Robotic Compartment-Based Radical Surgery in Early-Stage Cervical Cancer

A radical hysterectomy with pelvic lymphadenectomy is the recommended treatment option in patients with early-stage cervical cancer. Although various classifications were developed in order to define the resection margins of this operation, no clear standardization could be achieved both in the nomenclature and in the extent of the surgery. Total mesometrial resection (TMMR) is a novel procedure which aims to remove all components of the compartment formed by Müllerian duct in which female reproductive organs develop. TMMR differs from the conventional radical hysterectomy techniques in that its surgical philosophy, terminology, and partly resection borders are different. In this paper, a TMMR with therapeutic pelvic lymphadenectomy operation that we performed for the first time with robot-assisted laparoscopic (robotic) approach in an early-stage cervical cancer patient was presented. This procedure has already been described in open surgery by Michael Höckel and translated to the robotic surgery by Rainer Kimmig. Our report is the second paper, to our knowledge, to present the initial experience regarding robotic TMMR in the English literature

THE EFFECT OF TELEPHONE FOLLOW-UP INTERVENTION AND CONTINUOUS PATIENT TRAINING ON DISEASE MANAGEMENT AFTER PERCUTANEOUS CORONARY INTERVENTION: RANDOMIZED CONTROLLED STUDY

Bu araştırma, perkutan koroner girişim yapılan koroner arter hastalarında yaşam tarzı değişikliği konusunda yapılan mobil destekli izlem ve sürekli eğitimin yaşam kalitesini ve ilaç kullanımını arttırmaya, ve değiştirilebilir hastalık risk faktörlerini azaltmaya yönelik etkisini belirlemek amacıyla yapıldı. Araştırmanın evrenini, Aydın Devlet Hastanesi Kardiyoloji Servisi’nde Şubat – Eylül 2016 tarihleri arasında perkutan koroner girişim uygulanan 370 hasta oluşturdu. Örneklem, post-hoc güç analizi ile belirlendi ve toplam 102 hasta ile çalışma tamamlandı. Uzman görüşüne sunulan hasta eğitimi eğitici el kitapçığı doğrultusunda, yaşam tarzı değişikliği oluşturmak amacı ile bireysel eğitim ve mobil izlem gruplarına eğitim yapıldı. Broşür grubuna yazılı eğitim materyali verildi. Araştırmanın verileri “Hasta Bilgi Formu”, “Morisky 8-maddeli İlaca Uyum Anketi (MMAS-8)” ve “EQ-5D Genel Yaşam Kalitesi Ölçeği” kullanılarak taburculuk öncesi, taburculuk sonrası 3. ayda ve 6. ayda toplandı. Verilerin analizinde SPSS 24.0 ve PAST-3 programları kullanıldı. Değişkenler % 95 güven düzeyinde incelenmiş olup p değeri 0,05’ ten küçük anlamlı kabul edildi. Eğitim gruplarındaki hastaların yaş ortalaması 57,1 ± 10 olarak bulundu. Hastaların % 93,1’ inin erkek, % 77,5’ inin lise öncesi eğitime sahip, yarısından fazlasının sigara içtiği ve çok azının egzersiz yaptığı belirlendi. Bireysel eğitim ve mobil destekli eğitim verilen hastaların, broşür verilen hastalara göre 6. ayda ilaca uyumlarının anlamlı düzeyde yüksek olduğu izlendi (p < 0,05). Mobil destekli eğitim verilen hastalarda, broşür verilen hastalara göre 3. ay total kolesterol, 6. ay total kolesterol ve 6. ay LDL kolesterol değerlerinde anlamlı bir azalma olduğu belirlendi (p < 0,05). Sonuç olarak, her üç eğitim yöntemi de davranış değişikliği oluşturmada ve yaşam kalitesini arttırmada etkili oduğu izlenmiştir. Mobil destekli sürekli izlem ve eğitimin ilaca uyumu arttıran bir faktör olduğu söylenebilir.Adnan Menderes Üniversitesi Bilimsel Araştırma Projeleri Birimi tarafından ASYO-16005 proje numarası ile desteklenmiştirİÇİNDEKİLER