Cesarean scar pregnancy: A case report

Pregnancy implantation to the cesarean scar could be the life threatening, although it is a rare event, its ratio increased along with the increasing rate of cesarean delivery. Early diagnosis and treatment may be lifesaving with preserving fertility in these patients. In transvaginal ultrasonography; presence of an empty uterine and cervical cavity, lack of continuity of myometrial setting at the anterior isthmic region and pregnancy implantation to this region should suggest the diagnosis. In this article, we aimed to present a patient with scar ectopic pregnancy with the review of the literature

Długoterminowe wyniki radykalnej i zachowawczej chirurgii w późno rozpoznanych ciążach jajowodowych

Objective: To investigate long-term postoperative outcomes of conservative and radical surgery in ectopic tubal pregnancies, and evaluate the results of these techniques. Methods: A total of 145 patients that operated for tubal pregnancy between January 2006 and January 2009 were reviewed. Data on patient age, reproductive and surgical history, history of ectopic pregnancies, serum hCG levels at the time of diagnosis and intraoperative observation were retrospectively obtained from hospital records. Telephone interviews were used to obtain information about exact postoperative time interval in which the patients were trying to get pregnant, and the time when they spontaneously became pregnant. Results: There was no significant difference in cumulative spontaneous intrauterine pregnancy rate for a 2-year of conception period subsequent to conservative (64.3%) and radical (58.3%) surgery (p=0.636). During the same time interval, the rates of development of ectopic pregnancy for the conservative and radical surgery groups were 17.9% and 4.2%, respectively (p= 0.093). The patients who developed ectopic pregnancy after conservative surgery had significantly higher levels of serum hCG levels (7413+/-3155 IU/L) compared with those of patients who not-developed ectopic pregnancy (3436+/-2668 IU/L) (p=0.007). Conclusion: In late-diagnosed cases with higher serum hCG levels, conservative treatment should not be the first choice. Indeed, our results suggested that the cumulative pregnancy rates are not significantly higher, and the risk of ectopic pregnancy recurrence may be increased with conservative surgery in late tubal pregnancies.Cel: Badanie długoterminowych pooperacyjnych wyników leczenia zachowawczego i radykalnego w ekotopowych ciążach jajowodowych i ocena rezultatów tych metod. Metody: Przeanalizowano grupę 145 pacjentek operowanych z powodu ciąży jajowodowej pomiędzy styczniem 2006 i styczniem 2009. Dane dotyczące wieku pacjentek, przeszłości położniczej, operacji, ciąż ektopowych, poziomu hCG w surowicy w momencie postawienia diagnozy oraz obserwacje z przebiegu operacji zostały retrospektywnie uzyskane z dokumentacji szpitalnej. Informacje na temat dokładnego czasu po operacji, w którym pacjentka starała się zajść w ciążę oraz czas do zajścia w ciążę uzyskano w rozmowie telefonicznej. Wyniki: Nie znaleziono istotnej różnicy w skumulowanym wskaźniku spontanicznych ciąż wewnątrzmacicznych w ciągu 2 lat obserwacji po zachowawczym (64,3%) i radykalnym (58,3%) leczeniu operacyjnym (p=0,636). W tym samym przedziale czasu, odsetek ciąż ektopowych wynosił dla zachowawczej i radykalnej chirurgii odpowiednio, 17,9% i 4,2%, p=0,093. Pacjentki, u których doszło do rozwoju ciąży pozamacicznej po zachowawczej operacji miały istotnie wyższe poziomy surowiczego hCG (7413+/-3155 IU/L) w porównaniu do tych pacjentek, u których nie doszło do ciąży pozamacicznej (3436+/-2668 IU/L), p=0,007. Wnioski: W późno rozpoznanych przypadkach ciąży ektopowej z wyższym poziomem hCG, zachowawcze postępowanie nie powinno być leczeniem z wyboru. Nasze wyniki wskazują na to, że skumulowany wskaźnik ciąż nie jest istotnie wyższy a ryzyko ponownej ciąży pozamacicznej może być zwiększone w przypadkach późnego rozpoznania ciąży jajowodowej leczonej zachowawczą chirurgią

Intrauterine blood transfusion in immune hydrops fetalis, corrects middle cerebral artery Doppler velocimetry very quickly

