Uterine leiomyosarcomas: tumor size, mitotic index, and biomarkers Ki67, and Bcl-2 identify two groups with different prognosis

Objectives

This study aimed to assess the feasibility of a lifestyle intervention for promoting physical activity (PA) and diet quality during adjuvant chemotherapy for ovarian cancer.

Methods

Patients were enrolled post-operatively and received PA and nutrition counseling, at every chemotherapy visit for six cycles. Quality of life (QoL) was measured with the Functional Assessment of Cancer Therapy (FACT-G), PA with the Leisure Score Index (LSI), dietary intake with 3-day food records, and symptom severity/distress by the Memorial Symptom Assessment Scale (MSAS). Pedometer step count was collected during chemotherapy cycles.

Results

Recruitment was 73% with 27 patients enrolled. Mean [95% confidence interval] change in minutes of PA from cycle #3 to following cycle #6 was 61 min [− 3, 120] p = 0.063, and from baseline to after cycle #6 was 73 min [− 10, 15]; p = 0.082. Mean change in total fruit and vegetable consumption between baseline and during chemotherapy was 0.56 [− 0.09, 0.64]; p = 0.090. FACT-G increased from 75.4 at baseline to 77.6 during chemotherapy and 83.9 following chemotherapy (p = 0.001 for change from baseline to post-chemotherapy). Mean total MSAS score was 20.6 at baseline, 26.6 at cycle #3 and decreased to 17.0 following chemotherapy (p = 0.01 comparison of cycle #3 and following chemotherapy). Increased moderate to strenuous PA was correlated with higher physical well-being during chemotherapy (r = 0.48, p = 0.037).

Conclusions

Lifestyle counseling during adjuvant chemotherapy for ovarian cancer is feasible and may improve PA and diet quality. Randomized controlled trials examining the effects of lifestyle counseling on quality of life and treatment outcomes in ovarian cancer patients are warranted.     

Survivors of uterine cancer empowered by exercise and healthy diet (SUCCEED): a randomized controlled trial

Objective

The majority of endometrial cancer survivors (ECS) are obese and at risk for premature death. The purpose of this study was to evaluate an intervention for ECS to promote weight loss and a healthy lifestyle.

Methods

Early stage overweight and obese (body mass index ≥ 25) ECS (N = 75) were randomized to a 6-month lifestyle intervention (LI) or usual care (UC). The LI group received education and counseling for six months (10 weekly followed by 6 bi-weekly sessions). Weight change at 12 months was the primary endpoint. Secondary outcomes included fruit/vegetable servings/day and physical activity (PA). Multiple imputations were used for missing data and mixed models were used to analyze changes from baseline.

Results

Adherence was 84% and follow-up data were available from 92% of participants at 6 months and 79% at 12 months. Mean [95% CI] difference in weight change between LI and UC groups at 6 months was − 4.4 kg [− 5.3, − 3.5], p < 0.001 and at 12 months was − 4.6 kg [− 5.8, − 3.5], p < 0.001. Mean [95% CI] difference in PA minutes between groups at 6 months was 100 [6, 194], p = 0.038 and at 12 months was 89 [14, 163], p = 0.020. Mean difference in kilocalories consumed was − 217.8 (p < 0.001) at 6 months and − 187.2 (p < 0.001) at 12 months. Mean [95% CI] difference in fruit and vegetable servings was 0.91 servings/day at 6 months and 0.92 at 12 months (p < 0.001).

Conclusions

Behavior change and weight loss are achievable in overweight and obese ECS, however, the clinical implications of these changes are unknown and require a larger trial with longer follow-up.     

Self-efficacy,quality of life,and weight loss in overweight/obese endometrial cancer survivors (SUCCEED): A randomized controlled trial

Objective

More patient-centered programming is essential for endometrial cancer (EC) survivors needing to lose weight to reduce cardiovascular disease risk (CVD). The purpose of this study was to improve self-efficacy (SE) and quality of life (QOL) using a lifestyle intervention program designed for weight loss.

