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1.
Artigo em Inglês | MEDLINE | ID: mdl-34734462

RESUMO

AIM: To evaluate the efficacy of levonorgestrel 52 mg intrauterine system for intermenstrual bleeding in patients with previous cesarean delivery scar defects (PCDSs). METHODS: The medical records of 28 consecutive patients with previous cesarean delivery scar defect and intermenstrual bleeding who had undergone conservative treatment with levonorgestrel 52 mg intrauterine system were reviewed. The efficacy of treatment and frequency of adverse events were measured retrospectively. RESULTS: After 1 year of treatment, 22 patients (78.6%) reported an improvement in symptoms. The mean duration of menstruation were 18 and 5 days before and after treatment, respectively. No uterine perforations or pelvic inflammatory diseases occurred during or after the insertion procedures. Eighteen (64.3%) patients did not experience any adverse events, and the patients with adverse events reported that they could be managed by adjusting their medications or observation. CONCLUSION: Levonorgestrel intrauterine system may have a role in the safe and effective management of intermenstrual spotting in patients with PCDSs.

2.
Eur J Obstet Gynecol Reprod Biol ; 267: 99-104, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34739876

RESUMO

OBJECTIVE: Fertility-sparing progestin therapy is highly effective in selected young women with endometrial cancer. In present study, we attempted to evaluate the role of prolonged medication and identify factors predicting successful treatment, and also assess fertility outcomes among young women with early stage endometrial endometrioid carcinoma (EC). STUDY DESIGN: We retrospectively reviewed clinical data from patients aged <45 years with well-differentiated EC at presumed stage IA (without myometrial invasion) who wished to preserve fertility. They were managed with oral progestin at Kaohsiung Chang Gung Memorial Hospital between June 2005 and June 2019. RESULTS: Forty-five patients were included with a median follow-up of 53.5 months (range 12-170 months). Forty-one patients (91.1%) had complete remission, the cumulative complete response (CR) rates at 3, 6, 9, 12, and >12 months were 17.7%, 48.9%, 60.0%, 68.9% and 91.1%, respectively. Among the 41 responders, 23 attempted to conceive and nine (39.1%) achieved pregnancy with 12 live newborn infants. Eleven (27.5%) responders experienced recurrence at a median of 22 months from CR (range 3-54 months). Multivariate Cox regression analysis revealed that non-diabetes (HR: 4.59; 95% CI: 1.62-12.98) and endometrial thickness <2 cm (HR: 0.39; 95% CI: 1.41-17.67) were significantly factors associated with treatment response. CONCLUSIONS: We concluded that prolonged oral progestin treatment was possible with a certain proportion of responders (24.4%) being responded after one year. Diabetes controlled on metformin and endometrial thickness <2 cm could be used as surrogate markers to predict better treatment response.

3.
Taiwan J Obstet Gynecol ; 60(6): 1090-1093, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34794743

RESUMO

OBJECTIVE: Gestational trophoblast disease (GTD) in low-lying implantation ectopic pregnancy (LLIEP) is extremely rare. Surgical removal of GTD lesions which is the initial treatment of choice carries a high risk of intraoperative massive bleeding. Adequate management is challenging and inconclusive. CASE REPORT: We present two unusual cases with a diagnosis of GTD in advanced LLIEP. The first case had choriocarcinoma in cesarean scar and the second case had mole pregnancy in cervix. Both cases were managed with laparoscopy uterine artery ligations followed by transvaginal intrauterine curettage and vacuum aspiration with a small amount of surgical blood loss and then resumed regular menstruation. To understand the different surgical approaches and their potential advantages in managing such rare diseases, relevant cases in the literature were reviewed. CONCLUSION: Much attention should be paid to avoid massive bleeding at initial surgical intervention in patients with GTD in advanced LLIEP. This novel approach with combination of laparoscopic uterine artery ligations and evacuating curettage in selected patients is highly recommended to minimize surgical blood loss. The obvious advantages include technical feasibility, less surgery-related bleeding and potential fertility preservation.

