Fibroma mole gigante vulvar: relato de caso / Giant soft vulvar fibroma: case report

Fibroma mole, ou pólipo fibroepitelial, é uma lesão de proporções geralmente reduzidas, de cor hiperpigmentada ou igual à da pele, localizando-se frequentemente na face, pescoço, tronco e regiões intertriginosas. É um tumor classificado como benigno e pode acometer tanto homens quanto mulheres em idade reprodutiva e depois da quarta década de vida. Ocorre principalmente em obesos, diabéticos e durante a gestação. Com menor frequência, podem alcançar dimensões que excedem 5 cm. Seu crescimento pode ser lento ou rápido e comumente são assintomáticos, mas podem promover sangramentos por conta de ulcerações decorrentes de traumas repetidos. Apresentamos neste relato um fibroma mole, gigante, de localização vulvar, com 11 cm de comprimento, 11 cm de largura e 5 cm de espessura, pesando 500 g.

Giant soft vulvar fibroma is a fibroepithelial polyp lesion with generally reduced proportions, with a hyperpigmented color or similar to that of the skin, frequently located on the face, neck, trunk and intertriginous regions. It is a tumor classified as benign, can affect both men and women, of reproductive age and after the fourth decade, mainly obese, diabetic and during pregnancy. However, less frequently, they can reach dimensions that exceed 5 cm, may have a slow or accelerated evolution. They are commonly asymptomatic, but bleeding may be present due to ulcerations resulting from repeated trauma. In the current study, we describe a giant soft fibroma with a vulvar location measuring 11 cm in length, 11 cm in width, 5 cm in thickness and weighing 500 grams.

A propensity score-matched retrospective cohort study of hysterectomies for benign disease during the COVID-19 pandemic

SUMMARY OBJECTIVE: This study aimed to evaluate how the pandemic might have affected the number of elective and urgent hysterectomies for benign gynecological pathologies in a single-care tertiary center in the State of São Paulo, Brazil, and to identify if there were any changes in the need for blood transfusions. METHODS: This is a single-center retrospective cohort study. It involved all non-puerperal and non-oncological hysterectomies from October 2018 to July 2021. Patients were divided into two groups, namely, the pandemic group (46 patients) and the control group (92 patients). Data were collected by reviewing the physical and electronic patient records. We carried out the statistical analysis using the RStudio software. RESULTS: The number of planned hysterectomies was 82 in the pre-pandemic group and 23 in the analysis group, representing a 71.9% decrease. When considering only urgent surgeries, 10 of them happened in the pre-pandemic group, while 23 occurred in the pandemic group, representing an increase of 130%. CONCLUSION: Elective hysterectomies may improve the quality of life of women, reducing abnormal bleeding and pelvic pain. Treatment delay can worsen patients' physiological and biological conditions, such as lower labor production, humor, and social aspects, increasing costs to the healthcare system.

Comparison between gynecologic oncology ultrasound and magnetic resonance imaging in the assessment of early-stage cervical cancer: A local experience in cancer imaging / Philippine Journal of Obstetrics and Gynecology

Objective@#This study aimed to compare the diagnostic accuracy of gynecologic oncology ultrasound and magnetic resonance imaging (MRI) in the assessment of early-stage cervical cancer.@*Methodology@#This was a prospective, cross-sectional study of patients with early-stage cervical cancer eligible for radical hysterectomy in a tertiary government institution from November 25, 2020, to August 2, 2022. Preoperative gynecologic oncology (transabdominal/transvaginal/transrectal) ultrasound and MRI measurements were obtained and compared with histopathologic findings. Sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio were used to check for the diagnostic accuracy of each modality.@*Results@#A total of 27 patients were enrolled in the study. Four were stage IB1 (14.81%), 10 were stage IB2 (37.03%), nine were stage IB3 (33.33%), two were stage IIA1 (7.40%), and two were stage IIA2 (7.40%). Ultrasound has a comparable diagnostic accuracy with MRI to assess tumor size length, width, and height with an area under the curve of 0.789, 0.753, and 0.806, respectively. Both modalities can predict the absence of parametrial invasion and nodal involvement with a specificity of 100% and a negative predictive value of 88.89% and 81.48%, respectively. The results of the gynecologic oncology ultrasound showed good agreement with MRI.@*Conclusion@#Ultrasound has comparable diagnostic accuracy with MRI in assessing tumor size, parametrial invasion, and nodal involvement in patients with early-stage cervical cancer. It is a good alternative imaging modality to MRI in staging cervical cancer, especially in low- to middle-income countries.

