Is it possible to predict the success of single dose methotrexate in the treatment of tubal ectopic pregnancies?

Objectives: In this study, the aim was to determine whether the use of endometrial thickness or neutrophil/lymphocyte and platelet/lymphocyte ratio would be useful in predicting the success of methotrexate in the treatment of ectopic pregnancies located in the fallopian tubes. Materal and methods: This study was carried out by retrospectively examining 68 study group cases with an ultrasonographically detectable gestational sac in the fallopian tubes and 189 control group cases with an unruptured ectopic pregnancy diagnosis at any location. The cut-off value of endometrial thickness was calculated as a new marker between the cases in which single-dose methotrexate treatment was successful and the cases with treatment failure. Treatment success was evaluated with different models including endometrial thickness, fetal cardiac activity status, measurable crown-rump length, and β-hCG. Result: The cut-off value of β-hCG for treatment success was determined as 2960.5 ng/mL, and the cut-off value for endometrial thickness was determined as 10.5 mm. Although NLR seems to be a marker with a cut-off value of 2.49, it does not provide an extra benefit in combined use as it is not a specific predictor. The highest success in predicting treatment success was achieved in the modeling in which crown-rump length + fetal cardiac activity + β-hCG + endometrial thickness were used together. Conclusions: The use of endometrial thickness as a marker seems to be quite reliable in predicting treatment success. And we think it would be beneficial to thin the endometrium before using methotrexate

Midline epigastric scars can be associated with higher umbilical complications following DIEP flap harvest

Background: Umbilical complications can be relatively common after breast reconstruction with deep inferior epigastric perforator (DIEP) flaps. The medial umbilical ligaments and the ligamentum teres hepatis can be the sole blood supply to the umbilicus after a DIEP flap harvest. Prior incisions along the epigastric midline may disrupt the ligamentum teres hepatis. In this retrospective study, we assess the influence of previous midline epigastric scars on umbilical complications after DIEP flap harvest. Methods: All patients who underwent breast reconstruction with DIEP flaps were identified at an academic institution over six years. Relevant sociodemographic and clinicopathologic factors were reviewed in the electronic medical records. Univariate and multivariate analyses were performed to determine the role of clinical variables to predict the chance of umbilical complications. Results: A total of 243 patients met inclusion criteria, with 39 patients (16%) having prior surgery utilizing midline epigastric incisions. Twenty-one patients had umbilical complications. No significant difference in patient characteristics was found between patients with and without prior midline epigastric scars. Patients with a history of previous midline epigastric scars had a higher rate of umbilical complications (20.5% vs. 6.4%, p < 0.01). Bilateral medial row perforator-based DIEP flap harvest was also related to a higher rate of umbilical complications (18.4% vs. 6.2% p < 0.01). Conclusion: Previous midline epigastric scars are associated with higher rates of umbilical complications after DIEP flap harvest. Bilateral medial row perforator-based DIEP flap harvest exacerbates the rate of umbilical complications and should be avoided in patients with prior midline epigastric incision whenever possible