Addition of isosorbide mononitrate to misoprostol for cervical ripening in post-term pregnancy: A randomized controlled trial

ObjectiveThe purpose of this paper is to compare the effect of vaginal isosorbide mononitrate added to misoprostol versus misoprostol alone in cervical ripening and labor induction in post-term pregnancy.MethodsIn this double-blind controlled trial study, 150 pregnant women in post-term pregnancy who were candidates for labor induction were selected. The participants were assigned randomly to receive either vaginal isosorbide mononitrate (IMN) (40 mg) or placebo. Misoprostol (25 mg) was added to both groups as needed. Time to full cervical ripening, time to delivery, and the amount of misoprostol used in each group were assessed.ResultsThe time interval from the administration of IMN to full cervical ripening was shown to be significantly lower in the IMN+ misoprostol groups versus the comparison group (p = .032). The adjusted analysis of this time interval after controlling for age, BMI, gravidity, and Bishop score on administration remained significantly less (p = .045),the mean difference being ?4.85 h, CI 95% ?9.58 to ?.12. Isosorbide treatment resulted in significantly less misoprostol used versus misoprostol alone (2.37 ± 1.02 versus 3.08 ± 1.29), adjusted p-value = .001, CI 95% ?1.09 to ?.32. We found no significant increase in maternal–fetal outcomes or side effects of the IMN+ misoprostol group compared with the misoprostol group.ConclusionThis study found that intravaginal IMN added to misoprostol is more effective in reducing time to full cervical ripening versus misoprostol alone in post-term pregnancy. It also reduces the need for more misoprostol.     

Enoxaparin and aspirin therapy for recurrent pregnancy loss due to anti-phospholipid syndrome (APS)

BackgroundRecurrent miscarriage affects 1–2% of women. Thrombophilia included antiphospholipid syndrome has been identified in about 50% of women with recurrent miscarriage. Aspirin and heparin therapy is frequently prescribed for APS, yet there is no robust evidence for the most efficacious regime.ObjectiveTo determine maternal and foetal outcomes in women with APS managed with aspirin or enoxaparin plus aspirin during pregnancy.DesignProspective non randomized study.SettingHigh-risk pregnancy unit-Benha University Hospital.MethodsSeventy selected patients during pregnancy with clinical and/or serological findings of antiphospholipid syndrome were divided into two Groups: Group A (n = 47) had received aspirin (81 mg once daily orally) plus LMWH enoxaparin (40 mg subcutaneously/day) while Group B (n = 23) had received low-dose aspirin (81 mg day orally).Main outcome measuresMaternal outcomes included thromboembolic, haemorrhagic complications and pregnancy-induced hypertension. Prematurity, intrauterine growth restriction and neonatal death were considered as foetal complications.ResultsThere were significant differences between Groups A and B in the rate of miscarriages (4 in Group A (9%) versus 8 in Group B (35%); p = 0.02), number of live births (43/47(91%) versus 15/23(65%); p = 0.02), mean gestational age (37.86 ± 1.8 versus 36.13 ± 2.39 weeks; p = 0.005), neonatal birth weight (3252 ± 459 versus 2907 ± 618 g; p = 0.03) and rate of pre-eclampsia (3/43 (7%) versus 6/15 (40%); p = 0.009). Although not statistically significant, women in Group A tended to have lower rates of preterm births (6/43 (14%) versus 3/15 (20%); p = 0.89) and IUGR (5/43 (12%) versus 5/15 (33%); p = 0.13) than in Group B.ConclusionsUse of low dose aspirin and enoxaparin 40 mg subcutaneously daily in patients with RPL due to antiphospholipid syndrome resulted in higher live birth rates compared to low dose aspirin alone. Solid conclusions from this study are limited due to the small number of patients, non-randomization of groups and discrepancy in number between groups because the choice of the interventional drug was left to patient’s preference after counselling. A larger RCT is needed.     

