Ahmet Mete Ergenoglu

Comparison of melatonin and oxytocin in the prevention of critical illness polyneuropathy in rats with experimentally induced sepsis

BACKGROUND Critical illness polyneuropathy is an acute neuromuscular disorder of critically ill patients and is characterized by limb and respiratory muscle weakness. The purpose of the study was to evaluate the neuroprotective effects of melatonin (MEL) and oxytocin (OT) on the early stage of sepsis by recording compound muscle action potentials and measuring plasma tumor necrosis factor (TNF)-α levels, lipid peroxidation (malondialdehyde; MDA), and total antioxidant capacity. MATERIALS AND METHODS One hundred adult male Sprague-Dawley rats were included in the study. The cecal ligation and puncture (CLP) procedure was performed to induce the sepsis model. MEL (10, 20, and 40 mg/kg), OT (0.4, 0.8, and 1.6 mg/kg), and a combination of MEL (20 mg/kg) and OT (0.8 mg/kg) were administered intraperitoneally in the first hour of surgery. Electromyography (EMG) studies were achieved 24 h after CLP surgery and then blood samples were collected for biochemical measurements. RESULTS EMG findings revealed that compound muscle action potential amplitude was significantly decreased and distal latency was prolonged in the CLP group compared with the sham group (P < 0.05 and P < 0.0005). Moreover, the animals that received CLP surgery showed significantly higher TNF-α and MDA levels and lower total antioxidant capacity values than the sham group. The administration of MEL and OT to rats significantly abolished the EMG alterations and suppressed oxidative stress and TNF-α release in CLP-induced rats. CONCLUSIONS The inflammatory processes and imbalance in oxidative/antioxidative status play important roles in the pathogenesis of critical illness polyneuropathy. We suggest that both oxytocin and melatonin may have beneficial effects against sepsis-induced polyneuropathy in critical illness.

Comparison of the success of histopathological diagnosis with dilatation-curettage and Pipelle endometrial sampling

The aim of this study is to compare collection of sufficient material and diagnostic accuracy of Pipelle biopsy with curettage and hysterectomy. A total of 82 cases with indications for endometrial biopsy for any reason and in which endometrial biopsy was performed with dilatation and curettage (D&C) and Pipelle aspiration biopsy, and 66 cases in which an indication for hysterectomy was established for any reason were included in the study. Histopathological findings were examined in the following six groups: normal; endometrial polyps; hyperplasia without atypia; hyperplasia with atypia; atrophy; and insufficient material. Descriptive statistical methods and McNemars test were used. When the histopathological compatibility between Pipelle and D&C was considered (n = 82), a diagnosis that was different from that obtained by D&C was obtained in 22 of the 63 cases (34%), in whom normal endometrial histology was found with a Pipelle biopsy specimen. It was observed that only 1 of 13 cases of endometrial polyps was diagnosed with Pipelle biopsy. Insufficient material was obtained in six cases (7%) with Pipelle biopsies and three cases (4%) with D&C. While Pipelle biopsies and D&C have a nearly equal level of success in widespread endometrial lesions, Pipelle biopsies provide limited diagnostic accuracy in cases with focal pathologies.

Regression of Endometrial Implants by Resveratrol in an Experimentally Induced Endometriosis Model in Rats

Objective: To evaluate the effect of resveratrol on an experimentally induced endometriosis rat model. Study design: After endometriotic implants were surgically formed, rats were randomly divided into 2 groups as control group (saline treated, n = 6) and resveratrol group (10 mg/kg/d, n = 6). The inflammatory markers and histopathological changes were assessed at the end of the treatment period. Results Our results showed (1) significant reduction in the implant size (P < .0005); (2) significantly decreased levels of vascular endothelial growth factor (VEGF) in the peritoneal fluid and plasma (P < .005); and monocyte chemotactic protein 1 (MCP-1) in the peritoneal fluid (P < .05), (3) highly significant suppression of VEGF expression in the endometriotic tissue (P < .0005); and (4) considerable histological changes in the endometriotic foci following resveratrol treatment. Conclusion: Resveratrol appears to be effective on the development of endometriosis through its antiangiogenic and anti-inflammatory properties. Future studies with different doses of resveratrol might provide more comprehensive results regarding the treatment of endometriosis.

Innovative technique for enclosed morcellation using a surgical glove.

OBJECTIVE: To describe an innovative approach for enclosed morcellation using a surgical glove in multiport laparoscopic surgery. METHODS: Power morcellation was performed within an insufflated surgical glove in a completely enclosed manner between January and May 2014. The specimen was placed into the glove within the abdomen. The glove opening and thumb were exteriorized through the umbilical and left lower abdominal trocar incisions, respectively. The optical trocar and optic were inserted into the glove, which was then insufflated. The thumb tip was cut, and a power morcellator was inserted through this finger. The morcellation was accomplished within the completely enclosed glove. The thumb tip was closed, and the glove, containing residual specimens and bloody fluid, was removed from the abdomen through the umbilical incision. Thus, the risks of bag piercing and leakage during contained power morcellation were eliminated. Demographic and operative data were collected and analyzed for all cases. RESULTS: Thirty multiport laparoscopic myomectomy and morcellation procedures were performed during the study period. The median operative time was 85 minutes (range 60–140 minutes). The median morcellation preparation time, total morcellation time, and withdrawal time were 6 (range 4.5–14), 32 (range 15–55), and 1.2 (range 1–1.5) minutes, respectively. No intraoperative complications or bag ruptures were recorded. CONCLUSION: With our innovative technique, a disposable latex glove can be used for an enclosed morcellation that avoids piercing the enclosure container within the abdominal cavity, thereby offering decreased risks related to bag perforation and leakage compared with previous contained power morcellation techniques. LEVEL OF EVIDENCE: III

