Sonographic and Anatomical Evaluation of the Liver and Portal Vein Reference Values / Evaluación Ecográfica y Anatómica de los Valores de Referencia del Hígado y la Vena Porta

SUMMARY: This paper's aim is a morphometric evaluation of liver and portal vein morphometry using ultrasonography in healthy Turkish population. This study was carried out with 189 subjects (107 females, 82 males). The demographic data and the body surface area were calculated. The longitudinal axis of the liver for two lobes, diagonal axis or liver span, anteroposterior diameter of the liver and portal vein, portal vein transverse diameter, caudate lobe anteroposterior diameter, and portal vein internal diameters as well as longitudinal liver scans in an aortic plane, sagittal plane, transverse plane, and kidney axis were measured. All measurements were analyzed according to age, sex, body mass index, obesity and alcohol consumption. The mean values of the age, height, weight and body mass index were calculated as 44.39 years, 167.05 cm, 74.23 kg, and 27.06kg/m2 in females, respectively. The same values were 44.13 years, 167.70 cm, 75.93 kg and 26.71 kg/m2 in males, respectively. There was significant difference between demographic characteristics, gender, and alcohol consumption in terms of anteroposterior diameter of the liver, portal vein transverse diameter of the right side and liver transverse scan. Also, some measurements including portal vein transverse diameter, liver transverse scan and at kidney axis longitudinal scan of liver showed significant difference between the age groups. There was significant difference in diagonal axis and anteroposterior diameter of liver, portal vein internal diameter, and longitudinal liver scans of the aortic plane parameters between obesity situation. The findings obtained will provide important and useful reference values as it may determine some abnormalities related liver diseases. Also, age, sex, obesity and body mass index values can be effective in the liver and portal vein morphometry related parameters.

El objetivo de este artículo fue realizar una evaluación de la morfometría del hígado y la vena porta mediante ecografía en una población turca sana. Este estudio se llevó a cabo en 189 sujetos (107 mujeres, 82 hombres). Se calcularon los datos demográficos y la superficie corporal. Se midió eleje longitudinal del de dos lóbulos del hígado, el eje diagonal o la extensión del hígado, los diámetros anteroposterior del hígado y de la vena porta, el diámetro transversal de la vena porta, anteroposterior del lóbulo caudado y los diámetros internos de la vena porta, así como las exploraciones longitudinales del hígado en un plano aórtico. Se midieron el plano sagital, el plano transversal y el eje del riñón. Todas las mediciones se analizaron según edad, sexo, índice de masa corporal, obesidad y consumo de alcohol. Los valores medios de edad, talla, peso e índice de masa corporal se calcularon como 44,39 años, 167,05 cm, 74,23 kg y 27,06 kg/m2 en las mujeres, respectivamente. Las mismas variable fueron 44,13 años, 167,70 cm, 75,93 kg y 26,71 kg/m2. Hubo diferencias significativas entre las características demográficas, el sexo y el consumo de alcohol en términos de diámetro anteroposterior del hígado, diámetro transversal de la vena porta del lado derecho y exploración transversal del hígado. Además, algunas mediciones, incluido el diámetro transversal de la vena porta, la exploración transversal del hígado y la exploración longitudinal del hígado en el eje del riñón, mostraron diferencias significativas entre los grupos de edad. Hubo diferencias significativas en el eje diagonal y el diámetro anteroposterior del hígado, el diámetro interno de la vena porta y los parámetros de las exploraciones hepáticas longitudinales del plano aórtico entre situaciones de obesidad. Los hallazgos obtenidos proporcionarán valores de referencia importantes y útiles ya que pueden determinar algunas anomalías relacionadas con enfermedades hepáticas. Además, los valores de edad, sexo, obesidad e índice de masa corporal pueden ser eficaces en los parámetros relacionados con la morfometría del hígado y la vena porta.

Predictive Factors Affecting Recurrence of Anal Fistula after LIFT Procedure.

