Journal of the Turkish German Gynecological Association最新文献

Objective: Our aim was to reduce blood loss during C-section through the intraoperative temporary occlusion of the bilateral uterine vascular bundles.

Material and methods: This randomized controlled study included 99 singleton pregnant patients at 37 weeks of gestation or later, with normal fetal development and no obstetric complications, attending a university hospital. In the intervention group (n=45), bilateral occlusion of the uterine vascular bundles at their entry point to the uterus was performed using atraumatic Darmklemmen clamps after the delivery of the baby. In the control group (n=54), routine C-section was performed. Our primary outcome was the amount of blood loss, measured using the suction canister, gauze and abdominal mops and underpads after the operation, along with the comparison of preoperative and postoperative hemoglobin and hematocrit values. Our secondary outcomes were operative time, transfusion rate, maternal outcomes (including postoperative complications during follow-up), and neonatal outcomes.

Results: In the intervention group, blood loss measured in gauze, abdominal compress pads, underpads and total blood loss were significantly lower than in the control group (p=0.031, p=0.001, p=0.003, and p=0.010, respectively). The mean decrease in hematocrit value was 5.3±2.67% in the intervention group and 4.85±2.53% in the control group (p>0.05). Operative time and neonatal outcomes were similar between the two groups. No perioperative or postoperative complications were observed during follow-up.

Conclusion: Bilateral temporary occlusion of the uterine vascular bundles using atraumatic clamps was a feasible and safe technique for reducing blood loss during cesarean section without adverse maternal and neonatal outcomes. Trial registration number and date of registration: NCT05948436- July 10, 2023.

Objective: The association between skeletal muscle mass and postoperative morbidity in cancer patients has been demonstrated, but the results are not conclusive. The study aims to determine the predictive efficacy of rectus abdominis muscle (RAM) and psoas major muscle (PMM) thickness and other factors such as age, American Society of Anesthesiologists (ASA) score, operation duration, obesity, preoperative inflammatory markers, and pathological findings for postoperative morbidity.

Material and methods: One hundred forty-one patients who underwent total abdominal hysterectomy + bilateral salpingo-oophorectomy + retroperitoneal lymphadenectomy + omentectomy for endometrial cancer were assessed retrospectively. Standard procedures (antibiotic prophylaxis and thromboembolism prophylaxis) were applied pre- and postoperatively, and the thicknesses of the RAM and PMM were measured by computed tomography. Postoperative morbidity was defined in the 3-month postoperative period as patients treated with a diagnosis of postoperative infection, those who developed pulmonary complications, thromboembolic complications, lymphatic drainage disorders, intracranial hemorrhage, and mortality.

Results: The mean thickness of the right-left RAM in the morbidity group was 7.4±2.1 mm, and 8.2±2.1 mm in the group without morbidity (p=0.038). On the other hand, the thickness of the right-left PMM was similar in both groups. When the predictive cut-off value for RAM thickness was 7.52 mm, the sensitivity, specificity, and negative and positive predictive values were 54.2%, 65.6%, 73.5%, and 44.8%, respectively. Advanced age, high ASA score, and extended operation duration were associated with an increased risk of morbidity in univariate analysis. However, multivariate analysis revealed that only age and operation duration were independent risk factors for postoperative morbidity [respectively, odds ratio (OR): 1.06, 95% confidence interval (CI): 1.01-1.12, p=0.033 and OR: 1.003, 95% CI: 1.0003-1.007, p=0.039].

Conclusion: Age and operation duration were identified as independent risk factors for predicting postoperative morbidity. However, it has been shown that a more comprehensive evaluation, including RAM thickness and ASA score alongside these two factors, could provide more definitive results.

Multiple sclerosis (MS) is an autoimmune disease that involves the central nervous system. MS is prevalent among young adults and progressively destroys axons and myelin. Individuals with MS often experience complications, such as lower urinary tract dysfunction, urinary tract infections (UTIs) and sexual dysfunction. In young adults MS may cause sexual dysfunction and infertility, which worsens as the disease progresses. The available evidence from different studies (microbiological and clinical studies, retrieved from PubMed and Scopus databases) on possible microbial pathogens causing MS was reviewed. Lower urinary tract dysfunction, UTIs and sexual dysfunction were investigated in people with MS. Over the past two decades advances in MS treatment have significantly slowed disease progression and altered its natural history. However, UTI and sexual dysfunction continue to pose substantial challenges for affected patients. As there is a causal relationship between UTIs and corticosteroid use during outbreaks, awareness of essential complications of MS, such as UTIs and infertility, is crucial for prevention, early diagnosis, and adequate management.

Objective: Non-functioning pituitary adenomas (NFPAs) are a group of hormonally inactive adenomas. The aim of this study was to investigate the possible effects of NFPAs on pregnancy.

Material and methods: Thirty patients with NFPAs and without hormone deficiency or excess were included. We retrospectively evaluated anterior pituitary hormone levels, follow-up periods, pituitary imaging findings, symptoms associated with adenoma size increase during pregnancy, adverse pregnancy outcomes, delivery procedures, pregnancy week at delivery, birth weight, and lactation duration.

Results: The mean age of the patients was 41.26±9.06 years, and the mean follow-up after diagnosis was 92.8 months. Seven were diagnosed with macroadenomas (defined as the largest diameter >10 mm) and 23 had microadenomas. There were 92 pregnancies in total. The incidence of nausea-vomiting and visual impairment during pregnancy were more common in the macroadenoma group (p=0.016 and p=0.042, respectively). Spontaneous pregnancy rates were high. The patients with NFPAs did not have an increased risk of pregnancy-related complications compared to the general population, and there were no obvious negative effects on fetal development or lactation. NFPAs were not associated with an increased cesarean section rate.

Conclusion: These findings suggest that NFPAs, even macroadenomatous NFPAs, have no negative effects on pregnancy outcomes, fetal development, or lactation.

Objective: The transition nuclear protein 1 (TNP1) gene is a member of the TNP family and is abundantly expressed during spermatogenesis. Protamine 1 (PRM1), another sperm nuclear protein, is abundant in many species. The present study aimed to evaluate transition nuclear protein 1 (TNP1) and protamine 1 (PRM1) gene expression in infertile male patients with low and high sperm DNA fragmentation (SDF).

Material and methods: Semen samples (n=100) were obtained from male participants undertaking treatment with intracytoplasmic sperm injection. The expression levels of TNP1 and PRM1 were measured using real-time quantitative polymerase chain reaction. The data were compared with statistical tests, (independent samples T- or Mann-Whitney U) as appropriate. A p<0.05 was considered significant.

Results: Patients with low-SDF exhibited a significantly lower sperm concentration compared to those with high-SDF (p=0.002). There was significant down regulation of TNP1 (p=0.036) and PRM1 (p=0.04) in patients exhibiting high-SDF levels compared to those with low-SDF levels. A significant moderate positive correlation was observed between the relative expression levels of TNP1 and PRM1 (r=0.459, p<0.001).

Conclusion: In the present study TNP1 and PRM1 were differentially expressed in male patients being treated for infertility and who had low or high-SDF.