Cerrahi Tıp Bilimleri Bölümü Koleksiyonu

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https://hdl.handle.net/20.500.13055/57

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Harnessing generative pre-trained transformer technology for clinical decision support in retinal detachment
(Galenos Publishing House, 2025) Ağın, Abdullah; Öztürk, Yücel; Kıvrak, Ulviye
Aim: Considering the increasing incorporation of artificial intelligence (AI) in healthcare, it is crucial to comprehend the advantages and constraints of these technologies within ophthalmologic settings for their secure and efficient clinical utilization. This study aims to comprehensively assess the efficacy of three leading Generative Pre-trained Transformer (GPT) -based platforms in providing clinical decision-support for retinal detachment (RD). Methods: This cross-sectional comparative study was conducted between April 2024 and May 2024. Fifty questions were created based on the American Academy of Ophthalmology “Retina Book”, specifically targeting RD. The answers were produced by three different platforms and assessed by three independent reviewers who used Likert scales to evaluate their comprehensiveness and accuracy. Six readability metrics, including the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease Score (FRES), average words per sentence, average syllables per word, total sentence count, and total word count, were assessed. Results: Gemini earned the most outstanding results for comprehensiveness (4.11±0.72) and accuracy (1.49±0.61), followed by ChatGPT and Copilot. ChatGPT had superior readability metrics, achieving an FKGL of 15.62±2.85 and a FRES of 62.54±12.34, establishing it as the most accessible platform. ChatGPT demonstrated significantly higher performance compared to other platforms in the metrics of average syllables per word (p=0.0421) and total word count (p=0.0115). At the same time, no significant differences were found among the platforms in the metrics of average words per sentence (p=0.0842) and total sentence count (p=0.1603). Intraclass correlation coefficient (ICC) values indicated strong inter-rater agreement for comprehensiveness (ICC >0.74) and moderate to-high agreement for accuracy (ICC >0.56). Conclusion: Gemini’s detailed and accurate responses position it as a robust tool for professional use, while ChatGPT’s superior readability makes it suitable for patient education. These findings emphasize the synergistic advantages of AI platforms in research and development management and show the necessity for hybrid systems that integrate accessibility with accuracy.
Considering its mechanism of action it may be logical to choose letrozole as an initial option for endometrium preparation before vitrified-warmed embryo transfer
(Wiley, 2025) Aydın, Gerçek; Aslan, Kiper; Araç, Merve; Ergin, Elif; Kasapoğlu, Işıl; Uncu, Gürkan
Aim: To assess the efficacy of letrozole and programmed hormone replacement therapy (HRT) cycles in terms of obstetric outcomes for women undergoing a single vitrified-warmed blastocyst embryo transfer (SVBT). Methods: This study is a retrospective study conducted in a private IVF (in vitro fertilization) clinic. A total of 324 FET cycles (letrozole group = 183, HRT = 141), consisting of primary infertile patients aged <40 years, were enrolled. The cycle characteristics, pregnancy results, and perinatal parameters were recorded. The primary outcomes of this study are pregnancy and miscarriage rates, live birth rates, whereas hypertensive disease of pregnancy (HDP), intrauterine growth restriction (IUGR) and preterm birth are the secondary outcomes. Results: Positive β-HCG rates were 53% (97/183) versus 61% (86/141), whereas clinical pregnancy rates were 47% (86/183) versus 51.1% (72/141) for the letrozole and HRT groups, respectively. For clinical miscarriage, the results were 6.5% (12/183) for letrozole versus 15.6% (22/141) for HRT groups, which were statistically significant. For live birth rate (LBR), letrozole was found to be slightly better compared to HRT 40.4% (74/183) versus 35.5% (50/141). Considering the perinatal outcomes, the parameters were comparable between the groups. Conclusions: In terms of perinatal outcomes and IVF success, letrozole was not found to be inferior to HRT. Letrozole can be utilized as a safe and effective agent, even as a first-line treatment, given the potential benefits offered by its mechanism of action and being a reasonable option for both ovulatory and unovulatory patients.
