Yüksel Onaran

Influence of Gum Chewing on Postoperative Bowel Activity after Cesarean Section

Objective: To assess the effects of gum chewing on postoperative bowel function after cesarean section. Material and Methods: Women who underwent cesarean section were randomized to either a gum-chewing group (n = 74) or a non-gum-chewing group (n = 76). The two groups were compared with respect to the return of bowel activity, postoperative analgesic and antiemetic drug requirement and postoperative hospital stay. Results: Bowel sounds appeared in a significantly shorter duration of time in the study group, the mean being 5.9 h as compared to 6.7 h in the control group (p < 0.01). The first passage of flatus postoperatively was 22.4 h in the gum-chewing group and 31 h in the control group (p < 0.001). The total length of hospital stay was shorter in the gum-chewing group (2.1 days) than in the control group (2.3 days), but it was not statistically significant (p > 0.05). Postoperative analgesic requirement in both groups was similar, but the postoperative antiemetic need in the gum-chewing group was lower than in the control group (p < 0.01). Conclusion: On the basis of the tolerability and results on bowel function, gum chewing provides a simple method for early recovery of bowel function after cesarean section.

Impact of maternal fasting during Ramadan on fetal Doppler parameters, maternal lipid levels and neonatal outcomes

Objective: The aim of the present study was to evaluate whether fasting may cause changes in maternal lipid profile, glucose level and ketonuria, and whether it has any adverse effects on fetal Doppler, birthweight, preterm delivery or cesarean section rate. Methods: Fifty-six consecutive, healthy women with singleton uncomplicated pregnancies of ≥28 week gestation who had fasted for at least 10 consecutive days during the study period were defined as the study group. Fifty-four healthy non-fasted women matched for age, parity, and gestational age were defined as the control group. Groups were compared according to fetal middle cerebral artery and umbilical artery systolic/diastolic ratio, maternal serum lipid levels and neonatal outcomes (gestational age at delivery, birthweight, delivery type and neonatal intensive care admission). Results: No statistical difference was found between the groups according to fetal Doppler parameters, amniotic fluid index, gestational age at delivery, cesarean section rate, birthweight or NICU admission. However, lower levels of VLDL, triglyceride and higher incidence of ketonuria were detected in the fasting group (p < 0.05). Conclusion: Fasting of healthy women during pregnancy seems to have no adverse effects on amniotic fluid index, fetal Doppler and delivery parameters.

Topical Anesthetic (Lidocaine-Prilocaine) Cream Application Before Speculum Examination in Postmenopausal Women

STUDY OBJECTIVE To evaluate the effectiveness of lidocaine-prilocaine (EMLA 5%) cream application to genital mucosa for reducing pain or discomfort associated with speculum examination in postmenopausal women. DESIGN A randomized controlled study (Canadian Task Force classification I). SETTING A university hospital. PATIENTS One-hundred thirty-four postmenopausal women. INTERVENTIONS The subjects were randomized to an EMLA cream group, a lubricant gel group, or a control group. General data was collected, including age, body weight, gravidity, parity, smoking habits, history of diabetes mellitus, previous gynecologic operations, dyspareunia, sexual activity, and duration of menopause. All patients were asked to score pain at 3 time points (insertion, dilation, and extraction of speculum) during the procedure using a visual analog scale. Pain intensity during speculum examination was compared between the groups. MEASUREMENTS AND MAIN RESULTS There was no statistically significant difference between the EMLA cream, the lubricant gel, and the control groups in terms of age, weight, gravidity, parity, dyspareunia, duration of menopause, sexual activity, smoking habit, diabetes mellitus, previous vaginal and other gynecological procedures, vaginal length, and serum follicle-stimulating hormone and estradiol levels (p > .05). The pain scores obtained during all phases of speculum application were significantly lower in the EMLA group than in both the lubricant gel and the control groups (p < .001). Comparing the gel and the control groups, a lower pain score was observed in the former, except for the second phase of the examination (p < .001). CONCLUSION Topical application of EMLA 5% cream on genital mucosa of postmenopausal women before vaginal examination significantly reduces pain associated with speculum application.