Dosimetric effects of prone immobilization devices combined with a belly-board in intensity-modulated radiotherapy for gynecologic cancers / 中华放射医学与防护杂志

Objective:To investigate the dosimetric effects of prone immobilization devices combined with a belly board (PIDBBs) in the intensity-modulated radiotherapy (IMRT) for gynecologic cancers.Methods:A total of 20 patients with cervical or endometrial cancer treated with radiotherapy in the Third Affiliated Hospital of Sun Yat-sen University from August 2020 to June 2021 were retrospectively analyzed. Two sets of body contours were outlined for each patient. One set of body contours did not contain the immobilization devices, and the other contour set included the immobilization devices. For each patient, doses were calculated for the two sets of contours using the same 7-field IMRT plan and were recorded as Plan without and Plan with. The dosimetric difference caused by the immobilization devices was assessed by comparing the parameter values in the dose-volume histograms (DVHs) and by plan subtraction. The Gafchromic EBT3 film and anthropomorphic phantom were used to verify the calculated doses. Results:The target coverage and average dose of Plan with were lower than those of Plan without. Specifically, the V50 Gy, V49 Gy, and Dmean of planning target volume (PTV) decreased by 19.75%, 7.99%, and 2.54% ( t = 8.96, 10.49, 22.09, P < 0.01), respectively. The V40 Gy, V30 Gy, V20 Gy, V15 Gy, and Dmean of skins increased by 51.79%, 51.05%, 45.72%, 33.63% and 10.80% ( t = -2.54, -5.63, -15.57, -24.06, -13.88, P < 0.01), respectively. Doses to other organs at risk (OARs) showed no significant differences. As indicated by the EBT3 measurements, the doses to skins of the abdomen and pelvis on the anthropomorphic phantom increased by approximately 37.24% ( t = 10.86, P<0.01). Conclusions:Although PIDBBs can effectively reduce the low dose to the small intestine, the radiation attenuation caused by them can reduce the PTV coverage of radiotherapy plans and increase the doses to abdominal and pelvic skins sharply, especially for patients requiring irradiation of the groin and perineum.

Comparison of long-term clinical outcomes between transvaginal mesh and pelvic floor reconstruction with native tissue repair in the treatment of advanced pelvic organ prolapse / 中华妇产科杂志

Objective:To study the long-term clinical effect of transvaginal mesh (TVM) and pelvic floor reconstruction with native tissue repair (NTR) in the treatment of advanced pelvic organ prolapse (POP).Methods:Totally 207 patients with advanced POP who were treated in Hunan Provincial Maternal and Child Health Care Hospital from Jan. 2016 to Sep. 2019 were enrolled. The patient′s pelvic organ prolapse quantification were all at degree Ⅲ or above, and they all complained for different degree of symptoms. They were divided into two groups according to the different surgical methods, TVM group and NTR group. In TVM group, the mesh was implanted through the vagina for pelvic floor reconstruction, while in NTR group, the traditional transvaginal hysterectomy combined with uterosacral ligament suspension and anterior and posterior wall repair, as well as perineal body repair were performed. The median follow-up time was 60 months, during the follow up time, 164 cases (79.2%, 164/207) had completed follow-up, including 76 cases in TVM group and 88 cases in NTR group. The perioperative data and complication rates of the two groups were compared, and the subjective and objective outcomes of the two groups at 1, 3 and 5 years were observed, respectively. The objective efficacy was evaluated by three composite criteria, namely: (1) the distance from the farthest end of the prolapse of the anterior and posterior wall of the vagina to the hymen is ≤0 cm, and the descending distance of the top is ≤1/2 of the total length of the vagina; (2) determine the disappearance of relevant POP symptoms according to “Do you often see or feel vaginal mass prolapse？”; (3) no further operation or pessary treatment was performed due to prolapse. If the above three criteria were met at the same time, the operation is successful; otherwise, it was recurrence. The subjective efficacy was evaluated by the pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire-short form 7 (PFIQ-7).Results:The median follow-up time of the two groups was 60 months (range: 41-82 months). Five years after the operation, the subjective and objective cure rates of TVM group were 89.5% (68/76) and 94.7% (72/76), respectively. The subjective and objective cure rates in NTR group were 80.7% (71/88) and 85.2% (75/88), respectively. There were significant differences in the subjective and objective cure rates between the two groups ( χ2=9.869, P=0.002; χ2=3.969, P=0.046). The recurrence rate of TVM group was 5.3% (4/76), and that of NTR group was 14.8% (13/88). There was a significant difference between the two groups ( P=0.046). The postoperative PFDI-20 and PFIQ-7 scores of the two groups were significantly lower than those before surgery, and there were significant differences of the two groups before and after surgery (all P<0.05). Postoperative mesh exposure in TVM group was 1.3% (1/76). Conclusions:The long-term outcomes between the two groups show that the subjective and objective outcomes of pelvic floor reconstruction in TVM group are significantly higher than those in NTR group, and the recurrence rate is significantly lower than that in NTR group. TVM has certain advantages in the treatment of advanced POP.

