Prognostic value of isolated tumor cells in sentinel lymph nodes in low risk endometrial cancer: results from an international multi-institutional study.

OBJECTIVE: The prognostic significance of isolated tumor cells (≤0.2 mm) in sentinel lymph nodes (SLNs) of endometrial cancer patients is still unclear. Our aim was to assess the prognostic value of isolated tumor cells in patients with low risk endometrial cancer who underwent SLN biopsy and did not receive adjuvant therapy. Outcomes were compared with node negative patients. METHODS: Patients with SLNs-isolated tumor cells between 2013 and 2019 were identified from 15 centers worldwide, while SLN negative patients were identified from Mayo Clinic, Rochester, between 2013 and 2018. Only low risk patients (stage IA, endometrioid histology, grade 1 or 2) who did not receive any adjuvant therapy were included. Primary outcomes were recurrence free, non-vaginal recurrence free, and overall survival, evaluated with Kaplan-Meier methods. RESULTS: 494 patients (42 isolated tumor cells and 452 node negative) were included. There were 21 (4.3%) recurrences (5 SLNs-isolated tumor cells, 16 node negative); recurrence was vaginal in six patients (1 isolated tumor cells, 5 node negative), and non-vaginal in 15 (4 isolated tumor cells, 11 node negative). Median follow-up among those without recurrence was 2.3 years (interquartile range (IQR) 1.1-3.0) and 2.6 years (IQR 0.6-4.2) in the SLN-isolated tumor cell and node negative patients, respectively. The presence of SLNs-isolated tumor cells, lymphovascular space invasion, and International Federation of Obstetrics and Gynecology (FIGO) grade 2 were significant risk factors for recurrence on univariate analysis. SLN-isolated tumor cell patients had worse recurrence free survival (p<0.01) and non-vaginal recurrence free survival (p<0.01) compared with node negative patients. Similar results were observed in the subgroup of patients without lymphovascular space invasion (n=480). There was no difference in overall survival between the two cohorts in the full sample and the subset excluding patients with lymphovascular space invasion. CONCLUSIONS: Patients with SLNs-isolated tumor cells and low risk profile, without adjuvant therapy, had a significantly worse recurrence free survival compared with node negative patients with similar risk factors, after adjusting for grade and excluding patients with lymphovascular space invasion. However, the presence of SLNs-isolated tumor cells was not associated with worse overall survival.

Hora Dorada de neutropenia febril en cáncer pediátrico Hospital de Niños "J. M. de los Ríos"

Tratamientos intensificados se asocian con neutropenia severa, identificada como factor de riesgo de complicaciones infecciosas en pacientes con enfermedades neoplásicas. Objetivo: Evaluar la importancia del momento de inicio del tratamiento antibiótico en la evolución y pronóstico de pacientes con neutropenia febril (NF) por Cáncer ingresados al Hospital de Niños "J.M. de los Ríos" entre febrero 2020 ­ febrero 2022. Métodos: Estudio descriptivo, prospectivo, transversal, analítico, se registró formulario de recolección de datos y base de datos Google Drive para análisis estadístico por distribución de frecuencias y porcentajes. Se entregó Consentimiento y Asentimiento Informado a padres y pacientes, ambos aprobados por Comisión de Bioética, capacitándose en manejo de fiebre neutropénica. Incluyó pacientes con fiebre durante la primera hora después de recibir quimioterapia, indicándoseles antibióticos. Resultados: Sexo masculino 63,2 % (36/57) de los casos de NF y preescolares 43,9 % (25/57) fueron los más afectados. Leucemia Linfocítica Aguda fue el cáncer más frecuente 68,4 % (39/57) y Bacteriemia 40,4 % (23/57) la patología infecciosa predominante. Evolucionaron satisfactoriamente en la mayoría de los casos; la Media de la estancia hospitalaria fue 14,56 días, más prolongada en pacientes con Leucemia Linfocítica Aguda en fase de inducción. Gramnegativos los aislamientos predominantes 35,1 % (20/57), representados por Pseudomonas aeruginosa. El tiempo de cumplimiento de antibióticos fue 4 - 12 horas desde el inicio de fiebre. Mortalidad ocurrió por enfermedad de base mal controlada. Conclusiones: Cumplimiento de antibióticos durante la primera hora de fiebre neutropénica en pacientes pediátricos con cáncer disminuye complicaciones infecciosas, estancia hospitalaria y mortalidad.

