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1.
Aera Yoon Jeong-Yeol Park Jin-Young Park Yoo-Young Lee Tae-Joong Kim Chel Hun Choi Duk-Soo Bae Byoung-Gie Kim Jeong-Won Lee Joo-Hyun Nam 《Gynecologic oncology》2014
Objective
To assess prognostic factors associated with disease-related survival in endometrial stromal sarcoma (ESS) using the 2009 FIGO staging system.Methods
From January 1990 to January 2012, 114 patients with ESS were identified at the Samsung and Asan Medical Center and data were retrospectively analyzed.Results
Ten (8.7%) patients died of the disease and 33 (28.9%) patients relapsed. The 5- and 10-year overall survival (OS) rates for the entire cohort were 92.6% and 87.1%, respectively, and the 5- and 10-year recurrence-free survival (RFS) rates were 71.8% and 52.1%, respectively. The estimated median survival after recurrence for the 33 patients whose tumors relapsed was 133 months (95% CI, 7.7–258.4), and 5-year survival after recurrence was 68.9%. Stage I (P = 0.006), estrogen and/or progesterone receptor (ER/PR) positivity (P = 0.0027), and no nodal metastasis (P = 0.033) were associated with a good prognosis for OS in the univariate analysis. Ovarian preservation was revealed to be an independent predictor for poorer RFS (HR, 6.5; 95% CI, 1.23–34.19; P = 0.027). Positivity for ER/PR (HR, 0.05; 95% CI, 0.006–0.4; P = 0.006) and cytoreductive resection of recurrent lesions (HR, 0.14; 95% CI, 0.02–0.93; P = 0.042) were independent predictors of better survival after recurrence.Conclusions
Stage, expression of ER/PR, and nodal metastasis are significantly associated with OS in ESS. Bilateral salpingo-oophorectomy (BSO) as the primary treatment and cytoreductive resection of recurrent lesions should be considered for improving survival of patients with ESS. 相似文献2.
Trine Lembrecht Jørgensen Sandra TeiblumMerete Paludan Laurids Østergaard PoulsenAnni Young Stensgård Jørgensen Karin Herskind BruunJesper Hallas Jørn Herrstedt 《Gynecologic oncology》2012,127(2):367-374
Background
Age is associated with poor prognosis in ovarian cancer patients. Reasons could be increased comorbidity, more advanced stage, or nonoptimal surgery or chemotherapy. Objectives of this study were to evaluate the significance of comorbidity and age ≥ 70 years on receiving cytoreductive surgery, standard combination chemotherapy (TC), adherence to TC treatment, and prognosis.Methods
A retrospective cohort study of all women registered in a nation-wide database with ovarian or peritoneal cancer in 2005-2006. Logistic regression was employed for determining the predictive value of age and comorbidity (ASA score) on receiving cytoreductive surgery and TC, and on adhering to TC. Kaplan-Meier method and Cox proportional hazards analysis were employed for survival analyses.Results
Of 961 patients, 348 (36.2%) were elderly. Age ≥ 70 years was independently predictive of not receiving surgery, OR 0.2(95% CI 0.1-0.5) and TC treatment, OR 0.03 (95% CI 0.01-0.1). Comorbidity was also independently predictive of not receiving standard treatment: OR for receiving surgery with ASA score of ≥ 3 was 0.2 (95% CI 0.1-0.5), and for receiving TC it was 0.03 (95% CI 0.01-0.1). Overall, age ≥ 70 was a poor prognostic factor in OS and PFS, but the effect of age ceased after 16 months. Comorbidity was a poor prognostic factor throughout the study period but with time-varying effect. For patients treated with TC, age was not a prognostic factor, whereas ASA score ≥ 3 was.Conclusion
Elderly patients and patients with comorbidity less often receive optimal surgical and medical treatment. For those receiving optimal treatment, age ≥ 70 is not an independent poor prognostic factor, whereas severe comorbidity is. 相似文献3.
