Non-invasive quantification of hepatic steatosis in living, related liver donors using dual-echo Dixon imaging and single-voxel proton spectroscopy.

AIM: To evaluate the diagnostic implications of hepatic fat fraction calculated using dual-echo Dixon imaging and (1)H magnetic resonance spectroscopy (MRS) to detect hepatic steatosis in potential liver donors using histopathology as the reference standard. MATERIALS AND METHODS: One hundred and forty-five potential liver donors were included in the study. Magnetic resonance imaging (MRI) was performed using a 1.5 T system using a three-dimensional dual-echo MRI sequence with automated reconstruction of in-phase (IP), out-of-phase (OP), fat-signal-only, and water-signal-only images. Hepatic fat fraction was calculated by drawing 15 regions of interest on the IP, OP, fat-only, and water-only images. Single-voxel MRS was performed at echo times (TEs) of 30 ms in the right and left lobes of liver. Liver fat fraction was calculated from water and fat peaks. One hundred and forty-five biopsies were prospectively evaluated for steatosis by a pathologist using traditional determination of the cell-count fraction. MRI and pathology values of steatosis were correlated using Pearson's correlation coefficient. The sensitivity and specificity of each of these methods was calculated using histopathology as the reference standard. Reproducibility was assessed in 40 patients who had repeat scanning within 4-40 days. Measurement error was calculated from the coefficient of variation (CoV) with histopathologically proven <5% fat (n=112). RESULTS: The Bland-Altman limits of agreement with 95% confidence intervals (CI) was -2.9 to 5.3%. The intraclass correlation coefficient (ICC) for interobserver variability and reproducibility was 0.94 (95% CI: 0.91-0.97), 0.92 (95% CI: 0.91-0.97). The CoV was 7.6% (95% CI: 3.4-11.85). The area under the receiver operating characteristic (ROC) curve (AUC) for Dixon imaging 0.89 (95% CI: 0.87-0.91), for MRS 0.88 (95% CI: 0.86-0.90). The sensitivity for detecting <5% fat was 84% and specificity was 90%. CONCLUSION: Combination of dual-echo Dixon imaging and proton MRS is a useful tool for the preoperative diagnosis of hepatic steatosis in potential living liver donors. This can help avoid unnecessary biopsies in these patients.

Single-port access total laparoscopic hysterectomy with Korean-made OCTO Port: Turkish surgeons' initial experience.

We present our initial experience with single-port access total laparoscopic hysterectomy (TLH) surgery using a Korean-made laparoscopic port (OCTO™ Port). In a retrospective study, single-port access TLH (SPA-TLH) with the OCTO Port was performed on 34 patients with benign gynaecological indications from July 2013 to May 2014 by two surgeons (Ahmet Kale and Hasan Terzi). All patients were divided into two groups. The first 15 patients who underwent SPA-TLH were classified as Group 1, and the second 19 patients who underwent SPA-TLH were classified as Group 2. Patient data were analyzed for age, body mass index (BMI, kg/m(2)), weight of uterus, vaginal cuff suturation time, estimated blood loss, operation time, hysterectomy indications and operative outcomes. The median time needed for the surgery was 75 min in both groups. The duration of suturing of the vaginal cuff was shorter in Group 2 compared with that in Group 1. The estimated blood loss was less in Group 2 compared with Group 1: Four patients in Group 1 required blood transfusion while none of the patients in Group 2 required blood transfusion. The OCTO Port has soft and flexible instrumental movements, which can reduce crowding of instruments during surgery, and the cap rotates 360 degrees. The OCTO Port might facilitate the learning curve of single-port laparoscopic hysterectomy surgery.

New method: Are tumor markers in vaginal-washing fluid significant in the diagnosis of primary ovarian carcinoma?

