To evaluate the capabilities of two-dimensional magnetic resonance imaging (MRI)-based texture analysis features, tumor volume, tumor short axis and apparent diffusion coefficient (ADC) in predicting ...histopathological high-grade and lymphovascular space invasion (LVSI) in endometrial adenocarcinoma.
Seventy-three women (mean age: 66±11.5 SD years; range: 45–88 years) with endometrial adenocarcinoma who underwent MRI of the pelvis at 1.5-T before hysterectomy were retrospectively included. Texture analysis was performed using TexRAD® software on T2-weighted images and ADC maps. Primary outcomes were high-grade and LVSI prediction using histopathological analysis as standard of reference. After data reduction using ascending hierarchical classification analysis, a predictive model was obtained by stepwise multivariate logistic regression and performances were assessed using cross-validated receiver operator curve (ROC).
A total of 72 texture features per tumor were computed. Texture model yielded 52% sensitivity and 75% specificity for the diagnosis of high-grade tumor (areas under ROC curve AUC=0.64) and 71% sensitivity and 59% specificity for the diagnosis of LVSI (AUC=0.59). Volumes and tumor short axis were greater for high-grade tumors (P=0.0002 and P=0.004, respectively) and for patients with LVSI (P=0.004 and P=0.0279, respectively). No differences in ADC values were found between high-grade and low-grade tumors and for LVSI. A tumor short axis≥20mm yielded 95% sensitivity and 75% specificity for the diagnosis of high-grade tumor (AUC=0.86).
MRI-based texture analysis is of limited value to predict high grade and LVSI of endometrial adenocarcinoma. A tumor short axis≥20mm is the best predictor of high grade and LVSI.
Aldosterone plays important role in cardiovascular damage. Aim was to evaluate arterial subclinical damage through arterial stiffness parameters in patients with Essential Hypertension (EH) and ...Primary Aldosteronism (PA).
From 2018 to 2019 we consecutively enrolled 82 subjects (37 males and 45 women), distinguished in two groups: 60 EH systolic blood pressure (SBP) 143.4 ± 16.7 mmHg, diastolic blood pressure (DBP) 89.5 ± 12.1 mmHg and 22 PA (SBP 149 ± 19.5 mmHg, DBP 92.7 ± 12.4 mmHg) 5 with aldosterone-secreting adrenal adenoma(APA), 17 with idiopathic aldosteronism(IHA); 40 matched normotensive subjects (NS) were enrolled (SBP 109.7 ± 6.2 mmHg, DBP 71.3 ± 9.7 mmHg). We used non-invasive applanation tonometer to acquire pressure waveform.
PA patients showed higher μ-Albuminuria (UAE) (65.7 ± 11.0mg/24 h) than EH and NS (21.5 ± 7.0 mg/24 h and 21.5 ± 7.0 mg/24 h, respectively); APA group showed increased levels of arterial stiffness index (11.7 ± 4.8 m/s; p < 0.02) compared to EH subjects (8.3 ± 3 m/s) and NS subjects (7.2 ± 1.7 m/s) as well as higher carotid intima-media thickness (c-IMT); APA patients showed significant reduction of subendocardial viability ratio (SEVR) and travel time of the reflected waves (TI) respect EH and NS. PA groups showed high percentage of augmented “worsening age” (60%), compared to EH (38%) and NS (37%). PAC was positively correlated with Arterial Stiffness Index. Performing multiple linear regression analysis (evaluating anthropometric and biochemical parameters), we found UAE as predictor of Augmentation Index, Arterial Stiffness Index and Travel Time of reflected waves in the enrolled population.
PA patients showed higher cardiovascular subclinical damage respect to EH; UAE excretion had significant correlation with aldosterone, resulting best marker of subclinical vascular remodeling.
To evaluate feasibility of performing benign gynecologic pathology low pressure (7mmHg) laparoscopy (LPL) with AirSeal® system and to study benefits in terms of postoperative pain, when compared to a ...standard insufflation group (15mmHg).
In this prospective randomized pilot study, 60 patients had laparoscopy for gynecologic benign pathology: 30 with 7mmHg and AirSeal system, and 30 with 15mmHg standard insufflator. The primary endpoint was incidence of shoulder pain. A postoperative questionnaire was completed by each patient to assess shoulder pain (Numeric Rating Scale NRS, from 0 to 10) at H4, H8, H24, and consumption of morphinics was notified. During each procedure, anesthesia parameters were collected (peak airway pressure, systolic blood pressure, end tidal CO2).
Laparoscopy was performed on 30 patients in AirSeal®-LP group without need to increase pressure above 7mmHg, and no complication was reported. Incidence of shoulder pain was significantly lower in the AirSeal®-LP group (23.3% vs. 73.3%, P<0.001). NRS shoulder pain was significantly lower in AirSeal® LP group at hour 4, 8 and 24. Maximal values of ETCO2, systolic blood pressure, and peak airway pressure were significantly lower in AirSeal®-LP group.
LP (7mmHg) laparoscopy with AirSeal® platform allows laparoscopic surgery with less postoperative shoulder pain. These results could facilitate the development of ambulatory laparoscopy.
To assess the diagnostic and prognostic characteristics of borderline ovarian tumours (BOTs) detected during pregnancy, and to establish an inventory of French practices.
A retrospective multi-centre ...case study of 14 patients treated for BOTs, diagnosed during pregnancy between 2005 and 2017, in five French pelvic cancerology expert centres, including data on clinical characteristics, histological tumour characteristics, surgical procedure, adjuvant treatments, follow-up and fertility.
