Porównanie urazu tkanek podczas brzusznej, pochwowej i laparoskopowej histerektomii

Objective: The aim of the study was to compare the extent of tissue trauma after abdominal hysterectomy(AH), vaginal hysterectomy (VH), and total laparoscopic hysterectomy (TLH) using biochemical markers. Material and methods: Seventy-one patients requiring hysterectomy for benign uterine diseases were enrolled in the study and divided into three treatment groups: AH (n=24), VH (n=23), and TLH (n=24). Blood samples for assay of interleukin-6 (IL-6) and creatine phosphokinase (CPK) were collected pre-, intra-operatively, and 2, 6 and 24 h after surgery. Results: Serum levels of IL-6, and CPK were significantly elevated over basal values after surgery in all groups. IL-6 and CPK levels were significantly higher after AH as compared to VH and TLH. IL-6 concentrations were significantly higher in the VH group than the TLH group (p=0.001). There were no significant differences in CPK levels between the VH and TLH groups (p=0.824). TLH group had the smallest decrease in blood hemoglobin concentration and the shortest hospital stay. Conclusions: AH causes more tissue trauma as compared to VH and TLH. Owing to the fact that TLH is associated with less tissue trauma and offers significant clinical benefits, including less blood loss and shorter hospital stay, it should be considered in women with benign gynecologic conditions, especially in experienced centers.Cel pracy: Celem badania było porównanie rozległości urazu tkanek podczas brzusznej histerektomii (AH), pochwowej (VH) i laparoskopowej (TLH) przy pomocy biochemicznych markerów. Materiał i metoda: Do badania włączono siedemdziesiąt jeden pacjentek wymagających usunięcia macicy z powodu niezłośliwej patologii, które podzielono na trzy grupy badane: AH (n=24), VH (n=23), i TLH (n=24). Próbki krwi do badania w kierunku interleukiny 6 i kinazy fosfokreatynowej (CPK) pobierano przed-, podczas operacji, I 2,6 oraz 24 godziny po zabiegu. Wyniki: Poziom Il-6 i CPK w surowicy po operacji był istotnie podwyższony w porównaniu do poziomu wyjściowego we wszystkich grupach badanych. Poziom IL-6 i CPK były istotnie wyższe po AH niż po VH i TLH. Stężenie IL-6 było istotnie wyższe w grupie VH niż w grupie TLH (p=0.001). Nie stwierdzono istotnych różnic w poziomie CPK pomiędzy grupą VH i TLH (p=0.824). W grupie TLH odnotowano najmniejszy spadek hemoglobin I najkrótszy pobyt w szpitalu. Wnioski: AH powoduje większy uraz tkanek niż VH i TLH. Dzięki temu, że TLH jest związane z mniejszym urazem tkanek i daje istotne klinicznie korzyści, między innymi mniejszą utratę krwi i krótszy pobyt w szpitalu, powinno być rozważane u kobiet z niezłośliwą patologią, zwłaszcza w doświadczonych ośrodkach

The efficacy of preopoerative instruction in reducing anxiety following gyneoncological surgery: a case control study

<p>Abstract</p> <p>Background</p> <p>This is a quasi-experimental case control research focusing on the impact of systematic preoperative instruction on the level of postoperative anxiety in gyneoncologic patients. The population studied consists of the gyneoncologic surgery patients admitted to the Gynecologic Oncology Service at Zekai Tahir Burak Gynecology Training and Research Hospital from May to September 2010.</p> <p>Patients and methods</p> <p>Through a random sampling, 60 patients were recruited in each group. The study group was given a systematic preoperative instruction while the control group was given routine nursing care. Patients were interviewed in the postoperative period and anxiety was measured. The data-collecting tool consisted of the Individual Information Form and the State-Trait Anxiety Inventory. The collected data were analyzed by using the SPSS Program to find the frequency, the percentage, the mean and the standard variables, and the hypothesis was tested with Chi-square, variance, and t-independent test.</p> <p>Results</p> <p>It was found that the incidence rates from the post-operative anxiety score of the study group were lower than those of the control group (p < .05). The results of this research demonstrated that gyneoncologic surgery patients who were given systematic preoperative instruction felt less anxious than the ones who were given merely a routine nursing care.</p> <p>Conclusions</p> <p>Results of this study suggest that preoperative instruction programs aiming at informing gyneoncologic surgery patients at the preoperative stage should be organized in hospitals and have an essential role.</p

