Long-Term Results of an Imperforate Hymen Procedure that Leaves the Hymen Intact

Purpose of the StudyThe aim of this study was to show the clinical results of postoperative evaluation of cases of imperforate hymen that presented at our center during a 21-year period.MethodsA Foley’s catheter was inserted in 74 patients of imperforate hymen who reported to the Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, between January 1, 1996, and December 31, 2016 with history of pelvic pain. In each case, the hymen was opened via a circular incision from the central of the distended. A Foley’s catheter was inserted, and estrogen cream was prescribed for application on the hymenal structure for 14 days. The catheter was removed after 14 days.ResultsThe mean age of the patients at the time of this study was 28.3 ± 2.6 years, and the mean age at diagnosis was 13.2 ± 2.5 years. Twenty-nine (96.6%) patients had experienced vaginal bleeding during their first sexual intercourse experience, and one patient (3.4%) had not. Fourteen out of the 30 married women had become pregnant, of whom nine had delivered vaginally and five had delivered via a cesarean section. After undergoing renal ultrasound, none of the patients had any apparent anomalies. Only one patient had a uterine anomaly, which was a bicornuate uterus.ConclusionA circular incision with insertion of Foley’s catheter prevents many social problems by preserving the hymen’s architecture and allowing vaginal bleeding to occur during the first sexual intercourse experience.     

The importance of peripheral immune cells in inflammatory bowel disease.

Background/aims: Inappropriate down regulation of an activated immune system is considered as the main pathogenetic mechanism in inflammatory bowel disease. Migration of circulating cells to a diseased intestine is considered as an important factor in the pathogenesis of inflammatory bowel disease. We aimed to evaluate some features of circulating immune cells in inflammatory bowel disease. Methods: Twenty-two control, 29 Crohn's disease and 17 ulcerative colitis patients were studied. CD2, CD3, CD4, CD8, CD11b, CD11c, CD25, CD45RA, CD45RO, CD54 and HLA DR on the surface of peripheral blood lymphocytes and CD11b, CD11c, CD45RA and CD45RO on the phagocytes were researched with two-color immunofluorescence flow cytometry. Results: The percentages of CD2+ and CD4+ lymphocytes were found significantly reduced in ulcerative colitis. CD3+ and CD8+ lymphocytes in inflammatory bowel disease were higher than in controls. CD45RA+ lymphocytes were found significantly decreased in ulcerative colitis and active Crohn's disease. CD45RO+ lymphocytes and CD45RO+, CD11b+ and CD11c+ phagocytes were significantly increased in Crohn's disease. Conclusions: We demonstrated that there were significant differences between ulcerative colitis and Crohn's disease in the expression of some important surface markers on the peripheral blood immune cells. It seems that circulating CD11b-CD11c and CD45RA-CD45RO expressing phagocytes are important in inflammatory bowel disease and may be useful in distinguishing Crohn's disease from ulcerative colitis. These findings may give us some clues about the immunopathogenesis of inflammatory bowel disease.     

The frequency of sacroileitis and ankylosing spondylitis in inflammatory bowel disease and HLA-B27 association.

BACKGROUND/AIMS: The aim of this study was to investigate the frequency of sacroileitis and ankylosing spondylitis in inflammatory bowel disease and the relationship between disease activity, joint symptoms and HLA-B27 antigen positivity. METHODS: Sacroiliac joint radiography and three phase bone scanning of 33 ulcerative colitis patients (17 active and 16 in remission) and 29 Crohn's disease patients (15 active and 14 in remission) was performed. HLA-B27 was determined in all patients and 60 control subjects. RESULTS: Sacroileitis was found in 10 out of 33 patients with ulcerative colitis (30. 30%) and seven out of 29 patients with Crohn's disease (24. 13%). Of these patients, eleven had active (17.73%) disease and six were in remission (9. 68%). The diagnosis of sacroileitis was made by bone radiography in seven patients (41.18%) and by bone scanning in the other 10 patients (58.82%). A diagnosis of ankylosing spondylitis was made in three patients (17. 64%) who had previously been diagnosed by bone radiography to have sacroileitis. HLA-B27 was positive in six patients (9.67%) with inflammatory bowel disease and three subjects (5%) of the control group. There were no significant differences between these two groups (p>0.05). Compared to the control group, all three patients with ankylosing spondylitis were HLA-B27 positive, the difference being significant (p>0. 01). CONCLUSIONS: The clinical course of sacroileitis is independent of the activitiy of inflammatory bowel disease. Accordingly, patients with inflammatory bowel disease, especially those with sacroileitis, should be investigated for the presence of anklylosing spondylitis.     

The effect of body weight and weight loss on thyroid volume and function in obese women