Intensified treatments are associated with severe neutropenia, identified as a risk factor for infectious complications in patients with neoplastic diseases. Objective: To evaluate the importance of the moment of initiation of antibiotic treatment in the evolution and prognosis of patients with febrile neutropenia (NF) due to Cancer admitted to the Hospital de Niños J.M. de los Ríos between February 2020 - February 2022. Methods: Descriptive, prospective, cross-sectional, analytical study, a data collection form and Google Drive database were registered for statistical analysis by distribution of frequencies and percentages. Consent and Informed Assent were given to parents and patients, both approved by the Bioethics Commission, training in the management of neutropenic fever. It included patients with fever during the first hour after receiving chemotherapy, indicating antibiotics. Results: Male sex 63.2 % (36/57) of the cases of NF and preschoolers 43.9 % (25/57) were the most affected. Acute Lymphocytic Leukemia was the most frequent cancer 68.4 % (39/57) and Bacteremia 40.4 % (23/57) the predominant infectious pathology. They evolved satisfactorily in most cases; Mean hospital stay was 14.56 days, longer in patients with Acute Lymphocytic Leukemia in the induction phase. Gram-negative the predominant isolates 35.1 % (20/57), represented by Pseudomonas aeruginosa. Antibiotic compliance time was 4 - 12 hours from the onset of fever. Mortality occurred due to poorly controlled underlying disease. Conclusions: Antibiotic compliance during the first hour of neutropenic fever in pediatric patients with cancer reduces infectious complications, hospital stay and mortality.

Critical junctures and events in the trajectory of information modeling in Curitiba / Coyuntura y eventos críticos en la trayectoria del modelado de información en Curitiba / Conjunturas e eventos críticos na trajetória da modelagem da informação em Curitiba

Abstract Although it is a promising theory for understanding complex ongoing political processes, historical institutionalism has rarely been used to adress urban management and urban planning issues. We aim to (re)construct the trajectory of management and dissemination of communication and information technologies (ICTs) in Curitiba to identify critical junctures and events. Methodologically, it is a case study based on documents and discourse analysis. The results show that Curitiba used to be avant-garde in technological diffusion but today it develops more responsive than anticipatory actions; over time, the role of technology diffusion and management shifted from the urban management and planning structure to the direct municipal administration structure; technological initiatives have always taken place and are taking place sharply and decentrally for the consolidation of an ecosystem; the ideals of forming a digital or a smart city were motivators of Curitiba's current situation. The ideology underlying the game of politicians and party affiliations has been put aside in alignments of local groups to carry out technological adjustments; and that the management and diffusion of ICTs remain controversial in political disputes. The conclusion is that the political-technology dyad has absorbed the impacts of critical events, resulting in the remodeling of municipal institutions and organizations linked to the management and diffusion of ICTs that also need to deal with the game of interests and external pressures.

Resumen Aunque sea una teoría prometedora para comprender procesos políticos complejos en curso, el institucionalismo histórico ha sido poco utilizado en temas de planificación y gestión urbana. Así, el objetivo de este estudio es (re)construir la trayectoria de gestión y difusión de las tecnologías de la información y la comunicación en el municipio de Curitiba para identificar coyunturas y eventos críticos. Metodológicamente, se utilizan los procedimientos de levantamiento documental y análisis del discurso. Los resultados muestran que Curitiba fue vanguardista en difusión tecnológica, pero hoy desarrolla acciones más responsivas que anticipatorias; con el tiempo, el papel de la difusión y gestión de la tecnología pasó de la estructura de gestión y planificación urbana a la estructura de administración municipal directa; las iniciativas tecnológicas siempre se han dado y se están dando de manera acentuada y descentralizada para la consolidación de un ecosistema; los ideales de formar una ciudad digital o una ciudad inteligente fueron motivadores de la coyuntura más reciente; la ideología que subyace al juego de los políticos y las afiliaciones partidarias parece haber sido dejada de lado en alineamientos de grupos locales para realizar ajustes tecnológicos; y que la gestión y difusión de las TIC sigue siendo controvertida en las disputas políticas. La conclusión es que la díada política-tecnología ha absorbido los impactos de los eventos críticos, lo que termina redundando en la remodelación de las instituciones y organismos municipales vinculados a la gestión y difusión de las TIC que también necesitan lidiar con el juego de intereses y las presiones externas.

Resumo Embora seja uma teoria promissora para compreender complexos processos políticos continuados, o institucionalismo histórico tem sido pouco utilizado em questões de gestão e planejamento urbano. Assim, o objetivo deste estudo é (re)construir a trajetória de gestão e difusão tecnologias de comunicação e informação do município de Curitiba para identificar conjunturas e eventos críticos. Metodologicamente, utilizam-se os procedimentos de levantamento documental e análise de discurso. Os resultados mostram que Curitiba foi vanguardista na difusão tecnológica, mas hoje desenvolve ações mais responsivas do que antecipativas; com o passar do tempo o protagonismo da difusão e gestão tecnológica se deslocou da estrutura de gestão e planejamento urbano para a estrutura da administração municipal direta; as iniciativas tecnológicas sempre ocorreram e vêm ocorrendo acentuada e descentralizadamente para a consolidação de um ecossistema; os ideais de formação de uma cidade digital ou uma cidade inteligente foram motivadores da conjuntura mais recente; a ideologia subjacente ao jogo dos políticos e das filiações partidárias parece ter sido posta de lado em alinhamentos dos grupos locais para realizar ajustes tecnológicos; e que a gestão e a difusão de TIC's se mantém controversa nas disputas políticas. A conclusão é que a díade política-tecnologia tem absorvido os impactos dos eventos críticos, o que acaba por resultar na remodelagem das instituições e organizações municipais ligadas à gestão e à difusão das TIC's que também precisam lidar com o jogo de interesses e as pressões externas.

