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1.
Hum Cell ; 2020 Sep 20.
Artículo en Inglés | MEDLINE | ID: mdl-32954481

RESUMEN

The androgen receptor (AR) is a validated therapeutic target for prostate cancer and has been a focus for drug development for more than six decades. Currently approved therapies that inhibit AR signaling, such as enzalutamide, rely solely on targeting the AR ligand-binding domain and, therefore, have limited efficacy on prostate cancer cells that express truncated, constitutively active AR splice variants (AR-Vs). The LNCaP95 cell line is a human prostate cancer cell line that expresses both functional full-length AR and AR-V7. LNCaP95 is a heterogeneous cell population that is resistant to enzalutamide, with its proliferation dependent on transcriptionally active AR-V7. The purpose of this study was to identify a LNCaP95 clone that would be useful for evaluating therapies for their effectiveness against enzalutamide-resistant prostate cancer cells. Seven clones from the LNCaP95 cell line were isolated and characterized using morphology, in vitro growth rate, and response to ralaniten (AR N-terminal domain inhibitor) and enzalutamide (antiandrogen). In vivo growth of the clones as subcutaneous xenografts was evaluated in castrated immunodeficient mice. All of the clones maintained the expression of full-length AR and AR-V7. Cell proliferation of the clones was insensitive to androgen and enzalutamide but importantly was inhibited by ralaniten, which is consistent with AR-Vs driving the proliferation of parental LNCaP95 cells. In castrated immunodeficient animals, the growth of subcutaneous xenografts of the D3 clone was the most reproducible compared to the parental cell line and other clones. These data support that the enzalutamide-resistant LNCaP95-D3 subline may be suitable as a xenograft tumor model for preclinical drug development with improved reproducibility.

2.
Mol Oncol ; 14(10): 2455-2470, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32734688

RESUMEN

Resistance of castration-resistant prostate cancer (CRPC) to enzalutamide and abiraterone involves the expression of constitutively active, truncated androgen receptor (AR) splice variants (AR-Vs) that lack a C-terminal ligand-binding domain (LBD). Both full-length AR and truncated AR-Vs require a functional N-terminal domain (NTD) for transcriptional activity thereby providing rationale for the development of ralaniten (EPI-002) as a first-in-class antagonist of the AR-NTD. Here, we evaluated the antitumor effect of a next-generation analog of ralaniten (EPI-7170) as a monotherapy or in combination with enzalutamide in prostate cancer cells that express AR-V7 that were resistant to enzalutamide. EPI-7170 had 8-9 times improved potency compared to ralaniten. Enzalutamide increased levels of AR-V7 and expression of its target genes. Knockdown of AR-V7 restored sensitivity to enzalutamide, indicating a role for AR-V7 in the mechanism of resistance. EPI-7170 inhibited expression of genes transcriptionally regulated by full-length AR and AR-V7. A combination of EPI-7170 and enzalutamide resulted in synergistic inhibition of proliferation of enzalutamide-resistant cells that was consistent with results from cell cycle and clonogenic assays. In addition, this drug enhanced the antitumor effect of enzalutamide in enzalutamide-resistant CRPC preclinical models. Thus, a combination therapy targeting both the NTD and LBD of AR, and thereby blocking both full-length AR and AR-Vs, has potential for the treatment of enzalutamide-resistant CRPC.

