Czynnościowe efekty usunięcia polipropylenowej taśmy podcewkowej z powodu jej odsłonięcia/wystawania: czy prowadzi to do nawrotu nietrzymania moczu?

Objectives The Burch colposuspension, which was regarded as the gold standard treatment for stress urinary incontinence for several years, has been replaced by minimally invasive sling devices. Although these procedures are simple and minimally invasive, they are associated with complications such as infection, mesh erosion, chronic pain, and de novo detrusor overactivity, which may necessitate surgical resection or tape removal.The aim of the study was to assess urinary function outcomes including continence, after partial resection of suburethral tapes. Material and methods Patients were admitted for resection of tape due to extrusion/exposure , between 2011 and 2014.Patients were evaluated with physical examination, transvaginal ultrasound, cough stress test, 24-hour bladder diary, Incontinence Impact Questionnairre-7 form and Urogenital Distress Inventory-6 form. Results Minimum followup time was 2 months after treatment of the tape complication (mean 20, range 2 to 38).Recurrence of incontinence after partial tape resection was observed in 9% (3/32) cases.In two patients due to stress urinary incontinence recurrence repeat anti-incontinence surgery was necessary.Although one patient had suffered from incontinence after resection of tape, she did not desire operation. Conclusions The results of this study indicated that preservation of the anti-incontinence effects of slings might not be dependent on the intactness of the sling.Recurrence of incontinence after partial tape resection is uncommon and in the majority of cases this stress incontinence is minimally and does not require repeat operation.Cel: Operacja Burcha uważana dotąd za złoty standard w leczeniu wysiłkowego nietrzymania moczu, została zastąpiona przez małoinwazyjne zabiegi slingowe. Chociaż procedury te są proste i małoinwazyjne, to wiążą się z powikłaniami, takimi jak: zakażenie, erozja taśmy, przewlekły ból, pęcherz nadreaktywny, które mogą wymagać chirurgicznego wycięcia lub usunięcia taśmy. Celem badania była ocena trzymania moczu po częściowej resekcji taśmy podcewkowej. Materiał i metoda: Do analizy włączono pacjentki, które pomiędzy 2011 a 2014 rokiem zostały przyjęte do szpitala celem usunięcia taśmy z powodu jej obnażenia lub wystawania. U pacjentek wykonano badanie fizykalne, USG przezpochwowe, test kaszlowy, 24-godzinny dzienniczek mikcyjny oraz kwestionariusze: Incontinence Impact Questionnairre-7 i Urogenital Distress Inventory-6. Wyniki: Najkrótszy czas obserwacji po operacji naprawczej z powodu powikłań wynosił 2 miesiące (średnio 20, zakres 2 do 38). Nawrót nietrzymania moczu po częściowym usunięciu taśmy obserwowano w 9% przypadków (3/32). U dwóch pacjentek z powodu nawrotu nietrzymania moczu konieczna była ponowna chirurgiczna interwencja. Jedna pacjentka mimo nawrotu dolegliwości po usunięciu taśmy, nie zdecydowała się na ponowną operację. Wnioski: Wyniki naszego badania pokazują, że utrzymywanie się efektu założenia taśmy w postaci trzymania moczu, nawet po jej usunięciu, może nie być uzależnione od nienaruszalności taśmy. Nawrót nietrzymania moczu po częściowym usunięciu taśmy występuje rzadko, jest minimalny i w większości przypadków nie wymaga ponownej operacji

A case of bladder endometriosis that became symptomatic during the third trimester

AbstractBackgroundThe urinary tract endometriosis is observed in 1–2% of the patients and in 90% of these cases, there are endometriotic nodules in the bladder. With respect to knowledge, it is generally believed that pregnancy cures endometriosis. However in this case, symptoms developed during the third trimester of pregnancy.Case reportWe report a case of 31year old, 30week pregnant woman with a vegetative mass with 33×33×21 mm dimensions and irregular borders on the posterior wall of the bladder. After the cesarean section, the vegetative and superiorly localized mass on the internal wall of the bladder was excised with partial bladder excision. The patient had no other apparent findings of pelvic endometriosis at operation but the pathology result indicated endometriosis.ConclusionAlthough this case shows that endometriosis may become symptomatic during pregnancy, it has to be underlined that it cannot be discerned whether it is consequent to progress of the disease or to pregnancy-mediated modifications of a pre-existing lesion

