Coronary sinus ablations in pediatric patients with supraventricular arrhythmias.

BACKGROUND: Intracoronary sinus ablations have been performed for various arrhythmical substrates. The aim of this study is to report our experience on pediatric patients of the safety and efficacy of ablations in the coronary sinus. METHODS: This is a retrospective study of all patients who underwent ablations in the coronary sinus from October 2013 to October 2021 at a single center. Clinical presentation, type of arrhythmia causing tachycardia, ablation procedure, and outcome were recorded. RESULTS: A total of 27 patients were included in the study. Nineteen (69%) of those followed up received a diagnosis of Wolff-Parkinson-White syndrome (WPW), 4 (15%) were cases of supraventricular tachycardia with concealed accessory pathway (AP), 2 (8%) were cases of focal atrial tachycardia, and 2 (8%) were cases of permanent junctional reciprocating tachycardia. Negative delta wave was noteworthy especially in lead II in 11/19 (58%) cases and coronary sinus diverticulum was detected in the WPW cases. Of those with manifest AP (19 cases), 15 (79%) had a high-risk AP and the AP in all WPW cases was adenosine unresponsive. Radiofrequency (RF) catheter ablation was performed in 25/27 (93%) cases during the procedure, and 16/25 (64%) of these were irrigated RF catheters. No complications were observed in the follow-up, including coronary artery injury. CONCLUSIONS: Catheter ablation of supraventricular tachyarrhythmias can be accomplished effectively and potentially safely within the coronary sinus. Coronary sinus diverticula should be suspected in patients with manifest posteroseptal APs who have a previous failed ablation and typical electrocardiographic signs.

A rare association: first degree AV block and long QT syndrome.

The coexistence of long QT syndrome with 2:1 or complete atrioventricular blocks has been reported in the literature, but, to the best of our knowledge, this is the first pediatric case of long QT syndrome coexisting with first-degree atrioventricular blocks( 1 - 3 ).

Protective effect of curcumin on ovarian reserve in a rat ischemia model: an experimental study.

PURPOSE OF INVESTIGATION: To determine the protective effect of curcumin on ovarian reserve in a rat ischemia model. MATERIALS AND METHODS: Thirty female Albino rats were randomly divided into two groups by time of unilateral, left ovary ischemia/reperfusion (group 1: two-hour ischemia / two-hour reperfusion; group 2: four-hour ischemia / four-hour reperfusion). Each group was subdivided into three subgroups, sham, control, and curcumin (intraperitoneal curcumin (200 mg/kg) simultaneously with reperfusion). Histological grading of ischemic indices of paraffin-embedded ovarian tissue using hematoxylin and eosin (H&E), and anti-Mulerian hormone (AMH) levels by enzyme-linked immunosorbent assay (ELISA), were measured 40 days later. RESULTS: No difference was found between groups 1 and 2 or among subgroups within either group for right and left ovary grades. AMH levels were significantly higher in the curcumin subgroup compared to sham and control within group 2 and in group 2 versus group 1 curcumin subgroups. CONCLUSION: Curcumin maintains and protects ovarian functions in an ischemia-reperfusion rat model.

Adolescent pregnancy and depression: is there an association?

OBJECTIVE: The impact of being an adolescent and socio-demographic parameters on depression development during pregnancy were evaluated in this study. MATERIALS AND METHODS: Between September 2010 and September 2011, 105 consecutive adolescent women ≤ 17 years of age were defined as the study group and 105 consecutive pregnant women over 18 years of age and matched for gestational age, were defined as the control group. Groups were compared according to depression development. The predictors of depression were analyzed by regression analysis. RESULTS: Median Beck Depression Inventory-II (BDI-II) scores in adolescent and control groups were 16 and 6, respectively. The difference was statistically significant. In the adolescent group, 39.0% of patients had mild depression, 37.1% moderate, and 10.5% had severe depression. Only 4.8% of patients in the control group had mild depression while none of the control cases had moderate or severe depression. Multivariate analysis showed that most important factor that was associated with depression development during pregnancy was being an adolescent. CONCLUSION: Depression risk was increased 18.2-fold in adolescent patients with pregnancy. Therefore psychiatric evaluation should be considered for these patients.

