A New Technique for Surgical Treatment of Vaginal Agenesis Using Combined Abdominal-Perineal Approach

Optimum therapeutic approach in vaginal agenesis has always been an area of extensive controversies. Although surgical management gained priority due to the evolution of techniques, there is currently no consensus in the literature regarding the best type of surgical approach. The most commonly preferred surgical procedure among gynecologists is McIndoe operation which involves the creation of a space between bladder and rectum, insertion of a mold covered with split-thickness skin graft into that neovaginal space, and use of postoperative vaginal dilation to avoid stenosis. However, many modifications have been introduced in time in an attempt to increase the success rates. In this paper, we describe two cases with vaginal agenesis with functioning uterus who were subjected to surgery by combined abdominal-perineal approach. The surgical technique also included the use of a specially designed vaginal mold made up of polymethyl methacrylate and use of Hyalobarrier gel which is an adhesion-preventing agent

Anonymous Shopping in the Internet by Separation of Data

Whenever clients shop in the Internet, they provide identifying data of themselves to parties like the webshop, shipper and payment system. These identifying data merged with their shopping history might be misused for targeted advertisement up to possible manipulations of the clients. The data also contains credit card or bank account numbers, which may be used for unauthorized money transactions by the involved parties or by criminals hacking the parties' computing infrastructure. In order to minimize these risks, we propose an approach for anonymous shopping by separation of data. We argue for the feasibility of our approach by discussing important operations like simple reclamation cases and criminal investigations

Structural Alterations of Zirconia Depending on Sintering Parameters and Effects on Bond Strength After Different Surface Treatments

Objectives: Zirconia having different physical and optical properties is obtained after the application of different sintering parameters. This study aims to investigate structural variations after administering different sintering protocols and to evaluate the effect of different surface treatments on shear bond strength.Materials and Methods: Eighty translucent zirconia specimens (7x3 mm) were divided into two different sintering groups (1480 0C for 180 min; 1510 0C for 30 min), then divided into four subgroups according to surface treatments: control, sandblasted, Er-YAG, and Nd-YAG (n:10). One specimen from each group was analyzed with XRD and one from each subgroup was analyzed with SEM. Ceramics (5x3 mm) were fired onto the zirconia for shear bond strength test using universal testing machine and the failure mode was determined by using stereomicroscope. Translucency and contrast ratio were measured by using spectrophotometer, and biaxial flexural strength test performed by employing universal testing machine on specimens with a diameter (15x1,3 mm) from each sintering group (n:10). Data was analyzed by using two-way ANOVA and Bonferroni Post hoc tests (P<.05).Results: The short sintering group showed higher biaxial flexural strength (943.87±48.69 MPa). The highest surface roughness values were obtained in short sintering groups and within the groups Nd-YAG application was found the most effective method (4.11±0.28 Ra). The highest bond strength value was obtained in sandblasted short time sintered group (29.71±2.52 MPa). The translucency and contrast ratio showed no significant difference. Conclusion: Although a physically stronger zirconia is obtained by short sintering process, long-term sintered zirconia forms a more durable bond strength with ceramics. Sandblasting improve the ceramic-zirconia bond strength may have more benefits than the use of Er-YAG, and Nd-YAG lasers

Management of Iron-Deficiency Anemia in Inflammatory Bowel Disease:A Systematic Review

Anemia is the most frequent complication of inflammatory bowel disease (IBD), but anemia, mostly due to iron deficiency, has long been neglected in these patients. The aim was to briefly present the pathophysiology, followed by a balanced overview of the different forms of iron replacement available, and subsequently, to perform a systematic review of studies performed in the last decade on the treatment of iron-deficiency anemia in IBD. Given that intravenous therapies have been introduced in the last decade, a systematic review performed in PubMed, EMBASE, the Cochrane Library, and the websites of WHO, FDA, and EMA covered prospective trials investigating the management of iron-deficiency anemia in IBD published since 2004. A total of 632 articles were reviewed, and 13 articles (2906 patients) with unique content were included. In general, oral supplementation in iron-deficiency anemia should be administered with a target to restore/replenish the iron stores and the hemoglobin level in a suitable way. However, in patients with IBD flares and inadequate responses to or side effects with oral preparations, intravenous iron supplementation is the therapy of choice. Neither oral nor intravenous therapy seems to exacerbate the clinical course of IBD, and intravenous iron therapy can be administered even in active disease stages and concomitantly with biologics. In conclusion, because many physicians are in doubt as to how to manage anemia and iron deficiency in IBD, there is a clear need for the implementation of evidence-based recommendations on this matter. Based on the data presented, oral iron therapy should be preferred for patients with quiescent disease stages and trivial iron deficiency anemia unless such patients are intolerant or have an inadequate response, whereas intravenous iron supplementation may be of advantage in patients with aggravated anemia or flares of IBD because inflammation hampers intestinal absorption of iron

Anterior spinal cord herniation after multilevel anterior cervical corpectomy: A case report

Many complications related to the resection of an ossified posterior longitudinal ligament via the anterior approach have been reported. Postoperative neurological deterioration is one such complication that may appear due to massive anterior spinal cord herniation related to a dural defect following resection of the ossified posterior longitudinal ligament. Specifically, spinal cord herniations have been reported to be associated with posterior approaches, and a large number of theories regarding this association have been offered by various authors. However, anterior spinal cord herniation is extremely rare, and its pathophysiology has not yet been explained. In this case report, we report a male patient who experienced anterior spinal cord herniation following anterior surgery. Spinal cord herniation may develop following the removal of the anterior cervical corpectomy. Therefore, surgeons should be aware of this condition when planning treatments for cervical spondylotic myelopathy via the anterior approach

Thyroid Gland Hematoma After Blunt Neck Trauma

Hemorrhage of a previously normal thyroid gland as a result of blunt trauma is a very rare condition. We report a case of blunt trauma that caused acute hemorrhage into the thyroid gland and presented with hoarseness. The diagnosis of thyroid gland hematoma was made with a combination of fiberoptic laryngoscopy, cervical computed tomography, and carotid angiography. The patient was treated conservatively, had a favorable course without further complications, and was discharged four days after admission

Management of rectal foreign bodies

BACKGROUND: Entrapped anorectal foreign bodies are being encountered more frequently in clinical practice. Although entrapped foreign bodies are most often related to sexual behavior, they can also result from ingestion or sexual assault. METHODS: Between 1999 and 2009, 15 patients with foreign bodies in the rectum were diagnosed and treated, at Izmir Training and Research Hospital, in Izmir. Information regarding the foreign body, clinical presentation, treatment strategies, and outcomes were documented. We retrospectively reviewed the medical records of these unusual patients. RESULTS: All patients were males, and their mean age was 48 years (range, 33–68 years). The objects in the rectum of these 15 patients were an impulse body spray can (4 patients), a bottle (4 patients), a dildo (2 patient), an eggplant (1 patient), a brush (1 patient), a tea glass (1 patient), a ball point pen (1 patient) and a wishbone (1 patient, after oral ingestion). Twelve objects were removed transanally by anal dilatation under general anesthesia. Three patients required laparotomy. Routine rectosigmoidoscopic examination was performed after removal. One patient had perforation of the rectosigmoid and 4 had lacerations of the mucosa. None of the patients died. CONCLUSIONS: Foreign bodies in the rectum should be managed in a well-organized manner. The diagnosis is confirmed by plain abdominal radiographs and rectal examination. Manual extraction without anaesthesia is only possible for very low-lying objects. Patients with high- lying foreign bodies generally require general anaesthesia to achieve complete relaxation of the anal sphincters to facilitate extraction. Open surgery should be reserved only for patients with perforation, peritonitis, or impaction of the foreign body