Mekin Sezik

Total salpingectomy during abdominal hysterectomy: Effects on ovarian reserve and ovarian stromal blood flow

Aim:u2002 To investigate the short‐ and medium‐term consequences of performing total salpingectomy during abdominal hysterectomy (without oophorectomy) on certain ovarian reserve parameters and blood flow velocity measurements through the ovarian stroma.

Prediction of Adverse Neonatal Outcomes in Preeclampsia by Absent or Reversed End-Diastolic Flow Velocity in the Umbilical Artery

To evaluate the independent contribution of absent or reversed end-diastolic umbilical artery Doppler flow (AREDF) in the prediction of subsequent adverse neonatal outcomes, we performed Doppler examinations on 270 preeclamptic women with a singleton pregnancy. The end-point variables were low Apgar scores and adverse neonatal outcomes (respiratory distress syndrome, intracranial hemorrhage, sepsis, seizures, jaundice, hypoglycemia, hypocalcemia, thrombocytopenia, polycythemia, and neonatal mortality). Stepwise logistic regression was used to control for gestational age, oligohydramnios, and fetal growth restriction. Infants with AREDF had an increased frequency of hypoglycemia (odds ratio = 1.7) and polycythemia (odds ratio = 1.7), whereas the remaining neonatal outcomes were explained by gestational age and growth restriction. Therefore, live-born infants of preeclamptic patients with AREDF velocities, independent of prematurity and growth restriction, are prone to hypoglycemia and polycythemia.

Placebo-controlled randomized comparison of vaginal with rectal misoprostol in the prevention of postpartum hemorrhage

Aim: To compare vaginally administered misoprostol to rectally administered misoprostol and placebo in a prospective randomized placebo‐controlled study.

Raloxifene decreases serum malondialdehyde and nitric oxide levels in postmenopausal women with end-stage renal disease under chronic hemodialysis therapy

Aim:u2002 We prospectively aimed to investigate the relationship between raloxifene administration and serum malondialdehyde (MDA), nitric oxide (NO), high‐density lipoprotein (HDL), low‐density lipoprotein (LDL), and triglyceride levels in postmenopausal women undergoing hemodialysis treatment for chronic renal failure.

Prediction of domestic violence against married women in southwestern Turkey.

To determine the prevalence of, and independent risk factors for various domestic violence categories among married women of reproductive age in southwestern Turkey.

Medical students' participation in and perception of unprofessional behaviors: comparison of preclinical and clinical phases

We aimed to compare reported observations, participation in, and perceptions of unprofessional behaviors across preclinical and clinical medical students using a 23-item questionnaire that asked participants whether they witnessed or participated in the behavior and considered it unprofessional. Overall, 111 preclinical (year 3) and 104 clinical (year 4) students responded. For all of the behaviors, significant positive correlations were present between participation and affirmative perceptions. Participation rates for several unprofessional behaviors (14 of 23 items) were higher in the clinical phase. Clinical students more frequently perceived unprofessional behaviors as appropriate (17 of 23 items) compared with preclinical students. In conclusion, both preclinical and clinical medical students in our setting commonly witness unprofessional behaviors. Clinical students participate in and tend to rationalize these behaviors more frequently than preclinical students do.

Ultra-high dose of intra-amniotic or direct fetal intramuscular betamethasone for lung maturation in the preterm goat model

OBJECTIVEnTo evaluate the effects of intra-amniotic (IA) and fetal injections of a single ultra-high dose of betamethasone (BM) 48 h before preterm delivery on neonatal pulmonary function, using an experimental goat model.nnnSTUDY DESIGNnEighteen date-mated singleton pregnant Hair goats were randomized into four groups. At gestational day 118 (alveolar phase, term 150-155 days) after obtaining a sample of amniotic fluid, fetuses in group 1 (n=5) received 8 mg/kg IA BM, and in group 2 (n=5) 4 mg/kg fetal IM BM. In group 3 (n=4) (0.3mg/kg/day) maternal BM was administered at day 118 and 119 with a 24h interval; control fetuses (n=4) received 1 mL/kg of IA saline at day 118. At gestational day 120, after obtaining second sample of amniotic fluids 18 kids were delivered by preterm cesarean section, entubated, weighed, and mechanically ventilated for 15 min. Arterial blood gas samples and deflation/inflation lung pressure-volume measurements were obtained. After sacrifice, lungs were removed, weighed, gross examined and processed for further histological and immunohistochemical (IHC) evaluations. On hematoxylin and eosin (HE) stained slides, presence and severity of lung emphysema was evaluated; slides stained for surfactant proteins, and caspases were used for semi-quantitative evaluation of lung maturation. Kruskal-Wallis, Mann-Whitney, Wilcoxon signed rank, and chi-square tests were used for comparisons.nnnRESULTSnIA BM was associated with increased number of stillbirths (60% vs. 0% in control) (p=0.06) and emphysematous changes. Bodyweight-adjusted pressure-volume measurements were improved after maternal, but not IA or fetal, BM (p=0.06). Following mechanical ventilation, arterial blood gas parameters did not significantly alter across maternal and fetal administrations. However, pH was significantly lower (p<0.05) and carbon dioxide partial pressure was higher (p<0.05) in the control group, indicating hypercapnic acidemia in non-treated pregnancies. None of the treatments induced measurable alterations in amniotic fluid lecithin/sphingomyelin (L/S) values. IA and fetal routes were associated with decreased surfactant protein expressions and increased apoptotic activity in alveolar and bronchio-alveolar epithelial cells.nnnCONCLUSIONnUltra-high dose IA and fetal IM BM is not superior to the standard dose and maternal way of administration in our experimental design.

