Uterosacral Nerve Ablation and Presacral Neurectomy in the Treatment of Chronic Pelvic Pain in Women

Chronic pelvic pain affects 2–24% of women in the reproductive period. There are various causes of chronic pelvic pain in women including gynecologic, urologic, gastrointestinal, and musculoskeletal problems. The treatment of pain is directed toward the underlying pathology. However, in some cases, no pathology can be found, and sometimes, more than one underlying pathology may be found in the same patient. Surgical denervation methods may be used in the treatment of chronic pelvic pain in women including uterosacral nerve ablation and presacral neurectomy. Uterosacral nerve ablation has been used as a treatment method for uterine causes of pelvic pain. It has been used widely in the treatment of dysmenorrhea- and endometriosis-related pain. But recent randomized studies and meta-analysis have questioned the effect of uterosacral nerve ablation in the treatment of chronic pelvic pain. Presacral neurectomy involves damage of the uterine sympathetic innervation at the level of superior hypogastric plexus. It is effective in the treatment of midline pelvic pain. It has been found to be more effective than laparoscopic uterosacral nerve ablation in a randomized study. The method, effect, and studies evaluating uterosacral nerve ablation and presacral neurectomy will be discussed in this chapter

Adjustable Midurethral Slings in the Treatment of Female Stress Urinary Incontinence

Midurethral slings have become the gold standard in the surgical treatment of stress urinary incontinence (SUI). However, despite the high cure rates with these procedures, nearly 20% of the patients are incontinent after surgery. On the other hand, in a small percentage of women, voiding dysfunction may develop after surgery. Adjustable slings have been advocated in patients who fail an anti-incontinence surgery or have intrinsic sphincter deficiency (ISD) or in order to prevent postoperative voiding dysfunction. There are various options of adjustable slings according to the surgical route or the type of mesh used

Leiomyoma of the extrapleural chest wall: an atypical location

Tumours of the thoracic wall constitute a wide histological spectrum. However, the literature includes very few reports of a leiomyoma occurring at the extrapleural chest wall. In this report we present our experience together with a review of the literature. Our patient was a 33-year-old woman who was diagnosed with leiomyoma of the chest wall and treated accordingly and successfully. To the best of our knowledge, this is the seventh report in the literature defining the clinical entity

Management of Sternal Segment Dislocation in a Child with Closed Reduction

Trauma may lead to sternal fracture or dislocation. Dislocation of a sternal segment in the childhood period is very rare as for sternal fractures in children. There are only six case reports regarding the issue in the literature. Additionally, there is not an established consensus for the treatment of the pathology. In this paper we present traumatic dislocation of a sternal body segment in a 10-year-old child who was successfully managed conservatively by closed reduction together with the review of the literature. Surgical treatment is not necessary especially in acute cases. Pathology may be treated with closed reduction. Callus formation usually supports the dislocated part of the sternum in time

Coronary Bypass Surgery in a 105-Year-Old Patient with Cardiopulmonary Bypass

Coronary artery bypass grafting is one of the routine daily surgical procedures in the current era. Parallel to the increasing life expectancy, cardiac surgery is commonly performed in octogenarians. However, literature consists of only seldom reports of coronary artery bypass grafting in patients above 90 years of age. In this report, we present our management strategy in a 105-year-old patient who underwent coronary artery bypass grafting at our institution

Kounis Syndrome together with Myocardial Bridging Leading to Acute Myocardial Infarction at Young Age

Kounis syndrome, also named as “allergic angina syndrome,” is a diagnosis in which exposure to an allergen causes mostly coronary spasm and rarely plaque rupture, resulting in ischemic myocardial events. Myocardial bridging is defined as an intramural segment of a coronary artery and its systolic compression by overlying fibers. Myocardial bridging generally has a benign prognosis and mostly affects the mid portion of left anterior descending coronary artery. However, some cases with myocardial ischemia, infarction, and sudden death have also been reported. A 17-year-old boy presented to the clinic with acute anterolateral myocardial infarction after having first dose of clindamycin and diagnosed as Kounis syndrome. Further diagnostic workup of the patient showed myocardial bridging at the mid left anterior descending artery. In this report, we present the combination of Kounis syndrome and myocardial bridging leading to myocardial infarction at young age

A Rare Dermatologic Disease in Pregnancy: Rosacea Fulminans- Case Report and Review of the Literature

