Troponin I and D-Dimer levels in preeclampsia and eclampsia: prospective study.

OBJECTIVE: The aim of this study was to evaluate serum cardiac troponin I and D-Dimer (D-Di) levels in preeclampsia (PE), eclampsia (E), and normotensive healthy pregnant women in third trimester in order to define their diagnostic value. MATERIALS AND METHODS: The study group consisted of 42 preeclamptic patients and 16 eclamptic patient; 108 healthy normotensive pregnant women in third trimester who were chosen from outpatients clinic and examined regularly used as a control group. Serum cardiac troponin I and D-Di levels were measured using an immunoassay. RESULTS: The average levels of troponin I were 0.0134 ± 0.0091, 0.017 ± 0.0085, 0.180 ± 0.136 in control group, preeclamptic, and eclamptic patients, respectively. The levels of troponin in eclamptic patients were statistically higher than the normotensive and preeclamptic group (p = 0.016, p = 0.014). There were no differences in terms of troponin I level between preeclamptic group and normotensive pregnant women in third trimester (p = 0.089). The average D-Di levels were 634 ± 228 ng/ml, 1426 ± 430 ng/ml, 2067 ± 580 ng/ml in control group, preeclamptic, and eclamptic patients, respectively. The levels of D-Di in preeclamptic and eclamptic patients were found significantly higher than the control groups (p = 0.034, p = 0.020). CONCLUSION: Serum troponin I levels increased in eclamptic patient because of myocardial damage. An increased level of troponin was not detected in preeclamptic patients. However; D-Di level increased in preeclamptic and eclamptic patients.

Assessment of perioperative, early, and late postoperative complications of the inside-out transobturator tape procedure in the treatment of stress urinary incontinence..

OBJECTIVE: To evaluate the complications of urinary incontinence surgery with transobturator tape (TVT-O) system and to describe its diagnosis and management. MATERIALS AND METHODS: A total of 156 patients who were diagnosed as having stress incontinence and mixed incontinence with stress predominance underwent a TOT operation under spinal anesthesia by one surgeon or two surgeons (MB, AEY) from the team. TVT-obturator inside out material was used in the operation. Urodynamic tests and pad tests were done on all the patients. This is a prospective and retrospective study of the complications of TVT-O. The operation was performed under regional anesthesia, as described by Deval et al. Patients were excluded from the study if they had been operated under general or local anesthesia, had undergone any vaginal operations except for anterior repair (cystocele), wanted to have a baby, had severe systemic diseases or had been diagnosed as having urge incontinence in urodynamic tests. These situations may affect the rate of complications, the authors also excluded slings that had materials other than monofilament polypropylene, and patients who were suspected of having neurologic bladder conditions. The bladder and urethra were evaluated using cystoscopy. The durations of the TOT procedure, cystoscopy, and if performed, the cystocele operation, were recorded. Perioperative, early, and late postoperative complications were analyzed by follow-up visits (after two months to four years). RESULTS: Of the 156 patients included in the study, 100 (64.1%) had pure stress urinary incontinence and 56 (35.9%) had mixed incontinence, 20 (12.8%) had previous incontinence surgery. The mean duration of follow up was 30.3 ± 7.4 (range 17-42) months. The mean age of the patients was found to be 48.43 ± 6.24 years (range 42-68). The mean parity of the patients was 5.24 ± 2.86 (range 2-13), and mean body mass index was found to be 23.7 ± 4.8. Mean maximum detrusor pressure was 10.30 ± 4.08 and the mean ALP value was 80.80 ± 25.57. Mean operative time was found to be 13.8 ± 5.16 min in patients who underwent only TOT and TOT-anterior repair. Vaginal injury including to the lateral fornix (4.4%), hemorrhaging of more than 200 ml (3.2%), vascular damage (1.9%), hematoma on the leg (1.9%), hemorrhaging of more than 500 ml (0.064%), and bladder perforation (1.2%) were detected as perioperative complications. Urethral injury and perioperative nerve and intestinal injury did not occur. The most common complication in early postoperative period was inguinal pain extending the legs (30.7%), followed by headaches (23.7%), fever (12.8%), urinary tract infection (5.7%), and urinary retention (3.2%), respectively. Late postoperative complications included vaginal erosion (4.4%), de novo urge incontinence (8.9%), de novo dyspareunia (7.1%), perineal pain (4.4%), and worsening urgency (8.9%). CONCLUSION: Although the TVT-O technique is a minimal invasive surgery method applied to treat the urinary incontinence surgically, it does not imply that it is a complication-free surgical procedure. Despite the low incidence of intraoperative complications, there is a mild risk of early and late postoperative complications. Fortunately these complications can be taken under control by either conservative and simple medical treatments or surgical procedures.

Evaluation of the importance of the serum levels of CA-125, CA15-3, CA-19-9, carcinoembryonic antigen and alpha fetoprotein for distinguishing benign and malignant adnexal masses and contribution of different test combinations to diagnostic accuracy.

