The shortest distance between the skin and the peritoneal cavity is obtained with fascial elevation: a preliminary prospective laparoscopic entry study

The purpose of this study was to prospectively compare the measurement of skin-to-fascia distances in the neutral state, during manual elevation and by fascial elevation in patients who underwent laparoscopic surgery. In 53 patients, the distance between the skin and anterior wall of the rectus sheath was measured prospectively in following three different ways: (1) in neutral position, (2) during manual elevation and (3) during elevation of the fascia using forceps following an infraumbilical vertical skin incision. In all patients, subcutaneous tissue up to the fascia was dissected after a vertical skin incision. The skin-to-fascia distance of 30.9 mm (14.0-52.0 mm) in the neutral position decreased to 11.1 mm (0.0-26.0 mm) during the fascial elevation, while the mean distance increased to 40.1 mm (19-70 mm) during manual elevation (p < 0.001). In the closed laparoscopic entry technique in which a Veress needle is inserted into the peritoneum through a small incision, the needle should be introduced from the shortest distance between the skin and the peritoneum. Lifting the fascia with a proper surgical instrument in suitable patients could enable us to achieve this goal.

A retrospective analysis of patients treated for gestational trophoblastic diseases: a 4-year experience of a tertiary hospital

AIM

To study incidence, clinical outcome, and follow-up data of the gestational trophoblastic disease (GTD) in patients diagnosed in the present Department.

MATERIALS AND METHODS

This study included the authors' retrospective clinical records regarding the cases of GTD which were diagnosed and followed up between January 2011 and January 2015. Patients' age, gravidity and parity, obstetric history, subgroup of GTD, gestational weeks, management results, and pre-post treatment β-hCG levels was investigated and an incidence study was constituted.

RESULTS

Total of 56 GTD cases were hospitalized and clinical records of 16,840 normal spontaneous deliveries were evaluated during the study period. The incidence of GTD was 3.3/1,000 cases. After histopathological examination, nine of 47 cases were partial molar pregnancy, whereas 38 cases were complete moles. There were no choriocarcinoma and invasive moles. All cases were treated with vacuum curettage without complication.

CONCLUSION

The GTD incidence in this clinic is high with a rate of 3.3/1,000 per pregnancy compared to Turkish literature. High birth rates of our population may play a role in high incidence results. Further investigation in this field is essential.

Generation of bioethanol and VFA through anaerobic acidogenic fermentation route with press mud obtained from sugar mill as a feedstock

Acidogenic anaerobic fermentation route was explored for the production of bioethanol and volatile fatty acids (VFA) from the press mud (PM) obtained from sugar mill. Slurry was prepared from PM having 10% of total solids and the same was hydrolyzed under acidic thermal conditions. Both press mud slurry (PMS) and pre-treated press mud slurry (PTPMS) was used as feedstock with mixed microbial consortia (MMC) and enriched mixed microbial consortia (EMMC). Mix of bioethanol and VFA were obtained in all the four cases (PMS-MMC, PMS-EMMC, PTPMS-EMC and PTPMS-EMMC), but, bioethanol and VFA yield of 0.04 g/g and 0.27 g/g, respectively obtained from PTPMS with EMMC was found to be comparatively higher. Control experiments carried out with glucose yielded bioethanol and VFA of 0.042 g/g and 0.28 g/g, respectively demonstrating that the organism was using reducible sugars in the feedstock for the generation of bioethanol by simultaneously producing the VFA from COD.

A randomised controlled study comparing valethamate bromide and placebo in shortening the duration of active labour

The aim of this study is to compare the efficacy and safety of valethamate bromide and placebo against placebo in shortening the duration of active labour. A prospective randomised trial of 158 low-risk women in spontaneous labour was conducted. After evaluation of the patients according to exclusion criteria 30 women were given valethamate bromide (Group 1) and 32 women were given placebo (Group 2). Labour duration was the main outcome measure. The duration of the active phase after starting the treatment was similar in the two groups at 225 and 219 min, respectively. However, differences were not significant between the 2 groups. Side effects such as tachycardia, flushing of the face and dryness of mouth were noted with valethamate bromide administration. In conclusion, valethamate bromide did not significantly shortened the duration of active labour in nulliparous women with a singleton pregnancy at term.

