A new surgical approach for the management of severe postpartum hemorrhage due to uterine atony: preliminary results in 27 cases.

PURPOSE OF INVESTIGATION: To demonstrate a new suturing technique that effectively reduces severe postpartum hemorrhage secondary to uterine atony. MATERIALS AND METHODS: The study consisted of 27 patients with persistent postpartum bleeding due to uterine atony which was unresponsive to medical treatment. The patients were treated with ∞ compression sutures that passed through entire uterine wall on which the placenta was located and were knotted within uterine cavity. Demographic properties, complications, operative results are demonstrated. RESULTS: Uterine bleeding was controlled in 26 of 27 cases (%96.3). Total abdominal hysterectomy was performed in only one patient who had persistent incision site bleeding and disseminated intravascular coagulation. CONCLUSION: Uterine atony is an emergency and early intervention is necessary. As indicated by the preliminary results, the new technique effectively stopped bleeding in 96.3% of cases; no other techniques were carried out additionally. The technique is promising with properties as easy applicability, safety, and absence of major complications. A larger study is needed for further comparison of operative results.

The combined use of MODFLOW and precipitation-runoff modeling to simulate groundwater flow in a diffuse-pollution prone watershed.

A numerical modeling case study of groundwater flow in a diffuse pollution prone area is presented. The study area is located within the metropolitan borders of the city of Izmir, Turkey. This groundwater flow model was unconventional in the application since the groundwater recharge parameter in the model was estimated using a lumped, transient water-budget based precipitation-runoff model that was executed independent of the groundwater flow model. The recharge rate obtained from the calibrated precipitation-runoff model was used as input to the groundwater flow model, which was eventually calibrated to measured water table elevations. Overall, the flow model results were consistent with field observations and model statistics were satisfactory. Water budget results of the model revealed that groundwater recharge comprised about 20% of the total water input for the entire study area. Recharge was the second largest component in the budget after leakage from streams into the subsurface. It was concluded that the modeling results can be further used as input for contaminant transport modeling studies in order to evaluate the vulnerability of water resources of the study area to diffuse pollution.

The effect of icodextrin and glucose-containing solutions on insulin resistance in CAPD patients.

PURPOSE: Peritoneal dialysis patients have particular risks with respect to their lipid status and hyperinsulinemia. The aim of this study was to investigate the relation between insulin resistance and the type of the peritoneal dialysis solution. MATERIALS: 41 randomly selected non-diabetic patient cohort who were already under treatment with continuous ambulatory peritoneal dialysis (CAPD) and 10 healthy controls participated in the study. 24 of the 41 patients were using 3 standard 1.36% glucose solutions during the day and 1 hypertonic solution with 2.27% glucose dwell during the night (glucose group: mean age 45.54 +/- 16.67 years and median CAPD duration 16.5 months). The remaining 17 patients were using 3 standard 1.36% glucose solutions during the day and 1 icodextrin dwell during the night for 8-10 hours (icodextrin group: mean age 47.47 +/- 13.15 years, median duration of icodextrin use 6 months (range 2-20 months), and median CAPD duration 30 months). Insulin resistance (IR) was calculated according to the homeostasis model assesment (HOMA) formula: HOMA-IR = fasting glucose (mmol/l) x fasting insulin (microU/1/22.5. The HOMA cutoff point for diagnosis of insulin resistance was established with receiver-operating characteristic (ROC) curves. The patients were called HOMA-IR(+) if their HOMA scores were higher than cutoff value. RESULTS: There were no significant differences between age, BMI, triglyceride, total and high-density lipoprotein (HDL) cholesterol, iron and ferritin, alanine aminotransferase, fibrinogen, intact parathyroid hormone, magnesium, hemoglobin and hematocrit levels of the 2 groups. The mean glucose levels of the groups were not different but fasting insulin levels and HOMA scores of the icodextrin group were significantly lower than the glucose group (10.15 +/- 6.87 vs. 18.11 +/- 13.15, p = 0.028, and 2.28 +/- 1.67 vs. 4.26 +/- 3.27, p = 0.027, respectively). The ratio of patients with low HOMA scores (cutoff = 2.511) were significantly higher in the icodextrin group than in the glucose group (71% vs 38%, p = 0.037). Other than fasting insulin and glucose levels, significantly positive correlation was found between HOMA score and BMI in both groups. With regression analysis, we found that the main parameters effecting HOMA score were BMI (p = 0.008) and triglyceride (p = 0.029) in the glucose group, but no parameters were found to affect HOMA score in icodextrin group. CONCLUSION: These results suggest that insulin resistance is reduced in peritoneal dialysis patients using icodextrin-based dialysis fluid instead of glucose-based dialysis fluid.

Phase conjugation in an inhomogeneously broadened medium.

Calculation with NH3 shows that near resonance there is a significant dip in the intensity of a phase-conjugate wave that is generated by degenerate four-wave mixing processes in a Doppler-broadened medium. The magnitude of the dip is sensitive to pressure and temperature.