OBJECTIVE: Ovarian cancer is the seventh most common cancer in women worldwide, with nearly a quarter of a million women diagnosed every year. The serum tumor markers cancer antigens CA 125, CA 19-9, and carcinoembryonic antigen (CEA) are potentially of clinical value for the diagnosis of ovarian cancer. A diagnostic tool that is noninvasive, simple to perform, and specific is needed to predict primary ovarian cancer. The purpose of this study was to evaluate the diagnostic sensivitity and specificity of vaginal-washing tumor markers CA 125, CA 19-9, and CEA for diagnosis of primary ovarian cancer. MATERIALS AND METHODS: In the current prospective study, 30 patients with advanced primary ovarian cancer and 30 patients with benign ovarian cysts were enrolled. The vaginal-washing fluid samples were obtained the day before surgery and were immediately centrifuged and stored at -80 degrees C until analysis. Measurements of CA 125, CA 19-9, and CEA were determined using fully-automated chemiluminescent microparticle immunoassays. RESULTS: The vaginal fluid concentrations of CA 125, CA 19-9, and CEA in patients with primary ovarian carcinoma were significantly higher (p < 0.001) compared to those in patients with benign adnexal masses (p < 0.001). In the ROC curve analysis, the optimal cut-off values for the detection of primary ovarian cancer were >295 for CA 125 (p < 0.001), > 101 for CA 19-9 (p < 0.001), and >135 for CEA (p < 0.001). CONCLUSION: Vaginal-washing tumor markers CA 125, CA 19-9, and CEA are simple, noninvasive, and reliable diagnostic tests for the detection of primary ovarian cancer.

Uterine artery ligation at the beginning of total laparoscopic hysterectomy reduces total blood loss and operation duration.

The purpose of this study was to compare the feasibility, blood loss, duration of surgery and complications between patients in whom both uterine arteries were ligated by surgical clips and cut using a 5-mm ligature at the beginning of total laparoscopic hysterectomy (TLH) and patients in whom uterine arteries were not ligated at the beginning of TLH. In our prospective study, a total of 60 women underwent TLH. Uterine artery ligation (UAL) was done at the beginning of the procedure. Women were divided into TLH + UAL (n = 30) and TLH (n = 30) groups. In TLH group, TLH was done without ligating the uterine arteries at the beginning of the procedure. In TLH + UAL group, TLH was done with ligation of both uterine arteries at the beginning of the procedure. The mean operating time was longer for the TLH group (99.16 ± 7.01) than TLH + UAL group (63.27 ± 7.16). The median total blood loss was higher in TLH group (109.38 ± 33.03 mL) than TLH + UAL group (47.50 ± 8.12 mL). UAL at the beginning of TLH is a technically feasible procedure. It reduces the total blood loss and decreases the time taken for the procedure and length of hospital stay.

Amniotic fluid amino acid concentrations in fetal skeletal dysplasia.

The authors' objective was to measure amniotic fluid amino acid concentrations in pregnant women diagnosed as having fetuses with skeletal dysplasia in the second trimester of pregnancy. Eighteen pregnant women who had fetuses with with skeletal dysplasia detected by ultrasonography (skeletal dysplasia) in the second trimester and 35 women who had abnormal triple screenings indicating an increased risk for Down syndrome, but had healthy fetuses (control group), were enrolled in the study. Amniotic fluid was obtained by amniocentesis. The chromosomal analysis of the study and control groups was normal. Levels of free amino acids and non-essential amino acids were measured in amniotic fluid samples using GC/FID free (physiological) amino acid kit by gas chromatography. The mean levels of essential amino acids (histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine) in amniotic fluid were found to be significantly lower in fetuses with skeletal dysplasia than in the control group (p < 0.05). The detection of significantly lower amino acid concentrations in the amniotic fluid of fetuses with a skeletal dysplasia compared to healthy fetuses suggests amino acid deficiency may play an etiological role in the pathogenesis of skeletal dysplasia.

Sublingual misoprostol is better for cervical ripening prior to hysteroscopy in post-menopausal women.

BACKGROUND: The aim of the present study was to evaluate the efficacy of misoprostol administered sublingually, vaginally or rectally on cervical ripening before hysterescopic surgery in post-menopausal women. MATERIALS AND METHODS: Post-menopausal women were randomised to receive either 400 ug of misoprostol, administered sublingually, vaginally or rectally six hours and 12 hours prior to operative hysterescopy. RESULTS: Patients were randomized to receive receive sublingual (n = 30), rectal (n = 30) or vaginal (n = 30) misoprostol. The control group did not receive misoprostol (n = 30). The four groups were comparable in terms of preoperative cervical width after misoprostol administration. The mean cervical widths for control group was 9.0 +/- 1.1 mm and the mean post-treatment cervical widths for the sublingual, vaginal, and rectal groups were 7.1 +/- 1.1 mm, 8.9 +/- 1.3 mm, and 8.6 +/- 1.5 mm, respectively. The cervical widths of sublingual group were significantly different from control, vaginal; and rectal groups (p < 0.001). CONCLUSION: Four hundred micrograms of sublingual misoprostol, 12 and six hours prior to operative hysteroscopy has a significant cervical ripening effect compared with vaginal, rectal, and control groups in post-menopausal women.

