Comparison of the demographic and clinical features of pregnant and non-pregnant patients undergoing appendectomy.

BACKGROUND: This retrospective study aims to compare the demographic and clinicopathological characteristics of the pregnant and non-pregnant patients who underwent appendectomy with a presumed diagnosis of acute appendicitis. METHODS: Between June 2009 and January 2019, 431 reproductive-aged of female patients underwent appendectomy with a presumed diagnosis of acute appendicitis. Patients were divided into two groups considering their pregnancy status: pregnant group (n=48) and non-pregnant group (n=383). Both groups were compared with respect to demographic, clinical and histopathological features. RESULTS: No statistically significant difference was found between pregnant and non-pregnant groups except total bilirubin level (p=0.019) and ultrasonographic findings (p=0.016). In the non-pregnant group, negative appendectomy and perforation rates were 26% and 10.5%, where these rates for the pregnant group were 20.8% and 4.2%. Sensitivity, specificity and accuracy rates of ultrasonography for the pregnant group were 50%, 100% and 58.5%, where these rates for the non-pregnant group were 67.3%, 57.9% and 65%. The pregnancy date was the first trimester in 52.1%, the second trimester in 29.2% and the third trimester in 16.7% of the pregnants. None of the term births (87.5%) resulted in neither a fetal nor a maternal complication. However, 12.5% of the preterm births resulted in neonatal mortality. CONCLUSION: Although not statistically significant, this study points out relatively lower rates of negative appendectomy and perforated acute appendicitis among pregnant patients, which is related to the overly attentive evaluation of pregnants admitted due to acute abdomen.

RETROSPECTIVE ANALYSIS OF BORDERLINE OVARIAN TUMORS: OUTCOMES AT A SINGLE CENTER.

We wanted to discuss our experiences in the approach to borderline ovarian tumors, which constitute a group different from epithelial ovarian tumors with respect to their biological structure in line with retrospective information gathered from our cases. A total of 25 patients operated on for the indication of adnexal masses diagnosed as borderline ovarian tumors based on frozen section results were included in our study. Patient age, tumor diameter, tumor markers and surgeries performed were discussed in the light of the literature. Statistical analyses were performed using the SPSS software. The patient mean age was 43.84±11.34 years. The mass was localized in the right (n=13), left (n=11) or both (n=1) adnexal regions. The mean tumor diameter was 12.9±5.84 cm. Histopathologic examination established the diagnosis of serous borderline (n=14 patients) and mucinous borderline (n=11) ovarian tumors. Although the results of our study are consistent with current literature data, a greater number of current studies should be performed on borderline ovarian tumors, which are defined as a class of tumors different from epithelial ovarian tumors.

Treatment of unruptured cornual pregnancies by local injections of methotrexate or potassium chloride under transvaginal ultrasonographic guidance.

OBJECTIVE: To demonstrate the outcome of intralesional management and show the safety of local treatment of cornual pregnancy. METHODS: Eight patients were treated with local methotrexate or potassium chloride injection. All patients underwent transvaginal ultrasound examination and were diagnosed by the criteria defined by Timor-Tritsch. In the case of fetal heart beat observation, potassium chloride was injected; and in the case of no heart beat detection, methotrexate was used. A follicle aspiration needle was inserted directly into the gestational sac under transvaginal guidance. RESULTS: Although it has been considered to be a risk factor, none of the patients in our study had previous ectopic pregnancy, history of infertility / in vitro fertilization, or cornual pregnancy. One of the patients had a medical history of abortion. In four cases, methotrexate was injected, and three patients received potassium chloride as a local treatment. None of the patients had any complication in the peri- or postoperative period. CONCLUSION: Using a local approach, the treatment agent can reach the area of the cornual pregnancy in high concentrations. Based on this case series, a local approach seems to be an effective and fertility-sparing method for treating unruptured cornual pregnancies.

The relationships between blood pressure, blood glucose, and bone mineral density in postmenopausal Turkish women.

BACKGROUND: Hypertension, diabetes mellitus, and osteoporosis are important comorbidities commonly seen in postmenopausal women. The aim of the present study was to investigate the relationships between blood pressure, blood glucose, and bone mineral density (BMD) in postmenopausal Turkish women. METHODS: In this cross-sectional study, 270 consecutive patients who were admitted to an outpatient clinic with vasomotor symptoms and/or at least 1 year of amenorrhea were included. The patients were categorized into three groups according to their blood pressure and metabolic status as follows: normotensive, hypertensive nondiabetics, and hypertensive diabetics. The T- and z-scores of the proximal femur and lumbar vertebrae were measured with the dual-energy X-ray absorptiometry method to assess the BMD of the study groups. RESULTS: Lumbar vertebral T-scores (P<0.001), lumbar vertebral z-scores (P<0.003), and proximal femoral T-scores (P<0.001) were demonstrated to be significantly lower in the hypertensive diabetic group compared to the hypertensive nondiabetic and normotensive groups. Systolic blood pressure was significantly inversely correlated with lumbar vertebral T-scores (r=-0.382; P=0.001), lumbar vertebral z-scores (r=-0.290; P=0.001), and proximal femoral T-scores (r=-0.340; P=0.001). Moreover, diastolic blood pressure was significantly inversely correlated with lumbar vertebral T-scores (r=-0.318; P=0.001), lumbar vertebral z-scores (r=-0.340; P=0.001), and proximal femoral T-scores (r=-0.304; P=0.001). Hypertension (odds ratio [OR]: 2.541, 95% confidence interval [CI]: 1.46-3.48, P=0.003), diabetes mellitus (OR: 2.136, 95% CI: 1.254-3.678, P=0.006), and age (OR: 1.069, 95% CI: 1.007-1.163, P=0.022) were found to be significant independent predictors of osteopenia in a multivariate analysis, after adjusting for other risk parameters. CONCLUSION: The present study is the first to evaluate the relationships between blood pressure, blood glucose, and BMD in postmenopausal Turkish women. Moreover, both hypertension and diabetes were demonstrated as significant independent predictors of osteopenia in postmenopausal Turkish women. Clinicians should be aware of the high risk of developing osteopenia in diabetic hypertensive postmenopausal women.

Laparoscopic management of a translocated intrauterine device embedded in the gastric serosa.

Intrauterine devices (IUD) are the most common contraceptive methods all over the world. Besides many advantages, there are also some complications of this method. The most important complication of IUD is uterine perforation. The reported incidence of IUD perforation ranges from 0.2 to 9.6 per thousand insertions. In this article we would like to report a case that has an IUD migrated to the gastric serosa. A 41 years-old Turkish woman presented with abdominal pain. Plain X-ray of the abdomen demonstrated two IUDs, one in the upper quadrant of the abdomen, the other in the pelvic area and determined in the endometrium by TV-USG (transvaginal ultrasonography). Laparascopy was performed and the IUD, lying over the omentum of stomach was removed. This report demonstrates the first case in the literature that has an IUD embedded in the gastric serosa and also a second IUD in uterine cavity. The management was performed laparoscopically. No complication was observed during and after operation.