A randomised controlled study comparing valethamate bromide and placebo in shortening the duration of active labour

The aim of this study is to compare the efficacy and safety of valethamate bromide and placebo against placebo in shortening the duration of active labour. A prospective randomised trial of 158 low-risk women in spontaneous labour was conducted. After evaluation of the patients according to exclusion criteria 30 women were given valethamate bromide (Group 1) and 32 women were given placebo (Group 2). Labour duration was the main outcome measure. The duration of the active phase after starting the treatment was similar in the two groups at 225 and 219 min, respectively. However, differences were not significant between the 2 groups. Side effects such as tachycardia, flushing of the face and dryness of mouth were noted with valethamate bromide administration. In conclusion, valethamate bromide did not significantly shortened the duration of active labour in nulliparous women with a singleton pregnancy at term.

Serum human epididymis protein 4 can be a useful tumor marker in the differential diagnosis of adnexal masses during pregnancy: a pilot study

PURPOSE

The purpose of this study was to evaluate serum concentrations of human epididymis protein 4 (HE4) and cancer antigen 125 (CA 125) in healthy women and their pregnant counterparts to determine the influence of pregnancy on these biomarkers.

MATERIALS AND METHODS

Serum concentrations of CA 125 and HE4 were measured in 27 healthy non-pregnant women and 26 healthy pregnant women in the first and second trimesters.

RESULTS

Higher concentration of CA 125 was found in pregnants than in non-pregnant women (p = 0.002). There was no difference in CA 125 concentrations between first and second trimesters (p = 0.13). Serum HE4 concentration was not different in pregnant group compared to non-pregnant women (p = 0.510). Likewise, no difference was found in HE4 levels between the trimesters (p = 0.485). There was a positive correlation between increasing parity and CA 125 (p = 0.023), but not HE4 (p = 1.0).

CONCLUSION

HE4 serum biomarker is unaffected by pregnancy status and may be useful for evaluation of doubtful pelvic masses in pregnancy. Contrarily, increased serum levels of CA 125 could yield increased number of false-positive results.

Leuloplakia - review of a potentially malignant disorder

Leukoplakias are oral white lesions that have not been diagnosed as any other specific disease. They are grouped under premalignant lesions, now redesignated as potentially malignant disorders. Their significance lies in the fact that they have propensity for malignant transformation at a higher rate when compared to other oral lesions. This article reviews aetiology, epidemiology, clinical characteristics, histopathologic features, malignant potential and treatment of oral leukoplakia.

Immunohistochemical characterization of cyclin dependent kinase-4 in different histological grades of oral leukoplakia and oral squamous cell carcinoma

BACKGROUND

Cyclin dependent kinase-4 (CDK4) encoded by CDK gene, is a heterodimer protein of cell cycle in G1-S transition. This study aimed to characterize the CDK4 immunoreactivity in different histological grades of oral leukoplakias (OLs) and oral squamous cell carcinomas (OSCCs) and also aims to discuss its probable role in the tumor biogenesis.

MATERIALS AND METHODS

Expression of CDK4 was investigated in total of 52 samples including OL (15), OSCCs (30) and normal oral tissues (07). A labeled Streptavidin-Biotin immunohistochemistry assay was performed and staining intensity was evaluated.

RESULTS

The staining pattern was similar in all tissues and was located in both nuclei and cytoplasm. Dysplastic epithelium displayed a progressive increase in nuclear expression of CDK4 when compared to normal tissues. Also, positive staining cytoplasm was highly evident in OSCC with loss of differentiation.

CONCLUSION

Our study indicated a progressive over expression of CDK4 from normal to leukoplakias (various histological grades of dysplasias) and OSCCs.

Plasma fibrinogen degradation products in betel nut chewers - with and without oral submucous fibrosis

CONTEXT

Oral submucous fibrosis (OSMF) has a multifactorial etiology. Recent studies have shown that there is an increased level of fibrinogen degradation products (FDP) in plasma of OSMF patients suggesting its possible role in etiopathogenesis of OSMF.

AIMS

To detect the presence of FDP in the plasma of betel nut chewers with and without OSMF and in normal subjects without any habits, to correlate these levels with respect to the clinical and histological grading of OSMF and whether it can be used as a nonsurgical diagnostic aid in detection of suspected OSMF cases.

MATERIALS AND METHODS

Study comprised of 35 cases of betel nut chewers with OSMF, 10 patients with betel nut chewing habit but having apparently normal oral mucosa, and 10 normal patients without any habits. The patients were evaluated for plasma FDP levels.