Psychological Profile in Women with Chronic Pelvic Pain.

(1) Background: Chronic Pelvic Pain (CPP) is a prevalent medical condition with a complex treatment due to different variables that influence its clinical course. (2) Methods: Psychological variables such as depression, anxiety, catastrophizing or neuroticism have been described as influencing CPP. This is a cross-sectional study of 63 patients with CPP sent for a psychological evaluation due to participation in group therapy for CPP. The main purpose of this study was to characterize the baseline psychological characteristics of women with CPP. The NEO Five Factor Inventory (NEO-FFI), State and Trait Anxiety Inventory (STAI), Beck Depression Inventory-Fast Screen (BDI-FS), Pain Catastrophizing Scale (PCS) and Chronic Pain Acceptance Questionnaire (CPAQ) were performed. (3) Results: The personality profile of patients (NEO FFI) shows high neuroticism, low extraversion and low conscientiousness. The 25.4% of patients had moderate or severe depression according to BDI-FS results, almost half of the patients had high levels of anxiety trait (>P75, 49.2%) and more than half the patients had high levels of anxiety state (>P75, 59.5%). Punctuations of PCS and CPAQ are similar to patients with fibromyalgia. (4) Conclusions: CPP is associated with high levels of depression, anxiety, neuroticism, catastrophizing and low pain acceptance. It is important to develop interventions that can modify these psychological factors in order to improve the clinical course of CPP.

Clustering Molecular Subtypes in Breast Cancer, Immunohistochemical Parameters and Risk of Axillary Nodal Involvement.

(1) Background: To establish similarities in the risk of axillary lymph node metastasis between different groups of women with breast cancer according to immunohistochemical (IHC) parameters. (2) Methods: Data was collected retrospectively, from 2000 to 2013, of 1058 node-positive breast tumours. All patients were divided according to the St Gallen 2013 criteria and IHC features. The proportion of axillary involvement (pN > pN0; pN > pN1mi; pN > pN1) was calculated for each group. Similarities in axillary nodal dissemination were explored by cluster analysis and association between IHC and risk of axillary disease was studied with multivariate analysis. (3) Results: Among clinico-pathological surrogates of intrinsic subtypes, axillary involvement was more frequent in Luminal-B like HER2 negative (45.8%) and less frequent in Luminal-B HER2 positive (33.8%; p = 0.044). Axillary macroscopic involvement was more frequent in Luminal-B like HER2 negative (37.9%) and HER2 positive (37.8%) and less frequent in Luminal-B HER2 positive (25.5%) and Luminal-A like (25.6%; p = 0.002). Axillary involvement ≥pN2 was significantly less frequent in Luminal-A like (7.4%; p < 0.001). Luminal-A with Luminal-B HER2 positive, and triple-negative with Erb-B2 overexpressing tumours were clustered together regarding any axillary involvement, macroscopic disease or ≥pN2. Among the defined subgroups, axillary metastases were more frequent when Ki67 was higher. In a multivariate analysis, Ki67>14% were associated with a risk of axillary metastases (HR: 1.31; 95% CI, 1.51−6.80; p < 0.037). (4) Conclusions: there are two lymphatic drainage pathways of the breast according to the expression of hormone receptor-related genes. Positive-ER tumors are associated with lower axillary involvement and negative-ER tumors and Ki67 > 14% with higher nodal involvement.

Does MIS Play a Role in the Treatment of Advanced Ovarian Cancer?

Neoadjuvant chemotherapy allows a minimally invasive approach for interval debulking in patients with ovarian cancer considered unresectable to no residual disease by laparotomy at diagnosis. The aim of the study was to evaluate the type of surgical approach at interval debulking (ID) after three courses of carboplatin and taxol in patients with unresectable ovarian cancer at diagnosis compared with the type of surgical approach at primary debulking (PD). A secondary objective was to compare the perioperative outcomes of MIS vs. laparotomy at ID. A retrospective review of the type of surgical approach at ID following three courses of carboplatin and taxol was compared with the surgical approach at PD, and a review of the perioperative outcomes of MIS vs. open at ID was performed during the period from 21 January 2012, through 21 February 2013, for stage IIIC > 2 cm or IV epithelial ovarian cancer (EOC) unresectable at diagnosis and the surgical approach at PD. During the study period, 127 patients with stage IIIC or IV EOC met the inclusion criteria. Minimally invasive surgery (MIS), laparoscopic or robotic, was used in 21.6% of patients at ID and in 23.3% of patients at PD. At ID, MIS patients had a shorter hospital stay as compared to laparotomy (2 vs. 8 days; p < 0.001). At 5 year follow-up, 31.5% of EOC patients were alive (ID MIS: 47.5% vs. ID open: 30%; PD MIS: 41% vs. PD open: 28%), while 24.4% had no evidence of disease (ID MIS: 39% vs. ID open: 19.5%; PD MIS: 32% vs. PD open: 22%). Among living patients, 22% had evidence of disease. Neoadjuvant chemotherapy is a form of chemo-debulking and allows a minimally invasive approach at interval debulking in about one-fifth of the patients, with initial disease deemed unresectable to no residual tumor at initial diagnosis.

