Evaluation of a scoring system to predict treatment success with single-dose methotrexate in ectopic pregnancy.

PURPOSE: This study sought to assess the efficacy of a newly developed scoring system in predicting treatment outcomes for ectopic pregnancy among patients undergoing single-dose methotrexate therapy. The primary research question centered on the reliability and predictive accuracy of objective parameters in determining methotrexate therapy success. METHODS: Conducted as a retrospective single-center cohort study, data from 172 ectopic pregnancy patients treated with methotrexate between January 2021 and January 2023 were analyzed. Parameters including adnexal mass size, peritoneal fluid presence, yolk sac identification, endometrial thickness, ectopic pregnancy location, and initial B-hCG levels were meticulously evaluated for their association with treatment outcomes. RESULTS: Following the exclusion of 21 emergency surgery cases, the final analysis comprised 151 patients. Notable associations were observed between specific parameters (fetal cardiac activity, adnexal mass size > 3.5 cm, peritoneal fluid presence, yolk sac identification, endometrial thickness > 10 mm, and initial B-hCG levels) and treatment outcomes (p < 0.001). Additionally, the novel scoring system demonstrated promising predictive performance. At a cutoff of 2.50, it achieved a sensitivity of 91.7% and a specificity of 59.7%. Increasing the cutoff to 3.50 resulted in a sensitivity of 94.0%, with a specificity of 46.3%. CONCLUSION: Objective parameters, particularly those integrated into the developed scoring system, exhibited substantial associations with methotrexate therapy outcomes in ectopic pregnancy. These findings underscore the potential of an objective scoring model to significantly influence clinical decision-making in therapy, offering avenues for enhanced prognostication and patient care in treatment outcomes.

Uterine preserving technique in the treatment of pelvic organ prolapse: Laparoscopic pectopexy.

OBJECTIVE: Apical prolapse constitutes an important part of pelvic organ prolapse. In this study, our aim was to investigate the effectiveness of laparoscopic pectopexy that we made by preserving the uterus in the surgical treatment of apical prolapse. METHODS: A total of 36 patients with apical prolapse who wanted to preserve their uterus underwent laparoscopic rectopexy. Apical prolapse and sexual function of the patients were evaluated preoperatively and 12 months after surgery using the Pelvic Organ Prolapse Quantification (POP-Q) scale and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) sexual questionnaire form. Preoperative medical records and postoperative clinical results were recorded. RESULTS: There were no intraoperative or postoperative complications in the patients who underwent laparoscopic pectopexy. The average duration of surgery was 48.7 ± 9.8 min. Two patients had a recurrence of apical prolapse. In the Aa, Ba, C, and D points in the POP-Q staging, significant changes were observed. Postoperative PISQ-12 scores improved significantly (p < 0.05). CONCLUSION: Uterine-preserving laparoscopic pectopexy is a safe, feasible, and effective method for treating pelvic organ prolapse. It also improved the PISQ-12 and POP-Q scores in POP patients. Laparoscopic pectopexy may increase a surgeon's technical perspective for pelvic organ prolapse surgery.

A Distinct Technique of Intermaxillary Fixation Screw Application to Condylar Process to Fracture Reduction in Open Approach of Condylar Fracture Treatment.

ABSTRACT: The aim of this letter is to present the surgical experience obtained from a patient, in whom the proximal segment was better manipulated for precise alignment after application of the intermaxillary fixation screw.

Recommendations for management of diabetic foot ulcers during COVID-19 outbreak.

COVID-19 pandemia began in Wuhan, China, in December 2019. A total of 1 878 489 people were infected and 119 044 people were lost because of the disease and its complications by 15 April. Severe morbidity and mortality complications are mostly seen in elderly and patients having comorbidities. Diabetic foot ulcers (DFUs) are one of severe complications of diabetes mellitus and it may require urgent surgical interventions. In this paper, we aimed to create a management algorithm to prevent the unexpected complications that may occur in the patients and health care workers during the evaluation of COVID-19 in DFU patients who require urgent surgical intervention. We advise the use of thorax computerised tomography for preoperative screening in all DFU patients with severe signs of infection and especially those requiring urgent surgery for both the detection of the possible undiagnosed COVID-19 in the patient for the need for close follow-up and protection of the surgical and anaesthesiology team.

A Basic Algorithmic Surgical Approach for Nicolau Syndrome.

BACKGROUND: Nicolau syndrome (NS) is a rare complication that develops after the administration of intramuscular diclofenac sodium. The etiology and surgical treatments of 11 patients with NS were evaluated and studies in the literature were examined. The aim of this study was to compose a basic algorithm for surgical approaches to treat NS. MATERIALS AND METHODS: Eleven patients were evaluated for NS between December 2013 and January 2018. Two patients did not accept treatment, and nine patients underwent surgical debridement of necrotic tissues. The tissue defects of five patients were closed with a fasciocutaneous flap and, in four patients, the defects were repaired primarily. RESULTS: No complications, such as wound infection, wound dehiscence, seroma, or flap necrosis, were encountered. Of the seven patients who received concurrent antibiotic therapy, no patient had any problems at their follow-up (2-30 months). The results were satisfactory from an aesthetic and functional point of view. CONCLUSION: NS was more frequent in women with a high body mass index and high fat in gluteal regions. We considered that any kind of medication could lead to NS. Different methods are discussed for treatment.

Unsuspected Diagnosis of Uterine Leiomyosarcoma after Laparoscopic Myomectomy in an Isolated Bag.

Minimally invasive techniques are generally applied for patients suspected of having benign fibroids if medical treatment is insufficient. On the other hand, sometimes some occult carcinomas of uterus like leiomyosarcomas may be reported for the patients' applied morcellation. This condition is rare but outcomes are clinically significant. Fragmentation of occult sarcoma in the abdominal cavity without isolation bag results in widespread and poor survival. In this article, we report a case of 37-year-old woman suffering from pain due to unexpected leiomyosarcoma. Laparoscopic myomectomy was performed with power morcellation in an isolated bag. Although isolation bag is generally reported to be preventive, recurrence of sarcoma was seen at 5th month of follow-up. Even though morcellation within a bag seems to block wide spreading, dispersion of tumor cannot be stopped and more investigations have to be done.