Reproductive and hormonal considerations in women at increased risk for hereditary gynecologic cancers: Society of Gynecologic Oncology and American Society for Reproductive Medicine Evidence-Based Review.

Providers who care for women at risk for hereditary gynecologic cancers must consider the impact of these conditions on reproductive and hormonal health. This document reviews potential options for cancer prevention, family building, genetic testing and management of surgical menopause in this patient population.

Reproductive and Hormonal Considerations in Women at Increased Risk for Hereditary Gynecologic Cancers: Society of Gynecologic Oncology and American Society for Reproductive Medicine Evidence-Based Review.

Providers who care for women at risk for hereditary gynecologic cancers must consider the impact of these conditions on reproductive and hormonal health. This document reviews potential options for cancer prevention, family building, genetic testing and management of surgical menopause in this patient population. Capsule: Women predisposed to hereditary gynecologic cancer have options for fertility preservation, preimplantation genetic testing to select embryos without pathogenic variants, pregnancy through gestational carriers after hysterectomy and hormone replacement.

Needs Assessment in Care of Adults With Anorectal Malformations and Exstrophy-Epispadias Complex in Germany.

Introduction: Medical needs of adults with anorectal malformations (ARM) and the exstrophy-epispadias complex (EEC) are not fully understood. Therefore, the aim of the study was to evaluate how affected individuals get along with the current national medical care and what their medical or social long-term requirements are. Patients and Methods: Between 11/2014-07/2016 all adult members (≥18 years, ARM n = 113, EEC n = 126) of the German self-help organizations SoMA e.V. and Blasenekstrophie/Epispadie e.V. were contacted via email or post and asked to fill out an anonymous online questionnaire regarding medical requirements, treatment satisfaction, daily life impairment and expectations regarding physicians soft skills. The results were compared between both groups and male and female participants. Results: 56 participants with ARM (median age 26 years, IQR 19-38) and 52 participants with EEC (median age 31 years, IQR 22-37) filled in the questionnaire completely. Forty-five percent of the ARM and 67% of the EEC participants contacted an urologist. A general surgeon was visited by 23% of the ARM individuals, a peadiatric surgeon by 20%. Although 60% of the females with ARM and 82% of the females with EEC assessed gynecological counseling as helpful or neutral, a small subgroup of ARM females (n = 6, 16%; 70% non-isolated ARM or ARM with Hirschsprung disease and additional associated anomalies) were not satisfied. The majority of both groups reported no or only minor daily life impairment (p = 0.38). Professional knowledge, paying attention to patients' concerns, having empathy and taking enough time was important for over 90% of all participants. Thirty-eight percent of the ARM and 27% of the EEC individuals needed psychological support. Most medical consultations were judged to be helpful. Conclusion: Although adults with ARM and EEC being a self-help organization member and thus well informed and generally cope well, participants expressed their wish for expert counseling regarding family planning, reconstructive procedures, continence management, urological care and social welfare issues. Furthermore, specific expert consultations for gynecological issues in a subgroup of ARM females, mainly non-isolated, might be required. Actual needs of adults with rare conditions must be better clarified to improve medical care beyond childhood and adolescence.

The Effect of Nasal Packing Removal on Patients Anxiety.

AIM: We aimed to investigate the effect of removal of merocel nasal packings on patients anxiety after septoplasty using Hamilton Anxiety Scale. MATERIAL AND METHODS: Total amount of 50 patients who had septoplasty operation in the Department of Ear, Nose and Throat Clinic of our hospital were enrolled to the study. Patients anxiety determined using Hamilton Anxiety Scale. The patients anxiety levels were measured before 24 hours before the operation (Group 1), 48 hours after operation before nasal packing removal (Group 2) and 60 minutes after nasal packing removal (Group 3). RESULTS: Patients were evaluated according to the Hamilton Anxiety Scale; in Group 1 15.3 ± 7.2, 19.3 ± 7 in Group 2, 14.6 ± 6,5 in Group 3 was measured. CONCLUSION: There was no statistically significant difference between Groups 1 and 3. There is a statistically significant difference on patients anxiety levels 48 hours after operation before nasal packing removal (p<0.001). There is an statistically significant increase of patients anxiety before packing removal. We recommend using soluble packings or sewing techniques without nasal packings after septoplasty because of patient comfort after operation.