Methods

Overweight and obese early-stage EC survivors, n = 75, were randomized into two groups: 1) Survivors of Uterine Cancer Empowered by Exercise and Healthy Diet (SUCCEED), a six-month lifestyle intervention or 2) a usual care group (UC). Participants completed the Weight Efficacy Lifestyle Questionnaire (WEL) to assess SE and the Functional Assessment of Cancer Therapy—General (FACT-G) to measure QOL, and their body mass index (BMI) was calculated at baseline, 3, 6, and 12 months. Mixed, repeated-measures ANCOVA models with baseline covariates were employed using SPSS 20.0.

Results

Positive effects in every WEL domain, including the total score, were statistically significant in the SUCCEED group versus the UC group. A linear regression model demonstrated that, if BMI decreased by 1 unit, the total WEL score increased by 4.49 points. Significant negative correlations were found in the total WEL score and a change in BMI of R = − 0.356 (p = 0.006). Between-group differences in the FACT-G were significant from baseline in the fatigue domain at three months (p = .008) and in the physical domain at six months (p = .048). No other significant differences were found.

Conclusion

Overall, this study shows promise for targeted interventions to help improve SE, thus improving BMI.     

Conservative management of stage IA1 squamous cell carcinoma of the cervix with positive resection margins after conization

Objective

To evaluate the efficacy of cold knife conization with electrocauterization and the feasibility of conservative management in patients with stage IA1 carcinoma of the cervix according to margin status after conization.

Methods

Medical and histopathological records of 108 patients with stage IA1 cervical carcinoma were reviewed retrospectively. Patients underwent cold knife conization with electrocauterization or conization followed by hysterectomy. Disease recurrence was defined as a histologic diagnosis of cervical intraepithelial neoplasia (CIN) 2 or higher grade lesion.

Results

Forty patients underwent conization followed by hysterectomy; of 27 women with positive margins, 14 (35%) had a residual lesion. Sixty-eight patients underwent conization without further surgical intervention. Forty patients had a negative resection margin without recurrence, while 28 had a positive resection margin: positive exocervical (n = 11), positive endocervical (n = 17). Among these, there were 7 cases of recurrence: positive exocervical (n = 1); positive endocervical (n = 6).

Conclusion

Cold knife conization with electrocauterization appears to be a safe treatment option for patients with stage IA1 cervical carcinoma if careful follow-up is guaranteed for patients with CIN 3 exocervical resection margins. However, patients with CIN 3 endocervical resection margins should be managed surgically with repeat conization or hysterectomy.     

Immunoexpression of B7-H3 in endometrial cancer: relation to tumor T-cell infiltration and prognosis

Objective

B7-H3, a member of the B7 family of immune regulatory ligands regulates T cell-mediated peripheral immune response. The purpose of this study was to correlate the expression of B7-H3 and number of lymphocytes in patients with endometrial cancer.

Material and methods

A total of 107 patients with primary endometrial carcinoma (type I/endometrioid, n = 81; type II, n = 18) and endometrial hyperplasia (n = 8) were investigated. Expression of B7-H3 in endometrial hyperplasia, endometrial carcinoma, and the endothelium of tumor-associated vasculature was assessed using immunohistochemistry from paraffin-embedded tissue blocks. Detection of CD8-positive tumor-infiltrating lymphocytes (TIL) and CD8-positive tumor-associated lymphocytes (TAL) was correlated with the expression of B7-H3.

Results

Patients with high grade tumors and patients with type II carcinomas expressed significantly more B7-H3 than low grade and endometrioid tumors (p = < 0.0001 and p = 0.0001, respectively). The expression of B7-H3 in the endothelium of identified vasculature in the tumor specimens showed similar results with strong relation to high grade tumors (p = 0.001) and type II carcinomas (p = 0.004). We found a significant correlation between B7-H3 expression on cancer cells and tumor T-cell infiltration (TIL) (p = 0.017). In a univariate survival analysis, overexpression of B7-H3 in tumor cells was associated with shortened overall survival (p = 0.005).

