Mutlu Ercan

Disengagement of the deeply engaged fetal head during cesarean section in advanced labor: Conventional method versus reverse breech extraction

Maternal and fetal morbidity of two different methods of delivering the baby during cesarean section performed in advanced labor when the fetal head is deeply engaged was assessed retrospectively, i.e. delivering as ‘cephalic’ with or without assistance to push up the fetal head from the vagina (head first or push method) and ‘reverse breech extraction’ (feet first or pull method). Records of 182 women with a single fetus in cephalic presentation, who had undergone cesarean section at cervical dilatation at ≥7 cm, with the vertex at or below zero station, were reviewed. Extension of the uterine incision occurred in significantly more women during ‘cephalic’ delivery as compared to ‘reverse breech extraction’ (22.8% versus 2.2%; p = 0.001). Use of ‘reverse breech extraction’ is an attractive and safe alternative to the standard methods for intra‐operative disengagement of a deeply impacted fetal head in order to reduce maternal and fetal morbidity.

Can serum gamma-glutamyltransferase levels be useful at diagnosing gestational diabetes mellitus?

Objective: The aim of this study was to evaluate plasma gamma-glutamyltransferase (GGT) in gestational diabetes mellitus (GDM) in pregnant women at oral glucose tolerance test (OGTT) and the diagnosis of GDM and to explore whether this activity is associated with metabolic parameters. Method: This prospective control study included 37 women with GDM and 42 women with normal glucose tolerance in pregnancy (control group). In the study group (GDM), blood was taken for analyzing 100 g OGTT from women who have abnormal 50 g glucose challenge test (GCT). Results: Compared with the controls, the GDM group had significantly higher mean values for serum fasting glucose, insulin, homeostasis model assessment-insulin resistance (HOMA-IR), triglyceride and GGT. Within the GDM group, GGT levels were only negatively correlated with high-density lipoprotein (r = −0.41, p = 0.01). GGT was determined to be an independent metabolic parameter for GDM. While performing analyses receiver operational curve analysis, GGT cutoff set was set at 16 IU/L, the sensitivity was calculated as 86%, and specificity was as 37%. Conclusion: The increase at GGT level is an independent risk factor for GDM and identified as high-risk women for diagnosis of GDM.

Comparison of risk of malignancy index (RMI), CA125, CA 19-9, ultrasound score, and menopausal status in borderline ovarian tumor.

Objective: The aim of this study was to assess the prognostic values of risk of malignancy index (RMI IV), ultrasound score, menopausal status, and serum CA125 and CA19-9 level in patients with borderline ovarian tumor (BOT). Methods: Fifty women having borderline ovarian tumor (BOT) and 5O individuals with benign adnexal mass were enrolled in this retrospective study. The sensitivity, specificity, positive predictive values, negative predictive values and diagnostic accuracy of preoperative serum levels of the CA125 and CA19-9, ultrasound findings and menopausal status, and RMI IV were calculated for prediction of discrimination between BOTs and benign adnexal masses and the results were compared. Results: The RMI IV was the best method for discrimination between BOTs and benign adnexal masses and was more accurate than the other parameters. When Receiver Operator Characteristic area under the curves for menopausal status was analyzed, serum CA 125 and CA19-9 level, ultrasound score, RMI IV(CA125), and RMI IV(CA19-9) were, 0.580, 0.625, 0.548, 0.694, 0.734 and 0.711, respectively. The best RMI IV cut-off was found to be 200 for discrimination of benign and BOT lesions. In the RMI formulation, replacing CA125 with CA19-9 didn’t affect RMI IV sensitivity and specificity for discrimination. Conclusion: Compared to ultrasound, menopausal status, CA-125, CA19-9, the RMI IV was found to be the best predictive method for differentiation of BOTs from benign adnexal masses. RMI IV cut–off value of 200 is suitable for differentiation of benign and BOT’s.

Aynı Overin Multipl Matür Rekürrent Kistik Teratomu: Vaka Sunumu Ve Literatürün Gözden Geçirilmesi

Bu olgu sunumunda, olgun kistik teratomlarin nuks ve multilokulerite ozelliklerini vurguladik. 26 yasinda G0 kadin mide agrisi ve abdominal distansiyon yakinmalariyla jinekoloji poliklinigine basvurdu. Transvaginal ultrasonda sag overde mutipl dermoid kist lokuslari icinde ekojenik yag materyali dusunduren 9cm kitle gozlendi. Sag overe yerlesmis totalde yaklasik 9cm capli 2 ile 5 cm arasinda degisen dermoid kistin 7 ayri lokasyonuna tanisal laparoskopi planlandi. Hasta 2. gunde komplikasyonsuz bir operasyon sonrasi taburcu edildi. Bu hasta, Medline veritabaninda rekurren ve multilokuler ozellige sahip tek olgudur. Ozellikle genc hastalarin duzenli izlemi tumorun multilokularitesi ve bilateralitesi hakkinda cerrahin dikkatli olmasinda, nuks vakalarin cerrahisinde ve nuks kitlelerin erken tespitinde klinik oneme sahiptir

Cystoscopic suture removal by Holmium-YAG laser after Burch procedure.

Burch colposuspension remains one of the successful operations performed for stress incontinence. Accidental suturing of the bladder wall during the procedure or subsequent erosion may lead to lower urinary tract symptoms. Diagnosis and management of these sutures indicate precise evaluation for which a 70 degree cystoscope is used. In selected cases, Holmium-YAG laser may enable us to manage long-standing, encrustated neglected sutures. Here we would like to report successful removal of intravesical sutures using the Holmium-YAG laser.