A comparison of pelvic organ prolapse and sexual function after abdominal and laparoscopic hysterectomy

Objectives: Hysterectomy is one of the risk factors of pelvic organ prolapse (POP). There is no consensus on whether the route of hysterectomy affects the subsequent development of POP. The aim of the study was to assess POP and sexual function 1 year after a hysterectomy when comparing total abdominal hysterectomy (TAH) with total laparoscopic hysterectomy (TLH). The study applied the pelvic organ prolapse quantification (POP-Q) as the measure of POP and a short-form of the POP/Urinary Incontinence Sexual Function Questionnaire (PISQ-12).Material and methods: All patients that underwent either TAH or TLH due to benign causes between March 2016 and March 2017 at the tertiary hospital used for the study were included in our prospective cohort study. POP-Q measurements and PISQ-12 scores were assessed 1 year postoperatively.Results: We included 182 patients in the clinical examinations. There were no statistically significant differences in demographic characteristics between the TAH and TLH groups. Also, there we no differences observed in the objective POP measurements between the two study groups. Results of the two groups’ PISQ-12 scores were also similar. However, postoperative vaginal lengths were found to be significantly shorter in the patients who had undergone TAH compared with those who had undergone TLH.Conclusions: TAH and TLH are comparable regarding short-term objective pelvic organ prolapse. Although we foundstatistically a significant difference in vaginal lengths between the two groups, no clinical significance was found in terms of sexual function

Elevation in optic nerve sheath diameter due to the pneumoperitoneum and Trendelenburg is associated to postoperative nausea, vomiting and headache in patients undergoing laparoscopic hysterectomy

BACKGROUND: Optic nerve sheath diameter (ONSD) measurement with ultrasound has emerged as a simple, noninvasive and reliable surrogate of invasive intracranial pressure (ICP) measurement. Increase in ICP might lead to postoperative nausea and vomiting (PONV) and postoperative headache. Here, we aimed to evaluate the extent of change in ONSD., resulting from pneumoperitoneum (PP) and Trendelenburg (rp) position during the laparoscopic hysterectomy (LH), by using ultrasonographic ONSD measurement. We also aimed to investigate the relation of ONSD with PONV and postoperative headache

Predictors of Perinatal Mortality Associated With Placental Abruption: A Single Center Experience With 200 subjects

Objective: Despite recent advances in prenatal diagnostic techniques, placental abruption (PA) remains one of the most significant causes of maternal morbidity and perinatal mortality. The purpose of the present study is to summarize the current knowledge concerning PA and to present maternal and fetal outcomes of the patients admitted to our clinic who underwent cesarean delivery for PA

Low-pressure pulmonary recruitment maneuver: equal to or worse than moderate-pressure pulmonary recruitment maneuver in preventing postlaparoscopic shoulder pain? A randomized controlled trial of 72 patients

Introduction: The pulmonary recruitment maneuver (PRM) has emerged as an effective way of reducing post-lapa-roscopic shoulder pain (PLSP). However, the optimal lower pressure level for a PRM to reduce PLSP has not yet been investigated

A STUDY OF ARCHITECTS' UNDERSTANDING OF LAYPERSONS' LANGUAGE; SIMILARITY of ARCHITECT and LAYPERSON

This study discusses connotative meaning, which is a design input, and how it is understood by architects and laypersons. The study also examines layperson's value judgments and the factors that influence them. Studies of architects and laypersons have mainly attempted to acquire information from laypeople so that architects can use it to estimate their opinions. If architects know how connotative meanings affect laypersons, they can make better design decisions. For all these reasons, the author examined the opinions about connotative meanings between freshmen and seniors in the department of architecture and architects. The author also analyzed whether the architects comprehend the desires and likes of lay people. The primary hypothesis of the study is that architects and laypersons will make the same interpretations if the image overlaps the meaning. This study aims to find clues regarding shared opinions between designers and laypersons about connotative meanings. The experimental study in this paper mainly aims to determine which cognitive concepts are overlapped with which physical components by participants from the groups. Accordingly, the study aims to determine whether the meaning implied by the designer is recognized by laypeople, whether they comprehend it or not if they recognize it, whether they make the same interpretation as the designer and finally, whether they like it. Another aim of the study is to describe the extent to which laypeople differ among themselves and with architects. The study was conducted in two phases. In the first phase, the author identified the differences and similarities between the groups. Then buildings that overlapped the image and the meaning and data related to those images were collected. In the second phase, the author tried to find shared interpretations about overlapping images and meanings for the overlapping images and their data. The survey was done with the participation of four different groups: 40 freshmen in the department of architecture who were regarded as layperson, 40 seniors in the department of architecture, 40 academic architects and 8 independent judges. The author used 40 images to conduct the experimental study. The styles and functions of these images differ, and they were selected based on whether they had the components in the architectural components list. The author used the Lens Model to access the physical components through cognitive features and also to demonstrate the differences and similarities between architects and non-architects. The author asked the three groups of participants about the cognitive features and asked the group of independent judges about the physical components. Each group's evaluations of general aesthetics regarding the images were correlated with five cognitive features (functional connotation, connotation of meaning, complexity, familiarity and getting impressed). Then, the Pearson Correlation, the two groups' degrees of participation, was calculated regarding 20 buildings based on their cognitive features. Finally, the author determined to what extent the two groups agreed with each other about the general aesthetics of the buildings. One of the study's findings indicates that there are common interpretations between the groups. This is very significant since it identifies a cognitive concept common to the two groups for the first time and identifies the physical components that generate this cognitive concept. In this respect, this study is a foundation for further national and international research in this area. Designers should be informed about users' perception and interpretation of the buildings they design. They also should do so in their professional education. It is important that students of architecture are given the chance to make designs in design studios and are trained to understand common people. This is an important issue since it will provide data regarding design inputs. If the curriculum of studio lessons is organized to focus on these points, future generations will be more conscious and sensitive to environmental issues, and they will also be able to do user-centered design

