A retrospective study of pregnant patients with acute pancreatitis.

OBJECTIVE: Acute pancreatitis is a rare disease in pregnant patients. Although it may have serious maternal and fetal consequences, morbidity and mortality rates have decreased recently due to appropriate and rapid treatment with earlier diagnosis. The aim of this study was to evaluate pregnant patients diagnosed with acute pancreatitis. METHODS: The study included pregnant patients diagnosed with acute pancreatitis who were admitted to Adana City Training and Research Hospital in Adana, Turkey, between January 2014 and January 2022. Patients' files were screened. Patients' demographics, acute pancreatitis etiology, severity, complications, and applied treatment, as well as maternal and fetal outcomes were evaluated. RESULTS: The study included 65 pregnant patients with acute pancreatitis. The mean age was 26.6±5 (19-41) years. Acute pancreatitis was observed in the third trimester. The most common cause of acute pancreatitis was gallstones, and its severity was often mild. Only two patients required endoscopic retrograde cholangiopancreatography, and the remaining patients were treated medically. Maternal and infant death developed in a patient with necrotizing acute pancreatitis secondary to hyperlipidemia. CONCLUSION: The most common etiology of acute pancreatitis in pregnancy was gallstones. Acute pancreatitis occurred in the third trimester. Most of the patients had mild acute pancreatitis. Maternal and fetal complications were rare. We think that the reasons for the low mortality rate were mild disease severity and biliary etiology, and most patients were in the third trimester, as well as early diagnosis and no delay in the intervention.

Is advanced bipolar v anced bipolar vessel sealing de essel sealing device really eff eally effective in decreasing the pelvic lymphocele ratio in open surgery for endometrial cancer?

BACKGROUND: We aim to show pelvic lymphocele (PL) rates in patients who were operated for endometrial cancer (EC) and underwent systematic paraaortic bilateral pelvic lymph node dissection (PABPLND) with advanced bipolar vessel sealing device (ABVSD). METHODS: The medical files of all patients who underwent open surgery for EC between January 2017 and December 2021 were retrospectively analyzed. One hundred three patients who operated with the diagnosis of high-intermediate and high-risk endometrial cancer were included. Systematic PABPLND was performed with total abdominal hysterectomy with or without bilateral salpingo-oophorectomy during surgery to all patients. All operations were performed by same three surgeons who were expert in their field. While the lymph packages were removed during surgical dissection, the distal afferent and proximal efferent lymphatic channels were sealed with LigaSure™ blunt tip sealer/divider (Medtronic, Covidien, USA). The patients were scanned with computed tomography (CT) between 8 and 12 weeks postoperatively. Lymphocele diagnosis was confirmed by radiologists and largest diameter was recorded. Clinical-pathological findings of all patients were recorded. RESULTS: Mean age and body mass index (BMI) of all participants were 58.6 ±10.2 years and 28.1± 5.6 kg/m2 . The most histopathological findings were endometrioid type (84.5%) and grade 2 (44.2%) ECs. The pelvic lymphocele (PL) was detected with CT in 24 of 103 patients at 8 to 12 weeks postoperatively. Only two PL patients were symptomatic. The first patient had symptoms of pelvic fullness and compression while the second patient had infected image. PL was located to right pelvic area in first case while the second was located on the vaginal cuff. DISCUSSION: The dissection and sealing of major lymph vessels were achieved during the removal of all lymph packages with LigaSure™ blunt tip laparoscopic sealer/divider. The use of advanced bipolar systems can reduce the formation of PL in lymph node dissection in endometrial cancer.

The role of fetal fibronectin and plasminogen activator inhibitor 1 biomarkers in antenatal prediction of placenta accreta spectrum.

