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Sample records for underwent gynecological surgery

  1. Robotics in gynecologic surgery.

    Science.gov (United States)

    Frick, A C; Falcone, T

    2009-06-01

    Robotic surgery has evolved from an investigational surgical approach to a clinically useful adjunct in multiple surgical specialties over the past decade. Advocates of robotic-assisted gynecologic surgery revere the system's wristed instrumentation, ergonomic positioning, and three-dimensional high-definition vision system as significant improvements over laparoscopic equipment's four degrees of freedom and two-dimensional laparoscope that demand the surgeon stand throughout a procedure. The cost, lack of haptic feedback, and the bulky size of the equipment make robotics less attractive to others. Studies evaluating outcomes in robotic-assisted gynecologic surgery are limited. Multiple small retrospective studies demonstrate the safety and feasibility of robotic hysterectomy. With increased surgeon experience, operative times are similar to, or shorter than, laparoscopic cases. Robotic assistance can facilitate suturing in laparoscopic myomectomies, and is associated with decreased blood loss and a shorter hospital stay, although may require longer operative times. Robotic assistance has also been applied to multiple procedures in the subspecialties of infertility, urogynecology and gynecologic oncology with good success and relatively low morbidity. However, further research is warranted to better evaluate the relative benefits and costs of robotic assisted gynecologic surgery.

  2. Robotic surgery in gynecology.

    Science.gov (United States)

    Alkatout, Ibrahim; Mettler, Liselotte; Maass, Nicolai; Ackermann, Johannes

    2016-01-01

    Robotic surgery is the most dynamic development in the sector of minimally invasive operations currently. It should not be viewed as an alternative to laparoscopy, but as the next step in a process of technological evolution. The advancement of robotic surgery, in terms of the introduction of the Da Vinci Xi, permits the variable use of optical devices in all four trocars. Due to the new geometry of the "patient cart," an operation can be performed in all spatial directions without re-docking. Longer instruments and the markedly narrower mechanical elements of the "patient cart" provide greater flexibility as well as access similar to those of traditional laparoscopy. Currently, robotic surgery is used for a variety of indications in the treatment of benign gynecological diseases as well as malignant ones. Interdisciplinary cooperation and cooperation over large geographical distances have been rendered possible by telemedicine, and will ensure comprehensive patient care in the future by highly specialized surgery teams. In addition, the second operation console and the operation simulator constitute a new dimension in advanced surgical training. The disadvantages of robotic surgery remain the high costs of acquisition and maintenance as well as the laborious training of medical personnel before they are confident with using the technology.

  3. Robotic Surgery in Gynecologic Oncology

    Science.gov (United States)

    DeBernardo, Robert; Starks, David; Barker, Nichole; Armstrong, Amy; Kunos, Charles A.

    2011-01-01

    Robotic surgery for the management of gynecologic cancers allows for minimally invasive surgical removal of cancer-bearing organs and tissues using sophisticated surgeon-manipulated, robotic surgical instrumentation. Early on, gynecologic oncologists recognized that minimally invasive surgery was associated with less surgical morbidity and that it shortened postoperative recovery. Now, robotic surgery represents an effective alternative to conventional laparotomy. Since its widespread adoption, minimally invasive surgery has become an option not only for the morbidly obese but for women with gynecologic malignancy where conventional laparotomy has been associated with significant morbidity. As such, this paper considers indications for robotic surgery, reflects on outcomes from initial robotic surgical outcomes data, reviews cost efficacy and implications in surgical training, and discusses new roles for robotic surgery in gynecologic cancer management. PMID:22190946

  4. Robotic surgery in gynecology

    Directory of Open Access Journals (Sweden)

    Jean eBouquet De Jolinière

    2016-05-01

    Full Text Available Abstract Minimally invasive surgery (MIS can be considered as the greatest surgical innovation over the past thirty years. It revolutionized surgical practice with well-proven advantages over traditional open surgery: reduced surgical trauma and incision-related complications, such as surgical-site infections, postoperative pain and hernia, reduced hospital stay, and improved cosmetic outcome. Nonetheless, proficiency in MIS can be technically challenging as conventional laparoscopy is associated with several limitations as the two-dimensional (2D monitor reduction in-depth perception, camera instability, limited range of motion and steep learning curves. The surgeon has a low force feedback which allows simple gestures, respect for tissues and more effective treatment of complications.Since 1980s several computer sciences and robotics projects have been set up to overcome the difficulties encountered with conventional laparoscopy, to augment the surgeon's skills, achieve accuracy and high precision during complex surgery and facilitate widespread of MIS. Surgical instruments are guided by haptic interfaces that replicate and filter hand movements. Robotically assisted technology offers advantages that include improved three- dimensional stereoscopic vision, wristed instruments that improve dexterity, and tremor canceling software that improves surgical precision.

  5. Effect of different pneumoperitoneum pressure on stress state in patients underwent gynecological laparoscopy

    Directory of Open Access Journals (Sweden)

    Ai-Yun Shen

    2016-10-01

    Full Text Available Objective: To observe the effect of different CO2 pneumoperitoneum pressure on the stress state in patients underwent gynecological laparoscopy. Methods: A total of 90 patients who were admitted in our hospital from February, 2015 to October, 2015 for gynecological laparoscopy were included in the study and divided into groups A, B, and C according to different CO2 pneumoperitoneum pressure. The changes of HR, BP, and PetCO2 during the operation process in the three groups were recorded. The changes of stress indicators before operation (T0, 30 min during operation (T1, and 12 h after operation (T2 were compared. Results: The difference of HR, BP, and PetCO2 levels before operation among the three groups was not statistically significant (P>0.05. HR, BP, and PetCO2 levels 30 min after pneumoperitoneum were significantly elevated when compared with before operation (P0.05. PetCO2 level 30 min after pneumoperitoneum in group B was significantly higher than that in group A (P0.05. Conclusions: Low pneumoperitoneum pressure has a small effect on the stress state in patients underwent gynecological laparoscopy, will not affect the surgical operation, and can obtain a preferable muscular relaxation and vision field; therefore, it can be selected in preference.

  6. Bowel injury following gynecological laparoscopic surgery | Elbiss ...

    African Journals Online (AJOL)

    The role of robotic surgery and three-dimensional laparoscopic gynecological surgery on bowel injury needs to be further assessed. Conclusion: Early recognition of bowel injury is crucial for a favorable clinical outcome. A combined collaboration between gynecologists and general surgeons is important for timely and ...

  7. NUTRITION SUPPORT COMPLICATIONS IN PATIENT WHO UNDERWENT CARDIAC SURGERY

    OpenAIRE

    Krdžalić, Alisa; Kovčić, Jasmina; Krdžalić, Goran; Jahić, Elmir

    2016-01-01

    Background: The nutrition support complications after cardiac surgery should be detected and treated on time. Aim: To show the incidence and type of nutritional support complication in patients after cardiac surgery. Methods: The prospective study included 415 patients who underwent cardiac surgery between 2010 and 2013 in Clinic for Cardiovascular Disease of University Clinical Center Tuzla. Complications of the delivery system for nutrition support (NS) and nutrition itself were analy...

  8. Gynecologic Oncologist as surgical consultant: intraoperative consultations during general gynecologic surgery as an important focus of gynecologic oncology training.

    Science.gov (United States)

    Aviki, Emeline M; Rauh-Hain, J Alejandro; Clark, Rachel M; Hall, Tracilyn R; Berkowitz, Lori R; Boruta, David M; Growdon, Whitfield B; Schorge, John O; Goodman, Annekathryn

    2015-04-01

    The aim of this study is to explore the previously unexamined role of the Gynecologic Oncologist as an intraoperative consultant during general gynecologic surgery. Demographic and clinical data were collected on 98 major gynecologic surgeries that included both a general Gynecologist and a Gynecologic Oncologist between October 2010 and August 2014. Data were analyzed using XLSTAT-Prov2014.2.02. Of 794 major gynecologic surgeries, 98 (12.3%) cases that involved an intraoperative consultation were identified. There were 36 (37%) planned consults and 62 (63%) unplanned consults. Significantly more planned consults were during laparoscopy (100% v 58%; pGynecologic Oncologists play a pivotal role in the support of generalist colleagues during pelvic surgery. In this series, Gynecologic Oncologists were consulted frequently for complex major benign surgeries. It is important to incorporate the skills required of an intraoperative consultant into Gynecologic Oncology fellowship training. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. ANALYSIS OF QUALITY MANAGEMENT OF GYNECOLOGIC SURGERY

    Directory of Open Access Journals (Sweden)

    Borut Kobal

    2003-12-01

    Full Text Available Background. The »Quality Management Project«, prepared by the Slovene Medical Chamber, served as the basis for determination of the quality-control indicators for gynecologic surgery. The authors have created a questionnaire that enables the analysis of these indicators. A pilot data entry was carried out between April and October 2001; since January 2002 the data entry has been done regularly in all departments of obstetrics and gynecology in Slovenia. At the National Congress of Obstetricians and Gynecologists of Slovenia, the analysis of quality-control indicators for gynecologic surgery will be presented and discussed in order to determine the standards of quality management in this field.

  10. Pelvic Surgical Site Infections in Gynecologic Surgery

    Directory of Open Access Journals (Sweden)

    Mark P. Lachiewicz

    2015-01-01

    Full Text Available The development of surgical site infection (SSI remains the most common complication of gynecologic surgical procedures and results in significant patient morbidity. Gynecologic procedures pose a unique challenge in that potential pathogenic microorganisms from the skin or vagina and endocervix may migrate to operative sites and can result in vaginal cuff cellulitis, pelvic cellulitis, and pelvic abscesses. Multiple host and surgical risk factors have been identified as risks that increase infectious sequelae after pelvic surgery. This paper will review these risk factors as many are modifiable and care should be taken to address such factors in order to decrease the chance of infection. We will also review the definitions, microbiology, pathogenesis, diagnosis, and management of pelvic SSIs after gynecologic surgery.

  11. Bowel injury following gynecological laparoscopic surgery.

    African Journals Online (AJOL)

    Abstract. Background: Bowel injury remains a serious complication of gynecological laparoscopic surgery. We aimed to review the literature on this topic, combined with personal experiences, so as to give recommendations on how to avoid and manage this complication. Methods: We performed a narrative review on bowel ...

  12. Robot-assisted surgery in gynecological oncology

    DEFF Research Database (Denmark)

    Kristensen, Steffen E; Mosgaard, Berit J; Rosendahl, Mikkel

    2017-01-01

    INTRODUCTION: Robot-assisted surgery has become more widespread in gynecological oncology. The purpose of this systematic review is to present current knowledge on robot-assisted surgery, and to clarify and discuss controversies that have arisen alongside the development and deployment. MATERIAL...... was performed by screening of titles and abstracts, and by full text scrutiny. From 2001 to 2016, a total of 76 references were included. RESULTS: Robot-assisted surgery in gynecological oncology has increased, and current knowledge supports that the oncological safety is similar, compared with previous......-term detailed prospective cohorts or randomized controlled trials. The costs associated with acquisition, application, and maintenance have an unfavorable impact on cost-benefit evaluations, especially when compared with laparoscopy. Future developments in robot-assisted surgery will hopefully lead...

  13. Robot-assisted Surgery in Gynecologic Cancers.

    Science.gov (United States)

    Zanagnolo, Vanna; Garbi, Annalisa; Achilarre, Maria Teresa; Minig, Lucas

    Robotic-assisted surgery is a technological advancement that facilitates the application of minimally invasive techniques for complex operations in gynecologic oncology. The objective of this article was to review the literature regarding the role of robotic-assisted surgery to treat women with gynecologic cancers. The majority of publications on robotic surgery are still retrospective or descriptive in nature; however, the data for managing patients with a robotic-assisted approach show comparable, and at times improved, outcomes compared with both laparoscopy (2-dimensional) and laparotomy approaches. Robotic-assisted surgery has been used for patients with endometrial cancer and resulted in the increased use of minimally invasive surgery with improved outcomes compared with laparotomy and partially with laparoscopy. This has been shown in large cohorts of patients as well as in obese patients in whom the complication rates have significantly decreased. For early cervical cancer, robotic radical hysterectomy seems to be safe and feasible and to be preferable to laparotomy with seemingly comparable oncologic outcomes. Robotic-assisted surgery and conventional laparoscopy to stage women with early-stage ovarian cancer seem to have similar surgical and oncologic outcomes, with a shorter learning curve for robotic-assisted surgery. However, robotic-assisted surgery appears to be more expensive than laparotomy and traditional laparoscopy. In conclusion, robotic-assisted surgery appears to facilitate the surgical approach for complex operations to treat women with gynecologic cancers. Although randomized controlled trials are lacking to further elucidate the equivalence of robot-assisted surgery with conventional methods in terms of oncologic outcome and patients' quality of life, the technology appears to be safe and effective and could offer a minimally invasive approach to a much larger group of patients. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights

  14. Robotic gynecologic surgery: past, present, and future.

    Science.gov (United States)

    Chen, Chi Chiung Grace; Falcone, Tommaso

    2009-09-01

    Robotic techniques are increasingly being used to perform gynecologic surgical procedures including hysterectomies, performed for benign and malignant indications, myomectomies, tubal reanastomoses, and sacrocolpopexies. Robotic procedures seem to confer the same benefits as laparoscopic surgery without additional complications. It is unclear, however, whether robotic surgery imparts any additional benefits such as decreased operative times when compared with open or conventional laparoscopic techniques. The advantages to robotic surgery include improved visualization of the operative field with increased dexterity allowing more precise movements. Disadvantages include the learning curve associated with learning a new surgical technique and the equipment and operating costs of the robot and of using the robot.

  15. Robotic surgery in gynecologic oncology: impact on fellowship training.

    Science.gov (United States)

    Hoekstra, Anna V; Morgan, Jacqueline M; Lurain, John R; Buttin, Barbara M; Singh, Diljeet K; Schink, Julian C; Lowe, M Patrick

    2009-08-01

    To report the impact of a new robotic surgery program on the surgical training of gynecologic oncology fellows over a 12 month period of time. A robotic surgery program was introduced into the gynecologic oncology fellowship program at Northwestern University Feinberg School of Medicine in June 2007. A database of patients undergoing surgical management of endometrial and cervical cancer between July 2007 and July 2008 was collected and analyzed. Changes in fellow surgical training were measured and analyzed. Fellow surgical training for endometrial and cervical cancer underwent a dramatic transition in 12 months. The proportion of patients undergoing minimally invasive surgery increased from 3.3% (4/110 patients) to 43.5% (47/108 patients). Fellow training transitioned from primarily an open approach (94.4%) to a minimally invasive approach (11% laparoscopic, 49% robotic, 40% open) for endometrial cancer stagings, and from an open approach (100%) to an open (50%) and robotic (50%) approach for radical hysterectomies. Fellow participation in robotic procedures increased from 45% in the first 3 months to 72% within 6 months, and 92% by 12 months. The role of the fellow in robotic cases transitioned from bedside assistant to console operator within 3 months. Fellow surgical training underwent a dramatic change with the introduction of a robotic surgery program. The management of endometrial and cervical cancer was impacted the most by robotics. Robotic surgery broadened fellowship surgical training, but balanced surgical training and standardized fellow training modules remain challenges for fellowship programs.

  16. Be wary of “natural” therapy in gynecological surgery

    Directory of Open Access Journals (Sweden)

    Erian M

    2013-06-01

    Full Text Available Mark Erian,1 Glenda McLaren21Department of Obstetrics and Gynaecology, University of Queensland, Royal Brisbane and Women's Hospital, Herston, 2Obstetrician and Gynaecologist, Mater Mothers Private Hospital, University of Queensland, Brisbane, QLD, AustraliaAbstract: It is estimated that more than 4 billion people throughout the world use natural herbs for some aspect of primary health care. These over-the-counter medications, commonly referred to as “complementary and alternative medicines,” despite their proposed health benefits, may have serious and potentially fatal side effects. This paper presents the case of a patient who underwent a gynecological operation and suffered heavy postoperative bleeding as a result of her taking large doses of oral raw garlic in the weeks prior to her operation and discusses the issue of patients’ perioperative intake of herbal supplements. To our knowledge, this is the first paper to demonstrate the relationship between a natural therapy and postoperative bleeding in gynecological surgery. The patient presented with severe postoperative bleeding following a routine, unremarkable vaginal hysterectomy. The bleeding required a multidisciplinary management intervention involving gynecological surgeons, general surgeons, oncology surgeons, hematologists, anesthetists, and intensive care unit specialists. After careful history taking (unfortunately, undertaken postoperatively, it was unanimously agreed that the postoperative hemorrhage was due to the patient’s excessive preoperative oral ingestion of raw garlic. The case and brief literature review presented in this paper concern an area of paucity in gynecological surgery and highlight the relationship between a commonly taken over-the-counter herbal medication and postoperative hemorrhage.Keywords: herbs, gynecological surgery, complementary medicines, alternative medicines, postoperative hemorrhage

  17. Robotic-assisted surgery in gynecologic oncology.

    Science.gov (United States)

    Sinno, Abdulrahman K; Fader, Amanda N

    2014-10-01

    The quest for improved patient outcomes has been a driving force for adoption of novel surgical innovations across surgical subspecialties. Gynecologic oncology is one such surgical discipline in which minimally invasive surgery has had a robust and evolving role in defining standards of care. Robotic-assisted surgery has developed during the past two decades as a more technologically advanced form of minimally invasive surgery in an effort to mitigate the limitations of conventional laparoscopy and improved patient outcomes. Robotically assisted technology offers potential advantages that include improved three-dimensional stereoscopic vision, wristed instruments that improve surgeon dexterity, and tremor canceling software that improves surgical precision. These technological advances may allow the gynecologic oncology surgeon to perform increasingly radical oncologic surgeries in complex patients. However, the platform is not without limitations, including high cost, lack of haptic feedback, and the requirement for additional training to achieve competence. This review describes the role of robotic-assisted surgery in the management of endometrial, cervical, and ovarian cancer, with an emphasis on comparison with laparotomy and conventional laparoscopy. The literature on novel robotic innovations, special patient populations, cost effectiveness, and fellowship training is also appraised critically in this regard. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  18. Venous thromboembolic events in minimally invasive gynecologic surgery

    Science.gov (United States)

    Ramirez, Pedro T.; Nick, Alpa M.; Frumovitz, Michael; Schmeler, Kathleen M.

    2015-01-01

    The rate of venous thromboembolic events (VTE) including deep venous thrombosis (DVT) and pulmonary embolism (PE) among women undergoing gynecologic surgery is high, particularly for women with a gynecologic malignancy. Current guidelines recommend VTE thrombopropylaxis in the immediate postoperative period for patients undergoing open surgery. However, the VTE prophylaxis recommendations for women undergoing minimally invasive gynecologic surgery are not as well established. The risk of VTE in patients undergoing minimally invasive surgery appears to be low based on retrospective analyses. To date, there are no established guidelines that specifically provide a standard of care for patients undergoing minimally invasive gynecologic surgery for benign or malignant disease. PMID:23850360

  19. COMPARATIVE ASSESSMENT OF ANESTHESIA METHODS FOR GYNECOLOGIC SURGERY

    Directory of Open Access Journals (Sweden)

    I. I. Khusainova

    2016-01-01

    Full Text Available The purpose of the study: to improve the quality of anesthesia for gynecologic cancer surgery. materials and methods. The study included 421 patients who underwent a routine hysterectomy. The patients were divided into 3 groups with respect to analgesic method. The method of multimodal balanced analgesia was used in all cases. Group I patients additionally received epidural analgesia. Group II patients did not receive epidural analgesia (the control group. Group III patients received 600 mg of gabapentin as an adjuvant to opioid analgesia. Results. A significant difference in pain intensity within the first 72 hours after surgery between 3 groups of patients was found. Oral gabapentin as an adjunct to patient-controlled epidural analgesia provided efficient pain relief, reduction in the need for opioid analgesics in the perioperative period, as well as reduction in the incidence of postoperative nausea and vomiting after surgery.

  20. Opioid use following gynecologic and pelvic reconstructive surgery.

    Science.gov (United States)

    Hota, Lekha S; Warda, Hussein A; Haviland, Miriam J; Searle, Frances M; Hacker, Michele R

    2017-09-09

    Opioid use, addiction, and overdose are a growing epidemic in the USA. Our objective was to determine whether the amount of opioid medication prescribed following gynecologic and pelvic reconstructive surgery is insufficient, adequate, or in excess. We hypothesized that we were overprescribing postoperative opioids. Participants who were at least 18 years old and underwent gynecologic and/or pelvic reconstructive surgery from April through August 2016 were eligible to participate. Routine practice for pain management is to prescribe 30 tablets of opioids for major procedures and ten to 15 tablets for minor procedures. At the 2-week postoperative visit, participants completed a questionnaire regarding the number of tablets prescribed and used, postoperative pain control, and relevant medical history. Fisher's exact test was used to compare data. Sixty-five participants completed questionnaires. Half (49.1%) reported being prescribed more opioids than needed, while two (3.5%) felt the amount was less than needed. Though not significant, participants who underwent major surgeries were more likely to report being prescribed more than needed (53.5%) compared with participants who underwent minor surgeries (35.7%; p = 0.47). Though not significant, participants with anxiety were less likely to report being prescribed more tablets than needed compared with participants without anxiety (44.4% vs. 57.1%; p = 0.38). This was also true of participants with depression compared with those without (37.5% vs. 58.3%; p = 0.17), and those with chronic pain compared with those without (33.3% vs. 60.0%; p = 0.10). Our current opioid prescription practice for postoperative pain management may exceed what patients need.

  1. Prospective observational study comparing traditional laparoscopy and three-dimensional laparoscopy in gynecologic surgery.

    Science.gov (United States)

    Lara-Domínguez, Maria D; López-Jiménez, Araceli; Grabowski, Jacek P; Arjona-Berral, Jose E; Zapardiel, Ignacio

    2017-03-01

    To compare perioperative details among patients who underwent gynecologic surgery between traditional laparoscopy and three-dimensional laparoscopy. The present prospective non-randomized study enrolled all consecutive patients diagnosed with gynecologic pathology who underwent laparoscopic surgery at Reina Sofia Hospital, Cordoba, Spain between January 1 and April 30, 2014. Perioperative data, adverse events, and patient satisfaction were compared between patients who underwent treatment with two-dimensional and three-dimensional laparoscopic surgery techniques. The study enrolled 60 consecutive patients; 31 (52%) patients who underwent three-dimensional surgery and 29 (48%) who underwent traditional two-dimensional surgery. No significant differences were observed in the adverse-event rate, operating time, or perioperative parameters. A higher use of sealing devices was recorded among patients who underwent three-dimensional laparoscopy (P=0.021). No difference was recorded in patient satisfaction between the two patient groups. Although there was no impact on surgical outcomes, three-dimensional surgery could give a more accurate view of the surgical field. Performing three-dimensional surgery could be beneficial for more complex procedures although further comparative studies are required to investigate this hypothesis. © 2016 International Federation of Gynecology and Obstetrics.

  2. Robot-assisted gynecological surgery in a community setting.

    Science.gov (United States)

    Piquion-Joseph, Johann M; Nayar, Anju; Ghazaryan, Armine; Papanna, Ramesha; Klimek, Waldemar; Laroia, Rahul

    2009-06-01

    The objective of this study is to review our experience using the da Vinci robotic system to perform various gynecological surgeries for benign indications. Between July 2005 and April 2008, 110 patients underwent robot-assisted gynecological surgeries in Rochester General Hospital, NY. The records of these patients were retrospectively reviewed by an independent data collector to analyze the safety, effectiveness, and outcome of the surgeries done using the robotic system. The parameters reviewed include indication for surgery, type of procedure, operative time, blood loss, hospital stay, and intraoperative and post operative complications. The procedures completed include 74 hysterectomies including hysterectomies with bilateral salpingoophorectomy, 15 hysterectomies with sacrocolpopexy and other concomitant procedures, 18 myomectomies, and 3 oophorectomies. All procedures were completed robotically without the need for conversion to an open approach. The mean operation time was 2.15 h. Average estimated blood loss was 160 cc. Complications encountered include one cystotomy which was identified immediately and repaired in addition to one vault dehiscence and two post operative infections. The mean hospital stay was 1 day, with more than half of the patients being discharged within 24 h after the surgery. Post operative pain level was in the range of 0-6 in a scale of 0-10 (0: no pain, 10: worst pain in their life) and relieved by non-steroidal anti-inflammatory drugs. Robot-assisted laparoscopic benign surgical procedures are feasible techniques in a community setting. Robot-assisted laparoscopy has a promising future in minimally invasive surgery as it proved beneficial for our patients who experienced low complication rate and overall fast recovery compared to other approaches.

  3. Readmission After Gynecologic Surgery: A Comparison of Procedures for Benign and Malignant Indications.

    Science.gov (United States)

    Cory, Lori; Latif, Nawar; Brensinger, Colleen; Zhang, Xiaochen; Giuntoli, Robert L; Burger, Robert A; Morgan, Mark; Ko, Emily

    2017-08-01

    To compare 30-day postsurgical readmission rates and associated risk factors for readmission among women undergoing gynecologic surgery for benign and malignant conditions. In a retrospective cohort study, we identified patients after surgery for benign and malignant gynecologic conditions in the National Surgical Quality Improvement Program database between January 1, 2011, and December 31, 2012. Data collected included surgical factors, perioperative characteristics, surgical complications, and 30-day readmissions. The primary study outcome was readmission rates after gynecologic surgery for benign and oncologic conditions. Secondary study outcomes were risk factors associated with readmission among gynecologic surgeries performed for benign and oncologic conditions. Approximately 3% (1,444/46,718) compared with 8.2% (623/7,641) of patients who underwent gynecologic surgery for benign and malignant indications, respectively, were readmitted (Pgynecologic cancer surgery included worse preoperative conditions (OR 1.49, 95% CI 1.17-1.90) and major complications (OR 17.84, 95% CI 14.19-22.43). In comparison, independent risk factors for readmission after surgery for benign indications included comorbid conditions (OR 1.36, 95% CI 1.18-1.57), operative time (15-59 minutes: referent; 60 minutes or greater: 1.37, 95% CI 1.14-1.63) and major complications (OR 53.91, 95% CI 46.98-61.85). Among gynecologic surgeries, those performed for oncologic indications were associated with readmission rates 2.8 times that of surgeries performed for benign indications. In adjusted models, worse preoperative conditions and surgical complications remained independent risk factors associated with the higher rate of readmission among patients with gynecologic cancer.

  4. Concomitant Repair of Pelvic Floor Disorders in Women Undergoing Surgery for Gynecologic Malignancies.

    Science.gov (United States)

    Bochenska, Katarzyna; Mueller, Margaret; Geynisman-Tan, Julia; Leader-Cramer, Alix; Davé, Bhumy; Lewicky-Gaupp, Christina; Kenton, Kimberly

    2018-04-04

    The aims of this study were to determine the rate and describe 30-day postoperative complications of concomitant pelvic organ prolapse and/or urinary incontinence (POPUI) procedures in women undergoing surgery for a gynecologic malignancy. Women who underwent surgical intervention for a gynecologic malignancy between 2010 and 2014 were identified using postoperative International Classification of Diseases, Ninth Revision codes 179.0 to 184.9 in the American College of Surgeons National Surgical Quality Improvement Program database. Women who underwent POPUI procedures were identified using Current Procedural Terminology codes between 51840 and 58294. Infectious, pulmonary, cardiac, and venous thromboembolism complication rates were calculated. Patient demographics and postoperative complication rates were analyzed using Student t, χ, and Fisher exact tests and compared between women with a gynecologic malignancy who did and did not undergo concomitant POPUI procedures. We identified 23,501 women with a diagnosis of a gynecologic malignancy. The most common included uterine (63%), ovarian (25%), and cervical cancer (8%). Only a small proportion of the women undergoing gynecologic cancer surgery (n = 556 [2.4%]) had concomitant POPUI procedures. The most commonly performed POPUI procedures included anterior and/or posterior colporrhaphy (n = 205 [32%]), laparoscopic colpopexy (n = 181 [28.2%]), and midurethral sling (n = 70 [10.9%]). There were no differences in 30-day reoperation; infectious, pulmonary, and cardiac complications; or venous thromboembolic events between women who did and did not have concomitant POPUI surgery. Using a large national surgical database, only 2.4% of women undergoing gynecologic cancer surgery had a concomitant POPUI procedure. Our data suggest that postoperative complications may not increase when concomitant surgery for POPUI is done at the time of gynecologic cancer surgery.

  5. Characteristics of team briefings in gynecological surgery.

    Science.gov (United States)

    Forsyth, Katherine L; Hildebrand, Emily A; Hallbeck, M Susan; Branaghan, Russell J; Blocker, Renaldo C

    2018-02-24

    Preoperative briefings have been proven beneficial for improving team performance in the operating room. However, there has been minimal research regarding team briefings in specific surgical domains. As part of a larger project to develop a briefing structure for gynecological surgery, the study aimed to better understand the current state of pre-operative team briefings in one department of an academic hospital. Twenty-four team briefings were observed and video recorded. Communication was analyzed and social network metrics were created based on the team member verbal interactions. Introductions occurred in only 25% of the briefings. Network analysis revealed that average team briefings exhibited a hierarchical structure of communication, with the surgeon speaking the most frequently. The average network for resident-led briefings displayed a non-hierarchical structure with all team members communicating with the resident. Briefings conducted without a standardized protocol can produce variable communication between the role leading and the team members present. Copyright © 2018 Elsevier Ltd. All rights reserved.

  6. Postoperative adhesion prevention in gynecologic surgery with hyaluronic acid.

    Science.gov (United States)

    Carta, G; Cerrone, L; Iovenitti, P

    2004-01-01

    Despite improvements in surgical instrumentation and techniques, adhesions continue to form after most procedures. Peritoneal adhesions develop in 60-90% of women who undergo major gynecological operations. This adhesion formation causes significant postoperative morbidity such as bowel obstruction (65%), infertility (15-20%), and chronic pelvic pain (40%). To demonstrate the efficacy of a hyaluronic acid product (Hyalobarrier Gel) for the prevention of adhesions in gynecological surgery. From October 2000 to July 2002, 18 women from 26 to 41 years old (mean age 33.66) underwent myomectomy via laparotomy as their first abdominal operation. Between August 2001 and May 2003, the patients underwent a second-look laparoscopy (7 women, 38.9%, 15 sites, 42.8%) or a second-look laparotomy (11 women, 61.1%, 20 sites, 57.1%) during which all the 35 sites corresponding to the previous myomectomies were analyzed. During the second-look procedure the presence, localization and severity of adhesions were evaluated using the Operative Laparoscopy Study Group Classification (OLSG) and American Fertility Society Classification (AFSC). All patients underwent a second-look laparoscopy/laparotomy and only five of 18 (27.7%) showed pelvic adhesions in seven sites (20%) of previous myomectomies. No adhesion was found on the previous sites of myomectomies of pedunculated leiomyomas so, excluding those, adhesions were found in seven of 29 sites of myomectomies (24.1%). The present study emphasizes the need for improved treatments to prevent adhesions, as there is no doubt that adhesions represent one of the major causes of female morbidity.

  7. [Influence of previous abdominopelvic surgery on gynecological laparoscopic operation].

    Science.gov (United States)

    Jin, Haoran; Shi, Wei; Zhou, Yingfang; Wu, Beisheng; Peng, Chao

    2014-09-01

    To investigate the influence of previous abdominopelvic surgery on gynecological laparoscopic operation. A retrospective analysis of 3 283 cases of gynecological diseases by laparoscopic operation patients in Peking University First Hospital from 2007 January to 2012 December, among them, 719 (21.90%) patients with previous abdominopelvic surgery history (study Group), 2 564 (78.10%)patients have no history of abdominopelvic surgery (control group). Study group 719 patients, previous operation times: one time in 525 cases, 194 cases were multiple; previous operation: 185 cases of gynecological surgery, 305 cases of obstetric surgery, 108 cases of general surgery, and 121 complex surgery (include at least two kinds of surgery); previous operative approach: 650 cases laparotomy and 69 cases laparoscopy. Compared two groups of patients with abdominopelvic adhesion and the gynecologic laparoscopic operation situation, analyzed the influence of previous abdominopelvic surgery on abdominopelvic adhesion on and gynecological laparoscopic operation. The incidence of abdominopelvic adhesion in the patients with previous abdominopelvic surgery was 51.2% (368/719), which was significantly higher than that of 8.2% (211/2 564)in patients without previous abdominopelvic surgery (P surgery (23.1%, 166/719) was significantly higher than that in the control group (3.3% , 85/2 564;P laparotomy was 0.6% (4/719) significantly more than the control groups (0.1%, 2/2 564; P = 0.023). Compared with other groups, patients with gynecological or complex surgery or multiple operation history presented more severe abdominopelvic adhesion both in the score and degree (P laparotomy showed no statistical difference between the two groups (P > 0.05). The laparoscopic operation could be carried out successfully and safely in patients with a history of various abdominopelvic operations, but the conversion rate increases, for patients with a history of multiple operation because of pelvic adhesion

  8. The Role of Liver-directed Surgery in Patients with Hepatic Metastasis from a Gynecologic Primary Carcinoma

    Science.gov (United States)

    Kamel, Sarah I.; de Jong, Mechteld C.; Schulick, Richard D.; Diaz-Montes, Teresa P.; Wolfgang, Christopher L.; Hirose, Kenzo; Edil, Barish H.; Choti, Michael A.; Anders, Robert A.

    2013-01-01

    Background The management of patients with liver metastasis from a gynecologic carcinoma remains controversial, as there is currently little data available. We sought to determine the safety and efficacy of liver-directed surgery for hepatic metastasis from gynecologic primaries. Methods Between 1990 and 2010, 87 patients with biopsy-proven liver metastasis from a gynecologic carcinoma were identified from an institutional hepatobiliary database. Fifty-two (60%) patients who underwent hepatic surgery for their liver disease and 35 (40%) patients who underwent biopsy only were matched for age, primary tumor characteristics, and hepatic tumor burden. Clinicopathologic, operative, and outcome data were collected and analyzed. Results Of the 87 patients, 30 (34%) presented with synchronous metastasis. The majority of patients had multiple hepatic tumors (63%), with a median size of the largest lesion being 2.5 cm. Of those patients who underwent liver surgery (n = 52), most underwent a minor hepatic resection (n = 44; 85%), while 29 (56%) patients underwent concurrent lymphadenectomy and 45 (87%) patients underwent simultaneous peritoneal debulking. Postoperative morbidity and mortality were 37% and 0%, respectively. Median survival from time of diagnosis was 53 months for patients who underwent liver-directed surgery compared with 21 months for patients who underwent biopsy alone (n = 35) (p = 0.01). Among those patients who underwent liver-directed surgery, 5-year survival following hepatic resection was 41%. Conclusions Hepatic surgery for liver metastasis from gynecologic cancer can be performed safely. Liver surgery may be associated with prolonged survival in a subset of patients with hepatic metastasis from gynecologic primaries and therefore should be considered in carefully selected patients. PMID:21452068

  9. Obstructive sleep apnea and postoperative complications among patients undergoing gynecologic oncology surgery.

    Science.gov (United States)

    Bamgbade, Olumuyiwa A; Khaw, Rong R; Sawati, Raisah S; Holland, Cathrine M

    2017-07-01

    To investigate the prevalence of obstructive sleep apnea (OSA), physiological or risk factors associated with OSA, and OSA-associated postoperative complications among patients undergoing gynecologic oncology surgery. A prospective observational study enrolled gynecologic oncology patients undergoing abdominal surgery at a center in the UK between August 2009 and January 2013. All patients underwent perioperative sleep oximetry for the diagnosis of OSA. Data assessed included the body mass index, the STOP-Bang score, the Epworth Sleepiness Scale score, the apnea-hypopnea index, and postoperative complications. Associations were determined between preoperative OSA and postoperative OSA, postoperative complications, and risk factors such as body mass index, age, STOP-Bang score, and Epworth score. Among 160 participants, 72 (45.0%) were obese and 80 (50.0%) had OSA. Obesity, older age (more than 65 years), and a neck circumference of 40 cm or more were significantly associated with OSA. Overall, 58 (36.3%) patients had postoperative complications; 21 (13.1%) had surgical complications and 37 (23.1%) had medical complications. Complications were not associated with OSA (P=0.612). Four (2.5%) patients died; mortality was not associated with OSA (P=0.810). OSA is common among gynecologic oncology patients. Portable sleep oximetry identifies gynecology patients who have OSA or require postoperative critical care. Obesity is associated with OSA, but OSA is not associated with postoperative complications in gynecologic oncology patients. © 2017 International Federation of Gynecology and Obstetrics.

  10. Review of enhanced recovery programs in benign gynecologic surgery.

    Science.gov (United States)

    Trowbridge, Elisa R; Dreisbach, Caitlin N; Sarosiek, Bethany M; Dunbar, Catherine Page; Evans, Sarah Larkin; Hahn, Lee Anne; Hullfish, Kathie L

    2018-01-01

    Enhanced recovery programs (ERPs) are evidence-based protocols designed to improve functional rehabilitation after surgery. ERPs have gained widespread acceptance in many surgical disciplines, and their use leads to significant improvements in patient outcomes while reducing hospital length of stay (LOS). There remains a paucity of data on the use of ERPs in benign gynecologic surgery. The purpose of this review was to evaluate current literature on the use of ERP concepts in benign gynecologic surgery. A systematic search of PubMed, CINAHL, Web of Science, and the Cochrane databases was conducted, cross-referencing search terms related to gynecologic surgery and ERP concepts. The search was limited to publications available in English. Studies published prior to 2000, and those involving gynecologic oncology, nonadult patients, and outpatient surgery were excluded. Nine studies were included in the analysis. Due to heterogeneity of the included studies, no statistical pooling was possible and comparison between studies was limited to their respective themes. Primary study outcomes included LOS, postoperative nausea and vomiting (PONV), pain management, patient satisfaction, and hospital costs. Five studies investigated ERPs, two evaluated measures to improve PONV, and four focused on unique aspects of pain management. Across the studies, ERPs that focused on the patients' basic symptoms and recovery were found to have equal, if not better, outcomes than standard practice. This integrative review supports the implementation of ERPs in benign gynecologic surgery. The results showed that the use of ERPs decreased LOS, improved pain scores, and reduced hospital costs, without increasing perioperative complications. We suggest additional randomized controlled trials of ERP concepts in benign gynecologic surgery to support their more widespread use and application.

  11. Evaluation of indicated non-cosmetic panniculectomy at time of gynecologic surgery.

    Science.gov (United States)

    Rasmussen, Ryan W; Patibandla, Jay R; Hopkins, Michael P

    2017-08-01

    To report postoperative outcomes among patients undergoing indicated non-cosmetic panniculectomy at the time of gynecologic surgery. Medical charts were retrospectively reviewed for patients who underwent panniculectomy coupled with gynecologic surgery at a university-affiliated hospital in the USA in 1990-2014. The data reviewed included age, body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), surgical procedure, estimated blood loss, pathology, wound complication, diabetes, hypertension, smoking, and readmission rate. One-way analysis of variance and logistic regression were used to evaluate the data. In total, 300 patients underwent panniculectomy; the mean age was 51 years and the mean BMI was 46. Overall, there were 94 (31.3%) complications, including 85 (28.3%) cases of superficial cellulitis and 9 (3.0%) cases of surgical-site infection. In logistic regression, diabetes, hypertension, and smoking were significant predictors of wound complications, identifying 78% of women who subsequently developed wound complications. Panniculectomy combined with gynecologic surgery was found to be safe and effective for obese patients, with an acceptable incidence of wound infection. History of diabetes, hypertension, and smoking increased the risk of postoperative wound complications. These factors will help to predict patients at risk of wound complication. © 2017 International Federation of Gynecology and Obstetrics.

  12. [Comparison of robotic surgery documentary in gynecological cancer].

    Science.gov (United States)

    Vargas-Hernández, Víctor Manuel

    2012-01-01

    Robotic surgery is a surgical technique recently introduced, with major expansion and acceptance among the medical community is currently performed in over 1,000 hospitals around the world and in the management of gynecological cancer are being developed comprehensive programs for implementation. The objectives of this paper are to review the scientific literature on robotic surgery and its application in gynecological cancer to verify its safety, feasibility and efficacy when compared with laparoscopic surgery or surgery classical major surgical complications, infections are more common in traditional radical surgery compared with laparoscopic or robotic surgery and with these new techniques surgical and staying hospital are lesser than the former however, the disadvantages are the limited number of robot systems, their high cost and applies only in specialized centers that have with equipment and skilled surgeons. In conclusion robotic surgery represents a major scientific breakthrough and surgical management of gynecological cancer with better results to other types of conventional surgery and is likely in the coming years is become its worldwide.

  13. Appropriate Use of Prophylactic Antibiotic Agents in Gynecologic Surgeries at a Midwestern Teaching Hospital.

    Science.gov (United States)

    Uppendahl, Locke; Chiles, Caitlin; Shields, Stephanie; Dong, Fanglong; Kraft, Elizabeth; Duong, Jennifer; Delmore, James

    2018-02-16

    The purpose of this study was to establish compliance with guidelines published by the American College of Obstetricians and Gynecologists (ACOG) regarding prophylactic antibiotic use in gynecologic surgery at our institution, and define areas of improvement to promote antibiotic stewardship. This was a retrospective cohort study at a single, large tertiary care and teaching hospital in Kansas. Patients who underwent inpatient or outpatient gynecologic surgery during 2013 were included. Based on published guidelines for prophylactic antibiotic agents for gynecologic surgery by ACOG, procedures were classified as antibiotic-indicated or antibiotic-not-indicated. Chi-square and Fisher exact test analysis were used to identify factors associated with antibiotic use. Of the 1,735 cases eligible for inclusion, 1,045 (60.2%) had antibiotic agents recommended per guidelines, and appropriate antibiotic agents were given in 1,031 (98.7%) of those cases. In 690 (39.8%) cases, prophylactic antibiotics were either not recommended or the guidelines are not well defined. Of the 690 cases without indication for antibiotic agents, 394 (57.1%) received prophylactic antibiotic agents. Agreement with guidelines varied substantially based on patient age, race, insurance status, area of residence, and if the procedure was a resident case (p gynecologic surgeries for which published guidelines are not well defined. Future studies need to identify strategies to reduce antibiotic use in surgical procedures unlikely to benefit from prophylaxis.

  14. Does a robotic surgery approach offer optimal ergonomics to gynecologic surgeons?: a comprehensive ergonomics survey study in gynecologic robotic surgery

    Science.gov (United States)

    2017-01-01

    Objective To better understand the ergonomics associated with robotic surgery including physical discomfort and symptoms, factors influencing symptom reporting, and robotic surgery systems components recommended to be improved. Methods The anonymous survey included 20 questions regarding demographics, systems, ergonomics, and physical symptoms and was completed by experienced robotic surgeons online through American Association of Gynecologic Laparoscopists (AAGL) and Society of Robotic Surgery (SRS). Results There were 289 (260 gynecology, 22 gynecology-oncology, and 7 urogynecology) gynecologic surgeon respondents regularly practicing robotic surgery. Statistical data analysis was performed using the t-test, χ2 test, and logistic regression. One hundred fifty-six surgeons (54.0%) reported experiencing physical symptoms or discomfort. Participants with higher robotic case volume reported significantly lower physical symptom report rates (pergonomic settings not only acknowledged that the adjustments were helpful for better ergonomics but also reported a lower physical symptom rate (pergonomic settings (32.7%), took a break (33.3%) or simply ignored the problem (34%). Fingers and neck were the most common body parts with symptoms. Eye symptom complaints were significantly decreased with the Si robot (pergonomics were microphone/speaker, pedal design, and finger clutch. Conclusion More than half of participants reported physical symptoms which were found to be primarily associated with confidence in managing ergonomic settings and familiarity with the system depending on the volume of robotic cases. Optimal guidelines and education on managing ergonomic settings should be implemented to maximize the ergonomic benefits of robotic surgery. PMID:28657231

  15. Incidence and risk factors for lower limb lymphedema after gynecologic cancer surgery with initiation of periodic complex decongestive physiotherapy.

    Science.gov (United States)

    Deura, Imari; Shimada, Muneaki; Hirashita, Keiko; Sugimura, Maki; Sato, Seiya; Sato, Shinya; Oishi, Tetsuro; Itamochi, Hiroaki; Harada, Tasuku; Kigawa, Junzo

    2015-06-01

    Lower limb lymphedema (LLL) is one of the most frequent postoperative complications of retroperitoneal lymphadenectomy for gynecologic cancer. LLL often impairs quality of life, activities of daily living, sleep, and sex in patients with gynecologic cancer. We conducted this study to evaluate the incidence and risk factors for LLL after gynecologic cancer surgery in patients who received assessment and periodic complex decongestive physiotherapy (CDP). We retrospectively reviewed 126 cases of gynecologic cancer that underwent surgery involving retroperitoneal lymphadenectomy at Tottori University Hospital between 2009 and 2012. All patients received physical examinations to detect LLL and underwent CDP by nurse specialists within several months after surgery. The International Society of Lymphology staging of lymphedema severity was used as the diagnostic criteria. Of 126 patients, 57 (45.2%) had LLL, comprising 45 and 12 patients with stage 1 and stage 2 LLL, respectively. No patient had stage 3 LLL. LLL was present in 37 (29.4%) patients at the initial physical examination. Multivariate analysis revealed that adjuvant concurrent chemoradiotherapy and age ≥ 55 years were independent risk factors for ≥ stage 2 LLL. To minimize the incidence of ≥ stage 2 LLL, gynecologic oncologists should be vigilant for this condition in patients who are ≥ 55 years and in those who undergo adjuvant chemoradiotherapy. Patients should be advised to have a physical assessment for LLL and to receive education about CDP immediately after surgery involving retroperitoneal lymphadenectomy for gynecologic cancer.

  16. Review of transvaginal natural orifice transluminal endoscopic surgery in gynecology

    Directory of Open Access Journals (Sweden)

    Naoyuki Yoshiki

    2017-02-01

    Full Text Available Recent technologic advances in endoscopic instrumentation and optics have allowed the development of a less invasive alternative to conventional laparoscopic surgery. During the past decade, natural orifice transluminal endoscopic surgery (NOTES flourished in the field of general surgery, and it has emerged as a new concept of minimally invasive surgery. NOTES yields access to the abdominal cavity without any incisions on the abdominal wall (scarless surgery, and the natural orifices of the body surface, such as the mouth and the vagina, serve as the gateway to the peritoneal cavity. In gynecology, the vagina of a woman can be considered as an additional route for surgery. Recently, clinical application of transvaginal NOTES has broadened significantly in gynecology. Using transvaginal NOTES by applying the method of single-incision laparoscopic surgery via the vaginal route, not only adnexal surgery and hysterectomy, but also myomectomy and oncologic surgery could be performed safely and effectively in selected patients. In future, further studies should be conducted to evaluate the true clinical feasibility and safety of transvaginal NOTES.

  17. Exposure of Surgeons to Magnetic Fields during Laparoscopic and Robotic Gynecologic Surgeries.

    Science.gov (United States)

    Park, Jee Soo; Chung, Jai Won; Choi, Soo Beom; Kim, Deok Won; Kim, Young Tae; Kim, Sang Wun; Nam, Eun Ji; Cho, Hee Young

    2015-01-01

    To measure and compare levels of extremely-low-frequency magnetic field (ELF-MF) exposure to surgeons during laparoscopic and robotic gynecologic surgeries. Prospective case-control study. Canadian Task Force I. Gynecologic surgeries at the Yonsei University Health System in Seoul, Korea from July to October in 2014. Ten laparoscopic gynecologic surgeries and 10 robotic gynecologic surgeries. The intensity of ELF-MF exposure to surgeons was measured every 4 seconds during 10 laparoscopic gynecologic surgeries and 10 robotic gynecologic surgeries using portable ELF-MF measuring devices with logging capability. The mean ELF-MF exposures were .1 ± .1 mG for laparoscopic gynecologic surgeries and .3 ± .1 mG for robotic gynecologic surgeries. ELF-MF exposure levels to surgeons during robotic gynecologic surgery were significantly higher than those during laparoscopic gynecologic surgery (p gynecologic surgery and conventional laparoscopic surgery, hoping to alleviate concerns regarding the hazards of MF exposure posed to surgeons and hospital staff. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  18. Urological injuries following obstetrical and gynecological surgeries ...

    African Journals Online (AJOL)

    Background: Gynaecological operations have been reported to be associated with injuries to the ureter. This study was aimed at reviewing the urological complications resulting from obstetric and gynaecological surgeries in respect to frequency, clinical presentations, and time of diagnosis. The study was undertaken at ...

  19. Surgical site infection in women undergoing surgery for gynecologic cancer.

    Science.gov (United States)

    Mahdi, Haider; Gojayev, Anar; Buechel, Megan; Knight, Jason; SanMarco, Janice; Lockhart, David; Michener, Chad; Moslemi-Kebria, Mehdi

    2014-05-01

    The objectives of this study were to describe the rate and predictors of surgical site infection (SSI) after gynecologic cancer surgery and identify any association between SSI and postoperative outcome. Patients with endometrial, cervical, or ovarian cancers from 2005 to 2011 were identified from the American College of Surgeons National Surgical Quality Improvement Program. The extent of surgical intervention was categorized into modified surgical complexity scoring (MSCS) system. Univariate and multivariate logistic regression analyses were used. Odds ratios were adjusted for patient demographics, comorbidities, preoperative laboratory values, and operative factors. Of 6854 patients, 369 (5.4%) were diagnosed with SSI. Surgical site infection after laparotomy was 3.5 times higher compared with minimally invasive surgery (7% vs 2%; P laparotomy group, independent predictors of SSI included endometrial cancer diagnosis, obesity, ascites, preoperative anemia, American Society of Anesthesiologists class greater than or equal to 3, MSCS greater than or equal to 3, and perioperative blood transfusion. Among laparoscopic cases, independent predictors of SSI included only preoperative leukocytosis and overweight. For patients with deep or organ space SSI, significant predictors included hypoalbuminemia, preoperative weight loss, respiratory comorbidities, MSCS greater than 4, and perioperative blood transfusion for laparotomy and only preoperative leukocytosis for minimally invasive surgery. Surgical site infection was associated with longer mean hospital stay and higher rate of reoperation, sepsis, and wound dehiscence. Surgical site infection was not associated with increased risk of acute renal failure or 30-day mortality. These findings were consistent in subset of patients with deep or organ space SSI. Seven percent of patients undergoing laparotomy for gynecologic malignancy developed SSI. Surgical site infection is associated with longer hospital stay and more

  20. Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinoma

    NARCIS (Netherlands)

    Engelen, MJA; Kos, HE; Willemse, PHB; Aalders, JG; de Vries, EGE; Schaapveld, M; Otter, R; van der Zee, AGJ

    2006-01-01

    BACKGROUND. Consultant gynecologic oncologists from the regional Comprehensive Cancer Center assisted community gynecologists in the surgical treatment of patients with ovarian carcinoma when they were invited. For this report, the authors evaluated the effects of primary surgery by a gynecologic

  1. Gynecological Surgery and Low Back Pain in Older Women

    Science.gov (United States)

    Ericksen, Jeffery; Pidcoe, Peter E.; Ketchum-McKinney, Jessica M.; Burnet, Evie N.; Huang, Emily; Wilson, James C.; Hoogstad, Vincent

    2010-01-01

    Objective: To determine sacroiliac joint compliance characteristics and pelvic floor movements in older women relative to gynecological surgery history and back pain complaints. Design: Single-visit laboratory measurement. Setting: University clinical research center. Participants: Twenty-five women aged 65 years or older. Outcome Measures: Sacroiliac joint compliance measured by Doppler imaging of vibrations and ultrasound measures of pelvic floor motion during the active straight leg raise test. Results: Doppler imaging of vibrations demonstrated test reliability ranging from 0.701 to 0.898 for detecting vibration on the ilium and sacrum sides of the sacroiliac joint. The presence of low-back pain or prior gynecological surgery was not significantly associated with a difference in the compliance or laxity symmetry of the sacroiliac joints. No significant difference in pelvic floor movement was found during the active straight leg raise test between subject groups. All P values were ≥.4159. Conclusions: Prior gynecological surgery and low-back pain were not significantly associated with side-to-side differences in the compliance of the sacroiliac joints or in significant changes in pelvic floor movement during a loading maneuver in a group of older women. PMID:23569659

  2. The Society of European Robotic Gynaecological Surgery (SERGS) Pilot Curriculum for robot assisted gynecological surgery.

    Science.gov (United States)

    Rusch, Peter; Kimmig, Rainer; Lecuru, Fabrice; Persson, Jan; Ponce, Jordi; Degueldre, Michel; Verheijen, René

    2018-02-01

    To set forth experiences in the context of the SERGS Pilot Curriculum-the first standardized educational program for robotic use in gynecological surgery-in terms of feasibility, effectiveness and potential for certification. The Society of European Robotic Gynecological Surgery (SERGS) outlined a Pilot Curriculum for standardized education in robot-assisted laparoscopic gynecological surgery. Its feasibility and acceptance were checked in the form of a fellowship pilot program conducted at four European Centers of Excellence for robot-assisted surgery. Results and conclusions derived from this pilot program are presented. The SERGS Pilot Curriculum defines criteria for a standardized training and assessment of performance, boosts the learning curve of the candidate and increases contentment at work. Regarding face validity, it proves valuable as finally all candidates could perform the outlined procedure safely and efficiently without supervision. Due to the immense increase of robotic procedures in gynecology standardized training curricula are indispensable. This seems highly necessary to ensure patients' safety and surgical outcome. The SERGS Pilot Curriculum sets standards for a stepwise theoretical and practical training in gynecological robotic procedures. It seems feasible as instrument for accreditation as gynecologic robotic surgeon. Though as a general applicable guideline for systematic training in robot-assisted surgery, a definite curriculum should have a more definite timeline and implementation of a structured assessment of performance.

  3. Routine ultrasound examination by OB/GYN residents increase the accuracy of diagnosis for emergency surgery in gynecology.

    Science.gov (United States)

    Toret-Labeeuw, Flavie; Huchon, Cyrille; Popowski, Thomas; Chantry, Anne A; Dumont, Alexandre; Fauconnier, Arnaud

    2013-04-30

    Diagnostic accuracy of first-line sonographic evaluation by obstetrics/gynecology residents in determining the need for emergency surgery in women with acute pelvic pain is unknown. Aim of this study was to evaluate the diagnostic accuracy of routine ultrasound evaluation by obstetrics/gynecology residents, available 24 hours a day, in patients with acute pelvic pain. A cross-sectional retrospective study included consecutive patients who underwent emergency laparoscopy for acute pelvic pain at a teaching hospital gynecologic emergency unit, between January 1, 2004, and December 31, 2006. The laparoscopic diagnosis was the reference standard. Gynecologic and nongynecologic conditions requiring immediate surgery to avoid severe morbidity or death were defined as surgical emergencies. In all patients, obstetrics/gynecology residents routinely performed clinical examination and standardized ultrasonography was routinely recorded. Sonograms were re-interpreted for the study, blinded to physical examination and laparoscopic findings, according to evidence-based predetermined criteria. Sensitivity, specificity, and likelihood ratios were computed for clinical data alone, sonographic data alone, and the combination of both. Emergency laparoscopy was performed in 234 patients, diagnosing 139 (59%) surgical emergencies. Clinical and sonographic examinations performed by the residents each independently predicted a need for emergency surgery. Combining both examinations was superior over each examination alone and had an acceptable false-negative rate of 1%. First-line combined clinical and sonographic examination by obstetrics/gynecology residents is effective in ruling out surgical emergencies in patients with acute pelvic pain.

  4. Dysphagia among Adult Patients who Underwent Surgery for Esophageal Atresia at Birth

    Directory of Open Access Journals (Sweden)

    Valérie Huynh-Trudeau

    2015-01-01

    Full Text Available BACKGROUND: Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and/or anatomical anomalies.

  5. Fall risk and function in older women after gynecologic surgery.

    Science.gov (United States)

    Miller, Karen L; Richter, Holly E; Graybill, Charles S; Neumayer, Leigh A

    2017-11-01

    To examine change in balance-related fall risk and daily functional abilities in the first 2 post-operative weeks and up to 6 weeks after gynecologic surgery. Prospective cohort study in gynecologic surgery patients age 65 and older. Balance confidence (Activities-specific Balance Confidence Scale) and functional status (basic and instrumental activities of daily living) were recorded pre- and post-operatively daily for 1 week and twice the second week. Physical performance balance and functional mobility were measured pre- and 1 week post-operatively using the Tinetti Fall Risk Scale, Timed Up and Go, and 6-Minute Walk test. Measures were repeated 6 weeks after surgery. Non-parametric tests for paired data were used comparing scores baseline to post-operative (POD) 7 and to POD 42. Median age was 72 years (range 65-88). Fall risk was elevated during the first 2 post-operative weeks, greatest on the median discharge day, POD 2 (pgynecologic surgery, older women's fall risk is highest on POD 2 and remains elevated from baseline for 2 weeks. Functional limitations in the early home recovery period include the anticipated (bathing, cooking, etc.) and some unanticipated (medication management) ones. This information may help with post-operative discharge planning. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  6. Core Privileging and Credentialing: Hospitals' Approach to Gynecologic Surgery.

    Science.gov (United States)

    Siddique, Moiuri; Shah, Nemi; Park, Amy; Chen, Beatrice; Emery, Stephen; Falcone, Tommaso; Margulies, Rebecca; Rardin, Charles; Iglesia, Cheryl

    Privileging and credentialing requirements are determined by medical staff leadership at the hospital level to ensure clinicians provide safe healthcare services. No standardized guidelines exist for gynecologic surgery. The objective of this study is to examine the variability of the criteria used to grant surgical privileges and credentials for gynecologic procedures at 5 high-volume academic and community-based US hospitals. We conducted a cross-sectional study (Canadian Task Force classification III). Data was obtained from obtained from 5 geographically diverse hospital systems. We examined criteria for designating core gynecologic privileges, credentialing, and other training requirements as well as minimum and annual case numbers for initial granting and maintenance of surgical privileges. Major inconsistencies in privileging were found across the 5 institutions. Hospitals varied widely in procedures designated as core versus those requiring advanced training. Institutions greatly contrasted in the case numbers and temporal factors used to define experience. Of particular concern was absent privileging criteria for 38.4% to 76.9% of minor procedures, 26.7% to 46.7% of endoscopic procedures, and 6.67% to 56.7% of major procedures. Initial and maintenance privileging requirements for special procedures (i.e., robotic-assisted surgery) were likewise discrepant, with minimum annual case numbers ranging from 3 to 48 across hospitals. Considerable variability exists in the criteria used by hospitals for granting and maintaining surgical privileges for gynecologic procedures. Standardization will likely require efforts at a national leadership level. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  7. Opportunistic bilateral salpingectomy during benign gynecological surgery for ovarian cancer prevention: a survey of Gynecologic Oncology Committee of Japan Society of Obstetrics and Gynecology.

    Science.gov (United States)

    Mikami, Mikio; Nagase, Satoru; Yamagami, Wataru; Ushijma, Kimio; Tashiro, Hironori; Katabuchi, Hidetaka

    2017-07-01

    Recent evidence has supported the concept that epithelial ovarian cancer (EOC) arises from the cells of the fallopian tube or endometrium. This study investigated current practice in Japan with respect to performing opportunistic bilateral salpingectomy (OBS) during gynecological surgery for benign disease for Ovarian Cancer Prevention. We mailed a questionnaire to 767 hospitals and clinics, comprising 628 accredited training institutions of the Japan Society of Obstetrics and Gynecology (JSOG), Japan Society of Gynecologic Oncology (JSGO), or Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy (JSGOE) and 139 private institutions with at least one JSGOE-certified licensed gynecologic laparoscopist. Among the 767 institutions, 444 (57.9%) provided responses, including 91 (20.6%) that were both JSGOE and JSGO accredited, 71 (16.0%) that were only JSGO accredited, 88 (19.8%) that were only JSGOE accredited, and 194 (43.7%) that were unaccredited. It was found that awareness and performance of OBS largely depended on the JSGO and/or JSGOE accreditation status. OBS was only performed at 54.0% of responding institutions and just 6.8% of the institutions were willing to participate in randomized controlled trials to validate this method for reducing the incidence of ovarian cancer. The JSOG Gynecologic Tumor Committee will announce its opinion on salpingectomy for ovarian cancer prevention to all JSOG members and will develop a system for monitoring the number of OBS procedures in Japan. Copyright © 2017. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

  8. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  9. Robotic surgery in complicated gynecologic diseases: Experience of Tri-Service General Hospital in Taiwan

    Directory of Open Access Journals (Sweden)

    Shun-Jen Tan

    2012-03-01

    Conclusion: The present analyses include various complicated gynecologic conditions, which make the estimation of the effectiveness of robotic surgery in each situation individually not appropriate. However, our experiences do show that robotic surgery is feasible and safe for patients with complicated gynecologic diseases.

  10. A prospective comparison of postoperative pain and quality of life in robotic assisted vs conventional laparoscopic gynecologic surgery.

    Science.gov (United States)

    Zechmeister, Jenna R; Pua, Tarah L; Boyd, Leslie R; Blank, Stephanie V; Curtin, John P; Pothuri, Bhavana

    2015-02-01

    We sought to compare robotic vs laparoscopic surgery in regards to patient reported postoperative pain and quality of life. This was a prospective study of patients who presented for treatment of a new gynecologic disease requiring minimally invasive surgical intervention. All subjects were asked to take the validated Brief Pain Inventory-Short Form at 3 time points to assess pain and its effect on quality of life. Statistical analyses were performed using Pearson x(2) and Student's t test. One hundred eleven were included in the analysis of which 56 patients underwent robotic assisted surgery and 55 patients underwent laparoscopic surgery. There was no difference in postoperative pain between conventional laparoscopy and robotic assisted surgery for gynecologic procedures. There was a statistically significant difference found at the delayed postoperative period when evaluating interference of sleep, favoring laparoscopy (ROB 2.0 vs LSC 1.0; P = .03). There were no differences found between the robotic and laparoscopic groups of patients receiving narcotics (56 vs 53, P = .24, respectively), route of administration of narcotics (47 vs 45, P > .99, respectively), or administration of nonsteroidal antiinflammatory medications (27 vs 21, P = .33, respectively). Our results demonstrate no difference in postoperative pain between conventional laparoscopy and robotic assisted surgery for gynecologic procedures. Furthermore, pain did not appear to interfere consistently with any daily activity of living. Interference of sleep needs to be further evaluated after controlling for bilateral salpingo-oophorectomy. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Incidence and risk factors for surgical site infections in obstetric and gynecological surgeries from a teaching hospital in rural India

    Directory of Open Access Journals (Sweden)

    Ashish Pathak

    2017-06-01

    Full Text Available Abstract Background Surgical site infections (SSI are one of the most common healthcare associated infections in the low-middle income countries. Data on incidence and risk factors for SSI following surgeries in general and Obstetric and Gynecological surgeries in particular are scare. This study set out to identify risk factors for SSI in patients undergoing Obstetric and Gynecological surgeries in an Indian rural hospital. Methods Patients who underwent a surgical procedure between September 2010 to February 2013 in the 60-bedded ward of Obstetric and Gynecology department were included. Surveillance for SSI was based on the Centre for Disease Control (CDC definition and methodology. Incidence and risk factors for SSI, including those for specific procedure, were calculated from data collected on daily ward rounds. Results A total of 1173 patients underwent a surgical procedure during the study period. The incidence of SSI in the cohort was 7.84% (95% CI 6.30–9.38. Majority of SSI were superficial. Obstetric surgeries had a lower SSI incidence compared to gynecological surgeries (1.2% versus 10.3% respectively. The risk factors for SSI identified in the multivariate logistic regression model were age (OR 1.03, vaginal examination (OR 1.31; presence of vaginal discharge (OR 4.04; medical disease (OR 5.76; American Society of Anesthesia score greater than 3 (OR 12.8; concurrent surgical procedure (OR 3.26; each increase in hour of surgery, after the first hour, doubled the risk of SSI; inappropriate antibiotic prophylaxis increased the risk of SSI by nearly 5 times. Each day increase in stay in the hospital after the surgery increased the risk of contacting an SSI by 5%. Conclusions Incidence and risk factors from prospective SSI surveillance can be reported simultaneously for the Obstetric and Gynecological surgeries and can be part of routine practice in resource-constrained settings. The incidence of SSI was lower for Obstetric surgeries

  12. Effectiveness of local anesthetic on postoperative pain in different levels of laparoscopic gynecological surgery.

    Science.gov (United States)

    Selcuk, Selcuk; Api, Murat; Polat, Mesut; Arinkan, Arzu; Aksoy, Bilge; Akca, Tijen; Karateke, Ates

    2016-06-01

    The aim of this study was to assess the effects of preemptive and preclosure analgesia on postoperative pain intensity in patients undergoing different levels of laparoscopic surgery. Two hundred and twenty-six patients who underwent laparoscopic gynecological surgery were enrolled in this quasi-randomized, prospective, placebo controlled study. The operations were classified as level 1 or level 2 according to the extent of the surgery. Lidocaine 1 % was administered at the port sites before making the incision in the preincisional study group. In preincisional control group, same amount of saline was infiltrated in same manner. Lidocaine 1 % was infiltrated at the port site immediately after removing the trocars in preclosure study group. In preclosure control group, the same amount of saline was infiltrated in the same manner. Postoperative pain intensity was evaluated by linear visual analogue scale. It was found that preclosure lidocaine infiltration was more effective on postoperative pain intensity than its placebo group in level 1 and level 2 surgery groups at 1 and 2 h postoperatively. The administration of preincisional lidocaine improved postoperative pain scores significantly more than its placebo group in level 1 laparoscopic surgery group at 1 and 2 h postoperatively and in level 2 laparoscopic surgery group at 1 h postoperatively. Lidocaine infiltration at port sites had beneficial effects on pain intensity in the early postoperative period after laparoscopic gynecological surgery. However, the results of present study showed that the analgesic effect mechanism of local anesthetic was unrelated to the preemptive analgesia hypothesis.

  13. Venous thromboembolism prevention in gynecologic cancer surgery: a systematic review.

    Science.gov (United States)

    Einstein, M Heather; Pritts, Elizabeth A; Hartenbach, Ellen M

    2007-06-01

    Advanced age, pelvic surgery, and the presence of malignancy place gynecologic oncology patients at high risk for venous thromboembolism (VTE). This study was designed to systematically analyze the world's literature on VTE in these patients and determine the optimal prophylaxis regimen. Computerized searches of Pubmed, Ovid, DARE, ACP Journal Club, Cochrane Database of Systematic Reviews, and Cochrane Controlled Trials Registry 1966-2005 were performed, as well as EMBASE 1980-2005. Major conferences and target references were hand-searched. Inclusion criteria were randomized controlled trials (RCTs) evaluating VTE prophylaxis with heparin, low-molecular-weight heparin (LMWH), and sequential compression devices (SCD). The search yielded 278 articles; 11 met inclusion criteria. Data were abstracted by one author and analyzed with the Mantel-Haenszel method. The analysis of heparin-versus-control revealed a significant decrease in DVT in patients receiving heparin (RR=0.58, 95% CI 0.35-0.95). There were no significant differences in EBL or transfusions between the two groups. In the 320 patients in the heparin vs. LMWH studies, there was no significant difference in DVT (RR 0.91, 95% CI 0.38-2.17), although power analysis demonstrated insufficient numbers to show a difference. No patient in either group required re-exploration for bleeding. All gynecologic cancer patients should receive VTE prophylaxis. Although heparin, LMWH, and SCD have been shown to be safe and effective, due to the paucity of data in the gynecologic oncology literature, no one prevention modality can be considered superior at this time. Adequately powered RCTs are urgently needed to determine the optimal regimen in these high-risk patients.

  14. Single-site robotic surgery in gynecologic cancer: a pilot study

    OpenAIRE

    Yoo, Ha-Na; Kim, Tae-Joong; Lee, Yoo-Young; Choi, Chel Hun; Lee, Jeong-Won; Bae, Duk-Soo; Kim, Byoung-Gie

    2015-01-01

    Objective To discuss the feasibility of single-site robotic surgery for benign gynecologic tumors and early stage gynecologic cancers. Methods In this single institution, prospective analysis, we analyzed six patients who had undergone single-site robotic surgery between December 2013 and August 2014. Surgery was performed using the da Vinci Si Surgical System. Patient characteristics and surgical outcomes were analyzed. Results Single-site robotic surgery was performed successfully in all si...

  15. Costs associated with instrument sterilization in gynecologic surgery.

    Science.gov (United States)

    Van Meter, Mary M; Adam, Rony A

    2016-11-01

    With rising health care expenditures, hospitals must contain costs in ways that maintain high-quality patient care. A significant portion of perioperative costs are associated with materials and supplies; many reusable instruments on surgical trays go unused, which may account for significant annual excess processing costs. Reorganizing gynecologic trays to contain fewer instruments can result in significant cost savings. In the field of operative gynecology, there has been considerable attention to the various costs and surgical outcomes that are associated with hysterectomy performed in the abdominal, vaginal, and laparoscopic approaches; however, little research has been done on the cost differences that are associated with the reusable instruments that are used in these approaches. This study aimed to identify the percent usage of instruments within gynecologic surgery and to identify differences by surgical approach. We further aimed to estimate the costs of sterilizing surgical instruments and estimate the excess costs that are associated with processing unused instruments. This was a single site observational study. Specific instruments that were used from incision to closure were recorded on operating room count sheets via direct observation of surgeries that were performed in the gynecologic operating rooms by a trained investigator. Cost data on instrument transportation, employee wages, and instrument replacement was obtained from institutional supply chain management. In total, 28 surgical cases (5 abdominal, 11 laparoscopic, and 12 vaginal) were analyzed, with an average of 2 hours 37 minutes operating room time and 5.4 instrument trays for each case. One hundred fifty trays were observed. Trays had an average of 38 instruments per tray (range, 1-141). Surgeons used an average of 36.7 instruments of 184 available instruments per case, for a usage rate of 20.5±2.8%. A significant difference was noted between usage rates in abdominal cases (26.3±6

  16. Late aortic lymphocele and residual ovary syndrome after gynecological surgery

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    Iuliano Marialetizia

    2007-12-01

    Full Text Available Abstract Background Gynecological surgery, as radical hysterectomy or pelvic and aortic lymphadenectomy, accounts for more than 50% of iatrogenic injuries. In premenopausal women, an hysterectomy with ovarian sparing and concomitant lateral ovarian transposition is frequently performed. However, the fate of the retained ovary is complicated by the residual ovarian syndrome (ROS and one of the most common postoperative complications of the lymphadenectomy procedure is the lymphocele, with an average incidence of 22–48.5%. The differential diagnosis of a postoperative fluid collection includes, in addition to a lymphocele, urinoma, hematoma, seroma or abscess and the computed tomography (CT findings alone is not enough. Case presentation We describe a patient, affected by ROS concomitant with a asymptomatic lymphocele, initially confused with an aortic lymph nodes relapse, after abdominal radical hysterectomy. The patient was subjected to a surgical approach, included a diagnostic open laparoscopy and laparotomy with sovraombelico-pubic incision, wide opening of the pelvic peritoneum and retroperitoneum. Examination of the mass revealed, macroscopically, a ovary with multiloculated cystic masses filled with clear or yellow serous fluid and the layers were composed by flat or cuboidal mesothelial cells. Conclusion The tribute of this case illustrates the atypical appearance with uncertain aetiology after complex imaging. Gynecologist and radiologist should acquaint with the appearance of fluid collection (urinoma, lymphocele, seroma, hematoma, abscess in gynecologic oncology follow-up to properly differentiated from tumor recurrence.

  17. Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

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    Alessandro Varrica

    2015-01-01

    Full Text Available Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB, has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels. Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN measurement were drawn at five perioperative time-points. Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak (P0.05 have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery. Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

  18. Prevention, Recognition, and Management of Urologic Injuries During Gynecologic Surgery.

    Science.gov (United States)

    Sharp, Howard T; Adelman, Marisa R

    2016-06-01

    The urethra, bladder, and ureters are particularly susceptible to injury during gynecologic surgery. When preventive measures fail, prompt recognition and management of injury can avoid long-term sequelae such as fistula formation and loss of renal function. Intraoperative identification should be the primary goal when an injury occurs, although this is not always possible. Postoperative injury recognition requires a high level of suspicion and vigilance. In addition to history and physical examination, appropriate radiologic studies can be useful in localizing injury and planning management strategies. Some injuries may require Foley catheter drainage or ureteral stenting alone, whereas others will require operative intervention with ureteral resection and reanastomosis or reimplantation. Prompt restoration of urinary drainage or diversion will avoid further renal compromise.

  19. Gynecologic examination and cervical biopsies after (chemo) radiation for cervical cancer to identify patients eligible for salvage surgery

    International Nuclear Information System (INIS)

    Nijhuis, Esther R.; Zee, Ate G.J. van der; Hout, Bertha A. in 't; Boomgaard, Jantine J.; Hullu, Joanne A. de; Pras, Elisabeth; Hollema, Harry; Aalders, Jan G.; Nijman, Hans W.; Willemse, Pax H.B.; Mourits, Marian J.E.

    2006-01-01

    Purpose: The aim of this study was to evaluate efficacy of gynecologic examination under general anesthesia with cervical biopsies after (chemo) radiation for cervical cancer to identify patients with residual disease who may benefit from salvage surgery. Methods and Materials: In a retrospective cohort study data of all cervical cancer patients with the International Federation of Gynecology and Obstetrics (FIGO) Stage IB1 to IVA treated with (chemo) radiation between 1994 and 2001 were analyzed. Patients underwent gynecologic examination under anesthesia 8 to 10 weeks after completion of treatment. Cervical biopsy samples were taken from patients judged to be operable. In case of residual cancer, salvage surgery was performed. Results: Between 1994 and 2001, 169 consecutive cervical cancer patients received primary (chemo) radiation, of whom 4 were lost to follow-up. Median age was 56 years (interquartile range [IQR], 44-71) and median follow-up was 3.5 years (IQR, 1.5-5.9). In each of 111 patients a biopsy sample was taken, of which 90 (81%) showed no residual tumor. Vital tumor cells were found in 21 of 111 patients (19%). Salvage surgery was performed in 13 of 21 (62%) patients; of these patients, 5 (38%) achieved long-term, complete remission after salvage surgery (median follow-up, 5.2 years; range, 3.9-8.8 years). All patients with residual disease who did not undergo operation (8/21) died of progressive disease. Locoregional control was more often obtained in patients who underwent operation (7 of 13) than in patients who were not selected for salvage surgery (0 of 8 patients) (p < 0.05). Conclusions: Gynecologic examination under anesthesia 8 to 10 weeks after (chemo) radiation with cervical biopsies allows identification of those cervical cancer patients who have residual local disease, of whom a small but significant proportion may be salvaged by surgery

  20. Management of Mesh and Graft Complications in Gynecologic Surgery.

    Science.gov (United States)

    This document focuses on the management of complications related to mesh used to correct stress urinary incontinence or pelvic organ prolapse. Persistent vaginal bleeding, vaginal discharge, or recurrent urinary tract infections after mesh placement should prompt an examination and possible further evaluation for exposure or erosion. A careful history and physical examination is essential in the diagnosis of mesh and graft complications. A clear understanding of the location and extent of mesh placement, as well as the patient's symptoms and therapy goals, are necessary to plan treatment approaches. It is important that a treating obstetrician-gynecologist or other gynecologic care provider who seeks to revise or remove implanted mesh be aware of the details of the index procedure. Diagnostic testing for a suspected mesh complication can include cystoscopy, proctoscopy, colonoscopy, or radiologic imaging. These tests should be pursued to answer specific questions related to management. Given the diverse nature of complications related to mesh-augmented pelvic floor surgery, there are no universal recommendations regarding minimum testing. Approaches to management of mesh-related complications in pelvic floor surgery include observation, physical therapy, medications, and surgery. Obstetrician-gynecologists should counsel women who are considering surgical revision or removal of mesh about the complex exchanges that can occur between positive and adverse pelvic floor functions across each additional procedure starting with the device implant. Detailed counseling regarding the risks and benefits of mesh revision or removal surgery is essential and can be conducted most thoroughly by a clinician who has experience performing these procedures. For women who are not symptomatic, there is no role for intervention.

