LETTER TO THE EDITOR | |
1. | Treatment Modalities of Cesarean Scar Pregnancy Ahmet Şahbaz, İbrahim Polat, Ali İsmet Tekirdağ Page I |
RESEARCH ARTICLE | |
2. | IVF Pregnancies is Associated with Increased Risk for Preeclampsia Atınç Özer, Erbil Karaman, Yasemin Karaman, Cihan İnan, Hasan Talay doi: 10.5222/IKSST.2014.001 Pages 1 - 5 OBJECTIVE: The purpose of this study is to assess the association of intrauterine insemination, in vitro fertilization(IVF) and ovulation induction with the risk of preeclampsia. METHODS: A population based retrospective cohort study, pregnancies conceived by assisted reproductive technology referred to our hospital obstetric and gynecology department and after 24 weeks who had birth between 2006-2010 years were included to the study. 120 exposure subjects and 480 controls were randomly matched by maternal age, parity, plurality and smoking during pregnancy. The risk of preeclampsia associated with intrauterin insemination(IUI), in vitro fertilization(IVF) and ovulation induction has been evaluated using logistic regression analysis. RESULTS: İn vitro fertilization was associated with an increased risk for preeclampsia(OR = 3,91, 95% CI: 1.34, 11.36), whereas intrauterine insemination (OR = 0.74, 95% CI: 0.07, 7.41)and ovulation induction (OR = 0.74, 95% CI: 0.14, 3.81) was not associated with the risk for preeclampsia. CONCLUSION: There was a higher incidence of preeclampsia among pregnancies conceived by IVF, but no significant association was found in intrauterine insemination and ovulation induction. |
3. | Analysis of 147 Total Laparoscopic Hysterectomy Cases Performed in Our Clinic Tolga Karacan, Taner Abdullah Usta, Murat Mehmet Naki, Aysel Çalık, Alper Tosun, Erhan Okuyan doi: 10.5222/IKSST.2014.006 Pages 6 - 13 OBJECTIVE: The aim of this study was to evalute the results of our experience of 147 cases who underwent Total Laparoscopic Hysterectomy (TLH) operations. METHODS: During the study period, total of 147 Total Laparoscopic Hysterectomy operations were performed for both benign as well as malignant indication between December 2010 to December 2012. Demographic characteristics, indications of hysterectomy, uterine weight, intraoperative and postoperative complications, duration of the operation, length of hospital stay, blood loss of patients who underwent Total Laparoscopic Hysterectomy operations were retrospectively evaluated. Complications were classified as major complications, minor complications, and total complications according to the literature RESULTS: The mean age of patients was 51.3±7.9 (33-75) years old, the mean parity 3.4±2.0 (0-11), the mean of uterine weights were 167.4±97.4 g (83-735 g), the mean operation time was 127.4±53.8 min (40-251 min), the mean hospital stay was 3.2 ±1.4 days (2-9 days) and BMI (kg/m2) values were 29.1±5.1 kg/m2. Overall complications rate were 8.1 % (12/147) in patients. Major complications rate were 5.4 % and minor complications rate were 2.7 %. CONCLUSION: Although laparoscopic hysterectomy is a well-establish surgical procedure for the management of benign and malign gynecological conditions, it is not still performed widely enough because of insufficient technical equipment and lack of well-trained staff. Total laparoscopic hysterectomy after adequate training seems to be safe and effective procedure for patients. |
4. | Is Preoperative D&C Adequate for the Determination of Endometrial Pathologies Tolga Karacan, Taner Abdullah Usta, Hüseyin Dayan, Murat Mehmet Naki doi: 10.5222/IKSST.2014.014 Pages 14 - 19 OBJECTIVE: The aim of this study was to investigate the necessity of preoperative endometrial sampling for hysterectomies with benign as well as malignant indications. METHODS: The records of 144 patients on whom hysterectomy for benign indications as well as malignant indications were performed in Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital between December 2011 and December 2012 were evaluated retrospectively. Preoperative D&C and postoperative endometrial pathology results were compared. RESULTS: The diagnosis at D&C was ‘ insufficient tissue’ for 16 ( 11.1 %) patients.. D&C failed to detect intrauterine disorders especially endometrial polyps ( 73.9 %) in premenopausal and postmenopausal women. Malignant pathologies were determined at curettage material in 3 ( 2 %) cases and hysterectomy specimen in 11 ( 7.6 % ) cases. The malignancies were determined in three patients was endometrial adenocarcinoma at D&C. Hysterectomy in 11 patients was reported as a result of malignant pathologies; endometrial adenocarsinoma in 8 cases, leiomyosarcoma in 2 cases and endometrial stromal sarcoma in 1 case. D&C failed to detect uterine sarcoma. Sensitivity ( 27.2 % ), specificity ( 100 % ), positive ( 100 % ) and negative ( 94.5 %) predictive values, and accuracy ( 94.6 % ) were observed for all malignant endometrial pathologies obtained at dilatation and curettage. CONCLUSION: Endometrial biopsy is clearly less reliable for endometrial malignant pathology. Furthermore preoperative D&C is an inadequate diagnostic tool for uterine focal lesions. |
5. | The Importance of Clinical, Radiologic and Laboratory Parameters in the Diagnosis of Ovarian Torsion: Retrospective Study Salih Burçin Kavak, Ebru Kavak, Bülent Kurkut, Raşit İlhan, Melike Başpınar doi: 10.5222/IKSST.2014.020 Pages 20 - 22 OBJECTIVE: To examine the clinical, radiological and laboratory parameters in diagnosis of ovarian torsion. METHODS: This retrospective study is carried out by examining the records of patients operated at Fırat University, Obstetric and Gynecology Clinic between December 2011 and December 2012. Age, number of gravidy, parity and ultrasonographic findings (such as ovarian size, presence of ovarian cysts, peripheral follicles, vascular flow on doppler ultrasound, whirlpool sign, free fluid in the pelvic region) and laboratory parameters (such as hemoglobin, hematocrit, platelet and white blood cell count) supporting ovarian torsion were investigated. Also preoperative signs and symptoms such as nausea, vomitting, abdominal tenderness, defance, rebound were obtained from the patient records. RESULTS: In this study, 15 patients were examined retrospectively. Mean age(year) of the patients was 22,7±8,8, mean number of gravidy was 0,92±1,4, mean of WBC was 11000±2800 (/L), mean of hemoglobin and hematocrit values were 11,8±1,8 (gr/dl) and 35,8±4,3 (%) respectively. Abdominal tenderness and enlargement of ovarian (>4 cm) were present in 80% of patients and accompanying ovarian cysts and fluid in pelvis in 73% of cases. Additionally, in 60% of patients loss of blood flow on doppler examination was detected and in 60% of patients whirlpool sign was observed. By combining these findings to other signs and symptoms of ovarian torsion, it can be detected in 86.6% (n: 13) of cases. CONCLUSION: In cases of ovarian torsion clinical, laboratory and ultrasonographic parameters must be combined to make the diagnosis as soon as possible. |
6. | The Effect on Mortality and Morbidity of Neonatal Transport in Preterm Babies Sultan Kavuncuoğlu, Nurten Bayram, Erkut Öztürk, Esin Yıldız Aldemir, Ayşe Sibel Özbek doi: 10.5222/IKSST.2014.023 Pages 23 - 29 OBJECTIVE: To investigate the effects of neonatal transportation of high risk preterm infants on morbidity prospectively METHODS: Preterm infants between 24-37 gestational weeks younger than 7 days of age who were transported to Bakırköy Maternity and Children’s Hospital between May-December 2005 were our study group (Group l). The control group (Group ll) was included the same birth weight and gestational weeks preterms who were born in our hospital in the same period. Each group contained 50 preterm infants. The two groups were compared between maternal and perinatal risk factors, acute postnatal problems, neonatal morbidity and mortality rates. This study is a prospective nonrandomized controled study. RESULTS: Demographic data of maternal age, delivery mode, gender, birth weight and gestational weeks were similar between the groups. Both acute problems such as hypothermia, hypoglycemia, acidosis and morbidities developed during follow up such as sepsis and intraventricular hemorrhages of the germinal matrix (GM-IVH) were significantly higher in Group l than Group ll (p<0,05). There was no difference between the groups in term of other neonatal morbidities such as respiratory distress syndrome (RDS), retinopathy of prematurity (ROP), necrotizing enterocholitis (NEC), bronchopulmonary displasia (BPD) and hyperbilirubinemia. The length of oxygen therapy and hospital stay were longer and mortality was higher in Group l than Group ll (p<0,05). CONCLUSION: This study demonstrates that neonatal transportation increases the morbidity and mortality rates in high risk preterm infants. |
