A comparison of the clinical features of molar pregnancy in adolescents and adults.

Objective: To compare the age-specific clinical features of molar pregnancy and to describe the risk factors associated with this situation. Method: This retrospective case-control study was conducted at the Department of Obstetrics and Gynecology. Tepecik Education and Research Hospital, Izmir, Turkey. The participants included both adolescents (≤ 19 years) and adults with histologically confirmed hydatidiform moles in our institution between January 2015 and January 2022. The interventions and main outcome measures of this study involved evaluating the clinical and ultrasonographic features, as well as the risk factors, associated with molar pregnancies in adolescents. Results: This study of 137 patients with molar pregnancy found that adults had a higher incidence of partial molar pregnancy (20 patients versus seven patients) and lower beta-hCG levels than adolescents (176.890.71 mIU/ml versus 253.734.47 mIU/ml). Adolescents had a higher likelihood of hyperthyroidism (25.4% versus 9.2%). bleeding on admission (4.2% versus 1.51%),. longer hospital stays (5.44 ± 2.73 days versus 3.59 ± 3.08 days). Higher rates of uterine enlargement and postoperative bleeding (15.5% versus 1.5%). Adolescents also required more analgesia (97% versus 89.4%). Conclusions: Adolescents with Gestational trophoblastic diseases (GTD) may present with more severe symptoms compared to adults, which can lead to delayed diagnosis and treatment. Further research is needed to better understand the underlying mechanisms and risk factors for GTDs in this population. Increased awareness and education can help improve recognition and management of GTDs in adolescents and improve their overall health outcomes.

Association of polycystic ovary syndrome with mammographic density in Turkish women: a population-based case-control study.

OBJECTIVE: The objective of this study was to investigate the breast densities and Breast Imaging-Reporting and Data System scores of patients with polycystic ovary syndrome and normoovulatory women and to determine whether these patients constitute a high-risk population for breast cancer. METHODS: This retrospective case-control study was conducted at our institution between January 2022 and December 2022, involving patients diagnosed with polycystic ovary syndrome. Menstrual periods, hyperandrogenemic findings, and ultrasound reports of the patients were retrieved from our hospital's database. Patients who met at least two of the Rotterdam criteria were included in the polycystic ovary syndrome group. A total of 70 premenopausal patients over the age of 40 years, diagnosed with polycystic ovary syndrome, and 70 normoovulatory women, matched for age and body mass index, were included in the study. The two groups were compared regarding age at menarche, menstrual pattern, gravida, parity, levels of follicle-stimulating hormone, luteinizing hormone, and estradiol, endometrial thickness, breast density category, and Breast Imaging-Reporting and Data System classifications. RESULTS: Patients in the polycystic ovary syndrome group had a higher age at menarche (12.7 vs. 12.3, p=0.006). There was no difference between the gonadotropin levels in both groups. However, the estradiol level was higher in the polycystic ovary syndrome group (p<0.001). There was no statistically significant difference between the two groups in terms of breast density and Breast Imaging-Reporting and Data System scores (p=0.319 and p=0.650, respectively). CONCLUSION: Although we can conclude that the risk of breast malignancy is not increased in patients with polycystic ovary syndrome, the impact of the complex hormonal status of polycystic ovary syndrome on breast cancer remains unclear in the literature.

Which combination cause less inflammatory response during laparoscopic hysterectomy? Ligasure plus monopolar cautery or harmonic plus bipolar cautery?

