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Both the urethra passes through the prostate and during ejaculation, semen empties into the urethra and comes out of the urethra.

Lateral Section of Male Urogenital System

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The prostate is an essential organ like our eyes and ears, being only in men, and is at the exit of the urinary bladder, just below the urinary bladder and in front of the rectum (last part of the large intestine). Its main function is related to reproduction and it is a gland of 18-20 grams about the size of a walnut. Both the urinary canal (urethra) and the semen excretory ducts pass through it. The semen passes through the prostate and is eliminated into the urethra.

The importance of the prostate is due to the fact that it secretes a large part of the liquid called semen and that there are some substances in this liquid that give activity and mobility to the sperm and protect the sperm. Approximately 5-10% of the semen that comes out with ejaculation is composed of sperm cells, the remainder is composed of fluids from other glands (Seminal gland, Prostate and Bulbourethral gland) and which keep the sperm alive in the female reproductive organs. If there is a problem in prostate secretion, sperm movements and vitality will be impaired, so there may be a problem in conceiving a child, it might cause infertility.

The prostate enlarges in most of the men with aging, generally outward growth and inward growth, i.e. condensation of the urethra, the larger the prostate, the more difficult it is to urinate. When the prostate rises above its normal size, it does not follow similar path in every man. In some men, there is an enlargement of the urethra passing through the prostate, however, in some men there is an enlargement into the bladder. In this type of enlargement, while the prostate appears slightly enlarged on ultrasound images, serious complaints might occur in the patient. In cases where the prostate enlarges outward, if the urethra is not condensated, the patient does not complain the same even though the prostate is very large. When evaluating the prostate in male patients, we do not only look at its enlargement in volume, but mainly at the level of condensation of the urinary tract and difficulty in urination. The patient might have an outwardly enlarged prostate, if he has no difficulty in urination, and if the urinary tests and cancer screening tests are normal, the patient is usually monitored at 6-month intervals. Complaints about Prostate Enlargement:

  • A frequent need to pee,
  • Straining to pee,
  • Needing to get up frequently in the night to pee,
  • Needing to pee urgently, leaking urine,
  • Having the weak flow of of urine,
  • Not being able to pee at all
  • Swelling of the bladder

Getting a Diagnose of Prostate Enlargement

The diagnosis of prostate enlargement is get by blood and urine tests, ultrasonography, urine flow test (uroflow) and tests that are not disturb the patient in any way.

If the patient has persistent higher PSA despite antibiotic and anti-inflammatory treatment, if a nodule is identified in the prostate during rectal examination or ultrasound examination, it is certained whether there is a possible prostate cancer by performing a Multi-Parametric Prostate MRI examination and, if necessary, a Prostate Needle Biopsy under the guidance of Transrectal Prostate Ultrasound.

Because the treatment of benign prostate enlargement (BPH: Benign Prostatic Hyperplasia) is different, the treatment of prostate enlargement is different due to prostate cancer.

Both BPH and prostate cancer might be carried on one patient. Treatment might be diffirent according to condensation of urethra or stage of the disease. It is recommended that every man over the age of 40, whether or not they have urinary problems, need to visit a Urologist at least once a year for a prostate examination and PSA test. These check-ups are important, especially in people having prostate cancer in their first-degree relatives (father, brother). Because men having relatives with prostate cancer the risk of developing prostate cancer is 2-6 times higher than other men.

Benign Prostatic Hyperplasia Treatment (BPH)

BPH treatment divided into two groups as medical treatment and surgical treatment

In BPH treatment first aproach of treatment need to be medical treatment. Other treatments need to applied when medical treatment fails.

Purpose of drugs treatment, is to relieve the flow of urine, the drug groups used for this purpose and briefly their mechanisms of strenghts are as follows:

1-    Alpha Blockers:

Drugs in this group increase the urine flow rate by relaxing the smooth muscles in the bladder outlet and prostatic urethra, i.e, they provide more comfortable urination. (Tamsulosin, Terazosin, Alfuzosin, Silodosin, Doxazosin)

Since these drugs also relax smooth abdominal muscles, they cause hypotension.

Most known side effects:

1- Orthostatic Hypotension (Sudden drop in the blood pressure and darkening when sudden standing up, therefore it is recommended to stand up slowly)

2- Retrograde ejaculation (the semen cannot be eliminated, one has an orgasm, but because the bladder outlet is loosened, the semen is empjeculated into the bladder and then excreted from the urine)

3-Drugs that cause a decrease in prostate volume act by inhibiting alpha reductase and preventing the transformation of testosterone to di-hydro testosterone. (Drugs with active ingredients are Finasderid, Dutasteride)

4- A plant extract, sabal extract, is also sometimes used in medical treatment.

5- If urinary infection is identified, appropriate antibiotic treatment is administered according to the results of the culture-antibiogram test.

Surgical treatment are administered when medical treatment is not enough.This methods are followed as briefly:

Open Prostatectomy

Transurethral resection (TUR) is done with bipolar energy, plasmokinetics energy or monopolar energy

Laser Enucleation applied transurethrally is done with HOLEP-Holmium Laser.

