Semra Oruç Koltan

Effect of Pirfenidone on Vascular Proliferation, Inflammation and Fibrosis in an Abdominal Adhesion Rat Model.

ABSTRACT Aim: To study the efficacy of pirfenidone for prevention of postoperative adhesion formation in an adhesion rat model. Materials and Methods: Eighteen female Wistar rats were subjected to right-sided parietal peritoneum and right uterine horn adhesion model. Rats were randomized into three groups: group 1 (control) (closure of midline abdominal incision without any agent administration), group 2 (closure of incision after intraperitoneal administration of pirfenidone), and group 3 (closure of incision and only oral administration of pirfenidone for 14 days). Relaparotomy was performed 14 days after the first surgery. Effect of pirfenidone on adhesion formation was assessed on light microscopy by scoring vascular proliferation, inflammation, fibrosis, and collagen formation in the scarred tissue. Effect of pirfenidone on inflammation was assessed by measurement of transforming growth factor-β and interleukin-17 levels in scarred tissue. Results: The degree of vascular proliferation (1.32 ± 0.39 versus 2.34 ± 0.46, p < 0.001), inflammation (1.60 ± 0.70 versus 2.60 ± 0.52, p < 0.01), and fibrosis (1.50 ± 0.53 versus 2.40 ± 0.52, p < 0.01) were less prominent in group 2 compared to group 1, respectively. Only vascular proliferation was found to be less prominent in group 3 compared to group 1 (1.60 ± 0.42 versus 2.34 ± 0.46, p < 0.01). Intraperitoneal and oral administration of pirfenidone reduced tissue levels of inflammatory markers (TGF-β and IL-17) in parietal and visceral peritoneum compared to control group. Intraperitoneal administration of pirfenidone compared to oral administration was more effective in reducing tissue levels of inflammatory markers. Conclusion: Pirfenidone is an effective agent on the prevention of postoperative vascular proliferation, inflammation and fibrosis in scarred tissue particularly with intraperitoneal administration.

Evaluation of the effects of gonadotropin-relasing hormone antagonist (GnRH-ant) and agonist (GnRH-a) in the prevention of postoperative adhesion formation in a rat model with immunohistochemical analysis

OBJECTIVE To investigate the effects of GnRH antagonist (GnRH-ant) and agonist (GnRH-a) in the prevention of postoperative pelvic adhesions by a visual scoring system and immunohistochemical methods in a rat uterine horn model. DESIGN Controlled experimental animal study. SETTING Animal laboratory at an academic research environment. ANIMAL(S) Twenty-one Wistar albino rats. INTERVENTION(S) Rats were randomized into three groups. One week before the operation the rats received either GnRH-ant or GnRH-a or saline solution; they then underwent surgical laparotomy, and both uterine horns were traumatized by a scalpel. Three weeks later, all rats were sacrificed and extension and severity of the adhesions in each group were scored by a visual scoring system. Adhesion tissues were evaluated immunohistochemically for vitronectin and u-PAR. MAIN OUTCOME MEASURE(S) Scores of extend and severity of adhesions and staining of vitronectin and u-PAR. RESULT(S) The extent of adhesion scores were 1.85 ± 0.86, 0.78 ± 1.05, and 0.42 ± 0.64, and the severity of adhesion scores were 1.71 ± 0.91, 0.57 ± 0.85, 0.50 ± 0.75 for control, GnRH-ant, and GnRH-a groups, respectively. The extent and severity of adhesions were significantly lower in both GnRH-ant and GnRH-a groups when compared with the control group. Adhesion extent scores in the GnRH-a group were lower than in the GnRH-ant group, but this difference was not significant. vitronectin and u-PAR staining were significantly greater in both the GnRH-ant and GnRH-a groups than in the control group. CONCLUSION(S) GnRH-ant as well as GnRH-a reduced postoperative adhesion formation in a rat model. This finding was supported immunohistochemically by vitronectin and u-PAR staining.

