Combined procedure of cesarean delivery and preperitoneal mesh repair for inguinal hernia: An initial experience.

BACKGROUND: Combined surgery for cesarean delivery and preperitoneal mesh repair for inguinal hernia has not been previously reported. OBJECTIVES: Our aim was to describe the method and to present the results of this simultaneous surgery through a single incision. METHODS: From 2012 to 2014, 15 patients underwent cesarean delivery combined with preperitoneal mesh repair for inguinal hernia. All patient characteristics and perioperative findings were recorded. RESULTS: Among 15 patients, 13 had unilateral inguinal hernias and two had bilateral hernias. The mean times spent for unilateral and bilateral hernias were 35.8 minutes (range, 30-45 minutes) and 67.5 minutes (range, 65-70 minutes), respectively. Direct and indirect hernias were present in one and 15 patients, respectively. One patient had mixed hernia. No significant complication was observed perioperatively. Hospital stay ranged from 1 day to 3 days (mean, 1.87 days), and all patients were discharged without any problem. No recurrence was found during the follow-up periods. CONCLUSION: Single anesthesia, single incisional scar, and single hospitalization are the major advantages of this simultaneous approach of cesarean delivery and preperitoneal mesh repair for inguinal hernia. Our analysis suggests that this combined procedure can be performed safely in selected cases.

Do the first, second and third trimester maternal serum hepcidin concentrations clarify obstetric complications?

OBJECTIVE: To evaluate whether first, second, and third-trimester maternal serum hepcidin levels are different in pregnancies with and without adverse pregnancy outcomes (APO). METHODS: A 165 nullipar pregnant women were included in this prospective cohort study. Serum hepcidin, ferritin, IL-6, C-reactive protein (CRP) and Hb values were measured at 11-14, 24-28, and 30-34 weeks of gestation. The relation between these parameters and APO and neonatal outcomes were investigated. Preterm delivery, intrauterine growth restriction, pre-eclampsia, gestational hypertension and placental abruption were determined as adverse pregnancy outcomes. RESULTS: The risk of APO was three times higher in women with high IL-6 levels in the second trimester. High hepcidin levels in the second trimester were associated with a 1.6 times increased risk of APO. Newborns of women with high IL-6 levels in the third trimester had a 1.6-fold increased risk of neonatal complications. High ferritin levels in the third trimester were associated with minimally increased risk of neonatal complications. CONCLUSIONS: Mean serum hepcidin levels were similar in all pregnant women, however, elevated second trimester serum hepcidin and IL-6 levels were associated with a higher risk of APO and high third trimester hepcidin, ferritin and IL-6 levels were associated with higher risk of neonatal complications.

The platelet activating factor acetyl hydrolase, oxidized low-density lipoprotein, paraoxonase 1 and arylesterase levels in treated and untreated patients with polycystic ovary syndrome.

PURPOSE: To evaluate the platelet activating factor acetyl hydrolyze (PAF-AH), oxidized low-density lipoprotein (ox-LDL), paraoxonase 1 (PON1), arylesterase (ARE) levels and the effects of metformin and Diane-35 (ethinyl oestradiol + cyproterone acetate) therapies on these parameters and to determine the PON1 polymorphisms among PCOS patients. METHODS: Ninety patients with PCOS, age 30, and body mass index-matched healthy controls were included in the study. Patients were divided into three groups: metformin treatment, Diane-35 treatment and no medication groups. The treatment with metformin or Diane-35 was continued for 6 months and all subjects were evaluated with clinical and biochemical parameters 6 months later. One-way Anova test, t test and non-parametric Mann-Whitney U tests were used for statistical analysis. RESULTS: PAF-AH and ox-LDL levels were statistically significantly higher in untreated PCOS patients than controls, and they were statistically significantly lower in patients treated with metformin or Diane-35 than untreated PCOS patients. In contrast, there were lower PON1 (not statistically significant) and ARE (statistically significant) levels in untreated PCOS patients than the control group and they significantly increased after metformin and Diane-35 treatments. In PCOS patients serum PON1 levels for QQ, QR and RR phenotypes were statistically significantly lower than the control group. CONCLUSION: In patients with PCOS, proatherogenic markers increase. The treatment of PCOS with metformin or Diane-35 had positive effects on lipid profile, increased PON1 level, which is a protector from atherosclerosis and decreased the proatherogenic PAF-AH and ox-LDL levels.

