Gynecologic oncologic surgery in the elderly: A retrospective analysis of 213 patients

OBJECTIVES: The aims of the study were (1) to analyze morbidity and mortality for elderly women (>/=70 years) operated on for gynecological malignancies at our department between 1985 and 1996; and (2) to compare two periods of time (years 1985-1990 versus years 1991-1996) to investigate whether new expedience in the surgical technique as well as in the perioperative management introduced by 1991 influenced the feasibility and tolerability of surgery in elderly patients. METHODS: In a retrospective analysis, we evaluated tumor site, comorbidities, surgical features, morbidity, and mortality. By 1991, several modifications in management were introduced, including: (1) early postoperative mobilization; (2) self-donation with autologous blood transfusion; (3) intraoperative antibiotic prophylaxis; (4) the retroperitoneum was left open and drains were not used after pelvic and aortic lymphadenectomy; (5) use of coagulator forceps and hemoclips for meticolous hemostasis. RESULTS: In 213 patients, tumor site distribution was uterine corpus n = 93, ovary n = 51, vulva n = 29, cervix n = 23, breast n = 15, and vagina n = 2. There were advanced stage diseases in 47%, comorbid illnesses in 76%, and high surgical risk in 48%. Sixty-nine patients (group A) and 144 patients (group B) were treated in the first and second study periods, respectively. Overall, severe postoperative morbidity and mortality were 17 and 2.8%, respectively. Group B compared to group A showed more frequent use of major surgical procedures (P < 0.01) and lymphadenectomy (P < 0.04), lower transfusion rate (P < 0.001), reduced severe morbidity (P < 0.002), lower mortality (P = 0.3), and shorter hospital stay (P < 0.001). CONCLUSIONS: Our study suggests that surgery, including very radical procedures, is reasonably feasible and well tolerated by elderly patients. The introduction of technical and medical advances in the later years of the study resulted in a significant improvement of surgical rates.     

Total Hysteroscopic Treatment of Cervical Pregnancy: The 2-step Technique

Study ObjectiveTo evaluate the efficacy of total surgical treatment of ectopic cervical pregnancy [1] with a minimally invasive approach performed by hysteroscopy [2].DesignStep-by-step video demonstration of the surgical technique using 5 mm hysteroscopy followed by 10 mm resectoscopy.SettingA research and university hospital (IRCCS Burlo Garofolo, Trieste, Italy).PatientsA 41-year-old woman with an ultrasound diagnosis of ectopic cervical pregnancy at 6 + 6 weeks of gestation with a beta human chorionic gonadotropin serum level of 55.951 mUI/mL.InterventionsWe performed a 2-step technique using 5- and 10-mm hysteroscopy (Video 1). During the first step, a 5-mm Bettocchi hysteroscope (Karl Storz, Tuttlingen, Germany) with a 5F bipolar electrode Versapoint Twizzle (Gynecare, Menlo Park, CA) was used. In this phase, the gestational sac was identified in order to confirm the diagnosis and its site of implantation. Later, the gestational sac was opened, and the pregnancy was terminated by cord section under an embryoscopic view (Fig. 1). Finally, a partial vessel coagulation was performed. Afterward, the cervix was dilated, and a resectoscopy was performed. During the second step, a 10-mm Gynecare resectoscope with the bipolar Gynecare Versapoint was used and the gestational sac with the embryo was removed; subsequently, a complete chorial villi resection was achieved. At last, a coagulation of bleeding vessels on the implantation site in order to control the hemostasis was performed (Fig. 2).Measurements and Main ResultsThe study was approved by the institutional review board. The patient was discharged 24 hours after the procedure with an uneventful postoperative course, and the beta human chorionic gonadotropin serum level became negative in 20 days. After 40 days, the ultrasound cervical findings were regular, whereas office hysteroscopy showed the implantation site scar. After 5 months, the patient was pregnant with regular intrauterine implantation (Fig. 3).ConclusionThe total hysteroscopic approach with a 2-step technique offers an effective, safe, and minimally invasive surgical treatment to ectopic cervical pregnancy. Considering that our method, in contrast with the recent literature 3, 4, 5, is performed without any medical treatment, we reported for the first time an approach, that deserve more clinical data to confirm its effectiveness.     

Behavior of squamous cell carcinoma of the floor of the mouth. Is supraomohyoid neck dissection sufficiently safe to manage clinically N0 patients?

Aim

The main aim of the present report is to study the behavior of SCC of the floor of the mouth.

仰卧整复法治疗颈椎不稳所致颈性眩晕的经颅多普勒超声和X线观察

目的　观察仰卧整复手法治疗颈椎不稳所致颈性眩晕患者的经颅椎动脉多普勒超声和颈椎侧位X线摄片的变化 ,探讨其治疗颈性眩晕的可能机制。方法　回顾分析仰卧整复手法治疗颈椎不稳所致颈性眩晕患者 16例 ,观察手法治疗的效果及手法治疗前后患者经颅椎动脉多普勒超声和颈椎侧位X线摄片椎体间的位移变化 ,并和正常人群进行比较。结果　 16例患者治疗前椎动脉平均血流速度为 (48.6± 3.1)cm/s ,显著高于同龄正常人群 (P <0 .0 5 ) ;仰卧整复手法治疗后椎动脉平均血流速度为 (39.2± 3.5 )cm/s ,较治疗前有显著下降 (P <0 .0 5 )。治疗前颈椎侧位X线摄片示C3 ,4间的位移为 (3.18±0 .4 2 )mm ,C4,5间的位移为 (3.4 6± 0 .2 6 )mm ;治疗后分别为 (2 .2 5± 0 .35 )mm和 (3.2 8± 0 .35 )mm ,C3 ,4间的位移明显减少 (P<0 .0 5 )。手法治疗效果评价 :10例痊愈 ;4例显效 ;2例有效。结论　仰卧整复手法是治疗颈椎不稳所致颈性眩晕的有效手法 ,其治疗机制与改善椎动脉血流和恢复脊柱稳定性有关     

颈椎脱位复位后继发脊髓损伤

本文报告颈椎脱位复位后继发或加重脊髓损伤14例.其中发生在颅骨牵引后9例,手法复位后4例,手术复位后1例.复位前神经功能正常5例,有轻微损伤9例,复位后发生全瘫7例,有感觉无运动7例.本文讨论了继发损伤的原因及其预防.     

艾灸神阙等对宫颈癌放疗患者近期腹泻的临床观察

目的：观察艾灸对宫颈癌放疗患者近期腹泻的预防作用。方法：以神阙穴为主，采用艾条温和灸的方法，对36例放疗患者的近期腹泻情况与30例单纯放疗的近期腹泻相比较。结果：艾灸组的近期腹泻发生率和程度明显低于对照组（P＜0．05），结论：艾灸神阙等穴位对宫颈癌放疗患者近期腹泻的发生有一定的预防作用。     

颈椎带锁钢板在颈椎病治疗中的应用价值

目的　评价颈椎前路带锁钢板内固定治疗颈椎病的临床效果。方法　对 4 8例颈椎病患者手术应用带锁钢板固定 ,并对植骨愈合、颈椎生理弧度恢复、神经功能恢复进行观察。结果　术后随访 3～ 2 2个月 ,平均 11个月。椎间植骨全部融合 ,1例钢板螺丝钉松动者植骨在术后 6个月融合 ;术前JOA评分平均 10 .9分 ,术后平均 14 .8分。结论　在颈椎病前路手术治疗中 ,颈椎带锁钢板具有即刻及良好的稳定作用 ,可以提高植骨融合率 ,恢复椎间高度及生理弧度 ,对颈椎病患者神经功能恢复有利。     

重建钢板螺钉在枕颈融合中的应用

目的 探讨重建钢板螺钉在枕颈融合中的应用效果。方法 回顾分析应用重建钢板螺钉固定行枕颈融合5例病人的临床资料和手术效果。结果 术中、术后无并发症发生,经5～18个月的随访,全部病例3个月达到骨性融合,未见钢板折断、拔钉、断钉等。JOA骨髓功能评分分别提高2～5分。结论 运用重建钢板行枕颈融合固定是一种较方便、牢固、经济的方法。     

β-连环素与上皮型钙粘蛋白在宫颈鳞癌中的表达及意义

目的　探讨 β 连环素 (β cat)与上皮型钙粘蛋白 (E cad)在宫颈鳞癌中的表达及其临床意义。 方法　应用免疫组化SP法 ,检测 4 0例宫颈鳞癌 ,1 0例宫颈上皮内瘤样病变 (CIN)和 1 0例正常宫颈上皮组织中的 β cat与E cad的表达。结果　正常宫颈上皮组织中 ,β cat与E cad表达均显著位于细胞膜 ,而胞浆表达很少见 ;在CINⅢ与宫颈鳞癌组织中 ,β cat与E cad表达特征发生改变 ,胞膜表达量减少甚至缺失 ,呈现不同程度的胞浆表达 ,其中有些在细胞核内还可检出 β cat蛋白。随着肿瘤病理分级的升高 ,β cat与E cad的膜表达减弱 ,浆表达增强。淋巴结转移组的 β cat与E cad的异常表达率明显高于无淋巴结转移组 (P <0 .0 5 )。 结论　β cat异位表达可能参与了宫颈鳞癌发生、发展过程 ;β cat与E cad胞膜表达缺失可能与宫颈鳞癌的侵袭和转移有关。