Kyeong A So Jin Hwa Hong Hye Mi Jin Jae Won Kim Jae Yun Song Jae Kwan Lee Nak Woo Lee 《Gynecologic oncology》2014
Objective
Preoperative leukocytosis is known to be a negative prognostic factor for several gynecologic malignancies, but its relationship with epithelial ovarian carcinoma (EOC) is unknown. We sought to evaluate the prognostic implications of preoperative leukocytosis for women with EOC.Methods
We retrospectively reviewed the medical records of patients who underwent primary debulking surgery and adjuvant platinum-based chemotherapy for EOC between January 1993 and October 2011. Associations between leukocytosis and recurrence-free survival (RFS) and overall survival (OS) were determined by univariate analyses. Multivariate Cox proportional hazards regression was used to identify independent prognostic factors for RFS and OS.Results
Of 155 women, 23 (14.8%) had leukocytosis and 132 (85.2%) did not have leukocytosis. RFS and OS were significantly shorter for women with leukocytosis than for women without leukocytosis (P = 0.009 and P < 0.0001, respectively). The mortality rate was also higher among women with leukocytosis (P < 0.0001). Multivariate analysis revealed that preoperative leukocytosis (hazard ratio [HR]: 2.15; 95% confidence interval [CI]: 1.55–4.41; P = 0.009), advanced stage (HR: 3.12; 95% CI: 1.44–6.75; P = 0.004), and optimal cytoreduction (HR: 0.38; 95% CI: 0.14-0.70; P = 0.031) were independent prognostic factors for RFS. Additionally, preoperative leukocytosis was independently associated with decreased OS (HR: 7.66; 95% CI: 2.78–21.16; P < 0.0001).Conclusions
Among women with EOC, preoperative leukocytosis might be an independent prognostic factor for RFS and OS. A larger-scaled, prospective study is needed to verify these results. 相似文献4.
Camille C. Gunderson Eric D. Thomas Katrina N. Slaughter Regina Farrell Kai Ding Ronni E. Farris Jacob K. Lauer LaToya J. Perry D. Scott McMeekin Kathleen N. Moore 《Gynecologic oncology》2014
Objective
The aim of this study is to evaluate the effect of venous thromboembolism (VTE) chronology with respect to surgery on survival with epithelial ovarian cancer (EOC).Methods
An IRB approved, retrospective review was performed of patients treated for Stage I–IV EOC from 1996 to 2011. Cox proportional hazards model was used to assess associations between VTE and the primary outcomes of progression free survival (PFS) and overall survival (OS). SAS 9.3 was used for statistical analyses.Results
586 patients met study criteria. Median age was 63 years (range, 17–94); median BMI was 27.1 kg/m2 (range, 13.7–67.0). Most tumors were high grade serous (68.3%) and advanced stage (III/IV, 75.4%). 3.7% had a preoperative VTE; 13.2% had a postoperative VTE. Upon multivariate analysis adjusting for age, stage, histology, performance status, and residual disease, preoperative VTE was predictive of OS (HR 3.1, 95% CI: 1.6–6.1, p = 0.001) but not PFS (p = 0.55). Postoperative VTE was associated with shorter PFS (HR 1.45, 95% CI: 1.04–2.02, p = 0.03) and OS (HR 1.8, 95% CI: 1.3–2.6, p = 0.001). When VTE timing was modeled, preoperative VTE (HR 3.5, 95% CI: 1.8–6.9, p < 0.001) and postoperative VTE after primary therapy (HR 2.3, 95% CI: 1.4–3.6, p = 0.001) were predictive of OS.Conclusion
Preoperative and postoperative VTE appear to have a detrimental effect on OS with EOC. When modeled as a binary variable, postoperative VTE attenuated PFS; however, when VTE timing was modeled, postoperative VTE was not associated with PFS. It is unclear whether VTE is an inherent poor prognostic marker or if improved VTE prophylaxis and treatment may enable similar survival to patients without these events. 相似文献5.
