High Anxiety Levels before Elective Cesarean Section Can Negatively Affect the Mother and Fetus.

BACKGROUND: Both pregnancy and surgery cause anxiety. This situation may negatively affect the health of the mother and baby. AIM: The effect of anxiety level before cesarean section (CS) on feto-maternal outcomes was investigated. METHODS: The preoperative anxiety score was determined with the State-Trait Anxiety Inventory (STAI) in 224 pregnant women who were planned for elective CS. RESULTS: Among patients, 33.5% were in the low anxiety group, 27.2% in the moderate, and 39.3% in the high anxiety group. The average birth weight in the low anxiety group was noticeably higher than that of the high anxiety group (P = 0.018). The mean heart rate at postop 1st and 24th hour in the high anxiety group was higher than the moderate anxiety group (P < 0.028). In addition, diastolic blood pressure (DBP) at the sixth hour in the low anxiety group was found to be lower than in the moderate anxiety group (P < 0.05). CONCLUSION: According to these results, it was found that an increased anxiety score before CS is associated with low birth weight in the baby, higher heart rate, and DBP in the mother.

The Relationship of CRP/Albumin ratio level and prognosis in pregnant COVID-19 patients.

Background: The C-reactive protein (CRP)/albumin ratio (CAR) is one of the new tools to assess the severity of inflammation. It is used to determine clinical severity and prognosis in many diseases. Aim: The present study aimed to investigate the relationship between C-reactive protein (CRP)/albumin ratio (CAR) and prognosis in pregnant patients with more severe COVID-19 infection. Retrospective study. Patients and Methods: The study was conducted in a retrospective manner by scanning the files of pregnant patients who had a positive polymerase chain reaction test result and were hospitalized in Adiyaman Training and Research Hospital. The patients were divided into two groups: patients who were admitted to the intensive care unit and patients who were not admitted. CRP/albumin ratio (CAR) levels were compared between these two groups. The cut-off value was determined in the prediction of intensive-care admission and poor prognosis. Results: 117 patient files were reviewed. 13 patients were followed up with intensive care, whereas 104 patients completed their treatment in the service. The CAR levels of the patients admitted to intensive care were significantly higher (P < 0.01). In the estimation of intensive-care admission, the CAR level was determined to be 0.970 in the area under the curve with 100% sensitivity and 86.5% specificity in the receiver operating characteristic (ROC) curve. The cut-off CAR level was calculated as 1.8. Conclusion: CAR is a valuable biomarker for predicting prognosis, as well as follow-ups of pregnant COVID-19 patients.

House advancement flap anoplasty for severe post-hemorrhoidectomy anal stenosis.

Anal stenosis (AS), which is a very rare but serious complication, usually develops after hemorrhoidectomy. It may be mild, moderate or severe depending on the grade of stenosis. While mild and moderate types can be monitored with conservative treatment, most of the severe type require advancement flap anoplasty. There are several commonly used flap types such as Y-V, diamond and house-type flaps, but the best results belong to house-type flaps. In this paper, we aimed to present a case of severe post-hemorrhoidectomy AS, in which we performed house advancement flap anoplasty, with its video demonstrating the procedure step by step.

Virchow's node metastasis: an unusual presentation of ovarian cancer.

Ovarian primaries of supraclavicular metastases are extremely rare. The present study reports the case of a 64-year-old female with a left supraclavicular mass without any other symptoms. After performing a fine needle aspiration biopsy for pathological examination and positron emission imaging, she was diagnosed with FIGO Stage IV high-grade serous epithelial ovarian carcinoma. After three cycles of chemotherapy with paxlitaxel and carboplatin, complete response was achieved. There are only a few reports in literature that address patients with the initial symptom of left supraclavicular mass and final diagnosis of ovarian cancer. To the best of the authors' knowledge, this is the first report to describe the successful use of PET/CT to determine the primary site.

Relationship between nasal cavity volume changes and nasalance.

