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1.
J Hepatol ; 66(3): 610-618, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27894795

RESUMO

BACKGROUND & AIMS: Few data exist on predictors of long-term prognosis in patients with alcoholic liver disease (ALD). Most studies have only assessed short-term prognosis in patients with advanced ALD. We aimed to assess the prognostic impact of clinical, biochemical and histological parameters on long-term prognosis in patients with early/compensated and decompensated ALD. METHODS: Consecutive patients (n=192) with biopsy-proven liver disease due to alcohol abuse were analyzed retrospectively. Prognostic factors were evaluated in patients with early/compensated ALD (n=60) and in patients with decompensated ALD (clinical decompensation and/or bilirubin >3mg/dl at entry) (n=132). Factors that predict long-term survival were identified using Cox regression models. RESULTS: Liver-related mortality at 5years was 13% in early/compensated and 43% in decompensated ALD. In early/compensated ALD patients, long-term prognosis was determined by fibrosis stage, but not by clinical or biochemical variables. Severe fibrosis (F3/4) was present in 52% and had a major impact on 10-year mortality (F3/4: 45% vs. F0-2: 0%, p<0.001). In contrast, in decompensated patients, a combination of clinical features (sex), biochemical markers of liver failure (bilirubin, international normalized ratio [INR]), and histological features (pericellular fibrosis) predicted long-term survival. During follow-up, abstinence from alcohol was an important predictor of survival in both early/compensated and decompensated ALD. CONCLUSION: Fibrosis stage is the main predictor of long-term survival in patients with early/compensated ALD, while clinical, biochemical and histological parameters predict survival in patients with decompensated disease. Promoting abstinence may improve survival in patients with both early and advanced ALD. LAY SUMMARY: In this study, we evaluated long-term outcome in 192 patients with alcoholic liver disease who underwent liver biopsy: 60 patients with early disease (no symptoms) and 132 patients with advanced disease (jaundice, complications of cirrhosis). Importantly, half of the patients with 'early' disease already had severe fibrosis or cirrhosis on liver histology and dismal outcome (45% mortality at 10years). Abstinence from alcohol improved the prognosis in both early and advanced stages of the disease.


Assuntos
Abstinência de Álcool , Hepatopatias Alcoólicas/patologia , Hepatopatias Alcoólicas/psicologia , Adulto , Idoso , Bilirrubina/sangue , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Hepatopatias Alcoólicas/metabolismo , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Adulto Jovem
2.
Exp Dermatol ; 26(3): 263-269, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27623398

RESUMO

Little is known about the immunomodulation by tick saliva during a natural tick bite in human skin, the site of the tick-host interaction. We examined the expression of chemokines, cytokines and leucocyte markers on the mRNA levels and histopathologic changes in human skin biopsies of tick bites (n=37) compared to unaffected skin (n=9). Early tick-bite skin lesions (<24 hours of tick attachment) were characterized by a predominance of macrophages and dendritic cells, elevated mRNA levels of macrophage chemoattractants (CCL2, CCL3, CCL4) and neutrophil chemoattractants (CXCL1, CXCL8), of the pro-inflammatory cytokine, IL-1ß, and the anti-inflammatory cytokine, IL-5. In contrast, the numbers of lymphocytes and mRNA levels of lymphocyte cell markers (CD4, CD8, CD19), lymphocyte chemoattractants (CXCL9, CXCL10, CXCL11, CXCL13, CCL1, CCL22), dendritic cell chemoattractants (CCL20), and other pro- (IL-6, IL-12p40, IFN-γ, TNF-α) and anti-inflammatory cytokines (IL-4, IL-10, TGF-ß) did not differ from normal skin. With longer tick attachment (>24 hours), the numbers of innate immune cells and mediators (not significantly) declined, whereas the numbers of lymphocytes (not significantly) increased. Natural tick bites by Ixodes ricinus ticks initially elicit a strong local innate immune response in human skin. Beyond 24 hours of tick attachment, this response usually becomes less, perhaps because of immunomodulation by tick saliva.


