Management of adnexal torsion

Objective: To evaluate clinical findings, operative reports, the pathological results of patients with diagnosis of adnexal torsion. Methods: Fourteen patients with diagnosis of adnexal torsion who presented to our clinic between January 2009 and March 2013 were included in this retrospective analysis. Data including clinical findings, operative reports, the pathological results were recorded. Results: The mean age of the patients was 28.1 ± 10.5 with a range of 16 to 52 years. All patients underwent ultrasonography, and a pelvic mass appearance was detected in all cases. The mean diameter of the mass was 8,04±2,96 cm. All of the patients had lower abdominal pain, nausea and vomiting. Six patients were operated laparoscopically, while eight patients had laparotomy. Detorsion and cystectomy was performed in 7 (50.0%) of the patients. Two of patients were pregnant in operation time that treated by cystectomy and detorsion of the ovaries successfully in the first and third trimester (one by laparoscopy). There was one patient of isolated fallopian tube torsion due to hydrosalpinks treated by laparoscopic salpingectomy. Two of the patients had paratubal cyst and tubal torsion. Detorsion and cystectomy by laparoscopy and salpingectomy by laparotomy were performed for these patients respectively. The most common histopathology was serous cystadenoma (28,6%). Conclusion: Adnexal torsion is a rare gynecologic emergency of women and occur in reproductive ages mostly. Prompt diagnosis and conservative treatment is important for the safety of ovaries and fallopian tubes and future fertility. J Clin Exp Invest 2014; 5 (1): 7-1

Waning immunity to inactive SARS-CoV-2 vaccine in healthcare workers: Booster required

Aims Despite high vaccination rates, increasing case numbers continue to be reported with the identification of new variants of concern, and the issue of durability of the vaccine-induced immune response remains hot topic. Real-life data regarding time-dependent immunogenicity of inactivated COVID-19 vaccines are scarce. We aimed to investigate the changes in the antibody at the different times after the second dose of the CoronaVac vaccine. Methods The study included 175 HCWs vaccinated with inactive CoronaVac (Sinovac Life Sciences, China) SARS-CoV-2 vaccine in two doses. Anti-spike/RBD IgG levels were measured first, third, and sixth months after the second dose. Chemiluminescent microparticle immunoassay (IgG II Quant test, Abbott, USA), which is 100% compatible with plaque reduction neutralization test, was used. Results Mean age of the participants was 38 +/- 11.23 years (range between 22 and 66) of whom 119 (63.9%) were female, and 56 (32%) were male. Dramatic reductions were demonstrated in median antibody levels particularly in the infection-naive group, comprising 138 HCWs compared to those with prior history of COVID-19 infection (n = 37) (p < 0.001). There was no difference between the two groups in terms of age, gender, blood groups, BMI, and comorbid diseases. Conclusions While antibody positivity remained above 90% in the 6th month after two doses of inactivated vaccine in HCWs, the median titers of neutralizing antibodies decreased rapidly. The decrease was more rapid and significant in those with no history of prior COVID-19 infection. In this critical phase of the pandemic, where we are facing the dominance of the Omicron variant after Delta, booster doses have become vital.IU-Cerrahpasa Scientific Research Projects Uni

Response to: Microsurgical principles should be considered in studies addressing adhesion prevention: Caglar et al. (2014)

WOS: 000341826700006PubMed: 25027819

Ultrastructural evaluation of the effects of the Contrast Media on the rat kidney

PubMedID: 11989778In this study, the ultrastructural observations in rat kidneys were studied 2, 24 and 48 h after intravenous injection of 1, 3 and 9 g iodine per kg body of ioxaglate and iohexol. The effect of die contrast media was mainly on the proximal convoluted tubule cells, the presence of vacuoles containing granular and membranous structures was a striking feature. In the distal convoluted tubular cells, pycnotic nuclei and cytoplasmic bulges toward the lumen were observed. In some glomeruli, membranous structures in cytoplasm of podocytes and thickening of glomerular basal membrane were seen. Values of biochemical analysis were slightly higher especially at high doses in experimental groups when compared to the control. The results suggest that iohexol causes more degeneration than ioxaglate. Not only proximal convoluted tubule cells but also the other parts of the nephron were affected by contrast media

Persistent ascites due to sclerosing encapsulating peritonitis mimicking ovarian carcinoma: A case report