Granulomatosis with Polyangiitis-Mimicking Advanced Gynecological Cancer: A Case Report and Systematic Review of the Literature.

(1) Background: Granulomatosis with polyangiitis (GPA) is a necrotizing vasculitis that mimics gynecologic cancer. In GPA patients, the genitourinary system is affected in <1%. The objective of the study was to provide a systematic review of the literature of GPA patients with gynecological involvement. (2) Methods: PubMed and Embase were searched from inception to July 2021 for GPA patients with gynecological involvement Medical Subject Headings (MeSH) and free-text terms. Exclusion criteria were other language, review articles, pregnancy, fertility, or male patients. Data were extracted on clinical evolution, symptoms, examinations findings, diagnosis delay, treatment, outcome, patient status, and follow-up. (3) Results: Seventeen studies included data from patients with GPA and primary or relapsed gynecological involvement. 68% of the authors of this review thought the patient had cancer. The main gynecological symptom is bleeding, but exclusive gynecologic symptomatology is rare (ENT: 63%, lungs: 44%, kidneys-urinary tract: 53%). GPA could affect all areas of the genital tract, but the most frequent location is the uterine cervix. Medical treatment for GPA is effective. (4) Conclusions: GPA of the female genital tract must be considered when biopsies of an ulcerated malignant-appearing cervical or vaginal mass are negative for malignancy even when they are unspecific. Rheumatology consultation is indicated.

Oncologic outcomes of endometrial cancer in patients with low-volume metastasis in the sentinel lymph nodes: An international multi-institutional study.

OBJECTIVE: To assess oncologic outcomes in endometrial cancer patients with low-volume metastasis (LVM) in the sentinel lymph nodes (SLNs). METHODS: Patients with endometrial cancer and SLN-LVM (≤2 mm) from December 3, 2009, to December 31, 2018, were retrospectively identified from 22 centers worldwide. Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IV, adnexal involvement, or unknown adjuvant therapy (ATx) were excluded. RESULTS: Of 247 patients included, 132 had isolated tumor cell (ITC) and 115 had micrometastasis (MM). Overall 4-year recurrence-free survival (RFS) was 77.6% (95% CI, 70.2%-85.9%); median follow-up for patients without recurrence was 29.6 (interquartile range, 19.2-41.5) months. At multivariate analysis, Non-endometrioid (NE) (HR, 5.00; 95% CI, 2.50-9.99; P < .001), lymphovascular space invasion (LVSI) (HR, 3.26; 95% CI, 1.45-7.31; P = .004), and uterine serosal invasion (USI) (HR, 3.70; 95% CI, 1.44-9.54; P = .007) were independent predictors of recurrence. Among 47 endometrioid ITC patients without ATx, 4-year RFS was 82.6% (95% CI, 70.1%-97.2). Considering 18 ITC patients with endometrioid grade 1 disease, without LVSI, USI, or ATx, only 1 had recurrence (median follow-up, 24.8 months). CONCLUSIONS: In patients with SLN-LVM, NE, LVSI, and USI were independent risk factors for recurrence. Patients with any risk factor had poor prognosis, even when receiving ATx. Patients with ITC and grade 1 endometrioid disease (no LVSI/USI) had favorable prognosis, even without ATx. Further analysis (with more patients and longer follow-up) is needed to assess whether ATx can be withheld in this low-risk subgroup.

Validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of Brazilian schoolchildren.

