Cystic Group Research Articles

Comparison of therapeutic effects of arthroscopic popliteal cyst internal drainage and capsular wall resection

To investigate efficacy between arthroscopic popliteal cyst drainage and arthroscopic popliteal cyst resection. From January 2013 to June 2021, 54 patients with popliteal cyst (Rausching-Lindgren gradeⅠto Ⅲ) were treated with arthroscopic surgery. There were 24 males and 30 females. The age ranged from 44 to 72 years old, with a mean of (62.67±6.08) years old. The course of the disease ranged from 1 to 72 months, with a mean of(15±14) months. Twenty-four patients (group A) were underwent arthroscopic internal drainage of popliteal cyst. Thirty patients (group B) were underwent arthroscopic resection of popliteal cyst. Preoperative main symptoms included knee pain, swelling, walking pain, popliteal swelling, popliteal mass and so on. After 1, 3, 6 months and 1, 2 years of surgery, routine outpatient follow-up was conducted to observe and compare the surgical time, bleeding volume, preoperative and postoperative visual analog scale (VAS), knee Lysholm score, and complications between two groups. All incisions healed at one stage after operation. All 54 patients were followed up, and the duration ranged from 6 months to 2 years, with an average of (13.89±4.29) months. There was no intraoperative vascular or nerve injury. Operation time and intraoperative blood loss of the two groups:group A of (62.08±9.55) min and (8.00±1.69) ml, group B of (69.50±6.99) min and (8.70±2.00) ml. Popliteal pain, swelling, limitation of flexion and extension were significantly relieved after operation. VAS before and one month after operation between two groups:group A of 5.38±1.21 and 2.63±0.71, group B of 5.60±1.26 and 2.80±0.81. Lysholm scores of knee joint before and 6 months after operation:group A of 62.59±4.99 and 89.74±2.90, group B of 63.87±3.23 and 89.02±2.35. Knee joint function improved significantly in both groups. In group A, 4 cases had popliteal cyst at 3 months after operation, and 2 cases had small isolated cyst at 1 year after operation. There was no recurrence of cyst in group B. The results between two arthroscopic treatments of popliteal cyst are satisfactory, and there is no significant difference in the amount of blood loss, safety, postoperative pain VAS score and knee function recovery. It is suggested that arthroscopic resection of the cyst wall should be performed when the technique is mature, especially for large cysts and septal cysts.

SMAD2/3 Phosphorylation is correlated with matrix metalloproteinase 9 expression in human periapical lesions

ObjectiveThe aim of this study was to investigate the presence of phosphorylated SMAD2/3 (P-SMAD2/3) in periapical lesions in humans and its possible correlation with matrix metalloproteinase 9 (MMP9) during the development of apical periodontitis. DesignIn this study, a total of 38 samples were collected, consisting of 16 healthy controls and 22 periapical lesions. These samples underwent fixation, dehydration, and embedding for further histologic and immunochemical analysis. The expression of phosphorylated SMAD2/3 and MMP9 was quantified using the average integrated optical density. Additionally, immunofluorescence analysis was conducted to investigate the colocalization of phosphorylated SMAD2/3 and MMP9. ResultsThe study found that periapical lesions exhibited a stronger expression of MMP9 compared to healthy controls. Additionally, the expression of phosphorylated SMAD2/3 was observed to increase in the periapical granulomas and radicular cysts group, as compared to the normal group (P < 0.01). The results of the immunofluorescence test showed that phosphorylated SMAD2/3 was colocalized with MMP9. ConclusionsThe study found that SMAD2/3 phosphorylation is correlated with matrix metalloproteinase 9 expression in human periapical lesions, suggesting its potential involvement in tissue destruction and immune cell infiltration in periapical lesions.

The Difference Between Post-Laparoscopic Cystectomy Anti-Mullerian Hormone Levels In Endometrioma And Non-Endometrioma Cysts Patients