Joshua G. Cohen Arthur-Quan TranB.J. Rimel Ilana CassChristine S. Walsh Beth Y. KarlanAndrew J. Li 《Gynecologic oncology》2014
Objectives
A growing body of evidence supports a role for thrombocytosis in the promotion of epithelial ovarian cancer biology. However, studies have only linked preoperative platelet count at time of initial cytoreductive surgery to clinical outcome. Here, we sought to determine the impact of elevated platelet count at time of secondary cytoreductive surgery (SCS) for recurrent disease.Methods
Under an IRB-approved protocol, we identified 107 women with invasive epithelial ovarian cancer who underwent SCS between January 1997 and June 2012. We reviewed clinical, laboratory, and pathologic records from this retrospective cohort. The data was analyzed using the chi-squared, Fisher's exact, Cox proportional hazards, and Kaplan–Meier tests. We defined thrombocytosis as a platelet count ≥ 350 × 109/L and optimal resection at SCS as microscopic residual disease.Results
Thirteen of 107 women (12%) with recurrent ovarian cancer had thrombocytosis prior to SCS. Preoperative thrombocytosis at SCS was associated with failure to undergo optimal resection (p = 0.0001). Women with preoperative thrombocytosis at time of SCS demonstrated shorter overall survival (33 months) compared to those with normal platelet counts (46 months, p = 0.004). On multivariate analysis, only preoperative platelet count retained significance as an independent prognostic factor (p = 0.025) after controlling for age at SCS (p = 0.90), disease free interval from primary treatment (0.06), and initial stage of disease (0.66).Conclusions
Elevated platelet count at time of SCS is associated with suboptimal resection and shortened overall survival. These data provide further evidence supporting a plausible role for thrombocytosis in aggressive ovarian tumor biology. 相似文献6.
Koji Matsuo Todd B. Sheridan Seiji Mabuchi Kiyoshi Yoshino Kosei Hasegawa Kimberley D. Studeman Dwight D. Im Neil B. Rosenshein Lynda D. Roman Anil K. Sood 《Gynecologic oncology》2014
Objective
Recent studies have demonstrated that lymphovascular space invasion (LVSI) is associated with increased risk of hematogenous and lymphatic metastasis and poor clinical outcome of women with epithelial ovarian cancer. Given the suspected role of estrogen in promoting ovarian cancer metastasis, we examined potential links between estrogen receptor and LVSI in high-grade serous ovarian carcinoma.Methods
Tumoral expression of ER, PR, p53, MDR1, EGFR, HER2, DNA ploidy, and S-phase fraction was examined for 121 cases of stage I–IV high-grade serous ovarian carcinoma samples obtained at primary cytoreductive surgery. Biomarker expression was correlated to LVSI and survival outcomes.Results
LVSI was observed in 101 (83.5%) of all cases. Immunohistochemistry of tested biomarkers showed ER (86.7%) to be the most commonly expressed followed by p53 (71.4%), HER2 (68.3%), EGFR (52.1%), MDR-1 (14.3%), and PR (8.9%). ER expression was positively correlated to PR expression (r = 0.31, p = 0.001). LVSI was only correlated with ER (odds ratio 6.27, 95%CI 1.93–20.4, p = 0.002) but not with other biomarkers. In multivariate analysis, ER remained significantly associated with LVSI (p = 0.039). LVSI remained a significant prognostic factor for decreased progression-free survival (HR 3.01, 95%CI 1.54–5.88, p = 0.001) and overall survival (HR 2.69, 95%CI 1.18–6.23, p = 0.021) while ER-expression did not remain as a significant variable in multivariate analysis.Conclusion
Our data demonstrated that estrogen receptor was positively correlated with LVSI that was an independent prognostic indicator of poor survival outcomes of high-grade serous ovarian carcinoma. This study emphasizes the importance of estrogen pathway in promoting lymphatic or vascular spread of high-grade serous ovarian carcinoma. 相似文献7.