In this study, we aimed to assess the determining role of foetal fibronectin (FFN) and plasminogen activator inhibitor type (PAI-1) levels in the antenatal prediction of placenta accreta spectrum in cases with risk factors for placenta accreta spectrum. Singleton live pregnancies with placenta previa or low-lying placenta within 32-34 weeks of gestation were included in the study. The cases were divided into two groups after delivery as those with PAS and those with normal placentation. 54 cases diagnosed with placenta previa or low-lying placenta were included in the study. 17 of the cases underwent peripartum hysterectomy due to placenta accreta spectrum. 37 cases with normal placentation underwent caesarean delivery. Foetal fibronectin (p:.03) and PAI-1 (p:.02) levels were determined to be significantly different between cases with placenta accreta spectrum and cases with normal placentation. AUC for foetal FFN was calculated to be 0.69, while the AUC for, PAI-1was 0.66. Results for both FFN and PAI-1 were not found useful enough for the diagnosis of PAS. IMPACT STATEMENTWhat is already known on this subject? We lack biomarkers which can identify placenta accreta spectrum.What do the results of this study add? Maternal plasma levels of FFN and PAI-1 significantly altered in PASWhat are the implications of these findings for clinical practice and/or future research? If multiple of median values of FFN and PAI-1 levels in maternal blood are determined in future studies, it can be used in the antenatal diagnosis of PAS cases.

Mayer-rokitansky-kuster-hauser syndrome with presacral schwannoma presenting as a pelvic mass: A literature review and case report

A 32-year-old woman was admitted to our gynecology outpatient clinic with primary amenorrhea, a pelvic mass, and pain. Sonographic examination and magnetic resonance imaging revealed an approximately 124×103 mm heterogeneous mass. Moreover, laparotomy revealed fibrotic uterine bands with normal ovaries, tubes, and a solid retroperitoneal lesion. On the second postoperative day, the mass was removed, and the patient was discharged with full recovery. Microscopic examination of the pelvic mass confirmed the diagnosis of schwannoma. To the best of our knowledge, this is the first report on the co-occurrence of Mayer-Rokitansky-Küster-Hauser syndrome and schwannoma, without the presence of any other pathology.

Is Valsalva maneuver an alternative to use tenaculum for endometrial sampling procedure in cases where the cervix cannot be passed spontaneously with pipelle? A randomized study.

AIM: To evaluate the effect of the Valsalva maneuver on ease of the endometrial sampling procedure in cases where the cervix cannot be passed spontaneously. METHODS: A randomized prospective trial was conducted in 84 patients whose cervix could not pass spontaneously with pipelle, and they were randomized for the Valsalva maneuver or tenaculum groups. In 43 of a total of 84 patients, we requested Valsalva maneuver throughout the process to pass the cervical canal, and in 41 patients, we performed tenaculum to pass the cervix. RESULTS: Valsalva and tenaculum groups did not differ in success rates (P = 0.314). There was no difference between the two groups in the history of the disease, past surgery and education (P > 0.05). CONCLUSION: In endometrial sampling procedure with pipelle, when the cervix cannot be passed spontaneously, the transition with the Valsalva maneuver should be tried before using the tenaculum. Thus, a more painful procedure can be avoided and patient satisfaction may increase.

Glyceryl trinitrate for the treatment of preterm labor.

OBJECTIVE: This study was conducted to compare the tocolytic efficacy of glyceryltrinitrate (GTN) with that of magnesium sulfate (MgSO4) and to investigate serum nitric oxide metabolites before and after tocolysis. MATERIAL AND METHODS: In total, 48 women between 27 and 34 weeks' gestation with threatened preterm labor and intact membranes were randomly allocated to receive either GTN or MgSO4 tocolysis. Main outcome measures included tocolytic efficacy and maternal side effect(s) of the tocolytic agent. Obstetric and neonatal outcomes as well as pretreatment and posttreatment nitric oxide (NO) metabolites were assessed. RESULTS: Forty-one patients were included into the final analysis. Uterine contraction cessation times were 3.66±1.28 and 6.83±3.47 hours for GTN and MgSO4 groups, respectively. Similarly, maternal side effects were significantly lower in the GTN group than in the MgSO4 group, and no serious maternal side effects were recorded. Serum NO metabolite levels before treatment were significantly lower in the treatment groups than in the controls. Serum nitrite levels were significantly increased after tocolytic treatment both in MgSO4 and GTN groups. CONCLUSION: GTN effectively delays preterm delivery and reduces neonatal morbidity and mortality with less maternal side effects and seems to be an effective and safe alternative to MgSO4.

