Evaluation of the relationship between mesenchymal stem cells and immune system in vitro conditions.

BACKGROUND: Mesenchymal stem cells (MSCs), are a novel therapeutic option as the most common cell source, play an important role in the immunomodulation. In this study, it was aimed to determine the effect of MSCs on cytokines secreted by the immune system cells. METHODS: Intracellular cytokine levels (Interleukin-4 (IL-4), Interferon-γ (IFN-γ), and Interleukin-17 (IL-17)) detected by flow cytometry before and after co-culture between peripheral blood mononuclear cells (PBMCs) and MCSs. At the same time, supernatant cytokine levels were measured using the ELISA. RESULTS: In our study, MSCs were isolated from cord blood (CB) and Wharton's Jelly (WJ), and their surface markers (CD44 (100%), CD73 (99.6%), CD90 (100%), CD105 (88%)) shown by flow cytometry method. Both CB-MSCs and WJ-MSCs were used in co-culture MSC/PBMC ratios of 1/5 and 1/10, incubation times of 24 h and 72 h. In the present study, when we compared co-cultures of CB-MSC or WJ-MSC with PBMCs, intracellular levels of cytokines IFN-γ, IL-17 (pro-inflamatory) and IL-4 (anti-inflamatory) were increased, and supernatant levels were decreased significantly (p < 0.05). The level of transforming growth factor beta (TGF-ß) (anti-inflamatory) was significantly decreased for both CB-MSC and WJ-MSC in supernatant (p < 0.05). CONCLUSIONS: It was investigated pro-inflammatory and anti-inflammatory effects of CB-MSCs and WJ-MSCs on PBMCs with the obtained results. According to the results, MSCs demonstrated different immunologic effects after the incubation time and ratios. For further studies, it should be known between interaction of MSCs and immune system.

The Association between the Preoperative Prognostic Nutritional Index and the Controlling Nutritional Status Score on Tumor Stage, Chemotherapeutic Response and Overall Survival in Ovarian Cancer.

This study aimed to investigate the association between preoperative prognostic nutritional index (PNI) and controlling nutritional status (CONUT) scores on the stage of ovarian cancer (OC), chemotherapeutic response, and overall survival (OS) in patients with OC.The data of the patients who operated due to OC between January 2015 and January 2020 in a tertiary referral hospital were recorded. The patients' basic characteristics, preoperative total cholesterol, albumin, lymphocyte count, tumor markers, disease stage, grade, chemotherapeutic response, OS, and progression-free survival were recorded. The PNI and the CONUT score were calculated.The mean PNI level was considerably higher in the early-stage group than the advanced-stage group (50.02 ± 6.8 vs. 46.3 ± 7.4, p = 0.005). The AUC was 63% for the cutoff point 45.98 of PNI, whereas the AUC was 42% for the cutoff point 1.5 of CONUT score in predicting early-stage disease. The PFS and OS were significantly higher in the high PNI group than the low PNI group (p = 0.01, p = 0.002, respectively).The patients with early-stage OC had significantly higher PNI levels and lower CONUT scores in our study population.

Post-recurrence survival analysis of patients with pulmonary recurrence from gynaecologic cancers: a multi-institutional analysis of 122 patients.

In this retrospective study, patients with epithelial gynaecologic cancer with pulmonary recurrence (PR) were evaluated from five national gynaecologic oncology clinics. Patients with a diagnosis of primary endometrial, ovarian/fallopian tube/peritoneal, cervical or vaginal/vulvar tumours who developed an initial PR were included in the study A total of 122 patients were included in the study. The median follow-up time after recurrence was 7.5 (range, 1-84) months. The 2-year PRS was 48% in the main cohort. The risk of death was more than seven times higher in patients who did not receive salvage chemotherapy compared with those who did (hazard ratio: 7.6, 95% CI: 3.0-18.9; p < .001). When squamous cell carcinoma was compared with the other tumour types, the risk of death increased more than three times (hazard ratio: 3.7, 95% CI: 1.4-9.6; p = .007).IMPACT STATEMENTWhat is already known on this subject? Pulmonary recurrence (PR) from gynaecologic malignancies is rare and can cause major clinical problem. Therefore, defining the clinical and pathologic characteristics and recurrence patterns are essential.What the results of this study add? This study demonstrates non-squamous subtype and salvage chemotherapy at PR were associated with improved survival.What of these findings for clinical practice and/or further research? To the best of our knowledge, our study is the largest study to investigate the clinico-pathologic characteristics, recurrence patterns, treatment options, and post-recurrence survival (PRS) in patients with PR from epithelial gynaecologic cancers. Future research should examine the underlying causes of these findings.