3.
Cancers (Basel) ; 12(7)2020 Jul 21.
Artículo en Inglés | MEDLINE | ID: mdl-32708219

RESUMEN

Blocking androgen receptor (AR) transcriptional activity by androgen deprivation therapy (ADT) improves the response to radiotherapy for intermediate and high risk prostate cancer. Unfortunately, ADT, antiandrogens, and abiraterone increase expression of constitutively active splice variants of AR (AR-Vs) which regulate DNA damage repair leading to resistance to radiotherapy. Here we investigate whether blocking the transcriptional activities of full-length AR and AR-Vs with ralaniten leads to enhanced sensitivity to radiotherapy. Combination therapies using ralaniten with ionizing radiation were evaluated for effects on proliferation, colony formation, cell cycle, DNA damage, and Western blot analyses in human prostate cancer cells that express both full-length AR and AR-Vs. Ralaniten and a potent next-generation analog (EPI-7170) decreased expression of DNA repair genes whereas enzalutamide had no effect. FACS analysis revealed a dose-dependent decrease of BrdU incorporation with increased accumulation of γH2AX with a combination of ionizing radiation with ralaniten. An additive inhibitory effect on proliferation of enzalutamide-resistant cells was achieved with a combination of ralaniten compounds with ionizing radiation. Ralaniten and EPI-7170 sensitized prostate cancer cells that express full-length AR and AR-Vs to radiotherapy whereas enzalutamide had no added benefit.

4.
ACS Pharmacol Transl Sci ; 2(6): 453-467, 2019 Dec 13.
Artículo en Inglés | MEDLINE | ID: mdl-32259077

RESUMEN

Inhibition of the androgen receptor (AR) is the mainstay treatment for advanced prostate cancer. Ralaniten (formally EPI-002) prevents AR transcriptional activity by binding to its N-terminal domain (NTD) which is essential for transcriptional activity. Ralaniten acetate (EPI-506) the triacetate pro-drug of ralaniten, remains the only AR-NTD inhibitor to have entered clinical trials (NCT02606123). While well tolerated, the trial was ultimately terminated due to poor pharmacokinetic properties and resulting pill burden. Here we discovered that ralaniten was glucuronidated which resulted in decreased potency. Long-term treatment of prostate cancer cells with ralaniten results in upregulation of UGT2B enzymes with concomitant loss of potency. This has proven to be a useful model with which to facilitate the development of more potent second-generation AR-NTD inhibitors. Glucuronidated metabolites of ralaniten were also detected in the serum of patients in Phase 1 clinical trials. Therefore, we tested an analogue of ralaniten (EPI-045) which was resistant to glucuronidation and demonstrated superiority to ralaniten in our resistant model. These data support that analogues of ralaniten designed to mitigate glucuronidation may optimize clinical responses to AR-NTD inhibitors.

5.
Semin Reprod Med ; 36(2): 152-158, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30566981

RESUMEN

A variety of conditions can give rise to the perception of painful sexual intercourse in women with pelvic pain. Female sexual dysfunction may stem from psychological, medical such as endocrinological disturbances, and gynecological pathologies. This article provides a discussion of various conditions, offering diagnostic and therapeutic measures to consider in women with pelvic pain experiencing sexual dysfunction. Treatment and management options are also reviewed.


Asunto(s)
Dispareunia , Dolor Pélvico/complicaciones , Disfunciones Sexuales Fisiológicas , Dispareunia/complicaciones , Dispareunia/diagnóstico , Dispareunia/psicología , Dispareunia/terapia , Femenino , Humanos , Relaciones Profesional-Paciente , Disfunciones Sexuales Fisiológicas/complicaciones , Disfunciones Sexuales Fisiológicas/diagnóstico , Disfunciones Sexuales Fisiológicas/psicología , Disfunciones Sexuales Fisiológicas/terapia
7.
J Complement Integr Med ; 13(3): 257-265, 2016 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-27352447

RESUMEN

BACKGROUND: Goji berry (Lycium barbarum) has been used as traditional Chinese medicine and a functional food in China. Goji tea may interact with drugs such as warfarin by inhibiting the cytochrome P450 (CYP) 2C9, and this study was undertaken to characterize the effect of Goji products on CYP2C9/19-, CYP2D6 *1/*10-, CYP3A4/5/7-, CYP19-, and flavin-containing monooxygenase (FMO) 3-mediated metabolism. METHODS: Goji juice, water, and ethanol extracts were examined for their effect on CYP2C9/19-, 2D6-, 3A4/5/7-, 4A11-, CYP19-, and FMO3-mediated metabolism by using in vitro bioassay. The mechanism-based inactivation (MBI) of Goji juice on CYP3A4 was also examined. RESULTS: Data indicates that both fresh juice and commercially available juice caused strong inhibition (over 75 %) of most of the major CYP450 enzymes and moderate inhibition of FMO3 (30-60 %). Compared to juice, the Goji cold/hot water extracts effected low inhibition (below 30 %) of these enzymes. Ethanol (80 %) extracts exhibit the strongest inhibition on CYP2C9 and 2C19 (over 90 %). The inhibition pattern of dried and fresh berry extract and high-performance liquid chromatography (HPLC)-UV fingerprints were similar. CONCLUSIONS: These findings suggest that Goji products (berries, tea, tincture, and juice) can inhibit phase I drug metabolism enzymes and have the potential to affect the safety and efficacy of therapeutic products.


Asunto(s)
Sistema Enzimático del Citocromo P-450/metabolismo , Frutas , Interacciones de Hierba-Droga , Lycium , Fase I de la Desintoxicación Metabólica , Oxigenasas/metabolismo , Extractos Vegetales/farmacología , Humanos , Preparaciones de Plantas
8.
Am J Perinatol ; 33(5): 510-7, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26683604

RESUMEN

OBJECTIVE: The objective of this study was to evaluate the risk of recurrent group B streptococcus (GBS) colonization in a subsequent pregnancy and to assess clinical characteristics that influence this risk. STUDY DESIGN: A systematic review and meta-analysis was performed. Databases were searched from inception through June 2015 using PubMed, Embase, Scopus, Central, and ClinicalTrials.gov. Studies were eligible if they assessed antenatal GBS colonization in two successive pregnancies. The quality of included studies was evaluated. Independent patient data was requested from the authors of the included trials. Unadjusted odds ratios (OR) were pooled using the Mantel-Haenszel fixed effect model. RESULTS: In the five studies identified, two studies lacked a nonexposed cohort. GBS colonization in the index pregnancy was associated with a higher risk of recurrence of GBS colonization in a subsequent pregnancy (three studies: 50.2 compared with 14.1%; pooled fixed effects OR, 6.05; 95% confidence interval [CI], 4.84-7.55). When heavy colonization with GBS was compared with colonization by vaginal culture only, an increased risk of recurrence was shown (four studies: 52.0 compared with 45.1%, pooled fixed effects OR, 1.54; 95% CI, 1.02-2.31). CONCLUSION: Women colonized with GBS are at significantly higher odds for recurrent colonization in a subsequent pregnancy when compared with women who were not colonized in an index pregnancy. If the individual is considered heavily colonized with GBS, there appears to be an association with an increased risk compared with conventional culture. Subgroup analysis of the variables time interval ≤ 12 months between subsequent pregnancies, body mass index ≥ 30 kg/m(2), race, ethnicity, and primiparous in the subsequent pregnancy showed no effect.


Asunto(s)
Portador Sano/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Streptococcus agalactiae , Femenino , Humanos , Tamizaje Masivo , Oportunidad Relativa , Embarazo , Recurrencia
9.
J Pharm Pharm Sci ; 18(2): 124-31, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26158279

RESUMEN

PURPOSE: Natural health products (NHPs), including melatonin, are widely used products. Despite the widespread assumption that all NHPs are safe, they contain pharmacologically active substances and can therefore have adverse effects and/or interact with pharmaceuticals. OBJECTIVE: To investigate the mechanism underlying NHP interactions identified through the Pharmacy SONAR active surveillance study. METHODS: Active surveillance was undertaken in community pharmacies to identify adverse events in patients who had recently taken NHPs together with conventional pharmaceuticals. For suspected NHP-pharmaceutical interactions, the possible mechanism of action was explored by in vitro analysis of samples of different products to identify cytochrome P450 enzyme (CYP) inhibition potential. RESULTS: Active surveillance identified a 19-year-old male taking citalopram, nortriptyline and oxycodone concomitantly and who experienced severe sedation when melatonin was added to this regimen. In vitro analysis involving several melatonin products showed product-dependent inhibition of CYP1A2, CYP2C19 and CYP3A7. CONCLUSION: The adverse event was likely due to a primary pharmacokinetic interaction between melatonin and citalopram; although mechanistically, interactions affecting cytochrome P450-mediated metabolism may have occurred with all of these health products. A pharmacodynamic interaction may also be possible, but beyond the capacity of this study to establish.


Asunto(s)
Inhibidores Enzimáticos del Citocromo P-450/efectos adversos , Sedación Profunda/efectos adversos , Melatonina/efectos adversos , Espera Vigilante , Administración Oral , Citalopram/administración & dosificación , Citalopram/efectos adversos , Citalopram/farmacología , Inhibidores Enzimáticos del Citocromo P-450/administración & dosificación , Inhibidores Enzimáticos del Citocromo P-450/farmacología , Sistema Enzimático del Citocromo P-450/metabolismo , Relación Dosis-Respuesta a Droga , Humanos , Masculino , Melatonina/administración & dosificación , Melatonina/farmacología , Nortriptilina/administración & dosificación , Nortriptilina/efectos adversos , Nortriptilina/farmacología , Oxicodona/administración & dosificación , Oxicodona/efectos adversos , Oxicodona/farmacología , Relación Estructura-Actividad , Adulto Joven
10.
J Pharm Pharm Sci ; 17(3): 294-301, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25224344

RESUMEN

PURPOSE: Thirty-five commercially available Camellia sinensis (black and green) and herbal leisure teas and an assortment of Traditional Chinese medicinal teas were randomly selected and examined for their potential to inhibit the drug metabolizing enzyme cytochrome P450 3A4 (CYP3A4). The study was then extended to examine CYP2D6*1 and CYP2D6*10. METHODS: Microtiter fluorometric assays were utilized to examine the potential for the teas to inhibit CYP-mediated metabolism. Aqueous or alcoholic extracts of the dried tea plant material were examined. METHODS: Most of the black and green leisure teas generally inhibited CYP3A4 more than the Chinese medicinal teas. The medicinal Chinese teas were generally more inhibitory towards CYP3A4 compared to the CYP2D6 isozymes, and the aqueous extracts displayed more potency than the alcoholic extracts. CONCLUSIONS: Tea whether used for leisure or medicinal purposes has the potential to inhibit CYP3A4-mediated drug metabolism particularly black tea.


Asunto(s)
Citocromo P-450 CYP2D6/metabolismo , Citocromo P-450 CYP3A/metabolismo , Inhibidores Enzimáticos del Citocromo P-450/farmacología , Té/química , Camellia sinensis/química , Camellia sinensis/metabolismo , Inhibidores Enzimáticos del Citocromo P-450/química , Inhibidores Enzimáticos del Citocromo P-450/metabolismo , Medicina China Tradicional , Relación Estructura-Actividad , Té/metabolismo
11.
JSLS ; 18(2): 353-6, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24960506

RESUMEN

INTRODUCTION: Application of oxidized regenerated cellulose is commonly performed in laparoscopy to achieve hemostasis during surgery. The appearance of an abscess resembles oxidized regenerated cellulose, causing imaging studies to be difficult to interpret. CASE DESCRIPTION: We describe the cases of 3 patients who underwent oxidized regenerated cellulose placement during laparoscopic gynecologic surgery. They subsequently presented with signs and symptoms resembling an abscess. Computed tomographic imaging can be challenging to interpret in such cases; radiologic findings can be used to differentiate between the characteristics of oxidized regenerated cellulose and those of abscess formation on the vaginal cuff. DISCUSSION: Oxidized regenerated cellulose has an appearance that often mimics postsurgical abscess formation. There are distinct characteristics that distinguish both findings. It is essential that patients' records accurately describe the presence and location of regenerated oxidized cellulose when placed intraoperatively, and this information must be relayed to the interpreting radiologist to facilitate medical diagnosis and guide clinical management.


Asunto(s)
Absceso/diagnóstico , Celulosa Oxidada , Procedimientos Quirúrgicos Ginecológicos/métodos , Laparoscopía/métodos , Enfermedades Vaginales/diagnóstico , Adulto , Diagnóstico Diferencial , Errores Diagnósticos , Femenino , Hemostáticos , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X
12.
J Ethnopharmacol ; 155(1): 841-6, 2014 Aug 08.
Artículo en Inglés | MEDLINE | ID: mdl-24971793

RESUMEN

ETHNOPHARMACOLOGICAL RELEVANCE: Rhododendron groenlandicum (Bog Labrador tea), Rhododendron tomentosum (Marsh Labrador tea) and Juniperus communis (Juniper) are used in medicinal teas by Canadian aboriginal cultures alone and in combination with conventional drug products. The safety of this combination had not been previously examined and this study was initiated to examine the potential of medicinal teas to inhibit the major human drug metabolizing enzyme, cytochrome P450 3A4 (CYP3A4). MATERIALS AND METHODS: The decoctions of Rhododendron groenlandicum and Rhododendron tomentosum leaves and Juniperus communis berries were examined in a microtiter fluorometric assay to examine their potential to inhibit CYP-mediated metabolism. RESULTS: The decoctions showed progressive inhibition towards CYP3A4 the longer the leaves or berries were brewed. R. Rhododendron groenlandicum and Juniperus communis may have the potential to inhibit CYP3A4-mediated metabolism. CONCLUSIONS: The findings of this study with these traditional medicines are significant in that they provide mechanistic support that these products have the potential to affect the safety and efficacy of other health and medicinal products. As this study only examined CYP3A4, it is possible that these medicinals contain substances that could also affect other metabolic enzymes.


Asunto(s)
Citocromo P-450 CYP3A/efectos de los fármacos , Juniperus/química , Extractos Vegetales/farmacología , Rhododendron/química , Bebidas , Canadá , Citocromo P-450 CYP3A/metabolismo , Inhibidores del Citocromo P-450 CYP3A/aislamiento & purificación , Inhibidores del Citocromo P-450 CYP3A/farmacología , Fluorometría , Frutas , Humanos , Indios Norteamericanos , Medicina Tradicional , Hojas de la Planta , Factores de Tiempo
13.
J Pharm Pharm Sci ; 17(2): 254-65, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24934554

RESUMEN

PURPOSE: To study the effect of functional foods on human cytochrome P450 (CYP) and the gut bacterial microflora that may potentially affect drug metabolism and ultimately affect human health and wellness. METHODS: This study examined a variety of food plants from the Apiaceae, Fabaceae, and Lamiaceae families for their inhibitory potential on cytochrome 2D6-, 3A4-, 3A5-, and 3A7-mediated metabolism. The antimicrobial effects of these samples were also investigated with 7 selected bacterial surrogate species to determine potential effects on the gut microflora. RESULTS: The highest CYP inhibitory activities, based upon visual examination, were observed from extracts of celery seed, cumin, fennel seed, basil, oregano, and rosemary belonging to the Apiaceae and Lamiaceae families, respectively. Likewise, the strongest antimicrobial activities were also observed in the Apiaceae and Lamiaceae. No significant antimicrobial and CYP inhibition was observed in the Fabaceae extracts. CONCLUSION: Results demonstrated the possible risk of food-drug interactions from spice and herb plants may affect drug disposition and safety.


Asunto(s)
Antibacterianos/farmacología , Inhibidores Enzimáticos del Citocromo P-450/farmacología , Sistema Enzimático del Citocromo P-450/metabolismo , Alimentos Funcionales , Antibacterianos/química , Antibacterianos/aislamiento & purificación , Apiaceae/química , Apium/química , Cuminum/química , Inhibidores Enzimáticos del Citocromo P-450/química , Inhibidores Enzimáticos del Citocromo P-450/aislamiento & purificación , Relación Dosis-Respuesta a Droga , Foeniculum/química , Humanos , Lamiaceae/química , Pruebas de Sensibilidad Microbiana , Ocimum basilicum/química , Origanum/química , Semillas/química , Relación Estructura-Actividad
14.
J Minim Invasive Gynecol ; 21(6): 1015-21, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24792311

RESUMEN

STUDY OBJECTIVE: To determine if injection of local anesthetic into trocar insertion sites after laparoscopy improves postoperative pain. DESIGN: A prospective, 2-arm, randomized, double-blind, stratified, and controlled trial (Canadian Task Force classification I). SETTING: A university-based teaching hospital. PATIENTS: This study was performed on women who had a laparoscopic gynecologic procedure for benign indications from March 2013 to June 2013. One hundred thirty-five subjects were stratified by chronic pelvic pain or no chronic pelvic pain. Chronic pelvic pain was defined as pelvic pain occurring for 6 months or more in duration. Randomization was performed for this trial, with 68 receiving a bupivacaine block and 67 receiving no bupivacaine block. Of the 71 patients with chronic pelvic pain, 35 patients were in group 1 (i.e., bupivacaine block) and 36 patients were in group 2 (i.e., no bupivacaine block). INTERVENTIONS: After the laparoscopic surgery was completed, the trocar incision sites were closed. For subjects randomized to receive a local anesthesia block, bupivacaine (0.25%) was injected. Incisions 8 mm or greater were injected with 10 mL 0.25% bupivacaine. Incisions 5 mm or less were infiltrated with 5 mL. Injecting the local anesthetic through all preperitoneal layers provided a full-thickness local injection. Group 2 did not receive a local injection. MEASUREMENTS AND MAIN RESULTS: At the preoperative suite, the nurses gauged the patient's pain using the Numeric Rating Scale. This score was used as the baseline pain level with which the postoperative pain scores were compared. The primary objective was to measure changes in pain scores, from preoperative to postoperative time frames of 2 to 4 hours, 6 to 8 hours, 18 to 24 hours, and 3 to 7 days postoperatively. These score changes were measured as the main objective. Secondary objectives include estimated blood loss, operating time, length of hospital stay, and histopathologic diagnosis. The hospital personnel caring for the patient during the preoperative and postoperative course were given standard pain evaluation protocols. All study pain evaluators and patients were blinded to treatment assignments throughout the pain assessment process. There were no statistically significant differences in patient characteristics between the 2 treatment groups. No significant difference was found in secondary outcomes including estimated blood loss, length of hospital stay, and histopathologic diagnosis. In general, Numeric Rating Scale pain scores were lower (i.e., less pain) in the "bupivacaine block" group compared with the "no bupivacaine" block group at the following postsurgery time assessments: 2 to 4 hours, 6 to 8 hours, 18 to 24 hours, and 3 to 7 days after surgery. However, the effect was not large enough (<1 point) to show a statistical difference between the treatment groups at any of these postsurgery assessments. CONCLUSION: The postoperative injection of bupivacaine in trocar port sites did not significantly improve pain scores after laparoscopic gynecologic surgery.


Asunto(s)
Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Laparoscopía , Dolor Postoperatorio/prevención & control , Adulto , Anestesia Local/métodos , Método Doble Ciego , Femenino , Humanos , Laparoscopía/efectos adversos , Laparoscopía/instrumentación , Laparoscopía/métodos , Tiempo de Internación , Persona de Mediana Edad , Dolor/tratamiento farmacológico , Dimensión del Dolor , Dolor Postoperatorio/epidemiología , Instrumentos Quirúrgicos/efectos adversos
15.
J Robot Surg ; 8(1): 73-6, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-27637242

RESUMEN

The 'head butler' or 'iron maiden', as it is sometimes referred to, is a mountable shelf that is attached to the main operating room table using stirrup clamps or brackets. It provides an elevated flat surface, which protects the patient's face and chest from inadvertent trauma of robotic arms, instruments and camera while also serving as a platform for placement of instrumentation that minimizes handoffs to improve workflow. Its canted design also prevents slippage of instruments off the operating field during steep Trendelenburg positioning. This operating room equipment was designed to improve efficiency in an operating room set-up while ensuring safety during patient positioning when performing robotic procedures. A modification of the original Head Butler(®) (Tri-Medical Corporation, Portland, OR, USA) is presented here which improves upon the design by avoiding brachial plexus nerve injury to the patient due to pressure from the uprights pressing on the patient's shoulders during use.

17.
J Minim Invasive Gynecol ; 20(5): 667-71, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23714746

RESUMEN

The purpose of this prospective pilot case study was to determine whether instillation of trypan blue dye into the uterine cavity before laparoscopic hysterectomy and morcellation aids in gross identification of endometrium. The most common commercially available trypan blue stain, VisionBlue was used in this study. Instillation was performed at the beginning of the procedure using an embryo transfer catheter. A sterile solution of trypan blue, 0.5 mL, was instilled transcervically into the uterine cavities in 12 patients before laparoscopic hysterectomy with uterine morcellation. The morcellated specimens were sent for routine gross pathologic and histologic examination. It was concluded that intrauterine instillation of trypan blue stained the endometrium, thus aiding the pathologist in identification of the endometrium in morcellated uterine specimens.


Asunto(s)
Histerectomía/métodos , Neoplasias Uterinas/patología , Útero/patología , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Azul de Tripano , Neoplasias Uterinas/cirugía , Útero/cirugía
18.
J Robot Surg ; 7(4): 345-9, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27001873

RESUMEN

We present a retrospective case series of patients who underwent robotic-assisted laparoscopic trachelectomies from August 1, 2011 to August 30, 2012, with a description of the surgical technique for successful cervical removal. The patients, at the Department of Obstetrics and Gynecology, Division of Urogynecology and Minimally Invasive Surgery at Penn State Milton S. Hershey Medical Center, were identified using ICD-9 coding for robotic-assisted trachelectomy. Of the 180 patients who had robotic-assisted gynecologic surgery during the study period, eight underwent robotic-assisted laparoscopic trachelectomy. The patients' average age was 40.4 years, average parity was 1.5, and mean body mass index was 28. The time interval from initial surgery of supracervical hysterectomy to robotic-assisted trachelectomy was 4 years. Pre-operative cervical cytology was negative in all patients. The average length of stay was one overnight admission. The primary indication for prior supracervical hysterectomy was dense pelvic adhesions, and the main indications for robotic-assisted trachelectomy were pelvic pain due to endometriosis and cyclic vaginal bleeding. Surgical outcomes included minimal blood loss (<50 ml) and mean operative time of 1.15 h (74.88 min), without any immediate intra-operative or post-operative complications reported. Histopathology reports on all cervical specimens were normal. Adnexectomy is the most common concomitant procedure performed with trachelectomy. Robotic-assisted laparoscopic trachelectomy is a viable option for patients requesting a minimally invasive approach to cervical stump removal.

19.
Arch Gynecol Obstet ; 287(3): 407-11, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23053315

RESUMEN

OBJECTIVE: To determine elective induction of labor outcomes in term, low-risk women who delivered in a community teaching hospital. METHODS: This is a retrospective cohort study of women admitted from January 1, 2006 to January 31, 2010, for elective induction of labor. A comprehensive search of the perinatal database identified low-risk patients at ≥39 weeks gestation and ≤41 weeks with singleton pregnancies in vertex presentation. Data abstracted from manual chart review included patient demographics, admission cervical examination, and induction method. Outcome measures were delivery method and cesarean indications. Time categories calculated were mean times from induction to delivery, delivery to discharge, and total hospital length-of-stay. Descriptive statistics, frequencies, and percentages were reported using multiple regression analysis, analysis of variance, and effect tests with respective values reported. Data were analyzed using JMP software by SAS Institute Inc. RESULTS: Of the 1,159 women identified, 848 records passed exclusion criteria. Vaginal delivery was accomplished for 694 (81.8 %) of patients. The most common induction agent was oxytocin (73.7 %). Induction of labor with oxytocin and artificial rupture of membranes revealed a statistically significant shorter length of induction with average induction of labor for oxytocin of 11.9 h. Multiparous patients of parity >1 and patients presenting with cervical dilation of 3-4 cm had a statistically significant higher probability of vaginal delivery. Patients induced with a foley bulb or dinoprostone had statistically longer induction times (28.2 and 24.9 h, respectively) and had a statistically significant higher probability of cesarean delivery. CONCLUSION: Multiparous patients and patients with a favorable cervix (>2 cm) were more likely to have a vaginal delivery and shorter length of induction.


Asunto(s)
Amnios/cirugía , Dinoprostona , Trabajo de Parto Inducido/métodos , Oxitócicos , Oxitocina , Nacimiento a Término , Adolescente , Adulto , Cesárea/estadística & datos numéricos , Estudios de Cohortes , Parto Obstétrico/estadística & datos numéricos , Femenino , Hospitales Comunitarios , Hospitales de Enseñanza , Humanos , Paridad , Embarazo , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
20.
J Matern Fetal Neonatal Med ; 25(10): 1987-9, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22384795

RESUMEN

OBJECTIVE: The purpose of the study is to evaluate the incidence of women with prior GBS genital colonization who have recolonization in subsequent pregnancies. METHODS: This is a retrospective, cohort study of patients with a prior GBS genital colonization in pregnancy and a subsequent pregnancy with a recorded GBS culture result, from January 2000 through June 2007. Documentation of GBS status was through GBS culture performed between 35 to 37 weeks gestation. Exclusion criteria included pregnancies with unknown GBS status, patients with GBS bacteriuria, women with a previous neonate with GBS disease and GBS finding prior to 35 weeks. Data was analyzed using SPSS 15.0. The sample proportion of subjects with GBS genital colonization and its confidence interval were computed to estimate the incidence rate. Logistic regression was performed to assess potential determinants of GBS colonization. Regression coefficients, odds ratios and associated confidence intervals, and p-values were reported, with significant results reported. RESULTS: There were 371 pregnancies that met the test criteria. There were 151 subsequent pregnancies with GBS genital colonization and 220 without GBS recolonization. The incidence of GBS recolonization on patients with prior GBS genital colonization was 40.7% (95% confidence interval 35.7-45.69%). The incidence rate for the sample was significantly larger than 30% (p < .001), which is the estimated incidence rate for all pregnant women who are GBS carriers regardless of prior history. CONCLUSION: These results suggest that patients with a history of GBS are at a significantly higher risk of GBS recolonization in subsequent pregnancies.


Asunto(s)
Perineo/microbiología , Complicaciones Infecciosas del Embarazo/epidemiología , Infecciones Estreptocócicas/epidemiología , Streptococcus agalactiae/aislamiento & purificación , Vagina/microbiología , Adolescente , Adulto , Chicago/epidemiología , Estudios de Cohortes , Femenino , Humanos , Incidencia , Modelos Logísticos , Oportunidad Relativa , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/etiología , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/etiología , Adulto Joven
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