  1. [Patients with astigmatism who underwent cataract surgery by phacoemulsification: toric IOL x asferic IOL?].

    Science.gov (United States)

    Torres Netto, Emilio de Almeida; Gulin, Marina Carvalho; Zapparoli, Marcio; Moreira, Hamilton

    2013-01-01

    Compare the visual acuity of patients who underwent cataract surgery by phacoemulsification with IOL AcrySof(®) toric implantation versus AcrySof(®) IQ and evaluate the reduction of cylindrical diopters (CD) in the postoperative period. Analytical and retrospective study of 149 eyes with 1 or more diopters of regular symmetrical keratometric astigmatism, which underwent cataract surgery by phacoemulsification. The eyes were divided into two groups: the toric group with 85 eyes and the non-toric group with 64 eyes. In the pre-operative phase, topographic data and refraction of each eye to be operated were assessed. In the postoperative phase, refraction and visual acuity with and without correction were measured. The preoperative topographic astigmatism ranged from 1.00 to 5.6 DC in both groups. Average reduction of 1.37 CD (p<0.001) and 0.16 CD (p=0.057) was obtained for the toric and non-toric group when compared to the refractive astigmatism, respectively. Considering visual acuity without correction (NCVA), the toric group presented 44 eyes (51.7%) with NCVA of 0 logMAR (20/20) or 0.1 logMAR (20/25) and the toric group presented 7 eyes (10.93%) with these same NCVA values. The results show that patients with a significant keratometric astigmatism presented visual benefits with the toric IOL implantation. The reduction of the use of optical aids may be obtained provided aberrations of the human eye are corrected more accurately. Currently, phacoemulsification surgery has been used not only for functional improvement, but also as a refraction procedure.

  2. Principles of safe abdominal entry in laparoscopic gynecologic surgery

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    Jongrak Thepsuwan

    2013-11-01

    Full Text Available Laparoscopic gynecologic surgery has been widely used with a range of benefits. However, there are complications that are related to the abdominal entry process. Serious complications are gastrointestinal tract and major blood vessel injuries. This review introduces the recent available literature to prevent and eliminate the laparoscopic entry complications. The open entry technique is associated with a significant reduction of failed entry, compared to the closed entry technique; however there is no difference in the incidence of visceral or vascular injury. Laparoscopic entry by the left upper abdomen (i.e., Palmer's point or the middle upper abdomen (i.e., the Lee-Huang point could be considered in patients with suspected periumbilical adhesions or a history of umbilical hernia, or after three failed attempts of insufflation at the umbilicus. The Lee-Huang point has its own benefit for the operative laparoscopy in large pelvic pathologies and gynecology malignancy cases. The angle of Veress needle insertion varies from 45° in nonobese women to 90° in extraordinarily obese women. The high intra-peritoneal pressure entries, which range from 20 mmHg to 25 mmHg, minimize the risk of vascular injury. Therefore, this will not adversely affect the cardiopulmonary function in healthy women. The Veress intraperitoneal pressure (<10 mmHg is a reliable indicator of correct intraperitoneal placement of the Veress needle. The elevation of anterior abdominal wall for placement of a Veress needle increases the risks of failed entry and shows no advantage in regard to vascular or visceral complications. Surgeons should continue to increase their knowledge of anatomy, their training, and their experience to decrease laparoscopic complications.

  3. A model to predict risk of blood transfusion after gynecologic surgery.

    Science.gov (United States)

    Stanhiser, Jamie; Chagin, Kevin; Jelovsek, J Eric

    2017-05-01

    A model that predicts a patient's risk of receiving a blood transfusion may facilitate selective preoperative testing and more efficient perioperative blood management utilization. We sought to construct and validate a model that predicts a patient's risk of receiving a blood transfusion after gynecologic surgery. In all, 18,319 women who underwent gynecologic surgery at 10 institutions in a single health system by 116 surgeons from January 2010 through June 2014 were analyzed. The data set was split into a model training cohort of 12,219 surgeries performed from January 2010 through December 2012 and a separate validation cohort of 6100 surgeries performed from January 2013 through June 2014. In all, 47 candidate risk factors for transfusion were collected. Multiple logistic models were fit onto the training cohort to predict transfusion within 30 days of surgery. Variables were removed using stepwise backward reduction to find the best parsimonious model. Model discrimination was measured using the concordance index. The model was internally validated using 1000 bootstrapped samples and temporally validated by testing the model's performance in the validation cohort. Calibration and decision curves were plotted to inform clinicians about the accuracy of predicted probabilities and whether the model adds clinical benefit when making decisions. The transfusion rate in the training cohort was 2% (95% confidence interval, 1.72-2.22). The model had excellent discrimination and calibration during internal validation (bias-corrected concordance index, 0.906; 95% confidence interval, 0.890-0.928) and maintained accuracy during temporal validation using the separate validation cohort (concordance index, 0.915; 95% confidence interval, 0.872-0.954). Calibration curves demonstrated the model was accurate up to 40% then it began to overpredict risk. The model provides superior net benefit when clinical decision thresholds are between 0-50% predicted risk. This model

  4. Gynecological surgery from the Hippocratics to the fall of the Roman Empire.

    Science.gov (United States)

    Bliquez, Lawrence J

    2010-01-01

    The article aims to explore advances in the Greco-Roman gynecological surgery with particular emphasis on the Roman Empire. The development and improvement of the Roman surgical instrumentarium occurred in tandem with surgical advances, gynecological as well as general. It might therefore be said that the approach taken in this paper is one based on material culture.

  5. Assessing the safety and efficacy of combined abdominoplasty and gynecologic surgery.

    Science.gov (United States)

    Sinno, Sammy; Shah, Samir; Kenton, Kimberly; Brubaker, Linda; Angelats, Juan; Vandevender, Darl; Cimino, Victor

    2011-09-01

    Combined surgery is an attractive option for both patients and surgeons. Unfortunately, it remains unclear to patients whether plastic surgery can be combined safely and efficaciously with other surgeries, particularly gynecologic surgery. The goal of this study was to determine the safety and efficacy of combined abdominoplasty and gynecologic surgery. A case-control study of 25 patients undergoing combined abdominoplasty and intra-abdominal gynecologic surgery was performed. These combined patients were compared with control group patients undergoing abdominoplasty alone and gynecologic surgery alone. Demographic data, operative time, estimated blood loss, pre- and postoperative hemoglobin, length of hospitalization, and complications were compared between combined and control groups. Statistically significant reductions were seen in operative time, estimated blood loss, and total days of hospitalization when comparing the combined group to the sum of the control groups. In this study, no major complications, including the need for blood transfusion or pulmonary embolus, were noted in any of the patients. These results demonstrate success in performing abdominoplasty with gynecologic surgery, which may be an acceptable option for patients.

  6. Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy.

    Science.gov (United States)

    Gala, Rajiv B; Margulies, Rebecca; Steinberg, Adam; Murphy, Miles; Lukban, James; Jeppson, Peter; Aschkenazi, Sarit; Olivera, Cedric; South, Mary; Lowenstein, Lior; Schaffer, Joseph; Balk, Ethan M; Sung, Vivian

    2014-01-01

    The Society of Gynecologic Surgeons Systematic Review Group performed a systematic review of both randomized and observational studies to compare robotic vs nonrobotic surgical approaches (laparoscopic, abdominal, and vaginal) for treatment of both benign and malignant gynecologic indications to compare surgical and patient-centered outcomes, costs, and adverse events associated with the various surgical approaches. MEDLINE and the Cochrane Central Register of Controlled Trials were searched from inception to May 15, 2012, for English-language studies with terms related to robotic surgery and gynecology. Studies of any design that included at least 30 women who had undergone robotic-assisted laparoscopic gynecologic surgery were included for review. The literature yielded 1213 citations, of which 97 full-text articles were reviewed. Forty-four studies (30 comparative and 14 noncomparative) met eligibility criteria. Study data were extracted into structured electronic forms and reconciled by a second, independent reviewer. Our analysis revealed that, compared with open surgery, robotic surgery consistently confers shorter hospital stay. The proficiency plateau seems to be lower for robotic surgery than for conventional laparoscopy. Of the various gynecologic applications, there seems to be evidence that renders robotic techniques advantageous over traditional open surgery for management of endometrial cancer. However, insofar as superiority, conflicting data are obtained when comparing robotics vs laparoscopic techniques. Therefore, the specific method of minimally invasive surgery, whether conventional laparoscopy or robotic surgery, should be tailored to patient selection, surgeon ability, and equipment availability. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  7. Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery.

    Science.gov (United States)

    Shantavasinkul, Prapimporn Chattranukulchai; Omotosho, Philip; Corsino, Leonor; Portenier, Dana; Torquati, Alfonso

    2016-11-01

    Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for obesity and results in long-term weight loss and resolution of co-morbidities. However, weight regain may occur as soon as 1-2 years after surgery. This retrospective study aimed to investigate the prevalence of weight regain and possible preoperative predictors of this phenomenon after RYGB. An academic medical center in the United States. A total of 1426 obese patients (15.8% male) who underwent RYGB during January 2000 to 2012 and had at least a 2-year follow-up were reviewed. We included only patients who were initially successful, having achieved at least 50% excess weight loss at 1 year postoperatively. Patients were then categorized into either the weight regain group (WR) or sustained weight loss (SWL) group based upon whether they gained≥15% of their 1-year postoperative weight. Weight regain was observed in 244 patients (17.1%). Preoperative body mass index was similar between groups. Body mass index was significantly higher and percent excess weight loss was significantly lower in the WR group (Pweight regain was 19.5±9.3 kg and-.8±8.5 in the WR and SWL groups, respectively (Pweight loss. Moreover, a longer duration after RYGB was associated with weight regain. Multivariate analysis revealed that younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The present study confirmed that a longer interval after RYGB was associated with weight regain. Younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The findings of this study underscore the complexity of the mechanisms underlying weight loss and regain after RYGB. Future prospective studies are needed to further explore the prevalence, predictors, and mechanisms of weight regain after RYGB. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  8. [Analysis of prevalence and risk factors of pelvic organ prolapse of women underwent gynecologic health care in Peking Union Medical College Hospital].

    Science.gov (United States)

    Zhu, Lan; Wang, Jing-yi; Lang, Jing-he; Xu, Tao; Li, Lin

    2010-07-01

    To investigate prevalence and risk factors of pelvic organ prolapse in women underwent routine gynecologic health care in Peking Union Medical College Hospital (PUMCH). From Jan. 2008 to Aug. 2009, 972 women underwent gynecological health care in PUMCH were enrolled in this study. Questionnaires and pelvic examinations were given. The pelvic organ prolapse quantitive examination (POP-Q) system was used as the assessment tool. (1) Among all participants, the mean ages were (42 ± 10) years (range 22 to 78 years), the mean height were (162 ± 5) cm (range 142 to 180 cm), and the mean weight were (59 ± 8) kg (range 42 to 91 kg). 83.8% (815/972) of women were multipara. The mean total vaginal length (TVL) of 972 women was 8.20 cm. No women met the standard of pelvic organ prolapse, while 35.5% (345/972) of women presented mild posterior vaginal descent and 96.7% (940/972) presented mild anterior vaginal descent, all of them were asymptomatic. (2) The length of genital hiatus (gh), TVL and C, D proximal to the hymen in nullipara were (2.26 ± 0.32), (8.08 ± 0.30), (-7.08 ± 0.24) and (-8.08 ± 0.30) cm, which were significantly less than (2.33 ± 0.39), (8.22 ± 0.35), (-7.14 ± 0.28) and (-8.22 ± 0.35) cm in multipara (P 0.05). However, those in women at group of 22 - 34 years and 35 - 49 years showed statistical difference when compared with women at group of more than 50 years (P < 0.05). When compared with women at group of 22 - 34 years, the incidence of posterior and anterior vaginal wall protrusion were increased (OR = 1.713, 3.765). (4) Menopause status was associated with severities of all kinds of descent (P < 0.05) and presence of posterior vaginal protrusion (OR = 3.354). Mild anterior and posterior vaginal descent by POP-Q were common among women in China. The risk of anterior vaginal descent is relatively higher than posterior vaginal descent. However, most of the women with descent are asymptomatic and need no treatment. The most important factors

  9. Evaluation of extended antibiotic prophylaxis in patients undergoing indicated non-cosmetic panniculectomy at the time of gynecologic surgery.

    Science.gov (United States)

    Patibandla, Jay R; Kufel, Christina N; Hopkins, Michael P

    2018-01-08

    Panniculectomy at time of gynecologic surgery is used to improve visualization and prevent major complications in morbidly obese patients. We examine the role of extended antibiotic prophylaxis in prevention of surgical site infections (SSI), specifically based on patient risk factors (hypertension, diabetes, smoking). A prospective cohort study of all women who underwent panniculectomy at the time of gynecologic surgery from September 2014 to March 2016 at a university-affiliated hospital. The EAP cohort received standard antibiotics (cefazolin, 2 g) and continued oral antibiotic (doxycycline) for 10 days afterwards. Patients in this cohort were compared to historical controls from the same institution from 1990 to 2014. Specific attention was paid to the reduction of SSIs in patients with hypertension, diabetes, and a history of smoking. The mean age was 56.0 ± 12.6 years, and mean body mass index 44.5 ± 9.3 kg/m 2 (range 31-63.4 kg/m 2 ). The EAP cohort experienced fewer surgical-site infections overall, however these results were not significantly decreased from the historical controls, (13/56 [23.2%] vs 94/300 [31.3%]; P = 0.469). Though initially promising, extended antibiotic prophylaxis did not reduce surgical site infections in the obese women after indicated non-cosmetic panniculectomy at the time of gynecologic surgery. © 2018 Wiley Periodicals, Inc.

  10. [Development of better tolerated prosthetic materials: applications in gynecological surgery].

    Science.gov (United States)

    Debodinance, P; Delporte, P; Engrand, J B; Boulogne, M

    2002-10-01

    . Macro-porous meshes can cause erosive phenomena and adhesions. Retraction of synthetic tissues is observed in 20 to 30% of cases. Meshes in gynecology. In gynecology surgery, meshes made their first appearance in trans-abdominal sacrocolpopexy and slings. A detailed review of complications found in 32 articles studying slings and 22 studying sacrocolpopexy with approximately 10 types of meshes shows that intolerance of slings has oscillated between 1% with Prolene and 31% with Gore-Tex; for abdominal sacrocolpopexy the rate was between 1.7% with Prolene and 20% with Teflon. Rejection phenomena appear during the first year and are proportional to the surface area of the synthetic tissue and the proximity of the vaginal scar. New materials have been proposed over the last ten years for prolapse surgery, notably for cystocele, which accounts for 70% of all repair procedures. Nearly fifteen studies have reported a level of intolerance reaching 6%, the large majority of the meshes used being Prolene meshes. Our personal experience with 87 repair procedures has led us to the conclusion that Prolene is the most adapted mesh, allowing free tension between the bladder and the anterior vaginal wall. Continuous evaluation is needed to study these replacement materials which should in theory, improve the rate of recurrence, which is at present 20% with classic procedures not using a mesh.

  11. ACOG Technology Assessment in Obstetrics and Gynecology No. 6: Robot-assisted surgery.

    Science.gov (United States)

    2009-11-01

    The field of robotic surgery is developing rapidly, but experience with this technology is currently limited. In response to increasing interest in robotics technology, the Committee on Gynecologic Practice's Technology Assessment was developed to describe the robotic surgical system,potential advantages and disadvantages, gynecologic applications, and the current state of the evidence. Randomized trials comparing robot-assisted surgery with traditional laparoscopic, vaginal, or abdominal surgery are needed to evaluate long-term clinical outcomes and cost-effectiveness, as well as to identify the best applications of this technology.

  12. Woman experiencing gynecologic surgery: coping with the changes imposed by surgery 1

    Science.gov (United States)

    Silva, Carolina de Mendonça Coutinho e; Vargens, Octavio Muniz da Costa

    2016-01-01

    ABSTRACT Objectives: to describe the feelings and perceptions resulting from gynecologic surgery by women and analyze how they experience the changes caused by the surgery. Method: a qualitative, descriptive and exploratory study, which had Symbolic Interactionism and Grounded Theory as its theoretical framework. Participants of the study: 13 women submitted to surgery: Total Abdominal Hysterectomy, Total Abdominal Hysterectomy with bilateral Adnexectomy, Wertheim-Meigs surgery, Oophorectomy, Salpingectomy, Mastectomy, Quadrantectomy and Tracheloplasty. Individual interviews were conducted, recorded and analyzed according to the comparative analysis technique of the Grounded Theory. Results: from the data two categories emerged - Perceiving a different body and feeling as a different person and; building the meaning of mutilation. The changes experienced make women build new meanings and change the perception of themselves and their social environment. From the interaction with their inner self, occurred a reflection on relationships, the difference in their body and themselves, the functions it performs and the harm caused by the surgery. Conclusions: the participants felt like different women; the mutilation developed in concrete feelings, due the loss of the organ, and in abstract, linked to the impact of social identity and female functionality. The importance of the nurse establishing a multidimensional care, to identify the needs that go beyond the biological body is perceived. PMID:27579935

  13. Influence of Music on Preoperative Anxiety and Physiologic Parameters in Women Undergoing Gynecologic Surgery.

    Science.gov (United States)

    Labrague, Leodoro J; McEnroe-Petitte, Denise M

    2016-04-01

    The aim of this study was to determine the influence of music on anxiety levels and physiologic parameters in women undergoing gynecologic surgery. This study employed a pre- and posttest experimental design with nonrandom assignment. Ninety-seven women undergoing gynecologic surgery were included in the study, where 49 were allocated to the control group (nonmusic group) and 48 were assigned to the experimental group (music group). Preoperative anxiety was measured using the State Trait Anxiety Inventory (STAI) while noninvasive instruments were used in measuring the patients' physiologic parameters (blood pressure [BP], pulse [P], and respiration [R]) at two time periods. Women allocated in the experimental group had lower STAI scores (t = 17.41, p control group. This study provides empirical evidence to support the use of music during the preoperative period in reducing anxiety and unpleasant symptoms in women undergoing gynecologic surgery. © The Author(s) 2014.

  14. Laparoscopic major gynecologic surgery in patients with prior laparotomy bowel resection.

    Science.gov (United States)

    Fanning, James; Hojat, Rod; Deimling, Timothy

    2011-01-01

    To review the success and morbidity of laparoscopic major gynecologic surgery in patients with prior laparotomy bowel resection. Review of a prospective surgical database of all cases of laparoscopic major gynecologic surgery in patients with prior laparotomy bowel resection. No cases were excluded. Bowel diagnoses and procedures were total colectomy for inflammatory bowel disease (4), partial colectomy for colon cancer (6), partial small bowel resection for obstruction (1), and Whipple for pancreatic cancer (2). Two patients had 3 prior laparotomies, 8 patients had 2 prior laparotomies, and 3 patients had 1 prior laparotomy. All prior abdominal incisions were midline. Gynecologic diagnoses and procedures were laparoscopic cytoreduction for ovarian cancer (1), lsh/bso/staging for ovarian cancer (1), lavh/bso/lymphadenectomy for endometrial cancer (4), and lavh/bso, lsh/bso, or bso for large ovarian mass (7). Median patient age was 57 years, median BMI was 31kg/m(2), and all patients had medical comorbidities. All 13 laparoscopic gynecologic surgeries were successful without trocar insertion injury, conversion to laparotomy, and without enterotomy. Abdominal adhesions were present in all cases. Median operative time was 2 hours, median blood loss was 100cc, and median hospital stay was 1 day. There were no postoperative complications. Laparoscopic major gynecologic surgery in patients with prior laparotomy bowel resection is feasible for experienced laparoscopic surgeons.

  15. Cost analysis of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery.

    Science.gov (United States)

    Fanning, James; Fenton, Bradford; Jean, Geraldine Marie; Chae, Clara

    2011-12-01

    Prophylactic intraoperative ureteral stent placement is performed to decrease operative ureteric injury, though few data are available on the effectiveness of this procedure, and no data are available on its cost. To analyze the cost of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery. All cases of prophylactic ureteral stent placement performed in gynecologic surgery during a 1-year period were identified and retrospectively reviewed through the electronic medical records database of Summa Health System. Costs were obtained through the Healthcare Cost Accounting System. The principles of cost-effective analysis were used (ie, explicit and detailed descriptions of costs and cost-effectiveness statistics). Importantly, we evaluated cost and not charges or financial model estimates. In addition, we obtained the contribution margins (ie, the hospital's net profit or loss) for prophylactic ureteral stent placement. Other gynecologic procedures were also analyzed. Among 792 major inpatient gynecologic procedures, 18 cases of prophylactic intraoperative ureteral stents were identified. Median costs were as follows: additional cost of prophylactic intraoperative ureteral stenting, $1580; additional cost of surgical resources, $770; cost of ureteral catheters, $427; cost of surgeons, $383. The contribution margins per case for various gynecologic surgical procedures were as follows: oophorectomy, $2804 profit; abdominal hysterectomy, $2649 profit; laparoscopically assisted vaginal hysterectomy (LAVH), $1760 profit. When intraoperative ureteral stenting was added, the contribution margins changed to the following: oophorectomy, $782 profit; abdominal hysterectomy, $627 profit; LAVH, $262 loss. Overall, the contribution margin profit was decreased by about 85%, from $2400 to $380. Prophylactic intraoperative ureteral stenting in gynecologic surgery decreases a hospital's contribution margin. Because of the expense of this procedure, as well as

  16. [Contribution of Perioperative Oral Health Care and Management for Patients who Underwent General Thoracic Surgery].

    Science.gov (United States)

    Saito, Hajime; Minamiya, Yoshihiro

    2016-01-01

    Due to the recent advances in radiological diagnostic technology, the role of video-assisted thoracoscopic surgery in thoracic disease has expanded, surgical indication extended to the elderly patients. Cancer patients receiving surgery, radiation therapy and/or chemotherapy may encounter complications in conjunction with the oral cavity such as aspiration pneumonia, surgical site infection and various type of infection. Recently, it is recognized that oral health care management is effective to prevent the postoperative infectious complications, especially pneumonia. Therefore, oral management should be scheduled before start of therapy to prevent these complications as supportive therapy of the cancer treatment. In this background, perioperative oral function management is highlighted in the remuneration for dental treatment revision of 2012,and the importance of oral care has been recognized in generally. In this manuscript, we introduce the several opinions and evidence based on the recent previous reports about the perioperative oral health care and management on thoracic surgery.

  17. [Findings from Total Colonoscopy in Obstructive Colorectal Cancer Patients Who Underwent Stent Placement as a Bridge to Surgery(BTS)].

    Science.gov (United States)

    Maruo, Hirotoshi; Tsuyuki, Hajime; Kojima, Tadahiro; Koreyasu, Ryohei; Nakamura, Koichi; Higashi, Yukihiro; Shoji, Tsuyoshi; Yamazaki, Masanori; Nishiyama, Raisuke; Ito, Tatsuhiro; Koike, Kota; Ikeda, Takashi; Takayanagi, Yasuhiro; Kubota, Hiroyuki

    2017-11-01

    We clinically investigated 34 patients with obstructive colorectal cancer who underwent placement of a colonic stent as a bridge to surgery(BTS), focusing on endoscopic findings after stent placement.Twenty -nine patients(85.3%)underwent colonoscopy after stent placement, and the entire large intestine could be observed in 28(96.6%).Coexisting lesions were observed in 22(78.6%)of these 28 patients.The lesions comprised adenomatous polyps in 17 patients(60.7%), synchronous colon cancers in 5 patients(17.9%), and obstructive colitis in 3 patients(10.7%), with some overlapping cases.All patients with multiple cancers underwent one-stage surgery, and all lesions were excised at the same time.Colonoscopy after colonic stent placement is important for preoperative diagnosis of coexisting lesions and planning the extent of resection. These considerations support the utility of colonic stenting for BTS.

  18. Pain control in laparoscopic gynecologic surgery with/without preoperative (preemptive) parecoxib sodium injection: a randomized study.

    Science.gov (United States)

    Ratchanon, Sarwinee; Phaloprakarn, Chadakarn; Traipak, Khanitta

    2011-10-01

    To determine the effectiveness of preoperative parecoxib sodium injection for pain relief after laparoscopic gynecologic surgery. A prospective double-blind, randomized study was conducted in 268 patients who underwent laparoscopic gynecologic surgery at Vajira Hospital between November 1, 2010 and March 31, 2011. The patients were randomly allocated into two groups to receive either single intravenous 40 mg parecoxib (treatment group; n = 133) or normal saline (control group; n = 135) 30 min before surgery. The degree of postoperative pain was assessed every 2 h in the first 8 h postoperation, then every 4 h until completion of 24 h by using a verbal rating scale. Total consumption of meperidine over a 24-h period and the adverse events relevant to parecoxib sodium were also recorded. Mean pain scores at all measured times in the treatment group were insignificantly lower than those in the control group (p = 0.106). The mean 24-h postoperative meperidine consumption in the treatment group was significantly lower compared to that in the control group (26.3 +/- 28.1 mg and 39.1 +/- 34.6 mg, respectively, p = 0.001). The proportion of patients requiring meperidine in the treatment group was significantly lower than that in the control group (58.6% and 70.3%, respectively, p = 0. 045). No serious adverse events were observed in both groups. Preoperative parecoxib sodium significantly reduced postoperative meperidine requirement and consumption, while insignificantly declined the pain scores. Serious adverse events were not encountered

  19. The clinical experience of robot-assisted surgery in gynecologic cancer.

    Science.gov (United States)

    Li, Xue-Lian; Du, Dan-Feng; Jiang, Hua

    2017-04-01

    The comparison of robotic and conventional laparoscopic hysterectomy and pelvic lymphadenectomy in gynecologic cancer still needs to be studied. In all, 98 consecutive cases of patients with gynecologic cancer undergoing robot-assisted hysterectomy and pelvic lymphadenectomy, and another 98 consecutive cases of conventional laparoscopic hysterectomy and pelvic lymphadenectomy during the same period in the Obstetrics and Gynecology Hospital of Fudan University were included. The duration of the operation, blood loss, drainage during the first 24 h after the operation, total hospital stay, hospital stay after the operation, lymph nodes collected, perioperative complications, and the cost of each operation for both procedures were recorded. The duration of the operation was longer, and the cost of each operation was almost seven times higher in the robot group than that in the conventional laparoscopy group. But the differences with regard to blood loss, drainage during the first 24 h after the operation, total hospital stay, hospital stay after operation, the lymph nodes collected, and the rate of perioperative complications were not statistically significant. Robot-assisted surgery (RAS) in gynecologic cancer is as feasible as conventional laparoscopic surgery. We recommend further studies about the cost and effect of RAS in gynecologic cancer.

  20. [Complications in gynecologic laparoscopic surgery--retrospective and prospective study].

    Science.gov (United States)

    Gocevska, S; Gortchev, G; Tomov, S

    2011-01-01

    Laparoscopic surgery is a surgical approach with proven advantages in the contemporary treatment of gynaecological diseases. It is applied with proven results in oncologic patients in order to respect certain rules. Mini-invasive approach has less complication and therefore is widely recommended. In this respect, the constantly increasing interest in this surgery and additional training and education. Risk factors must be taken into consideration and patients should be informed about possible complications during surgery.

  1. Enhanced Recovery Pathways for Improving Outcomes After Minimally Invasive Gynecologic Oncology Surgery.

    Science.gov (United States)

    Chapman, Jocelyn S; Roddy, Erika; Ueda, Stefanie; Brooks, Rebecca; Chen, Lee-Lynn; Chen, Lee-May

    2016-07-01

    To estimate whether an enhanced recovery after surgery pathway facilitates early recovery and discharge in gynecologic oncology patients undergoing minimally invasive surgery. This was a retrospective case-control study. Consecutive gynecologic oncology patients undergoing laparoscopic or robotic surgery between July 1 and November 5, 2014, were treated on an enhanced recovery pathway. Enhanced recovery pathway components included patient education, multimodal analgesia, opioid minimization, nausea prophylaxis as well as early catheter removal, ambulation, and feeding. Cases were matched in a one-to-two ratio with historical control patients on the basis of surgery type and age. Primary endpoints were length of hospital stay, rates of discharge by noon, 30-day hospital readmission rates, and hospital costs. There were 165 patients included in the final cohort, 55 of whom were enhanced recovery pathway patients. Enhanced recovery patients were more likely to be discharged on postoperative day 1 compared with patients in the control group (91% compared with 60%, Pcontrol patients (P=.03). Postoperative pain scores decreased (2.6 compared with 3.12, P=.03) despite a 30% reduction in opioid use. Average total hospital costs were decreased by 12% in the enhanced recovery group ($13,771 compared with $15,649, P=.01). Readmission rates, mortality, and reoperation rates did not differ between the two groups. An enhanced recovery pathway in patients undergoing gynecologic oncology minimally invasive surgery is associated with significant improvements in recovery time, decreased pain despite reduced opioid use, and overall lower hospital costs.

  2. The Effectiveness of Adjuvant Hyperbaric Oxygen Therapy in Adults who Underwent Hypospadias Surgery

    Directory of Open Access Journals (Sweden)

    Onder Kara

    2017-01-01

    Full Text Available Aim: To evaluate the role of hyperbaric oxygen therapy (HBO2T with buccal mucosal tube urethroplasty in adult patients with hypospadias. Material and Method: Sixteen adult patients with hypospadias were included in our study. Patients with a short urethra and penile curvature were treated in two stages (orthoplasty buccal mucosal tube urethroplasty. Buccal mucosa was taken and prepared for tube urethroplasty around a 16 French (Fr nelaton catheter and the urethral tube was introduced between the urethral meatus and glans penis. Beginning the 1st postoperative day (HBO2T was applied for 10 sessions during weekdays in 13 patients. Results: The mean age was 21 (±1.23 years and mean follow-up time was 10.1 (±2.1 months. In the group who received HBO2T postoperatively (n=13, a two-stage (orthoplasty buccal mucosal tube urethroplasty procedure was performed in 6 (46%, and the mean length of graft was 5.4 (±1.23 cm. In this group of 13 the success rate without any additional manipulations (urethrotomy intern, fistula repair was 54% (7/13. After additional manipulations, complete healing was achieved in 11 out of 13 patients (84.6%. In the group who did not receive HBO2T postoperatively (n=3, a two-stage procedure was performed in 1 patient (33%, and the mean length of graft was 8 (±5 cm. In this group of 3, complete healing was not achieved in any of these patients as a result of the hypospadias surgery. However, after the additional manipulations, complete healing was achieved in 1 patient (33%. Discussion: Given the promising rates of surgical success, postoperative HBO2T might be considered as a supportive treatment modality for adult patients with hypospadias who undergo buccal mucosal tube urethroplasty. Randomized controlled studies are needed.

  3. Analysis of Ulcer Recurrences After Metatarsal Head Resection in Patients Who Underwent Surgery to Treat Diabetic Foot Osteomyelitis.

    Science.gov (United States)

    Sanz-Corbalán, Irene; Lázaro-Martínez, José Luis; Aragón-Sánchez, Javier; García-Morales, Esther; Molines-Barroso, Raúl; Alvaro-Afonso, Francisco Javier

    2015-06-01

    Metatarsal head resection is a common and standardized treatment used as part of the surgical routine for metatarsal head osteomyelitis. The aim of this study was to define the influence of the amount of the metatarsal resection on the development of reulceration or ulcer recurrence in patients who suffered from plantar foot ulcer and underwent metatarsal surgery. We conducted a prospective study in 35 patients who underwent metatarsal head resection surgery to treat diabetic foot osteomyelitis with no prior history of foot surgeries, and these patients were included in a prospective follow-up over the course of at least 6 months in order to record reulceration or ulcer recurrences. Anteroposterior plain X-rays were taken before and after surgery. We also measured the portion of the metatarsal head that was removed and classified the patients according the resection rate of metatarsal (RRM) in first and second quartiles. We found statistical differences between the median RRM in patients who had an ulcer recurrence and patients without recurrences (21.48 ± 3.10% vs 28.12 ± 10.8%; P = .016). Seventeen (56.7%) patients were classified in the first quartile of RRM, which had an association with ulcer recurrence (P = .032; odds ratio = 1.41; 95% confidence interval = 1.04-1.92). RRM of less than 25% is associated with the development of a recurrence after surgery in the midterm follow-up, and therefore, planning before surgery is undertaken should be considered to avoid postsurgical complications. © The Author(s) 2015.

  4. Thromboprophylaxis in women undergoing gynecological surgery or assisted reproductive techniques: new advances and challenges.

    Science.gov (United States)

    Piróg, Magdalena Maria; Jach, Robert; Undas, Anetta

    2016-01-01

    Venous thromboembolism (VTE) affects 0.1-0.3% people each year. The risk of VTE following gynecological surgery and invasive procedures is well established and presents one of the major challenges in gynecological practice. Moreover, commonly use assisted reproductive techniques (ART) are reported to increase the risk of VTE. Despite continued efforts to reduce its incidence, postoperative VTE remains the second most common perioperative complication and the third most common cause of mortality. Several practice guidelines have been developed regarding prophylaxis and treatment of VTE. However, there is a large inconsistency between the recommendations and the medical practice in various centers. Moreover, prophylaxis in gynecological patients and women undergoing ART should be chosen individually for the patient, taking into account the possible risk factors for VTE and perioperative bleeding complications. Until recently, the percentage of women, who have not received anticoagulant prophylaxis or administrated it inadequately may reach 50%. This paper presents the current recommendations regarding thromboprophylaxis in women undergoing gynecological surgery or assisted reproductive techniques and addresses challenging practical issues in this field.

  5. The Mid-Term Results of Patients who Underwent Radiofrequency Atrial Fibrillation Ablation Together with Mitral Valve Surgery

    Directory of Open Access Journals (Sweden)

    Abdurrahim Çolak

    Full Text Available Abstract Objetive: Saline-irrigated radiofrequency ablation, which has been widely used for surgical treatment of atrial fibrillation in recent years, is 80-90% successful in achieving sinus rhythm. In our study, our surgical experience and mid-term results in patients who underwent mitral valve surgery and left atrial radiofrequency ablation were analyzed. Methods: Forty patients (15 males, 25 females; mean age 52.05±9.9 years; range 32-74 underwent surgery for atrial fibrillation associated with mitral valvular disease. All patients manifested atrial fibrillation, which started at least six months before the surgical intervention. The majority of patients (36 patients, 90% were in NYHA class III; 34 (85% patients had rheumatic heart disease. In addition to mitral valve surgery and radiofrequency ablation, coronary artery bypass, DeVega tricuspid annuloplasty, left ventricular aneurysm repair, and left atrial thrombus excision were performed. Following discharge from the hospital, patients' follow-up was performed as outpatient clinic examinations and the average follow-up period of patients was 18±3 months. Results: While the incidence of sinus rhythm was 85.3% on the first postoperative day, it was 80% during discharge and 71% in the 1st year follow-up examination. Conclusion: Radiofrequency ablation is an effective method when it is performed by appropriate surgical technique. Its rate for returning to sinus rhythm is as high as the rate of conventional surgical procedure.

  6. Well-leg compartment syndrome after gynecological laparoscopic surgery

    DEFF Research Database (Denmark)

    Boesgaard-Kjer, Diana H; Boesgaard-Kjer, Daniel; Kjer, Jens Jørgen

    2013-01-01

    Well-leg compartment syndrome in the lower extremities after surgery in the lithotomy position is a rare but severe complication requiring early diagnosis and intervention. Several circumstances predispose to this condition as a consequence of increased intra-compartmental pressure, such as posit...

  7. Control and prevention of peritoneal adhesions in gynecologic surgery.

    Science.gov (United States)

    2006-11-01

    Postoperative adhesion formation is a natural consequence of surgical tissue trauma and healing and may result in infertility, pain, and bowel obstruction. Microsurgical principles and minimally invasive surgery may help decrease adhesion formation, but anti-inflammatory agents and peritoneal instillates have no demonstrable benefit. Although some surgical barriers are effective for reducing postoperative adhesions, none has been shown to improve fertility or to decrease pain or the incidence of postoperative bowel obstruction.

  8. A comparison of medical litigation filed against obstetrics and gynecology, internal medicine, and surgery departments.

    Science.gov (United States)

    Hamasaki, Tomoko; Hagihara, Akihito

    2015-10-24

    The aim of this study was to review the typical factors related to physician's liability in obstetrics and gynecology departments, as compared to those in internal medicine and surgery, regarding a breach of the duty to explain. This study involved analyzing 366 medical litigation case reports from 1990 through 2008 where the duty to explain was disputed. We examined relationships between patients, physicians, variables related to physician's explanations, and physician's breach of the duty to explain by comparing mean values and percentages in obstetrics and gynecology, internal medicine, and surgical departments with the t-test and χ(2) test. When we compared the reasons for decisions in cases where the patient won, we found that the percentage of cases in which the patient's claim was recognized was the highest for both physician negligence, including errors of judgment and procedural mistakes, and breach of the duty to explain, in obstetrics and gynecology departments; breach of the duty to explain alone in internal medicine departments; and mistakes in medical procedures alone in surgical departments (p = 0.008). When comparing patients, the rate of death was significantly higher than that of other outcomes in precedents where a breach of the duty to explain was acknowledged (p = 0.046). The proportion of cases involving obstetrics and gynecology departments, in which care was claimed to be substandard at the time of treatment, and that were not argued as breach of a duty to explain, was significantly higher than those of other evaluated departments (p obstetrics and gynecology departments, the proportion of cases in which it had been conceded that the duty to explain had been breached when seeking patient approval (or not) was significantly higher than in other departments (p = 0.002). It is important for physicians working in obstetrics and gynecology departments to carefully explain the risk of death associated with any planned procedure, and to obtain

  9. Bemiparin for thromboprophylaxis after benign gynecologic surgery: a randomized clinical trial.

    Science.gov (United States)

    Alalaf, S K; Jawad, A K; Jawad, R K; Ali, M S; Al Tawil, N G

    2015-12-01

    Venous thromboembolism (VTE) is the leading cause of mortality and morbidity in women following gynecologic surgery. To determine the efficacy of a second-generation low molecular weight heparin (bemiparin) for thromboprophylaxis after benign gynecologic surgery. We performed a single-blind randomized controlled trial including women in the moderate-risk, high-risk and highest-risk groups for developing VTE after benign gynecologic surgery. Participants were randomized at a 1 : 1 ratio into parallel groups to receive either seven daily doses of 3500 IU of subcutaneous bemiparin or to a non-intervention group receiving standard rehydration and advice on ambulation. Participants were followed up for 7 days and 30 days postoperatively for symptomatic VTE, which was confirmed by compression Doppler ultrasound, magnetic resonance imaging, or computed tomographic pulmonary angiography, according to the type of VTE. In total, 387 participants were randomized to the bemiparin group and 387 to the non-intervention group. The incidence of symptomatic VTE (deep vein thrombosis and pulmonary embolism) events was lower (0/377) in participants who received bemiparin than in those who received no pharmacologic intervention (12/380, 3.2%; 95% confidence interval [CI] 0.002-0.6). Logistic regression analysis showed significant associations between VTE and immobility (odds ratio [OR] 7.1; 95% CI 1.3-36.2), varicose veins (OR 16.8; 95% CI 3.1-76.2), and thrombophilia (OR 39.3; 95% CI 1.5-1006.7). There were no major bleeding events or side effects related to the use of bemiparin. Bemiparin was an effective thromboprophylactic agent for preventing venous thrombosis after benign gynecologic surgery. © 2015 International Society on Thrombosis and Haemostasis.

  10. [Multimodal analgesia in outpatient videolaparoscopic gynecologic surgery: comparison between parecoxib and tenoxicam.].

    Science.gov (United States)

    Belzarena, Sérgio D; Alves, Mozart T; Cucco, Máximo L D; D'Avila, Vanius D

    2005-04-01

    The quality of postoperative analgesia in patients submitted to outpatient videolaparoscopic gynecologic surgery was evaluated by comparing the effects of intravenous parecoxib and tenoxicam in a double-blind study. Participated in this prospective study 60 patients who were randomly divided into two groups. All patients were premedicated with midazolam and one group (P) received 40 mg parecoxib before surgery. The other group (T) received 20 mg tenoxicam in the same manner. Spinal anesthesia with bupivacaine and sufentanil was administered for videolaparoscopic gynecologic procedures. Postoperative analgesia was evaluated using verbal and visual scales. Pain site (incisional, visceral or shoulder), supplemental analgesics and side effects were recorded, in addition to patients' satisfaction with the technique. Analgesic quality was excellent with 76% Group P patients and 83% group T patients with no postoperative pain complaint or analgesic request. There were no statistical differences between groups in all evaluated criteria. Pruritus, although brief and mild, was the primary side effect. All patients were satisfied or very satisfied with the technique. Multimodal analgesia with subarachnoid local anesthetic and opioid associated to intravenous NSAID produces excellent postoperative pain relief with few adverse effects in outpatient videolaparoscopic gynecologic surgery. The choice of the NSAID seems to be of minor importance for such results.

  11. New Developments in Robotics and Single-site Gynecologic Surgery.

    Science.gov (United States)

    Matthews, Catherine A

    2017-06-01

    Within the last 10 years there have been significant advances in minimal-access surgery. Although no emerging technology has demonstrated improved outcomes or fewer complications than standard laparoscopy, the introduction of the robotic surgical platform has significantly lowered abdominal hysterectomy rates. While operative time and cost were higher in robotic-assisted procedures when the technology was first introduced, newer studies demonstrate equivalent or improved robotic surgical efficiency with increased experience. Single-port hysterectomy has not improved postoperative pain or subjective cosmetic results. Emerging platforms with flexible, articulating instruments may increase the uptake of single-port procedures including natural orifice transluminal endoscopic cases.

  12. Four Cases of Chylous Ascites following Robotic Gynecologic Oncological Surgery

    Directory of Open Access Journals (Sweden)

    Ahmet Göçmen

    2014-01-01

    Full Text Available Chylous ascites is an uncommon form of ascites characterized by milky-appearing fluid caused by blocked or disrupted lymph flow through chyle-transporting vessels. The most common causes of chylous ascites are therapeutic interventions and trauma. In this report, we present four cases of chylous ascites following robot-assisted surgery for endometrial staging and the treatment strategies that we used. After retroperitoneal lymph node dissection, leaving a drain is very useful in diagnosing chylous ascites and observing its resolution; furthermore, the use of octreotide in conjunction with TPN appears to be an efficient treatment modality for chylous ascites and should be considered before any invasive intervention.

  13. Citrus aurantium Naringenin Prevents Osteosarcoma Progression and Recurrence in the Patients Who Underwent Osteosarcoma Surgery by Improving Antioxidant Capability

    Directory of Open Access Journals (Sweden)

    Lirong Zhang

    2018-01-01

    Full Text Available Citrus aurantium is rich in flavonoids, which may prevent osteosarcoma progression, but its related molecular mechanism remains unclear. Flavonoids were extracted from C. aurantium and purified by reparative HPLC. Each fraction was identified by using electrospray ionisation mass spectrometry (ESI-MS. Three main components (naringin, naringenin, and hesperetin were isolated from C. aurantium. Naringenin inhibited the growth of MG-63 cells, whereas naringin and hesperetin had no inhibitory function on cell growth. ROS production was increased in naringin- and hesperetin-treated groups after one day of culture while the level was always lowest in the naringenin-treated group after three days of culture. 95 osteosarcoma patients who underwent surgery were assigned into two groups: naringenin group (NG, received 20 mg naringenin daily, n=47 and control group (CG, received 20 mg placebo daily, n=48. After an average of two-year follow-up, osteosarcoma volumes were smaller in the NG group than in the CG group (P>0.01. The rate of osteosarcoma recurrence was also lower in the NG group than in CG group. ROS levels were lower in the NG group than in the CG group. Thus, naringenin from Citrus aurantium inhibits osteosarcoma progression and local recurrence in the patients who underwent osteosarcoma surgery by improving antioxidant capability.

  14. Perioperative blood transfusion in gynecologic oncology surgery: analysis of the National Surgical Quality Improvement Program Database.

    Science.gov (United States)

    Prescott, Lauren S; Aloia, Thomas A; Brown, Alaina J; Taylor, Jolyn S; Munsell, Mark F; Sun, Charlotte C; Schmeler, Kathleen M; Levenback, Charles F; Bodurka, Diane C

    2015-01-01

    To use a large-scale multi-institutional dataset to quantify the prevalence of packed red blood cell transfusions and examine the associations between transfusion and perioperative outcomes in gynecologic cancer surgery. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) participant use file was queried for all gynecologic cancer cases between 2010 and 2012. Demographic, preoperative and intraoperative variables were compared between transfusion and non-transfusion groups using chi-squared, Fisher's exact and Wilcoxon rank-sum tests. The primary endpoint was 30-day composite morbidity. Secondary endpoints included composite surgical site infections, mortality and length of stay. A total of 8519 patients were analyzed, and 13.8% received a packed red blood cell transfusion. In the multivariate analysis, after adjusting for key clinical and perioperative factors, including preoperative anemia and case magnitude, transfusion was associated with higher composite morbidity (OR = 1.85, 95% CI 1.5-2.24), surgical site infections (OR 1.80, 95% CI 1.39-2.35), mortality (OR 3.38, 95% CI 1.80-6.36) and length of hospital stay (3.02 days v. 7.17 days, P gynecologic cancer should be scrutinized. Examination of institutional practices and creation of transfusion guidelines for gynecologic malignancies could potentially result in better utilization of blood bank resources and clinical outcomes among patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Patient positioning for robot-assisted laparoscopic benign gynecologic surgery: A review.

    Science.gov (United States)

    Takmaz, Ozguc; Asoglu, Mehmet Resit; Gungor, Mete

    2018-04-01

    Robotic surgical platforms are now in widespread use in the practice of gynecology all over the world. The introduction of robotic surgery has required some modifications of patient positioning when compared to standard laparoscopic surgery. Optimal patient positioning is likely to be the most essential step of robotic surgery as it provides the technical feasibility to have adequate access to the pelvic structures for performing the surgery. It is prudent to pay attention to preventing patient shifting in Trendelenburg position because of tendency of sliding down toward the direction of the head. Inappropriate patient positioning is associated with inadequate exposure of the operative field as well as detrimental complications that may lead to long-term side effects. These issues can be reduced with use of proper or strategic positioning technique. The purpose of this review is to highlight important points to properly position patient for robot-assisted laparoscopic benign gynecologic surgery and protect patient from position-related injuries. Copyright © 2018 Elsevier B.V. All rights reserved.

  16. Selective impairment of attention networks during propofol anesthesia after gynecological surgery in middle-aged women.

    Science.gov (United States)

    Chen, Chen; Xu, Guang-hong; Li, Yuan-hai; Tang, Wei-xiang; Wang, Kai

    2016-04-15

    Postoperative cognitive dysfunction is a common complication of anesthesia and surgery. Attention networks are essential components of cognitive function and are subject to impairment after anesthesia and surgery. It is not known whether such impairment represents a global attention deficit or relates to a specific attention network. We used an Attention Network Task (ANT) to examine the efficiency of the alerting, orienting, and executive control attention networks in middle-aged women (40-60 years) undergoing gynecologic surgery. A matched group of medical inpatients were recruited as a control. Fifty female patients undergoing gynecologic surgery (observation group) and 50 female medical inpatients (control group) participated in this study. Preoperatively patients were administered a mini-mental state examination as a screening method. The preoperative efficiencies of three attention networks in an attention network test were compared to the 1st and 5th post-operative days. The control group did not have any significant attention network impairments. On the 1st postoperative day, significant impairment was shown in the alerting (p=0.003 vs. control group, p=0.015 vs. baseline), orienting (pAttention networks of middle-aged women show a varying degree of significant impairment and differing levels of recovery after surgery and propofol anesthetic. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Effect of advanced blood pressure control with nifedipine delayedrelease tablets on the blood pressure in patients underwent nasal endoscope surgery

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    Qing-Hua Xia

    2016-08-01

    Full Text Available Objective: To explore the effect of advanced blood pressure control with nifedipine delayedrelease tablets on the blood pressure in patients underwent nasal endoscope surgery and its feasibility. Methods: A total of 80 patients who were admitted in ENT department from June, 2012 to June, 2015 for nasal endoscope surgery were included in the study and randomized into the observation group and the control group with 40 cases in each group. The patients in the observation group were given nifedipine delayed-release tablets for advanced blood pressure control before operation, and were given routine blood pressure control during operation; while the patients in the control group were only given blood pressure control during operation. The changes of blood pressure, mean central arterial pressure, and heart rate before anesthesia (T0, after intubation (T1, during operation (T2, extubation when waking (T3, 30 min after extubation (T4, and 3 h after back to wards (T5 in the two groups were compared. The intraoperative situation and the surgical field quality in the two groups were compared. Results: SBP, DBP, and MAP levels at T1-5 in the two groups were significantly lower than those at T0. SBP, DBP, and MAP levels at T2 were significantly lower than those at other timing points, and were gradually recovered after operation, but were significantly lower than those at T0. The effect taking time of blood pressure reducing, intraoperative nitroglycerin dosage, and postoperative wound surface exudation amount in the observation group were significantly less than those in the control group. The surgical field quality scores in the observation group were significantly superior to those in the control group. Conclusions: Advanced blood pressure control with nifedipine delayed-release tablets can stabilize the blood pressure during the perioperative period in patients underwent nasal endoscope surgery, and enhance the surgical field qualities.

  18. Sexual and psychological functioning in women after pelvic surgery for gynaecological cancer

    NARCIS (Netherlands)

    Aerts, L.; Enzlin, P.; Verhaeghe, J.; Vergote, I.; Amant, F.

    2009-01-01

    Pelvic surgery for gynecological cancer can affect sexuality through a number of anatomical, physiological and psychological mechanisms. We aimed to examine the prevalence Of Sexual dysfunction and psychological functioning in women who underwent pelvic surgery for gynecological cancer. Fifty women

  19. Intraperitoneal And Incisional Bupivacaine Analgesia For Major Abdominal/Gynecologic Surgery: A Placebocontrolled

    Directory of Open Access Journals (Sweden)

    R. Azarfarin

    2006-05-01

    Full Text Available Background:Postoperative pain is an important surgical problem. Recent studies in pain pathophysiology have led to the hypothesis that with perioperative administration of analgesics (pre-emptive analgesia it may be possible to prevent or reduce postoperative pain. This study was planned to investigate the efficacy of pre-emptive analgesia on postoperative pain after major gynecologic abdominal surgeries. Methods: In this prospective, double-blinded, randomized, and placebocontrolled trial, 60 ASA physical status I and II patients undergoing major abdominal gynecologic surgeries were randomized to receive 45 mL of bupivacaine 0.375% or 45mL of normal saline; 30 mL and 15 mL of the treatment solution was administered into the peritoneal cavity and incision, respectively, before wound closure. The pain score of the patients was evaluated by the visual analogue scale (VAS on awakening, and at 6, 12, and 24h after surgery. Time to first analgesia request and total analgesic requirements in the first 24h were recorded. Results: Pain scores were significantly higher in the placebo group than in the bupivacaine group on awakening (5.98±1.01 v.s 1.05±1.05; p<0.001, and at 6h after surgery (5.37±0.85 vs. 2.51±1.02; p<0.001. First request to analgesia was significantly longer in the bupivacaine patients than in the placebo group (5.87±3.04 h vs.1.35±0.36; p<0.001.Meperidine consumption over 24h was 96.00 ±17.53 mg in the placebo group compared with 23.28 ±14.89 mg in the bupivacaine patients (p<0.001.Conclusion:A combination of intraperitoneal and incisional bupivacaine infiltration at the end of abdominal gynecologic surgeries reduces postoperative pain on awakening and for 6 hours after surgery, and provides significant opioidsparing analgesia for 24 h after gynecologic abdominal surgeries.

  20. Effectiveness and safety of expanded perioperative thromboprophylaxis in complex gynecologic surgery.

    Science.gov (United States)

    Corr, Bradley R; Winter, Andrea M; Sammel, Mary D; Chu, Christina S; Gage, Brian F; Hagemann, Andrea R

    2015-09-01

    To determine the effectiveness and safety of an expanded perioperative venous thromboembolism (VTE) prophylaxis strategy in women undergoing complex gynecologic surgery. We performed a cohort study of 527 patients undergoing major surgery at a single institution over a thirty-month interval during which the gynecologic oncology service implemented an expanded approach to VTE prophylaxis. We compared rates of VTE pre- and post-intervention as well as bleeding and infectious complications. Prior to the intervention, there were 23 VTE events in 345 patients (rate of 6.67%): 8 deep vein thromboses (DVTs) and 15 pulmonary emboli (PEs). Post-intervention, there were 5 VTE events in 182 patients (2.7%): 3 DVTs and 2 PEs (RR=0.4, p=0.056). Time-to-event analysis showed a significantly higher incidence of VTE events in the pre-intervention time frame compared to the post-intervention period (p=0.049). There were no significant differences in bleeding or infection complications between groups. Implementation of a perioperative VTE prophylaxis protocol was safe, feasible and resulted in a clinically significant reduction in symptomatic VTE. Preoperative single-dose unfractionated heparin for all patients, combined with two weeks of thromboprophylaxis in gynecologic cancer patients, may decrease VTE events without increasing bleeding or infection. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Impact of surgical approach and patient factors on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scoring in gynecologic surgery.

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    Wallace, Sumer; Hanson, Kristine T; Dowdy, Sean C; Habermann, Elizabeth B

    2018-01-01

    We sought to compare the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey responses of women who underwent gynecologic surgery at our institution across patient factors and surgical approach. We identified patients with returned HCAHPS surveys following an inpatient laparoscopic surgery or laparotomy in gynecologic surgery from 10/1/2012-9/30/2015. Exclusions included patient agerating methodologies and dichotomized as "high" versus "low." Chi-square, Fisher's exact, and Wilcoxon rank sum tests, and multivariable logistic regression were performed. Of 403 women who met inclusion criteria, 109 (27%) underwent laparoscopic surgery (19% laparoscopic hysterectomy and 8% other laparoscopic procedures) and 294 (73%) laparotomy (28% open hysterectomy and 47% other open procedures). Length of stay (LOS) was longer for laparotomy cases vs. laparoscopy cases (median 2.5days following open hysterectomy and 4days following other open procedures vs 1day following laparoscopic hysterectomy and other laparoscopic procedures, pscores (79% vs 66% laparoscopic hysterectomy, 66% open hysterectomy, and 52% other laparoscopic procedures, p=0.005). After adjustment, non-hysterectomy laparotomy cases were more likely to have a low summary score than non-hysterectomy laparoscopy (OR 3.86, 95% CI 1.71-8.68, p=0.001). This significance did not remain after further adjusting for LOS. In Gynecologic Surgery, patients undergoing laparotomy gave lower hospital ratings compared to laparoscopy. Those with longer LOS reported poorer patient experience, which is the driving variable for lower scores. In the future, it may be necessary to adjust for surgical approach when reporting patient experience scoring. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. The effects of transfusion of irradiated blood upon cellular immune response in patients underwent open heart surgery

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    Togashi, Ken-ichi; Nakazawa, Satoshi; Moro, Hisanaga; Yazawa, Masatomo; Kanazawa, Hiroshi; Hayashi, Jun-ichi; Yamazaki, Yoshihiko; Eguchi, Shoji

    1989-01-01

    The purpose of this paper is to demonstrate the effect of the transfusion of blood received 1500 rad exposure upon the immune response in 14 patients underwent various type of cardiac surgery. 13 patients received known amounts banked blood and irradiated fresh blood, while one patient received a lot of amounts of banked and irradiated and non-irradiated fresh blood. The authors studied the numbers of lymphocytes as well as lymphocyte subsets such as pan-T cells, B cells, helper/inducer T cells (T H/I ), cytotoxic/supressor T cells (T C/S ), active T cells, natural killer (NK) cells and NK cell activity during two weeks after surgeries. In all 14 patients, pan-T lymphocytes decreased markedly in a few days after surgeries, but increased to higher levels on the eight postoperative day than the levels preoperatively. T H/I and T C/S lymphocytes changed on the similar pattern as pan-T lymphocytes. Active T and B cells did not change significantly in two weeks. The number and activity of NK cells gave the lowest levels on the second postoperative day and did not recovery to the preoperative levels in two weeks. One patient received non-irradiated fresh blood showed the similar immune response as other 13 patients, while he gave the lower levels than others did. This patient died of graft-versus-host disease (GVHD)-like syndrome on the 36th postoperative day. It may be thought that the transfusion of irradiated blood would prevent the host from GVHD and gave the better effects on the immune response than that of non-irradiated blood following open-heart surgeries. (author)

  3. A randomized-clinical trial examining a neoprene abdominal binder in gynecologic surgery patients

    Science.gov (United States)

    Szender, J.B.; Hall, K.L.; Kost, E.R.

    2016-01-01

    Summary Purpose of Investigation Pain control and early ambulation are two important postoperative goals. Strategies that decrease morphine use while increasing ambulation have the potential to decrease postoperative complications. In this study the authors sought to determine the effect of an abdominopelvic binder on postoperative morphine use, pain, and ambulation in the first day after surgery. Materials and Methods The authors randomly assigned 75 patients undergoing abdominal gynecologic surgery to either binder or not after surgery. Demographic data and surgical characteristics were collected. Outcome variables included morphine use, pain score, time to ambulation, and number of ambulations. Results A group at high risk for decreased mobility was identified and the binder increased the number of ambulatory events by 300%, 260%, and 240% in patients with vertical incisions, age over 50 years, and complex surgeries, respectively. Morphine use and pain scores were not significantly different. Conclusion The binder increased ambulations in the subset of patients at the highest risk for postoperative complications: elderly, cancer patients, and vertical incisions. Routine use of the binder may benefit particularly high-risk gynecologic surgical patients. PMID:25864252

  4. [Laparoendoscopic single-site surgery in gynecology: the situation in 2013].

    Science.gov (United States)

    Rabischong, B; Compan, C; Savary, D; Bourdel, N; Canis, M; Mage, G; Botchorishvili, R

    2013-09-01

    Single-incision laparoscopic surgery (SILS) is a recent technic of minimally invasive surgery that arouses a growing interest due to its potential benefits in terms of pain and cosmetic. However, in gynecology as well as in other surgical specialties, preliminary results seem to be controversial. Its feasibility and interest by comparison with conventional laparoscopy (CL) have not been confirmed by randomized multicenter studies. Compare in gynecological surgery, feasibility and surgical outcomes (conversion rate and complications, postoperative pain, duration of surgery, length of hospital stay, appearance and cost) between SILS and CL. For this, a review of the literature from a PUBMED and Medline databases was conducted. The clinical cases and series with fewer than 10 patients were excluded. Eligible data were compared and analyzed. A total of 46 studies including five prospective randomized were studied in gynecology. Conversion rates and complications appear identical to those of the CL. The learning curve is also comparable. The technique is not standardized and some ergonomic problems are described. Operating time and duration of hospitalization seems to be comparable. The postoperative pain assessment found conflicting results. The cosmetic results are in favor of the single incision laparoscopy. Finally, the cost is higher. According to the literature, the single incision laparoscopy seems feasible and safe, with better cosmetic results. But the cost is increased and associated with no benefit in terms of pain, operating time and duration of hospitalization. Beyond cosmetics results, further randomized studies are needed to identify a possible benefit. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  5. Woman experiencing gynecologic surgery: coping with the changes imposed by surgery.

    Science.gov (United States)

    Silva, Carolina de Mendonça Coutinho E; Vargens, Octavio Muniz da Costa

    2016-08-29

    to describe the feelings and perceptions resulting from gynecologic surgery by women and analyze how they experience the changes caused by the surgery. a qualitative, descriptive and exploratory study, which had Symbolic Interactionism and Grounded Theory as its theoretical framework. Participants of the study: 13 women submitted to surgery: Total Abdominal Hysterectomy, Total Abdominal Hysterectomy with bilateral Adnexectomy, Wertheim-Meigs surgery, Oophorectomy, Salpingectomy, Mastectomy, Quadrantectomy and Tracheloplasty. Individual interviews were conducted, recorded and analyzed according to the comparative analysis technique of the Grounded Theory. from the data two categories emerged - Perceiving a different body and feeling as a different person and; building the meaning of mutilation. The changes experienced make women build new meanings and change the perception of themselves and their social environment. From the interaction with their inner self, occurred a reflection on relationships, the difference in their body and themselves, the functions it performs and the harm caused by the surgery. the participants felt like different women; the mutilation developed in concrete feelings, due the loss of the organ, and in abstract, linked to the impact of social identity and female functionality. The importance of the nurse establishing a multidimensional care, to identify the needs that go beyond the biological body is perceived. descrever as sensações e percepções advindas das cirurgias ginecológicas pelas mulheres e analisar como elas vivenciam as mudanças geradas pelas cirurgias. estudo qualitativo, descritivo-exploratório, que teve o Interacionismo Simbólico e Grounded Theory como referencial teórico-metodológico. Participaram 13 mulheres submetidas às cirurgias: Histerectomia Total Abdominal, Histerectomia Total Abdominal com Anexectomia bilateral, cirurgia de Wertheim-Meigs, Ooforectomia, Salpingectomia, Mastectomia, Quadrantectomia e

  6. Warming intravenous fluids reduces perioperative hypothermia in women undergoing ambulatory gynecological surgery.

    Science.gov (United States)

    Smith, C E; Gerdes, E; Sweda, S; Myles, C; Punjabi, A; Pinchak, A C; Hagen, J F

    1998-07-01

    We evaluated whether warming i.v. fluids resulted in less hypothermia (core temperature 30 min were randomized to two groups: fluid warming at 42 degrees C or control (room temperature fluids at approximately 21 degrees C). All patients received general anesthesia with isoflurane, tracheal intubation, standard operating room blankets and surgical drapes, and passive humidification of inspired gases. Tympanic membrane (core) temperatures were measured at baseline and at 15-min intervals after induction. The incidence of shivering and postoperative requirement for meperidine and/or radiant heat were evaluated. Core temperatures were lower in the control compared with the warm fluid group at the end of surgery (35.6 +/- 0.1 degrees C vs 36.2 +/- 0.1 degrees C; P unit or the incidence of shivering between the groups. We conclude that fluid warming, in conjunction with standard heat conservation measures, was effective in maintaining normothermia during outpatient gynecological surgery; however, there was no improvement in patient outcome. Women who received i.v. fluid at body temperature had significantly higher core temperatures during and after outpatient gynecological surgery compared with women who received i.v. fluids at the temperature of the operating room.

  7. Enhanced Recovery Implementation in Major Gynecologic Surgeries: Effect of Care Standardization.

    Science.gov (United States)

    Modesitt, Susan C; Sarosiek, Bethany M; Trowbridge, Elisa R; Redick, Dana L; Shah, Puja M; Thiele, Robert H; Tiouririne, Mohamed; Hedrick, Traci L

    2016-09-01

    To examine implementing an enhanced recovery after surgery (ERAS) protocol for women undergoing major gynecologic surgery at an academic institution and compare surgical outcomes before and after implementation. Two ERAS protocols were developed: a full pathway using regional anesthesia for open procedures and a light pathway without regional anesthesia for vaginal and minimally invasive procedures. Enhanced recovery after surgery pathways included extensive preoperative counseling, carbohydrate loading and oral fluids before surgery, multimodal analgesia with avoidance of intravenous opioids, intraoperative goal-directed fluid resuscitation, and immediate postoperative feeding and ambulation. A before-and-after study design was used to compare clinical outcomes, costs, and patient satisfaction. Complications and risk-adjusted length of stay were drawn from the American College of Surgeons' National Surgical Quality Improvement Program database. On the ERAS full protocol, 136 patients were compared with 211 historical controls and the median length of stay was reduced (2.0 compared with 3.0 days; P=.007) despite an increase in National Surgical Quality Improvement Program-predicted length of stay (2.5 compared with 2.0 days; P=.009). Reductions were seen in median intraoperative morphine equivalents (0.3 compared with 12.7 mg; Pcontrols and demonstrated decreased intraoperative and postoperative morphine equivalents (0.0 compared with 13.0 mg; Pcontrol, nurses keeping patients informed, and staff teamwork; 30-day total hospital costs were significantly decreased in both ERAS groups. Implementation of ERAS protocols in gynecologic surgery was associated with a substantial decrease in intravenous fluids and morphine administration coupled with reduction in length of stay for open procedures combined with improved patient satisfaction and decreased hospital costs.

  8. Suprapubic compared with transurethral bladder catheterization for gynecologic surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Healy, Eibhlín F; Walsh, Colin A; Cotter, Amanda M; Walsh, Stewart R

    2012-09-01

    Suprapubic catheterization is commonly used for postoperative bladder drainage after gynecologic procedures. However, recent studies have suggested an increased rate of complications compared with urethral catheterization. We undertook a systematic review and meta-analysis of randomized controlled trials comparing suprapubic catheterization and urethral catheterization in gynecologic populations. PubMed, EMBASE, CINAHL, Google Scholar, and trial registries were searched from 1966 to March 2012 for eligible randomized controlled trials comparing postoperative suprapubic catheterization and urethral catheterization in gynecologic patients. We used these search terms: "catheter," "supra(-)pubic catheter," "urinary catheter," "gyn(a)ecological," "catheterization techniques gyn(a)ecological surgery," "transurethral catheter," and "bladder drainage." No language restrictions were applied. METHODS AND STUDY SELECTION: The primary outcome was urinary tract infection. Secondary outcomes were the need for recatheterization, duration of catheterization, catheter-related complications, and duration of hospital stay. Pooled effect size estimates were calculated using the random effects model from DerSimonian and Laird. In total, 12 eligible randomized controlled trials were included in the analysis (N=1,300 patients). Suprapubic catheterization was associated with a significant reduction in postoperative urinary tract infections (20% compared with 31%, pooled odds ratio [OR] 0.31, 95% confidence interval [CI] 0.185-0.512, Pgynecologic patients is clearly superior. The reduced rate of infective morbidity with suprapubic catheterization is offset by a higher rate of catheter-related complications and crucially does not translate into reduced hospital stay. As yet, there are insufficient data to determine which route is most appropriate for catheterization; therefore, cost and patient-specific factors should be paramount in the decision. Minimally invasive surgery may alter the

  9. Adverse post-operative outcomes in Jehovah's witnesses with gynecologic cancer within 30 days of surgery: A single institution review of 36 cases.

    Science.gov (United States)

    Moulton, Laura J; Rose, Peter G; Mahdi, Haider

    2017-11-01

    Rates of blood transfusion are reported as high as 32% in women undergoing major gynecologic cancer surgery. Therefore, care of the gynecologic oncology patient who refuses blood products, such as Jehovah's witnesses, can pose a unique challenge. The objective of this study was to determine rate of adverse post-operative outcomes within 30 days of surgery in Jehovah's witnesses with gynecologic cancer. This was a retrospective cohort study of Jehovah's witnesses undergoing laparotomy or minimally invasive surgery (MIS) for gynecologic cancer at a single institution. Data for post-adverse complications within 30 days of surgery were recorded. In total, 36 patients were included with a median age of 58.5 years (32-85 years). The majority had endometrial adenocarcinoma ( n  = 23; 63.9%) or epithelial ovarian, fallopian tube or peritoneal cancer (EOC) ( n  = 8; 22.2%). 61.1% ( n  = 22) of patients underwent laparotomy and 38.9% ( n  = 14) had MIS procedures. 31.8% of laparotomies ( n  = 7) were terminated prematurely due to surgeon concern for ongoing blood loss. In patients with advanced stage EOC, the rate of suboptimal cytoreduction (> 1 cm) was 50%. In the laparotomy cohort, there were four (18.2%) ICU admissions and two (9.1%) mortalities. The time to adjuvant chemotherapy or radiation was 45.5 days (31-64) for laparotomy compared to 35.0 days (12-64) for MIS. While the majority of patients (97.2%) were unwilling to accept packed red blood cells, over one third (38.9%) were agreeable to autologous blood transfusion. Additionally, five (13.9%) patients were accepting of fresh frozen plasma, six (16.7%) patients were agreeable to cryoprecipitate and seven (19.4%) patients were willing to accept platelet transfusions. There is a high rate of postoperative adverse outcomes among Jehovah's witnesses undergoing laparotomy for gynecologic malignancy compared. Acceptance of blood products is low among Jehovah's witnesses, even in the setting of major

  10. Gynecologic-obstetric changes after loss of massive excess weight following bariatric surgery.

    Science.gov (United States)

    Deitel, M; Stone, E; Kassam, H A; Wilk, E J; Sutherland, D J

    1988-04-01

    A clinical study was undertaken to assess gynecologic-obstetric changes in morbidly obese women who lost greater than or equal to 50% of their excess weight with bariatric surgery. The 138 females (109 of reproductive age), age 35 +/- 9 SD yr, weighed 124 +/- 23 kg before surgery and 79 +/- 13 kg after weight loss had stabilized. Menstrual irregularities were present in 40.4% of premenopausal patients preoperatively; after massive weight loss, cycles were abnormal in 4.6% (p less than 0.001). Infertility problems were present preoperatively in 29.3% Of these, nine tried to conceive after weight loss and were successful. During past pregnancies, medical complications were frequent (hypertension 26.7%, pre-eclampsia 12.8%, diabetes 7.0%, and deep vein thrombosis 7.0%). After weight-loss stabilization, these obstetric complications did not occur. Incidence of urinary stress incontinence decreased from 61.2% to 11.6% (p less than 0.001). Gynecologic-obstetric changes tended to normalize after loss of massive body weight.

  11. Port-site metastasis in laparoscopic gynecological oncology surgery: An overview

    Directory of Open Access Journals (Sweden)

    Vahan Manvelyan

    2016-02-01

    Full Text Available Despite the low frequency, port-site metastases are associated with poor outcomes in patients and account for significant patient morbidity. They remain a challenging complication of laparoscopic procedures for gynecologic malignancies. A comprehensive, systematic search for published studies was conducted using the PubMed databases. Various mechanisms of port-site metastases are addressed in the relevant literature. The review of the articles points out that in the development of port-site metastases, the major role is played by biologically aggressive diseases, tumor manipulation, wound contamination, and surgery-related factors. The advantages of laparoscopic oncologic surgery are unquestionable. Further investigations of the mechanisms of port-site metastasis would contribute to the prevention of this insidious pathology.

  12. Effects of parecoxib on postoperative pain and opioid-related symptoms following gynecologic surgery

    Directory of Open Access Journals (Sweden)

    Parsons B

    2016-11-01

    Full Text Available Bruce Parsons,1 Qijiang Zhu,2 Li Xie,3 Chunming Li,1 Raymond Cheung1 1Pfizer Inc, New York, NY, USA; 281st Hospital of Chinese People’s Liberation Army, Nanjing, People’s Republic of China; 3Pfizer Investment Co., Ltd, Beijing, People’s Republic of China Objective: To examine the analgesic and opioid-sparing effects of parecoxib following major gynecologic surgery.Methods: This is a large subset analysis of patients from a multicenter, randomized, double-blind, placebo-controlled study of parecoxib/valdecoxib (PAR/VAL for postoperative pain. Pain severity, pain interference with function, opioid use, occurrence of opioid-related symptoms, and Patient/Physician Global Evaluation of Study Medication were compared between placebo and PAR/VAL treatment groups in the days following surgery. Results: Pain scores were reduced in the PAR/VAL group (n=98, relative to placebo (n=97, on Day 2 (−21%, P<0.001 and Day 3 (−23%, P=0.004. Pain interference with function scores were also significantly lower in the PAR/VAL group, compared with placebo, on Day 2 (−29%, P<0.001 and Day 3 (−28%, P=0.013. Consumption of supplemental morphine was significantly lower in the PAR/VAL group relative to placebo at 24 hours (−37%, P=0.010 and trended lower at 48 (−28% and 72 hours (−26%. Patients in the PAR/VAL group also had a reduced risk of experiencing specific opioid-related symptoms, including “inability to concentrate” (relative risk =0.53 and “nausea” (relative risk =0.60 on Day 2. Both Patient and Physician Global Evaluation of Study Medication scores were better in the PAR/VAL group than in the placebo group. Conclusion: The current study adds support for the use of parecoxib in patients following major gynecologic surgery. Keywords: parecoxib, postoperative pain, gynecologic surgery

  13. CA-125–indicated asymptomatic relapse confers survival benefit to ovarian cancer patients who underwent secondary cytoreduction surgery

    Directory of Open Access Journals (Sweden)

    Wang Fang

    2013-02-01

    Full Text Available Abstract Background There is no consensus regarding the management of ovarian cancer patients, who have shown complete clinical response (CCR to primary therapy and have rising cancer antigen CA-125 levels but have no symptoms of recurrent disease. The present study aims to determine whether follow-up CA-125 levels can be used to identify the need for imaging studies and secondary cytoreductive surgery (CRS. Methods We identified 410 ovarian cancer patients treated at The University of Texas MD Anderson Cancer Center between 1984 and 2011. These patients had shown CCR to primary therapy. Follow-up was conducted based on the surveillance protocol of the MD Anderson Cancer Center. We used the Cox proportional hazards model and log-rank test to assess the associations between the follow-up CA-125 levels and secondary CRS and survival duration. Results The CA-125 level of 1.68 × nadir was defined as the indicator of recurrent disease (p  1.68 × nadir at relapse (55.7 and 10.4 months; p = 0.04 and 0.01, respectively. The overall and progression free survival duration of patients with asymptomatic relapse and underwent a secondary CRS was longer than that of patients with symptomatic relapse (p = 0.02 and 0.04 respectively. Conclusions The increase of serum CA-125 levels is an early warning of clinical relapse in ovarian cancer. Using CA-125 levels in guiding the treatment of patients with asymptomatic recurrent ovarian cancer, who have shown CCR to primary therapy, can facilitate optimal secondary CRS and extend the survival duration of the patients.

  14. Constructing predictive models for vaginal surgery in patients with noninvasive gynecological conditions.

    Science.gov (United States)

    Yuan, Lei; Zhou, Hong; Zhang, Hao; Tang, Haosha; Chen, Mo; Liu, Xishi; Xu, Congjian; Yao, Liangqing

    2014-09-01

    To develop predictive models for vaginal operative route selection based on clinical variables that can be easily assessed preoperatively in patients with noninvasive gynecological conditions. Retrospective study. University Hospital. Women with routine gynecological surgeries via different approaches. The medical records of 315 women without prolapse and undergoing hysterectomy, adnexal cystectomy or myomectomy were reviewed. Multiple logistic regression analysis was used to identify factors associated with the vaginal approach for each procedure. Predictive models were generated and optimal cut-off points were identified using the receiver operating characteristic curve. Predictive models for different vaginal surgical procedures. For hysterectomy, the patient's body mass index, dysmenorrheal complaints and uterine size were identified as negative predictors for vaginal hysterectomy, whereas previous vaginal delivery was positive. For adnexal cystectomy, adnexal pathology was a negative predictor, whereas previous vaginal delivery and ovarian cyst size were positive. For myomectomy, the body mass index and number of fibroids were negative predictors while previous vaginal delivery was positive. All three models were able to predict the vaginal procedures undergone by women and the areas under the curve were 0.88, 0.95 and 0.92, respectively. Each optimal model cut-off value (logit(p) = 0.53, 0.36, 0.73) resulted in good sensitivity (92.3%, 100% and 87.5%, respectively) and specificity (77.8%, 88.6% and 90.9%, respectively). These predictive models, which used clinical variables that can be easily assessed preoperatively, may help surgeons to select candidates for different vaginal procedures. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

  15. Acute inflammatory reaction following placement of sodium hyaluronate-carboxymethylcellulose barrier in a young woman undergoing gynecologic surgery: a case report.

