The relationship between C-reactive protein, carbohydrate antigen 125, and hematological parameters to endometriotic nodule localization in pelvis.

BACKGROUND: Endometriosis is a pelvic inflammatory process, and hormonal, environmental, and genetic factors play a role in its etiopathogenesis; especially, deep pelvic endometriosis exhibits an extensive anatomical distribution. In the present study, we evaluated the contribution of routinely measured hematological parameters to the diagnosis as the number of endometriotic nodule localization increases, when evaluated with C-reactive protein (CRP) and carbohydrate antigen (CA) 125. METHODS: The present study included patients with histopathologically confirmed diagnosis of endometriosis who underwent surgery at our hospital between January 2007 and December 2018. Their medical records were examined retrospectively. RESULTS: In total, 205 patients were included in the study, of which 129 patients (62.9%) with ovarian endometrioma and 76 patients (37.1%) with deep infiltrative endometriosis were assigned to Group 1 and Group 2, respectively, and the two groups were compared. Endometriotic nodules were observed in several localizations in 71 patients (34.6%) of the 205 patients with endometriosis. Pelvic nodules were grouped as per their four different localizations: uterosacral, recto-vaginal, bladder, and ureteral. Because the anatomical localization of endometriotic nodules increased in the pelvis, the variability in the levels of CA 125 and CRP as well as hematological parameters was examined. There were significant differences in hemoglobin (p < 0.036), CA 125 (p < 0.000), and CRP (p < 0.007) levels between patients with nodules in ≤2 localizations and those with nodules in ≥3 localizations. CONCLUSION: Our study included a total of 205 patients. There was a significant difference in the CRP, CA 125, and hemoglobin levels between Group 1 and Group 2, but it was concluded that coexistence of the endometriotic nodule had no effect on the other hematological parameters. For this purpose, prospective studies with a larger number of patients are needed.

Use of vacuum-assisted closure in massive puerperal genital hematoma.

Puerperal genital hematomas are rare but life-threatening complications of obstetric emergencies. A pregnant patient (39 weeks) underwent a mediolateral episiotomy during a vaginal delivery. An afterbirth hematoma (approximately 20 cm in diameter) was evacuated, but the use of a vacuum-assisted wound closure system was applied after the sutures opened on the 7th postoperative day. On the 10th day of the vacuum-assisted closure (VAC) application, the wound was completely closed. VAC is an alternative treatment modality that can drain an infection and increase the proportion of granulation tissue in humid and irregular surfaces such as the perineum.

A brief study on the knowledge and choice of contraception methods in married adolescent girls.

INTRODUCTION: The fertility rate is 0.25% for 15-19-year-old girls and 16% for 19-year-old girls who are mothers or pregnant with their first child. Fifty-two percent of married adolescents did not have affective contraception. To encourage using the right contraceptive methods in married adolescents, it is essential to examine the behaviors of this group, the level of contraceptive knowledge and the choices they make regarding contraceptive use. MATERIALS AND METHODS: One hundred and ten married adolescent females, less than 20 years of age, who visited a gynecology and obstetrics clinic between January 2015 and October 2016 were enrolled in this prospective study. RESULTS: Of them 96.4% were unemployed. At the time of the study, 70% of them were pregnant. Of these pregnancies, 46.4% was a first, 19.1% a second and 8.2% a third pregnancy. The abortion rate in this study was 18.3%, and stillbirth was 2.8%. The interval between pregnancies was 20.9 months. The unplanned pregnancy rate was 45.5% and 37.3% of these unplanned pregnancies resulted in at least one healthy child. The most common contraceptive method was the use of condoms (10.9%). Changes in contraceptive methods resulted in pregnancy in 66.7% of the cases. Although 20.9% of the husbands in the study used contraceptive methods, 40.9% of them felt that their husbands should be using contraception. Of the participants 43.5% received their knowledge regarding family planning and contraceptive methods from local health clinics. DISCUSSION: Teen marriage, pregnancy and teen parents result in socio-economic and educational difficulties. It is essential to support the adolescent parents using affective contraceptive methods and adolescent-friendly health clinics.

Congenital Ewing's Sarcoma, a Rare and Difficult Diagnosis: A Case Report.

We have interestedly read the article written by Thalia Wong BS in July 2015, which is about Pediatric Blood Cancer, including clinical findings and results of infants <1 year of age with Ewing sarcoma. We report a case with congenital Ewing's sarcoma that easily interfered with rabdomyosarcoma in a pregnant woman. A 32-year-old multigravida with a big neck mass at 35 weeks was referred to our clinic. The final diagnosis of extraskeletal Ewing's sarcoma was made. Hepatic metastasis was detected and treatment by chemotherapy was initiated. Ewing's sarcoma is usually noted among adolescents or young adults and more rarely than among newborns. This case is important because of its rarity.

A Randomized Trial Comparing Triple versus Single Uterine Tourniquet in Open Myomectomy.