Jelle M. Schaaf Anita C.J. Ravelli Ben Willem J. Mol Ameen Abu-Hanna 《European journal of obstetrics, gynecology, and reproductive biology》2012
Objective
To develop and validate a prognostic model for prediction of spontaneous preterm birth.Study design
Prospective cohort study using data of the nationwide perinatal registry in The Netherlands. We studied 1,524,058 singleton pregnancies between 1999 and 2007. We developed a multiple logistic regression model to estimate the risk of spontaneous preterm birth based on maternal and pregnancy characteristics. We used bootstrapping techniques to internally validate our model. Discrimination (AUC), accuracy (Brier score) and calibration (calibration graphs and Hosmer-Lemeshow C-statistic) were used to assess the model's predictive performance. Our primary outcome measure was spontaneous preterm birth at <37 completed weeks.Results
Spontaneous preterm birth occurred in 57,796 (3.8%) pregnancies. The final model included 13 variables for predicting preterm birth. The predicted probabilities ranged from 0.01 to 0.71 (IQR 0.02–0.04). The model had an area under the receiver operator characteristic curve (AUC) of 0.63 (95% CI 0.63–0.63), the Brier score was 0.04 (95% CI 0.04–0.04) and the Hosmer Lemeshow C-statistic was significant (p < 0.0001). The calibration graph showed overprediction at higher values of predicted probability. The positive predictive value was 26% (95% CI 20–33%) for the 0.4 probability cut-off point.Conclusions
The model's discrimination was fair and it had modest calibration. Previous preterm birth, drug abuse and vaginal bleeding in the first half of pregnancy were the most important predictors for spontaneous preterm birth. Although not applicable in clinical practice yet, this model is a next step towards early prediction of spontaneous preterm birth that enables caregivers to start preventive therapy in women at higher risk. 相似文献8.
Objective
The aims of this study are to investigate the actual time from primary surgery for epithelial ovarian cancer (OC) to initiation of chemotherapy (TI) amongst Danish women in 2005–2006, and to compare the survival for groups with early initiation (≤ median TI) and late initiation of adjuvant chemotherapy (> median TI).Methods
All Danish women who underwent surgery for OC in the period 1 January 2005 to 31 December 2006 and recorded in the Danish Gynaecological Cancer Database (DGCD) were included. The five-year survival was estimated overall and by TI exposure. The Cox proportional hazard regression analysis was used to compute the adjusted hazard ratio (HR).Results
The median TI was 32 days (25–75% quartile: 24 days; 41 days). The strongest prognostic factors for death were residual tumour and the International Federation of Obstetrics and Gynecology (FIGO) stage.The unadjusted HR for death in patients with TI > 32 days compared with TI ≤ 32 days was 0.85 (95% CI: 0.70; 1.04), p-value 0.12. When adjusted for residual tumour and FIGO-stage the HR was 1.13 (95% CI: 0.92; 1.39), p-value 0.26. The overall five-year survival was 42.8%, (95% CI: 38.9%; 46.5%).Conclusions
This nationwide population-based cohort study revealed a non-significant increased risk of death for patients with TI > 32 days compared with the reference TI ≤ 32 days. The strongest prognostic factors were residual tumour after surgery and FIGO-stage. The overall five-year survival was 42.8% (95% CI: 38.9%; 46.5%). 相似文献9.
