Klippel-Trenaunay Syndrome and Pregnancy

Klippel-Trenaunay syndrome is a rare congenital vascular disorder, and only few cases have been described in pregnancy. We describe two cases, in one patient without complications, the other patient developed postpartum deep venous thrombosis

Volumetric and three-dimensional examination of sella turcica by cone-beam computed tomography: reference data for guidance to pathologic pituitary morphology

Background: The aim of the study was to assess the dimensions and volume of sella turcica in healthy Caucasian adults with normal occlusion and facial appearance from cone-beam computed tomography (CBCT) images. Materials and methods: CBCT images of 80 Caucasian adult patients (40 males, 40 females) with normal facial appearance and occlusion taken previously for diagnostic purposes were evaluated. Two groups were constructed in accordance to gender. The volume, length, diameter, and depth of the sella turcica were measured by Romexis software programme. Mann-Whitney U test and Independent t-tests were used for statistical analysis. Results: The mean lengths of the sella were 9.9 mm and 10.2 mm, depths were 9.2 mm and 8.8 mm and diameters were 12.3 mm and 12.1 mm in female and male groups, respectively. Between the genders, no statistically significant differences were found for any of the measurements. There were significantly higher values for the volume of sella turcica in males than in females (1102 ± 285.3 mm3 and 951.3 ± 278.5 mm3, respectively). Conclusions: The dimensions of sella turcica in healthy Caucasian adults with normal occlusion and facial appearance revealed nonsignificant differences between the genders. Individual variability in dimensions and gender differences in the volume are of importance in comparison of patients with craniofacial syndromes and aberrations. Knowledge concerning the dimensions and volume of sella turcica will be clinically relevant for a guidance to consciously realize pituitary disorders

Investigation of changes in spermatozoon characteristics, chromatin structure, and antioxidant/oxidant parameters after freeze-thawing of hesperidin (Vitamin P) doses added to ram semen

We conducted this study to determine the potential cryopreservative effects of different hesperidin (vitamin P; H) doses on ram semen after freeze-thawing. Semen samples were obtained from Sonmez rams using an artificial vagina. The samples were divided into six groups: control, 10, 50, 100, 250, and 500 mu g/mL H (C, H10, H50, H100, H250, and H500, respectively). At the end of the study, sperm motility and kinetic parameters, acrosome integrity (AI), mitochondrial membrane potential (MMP), viability, lipid peroxidation levels (LPL), chromatin damage, oxidant parameters, and antioxidant parameters were assayed. None of the doses of H added to the semen extender showed any enhancing effects on progressive motility compared to C (p > 0.05). In fact, H500 had negative effects (p < 0.05). Moreover, AI was the highest at the H10 dose, while LPL values were the lowest at the same dose (p < 0.05). The doses of H10 and H50 added to the Tris extender medium showed positive effects on sperm cell chromatin damage. Consequently, we can say that H doses used in this study are not effective on semen progressive motility, but the H10 dose is effective on AI and chromatin damage by reducing LPL

Real-World Evidence: How Long Do Our Patients Fast?—Results from a Prospective JAGO-NOGGO-Multicenter Analysis on Perioperative Fasting in 924 Patients with Malignant and Benign Gynecological Diseases