Identifying risk factors for occult lower extremity lymphedema using computed tomography in patients undergoing lymphadenectomy for gynecologic cancers

ObjectiveTo identify risk factors for lower extremity lymphedema (LEL) using computed tomographic (CT) scan in patients undergoing lymphadenectomy for gynecologic cancers.MethodsWe retrospectively reviewed 511 consecutive gynecologic cancer patients undergoing lymphadenectomy. Mean difference (3.77 ± 3.14 mm) of subcutaneous layer thicknesses between preoperative and postoperative 1-year CT scans of 106 patients with clinical LEL was used as an objective criterion for regrouping all the patients into those with mean difference > 3.77 mm and ≤ 3.77 mm. Risk factors for clinical LEL and significant increase of subcutaneous layer thickness on CT were evaluated using a logistic regression model.ResultsA total of 106 (20.7%) patients were clinically diagnosed with LEL by a physician. Total number of lymph nodes (LNs) retrieved > 30 (Odds ratio [OR] 3.2; 95% Confidence interval [CI] 1.94–5.32; p < 0.001) and adjuvant pelvic radiotherapy (OR 3.1; 95% CI 1.75–5.52; p < 0.001) were risk factors for clinical LEL. One hundred-nineteen (23.3%) had subcutaneous layer thickness increase of > 3.77 mm. In addition to number of LNs retrieved > 30 (OR 2.3; 95% CI 1.40–3.74; p = 0.001) and adjuvant pelvic radiotherapy (OR 1.7; 95% CI 1.01–2.74; p = 0.046), open surgery (OR 1.8; 95% CI 1.01–3.11; p = 0.045), long operation time (OR 1.7; 95% CI 1.05–2.83; p = 0.032), and no use of intermittent pneumatic compression (IPC) (OR 2.1; 95% CI 1.06–4.16; p = 0.034) were risk factors for thick subcutaneous layer on postoperative CT.ConclusionsIn addition to high LN retrieval and adjuvant pelvic radiotherapy, open surgery, long operation time, and no IPC use could be risk factors for occult LEL after lymphadenectomy in gynecologic cancers.     

Venous thromboembolism (VTE) rates following the implementation of extended duration prophylaxis for patients undergoing surgery for gynecologic malignancies

ObjectiveTo compare the incidence of venous thromboembolism (VTE) before and after the implementation of standardized extended duration prophylaxis guidelines in women undergoing laparotomy for gynecologic cancer.MethodsIn October 2009, departmental practice guidelines were implemented for VTE prevention. Patients undergoing laparotomy for gynecologic cancer were started on low molecular weight heparin (LMWH) within 24 h of surgery and it was continued for a total of 28 days postoperatively. The incidence of VTE diagnosed within 30 and 90 days of surgery was determined and compared to a historic cohort of patients who underwent surgery prior to implementation of the guidelines.ResultsThe incidence of VTE within 30 days of surgery decreased from 2.7% (8/300) to 0.6% (2/334) following implementation of VTE prevention guidelines (78% reduction, p = 0.040). However, when the pre and post-guideline implementation groups were compared for the development of VTE within 90 days of surgery, there was no significant difference (11/300 (3.7%) vs. 10/334 (3.0%) respectively, p = 0.619). The median time between surgery and VTE diagnosis was 12 days in the pre-guideline implementation group, compared with 57 days in the post-guideline implementation group (p = 0.012).ConclusionPatients receiving extended duration LMWH were found to have significantly lower rates of VTE within 30 days of surgery when compared with similar patients who did not receive extended duration LMWH. However, this effect was not sustained when the groups were compared for VTE diagnosis within 90 days of surgery. Additional study is needed to further reduce long-term VTE rates in this high-risk population.     

