RESUMEN
Pregnancy-associated fulminant type 1 diabetes (PF) has received high clinical attention because of its low incidence and poor prognosis. It poses a great threat to the lives of mothers and infants; therefore, it is imperative to understand its characteristics and approach methods. However, no studies have described whether a cesarean section or conservative treatment should be considered at the onset of PF. We report a case of PF, review the published literature and consider a cesarean section at the onset of PF. A 39-year-old woman was admitted to our hospital with dyspnea and nausea. The patient was diagnosed with PF. Insulin Lispro and Glargine were administered to control the blood glucose levels. Six hours later, the fetus died. The fetal status due to PF probably worsened during the conservative treatment. No perioperative complications have been reported for cesarean sections under diabetic ketoacidosis due to PF and there have been cases of live birth by emergency cesarean section. Identifying the features of PF and considering and performing cesarean sections early after diagnosis is essential to save fetal life.
RESUMEN
Pregnant patients have an increased risk of torsion compared to that seen in nonpregnant patients, and those with larger cysts undergo torsion more frequently, which can cause obstructions during labor. The risks associated with emergent surgery are higher than those with elective surgery. Laparoscopic surgery can be safely performed during pregnancy. Single-port laparoscopic surgery is reported to be a minimally invasive laparoscopic technique. We report three cases of ovarian dermoid cysts, which were successfully removed during pregnancy through elective single-port laparoscopic surgery. In all cases, imaging showed a dermoid cyst and the cyst size was greater than 6 cm. All patients requested the surgery. The ovarian cysts were successfully removed by single-port laparoscopy without additional ports and without intra- or postoperative complications. All pregnancies progressed well and delivered vaginally at full term. The single-port laparoscopic approach is useful for removing ovarian cysts during pregnancy.
RESUMEN
AIM: The purpose of this study was to investigate whether the Ki67 values were associated with survival for predicting prognosis in patients with advanced ovarian cancer receiving neoadjuvant chemotherapy (NACT). METHODS: Among 17 patients treated with NACT, 13 patients were available for tissue samples from matched pre- and post-therapy tissues. Ki67 scores were transformed to a logarithmic scale for the statistical analyses. The optimal cutoff values of the log-phase Ki67 were assessed by receiver operating characteristic (ROC) analysis. Kaplan-Meier analysis, the log-rank test, and Cox regression analysis were carried out to analyze survival. RESULTS: The Ki67-decrease and post-NACT Ki67 were the independent factors associated with relapse-free survival (RFS) (p < 0.001 and p = 0.003). No association was observed on overall survival. The optimal cutoff values for the Ki67-decrease and the post-NACT Ki67 were 6.67% and 5.46 based on ROC where the area under ROC curves (AUC) were 1.00 (p < 0.001) with the 100% sensitivity and specificity. The median RFS was 537 days in patients showing Ki67-decrease >6.66% or post-NACT Ki67 level <5.46, while it was 224 days in those with Ki67 decrease ≤6.66% or post-NACT Ki67 level ≥5.46 (p = 0.001). CONCLUSIONS: The Ki67-decrease and the lower post-NACT Ki67 are independent factors associated with favorable RFS, indicating that they could be precise biomarker candidates for prognosis in NACT-administered patients with advanced ovarian cancer.