Transurethrally applied Laser Vaporization is done with Vaporization-KTP, Diode, Thulium Laser

The most recently administered treatment; Transperineal Prostate Laser Ablation Treatment. In this method, we administer laser directly into the prostate with fine needles, painlessly placing laser fiber tips into the prostate without any surgery. Since it is administered with local anesthesia, it is safely administered to elderly patients with severe disease. This practice has been started in our clinic.

It is also possible to treat prostate cancer with this method. Cancerous cells that are get early and have not metastasis beyond the prostate are treated much more easily by laser burning than other treatment methods.

In other treatment methods of prostate cancer, the entire prostate (neoplasm and cortex) is removed together with the seminal sacs. This procedure is called Radical Prostatectomy. The procedure is applied with one of the Open Surgery, Robotic Surgery, Laparoscopic Surgery methods. Depending on the pathology result, other treatments such as radiotherapy, hormonal therapy and chemotherapy are applied if necessary.

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Endoscopic View Of Enlargement Prostate

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TUR Prostatectomy Schematic View

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Laser Prostatik Vaporizasyon (Buharlaştırma) şematik görünüm

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Lazer Vaporizasyon sonrası prostatik üretranın endoskopik görünümü



The best treatment method is EDSWT in men who have erectil dysfunction.

EDSWT (ERECTIL DISFONCTION SHOCK WAVE THERAPY) : is a treatment that has no surgery, anesthesia, hospitilization, painless, needing aproaximetly 45 minutes, administering with a special device penis and around the penis.

It has two methods that applied:

  1. Electrical shock waves formed by the piezo-electric system
  2. Magnetic shock waves formed by the Electro-Magnetic system

In our hospital EDSWT theraphy is applied with NOVAMEDTEK brand device (Novamed ED60), which creates magnetic shock waves, with a linear applicator

It is administered 6 clinics, totally, twice a week for 3 weeks. (ex: Monday- Friday)

In every clinic a total of 3000 shock waves are given to the penis and its circumference by making 7500 shock wave shots from each focus in 4 foci.

A total of 18,000 shots are made in 6 sessions.

Addition to EDSWT theraphy PRP theraphy is recommended and supported with medical treatment. 3 months later, patient come for checking and if it is necessary 1 more EDSWT and PRP treatments cure are applied.

The main problem in Erectile Dysfunction is the consentating of the veins coming to the penis due to various reasons and therefore the erection problem as a result of the inability of sufficient blood go to the erection bodies of the penis for erection.

Erectile Dysfunction is seen more often in one who is over 40 year-old, has diabet, prostate disease, get Radical Prostatectomy operation because of prostate cancer, undergo radiotherapy to pelvic area, has hypercholesterolemic, hypertension, cardiac trouble and vascular disease, smokes and drinks alchol, is obese, has psychological problems.

EDSWT is a new theraphy method developed for erectile dysfunction, which is seen approximately 50% of over 40 year-old men.

In the scientific researches, has been proven that the magnetic shock waves made by the Novamed ED 60 device treats the insulted vascular internal structure and form new microveins (NEOENDOTELIZATION and ANGIOGENESIS) through stem cells, therefore increasing  the blood flow in the penis and treating the main cause of the erection dysfunction.

Erection Dysfunction is more successfull when it is applied with EDSWT theraphy and PRP  theraphy and medical theraphy

PRP (PLATELET Rich Plasma), is a plasma fluid getting from one’s own blood.

Approximately 5 cc of PRP liquid is get by treating 15cc of blood taken from one with the help of the filters and centrifuge in the disposable PRP kit. There are intensely platelets and growth factors (PDGF, VEGF, TGF-alpha and TGF-beta) in the PRP fluid. PRP fluid is given to the erectile bodies of the penis (Corpus Cavernosum = Cavernous Body) with an insulin injector needle. When PRP liquid is injected into the diseased area, it repairs this area, heals tissue, neoplasm, and rejevunates the stem cells in these tissues. However, PRP treatment is not directly a STEM CELL treatment.

In the reaction problem that occur due to organic reasons, the occlusion of the capillaries in the penis, cell death due to aging, called apoptosis, increasing collage tissue instead of dying cells, development of fibrosis, the erection function and elasticity of the penis are destroyed. The capillaries in the cavernous bodies that provide hardening are decreased. And smooth muscles are replaced by hard, inelastic hard fibrotic tissues. Therefore, the hardening of the penis and its ability to maintain its hardness is destroyed.

Injecting the PRP liquid into the cavernous body providing erection of the penis, providing new veins, providing erection (ANGIOGENESIS), regeneration of tissues, (REGENERATION) and rejuvenation.

In erectile dysfunction, PRP theraphy is applied once in two days, totally 3 clinics. Maintenance therapy as a single dose at 3, 6 and 12 months increases efficacy.