    Science.gov (United States)

    Temkin, Sarah M; Turner, Jerrold R; Lengyel, Ernst R

    2011-01-01

    Hyaluronate-carboxymethylcellulose (HA-CMC) is commonly used to inhibit adhesion formation in women undergoing gynecologic surgery. A 38-year old woman underwent a bilateral salpingo-oophorectomy for the indication of persistent pelvic pain following a hysterectomy, an ovarian cyst and endometriosis. HA-CMC was placed at the time of surgery. The patient returned to the operating room on postoperative day 3 with an acute inflammatory reaction and small bowel obstruction. A mast cell infiltrate and acute serosal damage was observed on final histopathology of the resection portion of small bowel. Few case reports describing adverse events with the use of HA-CMC have been published. This patient appears to have had a paradoxical inflammatory reaction to this adhesion barrier.

  16. CA-125–indicated asymptomatic relapse confers survival benefit to ovarian cancer patients who underwent secondary cytoreduction surgery

    Science.gov (United States)

    2013-01-01

    Background There is no consensus regarding the management of ovarian cancer patients, who have shown complete clinical response (CCR) to primary therapy and have rising cancer antigen CA-125 levels but have no symptoms of recurrent disease. The present study aims to determine whether follow-up CA-125 levels can be used to identify the need for imaging studies and secondary cytoreductive surgery (CRS). Methods We identified 410 ovarian cancer patients treated at The University of Texas MD Anderson Cancer Center between 1984 and 2011. These patients had shown CCR to primary therapy. Follow-up was conducted based on the surveillance protocol of the MD Anderson Cancer Center. We used the Cox proportional hazards model and log-rank test to assess the associations between the follow-up CA-125 levels and secondary CRS and survival duration. Results The CA-125 level of 1.68 × nadir was defined as the indicator of recurrent disease (p CA-125 biochemical progression prior to clinically-defined relapse was 31 days (ranging from 1 to 391 days). The median number of the negative imaging studies for the clinical relapse findings in patients with a CA-125 level of CA-125 level at relapse was an independent predictor of overall and progression free survival in patients who had shown CCR to primary therapy (p = 0.04 and 0.02 respectively). The overall and progression free survival durations in patients with a CA-125 level ≤ 1.68 × nadir at relapse (69.4 and 13.8 months) were longer than those with a CA-125 level > 1.68 × nadir at relapse (55.7 and 10.4 months; p = 0.04 and 0.01, respectively). The overall and progression free survival duration of patients with asymptomatic relapse and underwent a secondary CRS was longer than that of patients with symptomatic relapse (p = 0.02 and 0.04 respectively). Conclusions The increase of serum CA-125 levels is an early warning of clinical relapse in ovarian cancer. Using CA-125 levels in

  17. Gynecologic examination and cervical biopsies after (chemo) radiation for cervical cancer to identify patients eligible for salvage surgery

    NARCIS (Netherlands)

    Nijhuis, Esther R.; van der Zee, Ate G. J.; In 't Hout, Bertha A.; Boomgaard, Jantine J.; de Hullu, Joanne A.; Pras, Elisabeth; Hollema, Harry; Aalders, Jan G.; Jijman, Hans W.; Willemse, Pax H. B.; Mourits, Marian J. E.

    2006-01-01

    Purpose: The aim of this study was to evaluate efficacy of gynecologic examination under general anesthesia with cervical biopsies after (chemo) radiation for cervical cancer to identify patients with residual disease who may benefit from salvage surgery. Methods and Materials: In a retrospective

  18. Gynecologic examination and cervical biopsies after (chemo) radiation for cervical cancer to identify patients eligible for salvage surgery.

    NARCIS (Netherlands)

    Nijhuis, E.R.; Zee, A.G. van der; Hout, B.A. van; Boomgaard, J.J.; Hullu, J.A. de; Pras, E.; Hollema, H.; Aalders, J.G.; Nijman, H.W.; Willemse, P.H.B.; Mourits, M.J.E.

    2006-01-01

    PURPOSE: The aim of this study was to evaluate efficacy of gynecologic examination under general anesthesia with cervical biopsies after (chemo) radiation for cervical cancer to identify patients with residual disease who may benefit from salvage surgery. METHODS AND MATERIALS: In a retrospective

  19. [Retrospective analysis of 856 cases with stage 0 to III rectal cancer underwent curative surgery combined modality therapy].

    Science.gov (United States)

    Chen, Pengju; Yao, Yunfeng; Zhao, Jun; Li, Ming; Peng, Yifan; Zhan, Tiancheng; Du, Changzheng; Wang, Lin; Chen, Nan; Gu, Jin

    2015-07-01

    To investigate the survival and prognostic factors of stage 0 to III rectal cancer in 10 years. Clinical data and follow-up of 856 rectal cancer patients with stage 0-III underwent curative surgery from January 2000 to December 2010 were retrospective analyzed. There were 470 male and 386 female patients, with a mean age of (58 ± 12) years. Kaplan-Meier method was used to analyze the overall survival and disease free survival. Log-rank test was used to compare the survival between groups. Cox regression was used to analyze the independent prognostic factors of rectal cancer. The patients in each stage were stage 0 with 18 cases, stage I with 209 cases, stage II with 235 cases, and stage III with 394 cases. All patients received curative surgery. There were 296 patients evaluated as cT3, cT4 and any T with N+ received preoperative radiotherapy. 5.4% patients got pathological complete response (16/296), and the recurrence rate was 4.7% (14/296). After a median time of 41.7 months (range 4.1 to 144.0 months) follow-up, the 5-year overall survival rate in stage 0 to I of was 91.0%, stage II 86.2%, and stage III 60.0%, with a significant difference (P=0.000). The cumulative local recurrence rate was 4.8% (41/856), of which 70.7% (29/41) occurred within 3 years postoperatively, 97.6% (40/41) in 5 years. The cumulative distant metastasis rate was 16.4% (140/856), of which 82.9% (129/140) occurred within 3 years postoperatively, 96.4% (135/140) in 5 years. The incidence of abnormal imaging findings was significantly higher in pulmonary than liver and other sites metastases (75.0% vs. 21.7%, χ² =25.691, P=0.000). The incidence of CEA elevation was significantly higher in liver than lung and other sites metastases (56.8% vs. 37.8%, χ² =25.691, P=0.000). Multivariable analysis showed that age (P=0.015, HR=1.385, 95% CI: 1.066 to 1.801), surgical approach (P=0.029, HR=1.337, 95% CI: 1.030 to 1.733), differentiation (P=0.000, HR=1.535, 95% CI: 1.222 to 1.928), TNM stage (P

  20. Matching Trends for the Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) Since Participation in the National Residency Match Program (NRMP).

    Science.gov (United States)

    Vargas, Maria V; Milad, Magdy P

    2018-02-14

    To describe the level of interest in the fellowship in minimally invasive gynecologic surgery (FMIGS) using data from National Residency Match Program (NRMP) over the past 4 years. Retrospective report (Canadian Task Force Classification II-2) SETTING: Publically reported data from the NRMP PARTICIPANTS: Applicants using the NRMP to match into fellowship training. Reporting matching trends for the gynecologic surgical subspecialty programs starting in 2014, when the FMIGS programs started participating in the NRMP. From 2014 to 2017, the number of FMIGS positions increased from 28 to 37. Over the 4 application cycles, the FMIGS programs had the highest ratio of applicants to positions overall (range 1.7-2.0 for FMIGS) of the surgical gynecologic sub-specialty programs (gynecologic oncology, female pelvic medicine and reconstructive surgery, and reproductive endocrinology and infertility). Since the FMIGS programs began participating in the NRMP in 2014, the FMIGS match has been highly competitive as a gynecologic surgical subspecialty program, suggesting a high level of interest from residency graduates. This may reflect growing recognition that there is a body of knowledge that is unique to MIGS and that a well trained MIGS specialist can improve patient outcomes. Copyright © 2018. Published by Elsevier Inc.

  1. A call for new standard of care in perioperative gynecologic oncology practice: Impact of enhanced recovery after surgery (ERAS) programs.

    Science.gov (United States)

    Miralpeix, Ester; Nick, Alpa M; Meyer, Larissa A; Cata, Juan; Lasala, Javier; Mena, Gabriel E; Gottumukkala, Vijaya; Iniesta-Donate, Maria; Salvo, Gloria; Ramirez, Pedro T

    2016-05-01

    Enhanced recovery after surgery (ERAS) programs aim to hasten functional recovery and improve postoperative outcomes. However, there is a paucity of data on ERAS programs in gynecologic surgery. We reviewed the published literature on ERAS programs in colorectal surgery, general gynecologic surgery, and gynecologic oncology surgery to evaluate the impact of such programs on outcomes, and to identify key elements in establishing a successful ERAS program. ERAS programs are associated with shorter length of hospital stay, a reduction in overall health care costs, and improvements in patient satisfaction. We suggest an ERAS program for gynecologic oncology practice involving preoperative, intraoperative, and postoperative strategies including; preadmission counseling, avoidance of preoperative bowel preparation, use of opioid-sparing multimodal perioperative analgesia (including loco-regional analgesia), intraoperative goal-directed fluid therapy (GDT), and use of minimally invasive surgical techniques with avoidance of routine use of nasogastric tube, drains and/or catheters. Postoperatively, it is important to encourage early feeding, early mobilization, timely removal of tubes and drains, if present, and function oriented multimodal analgesia regimens. Successful implementation of an ERAS program requires a multidisciplinary team effort and active participation of the patient in their goal-oriented functional recovery program. However, future outcome studies should evaluate the efficacy of an intervention within the pathway, include objective measures of symptom burden and control, study measures of functional recovery, and quantify outcomes of the program in relation to the rates of adherence to the key elements of care in gynecologic oncology such as oncologic outcomes and return to intended oncologic therapy (RIOT). Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Early experience with the da Vinci® surgical system robot in gynecological surgery at King Abdulaziz University Hospital

    Directory of Open Access Journals (Sweden)

    Sait KH

    2011-07-01

    Full Text Available Khalid H SaitObstetrics and Gynecology Department, Faculty of Medicine, Gynecology Oncology Unit, King Abdulaziz University Hospital, Jeddah, Saudi ArabiaBackground: The purpose of this study was to review our experience and the challenges of using the da Vinci® surgical system robot during gynecological surgery at King Abdulaziz University Hospital.Methods: A retrospective study was conducted to review all cases of robot-assisted gynecologic surgery performed at our institution between January 2008 and December 2010. The patients were reviewed for indications, complications, length of hospital stay, and conversion rate, as well as console and docking times.Results: Over the three-year period, we operated on 35 patients with benign or malignant conditions using the robot for a total of 62 surgical procedures. The docking times averaged seven minutes. The mean console times for simple hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy were 125, 47, and 62 minutes, respectively. In four patients, laparoscopic procedures were converted to open procedures, giving a conversion rate of 6.5%. All of the conversions were among the first 15 procedures performed. The average hospital stay was 3 days. Complications occurred in five patients (14%, and none were directly related to the robotic system.Conclusion: Our early experience with the robot show that with proper training of the robotic team, technical difficulty with the robotic system is limited. There is definitely a learning curve that requires performance of gynecological surgical procedures using the robot.Keywords: da Vinci robot, gynecological surgery, laparoscopy

  3. Effects of peritoneal ropivacaine nebulization for pain control after laparoscopic gynecologic surgery.

    Science.gov (United States)

    Somaini, Marta; Brambillasca, Pietro; Ingelmo, Pablo Mauricio; Lovisari, Federica; Catenacci, Stefano Scalia; Rossini, Valeria; Bucciero, Mario; Sahillioglu, Emre; Buda, Alessandro; Signorelli, Mauro; Gili, Mauro; Joshi, Girish; Fumagalli, Roberto; Ferland, Catherine E; Diemunsch, Pierre

    2014-01-01

    To evaluate the effects of peritoneal cold nebulization of ropivacaine on pain control after gynecologic laparoscopy. Evidence obtained from a properly designed, randomized, double-blind, placebo-controlled trial (Canadian Task Force classification I). Tertiary care center. One hundred thirty-five women with American Society of Anesthesiologists disease classified as ASA I-III who were scheduled to undergo operative laparoscopy. Patients were randomized to receive either nebulization of 30 mg ropivacaine before surgery (preoperative group), nebulization of 30 mg ropivacaine after surgery (postoperative group), instillation of 100 mg ropivacaine before surgery (instillation group), or instillation of saline solution (control group). Nebulization was performed using the Aeroneb Pro device. Pain scores, morphine consumption, and ambulation time were collected in the post-anesthesia care unit and at 4, 6, and 24 hours postoperatively. One hundred eighteen patients completed the study. Patients in the preoperative group reported lower pain Numeric Ranking Scale values compared with those in the control group (net difference 2 points; 95% confidence interval [CI], 0.3-3.1 at 4 hours, 1-3 at 6 hours, and 0.7-3 at 24 hours; p = .01) Patients in the preoperative group consumed significantly less morphine than did those in the control group (net difference 7 mg; 95% CI, 0.7-13; p = .02). More patients who received nebulization walked without assistance within 12 hours after awakening than did those in the instillation and control groups (net difference 15%; 95% CI, 6%-24%; p = .001). Cold nebulization of ropivacaine before surgery reduced postoperative pain and morphine consumption and was associated with earlier walking without assistance. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  4. Committee Opinion No. 694: Management of Mesh and Graft Complications in Gynecologic Surgery.

    Science.gov (United States)

    2017-04-01

    This document focuses on the management of complications related to mesh used to correct stress urinary incontinence or pelvic organ prolapse. Persistent vaginal bleeding, vaginal discharge, or recurrent urinary tract infections after mesh placement should prompt an examination and possible further evaluation for exposure or erosion. A careful history and physical examination is essential in the diagnosis of mesh and graft complications. A clear understanding of the location and extent of mesh placement, as well as the patient's symptoms and therapy goals, are necessary to plan treatment approaches. It is important that a treating obstetrician-gynecologist or other gynecologic care provider who seeks to revise or remove implanted mesh be aware of the details of the index procedure. Diagnostic testing for a suspected mesh complication can include cystoscopy, proctoscopy, colonoscopy, or radiologic imaging. These tests should be pursued to answer specific questions related to management. Given the diverse nature of complications related to mesh-augmented pelvic floor surgery, there are no universal recommendations regarding minimum testing. Approaches to management of mesh-related complications in pelvic floor surgery include observation, physical therapy, medications, and surgery. Obstetrician-gynecologists should counsel women who are considering surgical revision or removal of mesh about the complex exchanges that can occur between positive and adverse pelvic floor functions across each additional procedure starting with the device implant. Detailed counseling regarding the risks and benefits of mesh revision or removal surgery is essential and can be conducted most thoroughly by a clinician who has experience performing these procedures. For women who are not symptomatic, there is no role for intervention.

  5. Committee Opinion No. 694 Summary: Management of Mesh and Graft Complications in Gynecologic Surgery.

    Science.gov (United States)

    2017-04-01

    This document focuses on the management of complications related to mesh used to correct stress urinary incontinence or pelvic organ prolapse. Persistent vaginal bleeding, vaginal discharge, or recurrent urinary tract infections after mesh placement should prompt an examination and possible further evaluation for exposure or erosion. A careful history and physical examination is essential in the diagnosis of mesh and graft complications. A clear understanding of the location and extent of mesh placement, as well as the patient's symptoms and therapy goals, are necessary to plan treatment approaches. It is important that a treating obstetrician-gynecologist or other gynecologic care provider who seeks to revise or remove implanted mesh be aware of the details of the index procedure. Diagnostic testing for a suspected mesh complication can include cystoscopy, proctoscopy, colonoscopy, or radiologic imaging. These tests should be pursued to answer specific questions related to management. Given the diverse nature of complications related to mesh-augmented pelvic floor surgery, there are no universal recommendations regarding minimum testing. Approaches to management of mesh-related complications in pelvic floor surgery include observation, physical therapy, medications, and surgery. Obstetrician-gynecologists should counsel women who are considering surgical revision or removal of mesh about the complex exchanges that can occur between positive and adverse pelvic floor functions across each additional procedure starting with the device implant. Detailed counseling regarding the risks and benefits of mesh revision or removal surgery is essential and can be conducted most thoroughly by a clinician who has experience performing these procedures. For women who are not symptomatic, there is no role for intervention.

  6. Dexmedetomidine versus Propofol in reducing postoperative nausea and vomiting in gynecologic laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Mansour Choubsaz

    2017-09-01

    Full Text Available Introduction: Post-Operative Nausea and Vomiting (PONV occurs in 20%-30% of patients, and is the second most common complaints after pain. This unpleasant complication can lead to rare but serious medical complications such as aspiration of gastric contents, suture dehiscence, esophageal rupture, subcutaneous emphysema, or pneumothorax. Annual PONV-related health care costs reach several hundred million dollars. Many interventions have been done to control PONV, but complications of drug interactions limit the use of drugs. For example, Dropridol has been placed on the Black Box Warning because of the risk of cardiac arrhythmias. Methods: This clinical trial recruited 80 patients with American Society of Anesthesiologist (ASA class I or II who were scheduled for elective gynecologic laparoscopic surgery. They were randomly divided into two groups: Propofol and Dexmedetomidine. The data was collected by the first nurse in PACUs and the second nurse in post-surgery ward, including age, weight, smoking history, nausea, vomiting and severity of vomiting. Patients and observers were blinded to the prescribed hypnotic drugs. The severity of nausea was assessed by visual analogue scale (ranging 0 to 10 in 0-2, 2-6 and 6-24 hours. The state of nausea was also recorded. Results: The incidence of nausea and the severity of vomiting significantly decreased in the dexmedetomidine group compared to the Propofol group (PV=0.001. Conclusion: The results showed that Dexmedetomidine can reduce the incidence of nausea and severity of vomiting compared to Propofol.

  7. Prognostic factors for perioperative myocardial infarction and immediate mortality in patients who underwent coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Mirtha López Ramírez

    2016-03-01

    Conclusions: Older age and higher body mass index were protective prognostic factors for perioperative acute myocardial infarction events. Prolonged surgical time and complications were independently associated with perioperative infarction and mortality after coronary artery bypass graft surgery. Low preoperative glomerular filtration rate was also associated with mortality.

  8. Ovarian Suspension With Adjustable Sutures: An Easy and Helpful Technique for Facilitating Laparoendoscopic Single-Site Gynecologic Surgery.

    Science.gov (United States)

    Chen, Kuo-Hu; Chen, Li-Ru; Seow, Kok-Min

    2015-01-01

    To describe a method of ovarian suspension with adjustable sutures (OSAS) for facilitating laparoendoscopic single-site gynecologic surgery (LESS) and to investigate the effect of OSAS on LESS. Prospective cohort study (Canadian Task Force classification: II-2). University teaching hospital. One hundred seventy-eight patients with benign 5- to 15-cm cystic ovarian tumors who underwent LESS with OSAS (suspension group, n = 90) and without OSAS (control group, n = 88). For patients who underwent OSAS (suspension group), 1 end of double-head straight needles with a polypropylene suture was inserted into the pelvic cavity through the abdominal skin to penetrate the cyst or ovarian parenchyma and puncture outside the abdominal skin. After cutting off the needles, both sides of the remaining suture were held together by a clamp, without knotting, so that the manipulator could "lift," "loosen," or "fix" the stitches to adjust the tension. The average time to create OSAS was 2.9 min. For the suspension and control groups, the average blood loss was 81.4 and 131.8 mL (p < .001), and the operative time was 42.0 and 61.3 min (p < .001), respectively. There were no significant differences in the incidence of complications (5.6% vs 9.1%; p = .365), but there were significant differences in conversions to standard non-single-site laparoscopy (5.6% vs 15.9%; p = .025) and laparotomy (1.1% vs 6.8%; p = .040). Logistic regression analysis revealed that the ratios of conversion to standard non-single-site laparoscopy (odds ratio [OR], 0.126; 95% confidence interval [CI], 0.311-0.508) and laparotomy (OR, 0.032; 95% CI, 0.002-0.479) were much lower in the suspension group; the risk of complications was comparable (OR, 0.346; 95% CI, 0.085-1.403). OSAS is an easy, safe, and feasible method that offers advantages during LESS. Although routine use of OSAS is not necessary, OSAS can be considered during LESS to facilitate the surgery. Copyright © 2015 AAGL. Published by Elsevier Inc. All

  9. Atrioventricular septal defect (AVSD) : A study of 219 patients who underwent surgery for AVSD at Rikshospitalet from 1979 to 1999

    OpenAIRE

    Skraastad, Ingrid Birthe Bendixen; Skraastad, Berit Kristine

    2010-01-01

    Background: The present study evaluates 219 consecutive patients that underwent surgical repair for AVSD in a long term follow-up. Methods: The patients had a surgical correction for AVSD at Rikshospitalet from January 1979 to December 1999. The follow-up was closed in January 2009. AVSD with additional defects and syndromes were included. Results: Forty-two patients died during the observational period. Early mortality was 12.8% and late mortality was 6.4%. Early mortality declined f...

  10. Fosaprepitant versus ondansetron for the prevention of postoperative nausea and vomiting in patients who undergo gynecologic abdominal surgery with patient-controlled epidural analgesia: a prospective, randomized, double-blind study.

    Science.gov (United States)

    Soga, Tomohiro; Kume, Katsuyoshi; Kakuta, Nami; Hamaguchi, Eisuke; Tsutsumi, Rie; Kawanishi, Ryosuke; Fukuta, Kohei; Tanaka, Katsuya; Tsutsumi, Yasuo M

    2015-10-01

    Postoperative nausea and vomiting (PONV) is the most common postoperative complication. The postoperative use of opioids is known to increase the incidence. We compared fosaprepitant, a neurokinin-1 (NK1) receptor antagonist, and ondansetron for their preventive effects on PONV in patients who underwent gynecologic abdominal surgery with patient-controlled epidural analgesia. This prospective, double-blind, randomized study comprised 44 patients who underwent gynecologic abdominal surgery. They were randomly allocated to receive 150 mg intravenous fosaprepitant (n = 24; NKI group) or 4 mg ondansetron (n = 20; ONS group) before anesthesia, which was maintained with volatile anesthetics, remifentanil, fentanyl, and rocuronium. All patients received postoperative fentanyl by patient-controlled epidural anesthesia. The incidence of nausea and vomiting, complete response rate (i.e., no vomiting and no rescue antiemetic use), rescue antiemetic use, nausea score (0-3), and visual analog scale score (VAS 0-10) for pain were recorded at 2, 24, 48, and 72 h after surgery. No (0 %) patient in the NKI group experienced vomiting after surgery; however, 4-6 (20-30 %) of 20 patients in the ONS group experienced vomiting. This difference was significant at 0-24, 0-48, and 0-72 h. During the study period, no significant differences existed between the NK1 and ONS groups in the incidence of PONV, complete response rate, rescue antiemetic use, nausea score, and VAS score for pain. Compared to ondansetron, fosaprepitant more effectively decreased the incidence of vomiting in patients who underwent gynecologic abdominal surgery with patient-controlled epidural analgesia.

  11. Berek & Novak's gynecology

    National Research Council Canada - National Science Library

    Berek, Jonathan S; Novak, Emil

    2012-01-01

    .... The third section is on preventive and primary care for women, and the remaining five sections are directed at methods of diagnosis and management in general gynecology, operative general gynecology, urogynecology and pelvic reconstructive surgery, reproductive endocrinology, and gynecologic oncology"--Provided by publisher.

  12. Gynecological Surgery and Low Back Pain in Older Women: Testing the Association With Sacroiliac Joint Stiffness and Pelvic Floor Movements

    OpenAIRE

    Ericksen, Jeffery; Pidcoe, Peter E.; Ketchum-McKinney, Jessica M.; Burnet, Evie N.; Huang, Emily; Wilson, James C.; Hoogstad, Vincent

    2010-01-01

    Objective: To determine sacroiliac joint compliance characteristics and pelvic floor movements in older women relative to gynecological surgery history and back pain complaints. Design: Single-visit laboratory measurement. Setting: University clinical research center. Participants: Twenty-five women aged 65 years or older. Outcome Measures: Sacroiliac joint compliance measured by Doppler imaging of vibrations and ultrasound measures of pelvic floor motion during the active straight leg raise ...

  13. Normalized lactate load is associated with development of acute kidney injury in patients who underwent cardiopulmonary bypass surgery.

    Directory of Open Access Journals (Sweden)

    Zhongheng Zhang

    Full Text Available Cardiac surgery associated acute kidney injury is a major postoperative complication and has long been associated with adverse outcomes. However, the association of lactate and AKI has not been well established. The study aimed to explore the association of normalized lactate load with AKI in patients undergoing cardiac surgery.This was a prospective observational cohort study conducted in a 47-bed ICU of a tertiary academic teaching hospital from July 2012 to January 2014. All patients undergoing cardiopulmonary bypass surgery were included. Normalized lactate load (L was calculated by the equation: [Formula: see text], where ti was time point for lactate measurement and vi was the value of lactate. L was transformed by natural log (Lln to improve its normality. Logistic regression model was fitted by using stepwise method. Scale of Lln was examined by using fractional polynomial approach and potential interaction terms were explored.A total of 117 patients were included during study period, including 17 AKI patients and 100 non-AKI patients. In univariate analysis Lln was significantly higher in AKI as compared with non-AKI group (1.43±0.38 vs 1.01±0.45, p = 0.0005. After stepwise selection of covariates, the main effect logistic model contained variables of Lln (odds ratio: 11.1, 95% CI: 1.22-101.6, gender, age, baseline serum creatinine and fluid balance on day 0. Although the two-term fractional polynomial model was the best-fitted model, it was not significantly different from the linear model (Deviance difference = 6.09, p = 0.107. There was no significant interaction term between Lln and other variables in the main effect model.Our study demonstrates that Lln is independently associated with postoperative AKI in patients undergoing CPB. There is no significant interaction with early postoperative fluid balance.

  14. Role of Intraoperative Ultrasound to Extend the Application of Minimally Invasive Surgery for Treatment of Recurrent Gynecologic Cancer.

    Science.gov (United States)

    Mascilini, Floriana; Quagliozzi, Lorena; Moro, Francesca; Moruzzi, Maria Cristina; Gallotta, Valerio; Alletti, Salvatore Gueli; Scambia, Giovanni; Testa, Antonia Carla; Fagotti, Anna

    2018-01-08

    To describe the potential role of intraoperative ultrasound (IOUS) in the detection and localization of recurrent disease in gynecologic cancer patients during minimally invasive surgery (MIS). A prospective cohort study (Canadian Task Force classification II-1). A university hospital. Fifty-one gynecologic cancer patients with isolated recurrent disease. IOUS during secondary cytoreductive surgery (SCS) by MIS. From November 2015 to February 2017 51 gynecologic cancer patients with isolated recurrent disease and candidates for SCS were treated by MIS. Recurrent tumor was preoperatively assessed at clinical examination, transvaginal and transabdominal sonography, and radiologic evaluation in all women. Twelve of 51 women (23.5%) needed IOUS. Type of disease was ovarian in 5 women (42%), endometrial in 4 (33%), cervical in 1 (8%), vaginal cancer in 1 (8%), and uterine sarcoma in 1 (8%). Recurrence was localized deep in the pelvis in 7 cases (58%), lymph nodes in 3 (25%), and extraperitoneal in 2 cases (17%). Recurrence was dimmed in the surgical field, due to either presence of adherences, deep anatomic position, small size, and/or lack of tactile feeling. IOUS was able to identify the lesions in all women, allowing MIS (83% laparoscopy and 17% robotic) complete cytoreduction, with no conversion to laparotomy. Median operative time was 150 minutes (range, 77-280). No intraoperative/postoperative complications occurred. Histologic examination confirmed the presence of recurrence in 11 of 12 cases (92%), whereas the remaining case showed inflammatory tissue. With a median follow-up time of 15 months (range, 6-19), all patients except 2 were still alive. About 1 of 4 patients (25%) with single gynecologic cancer recurrence needs IOUS to benefit from MIS for complete secondary cytoreduction. Copyright © 2018 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.

  15. "The first cut is the deepest": a psychological, sexological and gynecological perspective on female genital cosmetic surgery.

    Science.gov (United States)

    Barbara, Giussy; Facchin, Federica; Meschia, Michele; Vercellini, Paolo

    2015-09-01

    In recent years increased numbers of healthy women and girls have been seeking female genital cosmetic surgery for esthetic reasons and/or to enhance sexual functioning. This phenomenon is associated with the development of a new vulvovaginal standard due to Internet pornography and the increased exposure of female genitalia. This strict standard may negatively affect women's psychological health and cause increased insecurity, which may drive even teenagers to seek female genital cosmetic surgery. Psychological counseling is recommended to inform women that surgery is not a definitive solution to treat psychologically based pain or dysfunction. Moreover, there is no robust evidence supporting the effectiveness of female genital cosmetic surgery, especially regarding sexual enhancement, as underlined by major scientific societies. The importance of a definite regulation of female genital cosmetic surgery should be emphasized and be based on an ethically oriented, multidisciplinary model aimed at providing exhaustive information on all gynecological, sexological, and psychological concerns raised by this type of surgery. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  16. [Perioperative management of a child with central diabetes insipidus who underwent two surgeries before and after desmopressin administration].

    Science.gov (United States)

    Kiriyama, Keiji; Tachibana, Kazuya; Nishimura, Nobuyuki; Takeuchi, Muneyuki; Kinouchi, Keiko

    2013-03-01

    A 14-year-old girl weighing 32 kg was diagnosed with suprasellar tumor causing hydrocephalus, hypothyroidism, adrenal dysfunction and central diabetes insipidus. She was treated with levothyroxine and hydrocortisone and urged to take fluid to replace urine. She was scheduled to undergo ventricular drainage to relieve hydrocephalus prior to tumor resection. For the first surgery, desmopressin was not started and urine output reached 4,000 to 6,000 ml x day(-1), urine osmolality 64 mOsm x l(-1) and urine specific gravity 1.002. Anesthesia was induced with sevoflurane and maintained with propofol and remifentanil. Maintenance fluid was with acetated Ringer's solution and urine loss was replaced with 5% dextrose. Bradycardia and hypotension occurred after intubation, which was treated with volume load. Infusion volume was 750 ml and urine output was 1100 ml during 133 min of anesthesia. Postoperative day 1 nasal desmopressin was started. Ten days later, partial tumor resection was performed. Anesthesia was induced with propofol and fentanyl and maintained with sevoflurane and remifentanil. Infusion volume was 610 ml, urine output 380 ml, and blood loss 151 ml during 344 min of anesthesia. Hemodynamic parameters were stable throughout the procedure. Pathology of the tumor was revealed to be germinoma. Bradycardia and hypotension experienced during the first surgery was suspected to be caused by preoperative hypovolemia brought by polyuria. Desmopressin was proved to be effective to treat excessive urine output and to maintain good perioperative water balance.

  17. Suprapubic compared with transurethral bladder catheterization for gynecologic surgery: a systematic review and meta-analysis.

    LENUS (Irish Health Repository)

    Healy, Eibhlín F

    2012-09-01

    Suprapubic catheterization is commonly used for postoperative bladder drainage after gynecologic procedures. However, recent studies have suggested an increased rate of complications compared with urethral catheterization. We undertook a systematic review and meta-analysis of randomized controlled trials comparing suprapubic catheterization and urethral catheterization in gynecologic populations.

  18. Intraperitoneal injection of Bupivacaine and Lidocaine in reducing postoperative pain in gynecologic laparoscopic surgeries: a comparative study

    Directory of Open Access Journals (Sweden)

    Alleyassin A

    2007-08-01

    Full Text Available Background: As less invasive surgical procedures, such as laparoscopy, become more common, patients can go home soon after the surgery. However, some pain is accompanied by such procedures due to peritoneal stretching, diaphragmatic irritation, or, to a lesser extent, abdominal puncture. It is important to reduce the level of pain to the point that narcotics are not necessary. The administration of opioids for pain after abdominal surgeries is common. The receptors involved seem to be susceptible to blockade with low-dose local anesthesia, although this is subject to some controversy. In this study, we assess and compare the effectiveness of intraperitoneal Bupivacaine and Lidocaine in pain reduction after diagnostic gynecologic laparoscopy in infertility patients. Methods: In this randomized clinical trial, 150 patients admitted to Dr. Shariati Hospital for diagnostic gynecologic laparoscopy were entered into three randomized groups. Group B received Bupivacaine after the diagnostic laparoscopic procedure, group L received Lidocaine and group C, the control group, received a placebo after the surgery, all administered intraperi- toneally. Postsurgerical pain was assessed using the numeric visual analogue scale at 6 and 24 hours after surgery. Results: In group B, the pain scores at 6 and 24 hours after surgery were significantly less than those of group L. Conclusions: Administration of Bupivacaine after diagnostic gynecologic laparoscopic procedures is more effective in pain control than Lidocaine. The effect of this drug is temporary, yet it significantly decreases early postoperative pain, reducing the need for additional postoperative analgesics. Furthermore, the time at which patients can be discharged from the hospital is significantly reduced.

  19. A critical assessment of morcellation and its impact on gynecologic surgery and the limitations of the existing literature

    Science.gov (United States)

    Liu, Fong W.; Galvan-Turner, Valerie B.; Pfaendler, Krista S.; Longoria, Teresa C.; Bristow, Robert E.

    2015-01-01

    Uterine sarcomas are rare uterine malignancies that are difficult to diagnose preoperatively. Because of cases of disseminated sarcoma after laparoscopic hysterectomy, the role of power morcellators in gynecologic surgery has been questioned. Morcellation is an integral part of making laparoscopic surgery possible for the removal of large uterine leiomyomata, and the development of power morcellation has increased efficiency during these procedures. Minimally invasive surgery has demonstrated benefits that include improved pain control, decreased infection risk, and faster surgical recovery and return to work. In this review, we examine the risk of incidental sarcoma at the time of surgery, the quality of the data, the accuracy of clinical and radiologic predictors of uterine sarcoma, and the impact of morcellation on the prognosis of uterine sarcoma. PMID:25582101

  20. Korean and American music reduces pain in Korean women after gynecologic surgery.

    Science.gov (United States)

    Good, Marion; Ahn, Sukhee

    2008-09-01

    American music has been found to relieve pain in adults in several countries but has not been tested in Korea. Korean women have reported that they would like American music as well as Korean folk songs and religious music sung in Korean. The study purpose was to pilot-test the effects of music on pain after gynecologic surgery in Korean women and to compare pain relief between those who chose American or Korean music. Using a quasiexperimental pretest-posttest design, 73 South Korean women on a preoperative unit were assigned by day of the week to receive music (n = 34; 47%) or no music (n = 39; 53%). The music group chose among Korean (ballads and religious and popular songs) and American (soft slow piano and orchestra) music and heard it for 15 minutes at four time points (postoperatively), whereas the controls rested in bed. They marked VAS Sensation and Distress of Pain scales before and after each test. The two groups were similar on pretest pain. When controlling for pretest pain, MANCOVA indicated that there was significantly less posttest pain in those with music plus analgesics than those with analgesics alone at three of the four tests: p = .04 to .001. Two-thirds in the music group (n = 21; 62%) chose Korean music and one-third (n = 13; 38%) chose American, with no difference in pain: both were effective. In addition to analgesics, music can be used to reduce postoperative pain in Korean women. Patients selected music that was appealing to them. Nurses in many countries can consider music of the country and seek individual preferences to use in addition to analgesics for postoperative pain.

  1. Development of Transvaginal Uterus Amputation Device for Laparoscopic Hysterectomies in Gynecologic Surgeries

    Directory of Open Access Journals (Sweden)

    Serkan DİKİCİ

    2015-01-01

    Full Text Available Hysterectomy, that is removal of uterus, is one of the most common major operations in gynecologic surgeries. Laparoscopy technique is preferred in hysterectomy because of its advantages such as lower intra-operative blood loss, decreased surrounding tissue/organ damage, less operating time, lower postoperative infection and frequency of fever, shorter duration of hospitalization and post-operative returning time to normal activity. During total laparoscopic hysterectomy, first uterine vessels and ligaments are cauterized respectively, and then cervicovaginal connections are cauterized and coagulated to remove uterus completely. Uterine manipulators are used during laparoscopy to maximize the endoscopic vision of surgeons by moving related organs. However, conventional uterine manipulators have important drawbacks particularly to move uterus in three dimensions and to show cervicovaginal landmark during laparoscopic circular cauterization and amputation of the uterine cervix. A new transvaginal uterine manipulator may overcome these two important drawbacks of these currently available devices. For this reason, a3D scanned technique was used to get uterus sizes and computer aided design software is used in designing of the new manipulator and then 3D printer was used in prototyping. Special light emitting diodes (LEDs were mounted on the cervical cap of the manipulator to guide light beams from inside of cervicovaginal tissue to abdominal cavity to facilitate the visualization of tissue landmarks. Moreover, performances of different caps and LED systems will be evaluated. Furthermore, after integration of self-cutting and self-suturing mechanisms into our system, final prototype will be produced by using titanium which is biologically and mechanically appropriate. Therefore, aim of this study was to design and produce a new uterine manipulator with three dimensional movements, LED illumination, self-cutting and self-suturing systems to facilitate

  2. The importance of superficial basal cell carcinoma in a retrospective study of 139 patients who underwent Mohs micrographic surgery in a Brazilian university hospital

    Directory of Open Access Journals (Sweden)

    Luciana Takata Pontes

    2015-11-01

    Full Text Available OBJECTIVE: Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complications and the number of stages required for complete removal. METHODS: The records of patients who underwent Mohs micrographic surgery from October 2008 to November 2013 at the Dermatology Division of the Hospital of the Campinas University were assessed. The variables included were gender, age, anatomical location, histology, number of stages required and complications. RESULTS: Contingency tables were used to compare the number of stages with the histological diagnosis. The analysis showed that patients with superficial basal cell carcinoma were 9.03 times more likely to require more than one stage. A comparison between complications and histological diagnosis showed that patients with superficial basal cell carcinoma were 6.5 times more likely to experience complications. CONCLUSION: Although superficial basal cell carcinoma is typically thought to represent a less-aggressive variant of these tumors, its propensity for demonstrating “skip areas” and clinically indistinct borders make it a challenge to treat. Its particular nature may result in the higher number of surgery stages required, which may, as a consequence, result in more complications, including recurrence. Recurrence likely occurs due to the inadequate excision of the tumors despite their clear margins. Further research on this subtype of basal cell carcinoma is needed to optimize treatments and decrease morbidity.

  3. The importance of superficial basal cell carcinoma in a retrospective study of 139 patients who underwent Mohs micrographic surgery in a Brazilian university hospital.

    Science.gov (United States)

    Takata Pontes, Luciana; Fantelli Stelini, Rafael; Cintra, Maria Leticia; Magalhães, Renata Ferreira; Velho, Paulo Eduardo N F; Moraes, Aparecida Machado

    2015-11-01

    Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complications and the number of stages required for complete removal. The records of patients who underwent Mohs micrographic surgery from October 2008 to November 2013 at the Dermatology Division of the Hospital of the Campinas University were assessed. The variables included were gender, age, anatomical location, histology, number of stages required and complications. Contingency tables were used to compare the number of stages with the histological diagnosis. The analysis showed that patients with superficial basal cell carcinoma were 9.03 times more likely to require more than one stage. A comparison between complications and histological diagnosis showed that patients with superficial basal cell carcinoma were 6.5 times more likely to experience complications. Although superficial basal cell carcinoma is typically thought to represent a less-aggressive variant of these tumors, its propensity for demonstrating "skip areas" and clinically indistinct borders make it a challenge to treat. Its particular nature may result in the higher number of surgery stages required, which may, as a consequence, result in more complications, including recurrence. Recurrence likely occurs due to the inadequate excision of the tumors despite their clear margins. Further research on this subtype of basal cell carcinoma is needed to optimize treatments and decrease morbidity.

  4. A single FTO gene variant rs9939609 is associated with body weight evolution in a multiethnic extremely obese population that underwent bariatric surgery.

    Science.gov (United States)

    Rodrigues, Gisele K; Resende, Cristina M M; Durso, Danielle F; Rodrigues, Lorena A A; Silva, José Luiz P; Reis, Rodrigo C; Pereira, Solange S; Ferreira, Daniela C; Franco, Gloria R; Alvarez-Leite, Jacqueline

    2015-01-01

    The rs9939609 single nucleotide polymorphism (SNP) in the fat mass and obesity-associated (FTO) gene is involved in obesity. Few studies have been conducted on patients who underwent bariatric surgery. The aim of this study was to evaluate the influence of FTO SNPs on body weight, body composition, and weight regain during a 60-mo follow-up period after bariatric surgery. The rs9939609 was genotyped in 146 individuals using a real-time polymerase chain reaction TaqMan assay. Data for lifestyle, comorbidities, body weight, body mass index (BMI), excess weight loss (EWL), and body composition were obtained before and 6, 12, 18, 24, 36, 48, and 60 mo after surgery. Data were analyzed by comparing two groups of patients according to rs9939609 FTO gene polymorphism. Mixed-regression models were constructed to evaluate the dynamics of body weight, BMI, and EWL over time in female patients. No differences were observed between the groups during the first 24 mo after surgery. After 36, 48, and 60 mo, body weight, fat mass, and BMI were higher, whereas fat-free mass and EWL were lower in the FTO-SNP patient group. Weight regain was more frequent and occurred sooner in the FTO-SNP group. There is a different evolution of weight loss in obese carriers of the FTO gene variant rs9939609 after bariatric surgery. However, this pattern was evident at only 2 y postbariatric surgery, inducing a lower proportion of surgery success and a greater and earlier weight regain. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Prospective Pilot Investigation: Presurgical Depressive Symptom Severity and Anesthesia Response in Women Undergoing Surgery for Gynecologic Mass Removal.

    Science.gov (United States)

    Price, Catherine C; Pereira, Deidre B; Andre, Rachel; Garvan, Cynthia Wilson; Nguyen, Peter; Herman, Mary; Seubert, Christoph

    2015-08-01

    Anesthesia depth has been associated with mortality. The association between anesthesia depth and presurgery physical and health status, however, is currently debated. Depression is one comorbid condition that warrants investigation given its association to reduced frontal lobe activity and high prevalence in known surgery samples (e.g., gynecologic mass removal). This pilot study examined the hypothesis that severity of acute depressive symptoms would associate with greater sensitivity to anesthesia as measured by a frontal lobe electroencephalogram (EEG)-based monitor during the anesthesia induction phase among women undergoing gynecologic mass removal. This was a prospective and surgery anesthesia-controlled pilot investigation with 31 women undergoing surgery for removal of pelvic/gynecologic masses. Participants completed the Millon Behavioral Medicine Diagnostic (MBMD) inventory to assess depressive-related symptomatology. A Bispectral Index Score (BIS™) monitor (Aspect Medical Systems Inc., MA) was placed on the left frontal region to measure change in response from a set pre-anesthesia baseline point throughout the induction phase (6.5 min of the anesthetic). BIS™ change was calculated using a modified "area under the curve with respect to ground" formula. Greater sensitivity to anesthesia during induction was significantly associated with higher MBMD future pessimism scores and marginally associated with higher MBMD depression scores. Depressive personality, anxiety severity, tumor type, age, medication use, and comorbidity scores were not found to be predictors of BIS score change. These pilot findings suggest that preoperative psychological health and anesthesia response are not independent. Acute presurgery depression and anesthesia response warrant closer empirical examination.

  6. Segmentation of Uterus Using Laparoscopic Ultrasound by an Image-Based Active Contour Approach for Guiding Gynecological Diagnosis and Surgery.

    Science.gov (United States)

    Gong, Xue-Hao; Lu, Jun; Liu, Jin; Deng, Ying-Yuan; Liu, Wei-Zong; Huang, Xian; Yang, Yong-Heng; Xu, Qin; Yu, Zhi-Ying

    2015-01-01

    In laparoscopic gynecologic surgery, ultrasound has been typically implemented to diagnose urological and gynecological conditions. We applied laparoscopic ultrasonography (using Esaote 7.5~10MHz laparoscopic transducer) on the retrospective analyses of 42 women subjects during laparoscopic extirpation and excision of gynecological tumors in our hospital from August 2011 to August 2013. The objective of our research is to develop robust segmentation technique for isolation and identification of the uterus from the ultrasound images, so as to assess, locate and guide in removing the lesions during laparoscopic operations. Our method enables segmentation of the uterus by the active contour algorithm. We evaluated 42 in-vivo laparoscopic images acquired from the 42 patients (age 39.1 ± 7.2 years old) and selected images pertaining to 4 cases of congenital uterine malformations and 2 cases of pelvic adhesions masses. These cases (n = 6) were used for our uterus segmentation experiments. Based on them, the active contour method was compared with the manual segmentation method by a medical expert using linear regression and the Bland-Altman analysis (used to measure the correlation and the agreement). Then, the Dice and Jaccard indices are computed for measuring the similarity of uterus segmented between computational and manual methods. Good correlation was achieved whereby 84%-92% results fall within the 95% confidence interval in the Student t-test) and we demonstrate that the proposed segmentation method of uterus using laparoscopic images is effective.

  7. Gynecologic cancer

    International Nuclear Information System (INIS)

    Uehara, Takashi; Katsumata, Noriyuki

    2008-01-01

    Surgery and radiation therapy have been the main types of treatment for gynecologic cancer. However, chemotherapy in gynecologic oncology has recently made dramatic progress and presently is becoming the most widespread treatment. After the discovery of cisplatin in the field of chemotherapy for epithelial ovarian cancer, it has now become the leading treatment modality. According to the result of several important phase III randomized control trials (RCTs), the platinum-taxane combined therapy has now become the standard treatment regimen. Regarding endometrial cancer, Cisplatin-Adriamycin-Cyclophosphamide (CAP) therapy has been used as an effective adjuvant chemotherapy in Japan. The adjuvant chemotherapy (Adriamycin-Cisplatin therapy) for the endometrial cancer has now been recognized worldwide as the standard therapy based on the findings of a phase III RCT. Concurrent chemoradiotherapy for cervical cancer has also been recommended as the standard therapy in Japan since 1999 based on the successful results of numerous RCTs which proved its efficacy. The chemotherapy for gynecologic cancers has been investigated and standardized based on the results of numerous clinical trials. These trials have been conducted by many clinical trial groups, such as the Gynecologic Oncology Group (GOG), Southwest Oncology Group (SWOG), and the European Organization for Research and Treatment of Cancer (EORTC) throughout the world, in addition to the Japan Clinical Oncology Group (JCOG) and the Japanese Gynecologic Oncology Group (JGOG) in Japan. The valuable contributions of these clinical trials are helping in the development of new drug therapies, thus leading to such treatment regimens playing increasingly important and wider roles in the field of gynecologic oncology treatment in the future. (author)

  8. Prediction of vascular involvement and resectability by multidetector-row CT versus MR imaging with MR angiography in patients who underwent surgery for resection of pancreatic ductal adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Kyong [Department of Radiology, School of Medicine, Ewha Womans University, 911-1 Mok-dong, YangCheon-ku, Seoul 158-710 (Korea, Republic of); Kim, Ah Young [Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnab-dong, Songpa-ku, Seoul 138-736 (Korea, Republic of)], E-mail: aykim@amc.seoul.kr; Kim, Pyo Nyun; Lee, Moon-Gyu; Ha, Hyun Kwon [Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnab-dong, Songpa-ku, Seoul 138-736 (Korea, Republic of)

    2010-02-15

    Purpose: To compare the diagnostic value of dual-phase multidetector-row CT (MDCT) and MR imaging with dual-phase three-dimensional MR angiography (MRA) in the prediction of vascular involvement and resectability of pancreatic ductal adenocarcinoma. Methods and materials: 116 patients with proven pancreatic adenocarcinoma underwent both MDCT and combined MR imaging prior to surgery. Of 116 patients, 56 who underwent surgery were included. Two radiologists independently attempt to assess detectability, vascular involvement and resectability of pancreatic adenocarcinoma on both images. Results were compared with surgical findings and statistical analysis was performed. Results: MDCT detected pancreatic mass in 45 of 56 patients (80.3%) and MR imaging in 44 patients (78.6%). In assessment of vascular involvement, sensitivities and specificities of MDCT were 61% and 96% on a vessel-by-vessel basis, respectively. Those of MR imaging were 57% and 98%, respectively. In determining resectability, sensitivities and specificities of MDCT were 90% and 65%, respectively. Those of MR imaging were 90% and 41%, respectively. There was no statistical difference in detecting tumor, assessing vascular involvement and determining resectability between MDCT and MR imaging (p = 0.5). Conclusion: MDCT and MR imaging with MRA demonstrated an equal ability in detection, predicting vascular involvement, and determining resectability for a pancreatic ductal adenocarcinoma.

  9. Radiation Therapy for Gynecologic Cancers

    Science.gov (United States)

    ... with some form of gynecologic cancer this year. Cancers of the uterus and cervix are most common gynecologic cancers treated ... detected or removed by surgery. Radiation therapy kills ... of the uterus and cervix, called a hysterectomy. The surgeon may ...

  10. Perfuração de Luvas durante Cirurgias Ginecológicas Glove Perforation during Gynecologic Surgeries

    Directory of Open Access Journals (Sweden)

    Eddie Fernando Candido Murta

    2000-05-01

    Full Text Available Objetivo: analisar a incidência de perfuração de luvas cirúrgicas durante atos operatórios ginecológicos. Métodos: estudo prospectivo de 454 luvas usadas em 65 procedimentos utilizando-se o método de pressão de água. Resultados: do total de 454 luvas examinadas, foram verificadas perfurações em 54 (11,9%, sendo estatisticamente significativo o maior número de perfurações em comparação ao grupo controle, uma (1,7% em 60 analisadas (pPurpose: to analyze the frequency of glove perforation during gynecologic surgeries. Methods: a prospective study of 454 gloves used in 65 surgeries by the water pressure method. Results: of a total of 454 gloves, 54 (11.9% had perforations. Comparison with the control group showed p<0.05 (chi² test, 1 (1.7% perforation in 60 gloves tested. Of the total of gloves used in 65 surgeries, 29 (44.6% had perforations, 44 (81% had one perforation and 10 (19% had more than one perforation. The two most common sites of perforations were the index finger, 20 (29.5% and the thumb, 14 (25.9%. Perforation was predominant in the left hand (72.1%. The surgeons were the members of the team with the greatest number of glove perforations. Total hysterectomy was the most frequent surgery in which glove perforations occurred (50% of the cases. Conclusion: the glove perforations occurred with relatively high frequency during gynecologic surgeries. The index finger of the left hand proved to be the most affected region. Among the members of the team, the highest percentage of glove perforations occurred in those of the surgeons. Total hysterectomy had the highest perforation rate.

  11. Face and construct validity of virtual reality simulation of laparoscopic gynecologic surgery

    NARCIS (Netherlands)

    Schreuder, Henk W. R.; van Dongen, Koen W.; Roeleveld, Susan J.; Schijven, Marlies P.; Broeders, Ivo A. M. J.

    2009-01-01

    OBJECTIVE: The objective of the study was to validate virtual reality simulation in assessing laparoscopic skills in gynecology by establishing the extent of realism of the simulation to the actual task (face validity) and the degree to which the results of the test one uses reflects the subject

  12. Classification of Ovarian Cancer Surgery Facilitates Treatment Decisions in a Gynecological Multidisciplinary Team

    DEFF Research Database (Denmark)

    Bjørn, Signe Frahm; Schnack, Tine Henrichsen; Lajer, Henrik

    2017-01-01

    were correctly preclassified at the MDT meeting and distributed into 110 (52%) COVA 1, 71 (52%) COVA 2, and 17 (32%) COVA 3. Analyzing the subgroup of patients with cancer, 164 (47%) were correctly preclassified. Regarding the International Federation of Gynecology and Obstetrics (FIGO) stages, the pre...

  13. An evaluation of quality of life in women with endometriosis who underwent primary surgery: a 6-month follow up in Sabah Women & Children Hospital, Sabah, Malaysia.

    Science.gov (United States)

    M F, Ahmad; Narwani, Hussin; Shuhaila, Ahmad

    2017-10-01

    Endometriosis is a complex disease primarily affecting women of reproductive age worldwide. The management goals are to improve the quality of life (QoL), alleviate the symptoms and prevent severe disease. This prospective cohort study was to assess the QoL in women with endometriosis that underwent primary surgery. A pre- and post-operative questionnaire via ED-5Q and general VAS score used for the evaluation for endometrial-like pain such as dysmenorrhoea and dyspareunia. A total of 280 patients underwent intervention; 224 laparoscopically and 56 via laparotomy mostly with stage II disease with ovarian endometriomas. Improvements in dysmenorrhoea pain scores from 5.7 to 4.15 and dyspareunia from 4.05 to 2.17 (p <.001) were observed. The Self Rate Assessment was improved; 6.66-4.68 post-operatively (p < .05). In EQ-5 D Index, the anxiety and activities outcomes showed a significant worsening post-intervention. There was no correlation between the stage of disease and endometrial pain; (p = .289), method of intervention (p = .290) and usage of post-operative hormonal therapy (p = .632). This study concluded that surgical treatment improved the QoL with added hormonal therapy post-intervention, despite not reaching statistical significance, showed a promising result. Impact statement Surgical intervention does improve the QoL for women with endometriosis however post interventional hormonal therapy is remain inconclusive.

  14. Ergonomic deficits in robotic gynecologic oncology surgery: a need for intervention.

    Science.gov (United States)

    Craven, Renatta; Franasiak, Jason; Mosaly, Prithima; Gehrig, Paola A

    2013-01-01

    To evaluate surgeon strain using validated ergonomic assessment tools. Observational study (Canadian Task Force classification III). Academic medical center. Robotic surgeons performing gynecologic oncology surgical procedures. Videotape footage of surgeons performing robotic gynecologic oncology procedures was obtained. A human factors engineer experienced with health care ergonomics analyzed the video recordings and performed ergonomic evaluations of the surgeons. An initial evaluation was conducted using the Rapid Upper Limb Assessment (RULA) survey, an ergonomic assessment and prioritization method for determining posture, force, and frequency concerns with focus on the upper limbs. A more detailed analysis followed using the Strain Index (SI) method, which uses multiplicative interactions to identify jobs that are potentially hazardous. Seventeen hours of video recordings were analyzed, and descriptive data based on RULA/SI analysis were collected. Ergonomic evaluation of surgeon activity resulted in a mean RULA score of 6.46 (maximum possible RULA score, 7), indicating a need for further investigation. The mean SI grand score was 24.34. SI scores >10 suggest a potential for hazard to the operator. Thus, the current use of the surgical robot is potentially dangerous with regards to ergonomic positioning and should be modified. At a high-volume robotics center, there are ergonomics deficits that are hazardous to gynecologic surgeons and suggest the need for modification and intervention. A training strategy must be developed to address these ergonomic issues and knowledge deficiencies. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  15. A controlled clinical study of serosa-invasive gastric carcinoma patients who underwent surgery plus intraperitoneal hyperthermo-chemo-perfusion (IHCP).

    Science.gov (United States)

    Kim, J Y; Bae, H S

    2001-01-01

    Despite recent advances in the treatment of advanced gastric carcinomas, no satisfactory outcomes are available because of micrometastases and free-floating carcinoma cells already existing in the peritoneal cavity. From 1990, we started using intraperitoneal hyperthermo-chemo-perfusion (IHCP) to prevent and to treat peritoneal metastasis after surgical resection of stomach cancer. We analyzed 103 serosa-invasive gastric carcinoma patients who underwent surgical resection between 1990 and 1995. Fifty-two patients who received surgery plus IHCP were compared with 51 patients who underwent surgery only, as controls. IHCP was administered for 2 h with an automatic IHCP device (closed-circuit system) just after surgical resection, with the patient under hypothermic general anesthesia (32.4 degrees C-34.0 degrees C). As perfusate, we used 1.5% peritoneal dialysis solution mixed with 10 micrograms/ml of mitomycin-C (MMC), warmed at an inflow temperature of over 44 degrees C. The overall 5-year survival rate (5-YSR) of the 103 patients was 29.97%. The 5-YSR was higher in the IHCP group than in the control group, at 32.7% and 27.1%, respectively, but this difference was not significant. However, in the 65 serosa-invasive gastric carcinoma patients (excluding those in stage IV) the 5-YSR was significantly higher (P = 0.0379) in the IHCP group than in the control group, at 58.6% and 44.4%, respectively. On multivariate analysis of all 103 patients, depth of tumor invasion and lymph node metastasis were significant factors for survival, whereas significant factors on univariate analysis, such as combined operation, distant metastasis, and peritoneal metastasis, were not significant. The most common recurrence patterns were loco-regional in the IHCP group and peritoneal in the control group. Complete cytoreductive surgery plus IHCP is effective to prevent and to treat peritoneal metastasis, and it should lead to long-term survival for serosa-invasive gastric carcinoma patients

  16. The effect of pressure-controlled inverse ratio ventilation on lung protection in obese patients undergoing gynecological laparoscopic surgery.

    Science.gov (United States)

    Xu, Lili; Shen, Jianjun; Yan, Min

    2017-10-01

    To examine the effects of pressure-controlled inverse ratio ventilation (PCIRV) and volume-control ventilation (VCV) on arterial oxygenation, pulmonary function, hemodynamics, levels of surfactant protein A (SP-A), and tumor necrosis factor-α (TNF-α) in obese patients undergoing gynecological laparoscopic surgery. Sixty patients, body mass index (BMI) ≥30 kg/m 2 , scheduled for elective gynecological laparoscopic surgery were enrolled in the study. Patients were randomly allocated to receive either PCIRV with an inspiratory-expiratory (I:E) ratio of 1.5:1 (PCIRV group n = 30) or VCV with an I:E ratio of 1:2 (VCV group n = 30). Ventilation variables, viz. tidal volume (V T ), dynamic respiratory-system compliance (C RS ), driving pressure (ΔP = V T /C RS ), arterial blood oxygen partial pressure/fraction of inspiration oxygen (PaO 2 /FiO 2 ) and arterial blood carbon dioxide partial pressure (PaCO 2 ), were measured. Hemodynamic variables, viz. mean arterial pressure (MAP), heart rate (HR), and serum levels of SP-A and TNF-α, were also measured. When compared to patients in the VCV group, patients in the PCIRV group had higher V T , dynamic C RS , and PaO 2 /FiO 2 , and lower ΔP and PaCO 2 at 20 and 60 min after the start of pneumoperitoneum (p ventilation, promote gas exchange and oxygenation, and is associated with decreased levels of SP-A and TNF-α. These effects demonstrate improved lung protection provided by PCIRV in this patient population.

  17. Robot-assisted surgery in gynecological oncology: current status and controversies on patient benefits, cost and surgeon conditions - a systematic review.

    Science.gov (United States)

    Kristensen, Steffen E; Mosgaard, Berit J; Rosendahl, Mikkel; Dalsgaard, Tórur; Bjørn, Signe F; Frøding, Ligita P; Kehlet, Henrik; Høgdall, Claus K; Lajer, Henrik

    2017-03-01

    Robot-assisted surgery has become more widespread in gynecological oncology. The purpose of this systematic review is to present current knowledge on robot-assisted surgery, and to clarify and discuss controversies that have arisen alongside the development and deployment. A database search in PubMed and EMBASE was performed up until 4 March 2016. The search strategy was developed in collaboration with an information specialist, and by application of the PRISMA guidelines. Human participants and English language were the only restrictive filters applied. Selection was performed by screening of titles and abstracts, and by full text scrutiny. From 2001 to 2016, a total of 76 references were included. Robot-assisted surgery in gynecological oncology has increased, and current knowledge supports that the oncological safety is similar, compared with previous surgical methods. Controversies arise because current knowledge does not clearly document the benefit of robot-assisted surgery, on perioperative outcome compared with the increased costs of the acquisition and application. The rapid development in robot-assisted surgery calls for long-term detailed prospective cohorts or randomized controlled trials. The costs associated with acquisition, application, and maintenance have an unfavorable impact on cost-benefit evaluations, especially when compared with laparoscopy. Future developments in robot-assisted surgery will hopefully lead to competition in the market, which will decrease costs. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  18. In vivo confocal laser endomicroscopy during laparoscopy for gynecological surgery: A promising tool.

    Science.gov (United States)

    Chene, G; Chauvy, L; Buenerd, A; Moret, S; Nadaud, B; Beaufils, E; Le Bail-Carval, K; Chabert, P; Mellier, G; Lamblin, G

    2017-09-01

    To investigate the technical feasibility of optical biopsy (probe-based confocal laser endomicroscopy [pCLE]) during laparoscopy and by the vaginal route in the exploration of pelvic gynecological cancers. Prospective study including 31 patients undergoing laparoscopic hysterectomy (benign or malignant indication). Confocal microlaparoscopy (analysis of tubes, ovaries, and depending on the type de cancer, pelvic adenopathies) and optical biopsy of the endometrium were first carried out by the vaginal route under general anesthesia. The surgical procedure was then carried out. Thirty-one consecutive patients were included (16 for benign hysterectomy, 12 for endometrial cancer and 3 for ovarian carcinoma). pCLE offered dynamic pictures that were correlated with the histopathological images. pCLE provides high resolution imaging of cancerous and benign tissues in real-time similar to histopathological results. Both feasibility and safety were confirmed. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  19. Total Robotic Hysterectomy: Thailand’s First Case Report of Gynecologic Robotic Surgery

    Directory of Open Access Journals (Sweden)

    Korakot Sirimai

    2016-01-01

    Full Text Available Objective: This study aimed to report the feasibility, trouble shooting and surgical technique in the total robotic hysterectomy for the patient with adenomyoma uteri. Methods: A 51 year-old patient was diagnosed with adenomyosis. Total robotic hysterectomy was performed. Results: Total operating time was 350 min, estimated blood loss was 50 ml, and length of hospitalization was 6 days. The pathologic section revealed adenomyosis with myoma uteri. The intraoperative and post-operative complications were unremarkable. The patient was in good conditions at 6th week, 3rd, 6th, 12th and 24th month. Conclusion: Total robotic hysterectomy for benign gynecologic condition, such as adenomyosis, is safe and feasible. However, the sustained high consuming cost must be weighted with the patient’s advantages.

  20. [Assessment of the correlation between histological degeneration and radiological and clinical parameters in a series of patients who underwent lumbar disc herniation surgery].

    Science.gov (United States)

    Munarriz, Pablo M; Paredes, Igor; Alén, José F; Castaño-Leon, Ana M; Cepeda, Santiago; Hernandez-Lain, Aurelio; Lagares, Alfonso

    The use of histological degeneration scores in surgically-treated herniated lumbar discs is not common in clinical practice and its use has been primarily restricted to research. The objective of this study is to evaluate if there is an association between a higher grade of histological degeneration when compared with clinical or radiological parameters. Retrospective consecutive analysis of 122 patients who underwent single-segment lumbar disc herniation surgery. Clinical information was available on all patients, while the histological study and preoperative magnetic resonance imaging were also retrieved for 75 patients. Clinical variables included age, duration of symptoms, neurological deficits, or affected deep tendon reflex. The preoperative magnetic resonance imaging was evaluated using Modic and Pfirrmann scores for the affected segment by 2 independent observers. Histological degeneration was evaluated using Weiler's score; the presence of inflammatory infiltrates and neovascularization, not included in the score, were also studied. Correlation and chi-square tests were used to assess the association between histological variables and clinical or radiological variables. Interobserver agreement was also evaluated for the MRI variables using weighted kappa. No statistically significant correlation was found between histological variables (histological degeneration score, inflammatory infiltrates or neovascularization) and clinical or radiological variables. Interobserver agreement for radiological scores resulted in a kappa of 0.79 for the Pfirrmann scale and 0.65 for the Modic scale, both statistically significant. In our series of patients, we could not demonstrate any correlation between the degree of histological degeneration or the presence of inflammatory infiltrates when compared with radiological degeneration scales or clinical variables such as the patient's age or duration of symptoms. Copyright © 2017 Sociedad Española de Neurocirug

  1. Robotic Single-Site and Conventional Laparoscopic Surgery in Gynecology: Clinical Outcomes and Cost Analysis of a Matched Case-Control Study.

    Science.gov (United States)

    El Hachem, Lena; Andikyan, Vaagn; Mathews, Shyama; Friedman, Kathryn; Poeran, Jashvant; Shieh, Kenneth; Geoghegan, Michael; Gretz, Herbert F

    2016-01-01

    To assess the clinical outcomes and costs associated with robotic single-site (RSS) surgery compared with those of conventional laparoscopy (CL) in gynecology. Retrospective case-control study (Canadian Task Force classification II-2). University-affiliated community hospital. Female patients undergoing RSS or CL gynecologic procedures. Comparison of consecutive RSS gynecologic procedures (cases) undertaken between October 2013 and March 2014 with matched CL procedures (controls) completed during the same time period by the same surgeon. Patient demographic data, operative data, and hospital financial data were abstracted from the electronic charts and financial systems. An incremental cost analysis based on the use of disposable equipment was performed. Total hospital charges were determined for matched RSS cases vs CL cases. RSS surgery was completed in 25 out of 33 attempts; 3 cases were aborted before docking, and 5 were converted to a multisite surgery. There were no intraoperative complications or conversions to laparotomy. The completed cases included 11 adnexal cases and 14 hysterectomies, 3 of which included pelvic lymph node dissection. Compared with the CL group, total operative times were higher in the RSS group; however, there were no significant between-group differences in estimated blood loss, length of hospital stay, or complication rates. Disposable equipment cost per case, direct costs, and total hospital charges were evaluated. RSS was associated with an increased disposable cost per case of $248 to $378, depending on the method used for vaginal cuff closure. The average total hospital charges for matched outpatient adnexal surgery were $15,450 for the CL controls and $18,585 for the RSS cases (p total hospital charges for matched outpatient benign hysterectomy were $14,623 for the CL controls and $21,412 for the RSS cases (p cost per case and total hospital charges. Careful case selection and judicious use of equipment are necessary to

  2. Surgical results of pelvic exenteration in the treatment of gynecologic cancer

    OpenAIRE

    Petruzziello, Andrea; Kondo, William; Hatschback, Sergio B; Guerreiro, João A; Filho, Flávio Panegalli; Vendrame, Cristiano; Luz, Murilo; Ribeiro, Reitan

    2014-01-01

    Background Our aim in the present study was to evaluate surgical outcomes and complications of pelvic exenteration in the treatment of gynecologic malignancy and to compare surgery-related complications associated with different types of exenteration. Methods We performed a retrospective analysis of patients who underwent pelvic exenteration for the treatment of gynecologic cancer between January 2008 and August 2011. Patients were divided into two groups for comparison: total pelvic exentera...

  3. Intravenous iron sucrose for treatment of anemia in gynecology patients awaiting surgery

    OpenAIRE

    Animesh Gandhi; Meena N. Satia

    2016-01-01

    Background: Anemia refers to reduction in the total circulatory erythrocyte mass which results in decrease in the oxygen carrying capacity of the blood. Patients who require a surgical intervention as regards their complaints are many a times denied fitness because of anemia. Current anesthetic and surgical practice ideally recommend a hemoglobin level of > 10 g/dl or a hematocrit of >30 % for any surgical intervention. Surgery is postponed until cause of anemia is identified and the anemia c...

  4. Safe introduction of ancillary trocars in gynecological surgery: the "yellow island" anatomical landmark.

    Science.gov (United States)

    Vitale, Salvatore Giovanni; Gasbarro, Nicola; Lagana, Antonio Simone; Sapia, Fabrizio; Rapisarda, A M C; Valenti, Gaetano; Trovato, Maria Antonietta; Rossetti, Diego; Chiofalo, Benito; Barrasso, Giuseppina; Tinelli, Andrea; Corrado, Francesco

    2016-01-01

    This technical note aims to suggest a safe introduction of ancillary trocars in gynaecological surgery, in order to prevent inferior epigastric artery damage. We performed a narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases. Among the different techniques, the identification of the "yellow island" as anatomical landmark seems to be a useful aid to avoid complication. This particular landmark is identified taking the lateral third of a line between the anterior superior iliac spine and the umbilicus as reference points, by a subperitoneal accumulation of adipose tissue located in that area. "Yellow island" could be considered a safe place for trocars introduction because epigastric artery never runs there, even in patients with particular anatomical variants. This technique is particularly useful in obese patients, in which "yellow island" appears to be more evident respect to lean ones. Furthermore, the use of "open" trocars insertion may reduce the possibility of epigastric artery lesions respect to "Verres needle technique". The identification of the "yellow island" anatomical landmark could be considered an useful aid for the safe introduction of ancillary trocars in gynaecological surgery. Gynaecology, Laparoscopic surgery, Trocars placement.

  5. Comparison of three methods for the confirmation of laryngeal mask airway placement in female patients undergoing gynecologic surgery.

    Science.gov (United States)

    Zhou, Zhen-feng; Xia, Chen-zhong; Wu, Meng; Yu, Li-na; Yan, Guo-zhang; Ren, Qiu-sheng; Hu, Ci-xian; Yan, Min

    2015-05-01

    The laryngeal mask airway (LMA) is a supraglottic device that is commonly used to provide lung ventilation during general anesthesia. LMA placement needs to be confirmed to provide adequate lung ventilation. To investigate the feasibility of using ultrasound examination, compared with clinical tests and fiberoptic laryngoscopy, to confirm LMA placement, we performed a clinical study of 64 female patients classified as American Society of Anesthesiologists Physical Status I or II who were scheduled for gynecologic surgery with LMA insertion for airway management. After insertion, placement of the LMA was confirmed by clinical tests, ultrasound examination and fiberoptic laryngoscopy. Of the 64 women, placement was confirmed as acceptable in 89.1% by clinical tests, in 59.4% by fiberoptic laryngoscope assessment and in 67.2% by ultrasound examination. With respect to patients with oropharyngeal leaks classified as high, there were no differences in confirmation of acceptable placement between clinical tests and ultrasound examinations (p = 0.092), but the number of patients determined to have acceptable placement by ultrasound examination was greater than that determined by fiberoptic laryngoscopy (p = 0.034). Thus, ultrasound examination is a superior technique for confirming the seal on the LMA. Copyright © 2015. Published by Elsevier Inc.

  6. Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery: a committee opinion.

    Science.gov (United States)

    2013-05-01

    Postoperative adhesions are a natural consequence of surgical tissue trauma and healing and may result in infertility, pain, and bowel obstruction. Adherence to microsurgical principles and minimally invasive surgery may help to decrease postoperative adhesions. Some surgical barriers have been demonstrated effective for reducing postoperative adhesions, but there is no substantial evidence that their use improves fertility, decreases pain, or reduces the incidence of postoperative bowel obstruction. This document replaces the document of the same name last published in 2008 (Fertil Steril 2008;90[5 Suppl]:S144-9). Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  7. Combination of gabapentin and ramosetron for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective randomized comparative study.

    Science.gov (United States)

    Kim, Kyung Mi; Huh, Jin; Lee, Soo Kyung; Park, Eun Young; Lee, Jung Min; Kim, Hyo Ju

    2017-05-19

    As a drug originally introduced for its anticonvulsant effects, gabapentin has been recently shown to be effective in the treatment of nausea and vomiting in various clinical settings. This study compared the antiemetic efficacy of oral gabapentin, intravenous ramosetron and gabapentin plus ramosetron in patients receiving fentanyl-based patient-controlled analgesia after laparoscopic gynecologic surgery. One hundred and thirty two patients undergoing laparoscopic gynecologic surgery under general anesthesia were allocated randomly into three groups: group G received 300 mg oral gabapentin 1 h before anesthesia, group R received 0.3 mg intravenous ramosetron at the end of surgery, and group GR received a combination of 300 mg oral gabapentin 1 h before anesthesia and 0.3 mg intravenous ramosetron at the end of surgery. Postoperative nausea, retching, vomiting, rescue antiemetic drug use, pain, rescue analgesic requirements and adverse effects were assessed at 0-2, 2-24 and 24-48 h after surgery. Postoperative nausea and vomiting (PONV) was defined as the presence of nausea, retching or vomiting. The incidence of complete response (no PONV and no rescue antiemetics up to 48 h postoperatively) was significantly higher in group GR (26/40, 65%) than group G (16/40, 40%; P = 0.025) and group R (18/44, 41%; P = 0.027), whereas there was no significant difference between group G and group R (P = 0.932). There were no significant between-group differences in the incidence of emetic episodes, use of rescue antiemetics, severe emesis, use of rescue analgesics or any adverse effects. Postoperative pain scores were also similar among groups. The combination with gabapentin and ramosetron is superior to either drug alone for prevention of PONV after laparoscopic gynecologic surgery. ClinicalTrials.gov NCT02617121 , registered November 25, 2015.

  8. Incidence and Risk Factors of Lower Extremity Lymphedema After Gynecologic Surgery in Ovarian Cancer.

    Science.gov (United States)

    Ki, Eun Young; Park, Jong Sup; Lee, Keun Ho; Hur, Soo Young

    2016-09-01

    There is no standard method to establish an early diagnosis of lower extremity lymphedema (LEL). Lower extremity lymphedema can be diagnosed by physical examination and laboratory tests when patients complain of typical clinical symptoms. The objective of this study was to investigate the incidence and risk factors of LEL in patients with ovarian cancer. The medical records were reviewed retrospectively in patients with ovarian cancer treated at Seoul St. Mary's Hospital from January 2000 to July 2014. A total of 413 patients with epithelial ovarian cancer were analyzed. Forty-six patients (11.1%) developed LEL, and 67.4% of these patients had LEL within 1 year after surgery. The mean number of resected lymph nodes (LNs) was larger in patients with LEL (43.1 ± 16.7; range, 12-80) than in those without (32.3 ± 19.8; range, 0-99) (P < 0.0001). The number of resected LNs was significantly associated with the occurrence of LEL (odds ratio, 1.025; 95% confidence interval, 1.005-1.045; P < 0.05). A significant proportion of patients with ovarian cancer could develop LEL after surgery. This study suggests that the occurrence of LEL is associated with the number of resected LNs.

  9. [Primary intestinal parasitic fibroid, an incidental finding during gynecological laparoscopic surgery].

    Science.gov (United States)

    Alcalá-Alcalde, M M; Pantoja-Garrido, M; Frías-Sánchez, Z

    2016-09-01

    Uterine fibroids are the most frequent solid pelvic benign tumors in women. Their most common location is the uterine corpus, cervix and broad ligament but they can also be found in other areas, less commonly as extragenital locations and/or in a parasitic way. A 40 years old patient, who consulted for menorrhagia and dysmenorrhea on long evolution. On physical examination, the enlarged uterus, inflamated, hard consistency and normal mobility was identified. The sonographic features and location suggested a fibroid nodule type II (Wamsteker classification), which deformed the endometrial cavity. It was decided to perform the surgery and during the procedure the enlarged uterus, deformed at the expense of a localized fundal formation, like a intramural fibroid. By mobilizing the intestinal loops and change the position of the patient (Trendelenburg) a solid tumor, cranially separated from the internal genitals it was observed. In reviewing the insertion site, it was visualized that remained attached to antimesial of the jejunum. Total hysterectomy was performed with monopolar and bipolar energy, and vascular sealant. The postoperative was favorable, without complication. The pathological study reported a primary leiomyoma of the small intestine, while in the uterus of multiple myomas was confirmed. The parasitic fibroids are those located separately from the uterus that receive vascular irrigation from another organ or abdominopelvic structure. They are a very rare pathology. The diagnosis has made as an accidental event, during an abdominal surgery or during the differential diagnosis of a abdominopelvic tumor. The therapeutical choice depends on the clinical presentation, the location of the fibroid and the reproductive desires of the patient, most commonly recomending their surgycal removal.

