Laparoscopically-assisted vaginal hysterectomy for enlarged uterus: operative outcomes and the learning curve

Objectives: The aim of the study was to compare the effects of uterine size and surgeon experience on the surgical out­comes of laparoscopically-assisted vaginal hysterectomy (LAVH) for benign gynecological conditions. Material and methods: This was a retrospective analysis of 184 LAVH cases. All hysterectomies were performed by the same surgeon and divided into two groups, with uterine weight of < 280 g (group 1) and uterine weight of > 280 g (group 2). The groups were compared in terms of the effects of the uterine size and surgeon experience vs. the operative outcomes (operative time, change in hemoglobin levels, hospital stay, and perioperative complications). Results: No significant differences in mean age, parity, history of chronic systemic diseases and previous surgery history were observed between the two groups. However, operative time was significantly greater in group 2 as compared to group 1 (132.1 ± 42.7 minutes vs. 111.5 ± 30.4 minutes, p < 0.05). There were no differences in the hospital stay and perioperative complications between the two groups. One case of bladder injury occurred in each group and one patient underwent a second laparoscopic surgery for postoperative bleeding in group 2. Greater surgeon experience was demonstrated to be associated with decreased operative bleeding and, consequently, smaller differences between preoperative and postop­erative hemoglobin levels. Operative time was also reduced as the surgeon was getting more experienced but the effect did not reach statistical significance. Conclusions: Our study supports the thesis that LAVH is a safe and effective procedure for managing benign gynecologi­cal conditions. Despite increased operative time, LAVH can be safely performed for enlarged uterus in conjunction with increased surgeon experience

Laparoscopically-assisted vaginal hysterectomy for enlarged uterus: operative outcomes and the learning curve

Objectives: The aim of the study was to compare the effects of uterine size and surgeon experience on the surgical outcomes of laparoscopically-assisted vaginal hysterectomy (LAVH) for benign gynecological conditions

A critical analysis of low molecular weight heparin use during pregnancy in a tertiary referral centre

The aim of this study was to analyse low molecular weight heparin (LMWH) use during pregnancy in terms of patient evaluation, treatment indication and social and financial costs. This was a retrospective analysis of patients using LMWH in their pregnancies. A total of 147 women were included in the study. The most common indications were thrombophilia (55/147, 37.4%); recurrent pregnancy loss (RPL); (47/147, 32.0%) and previous single pregnancy loss (18/147, 12.2%). In the RPL group, 53.1% of patients were not evaluated with standard tests; 31.9% of women were incompletely evaluated and 15% were properly evaluated. Out of 104 women screened for thrombophilia, 32 (32/104, 30.8%) were tested during pregnancy. Despite published guidelines and increasing scientific evidence against their use in some indications, LMWHs are prescribed widely during pregnancy for a variety of indications. Public and healthcare providers' education to change this attitude should be implemented

Comparison of systemic and local methotrexate treatments in cesarean scar pregnancies: time to change conventional treatment and follow-up protocols

Objective: The aim of this study was to compare the use of systemic and local methotrexate in the treatment of cesarean scar pregnancy

A Case of Dichorionic Twin Pregnancy Concordant for Bilateral Cleft Lip and Palate and Discordant for Spina Bifida; Schisis Association

Backround: The schisis theory suggests that neural tube defect (NTD), cleft lip and palate (CL/P), omphalocele and diaphragmatic hernia are associated to each other more frequently than at the expected random combination rates in a given fetus. However, it is unusual to see schisis-associated defects concordantly in dichorionic twin pregnancy with other schisis-associated and non-associated defects. In addition, the association of lower limb oligodactly with oral cleft and spina bifida has not been reported before. Case: A 24-year-old woman with twin gestation at 21 weeks was referred to our unit. At ultrasound examination, bilateral CL/P and single umbilical artery in male fetus, and bilateral CL/P and open lumbar spina bifida in female fetus were revealed. At autopsy, oligodactyly of both lower limbs was demonstrated in the female fetus. The parents had no family history of NTD and CL/P. There was no consanguinity, nor was the mother exposed to teratogens

Concurrent endometrial carcinoma in hysterectomy specimens in patients with histopatholoical diagnosis of endometrial hyperplasia in curettage specimens

Objectives: The purpose of this study was to appraise the presence of Endometrial Carcinoma (EC) sequence in patients undergoing hysterectomy for Endometrial Hyperplasia (EH)

Acute fetal distress following tooth extraction and abscess drainage in a pregnant patient with maxillofacial infection

Oral infections have been implicated in adverse pregnancy outcomes such as pre-eclampsia, premature delivery and growth retardation. A 28-year-old and 9 months pregnant otherwise healthy woman with a complaint of facial swelling and dental pain was referred to the Department of Oral and Maxillofacial Surgery. Oral examination revealed perimandibular and masticator space infection related to the left mandibular third molar tooth. Eight hours after surgical intervention, fetal distress developed. The patient was immediately taken into surgery and a male baby delivered by Caesarean section. The baby was then admitted to the intensive care unit. On the twelfth day of his admission, the baby was discharged in good health. Severe maxillofacial infection in pregnancy is a medically complicated situation which should be treated by an oral and maxillofacial surgeon in consultation with an obstetric and gynaecology service

Effects of percutaneous mitral balloon valvuloplasty on P-wave dispersion in patients with mitral stenosis

P-wave dispersion (PWD) is a new electrocardio-graphic marker that has been associated with inhomogeneous and discontinuous propagation of sinus impulses.(1,2) It can be defined as the difference between maximum and minimum P-wave duration. The prolongation of intra-atrial and interatrial conduction time, and the inhomogeneous propagation of sinus impulses are well known electrophysiologic characteristics of the atrium prone to fibrillate. (1,2) Furthermore, prolonged P-wave duration and increased PWD have been reported to carry an increased risk for atrial fibrillation (AF).(2,3) reurnatic mitral stenosis (MS) is frequently seen in developing countries and causes significant morbidity and mortality.(4) Percutaneous mitral balloon valvuloplasty (PMBV) is the procedure of choice in patients who have symptomatic, hemodynamically severe MS, and are suitable for this procedure.(4-6) . This procedure is highly successful with a low complication rate and significant short- and long-term improvement in hemodynamics and symptoms.(7,8). 8 The objectives of this study were (1) to identify PWD in patients with MS, and (2) to determine the effects of PMBV on PWD. There is currently no study on the effects of MS and PMBV on PWD