Effect of laparoscopic ovarian cystectomy on ovarian reserve and the outcomes of in vitro fertilization patients with benign ovarian cysts / 中华妇产科杂志

Objective:To investigate the effect of laparoscopic ovarian cystectomy on anti-Mullerian hormone (AMH) level, ovarian response to gonadotropin stimulation and pregnancy rate for in vitro fertilization (IVF) patients with benign ovarian cysts.Methods:Patients with benign ovarian cysts who were admitted for cystectomy and had undergone IVF treatment were enrolled in the study. There were 373 participants with ovarian cysts underwent laparoscopic ovarian cystectomy in the experimental group. According to duration of post-surgery, there were four sub-groups: 1 year post-surgery (1Y POST), 2 years post-surgery (2Y POST), 4 years post-surgery (4Y POST) and ≥5 years post-surgery (≥5Y POST) in the experimental group. According to histopathologic types of ovarian cysts, there were two sub-groups: ovarian endometriotic cysts and ovarian non-endometriotic cysts. Two hundreds and three patients with no history of ovarian cysts and ovarian surgery were in the control group. The level of AMH and basic concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone (P), estradiol (E 2) were measured. Antral follicle counts (AFC) were calculated. There were other study variables: total dose of gonadotropins, duration of ovarian stimulation, the number of oocyte retrieved, the number of embryo obtained, blastocyst transfer rate and pregnancy rate. Results:The control group was matched as closely as possible to the experimental group, including age, body mass index and menstrual cycle (all P>0.05). Compared to the women in control group, the women in ovarian endometriotic cystectomy sub-group had significantly higher levels of basal FSH and basal P, lower level of AMH (all P<0.05); the women in ovarian endometriotic cysts sub-group had significantly higher dose of gonadotropins (all P<0.05); the women in ovarian endometriotic cysts ≥5Y POST sub-group had significantly lower number of oocyte retrieved, lower number of embryo obtained, lower blastocyst transfer rate, and lower pregnancy rate (all P<0.05). Compared to the women in control group, the women in ovarian non-endometriotic cysts sub-group had a significantly higher level of basal FSH and basal P (all P<0.05). The women in ovarian non-endometriotic cysts sub-group had lower level of AMH, higher dose of gonadotropins, lower number of oocyte retrieved, lower number of embryo obtained, lower rate of blastocyst transfer and lower rate of pregnancy than the control group but there were no statistically significant differences among them (all P>0.05). The women with unilateral ovarian endometriotic cysts had significantly lower number of oocyte retrieved on the side of surgery than another side ( P<0.05). Conclusions:In short term laparoscopic ovarian cystectomy has no significant effect on ovarian reserve. But with long-term follow-up ovarian reserve, ovarian response to gonadotropin stimulation and pregnancy rate are decreased. The effect of laparoscopic ovarian cystectomy in benign cysts on ovarian is associated with whether or not it is the surgical side.

Comparison of the effects of remimazolam besylate and midazolam on postoperative cognitive function in patients undergoing gynecologic laparoscopic surgery under general anesthesia / 中国医师杂志

Objective:To investigate the effects of remimazolam besylate and midazolam on postoperative cognitive function of patients undergoing gynecologic laparoscopic surgery under general anesthesia.Methods:From May 2019 to January 2021, 120 patients with gynecological laparoscopic surgery under general anesthesia in Haikou Maternal and Child Health Hospital were selected and divided into control group (60 cases) and observation group (60 cases) by random number table. The control group was given 0.05 mg/kg midazolam and 0.50 μg/kg sufentanil and 0.15 mg/kg vecuronium bromide were used for anesthesia induction. Patients in the observation group were given 0.3 mg/kg remimazolam besylate and 0.50 μg /kg sufentanil and 0.15 mg/kg vecuronium were used for anesthesia induction. The levels of hemodynamic indexes before anesthesia (T 0), during anesthesia (T 1), and after intubation (T 2) as well as the levels of postoperative anesthesia recovery indexes were compared between the two groups. The Visual Analogue Scale (VAS) score and Mini-Mental State Examination (MMSE) scores were recorded and compared before surgery, 24 h, 72 h after surgery. The total incidence of adverse reactions after surgery was recorded and compared between the two groups. Results:The heart rate (HR) at T 1 and T 2 in the two groups was higher than that at T 0, the oxygen saturation (SpO 2) at T 1 and T 2 was lower than that at T 0, the mean arterial pressure (MAP) at T 1 was lower than that at T 0, and the MAP at T 2 was higher than that at T 0, with statistically significant difference (all P<0.05); The HR and MAP at T 1 and T 2 in the observation group were lower than those in the control group, and SpO 2 was higher than those in the control group (all P<0.05); The recovery time of spontaneous respiration, eye opening time and extubation time in the observation group were significantly shorter than those in the control group (all P<0.05); The MMSE score at 24 h and 72 h after operation was lower than that before operation, and the VAS score at 24 h was higher than that before operation in both groups (all P<0.05); The MMSE scores in the observation group at 24 h and 72 h after operation were significantly higher than those in the control group (all P<0.05), and there was no significant difference in the VAS scores at 24 h and 72 h after operation between the two groups ( P>0.05); There was no significant difference in the total incidence of adverse reactions between the two groups (all P>0.05). Conclusions:Remimazolam besylate has little effect on cognitive function of patients undergoing gynecologic laparoscopic surgery under general anesthesia, with fast recovery and high safety, which is worthy of clinical promotion.

