia are a spectra of diseases that confer increased risk of breast cancer because of an increased probability of finding concomitant cancer after excision, or evolution toward in situ or invasive cancer over the long term. The widespread use of radiologic tools and core needle breast biopsies, in recent years, has led to an increase in the diagnosis of these atypical breast lesions. Concurrent with this has been an improvement in the classification and pathogenesis of these lesions. Current evidence suggests that the recognition and treatment of patients with atypical histology after biopsy and surgical excision requires a multidisciplinary approach to decrease the overdiagnosis and overtreatment risks. This focused review investigates the controversy and current management of atypical ductal hyperplasia, lobular neoplasia, flat epithelial atypia, and intraductal papilloma with atypia along with the risk-reducing strategies.Publication Metadata only Susceptibility-weighted magnetic resonance imaging for the evaluation of deep infiltrating endometriosis: preliminary results(SAGE PUBLICATIONS LTD, 2016) YOLDEMİR, AHMET TEVFİK; Cimsit, Canan; Yoldemir, Tevfik; Guclu, Mehmet; Akpinar, Ihsan NuriBackground: Knowledge of the precise sites of deep infiltrating endometriosis (DIE) lesions is essential for preoperative workup and treatment. Susceptibility-weighted imaging (SWI) has high sensitivity for blood products and have recently been applied in abdominal imaging. Purpose: To determine the value of SWI in the diagnosis of DIE. Material and Methods: Forty-three clinically suspected DIE patients with sonographically diagnosed ovarian endometriomas who had tenderness or palpable nodule(s) on rectovaginal examination were referred to pelvic magnetic resonance imaging (MRI) including SWI. Two patients were excluded from the study because of low quality of SWI series. Twenty-eight patients who were offered laparoscopic endometriosis surgery (LES) preferred medical treatment over surgical approach. Thirteen out of 41 participants had LES. Lesions were evaluated for their locations, signal intensities on T1-weighted (T1W) and T2-weighted (T2W) images, and presence of signal voids on SWI using 3T MRI and correlated with LES findings. Results: A total of 18 endometriosis foci were laparoscopically removed from 13 patients. DIE lesions removed at laparoscopy were located at the uterosacral ligament (9/18), rectovaginal region (4/18), retrocervical region (2/18), and fallopian tubes (3/18). Eleven out of 18 (61%) DIE foci were detected by their high-signal intensities on T1W images whereas 16 out of 18 (89%) DIE foci were detected by signal voids on SWI. Conclusion: SWI imaging with its high sensitivity to blood products, contributes to the diagnosis of DIE by depicting different phases of hemorrhage not seen by conventional MRI sequences.Publication Metadata only Strain elastography in placental dysfunction: placental elasticity differences in normal and preeclamptic pregnancies in the second trimester(SPRINGER HEIDELBERG, 2015) YOLDEMİR, AHMET TEVFİK; Cimsit, Canan; Yoldemir, Tevfik; Akpinar, Ihsan NuriThe aim of this study is to determine if the Strain elastography (SE) of the placenta measured in the second trimester differs between normal pregnancies and pregnancies complicated by preeclampsia (PE). 219 singleton pregnancies who had routine anomaly scanning between the 20th and 23rd weeks of gestation were included in this observational study. Women with either posterior placentations (n = 63) or other obstetric pathologies (n = 12) were excluded from the study, leaving 144 pregnant women for the evaluation of strain ratio with SE. One hundred and one women with normal pregnancies and normal deliveries without any perinatal complications formed Group A. Twenty-eight patients who were clinically diagnosed with early onset PE before anomaly scanning formed Group B. Fifteen normotensive pregnant women with either mild proteinuria, and past history of preeclampsia during their previous pregnancies formed Group C. The strain ratios were compared between the groups. The strain ratio of Group B was significantly higher than those of Group A and Group C (p < 0.05). The placental elasticity ratios measured by SE imaging during the second trimester differ between the normal pregnancies and the pregnancies complicated by PE. SE might be used as a supplement tool in addition to the existing methods for the prediction of PE.Publication Metadata only Quality of life among infertile PCOS patients(SPRINGER HEIDELBERG, 2019) YOLDEMİR, AHMET TEVFİK; Angin, Pinar; Yoldemir, Tevfik; Atasayan, KemalObjectiveTo investigate whether quality of life differs between