The Comparison of Inflammatory Responses and Clinical Results After Groin Hernia Repair Using Polypropylene or Polyester Meshes.

The aim of this study was to compare the clinical results and the inflammatory responses against polypropylene and polyester meshes after groin hernia repair. Ninety patients with unilateral inguinal hernia randomly underwent Shouldice herniorrhaphy or Lichtenstein hernioplasty using polypropylene or polyester meshes. Venous blood samples were collected to evaluate serum interleukin-6 (IL-6) and C-reactive protein (CRP) levels. Postoperative acute and chronic pain and time to attain to normal activities were evaluated. IL-6 levels decreased to preoperative levels in all groups at 48th hour. CRP levels of mesh-implanted groups are significantly higher than preoperative level at 48th hour, while it reduced to preoperative level in Shouldice herniorrhaphy group. Patients treated with mesh repair had less postoperative acute pain and recovered more rapidly than those who underwent Shouldice herniorrhaphy. It was concluded that polypropylene and polyester meshes used in hernia repair caused similar inflammatory responses and that clinical results after groin hernia repair with these prostheses were not significantly different.

The effect of different suture materials on the safety of colon anastomosis in an experimental peritonitis model.

BACKGROUND: The aim of this experimental study was to compare the safety of different suture materials in a left colonic anastomosis in the presence of peritonitis. MATERIALS AND METHODS: Twenty-one male Wistar albino rats were randomly divided into three groups. First, left colonic injuries were created in all groups for the peritonitis model. After 24 hours, coated polyglactin 910 and silk suture were used in Group I rats, polydioxanone and silk suture were used in Group II rats, and coated polyglactin 910 plus antibacterial suture and silk suture were used in Group III rats during colonic anastomosis. Tissue hydroxyproline, anastomotic bursting pressure, and histopathologic findings on the anastomosis line were evaluated on the 10th postoperative day by performing a relaparatomy. RESULTS: The mean bursting pressure values were 198 ± 11.37, 220 ± 17.7, and 244 ± 9.52 in Groups I, II, and III, respectively (Group I vs. II, p < 0.035; I vs III, p < 0.002; and II vs III, p < 0.021). The mean hydroxyproline levels were 1.21 ± 0.58, 1.47 ± 0.44, and 2.11 ± 0.32 in Groups I, II, and III, respectively (Group I vs II, p < 0.338; I vs III, p < 0.011; and II vs III, p < 0.025). When histopathologic findings of the groups were compared, the healing score of the intestinal tissue was higher in Group III than in Group I (p < 0.015), whereas there were no statistically significant differences among Groups I vs II and II vs III (p < 0.081 and p < 0.095, respectively). CONCLUSION: Antibacterial suture usage increased anastomosis safety in the presence of peritonitis in resection and primary anastomosis.

The effects of different prosthetic materials on the formation of collagen types in incisional hernia.

OBJECTIVE: The aim of this study was to determine the rate of collagen Type I/Type III for different meshes. METHOD: Fifty rats were used. Five groups were formed: prolene (n = 10), mersilene (n = 10), parietex (n = 10), e PTFE (n = 10) and control group (n = 10). In all animals, laparotomy was performed using a midline incision. After that four different kinds of meshes are placed into the retro-rectus plane and fixed with a non-absorbable suture. Rectus superficial fascia and skin are closed. In the control group, repairment is done primarily. Thirty days later, meshes are found through the incisions that were done previously. Scar tissues above and near by meshes and also in the control group are taken, and in these tissue samples, the ratio of Type I/III is evaluated histochemically. RESULTS: The Prolene mesh was found to contain more collagen fibers than e PTFE. As a result of the histopathologic evaluation, it was seen that Group I contained statistically significantly more collagen density than the other four groups (p < 0.05). Moreover, the collagen Type I/III ratio in the specimen taken from the top part and the surrounding area of Group I was found significantly higher than the collagen Type I/III ratios of the rest of the groups (p < 0.05). CONCLUSION: As a conclusion, the ratio of collagen Type I/III is the highest in the prolene group.

