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1.
Surg Oncol ; 49: 101948, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37210893

RESUMO

INTRODUCTION: The presence of residual disease after cytoreductive surgery is subjectively determined by the surgeon at the end of the operation. Nevertheless, in up to 21-49% of CT scans, residual disease can be found. The aim of this study was to establish the relationship between post-surgical CT findings after optimal cytoreduction in patients with advanced ovarian cancer and oncological outcome. MATERIAL AND METHODS: Patients with advanced ovarian cancer (FIGO II and IV), diagnosed between 2007 and 2019 in Hospital La Fe Valencia, in whom cytoreductive surgery was performed, achieving R0 or R1, were assessed for eligibility (n = 440). A total of 323 patients were excluded because a post-operative CT scan was not performed between the third and eighth post-surgery week and prior to the start of chemotherapy. RESULTS: 117 patients were finally included. The CT findings were classified into three categories: no evidence, suspicious or conclusive of residual tumour/progressive disease. 29.9% of CT scans were "conclusive of residual tumour/progressive disease". No differences were found when the DFS (p = 0.158) and OS (p = 0.215) of the three groups were compared (p = 0.158). CONCLUSION: After cytoreduction in ovarian cancer with no macroscopic disease or residual tumour < 1 cm result, up to 29.9% of post-operative CT scans before chemotherapy found measurable residual or progressive disease. Notwithstanding, a worse DFS or OS was not associated with this group of patients.


Assuntos
Procedimentos Cirúrgicos de Citorredução , Neoplasias Ovarianas , Feminino , Humanos , Neoplasia Residual/cirurgia , Neoplasia Residual/patologia , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/cirurgia , Carcinoma Epitelial do Ovário/patologia , Tomografia Computadorizada por Raios X , Estudos Retrospectivos
2.
Fetal Diagn Ther ; 45(1): 57-61, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29506014

RESUMO

OBJECTIVE: To assess the short and medium-term effects of milking maneuver (MM) compared with early cord clamping for infants born before 37 weeks of pregnancy. MATERIAL AND METHODS: 138 infants between 24+0 and 36+6 weeks of gestation were allocated to MM or early cord clamping. Primary outcomes were the requirement of red blood cell transfusions or phototherapy. RESULTS: Initial hemoglobin was significantly higher in the MM group by 1.675 g/dL (p < 0.05) and initial hematocrit by 5.36% (p < 0.05), but no differences in the need of transfusion during the first 30 days after delivery were found (RR 0.8; 95% CI 0.22-2.85). Peak serum bilirubin was similar in both groups (11,097 ± 3.21 vs. 11,247 ± 3.56 mg/dL, p = 0.837). Phototherapy requirements were higher in the MM group (RR 1.62; 95% CI 1.1-2.38). No differences regarding the need of oral iron supplementation, platelet transfusion, respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, meconium aspiration syndrome, use of surfactant, days of oxygen supplementation, need of vasopressors, length of stay in the neonatal intensive care unit, or postpartum hemorrhage were found. CONCLUSION: MM does not reduce the need for red blood cell transfusions and increases phototherapy requirements in preterm infants.


Assuntos
Sangue Fetal , Recém-Nascido Prematuro , Circulação Placentária , Nascimento Prematuro/sangue , Cordão Umbilical/cirurgia , Adulto , Constrição , Transfusão de Eritrócitos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Fototerapia , Gravidez , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/fisiopatologia , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Cordão Umbilical/fisiopatologia
3.
Indian J Radiol Imaging ; 28(3): 366-368, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30319217

RESUMO

Congenital high airway obstruction syndrome (CHAOS) is a rare sequence due to a complete obstruction of the fetal airway that blocks the larynx or trachea, either intrinsic atresia or extrinsic compression (e.g., congenital neck mass). Despite the true incidence of CHAOS is unknown, an incidence of 1 per 50,000 newborns is described. If any obstruction occurs in the tracheobronchial airway, this secretion cannot be extricated. Because of this situation, a knock-on effect starts: the enlargement of the lungs squeezes the heart and great veins, what results in a replacement of the heart to the center of the chest becoming small and dysfunctional. Decreased venous return and the failure of cardiovascular system end in ascites and hydrops. The diaphragm planes or inverts according to the severity of the process. In case of unrecognized syndrome during the prenatal period, it usually results in stillbirth or death shortly after delivery. The overall prognosis remains fatal, and long-term medical and surgical challenges for survivors remain considerable even after overcoming fetal intervention.

4.
Int J Gynecol Cancer ; 27(6): 1191-1199, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28557833

RESUMO

OBJECTIVE: The purpose of this study is to asses the impact of lymphovascular space invasion (LVSI) present in early-stage endometrial cancer, regarding its therapeutic management and prognosis knowledge, based on a survey among Spanish oncologic gynecologist. METHODS/MATERIALS: Between October and November 2014, the Young Spanish Onco-gynecologist Group carried out a survey to perform a cross-sectional study about the management of LVSI. All active members in the oncology field of the Spanish Society of Gynecology and Obstetrics were invited to participate in the survey. RESULTS: Most respondents consider LVSI a bad prognosis factor for endometrial cancer (66%) and also consider that it should be included in the International Federation of Gynecology and Obstetrics classification (56%). Seventy-five percent of all gynecologists did not modify their surgical treatment. Regarding follow-up, 38% of the respondents do not change their surveillance, 28% modify it, and 31% reported any change only with additional factors. Forty-seven percent of respondents advise systemic treatment with chemotherapy.Data were dichotomized between less than or equal to 20 versus greater than 20 years of OB-GYN specialist and less than or equal to 5 versus greater than 5 years of main dedication to gynecology oncology, but it was not possible to show any significant differences among the groups. The response rate (34 individuals) was too low to expect any significant differences. CONCLUSIONS: Results suggest that LVSI remains a controversial issue in the management of patients with endometrial cancer. Acquiring a deeper knowledge and uniform criteria could avoid the risk of undertreatment and overtreatment in this group of patients with early-stage endometrial cancer. The identification of vascular pseudoinvasion is recommended, although the clinical and prognostic implications still need to be determined.


Assuntos
Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/terapia , Sistema Linfático/patologia , Adulto , Estudos Transversais , Neoplasias do Endométrio/tratamento farmacológico , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Padrões de Prática Médica , Prognóstico , Espanha , Inquéritos e Questionários
5.
Minerva Ginecol ; 68(2): 106-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27008239

RESUMO

BACKGROUND: The aim of this study was to compare the obstetric outcomes after successful external cephalic version (cases) with a group of pregnant women with a spontaneous cephalic fetal position at delivery (controls). METHODS: Retrospective review of the cohort of study was performed at the University Hospital of Getafe (Madrid, Spain) between January 2012 and January 2013. SAMPLE POPULATION: 1516 patients (48 cases; 1468 controls). We compared the type of delivery in pregnant women after ECV performed successfully (cases) with spontaneous cephalic presentations (controls). Pregnancies with vaginal delivery contraindicated, elective cesarean section (CS) justified by maternal disease, multiple pregnancies, or pregnancies below 37 weeks were excluded. Maternal age, BMI, parity, gestational age at delivery, and onset of labor (spontaneous or induced) were controlled. RESULTS: Prevalence of CS and operative delivery in both groups. Women who underwent a successful ECV had a significantly higher CS rate compared with the women of the control group (12/48 [25%] vs. 202/1468 [13.76%]; P=0.028). There was no difference in the rate of operative delivery (6/48 [12.5%] vs. 177/1468 [12.05%] P=0.92). CONCLUSIONS: Deliveries following a successful ECV are associated with an increased CS rate compared with deliveries of fetuses with spontaneous cephalic presentations.


Assuntos
Cesárea/estatística & dados numéricos , Parto Obstétrico/métodos , Versão Fetal/métodos , Adulto , Feminino , Hospitais Universitários , Humanos , Gravidez , Estudos Retrospectivos , Espanha
6.
Rev. chil. obstet. ginecol ; 80(2): 140-144, abr. 2015. ilus, graf, tab
Artigo em Espanhol | LILACS | ID: lil-747535

RESUMO

OBJETIVOS: Determinar si el intervalo de nacimiento vía vaginal entre gemelos, se relaciona con un descenso de pH arterial/venoso de cordón umbilical del segundo gemelo respecto al primero, y establecer si el pH acidótico del primer gemelo predice la acidosis del segundo. MÉTODO: Estudio de cohortes retrospectivo en 77 pares de gemelos realizado en el Hospital de Getafe, España, en el periodo 2008-2013. Se relacionó el tiempo transcurrido entre el nacimiento de los gemelos con el resultado del pH de cordón y el exceso de bases. Estudiamos la correlación entre el tiempo transcurrido entre ambos nacimientos y la diferencia entre los valores de pH del primer y segundo gemelo, y la correlación con la diferencia de exceso de base. RESULTADOS: Hubo correlación lineal significativa entre el tiempo transcurrido entre el nacimiento de los gemelos y la diferencia de pH venoso del segundo gemelo respecto del primero (R=0,560; p=0,0001), así como con el pH arterial (R=0,502; p=0,0001). El pH <7,20 del primer gemelo se asoció con acidosis en el cordón del 2° gemelo (<7,20, p=0,000; <7,15, p=0,0001; <7,10, p=0,0001; <7,05, p=0,001; <7,00, p=0,0001). CONCLUSIONES: El pH del segundo gemelo siempre fue igual o menor que el del primer gemelo, hubo una correlación lineal entre el intervalo de nacimiento entre gemelos y el descenso del pH venoso y arterial del segundo gemelo respecto al primero. El pH acidótico del primer gemelo predice la acidosis del segundo.


OBJETIVOS: Determinate if the twin-to-twin vaginal delivery time interval, is related with a decline of the arterio-venous cord blood pH of the second twin regarding to the first twin, and to evaluate if the acidotic pH of first twin can predict the acidosis status of the second one. METHOD: A retrospective descriptive cohort study was performed at the Hospital of Getafe, Spain, in the period 2008-2013, with 77 pairs of twins that were registered and met the inclusion criteria. The twin-to-twin delivery time interval and the cord blood status results were registered. A statistical analysis was performed to study the relation of the twin-to-twin delivery time interval with the pH value differences between first and second twins, and with the base excess. RESULTS: A positive linear correlation between the twin-to-twin delivery time interval and the difference of venous pH of the second twin respect to the first one was found (R=0.560; p=0.0001), and also with the difference on arterial pH (R=0.502; p=0.0001). A pH value <7.20 of the first twin was associated with blood cord acidosis of the second twin (<7.20, p=0.000; <7.15, p=0.0001; <7.10, p=0.0001; <7.05, p=0,001; <7.00, p=0.0001). CONCLUSIONS: The second twin pH was equal to or less than the first twin pH in all cases. There is a linear relation between twin-to-twin delivery time interval and the decrease of the pH value of the second twin regarding to the first one. The acidosis of first twin could predict the acidosis status of the second twin.


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adulto , Acidose/sangue , Sangue Fetal/química , Gravidez de Gêmeos , Concentração de Íons de Hidrogênio , Espanha , Equilíbrio Ácido-Base , Fatores de Tempo , Artérias Umbilicais , Cordão Umbilical , Veias Umbilicais , Ordem de Nascimento , Estudos Retrospectivos , Estudos de Coortes
7.
Prog. obstet. ginecol. (Ed. impr.) ; 57(9): 422-428, nov. 2014.
Artigo em Espanhol | IBECS | ID: ibc-127149

RESUMO

Caso de rotura uterina por placenta pércreta confirmado histológicamente a las 20 semanas de gestación y revisión bibliográfica de casos clínicos publicados de menos de 28 semanas (AU)


We report a case of histologically-confirmed uterine rupture due to placenta percreta at 20 weeks of gestation. We provide a review of case reports of this event occurring at less than 28 weeks of pregnancy (AU)


Assuntos
Humanos , Feminino , Gravidez , Ruptura Uterina/diagnóstico , Ruptura Uterina/patologia , Ruptura Uterina/cirurgia , Abdome Agudo/complicações , Abdome Agudo/diagnóstico , Segundo Trimestre da Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/patologia , Abdome Agudo/fisiopatologia , Abdome Agudo/cirurgia
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