Management and treatment in vulvar necrotizing fasciitis [Vulvanın nekroti·zan fasi·i·ti·nde yönetim ve tedavi·]

Objective The aim of this study is to evaluate the treatment and its outcomes of patients having vulvar necrotizing fasciitis. Material and methods Parameters that evaluated from patients treated in our department between 1st of January, 2006 and 31st of December, 2009 were age, conditions causing immune deficiency, habits of cigarette or alcohol, the way of perineal hair removal, glucose and HbA1c levels at admission, number of debridement under general anesthesia, results of microbiological studies and antibiotics used. Diagnosis was made with physical examination and the finger test proposed by Andresen. All patients underwent to surgical debridement immediately. Wide spectrum antibiotics and attempt to eliminate the underlying causes were started simultaneously with surgical debridement under general anesthesia. Results Six patients were available regarding the study criteria. The mean age was 46,5 ± 10,4. All patients except one had uncontrolled diabetes. The remaining had hematological malignancy and immune suppression caused by the chemotherapeutics. The hygienic condition of perinea was poor in all. Numbers of debridement under general anesthesia were three, two and one in one, two and three of the patients consecutively. The mean hospital staying was 35 ± 14,9 days. Death due to necrotizing fasciitis was not observed in any cases. Two patients died long after their discharge because of the underlying disease. Necrotizing fasciitis did not relapse in anyone. Conclusion Results derived from the small number of patients show that synchronous and intensive surgical and medical treatments are promising. However, they need to be reevaluated in studies having larger number of cases

Misoprostol for midtrimester termination of pregnancy in women with 1 or more prior cesarean deliveries

PubMedID: 23195293Objective: To evaluate the safety and efficacy of vaginal misoprostol for midtrimester termination of pregnancy (TOP) in women with 1 or more prior cesarean deliveries (CDs). Methods: A retrospective study was conducted with 279 women undergoing TOP with vaginal misoprostol between 14 and 26 weeks of gestation. Of these, 193 had no uterine scars (group 1), 60 had 1 prior CD (group 2), and 26 had 2 or more prior CDs (group 3). The primary outcome was the success rate of TOP. Secondary outcomes were time from induction to abortion, total dose of misoprostol used, and occurrence of uterine rupture. Results: The success rates were 96.4% in group 1, 81.7% in group 2, and 76.9% in group 3 (P = 0.001). Time from induction to abortion, total dose misoprostol, and duration of hospital stay differed significantly among the groups (P = 0.001 for all variables). There were 3 cases (11.5%) of uterine rupture in group 3, for an overall rate of 1.1%. Conclusion: Misoprostol inserted vaginally was effective for midtrimester TOP but the safety of using misoprostol in women with 2 or more prior CDs cannot be confirmed from the present study. Misoprostol should be used carefully, particularly in women with 2 or more prior CDs. © 2012 International Journal of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved

Angiographic treatment of the arteriovenous malformation occurred after caesarean section [Sezaryen sonrasi geli·şmi·ş arteri·ovenöz malformasyonun anji·ografi·k olarak tedavi·?i]

Introduction: Uterine arteriovenous malformations are classified as acquired or congenital. Caesarean section which is performed more frequently on nowadays, uterine curettage and other uterine surgeries are the most common causes of the acquired arteriovenous malformations. Case: Twenty-two years old woman delivered her second child by caesarean section, due to history of caesarean section, was admitted with complaint of profuse vaginal bleeding 15 days after the surgery. She demonstrated the clinical features of the hypovolemic shock. At first she treated with four units of red blood suspension, two units of fresh frozen plasma and rapid infusion of the fluids. On endometrial curettage only blood and coagulum were obtained. The bleeding could only be controlled by the internal pressure of the 18 F Foley catheter. Doppler analyze of the uterus revealed a vascular malformation signifying a turbulent flow pattern with low pressure and high flow rate. A unilateral uterine artery embolization was performed to her and her menstruel cycles are restarted at the fifth month of the puerperium. Discussion: The clinical presentation of the uterine arteriovenous malformations depends on the localization and the dimensions of the malformation. The uterine arteriovenous malformation should be kept in mind in cases of late occurrence vaginal bleeding unresponsive to the uterotonic medications, especially in a woman with previous history of uterine damage, like curettage or caesarean section