Conclusions

B7-H3 is overexpressed on cancer cells and in the endothelium of tumor-associated vasculature in high grade tumors (G3) and type II carcinomas. B7-H3 expression on cancer cells is correlated with the number of T cells infiltrating the tumor. Endometrium tumor development and progression may be associated with downregulation of T-cell-mediated antitumor immunity through B7-H3.     

Phase II trial of cetuximab in the treatment of persistent or recurrent squamous or non-squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study

Purpose

The Gynecologic Oncology Group (GOG) conducted a phase II trial to assess the efficacy and tolerability of the anti-EGFR antibody cetuximab, in persistent or recurrent carcinoma of the cervix.

Patients and methods

Eligible patients had cervical cancer, measurable disease, and GOG performance status ≤ 2. Treatment consisted of cetuximab 400 mg/m² initial dose followed by 250 mg/m² weekly until disease progression or prohibitive toxicity. The primary endpoints were progression-free survival (PFS) at 6 months and response. The study used a 2-stage group sequential design.

Results

Thirty-eight patients were entered with 3 exclusions, leaving 35 evaluable for analysis. Thirty-one patients (88.6%) received prior radiation as well as either 1 (n = 25, 71.4%) or 2 (n = 10) prior cytotoxic regimens. Twenty-four patients (68.6%) had a squamous cell carcinoma. Grade 3 adverse events possibly related to cetuximab included dermatologic (n = 5), GI (n = 4), anemia (n = 2), constitutional (n = 3), infection (n = 2), vascular (n = 2), pain (n = 2), and pulmonary, neurological, vomiting and metabolic (n = 1 each). No clinical responses were detected. Five patients (14.3%; two-sided 90% CI, 5.8% to 30%) survived without progression for at least 6 months. The median PFS and overall survival (OS) times were 1.97 and 6.7 months, respectively. In this study, all patients with PFS at 6 months harbored tumors with squamous cell histology.

Conclusion

Cetuximab is well tolerated but has limited activity in this population. Cetuximab activity may be limited to patients with squamous cell histology.     

A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Nigeria

Objective

To determine whether the non-pneumatic anti-shock garment (NASG) can improve maternal outcome.

Methods

Women were enrolled in a pre-intervention phase (n = 83) and an intervention phase (n = 86) at a referral facility in Katsina, Nigeria, from November 2006 to November 2007. Entry criteria were obstetric hemorrhage (≥ 750 mL) and a clinical sign of shock (systolic blood pressure < 100 mm Hg or pulse > 100 beats per minute). To determine differences in demographics, condition on study entry, treatment, and outcome, t tests and χ² tests were used. Relative risk (RR) and 95% confidence interval (CI) were estimated for the primary outcome, mortality.

Results

Mean measured blood loss in the intervention phase was 73.5 ±93.9 mL, compared with 340.4 ± 248.2 mL pre-intervention (P < 0.001). Maternal mortality was lower in the intervention phase than in the pre-intervention phase (7 [8.1%]) vs 21 [25.3%]) (RR 0.32; 95% CI, 0.14-0.72).

Conclusion

The NASG showed potential for reducing blood loss and maternal mortality caused by obstetric hemorrhage-related shock.     

20 year experience of postoperative radiotherapy in IB-IIA cervical cancer patients with intermediate risk factors: impact of treatment period and concurrent chemotherapy

Objective

To compare the long-term clinical outcomes of adjuvant radiotherapy (RT) versus concurrent chemoradiotherapy (CCRT) in cervical cancer patients with intermediate risk factors.

