Sexual dysfunction after colpectomy and vaginal reconstruction with a vertical rectus abdominis myocutaneous flap.

BACKGROUND: The use of the vertical rectus abdominis myocutaneous flap in reconstruction after abdominoperineal resection or pelvic exenteration for neoplasia is well documented. However, functional outcomes after vaginal reconstruction, including sexual function, are poorly described. OBJECTIVE: This study aimed to examine sexual function in women following extensive pelvic surgery with colpectomy and vaginal reconstruction with the use of a vertical rectus abdominis myocutaneous flap. DESIGN: This study is a retrospective review of medical records in combination with patient questionnaires. Nonresponders were followed up with a second contact. SETTINGS: This study was performed at a tertiary care university medical center (Colorectal Section, Department of Surgery P, Aarhus University Hospital, Denmark) PATIENTS: All women undergoing pelvic surgery and simultaneous vaginal reconstruction with the use of a vertical rectus abdominis myocutaneous flap between 2004 and 2010 at our department were identified from a patient database. Thirty women who were alive at the time of identification were included in the study. MAIN OUTCOME MEASURES: Sexual function before and after surgery was evaluated by the use of the Sexual function Vaginal changes Questionnaire. The main outcome end point was whether the patient was sexually active after vaginal reconstruction. RESULTS: Twenty-six participants (87%) answered the questionnaire. Fifty percent of patients reported an active sex life before surgery. In general, patients reported an unchanged desire for both physical and sexual contact after surgery. However, only 2 patients (14%) reported being sexually active after surgery. LIMITATIONS: This was a retrospective study with a heterogeneous cohort involving several types of cancers and surgical procedures. Factors other than vertical rectus abdominis myocutaneous flap reconstruction itself may interfere with the sexual function. CONCLUSION: Extensive pelvic surgery with colpectomy leads to sexual dysfunction even when the vagina is reconstructed with a vertical rectus abdominis myocutaneous flap. This knowledge may improve the quality of information given to this group of patients before surgery.

Genetic predisposition to long telomeres is associated with increased mortality after melanoma: A study of 2101 melanoma patients from hospital clinics and the general population.

Whether there is an association between measured and genetically predicted telomere length and melanoma mortality is unclear. We tested the hypothesis that measured and genetically predicted telomere length is associated with mortality after a melanoma diagnosis. We followed 2,101 patients with melanoma from hospital clinics and the general population for risk of death for up to 26 years. All had telomere length measured in DNA from leukocytes, and 2052 of these were genotyped for the three single nucleotide polymorphisms rs7726159 (TERT), rs1317082 (TERC), and rs2487999 (OBFC1); all three genotypes are associated with telomere length and combined into an allele count from 0 to 6. For each telomere-lengthening allele, the hazard ratios (HRs) for mortality in the age-adjusted and multivariable-adjusted Cox analysis were 1.12 (95% confidence interval: 1.02-1.23) and 1.11 (1.01-1.23). However, for each standard deviation increase in measured telomere length, HR for mortality was 0.97 (0.88-1.08). In conclusion, in more than 2000 melanoma patients from hospital clinics and from the general population, genetically predicted long telomeres were associated with increased mortality, but measured leukocyte telomere length was not.

Measured and genetically predicted plasma YKL-40 levels and melanoma mortality.

PURPOSE: High plasma levels of YKL-40 might be associated with mortality in patients with melanoma, and it is unknown if YKL-40 is causally related to mortality. EXPERIMENTAL DESIGN: We studied two cohorts: 2618 patients with melanoma from hospital clinics and 1413 general population patients with melanoma, totalling 4031 patients followed up for mortality end-points for up to 20 years. All were genotyped for CHI3L1 rs4950928, highly predictive of lifelong plasma YKL-40, and plasma YKL-40 levels were measured in 2165 patients. We tested the hypotheses that measured and genetically predicted high plasma YKL-40 are associated with increased mortality in patients with melanoma. RESULTS: For the hospital melanoma cohort, age- and sex-adjusted hazard ratios for death in individuals with measured plasma YKL-40 in the 96-100th percentile versus 1-95th percentile and per 10-percentile increase were 1.52 (95% confidence interval, 1.07-2.16) and 1.07 (1.02-1.11), respectively, most pronounced for patients with localised melanomas. Each C-allele of the CHI3L1 rs4950928 genotype was associated with plasma YKL-40 level increases of 32% in the hospital melanoma cohort (p = 6 × 10-48) and 43% in the general population melanoma cohort (p = 7 × 10-13). Multifactorially adjusted ratios for these increases in the combined cohorts were 1.04 (1.00-1.09) observationally for measured plasma YKL-40 and 0.98 (0.86-1.12) for the genetically predicted plasma YKL-40. CONCLUSION: Measured, but not genetically predicted, increasing plasma YKL-40 was associated with increased mortality in patients with melanoma. Plasma YKL-40 is a marker but less likely to be a cause of increased mortality in patients with melanoma.

[Sentinel lymph node biopsy in patients with cutaneous malignant melanoma]. / "Sentinel node"-diagnostik hos patienter med kutant malignt melanom.

INTRODUCTION: In the Department of Plastic Surgery of Odense University Hospital patients having cutaneous melanoma from 1 to 4 mm underwent sentinel lymph node (SLN) biopsy. The aim of this study was to evaluate results and complications. MATERIAL AND METHODS: During the first three years one hundred and sixteen patients underwent SLN biopsy, one patient was excluded from the study. All patients were operated in general anaesthesia and followed according to recommendations of the Danish Melanoma Group. RESULTS: Median follow-up was 16 months. 76% had negative SLN and 24% had positive SLN. No significant difference was recorded in median thickness in the two groups. In two patients SLN were false negative; in both patients the primary melanoma was located in the face. The complication rate was 8.5%. DISCUSSION: We conclude that SLN biopsy is a reliable method in staging the regional lymph nodes and determining the need of elective lymphadenectomy and that our results match the ones of international standard.

[Penile malignant melanoma of the glans penis]. / Penilt malignt melanom på glans penis.

We present the case of a patient with malignant melanoma of the glans penis, which was found in a 53-year-old man with two pigmented lesions on penis. The patient was referred to partial surgical excision of the glans. The defect was covered with a full-thickness skin graft followed by left inguinal lymphadenectomy as second procedure by which a melanoma metastasis was found. The patient was well-being until two years after the surgery, when a metastatic melanoma was discovered in his right lung and in his liver. Early diagnosis is of paramount importance, as the prognosis becomes very poor if the tumour stage is advanced.