Endometriomas in Adolescents and Young Women

Study ObjectiveTo evaluate clinical aspects of endometriomas encountered in late adolescent females and young women and to review the issues specifically related to the disease in this age group.DesignRetrospective medical chart review study.SettingAdolescent gynecology and infertility clinic of a tertiary care hospital with women's health focus.ParticipantsSixty-three late adolescent females and young women aged ≤24 years with endometrioma.InterventionsOperative laparoscopy for endometriomas.Main Outcome MeasuresBaseline clinical characteristics of the patients including age, marital status, body mass index, symptoms on admission, family history of endometriosis, past medical history, CA-125 levels, presence of a müllerian anomaly, endometriosis characteristics at the time of surgery, and correlation between ASRM scores and patient characteristics.ResultsThe mean age and body mass index of the patients were 22 ± 2 (range 17-24) years and 20.8 ± 2.6 (range 16.6-28.5) kg/m² respectively. Chronic pelvic pain was the most common symptom (44%). Two patients had a diagnosis of genital malformation. Forty-one (65%) patients had endometrioma on the right ovary, and 14 (22%) patients had bilateral endometriomas. Only one patient had posterior cul-de-sac completely obliterated. Fifty-five (87%) patients had score <16 points for adnexal adhesions calculated according to the revised American Society for Reproductive Medicine classification.ConclusionEndometriomas, although rare, can be encountered in adolescents and young women. The disease in adolescent patient group offers particular importance since early intervention is essential in order to decrease pain, prevent progression of the disease and enhance future fertility.     

Evaluation of Systemic Levels of Neutrophilic Enzymes in Patients With Hypertension and Chronic Periodontitis

Background: Inflammation stimulates neutrophils to release their enzymes into the extracellular matrix. The aim of the present study is to investigate the serum levels of matrix metalloproteinase (MMP)‐8, MMP‐9, tissue inhibitor of MMP (TIMP)‐1, myeloperoxidase (MPO), and neutrophil elastase (NE) in patients with hypertension and chronic periodontitis (CP). Methods: A total of 95 patients were included in the study. Patients were categorized into three groups: healthy control (n = 29), hypertensive control (n = 32), and hypertensive CP (n = 34). Periodontal parameters were recorded, and serum samples were collected from each participant. Serum MMP‐8, MMP‐9, TIMP‐1, MPO, and NE levels in circulation were assessed by enzyme‐linked immunosorbent assay. Results: The hypertensive CP group had significantly higher serum MMP‐8, MMP‐9, and NE levels than the healthy control group (P <0.05). All study groups had similar serum TIMP‐1 levels (P >0.05). Significantly higher serum MPO levels were detected in patients with hypertension and CP than healthy controls and hypertensive controls (P <0.05); however, the difference in serum MPO levels was not significant between the healthy controls and hypertensive controls (P >0.05). There was no significant difference in MMP‐8/TIMP‐1 ratio among the study groups (P >0.05). MMP‐9/TIMP‐1 ratio was significantly higher in patients with hypertension and CP than healthy controls (P <0.05). Conclusions: The presence of hypertension along with CP has a considerable effect on serum neutrophilic enzyme levels, except TIMP‐1. However, the levels of these enzymes do not seem to be affected by the presence of hypertension only. Further studies including patients who have only CP might help illuminate the effect of CP on these enzymes in patients with hypertension.     

Clinical and radiographic evaluation of the efficacy of platelet-rich plasma combined with hydroxyapatite bone graft substitutes in the treatment of intra-bony defects in maxillofacial region

Objective. The aim of this study is to evaluate the efficacy of platelet-rich plasma (PRP) clinically and radiographically when combined with bovine derived hydroxyapatite (HA) bone grafting materials and resorbable collagen membranes for the treatment of intra-bony defects frequently seen at the distal aspect of mandibular second molars following the surgical extraction of fully impacted mandibular wisdom teeth. Study design. Eighteen patients were scheduled for post-operative visits at 1, 3 and 6 months post-operatively, probing depths were measured and digital panoramic radiographs were taken. Results. There were no significant differences on probing depths among two groups. Radiographic assessment also showed no significant difference among groups at 1st and 6th month intervals, while 3 months post-operatively the amount of radiographic density at the PRP side was significantly higher. Conclusion. Combined use of PRP and bovine-derived HA graft materials for the treatment of intra-bony defects might be an appropriate approach when the main goal is providing earlier bone regeneration.     

