Single-layer versus double-layer closure of the vaginal cuff with barbed sutures in laparoscopic hysterectomy

Objectives: The utilization of barbed sutures in laparoscopic hysterectomy has become popular among gynecologic sur­geons. Our aim was to compare the outcomes of two different techniques for closing the vaginal cuff with barbed sutures in laparoscopic hysterectomies. Material and methods: A retrospective study was completed on 202 patients who underwent laparoscopic hysterectomy for benign diseases at Istanbul Kanuni Sultan Suleyman Training and Research Hospital from April 2014 through June 2016. In group 1 (n = 139), a single-layer continuous suturing method was used; each bite contained the pubocervical fascia and vaginal mucosa anteriorly, and vaginal mucosa and rectovaginal fascia posteriorly. In group 2 (n = 63), a double-layer continuous suturing method was used; only vaginal mucosa was included in the first layer, and a second layer incorporated the pubocervical and rectovaginal fascias. Results: Patient characteristics (age, body mass index, parity, previous abdominal surgery, smoking, comorbidity) were similar between the two groups. There were also no differences in total operation time, length of hospitalization, intraop­erative complications, and perioperative change in hemoglobin levels. There was no difference between the two groups in terms of vaginal cuff dehiscence, which was the primary outcome measure of the study. Secondary outcome measures (presence of granulation tissue, spotting, cuff cellulitis) were also similar between the two groups.  Conclusions: We observed no differences in outcomes between single- or double-layer vaginal closure techniques with barbed sutures

Comparison of active vs. expectant management of the third stage of labor in women with low risk of postpartum hemorrhage: a randomized controlled trial

Objectives: To compare the ‘strictly’ active management protocol in women with low risk of postpartum hemorrhage using the expectant management protocol with respect to changes in hematologic parameters, uterotonics, blood transfusions, or additional interventions. Material and methods: A randomized controlled prospective trial in which 934 singleton parturients enrolled; 654 were randomly assigned to the active and mixed management groups. The primary outcome parameter was the reduction in hemoglobin concentrations due to delivery, and the secondary outcome parameters were changes in hemoglobin of more than 3 g/dL (ΔHb ≥ 3 g/dL), durations of the third stage of labor, need for additional uterotonic agents, blood transfusions, manual removal of the placenta, and surgical evacuation of retained products of conception. Results: The mean postpartum hemoglobin concentration was significantly higher (P = 0.04) in the active management group with a significantly lower reduction (P = 0.03). Falls of hemoglobin levels of more than 3 g/dL (ΔHb ≥ 3g/dL) were less common in the active management group though not significantly (P = 0.32). The mean duration of the third stage of labor was significantly (P < 0.001) shorter in the active management group. There was no significant difference between the two groups with regard to the need for additional uterotonic agents, uterine atony, blood transfusion, manual removal of the placenta, surgical evacuation of retained products of conception, and prolonged third stage of labor. Conclusions: Although active management of the third stage of labor was associated with higher postpartum hemoglobin levels, it did not influence the risk of ‘severe postpartum hemorrhage’ in women with low risk of postpartum hemorrhage

An Investigation of Anodic Aluminum Oxide for Electronic and MEMS Applications

In this dissertation, we have explored the use of a highly anisotropic film, porous anodic aluminum oxide (AAO) for electronic and MEMS applications. In the first part, AAO templates integrated with ferromagnetic material were studied for spiral inductors as a magnetic core. In the second part, the applications of AAO as a structure material, a mold for electroforming, and a sacrificial layer for MEMS applications were demonstrated. There is a strong demand for high performance and quality spiral inductors for radio frequency integrated circuits (RFIC). For this purpose, ferromagnetic materials are integrated into the spiral inductors to improve their performance and miniaturize their size. However, spiral inductors with ferromagnetic cores suffer from poor performance at high frequencies due to ferromagnetic resonance effect and eddy current loss occurrence in the layer of ferromagnetic materials. Since AAO templates are self-laminated and patterned, these drawbacks are solved by integration of ferromagnetic materials into the nanopores of AAO templates. By using nickel electroplated AAO templates as a magnetic core, we presented 21% enhancement of inductance value at 5 GHz with a quality factor of 14.48. High precision, high aspect ratio structures are needed for a variety of microelectromechanical systems (MEMS) applications. The most common technology for producing high aspect ratio structures for MEMS is deep reactive ion etching (DRIE). Despite the successes of the DRIE process for MEMS applications, it has several significant shortcomings which limit its adoption for many microstructure applications. The DRIE process is expensive, time consuming, requiring expensive dedicated etching equipment, and primarily useful for etching structures in silicon, making it unlikely to be used for non-silicon applications. Other technologies, such as LIGA and SU-8 are highly specialized, and while they can be used for making simple structures, they are generally not useful for producing MEMS-like structures. Since AAO templates are highly anisotropic and can be prepared at various thicknesses, deep vertical structures with high aspect ratios can be formed by a simple low cost wet etching process. Various types of MEMS structures were fabricated by using this technique