Effects of dexmedetomidine on vital signs during postoperative anesthesia recovery period in gynecological patients undergoing general anesthesia surgery and analysis on risk factors for complications / 中国基层医药

Objective:To investigate the effects of dexmedetomidine on vital signs during recovery from general anesthesia in gynecological patients undergoing general anesthesia surgery and analysis of risk factors for complications.Methods:A total of 80 gynecological patients undergoing general anesthesia surgery who received treatment in Lishui People's Hospital from March 2021 to March 2022 were included in this study. They were randomly divided into an observation group and a control group ( n = 40/group). All patients were subjected to general anesthesia. The observation group was infused with 0.5 μg/kg dexmedetomidine intravenously 15 minutes before induction of anesthesia and then infused with dexmedetomidine at a rate of 0.2 μg/kg per hour until 20-30 minutes before the end of the operation. The control group was identically given 0.9% normal saline. The recovery quality, vital signs before surgery and during recovery from general anesthesia (systolic blood pressure, diastolic blood pressure, heart rate, body temperature), and complications during recovery from general anesthesia were compared between the two groups. These patients were divided into a complication group and a non-complication group according to whether there were complications during recovery from general anesthesia. Univariate and multivariate Logistic regression analyses were performed to analyze the high-risk factors for complications occurring during recovery from general anesthesia in gynecological patients undergoing general anesthesia surgery. Results:The time to awaken, time to recover spontaneous respiration, and time to extubation in the observation group were significantly shorter than those in the control group ( t = 3.74, 2.97, 2.56, all P < 0.05). Systolic blood pressure, diastolic blood pressure, and heart rate measured during recovery from general anesthesia were significantly lower in the observation group compared with the control group ( t = 5.71, 4.53, 4.53, all P < 0.001). Body temperature ( t = 4.40, P < 0.001) and the incidence of complications ( χ2 = 5.69, P < 0.05) were significantly lower in the observation group compared with the control group. These patients were divided into complication ( n = 22) and non-complication ( n = 58) groups according to whether they had complications during recovery from general anesthesia. Univariate and multivariate logistic regression analyses showed that American Association of Anesthesiologists grade II, presence of underlying diseases, abnormal leukocyte count, and no use of dexmedetomidine were the risk factors for postoperative complications in gynecological patients undergoing general anesthesia surgery ( OR = 2.38, 2.86, 2.17, 3.60, all P < 0.05). Conclusion:Dexmedetomidine can improve awakening quality and vital signs and reduce complications during recovery from general anesthesia. American Association of Anesthesiologists grade, underlying disease, abnormal white blood cell count, and no use of dexmedetomidine are the risk factors for complications occurring during recovery from general anesthesia in gynecological patients undergoing general anesthesia surgery.

Application of TSPV 4-step teaching in skill training of gynecologic laparoscopic surgery / 中华医学教育探索杂志

Objective:To explore the application and teaching effect of TSPV (short for theoretical teaching, simulated surgical skills training, practical surgery training, and video-based review) 4-step teaching in skill training of gynecologic laparoscopic surgery.Methods:A total of 30 trainees who participated in gynecologic laparoscopic surgery training were randomly divided into two groups, with 15 in each group. The experimental group received TSPV 4-step teaching, while the control group adopted traditional teaching and completed training and assessment in stages. The general data, training assessment results, teaching feedback and satisfaction survey of the two groups were compared and analyzed. SPSS 20.0 was used for t-test and Chi-square test. Results:There was no statistical difference in age, gender distribution, education background, clinical working experiences and other general data between the two groups. There was no significant difference in the theoretical examination scores between the two groups [(85.3±4.6) vs. (83.4±4.3), P=0.252]. The scores of simulated operation assessment [(91.7±5.2) vs. [(72.4±5.9), P<0.001] and clinical practice assessment [(88.5±4.8) vs. (82.7±6.7), P=0.011] in the experimental group were better that those in the control group. In addition, the experimental group had a better overall evaluation of teaching satisfaction. Conclusion:TSPV 4-step teaching is a more optimized and popular gynecologic laparoscopic training mode, which is recommended to further promote the validation in teaching.

Progress on the relationship between consumption of added sugar and incidence of gynecologic cancer / 公共卫生与预防医学

Globally, gynecological malignancies are common types of female cancer and the main cause of cancer death among women. Cervical cancer, endometrial cancer and ovarian cancer, which are the main types of gynecological cancers, pose a significant threat to women's health worldwide. Studies have shown that diet plays an important role in the occurrence and development of gynecological cancers such as cervical cancer, endometrial cancer, and ovarian cancer, for which added sugar may be an influencing factor due to its food source characteristic and related biological effect. However, this paper reviewed the research progress on the relationship between consumption of added sugar and gynecological cancers such as endometrial cancer, ovarian cancer and cervical cancer, with a view to providing a reference for the active prevention of gynecological cancer.