Assuntos
Mordeduras e Picadas/imunologia , Citocinas/genética , Imunidade Celular , Ixodes/imunologia , Saliva/imunologia , Adolescente , Adulto , Idoso , Animais , Antígenos CD/metabolismo , Biópsia , Mordeduras e Picadas/genética , Mordeduras e Picadas/patologia , Estudos de Casos e Controles , Quimiocinas/genética , Células Dendríticas/imunologia , Feminino , Humanos , Imunidade Inata , Linfócitos/imunologia , Macrófagos/imunologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/imunologia , RNA Mensageiro/metabolismo , Pele/imunologia , Pele/patologia , Fatores de Tempo , Adulto Jovem
3.
J Sex Med ; 13(2): 253-9, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26782607

RESUMO

INTRODUCTION: Genital human papillomavirus (HPV) infections are very common in women 18 to 30 years old and substantially affect women's sexual health. AIM: To examine sexual activity, psychosexual distress, and fear of progression in women diagnosed with HPV-related precancerous genital lesions. METHODS: In this observational study, women diagnosed with premalignant lesions of the cervix, vagina, or vulva were recruited from a university hospital-based colposcopy clinic. MAIN OUTCOME MEASURES: Quantitative data from three validated patient-administered questionnaires (Sexual Activity Questionnaire, German version of the Cervical Dysplasia Distress Questionnaire, and Fear of Progression Questionnaire) were compared within the study population, according to the location of the genital lesion, and with relevant reference populations. Qualitative data from two written open-ended questions about women's thoughts regarding diagnosis and information were analyzed. RESULTS: Two-hundred nine women completed the questionnaires. Seventy-eight percent of women (n = 162) were referred for evaluation of suspect lesions of the cervix, 8% (n = 17) of the vagina, and 14% (n = 30) of the vulva. There were no significant differences in questionnaire results among the three patient groups, except for sexual consequences (Cervical Dysplasia Distress Questionnaire) and recent sexual activity (Sexual Activity Questionnaire). Women with vulvar lesions were most likely to worry about sexual consequences (ie, being unable to have children, being sexually less attractive, or infecting a sexual partner; P = .04). The Sexual Activity Questionnaire subscales sexual pleasure (P = .15) and sexual habits (P = 1.00) were similar to those in a healthy control population, whereas sexual discomfort (P = .51) was comparable to that in a reference population of women who survived cervical cancer. The subscale partner-specific concerns (Fear of Progression Questionnaire) was similar to that in a reference population of patients with cancer (P = .28). CONCLUSION: HPV-related precancerous genital lesions, especially of the vulva, are likely to cause concerns about sexual health. Effective information and communication are important to lessen negative sexual consequences and anxiety.


Assuntos
Ansiedade/diagnóstico , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/psicologia , Lesões Pré-Cancerosas/psicologia , Disfunções Sexuais Psicogênicas/diagnóstico , Displasia do Colo do Útero/psicologia , Adulto , Ansiedade/etiologia , Ansiedade/psicologia , Medo , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/fisiopatologia , Educação de Pacientes como Assunto , Disfunções Sexuais Psicogênicas/epidemiologia , Disfunções Sexuais Psicogênicas/psicologia , Parceiros Sexuais , Infecções Sexualmente Transmissíveis , Inquéritos e Questionários , Neoplasias do Colo do Útero/epidemiologia , Saúde da Mulher , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/fisiopatologia
4.
Clin Exp Hypertens ; 37(2): 108-15, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-24785704

RESUMO

BACKGROUND: The cardiotonic steroid marinobufagenin (MBG) is increasingly suggested to be responsible for some of the cardiovascular injury that has been previously attributed to aldosterone. We examined the clinical correlates of circulating MBG concentrations in hypertensive patients and tested the hypothesis that MBG serves as a reliable diagnostic tool for detecting primary aldosteronism (PA). METHODS: Plasma MBG concentrations (mean: 0.51±0.25 nmol/l) were measured in the morning fasting samples in 20 patients with PA and 20 essential hypertensive (EH) controls matched for age, sex, body mass index, renal function, urinary sodium and intake of antihypertensive medication (mean age: 51.6 years; 52.2% women). RESULTS: Overall, plasma MBG was directly correlated with plasma aldosterone, aldosterone to active renin ratio (AARR), diastolic blood pressure, mean carotid intima-media thickness, serum sodium, urinary protein to creatinine ratio and inversely with serum potassium levels. Plasma MBG levels were significantly higher in patients with PA compared to EH (mean: 0.68±0.12 versus 0.35±0.24 nmol/l; p<0.001). ROC analysis yielded a greater AUC for plasma MBG compared to the AARR, PAC and serum potassium levels for detecting PA. Youden's Index analyses yielded the optimal plasma MBG cut-off score for diagnosing PA at >0.49 nmol/l with specificity and sensitivity values of 0.85 and 0.95, respectively, which were higher than those at the optimum AARR cut-off at >3.32 ng/dl/µU/ml. CONCLUSIONS: In a well-characterized cohort, values of plasma MBG were significantly related to clinical correlates of cardiovascular and renal disease. Plasma MBG emerged as a valuable alternative to the AARR for screening of PA.


