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BACKGROUND: Despite the key role of optimized fasting in modern perioperative patient management, little current data exist on perioperative fasting intervals in routine clinical practice. METHODS: In this multicenter prospective study, the length of pre- and postoperative fasting intervals was assessed with the use of a specifically developed questionnaire. Between 15 January 2021 and 31 May 2022, 924 gynecology patients were included, from 13 German gynecology departments. RESULTS: On average, patients remained fasting for about three times as long as recommended for solid foods (17:02 ± 06:54 h) and about five times as long as recommended for clear fluids (9:21 ± 5:48 h). The average perioperative fasting interval exceeded one day (28:23 ± 14:02 h). Longer fasting intervals were observed before and after oncological or extensive procedures, while shorter preoperative fasting intervals were reported in the participating university hospitals. Smoking, treatment in a non-university hospital, an increased Charlson Comorbidity Index and extensive surgery were significant predictors of longer preoperative fasting from solid foods. In general, prolonged preoperative fasting was tolerated well and quality of patient information was perceived as good. CONCLUSION: Perioperative fasting intervals were drastically prolonged in this cohort of 924 gynecology patients. Our data indicate the need for better patient education about perioperative fasting.
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AIM: The aim of the present study was to evaluate the characteristics of borderline ovarian tumors (BOTs). PATIENTS AND METHODS: Data of 151 patients with BOTs were retrospectively evaluated. RESULTS: A total of 151 cases with BOTs were diagnosed. Histopathological evaluation identified 82.8% with serous, 10.6% with mucinous and 5.3% with mixed histology. Overall, 67.5% had International Federation of Gynecology and Obstetrics (FIGO) stage I, 10.6% FIGO stage II, 14.6% FIGO stage III and 4% FIGO stage IV. A total of 21.9% had peritoneal implants; of which 2.7% were invasive, 17.2% non-invasive and 2% both invasive and non-invasive. Microinvasion was observed in 5.3% and a micropapillary pattern in 12.6%. A total of 12.6% of patients presented second neoplasms. During a median follow-up period of 86 (range=0.1-432) months, there were relapses in 16.8%, of which 52.6% had invasive implants. Overall, 6.2% died of their disease, 28.5% with invasive implants. The median time-to-progression was 48 (range=8-120) months. CONCLUSION: Patients with BOTs have an excellent prognosis. Long-term follow-up is recommended, since recurrence occurs.
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Adenocarcinoma Mucinoso/terapia , Cistadenocarcinoma Seroso/terapia , Neoplasias Primarias Secundarias/terapia , Neoplasias Ováricas/terapia , Adenocarcinoma Mucinoso/mortalidad , Adenocarcinoma Mucinoso/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Cistadenocarcinoma Seroso/mortalidad , Cistadenocarcinoma Seroso/patología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Neoplasias Primarias Secundarias/mortalidad , Neoplasias Primarias Secundarias/patología , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/patología , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Adulto JovenRESUMEN
OBJECTIVES: The aim of the study was to assess oncologic and fertility outcome of treatment in patients with cervical cancer of more than 2 cm seeking parenthood. METHODS: The regimen consisted of laparoscopic lymphadenectomy as a staging procedure to confirm no lymph node metastases before neoadjuvant chemotherapy (NACT) consisting of 2 or 3 cycles of paclitaxel/ifosfamide/cisplatin followed by radical vaginal trachelectomy (RVT). Oncologic and fertility outcome was evaluated prospectively. RESULTS: Twenty women were enrolled up to now. The mean age was 32 years (range, 26-41 years), and mean tumor size was 3 cm (range, 2.1-5.0 cm). Lymphadenectomy was performed before NACT without complications. During NACT, hematologic toxicity grade 3 was observed in 2 of 20 patients, and renal toxicity grade 3 in 1 of 20 patients. Radical vaginal trachelectomy was performed in 18 women until now with 2 intraoperative complications (ureter injury and injury of internal iliac vein). There were no severe postoperative or long-term complications. Complete pathologic remission was found in 9 of 18 patients. In 2 of 18 patients, chemoradiation was recommended because of insufficient pathologic response in the RVT specimen. After a mean follow-up of 23 months (range, 1-88 months), 1 relapse was observed. After RVT, 7 women tried to conceive until now. Seven pregnancies occurred in 5 women. Four children were born, 2 of whom were premature (31 weeks 2 days and 33 weeks 4 days of gestation); 1 pregnancy is ongoing. CONCLUSIONS: Laparoscopic lymphadenectomy followed by NACT and RVT in pN0 patients with cervical cancer of more than 2 cm seems to be an oncologically safe procedure with promising fertility outcomes.