In erectile dysfunction treatment both EDSWT and PRP are effective methods. Scientific researchs show that treatment is more efficent when these two methods is applied together.

First, by applying ESWT treatment, micro-traumatic, stimulating areas are made in the cavernous bodies with shock waves, and the platelets start to repair this area and start the new vein formation process.

PRP fluid, on the other hand, repairs the damaged areas in the cavernous body with higher efficiency, since it is a fluid enriched with platelets (thrombocyte) with the procedures performed.

For this reason, in the treatment of Erectile Dysfunction, we achieve the most effective treatment results with PRP application at the end of EDSWT application.



Urology is the brach of medicine that examines urinary system of women and men and genital system of men.

Urınary system: is a sytem that formed with kidney, urethrea, bladder, ureter

Urethrea is approaximetly 3-5 centimetres. It is between bladder and the end of the vagina. In men it is between tip of penis and bladder, It is approaximetly 20-25 centimetres. It goes through end of the baldder and continues in the penis.

The branch of urology gets a diagnose and treats diseases of urinary system of men and women, also genital system of men (penis and testicles).

The branch of urology, besides open surgeries, also performs closed surgeries based on modern technological methods such as endoscopy and laporoscopy. We can classify these attempts as follows.

  1. ANDROLOGY ( Treatment and Diagnosis of Sexual Dysfunctions of Men)
  • Men Interfility
  • Erectil Dysfunciton, Medical and Interventional Treatment (EDSWT- Shockwave Therapy- PRP Therapy),
  • Premature Ejeculation
  • Maleformation in penis and curvature ( Peyronie’s disease)
  • Varicocele (varicose veins in the testicle) surgical and medical treatments (Treatment of varicocele with MICROSURGERY using intraoperative doppler under microscopic vision)

2.Endoüroloji

  • Kidney, ureter, bladder, disease of prostate, endoscopic (closed) surgeries and treatments.Böbrek, üreter, mesane, prostat hastalıkları (stone, tumor, stenosis)
  • Diagnostic Cystoscopy, ureterorenoscopy procedures
  • Ureteroscopic (closed) removal of kidney, ureter and bladder stones using laser (URS-RIRC)
  • Transrectal Prostate Guided Biopsy procedure with Fusion Biopsy technique in prostate diseases.
  • Endoscopic (closed) Prostatectomy operations with Laser or Bipolar system in prostate diseases
  • Laparoscopic kidney, bladder and prostate surgeries
  • Non-surgical prostate treatment using laser (Trans Perineal Laser Prostate Ablation Treatment TPLA)
  • Treatment of laser burning of the cancer applied without removing the prostate in prostate cancer (focal ablation in prostate cancer-organ preserving micro-invasive surgery)
  1. Woman Urology- Urogynecology
  • Medical and surgical treatments of incontinence
  • Bladder, rectum and uterine prolapse surgeries
  • TOT, TVT surgeries
  1. Urologic Oncology
  • Open and endoscopic (closed) surgeries and medical treatments of kidney, bladder, prostate, testicle tumors
  1. Pediatric Urology
  • Undescended testis
  • Medical and surgical treatments of hypospadias, vesicoureteral reflux, enuresis nocturna, enürezis nokturna, hydrocele, bubonocele, circumcision

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Hiccups and sneezing are very common in newborns.

Hiccups occur as a result of contraction of the diaphragm muscle, which separates the chest cavity from abdominal cavity. Vocal cords are pushed nearer during contraction, which results in the characteristic hiccup sound.

Occurring frequently in the first months of life and less frequently until the age of 1 year, hiccup is a natural reflex, indicating that the infant is full, and everything is normal with her stomach growing and digestive system developing normally. It can usually occur when the stomach is full after feeding, when she cannot pass gas properly, when she swallows air, at times of rapid temperature change and when she is excited. The common conception that “belly is growing” is not completely unfounded. Hiccups start as early as the fourth gestational month in the mother’s womb, as the first respiratory action and hiccups after parturition help the development of heart and lungs. Hiccups are usually not a source of discomfort for infants, but are surely bothersome for parents. When the infant is unable to fall asleep due to hiccups, making her swallow may eliminate the spasm of the diaphragm muscle. If it persists, rub your finger on a lemon and have your infant taste it. Such unfamiliar and sour taste will cause a shock, making her hold her breath for a few seconds which may resolve the diaphragm spasm and cure the hiccups.