Assuntos
Bufanolídeos/farmacocinética , Hiperaldosteronismo/tratamento farmacológico , Hipertensão/tratamento farmacológico , Aldosterona/sangue , Pressão Sanguínea/efeitos dos fármacos , Bufanolídeos/uso terapêutico , Espessura Intima-Media Carotídea , Hipertensão Essencial , Feminino , Seguimentos , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/fisiopatologia , Hipertensão/sangue , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Renina/sangue , Estudos Retrospectivos , Resultado do Tratamento , Vasoconstritores/farmacocinética , Vasoconstritores/uso terapêutico
5.
Clin Chem Lab Med ; 52(6): 825-33, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24406288

RESUMO

BACKGROUND: Although fetal blood sampling for pH is well established the use of lactate has not been widely adopted. This study validated the performance and utility of a handheld point-of-care (POC) lactate device in comparison with the lactate and pH values obtained by the ABL 800 blood gas analyzer. METHODS: The clinical performance and influences on accuracy and decision-making criteria were assessed with freshly taken fetal blood scalp samples (n=57) and umbilical cord samples (n=310). Bland-Altman plot was used for data plotting and analyzing the agreement between the two measurement devices and correlation coefficients (R²) were determined using Passing-Bablok regression analysis. RESULTS: Sample processing errors were much lower in the testing device (22.8% vs. 0.5%). Following a preclinical assessment and calibration offset alignment (0.5 mmol/L) the test POC device showed good correlation with the reference method for lactate FBS (R²=0.977, p<0.0001, 95% CI 0.9 59-0.988), arterial cord blood (R²=0.976, p<0.0001, 95% CI 0.967-0.983) and venous cord blood (R²=0.977, p<0.0001, 95% CI 0.968-0.984). CONCLUSIONS: A POC device which allows for a calibration adjustment to be made following preclinical testing can provide results that will correlate closely to an incumbent lactate method such as a blood gas analyzer. The use of a POC lactate device can address the impracticality and reality of pH sample collection and testing failures experienced in day to day clinical practice. For the StatStrip Lactate meter we suggest using a lactate cut-off of 5.1 mmol/L for predicting fetal acidosis (pH<7.20).


Assuntos
Análise Química do Sangue/instrumentação , Parto Obstétrico , Monitorização Fetal/instrumentação , Sistemas Automatizados de Assistência Junto ao Leito , Couro Cabeludo , Feminino , Sangue Fetal/química , Humanos , Concentração de Íons de Hidrogênio , Ácido Láctico/sangue , Gravidez
6.
Int Urogynecol J ; 25(8): 1023-30, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24819327

RESUMO

BACKGROUND: We conducted a prospective randomized controlled noninferiority trial to compare objective and subjective outcomes of retropubic tension-free vaginal tape (TVT) with those of transobturator tape (TVT-O) as primary treatment for stress urinary incontinence (SUI) in women. STUDY DESIGN: The study was conducted at 25 gynecology units in Austria and Germany; regional and academic hospitals participated. A total of 569 patients were randomly assigned to undergo TVT or TVT-O. RESULTS: A total of 480 patients (85%) were examined at 3 months. A negative cough stress test with stable cystometry to 300 ml was seen in 87% of patients after TVT and in 84% after TVT-O; 64% and 59% of patients, respectively, reported no pad use, and 88% of patients in both groups considered themselves much or very much better on the Patient Global Impression of Improvement (PGI-I) scale. Quality of life (QoL) as assessed with the SF-12 Health Survey, Kings' Health Questionnaire, (KHQ), and EuroQol-5D (EQ-5D) was significantly improved in both arms, with no differences between arms. There were no significant differences in postoperative pain or complications. CONCLUSIONS: Results of this trial demonstrate noninferiority between TVT and TVT-O with regard to postoperative continence and QoL and suggest little difference in perioperative problems (ClinicalTrials.gov NCT 00441454).