Effect of ethinyl estradiol-cyproterone acetate treatment on asymmetric dimethyl-arginine levels in women with polycystic ovary syndrome.

PURPOSE: Our study was undertaken to evaluate the levels of asymmetric dimethyl-arginine (ADMA) in a group of patients affected with polycystic ovary syndrome (PCOS)--under ethinyl estradiol-cyproterone acetate treatment or not--as compared with a group of healthy controls. METHODS: Fifty-eight women with PCOS and 45 patients as control group were included in the study. The 58 women with PCOS were separated into two groups: Group A (n = 29) were treated with an oral contraceptive pill containing 0.035 mg of ethinyl estradiol (EE) and 2 mg of cyproterone acetate (CA) (Diane-35) for 6 months. Group B (n = 29) did not take any drug. Group C (n = 45) was healthy women as control group. Serum levels of ADMA, lipid and glucose metabolism parameters, hormone profile were measured on the sixth month of treatment. RESULTS: ADMA levels were similar in women with PCOS and controls, whereas ADMA levels significantly decreased after a period of 6 months treatment with EE + CA in women with PCOS. ADMA levels and insulin resistance were decreased with treatment. However, patients with PCOS had significantly higher total cholesterol and Low-density lipoprotein cholesterol (LDL-C) compared to controls, treatment with EE + CA did not provide any improvement on lipid parameters. CONCLUSION: Serum ADMA levels and insulin resistance were lower in PCOS group treated with EE + CA than control group.

Serum levels of visfatin and possible interaction with iron parameters in gestational diabetes mellitus.

BACKGROUND/AIMS: Visfatin is a novel adipokine with insulinomimetic properties that increases in diabetes. However, for gestational diabetes mellitus (GDM) there are conflicting reports. Recent studies have reported a positive association of serum ferritin concentrations with insulin resistance. Thus, we assessed serum levels of visfatin in pregnant women with varying degrees of glucose tolerance and investigated the possible interaction of visfatin with parameters of iron metabolism. METHODS: Visfatin levels were measured at 24-28 weeks of gestation in 88 women who were divided into three groups according to their response to a 50-gram glucose challenge test and a 100-gram oral glucose tolerance test: control group (n = 28), impaired glucose tolerance (IGT) group (n = 30) and GDM group (n = 30). RESULTS: Visfatin levels were significantly higher in the GDM and IGT group than in control (p < 0.001 for GDM vs. control, and p = 0.004 for IGT vs. control). Serum visfatin was significantly associated with serum ferritin, insulin, age, gravidity, and body mass index. In a linear regression model, the covariates explained only 17% of variability of serum visfatin concentration. Body mass index (p < 0.001) contributed independently to visfatin variance. CONCLUSION: Serum visfatin concentration is significantly higher in GDM and is correlated with ferritin levels.

Levels of thrombin activatable fibrinolysis inhibitor in gestational diabetes mellitus.

Thrombin-activatable fibrinolysis inhibitor (TAFI) is a procarboxypeptidase, which is synthesised in liver and activated by thrombin and the thrombin-thrombomodulin complex. TAFI suppresses fibrinolysis by removing carboxy-terminal lysine residues from partially degraded fibrin. In this study we aimed to assess the circulating levels of TAFI antigen, 'a fibrinolytic parameter' in women with gestational diabetes (GDM). Thirty-four pregnant women with GDM and 50 pregnant women with normal glucose tolerance were included in the study. Plasma TAFI antigen levels were significantly higher in pregnant women with GDM when compared with controls. Increased TAFI levels may contribute to the decreased fibrinolytic potency, causing a thrombophilic state. GDM is regarded as a specific form of diabetes, and it could in addition be a predictor of type 2 diabetes mellitus in the future and the risk of complications due to hypercoagulability increases in this disease. Increased TAFI levels may also have a role in increased risk of hypercoagulability.