Objective: We aimed to compare the inflammatory response with alterations in hemogram parameters, in patients who underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy for benign gynecologic conditions with ligasure plus monopolar cautery or harmonic plus conventional bipolar cautery. Methods: Patients who underwent Laparoscopic hysterectomy with bilateral salpingo-oophorectomy between January 2017 and January 2022 for benign gynecologic pathology were identified. Patients were divided into two group, according to instruments used during surgery. Instruments were used according to surgeons preference. Preoperative and postoperative in the first 24 hours hematocrit (HCT), WBC, trombocyt, neutrophil- lymphocyte (NLR), platelet-lymphocyte (PLR) ratio, mean platelet volume- lymphocyte ratio (MPVLR) and red cell distribution width- platelet ratio (RPR) values were compared. Results: During study period, a total of 462 patients underwent hysterectomy for benign gynecologic pathology. After exclusion, 212 patients were included in the study. In the study group, 147 patients were operated with ligasure plus monopolar electrocauter and 65 with harmonic scalpel plus bipolar electrocautery. In the postoperative period, regardless of the procedure, WBC and RPR count increase, hematocrit and trombocyt decrease in both group but the inflammatory markers lymphocyte count, neutrophyl, NLR, PLR and MPVLR count changed less in the harmonic plus bipolar cautery group which shows less inflamatuar response in this group. Conclusions: Ligasure plus monopolar cautery group compared with harmonic plus bipolar cautery group cause more inflammatory changes in complete blood count values. However, further studies are needed to show whether these changes in laboratory findings affect clinical situations.

The effect of progesterone supplementation in women with threatened miscarriage on fetal fraction in non-invasive prenatal testing: A matched case-control study.

AIM: To evaluate the effect of progesterone use on fetal fraction (FF) in non-invasive prenatal testing (NIPT) due to the threat of first trimester miscarriage. METHODS: This case control study included the pregnant who were referred to our clinic for non-invasive prenatal testing. The patients were categorized into three groups: Pregnant women with vaginal bleeding and using progesterone, pregnant women with vaginal bleeding and not using progesterone, and pregnant women without bleeding. The groups were formed by matching gestational week. Women with multiple pregnancy, BMI (body mass index) ≥25, abnormal fetal karyotype, and chronic disease were excluded from the study. Maternal characteristics, FF of the NIPT were recruited from the computer based medical records. RESULTS: A total of 10,275 NIPT tests were performed during the study period. 3% of the patients (n = 308) were found at risk of miscarriage. 100 patients with a vaginal bleeding and 50 control patients were matched. The median value of the fetal fraction ratio was found to be 6.55 in pregnant women without vaginal bleeding, 7.05 in pregnant women who had vaginal bleeding and using progesterone, and 7.3 in pregnant women who had vaginal bleeding and did not use progesterone. Although the fetal fraction ratio was found to be higher in pregnant women with vaginal bleeding and lower in progesterone users, this situation could not reach the level of statistical significance (p = 0.351). CONCLUSIONS: The fetal fraction rate in maternal blood is not affected in pregnant women who use progesterone due to vaginal bleeding in early gestational weeks.

Facilitating method for removal of the large uterus after laparoscopic hysterectomy: Vaginal vault vertical incision.

BACKGROUND: In patients with a large uterus, an important part of the laparoscopic hysterectomy operation time is the phase of removing the uterus from the abdomen.The development of techniques that will shorten the morcellation time is the key to reducing the total operation time. AIM: To evaluate the effect of vaginal cuff vertical incision in accelerating removal of the large uterus in laparoscopic hysterectomy. METHODS: This study was performed with patients who underwent total laparoscopic hysterectomy. In the study group, a vertical incision was performed in the middle of the posterior vaginal stump before the vaginal removal of the larger uterus (weighing more than 500 g). The control group consisted of patients who underwent vaginal morcellation after conventional colpotomy. Patients in both groups were matched in terms of uterine weights +/-50 g and the same vaginal morcellation technique was applied to all patients. RESULTS: In patients who underwent a vertical incision procedure, the time to remove the uterus from the abdomen (17.55±2.53 min vs 26.62±4.72 min, p<0.001) and the total operation time (130.81±12.83 min vs.143.29±13, 15 min, p = 0.001) was statistically significantly less than the patients without vertical incision. There was no difference between the groups in terms of intraoperative complications, drop in hemoglobin levels, time to flatus, postoperative 6th,24th hour visual analog score and length of hospital stay. CONCLUSIONS: The vertical incision procedure reduces the time to remove the large uterus from the abdomen after laparoscopic hysterectomy and, accordingly, the total operation time. This procedure may be the preferred method before vaginal morcellation, especially in large uterus.