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.

Impact of pre-operative walking on post-operative bowel function in patients with gynecologic cancer.

BACKGROUND: There is a paucity of data on whether pre-operative walking and functional capacity has a direct association with post-operative gastrointestinal function in patients who have undergone surgery to treat gynecologic cancers. OBJECTIVE: To explore the relationship between pre-operative walking and post-operative recovery of bowel function. METHODS: This randomized trial was performed from January 1, 2018 to August 31, 2018. All patients had a diagnosis of endometrial or ovarian cancer and were scheduled for comprehensive staging. Group A served as the control group who did not walk regularly on the last night before surgery. Patients in group B walked for 30 min at an average speed of 3 km/h from 20.00 to 20.30 and 21.30. to 22.00 on the last night before surgery under the supervision of a nurse or doctor. The study was registered with clinicaltrials.gov (no: NCT03553121). RESULTS: A total of 85 patients were enrolled: 43 patients were assigned to the walking group and 42 to the control group. There were no significant differences in demographics between the groups. Median age was 57.3±8.5 in the control and 59.9±9.1 in the walking group. In addition, 28 patients had endometrial cancer and 14 had ovarian cancer in the control group. 33 patients and 10 patients in the walking group had endometrial and ovarian cancer, respectively. The mean time to first flatus was shorter in the walking group than in the control group (32.5±10.4 vs 40.6±16.9 hours, respectively; p=0.010). In addition, the time to first defecation was significantly shorter in the walking group (62.8±26.7 vs 91.4±51.8 hours; p=0.002). Patients who walked before surgery were less likely to have post-operative paralytic ileus (25.0% vs 60.7%; p=0.003). Walking before the operative period and laparoscopic surgery independently protected against the development of post-operative paralytic ileus. CONCLUSION: Walking before surgery expedited time to bowel motility and ability to tolerate food. In addition, this method significantly decreased the risk of post-operative paralytic ileus.We consider that walking before surgery may be integrated into the pre-operative management of patients under going surgery for gynecologic cancers. CLINICAL TRIAL REGISTRATION: clinicaltrial.org record number: NCT03553121.

Oxytocin infusion reduces bleeding during abdominal myomectomies: a randomized controlled trial.

PURPOSE: To evaluate the effectiveness of oxytocin infusion to reduce intraoperative bleeding during abdominal myomectomies. METHODS: This randomized, parallel group, blinded study was conducted between October 2017 and May 2018. Patients undergoing abdominal myomectomies were randomized 1:1 either to the oxytocin group or to the control group (saline). In the oxytocin group, 10 IU oxytocin in 500 ml of saline at a rate of 120 ml/h was given during the course of the operation. The primary outcome of this study was to measure intraoperative blood loss between the study groups. Correlation and multiple regression analysis were performed to illustrate factors associated with intraoperative blood loss during the myomectomy. RESULTS: The mean intraoperative blood loss during the surgery was 489.20 ± 239.72 ml in the oxytocin group and was 641.40 ± 288.21 ml in the control group. The hemoglobin decline was more evident in the control group than in the oxytocin group. Positive correlations were also observed between the intraoperative blood loss and number of fibroids removed during the surgery, largest fibroid removed and weight of fibroids removed. The use of oxytocin infusion during the myomectomy resulted in a reduction of bleeding in the regression model. CONCLUSION: Intravenous oxytocin infusion is a safe and practical method to reduce intraoperative blood loss during the abdominal myomectomy.