Corneal biomechanical parameters during pregnancy

Purpose To evaluate the variation in biomechanical properties and central corneal thickness (CCT) for each trimester during pregnancy and to compare the values with those in nonpregnant women. Methods We prospectively studied the eyes of 32 pregnant and 34 age-matched non-pregnant women. The parameters included corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOP), and corneal-compensated IOP measured by the Ocular Response Analyzer (ORA). The CCT was also measured with an ultrasonic pachymeter attached to the ORA. Results The mean age was 27.0 ± 3.8 years in the study group and 28.0 ± 4.1 years in the control group. The mean CH measurement was 10.6 ± 1.4 mmHg in the study group and 10.1 ± 1.3 mmHg in the control group. The mean CRF value was 9.6 ± 1.7 mmHg in the study group and 10.0 ± 1.4 mmHg in the control group. The mean CCT value was 541.1 ± 22.4 μm in the study group and 536.5 ± 27.1 μm in the control group. No statistically significant differences were found regarding CH, CRF, or CCT values between the 2 groups (independent t test, p = 0.160, p = 0.355, p = 0.450, respectively). Conclusions Hormonal changes during pregnancy may not affect corneal biomechanics. This may be due to the balanced effect of the various hormones on the cornea during pregnancy.

Cardiac flow parameters with conventional and pulsed tissue Doppler echocardiography imaging in patients with polycystic ovary syndrome

Background. Polycystic ovary syndrome (PCOS) is independently associated with the major cardiovascular risk factors. The aim of this study was to examine the echocardiographic profiles of patients with PCOS using conventional echocardiographic methods and tissue Doppler imaging. Methods. For this study, we have registered 48 women with PCOS and 21 healthy control subjects who were mathced with respect to age and body mass index. Standard two-dimensional and M-mode measurement, transmitral valve flows and tissue Doppler imaging of mitral and tricuspid anulus were recorded. Results. In PCOS and control groups, left ventricular and atrium diameters, ejection fraction, mitral E/A ratio, deceleration time and isovolumic relaxation time were similar. There were no significant differences between patients with PCOS and control subjects with respect to tissue Doppler profiles. Conclusion. Patients with PCOS execute echocardiographic measures of cardiac function that are similar to those of healthy women.

Ovarian vein thrombosis and Mirror syndrome in association with sacrococcygeal teratoma

Ballantyne’s syndrome has originally been described for hydrops fetalis, which is associated with rhesus isoimmunization; however, hydrops fetalis can also occur in association with non-immunological causes, including Ebstein’s anomaly, Galen’s vein aneurysm, fetal arrhythmias, and sacrococcygeal teratoma (SCT). SCT is the most commonly presenting tumor in newborn babies, occurring in approximately 1 in every 40,000 live births. Large or rapidly growing tumors are highly vascular, and lead to high-output cardiac failure, which is characteristic of hydrops fetalis. In non-immune hydrops fetalis maternal preeclampsia (Mirror syndrome) can also sometimes occur. The clinical manifestations of mirror syndrome are quite varied, and the pathophysiology of this syndrome is poorly understood.1–3 Ovarian vein thrombosis (OVT) is a rare complication of pregnancy; however, recognition and treatment of this condition are critical because a delay in diagnosis can lead to significant maternal morbidity. The diagnosis of OVT remains a challenge because there is no known profile of risk factors.4 In this manuscript, we describe a case of a rapidly growing SCT that is associated with Mirror syndrome and ovarian vein thrombosis.