Powell Perng Wei Perng Twalib Ngoma Crispin Kahesa Julius Mwaiselage Sofia D. Merajver Amr S. Soliman 《International journal of gynaecology and obstetrics》2013
Objective
To investigate promoters and barriers for cervical cancer screening in rural Tanzania.Methods
We interviewed 300 women of reproductive age living in Kiwangwa village, Tanzania. The odds of attending a free, 2-day screening service were compared with sociodemographic variables, lifestyle factors, and knowledge and attitudes surrounding cervical cancer using multivariable logistic regression.Results
Compared with women who did not attend the screening service (n = 195), women who attended (n = 105) were older (OR 4.29; 95% CI, 1.61–11.48, age 40–49 years versus 20–29 years), listened regularly to the radio (OR 24.76; 95% CI, 11.49–53.33, listened to radio 1–3 times per week versus not at all), had a poorer quality of life (OR 4.91; CI, 1.96–12.32, lowest versus highest score), had faced cost barriers to obtaining health care in the preceding year (OR 2.24; 95% CI, 1.11–4.53, yes versus no), and held a more positive attitude toward cervical cancer screening (OR 4.64; 95% CI, 1.39–15.55, least versus most averse).Conclusion
Efforts aimed at improving screening rates in rural Tanzania need to address both structural and individual-level barriers, including knowledge and awareness of cervical cancer prevention, cost barriers to care, and access to health information. 相似文献10.
Erin M. George Thomas J. Herzog Alfred I. Neugut Yu-Shiang Lu William M. Burke Sharyn N. Lewin Dawn L. Hershman Jason D. Wright 《Gynecologic oncology》2013
Objective
Ovarian carcinosarcomas (OCS) are rare tumors composed of both malignant epithelial and mesenchymal elements. We compared the natural history and outcomes of OCS to serous carcinoma of the ovary.Methods
Patients with OCS and serous carcinomas registered in the Surveillance, Epidemiology, and End Results (SEER) database between 1988 and 2007 were analyzed. Demographic and clinical characteristics were compared using chi square tests while survival was analyzed using Cox proportional hazards models and the Kaplan–Meier method.Results
A total of 27,737 women, including 1763 (6.4%) with OCS and 25,974 (93.6%) with serous carcinomas, were identified. Patients with carcinosarcomas tended to be older and have unstaged tumors (P < 0.0001). After adjusting for other prognostic factors, women with carcinosarcomas were 72% more likely to die from their tumors (HR = 1.72; 95% CI, 1.52–1.96). Five-year survival for stage I carcinosarcomas was 65.2% (95% CI, 58.0–71.4%) vs. 80.6% (95% CI, 78.9–82.2%) for serous tumors. Similarly, five-year survival for stage IIIC patients was 18.2% (95% CI, 14.5–22.4%) for carcinosarcomas compared to 33.3% (95% 32.1–34.5%) for serous carcinomas.Conclusions
Ovarian carcinosarcomas are aggressive tumors with a natural history that is distinct from serous cancers. The survival for both early and late stage carcinosarcoma is inferior to serous tumors. 相似文献11.
Vasileios Pergialiotis Dimitrios VlachosAthanasios Protopapas Kaliopi PappaGeorgios Vlachos 《International journal of gynaecology and obstetrics》2014
Background
Severe perineal lacerations represent a significant complication of normal labor with a strong impact on quality of life.Objectives
To identify factors that lead to the occurrence of severe perineal lacerations.Search strategy
We searched MEDLINE, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Google Scholar and reference lists from all included studies.Selection criteria
We included prospective and retrospective observational studies.Data collection and analysis
Predetermined data were collected and analyzed with the Mantel–Haenszel fixed-effects model or the DerSimonian–Laird random-effects model.Main results
The meta-analysis included 22 studies (n = 651 934). Women with severe perineal tears were more likely to have had heavier infants (mean difference 192.88 g [95% CI, 139.80–245.96 g]), an episiotomy (OR 3.82 [95% CI, 1.96–7.42]), or an operative vaginal delivery (OR 5.10 [95% CI, 3.33–7.83]). Epidural anesthesia (OR 1.95 [95% CI, 1.63–2.32]), labor induction (OR 1.08 [95% CI, 1.02–1.14]), and labor augmentation (OR 1.95 [95% CI, 1.56–2.44]) were also more common among women with perineal lacerations.Conclusions
Various factors contribute to the occurrence of perineal lacerations. Future studies should consistently evaluate all examined parameters to determine their possible interrelation. 相似文献12.
