Predictive value of hemogram parameters in malignant transformation of the endometrium in patients with different risk factors.

OBJECTIVES: To investigate whether the pretreatment hemogram parameters and their ratios can be used in predicting the endometrial transformation in patients with abnormal uterine bleeding. MATERIAL AND METHODS: Records of all patients who underwent an endometrial histopathological evaluation between 2011 and 2021 were investigated. Hemogram, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were analyzed. Chi square and Mann Whitney U tests were used for analysis. P<0.05 was considered statistically significant. RESULTS: 427 patients were included, of whom 117 were presented with endometrial hyperplasia without atypia (27.4%; mean age, 42±9.7; Group II), 70 with atypia (16.3%; mean age, 53.4±9; Group III), 102 with early endometrial cancer (EC) (23.8%; mean age, 63±7.8; Group IV) and 38 with advanced disease (8.8%; mean age, 63.3±10.5; Group V). Patients without pathology constituted the control group (23.4%; mean age, 42.2±9.5; Group I). Risk factors for atypia and carcinoma were determined as age, postmenopausal state, obesity, diabetes, and increased estrogen exposure (each, p<0.05). There was no significant difference in NLR and PLR (p>0.05). However, hemoglobin and hematocrit levels were higher in Groups IV and V (13.9 vs 13.1 mg/dL, and 39.1 vs 38.8%, respectively; p<0.01). Platelet value was significantly higher in Groups III to V (282x109/L, 283x109/L and 295x109/L; p<0.05, p<0.05 and p<0.01, respectively). CONCLUSIONS: Our findings support the impact of inflammation on malign transformation from normal endometrial mucosa to atypia and carcinoma. NLR and PLR values showed no statistical difference. Instead, thrombocytosis may have a predictive role in EC.

Use of expanded reverse sural artery flap in lower extremity reconstruction.

Coverage of defects of the distal third portion of the leg and foot remains a challenge for surgeons. The difficulty results from the limited mobility and availability of the overlying skin, the weight-bearing requirements, and the relatively poor circulation of the skin. From January 2008 to December 2009, 10 patients had defects of the foot and ankle covered using the 2-stage expanded reverse sural flap. Of these 10 patients, 6 had at least 1 risk factor for compromised wound healing, such as diabetes mellitus, peripheral arterial disease, venous insufficiency, tobacco smoking, or age older than 40 years. Flap necrosis was observed in only 1 patient (10%). Venous congestion was noted in 2 patients (20%) by the third postoperative day, 1 of whom responded to postural elevation of the extremity and 1 to medicinal leech therapy. Although it is a 2-stage procedure that requires wound dressing during the expansion, we strongly suggest the use of the expanded reverse sural flap for defects too large to be primarily closed, especially in patients older than 40 years with risk factors such as diabetes mellitus, peripheral arterial disease, or venous insufficiency.

Spondylolisthesis mimicking the progression of dissection in a case of chronic Stanford type B aortic dissection.

Aortic dissection is an acute lethal cardiovascular condition. A 67-year-old hypertensive woman was admitted to our Emergency Department with an abrupt onset of tearing pain in the interscapular area. A thoracic computed tomography scan with contrast showed chronic type B aortic dissection. The patient was transferred to intensive care and medical therapy was initiated. Upon spread of the pain to the lumbar area, the dissection was thought to have progressed. The patient, being hemodynamically stable, was examined using ultrasonography, and the dissection did not show any progression. In the neurological examination for the lumbar pain, the lumbar processus spinosus was found to be sensitive, and the sciatic nerve stretch test was positive at 30 degrees. Magnetic resonance imaging revealed spondylolisthesis and a centrally located disc herniation at the L3-4 level. No operation for the dissection was planned, but discectomy and fusion surgery was scheduled. Since the patient refused surgery, she was discharged with medical therapy. Our aim in this report was to emphasize the importance of spondylolisthesis mimicking the progression of dissection in the differential diagnosis of a chronic type B aortic dissection case.

The Effects of Fentanyl on Testicular Ischemia-Reperfusion Injury.