Sneezing, especially when it happens after bathing your baby, may cause concern that the baby may have gotten cold. You might be compelled to turn up the heater to make it extra warm in the apartment, putting on layers over layers of extra clothing to keep her warm, putting a hat on her head, which would in turn make the air dryer in the apartment. Dry air dehydrates the mucosa in the airways causing cracks, and microbes may contaminate these cracks causing illness. And the culprit would be falsely identified as “the baby got cold after bathing.” Which in turn compels the mother to bath the bay once a week during winter months to avoid illness. Getting cold is not a cause of illness; but microbes are. And sneezing is an indication that her tiny nose is clogged up and a reflex to help her unclog it. Infants’ tiny nostrils can get blocked very easily, causing difficulty breathing and nursing, as the baby must breathe through the nose when feeding. A few years back, I had received a phone call from a postpartum mother: “Nurse Ayşe, I had attended one of your seminars, and I had not problems beginning breastfeeding. But for the past two days, my baby is not taking my nipple. I have plenty of milk, and he advised I should harvest my breast milk and feed it using a baby bottle. But she won’t take the baby bottle also, so we are feeding her with a spoon.” I asked them to come for a visit, thinking that perhaps they were doing something wrong so I could try assisting her with breastfeeding the baby. When they showed up, I could tell from the way the baby was breathing that her nose was clogged up.

I applied a few drops of saline into her nose and cleaned her nose with a nasal aspirator. After that, the boor thing began breastfeeding and did not stop for nearly an hour! As you can imagine, infants are unable to clean nasal secretions like we can, and so mucus dries and crusts blocking the nose especially in winter months. And they might reach by sneezing even when someone opens the door and comes inside, as their tiny and sensitive noses can be easily blocked with the dirt and dust of this new world. Therefore, I would recommend cleaning her nose frequently with saline and a nasal aspirator to help her breathe and breastfeed easily. Because they are in lying position most of the time and nasal secretions flow back into the nasal passage, she may sometimes breathe noisily. Don’t be alarmed with the wheezing sound. They cannot clear their throat, like we can, by coughing away the secretions, and in this case also, saline can help eliminate the wheezing sound. If she has sniffles, however, it may be important, as the Eustachian tube has a large opening into the nasal passage while the tube itself is short. And because the infant is usually lying on her back, sniffles may increase the secretions which may flow into this canal and cling on the walls, providing an attractive spot for microbes and bacteria to grow, leading to an ear infection. Ear infections require attention in young infants. Because the ear is very close to the brain, inflammation may spread to the meninx, leading to meningitis. By applying nasal lavage with saline around the clock will prevent the secretion to become thicker, turning to a greenish color, and cling on the ear canal. Also, it may be advisable to place a pillow to raise her head a bit to help the secretion flow downward, and not toward the ear canal. You might notice some mucus in her stool during this time, but it is nothing to worry about; nasal secretion is also excreted in feces.


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It is a type of convulsion which is accompanied by fever. It is the most common type of childhood convulsions. It is usually seen in children aged 6 months to 5 years, and most frequently in the 18-22 month old age group. Familial inheritance is suspected.
Convulsion may manifest with loss of consciousness, eyes rolling back, blue lips, stopping breathing, muscle contractions in all or some parts of the body and urinary or fecal incontinence. Body temperature rises to 38.5°C or higher before or after convulsion.
Febrile convulsion usually lasts short, in most cases lasting for less than 3 minutes and ending by the time a doctor is consulted. In a quarter of patients, the first sign of fever may be febrile convulsion.
Convulsions lasting less than 15 minutes and not recurring within 24 hours are classified as simple convulsion.

Recurrence Risk of Seizures
• Experiencing the first febrile convulsion at less than one year of age
• History of epilepsy or febrile convulsion in first-degree relatives
• Having frequent infections
• Convulsion occurring at slightly higher body temperature (less than 40°C)
• Time between rising body temperature and convulsion is less than 2 hours
• Warnings for family members:
• Febrile convulsion may involve familial predisposition
• Febrile convulsion is not an epileptic seizure
• Risk of recurrence is lower after three years of age
• Short-lasting febrile convulsions do not cause brain damage
• Vaccination is not a risk factor

Febrile Convulsion May Recur at a Rate of 1/3, in which case:
• Lay the patient on a flat surface on their side
• Do not attempt to restrain the patient
• Do not attempt to open the jaw, arms and legs during the convulsions
• Do not feed anything orally
• Do not have the patient smell onions or other substances
• Do not pour cold water on the patient; however, a warm shower may be useful.


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• Those who exercise must consume a varied diet of healthy nutrients to increase their performance.
• There are six main categories of nutrients: carbohydrates, fats, proteins, vitamins, minerals and water.
• Nutrients have three major functions: supporting growth and development, providing energy, and regulating the metabolism.
• Those who exercise must consume at least 2-3 servings of milk, yoghurt, cheese, 2-3 servings of meat, fish, beans, eggs and dried nuts, 3-5 servings of vegetables, 2-4 servings of fruits, 6-11 servings of bread, cereals, rice and pasta.

