Abdominal pregnancy. Based upon six personal cases [LA GROSSESSE ABDOMINALE. A PROPOS DE SIX CAS PERSONNELS]

PubMedID: 1570458This study consists of six accurately diagnosed and treated cases of abdominal pregnancy over a 16-year period (1974-1989) in the Obstetrics and Gynecology Department of Cukurova University Medical Faculty in Adana. In this study the incidence of abdominal pregnancy we found was 1 per 4017 births. In two cases whose pregnancies continued until term, living babies were delivered. The separation of placenta was easy in four cases. However in the other two cases, the management of placenta detachment was difficult because of the stick adhesions with visseria; so in these cases the placenta tissues were left in the abdomen. The methotrexate was administered to erode to the placenta in these cases. One of them who received methotrexate died of infection

Lumbar plexus blockade with ropivacaine for postoperative pain management in elderly patients undergoing urologic surgeries

PubMedID: 16327304Background/Aims: We evaluated the effectiveness and safety of lumbar plexus blockade with ropivacaine for postoperative pain relief in elderly patients undergoing flank incision for urological surgery. Methods: 60 urological patients (>65 years old) were chosen randomly for paravertebral lumbar blockade. Postoperatively ropivacaine was used in group I (n = 30) and bupivacaine was administered in group II (n = 30) for lumbar plexus blockade. Heart rates, systolic and diastolic blood pressures, peripheral oxygen saturations, analgesia levels with visual analogue scales (VAS) were measured post-operatively at 5 and 30 min and 1, 3, 6, 8, and 12 h. Patient satisfaction scores and complications were recorded. Results: The hemodynamic parameters of the groups were in the normal ranges (p > 0.05). VAS were significantly decreased at 60 min in both groups (p 0.05). After the 8-hour measurement, analgesic was given to 7 patients in group I and 6 patients in group II (p 0.05). Patient satisfaction scores were found to be higher for all patients (p > 0.05). Conclusion: In elderly patients, lumbar plexus blockade with ropivacaine can be a simple, safe and effective analgesic technique especially in the early postoperative period after urologic surgeries with flank incision. Copyright © 2005 S. Karger AG

Uterus Didelphys with Unilateral Imperforate Vagina and Ipsilateral Renal Agenesis

PubMedID: 1804098EDITORIAL COMMENT: We accepted this case for publication to remind readers that genital tract abnormalities are common; just about any combination of uterovaginal malformations, with or without retained menses, that can be imagined, has been reported, and many presentations are bizarre in both obstetric and gynaecological practice. We consider the authors are excessively self critical in condemning the laparotomy performed on this patient, although it is always wise to have the results of intravenous pyelography before laparotomy. The Editor also wishes to report a similar case he encountered with Dr. Peter Dobson at the Austin Hospital in 1979. The patient was a 14-year-old menstruating girl, who also presented with abdominal pain. At examination under anaesthesia a large mass was noted bulging into the vagina through the upper two-thirds of the posterior wall; after discussion we aspirated the mass and when chocolate-brown fluid blood was obtained the mass was incised and drained. There was no evidence of a second cervix or vaginal septum. Intravenous pyelography revealed a normal right-sided and absent left kidney. At subsequent laparotomy a rudimentary left-sided uterine horn was found and excised with more difficulty than anticipated. The patient had no further menstrual problems but had 2 subsequent episodes of urinary tract infection. She was next seen at the Mercy Maternity Hospital antenatal clinic in 1984; after a pregnancy complicated by hyperemesis, she had an outlet forceps delivery at 38 weeks' gestation, of a healthy but growth retarded male infant, birth-weight 2,440 g, on September 18, 1984. Copyright © 1991, Wiley Blackwell. All rights reserve

Malassezia and Candida colonisation on glans penis of circumcised men

PubMedID: 16115108The Malassezia yeast are members of the normal human cutaneous flora in adults. They also are reported as part of the microflora of the male genital region in mostly uncircumcised males. It has been reported that Malassezia sympodialis and Malassezia globosa are the most frequent yeast belonging to the resident microflora of the penis as in other human skin areas. The aim was to evaluate the prevalence of Malassezia and Candida yeast colonisation on the glans penis of circumcised males. Impression preparations were made on modified Dixon agar. The isolates were identified by morphological and physiological characteristics. A total of 245 circumcised males were included in the study. Of the 245 patients examined, 55 (22.4%) were found to have a mycologically proven yeast fungi on their glans penis. In 17 (30.9%) Malassezia, in 36 (65.5%) Candida, in one (1.8%) Malassezia and Candida, and in one (1.8%) Saccharomyces strains were detected. Malassezia furfur (66.7%) was the most common species among the lipophilic yeast, followed by Malassezia globosa (11.1%), Malassezia obtusa (11.1%) and Malassezia slooffiae (11.1%). Candida albicans was the most common non-lipophilic yeast (46.0%), that was isolated among the other yeast, followed by unidentified Candida strains (18.9%), Candida tropicalis (8.1%), Candida glabrata (8.1%), Candida parapsilosis (8.1%), Candida zeylanoides (5.4%), Candida guilliermondii (2.7%) and Saccharomyces cerevisiae (2.7%). The results of this study showed that Malassezia species were also colonised like Candida on the glans penis of circumcised males. © 2005 Blackwell Publishing Ltd

