Determining the incidence of gynecoid pelvis using three-dimensional computed tomography in nonpregnant multiparous women

Objectives: To determine the incidence of gynecoid pelvis by using classical criteria and measured parameters obtained from three-dimensional computed tomography [3D CT] pelvimetry in nonpregnant multiparous women who delivered vaginally

Subjects and Methods: Our hospital's picture archiving and communication system was reviewed retrospectively. All adult women who had undergone CT examination with routine abdominal protocols were identified. In the pelvic inlet, midpelvis, and pelvic outlet, classical criteria and measured parameters, both alone and in combination, were used to determine the presence of gynecoid pelvis

Results: 3D CT pelvimetry was performed on 226 women aged 23-65 years without any history of cephalopelvic disproportion and who had at least one delivery of an average fetal size [>2,500 g]. The median parity was 4, and the mean [ +/- SD] birth weight was 3,700 +/- 498 g. Compared to the classical criteria, measured parameters and their combined use with the classical criteria significantly reduced the frequency of gynecoid pelvis [51.3 and 47.8%, respectively, vs. 71.6%; p = 0.001]; however, there was no significant difference between the measured parameters and their combined use with classical criteria with regard to the frequencies of gynecoid pelvis [p > 0.05]

Conclusions: With the use of measured parameters of 3D CT pelvimetry, the incidence of gynecoid pelvis reduces to a more acceptable level [51.3%] in accordance with obstetric knowledge. Since there is no considerable decrease with the addition of classical criteria, 3D CT pelvimetry alone has merit for determining a woman's pelvic capacity for obstetric needs after the improvement and standardization of measured parameters

Value of findings of diffusion-weighted magnetic resonance imaging in patients with lumbar disc degeneration

To determine the value of diffusion-weight MRI findings in patients with lumbar disc degeneration. Lumbar discs of 52 consecutive patients were imaged at 1.5 T MR including T2 and diffusion weighted imaging. Apparent diffusion coefficient [ADC] values, T2 signal intensity and height of the five lumbar intervertebral discs were measured and disc and endplate degenerations were graded. The mean ADC was 0.90x10H[3] mm[2]/s +/- 0.27 [ +/- S.D.] and the mean T2 was 93.98 +/- 32.32. There was significant correlation between mean diffusion and the T2 signal intensity values of all lumbar discs. The age of the cases was negatively correlated with the T2 signal intensities and ADC values and positively correlated with the disc height of from L1-L2 to L5-S1. There was no significant correlation between the disc height of from L1-L2 to L5-S1 and the measured ADC values and the T2 signal intensities. Evaluation of lumbar disc degeneration with diffusion weight MRI can be a useful procedure in the clinical practice for patients with several lumbar symptoms. There is need for the improvement of image quality of diffusion weighted MRI imaging for more precise diagnosis of the lumbar diseases

Persistent sciatic artery originating from left common iliac artery

Persistent sciatic artery is a very rare seen variation of the lower limb vessels. Anatomically the persistent sciatic artery is the continuation of internal iliac arteries and usually leads to several symptoms such as intermittent claudication, pulsatile mass in the buttocks, and pain radiating to the lower limb. However, in untreated patients with serious complications, amputation can occur. In this case report, we describe persistent sciatic artery originating from left common iliac artery in a 72-year-old male patient who complained pain in the left leg, because of the importance of clinical and diagnostic challenges

Clinical Analysis of 21 Cases of Spinal Cord Ependymoma : Positive Clinical Results of Gross Total Resection

OBJECTIVE: To evaluate the clinical results of gross total resection in the surgical approach to spinal ependymoma. METHODS: Between June 1995 and May 2009, 13 males and 8 females (mean age 34) diagnosed with intramedullary or extramedullary spinal ependymoma were surgically treated at our centre. The neurological and functional state of each patient were evaluated according to the modified McCormick scale. RESULTS: The average follow-up duration was 54 months (ranging from 12 to 168 months). The locations of the lesions were: thoracic region (4, 19%), lumbar region (7, 34%), cervical region (4, 19%), cervicothoracic region (3, 14%) and conus medullaris (3, 14%). Four patients (19%) had deterioration of neurological function in the early postoperative period. The neurological function of three patients was completely recovered at the 6th postoperative month, while that of another patient was recovered at the 14th month. In the last assessment of neurological function, 20 patients (95%) were assessed as McCormick grade 1. No perioperative complications developed in any of our patients. In one patient's 24-month assessment, tumour recurrence was observed. Re-operation was not performed and the patient was taken under observation. CONCLUSION: Two determinants of good clinical results after spinal ependymoma surgery are a gross total resection of the tumour and a good neurological condition before the operation. Although neurological deficits in the early postoperative period can develop as a result of gross total tumour resection, significant improvement is observed six months after the operation.