Detection of central nervous system tissue as bovine spongiform encephalopathy specified risk material in traditional Turkish meat products.

BACKGROUND: This study used enzyme-linked immunosorbent assay kits to investigate the presence of central nervous system (CNS) tissue in commercial raw and processed traditional Turkish meat products offered for consumption in various markets. RESULTS: Ninety-six raw traditional Turkish meat products (32 fresh raw beef patties, 32 cig kofta, 32 pastirma) and 64 processed traditional Turkish meat products (32 doner kebabs and 32 fresh processed beef patties) were analysed. CNS tissue was not found in pastirma, doner kebab, or fresh processed beef patty samples. The levels of CNS contamination in fresh raw beef patties were low (0.1% absorbance standard; 3.1%) and moderate (0.2% absorbance standard; 6.2%). The level of contamination in the cig kofta was low (0.1% absorbance standard; 18.8%). CONCLUSION: CNS tissue was present in all raw traditional Turkish meat products except for pastirma.

Are alanine, cysteine, glycine and valine amino acids the cause of non-immune hydrops fetalis?

Our objective was to measure amniotic fluid amino acid concentrations in pregnant women diagnosed as having fetuses with non immune hydrops fetalis in the second trimester of pregnancy. Twenty-three pregnant women who had fetuses with non immune hydrops fetalis detected by ultrasonography (non immune hydrops fetalis group) in the second trimester and 19 women who had healthy fetuses (control group) were enrolled in the study. Amniotic fluid was obtained by amniocentesis. The chromosomal analysis of the study and control groups was normal. Levels of free amino acids were measured in amniotic fluid samples using EZ: fast kits (EZ: fast GC/FID free (physiological) amino acid kit) by gas chromatography (Focus GC Al 3000 Thermo Finnigan analyzer). The mean levels of alanine, cysteine, glycine and valine amino acids were found to be significantly higher in fetuses with non immune hydrops fetalis than in the control group (p<0.05). The detection of significantly higher amino acid concentrations in the amniotic fluid of fetuses with a non immune hydrops fetalis in healthy fetuses suggests loss of amino acids from the fetus through capillary permeability or/and the lymphatic system through the amniotic fluid may contribute to the etiology of non-immune hydrops fetalis.

The role of amino acids in spina bifida.

Our objective was to measure amniotic fluid amino acid concentrations in pregnant women diagnosed as having fetuses with spina bifida in the second trimester of pregnancy. Fifteen pregnant women who had fetuses with spina bifida detected by ultrasonography (spina bifida group) in the second trimester and 19 women who had abnormal triple screenings indicating an increased risk for Down's syndrome but had healthy fetuses (control group) were enrolled in the study. Amniotic fluid was obtained by amniocentesis. The chromosomal analysis of the study and control groups was normal. Levels of free amino acids were measured in amniotic fluid samples using EZ: fast kits (EZ: fast GC/FID free (physiological) amino acid kit) by gas chromatography (Focus GC AI 3000 Thermo Finnigan analyzer). The mean levels of alanine, cystathionine, cysteine, phenylalanine, tryptophane, and tyrosine amino acids were found to be significantly higher in fetuses of the control group than in the spina bifida group (p<0.05). The detection of significantly higher amino acid concentrations in the amniotic fluid of healthy fetuses suggests loss of amino acids from the fetus through the spinal cord may contribute to the etiology of spina bifida.

Melatonin use in unilateral total salpingectomy in rats.