OBJECTIVES: The patency and volume of the nasal cavity affect the acoustic characteristics of the voice. The aim of this study was to investigate the effect of a nasal decongestant on nasal volumes and nasalance scores, and to determine the relationship between these measures. METHODS: Acoustic rhinometry and nasometry were performed in a group of 21 adult volunteers both prior to and following application of a nasal decongestant. The relationship between changes in nasalance scores and acoustic rhinometric parameters was investigated. RESULTS: After the application of nasal decongestant, statistically significant increases were observed in nasalance scores and in all of the acoustic rhinometric parameters assessed (i.e. minimal cross-sectional area, three cross-sectional areas, three volumes and total volume). However, no significant correlation was found between the changes in nasalance scores and acoustic rhinometric parameters. CONCLUSIONS: Nasal decongestion causes an increase in nasalance scores and nasal cavity volumes. However, the findings of this study indicate that changes in nasalance scores may result from factors other than nasal cavity volume changes.

Endothelium-dependent induction of vasorelaxation by Melissa officinalis L. ssp. officinalis in rat isolated thoracic aorta.

In the current study, vasorelaxant effect produced by the aqueous extract of Melissa officinalis L. ssp. officinalis (MOO) (Lamiaceae) and its possible mechanism in isolated rat aortic rings precontracted with phenylephrine were examined. In the first series of experiments, effect of MOO on the baseline and phenylephrine (10(-5)M) precontracted arteries was investigated, while in the second group of experiments, endothelium intact or endothelium denuded effect was determined. The agents used were N(omega)-nitro-L-arginine (L-NAME), an irreversible inhibitor of nitric oxide (NO) synthase, indomethacin (10 microM), a cyclooxygenase (COX) inhibitor, and glibenclamide (10 microM), an ATP-sensitive potassium channel blocker. The extract was found to exert a vasorelaxant effect and rosmarinic acid quantity, the characteristic compound of the plant, was analyzed by reversed-phase high-performance liquid chromatography (18.75%), and was further confirmed by LC-MS analysis giving a prominent [M(+1)] molecular ion peak at m/z 365. Total phenol amount in the extract was determined using Folin-Ciocalteau reagent (0.284 mg/mg extract). Vasorelaxant effect of the extract was entirely dependent on the presence of endothelium and was abolished by pretreatment with L-NAME, whereas pretreatment with indomethacin and glibenclamide reduced the relaxation to a minor extent. Rosmarinic acid was also tested in the same manner as the extract and was found to exert vasorelaxant effect. These results suggest that the aqueous extract of MOO vasodilates via nitric oxide pathway with the possible involvement of prostacycline and endothelium-derived hyperpolarizing factor (EDHF) pathways as well.

Endoscopic endonasal resection of a midline intradural frontobasal dermoid tumour.

Dermoid and epidermoid cysts are congenital, slowly growing tumours that usually become symptomatic when patients reach the middle of their third decade. An otherwise healthy 20-year-old man presented with an epileptic attack. Imaging studies including computed tomography and magnetic resonance imaging revealed an intradural cystic lesion located in the anterior subfrontal region. Choices of traditional approaches for such a lesion are a bicoronal craniotomy or a transfacial procedure. Taking the advantage of the endoscope, the authors decided to remove the lesion via an endonasal route. After a fully endoscopic endonasal operation, gross total resection of the dermoid tumour was achieved. We have not observed cerebrospinal fluid leakage or any infectious complication after the operation. In this report the technique of operation and reconstruction method are described. The endoscopic endonasal approach offers a good option for lesions located in the anterior skull base. Carefully piecemeal resection of the tumour while preserving the underlying neural and vascular structures should be the main strategy of the operation. Reconstruction is very important after the surgery and a carefully planned pedicled graft technique may help in the prevention of cerebrospinal fluid leakage.

Analysis of different surgical approaches for the treatment of cerebrospinal fluid rhinorrhea.