Beneficial effects of Salvia miltiorrhiza in the healing of burn wounds: an experimental study in rats

Introduction: Burn healing is a complicated process and very few treatments can positively alter its effects. The aim of this study was to investigate the effects Salvia miltiorrhiza (SM -Danshen), a traditional Chinese medicine, on burn wound healing.

Material and methods: Twenty rats were included in this study and divided into two groups. 3?×?2?cm wide burn areas were created in the dorsal skin of all the animals with thermal contact. Intraoral 1?ml/day saline and 1?g/kg/day SM were given in control and experiment groups, respectively. Fourteen days following the burn injury burn zones were evaluated with indocyanine green-SPY imaging device, and multiple samples were collected for histopathological evaluation. Standard photographs were taken for the evaluation of necrotic skin areas.

Results: Neovascularization was increased in the SM group when compared with the control group (p?=?0.0406). SPY studies revealed a meaningful increase in the tissue perfusion in the SM group (p?=?0.0286). The average amount of necrotic area in the control and experiment group on the postoperative 14th day was 71.6% (±16.51) and 42.5% (±10.64) respectively (p?=?0.0002).

Conclusion: Our study shows that SM can decrease the amount of necrosis in burn wounds by increasing tissue perfusion and neovascularization.     

Clinical services provided by interventional radiologists to Medicare beneficiaries in the United States, 2000-2003

To identify trends in Evaluation and Management (E&M) and non-E&M services of interventional radiologists (physician specialty type 94) from 2000 to 2003 for Medicare patients, Medicare Part B physician annual allowed services data from the Centers of Medicare and Medicaid Services (CMS) were analyzed for all interventional radiologists from 2000 to 2003. Because the number of interventional radiologists in the United States according to the Society of Interventional Radiology is, on average, 4.2 times the number of interventional radiologists who use physician specialty type 94, we extrapolated the E&M services for each year. During the period examined, the total number of E&M services by interventional radiologists increased 309%, from 9,698 in 2000 to 29,914 in 2003. The most commonly performed services were Office or Other Outpatient Visit (Current Procedural Terminology [CPT] codes 99211-99215) for established patients, followed by Subsequent Hospital Care (CPT 99231-99233) and Office or Other Outpatient Consultations (CPT 99241-99245). The extrapolated number of E&M services by interventional radiologists for Medicare patients in 2003 is approximately 107,853. The number of Office and Outpatient Visits for New Patients (CPT 99201-99205) increased 142%, whereas the number of Consultations for New Patients (CPT 99241-99245) increased 208%. The total number of codes reimbursed by CMS to interventional radiologists (type 94) increased from 2.8 million in 2000 to 3.8 million in 2003.     

Thyroglobulin increment after thyroid hormone withdrawal is a reliable indicator for the detection of significant remnants or metastases in patients with differentiated thyroid carcinoma

