IS LAPAROSCOPY RELIABLE FOR THE TREATMENT OF PATIENTS WITH ADNEXIAL MASSES

Amaç: Adneksiyal kitle nedeni ile laparoskopik girişim uygulanan hastaların sosyodemografikve klinik özelliklerinin değerlendirilmesiGereç ve yöntem: Ocak 2002-Ocak 2007 arasında adneksiyal kitle nedeni ile laparoskopikişlem uygulanan hastaların dosyaları retrospektif olarak incelendi. Demografikve klinik bilgiler hasta kayıtlarından elde edildi.Bulgular: Çalışmaya 14 ile 76 yaş arasında 186 hasta alındı. Hastalarda ortalamayaş 34,0 ± 11,2 idi. Hastaların %88,2'si premenapozal dönemdeydi. Ortalama hastanedeyatış süresi 3,27 ± 2,09 gün olarak saptandı. Olguların %64,6'sına laparoskopikkistektomi, %33,7'sine laparoskopik ooferektomi, %1,7'sine laparoskopik histerektomi+ salpingo-ooferektomi prosedürü uygulandı. Major komplikasyon oranı %2,7 (n=5)olarak bulundu. Laparotomiye geçiş oranı %7,0 (n=13) olarak bulundu. Hastaların %49,4'ünde geçirilmiş ameliyat mevcut olup en sık jineko-obstetrik ameliyat öyküsü alındı(%27,3). Başvuru anında yapılan ultrasonografik görüntülemede olguların % 27,0'sindekitlenin çapı 10 cm olarak bulundu.Alınan materyallerin patolojik incelemesinde %98,4 benign patoloji, %1,6 malign patolojisaptandı.Sonuç: Patolojisi bilinmeyen adneksiyal kitlelerde laparoskopik yaklaşım benignlezyonların belirlenmesi ve çıkarılması, malign lezyonların ise tespitinde altın standartolarak düşünülmesi gerektiği kanaatindeyiz.Objectives: The aim of this study is to evaluate the feasibility and safety oflaparoscopic intervention for the diagnosis and treatment of adnexial masses.Material and method: A total of 186 patients with adnexial mass were treated withlaparoscopy from January 2002 to January 2007. All clinical and demographic data ofthe patients were reviewed retrospectively.Results: 186 women underwent laparoscopic evaluation for the adnexial mass. Theultrasonographic measurements of masses were 10 cm in 5,3% of the cases. Themedian age of patients was 34 years (range, 14-76 years), 88.2% of patients were inpremenopausal women and 27.3% of all patients had a previous gynecologic/obstetricoperative intervention. Thehistopathologic results werereported as benign in 98.4%of cases and primary ovarian cancerin 1.6% of the women. Among thesecases 64.6%of the women underwent laparoscopic ovarian cystectomy, 33.7% underwent laparoscopicoopherectomy and 1.7% underwent laparoscopic hysterectomy-salphingo -oopherectomy. Overall 7.0% (13/186) of all laparoscopic interventions required conversionto laparotomy. Complications occured in 2.7% (5/186) of the patients. Postoperativehospitalization period of the patients were approximately 3.27 ±2.09 days.Conclusion: We conclude that laparoscopy may be regarded as a gold standard forthe diagnosis and treatment of adnexial masses with a low risk for malignancy

Juvenile Myelomonocytic Leukemia in Turkey: A Retrospective Analysis of Sixty-five PatientsÖzlem Tüfekçi1

Objective: This study aimed to define the status of juvenile myelomonocytic leukemia (JMML) patients in Turkey in terms of time of diagnosis, clinical characteristics, mutational studies, clinical course, and treatment strategies. Materials and Methods: Data including clinical and laboratory characteristics and treatment strategies of JMML patients were collected retrospectively from pediatric hematology-oncology centers in Turkey. Results: Sixty-five children with JMML diagnosed between 2002 and 2016 in 18 institutions throughout Turkey were enrolled in the study. The median age at diagnosis was 17 months (min-max: 2-117 months). Splenomegaly was present in 92% of patients at the time of diagnosis. The median white blood cell, monocyte, and platelet counts were 32.9x109/L, 5.4x109/L, and 58.3x109/L, respectively. Monosomy 7 was present in 18% of patients. JMML mutational analysis was performed in 32 of 65 patients (49%) and PTPN11 was the most common mutation. Hematopoietic stem cell transplantation (HSCT) could only be performed in 28 patients (44%), the majority being after the year 2012. The most frequent reason for not performing HSCT was the inability to find a suitable donor. The median time from diagnosis to HSCT was 9 months (min-max: 2-63 months). The 5-year cumulative survival rate was 33% and median estimated survival time was 30+-17.4 months (95% CI: 0-64.1) for all patients. Survival time was significantly better in the HSCT group (log-rank p=0.019). Older age at diagnosis (>2 years), platelet count of less than 40x109/L, and PTPN11 mutation were the factors significantly associated with shorter survival time. Conclusion: Although there has recently been improvement in terms of definitive diagnosis and HSCT in JMML patients, the overall results are not satisfactory and it is necessary to put more effort into this issue in Turkey