  10. A randomized, double-blind, placebo-controlled trial of oral pregabalin for relief of shoulder pain after laparoscopic gynecologic surgery.

    Science.gov (United States)

    Nutthachote, Pattiya; Sirayapiwat, Porntip; Wisawasukmongchol, Wirach; Charuluxananan, Somrat

    2014-01-01

    To investigate the efficacy of pregabalin for the relief of postoperative shoulder pain after laparoscopic gynecologic surgery. Prospective, randomized, double-blind, placebo-controlled trial (Canadian Task Force classification I). Tertiary referral center, university hospital. Fifty-six women undergoing elective laparoscopic gynecologic surgery between June 2012 and March 2013. Women in the study group received 75 mg pregabalin 2 hours before surgery and then every 12 hours for 2 doses, and women in the control group received an identical capsule and the same dosage of placebo. Visual analog scale (VAS) scores for shoulder pain and surgical pain at 24 and 48 hours after surgery were evaluated as primary outcome. Postoperative analgesics used and drug-related adverse events were also monitored. Patients in the pregabalin group had significantly lower postoperative VAS scores for shoulder pain at 24 hours, compared with the placebo group (median, 23.14 [range, 13.67-32.61] vs. 37.22 [27.75-46.64]; p = .04), and required less analgesic (p = .01). There were no significant differences in VAS scores for surgical pain and adverse events between the 2 groups (p = .56). Perioperative administration of 75 mg pregabalin significantly reduced postoperative laparoscopic shoulder pain and amount of analgesic used. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  11. Clinical outcomes for T1-2N0-1 oral tongue cancer patients underwent surgery with and without postoperative radiotherapy

    International Nuclear Information System (INIS)

    Shim, Su Jung; Cha, Jihye; Koom, Woong Sub; Kim, Gwi Eon; Lee, Chang Geol; Choi, Eun Chang; Keum, Ki Chang

    2010-01-01

    The aim of this study was to assess the results of curative surgery with and without radiotherapy in patients with T 1-2 N 0-1 oral tongue squamous cell carcinoma (OSCC) and to evaluate survival and prognostic factors. Retrospective analysis of 86 patients with T 1-2 N 0-1 OSCC who received surgery between January 2000 and December 2006. Fourteen patients (16.3%) received postoperative radiotherapy (PORT). Patient characteristics, tumor characteristics, treatment modality, failure patterns, and survival rates were analyzed. The median follow-up was 45 months. The five-year overall survival (OS) and disease-free survival (DFS) rates were 80.8% and 80.2%, respectively. Higher tumor grade and invasion depth ≥ 0.5 cm were the significant prognostic factors affecting five-year OS and DFS (OS rate; 65% vs. 91%, p = 0.001 for grade; 66% vs. 92%, p = 0.01 for invasion depth: DFS rate; 69% vs. 88%, p = 0.005 for grade; 66% vs. 92%, p = 0.013 for invasion depth). In the risk group, there was no local failure in patients with postoperative radiotherapy. In T 1-2 N 0-1 OSCC, factors that affected prognosis after primary surgery were higher tumor grade and deep invasion depth over 0.5 cm. Postoperative radiotherapy should be considered in early oral tongue cancer patients with these high-risk pathologic features

  12. Clinical outcomes for T1-2N0-1 oral tongue cancer patients underwent surgery with and without postoperative radiotherapy

    Directory of Open Access Journals (Sweden)

    Choi Eun

    2010-05-01

    Full Text Available Abstract Background The aim of this study was to assess the results of curative surgery with and without radiotherapy in patients with T1-2N0-1 oral tongue squamous cell carcinoma (OSCC and to evaluate survival and prognostic factors. Methods Retrospective analysis of 86 patients with T1-2N0-1 OSCC who received surgery between January 2000 and December 2006. Fourteen patients (16.3% received postoperative radiotherapy (PORT. Patient characteristics, tumor characteristics, treatment modality, failure patterns, and survival rates were analyzed. Results The median follow-up was 45 months. The five-year overall survival (OS and disease-free survival (DFS rates were 80.8% and 80.2%, respectively. Higher tumor grade and invasion depth ≥ 0.5 cm were the significant prognostic factors affecting five-year OS and DFS (OS rate; 65% vs. 91%, p = 0.001 for grade; 66% vs. 92%, p = 0.01 for invasion depth: DFS rate; 69% vs. 88%, p = 0.005 for grade; 66% vs. 92%, p = 0.013 for invasion depth. In the risk group, there was no local failure in patients with postoperative radiotherapy. Conclusions In T1-2N0-1 OSCC, factors that affected prognosis after primary surgery were higher tumor grade and deep invasion depth over 0.5 cm. Postoperative radiotherapy should be considered in early oral tongue cancer patients with these high-risk pathologic features.

  13. Spinopelvic balance evaluation of patients with degenerative spondylolisthesis L4L5 and L4L5 herniated disc who underwent surgery ?

    OpenAIRE

    Nunes, Viviane Regina Hernandez; Jacob, Charbel; Cardoso, Igor Machado; Batista, Jos? Lucas; Brazolino, Marcus Alexandre Novo; Maia, Thiago Cardoso

    2016-01-01

    ABSTRACT OBJECTIVE: To correlate spinopelvic balance with the development of degenerative spondylolisthesis and disk herniation. METHODS: This was a descriptive retrospective study that evaluated 60 patients in this hospital, 30 patients with degenerative spondylolisthesis at the L4-L5 level and 30 with herniated disk at the L4-L5 level, all of whom underwent Surgical treatment. RESULTS: Patients with lumbar disk herniation at L4-L5 level had a mean tilt of 8.06, mean slope of 36.93, an...

  14. The clinical impact of gynecologic MRI.

    Science.gov (United States)

    Ratner, Elena S; Staib, Lawrence H; Cross, Sarah N; Raji, Rhoda; Schwartz, Peter E; McCarthy, Shirley M

    2015-03-01

    OBJECTIVE. This study assessed the clinical impact of pelvic MRI performed after the diagnosis of an indeterminate pelvic mass on ultrasound or CT. MATERIALS AND METHODS. The radiologic records of 567 patients who underwent pelvic MRI at our hospital from 2004 to 2006 were reviewed. Of these patients, 214 patients underwent pelvic MRI for evaluation of a gynecologic mass detected on a preceding ultrasound or CT examination; this group of patients constituted the basis of our study. The imaging and clinical records from the database were used for our analysis. The medical records were reviewed for the impact of the radiologic findings on patient treatment, and the results were tabulated for the findings of the first modality, whether the first modality provided a diagnosis, what management plan would be made according to the first modality, and what management plan would be made as a result of the MRI. The adequacy of the imaging study was assessed on the basis of either obtaining an accurate exact diagnosis or ascertaining at the minimum whether the mass was benign or malignant. Further endpoints included specificity and sensitivity of the individual modalities in the diagnosis of a specific gynecologic mass and whether clinical management was altered. Exact binomial CIs were computed for individual proportions. RESULTS. The clinical management of the patient was altered as a result of MRI in 77% of the cases (CI = 0.70-0.82). Surgery was avoided in 36% (CI = 0.29-0.43), and surgery was changed to a more appropriate method (laparoscopy vs laparotomy, involvement or not of a gynecologic oncologist) in an additional 17% (CI = 0.12-0.23). CONCLUSION. Without having undergone MRI, many of the women and girls in this study would have undergone unnecessary surgery; a more costly type of surgery; or long-term follow-up with the associated financial costs, personal and physical costs, and mental costs from the resultant anxiety of an unresolved indeterminate mass.

  15. Investigating the Impacts of Preoperative Steroid Treatment on Tumor Necrosis Factor-Alpha and Duration of Extubation Time underwent Ventricular Septal Defect Surgery

    Directory of Open Access Journals (Sweden)

    H. Hakan Poyrazoğlu

    2016-04-01

    Full Text Available Background: Cardiopulmonary bypass is known to cause inflammatory events. Inflammation occurs due to many known important biological processes. Numerous mechanisms are known to be responsible for the development of inflammatory processes. Currently, there are many defined mediators as a tumor necrosis factor-α (TNF-α playing an active role in this process. Aims: This research was to investigate the effects of preoperative steroid use on inflammatory mediator TNF-α and on time to extubation postoperatively in ventricular septal defect patients undergoing cardiopulmonary bypass surgery. Study Design: Controlled clinical study. Methods: This study included 30 patients. These patients were assigned into two groups, each containing 15 patients. 5 micrograms/kg methylprednisolone was injected intravenously 2 hours before the surgery to Group I, whereas there was no application to the patients in Group II. TNF-α (pg/mL level was measured in arterial blood samples obtained at four periods including: the preoperative period (Pre TNF; at the 5th minute of cross-clamping (Per TNF; 2 hours after termination of cardiopulmonary bypass (Post TNF; and at the postoperative 24th hours in cardiovascular surgery intensive care unit (Post 24 h TNF. Results: The mean cross-clamp time was 66±40 and 55±27 minutes in Group I and Group II respectively. No significant difference was found between the groups in terms of cross-clamp time (p>0.05. The mean time to extubation was 6.1±2.3 hours in Group I and 10.6±3.4 hours in Group II. Group I extubation time was significantly shorter than Group II. Group I TNF-α levels at Post TNF and Post24h TNF was lower than Group II. These differences are also statistically significant (p<0.05. Conclusion: There is a strong indication that preoperative steroid treatment reduced the TNF-α level together with shortens duration of postoperative intubation and positively contributes to extubation in ventricular septal defect

  16. Effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery

    Directory of Open Access Journals (Sweden)

    Hiroaki Kawano

    2016-02-01

    Full Text Available BACKGROUND: We investigated the effects of a novel method of anesthesia combining propofol and volatile anesthesia on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery. METHODS: Patients were randomly divided into three groups: those maintained with sevoflurane (Group S, n = 42, propofol (Group P, n = 42, or combined propofol and sevoflurane (Group PS, n = 42. We assessed complete response (no postoperative nausea and vomiting and no rescue antiemetic use, incidence of nausea and vomiting, nausea severity score, vomiting frequency, rescue antiemetic use, and postoperative pain at 2 and 24 h after surgery. RESULTS: The number of patients who exhibited a complete response was greater in Groups P and PS than in Group S at 0-2 h (74%, 76% and 43%, respectively, p = 0.001 and 0-24 h (71%, 76% and 38%, respectively, p < 0.0005. The incidence of nausea at 0-2 h (Group S = 57%, Group P = 26% and Group PS = 21%, p = 0.001 and 0-24 h (Group S = 62%, Group P = 29% and Group PS = 21%, p < 0.0005 was also significantly different among groups. However, there were no significant differences among groups in the incidence or frequency of vomiting or rescue antiemetic use at 0-24 h. CONCLUSION: Combined propofol and volatile anesthesia during laparoscopic gynecological surgery effectively decreases the incidence of postoperative nausea. We term this novel method of anesthesia "combined intravenous-volatile anesthesia (CIVA".

  17. A Posterior TAP Block Provides More Effective Analgesia Than a Lateral TAP Block in Patients Undergoing Laparoscopic Gynecologic Surgery: A Retrospective Study.

    Science.gov (United States)

    Yoshiyama, Sakatoshi; Ueshima, Hironobu; Sakai, Ryomi; Otake, Hiroshi

    2016-01-01

    Background. There are a few papers that compared the lateral transversus abdominis plane (TAP) block with the posterior TAP block. Our study aimed to compare retrospectively the quality of analgesia after laparoscopic gynecologic surgery using the lateral TAP block with general anesthesia versus the posterior TAP block with general anesthesia. Method. Sixty-seven adult female patients were included in this retrospective study. Of these patients, thirty-four patients received the lateral TAP block with general anesthesia (lat. TAP group), and the rest of thirty-three patients received the posterior TAP block with general anesthesia (pos. TAP group). Pain scores both at rest and at movement and the use of additional analgesic drugs were recorded in the postoperative care unit within twenty-four hours after the operation. Postoperative complications were noted. Results. Patients who received pos. TAP reported lower visual analog scale (VAS) pain scores in all points, within twenty-four hours after the operation, than patients who received lat. TAP. Moreover, with the use of additional analgesic drugs, the incidence of nausea and vomiting during the first twenty-four hours after surgery was lower in the pos. TAP group than in the lat. TAP group. Conclusion. The posterior TAP block provided more effective analgesia than the lateral TAP block in patients undergoing laparoscopic gynecologic surgery.

  18. Spinopelvic balance evaluation of patients with degenerative spondylolisthesis L4L5 and L4L5 herniated disc who underwent surgery.

    Science.gov (United States)

    Nunes, Viviane Regina Hernandez; Jacob, Charbel; Cardoso, Igor Machado; Batista, José Lucas; Brazolino, Marcus Alexandre Novo; Maia, Thiago Cardoso

    2016-01-01

    To correlate spinopelvic balance with the development of degenerative spondylolisthesis and disk herniation. This was a descriptive retrospective study that evaluated 60 patients in this hospital, 30 patients with degenerative spondylolisthesis at the L4-L5 level and 30 with herniated disk at the L4-L5 level, all of whom underwent Surgical treatment. Patients with lumbar disk herniation at L4-L5 level had a mean tilt of 8.06, mean slope of 36.93, and mean PI of 45. In patients with degenerative spondylolisthesis at the L4-L5 level, a mean tilt of 22.1, mean slope of 38.3, and mean PI of 61.4 were observed. This article reinforces the finding that the high mean tilt and PI are related to the onset of degenerative spondylolisthesis, and also concluded that the same angles, when low, increase the risk for disk herniation.

  19. Spinopelvic balance evaluation of patients with degenerative spondylolisthesis L4L5 and L4L5 herniated disc who underwent surgery

    Directory of Open Access Journals (Sweden)

    Viviane Regina Hernandez Nunes

    Full Text Available ABSTRACT OBJECTIVE: To correlate spinopelvic balance with the development of degenerative spondylolisthesis and disk herniation. METHODS: This was a descriptive retrospective study that evaluated 60 patients in this hospital, 30 patients with degenerative spondylolisthesis at the L4-L5 level and 30 with herniated disk at the L4-L5 level, all of whom underwent Surgical treatment. RESULTS: Patients with lumbar disk herniation at L4-L5 level had a mean tilt of 8.06, mean slope of 36.93, and mean PI of 45. In patients with degenerative spondylolisthesis at the L4-L5 level, a mean tilt of 22.1, mean slope of 38.3, and mean PI of 61.4 were observed. CONCLUSION: This article reinforces the finding that the high mean tilt and PI are related to the onset of degenerative spondylolisthesis, and also concluded that the same angles, when low, increase the risk for disk herniation.

  20. Comportamiento de los pacientesancianosoperados de cirugíacardíaca con circulaciónextracorpórea/ Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2015-10-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks. Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass. Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014. Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively. Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  1. Pelvic Exenteration in Gynecologic Cancer: La Paz University Hospital Experience.

    Science.gov (United States)

    Moreno-Palacios, Elisa; Diestro, Maria D; De Santiago, Javier; Hernández, Alicia; Zapardiel, Ignacio

    2015-07-01

    Pelvic exenteration is an ultraradical surgery involving the en bloc resection of the pelvic organs, including the internal reproductive organs, the distal urinary tract (ureters, bladder, urethra), and/or anorectum. It is mainly applied as a salvage surgery for recurrent gynecologic tumors of any origin (vulva, vagina, cervix, uterine, and also ovary). Our aim was to establish the most favorable cases for this type of surgery by means of a review of our institution experience. Retrospective analyses of all patients treated with pelvic exenteration for recurrent gynecologic cancer from 2008 to 2014 at La Paz University Hospital. Ten patients underwent pelvic exenteration for recurrent gynecologic cancers including uterine, cervical, vaginal, vulvar, and ovarian cancer. All patients had received prior treatment: surgery, radiotherapy, and/or chemotherapy. Eight patients underwent total pelvic exenteration, one anterior and one posterior pelvic exenteration. Urinary diversions technique consisted of ileal conduits in all cases. Permanent colostomy was performed in all cases. Postoperative complications were related to the urinary diversion in 50% of the cases, to the reconstructive technique in 30%, and to systemic or pelvic infections in 20%. Despite the high morbidity and mortality rates, pelvic exenteration is feasible, and in selected cases of cancer recurrence is the last possible treatment.

  2. The effect of peritoneal gas drain on postoperative pain in benign gynecologic laparoscopic surgery: a double-blinded randomized controlled trial controlled trial

    Directory of Open Access Journals (Sweden)

    Tharanon C

    2016-08-01

    Full Text Available Chantip Tharanon, Kovit Khampitak Department of Obstetrics and Gynecology, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand Objectives: To compare the effect of peritoneal gas drain on postoperative pain in benign gynecologic laparoscopic surgery and the amount of postoperative analgesic dosage.Methods: The trial included 45 females who had undergone operations during the period December 2014 to October 2015. The patients were block randomized based on operating time (<2 and ≥2 hours. The intervention group (n=23 was treated with postoperative intraperitoneal gas drain and the control group (n=22 was not. The mean difference in scores for shoulder, epigastric, suprapubic, and overall pain at 6, 24, 48 hours postoperatively were statistically evaluated using mixed-effect restricted maximum likelihood regression. The differences in the analgesic drug usage between the groups were also analyzed using a Student’s t-test. The data were divided and analyzed to two subgroups based on operating time (<2 hours, n=20; and ≥2 hours, n=25.Results: The intervention had significantly lower overall pain than the control group, with a mean difference and 95% confidence interval at 6, 24, and 48 hours of 2.59 (1.49–3.69, 2.23 (1.13–3.34, and 1.48 (0.3–2.58, respectively. Correspondingly, analgesic drug dosage was significantly lower in the intervention group (3.52±1.47 mg vs 5.72±2.43 mg, P<0.001. The three largest mean differences in patients with operating times of ≥2 hours were in overall pain, suprapubic pain at 6 hours, and shoulder pain at 24 hours at 3.27 (1.14–5.39, 3.20 (1.11–5.26, and 3.13 (1.00–5.24, respectively. These were greater than the three largest mean differences in the group with operating times of <2 hours, which were 2.81 (1.31–4.29, 2.63 (0.51–4.73, and 2.02 (0.68–3.36. The greatest analgesic drug requirement was in the control group with a longer operative time.Conclusion: The use of

  3. Prevalência de transtornos depressivos e de ansiedade em pacientes obesos submetidos à cirurgia bariátrica Prevalence of depression and anxiety disorders in obese patients who underwent bariatric surgery

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    Mateus Astolfi

    2011-09-01

    Full Text Available A obesidade mórbida está relacionada a muitos transtornos psiquiátricos e possui como opção terapêutica a cirurgia bariátrica. Objetivo: caracterizar a prevalência de transtornos depressivos e de ansiedade em pacientes submetidos à cirurgia bariátrica no Hospital Universitário Regional de Maringá e do Centro de Cirurgia de Obesidade de Maringá. Métodos: o estudo foi realizado com 50 pacientes obesos mórbidos submetidos à Cirurgia Bariátrica em diferentes períodos: pré-operatório, um mês de pós-operatório, três meses de pós-operatório e seis meses de pós-operatório. A avaliação do Transtorno Depressivo foi realizada pela aplicação do Inventário de Depressão de Beck, sendo outro instrumento utilizado neste trabalho a Escala Hospitalar de Ansiedade e Depressão (HAD. Resultados: a prevalência de quadros sugestivos de ansiedade foi: 40% (20 pacientes no pré-operatório, 18% no primeiro mês pós-operatório, 8% no terceiro mês pós-operatório e 14% no sexto mês pós-operatório. Quadros sugestivos de depressão foram encontrados em: 26% (13 pacientes no pré-operatório, 10% no primeiro mês pós-operatório e no terceiro mês pós-operatório e 8% no sexto mês pós-operatório. Conclusão: Os níveis de Ansiedade foram altos no pré-operatório, diminuíram no 1º e 3º mês pós-operatório e voltaram a subir no sexto mês, atingindo níveis mais altos que no terceiro mês.Morbid obesity is associated to several psychiatric disorders and bariatric surgery is a therapeutic option. Current research characterizes the prevalence of depression and anxiety disorders in patients who underwent bariatric surgery at the Regional Hospital of Maringá and at the Obesity Surgery Center of Maringá, Maringá PR Brazil. Study was undertaken with 50 morbid obese patients who underwent bariatric surgery and comprised different periods, namely, pre-surgery, one month after surgery, three months after surgery and six months

  4. Efficacy of intermittent pneumatic compression for venous thromboembolism prophylaxis in patients undergoing gynecologic surgery: A systematic review and meta-analysis.

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    Feng, Jian-Ping; Xiong, Yu-Ting; Fan, Zi-Qi; Yan, Li-Jie; Wang, Jing-Yun; Gu, Ze-Juan

    2017-03-21

    We sought to comprehensively assess the efficacy of Intermittent Pneumatic Compression (IPC) in patients undergoing gynecologic surgery. A computerized literature search was conducted in Pubmed, Embase and Cochrane Library databases. Seven randomized controlled trials involving 1001 participants were included. Compared with control, IPC significantly lowered the deep vein thrombosis (DVT) risk [risk ratio (RR) = 0.33, 95% confidence interval (CI): 0.16 - 0.66]. The incidence of DVT in IPC and drugs group was similar (4.5% versus. 3.99%, RR = 1.19, 95% CI: 0.42 - 3.44). With regards to pulmonary embolism risk, no significant difference was observed in IPC versus control or IPC versus drugs. IPC had a lower postoperative transfusion rate than heparin (RR = 0.53, 95% CI: 0.32 - 0.89), but had a similar transfusion rate in operating room to low molecular weight heparin (RR = 1.06, 95% CI: 0.69 - 1.63). Combined use of IPC and graduated compression stockings (GCS) had a marginally lower risk of DVT than GCS alone (RR = 0.38, 95% CI: 0.14 - 1.03). In summary, IPC is effective in reducing DVT complications in gynecologic surgery. IPC is neither superior nor inferior to pharmacological thromboprophylaxis. However, whether combination of IPC and chemoprophylaxis is more effective than IPC or chemoprophylaxis alone remains unknown in this patient population.

  5. Low-Level Laser and Light-Emitting Diode Therapy for Pain Control in Hyperglycemic and Normoglycemic Patients Who Underwent Coronary Bypass Surgery with Internal Mammary Artery Grafts: A Randomized, Double-Blind Study with Follow-Up.

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    Lima, Andréa Conceição Gomes; Fernandes, Gilderlene Alves; Gonzaga, Isabel Clarisse; de Barros Araújo, Raimundo; de Oliveira, Rauirys Alencar; Nicolau, Renata Amadei

    2016-06-01

    This study aimed to evaluate the efficacy of low-level laser therapy (LLLT) and light-emitting diodes (LEDs) for reducing pain in hyperglycemic and normoglycemic patients who underwent coronary artery bypass surgery with internal mammary artery grafts. This study was conducted on 120 volunteers who underwent elective coronary artery bypass graft (CABG) surgery. The volunteers were randomly allocated to four different groups of equal size (n = 30): control, placebo, LLLT [λ = 640 nm and spatial average energy fluence (SAEF) = 1.06 J/cm(2)], and LED (λ = 660 ± 20 nm and SAEF = 0.24 J/cm(2)). Participants were also divided into hyperglycemic and normoglycemic subgroups, according to their fasting blood glucose test result before surgery. The outcome assessed was pain during coughing by a visual analog scale (VAS) and the McGill Pain Questionnaire. The patients were followed for 1 month after the surgery. The LLLT and LED groups showed a greater decrease in pain, with similar results, as indicated by both the VAS and the McGill questionnaire (p ≤ 0.05), on the 6th and 8th postoperative day compared with the placebo and control groups. The outcomes were also similar between hyperglycemic and normoglycemic patients. One month after the surgery, almost no individual reported pain during coughing. LLLT and LED had similar analgesic effects in hyperglycemic and normoglycemic patients, better than placebo and control groups.

  6. Reduction of postoperative complication rate with the use of early oral feeding in gynecologic oncologic patients undergoing a major surgery: a randomized controlled trial.

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    Minig, Lucas; Biffi, Roberto; Zanagnolo, Vanna; Attanasio, Anna; Beltrami, Carmen; Bocciolone, Luca; Botteri, Edoardo; Colombo, Nicoletta; Iodice, Simona; Landoni, Fabio; Peiretti, Michele; Roviglione, Giovanni; Maggioni, Angelo

    2009-11-01

    A randomized controlled trial was performed to assess the outcome of early oral postoperative feeding (EOF) compared with traditional oral feeding (TOF) in gynecologic oncology patients undergoing a complex laparotomy, including upper abdominal surgery. Patients aged 18-75 years, undergoing an elective laparotomy and with a preoperative suspicion of gynecologic malignancy, were eligible. Exclusion criteria included infectious conditions, intestinal obstruction, severe malnutrition, American Society of Anesthesiologists score C4, intestinal resection, and postoperative stay in the intensive care unit lasting 24 h. Patients allocated to EOF received liquid diet in the first postoperative day and then regular diet. Patients received traditional feeding scheme until resolution of postoperative ileus to start liquid diet. The primary end-point of the trial was length of hospital stay. Between January 1, 2007, and November 17, 2007, a total of 143 patients were randomized to receive either EOF or TOF. Hospital stay for patients who received EOF (n=71) was 4.7 vs. 5.8 days for the TOF group (n=72) (P=0.006). The mean level of postoperative satisfaction was significantly higher in the EOF group (82.8 vs. 71.7 mm, P B 0.001). Patients who received the TOF scheme had significantly higher overall postoperative complications (39 vs. 17% in EOF group, P=0.003) and infective complications (14% in TOF group vs. 3% in EOF group, P=0.017). Variables such as nausea and vomiting, analgesic and antiemetic requirement as well as level of pain and quality of life were not different between groups. On the basis of these findings, the policy of EOF should be used after a complex gynecologic oncologic laparotomy.

  7. Electronic patient-reported outcomes from home in patients recovering from major gynecologic cancer surgery: A prospective study measuring symptoms and health-related quality of life.

    Science.gov (United States)

    Cowan, Renee A; Suidan, Rudy S; Andikyan, Vaagn; Rezk, Youssef A; Einstein, M Heather; Chang, Kaity; Carter, Jeanne; Zivanovic, Oliver; Jewell, Elizabeth J; Abu-Rustum, Nadeem R; Basch, Ethan; Chi, Dennis S

    2016-11-01

    We previously reported on the feasibility of a Web-based system to capture patient-reported outcomes (PROs) in the immediate postoperative period. The purpose of this study was to update the experience of these patients and assess patient and provider satisfaction and feedback regarding the system. This is a prospective cohort study of patients scheduled to undergo laparotomy for presumed gynecologic malignancy. Patients completed a Web-based Symptom Tracking and Reporting (STAR) questionnaire preoperatively and weekly during a 6-week postoperative period. Email alerts were sent to study nurses when concerning patient responses were entered. The patient and the nurse assessments of STAR's usefulness were measured via an exit survey. The study enrolled 96 eligible patients. Of these, 71 patients (74%) completed at least four of seven total sessions. Of the patients who completed the exit satisfaction survey, 98% found STAR easy to use; 84% found it useful; and 82% would recommend it to other patients. Despite positive feedback from patients, clinical personnel found that the STAR system increased their current workload without enhancing patient care. Application of an electronic program for PROs in those recovering from major gynecologic cancer surgery is feasible, and acceptable to most patients. While most clinicians did not find STAR clinically helpful, the majority of patients reported a positive experience with the system and would recommend its use. The program helped many patients feel more empowered in their postoperative recovery. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Comparative Analysis of Inpatient Costs for Obstetrics and Gynecology Surgery Patients Treated With IV Acetaminophen and IV Opioids Versus IV Opioid-only Analgesia for Postoperative Pain.

    Science.gov (United States)

    Hansen, Ryan N; Pham, An T; Lovelace, Belinda; Balaban, Stela; Wan, George J

    2017-10-01

    Recovery from obstetrics and gynecology (OB/GYN) surgery, including hysterectomy and cesarean section delivery, aims to restore function while minimizing hospital length of stay (LOS) and medical expenditures. Our analyses compare OB/GYN surgery patients who received combination intravenous (IV) acetaminophen and IV opioid analgesia with those who received IV opioid-only analgesia and estimate differences in LOS, hospitalization costs, and opioid consumption. We performed a retrospective analysis of the Premier Database between January 2009 and June 2015, comparing OB/GYN surgery patients who received postoperative pain management with combination IV acetaminophen and IV opioids with those who received only IV opioids starting on the day of surgery and continuing up to the second postoperative day. We performed instrumental variable 2-stage least-squares regressions controlling for patient and hospital covariates to compare the LOS, hospitalization costs, and daily opioid doses (morphine equivalent dose) of IV acetaminophen recipients with that of opioid-only analgesia patients. We identified 225 142 OB/GYN surgery patients who were eligible for our study of whom 89 568 (40%) had been managed with IV acetaminophen and opioids. Participants averaged 36 years of age and were predominantly non-Hispanic Caucasians (60%). Multivariable regression models estimated statistically significant differences in hospitalization cost and opioid use with IV acetaminophen associated with $484.4 lower total hospitalization costs (95% CI = -$760.4 to -$208.4; P = 0.0006) and 8.2 mg lower daily opioid use (95% CI = -10.0 to -6.4), whereas the difference in LOS was not significant, at -0.09 days (95% CI = -0.19 to 0.01; P = 0.07). Compared with IV opioid-only analgesia, managing post-OB/GYN surgery pain with the addition of IV acetaminophen is associated with decreased hospitalization costs and reduced opioid use.

  9. Epidemiological profile and postoperative complications of women undergoing gynecological surgery in a reference center in the northern brazilian legal amazon

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    Sônia Maria Coelho

    Full Text Available Objective: To evaluate the epidemiological profile and the operative complications of patients undergoing gynecological operations for benign diseases in a tertiary public hospital in the state of Roraima, Brazil. Methods: We conducted a retrospective survey through the analysis of 518 records of patients submitted to gynecological operations between January and June 2012. We included the three major operations during this period (n = 175: hysterectomy, colpoperineoplasty and suburethral sling placement. We excluded 236 cases of tubal ligation and 25 cases where it was not possible to access to medical records. Results: The mean age was 47.6 years; the education level of most patients was completed junior high (36.6%; 77% were from the State capital, 47.4% were in stable relationships and 26.3% were housewives. The majority of patients had given birth three or more times (86.6%, with previous vaginal delivery in 50.2%, and cesarean delivery, 21%. The main diagnostic indications for surgical treatment were uterine myoma (46.3%, urinary incontinence (27.4% and genital dystopias (17.7%. We found three cases (1.7% of high-grade intraepithelial lesions on Pap smear. The most common procedure was total hysterectomy (19.8%, 15.5% vaginally. The most common complication was wound infection (2.2%. Conclusion: Women undergoing gynecological operations due to benign disease had a mean age of 47 years, most had levels of basic education, came from the capital, were in stable relationships, predominantly housewives, multiparous and showed low operative complication rates.

  10. Effects of high-frequency, high-intensity transcutaneous electrical nerve stimulation versus intravenous opioids for pain relief after gynecologic laparoscopic surgery: a randomized controlled study.

    Science.gov (United States)

    Platon, Birgitta; Mannheimer, Clas; Andréll, Paulin

    2018-04-01

    The aim of the study was to compare the pain relieving effect and the time spent in the recovery unit after treatment with high frequency, high-intensity transcutaneous electrical nerve stimulation (TENS) or intravenous (IV) opioids after gynecologic laparoscopic surgery. All patients who postoperatively reported visual analogue scale (VAS) pain score ≥ 3 were consecutively included in the study. The TENS treatment was given with a stimulus intensity between 40-60 mA during 1 minute, repeated once if insufficient pain relief. In the opioid group, a maximum dose of 10 mg morphine was given IV. If the patient reported insufficient pain relief (VAS ≥ 3) on the assigned treatment, the patient crossed over to the other treatment group. Ninety-three women were randomized to TENS (n = 47) or IV opioids (n = 46). Both groups reported significant pain relief at leave from the recovery unit (TENS group: VAS 5.4 to 1.0, P < 0.001; IV opioid group: VAS 5.2 to 1.1, P < 0.001) with no differences between the groups. When only responders, i.e. patients with VAS < 3 after assigned treatment, were compared the TENS responders spent significantly shorter time in the recovery unit (90 vs. 122 minutes, P = 0.008) compared to the responders in the opioid group. TENS and IV opioids are both effective treatments for pain relief after gynecologic laparoscopic surgery. TENS seems to be preferable for first choice of treatment as the treatment is associated with shorter time spent in recovery unit if the patient responds to the treatment.

  11. A Randomized Controlled Trial on the Efficacy and Safety of a New Crosslinked Hyaluronan Gel in Reducing Adhesions after Gynecologic Laparoscopic Surgeries.

    Science.gov (United States)

    Liu, Chongdong; Lu, Qi; Zhang, Zhiqiang; Xue, Min; Zhang, Youzhong; Zhang, Yi; Wang, Huilan; Li, Huajun; Zhou, Yingfang; Zhang, Zhenyu; Li, Wei

    2015-01-01

    To evaluate the safety and efficacy of a new crosslinked hyaluronan (NCH) gel in reducing postoperative adhesions. Randomized controlled trial (Canadian Task Force classification I). Seven departments of obstetrics and gynecology in China. A total of 216 women scheduled for gynecologic laparoscopic surgery for primary removal of adhesions, myomas, ovarian cysts, or endometriotic cysts. Patients were randomized to receive either NCH gel or saline with 1:1 allocation. All patients were evaluated using a modified American Fertility Society (mAFS) scoring system for the incidence, extent, and severity of pre-existing and postoperative adhesions at the 10 anatomic sites of ovaries/tubes and at the expanded 23 or 24 anatomic sites throughout the abdominopelvic cavity by laparoscopy. A total of 215 randomized patients were treated with either saline solution (108 of 108) or NCH gel (107 of 108), composing the full analysis set (FAS), and 196 patients (94 of 108 in the saline control group and 102 of 108 in the NCH gel group) completed the entire study, composing the per protocol set (PPS). The postoperative incidence of moderate or severe adhesions evaluated at the 10 sites (the primary endpoint for efficacy) was 27.7% in the control group and 9.8% in the NCH gel group, a difference of 14.4% (95% confidence interval [CI], 2.6%-20.6%) in the PPS, and 37.0% in the control group and 14.0% in the NCH gel group, a difference of 20.0% (95% CI, 8.9%-26.8%) in the FAS. The postoperative incidence of moderate or severe adhesions evaluated at the 24 sites was also significantly lower in the NCH gel group compared with the control group (5.9% vs 14.9%; p = .036) in the PPS. Also in the PPS, the NCH gel group had significantly lower postoperative adhesion scores of severity, extent, and mAFS: 60.0%, 50.8%, and 76.9%, respectively (median scores of the 10 sites; p = .002) and 48.5%, 50.0%, and 72.2% (median scores of the 24 sites; p = .001) lower than those recorded in the control

  12. Effects of CO2 Pneumoperitoneum on the Cognitive Function of Patients Undergoing Gynecologic Laparoscopy.

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    Liu, Lu-Lu; Bao, Ning; Lu, Huang-Wei

    2016-01-01

    To evaluate the effects of CO2 pneumoperitoneum during gynecologic laparoscopy on patients' postoperative cognitive function. This prospective clinical study included 225 adult female patients with American Society of Anesthesiologists physical status I or II. Patients underwent conventional open surgery (group I, n = 115) or gynecologic laparoscopy using abdominal insufflation with CO2 to an intra-abdominal pressure of 15 mm Hg (group II, n = 110). Serum S100β and neuron-specific enolase (NSE) concentrations were measured, both immediately before surgery and before the patient awoke after surgery. The Mini-Mental State Examination (MMSE) was administered 1 day before surgery as well as 1, 6, 12, 24 and 72 h after surgery and before discharge. MMSE scores were significantly lower relative to baseline at 1, 6 and 12 h post surgery, but returned to baseline by 48 h (group I) or 72 h (group II) post surgery. One hour after surgery, S100β serum levels were higher in group II than in group I (p gynecologic laparoscopy. © 2015 S. Karger AG, Basel.

  13. Effect of intraperitoneal and incisional port site lidocaine on pain relief after gynecological laparoscopic surgery: A randomized controlled study

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    Nahla W. Shady

    2018-03-01

    Conclusions: This study clearly depicts that incisional and intraperitoneal infiltration of lidocaine is an easy, safe, inexpensive, and noninvasive method that provides good analgesia during the early post-operative period and also provides early recovery from laparoscopic surgery.

  14. A prospective study of the feasibility and acceptability of a Web-based, electronic patient-reported outcome system in assessing patient recovery after major gynecologic cancer surgery.

    Science.gov (United States)

    Andikyan, Vaagn; Rezk, Youssef; Einstein, M Heather; Gualtiere, Gina; Leitao, Mario M; Sonoda, Yukio; Abu-Rustum, Nadeem R; Barakat, Richard R; Basch, Ethan M; Chi, Dennis S

    2012-11-01

    The purposes of this study are to evaluate the feasibility of capturing patient-reported outcomes (PROs) electronically and to identify the most common distressing symptoms in women recovering from major gynecologic cancer surgery. This was a prospective, single-arm pilot study. Eligible participants included those scheduled for a laparotomy for presumed or known gynecologic malignancy. Patients completed a Web-based "STAR" (Symptom Tracking and Reporting for Patients) questionnaire once preoperatively and weekly during the 6-week postoperative period. The questionnaire consisted of the patient adaptation of the NCI CTCAE 3.0 and EORTC QLQ-C30 3.0. When a patient submitted a response that was concerning, an automated email alert was sent to the clinician. The patient's assessment of STAR's usefulness was measured via an exit survey. Forty-nine patients completed the study. The procedures included the following: hysterectomy±staging (67%), resection of tumor (22%), salpingo-oophorectomy (6%), and other (4%). Most patients (82%) completed at least 4 sessions in STAR. The CTC generated 43 alerts. These alerts resulted in 25 telephone contacts with patients, 2 ER referrals, one new appointment, and one pharmaceutical prescription. The 3 most common patient-reported symptoms generating an alert were as follows: poor performance status (19%), nausea (18%), and fatigue (17%). Most patients found STAR useful (80%) and would recommend it to others (85%). Application of a Web-based, electronic STAR system is feasible in the postoperative period, highly accepted by patients, and warrants further study. Poor performance status, nausea, and fatigue were the most common distressing patient-reported symptoms. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Diagnostic Accuracy of Detecting Hashimoto's Thyroiditis in Thyroid Cancer Patients Who Underwent Thyroid Surgery: Comparison of Ultrasonography, Positron Emission Tomography/CT, Contrast Enhanced CT, and Anti-Thyroid Antibody

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    Kim, Young Gyun; Lee, Tae Hyun; Park, Dong Hee; Nam, Sang Been [Dept. of Radiology, Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    2012-11-15

    To compare the diagnostic accuracy of ultrasonography (US), F18-fluorodeoxyglucose positron emission tomography/CT (PET/CT), contrast enhanced CT (CECT), serum anti-thyroid antibody for detecting Hashimoto's thyroiditis in thyroid cancer patients who underwent neck surgery. A total of 150 patients with suspicious for thyroid cancer, who had previously undergone US guided needle aspiration of thyroid, were evaluated with the use of US, PET/CT, CECT and serum anti-thyroid antibody. The four studies were performed within two months before neck surgery. Hashimoto's thyroiditis was confirmed by histopathological results. The diagnostic accuracy of US, PET/CT, CECT and serum anti-thyroid antibody were calculated statistically. Hashimoto's thyroiditis was diagnosed in 51 out of the 150 patients, following neck surgery. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US were 76.5%, 92.9%, 84.8%, 88.5%, and 87.3%, respectively. The corresponding values of PET/CT were 37.3%, 96.0%, 82.6%, 74.8%, and 76.0%, and CECT were 62.7%, 89.9%, 76.2%, 82.4%, and 80.7%, and serum anti-thyroid antibody level were 90.2%, 93.9%, 88.5%, 94.9%, and 92.7%, respectively. McNemar test revealed significant difference among PET/CT and others, but no significant differences among US, CECT and serum anti-thyroid antibody. Overall, serum anti-thyroid antibody showed most accurate diagnostic performance. In detecting Hashimoto's thyroiditis, serum anti-thyroid antibody showed higher diagnostic accuracy than others. US also showed relatively high diagnostic accuracy.

  16. Management of refractory bleeding post-cardiopulmonary bypass in an acute heparin-induced thrombocytopenia type II renal failure patient who underwent urgent cardiac surgery with bivalirudin (Angiox®) anticoagulation.

    Science.gov (United States)

    Hassen, Kimberly; Maccaroni, Maria R; Sabry, Haytham; Mukherjee, Smitangshu; Serumadar, Shankari; Birdi, Inderpaul

    2018-04-01

    Acute heparin-induced thrombocytopenia (HIT) patients present a myriad of anticoagulation management challenges, in clinical settings where unfractionated heparin (UFH) is the traditional drug of choice. UFH use in cardiac surgery is a known entity that has been subject to rigorous research. Research has, thus, led to its unparalleled use and the development of well-established protocols for cardiac surgery. In comparison to UFH, bivalirudin use for acute HIT patients requiring urgent cardiac surgery with cardiopulmonary bypass (CPB) is still in its infancy. We describe the tailored post-CPB management of refractory bleeding in a 65-year-old infective endocarditis, acute HIT patient with renal failure who underwent urgent aortic valve replacement and mitral valve repair with bivalirudin anticoagulation. A management approach that entailed a combination of continuous venovenous haemofiltration (CVVH), 4-Factor prothrombin complex concentrate (PCC) (Beriplex), recombinant factor VIIa (rFactor VIIa) and desmopressin (DDAVP) were consecutively used post-operatively in theatre. Based on this case study experience, two modifications to institutional protocols are recommended. The first is the use of CVVH in theatre to eliminate bivalirudin in renal failure patients or in patients where bivalirudin elimination is prolonged. Secondly, a 'rescue therapy/intervention' algorithm for the swift identification of refractory bleeding post-CPB is also recommended. Rescue therapy agents, such as a 4-Factor PCCs and rFactor VIIa, should be incorporated into the protocol after a robust evidence-based search and agreement with the haematologist. The aim of these recommendations is to reduce the risk of bleeding associated with bivalirudin use for inexperienced institutions and experienced institutions alike, until larger randomized, controlled studies provide more in-depth knowledge to expand our clinical practice.

  17. Perfil epidemiológico de pacientes submetidos a tratamento cirúrgico de varizes de membros inferiores Epidemiologic profile of the patients underwent varicose vein surgery of the lower limbs

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    Esdras Marques Lins

    2012-12-01

    underwent to this surgery in the city of Recife. OBJECTIVE: The aim of this report was evaluate the epidemiologic profile of the patients underwent to varicose vein surgery of the lower limbs. MATERIAL AND METHODS: They were evaluated 201 patients underwent to varicose vein surgery of the lower limbs at the Vascular Surgery Service at the Instituto de Medicina Integral Professor Fernando Figueira (IMIP from august 2006 to april 2007. All the patients were evaluated considering the gender, age, sedentarism, overweight, obesity and the report of long-time in a standing position during work shift. RESULTS: Over all patients evaluated, 175 (87.1% were females and 26 (12.9% males. The majority of them (32.3% were aged from 41 to 50 years, overweight was found in 38.8% of the patients, and obesity in 7.5% of the cases. Long time standing during work shift was reported by 82.1% of the patients, and the time at the school, found in 83.2% of the patients, was eight or less years. Sedentarism was found in 69.2% of the patients. CONCLUSION: The majority of the patients evaluated in the present study was female and more than 40 years-old, reported sedentarism, did not have overweight or obesity and reported to stay a long-time in a standing position during work shift.

  18. Measurements of female genital appearance in Chinese adults seeking genital cosmetic surgery: a preliminary report from a gynecological center.

    Science.gov (United States)

    Cao, Yujiao; Li, Qiang; Zhou, Chuande; Li, Fengyong; Li, Senkai; Zhou, Yu

    2015-05-01

    Accurate and comprehensive measurements of the external genitalia in female adults are of great significance in surgery designs and for aesthetic evaluation in genital plastic surgeries. The authors carried out a 319-case study and provided baseline data and morphometric reference for plastic surgery involving the genital deformity caused by trauma or burns and male-to-female transsexual operations. Our study design recruited 319 women referred to the out-patient clinic from August 2010 to August 2013. From each individual we measured 16 parameters and assessed the significance of variations in age, height, weight, BMI, and marital status (as a proxy for parity). We tried to establish a female external genitalia database of the population presenting for cosmetic surgery and define the general proportions of female genitalia in Chinese adults from the data we obtained. A wide range of values was noted in female genital measurements especially in labia minora parameters. Four parameters, including clitoral prepuce length, clitoris to urethra, labial length, and perineal body length had a proportional relationship to some extent. The position of the clitoris and urethral orifice was found to be regular in female adults. Compared with unmarried women, perineal body length decreased (P = 0.048), while the apex to perineum (bilateral) and labial length increased (P = 0.005, 0.006, cosmetic surgery. Although the ranges of genital measurements vary, there is a proportional relationship in female genital appearance, which should be heeded in surgical designs and genital aesthetic evaluation.

  19. Effects of intraoperative high-dose vs low-dose remifentanil for postoperative epidural analgesia after gynecological abdominal surgery: a randomized clinical trial.

    Science.gov (United States)

    Yamashita, Soichiro; Yokouchi, Takako; Tanaka, Makoto

    2016-08-01

    To evaluate whether intraoperative high-dose remifentanil infusion increased local anesthetic consumption in postoperative epidural analgesia and postoperative pain scores compared with low-dose remifentanil infusion. Prospective, randomized controlled study. Operating room, university hospital. Thirty female patients scheduled for elective gynecological abdominal surgery. After epidural catheter placement and induction of general anesthesia, patients were randomly assigned to 2 anesthetic regimens. In the first group (high-dose remifentanil group), sevoflurane concentration was held constant at 1.2%, and the remifentanil infusion rate was titrated to maintain systolic blood pressure within 20% of baseline. In the second group (low-dose remifentanil group), the remifentanil infusion rate was held constant at 0.1μg/(kg min), and the sevoflurane concentration was titrated to maintain systolic blood pressure within 20% of baseline. As abdominal wall closure began, 6mL of 0.2% ropivacaine was administrated via epidural catheter; a patient-controlled analgesia device was set to deliver 4mL/h of 0.2% ropivacaine with 3μg/mL of fentanyl, with 2-mL incremental doses and a 15-minute lockout time. Local anesthetic consumption via postoperative epidural catheter and pain intensity with the Prince Henry pain scale were assessed for 48hours after surgery. The mean remifentanil infusion rate was 0.23μg/(kg min) in the high-dose remifentanil group, 2.3 times the rate used in the low-dose remifentanil group. The cumulative amount of local anesthetic used within 48hours of surgery was significant greater in the high-dose remifentanil group than in the low-dose remifentanil group (212±25mL vs. 181±35mL, respectively; Phigh-dose remifentanil infusion increased local anesthetic consumption in postoperative epidural analgesia relative to low-dose remifentanil. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Assessment of peri- and postoperative complications and Karnofsky-performance status in head and neck cancer patients after radiation or chemoradiation that underwent surgery with regional or free-flap reconstruction for salvage, palliation, or to improve function

    Directory of Open Access Journals (Sweden)

    Sertel Serkan

    2011-09-01

    Full Text Available Abstract Background Surgery after (chemoradiation (RCTX/RTX is felt to be plagued with a high incidence of wound healing complications reported to be as high as 70%. The additional use of vascularized flaps may help to decrease this high rate of complications. Therefore, we examined within a retrospective single-institutional study the peri--and postoperative complications in patients who underwent surgery for salvage, palliation or functional rehabilitation after (chemoradiation with regional and free flaps. As a second study end point the Karnofsky performance status (KPS was determined preoperatively and 3 months postoperatively to assess the impact of such extensive procedures on the overall performance status of this heavily pretreated patient population. Findings 21 patients were treated between 2005 and 2010 in a single institution (17 male, 4 female for salvage (10/21, palliation (4/21, or functional rehabilitation (7/21. Overall 23 flaps were performed of which 8 were free flaps. Major recipient site complications were observed in only 4 pts. (19% (1 postoperative haemorrhage, 1 partial flap loss, 2 fistulas and major donor site complications in 1 pt (wound dehiscence. Also 2 minor donor site complications were observed. The overall complication rate was 33%. There was no free flap loss. Assessment of pre- and postoperative KPS revealed improvement in 13 out of 21 patients (62%. A decline of KPS was noted in only one patient. Conclusions We conclude that within this (chemoradiated patient population surgical interventions for salvage, palliation or improve function can be safely performed once vascularised grafts are used.

  1. The influence of dexamethasone and ketolgan on postoperative nausea and vomiting and estimation of risk factors in women undergoing gynecologic laparoscopic surgeries.

    Science.gov (United States)

    Rimaitis, Kestutis; Svitojūte, Asta; Macas, Andrius

    2010-01-01

    The aim of this study was to determine the effect of dexamethasone and ketolgan on postoperative nausea and vomiting and to evaluate risk factors for postoperative nausea and vomiting. A prospective, double-blind, randomized clinical study was carried out. One hundred fifty-three ASA I-II women undergoing laparoscopic gynecologic operations were randomized into three groups: dexamethasone group (n=51), ketolgan group (n=51), and control group (n=51). Patients in the dexamethasone group were given 4 mg of dexamethasone intravenously before the induction of general anesthesia, the ketolgan group received 30-mg ketolgan intravenously, and control group did not receive any medication. The incidence and severity of postoperative nausea and vomiting were registered 24 hours after the surgery. The incidence of postoperative nausea and vomiting in the dexamethasone group was 13.8%; in the ketolgan group, 37.3%, and in the control group, 58.9% (P=0.026). Patients with a history of migraine suffered from postoperative nausea and vomiting in 70.3% of cases and migraine-free patients in 25.8% of cases (P=0.015). Opioids for postoperative analgesia increased the incidence of postoperative nausea and vomiting as compared with nonsteroidal anti-inflammatory drugs (P=0.00002). Preoperative medication with dexamethasone significantly reduces the incidence of postoperative nausea and vomiting. Avoidance of opioids for postoperative analgesia reduces the incidence of postoperative nausea and vomiting. Migraine and motion sickness are independent risk factors for postoperative nausea and vomiting.

  2. A randomized controlled study of the efficacy of misoprostol and hyaluronic acid in preventing adhesion formation after gynecological surgery: a rat uterine horn model.

    Science.gov (United States)

    Kaya, Cihan; Sever, Nurten; Cengiz, Hüseyin; Yıldız, Şükrü; Ekin, Murat; Yaşar, Levent

    2014-05-01

    To investigate the effect of misoprostol in the reduction of adhesion formation after gynecological surgery. A double blind, randomized controlled experimental study was designed. Twenty-one female Wistar Hannover rats were divided into three groups as control, misoprostol and Hyalobarrier(®) groups. A uterine horn adhesion model was created. After anesthesia induction, 1.5-2cm injuries were made to the each uterine horn by cautery. The control group received no special medications except for the standard surgical procedure. The misoprostol group received 10μcg/kg misoprostol in addition to the standard surgical procedure, and the Hyalobarrier(®) group received 1cm(3) ready-for-use Hyalobarrier(®) gel intraperitoneally in addition to the standard surgical procedure. After 14 days from the first surgical procedure, adhesion scores were evaluated. The extent (p<0.001), severity (p<0.001), degree (p<0.001) and total adhesion score (p<0.001) values of the control group were statistically higher than the values of misoprostol and Hyalobarrier(®) groups. The inflammation score value of misoprostol group was statistically lower than control and Hyalobarrier(®) groups (p<0.001). In this study, we have found a new therapeutic potential of misoprostol that may be useful in preventing pelvic adhesion and reducing inflammation scores. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. The effect of crystalloid versus Low molecular weight colloid solution on post-operative nausea and vomiting after ambulatory gynecological surgery - a prospective randomized trial

    LENUS (Irish Health Repository)

    Hayes, Ivan

    2012-07-31

    AbstractBackgroundIntravenous fluid is recommended in international guidelines to improve patient post-operative symptoms, particularly nausea and vomiting. The optimum fluid regimen has not been established. This prospective, randomized, blinded study was designed to determine if administration of equivolumes of a colloid (hydroxyethyl starch 130\\/0.4) reduced post operative nausea and vomiting in healthy volunteers undergoing ambulatory gynecologic laparoscopy surgery compared to a crystalloid solution (Hartmann’s Solution).Methods120 patients were randomized to receive intravenous colloid (N = 60) or crystalloid (N = 60) intra-operatively. The volume of fluid administered was calculated at 1.5 ml.kg-1 per hour of fasting. Patients were interviewed to assess nausea, vomiting, anti-emetic use, dizziness, sore throat, headache and subjective general well being at 30 minutes and 2, 24 and 48 hours post operatively. Pulmonary function testing was performed on a subgroup.ResultsAt 2 hours the proportion of patients experiencing nausea (38.2 % vs 17.9%, P = 0.03) and the mean nausea score were increased in the colloid compared to crystalloid group respectively (1.49 ± 0.3 vs 0.68 ± 0.2, P = 0.028). The incidence of vomiting and anti-emetic usage was low and did not differ between the groups. Sore throat, dizziness, headache and general well being were not different between the groups. A comparable reduction on post-operative FVC and FEV-1 and PEFR was observed in both groups.ConclusionsIntra-operative administration of colloid increased the incidence of early postoperative nausea and has no advantage over crystalloid for symptom control after gynaecological laparoscopic surgery.

  4. Pre-induction low dose pethidine does not decrease incidence of postoperative shivering in laparoscopic gynecological surgeries

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    Ishwar Bhukal

    2011-01-01

    Results: Core body temperatures were statistically insignificant between groups at pre-induction, post-induction, and in the PACU (P > 0.05. At the end of surgery, shivering was present in 18 patients (30%. In groups I, II, and III, six (30%, three (15%, and nine (45% patients shivered, respectively. The differences in incidence and grading of shivering among groups was found to be statistically insignificant (P > 0.05. The core body temperature of shiverers and non-shiverers were compared. In the PACU at 0, 15, and 30 minutes, the temperature among shiverers was significantly lower than that in the non-shiverers. Rescue drug i.v. pethidine 20 mg was given to patients with shivering grade ≥2. None of the patients had shivering after 10 minutes. Conclusions: Prophylactic pre-induction, low-dose pethidine does not have major role in preventing postoperative shivering.

  5. Comparison of analgesic efficacy of transversus abdominis plane block with direct infiltration of local anesthetic into surgical incision in lower abdominal gynecological surgeries.

    Science.gov (United States)

    Sivapurapu, Vijayalakshmi; Vasudevan, Arumugam; Gupta, Sumanlata; Badhe, Ashok S

    2013-01-01

    Transversus abdominis plane block is a safe, simple and effective technique of providing analgesia for lower abdominal surgeries with easily identifiable landmarks. To compare the analgesic efficacy of transversus abdominis plane block with that of direct infiltration of local anesthetic into surgical incision in lower abdominal procedures. Prospective randomized controlled trial in lower abdominal surgeries done under general anesthesia. 52 ASA I-II patients undergoing lower abdominal gynecological procedures under general anesthesia were divided randomly into two groups each after written informed consent. A bilateral TAP block was performed on Group T with 0.25% bupivacaine 0.6 ml/kg with half the volume on either side intra-operatively after skin closure before extubation using a short bevelled needle, whereas Group I received local infiltration intra-operatively after skin closure with the same amount of drug. The time taken for the first rescue analgesic and visual analog score (VAS) was noted, following which, the patient was administered intravenous morphine 0.1 mg/kg and connected to an intravenous patient controlled analgesia system with morphine for 24 hrs from the time of block administration. 24 h morphine requirement was noted. VAS and sedation scores were noted at 2, 4, 6 and 24 h postoperatively. The results were analyzed with SPSS 16. A P value < 0.05 was considered significant. Duration of analgesia and 24 h morphine requirement was analysed by Student's t-test. VAS scores, with paired comparisons at each time interval, were performed using the t-test or Mann-Whitney U-test, as appropriate. Categorical data were analyzed using Chi square or Fisher's exact test. In Group T, the time to rescue analgesic was significantly more and the VAS scores were lower (P = 0.001 and 0.003 respectively). The 24 hr morphine requirement and VAS at 2, 4, 6 and 24 h were less in the Group T (P = 0.001). Incidence of PONV was significant in Group I (P = 0

  6. Fertility preservation and survival among young women with early ovarian cancer living in US counties with gynecologic oncologist services.

    Science.gov (United States)

    Hillman, R Tyler; Saenz, Cheryl C; McHale, Michael T; Plaxe, Steven C

    2017-05-01

    To examine the association between living in a county with gynecologic oncologist provision, the performance of fertility sparing surgery, and survival among young women with early epithelial ovarian cancer. The present retrospective cohort study was based on the SEER 18 dataset of the US National Cancer Institute. Women younger than 45 years with early stage epithelial ovarian cancer diagnosed between 2000 and 2012 were included. Logistic regression and Cox proportional hazards methods were used to analyze all-cause survival. Adjustment was made for relevant clinical and demographic variables. In total, 1499 women were included. Women living in a county with gynecologic oncologist provision were less likely to undergo hysterectomy (adjusted odds ratio, 0.69; 95% confidence interval, 0.52-0.93) at the time of primary surgery. Women who underwent hysterectomy had a similar risk of mortality as women with uterine preservation (adjusted hazard ratio [HR], 0.73; 95% CI, 0.41-1.30). Living in a county with gynecologic oncologist provision was associated with reduced risk of mortality (adjusted HR, 0.53; 95% CI, 0.31-0.92). Living in a county with gynecologic oncologist provision was independently associated with the use of fertility sparing surgery among young women with early epithelial ovarian cancer. © 2017 International Federation of Gynecology and Obstetrics.

  7. The Different Volume Effects of Small-Bowel Toxicity During Pelvic Irradiation Between Gynecologic Patients With and Without Abdominal Surgery: A Prospective Study With Computed Tomography-Based Dosimetry

    International Nuclear Information System (INIS)

    Huang, E.-Y.; Sung, C.-C.; Ko, S.-F.; Wang, C.-J.; Yang, Kuender D.

    2007-01-01

    Purpose: To evaluate the effect of abdominal surgery on the volume effects of small-bowel toxicity during whole-pelvic irradiation in patients with gynecologic malignancies. Methods and Materials: From May 2003 through November 2006, 80 gynecologic patients without (Group I) or with (Group II) prior abdominal surgery were analyzed. We used a computed tomography (CT) planning system to measure the small-bowel volume and dosimetry. We acquired the range of small-bowel volume in 10% (V10) to 100% (V100) of dose, at 10% intervals. The onset and grade of diarrhea during whole-pelvic irradiation were recorded as small-bowel toxicity up to 39.6 Gy in 22 fractions. Results: The volume effect of Grade 2-3 diarrhea existed from V10 to V100 in Group I patients and from V60 to V100 in Group II patients on univariate analyses. The V40 of Group I and the V100 of Group II achieved most statistical significance. The mean V40 was 281 ± 27 cm 3 and 489 ± 34 cm 3 (p 3 and 132 ± 19 cm 3 (p = 0.003). Multivariate analyses revealed that V40 (p = 0.001) and V100 (p = 0.027) were independent factors for the development of Grade 2-3 diarrhea in Groups I and II, respectively. Conclusions: Gynecologic patients without and with abdominal surgery have different volume effects on small-bowel toxicity during whole-pelvic irradiation. Low-dose volume can be used as a predictive index of Grade 2 or greater diarrhea in patients without abdominal surgery. Full-dose volume is more important than low-dose volume for Grade 2 or greater diarrhea in patients with abdominal surgery

  8. Gynecological cancers.

    Science.gov (United States)

    Avril, Norbert; Gourtsoyianni, Sofia; Reznek, Rodney

    2011-01-01

    The clinical problems raised in patients presenting with all forms of gynecological malignancy are currently addressed using conventional cross-sectional imaging, usually MRI. In general, F-18 FDG PET-CT has not been shown to have a clinical role in any of these cancers at presentation, although studies are under way to use this form of metabolic imaging to predict prognosis and the response to treatment. Although F-18 FDG PET-CT is superior to conventional imaging techniques, it is only moderately sensitive in demonstrating lymph node metastasis preoperatively, and is inadequate for local staging of patients with endometrial cancer. In ovarian cancer, F-18 FDG PET-CT provides an accurate assessment of the extent of disease, particularly in areas difficult to assess for metastases by CT and MRI such as the abdomen and pelvis, mediastinum, and supraclavicular region. F-18 FDG PET-CT is a sensitive method of detecting pelvic and para-aortic lymph nodal disease in cervical cancer, and appears to be superior to MRI and CT despite the limitations in identifying small foci of disease. In the main, as elsewhere in patients with cancer, the value of PET-CT is in identifying and defining the extent of recurrent disease, in distinguishing between posttreatment fibrosis and recurrence, and possibly in monitoring response to therapy.

  9. Emergent gynecological operations: A report of 105 cases

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    Hatice Ender Soydinç

    2010-05-01

    Full Text Available Objectives: To evaluate the clinical characteristics of patients that hospitalized with acute abdominopelvic pain (AAP and underwent emergent gynecological operations in obstetrics and gynecology clinics.Methods: This retrospective study was performed at Dicle University Hospital, Department of Obstetrics and Gynecology, from June 2006 to May 2009. The data were collected from hospital records and patients charts. The age, gravidy, parity, last menstrual period, physical examination findings, initial complaints, operation diagnosis, preoperative and postoperative hematocrit values, the type of the operation that performed and the amount of blood products transfusions were investigated.Results: During the study period, a total of 105 patients were operated due to characteristic clinical sign and symptoms of acute abdomen. The initial complaints were abdominopelvic pain in 62 patients (59.0% and abdomino-pelvic pain with vaginal bleeding in 43 patients (41.0%. Of all cases; 60 (57.1% women had ruptured ectopic pregnancy, 29 (27.6% had corpus hemorrhagic cyst rupture. Only 68 (64.76% of the cases were subjected to laparotomy under emergency conditions, while 37 (35.2% of them were subjected to laparoscopy. Fifty five (52.4% women needed blood products transfusion.Conclusion: The initial evaluation of abdominopelvic pain related to gynecologic causes should include taking a careful history, performing abdominopelvic examination, pregnancy test, laboratory studies and color Doppler ultrasound. Although the patients can be followed conservatively, they may need an emergent surgery for life saving. J Clin Exp Invest 2010; 1(1: 12-15

  10. Musculoskeletal Pain in Gynecologic Surgeons

    Science.gov (United States)

    Adams, Sonia R.; Hacker, Michele R.; McKinney, Jessica L.; Elkadry, Eman A.; Rosenblatt, Peter L.

    2013-01-01

    Objective To describe the prevalence of musculoskeletal pain and symptoms in gynecologic surgeons. Design Prospective cross-sectional survey study (Canadian Task Force classification II-2). Setting Virtual. All study participants were contacted and participated via electronic means. Participants Gynecologic surgeons. Interventions An anonymous, web-based survey was distributed to gynecologic surgeons via electronic newsletters and direct E-mail. Measurements and Main Results There were 495 respondents with complete data. When respondents were queried about their musculoskeletal symptoms in the past 12 months, they reported a high prevalence of lower back (75.6%) and neck (72.9%) pain and a slightly lower prevalence of shoulder (66.6%), upper back (61.6%), and wrist/hand (60.9%) pain. Many respondents believed that performing surgery caused or worsened the pain, ranging from 76.3% to 82.7% in these five anatomic regions. Women are at an approximately twofold risk of pain, with adjusted odds ratios (OR) of 1.88 (95% confidence interval [CI], 1.1–3.2; p 5 .02) in the lower back region, OR 2.6 (95% CI, 1.4–4.8; p 5 .002) in the upper back, and OR 2.9 (95% CI, 1.8–4.6; p 5 .001) in the wrist/hand region. Conclusion Musculoskeletal symptoms are highly prevalent among gynecologic surgeons. Female sex is associated with approximately twofold risk of reported pain in commonly assessed anatomic regions. Journal of Minimally Invasive Gynecology (2013) 20, 656-660 PMID:23796512

  11. [Gender stereotypes in gynecology and obstetrics: obstacles for young male physicians?].

    Science.gov (United States)

    Buddeberg-Fischer, Barbara

    2003-10-01

    Up to the mid 1990s, a 'feminization' of medicine took place that was especially pronounced in the field of gynecology. The present paper looks into the reasons for this change based on the literature and results from a study conducted by the author. In 2001, two thirds of the new qualifications in gynecology/obstetrics were awarded to women. The feminist movement has led to the emancipation of women and the assertion that women should be treated by female doctors only. Parallel to this development, gender roles also underwent a change: nowadays, the ideal woman or man is 'androgynous'. Young physicians are both highly instrumental and highly expressive. The increasing similarities between the sexes exert an influence on lifestyle and biographical planning. An increasing number of young physicians no longer prioritize their profession. Male physicians with high expressiveness are often family oriented and consciously refrain from choosing to specialize in gynecology/obstetrics because of the long hours and heavy workload. On the other hand, quite a few women physicians are more instrumental and prioritize their professional commitment. If more male physicians are not attracted into gynecology/obstetrics over the next few years, a process of 'horizontal segregation' could occur, with women physicians accomplishing the patient-focused work while their male colleagues take over the surgery and scientific part of the specialty. It is the very differences between the sexes, however, and the exchange between them, which allow a medical discipline to thrive.

  12. A modified three-port “hidden scars” surgical approach in gynecology: A surgeon's experience of an initial 72 cases

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    Felix Wu Shun Wong

    2014-05-01

    Conclusion: The HS approach in gynecological surgery is feasible, safe, and reproducible when applied in women with gynecological diseases. The operation time, length of stay, and outcome would be comparable to conventional laparoscopic surgery.

  13. Perioperative Hyperglycemia and Glucose Variability in Gynecologic Laparotomies

    NARCIS (Netherlands)

    Polderman, Jorinde A. W.; Hollmann, Markus W.; DeVries, J. Hans; Preckel, Benedikt; Hermanides, Jeroen

    2015-01-01

    The glycemic response and its relation to postoperative complications following gynecologic laparotomies is unknown, although these surgeries carry a substantial risk for postoperative morbidity. Therefore, our objective was to assess the prevalence of perioperative hyperglycemia and glucose

  14. Consequências da vasectomia: experiência de homens que se submeteram à cirurgia em Campinas (São Paulo, Brasil Consequences of vasectomy: experience of men who underwent the surgery in Campinas (São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Nádia Maria Marchi

    2011-09-01

    qualitative stage, 10 semi-structured interviews were performed with men selected according to purposeful criteria of level of schooling and number of children. Then, a structured form was provided for 202 men, drawn from the complete list of those who had had a vasectomy between 1998 and 2004. A thematic analysis of the content of the semi-structured interviews was carried out. The quantitative data were keyboarded and a descriptive analysis was conducted. RESULTS: It was observed that 97% of the men were satisfied because they had undergone the surgery and only a few of them mentioned undesired effects. Among the few dissatisfied men, only one had had vasectomy reversal because he lived with a new partner and wanted to have children; among the others, dissatisfaction was due to the pain caused by the surgical procedure. The majority of the interviewees attributed to vasectomy changes for the best in their health, body, general relationship with their families and wives, in their sexual life and economic situation. The idea that prevailed was that vasectomy had brought only benefits. The possibility of regret was mentioned by the interviewees as something that would not happen to them. CONCLUSION: The results of this study allowed to verify that men who decide to have a vasectomy tend to see the method as a factor of positive changes, mainly in the sexual life and in the relationship with the partner and family in general.

  15. Optimal cytoreductive surgery in patients with advanced uterine carcinosarcoma: A multi-institutional retrospective study from the Japanese gynecologic oncology group.

    Science.gov (United States)

    Harano, Kenichi; Hirakawa, Akihiro; Yunokawa, Mayu; Nakamura, Toshiaki; Satoh, Toyomi; Nishikawa, Tadaaki; Aoki, Daisuke; Ito, Kimihiko; Ito, Kiyoshi; Nakanishi, Toru; Susumu, Nobuyuki; Takehara, Kazuhiro; Watanabe, Yoh; Watari, Hidemichi; Saito, Toshiaki

    2016-06-01

    The benefits of cytoreductive surgery for uterine carcinosarcoma (UCS) are unknown. The objective of this study was to determine the impact of optimal surgery on advanced UCS patient survival. We performed a multi-institutional, retrospective study of women diagnosed with stage IIIIV UCS between 2007 and 2012. Data were obtained retrospectively from medical records, including demographic, clinicopathologic, treatment, and outcome information. Optimal cytoreductive surgery was defined as surgery resulting in a maximum residual tumor of ≤1cm. The Kaplan-Meier method was used to calculate progression-free survival (PFS) and overall survival (OS), and the Cox regression model was used to examine the impact of selected factors on survival. A total of 225 UCS patients (median age, 63years) were identified, including 136 (60%) with stage III and 89 (40%) with stage IV disease. Among these patients, 170 (76%) received optimal cytoreductive surgery. The median follow-up time was 19months. The median PFS was 11.5months (95% confidence interval [CI], 10.6-13.4) and 8.1months (95% CI, 5.1-9.5) for patients who received optimal and suboptimal cytoreductive surgery, respectively (P1cm was associated with worse OS while pelvic lymph node dissection was associated with improved OS. Optimal cytoreductive surgery and pelvic lymph node dissection are associated with improved OS in advanced UCS patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Enhanced recovery pathways in gynecologic oncology.

    Science.gov (United States)

    Nelson, Gregg; Kalogera, Eleftheria; Dowdy, Sean C

    2014-12-01

    Many commonplace perioperative practices are lacking in scientific evidence and may interfere with the goal of optimizing patient recovery. Individual components of perioperative care have therefore been scrutinized, resulting in the creation of so-called "enhanced recovery" pathways (ERP), with the goal of hastening surgical recovery through attenuation of the stress response. In this review we examine the evidence for ERP in gynecologic oncology using data from our specialty and general surgery. We performed a systematic literature search on ERP in gynecologic oncology in June 2014 using PubMed/MEDLINE, EMBASE, and The Cochrane Library. All study types were included. References were hand reviewed to ensure completeness. The Enhanced Recovery After Surgery (ERAS) Society was contacted to identify any unpublished protocols. Seven investigations were identified that examined the role of ERP in gynecologic oncology. Common interventions included allowing oral intake of fluids up to 2 hours before induction of anesthesia, solids up to 6 hours before anesthesia, carbohydrate supplementation, intra- and postoperative euvolemia, aggressive nausea/vomiting prophylaxis, and oral nutrition and ambulation the day of surgery. In addition, bowel preparations, the NPO after midnight rule, nasogastric tubes, and intravenous opioids were discontinued. While no randomized data are available in gynecologic oncology, significant improvements in patient satisfaction, length of stay (up to 4 days), and cost (up to $7600 in savings per patient) were observed in ERP cohorts compared to historical controls. Morbidity, mortality, and readmission rates were no different between groups. Enhanced recovery is a safe perioperative management strategy for patients undergoing surgery for gynecologic malignancies, reduces length of stay and cost, and is considered standard of care at a growing number of institutions. Our specialty would benefit from a formalized ERP such as ERAS which audits

  17. Utility of PET in gynecological cancer

    International Nuclear Information System (INIS)

    Choi, Chang Woon

    2002-01-01

    Clinical application of positron emission tomography (PET) is rapidly increasing for the detection and staging of cancer at whole-body studies performed with 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG). Although many cancers can be detected by FDG-PET, there has been limited clinical experience with FDG-PET for the detection of gynecological cancers including malignancies in uterus and ovary. FDG-PET can show foci of metastatic disease that may not be apparent at conventional anatomic imaging and can aid in the characterization of indeterminate soft-tissue masses. Most gynecological cancers need to surgical management. FDG-PET can improve the selection of patients for surgical treatment and thereby reduce the morbidity and mortality associated with inappropriate surgery. FDG-PET is also useful for the early detection of recurrence and the monitoring of therapeutic effect. In this review, I discuss the clinical feasibility and imitations of this imaging modality in patients with gynecological cancers

  18. Cytologic and Clinical Evaluation of Human Papillomavirus in Women Underwent Routine Gynecologic Examination

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    Zehra Safi Öz

    2009-08-01

    CONCLUSION: Pap smear examination is a value of detection of cellular changes belonging Human Papillomavirus and if in this examination it is need to, these patients refer to Human Papillomavirus DNA screening it would be more cost effective.

  19. Single-port laparoscopy in gynecologic oncology: seven years of experience at a single institution.

    Science.gov (United States)

    Moulton, Laura; Jernigan, Amelia M; Carr, Caitlin; Freeman, Lindsey; Escobar, Pedro F; Michener, Chad M

    2017-11-01

    Single-port laparoscopy has gained popularity within minimally invasive gynecologic surgery for its feasibility, cosmetic outcomes, and safety. However, within gynecologic oncology, there are limited data regarding short-term adverse outcomes and long-term hernia risk in patients undergoing single-port laparoscopic surgery. The objective of the study was to describe short-term outcomes and hernia rates in patients after single-port laparoscopy in a gynecologic oncology practice. A retrospective, single-institution study was performed for patients who underwent single-port laparoscopy from 2009 to 2015. A univariate analysis was performed with χ 2 tests and Student t tests; Kaplan-Meier and Cox proportional hazards determined time to hernia development. A total of 898 patients underwent 908 surgeries with a median follow-up of 37.2 months. The mean age and body mass index were 55.7 years and 29.6 kg/m 2 , respectively. The majority were white (87.9%) and American Society of Anesthesiologists class II/III (95.5%). The majority of patients underwent surgery for adnexal masses (36.9%) and endometrial hyperplasia/cancer (37.3%). Most women underwent hysterectomy (62.7%) and removal of 1 or both fallopian tubes and/or ovaries (86%). Rate of adverse outcomes within 30 days, including reoperation (0.1%), intraoperative injury (1.4%), intensive care unit admission (0.4%), venous thromboembolism (0.3%), and blood transfusion, were low (0.8%). The rate of urinary tract infection was 2.8%; higher body mass index (P = .02), longer operative time (P = .02), smoking (P = .01), hysterectomy (P = .01), and cystoscopy (P = .02) increased the risk. The rate of incisional cellulitis was 3.5%. Increased estimated blood loss (P = .03) and endometrial cancer (P = .02) were independent predictors of incisional cellulitis. The rate for surgical readmissions was 3.4%; higher estimated blood loss (P = .03), longer operative time (P = .02), chemotherapy alone (P = .03), and

  20. Disparities in Gynecological Malignancies

    Directory of Open Access Journals (Sweden)

    Sudeshna eChatterjee

    2016-02-01

    Full Text Available Objectives: Health disparities and inequalities in access to care among different socioeconomic, ethnic, and racial groups have been well documented in the U.S. healthcare system. In this review, we aimed to provide an overview of barriers to care contributing to health disparities in gynecological oncology management and to describe site-specific disparities in gynecologic care for endometrial, ovarian, and cervical cancer. Methods: We performed a literature review of peer-reviewed academic and governmental publications focusing on disparities in gynecological care in the United States by searching PubMed and Google Scholar electronic databases. Results: There are multiple important underlying issues that may contribute to the disparities in gynecological oncology management in the United States, namely geographic access and hospital based-discrepancies, research-based discrepancies, influence of socioeconomic and health insurance status, and finally the influence of race and biological factors. Despite the reduction in overall cancer-related deaths since the 1990s, the 5-year survival for Black women is significantly lower than for White women for each gynecologic cancer type and each stage of diagnosis. For ovarian and endometrial cancer, black patients are less likely to receive treatment consistent with evidence-based guidelines and have worse survival outcomes even after accounting for stage and comorbidities. For cervical and endometrial cancer, the mortality rate for black women remains twice that of White women. Conclusions: Health care disparities in the incidence and outcome of gynecologic cancers are complex and involve biologic factors as well as racial, socioeconomic and geographic barriers that influence treatment and survival. These barriers must be addressed to provide optimal care to women in the U.S. with gynecologic cancer.