Bupivacaine-soaked absorbable gelatin sponges in caesarean section wounds: effect on postoperative pain, analgesic requirement and haemodynamic profile.

BACKGROUND: Pain is a common distressing adverse effect in the early postoperative period following caesarean section. The aim of this study was to investigate the effect on postoperative pain, analgesic requirement and haemodynamic profile of placing a suprafacial bupivacaine-soaked absorbable gelatin sponge in the caesarean section wound. METHODS: A total of 164 healthy patients scheduled to undergo general anaesthesia for elective caesarean section were randomised to a study group (n=81) or a control group (n=83). In the study group, a bupivacaine-soaked absorbable gelatin sponge was placed subcutaneously in the caesarean section wound. Intramuscular diclofenac 75 mg was given to all patients at 8-h intervals during the first 24h. Postoperatively, visual analogue scale pain scores, requirement for pethidine and diclofenac and changes in blood pressure and heart rate were compared between groups. RESULTS: Pain scores were lower in the study group compared to the control group at all assessments (P<0.001). During the first eight hours after surgery, fewer patients in the study group required rescue pethidine compared with the control group (4 vs. 33, P<0.001). In the study group, total opioid and diclofenac consumption was lower (P<0.001), and blood pressure and heart rate were lower (P<0.001) compared to the control group. CONCLUSION: Suprafascial wound placement of a bupivacaine-soaked absorbable gelatin sponge improved postoperative analgesia and decreased opioid consumption following caesarean section.

Does quality of female sexual function improve after a transobturator tape procedure?

The aim of this study was to use a questionnaire to evaluate any changes in sexual satisfaction of women who underwent a transobturator tape (TOT) procedure for stress urinary incontinence. A total of 30 women agreed to participate in the study and were invited to fill out the Female Sexual Function Index (FSFI) questionnaire prior to surgery and 3 months after surgery. As a result, after the TOT operation, there was a statistically significant improvement in libido (desire), arousal, lubrication, orgasm and satisfaction. The TOT procedure seems to have a positive effect on female sexual function by reducing the urinary leakage during sexual activity and by decreasing the pain during or after sexual activity.

Transcutaneous electrical nerve stimulation improves low back pain during pregnancy.

BACKGROUND: To compare the efficiency of transcutaneous electrical nerve stimulation (TENS) with those of exercise and acetaminophen for the treatment of pregnancy-related low back pain (LBP) during the third trimester of pregnancy. METHODS: This prospective study included 79 subjects (≥32 gestational weeks) with visual analog scale (VAS) pain scores ≥5. Participants were divided randomly into a control group (n = 21) and three treatment groups [exercise (n = 19); acetaminophen (n = 19); TENS (n = 20)]. The VAS and the Roland-Morris disability questionnaire (RMDQ) were completed before and 3 weeks after treatment to assess the impact of pain on daily activities. RESULTS: During the study period, pain intensity increased in 57% of participants in the control group, whereas pain decreased in 95% of participants in the exercise group and in all participants in the acetaminophen and TENS groups. Post-treatment VAS and RMDQ values were significantly lower in the treatment groups (p < 0.001). VAS and RMDQ scores indicated a significantly greater degree of pain relief in the TENS group than in the exercise and acetaminophen groups (p < 0.001). No adverse effect of TENS application on pregnant women was observed during the study. CONCLUSION: TENS is an effective and safe treatment modality for LBP during pregnancy. TENS improved LBP more effectively than did exercise and acetaminophen.

Maternal arrhythmias detected with electrocardiography during labour: are they significant clinically?