The Effects of Intravenous Ephedrine During Spinal Anesthesia for Cesarean Delivery: A Randomized Controlled Trial

We designed a randomized, double-blinded study to determine the efficacy and safety of 0.5 mg/kg intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Patients were randomly allocated into two groups: ephedrine group (n=21) and control group (n=21). Intravenous preload of 15 mL/kg lactated Ringer's solution was given. Shortly after the spinal injection, ephedrine 0.5 mg/kg or saline was injected intravenous for 60 sec. The mean of highest and lowest heart rate in the ephedrine group was higher than those of control group (P<0.05). There were significant lower incidences of hypotension and nausea and vomiting in the ephedrine group compared with the control group (8 [38.1%] vs. 18 [85.7%]); (4 [19%] vs. 12 [57.1%], respectively) (P<0.05). The first rescue ephedrine time in the ephedrine group was significantly longer (14.9+/-7.1 min vs. 7.9+/-5.4 min) than that of the control group (P<0.05). Neonatal outcome were similar between the study groups. These findings suggest, the prophylactic bolus dose of 0.5 mg/kg intravenous ephedrine given at the time of intrathecal block after a crystalloid fluid preload, plus rescue boluses reduce the incidence of hypotension.

Association of leptin with insulin resistance, body composition, and lipid parameters in postmenopausal women and men in type 2 diabetes mellitus

To determine the association of leptin with insulin resistance, body composition, and lipid parameters in postmenopausal women and men with type 2 diabetes mellitus T2DM. This study was conducted in 158 patients 87 postmenopausal women and 71 men with T2DM, and 99 healthy controls 52 postmenopausal women and 47 men. Type 2 diabetes mellitus patients were selected consecutively from the outpatient Endocrinology Service of Cumhuriyet University Hospital, Sivas, Turkey from April 2002 to March 2005. We collected demographic, leptin, insulin resistance, and lipid and body composition parameters. Serum leptin levels of females were significantly higher than those of men in both T2DM, and healthy participants. The basal metabolic rate, fat free mass, and total body water of males, were lower than those of females. In both T2DM and healthy participants, leptin was positively correlated with insulin resistance and body composition parameters in both gender. Serum leptin levels of females were higher compared with males in the same BMI, independent of T2DM. Leptin was associated with insulin, insulin resistance, and body composition parameters body mass index, basal metabolic rate, body weight,%fat, and fat mass in participants, with or without T2DM in both genders. Type 2 diabetes mellitus seemed more effective on insulin resistance than obesity. We suggest that the female gender, and fat mass, and not T2DM might have significant influence on leptin levels in age

Comparison of CT-Guided Sclerotherapy with Using 95% Ethanol and 20% Hypertonic Saline for Managing Simple Renal Cyst

OBJECTIVE: We wanted to compare the efficacies of 95% ethanol and 20% hypertonic saline (HS) sclerotherapies that were performed in a single session under CT guidance for the management of simple renal cysts. MATERIALS AND METHODS: A prospective series of 74 consecutive patients (average age: 57.6 +/- 8.1 years) with simple renal cysts were enrolled in this study. They were randomized into two groups and 95% ethanol or 20% HS, respectively, corresponding to 25% of the aspiration volume, was injected. Treatment success was determined six months later with follow-up clinical evaluation and performing ultrasonography. RESULTS: The sclerotherapy was accepted as technically successful without major complications in all except two patients who were excluded because of a communication between the simple renal cyst and the pelvicalyceal collecting system. Thirty-six patients in the ethanol group received sclerotherapy with 95% ethanol and 36 patients in the HS group underwent sclerotherapy with 20% HS. The complete regression ratio of the ethanol group was significantly higher (94% versus 72%, respectively) than that of the HS group. There was one patient with partial regression in each group. The failure ratio of the ethanol group was significantly lower (3% versus 25%, respectively) than that of the HS group. CONCLUSION: Ethanol sclerotherapy under CT guidance is a successful and safe procedure and it can be used for the treatment of simple renal cysts. Sclerotherapy with 95% ethanol is more effective than 20% HS sclerotherapy. Sclerotherapy with HS may be an option for patients preferring to undergo a less painful treatment procedure.