Successful treatment of a case of anal incontinence due to obsteric injury using ‘anterior overlapping sphincteroplasty’

Anal inkontinans, gaz ve dışkının istem dışı kaçırılması- dır. Fekal inkontinans vajinal doğumun çok korkulan bir komplikasyonudur. Bu durum sfinkter yırtılması, pudental sinir hasarlanması ya da her ikisi ile birlikte olabilmektedir. Anal inkontinans prevelansı araştırılan topluluğa göre farklılık göstermektedir. Genel olarak 30-90 yaş arası kadınlar incelendiğinde, en az bir aylık sürede katı veya sıvı dışkı tutamama prevalansı %7.7dir. Vajinal doğum veya sezaryen doğumdan 6 ay sonra anal inkontinans %13-25 arası olmakta fakat bu 12 aylık bir sürede %1-6 aralığına düşmektedir. Anal inkontinans yaşam kalitesi üzerinde önemli bir etkisi vardır. Kadınlarda en önemli neden doğum travmasıdır. Anal sfinkter defekti ile birlikte perine yırtılması %1-9 arasında değişmektedir. Tanımlanmamış sfinker hasarı %18-35 olarak yüksek bir değerdedir. Pudental nöropati doğumunun ikinci evresinde ıkınma ile birlikte sinirin gerilmesi ve fetal başın inmesi ile oluşmaktadır. Hatta bazen doğumun birinci evresinde bile olmaktadır. Sfinkter hasarı ve pudental nöropati risk faktörleri forsepsli doğum, büyük fetüs ölçüsü ve uzamış ikinci doğum evresidir. Özellikle ilk doğum süresince fekal inkontinans riski göz önünde bulundurulmalıdır. Rutin epizyotomi sfinker hasarını engellememekte hatta sebebiyet verebilmektedir. Anal inkontinanslı kadınların tedavi yaklaşımı altta yatan etyoloji temelli olmalıdır. Başlangıç tedavisi olarak önerilen tıbbi yaklaşım nadiren etkilidir. Prmer anal sfinkter cerrahisi yapılan hastaların yarısı kısa ve uzun dönemde kontinans problemi ile karşılaşabilmektedirler. Bu çalışmada obstetrik yaralanmaya bağlı olarak ortaya çıkan ve ‘Anterior Overlapping Sfinkteroplasti’ yöntemiyle başarı bir şekilde tedavi edilen anal inkontinanslı bir olguyu sunuyoruz.Anal incontinence means inability to control the release of flatus or stool. Fecal incontinence is one of the most feared complications of vaginal delivery. It may be the consequence of sphincter tears, of pudendal neuropathy, or of a combination of the two. The prevalence of fecal incontinence varies depending on the population studied. In one population-based, age-stratified postal survey of women aged 30 to 90 years, the prevalence of fecal incontinence (defined as at least monthly loss of liquid or solid stool) was 7.7 percent. At three to six months after vaginal or cesarean delivery, as many as 13 to 25 percent of women report fecal incontinence . However, the prevalence falls to 1 to 6 percent by 12 months. Fecal incontinence has a significant impact on quality of life. Most important cause of incontinence is obstetric trauma in women. The incidence of perineal tear with anal sphincteric defect varies from 1-9% and the incidence of unrecognized sphincter injury may be as high as 18-35%. Pudendal neuropathy is caused by nerve stretch during pushing in the second stage of labor and descent of the fetal head; it may occur even with the first delivery. Risk factors for sphincter injury and pudendal neuropathy include forceps delivery, large neonatal size, and prolonged second stage of labor. The risk of fecal incontinence must be considered even during the first pregnancy. Routine episiotomy does not prevent sphincter injury and may even predispose to it. Therapeutic management of the women with anal incontinence should be based on underlying etiology. Medical treatment, recommended as initial approach, is rarely effective. Half the women who undergo primary anal sphincter repair have short or long term continence problems. In this study we present a case of anal incontinence due to obstetric injury who was successfully treated using ‘anterior overlapping sphincteroplasty