OBJECTIVE: Testicular torsion is a condition that often occurs as a result of the rotation of the spermatic cord in childhood and adolescence in men, manifests with acute pain and causes infertility in the future even if emergency intervention is performed. The aim of this study is to investigate the protective and preventive effects of fentanyl, a potent analgesic agent frequently used in anaesthesia practice, on testicular ischemia reperfusion injury, which manifests through acute pain. METHODS: A total of 16 adult male Wistar rats, weighing 200-250 g, were used in this study. They were divided into two groups, consisting of eight animals in each group. Torsion was created in all rats by rotating left testicles 720 clockwise on the day of the experiment. 3 mM of fentanyl was applied intraperitoneally 30 minutes before detorsion to the fentanyl group. Following an hour of ischemia, the left testicle was reinstated, and tissues were repaired according to their physiology. Following 24 hours of reperfusion, the animals were euthanised after taking left testes and blood samples. RESULTS: Fentanyl, administered prior to testicular detorsion, significantly suppressed germ cell damage in torsioned tissue, catalase activity and malondialdehyde levels in blood samples taken from the heart. No significant differences were observed in plasma total thiol concentration, histological score, Leydig cell counts, percentage of necrosis and tubule rupture. CONCLUSION: These findings show that fentanyl administered before detortion creates a protective effect by preventing testicular ischemia reperfusion injury leading to infertility in the future.

Intraoperative perineural infiltration of lidocaine for acute postlaminectomy pain: preemptive analgesia in spinal surgery.

STUDY DESIGN: Prospective, cohort, and clinical study. SUMMARY OF BACKGROUND DATA: It was proven that effective control of postoperative pain in lumbar disk surgery improves the patient's recovery. Despite the many advances in surgical and nonsurgical techniques, the most accurate approach in pain relief is still under debate. OBJECTIVE: In this study, our aim was to determine whether neural root blockade before the onset of noxious stimuli could inhibit the production of pain. METHODS: Forty-five patients undergoing unilateral 1 spinal level (lumbar 5) hemipartial laminectomy were included in the study. In 20 of the patients (group 2), 0.5 mL 2% lidocaine was infiltrated onto the neural root immediately after the exposure; the 25 patients in the control group (group 1) were not injected. All patients were monitored regarding pain determination using a visual analog scale, and the exact time of analgesic requirement during the first postoperative day was noted. Total analgesic dose given during the first postoperative day was also recorded. RESULTS: Perineural lidocaine infiltration extended the early postoperative analgesic period. Although the pain was not completely suppressed, the lidocaine infiltration helped to manage the postoperative pain more effectively. The patients (group 2) who received lidocaine infiltration intraoperatively onto the neural root had a statistically significant longer time before analgesia requested (P<0.001) and also required significantly less analgesic when compared with the control group (P<0.001). CONCLUSIONS: For preemptive analgesia for acute postoperative pain in laminectomy surgery, which remains a major concern, we suggest that lidocaine infiltration onto the dorsal neural sheath immediately before retraction of the root may extend the time before analgesia requested and the total analgesic drug consumption.

The effects of pre-emptive analgesia with bupivacaine on acute post-laminectomy pain.

INTRODUCTION: This is a prospective, non-randomized, hospital-based, case-controlled, clinical trial to assess the efficacy of perineural infiltration with bupivacaine at the related neural root for acute pain relief after lumbar laminectomy. METHOD: Fifty-one patients undergoing unilateral one spinal level (lumbar 4) hemi-partial laminectomy were included in the study. In 22 of the patients (Group 2), bupivacaine was infiltrated onto the neural root immediately after the exposure; the 29 patients in the control group (Group 1) were not infiltrated. All patients were monitored post-operatively regarding pain determination using a visual analog scale, and the exact time of analgesic requirement during the first post-operative day was noted. Total analgesic dose given during the first post-operative day was also recorded. RESULTS: The patients who received bupivacaine infiltration intraoperatively onto the neural root (Group 2) had a statistically significantly longer time to first analgesia request (P < 0.001) and also required significantly less analgesic when compared to the control group (Group 1) (P < 0.001). Perineural bupivacaine infiltration extended the early post-operative analgesic period. While the pain was not completely suppressed, the bupivacaine infiltration helped to manage the post-operative pain more effectively. CONCLUSION: Our data suggests that pre-emptive analgesia via perineural infiltration of bupivacaine is a simple, and effective method for post-operative acute pain relief.

Acute cardiac tamponade due to spontaneous bleeding in a child with haemophilia A.

