Laparoscopically-assisted vaginal hysterectomy for enlarged uterus: operative outcomes and the learning curve

Objectives: The aim of the study was to compare the effects of uterine size and surgeon experience on the surgical out­comes of laparoscopically-assisted vaginal hysterectomy (LAVH) for benign gynecological conditions. Material and methods: This was a retrospective analysis of 184 LAVH cases. All hysterectomies were performed by the same surgeon and divided into two groups, with uterine weight of < 280 g (group 1) and uterine weight of > 280 g (group 2). The groups were compared in terms of the effects of the uterine size and surgeon experience vs. the operative outcomes (operative time, change in hemoglobin levels, hospital stay, and perioperative complications). Results: No significant differences in mean age, parity, history of chronic systemic diseases and previous surgery history were observed between the two groups. However, operative time was significantly greater in group 2 as compared to group 1 (132.1 ± 42.7 minutes vs. 111.5 ± 30.4 minutes, p < 0.05). There were no differences in the hospital stay and perioperative complications between the two groups. One case of bladder injury occurred in each group and one patient underwent a second laparoscopic surgery for postoperative bleeding in group 2. Greater surgeon experience was demonstrated to be associated with decreased operative bleeding and, consequently, smaller differences between preoperative and postop­erative hemoglobin levels. Operative time was also reduced as the surgeon was getting more experienced but the effect did not reach statistical significance. Conclusions: Our study supports the thesis that LAVH is a safe and effective procedure for managing benign gynecologi­cal conditions. Despite increased operative time, LAVH can be safely performed for enlarged uterus in conjunction with increased surgeon experience

An assessment of marital adjustment in patients with rheumatoid arthritis

Aim To investigate marital adjustment in patients with rheumatoid arthritis and factors affecting this. Methods A total of 32 patients diagnosed with Steinbrocker class 1-2 rheumatoid arthritis and 32 healthy individuals from a similar age group were included. Sociodemographic characteristics, the Beck Depression Inventory (BDI), short–form 36(SF-36) and the dyadic adjustment scale (DAS) were evaluated in both groups. A visual analogue scale (VAS), the disease activity score 28 (DAS28) and a health assessment questionnaire (HAQ) were also investigated in the patient group. Results Mean ages were 46.5±9.2 years in the patient group and 47.7±8.1 in the control group (p=0.5). No significant difference was determined between the two groups in terms of sociodemographic characteristics. No statistically significant correlation was observed between erythrocyte sedimentation rate (ESR), patient and physician global VAS, DAS28, HAQ and morning stiffness and DAS total score. Comparison of DAS subunits revealed a significant difference in dyadic satisfaction and affectional expression in the patient and control groups (p=0.046 and p=0.037). A statistically significant negative correlation was observed between duration of the disease and marital adjustment (p=0.01;r= -0.58). Conclusion Due to its progressive and prolonged course rheumatoid arthritis can also affect individuals’ social relationships besides restricted daily living activities. Activation of rheumatoid arthritis did not affect marital adjustment in this study, but adjustment decreased with duration of the disease

Riskli gebelerin doğum korkusu, emzirme özyeterlilik ve emzirme başarılarının belirlenmesi

