Pregnancy management and outcome after uterus transplantation.

Uterus transplantation is a novel approach in women whose uterus is absent or severely abnormal. However, it is still an experimental procedure that poses risks to both mother and baby. To date, 32 live births after uterus transplantation have been reported in peer-reviewed journals, with several maternal, fetal and neonatal complications. The most common complications were preterm delivery, hypertensive disorders and placenta previa. Four patients experienced episodes of transplant rejection during pregnancy. The appropriate management of complicated and non-complicated pregnancies following uterus transplantation is still unresolved. In this review, obstetric outcomes after uterus transplantation and optimal management during pregnancy are discussed in light of the available data. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Technical, Immunological, and Ethical Similarities and Differences Between Vascularized Composite Allotransplantation and Solid Organ Transplantation in Current Practice.

Solid organ transplantation (SOT) is a surgical method used as the gold standard in end-term organ failure. Following SOT, successful results have also been achieved in vascularized composite tissue transplantation, which improves the quality of life with the success of solid organ transplants and the development of modern immunosuppressive regimens. This review discusses the preoperative, operative, postoperative, and immunological differences between vascularized tissue transplantation and SOT.

Analysis of glenohumeral morphological factors for anterior shoulder instability and rotator cuff tear by magnetic resonance imaging.

OBJECTIVE: The aim of this study was to investigate whether there are glenohumeral morphological differences between normal population, glenohumeral instability, and rotator cuff pathology. METHOD: In this study, shoulder magnetic resonance (MR) images of 150 patients were evaluated. Patients included in the study were studied in three groups of 50 individuals: patients with anterior shoulder instability in group 1, patients with rotator cuff tear in group 2, and control subjects without shoulder pathology in group 3. RESULTS: There were statistically significant differences between groups in evaluations for glenoid version, glenoid coronal height, glenoid coronal diameter, humeral axial and coronal diameters, and coracohumeral interval distances. Significant differences were observed between groups 2 and 3 in glenoid axial diameter, glenoid coronal height, glenoid depth, humeral coronal diameter, and coracohumeral distances. CONCLUSION: The results obtained in this study suggest that glenoid version, glenoid coronal height and diameter, humeral diameter, and coracohumeral interval parameters in glenohumeral morphology-related parameters in patients with anterior instability are different from those of normal population and patients with rotator cuff pathology. In cases where there is a clinically difficult diagnosis, these radiological measurements will be helpful to clinicians in diagnosis and treatment planning, especially in cases of treatment-resistant cases.

Determination of IL-6, TNF-α and VEGF levels in the serums of patients with colorectal cancer.

Cytokines are multifunctional polypeptides synthesized by different body cells. They have clinical significance in terms of disease diagnosis, treatment and prevention. Cytokines TNF-α and IL-6 play an important role in the growth and differentiation of cells.Vascular Endothelial Growth Factor (VEGF) is excessively produced in epithelial, mesenchymal, and particularly in tumor cells. Studies have shown that the increased serum concentrations of IL-6, TNF-α, VEGF are strongly associated with colorectal cancer  and directly with the clinical stage of the disease. This can be used to diagnose cancer and to identify patients with a bad prognosis who can avail themselves of a more aggressive treatment. The present study investigated the role of cytokines in the development of cancer by comparing preoperative serum cytokine levels of patients suffering from colorectal cancer with those of the healthy control group. The prognostic significance of the data obtained has also been evaluated. For this purpose, IL-6, TNF-α and VEGF levels in 60 serums, 30 preoperatively taken from patients with colorectal cancer and 30 from a healthy control group at Çanakkale Onsekiz Mart University General Surgery Clinic, were determined by ELISA kits. The statistical analyses of the obtained data were evaluated on SPSS, a statistical package program. In this study, no significant difference was obtained between the mean scores concerning the IL-6 and VEGF serums of the colorectal cancer and healthy group (p>.05). But a statistically significant decrease was observed in the TNF-α serum level of the colorectal cancer group in comparison with the control group (p= .016; p < .05).

Outcome of Otologic Symptoms after Temporomandibular Joint Arthrocentesis.

