Safety and efficacy of using advanced electrosurgical bipolar vessel sealing during vaginal hysterectomy in morbidly obese patients: a retrospective cohort analysis

Objectives: To assess the safety and efficacy of electrosurgical bipolar vessel sealing during vaginal hysterectomy in morbidly obese patients Material and methods: A total of 105 morbidly obese patients who underwent vaginal hysterectomy due to benign gynecologic pathologies between January 2010 and April 2017 were included in the study. Patients were divided into two groups according to whether conventional suture ligation technique (n = 64) or electrosurgical bipolar vessel sealing (n = 41) were used during vaginal hysterectomy. The surgical procedure was performed with the same technique in both study groups. The primary outcomes were duration of surgery and estimated blood loss. The secondary outcomes were intra-operative complications and post-operative complications. Results: The duration of surgery and estimated blood loss in the vessel sealing group was significantly less than in the conventional suture group (p < 0.05). No significant difference was present between the two groups in the rate of intra-operative and post-operative complications. Conclusions: The primary outcome of our study is that the EBVS system can be used equally and even more effectively in some aspects; and as safe an alternative approach to conventional suture ligation technique during vaginal hysterectomies performed specifically on morbidly obese patients with reduced operation times and blood loss, and without increasing the complication rates

Appendectomy in the surgical treatment of benign ovarian mucinous cystadenomas — is it necessary?

Objectives: To determine if appendectomy as an adjunctive procedure is necessary in the surgical treatment of benign ovarian mucinous cystadenomas. Material and methods: Retrospective analysis of clinical data: in a research hospital, obstetrics and gynecology depart­ment setting, 63 cases of benign ovarian mucinous cystadenomas confirmed in the pathological evaluation were revised. 59 had the complete clinical, final pathological and follow-up data available and were included. Results: 20.6% (13/59) went through an appendectomy. Basic characteristics of patients with different appendiceal pathologies did not show any significant differences. In the study group the mean age, parity, adnexial mass size were (40.1 ± 12.4); (1.3 ± 1.1) and (9.1 ± 5.3 cm), respectively. Patients were either operated laparoscopically (20), laparotomically (39) to perform a unilateral salpingoopherectomy/cystectomy. In 7 patients, oopherectomy was an additional procedure with: 2 abdominal hysterectomies, 4 cesarean sections and 1 total laparoscopic hysterectomy. 2 synchronous appendiceal pathologies (mucinous cystadenomas of the appendix) were defined in appendectomies performed. In these cases, the ovarian tumour sizes were: 7 cm and 4 cm. Conclusions: In the presence of a benign or borderline unilateral ovarian mucinous tumour as defined during the operation and especially if it is larger than 10–12 cm and with normal peritoneal and appendiceal gross morphology, appendectomy is not a necessary adjunctive procedure

Implementation of nuclear medicine methods for assessment of child abuse and neglect

Çocuk istismarı ve ihmali, çocuğun bakımı ve korunmasından sorumlu kişilerin istismar veya ihmal etmesi sonucunda, çocuğun sağlığının, fiziksel ve psiko-sosyal gelişiminin olumsuz etkilenmesidir. Çocuk istismarı ve ihmali; tıbbi, ahlaki ve hukuki yönleri olan ciddi toplumsal bir sorundur. Çocuk istismarı ve ihmalinin araştırılması ve varlığı halinde belgelenmesi için görüntüleme yöntemleri önemli rol oynamaktadır. Öncelikli görüntüleme teknikleri radyolojik yöntemlerdir. Kemik yapının değerlendirilmesinde tüm iskelet sistemi grafileri çekilmektedir. Kafa ve iç organ hasarlarının tespiti için bilgisayarlı tomografi (BT), manyetik rezonans görüntüleme (MRG) ve ultrasonografi (US) uygulanmaktadır. Teknolojide hızlı gelişmelerden dolayı nükleer tıp tanı yöntemleri de istismar ve ihmalin tanısında kullanılmaya başlanmıştır. İstismar ve ihmalin saptanması, doğru tanı ve tedavinin yanında etik, ahlaki ve hukuki yükümlülükler taşımaktadır. Nükleer tıp yöntemlerinin çocuk istismar ve ihmalinde kullanılmasının adli olaylarda nesnel kanıtların ortaya konularak, davaların çözülmesi ve adil yargılamanın gerçekleşmesine önemli katkılar sağlayabileceği düşünülmektedir. Ayrıca konuyla ilgili uzmanlara objektif sonuçlar vermesi açısından yararlı olacağını ümit ediyorum.Child abuse and neglect are detrimental to a child’s health, physical and psychosocial development and result from inappropriate behavior or inattention on the part of those responsible for the child’s care and protection. Child abuse/neglect is a serious public problem encompassing medical, ethical and legal aspects. Imaging methods play an important role in investigating and documenting child abuse and neglect. Radiological imaging methods have particular priority. X-rays of the whole skeletal system are obtained for evaluation of the bone structure. Computerized tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US) are used for the detection of cranial and internal organ damage. Due to the rapid developments in technology, diagnostic methods using nuclear medicine have also been initiated for use in identifying abuse and neglect. Detection of abuse and neglect carries ethical, judicial and moral liabilities as well as a responsibility for accurate diagnosis and treatment. Implementation of diagnostic methods of nuclear medicine in determining child abuse and neglect might contribute significantly in resolving court cases by providing objective evidence in medicolegal cases for realization of fair trials and in facilitating substantial conclusions. It is hoped that nuclear medicine methods will be helpful in terms of providing objective evidence for the experts

Investigation of the Rail-Induced Vibrations on a Masonry Historical Building

Increasingly historic masonry buildings are subjected to higher levels of traffic and rail vibrations due to urbanization and population growth. Deterioration and destabilisation of these buildings may result, especially if they were previously damaged (e.g. earthquakes or settlement problems). To better understand building response, vibration measurements were conducted on the Little Hagia Sophia Mosque, located adjacent to Istanbul’s Sirkeci-Halkali railway line. Transport-induced vibrations were recorded at several points on the ground and building. Attenuation characteristics in the ground and amplification features on the building were examined. Peak particle velocities often exceeded previously established thresholds for human perception and in some cases for structural damage. These are evaluated with respect to the building’s condition.Deposited by bulk impor

Visual Attention Failures towards Vulnerable Road Users at Intersections: Results from On-road Studies

Crash data indicate that attention misallocation is a major factor in crashes with vulnerable road users (VRUs) at intersections. However, the extent that drivers fail to scan for VRUs at intersections is unknown. This thesis investigates driver visual attention failures toward VRUs at intersections using an instrumented vehicle and eye-tracking equipment. First, analysis of data collected in an earlier on-road study is presented, which informed the design of the main experiment where 26 drivers (ages 35-54; 13 cyclists) made 18 different turns at downtown Toronto intersections, half of which were identified to be higher risk. Almost half of the turns had a visual attention failure; and most were towards cyclists. The failures were significantly more common at higher risk intersections and among non-cyclist drivers. Overall, prevalence of failures is alarming. Further research is needed to generalize these findings. The thesis also provides an overview of the countermeasures on cyclist safety.M.A.S