Serum hepcidin is associated with parameters of glucose metabolism in women with gestational diabetes mellitus.

OBJECTIVES: Hepcidin is considered a major regulator of iron metabolism. Despite previous studies showing elevated ferritin and hepcidin levels in type 2 diabetes mellitus (DM), no study has investigated hepcidin levels in pregnant women with gestational DM (GDM). METHODS: A case-control study was conducted in 30 cases of GDM, 47 pregnant women with impaired glucose tolerance (IGT) and 72 pregnant women with normal glucose tolerance (control) between April 2009 and July 2011. Serum hepcidin and other iron metabolism parameters were analyzed in all groups. RESULTS: Serum ferritin and serum iron were significantly elevated in the GDM group compared to controls (p = 0.014, p = 0.018, respectively) and to the IGT group (p = 0.021, p = 0.008, respectively). Hepcidin levels were elevated significantly in the diabetic patients compared to the IGT group (p = 0.011) and controls (p = 0.002). We found no correlation between hepcidin and other iron metabolism parameters (Hb, serum iron and ferritin), whereas positive correlations were found between hepcidin and parameters of glucose metabolism (fasting blood glucose, fasting insulin level and glucose value response to glucose challenge test). CONCLUSIONS: Serum hepcidin concentrations were increased in pregnant women with IGT and GDM and this was not related to inflammation parameters.

Laparoscopic single-port Burch colposuspension with an extraperitoneal approach and standard instruments for stress urinary incontinence: early results from a series of 15 patients.

OBJECTIVE: We aimed to investigate the use of single-port laparoscopy in a series of patients undergoing Burch colposuspension with an extraperitoneal approach as an alternative treatment for scarless surgery in stress urinary incontinence. MATERIAL AND METHODS: From September 2010 to May 2011 we performed single-port extraperitoneal laparoscopic Burch colposuspension for stress incontinence in 15 patients. Fifteen women who were diagnosed with urodynamic stress incontinence were included in the study. Demographic and clinical data, intraoperative findings, and postoperative course were recorded. RESULTS: The mean age was 45,80 ± 9,91 years (range: 38-70 years). The mean body mass index was 25,67 ± 4.06 kg/m2 (range: 22.23-35.38 kg/m(2)). The mean operation time and mean blood loss were 40.80 ± 5.94 minutes (range: 30-50 minutes) and 30.67 ± 11.00 cc (range: 10-50 cc), respectively. The single-port laparoscopic operations were technically completed successfully without placement of additional trocars and there were no complications. The cure and improvement rates following laparoscopic Burch colposuspension via single port were 73.3 % and 20 % respectively. CONCLUSION: Single-port laparoscopic Burch can be an alternative treatment for scarless surgery in stress incontinence. Single-incision laparoscopic Burch colposuspension can offer suitable, effective and safe treatment in women with stress incontinence.

Does hormone replacement therapy have beneficial effects on renal functions in menopausal women?

BACKGROUND: The study was carried out to evaluate the possible effects of hormone replacement therapy (HRT) on renal functions in postmenopausal women. METHODS: A total of 85 postmenopausal women without a history of medical illness were enrolled in the study. They were divided into HRT users and control groups. After 30 weeks of HRT use, the changes in serum urea, creatinine, uric acid, urinary protein, urinary creatinine, urinary protein/creatinine ratio and glomerular filtration rate (GFR) (mL/min/1.73 m(2)) were evaluated. RESULTS: HRT was associated with statistically significant increases in glomerular filtration rate (p < 0.01), while serum urea, creatinine, uric acid, urinary protein, urinary creatinine and urinary protein/creatinine ratio did not change significantly in both groups. CONCLUSION: In our study, we suggested that usage of hormone replacement therapy appeared to affect renal functions in postmenopausal women. There were beneficial effects of HRT on GFR in our postmenopausal patients. HRT may have possible protective mechanisms for kidney against adverse effects of aging.