• Key carbohydrate sources that those who exercise must consume include bread, cereals, rice and pasta.
• Those who exercise should maintain a steady blood glucose level. They should consume foods rich in complex carbohydrates to keep their muscle glycogen reserves full.
• Those who exercise must consume an appropriate (moderate) level of proteins. Overconsumption of protein will not increase muscle mass.
• Intake of fatty foods should be limited, as they take longer to consume and are harmful if consumed in excessive amounts.
• Antioxidant vitamins, i.e. A, C and E, are particularly important for those who exercise intensively. They help cleanse the body of toxins that are generated during heavy exercise.
• Iron, calcium and zinc are highly important for those who exercise.
• You do not need additional vitamins, minerals or food supplements if you are eating an adequate and balanced diet.
• It is best to consume a varied diet, mainly composed of plant sources, limiting intake of animal-derived nutrients.
• It is imperative to always strike a balance in any choice of diet.
• Diet should be built on carbohydrate-rich nutrients. It is best to consume cereals and cereal derivatives, like bread and pasta, a few times a day. As shown in the nutrition pyramid, cereals and cereal derivatives should make up the basis of all meals. According to World Health Organization recommendations, more than half of daily energy intake should come from these groups of foods, as they are low in fat and rich in nutrients and active nutrients. The nutrients in this group make a significant contribution to intake of proteins, dietary fibers, minerals (i.e. calcium, potassium and magnesium) and Vitamin B.
• To increase fiber intake, try to eat whole-wheat bread, pasta and other cereal products.
• Do not avoid carbohydrates. They are a key source of energy for the organism, and they have lower energy compared to fats. A gram of carbohydrates provides 4 calories, whereas a gram of fat provides 9 calories.
• Foods with fiber have numerous benefits and they are rich in complex carbohydrates. Dietary fibers, which belong in this group of carbohydrates prevents constipation and diverticulitis, helps prevent hemorrhoids and reduce blood cholesterol. They also play a key role in regulating bodyweight.
• Prefer fresh vegetables and fruits (at least 400 grams a day). Most of us do not eat enough of these foods, but they provide basic micronutrients (like minerals and vitamins) which are essential to proper working of our organism. In particular, fresh vegetables and fruits are rich in iron, calcium, magnesium, potassium, vitamins A and C, folic acid, vitamin B6, dietary fibers, essential nutrients and non-nutrient ingredients. Also, vegetables and fruits have lower fat and energy content, i.e. they are “low-energy” foods. Therefore, consuming them in our daily diet reduces the risk of obesity and associated illnesses (e.g. cardiovascular disease, some types of cerebral disorders, certain cancers, type 2 diabetes mellitus).
• Animal-derived foods should be consumed in moderation. Animal-derived foods are not only important for growth and development of children and adolescents, they are also essential for proper functioning of the organism. This group consists of biologically valuable, high-quality proteins and essential amino acids that the organism cannot synthesize. They are also rich in vitamin B12 (which is not available in plant-based foods), iron, magnesium, zinc, chromium and fats.
Fish, which is unfortunately not consumed in sufficient quantities in our diet, are rich in omega 3 fatty acid, which is highly protective against chronic illnesses. It is important to increase our fish consumption.
Low-fat milk and dairy products should be preferred. The foods in this group are a good source of calcium, essential for bone development, and high-quality proteins and vitamins A, D and B. Cheese is a good source of calcium, but it contains a high amount of salt. Therefore, low-salt types should be preferred.
Exercising reduces the bad cholesterol (LDL) and increases the good cholesterol (HDL).
• Consume plenty of fluids. Water is a vital substance, which must be consumed in sufficient quantities, i.e. at least 2 liters per day for adults, up to 3 liters minimum during times of hot weather or intensive physical activity. Plain water is both a tasty and healthy source of fluids. Fruit juices, milk, tea, coffee and nonalcoholic beverages are also good choices for satisfying the need for fluids.
• Reduced water in the body when exercising diminished performance.
• Those who exercise should consume 100 ml of water every 15-20 minutes.
• Cool, plain water is the best beverage for those who exercise.
• You should not wait until feeling thirsty to drink water.
• Check the color and volume of your urine to determine whether you are sufficiently hydrated.