A pilot investigation on possible interactions between clinical parameters and the psychology of couples undergoing IVF
(Wiley, 2025) Aydın, Gerçek; Bülbül, Mehmet; Ergin, Elif; Aydin, Ayşe Gül; Akkaya, Cengiz; Hatırnaz, Şafak; Tinelli, Andrea
Objective: To investigate the potential reciprocal influences between in vitro fertiliza tion (IVF) and the psychological states of patients. Materials and Methods: A prospective cohort study involved 180 couples who sought consultation for IVF. To monitor the fluctuations in the emotional states of the cou ples throughout the IVF process, questionnaires were administered on two separate occasions: the first was conducted immediately before the initiation of medication, and the second was administered promptly following the completion of embryo trans fer. The BECK inventories for anxiety and depression were employed for evaluation. Pregnancy outcomes were exclusively analyzed for women who received high-quality blastocysts, with cleavage-stage embryo transfers being excluded from consideration. Results: Pregnancy rates did not significantly differ based on the presence of height ened anxiety and/or depression among couples. Notably, a correlation was identified between severe anxiety in women before IVF and diminished rates of fertilization, as well as lower blastocyst/oocyte and blastocyst/metaphase II (M2) ratios (8.7 ± 5.0 vs. 7.5 ± 6.1, P= 0.029; 0.284 ± 0.199 vs. 0.218 ± 0.209, P= 0.001; and 0.333 ± 0.209 vs. 0.272 ± 0.232, P= 0.016, respectively). In the male cohort, elevated anxiety scores, ei ther pre- or post-IVF treatment, were found to be linked with a reduced mean oocyte count, as well as lower rates of M2, fertilization, blastocyst, and total embryo counts (P< 0.05). Conclusions: Pregnancy rates were not affected by the presence of anxiety and de pression, as they do not exert a significant impact on the implantation success of blas tocysts. However, given that fertilization rates are statistically diminished in instances of severe anxiety, which consequently results in a reduced number of blastocysts and total embryos, a decline in cumulative pregnancy rates may be anticipated.
Pediatrik chiari malformasyonları
(Akademisyen Yayınevi Kitabevi, 2025) Çakıcı Öksüz, Nazlı; Akdemir, Hidayet
Chiari malformasyonları ilk kez 19.yy sonunda (1891) Avusturyalı patolog Hans Chiari tarafından postmortem incelenen 40 vakanın sonuçları ile tariflenmiş tir. Sonrasında Alman patolog Julius Arnold’un da miyelodisplazi ve arka beyin herniasyonu olan bir vaka tanımlaması CM II Arnold-Chiari sendromu adı ve rilmiştir (1–3). Hans Chiari ilk olarak 3 tip tanımlamış ve 4 yıl sonra yayınladığı yayında 2 vaka ile birlikte Chiari tip IV’ü tanımlamıştır (4,5). Ancak zaman için de bu tanımlamaların tam olarak kliniği ve radyolojik bulguları yansıtamaması nedeni ile yeni tiplerin tanımlanması ihtiyacı doğmuştur (6,7). En son yapılan tanımlamalar ile birlikte, CM Tip 0, I, 1.5, II, III, 3.5, IV ve 5 olarak yeni alt tip leri kullanılmaktadır (6–13). 2000 yıllarındaki yeni klinik ve deneysel araştırmaları ve teknolojik buluşları sonrası özellikle hakemli dergilerde tanımlanan CM’lerin tarihsel ve yeni güncel sınıflandırmaları Tip 0, Tip 0.5, Tip I, Tip 1.5, Tip II, Tip 3.5, Tip 5 ve kompleks tip gibi yeni alt tipleri kullanılmaktadır (6–14).
