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OBJECTIVE: To evaluate the effects of varying direct attachment shape and size on the forces and moments generated by thermoplastic aligners during simulated expansion. MATERIALS AND METHODS: An in vitro orthodontic force tester (OFT) was used to measure the forces and moments from a typodont where the buccal teeth were translated lingually 0.2 mm to simulate expansion. Hemi-ellipsoid and rectangular attachments with either 0.5 or 1.0 mm thickness were added on upper right first premolar (UR4), second premolar (UR5) and first molar (UR6). Analysis of variance (ANOVA) was used to determine two-way interactions among the factors on the outcomes. RESULTS: The interactions between group and tooth were significant for all outcomes (p < 0.001). The greatest buccal forces (Fy) were observed with 1 mm rectangular attachment on the UR4 (0.78 ± 0.29 N), with 1 mm hemi-ellipsoid attachment on UR5 (0.28 ± 0.21 N) and with 0.5 mm rectangular attachment on UR6 (1.71 ± 0.18 N). The greatest buccolingual moments (Mx) were obtained with 1 mm rectangular attachment on UR4 (5.61 ± 1.43 Nmm), without any attachments on UR5 (3.33 ± 1.73 Nmm) and with 1 mm hemi-ellipsoid attachment on UR6 (4.18 ± 4.31). CONCLUSION: Direct attachment shape and size had a significant effect on the orthodontic forces and moments generated by thermoplastic aligners during simulated expansion. Although loads varied significantly by tooth morphology and its location in the arch, best forces and moments for expansion were obtained with 1 mm rectangular attachments on UR4s, 1 mm hemi-ellipsoid attachments on UR5s and 0.5 mm rectangular attachments on UR6s.
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Introduced species can negatively impact endemic flora and fauna. Studies have primarily utilized camera trap observations and occupancy modelling to better clarify the presence/absence and temporal overlap of endemic and exotic predators. Longitudinal data from field research sites are important as they can provide a finer understanding of predator dynamics and their effects on endemic species. One such site is the Bezà Mahafaly Special Reserve, in southern Madagascar. Protected since the 1970s, the local human population around Bezà Mahafaly Special Reserve has greatly expanded, leading to habitat disturbance in the surrounding forests and increased contact between local wildlife, people and their livestock and dogs. Here we use a combination of scat sampling, field observations of successful and attempted predations, locations of scat samples with identifiable lemur remains, and camera trap data to better assess the predator ecology at Bezà Mahafaly Special Reserve. Our results indicate that forest cats (Felis catus), are effective predators of both adult and infant lemurs and appear to be a constant mammalian predator, utilizing mammal prey more than dogs. Dogs are both predators and scavengers of lemurs. Civets focus on small prey, such as insects and rodents as well as plant material. The fosa, Cryptoprocta ferox, are also present but may not hunt in the area continuously. The killing of an adult ring-tailed lemur by two men from outside the area indicate culturally imposed taboos against lemur killing may no longer be effective given that new arrivals may not share the same local cultural restrictions. Scat sampling of exotic predators is one way to expand our understanding of exotic and endemic predator impact on lemur populations, and long-term studies with multiple assessments of predation can provide a clearer understanding of how non-endemic and endemic predators affect endangered species survival.
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PURPOSE: A disparity exists in cancer screening rates for the Sexual and Gender Minority (SGM) community. We sought to understand the perceptions and baseline knowledge of cancer screening among SGM community members. METHODS: Survey administered via social media from June 2018 to October 2018. We asked 31 questions focused on cancer screening, human papillomavirus, emotional distress, and experience with the health care system. Those included were 18 years or older. Cancer screening attitudes and knowledge, as well as perceptions of the health care system were investigated. RESULTS: There were 422 respondents analyzed: 24.6% identified as female, 25.5% as male, 40.1% transgender, and 9.6% as other. 65.4% of the SGM community is not certain what cancer screening to do for themselves. Only 27.3% and 55.7% knew that HPV was a risk factor associated with head and neck cancer and anal cancer, respectively. Half stated their emotional distress prevents them from getting cancer screening. It was identified that process changes in making appointments, comforts during the visit, and formal training for physicians and nurses could increase cancer screening compliance for this community. The transgender population had a trend in more gaps in knowledge of appropriate cancer screening and significant excess emotional distress. CONCLUSION: Gaps in cancer screening knowledge and emotional and financial distress may be responsible for the disparity of lower cancer screening rates for the SGM population and the transgender population may be most at risk. Appreciating the cancer screening concerns of the SGM population can help shape future clinical and institutional approaches to improve health care delivery.