Comparison of extracorporeal shock wave therapy and high-intensity laser therapy on pain, grip strength, and function in patients with lateral epicondylalgia: a randomized controlled study.

This study aimed to compare the effects of extracorporeal shockwave therapy (ESWT) and high-intensity laser therapy (HILT) on pain, grip strength, and function in patients with lateral epicondylalgia. This prospective randomized controlled study included 42 patients (22 women and 20 men, mean age: 37) divided into 3 groups. The first group received physiotherapy (n = 14), the second received physiotherapy combined with ESWT (n = 14), and the third received physiotherapy combined with HILT (n = 14). All participants underwent 10 physiotherapy sessions for 2 weeks, 5 sessions per week. In addition to physiotherapy, the ESWT group received 4 ESWT sessions, 2 sessions per week, and the HILT group received 4 HILT sessions, 2 sessions per week. The outcomes were pain intensity as assessed by Visual Analog Scale, grip strength by hand dynamometer, and function by the Duruoz Hand Index and Patient-Rated Tennis Elbow Evaluation-Turkish version questionnaire. The participants were assessed at the beginning of the study (T1/week 0), at the end of treatment (T2/2nd week), and at follow-up (T3/6th week). At follow-up (T3), a significant improvement was observed in all outcomes compared to baseline (T1) in all groups (P < 0.05). Inter-group comparison of the mean differences between baseline and end values showed that the HILT group was superior in all outcomes (P < 0.05). This study showed that physiotherapy alone combined with ESWT and HILT positively affected the treatment of lateral epicondylalgia. Physiotherapy combined with HILT was found to be the most effective for improving pain, grip strength, and function. Clinical trial number: NCT674325.

Combined liver transplantation and off-pump coronary artery bypass grafting: a report of two cases.

INTRODUCTION: Liver transplantation (LT) is the most effective treatment modality in patients with end-stage liver disease (ESLD). With the increased prevalence of diabetes and non-alcoholic fatty liver disease (NAFLD), coupled with a steady increase in the age of transplant population, liver transplant candidates are at increased risk for coronary artery disease (CAD). Improvements in anesthesia, surgical experiences, and increased effectiveness of drugs have facilitated concurrent surgical interventions in transplantation, allowing for orthotopic LT to be performed in elderly patients with a high incidence of coexisting diseases, especially those of the cardiovascular system. In this study, we present two cases of combined off-pump coronary artery bypass surgery and living donor liver transplantation. CASE PRESENTATION: A 68-year-old male patient with ESLD due to chronic hepatitis C infection and multi-vessel CAD, and a 65-year-old female patient with NAFLD cirrhosis and multi-vessel CAD were referred to our institution for an LT evaluation. We performed combined living donor LT and off-pump coronary artery bypass surgery in both patients. Both the first and second patients were alive with good liver and cardiac function at the 25 and 15 months after surgery, respectively. CONCLUSION: Combined off-pump coronary artery bypass surgery and living donor LT are an alternative treatment for patients with severe CAD and ESLD. We consider that combined coronary artery bypass graft surgery and LT can be safely performed by experienced anesthesia and surgical teams in selected patients.

The effects of exogenous oral micronized progesterone on first trimester aneuploidy screening markers in women with threatened miscarriage: a matched case control study.