Effect of lung protective ventilation on lung ventilation function, serum serum Clara cell protein 16 level and prognosis in patients undergoing gynecological laparoscopic surgery / 中国医师进修杂志

Objective:To analyze the effect of lung protective ventilation on lung ventilation function and serum Clara cell protein 16 (CC16) level in patients undergoing gynecological laparoscopic surgery.Methods:The clinical data of 80 gynecological patients who underwent laparoscopic surgery in Yancheng City Jianhu County People′s Hospital from October 2018 to December 2020 were randomly divided into group A and group B by random number table, each group with 40 cases. The patients in group A were treated with intermittent positive-pressure ventilation, and the patients in group B were ventilated with whole course ventilation mode. The pulmonary ventilation function, CC16 level and postoperative pulmonary complications were observed before anesthesia, 10 min of pneumoperitoneum, 30 min of pneumoperitoneum, 5 min of pneumoperitoneum stop and 2 h after operation. The patients were divided into groups according to whether with pulmonary complications, and their pulmonary ventilation function and serum CC16 level were compared. The predictive value of the above indexes for pulmonary complications was analyzed by receiver operating characteristic (ROC) curve.Results:Repeated measurement analysis of variance showed that alveolar arterial oxygen differential pressure (PA-aDO 2) were significant differences in time point factors, time point interaction factors and group factors ( P<0.05); CC16 index were significant differences in time point factor and group factor ( P<0.05). According to the observation from postoperative to discharge, 4 patients (10.0%) in group A had pulmonary complications, 15 cases (37.5%) had pulmonary complications in group B, the levels of PA-aDO 2 and CC16 in patients with complications were significantly higher than those in patients without complications: group A:(332.9 ± 2.0) mmHg (1 mmHg = 0.133 kPa) vs. (290.4 ± 13.2) mmHg, (53.5 ± 1.5) μg/L vs. (39.5 ± 6.5) μg/L; group B: (339.1 ± 8.8) mmHg vs. (305.7 ± 17.9) mmHg, (41.5 ± 4.2) μg/L vs. (39.7 ± 5.8) μg/L, there were statistical differences ( P<0.05). ROC curve analysis showed that the area under the curve(AUC) of PA-aDO 2 and CC16 in predicting pulmonary complications in group A were 0.882 and 0.833, in group B was 0.885 and 0.731. Conclusions:Lung protective ventilation has little effect on lung ventilation function and serum CC16 in patients with gynecological laparoscopic surgery, and the probability of pulmonary complications is lower. The pulmonary ventilation function and CC16 have certain value in predicting postoperative pulmonary complications.

Research progress and enlightenment of unplanned readmission in postoperative gynecologic malignancy patients / 中国实用护理杂志

The high incidence of unplanned readmission of postoperative patients with gynecologic malignancies not only seriously affects the quality of life of patients, but also increases the medical burden. This paper reviews the current situation, common causes, relevant factors and insights of unplanned readmission of postoperative gynecologic malignancy patients, and further explores the unplanned readmission of postoperative gynecologic malignancy patients in China by drawing on existing foreign studies and combining them with the actual situation in China, with the aim of providing a basis for clinical health care professionals to develop targeted intervention plans, so as to effectively reduce the unplanned readmission of postoperative gynecologic malignancy patients.

Sociodemographic characteristics associated with indications for surgical menopause in women: a retrospective study

SUMMARY OBJECTIVE: The aim of this study was to evaluate the surgical menopause indications and sociodemographic characteristics of women. METHODS: In this retrospective study, we analyzed the sociodemographic characteristics of women with indications for surgical menopause in 2010-2020. The R Version 4.1.1 (2021-08-10) software and logistic regression analysis were used to evaluate the data. RESULTS: A total of 704 women's data were obtained in this study. Surgical menopause indications were found to stem from bleeding (46.0%), cancer (28.3%), cancer risk (18.9%), and other causes (6.8%). Surgical menopause indications originating from cancer were increased by 0.08 times (95%CI 0.01-0.68) due to smoking, 0.45 times (95%CI 0.23-0.88) due to regular drug use, and 0.36 times (95%CI 0.19-0.69) due to the presence of chronic disease (p<0.05). CONCLUSION: More than half of the women with surgical menopause indications were between 41 and 46 years of age. Additionally, 54.9% of the women had a chronic disease. Therefore, it is recommended to plan preventive health services for morbidity and mortality risks that may develop due to surgical menopause.

Ultrasound‑guided tru‑cut biopsy of pelvic tumors: First reported case series in the Philippines / Philippine Journal of Obstetrics and Gynecology

@#This paper documents the first reported cases of patients in the country who underwent transvaginal ultrasound‑guided Tru‑cut biopsy of pelvic tumors in a tertiary level health institution in 2019. Different indications for Tru‑cut biopsy were demonstrated highlighting its clinical utility in the diagnosis and management of malignant pelvic tumors. All patients warranted histologic diagnosis for further planning of the most appropriate management. Adequate tissue samples were obtained from all three patients with no procedure‑related complications.