Clinical outcome and prognostic markers for patients with gynecologic malignancies in phase 1 clinical trials: A single institution experience from 1999 to 2010

ObjectivesThere is a scarcity of outcome data regarding phase 1 trials for patients with gynecologic malignancy. The objective of this study was to assess toxicity, clinical benefit and prognosticators in gynecologic oncology patients participating in phase 1 trials.MethodsAll phase 1 oncology trials conducted at Albert Einstein Cancer Center from 1999 to 2010 were reviewed and extracted for relevant demographic and clinical data concerning patients with gynecologic malignancy. Cox-proportional and logistic regression modeling were used for multivariate analysis.Results120 distinct patients with gynecologic malignancy participated in 41 trials, constituting 30.6% of all phase 1 patients enrolled in the same time period. The median age is 59 years. Out of the 184 patients enrolled, 160 individual responses were evaluable. Seventeen DLT events (9.2%) occurred, including 1 (0.5%) treatment-related mortality. There were 27.2% ≥ grade 3 hematologic and 24.4% non-hematologic toxicity. Eighty patients had stable disease (SD, 50%), including 21.9% with SD ≥ 4 months, 11 (6.3%) with partial response (PR), and 3 (1.9%) achieving complete response (CR). The clinical benefit rate (CBR = SD + CR + PR) was 58.1%. Albumin (Alb) ≤ 3.5 g/dL and abnormal ANC were independent negative prognosticators of survival. We also found a continuous correlation between changes in Albumin (p = 0.02) and LDH (p = 0.02) and odds of achieving CBR ≥ 4 month.ConclusionsOur clinical outcome and safety data suggested that phase 1 trials may be a reasonable option for patients with advanced and recurrent gynecologic cancer. The potential prognosticators identified should be further validated in larger trials.     

Position-related injury is uncommon in robotic gynecologic surgery

ObjectiveTo assess the rate and risk factors for position-related injury in robotic gynecologic surgery.MethodsA prospective database from 12/2006 to 1/2014 of all planned robotic gynecologic procedures was retrospectively reviewed for patients who experienced neurologic injury, musculoskeletal injury, or vascular compromise related to patient positioning in the operating room. Analysis was performed to determine risk-factors and incidence for position-related injury.ResultsOf the 831 patients who underwent robotic surgery during the study time period, only 7 (0.8%) experienced positioning-related injury. The injuries included minor head contusions (n = 3), two lower extremity neuropathies (n = 2), brachial plexus injury (n = 1) and one large subcutaneous ecchymosis on the left flank and thigh (n = 1). There were no long term sequelae from the positioning-related injuries. The only statistically significant risk factor for positioning-related injury was prior abdominal surgery (P = 0.05). There were no significant associations between position-related injuries and operative time (P = 0.232), body mass index (P = 0.847), age (P = 0.152), smoking history (P = 0.161), or medical comorbidities (P = 0.229–0.999).ConclusionsThe incidence of position-related injury among women undergoing robotic surgery was extremely low (0.8%). Due to the low incidence we were unable to identify modifiable risk factors for position-related injury following robotic surgery. A standardized, team-oriented approach may significantly decrease position-related injuries following robotic gynecologic surgery.     

Laparoscopic staging of apparent early stage ovarian cancer: Results of a large,retrospective, multi-institutional series

ObjectiveThe aim of this study is to analyze the safety, adequacy, perioperative and survival figures in a large series of laparoscopic staging of patients with apparent early stage ovarian malignancies (ESOM).Patients and methodsRetrospective data from seven gynecologic oncology service databases were searched for ESOM patients undergoing immediate laparoscopic staging or delayed laparoscopic staging after an incidental diagnosis of ESOM.Between May 2000 and February 2014, 300 patients were selected: 150 had been submitted to immediate laparoscopic staging (Group 1), while 150 had undergone delayed laparoscopic staging (Group 2) of ESOM. All surgical, pathologic, and oncologic outcome data were analyzed in each group and a comparison between the two was carried out.ResultsLonger operative time, higher blood loss, more frequently spillage/rupture of ovarian capsule and conversion to laparotomy occurred in Group 1. No significant differences of post-operative complications were observed between the two groups. Histological data revealed more frequently serous tumors (0.06), Grade 3 (p = 0.0007) and final up-staging (p = 0.001) in Group 1. Recurrence and death of disease were documented in 25 (8.3%), and 10 patients (3.3%%), respectively. The 3-year disease free survival (DFS) and overall survival (OS) rates were 85.1%, and 93.6%, respectively in the whole series. There was no difference between Group 1 and Group 2 in terms of DFS (p value = 0.39) and OS (p value = 0.27).ConclusionIn this very large multi-institutional study, it appears that patients with apparent ESOM can safely undergo laparoscopic surgical management.     