Simple Summary: The concept of ERAS (Enhanced Recovery After Surgery) was introduced to reduce perioperative morbidity through a multimodal approach. Optimized and shortened perioperative fasting is a fundamental part of this modern concept of perioperative patient management, as prolonged fasting before and after surgery is associated with unfavorable outcomes. So far, it remains unclear whether increasingly established ERAS protocols lead to adequate short fasting intervals in clinical routines. We therefore conducted this prospective multicenter study and collected real-world data from 924 patients to evaluate actual perioperative fasting behavior. Patients reported drastically prolonged perioperative fasting durations. Even longer fasting intervals were reported for oncological and extensive procedures. Our data suggest that modern optimized fasting management is poorly implemented in clinical routine practice. This study should draw attention to the need for adequate implementation of ERAS protocols and sensitize clinicians to appropriate patient education about perioperative fasting. Background: Despite the key role of optimized fasting in modern perioperative patient management, little current data exist on perioperative fasting intervals in routine clinical practice. Methods: In this multicenter prospective study, the length of pre- and postoperative fasting intervals was assessed with the use of a specifically developed questionnaire. Between 15 January 2021 and 31 May 2022, 924 gynecology patients were included, from 13 German gynecology departments. Results: On average, patients remained fasting for about three times as long as recommended for solid foods (17:02 +/- 06:54 h) and about five times as long as recommended for clear fluids (9:21 +/- 5:48 h). The average perioperative fasting interval exceeded one day (28:23 +/- 14:02 h). Longer fasting intervals were observed before and after oncological or extensive procedures, while shorter preoperative fasting intervals were reported in the participating university hospitals. Smoking, treatment in a non-university hospital, an increased Charlson Comorbidity Index and extensive surgery were significant predictors of longer preoperative fasting from solid foods. In general, prolonged preoperative fasting was tolerated well and quality of patient information was perceived as good. Conclusion: Perioperative fasting intervals were drastically prolonged in this cohort of 924 gynecology patients. Our data indicate the need for better patient education about perioperative fasting

Development of a Solid-Type IV Self-Emulsifying Drug Delivery System of BCS Class II Drug

Self-emulsifying systems (SEEDS) are becoming increasingly popular for the preparation of oral dosage forms of low-water-soluble drugs. SEEDS are divided into subgroups according to their components; type IV formulations that are prepared using only surfactants and/or co-surfactants. The aim of the study was to increase the solubility of tadalafil, a class II drug according to the BCS, by preparing a type IV formulation. In the study, Labrasol, Kolliphor PS 20, Kolliphor PS 60, Kolliphor PS 80, Kolliphor CS 12, Kolliphor CS 20, Kolliphor HS 15, Kolliphor EL, Kolliphor ELP, Kolliphor PEG400, Gelucire 44/14 and Gelucire 48/16 were used as surfactants; Transcutol was used as a co-surfactant. The Kolliphor PS 80, Kolliphor EL, and Kolliphor HS 15 formulations were prepared in a ratio of 2:1 with Transcutol to form droplet sizes less than 50 nm and PDI values below 0.2. The formulations sensitivity to heat change and pH change was analysed by performing stability tests. Stable formulations of tadalafil formulations were obtained using Transcutol and Kolliphor PS 80 or Kolliphor EL. Solidifications of the optimum type IV formulations were made using fluorite, Neusilin US2, Neusilin FL2, Syloid 3050, and Syloid 3150. Dissolution studies of the prepared solid type IV formulations were first performed in 0.1 N HCl, and the dissolution profiles were examined by analysing the optimum solid type IV (s-type IV) formulations in pH 4.5 and pH 6.8. It was determined that the s-type IV prepared with Neusilin US2 and Neusilin UFL2 (2:1) had provided a dissolution of over 80% at the end of the first minute. The results indicated the potential bioavailability improvement of s-type IV for the BCS class II drug, Tadalafil, due to great enhancement in its dissolution rate

Streptokinaz ile tedavi edilen akut miyokart infaktüsünde gelişen retroperitoneal hematom : Olgu sunumu