The objectives of this study were to determine the prevalence of otologic complaints in patients with temporomandibular joint (TMJ) closed lock (CL), and to evaluate the efficacy of arthrocentesis in temporomandibular disorder (TMD) patients with otologic symptoms. Fifty-seven patients with TMJ CL were included in this study. The pre-treatment evaluations included assessment of the maximum mouth opening (MMO); pain level in palpation of the affected TMJ; pain level with function; and otologic complaints, including otalgia, tinnitus, vertigo, and hearing loss. Arthrocentesis treatment was performed for all the patients, and post-treatment data were recorded 1 month later. Before arthrocentesis and lavage, the mean MMO was 24.67 ± 4.61 mm; the mean tenderness score was 7.02 ± 1.09; and the mean score for pain in function was 6.86 ± 1.31. Following TMJ arthrocentesis and lavage, the mean MMO was 39.81 mm ± 4.56 mm; the mean tenderness score was 2.37 ± 0.65; and the mean score for pain in function was 2.45 ± 0.69. Seventeen (29.82%) patients reported at least 1 otologic complaint, 17 (29.82%) patients reported otalgia, and 8 (14.04%) patients reported tinnitus. Vertigo was noted in 5 (8.77%) patients. Complaints of hearing loss were not noted in any of the patients. After treatment, 14 patients no longer complained of otalgia, 5 patients no longer complained of tinnitus, and 2 patients no longer complained of vertigo. This represented a significant improvement in the patients' condition, especially in patients with otalgia (P < 0.0006). As evident from the results of this study, arthrocentesis procedures reduce both TMD symptoms and otologic complaints.

An improved method of supercharged transposed latissimus dorsi flap with the skin paddle for the management of a complicated lumbosacral defect.

OBJECTIVE: Treatment of non-healing wounds of lower back often poses a powerful challenge. We present one of the first report of treatment of a lumbosacral defect with a supercharged latissimus dorsi flap with the skin paddle. CASE REPORT: We report a case of a 59 year-old man with myeloma of the sacral spine who underwent radiotherapy and chemotherapy and subsequently, laminectomies and placement of hardware for ongoing paresis and spine instability. Then, he developed an open wound and osteomyelitis of the spine with culture positive tuberculous granulomas. After multiple surgical debridement, he presented to our service and was treated with a single stage debridement followed by the performance of a latissimus dorsi musculocutaneous flap based on paraspinal perforators and supercharged. RESULTS: This solution, allowed for augmentation of blood flow to the muscle with the inferior gluteal artery, provided coverage of the defect resistant to the pressure, and simplified post-operative management of the patient. CONCLUSIONS: Alternative treatment options, including free tissue transfer, posed difficulties in finding suitable recipient vessels near the defect, in inserting the flap so as to restore its original length without compromising blood flow, and in postoperative care of the patient. Treatment of a lumbosacral defect with a supercharged latissimus dorsi flap with the skin paddle may represent a milestone procedure for complicated lower spine wounds.

Effects of acute pancreatitis on plasma total and lipid bound sialic Acid levels: an experimental study in rats.

BACKGROUND: We investigated the relationship between serum levels of total sialic acid, lipid bound sialic acid and acute pancreatitis in a rat model of a common bile duct ligation induced acute pancreatitis. METHODS: Twenty five Sprague-Dawley male rats weighing 250-300 g were divided into two groups (n=10: control, n=15: experimental). In the control group only a sham laparotomy was performed. In the experimental group, acute pancreatitis was induced by common pancreatobiliary tract ligation. After 36 hours the rats were killed and amylase, serum total sialic acid, lipid bound sialic acid and lipid profiles were measured. Histopathological confirmation of acute pancreatitis was done using hematoxylin and eosin staining. RESULTS: Mean amylase, total sialic acid (TSA) and lipid bound sialic acid (LBSA) measurements in the experimental group were significantly higher than in the control group. There was no significant difference in the lipid profiles between the two groups. CONCLUSION: Increased levels of TSA and LBSA can be useful as specific markers in the diagnosis of acute pancreatitis independent of serum lipid profile.

Uterus retrieval in cadaver: technical aspects.

The authors describe uterus retrieval in cadavers. Uterine retrieval with its vasculature could be successfully achieved in four of the presented cases. Special attention was given to dissection of bilateral ureters and hypogastric vasculature. Uterine retrieval with its vasculature and supporting sacrouterine,vesicouterine peritoneal folds is an anatomically feasible procedure in preparation for uterus transplantation.

An investigation of Candida species isolated from blood cultures during 17 years in a university hospital.