OBJECTIVES: To evaluate the effect of using progesterone due to early vaginal bleeding on aneuploidy screening markers in the first trimester. MATERIAL AND METHODS: This case control study includes the pregnant women who applied to our clinic in order to have a screening test for Down syndrome in the weeks of 11°/7-136/7. The patients were divided into three groups. Self reported vaginal bleeding with progesterone therapy (Bl+, Prg+, n:70), Self reported vaginal bleeding without progesterone therapy (Bl+, Prg-, n:70) and as a control group pregnant women who had no vaginal bleeding. (NoBl, NoPrg, n:70). In all patients, free beta-human chorionic gonadotrophin (ß-hCG), pregnancy associated plasma protein-A (PAPP-A) levels and nuchal translucency (NT) thickness were analyzed. Mean MoMs of the markers were compared between three groups. RESULTS: In the two groups with vaginal bleeding (Bl+, Prg + and Bl+, Prg-) the free ß-Hcg MoM values were statistically higher (1.22 ± 0.72, 0.98 ± 0.45, respectively) compared to the No Bleeding/No Progesterone group (0.81 ± 0.52) (p ≤ 0.001, p ≤ .01, respectively). However, no significant difference was found between the free ß-hCG MoM value of women with Bl+, Prg + group (1.22 ± 0.72) and Bl+, Prg - group (0.98 ± 0.45). (p: .053, significance level limitation with Bonferroni correction p: .017). PAPP-A and NT thickness did not differ significantly between the groups. CONCLUSION: Our data did not find an association between the use of oral progesterone and any alternations in first trimester screening parameters. Regardless of the progesterone usage, vaginal bleeding in the first trimester pregnancies increased the free ß-hCG MoM values compared to pregnancies without vaginal bleeding during pregnancy.

Educational Features of YouTube Videos Depicting Breastfeeding: Quality, Utility, and Reliability Analysis.

Objective: In this study, we aimed to evaluate the quality, reliability, and utility of breastfeeding videos on YouTube. Materials and Methods: We conducted a YouTube search with the keyword "breastfeeding education" and limited our search results to the first 200 videos. After exclusion criteria, 165 videos were investigated. The viewer parameters including likes, dislikes, the total number of views, comments, and source of the videos were evaluated. The educational content of the videos was evaluated with the Global Quality Score. In addition, the popularity of the videos was assessed with the video power index (VPI). Upload sources were categorized as the academic institutions and individual users. Results: There were 134 (81.2%) videos in group 1 (poor and suboptimal quality videos) and 31 (18.8%) videos in group 2 (good and excellent quality videos). The mean number of views, likes, and comments were 96.212 ± 198.445, 241.2 ± 310.2, and 45.3 ± 67.9, respectively, in group 1, and 203.057 ± 388.722, 474.1 ± 560.6, and 63.6 ± 98, respectively, in group 2. Comparing both groups, the length of good-excellent videos was longer than poor-suboptimal videos. There were no differences between groups based on number of comments and number of dislikes. In addition, VPI values in group 2 were statistically higher than those in group 1 (p < 0.001). Conclusions: Only ∼18.8% of YouTube videos presenting breastfeeding education were good or excellent. YouTube videos depicting breastfeeding were a limited source for the patients.

Diagnostic value of preoperative ultrasonography, cervical length measurement, and POP-Q examination in cervical elongation estimation.

INTRODUCTION AND HYPOTHESIS: Cervical elongation (CE) has not been clearly defined and has similar symptoms to pelvic organ prolapse. We aimed to evaluate the diagnostic value of preoperative POP-Q examinations, ultrasonographic measurements, and direct cervical length measurement with a Foley catheter in predicting CE on postoperative hysterectomy specimens. METHODS: Fifty-six patients who underwent vaginal hysterectomy for apical pelvic organ prolapse were included. The patients were divided into two groups based on the hysterectomy specimens' corpus/cervix ratio (CCR) as follows: the non-CE group, CCR > 1; the CE group, CCR < 1. The preoperative direct cervical length measurement was performed using 10-French Foley catheters. The recommended cutoff values and sensitivity/specificity analysis of the cervical measurements with Foley, ultrasound, and C-D measurements according to POP-Q were determined by the receiver-operating characteristic analysis. RESULTS: There were 13 patients (23%) in the non-CE group and 43 patients (76%) in the CE group. The mean cervical measurements with Foley catheter and ultrasound, C-D diameter, and postoperative cervix measurements were 49.4 ± 12.6 mm, 42.14 ± 9.4 mm, 41.4 ± 17.2 mm, and 49.5 ± 13 mm, respectively. Cervical measurement with a Foley catheter had 65% sensitivity and 62.5% specificity with a 47.5-mm cutoff value. Among these preoperative measurements, Foley catheter measurements were the most compatible with postoperative cervical measurements. There was no significant association between CE and age, body mass index, menopause duration, point C, and point D. CONCLUSION: Cervical length measurement with a Foley catheter may be preferred for estimation of CE.