The effects of drainage on the rates of early wound complications and recurrences after Limberg flap reconstruction in patients with pilonidal disease.

BACKGROUND: Cavity drainage has been used routinely in Limberg flap repair for pilonidal disease but there have been few controlled studies on the rationale for routine usage of drains. The aim of this study was to determine whether routine cavity drainage affects the rates of early wound complications and recurrences after rhomboid excision with Limberg flap repair for pilonidal disease. METHODS: Sixty patients with pilonidal disease in the sacrococcygeal region were randomized sequentially into 2 groups as drained or non-drained. All of them underwent rhomboid excision and Limberg flap reconstruction. The patients were followed up by physical examination at 2 and 4 weeks after the operation and every 6 months thereafter. RESULTS: Two patients in the drained group and 3 patients in the non-drained group were excluded from the study because of non-attendance at the follow-up physical examinations. The average length of hospital stay was 3.1 ± 0.9 and 3.3 ± 0.8 days in the drained and non-drained groups, respectively. There were 5 seromas, 2 wound dehiscences and 1 hematoma in the non-drained group, while 3 seromas and 2 wound dehiscences developed in the drained group. The complication rates of groups were similar (29.6% in the non-drained group vs. 17.8% in the drained group). Pilonidal disease recurred in 2 patients in the drained group who had wound dehiscence and in 3 patients in the non-drained group who had wound dehiscence or seroma. CONCLUSIONS: Routine usage of drains for Limberg flap reconstruction in the sacrococcygeal region did not affect wound-related complications and recurrence rates.

The influence of obesity on ICSI outcomes in women with polycystic ovary syndrome.

The objective of the study was to compare intracytoplasmic sperm injection (ICSI) outcome and gonadotropin doses between obese women with PCOS and non-obese patients with PCOS. This follow-up study represents ICSI outcomes in obese women with PCOS (BMI ≥ 30 kg/m(2)) compared with non-obese women with PCOS (BMI < 30 kg/m(2)). Obese (n = 18) and non-obese (n = 26) women with PCOS underwent long protocol pituitary suppression, ovarian stimulation and ICSI with fresh embryo transfer. Obese patients with PCOS required higher doses of gonadotropin (2994 IU vs 1719 IU; p < 0.001). Miscarriage rate was significantly higher in obese women compared with the non-obese women with PCOS (60% vs 6.7%, p = 0.002). Our results are valuable for counselling couples before initiation of assisted reproduction techniques (ART).

SV40 in human thyroid nodules.

BACKGROUND: Simian virus 40 (SV40) has been a model experimental system for the study of cell transformation and tumorigenesis for many years. The study of SV40 in humans has aroused interest in the related BK virus (BKV) and JC virus (JCV) and their role in human disease. OBJECTIVES: SV40 has been found in a variety of human samples, both malignant and normal. Many independent studies have suggested that SV40 plays a role for some cancers. However, in most cases the role of SV40 remains unclear. STUDY DESIGN: The subject of this study consisted of 99 patients with thyroid nodules. Both thyroid nodule and normal thyroid tissue were taken from each patient to test whether they contained SV40 sequences. RESULTS: We detected SV40 sequences by polymerase chain reaction (PCR) in four of 99 thyroid nodules. Two of them were papillary thyroid carcinomas and the others were benign thyroid nodules. No SV40 was detected in 99 of normal thyroid tissues of the same patients. DNA sequence analysis, performed in four positive samples, confirmed that PCR products belong to the SV40 T antigen (Tag) region. CONCLUSION: The possible role of SV40 in the development of thyroid nodules and the spread of SV40 by horizontal infection in the human population are discussed.

Hemobilia.

