Sahin Zeteroglu

Amaç: Bu çalışmada, deneysel olarak overde torsiyon-detorsiyon yapılarak oluşturulan iskemi-reperfüzyon modeline eritropoetinin (EPO) etkisinin araştırılması amaçlandı. Gereç ve Yöntemler: Bu çalışmada Wister albino tipi 25 adet rat kullanıldı. Ratlar randomize olarak üç gruba bölündü. On rat over torsiyonu sonrası 24. saatte detorsiyon yapılıp EPO verilmeyen grup (grup 1), 10 rat over torsiyonu sonrası 24. saatte detorsiyon yapılıp intraperitoneal EPO verilen grup (grup 2) ve beş rat kontrol grubu (grup 3) olarak ayrıldı. Cerrahi işlem tamamlandıktan sonra bütün grupların sağ adneksleri yedinci günde eksize edilip kan örnekleri alındı. Her üç grubun histopatolojik bulguları ve hematolojik parametreleri karşılaştırıldı. İstatistiksel değerlendirmeler SPSS paket programı ile tek yönlü varyans analizi (one way ANOVA) ve iki ortalama arasındaki farkın önemlilik testi (t-test for independent samples) kullanılarak yapıldı. Bulgular: EPO verilen grupta ortaya çıkan histopatolojik değişiklikler, EPO verilmeyen gruba göre istatistiksel olarak anlamlı derecede farklı bulundu. EPO verilmeyen grupta doku bütünlüğünün bozulmasının yanı sıra, parsiyel nekroz ve bazı olgularda tama yakın nekroz gözlenirken, EPO verilen gruptaki hiçbir olgunun doku kesitlerinde nekroz olmadığı gözlendi. EPO verilen grupta tedavi sonrası hemoglobin, hematokrit ve eritrosit sayısı anlamlı derecede yüksek bulundu. Sonuç: Overde torsiyon- detorsiyon yapılarak oluşturulan iskemi- reperfüzyon modelinde EPO verilen grupta ortaya çıkan histopatolojik değişiklikler, EPO verilmeyen gruba göre anlamlı derecede farklı olarak bulunmuştur. Over torsiyonu sonrasında cerrahi olarak detorsiyon uygulanan olgulara intraperitoneal EPO verilmesi doku yaşamı üzerine olumlu etki yapmıştır.

Objective. The aim of this randomized trial was to compare the efficacy and safety of vaginal misoprostol and oxytocin for cervical ripening and labor induction in patients with premature rupture of membrane (PROM) at term. Methods. Ninety-seven women with PROM at term were assigned randomly to receive intravaginal misoprostol or oxytocin. The primary outcome measure was the induction–delivery interval. Secondary outcomes included the number of women who delivered vaginally within 12 hours of the start of the induction in the two groups, the cesarean, hyperstimulation, and failed induction rates, the mode of delivery, and the neonatal outcome. Results. Forty-eight women were assigned to intravaginal misoprostol and 49 to oxytocin administration. The mean interval from induction to delivery was 10.61 ± 2.45 hours in the misoprostol group and 11.57 ± 1.91 hours in the oxytocin group (p = 0.063). The rates of vaginal delivery were 83.3% and 87.7% and cesarean delivery were 16.7% and 8.2% in the misoprostol and oxytocin groups, respectively. Neonatal outcomes were not significantly different. Of the cases, 8.3% in the misoprostol group and 8.2% in the oxytocin group revealed uterine contraction abnormalities. Conclusion. Our study demonstrates that, intravaginally, misoprostol results in a similar interval from induction of labor to delivery when compared to oxytocin.

Uterine rupture and associated injury to the maternal bladder and urethra have been rarely reported. All those cases were associated with a scarred uterus or augmentation of labor. We report a case of simultaneous bladder, urethral and uterine rupture in an unscarred uterus following delivery at home. A 22-year-old woman was referred from a peripheral hospital to the emergency unit of the Medical Faculty, Yüzüncü Yil University, after delivering at home. On vaginal examination, the bladder neck and proximal one third of the urethra were ruptured. Intraoperatively it appeared that the posterior wall of the bladder and bladder base had ruptured and separated from the level of the interureteric ridge. An extensive rupture of the lower uterine segment to the left sidewall of the uterus was seen. To prevent these complications, uneducated, traditional birth attendants should be replaced by at least midwives, and the rate of unsupervised home delivery should be reduced.

Ruptured uterus is a serious obstetric emergency with a high maternal and perinatal mortality. It is a preventable and common obstetric problem in developing countries. The objective of this study was to review the incidence, methods of diagnosis and maternal and perinatal morbidity and mortality associated with uterine rupture. Case notes were reviewed for all patients with a ruptured uterus at Yüzüncü Yil University Medical Faculty Department of Obstetrics and Gynaecology from January 1995 to August 2003. Relevant data relating to the clinical characteristics of labour, operative procedures, maternal and perinatal outcome were assessed. There were 20 cases of ruptured uteri. The incidence was 0.40%. When patients referred from other hospitals were excluded, the revised ratio was 0.12%. There were 13 (65%) complete and seven (35%) incomplete ruptures. Nine (45%) cases occurred in patients with scarred uteri. Ten (50%) cases were grand multiparous. Subtotal abdominal hysterectomy was performed in five (25%) cases, total abdominal hysterectomy was performed in two (10%) cases and the remaining 13 (65%) cases had uterine rupture repair. There were two (10%) maternal deaths. Both of them were referred from other hospitals. There were seven (35%) perinatal deaths attributable to uterine rupture. Occurrence of uterine rupture is significantly associated with grand multiparity, scarred uterus, lack of antenatal care, unsupervised labour at home and low socioeconomic status of the patients. These factors are largely preventable.

Primary appendicular adenocarcinoma is a rare type of appendicular carcinoma. We report mucinous appendicular adenocarcinoma during pregnancy. To our knowledge, this is the third reported case. A 35-year-old woman at 21 weeks of gestation presented with acute abdominal symptoms for the previous 10 days and underwent appendectomy. Histopathologically, examination of the appendectomy material was reported as "mucinous appendicular cystadenocarcinoma." The pregnancy was terminated by misoprostol induction. A right hemicolectomy and staging procedure were performed on the third postpartum day with relaparotomy. Although it rarely coexists with pregnancy, primary appendicular adenocarcinoma should be considered in pregnant women with atypical acute abdominal symptoms of long duration. Primary adenocarcinoma of the appendix should be treated with right hemicolectomy even if it is a secondary procedure. Termination of pregnancy is not essential to the surgical procedure, and the decision on the outcome of the pregnancy should be made with the patient.