Comparison of pain and proper sample status according to usage of tenaculum and analgesia: a randomized clinical trial.

OBJECTIVE: Colposcopic biopsy is a discomfortable procedure. Additionally, it creates negative influence on sexuality. This study aimed to investigate the relationships among tenaculum, pain perception, and biopsy size during colposcopy. METHODS: In total, 228 patients who underwent colposcopy-directed biopsy were included, and randomized into 4 groups based on whether analgesic and tenaculum were used and replaced (tenaculum with n=58/without analgesic n=56, no tenaculum replacement with n=57/without analgesic n=57). Lidocaine hydrochloride (40 mg) plus adrenaline (0.025 mg) was administered in the analgesic groups. The pain was assessed using a linear visual analog scale. The biopsy specimen size was measured in millimeters. RESULTS: The mean age of the patients was 42.85±8.88 years. The most frequent colposcopy indications were atypical squamous cells of undetermined significance and human papilloma virus-positive results on cervical cytology (30.2%; n=69). Low- and high-grade intraepithelial lesions were noted in 14.91% (n=34) and 10.96% (n=25) women through colposcopy-directed biopsy results, respectively. Tenaculum replacement increased pain perception in the without analgesic group; however, no statistically significant differences were noted between of the groups with and without tenaculum replacement with analgesic. The size and number of biopsy specimens were not associated with tenaculum replacement and analgesic use. CONCLUSION: Administration of analgesics decreased discomfort and pain in patients. Tenaculum replacement aided colposcopists in manipulating the cervix. Additionally, administration of analgesics relieved pain in the tenaculum replacement group. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03279666.

The impact of concurrent HPV infections on the presentation of high grade cervical intraepithelial lesions.

OBJECTIVES: We investigate how concurrent high-risk (hr) HPV (human papillomavirus) genotypes affect CIN2-3 risk and evaluate the relationship of different genotype combinations with cervical epithelial lesions. MATERIAL AND METHODS: This study included HPV positive patients between the ages of 30 and 60 who underwent liquid-based cervical smears and HPV screening through community-based, cervical cancer screening programs between June 2015 and June 2017. The impact of the increase in hrHPV types was calculated by estimating how it changed the odds ratio of CIN2-3 risk. RESULTS: The rate of multiple concurrent HPV infections was 48.7% in the CIN2-3 group and 58.4% in the CIN1 group. Among patients in the CIN2-3 and CIN1 groups, the most common HPV coinfection was respectively HPV 16+31 and HPV 16+51. The HPV 51 ratio in CIN1 patients was 28.9% and the HPV 51 ratio in the CIN2-3 patient was 6.6%. With every increase in the number of hrHPV infection types, the frequency of CIN2-3 decreased [OR: 0.72, 95% CI: 0.54-0.95]. For all hrHPV combinations, the addition of HPV 16 was associated with a higher risk of CIN2-3. CONCLUSIONS: An increase in number of hrHPV types is associated with lower CIN2-3 risk. Further cohort studies with larger samples are needed to clarify this relationship. The available evidence suggests that HPV 16 genotype plays an important role in patients with high-grade cervical lesions and has a negative impact on the cervix in concurrent multiple HPV infections.