BACKGROUND: Laparoscopic procedures are safe and effective treatment methods in experienced hands. However, complications have been reported for laparoscopic procedures. One of the complications of laparoscopic cholecystectomy is vascular injuries. Hepatic and cystic artery injuries may occur alone or in association with bile duct injury. Bleeding from arterial injury may be seen during operation or in the late postoperative period. One of the most significant pathologies leading to this rare phenomenon is hemobilia. METHODS: We present a case of a 62-year-old woman who underwent routine laparoscopic cholecystectomy for cholelithiasis at another hospital. She presented 6 months later with the clinical feature of upper gastrointestinal bleeding. RESULTS: There was a 42 x 40 x 11 mm anechoic lesion and an echoic pattern compatible with a metallic object was found in the subhepatic region using abdominal ultrasonography. In the endoscopic examination, fresh blood was found in the stomach. The source of hemorrhage could not be identified. Bulbus duodeni was normal but a fresh clot on the papilla of Vateri was seen on gastroduodenoscopic examination. Laparotomy was performed and the provisional diagnosis of hemobilia was reached. The injured hepatic artery and pseudoaneurysmatic structure were repaired. CONCLUSION: Hemobilia is a late complication of laparoscopic cholecystectomy. We believe that it is important to take into consideration that bile duct injuries may be accompanied by arterial pathology.

The effects of melatonin and prostaglandin E1 analogue on experimental hepatic ischaemia reperfusion damage.

The effects of antioxidant melatonin and a prostaglandin E1 analogue (PGE1) on hepatic ischaemia reperfusion damage were investigated. Fifty rats were divided into five equal groups: sham, control, melatonin, PGE1 and combined treatment. No procedures were applied to the sham group. In the control and treatment groups, the hepatic hilus was clamped at the level of the hepatic artery and portal vein for 60 min and reperfusion was provided for two hours. In the treatment and combined treatment groups, melatonin was administered intramuscularly at a dose of 20 mg/kg 15 mins before reperfusion, and PGE1 was administered intravenously at a dose of 25 mg/kg 1 min before reperfusion. Blood samples for SGOT, SGPT, GSH-Px, SOD and MDA measurements and hepatic tissue samples were taken. The decrease in the plasma MDA levels was statistically significant in the melatonin and combined treatment groups, but not in the PGE1 group (p > 0.025). A significant decrease was found in the tissue MDA levels of the treatment groups (p < 0.025). The decrease in SGOT and SGPT levels in the PGE1 group was significant (p < 0.025), but the decreases in the melatonin and combined treatment groups were not significant (p>0.025). Melatonin and PGE1 were found to be effective in reducing the hepatic ischaemia reperfusion damage in rats. However, the damage could not be reversed. Combined treatment was found not to be superior to melatonin or PGE1 alone.

The relationship between the duration of menopause and lower urinary tract symptoms in women aged 40 to 59.

OBJECTIVE: To evaluate lower urinary tract symptoms in pre- and perimenopausal women. METHOD: Four hundred seventy-one women between 40 and 59 years of age with perimenopausal complaints attending our menopause clinic were evaluated for lower urinary tract symptoms by using the International Prostate Symptom Score questionnaire. The women were categorized by subgroups as being in premenopause, early menopause (1-<5 years' duration) and late menopause (> or = 5 years' duration), and by decade. Statistical evaluations were done by unpaired t test, one-way ANOVA, and simple and multiple regression analyses. RESULTS: The premenopausal women in their forties had more severe lower urinary tract symptoms when compared with early and late menopausal women. In comparisons the nocturia score tended to rise with age. CONCLUSION: Lower urinary tract symptoms appear to be affected by both age and the duration of menopause in women in their forties and fifties, and this observation might be taken into consideration while evaluating this age group for lower urinary tract symptoms.

Continuous versus cyclical transdermal oestrogen replacement therapy in postmenopausal women: effects on lipoprotein(a) and nitric oxide levels.

