The effect of the presence or absence of skull fractures on intracranial lesion development in road traffic accidents

OBJECTIVE

The aim of this study was to investigate the effect of the presence or absence of skull fractures on the development of intracranial lesions in cases of head trauma associated with traffic accidents.

MATERIALS AND METHODS

A retrospective review was made of the medico-legal reports of 774 cases with injuries sustained in a traffic accident and which applied for expert examination as forensic cases at the Department of Forensic Medicine of our University between 1 January 2014 and 31 December 2019. A total of 162 cases (20.1%) were identified which were radiologically diagnosed with at least one skull fracture or intracranial lesion. These cases were evaluated in terms of age, gender, type of accident, and localization of skull fractures and/or intracranial lesions, and they were compared statistically to determine whether the presence or absence of skull fractures affected the development of intracranial lesions.

RESULTS

The 162 cases evaluated comprised 120 males and 42 females with a mean age of 25.1 ± 16.4 years. Intracranial lesions were accompanied by skull fractures in 77 cases, skull fracture alone was determined in 18 cases, and intracranial lesion alone in 67 cases. Skull fractures were mostly (64.5%) seen in the 1-20 years age group, and the intracranial lesions (90%) were mostly seen in the ≥41 years age group. Linear and diastatic fracture rates were highest in the temporal and frontal regions. The intracranial lesion/case ratio was 1.5/1 in cases without skull fracture, and 1.2/1 in cases with skull fracture.

CONCLUSION

The results of this study showed that the rate of linear or diastatic fractures was higher in females, which was associated with skull thickness. Skull fractures were found to occur most between the ages of 1 and 20 years, and the presence of skull fractures was determined to reduce the incidence of intracranial lesions by decreasing intracranial pressure.

The assessment of maternal and umbilical cord homocysteine levels in obese pregnant women

PURPOSE

The aim of this study was to compare the maternal plasma and umbilical cord blood homocysteine levels in obese and non-obese pregnant women.

MATERIALS AND METHODS

One hundred-ten term pregnant women, who completed their 3711, gestational weeks and were not in active labor, were enrolled in the study. While 41 out of them were obese (BMI ≥ 30 kg/m(2)), 69 were non-obese (BMI < 30 kg/m(2)). The maternal plasma and umbilical cord homocysteine levels and umbilical cord pH values were compared between the groups. The statistical analyses were performed using t-test, Mann Whitney test, and Chi-square test. Ap < 0.05 value was set as statistically significant.

RESULTS

The mean of age was higher in obese group in borderline significance (26.8 ± 5.4 vs. 28.8 ± 5. l,p = 0.049). The mean of gestational weeks, birthweight, the mode of delivery, and umbilical cord pH values were similar between the groups (p > 0.05). The maternal plasma homocysteine levels [median (interquartile range); 7.6 (4.1) vs. 7.1 (4.9)] and umbilical cord homocysteine values were not statistically different [8.6 (4.2) vs. 8.8 (4.5)] between the groups (p > 0.05).

CONCLUSION

The maternal and umbilical cord blood homocysteine levels are not different in obese and non-obese pregnant women.

Ultrasound-guided intrauterine insemination versus blind intrauterine insemination: a randomized controlled trial

PURPOSE

This study was performed to determine the effects of ultrasound (US) guidance during intrauterine insemination (IUI) on pregnancy rate.

MATERIALS AND METHODS

This study is a prospective randomized controlled trial which was performed in Women's Health Research and Education Hospital, Infertility Unit. The study enrolled 130 couples who were scheduled to undergo IUI. The couples were randomized according to a computer-generated list into two groups; 1) the ultrasound-guided IUI group included 64 couples (n = 64) treated for 99 cycles 2) blind IUI group included 66 couples (n = 66) treated for 104 cycles. All women underwent controlled ovarian stimulation before IUI. The study's main measurements were pregnancy rate per cycle; pregnancy rate per woman.

RESULTS

The pregnancy rates were similar in both the ultrasound-guided (USG) (16.2%, 16/99) and non-ultrasound-guided (NUSG)(12.5%, 13/104) groups (p = 0.386).

CONCLUSIONS

The present results suggest a routine ultrasound guidance during IUI is not essential as it does not increase pregnancy rates but it can be used in such cases to overwhelm some sort of difficulties.

Adverse perinatal outcomes of adolescent pregnancies in one center in Istanbul, Turkey

PURPOSE

The objective of this study was to evaluate fetal and perinatal outcomes of pregnancies of adolescents and compare them with adult pregnancies.

MATERIALS AND METHODS

This retrospective case-control study was carried out at Bakirkoy Maternity and Children's Diseases Education and Research Hospital in Istanbul, Turkey. It enrolled 2,491 pregnancies who delivered between 2005-2010, of which 998 were adolescent pregnancies and 1,493 were adults as controls.

RESULTS

The mean age of the adolescent group was 17.10 years and in the control group the mean age was found to be 26.73 years. Intermarriage, vaginal delivery, preterm rupture of membranes, preterm birth, and preeclampsia were significantly higher in adolescent pregnancies than the control group. Gestational diabetes was more common with increasing age. There was no statistically meaningful difference between the groups in terms of intrauterine growth restriction (IUGR), low birth weight, anemia, 5-minute APGAR score, and intrauterine fetal demise.

CONCLUSIONS

Young maternal age is a risk factor for preterm birth, preterm rupture of membranes, and preeclampsia. According to this study, adolescent pregnancies are more risky and more likely to have adverse fetal outcomes.

Diagnosis and management of cesarean scar pregnancy

OBJECTIVE

To evaluate the diagnosis and management modalities of cesarean scar pregnancy according to our experience.

DESIGN AND SETTING

Retrospective study at the Women's Health Research and Education Hospital.

PATIENTS

Six patients were diagnosed and treated for cesarean scar pregnancy (CSP) with dilatation and curettage, methotrexate (MTX), or laparatomy.

RESULTS

One patient chose the surgical option due to her desire to have a tubal ligation. In the second case methotrexate was applied initially, but two weeks later suction curretage was applied due to abdominal pain and vaginal bleeding. Suction curettage was used as an initial treatment for four patients. There were not any complications in three of four patients. One patient had heavy vaginal bleeding which started after curettage. On ultrasonographic examination, increasing hemorrhage was seen between the uterus and the bladder so subtotal hysterectomy was performed.

DISCUSSION

Ultrasound should be used effectivelly in evaluation of pregnant patients with previous cesarean deliveries. There is still no unique treatment modality for CSP, so treatment should be tailored for each patient. Before the 7th week, abortion should be considered. After the 7th week, MTX and/or surgical options should be preferred.

Exaggerated placental site reaction detected during caesarean delivery: a case report

Exaggerated placental site (EPS) reaction is an exuberant physiologic process in which intermediate trophoblasts infiltrate the underlying endometrium and myometrium at the implantation site. During a caesarean section, we noted a polypoid well shaped smooth lesion, about 3 cm in diameter on the anterior wall of the uterus apart from the placenta. The histopathologic examination revealed an exuberant proliferation of trophoblastic cells in the placental site, a low Ki-67 labelling index and the absence of mitotic activity. Distinguishing EPS reaction from the other intermediate trophoblastic tumours is critical, as the latter may likely involve surgical intervention and/or chemotherapy, although no specific treatment and follow-up is required for EPS reaction. It is necessary to be aware of this pathology and take biopsies from suspicious lesions in the placental site for pathologic examination.