Role of ovarian stem cells in postnatal oogenesis and implications in fertility preservation
(Springer Nature Link, 2025) Benlioğlu, Can; Turan, Volkan; Öktem, Özgür
It is a long-held dogma in reproductive biology that females are born with a set nonrenewable number of oocytes in the ovary. While some animal studies challenged this dogma by demonstrating allegedly postnatal oogenesis and the presence of certain stem cell factor expression germ cell markers, their biological roles are yet to be defined. In this chapter, we revisited this issue revisit this dogma in light of most recent data. The chapter outlines the characteristics of these putative OSCs, including their morphological features, expression of germline markers (e.g., DDX4, DAZL), telomerase activity, and methods for their isolation and culture, acknowledging the ongoing debate and methodological controversies surrounding their identification, particularly the reliability of DDX4-based sorting. We critically evaluate the evidence for their capacity to differentiate into oocyte-like cells in vitro and in vivo, including experiments involving transplantation into animal models. Finally, the chapter explores the profound implications these OSCs hold for fertility preservation, especially for women facing premature ovarian insufficiency, age-related infertility, or gonadotoxic treatments. We discuss potential future applications, such as autologous OSC transplantation to restore ovarian function or in vitro generation of mature oocytes for fertilization. We highlight the significant technical and safety hurdles that must be overcome, including optimizing culture systems, ensuring genomic stability, and validating human functional competency. While the physiological role and definitive existence of functional OSCs in adult human ovaries remain contentious subjects requiring further rigorous investigation using advanced techniques like single-cell analysis and lineage tracing, the potential therapeutic promise continues to drive research in this exciting, albeit controversial, area of reproductive medicine.
Artificial intelligence in predicting macular hole surgery outcomes: A focus on optical coherence tomography parameters
(Springer Nature, 2025) Öztürk, Yücel; Ağın, Abdullah; Yelmi, Burcu; Zorlutuna Kaymak, Nilufer
Purpose To evaluate the predictive performance of optical coherence tomography (OCT)-based indices and artificial intelligence (AI) using a Generative Pre-Trained Transformer (GPT) model and compare them with traditional logistic regression in forecasting anatomical success following macular hole (MH) surgery. Methods This retrospective observational study included 51 eyes of 51 patients who underwent pars plana vitrectomy for idiopathic MH. Preoperative OCT measurements of macular hole index (MHI), traction hole index (THI), hole form factor (HFF), basal hole diameter (BHD), and minimum hole diameter (MHD) were recorded. GPT-based AI predictions were generated using masked input data. A logistic regression model was developed with the same variables. Predictive performance was assessed using accuracy, area under the curve (AUC), positive predictive value (POPV), negative predictive value (NPV), and Kappa statistics. Results Anatomical success was achieved in 72.5% of cases. MHI, THI, and HFF were significantly higher in the successful group (p<0.0001). GPT achieved an accuracy of 77.0% and AUC of 0.770, with perfect POPV (1.000) but low NPV (0.452). Logistic regression outperformed GPT, achieving an accuracy of 84.3%, an AUC of 0.759, a higher NPV (0.800), and better agreement (Kappa 0.568 vs. 0.392). BHD and MHD showed poor predictive power (AUC 0.291). Conclusion OCT-derived indices, especially MHI, THI, and HFF, effectively predict MH surgery outcomes. Logistic regression based on actual patient data demonstrated superior predictive performance compared to GPT. AI models hold potential but require further development, integration of multimodal data, and validation before clinical application.
Pilonidal disease: Gaps in the guidelines and future perspectives
(Galenos Publishing House, 2025) Arslan, Çiğdem
Pilonidal disease (PD) is an increasingly common condition that predominantly affects the young population. The variety of treatment modalities described in the literature makes it nearly impossible to design a study capable of definitively identifying the optimal method. As a result, treatment strategies are broadly categorized into minimally invasive and excisional approaches, with the choice often tailored to the severity and complexity of the disease on an individual basis. Currently, four major guidelines and consensus reports have been published on PD: The American (1), German (2), and Italian (3) guidelines, as well as the most recent guideline from the European Society of Coloproctology (ESCP) (4) in 2024. While these guidelines share certain points of agreement, they also diverge on several issues, and most of their recommendations are based on expert opinion or very low levels of evidence. Furthermore, many questions frequently encountered by surgeons in daily practice are either not addressed or remain unanswered in these guidelines.