KABUL VE ONAY SAYFASI i TEŞEKKÜR ii İÇİNDEKİLER iii SİMGELER VE KISALTMALAR DİZİNİ vi TABLOLAR DİZİNİ vii ÖZET viii ABSTRACT x 1. GİRİŞ 1 2. GENEL BİLGİLER 4 2.1. Koroner Arter Hastalığının Tanımı ve Epidemiyolojisi 4 2.2. Koroner Arter Hastalığının Fizyopatolojisi 4 2.3. Koroner Arter Hastalığının Etiyolojisi 5 2.3.1. Koroner Arter Hastalığı Değiştirilemez Risk Faktörleri 5 2.3.1.1. Yaş ve cinsiyet 5 2.3.1.2. Ailede koroner arter hastalığı öyküsü 6 2.3.2. Koroner Arter Hastalığı Değiştirilebilir Risk Faktörleri 6 2.3.2.1. Sigara ve tütün ürünleri kullanımı ve sigara dumanına maruz kalmak 6 2.3.2.2. Dislipidemi 7 2.3.2.3. Sağlıksız beslenme alışkanlığı 7 2.3.2.4. Fiziksel aktivite azlığı 7 2.3.2.5. Obezite veya fazla kilolu olmak 8 2.3.2.6. Hipertansiyon 8 2.3.2.7. Diabetes Mellitus 9 2.3.2.8. Psikososyal faktörler 9 2.4. Koroner Arter Hastalığının Klinik Seyri 9 2.5. Akut Koroner Hastalığında Tanı 10 2.5.1. Belirti ve Bulgular 10 2.5.2. Tanı Yöntemleri 12 2.6. Akut Koroner Sendromlarda Tedavi 13 2.6.1. Farmakolojik Tedavi 13 2.7. Koroner Arter Hastalığı Risk Faktörlerinin Azaltılmasına Yönelik Yaşam Tarzı Değişikliği Önerileri 15 2.7.1. Sigara Bırakma Önerileri 15 2.7.2. Beslenme ve Kilo Kontrolü Önerileri 15 2.7.3. Fiziksel Aktivite Önerileri 17 2.8. Hasta Eğitiminin Önemi 18 3. GEREÇ VE YÖNTEM 21 3.1. Araştırmanın Amacı ve Yöntemi 21 3.2. Araştırmanın Evreni ve Örneklemi 21 3.3. Araştırmaya Dâhil Edilme ve Dışlama Kriterleri 22 3.4. Araştırmanın Hipotezleri 23 3.5. Veri Toplama Araçları 23 3.5.1 Hasta Bilgi Formu (Ek 1) 23 3.5.2. Morisky 8-Maddeli İlaca Uyum Anketi (MMAS-8) (Ek 2) 24 3.5.3. EQ-5D Genel Yaşam Kalitesi Ölçeği (Ek 3) 24 3.6. Veri Toplama Yöntemi 25 3.7. Eğitim Materyallerinin Hazırlığı 25 3.8. Araştırmanın Uygulanması 26 3.9. Araştırma Verilerinin Değerlendirilmesi 27 3.10. Araştırmanın Finansal Kaynakları 28 3.11. Araştırmanın Sınırlılıkları 28 3.12. Araştırmanın Etik Yönü 28 4. BULGULAR 29 5. TARTIŞMA 46 6. SONUÇ VE ÖNERİLER 54 KAYNAKLAR 57 EKLER 65 ÖZGEÇMİŞ 8

Robotic Surgery for the Treatment of Apical Pelvic Organ Prolapse at a Single Institution

Objective: We sought to present implementation of robotic surgery for the treatment of apical pelvic organ prolapse at our clinic, with short-term outcomes. Study design: Clinical data of 11 consecutive patients with apical pelvic organ prolapse, who underwent robotic sacrocolpopexy or hysteropexy between July 2015 and August 2016, were collected prospectively. Primary endpoint of the study was anatomic cure and the secondary endpoint was symptomatic cure. Anatomic cure was defined as lack of anterior or posterior prolapse beyond the hymen and apical prolapse beyond the midvagina. Symptomatic cure was lack of vaginal bulge sensation. Results: Of the 11 patients, 9 underwent sacrocolpopexy and two underwent hysteropexy. Sacrocolpopexy was performed concomitantly with hysterectomy in 7 of the 9 patients. Mean operating time for all procedures was 254±65 minutes. No conversion to open surgery was required and no intraoperative complication was observed in any of the patients. The median hospital stay was 3 days. Four complications occurred postoperatively: 1 case of pulmonary thromboembolism, 2 cases of vaginal vault cellulitis and 1 case of mesh erosion. In total, 10 of 11 patients (90.9%) met the criteria for anatomic and symptomatic cure. Conclusion: Robotic pelvic support procedures can be readily adopted to routine clinical practice with high anatomic and symptomatic cure rates

