Bulent Duran

The Effect of Glyceryl Trinitrate on Hypertension in Women with Severe Preeclampsia, HELLP Syndrome, and Eclampsia

Objective: The goal of this study is to evaluate the effect of glyceryl trinitrate (GTN) in the management of hypertension in women with preeclampsia, eclampsia, and HELLP syndrome. Study Design: Fifty five women with preeclampsia, eclampsia, and HELLP syndrome administered GTN infusion for the management of hypertension were studied. Demographic, clinical, and perinatal outcome findings were collected for analyses. We recorded initial and maintenance doses of GTN, and duration of its use in prepartum and postpartum periods. We collected systolic and diastolic blood pressures (BPs) at admission and before the administration of GTN infusion. During the GTN infusion, we calculated average diastolic and systolic blood pressures 6 hours apart on the first day, 12 hours apart on the second day, and 24 hours apart on the third day. Results: Of 55 women, 24 with severe preeclampsia, 16 with HELLP syndrome, and 15 with eclampsia were included in this study. In severe preeclampsia group, GTN infusion significantly reduced systolic and diastolic BPs beginning from the second quarter and third quarter, respectively, of first day (p < 0.05). In the HELLP syndrome group, GTN infusion significantly decreased systolic and diastolic blood pressures beginning from the third quarter and second quarter, respectively, of the first day (p < 0.05). In the eclampsia group, GTN infusion significantly reduced systolic and diastolic blood pressures beginning from the third quarter and first quarter, respectively, of the first day (p < 0.05). Conclusion: In women with severe preeclampsia, eclampsia, and HELLP syndrome, infusion of GTN can be used as an alternative agent to well‐known drugs and causes no significant adverse effect to the mother and fetus.

Use of methylene blue and N,O-carboxymethylchitosan to prevent postoperative adhesions in a rat uterine horn model

OBJECTIVES To compare the anti-adhesion potential of 1% methylene blue (MB) solution and 2% N,O-carboxymethylchitosan (NOCC) gel in a rat uterine horn model. DESIGN Experimental animal study. SETTING University medical center. ANIMAL(S) Forty female Wistar albino rats randomized into four groups. INTERVENTION(S) We examined the effects of 1% MB solution and 2% NOCC gel to reduce the extent and severity of postoperative adhesions in a rat uterine horn model: no adjuvant therapy in control group, 2 mL of normal saline (NS) solution in NS group, 2 mL of 1% MB solution in MB group, and 2 mL of 2% NOCC gel in NOCC group was instilled onto uterine horns of the rats. MAIN OUTCOME MEASURE(S) Adhesions were scored according to their extent and severity. RESULT(S) The extent and severity scores of adhesions in MB and NOCC groups were significantly lower than those of control and NS groups. There was no statistically significant difference between the extent and severity scores of adhesions between MB and NOCC groups. CONCLUSION(S) These findings suggest that MB and 2% NOCC gel should be considered as an adjuvant in the prevention of postoperative intra-abdominal adhesions. Future experimental and clinical studies are required to find their optimal formulation and usage.

Effects of diazeniumdiolates (NONOates) and methylene blue on the reduction of postoperative adhesion in rats

We investigated the effects of spermine NONOate (SPER/NO), diethylenetriamine NONOate (DETA/NO) and methylene blue for preventing postoperative adhesion in a rat uterine horn model. Before operations, rats were randomly assigned into 6 groups, each composed of 12 rats. These were the sham, control, normal saline, SPER/NO, DETA/NO and methylene blue groups. Each rat was anesthetized with ketamine hydrochloride (40 mg/kg i.v.). The abdominal wall was shaved; the surgical site was scrubbed with povidone iodine and rinsed with sterile saline 3 times before surgery. Under sterile conditions, a 3-cm vertical midline incision was made in all groups. In the sham group, we closed the abdominal wall without any procedure. In the other groups, a 2-cm segment of each uterine horn was injured in 10 spots on the antimesenteric surface using unipolar cautery. Before the final abdominal closure, no adjuvant therapy was administered intraperitoneally to the rats in the control group; 2 ml of normal saline solution, 1% methylene blue solution, SPER/NO (0.5 mg/ml) and DETA/NO (0.1 mg/ml) were instilled into the uterine horns of the rats in the respective groups. The incision was closed with a running 4-0 monofilament delayed absorbable suture in a single layer of muscle and fascia in a running pattern, excluding the peritoneum, and in the covering layer of skin in an interrupted pattern, in all groups. Two weeks after the surgery, all animals were killed, second laparotomies were performed, and the extent and severity of adhesions were determined by a blinded examiner. The adhesion scores of the sham group were significantly lower than those of the other groups (p < 0.05). In the methylene blue, SPER/NO and DETA/NO groups, adhesion scores were significantly lower than in the normal saline and control groups (p < 0.05). However, there were no significant differences related to the extent and severity scores of adhesions between the methylene blue, SPER/NO and DETA/NO groups (p > 0.05). This study showed that SPER/NO, DETA/NO and methylene blue administered at the end of surgery reduced the adhesion formation in a rat uterine horn model.

The Oral Toxicity of Resorcinol During Pregnancy: A Case Report

Resorcinol (1,3 benzenediol; m‐dihydroxybenzene: resorcin) is a pharmaceutical agent used topically in dermatological treatments such as acne and related skin conditions. It could also be used in combination with the other acne treatment agents such as sulphur. It could be very hazardous if taken orally and there are limited reports on its toxic effects in human. The present work aimed to report a resorcinol poisoning case in which resorcinol was taken accidentally by a woman at 30 weeks of pregnancy. The major clinical findings were unconsciousness, drowsiness, and respiratory failure that required mechanical ventilation along with tonic‐clonic seizures and hypothermia. In addition, the laboratory findings were leucocytosis, high bilirubin levels, severe metabolic acidosis, and green‐colored urine. The fetus was considered dead 24 h after delivery; however, mothers prognosis was well with supportive management. It could be concluded that the basic approach to the patient with resorcinol poisoning should include the initial stabilization of immediate life‐threatening problems and elimination of the toxin. This is the first report on resorcinol poisoning in pregnant women, indicating its major clinical and laboratory findings.

