Mustafa Basaran

Diagnosis of acute appendicitis during pregnancy: a systematic review.

Objective: To perform a systematic review to evaluate the diagnostic performance of computed tomography (CT) and magnetic resonance imaging (MRI) for the diagnosis of appendicitis in pregnancy. Data Sources: A systematic literature search of MEDLINE from 1966 through August 2008, MEDION database, OVID MEDLINE from 1950 through August 2008, and bibliographies of review articles and eligible studies. Methods of Study Selection: Three articles related to the use of CT and 5 to the use of MRI for the diagnosis of acute appendicitis during pregnancy were identified. All of the identified studies were retrospective. Findings were compared to surgical pathology and/or clinical follow-up. Results were pooled using the Mantel–Haenszel fixed-effects model and the DerSimonian–Laird random-effects model. Tabulation, Integration, and Results: The pooled estimates of sensitivity and specificity, positive and negative likelihood ratios for the performance of CT in patients with prior normal/inconclusive ultrasonography result were 85.7% (95% CI: 63.7%–97%) and 97.4% (95% CI: 86.2%–99.9%), 10.1 (95% CI: 3.4–30.1), and 0.21 (95% CI: 0.05–0.88), respectively. The pooled estimates of sensitivity and specificity, positive and negative likelihood ratios for performance of MRI in patients with prior normal/inconclusive ultrasonography result were 80% (95% CI: 44%–98%) and 99% (95% CI: 94%–100%), 22.7 (95% CI: 6.0–87.5), and 0.29 (95% CI: 0.13–0.68), respectively. Conclusion: This review is limited by the small number and retrospective nature of the available studies. With these limitations in mind, CT and MRI seem to be highly sensitive and specific for the diagnosis of appendicitis in pregnancy and their use should be considered when the results of ultrasonography are normal or inconclusive and appendicitis is suspected. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to recall the obstacles to correct diagnosis of appendicitis in pregnancy, compare the advantages and disadvantages of magnetic resonance imaging and computed tomography in the evaluation of the gravid patient with suspected appendicitis, and state the risks to a pregnant patient and her fetus with appendicitis in pregnancy.

Combined vitamin C and E supplementation for the prevention of preeclampsia: a systematic review and meta-analysis.

Objective. To perform a systematic review and meta-analysis of the effectiveness of combined vitamin C and E (vitCE) supplementation for the prevention of preeclampsia. Data Sources. PubMED, Web of Science, and Cochrane Central Register of Controlled Trials from inception through June 2010, and bibliographies of review articles and eligible studies. Methods of Study Selection. Fifteen eligible studies that evaluated vitCE supplementation for the prevention of preeclampsia were identified. On the basis of prespecified inclusion and exclusion criteria, 9 were included in the meta-analysis. All were randomized controlled trials. The reporting and methodologic quality of the included studies was assessed with the CONSORT checklist and the Jadad scale. Tabulation, Integration, and Results. The 9 included studies had moderate-to-high CONSORT and Jadad scores. The incidence of preeclampsia was 9.7% (949 of 9833) in the vitCE group and 9.5% (946 of 9842) in the placebo group. A random effects model was used for pooling and no difference was found in the relative risk (RR) of preeclampsia between the vitCE and placebo groups (RR: 0.98; 95% confidence interval [CI]: 0.87–1.10). The incidence of gestational hypertension was 22.6% (1915 of 8491) in the vitCE group and 20.3% (1728 of 8500) in the placebo group (RR: 1.11, 95% CI: 1.05–1.17). The incidence of placental abruption was 0.58% (43 of 7379) in the vitCE group and 0.87% (64 of 7361) in the placebo group (RR: 0.67, 95% CI: 0.46–0.98). No significant differences were observed for other maternal and neonatal outcomes. Conclusion. Combined VitCE supplementation does not decrease the risk of preeclampsia and should not be offered to gravidas for the prevention of preeclampsia or other pregnancy induced hypertensive disorders. Furthermore, combined supplementation with vitCE increased the risk of GH but decreased the risk of placental abruption. However, these latter associations may not be causal, especially since they were the product of multiple statistical comparisons, and the 95% CI around the point estimates almost included one. Learning Objectives: After completion of this educational activity, the obstetrician/gynecologist should be better able to assess the causes of preeclampsia and related conditions; evaluate and interpret the evidence regarding the use of combined vitamins C and E in prevention of preeclampsia and related conditions; and interpret and understand the effects of the supplementation of vitamins C and E for the prevention of preeclampsia or other pregnancy induced hypertensive disorders. Target Audience: Obstetricians & Gynecologists, Family Physicians

Effect of menstrual cycle on the injection pain due to propofol.

