Burçin Kavak

The effect of hysterectomy and bilaterally salpingo-oophorectomy on sexual function in post-menopausal women

OBJECTIVE To examine the effects of hysterectomy and bilaterally salpingo-oophorectomy (BSO) on Female Sexual Function Index (FSFI) in the post-menopausal women. METHOD This study included 92 women who underwent vaginal hysterectomy (VH) and BSO (n:37) and who underwent abdominal hysterectomy (AH) and BSO (n:55). Estrogen replacement therapy (ERT) was given 21 women who underwent VH and BSO and 28 women who underwent AH and BSO in pre- and postoperative periods. All patients were evaluated preoperatively and postoperative 6th month in terms of FSFI scores. RESULTS It was found that hysterectomies by abdominal or vaginal routes reduced FSFI scores significantly (P<0.05). The use of ERT were no effect on total score of FSFI in AH and BSO (P>0.05). ERT prevented deterioration of FSFI in women who underwent VH relative to preoperative values but AH. CONCLUSION Hysterectomy causes unfavourable effects on sexual functions at least in the first 6 postoperative months and this negative effect can not be repaired by estrogen replacement therapy in AH and BSO.

Changes in serum obestatin, preptin and ghrelins in patients with Gestational Diabetes Mellitus.

OBJECTIVES The present study aims to establish the levels of acylated ghrelin, desacylated ghrelin, obestatin and preptin, during pregnancy and the postpartum period in pregnant women with Gestational Diabetes Mellitus (GDM) and healthy pregnancy women. DESIGN AND METHODS The study registered 20 pregnant women with GDM and 20 healthy pregnant women. Fasting venous blood samples were collected from all cases between weeks 24 and 28 of pregnancy and after 24h postpartum. Hormones were analyzed using ELISA method. RESULTS Serum acylated ghrelin (p:0.001), desacylated ghrelin (p:0.001), obestatin (p:0.006) and preptin (p:0.001) levels were all found statistically higher in both groups during the postpartum period, when compared to the pregnancy period. A positive correlation was established between desacylated ghrelin and acylated ghrelin (p:0.008), desacylated ghrelin and preptin (p:0.012) and preptin and insulin (p:0.039) in the GDM group during pregnancy. CONCLUSIONS The studied hormones (especially desacylated ghrelin and obestatin) are critical in GDM pathophysiology based on the comparison of measure after and before the delivery.

Posterior Reversible Encephalopathy Syndrome in severe preeclampsia: case report and literature review.

We describe a 23 year old primigravid patient with severe preeclampsia complicated by posterior reversible encephalopathy syndrome (PRES), who presented with sensory and motor deficits and amnesia in the postpartum period Cranial magnetic resonance imaging (MRI) showed abnormal areas in the white matter of bilateral parieto-occipital lobes, indicating brain edema which disappeared completely on the follow-up scan taken four weeks after delivery together with complete symptom regression. The development of PRES in preeclampsia is discussed and the importance of prompt postpartum blood pressure control is emphasized.

Effects of preoperative oral carbohydrate solution intake on thermoregulation

Background We aimed to investigate the oral carbohydrate solution administered preoperatively on thermoregulation. Material/Methods The study included 40 female patients under general anesthesia. Patients were randomly divided into 2 groups: Group CONT (stopped oral implementation 8 h before the operation) and Group CHO (800ml oral carbohydrate fluid 8 h before the operation and 400ml oral carbohydrate fluid 2 h before the operation). Patients were monitored as standard and temperature probes were placed. Temperatures were recorded immediately before anesthetics induction, 5 min after the anesthetics induction, and in the post-anesthesia care unit (PACU) every 10 min. Mean skin temperature (Tsk), mean body temperature (Tb), and vasoconstriction threshold were estimated. Results In general, we observed a decrease in tympanic temperature and Tb following anesthetic administration in groups, and increase in Tsk, and an increase in all 3 of these levels in the recovery unit. Tympanic temperature was significantly higher at 25, 55, 65, and 95 min after induction in Group CONT compared to Group CHO (p<0.05). Tsk was found to be lower in Group CONT compared to Group CHO in almost all periods. In PACU, it was found that the tympanic temperature was higher in Group CONT compared to Group CHO at 60 min (p<0.05). Postoperative shivering score was found to be significantly higher in Group C (p<0.01). Vasoconstriction threshold was higher in Group CONT than Group CHO. Conclusions Oral carbohydrate solution administered was established to have effects thought to be negative on tympanic temperature, vasoconstriction, and vasoconstriction threshold.