PURPOSE: The aim of this study was to investigate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPPV) of the serum levels of CA-125, CA15-3, CA19-9, carcinoembryonic antigen (CEA), and alpha-fetoprotein (AFP) in the differentiation of benign and malignant ovarian tumors histopathologically diagnosed in patients and to determine the effects of the different test combinations on diagnostic accuracy. MATERIAL AND METHODS: One-hundred sixty-eight patients that had their preoperative CA-125, CA15-3, CA19-9, CEA, AFP levels assessed and that were subsequently surgically treated for adnexal masses, were included in the study. For each tumor markers in these patients with histopathologically-confirmed diagnosis, the sensitivity, specificity, PPV and NPV, and diagnostic accuracy, and odds ratio were calculated. RESULTS: The sensitivity, specificity, PPV, NPV of CA125 with cut-off 35 U/ml, were found to be 78.9%, 86.9%, 63.8%, and 93.3%, respectively. The diagnostic odds ratio of CA-125 with cut-off of 35 U/ml, was found to be 25. With cut-off65 U/ml, the sensitivity, specificity, PPV, NPV values were 65.7%, 95.3%, 80.6%, and 90.5%, respectively. The sensitivity, specificity, PPV, and NPV of CEA were 16%, 93%, 37%, and 83%, respectively. For AFP, the sensitivity, specificity, PPV and NPV were to be 2.6%, 98%, 33.3%, and 77.5%, respectively. For CA 15-3, the sensitivity, specificity, PPV and NPV were found to be 26.3% 96.1%, 66.6%, and 81.6%, respectively. Likelihood ratio tests: positive (LR+) = 6.83 and negative (LR-) = 0.76, with an odds ratio: 8.9. The risk of malignancy for adnexal masses with higher CA15-3 increased by approximately nine times. For CA19-9, the sensitivity, specificity, PPV and NPV value were found to be 18.4%, 93%, 43.7%, and 79.6%, respectively. CA19-9 was not statistically significant in the differentiation of benign and malignant of adnexal masses. Even the combinations of CA125 + CEA + CA19-9 and CA125 + CEA + CA19-9 +AFP and CA125 + CA15-3 made a small contribution (one, two, and four cases, respectively), but was not statistically significant. CONCLUSION: The levels of CA-125 and CA15-3 were found to be significant in order to distinguish benign and malign; CA 19-9, CEA, and AFP were not found to be significant. The different test combinations did not have contribution for diagnostic accuracy.

Surgical correction of female urinary incontinence: comparison of colporrhaphy, sling and suspension procedures.

OBJECTIVE: To analyse clinical outcomes of three types of pelvic surgery for the correction of female mixed or stress urinary incontinence. METHODS: Women who underwent surgery for urinary incontinence between January 2000 and June 2010 were included in the study (n = 268). Patients were nonrandomly assigned to undergo colporrhaphy, suspension procedure or sling procedure according to their clinical situation. Perioperative parameters were recorded. Short- (< 5 years) and long-term (5-10 years) success rates were determined for each group. RESULTS: The short- and long-term complete cure rates were significantly lower, and the duration of catheterization significantly longer, in patients who underwent colporrhaphy compared with both other groups, but there were no significant differences between suspension or sling procedures. CONCLUSION: Sling and suspension procedures were equally effective in this study, and both were preferable to colporrhaphy.

Comparison of dual X-ray laser and dual energy X-ray absorptiometry techniques of osteodensitometry.

Dual X-ray laser (DXL) heel measurements of bone mineral density (BMD) and dual energy X-ray absorptiometry (DEXA) total hip and lumbar spine BMD measurements were compared for their ability to detect osteoporosis and osteopenia according to World Health Organization criteria. The study included 164 women aged 40 - 83 years. DXL heel measurements were recorded for all patients and 89 of the women underwent DEXA. For DXL heel measurements/DEXA lumbar spine measurements, the relative sensitivity was 50%, relative specificity was 97% and relative reliability (Kappa score) was 0.55 for osteoporosis detection. For detecting osteoporosis or osteopenia, the relative sensitivity increased to 86% but the relative specificity reduced to 38% and the relative reliability was considerably lower (Kappa score 0.21). Although previous studies have shown DXL heel measurement to be a good technique in the diagnosis and assessment of osteoporosis based on BMD, particularly for fast, cost-effective bone scanning, we suggest that there are currently insufficient data to prove its use as a standard measurement technique for BMD.

The use of local 17beta-oestradiol treatment for improving vaginal symptoms associated with post-menopausal oestrogen deficiency.

The effects of local 17beta-oestradiol therapy on the vaginal mucosa and endometrial thickness were studied in 35 post-menopausal women with symptoms of vaginal atrophy. Signs and symptoms of vaginal atrophy were measured by anamnesis, visual examination and the maturation index before and after 12 weeks' treatment with 17beta-oestradiol in the form of vaginal tablets. The maturation proportion on vaginal smear, endometrial thickness on transvaginal ultrasonography and plasma concentrations of follicle-stimulating hormone, luteinizing hormone and oestradiol were also determined. All vaginal atrophy signs and symptoms significantly improved and there was a significant increase in vaginal smear maturation with 17beta-oestradiol treatment. Endometrial thickness did not change significantly. It is concluded that 17beta-oestradiol improves the signs and symptoms of vaginal atrophy without causing endometrial stimulation and offers a safe and effective alternative to systemic hormone replacement therapy for the treatment of vaginal symptoms associated with post-menopausal oestrogen deficiency.