Laparoscopic type 7 total hysterectomy and adnexectomy with or without Burch colposuspension: operative technique with the LigaSure device and results.

INTRODUCTION: The purpose of the present study was to investigate the use of an operative technique incorporating the LigaSure vessel sealing system in patients undergoing type 7 total laparoscopic hysterectomy (TLH) and adnexectomy with or without Burch colposuspension. METHODS: Data were collected for 68 patients who underwent type 7 TLH with adnexectomy. Analyzed variables included patient characteristics (age, body mass index (BMI), parity, medical and surgical history, indications for hysterectomy, weight of the removed uterus), operative data (operative time, procedures performed in addition to TLH, intraoperative blood loss), complications, difference between preoperative and postoperative hemoglobin levels, and length of hospital stay. RESULTS: Mean age was 53.7 ± 6.9 years (range 46-74) and mean body mass index was 27.9 ± 6.1 kg/m(2) (range 19.4-45.7). Overall mean operative time was 100.4 ± 31.7 min (range 60-180), mean intraoperative blood loss was 98.1 ± 96.9 ml (range 0-700), and the mean difference between preoperative and postoperative hemoglobin levels was 1.39 ± 0.6 g/dl (range 0-3.4). Mean weight of the removed uteruses was 229.4 ± 174.8 g (range 60-750). Mean hospital stay was 1.12 ± 0.7 days (range 1-7). Additional operative procedures included Burch colposuspension (15; 22.1%), adhesiolysis (9; 13.2%), cholecystectomy (2; 2.9%), transabdominal preperitoneal hernia repair (1; 1.5%) and repair of intraoperative bladder injury (1; 1.5%). Major intraoperative complications were encountered in two patients. In one, the left ureter was injured and in the other the bladder was injured. Conversion to open surgery was not needed in any of the patients. CONCLUSION: The procedure we describe here for type 7 TLH with adnexectomy, performed alone or with additional Burch colposuspension, appears to be safe and effective.

Effect of the Macroplastique Implantation System for stress urinary incontinence in women with or without a history of an anti-incontinence operation.

INTRODUCTION AND HYPOTHESIS: We evaluated the outcomes and the effect of the Macroplastique Implantation System on the quality of life in women with stress incontinence with or without a history of an anti-incontinence operation during 12 to 62 months follow-up. METHODS: Thirty-five women with urodynamically proven stress incontinence with intrinsic sphincter deficiency were included in this study. Macroplastique injection was performed in all patients. Quality of life was evaluated prior to therapy, in early postoperative time (at the sixth weeks) and in late postoperative time (12 to 62 months follow-up) with the use of three different questionnaires: Incontinence Quality-of-Life Questionnaire (I-QOL), Incontinence Impact Questionnaire-7 (IIQ-7), and Urogenital Distress Inventory-6 (UDI-6). Questionnaires were also compared with those previous to the anti-incontinence operation and to the primary procedure groups. RESULTS: The median age of the women was 50.00 (interquartile range = 17.00) years. There were 24 primary procedures and 11 had undergone previous anti-incontinence surgery. Maximum follow-up time was 62 months, minimum follow-up time was 12 months, and the median follow-up time of the study was 58 (interquartile range = 44-60) months. When preoperative and postoperative median of the I-QOL, IIQ-7, and UDI-6 scores were compared, the differences between scores were found to be statistically significant. I-QOL, IIQ-7, and UDI-6 scores were related to the previous surgery. The overall I-QOL, IIQ-7, and UDI-6 summary scores showed high internal consistency. CONCLUSIONS: The Macroplastique injection system is an effective, safe, and acceptable option for stress urinary incontinence in women with or without a history of an anti-incontinence operation. Moreover, it can be performed under local anesthesia without cystoscopic guidance; moreover, side effects are rare.