Sclerosing encapsulating peritonitis, also known as ‘Cocoon Syndrome’, is a rare cause of bowel obstruction. The condition might be congenital or acquired and has non-specific symptomatology. Abdominal pain occurs due to the limitation of intestinal motility or segment obstruction by a thick homogenous fibrotic mantle covering the intra-peritoneal organs. Altered peritoneal fluid dynamics result in persistent ascites. Leading pathogenic theories are not well defined, but genetic factors, retrograde trans-tubal flow of causative agents, peritoneal infections, medications and peritoneal invasive procedures are all thought to play a role. There are no specific diagnostic criteria and exact diagnosis is only confirmed during surgery when the investing thick fibrous folds covering the bowel loops are visualised. We present here a case that had been suspected to have an ovarian malignancy due to a huge abdominal heterogeneous mass and ascites on preoperative diagnostic workup, but had a final diagnosis of abdominal Cocoon Syndrome made during surgery. © 2014 by the Turkish-German Gynecological Education and Research Foundation

Endometrial Curettage in Abnormal Uterine Bleeding and Efficacy of Progestins for Control in Cases of Hyperplasia

Ankarali, Handan Camdeviren/0000-0002-3613-0523WOS: 000338633500066PubMed: 24870785Background: Abnormal uterine bleeding (AUB) is the most important symptom of endometrial hyperplasia and endometrial curettage (EC) is the gold standard diagnostic procedure. We present the results of patients who underwent EC for AUB and the efficacy of progestin administration in those with endometrial hyperplasia. Materials and Methods: A total of 415 female patients who presented to Duzce Public Hospital in 2011-2012 for AUB and who underwent EC were included. We determined the reasons for AUB, and females with hyperplasia were treated with 10 mg/day medroxyprogesterone acetate for 14 days/month or 160 mg/day megestrol acetate continuously for 3 months. We evaluated the efficacy of progestins for periods of three and/or six cycles by repeating EC. A statistical analysis of specific endometrial causes according to age of presentation was conducted using the chi-square test. Results: Among the 415 females (average age, 53.5 years) followed for 6 months, 186 had physiological changes (44.8%), 89 had simple hyperplasia (21.44%), 1 had atypical hyperplasia (0.2%), 6 had (1.44%) complex hyperplasia, 3 had (0.72%) atypical complex hyperplasia, and 5 had adenocarcinoma (1.2%). Regression rates were 72.7-100%, and the optimum results were observed after 6 months of hormonal therapy. Conclusions: The main cause of AUB was physiological change. Progestin therapy resulted in significant regression even in females with atypical hyperplasia

Endosülfan’ın fare karaciğeri üzerine etkisinin ultrasütrüktürel ve biyokimyasal değerlendirilmesi

Giriş: Çalışmanın amacı, endosülfan’ın fare karaciğeri üzerine etkisini biyokimyasal veriler ile birlikte ultrasütrüktürel olarak araştırmak, ve aynı zamanda ışık mikroskobik değerlendirmek. Materyal ve Metod: Çalışmada 26-30 gram ağırlığında 12 erkek albino fare kullanıldı. Fareler iki eşit gruba ayrıldı. Endosülfan grubuna, fındık yağında çözülmüş endosülfan (13 mg/kg/gün, vücut ağırlığ) 10 gün süresince intragastrik yol ile oral olarak uygulandı. Kontrol grubuna, yalnızca fındık yağı verildi. Bütün fareler onuncu günün sonunda servikal dislokasyon ile sakrifiye edildi. Histolojik ve biyokimyasal analizler (SOD; superoksit dismutaz, GSH; glutatyon peroksidaz, CAT; katalaz, G6PD; glikoz-6-fosfat dehidrogenaz, MDA; malondialdehid) için doku örnekleri alındı. Bulgular: Bazı hepatositlerin mitokondrionlarının iç membranlarında bozulma, endoplazmik retikulum sisternalarında dilatasyon, lipid ve vakuoler yapıların varlığını gözlendi. Işık mikroskobik olarak belirgin vakuolizasyon görüldü. G6PD, SOD, GSH ve MDA aktivitelerinde artmaya rağmen CAT aktivitesinde azalma vardı. Sonuç: Endosülfanın fare karaciğeri üzerine olumsuz etkisinin nedeni olarak, endosülfanın hepatositlere direkt toksik etkisi yanısıra oksidatif stres indüksüyonuna bağlı olabileceği düşünülebilir.Purpose: The aim of this study is to examine the effect of endosulfan on mice liver as ultrastructural together with biochemical data, and also by light microscopy to evaluate. Materials and Methods: 12 male albino mice weighing between 26-30g were used. Mice were divided into two equal groups. For group receiving endosulfan, endosulfan (13 mg/kg/day, body weight) dissolved in nut oil was administered orally to mice via intragastric-during 10 days. The control group received only nut oil. At the end of the 10th day, all the mice were sacrificed with cervical dislocation. Tissue samples were taken for histological examination and biochemical analysis (SOD; superoxide dismutase, GSH; glutathione peroxidase, CAT; catalase, G6PD; glucose-6-phosphate dehidrogenase, MDA; malondialdehyde). Results: Disruption of inner membrane of mitochondria, dilatation of endoplasmic reticulum, the presence of large lipid droplets and vacuolar structures were observed in some hepatocytes. Prominent vacuolization was seen in light microscopic observation. There was an increment in activities of G6PD, SOD, GSH and MDA. However, there was a decrease in CAT activity. Conclusion: It may be considered that the adverse effect of endosulfan on mice liver may be due to direct toxic effect of endosulfan and induction of oxidative stress

