CO2 Flow Dynamics of Bladder Injury During Laparoscopy and the Effect of the Content of the Abdominal Viscera During Injury--Experimental Study.

BACKGROUND: Despite the well-known and easily recognizable signs of bladder injury during laparoscopy, some injuries remain unnoticed. Intra-operative diagnosis of a urinary bladder injury provides the opportunity to repair and prevent later complications involving the formation of fistula, infection, ascites and impairment of renal function. Small and unrecognized bladder injuries increase the chance of morbidity and permanent organ dysfunctions. OBJECTIVES: The aim of the study was to evaluate the CO2 flow dynamics of bladder injury occurring during laparoscopy and the effect of the content of the abdominal viscera during injury. MATERIAL AND METHODS: The study involved eight male New Zealand rabbits. Following urinary catheterization of the rabbits with an 8-gauge urinary catheter connected securely to a urinary drainage bag, pneumoperitoneum was created at a pressure level of 12 mm Hg. The experiment consisted of three phases. After the observational phase (Phase 1), the anterior wall of the urinary bladder was perforated with the tip of a 21 G needle (Phase 2) and methylene blue was administrated to evaluate the CO2 flow dynamics (Phase 3). RESULTS: The amount of CO2 consumption and accumulation in the urinary drainage bags differed significantly among the three phases of the experiment (p<0.05). There was no CO2 consumption or accumulation in the urinary drainage bags during Phase 1. The amount of CO2 consumption and accumulation in the urinary drainage bags during Phase 2 was significantly higher than during Phase 3. CONCLUSIONS: Urinary catheterization helps in the diagnosis of small or unnoticed urinary bladder injuries occurring during laparoscopy. CO2 flow and consumption is lower if the viscosity of the content overlying the injury site is higher.

A twin pregnancy provided with ICSI, an abortion of the first fetus at the 18th week and live birth of the second fetus at the end of the 36th week: a case report and literature review.

OBJECTIVE: The aim of this report was to evaluate and present the fourth longest delay among twin and multiple pregnancies described in the literature. METHODS: How can we optimize the health of the remaining fetus or fetuses after spontaneous abortion of the first fetus in multiple pregnancies? By considering one of our cases, we try to answer that question in light of the published literature. RESULTS: In our case, the second fetus was born at the end of the 36th week after abortion of the first fetus at the beginning of the 18th week. Delayed interval delivery was postponed 132 gestational days. CONCLUSIONS: The implementation of delayed intentional delivery is a reliable and required approach especially for infertility patients when they are selected carefully and monitored closely.

Effects of maternal left lateral position and rest on amniotic fluid index: a prospective clinical study.

OBJECTIVE: To compare the effect of both maternal rest and activity on the amniotic fluid index (AFI). STUDY DESIGN: Power analysis indicated that in order to achieve 20 mm of increase in AFI with 90% of power at one side alpha of 0.01, we needed at least 51 women in each group. The study group was comprised of pregnant women (n = 152) with a normal AFI and a singleton pregnancy at 26-40 weeks' gestation. Their AFI was determined by averaging the 2 repetitive measurements of the 4 amniotic fluid quadrants. The "rest" group (n = 77) was instructed to lie and rest in the left lateral position, and the "mild activity" group (n = 75) was instructed to sit and walk. RESULTS: AFI increased significantly, from 151.25 +/- 37.40 mm to 173.79 +/- 39.76 mm, in the "rest" group (p = 0.00). However, the change from 153.69 +/- 37.94 to 152.34 +/- 36.62 mm was not significant in the "mild activity" group (p = 0.167). CONCLUSION: Maternal rest in the left lateral position increases the AFI.

Effects of modernisation and new population policies on reproductive health in Kars, Turkey.

BACKGROUND: The 1983 Turkish Population Planning Act aimed at improving reproductive health outcomes. We examined the effects of the Act and of modernisation in a small, underdeveloped city and province, Kars. METHODS: Between June 2009 and January 2010, 576 parous women at a hospital in Kars participated in a study of reproductive histories and living standards. Results were compared by decade during which the birth took place of the first child who survived its first year, and urban/rural residence. Correlation and multi-way analyses of variance (ANOVA), χ(2) and t tests were used as appropriate. We also examined women's education and living standards and use of hospital and family planning (FP) facilities. RESULT: From 1970 through 2009 maternal age at first live birth increased by 4.9 years (p < 0.05) from a baseline of 18.9 years. The number of pregnancies fell from a mean of 8.1 per woman in the 1970s to 5.6 in the 1980s (p < 0.05), with strong indications of continued decreases through the 2000-2009 decade. FP sites in Kars province increased in number and services, as did antenatal hospital visits and the proportions of women giving birth in a hospital. Concomitantly, delivery by caesarean section augmented markedly over the decades. Education levels of both urban and rural women rose from two years of schooling in the 1970s to ten years in the last decade. CONCLUSION: Modernisation, including increasing urbanisation, education, and new governmental policies that translated into maternal-child health and FP services were likely the backbone for improved reproductive health and lower fertility rates of women in Kars over the 40 year-period we studied.

