The energy based devices for vaginal "rejuvenation," urinary incontinence, vaginal cosmetic procedures, and other vulvo-vaginal disorders: An international multidisciplinary expert panel opinion

Aims: Energy-based devices using radiofrequency and laser technologies have gained popularity as therapies for vaginal atrophy, urinary incontinence, and vaginal prolapse. They have been promoted by cosmetic and aesthetic industries for vaginal "laxity" and vaginal "rejuvenation," both of which are undefined conditions and terms. This article aims to review the current available literature and its quality on this emerging technology. Methods: An international panel of gynaecologists, urogynaecologists, and urologists undertook a review of the available published literature, identifying articles, guidance, and society statements on the use vaginal energy-based devices. Results: There is currently no formal guidance for the use of vaginal energy based therapies. No randomized controlled trials have been published. No comparative studies to existing treatment has been carried out. Studies suggest that vaginal laser can be used in the treatment of vaginal prolapse or "vaginal laxity" and stress urinary incontinence with no quality evidence supporting the use of the therapy for vaginal atrophy or lichen sclerosis. Conclusions: This international group propose that whilst there remains a paucity of good quality data describing the safety, benefits, and appropriate use of vaginal radiofrequency or laser treatments in gynaecology and urogynaecology, a consensus best practice document by an established scientific community needs to be developed.info:eu-repo/semantics/publishedVersio

Germ line BRCA1 and BRCA2 gene mutations in Turkish breast cancer patients

Cataloged from PDF version of article.Germ line BRCA1 and/or BRCA2 mutations were screened in 50 Turkish breast and/or ovarian cancer patients composed of hereditary, familial, early onset and male cancer groups. Genomic DNA samples were tested by heteroduplex analysis and DNA sequencing. Two truncating BRCA2 mutations, one novel (6880 insG) and one previously reported (3034 delAAAC), were found in two out of six (33%) hereditary breast and/or ovarian cancer patients. A novel truncating (1200 insA) and a missense (2080A→G) BRCA1 mutation was found in two of 27 (7%) individuals in the early onset group. A total of four (8%) disease-causing mutations in 50 breast cancer patients were identified in BRCA1 and BRCA2 genes. In addition, five BRCA1 sequence variants have been identified in 23 patients. These results indicate that BRCA1 and BRCA2 genes are involved in some, but not all, forms of hereditary predisposition to breast cancer in the Turkish population. Copyright (C) 2000

The neurogenic bladder: medical treatment

Neurogenic bladder sphincter dysfunction (NBSD) can cause severe and irreversible renal damage and bladder-wall destruction years before incontinence becomes an issue. Therefore, the first step in adequate management is to recognize early the bladder at risk for upper- and lower-tract deterioration and to start adequate medical treatment proactively. Clean intermittent catheterization combined with anticholinergics (oral or intravesical) is the standard therapy for NBSD. Early institution of such treatment can prevent both renal damage and secondary bladder-wall changes, thereby potentially improving long-term outcomes. In children with severe side effects or with insufficient suppression of detrusor overactivity despite maximal dosage of oral oxybutynin, intravesical instillation is an effective alternative. Intravesical instillation eliminates systemic side effects by reducing the first-pass metabolism and, compared with oral oxybutynin, intravesical oxybutynin is a more potent and long-acting detrusor suppressor. There is growing evidence that with early adequate treatment, kidneys are saved and normal bladder growth can be achieved in children so they will no longer need surgical bladder augmentation to achieve safe urinary continence in adolescence and adulthood

Reservoir and hydrogeochemical characterizations of geothermal fields in Salihli, Turkey

Geothermal and hydrochemical characteristics of thermal waters in the Salihli geothermal area are described in this study. This geothermal area is geographically divided into five main groups; Kurşunlu, Caferbey, Greenhouse, üfürük and Sart geothermal fields. In the study area, the outlet temperatures of the thermal waters are between 30 and 90°C, their discharges are between 2 and 80l/s in springs and the depths of wells vary between 200 and 1189m. Hydrochemical analysis results suggest four different water types of Na-HCO 3, Ca-Mg-HCO 3, Ca-Na-HCO 3 and Ca-Mg-SO 4 in Kurşunlu, Caferbey-Greenhouse, Sart, and üfürük, respectively. Cold waters are mainly dominated by the HCO 3 and SO 4 anions and Na, Ca, and Mg cations.Results of environmental isotope and chemical analysis show that the thermal waters are of meteoric origin and the major hydrogeochemical processes show that the thermal waters may be mixing of their end members and/or water-rock interaction at high temperature conditions. The mixed thermal waters are replenished by rainwater and/or groundwater at various depths. EC-tritium and EC-chloride plots indicated shallow and deep circulating groundwater types in the study area. Assessment of the various empirical chemical geothermometers and geochemical modelling suggests that the aquifer temperature in the study area is about 160. °C.The thermal waters are mostly supersaturated with respect to carbonate minerals (calcite, aragonite, and dolomite) at all temperatures. These are likely to cause scaling problems during production and utilization of thermal water. © 2012 Elsevier Ltd