7. | The Effect of Mode of Delivery on The Clinical Course of Very Low Birth Weight Infants Özge Serçe, Derya Benzer, Tuğba Gürsoy, Fahri Ovalı, Güner Karatekin doi: 10.5222/IKSST.2014.030 Pages 30 - 36 OBJECTIVE: The efficacy of mode of delivery on poor outcome in premature infants is contraversial. The objective was to compare the mortality and morbidity rates during hospitalization for infants delivered via caesarean section (C/S) versus vaginal delivery. METHODS: A retrospective study was carried out for the infants who born less than 1500 g and ≤ 32 weeks of gestation (GW) at Zeynep Kamil Maternity and Children’s Education and Training Hospital during 2 years period. The efficacy of mode of delivery on the clinical course of 221-240, 241-260, 261-280, 281-326 GW’s groups was analysed with logistic regresion analysis. RESULTS: Six hundred nineteen infants were included of which 483 (78%) were delivered by C/S, and 198 (31.8%) were died. C/S was associated with independently reduced mortality for infants delivered before 326 GW (OR=0.25, 95% CI=0.15-0.41, p<0.001), and between 281-326 GW subgroup (OR=0.32 95% CI=0.21-0.53, p<0.001), and morbidities such as respiratory distress syndrome (OR=0.44, 95% CI= 0.28-0.68; p<0.001), pneumothorax (OR=0.36, 95% CI=0.16-0.78; p=0.07), and intraventricular hemorrhage (OR=0.60, 95% CI=0.38-0.96; p=0.032) for infants delivered before 326 GW. CONCLUSION: C/S positively influences survival of VLBW infants. However, until prospective trials have verified this result, the decision of mode of delivery should be given by obstetric reasons, also taking into consideration the possible positive impact of C/S on neonates. |
8. | A Comparison Of Laparoscopic Versus Open Appendectomy For Acute Appendicitis in Children Emre Divarcı, Fahrettin Kılıç, Murat Kanğın doi: 10.5222/IKSST.2014.037 Pages 37 - 40 OBJECTIVE: Laparoscopic appendectomy is preferred more frequently in recent years. We aimed to compare the efficiency of laparoscopic and open appendectomy for acute appendicitis. METHODS: Retrospective analysis of children operated for acute appendicitis was performed. Patients were divided into two groups as laparoscopic appendectomy (LA) and open appendectomy (OA). Data including age, sex, operation duration, postoperative feeding day, length of hospitalization and complications were reviewed. RESULTS: 52 children were treated in our clinic between April 2011- June 2012. There were 36 boys and 16 girls, and mean age was 10±3. 8 years ( 2- 17 years). Laparoscopic appendectomy was performed in 30 patients and open appendectomy in 22 patients. 30 of 31 laparoscopic interventions were accomplished ultimately. Mean operation time was 43± 11 minutes in LA group and 41± 22 minutes in OA group (p>0, 05). Postoperative beginning of oral intake was 1 day in LA group and 1. 2 day in OA group (p>0, 05). Length of hospitalization was 2. 4± 0. 5 days in LA group and 3± 1 days in OA group (p>0, 05). One intraoperative complication was seen as a broken endoscopic instrument while laparoscopy. One intraabdominal abscess and one incisional infection was seen in LA group as postoperative complication. No postoperative complication was seen in AA group. Mean postoperative follow-up was 7± 3. 4 months (1- 14 months) and no mortality is seen. CONCLUSION: If endoscopic equipments are provided, laparoscopic appendectomy can be performed successfully even like our clinic as a new center. In our study, no statistical differences were determined at operation time, postoperative feeding day and length of hospitalization in both groups. It can be caused by admission of early feeding and discharge strategies in recent years. Laparoscopic appendectomy should be preferred primarily for acute appendicitis in children because of low postoperative pain and good cosmesis. |
