Hasan Kafali

Transcutaneous electrical nerve stimulation improves low back pain during pregnancy.

Background: To compare the efficiency of transcutaneous electrical nerve stimulation (TENS) with those of exercise and acetaminophen for the treatment of pregnancy-related low back pain (LBP) during the third trimester of pregnancy. Methods: This prospective study included 79 subjects (≥32 gestational weeks) with visual analog scale (VAS) pain scores ≥5. Participants were divided randomly into a control group (n = 21) and three treatment groups [exercise (n = 19); acetaminophen (n = 19); TENS (n = 20)]. The VAS and the Roland-Morris disability questionnaire (RMDQ) were completed before and 3 weeks after treatment to assess the impact of pain on daily activities. Results: During the study period, pain intensity increased in 57% of participants in the control group, whereas pain decreased in 95% of participants in the exercise group and in all participants in the acetaminophen and TENS groups. Post-treatment VAS and RMDQ values were significantly lower in the treatment groups (p < 0.001). VAS and RMDQ scores indicated a significantly greater degree of pain relief in the TENS group than in the exercise and acetaminophen groups (p < 0.001). No adverse effect of TENS application on pregnant women was observed during the study. Conclusion: TENS is an effective and safe treatment modality for LBP during pregnancy. TENS improved LBP more effectively than did exercise and acetaminophen.

Influence of Gum Chewing on Postoperative Bowel Activity after Cesarean Section

Objective: To assess the effects of gum chewing on postoperative bowel function after cesarean section. Material and Methods: Women who underwent cesarean section were randomized to either a gum-chewing group (n = 74) or a non-gum-chewing group (n = 76). The two groups were compared with respect to the return of bowel activity, postoperative analgesic and antiemetic drug requirement and postoperative hospital stay. Results: Bowel sounds appeared in a significantly shorter duration of time in the study group, the mean being 5.9 h as compared to 6.7 h in the control group (p < 0.01). The first passage of flatus postoperatively was 22.4 h in the gum-chewing group and 31 h in the control group (p < 0.001). The total length of hospital stay was shorter in the gum-chewing group (2.1 days) than in the control group (2.3 days), but it was not statistically significant (p > 0.05). Postoperative analgesic requirement in both groups was similar, but the postoperative antiemetic need in the gum-chewing group was lower than in the control group (p < 0.01). Conclusion: On the basis of the tolerability and results on bowel function, gum chewing provides a simple method for early recovery of bowel function after cesarean section.

Effect of maternal anxiety and music on fetal movements and fetal heart rate patterns.

Objective. Aimed to investigate (a) the effect of non-stress test (NST) and music on maternal anxiety (b) the effect of maternal anxiety and music on fetal heart rate (FHR) changes. Material and method. The two hundred and one pregnant women coming for routine prenatal care were randomized to receive either music (n = 96) or no music (n = 105) during NST. Before and after the test, these women were asked to complete the Spielberg State-Trait Anxiety Inventory on two interviews; primary outcome was considered as a maternal state anxiety score before and after NST. Secondary outcome was the baseline FHR, the number of fetal movement, large accelerations, dubious NST, variable decelerations, and the minimum procedure time. Results. Before NST, the mean state anxiety score of the music and control groups was found as 38.1 ± 8.8 and 38.08 ± 8.2, respectively (p > 0.05). On the other hand, after NST, the mean state anxiety score of the music and control groups was found as 35.5 ± 8.2 and 40.2 ± 9.2, respectively (p < 0.001). While in control group, NST brought about a statistically significant increase in a state anxiety score (38.08 ± 8.2 versus 40.2 ± 9.2, p < 0.001), listening to music during NST resulted in decrease in a state anxiety score of the study group but it was not statistically significant (38.1 ± 8.8 versus 35.5 ± 8.2, p > 0.05). The baseline FHR of the music group was significantly higher than that of the control group (134.09 ± 7.2 versus 130.3 ± 5.7, p < 0.001).The number of fetal movement in the music group was significantly higher than that of the control group (8.9 ± 4.7 versus 5.9 ± 3.9, p < 0.001). The number of large accelerations in music group was significantly higher than that of the control group (5.7 ± 2.1 versus 4.5 ± 2.04, p < 0.001). The minimum procedure time in music group was significantly lower than that of control group (13.4 ± 5.2 versus 15.6 ± 6.1, p < 0.05). The number of dubious NST and variable decelerations was found to be similar for both groups (p > 0.05). Conclusion. NST has anxiogenic effects on mothers and listening to music during the test has positive impact on both maternal and fetal parameters but it is an open question whether maternal anxiety during pregnancy may affect fetal accelerations to such an extent that it could influence clinical judgments.

