Metin Çapar

Serum TNF-α, IL-6, lupus anticoagulant and anticardiolipin antibody in women with and without a past history of recurrent miscarriage

ObjectiveThe aim of the this study was to investigate Lupus Anticoagulan (LA), Anticardiolipin Antibody (ACA), Tumor Necrosis Factor-α (TNF-α) and Interleukin-6 (IL-6) serum levels in 40 pregnant and 20 nonpregnant.Materials and methodsThe women were divided into three groups. The first group consisted of 20 pregnant women of less than 20 gestational weeks and a past history of habitual abortion . The second group consisted of 20 non pregnant patients with a past history of habitual abortion. The third group consisted of 20 healthy non pregnant women. RESULT: LA was found in only one patient in the Group 2. ACA Ig G positivity were found 1 patient in the Group 1, 3 patients Group 2 and 1 patient in Group 3. Mean ACA IgG was highest in the Group 2. High serum TNF-α levels were found in the 12 (60%), 6(30%) and 2 (10%) women in the Groups 1, 2, and 3, respectively. Significant difference were found for TNF-α among the groups (P<0.05). The highest level of TNF-α was found in the Group 1 and the lowest in the Group 3. There were statistically significant differences for IL-6 among the three groups (P>0.05).ConclusionWe propose that cytokines especially TNF-α was found to be related to the pregnancy loss.

The treatment of 65 women with imperforate hymen by a central incision and application of Foley catheter.

Objective  To determine the surgical outcome of 65 women with imperforate hymen treated with a central surgical incision and insertion of a Foley catheter.

Diagnosis and management of intra-abdominal, mislocated intrauterine devices

PurposeTo evaluate the predisposing factors, diagnosis and surgical treatment options of patients with intra-abdominal, mislocated intrauterine devices (IUDs).MethodsThe diagnosis and management of 18 patients with intra-abdominal, mislocated IUDs were analyzed in this retrospective study.ResultsTrained midwives inserted ten (55%) of the IUDs, while six (33%) were inserted by general practitioners and two (11%) by specialist gynecologists. Ten (55.5%) of the patients were diagnosed by gynecological examination and ultrasonography (USG); abdominal X-ray, in addition, was required in the other eight (44.4%). Eleven patients (61%) were managed by laparoscopy, whereas laparotomy was required in seven (39%). For all patients, laparoscopy was performed initially. No complication was encountered in any of the patients.ConclusionPersons who insert IUDs should receive adequate training before certification, because inadequate pelvic examination before insertion and inexperience of the inserting person might be predisposing factors for uterine perforation. If IUD strings are not visible during gynecologic examination, USG should be tried to locate the IUD and pelvic X-ray used only when USG fails to locate the IUD. Laparoscopy can be the first choice for removal.

Management and outcomes of adnexal torsion: a 5-year experience

PurposeTo discuss the surgical results of patients with diagnosis of adnexal torsion.MethodsOne hundred and fifty patients with diagnosis of adnexal torsion who presented to our clinic between January 2005 and December 2009 were included in this retrospective analysis. Data regarding age, gravidity, parity, size of mass, operation time, and duration of hospitalization were recorded and compared between the patients who had laparoscopy to those who had laparotomy. The pathological results of patients were also recorded.ResultsFifty-eight patients were treated laparoscopically while 92 patients had laparotomy. The most frequent presenting symptom was pelvic pain (96%). Laparoscopy group consisted of young patients with low parity; operation and hospital stay time was shorter in laparoscopy group. Velocity loss in Doppler ultrasonography was noted in 81.3% of the patients. Of the laparotomy group 35 postmenopausal patients had hysterectomy and bilateral salpingo-oopherectomy, and staging surgery was done for 16 of them. The pathological finding was found to be malignant in four and borderline serous tumor in four patients.ConclusionLaparoscopy is preferred for young patients who want to preserve their fertility. Because of high risk of malignancy in postmenopausal ovarian masses presenting with torsion; frozen section should be used. If not possible or not conclusive, staging surgery is more appropriate especially if there is suspicion of malignancy.

Ovarian cancer during pregnancy

To evaluate the clinical features, pregnancy outcome, and treatment of patients with ovarian cancer diagnosed during pregnancy.

Removal of intra-abdominal mislocated intrauterine devices by laparoscopy

This retrospective study was carried out on 15 patients who underwent laparoscopy for the removal of a mislocated IUD from 2003 to 2009. The mean duration of usage of an IUD was 16.1 months. The IUD was found in the Pouch of Douglas in six patients; in the posterior wall of the uterus in three patients; in the adnexa in three patients; in the omentum in two patients and it was embedded in the rectal serosa in one patient. The types of the IUDs were TCu-380A (n = 13) and Mirena® (n = 2). The mean laparoscopic operation time was 25 min. No major complications occurred. A second ancillary port was required in three patients. All patients were discharged within 24 h. Laparoscopic removal of the intra-abdominal IUD must be the first choice of therapy. If possible, a single ancillary port should be preferred for the removal of mislocated IUDs. We advise that surgical removal and surgical risk should be discussed with the patients, even if asymptomatic.