OBJECTIVE: To determine the predictive factors affecting the recurrence or persistence of anal fistula of demographic and technical variables. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of General Surgery and Radiology, Private Ortadogu Hospital General, Turkey, between 2014 and 2020. METHODOLOGY: The recurrence, persistence, and complication rates of 176 patients who underwent LIFT were compared with demographic and technical data by multivariate logistic regression analysis. Inclusion criteria were patients with anal fistula cryptoglandular origin. Exclusion criteria included patients with intersphincteric fistula, rectovaginal fistula, abscess, pilonidal sinus fistula, and inflammatory bowel disease. Recurrence was defined as the opening of a fistula that persisted after 3 months. RESULTS: The mean age was 38.6±9.0 years. The mean BMI was 31.9±5.7 Kg/m2. There were no statistically significant differences between the two groups concerning, age, the complexity of fistula tract(s), the surgical technique of suture versus ligation, operation time, and seton placement duration. Twenty-three patients had previous fistula surgery. Twenty-One patients had previously required seton drainage. Higher BMI, being male, having a prior fistula surgery, and having a height IFO >15 were independent risk factors for recurrence (OR =1.28, 5.69, 23.39, and 15.38 respectively). CONCLUSION: Higher BMI, male gender, having a prior fistula surgery, and having a height IFO >15 were independent risk factors for recurrence. KEY WORDS: LIFT, Anal fistula, Recurrence, Wexner incontinence score (WIS), Male, Prior fistula surgery, height 1FO.

Why do some patients with stage 1A and 1B endometrial endometrioid carcinoma experience recurrence? A retrospective study in search of prognostic factors.

OBJECTIVES: Endometrial endometrioid carcinoma (EEC) is the most encountered subtype of endometrial cancer (EC). Our study aimed to investigate the factors affecting recurrence in patients with stage 1A and 1B EEC. MATERIAL AND METHODS: Our study included 284 patients diagnosed with the International Federation of Gynecology and Obstetrics stage 1A/1B EEC in our center from 2010 to 2018. The clinicopathological characteristics of the patients were obtained retrospectively from their electronic files. RESULTS: The median age of the patients was 60 years (range 31-89). The median follow-up time of the patients was 63.6 months (range 3.3-185.6). Twenty-two (7.74%) patients relapsed during follow-up. Among the relapsed patients, 59.1% were at stage 1A ECC, and 40.9% were at stage 1B. In our study, the one-, three-, and five-year recurrence-free survival (RFS) rates were 98.9%, 95.4%, and 92.9%, respectively. In the multivariate analysis, grade and tumor size were found to be independent parameters of RFS in all stage 1 EEC patients. Furthermore, the Ki-67 index was found to affect RFS in stage 1A EEC patients, and tumor grade affected RFS in stage 1B EEC patients. In the time-dependent receiver operating characteristic curve analysis, the statistically significant cut-off values were determined for tumor size and Ki-67 index in stage 1 EEC patients. CONCLUSIONS: Stage 1-EEC patients in the higher risk group in terms of tumor size, Ki-67, and grade should be closely monitored for recurrence. Defining the prognostic factors for recurrence in stage 1 EEC patients may lead to changes in follow-up algorithms.

Prevention of uterine perforation during intracavitary brachytherapy of cervical cancer.

PURPOSE: Intracavitary brachytherapy (ICBT) is a part of standard treatment for loco-regionally advanced cervical cancers. ICBT requires a tandem applicator insertion through cervical canal into uterine cavity. Accurate placement through cervical canal, which is distorted by cancer, is crucial to successful treatment. The objective of this study was to investigate actual complication rate of a Smit sleeve insertion performed by experienced gynecologists in a tertiary referral center. MATERIAL AND METHODS: Clinical data of 328 patients with cervical cancer treated using ICBT, between January 2013 and August 2019, were retrospectively evaluated. Predisposing factors that could have increased the risk of uterine perforation were recorded. Pre-operative ultrasound was carried out for visualization of uterine curvature and selection of an appropriate Smith sleeve length. All applications were performed by a gynecologic oncology fellow or an expert gynecologist. RESULTS: 317 patients were suitable for analysis. Only one (0.3%) applicator placement resulted in uterine perforation. In two patients, Smit sleeve dislocated after first brachytherapy and reinserted. Adequate applicator placement was achieved, and treatment was completed as planned in 316 cases. CONCLUSIONS: A cervical sleeve technic, which reduced the need for multiple insertions and placement of this instrument by an expert gynecologist minimize the risk of complication relative to historical controls.