Ghrelin and obestatin expression in serous ovarian tumours.

Objective: To investigate ghrelin and obestatin expression in serous ovarian tumours. Materials and methods: Preparations of deparaffinized blocks obtained from the pathology archives of a total of 47 previously diagnosed cases of benign serous tumour (n = 20), borderline serous tumour (n = 7) and malignant serous tumour (n = 20) were subjected to immunohistochemical examination to find out ghrelin and obestatin expressions. Results: Mean ghrelin expressions decreased significantly in the benign group, relative to the malignant group (p < 0.05), while there was no significant change in mean obestatin expression. It was established that rates of preparations with moderate and severe ghrelin and obestatin expression displayed a significant increase from benign to malignant ones (p < 0.05). Conclusion: The fact that rates of preparations with severe expression correlated with an increase in malignancy suggests that ghrelin and obestatin may be effective in the malignant transformation in at least some cases.

Comparison of results of Bakri balloon tamponade and caesarean hysterectomy in management of placenta accreta and increta: a retrospective study

Abstract The aim of this study was to compare the postoperative results of the patients who were treated with Bakri balloon tamponade or hysterectomy for placenta accreta and increta. Patients who were diagnosed with placenta accreta or increta preoperatively and intraoperatively and treated with Bakri balloon tamponade (Group 1) or caesarean hysterectomy (Group 2) were compared in regards to the postoperative results. Among the 36 patients diagnosed with placenta accreta or increta, 19 patients were treated with Bakri balloon tamponade while 17 cases were treated with hysterectomy. Intraoperative blood loss amount was 1794 ± 725 ml in G1, which was lower than that in G2 (2694 ± 893 ml). Blood transfusion amount was 2.7 ± 2.6 units in G1, lower than that in G2 (5.7 ± 2.4 units), too. Operation time was 64.5 ± 29 min and 140 ± 51 min in G1 and G2, respectively, showing significant differences between two groups. The success rate of Bakri balloon was determined as 84.21%. In conclusion, cases with placenta accreta/increta, with predicted placental detachment who are willing to preserve fertility, application of uterine balloon tamponade devices before the hysterectomy is encouraging with its advantages compared with the hysterectomy. Impact statement What is already known on this subject: Invasive placental anomalies are the most common indication of postpartum hysterectomy. Recently, uterine balloon tamponade was also included in the treatment modalities of postpartum haemorrhage.This study aimed to compare the postoperative results of UBT or hysterectomy for patients with placenta accreta and increta. What the results of this study add: In this study, the total amount of blood loss was higher in the caesarean hysterectomy group when compared with the Bakri balloon tamponade group. The mean transfusion requirement, mean operation time and hospitalisation period was significantly longer in the caesarean hysterectomy group. The success rate of the Bakri balloon was determined as 84.21%. Two patients who were treated with balloon application had a successful pregnancy and delivery later. Maternal mortality was reported in neither balloon nor hysterectomy groups. What the implications are of these findings for clinical practice and/or further research: In conclusion, patients diagnosed with placenta accreta/increta with ultrasound should be taken into the operation in elective conditions, if possible, on lithotomy position. In cases with predicted placental detachment that are willing to preserve fertility, application of uterine balloon tamponade devices before the hysterectomy has advantages compared with the hysterectomy.

Comparison of patient‐controlled analgesia versus continuous infusion of tramadol in post‐cesarean section pain management

To evaluate and compare analgesic efficacy, drug consumption and patient satisfaction with the i.v. patient‐controlled and continuous infusion modes of administration of tramadol.

Mullerian inhibiting substance expression in papillary thyroid cancer

OBJECTIVE To examine the expression of Mullerian inhibiting substance (MIS) in papillary thyroid cancer. MATERIALS AND METHODS The MIS expression was examined by studying the immunohistochemistry in deparafinized sections prepared from tissue blocks of patients who were diagnosed with papillary thyroid cancer, as given in the pathology archive records (n = 23). RESULTS In all the cases studied, 50% (n = 10) showed strong staining and 50% showed moderate staining. The percentage of staining was found to be 94.2 ± 3.1% in strongly stained cases and 92.2 ± 2.1% in moderately stained cases. Normal thyroid tissues neighboring the tumor did not display any staining. CONCLUSION The MIS expression can be used as a significant tool in differential diagnosis of papillary thyroid cancer and also to shed light on its etiopathogenesis.