Management of ovarian cysts by laparoscopic extracorporeal approach using single ancillary trocar.

OBJECTIVE This prospective study aimed to evaluate an alternative laparoscopic extracorporeal approach for the treatment of benign ovarian cysts. MATERIALS AND METHODS The initial study population included 243 patients diagnosed with benign ovarian masses. Two patients with suspected malignancies and 21 patients with technical difficulties secondary to severe, dense pelvic adhesions were excluded from the study, and the final study population, therefore, comprised 220 patients. A primary 10-mm trocar was inserted, followed by a second incision on the side of the cyst and the introduction of an ancillary 5-mm trocar. The cystic content was aspirated using a needle. The capsule was held using an endograsper inserted through the ancillary trocar. The capsule was extracted from the abdomen. The 5-mm trocar and the endograsper were removed from the abdomen simultaneously. The capsule was completely detached. Homeostasis was performed and the ovary was then released. RESULTS The mean duration of the operation was 20 +/- 5 minutes. The size of the cysts ranged from 5 cm to 15 cm (mean, 8.4 +/- 2.6 cm). The pathologies of the cysts were simple cyst in 86 cases, endometrioma in 68, serous cyst in 57, mucinous cyst in eight and borderline in one. The perioperative complication rate was 2.27%. CONCLUSION This technique does not require the use of two or more ancillary trocars or widening of the trocar incision. The duration of surgery can be shortened considerably and complete excision of the cystic capsule can be performed. Homeostasis was achieved using 3-0 polyglactin sutures. No electrocoagulation was required.

EVALUATION OF THE RESULTS OF CORDOCENTESIS

OBJECTIVE To evaluate the results of cordocentesis carried out in our clinic at Meram Medicine Faculty of Selcuk University in Konya, Turkey. MATERIALS AND METHODS Cytogenetic results and complication data were obtained by cordocentesis from 250 pregnancies performed in our clinic. RESULTS Adequate amount of cord blood was taken 98% of the time, the successful culture rate was 92.8%, and none of the 18 cases in which no proliferation was detected in the culture accepted a new intervention. Cordocentesis was performed in 14 cases (5.6%), because no results were obtained from amniocentesis carried out for various indications. According to cytogenetic evaluation, chromosomal abnormality was detected in 12 cases (5.17%), including four cases of trisomy 21, four cases of trisomy 18, one case of trisomy 13, one case of triploidy (69,XXX) and two cases of chromosomal inversion. Of the 250 cordocentesis cases, there were 12 (4.8%) cases of fetal loss, including four cases of rupture of membranes, four cases of abdominal pain and vaginal bleeding and four cases of a spontaneous abortus. In 53 (21.2%) cases, cordocentesis was performed because of hydrops fetalis; and of the total 12 losses, six were in this group. The fetal loss rate was 11.32% in the hydrops fetalis group. CONCLUSION If cordocentesis is carried out by highly skilled physicians and optimal culture conditions are available, cordocentesis is an invasive prenatal diagnostic and therapeutic procedure that is performed secondary to amniocentesis with high accuracy and safety. In cases of hydrops fetalis in which cordocentesis is carried out, fetal loss is more likely to occur.

Balci technique for suspending vaginal vault at vaginal hysterectomy with reduced risk of vaginal vault prolapse

Aim:  The aim of this study was to evaluate the efficacy of a new technique of suspending the vaginal vault at vaginal hysterectomy (VH) for total uterine prolapse.

Closure versus nonclosure of peritoneum at cesarean section: evaluation of postoperative pain

AbstractOur purpose was to evaluate postoperative opioid requirements in the closure or nonclosure of peritoneum at cesarean section. Eighty patients who were to undergo cesarean delivery were randomly assigned to two groups. The operative technique was randomized to include either nonclosure of both visceral and parietal peritoneum (study group) or closure of both layers (control group). Operating time and duration of general anesthesia was recorded. The pain was evaluated at rest in the first 12, 24 and 36 h after operation. The amount of morphine used was recorded at the same hours. The mean operating and anesthesia time were significantly longer in the control group than in the study group. Visual analogue scale (VAS) showed no difference in postoperative pain comparing closure to nonclosure of the peritoneum but patients of the control group required significantly more postoperative opioids. In conclusion, nonclosure of the visceral and parietal peritoneum reduces operating time and postoperative opi...