Is it essential to perform complete paraaortic lymph node dissection if no metastases have been shown in the lower part of the aorta?

PubMedID: 7641738One hundred and twenty eight patients with cervical carcinoma underwent pretherapy staging laparotomy between the years 1991 and 1994. Adopting a transperitoneal approach nodal dissection was performed from the aortic bifurcation to the level of the renal artery. Specimens were segregated into those inferior to and superior to the origin of the inferior mesenteric artery (IMA) then sent for pathologic examination. Of the 15 histologically malign node samples inferior to the IMA, none were associated with neoplasia in the groups of node samples taken from above the IMA. Of the 5 malignant nodal samples taken from above the IMA, all had concurrent neoplastic changes in the specimens taken from below the IMA. An intraoperative complication rate of 8.7% was encountered in the lower nodal dissections. This was compounded by a resultant 7.7% complication rate with nodal dissection above the IMA. As a result of our findings we feel confident in omitting upper paraaortic lymph node (PALN) dissection in the absence of malignant findings in the inferior para-aortic lymph node at frozen section

Patient-controlled epidural analgesia after major urologic surgeries

WOS: 000184773700008PubMed ID: 12890955The efficiency and safety of patient-controlled epidural analgesia by using tramadol alone and combined with bupivacaine were investigated for postoperative pain treatment after major urological surgeries. For PCEA: in group I (n = 17) a loading dose of 20 mg tramadol with a continuous infusion of 1 mg/ml tramadol at a rate of 8 ml/h was given. In group II (n = 17), patients received an initial loading dose of 20 ml bupivacaine 0.125% and a supplemental continuous infusion of 8 ml/h. In group III (n = 17), a loading dose of 20 mg tramadol with 20 ml bupivacaine 0.125% were given and a supplemental infusion of 1 mg/ml tramadol in 20 ml bupivacaine 0.125% combination was begun with a rate of 8 ml/h. A demand epidural bolus dose of 5 ml with a lockout time of 30 min was also used in all patients. VAS for pain intensity, vital signs, sedation scale and side effects was monitored at 0, 15, 30 min and 1, 2, 3, 4, 8, 12, and 24 h of the postoperative period. Statistical significance was determined using Kruskal-Wallis, Fisher's exact, analysis of variance for repeated measurements and Tukey tests. The hemodynamic values and sedation scales were insignificantly different (p > 0.05). The adequate analgesia was provided in all patients. However VAS values were significantly lower in group III than in groups I and II at every measurement (p 0.05). In conclusion, we suggested that a combination of tramadol with bupivacaine can provide the most effective and safe postoperative analgesia with minimal risk for side effects. Copyright (C) 2003 S. Karger AG, Basel

Tinea cruris in routine urology practice

PubMedID: 15897702Introduction: Tinea cruris is almost exclusively a male dermatophytosis. This infection is also sexually transmitted, and may cause epidemics in public areas such as common bathing facilities, dormitories and among military recruits. It has been aimed to investigate the prevalence and the causative agents of tinea cruris and tinea pedis in patients who were admitted to the Department of Urology with various pathologies. Materials and Methods: Direct microscopy and cultures of the epithelial scrapings were performed to identify the causative agent in patients who were admitted to the Department of Urology. Results: Out of a total of 155 cases examined, 39 (25.1%) were mycologically proven cases of dermatomycosis. In 11 (28.2%) of the patients tinea pedis, in 3 (7.7%) tinea cruris and in 10 (25.6%) Candida intertrigo were detected. In the remaining 15 (38.5%) cases, only direct microscopic examinations were found positive. The most common causative agent was Candida albicans (33.4%) followed by Trichophyton rubrum (29.1%), Trichophyton mentagrophytes var. interdigitale (29.1%), Candida glabrata (4.2%) and Candida tropicalis (4.2%). Conclusion: The investigation of genital dermatomycosis should be a part of routine urological examination and the clinical diagnosis should be confirmed by mycological methods. Copyright © 2005 S. Karger AG