The impact of Ki-67 index, squamous differentiation, and several clinicopathologic parameters on the recurrence of low and intermediate-risk endometrial cancer.

Endometrial endometrioid carcinoma (EEC) represents approximately 75-80% of endometrial carcinoma cases. Three hundred and thirty-six patients with EEC followed-up in the authors' medical center between 2010 and 2018 were included in our study. Two hundred and seventy-two low and intermediate EEC patients were identified using the European Society for Medical Oncology criteria and confirmed by histopathological examination. Recurrence was reported in 17 of these patients. The study group consisted of patients with relapse. A control group of 51 patients was formed at a ratio of 3:1 according to age, stage, and grade, similar to that in the study group. Of the 17 patients with recurrent disease, 13 patients (76.5%) were Stage 1A, and 4 patients (23.5%) were Stage 1B. No significant difference was found in age, stage, and grade between the case and control groups (p > 0.05). Body mass index, parity, tumor size, lower uterine segment involvement, SqD, and Ki-67 index with p<0.25 in the univariate logistic regression analysis were included in the multivariate analysis. Ki-67 was statistically significant in multivariate analysis (p = 0.018); however, there was no statistical significance in SqD and other parameters. Our data suggest that the Ki-67 index rather than SqD needs to be assessed for recurrence in patients with low- and intermediate-risk EEC.

Association between antenatal maternal anxiety and fetal middle cerebral artery Doppler depends on fetal gender.

Objective: Several studies have demonstrated that antenatal maternal anxiety (AMA) during pregnancy is associated with an increased risk of abnormal fetal Doppler parameters and adverse perinatal outcomes. Despite these studies, the evidence of the association between them remains inconclusive due in part to the methodological limitations of existing studies. Hence, in the present study, we established strict criteria and excluded patients who may have moderate or confounding variables to investigate the relationship between AMA and fetal Doppler findings and adverse perinatal outcomes.Methods: This was a cross-sectional study of 160 healthy nulliparous pregnant women (gestational age 31-33 weeks) with uncomplicated obstetric histories, who underwent Doppler flow studies on uterine, umbilical and fetal middle cerebral artery (MCA). Maternal anxiety was measured by STAI-State and STAI-Trait inventory.Results: Statistical analyses revealed that STAI-Trait anxiety was associated with lower MCA pulsatility index at 31-33 weeks gestational age and lower birth weight for the female fetus. There were no significant differences in the birth weight of boys of mothers with high anxiety and without high anxiety.Conclusions: The adaptation of the fetus to this hostile environment as AMA differs by gender. Adaptation for the female fetus means the "brain sparing effect" and reduced birth weight. The findings emphasize the potential importance of maternal psychological wellbeing during pregnancy for fetal development.

A qualitative and quantitative assessment of simultaneous strain, shear wave, and point shear wave elastography to distinguish malignant and benign breast lesions.

