Abstract Objective The purpose of this retrospective study was to compare our umbilical stalk elevation (USE) technique with the classic Veress needle (VN) technique in obese patients. Study design ...The USE technique was performed on 40 patients. One control per case was randomly selected from among those undergoing the classic VN technique using a random number table. In USE technique, a 12 mm skin incision was created at the superior crease of the umbilical fold, and the underlying subcutaneous adipose tissue was bluntly dissected using the tip of a fine clamp until the umbilical stalk was isolated at the inferior and central part of the incision. Next, the umbilical stalk was covered and held by a towel clip, and the abdominal wall was elevated by upward traction. The VN was then inserted nearly perpendicular to the incision and turned toward the pelvis immediately after resistance to the needle had been lost. A post-hoc power analysis was performed. Results The number of attempts was significantly lower in the USE laparoscopy group than in the classic laparoscopy group (1.2 ± 0.4 vs. 2.1 ± 0.7, respectively; P < 0.001). The USE technique group had a slightly shorter abdominal entry time than did the classic technique group (328.52 ± 63.71 vs. 434.95 ± 124.10 s; P < 0.001). Six (7.5%) failed insufflations occurred in our study (5 patients in the classic group vs. 1 patient in the USE group ( P = 0.10). Conclusion Our novel USE technique can be an effective means of establishing pneumoperitoneum in obese patients undergoing gynecologic laparoscopic procedures.
Leiomyomas are benign smooth muscle uterine masses most frequently seen in females during the period when they can give birth. Extrauterine
leiomyomas are seen rare and where they are observed the ...most is the genitourinary tract. In general, patients come up with urinary and soft tissue
mass near the urethral meatus related problems. Here we report a case of distal urethral leiomyoma in a 40-year old woman who was admitted
with urethral obstructive symptoms and was operated for periurethral mass. Leiomyomas originating from the smooth muscle of the urethra, a rare
location, are generally diagnosed following surgery. These leiomyomas should be treated with great care during surgery due to their unusual location.
Patients who undergo surgery due to the presence of urethral stricture can also be seen after myomectomy.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The aim of this study was to assess the treatment options and survival of uterine cervical cancer (UCC) patients who develop isolated pulmonary metastases (IPM) and to establish risk factors for IPM.
...Data from patients diagnosed with UCC between June 1991 and January 2017 at the Gynecological Oncology Department, Tepecik Training and Research Hospital, were investigated. In total, 43 cases with IPM were evaluated retrospectively. Additionally, 172 control patients diagnosed with UCC without recurrence were matched according to the International Federation of Gynecology and Obstetrics (FIGO) 2009 stage when the tumor was diagnosed. They wereselected using a dependent random sampling method.
Of the 890 patients with UCC, 43 (4.8%) had IPM. The presence of lymphovascular space invasion (LVSI) and a mid-corpuscular volume (MCV) < 80 fL were statistically significant prognostic factors for IPM development in UCC patientsaccording to univariate regression analyses, and the presence of LVSI, a hemoglobin level < 12 g/dL, and an MCV < 80 fLwere statistically significant according to the multivariate regression analyses. We were unable to assess the role of lymph node status (involvement or reactive) as a prognostic factor in the development of IPM, because only seven patients (16.2%) in the case group underwent lymph node dissection.
IPM typically develops within the first 3 years after the diagnosis of UCC, and survival is generally poor. An MCV < 80 fL and the presence of LVSI are significant risk factors for IPM development.
Purpose
The purpose of this multicenter case–control study was to compare the demographic and clinical characteristics of patients with mucinous adenocarcinoma of the endometrium (MAE) and ...endometrioid endometrial carcinoma (EEC).
Methods
A retrospective review of two cancer registry databases in Turkey was conducted to identify patients diagnosed with MAE between January 1996 and December 2012. Each patient was matched with a control EEC patient by age and tumor grade. Cases and controls were compared in terms of known risk factors for lymph node metastasis, disease-free survival (DFS), and overall survival (OS).
Results
The analysis included 112 patients with MAE and 112 with EEC. No significant difference in baseline characteristics was evident between the two groups. Lymphovascular space invasion, deep myometrial invasion, cervical involvement, and tumor diameter did not differ significantly between the mucinous and endometrioid cases. Multivariate analysis confirmed that only mucinous histology (OR 2.2, 95 % CI 1.1–4.5;
P
= 0.02) was an independent predictor of lymph node involvement. Although the median DFS and OS tended to be better in the endometrioid group, the differences were not statistically significant. Routine appendectomy was performed in 52 (46.2 %) patients with MAE. No mucinous tumor of the appendix was identified.
Conclusion
Routine appendectomy is not necessary when the appendix is grossly normal at the time of surgery for MAE. Although the DFS and OS of EEC and MAE patients were similar, the risk of nodal metastasis in MAE patients was greater than that in ECC patients, and we thus suggest to perform retroperitoneal lymphadenectomy (both pelvic and para-aortic) for patients with MAE during the initial operation.
Purpose
Vulvar cancer is a relatively uncommon type of gynecologic cancer. The aim of
this study is to analyze the treatment results and prognostic factors of
vulvar cancer.
Methods
Forty-four vulvar ...cancer patients treated between 2000 and 2011 at the
Department of Radiation Oncology, Ege University Faculty of Medicine, were
retrospectively reviewed. External radiotherapy (RT) was applied with 6-18
MV linear accelerators with 1.8 Gy daily fractions with a median total dose
of 50.4 Gy (45-59.4 Gy) for postoperative cases and 64.8 Gy (range 54-66 Gy)
for definitive cases. Statistical analyses were performed with SPSS
13.0.