Urinary Tract Injury at Gynecological Surgery: Results from a Tertiary-Care Institution

Objective: To identify clinical features of urinary tract injuries detected during or after gynecologic surgeries, with a specific focus on incidence and role of surgeon and surgical route on urinary injury. Study design: The institutional database from January 2009 to January 2017 was reviewed with respect to gynecologic (non-obstetric) surgeries and urinary injuries. Results: A total of 8719 gynecologic surgeries were identified. Of these, 46 (0.52%) were found to be complicated with a bladder (N=34, 0.38%), ureteral (N=11, 0.12%) and/or urethral injury (N=1, 0.01%). Bladder injuries occurred mostly at the superior part of the bladder, while ureteric injuries at the most distal part of the ureter. Ureteric injuries were mostly delayed (81.8% vs. 5.9%, P<0.001) and were more related to thermal injury than bladder injuries (45.5% vs. 8.8%, P=0.029). Among all surgical procedures, radical hysterectomy had the highest incidence for the ureteric injury (8.53%), while Burch colposuspension via minimally invasive route had the highest incidence for the bladder injury (16.6%). Cumulative incidence of urinary injury significantly differed according to the surgical route preferred (P=0.032), with the vaginal surgeries were associated with the highest incidence (0.96%). However, there was no such a difference in injury rates between the low-volume (0.55%) and high-volume (0.52%) surgeons (P=0.328) Conclusion: Overall incidence of lower urinary tract injury at gynecologic surgeries is low, does not differ according to annual number of surgeries performed, but increases with the vaginal surgeries

Can gestation be considered as trauma in adolescent girls: post-traumatic stress disorder in teen pregnancy

Although post-traumatic stress disorder (PTSD) in adolescent pregnancy has been reported at high rates in the limited research in this area, no studies have evaluated gestation as trauma in teens. This study, aimed to evaluate PTSD in this high risk group. All pregnant adolescents who presented to our obstetrics and gynaecology clinics in a one-year period were invited to participate in the study. Adolescents with a history of domestic or dating violence, rape, and sexual abuse were excluded. PTSD was rated using the Child Post-Traumatic Stress Disorder-Reaction Index. When the pregnant adolescents and control group were compared, various severities of PTSD were observed in nearly two-thirds of the study group. Although there was clinically significant PTSD among 23.3% of the controls, PTSD was more frequently seen in adolescents with pregnancy compared with their healthy peers. Educating adolescents about birth control methods and preventing child marriages will be protective in this respect.Impact statement What is already known on this subject? Teen pregnancy has significant psychosocial and economic impacts for adolescents, their offspring, and the community in terms of education and employment, increased risk of abuse and neglect, and the physical and emotional well-being of the offspring. Pregnancy and birth-related risks are also higher than in adults. In this context, pregnancy itself may be accepted as trauma for adolescents. What do the results of this study add? There has been limited research on PTSD in pregnant teens and is mainly associated with traumatic childhood events. This is the first study to examine pregnancy-related PTSD and related conditions in this group. What are the implications of these findings for clinical practice and/or further research? The prevalence of pregnancy related-PTSD in pregnant teens can be considered high and alarming, considering the fact that most of them had never been treated for it at all. Healthcare providers serving this population need to be trained to recognise the core symptoms of PTSD, and should direct adolescents for professional assistance if needed. Strategies such as higher quality sexual health education and greater access to reproductive health services to reduce adolescent pregnancy and marriage are also imperative

Minimally Invasive Approaches for Combined Gynecologic Surgeries: Our Three Years Clinical Experiences

