RESUMO
PURPOSE: To assess the effectiveness of a long-acting anesthetic injection into the obturator membrane for pain relief in women undergoing trans-obturator tension-free vaginal tape. METHODS: A total of 22 women were randomized for the intra-operative injection of bupivacaine into one of their obturator membranes: the left or right side. All the participants were asked to define their groin pain on a visual analog scale (scored 0-10 cm) at 1, 6, 12, and 24 h post-operative. For each woman, pain scores were compared between the local anesthetic-injected side and the opposite side. RESULTS: Statistically significant differences were not observed in groin pain scores between the bupivacaine injection side and the no injection side at 1 h (p = 0.76), 6 h (p = 1), 12 h (p = 0.95), and 24 h (p = 0.82) post-operative. CONCLUSION: In women who undergo trans-obturator tension-free vaginal tape procedures, intra-operative intra-obturator injection of local anesthetics is not effective in alleviating the characteristic post-operative groin pain. TRIAL REGISTRATION: This study is registered on ClinicalTrials.gov (NCT03479996).
Assuntos
Anestésicos Locais , Bupivacaína , Medição da Dor , Dor Pós-Operatória , Slings Suburetrais , Humanos , Feminino , Bupivacaína/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Anestésicos Locais/administração & dosagem , Slings Suburetrais/efeitos adversos , Pessoa de Meia-Idade , Adulto , Virilha , Incontinência Urinária por Estresse/cirurgia , Injeções , IdosoRESUMO
OBJECTIVES: We aimed to investigate whether surgery for adnexal detorsion within 6 h from admission to the hospital was associated with less adnexal ischemia. DESIGN: This is a retrospective cohort study. PARTICIPANTS/MATERIALS, SETTING, AND METHODS: This retrospective study was conducted at two university-affiliated medical centers and assessed women aged 18-45 years with adnexal torsion who were hospitalized within 12 h from the pain onset and underwent surgery for detorsion within 24 h. The study group was divided into 2 groups: early, surgical intervention within less than 6 h and late, surgical intervention between 6 and 24 h. The primary outcome was the rate of macroscopic appearance of ischemic adnexa. RESULTS: Two hundred and twenty women fulfilled the inclusion criteria. In 101 women, the adnexa with the torsion appeared macroscopically ischemic. There was no difference in ischemic adnexa between the early and late intervention groups (48% vs. 40%; p = 0.269). No significant association was found between the physical examination or ultrasonographic findings and the rate of ischemic adnexa within each group. LIMITATIONS: The main limitations of our study are its retrospective nature. Much of the clinical and ultrasonographic data are subjective and operator-dependent. The decision to operate may vary from one surgeon to another. CONCLUSION: Immediate surgical intervention in patients with adnexal torsion is not associated with a lower rate of adnexal ischemia. These findings suggest that in acute adnexal torsion, there is a wider time window for a thorough evaluation before surgery.
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Doenças dos Anexos , Doenças dos Anexos/cirurgia , Feminino , Humanos , Isquemia/complicações , Torção Ovariana , Estudos Retrospectivos , Anormalidade Torcional/complicações , Anormalidade Torcional/cirurgiaRESUMO
OBJECTIVE: To study the possible association between uterine cancer and the BRCA1/2 associated cancer syndrome and discuss the implications of such an association on the clinical managment of patients with BRCA1/2 mutations. METHODS: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. Study protocol was prospectively registered at PROSPERO International prospective register of systematic reviews (registration number CRD42020193496). Considered for inclusion were studies providing the diagnosis rate of uterine cancer in patients with BRCA1/2 mutations by comparing observed and expected rate according to a known disease incidence. The results were measured by standardized incidence ratio (SIR). The primary outcome was defined as any uterine cancer diagnosis and subgroup analyses were conducted for uterine serous papillary cancer (USPC) specifically and for BRCA1 and BRCA2 mutations separately. RESULTS: 4591 records were identified through database search; eight studies were finally included, comprising 13,098 patients with BRCA1/2 mutations. BRCA1/2 mutated patients were found to have a significantly higher risk for uterine cancer compared to the general population (SIR = 2.22, 95% CI 1.76-2.8, p < 0.001). A higher incidence of USPC was also found in patients with BRCA1/2 mutations (SIR = 17.97, 95% CI 9.89-32.66, p < 0.001), as well as in a separate analysis for BRCA1 (SIR = 2.81, 95% CI 2.09-3.79, p < 0.001) and BRCA2 (SIR = 1.75, 95% CI 1.09-2.80, p < 0.001) mutations. CONCLUSION: Patients who carry a BRCA1/2 mutation are at a significantly higher risk of developing uterine cancer, specifically USPC, supporting that USPC may be a component of the BRCA1/2 syndrome. The decision to perform concurrent hysterectomy at the time of the risk reduction bilateral salpingo -oophorectomy surgery should be considered individually.
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Genes BRCA1/fisiologia , Genes BRCA2/fisiologia , Histerectomia/métodos , Neoplasias Uterinas/cirurgia , Tomada de Decisões , Feminino , Humanos , Neoplasias Uterinas/patologiaRESUMO
OBJECTIVE: Endometrial cancer prognosis is related to stage, histology, myometrial invasion, and lymphovascular space invasion. Several studies have examined the association between pretreatment thrombocytosis and patient outcomes with contrasting results regarding prognosis. Our aim was to evaluate the association of pretreatment platelet count with outcomes in endometrial cancer patients. METHODS: This is an Israeli Gynecologic Oncology Group multicenter retrospective cohort study of consecutive patients with endometrial cancer, who underwent surgery between January 2002 and December 2014. Patients were grouped as low risk (endometrioid G1-G2 and villoglandular) and high risk (endometrioid G3, uterine serous papillary carcinoma, clear cell carcinoma, and carcinosarcoma). Those with stage I disease were compared with stages II-IV. Disease stages were reviewed and updated to reflect International Federation of Gynecology and Obstetrics (FIGO) 2009 staging. All patients underwent pelvic washings for cytology and total abdominal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Pelvic lymph node assessment was performed in patients with tumors of moderate-high risk histology or deep myometrial invasion. Para-aortic sampling was performed at the surgeon's discretion. Patients were categorized by pretreatment platelet count into two groups: ≤400×109/L and >400×109/L (defined as thrombocytosis). Clinical and pathological features were compared using Student t-test, χ2 or Fisher's exact test. Survival measures were plotted with the Kaplan-Meier method and compared using the log-rank test. A Cox proportional hazards model was used for multivariable comparison of associations. RESULTS: Of the 1482 patients included, most had stage I disease (961; 74.8%) and most had endometrioid histology (927; 64.1%). A total of 1392 patients (94%) had pretreatment platelet counts ≤400×109/L and 90 (6%) had pretreatment thrombocytosis. Patients with thrombocytosis had a significantly higher rate of high-grade malignancy, advanced stage, lymphovascular space invasion, low uterine segment involvement, and lymph node metastases. They also had shorter 5 year disease-free survival (65% vs 80%, p=0.003), disease-specific survival (63% vs 83%, p<0.05) and overall survival (59% vs 77%, p<0.05). On multivariate analysis, an elevated pretreatment thrombocyte count remained a significant independent predictor for disease-specific survival and overall survival. CONCLUSIONS: Pretreatment thrombocytosis is an independent prognostic factor for decreased disease-specific survival and overall survival among patients with endometrial cancer, and can serve as a predictor of poor outcome.
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Adenocarcinoma de Células Claras/mortalidade , Carcinoma Endometrioide/mortalidade , Cistadenocarcinoma Seroso/mortalidade , Neoplasias do Endométrio/mortalidade , Trombocitose/epidemiologia , Adenocarcinoma de Células Claras/sangue , Adenocarcinoma de Células Claras/cirurgia , Carcinoma Endometrioide/sangue , Carcinoma Endometrioide/cirurgia , Cistadenocarcinoma Seroso/sangue , Cistadenocarcinoma Seroso/cirurgia , Neoplasias do Endométrio/sangue , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Israel/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Trombocitose/sangueRESUMO
INTRODUCTION: Advanced age is considered an adverse factor in endometrial cancers but may be a surrogate for other conditions that impact outcomes. The study objective was to assess the association of age with endometrial cancer features, treatment and prognosis. MATERIAL AND METHODS: In this multicenter cohort study, consecutive women with endometrial cancer treated at 10 Israeli institutions between 2000 and 2014 were accrued in an assimilated database. Postmenopausal women were stratified into age groups with a cut-off of 80. Clinical, pathological and treatment data were compared using t test or Mann-Whitney test for continuous variables, and Chi-square Test or Fisher's Exact test for categorical variables. Main outcome measures included disease recurrence and disease-specific and overall survival; these were plotted using the Kaplan-Meier method and compared using the log-rank test. The association between age and recurrence and survival, adjusted for other clinical and pathological factors, was assessed using multivariable Cox regression modeling. RESULTS: A total of 1764 postmenopausal women with endometrial cancer were identified. Adverse pathological features were more prevalent in older women, including high-risk histologies (35% vs 27%, P = .025), deep myoinvasion (44% vs 29%, P = .001) and lymphovascular involvement (22% vs 15%, P = .024). Surgical staging was performed less frequently among older women (33% vs 56%; P < .001). Chemotherapy was less often prescribed, even for non-endometrioid histologies (72% vs 45%; P < .001). On multivariable analysis, age remained a significant predictor for recurrence (HR = 1.75, P = .007), death of disease (HR = 1.89, P = .003) and death (HR = 2.4, P < .001). CONCLUSIONS: Older age in women with endometrial cancer is associated with more adverse disease features, limited surgery and adjuvant treatment, and worse outcomes. On multivariable analysis, age remains an independent prognosticator in this population.
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Neoplasias do Endométrio/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/terapia , Feminino , Humanos , Israel/epidemiologia , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Prognóstico , Taxa de SobrevidaRESUMO
INTRODUCTION: Cephalopelvic disproportion (CPD) is one of the most common obstetric complications. Since CPD is the disproportion between the fetal head and maternal bony pelvis, evaluation of the head circumference (HC) relative to the maternal bony pelvis may be a useful adjunct to pre-labor CPD evaluation. The aim of the present study was a proof-of-concept evaluation of the ratio between HC and pelvic circumference (PC) as a predictor of CPD. METHODS: Of 11,822 deliveries, 104 cases that underwent an abdominopelvic CT for any medical indication and who underwent normal vaginal deliveries (NVDs) (n = 84) or cesarean deliveries (CD) due to CPD (n = 20) were included retrospectively. Maternal pelvis dimensions were reconstructed and neonatal HC, as a proxy for fetal HC, was measured. The correlation between cases of CPD and cephalopelvic circumference index (CPCI), which represents the ratio between the HC and PC in percentage (HC/PC × 100), was evaluated. RESULTS: The mid-pelvis CPCI (MP-CPCI) was larger in CD groups as compared to the NVD group: 103 ± 11 versus 97 ± 8%, respectively (p = 0.0003). In logistic regression analysis, the MP-CPCI was found to be independently associated with CD due to CPD: each 1% increase in MP-CPCI increased the likelihood of CD for CPD by 11% (adjusted odds ratio [aOR] 1.11, 95% CI, 1.03-1.19, p = 0.004). The aOR for CD due to CPD increased incrementally as the MP-CPCI increased, from 3.56 (95% CI, 1.01-12.6) at MP-CPCI of 100 to 5.6 (95% CI, 1.63-19.45) at 105, 21.44 (95% CI, 3.05-150.84) at 110, and 28.88 (95% CI, 2.3-362.27) at MP-CPCI of 115. CONCLUSIONS: The MP-CPCI, representing the relative dimensions of the fetal HC and maternal PC, is a simple tool that can potentially distinguish between parturients at lower and higher risk of CPD. Prospective randomized studies are required to evaluate the feasibility of prenatal pelvimetry and MP-CPCI to predict the risk of CPD during labor.
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Desproporção Cefalopélvica , Desproporção Cefalopélvica/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Pelve/diagnóstico por imagem , Gravidez , Estudos Prospectivos , Estudos Retrospectivos , Fatores de RiscoRESUMO
Data supporting a survival advantage of endometrial cancer diagnosed before the onset of postmenopausal bleeding are lacking. This study sought to compare overall survival and disease recurrence between women who were asymptomatic at diagnosis and women who were symptomatic at diagnosis. A systemic search was conducted in databases using the terms: "asymptomatic," "ultrasound," "screening," and "endometrial cancer." Only original research studies that compared characteristics of tumour advancement and survival measures were included. The six articles included in the meta-analysis comprised 2961 patients. Data were collected on study design and period, number and characteristics of participants, and outcomes in terms of tumour histology and survival measures. Higher rates of stage I tumours were shown among asymptomatic patients (relative risk 1.19). The proportion of high-grade histology did not differ between the two groups (relative risk 0.92). The crude pooled estimate for overall survival did not yield statistical significance, nor did recurrence-free survival (which was reported by three studies). In conclusion, endometrial cancer diagnosed in asymptomatic women is not associated with higher survival than in symptomatic women. Invasive procedures in asymptomatic women with incidental ultrasonographic findings should be carefully weighed because no survival advantage is expected.
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Doenças Assintomáticas , Neoplasias do Endométrio/diagnóstico , Endométrio/patologia , Pólipos/patologia , Ultrassonografia/métodos , Hemorragia Uterina/etiologia , Intervalo Livre de Doença , Detecção Precoce de Câncer , Neoplasias do Endométrio/diagnóstico por imagem , Feminino , Humanos , Pólipos/diagnóstico por imagem , Análise de Sobrevida , Hemorragia Uterina/patologiaRESUMO
PURPOSE: This study aimed to assess the rates of retained products of conception (RPOC) after routine postpartum evaluation of patients who underwent post-delivery manual uterine revision due to retained placenta. METHODS: This is a retrospective cohort study of 599 consecutive women who underwent manual removal of placenta during 2010-2018. Group A comprised 465 women who underwent postpartum symptom-based evaluation (2010-2016). Group B comprised 134 women who were routinely evaluated by ultrasound and subsequently by hysteroscopic examination 6 weeks after delivery (2016-2018). RESULTS: The rates of abnormal postpartum bleeding were similar between groups A and B (12% and 13%, respectively, p = 0.72%). A significantly smaller proportion of women underwent hysteroscopy in group A than group B (12% vs. 37%, p < 0.05). The rate of persistent RPOC confirmed by hysteroscopy was significantly lower in group A than group B (9.7% vs. 23%, p < 0.05). CONCLUSION: Among patients who underwent post-delivery manual removal of placenta, a threefold higher rate of RPOC was discovered by routine elective evaluation than by evaluating only symptomatic patients. Future studies may show whether this approach translates to an effect on fertility.
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Histeroscopia/métodos , Placenta Retida/cirurgia , Ultrassonografia/métodos , Adulto , Estudos de Coortes , Feminino , Humanos , Gravidez , Estudos RetrospectivosRESUMO
OBJECTIVE: This study sought to compare the value of transvaginal ultrasonography (TVUS) and hysteroscopy in premenopausal and postmenopausal women in the diagnosis of endometrial polyp. METHODS: The records of 694 women with an ultrasonographic diagnosis of suspected endometrial polyp who underwent hysteroscopy were studied. Patients were divided into two groups according to menopausal status, and a comparison was made between two groups. RESULTS: There were 299 postmenopausal and 395 premenopausal women in the study. Hysteroscopy confirmed the ultrasonographic diagnosis of endometrial polyp in 212 (71%) and 212 (53%) patients in the postmenopausal and premenopausal groups, respectively (Pâ¯=â¯0.001). In postmenopausal patients, 94% of the polyps observed by hysteroscopy were confirmed by histology, whereas in premenopausal patients, the percentage was 85% (Pâ¯=â¯0.004). CONCLUSION: In premenopausal patients, the diagnostic value of TVUS and hysteroscopy is lower than in postmenopausal patients. The appropriate time for TVUS and hysteroscopy should be scheduled in premenopausal women, especially in women with abnormal uterine bleeding.
Assuntos
Pólipos/diagnóstico , Pós-Menopausa , Pré-Menopausa , Neoplasias Uterinas/diagnóstico , Feminino , Humanos , Histeroscopia , Pessoa de Meia-Idade , Pólipos/patologia , Valor Preditivo dos Testes , Ultrassonografia , Neoplasias Uterinas/patologiaRESUMO
OBJECTIVE: The appropriate management of endometrial polyps in asymptomatic postmenopausal patients remains controversial. The aim of the study was to evaluate the relationship between endometrial polyp size and malignancy risk among asymptomatic postmenopausal women. METHODS: This observational retrospective study investigated 472 postmenopausal asymptomatic women who underwent hysteroscopic polypectomy between 2010 and 2014 (Canadian Task Force Classification II-3). RESULTS: Of the 472 women, premalignant and malignant lesions were found in 11 (2.33%) cases; four (0.84%) had endometrial carcinoma, and seven (1.49%) had atypical endometrial hyperplasia. The incidence of premalignant or malignant lesions among various cut-offs of polyp size (10, 15, 20 mm) was not significantly different. CONCLUSION: In the current series no significant risk factor for malignancy was found among different cut-offs of polyp size.
Assuntos
Pólipos/epidemiologia , Pós-Menopausa , Neoplasias Uterinas/epidemiologia , Idoso , Feminino , Humanos , Israel/epidemiologia , Pessoa de Meia-Idade , Pólipos/etiologia , Pólipos/patologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias Uterinas/etiologia , Neoplasias Uterinas/patologiaRESUMO
OBJECTIVE: This study sought to compare the short-term outcome of uterine incision repair during a Caesarean section (CS) using a bidirectional knotless barbed suture versus polyglactin suture. METHODS: A randomized controlled trial was conducted at a university hospital. Participants undergoing a CS were randomly assigned to uterine incision closure by bidirectional knotless barbed suture (group A) or polyglactin (group B). The primary outcome was the time needed to repair the uterine incision. The analysis was by intent to treat. A sample size of 35 per group (nâ¯=â¯70) was planned to detect a 30% reduction in uterine repair time (Canadian Task Force Classification I). RESULTS: From July 2016 through October 2017, 150 women were screened, and 70 were statistically analyzed: group A (nâ¯=â¯35) and group B (nâ¯=â¯35). Time to complete uterine incision repair was 308 ± 57 seconds for group A and 411 ± 74 seconds for group B (P < 0.001). Total surgery time (33.4 ± 8.8 minutes vs. 33.2 ± 7.5 minutes; P = 0.64) was not significantly different between groups A and B, respectively. CONCLUSION: Repair of the CS uterine incision with barbed suture compared with polyglactin suture reduces suturing time.
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Cesárea/métodos , Técnicas de Sutura , Adulto , Cesárea/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Duração da Cirurgia , Poliglactina 910 , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Suturas , Resultado do TratamentoRESUMO
Epithelial ovarian cancer relapse is a devastating condition with a poor prognosis. Synthetic mesh carcinogenicity is an entity scarcely reported in the literature. We present a rare case of an ovarian serous tumor relapsed in a polypropylene mesh previously inserted for pelvic organ prolapse correction and a review of the available literature. Our case report point to a possible association between synthetic mesh and ovarian cancer relapse.
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Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Neoplasias Ovarianas/etiologia , Prolapso de Órgão Pélvico/cirurgia , Polipropilenos , Telas Cirúrgicas/efeitos adversos , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The sentinel lymph node (SLN) biopsy procedure is a well-known method for identifying solid tumors such as breast cancer, vulvar cancer, and melanoma. In endometrial and cervical cancer, SLN has recently gained acceptance. OBJECTIVES: To evaluate the detection rate of SLN with an indocyanine green and near-infrared fluorescent imaging (ICG/NIR) integrated laparoscopic system in clinically uterine-confined endometrial or cervical cancer. METHODS: Patients with clinically early-stage endometrial or cervical cancer were included in this retrospective study. ICG was injected into the uterine cervix and an ICG/NIR integrated laparoscopic system was used during the surgeries. The National Comprehensive Cancer Network (NCCN) protocol was followed. SLN and/or suspicious lymph nodes were resected. Side-specific lymphadenectomy was performed when mapping was unsuccessful. Systematic lymphadenectomy was completed in patients with high-grade histology or deep myometrial invasion. Enhanced pathology using ultra-staging and immunohistochemistry were performed in all cases. RESULTS: We analyzed 46 eligible patients: 39 endometrial and 7 cervical cancers. Of these, 44 had at least one SLN (93.6%). In 41 patients (89%) we detected bilateral SLN, in 3 (7%) only unilateral, and in 2 (4%) none were detected. Seven patients presented with lymph node metastasis. All were detected by NCCN/SLN protocol. Of these cases, two were detected with only pathological ultra-staging. CONCLUSIONS: SLN mapping in endometrial and cervical cancer can easily be performed with a high detection rate by integrating ICG/NIR into a conventional laparoscopic system. Precision medicine in patients evaluated by SLN biopsy changes the way patients with endometrial or cervical cancer are managed.
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Neoplasias do Endométrio/patologia , Metástase Linfática/diagnóstico por imagem , Imagem Óptica/métodos , Linfonodo Sentinela/diagnóstico por imagem , Neoplasias do Colo do Útero/patologia , Colo do Útero , Feminino , Humanos , Verde de Indocianina , Laparoscopia , Pessoa de Meia-Idade , Medicina de Precisão , Estudos RetrospectivosRESUMO
OBJECTIVES: Data on the outcome of stage IIA1 cervical cancer is limited, as these tumors comprise a small percentage of early tumors. NCCN guidelines suggest consideration of surgical management for small tumors with vaginal involvement. Our objective was to evaluate the risk of adjuvant radiotherapy in stage IIA1 cervical cancer and its associated features, in order to improve selection of patients for surgical management. METHODS: A retrospective cohort study comparing surgically treated cervical cancer patients with stage IB1 and stage IIA1 disease. Women treated between 2000 and 2015 in ten Israeli medical centers were included. Patient and disease features were compared between stages. The relative risk (Fisher's exact test) of receiving post-operative radiation was calculated and compared for each risk factor. A general linear model (GLM) was used for multivariable analysis. RESULTS: 199 patients were included, of whom 21 had stage IIA1 disease. Most features were comparable for stage IB1 and stage IIA1 disease, although patients with vaginal involvement were more likely to have close surgical margins (23.8% vs 8.5%, pâ¯=â¯0.03). Patients with stage IIA1 disease were more likely to receive radiation after surgery (76% vs. 46%, RRâ¯=â¯1.65 (1.24-2.2), pâ¯=â¯0.011). Vaginal involvement as well as depth of stromal invasion, LVSI and lymph node metastases were independent predictors of radiation on multivariable general linear modeling. CONCLUSIONS: Cervical cancer patients with vaginal involvement are highly more likely to require postoperative radiation. We recommend careful evaluation of these patients before surgical management is offered.
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Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/cirurgia , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Pós-Operatórios , Radioterapia Adjuvante , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologiaRESUMO
BACKGROUND: Incidental ultrasonographic findings in asymptomatic postmenopausal women, such as thickened endometrium or polyps, often lead to invasive procedures and to the occasional diagnosis of endometrial cancer. Data supporting a survival advantage of endometrial cancer diagnosed prior to the onset of postmenopausal bleeding are lacking. OBJECTIVE: To compare the survival of asymptomatic and bleeding postmenopausal patients diagnosed with endometrial cancer. STUDY DESIGN: This was an Israeli Gynecology Oncology Group retrospective multicenter study of 1607 postmenopausal patients with endometrial cancer: 233 asymptomatic patients and 1374 presenting with postmenopausal bleeding. Clinical, pathological, and survival measures were compared. RESULTS: There was no significant difference between the asymptomatic and the postmenopausal bleeding groups in the proportion of patients in stage II-IV (23.5% vs 23.8%; P = .9) or in high-grade histology (41.0% vs 38.4%; P = .12). Among patients with stage-I tumors, asymptomatic patients had a greater proportion than postmenopausal bleeding patients of stage IA (82.1% vs 66.2%; P < .01) and a smaller proportion received adjuvant postoperative radiotherapy (30.5% vs 40.6%; P = .02). There was no difference between asymptomatic and postmenopausal bleeding patients in the 5-year recurrence-free survival (79.1% vs 79.4%; P = .85), disease-specific survival (83.2% vs 82.2%; P = .57), or overall survival (79.7% vs 76.8%; P = .37). CONCLUSION: Endometrial cancer diagnosed in asymptomatic postmenopausal women is not associated with higher survival rates. Operative hysteroscopy/curettage procedures in asymptomatic patients with ultrasonographically diagnosed endometrial polyps or thick endometrium are rarely indicated. It is reasonable to reserve these procedures for patients whose ultrasonographic findings demonstrate significant change over time.
Assuntos
Adenocarcinoma de Células Claras/diagnóstico , Doenças Assintomáticas , Carcinoma Endometrioide/diagnóstico , Carcinossarcoma/diagnóstico , Neoplasias do Endométrio/diagnóstico , Neoplasias Císticas, Mucinosas e Serosas/diagnóstico , Pós-Menopausa , Hemorragia Uterina/etiologia , Adenocarcinoma de Células Claras/complicações , Adenocarcinoma de Células Claras/patologia , Adenocarcinoma de Células Claras/cirurgia , Idoso , Biópsia , Carcinoma Endometrioide/complicações , Carcinoma Endometrioide/patologia , Carcinoma Endometrioide/cirurgia , Carcinossarcoma/complicações , Carcinossarcoma/patologia , Carcinossarcoma/cirurgia , Causas de Morte , Quimioterapia Adjuvante , Intervalo Livre de Doença , Detecção Precoce de Câncer , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Endométrio/patologia , Feminino , Humanos , Histerectomia , Achados Incidentais , Israel , Excisão de Linfonodo , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Neoplasias Císticas, Mucinosas e Serosas/complicações , Neoplasias Císticas, Mucinosas e Serosas/patologia , Neoplasias Císticas, Mucinosas e Serosas/cirurgia , Pelve , Pólipos/patologia , Modelos de Riscos Proporcionais , Radioterapia Adjuvante , Estudos Retrospectivos , Salpingo-Ooforectomia , Taxa de Sobrevida , UltrassonografiaRESUMO
PURPOSE: Tubo-ovarian abscess (TOA) is a serious and potentially life-threatening complication of pelvic inflammatory disease (PID). TOA formation may be an uncommon, but serious complication associated with the use of an intrauterine device (IUD). While the majority of TOA respond to antibiotic therapy, in approximately 25% of cases surgery or drainage is indicated. In the present study, we compared the failure rate of conservative management in patients with and without IUD, who were admitted with a diagnosis of TOA. METHODS: In this retrospective case-control study, 78 women were diagnosed with TOA. All patients were treated initially by broad-spectrum intravenous antibiotics. The failure of conservative management after 72 h was followed by surgical intervention. RESULTS: The patients were divided into two groups: 24 patients were IUD-carriers, and 54 did not use IUD. There was no significant difference in surgical intervention rate between IUD group (50%) and no-IUD group (43%), p = 0.32. The WBC count was significantly higher in IUD-carriers diagnosed with TOA than in patients without IUD (16.5 ± 6.6 vs. 13.1 ± 4.6, p = 0.001). The patients with IUD had significantly larger abscesses as revealed by ultrasound than patients without IUD (61.6 ± 21.4 vs. 49.6 ± 20.6 mm, p = 0.02). CONCLUSION: The surgical intervention rate in TOA patients with and without IUD was similar.
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Abscesso/terapia , Antibacterianos/uso terapêutico , Remoção de Dispositivo , Doenças das Tubas Uterinas/diagnóstico , Doenças das Tubas Uterinas/terapia , Febre/etiologia , Procedimentos Cirúrgicos em Ginecologia , Dispositivos Intrauterinos/efeitos adversos , Doenças Ovarianas/diagnóstico , Doença Inflamatória Pélvica/tratamento farmacológico , Abscesso/complicações , Abscesso/diagnóstico , Adulto , Estudos de Casos e Controles , Tratamento Conservador , Doenças das Tubas Uterinas/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Doenças Ovarianas/complicações , Doenças Ovarianas/tratamento farmacológico , Doenças Ovarianas/cirurgia , Doença Inflamatória Pélvica/diagnóstico , Doença Inflamatória Pélvica/microbiologia , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Adulto JovemRESUMO
STUDY OBJECTIVE: To show the possibility of conservative laparoscopic management in a case of invasive mole perforating the uterus. DESIGN: Video with explanations. SETTING: An invasive mole is a potentially life-threatening complication of gestational trophoblastic disease [1]. This is a case of a 24-year-old female presenting with abdominal pain and vaginal bleeding. There have been several previous reports of cases of uterine perforation by an invasive mole, all of which were managed with abdominal hysterectomy [2-7]. To our knowledge, this is the first report of an invasive mole perforation with active bleeding managed by laparoscopy without hysterectomy. INTERVENTIONS: Sonography revealed a large amount of fluid and a 3 × 3-cm heterogeneous lesion next to the posterior uterine wall. Her hemoglobin level dropped from 10.6 mg/dL to 8.6 mg/dL, and her ß-human chorionic gonadotropin level was 19,004 mIU/mL. On laparoscopy, â¼2500 mL of hemoperitoneum was found, along with an actively bleeding bulging mass in the posterior uterine wall. This mass was dissected, and hemostasis was secured with sutures and electrocoagulation. Pathology confirmed the diagnosis of a complete mole. After surgery, the patient was treated with 5 courses of a methotrexate-folinic acid regimen. Her recovery was uneventful. CONCLUSION: Uterine perforation by an invasive mole can be managed conservatively with laparoscopic surgery and postoperative chemotherapy. The transmural lesion will increase the risk of future uterine rupture during pregnancy in this patient.
Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Mola Hidatiforme Invasiva/cirurgia , Laparoscopia/métodos , Neoplasias Uterinas/cirurgia , Ruptura Uterina/cirurgia , Adulto , Gonadotropina Coriônica Humana Subunidade beta , Feminino , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Humanos , Mola Hidatiforme Invasiva/complicações , Mola Hidatiforme Invasiva/patologia , Metotrexato/uso terapêutico , Gravidez , Hemorragia Uterina/etiologia , Hemorragia Uterina/cirurgia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/patologia , Ruptura Uterina/etiologia , Adulto JovemRESUMO
BACKGROUND: Office endometrial biopsy with a Pipelle cannula is the main method for sampling the endometrial lining. The Pipelle biopsy is safe, efficient, and cost effective. This office endometrial sampling method is also an accurate and safe procedure for endometrial sampling of patients with endometrial carcinoma. It is associated with minimal pain and does not require anesthesia. CASE: Pipelle is the most common method used for sampling the endometrial lining. No data are available of infectious complications related to endometrial biopsy. The incidence is presumed to be negligible. We present an unusual case of a 52-year-old woman who experienced septic shock and multiple organ failure following Pipelle endometrial sampling. CONCLUSION: Lower abdominal pain is the cardinal presenting symptom in woman with pelvic infection. Our case emphasizes that an atypical symptom such as abdominal pain after endometrial biopsy could be a sign of infectious complications.
Assuntos
Biópsia/efeitos adversos , Endométrio/patologia , Insuficiência de Múltiplos Órgãos/etiologia , Choque Séptico/etiologia , Dor Abdominal/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Infecção Pélvica/complicaçõesRESUMO
BACKGROUND: Tamoxifen acts as an estrogen antagonist within the breast tissue. In the uterus, tamoxifen is an agonist for some estrogen receptors and therefore can cause hyperplasia or neoplasia in the endometrium. OBJECTIVES: To compare characteristics of patients with uterine sarcoma who were and were not previously treated with tamoxifen. METHODS: The medical records of all women with uterine sarcoma who had been treated at the Carmel Medical Center in Haifa, Israel, during 2000-2013 were retrospectively reviewed. Disease characteristics, histological type of sarcoma, patient demographics, treatments and final outcomes were compared between patients who had and those who had not been exposed to tamoxifen. RESULTS: Of the 66 patients identified, 14 (21%) had been exposed to tamoxifen, one of them for 3 years and 13 for at least 5 years. Mean ages were 69 ± 8 and 66 ± 12 years for those exposed and those not exposed to the drug, respectively. Rates of uterine carcinosarcoma were 86% (12/14) and 44% (23/52), respectively (P < 0.006). Patients with carcinosarcoma were older than other sarcoma patients (73 ± 7 vs. 59 ± 11 P < 0.005).There were no statistically significant differences between the two groups in rates of diabetes mellitus, hypertension, dyslipidemia or heart disease. The mean time from diagnosis to death was 7.37 ± 0.42 years. The overall survival rates of carcinosarcoma patients were not statistically different from that of other sarcoma patients. Tamoxifen exposure was not associated with overall survival among all sarcoma patients, nor among the subgroup of carcinosarcoma patients. CONCLUSIONS: Tamoxifen treatment was associated with elevated incidence of carcinosarcoma among women with uterine sarcoma, but was not found to be associated with prognosis or with co-morbidities.