José H.T.G. Fregnani Maria R.D.O. Latorre Pablo R. Novik Ademar Lopes Fernando A. Soares 《European journal of obstetrics, gynecology, and reproductive biology》2009
Objectives
To evaluate risk factors for recurrence of carcinoma of the uterine cervix among women who had undergone radical hysterectomy without pelvic lymph node metastasis, while taking into consideration not only the classical histopathological factors but also sociodemographic, clinical and treatment-related factors.Study design
This was an exploratory analysis on 233 women with carcinoma of the uterine cervix (stages IB and IIA) who were treated by means of radical hysterectomy and pelvic lymphadenectomy, with free surgical margins and without lymph node metastases on conventional histopathological examination. Women with histologically normal lymph nodes but with micrometastases in the immunohistochemical analysis (AE1/AE3) were excluded. Disease-free survival for sociodemographic, clinical and histopathological variables was calculated using the Kaplan–Meier method. The Cox proportional hazards model was used to identify the independent risk factors for recurrence.Results
Twenty-seven recurrences were recorded (11.6%), of which 18 were pelvic, four were distant, four were pelvic + distant and one was of unknown location. The five-year disease-free survival rate among the study population was 88.4%. The independent risk factors for recurrence in the multivariate analysis were: postmenopausal status (HR 14.1; 95% CI: 3.7–53.6; P < 0.001), absence of or slight inflammatory reaction (HR 7.9; 95% CI: 1.7–36.5; P = 0.008) and invasion of the deepest third of the cervix (HR 6.1; 95% CI: 1.3–29.1; P = 0.021). Postoperative radiotherapy was identified as a protective factor against recurrence (HR 0.02; 95% CI: 0.001–0.25; P = 0.003).Conclusion
Postmenopausal status is a possible independent risk factor for recurrence even when adjusted for classical prognostic factors (such as tumour size, depth of tumour invasion, capillary embolisation) and treatment-related factors (period of treatment and postoperative radiotherapy status). 相似文献13.
14.
Objective
To assess the feasibility of adding letrozole to the standard regimen of mifepristone and misoprostol for termination of pregnancy up to 63 days.Study design
We recruited 50 subjects who had requested legal termination of pregnancy up to 63 days. Medical abortion was performed with a singe dose of 200 mg mifepristone and 10 mg of letrozole daily for 3 days followed by 800 mcg vaginal misoprostol.Results
The complete abortion rate was 98% (95% CI: 94–100%). The median induction-to-abortion interval of the regimen was 5.1 h (range 1.2–56 h). No serious adverse effects were reported.Conclusions
The results of this pilot study suggest that a regimen of mifepristone, letrozole and misoprostol is associated with a high complete abortion rate without major adverse events. 相似文献15.
Andreas Mueller Stefan P. Renner Lothar Haeberle Johannes Lermann Peter Oppelt Matthias W. Beckmann Falk Thiel 《European journal of obstetrics, gynecology, and reproductive biology》2009
Objective
To compare total laparoscopic hysterectomy (TLH) using the Hohl instrument with laparoscopy-assisted supracervical hysterectomy (LASH) in women with uterine leiomyoma.Study design
231 women underwent laparoscopic hysterectomy for the treatment of symptomatic leiomyoma between January 2005 and December 2007. A total of 113 women decided to undergo complete hysterectomy with removal of the cervix (TLH group) and 118 women wished to preserve the cervix; LASH was carried out in the latter group (LASH group).Results
No ureteral or bladder injury occurred in any of the patients. Two intraoperative complications and one postoperative complication occurred in the TLH group, while no complications occurred in the LASH group. When the TLH group was compared with the LASH group, the mean loss of hemoglobin was 1.6 ± 1.1 g/dL (95% CI 1.4–1.8) vs. 1.5 ± 1.4 g/dL (95% CI 1.2–1.7); the mean operating time was 114.0 ± 33.8 min (95% CI 107.6–120.2) vs. 116.5 ± 40 min (95% CI 109.3–124.0); and the mean uterus weight was 264.8 ± 133.6 g (95% CI 239.8–289.6) vs. 286.2 ± 209.3 g (95% CI 247.4–324.4). Hospital stay and use of analgesia in both groups were equal. No statistically significant differences were found.Conclusions
TLH using the Hohl instrument is an option comparable with laparoscopy-assisted supracervical hysterectomy for women with uterine leiomyoma. However, the complication rates may be lower when LASH is performed. 相似文献16.