The purpose of our study was to compare the effects of cyclical versus continuous transdermal oestrogen replacement therapy on lipoprotein (a) (Lp(a)) and nitric oxide levels. The patients were randomly assigned into two groups. The first group received transdermal 17-beta oestradiol 50 microg/day for 21 days and the second group the same treatment on a continuous basis. Medroxyprogesterone acetate (10 mg/day orally) was added between the 14th and 25th days to each group. Lipoprotein (a) and nitric oxide levels were measured before the study and after six months. These values were compared using the Wilcoxon rank test within the groups and the unpaired t-test between the groups. Lipoprotein (a) levels decreased significantly in each group at the sixth month (p < 0.05). When compared between the groups, the decrease of lipoprotein (a) levels in the second group was more prominent at the sixth month (p < 0.05). Nitric oxide levels increased in each group after six months (p < 0.05). No difference in nitric oxide levels was observed between the groups before and after the therapy (p > 0.05). Continuous transdermal estradiol had a better effect on lipoprotein (a) levels than cyclical therapy The seven day pause in the 21-day administration did not affect nitric oxide levels negatively after six months.

Long-term effects of continuous oral and transdermal estrogen replacement therapy on sex hormone binding globulin and free testosterone levels.

OBJECTIVE: To determine the long-term effects of estrogen replacement therapy on sex hormone binding globuline (SHBG) and free testosterone (fT) levels in surgical postmenopausal women. STUDY DESIGN: Forty patients with surgical menopause were enrolled in this prospective study. The women were randomly divided into two groups. The first group received oral therapy (continuous conjugated equine estrogens (CEE) - 0.625mg per day) and the second group received transdermal therapy (patches delivering continuous 17beta-estradiol (E2)--0.05mg per day). Serum SHBG and fT levels were determined at baseline and after first and second years of treatment. Two-way repeated measures analysis of variance with Bonferroni adjusted post-hoc test and unpaired-t-test were performed for statistical analysis with SPSS program. RESULTS: Serum SHBG levels increased significantly with oral CEE after first year of treatment (P<0.05) and remained at this level for the next year. Transdermal therapy did not affect SHBG levels after first and second years (P<0.05). Serum fT levels did not change significantly in either group at the end of the first or second years (P<0.05) although there was a significant difference between the groups after 2 years (P<0.05). CONCLUSION: Oral conjugated estrogens increased SHBG levels during therapy. This effect may balance the increased estrogen and androgen stimulation on breast tissue and may be more beneficial to the cardiovascular system in postmenopausal women.

The menopause and bladder weight.

The aim of the study was to determine, whether bladder weight changes in the menopause and whether there is any correlation between lower urinary tract symptoms and bladder weight or the duration of menopause. A total of 94 women (30 without gynecologic or obstetric complaints, 31 with menopause less than 5 years and 33 menopause of 5 years or longer) were entered into the study. Bladder weights were determined ultrasonographically. The International Prostate Symptom Score questionnaire was used to evaluate lower urinary tract symptoms. A negative correlation was found between bladder weight and the duration of menopause. There was no significant difference between the three groups in terms of overall symptom scores. However, urgency incontinence score was the highest in the early postmenopausal period. In addition, the postmenopausal women had a significant negative correlation between the duration of menopause and frequent voiding scores. It was concluded that, ultrasonographically measured bladder weight decreases with the duration of menopause. Detailed studies with larger numbers of older women are needed to determine clearly whether this decrease in bladder weight has more significant effects on lower urinary tract symptoms.

Correlation between maternal thyroid function tests and endothelin in preeclampsia-eclampsia.

