Adneksiyal Torsiyonlu Hastaların Tanısında Mean Platelet Volümün Rolü Var mıdır?

Amaç: Bu çalışmada amacımız adneksiyal torsiyonlu hastalara tanı koymada mean platelet volümün (MPV) diagnostik değerini araştırmaktır. Yöntemler: Çalışmamıza adneksiyal torsiyonlu toplam 21 hasta dahil edildi. Kontrol grubu olarak; rutin jinekolojik kontrol amacıyla polikliniğimize başvuran, kronik bir hastalığı olmayan ve ilaç kullanma hikâyesi bulunmayan 25 kadın dâhil edildi. Çalışmamızda trombosit fonksiyonunu etkileyebileceğinden dolayı anti-koagülan, non-steroid anti inflamatuar, oral kontraseptif kullanan ve kronik hastalığı olan kadınlar dâhil edilmedi. Tüm hastalarımızın ve kontrol grubu kadınların hemogramında lökosit, trombosit sayısı, nötrofil oranı ve MPV değerleri incelendi. Bulgular: MPV değeri adneksiyal torsiyonlu hastalarda kontrol grubuna oranla daha düşük olarak bulundu (6.23±1.14 fL, 7.11±1.21 fL, sırasıyla). Adneksiyal torsiyon grubunda MPV değeri 18 hastada normalden düşük iken, kontrol grubunda ise 4 kişide normalden düşük bulundu. MPV oranında saptanan bu azalma adneksiyal torsiyonlu hasta grubu ile kontrol grubu kıyaslandığında istatiksel olarak anlamlı olarak saptandı (p<0.011). Trombosit sayısı ile MPV değeri arasında negatif bir korelasyon saptandı. Yani trombosit sayısı arttıkça MPV değerinin azaldığı görüldü (p=0.022, r=-0.397). Sonuç: Adneksiyal torsiyonlu hastaların tanı-tedavide olabilecek gecikme hastalığın morbiditesini artırır. Adneksiyal torsiyonlu hastalarda MPV değeri önemli ölçüde azaldığından dolayı, bu hastaların tanısında MPV değerinin bakılması tanı koyamaya yardımcı yararlı bir belirteç olabilir

Protective Effect of N-Acetylcystein and Resveratrol on Ischemia-Reperfusion Injury in Rat Ovary

Objective: The aim of this study is evaluating the protective activity of N-acetyl cysteine and resveratrol treatment against ischemia - reperfusion damage created experimentally in rat ovaries. Methods: 42 female Wistar rats were used in our study. Rats were separated randomly into six groups consisting of seven rats as sham, torsion, torsion- detorsion, torsion-detorsion+saline, torsion-detorsion+resveretrol (20 mg/kg) and torsion- detorsion+N-acetyl cysteine (150 mg/kg). Except Sham, ovarian torsion procedure was implemented to all other groups for 2 hours. Detorsion procedure was implemented to other groups for 2 hours, except the torsion group. Medications were given through intraperitoneal way half an hour before the detorsion procedure in saline (two milliliter), resveratrol (20 mg/kg) and N-acetyl cysteine (150 mg/kg) groups. Then, 2 ml of blood samples were drawn for markers of oxidative stress and tumour necrosis factor-alpha (TNF-α) work and the ovaries, which were torsioned for the histologic examination, were ex­tracted from all rats. Edema, congestion, hemorrhage, leuko­cyte infiltration and degeneration of follicles were evaluated by histopathological examination. Results: According to histopathologic damage scores, the least damage was seen in sham group and the most damage was seen T-DT group (1.00±0.81 vs. 11.00±1.15, respectively; p<0.001). It was seen that resveratrol and N-acetyl cysteine treatments were effective in decreasing tissue damage (total damage score average 83.85±0.89 vs. 3.85±0.89, respec­tively; p<0.001), and on the other hand there was not any dif­ference between resveratrol and N-acetyl cysteine treatments (p=0.966). Besides, it was determined that oxidative stress levels were higher in torsion - detorsion group and the resve­ratrol and N-acetyl cysteine treatment caused a significant de­crease in oxidative stress levels. In additionally, the reductions of TNF-α levels were found to be equally effective in both drugs (8.68±1.88 vs. 7.85±2.08, P=0.968). Conclusion: Presented study showed that resveratrol and N-acetyl cysteine treatment can be effective in preventing tissue damage and oxidative stress, which is induced by ischemia-reperfusion that is created in rat ovaries. On the other hand, no difference was found between the resveratrol and N-acetyl cysteine with regards to protective activity