Hematopoietic Cell Transplantation Cures Adenosine Deaminase 2 Deficiency : Report on 30 Patients

Correction; Early Access: ' DOI: 10.1007/s10875-022-01280-y Early Access: APR 2022Purpose Deficiency of adenosine deaminase 2 (DADA2) is an inherited inborn error of immunity, characterized by autoinflammation (recurrent fever), vasculopathy (livedo racemosa, polyarteritis nodosa, lacunar ischemic strokes, and intracranial hemorrhages), immunodeficiency, lymphoproliferation, immune cytopenias, and bone marrow failure (BMF). Tumor necrosis factor (TNF-alpha) blockade is the treatment of choice for the vasculopathy, but often fails to reverse refractory cytopenia. We aimed to study the outcome of hematopoietic cell transplantation (HCT) in patients with DADA2. Methods We conducted a retrospective study on the outcome of HCT in patients with DADA2. The primary outcome was overall survival (OS). Results Thirty DADA2 patients from 12 countries received a total of 38 HCTs. The indications for HCT were BMF, immune cytopenia, malignancy, or immunodeficiency. Median age at HCT was 9 years (range: 2-28 years). The conditioning regimens for the final transplants were myeloablative (n = 20), reduced intensity (n = 8), or non-myeloablative (n = 2). Donors were HLA-matched related (n = 4), HLA-matched unrelated (n = 16), HLA-haploidentical (n = 2), or HLA-mismatched unrelated (n = 8). After a median follow-up of 2 years (range: 0.5-16 years), 2-year OS was 97%, and 2-year GvHD-free relapse-free survival was 73%. The hematological and immunological phenotypes resolved, and there were no new vascular events. Plasma ADA2 enzyme activity normalized in 16/17 patients tested. Six patients required more than one HCT. Conclusion HCT was an effective treatment for DADA2, successfully reversing the refractory cytopenia, as well as the vasculopathy and immunodeficiency. Clinical Implications HCT is a definitive cure for DADA2 with > 95% survival.Peer reviewe

Outcome of hematopoietic cell transplantation for DNA double-strand break repair disorders

Background: Rare DNA breakage repair disorders predispose to infection and lymphoreticular malignancies. Hematopoietic cell transplantation (HCT) is curative, but coadministered chemotherapy or radiotherapy is damaging because of systemic radiosensitivity. We collected HCT outcome data for Nijmegen breakage syndrome, DNA ligase IV deficiency, Cernunnos-XRCC4-like factor (Cernunnos-XLF) deficiency, and ataxia-telangiectasia (AT). Methods: Data from 38 centers worldwide, including indication, donor, conditioning regimen, graft-versus-host disease, and outcome, were analyzed. Conditioning was classified as myeloablative conditioning (MAC) if it contained radiotherapy or alkylators and reduced-intensity conditioning (RIC) if no alkylators and/or 150 mg/m(2) fludarabine or less and 40 mg/kg cyclophosphamide or less were used. Results: Fifty-five new, 14 updated, and 18 previously published patients were analyzed. Median age at HCT was 48 months (range, 1.5-552 months). Twenty-nine patients underwent transplantation for infection, 21 had malignancy, 13 had bone marrow failure, 13 received pre-emptive transplantation, 5 had multiple indications, and 6 had no information. Twenty-two received MAC, 59 received RIC, and 4 were infused; information was unavailable for 2 patients. Seventy-three of 77 patients with DNA ligase IV deficiency, Cernunnos-XLF deficiency, or Nijmegen breakage syndrome received conditioning. Survival was 53 (69%) of 77 and was worse for those receiving MAC than for those receiving RIC (P=.006). Most deaths occurred early after transplantation, suggesting poor tolerance of conditioning. Survival in patients with AT was 25%. Forty-one (49%) of 83 patients experienced acute GvHD, which was less frequent in those receiving RIC compared with those receiving MAC (26/56 [46%] vs 12/21 [57%], P=.45). Median follow-up was 35 months (range, 2-168 months). No secondary malignancies were reported during 15 years of follow-up. Growth and developmental delay remained after HCT; immune-mediated complications resolved. Conclusion: RIC HCT resolves DNA repair disorder associated immunodeficiency. Long-term follow-up is required for secondary malignancy surveillance. Routine HCT for AT is not recommended.Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Prolonged Pediatric Extracorporeal Membrane Oxygenation Support with Cardiopulmonary Failure in Juvenile Myelomonocytic Leukemia

