Tranexamic Acid: A Potential Adjunct to Resectoscopic Endometrial Ablation

Abnormal uterine bleeding (AUB) is a substantial cause of ill health in women worldwide. In this study, our aim was to evaluate the effectiveness of endometrial ablation using a modified urologic resectoscope along with tranexamic acid in AUB. Sixty patients were enrolled in this study. All patients underwent resectoscopic surgery. Patients were randomly divided into two groups. Group 1 (n = 30) received 500 mg of tranexamic acid. Group 2 (n = 30) served as the control group and underwent surgery without the administration of tranexamic acid. Total pictorial blood loss assessment chart (PBAC) scores were significantly lower postoperatively (152.14 +/- 9.65 versus 6.6 +/- 0.90; P 15 was lower in the tranexamic group (11 versus 17), but the differences were not statistically significant (P > 0.05). AUB is a complex disease that may need repeated treatments. In expert hands, the treatment rate of resectoscopic surgery seems acceptable. However, some patients may require additional interventions, like repeated surgery, hysterectomy, or a drug therapy in the long run. Introduction of tranexamic acid as a potential adjunct to rollerball endometrial ablation may present an interesting option that requires additional well-designed studies before firm conclusions can be made

The associtation between aberrant right subclavian artery and trisomy 21 in a tertiary center in Turkey

Objectives: We hoped to reveal the frequency of Aberrant Right Subclavian Artery (ARSA) and to find the relationship of isolated/non-isolated ARSA with chromosomal defects and other fetal congenital heart diseases (FCHD) in a heterogeneous population. Material and methods: This was a retrospective cohort study conducted between December 2015 to September 2018. Women admitted for routine ultrasound examination or referred to our hospital for a suspected fetal anomaly were underwent detailed fetal anomaly ultrasonography scan and tested for the presence of ARSA. Results: ARSA was detected in 27 patients and an isolated finding in 13 (48%) cases. Among 13 cases with isolated ARSA, trisomy 21 was diagnosed in 1 case. In the non-isolated group (n: 14, 52%), five cases presented with trisomy 21. There was no significant difference of trisomy 21 frequency between isolated and non-isolated groups (7.6% vs 35.7%, p = 0.08). In 3 patients, FCHD was diagnosed and 2 of them had trisomy 21. Conclusions: Our study shows that ARSA can be the only marker in trisomy 21. The examination of the subclavian artery must be a part of the fetal anomaly ultrasonography. Detecting an ARSA should increase the attentiveness of the sonographer to investigate for the other markers of trisomy 21. In the existence of other findings, invasive diagnostic procedures should be offered to the patients, whereas in cases that arsa is the only finding, other risk factors should be investigated to offer karyotyping or cell-free DNA analysis

Evaluation of inflammatuar response in hysterectomies: a retrospective study in Kocaeli, Turkey

Objectives: The authors aimed to detect the inflammatory marker changes in laparoscopic hysterectomy (LH) and abdominalhysterectomy (AH) and to determine whether oophorectomy affected the results.Material and methods: The patients who underwent LH and AH with or without oophorectomy between 2018 and2019 were identified as two groups. The records of patients were reviewed retrospectively. Preoperative and postoperativein the first 24 hours hematocrit (HCT), hemoglobin (HB), white blood cell (WBC), platelet-lymphocyte ratio (PLR), andneutrophil-lymphocyte ratio (NLR) values were compared.Results: WBC, NLR, and PLR were statistically increased, and HB and HCT were decreased in all groups in the postoperativeperiod. However, all changes were more prominent in the AH group than in the LH group. In other words, in the postoperativeperiod, there were fewer changes in the inflammatory markers WBC, NLR, and NLR in the LH group. Oophorectomydid not affect these results.Conclusions: LH, as in other laparoscopic operations, was associated with lower inflammatory response. The additionof oophorectomy did not increase inflammation in either AH or LH. Clinical Trials registration number is NCT04184765

Pektus ekskavatumun prenatal tanısı

Pektus ekskavatum (PE) manubrium sterninin alt kısmının ve ksifoid çıkıntının içe doğru çöküntüsü olarak tanımlanır. PE'li hastaların esas problemi torasik boşluğun daralmasına bağlı gelişen kardiyopulmoner morbiditedir. Günümüze kadar bu deformitenin prenatal tanısı sadece bir kez ve Down sendromu ile ilişkili olarak bildirilmiştir. Biz, ikinci trimester fetal anatomik tarama sırasında tespit ettiğimiz bir diğer olguyu sunuyoruz. Pektus şiddeti indeksi, bu hastalar için postnatal dönemde kullanılan bir indekstir; fakat bunun prenatal döneme uyarlanması ilk kez bizim olgumuzda gerçekleştirildi.Pectus excavatum (PE) is the depression of the lower part of manubrium sterni and xiphoid process. The main problem of PE depends on the cardiopulmonary morbidity caused by the narrowing of the thoracic space. To date, prenatal diagnosis of this deformity has been reported only once and was associated with Down syndrome. We present another case which we diagnosed as PE during a second-trimester fetal anatomic scan. The pectus severity index is used for these patients in postnatal life; however, prenatal adaption of this index is reported for the first time in our case