The first case of Horn Kolb Syndrome in Turkey, diagnosed prenatally at the 23(rd) week of a pregnancy: A very rare and unusual case far from the original geography.

BACKGROUND: The aim of this report was to evaluate and announce the first documented appearance of Horn Kolb syndrome in Turkey. CASE REPORT: Acheiropodia (Horn Kolb Syndrome) is the bilateral congenital amputation of the distal parts of the 4 extremities. It is an autosomal recessive developmental disorder. The characteristic features are amputation of the upper and lower extremities with aplasia of the hands and feet. The disorder affects only the extremities without other systemic manifestations. In this report, we present the first known case of Horn Kolb syndrome in Turkey, along with the diagnostic features. CONCLUSIONS: Severe dysmorphic skeletal anomalies should be excluded as soon as the earlier gestational weeks in every pregnancy by visualizing all 4 limbs of the fetus in routine prenatal ultrasound screening.

First trimester diagnosis of parapagus diprosopus dibrachius dipus twins with cranirachischisis totalis by three-dimensional ultrasound.

Parapagus (laterally fused), diprosopus (two faces), dibrachius (two upper extremities), dipus (two lower extremities) conjoined twinning is extremely rare. The coexistence of anencephaly with a contiguous spinal defect (craniorachischisis totalis) makes the present case one of the rarest of the published cases. In our case, it was difficult to make the final diagnosis by two-dimensional abdominal and vaginal ultrasound. Three-dimensional ultrasound was helpful for final diagnosis and post-abortal examination confirmed the prenatal ultrasound diagnosis. The heart, diaphragm, liver and perineum were all united. Fine dissection of the heart showed four vessels arising from the ventricles and a membranous type ventricular septal defect.

Effects of the maternal position and rest on the fetal urine production rate: a prospective study conducted by 3-dimensional sonography using the rotational technique (virtual organ computer-aided analysis).

OBJECTIVES: The purpose of this study was to determine the effect of the maternal left lateral decubitus position and rest on the fetal urine production rate. METHODS: Fifty-four pregnant women with a normal amniotic fluid volume who had a singleton pregnancy between 26 and 40 weeks' gestation were included in this prospective study. Exclusion criteria included rupture of membranes, intake of any food or liquid within the previous 4 hours, and maternal or fetal complications. The amniotic fluid index was determined by averaging 2 or 3 repetitive measurements of the 4 amniotic fluid quadrants at the time of fetal urinary bladder volume measurements. The fetal urine production rate was measured using virtual organ computer-aided analysis. The amniotic fluid index and fetal urine production rate before and after the left lateral position rest period were compared by a paired Student t test. The Pearson correlation was used to study the relationships among the maternal age, gestational age, test time, amniotic fluid index, and fetal urine production changes. RESULTS: The mean amniotic fluid indices ± SD before and after the rest period were 151.0 ± 45.0 and 172.5 ± 46.7 mm, respectively, indicating a significant increase in the amniotic fluid index (P < .05). The mean fetal urine production rates before and after the rest period were 73.7 ± 66.8 and 151.8 ± 119.9 mL/h, respectively, indicating a significant increase in fetal urine production (P < .05). CONCLUSIONS: The fetal urine production rate and amniotic fluid index are markedly increased by maternal rest in the left lateral decubitus position.

Lipid peroxidation in follicular fluid of women with polycystic ovary syndrome during assisted reproduction cycles.

OBJECTIVE: To investigate the ovarian lipid peroxidation pattern in polycystic ovary syndrome (PCOS). STUDY DESIGN: Twenty-six women with PCOS who underwent in vitro fertilization and embryo transfer (IVF-ET) cycles between January 1999 and November 2000 at the hospital IVF unit were included in the study. Seventeen regularly cycling women with male factors (oligospermia or azoospermia) were enrolled as the control group. Malondialdehyde (MDA) levels in preovulatory follicular fluid were measured. RESULTS: There was a significant difference in follicular fluid MDA levels among the control (median, 2.23 nmol/mL; range, 0.98-4.93) and PCOS group (median, 3.53 nmol/mL; range, 1.51-4.81). Follicular fluid MDA and plasma progesterone levels correlated positively in the subjects (r = 0.55, p = 0.041) and PCOS group (r = 0.074, p = 0.0001). Plasma luteinizing hormone/follicle stimulating hormone (LH/FSH) levels correlated positively with follicular fluid MDA levels in the PCOS group (r = 0.72, p = 0.0001). CONCLUSION: The specific ovarian lipid peroxidation profile of PCOS patients is probably related to insufficient progesterone production and higher FSH/LH levels.