CASE REPORT | |
9. | Conjoined Twins: A Case Report Dilek Kahvecioğlu, Serdar Alan, Duran Yıldız, Ufuk Çakır, Ömer Erdeve, Begüm Atasay, Saadet Arsan doi: 10.5222/IKSST.2014.041 Pages 41 - 43 Conjoined twins is a rare and highly mortal anomaly with an incidence of one per 50.000 to 100.000 gestations. The diagnosis of conjoined twins can be done as early as 12 weeks gestation on prenatal ultrasonography. Families should be informed about the possible pospartum risks. In order to increase the chance of survival, it is adviced to perform delivery in an advanced tertiary care center. Here, we report a case of conjoined twins with toracoomfalofagus and try to review the literature. |
10. | Perinatal Varicella Infection in the Light of the Literature: A Case Report Simla Okumuşoğlu Karaca, Zahide Küçük, Ayten Gilanlıoğlu, Yusuf Ergün doi: 10.5222/IKSST.2014.044 Pages 44 - 48 Aim: Chickenpox (caused by varicella zoster virus-vzv) is a viral infection, represents fever and specific vesicular skin lesions. Vzv during pregnancy is very important due to possibility of maternal varicella pnomonia, congenital varicella syndrome or neonatal varicella infection with 30% mortality risk. Antiviral drugs and varicella immunglobulin therapy (VZIG) reported to be effective in decreasing morbidity and mortality rates. This article discusses monitorisation and treatment of vzv infection in a patient diagnosed 3 days before birth with assisting literature. Case: 24-year-old woman with 39 weeks pregnancy applied to clinic complaning of decreased fetal movements. Itchy, vesicular lesions on her body revealed during examination. Diagnosed as chickenpox infection by the classical lesions, acylovir 5x800 mg has given. On the third day of her follow-up amniotic membrane riped spontaniosly and meconium evaluated. Diagnosed as fetal distress due to loss of variability at nonstress test and C section performed. Medical therapy started to newborn at ICU. After 30 days follow up no abnormal findings occured. Medication of mother continued at postpartum period. She didn’t show any sign of varicella pneumonia and dismissed. Discussion: Vzv infection which occures prior to 20 weeks of pregnancy,5 days before or 2 days after birth can increase the complication possibility. Infected pregnant women should be therated with medical therapy (acylovir, valacylovir), monitored frequently for high body temperature and pneumonia, isolated if necessary. After acylovir therapy admission, VZIG should given in 96 hours to newborn. In the absence of VZIG, IVIG treatment could began. |
11. | The Management of Cornual Ectopic Pregnancy: Two Case Reports Erbil Karaman, Bekir Gülaç, Yasemin Karaman, Derya Uyan Hendem, Ağahan Han doi: 10.5222/IKSST.2014.049 Pages 49 - 53 Cornual ectopic pregnancy is a rare condition which constitutes 2-4% of all ectopic pregnancy and lead to 5% maternal mortality.Early diagnosis and apropriate treatment settings will be life saving and preserve future fertility.It is a rare form of ectopic pregnancy which can be misdiagnosed by ultrasonography.Here, we report two cornual ectopic pregnancies.Case 1: 32 years old Gravida 3, Parity 2, Abortus 0 patient was misdiagnosed as intrauterin pregnancyby ultrasonography and curretage was applied,afterwards the cornual ectopic pregnancy diagnosis was made and she is treated with methotrexate conservatively.Case 2: 23 years old Gravida 3, Parity 1, Curettage 1 patient was admitted emergencey clinic with unstable hemodynamic condition and the diagnosis of ruptured ectopic pregnancy was made.She was treated with laparotomic cornual resection successfully.Here, the diagnosis, follow up and two different treatment options for cornual ectopic pregnancy emphasized based upon these two cases. |
LETTER TO THE EDITOR | |
12. | Letter to The Editör Aysun Savaş doi: 10.5222/IKSST.2014.054 Pages 54 - 56 Abstract | |