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1.
BJOG ; 127(3): 377-387, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31631477

RESUMO

OBJECTIVE: To assess the long-term risk factors predicting residual/recurrent cervical intraepithelial neoplasia (CIN 2-3) and time to recurrence after large loop excision of the transformation zone (LLETZ). DESIGN: Retrospective study. SETTING: Colposcopy clinic. POPULATION: 242 women with CIN 2-3 treated between 1996 and 2006 and followed up until June 2016. METHODS: Age, margins, and high-risk human papillomavirus (HR-HPV) were estimated using Cox proportional hazard and unconditional logistic regression models. The cumulative probability of treatment failure was estimated by Kaplan-Meier analysis. MAIN OUTCOME MEASURE: Histologically confirmed CIN 2-3, HR-HPV, margins, age. RESULTS: CIN 2-3 was associated with HR-HPV (HR = 30.5, 95% confidence interval [CI] = 3.80-246.20), age >35 years (HR = 5.53, 95% CI = 1.22-25.13), and margins (HR = 7.31, 95% CI = 1.60-33.44). HR-HPV showed a sensitivity of 88.8% and a specificity of 80%. Ecto+ /endocervical+ (16.7%), uncertain (19.4%) and ecto- /endocervical+ margins (9.1%) showed a higher risk of recurrence (odds ratio [OR] = 13.20, 95% CI = 1.02-170.96; OR = 15.84, 95% CI = 3.02-83.01; and OR = 6.60, 95% CI = 0.88-49.53, respectively). Women with involved margins and/or who were HR-HPV positive had more treatment failure than those who were HR-HPV negative or had clear margins (P-log-rank <0.001). CONCLUSIONS: HR-HPV and margins seem essential for stratifying post-LLETZ risk, and enable personalised management. Given that clear margins present a lower risk, a large excision may be indicated in older women to reduce the risk. TWEETABLE ABSTRACT: After LLETZ for CIN 2-3, recurrences appear more often in women with positive HR-HPV and involved margins and aged over 35.


Assuntos
Neoplasia Intraepitelial Cervical , Efeitos Adversos de Longa Duração , Margens de Excisão , Recidiva Local de Neoplasia/diagnóstico , Neoplasia Residual/diagnóstico , Infecções por Papillomavirus , Traquelectomia , Neoplasias do Colo do Útero , Transformação Celular Neoplásica , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/patologia , Neoplasia Intraepitelial Cervical/cirurgia , Colo do Útero/patologia , Colo do Útero/cirurgia , Feminino , Humanos , Estimativa de Kaplan-Meier , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/epidemiologia , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Estudos Retrospectivos , Medição de Risco/métodos , Espanha/epidemiologia , Traquelectomia/efeitos adversos , Traquelectomia/métodos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia
2.
Yonsei Med J ; 60(11): 1074-1080, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31637890

RESUMO

PURPOSE: Descent of the uterus is a major etiology of uterine prolapse. However, true cervical elongation can cause uterine prolapse without uterine descent. The aim of study was to investigate the clinical outcomes of Manchester operation in patients with uterine prolapse caused by "true cervical elongation," compared with vaginal hysterectomy (VH). MATERIALS AND METHODS: Medical records of patients who underwent Manchester operation or VH from 2006 to 2015 were reviewed. True cervical elongation was defined on the basis of C point of the Pelvic Organ Prolapse Quantification (POP-Q) system ≥0 and D point ≤-4, as well as estimated cervical length of ≥5 cm. The primary outcome was recurrence of pelvic organ prolapse (POP) evaluated by POP-Q system. The outcomes of two groups were compared after propensity score matching, for age, parity, and preoperative POP-Q stage. RESULTS: During the study period, 23 patients underwent Manchester operation and 374 patients underwent VH. The recurrence rate of POP (p=0.317) and complication rate were not statistically significant different between the two study groups. Manchester operation exhibited shorter operation time than VH (p=0.033). In subgroup analysis (POP-Q stage III), body mass index [odds ratio (OR)=1.74; 95% confidence interval (CI), 1.08-2.81] and not having concurrent anterior colporrhaphy (OR for concurrent anterior colporrhaphy, 0.06; 95% CI, 0.01-0.75) were identified as significant risk factors for recurrence of POP. CONCLUSION: The Manchester operation technique seems to be an effective and safe alternative procedure for the treatment of uterine prolapse caused by true cervical elongation, compared with VH.


Assuntos
Colo do Útero/cirurgia , Prolapso Uterino/cirurgia , Adulto , Índice de Massa Corporal , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/cirurgia , Cuidados Pré-Operatórios , Pontuação de Propensão , Recidiva , Fatores de Risco , Resultado do Tratamento
3.
Eur J Obstet Gynecol Reprod Biol ; 240: 156-160, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31288186

RESUMO

OBJECTIVES: Not being able to completely examine the cervical squamocolummar junction (SCJ) in colposcopy after large loop excision of the transformation zone (LLETZ) is an important issue regarding surveillance, as high-grade cervical intra-epithelial neoplasia recurrence risk is high. This study was conducted in order to identify risk factors for post-LLETZ unsatisfactory colposcopy. METHODS: This prospective multicenter observational study was performed in nine French University hospitals, with inclusions running from December 2013 to December 2017. All patients scheduled for LLETZ were included and were divided into two groups after the two to four months post-procedure colposcopic examination: a satisfactory and an unsatisfactory post-LLETZ colposcopy group. RESULTS: In total, 601 cases were analyzed and 71 post-LLETZ colposcopies (12%) were described as unsatisfactory (including 19 cervical stenosis). In a univariate analysis, we only observed a statistically significant increase of the following parameters in the unsatisfactory post-LLETZ group in comparison with the satisfactory post-LLETZ group: parity (2.11 [±1.55] and 1.49 [±1.24] respectively, p < .01), depth of the LLETZ specimen (10.9 mm [±3.37] and 9.76 [±3.79] respectively, p < .01), age (45.9 years [±11.7] and 37.9 [±9.42] respectively, p < .001) and an unsatisfactory pre-LLETZ colposcopy (43 satisfactory pre-LLETZ colposcopies [61%] and 456 [86%] respectively, p < .001). In a stepwise binary logistic regression analysis, only the two latter parameters were found to be independently associated with unsatisfactory post-LLETZ colposcopies. CONCLUSIONS: Surgeons should consider other therapeutic strategies when contemplating iterative diagnosis-LLETZ in older women with initially invisible SCJ, as an appropriate post-LLETZ surveillance is at higher risk of being impossible to achieve.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Colo do Útero/cirurgia , Colposcopia , Traquelectomia , Neoplasias do Colo do Útero/cirurgia , Adulto , Diatermia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
4.
Cancer Sci ; 110(9): 2992-3005, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31265190

RESUMO

Cervical clear cell carcinoma (cCCC) constitutes an extremely rare subtype of cervical cancer. Consequently, its pathogenesis remains largely unknown, with no cell lines established from primary tumors. Here, we report the first establishment of cCCC organoids, from biopsy samples of a 23-year-old patient diagnosed with cCCC. By applying a protocol that we recently optimized for gynecological tumors, we were able to propagate a patient-derived cell line (PDC) for more than 6 months as organoids. This PDC tolerated cryopreservation and proliferated either as spheroids or adherent cells, and developed xenografts in immunodeficient mice, ensuring robust utility as a cell line. Intriguingly, the resected tumor focally contained serous carcinoma (SC) in a tiny protruding lesion. Both organoids and derivative xenografts resembled the CCC component of the original tumor in histology, immunostaining profile, and genome-wide copy number changes, including focal gain of MET. Genomic analysis revealed that both organoids and the CCC component harbored only a few mutations, of which 2 mutations were shared in common. In contrast, the SC component showed a mutator-phenotype and prominent genome instability along with biallelic inactivation of TP53, but none of them were found in organoids or the CCC component. The PDC proved sensitive to major chemotherapeutic agents and MET inhibitors. These observations clearly indicated that the PDC, designated as YMC7, can be used as a novel cCCC cell line and provide novel insights into the pathogenesis of mixed cervical adenocarcinoma. As a valuable resource for rare cancer, it will likely contribute to investigations in many fields.


Assuntos
Adenocarcinoma de Células Claras/patologia , Colo do Útero/patologia , Organoides , Cultura Primária de Células , Neoplasias do Colo do Útero/patologia , Adenocarcinoma de Células Claras/cirurgia , Adulto , Animais , Linhagem Celular Tumoral , Colo do Útero/citologia , Colo do Útero/cirurgia , Feminino , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Esferoides Celulares , Neoplasias do Colo do Útero/cirurgia , Ensaios Antitumorais Modelo de Xenoenxerto , Adulto Jovem
6.
Eur J Obstet Gynecol Reprod Biol ; 240: 273-277, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31352128

RESUMO

OBJECTIVE: to provide a practical tool for the evidenced-based management of adenocarcinoma in situ (AIS) of the uterine cervix, a challenging diagnosis encountered by colposcopists in their daily practice. METHODS: the proposed recommendations were drafted by the Italian Society of Colposcopy and Cervical Pathology (SICPCV) based on comprehensive reviews of previous guidelines, large uncontrolled studies, metanalysis, and sytematic reviews. The quality Level and the strength of the recommendations were graded and respectively expressed in Roman numbers (I-VI) and letters (A-E). RESULTS: Women with all subcategories of abnormal glandular cells and AIS on cervical citology should be offered colposcopy with endocervical sampling (Strength of recommendation: A). In women with cytological AIS and negative colposcopy or endocervical curettage, an excisional treatment under colposcopic guidance is recommended (Strength of recommendation: A). If immediate post-conization endocervical sampling is positive, further conization is indicated (Strength of recommendation: C). In women who desire to preserve fertility with positive cone margins, further conization should be performed (Strength of recommendation: B). If colposcopy is adequate, a cylindrical excision that includes the whole transformation zone and at least 1-1.5 cm of endocervix beyond the squamous-columnar junction should be performed (Strength of recommendation: B). If colposcopy is inadequate, it is recommended that conization includes the whole transformation zone with a depth of 20-25 mm (Strength of recommendation: B). Hysterectomy is the standard definitive treatment for AIS in women who do not wish to preserve fertility (Strength of recommendation: B). CONCLUSION: the proposed recommendations should enable clinicians to correctly diagnose, treat and follow AIS patients, avoiding mismanagement.


Assuntos
Adenocarcinoma in Situ/cirurgia , Colo do Útero/cirurgia , Colposcopia , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma in Situ/patologia , Colo do Útero/patologia , Feminino , Humanos , Neoplasias do Colo do Útero/patologia
7.
Ceska Gynekol ; 84(1): 55-60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213059

RESUMO

OBJECTIVE: Contemporary role of cerclage as a preterm birth treatment. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology of the First Faculty of Medicine and General Teaching Hospital in Prague. METHODS: Research of existing literature, predominantly foreign journal articles, but also Czech literature and personal experience with the method. RESULTS: Cerclage is one of the well-known surgical procedures carried out during pregnancy. Its aim is to provide a mechanical support to the cervical canal and to keep the cervix closed. The cervical mucous plug serves as a mechanical barrier between the vagina and the uterine cavity, but it also contains many immune components which protect the fetal compartment from ascendent infections. Application of a cervical stitch can help to retain the mucous plug and thus increases the immunity of the cervical canal. Results of 15 randomised studies (Cochraine Database of Systematic R) suggest that in women with increased risk of preterm birth, cerclage decreases the occurrence of preterm birth relative to the expectant management. CONCLUSIONS: Despite the decreasing numbers of cerclage surgeries, it is still a useful method of preterm birth prevention for a specific group of women. More recently, a progesterone treatment has gained popularity. Its application, however, must begin before the 16th week of pregnancy.


Assuntos
Cerclagem Cervical/métodos , Colo do Útero/cirurgia , Nascimento Prematuro/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Incompetência do Colo do Útero/cirurgia , Medida do Comprimento Cervical , Feminino , Humanos , Gravidez , Cuidado Pré-Natal , Incompetência do Colo do Útero/diagnóstico , Vagina
8.
Med Sci Monit ; 25: 4202-4206, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31168048

RESUMO

BACKGROUND To study the clinical effective of emergency cervical cerclage (ECC) in pregnant women who have cervical insufficiency with prolapsed membranes. MATERIAL AND METHODS This study was devised as a retrospective cohort in a single medical center, in which we collected clinical data from patient records. Inclusion criteria were: physical examination indicated ECC was performed at 15 to 25 gestational weeks at the Sixth Medical Center of the PLA General Hospital, and singleton pregnancy. The collected clinical data included: duration of pregnancy at delivery, interval between ECC and delivery, neonatal weight, neonatal mortality, neonatal morbidity, and Neonatal Intensive Care Unit (NICU) admission. RESULTS We included 50 women with singleton pregnancies. No surgical complications occurred in any patients. The gestational age at cerclage was 21.3±2.2 weeks. No patients had membrane damage due to surgery. No surgical complications were reported. Five (10%) patients underwent chorioamnionitis. The time interval between ECC and delivery was 11.2±7.1 weeks. The mean gestational age at delivery was 34.1 weeks. The rate of vaginal delivery was 96%. Ten patients had pregnancy lasting longer than 36 weeks. The mean neonate delivery weight was 2510.7 g. Twenty neonates were admitted to the Neonatal Intensive Care Unit (NICU), and the mean NICU stay was 21 days. CONCLUSIONS ECC has good perinatal results. Our results provide clinical evidence for the efficacy and risks of ECC.


Assuntos
Cerclagem Cervical/mortalidade , Resultado da Gravidez/epidemiologia , Cerclagem Cervical/efeitos adversos , Cerclagem Cervical/métodos , Colo do Útero/cirurgia , China , Emergências , Feminino , Ruptura Prematura de Membranas Fetais/cirurgia , Idade Gestacional , Humanos , Recém-Nascido , Morte Perinatal/etiologia , Mortalidade Perinatal/tendências , Gravidez , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Suturas , Incompetência do Colo do Útero/cirurgia , Prolapso Uterino/complicações
9.
Medicine (Baltimore) ; 98(21): e15604, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124937

RESUMO

This study compared the efficacy of neoadjuvant chemotherapy (NACT) followed by radical surgery (RS) vs primary surgical treatment (PST) in patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IB2/IIA2 cervical cancer.Data of 303 cervical cancer patients who received primary therapy for stage IB2/IIA2 cervical cancer at 7 medical centers in Beijing, China between January 1, 2009 and December 31, 2016 and followed through December 31, 2017 were collected retrospectively. The response rates, surgical characteristics, and overall survival (OS) durations of patients who received NACT followed by RS were compared to those of patients who received PST.An improved short-term complete response rate was observed among patients who received intra-arterial chemotherapy compared with patients who had intravenous chemotherapy (18.3% vs 4.1%, Pdifference = .020). Patients who received NACT were more likely to undergo laparoscopic surgery and to have a lower blood loss volume (555.4 ±â€Š520.2 ml vs PST, 682.5 ±â€Š509.8 ml; P = .036) and increased estimated operative time (249.9 ±â€Š101.9 vs PST, 225.1 ±â€Š76.5 min; P = .022). No differences in high-risk factors (HRFs), the effects of supplemental treatment, or 5-year OS were observed between patients who received NACT and PST.Our findings indicate that patients who received NACT for FIGO stage IB2/IIA2 cervical cancer were more likely to undergo laparoscopic surgery. These findings have important implications regarding treatment with curative intent for stage IB2/IIA2 cervical cancer and warrant a further analysis of treatment strategies to ensure adequate treatment and patient-centered care.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Colo do Útero/cirurgia , Laparoscopia/mortalidade , Terapia Neoadjuvante/mortalidade , Neoplasias do Colo do Útero/terapia , Adulto , Quimioterapia Adjuvante/métodos , Quimioterapia Adjuvante/mortalidade , Feminino , Humanos , Laparoscopia/métodos , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia
11.
Biomed Res Int ; 2019: 2360185, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931323

RESUMO

Hypothesis/Aims of Study: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is the second most common cause of primary amenorrhea. The ESHRE/ESGE categorizes this disorder within the class 5 uterine malformation of the female genital tract anomalies. It is characterized by congenital absence of the uterus, cervix, and upper part of the vagina in otherwise phenotypically normal 46XX females. These patients have normal ovaries, biphasic ovarian cycle, and female psychosexual identification. Laparoscopic Vecchietti's operation-surgical method in which the vagina increases in size by gradually applying traction to the vaginal vault-is one of the methods used to treat MRKH. The aim of this study was to establish the urogynecological and sexual functions after Vecchietti's operation. Study Design Materials and Methods: Fifteen patients with MRKHS who underwent laparoscopic Vecchietti's operation were included. A control group of 15 age-matched, childless, sexually active women were examined during the same period. All patients underwent the basic evaluation of anatomical outcomes. Sexual outcomes were established by the Polish validated Female Sexual Function Index (FSFI) questionnaire. Continence status was assessed by Polish validated Urinary Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Results: Mean age of MRKH group was 22.06±5.13 yrs. Mean follow-up after surgery was 8.02±3.43 yrs. Mean age of women from control group was 22.4±4.35. Mean FSFI scores show good quality of sexual life in both groups. UDI-6 scores showed that patients after Vecchietti surgery have urogynecological problems significantly more often than healthy women do. Based on the IIQ-7, it is evident that one patient from the MRKH group (6,6%) suffers from stress urinary incontinence and the rest (20%) have rather irritative problems with the functioning of the lower urinary tract. Conclusion: Quality of sexual life after the Vecchietti's operation in long-term follow-up does not differ from that of healthy women, but these patients suffer more frequent from urogynecological complaints. The trial is registered with NCT03809819.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/cirurgia , Amenorreia/fisiopatologia , Anormalidades Congênitas/fisiopatologia , Laparoscopia/efeitos adversos , Ductos Paramesonéfricos/anormalidades , Vagina/cirurgia , Transtornos 46, XX do Desenvolvimento Sexual/complicações , Transtornos 46, XX do Desenvolvimento Sexual/fisiopatologia , Adolescente , Adulto , Amenorreia/etiologia , Colo do Útero/fisiopatologia , Colo do Útero/cirurgia , Anormalidades Congênitas/etiologia , Anormalidades Congênitas/cirurgia , Feminino , Humanos , Ductos Paramesonéfricos/fisiopatologia , Ductos Paramesonéfricos/cirurgia , Polônia , Comportamento Sexual , Saúde Sexual , Inquéritos e Questionários , Útero/fisiopatologia , Útero/cirurgia , Vagina/fisiopatologia , Saúde da Mulher , Adulto Jovem
12.
BJOG ; 126(8): 1065-1073, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30924606

RESUMO

OBJECTIVE: Robot-assisted surgery is a recognised treatment for pelvic-organ prolapse. Many of the surgical subgroup outcomes for apical prolapse are reported together, leading to a paucity of homogenous data. DESIGN: Prospective observational cohort study (NCT01598467, clinicaltrials.gov) assessing outcomes for homogeneous subgroups of robot-assisted apical prolapse surgery. SETTING: Two European tertiary referral hospitals. POPULATION: Consecutive patients undergoing robot-assisted sacrocolpopexy (RASC) and supracervical hysterectomy with sacrocervicopexy (RSHS). METHODS: Anatomical cure (simplified Pelvic Organ Prolapse Quantification, sPOPQ, stage 1), subjective cure (symptoms of bulge), and quality of life (Pelvic Floor Impact Questionnaire, PFIQ-7). MAIN OUTCOME MEASURES: Primary outcome: anatomical and subjective cure. SECONDARY OUTCOMES: surgical safety and intraoperative variables. RESULTS: A total of 305 patients were included (RASC n = 188; RSHS n = 117). Twelve months follow-up was available for 144 (RASC 76.6%) and 109 (RSHS 93.2%) women. Anatomical success of the apical compartment occurred for 91% (RASC) and in 99% (RSHS) of the women. In all compartments, the success percentages were 67 and 65%, respectively. Most recurrences were in the anterior compartment [15.7% RASC (symptomatic 12.1%); 22.9% RSHS (symptomatic 4.8%)]. Symptoms of bulge improved from 97.4 to 17.4% (P < 0.0005). PFIQ-7 scores improved from 76.7 ± 62.3 to 13.5 ± 31.1 (P < 0.0005). The duration of surgery increased significantly for RSHS [183.1 ± 38.2 versus 145.3 ± 29.8 (P < 0.0005)]. Intraoperative complications and conversion rates were low (RASC, 5.3 and 4.3%; RSHS, 0.0 and 0.0%). Four severe postoperative complications occurred after RASC (2.1%) and one occurred after RSHS (1.6%). CONCLUSIONS: This is the largest reported prospective cohort study on robot-assisted apical prolapse surgery. Both procedures are safe, with durable results. TWEETABLE ABSTRACT: European bi-centre trial concludes that robot-assisted surgery is a viable approach to managing apical prolapse.


Assuntos
Colposcopia/métodos , Histerectomia/métodos , Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Colo do Útero/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Sacro/cirurgia , Centros de Atenção Terciária , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(9): e14488, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817563

RESUMO

Placenta previa accreta is an obstetrical complication that severely affects the heath of the fetus and the mother due to massive hemorrhage during pregnancy. This study reported a new suture technique called "cervical internal os plasty" to control obstetrical hemorrhage in cesarean delivery for patients with placenta previa accreta and retrospectively evaluated the safety and effectiveness of the new technique.From January 2012 to May 2018, we collected 56 patients with this new suture technique, which repaired the damaged weak area with bleeding from the placental attachment site in the lower uterine segment, and restored the damaged anatomic internal os of the cervix. Meanwhile, we compared it with 60 cases with other conservative methods described by other obstetricians with the same qualifications. The perioperative outcomes (blood loss, blood transfusion, operative time, other applied medical technology, and so on) between the 2 groups were recorded in this report.There were no significant differences between 2 groups among age, gravidity, parity, gestational age, and previous dilatation and curettage techniques (P > .05). Of the patients with placenta previa accrete, 77.6% (90/116) had previous dilatation and curettage. The comparison between study group and control group on the rate of postpartum hemorrhage, blood transfusion, and mean operative time, average hospitalization days after cesarean delivery, expenses was not statistically significant (P > .05). Compared with the control group, other applied supplementary techniques (including uterine tamponade, pelvic arterial embolization, or emergency hysterectomy) for the bleeding from the the placental attachment site is fewer significantly in the study group. No operative accident and hemorrhea-related complication occurred in the 2 groups.Cervical internal os plasty is useful in patients with placenta previa accreta due to its simplicity, utility, and effectivity as well as its capacity for preserving fertility.


Assuntos
Cesárea/métodos , Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Técnicas de Sutura , Hemorragia Uterina/cirurgia , Adulto , Perda Sanguínea Cirúrgica , Estudos de Casos e Controles , Colo do Útero/cirurgia , Feminino , Humanos , Duração da Cirurgia , Placenta Acreta/etiologia , Placenta Prévia/etiologia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Hemorragia Uterina/etiologia , Útero/cirurgia
14.
J Gynecol Oncol ; 30(3): e42, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30887760

RESUMO

OBJECTIVE: To show noninferiority of a limited-excision (resection of the dysplastic lesion only) vs. classical Large Loop Excision of the Transformation Zone (LLETZ). METHODS: In this prospective, randomized, multicenter trial, women with human papillomavirus (HPV) positive cervical intraepithelial neoplasia grade 3 were randomized into two groups (1:1). Primary outcome was the rate of negative HPV tests after 6 months, secondary outcomes included cone size, complete resection rates as well as cytological and histological results after 6 and 12 months. A sample size of 1,000 was calculated to show noninferiority of the limited-excision compared to the LLETZ group using a noninferiority margin of 5%. Enrollment was stopped after 100 patients due to slow accrual. RESULTS: Patients in the limited-excision group did not show a lower number of negative HPV tests (78% [LLETZ]-80% [limited-excision]=-2%; 90% confidence interval=-15%, 12%). The limited-excision resulted in a substantially lower cone size (LLETZ: 1.97 mL vs. limited-excision: 1.02 mL; p<0.001) but higher numbers of involved margins (LLETZ: 8% vs. limited-excision: 20%). Although postoperative cytological results slightly differed, histological results were similar in both groups. One limited-excision patient received immediate re-conisation, whereas one patient in each group was scheduled for re-conisation after 6 months. CONCLUSION: The limited-excision could represent a promising option to reduce the surgical extent of conisations while maintaining oncological safety. The trial was not sufficiently powered to reach statistical significance due to early termination. Nevertheless, the study provides important insights in the feasibility of a limited-excision and could serve as a pilot study for future trials. TRIAL REGISTRATION: German Clinical Trials Register Identifier: DRKS00006169.


Assuntos
Transformação Celular Viral , Neoplasia Intraepitelial Cervical/patologia , Colo do Útero/cirurgia , Margens de Excisão , Infecções por Papillomavirus/patologia , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Neoplasia Intraepitelial Cervical/virologia , Colo do Útero/patologia , Conização , Estudos de Equivalência como Asunto , Feminino , Alemanha , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Infecções por Papillomavirus/complicações , Carga Tumoral , Displasia do Colo do Útero/virologia , Neoplasias do Colo do Útero/virologia , Adulto Jovem
15.
J Gynecol Obstet Hum Reprod ; 48(6): 391-394, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30905851

RESUMO

OBJECTIVE: Cervical cerclage is the principal treatment for women with a cervical insufficiency, which is a predominant factor in second trimester loss and preterm birth. A cervico-isthmic cerclage is recommended in case of a previous failure of McDonald cerclage or in case of an absent portio vaginalis of the cervix. In women who have prolapsed membranes at or beyond a dilated external cervical os before 24 weeks of gestation, an emergency cerclage can sometimes be performed. The aim of this study is to report our experience with emergency transvaginal cervico-isthmic cerclage. STUDY DESIGN: This is a retrospective, single-centre study conducted between 2009 and 2017 of women who received a transvaginal cervico-isthmic emergency cerclage. Emergency cerclage was defined as cerclage performed on women who had prolapsed membranes at or beyong a dilated external cervical os before 24 weeks of gestation. The exclusion criteria were twin pregnancy, preterm rupture of membranes, and clinical or biological signs of infection. RESULTS: Three women were included. One woman had a history of failure of emergency McDonald cerclage during her previous pregnancy. The two other women had a failure of McDonald cerclage during index pregnancy. All women presented prolapsed membranes at or beyond a dilated external cervical os as defined for an emergency cerclage. The emergency cerclage was performed at a mean gestational age of 21.5 weeks of gestation. The average gestational age of delivery was 38.5 weeks of gestation by caesarean section. CONCLUSION: Despite the small number of women, this study shows that this type of cerclage was effective in pregnancy prolongation for women at high risk of preterm birth in case of McDonald cerclage failure. Nevertheless, this technique requires a trained surgical team. A randomised trial should be performed to evaluate the need for emergency vaginal cervico-isthmic cerclage.


Assuntos
Cerclagem Cervical/métodos , Vagina , Adulto , Colo do Útero/cirurgia , Cesárea , Tratamento de Emergência , Feminino , Idade Gestacional , Humanos , Primeira Fase do Trabalho de Parto , Gravidez , Nascimento Prematuro/prevenção & controle , Estudos Retrospectivos , Falha de Tratamento , Incompetência do Colo do Útero/cirurgia
16.
Gynecol Oncol ; 153(2): 255-258, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30718123

RESUMO

OBJECTIVE: The impact of pathologic features of a cone biopsy on the management of women with early stage cervical cancer is understudied. Our objective was to evaluate the additive value of pathologic features of a cone biopsy toward identifying patients with high risk tumors for which adjuvant therapy may be indicated. METHODS: Patients with early stage cervical cancer undergoing a conization followed by radical hysterectomy from 1995 to 2016 were retrospectively identified. Clinical and pathologic data were abstracted from patient medical records. RESULTS: A total of 115 patients were identified. Based on final pathology, 70.5% were low risk, 10.4% intermediate risk, and 19.1% were high risk. The additive pathologic features of the conization specimen would have reclassified five patients from low into the intermediate risk group. Though depth of invasion did not correlate with final pathology results, when lymphovascular space invasion (LVSI) was present in the conization specimen, 51.2% of patients were noted to meet intermediate/high risk; compared to only 9.5% without LVSI. CONCLUSIONS: In women with early stage cervical cancer, additive pathology of the conization and hysterectomy specimen did not significantly impact risk stratification, only affecting 4.3% of patients. However, presence of LVSI in the conization was associated with intermediate risk criteria in 60% of cases and high risk criteria in 37% of cases. As patients with intermediate/high risk criteria would meet recommendations for adjuvant therapy, the evaluation of LVSI in conization specimens may influence the selection of primary treatment for women with cervical cancer.


Assuntos
Colo do Útero/patologia , Conização , Histerectomia , Seleção de Pacientes , Neoplasias do Colo do Útero/patologia , Adulto , Colo do Útero/cirurgia , Quimiorradioterapia Adjuvante/métodos , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco/métodos , Neoplasias do Colo do Útero/terapia
18.
J Obstet Gynaecol ; 39(4): 534-538, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30634880

RESUMO

Our objective was to compare the effectiveness of local lidocaine spray (LS) compared to forced coughing (FC) for relieving the pain during colposcopically guided cervical biopsies (CGBs). The study was a randomised study, which included patients with abnormal cervical cytologic results requiring a colposcopic biopsy procedure. The patients were randomly assigned to either the 10% LS or the FC groups before the biopsy procedure. As a primary outcome, the pain was assessed by using a 10 cm visual analogue scale at the different steps during the procedure. Forty-four and 42 patients had CGBs using LS and FC, respectively. The age, parity, body mass index, history of previous curettage and vaginal delivery, smoking status and the number of biopsies were similar in both groups. The mean ± SD pain scores after the cervical biopsy were 3.25 ± 1.4 and 4.4 ± 1.3 in the LS and FC groups, respectively (p< .05). The operative time was longer in the LS than in the FC group (7.6 ± 1.4 vs. 5.2 ± 0.8, p: .004). No complication or adverse effect was observed in both groups. The present study showed that LS use can be recommended for pain relief during colposcopically directed cervical biopsy procedure with a superiority to the FC in the terms of pain and absence of any adverse reactions. Impact Statement What is already known on this subject? A colposcopic-guided cervical biopsy is a painful procedure and different techniques have been proposed to relieve this pain with conflicting results. Studies have demonstrated that a forced coughing is a good and easy method for relieving pain with some disadvantages. Local lidocaine spray (LS) is another option for pain relief during the biopsy procedure. However, no randomised study has compared these two methods yet. What the results of this study add? The results from this randomised study suggest that LS has superiority in terms of pain relief during the colposcopic biopsy procedure and has no adverse reactions. What the implications are of these findings for clinical practice and/or further research? The evidence from different studies showed some conflicting results regarding the pain relief methods during the colposcopic biopsy procedure. The local LS can be used in this procedure in routine clinical practice. However, further studies with larger samples and comparison of different methods are needed.


Assuntos
Anestésicos Locais/administração & dosagem , Colposcopia/efeitos adversos , Lidocaína/administração & dosagem , Manejo da Dor/métodos , Dor Processual/terapia , Administração Tópica , Adulto , Colo do Útero/patologia , Colo do Útero/cirurgia , Tosse , Feminino , Humanos , Medição da Dor , Dor Processual/etiologia , Resultado do Tratamento
19.
BJOG ; 126(9): 1169-1174, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30663205

RESUMO

OBJECTIVE: To update the oncological results and identify recurrent risk factors in young patients with early stage cervical cancers following abdominal radical trachelectomy (ART). DESIGN: Retrospective study. SETTING: A university-based cancer hospital. POPULATION: Three hundred and thirty-three patients. METHODS: We conducted a retrospective analysis from a prospectively maintained database of patients undergoing ART from April 2004 to December 2017. MAIN OUTCOME MEASURES: Survival rate, clinicopathological factors related to recurrences. RESULTS: Two hundred and seventy-one patients had squamous carcinomas (SCC), 51 had pure adenocarcinomas (AC), and 11 had adenosquamous carcinomas (AS). One hundred thirty-two women (39.6%) had tumours ≥2 cm. With a median follow up of 56 months (range, 6-169), 11 patients (3.3%) had recurrence, and five patients (1.5%) died. The cumulative 5-year recurrence-free survival and overall survival rates were 96.3 and 98.6%, respectively. The recurrence rate in women with tumours ≥2 cm was comparable to that in patients with tumours <2 cm (5.3 versus 2.0%, respectively, P = NS). However, the recurrence rate was significantly higher in patients with AS histology than those with AC and SCC histology (18.2, 3.9, and 2.6%, respectively, P < 0.05). All of the recurrent patients with AS histology had tumours ≥2 cm. Multivariate analysis showed that the only independent risk factor for recurrence was histology type. CONCLUSIONS: This updated series showed a favourable survival rate following ART. These results further supported that ART was a safe option for well-selected patients with stage IB1 cervical cancers ≥2 cm. However, if patients with tumours ≥2 cm have AS histology, they should be advised with great caution when contemplating ART. TWEETABLE ABSTRACT: Abdominal radical trachelectomy could be a safe, fertility-sparing option for strictly selected patients with stage IA1-IB1 cervical cancers ≤4 cm.


Assuntos
Carcinoma/cirurgia , Recidiva Local de Neoplasia/mortalidade , Traquelectomia/mortalidade , Neoplasias do Colo do Útero/cirurgia , Abdome/cirurgia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Carcinoma/mortalidade , Carcinoma/patologia , Carcinoma Adenoescamoso/mortalidade , Carcinoma Adenoescamoso/patologia , Carcinoma Adenoescamoso/cirurgia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Colo do Útero/patologia , Colo do Útero/cirurgia , Bases de Dados Factuais , Feminino , Preservação da Fertilidade , Humanos , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Traquelectomia/métodos , Resultado do Tratamento , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia , Adulto Jovem
20.
J Minim Invasive Gynecol ; 26(1): 129-134, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29723645

RESUMO

STUDY OBJECTIVE: To evaluate the efficacy of a nonsurgical treatment for cervical pregnancy (CP) and cesarean section scar pregnancy (CSP). DESIGN: Retrospective clinical study (Canadian Task Force classification III). SETTING: Private assisted reproductive technology practice. PATIENTS: Nineteen women with CP (n = 16) or CSP (n = 3), including 6 patients with positive fetal heartbeat. INTERVENTION: Transvaginal local injection of absolute ethanol (AE) into the hyperechoic ring (lacunar space) around the gestational sac under ultrasound guidance. MEASUREMENTS AND MAIN RESULTS: Serum beta-human chorionic gonadotropin (ß-hCG) was measured at frequent intervals, and ultrasound and/or magnetic resonance imaging was used to observe the gestational sac. In 9 patients, the serum ß-hCG level was effectively reduced with a single AE injection at 2 hours. In the remaining 10 patients, the level decreased but then increased in 4 and slowly decreased in the other 6; all of these 10 patients required 2 to 5 repeat AE injections. In all patients, serum ß-hCG level was reduced by 50% within 3 days and decreased to <10% of the initial level within 14 days. In 18 patients (95%), the level was decreased to 1.0 mIU/mL within 40 days. Seven patients were treated on an outpatient basis. Twelve patients received no anesthesia. Five patients subsequently became pregnant, and each had a live birth. There was no recurrent CP or CSP. The procedure was successful in all 19 patients. CONCLUSION: This procedure is an effective treatment for CP or CSP that could be used in place of conventional surgical interventions and medical treatment using MTX.


Assuntos
Cesárea/efeitos adversos , Cicatriz/cirurgia , Cicatriz/terapia , Gravidez Ectópica/cirurgia , Gravidez Ectópica/terapia , Adulto , Colo do Útero/patologia , Colo do Útero/cirurgia , Gonadotropina Coriônica Humana Subunidade beta/sangue , Etanol/administração & dosagem , Feminino , Saco Gestacional/diagnóstico por imagem , Saco Gestacional/efeitos dos fármacos , Humanos , Injeções , Imagem por Ressonância Magnética , Gravidez , Complicações na Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Trofoblastos , Ultrassonografia
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