In vivo Evaluation of the Genotoxic Effects of Clomiphene Citrate on Rat Reticulocytes: A Micronucleus Genotoxicity

Objective: To determine the genotoxic effects of clomiphene citrate (CC) on rat reticulocytesin vivo. Methods: In this prospective, randomized, controlled study, rats were each assigned randomly to the CC 50, CC 100, CC 200, or control group and were given repeat doses of 0.16, 0.32 or 0.64 mg CC, or normal saline, respectively. Each study group received its CC dose in 2 ml of saline intraperitoneally for 5 days, while the control group received only 2 ml of saline. Each treatment cycle was repeated six times. Six months later, the rats were euthanized. Bone marrow tissues were removed, and pluripotent reticulocyte cells with micronuclei, nuclear buds, and binuclear abnormalities were analyzed using an in situmicronuclei assay under light microscopy. The proportion of micronucleated erythrocytes was measured. Results: Fewer cells with nuclear buds and binuclear abnormalities were detected in the CC 50 group and controls. The CC 100 and 200 groups had significantly (p < 0.05) more nuclear buds and binuclear abnormalities compared with the CC 50 group and controls in the cytogenetic analysis of bone marrow stem cells. Conclusion: In rats, the micronucleus genotoxicity assay suggests a dose-dependent CC effect on genomic instability in bone marrow stem cells in vivo.

Role of elective cesarean section in prevention of pelvic floor disorders.

Purpose of review The article reviews the current evidence and the role of elective Cesarean section in the prevention of pelvic floor disorders (PFDs). Recent findings Recent studies have revealed that operative vaginal delivery is an important risk factor for PFDs. The cause of PFD is multifactorial. Pregnancy itself also increases the PFDs. Elective Cesarean section carries diminished risk for stress urinary incontinence. Pelvic floor muscle training should be offered to all women in their first pregnancy as a preventive strategy. Summary The health provider should not offer elective Cesarean section to a pregnant woman without any prior risk of pelvic organ disorder for the prevention of urinary stress incontinence, anal incontinence, or pelvic organ prolapsus weighing the risks of Cesarean section.

Histopathological changes in ovary and endometrium after tubal ligation: a rat model.

Background. To evaluate the histopathological effects of tubal ligation on ovary and endometrium in a rat model.

Prevention of superficial wound disruption in Pfannenstiel incisions by using a subcutaneous drain.

Abdominal wound disruption is a major cause of morbidity following gynecologic surgical procedures. Despite advances in suture materials, antibiotics, and perioperative care, the rate of dehiscence varied little in the 20th century. There may remain a space when an abdominal incision is closed, and that space is conducive to seroma formation and wound infection. Only a few trials have studied the use of a subcutaneous suction drain in the prevention of wound dehiscence 1,2 ; and because in these trials midline incisions were performed on all patients, the effect of subcutaneous drainage has not yet been established for Pfannenstiel incisions. We aimed to determine the effect of subcutaneous drains in the prevention of superficial wound disruption following Pfannenstiel incisions in gynecologic surgery.

Effect of Clomiphene Citrate on Ovarian, Endometrial, and Cervical Histologies in a Rat Model

Objective: To examine the effect of clomiphene citrate (CC) on the ovarian, endometrial, and cervical histologies in a rat model. Methods: The rats (n = 40) were randomly assigned to 4 treatment groups: CC 50 (repetitive doses of 0.2 mg CC); CC 100 (repetitive doses of 0.4 mg CC); CC 200 (repetitive doses of 0.8 mg CC), and control (repetitive doses of normal saline). Each study group received its CC dose intraperitoneally in 2 ml saline for 5 days and the controls received 2 ml saline only. Each treatment cycle was repeated six times. Six months later the rats were euthanized. Their ovaries, uterine horns, and cervices were removed and examined for histologic changes. Results: We found no significant difference in the number of follicles and corpora lutea of the study groups (p > 0.05). The numbers of granulosa, theca, and luteal cells of the CC 100 and CC 200 groups were significantly higher than those of the CC 50 group and controls (p < 0.05). There was no important finding related to pre-malign and malign changes in ovarian, endometrial and cervical samples of the control and CC 50 groups. Focal atypia and atypical mitoses were noted in 2 cases of granulosa cells in the CC 100 and CC 200 groups. Conclusion: We did not find an association between the use of CC and ovarian, endometrial, and cervical neoplasms; nevertheless, we noticed an increase in granulosa, theca and luteal cells with high doses of CC, which may be a risk factor for granulosa, theca, and luteal cell tumors.

Navigation problems of ICSI or naive blastocyst can be solved with artificial blastocyst

Embryos have evolved a remarkable capacity to find implantation site. The impressive navigation ability of natural blastocysts may rely on highly sensitive signals arising from embryos and specialized signal processing strategies in the endometrium. Navigation capabilities may be compromised in ICSI embryos because of altered biochemical signaling. The design and delivery of artificial blastocyst (AB) carrying strong chemical signals may allow ICSI embryos to more easily locate to and be retained in the implantation zone. ICSI embryos will attach easily to the implantation zone after it is found by the AB. Co-transfer of the AB together with the ICSI embryo may overcome potential difficulties in implantation due to impaired embryo-maternal communication in cases with implantation failure.