Anrüptüre tubal ektopik gebeliklerde ayaktan metotreksat tedavi stratejileri

Aim: To evaluate the selection criteria for outpatient treatment of unruptured ectopic pregnancy.Methods: A total of 124 unruptured ectopic pregnancies that had been treated with single-dose intramuscularmethotrexate injections during the period from 2012 to 2017 at Duzce University Faculty of Medicine, Trainingand Research Hospital were evaluated.Results: Success rate of the medical treatment with single dose methotraxate was 76.61% (n 95) of 124patient. The mean duration of hospital stay was shorter in successful medical treatment group (p0.030).Combining ?-hCG level at the first day of methotrexate treatment with size of ectopic focus and/or the presenceof fluid in the abdomen significantly increased the sensitivity, specificity and positive predictivity forsuccessfully treated with methotrexate (sensitivity 70.3%, specificity 86.3%, positive predictive value80%).Conclusions: We can choose patients that will be good responder to methotrexate treatment of ectopicpregnancy without hospitalization by initial serum ?-hCG values, size of ectopic focus and the presence of fluidin the abdomen.Amaç: Rüptüre olmamış ektopik gebeliğin ayaktan tedavisi için seçim kriterlerini değerlendirmek.Yöntemler: Düzce Üniversitesi Tıp Fakültesi, Eğitim ve Araştırma Hastanesi'nde 2012-2017 yılları arasında tekdoz intramusküler metotreksat enjeksiyonları ile tedavi edilen toplam 124 rüptüre olmamış ektopik gebelikretrospektif olarak değerlendirildi.Bulgular: Tek doz metotreksat ile medikal tedavi 124 hastanın % 76,61'inde (n 95) başarılı bulundu. Başarılıolarak tedavi edilen grupta ortalama hastanede kalış süreleri daha kısa idi (p0,030). Metotreksatenjeksiyonunun 1.günü ?-hCG düzeyinin ektopik odak büyüklüğü ve / veya batın içinde sıvı varlığı ilebirleşmesi metotreksat ile başarılı bir şekilde tedavi edilmek üzere duyarlılık, özgüllük ve pozitif öngörüyüanlamlı olarak arttırmıştır (duyarlılık %70,3, özgüllük %86,3, pozitif kestirim değeri %80).Sonuç: Başlangıç serum ?-hCG seviyeleri, ektopik odak büyüklüğü ve batında sıvı varlığı ile metotreksattedavisine iyi yanıt verecek hastaları, hastane yatışı gerektirmeden seçebiliriz

Systemic Methotrexate and Vaginal Misoprostol Treatment In Cesarean Scar Pregnancy: A Case Report

Sezaryen skar gebeliği (SSG) gestasyonel kesenin geçirilmiş sezaryen skarına implante olmasıyla ortaya çıkan nadir bir ektopik gebelik çeşididir. SSG masif hemoraji ve uterinrüptüre neden olabilir. SSG'nin ile ilgili çok sayıda prospektifr andomize kontrollü çalışmanın bulunmaması nedeniyle tanı ve tedavisi ile net bir konsensüs yoktur. Bu raporda tek doz sistemik metotreksat (MTX) ve vajinal misoprostol ile tedavi edilen SSG olgusu sunulmuştur. Tek doz MTX ve vajinal misoprostol kombinasyon tedavisi olgumuzda başarıyla sonuçlanmış olsa da sessiz rüptür veya masif hemoraji riskine karşı hastalar dikkatli şekilde takip edilmelidir. Tek doz MTX ve misoprostol kombinasyon tedavisinin güvenilirliğinin tam olarak ortaya konabilmesi için kapsamlı randomize çalışmalara gereksinim vardırCesarean scar pregnancy (CSP) is a rare kind of ectopic pregnancy caused by the implantation of the gestational sac on cesarean section scar. CSP can cause massive bleeding and uterine rupture. Due to the lack of prospectiver and omized controlled studies on CSP; there is no clear consensus about diagnosis and treatment. In this report, a CSP case reported, treated with single dose methotrexate (MTX) and vaginal misoprostol combination. Although; single- dose MTX and vaginal misoprostol combination was successful in our patient, the patients should be monitored carefully during this treatment against silent rupture and massive hemorrhage. The reandomized comprehensive studies are needed to reveal the reliability of a single dose of MTX and misoprostol combination therap