Intrafascial versus extrafascial abdominal hysterectomy: effects on urinary urge incontinence

Our aim was to evaluate urinary urge incontinence following intrafascial and extrafascial abdominal hysterectomies in a prospective randomized study. Women scheduled for total abdominal hysterectomy were randomized to the extrafascial (n=38) and the intrafascial techniques (n=42). The groups were controlled for demographic variables, obstetric and gynecologic history, uterine size, indications for hysterectomy, and preoperative hemoglobin values. Short-term surgical morbidity and presence of urge incontinence defined as urodynamically established detrusor overactivity at the end of 12xa0months were the main outcome measures. Major surgical morbidity did not differ between the two groups. Percentages of women with urge incontinence at the end of the follow-up period were also similar. However, when women with pre-existing urge incontinence were evaluated separately, there was a trend towards the intrafascial operation to be associated with more urge-incontinence-free patients at the end of the follow-up period ( p =0.06, borderline significant). As a result, short-term surgical morbidity seems to be similar across the intrafascial and extrafascial techniques of abdominal hysterectomy. The effects of intrafascial abdominal hysterectomy on women presenting with urge incontinence in the preoperative period merit further investigation.

Can we consider cesarean myomectomy as a safe procedure without long-term outcome?

Abstract Aim: To investigate short- and long-term outcomes in women undergoing cesarean myomectomy (CM). Methods: This was a retrospective study that explored short-term outcomes of women, who underwent cesarean operations with or without myomectomies (CM controls) in a single tertiary center throughout a 6-year-period. For long-term outcomes, the mean duration of follow-up was 6.3u2009±u20091.0 years. Results: There were no differences among the CM (n=u200991) and control groups (nu2009=u200960) considering mean change in hemoglobin and hematocrit levels, hemorrhage, as well as requirement for blood transfusions with a slightly increased operative time. Multiple myomas, and cervical and cornual localization were associated with an increased drop of hemoglobin and hematocrit (pu2009<u20090.05). Subsequent pregnancy and recurrence rates were 35% (32/91) and 5.5% (5/91), respectively. Preterm delivery (nu2009=u20091, 3.1%), uterine dehiscence (nu2009=u20091, 3.1%), placenta previa (nu2009=u20091, 3.1%) and mild-to-severe post-CM adhesions (nu2009=u20098, 25%) were observed in subsequent pregnancies. Recurrence was identified in five of the nonpregnant (5.5%) women, and three of these (4.1%) underwent an additional major surgery. There was no recurrence in subsequent pregnancies. Conclusion: The recurrence of myoma was relatively low following CM. Subsequent pregnancy is protective for recurrence of myoma without increased adhesion formation and obstetric complications.

Abnormal Ductus Venosus Flow and Tricuspid Regurgitation at 11–14 Weeks' Gestation have High Positive Predictive Values for Increased Risk in First-Trimester Combined Screening Test: Results of a Pilot Study

OBJECTIVEnTo investigate the relationship between two novel first-trimester ultrasound markers (abnormal fetal ductus venosus [DV] flow and presence of tricuspid regurgitation [TR]) and the results of the first-trimester combined screening test in pregnancies with a normal karyotype. The screening test involves nuchal translucency measurement by ultrasound, and measurement of serum free beta-chorionic gonadotropin and pregnancyassociated plasma protein A.nnnMATERIALS AND METHODSnThe study included 58 pregnancies with amniocentesis-proven normal karyotypes and ultrasound-proven normal fetal anatomy. DV flow and TR were initially evaluated by ultrasound at 11-14 weeks gestation. Sensitivity, specificity, and positive and negative predictive values of abnormal DV flow and TR for determining increased test risk (> 1 in 300) were calculated.nnnRESULTSnAbnormal DV flow and TR were detected in seven (12%) and six (10%) women, respectively. The sensitivities of abnormal DV flow, TR, and dual abnormalities (abnormal DV flow plus TR) for predicting increased risk in the combined screening test were low (33.3%, 27.7%, and 26.3%, respectively). However, their corresponding specificities (97.5%, 97.5%, and 100%) and positive predictive values (85.7%, 83.3%, and 100%) were reasonably high, with particularly low false-positive rates (2.5%, 2.5%, and 0%). When abnormal DV flow and TR were both positive, the combined test risk was consistently above 1 in 300.nnnCONCLUSIONnDetermination of DV flow and TR as initial markers in unselected pregnancies merits further investigation, as the combination of these parameters might reliably predict an increased risk in combined screening test result, with low false positivity.