OBJECTIVE: To investigate the relationship between results of maternal thyroid function tests and endothelin levels in preeclamptic or eclamptic women. METHODS: Thyroid hormones, TSH, and endothelin were measured in plasma or serum from 37 proteinuric, preeclamptic or eclamptic women and 20 normotensive, nonlaboring, pregnant women. Subjects were subdivided into four groups according to hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and birth weights of infants with respect to gestational age. RESULTS: A significant decrease in concentrations of total thyroxine (T4) (13.76+/-1.84 microg/dL versus 10.00+/-1.48 microg/dL, P < .05), total triiodothyronine (T3) (180.58+/-30.84 ng/dL versus 141.16+/-27.31 ng/dL, P < .01), free T4 (1.45+/-0.27 ng/dL versus 1.10+/-0.21 ng/dL, P < .01) and free T3 (3.32+/-0.56 pg/mL versus 2.41+/-0.60 pg/mL, P < .01) and a significant increase in TSH (1.55+/-0.89 microIU/mL versus 2.96 +/-1.07 microIU/mL, P < .05) and endothelin (2.31+/-0.61 pg/mL versus 6.11+/-1.41 pg/mL, P < .001) levels were observed in the preeclamptic-eclamptic group compared with the normotensive group. Also, women without HELLP syndrome and without small-for-gestational-age infants had elevated levels of thyroid hormones and decreased levels of TSH and endothelin compared with other subgroups, but stastical significance was reached only in total T4 (P < .05), TSH (P < .05), and endothelin (P < .001). Birth weights of infants born to preeclamptic or eclamptic women correlated positively with total T4 (P < .01) and total T3 (P < .01) and negatively with TSH (P < .01) levels. A more significant negative correlation was found in preeclamptic-eclamptics (P < .001) between birth weight and endothelin levels than in control subjects (P < .05). Endothelin levels in preeclamptic or eclamptic women correlated negatively with total T4 (P < .01), total T3 (P < .05), free T4 (P < .05), and free T3 (P < .05) and positively with TSH levels (P < .01) compared with control subjects. CONCLUSION: Moderate decreases in thyroid hormones with concomitant increases in TSH levels in maternal serum correlated with severity of preeclampsia or eclampsia and high levels of endothelin. Changes in results of thyroid function tests induced by preeclampsia or eclampsia might be consequences of the dysfunction in the hypothalamic-pituitary-thyroid axis, secondary to the disease itself.

Comparison of the effects of conjugated estrogen treatment on blood lipid and lipoprotein levels when initiated in the first or fifth postmenopausal year.

Although estrogen replacement therapy (ERT) is known to be protective against the development of cardiovascular disease in patients with surgical menopause, the effects of ERT on blood lipids when started late after the operation is not yet clear. In this prospective study, blood lipid and lipoprotein levels were measured within a 2 year period, in Group I (n = 28 patients) and in Group II (n = 21 patients), who had total abdominal hysterectomy and bilateral salphingo-oophorectomy 10-16 or 55-65 months ago, respectively. Each patient received 0.625 mg conjugated equine estrogen once daily. Blood levels of total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL), high density lipoprotein (HDL) and very low density lipoprotein (VLDL) were measured at the beginning of the study as well as 12 and 24 months after ERT, was commenced. When the levels obtained after 12 and 24 months of ERT were compared to the baseline levels, LDL levels were decreased, whereas HDL levels were increased in Group I (p < 0.05); however, only the TC levels were significantly lower in Group II (p < 0.05). In conclusion, our results show that ERT is more effective on blood lipid changes when initiated within one year of oophorectomy compared with ERT initiated 5 years after the menopause.

The effects of different doses of medroxyprogesterone acetate on serum lipids, lipoprotein levels and atherogenic index in the menopausal period.

The purpose of our study was to make a contribution to research in determining the least harmful progestogen dose for women who have not had their uterus removed. The study was an open comparative trial. The patients were consecutively assigned to two groups. The first group (n = 19) were given 0.625-mg conjugated equine estrogen plus 5-mg medroxyprogesterone acetate (MPA), and the second (n = 18) 0.625-mg conjugated equine estrogen plus 2.5-mg MPA. Serum total cholesterol (T-cholesterol), triglyceride, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels plus LDL-C/HDL-C values (atherogenic index) were measured before the study and again after 6 and 12 months. These values were compared with ANOVA and postANOVA tests (Scheffe) within the groups and with unpaired t-test between the two groups. The triglyceride serum levels in the first group were decreased in the 12th month compared to baseline levels. In addition, LDL-C/HDL-C values were significantly decreased in the 6th month, but these values slightly increased in the following 6 months. In the second group, T-cholesterol, triglyceride, LDL-C and atherogenic index were decreased in the 12th month when compared to baseline levels within the groups. This decrease was statistically significant (p < 0.05). There was no significant difference between the two groups (p > 0.05). Hormone replacement therapy with continuous 0.625-mg conjugated equine estrogen and 2.5-mg MPA had a better effect on lipid profiles than 0.625-mg conjugated equine estrogens and 5-mg MPA after 12 months of treatment.