OBJECTIVE: To investigate the effects of melatonin use in unilateral total salpingectomy on ovarian histology in rats. SETTING: Firat University, Medical School, Obstetrics and Gynecology Department, Elazig. MATERIAL AND METHOD: Thirty adult, female rats of Wistar albino species with regular cycles were randomly allocated to three groups in the estrus phase. G1 (n: 10): The group where the abdomen was opened and closed, and left oophorectomy was performed six months later. G2 (n: 10): The group where left total salpingectomy was performed and followed by left oophorectomy six months later. G3 (n: 10): The group where the abdomen was opened, left total salpingectomy was performed 15 min after 10 mg/kg/IP melatonin administration, and left oophorectomy was performed six months later. Samples of the left ovary were fixed in formaldehyde. The preparations were stained with hematoxylineosin, and primordial, primary, secondary and tertiary follicles were counted. All the numbers were added up to determine the ovarian follicle reserve. Atretic follicles were counted. Corpus luteum and corpus albicans were counted. Number of total corpuses was calculated. Regression of the presence of angiogenesis within the corpus luteum was examined. Presence of fibrosis on the ovarian stroma was examined. An ordinal scale was formed for the presence of regression of angiogenesis within the corpus luteum and presence of fibrosis (none: 0p, present: 1p, markedly present: 2p). Follicle cysts in the ovary were counted. Kruskal Wallis variance analysis was used in the statistical analysis of data; p < 0.05 was considered significant. RESULTS: Primordial follicle count, ovarian follicle reserve and regression of angiogenesis in the corpus luteum were found to be significantly lower (p < 0.05, Mann-Whitney U test), and atretic follicle count, microscopic follicle cyst and fibrosis development were found to be significantly higher in G2, when compared to G1 and G3 (p < 0.05, Mann-Whitney U test). None of the rats in G1 and G3 had ovarian cysts, whereas five rats in G2 were identified as having macroscopic follicle cysts. Other data were found to be similar in G1, G2, and G3 (Kruskal Wallis variance analysis). CONCLUSION: Left total salpingectomy reduces primordial follicles, ovarian follicle reserve and regression of angiogenesis in the corpus luteum, while increasing atretic follicles, microscopic ovarian cysts and fibrosis development. It leads to the development of macroscopic follicle cysts in the ovary at a high rate (50%) in the sixth month. Melatonin use eliminates these harmful effects. Melatonin can be used to avoid the unfavorable effect of total salpingectomy on the ovary.

Examination of the effect of melatonin use in Pomeroy method of tubal ligation on ovarian histology in rats.

OBJECTIVE: To examine the effects of melatonin use in the unilateral Pomeroy method of tubal ligation on ovarian histology in rats. SETTING: Firat University Medical School, Obstetrics and Gynecology Department, Elazig. MATERIAL AND METHOD: Thirty adult, female rats of Wistar albino species with regular cycles were randomly allocated to three groups in the estrus phase: G1 (n: 10): The abdomen was opened and closed. G2 (n: 10): The group where the abdomen was opened, and the Pomeroy method of tubal ligation was performed. G3 (n: 10): The group where the abdomen was opened, and Pomeroy method of tubal ligation was performed 15 min after 10 mg/kg/ip melatonin administration. Abdomens of all rats were opened six months later and left oophorectomy was performed. Samples of the left ovary were fixed in formaldehyde. The preparations were stained with hematoxylin eosin, and primordial, primary, secondary and tertiary follicles were counted. All the numbers were added up to determine the ovarian follicle reserve. An atretic follicle count was made. The corpus luteum and corpus albicans were counted, and the number of total corpuses were calculated. Regression of angiogenesis within the corpus luteum was examined. Presence of fibrosis on ovarian stroma was examined. An ordinal scale was formed for the regression of angiogenesis within the corpus luteum and presence of fibrosis (none: 0p, present: 1p, markedly present: 2). Follicle cysts in the ovary were counted. Kruskal Wallis variance analysis was used in the statistical analysis of data; p < 0.05 were considered significant. RESULTS: The comparison between G1 and G3 showed that all values were similar (p > 0.05, Kruskal Wallis variance analysis). When G2 was compared with G1 and G3, regression of angiogenesis in the corpus luteum was found to be significantly lower (p < 0.05, Mann Whitney U test), while atretic follicle count and fibrosis were significantly higher in G2 (p < 0.05, Mann Whitney U test). CONCLUSION: The Pomeroy method of tubal ligation reduces regression of angiogenesis in the corpus luteum, and increases atretic follicles and fibrosis development. Melatonin use restores these harmful effects. Melatonin can be used to refrain from this negative effect of the Pomeroy method of tubal ligation on the ovary.

Comparison of diclofenac sodium with indomethacin suppositories for mediolateral episiotomies.