Laparoendoscopic Single-Site Sentinel Lymph Node Detection in Endometrial Cancer.

STUDY OBJECTIVE: To demonstrate the feasibility of sentinel lymph node (SLN) biopsy using a laparoendoscopic single-site (LESS) approach in endometrial cancer (EC). DESIGN: A step-by-step video demonstration of the surgical procedure (Canadian Task Force Classification III). SETTING: The satisfaction of patients who undergo LESS hysterectomy is greater than that reported by patients who undergo multiport laparoscopic hysterectomy, owing to better cosmesis and reduced postoperative analgesic requirements [1]. SLN biopsy is associated with significantly lower estimated blood loss, shorter operation time, and less morbidity compared with systematic lymphadenectomy [2]. LESS surgery can be more feasible and safer with the use of SLN biopsy compared with complete lymphadenectomy in patients with early-stage EC. INTERVENTIONS: This 69-year-old woman with grade 2 endometrioid EC underwent SLN mapping followed by LESS SLN biopsy, total hysterectomy, and bilateral salpingo-oophorectomy. Before the umbilical incision was made, 1.25 mg/mL of indocyanine green was injected into the cervical stroma at the 3 o'clock and 9 o'clock positions to both deep and superficial levels. A 10-mm 30° standard-length optical camera for near-infrared fluorescence imaging was used. The total operative time was 75 minutes, and the estimated blood loss was 20 mL. SLNs were detected bilaterally between proximal parts of the external iliac arteries and veins. After SLN resection, total hysterectomy and bilateral salpingo-oophorectomy were performed. No postoperative complications occurred. The patient was discharged at 30 hours after surgery. In the final pathology, stage 1A G2 EC was detected. CONCLUSION: LESS SLN biopsy and TLH-BSO is a feasible procedure and sentinel lymph node concept may increase the use of LESS in EC.

A different technique in gasless laparoendoscopic single-site hysterectomy.

The aim of this study was to show a different technique for a gasless laparoendoscopic single-site (LESS) hysterectomy and to present advantages and limitations of this technique. Women undergoing gasless LESS hysterectomy with a different technique were evaluated. A total of 14 LESS hysterectomies were performed using this gasless technique and rigid laparoscopic instruments by one surgeon. The mean age of the patients was 48.6 (±4.6). The average blood loss was 80 ± 35 ml. The average time between an umbilical incision and starting hysterectomy was 5 (±2,1) min. The time between starting hysterectomy and umbilical incision closure was 120 (±24) min in the laparoscopic suture group and 88 (±16) min in the vaginal suture group. The mean uterus weight was 188 (±95) g. In conclusion, this different technique is feasible and low cost, especially in non-obese patients. But further studies with large participants are needed to elucidate the safety. Impact statement Conventional CO2 pneumoperitoneum has many adverse effects on cardiopulmonary function, haemodynamic, metabolic and neurologic systems due to high-intraperitoneal pressure. The usage of gasless technique eliminates these adverse effects and postoperative shoulder pain. The satisfaction of patients is higher in laparoendoscopic single-site (LESS) hysterectomy due to improved cosmesis and reduced postoperative analgesic requirements. In the literature, there are a few studies showing techniques combining LESS and gasless laparoscopy for hysterectomy. In this study, a different approach for creating operational space in gasless laparoscopy is described. Creation of intraabdominal operational space is convenient and takes a short time in this technique. The average time between an umbilical incision and starting a hysterectomy is five minutes. Additional training is not needed for experienced surgeons in LESS. Also, cost-effectiveness is one of important advantages. It is quite safe, no possibility of vascular injury, including inferior epigastric or superficial epigastric vessels. Also suturing the vaginal cuff and knot tying is easier in this technique. This technique can be used safely in patients with poor cardiopulmonary reserve. Also, by means of its cost effectiveness, it can be preferred in developing countries. As a result, it may be a good alternative to conventional LESS hysterectomy.

Myomectomy for intramural fibroids during caesarean section: A therapeutic dilemma.