Predictors of failure of the commonly used single-dose methotrexate protocol for treating tubal ectopic pregnancies

Objectives: This study identified patients who would benefit from an earlier additional medical intervention and/or continuing close surveillance even if commonly used parameters indicated sufficient medical treatment to determine markers of treatment failure. Materials and methods: A retrospective analysis of patients with a preliminary diagnosis of ectopic pregnancy treated with the single-dose methotrexate protocol. Group 1: cases cured with a single dose of methotrexate; Group 2: cases who required more than one dose of methotrexate or surgery following the first dose. Demographics, clinical/sonographic findings, observation period, and β-human chorionic gonadotropin (hCG) levels were compared among the two groups. Thresholds were defined and a regression analysis was performed to define independent predictors of failure. Results: Data from 120 patients were analyzed: Group 1 (n = 92); Group 2 (n = 28). β-hCG levels measured at all time points, and day (0–4) and day (4–7) changes, presence of adnexial masses, and infertility were significantly different among the two groups. Only the day (0–4) and day (4–7) changes in β-hCG levels were independent predictors of failure. Conclusion: Day (0–4) thresholds or newly defined day (4–7) thresholds were not more sensitive than the conventional day (4–7) criteria. Day (0–4) β-hCG levels increased by more than 9.7% in half the patients who required additional methotrexate doses or surgery despite fulfillment of the conventional day (4–7) criteria. In contrast, no cases of treatment failure were observed if the day (0–4) decrease was >26.6%

Pleth Variability Index-Based Goal-Directed Fluid Management in Patients Undergoing Elective Gynecologic Surgery

Objectives: Data concerning the usefulness of pleth variability index (PVI)-based goal-directed fluid management (GDFM) in gynecologic surgery is limited

Female sexual function and associated factors during pregnancy

Aim The objective of this study was to assess the changes in female sexual function during pregnancy and to identify associated factors among Turkish population using a validated questionnaire. Furthermore, we aimed to examine Turkish pregnant women's beliefs regarding sexual activity and describe their source of information about sexuality during pregnancy. Material and Methods In this cross-sectional study, healthy heterosexual pregnant women who had been living with their partners within the last four weeks were asked to complete two self-administered questionnaires, one of which was Female Sexual Function Index (FSFI). Results A significant association was found between the decrease in intercourse frequency and trimesters, as a decline in frequency was reported by 58.3%, 66.1% and 76.5% of women in each trimester, respectively (P=0.01). Only the trimester of gestation and employment status were independent factors associated with the decline in sexual intercourse frequency during pregnancy. When the overall FSFI score were compared according to each trimester of pregnancy, there were no statistical significant differences between the first and second trimesters (P=0.71). The overall FSFI score in the third trimester was found to be significantly lower than the overall scores in the first two trimesters (P<0.001 for both). In linear regression analysis, overall FSFI scores were adversely affected by only being in the last trimester. 38.7% of women and 36.2% of male partners worried that sexual intercourse may harm the pregnancy. Among the total sample, only 23.8% of women discussed sexuality with the medical staff. Conclusion The third trimester is the independent variable for both decreased sexual activity frequency and sexual function scores in pregnancy. Counseling about sexuality during pregnancy is not frequent in the clinical setting, but conversations about this topic should happen on a regular basis during prenatal care visits

Malignant transformation arising from mature cystic teratoma of the ovary: A report of six cases

Aim: Malignant transformation of mature cystic teratoma (MCT) is an uncommon complication. Preoperative diagnosis is difficult because of the lack of specific symptoms and signs indicating malignancy. Thus, we retrospectively analyzed the clinical characteristics of patients and the role of surgery in their management

Characteristics of total laparoscopic hysterectomy among women with or without previous cesarean section: retrospective analysis

ABSTRACT BACKGROUND: The number of hysterectomized patients with previous cesarean sections (CSs) has increased due to increasing CS rates. A previous history of CS has been demonstrated to be an important risk factor for major complications in total laparoscopic hysterectomy. The aim here was to evaluate the major complications and safety of TLH in patients with previous CS. DESIGN AND SETTING: Retrospective analysis in a tertiary-level center. METHODS: The medical records of 504 total laparoscopic hysterectomy patients operated between May 2013 and May 2017 were reviewed retrospectively. Data on age, parity, surgical indications, duration of operation, length of hospital stay, histopathological diagnosis and major intra and postoperative complications were gathered. The patients were categorized into two groups according to their CS history, namely those with and those without previous CS. Major complications were defined as the presence of lower urinary tract injury (bladder or ureter injury), enterotomy/colostomy, bowel serosal injury or vascular injury. RESULTS: There was no difference between the groups in terms of parity, duration of operation, hospital stay or pre and postoperative hemoglobin levels. The conversion rates to laparotomy in the previous CS and no CS groups were 2% and 1.7%, respectively. The rates of major complications in the previous CS and no CS groups were 5% and 1.3%, respectively, and these results did not differ significantly (P > 0.05). CONCLUSION: TLH could be performed safely in the previous CS group, since the complication rate was not different from that of the patients without previous CS