Comparison of laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopic (CMPL) surgery for hysterectomy: long-term outcomes of abdominal incisional scar.

There is scarcity of data about the long-term results such as port-site hernia, body image scale and cosmesis scale outcomes between laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopy (CMPL) for hysterectomy. Eighty women, who underwent total hysterectomy by the LESS (n = 40) and CMPL (n = 40) technique due to benign and malign gynecological disorders, were evaluated with a cosmesis and body image questionnaire in an age-matched cohort study.Median follow-up time was 25 (6-30) months in both groups. The mean age of the patients was 49.3 ± 6.3 years. The mean body image scale scores were 5.3 ± 0.6 and 5.5 ± 1.2 in the LESS and CMPL groups, respectively (p = 0.268). The mean cosmesis and scar scale scores were significantly higher in the LESS group compared to the CMPL group (p = .011 and p < .001, respectively). Port-site hernia was detected in two patients in the LESS group, but not in the CMPL group. There was no cuff dehiscence in the LESS nor in the CMPL group. The LESS technique provides better cosmesis when compared with the CMPL technique. The body image perceptions in the two groups were similar. Women who wish to undergo the LESS surgery should be informed about the risk of incisional hernia.Impact statementWhat is already known on this subject? Short-term results of LESS hysterectomy such as complication rates, additional port requirement, conversion to CMPL or laparotomy, pain score and analgesic use were evaluated in various studies. Several studies have been published on the safety and efficacy of single-port laparoscopic hysterectomy (LH); however, it has been unclear whether single-port LH offers benefits over multiport LH regarding long-term patient satisfaction and cosmetic satisfaction.What do the results of this study add? In this prospective cohort study, we aimed to compare long-term results (at least six months) of abdominal incisional scar between LESS and CMPL surgery for hysterectomy. The LESS technique provides better cosmesis when compared with the CMPL technique, although, the body image perceptions in the two groups were similar.What are the implications of these findings for clinical practice and/or further research? LESS technique can be offered as an option for hysterectomy since it provides better long-term cosmesis compared to CMPL.

The effect of being diagnosed with human papillomavirus infection on women's sexual lives.

PROBLEM: Objective studies that use validated questionnaires are needed to evaluate the changes in the sexual functions of women diagnosed with human papillomavirus (HPV) infection. METHOD OF STUDY: The study comprised 80 sexually active women diagnosed with a high-risk HPV infection. These patients were divided into four groups as follows: group 1, HPV 16/18-positive and normal cytology; group 2, HPV 16/18-positive and abnormal cytology; group 3, non-16/18 HPV-positive and abnormal cytology; and group 4, non-16/18 HPV-positive and normal cytology. The sexual functions and anxiety statuses of the patients were assessed via the Female Sexual Function Index (FSFI) and Beck anxiety inventory (BAI) questionnaires, respectively, at their first clinical visits and then 2 months later. RESULTS: There was no statistically significant difference among the study groups in terms of the overall FSFI and domain sub-scores at either of the visits. Women who tested positive for the high-risk HPV 16/18 strains had a significantly less sexual desire after being informed about the test results. Those with HPV 16/18 and normal cytology had significantly higher anxiety levels at their second than first visits. The BAI scores of the HPV 16/18-positive women (normal or abnormal cytology) at the second visit were significantly higher than those of non-16/18 HPV-positive women with normal cytology. There was no significant difference between the patients with normal and abnormal cytology results regarding the difference of BAI, overall and domain FSFI sub-scores at the first and second visits. The desire and lubrication domain scores of the HPV 16/18-positive patients significantly decreased after the first visit compared with those of the non-16/18 HPV-positive patients. CONCLUSION: HPV 16/18 positivity decreases women's total FSFI and desire domain sub-scores.

Influence of Abdominal Binder Usage after Cesarean Delivery on Postoperative Mobilization, Pain and Distress: A Randomized Controlled Trial.