The aim of the present study was to assess the safety of myomectomy for intramural fibroids during caesarean section. A retrospective study of 63 women who underwent myomectomy during caesarean section and 63 women who underwent caesarean delivery without myomectomy was conducted. The study group was divided into subgroups according to the volume of fibroids and total incision count. The volume of fibroids, the preoperative and postoperative haemoglobin values and the difference between them, incidence of haemorrhage and blood transfusion, duration of operation and postoperative fever of patients were investigated. Duration of operation was longer (p < .001) and haemoglobin loss was higher (p = .01) in the myomectomy group. There was no difference between one incision and two incisions subgroups in terms of mean haemoglobin change (p = .068). Haemoglobin loss was higher in volume >50 cm3 group than volume <50 cm3 and control groups. These differences were statistically significant (p = .02; p = .001, respectively). Although intramural fibroids can be safely removed during caesarean section, large fibroids and extra incisions for myomectomy are risk factors for haemorrhage.

The Combination of Preoperative Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Sentinel Lymph Node Mapping in the Surgical Management of Endometrioid Endometrial Cancer.

OBJECTIVE: The goal of this study was to evaluate the combination of sentinel lymph node (SLN) mapping and F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) scan in detection of lymph node involvement in patients with endometrioid endometrial cancer (EEC). METHODS/MATERIALS: Ninety-five patients with EEC who had preoperative PET/CT imaging and underwent SLN mapping were retrospectively analyzed. Methylene blue dye was used and injected to the cervix at 3- and 9-o'clock positions (a total of 4 mL). Pelvic lymphadenectomy was performed on all of the patients after SLN mapping. If the SLN was negative in the initial hematoxylin and eosin staining, an ultrastaging study was performed for the SLNs. RESULTS: Sentinel lymph nodes were detected in 77 (81.1%) of 95 patients, with a mean of 2.95 SLNs. There was only 1 case (1.4%) with a positive SLN in the intraoperative frozen section examination in those patients with negative PET/CT findings and in whom SLNs were detected (n = 70). Among the remaining 69 patients with negative preoperative PET/CT findings and negative frozen section results for the SLNs, there were 2 patients with SLN involvement in the final ultrastaging pathology. In the patient-based analyses, the sensitivity, specificity, and positive and negative predictive values of the PET/CT and SLN frozen section were 33%, 100%, 100%, and 97.1%, respectively. CONCLUSIONS: As no metastases in the nonsentinel pelvic lymph nodes were found in patients with EEC who had both negative PET/CT findings and frozen section results of the SLNs in both hemipelvises, we suggest using both methods to reduce the incidence of unnecessary systematic lymphadenectomy.

Comparison of clinical and perinatal outcomes in early- and late-onset preeclampsia.

PURPOSE: To compare the clinical and laboratory findings and maternal-perinatal outcomes between women with early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE). METHODS: One hundred and fifty-four women with preeclampsia (PE) who delivered in our clinic were included in the study. Perinatal and obstetric outcomes were evaluated. RESULTS: The incidence of abnormal uterine artery (UtA) velocity waveform was significantly higher in the EO-PE group (71.4 vs 30.1 %) (p < 0.001). The incidences of small-for-gestational age, oligohydramnios, Apgar score <7 at 5 min, stillbirth and early neonatal death rates were significantly higher in women with EO-PE compared to LO-PE (p < 0.01). Maternal complications were only recorded in women with severe PE. CONCLUSION: EO-PE, especially with abnormal UtA Doppler findings defines a placentation abnormality with higher perinatal adverse outcomes.

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.

The in vitro treatment of mesenchymal stem cells for colorectal cancer cells.