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Absorventes Higiênicos , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Slings Suburetrais/efeitos adversos , Inquéritos e Questionários , Resultado do Tratamento
7.
Clin Oral Investig ; 17(1): 45-53, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22290063

RESUMO

OBJECTIVES: This study aims to evaluate the long-term success and stability of periodontal tissue around extensive one-piece prostheses supported by natural teeth in periodontally compromised maxillae. MATERIALS AND METHODS: A total of 28 fixed dental prostheses (FDPs) fabricated by different technologies were inserted in 28 patients with a history of chronic periodontitis after successful periodontal treatment. Subsequently, a program of supportive periodontal therapy (SPT) was instituted. Clinical parameters were evaluated in each patient after insertion of the FDP and during a follow-up examination. RESULTS: The reported follow-up examinations took place after a mean clinical service of 75.7 (9.9­232.7) months. Probing depths had remained essentially unchanged by that time (2.6 ± 0.8 mm at baseline versus 2.7 ± 0.6 mm at follow-up). Significant deteriorations were observed based on plaque index scores (from 24.8% to 33.2%) and bleeding on probing (from 8.5% to 26.2%). One case of framework fracture was noted. CONCLUSIONS: Restorative treatment with extensive one-piece FDPs resulted in long-term stability of the periodontal outcomes. Gingival conditions were shown to deteriorate mildly despite periodic recalls for SPT. An association between deterioration and compliance was observed, suggesting that periodic examinations are essential for maintaining oral hygiene and hence to the success of treatment. CLINICAL RELEVANCE: Given a favorable distribution of potential abutment teeth, treatment with tooth-supported extensive FDPs is desirable even in patients with a history of periodontitis. Removable dentures would involve a number of shortcomings, including functional problems and severe degradation of oral ecology. Tooth-supported FDPs are capable of restoring function, esthetics, phonation, and mastication.


Assuntos
Periodontite Crônica/terapia , Prótese Parcial Fixa , Arcada Parcialmente Edêntula/reabilitação , Maxila/patologia , Adulto , Periodontite Crônica/prevenção & controle , Dente Suporte , Cimentos Dentários/química , Índice de Placa Dentária , Porcelana Dentária/química , Falha de Restauração Dentária , Planejamento de Dentadura , Feminino , Seguimentos , Ligas de Ouro/química , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Higiene Bucal , Cooperação do Paciente , Desbridamento Periodontal , Índice Periodontal , Bolsa Periodontal/prevenção & controle , Bolsa Periodontal/terapia , Estudos Retrospectivos , Preparo Prostodôntico do Dente/métodos , Resultado do Tratamento , Adulto Jovem , Zircônio/química
8.
Int J Gynecol Pathol ; 31(4): 382-6, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22653354

RESUMO

The management of cervical intraepithelial neoplasia is becoming more individualized. The European Federation of Colposcopy has developed guidelines for quality assurance and also certifies specialists. The status of the resection margins of conization specimens is prognostically important and is a quality feature. We examined the rate of positive margins in conization specimens according to the training level of the gynecologic surgeon. We reviewed the hospital charts of 411 consecutive patients who underwent conization for cervical intraepithelial neoplasia or adenocarcinoma in situ between November 2006 and December 2009. Preoperative colposcopy was performed to localize and characterize the transformation zone and the lesion in all cases. Ninety-seven conizations were performed by residents, 138 by staff members, and 124 by 1 certified specialist for colposcopy. A total of 334 cold-knife conizations and 25 loop electrosurgical excision procedures were carried out. The rates of positive histologic margins in conization specimens were 16%, 22%, and 5% for residents, staff members, and the certified specialist, respectively (P<0.001). Expertise of the gynecologic surgeon in performing conization procedures appears to influence the rate of involved margins after conization. These data support quality-assured preoperative colposcopy and European Federation of Colposcopy quality assurance criteria. Specialization of gynecologic staff members in the field of colposcopy is warranted.


Assuntos
Conização/métodos , Ginecologia/estatística & dados numéricos , Displasia do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/cirurgia , Adulto , Idoso , Áustria , Distribuição de Qui-Quadrado , Estudos de Coortes , Conização/normas , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
10.
PLoS One ; 17(3): e0264625, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35231058

RESUMO

The aim of this study was to describe the morphology of the cavotricuspid isthmus (CTI) in detail and introduce a comprehensive scheme to describe the topology of this region based on functional considerations. This may lead to a better understanding of isthmus-dependent flutter and fibrillation and to improved intervention strategies. We used images of the cavotricuspid isthmus from 52 rabbits of both sexes with a median weight of 3.40 ± 0.93 kg. The area of the CTI was 124.25 ± 42.14 mm2 with 53.28 ± 21.13 mm2 covered by pectinate muscles connecting the terminal crest and the vestibule. Isthmus length decreased from inferolateral (13.09 ±2.14 mm) to central (9.85 ± 2.14 mm) to paraseptal (4.88 ± 1.96 mm) resembling the overall human geometry. Ramification sites of pectinate muscles were identified and six levels dividing the CTI from posterior to anterior were introduced. This allowed the classification of pectinate muscle segments based on the connected ramification level. To account for the high inter-individual variations in size and shape, the CTI was projected onto a normalized reference frame using bilinear transformation. Furthermore, two measures of complexity were introduced: (i) the ramification index, which reflects the total number of muscle segments connected to a ramification site and (ii) the complexity index, which reflects the type of ramification (branching or merging site). Topological analysis showed that the complexity of the pectinate muscle network decreases from inferolateral to paraseptal and that the number of electrically uncoupled parallel pathways increases in the central section between the terminal crest and the vestibule which introduces potential reentry pathways.