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Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Tratamientos Conservadores del Órgano , Resultado del Embarazo , Neoplasias del Cuello Uterino/cirugía , Adenocarcinoma/tratamiento farmacológico , Adulto , Antineoplásicos/administración & dosificación , Femenino , Fertilidad , Estudios de Seguimiento , Humanos , Recién Nacido , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos , Terapia Neoadyuvante , Embarazo , Resultado del Tratamiento , Neoplasias del Cuello Uterino/tratamiento farmacológicoRESUMEN
Recently antibodies against neuronal receptors have been identified as cause of a new type of encephalitis. The anti-N-methyl-D-aspartate receptor (anti-NMDA-R) encephalitis is the prototype of these disorders. Patients have a high incidence of teratomata. Removal of teratoma is considered the essential treatment of anti-NMDA-R encephalitis. Here, we aimed to investigate whether neurologically asymptomatic individuals suffering from ovarian teratomata may have positive anti-NMDA-R antibodies to be detected by an established assay. Over a time period of 15 months, all patients suffering from ovarian teratomata without neurological symptoms were included in this prospective study. Twenty consecutive patients were pair matched to patients with other benign ovarian disease and healthy controls. Preoperatively, patients had a gynaecological examination, transvaginal ultrasound, neurological examination and determination of anti-NMDA-R antibodies. None of the patients or controls presented with neurological symptoms. All tumours could be removed completely by laparoscopy. Anti-NMDA-R antibodies were absent in the group of patients with teratomata as well as in patients with benign ovarian tumours and healthy controls. Testing for anti-NMDA-R antibodies revealed negative findings in well-characterised patients with ovarian teratomata lacking neurological symptoms. Our data support the current clinical practice that a systematic screening for anti-NMDA-R antibodies in teratoma patients is not indicated.
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Autoanticuerpos/sangre , Neoplasias Ováricas/sangre , Receptores de N-Metil-D-Aspartato/inmunología , Teratoma/sangre , Adulto , Animales , Cerebelo/metabolismo , Femenino , Células HEK293 , Haplorrinos , Hipocampo/metabolismo , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/inmunología , Estudios Prospectivos , Ratas , Estudios Seroepidemiológicos , Teratoma/inmunologíaRESUMEN
OBJECTIVE: : Our aim was to present our initial clinical experience using a novel exoscopically based colposcopy system (VITOM) for the evaluation of cervical, vulvar, and vaginal diseases. MATERIALS AND METHODS: : Women referred to the Charite Cervix Center, Charite University, Berlin, Germany, were included. Patients with abnormal Pap smear results, vulvar lesions, or a biopsy report of neoplasia of the lower genital tract were included into the study. The VITOM was used for colposcopic evaluation and directed biopsies. Colposcopic findings were reported according to the criteria of the Committee on Nomenclature of the International Federation of Cervical Pathology and Colposcopy. Histologic diagnosis was described as normal, low-grade lesion, high-grade lesion (including cervical intraepithelial neoplasia 2,3, vulvar intraepithelial neoplasia 2,3, vaginal intraepithelial neoplasia 2,3), or cancer. RESULTS: : We recruited 76 patients (54 with cervical, 4 with vaginal, and 18 with vulvar disease) to the prospective study. Four patients were pregnant. Of patients with cervical disease, 29% had a history of previous conization and 3.7% had a history of trachelectomy. The sensitivity, specificity, negative predictive value, and positive predictive value of the VITOM for cervical intraepithelial neoplasia 2, 3 were 90%, 77%, 90% and 77%, respectively. Concordance of exocolposcopic impressions and histologic results was higher in high-grade lesions (K = 0.68, 95% CI = 0.32-0.87, p < .001) than in low-grade lesions (K = 0.41, 95% CI = 0.1-0.41, p < .05). CONCLUSIONS: : Exocolposcopy with the VITOM is accurate and shows good correlation to histologic findings in high-grade disease of the lower genital tract. The potential advantages include patient and trainee involvement in examination, decision making, and documentation.
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Colposcopía/métodos , Enfermedades del Cuello del Útero/diagnóstico , Enfermedades Vaginales/diagnóstico , Enfermedades de la Vulva/diagnóstico , Adulto , Anciano , Berlin , Biopsia , Femenino , Histocitoquímica , Humanos , Persona de Mediana Edad , Embarazo , Estudios Prospectivos , Enfermedades del Cuello del Útero/patología , Enfermedades Vaginales/patología , Enfermedades de la Vulva/patologíaRESUMEN
OBJECTIVE: The lymph node number as benchmark in oncologic operations depends on the patient's anatomy, surgeon's skill and pathologist's accuracy. The influence of the pathologist is barely evaluated. METHODS: A retrospective analysis of lymph node numbers after 700 laparoscopic lymphadenectomies in correlation to the examining pathologists was done. Three surgeons from the same department performed all operations at 2 campi, where 2 separate pathology institutions exist. Lymph node specimens were assigned randomly to any of the 62 involved pathologists. RESULTS: The mean number of lymph nodes was equal for all surgeons. Lymph node specimens were analyzed in the pathology institute of campus I and II in 416 and 284 cases, respectively. The mean number of lymph nodes following pelvic and para-aortic lymphadenectomy was 36 at campus II and 30 at campus I (p < 0.0001). There was also a significant difference for pelvic (19.9 vs. 17.7; p < 0.0001) and para-aortic lymph node counts (16.2 vs. 14.1; p < 0.01) between both pathology institutes. At campus II, 22.6% of lymph node counts did not meet the oncologic standard for pelvic and 16.7% did not meet the standard for para-aortic lymph nodes. Moreover, at campus I, 35.5 and 20.8% of pathologists described less than the oncologic limit of pelvic and para-aortic lymph nodes, respectively. CONCLUSION: The number of removed lymph nodes is not an absolute parameter for surgical radicality. Interdisciplinary cooperation with pathologists is mandatory to meet oncologic standards.