Wczesne versus opóźnione odżywianie po cięciu cesarskim z różnymi metodami znieczulenia – badanie randomizowane

Objective: The aim of the study was to evaluate the safety and efficacy of early feeding after cesarean delivery under different anesthetic methods. Study design: Two hundred women with elective cesarean delivery were randomly assigned to early oral feeding (EOF) or routine oral feeding (ROF) groups. EOF patients were informed that they could begin taking fluids orally (regime I) as soon as 2 hours after the delivery and then gradually progress to solid foods (regime III), if tolerated. ROF patients were informed that they could start regime I right after bowel sounds were heard on examination and then gradually move on to regime III. Hospitalization time and total time to ambulation (primary outcomes), gasstool discharge time and onset of bowel sounds (secondary outcomes) were compared in groups A [EOF patients after regional anesthesia (n=49)], B [EOF patients after general anesthesia (n=48)], C [ROF patients after regionalanesthesia (n=47)] and D [ROF patients after general anesthesia (n=48)]. Results: There were significant differences in primary and secondary outcomes between group A and the remaining groups, especially group D. The status of patients from group B was not better than group C. In fact, the latter were discharged home sooner and passage of gas, as well as initiation of regime I occurred earlier as compared to the former. Conclusions: Cesarean section under regional anesthesia and encouragement of oral feeding 2 hours after the operation should be recommended in order to achieve postoperative recovery and early hospital discharge. Routine oral feeding (right after bowel sounds are heard on examination) after cesarean section under general anesthesia should be the last choice.Cel: Celem badania była ocena bezpieczeństwa i skuteczności wczesnego włączenia odżywiania po cesarskim wykonanym przy różnych metodach znieczulenia. Do badania włączono 200 kobiet po elektywnym cięciu cesarskim. Po randomizacji pacjentki przydzielano do grupy wczesnego odżywiania dojelitowego (EOF) lub grupy zwykłego włączania jedzenia (ROF). Pacjentkom z grupy EOF pozwolono pić płyny już 2 godziny po porodzie (reżim I) a następnie stopniowo przechodzić do pokarmów stałych (reżim III). Pacjentki z grupy ROF mogły rozpocząć odżywianie wg reżimu I gdy w badaniu osłuchiwaniem obecna była perystaltyka a następnie stopniowo przechodzić do reżimu III. Czas hospitalizacji, całkowity czas do uruchomienia (pierwotny punkt końcowy), czas do oddania gazów i stolca i czas do rozpoczęcia perystaltyki (wtórny punkt końcowy) porównano pomiędzy grupami A [pacjentki EOF ze znieczuleniem przewodowym, n=49], B [EOF ze znieczuleniem ogólnym, n=48], C [ROF ze znieczuleniem przewodowym, n=47] i D [ROF ze znieczuleniem ogólnym, n=48]. Wyniki: Zaobserwowano istotne różnice pomiędzy grupą A a pozostałymi grupami, zwłaszcza grupą D, w odniesieniu do pierwotnego i wtórnego punktu końcowego. Status pacjentek z grupy B nie był lepszy niż z grupy C. W rzeczywistości pacjentki z grupy C były zwalniane do domu wcześniej, również pasaż gazów i włączenie diety wg reżimu I następowały wcześniej niż w grupie B. Wnioski: Cięcie cesarskie ze znieczuleniem przewodowym i włączeniem odżywiania 2 godziny po operacji powinno być zalecane ze względu na szybszą rekonwalescencję oraz wczesny wypis ze szpitala. Jako ostatnie powinno się wybierać cięcie cesarskie ze znieczuleniem ogólnym i rutynowym włączeniem odżywiania po usłyszeniu perystaltyki jelit