Serum Angiogenic and Anti-angiogenic Markers in Pregnant Women with Placenta Percreta

Background: Placenta percreta is the morbidly adherent form of all the placental invasion abnormalities. The pathology that underlies placenta percreta is poorly understood. Aims: To compare the levels of circulating vascular endothelial growth factor, placental growth factor and soluble fms-like tyrosine kinase 1 in pregnant women with placenta percreta to a control group. Study Design: Case-control study. Methods: Twenty-two women who underwent caesarean section due to placenta percreta and 22 women who underwent caesarean section for other obstetric reasons were included in this study. The diagnosis of placenta percreta was defined as extreme trophoblastic invasion involving serosa of the uterus. Venous blood samples were collected for biochemical comparison of circulating vascular endothelial growth factor, placental growth factor and soluble fms-like tyrosine kinase 1 from all pregnant women. Results: Women with placenta percreta were significantly older, had higher gravidity, received more frequent antenatal steroids and blood transfusions and delivered at an earlier gestational age when compared to the control group. In women with placenta percreta, preoperative circulating levels of vascular endothelial growth factor, placental growth factor and soluble fms-like tyrosine kinase 1 were lower than the controls (p<0.001, p<0.001 and p<0.05, respectively). While the postoperative levels of vascular endothelial growth factorand soluble fms-like tyrosine kinase 1 levels were higher in placenta percreta (p=0.001 and p<0.001, respectively), placental growth factor levels were similar in both groups. Conclusion: The findings of this study suggest that a decrease in vascular endothelial growth factor, placental growth factor and soluble fms-like tyrosine kinase 1 levels may be related to placenta percreta etiopathogenesi

A successful method for severe gestational thrombocytopenia: A rare case study

In a normally progressing pregnancy, especially in thethird trimester thrombocyte numbers reduce by about10%. The reason for this reduction is thought to be thehemodilution and increased consumption in pregnancy.Generally, it is recognized by chance during routine bloodcount and it is the second most common hematologicanomaly during pregnancy. Once thrombocytopenia isdiagnosed in pregnancy, research must be done to determinewhether it is a life-threatening risk factor in terms ofthe mother-fetus-infant. The majority of thrombocytopeniaseen in pregnancy is gestational thrombocytopenia. Thispaper examines an active labor, normal birthing case witha thrombocyte count of 7916/mm3.Key words: Gestational thrombocytopenia, idiopathicthrombocytopenic purpura, normal birt

Retrospective analysis of 14 patients who managed for adnexal torsion during pregnancy

Objective: To assess some clinical characteristics of patients who were treated for adnexal torsion during pregnancy. Methods: Medical records of 14 pregnant women with adnexal torsion who were surgically treated at our hospital between 1st January 2011 to 30th October 2015 were screened. In addition to the demographic features obtained from medical records, presenting complaints, physical examination and ultrasonographic findings, type of surgery, histopathologic findings, route of deliveries and complications were all recorded. Results: Mean age of patients included in the study was 27.8 ± 3.9 years, mean gravidity was 2.8 ± 1.8 and mean gestational age was 14.4 weeks. Most commonly seen complaint was pelvic pain followed by emesis and vomiting. All participants underwent abdominal surgery showing an adnexal mass with a mean volume of 48.4 ± 12.1 cm2. Also all participants underwent Doppler ultrasound assessment showing decreased ovarian blood flow. Among 14 patients, 3 of them were managed by laparoscopy while remaining was treated by laparotomy. Detorsion and cystectomy were performed in 10 patients while detorsion was performed in 3 patients, in 1 patient after detorsion no blood flow was observed therefore salpingo-oophorectomy was performed due to overt necrotic appearance. Most commonly seen histopathologic type was mature cystic teratoma. No operative complication was observed. Conclusion: Adnexal torsion should be kept in mind in pregnant presenting with acute abdominal pain. Early diagnosis and treatment are important for organ preserving surgery