This study examines the maternal and fetal effects of arrhythmias detected by electrocardiographic (ECG) monitoring during labour in parturients at term, with no cardiovascular pathology. Pregnant cases were classified into three groups based on determined stages of labour and a standard 12-lead surface electrocardiogram and long-lead 2 rhythm strips were recorded during the labour. Cardiac arrhythmia of any kind was detected in 82.3% of patients in all stages of labour. Sinus tachycardia was the most commonly observed arrhythmia. Arrhythmias in the form of supraventricular tachycardia, T-wave inversion and ventricular extrasystole were also detected. The highest rate of arrhythmia was recorded for the active phase and 2nd phase of labour. Arrhythmias that are detected by ECG during or after the labour in patients with no cardiovascular pathology display a benign nature and do not create any clinical risk for the mother and the baby.

Recurrence of ovarian cyst after sclerotherapy.

AIM: The aim of this paper was to evaluate correlation between cyst recurrence and some cyst characteristics after sclerotherapy of non-neoplastic ovarian cyst with alcohol-erythromycin combination. METHODS: Fifty two cases of simple ovarian cysts were subjected to sclerotherapy with alcohol and erythromycin. Two patients were excluded due to suspicious cytologic result. All patients were followed-up monthly with color Doppler ultrasonography for over 12 months. Failure of procedure was considered if recurrent cyst diameter exceeds 5 centimeters detected by ultrasound. Cyst size, volume and color of aspirate, steroid hormone, and tumor marker levels of the cyst fluid were correlated to the recurrence rate. RESULTS: The fluid of cyst was serous in 32 cases and dark chocolate-colored in twenty cases. Cytological analyses of thirty cysts were acellular sediment, twenty were suitable with endometrioma and two were reported as suspicious. At 12-month follow-up, 12 cyst recurrences was detected. There was no difference in aspirated cyst volume, cyst size and FSH and LH content of recurrent and resolved cyst. The cyst wall thickness of recurrent cyst was higher than that of resolved cyst (P<0.001). The mean estradiol and progesterone concentrations of resolved cysts were significantly higher than that of recurrent cysts on the other hand, the mean CA125 levels in recurrent cysts (347.9±204.4) was significantly higher as compared to the mean CA125 concentrations of resolved cyst (16.75±22.45). CONCLUSION: Aspiration and sclerotherapy with alcohol and erythromycin yielded a relatively high recurrence rate in cyst with a bloody aspirate and high CA125 levels in cyst fluid.

The oncologic surgery of Serefeddin Sabuncuoglu in the 15th century.

Serefeddin Sabuncuoglu (AD 1385-1468) was the author of the first illustrated surgical textbook in the Turkish-Islamic literature, Cerrahiyyet'ul-Haniyye (Imperial Surgery), written in old Turkish in 1465. Cerrahiyyet'ul-Haniyye, consists of three chapters and 193 sections which include coloured miniatures of surgical procedures, incisions, and instruments, for a variety of surgical specialties, including oncology. Serefeddin Sabuncuoglu was a surgeon, medical teacher, deontologist and a miniature artist who should be remembered as a contributor to the modern medical practice six centuries later.

Primary carcinoma of the fallopian tube mimicking tubo-ovarian abscess.

PURPOSE: The aim of the study is to report that the primary fallopian tube cancer can be presented as a tubo-ovarian abscess preoperatively. METHODS: A patient with a preoperative diagnosis of a tubo-ovarian abscess with abdominal pain, tenderness and an elevated fever with leukocytes underwent urgent exploratory laparotomy. RESULTS: Explorative laparotomy and accompanied frozen section revealed a right-sided tubal carcinoma. There was an inflammatory and purulent reaction in the tube that was adherent to the anterior uterus. Total hysterectomy and bilateral salpingo-oophorectomy were performed. CONCLUSION: Carcinoma of the fallopian tube should be considered in the differential diagnosis of acute pelvic peritonitis like a tubo-ovarian abscess.

Interactive effect of sevoflurane with isradipine or indomethacin on spontaneous contractile activity of isolated pregnant rat myometrium.

Volatile anesthetics, calcium antagonists and non-steroidal anti-inflammatory drugs inhibit contractile activity of myometrial smooth muscle. The aim of this study was to investigate the interactive effect of sevoflurane with isradipine or indomethacin on spontaneous contractile activity of myometrial strips isolated from pregnant rats. The myometrial strips were excised from rats (250-300 g) at 19-21 days of gestation and mounted in tissue baths for recording of isometric tension. Sevoflurane (0.5 to 3 MAC) inhibited the amplitude and frequency of spontaneous myometrial contractions in a concentration-dependent manner (P<0.05). Sevoflurane responses were repeated in the presence of isradipine (a dihydropyridine-type calcium channel blocker) and indomethacin (a non-selective cyclooxygenase (COX) inhibitor). Pretreatment with isradipine (10(-6) M) or indomethacin (10(-7) M), concentrations that themselves had no effect on spontaneous contractility, significantly increased the inhibitor responses to sevoflurane on amplitude and frequency of myometrial contractions, beginning at 1 MAC (P<0.05). Blockade of calcium channels in myometrial smooth muscle may increase the inhibitor effect of sevoflurane. Further work is needed to determine the cellular mechanism(s) of this interaction.

Management of non-neoplastic ovarian cysts with sclerotherapy.

OBJECTIVE: To evaluate sclerotherapy with alcohol and erythromycin in the management of simple ovarian cysts. METHODS: Twenty-four simple ovarian cysts were subjected to sclerotherapy with alcohol and erythromycin. All procedures were performed under local anesthesia and in an outpatient setting. Cytological examination was carried out in all cases and two patients were excluded from the study because of suspicious cytological results. The patients were followed up monthly with color Doppler sonography for more than 12 months. RESULTS: Cyst fluid was serous in 17 cases and dark-chocolate colored in seven cases. The volume of aspirated fluid ranged from 100 to 220 ml. The size of ovarian masses and cyst-wall thickness ranged from 5.5 to 8.5 cm and 1.5 to 5 mm, respectively. Cytological analysis of 15 cysts revealed acellular sediment, seven cysts were compatible with endometrioma, and two were reported as suspicious. During the 12-month follow-up, seven cyst recurrences were detected. CONCLUSION: Aspiration and sclerotherapy with alcohol and erythromycin are followed by a relatively high recurrence rate when the aspirate is bloody. However, patients with a simple cyst that is painful or liable to torsion could benefit from sclerotherapy. Such patients, who are at low risk for malignancy, are relieved with sclerotherapy while avoiding surgery.

Effects of propofol on vascular smooth muscle function in isolated rat aorta.

This study was undertaken to determine the direct actions of propofol, and whether propofol exerts any action on basal endothelium-derived relaxing factor release and vasodilator effect of acetylcholine on phenylephrine-induced contractile responses in isolated rat aortic rings. This compound is known to produce a fall in blood pressure in man and animals, and it has been suggested that the hypotension may result from a direct vasodilator action on the veins and arterioles. In this study, propofol did not induce any contractile response in aortic rings at various concentrations (10(-8)-10(-4) M). Propofol did not significantly alter phenylephrine-induced contractions at lower concentrations (10(-8)-10(-6) M) but at higher concentrations (10(-5)-10(-4) M) the depression caused by propofol was significant in both endothelium-intact and -denuded rings. Pretreatment of the endothelium-intact rings with propofol (10(-6) and 10(-5) M) produced a reduction in the relaxant effect of acetylcholine. The results obtained in this study demonstrate that clinically relevant concentrations of propofol (10(-6) M or less) have no direct vasodilator effects and that it reduces endothelium-dependent relaxation to acetylcholine.