Abdominal access in laparoscopic surgery of obese patients: a novel abdominal access technique.

BACKGROUND: An important step in laparoscopic surgery is abdominal access. Several abdominal access techniques have been described to reduce complications. We compare our novel abdominal access technique (MESAD) with other abdominal access techniques, particularly to reduce complications in obese patients. OBJECTIVE: Compare the MESAD method and other methods we use for abdominal access in gynecologic laparoscopic surgery of obese patients DESIGN: Retrospective SETTING: Gynecology department in university hospital PATIENTS AND METHODS: Patients who underwent abdominal access by the MESAD technique, the Veress needle technique, and the Hasson technique were included in our study. In addition to demographic data, minor and major complications, number of unsuccessful attempts, conversion to another technique, and abdominal access times were collected from all patient files. MAIN OUTCOME MEASURES: Clinical data and complications SAMPLE SIZE: 66 patients, 26 by MESAD technique, 24 by the Veress needle technique, and 16 by the Hasson technique. RESULTS: There were two major complications (one in the Veress group and one in the Hasson technique group) and 7 minor complications. No significant difference was found between the groups in terms of complications (P=.477, P=.476, respectively). The fastest technique for abdominal access was in the MESAD technique whereas the slowest was in the Hasson (P<.001). The failure of abdominal access and subsequent conversion to another technique was most common in the Veress group. However, no significant difference was found between the groups (P=.092). CONCLUSIONS: The MESAD technique is an easy method to both learn and teach. We think that the low major-minor complication rates in the MESAD technique will allow surgeons to reduce their anxiety at the first entry and to perform a more comfortable operation. LIMITATIONS: Retrospective CONFLICT OF INTEREST: None.

Comparison of Vitamin D Levels and Related Factors in Pregnant Women and Neonates Exposed to Second-Hand Smoke.

INTRODUCTION: Exposure to second-hand smoke, a significant public health issue today, may lead to various health problems, especially in pregnant women and their infants. Low vitamin D levels during pregnancy may lead to preeclampsia and gestational diabetes in the mother, while it may cause low birth weight and respiratory problems in the infant. METHOD: The study group consisted of 42 mothers, who smoked regularly, and their infants and 45 mothers (passive smokers), who were regularly exposed to second-hand smoke in their home environment, although they did not smoke, and their infants. Meanwhile, the control group consisted of 46 healthy mothers, who did not smoke and were not exposed to second-hand smoke at home, and their infants with similar gestational age and birth weight. Blood samples were taken as two different samples, from the mother and the baby, and 25-hydroxyvitamin D (25(OH)D) and related blood parameters were studied and compared statistically. RESULTS: 25(OH)D, calcium, and magnesium levels of mothers who smoked were significantly lower than those who were exposed to second-hand smoke and those who did not. Moreover, the vitamin D levels of mothers and babies exposed to second-hand smoke in the non-smoker group were significantly lower than mothers and babies who were not exposed to second-hand smoke. In the babies of these three groups, a significant decrease was observed only in vitamin D levels. CONCLUSION:  The present study shows that pregnant women and their infants exposed to second-hand smoke have lower vitamin D levels. Hence, more emphasis should be put on vitamin D monitoring and supplementation to prevent severe health problems in pregnant women and their infants exposed to tobacco smoke. Further studies are needed to assess the associated risks for maternal and fetal health as well as possible long-term implications for the infant.

Vitamin D Deficiency and Its Clinical Results in Preeclamptic Mothers and Their Babies.

INTRODUCTION: Vitamin D deficiency during pregnancy may lead to many health problems by negatively affecting the metabolism of the newborn and the mother, such as infantile rickets, poor fetal and neonatal growth and development, gestational diabetes, and preeclampsia. We aimed to investigate the levels and clinical results of vitamin D in preeclamptic mothers and their babies. METHODS: The study group consisted of 42 preeclamptic mothers, and their babies diagnosed with preeclampsia according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria, while the control group consisted of 49 healthy mothers and babies with similar gestational age and birth weight. All pregnant women participating in the study were routinely taking 1200 IU of vitamin D3 daily supplements. The cord blood vitamin D level of both groups of newborns was measured and the results were statistically compared. RESULTS: The birth week, weight, and height averages and APGAR score averages measured at the first minutes of the babies in the study group (preeclamptic mother babies) were statistically significantly lower than those of the babies in the control group (babies of healthy mothers) (p=0.001, p=0.001, p<0.001, p=0.004, respectively). Vitamin D and calcium levels of the mothers in the study group were lower than those of the mothers in the control group. When the infants were examined, only the level of vitamin D was statistically significantly lower in infants in the patient group (p<0.001, p<0.001, p=0.001, respectively). CONCLUSION: There is consistent evidence of an association between low vitamin D concentrations and adverse preeclampsia outcomes. Since vitamin D deficiency is more common in preeclamptic mothers and their infants, higher-dose vitamin D supplementation than routine may be recommended to the patients.

Evaluation of Plasma Free Amino Acid and Carnitine Levels in Patients with Cesarean Scar Pregnancy.

AIM AND OBJECTIVE: This study aimed to explore the plasma free amino acid (FAA) and carnitine levels in pregnant women with cesarean scar pregnancy (CSP), and to compare them with those of healthy pregnant women. MATERIALS AND METHODS: This prospective and randomized controlled study was conducted in patients admitted to Harran University Medical Faculty Hospital Obstetrics Clinic between January 2018 and January 2019. A total of 60 patients were included in the study, and the patients were divided into two groups: the CSP group (n = 30) and the healthy pregnant group as the control group (n = 30). The blood samples were taken from the participants between 7 - 12 weeks of gestation. Twenty-seven carnitines and their esters and 14 FAAs were analysed by liquid chromatography - mass spectrometry (LC-MS/MS). RESULTS: The mean plasma concentrations of some carnitines, including C2, C5, C5-OH, C5-DC, C6, C8-1, C12, C14, C14-1, C14-2, C16, C16-1, C18, and C18-1 were significantly higher in the CSP group than in the control group. However, other carnitines, including C0, C3, C4, C4-DC, C5- 1, C6-DC, C8, C8-DC, C10, C10-1, C18-1-OH, and C18-2, were similar in both groups. The plasma levels of some FAAs, including Methyl Glutaryl, Leu, Met, Phe, Arg, Orn, and Glu values, were significantly higher in the CSP group than in the control group. However, there was no statistical significance in other FAA levels, including Val, Asa, Tyr, Asp, Ala, Cit, and Gly between the two groups. Additionally, Pearson's correlation analysis showed that there were significantly positive correlations between many FAA and carnitine values. CONCLUSION: Since several plasma carnitines and FAA levels were higher in the CSP group than in the control group, we think that scar pregnancy increases the metabolic need for myometrial invasion. Also, we think that these results may be useful in clinical practice for CSP diagnosis.