Adnexal Torsion in the Third Trimester of Pregnancy: A Challenging Diagnosis

The incidence of adnexal torsion (AT) is reported 1 in 10000 births. AT is emergency condition in pregnancy, while the risk of late diagnosis is increased, in third trimester. Since it has been described as a severe complication after controlled ovarian hyper-stimulation for in vitro fertilization (IVF), it is more common in IVF pregnancies. This condition mainly occurs in the first trimester; it is rare during the late third trimester. Herein, we report a case of a 26-year-old woman, gravida 1, singleton pregnancy in the 30th week of gestation was presented to emergency department with 24-hour history of a stabbing pain because of AT. Removal of adnexa performed by laparotomy. The patient had labour pain and cervical dilatation at the 36th week of gestation and a healthy girl weighing 2,200 g was born by emergency caesarean section due to breech presentation

Economic and Social Impacts by Agricultural Irrigations in Turkey

In this study, we examined the Asartepe dam in Ankara province. We evaluated the economic and social effects of agricultural irrigation and selected main variables are determined as a agricultural usage of water, agricultural production, agricultural productivity, income and environment effects, social-cultural design, migration, economical conditions and etc. A significant portion of the material used in the survey, which was composed of any farming in the area of agriculture to data obtained by the enterprise survey. Survey by interviewing enterprises questionnaire forms have been filled out by going into enterprise. Data for the period from 2015 and 2016 production of agricultural enterprises are collected by questionnaire. In addition to the primary data obtained well as research findings that are previously made on the subject, which has benefited from the secondary data records and published by various organizations. Studies and surveys identified and then a set of selected enterprises are to be implemented by the Simple Random Sampling method (SRS). The information in the questionnaire data entry is made in the MS Office environment. The primary data analysis using SPSS and Eviews entered into the computer program and evaluated in the process of statistical tables are prepared. Keywords: Irrigation, Economic and Social effects, Turke

Clinical Outcomes and Effectiveness of Renal Artery Stenting in Patients With Critical Atherosclerotic Renal Artery Stenosis: Does it İmprove Blood Pressure Control and Renal Function Assessed by Estimated Glomerular Filtration Rate?

INTRODUCTION: Atherosclerotic renal artery stenosis (ARAS) is associated with uncontrolled hypertension and chronic renal failure. AIM: To evaluate the influence of gender and presence of chronic renal failure on the outcomes of percutaneous transluminal renal artery stenting (PTRAS) due to atherosclerosis. MATERIAL AND METHODS: A total of 28 ARAS patients underwent PTRAS and 36 stents were placed. Basal characteristics, laboratory data and blood pressure of patients were recorded. The differences between genders and improvement/deterioration of renal functions and blood pressure were analyzed. The predictors of outcomes were determined. RESULTS: Baseline characteristics were similar between men and women. Significant improvement of systolic and diastolic blood pressure control was achieved after PTRAS (153.04 ±17.07 mm Hg vs. 124.75 ±11.40 mm Hg, p = 0.001 and 92.50 ±10.76 mm Hg vs. 77.54 ±8.23 mm Hg, p < 0.001, respectively). Although mean estimated glomerular filtration rate (eGFR) and creatinine levels did not significantly improve at the 6-month follow-up visit compared to baseline values, of the 28 patients 13 (46.4%) patients had improvement of renal functions. CONCLUSIONS: Our results suggest that PTRAS is a safe procedure and may offer blood pressure control but beneficial effects of PTRAS on renal function may be anticipated in a selected group of patients, especially those with a low eGFR

Is routine echocardiography necessary after catheter ablation of atrioventricular nodal re-entrant tachycardia?

Background: The aim of this study was to investigate whether pericardial effusion (PE) detected by transthoracic echocardiography (TTE) was clinically significant and whether routine echocardiography was necessary after catheter ablation of atrioventricular nodal re-entrant tachycardia (AVNRT). Methods: A total of 202 patients with AVNRT were included in the study from three centers. The patients received basic electrophysiology-guided therapy, followed by radiofrequency ablation (RFA). All patients underwent TTE before and after RFA therapy. Results: The mean age of the study population was 46.2 &#177; 17.9 and 30.7% of the patients were male. Of these patients, six (3%) had postoperative PE, as detected by TTE. However, none of them had cardiac tamponade (CT). Four patients had minimal PE, while two had mild PE. Repeated TTE at one to three months showed resolved PE. No significant difference was seen among the patients with and/or without PE in terms of age, gender, the number of RFA applications, or RFA duration; however, significantly prolonged duration of fluoroscopy exposure was observed in the patients with PE. Conclusions: PE was detected in 3% of the patients by TTE and associated with prolonged duration of fluoroscopy exposure. However, no patients with moderate or large PE or cardiac tamponade were found in the study. In conclusion, we suggest that TTE should only be performed in the presence of clinical indications following ablation of AVNRT

Is metabolic syndrome related with coronary artery disease severity and complexity: An observational study about IDF and AHA/NHLBI metabolic syndrome definitions