4.
Cancers (Basel) ; 13(21)2021 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-34771742

RESUMO

BACKGROUND: Expression of the progesterone receptor (PR) has been reported to influence survival outcomes in patients with ovarian high-grade serous carcinoma (HGSC). In the present study, we attempted to investigate the association among PR and its isoforms' expression, platinum sensitivity, and survival in ovarian HGSC. MATERIAL AND METHODS: This retrospective study reviewed ovarian HGSC patients who received surgery followed by adjuvant chemotherapy. We analyzed total PR and PR isoform-B (PR-B) expression by immunohistochemical staining and quantified using the H-score. Then, we compared platinum sensitivity and survival outcomes between those patients with weak and strong PR-B expression. Cisplatin viability assays were carried out in ovarian HGSC cell lines (OC-3-VGH and OVCAR-3) with different PR-B expression. RESULTS: Among 90 patients, 49 and 41 patients were considered to have platinum-sensitive and platinum-resistant disease, respectively. Pearson's correlation model showed that the H-score of total PR correlated positively with PR-B (r = 0.813). The PR-B H-score of tumors was significantly higher in the platinum-sensitive group (p = 0.004). Multivariate analysis revealed that the PR-B H-score and optimal debulking status were independent factors predicting platinum sensitivity. When compared with strong PR-B expression, patients with weak PR-B had significantly poorer progression-free (p = 0.021) and cancer-specific survival (p = 0.046). In a cell model, cisplatin-resistant OC-3-VGH cells expressed a lower level of PR-B than wild-type cells. Overexpression of PR-B or progesterone could increase cisplatin sensitivity in both OC-3-VGH and OVCAR-3 cells via the mechanism of promoting cisplatin-related apoptosis. CONCLUSIONS: When compared to weak PR-B, ovarian HGSC patients with a strong PR-B expression had a better chance of platinum sensitivity and survival, and this finding was compatible with our experimental results. Progesterone seemed to be a platinum sensitizer, but the value of adding progesterone in the treatment of ovarian HGSC should be further investigated.

5.
Lipids Health Dis ; 20(1): 100, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496884

RESUMO

BACKGROUND: The deleterious effect of maternal high-fat diet (HFD) on the fetal rat liver may cause later development of non-alcoholic fatty liver disease (NAFLD). The aim of this study was to evaluate the effect of maternal HFD-induced maternal hepatic steatosis and dysbiosis on the fetal liver and intestines, and the effect of prenatal metformin in a rat model. METHODS: Sprague-Dawley rats were assigned to three groups (N = 6 in each group). Before mating, the rats were randomly assigned to HFD or normal-chow diet (NCD) group for 7 weeks. After mating, the HFD group rats were continued with high-fat diet during pregnancy and some of the HFD group rats were co-treated with metformin (HFMf) via drinking water during pregnancy. All maternal rats and their fetuses were sacrificed on gestational day 21. The liver and intestinal tissues of both maternal and fetal rats were analyzed. In addition, microbial deoxyribonucleic acid extracted from the maternal fecal samples was analyzed. RESULTS: HFD resulted in maternal weight gain during pregnancy, intrahepatic lipid accumulation, and change in the serum short-chain fatty acid profile, intestinal tight junctions, and dysbiosis in maternal rats. The effect of HFD on maternal rats was alleviated by prenatal metformin, which also ameliorated inflammation and apoptosis in the fetal liver and intestines. CONCLUSIONS: This study demonstrated the beneficial effects of prenatal metformin on maternal liver steatosis, focusing on the gut-liver axis. In addition, the present study indicates that prenatal metformin could ameliorate maternal HFD-induced inflammation and apoptosis in the fetal liver and intestines. This beneficial effect of in-utero exposure of metformin on fetal liver and intestines has not been reported. This study supports the use of prenatal metformin for pregnant obese women.

6.
Cancer Biomark ; 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397404

RESUMO

BACKGROUND: CA125 level normalization at different chemotherapy cycles has been reported to be a prognosticator in advanced epithelial ovarian cancer. OBJECTIVE: In the present study, we investigated whether the time (in days) to CA125 normalization or nadir during treatment could be used as markers to predict survival. METHODS: Patients with FIGO stage III-IV epithelial ovarian cancer treated with cytoreductive surgery followed by adjuvant chemotherapy between 2008 and 2016 were enrolled in this retrospective study. Clinicopathological characteristics, changes in CA125 level during treatment, and survival outcomes were analyzed. Time-dependent receiver operating characteristic curve analysis was used to determine the optimal cut-off values of the time to normalization and time to nadir of CA125 levels to predict survival. Univariate and multivariate Cox regression analysis were used to examine the impact of each variable on survival. RESULTS: A total of 106 patients were included in the analysis. The optimal cut-off values for the time to normalization and nadir for predicting survival were 60 and 194 days, respectively. In Kaplan-Meier survival analysis, CA125 level normalization ⩽ 60 days and CA125 ⩽ 35 u/mL after the third cycle, and CA125 level ⩽ 10 u/mL after the sixth cycle of chemotherapy were associated with significantly better 5-year progression-free survival (PFS) and overall survival (OS). In multivariate analysis, only CA125 level normalization > 60 days was significantly associated with poor survival outcomes (PFS, HR 2.62 [95% CI: 1.54, 4.45], p= 0.004; OS, HR 2.40 [95% CI: 1.19, 4.81], p= 0.014). CONCLUSIONS: Normalization of CA125 level within 60 days after cytoreductive surgery followed by adjuvant chemotherapy in patients with advanced ovarian epithelial cancer could be used as a marker to predict survival.

7.
Int J Gynecol Pathol ; 2021 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-34347667

RESUMO

Screening for mismatch repair (MMR) deficiency in unselected patients with endometrial carcinoma (EC) and the clinicopathologic descriptions of ECs with MMR deficiency have been well demonstrated in Western populations, but studies on Asian populations are relatively scarce. In this study, we described the clinicopathologic features of ECs according to MMR status in unselected Taiwanese patients. We also conducted subgroup analysis of MMR-deficient (dMMR) cases according to the presence or absence of MLH1. Patients diagnosed with ECs between January 2017 and February 2020 at our institution were included. Immunohistochemistry analysis of MLH1, PMS2, MSH2, and MSH6 proteins on endometrial primary tumors and clinicopathologic variables were assessed retrospectively. A total of 231 EC patients were enrolled, of whom 50 (21.6%) had dMMR tumors. Of these 50 cases, 39 had tumors that lacked MLH1 expression and 11 were positive for MLH1. The overall dMMR group was significantly related to older age, parity, and high histologic grade compared with the MMR-proficient (pMMR) group. ECs with MLH1 deficiency were obviously associated with several poor pathologic features, including high histologic grade, lymph node metastasis, and lymphovascular space invasion. Moreover, we first reported that parity and the late age at menopause are strongly correlated with MLH1-related dMMR EC group compared with pMMR group. In conclusion, triaging EC patients into pMMR, MLH1-related dMMR and non-MLH1-related dMMR groups by immunohistochemistry analysis may help clinicians to predict disease behavior and guide further management. The strong association between parity and MLH1-related dMMR ECs warrants further investigation on the underlying mechanism.

8.
Biomed J ; 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34237454

RESUMO

BACKGROUND: The most appropriate diagnostic tests for the assessment of the uterine cavity in patients undergoing standard infertility evaluation in daily practice remain unclear. Routine hysteroscopic uterine cavity evaluation before an in vitro fertilization-embyo transfer (IVF-ET) cycle is not a uniformly accepted procedure. However, cervical findings associated with difficult ET have rarely been reported in previous hysteroscopic studies. The main objective of this study was to examine the relationship between cervical finding under flexible outpatient hysteroscopy (OH) and difficult ET. MATERIAL AND METHODS: A cohort clinical study was conducted with 650 patients undergoing their first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) from January 2010 to December 2017. Of them, 605 women with available embryos underwent transfer cycles. Outpatient hysteroscopies were scheduled during the follicular phase of the menstrual cycle, 1-3 months before starting IVF/ICSI treatment. RESULTS: Among the 650 women who underwent transvaginal sonography (TVS) and outpatient hysteroscopy, abnormal sonographic findings were observed in 51 women (7.8%) in which submucous myoma, endometrial polyp, and endometrial hyperplasia were the most common. Abnormal hysteroscopic intracavitary findings were observed in 158 cases (24.3%) in which endometrial polyp, submucous myoma, and intrauterine adhesions were the most common. These results showed that TVS was specific (100%) but not sensitive (32.3%) compared with OH. Embryo transfer was difficult in 25% of women with cervical stenosis or tortuous cervical canal and was significantly more difficult in women in the tortuous cervical canal group (30.7%) than in the cervical stenosis group (19.6%). CONCLUSION: Outpatient hysteroscopy can identify cervical charactistics associated with a high incidence of difficult embryo transfer.

9.
Cancer Manag Res ; 13: 5413-5422, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34262349

RESUMO

Aim: To investigate whether the time interval between primary debulking surgery (PDS) and initiating adjuvant chemotherapy affects survival in patients with epithelial ovarian cancer (EOC). Methods: We retrospectively reviewed FIGO stage IIB to IV EOC patients who received PDS followed by adjuvant chemotherapy in our hospital between January 2008 and December 2016. The optimal cut-off time interval to chemotherapy related to survival was determined using the Contal and O'Quigley method and Cox hazard models. Cox regression analysis was used to identify the independent effect of time interval on survival. Results: A total of 152 patients were identified and divided into three groups based on the time interval between PDS and initiating adjuvant chemotherapy: early (<23 days), intermediate (23-43 days) and late (>43 days). The intermediate group had a significantly better median progression-free survival (PFS, 35.5 months) compared to the early (20 months) and late (22.6 months) groups. After adjustments for confounding factors, time interval was still an independent variable affecting PFS. The intermediate group was associated with a better PFS compared with the early and late groups (hazard ratio 0.27, 95% CI 0.10-0.83, p=0.002). There was no statistical significance in overall survival (OS) in univariate or multivariate analysis, although there was a trend towards better OS in the intermediate group. Conclusion: Our results provide evidence that the time interval from PDS to chemotherapy influences PFS in patients with advanced EOC. The optimal time to initiate chemotherapy was between 23 and 43 days, within 3-6 weeks post-operatively. Initiating chemotherapy early (<23 days) did not appear to benefit PFS.

10.
J Obstet Gynaecol Res ; 47(8): 2729-2736, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34028127

RESUMO

AIM: The predictive accuracy of frozen sections for borderline ovarian tumors (BOTs) is suboptimal. The aim of this study was to determine the diagnostic accuracy of BOTs and factors associated with an upgrade to a permanent pathological diagnosis of invasive carcinoma in patients diagnosed with BOTs by frozen section. METHODS: We conducted a retrospective study between 2011 and 2018 at Kaohsiung Chang Gung Memorial Hospital (KCGMH). Two hundred and twenty-five records of eligible patients with a diagnosis of BOT by frozen section or permanent diagnosis were reviewed. Positive predictive value and the diagnostic accuracy of frozen sections were calculated. Univariate and multivariate analyses were used to determine the clinicopathological factors associated with an upgrade of the diagnosis from a borderline tumor to malignancy. RESULTS: The agreement between frozen section and permanent pathological diagnoses was 63.1%, and the positive predictive value was 72.1%. The multivariate analysis revealed that CA-125 level > 136 U/mL (odds ratio [OR] = 2.96, 95% confidence interval [CI] = 1.3-6.9; p = 0.012), and tumor histologic type (clear cell/endometrioid vs. mucinous; OR:32.8, 95% CI = 6.9-154.8, p < 0.001; clear cell/endometrioid vs. serous: OR 48.1, 95% CI = 8.8-261.8, p < 0.001) were independent risk factors for an upgrade of the permanent diagnosis from a BOT to ovarian carcinoma. CONCLUSION: An elevated CA-125 level (over 136 U/mL) and tumor histologic type (clear cell and endometrioid subtypes) were associated with an upgrade in the diagnosis of ovarian tumor from a BOT on frozen section to a permanent diagnosis of malignancy.


Assuntos
Secções Congeladas , Neoplasias Ovarianas , Antígeno Ca-125 , Feminino , Humanos , Neoplasias Ovarianas/diagnóstico , Valor Preditivo dos Testes , Estudos Retrospectivos
11.
Taiwan J Obstet Gynecol ; 60(1): 148-151, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33494991

RESUMO

OBJECTIVE: The risk of venous thromboembolism in pregnancies increased in ovarian hyperstimulation syndrome (OHSS) after assisted reproductive technologies (ART). We present a rare case with protein S deficiency receiving ART treatment with OHSS, following right neck venous thromboembolism. CASE REPORT: A 34-year-old women with primary infertility underwent IVF treatment and presented with OHSS. However, thromboembolism in the right jugular and subclavian veins was diagnosed at eight weeks of gestation. She was continuously treated with low molecular weight heparin (LMWH) since eight weeks of gestation and the diagnosis of protein S deficiency was made. Due to placenta previa with massive bleeding, she gave live birth to two healthy babies via cesarean section at 34 weeks of gestation. CONCLUSION: Thromboembolism is one of life-threatening complications among women with OHSS. Although inherited thrombophilia is rare diseases, thrombophilia workup may be taken into consideration for women with thrombotic events.


Assuntos
Pescoço/irrigação sanguínea , Síndrome de Hiperestimulação Ovariana/complicações , Complicações Cardiovasculares na Gravidez/etiologia , Deficiência de Proteína S/complicações , Tromboembolia Venosa/etiologia , Adulto , Cesárea , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Infertilidade Feminina/terapia , Veias Jugulares , Nascido Vivo , Ilustração Médica , Gravidez , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Gravidez de Gêmeos , Técnicas de Reprodução Assistida/efeitos adversos , Veia Subclávia , Tromboembolia Venosa/tratamento farmacológico
12.
J Assist Reprod Genet ; 38(1): 85-93, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32862335

RESUMO

PURPOSE: To study the association between paternal age and schizophrenia in offspring. METHODS: This report describes a nationwide population-based cohort study from 1997 to 2013. Data from Taiwan's National Health Insurance Research Database were utilized to answer the research question. A total of 17,649 offspring with schizophrenia were selected from 11 million offspring in the general population. Additionally, we established the offspring without schizophrenia as the comparison group by matching the study cohort by age, gender in a 1:4 ratio (n = 70,596). RESULTS: The median age at first presentation with schizophrenia was 20 years (interquartile range (IQR), 17 to 24). Comparison of the schizophrenia and non-schizophrenia groups indicated that father's age at birth (30.0 (IQR), 27 to 33 vs. 29.0 (IQR), 26 to 32 years), mother's age at birth (26.0 (IQR), 24 to 29 vs. 26.0 (IQR), 23 to 29 years), paternal schizophrenia (2.6% vs. 0.6%), and maternal schizophrenia (4.4% vs. 0.7%) were all significantly greater in the schizophrenia group. In addition, each 5-year increase in father's age increased the odds of being diagnosed with schizophrenia (model 1: aOR = 1.22; 95% CI 1.20, 1.24; model 2: aOR = 1.20; 95% CI 1.18, 1.23). Subgroup analysis showed that each 5-year increase in father's age increased the odds of being diagnosed with schizophrenia in male and female offspring, as well as in offspring of mothers and fathers with or without schizophrenia (aOR = 1.20 to 2.20, all p values < 0.01). CONCLUSION: This study indicated that advanced paternal age increased the risk of schizophrenia in offspring. Offspring born to fathers older by 5-year increments were at heightened risk of schizophrenia.


Assuntos
Idade Paterna , Esquizofrenia/genética , Adolescente , Adulto , Estudos de Coortes , Pai , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mães , Fatores de Risco , Esquizofrenia/epidemiologia , Esquizofrenia/fisiopatologia , Adulto Jovem
13.
Int J Hyperthermia ; 37(1): 1279-1286, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33198563

RESUMO

BACKGROUND: Acute renal impairment (ARI) is a major complication after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for cancer patients with peritoneal metastases. This study aimed to investigate the incidence and identify the risk factors of post-HIPEC creatinine increased. METHODS: From April 2015 to December 2019, demographic and perioperative data of 169 patients undergoing CRS/HIPEC with a preoperative creatinine level <1.5 mg/dL were retrospectively reviewed. Renal impairment was defined according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0. The risk factors of creatinine increased were analyzed using univariate and multiple logistic regression analyses. RESULTS: Among the 169 enrolled patients, 21 (12.4%) had postoperative creatinine increased (ARI group) and 148 (87.6%) did not (non-ARI group). Significantly more of the ARI group received a cisplatin HIPEC regimen than the non-ARI group (71.4 vs. 37.8%, p = 0.004). Multiple logistic regression analysis revealed that the patients who received a cisplatin HIPEC regimen (adjusted odds ratio [AOR] = 11.38, p < 0.001) and peritoneal dialysis solution as HIPEC perfusate (AOR = 7.07, p = 0.002) were more likely to develop post-HIPEC creatinine increased. CONCLUSIONS: Identifying the risk factors of post-HIPEC creatinine increased can help to improve patient selection, a dose of HIPEC regimens modification and perioperative care. We also identified the detrimental renal effect of peritoneal dialysis solution as HIPEC perfusate. More prospective studies are warranted to confirm these findings.


Assuntos
Hipertermia Induzida , Neoplasias Peritoneais , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Humanos , Hipertermia Induzida/efeitos adversos , Quimioterapia Intraperitoneal Hipertérmica , Neoplasias Peritoneais/tratamento farmacológico , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco
14.
Cancer Biomark ; 28(3): 285-292, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32390605