Utilization and fertility preservation outcomes in women undergoing embryo cryopreservation before breast cancer treatment: A meta-analysis
(Elsevier, 2025) Turan, Volkan; Öktem, Özgür; Bang, Heejung; Oktay, Kutluk Han
Our aim was to assess fertility preservation (the proportion of women who had at least 1 live birth) and utilization rates (the proportion of women who utilized their cryopreserved embryos) rates among women who cryopreserved their embryos before breast cancer treatments. PubMed and Cochrane library database were searched until December 2024. We included all studies that reported pregnancy outcomes, the number of women who returned for frozen embryo transfer, and the number of women who preserved their fertility. The primary outcome measures were the utilization and fertility preservation rates. Secondary outcome measures were implantation, clinical pregnancy, and live birth rates. Of the 12 studies, 9 met the criteria, encompassing >2126 women with breast cancer who cryopreserved their embryos for fertility preservation. In 9 studies that reported the total number of attempts, 424 women underwent 863 embryo transfers. Based on those studies, the clinical pregnancy and live birth rates were 50% (95% CI: 35-65, I 2: 80%) and 33% (95% CI: 22-46, I 2: 76%), respectively. The utilization and fertility preservation rates were 18% (95% CI: 9-32, I 2: 95%) and 39% (95% CI: 29-51, I 2: 48%), respectively, all from random-effects models. Fertility preservation success with embryos cryopreserved before breast cancer treatments seems to be promising. However, the utilization rate of cryopreserved embryos is low. Additional studies with larger sample size and longer follow up are required to evaluate the long-term utility rates.
Early fibrinogen replacement based on shock index and lactate levels in massive postpartum hemorrhage: A retrospective cohort study
(SIMTI, 2025) Küçükbaş, Mehmet; Güner Özen, Eda; Özen, Süleyman; Selçuk, Selçuk; Polat, Mesut; Karateke, Ateş
Background - Massive postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality worldwide. Timely fibrinogen replacement is critical in hemostatic resuscitation, yet laboratory delays may hinder early intervention. This study evaluates the clinical outcomes of early fibrinogen concentrate administration in massive PPH using a protocol based on shock index and serum lactate levels rather than laboratory-confirmed hypofibrinogenemia. Materials and methods - This retrospective cohort study included 103 PPH patients treated at a tertiary hospital in Istanbul, Turkey, between 2016 and 2020. Patients were divided into four groups based on fibrinogen dose: Group I (<2 g), Group II (2–4 g), Group III (>4 g), and Group IV (non-massive PPH, no fibrinogen). A predefined protocol guided early fibrinogen administration based on clinical indicators. Fibrinogen was administered without awaiting lab confirmation. Results - Group III had the highest estimated blood loss (2,600±500 mL) and Group IV the lowest (600±150 mL; p<0.001). ICU admission was significantly lower in Group III (23.8%) than in Group I (62.1%; p=0.020). Group III patients also had fewer secondary surgical interventions and reduced transfusion requirements compared to Groups I and II. No thromboembolic events or mortality were observed in any group. Discussion - Early fibrinogen replacement based on shock index and lactate levels appears feasible and beneficial in managing massive PPH. This approach was associated with improved hemostatic control, reduced ICU admissions, and fewer surgical interventions. Prospective studies are warranted to further assess this strategy’s safety, efficacy, and cost-effectiveness.