Attibele Palaksha Manjunath Nidhika Chhabra Shivarudraiah Girija Sreekumaran Nair 《European journal of obstetrics, gynecology, and reproductive biology》2012
Objective
The intraperitoneal route of analgesia has been studied over the years for effective perioperative pain relief during minimally invasive surgery, but there were conflicting reports of the use of intraperitoneal analgesic administration and moreover there was no consensus regarding the dose and type of drugs used. We report a randomized trial to assess the safety and effectiveness of intraperitoneal lignocaine as an intraoperative and postoperative analgesic in laparoscopic tubal ligation.Study design
This is a double masked, randomized parallel group placebo-controlled trial of women seeking laparoscopic sterilization under local anaesthesia at a university hospital. The intervention group and placebo group received 20 ml of 0.5% lignocaine and 20 ml of isotonic saline intraperitoneally respectively. Allocation concealment was done by fixed block randomization. The participating women, the surgeon, anaesthetist, technician and the doctor who assessed the pain score were masked to the type of intervention. Intraoperative and postoperative pain was assessed by visual analogue pain scale and the scores are expressed as mean difference (95% confidence interval) between groups. Our trial is registered with the Clinical Trials Registry, India (http://www.ctri.nic.in/, CTRI/2009/091/000072).Results
Out of 200 women recruited, 196 were available for final analysis with 98 women in each arm. The mean difference in the intraoperative pain score at the time of tubal ligation was 3.5 cm (95% CI 2.91–4.09). The mean difference in the postoperative pain scores at half an hour was 2.9 (95% CI 2.50–3.44), 1 h was 2.5 (95% CI 2.08–3.00) and 3 h was 1.2 (95% CI 0.75–1.76). There was no case of adverse reaction to lignocaine.Conclusion
Our findings show that intraperitoneal instillation of lignocaine is a safe and effective method for perioperative pain relief during laparoscopic tubal occlusion performed under conscious sedation. 相似文献17.
Gali Pariente Eyal Sheiner Roy Kessous Sherf Michael Ilana Shoham-Vardi 《International journal of gynaecology and obstetrics》2013
Objective
To investigate whether delivering a small-for-gestational-age (SGA) newborn is a risk factor for subsequent long-term maternal cardiovascular morbidity.Methods
Data were analyzed from consecutive pregnant women who delivered at Soroka University Medical Center, Beer-Sheva, Israel, between 1988 and 1999, and were followed-up retrospectively until 2010. Long-term cardiovascular morbidity was compared among women with and without SGA neonates.Results
During the study period, 47 612 deliveries met the inclusion criteria, and 4411 (9.3%) women delivered an SGA neonate. Delivery of an SGA neonate was a risk factor for long-term complex cardiovascular events, including congestive heart failure, hypertensive heart and kidney disease, and acute cor pulmonale (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.3–4.4; P = 0.006); and long-term cardiovascular mortality (OR, 3.4; 95% CI, 1.5–7.6; P = 0.006). Women who delivered an SGA neonate had a significantly higher risk for cardiovascular mortality during the follow-up period (Kaplan–Meier survival analysis, P = 0.002). Delivery of an SGA neonate remained an independent risk factor for long-term maternal cardiovascular mortality (Cox multivariable regression: adjusted hazard ratio, 3.5; 95% CI, 1.5–8.2; P = 0.004).Conclusion
Delivery of an SGA neonate is an independent risk factor for long-term cardiovascular morbidity in a follow-up period of more than 10 years. 相似文献18.
