Bilateral hypogastric artery ligation in emergency setting for intractable postpartum hemorrhage: a secondary care center experience.

OBJECTIVE: To report the authors' experience in bilateral hypogastric (internal iliac) artery ligation which was performed for controlling intractable postpartum hemorrhage in a secondary care center. MATERIALS AND METHODS: The patients that required bilateral hypogastric artery ligation for severe intractable postpartum hemorrhage from November 2007 to August 2009 were included in this retrospective study. Data were retrieved from patients' hospital records. RESULTS: A total of 26 cases required hypogastric artery ligation during the study period. Causes of postpartum hemorrhage included uterine atony, placental abruption, uterine rupture, and placenta accreta. Hemorrhage was effectively controlled in 20 of 26 cases (76.9%) and hysterectomy was avoided. Iliac vein injury occurred in one patient (3.8%) as an operative complication. There was one maternal death. CONCLUSION: Hypogastric artery ligation is an effective therapeutic option for severe postpartum hemorrhage and should be kept in mind during obstetric emergency conditions.

Gestational choriocarcinoma arising in a tubal ectopic pregnancy: case report.

OBJECTIVES: Gestational choriocarcinoma associated with ectopic pregnancy is an extremely rare event. Here we report one of these cases. CASE: A 38-year-old, gravida 4, parity 3, patient was admitted to the emergency room with the complaint of abdominal pain. Peritoneal irritation signs were present and serum hCG level was found to be greater than 15000 mUI/ml. Transvaginal ultrasound images were compatible with ruptured tubal ectopic pregnancy. Hemoperitoneum and ruptured tuba were found at laparatomy and a right salpingectomy was performed. The histopathological evaluation reported the lesion as primary tubal choriocarcinoma. The patient was referred to a tertiary care center for treatment and follow-up. CONCLUSION: Adequate monitoring of beta-hCG titers and careful examinations of pathologic specimens are important to avoid misdiagnosis of ectopic gestational trophoblastic disease.

Seroprevalence of IgG antibodies against Bordetella pertussis in healthy individuals aged 4-24 years in Turkey.

The distribution of IgG antibodies to Bordetella pertussis was investigated in serum samples from 550 subjects, aged 4-24 years, to determine the optimal age for booster immunisation. Levels of antibody to B. pertussis antigens were determined using an ELISA that measures a mixture of pertussis toxin, filamentous haemagglutinin and lipopolysaccharide. Geometric mean titres of anti-pertussis antibodies in subjects aged 4-6 years were significantly lower than those in other age groups, which reflects waning immunity following vaccination. High positive titres in older children and adolescents suggested acquired B. pertussis infection, and booster doses at the ages of 7 and 15 years are therefore suggested.

First pulmonary valve replacement with Freedom Solo stentless valve in an adolescent. A case report.

Tetralogy of Fallot (TOF) is a common form of cyanotic heart disease. Complete surgical correction in younger age group offers good long-term results with reasonable morbidity and improved prognosis in patients with TOF. However, following corrective surgery pulmonary valve replacement (PVR) might be required for residual pulmonary regurgitation in order to avoid irreversible right ventricular remodeling. Otherwise, residual uncorrected pulmonary regurgitation may lead to right ventricular dilatation, impaired biventricular function, ventricular arrhythmias and limited exercise capacity. We report the first case of Freedom Solo stentless valve (Sorin Group, Saluggia, Italy) implantation in the pulmonary position in an adolescent with severe pulmonary insufficiency 12 years after the repair of TOF. Pericardial stentless valves may be an alternative choice for pulmonary valve replacement to improve right ventricular contractile recovery and remodeling after PVR and may have impact on long-term survival.

Recombinant human erythropoietin administration in cardiac surgery.

OBJECTIVE: Postoperative anemia and multiple blood transfusions are still important problems in cardiac surgery. During the past few years, there have been some reports indicating that multiple recombinant human erythropoietin infusions starting at least 2 weeks before the operation induced erythropoiesis. We aimed to reduce the risk of adverse reactions of high doses of recombinant human erythropoietin and reduce the period of hospitalization by using it only once, 4 days before the operation. METHODS: Twenty-five patients received recombinant human erythropoietin 4 days before the operation, and 28 patients comprised the control group. All the hematologic parameters of the patients are measured on the day of admission, the day before the operation (fourth day), the first day after the operation, and 1 week later. RESULTS: In the recombinant human erythropoietin group the mean hemoglobin concentration increased on the morning of the operation (14.5 +/- 0.52 g/dL in the recombinant human erythropoietin group and 12.4 +/- 0.65 in the control group, P <.05). To maintain hemoglobin levels at greater than 8.5 g/dL, 330 +/- 33 mL of homologous transfusion was required in the recombinant human erythropoietin group, whereas 680 +/- 75 mL was required in the control group (P <.01). CONCLUSION: Recombinant human erythropoietin induces erythropoiesis rapidly, even when it is used with a low single dose just 4 days before the operation. No adverse reactions were seen with this kind of recombinant human erythropoietin treatment.

A multivesicular cardiac hydatid cyst with hepatic involvement.

Cardiac hydatid cyst is an uncommon lesion, mostly caused by Echinococcus granulosus. Occurrence of the disease in man appears to be limited geographically to areas where close and continuous contact exists between domesticated carnivores such as dogs and ungulates such as cattle and sheep. Generally cardiac hydatid cysts are univesicular. Here we report our clinical and surgical experience of treatment in a case of a multivesicular cardiac hydatid cyst with hepatic involvement.

Hemodynamic advantages of left atrial epinephrine administration in open heart operations.

BACKGROUND: It is often necessary to administer a catecholamine to patients who have undergone cardiac operations. However, there are some potential disadvantages to using the central venous circulation, a routine route for catecholamine infusion. The advantages of the left atrial infusion of epinephrine were investigated in 21 patients. METHODS: The first group received epinephrine through the central venous route (central venous group), and the second group received adrenaline through the left atrial route (left atrial group). Hemodynamic studies were performed in all patients before and after the infusions. Blood samples were also taken from the radial and pulmonary arteries to determine the epinephrine concentrations. RESULTS: The average pulmonary arterial pressure and pulmonary vascular resistance were higher in the central venous group, whereas higher cardiac indices and average blood pressures were noted in the left atrial group (p < 0.05). There was a statistically significant difference in the epinephrine concentrations in the pulmonary arterial and radial arterial samples between the two groups. CONCLUSIONS: We conclude that epinephrine infusion through the left atrial route is associated with greater hemodynamic advantages than infusion through the central venous route.

Cardiac echinococcsis with multivisceral involvement.

Cardiac hydatid cyst is an uncommon lesion. The infection, often acquired by children during play with infected dogs, is most common in sheep-raising areas of the world. We report our clinical and surgical experience in the treatment of one of the youngest reported cardiac hydatidosis patients with multivisceral involvement.