BACKGROUND: Single and triple uterine tourniquet significantly reduces blood loss during myomectomy and both are highly effective. Triple tourniquet, however, blocks ovarian circulation and there is doubt that it causes ischemic damage to ovaries. These 2 methods have not been compared by a randomised controlled study yet. The purpose of this study was to compare triple uterine tourniquet with single tourniquet in terms of blood loss during open myomectomy. MATERIAL AND METHODS: Women were randomized to triple (n = 24) or to single tourniquet (n = 24) at open myomectomy. All women with a myomatous uterus greater than 12 weeks of gestation were eligible to be part of the study. The primary outcome of the study was the amount of blood loss during surgery. Sample size was set to detect a 250 mL difference in blood loss with 80% power at α = 0.05. We also compared the change in anti-Müllerian Hormone (AMH) levels before and after surgery. RESULTS: There was no significant difference in the outcome of blood loss between triple and single uterine tourniquet (322 ± 223 vs. 426 ± 355 mL, p = 0.230). Change in AMH was not different between the groups. CONCLUSIONS: There is no clinically significant difference between triple and single uterine tourniquets on blood loss at open myomectomy.

The effect of increased number of cesarean on maternal and fetal outcomes.

OBJECTIVES: The aim of this study was to evaluate the effects of multiple cesarean deliveries (CDs) on maternal-fetal mor-bidity and mortality rates. MATERIAL AND METHODS: This retrospective study included a total of 1,506 patients who underwent multiple CDs between January 2006 and May 2014. The patients were divided into two groups. One group consisted of patients with four or more CDs (n = 444) and a control group of patients with three CDs (n=1,062). Both groups were analyzed for demographics, complications from multiple cesarean deliveries and perinatal outcomes. RESULTS: The mean age was higher in the study group (p < 0.001). Dense adhesion (p < 0.001), demand for tubal ligation (p < 0.001), the requirement of pelvic drainage (p < 0.001), duration of hospitalization (p < 0.001) and the requirement for blood transfusion (p=0.03) was also significantly higher in the study group. Hemoglobin levels (p = 0.002) were signifi-cantly higher in the control group on the second postoperative day. Regarding perinatal morbidity; umbilical artery pH results (p = 0.003) were significantly lower in the study group. There was no significant difference in the maternal and fetal mortality rates between both groups. CONCLUSIONS: According to our study results, an increase in the number of cesarean sections increases maternal and fetal morbidity rates significantly. Therefore, we recommend decreasing the rate of primary cesarean deliveries by encouraging vaginal birth after CD. We also advocate the use of permanent contraceptive methods in patients with a high number of CD's. Further large-scale prospective results are required to establish a definitive conclusion.

The effect of metamizole on ischemia/reperfusion injury in the rat ovary: An analysis of biochemistry, molecular gene expression, and histopathology.

OBJECTIVES: In this study, we investigated the effect of metamizole on ischemia/reperfusion (I/R) injury an analysis of biochemistry, molecular gene expression, and histopathology in the rat ovary of female albino Wistar rats. MATERIALS AND METHODS: Animals were divided into four groups; control group with induced ischemia-reperfusion (IRC), ischemia-reperfusion +100 mg/kg metamizole sodium (MS) (IRM-100), ischemia-reperfusion +200 mg/kg MS (IRM-200), and healthy group applied sham operation (SG). RESULTS: Myeloperoxidase (MPO) activity and gene expression increased significantly in IRC and IRM-100 group rat ovarian tissue compared with the SG group (P < 0.0001). However, MPO activity and gene expression in IRM-200 group ovarian tissue decreased significantly compared with the IRC and IRM-100 groups (P < 0.0001). Histopathologically, pronounced congestion, dilated vessels, hemorrhage, edema, degenerative cells, and neutrophil migration and adhesion to the endothelium were observed in the IRC and IRM-100 group ovarian tissues. A small number of congested dilated vessels, mild congestion, and edema were observed in the IRM-200 group, but no neutrophil migration and adhesion to the endothelium or degenerative cells. CONCLUSIONS: At 200 mg/kg dose metamizole prevented ovarian injury induced with I/R. This data show that metamizole can be used in the ovarian I/R injury treatment.

Angiomyofibroblastoma of the vulva during pregnancy.

Angiomyofibroblastoma is a rare, benign and recently defined soft tissue tumor. It generally arises from superficial soft tissues, especially from mesenchymal cells in the subepithelial myxoid stromal zone of the vulvovaginal region. The tumor is usually positive for estrogen and progesterone receptor. We report a pregnant woman who developed vulvar angiomyofibroblastoma within 2 months. The tumor was negative for estrogen and progesterone receptor.

Maternal serum interleukin-10, interleukin-2 and interleukin-6 in pre-eclampsia and eclampsia.

PROBLEM: The aim of the study was to investigate and compare the concentrations of interleukin (IL)-2, IL-6, and IL-10 in serum of women with mild pre-eclampsia, severe pre-eclampsia, eclampsia, and normotensive pregnancy. METHOD OF STUDY: A total of 69 consecutive cases, 38 mild pre-eclampsia, 20 severe pre-eclampsia, 11 eclampsia, and 20 normotensive controls were included in this study. Serum IL-2, IL-6, and IL-10 levels were determined using enzyme-linked immunosorbent assay method. RESULTS: Gestational age (P = 0.210) and body mass index (P = 0.214) between the groups were similar. The mean concentration of serum IL-2 and IL-6 were not different between the groups (P = 0.261, P = 0.141 respectively). The median concentrations of serum IL-10 in patients with mild and severe pre-eclampsia were similar (P < 0.282) and was significantly lower than those of controls (P < 0.001) and patients with eclampsia (P < 0.001). In patients with eclampsia, the median concentration of IL-10 was significantly higher than that of all other groups (P < 0.001 for each comparison). CONCLUSION: Pre-eclampsia is associated with a deficiency serum IL-10. High serum IL-10 is correlated with the presence of eclampsia.