The Relationship between Androgens,Regulators of Collagen Metabolism,and Peyronie's Disease: A Case Control Study

IntroductionChanges in collagen metabolism have been postulated to play a pivotal role in the pathogenesis of Peyronie's Disease (PD). Androgens such as dehydroepiandrosterone sulfate (DHEA-S) and testosterone influence collagen metabolism by modulating the activity of matrix metalloproteases (MMP) and tissue inhibitors of metalloproteases (TIMP).AimThe aim of this study was to evaluate the interrelationship between androgens (DHEA-S and testosterone), key regulators of collagen metabolism such as insulin-like growth factor (IGF) 1 and IGF Binding Protein 3 (IGF-BP3), the MMP/TIMP system, and PD.MethodsAge matched PD patients (14) and healthy men (10) who acted as controls were recruited. Blood samples were collected from all subjects in the early morning hours after an overnight fast.Main Outcome MeasuresSerum levels of testosterone, sex hormone binding globulin, DHEA-S, 3-α-androstanediol glucuronide, pro-MMP-1, MMP-1, MMP-2, TIMP-1, TIMP-2, IGF-1 and IGF-BP3 were measured in both groups. Statistical methods included univariate, bivariate, and multivariate regression models.ResultsLevels of DHEA-S (114.5 vs. 169.5 µg/dL; p = 0.03), IGF-BP3 (2.96 vs. 3.79 µg/mL; p = 0.01), and TIMP-1 (173.1 vs. 195 ng/mL; p = 0.01) were significantly lower in PD patients. In contrast, the level of TIMP-2 (102 vs. 85 ng/mL; p = 0.001) was significantly lower in the control group. Using stepwise regression analysis, only TIMP-2 (p < 0.001) and DHEA-S (p = 0.04) were significantly related to PD in the final model (R² = 0.63). TIMP-1 and DHEA-S (r = 0.55, p < 0.05) were positively correlated in the PD group, whereas IGF-1 and testosterone (r = ?0.54, p < 0.05), and IGF-BP3 and testosterone (r = ?0.68, p < 0.05) were negatively correlated in PD patients.ConclusionsOur findings suggest that decreased levels of adrenal androgens may be implicated in the pathogenesis of PD. The mechanism and clinical relevance of this observation remain to be established. Karavitakis M, Komninos C, Simaioforidis V, Kontos S, Lefakis G, Politis V, Koritsiadis G, Konstantellou K, and Doumanis G. The relationship between androgens, regulators of collagen metabolism, and peyronie's disease: A case control study.     

The relationship between antisperm antibodies prevalence and genital Chlamydia trachomatis infection in women with unexplained infertility

BackgroundChlamydia trachomatis infection is one of the most common sexually transmitted diseases. Sperm-associated antibody could impair fertility through various mechanisms; both factors could be correlated to affect the fertility status of women.DesignA retrospective case-control study was performed enrolling ninety (n = 90) patients with primary or secondary infertility as the case group, in addition to another eighty (n = 80) healthy women attending the family planning clinic to investigate the correlation between C. trachomatis past and current infections and antisperm antibodies (ASA) in women with unexplained infertility.ResultsThe PCR prevalence of C. trachomatis did not differ significantly among both groups (2.4% versus 1.6%, p value = 0.66). In contrast, significantly higher prevalence of anti-C. trachomatis specific IgG (39% versus 19%, p value = 0.87) antibodies was found among infertile women. ASA prevalence was significantly higher in infertile group (20% versus 5%, p = 0.04). The final study results have failed to find a positive correlation between current or past C. trachomatis infection and the level of antisperm antibodies level in women suffering of un-explained infertility.ConclusionAntisperm antibodies were significantly higher in infertile women, but without a significant difference between the incidences of ASA in infertile women with past or current C. trachomatis current infection.     