Background: Endometrioma is a complex gynecological disease with increasing global prevalence. Laparoscopic cystectomy remains to be the primary choice of modality. Several studies, however, have revealed that laparoscopic cystectomy in endometriomas can cause ovarian damage and reduction in ovarian reserve. They demonstrated a decrease in serum AMH levels in endometrioma patients following laparoscopic cystectomyObjective: To identify the difference between the mean post-laparoscopic cystectomy AMH levels in endometrioma and non-endometrioma cysts patientsMethods: A prospective cohort study with 40 selected patients undergoing laparoscopic cystectomy in Kariadi General Hospital Semarang. They were divided into 2 groups of endometrioma and non-endometrioma cysts. AMH levels were measured before and after laparoscopic cystectomy surgery in both groupsResults: The mean age of endometrioma and non-endometrioma group were 32.40 ± 6.26 and 30.6 ± 3.69 years consecutively. The most common cysts were unilateral cysts with a diameter of &gt; 4 cm which were dominated by endometrioma cysts. The group of subjects with endometrial cysts had lower AMH levels, both before (9.47 + 5.26 ng/mL) and after laparoscopic cystectomy (7.80 + 4.27 ng/mL). AMH levels before and after laparoscopic cystectomy in the endometrioma group showed a significant difference (p=0.004). In contrast, there was no significant difference in delta AMH between the non-endometrioma group (-1.63 + 4.12; p=0.685) and the endometrioma group (-1.74 + 2.37 ng/mL; p=0.685)Conclusion: Both endometrioma and non-endometrioma groups showed a decrease in AMH levels after laparoscopic cystectomy but they did not show a significant difference.

Evaluation of the efficacy of diffusion-weighted magnetic resonance imaging and apparent diffusion coefficients in the diagnosis of maxillary diseases

We investigated the efficacy of using diffusion-weighted imaging (DWI) with quantitative apparent diffusion coefficient (ADC) mapping in the diagnosis of maxillary diseases. We evaluated 146 cases of maxillary diseases (32 malignant tumors, 11 benign tumors, 28 maxillary cysts, 60 cases of maxillary sinusitis, and 15 maxillary sinus retention cysts) that had been examined using magnetic resonance imaging. The DWI sequence was obtained with b values of 0 and 800 s/mm2 and ADC values were calculated. We used one-way analysis of variance and the Tukey honestly significant difference test to identify differences within and between the types of diseases. Mean ADC values for malignant tumors (1.07 × 10-3 mm2 s-1) were significantly lower than ADCs for benign tumors (1.85 × 10-3 mm2 s-1), maxillary cysts (1.77 × 10-3 mm2 s-1), maxillary sinusitis (2.34 × 10-3 mm2 s-1), and maxillary sinus retention cysts (2.52 × 10-3 mm2 s-1), with P < 0.001. Mean ADC differed significantly between all disease types except between maxillary sinusitis and maxillary sinus retention cysts. ADC values also significantly differed between specific lesions within the malignant tumor and maxillary cyst groups. The use of ADC values can be useful in the differential diagnosis of malignant maxillary diseases, benign lesions, cysts, and inflammatory and reactive conditions.

The Role of CA19-9 and CA125 in Differentiation of Ovarian Dermoid Cyst and Ovarian Malignancy: A Case-Control Study

Background: An ovarian dermoid cyst is one of the most prevalent benign tumors in women of reproductive age. They can get complicated or be mistaken for malignant tumors. Most of the time, their pathology will not be discovered until after surgery. Objectives: Finding the role of CA19-9 and CA125 tumor markers in diagnosing the dermoid cyst before surgery and distinguishing it from the malignant type. Methods: A case-control study was conducted on all cases of dermoid cysts and malignant tumors (both diagnosed by pathology) from 2019 to 2021. Required information such as age, level of tumor markers, size, and whether it is unilateral or bilateral were extracted, and the tumor marker levels were analyzed in benign and malignant groups. Results: In this study, 95 cases of ovarian cysts and 85 control of malignant ovarian tumors were included. The mean level of CA19-9 and CA125 in the patients with dermoid cysts was 32.26 ± 5.45 units/mL and 31.37 ± 4.77 units/mL, respectively. In the malignant ovarian tumor group, the average level of CA19-9 and CA125 was equal to 9.56 ± 3.54 units/mL and 233.79 ± 54.57 units/mL, respectively. CA19-9 level was significantly higher in the dermoid cyst group (P-value &lt; 0.001). CA125 level was significantly elevated among the malignant group (P-value &lt; 0.001). It was observed that there was a significant relationship between the level of CA19-9 with the size of the cyst and the level of CA125 with the age of the patients. No significant relationship was found between the level of tumor markers and whether they were unilateral or bilateral. Conclusions: Regarding the correlation between the cyst size and CA19-9 in the comparison of the two groups, this tumor marker may be a suitable diagnostic marker in benign ovarian cysts along with ultrasound.

The relationship between hormonal levels and hematological parameters in cystic ovarian syndrome.