An Investigation of Anodic Aluminum Oxide for Electronic and MEMS Applications

In this dissertation, we have explored the use of a highly anisotropic film, porous anodic aluminum oxide (AAO) for electronic and MEMS applications. In the first part, AAO templates integrated with ferromagnetic material were studied for spiral inductors as a magnetic core. In the second part, the applications of AAO as a structure material, a mold for electroforming, and a sacrificial layer for MEMS applications were demonstrated. There is a strong demand for high performance and quality spiral inductors for radio frequency integrated circuits (RFIC). For this purpose, ferromagnetic materials are integrated into the spiral inductors to improve their performance and miniaturize their size. However, spiral inductors with ferromagnetic cores suffer from poor performance at high frequencies due to ferromagnetic resonance effect and eddy current loss occurrence in the layer of ferromagnetic materials. Since AAO templates are self-laminated and patterned, these drawbacks are solved by integration of ferromagnetic materials into the nanopores of AAO templates. By using nickel electroplated AAO templates as a magnetic core, we presented 21% enhancement of inductance value at 5 GHz with a quality factor of 14.48. High precision, high aspect ratio structures are needed for a variety of microelectromechanical systems (MEMS) applications. The most common technology for producing high aspect ratio structures for MEMS is deep reactive ion etching (DRIE). Despite the successes of the DRIE process for MEMS applications, it has several significant shortcomings which limit its adoption for many microstructure applications. The DRIE process is expensive, time consuming, requiring expensive dedicated etching equipment, and primarily useful for etching structures in silicon, making it unlikely to be used for non-silicon applications. Other technologies, such as LIGA and SU-8 are highly specialized, and while they can be used for making simple structures, they are generally not useful for producing MEMS-like structures. Since AAO templates are highly anisotropic and can be prepared at various thicknesses, deep vertical structures with high aspect ratios can be formed by a simple low cost wet etching process. Various types of MEMS structures were fabricated by using this technique

Conservative Treatment of a Gossypiboma Causing Uterine Wound Dehiscence

We present a rare case with gossypiboma following cesarean section which led to uterine wound dehiscence. A 30-year-old woman had been submitted to an emergency cesarean section 4 months previously at another hospital. Clinical and ultrasound findings revealed a large intra-abdominal mass and diffuse peritonitis. At laparotomy, a gossypiboma causing an abscess and uterine wound dehiscence with necrosis of the margins was detected. We performed repetitive wound debridements under broad-spectrum antibiotic cover and eventually resutured the incision. Although hysterectomy has so far been the choice of treatment in the literature once a uterine wound dehiscence had occurred, it was possible in this case to preserve the uterus

PRENATAL DIAGNSIS OF INTRACARDIAC HAMARTOMA AND TURNER SYNDROME

Turner syndrome is associated with a higher frequency of heart defects detected prenatally when compared to postnatal reports. The most common heart defects detected prenatally are hypoplastic left heart syndrome and coarctation of the aorta. We report a case involving a fetus at 16 gestational weeks with a septated cystic hygroma located on the neck and head, an interventricular septal mass, a hypoplastic left ventricle due to aortic stenosis, mitral stenosis, and a hypoplastic aortic arch with a karyotype of mos 45, X, [47 cells]/47, XXX [3 cells]. The autopsy findings confirmed our prenatal diagnosis with a final diagnosis of Turner syndrome and congenital cardiac vascular malformation

Stability analysis of second order pulsed Raman laser in dispersion managed systems

Wavelength tunable synchronous pulse sources are highly desirable for spectroscopy and optical diagnostics. The common method to generate short pulses in the fiber is the use of nonlinear induced spectral broadening which result in soliton shaping in anomalous dispersion regime. However, to generate ultra-short pulses, broadband gain mechanism is also required. In recent years, Raman fiber lasers have retrieved strong interest due to their capability of serving as pump sources in gain-flattened amplifiers for optical communication systems. The fixed-wavelength Raman lasers have been widely studied in the last years, but recently, much focus has been on the multi wavelength tunable Raman fiber lasers which generate output Stokes pulses in a broad wavelength range by so called cascaded stimulated Raman scattering. In this paper we investigate synchronous 1(st) and 2(nd) order pulsed Raman lasers that can achieve frequency spacing of up to 1000cm(-1) that is highly desired for CARS microscopy. In particular, analytical and numerical analysis of pulsed stability derived for Raman lasers by using dispersion managed telecom fibers and pumped by 1530nm fiber lasers. We show the evolution of the 1st and 2nd order Stokes signals at the output for different pump power and SMF length (determines the net anomalous dispersion) combinations. We investigated the stability of dispersion managed synchronous Raman laser up to second order both analytically and numerically. The results show that the stable 2(nd) order Raman Stokes pulses with 0.04W to 0.1W peak power and 2ps to 3.5ps pulse width can be achieved in dispersion managed system

Early and vigorous fluid resuscitation prevents acute renal failure in the crush victims of catastrophic earthquakes

This study analyzes the effects of fluid resuscitation in the crush victims of the Bingol earthquake, which occurred in May 2003 in southeastern Turkey. Questionnaires asking about demographic, clinical, laboratory, and therapeutic features of 16 crush victims were filled in retrospectively. Mean duration under the rubble was 10.3 +/- 7 h, and all patients had severe rhabdomyolysis. Fourteen patients were receiving isotonic saline at admission, which was followed by mannitol-alkaline fluid resuscitation. All but two patients were polyuric. Admission serum creatinine level was lower than and higher than 1.5 mg/dl in 11 and 5 patients, respectively. Marked elevations were noted in muscle enzymes in all patients. During the clinical course, hypokalemia was observed in nine patients, all of whom needed energetic potassium chloride replacement. Four (25%) of 16 victims required hemodialysis. Duration between rescue and initiation of fluids was significantly longer in the dialyzed victims as compared with non-dialyzed ones (9.3 +/- 1.7 versus 3.7 +/- 3.3 h, P < 0.03). Sixteen fasciotomies were performed in 11 patients (68%), nine of which were complicated by wound infections. All patients survived and were discharged from the hospital with good renal function. Early and vigorous fluid resuscitation followed by mannitol-alkaline diuresis prevents acute renal failure in crush victims, resulting in a more favorable outcome