Colorectal cancer is the most common tumor of the gastrointestinal system. The conventional treatment options for colorectal cancer are troublesome for both patients and clinicians. Recently, mesenchymal stem cells (MSCs) have been the novel focus for cell therapy due to their migration to tumor sites. In this study, the apoptotic effect of MSCs on colorectal cancer cell lines has been aimed. HCT-116 and HT-29 were selected as the colorectal cancer cell lines. Human umbilical cord blood and Wharton's jelly were used as mesenchymal stem cell sources. To discriminate against the apoptotic effect of MSC on cancer, we also used peripheral blood mononuclear cells (PBMC) as a healthy control group. Cord blood-MSC and PBMC were obtained by ficoll-paque density gradient, and Wharton's jelly-MSC by explant method. Transwell co-culture systems were used as cancer cells or PBMC/MSCs at ratios of 1/5 and 1/10, with incubation times of 24 h and 72 h. The Annexin V/PI-FITC-based apoptosis assay was performed by flow cytometry. Caspase-3 and HTRA2/Omi proteins were measured by ELISA. For both ratios in both cancer cells, it was found that the apoptotic effect of Wharton's jelly-MSC was significantly higher in 72-h incubations (p < 0.006), whereas the effect of cord blood mesenchymal stem cell in 24-h incubations were higher (p < 0.007). In this study, we showed that human cord blood and tissue-derived MSCs treatment led to colorectal cancers to apoptosis. We anticipate that further in vivo studies may shed light on the apoptotic effect of MSC.

Increasing Apoptotic Effect of Cord Blood and Wharton's Jelly-derived Mesenchymal Stem Cells on HT-29.

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer worldwide. Recently, mesenchymal stem cells (MSCs) have been considered a suitable cell therapy option for cancer due to their high migration rate to the tumor site. OBJECTIVES: The study aimed to compare the effects of human umbilical cord blood derived-MSC (UCMSC) and human Wharton's Jelly derived-MSC (WJ-MSC) on the HT-29 cell line. METHODS: UC-MSC was obtained by Ficoll-Paque density gradient and WJ-MSC by explant method. The characterizations of MSCs and apoptosis assays were performed by flow cytometry, and caspase-3 protein levels were measured by ELISA. RESULTS: After 72 hours of HT-29 cancer cells incubation, it was indicated that WJ-MSC was more effective at 1:5 and 1:10 ratios. Similar results were found for caspase-3 by ELISA. Moreover, WJ-MSC (1:5, p < 0.006; 1:10, p < 0.007) was found to be more effective at both doses compared to UC-MSC. CONCLUSION: In this study, we used two different MSC sources at two different ratios to evaluate the apoptotic effect of MSC in vitro on HT-29 CRC cells. As a result, WJ-MSC indicated a more apoptotic effect on HT-29 cells compared to CB-MSC. We anticipated that this preliminary in vitro study would be extended in future in vitro/in vivo studies. Moreover, investigating the behavior of MSC in colorectal tumor microenvironment will be beneficial for the stem cell therapy approach.

Serum anti-müllerian hormone, follicle stimulating hormone and antral follicle count measurement cannot predict pregnancy rates in IVF/ICSI cycles.

PURPOSE: To investigate whether serum anti-müllerian hormone (AMH), follicle stimulating hormone (FSH), or antral follicle count (AFC) are predictive for clinical pregnancy in in vitro fertilization (IVF) patients. METHODS: Serum AMH, inhibin B, FSH, luteinizing hormone (LH), estradiol (E2), prolactin, and thyroid stimulating hormone (TSH) levels and AFC of 189 women under 40 years of age were investigated. Pregnant and non-pregnant women were compared. RESULTS: Forty-seven (24.8 %) clinical pregnancies were observed in 189 women. There was no significant difference in terms of mean age, duration of infertility, body mass index, AMH, LH, FSH, E2, TSH, Inhibin B, AFC and total oocyte number between women who did and who did not become pregnant. Additionally, there was no significant difference in clinical pregnancy rates between the quartiles of AMH, FSH and AFC. (P values were 0.668, 0.071, and 0.252, respectively.) CONCLUSION: Serum AMH and FSH, and AFC cannot predict clinical pregnancy in IVF patients under 40; the pregnancy rate tends to increase as AMH increases, although this remains non-significant.

The effect of omentectomy on the blood levels of adipokines in obese patients with endometrial cancer.