• Take your weight before and after exercise to determine the amount of fluid lost, and replenish it by drinking the same amount of water. To increase fluid intake, you should consume fluids throughout the day and eat plenty of vegetables and fruits which are rich in fluid content. Plain water is the best beverage for those who exercise. Besides water, other beverages like milk, ayran, juices and soups are also useful for hydrating our body. On the other hand, tea and coffee is not retained and quickly excreted. Tea and coffee consumption should be minimized as far as possible. Caffeinated foods and beverages (e.g. coffee) should be avoided. Caffeine stimulates urine production and causes dehydration, besides the inconvenience of a full bladder.
Fluid intake should be increased before, during and after exercise. Drink 2-3 glasses of water to fill up the fluid reserves 2 hours before starting exercising. And drink half a glass of water every 15-20 minutes during exercise. Make sure everyone has a separate water bottle. The water lost during exercise should be replenished, which is why you must drink plenty of water after exercise. Consume at least 8-10 glasses of water every day. Water loss is higher during hot and humid weather, and therefore you must try and drink more water during hot and humid days. Record your weight before and after exercise to determine the weight loss, and drink water to compensate for it. Athlete’s beverages may be used during prolonged exercises or competitions. These beverages contain 6 to 8% of carbohydrates and electrolytes that athletes lose during exercise, and are suitable for prolonged endurance exercises (e.g. running, swimming, cycling). However, instead of athlete beverages, you may also dilute fruit juice half and half to obtain the carbohydrates needed during exercise. For instance, you can add 200 ml of water to a bottle of commercially available 200 ml apple juice and use it during exercise. Also, you can mix 12-15 sugar cubes, half a spoon of salt and some lemon juice in a liter of water to obtain a beverage similar to what athletes use.
Do not wait to feel thirsty to drink water, because the sensation of thirstiness dissipates when the body is severely dehydrated. Anyhow, you can determine whether you are sufficiently hydrated by checking the color of your urine: if your urine is dark colored, you are dehydrated, or if it is light colored, your body is sufficiently hydrated. Also, urinating less frequently than usual, it may also be a sign of dehydration. Drink plenty of water to prevent dehydration. Avoid taking in more energy than what you have expended.
If your energy intake is high, i.e. “you eat more than you burn,” your body mass increases, which may cause chronic illnesses over time. We have failed to preserve our traditional dietary habits and instead, adopted ill-advised “new lifestyles,” consuming the diets that go along with them (e.g. hamburgers, pizzas, fries) while abandoning walking and cycling, instead using motorized transports. We move much less, sit in front of the computer or TV during on our free time.
A healthy bodyweight can be achieved only by consuming adequate amounts of healthy foods, as shown in the nutrition pyramid, and by exercising daily. A healthy bodyweight is dependent on various factors, including sex, height, age and heritable factors. Growing body mass is a risk factor for various diseases, such as heart disease and cancer. Fat forms in the body when we consume more energy than we burn. Such extra energy intake may result from overconsumption of proteins, fats, carbohydrates or alcohol. However, fats are the highest source of energy. Physical exercise is not only a good way to consume energy, it makes us feel better. It has been shown that walking daily at a brisk pace (@6 km/60 minutes) is sufficient to maintain a daily balance of energy. Daily walks can be completed in several shorter sessions. The same effect can be achieved by cycling for 30-60 minutes, swimming or other sports, or jogging.
• Check your bodyweight and body composition: “Body Mass Index (BMI)” should be in the range of 18.5 to 25 kg/m2. You can calculate your BMI using the formula: BMI = weight (kg) / height (m)2 to check if your bodyweight is normal. Example: a person who is 160 cm tall and weighing 55 kg has a BMI of 55/(1.60)2 ) 21.4, which is in the normal range. However, BMI is not an accurate indicator of proper bodyweight for individuals who exercise regularly and heavily (e.g. athletes). Individuals with a large muscle mass would have a higher-than-normal BMI, although they may not be overweight (e.g. 26). This is a common occurrence among athletes. Therefore, body composition (fat percentage) should be also accounted for. If body fat percentage and bodyweight are both high, the person needs to exercise and adopt a diet under dietitian supervision, with a target of losing 0.5 to 1 kg a week. It is inadvisable to exceed this rate of weight loss.
• Consume a balanced diet. If you can keep your servings at an adequate level, you may eat anything you wish, without having to exclude specific foods from your diet. If eating out, share your servings with a friend.
• Eat frequently. Skipping meals, particularly breakfast, would lead to eating more at subsequent meals, and cause reduced work output and uncontrolled hunger. Eating snacks between meals may help satisfy hunger, but must be eaten in moderation so as not to replace a regular meal.