Polycystic ovarian syndrome (PCOS) is characterized by the abnormal production of ovarian androgens resulting in elevated levels of male sex hormones in women. This condition is often marked by the development of a group of small cysts, fluid-filled sacs (cysts) in the ovaries. This study aimed to analyze serum levels of prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and specific hematological parameters in women with PCOS. In total, 70 women were enrolled, of which 50 were diagnosed with PCOS at an obstetrics institution in Karbala from February and May 2022, and 20 were excluded. Participant selection was based on the Rotterdam 2003 criteria, and we excluded postmenopausal women, those with hyperprolactinemia, and those with overt thyroid dysfunction. The control group included 20 fertile women with normal hormone levels, regular menstrual cycles, and no signs of hyperandrogenism, as verified by ultrasonography. Ages 15 to 46 were similar with regard to the frequency of illness, with those under 36 having a higher incidence. Data were collected via questionnaires, hormone level assessments, and complete blood count (CBC) tests. There was a significant increase in hormone levels (LH, FSH, prolactin, TSH) and CBC values (WBC, Hb, and Plt) in the PCOS group compared to the control group. We observed that women between 26 and 35 were more susceptible to PCOS. Furthermore, women who were overweight demonstrated a higher susceptibility to the syndrome.

Laparoscopic Management of Benign Cystic Lesions of the Liver

Background: Benign cystic lesions of the liver are rare conditions. Owing to the improvement in investigation modalities like ultrasound and CT scan these lesions are found frequently today. A safe and effective method of laparoscopic management for hepatic hydatid cysts, simple liver cysts and liver abscess is described along with a review of the relevant literature. Objectives: To report our experience in laparoscopic management of hepatic hydatid cysts, simple liver cysts and liver abscess with the outcome, feasibility and complications of the procedure. Methods: This was a prospective observational study held at BSMMU, BIRDEM, DMCH, ShMCH and some private hospital in Dhaka city from July 2014 to December 2014. Total sample size was thirty cases. All patients diagnosed on ultrasound and CT scan and who have ful-filed the inclusion and exclusions criteria were included in the study. Laparoscopic unroofing, evacuation inocleation and aspiration were done. Operative procedure, operation time, conversion to laparotomy, complications, and mortality and recurrence rates were analysed. Results: There were three groups of benign cystic lesions: hepatic hydatid cysts (n=18), simple liver cysts (n=8) and liver abscess (n=4). Mean age of the patients were 43.6 years with hydatid cysts, 46.7 years with simple liver cysts, and 59.6 years in patients with liver abscess. Minimum age was 17 years and maximum age was 69 years. Male patients were 10 in hydatid cysts group, 3 in simple liver cysts group and 3 in liver abscess group. Most of the patients presented with pain, 72.22% in hydatid cysts, 62.5% in simple liver cysts and 100% in liver abscess. Most of the lesions were single and they were located in the right lobe of the liver in majority of cases. Benign cystic lesions were successfully treated laparoscopcally in 29 cases. Open surgery conversion was needed in one case 3.33%, with hepatic hydatid cysts. Complications included port site infection in 2 (6.67%), one in .....

Concomitant Subchondral Bone Cysts Negatively Affect Clinical Outcomes Following Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus

To study the effects of concomitant subchondral bone cysts (SBCs) on prognosis after arthroscopic bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) less than 100 mm2 and to further assess the correlation between cystic OLT area, depth, or volume and postoperative outcomes. We retrospectively analyzed consecutive patients with OLTs (<100 mm2) who received BMS between April 2017 and May 2020 with a minimum follow-up of 24 months. Lesion area, depth, and volume were collected on preoperative magnetic resonance imaging. Visual analog scale (VAS), American Orthopedic Foot and Ankle Society, Karlsson-Peterson, Tegner, Foot and Ankle Ability Measure (FAAM)-Activities of Daily Life and Sports scores were assessed before surgery and at the latest follow-up. Additionally, a general linear model (GLM) and a Pearson correlation analysis (PCA) were performed to investigate the effects of concomitant cysts on postoperative results. Eighty-two patients with a mean follow-up of 39.22 ± 12.53 months were divided into non-cyst (n= 45; 39.91 ± 13.03 months) and cyst (n= 37; 38.37 ± 12.02 months) groups. There was no significant difference in the OLT area between the non-cyst and cyst groups (46.98 ± 19.95 mm2 vs 56.08 ± 22.92 mm2; P= .093), but the cyst group showed significantly greater depth (6.06 ± 1.99 mm vs 3.96 ± 1.44 mm; P= .000) and volume (248.26 ± 156.81 mm3 vs 134.58 ± 89.68 mm3; P= .002). The non-cyst group showed significantly more improvement in VAS pain, Karlsson-Peterson, Tegner, and FAAM scores than the cyst group (P < .05). The GLM indicated that SBCs negatively affected VAS pain and Tegner scores (P < .05). For OLTs with cysts, the PCA showed that an area of 90.91 mm2, depth of 7.56 mm, and volume of 428.13 mm3 were potential cutoff values associated with poor outcomes. The concomitant SBCs negatively affected the prognosis of OLTs after BMS. For OLTs with cysts, an area of 90.91 mm2, depth of 7.56 mm, and volume of 428.13 mm3 were the potential cutoff values associated with poor outcomes after BMS. Level III, retrospective comparative study.