OBJECTIVE: The study was carried out to compare the analgesic effect of diclofenac sodium and indomethacin suppositories for management of right mediolateral episiotomy repair. METHOD: A total of 70 patients who gave birth vaginally with right mediolateral episitomy were randomly assigned to receive 100 mg diclofenac sodium suppositories/day (G1, n = 35) or 100 mg indomethacin supposotories/day (G2, n = 35) after episiotomy repair and postpartum for three days. Pain ratings were recorded before, the first hour and 24 hours after medication. The verbal rating scale (VRS) and visual analog scale (VAS) were used for pain recording. The independent T test, Mann-Whitney U and Wilcoxon rank test were used for statistical analysis and Spearman correlation analysis was used for comparison between VRS and VAS. RESULTS: Diclofenac sodium was a more effective analgesic than indomethacin suppositories for right mediolateral episiotomy pain. For G1 the first hour VRS was 2.6 +/- 0.5 points and VAS 4.9 +/- 0.8 points; for G2 the first hour VRS was 3.4 +/- 0.6 points VAS 6.6 +/- 1.2 points; this difference was statistically significant (p < 0.05, Mann-Whitney U test). For G1 at the 24th hour VRS was 1.2 +/- 0.4 points and VAS 2.4 +/- 0.9 points; for G2 at the 24th hour VRS was 2 +/- 0.7 points and VAS was 3.4 +/- 1.3 points; the difference was statistically significant (p < 0.05, Mann-Whitney U test). The first and 24th hour pain scores (VAS1-VAS24, VRS1-VRS24) were decreased dramatically for both groups (p < 0.05, Wilcoxon rank test). A positive correlation was obtained between the first and 24th hour VRS and VAS by Spearman correlation analysis (r(s) = 0.9, n = 70, p = 0.000). CONCLUSION: The two analgesics were effective after episiotomy repair, however diclofenac sodium suppositories may be the preferred choice because they were more effective.

Obturator nerve endometriosis: A systematic review of the literature.

Background: Symptomatic obturator nerve endometriosis is a rare condition. In this paper, we aim to review and discuss the characteristics of obturator nerve endometriosis in light of current literature. Methods: An electronic search was conducted using the PubMed/Medline database. Results: Symptomatic obturator nerve endometriosis is rare; only 8 cases have been reported in the literature. Symptoms including difficulty walking, weak thigh adduction and pain in the inner thigh, which are all related to obturator nerve function, could be seen in the case of the entrapment of the nerve by endometrial nodules. A history of recurrent symptoms during menstrual cycles and physical examination, combined with appropriate radiologic imaging, led to a suspicion of obturator nerve involvement. Conclusion: Early diagnosis and surgical treatment of obturator nerve endometriosis is essential to minimise the nerve damage caused by recurrent cycles of bleeding and fibrosis, which are characteristics of endometriosis. The laparoscopic minimally invasive technique is feasible for the surgery of obturator nerve endometriosis. It offers the advantage of precise discrimination of vital structures and excellent access to deep anatomic sites. What is New?: Obturator nerve endometriosis may be a severe cause of chronic pelvic pain in women of reproductive age. Treatment may be achieved surgically and in experienced hands, laparoscopic surgery would be the preferred choice.

Surgical Treatment of Catamenial Chest Pain: Excision of diaphragmatic endometriosis during robot-assisted laparoscopic surgery.

Background: 10% of women of reproductive age are affected by endometriosis, and diaphragmatic endometriosis represents 1-1.5% of these cases. Diaphragmatic endometriotic lesions often require surgical treatment. Objective: This video aims to demonstrate the appearance of diaphragmatic endometriosis and describe our experience with robot-assisted laparoscopic excision of full thickness diaphragmatic endometriosis. Materials and Methods: The patient was a 37-year-old female with the complaint of cyclical right shoulder pain (for 1 year). She previously had caesarean section scar and umbilical endometriosis excision procedures. The magnetic resonance imaging (MRI) of the abdomen highlighted three endometriotic nodules, one of which was described as full thickness on the right hemi-diaphragm. The patient underwent a robot-assisted laparoscopic endometriosis surgery as a joint procedure between the gynaecology and general surgery teams. The falciform ligament was completely divided to obtain full views of the endometriotic lesions on the diaphragm. Superficial diaphragmatic lesions were first excised. The larger deep nodule, which was described on the MRI, was then excised with the full thickness of diaphragm. Pleural cavity was entered intentionally to achieve complete excision of the nodule. Laparoscopic assessment of the right lower pleural cavity through this opening did not show any endometriotic lesions. After the excision, the diaphragm was repaired with a barbed suture. Negative pressure suction of the pleural cavity was performed at the end of this repair instead of using a chest tube. Results: The patient was discharged on the 3rd day with no complications encountered. Histopathological examination confirmed endometriosis. The patient was asymptomatic three months after surgery. Conclusion: Robotic-assisted surgery is an easy and safe choice especially in such challenging dual compartment surgeries by providing a 3D view that abolishes sensory loss and increases depth perception, providing better manoeuvrability with tremor absence.

