Iatrogenic Port Site Parasitic Myoma; Case Report and Literature Review

Introduction: We report a case of iatrogenic parasitic myoma of the anterior abdominal wall and discuss the differential diagnosis, treatment, and prevention of complication with relevant literature. Case Report: A 33-year-old woman presented with anterior abdominal wall mass 3 years after initial laparoscopic myomectomy surgery. A mass with a 38 3 26 mm diameter was observed in the anterior abdominal wall at the site of inferior left side port of previous surgery. It was excised from the anterior abdominal wall outside of the peritoneum, below the fascia. The pathologic examination of the excised mass revealed cellular myoma. This case is the 4th port site parasitic myoma in literature. Conclusion: The risk of implantation and subsequent growth of minute myoma fragments should be kept in mind during morcellation procedures and, in order to avoid such complications, all fragments should be tracked during morcellation. The inspection of trocar sites after the removal of trocars for retained fragments would prevent such recurrences

Time dependent influence of etonogestrel on the caspase-3 imunereactivity and apoptotic indexes of rat uterus and ovaries

Apoptosis is necessary for the balance between cell proliferation and loss. Thirty-six Wistar-Albino rats were subjected to investigate apoptotic effect of widely used implantable progestins on ovarian and uterine tissues. Rats were divided into 6 groups. In the first five groups, we applied etonogestrel (IMP) subcutaneous implants (n = 30). The rats in groups were sacrificed sequentially every 10 days after application. The rats in the last group (n = 6) were accepted as controls. Apoptotic index (AI) values and Caspase-3 immunereactivities of ovaries and uterus were recorded. In IMP groups, AI and Hscore values in stroma and glandular epithelium of uterus, granulosa and teca-lutein cells of the ovary increased with the longer progesterone exposure. Increase in AI and Hscore values were more prominent after 30 days of exposure for teca-lutein cells of ovary. Progestins increased apoptosis in ovaries and uterus by the longer exposure. Apoptosis increased in ovaries by chronic progesterone exposure. The apoptotic effect of progestin on endometrium is clear but long-term systemic application may lead to alterations in ovarian physiology. We evaluated time dependent apoptotic effect of etonogestrel on reproductive physiology and discussed progestins effect from another point of view in this study

Alterations of Ionized and Total Magnesium Levels in Pregnant Women with Gestational Diabetes Mellitus

Background/Aims: The aim of this prospective study was to determine ionized and total magnesium (Mg) levels in pregnant subjects with and without gestational diabetes mellitus (GDM). Methods: Eighty-five women, 26-28 weeks pregnant, were recruited for routine oral glucose tolerance tests (OGTT); 45 had normal OGTT results and 40 were diagnosed with GDM. Electrolyte levels, including ionized and total Mg, were analyzed. Results: Gestational age and BMI were similar between the two groups (p = 0.800, p = 0.025). Multivitamin use was higher in the control group (p = 0.036). Fasting blood glucose was higher in the GDM group (p < 0.001). The median total Mg levels were 1.9 mg/dl (range 1.6-2.2) in the control group and 1.8 mg/dl (range 1.2-2.1) in the GDM group (p < 0.001). The median ionized Mg levels were 0.5 mmol/l (range 0.4-0.6) in the control group and 0.4 mmol/l (range 0.4-0.5) in the GDM group (p < 0.001). Conclusion: Our study revealed a relationship between low total and ionized Mg levels and GDM, as in type 2 diabetes mellitus (DM). The literature regarding type 2 DM and our findings suggest that Mg is the key ion in the pathophysiology of GDM. Low-dose Mg supplementation was not related to GDM; however, pharmacological doses in the various stages of pregnancy could be beneficial and should be investigated. (C) 2014 S. Karger AG, Base

BEYİN ÖLÜMÜ KAVRAMI VE DEÜTF ANESTEZİ YOĞUN BAKIM ÜNİTESİNDEKİ OLGULARIN RETROSPEKTİF İNCELENMESİ

Bu çalışmada beyin ölümü kavramı, tarihçesi, klinik kriterleri, tanı testleri açısından değerlendirilmi

Outcome of intrauterine pregnancies with intrauterine device in place and effects of device location on prognosis

Objectives: This study aimed to compare the outcome of pregnancies with retained or removed intrauterine devices (IUDs) and the effect of IUD location on pregnancy outcome. Study design: In a retrospective cohort study, we searched 27,578 records of women who had CuT380 IUD inserted, and 144 pregnancies with IUD were analyzed. IUDs were removed from 114 patients and retained for 30 patients. Results: The combined risk of adverse pregnancy outcomes (miscarriage, intrauterine fetal death, intrauterine growth retardation, preterm birth and preterm premature rupture of membranes) was 36.8% in the IUD-removed group and 63.3% in the IUD-retained group [p<.01; relative risk (RR)=2.0; 95% confidence interval (CI) 1.3-3.3]. Newborns of the IUD-retained women had significantly lower Apgar scores and significantly higher admission rate to the neonatal intensive care unit (p=.01; RR=10.8; 95% CI 1.04-111.6 and p<.01; RR=4.5; 95% CI 1.5-12.9, respectively). There were more miscarriages and adverse pregnancy outcome when the IUD was retained (16.9% vs. 66.7%) in patients with an IUD in low-lying position (p<.01; RR=3.9; 95% CI 1.8-8.6). Conclusion: Women who conceived with an IUD in place and chose to continue the pregnancy without removing the IUD need close followup, as there appears to be higher risk of adverse pregnancy and neonatal outcome. Furthermore, when the IUD is retained in the low-lying position, there is increased risk of miscarriage and adverse pregnancy outcome compared to removal of the IUD. Future randomized controlled studies are needed to determine the outcome of pregnancies with retained or removed IUD. Implications: In this study, we have evaluated the IUD location and its effect on pregnancy outcome in women with a retained or removed IUD. This study is the first to investigate the relationship between IUD location and pregnancy outcome in women who conceived with an IUD. We need evidence from a collaborative multicenter randomized trial to answer the question of whether the IUD should be removed in case of pregnancy. (C) 2014 Elsevier Inc. All rights reserved