  1. Surgical outcome of extraperitoneal paraaortic lymph node dissections compared with transperitoneal approach in gynecologic cancer patients.

    Science.gov (United States)

    Morales, Sara; Zapardiel, Ignacio; Grabowski, Jacek P; Hernandez, Alicia; Diestro, Maria D; Gonzalez-Benitez, Cristina; De Santiago, Javier

    2013-01-01

    To evaluate the surgical outcome of extraperitoneal paraaortic lymph node dissection compared with the traditional transperitoneal approach. Retrospective review (Canadian Task Force classification III). University hospital. Women with gynecologic malignancies admitted to our hospital between 2007 and 2011 who underwent laparoscopic paraaortic lymphadenectomy. Indication, diagnosis, and outcome according to type of surgery were evaluated. Of 47 patients who underwent laparoscopic paraaortic lymphadenectomy because of gynecologic indications, 28 patients underwent extraperitoneal paraaortic lymph node dissection and 19 underwent the same procedure via the classic transperitoneal technique. The most frequent indication for extraperitoneal lymph node dissection was cervical cancer (71.4%), and for the transperitoneal technique was endometrial cancer (47.4%). The mean (SD) duration of surgery was 211 (38) minutes in the transperitoneal approach group, and 173 (51) minutes in the extraperitoneal lymphadenectomy group (p = .009). No significant differences between groups were found in the number of lymph nodes removed (15 [5.9] nodes in the extraperitoneal group vs 17.4 [8.6] in the transperitoneal group; p = .25). However, a higher rate of positive nodes was observed in the extraperitoneal group than in the transperitoneal group (42.8% vs 36.2%, respectively [p = .001]), and a significantly shorter stay in the intensive care unit in the extraperitoneal group (0.59 [0.5] vs 1.1 [0.5] days, respectively; p = .02). No significant differences in complication rate were found between groups. Extraperitoneal paraaortic lymph node dissection is a minimally invasive procedure that is an excellent and safe approach to the paraaortic area, with a low complication rate, sufficient number of lymph nodes, and short hospital stay. It seems to be a good alternative to the classic transperitoneal approach. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  2. Danish Gynecological Cancer Database

    DEFF Research Database (Denmark)

    Sørensen, Sarah Mejer; Bjørn, Signe Frahm; Jochumsen, Kirsten Marie

    2016-01-01

    AIM OF DATABASE: The Danish Gynecological Cancer Database (DGCD) is a nationwide clinical cancer database and its aim is to monitor the treatment quality of Danish gynecological cancer patients, and to generate data for scientific purposes. DGCD also records detailed data on the diagnostic measures...... for gynecological cancer. STUDY POPULATION: DGCD was initiated January 1, 2005, and includes all patients treated at Danish hospitals for cancer of the ovaries, peritoneum, fallopian tubes, cervix, vulva, vagina, and uterus, including rare histological types. MAIN VARIABLES: DGCD data are organized within separate...... is the registration of oncological treatment data, which is incomplete for a large number of patients. CONCLUSION: The very complete collection of available data from more registries form one of the unique strengths of DGCD compared to many other clinical databases, and provides unique possibilities for validation...

  3. Obstetric and gynecologic imaging

    International Nuclear Information System (INIS)

    Wicks, J.D.

    1987-01-01

    Obstetric and gynecologic imaging has undergone marked changes in the past 10 years, primarily because of the influence of new imaging modalities. The single modality that has most significantly changed the diagnostic approach to obstetric and gynecologic problems is diagnostic ultrasound. The remarkable ability of this technique to display the anatomy of the gravid and nongravid female pelvis without the use of ionizing radiation motivated the development of techniques and instrumentation that have supplanted but not totally replaced many x-ray based examinations. The use of diagnostic ultrasound for the evaluation of obstetric and gynecologic problems is the dominant theme of this chapter. Areas of patient diagnosis and management in which additional imaging techniques, x-rays, or magnetic resonance are used are presented where appropriate

  4. Gynecological cancer alarm symptoms:

    DEFF Research Database (Denmark)

    Balasubramaniam, Kirubakaran; Ravn, Pernille; dePont Christensen, René

    2016-01-01

    INTRODUCTION: To determine the proportion of patients who were referred to specialist care after reporting gynecological cancer alarm symptoms to their general practitioner. To investigate whether contact with specialist care was associated with lifestyle factors or socioeconomic status. MATERIAL...... and odds ratios (ORs) for associations between specialist care contact, lifestyle factors and socioeconomic status. RESULTS: The study included 25 866 non-pregnant women; 2957 reported the onset of at least one gynecological cancer alarm symptom, and 683 of these (23.1%) reported symptoms to their general......: Educational level influence contact with specialist care among patients with gynecological cancer alarm symptoms. Future studies should investigate inequalities in access to the secondary healthcare system. This article is protected by copyright. All rights reserved....

  5. Application of laparoscopy in the combined surgical procedures of gynecological and digestive disorders in obese women: a retrospective cohort study.

    Science.gov (United States)

    Wang, Haibo; Zhou, Ailing; Fan, Min; Li, Ping; Qi, Shengwei; Gao, Licai; Li, Xiujuan; Zhao, Jinrong

    2015-04-01

    Laparoscopy surgery has been widely used for many decades and combined laparoscopic procedures have become favorable choices for concomitant pathologies in the abdomen. However, the type of combination procedures and their safety in obese women have not been well elucidated in obese women. Here we retrospectively reported 147 obese women underwent combined laparoscopic gynecological surgery and cholecystectomy/appendicectomy in our hospital from January 2003 to December 2011. Of the total number of patients (n = 147), various laparoscopic gynecological surgeries were combined with laparoscopic cholecystectomy in 93 patients, and were combined with laparoscopic appendectomy in the rest 54 patients. Patients' ages ranged from 24 to 55 years with an average of 33 years. Our results showed that combined procedures caused various operative time and blood loss, with no difference considering the time to resume oral intake and length of hospital stay. Intraoperative complications occurred in a total of 7 patients (4.8%). None of the patients suffered from major complications after laparoscopic surgery, and minor postoperative complications occurred in 30 patients (20.4%). The follow-up period ranged from 6 to 24 months (average, 18.5 months). None of the patients developed complications during follow-up, except that one patient suffered from colporrhagia. Our results further suggest that the combined abdominal laparoscopic procedures of gynecologic and general surgery are safe and economic choices for obese women, and benefit patients in many ways including lesser pain, shorter hospital stays and earlier recovery. Copyright © 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  6. Diagnostic and interventional radiology in gynecologic neoplasms

    International Nuclear Information System (INIS)

    Thorvinger, B.

    1990-05-01

    The role and clinical value of the modern radiologic methods for evaluation of gynecologic tumors is not finally settled. The aims of our investigation were therefore to compare clinical examination with CT in patients with possible recurrence of cervical carcinoma; to evaluate the usefulness of CT in patients with fistulas following gynecologic tumors or their treatment; to evaluate the ability of transabdominal US and MR imaging in intrauterine staging including myometrial invasion on patients with endometrial carcinoma; to evaluate CT in the capacity of monitoring therapy response, probable recurrence or clinical remission in patients with ovarian carcinoma; and to evaluate the effect of intraarterial occlusion in facilitating surgery and in evaluating the role of the intraarterial infusion in gynecologic tumors otherwise refractory to all therapy given. CT was more accurate (91%) than clinical pelvic examination (78%) in revealing extensive disease after radiation and/ or surgical treatment. CT was also a most valuable tool in demonstrating genital fistulas following gynecologic malignancy or its treatment. Transabdominal US did not improve staging in early endometrila carcinoma while MR had potential for delineating intrauterine tumor growth (accuracy for myometrial invasion 95%). CT was most valuable in the evaluation of therapeutic response of ovarian malignancy. For possible recurrence or in clinical remission, only positive CT was of clinical significance. The potentials of transcatheter intraarterial management in order to facilitate operability are also discussed. (92 refs.)

  7. Quality indicators in ovarian cancer surgery: report from the French Society of Gynecologic Oncology (Societe Francaise d'Oncologie Gynecologique, SFOG).

    Science.gov (United States)

    Querleu, D; Ray-Coquard, I; Classe, J M; Aucouturier, J S; Bonnet, F; Bonnier, P; Darai, E; Devouassoux, M; Gladieff, L; Glehen, O; Haie-Meder, C; Joly, F; Lécuru, F; Lefranc, J P; Lhommé, C; Morice, P; Salengro, A; Stoeckle, E; Taieb, S; Zeng, Z X; Leblanc, E

    2013-11-01

    Based on registries, the European experience has been that definition of qualitative indicators in ovarian cancer surgery in France. This endeavour was undertaken by the French Society of Gynaecologic Oncology (SFOG) in partnership with the French National College of Obstetricians and Gynecologists and all concerned learned societies in a multidisciplinary mindset. The quality indicators for the initial management of patients with ovarian cancer were based on the standards of practice determined from scientific evidence or expert consensus. The indicators were divided into structural indicators, including material (equipment), human (number and qualification of staff), and organizational resources, process indicators, and outcome indicators. The enforcement of a quality assurance programme in any country would undoubtedly promote improvement in the quality of care for ovarian cancer patients and would result in a dramatic positive impact on their survival. Such a policy is not only beneficial to the patient, but is also profitable for the healthcare system.

  8. STATISTICS OF GYNECOLOGICAL MALIGNANCIES

    Directory of Open Access Journals (Sweden)

    Ye. M. Aksel

    2009-01-01

    Full Text Available The paper analyzes data on the state-of-the-art of oncological care given to patients with gynecological cancer, considers differences in morbidity rates between individual population groups and regions, and compares the maximum and minimum cancer morbidity rates among different populations.

  9. STATISTICS OF GYNECOLOGICAL MALIGNANCIES

    OpenAIRE

    Ye. M. Aksel

    2009-01-01

    The paper analyzes data on the state-of-the-art of oncological care given to patients with gynecological cancer, considers differences in morbidity rates between individual population groups and regions, and compares the maximum and minimum cancer morbidity rates among different populations.

  10. Development of a mucoadhesive delivery system for control release of doxepin with application in vaginal pain relief associated with gynecological surgery.

    Science.gov (United States)

    Sanz, Roser; Clares, Beatriz; Mallandrich, Mireia; Suñer-Carbó, Joaquim; Montes, María Jesús; Calpena, Ana C

    2018-01-15

    The main purpose of this study was to develop a semisolid mucoadhesive formulation for the non-invasive vaginal administration of doxepin (DOX) for relief of pain derived from the scarring process after surgery. An orafix ® platform loading DOX was tested for adequate stability, rheology and vaginal mucoadhesion capacity. The formulation exhibited appropriate pH and was microbiologically stable. The rheological studies confirmed its pseudoplastic and thixotropic nature with prevalence of the elastic behavior component over the viscous one. Appropriate syringeability and spreadability results were also confirmed. Different experiments showed adequate mucoadhesion capacity even in the presence of simulated vaginal fluid. Finally, DOX release, permeation and retention in vaginal mucosa studies were also accomplished with promising results. DOX release kinetics followed the modified Higuchi model and the permeation studies did not render such high values as to suggest potential systemic absorption which could lead to undesirable systemic side effects. Therefore, we can hypostatize that the proposed formulation may assist to fill in the therapeutic gap regarding pure pain relief at local level in vagina. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Perfil dos microrganismos isolados no trato urinário após sondagem vesical em cirurgia ginecológica Profile of microorganisms found in urocultures after urinary catheterization in patients undergoing elective gynecological surgery

    Directory of Open Access Journals (Sweden)

    Sônia Cristina Hinrichsen

    2009-03-01

    Full Text Available OBJETIVOS: determinar os microrganismosfreqüentemente encontrados nas uroculturas apóssondagem vesical e o perfil de sensibilidade aos antibióticos em mulheres submetidas a cirurgia ginecológica eletiva. MÉTODOS: estudo de corte transversal em mulheres submetidas a cirurgia ginecológica com sondagem vesical, no Instituto de Medicina Integral Professor Fernando Figueira (IMIP, em Recife, Pernambuco, Brasil, de janeiro a maio de 2007. As uroculturas foram coletadas em dois períodos: até 24h da retirada do cateter e após sete/10 dias. RESULTADOS: amostras de urina foram colhidas em 249 mulheres. Encontrouse 23,6% (n=46 de uroculturas positivas com até 24h da retirada da sonda e 11,1% (n=25 com sete/10 dias após sondagem vesical. Não foi observada diferença significativa em relação aos microrganismos, quando se compararamas duas uroculturas. A Klebsiella spp. foi o principal microrganismo em ambas uroculturas (até 24h=47,8% vs sete/10 dias=44,0%; p=0,76, seguido de Escherichia coli e outros Gram-negativos. Os antibióticos amicacina, cefepima, ciprofloxacina, meropenem e ticarcilina-clavulanato foram os que apresentaram sensibilidade igual ou superior a 75%para os principais microrganismos isolados. CONCLUSÕES: Klebsiella spp. foi o microrganismo mais encontrado nas uroculturas após sondagem vesical em cirurgias ginecológicas e o antibiótico com sensibilidade igual ou maior a 95% com via de administração oral foi a ciprofloxacina.OBJECTIVES: to determine the microorganisms mostfrequently found in urocultures after urinary catheterization and their antibiotic sensitivities in women undergoing elective gynecological surgery. METHODS: the study was carried out at theInstituto de Medicina Integral Professor FernandoFigueira, IMIP, in Recife, Pernambuco, Brazil, between January and May 2007. Urine cultures wereobtained from these patients on two occasions subsequent to the removal of the catheter: within the first 24h and 710 days

  12. Surgical results of pelvic exenteration in the treatment of gynecologic cancer.

    Science.gov (United States)

    Petruzziello, Andrea; Kondo, William; Hatschback, Sergio B; Guerreiro, João A; Filho, Flávio Panegalli; Vendrame, Cristiano; Luz, Murilo; Ribeiro, Reitan

    2014-09-08

    Our aim in the present study was to evaluate surgical outcomes and complications of pelvic exenteration in the treatment of gynecologic malignancy and to compare surgery-related complications associated with different types of exenteration. We performed a retrospective analysis of patients who underwent pelvic exenteration for the treatment of gynecologic cancer between January 2008 and August 2011. Patients were divided into two groups for comparison: total pelvic exenteration (TPE) and nontotal pelvic exenteration (NTE, including anterior pelvic exenteration (APE) posterior pelvic exenteration (PPE)). Outcomes are reported according to the modified Clavien-Dindo Classification of Surgical Complications. Twenty-eight patients were included in the analysis. Eighteen had cervical cancer (64.3%). The prevalence of stage IIIB cervical cancer was 55%. Primary treatment with radiotherapy was performed in 53.3% of patients. Fifty percent of patients underwent TPE, 25% had APE and 25% underwent PPE. Patients who underwent TPE had worse outcomes, with a mean operative time of 367 minutes, use of blood transfusion in 93% of patients, ICU stay of 4.3 days and total hospital stay of 9.4 days. The overall mortality rate was 14.3%, and the surgical site infection rate was 25%. In the TPE group, 78.6% of patients experienced surgical complications. One-fourth of the total patient sample required reoperation, and the leading cause was urinary fistula (57.1%). Urinary leakage occurred in 22.7% of urinary reconstruction patients. Wet colostomy was the most common form of reconstruction with 10% of leakage. Postoperative urinary and infectious complications accounted for 75% of all causes of morbidity and mortality after pelvic exenteration. TPE is a more complex and morbid procedure than NTE.

  13. Robotic radical hysterectomy in the management of gynecologic malignancies.

    Science.gov (United States)

    Pareja, Rene; Ramirez, Pedro T

    2008-01-01

    Robotic surgery is being used with increasing frequency in gynecologic oncology. To date, 44 cases were reported in the literature of radical hysterectomy performed with robotic surgery. When comparing robotic surgery with laparoscopy or laparotomy in performing a radical hysterectomy, the literature shows that robotic surgery offers an advantage over the other 2 surgical approaches with regard to operative time, blood loss, and length of hospitalization. Future studies are needed to further elucidate the equivalence or superiority of robotic surgery to laparoscopy or laparotomy in performing a radical hysterectomy.

  14. [The main aspects of vesical risk in intraperitoneal surgery].

    Science.gov (United States)

    Tode, V; Voinea, F; Marin, O

    2001-01-01

    They are described the main aspects of vezical risk in intraperitoneal surgery: subembilical celiostomy, haernios surgery, rectal surgery, gynecological surgery. It is shown few aspects of our experience in the treatment of haernias, vesicovaginal fistules secondary to total hysterectomy.

  15. Effectiveness of Fibrin Sealant Patch in Reducing Drain Volume after Pelvic Lymph Node Dissection in Women with Gynecologic Malignancy

    Directory of Open Access Journals (Sweden)

    Hwa Cheong Kim

    2017-01-01

    Full Text Available Background. The goal of this study was to evaluate the effectiveness of fibrin sealant in decreasing postoperative lymphatic drainage in women after pelvic lymphadenectomy and/or para-aortic lymphadenectomy during gynecologic cancer surgery. Methods. This study is a retrospective case-control study. Forty-five patients who underwent staging surgery were enrolled. Twenty-seven patients were in the fibrin sealant group (group A and 18 in the control group (group B. The two groups were compared for the total volume of drain, hospital stay, harvested lymph node, and incidence of asymptomatic lymphocele. Lymphocele formation was evaluated by computed tomography (CT on 3 months after surgery. Results. There were no significant differences in patient demographics between group A and B with respect to age, BMI, and harvested lymph nodes. Patients who received fibrin sealants had reduced total volume of drainage from postoperative days 2 to 5 compared to the control group (group A versus group B: 994.819±745.85 ml versus 1847.89±1241.41 ml; P=0.015. However no differences were observed in hospital stay (P=0.282, duration of drain (P=0.207, and incidence of asymptomatic lymphocele at 3 months (P=0.126. Conclusion. The results of this study indicate that the application of fibrin sealants after pelvic and/or para-aortic lymphadenectomy may reduce lymphatic drainage in gynecologic malignancy.

  16. Radiation therapy of gynecological cancer

    International Nuclear Information System (INIS)

    Nori, D.; Hilaris, B.S.

    1987-01-01

    This book consists of three parts: General Principles; Clinical Applications; and Special Topics. Some of the papers are: Introduction to Basic Radiobiology; Staging and Work-up Procedures for Patients with Gynecological Cancers; Radiation Therapy in the Treatment of Cancer of the Cervix; Role of Interstitial Implantation in Gynecological Cancer; Role of Radiocolloids in Gynecological Cancer; Radiosensitizers and Protectors; and Management of Lymphoma Associated with Pregnancy

  17. The debate over robotics in benign gynecology.

    Science.gov (United States)

    Rardin, Charles R

    2014-05-01

    The debate over the role of the da Vinci surgical robotic platform in benign gynecology is raging with increasing fervor and, as product liability issues arise, greater financial stakes. Although the best currently available science suggests that, in the hands of experts, robotics offers little in surgical advantage over laparoscopy, at increased expense, the observed decrease in laparotomy for hysterectomy is almost certainly, at least in part, attributable to the availability of the robot. In this author's opinion, the issue is not whether the robot has any role but rather to define the role in an institutional environment that also supports the safe use of vaginal and laparoscopic approaches in an integrated minimally invasive surgery program. Programs engaging robotic surgery should have a clear and self-determined regulatory process and should resist pressures in place that may preferentially support robotics over other forms of minimally invasive surgery. Copyright © 2014 Mosby, Inc. All rights reserved.

  18. Effect of Intraperitoneal Bupivacaine on Postoperative Pain in the Gynecologic Oncology Patient.

    Science.gov (United States)

    Rivard, Colleen; Vogel, Rachel Isaksson; Teoh, Deanna

    2015-01-01

    To evaluate if the administration of intraperitoneal bupivacaine decreased postoperative pain in patients undergoing minimally invasive gynecologic and gynecologic cancer surgery. Retrospective cohort study (Canadian Task Force classification II-3). University-based gynecologic oncology practice operating at a tertiary medical center. All patients on the gynecologic oncology service undergoing minimally invasive surgery between September 2011 and June 2013. Starting August 2012, intraperitoneal administration of .25% bupivacaine was added to all minimally invasive surgeries. These patients were compared with historical control subjects who had surgery between September 2011 and July 2012 but did not receive intraperitoneal bupivacaine. One-hundred thirty patients were included in the study. The patients who received intraperitoneal bupivacaine had lower median narcotic use on the day of surgery and the first postoperative day compared with those who did not receive intraperitoneal bupivacaine (day 0: 7.0 mg morphine equivalents vs 11.0 mg, p = .007; day 1: .3 mg vs 1.7 mg, p = .0002). The median patient-reported pain scores were lower on the day of surgery in the intraperitoneal bupivacaine group (2.7 vs 3.2, p = .05) CONCLUSIONS: The administration of intraperitoneal bupivacaine was associated with improved postoperative pain control in patients undergoing minimally invasive gynecologic and gynecologic cancer surgery and should be further evaluated in a prospective study. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  19. [Gynecological Care and Prevention of Gynecological Malignancies in BRCA1 and BRCA2 Mutation Carriers].

    Science.gov (United States)

    Zikán, M

    2016-01-01

    This paper summarizes the current knowledge of gynecological care aspects in women with inherited predisposition to breast and ovarian cancer, i.e. BRCA1 and BRCA2 mutation carriers, and proposes guidelines for furher management of these women, addressing follow-up recommendations, prophylactic surgery indications and preimplantation genetic conseling. It evaluates cancer risk and severity of ovarian cancer in particular with regards to its high mortality resulting from aggressive biological behavior of the tumor and late detection rates. BRCA-positive women should be enrolled in prevention programs including carefull surveillance, prophylactic surgery or pre-implantation genetic counseling. Follow-up care consists of gynecological examination, expert oncogynecological ultrasound and tumor marker CA125 examination every six months. However, the most effective strategy for mortality reduction in ovarian cancer is prophylactic surgery--salpingo-oophorectomy (and hysterectomy). The optimal age for surgery is between 35 to 40 years. Prophylactic salpingo-oophorectomy performed in premenopausal women was proved to reduce the risk of ovarian as well as breast cancer. Symptoms of estrogen deficiency after prophylactic surgery can be suppressed by administration of hormone replacement therapy without increasing the risk of breast cancer. Preimplantation genetic diagnosis is an effective way to prevent the trans--mission of hereditary predisposition to the next generation. The management of patients with hereditary suspceptibility to ovarian cancer should be confined to specialized centres.

  20. Bowel injury following gynecological laparoscopic surgery.

    African Journals Online (AJOL)

    ular having midline scar), severe endometriosis, and com- plicated pelvic pathology should ... intra-peritoneal adhesions.13 However, previous splenec- tomy and splenomegaly might be .... Figure 4: Ultrasound appearance of significant intra-peritoneal free air using a linear probe (10-12 MHZ). There is a hyper-echogenic ...

  1. OCT in Gynecology

    Science.gov (United States)

    Kuznetsova, Irina A.; Gladkova, Natalia D.; Gelikonov, Valentin M.; Belinson, Jerome L.; Shakhova, Natalia M.; Feldchtein, Felix I.

    Timely and efficient diagnosis of diseases of the female reproductivesystem is very important from the social viewpoint [1, 2]. Diagnosticefficacy of the existing techniques still needs improvement sincemalignant neoplasms of the female reproductive system organs are stableleaders among causes of death (over 35.9 %) [3]. Each year, 851.9 thousand genital cancer cases are recorded worldwide [1, 2]. However, the diagnostic efficacy of the visual examination with biopsy is limited. Correct interpretation of colposcopic features requires high skills and long-term clinical experience, which makes colposcopy very subjective and limits interobserver agreement [8-10]. OCT is known to visualize in vivo and noninvasively tissue microstructure with spatial resolution approaching the histologic level and therefore can be expected to guide biopsies and to provide real-time tissue structure information when biopsies are contraindicated or impractical. Although thorough clinical studies are required to determine if OCT can be suitable for this purpose in gynecology in general and for cervical cancer in particular, the early results look encouraging. In this chapter, we present a wide spectrum of the OCT studies of different partsof the female reproductive system and demonstrate the potential of the clinical use of this new visualization method in gynecological practice.

  2. Diagnostic Ultrasound in Gynecologic Diagnosis

    OpenAIRE

    Coates, C. F.

    1983-01-01

    Diagnostic ultrasound is helpful in the assessment of many common gynecological conditions from early teens to the late postmenopause. Female pelvic anatomy and pathology are readily imaged through a distended urinary bladder. In gynecologic cancer, examination of peritoneal cavity, kidneys and liver can suggest metastatic spread, which aids tumor staging.

  3. Resultado funcional e índice macular em portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna Functional outcome and macular index in macular hole patients who underwent surgery with internal limiting membrane removal

    Directory of Open Access Journals (Sweden)

    José Ricardo Diniz

    2008-04-01

    Full Text Available OBJETIVOS: Avaliar o resultado funcional e o índice macular dos portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna. MÉTODOS: Quinze olhos de 15 pacientes com buraco macular estágios 2, 3 e 4 foram incluídos no estudo. Todos foram submetidos à cirurgia de buraco macular convencional com remoção da membrana limitante interna corada pelo azul de tripan. Melhor acuidade visual com correção e cortes transversais medidos por tomografia de coerência óptica (OCT foram avaliados no pré- e pós-operatório. O índice macular (razão entre a altura e base do buraco macular foi calculado e correlacionado com o diâmetro mínimo do buraco macular e o ganho de acuidade visual pós-operatória. RESULTADOS: Obteve-se fechamento do buraco macular em todos pacientes operados. Em 86,7%, houve ganho de pelo menos três linhas de visão. O índice macular demonstrou correlação negativa significante com o diâmetro mínimo (r=0,811. Não foi observada correlação significante entre o índice macular e o ganho de acuidade visual pós-operatória (r=0,351. CONCLUSÃO: Os resultados funcionais na cirurgia do buraco macular com remoção da membrana limitante interna foram bons neste grupo de pacientes. O índice macular demonstrou ser compatível com a configuração espacial do buraco macular, porém não foi preditor de resultados visuais.PURPOSE: To evaluate the functional outcome and macular index in patients with macular hole who underwent surgery with internal limiting membrane removal. METHODS: Fifteen eyes of 15 patients with idiopathic macular hole stages 2, 3 or 4 were enrolled in this study. All patients underwent conventional macular hole surgery with trypan blue staining to remove the internal limiting membrane. The best-corrected visual acuity and cross-sectional images of macular hole measured by optical coherence tomography (OCT were evaluated pre- and postoperatively. The macular hole index

  4. Urinary Tract Injury in Gynecologic Laparoscopy for Benign Indication: A Systematic Review.

    Science.gov (United States)

    Wong, Jacqueline M K; Bortoletto, Pietro; Tolentino, Jocelyn; Jung, Michael J; Milad, Magdy P

    2018-01-01

    To perform a comprehensive literature review of the incidence, location, etiology, timing, management, and long-term sequelae of urinary tract injury in gynecologic laparoscopy for benign indication. A systematic review of PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov was conducted. Four hundred thirty-three studies were screened for inclusion with 136 full-text articles reviewed. Ninety studies published between 1975 and 2015 met inclusion criteria, representing 140,444 surgeries. Articles reporting the incidence of urinary tract injury in gynecologic laparoscopy for benign indication were included. Exclusion criteria comprised malignancy, surgery by urogynecologists, research not in English, and insufficient data. A total of 458 lower urinary tract injuries were reported with an incidence of 0.33% (95% CI 0.30-0.36). Bladder injury (0.24%, 95% CI 0.22-0.27) was overall three times more frequent than ureteral injury (0.08%, 95% CI 0.07-0.10). Laparoscopic hysterectomy not otherwise specified (1.8%, 95% CI 1.2-2.6) and laparoscopically assisted vaginal hysterectomy (1.0%, 95% CI 0.9-1.2) had the highest rates of injury. Most ureteral injuries resulted from electrosurgery (33.3%, 95% CI 24.3-45.8), whereas most bladder injuries resulted from lysis of adhesions (23.3%, 95% CI 18.7-29.0). Ureteral injuries were most often recognized postoperatively (60%, 95% CI 47-76) and were repaired by open ureteral anastomosis (47.4%, 95% CI 36.3-61.9). In contrast, bladder injuries were most often recognized intraoperatively (85%, 95% CI 75-95) and were repaired by laparoscopic suturing (34.9%, 95% CI 29.2-41.7). The incidence of lower urinary tract injury in gynecologic laparoscopy for benign indication remains low at 0.33%. Bladder injury was three times more common than ureteral injury, although ureteral injuries were more often unrecognized intraoperatively and underwent open surgical repair. These risk estimates can assist gynecologic surgeons in effectively

  5. Sources of pain in laparoendoscopic gynecological surgeons: An analysis of ergonomic factors and proposal of an aid to improve comfort

    OpenAIRE

    Lee, Sa Ra; Shim, Sunah; Yu, Taeri; Jeong, Kyungah; Chung, Hye Won

    2017-01-01

    Minimally invasive surgery (MIS) offers cosmetic benefits to patients; however, surgeons often experience pain during MIS. We administered an ergonomic questionnaire to 176 Korean laparoscopic gynecological surgeons to determine potential sources of pain during surgery. Logistic regression analysis was used to identify factors that had a significant impact on gynecological surgeons' pain. Operating table height at the beginning of surgery and during the operation were significantly associated...

  6. Surgery

    Science.gov (United States)

    ... and sterile gloves. Before the surgery begins, a time out is held during which the surgical team confirms ... the Consumer Version. DOCTORS: Click here for the Professional Version What Participants Need to Know About Clinical ...

  7. Gynecologic anatomic abnormalities following anorectal malformations repair.

    Science.gov (United States)

    Vilanova-Sanchez, Alejandra; Reck, Carlos A; McCracken, Kate A; Lane, Victoria A; Gasior, Alessandra C; Wood, Richard J; Levitt, Marc A; Hewitt, Geri D

    2018-04-01

    Patients may present with gynecologic concerns after previous posterior sagittal anorectoplasty (PSARP) for repair of an anorectal malformation (ARM). Common findings include an inadequate or shortened perineal body, as well as introital stenosis, retained vaginal septum, and remnant rectovestibular fistula. An inadequate or shortened perineal body may impact fecal continence, sexual function and recommendations regarding obstetrical mode of delivery. We describe our experience with female patients referred to our center for evaluation of their previously repaired ARM, with a specific focus on perineal body anatomy and concomitant gynecologic abnormalities. We outline our collaborative evaluation process and findings as well as subsequent repair and outcomes. A single site retrospective chart review from May 2014 to May 2016 was performed. Female patients with a history of prior ARM repair who required subsequent reoperative surgical repair with perineoplasty were included. The decision for reoperation was made collaboratively after a multidisciplinary evaluation by colorectal surgery, urology, and gynecology which included examination under anesthesia (EUA) with cystoscopy, vaginoscopy, rectal examination, and electrical stimulation of anal sphincters. The type of original malformation, indication for reoperative perineoplasty, findings leading to additional procedures performed at time of perineoplasty, postoperative complications, and the length of follow up were recorded. During the study period 28 patients were referred for evaluation after primary ARM repair elsewhere and 15 patients (60%) met inclusion criteria. Thirteen patients (86.6%) originally had a rectovestibular fistula with prior PSARP and 2 patients (13.4%) originally had a cloacal malformation with prior posterior sagittal anorectovaginourethroplasty. The mean age at the time of the subsequent perineoplasty was 4.6years (0.5-12). Patients had an inadequate perineal body requiring reoperative

  8. Preoperative screening of thromboembolism using plasma D-dimer test and proximal vein compression ultrasonography in Japanese gynecologic patients.

    Science.gov (United States)

    Shigemi, Daisuke; Matsuhashi, Tomohiko; Yamada, Takashi; Kamoi, Seiryu; Takeshita, Toshiyuki

    2017-03-01

    Venous thromboembolism (VTE) is a serious complication of surgery, including gynecologic surgery. The plasma D-dimer test and proximal/distal vein compression ultrasonography are frequently used as an easy, preoperative VTE screening method. However, targeted patients for these two examinations have not been established. We retrospectively reviewed 380 gynecologic surgical patients who underwent preoperative VTE screening including the plasma D-dimer test and proximal/distal vein compression ultrasonography from March 2014 to February 2015. All patients underwent laparotomy or laparoscopy. In patients with a high risk of pulmonary thromboembolism, compression ultrasonography was substituted by or combined with contrast-enhanced computed tomography. With regard to D-dimer level, patients were divided to three groups: D-dimer level ≤0.5 μg/mL (group A), D-dimer level between 0.6 and 0.9 μg/mL (group B), and D-dimer level ≥ 1.0 μg/mL (group C). Twenty-seven cases had preoperatively detected VTE. Three patients in group B with benign disease were diagnosed with VTE before surgery. Among benign patients in group B, there was a significant difference in preoperative VTE occurrence between patients without risk factors (0/68 cases) and those with risk factors (3/54 cases). All 11 patients with benign disease having preoperative VTE had one or more risk factors. Even in benign cases with low preoperative D-dimer levels (0.6-0.9 μg/mL), an imaging test should be added when the patient has one or more VTE risk factors.

  9. Sources of pain in laparoendoscopic gynecological surgeons: An analysis of ergonomic factors and proposal of an aid to improve comfort.

    Science.gov (United States)

    Lee, Sa Ra; Shim, Sunah; Yu, Taeri; Jeong, Kyungah; Chung, Hye Won

    2017-01-01

    Minimally invasive surgery (MIS) offers cosmetic benefits to patients; however, surgeons often experience pain during MIS. We administered an ergonomic questionnaire to 176 Korean laparoscopic gynecological surgeons to determine potential sources of pain during surgery. Logistic regression analysis was used to identify factors that had a significant impact on gynecological surgeons' pain. Operating table height at the beginning of surgery and during the operation were significantly associated with neck and shoulder discomfort (P ergonomic solutions to reduce gynecological laparoscopic surgeons' pain. Based on our results, we propose the use of an ergonomic surgical step stool to reduce physical pain related to performing laparoscopic operations.

  10. Imaging of gynecological disorders in infants and children

    International Nuclear Information System (INIS)

    Mann, Gurdeep S.; Blair, Joanne C.; Garden, Anne S.; Lancaster Univ.

    2012-01-01

    This textbook provides a comprehensive review of gynecological imaging in infancy, childhood, and adolescence. Experts from the disciplines of pediatric radiology, gynecology, surgery, and endocrinology have come together to produce a textbook that, while written primarily from the perspective of the radiologist, will be of interest to all professionals involved in the management of these patients. The normal development of the female reproductive tract is described in detail through embryological development, normal childhood appearances, and puberty. Congenital abnormalities are addressed in chapters reviewing structural abnormalities of the reproductive tract and disorders of sex development. A symptoms-based approach is followed in chapters devoted to the assessment of the patient with gynecological pain and disorders of menstruation. Disorders of the breast and the imaging of patients with gynecological neoplasia are considered in dedicated chapters. The specialty of pediatric gynecology is evolving rapidly, drawing on the skills and expertise of professionals from a wide range of specialties. This textbook should prove valuable to all who are involved in this new field of medicine. (orig.)

  11. Imaging of gynecological disorders in infants and children

    Energy Technology Data Exchange (ETDEWEB)

    Mann, Gurdeep S. [Alder Hey Children' s Hospital, Liverpool (United Kingdom). Dept. of Paediatric Radiology; Blair, Joanne C. [Alder Hey Children' s Hospital, Liverpool (United Kingdom). Dept. of Paediatric Endocrinology; Garden, Anne S. (eds.) [Alder Hey Children' s Hospital, Liverpool (United Kingdom). Dept. of Paediatric Gynaecology; Lancaster Univ. (United Kingdom). Lancaster Medical School

    2012-07-01

    This textbook provides a comprehensive review of gynecological imaging in infancy, childhood, and adolescence. Experts from the disciplines of pediatric radiology, gynecology, surgery, and endocrinology have come together to produce a textbook that, while written primarily from the perspective of the radiologist, will be of interest to all professionals involved in the management of these patients. The normal development of the female reproductive tract is described in detail through embryological development, normal childhood appearances, and puberty. Congenital abnormalities are addressed in chapters reviewing structural abnormalities of the reproductive tract and disorders of sex development. A symptoms-based approach is followed in chapters devoted to the assessment of the patient with gynecological pain and disorders of menstruation. Disorders of the breast and the imaging of patients with gynecological neoplasia are considered in dedicated chapters. The specialty of pediatric gynecology is evolving rapidly, drawing on the skills and expertise of professionals from a wide range of specialties. This textbook should prove valuable to all who are involved in this new field of medicine. (orig.)

  12. Gynecologic electrical impedance tomograph

    Science.gov (United States)

    Korjenevsky, A.; Cherepenin, V.; Trokhanova, O.; Tuykin, T.

    2010-04-01

    Electrical impedance tomography extends to the new and new areas of the medical diagnostics: lungs, breast, prostate, etc. The feedback from the doctors who use our breast EIT diagnostic system has induced us to develop the 3D electrical impedance imaging device for diagnostics of the cervix of the uterus - gynecologic impedance tomograph (GIT). The device uses the same measuring approach as the breast imaging system: 2D flat array of the electrodes arranged on the probe with handle is placed against the body. Each of the 32 electrodes of the array is connected in turn to the current source while the rest electrodes acquire the potentials on the surface. The current flows through the electrode of the array and returns through the remote electrode placed on the patient's limb. The voltages are measured relative to another remote electrode. The 3D backprojection along equipotential surfaces is used to reconstruct conductivity distribution up to approximately 1 cm in depth. Small number of electrodes enables us to implement real time imaging with a few frames per sec. rate. The device is under initial testing and evaluation of the imaging capabilities and suitability of usage.

  13. Surgery

    Science.gov (United States)

    ... surgery has several common causes, including the following: Infections at the operative site Lung problems such as pneumonia or collapsed lung ... the trauma of an operation. The risk of infections at the operative site, DVTs, and UTIs can be decreased by meticulous ...

  14. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2015-09-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  15. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2013-01-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  16. Avaliação da dor em recém-nascidos submetidos à cirurgia cardiáca Evaluación del dolor en recién nacidos sometidos a cirugía cardiaca Pain assessment in neonates who underwent cardiac surgery

    Directory of Open Access Journals (Sweden)

    Mariana Bueno

    2007-12-01

    Full Text Available OBJETIVOS: Identificar o método utilizado para avaliar a dor pós-operatória em cirurgia cardíaca neonatal; verificar a freqüência de avaliação e identificar a prevalência de dor pós-operatória. MÉTODOS: Estudo transversal com coleta de dados retrospectiva. RESULTADOS: A maioria (80,0% dos neonatos foi avaliada quanto a dor, o método mais utilizado foi a escala Neonatal Infant Pain Scale (NIPS (56,7%. A freqüência de avaliações variou entre uma e 13 vezes e a maior parte dos neonatos teve sete ou mais avaliações. A maioria (56,7% apresentou registro de dor e a média de episódios de dor foi 1,8. CONCLUSÃO: Tanto o método quanto a freqüência de avaliação de dor não seguem padronização e a prevalência de ocorrência de dor foi elevada.OBJETIVOS: Identificar el método utilizado para evaluar el dolor post-operatoria en cirugía cardiaca neonatal; verificar la frecuencia de la evaluación e identificar la prevalencia del dolor post-operatorio. MÉTODOS: Estudio transversal con recolección de datos retrospectiva. RESULTADOS: La mayoría (80,0% de neonatos fue evaluado en cuanto al dolor, el método más utilizado fue la escala Neonatal Infant Pain Scale (NIPS (56,7%. La frecuencia de evaluaciones varió entre una y 13 veces y la mayor parte de los neonatos tuvo siete o más evaluaciones. La mayoría (56,7% presentó registro de dolor y el promedio de los episodios fue de 1,8. CONCLUSIÓN: el método respecto a la frecuencia de evaluaciones del dolor no siguen un patrón y la prevalencia de su ocurrencia fue elevada.Objectives: To identify pain assessment methods used in neonates who underwent cardiac surgeries, to verify pain assessment frequency and to verify pain prevalence. METHODS: Cross-sectional study. Retrospective data collection. RESULTS: Pain assessment was performed in most (80.0% of the neonates, between one and thirteen times. Specific pain assessment scale was used in 56.7% neonates. Pain assessment was

  17. Evidence-based practice in the management of lower limb lymphedema after gynecological cancer.

    Science.gov (United States)

    Iwersen, Lisandra Fossari; Sperandio, Fabiana Flores; Toriy, Ariana Machado; Palú, Marina; Medeiros da Luz, Clarissa

    2017-01-01

    Lower limb lymphedema (LLL) is characterized as a physical-functional chronic complication that impacts the quality of life of women who have gone through treatment for gynecological cancer. The present study aims to check the conservative treatments available for lymphedema after gynecological cancer in the context of evidence-based practice. The selection criteria included papers from May 1993 discussing treatment protocols used in LLL after treatment for gynecological cancer. The search was performed until October 2014 in MEDLINE, SciVerse, and PEDro using "rehabilitation," "treatment outcome," "therapeutics," "clinical protocol," "gynecologic surgery," "lower extremity," "lower limb," and "lymphedema" as keywords, focused on women with a previous diagnosis of gynecological cancer who received radiation and/or chemotherapy and/or surgery and/or lymphadenectomy as part of their treatment. From 110 studies found, 3 articles that used the complex decongestive therapy (CDT) as a treatment protocol were selected. There were no randomized clinical trials associated with the conservative treatment of LLL post-treatment of gynecological cancer. The three selected articles are retrospective, and had the same outcome - decreased volume of the affected limb lymphedema. Although LLL is more or as frequent and detrimental as upper limb lymphedema post-cancer treatment, there are only a few studies about this subject. Publications are even scarcer when considering studies with interventional approach. Randomized controlled trials are necessary to support rehabilitation resources on lymphedema post-gynecological cancer treatment.

  18. The Effect of Student Gender on the Obstetrics and Gynecology Clerkship Experience

    Science.gov (United States)

    Odrobina, Michele R.; McIntyre-Seltman, Kathleen

    2010-01-01

    Abstract Objectives To explore the effects of the students' gender on their perception of quality and quantity of teaching, the amount of experiential learning, and their interest in obstetrics and gynecology. Methods Anonymous, self-administered surveys to third-year medical students rotating on the obstetrics and gynecology clerkship. Results Eighty-one of 91 students participated (89% response rate): 33 men, 46 women, 2 declined to reveal their gender. No significant gender differences existed regarding number of interactions with residents and faculty; number of deliveries, surgeries, or examinations performed; perceived quality of teaching; or feeling included as part of the clinical team. Male students were more likely to report performing specific surgical procedures, such as operating the bovie cautery during gynecological surgeries (p = 0.005). More men experienced patients refusing to allow them to participate in the clinical interview (p obstetrics and gynecology, male students were more likely to report that their interest increased at the end of the clerkship. Conclusions Male students were more likely to experience gender bias from patients on the obstetrics and gynecology service. Male students also described feeling socially excluded from female-dominated clinical teams. Obstetrics and gynecology educators need to consider methods of encouraging patients to accept medical student participation regardless of gender. Obstetrics and gynecology faculty and residents need to be sensitive to subtle forms of gender bias and ensure equal inclusion for both male and female medical students. PMID:20088663

  19. Radical surgical resection and high-dose intraoperative radiation therapy (HDR-IORT) in patients with recurrent gynecologic cancers

    International Nuclear Information System (INIS)

    Gemignani, Mary L.; Alektiar, Kaled M.; Leitao, Mario; Mychalczak, Boris; Chi, Dennis; Venkatraman, Ennapadam; Barakat, Richard R.; Curtin, John P.

    2001-01-01

    Objective: To determine the outcome for patients with recurrent gynecologic tumors treated with radical resection and combined high-dose intraoperative radiation therapy (HDR-IORT). Methods and Materials: Between November 1993 and June 1998, 17 patients with recurrent gynecologic malignancies underwent radical surgical resection and high-dose-rate brachytherapy. The mean age of the study group was 49 years (range 28-72 years). The site of the primary tumor was the cervix in 9 (53%) patients, the uterus in 7 (41%) patients, and the vagina in 1 (6%) patient. The treatment for the primary disease was surgery with or without adjuvant radiation in 14 (82%) patients and definitive radiation in 3 (18%) patients. The current surgery consisted of exenterative surgery in 10 (59%) patients and tumor resection in 7 (41%) patients. Complete gross resection was achieved in 13 (76%) patients. The mean HDR-IORT dose was 14 Gy (range 12-15). Additional radiation in the form of permanent Iodine-125 implant was given to 3 of 4 patients with gross residual disease. The median peripheral dose was 140 Gy. Results: With a median follow-up of 20 months (range 3-65 months), the 3-year actuarial local control (LC) rate was 67%. In patients with complete gross resection, the 3-year LC rate was 83%, compared to 25% in patients with gross residual disease, p<0.01. The 3-year distant metastasis disease-free and overall survival rates were 54% and 54%, respectively. The complications were as follows: gastrointestinal obstruction, 4 (24%); wound complications, 4 (24%); abscesses, 3 (18%); peripheral neuropathy, 3 (18%); rectovaginal fistula, 2 (12%); and ureteral obstruction, 2 (12%). Conclusion: Radical surgical resection and combined IORT for patients with recurrent gynecologic tumors seems to provide a reasonable local-control rate in patients who have failed prior surgery and/or definitive radiation. Patient selection is very important, however, as only those patients with complete gross

  20. Enhanced Recovery Pathways in Gynecology and Gynecologic Oncology

    Science.gov (United States)

    Barber, Emma L; Van Le, Linda

    2015-01-01

    Importance Enhanced recovery programs (ERPs) are considered standard of care across a variety of surgical disciplines, but ERPs have not been widely adopted in gynecology. Objective To describe ERP principles and the role of ERPs in gynecology and gynecologic oncology. Evidence Acquisition Comprehensive literature search performed using MEDLINE, the Cochrane Collaboration Database, and PubMed. Results Meta-analyses of a substantial number of randomized-controlled trials have shown that implementation of ERP protocols is associated with decreased length of hospital stay, a decrease in rates of postoperative complication, decreased morbidity, and cost savings while preserving patient satisfaction and quality of life. Conclusions and Relevance High quality evidence exists for improved outcomes among patients in ERPs. ERPs save resources and costs across the health care system. As quality metrics and bundled payments increase in healthcare, ERPs will have increasing prominence. PMID:26676149

  1. Predicting perioperative venous thromboembolism in Japanese gynecological patients.

    Directory of Open Access Journals (Sweden)

    Masae Ikeda

    Full Text Available To develop a convenient screening method that can predict perioperative venous thromboembolism (VTE and identify patients at risk of fatal perioperative pulmonary embolism (PE.Patients hospitalized for gynecological abdominal surgery (n = 183 underwent hematology tests and multidetector computed tomography (MDCT to detect VTE. All statistical analyses were carried out using the SPSS software program (PASWV19.0J.The following risk factors for VTE were identified by univariate analysis: plasmin-alpha2-plasmin inhibitor complex (PIC, thrombin-antithrombin III complex (TAT, and prolonged immobility (all p<0.001; age, neoadjuvant chemotherapy (NAC, malignancy, hypertension, past history of VTE, and hormone therapy (all p<0.01; and hemoglobin, transverse tumor diameter, ovarian disease, and menopause (all p<0.05. Multivariate analysis using these factors revealed that PIC, age, and transverse tumor diameter were significant independent determinants of the risk of VTE. We then calculated the incidence rate of perioperative VTE using PIC and transverse tumor diameter in patient groups stratified by age. In patients aged ≤40 years, PIC ≥1.3 µg/mL and a transverse tumor diameter ≥10 cm identified the high-risk group for VTE with an accuracy of 93.6%. For patients in their 50 s, PIC ≥1.3 µg/mL identified a high risk of VTE with an accuracy of 78.2%. In patients aged ≥60 years, a transverse tumor diameter ≥15 cm (irrespective of PIC or PIC ≥1.3 µg/mL identified the high-risk group with an accuracy of 82.4%.We propose new screening criteria for VTE risk that are based on PIC, transverse tumor diameter, and age. Our findings suggest the usefulness of these criteria for predicting the risk of perioperative VTE and for identifying patients with a high risk of fatal perioperative PE.

  2. Annual report of Women's Health Care Committee, Japan Society of Obstetrics and Gynecology, 2013.

    Science.gov (United States)

    Douchi, Tsutomu; Wakatsuki, Akihiko

    2014-02-01

    The activity of the Women's Health Care Committee for 1 year up to June 2013 includes: (i) guides for the management of health care in middle-aged women; (ii) postoperative women's health care; (iii) survey on the treatment of pelvic organ prolapse; and (iv) survey of postoperative infection in gynecologic surgery. The detailed activity of the four subcommittees is described in the text. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  3. Responses of advanced directives by Jehovah's Witnesses on a gynecologic oncology service.

    Science.gov (United States)

    Nagarsheth, Nimesh P; Gupta, Nikhil; Gupta, Arpeta; Moshier, Erin; Gretz, Herbert; Shander, Aryeh

    2015-01-01

    To review the responses of advance directives signed by Jehovah's Witness patients prior to undergoing surgery at a gynecologic oncology service. A retrospective chart review of gynecologic oncology patients undergoing surgery at a bloodless surgery center from 1998-2007 was conducted. Demographic, pathologic, and clinical data were recorded. The proportion of patients who accepted and refused various blood-derived products was determined and was compared to previously published results from a similar study of labor and delivery unit patients. No gynecologic oncology patients agreed to accept transfusions of whole blood, red cells, white cells, platelets, or plasma under any circumstance, whereas 9.8% of pregnant patients accepted transfusion (P=0.0385). However, 98% of gynecologic oncology patients agreed to accept some blood products, including fractions such as albumin, immunoglobulins, and clotting factors, while only 39% of pregnant patients agreed (Pgynecologic oncology patients (100%) accepted intraoperative hemodilution, compared to 55% of pregnant patients (Pgynecologic oncology service will accept a variety of blood-derived products (minor fractions) and interventions designed to optimize outcomes when undergoing transfusion-free surgery. Patients presenting to a gynecologic oncology service respond differently to advanced directives related to bloodless surgery, as compared to patients from an obstetrical service.

  4. Responses of advanced directives by Jehovah’s Witnesses on a gynecologic oncology service

    Science.gov (United States)

    Nagarsheth, Nimesh P; Gupta, Nikhil; Gupta, Arpeta; Moshier, Erin; Gretz, Herbert; Shander, Aryeh

    2015-01-01

    Objectives To review the responses of advance directives signed by Jehovah’s Witness patients prior to undergoing surgery at a gynecologic oncology service. Study design A retrospective chart review of gynecologic oncology patients undergoing surgery at a bloodless surgery center from 1998–2007 was conducted. Demographic, pathologic, and clinical data were recorded. The proportion of patients who accepted and refused various blood-derived products was determined and was compared to previously published results from a similar study of labor and delivery unit patients. Results No gynecologic oncology patients agreed to accept transfusions of whole blood, red cells, white cells, platelets, or plasma under any circumstance, whereas 9.8% of pregnant patients accepted transfusion (P=0.0385). However, 98% of gynecologic oncology patients agreed to accept some blood products, including fractions such as albumin, immunoglobulins, and clotting factors, while only 39% of pregnant patients agreed (Pgynecologic oncology patients (100%) accepted intraoperative hemodilution, compared to 55% of pregnant patients (Pgynecologic oncology service will accept a variety of blood-derived products (minor fractions) and interventions designed to optimize outcomes when undergoing transfusion-free surgery. Patients presenting to a gynecologic oncology service respond differently to advanced directives related to bloodless surgery, as compared to patients from an obstetrical service. PMID:25565911

  5. The Danish Gynecological Cancer Nursing Database

    DEFF Research Database (Denmark)

    Seibæk, Lene; Jakobsen, Dorthe Hjort; Høgdall, Claus

    2018-01-01

    Database (DGCD) established a nursing database in 2011. The aim of DGCD Nursing is to monitor the quality of preoperative and postoperative care and to generate data for research. MATERIAL AND METHODS: In accordance with the current data protection legislation, real-time data are entered by clinical nurses...... at all national cancer centers. The DGCD Nursing includes data of preoperative and postoperative care, and nurses are independently represented in the steering committee. The aim of the present article is to present the first results from DGCD Nursing and the national care improvements that have followed......, pain score, vital functions, and psychosocial support. CONCLUSIONS: At national level, DGCD offers a comprehensive overview of the total patient pathway within gynecological cancer surgery. The DGCD Nursing has added to the quality and implementation of evidence-based preoperative and postoperative...

  6. Treatment of selected primary gynecologic and pelvic malignancies with 241Americium

    International Nuclear Information System (INIS)

    Chung, Joyce Y.; Peschel, Richard E.; Kacinski, Barry; Nath, Ravinder; Pourang, Rauman; Roberts, Kenneth; Fischer, Diana; Chambers, Joseph; Schwartz, Peter E.; Wilson, Lynn

    1995-01-01

    Purpose: To evaluate the efficacy of encapsulated 241 Am in the treatment of primary gynecological malignancies and in previously irradiated patients with recurrent disease in the pelvis. Materials and Methods: Encapsulated 241 Am primarily emits 60keV photons which are effectively shielded by thin layers of high atomic number materials. Dose distributions in water are similar to those produced by Cs-137 photons but with a half-value layer that is considerably less. Cases of 28 patients (12-primary, 16-recurrent) who have been treated with 241 Am at the Yale University School of Medicine since 1986 were retrospectively reviewed. Data concerning dosimetry, disease site, prior treatment, recurrence, disease-free survival, overall survival, and complications were evaluated. Results: Median follow up for the 12 patients with primary gynecological tumors was 19 months (7mo-51mo). There were 6 vulvar, 3 vaginal, 2 cervical and 1 endometrial carcinomas. Median surface dose of 241 Am was 42.2 Gy (23.3Gy-106.6Gy). As part of their initial therapy 11 received pelvic external beam radiation therapy, 6 underwent surgery and 2 received other forms of intracavitary brachytherapy. Of these 12 patients, 11 achieved a complete response (CR) with the duration of CR ranging from 7 to 51 months. Actuarial disease-free survival at 3 years was 66% (S.E.=.16) and actuarial overall survival at 3 years was 91% (S.E.=.08). Median follow up for the 16 patients with recurrent pelvic malignancies was 72 months (20mo-99mo). There were 9 cases of endometrial, 3 vulvar, 3 colorectal, and 1 cervical carinomas. Fifteen of 16 received some form of surgery and radiotherapy prior to their treatment with 241 Am. Median surface dose of 241 Am was 40.3 (17.6Gy-141.7Gy). Of these 16 patients, 10 achieved a CR with the duration of CR ranging from 3 to 88 months. Actuarial disease-free survival at 5 years was 51% (S.E.=.16) and actuarial overall survival at 5 years was 43% (S.E.=.14). Complications were

  7. CCCT - NCTN Steering Committees - Gynecologic Cancers

    Science.gov (United States)

    The Gynecologic Cancers Steering Committee evaluates and prioritizes concepts for phase 2 and 3 clinical trials in adult gynecologic cancers. The GCSC is also intent on fostering collaboration with international groups and institutions conducting trials.

  8. Pelvic floor disorders in gynecological malignancies. An overlooked problem?

    Directory of Open Access Journals (Sweden)

    Oana M. Bodean

    2018-04-01

    Full Text Available Cervical, endometrial, ovarian, vulvar, and vaginal cancers affect women of a broad age spectrum. Many of these women are still sexually active when their cancer is diagnosed. Treatment options for gynecological malignancies, such as gynecological surgery, radiation, and chemotherapy, are proven risk factors for pelvic floor dysfunction. The prevalence of urinary incontinence, fecal incontinence, and sexual dysfunction before cancer treatment is still unclear. Hypotheses have been raised in the literature that these manifestations could represent early symptoms of pelvic cancers, but most remain overlooked even in cancer surviving patients. The primary focus of therapy is always cancer eradication, but as oncological and surgical treatment options become more successful, the number of cancer survivors increases. The quality of life of patients with gynecological cancers often remains an underrated subject. Pelvic floor disorders are not consistently reported by patients and are frequently overlooked by many clinicians. In this brief review we discuss the importance of pelvic floor dysfunction in patients with gynecological malignant tumors.

  9. Gynecologic cancer treatment: risk factors for therapeutically induced neoplasia

    International Nuclear Information System (INIS)

    Messerschmidt, G.L.; Hoover, R.; Young, R.C.

    1981-01-01

    Therapeutic intervention in a course of illness, while producing the desired result, also may have some adverse long-term effects on the patient. Second malignancies are one of the known complications of therapy. The treatments of gynecologic cancers by surgery, irradiation and chemotherapy have been associated with subsequent neoplasms. Care must be exercised in associating previous therapy and a subsequent malignancy. Naturally occurring second cancers must be separated from those which are iatrogenic. Associations in the literature have been made involving malignancies as a sequelae of prior gynecologic therapy. The use of normal skin from the thigh to fabricate an artificial vagina has resulted in more squamous cell carcinomas than expected. Alkylating agents used in the treatment of ovarian cancer and other diseases have been shown to lead to an increased risk of leukemia. Irradiation therapy, however, has not yet been shown to be related to leukemia in cervical cancer patients. The incidence of lymphoma and uterine, urinary bladder and colon carcinomas has been associated with prior irradiation for gynecologic disease. The literature regarding the therapeutically induced risk factors in gynecologic therapy is reviewed and areas of our knowledge that require more investigation are identified

  10. Your Daughter's First Gynecological Exam

    Science.gov (United States)

    ... starts, your daughter should continue to go for gynecologic visits every year to keep her informed and healthy. Reviewed by: Elana Pearl Ben-Joseph, MD Date reviewed: October 2013 More on this topic for: Parents Teens Sexual Development About Birth Control: What Parents Need to Know When Should My ...

  11. Sexuality, intimacy, and gynecological cancer

    NARCIS (Netherlands)

    Weijmar Schultz, W.C.M.; van de Wiel, H.B.M.

    2003-01-01

    On a psychological level, not all changes in sexual functioning following gynecological cancer treatment automatically lead to sexual problems or dysfunctions. Whether sexual dissatisfaction occurs will also depend on personal factors, social factors, and the context in which these negative changes

  12. Management of gynecologic oncology emergencies

    International Nuclear Information System (INIS)

    Harwood-Nuss, A.L.; Benrubi, G.I.; Nuss, R.C.

    1987-01-01

    Gynecologic malignancies are the third most common cancer among women in the United States. Because of often subtle early findings, the diagnosis may not be made before the widespread dissemination of the disease. The Emergency Department physician will commonly encounter a woman with vaginal bleeding, pelvic pain, or a symptomatic abdominal mass. In this article, we have described the epidemiology, recognized patterns of spread, and associated findings of gynecologic tumors. The proper Emergency Department evaluation and management of these problems is emphasized with guidelines for the timing of referrals and consultation with the gynecologic oncologist. The treatment of gynecologic malignancies is often complicated and responsible for Emergency Department visits. The various modalities are addressed according to the organ systems affected and include sections on postoperative problems, gastrointestinal complaints, urologic complications of therapy, radiation therapy and its complications, with an emphasis on the most serious complications necessitating either careful outpatient management or hospital admission. As cost-containment pressure grows, we have included sections on chemotherapy and total parenteral nutrition, both of which are becoming common outpatient events for the cancer patient. 28 references

  13. Determination of attitudes with gynecologic examination and anxiety of Turkish women before gynecologic examination

    OpenAIRE

    Nülüfer Erbil; Asuman Şenkul; Yeşim Sağlam; Nesrin Ergül

    2008-01-01

    Objective: This study was planned with the purpose determination of attitudes with gynecologic examination and anxiety of Turkish women before gynecologic examination.Material & Methods: The sample of this descriptive and cross-sectional constituted by 240 women, applying for gynecologic examination in Gynecologic Policlinic of Ordu Maternity-Gynecologic and Child Hospital of who accepted to participate in the research. The data were collected with of a questionnarie form and  State ...

  14. Gynecologic cancers in pregnancy

    DEFF Research Database (Denmark)

    Amant, Frédéric; Halaska, Michael J; Fumagalli, Monica

    2014-01-01

    , optimizing maternal treatment while considering fetal safety. To maximize the maternal outcome, cancer treatment should follow a standard treatment protocol as for nonpregnant patients. Iatrogenic prematurity should be avoided. Individualization of treatment and effective psychologic support is imperative...... to provide throughout the pregnancy period. Diagnostic procedures, including staging examinations and imaging, such as magnetic resonance imaging and sonography, are preferable. Pelvic surgery, either open or laparoscopic, as part of a treatment protocol, may reveal beneficial outcomes and is preferably...... prognosis. SUPPLEMENTARY INFORMATION: Supplementary data on teratogenic effects, ionizing examinations, sentinel lymph node biopsy, tumor markers during pregnancy, as well as additional references and tables are available at the extended online version of this consensus article, go to http...

  15. Economics of gynecologic morcellation.

    Science.gov (United States)

    Bortoletto, Pietro; Friedman, Jaclyn; Milad, Magdy P

    2018-02-01

    As the Food and Drug Administration raised concern over the power morcellator in 2014, the field has seen significant change, with patients and physicians questioning which procedure is safest and most cost-effective. The economic impact of these decisions is poorly understood. Multiple new technologies have been developed to allow surgeons to continue to afford patients the many benefits of minimally invasive surgery while minimizing the risks of power morcellation. At the same time, researchers have focused on the true benefits of the power morcellator from a safety and cost perspective, and consistently found that with careful patient selection, by preventing laparotomies, it can be a cost-effective tool. Changes since 2014 have resulted in new techniques and technologies to allow these minimally invasive procedures to continue to be offered in a safe manner. With this rapid change, physicians are altering their practice and patients are attempting to educate themselves to decide what is best for them. This evolution has allowed us to refocus on the cost implications of new developments, allowing stakeholders the opportunity to maximize patient safety and surgical outcomes while minimizing cost.

  16. Will patients benefit from regionalization of gynecologic cancer care?

    Directory of Open Access Journals (Sweden)

    Kathleen F Brookfield

    Full Text Available OBJECTIVE: Patient chances for cure and palliation for a variety of malignancies may be greatly affected by the care provided by a treating hospital. We sought to determine the effect of volume and teaching status on patient outcomes for five gynecologic malignancies: endometrial, cervical, ovarian and vulvar carcinoma and uterine sarcoma. METHODS: The Florida Cancer Data System dataset was queried for all patients undergoing treatment for gynecologic cancers from 1990-2000. RESULTS: Overall, 48,981 patients with gynecologic malignancies were identified. Endometrial tumors were the most common, representing 43.2% of the entire cohort, followed by ovarian cancer (30.9%, cervical cancer (20.8%, vulvar cancer (4.6%, and uterine sarcoma (0.5%. By univariate analysis, although patients treated at high volume centers (HVC were significantly younger, they benefited from an improved short-term (30-day and/or 90-day survival for cervical, ovarian and endometrial cancers. Multivariate analysis (MVA, however, failed to demonstrate significant survival benefit for gynecologic cancer patients treated at teaching facilities (TF or HVC. Significant prognostic factors at presentation by MVA were age over 65 (HR = 2.6, p<0.01, African-American race (HR = 1.36, p<0.01, and advanced stage (regional HR = 2.08, p<0.01; advanced HR = 3.82, p<0.01, respectively. Surgery and use of chemotherapy were each significantly associated with improved survival. CONCLUSION: No difference in patient survival was observed for any gynecologic malignancy based upon treating hospital teaching or volume status. Although instances of improved outcomes may occur, overall further regionalization would not appear to significantly improve patient survival.

  17. Major clinical research advances in gynecologic cancer in 2017.

    Science.gov (United States)

    Suh, Dong Hoon; Kim, Miseon; Lee, Kyung Hun; Eom, Keun Yong; Kjeldsen, Maj Kamille; Mirza, Mansoor Raza; Kim, Jae Weon

    2018-03-01

    In 2017, 10 topics were selected as major clinical research advances in gynecologic oncology. For cervical cancer, efficacy and safety analysis results of a 9-valent human papillomavirus (HPV) vaccine and long-term impact of reduced dose of quadrivalent vaccine were updated. Brief introduction of KEYNOTE trials of pembrolizumab, a monoclonal antibody that blocks the interaction between programmed death (PD)-1 and its ligands, PD-L1 and PD-L2, followed. Tailored surveillance programs for gynecologic cancer related with Lynch syndrome and update on sentinel lymph node mapping were reviewed for uterine corpus cancer. For ovarian cancer, 5 topics were selected including poly(ADP-ribose) polymerases inhibitors and immunotherapy. The other potential practice changers covered in this review were lymphadenectomy in advanced disease, secondary cytoreductive surgery in recurrent disease, weekly dose-dense regimen for first-line chemotherapy, incorporation of bevacizumab maintenance in platinum-sensitive recurrent disease, and effect of platinum-free interval prolongation. Conflicting opinions of academic societies on periodic pelvic examination were introduced in conjunction with relevant literature review. For the field of radiation oncology, results of 2 big trials, The Postoperative Radiation Therapy in Endometrial Carcinoma-3 and Gynecologic Oncology Group-258, for endometrial cancer and recent advance in high-dose-rate brachytherapy for cervical cancer were reported. Topics for breast cancer covered adjuvant capecitabine after preoperative chemotherapy, adjuvant pertuzumab and trastuzumab in early human epidermal growth factor receptor 2-positive disease, olaparib for metastatic cancer in patients with a germline BRCA mutation, 20-year risks of recurrence after stopping endocrine therapy at 5 years, and contemporary hormonal contraception and the risk of breast cancer. Copyright © 2018. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.

  18. Utilization of gynecologic services in women with breast cancer receiving hormonal therapy.

    Science.gov (United States)

    Wright, Jason D; Desai, Vrunda B; Chen, Ling; Burke, William M; Tergas, Ana I; Hou, June Y; Accordino, Melissa; Ananth, Cande V; Neugut, Alfred I; Hershman, Dawn L

    2017-07-01

    The selective estrogen receptor modulator tamoxifen is now widely used for the treatment and prevention of breast cancer. Tamoxifen use has been associated with a variety of gynecologic problems. Despite the frequency with which hormonal therapy is used for the treatment of breast cancer, limited population-level data are available to describe the occurrence of gynecologic conditions and the use of surveillance testing in women receiving tamoxifen and aromatase inhibitors. We performed a population-based analysis among women with breast cancer receiving hormonal therapy with tamoxifen, a drug commonly used in premenopausal and sometimes postmenopausal women, to determine the frequency of gynecologic abnormalities and use of diagnostic and surveillance testing. We compared these findings to women treated with aromatase inhibitors, agents commonly used in postmenopausal women. The MarketScan database was used to identify women diagnosed with breast cancer from 2009 through 2013 who underwent mastectomy or lumpectomy. Women receiving tamoxifen (age gynecologic symptoms and diseases (vaginal bleeding, endometrial polyps, endometrial hyperplasia, and endometrial cancer) and gynecologic procedures and interventions (transvaginal ultrasound, endometrial biopsy, hysteroscopy/dilation and curettage, and hysterectomy). Time-dependent analyses were performed to examine symptoms and testing. A total of 75,170 women, including 15,735 (20.9%) age gynecologic symptom or pathologic diagnosis during the study period was 20.2%, 12.3%, and 3.5%, respectively (P gynecologic procedure or intervention during the study period was 34.2%, 20.9%, and 9.0%, respectively (P gynecologic symptoms, procedures, and pathology are higher for both premenopausal and postmenopausal women with breast cancer on tamoxifen. Increased efforts to curb use of gynecologic interventions in asymptomatic women are needed. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Virtual Laparoscopy Simulation: a Promising Pedagogic Tool in Gynecology.

    Science.gov (United States)

    Paquette, Joalee; Lemyre, Madeleine; Vachon-Marceau, Chantale; Bujold, Emmanuel; Maheux-Lacroix, Sarah

    2017-01-01

    Virtual simulators have played a vital role in preparing surgeons for laparoscopic and robotic procedures in gynecologic surgery. The efficacy of the simulator was evaluated to improve basic (trainee) laparoscopic skills and assess training levels. This prospective, comparative study was conducted in volunteer residents in the obstetrics and gynecology training program of Université Laval. Study participants performed 9 laparoscopic simulator tasks on 2 different occasions. Skills improvement between sessions and differences between junior and senior residents were examined. Thirteen junior and 11 senior residents participated in the study. Junior trainees significantly improved their speed of execution, accuracy, and maintenance of horizontal view. Senior trainees mainly accelerated their rapidity in completing different tasks. They performed better than junior trainees, with economy of movements, and tended toward greater precision, speed of execution, and safe retraction in various tasks. Virtual simulators are useful pedagogic tools that could benefit both junior and senior residents. Integration into the residency curricula should be considered.

  20. Designing a Standardized Laparoscopy Curriculum for Gynecology Residents

    DEFF Research Database (Denmark)

    Shore, Eliane M; Lefebvre, Guylaine G; Husslein, Heinrich

    2015-01-01

    surgery, and asked 39 experts in gynecologic education to rate the items on a Likert scale (1-5) for inclusion in the curriculum. Consensus was predefined as Cronbach α of ≥0.80. We then conducted another Delphi survey with 9 experienced users of laparoscopic virtual reality simulators to delineate...... of the curriculum Delphi, and after 2 rounds (Cronbach α=0.80) in the virtual reality curriculum Delphi. Consensus was reached for cognitive, technical, and nontechnical skills as well as for 6 virtual reality tasks. Median time and economy of movement scores defined benchmarks for all tasks. CONCLUSIONS...... residents using Delphi consensus methodology. METHODS: This study began with Delphi methodology to determine expert consensus on the components of a gynecology laparoscopic skills curriculum. We generated a list of cognitive content, technical skills, and nontechnical skills for training in laparoscopic...

  1. Assessing the prevalence of autoimmune, endocrine, gynecologic, and psychiatric comorbidities in an ethnically diverse cohort of female fibromyalgia patients: does the time from hysterectomy provide a clue?

    Science.gov (United States)

    Brooks, Larry; Hadi, Joseph; Amber, Kyle T; Weiner, Michelle; La Riche, Christopher L; Ference, Tamar

    2015-01-01

    This retrospective chart review investigated differences in the prevalence of medical comorbidity between women with fibromyalgia (FM) (n=219) and a control group women with chronic pain (CP) without FM (n=116). The specific aims were to compare the prevalence of autoimmune, psychiatric, endocrine, gynecologic pathology, the relationship between timing of gynecologic surgery, and pain onset. We additionally sought to compare the number of comorbidities in an ethnically diverse cohort. This was a retrospective chart review of patients seen in FM or CP clinics at an academic medical center in 2009-2010. Logistic regression modeling found that gynecologic, endocrine, and autoimmune diagnoses were independently associated with a diagnosis of FM. Detailed analyses showed that thyroid disease (Pgynecologic surgery (Pgynecologic, or psychiatric pathologies. A relationship was observed between the timing of gynecologic surgery and pain onset in FM, with more surgeries observed in the years just prior to pain onset or in the year after pain onset. A similar pattern was not found in the control group. This study demonstrates that autoimmune, endocrine, and gynecologic pathologies occur more commonly in women with FM than in those with CP, which is consistent with findings in less ethnically diverse samples. Moreover, a relationship was found between timing of pain onset and gynecologic surgery. A larger prospective study of the relationship between gynecologic surgery and pain onset in FM is warranted.

  2. Roentgenodiagnosis in obsterics and gynecology

    International Nuclear Information System (INIS)

    Demidkin, P.N.; Shnirel'man, A.I.

    1980-01-01

    A whole range of problems of roentgenologic diagnosis in gynecology and obstetrics is considered. The basic techniques currently used are described; their characteristic is given, as well as the analysis of the data obtained. The problems of diagnosing the course and versions of normal pregnancy, all types of obstetric pathology, sterility, development defects, functional derangements of genitals, uterine alterations due to abdominohysterotomy, inflammatory processes and endometriosis, are considered. The x-ray characteristic of small pelvis shape and pelvimetry are considered in detail. A special importance is attached to the oncological problems, such as X-ray diagnosis of benign and malignant tumors of the uterus and uterine appendages and their differential diagnosis, methods of diagnosing the proliferation of malignant neoplasms, possibilities of controlling radiation and surgical treatment. The results of analyzing the diagnostic and prognostic importance of X-ray investigations in obstetrics and gynecology, recommendations for applying certain techniques and their combinations, are given [ru

  3. Palliative care in gynecologic oncology.

    Science.gov (United States)

    Karlin, Daniel; Phung, Peter; Pietras, Christopher

    2018-02-01

    Patients with gynecologic malignancies face many difficult issues in the course of their diseases, ranging from physical symptoms to advance care planning in light of a poor prognosis. This review examines the evidence supporting integration of palliative care early in the course of disease and symptom management, and provides a framework for difficult conversations. Palliative care has been demonstrated to improve quality of life and promote survival if integrated early in the course of disease. An evidence-based approach should guide symptom management, such as pain and nausea. Advance care planning and goals of care discussions are enhanced by a framework guiding discussion and the incorporation of empathetic responses. Palliative care is a diverse multidisciplinary field that can provide significant benefit for patients with gynecologic malignancies.

  4. Leg pain and gynecologic malignancy.

    Science.gov (United States)

    Singh, Lilly; Stevens, Erin E

    2013-09-01

    Gynecologic malignancies affect more than 83 000 women in the United States, each year. Because the disease involves the pelvis, many patients have side effects distal to this area in their lower extremities. The differential diagnosis of leg pain can be divided into vascular, neurologic, and musculoskeletal causes. In this review article, we address numerous etiologies of leg pain, reviewing the prevalence of disease, physical examination findings, diagnostic as well as treatment modalities.