140 exéresis de lesiones de cérvix con asa de diatermia. Márgenes,tabaco y persistencia

ObjectiveTo evaluate the factors that influence in the cervix lesion persistence after removingDesignRetrospective studySubjets140 patients who suffered diathermy loop excisional procedures of cervix lesionsResultsThe half age was 37.5 (19–74); 72.5% smokers. Persistence in patients with margins affections was 31.3% at sixth months, in front of 17.2% with free margins (15 of 87) (OR: 2.18; CI: 0.6–7.2) (p = 0.2). Two lesions persisted eighteen month later (cure in 96.1%), both cases with free margins. After 6 months the lesion persisted in 26.5% in smokers, versus 13.3% in non smokers (OR: 2.34; CI: 0.5–11.8) (p = 0.3). The two patients with persistence after 18 months were smokers. 19.3% of high degree lesions persisted after 6 months and 3.9% after 18 months; 29.4% of low degree persisted after 6 months and no case of low degree persisted after 18 months (p = 0.8)ConclusionsThe persistence of the lesion after eighteen months did not depend on the affectation of the resection margins, of the histology neither of the smoking habit. It is not necessary the later surgery in the patients that have incomplete resection of a lesion of the uterine cervix, and only the pursuit with cytology and colposcopia can justify the reintervention     

Value of endocervical margin and high-risk human papillomavirus status after conization for high-grade cervical intraepithelial neoplasia,adenocarcinoma in situ,and microinvasive carcinoma of the uterine cervix

ObjectiveThe aim of this study was to analyze clinico-pathologic factors and the optimal cut-off value of high-risk human papillomavirus (HR-HPV) viral load for predicting high-grade residual/recurrent disease after the conization in cervical intraepithelial neoplasia (CIN 2–3), adenocarcinoma in situ (AIS), and microinvasive carcinoma of the uterine cervix (MICA).MethodsWe retrospectively reviewed data from 701 patients with CIN 2–3, AIS, and MICA who underwent conization between September 2003 and June 2012. Receiver-operating characteristic curve analysis was used to find out the cut-off value of HR-HPV viral load for predicting residual/recurrent disease. Clinico-pathologic variables, including resection margin and HR-HPV status, were evaluated as possible predictors of residual/recurrent disease.ResultsAt a cut-off value of 1.16 RLU/CO for post-cone HR-HPV viral load, the sensitivity was 88.2% and the specificity was 98.3%. Multivariate analysis demonstrated that post-cone cytology (p = 0.001, OR = 83.808, 95% CI = 6.688–1050.232), endocervical margin status (p < 0.001, OR = 80.478, 95% CI = 7.421–872.732), and post-cone HR-HPV status (p < 0.001, OR = 79.660, 95% CI = 8.539–743.129) were significantly associated with residual/recurrent disease. The post-cone HR-HPV positivity was observed more in the patients who showed positive endocervical margin than in the patients with positive ectocervical margin (32.6% vs. 5.3%, p = 0.002).ConclusionsFollow-up using liquid based cytology in combination with HR-HPV test at 12 months after the conization, and not the early HR-HPV test, might be acceptable. Post-cone endocervical margin status combined with post-cone HR-HPV test is critical for predicting residual/recurrent disease and clinical management.     

Impact of statin therapy on survival in epithelial ovarian cancer

Objective3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors, or statins, are common therapeutic agents in the management of dyslipidemias. Epidemiologic and pharmacologic data also suggest statins have an effect on cancer biology. We sought to determine the association between use of statins and epithelial ovarian cancer survival, disease progression, and clinico-pathologic factors.MethodsAfter IRB approval, we performed a retrospective review of all patients with advanced stage (III/IV) epithelial ovarian or primary peritoneal cancer undergoing primary cytoreductive surgery by a gynecologist oncologist between 6/1996 and 6/2001. Abstracted data included statin use at time of initial cytoreductive surgery, as well as clinico-pathologic factors and survival. Statistical analysis included Fisher's exact test, Kaplan–Meier survival, and Cox regression analyses.Results126 patients met criteria for review. Seventeen (14%) patients were undergoing concurrent statin therapy at time of initial cytoreductive surgery. Statin users were statistically older (median age 67 years, versus 60 years for non-users, p = 0.002) and had a greater incidence of diabetes mellitus (18% versus 3% in non-users, p = 0.03). Of the entire cohort, 21 patients (17%) were suboptimally cytoreduced after initial surgery, with residual disease > 1 cm; statin use did not correlate with incidence of optimal resection (p = 0.3). Median progression-free survival for statin users was 24 months, compared to 16 months for statin non-users (p = 0.007). Similarly, overall survival was significantly longer for statin users (62 months) compared to statin non-users (46 months, p = 0.04). Multivariable analysis identified statin use as an independent positive prognostic factor, after controlling for age, stage, grade, and suboptimal cytoreduction (p = 0.02).ConclusionsThese data indicate statin use in patients diagnosed with epithelial ovarian cancer is associated with improved survival, and suggest a potential suppressive impact of HMG-CoA reductase inhibitors on tumor biology. Studies are proposed to explore the molecular mechanisms underlying these clinical observations.     

Social–cognitive processes associated with fear of recurrence among women newly diagnosed with gynecological cancers

ObjectiveThis cross sectional study aimed to characterize fears of recurrence among women newly diagnosed with gynecologic cancer. The study also evaluated models predicting the impact of recurrence fears on psychological distress through social and cognitive variables.MethodsWomen (N = 150) who participated in a randomized clinical trial comparing a coping and communication intervention to a supportive counseling intervention to usual care completed baseline surveys that were utilized for the study. The survey included the Concerns about Recurrence Scale (CARS), Beck Depression Inventory (BDI), Impact of Event Scale (IES), and measures of social (holding back from sharing concerns and negative responses from family and friends) and cognitive (positive reappraisal, efficacy appraisal, and self-esteem appraisal) variables. Medical data was obtained via medical chart review.ResultsModerate-to-high levels of recurrence fears were reported by 47% of the women. Younger age (p < .01) and functional impairment (p < .01) correlated with greater recurrence fears. A social–cognitive model of fear of recurrence and psychological distress was supported. Mediation analyses indicated, that as a set, the social and cognitive variables mediated the association between fear of recurrence and both depression and cancer-specific distress. Holding back and self-esteem showed the strongest mediating effects.ConclusionFears of recurrence are prevalent among women newly diagnosed with gynecologic cancer. Social and cognitive factors play a role in women's adaptation to fears and impact overall psychological adjustment. These factors may be appropriate targets for intervention.     

Plasma concentrations of the vitamin E-binding protein afamin are associated with overall and progression-free survival and platinum sensitivity in serous ovarian cancer—a study by the OVCAD consortium

ObjectiveComparative proteomics identified the plasma protein afamin as potential biomarker for ovarian cancer (OC). Significantly decreased afamin plasma concentrations in pre-therapeutic OC patients reconstituted to control values after successful tumor surgery. This study evaluates the association of afamin with survival and response to therapy in serous OC patients within the OVCAD consortium project.MethodsWe measured afamin in 215 pre-therapeutic plasma samples, 246 tumor lysates and 109 plasma samples taken 6 months after finishing platinum-based chemotherapy. Differences in afamin plasma concentrations among FIGO stages were tested by Kruskal–Wallis test; association of afamin concentrations with overall and progression-free survival was evaluated using Kaplan–Meier survival plots and multivariate adjusted COX regression analysis.ResultsPre-therapeutic afamin correlated significantly with FIGO stages (p = 0.012) and was lower in the presence of metastases (p = 0.013) and poorly differentiated OC in patients responding to therapy (p = 0.016). Afamin ≥ 48.0 mg/L was also associated with a lower hazard ratio for recurrent disease as compared to afamin < 48.0 mg/L (p = 0.007). Post-therapeutic afamin ≥ 48 mg/L was positively correlated with overall (p < 0.001) and progression-free (p = 0.012) survival and was lower in non-responders than in responders (p = 0.048). Thus, afamin returned post-therapeutically to values of healthy controls in responders (p < 0.001) but not in non-responders (p = 0.114). Afamin in tumor lysates was lower in poorly differentiated OC than in G 1 + 2 tumors (p = 0.041). Higher afamin concentrations in tumor lysates were associated with increased overall survival (p = 0.003).ConclusionThese data indicate that afamin is associated with therapy response and survival rate in advanced OC patients.     

Macular thickness measured by optical coherence tomography correlates with proteinuria in pre-eclampsia

ObjectivesPre-eclampsia is associated with ocular changes. The aim of this study was to examine the macular changes of patients with early-onset severe pre-eclampsia using optical coherence tomography (OCT).MethodsThis prospective study was performed at Tygerberg Academic Hospital, a secondary and tertiary referral centre in Cape Town, South Africa. Twenty women with early onset pre-eclampsia and 20 women without hypertensive or vascular complications, matched for gestational age, were examined before and after delivery.ResultsThere was a trend showing a positive correlation between increased central retinal thickness and increasing proteinuria in patients with pre-eclampsia antepartum (left eye r = 0.52, p = 0.04) and postpartum (left eye r = 0.60, p = 0.01). A positive correlation between average central 1 mm and proteinuria was noted antepartum (left eye r = 0.63, p = 0.01) and postpartum (right eye r = 0.52, p = 0.03). There were no significant correlations between blood pressure and any of the retinal parameters. Two of the 23 patients with pre-eclampsia developed serous retinal detachments, both of which resolved completely postpartum.ConclusionsMacular thickness parameters measured using OCT correlated with the degree of proteinuria in pre-eclampsia. These changes reversed soon after delivery.     

Analysis of the Impact of Body Mass Index on the Surgical Outcomes after Robot-Assisted Laparoscopic Myomectomy

Study ObjectiveTo estimate the impact of body mass index (BMI) on surgical outcomes in patients undergoing robotic myomectomy.DesignA retrospective cohort data analysis (Canadian Task Force classification II-2).SettingCommunity-based teaching hospital.PatientsA total of 77 consecutive patients from January 2005 through November 2008 with symptomatic leiomyomata.InterventionRobotic-assisted laparoscopic myomectomy.Measurements and Main ResultsBody mass index ([BMI] expressed as kg/m²) was abstracted from the medical charts of all patients undergoing robotic myomectomy. Data on estimated blood loss, procedure time, length of hospital stay, diameter of the largest fibroid, and specimen weight were also extracted. Overall patient demographics between the groups were similar. Thirty-two patients (41.6%) were obese or morbidly obese (BMI > 30). The parameters analyzed for associations with the continuous measure of BMI included length of postoperative hospital stay (LOS), estimated blood loss (EBL), and procedure duration. Median (range) procedure time among all patients was (195 minutes, 98-653 minutes), estimated blood loss was (100 mL, 10-700 mL), and length of hospital stay was (1 day, 1-5 days). No associations were determined between BMI and LOS (r = 0.14, p = .22), EBL (r = 0.25, p = .03), or procedure duration (r = 0.16, p = .22) with Spearman correlations. The size of the largest leiomyoma diameter did not affect these associations.ConclusionPreoperative obesity is not a risk factor for poor surgical outcome in patients undergoing robotic myomectomy.     

L’utilisation du TachoSil permet-elle de réduire la morbidité du curage axillaire ?

The lymphocele is the most frequently encountered complication after axillary dissection performed for breast cancer (15–81%). This study compares the efficacy of a lympho-hemostatic combipatch TachoSil^® versus conventional implementation of a suction drain on the incidence and severity of lymphoceles. This is a case (group TachoSil^® n = 20) control (drainage group) n = 40 study. In our study, we demonstrated an increased rate of postoperative complications (< 3 weeks) in the group TachoSil^® (P = 0.0265) explained by a lymphocele rate significantly higher (P = 0.0194). However, no significant difference was demonstrated on the severity of these lymphoceles. Beyond 3 weeks postoperatively, the two groups were comparable in terms of postoperative complications. The TachoSil^® does not prevent the formation of seroma but their severity is not increased. In addition, it reduces of more than 48 hours the duration of hospitalization stay (P = 0.002).     