Assuntos
Flutter Atrial , Ablação por Cateter , Lagomorpha , Animais , Ablação por Cateter/métodos , Feminino , Átrios do Coração , Masculino , Coelhos , Resultado do Tratamento
11.
Geburtshilfe Frauenheilkd ; 82(8): 852-858, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35967742

RESUMO

Introduction Preterm birth is defined as a live birth before 37 weeks of gestation and is associated with increased neonatal morbidity and mortality. The aim of this study is to compare the efficacy of hexoprenaline and atosiban for short- and long-term tocolysis and their effects on neonatal and maternal outcomes. Methods This retrospective cohort study included women with threatened preterm labor between 24 + 0 and 34 + 0 weeks of gestation without premature rupture of membranes. The tocolytic efficacy of hexoprenaline and atosiban was compared in women receiving one of the two medications for short- and long-term tocolysis. Continuous variables were compared using t-test or Mann-Whitney U test, as appropriate. Comparison of categorical variables between the two groups was done with χ 2 test after Pearson's and Fisher's exact test. Results 761 women were enrolled in this study; 387 women received atosiban and 374 women received hexoprenaline as their primary tocolytic agent. Atosiban showed a higher efficacy as a primary tocolytic agent (p = 0.000) within 48 hours. As regards long-term tocolysis, there were no differences between the treatment groups (p = 0.466). Maternal side effects such as tachycardia (p = 0.018) or palpitations (p = 0.000) occurred more frequently after the administration of hexoprenaline, while there were no differences between the two drugs administered with regard to any other maternal or neonatal outcome parameter. Conclusion Our retrospective study shows a significantly higher efficacy of atosiban in the first 48 hours, especially when administered at an early gestational age. There were no significant differences in terms of neonatal outcome but significantly more maternal adverse effects during the administration of hexoprenaline.

12.
Twin Res Hum Genet ; 14(6): 573-9, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22506314

RESUMO

OBJECTIVE: To examine the effect of twin-to-twin delivery time (TTDT) on neonatal outcome. METHODS: We evaluated twin deliveries >34 weeks of gestation. Twin pregnancies with both twins delivered by cesarean section and pregnancies with antenatal complications were excluded. We analyzed TTDT and neonatal outcomes of the second twin (umbilical arterial pH value (pH(art)), Apgar scores at 1, 5 and 10 minutes, need for intensive care). The study population was divided into two homogenous groups based on the mode of delivery: (A) vertex presentation and vaginal delivery of both twins, (B) vertex presentation and vaginal or vaginal operative delivery of twin I, breech or transverse presentation and vaginal breech delivery or cesarean section (CS) of twin II. RESULTS: A total of 207 twin pairs were included in our study. In Group A (n = 151) there were no significant correlations between TTDT and pH(art) or Apgar scores at 1,5 and 10 minutes of twin II (p = .156; 0.861; 0.151 and 0.384, respectively). In Group B (n = 56), the mean pH(art) of twin II was inversely correlated to TTDT, but not significantly (p = .417). TTDT was inversely related to 1-min and 5-min Apgar scores, but not significantly (p = .330; p = .138, respectively). The 10-min Apgar score showed no correlation with TTDT (p = .638). CONCLUSION: Increasing TTDT was not associated with adverse fetal outcome. Expectant management of the second twin appears possible and elapsed time alone does not appear to be an indication for intervention.


Assuntos
Parto Obstétrico/métodos , Resultado da Gravidez , Gravidez de Gêmeos , Índice de Apgar , Cesárea , Feminino , Idade Gestacional , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Gravidez , Fatores de Tempo
13.
Gynecol Oncol ; 115(1): 12-17, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19654070

