Treatment of Ileus after hysterectomy with Drain and medical applications; a case repor

Postoperatif ileus (POI), önemli morbidite ve mortalitesi olan karmaşık bir olgu olup, birçok cerrahi alanda görülebilmektedir. Bilinen riski olmayan 50 yaşında bir kadın hastaya tedaviye dirençli menometroraji tanısı ile total abdominal histerektomi ve bilateral salpenjeooferektomi (TAH+BSO) uygulandı. Peroperatif ve postoperatif dönemde herhangi bir problemi olmayan, gaz gaita çıkışı gözlemlenen hasta postoperatif 4. günde taburcu edildi. Ancak postoperatif 6. günde kusma karın ağrısı (akut batın tablosu) ile acil servise başvurduğunda kliniği, tahlilleri ve görüntüleme yöntemleriyle ileus gelişmiş olduğu saptandı. Bunun üzerine, hastada oral alım kapatıldı, medikal tedavi olarak metoklopramid ve laktasif lavman başlandı. Yapılan görüntülenme yöntemlerinde batın içi ve cilt altı ileusa bağlı seröz sıvı izlendi ve hastaya cilt altı hemovac dren konularak batın rahatlatıldı. Yaklaşık 5 gün içinde re-operasyona gerek duyulmadan hastanın ileusu sonlandı ve hasta şifa ile taburcu edildi. Biz bu olgu sunumumuzda basit ama etkili yöntemlerle POI’nin önlenip, erken dönemde operasyona gerek kalmadan, tedavi edilebileceğini göstermiş olduk.Postoperative ileus (POI) is a complex phenomenon with significant morbidity and mortality and can be seen in many surgical fields. A 50-year-old woman with no known risk was diagnosed with treatment-resistant menometrorrhagia and underwent total abdominal hysterectomy and bilateral salpingeooophorectomy (TAH+BSO). The patient, who did not have any problems in the perioperative and postoperative periods, and gas-fecal output was observed, was discharged on the 4th postoperative day. However, on the 6th postoperative day, when he applied to the emergency service with vomiting and abdominal pain (acute abdomen), ileus was found to have developed by his clinic, analyzes and imaging methods. Thereupon, oral intake was stopped in the patient, and metoclopramide and lactase enema were started as medical treatment. In the imaging methods performed, serous fluid related to the intra-abdominal and subcutaneous ileus was observed and the patient was relieved by placing a subcutaneous hemovac drain. In about 5 days, the patient's ileus ended without the need for re-operation and the patient was discharged with full recovery. In this case report, we have shown that POI can be prevented and treated without the need for an operation in the early period with simple but effective methods

Anti-Mullerian hormone levels in spontaneous pregnancies with hyperemesis gravidarum

We investigated the serum anti-Mullerian hormone (AMH), oestrogen and progesterone levels in spontaneously conceiving pregnant women, diagnosed for hyperemesis gravidarum (HG), in the first trimester. Pregnant women admitted at Hospital between 5 and 12 gestational weeks and treated for HG were compared, in this prospective case–control study, to a control group. The serum AMH, oestradiol, and progesterone values of both groups were evaluated and compared, and potential correlations were calculated. The serum AMH values were significantly higher in the HG group than the control group (3.15 ± 1.51 ng/mL vs. 2.27 ± 1.20 ng/mL; p = 0.012). No significant difference in the two groups was about serum oestradiol and progesterone values (p = 0.264, p = 0.235). In the HG group, there was no significant correlation between AMH and oestradiol (p = 0.570). However, a significant positive correlation was determined between AMH and progesterone (p = 0.050). The area under the ROC curve (AUC) was 0.669 and the cut-off value was 2.65 ng/ml with sensitivity of 58.3% and specificity of 66.7% for AMH in pregnant women with HG. A correlation between AMH high values and unexplained HG was detected in spontaneous pregnancies in the first trimester. High AMH levels may play a role in HG etiopathogenesis, especially in pregnant women with low progesterone levels.Impact statement What is already known on this subject? Aetiological causes of Hyperemesis gravidarum (HG) include hormonal, immunological, genetic, and psychological issues. However, no conclusive etiopathogenesis to explain the pathophysiological mechanism of HG has been stated. What do the results of this study add? Authors focussed on investigation a possible correlation between pregnant hormones and the HG pathogenesis, prevalent in the first trimester, when hormones are produced by either the placenta or corpus luteum. High anti-Mullerian hormone (AMH) levels may play a role in HG etiopathogenesis, especially in pregnant women with low progesterone levels. What are the implications of these findings for clinical practice and/or further research? A serum AMH level of ≥2.65 mg/mL could be predictive for the development of HG in the first trimester of a spontaneous pregnancy. Basing on these findings, more selective pharmacological treatments could be administrated to these patients

