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.

Diagnostic accuracy of pre-induction cervical elastography, volume, length, and uterocervical angle for the prediction of successful induction of labor with dinoprostone.

PURPOSE: The study's aim is to define among a group of ultrasonographic cervical measurements a candidate parameter predictive of successful of induction of labor in term pregnancies with unfavorable cervix. METHODS: This prospective observational study included 141 pregnant women at term with an unfavorable cervix (Bishop score ≤ 6). All patients underwent clinical and ultrasonographic cervical evaluation before dinoprostone induction. Pre-induction cervical assessments included the Bishop score, cervical length, cervical volume, uterocervical angle, and cervical elastographic parameters. Vaginal delivery (VD) was accepted as successful dinoprostone induction. Multivariate logistic regression was conducted to identify the potential risk factors significantly associated with CS while controlling for possible confounding variables. RESULTS: The vaginal delivery rate was 74% (n = 93) and the cesarean section (CS) rate was 26% (n = 32). Sixteen patients who had a cesarean section due to fetal distress before the active phase of labor were excluded from the study. The mean induction-to-delivery interval was 1176.1 ± 352 (540-2150) for VD and 1359.4 ± 318.4 (780-2020) for CS (p = 0.01). Bishop score was lower in women with cesarean section (p = 0.002). When both groups were compared in terms of delivery type, no difference was found between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. Multivariable logistic regression model failed to show significant differences between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. CONCLUSION: Cervical length, cervical elastography, cervical volume, and uterocervical angle measurements did not provide a clinically useful prediction of outcomes following labor induction in our study group with unfavorable cervix. Cervical length measurements significantly predicted the time interval from induction to delivery.

Isolated Subclinical Right Ventricle Systolic Dysfunction in Patients after Liver Transplantation.

Although hemodynamic alterations in end-stage liver disease (ESLD) and its association with porto-pulmonary hypertension have been well-established, the long-term effects of ESLD on RV systolic function in patients without porto-pulmonary hypertension remain disregarded. Here we aimed to assess the long-term effect of ESLD on RV function and its relationship with the use of NSBBs and clinical, laboratory and imaging parameters in end-stage liver disease. The use of NSBBs is still controversial due to concerns about reduced cardiac contractility and the possibility of increased mortality. Thirty-four liver transplant recipients were included. Demographic characteristics, laboratory and baseline echocardiography measures were obtained. Patients were recalled for transthoracic echocardiographic evaluation after transplantation. Right ventricle dysfunction was identified by having at least one value below the reference levels of RV S', or TAPSE. Isolated subclinical RV dysfunction was observed at 20.6% of the sample population. The present study demonstrates hemodynamic circulation in cirrhosis and increased preload and afterload might have long-term effects on RV function, even the lack of porto-pulmonary hypertension. These findings underline the significance of cardiac function follow-up in cirrhotic patients after transplantation. In this study, patients treated with propranolol seemed to have better RV function and less gastrointestinal bleeding. We speculated that preoperative propranolol treatment might help preserve RV function by providing RAS suppression, improving endothelial function and hyperdynamic circulation seen in ESLD. This potential protective relationship between the use of propranolol and RV function might improve mortality or graft-failure during OLT and after liver transplantation in patients with cirrhosis.

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.

How does the type of delivery affect pelvic floor structure? MRI parameter-based anatomical study.

OBJECTIVES: The aim of this study is to examine the effects of delivery type and birth weight on pelvic floor structure using muscle defects, uterus-vagina angles and landmarks in pelvic magnetic resonance imaging (MRI). MATERIAL AND METHODS: This is a retrospective study. Pelvic MR images of 38 vaginal deliveries and 62 cesarean section patients who met the study criteria were analyzed. Pubococcygeal line, H line, M line were marked on MR images, uterus cervix, cervix upper vagina, upper and middle vagina, middle and lower vagina angles, urogenital hiatus width, levator hiatus width, obturator internus muscle area, levator ani defect was measured. The urinary incontinence and pelvic organ prolapse examination findings were recorded. The patients' age, body mass index (BMI), parity, delivery type, maximum birth weight questions were asked. The data of both groups were compared. RESULTS: Uterocervical angle and levator ani muscle defect was significantly higher in the vaginal delivery group (p < 0.001). In the vaginal delivery group, a significant positive correlation was found between the parity and the levator ani muscle defect (r = 0.552), (p = 0.000). A significant negative correlation was found between the parity and the uterocervical angle (r = -0.337), (p = 0.039). A significant negative correlation was found between maximum birth weight and cervix upper vagina angle (r = -0.365) (p = 0.024). In the vaginal delivery group, a negative significant correlation was found between birth weight and obturator internus muscle area (r = -0.378), (p = 0.019). CONCLUSIONS: These results show that cesarean section exposes the pelvic floor to less trauma and suggest that cesarean section may protect the pelvic floor.