V-NOTES hysterectomy under spinal anaesthesia: A pilot study.

Background: Spinal anaesthesia has not been widely adopted for laparoscopic surgeries until now. There are a few studies that have shown that spinal anaesthesia is at least as safe as general anaesthesia. The need for additional analgesics can be reduced by utilising early postoperative analgesic effects of spinal anaesthesia, and maximum benefit can be obtained from minimally invasive approaches when V-NOTES surgery is performed under spinal anaesthesia. Objective: Combining V-NOTES with spinal anaesthesia to improve minimally invasive surgical techniques and provide maximum benefit to patients. Materials and Methods: Patients who were found to have benign pelvic organ pathologies, required a hysterectomy and were considered suitable for V-NOTES hysterectomy under spinal anaesthesia were included in this study. Spinal anaesthesia was achieved with 12.5 mg 0.5% hyperbaric bupivacaine in the sitting position. Perioperative events and complications related to spinal anaesthesia were noted. Postoperatively, the pain was evaluated using a visual analogue scale at the 6th, 12th, and 24th hours. Main outcome measures: To evaluate the feasibility and safety of spinal anaesthesia in VNOTES hysterectomy and to increase the advantages of minimally invasive surgical procedures. Results: No conversion to conventional laparoscopy or laparotomy was required in all six operated patients. Conversion from spinal anaesthesia to general anaesthesia was unnecessary, and no major perioperative incident occurred in any of the cases. Conclusion: In the current study by our team, we demonstrated that V-NOTES hysterectomy could be performed safely under spinal anaesthesia in well-selected patients. The need for additional analgesics can be reduced by utilising early postoperative analgesic effects of spinal anaesthesia, and maximum benefit can be obtained from minimally invasive approaches when VNOTES surgery is performed under spinal anaesthesia. What is new?: V-NOTES hysterectomy could be performed safely under spinal anaesthesia in well-selected patients.

Resistin may not associate with gestational diabetes mellitus although insulin resistance.

OBJECTIVE: Resistin is a potent regulator of glucose homeostasis which is thought to oppose the action of insulin in peripheral tissues. The aim of this study was to determine changes in resistin levels in gestational diabetes mellitus (GDM). MATERIAL AND METHOD: Twenty women with GDM (mean age 32.28 +/- 5.01 years old, and gestational age 32.2 +/- 4.8 weeks) matched with 22 non diabetic pregnant women (NGDM) (mean age 30.30 +/- 4.5 years old, and gestational age 34.8 +/- 3.5 weeks) were included in the study. Body mass index (BMI) was calculated. Serum resistin levels were measured and insulin resistance was calculated with HOMA-IR. The Mann Whitney U test was used for statistical analysis. RESULTS: BMI was 33.8 +/- 6.2 kg/m2 in the GDM group and 28.4 +/- 6.2 kg/m2 in the NGDM group (p = 0.04). Serum resistin levels were 8.7 +/- 2.1 ng/ml in the GDM group and 8.1 +/- 2.5 ng/ml in the NGDM group. Mean resistin level was not different between the two groups. HOMA-IR in GDM was higher than in the NGDM group (13.2 +/- 12.2 vs 5.8 +/- 5.1, p = 0.02, respectively). CONCLUSION: Although mean BMI in GDM was higher than in NGDM and insulin resistance in GDM was more marked than in NGDM, serum resistin levels in GDM were not found to be any different from NGDM.

Impact of Social Vulnerability on Access to Educational Programming Designed to Enhance Living Donation.