The prevalence of COVID-19 infection among gynecologic oncology patients receiving cancer treatment in a COVID-19 referral hospital / Philippine Journal of Obstetrics and Gynecology

Introduction@#Cancer patients are more susceptible to coronavirus disease-19 (COVID-19) infection because they are immunosuppressed by their disease or therapy, most of them have coexisting medical conditions, and they frequently visit hospitals for treatment and surveillance. @*Objective@#The objective of this study was to determine the prevalence of COVID-19 infection among gynecologic oncology patients receiving treatment in a COVID-19 referral hospital. @*Materials and Methods@#A descriptive, cross-sectional study involving 47 gynecologic cancer patients receiving treatment from June 2020 to December 2020 was performed. All patients underwent SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) swab test and symptom and exposure assessment before the start of cancer treatment. Patients with negative SARS-CoV-2 RT-PCR swab test results received their planned treatment, and a repeat swab test and triage assessment were done midtreatment and after treatment. @*Results@#Five (10.6%) patients had positive baseline SARS-CoV-2 RT-PCR swab results, but all proceeded with treatment after negative results were obtained. Only 1 (2.13%) patient had a positive SARS-CoV-2 RT-PCR swab test result at midtreatment. All patients had no COVID-19-associated symptoms and none of them tested positive for COVID-19 infection posttreatment. @*Conclusion@#The prevalence of COVID-19 infection among gynecologic cancer patients receiving cancer treatment is 2.13%. All patients who had positive SARS-CoV-2 RT-PCR swab test results at baseline or midtreatment were able to continue and complete treatment. There were no severe clinical events or mortalities among those affected with COVID-19 infection.

Cirugía laparoscópica en pacientes con obesidad mórbida y cáncer de endometrio

Introducción: La cirugía, en pacientes con obesidad mórbida, como tratamiento del cáncer ginecológico supone un reto para el cirujano y el anestesiólogo, pues se asocia a un incremento de las complicaciones intra y posoperatorias. Objetivo: Describir los principales resultados con la cirugía laparoscópica, en pacientes con obesidad mórbida y adenocarcinoma de endometrio, tratadas en el Instituto Nacional de Oncología y Radiobiología (INOR) de la Habana, Cuba, en el período comprendido enero de 2019 a marzo de 2020. Método: Se realizó un estudio descriptivo, observacional y transversal, en 22 pacientes con índice de masa corporal mayor de 40 kg/m2 y diagnóstico de adenocarcinoma de endometrio, que fueron sometidas a cirugía laparoscópica. El dato primario fue obtenido a través de las historias clínicas, con los que se confeccionó una base de datos en una hoja de Microsoft Excel para sintetizar toda la información. Resultados: Predominó la edad entre 61 a 70 años. El adenocarcinoma endometrioide fue el más frecuente con el 77,27 %. El grado de diferenciación fue el bien diferenciado, infiltrando menos del 50 % del miometrio. El estadiamiento quirúrgico predominante fue el IA (72,72 %). El sangrado transoperatorio fue de 78,9 ± 5,7ml (rango 10 y 200 ml), la media del acto operatorio de 82 min (rango 75-132 min), y la estadía hospitalaria de menos de 24 horas (90,90 %). La conversión quirúrgica se realizó en el 4,54 % de los casos. Conclusiones: Las pacientes con obesidad mórbida pueden beneficiarse del abordaje laparoscópico para el tratamiento y la estatificación quirúrgica laparoscópica del carcinoma endometrial, lo que disminuye la morbilidad y la estadía hospitalaria.

Introduction: Surgery in morbidly obese patients as a treatment for gynecologic cancer is a challenge for surgeons and anesthesiologists, since it is associated with the processes of increasing intraoperative and postoperative complications. Objective: To describe the main results gained with the use of laparoscopic surgery in patients with morbid obesity and endometrial adenocarcinoma treated at the Instituto Nacional de Oncología y Radiobiología (INOR) of Havana, Cuba, from January 2019 to March 2020. Method: A descriptive, observational, cross-sectional study was carried out in 22 patients, with body mass index more than 40 kg/m2 and diagnosis of endometrial adenocarcinoma, who underwent laparoscopic surgery. The primary data was obtained from the medical records, which were used to create a database in a Microsoft Excel spreadsheet to synthesize all the information. Results: The predominant age group was between 61 and 70 years old. Endometrial adenocarcinoma was the most frequent cancer (77.27%). The degree of differentiation was well differentiated, infiltrating less than 50 % of the myometrium. The predominant surgical staging was IA (72.72%). Transoperative bleeding was 78.9 ± 5.7 ml (range between 10 and 200 ml), mean operative time was 82 min (range 75-132 min), and hospital stay was less than 24 hours (90.90%). Surgical conversion was performed in 4.54% of cases. Conclusions: Morbidly obese patients may benefit from the laparoscopic approach for the treatment and laparoscopic surgical staging of endometrial carcinoma, which decreases morbidity and hospital stay.