PCOS and non-PCOS infertile women.Study designTwo questionnaire forms of quality of life (PCOSQ, SF-36) were given to 238 women. Patients were asked to answer all of the questions in both of the questionnaires. Of these 238 women, only 49 infertile PCOS patients, 47 infertile non-PCOS patients and 62 fertile PCOS patients flled the forms completely.ResultsBoth PCOSQ and SF-36 scores are lowest in infertile PCOS group. Although total PCOSQ score of infertile non-PCOS group was better than non-infertile PCOS and fertile PCOS groups; there was trend for lower scores when infertility is added on PCOS status.ConclusionThe quality of life is lowest among infertile PCOS women. Both PCOS and infertility as individual factors may have negative impact in quality of life of reproductive age women.Publication Metadata only The effect of PCOS status on atherosclerosis markers and cardiovascular disease risk factors in young women with vitamin D deficiency(TAYLOR & FRANCIS LTD, 2021) YOLDEMİR, AHMET TEVFİK; Atasayan, Kemal; Yoldemir, TevfikObjective To investigate whether polycystic ovary syndrome (PCOS) had further deteriorating influence on endothelial function or cardiometabolic parameters in women with vitamin D deficiency during reproductive age. Study design The study group was composed of women with PCOS and vitamin D deficiency and insufficiency between the ages of 18 and 35 years. Age and body mass index (BMI)-matched women were chosen as controls. Serum 25(OH) Vit D levels below 20 ng/mL were considered as vitamin D deficiency. The cutoff level of vitamin D insufficiency was suggested at 30 ng/mL. Serum FSH, LH, estradiol, testosterone, DHEA-S, fasting glucose, total cholesterol, HDL, LDL, triglyceride levels were analyzed. Carotid artery intima-media thickness (CIMT) was measured, and the flow-mediated vasodilation (FMD) was calculated. Results CIMT and FMD values in both vitamin D deficiency and insufficiency subgroups showed no significant difference between PCOS and non-PCOS groups. There was a weak negative correlation between BMI, waist/hip ratio, CRP, and 25(OH) Vitamin D. Conclusion PCOS is a heterogeneous disease with different combinations of the diagnostic components. Vitamin D is an important variable for a healthy cardiovascular system. We did not find any difference in early atherosclerotic markers and cardiometabolic features between PCOS and non-PCOS group with Vitamin D deficiency.Publication Metadata only Prevalence of dynamic magnetic resonance imaging-identified pelvic organ prolapse in pre- and postmenopausal women without clinically evident pelvic organ descent(SAGE PUBLICATIONS LTD, 2016) YOLDEMİR, AHMET TEVFİK; Cimsit, Canan; Yoldemir, Tevfik; Akpinar, Ihsan NuriBackground Dynamic magnetic resonance imaging (dMRI) is an imaging tool that can be used to evaluate and stage pelvic organ prolapse (POP). Greater understanding of the incidental detection of POP in asymptomatic patients is needed. Purpose To evaluate the prevalence of dMRI-detected POP in pre-and postmenopausal women who were imaged for reasons unrelated to pelvic floor dysfunction. Material and Methods A total of 227 women who had diagnoses that did not include POP underwent abdominal/pelvic dMRI. Patients with a positive gynecological examination for or a clinical history of POP (n=11), hysterectomy (n=4), or gynecologic-oncology surgery (n=2) were excluded, as well as patients who were unable to strain during MRI (n=11). A total of 199 patients without visible prolapse were enrolled in the study. An H-line, M-line, pubococcygeal line (PCL), and mid-pubic line (MPL) were used to detect and grade prolapse. Results The prevalence of dMRI-identified POP was higher in postmenopausal subjects. The PCL led to a greater frequency of prolapse detection than the MPL. The frequency of middle compartment descent was similar regardless of whether the PCL or MPL was used as a reference line. There was a higher incidence of prolapse in the posterior compartment. Using an H-line and PCL as references, the anterior and posterior compartments were found to significantly differ between pre- and postmenopausal subjects. The MRI parameters that were used to define POP were not correlated with parity, vaginal birth, BMI, or fetal birth weight. With respect to the MPL, age was correlated with both the presence of an elongated H-line and with descent. Conclusion Dynamic MRI identified incidental pelvic organ prolapse in asymptomatic patients. The prevalence of dMRI-detected POP was higher in postmenopausal women without visible prolapse. These findings suggest the need for further studies to identify how to modify the currently used dMRI thresholds for postmenopausal women.