Background: The aim of the present study was to assess the relation between metabolic syndrome (MS) and coronary artery disease (CAD) complexity, assessed by Syntax score (SS), and severity in non-diabetic patients with stable CAD who underwent coronary angiography, and to evaluate whether the MS defined by different definitions, including International Diabetes Federation (IDF) and American Heart Association/National Heart Lung Blood Institute (AHA/NHLBI) guidelines, similarly correlated with SS.Methods: The present study is cross sectional and observational with prospective inclusion of 248 consecutive patients (157 male) who underwent coronary angiography due to stable CAD.Results: The prevalence of MS was 54.4% according to IDF definition and 50.4% according to AHA/NHLBI definition. MS score according to IDF definitions (r = 0.446, p &lt; 0.001), MS score according to AHA/NHLBI definitions (r = 0.341, p &lt; 0.001) were moderately correlated with SS. In Fisher r to z transformation test the correlations of the presence of MS according to IDF and AHA/NHLBI definitions with SS were not statistically significant (p = 0.168, z = –1.38). The systolic blood pressure (p &lt; 0.001, B = 0.354, 95% CI = –0.308 to 0.228), diastolic blood pressure (p = 0.006, B = –0.194, 95% CI = –0.333 to –0.056), age (p = 0.014, B = 0.147, 95% CI = 0.029 to 0.264), left ventricular ejection fraction (p = 0.031, B = –0.150, 95% CI= –0.286 to –0.014), waist/hip circumference (p &lt; 0.001, B = 45.713, 95% CI = 23.235 to 68.1919) and log10 high density lipoprotein (p &lt; 0.001, B = –22.209, 95% CI = –33.298 to–11.119) were the independent predictors of SS in linear regression analysis.Conclusions: MS is associated with the presence and complexity of CAD. Besides the presence of discrepancy in the limits of waist circumference, both IDF and AHA/NHLBI criteria were similarly correlated with CAD complexity

Fetal conotruncal heart anomalies: Is fourchamber view sufficient in the prenatal screening?

Amaç: Bu çalışmada hastanemiz perinatoloji ünitesinde konotrunkalkalp anomalisi tanısı alan olguların kayıtları incelenerek prenataldönemde konotrunkal kalp anomalisi tanısına yönlendiren faktörlerindeğerlendirilmesi ve prenatal konotrunkal kalp anomalisitanısı ile ilgili farkındalığın artırılması amaçlandı.Yöntem: Ocak 2015 – Aralık 2016 tarihleri arasında Kanuni SultanSüleyman Eğitim ve Araştırma Hastanesi Perinatoloji Ünitesindekonotrunkal kalp anomalisi tanısı alan olguların yönlendirilmenedenleri, eşlik eden kalp dışı anomali ve kromozom anomalisivarlığı, olguların perinatal sonuçları ve postnatal dönemde tanı-nın doğrulanma başarısı değerlendirildi.Bulgular: Tüm konjenital kalp anomalilerinin içinde konotrunkalkalp anomalisi sıklığı %20.4 idi. Çalışmaya dahil edilen 101 olgunun37’sinde (%36.6) gebelik terminasyonu gerçekleştirildi. ‹ntrauterinfetal ölüm 5 (%5) olguda gözlendi. Olguların %26.7’sindekromozom anomalisi ve %34.7’sinde kalp dışı ek yapısal anomalisaptandı. Canlı doğan 59 (%58.4) olgunun 52’sinde (%88.1) prenataltanı doğrulandı. Olguların yalnızca %27.7’sinde dört oda görünümününanormal olduğu saptandı.Sonuç: Dört oda görünümünün konotrunkal kalp anomalilerindesıklıkla normal olması nedeni ile bu anomalilerin prenatal tanı sıklığının artırılabilmesi için temel fetal kardiyak tarama programlarında üç damar ve üç damar trakea kesitleri rutin olarak görüntülenmelidir.Objective: In this study, we aimed to assess the factors leading to the diagnosis of conotruncal heart anomaly in the prenatal period by reviewing the records of the cases which were diagnosed with the conotruncal heart anomaly in our perinatology unit, and to raise the awareness of the diagnosis of prenatal conotruncal heart anomaly. Methods: The referral reasons, the presence of concomitant non-cardiac anomaly and chromosomal anomaly, perinatal outcomes of the cases and the confirmation success of the diagnosis at postnatal period of the cases which were diagnosed with the conotruncal hearth anomaly at the Perinatology Unit of Kanuni Sultan Süleyman Training and Research Hospital between January 2015 and December 2016 were evaluated. Results: Among all congenital cardiac anomalies, the incidence of conotruncal heart anomaly was 20.4%. The termination of pregnancy was performed in 37 (36.6%) of 101 cases included in the study. Intrauterine fetal death was observed in 5 (5%) cases. Chromosomal anomaly and non-cardiac additional structural anomaly were found in 26.7% and 34.7% of the cases, respectively. Prenatal diagnosis was confirmed in 52 (88.1%) of 59 (58.4%) cases which born alive. It was found that four-chamber view was abnormal in only 27.7% of the cases. Conclusion: Three vessels (3V) and three vessels trachea (3VT) views should be displayed routinely in basic fetal cardiac screening in order to increase the prenatal diagnosis frequency of these anomalies as four-chamber view is mostly normal in conotruncal heart anomaly

Does MESNA application make sense in chronic otitis media surgery?

We have read with pleasure the article by Kalcioglu MT. et al. [1] which presents very important clinical observations. We would like to make some comments on this problem, basing on our experience and the literature review. MESNA (sodium 2-mercapto-ethane sulphonate) is a synthetic sulfur compound that produces mucolysis by disrupting disulfide bonds of the mucus polypeptide chain. MESNA can be used during ear surgeries (cholesteatoma or atelectasis), to make the dissection of keratinocyte layers [2,3]. But a question remains over the possible mechanism of action of MESNA in chronic otitis media. Therefore, we would like to share our opinion in this subject