Liposomes as a Promising Ultrasound-Triggered Drug Delivery System in Cancer Treatment.

The initial uses of ultrasound waves in the medical field were limited to the thermal ablation of solid tumors and as a diagnostic tool. Recent advances at the preclinical stage have allowed the use of ultrasound as a powerful tool to improve drug delivery when the agent is administered encapsulated inside a nanoparticle. This spatial and temporal control of drug release, using a non-invasive modality, is a promising approach to decrease the side effects of conventional chemotherapy in cancer treatments, as it reduces the interaction of the anti-neoplastic agent with healthy tissues. In this review, we explain the physics of ultrasound, introduce and discuss several examples on the use of nanoparticles as drug carriers, with a focus on liposomes. Examples of in vitro and in vivo studies are presented and discussed.

Surgery for endometriosis-associated infertility: do we exaggerate the magnitude of effect?

OBJECTIVE: Surgery remains the mainstay in the diagnosis and management of endometriosis. The number of surgeries performed for endometriosis worldwide is ever increasing, however do we have evidence for improvement of infertility after the surgery and do we exaggerate the magnitude of effect of surgery when we counsel our patients? The management of patients who failed the surgery could be by repeat surgery or assisted reproduction. What evidence do we have for patients who fail assisted reproduction and what is their best chance for achieving pregnancy? MATERIAL AND METHODS: In this study we reviewed the evidence-based practice pertaining to the outcome of surgery assisted infertility associated with endometriosis. Manuscripts published in PubMed and Science Direct as well as the bibliography cited in these articles were reviewed. Patients with peritoneal endometriosis with mild and severe disease were addressed separately. Patients who failed the primary surgery and managed by repeat or assisted reproduction technology were also evaluated. Patients who failed assisted reproduction and managed by surgery were also studied to determine of the best course of action. RESULTS: In patients with minimal and mild pelvic endometriosis, excision or ablation of the peritoneal endometriosis increases the pregnancy rate. In women with severe endometriosis, controlled trials suggested an improvement of pregnancy rate. In women with ovarian endometrioma 4 cm or larger ovarian cystectomy increases the pregnancy rate, decreases the recurrence rate, but is associated with decrease in ovarian reserve. In patients who have failed the primary surgery, assisted reproduction appears to be significantly more effective than repeat surgery. In patients who failed assisted reproduction, the management remains to be extremely controversial. Surgery in expert hands might result in significant improvement in pregnancy rate. CONCLUSION: In women with minimal and mild endometriosis, surgical excision or ablation of endometriosis is recommended as first line with doubling the pregnancy rate. In patients with moderate and severe endometriosis surgical excision also is recommended as first line. In patients who failed to conceive spontaneously after surgery, assisted reproduction is more effective than repeat surgery. Following surgery, the ovarian reserve may be reduced as determined by Anti Mullerian Hormone. The antral follicle count is not significantly reduced. In women with large endometriomas > 4 cm the ovarian endometrioma should be removed. In women who have failed assisted reproduction, further management remains controversial in the present time.

Recurrence of endometriosis after hysterectomy.

AIM: Persistent or recurrent pain after hysterectomy is one of the most frustrating clinical scenarios in benign gynaecology. We attempt to review the current evidence regarding the recurrence of pelvic pain after hysterectomy for endometriosis. The impact of ovarian conservation, type of hysterectomy and the extent of surgical excision were analysed. METHODS: Peer reviewed published manuscripts in the English language in the period between 1980 and 2014 were reviewed using Pubmed and science direct regarding the incidence, causes and recurrence of endometriosis. RESULTS: Sixty-seven articles were identified. Incomplete excision of endometriosis is the most predominant reason in the literature for the recurrence of endometriosis, and the type of Hysterectomy affects the recurrent symptoms mainly by impacting the extent of excision of the lesion. Ovarian cyst drainage is associated with the highest rate of ovarian cyst reformation within three to six months after surgery. The use of hormone replacement therapy is associated with recurrence of pelvic pain in 3.5% of cases. No studies addressed the recurrence of endometriosis after standard vs robotic assisted hysterectomy. CONCLUSION: A high recurrence rate of 62% is reported in advanced stages of endometriosis in which the ovaries were conserved. Ovarian conservation carries a 6 fold risk of recurrent pain and 8 folds risk of reoperation. The decision has to be weighed taking into consideration the patient's age and the impact of early menopause on her life style. The recurrence of endometriosis symptoms and pelvic pain are directly correlated to the surgical precision and removal of peritoneal and deeply infiltrated disease. Surgical effort should always aim to eradicate the endometriotic lesions completely to keep the risk of recurrence as low as possible.

Low-malignant-potential tumor of the ovary: sonographic features with clinicopathologic correlation in 41 patients.

The biologic, behavioral, and pathologic features of low-malignant-potential (LMP) tumor of the ovary are distinct from their invasive counterpart. LMP tumors affect patients at a younger age and have a much better 5- and 20-year survival rate compared with invasive ovarian malignancy. The authors retrospectively reviewed the records and sonograms of 41 patients (51 masses) with LMP tumor of the ovary. They demonstrated a wide variety of morphologies on the presentation sonograms with six masses favored to be benign, four indeterminate, 18 likely malignant, and 23 clearly malignant. Eighteen of 51 masses (35.3%) had a unique appearance-a cyst within the ovary of small to medium size with vascular mural nodularity and preserved surrounding ovarian parenchyma. Low-level echoes within the cystic components of the mass, reminiscent of typical endometrioma, were present in 19 of 51 masses (37.2%). Peritoneal dissemination was present in six patients at presentation, all! whom were alive at follow-up between 45 and 120 months. The authors think that many LMP tumors may be recognized and treated while they are still small. Ovary-sparing surgery may preserve patient fertility. LMP tumors may present initially with a benign morphology, although temporal evolution tends to show more suspicious features. Because these tumors may also appear frankly malignant or show peritoneal dissemination, the possibility of LMP tumor must be considered in light of their much better prognosis compared with invasive ovarian malignancy.