  5. A Phase 2 Trial of Radiation Therapy With Concurrent Paclitaxel Chemotherapy After Surgery in Patients With High-Risk Endometrial Cancer: A Korean Gynecologic Oncologic Group Study

    International Nuclear Information System (INIS)

    Cho, Hanbyoul; Nam, Byung-Ho; Kim, Seok Mo; Cho, Chi-Heum; Kim, Byoung Gie; Ryu, Hee-Sug; Kang, Soon Beom; Kim, Jae-Hoon

    2014-01-01

    Purpose: A phase 2 study was completed by the Korean Gynecologic Oncologic Group to evaluate the efficacy and toxicity of concurrent chemoradiation with weekly paclitaxel in patients with high-risk endometrial cancer. Methods and Materials: Pathologic requirements included endometrial endometrioid adenocarcinoma stages III and IV. Radiation therapy consisted of a total dose of 4500 to 5040 cGy in 5 fractions per week for 6 weeks. Paclitaxel 60 mg/m 2 was administered once weekly for 5 weeks during radiation therapy. Results: Fifty-seven patients were enrolled between January 2006 and March 2008. The median follow-up time was 60.0 months (95% confidence interval [CI], 51.0-58.2). All grade 3/4 toxicities were hematologic and usually self-limited. There was no life-threatening toxicity. The cumulative incidence of intrapelvic recurrence sites was 1.9% (1/52), and the cumulative incidence of extrapelvic recurrence sites was 34.6% (18/52). The estimated 5-year disease-free and overall survival rates were 63.5% (95% CI, 50.4-76.5) and 82.7% (95% CI, 72.4-92.9), respectively. Conclusions: Concurrent chemoradiation with weekly paclitaxel is well tolerated and seems to be effective for high-risk endometrioid endometrial cancers. This approach appears reasonable to be tested for efficacy in a prospective, randomized controlled study

  6. A Phase 2 Trial of Radiation Therapy With Concurrent Paclitaxel Chemotherapy After Surgery in Patients With High-Risk Endometrial Cancer: A Korean Gynecologic Oncologic Group Study

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Hanbyoul [Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Institute of Women' s Life Medical Science, Yonsei University College of Medicine, Seoul (Korea, Republic of); Nam, Byung-Ho [Cancer Biostatistics Branch, Research Institute for National Cancer Control and Evaluation, National Cancer Center, Goyang (Korea, Republic of); Kim, Seok Mo [Department of Obstetrics and Gynecology, Chonnam National University School of Medicine, Gwangju (Korea, Republic of); Cho, Chi-Heum [Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu (Korea, Republic of); Kim, Byoung Gie [Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Ryu, Hee-Sug [Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon (Korea, Republic of); Kang, Soon Beom [Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul (Korea, Republic of); Kim, Jae-Hoon, E-mail: jaehoonkim@yuhs.ac [Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Institute of Women' s Life Medical Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-09-01

    Purpose: A phase 2 study was completed by the Korean Gynecologic Oncologic Group to evaluate the efficacy and toxicity of concurrent chemoradiation with weekly paclitaxel in patients with high-risk endometrial cancer. Methods and Materials: Pathologic requirements included endometrial endometrioid adenocarcinoma stages III and IV. Radiation therapy consisted of a total dose of 4500 to 5040 cGy in 5 fractions per week for 6 weeks. Paclitaxel 60 mg/m{sup 2} was administered once weekly for 5 weeks during radiation therapy. Results: Fifty-seven patients were enrolled between January 2006 and March 2008. The median follow-up time was 60.0 months (95% confidence interval [CI], 51.0-58.2). All grade 3/4 toxicities were hematologic and usually self-limited. There was no life-threatening toxicity. The cumulative incidence of intrapelvic recurrence sites was 1.9% (1/52), and the cumulative incidence of extrapelvic recurrence sites was 34.6% (18/52). The estimated 5-year disease-free and overall survival rates were 63.5% (95% CI, 50.4-76.5) and 82.7% (95% CI, 72.4-92.9), respectively. Conclusions: Concurrent chemoradiation with weekly paclitaxel is well tolerated and seems to be effective for high-risk endometrioid endometrial cancers. This approach appears reasonable to be tested for efficacy in a prospective, randomized controlled study.

  7. Perfil de recém-nascidos submetidos à cirurgia cardíaca em hospital privado do Município de São Paulo Perfil de los recién nacidos sometidos a cirugía cardiaca en un Hospital privado del municipio de Sao Paulo Profile of newborns who underwent cardiac surgery in a private hospital in the city of São Paulo

    Directory of Open Access Journals (Sweden)

    Mariana Bueno

    2008-03-01

    planificación y organización del servicio en la implementación de la asistencia a estos pacientes.The aim of this cross-sectional study was to characterize newborns that underwent cardiac surgery in a private hospital, a reference center in neonatal cardiac surgery, in the city of São Paulo. Data were collected from medical reports from July, 2001 to December, 2005. Newborns with gestational age of more than 35 weeks were included in the study. Newborns that died on the first 48 postoperative hours and with other malformations were excluded. Most of the neonates were term, weighted 2,500 grams or more, and underwent surgery in the first week of life. There were 24 different diagnoses identified and 14 different types of surgery performed. In the first post-operative day, all newborns had invasive devices for vital signs monitoring or for treatment and life support, which shows not only the complexity of the treatment but the need for planning and organizing health services in order to provide adequate care for these patients.

  8. Avaliação dos níveis basais de FSH em pacientes inférteis com endometriose profunda de ovário tratadas cirurgicamente Evaluation of basal FSH serum levels in infertile patients with deep ovarian endometriosis who underwent surgery

    Directory of Open Access Journals (Sweden)

    Sandra Frankfurt

    2009-07-01

    Full Text Available OBJETIVO: avaliar a reserva ovariana de pacientes inférteis portadoras de endometriose profunda de ovário, submetidas à cirurgia excisional dos endometriomas, atendidas entre os meses de Fevereiro e Novembro de 2008. MÉTODOS: estudo prospectivo que incluiu 30 pacientes portadoras de endometriose graus III e IV com comprometimento profundo de ovário submetidas à cirurgia excisional dos endometriomas e 30 pacientes portadoras de endometriose graus I e II que foram alocadas como Grupo Controle. A reserva ovariana foi avaliada indiretamente a partir do valor do hormônio folículo estimulante (FSH basal (U/L, entre o terceiro e quinto dias do ciclo, após um período de 12 meses da cirurgia. O índice de massa corpórea (IMC foi calculado conforme a fórmula de Quetelet [peso (kg/estatura (cm²]. Para a comparação das variáveis "idade", "IMC" e "valores de FSH basal" entre os grupos, foi utilizado o teste não paramétrico U de Mann-Whitney. RESULTADOS: não foi encontrada diferença significativa entre os grupos em relação à idade e ao IMC. Em relação ao FSH basal, observou-se que, no grupo das pacientes com endometriose profunda, o valor médio foi de 7,0 U/L, enquanto que, no Grupo Controle, foi de 5,6 U/L (p=0,3, o que demonstra que a diferença no valor médio de FSH encontrado nos dois grupos não foi significativa. CONCLUSÕES: a cirurgia não influenciou de forma deletéria a reserva ovariana das pacientes com endometriose profunda de ovário.PURPOSE: to evaluate the ovarian reserve of infertile patients with severe ovarian endrometriosis, submitted to excisional surgery of endometriomas and attended from February to November, 2008. METHODS: prospective study, including 30 patients with endometriosis grades III and IV, with severe ovarian impairment, submitted to excisional surgery of the endometriomas, and 30 patients with endometriosis grades I and II, allocated as a Control Group. The ovarian reserve was indirectly assessed

  9. How can we predict ureteral obstruction after gynecological surgery? The changes in Doppler resistive index and plasma creatinine and magnesium concentrations after surgical, unilateral ureteral obstruction in a rabbit model.

    Science.gov (United States)

    Terek, M C; Tamsel, S; Aygul, S; Akman, L; Irer, S V; Itil, I M; Alper, G

    2006-01-01

    The aim of this study is to evaluate the changes in Doppler resistive index (RI) and plasma creatinine and magnesium concentrations after unilateral ureteral obstruction in a rabbit model. Fourteen adult female rabbits were used in this study. In seven rabbits, the left ureter was ligated with silk suture, and the control group was sham operated. Before surgery and on the second and seventh days after surgery, blood samples were obtained to measure plasma creatinine and magnesium concentrations. Doppler RIs of both kidneys were also measured before surgery and on the second and seventh days after the surgical procedure. With regard to magnesium levels, there was a significant within-subjects sessions difference [F(2, 20) = 15.21, P= 0.001] indicating a decrease through sessions. Magnesium concentrations decreased significantly at the postoperative second and seventh days compared to preoperative baseline levels (P= 0.003 and P= 0.001, respectively). Multifactorial analysis of variance was applied for each session separately with laterality, and groups as factors. The Doppler RI and the creatinine level did not show any significant differences or interactions for all sessions (P > 0.05). The decreasing plasma magnesium concentration after surgery may indicate ureteral injury; however, Doppler studies and creatinine levels may not be useful as well.

  10. Gynecologic reconstruction with a rectus abdominis myocutaneous flap: an update.

    Science.gov (United States)

    Carlson, J W; Carter, J R; Saltzman, A K; Carson, L F; Fowler, J M; Twiggs, L B

    1996-06-01

    This series reports the outcomes and significant complications associated with the rectus myocutaneous flap when used for pelvic or inguinal reconstruction in patients with gynecologic cancers. Perioperative variables were retrospectively reviewed to identify social and medical risk factors as well as intraoperative and postoperative complications that predisposed to rectus flap failure. Fifteen patients with gynecologic malignancies underwent reconstructive procedures using a vertically oriented rectus abdominis myocutaneous flap for either vaginal (n = 14) or inguinal (n = 1) reconstruction. The patients' primary cancers were cervical (n = 11), rectal (n = 1), ovarian (n = 1), vulvar (n = 1), and vaginal (n = 1). The median age was 50 years. The median follow-up was 17 months. All flaps were mobilized in conjunction with a radical salvage operation. There were no cases of vaginal prolapse and no abdominal wound infections. However, 4 patients (27%) had major postoperative morbidity in this small series. There was one wound dehiscence and three episodes of necrosis of the subcutaneous and cutaneous portions of the flap. All 4 of these patients required additional operative intervention or debridement. Eleven patients had complete healing of the flap. The rectus abdominis myocutaneous flap is a valuable option for gynecologic reconstructive procedures. Perioperative strategies for improving flap viability include the identification of risk factors that may compromise flap perfusions such as prior abdominal incisions, peripheral vascular disease, and obesity. Meticulous surgical technique is required to preserve the vascular pedicle. These strategies may be useful in preoperative counseling, the perioperative evaluation, and the intraoperative management.

  11. Digital rectal fecal occult blood screening during gynecologic examination.

    Science.gov (United States)

    Willis, Farinna L; Fanning, James

    2004-05-01

    The purpose of this study was to test the feasibility of digital rectal fecal occult blood screening during pelvic examination. We reviewed the data for 232 consecutive women who underwent digital rectal fecal occult blood screening during routine pelvic examination and who had had at least 1-year of follow-up visits: 59% of the women were followed for gynecologic cancer, and 41% of the women were followed for benign gynecologic disease. The median age was 62 years. Patients with positive digital rectal fecal occult blood screening were sent for gastroenterologic examination. Sixteen of 232 patients (7%) had a positive digital rectal fecal occult blood screening result. On gastroenterologic examination, 5 of the 16 patients (31%) were found to have disease (2 polyps, 1 diverticular disease, 2 radiation proctitis). At 1-year follow-up, no patient had colon cancer. Until better compliance can be obtained with home stool sample fecal occult blood testing, we recommend a larger study of digital rectal fecal occult blood screening during gynecologic examination to verify our results.

  12. Field-expedient gynecologic examination table.

    Science.gov (United States)

    Hughey, M J; Patel, T G; Herrold, S B

    1997-10-01

    In field operational environments, the gynecologic health needs of women may be difficult to provide because of the lack of a small, lightweight, durable, inexpensive gynecologic examination table. Such a table already exists, in pieces, in the inventory of most field-deploying units of battalion aid station size or larger. Because the table's existence is not commonly known, we describe the assembly and use of this field-expedient gynecologic examination table.

  13. American Society for Laser Medicine and Surgery

    Science.gov (United States)

    ... Back Specialty Laser and Energy-Based Device Use Dentistry Dermatology General Surgery Neurosurgery Obstetrics/Gynecology Oncology Ophthalmology ... About ASLMS Code of Ethics Standards of Practice History Governance Back Governance Board of Directors Committees Membership ...

  14. Palliative Care Education in Gynecologic Oncology: a Survey of Gynecologic Oncologists and Gynecologic Oncology Fellows in Thailand.

    Science.gov (United States)

    Ratanakaaew, A; Khemapech, N; Laurujisawat, P

    2015-01-01

    The main purpose of this study was to survey the education and training of certified gynecologic oncologists and fellows in Thailand. A secondary objective was to study the problems in fellowship training regarding palliative care for gynecologic cancer patients. A descriptive study was conducted by sending a questionnaire regarding palliative care education to all certified gynecologic oncologists and gynecologic oncology fellows in Thailand. The contents of the survey included fellowship training experience, caring for the dying, patient preparation, attitudes and respondent characteristics. Statistics were analyzed by percentage, mean and standard deviation and chi-square. One hundred seventy completed questionnaires were returned; the response rate was 66%. Most certified gynecologic oncologists and fellows in gynecologic oncology have a positive attitude towards palliative care education, and agree that "psychological distress can result in severe physical suffering". It was found that the curriculum of gynecologic oncology fellowship training equally emphasizes three aspects, namely managing post-operative complications, managing a patient at the end of life and managing a patient with gynecologic oncology. As for experiential training during the fellowship of gynecologic oncology, education regarding breaking bad news, discussion about goals of care and procedures for symptoms control were mostly on-the-job training without explicit teaching. In addition, only 42.9% of respondents were explicitly taught the coping skill for managing their own stress when caring for palliative patients during fellowship training. Most of respondents rated their clinical competency for palliative care in the "moderately well prepared" level, and the lowest score of the competency was the issue of spiritual care. Almost all certified gynecologic oncologists and fellows in gynecologic oncology have a positive attitude towards learning and teaching in palliative care. In this

  15. Effects of oxidized regenerated methylcellulose on lymphocyst formation and peritoneum in gynecologic cancer patients.

    Science.gov (United States)

    Ayhan, Ali; Basaran, Ahmet; Güler, Tolga Omer

    2010-01-01

    The role of oxidized regenerated methylcellulose (ORC) in the lymphocyst formation after systematic lymphadenectomy. This was a retrospective case-control study. Patients with gynecologic cancer who underwent systematic lymphadenectomy from May 2000 to April 2006 were considered. Retroperitoneal "no closure" method was performed in all patients. Two groups were identified according to ORC use. The lymphocysts were evaluated via ultrasonography/computed tomography/magnetic resonance imaging between the third and sixth months after surgery. The overall lymphocyst incidence was found to be 75 (29.8%) of 252, and lymphocyst incidence in the ORC and control groups was 45 (30%) of 150 and 30 (29.4%) of 102, respectively. The mean (SD) total number of extracted lymph nodes in the ORC group was 27.5 (10.6), which was significantly higher than that in the control group (22.1 [10.8]; P = 0.001). Duration of drain was significantly longer in the ORC group (P = 0.028). However, when confounding variables were included into the binary logistic regression analysis for the prediction of the duration of drains, only the stage of disease predicted the duration of drains. Use of ORC does not seem to affect lymphocyst formation. Oxidized regenerated methylcellulose use does not affect the duration of drains, hence ORC does not seem to pose a stimulatory effect on the peritoneum.

  16. Low vs Standard Pressures in Gynecologic Laparoscopy: a Systematic Review.

    Science.gov (United States)

    Kyle, Esther B; Maheux-Lacroix, Sarah; Boutin, Amélie; Laberge, Philippe Y; Lemyre, Madeleine

    2016-01-01

    The optimal intraperitoneal pressure during laparoscopy is not known. Recent literature found benefits of using lower pressures, but the safety of doing abdominal surgery with low peritoneal pressures needs to be assessed. This systematic review compares low with standard pneumoperitoneum during gynecologic laparoscopy. We searched Medline, Embase, and the Cochrane Library for randomized controlled trials comparing intraperitoneal pressures during gynecologic laparoscopy. Two authors reviewed references and extracted data from included trials. Risk ratios, mean differences, and standard mean differences were calculated and pooled using RevMan5. Of 2251 studies identified, three were included in the systematic review, for a total of 238 patients. We found a statistically significant but modest diminution in postoperative pain of 0.38 standardized unit based on an original 10-point scale (95% confidence interval [CI], -0.67 to -0.08) during the immediate postoperative period when using low intraperitoneal pressure of 8 mm Hg compared with ≥ 12 mm Hg and of 0.50 (95% CI, -0.80 to -0.21) 24 hours after the surgery. Lower pressures were associated with worse visualization of the surgical field (risk ratio, 10.31; 95% CI, 1.29-82.38). We found no difference between groups over blood loss, duration of surgery, hospital length of stay, or the need for increased pressure. Low intraperitoneal pressures during gynecologic laparoscopy cannot be recommended on the behalf of this review because improvement in pain scores is minimal and visualization of the surgical field is affected. The safety of this intervention as well as cost-effectiveness considerations need to be further studied.

  17. Urological injuries following gynecological operations--our experience in a teaching hospital in Nigeria.

    Science.gov (United States)

    Chianakwana, G U; Okafor, P I S; Ikechebelu, J I; Mbonu, Okechukwu O

    2006-01-01

    Various grades of urological injuries occur following gynecological operations. Some are recognized during or after surgery but others pass unnoticed. To study the urological injuries that follow gynecological operations in our centre. Retrospective study. Nnamdi Azikiwe University Teaching Hospital, Nnewi Nigeria, a third generation tertiary institution serving rural, semi-urban, and urban communities. Searching through the records, all the gynecological operations performed in our centre from 1st July 1998 to 30th June 2003 were reviewed. Those patients in whom there were documented evidences of urological injuries were noted. Similarly, all the urological injuries treated in our institution during the same period but resulting from gynecological operations carried out in peripheral hospitals were also noted. From the relevant medical records, the following data were extracted: type of gynecological operation, nature of urological injury, time when injury was detected, status of the surgeon, management modalities, and outcome. A total of 37 urological injuries occurred but, because of incomplete records in five, only 32 patients were included in this study. Ligation of the ureters following hysterectomy was the most common injury and occurred in 28 (87.5%) of the patients. Ureteric ligation is a common urological injury following gynecological operations in our centre.

  18. Short-term outcomes after incontinent conduit for gynecologic cancer: comparison of ileal, sigmoid, and transverse colon.

    Science.gov (United States)

    Tabbaa, Zaid M; Janco, Jo Marie T; Mariani, Andrea; Dowdy, Sean C; McGree, Michaela E; Weaver, Amy L; Cliby, William A

    2014-06-01

    The aim of this study is to estimate the overall rates of significant incontinent conduit-related complications and compare rates between conduit types. This was a retrospective review of 166 patients who underwent incontinent urinary diversion from April 1993 through April 2013. Patients were categorized by conduit type-ileal, sigmoid colon, and transverse colon. Significant conduit-related complications were assessed at 30 and 90days after surgery. Significant conduit-related complication was defined as any of the following: ureteral stricture, conduit leak, conduit obstruction, conduit ischemia, ureteral anastomotic leak, stent obstruction requiring intervention via interventional radiology procedure or reoperation, and renal failure. A total of 166 patients underwent formation of an incontinent urinary conduit, most commonly during exenteration for gynecologic malignancy. There were 129 ileal, 11 transverse colon, and 26 sigmoid conduits. The overall significant conduit-related complication rate within 30days was 15.1%. Complication rates for ileal, transverse and sigmoid conduits were 14.7%, 0%, and 23.1%, respectively (Fisher's exact test, p=0.24). By 90days, the Kaplan-Meier estimated rates of significant complications were 21.8% overall, and 22.3%, 0%, and 28.9%, respectively, by conduit type (log-rank test, p=0.19). The most common significant conduit-related complications were conduit or ureteral anastomotic leaks and conduit obstructions. By 1 and 2years following surgery, the Kaplan-Meier estimated overall rate of significant conduit-related complication increased to 26.5% and 30.1%, respectively. Our study suggests that there are multiple appropriate tissue sites for use in incontinent conduit formation, and surgical approach should be individualized. Most significant conduit-related complications occur within 90days after surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Alternatives to commonly used pelvic reconstruction procedures in gynecologic oncology.

    Science.gov (United States)

    Chao, Albert H; McCann, Georgia A; Fowler, Jeffrey M

    2014-07-01

    The objective of this review is to discuss alternatives to commonly used methods of soft tissue reconstruction in patients with gynecologic malignancies, and in particular alternatives to skin grafts, local skin flaps, and rectus abdominis/gracilis flaps. A review of the literature was performed on soft tissue reconstruction in patients with gynecologic malignancies. Soft tissue reconstruction is often necessary to achieve successful wound healing, minimize complications, and to restore anatomic form and function. Commonly used methods such as skin grafts, local skin flaps, and rectus abdominis/gracilis flaps are effective, but many scenarios exist where they may be suboptimal or unavailable for use. Situations faced by the gynecologic oncologist where this may be the case include patients in whom prior treatments and/or tumor involvement have affected the vascular supply and tissues of commonly used options, those with disease recurrence who have previously undergone tumor extirpation and reconstruction, and patients undergoing radical surgery where commonly used options alone are inadequate. Under these circumstances, there are several alternative options, and an understanding of the full spectrum of reconstructive techniques is essential. Many clinical scenarios exist where commonly used options for soft tissue reconstruction are suboptimal or unavailable. Current evidence supports use of alternative methods of reconstruction in these situations. However, further larger scale and comparative studies are needed to refine surgical decision-making. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Major clinical research advances in gynecologic cancer in 2014.

    Science.gov (United States)

    Suh, Dong Hoon; Lee, Kyung Hun; Kim, Kidong; Kang, Sokbom; Kim, Jae Weon

    2015-04-01

    In 2014, 9 topics were selected as major advances in clinical research for gynecologic oncology: 2 each in cervical and corpus cancer, 4 in ovarian cancer, and 1 in breast cancer. For cervical cancer, several therapeutic agents showed viable antitumor clinical response in recurrent and metastatic disease: bevacizumab, cediranib, and immunotherapies including human papillomavirus (HPV)-tumor infiltrating lymphocytes and Z-100. The HPV test received FDA approval as the primary screening tool of cervical cancer in women aged 25 and older, based on the results of the ATHENA trial, which suggested that the HPV test was a more sensitive and efficient strategy for cervical cancer screening than methods based solely on cytology. For corpus cancers, results of a phase III Gynecologic Oncology Group (GOG) 249 study of early-stage endometrial cancer with high-intermediate risk factors are followed by the controversial topic of uterine power morcellation in minimally invasive gynecologic surgery. Promising results of phase II studies regarding the effectiveness of olaparib in various ovarian cancer settings are summarized. After a brief review of results from a phase III study on pazopanib maintenance therapy in advanced ovarian cancer, 2 outstanding 2014 ASCO presentations cover the topic of using molecular subtypes in predicting response to bevacizumab. A review of the use of opportunistic bilateral salpingectomy as an ovarian cancer preventive strategy in the general population is presented. Two remarkable studies that discussed the effectiveness of adjuvant ovarian suppression in premenopausal early breast cancer have been selected as the last topics covered in this review.

  1. Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

    Directory of Open Access Journals (Sweden)

    Esdras Marques Lins

    2013-12-01

    Full Text Available BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours. RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6% of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

  2. Role of interstitial implantation in gynecological cancer

    International Nuclear Information System (INIS)

    Nori, D.; Hilaris, B.S.

    1987-01-01

    Recurrent cancer at any site carries a gloomy prognosis. Cancer of the cervix that recurs after radical surgery or curative radiation therapy is a perplexing problem confronting both gynecological and radiation oncologists. In the authors' series, 45% of the patients survived disease-free at 1 year and 10% survived without disease at 5 years or longer following interstitial implantation for recurrent cervical cancer. The optimal utilization of this procedure seems to depend on the site of recurrence, the extent of the disease in the pelvis, and the status of para-aortic node involvement. This retrospective analysis enabled the authors to identify the prognostic factors. The most favorable group benefited by this technique were those who presented with either central recurrence or unilateral, localized pelvic side wall recurrent disease. The least morbidity was noticed in those patients with minimal surgical manipulations at the time of the interstitial implantation. The authors recommended that only a limited and essential surgical procedure should accompany interstitial implantation, since the associated morbidity and mortality is high and survival brief

  3. Challenges associated with the management of gynecological cancers in a tertiary hospital in South East Nigeria

    Directory of Open Access Journals (Sweden)

    Iyoke CA

    2014-01-01

    Full Text Available Chukwuemeka Anthony Iyoke,1 George Onyemaechi Ugwu,1 Euzebus Chinonye Ezugwu,1 Frank Okechukwu Ezugwu,2 Osaheni Lucky Lawani,3 Azubuike Kanayo Onyebuchi3 1Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, 2Department of Obstetrics and Gynaecology, Enugu State University Teaching Hospital, Park Lane, Enugu, 3Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria Background: There are reports of increasing incidence of gynecological cancers in developing countries and this trend increases the need for more attention to gynecological cancer care in these countries. Objective: The purpose of this study was to describe the presentation and treatment of gynecological cancers and identify barriers to successful gynecological cancer treatment in a tertiary hospital in South East Nigeria. Methods: This study was a retrospective longitudinal analysis of the presentation and treatment of histologically diagnosed primary gynecological cancers from 2000 to 2010. Analysis was by descriptive and inferential statistics at the 95% level of confidence using Statistical Package for the Social Sciences version 17 software. Results: Records of 200 gynecological cancers managed during the study period were analyzed. Over 94% of cervical cancers presented in advanced stages of the disease and received palliative/symptomatic treatment. Only 1.9% of cervical cancer patients had radical surgical intervention, and postoperative mortality from these radical surgeries was 100%. Approximately 76% of patients with ovarian cancer had debulking surgery as the mainstay of treatment followed by adjuvant chemotherapy. Postoperative mortality from ovarian cancer surgery was 63%. Cutting edge cytotoxic drugs were not used as chemotherapy for ovarian and chorionic cancers. Compliance with chemotherapy was poor, with over 70% of ovarian cancer patients failing to complete the

  4. Small cell carcinoma of the gynecologic tract: a multifaceted spectrum of lesions.

    Science.gov (United States)

    Atienza-Amores, Maria; Guerini-Rocco, Elena; Soslow, Robert A; Park, Kay J; Weigelt, Britta

    2014-08-01

    Small cell carcinoma (SmCC) of the female genital tract constitutes a diagnostic and clinical challenge given its rarity and the lack of standardized therapeutic approaches. Here we review the morphological, clinical and molecular features of gynecologic SmCCs and discuss potential areas for future research. Data for this review article were identified by searches of PubMed, EMBASE and the Internet using the search terms "small cell carcinoma" or "neuroendocrine carcinoma" and "gynecologic", "uterine cervix", "cervix", "uterus", "endometrium", "ovary", "vagina", "fallopian tube" or "vulva", and research articles published in English between 1972 and February 2014 were included. SmCCs arising from different organs within the gynecologic tract share the same histopathologic characteristics, which closely resemble those of small cell lung carcinoma. The expression of at least one immunohistochemical neuroendocrine marker is a common finding. The uterine cervix is the most frequent site of SmCC in the female genital tract. HPV infection seems to play a role in the development of cervical SmCC but not in cancers of other gynecologic sites. FIGO stage is an established prognostic factor, in particular in SCCs of the cervix. Irrespective of the site, SmCCs of the gynecologic tract display an aggressive clinical behavior with few reported long-term survivors. The therapeutic management includes surgery, radiotherapy and chemotherapy. Despite the potential differences in etiology and risk factors, SmCCs from different sites of the gynecologic tract have similar morphologic appearances and clinical behavior. Recent genomic analyses of small cell carcinoma of the lung have revealed potential driver genomic alterations. We posit that the comprehensive genomic characterization of gynecologic SmCCs may lead to the identification of markers that result in an improvement of diagnostic reproducibility of SmCCs of the gynecologic tract, and of molecular aberrations that may be

  5. Parallel side-docking technique for gynecologic procedures utilizing the da Vinci robot.

    Science.gov (United States)

    Silverman, Suzanne; Orbuch, Laurence; Orbuch, Iris

    2012-09-01

    Minimally invasive approaches to gynecologic surgery have quickly gained favor. The da Vinci surgical system robot as an option for minimally invasive surgery offers many advantages. As the placement of the system between the legs can be prohibitive, we propose a modification of the standard docking procedure by aligning the system parallel to the operating room table. Our experience is that parallel side-docking allows access to the perineum without compromising docking time and range of motion.

  6. Gynecology

    International Nuclear Information System (INIS)

    Bouchbika, Z.; Benmensour, M.; Bourhaleb, Z.; Benchakroun, N.; Jouhadi, H.; Tawfiq, N.; Sahraoui, S.; Acharki, A.; Benider, A.; Boughrara, W.; Boudraa, B.; Bali, M.S.; Djemaa, A.; Metayer, Y.M.; Peiffert, D.P.; Chemin, A.C.; Malet, C.M.; Meyer, P.M.; Lisbona, A.L.; Charra-Brunaud, C.; Ahmad, F.; Metayer, Y.; Haie, C.; Thomas, L.; Barillot, I.; Castelain, B.; Delannes, M.; Chilles, A.; Tournier Rangeard, L.; Buchheit, I.

    2005-01-01

    Fractionated radiotherapy and chemotherapy in the cancer of the uterine cervix carcinomas, brachytherapy with pulse rate, three dimensional calculations to determine volume to irradiate and then to optimize the dosimetry are the different points tackled in this part devoted to the cervix uterine cancer. (N.C.)

  7. Prevention of diseases in Gynecology

    Directory of Open Access Journals (Sweden)

    Sebija Izetbegovic

    2013-01-01

    Results: There are five primary functions of management as: Anticipate and plan, organize, command, coordinate and control. If we introduce the following definition in the sense of medical science and apply it to the medical practice that would mean way of recognizing, managing and resolving issues of diagnosis and therapy of diseases (in this case gynecology diseases according to certain guidelines and treatment algorithms. Treatment of family doctors is an important aspect in the quality-of-life of women and their reproductive health as well as a significant issue in public, environmental and social problems. Conclusions: It is very important to deal with it on the primary care level and in addition to promote the primary and secondary prevention of diseases, which is sometimes more important than the curative procedures. The primary prevention involves regular gynecological examinations and screening. The doctors have also a duty to educate women about the risk factors for malignant diseases, as well as proposing some of the qualitative preventive measures.

  8. A multidisciplinary evidence-based guideline for minimally invasive surgery.: Part 1: entry techniques and the pneumoperitoneum

    NARCIS (Netherlands)

    la Chapelle, Claire F.; Bemelman, Willem A.; Rademaker, Bart M. P.; van Barneveld, Teus A.; Jansen, Frank Willem

    2012-01-01

    The Dutch Society for Endoscopic Surgery together with the Dutch Society of Obstetrics and Gynecology initiated a multidisciplinary working group to develop a guideline on minimally invasive surgery to formulate multidisciplinary agreements for minimally invasive surgery aiming towards better

  9. Definitions of Obstetric and Gynecologic Hospitalists.

    Science.gov (United States)

    McCue, Brigid; Fagnant, Robert; Townsend, Arthur; Morgan, Meredith; Gandhi-List, Shefali; Colegrove, Tanner; Stosur, Harriet; Olson, Rob; Meyer, Karenmarie; Lin, Andrew; Tessmer-Tuck, Jennifer

    2016-02-01

    The obstetric hospitalist and the obstetric and gynecologic hospitalist evolved in response to diverse forces in medicine, including the need for leadership on labor and delivery units, an increasing emphasis on quality and safety in obstetrics and gynecology, the changing demographics of the obstetric and gynecologic workforce, and rising liability costs. Current (although limited) research suggests that obstetric and obstetric and gynecologic hospitalists may improve the quality and safety of obstetric care, including lower cesarean delivery rates and higher vaginal birth after cesarean delivery rates as well as lower liability costs and fewer liability events. This research is currently hampered by the use of varied terminology. The leadership of the Society of Obstetric and Gynecologic Hospitalists proposes standardized definitions of an obstetric hospitalist, an obstetric and gynecologic hospitalist, and obstetric and gynecologic hospital medicine practices to standardize communication and facilitate program implementation and research. Clinical investigations regarding obstetric and gynecologic practices (including hospitalist practices) should define inpatient coverage arrangements using these standardized definitions to allow for fair conclusions and comparisons between practices.

  10. Microparticles and Exosomes in Gynecologic Neoplasias

    NARCIS (Netherlands)

    Nieuwland, Rienk; van der Post, Joris A. M.; Lok Gemma, Christianne A. R.; Kenter, G.; Sturk, Augueste

    2010-01-01

    This review presents an overview of the functions of microparticles and exosomes in gynecologic neoplasias. Growing evidence suggests that vesicles released from cancer cells in gynecologic malignancies contribute to the hypercoagulable state of these patients and contribute to tumor progression by

  11. Fertility preservation for patients with gynecologic malignancies: The Korean Society for Fertility Preservation clinical guidelines.

    Science.gov (United States)

    Lee, Sanghoon; Kim, Seul Ki; Hwang, Kyung Joo; Kim, Tak; Kim, Seok Hyun

    2017-12-01

    Fertility preservation plays a central role in cancer care since an increasingly large number of cancer patients are surviving as a result of improvements in diagnostic and therapeutic strategies. Physicians who take part in the initial diagnosis and management of gynecologic cancer should understand the importance of fertility preservation. Since indications for fertility preservation are limited to early-stage gynecologic cancer, a surgeon must carefully consider each indication. Before performing fertility-sparing surgery, health professionals should compare its oncologic and pregnancy outcomes with those of other standard treatments. Individualized treatment strategies should be delivered depending on the patient's situation, and physicians should provide timely information and appropriate counseling.

  12. Conscious sedation for the performance of gynecologic examination of individuals with intellectual disability.

    Science.gov (United States)

    Jaffe, Joshua S

    2005-05-01

    Gynecologic examination of some individuals with intellectual disability can be especially problematic. Many of these women reside in a community setting and a widely applicable method for performing these examinations is desirable. Intellectually disabled women were referred by their primary care providers for gynecologic examinations under sedation in the emergency room facility of a community hospital. Intravenous conscious sedation was administered under the direction of an emergency room physician. Thirteen adult women underwent 22 examinations over a four-year period. Papanicolau smears, screening for sexually transmitted disease and cervical and endometrial biopsies were obtained without complications. Hospital charges were relatively low and lengths of stay were short. In selected individuals with intellectual disability, intravenous conscious sedation in a community hospital emergency room setting provides a safe, effective and relatively inexpensive means for performing gynecologic examinations.

  13. A case that underwent bilateral video-assisted thoracoscopic ...

    African Journals Online (AJOL)

    No Abstract Available A case that underwent bilateral video-assisted thoracoscopic surgical (VATS) biopsy combined with pneumonectomy is presented. The patient developed hypoxia during the contralateral VATS biopsy. His hypoxia was treated with positive expiratory pressure (PEEP) to the dependent lung and apneic ...

  14. Obstetrics and Gynecology Hospitalist Fellowships.

    Science.gov (United States)

    Vintzileos, Anthony M

    2015-09-01

    This article establishes the rationale and development of an obstetrics and gynecology (OB/GYN) hospitalist fellowship program. The pool of OB/GYN hospitalists needs to be drastically expanded to accommodate the country's needs. Fellowship programs should provide extra training and confidence for recent resident graduates who want to pursue a hospitalist career. Fellowships should train physicians in a way that aligns their interests with those of the hospital with respect to patient care, teaching, and research. Research in the core measures should be a necessary component of the fellowship so as to provide long-term benefits for all stakeholders, including hospitals and patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. [HYPNOSIS IN OBSTETRICS AND GYNECOLOGY].

    Science.gov (United States)

    Rabinerson, David; Yeoshua, Effi; Gabbay-Ben-Ziv, Rinat

    2015-05-01

    Hypnosis is an ancient method of treatment, in which an enhanced state of mind and elevated susceptibility for suggestion of the patient, are increased. Hypnosis is executed, either by a caregiver or by the person himself (after brief training). The use of hypnosis in alleviating labor pain has been studied as of the second half of the 20th century. In early studies, the use of hypnosis for this purpose has been proven quite effective. However, later studies, performed in randomized controlled trial terms, have shown controversial results. Other studies, in which the effect of hypnosis was tested in various aspects of both obstetrics and gynecology and with different levels of success, are elaborated on in this review.

  16. Gynecologic management of neuropathic pain.

    Science.gov (United States)

    Tu, Frank F; Hellman, Kevin M; Backonja, Miroslav M

    2011-11-01

    Obstetrician/gynecologists often are the initial management clinicians for pelvic neuropathic pain. Although treatment may require comprehensive team management and consultation with other specialists, there are a few critical and basic steps that can be performed during an office visit that offer the opportunity to improve quality of life significantly in this patient population. A key first step is a thorough clinical examination to map the pain site physically and to identify potentially involved nerves. Only limited evidence exists about how best to manage neuropathic pain; generally, a combination of surgical, manipulative, or pharmacologic methods should be considered. Experimental methods to characterize more precisely the nature of the nerve dysfunction exist to diagnose and treat neuropathic pain; however, additional scientific evidence is needed to recommend these options unanimously. In the meantime, an approach that was adopted from guidelines of the International Association for the Study of Pain has been tailored for gynecologic pain. Copyright © 2011 Mosby, Inc. All rights reserved.

  17. Replicating viruses for gynecologic cancer therapy.

    Science.gov (United States)

    Park, J W; Kim, M

    2016-01-01

    Despite advanced therapeutic treatments, gynecologic malignancies such as cervical and ovarian cancers are still the top ten leading cause of cancer death among women in South Korea. Thus a novel and innovative approach is urgently needed. Naturally occurring viruses are live, replication-proficient viruses that specifically infect human cancer cells while sparing normal cell counterparts. Since the serendipitous discovery of the naturally oncotropic virus targeting gynecologic cancer in 1920s, various replicating viruses have shown various degrees of safety and efficacy in preclinical or clinical applications for gynecologic cancer therapy. Cellular oncogenes and tumor suppressor genes, which are frequently dysregulated in gynecologic malignancies, play an important role in determining viral oncotropism. Published articles describing replicating, oncolytic viruses for gynecologic cancers are thoroughly reviewed. This review outlines the discovery of replication-proficient virus strains for targeting gynecologic malignancies, recent progresses elucidating molecular connections between oncogene/tumor suppressor gene abnormalities and viral oncotropism, and the associated preclinical/clinical implications. The authors would also like to propose future directions in the utility of the replicating viruses for gynecologic cancer therapy.

  18. The Use of Peritoneal Suction Drainage to Reduce Shoulder Pain Caused by Gynecological Laparoscopy.

    Science.gov (United States)

    Haghgoo, Ameneh; Chaichian, Shahla; Ghahremani, Mehran; Nooriardebili, Shahla; Akbaian, Abdolrasool; Moazzami, Bahram

    2016-03-01

    To compare the outcomes of patients undergoing uncomplicated laparoscopic gynecologic procedures with and without drainage, and investigate the effects of drainage on postoperative shoulder pain, hospital stay and analgesic medications. In this randomized clinical trial, 92 patients undergoing uncomplicated laparoscopic gynecologic procedures at Pars Hospital, Tehran, Iran, between April 2012 and July 2014 entered the study. Patients were randomly divided into two groups: one group received a drain at the end of operation, whereas the second group didn't receive a drain. For patients closed with drainage, Hemovac plastic passive drains were inserted without negative pressure. Severity of the patients' postoperative shoulder pain was evaluated at rest using the 10-point visual analogue scale (VAS) at 12 h, 24 h, and 48 h after surgery. There was no difference between the two groups regarding age, weight, height, BMI, the cause of surgery and the blood loss during the surgery. At 12 h and 24 h after surgery, the shoulder pain was statistically lower in the group with drainage (P shoulder pain among patients undergoing gynecological laparoscopic surgeries and decrease the need for pain medication. Further studies are recommended to assess the feasibility and cost effectiveness of using this method for reducing the postoperative shoulder pain.

  19. Diagnostic delay experienced among gynecological cancer patients: a nationwide survey in Denmark

    DEFF Research Database (Denmark)

    Robinson, Kirstine M; Ottesen, Bent; Christensen, Karl Bang

    2009-01-01

    OBJECTIVE: To examine diagnostic delay among gynecological cancer patients. DESIGN: Nationwide study. SETTING: The cohort comprised all women receiving their first treatment for cervical, endometrial, or ovarian cancer between 1 October 2006 and 1 December 2007 in four of the five centers...... for gynecological cancer surgery in Denmark. SAMPLE: Of the 911 women alive, 648 participated, resulting in a response rate of 71.1%; of these, 30.1% were diagnosed with cervical cancer, 31.0% with endometrial cancer, and 38.9% with ovarian cancer. METHODS: Questionnaire survey. MAIN OUTCOME MEASURES: Diagnostic...... experiencing very long delays. Ovarian cancer patients experienced significantly shorter delays compared with other gynecological cancer patients in all parts of the health care system. CONCLUSIONS: Delays occur in all parts of the diagnostic process, suggesting that a multifaceted approach should be adopted...

  20. [Analysis of 82 forensic expertise cases on medical disputes in obstetrics and gynecology].

    Science.gov (United States)

    Zhou, Min; Huang, Yun; Deng, Zhen-Hua

    2009-06-01

    To study the rules of forensic expertise on medical disputes in obstetrics and gynecology, and the characteristics of medical faults in order to provide theoretical supports for forensic expertise. Eighty two cases of forensic expertise on medical disputes in obstetrics and gynecology were respectively analyzed, which were performed in Forensic Science Center of West China from 2002 to 2008. It has been found that cases of forensic expertise on medical disputes in obstetrics and gynecology were increasing year by year, with more dispute cases from municipal (district) and county hospitals than other hospitals. More disputes involved in childbearing and surgery cases. The main reasons of the medical faults were due to defects of medical techniques and managements. The forensic expertise of medical dispute must focus on the corresponding clinical regulations and whether the doctor fulfill their obligations. Meanwhile, whether there are physician negligence, technique faults and management defects should be investigated.

  1. 21 CFR 884.1720 - Gynecologic laparoscope and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gynecologic laparoscope and accessories. 884.1720... Devices § 884.1720 Gynecologic laparoscope and accessories. (a) Identification. A gynecologic laparoscope...) Class II (performance standards). (2) Class I for gynecologic laparoscope accessories that are not part...

  2. Physical activity in the elderly who underwent joint replacement surgery in the course of rheumatic diseases

    Directory of Open Access Journals (Sweden)

    Agnieszka Prusinowska

    2016-07-01

    Full Text Available According to the forecasts of the Central Statistical Office of Poland, in 2030 people at the age of 65 and older will account for 23.8%, i.e. their number will amount to approx. 8.5 m people. Geriatric rheumatic patients more often decide to undergo surgical joint replacement. According to the National Health Fund, the number of joint replacement services provided in 2014 increased by 93%, as compared to 2005. Improving the physical performance of this constantly expanding group of patients requires taking into account many factors to raise their functional status, reduce the risk of falling, teach rules of proper functioning with an artificial joint and encourage unassisted physical activity. Restoring fitness and independence is a difficult but necessary task due to an increasing number of seniors with replaced joint.

  3. Intensive Nutrition Management in a Patient with Short Bowel Syndrome Who Underwent Bariatric Surgery

    OpenAIRE

    Kweon, MeeRa; Ju, Dal Lae; Park, Misun; Choe, JiHyeong; Suh, Yun-Suhk; Seol, Eun-Mi; Lee, Hyuk-Joon

    2017-01-01

    Many individuals with short bowel syndrome (SBS) require long-term parenteral nutrition (PN) to maintain adequate nutritional status. Herein, we report a successful intestinal adaptation of a patient with SBS through 13 times intensive nutritional support team (NST) managements. A thirty-five-year-old woman who could not eat due to intestinal discontinuity visited Seoul National University Hospital for reconstruction of the bowel. She received laparoscopic Roux-en-Y gastric bypass (RYGB) due ...

  4. Single port laparoscopic surgery

    DEFF Research Database (Denmark)

    Springborg, Henrik; Istre, Olav

    2012-01-01

    potential benefits. Theoretically, cosmetic outcomes, postoperative pain and complication rates could be improved with use of single site surgery. This study describes introduction of the method in a private hospital in Denmark, in which 40 patients have been treated for benign gynecologic conditions......LESS, or laparo-endoscopic single site surgery, is a promising new method in minimally invasive surgery. An increasing number of surgical procedures are being performed using this technique, however, its large-scale adoption awaits results of prospective randomized controlled studies confirming...

  5. Maintaining Sexual Health throughout Gynecologic Cancer Survivorship: A Comprehensive Review and Clinical Guide

    Science.gov (United States)

    Huffman, Laura B.; Hartenbach, Ellen M.; Carter, Jeanne; Rash, Joanne K.; Kushner, David M.

    2016-01-01

    Objective The diagnosis and treatment of gynecologic cancer can cause short- and long-term negative effects on sexual health and quality of life (QoL). The aim of this article is to present a comprehensive overview of the sexual health concerns of gynecologic cancer survivors and discuss evidence-based treatment options for commonly encountered sexual health issues. Methods A comprehensive literature search of English language studies on sexual health in gynecologic cancer survivors and the treatment of sexual dysfunction was conducted in MEDLINE databases. Relevant data are presented in this review. Additionally, personal and institutional practices are incorporated where relevant. Results Sexual dysfunction is prevalent among gynecologic cancer survivors as a result of surgery, radiation, and chemotherapy--negatively impacting QoL. Many patients expect their healthcare providers to address sexual health concerns, but most have never discussed sex-related issues with their physician. Lubricants, moisturizers, and dilators are effective, simple, non-hormonal interventions that can alleviate the morbidity of vaginal atrophy, stenosis, and pain. Pelvic floor physical therapy can be an additional tool to address dyspareunia. Cognitive behavioral therapy has been shown to be beneficial to patients reporting problems with sexual interest, arousal, and orgasm. Conclusion Oncology providers can make a significant impact on the QoL of gynecologic cancer survivors by addressing sexual health concerns. Simple strategies can be implemented into clinical practice to discuss and treat many sexual issues. Referral to specialized sexual health providers may be needed to address more complex problems. PMID:26556768

  6. Obstetrics and Gynecology: Considerations in Career Selection

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    Stephen Petrilli, Edmund

    1981-01-01

    Current training programs in obstetrics and gynecology are not producing an excess of specialists in view of future manpower needs. In addition to being specialists and consultants, obstetrician-gynecologists also function as providers of primary care for women. During the last decade, three formal sub-specialties of obstetrics and gynecology have evolved: gynecologic oncology, maternal-fetal medicine and reproductive endocrinology. These have improved patient care and have altered the structure of resident education. With more American medical school graduates entering this specialty, the quality of resident applicants has improved, creating intense competition for desirable training positions. Those inclined toward a career in obstetrics and gynecology can be assured that it will provide an increasingly favorable and challenging environment for professional activity in the future. PMID:7210670

  7. GYNECOLOGICAL STATUS OF PATIENTS WITH COLORECTAL CANCER

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    V. A. Solodky

    2015-01-01

    Full Text Available The purpose of the study was to identify risk factors for colorectal cancer on the basis of retrospective analysis of gynecological history and status of 183 patients with colon adenocarcinoma treated at the Russian X-Ray Radiology Research Center between 1996 and 2011. Evaluation of gynecological status was based on findings  of gynecological, transvaginal and ultrasound examinations of the genitals, as well as on cytological cervical screening and colposcopy. Hysteroscopy and separate diagnostic curettage were performed if necessary. Gynecological status of patients with colorectal cancer was characterized by ovarian hypofunction and high incidence of benign non-inflammatory (78.1 % and inflammatory (88.0 % disorders of genital tract. In most cases (63.9 % polyneoplasia in patients with colorectal cancer combined with breast, endometrial and ovarian cancers. Considering younger age of the onset of benign disease of the genital tract, this group of patients should be followed up carefully for the development of colon cancer.

  8. Durvalumab, Tremelimumab + Radiotherapy in Gynecologic Cancer

    Science.gov (United States)

    2018-01-30

    Recurrent Gynecological Cancer; Metastatic Cervical Cancer; Metastatic Ovarian Cancer; Metastatic Vaginal Cancer; Metastatic Vulvar Cancer; Metastatic Endometrial Cancer; Recurrent Cervical Carcinoma; Recurrent Ovarian Carcinoma; Recurrent Vaginal Cancer; Recurrent Vulvar Cancer; Recurrent Endometrial Cancer

  9. Effect of using pump on postoperative pleural effusion in the patients that underwent CABG

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    Mehmet Özülkü

    2015-08-01

    Full Text Available Abstract Objective: The present study investigated effect of using pump on postoperative pleural effusion in patients who underwent coronary artery bypass grafting. Methods: A total of 256 patients who underwent isolated coronary artery bypass grafting surgery in the Cardiovascular Surgery clinic were enrolled in the study. Jostra-Cobe (Model 043213 105, VLC 865, Sweden heart-lung machine was used in on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting was performed using Octopus and Starfish. Proximal anastomoses to the aorta in both on-pump and off-pump techniques were performed by side clamps. The patients were discharged from the hospital between postoperative day 6 and day 11. Results: The incidence of postoperative right pleural effusion and bilateral pleural effusion was found to be higher as a count in Group 1 (on-pump as compared to Group 2 (off-pump. But the difference was not statistically significant [P>0.05 for right pleural effusion (P=0.893, P>0.05 for bilateral pleural effusion (P=0.780]. Left pleural effusion was encountered to be lower in Group 2 (off-pump. The difference was found to be statistically significant (P<0.05, P=0.006. Conclusion: Under the light of these results, it can be said that left pleural effusion is less prevalent in the patients that underwent off-pump coronary artery bypass grafting when compared to the patients that underwent on-pump coronary artery bypass grafting.

  10. Gynecologic imaging: Current and emerging applications

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    Iyer V

    2010-01-01

    Full Text Available Common diagnostic challenges in gynecology and the role of imaging in their evaluation are reviewed. Etiologies of abnormal uterine bleeding identified on pelvic sonography and sonohysterography are presented. An algorithmic approach for characterizing an incidentally detected adnexal mass and use of magnetic resonance imaging for definitive diagnosis are discussed. Finally, the role of F18-fluorodeoxyglucose positron emission tomography in the management of gynecological malignancies, and pitfalls associated with their use are examined.

  11. Epidemiology of gynecologic cancers in China.

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    Jiang, Xiyi; Tang, Huijuan; Chen, Tianhui

    2018-01-01

    Cancer has become a major disease burden across the globe. It was estimated that 4.29 million new incident cases and 2.81 million death cases of cancer would occur in 2015 in China, with the age-standardized incidence rate (ASIR) of 201.1 per 100,000 and age-standardized mortality rate (ASMR) of 126.9 per 100,000, respectively. For females, 2 of the top 10 most common types of cancer would be gynecologic cancers, with breast cancer being the most prevalent (268.6 thousand new incident cases) and cervical cancer being the 7th most common cancer (98.9 thousand new incident cases). The incidence and mortality of gynecologic cancers have been constantly increasing in China over last 2 decades, which become a major health concern for women. Survival rates of gynecologic cancers are generally not satisfactory and decrease along with advancing stage, though national data on survival are still not available. It is of great importance to overview on the epidemiology of gynecologic cancers, which may provide scientific clues for strategy-making of prevention and control, and eventually lowering the incidence and mortality rate as well as improving the survival rate in the future. Copyright © 2018. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.

  12. Sexuality in Irish women with gynecologic cancer.

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    Cleary, Vicki; Hegarty, Josephine; McCarthy, Geraldine

    2011-03-01

    To investigate sexual self-concept, sexual relationships, and sexual functioning, and the relationship between these and certain demographic variables of Irish women, following a diagnosis of gynecologic cancer. Descriptive, correlational. Outpatient gynecologic oncology clinic in a large university hospital in Southern Ireland. 106 women with a diagnosis of and treatment for various gynecologic cancers (cervical, ovarian, endometrial, and vulvar). The Body Image Scale, Sexual Esteem Scale, and Sexual Self-Schema Scale were administered to women a minimum of six weeks postdiagnosis of any form of gynecologic cancer to measure sexual self-concept; the Intimate Relationships Scale to measure sexual relationships; and the Arizona Sexual Experiences Scale to measure sexual functioning. Sexual self-concept, body image, sexual esteem, sexual self-schema, sexual relationships, and sexual functioning. Participants reported negative changes in relation to their sexual self-concept, sexual relationships, and sexual functioning. Participants reported negative changes in relation to all stages of the sexual response cycle. Gynecologic cancer has the potential to negatively affect a woman's sexual self-concept, sexual relationships, and sexual functioning. Sexuality is a multidimensional construct and must be measured in this way. Healthcare professionals must use a holistic approach when providing information and support to patients with gynecologic cancer. Information must be provided to women on how cancer and its treatment has the potential to affect their sexual self-concept, sexual relationships, and sexual functioning, including information on how to overcome these alterations.

  13. Major clinical research advances in gynecologic cancer in 2014

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    Lee, Kyung-Hun; Kim, Kidong; Kang, Sokbom

    2015-01-01

    In 2014, 9 topics were selected as major advances in clinical research for gynecologic oncology: 2 each in cervical and corpus cancer, 4 in ovarian cancer, and 1 in breast cancer. For cervical cancer, several therapeutic agents showed viable antitumor clinical response in recurrent and metastatic disease: bevacizumab, cediranib, and immunotherapies including human papillomavirus (HPV)-tumor infiltrating lymphocytes and Z-100. The HPV test received FDA approval as the primary screening tool of cervical cancer in women aged 25 and older, based on the results of the ATHENA trial, which suggested that the HPV test was a more sensitive and efficient strategy for cervical cancer screening than methods based solely on cytology. For corpus cancers, results of a phase III Gynecologic Oncology Group (GOG) 249 study of early-stage endometrial cancer with high-intermediate risk factors are followed by the controversial topic of uterine power morcellation in minimally invasive gynecologic surgery. Promising results of phase II studies regarding the effectiveness of olaparib in various ovarian cancer settings are summarized. After a brief review of results from a phase III study on pazopanib maintenance therapy in advanced ovarian cancer, 2 outstanding 2014 ASCO presentations cover the topic of using molecular subtypes in predicting response to bevacizumab. A review of the use of opportunistic bilateral salpingectomy as an ovarian cancer preventive strategy in the general population is presented. Two remarkable studies that discussed the effectiveness of adjuvant ovarian suppression in premenopausal early breast cancer have been selected as the last topics covered in this review. PMID:25872896

  14. Comparison of libido, Female Sexual Function Index, and Arizona scores in women who underwent laparoscopic or conventional abdominal hysterectomy

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    Kayataş, Semra; Özkaya, Enis; Api, Murat; Çıkman, Seyhan; Gürbüz, Ayşen; Eser, Ahmet

    2017-01-01

    Objective: The aim of the present study was to compare female sexual function between women who underwent conventional abdominal or laparoscopic hysterectomy. Materials and Methods: Seventy-seven women who were scheduled to undergo hysterectomy without oophorectomy for benign gynecologic conditions were included in the study. The women were assigned to laparoscopic or open abdominal hysterectomy according to the surgeons preference. Women with endometriosis and symptomatic prolapsus were excluded. Female sexual function scores were obtained before and six months after the operation from each participant by using validated questionnaires. Results: Pre- and postoperative scores of three different quationnaires were found as comparable in the group that underwent laparoscopic hysterectomy (p>0.05). Scores were also found as comparable in the group that underwent laparotomic hysterectomy (p>0.05). Pre- and postoperative values were compared between the two groups and revealed similar results with regard to all three scores (p>0.05). Conclusion: Our data showed comparable pre- and the postoperative scores for the two different hysterectomy techniques. The two groups were also found to have similar pre- and postoperative score values. PMID:28913149

  15. Barriers Prevent Patient Access to Personalized Therapies Identified by Molecular Tumor Profiling of Gynecologic Malignancies

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    R. Tyler Hillman

    2015-05-01

    Full Text Available Objective. This study was designed to evaluate the ability of commercial molecular tumor profiling to discover actionable mutations and to identify barriers that might prevent patient access to personalized therapies. Methods. We conducted an IRB-approved retrospective review of 26 patients with gynecologic malignancies who underwent commercial tumor profiling at our institution during the first 18 months of test availability. Tumor profiles reported targeted therapies and clinical trials matched to patient-specific mutations. Data analysis consisted of descriptive statistics. Results. Most patients who underwent tumor profiling had serous epithelial ovarian, primary peritoneal, or fallopian tube carcinoma (46%. Patients underwent profiling after undergoing a median of two systemic therapies (range 0 to 13. A median of one targeted therapy was suggested per patient profile. Tumor profiling identified no clinically actionable mutations for seven patients (27%. Six patients sought insurance approval for a targeted therapy and two were declined (33%. One patient (4% received a targeted therapy and this was discontinued due to tumor progression. Conclusions. There are formidable barriers to targeted therapy for patients with gynecologic malignancies. These barriers include a dearth of FDA-approved targeted agents for gynecologic malignancies, lack of third party insurance coverage and limited geographic availability of clinical trials.

  16. Pigmented Villonodular Synovitis in a Patient who Underwent Hip Arthroplasty

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    Nevzat Dabak

    2014-09-01

    Full Text Available Pigmented villonodular synovitis (PVNS is a rare, benign, but a locally aggressive tumor. It is characterized by the proliferation of synovial membrane, but it can also be seen in tendon sheaths and bursae. Clinical presentation of solitary lesions include compression and locking of the joint suggesting loose bodies in the joint and a subsequent findings of an effusion, whereas diffuse lesions manifest with pain and chronic swelling. In this article, we presented a curious case of PVNS in a female patient who have been followed up due to an acetabular cystic lesion. She underwent total hip arthroplasty for severe osteoarthritis of the hip joint and associated pain. The diagnosis of PVNS was established intraoperatively. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 235-7

  17. Trends in malpractice claims for obstetric and gynecologic procedures, 2005 through 2014.

    Science.gov (United States)

    Glaser, Laura M; Alvi, Farah A; Milad, Magdy P

    2017-09-01

    paid-to-closed ratios than most other medical specialties. Claims most frequently relate to gynecologic surgery, but obstetric procedures are more expensive. Possible factors may include procedural experience and unique perioperative complications. We encourage efforts addressing procedures, litigation, and quality interventions to improve outcomes, mitigate risk, and potentially lower indemnity payments. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Metronomic therapy for gynecologic cancers

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    Wen-Hsiang Su

    2012-06-01

    Full Text Available Systemic administration of cytotoxic drugs is the primary treatment strategy for patients with advanced cancer. The effect of cytotoxic drugs is to disrupt the DNA of the cells, rendering them unable to replicate and finally killing them; therefore, the fundamental role of a wide range of treatment regimens is typically to induce lethal toxicity in the largest possible number of cancer cells. However, these cytotoxic drugs also damage the normal cells of the host, which limits the dose of the cytotoxic drug. Thus, cancer patients are usually treated at or near the maximum tolerated dose with the implicit intent of eradicating (curing the tumor after balancing between efficacy in tumor killing and toxicity to the host. With significantly improving patient care, most efforts are focused on the corollary, “The higher the dose, the better.” However, the concept that cancer could be considered as a chronic disease and might be treated like other chronic diseases to achieve a status called tumor dormancy is gaining popularity. In addition, there has been increasing interest in putting more effort into administering cytotoxic drugs on a more continuous basis, with a much shorter break period, or none at all, and generally lower doses of various cytotoxic drugs or combinations with other newer, targeted therapies, like anti-angiogenesis agents. This practice has come to be known as metronomic chemotherapy. There is still much to be learned in this field, especially with regard to optimization of the proper drugs, dose, schedule, and tumor type applications. This review will explore recent studies that have addressed the mechanism of metronomic chemotherapy in the management of various tumors, especially gynecologic cancers.

  19. Nutritional status of patients with gynecologic and breast cancer.

    Science.gov (United States)

    Zorlini, R; Akemi Abe Cairo, A; Salete Costa Gurgel, M

    2008-01-01

    To identify the preoperative nutritional status of women with gynecologic or breast cancer, in correlation with disease site and staging as well as previous treatments. A cross-sectional study of 250 women evaluated by Body Mass Index (BMI) and Subjective Global Assessment (SGA). For data analysis, the chi-square test was applied. Breast cancer was the most frequent cancer, predominating in 56.2%. The median age of the patients was 52 years. In about 57% of these women, the tumor was restricted to clinical stages 0, I and II and 77% of the women had not undergone any other oncologic treatment prior to surgery. Subjective Global Assessment detected 76% of nourished women and 24% undernourished women, while Body Mass Index identified 34% of nourished women, 3.6% undernourished women and 62.4% overweight/obese women. A low level of diagnostic agreement between normal nutrition and malnutrition by both methods was observed (63.8%; kappa (95% CI) = 0.0884 (-0.07-0.24). No correlation between nutritional evaluation and previous treatment and disease staging was observed. Concerning anatomic site, it was subjectively observed that women with cancer of the uterine corpus were more malnourished than the rest (p = 0.02). The findings suggest that a more careful evaluation should be employed to identify preoperative nutritional status in women with gynecologic or breast cancer.

  20. Robotic-assisted radical parametrectomy in patients with malignant gynecological tumors.

    Science.gov (United States)

    Gorchev, Grigor A; Tomov, Slavcho T; Radionova, Zdravka V; Tanchev, Lachezar S

    2013-12-01

    We describe the operative technique of robotic-assisted laparoscopic radical parametrectomy and analyze perioperative data including adequacy of resections, pathology, and complications in our initial cases. A retrospective study was performed of seven patients with gynecological cancers involving the cervix who had previously been treated with simple hysterectomies and then underwent robotic-assisted radical parametrectomies. Pathology from the initial hysterectomies and the radical parametrectomies was reviewed. Postoperative complications, operative times, estimated blood loss, and length of hospital stay were assessed. The upper part of the vagina, parametrial tissue, and bilateral pelvic lymph nodes of all seven patients who had undergone a previous simple hysterectomy were removed. The mean age was 56.4 (SD ± 10.7) years. Diagnoses from hysterectomy specimens were invasive squamous carcinoma (n = 4), endometrial adenocarcinoma (n = 2), and clear-cell papillary adenocystic cervical carcinoma (n = 1). The median number of lymph nodes removed was 8 (min 4, max 29), and one patient had nodal metastasis. The mean operative time was 228.6 (SD ± 38.9) min, estimated blood loss was 147 (SD ± 58.2) ml, and length of hospital stay was five (SD ± 2.3) days. One intraoperative complication (cystotomy) occurred and was successfully repaired. One postoperative fistula developed on postoperative day 10. This early experience demonstrates that the basic surgical and anatomical principles of radical parametrectomy can be applied to robotic-assisted laparoscopic surgery. Genitourinary fistulae are always a concern with this procedure, and minimization of electrocautery near the bladder and ureters may further reduce complications.

  1. Asian Society of Gynecologic Oncology International Workshop 2014

    Science.gov (United States)

    Park, Jeong-Yeol; Ngan, Hextan Yuen Sheung; Park, Won; Cao, Zeyi; Wu, Xiaohua; Ju, Woong; Chung, Hyun Hoon; Chang, Suk-Joon; Park, Sang-Yoon; Ryu, Sang-Young; Kim, Jae-Hoon; Cho, Chi-Heum; Lee, Keun Ho; Lee, Jeong-Won; Kumarasamy, Suresh; Kim, Jae-Weon; Wilailak, Sarikapan; Kim, Byoung-Gie; Kim, Dae-Yeon; Konishi, Ikuo; Lee, Jae-Kwan; Wang, Kung-Liahng

    2015-01-01

    The Asian Society of Gynecologic Oncology International Workshop 2014 on gynecologic oncology was held in Asan Medical Center, Seoul, Korea on the 23rd to 24th August 2014. A total of 179 participants from 17 countries participated in the workshop, and the up-to-date findings on the management of gynecologic cancers were presented and discussed. This meeting focused on the new trends in the management of cervical cancer, fertility-sparing management of gynecologic cancers, surgical management of gynecologic cancers, and recent advances in translational research on gynecologic cancers. PMID:25609163

  2. Gynecologic oncology training systems in Europe: a report from the European network of young gynaecological oncologists.

    Science.gov (United States)

    Gultekin, Murat; Dursun, Polat; Vranes, Boris; Laky, Rene; Bossart, Michaela; Grabowski, Jacek P; Piek, Jurgen M J; Manchanda, Ranjit; Grimm, Christoph; Dallaku, Kastriot; Babloyan, Syuzanna; Moisei, Anna; Van Gorp, Toon; Cadron, Isabelle; Markov, Peter; Micevska, Ana; Halaska, Michael; Steffensen, Karina Dahl; Gristsenko, Liidia; Nissi, Ritva; Lambaudie, Eric; Tsitsishvili, Zaza; Haidopoulos, Dimitrios; Tsolakidis, Dimitrios; Novak, Zoltan; Peiretti, Michele; Dunenova, Gauhar; Macuks, Ronalds; Hetland, Thea E; Michelsen, Trond M; Martins, Filipe C; Achimas-Cadariu, Patriciu; Ulrikh, Elena A; Uharcek, Peter; Malic, Sladjana; Ognjenovic, Dejan; Zapardiel, Ignacio; Johann, Silke; Sukhin, Vladyslav S; Manchanda, Ranjit

    2011-11-01

    The objectives of the study were to highlight some of the differences in training systems and opportunities for training in gynecologic oncology across Europe and to draw attention to steps that can be taken to improve training prospects and experiences of European trainees in gynecologic oncology. The European Network of Young Gynaecological Oncologists national representatives from 34 countries were asked to review and summarize the training system in their countries of origin and fulfill a mini-questionnaire evaluating different aspects of training. We report analysis of outcomes of the mini-questionnaire and subsequent discussion at the European Network of Young Gynaecological Oncologists national representatives Asian Pacific Organization for Cancer Prevention meeting in Istanbul (April 2010). Training fellowships in gynecologic oncology are offered by 18 countries (53%). The median duration of training is 2.5 years (interquartile range, 2.0-3.0 years). Chemotherapy administration is part of training in 70.5% (24/34) countries. Most of the countries (26/34) do not have a dedicated national gynecologic-oncology journal. All trainees reported some or good access to training in advanced laparoscopic surgical techniques, whereas 41% indicated no access, and 59% some access to training opportunities in robotic surgery. European countries were grouped into 3 different categories on the basis of available training opportunities in gynecologic oncology: well-structured, moderately structured, and loosely structured training systems. There is a need for further harmonization and standardization of training programs and structures in gynecologic oncology across Europe. This is of particular relevance for loosely structured countries that lag behind the moderately structured and well-structured ones.

  3. Study of the seroma volume changes in the patients who underwent Accelerated Partial Breast Irradiation

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    Kim, Dae Ho; Son, Sang Jun; Mun, Jun Ki; Seo, Seok Jin; Lee, Je Hee [Dept. of Radiation Oncology, Seoul National University Hospital, Seoul (Korea, Republic of)

    2016-06-15

    By analyzing seroma volume changes in the patients who underwent Partial breast radiation therapy after breast conserving surgery, we try to contribute to the improvement of radiotherapy effect. Enrolled 20 patients who underwent partial breast radiation therapy by ViewRay MRIdian System were subject. After seeking for the size of the removed sample in the patients during surgery and obtained seroma volume changes on a weekly basis. On the Basis of acquired volume, it was compared with age, term from start of the first treatment after surgery, BMI (body mass index) and the extracted sample size during surgery. And using the ViewRay MRIdian RTP System, the figure was analyzed by PTV(=seroma volume + margin) to obtain a specific volume of the Partial breast radiation therapy. The changes of seroma volume from MR simulation to the first treatment (a week) is 0~5% in 8, 5~10% in 3, 10 to 15% in 2, and 20% or more in 5 people. Two patients(A, B patient) among subjects showed the biggest change. The A patient's 100% of the prescribed dose volume is 213.08 cc, PTV is 181.93 cc, seroma volume is 15.3 cc in initial plan. However, while seroma volume decreased 65.36% to 5.3 cc, 100% of the prescribed dose volume was reduced to 3.4% to 102.43 cc and PTV also did 43.6% to 102.54 cc. In the case of the B patient, seroma volume decreased 42.57% from 20.2 cc to 11.6 cc. Because of that, 100% of the prescribed dose volume decreased 8.1% and PTV also did to 40%. As the period between the first therapy and surgery is shorter, the patient is elder and the size of sample is smaller than 100 cc, the change grow bigger. It is desirable to establish an adaptive plan according to each patient's changes of seroma volume through continuous observation. Because partial breast patients is more sensitive than WBRT patients about dose conformity in accordance with the volume change.

  4. Frequency of Helicobacter pylori in patients underwent endoscopy

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    Ahmet Tay

    2012-06-01

    Full Text Available Objectives: The aim of this study was to investigate thefrequency of Helicobacter pylori in patients underwent endoscopyeastern Anatolia.Materials and methods: The patients whose endoscopicantral biopsies were taken for any reason in our endoscopyunit in February-June 2010 period were includedand retrospectively investigated. The frequency of Helicobacterpylori was determined as separating the patientsaccording to general, sex and the age groups. Antral biopsieswere stained with hematoxylin-eosin and modified giemsamethod and examined under light microscope andreported as (+ mild, (++ moderate, (+++ severe positiveaccording to their intensities.Results: Biopsy specimens of 1298 patients were includedinto the study. The mean age was 47.5 ± 17.5 years(range 14-88 and 607 of these patients (47% were male.Histopathological evaluation revealed that, 918 of the patientswere (71% positive and 379 (29% were negativefor Helicobacter pylori. Approximately 60% of our patientshad mild, 29% had moderate and 11% had severe positivityfor Helicobacter pylori. No significant difference wasfound in the frequency of Helicobacter pylori betweenwomen and men. The frequencies of Helicobacter pyloriwere 73.2%, 71.5%, 68.6% and 70.4%, respectively, inthe age groups of 14-30 years, 31-45 years, 46-60 yearsand 61-88 years.Conclusion: The frequency of Helicobacter pylori was71% in Eastern Anatolia Region. No statistically significantdifference was found between genders and agegroups in term of the frequency of Helicobacter pylori.

  5. Phytochemicals: A Multitargeted Approach to Gynecologic Cancer Therapy

    Science.gov (United States)

    Oh, Se-Woong; Song, Yong Sang; Tsang, Benjamin K.

    2014-01-01

    Gynecologic cancers constitute the fourth most common cancer type in women. Treatment outcomes are dictated by a multitude of factors, including stage at diagnosis, tissue type, and overall health of the patient. Current therapeutic options include surgery, radiotherapy, and chemotherapy, although significant unmet medical needs remain in regard to side effects and long-term survival. The efficacy of chemotherapy is influenced by cellular events such as the overexpression of oncogenes and downregulation of tumor suppressors, which together determine apoptotic responses. Phytochemicals are a broad class of natural compounds derived from plants, a number of which exhibit useful bioactive effects toward these pathways. High-throughput screening methods, rational modification, and developments in regulatory policies will accelerate the development of novel therapeutics based on these compounds, which will likely improve overall survival and quality of life for patients. PMID:25093186

  6. [A survey of perioperative asthmatic attack among patients with bronchial asthma underwent general anesthesia].

    Science.gov (United States)

    Ie, Kenya; Yoshizawa, Atsuto; Hirano, Satoru; Izumi, Sinyuu; Hojo, Masaaki; Sugiyama, Haruhito; Kobayasi, Nobuyuki; Kudou, Kouichirou; Maehara, Yasuhiro; Kawachi, Masaharu; Miyakoshi, Kouichi

    2010-07-01

    We investigated the risk factor of perioperative asthmatic attack and effectiveness of preventing treatment for asthmatic attack before operation. We performed retrospective chart review of one hundred eleven patients with asthma underwent general anesthesia and surgical intervention from January 2006 to October 2007 in our hospital. The rate of perioperative asthmatic attack were as follows; 10.2% (5 in 49 cases) in no pretreatment group, 7.5% (3 in 40 cases) in any pretreatments except for systemic steroid, and 4.5% (1 in 22 cases) in systemic steroid pretreatment group. Neither preoperative asthma severity nor duration from the last attack had significant relevancy to perioperative attack rate. The otolaryngological surgery, especially those have nasal polyp and oral surgery had high perioperative asthma attack rate, although there was no significant difference. We recommend the systemic steroid pretreatment for asthmatic patients, especially when they have known risk factor such as administration of the systemic steroid within 6 months, or possibly new risk factor such as nasal polyp, otolaryngological and oral surgery.

  7. Comparison of Women in Department Leadership in Obstetrics and Gynecology With Those in Other Specialties.

    Science.gov (United States)

    Hofler, Lisa G; Hacker, Michele R; Dodge, Laura E; Schutzberg, Rose; Ricciotti, Hope A

    2016-03-01

    To compare the representation of women in obstetrics and gynecology department-based leadership to other clinical specialties while accounting for proportions of women in historical residency cohorts. This was a cross-sectional observational study. The gender of department-based leaders (chair, vice chair, division director) and residency program directors was determined from websites of 950 academic departments of anesthesiology, diagnostic radiology, general surgery, internal medicine, neurology, obstetrics and gynecology, pathology, pediatrics, and psychiatry. Each specialty's representation ratio-proportion of leadership roles held by women in 2013 divided by proportion of residents in 1990 who were women-and 95% confidence interval (CI) were calculated. A ratio of 1 indicates proportionate representation. Women were significantly underrepresented among chairs for all specialties (ratios 0.60 or less, P≤.02) and division directors for all specialties except anesthesiology (ratio 1.13, 95% CI 0.87-1.46) and diagnostic radiology (ratio 0.97, 95% CI 0.81-1.16). The representation ratio for vice chair was below 1.0 for all specialties except anesthesiology; this finding reached statistical significance only for pathology, pediatrics, and psychiatry. Women were significantly overrepresented as residency program directors in general surgery, anesthesiology, obstetrics and gynecology, and pediatrics (ratios greater than 1.19, P≤.046). Obstetrics and gynecology and pediatrics had the highest proportions of residents in 1990 and department leaders in 2013 who were women. Despite having the largest proportion of leaders who were women, representation ratios demonstrate obstetrics and gynecology is behind other specialties in progression of women to departmental leadership. Women's overrepresentation as residency program directors raises concern because education-based academic tracks may not lead to major leadership roles.

  8. Comparison of Women in Department Leadership in Obstetrics and Gynecology With Other Specialties

    Science.gov (United States)

    Hofler, Lisa G.; Hacker, Michele R.; Dodge, Laura E.; Schutzberg, Rose; Ricciotti, Hope A.