BACKGROUND: Ultrasound (US) elastography has become a routine instrument in ultrasonographic diagnosis that measures the consistency and stiffness of tissues. PURPOSE: To distinguish benign and malignant breast masses using a single US system by comparing the diagnostic parameters of three kinds of breast elastography simultaneously added to B-mode ultrasonography. MATERIAL AND METHODS: A total of 163 breast lesions in 159 consecutive women who underwent US-guided core needle biopsy were included in this prospective study. Before the biopsy, the lesions were examined with B-mode ultrasonography and strain (SE), shear wave (SWE), and point shear wave (STQ) elastography. The strain ratio was computed and the Tsukuba score determined. The mean elasticity values using SWE and STQ were computed and converted to Young's modulus E (kPa). RESULTS: All SE, SWE, and STQ parameters showed similar diagnostic performance. The SE score, SE ratio, SWEmean, SWEmax, STQmean, and STQmax yielded higher specificity than B-mode US alone to differentiate benign and malignant masses. The sensitivity of B-mode US, SWE, and STQ was slightly higher than that of the SE score and SE ratio. The SE score, SE ratio, SWEmean, SWEmax, STQmean, and STQmax had significantly higher positive predictive value and diagnostic accuracy than B-mode US alone. The area under the curve for each of these elastography methods in differentiating benign and malignant breast lesions was 0.93, 0.93, 0.98, 0.97, 0.98, and 0.96, respectively; P<0.001 for all measurements. CONCLUSION: SE (ratio and score), SWE, and STQ had higher diagnostic performance individually than B-mode US alone in distinguishing between malignant and benign breast masses.

McDonald versus modified Shirodkar rescue cerclage in women with prolapsed fetal membranes.

Purpose: We compared the efficacy of modified Shirodkar and McDonald rescue cerclage techniques in women with singleton pregnancies.Methods: The study sample included 47 women who presented at two tertiary hospitals in Turkey from 2008 to 2017 and underwent rescue cerclage due to cervical incompetence and cervical dilatation with fetal membranes prolapsed into the vagina. The outcomes were compared by cerclage technique used, Shirodkar or McDonald.Results: The McDonald cerclage was applied in 27 cases, and modified Shirodkar cerclage in 20 cases. A longer cerclage-to-birth interval (83.8 ± 37.6 vs. 63.7 ± 38.9 days) and later gestational age at delivery (33 vs. 31 weeks) were observed with the Shirodkar cerclage, although these differences were not statistically significant (p = .08 and .63, respectively). Both groups had similar delivery rates after 28, 32, and 37 weeks (p = .20, .15, and .25, respectively), whereas the modified Shirodkar technique resulted in a higher rate of live births although these differences were not statistically significant (85% vs. 63%, p = .09).Conclusion: The effects of the McDonald and modified Shirodkar cerclage procedures on prolonging pregnancy and improving the live birth rate were similar. Therefore, either technique can be applied to prevent neonatal loss due to advanced prematurity.

Assessment of Factors Influencing Lymph Node Count in Colorectal Cancer.

OBJECTIVE: To evaluate the factors that influence pericolorectal lymph node (LN) retrieval from colectomy specimens in colorectal in cancer staging. STUDY DESIGN: Descriptive study Place and Duration of Study: Ortadogu Private Hospital Adana, Turkey, between January 2012 and March 2018. METHODOLOGY: The inclusion criteria was right hemi-colon, left hemi-colon and rectum carcinoma specimen, respectively. The exclusion criteria was total colectomies due to synchronous colorectal carcinomas and cancers developed on the basis of ulcerative colitis and familial polyposis coli. Age and gender of the patients, the length of the colectomy specimen, the location and size of the tumor-node-metastasis (TNM) stage, and the count of retrieved lymph nodes were evaluated. RESULTS: Among the 145 patients in this study, the mean count of recovered and metastatic lymph nodes was 32.5 and 2.9, respectively. Sufficient lymph node assessment was done in 130 of the 145 patients. The number of lymph node yields was independently associated with depth of invasion, T-classification, tumor size, AJCC/UICC stage as well as right-sided tumor location. The count of harvested lymph nodes significantly decreased in patients who received preoperative therapy. Increased node counts were associated with increased overall survival (OS). CONCLUSION: Tumor site and size, length of the surgical specimen, T-classification, depth of invasion and AJCC/UICC stage are predictors for the lymph node numbers in colorectal cancer surgery. Retrieval of removed nodes and counting helps in staging and number of removed nodes, and affects survival.