Amaç: Bu çalışmada, yüksek riskli gebelerin doğum korkusu, emzirme özyeterlilik ve emzirme başarısı arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Kesitsel ve tanımlayıcı tipte yapılan çalışma Ankara’da bir eğitim araştırma hastanesinde Ocak-Kasım 2017 tarihleri arasında perinatoloji servisine doğum amaçlı yatan gebelere uygulanmıştır. 326 gebe ile çalışma tamamlanmıştır. Çalışmaya katılan tüm gebelerden yazılı ve sözlü onam alındıktan sonra, anket form (sosyo demografik, obstetrik, geçmiş emzirme deneyimi ve doğum eylemi süreciyle ilgili özellikler) yüzyüze doldurulmuştur. Doğum Korkusu Ölçeği (DKÖ), servikal dilatasyon 3cm (DKÖ-1), 6 cm (DKÖ-2) ve 9 cm iken (DKÖ-3), Emzirme Öz-Yeterlilik Ölçeği (EÖYÖ) ve Latch Emzirmeyi Değerlendirme ve Tanılama Ölçeği (LATCH) kullanılmıştır. Bulgular: Çalışmaya katılan tüm gebelerde DKÖ puan ortalaması 37,92±6,87 olarak bulunmuştur. Herhangi bir işte çalışmayan, geliri giderinden düşük olan, kronik bir rahatsızlığı olan gebelerde DKÖ puan ortalaması daha yüksek bulunmuştur (p<0,05). Çalışmada DKÖ-1 puan ortalaması 43,40±8,28, DKÖ-2 puan ortalaması 37,49±7,89, DKÖ-3 puan ortalaması 32,87±8,69 olarak tesbit edilmiştir. Ölçümler arasında farkın istatistiksel olarak anlamlı olduğu bulunmuştur (p<0,001). Çalışmada DKÖ puan ortalaması ile EÖYÖ puan ortalaması arasında istatistiksel olarak anlamlı bir ilişkinin olmadığı (p=0,199, r=-0,071), LATCH puan ortalaması ile pozitif yönlü ilişkisinin olduğu (p<0,001, r=0,229) saptanmıştır. Sonuç: Yüksek düzeyde doğum korkusu yaşayan annelerin emzirme başarılarının daha düşük olduğu tesbit edilmiştir. Bu kapsamda, doğum öncesi dönemde gebelerin doğuma hazırlık eğitimine katılarak; gebelik, doğum, postpartum dönem ve emzirme konularında destek alması önerilmektedir

Microflora On The Skin Of European Eel (Anguilla Anguilla L., 1758) Sampled From Creek Yuvarlakçay, Turkey

Bacterial skin microflora of eel obtained from Mugla (Turkey) province were studied. The aero- bic bacteria associated with skin and slime were estimated using the dilution plate technique. The dominant bacterial species were Pseudomonas spp. (17.23%), Acinetobacter baumannii (15.51%) and Stenotrophomonas maltophilia (12.05%). A lower frequency of Gram-positive bacteria (18.93%) was found in samples

Alternate pathway 17,20-lyase enzyme activity in the adrenals is enhanced in patients with polycystic ovary syndrome

Objective: To assess the activity of the enzyme cytochrome P450c17 alpha in patients with polycystic ovary syndrome (PCOS)

Medical treatment regimens of hirsutism

Hirsutism, which is a common clinical problem in women of reproductive age, is characterized by excessive growth of terminal hair in the androgen-sensitive skin regions. It is the result of either androgen excess or increased sensitivity of the hair follicles to normal levels of androgens. The management, which includes cosmetic measures and medical treatment, is far from satisfactory. Anti-androgen drugs play a key role in the treatment of hirsutism, but they have some side-effects which may result in cessation of the drug. On the other hand, anti-androgen treatment often needs to be continued for a long time. So, safe, inexpensive, and effective anti-androgen drugs are needed. Recently low-dose anti-androgen drugs have been shown to be effective in the maintenance of treatment. On the other hand, cyproterone acetate plus ethyniloestradiol and spironolactone, cyproterone acetate plus ethyniloestradiol and finasteride, and spironolactone and finasteride combinations have been used succesfully in decreasing the hirsutism score. There are also some promising data regarding the effects of insulin sensitizers in the treatment of hirsutism, particularly in patients with polycystic ovarian syndrome. In the present review, the main features of anti-androgen drugs, new combined treatments, and insulin sensitizers in the treatment of hirsutism are discussed

The frequency of late-onset 21-hydroxylase and 11 beta-hydroxylase deficiency in women with polycystic ovary syndrome

Objective: To determine the frequency of late-onset adrenal hyperplasia (LOCAH) due to 21-hydroxylase (21-OH) and 11 beta-hydroxylase (11 beta-OH) deficiency in women with clinical and biochemical features of polycystic ovary syndrome (PCOS)