The aim of our study was to evaluate the middle cerebral artery velocimetry before and after intrauterine blood transfusion in immune hydrops fetalis. The current study was conducted in a tertiary research hospital, from February 2009 to January 2011. Nineteen intrauterine blood transfusions performed during the study period. The factors recorded were age of the mothers, gestational weeks, pre-transfusion fetal hematocrit and post-transfusion fetal hematocrit, and also middle cerebral artery peak systolic velocimetry (MCA-PSV) was detected and recorded before and after intrauterine transfusion. A control group of twenty two cases for normal MCA doppler velocimetry was also included to the study. During the study, a total of eleven rhesus isoimmunized pregnancies underwent intrauterine blood transfusions at our perinatal diagnose unit. Before transfusion seventeen severe and two moderate anemias were detected and mean MoM of MCA-PSV was 1.76±0.38 MoM. Post transfusion mean MoM of MCA-PSV in the patient group and control group were 1.08±0.22 MoM and 0.96±0.21 MoM, respectively. The mean MCA-PSV values were higher in RI fetuses than post transfusion and control group. In current study, we found that MCA-PSV is a valuable parameter in detecting fetal anemia requiring intrauterine transfusion and mean MCA-PSV values is higher than 1.5 MoM in fetuses with anemia. And also decrease in MCA-PSV just after transfusion in anemic fetuses showed the quick response of the fetus to correction of anemia

Diyaliz hastalarında asimetrik dimetilarjinin ve homosistein düzeyleri

Kardiyovasküler hastalıklar ve endotelyal disfonksiyon son dönem böbrek yetmezliği hastalarında en önemli ölüm nedenleridir. Periton diyalizi ve hemodiyaliz gibi tedavi yöntemlerinin farklı parametreler üzerine farklı etkileri vardır. Asimetrik dimetilarjinin endojen nitrik oksit sentaz inhibitörüdür ve kronik böbrek yetmezliğinin progresyonunda yeni bir belirteç olduğu gösterilmiştir. Homosistein endotel hasarı, damar düz kas hücre proliferasyonu ve koagülasyon anormallikleri yoluyla trombogenez ve atero- geneze neden olur. Daha önceki çalışmalarda periton diyalizi (PD) ve hemodiyalizin (HD) oksidan ve antioksidan sistemler üzerine etkisiyle ilgili çelişkili bulgular vardır. Bu çalışmada HD, PD ve sağlıklı kişilerde ADMA, homosistein ve CRP düzeylerini belirlemeyi amaçladık. Çalışmaya 44 PD (23E,21K), 26HD (13E,13K) hastası ve 29 (15E,14K) sağlıklı kişi katıldı. ADMA, homosistein, arjinin ve CRP düzeyleri ölçüldü. Son dönem böbrek yetmezliği (SDBY) hastalarının ADMA, homosistein ve CRP düzeyleri sağlıklı kontrol grubuna göre yüksek (p0.001), arjinin düzeyleri düşük olarak bulundu(p0.001). HD ve PD gruplarında ADMA, homosistein ve CRP seviyeleri açısından farklılık bulunamadı (sırasıyla p:0.287, p: 0.587, p: 0.835) Bizim sonuçlarımız HD,PD hastalarında sağlıklı kontrole göre ADMA ve homosistein düzeylerinin yüseldiğini gösterdi. Bu bulgular; diyaliz hastalarında endotel disfonksiyonu, inflamasyon ve oksidatif stresin arttığını ve ADMA ve homosistein düzeylerinin diyaliz tedavi yönteminden etkilenmediğini gös- termektedirCardiovascular diseases and endothelial disfunction are major causes of mortality in patients with end stage renal disease (ESRD). Treatment strategies like continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) have different effects on dif- ferent parameters. Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide (NO) synthase inhibitor and it has been reported to be a novel marker for the progression of chronic kidney disease (CKD). Homocysteine is believed to cause atherogen- esis and thrombogenesis via endothelial damage, vascular smooth muscle proliferation and coagulation abnormalities. In previ- ous studies, conflicting findings have been reported about the effect of HD and CAPD on oxidant and antioxidant systems. In this study, we aimed to investigate ADMA, homocysteine and C- reactive protein (CRP) levels in patients with ESRD having HD and CAPD treatment and healthy individuals. This study was performed on 44 (23M, 21F) CAPD patients, 26 (13M, 13F) HD patients and 29 (15M, 14F) age and sex matched healthy control subjects. The lipid profile, ADMA, homocysteine, arginine and CRP levels were measured. Serum ADMA, homocysteine and CRP levels of the ESRD patients were significantly higher, whereas serum arginine levels were significantly lower in both HD and CAPD patients compared to control subjects. No differences were found between serum ADMA, homocysteine and CRP levels of the CAPD and HD patients. Our results suggest that ADMA, homocysteine and CRP levels were increased in HD and CAPD patients compared to the control subjects. These findings suggest that ESRD patients are prone to inflammation, oxidative stress and endothelial dysfunction. We conclude that endothelial dysfunction, inflammation and oxidative stress are increased in dialysis patients and ADMA concentrations are not affected by the modality of dialysis treatment