RESUMO

OBJECTIVE: Recent prospective data support the trend towards systematic retroperitoneal lymphadenectomy in patients with high-risk endometrial cancer. Because para-aortic node involvement in the absence of pelvic node involvement is uncommon, a reliable finding of negative pelvic lymph nodes (PLN) at intraoperative frozen section examination might allow omitting para-aortic dissection. We analyzed the diagnostic accuracy of frozen section examination of PLN in patients with endometrial cancer. METHODS: We reviewed 131 patients with endometrial cancer who underwent surgery including systematic pelvic lymphadenectomy (n=101) or pelvic and para-aortic lymphadenectomy (n=27). Intraoperative frozen section examination of PLN was performed in 72 (55%) patients. Results of frozen section examination were compared with those of final histopathology and the diagnostic accuracy of frozen section examination of PLN was calculated. One pathologist measured the diameters of PLN metastases retrospectively. RESULTS: A total of 1063 and 2666 PLN were analyzed by frozen section examination and by final histopathology, respectively. PLN metastases were found in 7 cases (10%) at frozen section examination, and in 17 cases (24%) at final histopathology (false negative rate, 59%). No false positive cases were noted. The mean diameter of all PLN metastases at final histopathology was 4.3 mm, as compared to 9.0 mm for the metastases detected at frozen section analyses. The mean diameter of PLN metastases missed at frozen section examination was 2.0 mm. CONCLUSION: In this review at a single institution, intraoperative frozen section histology missed nearly two of three endometrial cancer patients with positive nodes. These results do not support tailoring the extent of lymphadenectomy according to the results of frozen section examination.


Assuntos
Neoplasias do Endométrio/patologia , Secções Congeladas/métodos , Linfonodos/patologia , Adulto , Idoso , Carcinoma Endometrioide/diagnóstico , Carcinoma Endometrioide/patologia , Carcinoma Endometrioide/cirurgia , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/cirurgia , Feminino , Secções Congeladas/normas , Humanos , Excisão de Linfonodo , Linfonodos/cirurgia , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias
14.
Liver Int ; 29(10): 1516-20, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19732329

RESUMO

BACKGROUND: Indocyanine green (ICG) clearance has been proposed as a quantitative liver function test several decades ago. Interest in this method has been renewed following the development of finger pulse densitometry for noninvasive estimation of the ICG plasma disappearance rate (PDR). On the other hand, the model for end-stage liver disease (MELD), which is based on routine laboratory parameters, is widely used for estimation of short-term survival in cirrhosis, but its prognostic value in critically ill cirrhotic patients is unclear. AIMS: The aim of the present study was to compare the diagnostic accuracy of ICG PDR vs. MELD for estimation of short-term prognosis in cirrhotic patients. METHODS: Ninety consecutive cirrhotic patients who were admitted for decompensated disease or were being evaluated for liver transplantation were screened. Patients who underwent liver transplantation within the following 90 days and those with hepatocellular carcinoma were excluded. In the remaining 70 patients, routine laboratory parameters and ICG clearance were analysed. Following an injection of ICG 0.25 mg/kg, PDR was measured by finger pulse densitometry. The diagnostic accuracy of ICG PDR and MELD for prediction of 90-day survival was assessed by receiver-operating characteristic (ROC) curve analysis. RESULTS: ROC curve analysis revealed superior diagnostic accuracy for MELD as compared with ICG PDR in predicting 90-day survival (area under the ROC curve 0.89 vs. 0.71). A MELD cut-off of 22 provided the best discrimination for prediction of 90-day survival. CONCLUSIONS: MELD is superior to ICG PDR for estimation of short-term survival in patients with decompensated cirrhosis.


Assuntos
Verde de Indocianina , Cirrose Hepática/mortalidade , Falência Hepática/mortalidade , Adulto , Estudos de Coortes , Feminino , Humanos , Verde de Indocianina/farmacocinética , Transplante de Fígado , Modelos Logísticos , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Prognóstico , Curva ROC
15.
Psychooncology ; 18(5): 476-82, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-18702067

RESUMO

OBJECTIVE: The purpose of the study was to investigate the long-term treatment side effects on the quality of life (QoL) and sexual functioning of cervical cancer survivors undergoing different treatment regimens. METHODS: QoL and sexual functioning were measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, the Cervix Cancer Module, and the Sexual Activity Questionnaire. RESULTS: One hundred twenty-one cervical cancer survivors (63 Surgery, 38 Surgery/CT, and 20 Surgery/RT) participated. Patients in the Surgery/RT Group reported significantly worse QoL outcomes (lower scores on physical, role, cognitive, and social functioning) compared with patients in the Surgery Group or patients in the Surgery/CT Group. The level of symptoms such as nausea/vomiting, pain, appetite loss, frequent urination (p=0.019), leaking of urine (p=0.015), and the feeling of a tight vagina (p=0.018) was significantly higher in irradiated patients. Concerning sexual functioning, patients in the Surgery/RT Group reported a significantly lower sexual activity rate compared with women in the Surgery Group or women in the Surgery/CT group (p<0.05). However, there were no statistically significant differences concerning sexual pleasure and sexual discomfort among the three treatment groups (p>0.05). CONCLUSIONS: Cervical cancer survivors treated with adjuvant radiotherapy are more likely at risk for impaired QoL. Survivors treated with surgery or adjuvant chemotherapy return to a similar level of QoL as women without a history of cancer. Although the sexual activity rate is lower in irradiated patients their sexual pleasure is similar to patients after surgery and chemotherapy.