In-depth analysis of the demographic landscape and clinical outcomes of assisted reproductive technologies in Türkiye: A comprehensive survey for the years 2020 and 2021
(Galenos Publishing House, 2025) Benlioğlu, Can; Aydın, Yunus; Bostancı, Mehmet Sühha; Bozdağ, Gürkan; Bulgurcuoğlu, Sibel; Demir, Ahmet; Dilbaz, Serdar; Dirican, Enver Kerem; Turan, Volkan; Balaban, Başak
Objective: To investigate patient characteristics and outcomes of assisted reproductive technology (ART) cycles conducted in Türkiye during the coronavirus disease-2019 (COVID-19) pandemic (2020-2021). Material and methods: ART centers in Türkiye were invited to participate in this survey. The questionnaire focused on patient demographics and performance outcomes and was sent to center directors via anonymous Qualtrics™ links. Results: The survey was sent to 167 centers and data were collected from 15 centers in 2020 and 24 centers in 2021. The clinical pregnancy rate from intrauterine insemination (IUI) procedures remained similar, with 15.1% in 2020 (1,245 IUI cycles) and 14.5% in 2021 (2,023 IUI cycles), while successful delivery rates were 12.5% and 11.5%, respectively. For ART treatments, the clinical pregnancy rate from fresh embryo transfers increased from 45.1% in 2020 (3,119 transfers) to 50.4% in 2021 (8832 transfers), with similar live birth rates, 34.2% vs. 34.4%. Frozen embryo transfers resulted in clinical pregnancy rates of 47.8% in 2020 (2,498 transfers) and 51.9% in 2021 (12,015 transfers), with live birth rates rising from 39.8% to 42.7%. Preimplantation genetic testing cycles resulted in clinical pregnancy rates of 64.2% in 2020 (271 transfers) and 60.8% in 2021 (2,102 transfers), with live birth rates of 53.5% and 48.2%, respectively. Regarding techniques for fertility preservation in females, 11 prepubertal and 61 postpubertal ovarian tissue cryopreservation procedures were reported, alongside 1,346 cycles performed within the same period. In males, 144 post-pubertal testicular tissue, 871 epididymal and 2,480 ejaculated sperm cryopreservations were reported. During the two years, six ovarian tissue transplantations followed by ART were performed, with 96 women using cryopreserved oocytes. In addition, 40 testicular tissue, 298 epididymal, and 238 ejaculated sperm samples were used for ART purposes. Conclusion: This survey provides a comprehensive overview of ART practices in Türkiye for 2020 and 2021, establishing a long-term, nationallevel analysis while highlighting the challenges posed by the COVID-19 pandemic. The longitudinal analysis established a foundation for future annual reports and offers critical insights into emerging trends over these two years.
From surgery to sports career: The long-term fate of athletes with discoid meniscus
(Lippincott Williams and Wilkins Ltd., 2025) Erden, Tunay; Ağır, Muzaffer; Ali, Jotyar; Toker, Berkin; Taşer, Ömer
Objective: This study aimed to evaluate the long-term effectiveness of different surgical techniques for discoid meniscus in athletes. Design: This retrospective cohort study included 44 athletes (51 knees) who underwent arthroscopic surgery for symptomatic discoid meniscus between 1996 and 2019. Setting: The study was conducted at a tertiary-level sports medicine center. Patients: Athletes aged 15 to 35 years with symptomatic discoid meniscus confirmed by magnetic resonance imaging and requiring surgical treatment were included. Exclusion criteria were cartilage injuries (Outerbridge grades 3-4), concomitant ligament injuries requiring surgery, osteochondritis dissecans, and prior knee surgery. Interventions: Patients underwent arthroscopic partial, subtotal, or total meniscectomy, with or without meniscus repair. Main outcome measures: Functional outcomes were assessed using Visual Analog Scale (VAS), International Knee Documentation Committee (IKDC), and Lysholm scores. Osteoarthritis progression was evaluated using the Kellgren-Lawrence classification. Return to sports time and total career duration were also recorded and compared between the surgical groups. Results: The mean follow-up was 13.5 ± 6.2 years (range: 5-27 years). At the final follow-up, 72% of the meniscus-preserving group (partial meniscectomy and repair) had KL grade 0 osteoarthritis, whereas 38% of the subtotal/total meniscectomy group developed KL grades 3 to 4 osteoarthritis (P < 0.001). All groups showed significant postoperative functional improvements (P < 0.001), but career duration and return to play time were significantly longer in the meniscus-preserving group (P = 0.004, P < 0.001, respectively). Conclusions: Subtotal/total meniscectomy significantly accelerates osteoarthritis progression. Meniscus-preserving techniques provide better long-term outcomes.
