The use of coffee for the prevention of ileus following abdominal surgery: A review of the current evidence

Postoperative ileus (POI) is a form of intestinal paralysis that is seen especially after surgical procedures performed by entering the abdominal cavity. POI is common, particularly after abdominal surgery, with an incidence of 8-30%. The initial phase of postoperative paralytic ileus is treated with decompression using a nasogastric tube to correct electrolyte imbalances, with analgesia applied as needed. Prokinetic compounds have been used to prevent ileus and control pain (such as serotonin receptor antagonists, neostigmine, alvimopan, and ghrelin agonists), along with early mobilization, minimally invasive surgery, early introduction of solid food into the diet, thoracic epidural analgesia, and fluids. Coffee has been shown to accelerate postoperative bowel movements. However, despite extensive research on the physiological impacts of coffee, little is acknowledged regarding how it affects the gut. Coffee increases colonic motility within 4 min of consumption. In the postoperative period, the number of intestinal vocals heard by auscultation of intestinal vocals, first gas and first defecation times of patients who consume coffee are smaller/shorter than patients who do not consume coffee. Patients who drink coffee also have shorter hospital stays

Retrospective analysis of urogynecological symptoms of patients undergoing gynecological oncology surgery

Objectives: Treating gynecological cancer with radical surgery, pelvic radiotherapy, and systemic chemotherapy may lead to pelvic floor dysfunction. Materials and Methods: Lower urinary tract symptoms are common after surgery for gynecological cancer. We used the Urogenital Distress Inventory (UDI)-6, Incontinence Impact Questionnaire (IIQ)-7, and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) to compare the severity of urinary incontinence and quality of life between patients who underwent staging surgery for gynecological caner and those who underwent hysterectomy for benign disease. In total, 50 patients with cancer and 50 patients with benign disease were included in the patient and control groups, respectively. Results: There were no significant differences between the groups in terms of preoperative IIQ-7, UDI-6, and ICIQ-SF scores. There was a significant difference between the groups in scores 1 and 12 months after surgery. Postoperative IIQ-7, UDI-6, and ICIQ-SF scores were significantly increased compared to preoperative scores, although there were no significant differences between preoperative and postoperative scores in the control group. Incontinence was present after surgery in 15 (43.2%) and 4 (21.1%) patients in the test and control groups, respectively. In multivariate analyses of variance, surgery for cancer was an independent risk factor for urinary incontinence. Conclusion: Genitourinary symptoms should be evaluated in cancer patients undergoing staging procedure. The quality of life of patients should be assessed in terms of incontinence in the postoperative period

Isolated pulmonary metastases in patients with cervical cancer and the factors affecting survival after recurrence

Objectives: The aim of this study was to assess the treatment options and survival of uterine cervical cancer (UCC) patients who develop isolated pulmonary metastases (IPM) and to establish risk factors for IPM.Material and Methods: Data from patients diagnosed with UCC between June 1991 and January 2017 at the Gynecological Oncology Department, Tepecik Training and Research Hospital, were investigated. In total, 43 cases with IPM were evaluated retrospectively. Additionally, 172 control patients diagnosed with UCC without recurrence were matched according to the International Federation of Gynecology and Obstetrics (FIGO) 2009 stage when the tumor was diagnosed. They wereselected using a dependent random sampling method.Results: Of the 890 patients with UCC, 43 (4.8%) had IPM. The presence of lymphovascular space invasion (LVSI) anda mid-corpuscular volume (MCV) < 80 fL were statistically significant prognostic factors for IPM development in UCC patientsaccording to univariate regression analyses, and the presence of LVSI, a hemoglobin level < 12 g/dL, and an MCV < 80 fLwere statistically significant according to the multivariate regression analyses. We were unable to assess the role of lymph node status (involvement or reactive) as a prognostic factor in the development of IPM, because only seven patients (16.2%) in the case group underwent lymph node dissection.Conclusions: IPM typically develops within the first 3 years after the diagnosis of UCC, and survival is generally poor. AnMCV < 80 fL and the presence of LVSI are significant risk factors for IPM development

Stage IB1 cervical cancer treated with modified radical or radical hysterectomy: does size determine risk factors?

Objectives: This study was performed to investigate prognostic factors status at smaller tumors in patients with stageIB1 cervical cancer (CC) who underwent modified radical or radical hysterectomy.Matherial and metods: Data from patients diagnosed with CC between January 1995 and January 2017 at the GynecologicalOncology Department, Tepecik Training and Research Hospital and Bakirkoy Dr. Sadi Konuk Training and Research Hospital,Istanbul, Turkey, were investigated. A total of 182 stage IB1 CC cases were evaluated retrospectively.Results: Patients were divided into two groups according to tumor size (< 2 cm and ≥ 2 cm). There were no complicationsassociated with the operation in patients with a tumor size < 2 cm. Among patients with a tumor size ≥ 2 cm, however, 0.9% (n = 1) developed bladder laceration, 0.9% (n = 1) rectum laceration, and 0.9% (n = 1) pulmonary emboli (P = 0.583). The rates of intermediate risk factors (depth of stromal invasion and lymphovascular space invasion) were significantly higher and lymph node involvement significantly more frequent in patients with a tumor size ≥ 2 cm. However, there were no significant differences in parametrial invasion or vaginal margin involvement between the two groups.Conclusions: Intermediate risk factors and lymph node metastasis were significantly less frequent in patients with smalltumors measuring < 2 cm. However, although parametrial involvement and vaginal margin involvement were less common in patients with small tumors compared with large tumors (≥ 2 cm), the differences were not significant

Postmenopausal Tuberculosis Endometritis

Tuberculosis remains a global health problem, primarily in developing countries with inadequate health services. A significant portion of tuberculosis in these settings is extrapulmonary, including tuberculosis of the genitourinary tract. Patients with genital tuberculosis are usually young women detected during work up for infertility. After menopause, tuberculosis of the endometrium is a rare possibility probably because of the decreased vascularity of the tissues. We present a case of endometrial tuberculosis with postmenopausal vaginal bleeding

Management of cervical cancer during pregnancy

WOS: 000373739200023PubMed ID: 26467977Cervical cancer (CC) is the most common gynaecological cancer during pregnancy. The rarity of the disease and lack of randomised control studies have prevented the establishment of treatment guidelines. The management of CC mainly follows the guidelines for the non-pregnant disease state, expert opinions and limited case reports. Although the management of CC diagnosed during pregnancy appears to be a significant dilemma for the patients and specialists, the prognosis of CC is not influenced by pregnancy. The treatment decision should be made collaboratively with a multidisciplinary team consisting of an obstetrician, gynaecologist, oncologist and paediatrician. The concerns of the patient should be taken into account

Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention