Impact of clinicopathological variables on laparoscopic hysterectomy complications, a tertiary center experience

Objectives: To analyze intraoperative and postoperative complications according to Clavian-Dindo Classification (CDC) and evaluate the influence of clinicopathological features on the feasibility and safety of total laparoscopic hysterectomy (TLH) in patients that underwent surgery in a tertiary center. Material and methods: We retrospectively reviewed the database of 469 patients that underwent surgery for patients who underwent extra facial TLH from 2013 to 2020. Results: A total of 86 (18.3%) peri-postoperative complications were observed. The incidence of intraoperative complications was 2% (n = 10). The overall conversion rate to open surgery was 1.9% (n = 9). A total of 76 postoperative complications were observed in 61 patients (14.3%). The incidence of minor (Grade I [n = 16, 3.4%] and II [n = 42, 8.9%]) and major complications (Grade III [n = 15, 3.2%], IV [n = 2, 0.4%] and V [n = 1, 0.2 %]) were 12.3% and 3.8%, respectively. A higher BMI and performing surgery at the first step of learning are found to be associated with intraoperative and postoperative complications (p < 0.05). Postoperative complications related to having a history of the cesarean section, additional comorbidities, and uterine weight ≥ 300 g (p < 0.05). Conclusions: The implementation of TLH by experienced surgeons appears to have remarkable advantages over open surgery. However, the risk factor for complications should be taken into account by surgeons in the learning curve in selecting the appropriate patient for surgery.

Değişik tür canlılarda saptanan kompleman aktiviteleri

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.ÖZET Çeşitli canlıların kompleman aktivitelerini karşılaştırma amacıyla on canlı türü ele alınmış ve dokuzunun beşer erkek ve dişi serumları, kedilerde ise ancak dört örneğin serumu incelenmiştir. Bu çalışma yapılırken yanılgılara düşmemek amacıyla, kompleman aktivitesi üzerine olumsuz etki gösteren koşullardan dikkatle uzak bulunmaya çalışılmıştır. Testimizde tümüyle Kolmer kompleman titrasyonu tekniğine bağlı kalınmıştır. Bulunan titreler ve üniteler tablo haline getirilmiş ve her cinsin ortalama ünite/ml.si de hesaplanarak kullandığımız tekniğe benzer çalışan iki grubun sonuçlarıyla kıyaslanmıştır. Sonuç olarak., kobay, komplemanı ve hazır liyofillize kompleman bulunmadığında, laboratuvarların kompleman gereksinimine, kobay la yakın aktiviteyi içeren sıçan veya titresi küçümsenemeyecek yükseklikte olan insan serumlarının cevap verebileceği kanısına varılmıştır. -46

Tüberküloz meninjitte beyin-omirilik sıvısında adenozin deaminaz aktivitesi

überküloz meninjit; tüberkülozun en ağır klinik şeklidir. Mortalite ve sekel oranlarının yüksek olması nedeniyle hastalığın erken tanı ve tedavisi çok önemlidir. Tüberküloz meninjit tanısında hızlı sonuç veren ve duyarlılığı yüksek testlere gereksinim vardır. Bu amaçla, bu çalışmada; tüberküloz meninjitli olguların beyin-omurilik sıvısı (BOS)'nda Adenozin Deaminaz (ADA) aktivitesi ölçümünün tanıya katkısı değerlendirildi. Çalışmaya 20 tüberküloz meninjit öntanılı olgu ve 20 kontrol olgusu alındı. Beyin-omurilik sıvısı ADA aktivitesi bu iki grupta sırasıyla 16.02 + 10.95 U/L ve 2.30 + 1.27 U/L olarak saptandı. Tüberküloz meninjit öntanılı grupta BOS ADA aktivitesi kontrol grubuna göre istatistiksel olarak anlamlı derecede yüksek bulundu (p= 0.000). Farklı cut-off değerlerine göre BOS ADA düzeylerinin özgüllüğü ve duyarlılığı hesaplandı. Sonuç olarak; BOS'ta ADA ölçümünün, tüberküloz meninjitin ayırıcı tanısında destekleyici bir test olduğu saptandı.uberculous meningitis is the most severe form of tuberculosis. Because of high morbidity and mortality rates, early diagnosis and treatment are very important. For diagnosis of tuberculous meningitis there is requirement for rapid laboratory tests with high sensitivity. For this purpose, in this study the contribution of cerebrospinal fluid (CSF) Adenosine Deaminase (ADA) activity measurement to the diagnosis of tuberculous meningitis was evaluated. Twenty suspected tuberculous meningitis cases and 20 control cases were taken into the study. Cerebrospinal fluid ADA measurements were 16.02 + 10.95 U/L and 2.30 + 1.27 U/L in these two groups, respectively. In the suspected tuberculous meningitis group CSF ADA activity was significantly higher than the control group (p= 0.000). Specifity and sensitivity of the CSF ADA levels were calculated for different cut-off values. As conclusion, measurement of CSF ADA activity was found to be helpful in the diagnosis of tuberculous meningitis

Two Cases of Travel-Related Acute Hepatitis E

Hepatitis E virus (HEV) infection is an acute viral hepatitis that is transmitted primarily by the fecal-oral route. The highest incidence of HEV infection is in Asia, Africa, the Middle East, and Central America, and HEV is the second most common cause of sporadic hepatitis in North Africa and the Middle East. In western countries, although sporadic cases are limited to visitors who traveled to areas of the world in which the infection is endemic, cases unassociated with travel are also reported. In this article, we describe acute viral hepatitis E diagnosed in two travelers from a nonendemic region, Australia, in whom the transmission of the infection was related to their travel to an endemic region. The couple, each aged 52 years, admitted to the hospital with the complaint of jaundice. On the physical examination, both patients appeared well, except for subicteric sclerae and skin. Alanine aminotransferase (ALT) was 2992 U/L and 1849 U/L in the male and female patient, respectively. They had a history of travel to India approximately three months before admission, and no other risk factor was found. HBsAg and anti-HAV IgM, anti-HCV, and anti-HBc IgM and IgG antibodies were negative, while anti-HEV IgM and anti-HEV IgG antibodies were positive in both patients. At the third week, ALT had decreased to 143 U/L and 100 U/L in the male and female patient, respectively, and both were discharged. These cases are presented to highlight the importance of medical history regarding travel in patients with acute viral hepatitis

Could the long-term oncological safety of laparoscopic surgery in low-risk endometrial cancer also be valid for the high–intermediate-and high-risk patients? A multi-center turkish gynecologic oncology group study conducted with 2745 endometrial cancer cases. (trsgo-end-001)

This study was conducted to compare the long-term oncological outcomes of laparotomy and laparoscopic surgeries in endometrial cancer under the light of the 2016 ESMO-ESGO-ESTRO risk classification system, with particular focus on the high–intermediate-and high-risk categories. Using multicentric databases between January 2005 and January 2016, disease-free and overall survivals of 2745 endometrial cancer cases were compared according to the surgery route (laparotomy vs. laparoscopy). The high–intermediate-and high-risk patients were defined with respect to the 2016 ESMO-ESGO-ESTRO risk classification system, and they were analyzed with respect to differences in survival rates. Of the 2745 patients, 1743 (63.5%) were operated by laparotomy, and the remaining were operated with laparoscopy. The total numbers of high–intermediate- and high-risk endometrial cancer cases were 734 (45%) patients in the laparotomy group and 307 (30.7%) patients in the laparoscopy group. Disease-free and overall survivals were not statistically different when compared between laparoscopy and laparotomy groups in terms of low-, intermediate-, high–intermediateand high-risk endometrial cancer. In conclusion, regardless of the endometrial cancer risk category, long-term oncological outcomes of the laparoscopic approach were found to be comparable to those treated with laparotomy. Our results are encouraging to consider laparoscopic surgery for high–intermediate- and high-risk endometrial cancer cases

Prognostic Factors in Squamous Cell Carcinoma of the Vulva: a Retrospective Multicenter Study

The study aim to determine the clinicopathological factors for disease-free survival (DFS) and overall survival (OS) in women with vulvar cancer and to analyze the the possible effect of metformin on survival of the patients. From 2011 to 2017, medical records of 142 patients who underwent primary radical surgery for VC at 6 referral centers in Turkey were collected, retrospectively. The median age of the cohort was 67.0 years. 124 patients underwent radical surgery and inguinofemoral lymphadenectomy. The overall recurrence rate was 33.8% within a median follow-up time of 22 months. Five-year DFS and OS rates were 55.8% and 62.6%, respectively. Multivariate analysis showed surgical margin (HR:6.4, p= 0.017 for DFS; HR: 13.6, p=0.009 for OS) and lymph node metastasis (HR: 4.1, p= 0.014 for DFS; HR: 6.3, p= 0.020 for OS) were the independent prognostic factors. There was no statistically difference in DFS and OS for patients who had used metformin

Is the extent of lymphadenectomy a prognostic factor in International Federation of Gynecology and Obstetrics stage II endometrioid endometrial cancer?

Aim This study aimed to evaluate the prognostic significance of adequate lymph node dissection (LND) (>= 10 pelvic lymph nodes (LNs) and >= 5 paraaortic LNs removed) in patients with International Federation of Gynecology and Obstetrics (FIGO) stage II endometrioid endometrial cancer (EEC)