    2016-01-01

    Objective To compare the representation of women in Obstetrics and Gynecology department-based leadership to other clinical specialties, while accounting for proportions of women in historical residency cohorts. Methods This was a cross-sectional observational study. The gender of department-based leaders (chair, vice chair, division director) and residency program directors was determined from websites of 950 academic departments of Anesthesiology, Diagnostic Radiology, General Surgery, Internal Medicine, Neurology, Obstetrics and Gynecology, Pathology, Pediatrics, and Psychiatry. Each specialty's representation ratio—proportion of leadership roles held by women in 2013 divided by proportion of residents in 1990 who were women—and 95% confidence interval (CI) were calculated. A ratio of one indicates proportionate representation. Results Women were significantly under-represented among chairs for all specialties (ratios ≤0.60, P≤0.02) and division directors for all specialties except Anesthesiology (ratio: 1.13, 95% CI: 0.87–1.46) and Diagnostic Radiology (ratio: 0.97, 95% CI: 0.81–1.16). The representation ratio for vice chair was below 1.0 for all specialties except Anesthesiology; this finding reached statistical significance only for Pathology, Pediatrics, and Psychiatry. Women were significantly over-represented as residency program directors in General Surgery, Anesthesiology, Obstetrics and Gynecology, and Pediatrics (ratios >1.19, P≤0.046). Obstetrics and Gynecology and Pediatrics had the highest proportions of residents in 1990 and department leaders in 2013 who were women. Conclusion Despite having the largest proportion of leaders who were women, representation ratios demonstrate Obstetrics and Gynecology is behind other specialties in progression of women to departmental leadership. Women's over-representation as residency program directors raises concern because education-based academic tracks may not lead to major leadership roles. PMID

  9. Flexible CO2 laser fiber: first look at the learning curve required in gynecological laparoscopy training.

    Science.gov (United States)

    Vanni, Valeria S; Ottolina, Jessica; Candotti, Giorgio; Castellano, Laura M; Tandoi, Iacopo; DE Stefano, Francesca; Poppi, Giorgia; Ferrari, Stefano; Candiani, Massimo

    2018-02-01

    The advent of flexible CO2 laser fiber to gynecology arena might represent a turning point in the use of laser energy on a large-scale basis in gynecological surgery. However, there might be some concerns regarding the degree of surgical skills required to use the flexible system. The purpose of our study is to evaluate whether flexible CO2 laser fiber is technically accessible. Fourteen residents in Obstetrics and Gynecology without surgical experience attending laparoscopic box training with both flexible CO2 laser fiber and traditional line-of-sight CO2 laser using Lumenis AcuPulse Duo CO2 laser (Lumenis, Yokne'am Illit, Israel) were prospectively enrolled. Participants were tested at sequential time points on specific surgical tasks and results obtained with the flexible CO2 laser fiber and the traditional line-of-sight CO2 laser were compared. Results were compared by means of paired t-test and a two-tailed P value flexible fiber and line-of-sight CO2 laser. At the end of training, significant improvement in surgical skills was obtained for both techniques, with a statistically significant higher grading for flexible fiber CO2 laser compared to line-of-sight CO2 laser. Our study found that residents without surgical experience show better skills with the flexible CO2 laser fiber delivery system compared to the standard line-of-sight CO2 laser system after a two-month training period with gynecological laparoscopic box. According to our results, flexible CO2 laser fiber delivery system is technically accessible and holds a potential in gynecological surgery.

  10. Reasons for diagnostic delay in gynecological malignancies

    DEFF Research Database (Denmark)

    Vandborg, Mai Partridge; Christensen, René dePont Christensen; Kragstrup, Jakob

    2011-01-01

    Aim The primary aim of this study was to identify and describe different delay types in women with gynecologic cancer, and to analyze the relationship between diagnostic delay and a number of characteristics for patients, cancers and the health care system. Setting A cohort study of women newly......) and The Danish Gynecological Cancer Database (DGCD). 161 women were included; ovarian cancer: 63, endometrial cancer: 50, cervical cancer: 34 and vulvar cancer: 14. Outcome measures were different delay types counted in days and the influence of four clinical important variables: Presence of alarm symptoms, age...... (≤ or > 60 years), performance of gynecological examination by the GP and notification of cancer suspicion on first referral from GP’s on the diagnostic delay (short delay ≤90 days and long delay >90 days). Results Across cancer type a median total delay of 101 days was observed. The 10% of women...

  11. Efficacy of continuous wound infiltration of local anesthetic for pain relief after gynecologic laparoscopy.

    Science.gov (United States)

    Kong, Tae-Wook; Park, Hyogyeong; Cheong, Ji-Yoon; Min, Sang-Ki; Ryu, Hee-Sug

    2014-03-01

    To assess the efficacy of analgesia provided by continuous ropivacaine wound infiltration after gynecologic laparoscopy. Sixty patients who underwent gynecologic laparoscopy at Ajou University School of Medicine, Suwon, Republic of Korea, between March and May 2012 were randomized to receive either intravenous fentanyl and ketorolac infusion on demand by patient-controlled analgesia (IV PCA group, n=31) or continuous wound infiltration of local ropivacaine (CWI group, n=29). Postoperative pain and postoperative nausea and vomiting (PONV) were assessed via a visual analog scale. The number of patients who requested rescue analgesia was recorded. There was no significant difference in postoperative pain between the 2 groups, but more patients requested rescue analgesia in the CWI group than in the IV PCA group in 24 hours (18 versus 9 patients, respectively; P=0.010). The PONV scores at 12 and 24 hours were, respectively, 0.28 and 0.27 in the CWI group, and 0.71 and 0.73 in the IV PCA group (P=0.004). Nine patients requested cessation of IV PCA because of severe nausea or vomiting. Continuous ropivacaine wound infiltration was found to be as effective as patient-controlled analgesia for postoperative pain relief after gynecologic laparoscopy. This technique provides good analgesia with less opioid analgesic requirement and few adverse effects. Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  12. A multidisciplinary evidence-based guideline for minimally invasive surgery.

    OpenAIRE

    la Chapelle, Claire F.; Bemelman, Willem A.; Rademaker, Bart M. P.; van Barneveld, Teus A.; Jansen, Frank Willem

    2012-01-01

    The Dutch Society for Endoscopic Surgery together with the Dutch Society of Obstetrics and Gynecology initiated a multidisciplinary working group to develop a guideline on minimally invasive surgery to formulate multidisciplinary agreements for minimally invasive surgery aiming towards better patient care and safety. The guideline development group consisted of general surgeons, gynecologists, an anesthesiologist, and urologist authorized by their scientific professional association. Two advi...

  13. Evaluation of patients who underwent resympathectomy for treatment of primary hyperhidrosis.

    Science.gov (United States)

    de Campos, José Ribas Milanez; Lembrança, Lucas; Fukuda, Juliana Maria; Kauffman, Paulo; Teivelis, Marcelo Passos; Puech-Leão, Pedro; Wolosker, Nelson

    2017-11-01

    Video thoracoscopic sympathectomy is the recommended surgical treatment for primary hyperhidrosis and has a high success rate. Despite this high success rate, some patients are unresponsive and eventually need a resympathectomy. Few studies have previously analysed exclusively the results of these resympathectomies in patients with primary hyperhidrosis. None of the studies have objectively evaluated the degree of response to surgery or the improvement in quality of life after resympathectomies. This is a retrospective study, evaluating 15 patients from an initial group of 2300 patients who underwent resympathectomy after failure of the primary surgical treatment. We evaluated sympathectomy levels of resection, technical difficulties, surgical complications preoperative quality of life, response to treatment and quality-of-life improvement 30 days after each surgery. Regarding gender, 11 (73.3%) patients were women. The average age was 23.2 with SD of 5.17 years, and the mean body mass index was 20.9 (SD 2.12). Ten patients had major complaints about their hands (66%) and 5 (33%) patients about their forearms. A high degree of response to sympathectomy occurred in 73% of patients. In 11 of these patients, the improvement in quality of life was considered high, 3 showed a mild improvement and 1 did not improve. No major complications occurred; the presence of adhesions was reported in 11 patients and pleural drainage was necessary in 4 patients. Resympathectomy is an effective procedure, and it improves the quality of life in patients with primary hyperhidrosis who failed after the first surgery. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  14. Pathologic Findings at Risk-Reducing Salpingo-Oophorectomy: Primary Results From Gynecologic Oncology Group Trial GOG-0199

    Science.gov (United States)

    Sherman, Mark E.; Piedmonte, Marion; Mai, Phuong L.; Ioffe, Olga B.; Ronnett, Brigitte M.; Van Le, Linda; Ivanov, Iouri; Bell, Maria C.; Blank, Stephanie V.; DiSilvestro, Paul; Hamilton, Chad A.; Tewari, Krishnansu S.; Wakeley, Katie; Kauff, Noah D.; Yamada, S. Diane; Rodriguez, Gustavo; Skates, Steven J.; Alberts, David S.; Walker, Joan L.; Minasian, Lori; Lu, Karen; Greene, Mark H.

    2014-01-01

    Purpose Risk-reducing salpingo-oophorectomy (RRSO) lowers mortality from ovarian/tubal and breast cancers among BRCA1/2 mutation carriers. Uncertainties persist regarding potential benefits of RRSO among high-risk noncarriers, optimal surgical age, and anatomic origin of clinically occult cancers detected at surgery. To address these topics, we analyzed surgical treatment arm results from Gynecologic Oncology Group Protocol-0199 (GOG-0199), the National Ovarian Cancer Prevention and Early Detection Study. Participants and Methods This analysis included asymptomatic high-risk women age ≥ 30 years who elected RRSO at enrollment. Women provided risk factor data and underwent preoperative cancer antigen 125 (CA-125) serum testing and transvaginal ultrasound (TVU). RRSO specimens were processed according to a standardized tissue processing protocol and underwent central pathology panel review. Research-based BRCA1/2 mutation testing was performed when a participant's mutation status was unknown at enrollment. Relationships between participant characteristics and diagnostic findings were assessed using univariable statistics and multivariable logistic regression. Results Invasive or intraepithelial ovarian/tubal/peritoneal neoplasms were detected in 25 (2.6%) of 966 RRSOs (BRCA1 mutation carriers, 4.6%; BRCA2 carriers, 3.5%; and noncarriers, 0.5%; P < .001). In multivariable models, positive BRCA1/2 mutation status (P = .0056), postmenopausal status (P = .0023), and abnormal CA-125 levels and/or TVU examinations (P < .001) were associated with detection of clinically occult neoplasms at RRSO. For 387 women with negative BRCA1/2 mutation testing and normal CA-125 levels, findings at RRSO were benign. Conclusion Clinically occult cancer was detected among 2.6% of high-risk women undergoing RRSO. BRCA1/2 mutation, postmenopausal status, and abnormal preoperative CA-125 and/or TVU were associated with cancer detection at RRSO. These data can inform management decisions

  15. Effect of Music Therapy on Postoperative Pain Management in Gynecological Patients: A Literature Review.

    Science.gov (United States)

    Sin, Wai Man; Chow, Ka Ming

    2015-12-01

    Unrelieved postoperative pain may have a negative impact on the physiological and psychological well-being of patients. Pharmacological methods are currently used to relieve such pain in gynecological patients; however, inadequate pain control is still reported, and the use of nonpharmacological pain-relieving methods is increasingly being advocated, one of which is music therapy. The purpose of this literature review was to identify, summarize, and critically appraise current evidence on music therapy and postoperative pain management among gynecological patients. A systematic search of MEDLINE, CINAHL, PsycINFO, British Nursing Index, and Allied and Complementary Medicine was conducted using the search terms music, gynecological, pain, surgery, operative, and post-operative to identify relevant articles in English from 1995 to the present. All identified articles were assessed independently for inclusion into review. A total of 7 articles were included after removal of duplicates and exclusion of irrelevant studies. All the included studies assessed the effects of music therapy on postoperative pain intensity, and three of them measured pain-related physiological symptoms. The findings indicated that music therapy, in general, was effective in reducing pain intensity, fatigue, anxiety, and analgesic consumption in gynecological patients during the postoperative period. It is recommended as an adjunct to pharmacological pain-relieving methods in reducing postoperative pain. Future researches on music therapy to identify the most effective application and evaluate its effect by qualitative study are recommended. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  16. Ultrasound in gynecological cancer: is it time for re-evaluation of its uses?

    Science.gov (United States)

    Fischerova, Daniela; Cibula, David

    2015-06-01

    Ultrasound is the primary imaging modality in gynecological oncology. Over the last decade, there has been a massive technology development which led to a dramatic improvement in the quality ultrasound imaging. If performed by an experienced sonographer, ultrasound has an invaluable role in the primary diagnosis of gynecological cancer, in the assessment of tumor extent in the pelvis and abdominal cavity, in the evaluation of the treatment response, and in follow-up. Ultrasound is also a valuable procedure for monitoring patients treated with fertility-sparing surgery. Furthermore, it is an ideal technique to guide tru-cut biopsy for the collection of material for histology. Taking into consideration that besides its accuracy, the ultrasound is a commonly available, non-invasive, and inexpensive imaging method that can be carried out without any risk or discomfort to the patient; it is time to reconsider its role in gynecologic oncology and to allocate resources for a specialized education of future experts in ultrasound imaging in gynecology.

  17. Risk factors in patient safety : Minimally invasive surgery versus conventional surgery

    NARCIS (Netherlands)

    Rodrigues, S.P.; Wever, A.M.; Denkelman, J.; Jansen, F.W.

    2011-01-01

    Background This study aimed to identify the frequency of events in the different patient safety risk domains during minimally invasive surgery (MIS) and conventional surgery (CS). Methods A convenience sample of gynecologic MIS and CS was observed. Events were observed and categorized into one of

  18. 42 CFR 493.945 - Cytology; gynecologic examinations.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Cytology; gynecologic examinations. 493.945 Section... gynecologic examinations (Pap smears) in cytology, a program must provide test sets composed of 10- and 20... Nonwaived Testing Proficiency Testing Programs by Specialty and Subspecialty § 493.945 Cytology; gynecologic...

  19. 42 CFR 493.855 - Standard; Cytology: gynecologic examinations.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Standard; Cytology: gynecologic examinations. 493... Complexity, Or Any Combination of These Tests § 493.855 Standard; Cytology: gynecologic examinations. To participate successfully in a cytology proficiency testing program for gynecologic examinations (Pap smears...

  20. 21 CFR 884.4550 - Gynecologic surgical laser.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gynecologic surgical laser. 884.4550 Section 884.4550 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED....4550 Gynecologic surgical laser. (a) Identification. A gynecologic surgical laser is a continuous wave...

  1. 21 CFR 884.4120 - Gynecologic electrocautery and accessories.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gynecologic electrocautery and accessories. 884.4120 Section 884.4120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Surgical Devices § 884.4120 Gynecologic electrocautery and accessories. (a) Identification. A gynecologic...

  2. Gonadotrophin-releasing hormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopic surgery for endometriosis: a multi-center randomized trial.

    Science.gov (United States)

    Granese, Roberta; Perino, Antonino; Calagna, Gloria; Saitta, Salvatore; De Franciscis, Pasquale; Colacurci, Nicola; Triolo, Onofrio; Cucinella, Gaspare

    2015-06-01

    To evaluate the efficacy of dienogest + estradiol valerate (E2V) and gonadotrophin-releasing hormone analogue (GnRH-a) in reducing recurrence of pain in patients with chronic pelvic pain due to laparoscopically diagnosed and treated endometriosis. Multi-center, prospective, randomized study. Three university departments of obstetrics and gynecology in Italy. Seventy-eight women who underwent laparoscopic surgery for endometriosis combined with chronic pelvic pain. Post-operative administration of dienogest + E2V for 9 months (group 1) or GnRH-a monthly for 6 months (group 2). A visual analogue scale was used to test intensity of pain before laparoscopic surgery at 3, 6 and 9 months of follow up. A questionnaire to investigate quality of life was administered before surgery and at 9 months of follow up. The visual analogue scale score did not show any significant differences between the two groups (p = 0.417). The questionnaire showed an increase of scores for all women compared with pre-surgery values, demonstrating a marked improvement in quality of life and health-related satisfaction with both treatments. No significant differences were found between the groups. The rate of apparent endometriosis recurrence was 10.8% in group 1 and 13.7% in group 2 (p = 0.962). Both therapies seemed equally efficacious in preventing endometriosis-related chronic pelvic pain recurrence in the first 9 months of follow-up. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  3. A Pregnant Woman Who Underwent Laparoscopic Adrenalectomy due to Cushing’s Syndrome

    Directory of Open Access Journals (Sweden)

    Halit Diri

    2014-01-01

    Full Text Available Cushing’s syndrome (CS may lead to severe maternal and fetal morbidities and even mortalities in pregnancy. However, pregnancy complicates the diagnosis and treatment of CS. This study describes a 26-year-old pregnant woman admitted with hypertension-induced headache. Hormonal analyses performed due to her cushingoid phenotype revealed a diagnosis of adrenocorticotropic hormone- (ACTH- independent CS. MRI showed a 3.5 cm adenoma in her right adrenal gland. After preoperative metyrapone therapy, she underwent a successful unilateral laparoscopic adrenalectomy at 14-week gestation. Although she had a temporary postoperative adrenal insufficiency, hormonal analyses showed that she has been in remission since delivery. Findings in this patient, as well as those in previous patients, indicate that pregnancy is not an absolute contraindication for laparoscopic adrenalectomy. Rather, such surgery should be considered a safe and efficient treatment method for pregnant women with cortisol-secreting adrenal adenomas.

  4. Safety and efficacy of immediate postoperative feeding and bowel stimulation to prevent ileus after major gynecologic surgical procedures.

    Science.gov (United States)

    Fanning, James; Hojat, Rod

    2011-08-01

    Postoperative ileus is a major complication of abdominal surgical procedures To evaluate the incidence of ileus and gastrointestinal morbidity in patients who received immediate postoperative feeding and bowel stimulation after undergoing major gynecologic surgical procedures. During a 5-year period, the authors tracked demographic, surgical outcome, and follow-up information for 707 patients who underwent major gynecologic operations. All patients received the same postoperative orders, including immediate feeding of a diet of choice and bowel stimulation with 30 mL of magnesium hydroxide (milk of magnesia) twice daily until bowel movements occurred. Of 707 patients, 6 (<1%) had postoperative ileus. No patients experienced postoperative bowel obstruction and 2 patients (0.3%) had postoperative intestinal leak. No serious adverse effects associated with bowel stimulation were reported. Immediate postoperative feeding and bowel stimulation is a safe and effective approach to preventing ileus in patients who undergo major gynecologic surgical procedures.

  5. Continuous wound infiltration system for postoperative pain management in gynecologic oncology patients.

    Science.gov (United States)

    Lee, Banghyun; Kim, Kidong; Ahn, Soyeon; Shin, Hyun-Jung; Suh, Dong Hoon; No, Jae Hong; Kim, Yong Beom

    2017-05-01

    Major open surgery for gynecologic cancer usually involves a long midline skin incision and induces severe postoperative surgical site pain (POSP) that may not be effectively controlled with the conventional management. We investigated whether combining a continuous wound infiltration system (CWIS, ON-Q PainBuster ® ) and intravenous patient-controlled analgesia (IV PCA) effectively decreases POSP, compared with IV PCA alone, in gynecologic oncology patients. This retrospective study included 62 Korean patients who received a long midline skin incision during gynecologic cancer surgery. The combined therapy group (n = 31), which received CWIS (0.5% ropivacaine infused over 72 h) and IV PCA (fentanyl citrate), and the IV PCA only group (n = 31) were determined using 1:1 matching. POSP was assessed using resting numeric rating scale (NRS) scores measured for 96 h after surgery, which were analyzed using a linear mixed model. The slopes of the predicted NRS values from the linear mixed model were significantly different between the groups. Compared with the control group, the combined therapy group had lower predicted NRS scores for the first 72 h, but higher predicted scores between 72 and 96 h. Moreover, the mean NRS scores over the first 48 h postoperation were significantly lower in the combined therapy group than in the control group; the scores were similar in both groups during the remaining period. With the exception of a higher body mass index in the CWIS group, the other variables, such as the dosage and usage time of fentanyl citrate, use of additional painkillers, and side effects, including wound complications, did not differ between groups. Combined therapy using CWIS and IV PCA may be a useful strategy for POSP management in gynecologic oncology patients.

  6. Experience with diagnostic laparoscopy for gynecological indications

    African Journals Online (AJOL)

    2012-02-27

    Feb 27, 2012 ... Diagnostic laparoscopy for gynecological indications is safe and wider application of this modern ... JI Ikechebelu. Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, and Life Fertility. Centre .... The hemorrhage would have been controlled or control attempted ...

  7. Acute gynecologic disorders in adolescents: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Tong [Soonchunhyang Univ. Cheonan Hospital/Soonchunhyang Univ. College of Medicine, Cheonan (Korea, Republic of)

    2012-09-15

    Gynecologic disorders that cause pelvic pain in adolescents include hemorrhagic ovarian cysts, rupture or torsion of ovarian cyst or tumors, hematocolpos caused by vaginal obstruction, endometriosis, cystic uterine adenomyosis, pelvic inflammatory diseases, and pelvic inclusion cyst. The use of CT for the evaluation of pelvic pain is increasing, and CT is useful if ultrasound findings are not decisive and the lesion is extensive.

  8. Dermatoglyphic patterns on fingers and gynecological cancers.

    Science.gov (United States)

    Abbasi, Sakineh; Rasouli, Mina

    2018-03-01

    Fingerprints have so far been used for determining the basis of certain malignant diseases, with positive outcomes. Considering the high rates of cancer-related mortality in Iran, this study was conducted for the purpose of examining the dermatoglyphic pattern of fingers in patients with gynecological cancers as compared to healthy people. The present study was conducted on 151 women with gynecological cancers as the case group and 152 healthy women with no history of such cancers as control group. The dematographic details of participants from both control and case groups were collected using a checklist, and the pattern of their fingerprints was prepared and examined. The data were analyzed for their significance using chi-square test and t- test. Odds ratio with 95% confidence intervals were calculated. Dermatoglyphic analysis showed that arch and loop patterns significantly changed in cases group as compared to control. However, the odds ratio suggested that loop pattern in 6 or more fingers might be a risk factor for developing gynecological cancers. Our results showed that there is an association between fingerprint patterns and gynecological cancers and so, dermatoglyphic analysis may aid in the early diagnosis of these cancers. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Integrating Prevention into Obstetrics/Gynecology.

    Science.gov (United States)

    Carey, J. Christopher

    2000-01-01

    Discusses formats to teach preventive medicine in obstetrics and gynecology (including learning objectives, lectures/seminars, and rounds/office practice) and evaluation methods (oral examinations, computerized question banks, objective structured clinical examinations). Offers examples from specific programs at American medical schools, including…

  10. [GnRH-agonists in gynecology I].

    Science.gov (United States)

    Herrera Suastegui, T; Garza Evia, A G; Reyes Cuervo, H; Alvarado Durán, A

    1992-05-01

    The present review has the objective to describe the chemical and pharmacological characteristics of GnRH analogs and the present time indications of it's use in gynecology. It is a critical review about use of GnRH analogs in: Anticonception, Assisted Reproduction, Uterine leiomyomas, Endometriosis, Polycystic Ovarian Syndrome, Precosious Puberty, Premenstrual Tension Syndrome and Breast Cancer.

  11. [GnRH-agonists in gynecology II].

    Science.gov (United States)

    Herrera Suastegui, T; Garza Evia, A G; Reyes Cuervo, H; Alvarado Durán, A

    1992-06-01

    The present review has the objective to describe the chemical and pharmacological characteristics of GnRH analogs and the present time indications of it's use in gynecology. It is a critical review about use of GnRH analogs in: Anticonception, Assisted reproduction, Uterine leiomyomas, Endometriosis, Polycystic ovarian syndrome, Precocious puberty, Premenstrual tension syndrome and breast cancer.

  12. Structural determination and gynecological tumor diagnosis using ...

    African Journals Online (AJOL)

    Purpose: To identify markers for gynecological tumor diagnosis using antibody chip capture. Methods: Marker proteins, including cancer antigen 153 (CA153), CA125, and carcinoembryonic antigen (CEA), were analyzed using antibody chip capture of serum samples. Fifteen agglutinin types that specifically recognized five ...

  13. Gynecologic screening in hereditary nonpolyposis colorectal cancer

    NARCIS (Netherlands)

    Rijcken, FEM; Mourits, MJE; Kleibeuker, JH; Hollema, H; van der Zee, AGJ

    2003-01-01

    Objective. In hereditary nonpolyposis colorectal cancer (HNPCC), women with a mismatch repair (MMR) gene mutation have a cumulative lifetime risk of 25-50% for endometrial cancer and 8-12% for ovarian cancer. Therefore, female members of HNPCC families are offered an annual gynecologic and

  14. Acute gynecologic disorders in adolescents: CT findings

    International Nuclear Information System (INIS)

    Kim, Young Tong

    2012-01-01

    Gynecologic disorders that cause pelvic pain in adolescents include hemorrhagic ovarian cysts, rupture or torsion of ovarian cyst or tumors, hematocolpos caused by vaginal obstruction, endometriosis, cystic uterine adenomyosis, pelvic inflammatory diseases, and pelvic inclusion cyst. The use of CT for the evaluation of pelvic pain is increasing, and CT is useful if ultrasound findings are not decisive and the lesion is extensive

  15. Ureteric injuries complicating obstetric and gynecologic operations ...

    African Journals Online (AJOL)

    A retrospective study to determine the rate and pattern of ureteric injuries complicating gynecologic and obstetric operations in the University of Calabar Teaching Hospital (UCTH) during a ten-year period (1990 –1999) was undertaken. The number of major operations carried out during the period was 9350. Of these, 8670 ...

  16. Prospective comparison of single port versus conventional laparoscopic surgery for ectopic pregnancy.

    Science.gov (United States)

    Kim, Min Kyung; Kim, Jeong Jin; Choi, Joong Sub; Eom, Jeong Min; Lee, Jung Hun

    2015-04-01

    To investigate the feasibility and safety of single port laparoscopic surgery (SP-LS) for ectopic pregnancy, irrespective of type of ectopic pregnancy and hemodynamic stability. A prospective case-control study of 106 women who underwent SP-LS or conventional LS for a suspected ectopic pregnancy was performed at a university teaching hospital from January 2009 to March 2012. Twenty-six women underwent SP-LS (SP-LS group) and 80 women underwent conventional LS (conventional LS group). There were no statistical differences between the groups in terms of demographic characteristics, operating time, hemoglobin change, return of bowel activity, hospital stay or complication rate. There were no cases of additional trocar use or conversion to laparotomy. Of five women with heterotopic pregnancy, one underwent SP-LS, and three underwent conventional LS for tubal pregnancy, which all resulted in vaginal delivery without obstetric complication; one woman received SP-LS for cornual pregnancy and had an ongoing pregnancy. SP-LS for ectopic pregnancy is feasible and safe regardless of the type of ectopic pregnancy and hemodynamic stability. However, further work is needed to confirm this conclusion and to demonstrate any advantage of SP-LS for ectopic pregnancy. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  17. Variation in Use of Prophylactic Antibiotics in Gynecologic Procedures Before and After an Educational Intervention.

    Science.gov (United States)

    Wu, Emily; Langsjoen, Jessica; Pruszynski, Jessica; Kuehl, Thomas J; Larsen, Wilma I

    2017-12-01

    Guidelines for use of prophylactic antibiotics in gynecologic procedures are outlined by the American Congress of Obstetricians and Gynecologists. There remains, however, a high rate of unindicated administration of antibiotics for surgeries. A retrospective study performed at our institution in 2012-2013 demonstrated that unindicated prophylactic antibiotics were administered over half the time. This study aimed to examine variations in the use of prophylactic antibiotics in patients undergoing gynecologic surgery at Scott and White Memorial Hospital and determine whether an educational intervention to gynecology physicians was associated with a significant decrease in unindicated prophylactic antibiotics. A retrospective chart review was performed for all women undergoing gynecologic surgery at Scott and White Memorial Hospital in Temple, Texas for 1 year. An educational intervention regarding prophylactic antibiotic usage was held for obstetricians and gynecologists in the middle of that year. Subjects were included if they had procedures with a Current Procedural Terminology code corresponding to a procedure that does not require prophylactic antibiotics. Subjects were excluded if they had concurrent procedures for which antibiotics are recommended. A total of 500 subjects met inclusion and exclusion criteria, with 243 before the educational intervention and 257 after the intervention. In our study, a significant decrease ( P gynecology oncology and reproductive endocrinology and infertility divisions had the highest rates of unindicated antibiotic use-91.7% (44/48) and 91.7% (33/36), respectively. The generalist and urogynecology divisions had the lowest rates for specialists before the intervention: 20.6% (30/146) and 30.8% (4/13), respectively. After the intervention, all of the divisions demonstrated an improvement in their rates of unindicated prophylactic antibiotic use. The urogynecology division demonstrated an improvement that can be considered

  18. Comparison of Laparoscopic Hysterectomy Morbidity for Gynecologic, Oncologic, and Benign Gynecologic Conditions

    Science.gov (United States)

    Mahdavi, Ali; Peiretti, Michele; Dennis, Sylvia

    2006-01-01

    Objectives: We compared the perioperative morbidity of laparoscopic hysterectomy for gynecologic oncologic (group A) and benign gynecologic (group B) indications at a single institution. Methods: This is a retrospective analysis of 159 consecutive cases of laparoscopic hysterectomy at a tertiary care university hospital. It includes 74 women with gynecologic cancers and 85 women with benign gynecologic conditions. Results: Patients in group A were significantly older and had higher body mass index (P≤0.001). The differences in mean blood loss (A, 201.1 mL; B, 183.6 mL, P=0.504), conversion to laparotomy (2 for each group), and wound infection (none) were not significant in the 2 groups. The mean operating time (253.2 and 188.2 minutes, P<0.001) and the mean length of hospital stay (3.5 days and 2.5 days, P<0.001) were significantly longer in group A. Transfusion was required for 2 patients in group A and 4 in group B. One intraoperative injury to the bladder occurred in group A. Conclusions: In spite of older age and longer operative time in cancer patients, there was no difference in perioperative complications associated with laparoscopic hysterectomy for gynecologic malignancies compared with benign gynecologic conditions. PMID:17575753

  19. CT and MR Imaging of Gynecologic Emergencies.

    Science.gov (United States)

    Iraha, Yuko; Okada, Masahiro; Iraha, Rin; Azama, Kimei; Yamashiro, Tsuneo; Tsubakimoto, Maho; Aoki, Yoichi; Murayama, Sadayuki

    2017-01-01

    Gynecologic emergencies include various diseases that result from adnexal and uterine disorders. Adnexal disorders may be classified into the following three categories: (a) disorders that cause hemorrhage (hemorrhagic ovarian cysts and ectopic pregnancies); (b) disorders related to adnexal tumors (adnexal torsion and rupture of ovarian tumors); and (c) disorders related to pelvic inflammatory disease, such as tubo-ovarian abscesses. Unusual adnexal torsion, such as massive ovarian edema, isolated fallopian tube torsion, and paraovarian cyst torsion, has also been described. Uterine disorders in gynecologic emergencies may be classified into two categories: (a) acute fibroid complications, including red degeneration of a uterine leiomyoma, torsion of subserosal myomas, and torsion of the uterus; and (b) causes of acute uterine bleeding, including retained products of conception and uterine arteriovenous malformations. Some gynecologic diseases are self-limited, while others cause infertility or life-threatening infection or bleeding if left untreated. Therefore, prompt and accurate diagnosis is important for appropriate life-saving treatment and for the preservation of fertility. The imaging findings are important when evaluating acute gynecologic diseases because the symptoms and physical examination findings are often nonspecific and limited. Ultrasonography is the first-line imaging modality; however, when a definitive diagnosis cannot be established, computed tomography (CT) and magnetic resonance (MR) imaging may narrow the differential diagnosis. Appropriate management requires radiologists to be familiar with the CT and MR imaging features of gynecologic emergencies. With respect to rare conditions, radiologists should take into account the representative findings presented in this article to increase diagnostic accuracy. © RSNA, 2017.

  20. Does lubrication of the vaginal speculum reduce pain during a gynecologic oncology examination?

    Science.gov (United States)

    Gungorduk, Kemal; Ozdemir, Aykut; Gökçü, Mehmet; Sancı, Muzaffer

    2015-01-01

    To evaluate the effectiveness of lubricant gel for reducing pain during a vaginal speculum examination (SE) in patients with gynecologic cancers. This non blind randomized controlled trial included 200 women who underwent SE for post-treatment surveillance. One-hundred patients each were allocated to the water and lubricant gel groups. All patients were asked to score their pain during speculum insertion, dilatation, and extraction using a visual analog scale (VAS). Pain intensity during speculum insertion was the primary outcome measure. There were no statistically significant differences in demographic characteristics between the water (n = 97) and lubricant gel (n = 98) groups. The VAS pain scores obtained during all phases of the SE were significantly lower in the lubricant gel group compared with the water group during the insertion (3.95 ± 1.57 vs. 5.28 ± 1.71, P gynecologic oncology patients. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Influence of perioperative administration of amino acids on thermoregulation response in patients underwent colorectal surgical procedures

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    Zeba Snježana

    2007-01-01

    Full Text Available Background. Hypothermia in the surgical patients can be the consequence of long duration of surgical intervention, general anesthesia and low temperature in operating room. Postoperative hypothermia contributes to a number of postoperative complications such as arrhythmia, myocardial ischemia, hypertension, bleeding, wound infection, coagulopathy, prolonged effect of muscle relaxants. External heating procedures are used to prevent this condition, but some investigations reported that infusion of aminoacids during surgery can induce thermogenesis and prevent postoperative hypothermia. Case report. We reported two males who underwent major colorectal surgery for rectal carcinoma. One patient received Aminosol 15% solution, 125 ml/h, while the other did not. The esophageal temperatures in both cases were measured every 30 minutes during the operation and 60 minutes after in Intensive Care Unit. We were monitoring blood pressure, heart rate, ECG, and shivering. Patient who received aminoacids showed ameliorated postoperative hypothermia without hypertension, arrhythmia, or shivering, while the other showed all symptoms mentioned above. Conclusion. According to literature data, as well as our findings, we can conclude that intraoperative intravenous treatment with amino acid solution ameliorates postoperative hypothermia along with its complications. .

  2. Improvement of Gynecological Screening of Female Renal Transplant Recipients by Self-Sampling for Human Papillomavirus Detection.

    Science.gov (United States)

    Hinten, Floor; Hilbrands, Luuk B; Meeuwis, Kim A; van Bergen-Verkuyten, Muriël C; Slangen, Brigitte F; van Rossum, Michelle M; Rahamat-Langendoen, Janette; Massuger, Leon F; de Hullu, Joanne A; Melchers, Willem J

    2017-01-01

    Female renal transplant recipients (RTRs) have increased risk for developing human papillomavirus (HPV)-related (pre)malignancies of the lower genital tract. Annual cervical screening is advised for RTRs, but the participation rate is low. The aim of this study is to investigate whether HPV self-sampling is suitable for gynecological screening of RTRs to increase participation rate. A large cohort of 253 RTRs was investigated for the prevalence of HPV. All participants received a device for a cervicovaginal self-sample. Questionnaires were sent to assess the experience with this device. High-risk (hrHPV) presence was determined with the SPF10-LiPA25 system and GP5+/6+ PCR. HrHPV-positive patients underwent gynecological examination. More than 90% of the patients rated their experience with the self-sample device as good to excellent, and 77% preferred self-sampling over a physician taken sample. Approximately thirty-five of 217 women tested hrHPV positive with SPF10- LiPA25, and 22 tested positive with the GP5+/6+ PCR. Eleven hrHPV-positive patients had clinically relevant gynecological abnormalities, and they all tested positive with GP5+/6+ PCR. Self-sampling is clinically applicable in a gynecological screening and is preferred by female RTRs. Therefore, self-sampling could be implemented with the aim to increase the participation rate of female RTRs in yearly gynecological screening.

  3. Gynecologic Oncologist Views Influencing Referral to Outpatient Specialty Palliative Care.

    Science.gov (United States)

    Hay, Casey M; Lefkowits, Carolyn; Crowley-Matoka, Megan; Bakitas, Marie A; Clark, Leslie H; Duska, Linda R; Urban, Renata R; Chen, Lee-May; Creasy, Stephanie L; Schenker, Yael

    2017-03-01

    Early specialty palliative care is underused for patients with advanced gynecologic malignancies. We sought to understand how gynecologic oncologists' views influence outpatient specialty palliative care referral to help inform strategies for improvement. We conducted a qualitative interview study at 6 National Cancer Institute-designated cancer centers with well-established outpatient palliative care services. Between September 2015 and March 2016, 34 gynecologic oncologists participated in semistructured telephone interviews focused on attitudes, experiences, and preferences related to outpatient specialty palliative care. A multidisciplinary team analyzed transcripts using constant comparative methods to inductively develop a coding framework. Through an iterative, analytic process, codes were classified, grouped, and refined into themes. Mean (SD) participant age was 47 (10) years. Mean (SD) interview length was 25 (7) minutes. Three main themes emerged regarding how gynecologic oncologists view outpatient specialty palliative care: (1) long-term relationships with patients is a unique and defining aspect of gynecologic oncology that influences referral, (2) gynecologic oncologists value palliative care clinicians' communication skills and third-party perspective to increase prognostic awareness and help negotiate differences between patient preferences and physician recommendation, and (3) gynecologic oncologists prefer specialty palliative care services embedded within gynecologic oncology clinics. Gynecologic oncologists value longitudinal relationships with patients and use specialty palliative care to negotiate conflict surrounding prognostic awareness or the treatment plan. Embedding specialty palliative care within gynecologic oncology clinics may promote communication between clinicians and facilitate gynecologic oncologist involvement throughout the illness course.

  4. Intensive postoperative glucose control reduces the surgical site infection rates in gynecologic oncology patients.

    Science.gov (United States)

    Al-Niaimi, Ahmed N; Ahmed, Mostafa; Burish, Nikki; Chackmakchy, Saygin A; Seo, Songwon; Rose, Stephen; Hartenbach, Ellen; Kushner, David M; Safdar, Nasia; Rice, Laurel; Connor, Joseph

    2015-01-01

    SSI rates after gynecologic oncology surgery vary from 5% to 35%, but are up to 45% in patients with diabetes mellitus (DM). Strict postoperative glucose control by insulin infusion has been shown to lower morbidity, but not specifically SSI rates. Our project studied continuous postoperative insulin infusion for 24h for gynecologic oncology patients with DM and hyperglycemia with a target blood glucose of controlled with intermittent subcutaneous insulin injections. Group 2 was composed of patients with DM and postoperative hyperglycemia whose blood glucose was controlled by insulin infusion. Group 3 was composed of patients with neither DM nor hyperglycemia. We controlled for all relevant factors associated with SSI. We studied a total of 372 patients. Patients in Group 2 had an SSI rate of 26/135 (19%), similar to patients in Group 3 whose rate was 19/89 (21%). Both were significantly lower than the SSI rate (43/148, 29%) of patients in Group 1. This reduction of 35% is significant (p = 0.02). Multivariate analysis showed an odd ratio = 0.5 (0.28-0.91) in reducing SSI rates after instituting this protocol. Initiating intensive glycemic control for 24h after gynecologic oncology surgery in patients with DM and postoperative hyperglycemia lowers the SSI rate by 35% (OR = 0.5) compared to patients receiving intermittent sliding scale insulin and to a rate equivalent to non-diabetics. Copyright © 2014. Published by Elsevier Inc.

  5. Assessing the prevalence of autoimmune, endocrine, gynecologic, and psychiatric comorbidities in an ethnically diverse cohort of female fibromyalgia patients: does the time from hysterectomy provide a clue?

    Directory of Open Access Journals (Sweden)

    Brooks L

    2015-08-01

    Full Text Available Larry Brooks,1 Joseph Hadi,2 Kyle T Amber,1 Michelle Weiner,3 Christopher L La Riche,4 Tamar Ference1 1Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, 2Anesco Interventional Pain Institute, Margate, 3Miami Pain and Diagnostics, Miami, 4Department of Psychiatry and Behavioral Health, Florida International University Wertheim College of Medicine, University Park, FL, USABackground: This retrospective chart review investigated differences in the prevalence of medical comorbidity between women with fibromyalgia (FM (n=219 and a control group women with chronic pain (CP without FM (n=116. The specific aims were to compare the prevalence of autoimmune, psychiatric, endocrine, gynecologic pathology, the relationship between timing of gynecologic surgery, and pain onset. We additionally sought to compare the number of comorbidities in an ethnically diverse cohort.Methods: This was a retrospective chart review of patients seen in FM or CP clinics at an academic medical center in 2009–2010.Results: Logistic regression modeling found that gynecologic, endocrine, and autoimmune diagnoses were independently associated with a diagnosis of FM. Detailed analyses showed that thyroid disease (P<0.01 and gynecologic surgery (P<0.05 were significantly more common in FM. Women with FM were more likely to have multiple autoimmune, endocrine, gynecologic, or psychiatric pathologies. A relationship was observed between the timing of gynecologic surgery and pain onset in FM, with more surgeries observed in the years just prior to pain onset or in the year after pain onset. A similar pattern was not found in the control group.Conclusion: This study demonstrates that autoimmune, endocrine, and gynecologic pathologies occur more commonly in women with FM than in those with CP, which is consistent with findings in less ethnically diverse samples. Moreover, a relationship was found between timing of pain onset and gynecologic

  6. Preferences and Outcomes for Chemotherapy Teaching in a Postgraduate Obstetrics and Gynecology Training Program.

    Science.gov (United States)

    Anderson, Matthew L; Ogunwale, Abayomi; Clark, Brian A; Kilpatrick, Charlie C; Mach, Claire M

    2015-01-01

    To determine whether chemotherapy teaching is a desired component of postgraduate training programs in obstetrics and gynecology and assess its effect on practicing clinicians. After obtaining institutional review board approval, 99 individuals who completed postgraduate training at a single academic medical center between 2005 and 2013 were invited to complete an online survey. Descriptive statistics were used to summarize responses. Of the 99 individuals, 68 (68%) completed the survey. Respondents included physicians currently practicing in both academic medicine (n = 36, 52.9%) and private practice (n = 24, 35.2%). Most respondents (n = 60, 88.2%) indicated that chemotherapy teaching was a desired feature of their training and expressed a preference for both formal didactics and direct clinical involvement (n = 55, 80.2%). Benefits identified by respondents included improved insight into the management of symptoms commonly associated with chemotherapy (n = 55, 82.1%) and an enhanced ability to counsel patients referred for oncology care (n = 48, 70.5%). All respondents who pursued training in gynecologic oncology following residency (n = 6) indicated that chemotherapy teaching favorably affected their fellowship experience. Of the 6 gynecologic oncologists, 3 (50%) who responded also indicated that chemotherapy teaching during residency improved their performance in fellowship interviews. Chemotherapy teaching was a desired feature of postgraduate training in general obstetrics and gynecology at the institution studied. Consideration should be given to creating curricula that incorporate the principles and practice of chemotherapy and address the needs of obstetrics and gynecology trainees who intend to pursue both general and subspecialty practice. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  7. The roles of pathology in targeted therapy of women with gynecologic cancers.

    Science.gov (United States)

    Murali, Rajmohan; Grisham, Rachel N; Soslow, Robert A

    2018-01-01

    The role of the pathologist in the multidisciplinary management of women with gynecologic cancer has evolved substantially over the past decade. Pathologists' evaluation of parameters such as pathologic stage, histologic subtype, grade and microsatellite instability, and their identification of patients at risk for Lynch syndrome have become essential components of diagnosis, prognostic assessment and determination of optimal treatment of affected women. Despite the use of multimodality treatment and combination cytotoxic chemotherapy, the prognosis of women with advanced-stage gynecologic cancer is often poor. Therefore, expanding the arsenal of available systemic therapies with targeted therapeutic agents is appealing. Anti-angiogenic therapies, immunotherapy and poly ADP ribose polymerase (PARP) inhibitors are now routinely used for the treatment of advanced gynecologic cancer, and many more are under investigation. Pathologists remain important in the clinical management of patients with targeted therapy, by identifying potentially targetable tumors on the basis of their pathologic phenotype, by assessing biomarkers that are predictive of response to targeted therapy (e.g. microsatellite instability, PD1/PDL1 expression), and by monitoring treatment response and resistance. Pathologists are also vital to research efforts exploring novel targeted therapies by identifying homogenous subsets of tumors for more reliable and meaningful analyses, and by confirming expression in tumor tissues of novel targets identified in genomic, epigenetic or other screening studies. In the era of precision gynecologic oncology, the roles of pathologists in the discovery, development and implementation of targeted therapeutic strategies remain as central as they are for traditional (surgery-chemotherapy-radiotherapy) management of women with gynecologic cancers. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Maintaining sexual health throughout gynecologic cancer survivorship: A comprehensive review and clinical guide.

    Science.gov (United States)

    Huffman, Laura B; Hartenbach, Ellen M; Carter, Jeanne; Rash, Joanne K; Kushner, David M

    2016-02-01

    The diagnosis and treatment of gynecologic cancer can cause short- and long-term negative effects on sexual health and quality of life (QoL). The aim of this article is to present a comprehensive overview of the sexual health concerns of gynecologic cancer survivors and discuss evidence-based treatment options for commonly encountered sexual health issues. A comprehensive literature search of English language studies on sexual health in gynecologic cancer survivors and the treatment of sexual dysfunction was conducted in MEDLINE databases. Relevant data are presented in this review. Additionally, personal and institutional practices are incorporated where relevant. Sexual dysfunction is prevalent among gynecologic cancer survivors as a result of surgery, radiation, and chemotherapy-negatively impacting QoL. Many patients expect their healthcare providers to address sexual health concerns, but most have never discussed sex-related issues with their physician. Lubricants, moisturizers, and dilators are effective, simple, non-hormonal interventions that can alleviate the morbidity of vaginal atrophy, stenosis, and pain. Pelvic floor physical therapy can be an additional tool to address dyspareunia. Cognitive behavioral therapy has been shown to be beneficial to patients reporting problems with sexual interest, arousal, and orgasm. Oncology providers can make a significant impact on the QoL of gynecologic cancer survivors by addressing sexual health concerns. Simple strategies can be implemented into clinical practice to discuss and treat many sexual issues. Referral to specialized sexual health providers may be needed to address more complex problems. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Barriers to Global Health Training in Obstetrics and Gynecology.

    Science.gov (United States)

    Pope, Rachel; Shaker, Maria; Ganesh, Prakash; Larkins-Pettigrew, Margaret; Pickett, Stephanie Deter

    The Lancet Commission on Global Surgery includes obstetrics and gynecology as an area needing international strengthening in low- and middle-income countries. Despite interest, a majority of participants in US residency programs graduate with little exposure to global health or preparation to work abroad. The aim of this study was to determine the level of interest of obstetrics and gynecology (Ob/Gyn) residents in gaining global health training and to identify perceived barriers to receiving training. Residents in accredited Ob/Gyn programs were identified using a national residency database. The survey was online and anonymous. A total of 278 residents completed the survey. A high level of motivation to participate in a global health elective was associated with interests in preparation for future global work, desire for activism in maternal health and social determinants of health, and becoming better informed on global health policy. Eighty-two percent of respondents stated they would participate in a global health curriculum if it were offered, and 54.8% would use their vacation time. There were associations between personal safety, family, lack of resources, and lack of interest from faculty and motivational level as perceived barriers. Eighty-one percent strongly agreed that scheduling conflicts and time constraints pose barriers; more than 80% either agreed or strongly agreed that funding such endeavors and a lack of mentorship are major deterrents to pursuing global health. Because resident motivation is clearly high and international need persists, we determined that most barriers to training abroad are related to the structure and budget of residency programs. Copyright © 2016. Published by Elsevier Inc.

  10. Safety culture in the gynecology robotics operating room.

    Science.gov (United States)

    Zullo, Melissa D; McCarroll, Michele L; Mendise, Thomas M; Ferris, Edward F; Roulette, G D; Zolton, Jessica; Andrews, Stephen J; von Gruenigen, Vivian E

    2014-01-01

    To measure the safety culture in the robotics surgery operating room before and after implementation of the Robotic Operating Room Computerized Checklist (RORCC). Prospective study. Gynecology surgical staff (n = 32). An urban community hospital. The Safety Attitudes Questionnaire domains examined were teamwork, safety, job satisfaction, stress recognition, perceptions of management, and working conditions. Questions and domains were described using percent agreement and the Cronbach alpha. Paired t-tests were used to describe differences before and after implementation of the checklist. Mean (SD) staff age was 46.7 (9.5) years, and most were women (78%) and worked full-time (97%). Twenty respondents (83% of nurses, 80% of surgeons, 66% of surgical technicians, and 33% of certified registered nurse anesthetists) completed the Safety Attitudes Questionnaire; 6 were excluded because of non-matching identifiers. Before RORCC implementation, the highest quality of communication and collaboration was reported by surgeons and surgical technicians (100%). Certified registered nurse anesthetists reported only adequate levels of communication and collaboration with other positions. Most staff reported positive responses for teamwork (48%; α = 0.81), safety (47%; α = 0.75), working conditions (37%; α = 0.55), stress recognition (26%; α = 0.71), and perceptions of management (32%; α = 0.52). No differences were observed after RORCC implementation. Quality of communication and collaboration in the gynecology robotics operating room is high between most positions; however, safety attitude responses are low overall. No differences after RORCC implementation and low response rates may highlight lack of staff support. Copyright © 2014. Published by Elsevier Inc.

  11. Recent advances in laparoscopic surgery.

    Science.gov (United States)

    Lee, Wei-Jei; Chan, Chien-Pin; Wang, Bing-Yen

    2013-02-01

    Laparoscopic surgery has been widely adopted and new technical innovation, procedures and evidence based knowledge are persistently emerging. This review documents recent major advancements in laparoscopic surgery. A PubMed search was made in order to identify recent advances in this field. We reviewed the recent data on randomized trials in this field as well as papers of systematic review. Laparoscopic cholecystectomy is the most frequently performed procedure, followed by laparoscopic bariatric surgery. Although bile duct injuries are relatively uncommon (0.15%-0.6%), intraoperative cholangiography still plays a role in reducing the cost of litigation. Laparoscopic bariatric surgery is the most commonly performed laparoscopic gastrointestinal surgery in the USA, and laparoscopic Nissen fundoplication is the treatment of choice for intractable gastroesophageal reflux disease. Recent randomized trials have demonstrated that laparoscopic gastric and colorectal cancer resection are safe and oncologically correct procedures. Laparoscopic surgery has also been widely developed in hepatic, pancreatic, gynecological and urological surgery. Recently, SILS and robotic surgery have penetrated all specialties of abdominal surgery. However, evidence-based medicine has failed to show major advantages in SILS, and the disadvantage of robotic surgery is the high costs related to purchase and maintenance of technology. Laparoscopic surgery has become well developed in recent decades and is the choice of treatment in abdominal surgery. Recently developed SILS techniques and robotic surgery are promising but their benefits remain to be determined. © 2012 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  12. The evaluation of relationship between prior uterine surgery and adenomyosis incidence

    Directory of Open Access Journals (Sweden)

    azin Alavi

    2016-05-01

    Full Text Available Background : Adenomyosis is a common benign disorder in premenopausal women. It may be presents with uterus enlargement, pelvic pain, abnormal uterine bleeding and dysmenorrheal. The main objective of this study was to assess prior uterine surgery was a risk factor for adenomyosis. Materials and Methods: In this cross-sectional study, we reviewed the medical records of all women who underwent hysterectomy for benign and nonemergency gynecologic condition between 2001 – 2006 in Shariate hospital of Bandar Abbas. Data included: age, gravidity, parity, abortion, prior uterine surgery and uterine size by physical examination before hysterectomy, were collected from the clinical records and the information about adenomyosis was obtained from pathology records. Analysis was done using SPSS-16, descriptive statistics, T test and ANOVA. Significant level was set as P<0.05. Results: Of the 191 participants , 72 (37.7% women had pathologically confirmed adenomyosis. The prevalence of adenomyosis in this study was 37.7%. women with adenomyosis reported a history of prior uterine surgery more frequently than women without adenomyosis but age, menarch, gravidity, parity and history of abortion were similar between the 2 groups. Conclusion: This study indicated that adenomyosis had significant correlation with prior uterine surgery. And, confirmed that we can decrease prevalence of adenomyosis with decreased unnessecery uterine surgery.

  13. Outcomes and Cost Analysis in High-Risk Patients Undergoing Simultaneous Free Flap Breast Reconstruction and Gynecologic Procedures.

    Science.gov (United States)

    Del Corral, Gabriel A; Wes, Ari M; Fischer, John P; Serletti, Joseph M; Wu, Liza C

    2015-11-01

    For patients with BRCA mutations, a simultaneous procedure that combines risk-reducing operation of the ovaries with mastectomy and breast reconstruction is an attractive option. The purpose of this study was to assess the outcomes and associated cost of performing simultaneous mastectomy, free flap breast reconstruction (FFR), and gynecologic procedure. A retrospective chart review was performed on patients who underwent bilateral FFR from 2005 to 2012. Four hundred twenty-two patients were identified who underwent bilateral breast reconstruction without a simultaneous gynecologic procedure. Forty-two patients were identified who underwent simultaneous FFR and gynecologic procedure. Clinical outcomes, medical and surgical complications, and hospital costs were analyzed and compared between the 2 groups. A total of 928 free flaps were performed on 464 patients. Forty-two patients had a simultaneous gynecologic procedure at the time of breast reconstruction. Twenty-three (54.8%) patients within the study group underwent simultaneous bilateral salpingo oophorectomy (BSO), whereas the other 19 (45.2%) underwent both total abdominal hysterectomy and BSO. Eighty-four free flaps were performed in this cohort (n = 48 muscle-sparing transverse rectus abdominis myocutaneous, n = 28 deep inferior epigastric perforator, n = 4 superficial inferior epigastric perforator, n = 4 transverse upper gracilis). Mean operative time was 573 minutes. Mean hospitalization was 5.3 days. Postoperatively, 4 patients experienced an anastomotic thrombosis; 2 patients had an arterial thrombosis and 2 patients had a venous thrombosis. There were 2 flap failures, 2 patients with mastectomy skin flap necrosis, 11 patients who developed breast wound healing complications, and 6 patients who developed abdominal wound healing complications. Surgical and medical complication rates did not differ significantly between those who had simultaneous procedures, and those who did not. There was a

  14. The Limited Utility of Currently Available Venous Thromboembolism Risk Assessment Tools in Gynecologic Oncology Patients

    Science.gov (United States)

    BARBER, Emma L; CLARKE-PEARSON, Daniel L

    2016-01-01

    BACKGROUND Use of risk assessment tools, such as the Caprini score or Rogers score, is recommended by national societies to stratify surgical patients by venous thromboembolism (VTE) risk and guide prophylaxis. However, these tools were not developed in a gynecologic oncology patient population and their utility in this population is unknown. OBJECTIVE To examine the ability of both the Caprini and Rogers score to stratify gynecologic oncology patients by risk of VTE. STUDY DESIGN Patients undergoing surgery for cervical, ovarian, uterine, vaginal and vulvar cancers between 2008 and 2013 were identified from the National Surgical Quality Improvement Database using ICD-9 codes. Caprini and Rogers scores were calculated for each patient based upon recorded demographic and procedure data. VTE events were recorded for 30 days postoperatively. Patients were categorized into risk groups based on calculated Caprini and Rogers scores and the incidence of VTE and 95% confidence interval was estimated for each of these groups. The relationship between risk score and VTE incidence was examined with Pearson’s correlation coefficient. RESULTS Of 17,713 patients, 1.8% developed a VTE. No patients were classified by the Caprini score as low risk, 0.1% were moderate risk, 3.0% were higher risk (score 4), and 96.9% were highest risk (score >=5). The Caprini score groupings did not correlate with VTE. The high-risk group had a paradoxically higher incidence of VTE of 2.5% compared to the highest risk group, 1.7% (p=0.40). However, when the highest risk group of the Caprini score was sub-stratified, it was highly correlated with VTE (R2=0.93). For the Rogers score, only 0.2% of patients were low risk (score 10). When the highest risk group of the Rogers score was sub-stratified, it was also highly correlated with VTE (R2=0.99). CONCLUSIONS Gynecologic oncology patients score very high on current VTE risk assessment models. The Caprini score is limited in its ability to discriminate

  15. Gynecological pelvic pain as emergency pathology.

    Science.gov (United States)

    Rivera Domínguez, A; Mora Jurado, A; García de la Oliva, A; de Araujo Martins-Romeo, D; Cueto Álvarez, L

    Acute pelvic pain is a common condition in emergency. The sources of acute pelvic pain are multifactorial, so it is important to be familiar with this type of pathologies. The purpose of this article is review the main causes of gynecological acute pelvic pain and their radiologic appearances to be able to make an accurate diagnosis and provide objective criteria for patient management. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Laparoscopy to Predict the Result of Primary Cytoreductive Surgery in Patients With Advanced Ovarian Cancer: A Randomized Controlled Trial.

    Science.gov (United States)

    Rutten, Marianne J; van Meurs, Hannah S; van de Vrie, Roelien; Gaarenstroom, Katja N; Naaktgeboren, Christiana A; van Gorp, Toon; Ter Brugge, Henk G; Hofhuis, Ward; Schreuder, Henk W R; Arts, Henriette J G; Zusterzeel, Petra L M; Pijnenborg, Johanna M A; van Haaften, Maarten; Fons, Guus; Engelen, Mirjam J A; Boss, Erik A; Vos, M Caroline; Gerestein, Kees G; Schutter, Eltjo M J; Opmeer, Brent C; Spijkerboer, Anje M; Bossuyt, Patrick M M; Mol, Ben Willem; Kenter, Gemma G; Buist, Marrije R

    2017-02-20

    Purpose To investigate whether initial diagnostic laparoscopy can prevent futile primary cytoreductive surgery (PCS) by identifying patients with advanced-stage ovarian cancer in whom > 1 cm of residual disease will be left after PCS. Patients and Methods This multicenter, randomized controlled trial was undertaken within eight gynecologic cancer centers in the Netherlands. Patients with suspected advanced-stage ovarian cancer who qualified for PCS were eligible. Participating patients were randomly assigned to either laparoscopy or PCS. Laparoscopy was used to guide selection of primary treatment: either primary surgery or neoadjuvant chemotherapy followed by interval surgery. The primary outcome was futile laparotomy, defined as a PCS with residual disease of > 1 cm. Primary analyses were performed according to the intention-to-treat principle. Results Between May 2011 and February 2015, 201 participants were included, of whom 102 were assigned to diagnostic laparoscopy and 99 to primary surgery. In the laparoscopy group, 63 (62%) of 102 patients underwent PCS versus 93 (94%) of 99 patients in the primary surgery group. Futile laparotomy occurred in 10 (10%) of 102 patients in the laparoscopy group versus 39 (39%) of 99 patients in the primary surgery group (relative risk, 0.25; 95% CI, 0.13 to 0.47; P laparoscopy group, three (3%) of 102 patients underwent both primary and interval surgery compared with 28 (28%) of 99 patients in the primary surgery group ( P laparoscopy reduced the number of futile laparotomies in patients with suspected advanced-stage ovarian cancer. In women with a plan for PCS, these data suggest that performance of diagnostic laparoscopy first is reasonable and that if cytoreduction to < 1 cm of residual disease seems feasible, to proceed with PCS.

  17. Impact of a Pediatric and Adolescent Gynecology Curriculum on an Obstetrics and Gynecology Residency.

    Science.gov (United States)

    Palaszewski, Dawn M; Miladinovic, Branko; Caselnova, Petra M; Holmström, Shelly W

    2016-12-01

    To determine the effectiveness of a new pediatric and adolescent gynecology (PAG) curriculum for improving obstetrics/gynecology resident physician knowledge and comfort level in patient management and to describe the current deficiencies in resident physician knowledge and comfort level in PAG. A PAG curriculum was implemented for the obstetrics/gynecology resident physicians (n = 20) at the University of South Florida in July 2013. Before and after the curriculum was introduced, resident physicians and recent graduates of the residency program completed a survey to assess their comfort level and a knowledge assessment consisting of 20 case-based questions. University-based residency program. Resident physicians and recent resident physician graduates in the Department of Obstetrics and Gynecology. Introduction of a PAG curriculum during the 2013-2014 academic year. Improvement in resident physicians' comfort level and knowledge in PAG. After the curriculum was introduced, comfort increased in examining the genitals of a pediatric gynecology patient (median difference = 1.5; P = .003) and history-taking, physical examination skills, and management (median difference = 1; P = .002) compared with before the curriculum. There was no significant difference in overall quiz score (15.5 ± 1.87 vs 15.8 ± 1.3; P = .78). A curriculum in PAG did improve resident comfort level in managing PAG patients, but did not significantly improve knowledge of this topic. Copyright © 2016.

  18. Gynecologic cancer disparities: a report from the Health Disparities Taskforce of the Society of Gynecologic Oncology.

    Science.gov (United States)

    Collins, Yvonne; Holcomb, Kevin; Chapman-Davis, Eloise; Khabele, Dineo; Farley, John H

    2014-05-01

    To review the extent of health disparities in gynecologic cancer care and outcomes and to propose recommendations to help counteract the disparities. We searched the electronic databases PubMed and the Cochrane Library. We included studies demonstrating quantifiable differences by race and ethnicity in the incidence, treatment, and survival of gynecologic cancers in the United States (US). Most studies relied on retrospective data. We focused on differences between Black and White women, because of the limited number of studies on non-Black women. White women have a higher incidence of ovarian cancer compared to Black women. However, the all-cause ovarian cancer mortality in Black women is 1.3 times higher than that of White women. Endometrial and cervical cancer mortality in Black women is twice that of White women. The etiology of these disparities is multifaceted. However, much of the evidence suggests that equal care leads to equal outcomes for Black women diagnosed with gynecologic cancers. Underlying molecular factors may play an additional role in aggressive tumor biology and endometrial cancer disparities. Gynecologic cancer disparities exist between Black and White women. The literature is limited by the lack of large prospective trials and adequate numbers of non-Black racial and ethnic groups. We conclude with recommendations for continued research and a multifaceted approach to eliminate gynecologic cancer disparities. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Identificação das características definidoras de medo e ansiedade em pacientes programadas para cirurgia ginecológica Identificación de las características definidoras de miedo y ansiedad en pacientes programadas para cirugía ginecológica Identification of the defining characteristics of fear and anxiety in patients scheduled for gynecological surgery

    Directory of Open Access Journals (Sweden)

    Maria Lucia Fernandez Suriano

    2009-01-01

    Full Text Available OBJETIVOS: Identificar a presença das características definidoras Medo e Ansiedade no pré-operatório imediato de 50 pacientes submetidas à cirurgia ginecológica, e verificar a Síndrome da Ansiedade Perioperatória. MÉTODOS: Estudo de coorte de caráter transversal teve como objetivo Realizado na Unidade de Ginecologia do Hospital São Paulo em maio de 2007. RESULTADOS: Confirmou-se a presença dos diagnósticos de interesse em 48 pacientes (96,0% do total de 50 mulheres (100,0%. A Síndrome da Ansiedade Perioperatória foi identificada em 48 (96,0% das pacientes. CONCLUSÃO: A pesquisa comprovou a presença dos diagnósticos Medo e Ansiedade, devido às manifestações clínicas, também contribuintes para evidenciar a Síndrome da Ansiedade PerioperatóriaOBJETIVOS: Identificar la presencia de las características definidoras de Miedo y Ansiedad en el pre-operatorio inmediato de 50 pacientes sometidas a cirugía ginecológica, y verificar el Síndrome de Ansiedad Perioperatoria. MÉTODOS: Este estudio de cohorte de carácter transversal tuvo como objetivo fue realizado en la Unidad de Ginecología del Hospital Sao Paulo en mayo del 2007. RESULTADOS: Se confirmó la presencia de los diagnósticos de interés en 48 pacientes (96,0% de un total de 50 mujeres (100,0%. El Síndrome de Ansiedad Perioperatoria fue identificada en 48 (96,0% de las pacientes. CONCLUSIÓN: Con la investigación se comprobó la presencia de los diagnósticos Miedo y Ansiedad, debido a las manifestaciones clínicas, también contribuyentes para evidenciar el Síndrome de Ansiedad Perioperatoria.OBJECTIVES: To identify defining characteristics of fear and anxiety during the immediate preoperative period in patient scheduled for gynecological surgery, and to diagnose preoperative anxiety syndrome. METHODS: This was a cross-sectional study with 50 patients from the gynecological unit of the São Paulo hospital. Data was collected in May 2007. RESULTS: Preoperative

  20. THREE-DIMENSIONAL ULTRASOUND IN GYNECOLOGIC ONCOLOGY

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    Iztok Takač

    2003-12-01

    Full Text Available Background. Although three-dimensional ultrasound (3D US imaging has been used for a decade, debate continues about its potential clinical aplications in gynecology. The same is true for the field of gynecologic oncology. Also, reports regarding usfulness of 3D US in gynecologic oncology are limited. A few potentially useful clinical applications have been described and some of these are now gaining general acceptance. In this paper, the usfulness of 3D US in the main areas of its application is demonstrated: diagnostics of cervical, endometrial, ovarian and breast cancer.Conclusions. An important advantage of 3D US over conventional two-dimensional imaging is the ability to reconstruct and display any arbitrarily chosen section within the volume dataset as well as ability to measure the volume of pelvic organs regardless of their shape. 3D US also allows the realtime analysis of the acquired image data to be conducted at a later time when the patient is off the examination table.

  1. Physicians' liability in obstetric and gynecology practice.

    Science.gov (United States)

    Mavroforou, Anna; Koumantakis, Evgenios; Michalodimitrakis, Emmanuel

    2005-03-01

    Litigation in obstetric and gynecologic practice has arisen as an important issue. This article aims to highlight issues related to malpractice in obstetrics and gynecology in order to point out several important aspects of medical practice, which may offer adequate professional protection. Search of the current relevant literature. The four most common clinical causes of medical litigation in obstetrics and gynecology are cases involving fetal distress, uterine rupture after a vaginal birth in a woman with a previous Cesarean section, shoulder dystocia, and misdiagnosis of breast cancer. Litigation raised in most of the cases is driven by bad outcomes and not by malpractice. Additionally, both juries and the public often expect perfection as the natural result of pregnancy and any deviation from this expectation has to be the result of someone's negligence. For this reason it has become mandatory for doctors in hospitals and private practices to acquire a sufficient knowledge relating to modem management, to document carefully in writing their procedural and management plans and to become familiar with the legal aspects of medical practice. Adequate communication and a written patient's consent form are of paramount importance. Maintenance of high standards in daily practice with continuous training, clear communication and a signed Patient's Informed Consent Form along with the appropriate documentation of any procedure carried out may provide professional safety to practicing obstetricians and gynecologists in case of medical litigation.

  2. Clinical outcomes for 14 consecutive patients with solid pseudopapillary neoplasms who underwent laparoscopic distal pancreatectomy.

    Science.gov (United States)

    Nakamura, Yoshiharu; Matsushita, Akira; Katsuno, Akira; Yamahatsu, Kazuya; Sumiyoshi, Hiroki; Mizuguchi, Yoshiaki; Uchida, Eiji

    2016-02-01

    The postoperative results of laparoscopic distal pancreatectomy for solid pseudopapillary neoplasm of the pancreas (SPN), including the effects of spleen-preserving resection, are still to be elucidated. Of the 139 patients who underwent laparoscopic pancreatectomy for non-cancerous tumors, 14 consecutive patients (average age, 29.6 years; 1 man, 13 women) with solitary SPN who underwent laparoscopic distal pancreatectomy between March 2004 and June 2015 were enrolled. The tumors had a mean diameter of 4.8 cm. Laparoscopic spleen-preserving distal pancreatectomy was performed in eight patients (spleen-preserving group), including two cases involving pancreatic tail preservation, and laparoscopic spleno-distal pancreatectomy was performed in six patients (standard resection group). The median operating time was 317 min, and the median blood loss was 50 mL. Postoperatively, grade B pancreatic fistulas appeared in two patients (14.3%) but resolved with conservative treatment. No patients had postoperative complications, other than pancreatic fistulas, or required reoperation. The median postoperative hospital stay was 11 days, and the postoperative mortality was zero.None of the patients had positive surgical margins or lymph nodes with metastasis. The median follow-up period did not significantly differ between the two groups (20 vs 39 months, P = 0.1368). All of the patients are alive and free from recurrent tumors without major late-phase complications. Laparoscopic distal pancreatectomy might be a suitable treatment for patients with SPN. A spleen-preserving operation is preferable for younger patients with SPN, and this study demonstrated the non-inferiority of the procedure compared to spleno-distal pancreatectomy. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  3. Radical Trachelectomy for Early-Stage Cervical Cancer: A Survey of the Society of Gynecologic Oncology and Gynecologic Oncology Fellows-in-Training.

    Science.gov (United States)

    Churchill, Sara J; Armbruster, Shannon; Schmeler, Kathleen M; Frumovitz, Michael; Greer, Marilyn; Garcia, Jaime; Redworth, Glenda; Ramirez, Pedro T

    2015-05-01

    The aim of this study was to survey gynecologic oncologists and fellows-in-training regarding the role of radical trachelectomy (RT) and conservative surgery in patients with early-stage cervical cancer. From June 2012 to September 2012, the Society of Gynecologic Oncology member practitioners (n = 1353) and gynecologic oncology fellows (n = 156) were sent group-specific surveys investigating current practice, training, and the future of RT for early-stage cervical cancer management. Twenty-two percent of practitioners (n = 303) and 24.4% of fellows (n = 38) completed the surveys. Of the practitioners, 50% (n = 148) report performing RT, 98% (n = 269) support RT as treatment for squamous carcinoma, and 71% (n = 195) confirm the use of RT for adenocarcinoma. Most practitioners offer RT treatment for stages IA2 to IB1 smaller than 2 cm (n = 209, 76.8%) regardless of grade (77.7%) or lymph vascular space invasion (n = 211, 79.3%). Only 8% (n = 23) of practitioners feel that RT is appropriate for stage IBI larger than 2 cm. Respectively, both practitioners and fellows most frequently perform robotic-assisted (47.0%, n = 101 and 59.1%, n = 13) and abdominal (40.5%, n = 87 and 68.2%, n = 15) RT approaches. After training, fellows project the use of robotic-assisted (71%, n = 22) or abdominal methods (58.1%, n = 18). Overall, 75% (n = 227) of practitioners and 60% (n = 23) of fellows speculate that over the next 5 years, less radical procedures will be used to manage early-stage cervical cancer. Our findings suggest that practitioners and fellows believe RT remains an option for early-stage cervical cancer patients. However, a significant proportion of all respondents believe that less radical surgery may be a future consideration for patients with low-risk early-stage cervical cancer.

  4. Simultaneous surgery in patients with both cardiac and noncardiac diseases

    Directory of Open Access Journals (Sweden)

    Yang Y

    2016-07-01

    Full Text Available Yang Yang,1 Feng Xiao,1 Jin Wang,1 Bo Song,1 Xi-Hui Li,1 Jian Li,2 Zhi-Song He,3 Huan Zhang,4 Ling Yin5 1Department of Cardiac Surgery, 2Department of Thoracic Surgery, 3Department of Urology Surgery, 4Department of General Surgery, 5Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People’s Republic of China Background: To investigate the possibility and feasibility of simultaneous cardiac and noncardiac surgery.Methods: From August 2000 to March 2015, 64 patients suffering from cardiac and noncardiac diseases have been treated by simultaneous surgeries.Results: Two patients died after operations in hospital; thus, the hospital mortality rate was 3.1%. One patient with coronary heart disease, acute myocardial infarction, and a recurrence of bladder cancer accepted emergency simultaneous coronary artery bypass grafting (CABG, bladder cystectomy, and ureterostomy. He died of acute cerebral infarction complicated with multiple organ failure on the 153rd day after operation. The other patient with chronic constrictive pericarditis and right lung cancer underwent pericardial stripping and right lung lower lobectomy, which resulted in multiple organ failure, and the patient died on the tenth day postoperatively. The remaining 62 patients recovered and were discharged. The total operative morbidity was 17.2%: postoperative hemorrhage (n, % [1, 1.6%], pulmonary infection and hypoxemia (2, 3.1%, hemorrhage of upper digestive tract (1, 1.6%, incisional infection (3, 4.7%, subphrenic abscess (1, 1.6%, and postoperative acute renal failure and hemofiltration (3, 4.7%. Of the 62 patients discharged, 61 patients were followed up. Eleven patients died with 10 months to 10 years during the follow-up. The mean survival time is 116.2±12.4 months. The cumulative survival rate is 50.8%.Conclusion: Simultaneous surgeries in patients suffering from both cardiac and noncardiac benign or malignant diseases are safe and possible

  5. Breast and Gynecologic Cancer | Division of Cancer Prevention

    Science.gov (United States)

    [[{"fid":"184","view_mode":"default","fields":{"format":"default","field_file_image_alt_text[und][0][value]":"Breast and Gynecologic Cancer Research Group Homepage Logo","field_file_image_title_text[und][0][value]":"Breast and Gynecologic Cancer Research Group Homepage Logo","field_folder[und]":"15"},"type":"media","attributes":{"alt":"Breast and Gynecologic Cancer Research Group Homepage Logo","title":"Breast and Gynecologic Cancer Research Group Homepage Logo","height":"266","width":"400"," | Prevention and early detection of breast, cervix, endometrial and ovarian cancers and their precursors.

  6. Comparative analysis of pain in patients who underwent total knee replacement regarding the tourniquet pressure

    Directory of Open Access Journals (Sweden)

    Marcos George de Souza Leão

    Full Text Available ABSTRACT OBJECTIVES: To evaluate through the visual analog scale (VAS the pain in patients undergoing total knee replacement (TKR with different pressures of the pneumatic tourniquet. METHODS: An observational, randomized, descriptive study on an analytical basis, with 60 patients who underwent TKR, divided into two groups, which were matched: a group where TKR was performed with tourniquet pressures of 350 mmHg (standard and the other with systolic blood pressure plus 100 mmHg (P + 100. These patients had their pain assessed by VAS at 48 h, and at the 5th and 15th days after procedure. Secondarily, the following were also measured: range of motion (ROM, complications, and blood drainage volume in each group; the data were subjected to statistical analysis. RESULTS: After data analysis, there was no statistical difference regarding the incidence of complications (p = 0.612, ROM (p = 0.202, bleeding after 24 and 48 h (p = 0.432 and p = 0.254 or in relation to VAS. No correlation was observed between time of ischemia compared to VAS and bleeding. CONCLUSIONS: The use of the pneumatic tourniquet pressure at 350 mmHg or systolic blood pressure plus 100 mmHg did not influence the pain, blood loss, ROM, and complications. Therefore the pressures at these levels are safe and do not change the surgery outcomes; the time of ischemia must be closely observed to avoid major complications.

  7. Congenital hydrocele: prevalence and outcome among male children who underwent neonatal circumcision in Benin City, Nigeria.

    Science.gov (United States)

    Osifo, O D; Osaigbovo, E O

    2008-06-01

    To determine the prevalence and spontaneous resolution of congenital hydrocele diagnosed in male neonates who underwent circumcision at our centre. All male neonates presented for circumcision at the University of Benin Teaching Hospital, Benin City, Nigeria between January 2002 and December 2006 were examined for the presence of hydrocele. Those diagnosed with this condition were recruited and followed up in a surgical outpatient clinic for 2 years. The number of cases of spontaneous resolution and age at which this occurred were documented on a structured pro forma. A total of 2715 neonates were circumcised and 128 (4.7%) were diagnosed with 163 cases of hydrocele, while 27 cases in 25 (0.9%) children failed to resolve at the age of 2 years. Neonatal hydrocele was bilateral in 112 (68.7%), and there were 20 (12.3%) right and 31 (19.0%) left. Among those with hydrocele, 28.1% were delivered preterm and resolution was spontaneous in many of them, with no observed significant statistical difference to those delivered full term (P=0.4740). Of the 163 hydrocele cases, 136 (83.4%) resolved spontaneously by age 18 months with peak resolution at 4-6 months. No spontaneous resolution occurred after 18 months and no hydrocele-related complication occurred during follow up. Neonates with congenital hydrocele should be observed for spontaneous resolution for at least 18 months before being subjected to surgery.

