The shortest distance between the skin and the peritoneal cavity is obtained with fascial elevation: a preliminary prospective laparoscopic entry study.

The purpose of this study was to prospectively compare the measurement of skin-to-fascia distances in the neutral state, during manual elevation and by fascial elevation in patients who underwent laparoscopic surgery. In 53 patients, the distance between the skin and anterior wall of the rectus sheath was measured prospectively in following three different ways: (1) in neutral position, (2) during manual elevation and (3) during elevation of the fascia using forceps following an infraumbilical vertical skin incision. In all patients, subcutaneous tissue up to the fascia was dissected after a vertical skin incision. The skin-to-fascia distance of 30.9 mm (14.0-52.0 mm) in the neutral position decreased to 11.1 mm (0.0-26.0 mm) during the fascial elevation, while the mean distance increased to 40.1 mm (19-70 mm) during manual elevation (p < 0.001). In the closed laparoscopic entry technique in which a Veress needle is inserted into the peritoneum through a small incision, the needle should be introduced from the shortest distance between the skin and the peritoneum. Lifting the fascia with a proper surgical instrument in suitable patients could enable us to achieve this goal.

Association of basal serum androgen levels with ovarian response and ICSI cycle outcome.

BACKGROUND: The purpose of this study was to assess the predictive value of basal serum testosterone (T) and dehydroepiandrosterone sulfate (DHEAS) levels during follicular phase for ovarian response and outcome in intracytoplasmic sperm injection (ICSI) cycles of women with diminished ovarian reserve. METHODS: We prospectively gathered data of basal serum androgen levels and ICSI cycle characteristics of 120 women with diminished ovarian reserve. Association of basal serum T and DHEAS levels with ovarian response was analyzed. RESULTS: Basal T and DHEAS levels were similar between pregnant and non-pregnant cases (P > 0.05). There were significant differences between groups with and without successful embryo implantation in terms of serum follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), gonadotropin starting and total dose, and peak estradiol level (P < 0.05). There were 58 (49.2%) cases who did not reach to the embryo transfer stage due to several reasons including cancelation of stimulation due to unresponsiveness (n = 26, 21.7%), no oocyte at oocyte pickup (n = 11, 9.2%), no mature oocyte (n = 6, 5%), and failure of fertilization or embryo development (n = 15, 12.5%). Basal androgen levels were not significant predictors for any of the cycle outcome. AMH level was a significant predictor for failure of fertilization or embryo development (AUC 0.722, P = 0.01) and cancelation of stimulation (AUC 0.801, P < 0.001). FSH was a significant predictor for cancelation of stimulation (AUC 0.774, P < 0.001). CONCLUSION: In women with diminished ovarian reserve, basal T and DHEAS levels have no value in predicting any of the cycle outcome parameters.

Neutrophil to lymphocyte and platelet to lymphocyte ratios increase in ovarian tumors in the presence of frank stromal invasion.

OBJECTIVE: The aim of this study was to assess the predictive value of neutrophil/lymphocyte and platelet/lymphocyte ratios for borderline, malignant ovarian tumors, and borderline cases with microinvasion. METHODS: Totally 275 women with sonographically detected ovarian tumor were enrolled for this study. All subjects underwent gynecological surgery via endoscopic or conventional approach and ovarian masses were all evaluated histopathologically by the same pathologist. All study population was divided into three groups as group with borderline tumors, benign tumors, or malignant tumors according to the histopathological diagnosis. Just before surgical intervention, a blood sample was obtained from each participant to analyze CA125 level, neutrophil, platelet, and lymphocyte count. RESULTS: Neutrophil/lymphocyte ratio (AUC = 0.604, P = 0.02) was a significant predictor for malignant cases. Optimal cutoff value for the neutrophil/lymphocyte ratio was found to be 2.47 with 63.4% sensitivity and 63.5% specificity for malignancy prediction. Odds ratio of high neutrophil/lymphocyte ratio for malignancy risk was 2.5 (95% CI 1.3-4.8, P = 0.004). Platelet/lymphocyte ratio (AUC = 0.621, P = 0.007) was a significant predictor for malignant cases. Platelet/lymphocyte ratio (AUC = 0.568, P = 0.05) was also predictive for cases without a benign mass. Optimal cutoff value for the platelet/lymphocyte ratio was found to be 144.3 with 54% sensitivity and 59% specificity for malignancy prediction. Odds ratio of high platelet/lymphocyte ratio for malignancy risk was 2.1 (95% CI 1.1-3.8, P = 0.02). CONCLUSION: Neutrophil/lymphocyte and platelet/lymphocyte ratios are predictors for malignant ovarian tumors but not borderline tumors even in case of microinvasion.