Candidemia is the most frequent manifestation observed with invasive candidiasis. The aim of this study was to analyse the trends of candidemia in a large tertiary-care hospital to determine the overall incidence during January 1996-December 2012, as well as to determine the susceptibility of 453 isolates according to the revised Clinical and Laboratory Standards Institute (CLSI) breakpoints. Candidemia episodes in adult and paediatric patients were retrospectively analysed from the laboratory data of Uludag University Healthcare and Research Hospital. The 17-year period studied was divided into three periods (1996-2001, 2002-2007 and 2008-2012) for better comparison, and candidemia incidence was determined by the ratio of total number of patients with candidemia per 1000 patients admitted to the hospital and per 10 000 patient days in these three periods. Redefined CLSI M27-A3 breakpoints were used for interpretation of antifungal susceptibility results. Candidemia incidence was determined as 2.2, 1.7 and 1.5 per 1000 admitted patients during 1996-2001, 2002-2007 and 2008-2012 respectively. A significantly decreased candidemia incidence was obtained in the third period. C. albicans (43.8%) was the most common candidemia agent, followed by C.parapsilosis (26.5%) in all three periods. According to the revised CLSI breakpoints, there was fluconazole resistance in C. albicans, C.parapsilosis, C.tropicalis and C.glabrata species (1.4%, 18.2%, 2.6% and 14.3% respectively). Almost all Candida species were found susceptible to voriconazole except one C.glabrata (7.1%) isolate. Candidemia is an important health problem. Local epidemiological data are determinative in the choice of appropriate antifungal treatment agents.

Late spontaneous rupture of the extensor pollicis longus tendon after corticosteroid injection for flexor tenosynovitis.

INTRODUCTION: Spontaneous rupture of the extensor pollicis longus (EPL) tendon has been reported after trauma, rheumatoid arthritis and sports. Rupture may also occur as a consequence of the use of anabolic steroids for recreational purposes, or systemic steroids for the treatment of a variety of medical conditions. CASE REPORT: We present a case report of a woman affected with a spontaneous EPL tendon rupture resulted 14 months after a corticosteroid injection for flexor tenosynovitis, "trigger finger," of the thumb. The edges of the tendon were debrided and sutured using figure of eight stitch and a running locked stitch. In addition multiple specimens were sent to Pathology. DISCUSSION: Duplay in 1876 described spontaneous rupture as a problem of mechanical and pressure phenomena. Another cause of EPL rupture is related to the development and persistence of inflammatory processes seen in patients with medical illnesses such as rheumatoid arthritis. There have been no reports in the literature to date of spontaneous EPL tendon rupture in the late period after steroid injection. Tendon ruptures in the hand usually occur one or two weeks after a corticosteroid injection, and the affected tendons are usually in neighbouring areas.

4D digital subtraction angiography: implementation and demonstration of feasibility.

BACKGROUND AND PURPOSE: Conventional 3D-DSA volumes are reconstructed from a series of projections containing temporal information. It was our purpose to develop a technique which would generate fully time-resolved 3D-DSA vascular volumes having better spatial and temporal resolution than that which is available with CT or MR angiography. MATERIALS AND METHODS: After a single contrast injection, projections from the mask and fill rotation are subtracted to create a series of vascular projections. With the use of these projections, a conventional conebeam CT reconstruction is generated (conventional 3D-DSA). This is used to constrain the reconstruction of individual 3D temporal volumes, which incorporate temporal information from the acquired projections (4D-DSA). RESULTS: Typically, 30 temporal volumes per second are generated with the use of currently available flat detector systems, a factor of ∼200 increase over that achievable with the use of multiple gantry rotations. Dynamic displays of the reconstructed volumes are viewable from any angle. Good results have been obtained by using both intra-arterial and intravenous injections. CONCLUSIONS: It is feasible to generate time-resolved 3D-DSA vascular volumes with the use of commercially available flat detector angiographic systems and clinically practical injection protocols. The spatial resolution and signal-to-noise ratio of the time frames are largely determined by that of the conventional 3D-DSA constraining image and not by that of the projections used to generate the 3D reconstruction. The spatial resolution and temporal resolution exceed that of CTA and MRA, and the small vessel contrast is increased relative to that of conventional 2D-DSA due to the use of maximum intensity projections.

Modification of the Bascom cleft lift procedure for chronic pilonidal sinus: results in 141 patients.

AIM: There is no definitive consensus on the best treatment for pilonidal sinus. The Bascom cleft lift technique has been reported to produce successful results. This study presents the results of a modified cleft lift procedure in which the sinus tissue was excised and the lower end of the incision was kept outside the intergluteal sulcus by extending the lower end of the incision laterally. METHOD: Between August 2010 and January 2012, 141 consecutive patients who presented with primary or recurrent pilonidal sinus disease were included in the study, which was conducted at a single tertiary academic medical centre. Prospectively collected data were recorded, including complications, pain score, satisfaction level, primary healing rate, length of hospital stay and early recurrence. RESULTS: The mean operating time was 30 min and the mean length of hospital stay was 1.2 days. The most common surgical-site complication was a collection followed by partial wound dehiscence and superficial infection. The primary healing rate was 88%, the mean time for functional recovery was 13 days and the mean follow-up time was 14 months. No recurrence was observed within this follow-up period. CONCLUSION: The modified Bascom cleft lift technique is effective and reliable. It is applicable to all pilonidal sinus cases and has low complication rates, high satisfaction scores, rapid early recovery and low recurrence rates.