The current treatment method for cerebrospinal fluid (CSF) rhinorrhea is surgical repair of the fistula. The aim of this study was to analyse different surgical approaches used for the treatment of CSF rhinorrhea regarding several preoperative and postoperative variables to determine the optimal method in these patients. Patients' charts were retrospectively reviewed to get the required data. Twenty-six patients who underwent different types of surgical approach for the treatment of CSF rhinorrhea were included in the study. Patients who had extensive comminuted fractures of the anterior cranial base and additional brain injury besides CSF rhinorrhea, mostly as a result of gunshot injuries, underwent craniotomy (n = 14). Osteoplastic frontal sinusotomy was used in two patients with a dural defect located at the posterior wall of the frontal sinus. Uncomplicated CSF fistulas in ten patients, located at the anterior and posterior ethmoid roof and in the sphenoid sinus, were closed with an endonasal endoscopic approach. Postoperative success rate was higher (97 % for intracranial approach, 100 % for extracranial external and endonasal endoscopic approach) for all techniques. Anosmia was the most frequent permanent complication (n = 5), seen after craniotomy. In conclusion, endonasal endoscopic approach can be preferred for the closure of uncomplicated CSF fistula, located at the anterior or posterior ethmoid roof and in the sphenoid sinus, due to its minimal postoperative morbidity. Uncomplicated CSF fistula, located at the posterior wall of frontal sinuses can be repaired extradurally with osteoplastic frontal sinusotomy. Intracranial approaches should be reserved for more complicated CSF rhinorrhea which results from extensive comminuted fractures of the anterior cranial base and is accompanied with intracranial complications.

Antimycobacterial screening of some Turkish plants.

Extracts of 44 plant species distributed among 17 families from Turkey were screened against Mycobacterium tuberculosis H(37)Ra using microplate Alamar blue assay test. Six plants inhibited growth of M. tuberculosis H(37)Ra at 50 microg/ml concentrations.

Determination of genistein in the Turkish Genista L. species by LC-MS.

In this study, Genista species growing in Turkey were analysed for their total and free genistein content by using LC-MS method. The highest amount of total and free genistein was found in Genista tinctoria as 1.05% and 0.27% respectively and trace amount in G. libanotica. Total and free genistein content of the aerial parts of other Genista species varied from 0.01 to 0.18% and from 0.01 to 0.13% respectively.

Toxicity of dietary Heliotropium circinatum to rats.

Pyrrolizidine alkaloid intoxication was produced in adult, male rats by feeding different levels (0, 1, 3, 5 or 10%) of Heliotropium circinatum for 20 w. Combined GC-MS revealed 0.15% total alkaloid content in the plant material of which 12% and 88% were basic and N-oxide forms, respectively. The specific alkaloids identified were europine (67.33%), heliotrine (16.34%), lasiocarpine (8.12%), heleurine (4.18%), echinatine (1.56%), 7-angeylheliotrine (1.19%), and an unknown alkaloid (1.28%). Neither mortality nor significant clinical changes occurred in test groups. Mild to moderate, dose-related hepatic megalocytosis was the most prominent histopathological finding. In addition to chronic hepatotoxicity, notable medial thickening occurred in the pulmonary arterioles and arteries of the high-dosed groups. This study indicated that H. circinatum plant has limited toxic potential in rats with mild to moderate histological changes and no mortality at the dosing levels, total doses, or time of exposure employed.

Toxicity of Senecio vernalis to laying hens and evaluation of residues in eggs.

Diets with 0.0, 0.5,2.0, or 4.0% ground-aerIal parts of Senecio vernalis were fed to groups of 10 laying hens for 210 d. Plant alkaloid content was 0.14% with 8.57% in the basic form and 91.43% in the N-oxide form. Specific alkaloids were senecionin (66.65%), senecivernin (10.37%), seneciphylline (8.51%), integerrimine (8.44%), retrorsine (3.03%), senkirkine (2.35%) and hydroxysenkirkine (0.65%). At the end of the feeding period, no mortality or clinical signs occurred in any test group. However, decreases in egg production, feed efficiency, feed intake and body weight occurred on diets containing 2 or 4% of the plant. Serum gamma-GT was significantly elevated and serum albumin and protein were significantly decreased in hens fed the 2 and 4% diets. Total bilirubin was significantly higher in the 4% group. No free pyrrolizidine alkaloids were detected in eggs indicating that at these rates of dietary exposure, they did not produce residues at the level of detection or that they were bound irreversibly to egg proteins. Hens fed 2 or 4% plant diets had mild to moderate chronic liver changes of periportal or septal fibrosis, megalocytosis, bile duct hyperplasia and early regenerative nodule formation.