RESUMO

BACKGROUND: Epithelial ovarian cancer is a highly lethal gynecological malignancy. Accurate and cost-effective predictive tools to estimate the prognosis of patients with epithelial ovarian cancer before treatment are currently lacking. OBJECTIVE: The purpose of this study was to evaluate the prognostic significance of pretreatment serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen-125 (CA-125) in primary epithelial ovarian cancer. METHODS: Between 2008 and 2016, 326 patients with a diagnosis of primary epithelial ovarian cancer were retrospectively reviewed. We attempted to identify an optimal cut-off value of CEA to predict survival using ROC curve analysis. Cox regression univariate and multivariate analyses were used to evaluate prognostic factors. RESULTS: The optimal cut-off value of CEA was 2.6 ng/mL. In univariate and multivariate analyses, FIGO stage and pretreatment CA-125 and CEA levels significantly predicted progression-free and overall survival. The 5-year progression-free survival rate for patients with both a CEA level < 2.6 ng/mL and CA-125 level < 35 U/mL was 84%, compared to only 33% for the patients with higher levels of both markers (p< 0.001). The 5-year cancer specific survival rate was 94% in those with a CEA level < 2.6 ng/mL and CA-125 level < 35 U/mL, and only 39% for those with higher levels of both markers (p< 0.001). CONCLUSIONS: In addition to traditional prognostic factors, a pretreatment serum CEA level ⩾ 2.6 ng/mL and CA-125 level ⩾ 35 U/mL were also independent prognostic factors for epithelial ovarian cancer. Patients with an elevated CEA and/or CA-125 level before treatment should be considered to be at high-risk of recurrence and death.


Assuntos
Antígeno Ca-125/sangue , Antígeno Carcinoembrionário/sangue , Carcinoma Epitelial do Ovário/mortalidade , Proteínas de Membrana/sangue , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Ovarianas/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Epitelial do Ovário/sangue , Carcinoma Epitelial do Ovário/patologia , Carcinoma Epitelial do Ovário/cirurgia , Procedimentos Cirúrgicos de Citorredução , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Ovariectomia/métodos , Ovário/patologia , Ovário/cirurgia , Período Pré-Operatório , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
15.
Taiwan J Obstet Gynecol ; 59(1): 85-90, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32039807

RESUMO

OBJECTIVE: To evaluate differences in hysteroscopic findings between benign endometrial polyps and endometrial cancer. MATERIALS AND METHODS: From January 2012 to December 2016, we extracted 179 cases with endometrial polyps from 3066 women who underwent hysteroscopy followed by dilatation and curettage or transcervical resection, with 154 and 25 cases of benign and malignant endometrial polyps, respectively. Clinical characteristics, histopathological and hysteroscopic findings of the women were evaluated retrospectively. RESULTS: The hysteroscopic findings of malignant polyps were hyper-vascular (72%, 18/25), ulcerative (64%, 16/25) and polyps with irregular surfaces (24%, 6/25). In contrast, pedunculate small growths with smooth surfaces were usually seen in the benign endometrial polyps (38.3%, 59/154). Hyper-vascular (OR: 142.6, 95% CI: 25.98-783.4) and polyps with irregular surfaces (OR: 12.02, 95% CI: 1.765-81.83) in hysteroscopic findings were significant strong predictors of endometrial polyps with endometrial cancer. Hysteroscopic findings of ulcerative changes were most strongly associated with a diagnosis of malignant polyps, with sensitivity, specificity, negative (NPV) and positive (PPV) predictive values of 64.0%, 100%, 94.5%, and 100%, respectively. CONCLUSION: Women with hysteroscopic findings of endometrial polyps with hyper-vascular, ulcerative, and polyps with irregular surfaces had a high likelihood of endometrial cancer. A target biopsy of the polyps with these specific appearances should be performed to exclude malignant lesions.


Assuntos
Neoplasias do Endométrio/diagnóstico , Histeroscopia/estatística & dados numéricos , Pólipos/diagnóstico , Doenças Uterinas/diagnóstico , Adulto , Biópsia , Diagnóstico Diferencial , Dilatação e Curetagem , Endométrio/patologia , Feminino , Humanos , Histeroscopia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
16.
J Gynecol Oncol ; 31(1): e5, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31788995

RESUMO

OBJECTIVES: An Asian Gynecologic Oncology Group phase III randomized trial was conducted to determine whether maintenance chemotherapy could improve progression-free survival (PFS) in stages III/IV ovarian cancer. METHODS: Between 2007 and 2014, 45 newly-diagnosed ovarian cancer patients were enrolled after complete remission and randomized (1:1) to arm A (4-weekly carboplatin area under the curve 4 and pegylated liposomal doxorubicin [PLD] 30 mg/m², n=24) for 6 cycles or arm B (observation, n=21). The primary end-point was PFS. A post hoc translational study was conducted to deep sequence BRCA/homologous recombination deficiency (HRD) genes, because BRCA/HRD mutations (BRCA/HRDm) are known to be associated with better prognosis. RESULTS: Enrollment was slow, accrual was closed when 7+ years had passed. With a median follow-up of 88.9 months, the median PFS was significantly better in arm A (55.5 months) than arm B (9.2 months) (hazard ratio [HR]=0.40; 95% confidence interval [CI]=0.19-0.87; p=0.020), yet the median overall survival was not significantly different in arm A (not reached) than arm B (95.1 months) (p=0.148). Overall grade 3/4 adverse events were more frequent in arm A than arm B (60.9% vs 0.0%) (p<0.001). Quality of life was generally not significantly different. Distribution of BRCA1/2m or BRCA/HRDm was not significantly biased between the two arms. Wild-type BRCA/non-HRD subgroup seemed to fare better with maintenance therapy (HR=0.35; 95% CI=0.11-1.18; p=0.091). CONCLUSIONS: Despite limitations in small sample size, it suggests that maintenance carboplatin-PLD chemotherapy could improve PFS in advanced ovarian cancer.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carboplatina/administração & dosagem , Carcinoma Epitelial do Ovário/tratamento farmacológico , Doxorrubicina/análogos & derivados , Quimioterapia de Manutenção/métodos , Neoplasias Ovarianas/tratamento farmacológico , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carboplatina/efeitos adversos , Carcinoma Epitelial do Ovário/mortalidade , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/mortalidade , Polietilenoglicóis/administração & dosagem , Polietilenoglicóis/efeitos adversos , Taiwan
17.
Artigo em Inglês | MEDLINE | ID: mdl-31756939

RESUMO

BACKGROUND: Pyruvate kinase M2 (PKM2) is a regulator of the processes of glycolysis and oxidative phosphorylation, but the roles that it plays in endometrial cancer remain largely unknown. This study evaluated the PKM2 expression in normal endometrium, endometrial hyperplasia, and endometrial carcinoma, and its prognostic value was investigated in endometrial carcinoma patients. METHODS: A hospital-based retrospective review was conducted to examine the immunohistochemical PKM2 distribution in 206 endometrium samples from biopsies or hysterectomies. The immunoreactivity of PKM2 was divided into groups of low and high scores according to the extent and intensity of staining. RESULTS: Intense cytoplasmic staining was observed for the PKM2 protein in malignant endometrial lesions. A high PKM2 score was observed in many endometrial carcinoma samples (50.0%), but there was a low percentage in endometrial atypical hyperplasia (12.5%). High PKM2 expression was not found in the normal endometrium (0.0%) nor endometrial hyperplasia without atypia (0.0%). The PKM2 protein score was significantly higher in endometrial carcinoma samples than premalignant endometrial lesions (p < 0.001). Notably, higher PKM2 scores in cases of endometrial carcinoma correlated with poor overall survival (p = 0.006), and the hazard ratio for death was 3.40 (95% confidence interval, 1.35-8.56). CONCLUSIONS: Our results indicate that the prevalence of PKM2high tumor cells in endometrial carcinoma is significantly associated with worse prognostic factors and favors a poor prognosis. The expression of PKM2 is also a potential histopathological biomarker for use in the differential diagnosis of malignant and premalignant endometrial lesions.


Assuntos
Carcinoma/enzimologia , Neoplasias do Endométrio/enzimologia , Lesões Pré-Cancerosas/enzimologia , Piruvato Quinase/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Carcinoma/patologia , Neoplasias do Endométrio/patologia , Endométrio/patologia , Feminino , Glicólise , Humanos , Histerectomia , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/patologia , Estudos Retrospectivos , Adulto Jovem
18.
J Obstet Gynaecol Res ; 45(10): 2015-2020, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31381242

RESUMO

AIM: To evaluate the efficacy of levonorgestrel intrauterine system (LNG-IUS) treatment in patients with previous cesarean delivery scar defect (PCDS)-related intermenstrual bleeding. METHODS: A total of six premenopausal patients who experienced PCDS-related intermenstrual bleeding were enrolled for conservative therapy with LNG-IUS (levonorgestrel 20 µg/24 h) insertion. The durations of menstruation before and after LNG-IUS insertion at 1, 6 and 12 months were recorded. A total of three missed menstrual cycles was defined as amenorrhea. Any side effects and the device expulsion rate were also recorded. Patient follow-up was at an outpatient clinic. Any missing data were obtained by telephone. RESULTS: At the start of the study the median duration of intermenstrual bleeding was 6.5 days (range 3-22 days). After 6 months treatment, two of the six patients had developed amenorrhea and two patients experienced cessation of vaginal spotting. One patient reported expulsion of the device. All patients except the one with device expulsion responded to the conservative treatment after 1 year. CONCLUSION: The findings of the current study support LNG-IUS being effective for the treatment of PCDS-related intermenstrual bleeding. The authors recommend LNG-IUS as a treatment option for PCDS-related intermenstrual bleeding.