BONE MINERAL DENSITY AND THYROID-STIMULATING HORMONE ASSOCIATION IN POSTMENOPAUSAL HEALTHY WOMEN

Amaç: Postmenopozal sağlıklı kadınlarda femoral ve lomber kemik mineralyoğunluğunun tiroid stimülan hormon düzeyi ile ilişkisini araştırmak.Gereç ve yöntem: Çalışmaya 152 postmenopozal sağlıklı kadın dahil edilmiştir.Kemik mineral yoğunluğu, DEXA ile anterior-posterior lomber (L1-L4) spine'ler ve femurüzerinden yapıldı ve TSH düzeyi kemilüminesans yöntemi kullanılarak ölçüldü.İstatistiksel analizde Pearson korelasyonu, t - testi, tek yönlü varyans analizi (ANOVA),multiple regresyon analizi kullanıldı p < 0,05 anlamlı kabul edildi.Bulgular: Tiroid stimülan hormon düzeyi ile kemik mineral yoğunluğu arasında anlamlıbir ilişki saptanmadı (toplam lomber spinal (L1-4) T skoru için p = 0,11 ve toplam femurT skoru için p = -0,03). Toplam femur T skoru ile yaş, menopoz yılı, vücut kitle indeksiarasındaki ilişki anlamlı bulundu (p<0,05) Toplam lomber spinal (L1-4) T skoru ile vücutkitle indeksi, menopoz yılı ve hormon replasman tedavisi kullanım süresi arasındakiilişki anlamlı bulundu (p < 0,05). Doğal menopozda, cerrahi menopoza göre toplamfemur T skoru ölçümleri anlamlı olarak daha düşük bulundu (p=0,04). Toplam femur vetoplam lomber spinal (L1-4) T skoru ölçümlerinin her ikisi ile VKI arasında anlamlı birilişki saptandı (p < 0,01) (femur için r2 = 0,15, lomber vertebra spine için r2 =0,12).Sonuç: Postmenopozal sağlıklı kadınlarda kemik mineral yoğunluğu ile iroid stimülanhormon değerleri arasında anlamlı bir korelasyon saptanmadı. Tiroid stimülan hormondeğerinin kemik mineral yoğunluğunu göstermek için iyi bir marker olmadığı düşünüldü.Vücut kitle indeksi ile hem spinal hem de femur T skorları arasında anlamlı bir ilişkiolması ile birlikte vücut kitle indeksinin kemik mineral yoğunluğu için iyi bir göstergeolabileceği görüldü. Benzer çalışmalar menopozal ve premenopozal dönemlerde de yapılarakkemik mineral yoğunluğunun tiroid stimülan hormon düzeyi ve vücut kitle indeksiile ilişkisi daha geniş profilde değerlendirilebilir ve tekrarlayan ölçümlerle bu değişimdaha iyi gösterilebilir.Objective: To investigate the association between bone mineral density (BMD) andserum Thyroid-Stimulating Hormone levels in postmenopausal healthy women.Postmenopozal sağlıklı kadınlarda kemik mineral yoğunluğu-tiroid stimülan 2 hormon ilişkisiMaterial and method: 152 postmenopausal healthy women were included in ourstudy. We measured BMD at the lumbar spine (L1-L4) and femur using dual energy Xrayabsorptiometry and serum TSH concentration using chemiluminisence. Pearson'sCorrelation, t-test, analysis of variance (ANOVA), multiple regression analysis wereused in statistical analysis and p<0.05 was considered statistically significant.Results: There was no significant relation between TSH levels and BMD scores (forlumbar spine p = 0,11 and femur p = -0,03). A significant relation was determinedbetween the total femur T score and age, years since menopause, body mass index(VKI) (p<0.05 ). Also there was a significant relation between total lumbar spine T scoreand VKI, years since menopause, duration for hormone replacement therapy (p<0.05).Total femur T score was lower in natural menopause group than surgical menopausegroup (p=0.04). There was a significant correlation between VKI and both T scores (p <0.01) (for femur r2 = 0.15, for lumber spine r2 =0.12)Conclusion: We did not determine a significant relation between BMD and TSH. TSHvalue seems not a good predictive marker for detecting bone mineral density. Therewas a close relation between VKI and BMD, so we conclude that VKI is a usefulindicator for detecting BMD. Similar studies can be performed in premenopausal andmenopausal women to show the association between TSH, VKI and BMD

Fetal Circulatory Variation in an Acute Incident Causing Bradycardia

Umbilical artery\vein, middle cerebral artery, and ductus venosus Doppler velocimetry were performed at 33 weeks of gestation in the settings of an intrauterine growth restricted fetus during a heart rate deceleration. Interestingly, we recorded a sudden onset redistribution of fetal blood flow with fetal bradycardia. Spontaneous normalization of waveforms was observed once fetal heart rate returned to normal. Our case provides evidence to circulatory variation of a human fetus resulting from an acute incident causing bradycardia