Radiation-Induced Uterine Carcinosarcoma after Concurrent Chemoradiotherapy for Cervical Squamous Cell Carcinoma.

OBJECTIVE: To describe a case of radiation-induced uterine carcinosarcoma 6 years after a cervical squamous cell carcinoma treatment, which imposed some diagnostic and management challenges. CASE REPORT: A 57-year-old woman with a history of pelvic chemoradiotherapy ∼ 6.5 years before the event described in this study, following an International Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical cancer, presented with a cervical mass, involving the uterine cavity, the cervical canal and the upper two thirds of the vagina. The biopsy showed a poorly differentiated carcinoma, and a positron emission tomography (PET) scan excluded distant metastasis, although it was unable to define the origin of the tumor as either a new primary malignancy of the endometrium/cervix or as a cervical recurrence. Surgical staging procedure was performed, and the diagnosis was endometrial carcinosarcoma, FIGO stage IIB. The patient was not able to complete the adjuvant therapy, and the progression of the disease was remarkable. CONCLUSION: The present case highlights one of the less common but more serious consequences of radiotherapy for cervical cancer, which has an increasing incidence in younger women, raising concerns about the long-term consequences of its management.

Late Retroperitoneal Hematoma with Abscess Formation Following Laparoscopic Staging of Endometrial Cancer.

Herein, we report a case of a 63-year-old, nonobese, woman who underwent laparoscopic surgical staging for endometrial cancer with pelvic and para-aortic lymph node dissection. After being discharged, the patient presented to the emergency department with fever and abdominal pain, 1 week after the procedure. Abdominal tenderness, fever, and anemia were the key clinical and laboratory findings. A computed tomography (CT) scan revealed a cystic mass with air bubbles, located in the right iliopsoas region. The features were consistent with an infected hematoma at the right iliopsoas region, which was managed with antibiotics and CT-guided pigtail drainage. Laparoscopic surgical staging for endometrial cancer has been shown to have fewer early complications than open surgery. However, complications can still occur in the most experienced hands. Abscess arising from hematomas after laparoscopic surgical staging can be managed adequately with noninvasive CT-guided drainage.

Building a Maternal and Newborn Care Training Programme for Health-Care Professionals in Guinea-Bissau.

INTRODUCTION: The Integrated Programme of Maternal and Child Health aims to reduce maternal and child mortality in Guinea-Bissau. The purpose of this article is to share our experience in building a training programme on maternal and newborn care for health-care professionals in Guinea-Bissau. MATERIAL AND METHODS: Regional directors of the four target areas chose a group of staff who provide prenatal and childbirth care to attend the course (12 to 15 trainees per region). In each region, 15 highly interactive and practical sessions were scheduled over eight weeks. The trainees' summative and reactive assessment was obtained using a multiple choice questionnaire (final test) and an anonymous survey, respectively. RESULTS: Attendees included 25 nurses, 17 midwives and 14 doctors. About two thirds had five years' practice or less. Test median scores were higher among trainees with two to nine years of practice (54.4% to 60.9%), as compared to those with a year or less (47.8%) or 10 or more years (45.7%). Pedagogical variables were rated as 'good' or 'very good' by 91% to 95% of the attendees. DISCUSSION: Use of an interactive and practical pedagogical methodology produced positive results and was crucial to tailoring the training to local needs. However, adapting the syllabus according to professional categories and experiences should be considered. CONCLUSION: Our results warrant further development and evaluation of training programmes on maternal and neonatal care in Guinea-Bissau.

Introdução: O Programa Integrado de Saúde Materna e Infantil visa reduzir a mortalidade materno-infantil na Guiné-Bissau. O objetivo deste artigo é partilhar a experiência no desenvolvimento do treino em cuidados maternos e ao recém-nascido, em quatro regiões da Guiné-Bissau. Material e Métodos: Os diretores regionais indicaram 12 a 15 profissionais que prestavam assistência pré-natal e ao parto para participarem no treino. Durante oito semanas, 15 sessões predominantemente interativas e práticas foram ministradas em cada região. Foram efetuadas avaliações sumativa e reativa através de um teste final com perguntas de escolha múltipla e de um questionário de satisfação anónimo, respetivamente. Resultados: Participaram no treino 25 enfermeiras, 17 parteiras e 14 médicos. Praticamente dois terços tinham cinco ou menos anos de prática clínica. Os resultados do teste final foram superiores nos formandos com dois a nove anos de experiência (medianas de 54,4% a 60,9%), comparativamente àqueles até um ano (47,8%) ou com 10 ou mais anos (45,7%). As variáveis pedagógicas foram classificadas como 'bom' ou 'muito bom' por 91% a 95% dos participantes. Discussão: A metodologia interativa e prática produziu bons resultados e foi muito útil para moldar o treino às necessidades locais. Contudo, o programa de estudos deve ser adaptado de acordo com categorias e experiências profissionais. Conclusão: Os resultados obtidos justificam o desenvolvimento e a avaliação adicional de programas de formação em cuidados de saúde materna e neonatal na Guiné-Bissau.

Radiation-Induced Uterine Carcinosarcoma after Concurrent Chemoradiotherapy for Cervical Squamous Cell Carcinoma

Abstract Objective To describe a case of radiation-induced uterine carcinosarcoma 6 years after a cervical squamous cell carcinoma treatment, which imposed some diagnostic and management challenges. Case Report A 57-year-old woman with a history of pelvic chemoradiotherapy ~ 6.5 years before the event described in this study, following an International Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical cancer, presented with a cervical mass, involving the uterine cavity, the cervical canal and the upper two thirds of the vagina. The biopsy showed a poorly differentiated carcinoma, and a positron emission tomography (PET) scan excluded distant metastasis, although it was unable to define the origin of the tumor as either a new primary malignancy of the endometrium/cervix or as a cervical recurrence. Surgical staging procedure was performed, and the diagnosis was endometrial carcinosarcoma, FIGO stage IIB. The patient was not able to complete the adjuvant therapy, and the progression of the disease was remarkable. Conclusion The present case highlights one of the less common but more serious consequences of radiotherapy for cervical cancer, which has an increasing incidence in younger women, raising concerns about the long-termconsequences of its management.