Epitelyal over kanserinde hipertermik intraperitoneal kemoterapi
(Turkiye Klinikleri Yayınevi, 2025) Şahin, Hanifi; Şahin, Turan; Uyar, Oğuz
Over kanseri periton yüzeyine hem primer hem de nüks olgularda tutmaktadır. Bundan dolayı özellikle periton yüzeyini hedef alan terapötik yaklaşımlardan biri olan Hipertermik İntraperitoneal Kemoterapi (HIPCE) literatürde tartışılan önemli bir tedavi modalitesidir. Bugün için over kanserinin standart tedavisinde etkin bir sitoredüksiyon veplatin bazlı kemoterapi standart yerini korumaktadır. HIPEC ile ilgili tartışma devam etmektedir. Eldeki veriler HIPEC'in Neoadjuvan Kemoterapi (NACT) sonrası İnterval Debulking Cerrahisi (IDS) sağkalımı artırdığı yönündedir. Primer ve Nüks cerrahisinde sağkalımı arttırdığına dair çalışmalar olsa da standart bir yaklaşım değildir.
Developments in pharmacotherapy for the preservation of ovarian function during cancer treatment
(Taylor & Francis, 2025) Turan, Volkan; Oktay, Kutluk
Introduction: Cancer is one of the major causes of human death, and anti-cancer therapy often results in premature ovarian failure and infertility, depending on factors such as age, initial ovarian reserve, and chemotherapy type and dose. Fertility preservation procedures, such as oocyte, embryo, and ovarian cortex cryopreservation, can help women achieve pregnancy after cancer treatment. However, the development of pharmacological therapies to protect ovarian function during chemotherapy would represent a significant advancement. Areas covered: We searched the published articles in PubMed up to December 2024, containing key words '"chemotherapy",' 'cancer,' '"ovarian protection",' '"pharmacological therapy",' '"ovarian reserve"' and '"fertility".' Chemotherapeutic agents act via various mechanisms in the human ovary, including direct DNA damage leading to oocyte apoptosis, as well as damage to ovarian stroma and microvascular architecture. In recent years, numerous protective agents have emerged, showing promise in protecting ovaries from chemotherapy-induced damage. However, most studies have relied on animal models, and only a limited number have directly tested these agents in human ovarian tissue. At present, no pharmacological treatment has been conclusively proven effective for preserving fertility. Expert opinion: A comprehensive understanding of the mechanisms underlying chemotherapy-induced ovarian damage is critical for the development of efficient and targeted pharmacological therapies.