Effect of parity on healthy promotion lifestyle behavior in women.

BACKGROUND: Health-promoting lifestyle behaviors are not only for the prevention of a disease or discomfort, but are also behaviors that aim to improve the individual's general health and well-being. Nurses have an important position in the development of healthy lifestyle behaviors in women. OBJECTIVE: The aim of this study was to assess the effect of parity on health-promoting lifestyle behaviors in women. METHOD/DESIGN: This descriptive and cross-sectional survey was performed in Adana, Turkey. This study was conducted with 352 women. The questionnaire consisted of two parts; the first part consisted of questions that assessed the socio-demographic and obstetric characteristics, and the second part employed the "Health Promotion Lifestyle Profile Scale" (HPLP). Data analysis included percentage, arithmetic average, and ANOVA tests. RESULTS: The results revealed that 24.1% of the women had no parity, 13.6% had one parity, 30.7% had two parities, 14.6% had three parities, and 17% had four and above parities. The mean total HPLP was 126.66±18.12 (interpersonal support subscale, 24.46±4.02; nutrition subscale, 21.59±3.92; self-actualization subscale, 24.42±4.30; stress management subscale, 18.73±3.81; health responsibility subscale, 21.75±4.31; and exercise subscale, 15.71±4.22). CONCLUSIONS: The health behavior of women was moderate. A statistically significant correlation was found between the number of parities and the Health Responsibility, Nutrition, Interpersonal Support, which is the subscale of the HPLP Scale.

Can different geographic conditions affect the formation of striae gravidarum? A multicentric study.

AIM: Striae gravidarum (SG) is a most common physiological skin change that many pregnant women experience during pregnancy. We investigated the effects of geographic conditions and altitude on the formation of SG. MATERIAL AND METHODS: A total of 508 nulliparous women with singleton gestation were included in the study from three different geographic locations. The first city is located in the mountainous area at an altitude of approximately 1900 m (approximately 6233 ft). The second city is located on a plain in the middle of the country at an altitude of 900 m (approximately 2952 ft). The third city is located by the seaside (altitude 26 m, 85 ft). Twelve variables were recorded for each woman in the prepartum period, and striae were scored using the numerical scoring system of Atwal et al. RESULTS: We found that striae formation was significantly more common in higher areas. According to the regression analyses, when the third region, located at sea level, was taken as a reference point, the appearance of SG was 2.1- and 1.8-fold more common in the first region (altitude 1900 m) and the second region (altitude 900 m), respectively (P = 0.020). CONCLUSION: To the best of our knowledge, this study is the first to evaluate the effect of environmental factors on SG formation. Moreover, our study group is one of the largest in the published work. Environmental factors can affect the formation of striae gravidarum. Further studies with different ethnic groups are needed.

Impact of transobturator tape procedure on female and their partner sexual function: it improves sexual function of couples.

AIM: To assess the impact of transobturator tape (TOT) procedure on female sexual function as well as their male partners. MATERIALS AND METHODS: Sexually active 28 women and their partners included for the study. Before TOT operation, the patients completed incontinence impact questionnaire (IIQ-7) and urogenital distress inventory (UDI-6) to assess the effect of surgery on incontinence. Also the women and their partners completed a self-administered questionnaire evaluating the female sexual function index (FSFI) and international index of erectile function (IIEF-5), respectively. Three months after TOT surgery, the women were asked to complete IIQ-7 and UDI-6 questionnaires to measure the success of TOT procedure. Also, FSFI and IIEF forms were completed by the women and their partners to assess TOT-related sexual life change. RESULTS: After TOT procedure, the mean value of IIQ-7 and UDI-6 questionnaires was lower than the mean scores that measured before treatment (p < 0.001). The mean values of FSFI scores before and 3 months after the operation were 23.15 ± 8.21 vs. 30.01 ± 9.13, respectively (p < 0.001). The mean values of IIEF before and 3 months after the operation were 50.14 ± 5.21 vs. 60.96 ± 10.03, respectively (p < 0.001). CONCLUSION: According to our results, both women and their partners' sexual life improved after TOT surgery for incontinence.