Prognostic Value of CDX2 and Villin Expression in Advanced Stage Colorectal Carcinoma.

OBJECTIVE: To determine the frequency of expression of CDX2 and Villin in a subsection of advanced stage primary colorectal cancers and detect its association with tumour differentiation, lymph node metastasis, invasion and survival. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Ortadogu Private Hospital, Adana, Turkey, from January 2012 to March 2017. METHODOLOGY: Formalin-fixed, paraffin-embedded tissue specimens were obtained from 70 patients who underwent surgery for colorectal carcinoma. Inclusion criteria were patients who underwent surgery with stage 3 and stage 4 colorectal cancer. The exclusion criteria were patients who had recurrent colorectal cancer and/or accompanying cancer in another region. Immunohistochemical technique was used for the localisation of CDX2 and Villin in colorectal cancer tissues. The catagorical variables between the groups was analysed by using the Chi-square test or Fisher Exc. test. Overall survival time was defined as the years elapsed between date of after operation and death as a result of disease (or the last follow-up date). Overall survival was analysed using the Wald test, and the log-rank test was used to examine their relationship when different parameters were applied. The survival curve was plotted using the standard Kaplan-Meier methodology. Values of p <0.05 were considered statistically significant. RESULTS: Both CDX2 and Villin had relation with gender (p=0.045, p=0.016), male and female expression of CDX2 was n=31 (67.4%), n=15 (32.6%), respectively and Villin was n=34 (68.0%), n=16 (32.0%), respectively; age (p=0.804, p=0.791), had no relation with tumor site (p=0.131, p=0.921) and histologic grade (p=0.209, p=0.579) and lymph node metastasis (p=0.063, p=0.392) and perineural invasion (p=0.476, p=0.053) and lymphovasculer invasion (p=0.080, p=0.791) and overall survival ( p=0.121, hep=0.059). CONCLUSION: CDX2 and Villin were not associated with any of the clinicopathologic parameters. Overall survival analysis also did not show a significant association with immunoexpression of these molecules and survival. CDX2 and Villin might not be useful as a prognostic factor in advanced stage colorectal carcinoma.

Omental Micrometastasis in Endometrial Cancer.

INTRODUCTION: Although there are several reports on omentum metastasis, limited studies have evaluated omental micrometastases, particularly isolated microscopic metastases in endometrial cancer (EC). We performed this study to assess the frequency of omental micrometastasis in EC, especially when the omentum is the only site of extrauterine spread. METHODS: A retrospective study was conducted to assess cases of EC with an omental sample during primary surgical treatment for EC at the Gynecological Oncology Unit, Uludag University Hospital, Bursa, Turkey, between January 2005 and May 2018. RESULTS: In total, 435 patients fulfilled the inclusion criteria, which comprised a complete surgical staging. The prevalence of omental metastases was 5.3% (n = 23), regardless of the subtype or clinical stage. Omental micrometastasis was detected in four cases (17.4%). In half of these patients, the omentum was the only site of disease outside the uterus, with an estimated 0.46% of isolated omental involvement. The grade of the endometrioid tumor was found to be statistically correlated with omental metastases (p = 0.01). There was a significant correlation between omental metastasis and positive peritoneal cytology, as well as adnexal involvement (p = 0.001 and p = 0.03, respectively). CONCLUSION: We recommend omentectomy routinely in serous EC. In addition, we suggest selective omentectomy in patients with EC who have concomitant adnexal involvement or grade 3 tumors.

Current approaches in the surgical treatment of liver hydatid disease: single center experience.