Evaluation of occult uterine leiomyosarcomas

Objectives: To determine the frequency of occult uterine leiomyosarcomas following hysterectomies and myomectomies performed for benign reasons at our clinic and to draw comparisons with similar studies in the literature.  Material and methods: All hysterectomies and myomectomies that have been performed for benign reasons at our clinic between 2010 and 2017 were retrospectively examined via the hospital’s information system and the patients that were found to have leiomyosarcomas were analysed. The incidence of occult uterine leiomyosarcoma per 1000 surgeries at our clinic was calculated using the Wilson score interval.  Results: A total of 6,173 hysterectomies were performed, and occult uterine leiomyosarcoma was identified in 5 patients. The incidence of occult uterine leiomyosarcoma was calculated to be 0.08% (95% CI 0.03–0.018%). Only 1 of the 771 patients who underwent myomectomy was identified with occult uterine leiomyosarcoma, making its incidence in myomectomy 0.12% (95% CI 0.02–0.073%). When all the patients are considered, occult uterine leiomyosarcoma was identified in 6 of the 6,944 patients, and the general incidence of occult uterine leiomyosarcoma was calculated as 0.08% (95% CI 0.03–0.018%).  Conclusions: In our study, the incidence of occult uterine sarcoma following myomectomy and hysterectomy was found to be lower than that reported in the literature. The reason for this lower incidence includes not only genetic causes and racial differences but also preoperative imaging, endometrial and cervical sampling that is performed on every patient

Pemantauan Senyawa Dichlorodiphenyltrichloroethane (Ddt) dan Turunannya di Daerah Cianjur, Jawa Barat

Persistent Organic Pollutants (POPs) merupakan senyawa organik yang relatif bertahan lama di lingkungan, sulit terdegradasi melalui proses kimia, biologi, dan fotolisis serta sukar larut di dalam air tetapi cenderung larut dalam lemak. Oleh karena sifatnya ini, POPs cenderung bersifat akumulatif dan bertahan di lingkungan. Selain itu, sen­yawa ini juga bersifat semivolatil sehingga dapat berada dalam fase uap ataupun terserap di dalam partikel debu, sehingga POPs dapat menempuh jarak yang jauh di udara (long-range air transport) sebelum akhirnya terdepo­sisi di bumi. Dari beberapa bentuk senyawa POPs, senyawa insektisida organoklorin yang paling bertahan lama dan mempunyai sifat bioakumulasi, diantaranya adalah Dichlorodiphenyltrichloroethane ( DDT ). Pemantauan kualitas lingkungan akibat pencemaran kelompok senyawa POPs, termasuk senyawa DDT dan turunannya telah dilakukan didaerah holtikultura Cianjur. Sampel diambil di beberapa lokasi yaitu PLTA Cijedil, Desa Cibeureum, Desa Sukatani, Agropolitan, dan Desa Sindang Jaya. Matriks yang diambil adalah air, sedimen sungai, dan tanah pertanian/perkebunan. Sampling air dan sedimen sungai dilakukan dengan metode sesaat sedangkan untuk tanah, menggunakan metode komposit tempat. Pemantauan ini mempunyai tujuan untuk menginventarisir jenis dan kon­sentrasi residu senyawa POPs yang terdapat di lingkungan terutama DDT dan turunannya. Isomer DDT yang paling banyak terbentuk di lingkungan adalah p,p\u27-DDT ( 80 % ) dan o,p\u27-DDT ( 20 % ). Senyawa POPs diekstrak dengan menggunakan pelarut organik, kemudian di clean-up dan dianalisis dengan GCMS menggunakan kolom kapiler non polar. Pada pemantauan tahun 2011, senyawa p,p\u27-DDT tidak terdeteksi dalam sampel sedimen, tetapi pada tahun 2012, ditemukan sekitar 3.7 ng/g dalam sedimen Sungai Cibeureum dekat PLTA Cijedil, Cugenang -Jawa Barat dan meningkat sebesar 6.95 ng/g pada tahun 2012 di lokasi yang sama. Masih pada tahun 2011, p,p\u27-DDT dan p,p\u27-DDE ditemukan tertinggi di tanah perkebunan Desa Sindang Jaya, Cipanas – Jawa Barat sebesar 446 ng/g, dan 184 ng/g, Tahun 2012 dan 2013 DDT dan turunannya masih terdeteksi namun konsentrasi cenderung menurun. Sementara itu pada sampel air tidak ditemukan senyawa DDT dan turunanny

