Posterior Reversible Encephalopathy Syndrome in an Eclamptic Patient After Cardiac Arrest; Case Report and Literature Review.

Posterior reversible encephalopathy (PRES) is a disorder characterized by hypertension, headache, seizures and visual impairment. Causes of PRES include; severe hypertension, pre-eclampsia or eclampsia, sepsis, history of renal and autoimmune diseases and use of immunosuppressive or cytotoxic agents. Diagnosis of the syndrome can be difficult. For this reason clinical and radiological findings should be evaluated together. In this report, a 19-year old, 32 week pregnant eclamptic woman, who had been diagnosed with PRES, is presented with a discussion of the relevant literature.

Investigation of middle ear pressure changes during prone position under general anesthesia without using nitrous oxide.

PURPOSE: The effects of different body positions on the middle ear were reported in several studies, but there are no data about the effects on patients under general anesthesia. The aim of this study is to determine the effect of prone position on middle ear pressure (MEP) during general anesthesia without using nitrous oxide. METHODS: Twenty patients under general anesthesia during prone position were included in the study. The performed anesthesia method was the same for all patients. Remifentanil was used for analgesia instead of nitrous oxide. MEPs were measured 5 times with a middle ear analyzer: before induction (BI), after intubation (AI), after turned to the prone position (PP1), at the end of the prone position (PP2), and after returned to the supine position (SP). Duration of prone position was also recorded. RESULTS: Of the 20 patients were 11 women and 9 men with a 49 ± 13 mean age. BI-AI, AI-PP1, PP1-PP2, and PP2-SP comparisons of both MEPs were statistically significant (P < 0.0001). Right mean MEPs were BI, -1 ± 23 daPa; AI, 41 ± 51 daPa; PP1, 124 ± 76 daPa; PP2, 152 ± 59 daPa; and SP, 63 ± 29 daPa; whereas left mean MEPs were BI, -24 ± 55 daPa; AI, 28 ± 34 daPa; PP1, 132 ± 67 daPa; PP2, 162 ± 48 daPa; and SP, 70 ± 89 daPa. Significant increases were detected at the start and continuation of the prone position. The mean duration of prone position was 98 ± 51 per minute. CONCLUSIONS: The significant MEP increases during the prone position under general anesthesia depend on a number of reasons. Among them are inhaler agents, pressure changes in mucosal blood vessels due to venous congestion, and the mastoid bone volume. Further researches are required to determine and explain the mechanisms of increase in MEP during prone position.

Severity of pain and circadian changes in uterine artery blood flow in primary dysmenorrhea.

OBJECTIVE: To investigate the severity of pain and circadian changes in uterine artery blood flow in primary dysmenorrhea cases. MATERIALS AND METHODS: The study included 27 cases diagnosed as primary dysmenorrhea and 25 individuals who had no dysmenorrhea complaint. Bilateral uterine artery systole/diastole rates (S/D), pulsatility indices (PI) and resistance indices (RI) of all cases were measured using transvaginal colour Doppler at 12.00-02.00 p.m. and 12.00-02.00 a.m. Severity of pain was evaluated in dysmenorrhea cases at the same hours using a verbal pain assessment scale. FINDINGS: Doppler measurements of dysmenorrhea cases conducted at 12.00-02.00 p.m. showed right uterine artery S/D: 3.37 +/- 0.26, RI: 0.73 +/- 0.07, PI: 2.38 +/- 0.34 and left uterine artery S/D: 3.33 +/- 0.37, RI: 0.74 +/- 0.14, PI: 2.41 +/- 0.15, while measurements carried out at 12.00-02.00 a.m. showed right uterine artery S/D: 3.88 +/- 0.12, RI: 0.87 +/- 0.14, PI: 2.94 +/- 0.21 and left uterine artery S/D: 3.90 +/- 0.27, RI: 0.92 +/- 0.12, PI: 2.93 +/- 0.21. Comparisons revealed significantly higher Doppler indices at night (P < 0.05) than in the day in dysmenorrhea cases. There was not any significant circadian difference in individuals who did not have dysmenorrhea (P > 0.05). Pain score in the verbal pain assessment of dysmenorrhea cases was found 3.6 +/- 1.4 in the day and 5.8 +/- 1.7 at night. The difference was found significant (P < 0.05). CONCLUSION: Uterine artery blood flow is reduced at night in dysmenorrhea cases. In correlation with this, the cases feel more pain at night. Our results may be important on the planning of working hours and their quality of life.

Prevalence of primary dysmenorrhea in young adult female university students.

OBJECTIVE: To determine the prevalence of primary dysmenorrhea and attitudes and behavior toward dysmenorrhea in the female students of an university toward this problem. MATERIALS AND METHODS: A total of 1,266 female university students were anonymously surveyed by doctors. RESULTS: It was found that mean age of the surveyed students was 21.02+/-2.13 years, mean menarche age was 13.3+/-1.4 years, and menstruation frequency was 32.58+/-19.8 days. Of the students, 45.3% were found to suffer pain in each menstruation, 42.5% in some and 12.2% in none. Of those with primary dysmenorrhea, 66.9% were established to take analgesic drugs. CONCLUSION: Prevalence of primary dysmenorrhea was found higher than that cited in the literature. It was established that although the rate of consultation with health professionals about menstruation and related changes was low, use of agents known to be effective in primary dysmenorrhea treatment was highly common.

The efficacy of venlafaxine in the treatment of women with stress urinary incontinence.

OBJECTIVE: To examine the efficacy of venlafaxine, which is used as an antidepressant, in the treatment of stress urinary incontinence. MATERIALS AND METHODS: The study was designed as a placebo-controlled, double-blind and randomized clinical study. Patients in Group 1 (n=20) were administered 75 mg venlafaxine, those in Group 2 (n=20) were administered placebo for 12 weeks. All the cases were evaluated in terms of weekly incontinence episode frequency (IEF), change in void interval (VI), the Incontinence Quality of Life (I-QOL) in weeks 0, 4, 8 and 12. Additionally, PGI-S was assessed at baseline and was followed by PGI-I evaluations in weeks 4, 8 and 12. RESULTS: Evaluations in weeks 0, 4, 8 and 12 did not show any significant difference in IEF, VI, IQOL and PGI-I values of placebo group (p>0.05). However, in the patients who were administered venlafaxine declines in IEF and PGI-I values as well as the elevations in VI and IQOL scores showed significant changes parallel to the increasing follow-up period (p<0.05). Nausea was observed in 40% of cases in venlafaxine group, and 15% of those in placebo group (p<0.05). CONCLUSION: It was seen in our study that efficacy of venlafaxine started early and the clinical efficacy associated with the use of the drug continued in the following months. Venlafaxine should be considered a clinically efficient alternative drug in the treatment of SUI.

Risk factors for depression in postnatal first year, in eastern Turkey.

BACKGROUND: There are few studies reporting depression in the postnatal period in developing countries. In this study our objective was to evaluate women from eastern Turkey in the postnatal one-year period in order to analyse the risk factors for depression. METHODS: In this cross-sectional, multi-centre study, we selected a study sample from five eastern provinces. Among 2602 randomly selected women who gave birth within the last year, we included 2514 women in our analysis. The Edinburgh Postnatal Depression Scale was used for the evaluation of depression. RESULTS: The percentage of women with high depression scores was 27.2%. Excess risk of depression was associated with several factors including unemployment, low education, poverty, poor family relations, low marital age, lack of medical services, and mental health problems. CONCLUSIONS: Depression in postnatal women is an important public health problem in the less developed eastern part of Turkey.