Psychological assessment tool for patients diagnosed with absolute uterine factor infertility and planning to undergo uterine transplantation.

Uterine transplantation (UTn) has been proposed as a treatment option for women diagnosed with absolute uterine factor infertility (AUFI) and who are willing to bear their own child. AUFI renders a woman 'unconditionally infertile'. For AUFI women in general, UTn may offer a way to re-discover their own femininity through the restoration of fertility. Thus, when faced with a patient who may undergo UTn, the 'holistic approach' takes on an extra meaning. This is because the psychological element is two-sided for these patients. On one side lies the psychology of infertility, and on the other and equally important, is the substantially higher prevalence of psychiatric disorders in transplant candidates and recipients than in the general population. However, the psychology of a potential recipient of a uterine graft in order to bring about fertility has not been adequately explored or reviewed scientifically. We have presented here an outline of the areas which should be included in a psychological assessment for patients wishing to undergo UTn.

Uterine transplantation: what else needs to be done before it can become a reality?

Uterine transplantation may be a possible treatment option in the future for absolute uterine infertility. We describe three important areas of research that we feel are important in order to move closer to a successful and, crucially, safe transplant in the human setting. With closer collaboration among the various international teams working on this project, the first human uterine transplant should be possible in the next few years.

Abdominal radical trachelectomy in West London.

OBJECTIVE: Traditionally, the surgical management of invasive cervical carcinoma that has progressed beyond microinvasion has been a radical abdominal hysterectomy. However, this results in the loss of fertility, with significant consequences for the young patient. This report describes abdominal radical trachelectomy (ART) as a potential replacement for radical hysterectomy in patients with stage IA2-IIA cervical cancer who desire a fertility-sparing procedure without decreasing the curative rates. DESIGN: Observational, retrospective study. SETTING: Teaching hospital and regional cancer centre in London, UK. POPULATION: Patients undergoing ART. METHODS: Patients presenting during the period 2000-2009 with cervical cancer stage IA2-IIA were offered a trachelectomy, if they expressed a desire to preserve fertility. The type of trachelectomy (vaginal/abdominal) was chosen based on patient anatomy and neoplastic and magnetic resonance imaging characteristics. Each patient was counselled as to the experimental nature of the procedure. MAIN OUTCOME MEASURES: Survival, recurrence and fertility issues among ART patients. RESULTS: A total of 30 patients underwent ART (open and laparoscopic) between 2001 and 2009. Three patients presented with a recurrence, two of which have died (median follow-up: 24 months). Only three patients required further surgical re-intervention because of operative complications. Ten patients attempted to conceive, resulting in three conceptions (30%) and two live children. CONCLUSIONS: Abdominal radical trachelectomy provides a feasible, cost-effective and safe treatment option for young women who have been diagnosed with early-stage cervical cancer and wish to preserve their fertility.

The role of supracervical hysterectomy in benign disease of the uterus.

The aim of this study was to investigate the type of hysterectomy that gynaecological surgeons and female hospital staff would choose for benign disease of the uterus, and to investigate the most influential factors in that choice. We performed a prospective survey of 369 gynaecological surgeons and 370 female staff members of a large teaching hospital. Our survey found that 88% of UK gynaecological oncologists and 50% of US gynaecological oncologists responding would perform a supracervical hysterectomy (SCH) over a total abdominal hysterectomy (TAH) for benign disease of the uterus. A total of 72% of the female staff surveyed would choose a SCH for benign disease of the uterus. In conclusion, our study has given gynaecological and prospective patient approval to support the idea of replacing total hysterectomy with supracervical hysterectomy for benign disease of the uterus.

[Neonatal conjunctivitis in a hospital at Gran Buenos Aires. Last 5 years up-date]. / Conjuntivitis neonatal en un hospital del Gran Buenos Aires. Situación de los últimos 5 años.

