Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 7 de 7
Filtrar
1.
Photodermatol Photoimmunol Photomed ; 33(1): 32-40, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27943450

RESUMO

BACKGROUND: The aim of our study was to examine the effects of photobiomodulation therapy (PBMT) in the treatment of breast cancer-related lymphedema using a compactly designed treatment regime consisting of eight therapy sessions in combination with a cluster laser device covering a total area size of 78.54 cm² over the axillary. METHODS: Forty patients with unilateral lymphedema were enrolled in this double-blind, placebo-controlled trial in order to evaluate effects of PBMT on lymphedema-related pain, quality of life, grip strength and limb volume difference. Subjects received irradiation for ten minutes per session using a cluster laser covering a beam area of 78.54 cm². The applied energy was 384 Joules resulting in an energy density of 4.89 J/cm². RESULTS: Post-treatment, a 50% reduction in median pain scores and an increase in mean quality of life were observed. Mean grip strength was persistently higher after eight sessions of PBMT compared with pretreatment; however, no statistically significant intergroup differences (P > 0.05) were found over the time course. CONCLUSION: PBMT using a compactly designed treatment regime in combination with a cluster laser device did not significantly improve quality of life, pain scores, grip strength and limb volume over the time course.


Assuntos
Braço/patologia , Neoplasias da Mama/terapia , Terapia com Luz de Baixa Intensidade/métodos , Excisão de Linfonodo/efeitos adversos , Linfedema/patologia , Linfedema/radioterapia , Idoso , Axila , Feminino , Força da Mão , Humanos , Lasers Semicondutores/uso terapêutico , Terapia com Luz de Baixa Intensidade/instrumentação , Linfedema/etiologia , Pessoa de Meia-Idade , Tamanho do Órgão , Dor/etiologia , Qualidade de Vida , Biópsia de Linfonodo Sentinela/efeitos adversos
2.
PLoS One ; 11(11): e0166659, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27898669

RESUMO

INTRODUCTION: Uterine leiomyomas are the most common benign gynecologic tumors. To date laparoscopy myomectomy is the gold standard for treatment of symptomatic fibroids in reproductive-aged women. Detailed counseling about the effects of this procedure on postoperative sexuality and quality of life is important in these patients. However, available data on these subjects are limited and contradictory. The aim of this study was to assess sexual function and quality of life in premenopausal women undergoing laparoscopic myomectomy for symptomatic uterine fibroids. MATERIAL AND METHODS: All premenopausal women who underwent laparoscopic myomectomy for symptomatic fibroids between April 2012 and August 2014 at a tertiary university center were enrolled in this prospective observational cohort study. Sexual function and quality of life were assessed for the pre- and postoperative (six months post-operatively) state using two validated questionnaires, the Female Sexual Function Index (FSFI) and the European Quality of Life Five-Dimension Scale (EQ-5D). RESULTS: Ninety-five of the 115 (83%) eligible patients completed the study. Overall a significant improvement in quality of life and sexual function was observed in the study cohort: Median FSFI (28 (18.7-35.2)) and EQ-5D scores (1 (0.61-1) after laparoscopic myomectomy were significantly higher than preoperative scores (21.2 (5.2-33.5); 0.9 (0.2-1); p ≤ 0.01). The number, position and localization of the largest fibroids were not correlated with pre- or postoperative sexual function or quality of life. CONCLUSION: Laparoscopic myomectomy might have positive short-term effects on postoperative quality of life and sexual function in premenopausal women suffering from symptomatic fibroids.


Assuntos
Laparoscopia , Leiomioma/cirurgia , Pré-Menopausa/fisiologia , Qualidade de Vida , Comportamento Sexual/fisiologia , Miomectomia Uterina/efeitos adversos , Adulto , Estudos de Coortes , Feminino , Humanos , Leiomioma/fisiopatologia , Período Pós-Operatório , Estudos Prospectivos
3.
Int J Gynaecol Obstet ; 134(2): 225-30, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27233815