We report a case of a child survival after extracorporeal membrane oxygenation (ECMO) support of 25 days for cardiopulmonary failure and septic shock in the context of juvenile myelomonocytic leukemia (JMML). ECMO support is still a matter of debate for the management of septic patients with malignancy. However, these patients are at increased risk for early death secondary to pulmonary complications due to leukostasis, direct pulmonary infiltration with WBC, and systemic inflammatory response syndrome following malignant cell lysis. Despite the high risk of complications, ECMO support must be discussed as part of management, providing better outcome in this group of patients

Abdominal Sarcoidosis May Mimic Peritoneal Carcinomatosis

Sarcoidosis is a multisystem inflammatory disorder of unknown etiology. It shows a great variety of clinical presentation, organ involvement, and disease progression. Lungs and lymphoid system are the most common sites involved with a frequency of 90% and 30%, respectively. Extrapulmonary involvement of sarcoidosis is reported in 30% of patients and abdomen is the most frequent site. Furthermore, peritoneal involvement is extremely rare in sarcoidosis. The case presented here described peritoneal manifestations of sarcoidosis without involvement of lungs. A 78-year-old woman possessing signs of malignancy on blood test and abdominal magnetic resonance imaging underwent laparatomy with a suspicion of ovarian malignancy. The macroscopic interpretation during surgery was peritoneal carcinomatosis. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal biopsies, total omentectomy, and appendectomy were performed. Final histopathological result revealed the diagnosis of sarcoidosis. Clinicians must keep in mind that peritoneal sarcoidosis can mimic intra-abdominal malignancies

Targeted Agents in Ovarian Carcinoma

Gynecologic malignancies take an important part in female cancers. Ovarian cancer is the second most common gynecologic cancer with the highest mortality rate in developed countries. Most of the patients need an adjuvant chemotherapy regimen after the initial surgery. Despite their suppressive effect on tumor cells, much toxicity on healthy cells could be seen with these standard chemotherapeutics. In that manner a new way of tumor cell disruption with less toxicity and cancer selective effect is needed, which is called targeted therapy. Moreover this approach could prevent chemo-resistance and increase chemo-sensitivity of the disease. Primary cytoreductive surgery with platinum based chemotherapy shape the initial management of these tumors. However, recently we are on the edge of molecular therapy for this cancer. In this setting we need to identify a dominant biological pathway for tumor progression and discover a functional and structural molecule within this pathway. The new therapeutic modalities with targeted molecules should build up new perspectives insight tumor cell behaviour. Agents against angiogenesis and receptors of growth factors in addition to signalling cascades and intracellular enzymes could shape the individual treatment protocols for cancer survivors. [Med-Science 2016; 5(2.000): 547-61

Case Report Abdominal Sarcoidosis May Mimic Peritoneal Carcinomatosis

Sarcoidosis is a multisystem inflammatory disorder of unknown etiology. It shows a great variety of clinical presentation, organ involvement, and disease progression. Lungs and lymphoid system are the most common sites involved with a frequency of 90% and 30%, respectively. Extrapulmonary involvement of sarcoidosis is reported in 30% of patients and abdomen is the most frequent site. Furthermore, peritoneal involvement is extremely rare in sarcoidosis. The case presented here described peritoneal manifestations of sarcoidosis without involvement of lungs. A 78-year-old woman possessing signs of malignancy on blood test and abdominal magnetic resonance imaging underwent laparatomy with a suspicion of ovarian malignancy. The macroscopic interpretation during surgery was peritoneal carcinomatosis. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal biopsies, total omentectomy, and appendectomy were performed. Final histopathological result revealed the diagnosis of sarcoidosis. Clinicians must keep in mind that peritoneal sarcoidosis can mimic intra-abdominal malignancies