OBJECTIVE: To investigate the blood levels of adipokines in obese patients with endometrial cancer who have and have not undergone omentectomy. METHODS: Between September 2017 and September 2019, the study recruited 54 patients with endometrial cancer. Measurements were taken of blood levels of human leptin, perilipin-1, adiponectin, adipolin, resistin, visfatin, and estrone preoperatively and postoperatively before adjuvant therapy or at the end of one month. The serum samples were separated by centrifugation for 10 mins at 3,000 revolutions/min, then stored at -80 °C until assay. RESULTS: In this prospective study, a total of 54 endometrial cancer patients were analyzed in two separate groups according to the omentectomy status. Comprehensive staging surgery with omentectomy and without omentectomy was performed in 26 patients and 28 patients, respectively. The age, body mass index, body fat index, waist circumference, and skin thickness values of the patients with and without omentectomy were found to be similar. No statistically significant difference was determined between the patients with and without omentectomy in respect of the blood level of the adipokines measured preoperatively. A strong statistically significant correlation was determined between the pre and postoperative levels of Human Leptin (p = 0.002), perilipin-1(p = 0.001), adipolin (p < 0.001), adiponectin (p < 0.001), resistin (p = 0.001), visfatin (p < 0.001), and estrone (p = 0.004) (r = -0.43, -0.47, 0.75, 0.84, -0.47, - 0.58, -0.41, respectively) CONCLUSIONS: Omentectomy affected the postoperative blood levels of adipokines in obese patients with endometrial cancer. As omentectomy may have some positive effects on metabolism in these patients, it may be considered during endometrial cancer surgery due to the possible positive metabolic effects.

Craniorachischisis with a variant of pentalogy of Cantrell, with lung extrophy.

A case of cranioraschischisis including incomplete pentalogy of Cantrell (PC) is described. The female fetus had a large omphalocele with evisceration of the heart, left lung, liver, stomach, and intestines accompanying anencephaly, cervical, thoracal lumbar, spina bifida. The fetus had ectopia cordis and diaphragmatic agenesia with an intact sternum. We present a case of a neonate with the stigmata for PC with the exception of a sternal defect. A literature review is also included. Sonographers should check for ventral and dorsal anomalies with PC because they may occur simultaneously.

Coffee consumption for recovery of intestinal function after laparoscopic gynecological surgery: A randomized controlled trial.

BACKROUND: To investigate the effect of postoperative coffee consumption on bowel motility after laparoscopic gynecological surgery. MATERIALS AND METHODS: In this randomized controlled trial, patients were allocated postoperatively to 3 cups of either coffee or warm water at 6, 12, or 18 h after the operation. Total hysterectomy and bilateral salpingectomy were performed on all patients. In addition, a salpingo-oophorectomy and systematic pelvic with/without para-aortic lymphadenectomy were performed according to clinical indications. The primary endpoint was time to the first passage of flatus after surgery. RESULTS: A total of 96 patients were enrolled; 49 patients were assigned to the coffee group, and 47 were enrolled in the control group (warm water). The median time to flatus (19 [13-35] vs. 25 [15-42] h; hazard ratio [HR] 1.9, 95% confidence interval [CI], 1.2-2.9; P = 0.0009), median time to defecation (30 [22-54] vs. 38 [26-65] h, HR 2.4, 95% CI, 1.5-3.8; P < 0.0001), and mean time to tolerate food (2 [2-5] vs. 3 [2-8] days, HR 1.5, 95% CI, 1.02-2.3; P = 0.002) were decreased significantly in patients who consumed coffee compared with the control subjects. Postoperative ileus was observed in seven patients (14.9%) in the control group and one patient (2.0%) in the coffee group (P = 0.02). No adverse events were attributed to coffee consumption. CONCLUSION: Postoperative coffee intake after laparoscopic gynecological surgery hastened the recovery of gastrointestinal function by reducing the time to the first passage of flatus, time to the first defecation, and time to tolerate a solid diet. This simple, cheap, and well-tolerated treatment merits routine use alongside other existing enhanced recovery pathways in the postoperative setting.

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.