Erectile dysfunction and depression in patients with chronic lead poisoning.

In this retrospective study, we aimed to evaluate the relationship between erectile dysfunction (ED) and chronic lead intoxication (CLI) as well as the role of depression in this relationship. We compared the findings of 26 male patients with CLI and 24 male patients as the control group between November 2008 and January 2009. The blood lead levels and smoking index of patients were evaluated for both groups. The International Index of Erectile Dysfunction-erectile function domain (EFD) and Beck Depression Inventory (BDI) were obtained and reviewed in both groups. The mean blood lead levels of patients in the CLI and control groups were 42.1 and 3.2 µg dl(-1) respectively (P < 0.01). The mean interval of lead exposure of patients in CLI group was 71.5 (6-360) months. EFD scores of patients in CLI group were significantly lower, and number of patients with ED in CLI group was statistically higher (P < 0.05). BDI scores of patients in CLI group were significantly higher (P < 0.05). We detected a mildly negative and statistically significant relationship between the EFD scores and blood lead levels (r = -0.453 and P < 0.05). Our results showed that the increased frequency of ED is an independent factor in CLI group.

"Diagnostic value of MRCP in biliary pancreatitis: result of long-term follow-up".

AIM: Magnetic resonance cholangiopancreatography (MRCP) has increasingly been used to evaluate the common bile duct. This study was to determine the role of MRCP instead of endoscopic retrograde cholangiopancreatography (ERCP) in the management of patients with acute biliary pancreatitis. METHODS: A total of 81 patients with mild or moderate biliary pancreatitis who underwent MRCP and were treated in our department with selective ERCP between May 2001 and July 2007 were entered into a prospective database. RESULTS: MRCP was considered abnormal in 13 patients. Ten patients underwent ERCP. Three patients did not undergo ERCP due to protocol violations. In nine patients, stone extraction was performed. The remaining patient who had dilatation of the CBD underwent ES. The false positive rate of MRCP was 10%. The median follow-up of overall patients was 36 months (range 23-99 months). The patients with normal MRCP had a median follow-up of 39.5 months (range 23-99 months). During the follow-up period in the normal MRCP group, five patients were diagnosed with recurrent biliary pancreatitis, of which three underwent ERCP (7.4%). There was no disease-related mortality during this period. CONCLUSION: In conclusion, the use of MRCP in acute biliary pancreatitis is safe and may be recommended as a tool to aid in the selective use of ERCP.

Salvage repair of anastomotic dehiscence following colon surgery using an expanded polytetrafluoroethylene graft.

Anastomotic dehiscence is a serious complication of colorectal surgery that causes death in up to 40% of cases in which it occurs. Edema and inflammation due to abdominal sepsis can prevent the use of standard management (i.e., colostomy, ileostomy or Hartmann's procedure), in which case alternative salvage repair methods are required. The present report describes the treatment of a 73-year-old female patient at high risk of mortality because of intraabdominal sepsis due to suture dehiscence following a right hemicolectomy and ileo-transversostomy. Several surgical repair procedures were tried, but all failed. We then used an expanded polytetrafluoroethylene (ePTFE) graft in salvage repair, and this approach proved successful. This is the first report to describe clinical, macroscopic and histopathological findings, following use of an ePTFE graft in colorectal repair in humans.

The first (double) hand transplantation in Turkey.

In September 2010, a bilateral hand allotransplantation was performed on a 28-year-old man who had suffered amputations at the level of 1/3 of the proximal forearm on the right and 1/3 of the distal forearm on the left 2 years previously. This was the first hand transplantation case in Turkey. Preoperative organization, legal difficulties, technical aspects of the operation, and immunosuppressive regimen are detailed herein. The early results of the first composite tissue allograft (CTA) transplantation are also reported. The results were encouraging for all future types of CTA transplantation, including hand and face. Following the early promising outcome of the first case of hand transplantation in Turkey, we have accelerated preparation of regulations for CTA transplantation, including hand and face allotransplantation.

Outcome of kidney transplantation following end-stage renal disease due to reflux nephropathy.