Methods

Between 1990 and 2010, 110 cervical cancer patients with 2 or more intermediate risk factors (deep stromal invasion, lymphovascular space invasion, and large tumor size) underwent adjuvant RT (n = 56) or CCRT (n = 54) following radical surgery. Because CCRT had been performed since 2000, patients were divided into 3 groups regarding treatment period and the addition of chemotherapy, RT 1990-1999 (n = 39), RT 2000-2010 (n = 17) and CCRT 2000-2010 (n = 54). Majority of concurrent chemotherapeutic regimens were carboplatin and paclitaxel (n = 48).

Results

Five-year relapse-free survival (RFS) rates for RT 1990-1999, RT 2000-2010 and CCRT 2000-2010 were 83.5%, 85.6% and 93.8%, respectively. CCRT 2000-2010 had a significant decrease in pelvic recurrence (p = 0.012) and distant metastasis (p = 0.027). There were no significant differences in overall survival and RFS between RT 1990-1999 and RT 2000-2010. Acute grade 3 and 4 hematologic toxicities were more frequently observed in CCRT 2000-2010 (p < 0.001). However, acute grade 3 and 4 gastrointestinal (GI) and chronic toxicities did not differ between the groups.

Conclusions

This study shows that the addition of concurrent chemotherapy to postoperative RT in cervical cancer patients with intermediate risk factors may improve RFS without increasing acute GI and chronic toxicities, although hematologic toxicities increased significantly.     

Effect of continuous support during labor on duration of labor and rate of cesarean delivery

Objective

To evaluate the effect of continuous support provided by midwives during labor on the duration of the different stages of labor and the rate of cesarean delivery.

Method

A randomized trial of 100 eligible nulliparous women who had not received education classes on childbirth. In the intervention group (n = 50), continuous support during labor was provided; the control group (n = 50) did not receive continuous support.

Results

The two groups did not differ by age, employment, educational level, gestational age, economic status, and neonatal weight. Mean duration of the active phase of labor (167.9 ± 76.3 vs 247.7 ± 101 min, P < 0.001), second stage of labor (34.9 ± 25.4 vs 55.3 ± 33.7 min, P = 0.003), and the number of cesarean deliveries (4 vs 12, P = 0.026) were significantly lower in the intervention group compared with the control group. The rates of oxytocin use and Apgar scores of less than 7 at 5 minutes were similar between the two groups.

Conclusion

Continuous support provided by midwives during labor may reduce the duration of labor and the number of cesarean deliveries; this model of support should be available to all women.     

Co-morbidity and pain sites in long-term gynecological cancer survivors and women in the general population

Objective

Pain is associated with cancer, cancer treatment, co-morbidity and socioeconomic conditions. The aim of this cross-sectional study was to explore the relationship between co-morbidity and number of pain sites (NPS) in long-term survivors of gynecological cancer and a representative sample of women from the general population.Study population comprised recurrence-free long-term gynecological cancer survivors (n = 160) and women selected at random from the general population (n = 493) in Mid-Norway. Mean age was 58 and 57 (range 32-75), respectively. Mean follow-up time after treatment for gynecological cancer was 12 years (SD 2.6; range 8-17).

Methods

Co-morbidity was assessed as conditions/diseases over the past 12 months. NPS was recorded using a body outline diagram indicating where the respondents had experienced pain during the past week. Socioeconomic conditions were measured by Socioeconomic Condition Index (SCI). All assessments were self-reported. We tested three models of covariates with NPS as outcome: 1-2/0 (A), 3/0 (B) and 4-7/0 (C) pain sites in forward stepwise logistic regression. Outcome measure was adjusted odds ratio (aOR) with 95% confidence intervals (CI).

Results

There were no differences in co-morbidity and NPS between gynecological cancer survivors and women from the general population. After adjustment for SCI, age and BMI, musculoskeletal disorders were the strongest predictor of NPS in all models, whereas migraine/headache, sleeping and psychiatric disorders were significantly associated with NPS in model A/B/C, B/C, and C, respectively.

Conclusions

Gynecological cancer survivors are as healthy, and carry as much co-morbid conditions as women from the general population assessed through associations with NPS.     