The mean age of patients was 29.3 standard deviation (SD) 6.2 years. Most BOTs were diagnosed on ultrasonography in the first trimester (85.7 %), and most of these cases (78.5 %) also underwent magnetic resonance imaging to confirm the diagnosis (true positives 54.5 %). Most patients underwent surgery during pregnancy (57 %), with complete staging surgery in two cases (14.3 %). Laparoscopy was performed more frequently than other procedures (50 %), and unilateral adnexectomy was more common than cystectomy (57.5 %). Tumour size influenced the surgical approach significantly (mean size 7.5 cm for laparoscopy, 11.9 cm for laparoconversion, 14 cm for primary laparotomy; P = 0.08), but the type of resection did not. Most patients were initially diagnosed with International Federation of Gynecology and Obstetrics stage IA (92.8 %) tumours, but many were upstaged after complete restaging surgery (57.1 %). Most BOTs were serous (50 %), two cases had a micropapillary component (28.5 %), and one case had a micro-invasive implant. BOTs were bilateral in two cases (14.2 %). Mean follow-up was 31.4 (SD 14.8) months. Recurrent lesions occurred in two patients (14.2 %) and no deaths have been recorded to date among the study population.
BOTs remain rare, but this study – despite its small sample size – supports the hypothesis that BOTs during pregnancy have potentially aggressive characteristics.
Aortic valve stenosis (AVS) is a well-known risk factor for sudden cardiac death. Therefore, some non-invasive, electrocardiographic markers are capable to stratify the risk of sudden death at rest ...and during light mental challenge mini-mental state examination (MMSE) administration.
We compared short period RR, QT and Te intervals variability in 42 candidates to and 12 age-matched hypertensive control patients at rest and during mental challenge.
At rest, AVS patients showed a higher QT standard deviation (sd), QT low frequency power (LF), QT High Frequency (HF), Tpeak-Tend intervals sd (Te sd) and Te HF than the control group. During mental challenge AVS group showed a decrease of RR mean and RR HF, expressed in normalized units (NU), and an increase of RR total power (TP), RR LF, RR LF NU, RR LF, HF ratio (LF/HF). During this same mental test, QT sd, QT LF, QT HF, Te sd, Te LF, Te HF, QT variability index (VI), TeVI, QT normalized variance (VN) were higher in AVS patients than the control group. During mental challenge Te LF (r:0.825, p<0.05) was significantly associated to: serum albumin (β:-0.473, p<0.001), MMSE (β:-0.267, p:0.038), diastolic blood pressure (β:-0.443, p:0.03) and cardiac index (β:-0.303, p:0.029).
AVS patients showed temporal dispersion of ventricular repolarization phase, useful maker to individuate high risk patients. MMSE administration induced a sympathetic sinus activation and vagal deactivation in AVS subjects. Frailty and mental function influenced Te HF and Te LF.
Vaginal gas: Review Amarenco, G; Turmel, N; Chesnel, C ...
Progrès en urologie (Paris)
29, Številka:
17
Journal Article
Recenzirano
Odprti dostop
The aim of this article was to review the literature about vaginal winds (VW).
A literature review (Medline database, Cochrane Library and Google scholar) with no time limit was performed using ...keywords "vaginal winds", "vaginal noise", "vaginal gaz", "flatus vaginalis", "vaginal flatus", "colpophony", "Garrulitas vulvae", "vaginal laxity".
From 412 articles about VW, 15 have been selected and 99 from 110 about vaginal laxity. VW occurs during physical exercises but also during and just after coïtus. The prevalence is about 20%. The pathophyiology of VW is probably a vaginal hyperlaxity itself secondary to pelvic floor muscles weakness and thus increased diameter of vaginal hiatus. VW alter sexual function in female patients but this sexual function seems not influenced in male partners. Tampons or pessaries are currently the most commonly proposed treatment (but naturally impossible to use during sexual intercourse), but some results from vaginal laser therapy are encouraging.
Data from the literature suggest that vaginal winds are frequent and seriously impact quality of life of female patients. Childbirth and more generally vaginal laxity are the main causes. Pelvic-floor exercises, tampons, pessaries, surgery and laser can be proposed in order to improve sexual function in patients seeking treatment.
INTRODUCTIONPara-aortic lymphadenectomy plays a fundamental role in the surgical management of pelvic gynecological cancers. Two laparoscopic approaches exist: the transperitoneal (TP) and the ...extraperitoneal (EP). The aim of this study was to compare these 2 approaches in terms of surgical outcomes, specially the number of removed lymph nodes according to the surgical technique, and morbidity. MATERIALS AND METHODA single-center retrospective study was carried out at the Lariboisiere University Hospital between January 2011 and March 2020 including all patients who underwent para-aortic lymphadenectomy for the management of a pelvic gynecological cancer (cervix, endometrium, ovary). Univariate and multivariate analysis (logistic regression) were performed to compare the TP and the EP groups. RESULTS143 patients were included: 74 in the TP group and 69 in the RP group. The total duration of surgery was 220.8minutes in the TP group and 166.4minutes in the EP group (P<0.001 in multivariate analysis). No significant difference between groups were found in the average total number of lymph nodes removed but there was a statistically significant difference in the average latero-aortic number of lymph nodes removed: 8.5 lymph nodes in the TP group and 11.3 lymph nodes in the group RP (P<0.001 in multivariate analysis). There was no difference between groups in peri and postoperative morbidity. CONCLUSIONEP para-aortic lymphadenectomy reduces duration of surgery and increases the average latero-aortic number of lymph nodes removed with same morbidity compared to TP para-aortic lymphadenectomy, this confirming its preferred indication in endometrial and in cervical cancers.
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