Pregnancy and Toxoplasma Infection

Toksoplazma gondii isimli bir protozoanın sebep olduğu toksoplazmozis enfeksiyonu gebelikte fetal anomalilere ve düşük-ölü doğum gibi olumsuz perinatal sonuçlara yol açabildiği için oldukça önemlidir. Özellikle çiğ et, kontamine yiyeceklerle bulaşan bu enfeksiyonun prenatal dönemde uygun zamanda, doğru tanı ve yönetimi ile ciddi nörolojik sekel riski azaltılabilmektedir. Dolayısıyla gebe takibi yapan klinisyenlerin bu enfeksiyonu derinlemesine bilmesi önem arz etmektedir. Bu amaçla makalemizde, toksoplazma enfeksiyonun prenatal dönemde tanısı, komplikasyonları ve tedavisini özetlemeyi amaçladıkToxoplasmosis is an infectious disease caused by a protozoa named Toxoplasma gondii. It is a very important disease because it is related to fetal anomalies and poor perinatal outcomes like abortus and stillbirth. It spreads via uncooked meat and contaminated food. Timely and appropriate treatment and management of this infection prenatally reduces the risk of serious neurological sequelae. Therefore it is crucial that clinician who takes care of pregnant women know this infection deeply. In this review we aimed to summarize the prenatal diagnosis, complications and treatment of toxoplasma infectio

Thrombocytopenia in Pregnancy

Trombositopeni gebeliklerin %7-10'unda saptanan, trombosit sayısının düşüklüğüyle karakterize bir durumdur. Gebelikte görülen trombositopenin en sık sebebi gestasyonel trombositopenidir. Bu hastalarda trombositopeni genelde hafif olduğundan semptom görülmez. Tanı çoğunlukla bağ dokusu hastalıklarının,ilaç etkilerinin, obstetriyle ilişkili sebeplerin dışlanmasıyla konulur. Erken gebelik haftalarında görülen trombositopenin etyolojisinde en fazla otoimmun sebepler rol alır. Preeklampsi,HELLP sendromu gibi obstetriyle ilişkili nedenlere ikincil gelişen trombositopeniler ise her zaman akılda tutulmalıdır. Bu durumların varlığında çoğu zaman doğum gerçekleşmeden trombositopeni düzelmeyecektir. Klinisyen; tedavi gerektirmeyen trombositopenilerle, annenin fetusun hayatını tehdit eden ve bu nedenle acil ve ciddi bakım gerektiren trombositopeni sebepleri arasında ayırımı iyi yapabilmelidir.Thrombocytopenia, which is encountered in 7-10% of pregnancies is characterized with decreased number of thrombocytes. The most frequent cause of thrombocytopenia during pregnancy is gestational thrombocytopenia. These patients usually do not have symptoms due to mild thrombocytopenia. The diagnosis is usually established by excluding connective tissue disorders, drug effects and obstetric causes. The etiology of thrombocytopenia during early pregnancy is most frequently due to autoimmune causes. Thrombocytopenia secondary to obstetric causes like preeclampsia, HELLP syndrome should always be kept in mind. Under these circumstances the thrombocytopenia will not resolve unless pregnancy is terminated. The clinician should be able to distinguish between thrombocytopenia that does not require treatment and the causes that require emergent and serious medical interventions

Uterusun diffüz kavernöz hemanjiyomunun antenatal sonografik tanısı

Uterusun kavernöz hemanjiyomu, endometriyal polip veya myoma benzeyen bir kitle şeklinde ortaya çıkabileceği gibi (lokalize tip), uterus duvarında normal myometriumun yerini alan geniş vaskuler boşluklar şeklinde de (diffüz tip) görülebilir. Genellikle asemptomatiktir, ancak jinekolojik pratikte menometroraji ve infertilite şeklinde, obstetrik hastalarda ise intrapartum veya postpartum kanama ya da tromboembolizm şeklinde ortaya çıkabilir. Diffüz kavernöz hemanjiyom, türbülan akım içeren kavernöz boşluklarla dolu kalınlaşmış uterus duvarı görüntüsüyle, rutin antenatal ultrasonografi incelemesi sırasında nadiren saptanabilir. Fetusta ağır gelişme geriliği olan, sezaryen sırasında ve sonrasında hemorajik komplikasyon gelişmeyen ve antenatal dönemde tanısı koyulan bir diffüz kavernöz hemanjiyom olgusu sunmaktayız.Cavernous hemangioma of the uterus may be either localized presenting as an endometrial polyp or a uterine mass mimicking myoma, or as a diffuse mass in which most of the uterine wall is composed of enlarged vascular spaces replacing the normal myometrium. It is usually asymptomatic, but can present with menometrorrhagia and infertility in gynecological practice, and intra or postpartum bleeding or thromboembolism in obstetric patients. Diffuse cavernous hemangioma can be seldom, identified during routine antenatal ultrasonographic examination as the thickened uterine wall composed of cavernous fluid-filled spaces with turbulent flow. We present an antenatally diagnosed case of diffuse cavernous hemangioma in which the fetus was severely growth-restricted. Caesarean section was performed successfully without any intra or postpartum hemorrhage