OBJECTIVES: Echocardiographic (echo) screening is an important tool to estimate rheumatic heart disease (RHD) prevalence, but the natural history of screen-detected RHD remains unclear. The PROVAR+ (Programa de RastreamentO da VAlvopatia Reumática) study, which uses non-experts, telemedicine and portable echo, pioneered RHD screening in Brazil. We aimed to assess the mid-term evolution of Brazilian schoolchildren (5-18 years) with echocardiography-detected subclinical RHD and to assess the performance of a simplified score consisting of five components of the World Heart Federation criteria, as a predictor of unfavourable echo outcomes. SETTING: Public schools of underserved areas and private schools in Minas Gerais, southeast Brazil. PARTICIPANTS: A total of 197 patients (170 borderline and 27 definite RHD) with follow-up of 29±9 months were included. Median age was 14 (12-16) years, and 130 (66%) were woman. Only four patients in the definite group were regularly receiving penicillin. PRIMARY AND SECONDARY OUTCOME MEASURES: Unfavourable outcome was based on the 2-year follow-up echo, defined as worsening diagnostic category, remaining with mild definite RHD or development/worsening of valve regurgitation/stenosis. RESULTS: Among patients with borderline RHD, 29 (17.1%) progressed to definite, 49 (28.8%) remained stable, 86 (50.6%) regressed to normal and 6 (3.5%) were reclassified as other heart diseases. Among those with definite RHD, 13 (48.1%) remained in the category, while 5 (18.5%) regressed to borderline, 5 (18.5%) regressed to normal and 4 (14.8%) were reclassified as other heart diseases. The simplified echo score was a significant predictor of RHD unfavourable outcome (HR 1.197, 95% CI 1.098 to 1.305, p<0.001). CONCLUSION: The simple risk score provided an accurate prediction of RHD status at 2-year follow-up, showing a good performance in Brazilian schoolchildren, with a potential value for risk stratification and monitoring of echocardiography-detected RHD.

The My Child Matters programme: effect of public-private partnerships on paediatric cancer care in low-income and middle-income countries.

In low-income and middle-income countries, an excess in treatment failure for children with cancer usually results from misdiagnosis, inadequate access to treatment, death from toxicity, treatment abandonment, and relapse. The My Child Matters programme of the Sanofi Espoir Foundation has funded 55 paediatric cancer projects in low-income and middle-income countries over 10 years. We assessed the impact of the projects in these regions by using baseline assessments that were done in 2006. Based on these data, estimated 5-year survival in 2016 increased by a median of 5·1%, ranging from -1·5% in Venezuela to 17·5% in Ukraine. Of the 26 861 children per year who develop cancer in the ten index countries with My Child Matters projects that were evaluated in 2006, an estimated additional 1343 children can now expect an increase in survival outcome. For example, in Paraguay, a network of paediatric oncology satellite clinics was established and scaled up to a national level and has managed 884 patients since initiation in 2006. Additionally, the African Retinoblastoma Network was scaled up from a demonstration project in Mali to a network of retinoblastoma referral centres in five sub-Saharan African countries, and the African School of Paediatric Oncology has trained 42 physicians and 100 nurses from 16 countries. The My Child Matters programme has catalysed improvements in cancer care and has complemented the efforts of government, civil society, and the private sector to sustain and scale improvements in health care to a national level. Key elements of successful interventions include strong and sustained local leadership, community engagement, international engagement, and capacity building and support from government.

Methotrexate-treated ectopic pregnancy: beta human chorionic gonadotropin serum changes as a success predictor using a mathematical model validation.

BACKGROUND: Surgical rescue of methotrexate-treated ectopic pregnancy is necessary when tubal rupture or medical therapy failure is detected during post-therapeutic monitoring. It is known that an increased beta human chorionic gonadotropin (ß-hCG) concentration is the most important factor associated with treatment failure. Therefore, we suggested that relative changes in serum ß-hCG could predict a successful result of medical treatment, leading to facilitation of the decision to forgo the prospect of possible surgical rescue. METHODS: A retrospective observational study of 115 patients with an ectopic pregnancy who were treated with a single dosage protocol of 50mg/m2 of methotrexate injected intramuscularly was performed at Puerta de Hierro University Hospital and Gregorio Marañón University General Hospital. Standard statistical tests were applied in order to evaluate the relative changes in ß-hCG concentration between the 1st and the 4th days following methotrexate injection. RESULTS: Methotrexate treatment has a 95% probability to be successful if the relative change of ß-hCG from the 1st to the 4th day of monitoring is within the following interval: [-1.02; 0.15]. Moreover, if the values of ß-hCG-relative change from 1st to 4th day of monitoring are within [0.54; 1.2], it assures a negative result of treatment with 95% probability. Therefore, the value 0.15 (15%) of ß-hCG relative change can be considered a cut-off value for a positive result to treatment. CONCLUSIONS: Our data support that negative ß-hCG relative changes on the 4th day of treatment likely predict a successful result of methotrexate therapy, with a cut-off point of 0.15. Expectant management should be carried out in these cases if no clinical indications of surgery are presented.

Orbital apocrine hidrocystoma with immunohistochemical confirmation / Hidrocistoma apócrino orbitário com confirmação imunohistoquímica

ABSTRACT The authors report the first case in Brazilian literature of orbital apocrine hidrocystoma with immunohistochemistry confirmation. The tumor had been growing slowly and progressively, there was no history of impaired vision, diplopia, watering, discharge, or prior trauma. There was no proptosis and extraocular mobility was normal. The radiologic study by orbital computerized tomography revealed an extraconal nodule, with partially defined limits, with cystic and solid areas in the superomedial right orbit. An anterior orbitotomy, with full excision of the tumor was performed. A histopathology examination revealed apocrine hidrocystoma and immunohistochemistry confirmed the diagnosis. After surgery, the patient had total remission of symptoms.