OBJECTIVE: Thyroid volume and thyroid function may vary in obese and nonobese women. It is not known whether weight loss could affect thyroid volume and function in obese subjects. PATIENTS AND METHODS: The study population consisted of 98 premenopausal euthyroid obese [body mass index (BMI) = 30 kg/m2] women (mean age 40.5 +/- 11.4 years) and 31 nonobese (BMI < 25 kg/m2) women (mean age 38.6 +/- 12.9 years). Weight, height, BMI, waist circumference, body fat percentage and fat weight of all subjects were measured. Thyroid function and thyroid ultrasonography were performed at baseline and after 6 months of obesity treatment. Subgroup analysis was done according to weight loss. RESULTS: Thyroid volume (P = 0.021) and TSH concentration (P = 0.047) were higher; free T3 (P < 0.001) and free T4 concentrations (P = 0.045) were lower in obese women; however, all were still in the normal range. There was a positive correlation between thyroid volume and body weight (r = 0.319, P = 0.002), BMI (r = 0.504, P < 0.001), body fat percentage (r = 0.375, P = 0.001), body fat weight (r = 0.309, P = 0.01) and waist circumference (r = 0.386, P = 0.004). There was a positive correlation between TSH concentration and body weight (r = 0.227, P = 0.042) and body fat weight (r = 0.268, P = 0.038). After 6 months of obesity treatment, thyroid volume (P = 0.008) and TSH concentration (P = 0.006) decreased only in obese women who lost > 10% body weight. There was a positive correlation between the changes of thyroid volume and the change of body weight (r = 0.341, P = 0.009) and the change of body fat weight (r = 0.406, P = 0.013). CONCLUSIONS: Our study suggests that thyroid volume and function may vary in obese women in association with body weight and fat mass; > 10% weight loss may affect thyroid volume and function, which however, is clinically insignificant.     

Clinical utility of insulin and insulin analogs

Diabetes is a pandemic disease characterized by autoimmune, genetic and metabolic abnormalities. While insulin deficiency manifested as hyperglycemia is a common sequel of both Type-1 and Type-2 diabetes (T1DM and T2DM), it does not result from a single genetic defect—rather insulin deficiency results from the functional loss of pancreatic β cells due to multifactorial mechanisms. Since pancreatic β cells of patients with T1DM are destroyed by autoimmune reaction, these patients require daily insulin injections. Insulin resistance followed by β cell dysfunction and β cell loss is the characteristics of T2DM. Therefore, most patients with T2DM will require insulin treatment due to eventual loss of insulin secretion. Despite the evidence of early insulin treatment lowering macrovascular (coronary artery disease, peripheral arterial disease and stroke) and microvascular (diabetic nephropathy, neuropathy and retinopathy) complications of T2DM, controversy exists among physicians on how to initiate and intensify insulin therapy. The slow acting nature of regular human insulin makes its use ineffective in counteracting postprandial hyperglycemia. Instead, recombinant insulin analogs have been generated with a variable degree of specificity and action. Due to the metabolic variability among individuals, optimum blood glucose management is a formidable task to accomplish despite the presence of novel insulin analogs. In this article, we present a recent update on insulin analog structure and function with an overview of the evidence on the various insulin regimens clinically used to treat diabetes.     

Has Admission Blood Pressure Any Prognostic Value in Patients With Subarachnoid Hemorrhage: An Emergency Department Experience

Hypertension is a well‐known risk factor for the development and rupture of cerebral aneurysms. The authors conducted a study to investigate the prognostic value of admission blood pressure (BP) on prognosis in patients with subarachnoid hemorrhage (SAH). Two hundred patients with SAH were divided into two groups according to Hunt Hess score (good prognosis: 1 to 3, and poor prognosis: 4 and 5) and according to death in hospital (surveyed and died). The prognostic factors of SAH and BP changes according to Hunt Hess scores in the acute stages of the event were evaluated. Admission mean arterial BP values of the patients who died in hospital were significantly lower than in the patients who were surveyed (P=.026). The admission mean arterial BP values were found to be lower in the poor prognostic patients (Hunt Hess score of 4 and 5) (P<.001). Decreased admission BP values were found to be associated with poor prognosis and mortality.     

Changing cerebral blood flow velocity detected by transcranial Doppler ultrasound during head up tilt in patients with multiple sclerosis

Background and purpose:  Multiple sclerosis (MS) is a chronic inflammatory disease of central nervous system. We aimed to investigate the cerebral blood flow velocity (CBFV) changes in MS by transcranial Doppler.
Methods:  Twenty patients with MS, 20 age-matched healthy controls were included in the study. In both groups, blood flow velocities (BFVs) of middle cerebral arteries (MCAs) were evaluated. The changes of blood pressure, heart rate along with the changes in BFV of MCA were recorded after the patients were raised to upright position.
Results:  In both groups, upon raising the tilt table to the upright position, the mean CBFV values were found to be lower in comparison with the recorded baseline values ( P values <0.05). The decline in the mean CBFV values was more significant in patients with MS ( P  = 0.01).
Conclusion:  Our study showed upon raise of the tilt table, the mean BFVs decreased more in MS patients than control group with a more prominent change in the subgroup of MS patients with expanded disability scale scores ≥2. By use of transcranial Doppler ultrasound, it may be possible to evaluate BFV changes in patients with MS.     

Anterior segmental distraction of the hypoplastic maxilla by a tooth borne device: a study on the movement of the segment

The aim of this study is to determine the relative movement of the teeth and bone after premaxillary distraction with a tooth-borne device constructed in the authors’ centre. To evaluate the effects of this device on the anterior segment and teeth, the space formed between the anterior and posterior segments of the maxilla was measured on computerized tomography images from 10 patients. The average differences were 3.5 mm at the apex level, 5.5 mm at alveolar ridge level and 7.4 mm at crown level on the right side. On the left side, the average differences were 3.2, 5.2 and 7.1 mm, respectively. There were statistically significant differences between all these measurements (p < 0.05), but the difference between right and left sides was not statistically significant (p > 0.05). The ratio between the movements at apex and crown levels was 46%. These results showed that the tooth-borne distractor was able to distract the anterior segment of the maxilla but it also caused anchorage loss of the maxillary incisors.