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.

Can prepartum platelet indices be a parameter to predict postpartum hemorrhage?

OBJECTIVE: Postpartum hemorrhage (PPH) is the single largest contributor to maternal mortality worldwide. It has been demonstrated that certain platelet parameters are indicative of platelet reactivity. The aim of this study was to determine whether antenatal platelet indices can be used as risk factors in the prediction of primary PPH. METHODS: This comparative case-control study involved 3207 pregnant women at term who were recruited over one year period in Istanbul. Postpartum hemorrhage, defined as blood loss ≥1000 mL within 24 h after delivery. The study group consisted of 42 patients who developed primary PPH after vaginal delivery without defined risk factors. The patients in the control group were matched with age, parity, body mass index (BMI), and hemoglobin value. Platelet indices - platelet count, mean platelet volume (MPV), platelet distribution width, and plateletcrit were measured prior to delivery and evaluated for the prediction of PPH. RESULTS: Prepartum MPV and PDW values were determined to be lower in the patients with in the PPH group, when compared to the healthy group (respectively, p < .001 and p < .004). By receiver-operating characteristic analysis, MPV and PDW were able to distinguish between patients with and without any bleeding (respectively, AUC 0.823, 95% confidence interval (CI) 0.735-0.912, (AUC) 0.682, 95% CI 0.569-0.795). Prepartum MPV (cutoff = 10.95 fL) had a high AUC (>0.8) for predicting PPH, with a specificity of 81% and sensitivity of 69%. CONCLUSION: Results suggest a novel hypothesis that pre-delivery lower MPV value may be used predicting PPH.

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.

Switching Ticagrelor to 600 mg or 300 mg Clopidogrel Loading Bridge in Patients with Unstable Angina.

Ticagrelor is believed to be a more potent and faster antiplatelet agent compared with clopidogrel and may result in lower ischemic outcomes in patients with acute coronary syndrome. However, the best strategy of switching from ticagrelor to clopidogrel is unclear. Current guidelines advocate clopidogrel bridging with a 600 mg loading dose (LD). This study aimed to compare the safety and feasibility of switching protocols from ticagrelor to clopidogrel 600 mg or 300 mg LD in patients with unstable angina pectoris (USAP). One hundred and eighty patients with USAP undergoing adhoc percutaneous coronary intervention (PCI) received preprocedural ticagrelor 180 mg/daily. The decision to switch antiplatelet therapy to clopidogrel with either 300 mg LD or 600 mg LD at 12 h was left to the discretion of the treating physician. The primary outcome was a composite of an efficacy endpoint major adverse cardiac and cerebrovascular events (MACCEs) and a safety endpoint Bleeding Academic Research Consortium scale (BARC) (≥1). There were no differences in our composite clinical endpoint of MACCE between the two strategies, with one event occurring in each group. One patient in each group had myocardial infarction due to stent thrombosis, and the patient in the 300 mg switching group died due to stent thrombosis. No difference between the two arms was observed in terms of BARC bleeding criteria. This study showed that among USAP patients undergoing PCI, switching to clopidogrel with 300 mg LD showed no significant difference compared to 600 mg clopidogrel LD. Ticagrelor LD in ad hoc PCI and de-escalation to clopidogrel with 300 mg LD could translate to lower costs for patients with USAP without compromising safety and efficacy.

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.

M-mode Ultrasound Scan as a Potential Alternative Technique for Monitoring Uterine Contractions in Obese Patients.