RESUMO Os autores relatam o primeiro caso de hidrocistoma apócrino orbitário com confirmação imunohistoquímica. O tumor apresentou crescimento lento e progressivo, sem relato de baixa de acuidade visual, diplopia, epífora, secreção ou trauma prévio. Não houve proptose ou alteração da motilidade extraocular. O exame de imagem por tomografia computadorizada da órbita revelou uma lesão nodular, extraconal, de limites imprecisos, com áreas císticas e sólidas no seu interior, na região súpero-medial de órbita direita. O paciente foi submetido à orbitotomia por via anterior, com exérese integral da tumoração. O exame histopatológico revelou o diagnóstico de hidrocistoma apócrino e a imunohistoquímica confirmou o diagnóstico. Após a cirurgia, o paciente teve regressão total dos sintomas.

"The impact of debulking surgery in patients with node-positive epithelial ovarian cancer: Analysis of prognostic factors related to overall survival and progression-free survival after an extended long-term follow-up period".

OBJECTIVE: to estimate the prognostic factors associated with survival and progression free survival (PFS) in patients with node-positive epithelial ovarian cancer (EOC) after an extended long-term follow-up period. METHODS: Data was provided by the Tumor Registry of the Mayo Clinic, Scottsdale, Arizona on 116 node-positive EOC patients who underwent primary cytoreductive surgery observed over the period 1996-2014. RESULTS: At censoring date, 21 patients were alive (18%), 95 dead (82%), 18 without evidence of disease (NED) (15 alive, 3 dead) and 76 with evidence of disease (ED) (2 alive, 74 dead). Twenty-nine ED patients (38.2%) experienced a recurrence within 2 years, 53 patients (69.7%) before 5 years. No recurrences were recorded after 10 years. The median follow-up in alive patients was 169.8 months (1.20-207.9 months), 34.9 months (0.30-196.2 months) in dead patients, 128.4 months for NED patients (72.8-202.5 months) and 34.6 months (0.1-106.9 months) in ED patients. Multivariate analysis showed an increased risk of dead in patients with age ≥ 60 years (HR: 3.20; p < 0.002), stage IVA/B (compared with stage IIIA1/2, HR: 4.31; p < 0.001 and stage IIIB/C, HR: 5.31; p < 0.010) and incomplete surgery (compared with complete surgery, HR: 3.10; 95% CI, 1.41-6.77; p < 0.003) and a decreased PFS in stage IVA/B (compared with stages IIIB/C; p = 0.003 and stage IIIA; p = 0.000) and residual volume after surgery >0.6 cm (compared with residual disease <0.5 cm; p < 0.023). CONCLUSIONS: prognostic factors for an extended long-term PFS are similar as those for survival, because after 17-year follow-up period, the majority of alive patients are NED patients.

Peritoneal carcinomatosis: A malignant disease with an embryological origin?

INTRODUCTION: In 1931, Simpson et al. coined the term "peritoneal carcinomatosis" to describe the regional spread of ovarian tumors as localized or extended with involvement of the peritoneal serous membrane and neighboring anatomical structures. Research into the origin of peritoneal carcinomatosis is based on two phases in a woman's life: EMBRYO DEVELOPMENT: During week 3, the bilaminar disc becomes a trilaminar disc called the mesoderm. Inside the lateral plate mesoderm, the coelomic cavity is divided into 2 layers: the parietal (somatic) mesoderm, which gives rise to the parietal peritoneum and pleural surfaces; and the visceral (splanchnic) mesoderm, which gives rise to the visceral peritoneum, visceral surface of the pleura, gonadal stroma, and the muscular layer of the hollow viscera and its mesenteries. TUMOR SPREAD: Transcoelomic metastasis and metaplasia of pluripotent stem cells in the peritoneum was involved in the pathogenesis of ovarian cancer. This involvement takes the form of a synchronous malignant transformation at multiple foci and may cause intraperitoneal field cancerization. Pluripotent stem cells play a role both in the development of the embryonic peritoneum and in the spread of transcoelomic tumors. Consequently, knowledge of the origin of these cells (embryonic or current) could be extremely useful. The many markers that act during the embryonic period can affect descendants, that is, cells are already marked before specification and differentiation are activated. Thus, programmed activation could be attributed to genetic and epigenetic changes.

Lymphatic ascites after retroperitoneal lymphadenectomy in gynecologic cancer.