Chronic Cervical Perforation by an Intrauterine Device

The intrauterine device (IUD) is a widely used, highly effective method of birth control. Uterine perforation is a rare yet serious complication and is usually seen during insertion of the IUD. A regular examination is necessary for follow-up. We present a patient with an IUD that had perforated the cervix. The diagnosis was made during routine gynecological examination, and the patient was treated in a timely manner before any complications such as ectopic pregnancy, intrauterine pregnancy, infection or irreversible harm to the cervix arose. This case stresses the importance of regular visits to maintain health and diagnose possible adverse effects of intrauterine contraceptive methods.

Comparison of Subcuticular Suture Materials in Cesarean Skin Closure.

Aim. Comparison of the rate of wound complications, pain, and patient satisfaction based on used subcuticular suture material. Methods. A total of 250 consecutive women undergoing primary and repeat cesarean section with low transverse incision were prospectively included. The primary outcome was wound complication rate including infection, dehiscence, hematoma, and hypertrophic scar formation within a 6-week period after operation. Secondary outcomes were skin closure time, the need for use of additional analgesic agent, pain score on numeric rating scale, cosmetic score, and patient scar satisfaction scale. Results. Absorbable polyglactin was used in 108 patients and nonabsorbable polypropylene was used in 142 patients. Wound complication rates were similar in primary and repeat cesarean groups based on the type of suture material. Skin closure time is longer in nonabsorbable suture material group in both primary and repeat cesarean groups. There was no difference between groups in terms of postoperative pain, need for additional analgesic use, late phase pain, and itching at the scar. Although the cosmetic results tended to be better in the nonabsorbable group in primary surgery patients, there was no significant difference in the visual satisfaction of the patients. Conclusions. Absorbable and nonabsorbable suture materials are comparable in cesarean section operation skin closure.

Management of a Giant Border-line Malign Musinous Tumor of the Ovary in an Infertile Woman

though the vast majority of these tumors are benign (75%), borderline (atypical proliferative) types (10%) and carcinomas (15%) are also seen. It was thought that mucinous carcinomas of the ovary may develop from benign and mucinous borderline tumors.2 Mucinous borderline ovarian tumors (BOTs) are classified as gastrointestinal type (85%) and seromucinous type (15%), depending on their histological architecture and type of tumor cells. Seromucinous ovarian tumors are not common and their clinical behavior is not as aggressive as much as other types. The reported mortality rate with these tumors is low.2 There is slightly increased relationship between infertility and BOTs.3,4

EKTOPİK GEBELİK TEDAVİSİ: 74 OLGUNUN RETROSPEKTİF DEĞERLENDİRİLMESİ

Amac: Ektopik gebelik tedavisinde farkli olgularda farkli tedavi yaklasimlarinin ve etkinliginin incelenmesi amaciyla retrospektif olarak olgularin degerlendirilmesidir. Gerec ve yontem: Kasim 2006 – Temmuz 2009 tarihleri arasinda Celal Bayar Universitesi Hastanesi Kadin Hastaliklari ve Dogum Kliniginde ektopik gebelik tanisi alan ve tedavi edilen 74 olgu retrospektif olarak incelendi. Bulgular: Klinigimizde ektopik gebelik tanisi almis 44 hasta sistemik metotreksat tedavisi, 23 hasta cerrahi ve 7 hasta noninvazif nonmedikal bekleyici yaklasim ile tedavi edilmistir. Metotreksat tedavisine yanit %90.9 olarak bulunmustur. Cerrahi endikasyonlari ruptur ve kornual gebelik olarak saptanmistir. Sonuc: Ektopik gebeligin erken ve dogru tanisi mortalite ve morbiditeyi onlemek icin onemlidir. Tedavide metotreksat uygulamasi, cerrahi girisim ve bekleyici yaklasim dogru hastalarda uygulandiginda basari oranlari komplikasyon gelismeden yuksek olmaktadir.