Assuntos
Qualidade de Vida/psicologia , Comportamento Sexual/psicologia , Sobreviventes/psicologia , Neoplasias do Colo do Útero , Adulto , Imagem Corporal , Terapia Combinada , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de Tempo , Neoplasias do Colo do Útero/psicologia , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/cirurgia
16.
Eur J Obstet Gynecol Reprod Biol ; 236: 205-209, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30965187

RESUMO

OBJECTIVE: To examine the impact of different treatment strategies - surgical treatment or watchful waiting- on sexual activity, psychosocial distress, and fear of progression in women with Human Papillomavirus (HPV)-associated premalignant genital lesions. STUDY DESIGN: Observational cohort study of women diagnosed with HPV-associated premalignant lesions of the cervix, vagina or vulva. Patients were stratified into two groups depending on the severity of their premalignancy: surgical treatment or watchful waiting. Validated patient administered questionnaires, i.e. Fear of Progression questionnaire (FoP-Q), Cervical Dysplasia Distress Questionnaire (CDDQ), and Sexual Activity Questionnaire (SAQ) were completed after clinical evaluation (baseline), at 6- and 12-months follow-ups. RESULTS: 209 women treated with surgery (N = 125) were compared with women who were monitored in regular intervals (N = 82). During an observational period of 12 months there were no significant differences in fear of progression, psychosocial distress, and sexual activity (p > 0.05). The level of concerns and anxiety about the future, and fear of progression were present, mostly at baseline. While there was a small increase of tension from visit to visit in both groups, patients generally were able to cope with their clinical situation quite well. CONCLUSIONS: Fear of progression, psychosocial distress and sexual activity in women with precancerous HPV- associated premalignant genital lesions seem to be independent from type of treatment. Both treatment strategies may be applied without major psychological sequelae, as long as adequate information is provided.


Assuntos
Infecções por Papillomavirus/terapia , Lesões Pré-Cancerosas/terapia , Comportamento Sexual/psicologia , Estresse Psicológico/psicologia , Displasia do Colo do Útero/terapia , Conduta Expectante , Adulto , Ansiedade/psicologia , Progressão da Doença , Medo/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/psicologia , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/psicologia , Displasia do Colo do Útero/patologia , Displasia do Colo do Útero/psicologia , Adulto Jovem
17.
Int J Gynaecol Obstet ; 101(3): 264-8, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18289539

RESUMO

OBJECTIVE: To assess neonatal outcome and 2-year follow-up of pregnancies complicated by second trimester preterm premature rupture of membranes (PPROM). METHODS: A retrospective review of obstetric and neonatal records for 87 pregnancies (56 singletons, 6 twins, 1 triplet) with PPROM between 14+0 and 24+6 weeks of gestation. Patients received antibiotics and steroids for fetal lung maturity once they reached 24 weeks of gestation. Placentas were examined histopathologically. Surviving infants were followed-up at 2 years of age. RESULTS: Median latency from PPROM to delivery was 4 days. Survival rate of 56 singletons was 45% (25/56); and 13 died in hospital. Survival rate of infants discharged from hospital was 23% (12/56). Chorioamnionitis was seen histologically in 42% (5/12) of surviving infants compared with 92% (12/13) of those that died in hospital. Of the 12 surviving infants, 50% had a normal neurological and developmental outcome at 2 years of age. CONCLUSION: Gestational age, birth weight, and histologic chorioamnionitis have prognostic importance in pregnancies complicated by PPROM. Surviving infants have a 50% chance of achieving an adequate health status at 2 years of age.


