Review of a Challenging Clinical Issue: Acute Biliary Pancreatitis During Pregnancy

Acute pancreatitis is an inflammatory condition of the pancreas most commonly caused by gallstone. Approximately 70% cases of acute pancreatitis during pregnancy are secondary to gallstones or sludge. Acute pancreatitis is a rare complication with a reported incidence of one per 1.500-4.500 pregnancies. Gallstones cause bile duct obstruction and pancreatic hyperstimulation. These processes lead to increased hydrostatic pressure, trypsin reflux and activation of digestive enzymes within the pancreas and cause autodigestion of pancreas, followed by local inflammation. During pregnancy, the steroid hormones of pregnancy affect the gallbladder motility and bile content. Progesterone induces gallbladder smooth muscle relaxation and estrogens increase bile cholesterol level, enhancing bile stasis. The clinical symptoms include pain in the right upper abdominal area and/or epigastric area, which can radiate to the right flank, scapula and shoulder, anorexia, nausea, vomiting, dyspepsia, low-grade fever and sinus tachycardia, hyperventilation and smell of acetone in the breath. The diagnosis of acute pancreatitis in pregnancy is confirmed by laboratory investigations and imaging methods. The management of acute biliary pancreatitis during pregnancy is similar on a large scale

Single-center Experiences of Ovarian Sex Cord Stromal Tumors

Objective:The aim of this study is to examine the sex cord stromal tumors of the ovary operated in our clinic in the last 4 years and to contribute to the literature on this rare tumor.Method:The clinical and laboratory findings of 34 patients with pathological diagnosis of ovarian sex cord stromal tumor, who were operated in our obstetrics and gynecology clinic between 2016 and 2020, were evaluated retrospectively. Pathological diagnoses were classified and other accompanying pathologies and complaints were evaluated for each type.Results:Ovarian sex cord stromal tumors usually attract attention with the peripheral effects of the hormones produced by the tumor tissue. They rarely come to very large sizes. They are mostly benign. When the hormone estrogen is produced, accompanying endometrial pathologies should not be overlooked. Hormonal complaints in patients improve dramatically after surgery both clinically and laboratory. Oncological follow-up is required following diagnosis in some malignant types.Conclusion:If ovarian sex cord stromal tumor is suspected, preoperative blood androgen levels, inhibin A, and alpha feto protein (AFP) should be evaluated. In addition, ultrasonographic and, if necessary, endometrial histopathological evaluations are important for patient follow-up as well as diagnosis. The patient's fertility desire and age should be considered during treatment

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels >2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p < 0.001).DiscussionQuestioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases. Trial RegistrationClinicaltrials.gov NCT04120168

Review of a challenging clinical issue: Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a reversible pregnancy-specific cholestatic condition characterized by pruritus, elevated liver enzymes, and increased serum bile acids. It commences usually in the late second or third trimester, and quickly resolves after delivery. The incidence is higher in South American and Scandinavian countries (9.2%-15.6% and 1.5%, respectively) than in Europe (0.1%-0.2%). The etiology is multifactorial where genetic, endocrine, and environmental factors interact. Maternal outcome is usually benign, whereas fetal complications such as preterm labor, meconium staining, fetal distress, and sudden intrauterine fetal demise not infrequently lead to considerable perinatal morbidity and mortality. Ursodeoxycholic acid is shown to be the most efficient therapeutic agent with proven safety and efficacy. Management of ICP consists of careful monitoring of maternal hepatic function tests and serum bile acid levels in addition to the assessment of fetal well-being and timely delivery after completion of fetal pulmonary maturity. This review focuses on the current concepts about ICP based on recent literature data and presents an update regarding the diagnosis and management of this challenging issue

Examination of basic motor skills in children and adolescents

Aim of the study: The aim of this study was the investigation of basic motor skills in 5–14-year-old boys and girls.Materials and Methods: A total of 842 primary school children, 421 boys and 421 girls, participated in the study. 13.3% of the participants were 5–6 years old, 29.5% were 7–8 years old, 21.5% were 9–10 years old, 16.4% were 11–12, and 19.4% were 13–14 years old. The balance skills of the participants were measured with the (Körperkoordinationstest für Kinder) KTK test.Findings: When the classification of children according to KTK defining classes is examined, 40.7% are very good. When the children’s KTK Backward Balancing scores were examined, a statistically significant difference was found between gender and age groups (p < 0.05). Girls between the ages of 5–6 and 7–8 years had a higher score for KTK backward balance. KTK Total scores were examined according to the Body Mass Index groups, when the total scores of KTK were compared, the lowest scores were in the obese group.Conclusion: According to the study results, age is an essential factor for balance skills. As the age increased, the overall scores of the KTK increased. It was determined that girls’ KTK backward balancing scores were higher than boys. According to BMI results, the balance performances of obese children were found to be lower than the other groups. This difference can be explained by the negative effect of obesity in this age group. According to these results, it may be recommended to observe and improve the balance performances of obese children

A Rare Case of a Gunshot Injury: No Urinary Symptoms with a Voided Bullet

Gunshot injuries to the abdominal cavity are cases of emergency which can be life-threatening depending on the organ/s affected. High-velocity penetrating injuries can cause both a penetrating injury to the organs on its’ route or can cause blast injury nearby. In most of the cases, the bullet can be found and the defect can be repaired intraoperatively. Here, we present a rare case of a patient with an intrabdominal penetrating gunshot wound with no organ injury, including the bladder, who voided the bullet spontaneously 30 days after the injury