Annette J. Reid Andrew D. Beggs Abdul H. Sultan Anne-Marie Roos Ranee Thakar 《International journal of gynaecology and obstetrics》2014
Objective
To prospectively assess change in bowel symptoms and quality of life (QoL) approximately 3 years after primary repair of obstetric anal sphincter injuries (OASIS).Methods
Between July 2002 and December 2007 women who attended the perineal clinic at Croydon University Hospital, UK, 9 weeks following primary repair of OASIS were asked to complete the Manchester Health Questionnaire and a questionnaire to obtain a St Mark incontinence score. All women had endoanal scans at this visit. In June 2008 all women were asked to complete the questionnaires again.Results
Of 344 patients who responded to the questionnaires and were included in the analysis, long-term symptoms of fecal urgency, flatus incontinence, and fecal incontinence occurred in 62 (18.0%), 52 (15.1%), and 36 (10.5%), respectively. Overall, there was a significant improvement in fecal urgency (P < 0.001) and flatus incontinence (P < 0.001) from 9 weeks to 3 years. Of 31 women with fecal incontinence symptoms at early follow-up, 28 were asymptomatic at 3 years. However, 33 women developed de novo symptoms. The only predictors of fecal incontinence at 3 years were fecal urgency at 9 weeks (OR 4.65; 95% CI, 1.38–15.70) and a higher St Mark score (OR 1.40; 95% CI, 1.09–1.80).Conclusion
Following primary repair of OASIS, the majority of symptoms and QoL significantly improve, unless there is a persistent anal sphincter defect. This highlights the importance of adequate repair. 相似文献19.
Samith Sandadi Kara Long Vaagn Andikyan Jessica Vernon Oliver Zivanovic Eric L. Eisenhauer Douglas A. Levine Yukio Sonoda Richard R. Barakat Dennis S. Chi 《Gynecologic oncology》2014
Objective
Primary cytoreductive surgery in patients with stage IIIC–IV epithelial ovarian cancer frequently includes diaphragm peritonectomy or resection, which can lead to symptomatic pleural effusions when the resection specimen is ≥ 10 cm. Our objective was to evaluate whether the placement of an intraoperative thoracostomy tube decreased the incidence of symptomatic pleural effusions in these cases.Methods
We identified 156 patients who underwent primary debulking surgery involving diaphragm peritonectomy or resection for stage III–IV ovarian cancer from 1/01–12/09. Using standard statistical tests, the incidence of symptomatic pleural effusions and other variables were compared between patients who did and did not have intraoperative chest tubes placed.Results
Forty-nine patients had a resected diaphragm specimen ≥ 10 cm in largest dimension; 28 (57%) did not undergo chest tube placement (NCT group) while 21 (43%) did (CT group).Mediastinal lymph node dissection (0% vs 19%, P = 0.028) and liver resections (11% vs 38%, P = 0.037) were higher in the CT group.Postoperatively, 57% of the NCT group developed a moderate or large pleural effusion compared to 19% of the CT group (P = 0.007). Thirteen patients (46%) in the NCT group developed respiratory symptoms requiring either placement of a postoperative chest tube or thoracentesis compared to 3 patients (14%) in the CT group (P = 0.018).Conclusions
Diaphragm peritonectomy or resection can often lead to moderate or large pleural effusions that may become symptomatic. In these patients, intraoperative chest tube placement may be considered to decrease the incidence of symptomatic effusions and the need for postoperative chest tube placement or thoracentesis. 相似文献20.
A. Fagotti M. Petrillo B. Costantini F. Fanfani V. Gallotta V. Chiantera L.C. Turco C. Bottoni G. Scambia 《Gynecologic oncology》2014