Bilateral non-arteritic anterior ischemic optic neuropathy following second-trimester spontaneous abortion-related haemorrhage

Bilateral anterior ischemic optic neuropathy is a rare complication of massive haemorrhage and related hypotension and anaemia in young individuals. We report a 34-year-old woman with bilateral non-arteritic ischemic optic neuropathy (NAION) after a massive spontaneous abortion-related haemorrhage who presented with sudden painless visual loss in her left eye. Visual acuity was 20/20 in the right eye with only hand motion discernible in the left eye. There was a left relative afferent papillary defect (RAPD). Fundus examination revealed bilateral swollen, hyperaemic optic discs and nerve fiber layer haemorrhages. Brain MRI and magnetic resonance venography were normal. The diagnosis of bilateral NAION was made and intravenous pulse corticosteroid therapy (1000 mg/day) was administered for three days. On the sixth day, optic disc oedema regressed bilaterally and on the third week, the visual acuity improved to 20/80 in the left eye. The visual field showed only a small spared area in the nasal region, and persistent RAPD was present. After two months, fundus examination showed a small and crowded optic disc on the right and a pale optic disc on the left. Severe acute haemorrhage is an important risk factor for NAION in healthy young individuals. In addition to correction of hypotension and anaemia, intravenous high dose corticosteroid might be beneficial for treatment.

Prenatal diagnosis and follow-up of giant sacrococcygeal teratoma

Sacrococcygeal teratoma is a non-organ-specific soft tissue lesion composed of extragonadal tissues located in the pericoccygeal region. Sacrococcygeal tumor, a germ cell tumor, is quite rare in the general population; however, it is the most common congenital tumor in newborns. The incidence for this tumor is estimated to be 1:40,000 live births [1]. Although it has a benign histological character, it has a relatively high mortality rate (>50%) among patients diagnosed prenatally [2]. We hereby, present a patient who presented to our department with an estimated gestational age of 32 weeks, whose fetus was observed to have a sacrococcygeal teratoma measuring 20 cm by ultrasound (US) and fetal magnetic resonance imaging (MRI) evaluations. A 23-year-old primigravid woman presented to our department for antenatal follow-up at the 32 gestationalweek. She stated that she had been followed-up regularly in another medical center throughout previous gestational weeks. A solid lesion with solid cyctic components with a size of 20 cm 18 cm located in the sacrococcygeal region of the fetus was detected on ultrasonic examination of the patient. Her amniotic index was measured as 210 mm and placentomegaly was noted. We confirmed the gestational age consistentwith32weeksof gestation. Furthermore, a detailed investigation was performed to affirm clear diagnosis. Color Doppler sonography designated that the mass was not well vascularized, and there was no evidence of fetal hydrops. Fetal echocardiographic examination was normal. Fetal MRI investigation revealed a solid lesion measuring 20 cm 17 cm with a hypointense peripheral margin extending through the pelvic and anal region, involving diffuse cyctic areas. Its main component was located at the right side of the fetus. The lesion primarily suggested the diagnosis of Type I sacrococcygeal teratoma (Fig. 1). The patient was hospitalized and monitored with serial US and external fetal monitoring. There was no designated

Investigation of oxidative balance in patients with dysmenorrhea by multiple serum markers

OBJECTIVE To investigate the level of oxidative stress in patients with dysmenorrhea by multiple serum markers including malondialdehyde (MDA), nitrotyrosine (3-NT), deoxyguanosine (8-OHdG) and superoxide dismutase (SOD). MATERIAL AND METHODS Fifty-eight women, aged between 20 and 34, who had had regular menses for at least six previous cycles, were involved. The women were divided into two groups. The study group consisted of 33 patients with primary dysmenorrhea, and the control group consisted of 25 healthy women. RESULTS Demographic characteristics of patients were similar between the two groups. The serum MDA levels were 1.32±0.46 and 0.91±0.26 nmol/mL for the dysmenorrhea and control groups, respectively (p<0.001). The differences in plasma levels of 3-NT, SOD and serum 8-OhdG were similar in both groups (p>0.05). Also, no correlation was found between the severity of dysmenorrhea and the levels of oxidative markers. CONCLUSION Oxidative stress is slightly aggravated in patients with dysmenorrhea.