Acute cholecystitis in pregnancy: Retrospective evaluation of 21 patients

Objective: We aimed to evaluate our diagnosis and treatment approach to pregnant patients with acute cholecystitis in our high birth rate region. Methods: Twenty-one patients who suffering from acute cholecystitis during their pregnancy were analyzed retrospectively between January 2010 August 2014 at Harran University Medical School, Department of General Surgery. Treatment methods, complications, demographic and laboratory data were recorded for each patient. Results: Twenty one patients with abdominal pain and diagnosed as acute cholecystitis were included in this study. The mean age and gestational weeks of patients were 28 ± 7.4 years, 23.4 ± 8.5 respectively. Upper abdominal pain and nausea-vomiting were the most frequent complaints of the patients to hospital admissions. For the surgical treatment one patient underwent open cholecystectomy due to bladder perforation during the second trimester of her pregnancy, laparoscopic cholecystectomy was performed in one patient due to recurrent cholecystitis and in two patients due to decline cholecystitis findings. All other patients were treated medically. Maternal or fetal complication after treatment was not observed. Conclusion: Although, during pregnancy acute cholecystitis episodes are seen rare successful results can be obtained with medical therapy. When medical therapy has failed, especially in the second trimester, laparoscopic surgery can be considered as reliable surgical intervention for mother and fetus

Retrospective Analysis of 114 Cases Treated for Dermoid Cyst

Objective: The purpose of this study is to evaluate the clinical findings, tumor markers, surgical treatment ap­proaches and final pathological results of the dermoid cyst subjects treated at our hospital. Methods: The study was planned retrospectively. 114 subjects with dermoid cyst were included from our hos­pitals electronic log system. Along with the demographic data’s, pre-operative clinical findings, tumor sizes, ul­trasonographic characteristics, tumor marker results, surgical treatment method (laparotomy-laparoscopy), administered surgical treatment procedure (cystectomy, oopherectomy, salpingo-oopherectomy, total abdominal hysterectomy-salpingo-oopherectomy) and pathology re­sults were recorded from the patient files. Results: Mean age of the patients was 33.59±12.79 years (11-70). Abdominal pain was observed in 32 patients (%28.07) as the most common complaint during hospi­tal admission. 70 patients (%38.59) were determined in­cidentally. Average cyst size was 47.70±48.49 cm2 dur­ing the ultrasonographic examination. Ca 125 level was higher than normal limits in only 12 (%10.52) patients and Ca 19-9 level was higher in only 29 (%25.43) of patients. The most common final histopathological diagnosis was dermoid cyst in 103 (%90.40) patients. Other histopatho­logical diagnoses were immature teratoma, squamous cell carcinoma and serous carcinoma. Conclusion: Ovarian dermoid cysts are usually benign neoplasms and rarely show malign transformations. Tu­mor markers are not fairly enough to make discrimina­tions. However especially in older patients treatment should be done cautiously due to the raised risk of ma­lignity

Supplemental Oxygen in Elective Cesarean Section under Spinal Anesthesia: Handle the Sword with Care

Background and objectives: : We aimed to investigate the effect of 21% and 40% oxygen supplementation on maternal and neonatal oxidative stress in elective cesarean section (CS) under spinal anesthesia. Methods: Eighty term parturients undergoing elective CS under spinal anesthesia were enrolled in the study. We allocated patients randomly to breathe 21% (air group) or 40% (oxygen group) oxygen from the time of skin incision until the end of the operation. We collected maternal pre- and post-operative and umbilical artery (UA) blood samples. Total antioxidant capacity (TAC), total oxidant status (TOS) and the oxidative stress index (OSI) were measured. Results: Age, weight, height, parity, gestation week, spinal-skin incision time, skin incision-delivery time, delivery time, operation time, 1st and 5th minutes Apgar scores, and birth weight were similar between the groups (p > 0.05 for all comparisons). There were no differences in preoperative TAC, TOS, or OSI levels between the groups (p > 0.05 for all comparisons). Postoperative maternal TAC, TOS and OSI levels significantly increased in the oxygen group (p = 0.047, < 0.001 and 0.038, respectively); umbilical artery TAC levels significantly increased in the oxygen group (p = 0.003); and umbilical artery TOS and OSI levels significantly increased in the air group (p = 0.02 and < 0.001, respectively). Conclusions: The difference in impact on maternal and fetal oxidative stress of supplemental 40% compared to 21% oxygen mandates further large-scale studies that investigate the role of oxygen supplementation during elective CS under spinal anesthesia. Keywords: Anesthesia, Spinal, Cesarean Section, Oxidative Stress, Oxygen, Oxygen Inhalation Therap