  8. Phase II clinical trial of robotic stereotactic body radiosurgery for metastatic gynecologic malignancies

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    Charles eKunos

    2012-12-01

    Full Text Available Background Recurrent gynecologic cancers are often difficult to manage without significant morbidity. We conducted a phase II study to assess the safety and the efficacy of ablative robotic stereotactic body radiosurgery (SBRT in women with metastatic gynecologic cancers. Methods A total of 50 patients with recurrent gynecologic cancer who had single or multiple (≤4 metastases underwent robotic-armed Cyberknife SBRT (24Gy/3 daily doses. Toxicities were graded prospectively by common toxicity criteria for adverse events (version 4.0. SBRT target responses were recorded following RECIST criteria (version 1.0. Rates of clinical benefit for SBRT and non-radiosurgical disease relapse were calculated. Disease-free and overall survivals were estimated by the Kaplan-Meier method and the Cox proportional hazards model was used to control for prognostic variables.Findings SBRT was safely delivered, with 49 (98% of 50 patients completing three prescribed fractions. The most frequent grade 2 or higher adverse events attributed to SBRT included fatigue (16%, nausea (8% and diarrhea (4%. One (2% grade 4 hyperbilirubinemia occurred. SBRT target response was 96% (48 of 50 patients. A 6-month clinical benefit was recorded in 34 (68% [95% CI, 53.2, 80.1] patients. No SBRT-targeted disease progressed. Non-radiosurgical disease relapse occurred in 31 (62% patients. Median disease-free survival was 7.8 months (95% CI, 4.0, 11.6. Median overall survival was 20.2 months (95% CI, 10.9, 29.5.Interpretation SBRT safely controlled metastatic gynecologic cancer targets. Given an observed high rate of non-radiosurgical disease relapse, a phase I trial assessing co-administration of SBRT and cytotoxic chemotherapy is underway.Funding Case Comprehensive Cancer Center

  9. Phase II Clinical Trial of Robotic Stereotactic Body Radiosurgery for Metastatic Gynecologic Malignancies

    International Nuclear Information System (INIS)

    Kunos, Charles A.; Brindle, James; Waggoner, Steven; Zanotti, Kristine; Resnick, Kimberly; Fusco, Nancy; Adams, Ramon; Debernardo, Robert

    2012-01-01

    Background: Recurrent gynecologic cancers are often difficult to manage without significant morbidity. We conducted a phase II study to assess the safety and the efficacy of ablative robotic stereotactic body radiosurgery (SBRT) in women with metastatic gynecologic cancers. Methods: A total of 50 patients with recurrent gynecologic cancer who had single or multiple (≤4) metastases underwent robotic-armed Cyberknife SBRT (24Gy/3 daily doses). Toxicities were graded prospectively by common toxicity criteria for adverse events (version 4.0). SBRT target responses were recorded following RECIST criteria (version 1.0). Rates of clinical benefit for SBRT and non-radiosurgical disease relapse were calculated. Disease-free and overall survivals were estimated by the Kaplan–Meier method and the Cox proportional hazards model was used to control for prognostic variables. Findings: SBRT was safely delivered, with 49 (98%) of 50 patients completing three prescribed fractions. The most frequent grade 2 or higher adverse events attributed to SBRT included fatigue (16%), nausea (8%), and diarrhea (4%). One (2%) grade four hyperbilirubinemia occurred. SBRT target response was 96% (48 of 50 patients). A 6-month clinical benefit was recorded in 34 [68% (95% CI, 53.2, 80.1)] patients. No SBRT targeted disease progressed. Non-radiosurgical disease relapse occurred in 31 (62%) patients. Median disease-free survival was 7.8 months (95% CI, 4.0, 11.6). Median overall survival was 20.2 months (95% CI, 10.9, 29.5). Interpretation: SBRT safely controlled metastatic gynecologic cancer targets. Given an observed high rate of non-radiosurgical disease relapse, a phase I trial assessing co-administration of SBRT and cytotoxic chemotherapy is underway. Funding: Case Comprehensive Cancer Center.

  10. Place of radiation therapy for the treatment of gynecologic and urologic tumors in 1994

    International Nuclear Information System (INIS)

    Maulard-Durdux, C.; Housset, M.

    1995-01-01

    External-beam radiation therapy and brachytherapy are currently used both as curative and as palliative therapy in patients with gynecologic and urologic tumors. Ionizing radiation plays a key role in the locoregional control of uterine and prostatic tumors, in particular in combination with surgery. External-beam radiation therapy in combination with concomitant radiosensitizing chemotherapy may allow conservation of the bladder in patients with infiltrating vesical tumors classically treated by cystectomy. It has beneficial effects on some of the most incapacitating complications of these cancers: its hemostatic effect is valuable in patients with vaginal bleeding or hematuria and it relieves the pain due to bone metastases, which are particularly common in prostatic cancer. Furthermore, use of high energy accelerators, development of better imaging techniques, and advances in dosimetry have substantially reduced the rate of delayed radiation-induced complications. Thus, external-beam radiation therapy and brachytherapy are important tools for the treatment of gynecologic and urologic tumors. A discussion is provided of the role of radiation therapy in the four most common types of gynecologic and urologic cancer: cancers of the prostate, bladder, uterine cervix, and uterine corpus. (authors). 52 refs., 2 tabs

  11. Detection of peritoneal dissemination in gynecological malignancy: evaluation by diffusion-weighted MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Fujii, Shinya; Matsusue, Eiji; Kanasaki, Yoshiko; Nakanishi, Junko; Sugihara, Shuji; Ogawa, Toshihide [Tottori University, Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Yonago (Japan); Kanamori, Yasunobu; Kigawa, Junzo; Terakawa, Naoki [Tottori University, Division of Reproductive-Perinatal Medicine and Gynecological Oncology, Department of Surgery, Faculty of Medicine, Yonago (Japan)

    2008-01-15

    The aim of this study is to evaluate the usefulness of diffusion-weighted (DW) magnetic resonance (MR) imaging in detecting peritoneal dissemination in cases of gynecological malignancy. We retrospectively analyzed MR images obtained from 26 consecutive patients with gynecological malignancy. Peritoneal dissemination was histologically diagnosed in 15 of the 26 patients after surgery. We obtained DW images and half-Fourier single-shot turbo-spin-echo images in the abdomen and pelvis, and then generated fusion images. Coronal maximum-intensity-projection images were reconstructed from the axial source images. Reader interpretations were compared with the laparotomy findings in the surgical records. Receiver-operating characteristic (ROC) curves were used to represent the presence of peritoneal dissemination. In addition, the sensitivity and specificity were calculated. DW imaging depicted the tumors in 14 of 15 patients with peritoneal dissemination as abnormal signal intensity. ROC analysis yielded Az values of 0.974 and 0.932 for the two reviewers. The mean sensitivity and specificity were 90 and 95.5%. DW imaging plays an important role in the diagnosis and therapeutic management of patients with gynecological malignancy. (orig.)

  12. MR imaging in gynecology and obstetrics

    International Nuclear Information System (INIS)

    Bauer, M.; Tontsch, P.; Schulz-Wendtland, R.

    2000-01-01

    The toolbook covers the full range of indications for MRI in obstetrics and gynecology. It is the joint work of radiologists and obstetrician-gynecologists and supplies state-of-the-art information needed by doctors in the private practice or a hospital department. Examples from the Table of Contents: Physical principles of MRI, applications and performance aspects. Systematic presentation of diagnostic findings for comparative analysis and assessment. Biological effects and risks. Benign and malignant neoplasms of the mammary glands and the female genital organs. MRI for prenatal care and diagnostic evaluation. New method: MR spectroscopy. (orig./CB) [de

  13. Epidemiology of gynecologic cancers in China

    OpenAIRE

    Jiang, Xiyi; Tang, Huijuan; Chen, Tianhui

    2017-01-01

    Cancer has become a major disease burden across the globe. It was estimated that 4.29 million new incident cases and 2.81 million death cases of cancer would occur in 2015 in China, with the age-standardized incidence rate (ASIR) of 201.1 per 100,000 and age-standardized mortality rate (ASMR) of 126.9 per 100,000, respectively. For females, 2 of the top 10 most common types of cancer would be gynecologic cancers, with breast cancer being the most prevalent (268.6 thousand new incident cases) ...

  14. Gynecologic and other infections in pregnancy.

    Science.gov (United States)

    Torres, Mercedes; Moayedi, Siamak

    2012-11-01

    The treatment of gynecologic and other infections in obstetric patients involves consideration of the physiologic changes of pregnancy, the clinical implications of the infection for the patient as well as the fetus, and the safety of antimicrobials available for therapy. This article highlights the treatment of infections of the vagina, uterus, and urinary tract, with a focus on how therapy changes in obstetric patients. In addition, the emergency department management of other clinically important infections in pregnancy, such as those caused by the human immunodeficiency virus, influenza viruses, methicillin-resistant Staphylococcus aureus, Parvovirus, Listeria, and others is reviewed. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Argon Beam Coagulator in Breast Surgery: Effect on the Incidence of Breast Seroma.

    Science.gov (United States)

    Lefemine, Valentina; Cornish, Julie A; Abou-Samra, Walid

    2011-12-01

    Although Argon Beam Coagulators (ABCs) are widely used in urological and gynecological procedures, there have been only two studies published so far on their use and benefits in breast surgery. This study compares the incidence of breast seroma following mastectomy upon the use of ABC versus standard monopolar diathermy. This is a retrospective cohort study, with data collected from January 2006 to August 2008 for all patients who underwent a simple mastectomy and axillary surgery. Outcomes included incidence of seroma, amount of drainage on day of discharge, and timing of seroma formation. Fifty-six patients were studied, with 30 undergoing simple mastectomy using ABC diathermy and 25 using simple diathermy. The incidence of postoperative breast seroma development was 30% (n = 9) in the former group and 36% (n = 9) in the latter. In the ABC group, a high postoperative drainage at discharge was predictive of developing a seroma; this was not observed in the monopolar group. The search for methods to reduce the incidence of seroma in breast surgery is ongoing worldwide. Despite a previous report, this study failed to show any significant difference between ABC and monopolar diathermy in the incidence of breast seroma formation following simple mastectomy and axillary surgery. ABC diathermy is more costly, and its use needs to be carefully considered in an era of a stretched National Health Service financial budget.

  16. Committee opinion no. 607: Gynecologic concerns in children and adolescents with cancer.

    Science.gov (United States)

    2014-08-01

    Advancements in radiation therapy, chemotherapy, surgery, and multimodal treatment have dramatically improved childhood cancer survival. However, cancer and its treatment may have immediate or delayed adverse effects on reproductive health. Gynecologists should be prepared to manage gynecologic concerns in young cancer patients and survivors before, during, and after their treatment. Gynecologists may be consulted regarding pubertal concerns; heavy menstrual bleeding and anemia; sexuality; contraception; ovarian function, including fertility preservation; and breast and cervical cancer screening. The science of fertility preservation is a rapidly evolving field; therefore, a referral to a reproductive endocrinologist is recommended to explore the full range of available options.

  17. Interobserver Reproducibility Among Gynecologic Pathologists in Diagnosing Heterologous Osteosarcomatous Component in Gynecologic Tract Carcinosarcomas.

    Science.gov (United States)

    Sangoi, Ankur R; Kshirsagar, Malti; Roma, Andres A; Horvai, Andrew E; Chivukula, Mamatha; Ellenson, Lora H; Fadare, Oluwole; Folkins, Ann K; Garg, Karuna; Hanley, Krisztina; Longacre, Teri A; Haas, Jacqueline; McCluggage, W Glenn; McKenney, Jesse K; Nucci, Marisa R; Oliva, Esther; Park, Kay J; Parkash, Vinita; Quick, Charles M; Rabban, Joseph T; Rutgers, Joanne K L; Soslow, Robert; Vang, Russell; Yemelyanova, Anna; Zaloudek, Charles; Beck, Andrew H

    2017-07-01

    Distinguishing hyalinized stroma from osteoid production by a heterologous osteosarcomatous component can be challenging in gynecologic tract carcinosarcomas. As heterologous components in a carcinosarcoma may have prognostic and therapeutic implications, it is important that these are recognized. This study examines interobserver reproducibility among gynecologic pathologists in the diagnosis of osteosarcomatous components, and its correlation with expression of the novel antibody SATB2 (marker of osteoblastic differentiation) in these osteosarcomatous foci. Digital H&E images from 20 gynecologic tract carcinosarcomas were reviewed by 22 gynecologic pathologists with a request to determine the presence or absence of an osteosarcomatous component. The 20 preselected cases included areas of classic heterologous osteosarcoma (malignant cells producing osteoid; n=10) and osteosarcoma mimics (malignant cells with admixed nonosteoid matrix; n=10). Interobserver agreement was evaluated and SATB2 scored on all 20 cases and compared with the original diagnoses. Moderate agreement (Fleiss' κ=0.483) was identified for the 22 raters scoring the 20 cases with a median sensitivity of 7/10 and a median specificity of 9/10 for the diagnosis of osteosarcoma. SATB2 showed 100% sensitivity (10/10) and 60% (6/10) specificity in discriminating classic osteosarcoma from osteosarcoma mimics. Utilizing negative SATB2 as a surrogate marker to exclude osteosarcoma, 73% (16/22) of the reviewers would have downgraded at least 1 case to not contain an osteosarcomatous component (range, 1-6 cases, median 1 case). Gynecologic pathologists demonstrate only a moderate level of agreement in the diagnosis of heterologous osteosarcoma based on morphologic grounds. In such instances, a negative SATB2 staining may assist in increasing accuracy in the diagnosis of an osteosarcomatous component.

  18. Analgesia pós-operatória multimodal em cirurgia ginecológica videolaparoscópica ambulatorial: comparação entre parecoxib e tenoxicam Analgesia pos-operatoria multimodal en cirugía ginecológica videolaparoscópica ambulatorial: comparación entre parecoxib y tenoxican Multimodal analgesia in outpatient videolaparoscopic gynecologic surgery: comparison between parecoxib and tenoxicam

    Directory of Open Access Journals (Sweden)

    Sérgio D. Belzarena

    2005-04-01

    tenoxican venoso en un estudio doblemente encubierto. MÉTODO: Fueron estudiadas prospectivamente 60 pacientes divididas de forma aleatoria en 2 grupos. Todas recibieron sedación pre-operatoria con midazolan. Un de los grupos (P recibió antes de iniciar la cirugía 40 mg de parecoxib y en el otro (T 20 mg de tenoxican. En la sala de operación fue hecha raquianestesia con bupivacaína y sufentanil. La analgesia pos-operatoria fue evaluada mediante la intensidad del dolor con escalas verbal y visual, localización del dolor (incisional, visceral, en el hombro y el consumo de analgésicos suplementares. Fueron registrados los efectos colaterales adversos La satisfacción de la paciente con la técnica fue pesquisada. RESULTADOS: La calidad analgésica fue excelente, con 76% de las pacientes del grupo P y 83% de las pacientes del grupo T sin queja de dolor y tampoco el uso de analgésicos en el pos-operatorio. No hubo diferencia entre los grupos en todos los criterios y períodos de evaluación analgésica. La incidencia de efectos adversos fue pequeña, no obstante, prurito de intensidad leve y de corta duración ocurrió frecuentemente. Todas las pacientes quedaron satisfechas o también muy satisfechas con la técnica empleada. CONCLUSIONES: Una técnica de analgesia multimodal, con un componente de anestésico local y opioide por vía subaracnóidea asociado con AINE venoso produce analgesia pos-operatoria de excelente calidad con pocos efectos colaterales adversos en cirugía videolaparoscópica ginecológica ambulatorial. La elección del AINE no parece importante para la obtención de estos resultados.BACKGROUND AND OBJECTIVES: The quality of postoperative analgesia in patients submitted to outpatient videolaparoscopic gynecologic surgery was evaluated by comparing the effects of intravenous parecoxib and tenoxicam in a double-blind study. METHODS: Participated in this prospective study 60 patients who were randomly divided into two groups. All patients were

  19. [Consequences of increasing and ageing population of Basse-Normandie on gynecology and obstetrics activity].

    Science.gov (United States)

    Mandon, M; Macé, J-M; Dreyfus, M; Berger, L

    2015-11-01

    In Basse-Normandie, the population over 65 years old will expend more rapidly between 2007 and 2042 (+11.6%) than the rest of the French population (+9.2%). The same population of Basse-Normandie will get old in the 15 years to come. The impact of these demographic changes over the activity in the gynecology-obstetrics field is not clearly identified. Although we cannot predict the technical and scientific developments in the next 15 years, we are presenting a model allowing to hypothesize about changes of gynecology and obstetrics according to population's aging. We have established a projection model for the realizable surgical acts in obstetrics and gynecology in accordance with the aging of the population in Basse-Normandie. The study was realized based on the acts concerning the cesarean sections (C-section), tubal sterilization, hysteroscopy and hysterectomy as well as ovarectomy and breast surgery. For each activity branch, the codes of the Classification commune des actes médicaux (CCAM) were selected and then removed from the Programme médicalisé des systèmes d'information (PMSI) database. We have used and adapted the Omphale model of the National Statistics and Economical Studies Institute and we have applied it for the period of 2009-2025. Our projection model has permeated to show a 5.5% regression of the C-section acts, a 2% incretion of the hysterectomies and hysteroscopies, 7.7% of ovarectomies as well as a 9.8% augmentation of the breast surgeries. However, we predict a 11.8% diminution of the sterilizations by tubal implants. Globally, the activity in obstetrics and gynecology will remain constant with an insignificant augmentation of 46 acts (0.01%). In Basse-Normandie, the surgical activity in gynecology-obstetrics will moderately increase in the next 15 years. This constant activity signifies that there is no need to form more residents than the number of practitioner to retire. The interest of this model is that it is applicable at a

  20. Sources of pain in laparoendoscopic gynecological surgeons: An analysis of ergonomic factors and proposal of an aid to improve comfort.

    Directory of Open Access Journals (Sweden)

    Sa Ra Lee

    Full Text Available Minimally invasive surgery (MIS offers cosmetic benefits to patients; however, surgeons often experience pain during MIS. We administered an ergonomic questionnaire to 176 Korean laparoscopic gynecological surgeons to determine potential sources of pain during surgery. Logistic regression analysis was used to identify factors that had a significant impact on gynecological surgeons' pain. Operating table height at the beginning of surgery and during the operation were significantly associated with neck and shoulder discomfort (P <0.001. The ability to control the operating table height was the single factor most significantly associated with neck (P <0.001 and shoulder discomfort (P <0.001. Discomfort of the hand/digits was significantly associated with the trocar site (P = 0.035. The type of electrocautery activation switch and foot pedal were significantly related to surgeons' foot and leg discomfort (P <0.001. In evaluating the co-occurrence of pain in 4 different sites (neck, shoulder, back, hand/digits, the neck and shoulder were determined to have the highest co-occurrence of pain (Spearman's ρ = 0.64, P <0.001. These results provide guidance for identifying ergonomic solutions to reduce gynecological laparoscopic surgeons' pain. Based on our results, we propose the use of an ergonomic surgical step stool to reduce physical pain related to performing laparoscopic operations.

  1. Endometrial aspiration cytology in gynecological disorders

    Directory of Open Access Journals (Sweden)

    Meenal V Jadhav

    2016-01-01

    Full Text Available Context: Endometrial aspiration is not a popular modality for the study of the endometrium despite its simplicity and potential utility. Aim: The present study was aimed at evaluating the utility of endometrial aspiration in various gynecological disorders. Materials and Methods: In this diagnostic accuracy study, 55 prospectively registered women with various gynecological disorders were evaluated clinically and subjected to endometrial aspiration cytology and study of endometrial histology. Endometrial aspiration was performed by infant feeding tube in 10 cases and intra cath cannula in 45 cases. The slides were stained with rapid Papanicolaou (PAP stain and Leishman stain. Results: Endometrial aspiration cytology showed 90% and 94.6% sampling adequacy with infant feeding tube and intra cath cannula, respectively. Intra cath cannula was very convenient to handle and superior to infant feeding tube in aspirating the endometrium. Of the two stains used, rapid PAP stain was less time-consuming and superior to Leishman stain in studying the nuclear details. Leishman stain was helpful in detecting cytoplasmic vacuoles of secretory endometrium. Overall diagnostic accuracy of endometrial cytology was 90.4% while that for morphological hormonal evaluation was 97.6%. It enjoyed a sensitivity of 91.66%, a specificity of 88.23%, positive predictive value of 94.28%, and negative predictive value of 83.33%. Conclusion: Intra cath cannula emerged as an inexpensive, effective, and convenient device for endometrial aspiration. Endometrial aspiration proved to be a fairly effective, simple, and informative diagnostic modality.

  2. The representations of adolescents about gynecological consultation

    Directory of Open Access Journals (Sweden)

    Vera Lúcia de Oliveira Gomes

    2014-06-01

    Full Text Available Objective: To analyze the social representation of adolescents about gynecological consultation and the influence of those in searching for consultations. Method: Qualitative descriptive study based on the Social Representations Theory, conducted with 50 adolescents in their last year of middle school. The data was collected between April and May of 2010 by Evocations and a Focal Group. The software EVOC and contextual analysis were used in the data treatment. Results: The elements fear and constraint, constant in the central nucleus, can justify the low frequency of adolescents in consultations. The term embarrassment in the peripheral system reinforce current sociocultural norms, while prevention, associated with learning about sex and clarifying doubts, allows to envision an educative function. Obtained testimonies in the focal groups exemplify and reinforce those findings. Conclusion: For an effective health education, professionals, including nurses, need to clarify the youth individually and collectively about their rights to privacy, secrecy, in addition to focus the gynecological consultation as a promotion measure to sexual and reproductive health.

  3. Clinical outcomes research in gynecologic oncology.

    Science.gov (United States)

    Melamed, Alexander; Rauh-Hain, J Alejandro; Schorge, John O

    2017-09-01

    Clinical outcomes research seeks to understand the real-world manifestations of clinical care. In particular, outcomes research seeks to reveal the effects of pharmaceutical, procedural, and structural aspects of healthcare on patient outcomes, including mortality, disease control, toxicity, cost, and quality of life. Although outcomes research can utilize interventional study designs, insightful use of observational data is a defining feature of this field. Many questions in gynecologic oncology are not amenable to investigation in randomized clinical trials due to cost, feasibility, or ethical concerns. When a randomized trial is not practical or has not yet been conducted, well-designed observational studies have the potential to provide the best available evidence about the effects of clinical care. Such studies may use surveys, medical records, disease registries, and a variety of administrative data sources. Even when a randomized trial has been conducted, observational studies can be used to estimate the real-world effect of an intervention, which may differ from the results obtained in the controlled setting of a clinical trial. This article reviews the goals, methodologies, data sources, and limitations of clinical outcomes research, with a focus on gynecologic oncology. Copyright © 2017. Published by Elsevier Inc.

  4. Culturally sensitive gynecologic care in adolescence.

    Science.gov (United States)

    Pons, José Enrique

    2012-01-01

    Culturally sensitive gynecologic care means rendering gynecologic care taking into account adolescents' needs, problems and feelings, as seen by adolescents themselves. Adolescence is a period of turmoil, where limits are being tested and risks taken. A certain degree of rebellion is necessary and normal. In contemporary societies, risk-taking behaviors seem to outnumber any previous historical period. Antagonistic depictions of 'two worlds', transforms the question into one between a culture and a counterculture. Sometimes, the perspectives are exaggerated by attitudes of superiority, leading to inadequate or punitive practices. Health providers need to confront their own prejudices, so as to understand that in their role as health workers, what adolescents ask for is help to cope with their problems in the fields that professionals are qualified for, but not to behave as policemen, judges or priests. Adolescents also need help to overcome resistance to formal environments. In order to achieve success, they have to have the opportunity to be heard and to participate in tailoring programs. These undertakings should be aimed at contributing to health promotion, encouraging self-care and reaffirming confidence in adolescents' responsibility, while generating trust in health services and professionals. Copyright © 2012 S. Karger AG, Basel.

  5. Robotic surgery: changing the surgical approach for endometrial cancer in a referral cancer center.

    Science.gov (United States)

    Peiretti, Michele; Zanagnolo, Vanna; Bocciolone, Luca; Landoni, Fabio; Colombo, Nicoletta; Minig, Lucas; Sanguineti, Fabio; Maggioni, Angelo

    2009-01-01

    To study the effect of robotic surgery on the surgical approach to endometrial cancer in a gynecologic oncology center over a short time. Prospective analysis of patients with early-stage endometrial cancer who underwent robotic surgery. Teaching hospital. Eighty patients who underwent robotic surgery. Between November 2006 and October 2008, 80 consecutive patients with an initial diagnosis of endometrial cancer consented to undergo robotic surgery at the European Institute of Oncology, Milan, Italy. We collected all patient data for demographics, operating time, estimated blood loss, histologic findings, lymph node count, analgesic-free postoperative day, length of stay, and intraoperative and early postoperative complications. Mean (SD) patient age was 58.3 (11.5) years (95% confidence interval [CI], 55.7-60.9). Body mass index was 25.2 (6.1) kg/m(2) (95% CI, 23.6-26.7). In 3 patients (3.7%), conversion to conventional laparotomy was required. Mean operative time was 181.1 (63.1) minutes (95% CI, 166.7-195.5). Mean docking time was 4.5 (1.1) minutes (95% CI, 2.2-2.7). Mean hospital stay was 2.5 (1.1) days (95% CI, 2.2-2.7), and 93% of patients were analgesic-free on postoperative day 2. Over a relatively short time using the da Vinci surgical system, we observed a substantial change in our surgical activity. For endometrial cancer, open surgical procedures decreased from 78% to 35%. Moreover, our preliminary data confirm that surgical robotic staging for early-stage endometrial cancer is feasible and safe. Age, obesity, and previous surgery do not seem to be contraindications.

  6. Global epidemiology of hysterectomy: possible impact on gynecological cancer rates

    DEFF Research Database (Denmark)

    Hammer, Anne; Rositch, Anne; Kahlert, Johnny Abildgaard

    2015-01-01

    Despite the fact that hysterectomy is the most common surgical procedure worldwide in gynecology, national reporting of the incidence rate of gynecological cancers rarely removes the proportion no longer at risk of the disease from the population-at-risk-denominator (ie. women who have had a hyst...

  7. Ultrasonography in obstetrics and gynecology, 2nd edition

    International Nuclear Information System (INIS)

    Callen, P.W.

    1988-01-01

    A text on obstetric and gynecologic ultrasound for radiologists, OB/GYN practitioners, and radiologic technicians. The second edition places greater emphasis on diagnosis of specific systemic disorders in the fetus, as well as the most current applications of ultrasound in gynecologic diagnosis

  8. Incidence and survival of gynecologic sarcomas in England.

    Science.gov (United States)

    Francis, Matthew; Dennis, Nicola L; Hirschowitz, Lynn; Grimer, Robert; Poole, Jason; Lawrence, Gill; Nordin, Andy

    2015-06-01

    Gynecologic sarcomas account for approximately 3% to 4% of all gynecologic malignancies and are associated with poor outcomes compared with gynecologic carcinomas. The aim of this study is to report the incidence and survival rates of the main gynecologic sarcomas using national English cancer registration data. Records of gynecologic sarcomas diagnosed between 1985 and 2008 were extracted from the English National Cancer Data Repository. ICD-O3 morphology codes were used to assign tumor records to specific histologic subgroups. Incidence and 5-year relative survival rates were calculated. There were 5316 new cases of gynecologic sarcoma diagnosed in England between 1985 and 2008. Incidence rates increased significantly in the early 1990s, probably due to coding changes. Age-specific incidence rates were highest in women aged between 45 and 64 years. In the most recent period studied (2001-2008), incidence rates fluctuated between 8 and 9.6 per million. The most common anatomical site was the uterus (83% of all diagnoses), and the most common histologic diagnosis was leiomyosarcoma (52% of all diagnoses). Overall 5-year relative survival increased significantly between 1985-1989 and 2000-2004, from 34% to 48%. Gynecologic sarcoma incidence rates have varied little since 1993, whereas survival has improved significantly. These results are consistent with previously published small series and case studies, and provide a more complete picture of gynecologic sarcoma incidence and survival patterns in England.

  9. Parecoxib increases muscle pain threshold and relieves shoulder pain after gynecologic laparoscopy: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Zhang HF

    2016-09-01

    Full Text Available Hufei Zhang,1,* Xinhe Liu,2,* Hongye Jiang,3 Zimeng Liu,4 Xu-Yu Zhang,1 Hong-Zhe Xie,3 1Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 2Department of Anesthesiology, Shenzhen Hospital, University of Hong Kong, Shenzhen, 3Department of Obstetrics and Gynecology, 4Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China *These authors contributed equally to this work Objectives: Postlaparoscopic shoulder pain (PLSP remains a common problem after laparoscopies. The aim of this study was to investigate the correlation between pressure pain threshold (PPT of different muscles and PLSP after gynecologic laparoscopy, and to explore the effect of parecoxib, a cyclooxygenase-2 inhibitor, on the changes of PPT.Materials and methods: The patients were randomly allocated into two groups; group P and group C. In group P, parecoxib 40 mg was intravenously infused at 30 minutes before surgery and 8 and 20 hours after surgery. In group C, normal saline was infused at the corresponding time point. PPT assessment was performed 1 day before surgery and at postoperative 24 hours by using a pressure algometer at bilateral shoulder muscles (levator scapulae and supraspinatus and forearm (flexor carpi ulnaris. Meanwhile, bilateral shoulder pain was evaluated through visual analog scale score at 24 hours after surgery. Results: Preoperative PPT level of the shoulder, but not of the forearm, was significantly and negatively correlated with the intensity of ipsilateral PLSP. In group C, PPT levels of shoulder muscles, but not of forearm muscles, decreased after laparoscopy at postoperative 24 hours. The use of parecoxib significantly improved the decline of PPT levels of bilateral shoulder muscles (all P<0.01. Meanwhile, parecoxib reduced the incidence of PLSP (group P: 45% vs group C: 83.3%; odds ratio: 0.164; 95% confidence interval: 0.07–0.382; P<0

  10. Robotic surgery

    Science.gov (United States)

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  11. Long-Term Survivors Using Intraoperative Radiotherapy for Recurrent Gynecologic Malignancies

    International Nuclear Information System (INIS)

    Tran, Phuoc T.; Su Zheng; Hara, Wendy; Husain, Amreen; Teng, Nelson; Kapp, Daniel S.

    2007-01-01

    Purpose: To analyze the outcomes of therapy and identify prognostic factors for patients treated with surgery followed by intraoperative radiotherapy (IORT) for gynecologic malignancies at a single institution. Methods and Materials: We performed a retrospective review of 36 consecutive patients treated with IORT to 44 sites with mean follow-up of 50 months. The primary site was the cervix in 47%, endometrium in 31%, vulva in 14%, vagina in 6%, and fallopian tubes in 3%. Previous RT had failed in 72% of patients, and 89% had recurrent disease. Of 38 IORT sessions, 84% included maximal cytoreductive surgery, including 18% exenterations. The mean age was 52 years (range, 30-74), mean tumor size was 5 cm (range, 0.5-12), previous disease-free interval was 32 months (range, 0-177), and mean IORT dose was 1,152 cGy (range, 600-1,750). RT and systemic therapy after IORT were given to 53% and 24% of the cohort, respectively. The outcomes measured were locoregional control (LRC), distant metastasis-free survival (DMFS), disease-specific survival (DSS), and treatment-related complications. Results: The Kaplan-Meier 5-year LRC, DMFS, and DSS probability for the whole group was 44%, 51%, and 47%, respectively. For cervical cancer patients, the Kaplan-Meier 5-year LRC, DMFS, and DSS estimate was 45%, 60%, and 46%, respectively. The prognostic factors found on multivariate analysis (p ≤ 0.05) were the disease-free interval for LRC, tumor size for DMFS, and cervical primary, previous surgery, and locoregional relapse for DSS. Our cohort had 10 Grade 3-4 complications associated with treatment (surgery and IORT) and a Kaplan-Meier 5-year Grade 3-4 complication-free survival rate of 72%. Conclusions: Survival for pelvic recurrence of gynecologic cancer is poor (range, 0-25%). IORT after surgery seems to confer long-term local control in carefully selected patients

  12. Optical coherence tomography in gynecology: a narrative review

    Science.gov (United States)

    Kirillin, Mikhail; Motovilova, Tatiana; Shakhova, Natalia

    2017-12-01

    Modern gynecologic practice requires noninvasive diagnostics techniques capable of detecting morphological and functional alterations in tissues of female reproductive organs. Optical coherence tomography (OCT) is a promising tool for providing imaging of biotissues with high resolution at depths up to 2 mm. Design of the customized probes provides wide opportunities for OCT use in gynecology. This paper contains a retrospective insight into the history of OCT employment in gynecology, an overview of the existing gynecologic OCT probes, including those for combination with other diagnostic modalities, and state-of-the-art application of OCT for diagnostics of tumor and nontumor pathologies of female genitalia. Perspectives of OCT both in diagnostics and treatment planning and monitoring in gynecology are overviewed.

  13. Subspecialist training in surgical gynecological oncology in the nordic countries

    DEFF Research Database (Denmark)

    Antonsen, Sofie L; Avall-Lundqvist, Elisabeth; Salvesen, Helga B

    2011-01-01

    To survey the centers that can provide subspecialty surgical training and education in gynecological oncology in the Nordic countries we developed an online questionnaire in cooperation with the Nordic Society of Gynecological Oncology. The link to the survey was mailed to 22 Scandinavian...... gynecological centers in charge of surgical treatment of cancer patients. Twenty centers (91%) participated. Four centers reported to be accredited European subspecialty training centers, a further six were interested in being accredited, and 11 centers were accredited by the respective National Board. Fourteen...... (74%) centers were interested in being listed for exchange of fellows. Our data show a large Nordic potential and interest in improving the gynecologic oncology standards and can be used to enhance the awareness of gynecological oncology training in Scandinavia and to facilitate the exchange...

  14. Improving quality and decreasing cost in gynecologic oncology care. Society of gynecologic oncology recommendations for clinical practice.

    Science.gov (United States)

    Rimel, B J; Burke, William M; Higgins, Robert V; Lee, Paula S; Lutman, Christopher V; Parker, Lynn

    2015-05-01

    To identify potential cost savings in gynecologic oncology care without sacrificing quality. Members of the Clinical Practice Committee of the Society of Gynecologic Oncology were asked to review current practice patterns in gynecologic oncology and assess the potential for cost savings founded on evidence-based medicine and current guidelines. Five clinical practices were identified including the following: vaginal cytology for endometrial cancer survivors; colposcopy for low grade cytologic abnormalities for cervical cancer survivors; routine imaging studies for gynecologic cancer survivors; screening for ovarian cancer with serum biomarkers and ultrasound; and improving palliative care for gynecologic cancer patients. Review of the published literature and guidelines were performed to make evidence-based recommendations for cost effective quality gynecologic oncology care. • Do not perform Pap tests of the vaginal cuff in patients with a history of endometrial cancer. • Do not perform colposcopy for low grade Pap tests in women with a history of cervical cancer. • Avoid routine imaging for cancer surveillance in asymptomatic women with gynecologic cancer, specifically ovarian, endometrial, cervical, vulvar and vaginal cancer. • Do not screen women at low risk for ovarian cancer with ultrasound or CA-125 or other biomarkers. • Do not delay basic level palliative care for women with advanced or relapsed gynecologic cancer, do refer to a palliative care specialist when needed, and avoid unnecessary treatments at life's end. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. The ongoing emergence of robotics in plastic and reconstructive surgery.

    Science.gov (United States)

    Struk, S; Qassemyar, Q; Leymarie, N; Honart, J-F; Alkhashnam, H; De Fremicourt, K; Conversano, A; Schaff, J-B; Rimareix, F; Kolb, F; Sarfati, B

    2018-02-02

    Robot-assisted surgery is more and more widely used in urology, general surgery and gynecological surgery. The interest of robotics in plastic and reconstructive surgery, a discipline that operates primarily on surfaces, has yet to be conclusively proved. However, the initial applications of robotic surgery in plastic and reconstructive surgery have been emerging in a number of fields including transoral reconstruction of posterior oropharyngeal defects, nipple-sparing mastectomy with immediate breast reconstruction, microsurgery, muscle harvesting for pelvic reconstruction and coverage of the scalp or the extremities. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  16. Sinus surgery: optimal surgery, optimal outcome?

    NARCIS (Netherlands)

    Fokkens, Wytske J.

    2016-01-01

    Sinus surgery remains an issue of discussion. We lack data on a number of important issues. In this issue of the journal Jiang et al. show that 67 % of their patients who underwent FESS for CRS had OSAS (of which more than half moderate to severe) but only 38% complained of daytime sleepiness

  17. Surgical outcomes of 380 patients with double outlet right ventricle who underwent biventricular repair.

    Science.gov (United States)

    Li, Shoujun; Ma, Kai; Hu, Shengshou; Hua, Zhongdong; Yang, Keming; Yan, Jun; Chen, Qiuming

    2014-09-01

    The study objective was to report the outcomes of biventricular repair in patients with double outlet right ventricle. Patients with double outlet right ventricle who underwent biventricular repair at Fuwai Hospital from January 2005 to December 2012 were included. Patients were excluded if double outlet right ventricle was combined with atrioventricular septal defect, heterotaxy syndrome, atrioventricular discordance, or univentricular physiology. A total of 380 consecutive patients with a mean age of 1.9 ± 2.1 years (range, 1 month to 6 years) were included. Varied types of biventricular repair were customized individually. Follow-up was 90.4% complete, and the mean follow-up time was 3.4 ± 3.9 years. There were 17 (4.5%) early deaths and 7 (2.1%) late deaths. Preoperative pulmonary hypertension was the only risk factor for early mortality. Postoperative significant left ventricular outflow tract obstruction was present in 9 survivors. Patients with noncommitted ventricular septal defect had a longer crossclamp time, longer cardiopulmonary bypass time, and higher incidence of postdischarge left ventricular outflow tract obstruction. There were 4 reoperations, all of which were caused by subaortic left ventricular outflow tract obstruction. All of the pressure gradients were decreased to less than 20 mm Hg after the modified Konno procedure with an uneventful postoperative course. Optimal results of varied types of biventricular repair for double outlet right ventricle have been acquired. Although noncommitted ventricular septal defect is technically difficult, the outcomes of patients are favorable. Late-onset left ventricular outflow tract obstruction is the main reason for reoperation but can be successfully relieved by the modified Konno procedure. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  18. Prediction of Pathological Complete Response Using Endoscopic Findings and Outcomes of Patients Who Underwent Watchful Waiting After Chemoradiotherapy for Rectal Cancer.

    Science.gov (United States)

    Kawai, Kazushige; Ishihara, Soichiro; Nozawa, Hiroaki; Hata, Keisuke; Kiyomatsu, Tomomichi; Morikawa, Teppei; Fukayama, Masashi; Watanabe, Toshiaki

    2017-04-01

    Nonoperative management for patients with rectal cancer who have achieved a clinical complete response after chemoradiotherapy is becoming increasingly important in recent years. However, the definition of and modality used for patients with clinical complete response differ greatly between institutions, and the role of endoscopic assessment as a nonoperative approach has not been fully investigated. This study aimed to investigate the ability of endoscopic assessments to predict pathological regression of rectal cancer after chemoradiotherapy and the applicability of these assessments for the watchful waiting approach. This was a retrospective comparative study. This study was conducted at a single referral hospital. A total of 198 patients with rectal cancer underwent preoperative endoscopic assessments after chemoradiotherapy. Of them, 186 patients underwent radical surgery with lymph node dissection. The histopathological findings of resected tissues were compared with the preoperative endoscopic findings. Twelve patients refused radical surgery and chose watchful waiting; their outcomes were compared with the outcomes of patients who underwent radical surgery. The endoscopic criteria correlated well with tumor regression grading. The sensitivity and specificity for a pathological complete response were 65.0% to 87.1% and 39.1% to 78.3%. However, endoscopic assessment could not fully discriminate pathological complete responses, and the outcomes of patients who underwent watchful waiting were considerably poorer than the patients who underwent radical surgery. Eventually, 41.7% of the patients who underwent watchful waiting experienced uncontrollable local failure, and many of these occurrences were observed more than 3 years after chemoradiotherapy. The number of the patients treated with the watchful waiting strategy was limited, and the selection was not randomized. Although endoscopic assessment after chemoradiotherapy correlated with pathological response

  19. Randomized controlled trial of enoxaparin versus intermittent pneumatic compression for venous thromboembolism prevention in Japanese surgical patients with gynecologic malignancy.

    Science.gov (United States)

    Nagata, Chie; Tanabe, Hiroshi; Takakura, Satoshi; Narui, Chikage; Saito, Motoaki; Yanaihara, Nozomu; Okamoto, Aikou

    2015-09-01

    The aim of this study was to compare the efficacy and safety of enoxaparin and intermittent pneumatic compression (IPC) for venous thromboembolism (VTE) prevention in Japanese surgical patients with gynecologic malignancy. Patients ≥ 40 years old undergoing major surgery for gynecologic malignancy without preoperative VTE were included. Written informed consent was obtained. Enrolled patients received IPC immediately before surgery. After surgery, they were randomly assigned to either an enoxaparin group or an IPC-alone group. The enoxaparin group received enoxaparin injection (20 mg, subcutaneous, every 12 h) from postoperative day 2 to 8. IPC was discontinued after the first injection. In the IPC-alone group, IPC was continued until full ambulation. The primary end-point was incidence of VTE, including pulmonary embolism and deep vein thrombosis, regardless of symptoms. An interim analysis was to be conducted when the first 30 patients had completed the study protocol. A Data and Safety Monitoring Board was established for making recommendation on the continuation or termination of the study based on the interim results. At the time of the interim analysis, six cases of VTE were found: five in the IPC-alone group and one in the enoxaparin group (Fisher's exact test, P = 0.08). Three patients in the IPC-alone group developed pulmonary embolism, but none in the enoxaparin group did so (Fisher's exact test, P = 0.10). The study was terminated following the Data and Safety Monitoring Board's recommendation. Enoxaparin might have lowered the risk of VTE among surgical patients with gynecologic malignancy. Further studies are necessary to confirm this. © 2015 Japan Society of Obstetrics and Gynecology.

  20. Compliance with research standards within gynecologic oncology fellowship: A Gynecologic Oncology Fellowship Research Network (GOFRN) study.

    Science.gov (United States)

    Moulton, Laura J; Michener, Chad M; Levinson, Kimberly; Cobb, Lauren; Tseng, Jill; Jernigan, Amelia

    2017-09-01

    Participation in clinical and basic science research is emphasized in gynecologic oncology training. We sought to identify trends in adherence to expected research practices and reasons for non-adherence among gynecologic oncology fellows. An anonymous 31-question online survey assessing academic behaviors, including IRB compliance, authorship assignment, data sharing, and potential barriers to non-adherence was distributed to all SGO gynecologic oncology fellow members in July 2016. Descriptive statistics and univariate analyses were performed. Of 190 members, 35.3% (n=67) responded. 73% (n=49) of respondents reported personal non-compliance and 79.1% (n=53) reported having witnessed others being non-complaint with at least one expected research practice. Areas of compliance failure included changing a research question without appropriate IRB amendment (20%; n=14), conducting research under a nonspecific IRB (13.9%; n=9), and performing research without IRB approval (6.1%; n=4). Longer institutional time for IRB approval was significantly associated with IRB non-adherence (p1000 patients. Thirty respondents (45.5%) assigned authorship to someone who failed to meet ICMJE criteria and twelve (18.5%) accepted authorship without meeting ICMJE criteria. Most commonly cited reasons for non-adherence were: cumbersome IRB processes (80.3%), pressure from senior authors (78.8%), fear of someone else publishing first, (74.2%) and lack of support navigating appropriate research practices (71.2%). Fellow non-compliance with expected research practices is high, particularly with regards to secure storage of PHI and appropriate authorship assignment. Time-consuming and cumbersome IRB procedures, perceived pressure from senior authors, and lack of research support contribute to non-adherence. Further support and education of gynecologic oncology fellows is needed in order to help address these barriers. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Assessment of palliative care training in gynecologic oncology: A gynecologic oncology fellow research network study

    Science.gov (United States)

    Eskander, Ramez N.; Osann, Kathryn; Dickson, Elizabeth; Holman, Laura L.; Rauh-Hain, J. Alejandro; Spoozak, Lori; Wu, Eijean; Krill, Lauren; Fader, Amanda Nickles; Tewari, Krishnansu S.

    2014-01-01

    Objective Palliative care is recognized as an important component of oncologic care. We sought to assess the quality/quantity of palliative care education in gynecologic oncology fellowship. Methods A self-administered on-line questionnaire was distributed to current gynecologic oncology fellow and candidate members during the 2013 academic year. Descriptive statistics, bivariate and multivariate analyses were performed. Results Of 201 fellow and candidate members, 74.1% (n = 149) responded. Respondents were primarily women (75%) and white (76%). Only 11% of respondents participated in a palliative care rotation. Respondents rated the overall quality of teaching received on management of ovarian cancer significantly higher than management of patients at end of life (EOL), independent of level of training (8.25 vs. 6.23; p Gynecologic oncology fellow/candidate members reported insufficient palliative care education. Those respondents reporting higher quality EOL training felt more prepared to care for dying patients and to address complications commonly encountered in this setting. PMID:24887355

  2. Women's experiences of the gynecologic examination: factors associated with discomfort.

    Science.gov (United States)

    Hilden, Malene; Sidenius, Katrine; Langhoff-Roos, Jens; Wijma, Barbro; Schei, Berit

    2003-11-01

    The aim of this study was to evaluate how women experience the gynecologic examination and to assess possible factors associated with experiencing discomfort during the gynecologic examination. Consecutive patients visiting the Department of Obstetrics and Gynecology at Glostrup County Hospital, Denmark, were invited to participate in the study, and received a postal questionnaire that included questions about the index visit, obstetric and gynecologic history and sexual abuse history. The response rate was 80% (n = 798). The degree of discomfort during the gynecologic examination was indicated on a scale from 0 to 10. Experiencing discomfort was defined as a score of 6 or more, based on the 75th percentile. Discomfort during the gynecologic examination was strongly associated with a negative emotional contact with the examiner and young age. Additionally, dissatisfaction with present sexual life, a history of sexual abuse and mental health problems such as depression, anxiety and insomnia were significantly associated with discomfort. The emotional contact between patient and examiner seemed to have great importance when focusing on discomfort during the gynecologic examination. Furthermore, we found that discomfort was associated with a number of factors that are seldom known to the gynecologists, such as sexual abuse history, mental health problems and patients' sexual life. Gynecologists need to focus on the emotional contact and to reevaluate issues for communication before the examination.

  3. Extreme Sport/Adventure Activity Correlates in Gynecologic Cancer Survivors.

    Science.gov (United States)

    Crawford, Jennifer J; Vallance, Jeff K; Holt, Nicholas L; Courneya, Kerry S

    2016-03-01

    We examined the demographic, medical and behavioral correlates of participation and interest in extreme sport/adventure activities (ESAA) in gynecologic cancer survivors. A random sample of 621 gynecologic cancer survivors in Alberta, Canada, completed a mailed self-report questionnaire assessing medical, demographic, and behavioral variables and participation and interest in ESAA. Multivariate analyses revealed that gynecologic cancer survivors were more likely to participate in ESAA if they met aerobic exercise guidelines (OR=1.75 [95%CI:1.02-2.99]), had better general health (OR=1.71 [95%CI: 1.01-2.90]), had cervical or ovarian cancer (OR=1.95 [95%CI:0.97-3.93]), were employed (OR=1.71 [95%CI:0.95-3.08]), and were of healthy weight (OR=1.58 [95%CI:0.93-2.68]). Moreover, gynecologic cancer survivors were more likely to be interested in trying an ESAA if they had cervical or ovarian cancer (OR=1.76 [95%CI:0.94-3.27]) and were meeting the strength exercise guidelines (OR=1.68 [95%CI:0.95-2.98]). Medical, demographic, and behavioral variables correlate with participation and interest in ESAA in gynecologic cancer survivors. The pattern of correlates suggests that gynecologic cancer survivors are more likely to participate in ESSA if they have the physical capability and financial resources. Interventions to promote ESAA in gynecologic cancer survivors need to address these 2 key barriers.

  4. Diaphragmatic surgery during primary cytoreduction for advanced ovarian cancer: peritoneal stripping versus diaphragmatic resection.

    Science.gov (United States)

    Zapardiel, Ignacio; Peiretti, Michele; Zanagnolo, Vanna; Biffi, Roberto; Bocciolone, Luca; Landoni, Fabio; Aletti, Giovanni; Colombo, Nicoletta; Maggioni, Angelo

    2011-12-01

    Standard approach for medically stable advanced ovarian cancer patients should be primary cytoreduction following platinum-based chemotherapy. The aim of surgical effort should be the complete removal of all visible disease. Our objective was to compare perioperative features, postoperative complications, and secondarily oncological outcomes of patients who underwent diaphragmatic stripping with those who underwent diaphragmatic resection for advanced ovarian cancer. One hundred twelve cases were identified, among them 79 underwent diaphragmatic stripping and 33 underwent diaphragmatic full-thickness resection. Data collected included patients' age, all perioperative details and pathological findings, International Federation of Gynecology and Obstetrics stage, adjuvant therapy, and follow-up data. Larger residual tumors (mean, 5.1 vs 1.6 mm, respectively; P < 0.01) but shorter operating time (25 minutes shorter operative time, P = 0.07) were observed in the stripping group. Higher postoperative pleural effusions rates (63.6% vs 37.9%, P = 0.01), but no differences in the remaining complications, were observed in the resection group. After a mean of 31 months of follow-up, disease-free survival rates were 27.8% in the stripping group and 39.4% in the resection group (P = 0.04). No significant differences were observed for overall survival. Diaphragmatic surgery at the time of primary cytoreductive surgery for advanced ovarian cancer may contribute to the achievement of complete cytoreduction with low perioperative complication rate; full-thickness resection is preferable if peritoneum stripping will not achieve a complete removal of the disease.

  5. Gynecologic cancer prevention in Lynch syndrome/hereditary nonpolyposis colorectal cancer families.

    Science.gov (United States)

    Chen, Lee-may; Yang, Kathleen Y; Little, Sarah E; Cheung, Michael K; Caughey, Aaron B

    2007-07-01

    Women from Lynch syndrome/hereditary nonpolyposis colorectal cancer (Lynch/HNPCC) families have an increased lifetime risk of developing endometrial and ovarian cancer. This study models a comparison of management strategies for women who carry a Lynch/HNPCC mutation. A decision analytic model with three arms was designed to compare annual gynecologic examinations with annual screening (ultrasonography, endometrial biopsy, CA 125) and with hysterectomy with bilateral salpingo-oophorectomy at age 30 years The existing literature was searched for studies on the accuracy of endometrial and ovarian cancer screening using endometrial biopsy, transvaginal ultrasonography, and serum CA 125. The Surveillance, Epidemiology and End Results database from 1988 to 2001 was used to estimate cancer mortality outcomes. In the surgical arm, 0.0056% of women were diagnosed with ovarian cancer and 0.0060% of women with endometrial cancer. These numbers increased to 3.7% and 18.4% in women being screened, and 8.3% and 48.7% in women undergoing annual examinations, respectively. Surgical management led to the longest expected survival time at 79.98 years, followed by screening at 79.31 years, and annual examinations at 77.41 years. If starting at age 30 and discounting life years at 3%, surgery still leads to the greatest expected life years. When comparing prophylactic surgery with the screening option, one would need to perform 75 surgeries to save one woman's entire life. For cancer prevention, however, only 28 and 6 prophylactic surgeries would need to be performed to prevent one case of ovarian and endometrial cancer, respectively. Risk-reducing hysterectomy and bilateral salpingo-oophorectomy may be considered in women with Lynch/HNPCC to prevent gynecologic cancers and their associated morbidities.

  6. The Usefulness of Ultrasound Imaging in Gynecologic Oncology.

    Science.gov (United States)

    Woodfield, Courtney A

    2018-04-01

    Pelvic ultrasound examination is the primary imaging modality for evaluating a wide range of female pelvic symptomatology, and is often the first imaging test to detect a gynecologic malignancy. Ultrasound imaging is particularly useful for evaluating the thickness and appearance of the endometrium in patients with abnormal bleeding, and in detecting and characterizing ovarian lesions. This article reviews the ultrasound appearance of gynecologic neoplasms grouped by anatomic site of origin, the ultrasound appearance of select benign pelvic pathology not to be misinterpreted as malignancy, as well as available ultrasound imaging-based guidelines for managing potential gynecologic neoplasms. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Association of Hysteroscopic vs Laparoscopic Sterilization With Procedural, Gynecological, and Medical Outcomes.

    Science.gov (United States)

    Bouillon, Kim; Bertrand, Marion; Bader, Georges; Lucot, Jean-Philippe; Dray-Spira, Rosemary; Zureik, Mahmoud

    2018-01-23

    Safety of hysteroscopic sterilization has been recently questioned following reports of general symptoms such as allergy, tiredness, and depression in addition to associated gynecological results such as pelvic pain, perforation of fallopian tubes or uterus, and unwanted pregnancy. To compare the risk of reported adverse events between hysteroscopic and laparoscopic sterilization. French nationwide cohort study using the national hospital discharge database linked to the health insurance claims database. Women aged 30 to 54 years receiving a first hysteroscopic or laparoscopic sterilization between 2010 and 2014 were included and were followed up through December 2015. Hysteroscopic sterilization vs laparoscopic sterilization. Risks of procedural complications (surgical and medical) and of gynecological (sterilization failure that includes salpingectomy, second sterilization procedure, or pregnancy; pregnancy; reoperation) and medical outcomes (all types of allergy; autoimmune diseases; thyroid disorder; use of analgesics, antimigraines, antidepressants, benzodiazepines; outpatient visits; sickness absence; suicide attempts; death) that occurred within 1 and 3 years after sterilization were compared using inverse probability of treatment-weighted Cox models. Of the 105 357 women included (95.5% of eligible participants; mean age, 41.3 years [SD, 3.7 years]), 71 303 (67.7% ) underwent hysteroscopic sterilization, and 34 054 (32.3%) underwent laparoscopic sterilization. During the hospitalization for sterilization, risk of surgical complications for hysteroscopic sterilization was lower: 0.13% for hysteroscopic sterilization vs 0.78% for laparoscopic sterilization (adjusted risk difference [RD], -0.64; 95% CI, -0.67 to -0.60) and was lower for medical complications: 0.06% vs 0.11% (adjusted RD, -0.05; 95% CI, -0.08 to -0.01). During the first year after sterilization, 4.83% of women who underwent hysteroscopic sterilization had a higher risk of sterilization

  8. Assessment of quality of life of patients who underwent anterior cruciate ligament reconstruction and a rehabilitation program

    Directory of Open Access Journals (Sweden)

    Moises Cohen

    2004-12-01

    Full Text Available Introduction: Quality of life can be defined as the expression of aconceptual model that tries to represent patient’s perspectivesand his/her level of satisfaction expressed by numbers. Theobjective of this study is to evaluate the parameters of quality oflife of 23 patients who underwent surgery for anterior cruciateligament reconstruction. Methods: We adopted SF-36, a generichealth-related evaluation questionnaire, to obtain informationregarding several aspects of patients’ health conditions, and theLysholm questionnaire, specific to evaluate the symptoms andfunction of the knee. The questionnaires were applied at two stagesof the treatment: pre- and postoperatively (after the rehabilitationprogram. Results: Before surgery, the Lysholm questionnairepresented the following results: excellent in 4% of the cases, goodin 22%, fair in 22%, and poor in 52%. After surgery (Lysholm e SF-36 the correlation level was approximately 44% (p = 0.041.Discussion: The correlation between the Lysholm and the SF-36questionnaires showed the following: the lower the level of pain,the higher the Lysholm score. The high scores presented by theLysholm questionnaire are directly proportional to physical andemotional aspects, and to functional capacity. Conclusion:Analysis of both questionnaires, as well as of their correlation,showed some improvement in patients´ quality of life. We werealso able to demonstrate the importance and usefulness of applyingthe two questionnaires at three different moments: before, duringand after physiotherapeutic intervention.

  9. 21 CFR 884.4530 - Obstetric-gynecologic specialized manual instrument.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric-gynecologic specialized manual... Gynecological Surgical Devices § 884.4530 Obstetric-gynecologic specialized manual instrument. (a) Identification. An obstetric-gynecologic specialized manual instrument is one of a group of devices used during...

  10. Cosmetic Surgery

    Science.gov (United States)

    ... Body Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a number ... about my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face many ...

  11. Systematic Review: The Impact of Cancer Treatment on the Gut and Vaginal Microbiome in Women With a Gynecological Malignancy.

    Science.gov (United States)

    Muls, Ann; Andreyev, Jervoise; Lalondrelle, Susan; Taylor, Alexandra; Norton, Christine; Hart, Ailsa

    2017-09-01

    Worldwide, 1,470,900 women are diagnosed yearly with a gynecological malignancy (21,000 in the UK). Some patients treated with pelvic radiotherapy develop chronic changes in their bowel function. This systematic review summarizes current research on the impact of cancer treatment on the gut and vaginal microbiome in women with a gynecological malignancy. The Preferred reporting Items for Systematic Reviews and Meta-analyses guidelines for systematic reviews were used to ensure transparent and complete reporting. Quantitative studies exploring the gut or vaginal microbiome in this patient cohort were included. Animal studies were excluded. There were no language restrictions. No studies examined the possible effects of surgery or chemotherapy for gynecological cancers on the gut or vaginal microbiome.Three prospective cohort studies were identified using sequencing of changes in the gut microbiome reporting on a total of 23 women treated for gynecological cancer. All studies included patients treated with radiotherapy with a dosage ranging from 43.0 to 54.0 Gy. Two studies assessed gastrointestinal toxicity formally; 8 women (57%) developed grade 2 or 3 diarrhea during radiotherapy. The outcomes suggest a correlation between changes in the intestinal microbiome and receiving radiotherapy and showed a decrease in abundance and diversity of the intestinal bacterial species. Before radiotherapy, those who developed diarrhea had an increased abundance of Bacteroides, Dialister, and Veillonella (P vaginal and gut microbiome in women treated for a gynecological malignancy are warranted to explore the impact of cancer treatments on the microbiome and its relation to developing long-term gastrointestinal toxicity. This may lead to new avenues to stratify those at risk and explore personalized treatment options and prevention of gastrointestinal consequences of cancer treatments.

  12. Patients' Evaluations of Gynecologic Services Provided by Nurse Practitioners.

    Science.gov (United States)

    Wagener, J. Mark; Carter, Glenna

    1978-01-01

    The development, operating principles, and users' evaluations of a broad based gynecologic program emphasizing effective birth control on a university campus are discussed. A major feature explored is the use of nurse practitioners as the primary service providers. (JMF)

  13. Large Gastrointestinal Stromal Tumor Mimicking A Gynecologic Tumor

    Directory of Open Access Journals (Sweden)

    Sew-Khee Yeat

    2005-06-01

    Conclusion: GISTs express c-kit proteins (CD-117 on immunohistochemistry. They may mimic gynecologic tumors since they share the same pelvic cavity. One should always consider GISTs as part of the differential diagnosis in pelvic tumors.

  14. Nursing intervention in gynecologic brachytherapy under general anesthesia

    International Nuclear Information System (INIS)

    Maeda, Shoko; Goto, Yukimi; Nagai, Michiyo; Hashiguchi, Chikako; Fujii, Osamu; Ota, Yosuke; Tsujino, Kayoko; Soejima, Toshinori; Kato, Hiromi

    2010-01-01

    We reconsidered our nursing intervention in gynecologic intracavitary brachytherapy as general anesthesia was introduced. We recognized that safety, comfort, privacy protection and relief of anxiety of the patients were important points for nursing with corporation of other medical staffs. (author)

  15. [110 years--University Obstetrics and Gynecology Hospital "Maichin dom"].

    Science.gov (United States)

    Zlatkov, V

    2014-01-01

    The first specialized Obstetrics and Gynecology Hospital in Bulgaria was founded based on the idea of Queen Maria Luisa (1883). Construction began in 1896 and the official opening of the hospital took place on November 19, 1903. What is unique about the University Obstetrics and Gynecology Hospital "Maichin dom" is above all the fact that the Bulgarian school of obstetrics and gynecology was founded within its institution. Currently, the hospital has nearly 400 beds and 600 employees who work at nine clinics and six laboratories, covering the entire spectrum of obstetric and gynecological activities. Its leading specialists still continue to embody the highest level of professionalism and dedication. The future development of the hospital is chiefly associated with the renovation of facilities, resources and equipment and with the enhancement of the professional competence of the staff and of the quality of hospital products to improve the health and satisfaction of the patients.

  16. North American Society for Pediatric and Adolescent Gynecology

    Science.gov (United States)

    ... Join NASPAG ACRM ACRM Abstract Guidelines Meeting Registration Future ACRM Dates ACRM Roomates Wanted Hotel Reservation Exhibit & ... removeClass('notactive'); autoPlay();}); }); About NASPAG The North American Society for Pediatric and Adolescent Gynecology (NASPAG), founded in ...

  17. Review of the afterloading techniques in gynecologic radiation therapy

    International Nuclear Information System (INIS)

    Rotte, K.

    1975-01-01

    A review of clinically used afterloading techniques - remote controlled and manually operated ones - is given by tables. The advantages of afterloading techniques are discussed with regard to radiation protection as well as to the therapy of gynecologic carcinomas. (orig.) [de

  18. "It's about time": College women's perceptions of gynecologic health.

    Science.gov (United States)

    Canales, Mary K; Carr, Jeanine; Wohlberg, Jeri

    2005-06-01

    To examine college women's perceptions of gynecologic health, with a particular emphasis on healthcare decision making. Women's perceptions of health promotion efforts that would influence gynecologic health were also examined. Verbatim transcripts of individual and focus group interviews from 34 college women, 18-25 years of age, were thematically analyzed. Questions related to women's decisions to seek gynecologic health care and their healthcare experiences with providers. Three themes were identified: (dis)connecting with their changing bodies, experiencing the healthcare encounter, and making healthcare decisions. Results suggest that college can be "the time" when college women begin to think about and act on decisions about gynecologic health. Implications for practice By acknowledging college women's multidimensional definitions of health and knowledge of healthy behaviors, advanced practice nurses can assist women in developing strategies for enacting these definitions and integrating desired healthy behaviors into their busy college lives.

  19. The principles and practice of ultrasonography in obstetrics and gynecology

    International Nuclear Information System (INIS)

    Sanders, R.C.; James, A.E.

    1985-01-01

    This is the latest edition of a reference on diagnostic ultrasound in obstetrics and gynecology. Chapters have been added on infertility, legal aspects of ultrasound, and interventional techniques. Descriptions of instrumentation, physics and bioeffects, measurement data and normal anatomy in the fetus are given. There is a section on fetal anomalies and the investigation and management of various obstetrical problems, such as multiple pregnancy and hydatidiform mole. Coverage of gynecological ultrasound includes normal pelvic anatomy, pelvic masses, pelvic inflammatory disease, and breast evaluation

  20. Proposals for common definitions of reference points in gynecological brachytherapy

    International Nuclear Information System (INIS)

    Chassagne, D.; Horiot, J.C.

    1977-01-01

    In May 1975 the report of European Curietherapy Group recommended in gynecological Dosimetry by computer. Use of reference points = lymphatic trapezoid figure with 6 points, Pelvic wall, all points are refering to bony structures. Use of critical organ reference points = maximum rectum dose, bladder dose mean rectal dose. Use of 6,000 rads reference isodose described by height, width, and thickness dimensions. These proposals are the basis of a common language in gynecological brachytherapy [fr

  1. Geographic access to gynecologic cancer care in the United States.

    Science.gov (United States)

    Shalowitz, David I; Vinograd, Alexandra M; Giuntoli, Robert L

    2015-07-01

    Women who live distant from the closest subspecialty treatment center are at risk of failing to utilize high-quality care for gynecologic cancers. There has not yet been a comprehensive, national investigation of populations affected by geographic barriers to gynecologic cancer care. Geographic Information Systems (GIS) were used to identify United States counties farther than 50miles from the closest gynecologic oncologist, and hospital referral regions (HRRs) that do not contain the primary professional address of at least one gynecologic oncologist. US Census data were used to analyze counties' demographic characteristics. County-level cancer incidence was estimated using the Centers for Disease Control and Prevention's State Cancer Profiles. Thirty-six percent (1125/3143) of counties are further than 50miles from the nearest gynecologic oncologist. A total of 14.8 million women live in low-access counties (LACs). Annually, approximately 7663 women with gynecologic cancers may experience geography-related disparities in access. Residents of LACs have lower median household income, are more likely to be White and/or Hispanic, and less likely to be Black. Forty percent (123/306) of HRRs do not contain the primary address of a gynecologic oncologist. Approximately 9% of the female population of the United States may experience geographic barriers to access high-quality care for gynecologic malignancies. Future investigations should assess whether residents of low-access counties utilize high-quality care less often, and whether there is a disparity in clinical outcomes. Disparities might be addressed by ensuring subspecialty care in low-access regions, and/or adjusting system structures to minimize the burdens of traveling long distances for cancer care. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. The association of gynecological symptoms with psychological distress in women of reproductive age: a survey from gynecology clinics in Beirut, Lebanon

    OpenAIRE

    Chaaya, M. M.; Bogner, H. R.; Gallo, J. J.; Leaf, P. J.

    2003-01-01

    To date there has been no previous research into a possible association between psychological distress and gynecologic symptoms in the Arab world. We hypothesized that psychological distress would be associated with specific gynecologic complaints as well as with psychosocial factors.

  3. Surveillance and Care of the Gynecologic Cancer Survivor.

    Science.gov (United States)

    Faubion, Stephanie S; MacLaughlin, Kathy L; Long, Margaret E; Pruthi, Sandhya; Casey, Petra M

    2015-11-01

    Care of the gynecologic cancer survivor extends beyond cancer treatment to encompass promotion of sexual, cardiovascular, bone, and brain health; management of fertility, contraception, and vasomotor symptoms; and genetic counseling. This is a narrative review of the data and guidelines regarding care and surveillance of the gynecologic cancer survivor. We searched databases including PubMed, Cochrane, and Scopus using the search terms gynecologic cancer, cancer surveillance, and cancer survivor and reached a consensus for articles chosen for inclusion in the review based on availability in the English language and publication since 2001, as well as key older articles, consensus statements, and practice guidelines from professional societies. However, we did not undertake an extensive systematic search of the literature to identify all potentially relevant studies, nor did we utilize statistical methods to summarize data. We offer clinical recommendations for the management of gynecologic cancer survivors based on review of evidence and our collective clinical experience. Key messages include the limitations of laboratory studies, including CA-125, and imaging in the setting of gynecologic cancer surveillance, hormonal and non-hormonal management of treatment-related vasomotor symptoms and genitourinary syndrome of menopause, as well as recommendations for general health screening, fertility preservation, and contraception. A holistic approach to care extending beyond cancer treatment alone benefits gynecologic cancer survivors. In addition to surveillance for cancer recurrence and late treatment side effects, survivors benefit from guidance on hormonal, contraceptive, and fertility management and promotion of cardiovascular, bone, brain, and sexual health.

  4. Gynecologic clinical examination of the child and adolescent.

    Science.gov (United States)

    Cheikhelard, Alaa; Chaktoura, Zeina; Thibaud, Elisabeth

    2012-01-01

    Pediatric gynecological examination is very simple, but usually unrecognized by physicians without a specific experience in pediatric gynecology. It is always necessary and most of the time sufficient in children and adolescents consulting for gynecological complaints, endocrine problems, or sexual abuse. However, accurate evidence-based data on its normality is poor in the literature, because of bias represented by the inclusion of abused patients in these studies. Our aim was to describe the preparation to a full gynecological examination, the adequate positions, and the sequence and technique required for a well-accepted and nontraumatic clinical examination. Normal findings are described depending on the age of the patient (child, newborn, adolescent), and are based on evidence from the literature. Indications for vaginoscopy and bacterial sampling are discussed according to the age of the patient. The most important factors in the achievement of a full gynecological examination and a trusting patient-physician relationship are a good anatomical and physiological knowledge of the genital system in children, and the learning of nonaggressive examination technical skills associated with good communication skills. Clinical examination is always necessary and most of the time is sufficient together with the medical history to diagnose and treat the child's gynecological problems. Evidence-based data on normal genital findings is poor in the literature, because many studies include abused children or present bias in the methods of recruitment and assessment of normal girls [1]. Copyright © 2012 S. Karger AG, Basel.

  5. An Overview of Immune Checkpoint Inhibitors in Gynecologic Cancers.

    Science.gov (United States)

    Castellano, Tara; Moore, Kathleen N; Holman, Laura L

    2018-03-01

    The goal of this study was to compile a review of topics pertinent to the use of immune checkpoint inhibitors in gynecologic malignancies, including foundation for use, current agents available and trials in gynecologic cancers, special populations of interest, identification and management of toxicities, and considerations in predictive biomarkers and response assessment. A literature review of selected topics in reference to immune checkpoint inhibitors and gynecologic cancers was conducted on PubMed and the US Food and Drug Administration drug search application. A review of current and ongoing clinical trials was performed in clinicaltrials.gov, and selected preliminary results reported in PubMed abstracts and through the American Society of Clinical Oncologists were compiled. Although immunotherapy in gynecologic malignancy is relatively new, 7 agents are currently approved for use in other oncologic indications, and a multitude of trials in gynecologic cancer are ongoing. Immunotherapy has a specific set of drug toxicities that manifest and are managed unlike traditional cytotoxic therapies. Application of the knowledge of immune checkpoint inhibitor use in gynecologic cancers will improve care for women with cancers of the female reproductive tract. As more complex and newer immunotherapies evolve, it will be vital to accurately characterize each specific drug class and management thereof. Copyright © 2018 Elsevier HS Journals, Inc. All rights reserved.

  6. Robotic assisted minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Palep Jaydeep

    2009-01-01

    Full Text Available The term "robot" was coined by the Czech playright Karel Capek in 1921 in his play Rossom′s Universal Robots. The word "robot" is from the check word robota which means forced labor.The era of robots in surgery commenced in 1994 when the first AESOP (voice controlled camera holder prototype robot was used clinically in 1993 and then marketed as the first surgical robot ever in 1994 by the US FDA. Since then many robot prototypes like the Endoassist (Armstrong Healthcare Ltd., High Wycombe, Buck, UK, FIPS endoarm (Karlsruhe Research Center, Karlsruhe, Germany have been developed to add to the functions of the robot and try and increase its utility. Integrated Surgical Systems (now Intuitive Surgery, Inc. redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System ® classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist ® . It was approved by FDA in July 2000 for general laparoscopic surgery, in November 2002 for mitral valve repair surgery. The da Vinci robot is currently being used in various fields such as urology, general surgery, gynecology, cardio-thoracic, pediatric and ENT surgery. It provides several advantages to conventional laparoscopy such as 3D vision, motion scaling, intuitive movements, visual immersion and tremor filtration. The advent of robotics has increased the use of minimally invasive surgery among laparoscopically naοve surgeons and expanded the repertoire of experienced surgeons to include more advanced and complex reconstructions.

  7. Nuclear medicine in gynecologic oncology: Recent practice

    International Nuclear Information System (INIS)

    Lamki, L.M.

    1987-01-01

    Nuclear medicine tests tell more about the physiological function of an organ that about its anatomy. This is in contrast to several other modalities in current use in the field of diagnostic imaging. Some of these newer modalities, such as computerized tomography (CT), offer a better resolution of the anatomy of the organ being examined. This has caused physicians to drift away from certain nuclear medicine tests, specifically those that focus primarily on the anatomy. When CT scanning is available, for instance, it is no longer advisable to perform a scintigraphic brain scan in search of metastasis;CT scanning is more accurate overall and more likely than a nuclear study to result in a specific diagnosis. In certain cases of diffuse cortical infections like herpes encephalitis, however, a scintiscan is still superior to a CT scan. Today's practice of nuclear medicine in gynecologic oncology may be divided into the three categories - (1) time-tested function-oriented scintiscans, (2) innovations of established nuclear tests, and (3) newer pathophysiological scintistudies. The author discusses here, briefly, each of these categories, giving three examples of each

  8. Bulimia from a gynecological view: hormonal changes.

    Science.gov (United States)

    Resch, M; Szendei, G; Haász, P

    2004-11-01

    Gynecological problems are one of the most frequent somatic complications of eating disorders. The purpose of the present study was to assess the role of improper eating habits in the aetiology of menstrual disturbances, anovulation and hormonal related changes. Bulimia nervosa is the focus of attention since amenorrhea is considered a diagnostic criterium in anorexia nervosa. Subjects of the BITE (Bulimia Investigation Test, Edinburgh) test who were infertile were studied (n = 58) In the studied population there were 6 cases of clinical and 8 cases of subclinical bulimia nervosa. Symptoms and severity subscales of the BITE test significantly correlated with body mass index (p = 0.003). All 14 patients suffering from clinical and subclinical bulimia nervosa had pathologically low FSH and LH hormone levels. In those with clinical bulimia nervosa (n = 6) we diagnosed 4 cases of multicystic ovary (MCO) and in the eating disorder not otherwise specified (EDNOS) group (n = 22) there were 2 cases of MCO and 5 cases of polycystic ovary syndrome (PCOS). The results suggest that unsatisfactory nutrition (binges and "crash diet") in bulimia nervosa results in hormonal dysfunction, menstrual disturbances and infertility. The authors question the necessity for immediately estrogen replacement: they consider the reversibility of the hormonal status by early treatment of eating disorders is more appropriate. Excessive use of hormonal contraceptives in therapy has to be questioned.

  9. Immunoscintigraphy of recurrences of gynecologic carcinomas

    International Nuclear Information System (INIS)

    Chatal, J.F.; Fumoleau, P.; Saccavini, J.C.

    1987-01-01

    In a first, retrospective study, 15 patients with known ovarian carcinoma were injected with 131 I-OC 125 F(ab')2 monoclonal antibody (MAb). The sensitivity of immunoscintigraphy based on the number of the tumor sites was 67% (12/18). In a second, prospective study, 29 patients with gynecologic carcinoma were injected with 131 I-OC 125 F(ab')2 (24) or 131 I-19-9 F(ab')2 (5) MAbs according to the histologic type. Based on the number of tested anatomic sites, sensitivity was 72% and specificity 86%. In two patients injected with both 131 I-OC-125 F(ab')2 and 125 I-NS F(ab')2 (nonspecific immunoglobulin) 1 and 4 days before tumor resection, tumor uptake of the specific antibody was 2.2 and 4.5 times greater than that of NS. Immunoscintigraphic results were complementary with those of ultrasonography and computed tomography. Finally, in one patient injected successively with 131 I-OC 125 F(ab')2 and 111 In-DTPA-OC 125 F(ab')2, the recurrent tumor was visualized with both radionuclides, with 111 In providing better abdominal tumor contrast but causing much greater liver radioactivity than 131 I

  10. Transperineal high-dose-rate interstitial radiation therapy in the management of gynecologic malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Itami, Jun; Hara, Ryuseke; Kozuka, Takuyou; Yamashita, Hideomi; Nakajima, Kaori; Shibata, Kouji; Abe, Yoshihisa; Fuse, Masashi; Ito, Masashi [International Medical Center of Japan, Tokyo (Japan). Dept. of Radiation Therapy and Oncology

    2003-11-01

    Background: High-dose-rate interstitial radiation therapy is a newly introduced modality, and its role in the management of gynecologic malignancies remains to be studied. Clinical experience in high-dose-rate interstitial radiation therapy was retrospectively investigated. Patients and Methods: Eight patients with primary and nine with recurrent gynecologic malignancies underwent high-dose-rate interstitial radiation therapy with/without external-beam irradiation. Fractional dose of the high-dose-rate interstitial radiation therapy ranged between 4