Prognostic value of responsiveness of neoadjuvant chemotherapy before surgery for patients with stage IB2/IIA2 cervical cancer

ObjectiveTo evaluate the factors that might affect the putative survival benefit from pre-operative neoadjuvant chemotherapy (NAC) in patients with early stage bulky cervical cancer.MethodsA retrospective review for 304 patients with stage IB₂/IIA₂ cervical cancer was performed. Two groups were made according to pre-operative NAC or not: NAC group (n = 154) and primary surgery group (PST, n = 150). Recurrence risks and survival were analyzed.ResultsThe total response rate was 72.1%. For those NAC-responders, NAC decreased the ratio of lymphovascular space invasion (0 vs. 4.7%, p = 0.022; 0 vs. 3.3%, p = 0.052), deep stromal invasion (19.8% vs. 53.5%, p = 0.000; 19.8% vs. 29.3%, p = 0.08), lymph node metastasis (8.1% vs. 25.6%, p = 0.004; 8.1% vs. 17.3%, p = 0.031), and the need of adjuvant radiotherapy (5.5% vs. 30.2%, p = 0.000; 5.4% vs. 15.3%, p = 0.012), whereas improve 5-year PFS rate (94% vs. 86%, p = 0.041; 94% vs. 80%, p = 0.089) and 5-year OS rate (96% vs. 86%, p = 0.015; 96% vs. 82%, p = 0.05), as compared with non-responders and PST. Multivariate analysis suggested that the response to NAC is an independent prognostic factor of PFS (HR 0.221, 95% CI 0.048–1.022, p = 0.053) and OS (HR 0.126, 95% CI 0.016–1.000, p = 0.05); as compared, stage IIA disease demonstrates negative impact upon PFS (HR 4.778, 95% CI 1.490–15.317, p = 0.009) and OS (HR 4.142, 95% CI 1.258–13.639, p = 0.019).ConclusionResponsiveness of NAC before surgery might be an independent prognostic factor for the patients with early stage bulky cervical cancer.     

A prospective study of quality of life in patients undergoing pelvic exenteration: Interim results

ObjectiveLittle prospective data exist on quality of life (QOL) after pelvic exenteration (PE). This ongoing study prospectively examines the QOL changes following this radical procedure using a comprehensive battery of psychological instruments.MethodsSince 2005, enrolled patients were interviewed (EORTC QLQ-C30, EORTC QLQ-CR38, EORTC QLQ-BLM30, BFI, BPI-SF, IADL, CES-D, IES-R) preoperatively and at 3, 6, and 12 months after PE for physical/psychological symptoms. Data were examined using repeated measure ANOVA.ResultsSixteen women (3 anterior, 1 posterior, and 12 total PEs), with more than 1 year of follow-up, completed all scheduled interviews. Median age was 58 years (range, 28–76 years). Overall QOL (F = 6.3, p < 0.02), ability to perform instrumental daily activities (F = 6.8, p < 0.02), body image (F = 11.9, p < 0.00), and sexual function (F = 8.0, p < 0.01) all declined at 3 months but were near baseline by 12 months after PE. Although, overall, physical function followed a similar trend (F = 14.8, p < 0.00), it did not return to baseline. At the 12-month interview, patients reported increased gastrointestinal symptoms (F = 8.9, p < 0.01) but significantly less stress-related ideation (F = 6.1, p < 0.03) compared to baseline. Pain levels did not change significantly during the study period (F = 0.4, p < 0.74).ConclusionsAlthough patients report lingering gastrointestinal symptoms and some persistent decline in physical function after PE, most adjust well, returning to almost baseline functioning within a year. Providers can counsel patients that many, though not all, symptoms in the first 3 months following exenteration are likely to improve as they adapt to their changed health status. These preliminary results await confirmation of a larger analysis.