INTRODUCTION: Transplant candidate participation in the Living Donor Navigator Program is associated with an increased likelihood of achieving living donor kidney transplantation; yet not every transplant candidate participates in navigator programming. RESEARCH QUESTION: We sought to assess interest and ability to participate in the Living Donor Navigator Program by the degree of social vulnerability. DESIGN: Eighty-two adult kidney-only candidates initiating evaluation at our center provided Likert-scaled responses to survey questions on interest and ability to participate in the Living Donor Navigator Program. Surveys were linked at the participant-level to the Centers for Disease Control and Prevention Social Vulnerability Index and county health rankings and overall social vulnerability and subthemes, individual barriers, telehealth capabilities/ knowledge, interest, and ability to participate were assessed utilizing nonparametric Wilcoxon ranks sums tests, chi-square, and Fisher's exact tests. RESULTS: Participants indicating distance as a barrier to participation in navigator programming lived approximately 82 miles farther from our center. Disinterested participants lived in areas with the highest social vulnerability, higher physical inactivity rates, lower college education rates, and higher uninsurance (lack of insurance) and unemployment rates. Similarly, participants without a computer, who never heard of telehealth, and who were not encouraged to participate in telehealth resided in areas of highest social vulnerability. CONCLUSION: These data suggest geography combined with being from under-resourced areas with high social vulnerability was negatively associated with health care engagement. Geography and poverty may be surrogates for lower health literacy and fewer health care interactions.

Pregnancy-related acute renal failure in the southeast region of Turkey: analysis of 75 cases.

OBJECTIVE: To study the clinical profile, management and outcome of the patients with pregnancy-related acute renal failure (PRARF). METHODS: All patients with PRARF admitted between January 2006 and January 2009 were analyzed. RESULTS: The total number of women with PRARF was 75. Age range of women with PRARF was 21 to 46 years and 36% of the cases of PRARF were seen in the postpartum period. PRARF was caused by sepsis in 14.6%, toxemias of pregnancy in 75.2%, and hemorrhage of pregnancy in 12%. Postabortal sepsis was the cause in 14.6%. Dialysis was needed in 33.3%. Maternal mortality rate was 10.6%. CONCLUSIONS: Pregnancy-related acute renal failure is a major health problem and carries very high mortality and morbidity. Poor healthcare facilities and lack of antenatal healthcare clinics are major identified causes.

Factors affecting maternal and perinatal outcomes in HELLP syndrome: evaluation of 126 cases.

OBJECTIVES: To ascertain the characteristics, clinical features, and maternal fetal outcome in HELLP (hemolysis elevated liver enzymes, low platelets) syndrome at a tertiary referral center. MATERIAL AND METHODS: This was a cross-sectional study carried out at Dicle University between January 2004 and December 2008 in which the charts of 126 cases were retrieved retrospectively and data analyzed descriptively. RESULTS: Of all deliveries 0.9% were complicated by HELLP syndrome. Of the cases with HELLP syndrome 79 (62.6%) had preeclampsia, 28 (22.2%) had eclampsia and 19 (15.2%) had a diagnosis of HELLP syndrome. The values of significant biochemical parameters (mean +/- SD) were documented as ALT (alanin aminotransferase) 224 +/- 42 IU/I and ALT1 (after birth) 140 +/- 22, AST 379 +/- 23 IU/l and AST1 215 +/- 51, LDH (lactate dehydrogenase) 1418 +/- 67 IU/l and LDH1 875 +/- 16, together with the hematological parameters as platelet count (86 +/- 12 K/Ul), urine protein (3 + in urine test stick) and albumin levels (2 + 0.9 g/dl). Eighty-six (68.25%) of the patients required albumin replacement. Thirty-one (24.6%) cases were nullipara and 95 (75.4%) multipara; of which 32 women (25.4%) were in Class I, and 94 (74.6 %) in Class II of complete HELLP syndrome. Regular antenatal examination was accomplished in a very small number of patients (12.25%). Fifty-eight (46.03%) patients required transfusions with blood or blood products and 12 (9.5%) underwent laparotomy due to major intraabdominal bleeding. Magnesium sulphate to prevent convulsions and corticosteroids (12 mg betametazone) to enhance fetal lung maturity were administered. Forty-four (34.9%) cases had vaginal delivery and 82 (65.1%) cesarean section; another 18 (14.2%) were with in utero stillbirth. Fifteen babies (11.9%) died, 26 (20.63%) developed placental abruption, 14 (11.11%) acute renal insufficiency, and 13 (10.31%) postoperative subcutaneous hematomas. Maternal mortality occurred in ten cases (7.93%). CONCLUSION: HELLP syndrome is a pathology associated with a high incidence of maternal and perinatal complications. Laboratory parameters in cases with HELLP syndrome are not efficient in detecting perinatal results, but can be used as risk denominators in evaluating maternal complications. Therefore, for patients with HELLP syndrome, standard antenatal follow-up protocols should be applied in order to obtain early diagnosis and improve the speed of transfer to obstetric departments with expertise in this field.