Sezaryen Skar Gebeliğinde İntraamniyotik Metotreksat Tedavisi Olgu Sunumu

Sezaryen skar gebelik insidansı, sezaryen artışına bağlı yükselmekte, konu ile ilgili dünya ve ülkemizdeartan bilgi birikimi, skar gebeliklerde tanı, yönetim ve sonuçlar ile ilgili yayınlarla ortaya konulmaktadır.Sezaryen sonrası gebelikler, gebelik kesesinin skara yakınlığına göre: düşükler, morbidite yaratanplasenta adezyon anomalileri (plasenta akreta-inkreta, perkreta) uterus rüptürü, dissemine intravaskularkoagulasyon ve anne ölümleri gibi komplikasyonlarla karşımıza çıkabilmektedir. Nadir görülmesinedeniyle sezaryen skar gebeliğine dair veriler çoğunlukla olgu sunumlarına dayanır. Bu nedenle tanıve tedavisi üzerinde fikir birliğine varılmış bir klinik yönetimi bulunmamaktadır. Biz bu çalışmamızdaönce gerekli kürü sağlayamayan lokal olarak metotreksat enjeksiyonu tedavisi sonrası sedasyon altındaultrasonografi eşliğinde aspirasyon dilatasyon ve küretaj işlemi ile tedavi olmuş sezaryen yeri skargebeliğini işleyeceğiz

Nausea and vomiting during pregnancy: a possible correlation with obsessive compulsive disorder and alexithymia

The possible correlation between nausea and vomiting during pregnancy (NVP) with obsessive-compulsive disorder (OCD) and alexithymia were examined in this cross-sectional study. A cohort of pregnant women at the first trimester of pregnancy experiencing NVP were divided into three groups, according to severity (mild, moderate and severe) with the Pregnancy Unique Quantification of Emesis and Nausea (PUQE) test. The Maudsley Obsessive Compulsive Disorder Scale (MOCQ) and the Toronto Alexithymia Scale (TAS-20) were applied. Scores of scales were compared in all three groups, and the relationship between NVP severity and OCD and alexithymia was evaluated. On the 110 enrolled pregnant women, 42 had mild, 36 had moderate and 32 had severe NVP. Pregnant women with mild NVP had lower MOCQ scores than those with severe NVP (p = .010). Total scores of TAS-20 were higher among subjects with greater NVP severity (p < .001). PUQE scores were demonstrated significant correlations with MOCQ and total and subsection scores of the TAS-20, regardless of NVP groups. Study results showed that women with more pronounced OCD and/or alexithymia can experience somatic complaints, such as NVP, particularly intense in their first trimester of pregnancies. For this reason, psychotherapy in addition to medical treatments could be recommended to pregnant women with severe NVP.Impact statement What is already known on this subject? NVP is a condition experienced by most women, particularly in the first trimester of pregnancy, which can be affected by the psychosomatic condition of the pregnant woman. What do the results of this study add? The severity of nausea and vomiting according to PUQE test were significantly associated with OCD and alexithymia presence in pregnant women during their first trimester period. What are the implications of these findings for clinical practice and/or further research? These findings might demonstrate the symptoms of NVP are correlated to OCD, as well as alexithymia. Longitudinal studies are required to demonstrate the clear causal relationship between NVP and psychiatric symptoms as in OCD and in alexithymia