Effect of the interval between onset of sustained fetal bradycardia and cesarean delivery on long-term neonatal neurologic prognosis

Objective

To examine the effect of the interval between onset of sustained fetal bradycardia and cesarean delivery on long-term neonatal neurologic prognosis.

Method

A retrospective observational case-series performed with patients who had sudden-onset and sustained (< 100 beats per minute) fetal bradycardia during labor. Fetal heart rate was monitored closely until cesarean delivery. The effect of the interval between the onset of bradycardia and delivery on neonatal neurologic prognosis was examined.

Results

Among 2267 deliveries in 2002-2003 at Kitasato University Hospital, 19 pregnancies met the inclusion criteria. Episodes of fetal bradycardia were due to umbilical cord prolapse (n = 5), placental abruption (n = 4), uterine rupture (n = 3), maternal respiratory failure (n = 1), and other causes (n = 6). Mean onset of fetal bradycardia to delivery interval (BDI) was 20.5 ± 8.9 minutes. Mean decision-to-cesarean delivery interval was 11.4 ± 3.9 minutes. BDI was negatively correlated with umbilical arterial pH at delivery. There were 3 postnatal deaths. Neurologic assessment at the age of 2 years revealed that 15 of 16 children were neurologically normal. When the BDI was less than 25 minutes, all term pregnancies led to normal neonatal neurologic development.

Conclusion

In the event of sustained intrapartum fetal bradycardia, delivery by emergency cesarean within 25 minutes improved long-term neonatal neurologic outcome.     

Prevalence and risk factors for domestic violence against infertile women in an Iranian setting

Objective

To determine the prevalence of and risk factors for domestic violence against women with female factor infertility in an Iranian setting.

Methods

In this cross-sectional survey conducted from August 1, 2009 to January 31, 2010, 400 women with primary infertility attending Valiasr Reproductive Health Research Center in Tehran, Iran, were interviewed using the Revised Conflict Tactics Scales questionnaire (CTS₂). This instrument was developed to investigate the presence domestic violence.

Results

A total of 247 women (61.8%) reported having experienced domestic violence because of their infertility. The most common type of violence was psychological (n = 135 [33.8%]), followed by physical (n = 56 [14%]) and sexual (n = 32 [8%]), with 24 women (6%) reporting injuries. All women reported their husbands to be the perpetrators.

Conclusion

Domestic violence against infertile women is a considerable yet unreported problem. Clinicians should identify the abused women and provide them with medical care and supportive counseling.     

Factors associated with operative hysteroscopy outcome in patients with uterine adhesions or submucosal myomas

Objective

To determine the factors associated with hysteroscopic surgery long-term outcome in patients with intrauterine adhesions or submucosal myomas.

Methods

Factors thought to be associated with outcome were retrospectively evaluated from the records of 591 patients who were followed up for at least 5 years after undergoing hysteroscopic adhesiolysis (n = 203) or myomectomy (n = 388).

Results

The major factors affecting outcome were degree of adhesion (OR, 1.91; P = 0.03) in the former group and parity (OR, 0.55; P = 0.005) and depth of intramural penetration of the myoma (OR, 30.74; P < 0.001) in the latter. Severe intrauterine adhesion, low parity, and deep intramural penetration of submucosal myoma had an associated increase risk of poor outcome. The overall complication rate was 1.35% and, respectively, 12.8% and 9.3% of the patients who underwent hysteroscopic adhesiolysis or myomectomy needed a second intervention.

Conclusion

Hysteroscopic surgery is a safe and effective procedure. Degree of adhesion or parity and depth of intramural penetration of myomas are the major factors affecting outcome in patients with these lesions.     

Withdrawal from familial ovarian cancer screening for surgery: findings from a psychological evaluation study (PsyFOCS)

Objective

A prospective psychological evaluation study of familial ovarian cancer screening (PsyFOCS) is underway in partnership with the UK Familial Ovarian Cancer Screening Study (UK FOCSS Phase 2). One of the aims of PsyFOCS is to examine factors associated with withdrawal from the UK FOCSS prior to the onset of 4-monthly screening.