Impact of maternal fasting during Ramadan on fetal Doppler parameters, maternal lipid levels and neonatal outcomes

Objective: The aim of the present study was to evaluate whether fasting may cause changes in maternal lipid profile, glucose level and ketonuria, and whether it has any adverse effects on fetal Doppler, birthweight, preterm delivery or cesarean section rate. Methods: Fifty-six consecutive, healthy women with singleton uncomplicated pregnancies of ≥28 week gestation who had fasted for at least 10 consecutive days during the study period were defined as the study group. Fifty-four healthy non-fasted women matched for age, parity, and gestational age were defined as the control group. Groups were compared according to fetal middle cerebral artery and umbilical artery systolic/diastolic ratio, maternal serum lipid levels and neonatal outcomes (gestational age at delivery, birthweight, delivery type and neonatal intensive care admission). Results: No statistical difference was found between the groups according to fetal Doppler parameters, amniotic fluid index, gestational age at delivery, cesarean section rate, birthweight or NICU admission. However, lower levels of VLDL, triglyceride and higher incidence of ketonuria were detected in the fasting group (p < 0.05). Conclusion: Fasting of healthy women during pregnancy seems to have no adverse effects on amniotic fluid index, fetal Doppler and delivery parameters.

Topical Anesthetic (Lidocaine-Prilocaine) Cream Application Before Speculum Examination in Postmenopausal Women

STUDY OBJECTIVE To evaluate the effectiveness of lidocaine-prilocaine (EMLA 5%) cream application to genital mucosa for reducing pain or discomfort associated with speculum examination in postmenopausal women. DESIGN A randomized controlled study (Canadian Task Force classification I). SETTING A university hospital. PATIENTS One-hundred thirty-four postmenopausal women. INTERVENTIONS The subjects were randomized to an EMLA cream group, a lubricant gel group, or a control group. General data was collected, including age, body weight, gravidity, parity, smoking habits, history of diabetes mellitus, previous gynecologic operations, dyspareunia, sexual activity, and duration of menopause. All patients were asked to score pain at 3 time points (insertion, dilation, and extraction of speculum) during the procedure using a visual analog scale. Pain intensity during speculum examination was compared between the groups. MEASUREMENTS AND MAIN RESULTS There was no statistically significant difference between the EMLA cream, the lubricant gel, and the control groups in terms of age, weight, gravidity, parity, dyspareunia, duration of menopause, sexual activity, smoking habit, diabetes mellitus, previous vaginal and other gynecological procedures, vaginal length, and serum follicle-stimulating hormone and estradiol levels (p > .05). The pain scores obtained during all phases of speculum application were significantly lower in the EMLA group than in both the lubricant gel and the control groups (p < .001). Comparing the gel and the control groups, a lower pain score was observed in the former, except for the second phase of the examination (p < .001). CONCLUSION Topical application of EMLA 5% cream on genital mucosa of postmenopausal women before vaginal examination significantly reduces pain associated with speculum application.

A new radiological approach to cyclic mastalgia: Venous doppler ultrasound

OBJECTIVE To evaluate the role of the venous system in cyclical mastalgia. MATERIALS AND METHODS 25 healthy women and 39 women with cyclic mastalgia underwent venous Doppler examination in both pre- and postmenstrual period. Upper-outer quadrant veins of breast were evaluated. The impedance indices of both groups were compared in both the premenstrual and postmenstrual period. RESULTS During the premenstrual period, venous impedance indices were significantly higher in the patients with cyclic mastalgia (p=0.004) than in the control group. After the menstrual period, there was no difference in venous impedance indices between the groups. CONCLUSION Excessive tissue oedema might be responsible for both a tension-mediated pain and a compression of the venous system thereby showing higher impedance than that in control group.

Effect of liquid-based gel application during speculum examination on satisfactory level of smear examination

PurposeThe aim was to evaluate the use of liquid-based gel during cytologic follow-up and the effect of liquid-based gel application during speculum examination on satisfactory level of smear.MethodsA total of 1,999 patients were taken into the study. Patients were divided into two groups as gel-applied group and control group. Age and menopausal status of patients, and the physicians taking the smear (resident or specialist) were recorded. In control group, dry speculum was used for the collection of smear sample. All specimens were evaluated for correlation of the cytopathology, the number of “unsatisfactory” samples, and any secondary diagnoses.ResultsAssessment of smear satisfactoriness revealed that 2.2% (43) of them were unsatisfactory. Unsatisfactory smear ratio was significantly high in gel-applied group. Screening done by residents increased unsatisfactory result risk for about 5.5 times. Evaluation of effect of menopausal status on smear adequency revealed no difference between premenopausal and postmenopausal women.ConclusionCervical smear seems to be more accurate without gel application. Experience of the physician is also important. Water-based gel can be used in some women who experience overt pain during speculum examination, but these patients must be warned about unsatisfactory results and the need of repeat test.

