Selçuk Köksal

Results and complications of high dose rate and low dose rate brachytherapy in carcinoma of the cervix: Cerrahpaşa experience

PURPOSE To evaluate the results and complications of treatment with high dose rate (HDR) compared to low dose rate (LDR) brachytherapy in cervical carcinoma. METHODS Three hundred and seventy patients who were treated with external irradiation and intracavitary brachytherapy and followed for more than 2 years between 1978 and 1998 have been recently updated. The low dose rate group consisted of 77 cases treated between 1978 and 1982 and HDR group consisted of 293 cases treated between 1982 and 1998. All patients first received external irradiation with 60Co or 9-18 MV photons and a median dose of 54 Gy was given in 6 weeks. In the LDR group, intracavitary treatment was given with Manchester applicators loaded with radium (30 mg) in an intrauterine tube and 20 mg in vaginal ovoids. The dose delivered to point A was on average 32 Gy in one application. In the HDR group, a total dose of 24 Gy was given to point A in three insertions 1 week apart. The dose rate was 0.62 Gy at point A. RESULTS The 5-year pelvic control rate was found to be 73% in the HDR group, compared with 86% in the radium group for stage I cases. In stage IIB and IIIB cases, the rates were 68% and 45% for HDR and 65% and 53% for LDR, respectively. In all stages, there was no statistical difference in pelvic control and survival rates between the two groups. Overall incidence of late complications was found as 31.1% and 31.9% in HDR and LDR groups, respectively. The grade 2-4 late complication rate was 14% in the HDR group compared to 19% in the LDR group (P>0.05). CONCLUSION HDR brachytherapy in the management of the cervix appears to be a safe and efficacious approach. Pelvic control, survival and complications rates are quite similar when compared with LDR.

Assessment of Knowledge, Behaviour and Sun Protection Practices among Health Services Vocational School Students

There has been a significant increase in the cases of skin cancer throughout the world in the last few decades. Although the mortality rate of skin cancer is relatively low, its impact on other health aspects is high and the treatment of undesired aesthetic damage is costly. According to disability-adjusted life year rates (DALY), 1.5 million days are estimated to be lost from people’s lives every year worldwide due to ultraviolet (UV) radiation. The purpose of this study was to raise sun health awareness levels among health services vocational school students. A total of 414 students were included in the analysis. A questionnaire form was used to evaluate knowledge, attitudes and behaviours among the survey sample. The average level of knowledge concerning the effects of the sun was found to be 8.64 ± 2.5 out of 15 points. All socio-demographic factors were analysed, but the only significant variables found were age and the possible presence of skin cancer within the immediate family (p < 0.05).

Analysis of laparoscopic colorectal surgery in high-risk patients.

The aim of this retrospective study is to examine the feasibility and safety of laparoscopic colorectal resection for colorectal malignancies to determine “high-risk” patients. In our classification, 3 minor criteria including patients over 70 years of age, body mass index over 30 m/kg2, and cigarette smoking and 5 major criteria including cardiac, pulmonary, renal, liver disease, and diabetes mellitus were selected to determine a high-risk group. Patients carrying 1 minor and 1 major criteria were classified as the high-risk group. Concerning patients and operations, hemodynamic values (mean arterial systolic and diastolic pressures and heart rates), oxygen saturations, end-expiratory carbon dioxide levels, respiratory mechanics (dynamic compliance, peak inspiratory pressure, airway resistance) were analyzed. Cardiovascular system (myocardial infarction, arrhythmia, hypertension), pulmonary system (respiratory insufficiency), digestive system (anastomotic leak, fistula, and paralytic ileus), fever, thrombophlebitis, urinary infections, wound infections, and central nervous system (delirium and cerebrovascular accident) were also investigated. A total number of 85 high-risk patients were included in the study. Gastrointestinal leaks in 2.3%, fistula in 1.1%, ileus in 3.5%, postoperative bleeding in 2.3%, postoperative fever in 5.8%, wound infection in 5.8%, and cerebrovascular accidents in 1.1% of patients were detected. The lowest values of hemodynamic and respiratory mechanics were observed at the induction of pneumoperitoneum and in this period the compliance and mean arterial pressure were determined to be 36±14 mm Hg and 84±14 mm Hg, respectively. No mortalities occurred. In experienced hands, laparoscopic colorectal resection can be performed safely for “high-risk” surgical patients.

Association of blood lead levels with demographic, reproductive and employment related factors in Turkish women

OBJECTIVE The aim of this study is to compare the blood lead levels in employed and unemployed women and associate the difference with sociodemographic and reproductive factors. PARTICIPANTS Out of a 100 women attending the routine check-up unit of Family Medicine Department for screening of osteoporosis and blood lead levels, 63 post-menopausal participants; 36 unemployed and 27 employed, were included in the study. METHODS Patients completed a questionnaire regarding their sociodemographics. Their blood chemistry and blood lead levels were determined and bone mineral densities were measured by Dual Energy X-Ray Absorptiometry. In the statistical analysis, Mann-Whitney U test was used to compare means and χ ^{2} was used to compare ratios. Backward logistic regression was used for multivariate analysis. RESULTS There was no significant difference between the age (57.17 ± 7.46; unemployed, 54.19 ± 5.36; employed). The mean blood lead levels were 25.92 ± 9.31 μ g/dl in the unemployed group and 33.98 ± 13.50 μg/dl in the employed group (p=0.011) adjusted for age. Smoking rate was significantly higher in employed women (p=0.033) whereas the number of births (p=0.032) and duration of breastfeeding (p=0.008) were significantly lower. Although both groups were osteoporotic and post-menopausal, there was no association between osteoporosis and employment while unemployed women had an earlier menopause (p=0.037). CONCLUSIONS Lead levels are above the accepted threshhold (20 μg/dl) in both groups. Strict environmental and social improvement efforts in both groups are recommended.

Mechanical bowel preparation with different solutions in rats with selective left colonic ischemia and reperfusion injury

BACKGROUND The aim of this study was to evaluate the effects of preoperative mechanical bowel preparation (MBP) on colonic ischemia/reperfusion (I/R) injury. METHODS Seventy adult male Sprague-Dawley rats were divided randomly into 7 equal groups of 10 rats each. Groups were assigned as follows: group I = sham surgery; group II = I/R of left colon (control group); group III = intravenous heparin and metronidazole followed by I/R of the left colon; groups IV through VII = before I/R of the left colon, heparin and metronidazole and MBP were performed with sodium chloride (NaCl), Na phosphate, polyethylene glycol, and mannitol, respectively. Histopathologic and biochemical parameters were evaluated. RESULTS According to the histopathologic changes, the groups least affected by I/R injury were groups V and VII. Catalase activity was significantly higher in groups V and VII, and copper-zinc superoxide dismutase activity was significantly higher in group VII compared with the control group (P <.002). CONCLUSIONS MBP with sodium phosphate and mannitol appears to be more protective against I/R injury.