RESUMO

OBJECTIVE: To evaluate the learning process for total laparoscopic hysterectomy (TLH) and laparoscopic supracervical hysterectomy (LSH) for benign uterine pathologies among surgeons inexperienced in laparoscopy. METHODS: A retrospective comparative study was conducted of all hysterectomies performed by four attending surgeons and three resident surgeons at a tertiary university center in Homburg/Saar, Germany. Laparoscopic procedures were assessed between October 1, 2009, and October 31, 2010 (period A); November 1, 2010, and March 31, 2012 (period B); and April 1, 2012, and June 30, 2013 (period C). Data were obtained by medical chart review. RESULTS: Overall, 269 patients underwent TLH and 165 underwent LSH. Duration of surgery for all surgeons decreased from 136 ± 60 minutes in period A to 118 ± 44 minutes in period B (P=0.013), but increased to 122 ± 56 minutes in period C (A vs C: P=0.067). Among attending surgeons, the duration of surgery seemed to decrease after 20 TLH procedures and after 10 LSH procedures. Among resident surgeons, duration decreased after 10 LSH procedures; no fall was apparent for TLH. CONCLUSION: Both TLH and LSH were readily adopted among a group of surgeons inexperienced in laparoscopy, although LSH might be easier to learn. Experienced surgeons have a steeper learning curve than do their inexperienced counterparts.


Assuntos
Histerectomia/educação , Laparoscopia/educação , Curva de Aprendizado , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Complicações Pós-Operatórias/epidemiologia , Útero/cirurgia , Centros Médicos Acadêmicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha , Humanos , Tempo de Internação , Modelos Lineares , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento , Doenças Uterinas/cirurgia
4.
Cancer Res ; 75(24): 5248-59, 2015 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-26631268

RESUMO

Cervical cancer is a consequence of persistent infection with human papillomaviruses (HPV). Progression to malignancy is linked to an inflammatory microenvironment comprising T-helper-17 (Th17) cells, a T-cell subset with protumorigenic properties. Neoplastic cells express only low endogenous levels of the Th17 chemoattractant CCL20, and therefore, it is unclear how Th17 cells are recruited to the cervical cancer tissue. In this study, we demonstrate that CCL20 was predominantly expressed in the stroma of cervical squamous cell carcinomas in situ. This correlated with stromal infiltration of CD4(+)/IL17(+) cells and with advancing International Federation of Gynecology and Obstetrics (FIGO) stage. Furthermore, we show that cervical cancer cells instructed primary cervical fibroblasts to produce high levels of CCL20 and to attract CD4/IL17/CCR6-positive cells, generated in vitro, in a CCL20/CCR6-dependent manner. Further mechanistic investigations identified cervical cancer cell-derived IL6 as an important mediator of paracrine CCL20 induction at the promoter, mRNA, and protein level in fibroblasts. CCL20 was upregulated through the recently described CCAAT/enhancer-binding protein ß (C/EBPß) pathway as shown with a dominant-negative version of C/EBPß and through siRNA-mediated knockdown. In summary, our study defines a novel molecular mechanism by which cervical neoplastic cells shape their local microenvironment by instructing fibroblasts to support Th17 cell infiltration in a paracrine IL6/C/EBPß-dependent manner. Th17 cells may in turn maintain chronic inflammation within high-grade cervical lesions to further promote cancer progression.


Assuntos
Linfócitos do Interstício Tumoral/imunologia , Células Th17/imunologia , Microambiente Tumoral/imunologia , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia , Western Blotting , Proteínas de Transporte/imunologia , Células Cultivadas , Quimiocina CCL20/imunologia , Quimiotaxia de Leucócito/imunologia , Progressão da Doença , Ensaio de Imunoadsorção Enzimática , Feminino , Fibroblastos/imunologia , Citometria de Fluxo , Imunofluorescência , Células HeLa , Humanos , Imuno-Histoquímica , Interleucina-6/imunologia , RNA Interferente Pequeno , Proteínas de Ligação a RNA , Reação em Cadeia da Polimerase em Tempo Real , Transdução de Sinais/imunologia , Transfecção , Neoplasias do Colo do Útero/imunologia , Displasia do Colo do Útero/imunologia
6.
Eur J Obstet Gynecol Reprod Biol ; 171(1): 122-7, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23998556

