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Introduction: Intraabdominal adhesions that develop because of prior abdominal or pelvic surgery may cause problems during surgery. Complications can include difficult intraabdominal entry; injury to the urinary bladder, uterus or small intestine; longer operation times, and increased blood loss. The goal of the present study was to evaluate the association between abdominal striae gravidarum and intraabdominal adhesions in the preoperative period in pregnant women with a history of cesarean section. Materials and Methods: The study included 247 pregnant women at ≥ 37 weeks of gestation admitted to the labor unit for delivery; all had undergone at least one previous cesarean section. Abdominal striae were assessed preoperatively using the Davey scoring system; the severity and intensity of adhesions were subsequently evaluated intraoperatively according to the modified Nair scoring system. Results: No striae were seen in 104 pregnant women; 41 had mild striae and 102 had severe striae. Overall, 113 cases had no adhesions (grade 0), 106 had grade 1-2 adhesions, and 28 had grade 3-4 adhesions. Among patients with grade 0 adhesions, 34 (13.7 %) had no striae, while 79 (31.9 %) had mild-to-severe striae (p < 0.001; sensitivity 55 %; specificity 67 %; positive predictive value 69 %; negative predictive value 52 %). Among women with grade 1-2 adhesions, 48 (19.4 %) had no striae, while 58 (23.4 %) had mild-to-severe striae. Finally, among women with grade 3-4 adhesions, 22 (8.9 %) had no striae, while 6 (2.4 %) had mild-to-severe striae (p < 0.001). A p-value < 0.05 was taken to indicate statistical significance. Conclusions: The abdominal adhesion score dropped as the abdominal striae gravidarum score rose during the preoperative period. Addition of this useful, easy-to-apply, inexpensive, adjunctive, observational, abdominal scoring method to the obstetrical work-up can provide important clues about the intraabdominal adhesion status of pregnant women scheduled for cesarean delivery because of previous cesarean section. © Georg Thieme Verlag KG. Source


Unal O.U.,Ataturk University | Oztop I.,Dokuz Eylul University | Unek I.T.,Tepecik Education and Research Hospital | Yilmaz A.U.,Izmir University
Asian Pacific Journal of Cancer Prevention | Year: 2013

Background: The aim of this study was to evaluate the efficacy and tolerability of a gemcitabine, 5-fluorouracil and leucovorin (GEMFUFOL) chemotherapy regimen as first line treatment of metastatic biliary tract cancer. Materials and Methods: All patients received folinic acid 400 mg/m2 on day 1, 5-fluorouracil bolus 400 mg/m2 on day 1, IV infusion of 5-fluorouracil 2400 mg/m2 over 46 hours, and gemcitabine 1250 mg/m2 on day 1. Results: A total of 29 patients with metastatic biliary tract cancer received GEMFUFOL regimen as the first-line treatment. The mean follow-up was 22.1 months (95%CI, 12.5-31.8). One patient (3.4%) achieved complete response, 5 (17.2%) had partial response, and 4 (13.8%) had stable disease. The median progression-free survival was 3.3 months (95%CI, 2.9-3.7), and the median overall survival was 8.8 months (95%CI, 3.5-14). The 1-year and 2-year survival rates were 58.6% and 30%, respectively. Grade 3 and 4 toxicity included neutropenia in 4 patients (13.7%), thrombocytopenia in 2 (6.8%), anemia in 2 (6.8%), and alopecia in 1 (3.4%). Two patients (6.8%) developed febrile neutropenia. A dose reduction was achieved in 8 patients (27.6%) while 5 patients had extended-interval dosage (17.2%) for toxicity. Conclusions: The GEMFUFOL chemotherapy regimen was generally efficacious and tolerable as a first-line treatment of metastatic biliary tract cancer. Source


Akman T.,Tepecik Education and Research Hospital | Yavuzsen T.,Dokuz Eylul University | Sevgen Z.,Dokuz Eylul University | Ellidokuz H.,Dokuz Eylul University | Yilmaz A.U.,Izmir University
European Journal of Cancer Care | Year: 2015

Insomnia, poor sleep quality and short sleep durations are the most common problems seen in cancer patients. More studies are needed about sleep disorders in cancer patients. In our study, we aimed to investigate the prevalence of sleep disorders and the impact of these problems on the quality of life in cancer patients. Pittsburgh Sleep Quality Index (PSQI) was given to a total of 314 patients. The psychometric evaluation of the Turkish version of PSQI in cancer patients revealed that 127 (40.4%) patients had global PSQI scores >5, indicating poor sleep quality. There was no statistically significant relationship between PSQI scores and sexuality, marital status, cancer stage and chemotherapy type (P > 0.05); while the patients with bone and visceral metastasis had much lower PSQI scores (P = 0.006). Patients with Eastern Cooperative Oncology Group performance scores of 3 or more had also significantly lower PSQI scores (P = 0.02). In conclusion, PSQI questionnaire may be used to evaluate the sleep disorders in cancer patients. Consistent use of multi-item measures such as PSQI with established reliability and validity would improve our understanding of difficulties experienced by cancer patients with chronic insomnia. © 2015 John Wiley & Sons Ltd. Source


Yaman O.,Tepecik Education and Research Hospital | Dalbayrak S.,Neurospinal Academy
Turkish Neurosurgery | Year: 2014

Measurement of a curvature angle higher than 10 degrees on anterior-posterior X-rays is known as scoliosis. Idiopathic scoliosis forms 80% of coronal structural deformities. Deformity causes coronal, sagittal and axial plane imbalance. Idiopathic scoliosis is divided into three sub-groups by age infantile (0-3 years), juvenile (4-9 years), and adolescent (10 years of age to maturity). Surgery should be considered for progressive deformities and progressive neurological deficits despite conservative treatment. Patients with idiopathic scoliosis should be evaluated according to the patient's age, degree of curvature, and present condition. Source


Yaman O.,Tepecik Education and Research Hospital | Dalbayrak S.,Neurospinal Academy
Turkish Neurosurgery | Year: 2014

A Cobb angle measurement, the angle between upper end plate of T5 and lower end plate of T12, higher than 40 degrees known as kyphosis. Although various etiologies cause kyphosis, the best-known form, Scheuermann's kyphosis causes disorder in sagittal balance. Surgery should be considered for persistent pain despite conservative treatment, progressive neurological deficits and cosmetic reasons. For this purpose, correction osteotomies have to be performed to provide spinal alignment and to maintain sagittal balance. Source

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