Adnexal torsion in the first trimester of a spontaneous pregnancy: detorsion and oophoropexy

Introduction: Adnexal torsion is a rare cause of acute abdominal pain during pregnancy. In this case report, we present a case of adnexal torsion during the first trimester of pregnancy and its treatment. Case Presentation: A 28-year old, gravida 1, para 0 patient at 9 weeks gestational age presented to the antenatal clinic with acute abdominal pain in the right lower-abdominal quadrant. The patient was diagnosed with torsion of the right adnexa during pregnancy, and detorsion was performed. The patient was followed throughout the course of pregnancy. She delivered a healthy baby at term by caesarian section. During the caesarian section, both of the adnexa were observed to be normal. Conclusions: With acute abdominal pain, especially in the lower-abdominal quadrant during pregnancy, adnexal pathologies should be considered. Diagnosis of adnexal torsion during the first trimester of pregnancy is often missed due to the nonspecific clinical features and uncommon objective findings. Although surgical intervention should be considered to treat pregnant women suffering from adnexal torsion regardless of the gestational week, abdominal surgery carries some risks to the pregnant woman and unborn fetus

Spontaneous Lens Absorption Initially Misdiagnosed as Crystalline Lens Luxation

Spontaneous lens absorption (SLA) is a rare complication of hypermature cataract. However, this condition has been reported in several cases of hypermature cataracts that were caused by trauma, senility, uveitic disorders such as Fuchs’ uveitis syndrome (FUS), and infectious disorders including leptospirosis and rubella. We report a case of spontaneous absorption of a hypermature cataract secondary to FUS. To our knowledge, this is the first report of SLA that was followed by dislocation of the capsular remnants into the vitreous and resulted in a misdiagnosis as crystalline lens luxation

Application of Bakri balloon in a patient who developed massive postpartum hemorrhage after caesarean section

Postpartum hemorrhage is an important emergency in obstetrics. In this study, we present the application of intrauterine balloon tamponade and its outcomes in a patient who developed massive postpartum hemorrhage after caesarean section. A 39- year-old, G5 P3 and 38 weeks pregnant (based on last menstrual period) patient was subjected to emergency caesarean section due to diagnosis of uteroplacental insufficiency and recurrent caesarean section. Four hours after the operation, atony occurred and despite medical treatment the hemorrhage persisted. We inserted a SOS Bakri balloon through the vaginal route and inflated it with 500cc intracavitary saline for achievement of intrauterine tamponade. Vaginal bleeding ended immediately after the procedure. Use of an intrauterine balloon is an easy-to-apply alternative to surgery that provides rapid hemostasis in serious postpartum hemorrhage

Is it essential to perform preoperative diagnostic curettage in patients scheduled for uterine myoma surgery?

Objective: Uterine myoma, which arises from the myometrium of uterus, is among the most common benign tumors of women. Generally, it has an asymptomatic character, however, in symptomatic cases, it presents with abnormal uterine bleeding. The objective of this study is to determine whether preoperative diagnostic curettage is essential or not by comparing the preoperative and postoperative endometriums of patients that underwent surgery with uterine myoma diagnosis. Material and Method: In this study,260 patients that received surgery with uterine myoma diagnosis in the Gynecology and Obstetrics Department of Taksim Education and Research Hospital in Istanbul between January 2007 and January 2010, were included. The histopathologic analysis of specimens obtained by preoperative curettage and hysterectomy, was carried out in a retrospective fashion. Results: The mean age of patients was 48.3 ± 7.5 years. The distribution of preoperative curettage specimens with regard to endometrial status was as follows: phase compatible endometrium in 156 (60%), endometrial polyp in 74 (28.5%), atrophic endometrium in 20 (7.7%), and endometrial hyperplasia in 10 patients (3.8%). Among the phase compatible endometriums, 85 patients (54.5%) had proliferative endometrium, 39 patients (25%) had late secretory phase endometrium, and 32 patients (20.5%) had early secretory phase endometrium. The distribution of postoperative hysterectomy specimens with regard to endometrial status was as follows: Phase compatible endometrium in 160 patients (61.5%), endometrial polyp in 61 patients (22.5%), endometrial hyperplasia in 14 patients (5.4%), and atrophic endometrium in 25 patients (9.6%). Among the phase compatible endometriums; 96 patients (60%) had proliferative endometrium, 44 patients (27.5%) had late secretory endometrium, and 20 patients (12.5%) had early secretory endometrium. Conclusion: No difference was observed between the histopathologic results of diagnostic curettage and hysterectomy relative to malignancy or a pathology that would change the surgery plan. The result is very important because it shows that performing curettage before myoma surgery is not an essential procedure. In this study, since endometrial cancer may not have been detected due to limited number of patients, further studies including higher number of patients are required to confirm our results