BACKGROUND: Rosacea is a common, chronic disorder that can present with a variety of cutaneous or ocular manifestations. Skin involvement primarily affects the central face, with findings such as persistent centrofacial redness, papules, pustules, flushing, telangiectasia, and phymatous skin changes. The pathways that lead to the development of rosacea are not well understood. The relationship of pyoderma faciale (also known as rosacea fulminans) to rosacea also is uncertain. We aimed to write this article with the aim of showing how a pregnant patient who has been aggravated by the degree of lesions on the face during the first trimester of pregnancy is treated and to show what is in the literature in this issue.CASE REPORT: A 22-year-old woman complained of painful erythema, papules and pustules on the face. She had fever and malaise during the sixth week of her first pregnancy and a history of the mild eruption and seborrhea before her pregnancy with flaring over the preceding 4 weeks. Dermatologic examination revealed red erythema of all involved facial areas; the lesions consisted of papules, pustules and nodules. The case was diagnosed as rosacea fulminans (pyoderma faciale) by these findings. In the literature, there are some effective therapeutic options such as retinoids, tetracyclines, antiandrogenic contraceptives, and dapsone and these were not used because they are contraindicated in pregnancy. Amoxicillin-clavulanic acid 1 gr/day, wet compresses, and a fusidic acid cream were started. After the activity of the disease had been suppressed for 10 days, antibiotic was stopped, and the other treatment options were applied topically for the next month. One month after cessation of treatment, the lesions had disappeared with only mild erythema remaining. There was minimally flushing on the face and no telangiectasia.CONCLUSION: In conclusion, there is no substantial evidence as to the mechanism by which pregnancy may trigger this conditioner whether the gender of the fetus influences the development of rosacea fulminans, but is generally accepted that hormonal changes in pregnancy play an important role. The pathogenesis of rosacea fulminans remains uncertain, but it is obvious that the further basic and clinical research is required to optimise the management of this rare facial dermatosis

Contraception counselling during gynecology visit — does a questionnaire help?

Objectives: Women are at risk of unplanned pregnancy and inappropriate choice of contraception if not given effectivecontraception counselling. We aimed to understand the contraceptive needs of women, improve effective contraceptioncounselling promoting modern contraception methods during gynecology outpatient visit using a contraception counsellingquestionnaire.Material and methods: All reproductive-age women over 18 were given Contraception Counselling Project Form to fill inwhile in the waiting room. The form consisted of 15 questions evaluating patients’ characteristics and contraceptive methodused. Physicians evaluated these forms during the examination and an appropriate method was chosen. Forms of pregnant,postmenopausal and sexually inactive patients as well as forms with more than one answer missing were excluded.Results: 778 questionnaires were accepted for evaluation. 340 women (43.8%) used modern contraception, 112 (14.4%)used interrupted coitus, 3 (0.4%) used calendar method. 738 women could be given adequate contraception counsellingby the physicians. 215 women among 323 women (66.5%) who did not use modern contraception and did not desirepregnancy, were convinced to use modern contraception and 103 (91.9%) among 112 women who used interruptedcoitus for contraception were convinced to use modern contraception. There was a significant relationship between age,education, working state, parity, number and type of delivery, previous OCP usage, resources of contraception and thepreferred contraception method.Conclusions: More than half the women preferred to use modern contraception methods by means of contraceptioncounselling questionnaire. Women’s backgrounds significantly affected their choice of contraception method

Mean platelet volume is elevated in patients with patent foramen ovale

INTRODUCTION: Platelets play a major role in thromboembolic events. Increased mean platelet volume (MPV) indicates higher platelet reactivity and also a tendency to thrombosis. Patent foramen ovale (PFO), persistence of the fetal anatomic shunt between right and left atria, is strongly associated with cryptogenic stroke. The aim of this study is to determine the relationship between MPV and PFO and if such an association exists, whether higher MPV levels may require antiplatelet therapy before a thromboembolic event happens, together with a literature review. MATERIAL AND METHODS: Thirty patients (15 women, 15 men), free of any cerebrovascular events, were diagnosed with PFO by transesophageal echocardiography (TEE), enrolled as the study group. Thirty consecutive patients (16 women and 14 men), who were diagnosed as normal in TEE, were enrolled as the control group. These two groups were compared according to MPV and anatomical features of the right atrium. RESULTS: There was no significant difference between study and control groups in clinical features and also no difference was observed in platelet counts; however, MPV in the PFO group was significantly higher than the control group (8.38 ±0.93 fl and 7.45 ±0.68 fl respectively). CONCLUSIONS: Our results indicate that elevated MPV may be detected in patients with PFO. This might be one of the explanations for the relationship between PFO and cryptogenic stroke; however, larger cohorts are warranted in order to define further mechanisms