Comparison of conservative and radical surgery in the management of placenta previa percreta

Objective We aimed to compare the uterine sparing (US) surgery and hysterectomy for placenta previa percreta (PPP) management. Methods Data from PPP patients with anterior invasion who underwent US surgery and caesarean hysterectomy were retrospectively analyzed. The clinical and surgical outcomes of patients with PPP were compared according to the type of surgery. Results The mean intraoperative blood loss was lower in US surgery group than in caesarean hysterectomy group (1227.78±204.80 ml vs 1442.22±125.68 ml; p=0.017). The hemoglobin drop was also significantly lower in the patients with US surgery (1.87±0.68 g/dl vs 2.88±1.04 g/dl; p=0.026). Moreover, the mean total transfusion rate was also significantly lower in the patients with US surgery (1.33±0.87 U vs 2.33±0.71 U; p=0.016). Conclusion Uterine sparing surgery reduces intraoperative blood loss and transfusion rate in PPP patients with anterior placental invasion compared to hysterectomy. The temporary blockage of bilateral uterine and uteroovarian arteries with Satinsky clamps may potentially contribute to the success of US surgery

Organophosphate Poisoning in Pregnant Patients: A Case Report

Organofosfata maruz kalma veya zehirlenme kadınların tarım işçisi olarak çalıştığı gelişmekte olan ülkelerde yaygın olarak görülmektedir. Organofosfatların toksisitesi kolinesteraz aktivitesinin inhibisyonu ve reseptör bölgesindeki asetilkolin etkisinin uzaması ile kendini gösterir. Semptom ve bulgular nikotinik veya muskarinik reseptörler hangisinin daha çok etkilendiğine bağlıdır. Gebelikte organofosfat zehirlenme vakaları oldukça nadirdir. Bu olgu sunumunda iki saattir devam eden baş dönmesi, tekrarlayan bulantı kusma, hipersalivasyon ve görme keskinliğinde azalma şikayetleriyle hastanemize başvuran 26 yaşındaki hamile kadın hastayı bildirmeyi amaçladık. Alınan anamnezinde şikayetlerinin ilaçlanmış sebze yendikten sonra başladığı öğrenildi. Hastada organofosfat zehirlenmesinde sıklıkla karşılaşılan sekresyon artışı ve bilateral miyosiz mevcuttu. Organofosfat zehirlenmesi olduğu klinik ve laboratuvar olarak teyid edilen hastaya intravenöz atropin tedavisine başlandı ve oksim tedavisi uygulanmadı. Üç gün içerisinde kliniği düzelen hasta şifayla taburcu edildi ve beş hafta sonra normal vajinal doğum gerçekleşti. Bebekte organofosfat ve atropine maruz kalma belirti ve bulguları gözlenmedi. Gebe hastalarda organofosfata zehirlenmelerine bağlı oluşan spontan abortus vakaları bildirilmiştir. Gebelikte organofosfat zehirlenmelerine bağlı olarak hem annede hem fetüste ciddi etkilere neden olabilmektedir. Bununla birlikte, gebeliğin devamını sağlamak üzerine kesin bir strateji bulunmamaktadır. Gebelerde atropin ile tedavi organofosfat zehirlenmelerinin klinik etkilerini geri döndürmekte başarılı olabilmektedir.Organophosphate exposures and poisoning are common and generally under-reported in developing countries where women are mainly involved in agricultural work. Toxicity of organophosphates is due to inhibition cholinesterase activity and prolonging the effects of acetylcholine in the receptor site. Symptoms and findings depend on the equilibrium between the nicotinic and muscarinic receptors. Cases of organophosphate poisoning in pregnancy are rare. In this case report we reported that a 26-year-old pregnant woman who presented at the our hospital with two hour history of dizziness, recurrent vomiting, increased saliva and loss of visual acuity. These symptoms started after eating vegetable which sprayed with Organophosphate. Our patient's signs of organophosphate toxicity included increased secretion and bilateral miosis. After clinical and laboratory confirmation for organophosphate poisoning, the patient responded to intravenous doses of atropine; oximes were not applied. Although She recovered within 3 days and delivered a healthy baby 5 weeks later by spontaneous vaginal delivery after being discharged. The child showed no signs or symptoms of organophospate and atropine exposure. Organophosphate poisoning that occurs due to spontaneous abortion was reported in pregnant patients. Poisoning during pregnancy may result in serious adverse effects for both mother and the fetus or neonate. Nonetheless, no definite strategy focused on maintaining pregnancy. Maternal treatment with atropine was successful in reversing the organophosphate toxicity

Evaluation of serum M30 and M65 activity in patients with stage-I endometrial cancer

We aimed to analyse the prognostic value of serum oxidative stress parameters and apoptotic markers of serum M30/65 levels in endometrial cancer patients. Serum M30/65 levels and oxidative stress parameters were evaluated in 52 women with stage I endometrial cancer (n = 26) and a control group of healthy females (n = 26). The total antioxidant status (p = .002), oxidative stress index (p = .003) and serum M30/65 levels (p < .001) were significantly higher in women with stage-I endometrial cancer in comparison to the control group. Furthermore, serum M30/65 levels were significantly lower on postoperative day 8, compared to preoperative levels (p = .001 and p < .001, respectively), in the endometrial cancer group. Although impaired apoptotic activity plays a crucial role in the aetiopathogenesis of endometrial cancer, oxidative stress may be instrumental in malignant transformation. We concluded that measurement of M30/65 levels would be beneficial in the follow-up of women with endometrial cancer.Impact Statement What is already known on this subject: Although M30 has been evaluated as a marker of apoptosis in tissue samples from women with endometrial cancer (EC), no previous studies have simultaneously analysed serum M30 and M65 levels and oxidative stress in patients with stage-I EC. What the results of this study add: Total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI) and serum M30/65 levels were significantly higher in women with stage I EC in comparison to the control group. Furthermore, serum M30/65 levels were significantly lower on postoperative day 8, compared to preoperative levels, in the EC group. The fact that pre-operative M30/M65 levels were higher than the post-operative levels may be very important in early-stage EC What the implications are of these findings for clinical practice and/or further research: Although impaired apoptotic activity plays a crucial role in the aetiopathogenesis of EC, oxidative stress may be instrumental in malignant transformation. The fact that serum M30/M65 levels decreased in accordance with the reduction of post-operative tumour burden led us to conclude that measurement of M30/65 levels would be beneficial in the follow-up of women with EC

A successful method for severe gestational thrombocytopenia: A rare case study

In a normally progressing pregnancy, especially in thethird trimester thrombocyte numbers reduce by about10%. The reason for this reduction is thought to be thehemodilution and increased consumption in pregnancy.Generally, it is recognized by chance during routine bloodcount and it is the second most common hematologicanomaly during pregnancy. Once thrombocytopenia isdiagnosed in pregnancy, research must be done to determinewhether it is a life-threatening risk factor in terms ofthe mother-fetus-infant. The majority of thrombocytopeniaseen in pregnancy is gestational thrombocytopenia. Thispaper examines an active labor, normal birthing case witha thrombocyte count of 7916/mm3.Key words: Gestational thrombocytopenia, idiopathicthrombocytopenic purpura, normal birt

Management Of Misplaced Intrauterine Device And Complications

Uterin perforation is the one of the most important complication of intra-uterine deviceapplication. We aimed to discuss management and complications of lost intrauterine device inthe case series of 10 patients who are operationally treated with this diagnosis, betweenSeptember 2007 and June 2009 in our clinic. In the algoritm we described ultrasonography keepit’s importance and there is usually no need for other radiologic techniques