BACKGROUND: Liver hydatid disease is a common benign condition in many countries. Compared to open surgery, laparoscopic treatment can play an important role in improving the post-operative recovery, reducing the morbidity and recurrence rate of these patients.The purpose of this study is to show that the laparoscopic method is effective and safe in the treatment of liver hydatid cysts compared to open surgery, even in large cysts. METHODS: All consecutive cases surgically managed for liver hydatid cyst from 7 January 2008 and 15 January 2010 in our institution were included in this study.The surgical approach (laparoscopic or open) and operative strategy, as well as operative and prognostic outcomes, were analyzed. Cyst size, type, location, presence of biliary tract communication, radiological findings, duration of hospitalization, recurrence and postoperative morbidity were analysed and compared retrospectively. RESULTS: A total of 60 patients were included in the study.A total of 23 patients underwent open surgery, and 37 patients underwent laparoscopic surgery.Operation types of laparoscopic surgery were as follows: partial pericystectomy (12patients), total cystectomy(2 patients), partial pericystectomy+total cystectomy(7patients) and cystectomy(16patients).The surgical procedures chosen for open treatment of the residual cavity were partial pericystectomy and omentoplasty(17cases), total pericystectomy(3cases) and partial and total pericystectomy(3cases).Cysto-biliary communication was found in 9 patients. A total of 10 patients underwent preoperative endoscopic retrograde cholangiography, and one patient underwent postoperative endoscopic retrograde cholangiography.There was a progression of hypernatremia in 1 patient, wound infections in 3 patients, and perioperative hemorrhage in 3 patients. There were no statistically significant differences concerning age(p = 0.344), gender(p = 0.318), ASA classification(p = 0.963), Gharbi classification(p = 0.649) whereas there were significant differences related to cyst location(p = 0.040) and size(p = 0.022) in patients undergoing laparoscopic and open surgery. Postoperative temporary biliary fistulas were observed in 2 patients undergoing open surgery. Patients undergoing laparoscopic surgery had the advantages of shorter hospital stays and operation times, less blood loss, faster recovery, and lower wound infection rates. Recurrences were detected in 2.7% of patients undergoing laparoscopic surgery and 4.7% of those undergoing open procedures. CONCLUSION: Compared to open surgery in the treatment of liver hydatid cysts, we have shown that laparoscopic method can be safely performed even in large cysts and/or cysto-biliary communication.

Comparing Reinforcement Options for the Staple Line of Laparoscopic Sleeve Gastrectomy.

OBJECTIVE: To compare three reinforcement options (suture, fibrin glue, and no reinforcement) for staple line reinforcement of patients undergoing laparoscopic sleeve gastrectomy. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Ortadogu Hospital, Adana, Turkey, from 2013 to 2017. METHODOLOGY: The inclusion criteria were patients with BMI > 40 Kg/m² or >35 Kg/m² (if there were comorbid diseases associated with obesity). The exclusion criteria were patients who were older than 65 years or had a bariatric procedure earlier. The patients were placed in three groups. Group 1 had no staple line reinforcement, group 2 had fibrin glue on the staple line, and group 3 had barbed continued suture on the staple line. The primary endpoints included stenosis, bleeding, and postoperative leaks. The secondary outcomes included total operation time and time for staple line reinforcement. Values of p<0.05 were deemed significant for all statistical tests. RESULTS: The mean time to perform the staple line reinforcement was significantly higher in group 3 (22.05 ± 2.83 minutes) than in group 2 (fibrin glue, 10.86 ± 2.15 minutes, p<0.001). The mean total operation times were significantly different between all three groups; 70.8 ± 5.4 minutes for group 1, 74.7 ± 6.2 minutes for group 2, and 81.2 ± 3.0 minutes for group 3 (p<0.001). The groups had no statistical differences regarding complications. CONCLUSION: The use of fibrin glue and barbed continuous suture for staple line reinforcement during laparoscopic sleeve gastrectomy had no effect on post- or per-operative hemorrhage and leakage; however, these procedures significantly extended the operation time.

Evaluation of 1294 Female Patients with Breast Pain: A Retrospective Study.