Laparoscopic supracervical hysterectomy, bilateral salpingo-oophorectomy, sacrocolpopexy and Burch colposuspension performed during the same operative session via a single port.

Laparoscopic methods that combine multiple surgical procedures are becoming more widely used, but few combined procedures performed through a single incision have been reported. A major difficulty with the single-incision approach is that all the instruments are necessarily oriented along the same axis. Here, we describe a patient in whom supracervical hysterectomy, bilateral salpingo-oophorectomy, sacrocolpopexy and Burch colposuspension were performed during the same operative session via a single umbilical port.

Nifedipine for the treatment of preterm labor in twin and singleton pregnancies.

PURPOSE: To investigate the outcomes of singleton and twin pregnancies that were complicated by spontaneous preterm labor and received nifedipine tocolysis. METHODS: We identified the following subjects from a computerized, hospital database: 58 singleton and 32 twin pregnancies that were between 24 and 34 weeks of gestation, admitted for spontaneous preterm labor without rupture of the membranes, and receiving tocolysis with nifedipine. Data were analyzed using the Chi-square test, the Mann-Whitney test, and the Kaplan-Meier survival analysis. RESULTS: Spontaneous, preterm delivery occurred in 31.1% cases of singleton and 81.3% of twin pregnancies. Although the 22% of the mothers of twins did not have cervical changes upon admission, 37% of twins were delivered within 48 h. Mean for delivery weeks from admission to 36 weeks was significantly less for twin than it was for singleton gestations (32.3 ± 1.0 vs. 35.0 ± 0.5 weeks, respectively; Mantel-Cox X (2) = 41.118; p < 0.001). The maternal side effects were not significantly different between the groups. No serious cardiovascular complication had been found in either group. CONCLUSIONS: Tocolysis with nifedipine is effective and safe for use in both singleton and twin gestations.

Serum platelet-activating factor acetylhydrolase activity: relationship with metabolic syndrome in women with history of gestational diabetes mellitus.

OBJECTIVE: The aim of this study was to evaluate plasma platelet-activating factor acetylhydrolase (PAF-AH) activity in euglycaemic women with history of gestational diabetes (GDM), and to explore whether this activity is associated with metabolic syndrome (MS) in this group of women. METHODS: The cross-sectional study included 36 women with history of GDM and 40 women with history of normal glucose tolerance in pregnancy (control group). RESULTS: Compared to the controls, the GDM group had significantly higher mean values for serum glucose, insulin, HOMA-IR, triglyceride, GGT and plasma PAF-AH activity, and a statistically higher prevalence of MS. Within the GDM group, women diagnosed with MS had significantly higher PAF-AH activity than those without MS (p=0.002). CONCLUSION: This is the first study to have shown that plasma PAF-AH activity and GGT levels may be significant for evaluating atherosclerosis risk and metabolic hepatic damage in women with history of GDM.

Does glomerular hyperfiltration in pregnancy damage the kidney in women with more parities?

OBJECTIVES: We aimed to investigate the glomerular hyperfiltration due to pregnancy in women with more parities. METHODS: Five hundred women aged 52.57 +/- 8.08 years, without a history of hypertension, diabetes mellitus or complicated pregnancy were involved in the study. They were divided into three groups. Group 1: women with no or one parity (n = 76); group 2: women with two or three parities (n = 333); group 3: women with four or more parities (n = 91). Laboratory parameters and demographical data were compared between the three groups. RESULTS: Mean age, serum urea and serum creatinine were similar between three groups. Patients in group 3 had significantly higher GFR values compared to groups 1 and 2 (109.44 +/- 30.99, 110.76 +/- 30.22 and 121.92 +/- 34.73 mL/min/1.73 m(2) for groups 1, 2 and 3, respectively; P = 0.008 for group 1 vs group 3; P = 0.002 for group 2 vs group 3). CONCLUSIONS: In our study, we suggest that glomerular hyperfiltration due to pregnancy does not have adverse effects on kidney in women with more parities. Pregnancy may have possible protective mechanisms for kidney against adverse effects of glomerular hyperfiltration.

