Banu Bingol

Multiple repeated cesarean deliveries: operative complications in the fourth and fifth surgeries in urgent and elective cases.

OBJECTIVE To evaluate the maternal and neonatal risk related with multiple repeated cesarean sections. MATERIALS AND METHODS A case control study was conducted in a single tertiary maternity and childrens center. The outcome of a study group including 122 pregnant women undergoing cesarean section for the fourth or fifth time was compared with a control group comprising 146 women sectioned for the second and third time. All multiple repeated cesarean sections were divided into urgent and elective groups to compare the outcome measures of demographic, neonatal, intra- and post-operative data. RESULTS Compared with the control group, the study group had significantly lower birth weights (p=0.026), lower Apgar scores at 1 minute (p=0.0001) and 5 minutes (p=0.042), higher numbers of fetal death (p=0.03), higher rate of omentum adhesions (p =0.0001) and peritoneal adhesions (p=0.008), increased risk of cesarean hysterectomy (p = 0.014), increased need for transfusion (p = 0.018), and an increase in hospitalization days (p=0.005). Compared with the elective group, preterm birth incidence was higher (p = 0.01) and birth weight was lower (p=0.004) in the urgent group. The risk for myometrium herniation (p=0.018), need for drainage during operation (p=0.018), and post-operative fever (p =0.001) was also more common in the urgent group. CONCLUSION Multiple repeated cesarean sections increase the risks for operative complications and poor perinatal outcomes. Patients must be informed about the related risks of multiple repeated cesarean sections and tubal ligation needs to be encouraged.

HPV Infection and HPV Subtypes in Normal and Abnormal Cervical Cytology in Turkish Women

Results: Considering all the cases, 94,4 % (n=2040) had normal cytology, 3,8 % (n=82) had LSIL and 1,8 % (n=39) had HSIL. In the cytological evaluation, 8,75% (n=189; n=115 HPV(+), n=74 HPV(-)) of the patients were diagnosed as ASCUS. The incidence of HPV positivity was 12,6% (n=272). The most common subtype was HPV type 6 (n=109, 5%) while the incidences of the other subtypes from second most common to least common were as follows; type 18 (n=63, 2,9%), type 16 (n=53, 2,4%), type 11 (n=20, 0,9%), type 45 (n=10, 0,4%), type 52 (n=10, 0,4%), type 59 (n=4, 0,18%) and type 51 (n=3, 0,14%). Among the HPV positive patients, the most common HPV subtype was type 6 (n=109, 40%), and the other subtypes were type 18 (n=63, 23,2%), type 16 (n=53, 19,5%), type 11 (n=20, 7,3%), type 45, 51, 52 and 59. Conclusions: Eighty-nine percent of the HSIL smears were positive for HPV subtype 16 and/or 18. This suggests that by the use of vaccination programs, a significant amount of precancerous cervical lesions and cancer might be prevented.

Prenatal early diagnosis of dacryocystocele, a case report and review of literature.

Dacryocystocele (mucocele, amniocele) is a relatively rare variant of nasolacrimal duct obstruction which refers to the cystic dilatation of lacrimal pathway above and below the lacrimal sac. It is a benign pathology and can be treated successfully after birth, but its prenatal detection is important, because it may be seen in numerous syndromes and may serve as their marker. Bilateral cysts have the possibility for intranasal extension and an obstruction to the nasal passages may result in neonatal respiratory distress requiring surgical intervention Unilateral cases are important for the differential diagnosis with serious facial abnormalities. We present a case of early prenatal detection of a 28 year-old G: 1 P: 0 pregnant woman with bilateral dacryocystocele. She presented a live, normally developed singleton fetus on sonographic examination at 12, 16 and 22 weeks. At 25(th) weeks, we diagnosed a hypoechogenic mass, that was situated inferomedially to the eyes in the fetal face with 2 and 3-D ultrasound. A 3850-g live female infant was delivered by Cesarean section due to breech presentation at 39 weeks following preterm rupture of membranes. We report the case with intranasal components studied during fetal life by 2 and 3-D ultrasound and magnetic resonance (MR) imaging.

Laparoscopic surgery of interstitial (cornual) pregnancy, a case report

We report a successful laparoscopic management of an interstitial pregnancy of a 24- year-old single woman, treated by cornuostomy. The patient was first managed with methotrexate treatment. After the 2. methotrexate administration, the patient suffered from low abdominal pain, and intraabdominal bleeding signs were reported by transvaginal ultrasonograpy. The hemoglobin level was decreased from 12.8 gr/dl to 11.8 gr/dl and the beta hCG level was increased from 8,314 mIU/l to 11,541 mIU/l. The laparoscopic approach to interstitial pregnancy was presented and other management strategies such as medical treatment and laparotomy have been reviewed.

Enterobius vermicularis infection in uterine cavity mimicking endometrial cancer: a case report

Enterobius vermicularis (pinworm) is an intestinal nematode of humans and causes helminthic infection with a worldwide distribution and high prevalence especially in countries with temperate climates. The adult pinworms usually inhabit the cecum and adjacent gut. Gravid females migrate to the rectum and emerge on the perineum at night depositing eggs [1]; they can also migrate into the vagina and invade reproductive systems of women [2, 3]. The ova and larvae of the pinworm can be observed in cervicovaginal smears and there are several reports in literature describing associated salpingitis, pelvic inflammatory disease, infections of the ovary, endometrium, pelvic abscess, and generalised peritonitis [4–11]. While there have been limited case reports of enterobiasis of the female reproductive system, we describe a case of postmenopausal woman with enterobiasis in the uterine cavity mimicking endometrial cancer.

Laparoscopic management of a cornual ectopic pregnancy associated with persistant gestational throphoblastic disease: a case report

A 30-year-old woman underwent laparoscopy for diagnosis and treatment of ectopic pregnancy. A dark-red bulging mass was observed in the right uterine horn. Laparoscopic hysterotomy was performed. The histological examination revealed a hydatidiform mole, which was confirmed by DNA ploidy analysis showing triploidy (69 XXY) as apartial hydatidiform mole after the cytogenetic examination. On the third postoperative day, the thoracic computed tomography scan revealed punctuate lesions. These lesions disappeared after single-agent chemotherapy with methothrexate. To the best of our knowledge, this is the first case of cornual persistent gestational trophoblastic neoplasia managed by laparoscopic surgery.