WHAT IS A HEALTHY DIET FOR ME?
A healthy diet means consuming an adequate and balanced mixture of essential macronutrients (carbohydrates, proteins, fats) and micronutrients (minerals and vitamins) which are required to maintain proper functioning of our body. Our diet must meet our nutrition needs to support normal growth and development in children and adolescents and correct functioning of organs, both at rest and when exercising. The quality of a diet, the quantities consumed and the timing of meals affect exercise performance. Taking care to eat a variety of foods ensures adequate intake of essential vitamins and minerals. While there is not a magic formula, essential elements of diet to support good performance and wellbeing include the following:
• Eat adequately to meet energy need
• Obtain energy mainly from carbohydrates
• Regulate foods and drinks to meet carbohydrate needs during and after performance
• Eat a varied diet to meet protein, vitamin and mineral needs
• Take an adequate amount of fluids to maintain hydration
• Take care with using dietary supplements.

Ask yourself the following for a healthy life:
How many main meals and snack meals do you have?
Have you ever considered which nutrients you eat in your daily diet (at breakfast, lunch and dinner)?
How much fresh fruits and vegetables do you consume on a daily basis, and how does that compare to the optimal level?
How active are you physically in your free time?

WHICH DIET IS BEST?
The nutrients that we consume are essential to providing the energy that we need to support our heart, brain, liver and other organs and to maintain life support functions, such as breathing. We do not sit all the time; we move, change locations and work, all of which require energy. A good and popular metaphor is a car: can it run without fuel?
The energy which is essential to our being is mainly provided by sugar (carbohydrates). Only in situations where carbohydrates is not available may fats (lipids) can be used as a source of energy. Fats essentially provider energy, but they also carry vitamins A, D, E and K, which are soluble in fat. Energy may only be obtained from proteins. For normal growth, development and proper functioning of organs, our organism also needs vitamins and minerals.
The studies have shown that our eating habits are not particularly healthy and require improvement. Available data, combined with anthropometric measurements, suggest a grim public health outlook for our societies. Based on BMIs, more than 50% of people are overweight, and nearly a half have high blood pressure.
Studies have shown that exercise regulates high blood pressure.
Considering that only 15% of the population engages in exercise for at least 30 minutes 2 times a month, the picture on unhealthy eating habits and physical activity is indeed grim.


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Obviously, breast milk is a miraculous nutrient for newborns; in fact, calling breast milk merely a nutrient does not do it justice. Not a day passes without a study reporting new findings of the benefits of mother’s milk. A study published in June 2015 has shown that incidence of leukemia was significantly reduced in infants who were breastfed for at least 6 months compared to those who were not breastfed, or fed breast milk for a shorter period of time. The study reported that the incidence of leukemia, accounting for 30% of childhood cancers, was 19% lower in children who were breastfed for at least 6 months. Scientists have various hypotheses to explain this situation, including mainly the protective role of immune system components which are transferred to the infant by breast milk.

Besides the often-reported new information on the benefits of mother’s milk, let us remember WHO and UNICEF recommendations on breastfeeding.

• Infants must receive only breast milk and nothing else, not even water, for the first 6 months.
• Assistance should be provided to the postpartum mother to begin breastfeeding as soon as possible.
• No supplements should be recommended during infancy, unless medically indicated.
• Pacifiers should be withheld until the infant is 3 to 4 weeks old and able to properly suck on the nipple.
• The sleeping place of the infant should be close to the mother.


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It is important to know how to safely and properly store harvested breast milk. Let us look at some dos and don’ts:

What type of a container should I use to store harvested breast milk? You can use a glass or plastic bottle with a cap, washed in dishwasher or with soap and hot water and rinsed well, to store harvested breast milk. If you are unsure about the quality of the washing water, you may boil the bottle after washing.

If you are harvesting breast milk to use within three days, you may also use plastic bags specifically designed for storing milk. However, using plastic bags for long-term storage is not recommended, as they may leak and are more susceptible to bacterial contamination compared to containers made of hard materials. Also, long-term storage in a plastic bag may cause some of the materials in the milk to cling on the bag, depriving your infant from valuable nutrients.

How Best to Store Harvested Breast Milk? You may store harvested breast milk in a refrigerated or deep freezer. Be sure to affix the container with a water resistant label and ink and note the date and time of harvesting. Place the containers in the back most part of the refrigerator or freezer where it is the coldest. Use the oldest stored milk first.

To minimize waste, the amount of milk stored in each container must not be more than how much your infant consumes at a time. Also, for contingencies and delays in feeding, store some milk in smaller quantities (25-50 grams). Remember that breast milk expands when frozen, and avoid filling up the container to the brim.

Can I Add Freshly Harvested Milk to Previously Stored Milk? You may add freshly harvested milk to refrigerated or frozen milk, as long as it has been harvested the same day. Before adding freshly harvested milk to previously harvested milk, be sure to cool it in the refrigerator or cooling box for at least one hour. Do not add warm breast milk to frozen milk, as it may cause it to thaw. Store milk harvested on different days in separate containers.


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Raynaud Phenomenon is considered to be a nonobstructive vascular disease. It may be linked with certain rheumatismal conditions or it may develop independently. It usually manifests with reduced or decelerated blood circulation in hands and feet, causing a sensation of coldness, pain, bruising, tingling sensation or coldness. Blood vessels contract in cold weather to preserve heat, and it lasts longer in persons who are affected by this condition.

STRESS MAY ALSO CAUSE IT!
Smoking, severe emotional stress and cold are known triggers of this disease. Additionally, long-term medications may also cause it as a side effect. In particular, some migraine and headache medications, which were commonly used in the past, and some older generation heart medications may also induce this disease. Typically, patients with this condition are younger than patients with obstructive vascular conditions. It may affect youths undergoing heavy psychological burden of academic tests or work, or even children in some cases. It is more common in populations living in cold regions, or working in low temperature conditions. In some cases, manifestations of Raynoud may be severe with serious complications, akin to those of late-stage obstructive vascular disorders. Both medicinal and surgical treatments are possible, and 90% of symptoms can be preempted by taking appropriate measures. If complaints persist despite precautions, it is advisably to promptly see a cardiovascular surgeon.

1. Change Your Habits: Stop tobacco use immediately, including smoking, and avoid smoky locations as far as possible. If having difficulty quitting smoking, you could try alternative methods such as bioresonance therapy, or seek professional help at a smoking cessation center.

2. Change Your Physical Environment: Stay away from cold and low-temperature areas as far as possible. Be sure to wear gloves and thick socks before going out in the cold, minimize contact with cold water, and use oil-based creams that protect from cold. If you must wash dishes or laundry manually, wear gloves at all times. In severe cases, it may be advisable to move to a place with a more temperate climate.