Investigation of cardiovascular disease risk in women with uterine leiomyomas.

OBJECTIVE: The aim of this study was to investigate the cardiovascular disease risk of patients with uterine leiomyoma using carotid intima-media thickness (CIMT), insulin resistance and lipid profile. METHODS: A total of 84 reproductive-aged women (20-45 years) were divided into two groups as the study group (n = 42) of women with leiomyoma and the control group (n = 42) of healthy women without leiomyoma. The risk factors for cardiovascular disease such as age, body mass index (BMI), low-density lipoprotein (LDL), triglycerides (Tg), high-density lipoprotein (HDL), total cholesterol and lipoprotein a levels, systemic disorders, cigarette smoking and CIMT were all recorded and compared between groups. RESULTS: The mean age, gravida, parity, BMI, total cholesterol level and CIMT were significantly different between the groups (p < 0.05). CIMT after adjusted for the age and age, BMI was significantly lower in study groups (<0.001). Insulin resistance, serum LDL, Tg, HDL, lipoprotein a, and endometrial thickness were comparable between groups (p > 0.05). The number of leiomyoma was significantly correlated with Tg (r = 0. 322, p = 0.037) and LDL (r = 0. 431, p = 0.006). The size of leiomyoma was significantly correlated with HOMA-IR values (r = -0.370, p = 0.016). CONCLUSION: Uterine leiomyoma was associated with lipid profile, insulin resistance and CIMT in reproductive-aged women.

Experience with different techniques for the management of postpartum hemorrhage due to uterine atony: compression sutures, artery ligation and Bakri balloon.

OBJECTIVES: To report our experience with different management approaches to treat postpartum hemorrhage (PPH) due to uterine atony with reference to need for hysterectomy. METHODS: A retrospective study of data of all women who delivered in Dr. Sami Ulus Medical and Research Hospital between April 2010 and April 2013 was collected from the department's medical records, to identify patients who had undergone the compressive suture techniques, artery ligation, Bakri balloon application and hysterectomy operation because of PPH due to uterine atony. RESULTS: A total of 32 cases who had PPH due to uterine atony were identified. Bleeding was successfully treated without the need for hysterectomy in 25 patients. Compressive suture technique and artery ligation without Bakri balloon application were used in 22 patients with the success rate of 72.7%. Bakri balloon was applied to ten patients, and there were three cases with failure: two patients needed an additional procedure (hypogastric artery ligation and B-Lynch suture) and one patient needed hysterectomy. The overall success rate of intrauterine balloon tamponade alone was 70%. The success of Bakri balloons in combination with artery ligation and B-Lynch suture was promising. CONCLUSION: Our case series suggest that in the condition of PPH due to atony, both compression sutures and Bakri balloon tamponade are effective methods. In combination of uterine artery ligation and B-Lynch suture with Bakri balloon tamponade might be the best surgical approach due to its higher success according to our results. To obtain more information further studies with large case series are important.

Ovarian cryopreservation.

Cryopreservation of ovarian tissue and future autotransplantation are new promising strategies for fertility preservation in various malignant and non-malignant diseases facing the risk of ovarian failure. Ovarian cortrical tissue pieces or intact whole ovary can be removed by laparoscopy without any significant delay in chemotherapy. Slow freezing and vitrification methods are developed to avoid damage to follicles. Ovarian tissue can be transplanted in an orthotopic or heterotopic location when the patient is cured from the disease. Autotransplantation can be performed if absence of malignant cells in the graft is confirmed. Although the procedures are still experimental, ovarian cryopreservation is the single option in prepubertal girls who have not sexual maturity. Earlier team approach of oncologists and reproductive endocrinologists may provide a more successful and professional way of fertility preservation.

