The effect of lymph node metastasis on overall survival and disease-free survival in vulvar cancer patients

Objectives: To examine the effect of lymphadenectomy on survival in patients with squamous cell vulvar carcinoma.Material and methods: Patients with squamous cell vulvar cancer who underwent surgery were retrospectively analyzed.All procedures were performed according to current recommendations/standard of treatment. The clinical and pathologicalfeatures were examined. Sixty-eight patients were studied. The mean age was 64.7 ± 10.9 years. Twenty-three (33.8%)patients had nodal metastasis. Most patients (60.3%) were in stage IB. Adjuvant radiotherapy and chemo-radiotherapy wereadministered to 33.8% and 25% of the patients, respectively. The median follow-up time was 28.5 (4–183) months. Recurrenceoccurred in 18 (26.5%) cases.Results: There was no significant difference between node-positive and node-negative patients in terms of age, number ofdissected lymph nodes and recurrence. Tumor diameter was significantly higher in the metastatic group. Age and surgicalmargin positivity were independent prognostic factors for overall survival (OS). Surgical margin positivity and lymph nodemetastasis had no effect on disease-free survival (DFS).Conclusions: Our results showed that age and surgical margin positivity were independent prognostic factors for OS.Although surgical margin positivity increased the risk of recurrence in univariate analysis, it was not a significant factoraffecting DFS. OS was significantly lower in patients with lymph node metastasis

Volume CXIV, Number 4, November 7, 1996

Objective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population.Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014.Results: The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosis) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto's thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%.Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespa

Risk assessment in health services sector: Hospital central laboratory model

Tıpta Uzmanlık TeziSağlık hizmetleri sektörü; emek yoğun süreçleri içeren, birçok riskle karşılaşılabilinen, gün boyu kesintisiz sunulması gerekli hizmetler bütünüdür. Hastane merkez laboratuvarları da “Çok Tehlikeli” iş yeri sınıfındadır. Araştırmamızın amacı; mesleki risk ve tehlikelerin farkındalığını arttırmak, mevcut riskleri değerlendirerek sınıflandırmak, öncelikli sorunlara yönelik çözüm önerileri üreterek, risk değerlendirmesinin sağlık hizmetleri sektöründeki yerine vurgu yapıp akademik platformda tartışma imkanı sağlamaktır. Araştırma 15.12.2013 – 15.05.2014 tarihlerinde Trakya Üniversitesi Sağlık Uygulama ve Araştırma Merkezi Merkez Laboratuvarı birimleri ve çalışanlarında yapıldı. Araştırmanın evreni olan 28 birim ve 66 çalışanın tamamı araştırmaya dahil edildi. Çalışanlara özellik, bilgi ve farkındalıklarını sorgulayan anket uygulanmıştır. Riskleri değerlendirirken kontrol listesi kullanılmış ve gözlem yapılmıştır. Ayrıca ortamda ışık, gürültü, sıcaklık ve nem ölçümleri yapılmıştır. Elde edilen sonuçlarla, olasılık ve şiddetleri belirlenen riskler 5x5 L Tipi Matris yöntemiyle değerlendirildi. En sık karşılaşılan iş kazası delici kesici alet yaralanması (24 kez), çalışma ortamı kaynaklı en sık sağlık sorunu varis (7 kez)’tir. Çalışanların % 55,3’ü laboratuarın “Çok Tehlikeli” iş yeri sınıfına girdiğini bilmemektedir. Çalışanların çalışma ortamı tehlike ve risklerine karşı bilgi ve farkındalıkları düşüktür. Merkez laboratuvarda çeşitli birimlerde gürültü sonucu işitme kaybı ve kaza geçirme riski, yetersiz aydınlatma sonucu kaza riski, lokal vibrasyon sonucu hastalık riski, düşük termal neden olduğu risk, öfke stres gelişimi ve şiddet riski “Orta Risk”tir. Bazı birimlerde iyonize edici olmayan radyasyona bağlı risk, elektrik çarpması riski, patlama ve yangın riski, kimyasaldan toksik etkilenim riski, cilt teması ve havayoluyla enfeksiyon riski ve delici kesici alet yaralanması riski “Yüksek Risk”tir.AbstractHealth sector comprises intensive labor including lot of risks which should be dealt with continuously. As a workplace the central laboratory of the hospital is in “the most risky” group. The aim of our study is, to increase the awareness of occupational risks and hazards, to evaluate the current risks, produce solutions for the priority risks and facilitate to debate the risk evaluation in health services sector in academic platforms. The investigation conducted between 15.12.2013 and 15.05.2014 in Trakya University Hospital Central Laboratory Units and with employees working in these units. All of 28 units and 66 employees formed the study population. A questionnaire that showed socio-demographic characteristics, knowledge and awareness of employees implemented. Control lists and observations were used for evaluating risks. Light, heat, noise and humidity measurements were done in all units. Obtaining probability and severity of risks evaluated by L type 5x5 matrix technique. The most frequent occupational accident is penetrative and sharp equipment accidents (24 times), the most frequent occupational disease is varicose (7 times). 53 % of employees do not know that their workplace is in “the most risky” group. The awareness and knowledge of employees about workplace hazards and risks are low. In some units of Central Laboratory, hearing loss and accidental risks because of noise, because of inadequate enlightenment, because of ergonomic risks, disease risks because of vibration, heat or cold is in “moderate” risk category. In some units, there is ionizing radiation risk, electric shock risk, fire and eruption risk, chemical risks and infection risk is in “high” risk category

A Novel Constellation Modification Method for Harmonic Modulated MPSK Data Transmission in Millimeter Wave Communication

The size of the data transmitted in communication systems is constantly increasing and leads to the need for high bandwidth. Therefore, using the millimeter wave (mmWave) band is one of the best solutions in data transmission. Frequency multiplication via nonlinear components is used for signal generation at higher frequencies in the millimeter to submillimeter bands and it is of great importance in generating signals up to 2.2 THz. Although communication systems with the highest carrier frequency using these components are available at the 300 GHz-340 GHz, standard communication models do not comply with data transmission at this band, bringing problems caused by nonlinearity throughout data recovery. We solve these problems with the proposed constellation modification method, which has not been studied before. In this study, it is aimed to provide data transmission in the mmWave band with an experimental communication system that is compatible with the frequency multiplication and has high spectral efficiency. For the first time to our knowledge, a novel constellation modification method that can be modified according to the frequency multiplication on the standard M-ary phase shift keying (MPSK) data is proposed. In this method, the existing receiver structure is preserved and MPSK with harmonic modulation is carried. In the experimental demonstration part, harmonic binary shift keying (BPSK) data transmission via frequency multiplied 30 GHz transmitter was achieved with a power penalty of 2.3 dB, and this shows that MPSK data transmission over harmonic mmWave or submillimeter band sources is now possible