OBJECTIVES: The incidence, diagnosis, treatment and outcome of lymphatic ascites (LA) are studied on 85 consecutive patients with gynecologic cancer who had undergone pelvic and/or paraaortic lymphadenectomy by means of laparotomy or laparoscopy. METHODS: Patients were distributed in two groups depending in the access: Laparoscopy (study group: 44 patients) and laparotomy (control group: 41 patients). All surgical parameters were collected and patients underwent ultrasound examination on postoperative days 7, 14, and 28. The main outcome measure was the development of symptomatic or asymptomatic LA. DESIGN: Prospective cohort study. RESULTS: LA developed in 3 patients (6.8%) in the study group and 9 in the control group (22%), with statistical difference (p < 0.05). The relative risk to develop lymphatic ascites after surgery performed by laparotomy was 3.2 (95% CI 1.05-11.07). Mean nodes harvested during the surgery was 18.6 (SD 6.6) in the LA group and 20.4 (SD 9.1) in the group with no LA (p = 0.527). CONCLUSIONS: The incidence of LA after retroperitoneal lymphadenectomy in gynecologic cancer patients is lower in the patients treated by laparoscopy.

International Federation of gynecology and obstetrics staging classification for cancer of the ovary, fallopian tube, and peritoneum: estimation of survival in patients with node-positive epithelial ovarian cancer.

OBJECTIVE: The objective of this study was to determine the survival of patients with node-positive epithelial ovarian cancer according to the 2014 International Federation of Gynecology and Obstetrics (FIGO) staging system. MATERIALS AND METHODS: We performed a retrospective chart review. Data from all consecutive patients with node-positive epithelial ovarian cancer (stages IIIC and IV) who underwent cytoreductive surgery at the Mayo Clinic from 1996 to 2000 were reassessed to evaluate the prognostic significance of the new FIGO stages. Multivariate Cox regression was performed, and Kaplan-Meier survival curves constructed. RESULTS: The distribution of the restaged patients was as follows: IIIA1, 23 patients (IIIA1i, 9 patients; and IIIA1ii, 14 patients); IIIA2, 3 patients; IIIB, 4; IIIC, 67 patients; IVA, 4 patients; and IVB, 15 patients. In the univariate analysis, the relative risk for positive nodes greater than 10 mm on the longer axis was 2.57 and 3.00 for patients with microscopic peritoneal disease, compared with patients with microscopic positive nodes. However, the difference was not statistically significant. Moreover, the univariate analyses revealed statistically significant differences for 2014 FIGO stages (IIIA, IIIB, IIIC, and IVA-B), anatomical sites of peritoneal metastases, and disease staged at IIIC because of the presence of omental metastases. Multivariate analysis showed that survival was higher in patients restaged to IIIA-B than in those restaged to IIIC and IV (hazard ratios, 2.75 and 3.16, respectively; P = 0.002). The hazard ratio for patients with abdominal peritoneal metastases was 2.76 compared with patients with pelvic peritoneal metastases (P = 0.001). CONCLUSIONS: The current 2014 FIGO staging system for ovarian cancer successfully correlates survival, anatomical location of peritoneal metastases, and extra-abdominal lymph node metastases.

Hysteroscopy in pregnancy-related conditions: descriptive analysis in 273 patients.

STUDY OBJECTIVE: To describe the feasibility of office hysteroscopy in patients with pregnancy-related problems such as retained trophoblastic tissue, persistent molar tissue, pregnancy with in situ intrauterine device (IUD), isthmocele, embryoscopy, and osseous metaplasia. DESIGN: Retrospective cohort chart review of use of hysteroscopy in 273 patients with pregnancy-related conditions (Canadian Task Force classification II-2). SETTING: University tertiary-care hospital. PATIENTS: Office hysteroscopy with the indication of pregnancy-related conditions such as retained trophoblastic tissue, pregnancy with IUD, molar pregnancy, cesarean scar defects, and fetal death were studied. The study included 273 patients: 185 with retained trophoblastic tissue, 14 with persistent molar tissue, 7 with an in situ IUD, 22 with symptomatic isthmocele, 41 with embryoscopy, and 4 with osseous metaplasia. INTERVENTION: Diagnostic and operative office hysteroscopy. MEASUREMENTS AND MAIN RESULTS: Variables studied included resolution of abnormal uterine bleeding in patients with persistent trophoblastic tissue, normalization of ß-human chorionic gonadotropin levels in patients with persistent molar tissue, continuation of pregnancy after retrieval of lost IUDs, resolution of postmenstrual bleeding in patients with symptomatic isthmocele, rate of uncontaminated embryonic tissue after embryoscopic biopsy, and successful extraction of bony tissue in patients with osseous metaplasia. Office hysteroscopy enabled resolution of most cases of retained trophoblastic tissue (91.8%) and all 14 cases of persistent molar tissue. 7 IUDs were extracted from pregnant patients. Fifteen isthmoceles resolved with office hysteroscopy, and 7 were resected in the operating room. A normal karyotype was obtained in 37 embryoscopies (90.2%). Four osseous metaplasia cases resolved with either office hysteroscopy (75%) or resectoscopy in the operating room (25%). CONCLUSION: Office hysteroscopy is a safe and minimally invasive treatment for pregnancy-related conditions, with good clinical and functional results.