Pharmacovigilance analysis of immune checkpoint inhibitor-related reproductive adverse effects based on the FDA adverse event reporting system
(Springer Nature, 2025) Köylü, Bahadır; Esen, Buğra Han; Bektaş, Şevval Nur; Özbek, Laşin; Turan, Volkan; Urman, Bülent; Öktem, Özgür; Selçukbiricik, Fatih
This study aims to investigate the adverse effects of immune checkpoint inhibitors (ICIs) on the female and male reproductive systems. In the FDA Adverse Event Reporting System (FAERS) database, adverse reactions under the "Reproductive system and breast disorders" category in the System Organ Classes were included, covering a period from January 1, 2015, to June 30, 2023. We identified 133,512 patients treated with ICIs. Immune checkpoint inhibitor-related reproductive adverse effects (irRAEs) were reported in 568 (0.43%) patients. Spermatogenesis abnormality (ROR025 = 7.91) had the highest signal strength associated with ICI use in males. Genital tract fistula was the only significant irRAE (ROR025 = 2.72) in females. PD-1 inhibitors pose greater risk than CTLA-4 inhibitors (OR = 1.65 [1.05-2.79], p = 0.045). Gynecologic cancers in females (OR = 3.77 [2.82-4.99], p < 0.0001) and urogenital cancers in males (OR = 1.56 [1.17-2.06], p = 0.0018) carried the highest risk compared to other cancers. Additional targeted drugs (OR = 2.32 [1.76-3.02], p < 0.0001), particularly lenvatinib (OR = 3.50 [2.48-4.94], p < 0.0001) and cabozantinib (OR = 3.71 [1.96-7.03], p < 0.0001) significantly increased the risk for females. Additional use of chemotherapy drugs was associated with a significant reduction in the risk for males (OR = 0.65 [0.42-0.96], p = 0.042) except for doxorubicin (OR = 2.58 [1.22-5.47], p = 0.013) and cyclophosphamide (OR = 2.36 [1.05-5.29], p = 0.038). This study demonstrates that ICIs could potentially lead to a wide range of adverse effects in the reproductive system in both males and females.
Determination of anti-mullerian hormone and inhibin b reference ranges according to pubertal stages in children and adolescent girls
(Karger, 2024) Kaynar, Özge; Turan, Hande; Tarçın, Gürkan; Karakaş, Hasan; Evliyaoğlu, Olcay; Turan, Volkan; Bayramoğlu, Elvan
Determination of Anti-Mullerian Hormone and Inhibin B Reference Ranges According to Pubertal Stages in Children and Adolescent Girls
Vasküler travmada kompartman sendromu
(Akademisyen Yayınevi A.Ş., 2024) Doğan, Emre; Yiğit, Görkem
Kalp ve damar cerrahları olarak, kompartman sendromunu (KS) en sık ekstremiteler de tecrübe etmekteyiz. Kompartman sendromunu, fasya ile sarılı olan kas gruplarının bulunduğu bir alanda basıncın artması ile gelişen perfüzyon bozukluğu olarak tanımla yabiliriz (1,2).KS tanısı koymak ve ardından tedavilerine başlamak hayatidir. Erken tanı ve uygun müdahale ile kompartman sendromunun komplikasyonlarından (rabdomyoliz, hiperkalemi, akut böbrek hasarı…) kaçınılabilir.
Maternal health experiences on respectful and adequate care of immigrant women: A prospective multicenter study
(Wiley, 2024) Topçu, Elif Göknur; Terzioğlu, Merve; Okumuş, Zihniye Gonca; Şavklı, Ayşe Özge; Demirkıran, Cansu İrem
Objective: Migration of pregnant women can be challenging. Access to adequate and respectful care may not be possible. We aimed to assess the maternity care that im migrant women receive and their satisfaction with the care they experience. Methods: This multicenter prospective study was conducted in a tertiary public hos pital and a private hospital in Istanbul between April 2023 and July 2023. A face-to face questionnaire was completed in the postpartum department by obstetricians and translators. Results: In total, 267 patients participated in this study. A majority of these patients delivered at the public hospital (75%). Approximately 21% of all deliveries in both hos pitals were with foreign mothers. A majority of the patients (82%) in the public hospi tal said they easily reached midwives, nurses, and an obstetrician, while this number rose to 100% in the private hospital. Patients in the private hospital had a higher average number of obstetrician visits compared to those in the public hospital, which was statistically significant (P< 0.05). Patients in the public hospital were significantly less informed about various maternity topics than those in the private hospital group (P< 0.001 for all topics). Most patients said their ideas and thoughts were taken seri ously by the health care providers (80% and 97% in the public and private hospitals, respectively). Almost all patients recommended giving birth in the same hospital (94% vs. 96%, public and private hospitals, respectively), while around 99% recommended giving birth in Turkey. Conclusion: Immigrant women are overall satisfied with the care they receive in both public and private hospitals. They have easier access to obstetricians in private hospi tals, as well as being more informed on maternal health issues. Clinical efforts should focus on patient education in antenatal care.
