Quality-of-life implications of risk-reducing cancer surgery.

BACKGROUND: Modern advances in genetic sequencing techniques have allowed for increased availability of genetic testing for hereditary cancer syndromes. Consequently, more people are being identified as mutation carriers and becoming aware of their increased risk of malignancy. Testing is commonplace for many inheritable cancer syndromes, and with that comes the knowledge of being a gene carrier for some patients. With increased risk of malignancy, many guidelines recommend that gene carriers partake in risk reduction strategies, including risk-reducing surgery for some syndromes. This review explores the quality-of-life consequences of genetic testing and risk-reducing surgery. METHODS: A narrative review of PubMed/MEDLINE was performed, focusing on the health-related quality-of-life implications of surgery for hereditary breast and ovarian cancer, familial adenomatous polyposis and hereditary diffuse gastric cancer. RESULTS: Risk-reducing surgery almost uniformly decreases cancer anxiety and affects patients' quality of life. CONCLUSION: Although the overwhelming quality-of-life implications of surgery are neutral to positive, risk-reducing surgery is irreversible and can be associated with short- and long-term side-effects.

Midtrimester abortion with Laminaria and vacuum evacuation on a teaching service.

Midtrimester abortion by the dilatation and evacuation (D&E) method has generated controversy among health-care providers; many authorities insist that this procedure should be performed only by a small group of experts. Our institution has been providing abortions for patients who were at 13-16 1/2 menstrual weeks on a teaching service with Laminaria and vacuum evacuation (midtrimester D&E). The procedures were performed under local anesthesia in a separate, specially staffed, in-hospital pregnancy termination unit on an ambulatory basis. Twelve resident physicians at different training levels performed 87% of the procedures under the direct, hands-on supervision of a small but experienced faculty group. Records of 1,392 consecutive patients who underwent midtrimester D&E at Brigham and Women's Hospital between January 1, 1979, and December 31, 1980, were analyzed. There were no maternal deaths or life-threatening complications. Immediate and late morbidity was minimal. There were no major complications that necessitated laparotomy. Despite the use of Laminaria overnight, a "no-touch" rather than full sterile technique and no prophylactic antibiotics, infectious complications were minimal. We conclude that midtrimester D&E can be performed safely and efficiently by resident physicians in an appropriate teaching facility under close supervision. That ultimately can increase accessibility to the D&E procedure by increasing the number of physicians trained in this modality.

PIP: Midtrimester abortion by the dilatation and evacuation (D&E) method has generated controversy among health care providers; many authorities insist that this procedure should be performed only by a small group of experts. The author's institution has been providing abortions for patients who were at 13-16 1/2 menstrual weeks on a teaching service with laminaria and vacuum evacuation (midtrimester D&E). The procedures were performed under local anesthesia in a separate, specially staffed, in-hospital pregnancy termination unit on an ambulatory basis. 12 resident physicians at different training levels performed 87% of the procedures under the direct, hands-on supervision of a small but experienced faculty group. Records of 1392 consecutive patients who underwent midtrimester D&E at Brigham and Women's Hospital between January 1, 1979 and December 31, 1980 were analyzed. There were no maternal deaths or life-threatening complications. Immediate and late morbidity was minimal. There were no major cmplications that necessitated laparotomy. Despite the use of laminaria overnight, a "no-touch" rather than full sterile technique and no prohylactic antibiotics, infectious complications were minimal. The authors conclude that midtrimester D&E can be performed safely and efficiently by resident physicians in an appropriate teaching facility under close supervision. That ultimately can increase accessibility to the D&E procedure by increasing the number of physicians trained in this modality.

Randomized trial of one versus two days of laminaria treatment prior to late midtrimester abortion by uterine evacuation: a pilot study.

PIP: Cervical dilatation prior to midtrimester abortion by surgical evacuation has been accomplished rapidly with metal dilators, or gradually with expanding laminaria tents, either as a single set left in place overnight or as multiple sets of laminaria replaced every few hours over a 40-hour period. In the effort to determine the benefit of an additional day of use of laminaria, 60 volunteer women who requested abortion at 17-19 weeks were randomly assigned to either of 2 experimental groups. Group A received 1 set of 3-7 small or medium laminaria Japonicum tents, and the abortions were performed the next morning, 18-22 hours later. Group B returned on the 2nd day for removal of the 1st set of laminaria tents and insertion of a 2nd set of 7-19 tents. Their abortions were performed on the 3rd day, 44-48 hours later. The cervical canal was calibrated with Hegar dilators prior to placement of laminaria tents, immediately prior to the abortion, and 2 weeks after the abortion. Pain from use of the laminaria tents was quantified on a 5-point scale. Mean age was 21.1 +or- 5.1 years in Group A and 22.6 +or- 5.6 years in Group B. Group A contained more primigravid women (15) than did Group B (6). Considerable cervical dilatation was accomplished by the laminaria treatment in both groups. Greater posttreatment dilatation and a greater difference between pretreatment and posttreatment measurements were accomplished by the 2-day regimen used with Group B. Equivalent posttreatment dilatations and dilatation differences were observed for nulliparous and parous women. Group B patients were more likely to report pain during laminarian treatment than were Group A patients. The surgeon experienced problems in extracting the fetal calvaria in 6 Group A patients and in only 2 Group B patients, but these frequencies were not statistically separable. Operating time and measured loss of blood were not different for the 2 groups, except for those patients in each group aborted after 18 weeks. Postabortal cervical measurements showed recovery of the cervix to small diameters, suggesting that gradual dilatation with laminaria tents to wide diameters is completely reversible, in contrast to dilatation accomplished forcibly with metal dilators.^ieng

Sindrome de Poland. Apresentacao de um caso. / Poland's syndrome.Report of a case

Os autores fazem em seu artigo uma revisao de literatura da sindrome de Poland, assim como a descricao de um caso clinico, matriculado em servicos do Hospital Central da Irmandade da Santa Casa de Misericordia de Santos

Ultrasonically guided transabdominal encephalocentesis.

Transabdominal craniocentesis for the decompression of an advanced hydrocephalic fetal skull was performed under high-speed, sector scanning ultrasonic guidance. This technique can be used to facilitate delivery of a hydrocephalic fetal skull via the vaginal or abdominal route. The ability to monitor internal landmarks while advancing the needle is a decided advantage over the fluoroscopic technique.