Neonatal conjunctivitis is one of the most important consultation reasons in the first days of life. Causes may be chemical or infectious. Neonatal conjunctivitis study for common microorganisms and Chlamydia trachomatis is being performed at Posadas Hospital since 1995, in a progressive form. The objective of this study was to know the epidemiological situation in the last five years (1999-2003), and to describe the variations detected between two periods, 1995-1998, and 1999-2003. It was observed no change about C. trachomatis prevalence (8%), during all the time in the population studied. With regard to common microorganisms it was showed a decrease in the second period (36.6%) with respect to the first (52.4%). Likely, the causes may be due to changes about sample collection conditions, or to epidemiological variations. The most frequent microorganisms found were: Staphylococcus aureus 69 (27.6%), Streptococcus pneumoniae 68 (27.2%), and Haemophilus influenzae 64 (25.6%). We consider important to evaluate the kind of ocular secretions at the first consultation, which can lead to a symptomatic treatment that will be corroborated or not, according to microbiological results.

[Streptococcus agalactiae in pregnant women. Prevalence at the Posadas Hospital]. / Streptococcus agalactiae en embarazadas. Prevalencia en el Hospital Nacional Alejandro Posadas.

Streptococcus agalactiae (Lancefield group B Streptococcus), is the most frequent microorganism involved in neonatal infections through the mother-fetus vertical transmission. It is also responsible for infections in pregnant women, and adults with underlying diseases. The objective of this work was to know the S. agalactiae carrier prevalence in pregnant women who attended to Posadas Hospital, and to study the susceptibility pattern of the isolates to penicillin, erythromycin and clindamycin. From 1203 pregnant women studied, S. agalactiae was recovered in 113, which means a prevalence of 9.39%. Antimicrobial susceptibility was tested to 87 isolates. All of them were susceptible to penicillin, and only 2 isolates were resistant to erythromycin and clindamycin (constitutive MLS mechanism). We emphasize the importance of knowing these last resistance, in the case of beta-lactam antibiotics allergic women.

Urinary incontinence in gynecological oncology patients.

The objective of this study was to investigate the prevalence and significance of urinary incontinence (UI) symptoms in gynecological oncology (GO) patients and to test the gynecologists' proficiency in eliciting these symptoms. A prospective survey using questionnaires was designed. Two faculty practice offices in the United States were chosen for the study. Forty GO patients and 40 general gynecology patients were selected from the most recent outpatient appointments of the two hospitals. We used the Urogenital Distress Inventory and the Incontinence Impact Questionnaire to elicit UI symptoms in GO patients and compared the results with their medical records. A control group, selected from a general gynecological practice, was included for comparison. The main outcome measures were to investigate the prevalence and detection rates of UI in GO patients. GO patients were significantly more likely to report UI symptoms on the questionnaire than their gynecologist was able to elicit during a consultation (P < 0.001). The survey found that 60% (24/40) of the GO patients reported at least one symptom of UI, with 23% complaining of "severe" symptoms. Of those patients who reported the symptoms on questionnaire, only 5% (2/40) were detected at the initial physician assessment (P < 0.01). Eighteen percent of the GO patients reported that the UI symptoms adversely affected their quality of life. The prevalence of symptoms was not associated with the primary cancer site. There was no difference in detection rates between the two practice settings. In a multivariate analysis, there was no factor that emerged as the best discriminator for a positive response to the questionnaire. A significant proportion of GO patients report severe UI symptoms that are not detected by gynecologic oncologists or gynecologists during routine consultations.

Selective vessel ligation in the pelvis: an invaluable tool in certain surgical procedures.