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Neoplasias , Minorias Sexuais e de Gênero , Detecção Precoce de Câncer , Feminino , Identidade de Gênero , Disparidades em Assistência à Saúde , Humanos , Masculino , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Comportamento SexualRESUMO
BACKGROUND: Pseudomyxoma peritonei (PMP) syndrome is a disease process that typically occurs from ruptured appendiceal mucocele neoplasms. PMP syndrome arising from malignant transformation of an ovarian primary mature cystic teratoma (MCT) is a pathogenesis rarely encountered. CASE PRESENTATION: Herein, we report a 28-year-old patient evaluated and treated for a right ovarian mass and large volume symptomatic abdominopelvic mucinous ascites. Molecular profiling and genetic analysis revealed mutations in ATM, GNAS, and KRAS proteins while IHC demonstrated gastrointestinal-specific staining for CK20, CDX2, CK7, and SATB2. Peritoneal cytology showed paucicellular mucin. Diffuse peritoneal adenomucinosis (DPAM) variant of PMP arising from a ruptured ovarian primary MCT after malignant transformation to a low-grade appendiceal-like mucinous neoplasm was ultimately confirmed. Treatment included staged therapeutic tumor debulking and right salpingo-oophorectomy followed by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). CONCLUSIONS: Our report builds upon the existing literature supporting this aggressive treatment option reserved for advanced abdominal malignancies utilized in this patient with a rare clinical entity.
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Procedimentos Cirúrgicos de Citorredução , Quimioterapia Intraperitoneal Hipertérmica , Neoplasias Ovarianas , Pseudomixoma Peritoneal , Teratoma , Adulto , Feminino , Humanos , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Ovariectomia , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/etiologia , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/cirurgia , Peritônio/patologia , Peritônio/cirurgia , Pseudomixoma Peritoneal/tratamento farmacológico , Pseudomixoma Peritoneal/etiologia , Pseudomixoma Peritoneal/patologia , Pseudomixoma Peritoneal/cirurgia , Salpingectomia , Síndrome , Teratoma/complicações , Teratoma/tratamento farmacológico , Teratoma/patologia , Teratoma/cirurgiaRESUMO
PURPOSE: To assess oncofertility content on fertility clinic websites as indicated by eight relevant keywords. Additionally, we sought to describe the relationship between oncofertility content and five predetermined clinic characteristics. METHODS: We examined 381 fertility clinic websites that are members of the Society for Associated Reproductive Technology (SART). Extracted data included clinic location, practice type (private vs academic), size (cycles/year), type of NCI designated center (cancer center vs comprehensive cancer center), and distance from the nearest NCI center. Additionally, we documented whether the clinic was located in a state mandating reproductive and infertility services and/or included fertility preservation for "iatrogenic infertility" as reported by the American Society for Reproductive Medicine (ASRM). Data were summarized using descriptive statistics and compared using chi-squared or t-test as appropriate. RESULTS: Of the 381 fertility clinic websites analyzed, 322 (85%) contained at least one oncofertility-related keyword. Most frequently used terms included cancer (79%) and fertility preservation (78%), while less frequently used terms included suppression (9.4%) and shielding (5.0%). Practices that initiated ≥ 501 cycles per year were more likely to mention one of the oncofertility keywords (OR 1.2; 95% CI 1.1-1.3). The associations of oncofertility website content with practice type, state-mandated fertility insurance coverage, and distance from an NCI-designated cancer center were not statistically significant. Large clinic size was the only predictive factor for inclusion of oncofertility website content. Further studies are required to evaluate whether inclusion of oncofertility content on clinic websites impacts the use of these services by patients with cancer. CONCLUSION: This is the first study correlating availability of oncofertility content on SART fertility clinic websites with consideration of geographic proximity to NCI designated cancer centers. Large clinic size was the only predictive factor for inclusion of oncofertility website content.
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Preservação da Fertilidade , Infertilidade , Neoplasias , Medicina Reprodutiva , Fertilidade , Clínicas de Fertilização , Humanos , Neoplasias/complicações , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: The craniofacial developmental abnormality can significantly complicate the oral rehabilitation of patients with oligodontia. This case report describes an interdisciplinary approach that took 7 years to successfully treat a young patient with non-syndromic oligodontia and midface deficiency. CASE PRESENTATION: A 14-year-old patient with complex oral and maxillofacial conditions and diagnosis of oligodontia presented to our clinic. In addition to 4 retained deciduous teeth and congenitally missing 10 permanent teeth, dentofacial findings included maxillary and malar deficiency with a concave facial profile, Angle Class III malocclusion, and poor dental esthetics. The interdisciplinary treatment included pre-surgical orthodontic decompensation, high Le Fort I maxillary osteotomy, postsurgical orthodontic therapy, osseous ridge augmentation using recombinant human bone morphogenetic protein-2 (rhBMP-2), interim removable partial denture, dental implant installation, interim implant prostheses, and final prosthetic rehabilitation. CONCLUSIONS: The successful treatment of patients with oligodontia and complex dentofacial abnormalities requires the close and orderly collaboration among orthodontist, oral maxillofacial surgeon, and prosthodontist. Within the limitations of this case report, presented interdisciplinary approaches may optimize the oral rehabilitation outcome in patients with similar clinical challenges. A prospective clinical investigation is desired to verify the benefit of presented interdisciplinary approach.
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Anodontia , Implantes Dentários , Prótese Parcial Removível , Adolescente , Anodontia/terapia , Assistência Odontológica , Humanos , Maxila/cirurgia , Estudos ProspectivosRESUMO
Uterine smooth muscle tumors are the most common tumors of the female genital tract and include leiomyoma (LM) and its variants, smooth muscle tumors of uncertain malignant potential (STUMP), and leiomyosarcoma (LMS). Accurate diagnosis of LMS is determined by nuclear atypia, mitotic count, and the presence or absence of tumor cell necrosis, a process which is often difficult and subjective. In this study, we correlated digital quantification of proliferation marker Ki-67 and mitotic marker phosphohistone H3 (PHH3) to mitotic count, classification of uterine smooth muscle tumors, and clinical outcomes. A total of 39 cases (17 LMS, 5 STUMP, 10 LM with bizarre nuclei, and 7 LM) were included. Mitotic count, Ki-67, and PHH3 were significantly correlated. When comparing the LMS group to the STUMP, LM with bizarre nuclei, and LM groups combined, LMS showed a significantly greater digital quantification of Ki-67 (median 10.6% vs. 0.4%, P<0.001) and PHH3 (median 0.5% vs. 0.14%, P=0.022). Ki-67 was a better predictor of LMS compared with PHH3 (area under the curve 0.92 vs. 0.73, P=0.017). Above a threshold Ki-67 value of 3.8%, the sensitivity was 82% and specificity was 91%. Clinical outcomes were available for 10 patients (8 LMS and 2 STUMP), and inferior progression-free survival was noted for patients with higher Ki-67 values. Overall, this study suggests that digital quantification of Ki-67 can potentially aid in diagnosis of LMS.
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Leiomioma , Leiomiossarcoma , Tumor de Músculo Liso , Neoplasias Uterinas , Biomarcadores Tumorais , Feminino , Humanos , Imuno-Histoquímica , Antígeno Ki-67 , Leiomioma/diagnóstico , Leiomiossarcoma/diagnóstico , Tumor de Músculo Liso/diagnóstico , Neoplasias Uterinas/diagnósticoRESUMO
OBJECTIVE: To assess the efficacy and safety of stereotactic body radiation therapy (SBRT) for oligometastatic gynecologic malignancies. METHOD: A comprehensive search of the PubMed, Medline, and EMBASE databases was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. "Oligometastatic" was defined as a limited number of uncontrolled/untreated metastatic lesions (typically ≤ 5), including regional nodal metastases. Primary outcomes were response rate (complete response or partial response), local control of oligometastatic lesions, and toxicity. RESULTS: Of 716 screened records, 17 studies (13 full length articles, 4 conference abstracts) were selected and analyzed as 16 unique studies. A total of 667 patients were treated with ~1071 metastatic lesions identified. Primary sites included ovarian (57.6%), cervical (27.1%), uterine (11.1%), vaginal (0.4%), vulvar (0.3%), and other/unspecified (3.4%). Most patients (65.4%) presented with a single metastatic lesion. Metastatic lesion sites included the abdomen (44.2%), pelvis (18.8%), thorax (15.5%), neck (4.6%), central nervous system (4.3%), bone (1.6%), and other/unspecified (11%). Of the lesions, 64% were nodal. Response rate (among 8 studies) ranged from 49% to 97%, with 7/8 studies reporting > 75% response rate. Local control ranged from 71% to 100%, with 14/16 studies reporting ≥ 80% local control. No grade ≥ 3 toxicities were observed in 9/16 (56%) studies. Median progression-free survival (PFS) (among 10 studies) ranged from 3.3 months to 21.7 months. Disease progression most commonly occurred outside of the SBRT radiation field (79% to 100% of failures). CONCLUSIONS: SBRT for oligometastatic gynecologic malignancies is associated with favorable response and local control rates but a high rate of out-of-field progression and heterogeneous PFS. Additional study into rational combinations of SBRT and systemic therapy appears warranted to further improve patient outcomes.