Introdução: A cirurgia, em pacientes com obesidade mórbida, como tratamento para o câncer ginecológico é um desafio para o cirurgião e para o anestesiologista, pois está associada ao aumento de complicações intra e pós-operatórias. Objetivo: Descrever os principais resultados da cirurgia laparoscópica, em pacientes com obesidade mórbida e adenocarcinoma endometrial, tratados no Instituto Nacional de Oncología y Radiobiología (INOR) em Havana, Cuba, no período de janeiro de 2019 a março de 2020. Método: A estudo descritivo, observacional e transversal realizado em 22 pacientes com índice de massa corporal superior a 40 kg/m2 e diagnóstico de adenocarcinoma de endométrio, submetidas à cirurgia laparoscópica. Os dados primários foram obtidos por meio dos prontuários, com os quais foi criado um banco de dados em uma planilha do Microsoft Excel para sintetizar todas as informações. Resultados: Predominou a idade entre 61 a 70 anos. O adenocarcinoma endometrioide foi o mais frequente com 77,27%. O grau de diferenciação foi bem diferenciado, infiltrando menos de 50% do miométrio. O estadiamento cirúrgico predominante foi IA (72,72%). O sangramento transoperatório foi de 78,9 ± 5,7 ml (variação de 10 e 200 ml), a média do ato cirúrgico foi de 82 min (variação de 75-132 min) e o tempo de internação foi inferior a 24 horas (90,90%). A conversão cirúrgica foi realizada em 4,54% dos casos. Conclusões: Pacientes com obesidade mórbida podem se beneficiar da abordagem laparoscópica para o tratamento e estadiamento cirúrgico laparoscópico do carcinoma endometrial, o que diminui a morbidade e o tempo de internação.

Avaliação do interesse das mulheres assistidas pelo centro de atenção à mulher de Rio do Sul em cirurgias estéticas íntimas / Evaluation of the interest of women assisted by the Centro de Atenção à Mulher (CAM) of Rio do Sul in intimate aesthetic surgeries

Introdução: O termo cirurgia genital feminina engloba várias técnicas com o objetivo de melhorar a área vulvar feminina estética e funcionalmente. Sentimentos de sofrimento emocional são comuns nas mulheres que buscam tais cirurgias, impactando significativamente em sua autoestima, sexualidade, higiene e funcionalidade vulvar. O objetivo é avaliar Avaliar o interesse das mulheres assistidas em um Centro de Atenção à Mulher em cirurgias íntimas. Métodos: Estudo observacional transversal ocorrido no Centro de Atenção à Mulher (CAM) de Rio do Sul-SC. Para coleta dos dados, foi utilizado um questionário semiestruturado elaborado pelos autores. Os dados foram tratados e agrupados no programa Microsoft Excel e realizadas as análises descritivas dos dados utilizando o programa Statistical Package for the Social Sciences (SPSS). Resultados: Os achados indicaram que houve um grande interesse geral na realização de cirurgias de estética íntima. Das 100 mulheres entrevistadas, 32 apresentavam interesse em realizar algum tipo de cirurgia de estética íntima. Conclusão: Devido à importância dada à estética íntima na interferência física, psicossocial, sexual e cotidiana, com importante impacto na qualidade de vida dessas pessoas, é imperativo que recursos adequados sejam alocados para maior fornecimento de tais procedimentos no Sistema Único de Saúde para a população do Brasil.

Introduction: The term female genital surgery encompasses several techniques to improve the female vulvar area, both aesthetically and functionally. Feelings of emotional distress are common in women who seek such surgeries, significantly impacting their self-esteem, sexuality, hygiene and vulvar functionality. The objective is to To evaluate the interest of women assisted in a Women Care Center in intimate surgery. Methods: Observational study carried out at the Women Care Center (CAM) in Rio do Sul-SC. For data collection, a semi-structured questionnaire developed by the authors was used. Data were processed and grouped in Microsoft Excel, and descriptive data analysis was performed using the Statistical Package for Social Sciences (SPSS) program. Results: The findings indicated a great general interest in performing intimate aesthetic surgeries. Of the 100 women interviewed, 32 were interested in performing some intimate aesthetic surgery. Conclusion: Due to the importance given to intimate cosmetics in physical, psychosocial, sexual and everyday interference, with a major impact on the quality of life of these people, adequate resources must be allocated to a greater supply of such procedures in the Unified Health System for the population of Brazil.