While developing the technique of abdominal radical trachelectomy for conservative cervical cancer management, the vascular supply of the uterus was thoroughly examined. The question of how many vessels the uterus requires to ensure its viability arose. Following an abdominal radical trachelectomy for stage IB cervical carcinoma, blood supply of the body of the uterus is successfully maintained by only the two infundibulopelvic vessels (n= 34). Pregnancy has resulted following this technique (n= 2). Selective ligation of the pelvic vasculature has been utilized in the abdominal radical trachelectomy procedure. The objectives of this study were to investigate the vasculature of the infundibulopelvic and broad ligaments, to assess the contribution of the ovarian and uterine vessels to overall uterine perfusion, and to consider the clinical applications of selective pelvic vessel ligation. Ten fresh dissections of the infundibulopelvic vessels, broad ligaments of benign total abdominal hysterectomy, and bilateral salpingo-oophorectomy specimens were performed. Perfusion index (PI) and oxygen saturation (O(2)Sat) measurements using a modified probe were taken at specified intervals at the uterine cornu during ten routine benign abdominal hysterectomies to assess the contribution of the ovarian and uterine vessels to overall uterine perfusion and the concepts studied were utilized in certain gynecological procedures. The ovarian/infundibulopelvic vessels course medially through the broad ligament toward the uterine cornu and consistently give off a branch to the ovary on its lateral border. In addition, further vessels were noted to run laterally from the uterine cornu along the ovarian ligament to the medial aspect of the ovary. PI and O(2)Sat measurements imply that the uterine and ovarian vessels contribute almost equally to uterine perfusion. Clinical application by selective ligation of the pelvic vasculature has been utilized in certain gynecological procedures often prone to torrential life-threatening uterine hemorrhage. Selective temporary ligation of the uterine and ovarian vessels has proven useful in the surgical management of chemoresistant gestational trophoblastic disease, in the Strassman procedure, fertility-sparing surgery in ruptured cornual ectopic pregnancies, and unrelenting postpartum hemorrhage. Of the six supplying vessels (ovarian, uterine, and vaginal) to the uterus only two (ovarian or uterine or a combination thereof) are required for uterine viability.

Streptococcus agalactiae en embarazadas. Prevalencia en el Hospital Nacional Alejandro Posadas / [Streptococcus agalactiae in pregnant women. Prevalence at the Posadas Hospital]

Streptococcus agalactiae (Lancefield group B Streptococcus), is the most frequent microorganism involved in neonatal infections through the mother-fetus vertical transmission. It is also responsible for infections in pregnant women, and adults with underlying diseases. The objective of this work was to know the S. agalactiae carrier prevalence in pregnant women who attended to Posadas Hospital, and to study the susceptibility pattern of the isolates to penicillin, erythromycin and clindamycin. From 1203 pregnant women studied, S. agalactiae was recovered in 113, which means a prevalence of 9.39

. Antimicrobial susceptibility was tested to 87 isolates. All of them were susceptible to penicillin, and only 2 isolates were resistant to erythromycin and clindamycin (constitutive MLS mechanism). We emphasize the importance of knowing these last resistance, in the case of beta-lactam antibiotics allergic women.

Conjuntivitis neonatal en un hospital del Gran Buenos Aires. Situación de los últimos 5 años / [Neonatal conjunctivitis in a hospital at Gran Buenos Aires. Last 5 years up-date]

Neonatal conjunctivitis is one of the most important consultation reasons in the first days of life. Causes may be chemical or infectious. Neonatal conjunctivitis study for common microorganisms and Chlamydia trachomatis is being performed at Posadas Hospital since 1995, in a progressive form. The objective of this study was to know the epidemiological situation in the last five years (1999-2003), and to describe the variations detected between two periods, 1995-1998, and 1999-2003. It was observed no change about C. trachomatis prevalence (8

), during all the time in the population studied. With regard to common microorganisms it was showed a decrease in the second period (36.6

) with respect to the first (52.4

). Likely, the causes may be due to changes about sample collection conditions, or to epidemiological variations. The most frequent microorganisms found were: Staphylococcus aureus 69 (27.6

), and Haemophilus influenzae 64 (25.6

). We consider important to evaluate the kind of ocular secretions at the first consultation, which can lead to a symptomatic treatment that will be corroborated or not, according to microbiological results.