Examination of the ovarian reserve after generation of unilateral rudimentary uterine horns in rats.

OBJECTIVE: The purpose of this experimental rat model study is to evaluate the changes in the ovarian environment after excision of the rudimentary horn. METHODS: Ten female Wistar albino rats were used in this study. One cm of right uterine horn length was excised in the first operation. Two months after the first operation, all animals were sacrificed to obtain ovaries for histological examination. Mann-Whitney U test and Student's t-test were used for statistical analysis purposes. Statistical significance was defined as P < 0.005. RESULTS: The number of primordial follicles (P = 0.415), primary follicles (P = 0.959), preantral follicles (P = 0.645), antral follicles (P = 0.328), and Graafian follicles (P = 0.721) was decreased and the number of atretic follicles (P = 0.374) increased in the right ovarian side. Howeve,r this difference was not found to be statistically significant. CONCLUSION: The results of this experimental rat model study suggest that the excision of rudimentary horn could have negative effects on ipsilateral ovarian functions.

Investigating the clinical significance of mesh peritonization in abdominal vault suspension surgery using a comparative rabbit model.

OBJECTIVE: To investigate the clinical significance of mesh peritonization in an experimental rabbit model. STUDY DESIGN: Twenty rabbits were randomly assigned to two groups. A sacrouteropexy operation was performed in both groups using a polypropylene mesh. In the first group, the pelvic peritoneum was not closed over the mesh, and in the second group, the mesh was buried throughout the pelvic retroperitoneal tunnel. One month after mesh implantation, the abdomen was opened and the previous surgical site was explored. The primary outcome was intraabdominal adhesion formation; the secondary outcome was the histologic degree of tissue remodeling. RESULTS: There were no statistically significant differences between the two groups in terms of adhesion scores and collagen organization (P=0.692, P=0.097, respectively). There was a greater degree of inflammation in the second group as identified by significantly higher scores for eosinophils-neutrophils, macrophages-foreign body giant cells and mononuclear cells (P=0.002, P=0.001 and P=0.002, respectively). CONCLUSIONS: Similar adhesion and collagen organization patterns were found in both groups, but indicators of the inflammatory process were significantly higher in the second group.

Comparison of the use of LigaSure, HALO PKS cutting forceps, and ENSEAL tissue sealer in total laparoscopic hysterectomy: a randomized trial.

STUDY OBJECTIVE: There are many instruments with different energy modalities or with different properties that are available for use in total laparoscopic hysterectomy. The aim of the study was to compare the use of LigaSure (Valleylab, Boulder, CO), HALO PKS cutting forceps (Gyrus-ACMI, Maple Grove, MA), and ENSEAL tissue sealer (SurgRx, Inc. Redwood City, CA) in total laparoscopic hysterectomy with respect to operation time and blood loss as main outcomes. Perioperative complications, return of gastrointestinal activity, and hospitalization time were assessed as secondary outcomes. DESIGN: Randomized prospective study (Canadian Task Force classification I). SETTING: Adana Numune Training and Research Hospital. PATIENTS: Forty-five patients with the indication of hysterectomy were randomized into 3 groups for total laparoscopic hysterectomy. Patients with malignancies, having 3 or more previous abdominal surgeries, a uterus larger than 12 weeks of gestation, and who had to undergo additional surgical procedures during the same operation were excluded. INTERVENTIONS: Total laparoscopic hysterectomy. MEASUREMENTS AND MAIN RESULTS: Operations were completed in all 15 patients in the LigaSure and HALO PKS Cutting Forceps groups with the planned instruments. In 2 patients in the ENSEAL group, bleeding could not be controlled with ENSEAL, and additional instruments were used. One patient in the ENSEAL group had bladder injury. The mean operation time and blood loss were 52.4 ± 12.8, 51.86 ± 14.11, and 55.7 ± 15.7 minutes (p > .05) and 138 ± 54.3, 118 ± 63.3, and 218 ± 115.9 mL (p < .05) in the LigaSure, HALO PKS, and ENSEAL groups, respectively. Changes in hemoglobin/hematocrit levels, return of gastrointestinal activity, and hospitalization time did not differ between groups. CONCLUSION: These 3 novel bipolar platforms had similar results in total laparoscopic hysterectomy. These instruments were not determined to be independent predictors of operating time and amount of blood loss.