Background This prospective, double-blind and randomized study is designed to determine the effect of menstrual cycle on the injection pain of propofol. Methods Seventy-two patients scheduled for elective surgery under general anaesthesia were divided into two groups according to the phase of the menstrual cycle. Patients were at follicular phase (Pd 8–12) in Group F (n = 36) and luteal phase (Pd 20–24) in Group L (n = 36). Injection pain was evaluated with 10-point numeric rating scale after 25% of the total propofol dose was injected over 20 s. Results There were no significant differences in terms of patient characteristics (P > 0.05). The mean propofol pain score was found 1.81 ± 2.30 in Group F and 4.83 ± 3.09 in Group L. Group L was found to have higher propofol injection pain scores than Group F (P < 0.001). Conclusion We conclude that the menstrual phase changes the perception of pain due to propofol injection, which is higher in the lutheal phase. In clinical practice, the phases of the menstrual cycle may have a significant role on injection pain of propofol in woman.

Ovarian adenomyoma following gonadotrophin treatment for infertility

An ovarian adenomyoma developed in a 38-year-old infertile patient following treatment with exogenous gonadotrophins. Laparoscopic excision was performed. Histological examination showed thick muscular bundles resembling myometrium lined with endometrial glands and stroma. Gonadotrophins might be involved in the pathogenesis of extrauterine adenomyoma.

Comparison of satisfaction and pain relief between patients-controlled analgesia and interval analgesia after laparoscopic ovarian cystectomy

Preoperative and postoperative psychological factors, postoperative pain, analgesic consumption, treatment satisfaction were compared in patients treated with intravenous patient-controlled analgesia (IV-PCA) or intramuscular analgesics after laparoscopic ovarian cystectomy. Thirty-one women with laparoscopically operated benign ovarian cysts were recruited in Zonguldak Karaelmas University Faculty of Medicine, Department of Obstetrics and Gynecology. Postoperatively sixteen women received morphine delivered by IV-PCA pump system and 15 women were prescribed another opioid (meperidine) intramuscularly. Two weeks before and one day after the surgery, Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were self-administered. Afterwards, the operation visual analog scale (VAS) and satisfaction with pain control scale were recorded. Preoperative BDI and BAI scores of both groups were comparable. Postoperative BDI (7.9 ± 7.2 versus 13.8 ± 6.9, P = 0.03) and BAI (11.4 ± 9.1 versus 17.4 ± 6.2, P = 0.045) scores were significantly lower in the IV-PCA group. Morphine usage with PCA resulted in significantly higher pain scores than equivalent doses of meperidine administered intramuscularly (2.94 ± 1.0 versus 1.67 ± 0.7, P = 0.001). Although higher pain scores were obtained from IV-PCA group, self-reported satisfaction rates were higher in this group (8.3 ± 1.1 versus 7.4 ± 1.1, P = 0.04). Involvement of patients in their pain management might increase the awareness of pain but their satisfaction about the control of postoperative pain was significantly improved.

Measurement of choroid thickness in pregnant women using enhanced depth imaging optical coherence tomography

PURPOSE To investigate choroidal thickness in healthy pregnant women during different trimesters using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS This prospective study included 90 healthy pregnant women in their first, second, or third trimester (groups 1, 2, and 3, respectively) and 30 non-pregnant healthy women (group 4). The age range for all groups was 18-40 years. Spectral domain optical coherence tomography scans were obtained to estimate the average choroidal thickness. Using EDI-OCT, we measured choroidal thickness manually from the outer border of the retinal pigment epithelium to the inner scleral border at the subfovea, 3 mm temporal, and 3 mm nasal to the fovea. Differences among groups were analyzed by one-way ANOVA. RESULTS We found a statistically significant difference between groups 2 and group 4 for subfoveal, temporal, and nasal mean choroidal thickness (p=0.007, p<0.001, p=0.026, respectively). The mean choroidal thickness for group 2 was 395 ± 80 μm, 338 ± 74 μm, and 233 ± 61 μm at the regions subfoveal, temporal, and nasal to the fovea, respectively. In comparison, the mean choroidal thickness for group 4 was 335 ± 86 μm, 274 ± 54 μm, and 200 ± 53 μm at the regions subfoveal, temporal, and nasal to the fovea, respectively. No statistically significant differences were found for choroidal thickness among groups 1-4 (p=0.214, p=0.177, p=0.094, respectively) and between groups 3-4 (p=0.105, p=0.261, p=0.695, respectively) for all measured points. CONCLUSION Our results suggest that choroidal thickening can occur at the regions subfoveal, temporal, and nasal to the fovea in the second trimester.

Plasma total oxidant and antioxidant status after oral glucose tolerance and mixed meal tests in patients with polycystic ovary syndrome

PurposeInsulin resistance (IR) and increased oxidative stress (OS) are the characteristics of polycystic ovary syndrome (PCOS). In this study, we aimed to evaluate the effects of oral glucose tolerance (OGTT) and mixed meal tests (MMT) on plasma total oxidant (TOS) and total antioxidant status (TAS) in patients with PCOS and the relationship between these parameters and IR, calculated via homeostasis of model assessment-IR (HOMA-IR) and Matsuda’s insulin sensitivity index (ISI) derived from OGTT and MMT.MethodsTwenty-two patients with PCOS, and age- and body mass index (BMI)-matched 20 women as controls were enrolled into the study. Five-hour OGTT and MMT were performed on different days, and before and after these tests, plasma TOS and TAS levels were investigated. IR was calculated with HOMA-IR and Matsuda’s ISI.ResultsHOMA-IR levels were higher in patients with PCOS, compared to controls, while Matsuda’s ISI derived from OGTT and MMT was higher in controls. Plasma TOS levels before OGTT and MMT were higher in patients with PCOS than controls, while TAS levels were similar. After OGTT, plasma TOS levels became decreased at 5th hour, when compared to baseline values in PCOS group. Likewise, the same decrement was found in controls, but the decrement was not significant. After OGTT and MMT at 5th hour, no changes were observed in TAS levels, compared to baseline.ConclusionMatsuda’s ISIs derived from OGTT and MMT can be used instead of each other, and interestingly, we found a decrease in TOS levels after OGTT in patients with PCOS.