Preoperative Neutrophil Lymphocyte Ratio in Prediction of Adnexal Mass Torsion.

Adnexal torsion commonly affects reproductive age group females. Prompt diagnosis and early management help in the preservation of fertility. However, its diagnosis is challenging. Preoperative diagnosis can be suspected in only 23-66% of the cases and half of the patients operated for adnexal torsion have different diagnosis. This article thus aims to identify the diagnostic value of preoperative neutrophil lymphocyte ratio in adnexal torsion in comparison with other untwisted unruptured ovarian cysts. This was a retrospective study conducted in the duration of five years from 1st January 2016 to 1st January 2020. The data about demographic parameters, hematological parameters, operative approach, operative technique, and histopathological reports were derived from an electronic database and documented on proforma. SPSS was used for statistical analysis. Logistic regression analysis and influence of each factor on preoperative diagnosis of Adnexal torsion was evaluated. A total of 125 patients were included in the article (adnexal torsion group n = 25, untwisted unruptured ovarian cyst group n = 100). There was no statistically significant difference in comparison to age, parity, and abortion between both groups. Most patients had undergone laparoscopic surgery which was based on surgeon's skill and preference. Nineteen (78%) patients in the adnexal torsion group underwent oophorectomy while infarcted ovary was seen in only 4 cases. Among the blood parameters, only neutrophil-lymphocyte ratio (NLR) >3 was found to be statistically significant under logistic regression analysis. Most common adnexal pathology to undergo torsion was serous cyst. Preoperative neutrophil-lymphocyte ratio can be a predictive marker for diagnosis of adnexal torsion and can differentiate it from untwisted unruptured ovarian cysts.

Value of chromosomal microarray analysis for the diagnosis of fetuses with anomalies of central nervous system

To assess the value of chromosomal microarray analysis (CMA) for the diagnosis of fetuses with anomalies of the central nervous system (CNS) and summarize the outcome of the pregnancies and follow-up. A total of 636 fetuses from June 2014 to December 2020 who were referred to the Prenatal Diagnosis Center of Nanjing Drum Tower Hospital due to abnormal CNS prompted by ultrasound were selected as the research subjects. Based on the ultrasound findings, the fetuses were divided into ventricular dilatation group (n = 441), choroid plexus cyst group (n = 41), enlarged posterior fossa group (n = 42), holoprosencephaly group (n = 15), corpus callosum hypoplasia group (n = 22), and other anomaly group (n = 75). Meanwhile, they were also divided into isolated (n = 504) and non-isolated (n = 132) groups based on the presence of additional abnormalities. Prenatal samples (amniotic fluid/chorionic villi/umbilical cord blood) or abortus tissue were collected for the extraction of genomic DNA and CMA assay. Outcome of the pregnancies and postnatal follow-up were summarized and subjected to statistical analysis. In total 636 fetuses with CNS anomalies (including 89 abortus tissues) were included, and 547 cases were followed up. The overall detection rate of CMA was 11.48% (73/636). The detection rates for the holoprosencephaly group, ACC group, choroid plexus cyst group, enlarged posterior fossa group, ventricular dilatation group and other anomaly group were 80% (12/15), 31.82% (7/22), 19.51% (8/41), 14.29% (6/42), 7.48% (33/441) and 9.33% (7/75), respectively. Compared with the isolated CNS anomaly group, the detection rate for the non-isolated CNS anomaly group was significantly higher (6.35% vs. 31.06%) (32/504 vs. 41/132) (χ² = 62.867, P < 0.001). Follow up showed that, for 52 fetuses with abnormal CMA results, 51 couples have opted induced labor, whilst 1 was delivered at full term with normal growth and development. Of the 434 fetuses with normal CMA results, 377 were delivered at full term (6 had developmental delay), and 57 couples had opted induced labor. The rate of adverse pregnancy outcome for non-isolated CNS abnormal fetuses was significantly higher than that of isolated CNS abnormal fetuses (26.56% vs. 10.54%) (17/64 vs. 39/370) (χ² = 12.463, P < 0.001). Fetuses with CNS anomaly should be tested with CMA to determine the genetic cause. Most fetuses with negative CMA result have a good prognosis, but there is still a possibility for a abnormal neurological phenotype. Fetuses with CNS abnormalities in conjunct with other structural abnormalities are at increased risk for adverse pregnancy outcomes.

