Aim: The study objective was to compare intraoperative and early postoperative outcomes among patients who underwent hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (and singleport lararoscopy for presumed benign gynecologic disorders). Methods: We retrospectively reviewed 40 patients who underwent single-port laparoscopic hysterectomy and 20 patients who underwent hysterectomy via natural orifice transluminal endoscopic surgery. Patients' age, body mass index, history of previous delivery and surgery, total operation time (from skin incision to closure), intraoperative and postoperative complications conversion to another surgical procedure, drop of hemoglobin level, postoperative pain at 1 and 18 h, average hospital stay, and clinical outcomes were analyzed. Results: Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery was superior to single-port hysterectomy concerning the length of hospitalization (p < 0.001) and visual analog scale at 1 h (p = 0.024) and 18 h (p < 0.001). In transvaginal natural orifice transluminal endoscopic group, postoperative complications were lower than single-port laparoscopy group (p = 0.023). In transvaginal natural orifice transluminal endoscopy, group conversion to a standard vaginal hysterectomy occurred in two cases (10%). Four patients in the single-port laparoscopic hysterectomy group had umbilical herniation, three had portsite infections, and two patients had vaginal cuff hematoma. These patients required rehospitalization. Conclusions: Despite hysterectomy via transvaginal natural orifice transluminal surgery has not yet found its place in routine practice in gynecology departments, it could be a prominent alternative approach to other minimally invasive surgical procedures in selected patients with many advantages including lesser pain and lower complication rates compared with single-port laparoscopic hysterectomy.
INTRODUСTION The pandemic of coronavirus infection is a novel reality for the obstetrical community. Since pregnancy is known to be associated with the suppressed immune response, the issues of the prevention and treatment of coronavirus disease (COVID-19) are of outstanding importance [1-3]. This infection was found to be involved in the disturbing fetal-maternal immune interaction. Therefore the increased level of pre-eclampsia and preterm birth was reported in pregnant women with COVID-19 [4]. Life-threatening pneumonia with respiratory distress syndrome was found in the majority of fatal cases of COVID-19 [5]. The elevated intraabdominal pressure in pregnancy reduces the motility of diaphragm and lung vital capacity. Severe comorbidity is a serious risk factor for the mortal outcome in COVID-19 [6, 7]. Diabetes mellitus is a systemic disease that impairs immunity and vascular system. Gestational diabetes mellitus (GDM) enhances proinflammatory mechanisms of end-organ lesions. COVID-19 patients were found to have an increased level of Il-6 and C-reactive protein. Thus, pregnant women with GDM are at risk of systemic inflammatory response (SIRS) syndrome and fatal complications of COVID-19 [7]. We report a mortal case of COVID-19 associated with bilateral pneumonia and SIRS syndrome in a pregnant woman with GDM. The study protocol was approved by the Bioethics Committee of the Kharkiv Medical Academy of Postgraduate Education (registration number 0116U002865). CASE PRESENTATION A pregnant woman aged 35 years was admitted to Kocaeli Derince Training and Research Hospital (Kocaeli, Turkey) at 31 weeks of gestation. She complained of dry cough, fever, dizziness for three days. She felt fetal activities. She had blood pressure of 130/80 mm Hg, a pulse of 96 per minute, the rate of respiration of 20 per minute, and a body temperature of 38.2 °C at the time of hospitalization. Woman was obese with body mass index 40 kg/m 2. This pregnancy was 4 th , and two of pregnancies were completed by cesareans. She had regular antenatal visits. GDM was diagnosed at 24 weeks of gestation and insulin injections were started. The uterine tone was normal, palpation of the postcesarean scar was painless, and the cervix was closed. The fetal status was found to be normal via Doppler ultrasound. Computer tomography of the chest was performed. The bilateral pneumonia was diagnosed (Fig.). The tests for COVID-19 were positive. Patient was admitted to the Intensive Care Unit. The majority of laboratory tests were unremarkable (hemoglobin, leukocytes, platelet count, serum aspartate aminotransaminase (AST), serum alanine aminotransaminase (ALT), serum urea, serum creatinine concentration, and coagulation profile were normal). But lymphopenia, hyperglycemia, trace of proteinuria, and ketonuria in urinalysis were detected. C-reactive protein (131.2 mg/l) was considerably elevated, and procalcitonin (0.08 ng/ml) was slightly increased. Therefore, she had a disturbed carbohydrate metabolism and markers of the systemic inflammation. Anti-infla...