OBJECTIVE: The purpose of the present study was to determine the effect of abdominal binder usage on mobilization, postoperative pain, and distress after cesarean delivery. MATERIALS AND METHODS: This prospective randomized controlled study was conducted between September 1, 2017 and January 31, 2018 at Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey. A total of 89 women undergoing elective cesarean were randomized to the study (binder, n=45) or control (no binder, n=44) groups. Patients in the study group were fitted with a binder before leaving the operating room. Mobilization (6-minute walk test), postoperative pain (measured by Short-Form McGill Pain Questionnaire and Visual Analog Scale), and perceived distress status of both groups were evaluated within 8th (first mobilization time), 24th, and 48th h of surgery. RESULTS: We found that the binder group (BG) walked longer than the control group during the 6-minute walking distance test. At the first mobilization time (postoperative 8th h), the BG (99.4±27.3 m) covered significantly more distance than the control group (81.0±22.2 m) (p=0.001) in the walking distance test. At postoperative 24th h, the McGill pain score in the BG was significantly lower than that in the control group (p=0.004). For all three test times, the Symptom Distress Scale of the BG was lower than that of the control group (postoperative 8th h p=0.024, 24th h p<0.001, and 48th h p<0.001). CONCLUSION: The evidence is consistent with abdominal binder usage after cesarean section decreasing the feeling of distress and increasing mobility.

Clinical Outcomes of Synchronous Laparoscopic Cholecystectomy with Coronary Artery Revascularization.

BACKGROUND: There are limited data about the results of simultaneous coronary revascularization, either with coronary artery bypass grafting (CABG) surgery or percutaneous coronary intervention (PCI), and cholecystectomy operations. Here we present clinical outcomes of the patients who underwent simultaneous laparoscopic cholecystectomy (LC) and coronary revascularization at the same session. PATIENTS AND METHODS: We included a total of 19 patients who underwent simultaneous LC and CABG or PCI. Thirteen of them had been hospitalized because of acute cholecystitis prior to coronary angiography. Simultaneous CABG and LC were performed in 10 patients (group I). LC was performed immediately after CABG surgery at the same session. PCI (group II) was performed in 9 patients. In the PCI group, LC was performed under general anesthesia 2 or 3 days after PCI. RESULTS: No mortality was seen after the procedures. In the CABG group, the mean number of bypass grafts was 3.4 ± 1.9. The mean extracorporeal circulation and the total operation times were 95 ± 13.5 minutes and 259 ± 18.9 minutes, respectively; the mean intubation duration was 17 ± 4.8 hours. In the PCI group, the mean number of stents per patient was 2.1 ± 0.7; LC was performed 2 or 3 days after the PCI without the cessation of clopidogrel and acetylsalicylic acid. The mean operation times for LC were 56.5 ± 15.6 minutes and 51.3 ± 17.6 minutes in the CABG and PCI groups, respectively (P = .86). In the CABG group, the mean durations of ICU and hospital stays were 3.1 ± 1.4 and 14.2 ± 3.7 days, respectively. In the PCI group, the mean durations of ICU stay and hospitalization were 1.7 ± 0.4 and 7.4 ± 2.2 days, respectively. Significant differences were found between the 2 groups in terms of the intubation time, duration of ICU stay, and hospitalization periods (P =.001, P =.0001, and P =.001, respectively). No intra-abdominal complications or bleeding was encountered in any group. Postoperative complications of the abdominal wall or mediastinitis were not seen in the setting of concomitant procedures in the CABG group. CONCLUSION: Simultaneous CABG or PCI with LC may be performed safely in patients with cholecystitis. The durations of postcholecystectomy ICU stay and the intubation time were significantly lower in the PCI group. According to our results, PCI may be the first choice of revascularization procedure in selected patients requiring cholecystectomy prior to discharge.

The effectiveness of neutrophil to lymphocyte ratio in prediction of medical treatment failure for tubo-ovarian abscess.