Effect comparison of neuroendoscopic vs. craniotomy in the treatment of adult intracranial arachnoid cyst.

Intracranial arachnoid cysts are common, accounting for about 1%-2% of intracranial space-occupying lesions. There is controversy over the method of surgical intervention, and in order to provide guidance for surgical decision making, this study compares the efficacy of craniotomy vs. neuroendoscopic surgery in treating arachnoid cysts. The adult patients with arachnoid cyst admitted to our department from October 2016 to August 2021 were retrospectively analyzed. Thirteen adult patients were recruited, and divided into two groups: neuroendoscopic group (group A) and craniotomy group (group B). We compared the gender, age, clinical symptoms, preoperative and postoperative cyst sizes, symptom improvement, complications, length of hospital stay, and hospital costs between two groups to analyze the therapeutic effects of these two surgical methods. The cost of hospitalization in group A was significantly lower than that in group B (47,292.8 vs. 65,151.8 yuan, P < 0.05), and there was no difference in the length of hospital stay between the two groups. The preoperative cysts in group A were significantly larger than those in group B (6.38 vs. 2.97 cm, P < 0.05). In groups A and B, the short-term symptom improvement rates were 100% and 75.0%, respectively. The long-term symptom improvement rates were 77.78% and 75.0% (P > 0.05), respectively. Both neuroendoscopic and craniotomy have good curative effects for the treatment of intracranial arachnoid cysts. There was no significant difference in the outcomes between the two surgical techniques. The cost of hospitalization can be reduced with neuroendoscopic surgery. Neuroendoscopic treatment is recommended for large intracranial arachnoid cysts, and craniotomy is suitable for small intracranial arachnoid cysts.

LAPAROSCOPIC ADRENAL-SPARING SURGERY CASE SERIES: PARTIAL ADRENALECTOMY AND CYST RESECTION.

The aim is to present our case series documenting indications, laparoscopic technique, surgical and endocrinologic outcomes of laparoscopic partial adrenalectomy. In the period from April 2011 until October 2021, we performed 39 procedures. The patients were divided into three groups: unilateral adrenal gland tumor with a normal contralateral gland (group 1), tumor of the solitary adrenal gland (group 2), and adrenal cysts (group 3). There were 20 patients in group 1, 6 patients in group 2, and 13 patients in group 3. The most common histology in group 1 was adenoma (40%), all tumors in group 2 were renal cell carcinoma metastases, and all cysts in group 3 were benign. There were no major complications (Clavien Dindo grade ≥2) in the whole cohort. All patients in groups 1 and 3 had favorable endocrinologic outcomes, and 50% of group 2 patients required lifelong hydrocortisone replacement therapy. The procedure is safe and feasible with favorable outcomes in the hands of a high volume adrenal surgeon.

Urethral diverticulum and periurethral cyst: symptoms, diagnostics, treatment and outcome.

Objectives. In order to contribute to better diagnostic and treatment, we compared the symptomatology, diagnostics, treatment and outcome in women with a urethral diverticulum or a periurethral cyst. Methods. We performed a retrospective extraction of data from medical records including 70 women with a urethral diverticulum or a periurethral cyst, operated at our department from January 2010 until December 2013. Fischer’s exact test and t-test were used for statistical analyses. Results. In total, 31 women were diagnosed with a diverticulum and 39 with a periurethral cyst. Women with a diverticulum had significantly more often voiding pain (45 % vs 8 %, p=0.001), urethral/vaginal pain (45% vs 15 %, p=0.01), recurrent urinary tract infection (23 % vs. 5 %, p=0.01), urinary incontinence (45 % vs. 21 %, p=0.04), and urethral discharge (39 % vs. 15 %, p=0.03) compared to women with a periurethral cyst. The only symptom less frequent in the diverticulum group was a bulky feeling (42 % vs. 74 %, p=0.01). In the diverticulum group, 87% had resections and 13% marsupialization, while in the cyst group 59 % had resections and 41 % marsupialization (p=0.02). In the diverticulum group four (13%) experienced recurrence compared to none in the cyst group (p=0.03). Furthermore, one patient referred as a diverticulum had urethral cancer. Conclusions. Urethral diverticula and periurethral cysts should be considered in women with lower urinary tract symptoms and pain. Urethral diverticula are more complicated to diagnose and to treat. Tweetable abstract: Urethral diverticula and periurethral cysts should be considered in women with lower urinary tract symptoms and pain

Evaluation of CT and MRI Imaging Results of Radicular Cysts, Odontogenic Keratocysts, and Dentigerous Cysts and their Contribution to the Differential Diagnosis.