RESUMO

OBJECTIVE: Residual carbon dioxide contributes substantially to pain following laparoscopic surgery. We evaluated the effects of extended assisted ventilation (EAV) with an open umbilical trocar valve for five additional minutes following laparoscopic hysterectomy on postoperative abdominal and shoulder pain levels. We also examined whether a combination of EAV and trocar site infiltration (TSI) with lidocaine could further reduce postoperative pain levels. STUDY DESIGN: In this prospective randomized trial, the effectiveness of EAV and EAV/TSI in reducing postoperative abdominal and shoulder pain were compared with that of a standard treatment regime in 283 patients undergoing laparoscopic hysterectomy (total or supracervical). Pain levels were evaluated by self-assessment questionnaire using a numeric rating scale (NRS) and by postoperative piritramid requirement, a surrogate parameter for postoperative analgesic drug requirement. The incidence of nausea and vomiting was also assessed. RESULTS: Compared with the standard treatment regime, EAV reduced abdominal pain levels significantly at 3h (NRS score, 3.21 ± 1.56 vs. 4.73 ± 1.71) and 24h (3.82 ± 1.49 vs. 4.95 ± 1.68) postoperatively (both p < 0.01). EAV also significantly reduced shoulder pain at 24h (EAV vs. control, 4.28 ± 1.51 vs. 5.14 ± 1.49) and 48 h (3.64 ± 1.66 vs. 4.22 ± 1.43) postoperatively (both p < 0.01). Patients in the EAV group had significantly lower piritramid requirements compared with standard treatment at 3h post-operatively (4.28 ± 2.09 mg vs. 6.31 ± 2.21 mg; p<0.01). EAV/TSI showed no additional benefit in terms of pain reduction compared with EAV alone. Incidences of postoperative nausea and vomiting were not reduced by EAV or EAV/TSI. CONCLUSION: EAV was found to be an effective and safe method to reduce postoperative pain levels in patients undergoing laparoscopic hysterectomy.


Assuntos
Dor Abdominal/prevenção & controle , Dióxido de Carbono/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Respiração Artificial/métodos , Dor de Ombro/prevenção & controle , Dor Abdominal/etiologia , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Feminino , Humanos , Histerectomia/efeitos adversos , Laparoscopia/efeitos adversos , Lidocaína/administração & dosagem , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Pirinitramida/administração & dosagem , Náusea e Vômito Pós-Operatórios/etiologia , Período Pós-Operatório , Estudos Prospectivos , Dor de Ombro/etiologia , Instrumentos Cirúrgicos , Umbigo
7.
Arch Gynecol Obstet ; 287(4): 715-22, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23179797

RESUMO

PURPOSE: We evaluated the long-term results and patient's satisfaction in reduction mammaplasties for symptomatic mammary hypertrophy. METHODS: From 2002 to 2008 a total of 92 women underwent bilateral mammaplasty for a symptomatic macromastia at our department. Three different surgical techniques for reduction mammaplasty were used (Bostwick, Stroembeck, Ribeiro). Patients were re-contacted in 2009 and asked to complete a self-assessment survey in order to asses their satisfaction with the post-operative symptom-relief and the overall outcome. RESULTS: 90.5 % of all patients stated, that they would retrospectively re-opt for a reduction mammaplasty. Preoperative patients' age, BMI and severity of macromasty-related symptoms were found to be factors positively correlated with a high post-interventional satisfaction with the achieved symptom-relief and the overall outcome. No correlation was found between the amount of intra-operatively resected breast tissue and the post-operative patients' assessment. Patients' assessment regarding the achieved post-operative symptom relief was comparable for all three surgical techniques, however the overall outcome rating for both bi-pedicled approaches (Stroembeck and Ribeiro) was higher compared to the mono-pedicled Bostwick technique. CONCLUSIONS: Reduction mammaplasty for patients with a mammary hypertrophy and somatic symptoms could offer a causal and effective treatment. The predictive factors for a high patients' satisfaction identified in this study could become a valuable tool in the pre-operative patients counceling and their role should be further evaluated prospectively. The use of bi-pedicled surgical techniques seems to favor a high post-operative patients' assessment.


Assuntos
Hipertrofia/cirurgia , Mamoplastia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Mama/anormalidades , Mama/cirurgia , Feminino , Humanos , Hipertrofia/complicações , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA