A systematic review of outcome and outcome-measure reporting in randomised trials evaluating surgical interventions for anterior-compartment vaginal prolapse: a call to action to develop a core outcome set

INTRODUCTION: We assessed outcome and outcome-measure reporting in randomised controlled trials evaluating surgical interventions for anterior-compartment vaginal prolapse and explored the relationships between outcome reporting quality with journal impact factor, year of publication, and methodological quality. METHODS: We searched the bibliographical databases from inception to October 2017. Two researchers independently selected studies and assessed study characteristics, methodological quality (Jadad criteria; range 1-5), and outcome reporting quality Management of Otitis Media with Effusion in Cleft Palate (MOMENT) criteria; range 1-6], and extracted relevant data. We used a multivariate linear regression to assess associations between outcome reporting quality and other variables. RESULTS: Eighty publications reporting data from 10,924 participants were included. Seventeen different surgical interventions were evaluated. One hundred different outcomes and 112 outcome measures were reported. Outcomes were inconsistently reported across trials; for example, 43 trials reported anatomical treatment success rates (12 outcome measures), 25 trials reported quality of life (15 outcome measures) and eight trials reported postoperative pain (seven outcome measures). Multivariate linear regression demonstrated a relationship between outcome reporting quality with methodological quality (β = 0.412; P = 0.018). No relationship was demonstrated between outcome reporting quality with impact factor (β = 0.078; P = 0.306), year of publication (β = 0.149; P = 0.295), study size (β = 0.008; P = 0.961) and commercial funding (β = -0.013; P = 0.918). CONCLUSIONS: Anterior-compartment vaginal prolapse trials report many different outcomes and outcome measures and often neglect to report important safety outcomes. Developing, disseminating and implementing a core outcome set will help address these issues

Pregnancy Outcome in Women with Familial Mediterranean Fever: A Retrospective Analysis of 50 Cases with A 10-Year Experience

Objectives: Since little is known about perinatal outcome of patients with familial Mediterranean fever (FMF), we report our clinical experience about pregnant women with FMF in this study. Patients and methods: Fifty pregnant women (mean age 29.5 years; range 19 to 39 years) with FMF were enrolled between January 2002 and December 2012. Patient data were collected from computerized database. Clinical characteristics including demographics, pregnancy outcome, maternal and fetal complications during pregnancy or delivery, hypercoagulation disorders and colchicine use were recorded. Labor patterns and perinatal outcomes were assessed. Results: The mean gestational week at delivery was 36.3. Maternal complications were encountered in two patients including hemodialysis associated sepsis and cerebrovascular accident. We did not encounter FMF attacks in the course of pregnancies. A total of 42 patients (84%) were on drug therapy of colchicine. Two congenital anomalies were encountered, one was tanatrophic dysplasia (on colchicine therapy) and the other was an open type neural tube defect (not on colchicine therapy). Patients were also searched for thrombophilias and 15 (30%) had positive test result. The course of the pregnancy was free of venous complications with low molecular weight heparin prophylaxis. Preterm delivery, low birth weight and congenital anomalies were not significantly associated with colchicine therapy. Conclusion: A favorable pregnancy and perinatal outcome may be expected in patients with FMF treated with colchicine. However, close follow-up with prenatal test and laboratory investigations for maternal and fetal well-being including hypercoagulation disorders are thought to be essential.Wo

Vaginoperineal Fistula As A Complication Of Perianal Surgery In A Patient With Sjögren’S Syndrome: A Case Report

Forty-seven-year-old woman with Sjögren’s syndrome had been operated on because of transsphincteric perianal fistula secondary to perianal abscess. Vaginal wall injury occurred during the course of the operation and injured tissue was repaired primarily. Three months later, patient suffered from the recurrence of perianal fistula symptoms and fistulectomy was performed once again under antibiotic suppression. Several months later, perineal discharge continued, and, therefore, patient was admitted to the hospital for the third time and a fistulotomy was performed. Two months after the third operation, patient was admitted with leukorrhea and a perineovaginal fistula was detected. This time, not only her surgical problem but also her immune system disorder was considered in the preoperative workup. Then, patient was hospitalized for the fourth time and “fistulectomy/perineoplasty” was performed successfully. We believe that patients with autoimmune disorders with or without medical treatment may have healing problems during the course of surgical processes and therefore such medical problems must be taken into consideration by the surgeons.PubMe

İki Farklı Semptom ve Malignensi Riski ile Yansıyan Hipertekozis: İki Vaka Sunumu

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Myomectomy During Cesarean Section And Adhesion Formation As A Long-Term Postoperative Complication

Objectives: We aimed to evaluate the incidence and features of postoperative adhesion related complications occurring following myolysis or myomectomy performed during cesarean section (C/S). Methods: This cross-sectional study consists of four groups of patients who underwent C/S: group I; myolysis is performed by electric cauterization for small superficial fibroids less than 2 cm. (n: 21), group II; myomectomy is performed for pedunculated fibroids (n; 18), group III; myomectomy is performed for intramural/subserous fibroids less than 5 cm. (n: 23), group IV; control group (n; 19) who did not go through myomectomy. Repeat C/S is performed to study subjects within 1-5 years. All cases are evaluated in terms of mild to moderate adhesions between omentum and uterus, mild to moderate adnexial area adhesions, mild to moderate incision area adhesions and surgical difficulty due to severe adhesions. Results: The incidence of adhesions of omentum and uterus (p= 0.278), mild to moderate adnexial area adhesions (p= 0.831), mild to moderate incision area adhesions (p= 0.804) were similar between the intervention groups (group I, II, and III) and the controls (group IV). Conclusion: Cesarean myomectomy is a safe procedure and can be performed without significant postoperative adhesion formation.WoSScopu