Jinekolojik muayene öncesinde Türk kadınların anksiyete seviyeleri ve muayeneye ilişkin tutumlarının belirlenmesi

Objective: This study was planned with the purpose determination of attitudes with gynecologic examination and anxiety of Turkish women before gynecologic examination.Material & Methods: The sample of this descriptive and cross-sectional constituted by 240 women, applying for gynecologic examination in Gynecologic Policlinic of Ordu Maternity-Gynecologic and Child Hospital of who accepted to participate in the research. The data were collected with of a questionnarie form and  State Anxiety Inventory. This study was made between the dates of 4 April- 30 May 2006. In the analysis of data, frequency, percentage, standart deviation, arithmetic mean, Kruskal wallis test, t test, ANOVA varience analysis, Mann –Whitney  U test and Chi square test were used.Results: In the research, it was determined that the state axiety average point of women is 43.85±5,41. It was been that level anxiety of women before gynecologic examination was “middle level anxiety”. It was found that there is a significant between state anxiety inventory points according to the job  and gynecologic examination experience of women order in the family with state anxiety (P=,000). Doctor’s knowledge and capability (63,8%), doctor’s knowledge giving (44,6%) and doctor’s complaisant (41,7%) were important in women’ doctor preferring for gynecologic examination.  It was found that 37,5% of the women desired only doctor and 37,1% of the women desired their husband during gynecologic examination. It was determined that women felt uncomfortable because of nakedness genital organs of them (67,1%) and negatif communication between doctor and women (39,6%) in previously gynecologic examination. Women perceived feelings as embarrassment (62,5%), distress (38,8%), fear (37,9%), pain (21,7%) during gynecologic examination. Expectations  of women from health professionals during gynecologic examination were complaisant (45,0%),  interest  (28,3%), perceptiveness (24,2%).Conclusion: This study provides information about attitudes with gynecologic examination and anxiety levels of women before gynecologic examination that may inform health personnel’ practices and also for future research.Amaç: Bu araştırma, jinekolojik muayene öncesinde Türk kadınların anksiyete seviyeleri ve muayeneye ilişkin tutumlarının belirlenmesi amacıyla planlanmıştır. Yöntem: Tanımlayıcı ve kesitsel tipte olan araştırmanın örneklemine Jinekoloji polikliniğine muayene olmak üzere başvuran ve araştırmaya katılmayı kabul eden 240 kadın alınmıştır. Araştırma  4 Nisan 2006-30 Mayıs 2006 tarihleri arasında yapılmıştır. Araştırmanın verileri soru formu ve durumluk anksiyete ölçeği ile toplanmıştır. Verilerin analizi, sıklık, yüzde, aritmetik ortalama, standart sapma, Kruskal-Wallis testi, t- testi, ANOVA varyans analizi, Mann Whitney - U testi, Chi-square  testi ile yapılmıştır.Bulgular: Jinekolojik muayene öncesi kadınların durumluk anksiyete puan ortalamaları 43.85±5,41’dir. Kadınların jinekolojik muayene öncesinde “orta düzeyde anksiyete” yaşadıkları belirlenmiştir. Kadınların %18,3’ünün daha önce hiç muayene olmadığı, %66,3’ünün  ise 1-5 kez muayene olduğu belirlenmiştir. Yaşanan anksiyetede, etkili faktörlerin kadınların mesleği (P=,000) ve jinekolojik muayene olma sayısı (P=,000) olduğu belirlenmiştir. Kadınların jinekolojik muayene olacağı doktoru tercih etmesinde, doktorun bilgili ve yetenekli olması (%63,8), bilgi vermesi (%44,6) ve güler yüzlü olması (%41,7) öncelikle aranan özelliklerdir. Jinekolojik muayene esnasında kadınların %37,5’i doktordan başka kimseyi yanında istemezken, %37,1’i eşinin olmasını istemektedir. Daha önceki jinekolojik muayenelerinde, kadınların % 67,1’i mahrem organını göstermenin ve %39,6’sı doktorun yaklaşımının rahatsızlık verdiğini, % 62,5’i utanma, % 38,8’i sıkıntı, %37,9’u korku, %21,7’si ağrı yaşadığını ifade etmiştir. Jinekolojik muayene sırasında kadınların sağlık personelinden beklentileri, güler yüz (%45,0), ilgi (%28,3) ve anlayış (%24,2)’tır.Sonuç: Bu çalışma, kadınların jinekolojik muayenede anksiyete ve muayeneye ilişkin tutumları hakkında sağlık personelinin uygulamalarına ve gelecekteki araştırmalara bilgi sağlar