Hyaluronic acid plus heparin for improved efficacy in prevention of adhesion formation in rat uterine horn model.

OBJECTIVE: To determine the effectiveness of hyaluronic acid (HA) and heparin [unfractioned heparin (UH) or low molecular weight heparin (LMWH)] combination in reducing adhesion formation in a rat uterine horn model. STUDY DESIGN: Prospective, randomized, comparative study in a rat model was done in Surgical Research Laboratory, Erciyes University. A standard lesion was created by unipolar electrocautery in 120 uterine horns of total 60 female Wistar-Albino rats. Animals were then randomly assigned into four groups, each consisting of 15 animals: (1) control, no adjuvant given; (2) HA, 1 ml of 0.4% solution given onto each horn preoperatively; (3) HA, 1 ml of 0.4% solution given preoperatively plus 1 ml of UH given postoperatively; (4) HA, 1 ml of 0.4% solution given before injury plus 1 ml of LMWH given after injury. A second-look laparotomy was performed two weeks after surgery. The number of horns with adhesion was determined and a scoring system applied. RESULT(S): The number of horns without adhesion formation was significantly higher in HA plus UH (P<0.05) and HA plus LMWH (P<0.01) groups compared to control group. The extent, severity and total scores of adhesion formation were also found to be significantly reduced in other groups when compared to control group. Combination of HA plus UH and HA plus LMWH significantly reduced all adhesion scores compared to HA alone. But a direct comparison of the ability of HA plus UH versus HA plus LMWH in reducing adhesion scores in the rat uterine horn yielded an insignificant difference. CONCLUSION: Administration of HA before injury followed by UH or LMWH given after injury has been documented to improve the efficacy of HA alone in reducing adhesion formation.

Recurrent molar pregnancy after ovulation induction and repeat ovulation induction. A case report.

BACKGROUND: Although hydatidiform mole is not commonly encountered following ovulation induction, patients who have already had molar pregnancies are at increased risk of developing further molar diseases with worsening histologic characteristics. That fact underlies the ethical dilemma of repeat ovulation induction. CASE: A 38-year-old woman, gravida 3, para 0, had three consecutive episodes of hydatidiform subsequent to clomiphene citrate and gonadotropin ovulation induction. She seems to be the first in the literature to develop three consecutive molar pregnancies without a normal intrauterine pregnancy. CONCLUSION: Although ovulation induction commenced again in this patient after she gave informed consent, the risks underlying the ethical dilemma persist.

Twenty two weeks of transdermal estradiol increases sex hormone-binding globulin in surgical menopausal women.

OBJECTIVE: To compare the effects of continuous noncombined transdermal estradiol versus oral conjugated estrogen on serum sex hormone-binding globulin (SHBG) levels prior to and during the 10th and 22nd weeks of therapy in patients with surgical menopause. STUDY DESIGN: Open, comparative trial. Patients were consecutively assigned to three groups: group 1 (n = 18) received continuous transdermal estradiol (0.050 mg/day), group 2 (n = 18) continuous oral conjugated estrogens (0.625 mg/day), whereas group 3 (n = 15) received no treatment. Serum SHBG levels were determined before treatment and after 10 and 22 weeks of treatment. RESULTS: Serum SHBG increased significantly with oral conjugated estrogens at 10 (p < 0.01) and 22 weeks (p < 0.01) compared with baseline. With transdermal estrogens there was a much smaller increase of SHBG. At 22 weeks, this increase was significant compared with baseline (p < 0.05), but not compared with the control group (p > 0.05). CONCLUSION: Transdermal estrogen has no effect on SHBG, whereas oral conjugated estrogens causes considerable increase.

A strange condition: postmenopausal pregnancy.

Climacterium is characterized by symptoms that occur as a result of the differentiation of hormonal equilibrium. It begins around the age of 40 and continues up to the age of 60. In this period cycles are usually anovulatory. This paper presents a case which may be diagnosed as abortus incompletus despite the patient being in menopause for five years previously.