Conjuntivitis neonatal en un hospital del Gran Buenos Aires. Situación de los últimos 5 años. / [Neonatal conjunctivitis in a hospital at Gran Buenos Aires. Last 5 years up-date]

Neonatal conjunctivitis is one of the most important consultation reasons in the first days of life. Causes may be chemical or infectious. Neonatal conjunctivitis study for common microorganisms and Chlamydia trachomatis is being performed at Posadas Hospital since 1995, in a progressive form. The objective of this study was to know the epidemiological situation in the last five years (1999-2003), and to describe the variations detected between two periods, 1995-1998, and 1999-2003. It was observed no change about C. trachomatis prevalence (8

), during all the time in the population studied. With regard to common microorganisms it was showed a decrease in the second period (36.6

) with respect to the first (52.4

). Likely, the causes may be due to changes about sample collection conditions, or to epidemiological variations. The most frequent microorganisms found were: Staphylococcus aureus 69 (27.6

), Streptococcus pneumoniae 68 (27.2

), and Haemophilus influenzae 64 (25.6

). We consider important to evaluate the kind of ocular secretions at the first consultation, which can lead to a symptomatic treatment that will be corroborated or not, according to microbiological results.

Streptococcus agalactiae en embarazadas. Prevalencia en el Hospital Nacional Alejandro Posadas. / [Streptococcus agalactiae in pregnant women. Prevalence at the Posadas Hospital]

Streptococcus agalactiae (Lancefield group B Streptococcus), is the most frequent microorganism involved in neonatal infections through the mother-fetus vertical transmission. It is also responsible for infections in pregnant women, and adults with underlying diseases. The objective of this work was to know the S. agalactiae carrier prevalence in pregnant women who attended to Posadas Hospital, and to study the susceptibility pattern of the isolates to penicillin, erythromycin and clindamycin. From 1203 pregnant women studied, S. agalactiae was recovered in 113, which means a prevalence of 9.39

. Antimicrobial susceptibility was tested to 87 isolates. All of them were susceptible to penicillin, and only 2 isolates were resistant to erythromycin and clindamycin (constitutive MLS mechanism). We emphasize the importance of knowing these last resistance, in the case of beta-lactam antibiotics allergic women.

A comparison of thromboembolic prophylaxis in gynecologic oncology patients.

The objective of this study was to compare two methods of thromboembolic prophylaxis: sequential compression devices alone (SCDs) vs. SCDs with subcutaneous low-dose unfractionated heparin (UH). A retrospective cohort study was conducted of 168 patients who had undergone surgery for suspected gynecological malignancies. These patients were examined for associated risk factors, method of prophylaxis, and incidence of clinically significant thromboembolic events. Of these patients, 94 (56%) received perioperative and postoperative sequential compression devices alone, while 74 (44%) received both SCDs and subcutaneous low-dose UH. The postoperative course of these patients, while in the hospital and after discharge, was followed for clinically evident thromboembolic complications. Univariate and multivariate analyses were performed. The two groups were comparable in terms of most risk factors, including age, stage, height, weight, body surface area, estimated blood loss, total anesthesia time, and nodal disease. Six of 94 patients (6.4%) in the SCDs group suffered from venous thromboembolism, while four of 74 patients (5.4%) who received both SCDs and low-dose UH had a thromboembolic event (chi2 P = 0.79). There was no difference in postoperative changes in platelet counts between the two groups. Heparin added additional cost, 105 extra minutes of nursing time per patient per admission, and additional pain for the patient. In conclusion, the addition of subcutaneous low-dose unfractionated heparin to SCDs for prophylaxis against deep venous thrombosis in women undergoing surgery for gynecologic malignancies does not improve the outcome. Adding heparin was more expensive, time consuming, and painful. Heparin should not be used with SCDs unless an additional benefit can be demonstrated in a randomized controlled trial.

Uterine transplantation, abdominal trachelectomy, and other reproductive options for cancer patients.