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Neoplasias dos Genitais Femininos/radioterapia , Metástase Neoplásica/radioterapia , Radiocirurgia/estatística & dados numéricos , Idoso , Feminino , Neoplasias dos Genitais Femininos/mortalidade , Humanos , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Estudos RetrospectivosRESUMO
OBJECTIVES: To investigate survival disparities and prognostic factors in vulvar cancer by age at diagnosis. METHODS: Women who underwent surgery and were diagnosed with stage I-IV vulvar cancer from 2004 to 2014 in the National Cancer Database were eligible. Proportions were compared using Chi-Square test. Survival was evaluated using Cox analysis. RESULTS: There were 18,207 eligible women. Median age at diagnosis was 64 years, and 31% diagnosed ≥75 years old were categorized as elderly. Most vulvar cancers were diagnosed at stage I and with squamous histology. Diagnosis with higher stage or non-squamous histology was more common in elderly vs. non-elderly patients (P < 0.001). Survival was 3.5 times worse in the elderly than the non-elderly (P < 0.0001). Risk of death for each 5-year increment in age increased by 22% for non-elderly and 43% for elderly patients (P < 0.0001). The prognostic value of comorbidity score, stage, regional node assessment and histology was smaller in elderly vs. non-elderly women (each P < 0.05). Adjuvant chemoradiotherapy (CTRT) use in the elderly vs. non-elderly was rare for stage I-II disease (3% vs. 2%) and more common for stage III-IV disease (6% vs. 43%), respectively (P < 0.0001). The survival disadvantage for elderly patients persisted following no adjuvant therapy, radiotherapy or chemotherapy alone, or CTRT (P < 0.0001). In stage III-IV disease, survival was superior following CTRT vs. radiotherapy when diagnosed <75 years (HR = 0.80, 95% CI = 0.69-0.93) but not in the elderly (HR = 0.99, P > 0.05). CONCLUSIONS: Age-associated risk of death increased at different rates in vulvar cancer and was larger in elderly vs. non-elderly patients. The impact of other prognostic factors was smaller in elderly vs. non-elderly women. The survival benefit of CTRT over radiotherapy in stage III-IV did not extend to the elderly.
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Institutos de Câncer/estatística & dados numéricos , Neoplasias Vulvares/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia Adjuvante/estatística & dados numéricos , Procedimentos Cirúrgicos de Citorredução/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radioterapia Adjuvante/estatística & dados numéricos , Estados Unidos/epidemiologia , Neoplasias Vulvares/patologia , Neoplasias Vulvares/terapia , Adulto JovemRESUMO
BACKGROUND: For patients with generalized epilepsy who do not respond to antiseizure medications, the therapeutic options are limited. Vagus nerve stimulation (VNS) is a treatment mainly approved for therapy-resistant focal epilepsy. There is limited information on the use of VNS on generalized epilepsies, including Lennox-Gastaut Syndrome (LGS) and genetic generalized epilepsy (GGE). METHODS: We identified patients with a diagnosis of generalized epilepsy (including LGS and GGE), who underwent VNS implantation at the London Health Sciences Centre and Western University, London, Ontario, since this treatment became available in Canada in 1997 until July 2018. We assessed response to the treatment, including admissions to hospital and complications. RESULTS: A total of 46 patients were included in this study with a history of therapy-resistant generalized epilepsy. The mean age at implantation was 24â¯years (interquartile range [IQR]â¯=â¯17.8-31â¯years), significantly younger in the LGS group (pâ¯=â¯0.02) and 50% (nâ¯=â¯23) were female. The most common etiologies were GGE in 37% (nâ¯=â¯17) and LGS in 63% (nâ¯=â¯29). Median follow-up since VNS implantation was 63â¯months (IQR: 31-112.8â¯months). Of the LGS group 41.7% (nâ¯=â¯12) of patients had an overall seizure reduction of 50% or more, and 64.7% (nâ¯=â¯11) in the GGE group without statistical significance between the groups. The best response in seizure reduction was seen in generalized tonic-clonic seizures, with a significant reduction in the GGE group (pâ¯=â¯0.043). There was a reduction of seizure-related hospital admissions from 91.3% (Nâ¯=â¯42) preimplantation, to 43.5% (Nâ¯=â¯20) postimplantation (pâ¯<â¯0.05). The frequency of side effects due to the stimulation was almost equal in both groups (62.1% in LGS and 64.7% in GGE). CONCLUSIONS: Vagus nerve stimulation should be considered as a treatment in patients with therapy-resistant generalized epilepsy, especially in cases with GGE.
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Epilepsia Resistente a Medicamentos/epidemiologia , Epilepsia Resistente a Medicamentos/terapia , Eletrodos Implantados , Epilepsia Generalizada/epidemiologia , Epilepsia Generalizada/terapia , Estimulação do Nervo Vago/métodos , Adolescente , Adulto , Epilepsia Resistente a Medicamentos/fisiopatologia , Epilepsia Generalizada/fisiopatologia , Feminino , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Estimulação do Nervo Vago/instrumentação , Adulto JovemRESUMO
OBJECTIVES: This pilot study evaluated whether contrast-enhanced subharmonic imaging (SHI) could be used to characterize adnexal masses before surgical intervention. METHODS: Ten women (with 12 lesions) scheduled for surgery of an ovarian mass underwent an SHI examination of their adnexal region using a modified LOGIQ E9 scanner (GE Healthcare, Waukesha, WI) with an endocavitary transducer, in which digital clips were acquired by pulse destruction-replenishment SHI across the lesions. Time-intensity curves were created offline to quantitatively evaluate SHI parameters (fractional tumor perfusion, peak contrast intensity, time to peak contrast enhancement, and area under the time-intensity curve), which were compared to pathologic characterizations of the lesions. RESULTS: Of the 12 masses, 8 were benign, and 4 were malignant. A qualitative analysis of the SHI images by an experienced radiologist resulted in diagnostic accuracy of 70%, compared to 56% without contrast, whereas an inexperienced radiologist improved from 50% to 58% accuracy, demonstrating the benefit of SHI. A quantitative analysis of SHI parameters produced diagnostic accuracy as high as 81%. Peak contrast intensity was significantly greater in malignant than benign masses (mean ± SD, 0.109 ± 0.088 versus 0.046 ± 0.030 arbitrary units; P = .046). Malignant masses also showed significantly greater perfusion than benign masses (24.79% ± 25.34% versus 7.62% ± 6.50%; P = .045). When the radiologist reads were combined with the most predictive quantitative SHI parameter (percent perfusion), diagnostic accuracy improved to 84% for the experienced radiologist and 96% for the novice radiologist. CONCLUSIONS: Results indicate that SHI for presurgical characterization of adnexal masses may improve the determination of malignancy and diagnostic accuracy, albeit based on a small sample size.
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Doenças dos Anexos/diagnóstico por imagem , Meios de Contraste , Aumento da Imagem/métodos , Neoplasias Ovarianas/diagnóstico por imagem , Ultrassonografia/métodos , Anexos Uterinos/diagnóstico por imagem , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: Microscopic residual disease following complete cytoreduction (R0) is associated with a significant survival benefit for patients with advanced epithelial ovarian cancer (EOC). Our objective was to develop a prediction model for R0 to support surgeons in their clinical care decisions. METHODS: Demographic, pathologic, surgical, and CA125 data were collected from GOG 182 records. Patients enrolled prior to September 1, 2003 were used for the training model while those enrolled after constituted the validation data set. Univariate analysis was performed to identify significant predictors of R0 and these variables were subsequently analyzed using multivariable regression. The regression model was reduced using backward selection and predictive accuracy was quantified using area under the receiver operating characteristic area under the curve (AUC) in both the training and the validation data sets. RESULTS: Of the 3882 patients enrolled in GOG 182, 1480 had complete clinical data available for the analysis. The training data set consisted of 1007 patients (234 with R0) while the validation set was comprised of 473 patients (122 with R0). The reduced multivariable regression model demonstrated several variables predictive of R0 at cytoreduction: Disease Score (DS) (p<0.001), stage (p=0.009), CA125 (p<0.001), ascites (p<0.001), and stage-age interaction (p=0.01). Applying the prediction model to the validation data resulted in an AUC of 0.73 (0.67 to 0.78, 95% CI). Inclusion of DS enhanced the model performance to an AUC of 0.83 (0.79 to 0.88, 95% CI). CONCLUSIONS: We developed and validated a prediction model for R0 that offers improved performance over previously reported models for prediction of residual disease. The performance of the prediction model suggests additional factors (i.e. imaging, molecular profiling, etc.) should be explored in the future for a more clinically actionable tool.
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Procedimentos Cirúrgicos de Citorredução/estatística & dados numéricos , Modelos Estatísticos , Neoplasias Epiteliais e Glandulares/patologia , Neoplasias Epiteliais e Glandulares/cirurgia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Idoso , Antígeno Ca-125/análise , Carcinoma Epitelial do Ovário , Estudos de Coortes , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Proteínas de Membrana/análise , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasia Residual , Valor Preditivo dos Testes , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Análise de RegressãoRESUMO
INTRODUCTION: Gynecologic oncology patients represent a distinct patient population with a variety of surgical risks. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database provides an opportunity to analyze large cohorts of patients over extended periods with high accuracy. Our goal was to develop a postoperative risk assessment calculator capable of providing a standardized, objective means of preoperatively identifying high-risk patients in the gynecologic oncology population. METHODS: We queried the ACS NSQIP database for gynecologic oncology patients from 2005 to 2013. Multivariate logistic regression was performed to generate predictive models specific for 30-day postoperative mortality and major morbidity. RESULTS: There were 12,831 patients with a primary gynecologic malignancy identified: 7847 uterine, 3366 adnexal, 1051 cervical, and 567 perineum cancers. In this cohort, 125 (0.97%) patients died, and 784 (6.11%) major morbidity events were recorded within 30 days of their surgery. For 30-day mortality, the mean calculated predictive probability was 0.128 (SD, 0.219) compared with 0.009 (SD, 0.027) in patients alive 30 days postoperatively (P < 0.0001). The mean predictive probability of major morbidity was 0.097 (SD, 0.095) compared with 0.059 (SD, 0.043) in patients who did not experience major morbidity 30 days postoperatively (P < 0.0001). CONCLUSIONS: Using NSQIP data, these predictive models will help to determine patients at risk for 30-day mortality and major morbidity. Further clinical validation of these models is required.
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Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Bases de Dados como Assunto , Feminino , Neoplasias dos Genitais Femininos/mortalidade , Procedimentos Cirúrgicos em Ginecologia/mortalidade , Humanos , Complicações Pós-Operatórias/mortalidade , Medição de Risco , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: The purpose of this study was to determine the effect of retroperitoneal (RP) exploration on progression-free survival (PFS) and overall survival (OS) in epithelial ovarian cancer (EOC) patients with stage IIIC disease who underwent optimal debulking surgery. METHODS: Data were collected from records of the Gynecologic Oncology Group 182 (GOG-182) study of stage IIIC EOC patients cytoreduced to no gross residual disease (R0) or minimal gross residual (<1 cm) disease (MGRD) at primary surgery. Patients with stage IIIC disease by intraperitoneal (IP) tumor were included and divided into 3 groups: 1) > 2 cm IP tumor without lymph node involvement (IP/RP-), 2) > 2 cm IP tumor with lymph node involvement (IP/RP+), and 3) > 2 cm IP tumor with no RP exploration (IP/RP?). The effects of disease distribution and RP exploration on PFS and OS were assessed using Kaplan-Meier and proportional hazards methods. RESULTS: There were 1871 stage IIIC patients in GOG-182 who underwent optimal primary debulking surgery. Of these, 689 (36.8%) underwent RP exploration with removal of lymph nodes from at least 1 para-aortic site, and 1182 (63.2%) did not. There were 269 patients in the IP/RP- group, 420 patients in the IP/RP + group, and 1182 patients in the IP/RP? group. Improved PFS (18.5 vs 16.0 months; P < .0001) and OS (53.3 vs 42.8 months; P < .0001) were associated with RP exploration versus no exploration. Patients with MGRD had improved PFS (16.8 vs 15.1 months, P = 0.0108) and OS (44.9 vs 40.5 months, P = 0.0076) versus no exploration. CONCLUSIONS: RP exploration at the time of primary surgery in patients with optimally debulked stage IIIC EOC is associated with a survival benefit. Cancer 2017;123:985-93. © 2016 American Cancer Society.
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Procedimentos Cirúrgicos de Citorredução , Neoplasias Epiteliais e Glandulares/patologia , Neoplasias Epiteliais e Glandulares/cirurgia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Epitelial do Ovário , Feminino , Humanos , Linfonodos/patologia , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasias Epiteliais e Glandulares/mortalidade , Razão de Chances , Neoplasias Ovarianas/mortalidade , Espaço Retroperitoneal/cirurgia , Análise de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVE: Only 3% of patients with epithelial ovarian cancer (EOC) have a longer treatment-free interval (TFI) after second-line intravenous (IV) platinum chemotherapy than with frontline IV therapy. We sought to examine what impact second-line combination IV/intraperitoneal (IV/IP) platinum therapy might have on the ratio of second-line to first-line TFI in patients treated with second-line IP platinum chemotherapy for first recurrence after front-line IV therapy. METHODS: A retrospective analysis of women who received combination platinum-based IV/IP chemotherapy for recurrent EOC between January 2005 and March 2011 was conducted. Patients were identified from the tumor registry, and office records from a large gynecologic oncology practice and patient records were reviewed. The first and second TFIs were defined as the time from the end of previous platinum-based therapy to the start of next therapy. RESULTS: Twenty-five women received IV/IP chemotherapy for their first EOC recurrence after IV chemotherapy. In 10 patients (40%), we observed a longer TFI after IV/IP chemotherapy than after primary IV chemotherapy. For these 10 patients, the median TFI for primary response was 22 months (range, 15-28), whereas median TFI after IV/IP chemotherapy for recurrent disease was 37 months (range, 12-61). CONCLUSIONS: For EOC patients with limited peritoneal recurrence, 40% of patients had a second-line IP-platinum TFI that exceeded their frontline IV-platinum TFI compared to published data. These data support the use of IV/IP chemotherapy as a treatment for recurrence.
Assuntos
Adenocarcinoma de Células Claras/mortalidade , Adenocarcinoma Mucinoso/mortalidade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cistadenocarcinoma Seroso/mortalidade , Neoplasias do Endométrio/mortalidade , Recidiva Local de Neoplasia/mortalidade , Neoplasias Ovarianas/mortalidade , Adenocarcinoma de Células Claras/tratamento farmacológico , Adenocarcinoma de Células Claras/patologia , Adenocarcinoma Mucinoso/tratamento farmacológico , Adenocarcinoma Mucinoso/patologia , Adulto , Idoso , Cisplatino/administração & dosagem , Cistadenocarcinoma Seroso/tratamento farmacológico , Cistadenocarcinoma Seroso/patologia , Neoplasias do Endométrio/tratamento farmacológico , Neoplasias do Endométrio/patologia , Feminino , Seguimentos , Humanos , Infusões Parenterais , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Paclitaxel/administração & dosagem , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
STUDY OBJECTIVE: There has recently been an expansion in the use of bilateral salpingectomy at the time of sterilization to theoretically decrease ovarian cancer risk. We sought to determine if postpartum salpingectomy is equivalent to postpartum bilateral tubal ligation (BTL) in terms of duration, estimated blood loss (EBL), and complication rate. DESIGN: A retrospective case series (Canadian Task Force Classification II-2). SETTING: An academic inner-city hospital. PATIENTS: All patients admitted for delivery of full-term intrauterine pregnancy desiring permanent sterilization between March 2014 and March 2015 were included. Excluded patients included those who had sterilization at the time of the cesarean section or other surgical procedure. Two cohorts were identified, those who had a planned postpartum tubal ligation and those having a postpartum salpingectomy. INTERVENTIONS: Postpartum sterilization. MEASUREMENTS AND MAIN RESULTS: Researchers of this study recorded demographics, medical histories, and abdominal surgical histories for all patients who met the inclusion criteria. Surgical times, EBL, and complication rates were reviewed. Unpaired t test calculations were used to identify differences between age, body mass index, parity, and surgical time between the 2 cohorts. Chi-square tests were used to determine the statistical significance between complication rates, history of abdominal surgery, and past medical history of tubal disease between the 2 cohorts. Eighty women were identified, 64 in the BTL group and 16 in the salpingectomy cohort. The demographics of each cohort were equivocal. The average surgical time was 59.13 and 71.44 minutes in the BTL and salpingectomy cohorts, respectively. Of the 80 patients, only 1 had an EBL greater than 50 mL; this patient was in the BTL group. Four complications were noted in the BTL cohort, but none were evident in the salpingectomy group. There were no documented sterilization failures in the follow-up period (median = 9 months). CONCLUSION: Postpartum salpingectomy is slightly longer in duration but with similar blood loss and complication rates. Salpingectomy could be considered in particularly high-risk patients at risk for ovarian cancer when consenting for a postpartum sterilization procedure.
Assuntos
Tubas Uterinas/cirurgia , Salpingectomia/métodos , Esterilização Tubária/métodos , Adolescente , Adulto , Cesárea , Feminino , Humanos , Pessoa de Meia-Idade , Duração da Cirurgia , Neoplasias Ovarianas/etiologia , Paridade , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Esterilização Reprodutiva/métodos , Adulto JovemRESUMO
STUDY OBJECTIVE: To identify, collate, and summarize the most common causes and pathologies of electric morcellation-related reoperations after laparoscopic myomectomy and nonmyomectomy procedures. DESIGN: A systematic review of published medical literature from January 1990 to February 2014 reporting morcellation-related reoperations after laparoscopic myomectomy and nonmyomectomy procedures involving the use of intracorporeal electric tissue morcellators. Publications were included in this review if patients underwent a second surgical procedure because of the onset of new clinical symptoms after a primary surgical procedure that involved intracorporeal morcellation or if histopathology of the morcellated surgical specimen revealed malignancy (Canadian Task Force classification II-3). SETTING: All case reports and case series were reported from community and academic hospitals in the United States and the rest of the world. PATIENTS: We identified 66 patients from 32 publications. INTERVENTIONS: Reoperation after laparoscopic myomectomy and nonmyomectomy procedures involving intracorporeal electric tissue morcellation. MEASUREMENTS AND MAIN RESULTS: For patients who presented with new clinical symptoms requiring reoperation, we recorded the follow-up period, nature and duration of the new symptoms, details of the second surgical procedure, intraoperative findings during the second surgical procedure, and the final histopathologic diagnosis. When histopathology of the morcellated specimen revealed malignancy, we recorded the specific type of malignancy, the corresponding surgical treatment that the patient underwent, and the follow-up period. Percentages and 95% confidence intervals were calculated for all categoric variables. Twenty-four (36.4%) patients underwent laparoscopic myomectomies, of which 19 (79.2%) and 5 (20.8%) patients required a second surgical procedure because of new clinical symptoms and the diagnosis of malignancy in the morcellated surgical specimen, respectively. Forty-two (63.6%) patients underwent laparoscopic hysterectomies; of these, 25 (59.5%) patients required a second surgical procedure because of the onset of new clinical symptoms, whereas the remaining 17 (40.5%) patients underwent a second surgical procedure because of the diagnosis of malignancy in the morcellated surgical specimen. The most common benign pathology was parasitic leiomyomata (22 patients, 33.3%). The most common malignant pathology was leiomyosarcoma (16 patients, 24.2%). CONCLUSION: Dispersion of tissue fragments into the peritoneal cavity at the time of morcellation continues to be a concern. It was previously thought that morcellated tissue fragments are resorbed by the peritoneal cavity; however, there is some evidence highlighting the long-term sequelae related to the growth and propagation of these dispersed tissue fragments in the form of parasitic leiomyomata, iatrogenic endometriosis, and cancer progression. Yet, the majority of laparoscopic myomectomy and nonmyomectomy procedures involving the use of intracorporeal electric tissue morcellators are uncomplicated, and institutions having no women with endometriosis or cancer are very unlikely to report surgical outcomes of uneventful electric morcellation. Thus, prospective studies are still required to validate the role of electric intracorporeal tissue morcellation in the pathogenesis of parasitic leiomyomata, iatrogenic endometriosis, and cancer progression.
Assuntos
Histerectomia , Complicações Intraoperatórias , Laparoscopia/efeitos adversos , Leiomioma , Reoperação , Miomectomia Uterina , Adulto , Endometriose/cirurgia , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Laparoscopia/métodos , Leiomioma/patologia , Leiomioma/cirurgia , Prontuários Médicos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Cavidade Peritoneal/patologia , Reoperação/métodos , Reoperação/estatística & dados numéricos , Risco Ajustado , Miomectomia Uterina/efeitos adversos , Miomectomia Uterina/métodos , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgiaRESUMO
Terra firma-forme dermatosis is a benign dermatologic condition that presents as dirt-colored patches and plaques, mainly affecting children and adolescents. It is resistant to conventional washing with soap and water but is easily treated with isopropyl alcohol. Clinical awareness of this condition provides a quick, simple resolution. Here we present two cases involving 14-year-old girls with uncommon presentations of terra firma-forme dermatosis. One case involved an upper extremity and the other presented with a history of knee brace occlusion. After diagnosis, both patients were successfully treated with weekly isopropyl alcohol applications.