Serum thyroglobulin (Tg) measurement has a pivotal role in the management of differentiated thyroid carcinoma (DTC). Serum Tg increment after thyroid hormone discontinuation seems to be a better predictor of tumor recurrence, however, minimal Tg increment may not be a specific marker. This study tries to evaluate the importance of different levels of Tg increment after thyroid hormone discontinuation. Fifty-five patients (46 females and 9 males with mean age of 41.40 yrs) with DTC, treated with total or subtotal thyroidectomy and radioiodine-131 ((131)I) were studied. Ninety-one per cent of the patients had papillary carcinoma. Serum Tg and thyroid stimulating hormone (TSH) were measured using high sensitive IRMA assays during thyroxine (T4) suppression and after discontinuation of T4 treatment. The mean time interval between Tg on T4 and off T4 was 110.29+/-53.43 days and less than 180 days in all patients. Serum Tg level was increased >or= 1 ng/ml in 25 patients after discontinuation of T4. Of these patients, 17 had metastatic disease or a detectable thyroid remnant. Of 16 patients with unchanged Tg (-1or= 7 ng/ml had residual disease or metastases. If DeltaTg was unchanged or decreased, the negative predictive value was 83.3%. The sensitivity of WB(131)IS was 63.6% for the detection of thyroid remnant or metastases. Our study indicates that DeltaTg is a more reliable indicator of remnant disease than on T4-Tg or off T4-Tg levels.     

Effect of intraurethral papaverine on penile erection in rats

OBJECTIVES: The aim of this study is to investigate erectile response to intraurethral administration of papaverine in rats. MATERIAL AND METHODS: Male Sprague-Dawley rats were used in this study. Under urethane anesthesia, penis was exposed and intracavernous pressure (ICP) was recorded through a 23-gauge needle, which was inserted into right corpus cavernosum. Effects of intraurethral application of incremental doses of 0.2 ml papaverine gel (4-17.5 mg) on intracavernosal pressure were observed and compared with those of 0.4 mg papaverine applied into corpus cavernosum. Mean arterial blood pressure (MABP) and heart rate were also monitored. RESULTS: The mean basal ICP was 8.9 +/- 1.8 mm Hg. Intraurethral administration of papaverine did not increase ICP at any doses used in this study. After intracavernous injection of papaverine (0.4 mg), a significant increase in the ICP occurred from resting (8.9 +/- 1.8 mm Hg) to a peak at 57.5 +/- 9.9 mm Hg and persisted for 22.3 +/- 6.7 minutes (p < 0.05). The latter application significantly decreased MABP (22.3 +/- 3.1 mm Hg; p < 0.05). CONCLUSIONS: Intraurethral administration of papaverine does not seem to be an alternative to other erectile dysfunction treatment modalities. However, further studies on animals are necessary at higher concentrations or in combination with other mucosal enhancers to increase the effect of intraurethral administration of papaverine.     

MRI and discography in traumatic intervertebral disc lesions

In this study we evaluated magnetic resonance imaging (MRI) in trauma patients for assessing traumatised adjacent discs of fractured vertebrae before dorsoventral stabilisation. In a prospective study, MRI of 54 discs was performed with a 1.5-T MRI unit. The preoperative MRI with sagittal T1-W-SE and T2-W-TSE was compared to intraoperative discography, which was carried out on both intervertebral discs adjacent to the fractured vertebrae. Signal alterations, morphological changes in the adjacent discs, fractured vertebrae and associated ligament injuries were evaluated. In 47/54 (87%) of the intervertebral discs, the results of both imaging findings were concordant. The discs adjoining vertebral fractures were normal in 18 cases. Regarding the positive concordant imaging findings, MRI and discography revealed traumatised adjacent cranial and caudal discs in 22 discs. In 7 cases, only the cranial adjacent disc was affected. Moreover, 17 cases of intradiscal bleeding, 13 intraosseous herniations into the fractured vertebrae and 20 anuluar tears were visualised in MRI. Associated ligament injuries were detected in 18 cases. Findings were discordant in eight discs. In six discs, MRI was abnormal, demonstrating signal alterations suggestive of positive imaging findings, whereas discography demonstrated no disc injury. MRI failed to detect disc injury in two discs, whereas discography was positive, showing an irregular intradiscal contrast media distribution. MRI, as a non-invasive method for assessing fractures of the thoraco-lumbar spine, may detect traumatised adjacent intervertebral discs. MRI is superior to intraoperative discography. The performance of MRI of the thoraco-lumbar spine is recommended before dorsoventral stabilisation in trauma patients, as it can reveal additional preoperative information such as fractures, disc and associated ligament injuries.