Conservative management of endometrial cancer: a survey amongst European clinicians.

OBJECTIVE: To investigate differences and similarities in the clinical approach of young clinicians managing women with endometrial cancer (EC) conservatively. METHODS: A web-based survey was carried out. A platform of the European Network of Young Gynaecological Oncologists (ENYGO) database was used. A 38-item multiple-choice questionnaire was used to evaluate current practice in fertility-sparing management of EC. The survey covered investigations, treatment options, follow-up and management of recurrence and future family planning. Descriptive statistics were used. RESULTS: Overall, 116 out of 650 (17.84%) ENYGO members responded to the survey. In 92 (79.3%) centres, the caseload of early stage EC treated conservatively was less than 10 per year. One hundred and seven responders (93.8%) believe that treatment with progestins could be offered in grade 1 EC without myometrial invasion, but a minority would recommend it even for grade 2 tumours with no myometrial invasion or grade 1 with superficial invasion. The diagnostic tool for establishing grade of tumour was hysteroscopy with dilatation and curettage in 64 (55%) centres. Medroxyprogesterone acetate represents the most commonly prescribed progestogen (55, 47.4%). In 78 (67.2%) centres, a repeat endometrial biopsy was offered after 3 months of treatment commencement. Recurrences are treated mostly with hysterectomy (81, 69.9%) with only a small number of responders recommending to repeat progestin treatment. Lynch syndrome is a contraindication for conservative management in half of the responders (57, 49.1%). Most clinicians agree that patients should be referred promptly for assisted reproductive techniques once complete response has been achieved (68, 58.6%). CONCLUSIONS: Our study shows that conservative management is increasingly offered to women affected by early stage EC wishing to preserve their fertility. Further studies and joint registries are required to evaluate safety and effectiveness of this approach in this probably growing number of patients.

Current situation in gynecological oncology training in Spain: where we are and where we want to go.

BACKGROUND: It is important to know what a young gynecologic oncologist perceives as a need to achieve a good training in gynecologic oncology. OBJECTIVE: This study aims to evaluate the level of training in gynecologic oncology in Spain. METHODS: A Web-based anonymous questionnaire was sent via e-mail to Spanish trainees listed in European Network of Young Gynecological Oncology (ENYGO). The survey was developed in four sections: (1) general training in gynecologic oncology, (2) distribution of current clinical activity, (3) surgical training, and (4) perspective future gynecologic oncology. It contained 51 questions, with multiple-choice answers that had to be answered by the ENYGO members. RESULTS: The questionnaire was sent to 64 people listed in the ENYGO database. Of these, 37 members responded (response rate of 58%). Overall, more training in surgery is necessary, to perform radical oncological surgeries. It is claimed a sub-specialty recognition, to ensure an equalitarian and homogeneous training.

Incidental (Prophylactic) Salpingectomy at Benign Gynecologic Surgery and Cesarean Section: a Survey of Practice in Austria.

Introduction: Most serous ovarian cancers are now thought to originate in the fallopian tubes. This has raised the issue of performing incidental salpingectomy (also called elective, opportunistic, prophylactic or risk-reducing salpingectomy) at the time of benign gynecologic surgery or cesarean section. We conducted an online survey to ascertain the policies regarding incidental salpingectomy in Austria in late 2014. Material and Methods: All 75 departments of obstetrics and gynecology in public hospitals in Austria were surveyed for their policies regarding incidental salpingectomy at benign gynecologic surgery or cesarean section. Results: Sixty-six of 75 surveyed departments completed the questionnaire, resulting in a response rate of 88 %. Overall, 46 of 66 (70 %) units reported offering or recommending incidental salpingectomy at benign gynecologic surgery, 12 units (18 %) did not, and eight units (12 %) did not have a consistent policy. Salpingectomy was the preferred method for surgical sterilization, including sterilization at the time of cesarean section (71 % and 64 % of units, respectively). Conclusions: Incidental (elective, opportunistic, prophylactic, risk-reducing) salpingectomy is now widely offered at benign gynecologic surgery and cesarean section in Austria. Evidence for the role of the fallopian tubes in the origin of serous pelvic cancer has led to changes in clinical practice.

The Decreasing Length of Hospital Stay following Vaginal Hysterectomy: 2011-2012 vs. 1996-1997 vs. 1995-1996.

Background/Definition of the Problem: In recent years, postoperative management has changed towards rapid mobilisation, early oral feeding and rapid rehabilitation (known as Fast-Track or Enhanced Recovery Concepts). This study analysed the postoperative length of stay after vaginal hysterectomy in 3 different periods of time. Material and Methods: In the period October 2011 - September 2012, 75 patients underwent vaginal hysterectomies (± adnexectomy); another 114 vaginal or laparoscopic hysterectomies with additional operations (e.g. prolapse surgery and incontinence surgery) and malignancies were not included. The time periods August 1995 - July 1996 (n = 50) and October 1996 - September 1997 (n = 96) served as a comparison. Reducing the length of stay was not an explicit goal. Results: The median postoperative stay was shortened from 7 (5-9) to 5 (3-15) or 3 (0-5) days (p < 0.001). The recovery rate remained unchanged at 2.7 % (n = 2), cf. 2 % (n = 1) and 3.1 % (n = 3). In 40/75 cases (53.3 %), the surgery took place on the day of admission. Conclusion: The length of hospital stay after vaginal hysterectomy has more than halved since 1995/1996 and continues to decline. This development occurred without a shortened stay being an explicit goal of the clinic. The shortened length of stay does not appear to have a negative impact on postoperative complications and recovery rate.

[Septic arthrodesis of the talocrural joint]. / A septicus felsö ugróízület arthrodesise.

Authors report on 20 arthrodeses of the talocrural joint performed in infected surrounding. The accident anamnesis was the following: Talar fracture (3 cases), malleolar fracture (10 cases), "pylon tibial" fracture (7 cases). The operative method was a simple transversal resection and fixation with fixateur externe. The average time of bony fusion was 9.9 months. The patients were controlled in average 3.8 years after the operation. 17 patients could be controlled, all of them could walk. 6 have their original jobs, 4 have an easier work, 7 are invalids. 12 patients have no pains, 5 have major or minor complaints. All patients judge their state as being better than before the operation.

[Management of dislocated subcapital fractures of the humerus by intramedullary wiring]. / A felkar dislocalt subcapitalis töréseinek kezelése velöürdrótozással.

Author treated 24 subcapital dislocated humeral fractures with wire fixation of the medullary cavity. The fractures were classified according to Neer. The operation was begun in general anaesthesia with closed reduction; the fixation was made with K-wires through the bone window prepared on the dorsal side of the humerus, above the fossa olecrani. Gymnastics were begun on the 2-3 week. The results were assessed using the point system of Neer. Functional restitution followed in 2-4 months in every patient.

[Results of treatment of infected osteosynthesis cases]. / Inficiált osteosynthesiseink kezelési eredményei.

At the author's Department 70 infected osteosyntheses were treated. The preliminaries of infection were in 48 cases open, and in 22 cases closed fractures. The original stabilisation was performed in 48 injuried with plates, in 12 cases with intramedullary nails and in 10 other patients with various methods. In 12 cases healing of the infection was reached in a short time. In 58 cases the infection became chronic. In 34 cases the fractures healed in spite of persistant infection, in 24 cases infected pseudarthrosis developed. To reach healing or the definite state frequently more operations were needed. Finally it succeeded to heal both the infection and the fracture in 62 patients. Fistula, resistant to treatment remained in 7 patients.

Aimed application of antibiotics in treating hand infections.

Surgical exploration is of prime importance in treating hand infections. In addition, it is essential to apply up-to-date and adequate antibiotic treatment. Authors employed antibiotics during the treatment of hand infections of 65 various aetiologies and types by considering the antibiotic sensitivity spectrum of the most frequent pathogens as also the effective concentration of the antibiotic acting in the inflammatory focus. For assessing effective antibiotic concentrations, samples were collected during exploration from the inflammatory tissues, and based on their assessments, it was pointed out that an adequate inhibitory antibiotic concentration cannot be reached by each antibiotic by applying it in the usual dose and way. The use of certain antibiotics is recommended in view of the most frequent pathogens of hand infections, of the spectrum of the antibiotic selected by the authors as well as in that of the measured tissue antibiotic concentrations in the dosage used by them. The effective application as well as dosage are also published. Regarding that, in practice, antibiotic treatment should be started according to the nature of the disease without knowing the spectrum of resistance and the pathogen, it is considered important for them to select initially, beside the surgical treatment, an antibiotic which is probably effective and is capable of entering in a sufficient amount the focus of inflammation.

[Model studies of the antibiotic release of gentamycin, tobramycin and cephalothin polymethylmethacrylate beads in vivo]. / Modellversuche zur Antibiotikaabgabe von Gentamycin-. Tobramycin- und Cephalothin-Polymethylmethacrylatkugeln in vivo.

Gentamycin-, tobramycin-, and cephalothin-polymethylmethacrylat beads were implanted into a bone cavity of the rabbit tibia. The antibiotic release of the implants was observed by measure of the antibiotic concentration of the secretion respectively of the neighbouring bone tissue in the surroundings of the beads produced by punction. An antibiotic concentration about 1 microgram/ml could be measured with gentamycin and tobramycin for 120 to 150 days and with cephalothin for 30 to 50 days in the surroundings of the beads.

[Intra-arterial antibiotic therapy in the management of chronic post-traumatic osteomyelitis of the extremities (experimental and clinical studies]. / Intraarterielle Antibiotikatherapie in der Behandlung der chronischen posttraumatischen Osteomyelitis der Extremitäten (Experimentelle und klinische Untersuchungen).

Authors examined the changes of antibiotic concentration in the inflammatory focus after administering Gentamycin and Cephalothin intravenously or intraarterially in case of experimentally induced osteomyelitis in the tibia of rabbit. Administering Gentamycin i. v. no therapeutic level could be measured, while Cephalothin showed a therapeutic level of antibiotic concentration just for a short period. When the same doses of these antibiotics were administered in the femoral artery, effective local antibiotic concentration could be detected for 3 hours. Authors' clinical studies also support these experimental results. Performing 43 i. a. treatments in 38 patients with osteomyelitis 39 was rated as effective.