Labiaplasty revision surgery with using clitoral hood flap: A case-cohort study
(Springer, 2024) Şahin, Eda Adeviye; Ağlamış, Özgür; Şahin, Hanifi; Ozan Şahin, Elif; Yılmaz Ergani, Seval
Background: The demand for labia minora reduction surgery has increased due to aesthetic preferences and discomfort caused by labial hypertrophy. This study aims to share experiences with labial reconstruction using clitoral hood flaps in patients who underwent aggressive trim labiaplasty. Methods: Twenty-eight patients who had previously undergone only labiaplasty surgery were included in this study. Surgical techniques focused on preserving blood supply and achieving symmetry. Postoperative care included hospitalization, wound care training, and regular follow-up visits. Complications were monitored and managed as needed. Results: All 28 patients, comprising 23 bilateral and 5 unilateral labiaplasty cases, underwent revision surgery using 49 clitoral hood flaps. Complications occurred in 6 cases, including suture dehiscence, flap necrosis, and infection, all of which were effectively managed. All flaps maintained their viability, and high patient satisfaction was reported. Conclusion: Clitoral hood flap reconstruction following aggressive trim labiaplasty is a viable technique with minimal complications and high patient satisfaction. Further multicenter, long-term studies are necessary to validate these findings and improve surgical outcomes. Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Yaşlılarda safra kesesi hastalıklarına yaklaşım
(Akademisyen Kitabevi, 2024) As, Abdullah; Kanat, Burhan Hakan; Öndeş, Bahadır
Yaşlılığın ne olduğu ve hangi yaştan itibaren başladığı daima tartışılan bir konu olmuştur. Son yüzyıl içinde, tıp ve teknolojideki gelişmekte paralel olarak insan yaşamının uzadığı bilinen bir gerçektir. Bu durumla birlikte, dünya üzerindeki insan nüfusunun giderek yaslandığı ve yaşlı hastalara cerrahi müdahale gerekliliğinin giderek artmakta olduğu gözlenmektedir. Dünya Sağlık Örgütü verilerine göre 2019 yılı itibari ile 60 yaşını geçen insan popülasyonu 1 milyara yükselmiştir. 2030 yılına kadar bu rakamın 1.4 milyara, 2050 yılı itibariyle ise 2.1 milyara çıkacağı ön görülmektedir.
Autologous ovarian tissue transplantation: Preoperative assessment and preparation of the patient
(Wolters Kluwer Health, 2024) Turan, Volkan; Öktem, Özgür
Importance: Ovarian tissue cryopreservation (OTC) is an innovative and established fertility preservation method. More than 150 live births have been reported worldwide to date with the use of this strategy. OTC is one of the options to preserve fertility in prepubertal girls and for women who have time constraints and/or contraindications for ovarian stimulation for oocyte/embryo freezing before cancer treatment. The success rate of the ovarian tissue transplantation (OTT) depends on many interrelated factors. Therefore, preoperative evaluation and preparation of the candidate patients for the procedure are of paramount importance. Objective: In this review, our aim was to provide a guide for the clinicians, which demonstrates step-by-step assessment and preparation of the patients and ovarian tissue samples for transplantation. Evidence Acquisition: We searched for published articles in the PubMed database containing key words, such as OTT, OTC, preoperative assessment, primordial follicle density, and cancer, in the English-language literature until May 2024. We did not include abstracts or conference proceedings. Results: OTT is still a developing method as an effective fertility preservation approach. It is essential to perform a thorough preoperative evaluation of the patient to improve the success rates of transplantation. Conclusions and Relevance: Preoperative evaluation and preparation of women for ovarian transplantation surgery should include safety management to prevent reimplantation of malignant cells, transplanting ovarian tissue with minimum follicle loss and the decision of the best transfer site.

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