Does pelvic floor muscle training abolish symptoms of urinary incontinence? A randomized controlled trial

Objective: To determine whether symptoms of urinary incontinence is reduced by pelvic floor muscle training, to determine whether urinary incontinence can be totally eliminated by strengthening the pelvic floor muscle to grade 5 on the Oxford scale. Design: Prospective randomized controlled clinical trial. Setting: Outpatient urogynecology department. Subjects: One hundred thirty cases with stress and mixed urinary incontinence. Intervention: All participants were randomly allocated to the pelvic floor muscle training group or control group. A 12-week home based exercise program, prescribed individually, was performed by the pelvic floor muscle training group. Main measures: Urinary incontinence symptoms (Incontinence Impact Questionnaire-7, Urogenital Distress Inventory-6, bladder diary, stop test and pad test) were assessed, and the pelvic floor muscle strength was measured for (PERFECT testing, perineometric and ultrasound) all participants before and after 12 weeks of treatment. Results: The pelvic floor muscle training group had significant improvement in their symptoms of urinary incontinence (P=0.001) and an increase in pelvic floor muscle strength (P=0.001, by the dependent t test) compared with the control group. All the symptoms of urinary incontinence were significantly decreased in the patients that had reached pelvic floor muscle strength of grade 5 and continued the pelvic floor muscle training (P<0.05). Conclusion: The study demonstrated that pelvic floor muscle training is effective in reducing the symptoms of stress and mixed urinary incontinence and in increasing pelvic floor muscle strength.

Effect of spaced training with a box trainer on the acquisition and retention of basic laparoscopic skills

To investigate whether basic laparoscopic skills acquired via structured spaced training on a box trainer persist after 6 months.

Evaluation of glycemic and oxidative/antioxidative status in the estradiol valerate-induced PCOS model of rats

OBJECTIVE The aim of this study was to show glycemic and oxidative/antioxidative status (GOAS) in rats with estradiol valerate (EV)-induced polycystic ovarian syndrome. STUDY DESIGN Thirty mature female rats were randomly allocated to EV-induced PCOS, sham and control groups. Malondialdehyde, catalase and fasting blood glucose levels were determined in order to evaluate GOAS. RESULTS There was a statistically significant difference between PCOS and control groups (p<0.001) for hemolysate MDA while no difference was determined for either catalase or fasting blood glucose levels. On histopathological examination, the EV-induced PCOS group revealed disease-characteristic ovarian morphology. CONCLUSION There was an increased compensation for oxidative stress by antioxidative biologic mechanisms in EV-induced PCOS rats. Interestingly, the sole result derived from this limited study is that the sesame oil+EV combination is not appropriate for the evaluation of oxidant-antioxidant status and also glycemic condition in PCOS. This study demonstrates the need for better designed experimental studies to elucidate the aetiopathogenesis of PCOS via novel techniques.

The impact of salpingectomy and single-dose systemic methotrexate treatments on ovarian reserve in ectopic pregnancy.

OBJECTIVE To investigate the effects of salpingectomy and methotrexate treatments on ovarian reserve in ectopic pregnancy. STUDY DESIGN In this prospective study, a total of 131 patients with ectopic pregnancy were divided into 3 groups of methotrexate (MTX) only (Group-1, n: 55), salpingectomy only (Group-2, n: 61), and salpingectomy following MTX (Group-3, n: 15). Pretreatment and post-treatment anti-Müllerian hormone (AMH) levels were evaluated. RESULTS Significant differences in AMH levels were detected between group 1 and group 2 (2.52±1.28 vs. 1.96±1.66, p=0.043), and group 1 and group 3 (2.52±1.28 vs. 1.77±0.76, p=0.035) at one month postoperative. However, these differences disappeared at the 3rd postoperative month. When AMH levels were compared within the same group, postoperative one month AMH levels were significantly lower than the preoperative AMH levels only in group 3 (p=0.03). However, this difference also disappeared at the 3rd postoperative month. CONCLUSION Systemic single-dose methotrexate treatment, unilateral salpingectomy, and salpingectomy following methotrexate administration in ectopic pregnancy were reassuring based on pretreatment and post-treatment AMH levels. Current medical and surgical treatment approaches do not have an obvious negative effect on ovarian reserve.

Comparison of three-dimensional ultrasound and magnetic resonance imaging diagnosis in surgically proven Mullerian duct anomaly cases

OBJECTIVE To determine and compare the diagnostic accuracy of 3-dimensional ultrasound (3D US) and magnetic resonance imagining (MRI) in patients with surgically diagnosed Mullerian duct anomaly (MDA). STUDY DESIGN Charts of patients with MDA were retrospectively evaluated. Patients who underwent both laparoscopic and hysteroscopic surgery and had 3D US and MRI examinations were included in the study. The diagnoses achieved via 3D US and MRI were compared with the surgical diagnoses to determine the diagnostic accuracy of these imagining techniques. RESULTS Twenty-nine patients were included in the study. Three-dimensional ultrasound detected 28 out of 29 (96%) patients correctly. Only one patient was diagnosed with a uterine septum instead of uterine arcuatus. Magnetic resonance imaging detected 23 out of 29 patients correctly (79%). The Kappa indexes of the 3D US and MRI were 0.896 and 0.592, respectively. CONCLUSION Our results indicate that 3D US has a higher diagnostic accuracy level than MRI in evaluating MDA, especially when used in experienced hands. However, additional, well-designed studies are needed to better compare the diagnostic accuracy of the 3D US and MRI.

Overactive bladder and its effects on sexual dysfunction among women

To evaluate the relation between overactive bladder (OAB) and sexual dysfunction in sexually active nurses without stress urinary incontinence and pelvic organ prolapse.