More and more women with cancer issues are now raising fertility concerns as survival improves and childbearing is delayed. Pregnancy is no longer contraindicated in cancer patients including breast and endometrial cancer survivors. In fact, survival in patients treated for breast cancer who subsequently become pregnant is actually higher than that in patients who do not become pregnant. "Therapeutic" abortions are no longer recommended. Assisted reproductive technology (ART) have been associated with ovarian neoplasms, but the association is probably not causal. Neither ART nor hormone replacement is contraindicated in cancer patients. Our institution is very supportive of patients and the difficult decisions cancer survivors face. Using a program of counseling and close collaboration between oncologists, perinatologists, and reproductive endocrinologists, informed patients are offered every possible option, including ART and uterine transplantation, to achieve their family planning objectives.

A critical birth weight and other determinants of survival for infants with severe intrauterine growth restriction.

Our objective was to assess the perinatal management and neonatal outcomes of premature, severely intrauterine growth-restricted (IUGR) neonates. A cohort of neonates <1000 grams, < or = first percentile for weight, and <37 weeks' gestation was identified and matched 2:1 to two control sets of premature, appropriate-for-gestational age (AGA) infants-one with similar gestational age (AGA-GA group) and the other with similar birth weight (AGA-BW group) to determine the effect of IUGR on the outcome of the premature infant. The IUGR group was then examined in detail for descriptive statistics. Data were analyzed by t-tests and Chi-square analyses where appropriate. The IUGR infants had worse outcomes than AGA-GA controls but had somewhat better results than the AGA-BW controls. In the IUGR group, a birth weight less than 550 grams was significantly associated with neonatal death (p < 0.001). However, increasing gestational age was not associated with neonatal survival (p = 0.661) if birthweight remained below 550 grams. Classical cesarean delivery was associated with neonatal death (p = 0.003). Neonatal variables associated with poor outcome included patent ductus arteriosus (p = 0.034), feeding intolerance (p = 0.046), and failure to thrive (p = 0.05). Overall, neonatal survival was 73%. Of the surviving neonates, 69% had evidence of neurodevelopmental delay when tested at 6 and 12 months. Premature, growth-restricted neonates with birth weights of <550 grams versus those of >550 grams have dismal outcomes despite a gestational age that is compatible with survival.

Endometrial brush biopsy for the diagnosis of endometrial cancer.

OBJECTIVE: To evaluate a new technique for processing endometrial cytology for the diagnosis and exclusion of endometrial cancer. STUDY DESIGN: All women at risk for endometrial cancer with clinical indications for endometrial biopsy were evaluated by endometrial brush biopsy (Tao Brush, Cook OB-GYN, Bloomington, Indiana) and Pipelle (Cooper Surgical, Shelton, Connecticut) endometrial biopsies during one office visit. Patients were followed longitudinally for the development of endometrial cancer or until undergoing dilatation and curettage or hysterectomy. All comparisons were analyzed using the chi 2 or t test. RESULTS: One hundred one women (mean age, 58; range, 35-86) had endometrial biopsies performed. Median follow-up was > 21 months (range, 3-29). Twenty-two had cancer or atypia, while the remaining had benign diagnoses. When correlated with the final diagnosis, the Tao Brush had 95.5% sensitivity and the Pipelle, 86% sensitivity. Both devices had 100% specificity, positive predictive value of 100% and negative predictive value of 98%. When the results of the two biopsy devices are considered together, the positive and negative predictive value for detecting or excluding endometrial cancer was 100%. Based on 1998 Medicare reimbursements, a simultaneous second office biopsy using the Tao brush could save approximately $67 per case as compared to a sonohistogram and much more when compared to dilatation and curettage. CONCLUSION: Endometrial cancer can be reliably detected and excluded using these two distinct office biopsy devices simultaneously during one office visit. In patients with an indication for endometrial biopsy, no further diagnostic test may be necessary to exclude or diagnose endometrial cancer or atypia.