The impact of pelvic retroperitoneal invasion and distant nodal metastases in epithelial ovarian cancer.

BACKGROUND: The absence of disease after debulking surgery is the most important prognostic factor in the treatment of advanced epithelial ovarian cancer (EOC). Occasionally, the presence of extra-abdominal disease complicates the ability to obtain a complete surgery, considering some locations of the metastatic disease as unresectable. The objective of the study was to estimate the survival impact of pelvic retroperitoneal invasion and extrapelvic and aortic distant nodal metastases in EOC patients. The anatomical landmarks of primary cytoreductive surgery will be discussed. MATERIAL AND METHODS: We reviewed data from 116 consecutive Mayo Clinic patients with epithelial ovarian cancer (EOC) stage IIIC and IV, undergoing primary cytoreduction surgery between 1996 and 2000. Univariate and multivariate analysis for patients with positive distant nodes and pelvic retroperitoneal invasion was performed, including 57 patients with no residual disease after surgery. Kaplan-Meier curves were used to estimate the probability of survival. RESULTS: The median patient's age was 65 years (range 24-87 years). The 5 years overall survival was 44.8% (range 30.1-57.9 months) and the median length of survival was 39.9 months (range 0.13-60 months, 95% confidence interval: 30.1-57.9). Pelvic retroperitoneal invasion was present in 22 EOC patients (18.9%) and distant positive nodes were noted in 11 (9.5%): suprarenal/celiac (5.2%), inguinal (4.3%) and supraclavicular (0.9%). Univariate and multivariate Cox regression analysis, identified distant positive lymph nodes and pelvic retroperitoneal invasion as factors statistically associated with overall survival (p = 0.002 and p = 0.025, respectively). CONCLUSIONS: Metastatic distant nodes and pelvic retroperitoneal invasion are independent prognostic factors for survival in patients with advanced EOC.

Fisioterapia durante a hemodiálise de pacientes com doença renal crônica / Physical therapy during hemodialyse in patients with chronic kidney disease

INTRODUÇÃO: O objetivo do estudo foi avaliar os efeitos de um programa de fisioterapia em pacientes com doença renal crônica (DRC) durante a hemodiálise (HD). MÉTODOS: Cinquenta e seis pacientes com DRC participaram, durante 16 meses, de um programa de fisioterapia supervisionado nas sessões de HD. As avaliações ocorreram antes e 16 meses após o início do treinamento. O programa consistiu de exercícios de fortalecimento muscular, alongamento e bicicleta ergométrica estacionária. As análises se compuseram de teste de caminhada de seis minutos (TC6M); nível de esforço pela escala de BORG, teste de uma repetição máxima (1RM), para mensurar a força muscular de quadríceps; qualidade de vida (QV) e medidas de pressão arterial (PA), frequências cardíaca (FC) e respiratória (FR). RESULTADOS: Houve aumento na distância percorrida (54 m; p < 0,001) pelo TC6M e da força muscular de quadríceps (média de +3 para +4; p < 0,001); redução da FC e FR (média de 8 bpm e 5 irpm, respectivamente; p < 0,001); melhora no escore total da SF-36 (p < 0,006), porém significativamente na capacidade funcional (p < 0,006) e dor (p < 0,001). A PA reduziu, entretanto, não significativamente (p < 0,08). Verificou-se correlação apenas nos domínios dor e capacidade funcional, individualmente, com o aumento da distância percorrida no TC6M (p < 0,013 e p < 0,002); houve correlação entre diminuições na FC e FR, atreladas à redução na escala de BORG (p < 0,043). CONCLUSÃO: A fisioterapia, por meio de um programa de exercícios físicos durante o período intradialítico, pode proporcionar melhora significativa da QV e capacidade física dos pacientes com DRC.

INTRODUCTION: The aim of this study was to evaluate the effects of a physical therapy program in patients with chronic kidney disease (CKD) during hemodialysis (HD). METHODS: Fifty-six CKD patients participated for 16 months in a supervised physical therapy program in HD sessions. They underwent evaluation before the start of the program and 16 months after this training. The program consisted of muscle strengthening exercises, stretching and stationary exercise bike. The analysis is composed of test six-minute walk (6MWT), level of effort by the BORG scale test of one repetition maximum (1RM) to measure the quadriceps strength, quality of life (QOL) and arterial blood pressure (BP), heart (HR) and respiratory (RR). RESULTS: The results showed an increase in distance traveled for the 6MWT and quadriceps strength, reduction of HR and RR and improvement in total score SF-36, but significantly in functional capacity and pain BP reduced, though not significantly. It was found by the Spearman correlation test, only in the areas correralation pain and functional capacity, individually, with the increase in distance walked in 6MWT; correlation between decreases in HR and RR linked to reduction in the Borg scale. CONCLUSION: Physical therapy, through an exercise program during the intradialytic period, can provided a significant improvement of QOL and physical ability of patients with CKD.