Can extracorporeal magnetic innervation be a treatment modality for primary dysmenorrhea?

BACKGROUND/AIMS: To evaluate the efficacy of extracorporeal magnetic innervation (ExMI) as a treatment for primary dysmenorrhea compared with nonsteroidal anti-inflammatory drugs (NSAIDs) and combined oral contraceptives (COCs). METHODS: The cases were randomized into three groups (NSAID = 51, ExMI = 53, COC = 54). ExMI was applied for a total of 10 sessions. Women in the NSAID group used an oral NSAID at the start of each menstruation. Women in the COC group were given combined pills. Of the treatment options, ExMI was applied for only a single period, whereas NSAID and COC use continued for 12 months. RESULTS: At the first menstruation, visual analog scale (VAS) scores improved significantly in all groups (p < 0.001). NSAIDs and COCs continued to show efficacy over the entire study period (p < 0.05). However, in the ExMI group, VAS values increased from the first menstruation until 12 months. The VAS score at the 12th month was significantly higher in the ExMI group than in the other groups (p < 0.05), but markedly lower than the pretreatment value (49.9 ± 8.3 vs. 71.1 ± 10.1, p < 0.001). CONCLUSIONS: ExMI therapy might be a promising novel noninvasive option for primary dysmenorrhea. Efficacy began to decline after 3 months, but continued for 12 months.

Comparison of the effects of meloxicam and dexketoprofen on postoperative adhesion formation in a rat uterine horn surgical model.

STUDY OBJECTIVE: To compare the effects of 2 nonsteroidal antiinflammatory drugs of different chemical classes (meloxicam and dexketoprofen) on postoperative intraabdominal adhesion formation in a rat model. DESIGN: Experimental study (Canadian Task Force classification I). SETTING: Center for research and development. ANIMALS: Thirty female Wistar albino rats. INTERVENTIONS: The animals were randomly assigned to 1 of 3 groups (10 rats per group) and received intramuscular injections of 0.5 mg/kg dexketoprofen (group 1), 0.5 mg/kg meloxicam (group 2), or 1 mL sterile saline solution (control; group 3) daily for 2 days. Laparotomy was performed, and 1 of the uterine horns was damaged via monopolar electrocautery, whereas an incision was made in the other horn using a scalpel and was sutured to promote adhesion formation. The surgeons were blinded to the treatment method. Drug administration was continued for 5 days. The animals were euthanized at 14 days after surgery. MEASUREMENTS AND MAIN RESULTS: Intraperitoneal macroscopic and microscopic adhesions were assessed using standard adhesion scoring systems. Macroscopic adhesion scores were similar among the 3 groups in each horn (p > .50). The total histologic score was significantly lower in the meloxicam group than in the control group (8.0 vs 15.5; p = .006). Dexketoprofen did not significantly affect the total histologic score (11.0 vs 15.5; p = .09) or individual items (i.e., inflammation, fibroblastic activity, foreign body reaction, collagen formation, and vascular proliferation) compared with the control group (p > .02). Meloxicam significantly inhibited inflammation and collagen formation compared with the control group (p < .02). Meloxicam was also significantly superior to dexketoprofen in reducing inflammation (p = .006). CONCLUSION: Although meloxicam did not affect clinical adhesion formation, it significantly decreased histologic scores compared with those of the control group. Therefore, meloxicam may be suitable in reducing postoperative intraabdominal adhesion formation.

Effectiveness of screening for gestational diabetes during the late gestational period among pregnant Turkish women.

AIM: To assess the incidence of gestational diabetes mellitus (GDM) beyond 30 gestational weeks (GW) in pregnant Turkish women and to determine the criteria for repeating the test during the late period of gestation when the results were normal after the initial screen. MATERIALS AND METHODS: Two hundred pregnant women were enrolled. Maternal age, gravidity, parity and presence of other risk factors (family history of diabetes mellitus, habitual abortions, prior fetal macrosomia, obesity, gestational hypertension history) were collected. First, GDM was evaluated between the 24th and 28th GW by screening (50-g glucose challenge test) and diagnostic tests. This protocol was repeated again at least 1 month from the first screen at the 30th-34th GW in all patients, except those diagnosed with GDM due to an abnormal 3-h test. The results were compared with the clinical risk factors. RESULTS: In total, 19.5% of the cases had positive results in the first screening test. Six patients were diagnosed with GDM. Among the remaining 194 pregnancies, another 10 cases were diagnosed as having GDM with repeated tests, and the incidence of newly diagnosed GDM was 5.2%. Only the mean age (34.2 years) (P = 0.010) and a history of delivering a macrosomic infant (P < 0.010) were significantly high in the late-gestation GDM-positive cases. CONCLUSIONS: Even when early screening tests are negative, pregnancies with advanced maternal ages and those with a history of delivering a macrosomic infant should be re-evaluated for GDM during the late gestational period with screening and diagnostic tests.

Benign cystic lymphangioma presenting as a pelvic mass.

We report a case of a 48-year-old woman with a complaint of chronic pelvic pain with a pelvic mass not related with uterus or adnexes. Preoperative ultrasonography or contrast enhanced computed tomography did not give accurate information on the origin of tumor. At laparotomy a cystic, retroperitoneal mass was totally resected without rupture. Final histopathological examination revealed that cystic spaces with abundant lymphocytes suggesting lymphangioma. No recurrence was detected in the follow up 6 months after total resection. As a result cystic lymphangioma should be considered as a rare cause of pelvic mass in women.

The possibility of nervus ilioinguinalis and nervus iliohypogastricus injury in lower abdominal incisions and effects on hernia formation.

AIM: The aim of this study was to determine the distances of nervus ilioinguinalis and nervus iliohypogastricus to McBurney's and paramedian incisions. MATERIALS AND METHODS: This study was performed on 12 adult cadavers. Right and left inguinal regions of the cadavers were dissected by inguinal incision. The points where the nerves perforated the internal obliquus muscles were determined, and the distances of these points to the spina iliaca anterior superior (SIAS) and to the umbilicus were measured. These distances were marked over a diagram, and distances of the nerves to McBurney's and paramedian incisions were measured by illustrating these incisions on the same diagram. FINDINGS: While the distance of the iliohypogastric nerve from the SIAS was 1.5-8 cm on the right and 2.3-3.6 cm on the left, the distance of the ilioinguinal nerve from the SIAS was 3-6.4 cm on the right and 2-5 cm on the left. The distance of the ilioinguinal nerve from McBurney's incision was 0.2-6.1 cm on the right and 1.8-7.5 cm on the left, and that of the iliohypogastric nerve was 2.2-6.9 cm on the right and 2.9-6.2 cm on the left. The distances of the nerves from paramedian incision were found to be 4.6-10 cm on the right and 6.4-11.2 cm on the left for the ilioinguinal nerve and 5-11.2 cm on the right and 7.4-11.6 cm on the left for the iliohypogastric nerve. CONCLUSION: Both nerves perforate the musculus obliquus internus, scattered in a wide area. Considering the distances, the paramedian incision seems to be more reliable with respect to the risk of nerve injury. Incisions performed in the lower abdomen carry the risk of injury to the ilioinguinal and iliohypogastric nerves.