Assuntos
Antibacterianos/uso terapêutico , Ruptura Prematura de Membranas Fetais/terapia , Doenças do Prematuro/mortalidade , Trabalho de Parto Prematuro/terapia , Resultado da Gravidez , Segundo Trimestre da Gravidez , Corticosteroides , Adulto , Corioamnionite/tratamento farmacológico , Feminino , Morte Fetal/etiologia , Ruptura Prematura de Membranas Fetais/diagnóstico , Maturidade dos Órgãos Fetais/efeitos dos fármacos , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Prontuários Médicos , Gravidez , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo
18.
Anticancer Res ; 38(11): 6507-6511, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30396979

RESUMO

BACKGROUND: Two studies have found primary ovarian carcinomas in stage I disease to be larger than those in stage III. Thus, these stages may represent different tumor entities. MATERIALS AND METHODS: The clinical data from 553 patients operated on between 1985 and 2012 for epithelial ovarian cancer were retrospectively analyzed. RESULTS: Primary lesions including invasive, borderline and benign components were significantly larger in stage I compared to stage III disease (p<0.001). However, the maximum diameter of invasive components in those with stage III disease were significantly larger than in those with stage I disease (p=0.001). The size of the invasive component was not associated with the largest size of intraperitoneal metastasis. CONCLUSION: We were only, in part, able to reproduce the data from the two smaller published studies. The prognosis of patients with stage III disease strongly depends on the size of intraperitoneal metastases.


Assuntos
Neoplasias Epiteliais e Glandulares/patologia , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Epitelial do Ovário , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Carga Tumoral
19.
Am J Obstet Gynecol ; 197(6): 678.e1-7, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18060980

RESUMO

OBJECTIVE: The aim of this study was to analyze lymphatic spread to pelvic, parametrial, and paraaortic lymph nodes in patients with cervical cancer. STUDY DESIGN: We reviewed 619 patients with invasive cervical cancer treated by radical abdominal hysterectomy and systematic pelvic or pelvic and paraaortic lymphadenectomy between 1971 and 2005. The present study included 61 patients with one positive lymph node (10%) and 59 patients with two positive lymph nodes (10%) at any location. RESULTS: The external iliac (43%) and obturator (26%) regions and the parametrium (21%) were the most commonly involved pelvic lymph node sites with solitary metastases. Isolated metastases to common iliac, presacral (internal iliac), and paraaortic nodes were found in 7%, 1%, and 1% of patients, respectively. Patients with 2 positive nodes had 1 parametrial and 1 pelvic node involved (32%), 2 ipsilateral positive nodes (31%), 1 positive lymph node on both sides of the pelvis (27%), and 2 positive nodes within the parametrium (10%). CONCLUSIONS: In cervical cancer patients with only 1 positive lymph node, this node is most frequently located within the external iliac and obturator regions and the parametrium. Sentinel node identification should primarily address these lymph node sites. If 1 positive lymph node is found, further metastases are unpredictable within pelvic and parametrial lymph node sites. Paraaortic spread without pelvic node involvement is rare.


Assuntos
Biópsia de Linfonodo Sentinela , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Excisão de Linfonodo , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias do Colo do Útero/cirurgia
20.
Twin Res Hum Genet ; 10(3): 521-7, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17564511

RESUMO

Our objective was to examine the neonatal outcome of second twins depending on presentation and mode of delivery. Using a database we analyzed the short-term neonatal outcome in twin pregnancies offered a trial of labor with special emphasis on the second twin depending on presentation and mode of delivery. Neonatal outcome was evaluated by Apgar scores, umbilical cord blood pH values, and perinatal or neonatal morbidity and mortality. Overall, in 219 (78%) of 281 pregnancies successful vaginal birth (VB) of both twins (VB-VB) was possible, 48 (17%) women had to be delivered by cesarean section (CS) of both twins (CS-CS), and in 14 (5%) women the second twin had to be delivered by CS after VB of the first twin (VB-CS). Successful VB was most common for vertex-vertex (V/V; n=171, 82%) and vertex-nonvertex (n=48, 75%) presentation (V/NV). Twins delivered by VB-CS had the lowest values for pHart (p=.006) and pHven (p=.010). pHart less than or equal to 7.00 values occurred only in second twins delivered VB-VB or VB-CS. Lower Apgar scores of the second twin occurred more frequently in the VB-CS and in the VB-VB than in the CS-CS groups (ps<.05). Lower levels of pHart (p=.002) and frequency of pHart less than or equal to 7.00 occurred more often in nonvertex second twins than in vertex second twins (p<.022). The high CS rate in V/NV presentation and the significantly worse perinatal short-term outcome of NV second twins after VB of the first twin underline that randomized studies are necessary to evaluate the best delivery mode for V/NV twins.


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Apresentação no Trabalho de Parto , Complicações na Gravidez/cirurgia , Gravidez Múltipla/estatística & dados numéricos , Gêmeos , Adulto , Estudos de Coortes , Parto Obstétrico/mortalidade , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
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