INTRODUCTION: Mastalgia, or breast pain, is one of the most important complaints referred to outpatient clinics. The objective of this study was to evaluate the factors causing mastalgia. All patients who presented to our clinic with complaints of mastalgia were assessed along with their type of mastalgia symptoms, menopausal status, and radiology results. METHODS: A total of 3157 patients with mastalgia complaints visited our clinic between January 2015 and February 2018. Only 1294 of them were retrospectively screened. Age, sex, menopausal (premenopausal, postmenopausal) status, mastalgia type (cyclic, non-cyclic), and imaging findings of the patients were examined. RESULTS: The mean age was 43.8 ± 11.8 (13-86) years, with 453 (35%) patients younger than 40 years and 841 (65%) older than 40. Cyclic mastalgia was found in 207 (16%) patients, and non-cyclic mastalgia was seen in 1087 (84%) patients. A total of 786 (60.7%) patients were premenopausal, and 508 (39.3%) were postmenopausal. Mammography was used in 545 (42.1%) patients; 1190 (92.0%) women had breast ultrasonography. CONCLUSION: Although breast pain is a common symptom in women who are referred to breast outpatient clinics, we concluded that patients who complain of mastalgia should not be afraid of cancer. Despite this and for reassurance, clinical imaging may be necessary to alleviate these patients' suspicions.

Comparing laparoscopic cholecystectomy in patients with chronic obstructive pulmonary disease under spinal anesthesia and general anesthesia.

BACKGROUND: Epidemiological data demonstrate that the worldwide prevalence of chronic obstructive pulmonary disease is increasing. These patients have an increased risk of mortality and morbidity and have constant limitations in airflow. Comparing laparoscopic cholecystectomy (LC) in patients with chronic obstructive pulmonary disease (COPD) under spinal anesthesia (SA) and general anesthesia (GA). METHODS: We prospectively evaluated COPD patients who underwent laparoscopic cholecystectomy under general anesthesia (Group 1, n = 30) or spinal anesthesia (Group 2, n = 30) in our clinic between January 2016 and January 2018. Patients with COPD were further divided into groups according to their preoperative stages (Stage 1-4). Intraoperative vital findings, postoperative pain, complications, and length of hospitalization were compared between the general (GA) and spinal anesthesia (SA) groups. RESULTS: The mean age of the patients in the GA group was 61.0 ± 6.7 years and was 61.0 ± 7.7 years in the SA group. In the GA and SA groups, the mean ASA score was 2.8 ± 0.6 and 2.9 ± 0.6, respectively, the mean operation duration was 31.7 ± 5.1 and 30.6 ± 5.1 min, respectively, and the length of hospitalization was 3.2 ± 1.7 and 1.5 ± 0.5 days, respectively. The partial carbon dioxide rates (PaCO2) at the postoperative 5th and 20th minutes were lower in the SA group than in the GA group. Further, the requirement for postoperative analgesia was lower in the SA group, and the length of hospitalization was significantly shorter in the SA group. There was no significant difference between the two groups in terms of operation duration. CONCLUSION: Laparoscopic cholecystectomy is a rather safe procedure for COPD patients under general and spinal anesthesia. However, spinal anesthesia is preferred over general anesthesia as it has better postoperative analgesia and causes no impairment of pulmonary functions.

Permacol™ Collagen Paste Injection in Anal Fistula Treatment: A Retrospective Study with One-Year Follow-Up.