Results
Among 44 patients with a median age of 68 years (range 28-86), 14 (31.8%)
were treated with curative and 30 (68.2%) were treated with postoperative RT
or radiochemotherapy (RCT). According to International Federation of
Gynecology and Obstetrics staging, 11 (25%) had stage IB, 10 (22.7%) had
stage II, 6 (13.6%) had stage IIIA, 5 (11.4%) had stage IIIB, and 12 (27.3%)
had stage IVA disease. Within a median of 24 months (range 6-135) of
follow-up, 11 (27.3%) patients had local recurrence, 8 had regional
recurrence, 2 had both local and regional recurrence, and 6 had distant
metastases. Five-year locoregional, disease-free, and overall survival rates
were 45%, 40%, and 54%, respectively. Older age, poor tumor differentiation,
positive surgical margin, and lymphovascular space invasion were found to be
important prognostic factors for disease-related outcomes.
Conclusions
Prognosis of vulvar cancer remains poor even with a multidisciplinary
approach. Molecular prognostic factors need to be defined for individualized
treatment options to achieve better treatment results.
Aim: Information on the clinical behavior of ovarian Sertoli-Leydig cell tumors (SLCTs) as well as its prognostic factors and optimal management is limited due to a substantially low incidence of the ...disease. Also, limited data is available regarding the role of chemotherapy in the management of SLCTs. The aim of the study is to evaluate clinicopathological features and outcome of patients with ovarian SLCTs.
Materials and Methods: Twenty-seven patients with SLCT treated at two centers were reviewed retrospectively during 21 years.
Results: The median age was 45 years (range, 16-81) and the mean follow-up time was 86 months (range, 16-181). Twenty-three patients had stage IA, three patients had IC, and one patient had stage II disease. Eleven tumors (41%) were well-differentiated and 16 (59%) tumors were intermediately differentiated. Nine patients underwent unilateral salpino-oophorectomy and one patient, with a history of infertility, underwent cystectomy for fertility preservation. Eight patients with intermediately differentiated types of SLCT received adjuvant systemic chemotherapy including the combination bleomycin, etoposide, and cisplatin (BEP). Recurrence occurred in one patient with intermediated differentiated type SLCT with heterologous elements. She received four cycles of BEP chemotherapy. Twelve months later, she underwent cytoreductive surgery and received six cycles of cisplatin plus carboplatin. She died 24 months after the initial diagnosis.
Conclusion: SLCTs of the ovary are usually in early stage, unilateral, and benign. Fertility-sparing surgery is the preferred option in young women. In the adjuvant treatment setting, although information about chemotherapy is limited, BEP is a commonly used regimen. The degree of differentiation and the presence of heterologous elements relate to a poor prognosis.
Fallopian tube cancer is very rare in the literature and so there are not enough data about the therapeutic approaches. The approaches are generally determined in accordance with the data obtained ...from ovarian cancer. Many prognostic factors have been investigated in an effort to better estimate patient outcome. Stage, age, and residual tumor after surgery are consistently important prognostic factors. In this study, we aimed to evaluate the prognostic factors and survival rates of primary fallopian tube cancer (PFTC), which is rare among gynecological cancers.
Thirty-eight patients with a diagnosis of PFTC were identified through the gynecologic oncology service database of our Research and Training Hospital in the period 1995-2013. Clinicopathological and surgical data were collected. All patients were evaluated for survival and disease-free survival between the dates specified.
A significant relationship and correlation was found between optimal surgery and life expectancy. Better results were obtained in patients treated with optimal surgery. The survival probability was found to be higher in patients with lower CA-125 levels and serous histologic type adenocarcinoma.
Stage is one of the factors affecting the survival probability. We determined that the pathological type of tumor, the diameter of residual tumor remaining after surgery, tumor grade, preoperative CA-125 levels and presence of ascites affect the survival probability.
Objective: This study aimed to determine the residual disease status of high-grade cervical intraepithelial lesion-positive (HSIL) patients with
margin positive at first cervical excision.
Methods: ...This study included patients with HSIL-positive surgical margins following cervical excision procedures between March 2015 and
August 2020. The patients with normal histopathology results, cervical intraepithelial neoplasia (CIN)1, CIN2-3 with negative surgical margins, and
confirmed cervical malignancy were excluded. HSIL in the second cervical excision pathology was accepted as a residual disease. Demographic
and clinical characteristics, pathology results and human papilloma virus genotypes of the patients were assessed.
Results: Surgical margin was positive in 354 (21.3%) of 1,656 patients who underwent cervical excision procedures with the indication of HSIL.
Computer-based medical records of 330 patients who underwent the second cervical excision procedure from these patients were reviewed and
analyzed. Residual disease was diagnosed in 31.3% (31/99) patients whose first cervical biopsy was CIN2 and in 48.4% (112/231) patients with
CIN3. Additionally, 3 of the patients with CIN3 had microinvasive cervical cancer in final pathology. In patients with residual disease (≥ CIN2),
the rate of CIN3 at first excision, the rate of smokers, and the rate of glandular involvement in the excision specimen was higher (respectively;
p=0.04, p=0.01, p=0.03).
Conclusion: Residual disease high in patients with the first cervical excision histopathology of CIN3, endocervical glandular involvement, and
previously or currently smoked. In the disease management of women with CIN3 and positive margins, re-excision rather than follow-up may
be a better option.
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