In this study, we aimed to investigate the association of the neutrophil-to-lymphocyte ratio (NLR) with Global Registry of Acute Coronary Events (GRACE) risk score in patients with ST-segment elevated myocardial infarction (STEMI). We analyzed 101 consecutive patients with STEMI. Patients were divided into 3 groups by use of GRACE risk score. The association between NLR and GRACE risk score was assessed. The NLR showed a proportional increase correlated with GRACE risk score (P < .001). The occurrence of in-hospital cardiac death, reinfarction, or new-onset heart failure was significantly related to NLR at admission (P < .001). Likewise, NLR and GRACE risk score showed a significant positive correlation (r = .803, P < .001). In multivariate analysis, NLR resulted as a predictor of worse in-hospital outcomes independent of GRACE risk score. Our study suggests that the NLR is significantly associated with adverse in-hospital outcomes, independent of GRACE risk score in patients with STEMI.

It is difficult to conduct studies with larger series in rarely observed diseases. We report our experience in managing cesarean scar endometriosis (CSE) and emphasize the diagnosis and treatment options. The objective of our study is to review the clinical characteristics of CSE and to evaluate our surgical outcomes. We have collected and documented a case series of 12 patients who underwent surgical wide en bloc excision with surrounding clear margins for CSE. Patients' demographic features, symptoms, and clinical and operative findings were evaluated. The mean age was 34.6 years. Cyclical pain was documented in seven patients, while three patients presented with noncyclical pain. Menstrually-related enlargement of the nodule was observed in four patients, and only one patient had a complaint of dark brown leakage. The mean operation time was 26 min. The endometriotic lesions ranged from a diameter of 2 to 8 cm in size. Patients recovered completely, and no recurrence was observed. To prevent iatrogenic transplantation, additional attention is needed during surgery that exposes endometrial tissue. Complete wide excision of CSE is both diagnostic and therapeutic. To avoid unnecessary referrals, awareness of its typical clinical manifestations remains the mainstay for intervention. The most important issues to be considered during surgery is nonspreading endometriosis while manipulation.

RALM appears to provide the same surgical outcomes when compared with traditional laparoscopic myomectomy.

No abstract

A 65-year-old, G 3 , P 3 woman referred to gynaecology clinic due to sensation of fullness in the pelvis and a palpable mass in the abdomen since 2 weeks. She had a medical history of osteoarthritis, hypertension and non-insulin-dependent diabetes mellitus. The patient's body mass index was 36 kg/m 2 . Physical examination revealed a large palpable, relatively mobile, non-tender mass in the pelvic region. Ultrasound demonstrated a loculated heterogeneous, cystic mass in pelvis and mild free fluid in the Pouch of Douglas. The lesion had mixed echogenicity with hypo echoic and hyper echoic components, contained solid parts within distinct margins, and were 18cm×15cm×12cm in size. Computed tomography was performed because the lesion extended beyond the pelvis [Table/ Fig-1]. Computed tomography showed a large complex, well-circumscribed mass measuring 18 cm in the largest transverse diameter occupying the pelvis. Her CA-125 levels were 36U/L. Based on the clinical findings and imaging studies malignancy was highly probable, so the patient was prepared for surgery. The patient underwent an exploratory midline laparotomy from above the umbilicus to the symphysis pubis. At surgery, Malignant Mixed Mullerian Tumour of the Ovary (OMMMT), also referred to as carcinosarcoma is a very rare tumour accounting for less than 1% of all ovarian cancers. Due to the rarity of OMMMT, little is known about the disease course and outcome of women with these tumours. It is important to evaluate because of its aggressive behaviour with extremely unfavourable prognosis. These tumours are composed of both malignant epithelial and mesenchymal elements. Current data in the literature is still limited to small case series and case reports, therefore, its optimal treatment is somewhat controversial. In the current report, we introduce a case of OMMMT which was successfully treated with Platinum-based combination chemotherapy after optimal cytoreductive surgery. The clinical manifestations, pathologic characteristics, diagnosis and management of these tumours are reviewed here. Although the most effective treatment is currently unknown, optimal cytoreductive surgery and platinum-based chemotherapy appears to improve the outcomes. Despite the aggressive nature of this tumour and its poor response to the treatment, management works best when cancer is found early. The stage of the disease is the most important prognostic factor. Therefore, the crucial question is how to diagnose the cancer at earlier stages rather than seeking the optimal treatment.keywords: Cytoreductive surgery, Ovarian neoplasms, Platinum-based chemotherapy the pelvic and abdominal organs were closely inspected. The tumour originated from the left ovary and abdominal ascites was noted. The gross appearance of the tumour was predominantly solid and lobulated mass, with varying degrees of haemorrhage and necrosis. We found that no organ was infiltrated, and the right ovary was atrophied. Peritoneal washings were obtained. Frozen section revealed a malignant tumour. The patient...