Stres Üriner Inkontinansi Olan Kadinlarda Suburetral Doku Elastikiyetinin Değerlendirilmesinde Elastosonografinin Yeri

Amaç: Stres Üriner İnkontinansı (SÜİ) olan kadın hastalarda Elastosonografinin (ES) klinik ve diagnostik deerini saptamak. Gereç ve yöntemler: SÜİ tanısı olan 30 kadın ve şikayeti olmayan 30 kadın hastanın ES tetkikindeki suburetral doku elastikiyetleri karşılaştırıldı. Ped testi, Q-tip ve stres testleriyle SÜİ ve mesane boynunun hipermobilitesi teşhis edildi. ES tetkikinde mesane altı (MA) ve cilt altı (CA) dokular ile üretra (Ü) ölçüm alanları olarak deerlendirildi. MAĞCA,ÜĞCA ve MAĞÜ oranları hesaplandı. ES esnasında elde edilen bu oranların tanısal deeri ROC curve analizi ile incelendi. Bulgular: MAĞCA (AUC0.962, P0.001) ve ÜĞCA (AUC0.953, P0.001) stres test pozitişii için anlamlı prediktördür. MAĞCA (AUC0.883, P0.001) ve ÜĞCA (AUC0.885, P0.001) Ped testi için anlamlı prediktördür. MAĞCA (AUC0.877, P0.001) ve ÜĞCA (AUC0.857, P0.001) Q tip test pozitişii için anlamlı prediktördür. Lineer regresyon analizinde Stres test pozitişii MAĞCA (R20.84, beta0.369, P0.026) ve ÜĞCA (R20.84, beta0.496, P0.003) ile istatistiksel olarak anlamlı birliktelik göstermektedir. Sonuç: ES ile doku elastikiyetinin karakterizasyonu, SÜİ ve mesane boynu hipermobilitesinin teşhisinde umut verici bir teknik olup, SÜİ cerrahisi için hasta seçiminde ek metot olarak kullanılabilir.Objective: To determine clinical and diagnostic value of elastosonography (ES) in women with stress urinary incontinence (SUI). Material and methods: Thirty subjects with SUI and 30 subjects without SUI were compared in terms of elastosonographic suburethral tissue elasticity. SUI and bladder neck hypermobility was determined by pad test, Q-tip and stress tests. Measurements points included under bladder (UB), subcutaneous fatty tissue (SC), and the urethra (U) points. Three indices were calculated using these measurements (UB/SC, U/SC and UB/U). The diagnostic value of ES indices were investigated using receiver operating characteristic (ROC) curve analyses. Results: ES UB/SC (AUC0.962, P0.001) and U/SC (AUC0.953, P0.001) were significant predictors for stress test positivity. ES UB/SC (AUC0.883, P0.001) and U/SC (AUC0.885, P0.001) were significant predictors for pad test positivity. ES UB/SC (AUC0.877, P0.001) and U/SC (AUC0.857, P0.001) were significant predictors for Q tip test positivity. In linear regression analysis, stress test positivity was significantly associated with the ES UB/SC (R20.84, beta0.369, P0.026) and ES U/SC (R20.84, beta0.496, P0.003). Conclusion: Elastosonographic tissue elasticity determination is a promising tool in bladder neck hypermobility and SUI diagnosis, and may be used as an adjunctive method in selecting patients appropriate for stress urinary incontinence surgery

Intraoperative cardiac arrest during radical vulvectomy under combined spinal-epidural anesthesia: First among 2500 malignant cases in a single center

Abstract Complications which were related either to radical vulvectomy or to lymphadenectomy have mostly developed in post operative period. Here, we report an intra-operative cardiac arrest case during radical vulvectomy which is under combined spinal and epidural anesthesia. A 78 year-old female patient underwent radical vulvectomy under spinal anesthesia with a diagnosis of vulvar cancer. Intraoperative cardiac arrest developed and after immediate cardio-pulmonary ressusitation, sinus rhythm was restored. Cardiac arrest due to spinal anesthesia is a rare complication with the incidence of 0.063%. Despite, vulvar surgery is known as a relatively safe procedure for complications like cardiac arrest, maximum care should be given both before and during the operation. It can be descriced as "once in a life" experience for a surgeon and instant decisions for the management of this condition will be life saving or mortal

Alternative tumor markers in the diagnosis of ovarian cancer

Objective: The aim of the study was to assess the usefulness of various tumor markers (CA125, HE4, bcl2) measured in serum, urine and saliva in the differential diagnosis of adnexal masses. Material and methods: Our study was conducted at the Baskent University Medical School, Department of Obstetrics and Gynecology, Ankara, Turkey, between November 2010 and March 2011. Fifty patients with a suspicion of malignant adnexal mass and 30 controls were included in the study. Serum and urine CA-125, HE4, and bcl2 levels were evaluated for their role in the diagnosis of epithelial ovarian cancer (EOC). Results: Serum CA-125 and HE4 levels, and urine HE4 levels were significantly higher in malignant cases as compared to controls (p 0.05). Conclusions: We demonstrated that serum CA125, serum HE4 and urine HE4 levels were elevated in patients with ovarian cancer. These findings should be assessed in future studies with larger sample sizes in order to reach more definite conclusions