The Surgical Benefit of Hysterolaparoscopy in Endometriosis-Related Infertility: A Single Centre Retrospective Study with a Minimum 2-Year Follow-Up.

AIM: This study examined the fertility performance of women after combined hysterolaparoscopic surgical management of endometriosis. Design: This study is a hospital-based retrospective review. MATERIALS AND METHODS: Data collected from the records of all patients presented with endometriosis-related infertility using a checklist designed for the purpose. Result: A total of 81.3% (370/455) of women who have had the desire to have children became pregnant during the study period after the surgery. Of those who became pregnant, all three-hundred-forty-seven patients were followed to the end of their pregnancies. A successful live birth occurred in 94.2% (327/347) of individuals, and pregnancy loss occurred in 5.8% (20/347). The mean patient age was 34.1 ± 4.1 years, and the average duration of infertility was 3.4 ± 3.3 years. Pregnancy occurred spontaneously in 39.5% (146/370) of patients, after artificial insemination (AIH) in 3.8% (14/370) of women, and after in vitro fertilization-embryo transfer (IVF-ET) in 56.8% (210/370) of cases. Patients aged ≤ 35 years had a higher chance of conception post-surgery-84% versus 77%, respectively (p = 0.039). Based on the modes of pregnancy, the timely introduction of an assisted reproductive technique (ART) demonstrated a significant effect on fertility performance postsurgery. Comparatively, this effect was 91.3% vs. 74.1% among the ≤35- and >35-year-old age groups, respectively. There was no significant difference in reproductive performance based on stages of endometriosis, nor in the other parameters evaluated. Conclusion: Our data are consistent with previous clinical studies regarding the management options of endometriosis-related infertility. Overall, the combined hysterolaparoscopy treatment is a very effective and reliable procedure, and is even more effective when combined with ART. It enhances women's wellbeing and quality of life, and significantly improves reproductive performance.

[Actor as a simulated patient in medical education at the University of Pécs]. / A színész mint szimulált páciens az oktatásban a Pécsi Tudományegyetemen.

INTRODUCTION: Medical training in the 21st century faces simulation-based education as one of the challenges that efficiently contributes to clinical skills development while moderating the burden on the clinicians and patients alike. AIM: The University of Pécs, Medical School has launched a simulation program in the MediSkillsLab based on history taking with actors to improve patient interviewing communication skills. METHOD: This new program was inspired by experiences gathered in previous medical language teaching and integrates the method of the "Standardized Patient Program". The method has been applied in America since the 1960s. RESULTS: This is the first time the program has been introduced in Hungary and implemented in an interdisciplinary design, where medical specialists, linguists, actor-patients and medical students collaborate to improve professional, language and communicative competence of the students. CONCLUSION: A course like this has its pivotal role in the medical training, and as a result more efficient and patient-oriented communication may take place at the clinical setting. Orv Hetil. 2017; 158(26): 1022-1027.

The time of sunrise and the number of hours with daylight may influence the diurnal rhythm of acute heart attack mortality.

We investigated whether the time of sunrise and the number of daylight hours have an effect on the seasonality, or the daily rhythm of heart attack mortality. We analyzed retrospectively data of patients admitted to hospitals with the diagnosis of heart attack (n=32,329) and patients who deceased of a heart attack (n=5142) between January 1, 2004 and December 31, 2005 in Hungary. Heart attack mortality was highest during winter, while lowest number of events was recorded during summer . The daily peak of diurnality was between 6:00 am and 12:00 pm (33.77%). A positive correlation was found between the time of sunrise, time of sunset and the mortality caused by myocardial infarction (p<0,01). In the analysis of the number of daylight hours and the heart attack mortality we found a negative correlation (r=-0.105, p<0.05). No significant difference was found between sexes and different age-groups in heart attack mortality. Our data suggest, that the occurrence and the mortality of heart attack may be related to the time of sunrise and the number of daylight hours.

Effect of the removal of the Fallopian tube during hysterectomy on ovarian survival: the orphan ovary syndrome.

OBJECTIVE: The objective was to assess the long-term impact on ovarian survival of removing the Fallopian tube during hysterectomy. STUDY DESIGN: We modified our standard operative policy by adding the option of removing the Fallopian tube, thus leaving an "orphan" ovary behind. In a follow-up study, we identified 82 patients who had undergone hysterectomy followed by a second operation for an adnexal condition. In 45 there was presence and in 37 there was absence of the Fallopian tube. Data analysis included the time interval between hysterectomy and the occurrence of adnexa-related complaints; diagnoses prior to and the type of the second surgery; histological diagnosis after and the success rate of the second surgery. For statistical analysis, Kruskal-Wallis One-Way ANOVA on Ranks and the Mann-Whitney Rank Sum Test were used. RESULTS: In 35.5% of patients with an intact Fallopian tube, hydrosalpinx developed. Cystic degeneration of orphan ovaries occurred significantly earlier than that of the "regular" adnexae group (50.0 months vs. 84.2 months, p=0.031). Laparotomy and laparoscopy for second surgery showed equal success rates. CONCLUSION: Removal of the Fallopian tube at abdominal hysterectomy decreases the incidence of the development of pelvic masses later, but causes earlier cystic degeneration of the remaining ovaries.