INTRODUCTION: This study aimed to evaluate the applicability, safety, results, and functional performance of Permacol™ collagen paste injection in patients with an anal fistula. METHODS: Thirty-one patients with anal fistula underwent Permacol™ collagen paste injection between February 2015 and February 2017. The patients were followed up for a total of 12 months with recovery conditions monitored at intervals of 3, 6, and 12 months. Preoperative insertion of seton was performed in 15 patients for a period of 6-8 weeks and 2 patients for a period of 12 weeks. RESULTS: A trans-sphincteric anal fistula was present in 20 patients and an intersphincteric fistula was present in 11 patients. There was a recurrence in 7 patients (22.5%): 1 patient (3.2%) after 1-month follow-up, 3 patients (9.7%) after 3-month follow-up, 2 patients (6.5%) after 6-month follow-up, and 1 patient (3.2%) after 12-month follow-up. A complete recovery was observed in 24 (77.5%) patients after a 12-month follow-up. The mean Fecal Incontinence Severity Index score was 0.29 ± 0.64 preoperatively and 0.55 ± 1.03 after 12 months. CONCLUSION: In this study, we show that treatment of patients with an anal fistula by injection of Permacol™ is a safe and successful method that does not compromise continence.

Rescue cerclage when foetal membranes prolapse into the vagina.

A cross-sectional study was conducted to evaluate the efficacy of rescue cerclage in patients with a dilated cervix and prolapsed foetal membranes. Thirty-five patients presenting with cervical dilatation and prolapsed foetal membranes were included in the study. A McDonald cerclage was placed in 27 patients. The duration of pregnancy prolongation and the number of deliveries after 28 weeks were evaluated. The median prolongation of pregnancy after cerclage placement differed significantly between the cerclage and bed-rest groups (64 days versus 13.5 days). Of the 27 patients who had cerclage, 17 (63%) delivered after 28 weeks of gestation, whereas all patients in the bed-rest group delivered before 28 weeks of gestation. The take-home baby rate was 63% in the cerclage group. When pregnancies were complicated by cervical dilatation with membrane prolapse into the vagina, placement of a McDonald cerclage in appropriately selected patients can be a beneficial therapeutic option. Impact statement Although the effectiveness and safety of rescue cerclage is controversial, our study provides strong support for the notion that cervical cerclage accompanied by long-term broad-spectrum antibiotics improves the perinatal outcomes in singleton gestations with membrane prolapsed into the vagina. Further prospective randomised trial is required to prove these findings.

Effect of intravenous hyoscine-N-butyl bromide on active phase of labor progress: a randomized double blind placebo controlled trial.

INTRODUCTION: Appropriate cervical dilatation and effacement are essential for the progression of labor. With the active management of labor, number of cesarean deliveries reduces and the duration of labor shortens. Cervical dilatation can be facilitated by mechanical, pharmacological and non-pharmacologic methods. Cervix is richly supplied by autonomic nerves, which may play a role in the dilatation of cervix. Hyoscine-N-butylbromide (HBB) is a muscarinic antagonist and acts as a cervical spasmolytic agent. After intravenous administration it is rapidly distributed into the tissues. We aimed to study the effects and safety of a single dose 20 mg HBB injection during the active phase of labor in both primi- and multigravid women. MATERIALS AND METHOD: A randomized, double-blinded, controlled trial, with healthy primigravid and multigravid women in spontaneous labor at term was considered in this study. Once the active phase of labor was achieved, either a single dose of 20 mg (1 mL) of HBB or placebo (1 mL saline) was given intravenously. RESULTS: The mean duration of the first stage of labor was 191.1 ± 43.06 min in the primigravid patients of the HBB group, while it was 248.2 ± 66.1 min in the placebo group, a statistically significant difference of 57 min (p < 0.001). The mean duration of the first stage of labor was 170.1 ± 50.8 min in the multigravid patients of the HBB group, while it was 224.06 ± 53.7 min in the placebo group (difference of 54 min, p < 0.001). The mean duration of the first stage of labor was significantly different both for multigravida and primigravid patients. There was no significant change in the times for the second and third stages of labor. There were no significant differences in terms of APGAR scores noted at 1 and 5 min, prepartum and postpartum hemoglobin levels and birth weight. No adverse maternal and fetal effects were observed in both HBB and placebo groups. CONCLUSION: A single dose of 20 mg intravenous HBB is effective and safe in shortening the duration of the first stage of labor without any adverse effects on fetus and mother.