Toxicity of dietary Heliotropium dolosum seed to mice.

Experimental pyrrolizidine alkaloid intoxication was produced in inbred Swiss mice. Animals were fed diets containing 0, 1, 3, 5, or 10% Heliotropium dolosum seed for 24 w. The seeds contained 0.13% total alkaloid concentration composed of 4 specific components: lasiocarpine (78.79%), heliosupine (11.96%), echimidine (5.43%), and heliotrine (3.82%). Deaths occurred in all dosed groups and increased with dietary seed concentration. Massive to submassive liver necrosis together with sinusoidal congestion, and hemorrhage or multifocal hepatocytic necrosis was limited to animals which survived < 5 w and were fed on 10% seed. Moderate to severe hepatomegalocytosis, scattered single cell necrosis, and mild subcapsuler fibrosis were seen in all test group animals that survived > 5 w. Intranuclear eosinophilic inclusions in hepatocytes and bile duct and ductular cell hyperplasia were the most noticeable lesions in the 1, 3, and 5% groups. There was mild to moderate renal tubular megalocytosis in the 3, 5, and 10% groups. It seems likely that H dolosum seed, at least to a limited extent, constitutes a health hazard for certain animal species.

Revision myringoplasty with solvent-dehydrated human dura mater (Tutoplast).

OBJECTIVES: Several grafting materials have been used in the reconstruction of the perforations of the tympanic membrane. The use of dehydrated dura homografts as a substitute for the tympanic membrane has not been fully documented. On the other hand, revision surgery is more critical in terms of patients' expectations. The aim of this study is to determine the tissue stiffness, the compliance, and the wound healing rate of dura homografts in revision surgery of perforations of the tympanic membrane. STUDY DESIGN AND SETTING: The charts of 45 patients who have received dura grafts because of re-perforation or failure of the myringoplasty have been reviewed retrospectively. The healing process of the myringoplasty, graft take rate, pure-tone hearing level, and tympanogram were reviewed. RESULTS AND CONCLUSION: It has been concluded that dura homografts, which have excellent tissue-compatibility, stability, and an 86.7% graft success rate, are preferred in patients in whom their own temporalis fascia cannot be used because of previous operations. It has been demonstrated by tympanometric analysis that the compliance of the graft during various pressure applications is as good as the normal eardrum.

Sphenochoanal polyp: endoscopic surgery.

Sphenochoanal polyp is a rare entity originating from sphenoid sinus. It may be confused with antrochoanal polyp on anterior rhinoscopy because of its similar appearance. Computerized tomography and nasal endoscopy have contributed to an increase of accuracy in the diagnosis of these masses. Simple polypectomy that leaves some part of the polyp inside the sphenoid sinus carries a high risk of recurrence. Destructive external approaches to gain access to the sphenoid sinus are also not advisable in children for a benign disease. We present two cases of sphenochoanal polyps in two children that were operated by endonasal endoscopic approach. They were free of symptoms after surgery. No complications and recurrences were observed at 28 and 18 months of follow-up periods respectively.

Osteoma of the middle ear.

Osteomas are benign pedunculated tumours of the lamellar bone, which commonly originates from paranasal sinuses. Within the temporal bone they are seen commonly in the external ear canal. Osteomas originating from the middle ear are very rare. There are only 12 cases reported in the medical literature up to now. Five of those cases caused conductive hearing loss and the others were asymptomatic and diagnosed incidentally.

Nasal surgery for contact point headaches.

Headache due to the pressure on nasal mucosa of anatomical variations, nasal polyps, or mucosal swelling in the absence of inflammation of the paranasal sinuses is a clinical entity that has gained wide acceptance. In this paper, the outcomes of surgical treatment in 30 patients whose headaches were believed to be the result of intranasal contact points are presented. Total relief of the headache and significant improvement were achieved in 43% and 47% of the patients, respectively, after endoscopic endonasal surgery. The intensity of the headache was the same as preoperatively in 10% of the patients. In the absence of any other identifiable etiological factors, intranasal mucosal contacts must be kept in mind as a cause of the headache.