Assuntos
Cesárea/efeitos adversos , Contraceptivos Hormonais/administração & dosagem , Levanogestrel/administração & dosagem , Distúrbios Menstruais/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Adulto , Cicatriz/complicações , Feminino , Humanos , Dispositivos Intrauterinos Medicados , Distúrbios Menstruais/etiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
19.
BMC Womens Health ; 19(1): 103, 2019 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340789

RESUMO

BACKGROUND: Probiotics has been shown to be effective in reducing vaginal colonization of pathogenic organisms. The aim of this study was to investigate the influence of probiotic strains Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on genital high-risk human papilloma virus (HR-HPV) clearance and quality of cervical smear. METHODS: This was a randomized, double-blinded, placebo-controlled trial. Women with genital HR-HPV infection were randomized into study and control groups. A probiotic or placebo preparation was administered orally (one capsule daily) until negative HR-HPV testing. A cervical smear and HR-HPV tests were performed at the beginning of the study and every 3 months thereafter until a negative result was obtained. RESULTS: A total of 121 women with genital HR-HPV infection were enrolled (62 in the study group and 59 in the control group). There was no significant difference in HR-HPV clearance rate between the two groups (58.1% vs. 54.2%). The only factor predicting HR-HPV clearance was a lower initial viral load (HR 3.214; 95% CI: 1.398, 7.392; p = 0.006). Twenty-two women had a mildly abnormal initial cervical smear and nine had an unsatisfactory smear. At 6 months follow-up, both mildly abnormal cervical smear and unsatisfactory smear rates had decreased significantly in the study group compared to the control group (p = 0.017 and 0.027). CONCLUSIONS: The application of probiotic strains Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 did not influence genital HR-HPV clearance, but may have decreased the rates of mildly abnormal and unsatisfactory cervical smears. TRIAL REGISTRATION: Clinicaltrials.gov NCT01599416 , May, 2012. Retrospectively registered.


Assuntos
Colo do Útero/patologia , Colo do Útero/virologia , Papillomaviridae , Infecções por Papillomavirus/terapia , Probióticos/uso terapêutico , Vagina/virologia , Adulto , Método Duplo-Cego , Feminino , Genótipo , Humanos , Lactobacillus reuteri , Lactobacillus rhamnosus , Pessoa de Meia-Idade , Papillomaviridae/genética , Infecções por Papillomavirus/virologia , Estudos Retrospectivos , Esfregaço Vaginal , Carga Viral
20.
Taiwan J Obstet Gynecol ; 58(4): 541-544, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307748

RESUMO

OBJECTIVE: The aim of the present study was to describe various hysteroscopic findings of previous cesarean delivery scar defects (PCDS), and evaluate the relationship between these findings and abnormal uterine bleeding. MATERIALS AND METHODS: This was a retrospective study including patients with abnormal uterine bleeding after a cesarean section. Transvaginal ultrasound and hysteroscopy were used to detect the origin of the symptoms, and the gynecological symptoms and hysteroscopic findings were recorded. Relationships between the hysteroscopic findings and abnormal uterine bleeding were evaluated. RESULTS: Ninety-six (82.8%) patients presented with intermenstrual bleeding. The most common findings of scar defects on hysteroscopy were increased local vascularization (74.1%) and oozing spots (47.4%). Increased local vascularization on the defect was significantly related to intermenstrual bleeding (p = 0.048). CONCLUSION: This study categorized different findings of PCDS under hysteroscopy. Increased local vascularization on the scar defect was significantly related to intermenstrual bleeding.


Assuntos
Cesárea/efeitos adversos , Cicatriz/diagnóstico , Cicatriz/etiologia , Histeroscopia/métodos , Hemorragia Uterina/epidemiologia , Adulto , Cesárea/métodos , Cicatriz/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Incidência , Gravidez , Prognóstico , Estudos Retrospectivos , Medição de Risco , Taiwan , Hemorragia Uterina/etiologia , Hemorragia Uterina/cirurgia
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