BACKGROUND: Reflux nephropathy (RN) has an important place among the etiologies of end-stage renal disease (ESRD). In this retrospective study we sought to analyze posttransplantation complications among renal transplant recipients whose primary disease was RN. METHODS: Seven hundred forty-five patients who underwent transplantation in our institution between 1983 and 2006 were included in the study. The outcomes of patients with RN (Group 1) were compared with a control group (Group 2) that consisted of age-matched, nondiabetic patients whose primary disease was chronic glomerulonephritis or unknown etiologies. RESULTS: Group 1 consisted of 52 patients, including 20 males with a mean overall age of 25 years. Group 2 included 47 patients, including 21 males with a mean age of 27 years. There was no significant difference with regard to age, gender, donor type, donor age, modality of hemodialysis, or HLA match between the 2 groups. Group 1 graft survival rates in the first and fifth years were 95% and 90%, respectively, and in Group 2 they were 86% and 70%, respectively (P = .302 and P = .072, respectively). There was no significant difference with respect to follow-up duration, hospital stay, or incidence of biopsy-proven or clinically suspected acute rejection episodes between the groups. During the 6-year follow-up, the incidence of biopsy-proven chronic allograft nephropathy was the same in both groups. One patient in Group 1 and 2 in Group 2 died of cardiovascular issues; 1 Group 2 patient died of infection. The frequency of urinary tract infection in Group 1 was greater than that of Group 2 (40% vs, 23%; P = NS). CONCLUSION: Despite the higher incidence of urinary tract infections, there was no significant difference in posttransplantation complications or patient and graft survival rates between RN patients compared with the control group.

Parathyroid cyst: the forgotten diagnosis of a neck mass.

The differential diagnosis of cystic cervical masses includes cystic thyroid disease or some embryological diseases. Parathyroid cyst is one of the less common causes of the cervical masses. The Swedish anatomist Sandstrom reported the first description of parathyroid cyst in 1880. Up to date, only about 300 cases have been reported in the world literature. They may be functional or nonfunctional, depending on the presence or absence of the hyperparathyroidism and treatment options vary for both presentations. Particularly, nonfunctional cysts are often considered as thyroid cysts. Diagnosis is best made by monitoring serum calcium levels and sending cyst fluid for parathormone analysis. We herein report a patient diagnosed with a parathyroid cyst who had received the diagnosis of goitre at other institute; including a review of the literature.

A newly described scorpion species, Leiurus abdullahbayrami (Scorpion: Buthidae), and the lethal potency and in vivo effects of its venom

Currently, medically significant scorpion species belong to the Buthidae family and are represented by the genera Androctonus, Buthus, Mesobuthus, Hottentotta, Parabuthus, Tityus, Centruroides, Leiurus. Although Leiurus was originally considered a monotypic genus, four additional species have since been described. Leiurus abdullahbayrami (previously identified as L. quinquestriatus in Turkey) was classified as a new Leiurus species. This is the first report conducted on the lethality and biologic effects of L. abdullahbayrami scorpion venom in mice. In this study, the electrophoretic protein pattern of its venom was also determined. Two protein bands with molecular masses of 4 and 6 kDa were more strongly detected than other protein bands in the venom sample. Electrophoresis showed that L. abdullahbayrami scorpion venom possesses both short- and long-chain neurotoxins. The median lethal dose of this venom was found to be 0.19 mg/kg by subcutaneous (SC) injection in mice. Animals experimentally envenomed with L. abdullahbayrami venom exhibited hyperexcitability, agitation, aggressive behavior, squeaking and fighting, tachypnea, weakness, convulsions, and death due to cardiac and respiratory failure. In further studies, the potency of antivenom should be investigated in relation to the scorpion venom. Molecular and pharmacological studies are also required to identify and characterize L. abdullahbayrami scorpion venom.(AU)

Effect of local gentamicin application on healing and wound infection in patients with modified radical mastectomy: a prospective randomized study.

This study investigated the effects of Gentacoll implants on healing in patients (n = 44) undergoing modified radical mastectomy and axillary dissection. Group I, the Gentacoll group (n = 22), underwent surgery followed by insertion of 10 × 10 × 0.5 cm Gentacoll implants (280 mg collagen sponge plus 200 mg gentamicin sulphate) into the axillary area and under the flap area of the breast before wound closure. Group II, the control group (n = 22), underwent surgery without the application of Gentacoll. Neither group received oral or parenteral post-operative antibiotic therapy. Outcome measures included wound infection, seroma formation, total drainage volumes, drain removal time and duration of hospital stay. Post-operative infection rate, seroma formation, drainage volumes and duration of hospital stay were significantly reduced in the Gentacoll group compared with the control group. In conclusion, the application of Gentacoll significantly improved post-operative outcomes in patients undergoing modified radical mastectomy.