RESULTS

All the betel nut chewers with OSMF showed the presence of plasma FDP. However, controls and subjects with habit, but without OSMF did not show FDP in the plasma. Spearman's rank correlation was used to find the association between the clinical and histological grades and it was not statistically significant (P = 0.910) and the correlation being 0.020.

CONCLUSION

Since only those patients with OSMF have showed the presence of FDP in plasma, we suggest that our test can be utilized as a nonsurgical diagnostic aid in suspected OSMF patients.

The prosthodontic management of a young edentulous patient with the papillon lefevre syndrome-a rare case report

The Papillon Lefevre syndrome is an autosomal recessive disorder which is characterized by various dermatological manifestations and periodontitis as a manifestation of a systemic disease. Its aetiopathogenesis is thought to be secondary to the mutation of the Cathepsin C gene. Various studies have shown that the immune related cells like the polymorphonuclear leucocytes and the macrophages and their precursors were affected.This report elicits about an edentulous male with this syndrome, who was treated with a modified complete denture prosthesis (hollow, maxillary, complete denture), considering his young age and low socioeconomic status.

Evaluation of the outcome benefit conferred by intensive surveillance strategies in women with early-stage endometrial cancer

INTRODUCTION

The optimum follow-up regimen after treatment for early-stage endometrial cancer with curative intent is unknown. The National Comprehensive Cancer Network recommends a physical exam and vaginal cytology every three to six months for two years then at six to 12 month intervals with annual chest X-rays (CXR). However, there is debate as to whether intensive follow-up results in an improvement in outcomes for those with recurrent endometrial cancer.

OBJECTIVE

To determine if intensive surveillance for recurrent cancer in women with early-stage endometrial cancer improves their outcomes.

MATERIALS AND METHODS

The Roswell Park Cancer Institute tumor registry was used to identify patients with Stage I and II endometrial cancer initially diagnosed and treated over an 18-year period, who subsequently recurred. Clinico-pathological variables were abstracted. Patients were divided into two groups, depending on their mode of diagnosis of recurrent cancer: 1) routine screening, or 2) symptomatic. The outcomes between the two groups were compared.

RESULTS

Fifty-two patients met inclusion criteria. Twenty-three patients were diagnosed via routine screening methods and 29 were symptomatic at presentation. Groups were equally represented with respect to age, stage, grade, adjuvant therapy, site of recurrence (local, distant), and time to recurrence (p > 0.05). Median survival time was 79 months for those diagnosed during routine screening and 80 months for symptomatic patients (p > 0.05).

CONCLUSION

Pap smear and CXR appear to be of limited utility as the present study has shown that women diagnosed as a result of intensive surveillance did not have a better outcome than those who presented when symptomatic.

Progression of early phase diabetic nephropathy in streptozotocin-induced diabetic rats: evaluation of various kidney-related parameters

Diabetic nephropathy (DN) is one of the serious secondary complications of diabetes, which results in end-stage renal failure. Reports on the progressive nature of early phase DN especially with respect to kidney parameters such as kidney weight, type IV collagen excretion, total kidney and urinary glycosaminoglycans (GAGs) are few. This work was undertaken to determine systematically the progression of early phase DN in relation to various kidney-related parameters for a period of four months. Experimentally-induced diabetic rats were grouped based on fasting blood glucose levels. Various basic and kidney-related parameters such as kidney weight, microalbuminuria, urinary excretion of GAGs and type IV collagen, total kidney GAGs, histopathology, glomerular area and glomerular volume were examined in control and diabetic rats. There was a progressive increase in fasting blood sugar, urine sugar, kidney weight, microalbuminuria, urine glycosaminoglycans, urine type IV collagen, glomerular area and glomerular volume but there was a progressive decrease in kidney glycosaminoglycans. Glomerular sclerotic condition was aggravated with the increase in duration of diabetes from 1 to 4 months. Onset of DN in rats begins subtly after one month of diabetes but gets vitiated and more pronounced at the end of four months.

Synthesis and anti-inflammatory activity of 2-substituted-((N, N-disubstituted)-1, 3-benzoxazole)-5-carboxamides

A series of 2-substituted-((N, N-disubstituted)-1, 3-benzoxazole)-5-carboxamides derivatives were synthesized by the reaction of 2-substituted-5-carbomethoxy benzoxazole with different secondary amines. The newly synthesized compounds were characterized on the basis of spectral (FT-IR, 1H NMR, MS) & elemental analysis. All these compounds were screened for anti-inflammatory activity using carrageenan induced rat paw edema method. All of these compounds exhibited significant activity. Among the tested compounds Ve, Vg, Vf and Va were considered to have potent anti-inflammatory activity and was comparable with standard.