Polycystic ovary syndrome and fibrocystic breast disease: is there any association?

OBJECTIVE: We aimed to investigate the association between a polycystic ovary syndrome (PCOS) and fibrocystic breast disease. METHODS: A total of 93 women, aged between 17 and 36 years, not using oral contraceptives, were entered in this case-control study. Laboratory, clinical and ultrasound findings were used to diagnose PCOS. The study group was consisted of 53 PCOS women and the control group consisted of 40 women. Breast ultrasonography was performed for all patients. Fibrocystic breast disease is described as common benign changes involving the tissues of the breast. RESULTS: Twenty-one (39.6%) of 53 women with a PCOS had fibrocystic breast disease. Five (8%) of 40 controls had fibrocystic breast disease. The difference between the groups was statistically significant (p = 0.004). Relative risk (95% CIs) was 3.17 (1.31-7.68). Overall sonographic benign breast pathologies were significantly higher in the PCOS group (p = 0.036). CONCLUSION: This study showed a statistically significant association between a PCOS and fibrocystic breast disease. Women with a PCOS should be evaluated for fibrocystic breast disease.

Familial mediterranean fever: a diagnostic challenge in pregnancy.

Familial Mediterranean Fever (FMF) is an autosomal recessive disease which is characterized by recurrent, self-limiting, short attacks of serositis while abdominal pain is the most common symptom. The underlying clinical and pathological picture is that of acute peritonitis. These abdominal signs are often so striking that they mimic an acute abdominal calamity suggesting several possible gastrointestinal, gynecologic or urologic diagnoses. Diagnosis of acute abdomen in pregnancy also remains one of the most challenging conditions as the physiological consequence of pregnancy and nonspecific laboratory parameters. A limited number of studies addressed FMF in pregnancy and none of them mentioned the diagnostic challenging of FMF during pregnancy because the patients had al been diagnosed previously. In this paper, we discussed a 20 year old, gravida 1, parity 0 patient whose twin pregnancy wash complicated by an acute abdominal condition after amniocentesis and the difficulties of making the diagnosis of FMF with the complications during this diagnostic period in pregnancy.

Increased thrombin-activatable fibrinolysis inhibitor antigen levels as a clue for prothrombotic state in polycystic ovary syndrome.

OBJECTIVES: Our study was undertaken to evaluate the levels of thrombin-activatable fibrinolysis inhibitor (TAFI) antigen and also its relationship with other hemostasis markers in a group of patients affected with polycystic ovary syndrome (PCOS)-under Diane-35 (ethinyl estradiol 0.035 mg/cyproterone acetate 2 mg) treatment or not-as compared with a group of healthy controls. METHODS: Forty-two women with PCOS and 30 age-matched healthy controls were involved in the study. Group A were on Diane-35 for at least 6 months; group B did not take any drug; group C served as a control group. RESULTS: TAFI antigen levels of groups A and B were significantly higher than in controls, but no difference was observed between them. All of the other coagulation and fibrinolysis parameters (including prothrombin time, activated partial thromboplastin time, fibrinogen and D-dimer) were comparable between the three groups. CONCLUSION: The evidence presented herein suggests that women with PCOS have impaired fibrinolysis, as reflected by increased TAFI. This impairment can contribute to the risk of cardiovascular disease in PCOS. Elucidation of the modifiable mechanisms in PCOS can represent an opportunity for preventive therapy of the cardiovascular risks associated with PCOS.