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1.
BMC Womens Health ; 24(1): 297, 2024 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-38762459

RESUMO

OBJECTIVE: The aim of this study is to explore the efficacy and safety of chemotherapy (CT) as a monotherapy in patients with recurrent intermediate/high-risk factors following radical hysterectomy for stage IB-IIA cervical cancer. METHODS: A retrospective analysis was conducted on the medical records of patients diagnosed with stage IB-IIA cervical cancer who underwent radical hysterectomy at the People's Hospital of Suzhou High-tech District between 2010 and 2020. A total of 66 patients with intermediate or high-risk factors for recurrence were treated exclusively with CT. This cohort included 42 patients in the intermediate-risk group and 24 in the high-risk group. Treatment protocols consisted of 4-6 cycles of paclitaxel and cisplatin drugs for the intermediate-risk group, and 6 cycles for the high-risk group. The relapse-free survival (RFS), recurrence rates, and common CT-related adverse reactions, including bone marrow suppression, nausea and vomiting, and diarrhea, were assessed for both groups. RESULTS: (1) The cumulative 3-year RFS rates for the intermediate-risk and high-risk groups were 97.3% (36/37) and 82.4% (14/17), respectively, with cumulative 5-year RFS rates of 97.1% (34/35) and 82.4% (14/17), respectively. The Log rank test revealed no significant difference between the two groups (P > 0.05), (χ² = 2.718, P = 0.099). The 5-year recurrence rates in the intermediate-risk and high-risk groups were 2.38% (1/42) and 12.50% (3/24), respectively. (2) The incidence of grade III bone marrow suppression in the intermediate-risk and high-risk groups was 21.19% (11/42) and 25.00% (6/24), respectively, while the incidence of grade IV bone marrow suppression was 11.90% (5/42) and 8.33% (2/24), respectively. There was no statistically significant difference in bone marrow suppression grades between the two groups (P > 0.05). CONCLUSION: CT with paclitaxel and cisplatin, administered as monotherapy post-radical hysterectomy for stage IB-IIA cervical cancer, demonstrates satisfactory survival benefits with an acceptable safety profile. Moreover, no significant differences were observed in prognosis or adverse reactions between the different risk groups treated solely with CT.


Assuntos
Cisplatino , Histerectomia , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Paclitaxel , Neoplasias do Colo do Útero , Humanos , Feminino , Neoplasias do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/patologia , Estudos Retrospectivos , Histerectomia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Adulto , Paclitaxel/uso terapêutico , Cisplatino/uso terapêutico , Cisplatino/administração & dosagem , Fatores de Risco , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Idoso , Antineoplásicos/uso terapêutico
2.
Health Aff (Millwood) ; 43(5): 740-742, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38709964

RESUMO

An African American woman with uterine fibroids is advised to get a hysterectomy, despite the availability of less life-altering options.


Assuntos
Negro ou Afro-Americano , Histerectomia , Leiomioma , Neoplasias Uterinas , Humanos , Feminino , Histerectomia/métodos , Leiomioma/cirurgia , Neoplasias Uterinas/cirurgia , Pessoa de Meia-Idade
3.
J Cancer Res Clin Oncol ; 150(5): 236, 2024 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-38710946

RESUMO

PURPOSE: We conducted this study to evaluate the efficacy of total hysterectomy versus radical hysterectomy in the treatment of neuroendocrine cervical cancer (NECC). METHODS: Eligible NECC patients were identified from the Surveillance, Epidemiology and End Results (SEER) database. Demographic characteristics, clinical treatment and survival of the patients were collected. The overall survival (OS) and cancer-specific survival (CSS) were estimated by Kaplan-Meier analysis with log-rank test. RESULTS: A total of 286 patients were included, with 104 patients undergoing total hysterectomy and 182 patients undergoing radical hysterectomy. The 5-year OS were 50.8% in the total hysterectomy group and 47.5% in the radical hysterectomy group (p = 0.450); and the corresponding 5-year CSS were 51.6% and 49.1% (p = 0.494), respectively. Along with surgery, radiotherapy was given to 49.0% of patients in the total hysterectomy group and 50.5% in the radical hysterectomy group; and chemotherapy was administered to 77.9% of patients in the total hysterectomy group and 85.7% in the radical hysterectomy group. Unexpectedly, in patients who received adjuvant radiotherapy with or without chemotherapy, the OS was superior in the total hysterectomy group compared with the radical hysterectomy group (p = 0.034). While in patients who received chemotherapy alone and those who received neither radiotherapy nor chemotherapy, the OS still remained comparable between the total hysterectomy and radical hysterectomy group. CONCLUSION: Compared with radical hysterectomy, total hysterectomy was not associated with compromised survival prognosis in patients with NECC. Total hysterectomy has the potential to be a surgical alternative in the multimodal management of NECC.


Assuntos
Histerectomia , Programa de SEER , Neoplasias do Colo do Útero , Humanos , Feminino , Histerectomia/métodos , Neoplasias do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/mortalidade , Pessoa de Meia-Idade , Adulto , Carcinoma Neuroendócrino/cirurgia , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/mortalidade , Idoso
4.
Klin Onkol ; 38(2): 126-133, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38697821

RESUMO

BACKGROUND: While total hysterectomy and bilateral salpingo-oophorectomy without lymph node staging are standard for low- and intermediate-risk endometrial cancer, certain histopathologic factors revealed after surgery can necessitate additional interventions. Our study assessed the influence of sentinel lymph node biopsy on postoperative decision-making. MATERIALS AND METHODS: In the SENTRY trial (July 2021 - February 2023), we enrolled patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IA-IB low-grade endometrioid endometrial cancer. Laparoscopic sentinel lymph node mapping using indocyanine green was performed alongside total hysterectomy with bilateral salpingo-oophorectomy. Subsequent management changes based on sentinel lymph node biopsy results were evaluated. The trial was registered at ClinicalTrials.gov (NCT04972682). RESULTS: Of the 100 enrolled participants, a bilateral detection rate of 91% was observed with a median detection time of 10 min (interquartile range 8-13 min). Sentinel lymph node metastases were found in 8% (N = 8) of participants. Postoperative FIGO staging increased in 15% (N = 15) and decreased in 5% (N = 5) of patients. Sentinel lymph node biopsy results altered the adjuvant treatment plan for 20% (N = 20): external beam radiotherapy was omitted in 12% (N = 12) while 6% (N = 6) had external beam radiotherapy +/- systemic chemotherapy added due to sentinel lymph node metastases. In 2% (N = 2), the external beam radiotherapy field was expanded with the paraaortic region. No intraoperative complications were reported and no 30-day major morbidity and mortality occurred. Throughout a median follow-up of 14 (95% CI 12-15 months, neither patient-reported lymphedema nor pelvic recurrence surfaced in the cohort. CONCLUSIONS: Sentinel lymph node biopsy using indocyanine green is a safe procedure and allows tailoring adjuvant therapy in presumed low- and intermediate-risk endometrial cancer. It assists in avoiding external beam radiotherapy overtreatment and introducing additional modalities when necessary.


Assuntos
Neoplasias do Endométrio , Biópsia de Linfonodo Sentinela , Humanos , Feminino , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Neoplasias do Endométrio/terapia , Pessoa de Meia-Idade , Histerectomia , Idoso , Salpingo-Ooforectomia , Verde de Indocianina , Estadiamento de Neoplasias , Metástase Linfática , Cuidados Pós-Operatórios , Laparoscopia , Carcinoma Endometrioide/patologia , Carcinoma Endometrioide/cirurgia , Carcinoma Endometrioide/terapia
5.
BMC Cancer ; 24(1): 575, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38724921

RESUMO

OBJECTIVE: To identify the risk factors of cervical high-grade squamous intraepithelial lesion(HSIL) complicated with occult cervical cancer and standardize the management of initial treatment for HSIL. METHOD: The clinical data of patients who underwent total hysterectomy directly due to HSIL in the obstetrics and gynecology department of two tertiary hospitals and three secondary hospitals from 2018 to 2023 were collected. Their general characteristics, pathological parameters and survival status were analyzed. Logistic regression model was used to analyze the correlation between clinical parameters and postoperative pathological upgrading. RESULT: 1. Among the 314 patients with HSIL who underwent total hysterectomy directly, 73.2% were from primary hospitals. 2. 25 patients (7.9%) were pathologically upgraded to cervical cancer, all of which were early invasive cancer. 3. Up to now, there was no recurrence or death in the 25 patients with early-stage invasive cancer, and the median follow-up period was 21 months(range 2-59 months). 4. Glandular involvement(OR 3.968; 95%CI 1.244-12.662) and lesion range ≥ 3 quadrants (OR 6.527; 95% CI 1.78-23.931), HPV 16/18 infection (OR 5.382; 95%CI 1.947-14.872), TCT ≥ ASC-H (OR 4.719; 95%CI 1.892-11.766) were independent risk factors that affected the upgrading of postoperative pathology. 5. The area under the curve (AUC) calculated by the Logistic regression model was 0.840, indicating that the predictive value was good. CONCLUSION: There is a risk of occult cervical cancer in patients with HSIL. Glandular involvement, Lesion range ≥ 3 quadrants, HPV 16/18 infection and TCT ≥ ASC-H are independent risk factors for HSIL combined with occult cervical cancer. The prognosis of biopsy-proved HSIL patients who underwent extrafascial hysterectomy and unexpected early invasive cancer was later identified on specimen may be good.


Assuntos
Histerectomia , Neoplasias do Colo do Útero , Humanos , Feminino , Histerectomia/métodos , Estudos Retrospectivos , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/patologia , Adulto , Fatores de Risco , Idoso , Lesões Intraepiteliais Escamosas Cervicais/patologia , Lesões Intraepiteliais Escamosas Cervicais/cirurgia , Lesões Intraepiteliais Escamosas/patologia , Lesões Intraepiteliais Escamosas/cirurgia , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/virologia , Infecções por Papillomavirus/patologia , Displasia do Colo do Útero/cirurgia , Displasia do Colo do Útero/patologia , Gradação de Tumores
6.
BMJ Case Rep ; 17(5)2024 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-38782421

RESUMO

Urogenital myiasis is a rare entity that is usually manifested in women belonging to lower socioeconomic status residing in tropical or subtropical nations with poor hygiene or intellectual disability. It is caused by fly larvae capable of penetrating body orifices and healthy or necrotic tissue. The larvae penetrate the skin, forming painful, inflammatory nodules that can form fistula to the internal organs or the skin's surface. Serous and haemorrhagic exudation, along with crawling larvae, are encountered. Some complications, such as secondary infection and tetanus, have been documented. The prognosis is generally good, and treatment consists of removing the parasitic larvae and thoroughly cleansing the affected area.We present a case of a postmenopausal woman with parity 3 and live issue 1 in her early 50s from lower socioeconomic status diagnosed with uterovaginal prolapse complicated by myiasis. The patient was managed successfully with systemic antibiotics, manual removal of myiasis and hysterectomy.


Assuntos
Miíase , Prolapso Uterino , Humanos , Feminino , Miíase/diagnóstico , Miíase/complicações , Miíase/parasitologia , Prolapso Uterino/cirurgia , Prolapso Uterino/complicações , Pessoa de Meia-Idade , Histerectomia , Antibacterianos/uso terapêutico , Animais
7.
Int J Pharm Compd ; 28(3): 260-263, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38768506

RESUMO

Pyometra is a common disease in intact female canines characterized by an infection of the uterus. If it is not treated immediately, it could result in various complications such as fistulous tract development, sepsis, hemorrhage, uveitis, conjunctivitis, pyelonephritis, urinary tract infection, and myocarditis. In this case report, we highlight the benefits of the application of a topical ointment on wound healing after ovariohysterectomy in canine Pyometra. Following surgical intervention, the dog developed necrosis in her nipples and lost a portion of her mammary tissues. A large cyst formed and later ruptured, leaving the animal with a large wound. The vet applied a topical ointment, AlpaWash, to the affected area and prescribed antibiotic, analgesic, and antiinflammatory drugs to help manage the condition. The vet reported complete healing of the wounds within one month from the commencement of the treatment regimen.


Assuntos
Piometra , Cicatrização , Animais , Feminino , Cães , Piometra/veterinária , Piometra/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Histerectomia/veterinária , Doenças do Cão/tratamento farmacológico , Ovariectomia/veterinária , Pomadas , Ferida Cirúrgica/tratamento farmacológico , Ferida Cirúrgica/veterinária
8.
Pan Afr Med J ; 47: 83, 2024.
Artigo em Francês | MEDLINE | ID: mdl-38737224

RESUMO

Uterine rupture is a life-threatening obstetric complication. The purpose of this study was to investigate the epidemiological features, maternal and foetal prognosis and different treatment options for uterine rupture in healthy and scarred uteri. We conducted a retrospective monocentric descriptive and analytical study of 60 cases of uterine rupture collected in the Department of Gynaecology-Obstetrics of the Center of Maternity and Neonatology, Monastir, from 2017 to 2021. Patients were classified according to the presence or absence of a uterine scar. Sixty patients were enrolled in the study. The majority of cases of rupture occurred in patients with scarred uterus (n=55). The most common clinical sign was abnormal foetal heart rate. No maternal deaths were recorded and perinatal mortality rate was 11%. Mean BMI, fetal macrosomia rate and mean parity were significantly higher in the healthy uterus group than in the scarred uterus group (p=0.033, 0.018, and 0.013, respectively). The maternal complications studied (post-partum haemorrhage, hysterectomy, blood transfusion, prolonged hospitalisation) were significantly more frequent in patients with unscarred uterine rupture (p=0.039; p=0.032; p=0.009; p=0.025 respectively). Uterine rupture is a life-threatening obstetrical event for the foetus and the mother. Fetal heart rate abnormality is the most common sign associated with uterine rupture. Management is based on conservative treatment in most cases. Patients with scarred uterus have a better prognosis.


Assuntos
Hemorragia Pós-Parto , Ruptura Uterina , Humanos , Feminino , Tunísia/epidemiologia , Estudos Retrospectivos , Ruptura Uterina/epidemiologia , Ruptura Uterina/etiologia , Adulto , Gravidez , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/terapia , Hemorragia Pós-Parto/etiologia , Adulto Jovem , Cicatriz , Prognóstico , Histerectomia/estatística & dados numéricos , Mortalidade Perinatal , Macrossomia Fetal/epidemiologia , Recém-Nascido , Frequência Cardíaca Fetal , Transfusão de Sangue/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos
9.
Cancer Treat Res Commun ; 39: 100816, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38714022

RESUMO

OBJECTIVE: To evaluate the effectiveness of methylene blue dye in detecting sentinel lymph nodes (SLNs) in women with early-stage operable (defined as FIGO I-IIA) cervical cancer. It also aims to evaluate procedural challenges and accuracy. METHOD: This prospective study, which focused on 20 women with early-stage cervical cancer, was carried out between June 2016 and December 2017. These patients had SLN mapping with methylene blue dye injections and thorough examinations, including imaging. All patients underwent radical hysterectomy and complete bilateral pelvic lymphadenectomy. No additional investigation was done on the lymph node in cases where a metastasis was found in the first H&E-stained segment of the sentinel node. RESULT: 20 patients were included in the analysis. The median age of the subjects was 53, and 95 % of them had squamous cell carcinoma. 90 % of the time, the identification of SLNs was effective, and 55 SLNs were found, of which 52.7 % were on the right side of the pelvis and 47.3 % on the left. The obturator group had the most nodes, followed by the external and internal iliac groups in descending order of occurrence. Metastasis was detected in 3 patients, resulting in a sensitivity of 100 % and a specificity of 93.75 % for SLN biopsy. Notably, no false-negative SLNs were found. Complications related to methylene blue usage included urine discoloration in 30 % of patients. CONCLUSION: This trial highlights the promising efficacy and safety of methylene blue dye alone for SLN identification in early-stage operable cervical cancer, with a notably higher success rate. Despite limitations like a small sample size, healthcare professionals and researchers can build upon the insights from this study to enhance cervical cancer management.


Assuntos
Excisão de Linfonodo , Azul de Metileno , Biópsia de Linfonodo Sentinela , Neoplasias do Colo do Útero , Humanos , Feminino , Neoplasias do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/patologia , Biópsia de Linfonodo Sentinela/métodos , Estudos Prospectivos , Pessoa de Meia-Idade , Excisão de Linfonodo/métodos , Adulto , Estadiamento de Neoplasias , Pelve , Idoso , Histerectomia/métodos , Metástase Linfática/patologia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologia , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Corantes
12.
Int J Med Robot ; 20(3): e2636, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38757434

RESUMO

BACKGROUND: To assess the feasibility of use of indocyanine green (ICG) in identifying and minimising urinary tract injury during surgical resection of endometriosis through robotic transvaginal natural orifice transluminal endoscopy surgery (RvNOTES). METHODS: We conducted a retrospective case series in two academic tertiary care hospitals. We examined 53 patients who underwent RvNOTES hysterectomy with planned endometriosis resection. RESULTS: The study involved 53 patients undergoing RvNOTES with ICG fluorescence for endometriosis resection. Mean patient age was 37.98 ± 6.65 years. Operative time averaged 181.32 ± 53.94 min, with estimated blood loss at 45.57 ± 33.62 mL. Postoperative stay averaged 0.23 ± 0.47 days. No ICG-related complications occurred. CONCLUSION: No complications occurred with ICG fluorescence in RvNOTES. It appears to be a safe option for ureteral localisation and preservation. ICG fluorescence is widely used in diverse medical specialities for identifying ureters during complex surgeries. Larger studies are needed to firmly establish its advantages in intraoperative ureteral visualisation during RvNOTES for deep infiltrative endometriosis.


Assuntos
Endometriose , Estudos de Viabilidade , Verde de Indocianina , Cirurgia Endoscópica por Orifício Natural , Procedimentos Cirúrgicos Robóticos , Ureter , Humanos , Feminino , Endometriose/cirurgia , Endometriose/diagnóstico por imagem , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Estudos Retrospectivos , Cirurgia Endoscópica por Orifício Natural/métodos , Ureter/cirurgia , Pessoa de Meia-Idade , Fluorescência , Vagina/cirurgia , Duração da Cirurgia , Histerectomia/métodos
13.
Sensors (Basel) ; 24(9)2024 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-38733032

RESUMO

Performing a minimally invasive surgery comes with a significant advantage regarding rehabilitating the patient after the operation. But it also causes difficulties, mainly for the surgeon or expert who performs the surgical intervention, since only visual information is available and they cannot use their tactile senses during keyhole surgeries. This is the case with laparoscopic hysterectomy since some organs are also difficult to distinguish based on visual information, making laparoscope-based hysterectomy challenging. In this paper, we propose a solution based on semantic segmentation, which can create pixel-accurate predictions of surgical images and differentiate the uterine arteries, ureters, and nerves. We trained three binary semantic segmentation models based on the U-Net architecture with the EfficientNet-b3 encoder; then, we developed two ensemble techniques that enhanced the segmentation performance. Our pixel-wise ensemble examines the segmentation map of the binary networks on the lowest level of pixels. The other algorithm developed is a region-based ensemble technique that takes this examination to a higher level and makes the ensemble based on every connected component detected by the binary segmentation networks. We also introduced and trained a classic multi-class semantic segmentation model as a reference and compared it to the ensemble-based approaches. We used 586 manually annotated images from 38 surgical videos for this research and published this dataset.


Assuntos
Algoritmos , Laparoscopia , Redes Neurais de Computação , Ureter , Artéria Uterina , Humanos , Laparoscopia/métodos , Feminino , Ureter/diagnóstico por imagem , Ureter/cirurgia , Artéria Uterina/cirurgia , Artéria Uterina/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Semântica , Histerectomia/métodos
14.
Curr Oncol ; 31(5): 2836-2845, 2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38785496

RESUMO

The Laparoscopic Approach to Cervical Cancer (LACC) trial was published in 2018 and demonstrated that minimally invasive surgery (MIS) yields inferior survival outcomes in early-stage cervical cancer compared to open surgery. This study investigates how the results of the LACC trial have impacted the selection of the primary treatment modality and adjuvant radiation utilization in early-stage cervical cancer. Using the National Cancer Database (NCDB), we compared patients with stage IA2-IB1 cervical cancer before (1/2016-12/2017) and after (1/2019-12/2020) the LACC trial. A total of 7930 patients were included: 4609 before and 3321 after the LACC trial. There was a decline in MIS usage from 67% pre-LACC to 35% thereafter (p < 0.001). In both the pre- and post-LACC periods, patients undergoing radical MIS more frequently had small volume disease (pre-LACC tumors ≤ 2 cm, 48% MIS vs. 41% open, p = 0.023; post-LACC stage IA2, 22% vs. 15%, p = 0.002). Pre-LACC, MIS radical hysterectomy was associated with White race (82% vs. 77%, p = 0.001) and private insurance (63% vs. 54%, p = 0.004), while there was no difference in socioeconomic factors in the post-LACC period. Although the proportion of patients treated with primary chemoradiation remained stable, the post-LACC cohort had a younger median age (52.47 vs. 56.37, p = 0.005) and more microscopic disease cases (13% vs. 5.4%, p = 0.002). There was no difference in the rate of radiation after radical hysterectomy before and after the trial (26% vs. 24%, p = 0.3). Conclusions: Post-LACC, patients were less likely to undergo MIS but received adjuvant radiation at similar rates, and primary chemoradiation patients were younger and more likely to have microscopic disease.


Assuntos
Bases de Dados Factuais , Estadiamento de Neoplasias , Neoplasias do Colo do Útero , Humanos , Feminino , Neoplasias do Colo do Útero/terapia , Pessoa de Meia-Idade , Estados Unidos , Idoso , Histerectomia/métodos , Adulto , Radioterapia Adjuvante/estatística & dados numéricos
15.
Asian J Endosc Surg ; 17(3): e13315, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38689524

RESUMO

INTRODUCTION: Despite a potential risk of bladder injury in laparoscopic hysterectomy (LH) and robot-assisted LH (RaLH), an intraoperative method for delineating the entire bladder with indocyanine green (ICG) has not been established. METHODS: We conducted a preliminary experiment using porcine bladders to verify the appropriate amount of ICG for intraoperative bladder visualization. Afterward, intraoperative bladder visualization was tried in LH and RaLH in two patients suspected of having adhesions around the bladder after previous abdominal surgery. RESULTS: Although near-infrared (NIR) fluorescence was well observed through the wall of the porcine bladder filled with ICG solution at a concentration of 0.024 mg/mL, the subsequent replacement of the ICG solution with saline made the NIR fluorescence brighter. In both patients, the bladder was successfully delineated by NIR fluorescence after filling the bladder with ICG solution and the subsequent washout with saline. CONCLUSION: The ICG-Washout method for locating the bladder by NIR fluorescence could be useful in LH and RaLH.


Assuntos
Corantes , Histerectomia , Verde de Indocianina , Bexiga Urinária , Feminino , Animais , Suínos , Histerectomia/métodos , Bexiga Urinária/cirurgia , Humanos , Laparoscopia/métodos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos
16.
Can Vet J ; 65(5): 457-461, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38694738

RESUMO

A pregnant female domestic longhair cat ~8 mo of age was referred to the Western College of Veterinary Medicine (Saskatoon, Saskatchewan) for a diagnostic evaluation of severe anemia (PCV: 10.8%) after a 2-day period of lethargy. A CBC, serum biochemistry profile, FeLV/FIV testing, and abdominal radiographs were completed and did not determine a cause for the anemia. Abdominal ultrasonography identified 1 viable and 6 nonviable and fetuses, anechoic fluid in the uterus, and a mild volume of peritoneal effusion. A whole-blood transfusion and C-section with ovariohysterectomy were performed even though a definitive presurgical diagnosis for the anemia had not yet been established. Exploratory surgery revealed a left uterine horn torsion with a necrotic base, severe congestion, and 7 nonviable fetuses. Following surgery, the queen made a full clinical recovery. Key clinical message: Uterine torsion can be easily overlooked as a cause of severe anemia due to the relative infrequency of this condition in cats and the low sensitivity of ultrasonography to provide a definitive presurgical diagnosis. Client communication must emphasize the need for a prompt surgical intervention to establish the diagnosis and to save the cat, despite poor rates of neonatal survival. Once the animal is stabilized after surgery, further diagnostic tests and procedures are indicated if the cause of anemia has not yet been identified.


Reconnaître la torsion utérine comme un diagnostic différentiel chez les chattes gestantes souffrant d'anémie sévère afin de fournir des soins appropriés et opportuns en l'absence d'un diagnostic pré-chirurgical définitif. Une chatte domestique à poils longs, âgée d'environ 8 mois, a été référée au Western College of Veterinary Medicine (Saskatoon, Saskatchewan) pour une évaluation diagnostique d'anémie sévère (hématocrite : 10,8 %) après une période de léthargie de 2 jours. Une formule sanguine complète, un profil biochimique sérique, des tests FeLV/FIV et des radiographies abdominales ont été réalisés et n'ont pas permis de déterminer la cause de l'anémie. L'échographie abdominale a identifié 1 foetus viable et 6 non viables, du liquide anéchoïque dans l'utérus et un léger volume d'épanchement péritonéal. Une transfusion de sang total et une césarienne avec ovariohystérectomie ont été réalisées même si le diagnostic pré-chirurgical définitif de l'anémie n'avait pas encore été établi. La chirurgie exploratoire a révélé une torsion de la corne utérine gauche avec une base nécrotique, une congestion sévère et 7 foetus non viables. Après l'opération, la chatte s'est complètement rétablie cliniquement.Message clinique clé:La torsion utérine peut facilement être négligée comme cause d'anémie sévère en raison de la rareté relative de cette affection chez le chat et de la faible sensibilité de l'échographie pour fournir un diagnostic pré-chirurgical définitif. La communication avec le client doit souligner la nécessité d'une intervention chirurgicale rapide pour établir le diagnostic et sauver le chat, malgré de faibles taux de survie néonatale. Une fois l'animal stabilisé après la chirurgie, d'autres tests et procédures de diagnostic sont indiqués si la cause de l'anémie n'a pas encore été identifiée.(Traduit par Dr Serge Messier).


Assuntos
Anemia , Doenças do Gato , Anormalidade Torcional , Doenças Uterinas , Animais , Feminino , Gatos , Gravidez , Anemia/veterinária , Anemia/diagnóstico , Doenças do Gato/diagnóstico , Doenças do Gato/cirurgia , Doenças do Gato/diagnóstico por imagem , Doenças Uterinas/veterinária , Doenças Uterinas/diagnóstico , Doenças Uterinas/cirurgia , Anormalidade Torcional/veterinária , Anormalidade Torcional/cirurgia , Anormalidade Torcional/diagnóstico , Diagnóstico Diferencial , Complicações na Gravidez/veterinária , Complicações na Gravidez/cirurgia , Complicações na Gravidez/diagnóstico , Histerectomia/veterinária
17.
Clin. transl. oncol. (Print) ; 26(4): 1033-1037, Abr. 2024.
Artigo em Inglês | IBECS | ID: ibc-VR-66

RESUMO

Objective: To know the risk of endometrial cancer (EC) in a population of women with BRCA 1/2 pathogenic or likely pathogenic variants after risk-reducing salpingo-oophorectomy (RRSO). Methods: The study cohort included data from 857 women with BRCA mutations who underwent RRSO visited four hospitals in Catalonia, Spain, from January 1, 1999 to April 30, 2019. Standardized incidence ratio (SIR) of EC was calculated in these patients using data from a regional population-based cancer registry. Results: After RRSO, eight cases of EC were identified. Four in BRCA 1 carriers and four in BRCA2 carriers. The expected number of cases of EC was 3.67 cases, with a SIR of 2.18 and a 95% CI (0.93–3.95). Conclusions: In our cohort, the risk of EC in BRCA1/2 carriers after RRSO is not greater than expected. Hysterectomy is not routinely recommended for these patients.(AU)


Assuntos
Humanos , Masculino , Feminino , Carcinoma Endometrioide , Carcinossarcoma , Histerectomia , Neoplasias do Endométrio , Neoplasias da Mama , Salpingo-Ooforectomia , Estudos de Coortes , Mutação , Tamoxifeno , Predisposição Genética para Doença
18.
BMC Womens Health ; 24(1): 208, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38561713

RESUMO

OBJECTIVE: Placenta accreta spectrum disorder (PAS) is a serious obstetric complication associated with significant maternal morbidity and mortality. Prophylactic balloon occlusion (PBO), as an intravascular interventional therapies, has emerged as a potential management strategy for controlling massive hemorrhage in patients with PAS. However, current evidence about the clinical application of PBO in PAS patients are still controversial. This study aimed to evaluate the effectiveness and safety of PBO in the management of PAS. METHODS: A retrospective cohort study including PAS patients underwent cesarean delivery was conducted in a tertiary hospital from January 2015 to March 2022. Included PAS patients were further divided into balloon and control groups by whether PBO was performed. Groups were compared for demographic characteristics, intraoperative and postoperative parameters, maternal and neonatal outcomes, PBO-related complication and follow up outcomes. Additionally, multivariate-logistic regression analysis was performed to determine the definitive associations between PBO and risk of massive hemorrhage and hysterectomy. RESULTS: A total of 285 PAS patients met the inclusion criteria were included, of which 57 PAS patients underwent PBO (PBO group) and 228 women performed cesarean section (CS) without PBO (control group). Irrespective of the differences of baseline characteristics between the two groups, PBO intervention did not reduce the blood loss, hysterectomy rate and postoperative hospital stay, but it prolonged the operation time and increased the cost of hospitalization (All P < 0.05) Additionally, there were no significant differences in postoperative complications, neonatal outcomes, and follow-up outcomes(All P > 0.05). In particular, patients undergoing PBO were more likely to develop the venous thrombosis postoperatively (P = 0.001). However, multivariate logistic regression analysis showed that PBO significantly decreased the risk of massive hemorrhage (OR 0.289, 95%CI:0.109-0.766, P = 0.013). The grade of PAS and MRI with S2 invasion were the significant risk factors affecting massive hemorrhage(OR:6.232 and OR:5.380, P<0.001). CONCLUSION: PBO has the potential to reduce massive hemorrhage in PAS patients undergoing CS. Obstetricians should, however, be aware of potential complications arising from the PBO. Additionally, MRI with S2 invasion and PAS grade will be useful to identify PAS patients who at high risk and may benefit from PBO. In brief, PBO seem to be a promising alternative for management of PAS, yet well-designed randomized controlled trials are needed to convincingly demonstrate its benefits and triage the necessity of PBO.


Assuntos
Oclusão com Balão , Placenta Acreta , Recém-Nascido , Gravidez , Humanos , Feminino , Cesárea , Placenta Acreta/cirurgia , Estudos Retrospectivos , Perda Sanguínea Cirúrgica/prevenção & controle , Histerectomia , Placenta
19.
J Cardiothorac Surg ; 19(1): 209, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38616243

RESUMO

Uterine leiomyoma invading internal iliac vein and consequently disseminating into the right atrium is an extremely rare condition, and surgical strategy is controversial. Here, we reported a specific case with successful surgical resection through one-stage total hysterectomy, bilateral oophorectomy, and the intracardiovascular lesion. This procedure would be an optimal choice for uterine leiomyoma invading inferior vena cava and spreading to right atrium.


Assuntos
Leiomiomatose , Feminino , Humanos , Leiomiomatose/complicações , Leiomiomatose/diagnóstico por imagem , Leiomiomatose/cirurgia , Histerectomia , Átrios do Coração/cirurgia , Doenças Raras , Síncope
20.
Minerva Obstet Gynecol ; 76(2): 200-204, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38624194

RESUMO

Uterine leiomyosarcoma is a rare malignant gynecologic tumor that arises from the myometrial or endometrial stromal precursor cells. This tumor has the highest prevalence in the pre- and post-is more frequent between 40 and 60 years old. It has a very unfavorable prognosis: only early-stage tumors have an acceptable prognosis; unfortunately, it is often diagnosed accidentally, typically on an advanced stage, when hematological metastases have already spread. Surgery is the main treatment strategy, while systemic treatment and radiotherapy are not recommended due to the lack of results. Since metastatization is mainly hematological, lymphadenectomy is not recommended. Recent progresses have been achieved in advanced and recurrent disease, often inoperable, thanks to new chemotherapies, target therapies and immunotherapies. We reported the case of a 51-year-old woman evaluated for lumbar pain in the right region compatible with renal colic. The ultrasound evaluation revealed right hydronephrosis and the presence of a paraovarian or intraligamentary mass compatible with fibroma. The abdominal CT confirmed the presence of a mass with heterogeneous vascularization. Therefore, the patient underwent laparoscopic surgery to remove the lesion which resulted to be a leiomyosarcoma G2. During the following week the patient underwent a laparoscopic hysterectomy. The first step for differential diagnosis consists in the evaluation of clinicopathological features, followed by the analysis of preoperative imaging. Pelvic MRI represents the gold standard, while CT is used to detect metastases. The main issue is that imaging shows limited ability in differential diagnosis between benign and malign smooth muscle tumor. The definitive diagnosis is confirmed by histological analysis; this implies the necessity of improved attentions on the surgical procedure, which is often performed by steps with prolongation of the treatment pathway. To distinguish which fibroids presents a major risk to be misdiagnosed, some risk scores were developed (rPRESS in 2014 and pLMS in 2019), though actually they are not applied in clinical practice. Uterine leiomyosarcoma (uLMS) is rare but causes several deaths in perimenopausal women due to lack of effective treatments, although target therapies represent a future hope. Furthermore, clinical practice needs support through the development and improvement of diagnostic risk scores and their integration into guidelines.


Assuntos
Leiomioma , Leiomiossarcoma , Neoplasias Pélvicas , Neoplasias Uterinas , Feminino , Humanos , Pessoa de Meia-Idade , Adulto , Leiomiossarcoma/complicações , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/patologia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico , Leiomioma/cirurgia , Histerectomia/métodos , Neoplasias Pélvicas/cirurgia
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