Craniorachischisis totalis: a case report and review of the literature

OBJECTIVE

To discuss a fetus with craniorachischisis diagnosed antenatally and to review the literature.

METHOD

Case report.

RESULTS

Craniorachischisis was detected on ultrasound scan in a fetus at gestational week 13. Pregnancy was terminated and diagnosis was verified postnatally.

CONCLUSION

Craniorachischisis is a rare and severe form of neural tube defects (NTDs). The majority of currently known cases of mouse craniorachischisis have been found to result from disturbance of a single molecular signaling cascade, called planar cell polarity pathway (PCP). The mutant genes that have been causative in disturbance of PCP in mouse models have been examined in human malformations but none of them have so far been implicated in human craniorachischisis. To date, no other genes except the gene encoding 5,10-methylenetetrahydrofolate reductase have been specifically implicated in predisposition to NTDs. We suggest that other PCP genes should be considered as candidates for a role in the etiology of human NTDs. Further investigations are therefore necessary.

Age at menarche in Turkish adolescents in Kahramanmaras, Eastern Mediterranean region of Turkey

OBJECTIVES

To determine the age at menarche in adolescents in the Eastern Mediterranean city of Kahramanmaras, Turkey.

METHODS

The study was conducted in primary and high schools of Kahramanmaras, during the academic year 2003-2004. Data of 8212 female students were collected by using a standard questionnaire. Mean and median ages at menarche (with 95% confidence intervals) were calculated by Kaplan-Meier survival analysis. Also, probit analysis was performed to determine the age at menarche for all girls by estimating the age at which 10, 25, 50, 75 and 90% of the girls reached menarche.

RESULTS

According to the answers obtained through the questionnaire, 5506 (67.5%) of 8161 respondents had had their menarche. Mean age at menarche was 13.04 years (95% CI: 13.01-13.06), and median age 13.00 years (95% CI: 12.97-13.03). According to probit analyses, the probability of menstruating before the age of 11.48 years was 10% and before 15.08 years 90%.

CONCLUSION

We provide data about age at menarche in Kahramanmaras, an Eastern Mediterranean city of Turkey.

A case with diffuse uterine leiomyomatosis and review of the literature

Leiomyomas and diffuse uterine leiomyomatosis are smooth muscle tumors of the uterus. Diffuse uterine leiomyomatosis is a benign and extremely rare condition in which the uterus is symmetrically enlarged as a result of the almost complete replacement of the myometrium by innumerable poorly defined, confluent nodules. The etiology of these neoplasms is not completely understood. Initial symptoms of the diffuse uterine leiomyomatosis usually are abdominal pain and abnormal uterine bleeding. Similar to uterine leiomyomas, patients with leiomyomatosis present with menorrhagia, dysmenorrhea, abdominal pain, infertility, and pelvic pressure. Hormonal treatment usually fails to control the symptoms, anemia, or tumor growth after treatment is stopped. As a result, despite patients being in the third or fourth decades of life, hysterectomy has been the only permanent treatment option offered to patients for treatment of the symptoms related to uterine fibroids in diffuse leiomyomatosis. A case of a patient with a huge uterine mass (2,650 g in weight) who underwent hysterectomy due to diffuse uterine leiomyomatosis is presented together with a review of the literature.

CA 19-9 can be a useful tumor marker in ovarian dermoid cysts

PURPOSE

To evaluate the importance of CA-19-9 as an aiding tool in the diagnosis of mature cystic teratomas.

METHODS

We found 43 cases of dermoid cysts that were operated on at our clinic, and whose tumor marker CA 19-9 was studied before the operation.

RESULTS

Thirty-seven of 43 patients (86%) had elevated CA 19-9 levels. Using Pearson's correlation, the average diameter and weight of the tumor had a strong possitive correlation with the level of CA 19-9 (p < 0.01). Thirty-one out of the 43 (72%) cases had a dermoid cyst in the right ovary, nine (20.9%) in the left ovary, and three (7%) had bilateral dermoid cysts. Right predominancy was very high among the patients (p < 0.05).

CONCLUSION

We suggest that besides ultrasonography and computed tomography, serum CA 19-9 level could be a useful tumor marker in the diagnosis of dermoid cysts.