In severe haemophilia A, patients, start from the first years of life, with spontaneous bleeding and require transfusion. However, cardiac tamponade due to spontaneous pericardial bleeding is rare. An 11-year-old boy receiving haemophilia A treatment was referred to the Department of Paediatric Haematology with pneumonia, fever, dyspnoea, and palpitation. In his PA chest radiograph, pneumonic infiltration in the right lung and enlargement in the pericardial area were found. On his echocardiograph, pericardial effusion reaching 3.9 cm and other findings of tamponade were detected. APTT was outside the measurable range. It was deranged to > 120 seconds. The patient received 1000 U of factor VIII intravenously. A pericardial window was made via left anterior mini thoracotomy due to fluid drained. In his control echocardiograph taken after one month, no pathology was found. At 50th day, the patient showed left pleural serohaemorrhagic effusion, which was treated with tube thoracostomy. In haemophilia A patients, either pericardiocentesis or subxiphoid pericardial drainage or pericardial window creation via thoracotomy may be applied, depending on the primary pathology. In paediatric cases, pericardial window creation via mini thoracotomy can be an alternative treatment of choice considering complications such as recurring bleeding and effusion during pericardiocentesis.

Is circumcision a modified ritual of castration?

AIM: In the earliest records of human religion, castration was regarded as an act of devotion. Moreover, the ritual of circumcision is still followed by many modern religions. In this article, we have exposed the archeological, historical, cultural and religious evidence between the ancient ritual of castration and circumcision. MATERIALS AND METHODS: We reviewed the reports about circumcision and castration in the English, French, and Turkish literature. RESULT: Both the rituals of circumcision and castration had similar aims in human religions. CONCLUSION: The ritual of castration evolved into circumcision as a less-invasive and bloody procedure than castration.

Status of high-risk oncogenic human papillomavirus subtypes harbored in the prepuce of prepubertal boys.

OBJECTIVE: To evaluate whether the high-risk human papillomavirus (HPV) subtypes that are strongly related to cervical cancer are harbored in the prepuce of the circumcised tissue of prepubertal boys in the period just before active sexual life. METHODS: The present study enrolled 30 healthy boys (age range 4-11 years, mean age 8.1 ± 1.6) who underwent a standard circumcision procedure, with hypospadias repair in 3 patients. All prepuceal samples were studied using real-time polymerase chain reaction and grouped according to HPV subtype prevalence as groups 1 (types 16 and 18), 2 (types 31, 33, 45, 52, and 58), and 3 (types 35, 39, 51, 56, 59, 66, and 68). RESULTS: HPV DNA was reported in 25 (83.3%) of the 30 subjects. All samples showed a negative result for group 2. Although most of the positive findings were for group 3 (25 [83.3%] of 30), a positive result was reported for only 1 subject for group 1 (3.3%). CONCLUSION: The results of the present study have shown that the prepuce harbored the rarest HPV types, including types 35, 39, 51, 56, 59, 66, and 68 in preadolescence boys with a high rate (83%). These findings are in contrast to the common knowledge of HPV prevalence in adults that points to the dominance of HPV subtypes 16 and 18.

Accidental chlorine gas intoxication: evaluation of 39 patients.

BACKGROUND: Chlorine is a known pulmonary irritant gas that may cause acute damage in the respiratory system. In this paper, the socio-demographic and clinical characteristics of 39 accidentally exposed patients to chlorine gas are reported and different emergency treatment modalities are also discussed. METHODS: Two emergency departments applications were retrospectively analyzed for evaluation of accidental chlorine gas exposure for year 2007. Patients were classified into 3 groups according to severity of clinical and laboratory findings based on the literature and duration of land of stay in the emergency department. The first group was slightly exposed (discharged within 6 hours), second group moderately exposed (treated and observed for 24 hours), and third group was severely exposed (hospitalized). Most of the patients were initially treated with a combination of humidified oxygen, corticosteroids, and bronchodilators. RESULTS: The average age was 17.03 ± 16.01 years (95% CI). Seven (17.9%) of them were female and 29 (74.4%) were children. Twenty-four patients (61.5%) were included in the first, nine (23.1%) were in second and six (15.4%) were in the third group. The presenting symptoms were cough, nausea, and vomiting and conjunctiva hyperemia for the first group, first groups symptoms plus dyspnea for the second group. Second groups symptoms plus palpitation, weakness and chest tightness were for the third group. Cough and dyspnea were seen in 64.1% and 30.8% of the patients respectively. No patients died. CONCLUSIONS: The authors recommend that non symptomatic or slightly exposed patients do not need any specific treatment or symptomatic treatment is sufficient. KEYWORDS: Accidental; Chlorine exposure; Chlorine gas; Chlorine intoxication; Emergency department.