Laparoscopic treatment of splenic lymphangiomas: report of three cases

Background and aim. Since 1991, laparoscopic splenectomy has been performed in many different pathologies of the spleen. Although it is a rare lesion, splenic lymphagiomas are cystic lesions of the spleen requiring splenectomy. Herein, we present three females who have undergone laparoscopic splenectomy with the diagnosis of cystic splenic lymphangioma. Patients and methods. In the last four years, in Istanbul Medical School, Department of General Surgery (Turkey) and in University of Catania Medical School, Department of Surgery (Italy), we performed laparoscopic splenectomy in three cases of splenic lymphangioma. Results. These three female patients, with the age of 26, 30 and 40, had nonspecific abdominal pain requiring abdominal CT scan and magnetic resonance imaging, which showed incidental cystic lesions in the spleen, associated with cholelithiasis in one case. Preoperative laboratory tests and physical examinations were normal. Laparoscopic splenectomy was performed successfully with three 10 mm trocars in two patients in less than 1 hour, and with an Hasson trocar, two 5 mm trocars and one 10-12 mm trocar in the last case, who required simultaneous cholecystectomy. No peroperative and postoperative complications has occurred. Histopathological examinations confirmed the preoperative diagnosis. Conclusion. Laparoscopic splenectomy is the best treatment for patients with suspected cystic lymphangioma. It permits a total pathological examination of the spleen, and it should be preferred to partial splenectomy because of possible multiple lesions. In conclusion, minimal invasive treatment of this rare pathology is an effective and safe procedur

NEUROENDOCRINE DIFFERENTIATED BREAST CARCINOMA: A CASE REPORT

Neuroendocrine tumors are rarely seen in the breast. They are commonly located in the gastrointestinal tract and the lungs. These tumors of the breast may be purely neuroendocrine or neuroendocrine diff erentiated. Some breast tumors may have neuroendocrine foci. The clinical significance of these tumors are unclear. However, they are thought to have no relation with the prognosis and patient outcome. This is the report of a patient with neuroendocrine diff erentiated invasive breast carcinoma treated surgically in the classical manner

Lithium-associated primary hyperparathyroidism complicated by nephrogenic diabetes insipidus

Lithium-associated hyperparathyroidism is the leading cause of hypercalcemia in lithium-treated patients. Lithium may lead to exacerbation of pre-existing primary hyperparathyroidism or cause an increased set-point of calcium for parathyroid hormone suppression, leading to parathyroid hyperplasia. Lithium may cause renal tubular concentration defects directly by the development of nephrogenic diabetes insipidus or indirectly by the effects of hypercalcemia. In this study, we present a female patient on long-term lithium treatment who was evaluated for hypercalcemia. Preoperative imaging studies indicated parathyroid adenoma and multinodular goiter. Parathyroidectomy and thyroidectomy were planned. During the postoperative course, prolonged intubation was necessary because of agitation and delirium. During this period, polyuria, severe dehydration, and hypernatremia developed, which responded to controlled hypotonic fluid infusions and was unresponsive to parenteral desmopressin. A diagnosis of nephrogenic diabetes insipidus was apparent. A parathyroid adenoma and multifocal papillary thyroid cancer were detected on histopathological examination. It was thought that nephrogenic diabetes insipidus was masked by hypercalcemia preoperatively. A patient on lithium treatment should be carefully followed up during or after surgery to prevent life-threatening complications of previously unrecognized nephrogenic diabetes insipidus, and the possibility of renal concentrating defects on long-term lithium use should be sought, particularly in patients with impaired consciousness