3. Change Your Psychological Condition: You must learn to guard yourself against excessive sadness, excitement or fear, which increases stress. You can begin by using relaxation techniques, and physical and mental exercises. However, if you cannot cope with stress by yourself, you should seek psychological support or, if necessary, psychiatric therapy including medication, if indicated.

4. See a Doctor: See a doctor to ascertain whether the underlying cause is an obstructive vascular disorder, whether there are any concurrent rheumatismal disorders, and ensure that you are not using any medication which may be the culprit for Raynaud.


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According to statistics, one in every 10 women in Europe and one in every 8 women in the USA develop breast cancer. In breast cancer, there are mainly three recommended approaches for early detection: Breast Self Examination (BSE) and Clinical Examination and Mammography.
BSE encourages women to take responsible for their own body, recognize their own anatomy and detect any changes at the early stage. After the age of 20, every woman should self check their breasts within 7 to 10 days after menstruation, or in the case of postmenopausal women, the same day every month.

Clinical examination, i.e. examination by a practitioner, should be a part of regular health checkups for women.
Even if there are no complaints, every women after the age of 20 should see a doctor for clinical examination once every 2-3 years, and after the age of 40, once every year.
Despite its drawbacks, mammography remains to be the best imaging method for breast cancer. Mammography can detect masses which are suspect, but too small to be palpated.

Although breast self examination is important, it should not be overlooked that mammography is the most effective method for early detection of breast cancer. Every woman after the age of 50 should have a mammography once every 2 years. Women with a familial history of breast cancer, or are otherwise at risk for breast cancer should have a mammography at the age and frequency as recommended by their doctor.

If any suspect masses are found in the breast, biopsy is used for definitive diagnosis. Biopsy is conducted under imaging-guidance using a special needle to collect a small piece from the tumor. For very small tumors, the tumor is marked and resected completely.

After making a diagnosis of breast cancer, the stage of the disease and whether it metastasized to other organs should be also investigated. Sentinel Lymph Node Biopsy is the new golden standard for staging and treating breast cancer.
Sentinel lymph node biopsy allows for staging of breast cancer patients during therapy with minimal side effects. The “first” lymph node in the armpit is identified and examined surgically, and it may not be necessary to resect all lymph nodes.

To properly plan treatment, the physician must know the stage of disease, which is a measure of the tumor size and how much or whether it has metastasized.
Staging may involve X-ray imaging and laboratory testing to determine whether the cancer has metastasized, and if so to which organs or tissues. When breast cancer has metastasized, usually cancer cells can be found in the lymph nodes inside the armpit.

Usually, the size of cancer cannot be known until the tumor in the breast and lymph nodes inside the armpit have been surgically removed. The disease is staged from 0 to 4, which also determines the treatment approach.

While the definitive cause of breast cancer is not known, there are some potential risk factors. It is considered that genetic, environmental, hormonal and socio-psychological factors play a role in the disease.

Having a familial history of breast cancer, beginning menstruation at an early age (before the age of 12), entering menopause at a later age, being overweight and in particular, postmenopausal weight gain, smoking and regular consumption of alcohol increase the risk for breast cancer. Marriage and giving birth at a later age, reduced infertility, stress, difficult living conditions, uncontrolled and prolonged intake of hormones, environmental pollution and an imbalanced diet are also suspected to be a factor for higher incidence of disease. Women who have some of these risk factors are more likely to develop breast cancer.

Nevertheless, women who have none of the risk factors may also develop breast cancer. Advanced age is a key risk factor in breast cancer. The frequency of breast cancer in women aged older than 50 years is four-times higher compared to women younger than 50 years of age, hence the importance of regular screening in women aged older than 50 years.

In breast cancer, it is important to detect the disease before onset of symptoms; experiencing symptoms means the disease has already progressed.
The most common signs of breast cancer include palpable masses inside the breast or armpits, changes in the size or form of breasts, bloody exudations from nipples, deformation or discoloration of breast skin or nipples, depression of breast or nipples, palpable masses inside the armpits or neck, despite absence of any palpable masses in the breasts.

“Breast cancer is mainly treated surgically”

In other words, the first-line therapy is surgical intervention, unless it is already too late. In recent years, breast cancer surgery usually involves breast protective surgery.

Thanks to “sentinel lymph node biopsy,” which is becoming more prevalent, it is possible to evaluate whether metastasis exists in regional lymph nodes, which informs the decision to resect or leave armpit lymph nodes.

This not only prevents unnecessary surgery for the patient, it also helps avoid untoward surgical complications which may impair the patient’s quality of life. It is essential to personalize treatment in breast cancer, as with all the other types of cancer.

Ideally, all breast cancer patients should be evaluated by a multidisciplinary team of breast cancer specialists, and the patient should be involved in the treatment decision. Studies have shown that clinical outcomes are improved in patients where treatment was decided in collaboration with the patient.



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