OBJECTIVE: To evaluate outcomes of gynecological patients with multiple pathologic conditions who were treated with combined laparoscopic procedures. MATERIAL AND METHOD: We retrospectively analyzed 48 consecutive patients who underwent a combination of laparoscopic surgical procedures during a single operative session in Turgut Ozal University Hospital, Department of Gynecology. Outcomes included operative time, intraoperative blood loss, hemoglobin levels, mean hospital stay and complication rate. To investigate the relationship between body mass index (BMI) and other variables, we assigned each patient to three BMI groups. RESULTS: The most common combination of procedures was laparoscopic hysterectomy and laparoscopic Burch colposuspension (18 patients). Blood loss was positively correlated with number of ports. Higher BMI was correlated with greater blood loss and operative time but not with complication rate. CONCLUSIONS: Multiple pathologic conditions could be treated safely and effectively in a single laparoscopic operation. Obesity did not appear to be a risk factor for complications

The platelet activating factor acetyl hydrolase, oxidized low-density lipoprotein, paraoxonase 1 and arylesterase levels in treated and untreated patients with polycystic ovary syndrome

Purpose To evaluate the platelet activating factor acetyl hydrolyze (PAF-AH), oxidized low-density lipoprotein (ox-LDL), paraoxonase 1 (PON1), arylesterase (ARE) levels and the effects of metformin and Diane-35 (ethinyl oestradiol + cyproterone acetate) therapies on these parameters and to determine the PON1 polymorphisms among PCOS patients

Successful Treatment of Uterine Arteriovenous Malformation due to Uterine Trauma

Uterine arteriovenous malformation (AVM) is defined as abnormal and nonfunctional connections between the uterine arteries and veins. Although the patients typically present with vaginal bleeding, some patients may experience life-threatening massive bleeding in some circumstances. The treatment of choice depends on the symptoms, age, desire for future fertility, and localization and size of the lesion; however, embolization of the uterine artery is the first choice in symptomatic AVM in patients at reproductive age with expectations of future fertility. We report a case of acquired AVM (after D/C) with an extensive lesion, which was successfully treated with bilateral uterine artery embolization (UAE)

Assessment of circulating betatrophin concentrations in lean glucose-tolerant women with polycystic ovary syndrome

The aims of the current study were to investigate the betatrophin levels in lean glucose-tolerant women with polycystic ovary syndrome (PCOS), and to explore the relationships between these levels and antropometric, hormonal and metabolic parameters. The study population consisted of 50 lean (body mass index [BMI] < 25 kg/m2) women diagnosed with PCOS using the Rotterdam criteria, and 60 age- and BMI-matched healthy controls without any features of clinical or biochemical hyperandrogenism. Before recruitment, glucose tolerance was evaluated in all of the subjects using the 2-h 75 g oral glucose-tolerance test, and only those exhibiting normal glucose tolerance were enrolled. Serum betatrophin levels were significantly higher in women with PCOS (median 322.3; range 44.7–1989.3 ng/L) compared to the controls (median 199.9; range 6.2–1912.9 ng/L; p = .005). In the control group, no significant correlation was evident between betatrophin levels and clinical or biochemical parameters. In the PCOS group, betatrophin levels were positively correlated with prolactin levels (r = .286, p = .046) and negatively correlated with BMI (r = −.283, p = .049), waist/hip ratio (r = −.324, p = .023), and low-density lipoprotein cholesterol levels (r = −.385, p = .006).Impact statement What is already known on this subject: Several studies have suggested that primary alteration in beta-cell function is a pathophysiological feature of PCOS, and insulin resistance is the most significant predictor of beta-cell dysfunction independent of obesity. Betatrophin is a circulating protein that is primarily expressed in the liver in humans. Early experimental investigations demonstrated that overexpression of betatrophin significantly promoted pancreatic beta-cell proliferation, insulin production and improved glucose tolerance. Few studies have investigated the association between PCOS and betatrophin. However, in contrast to our study, the authors included overweight/obese patients and glucose tolerance was not evaluated before recruitment. What the results of this study add: Our results showed that serum betatrophin levels were significantly higher in lean glucose-tolerant PCOS women than in age- and BMI-matched healthy controls. What are the implications of these findings for clinical practice and/or further research: Elevated betatrophin levels in PCOS women, in the absence of obesity and glucose intolerance, may reflect a compensatory mechanism in order to counteract metabolic syndrome-related risk factors