A new medical treatment with botulinum toxin in persistent genital arousal disorder: successful treatment of two cases.

Persistent genital arousal disorder is described in a spontaneous, persistent, and uncontrollable genital arousal in women, with or without orgasm or genital engorgement, unrelated to any feelings of sexual desire. This study aimed to argue that application of Botulinum toxin in the periclitoral region in order to block the dorsal nerve of the clitoris might decrease symptoms of persistent genital arousal disorder. The authors presented 2 cases, in which application of Botulinum toxin resulted in improvement of the symptoms of persistent genital arousal disorder. Botulinum toxin type A treatment protocol is seen as a promising application for the persistent genital arousal disorder. However, further controlled studies in large samples are needed.

An evaluation of the effects of the transobturator tape procedure on sexual satisfaction in women with stress urinary incontinence using the libido scoring system.

Introduction and Hypothesis. Most women experience automatic urine leakage in their lifetimes. SUI is the most common type in women. Suburethral slings have become a standard surgical procedure for the treatment of stress urinary incontinence when conservative therapy failed. The treatment of stress urinary incontinence by suburethral sling may improve body image by reducing urinary leakage and may improve sexual satisfaction. Methods. A total of 59 sexually active patients were included in the study and underwent a TOT outside-in procedure. The LSS was applied in all patients by self-completion of questionnaires preoperatively and 6 months after the operation. General pleasure with the operation was measured by visual analogue score (VAS). Pre- and postoperative scores were recorded and analyzed using SPSS 11.5. Results. Two parameters of the LSS, orgasm and who starts the sexual activity, increased at a statistically significant rate. Conclusion. Sexual satisfaction and desire have partially improved after the TOT procedure.

Glutaraldehyde-induced bowel injury during gynecologic laparoscopy.

Glutaraldehyde is a widely used disinfectant, especially in developing countries, for rapid and effective disinfection of laparoscopic instruments that are not suitable for sterilization in an autoclave. This incident report demonstrates that even remarkably small residual amounts of glutaraldehyde on inadequately cleaned laparoscopic instruments can cause chemical burns during laparoscopic surgery. Our goal is to raise awareness of the possible hazardous effects of glutaraldehyde when necessary measures are not taken to properly sterilize laparoscopic instruments.

Factors affecting sexual function in premenopausal age women with type 2 diabetes: a comprehensive study.

OBJECTIVE: To compare the factors affecting sexual function in premenopausal women with type 2 diabetes using the female sexual function index (FSFI). DESIGN: Cross-sectional study. SETTING: Premenopausal women with type 2 diabetes and healthy volunteers in an academic research environment. PATIENT(S): Sixty-two type 2 diabetic women were compared with 50 controls. The FSFI scores of the patients were compared according to age, duration of diabetes, marriage, socioeconomic status, parity, menstruation regularity, body mass index (BMI), and smoking. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Female sexual function index scores. RESULT(S): The mean FSFI score in diabetics was lower than in controls. Menstrual irregularity and duration of diabetes affected female sexual function unlike age, BMI, socioeconomic status, duration of marriage, or parity. Regularly menstruating women had higher FSFI scores (27.1 ± 6.7) than irregularly menstruating women (20.7 ± 7.4). Type 2 diabetics were divided into three groups according to duration of diabetes. The women having diabetes longer than 10 years had the worse sexual function. Also, smoking affected inversely female sexual well being. CONCLUSION(S): Menstrual disturbance, smoking, and longer duration of diabetes (more than 10 years) impair FSFI scores in premenopausal women with type 2 diabetes.