Retroperitoneal hematom (RPH) çoğunlukla travma, vasküler lezyonlar, cerrahi girişim, antikoagülan tedavi ve bazen de idiyopatik olarak görülebilen ve ölümcül seyredebilen bir durumdur. Çoğunlukla destek tedavisinin yapıldığı, çok az vakada cerrahi girişimin uygulandığı bir durumdur. Akut miyokart infaktüsü (Anterior) tanısıyla 78 yaşındaki bayan hastaya streptokinaz tedavisi verildi. Streptokinaz sonrasında şiddetli sol yan ağrısı, sırt ağrısı ve uyluk ağrısı başladı. Sol alt extremitede hareket kısıtlılığı ve parastezi gelişti. Herhangi bir travma, düşme yada antikoagülan kullanım öyküsü yoktu. Hastaya intraabdominal kanama şüphesi ile abdominal BT çekildi ve retroperitoneal alanda hematom ile uyumlu lezyon gözlendi. Bunun üzerine hastanın antikoagülan ilaçları kesildi ve hastaya eritrosit süspansiyonu verildi. Hastanın abdomen USG ile takiplerinde hematom boyutlarında artma gözlenmedi. Klinik olarak şikayetleri gerileyen vital bulguları stabil seyreden hasta kontrole çağrılarak taburcu edildi. Literatürde streptokinaza bağlı RPH vakası nadir bulunmasından ötürü bu vakayı paylaşmayı uygun buluyoruz.Retroperitoneal hematoma (RPH) is a potentially life threatening condition commonly associated with trauma, vascular lesions, surgical intervention and anticoagulant therapy which may occasionally be seen as an idiopathic presentation. Treatment of RPH is usually supportive, with only a minority of cases undergoing surgical intervention. A 78 year old female diagnosed with acute myocardial infarction (anterior) received streptokinase treatment. She had severe left side pain, back pain and thigh pain following streptokinase administration. Paresthesia and movement restriction developed in her left lower extremity. The patient reported no history of trauma, falling or anticoagulant use. CT was performed due to suspected intraabdominal hemorrhage, and a lesion consistent with hematoma was detected in the retroperitoneal area. Subsequently, anticoagulant medications were discontinued and the patient received erythrocyte suspension. Size of the hematoma was not increased in the follow-up abdominal USG. Upon regression of her clinical complaints and with stabile vital findings, the patient was discharged and scheduled for a control visit. We would like to report this case as streptokinase related RPH cases are rare in the literature

The effects of N-acetylcysteine on hepatic function during isoflurane anaesthesia for laparoscopic surgery patients

Introduction: Although most general anaesthesia procedures are performed without any complications, volatile agents may have adverse effects on various living systems. This study aims to compare the antioxidant effects of isoflurane and N-acetylcysteine (NAC) on liver function. Methods: Forty-one patients in the ASA I-II risk groups, who were scheduled to undergo gynaecologic laparoscopy, were randomly divided into two groups: The placebo (group P, n=21) and the NAC group (group N, n=20). In both groups, anaesthesia was maintained with 1-2% isoflurane in 50% Oxygen-50% N 2 O at 6 l/min, also administered by inhalation. Venous blood samples were obtained before anaesthesia induction, and then in the postoperative 1 st hour and at the 24 th hour. The samples were centrifuged and serum levels of glutathione S-transferase (GST), malondialdehyde (MDA), aspartate amino transferase (AST), alanine amino transferase (ALT), lactate dehydrogenase (LDH), gamma glutamyltranspeptidase (GGT), prothrombin time (PT), activated partial thromboplastin time (aPTT) and international normalised ratio were determined. Results: GST levels were significantly higher in group N than in group P in the postoperative 1 st hour. Postoperative values of GST in the two groups were higher when compared to preoperative values (P<0.05). When postoperative levels were compared with preoperative levels, the postoperative MDA levels of group N were significantly higher (P<0.05). Levels of AST, ALT, GGT and LDH in both groups revealed significant decreases at the postoperative 1 st hour and postoperative 24 th hour compared to preoperative values (P<0.05, P<0.001). PT values were significantly higher in both groups in the postoperative 1 st hour and 24 th hour (P<0.05, P<0.001), although there were no differences in aPTT levels. Conclusion: Our results showed that liver functions were well preserved with administration of NAC during anaesthesia with isoflurane. Isoflurane with NAC has lesser effect on liver function tests compared to isoflurane alone