This study aimed to evaluate the contribution of the MRI and CT results to the differential diagnosis of histopathologically different odontogenic cysts. Odontogenic cysts are commonly seen in the jaw bone and their surgical operations have an important place in the practice of maxillofacial surgery; treatment options for these cysts differ according to their histopathology. Differential results that can be obtained from the radiological evaluations of different cyst groups will allow the surgeon to plan a more accurate approach at the beginning of the operation. In this study, computed tomography (CT) and magnetic resonance imaging (MRI) results of different cyst groups were interpreted together with their histopathological diagnosis. CT and MRI results of 17 patients aged between 19-61 were evaluated, whose histopathological diagnosis consisted of 3 radicular cysts (RC), a total of 9 odontogenic keratocysts (OKC) of which 4 were inflamed, and a total of 5 dentigerous cysts (DC) of which one of them was inflammatory. In the CT scan, all cysts showed lytic, a sclerotic surrounding, and showed MRI peripheral enhancement, whereas solid nodular enhancement was only observed in OKCs. Edema and/or air in the surrounding bone medulla was observed in the infected lesions. OKC was heterogeneous, whereas RC and DC were more homogeneous. Diffusion restriction was observed to be frequent in OKCs. The OKCs were ellipsoidal in appearance and were located parallel to the long axis of the bone, and their dimensions were observed to be larger than the other cysts. OKCs may be accompanied by unerupted teeth. Radicular cysts were located perpendicular to the long axis of the bone and were globular in appearance, and their dimensions were smaller and more homogeneous compared to the OKCs. Dentigerous cysts are also accompanied by an unerupted tooth, and their peripheral enhancement is minimal and homogeneous. However, dentigerous cysts can be dense in content and smaller in size, and ellipsoidal localization is more common than OKCs. In addition to classic panoramic radiography in the evaluation and differential diagnosis of maxillary and mandibular lesions, CT and MRI evaluations can provide helpful information to the surgeon and pathologist in making the diagnosis and may further help plan the operation.

Edukasi Tentang Hiperemesis Gravidarum di Wilayah Kerja Puskesmas Rejosari Pekanbaru

Hyperemesis Gravidarum is nausea and vomiting during pregnancy. Although complaints Hyperemesis Gravidarum is nausea and vomiting during pregnancy. Although complaints of nausea and vomiting are considered normal for pregnant women and do not harm the fetus in the womb. However, if the frequency of nausea and vomiting is excessive, caution is still needed. Nausea followed by severe vomiting can be a sign of a problem with your pregnancy. For example in wine pregnancy, where the placenta develops into a group of abnormal cysts. Another possibility is hyperemesis gravidarum, which is a condition when pregnant women lose large amounts of body weight and body fluids. So that nausea and vomiting need to be avoided by being given drugs or other alternatives to reduce the complaint. So that education is needed about hyperemesis gravidarum to mothers who experience nausea and vomiting. The purpose of this activity is to provide education about hyperemesis gravidarum. The subjects of this community service activity are pregnant women in the Rejosari Health Center, Pekanbaru. Community service activities are supported by extension methods, question and answer, and discussion. The results showed that the participants were able to understand about emesis gravidarum, including understanding, causes, predisposing factors, and handling of emesis gravidarum. of nausea and vomiting are considered normal for pregnant women and do not harm the fetus in the womb. However, if the frequency of nausea and vomiting is excessive, caution is still needed. Nausea followed by severe vomiting can be a sign of a problem with your pregnancy. For example in wine pregnancy, where the placenta develops into a group of abnormal cysts. Another possibility is hyperemesis gravidarum, which is a condition when pregnant women lose large amounts of body weight and body fluids. So that nausea and vomiting need to be avoided by being given drugs or other alternatives to reduce the complaint. So that education is needed about hyperemesis gravidarum to mothers who experience nausea and vomiting. The purpose of this activity is to provide education about hyperemesis gravidarum. The subjects of this community service activity are pregnant women in the Rejosari Health Center, Pekanbaru. Community service activities are supported by extension methods, question and answer, and discussion. The results showed that the participants were able to understand about emesis gravidarum, including understanding, causes, predisposing factors, and handling of emesis gravidarum.