Chorionic villus sampling and the risk of preeclamspia: a systematic review and meta-analysis

ObjectiveTo perform systematic review and meta-analysis to evaluate the risk of preeclampsia after chorionic villus sampling (CVS).Data sourcesA systematic search of PubMED and Web of Science from inception through August 2010, and bibliographies of review articles and eligible studies were performed.Methods of study selectionSix studies reported the risk of preeclampsia after CVS. All of the identified studies were retrospective and included in analysis.Tabulation, integration, and resultsReporting quality of the identified studies according to quality assessment scale for methodology in retrospective clinical reporting was moderate. Pooling was performed in two strata for control: (1) patients without any invasive prenatal diagnostic procedure served as control group: no significant difference was found in the odds ratio (OR) of preeclampsia (OR 0.79, 95% CI 0.38–1.64), severe preeclampsia (OR 0.49, 95% CI 0.04–5.78), gestational hypertension (OR 0.76, 95% CI 0.46–1.26), all pregnancy-induced hypertensive disorders (OR 0.80, 95% CI 0.46–1.41) between CVS and control groups. (2) Patients with amniocentesis combined with patients without any invasive prenatal diagnostic procedure served as control group: no significant difference was found in the OR of preeclampsia (OR 0.76, 95% CI 0.37–1.53), severe preeclampsia (OR 0.83, 95% CI 0.14–4.85), all pregnancy-induced hypertensive disorders (OR 0.92, 95% CI 0.55–1.53) between CVS and combined control groups.ConclusionNone of the included studies were randomized prospective trials designed to investigate the effect of CVS on preeclampsia. Accordingly, this review is limited by the heterogeneity, small number and retrospective nature of the available studies. CVS does not seem to increase the risk of preeclampsia or other pregnancy-induced hypertensive disorders. However, randomized prospective trials that are designed to investigate the risk of preeclampsia after CVS are needed to make a definite conclusion.

The mean platelet volume and neutrophil to lymphocyte ratio in obese and lean patients with polycystic ovary syndrome

PurposeMean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) are the new markers of the detection of inflammation. Our aim is to investigate MPV and NLR in lean and obese patients with polycystic ovary syndrome (PCOS).MethodsThis study was designed to investigate MPV, NLR, and high-sensitive C-reactive protein (hsCRP) levels in 25 obese patients with PCOS and 16 lean patients with PCOS, and our study group was matched with 16 obese and 14 non-obese controls, respectively.ResultsPCOS group had higher MPV, NLR, neutrophil count, neutrophil to total leucocyte ratio, basophil count, waist circumference (WC), insulin, glucose, and HOMA-IR rates than those of controls. hsCRP levels were similar in both groups. Subgroup analyses revealed that obese PCOS group had higher insulin and HOMA-IR levels, compared to those of controls. In this subgroup, total leucocyte counts, MPV, and hsCRP levels were similar. On the other hand, lean PCOS group had higher WC, NLR, MPV, and basophil count than controls. In correlation analysis, hsCRP was positively correlated with body mass index (BMI), WC, total leucocyte count, neutrophil count, while negatively correlated with lymphocyte ratio. Although leucocyte count was positively correlated with BMI, MPV was negatively correlated with BMI, total leucocyte, platelet, and neutrophil counts. NLR was positively correlated with HOMA-IR, hsCRP, BMI, WC, and insulin.ConclusionOur study demonstrated that MPV and NLR levels are increased despite similar hsCRP levels in patients with PCOS. However, we failed to demonstrate these differences in obese PCOS patients. Further studies with larger sample size are required to determine the significance of BMI in the inflammation of PCOS patients.

Brief report: the effects of the menstrual cycle on the hemodynamic response to laryngoscopy and tracheal intubation.

We designed this study to determine the effect of the menstrual cycle on the hemodynamic response to tracheal intubation (TI). Sixty-two ASA I women who were either in the follicular phase (group F, n = 31) or luteal phase (group L, n = 31) of their menstrual cycle were included in the study. Patients received propofol and rocuronium for intubation. Hemodynamic variables were recorded before administration of the IV anesthetic, as well as after TI. Rate pressure products were calculated. Groups were similar in terms of demographic data. Rate pressure products values at the first minute after TI were significantly increased in group L than were those in group F (P < 0.001). We conclude that the phase of the menstrual cycle is an important factor in the hemodynamic response to TI.