ANALYSING THE EXTENT OF VOCATIONAL BURNOUT PORT EMPLOYEES SUFFER FROM: A CASE STUDY AT SEAPORTS

Mesleki tükenmişlik, ağır iş yükü ve iş kaynaklı ağır zihinsel zorlanmalarda ortaya çıkabilen ruhsal bir hastalık olarak tanımlanmaktadır. Başka bir deyişle, meslek sebepli ruhsal ve fiziksel olarak bitme durumu şeklinde ifade edilmektedir. Mevcut yazın incelendiğinde, mesleki tükenmişlik konusunun birçok meslek grubunda irdelenmiş olduğu görülmektedir. Günümüzde artan ticaret hacminin denizyolu taşımacılığına yansımaları sebebiyle limanlardaki yoğunluk her geçen gün artmaktadır. Limanları mesleki kariyer alanları olarak seçen liman çalışanlarının bu yoğun tempodaki çalışma şartları her geçen gün daha da ağırlaşmaktadır. Bu sebeplerden dolayı, çalışmanın örneklemi bir liman işletmesinin çalışanları olarak seçilmiştir. Bu çalışmanın amacı, zorlu bir meslek olduğu tespit edilmiş limancılık mesleği çalışanlarının mesleki olarak tükenmişlik seviyelerini, en yaygın tükenmişlik envanterlerinden biri olan "Maslach Tükenmişlik Envanteri" (Maslach Burnout Inventory) yardımıyla saptamaktır. Bu çalışmada tükenmişlik seviyeleri, hem liman çalışanlarının demografik durumları ile ilişkilendirilmiş hem de mesleki kariyerlerine etkileri araştırılmıştır. Vocational burnout is defined as a psychological malady, or disease, likely to stem from certain pressure on mind as well as tough and stressful working conditions. In other words, it is thought to get exhausted both physically and psychologically mainly due to vocational (professional) environments. A relevant literature review reveals that vocational fatigue or burnout has been studied for various vocational groups. The ever growing trade volume has recently affected the growth of seaborne trade and thus shipping, which in turn has increased the work density at seaports. Hence, the working conditions at seaports, for those who have chosen to work at ports as their career, have become tougher and tougher. That's why the population sample for this study has constituted the employees of a seaport. The purpose of this research is to analyze the extent (level) of vocational fatigue seaport employees suffer from. For this analysis, "Maslach Burnout Inventory", one of the most prevalent fatigue-related inventories, has been used. In this research, the extents/levels of fatigue have been interrelated with the demographic data concerning the seaport employees, and the effect of the fatigue levels on vocational careers has been scrutinized

Yeşim Yılmaz

Töz problemi Antik Çağ’dan bu yana farklı adlandırmalar, farklı yorumlamalar şeklinde tartışılmaktadır. Bu çalışma, modern felsefenin kurucularından ve rasyonalist düşünürler olan René Descartes’ın epistemolojisinde ve Benedictus Spinoza’nın ontolojisinde oldukça ciddi bir öneme sahip olan töz kavramının neye karşılık geldiğini ve ortaya çıkardığı temel problemleri ele almaktadır. Descartes’ın birden fazla tözün olabileceği fikri ile düalist bir töz anlayışı geliştirdiği yerde, Spinoza Descartes’a bir eleştiri olarak tek bir tözün kabulüne dayalı monist bir töz anlayışı geliştirmiştir. Doğal olarak bu çalışma töz kavramına tarihsel bir çerçeve çizerek, Descartes’ın ruh-beden düalizmine dayanan töz anlayışı ile Spinoza’nın Tanrı temelli töz anlayışını karşılaştırmayı amaçlamaktadır