Application of transumbilical single-port laparoscopy with self-made approach in common gynecological operations / 中国医师杂志

Objective:To explore the clinical application of transumbilical single-port laparoscopy with self-made approach in common gynecological operations.Methods:105 cases of transumbilical single-port laparoscopic surgery with self-made approach successfully (single-port laparoscopic group) carried out in Karamay Central Hospital from January 2018 to September 2020 were retrospectively collected, and 105 cases of multi-port laparoscopic surgery (multi-port laparoscopic group) with matching conditions were selected. The operation time, intraoperative blood loss, postoperative first exhaust time, postoperative first out of bed activity time, postoperative 24-h pain score, postoperative satisfaction score of patients 3 months after operation, incision cosmetic score of doctors 3 months after operation, postoperative hospital stay, intraoperative surgeon′s feeling score and intraoperative and postoperative complications were compared between the two groups.Results:All operations were successfully completed under laparoscopy, without conversion to laparotomy, without auxiliary holes, and no obvious complications occurred during the operation. The operation time and intraoperative blood loss in the single-port laparoscopic group were greater than those in the multi-port laparoscopic group (all P<0.05). The incision cosmetic score of single-port laparoscopic group was significantly better than that of multi-port laparoscopic group ( P<0.05). The intraoperative surgeon′s feeling score in multi-port laparoscopic group was better than that in single-port laparoscopic group ( P<0.05). There was no significant difference between the two groups in the first postoperative exhaust time, the first postoperative out of bed activity time, 24-hour postoperative pain score, surgical satisfaction score and postoperative hospital stay (all P>0.05). The operation time and intraoperative blood loss of ovarian cyst stripping, hysteromyomectomy and total hysterectomy in the multi-port laparoscopic group were less than those in the single-port laparoscopic group (all P<0.05). There was no significant difference between the two groups in the operation time and intraoperative blood loss of salpingectomy and adnexectomy (all P<0.05). The feeling of doctors in multi-port laparoscopic group was better than that in single-port laparoscopic group (all P<0.05). Conclusions:Under the condition of appropriate case selection, laparoendosopic single-port surgery with self-made approach is feasible in common gynecological operations. The prominent advantage of laparoendosopic single-port surgery is postoperative cosmetic effect.

Optimization strategy of anaesthesia for laparoscopic gynecological surgery: anterior quadratus lumborum block at supra-arcuate ligament combined with general anesthesia / 中华麻醉学杂志

Objective:To evaluate the optimization efficacy of anterior quadratus lumborum block at supra-arcuate ligament (SA-AQLB) combined with general anesthesia for laparoscopic gynecological surgery.Methods:Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 28-64 yr, weighing 52-78 kg, with height of 154-166 cm, scheduled for elective laparoscopic gynecological surgery, were divided into general anesthesia group (group G, n=40) and SA-AQLB combined with general anesthesia group (group SG, n=40) using a random number table method.In group SG, bilateral SA-AQLB was performed under ultrasound guidance before anesthesia induction, and 0.4% ropivacaine 25 ml plus dexamethasone 5 mg was injected into both sides.Combined intravenous-inhalational anesthesia was applied in both groups.Patient-controlled intravenous analgesia (PCIA) with sufentanil 2 μg/kg (in 150 ml of normal saline) was performed after surgery.The PCIA pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Visual analogue scale (VAS) scores for abdomen, pelvis and shoulder pain were recorded at 1, 6, 12, 24 and 48 h after operation.Flurbiprofen was used for rescue analgesia when VAS score >4.The occurrence of intraoperative cardiovascular events and amount of sufentanil used during operation were recorded.The time to first pressing the analgesia pump, effective pressing times of PCA, requirement for rescue analgesia and consumption of sufentanil after operation were recorded.The extubation time, time to first flatus after operation, first ambulation time, length of hospital stay and development of postoperative adverse reactions such as nausea and vomiting, urinary retention and respiratory depression within 48 h after operation were recorded. Results:Compared with group G, the incidence of intraoperative hypertension and tachycardia was significantly decreased, the incidence of intraoperative hypotension and bradycardia was increased, the intraoperative consumption of sufentanil was reduced, the extubation time was shortened, the time to first pressing the analgesia pump was prolonged, the effective pressing times of PCA, requirement for rescue analgesia and postoperative consumption of sufentanil were reduced, the time to first flatus, first ambulation time and length of hospital stay were shortened, VAS scores for abdomen, pelvis and shoulder pain were decreased at each time point after operation, and the incidence of nausea and vomiting, urinary retention and respiratory depression after operation was decreased in group SG ( P<0.01). Conclusions:Compared with general anesthesia, the combination of SA-AQLB and general anesthesia can reduce the opioid consumption, inhibit intraoperative stress responses and postoperative hyperalgesia and promote early postoperative recovery when used for the patients undergoing laparoscopic gynecological surgery.

Research progress on application of artificial intelligence in radiotherapy for gynecological malignancy / 中华放射肿瘤学杂志

The gynecological malignancy has a high incidence and mortality. More efficient treatment methods still need to be explored to improve the survival benefits. Artificial intelligence (AI) aims to intelligently process the original problems by simulating the thinking way of human brain. It has obtained significant progress in gynecological malignancy, with great potential in the field of cancer diagnosis and treatment. This paper reviews the application of AI in the diagnosis and treatment of gynecological malignancy, and mainly introduces the research progress on AI in the radiotherapy. This paper mainly focuses on the key issues such as automatic delineation, dose prediction, radiotoxicity prediction and efficacy prediction, and discusses the current benefits and limitations of AI in radiotherapy of gynecological malignancy.