We investigate motion mode (M-mode) ultrasound scan as a potential non-invasive uterine monitoring technique and compare its contraction characteristics with external tocodynamometry (TOCO). This prospective diagnostic accuracy study included 39 term pregnant woman in active spontaneous labor. M-mode and TOCO were simultaneously performed and uterine contraction characteristics and consistency were compared quantitatively and visually. The results identified a 71.5% ± 35.3% uterine wall thickening during uterine contractions on M-mode. Uterine monitoring with M-mode had a consistency rate of 88.7% ± 6.9% with conventional TOCO method. During 20-min monitoring, the number of detected contractions was significantly higher (p < 0.001) in M-mode (8.2 ± 1.2) than TOCO (7.4 ± 1.5). As for the mean value of the duration of a contraction (seconds), it was significantly shorter (p < 0.001) in M-mode (38.5 ± 3.5) than TOCO (49.2 ± 4.1). For M-mode, the number of detected contractions had a negative but insignificant correlation with the body mass index (BMI) (r = - 0.25 [- 0.52, 0.07], p = 0.127) and the subcutaneous tissue thickness (STT) (r = - 0.21 [- 0.49, 0.11], p = 0.200). As for TOCO, the contractions had a negative and significant correlation with BMI (r = - 0.41 [- 0.64, - 0.11], p = 0.009) and negative and insignificant correlation with STT (r = - 0.26 [- 0.54, 0.06], p = 0.104). The evidence suggests that contraction detection with M-mode is a promising non-invasive technique for uterine monitoring. The preliminary analysis finds that contraction detection is not affected by BMI or STT. With future sensitivity studies, and improvements in image-processing and software technologies, the proposed technique promises to be a viable alternative to existing techniques, especially for obese patients.

The impact of cryotherapy for symptomatic cervical ectropion on female sexual function and quality of life.

In rare cases, cervical ectropion causes symptoms such as abundant leucorrhoea, postcoital bleeding, recurrent cervicitis, pelvic pain, and dyspareunia. Cryotherapy is a commonly used treatment for symptomatic cervical ectropion. We assessed the impact of cryotherapy on sexual function and quality of life among patients with symptomatic cervical ectropion. In this prospective observational study, 73 patients were assessed before and six months after cryotherapy treatment using the Female Sexual Function Index (FSFI) and Short Form-12 Health Survey questionnaires. The double-freeze cryotherapy procedure was performed using a cryotherapy unit, and liquid nitrogen was used as a refrigerant. The mean physical and mental quality of life scores were significantly improved after treatment. With the exception of the pain domain, the overall and domain FSFI scores exhibited no significant differences before and after cryotherapy. The sexual pain domain scores were significantly increased after treatment. There was a statistically significant improvement in vaginal discharge, pelvic pain, and postcoital bleeding symptoms after the cryotherapy. We concluded that cryotherapy is an effective and feasible treatment for symptomatic cervical ectropion. Although cryotherapy results in improved quality of life scores, it has no significant impact on female sexual function.Impact statementWhat is already known on this subject? Cryotherapy is the most preferred treatment option for symptomatic cervical ectropion. Its feasibility and effectiveness with respect to symptom relief have been observed in previous studies. No study has evaluated quality of life and sexual function after cryotherapy among patients with symptomatic cervical ectropion.What do the results of this study add? Although the patients' quality of life scores were significantly improved after treatment, no significant improvement was observed in overall and domain sexual function scores, with the exception of the pain domain. The sexual pain domain scores were significantly improved after cryotherapy.What are the implications of these findings for clinical practice and/or further research? Patients should not expect better sexual function after cryotherapy. Comparative studies should seek to identify the ideal treatment option, which would result in both symptom relief and better sexual function.

Value of Renal Vascular Doppler Sonography in Cardiorenal Syndrome Type 1.

OBJECTIVES: Worsening of renal function in a patient with acute decompensated heart failure is called cardiorenal syndrome (CRS) type 1. Recent studies have shown an association of persistent systemic venous congestion with renal dysfunction. This trial was set up to investigate the changes of renal Doppler parameters with diuretic therapy in patients with CRS type 1. METHODS: Cases of CRS type 1 were identified among patients hospitalized for decompensated heart failure. Serial measurements of the renal venous impedance index (VII) and arterial resistive index (ARI) were calculated by pulsed wave Doppler sonography. RESULTS: A total of 30 patients who had creatinine improvement with diuresis (group 1) and 34 patients without any improvement (group 2) were analyzed. Patients in group 1 had higher median VII and ARI (VII, 0.86 versus 0.66; P < .001; ARI, 0.78 versus 0.65; P < .001) on admission. A high ARI on admission (odds ratio, 6.25; 95% confidence interval, 1.84-14.3; P = .003) predicted the improvement of serum creatinine levels with diuretic therapy independent of confounding factors in patients with CRS type 1. CONCLUSIONS: Renal vascular Doppler parameters might offer guidance on the diagnostic and therapeutic strategies in prescribing decongestive therapy for decompensated heart failure.

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.