Sequence stratigraphy and microplankton palaeoenvironmental dynamics across the Jurassic–Cretaceous transition in the Canadian Arctic

ABSTRACTThe Jurassic to Cretaceous strata exposed in the Rollrock Section, Sverdrup Basin, Arctic Canada, represent one of the northernmost continuous outcrops spanning this poorly understood transition. The Oxfordian–Valanginian mudstones of the Rollrock Section were deposited in a shallow marine environment and, as such, provide the ideal lithology to investigate the response of high latitude dinoflagellate cyst populations to the frequent environmental perturbations of this time. Using a multivariate statistical approach, distinct palaeoecologically significant groups are identified and directly linked to time and palaeoenvironments, allowing for the reconstruction of underlying long term palaeoenvironmental trends. These palaeoenvironmental trends are identified to be driven by sequence stratigraphic cycles. For the first time, fourth order sequences are recorded from this pivotal period in the Sverdrup Basin and reveal an additional level of short term climatic events that complicate the identification of long term trends. The relationship existing between marine phytoplankton and climate is utilised to decipher the interplay of long-term and short-term climate fluctuations, distinguishing them from evolutionary trends. Two groups of dinoflagellate cysts, identified by process morphology, are recorded to act as environmental proxies. High percentages of proximochorate dinoflagellate cysts, such as Trichodinium erinaceoides, indicate more proximal, high energy, nutrient rich conditions and are dominant in fourth order transgressive systems tracts. High percentages of chorate dinoflagellate cysts, such as Oligosphaeridium complex, signify distal, low energy, nutrient depleted conditions and are dominant in fourth order highstand systems tracts.

Clinical Presentation of Thyroglossal Cysts and Sinuses

Objective: To see the clinical presentation of thyroglossal cysts and sinuses.&#x0D; Methods: Observational type of Cross sectional study. Department of ENT &amp; Head-Neck Surgery in Sher-E-Bangla Medical College Hospital, Barishal from September 2014 to February 2015. All patients attended in the Department of ENT and Head Neck Surgery in Sher-E-Bangla Medical College Hospital, Serum TSH, USG of thyroid swelling and FNAC were done for diagnoses and for evaluation.&#x0D; Results: Thyroglossal cysts and sinuses were found in 23(63.9%) and 13(36.1%) cases respectively. The mean age of presentation was found 16.6±11.3 years in cysts group and 15.5±7.2 years in sinus group. Regarding the site of cysts 4(17.4%) cases was suprahyoid, 11(47.8%) infrahyoid and 8(34.8%) at the level of hyoid. Regarding the site of sinus 1(7.7%) case was suprahyoid, 9(69.2%) infrahyoid and 3(23.1%) at the level of hyoid. All the patients had normal thyroid gland in both group, all of them had normal serum TSH level. FNAC was done in all cyst patients and shows normal cystic lesion with no malignancy. But in sinus patients only one FNAC was done and reported as cystic lesion.&#x0D; Conclusion: Thyroglossal cysts and sinuses were more common in 2nd decade and male predominant. Majority of the cysts are Infrahyoid and on the right side of midline and majority of sinuses are Infrahyoid and on the right side. Development of sinuses is due to operation following abscess formation in majority of cases.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(1): 7-15

Platelet-to-Lymphocyte Ratio and CA125 Level as a Combined Biomarker for Diagnosing Endometriosis and Predicting Pelvic Adhesion Severity.

Adhesion is a significant biological characteristic of endometriosis, and accurate evaluation of the pelvic adhesion is necessary for surgical treatment. Serum CA125 is yet the most common used biomarker in the diagnosis and follow-up of patients with endometriosis despite of its high false-positive rate and low specificity. Herein, we aimed to examine the diagnostic value of the combination of the platelet-to-lymphocyte ratio (PLR) and CA125 for patients with different stages of endometriosis and their correlations with pelvic adhesion. We retrospectively analyzed the clinical data and blood count parameters of patients with both endometriosis and other benign ovarian tumors. The mean level of CA125, the PLR and the combined marker (the CA125 level multiplied by the PLR) in the EMs group were significantly higher than those in the Cyst group (P < 0.05). ROC curve analysis was used to compare the diagnostic values of serum PLR, CA125, and the combined marker in ovarian endometriosis. The cut-off value of the PLR was 176.835, with 28.3% sensitivity and 96.9% specificity. The cut-off value of CA125 was 31.67 U/mL, with 84.1% sensitivity and 87.4% specificity. The cut-off value of the combined marker was 3894.97, with 83.4% sensitivity and 95.8% specificity. It was found that the severity of adhesion in endometriosis was positively correlated with the PLR (r = 0.286, P < 0.01), CA125 (r = 0.276, P < 0.01), and combined marker (r = 0.369, P < 0.01). The combined marker showed the highest AUC value (0.751, 95% CI: 0.666–0.837), with a sensitivity of 56.0% and a specificity of 89.6%, and the cut-off value was 9056.94. Besides, the levels of CA125, PLR, and their combination were significantly elevated in patients with endometriosis. The combined marker was not only positively correlated with pelvic adhesion but also showed a greater diagnostic value and specificity than CA125 alone. These findings indicate that the combined marker may be a potential inflammatory biomarker playing an important role in the diagnosis and assessment of adhesion in endometriosis.