Oxidative stress markers are not valuable markers in lean and early age of polycystic ovary syndrome patients.

BACKGROUND: Early atherosclerosis and increased risk of cardiovascular diseases (CVD) have been reported in patients with polycystic ovary syndrome (PCOS). Oxidative stress is an accepted risk factor for the development of CVD. AIM: To evaluate the association between oxidative stress markers [ischemia-modified albumin (IMA), total antioxidant status (TAS), and total oxidant status (TOS) levels], carotid intima- media thickness (CIMT), endocrine and metabolic parameters in patients with PCOS. MATERIALS, SUBJECTS, AND METHODS: We studied 52 patients with PCOS and 36 age- and body mass index (BMI)-matched controls. The diagnosis of PCOS was made according to the Rotterdam criteria. Metabolic, hormonal parameter and IMA, TAS, TOS levels were measured. RESULTS: No statistically significant difference was determined in relation to age, BMI and waist-hip ratio, IMA, TAS, and TOS levels between groups. Mean IMA level was higher in PCOS patients, however, statistical significant difference was not observed. Mean CIMT and homeostasis model assessment of insulin resistance levels were significantly higher in patients with PCOS than in control subjects. CONCLUSION: Our study has shown that although CIMT levels, showing CVD risk, were higher in PCOS patients, TAS and TOS oxidative stress markers were found to be similar between groups, IMA was higher in PCOS patients however the difference was not reach statistical significant. The present results suggest that CIMT increases before the state of ischemia and shows preischemic state of vasculature, while oxidative stress markers are considered to be indicators of ischemia and reperfusion injury in progressive vascular disease. Further studies are needed to show the association between oxidative stress markers, CVD and PCOS.

Prevalance of latex sensitization and associated risk factors in Turkish children with spina bifida.

PURPOSE: Among children with spina bifida there is a high prevalence of latex allergy in reports from Europe and USA. The aim of this study was to investigate the incidence of latex sensitization and associated risk factors in children with spina bifida in Middle-Eastern region (Istanbul, Turkey). MATERIALS AND METHODS: Eighty consecutive children affected with spina bifida were included in the study. Data were collected about age, sex, family and personal history of atopy, and the number and type of operations classified as neurosurgical, urological, and orthopedic. All patients underwent skin prick test using latex solutions and cross-reacting foods. Total and latex-specific IgE levels were also measured. RESULTS: Latex sensitization was shown in 16% (13/80) of the patients with specific IgE > 0.7 kU/L. The number of operation, using intermittent bladder catheterization and ventricular-peritoneal shunt were significantly associated with latex sensitization. CONCLUSION: The incidence of latex sensitization in this study was lower than reported in the literature. Environmental factors such as the type and number of operations and geographical location may play a role in the development of latex sensitization.

Evaluation of family functioning and anxiety-depression parameters in mothers of children with asthma.

BACKGROUND: Psychological problems are more commonly observed in mothers of children with asthma when compared to the general population. Smoking in the house and parental cooperation are the other factors which influence psychological status in mothers of children with asthma. In our study, we aimed to investigate family functioning and frequency of psychological symptoms in mothers of children with asthma. METHODS: The study group consisted of 160 mothers of 4-15 year old children with asthma and the control group consisted of 90 mothers of healthy children. Beck's inventory, continuous anxiety inventory and family assessment device were administered to each group of mothers. RESULTS: Results indicated that levels of depression and anxiety symptoms were higher and perception of family functioning was less healthy in mothers of children with asthma compared to those in the control group (p<0.0001). Smoking status at home and level of communication with the father were found to have a significant impact on the evaluation scale in mothers in the case group. DISCUSSION: Psychiatric symptoms observed in mothers of asthmatic children might be associated to influencing the functioning of the entire family rather that of the mother alone. Therefore, evaluation of family functioning in mothers of children with asthma might be beneficial in terms of follow-up and control of disease.