Evaluation of total oxidant status, total antioxidant capacity and oxidative stress levels in humor aqueous of diabetic cataract patients

Purpose: Diabetic retinopathy (DRP) is one of the most common complications of diabetes mellitus and various studies have demonstrated the role of increased oxidative stress due to hyperglycemia in its pathophysiology. There are few studies in the literature examining total antioxidant capacity (TAC) and total oxidant status (TOS) in humor aqueous, and we were unable to find any, which measured oxidative stress index (OSI). The aim of this study was to investigate whether TAC, TOS, and OSI in the aqueous humor changed according to DRP stage. Materials and Methods: This prospective study included a total of 86 cataract patients: 31 healthy patients with senile cataract (Group 1), 19 diabetic patients without DRP (Group 2), 17 patients with nonproliferative DRP (Group 3), and 19 patients with proliferative DRP (Group 4). Aqueous humor samples were obtained prior to cataract surgery. TAC, TOS, and OSI levels were measured spectrophotometrically and compared between the groups. Results: The analysis of TAC levels revealed that TAC levels were significantly higher in the control group (Group 1) compared to DRP patients (Group 3 and 4, p=0.042 and p=0.02, respectively), while TOS and OSI levels were lower in Group 1 compared to all diabetic groups (Group 2, 3, and 4) (p<0.05). Conclusion: The findings of increased TOS and OSI and decreased TAC levels in diabetic patients support the belief that oxidative stress might be an important etiologic factor in DRP. Increased oxidative stress may be a potential therapeutic target in the prevention and management of DRP. © 2020 Gazi Eye Foundation. All rights reserved

Clinical Performance and Patient Satisfaction of Hybrid Contact Lenses in Patients with Keratoconus

Objectives:The aim of the study was to evaluate the fitting process, clinical performance, and patient satisfaction of hybrid contact lenses (HCL) in patients with keratoconus (KC).Materials and Methods:Sixty-eight KC patients (35 female, 33 male) who were prescribed HCL were included in the study. Corneal topographic parameters, best corrected visual acuity (BCVA) with eyeglasses, the number of HCL trials, prescribed HCL base curve (BC), and visual acuity with HCL were recorded from hospital records. A contact lens satisfaction survey was sent to the patients via email or WhatsApp and the data was statistically analyzed using IBM SPSS Statistics version 22.0.Results:The study included 110 eyes of 68 patients with a mean age of 27.34±8 years (range: 12-48 years). According to the Amsler-Krumeich classification, 35.5% of the eyes were stage 1, 50.9% were stage 2, and 13.5% were stage 3 or 4. Mean K1, K2, and Kmean values were 7.14±0.50 mm (range 5.72-8.30 mm), 6.63±0.49 mm (range 5.07-7.84 mm), and 6.89±0.48 mm (range 5.39-8.06 mm), respectively. The average number of lens trials was 1.59±0.82 (range 1-4). The mean BC of the prescribed HCL was 6.84±0.50 mm (range 5.60-8.00 mm). BCVA with glasses was 0.36±0.2 (range 0.05-0.8), and 0.80±0.14 (range 0.3-1.0) with HCL (pmean value and in most of the patients, fitting was successful with the first or second CL trial. The overall satisfaction score was moderate to good and the disadvantages were low comfort compared to soft CL, difficulty with insertion and removal, short lens life, and high cost

24-h Efficacy of Glaucoma Treatment Options

Current management of glaucoma entails the medical, laser, or surgical reduction of intraocular pressure (IOP) to a predetermined level of target IOP, which is commensurate with either stability or delayed progression of visual loss. In the published literature, the hypothesis is often made that IOP control implies a single IOP measurement over time. Although the follow-up of glaucoma patients with single IOP measurements is quick and convenient, such measurements often do not adequately reflect the untreated IOP characteristics, or indeed the quality of treated IOP control during the 24-h cycle. Since glaucoma is a 24-h disease and the damaging effect of elevated IOP is continuous, it is logical that we should aim to understand the efficacy of all treatment options throughout the 24-h period. This article first reviews the concept and value of diurnal and 24-h IOP monitoring. It then critically evaluates selected available evidence on the 24-h efficacy of medical, laser and surgical therapy options. During the past decade several controlled trials have significantly enhanced our understanding on the 24-h efficacy of all glaucoma therapy options. Nevertheless, more long-term evidence is needed to better evaluate the 24-h efficacy of glaucoma therapy and the precise impact of IOP characteristics on glaucomatous progression and visual prognosis