HCG Trigger of GnRH Agonist-Induced Functional Ovarian Cysts Does Not Decrease Clinical Pregnancy Rate in GnRHa Pretreated Frozen Cycles: Evidence From a Retrospective Cohort Study.

BackgroundGnRH agonist (GnRHa) pretreatment before the frozen-thawed embryo transfer (FET) was increasingly utilized. However, the incidence of GnRHa-induced functional ovarian cysts (FC) was inevitable. The feasibility and efficacy of HCG triggering GnRHa-induced FC are unknown.ObjectiveThe aim of the study was to investigate the effect of HCG triggering GnRHa-induced FC on FET outcomes.MethodsA total of 657 HRT-FET cycles with GnRHa pretreatment were retrospectively analyzed. Patients were divided into the FC group and the no functional cysts (NC) group according to whether the patient developed FC (follicular diameter of ≥7 mm and E2 of ≥100 pg/ml). Risk factors associated with the incidence of GnRHa-induced FC were determined by multivariate regression analysis. Pregnancy outcomes were compared between the FC group and the NC group. Propensity score matching (PSM) was performed to reduce the impact of confounding factors. Three multivariate regression models were performed to assess the association between HCG triggering GnRHa-induced FC and clinical pregnancy. Interactive analysis and subgroup analysis were also analyzed.ResultsThe incidence rate of GnRHa-induced FC was 9.74%. Older age (aOR 1.10, 95% CI 1.05-1.15, p-value < 0.001) and lower BMI (aOR 0.81, 95% CI 0.71-0.93, p-value=0.002) are risk factors for GnRHa-induced FC. The implantation rate, clinical pregnancy rate (CPR), and miscarriage rate were not significantly different between the FC group and the NC group before or after PSM (p-value > 0.05). Multivariate logistic models showed that HCG triggering GnRHa-induced FC does not decrease CPR in the general population (p-value > 0.05). The effect of HCG triggering GnRHa-induced FC on clinical pregnancy is interactive with age (p-value for interaction: 0.003); HCG trigger is associated with significantly higher CPR than HRT-FET cycles without FC in patients ≥35 years (aOR 4.40, 95% CI 1.57–12.3, p-value = 0.005).ConclusionsHCG triggering GnRHa-induced FC does not decrease the chance of clinical pregnancy in HRT-FET cycles pretreated with GnRHa.

Sacrococcygeal Local Anesthesia for Complicated Versus Uncomplicated Pilonidal Sinus Surgery: A Single Center Study.

Several anesthetic techniques have been used for pilonidal sinus surgery such as general, spinal, and local anesthesia infiltration. However, the most effective technique remains controversial. The aim of this study was to assess the effectiveness of sacrococcygeal local anesthesia for complicated pilonidal cysts in terms of postoperative analgesic consumption. This was a retrospective cohort study conducted by collecting data from medical records for male patients who underwent pilonidal surgery using sacrococcygeal local anesthesia from 2008 to 2018. Patients' demographics, operative data, and postoperative outcomes such as pain, nausea, as well as analgesic consumption at 0 and 3 hours were analyzed. Pain scores at rest and upon pressure were recorded using the Visual Analogue Scale. The length of complicated pilonidal sinus was considered to be greater than or equal to 7 cm with multiple openings. A total of 394 patients were included in the study, 173 patients (43.9%) had complicated cysts while 221 patients (56.1%) had uncomplicated cysts. The majority of patients were males (85.5% vs. 76.9% in the complicated and uncomplicated groups respectively). Patients' weight was significantly higher in the complicated cyst group (87.12 ± 17.07 vs. 82.43 ± 20.30 kg, P value = 0.02). Around 41% of the patients in the complicated group were obese (body mass index ≥ 30 kg/m^2) compared to 32.0% of the patients in the uncomplicated group. Mean arterial pressure and heart rate at baseline, intraoperatively and at the end of the operation were similar between the two groups. Pain scores at rest and upon pressure were low in both groups. Analgesic consumption was similar between the two groups. Eight patients (4.6%) in the complicated group required acetaminophen at 0 hour compared to 6 patients (2.7%) in the uncomplicated group. Three patients (1.7%) received ketoprofen at 0 hour in the complicated group and 3 patients (1.4%) in the other group. Three patients, 2 (1.2%) in the complicated group and 1 (0.5%) in the second group required tramadol hydrochloride. Sacrococcygeal local anesthetic technique for complex pilonidal sinus surgery provided intra-operative hemodynamic stability as well as low post-operative pain and analgesic consumption.