Endothelial dysfunction and insulin resistance in young women with polycystic ovarian syndrome

Background/aim: To evaluate whether there is a correlation between insulin resistance and nitric oxide-related endothelial dysfunction in patients with polycystic ovarian syndrome (PCOS). Materials and methods: The study was conducted with 25 young women with PCOS and 25 young healthy women, between 18 and 35 years of age. Plasma asymmetric dimethylarginine (ADMA) levels, serum nitric oxide (NO) levels, and homeostatic model assessment of insulin resistance (HOMA-IR) rates were measured in both the patient and control groups. Results: Plasma ADMA levels were significantly higher in PCOS patients than in the controls (P = 0.001). Serum NO levels were significantly lower in patients than in the controls (P = 0.008). The HOMA-IR rates, accepted as an insulin resistance parameter, were significantly higher in patients than in the controls (P = 0.001). Conclusion: Results of the present study indicate that, independent of age, body mass index, and blood lipid profile, there is significant insulin resistance in PCOS patients. However, no correlation was found between HOMA-IR as an insulin resistance determinant and altered ADMA and NO levels. This finding may indicate that there are additional mechanisms of cardiovascular risks in PCOS patients other than insulin resistance

İnsan Bacak Hareketleri İçin Prototip Dış İskelet Robotik Sisteminin Mekanik Tasarımı Ve Hareket Verilerinin Yapay Sinir Ağları İle Elde Edilmesi

Target of this study is designing a exoskeleton system for single lower extremity disabled person and controlling this exoskeleton system with neural network. Exoskeleton system is modeled by using SolidWorks. At the same time, gait data is acquired on human body and sole is divided four parts after that reaction forces are gauged during the walking. Distributions of strain and deformation are obtained by using experimental gait data. The walking is designed using the obtained data and walking data is derived for control stage. Power requirements of actuators are defined

Mechanical Design Of Prototype Exoskeleton Robotic System For Human Leg Movements And Implementation Of Gait Data With Neural Network

Target of this study is designing a exoskeleton system for single lower extremity disabled person and controlling this exoskeleton system with neural network. Exoskeleton system is modeled by using SolidWorks. At the same time, gait data is acquired on human body and sole is divided four parts after that reaction forces are gauged during the walking. Distributions of strain and deformation are obtained by using experimental gait data. The walking is designed using the obtained data and walking data is derived for control stage. Power requirements of actuators are defined

Tuberculosis in peritoneal dialysis patients in an endemic region.

Tuberculosis has been paid more attention in recent years because of the increase in the number of patients with immune suppression-such as those with renal failure. In the present study, we analyzed patients on peritoneal dialysis (PD) in our city to determine the prevalence and clinical characteristics of tuberculosis in those patients. Patients who had been on a PD program for more than 3 months were reviewed. Demographic characteristics, primary renal disease, comorbidities, and duration of PD were recorded. With regard to tuberculosis, the timing of the diagnosis, any previous history of antituberculosis treatment, family history, site of presentation, drugs used, drug side effects, and disease outcome were recorded. Among 322 patients from 5 PD units who were reviewed, 4 (1.240%) were found to have tuberculosis. Pulmonary involvement was noted in 2 (50%). The diagnosis was made through microbiology in 1 patient, through pathology in 1, and through clinical and radiologic assessment in the remaining 2. Mild transaminitis was recorded in 2 patients as a side effect of treatment. Of the 4 patients, 2 were cured, 1 died, and 1 was taking ongoing treatment. The prevalence of tuberculosis was significantly higher in the study population than in the general population. In a dialysis population, a diagnosis of tuberculosis is often difficult, and extrapulmonary involvement is more common, as observed in our study. The diagnosis of tuberculosis may be made through non-microbiologic approaches, and temporary transaminase elevations may be seen during therapy

Characteristics and outcomes of hospitalised older patients with chronic kidney disease and COVID-19: A multicenter nationwide controlled study

Objective Older adults with co-morbidities have been reported to be at higher risk for adverse outcomes of coronavirus disease 2019 (COVID-19). The characteristics of COVID-19 in older patients and its clinical outcomes in different kidney disease groups are not well known