Background. Cyclophosphamide is a drug used in various types of cancer. It can cause oxidative and inflammatory ovarian damage and infertility. Thiamine pyrophosphate (TPP) to be investigated for its effect on cyclophosphamide-induced ovarian damage and reproductive dysfunction in the present study is the active metabolite of thiamine. It has been shown that TPP protects organs and tissues from oxidative stress and proinflammatory cytokine damage. Objectives.To investigate the effect of TPP against the ovarian damage and reproductive dysfunction caused by cyclophosphamide in rats. Materials and methods.Albino Wistar type female rats were divided into healthy control (HG), cyclophosphamide (CYC) and TPP + cyclophosphamide (TPPC) groups (for each group, n = 12). Thiamine pyrophosphate at a dose of 25 mg/kg was injected intraperitoneally (ip.) in the TPPC group, and 0.9% NaCI solution was injected ip. in the CYC and HG groups. One hour after the injection, 75 mg/kg of cyclophosphamide was administered ip. in the TPPC and CYC groups. This procedure was repeated once a day for 30 days. At the end of this period, 6 rats from each group were euthanized with a high dose of anesthetic (50 mg/kg of sodium thiopental). Biochemical and histopathological examinations were performed on the extracted ovarian tissue. The remaining animals were kept in the laboratory with mature male rats for 2 months for reproduction.Results. Thiamine pyrophosphate significantly decreased the cyclophosphamide-induced increase in the levels of the oxidant parameter malondialdehyde (MDA), proinflammatory nuclear factor kappa B (NF-κB), tumor necrosis factor alpha (TNF-α), and interleukin 1 beta (IL-1β). In addition, TPP decreased the severe histopathological damage associated with cyclophosphamide in the ovarian tissue and prevented infertility. Conclusions.Our experimental results have suggested that TPP could be beneficial in the treatment of cyclophosphamide-induced ovarian injury and infertility.
Aim and objective: The study was aimed to investigate possible complications such as intrauterine synechiae following the B-Lynch suture, which was used to control postpartum hemorrhage (PPH). Materials and methods: Our study included 36 patients, which underwent B-Lynch suture due to PPH from 2013 to 2015. Results: Asherman's syndrome was found in 3 (8.3%) of 36 patients who participated in the study. Two patients with Asherman's syndrome had a history of placenta accreta and one patient placenta previa. Conclusion:Compared to procedures that require experiences such as hysterectomy or internal iliac artery ligation, B-Lynch suture is a highlevel PPH approach that preserves fertility potential with preventing complications.
Aim of this study is to investigate whether the risk of miscarriage increases in pregnant women who had COVID-19 in fi rst trimester. Our study included 52 patients with SARS-CoV-2 infection detected by RT-PCR and 53 patients with negative RT-PCR test in samples taken with nasopharyngeal swab in the fi rst trimester between March 1 and December 31, 2020. Complete abortion, incomplete abortion, blighted ovum, intrauterine exitus, biochemical pregnancies were accepted as in the miscarriage group (MG). Pregnant women with COVID-19 and control group were compared in terms of demographic data, miscarriage rate and laboratory results. Patients were divided into MG and ongoing pregnancy groups (OPG) and compared in terms of the diagnosed weeks, clinical fi ndings, laboratory results, treatments, and hospitalization. While miscarriage was observed in 15 (28.8%) of pregnant women infected with SARS-CoV-2 in the fi rst trimester, this number was 7 (13.2%) in the control group. While the common symptoms in the MG were cough (60%), fever (53.3%), shortness of breath (53.3%), and fatigue (46.7%) (p<0.05); asymptomatic patients (51.4%) were higher in the OPG (p<0.001).Hospitalized patients were 33.3% in the MG and 8.1% in the OPG (p=0.02). According to the results of our study, the risk of miscarriage increases in pregnant women infected with SARS-CoV-2 (especially in severe infection) in the fi rst trimester.
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