AIM: We aimed to compare the neutrophil-to-lymphocyte ratio (NLR) in tubo-ovarian abscess (TOA) patients who responded to medical treatment or who underwent surgical intervention due to medical treatment failure. METHODS: The files of the patients, hospitalized in our Obstetrics and Gynecology Department with TOA diagnosis between August 2015 and December 2017, were evaluated retrospectively. The conservative management group was comprised of 38 of the 81 patients (46.9%) who responded to sole medical treatment with the triple antibiotic regimen (gentamicin-clindamycin-ampicillin) and the surgical intervention group was comprised of 43 patients (53.1%) who did not respond to medical treatment and needed further surgery and/or interventional radiologic abscess drainage. Demographic and clinical data, imaging findings, and laboratory results including NLR were compared between two groups. RESULTS: There were statistically significant differences between the groups in terms of age, TOA diameter, white blood cell and neutrophil counts, and NLR levels (P < 0.05). The mean NLR was 7.4 ± 5.8 for the conservative management group and 10.3 ± 5.8 for the surgical intervention group (P = 0.004). The area under the curve (AUC) for NLR was 0.69 (threshold value was ≥6.97, 95% confidence interval, sensitivity 79.1%, specificity 57.9%). On multiple regression analysis, a significant correlation was identified between age, NLR and resistance to the medical treatment. CONCLUSION: Neutrophil-to-lymphocyte ratio and age are significantly higher in patients with medical treatment failure and NLR could be used as a novel marker in addition to white blood cell in the prediction of medical treatment failure in TOA patients.

Does the 'equal management of equal risks' model cause overtreatment in patients with positive cervical cytology results for ASCUS/non-HPV16/18 oncogenic types?

OBJECTIVES: According to the American Society of Colposcopy and Cervical Pathology (ASCCP), cervical cytology patients who test positive for atypical squamous cells of undetermined significance (ASCUS) and the human papilloma virus (HPV) positive are recommended to undergo colposcopies. This study compared the colposcopic biopsy evaluation results of patients with positive cervical cytology results for ASCUS and HPV with regards to their HPV genotypes. METHODS: This study included 179 patients who underwent cervical cancer screening tests between June 2015 and June 2017 and whose results displayed positive cervical cervical cytology results for ASCUS and HPV. Cytological samples were classified using the Bethesda system in liquid-based specimens. The Hybrid Capture II system was used to define the HPV-DNA. Colposcopic diagnoses and biopsy results were compared in terms of the outcomes of the Pap test and HPV genotypes. RESULTS: There were 107 ASCUS/HPV16/18-positive patients. Of the HPV 16/18 positive patients; 28 (26.1%) patients were detected with CIN1, 8 (7.5%) patients were detected with CIN2, 6 (6%) patients were detected with CIN3, and 1 (0.9%) patient was detected with cervical cancer. Of the 72 non-HPV 16-18 positive patients; 8 (11%) patients were detected with CIN1 and 2 (2.7%) patients were detected with CIN2. CONCLUSION: This study believes that the ASCCP recommendations, which state that a 'colposcopy should be performed on all women with positive cytology for ASCUS/non-HPV16/18 oncogenic types', is required to be revised. This will reduce the rate of the colposcopy procedures by 40% in women with ASCUS/HPV positivity.

A spontaneous heterotopic pregnancy presenting with acute abdomen treated with natural orifice transluminal endoscopic surgery procedure: Case report.

Heterotopic pregnancy occurs 1 in 30000 pregnancies. We present case of an acute abdomen caused by a ruptured ectopic component. Our patient had no known risk factors, which made the diagnosis even more challenging. Intrauterine pregnancy was desired by patient and her husband. A natural orifice transluminal endoscopic surgery (NOTES) procedure was performed, which is a next-generation minimally invasive procedure in this area. After the procedure, our patient was discharged one day after surgery with a viable intrauterine pregnancy.