Placement of Bupivacaine-soaked Spongostan in Episiotomy Bed Is Effective Treatment Modality for Episiotomy-associated Pain

STUDY OBJECTIVE To investigate the efficacy of placing bupivacaine-soaked Spongostan (Ferrosan, Soeborg, Copenhagen, Denmark) in episiotomy beds for relief of postpartum pain. DESIGN Randomized, controlled study (Canadian Task Force classification I). SETTING University medical school. PATIENTS Women with mediolateral episiotomy. INTERVENTIONS Patients were recruited and randomized into 2 groups by using a random number table. Group I (control group) received local lignocaine infiltration 1% up to 20 mL. For group II (Spongostan group), in addition to local lignocaine infiltration, bupivacaine-soaked Spongostan was placed in the episiotomy bed. All patients received routine postpartum perineal care in addition to the regular pain drugs (75 mg of diclofenac every 4 hours if needed). The primary outcome for the study was severity of pain, rated on a 10-cm visual analog scale from 0 to 10. Rating was recorded at 0, 1, 1.5, 2, 6, and 24 hours after delivery. MEASUREMENTS AND MAIN RESULTS In all, 48 women were randomized to group I (local lignocaine alone) and 51 women to group II (local lignocaine plus Spongostan). The Spongostan and control groups were similar with respect to maternal age, parity, gestational age, maternal weight, and neonatal birth weight (p >.05; CI for difference: -2.6/10, 0.1/0.3, 0.3/0.7, 6.9/1.7, and -7/1.9, respectively). Episiotomy length (both vaginal and perineal) and episiotomy depth were higher in Spongostan group than control group (p <.05; 95% CI: -0.9/0, -0.8/-0.1, and -0.6/0, respectively). However, episiotomy reconstruction time of both groups was similar (p >.05; CI: 1.7/6.2). The pain score of Spongostan group was lower than control group and it was statistically significant at all time intervals (0, 1, 1.5, 2, 6, and 24 hours) between the Spongostan and control groups (p <.05; CI: 0.6/1.9, 1.1/2.4, 1.0/2.5, 0.9/2.4, 0.3/1.9, and 0.5/1.8, respectively). Postpartum total analgesic requirement (mg/person) again was significantly lower in the Spongostan group than control group (p <.01; CI: 0.1/0.4). CONCLUSION Placement of bupivacaine-soaked spongostan into the episiotomy bed resulted in decreased postpartum pain and drug requirement. It may be attributed to a higher drug concentration at episiotomy bed and prolonged drug effect.

Diagnostic value of hysteroscopy and hysterosonography in endometrial abnormalities in asymptomatic postmenopausal women

ObjectiveTo estimate the diagnostic value of hysteroscopy and hysterosonography in endometrial pathologies in asymptomatic postmenopausal women.Materials and methodsIn this prospective study, 77 asymptomatic postmenopausal women that had a suspicion of endometrial abnormalities based upon transvaginal ultrasonography were studied. The patients underwent transvaginal ultrasonography and hysterosonography. All patients then had office diagnostic hysteroscopy or operative hysteroscopy. The final diagnosis was made by operative hysteroscopy with resection and excision of the lesions or endometrial biopsy with vacuum curettage. Sensitivity, specificity, positive predictive value and negative predictive value of transvaginal ultrasonography, hysterosonography and diagnostic hysteroscopy were calculated.ResultsThe patients’ age ranged from 45 to 80. The most common frequent abnormalities were endometrial hyperplasia in transvaginal ultrasonography (62.33%), endometrial polyp in sonohisterography (57.14%), and also endometrial polyp in diagnostic hysteroscopy (51.94%). Transvaginal ultrasonography revealed a sensitivity of 59.7% and a specificity of 35.5%. Sonohysterography revealed a sensitivity of 88.8% and a specificity of 84.4%. Diagnostic hysteroscopy revealed a sensitivity of 91% and a specificity of 82%.ConclusionHysterosonography showed very good agreement with hysteroscopy for the diagnosis of endometrial abnormalities in asymptomatic postmenopausal women. In asymptomatic postmenopausal women that had a suspicion of endometrial abnormalities based upon transvaginal ultrasonography should undergo both hysterosonography and hysteroscopy.

Vulvar pilonidal sinuses: treatment of a rare cause of vulvar pain

It is hoped that if cases of vulvar pilonidal sinus (PS) are known to readers of this article, they will be called to the writers attention and that further studies of the origin and cause of these anterior pathologic developments will result. A delay in diagnosis and treatment of this relatively harmless condition can lead to complications like abscess formation. Early diagnosis, complete excision and elimination of the anatomical factor that cause accumulation of hair fragments are followed by an excellent prognosis.