Method

1999 of 3224 women completed a baseline questionnaire. 110 (5.5%) women withdrew from screening prior to their first routine Phase 2 screen, of which 73 (66.4% of withdrawals) had withdrawn because they had undergone removal of their ovaries and fallopian tubes (withdrawn group). The comparison group consisted of 1868 women who remained on screening. The baseline questionnaire included measures of cancer-specific distress, anxiety, depression and illness perceptions.

Results

Logistic regression analysis indicated that having had prior annual (Phase 1) screening (OR = 13.34, p < .01), past experience of further tests (OR = 2.37, p < .01) and greater cancer-specific distress (OR = 1.38, p < .01) were associated with withdrawal for surgery. Belief in ageing as a cause of ovarian cancer was also associated with withdrawal (OR = 1.32, p = .05).

Conclusion

These cross-sectional data suggest that withdrawal from familial ovarian cancer screening may be influenced by both clinical and psychological factors. These may reflect women's experience of the drawbacks of screening and increased concern about ovarian cancer risk, as well as having opportunities to consider surgery as an alternative risk management strategy whilst using screening as an interim measure.     

Impact of smoking on perioperative pulmonary and upper respiratory complications after laparoscopic gynecologic surgery

Objective

To determine the impact of smoking on the rate of pulmonary and upper respiratory complications following laparoscopic gynecologic surgery.

Methods

We retrospectively identified all patients who underwent laparoscopic gynecologic surgery at one institution between January 2000 and January 2009. Pulmonary and upper respiratory complications were defined as atelectasis, pneumonia, upper respiratory infection, acute respiratory failure, hypoxemia, pneumothorax, or pneumomediastinum occurring within 30 days after surgery

Results

Nine hundred three patients underwent attempt at laparoscopic surgery. Fifty-four were excluded because of conversion to laparotomy and 31 because of insufficient data. Of the 818 patients included, 356 (43%) had cancer. A total of 576 (70%) patients were never smokers, 156 (19%) were past smokers, and 86 (10%) were current smokers (smoked within 6 weeks before surgery). These three groups were similar with regard to median body mass index, operative time, and length of hospital stay. Compared to never and past smokers, current smokers were more likely to undergo high-complexity laparoscopic procedures (10.4%, 15.4%, and 19.8%, respectively; p = 0.015) and had younger median age 49 years, 51 years, and 46 years, respectively; p = 0.035. Nineteen (2.3%) patients experienced pulmonary complications — symptomatic atelectasis (n = 9), pneumonia (n = 5), acute respiratory failure (n = 2), hypoxemia (n = 1), pneumomediastinum (n = 1), and pneumothorax (n = 2). The rate of pulmonary complications was 2.1% (12 of 564 patients) in never smokers, 4.5% (7 of 156 patients) in past smokers, and zero in current smokers.

Conclusion

In this cohort, smoking history did not appear to impact postoperative pulmonary and upper respiratory complications. In smokers scheduled for operative procedures, laparoscopy should be considered when feasible.     

Physician pain and discomfort during minimally invasive gynecologic cancer surgery

Objective

Despite increasing awareness of physical strain to surgeons associated with minimally invasive surgery (MIS), its use continues to expand. We sought to gather information from gynecologic oncologists regarding physical discomfort due to MIS.

Methods

Anonymous surveys were e-mailed to 1279 Society of Gynecologic Oncology (SGO) members. Physical symptoms (numbness, pain, stiffness, and fatigue) and surgical and demographic factors were assessed. Univariate and multivariate analyses were performed to determine risk factors for physical symptoms.

Results

We analyzed responses of 350 SGO members who completed the survey and currently performed > 50% of procedures robotically (n = 122), laparoscopically (n = 67), or abdominally (n = 61). Sixty-one percent of members reported physical symptoms related to MIS. The rate of symptoms was higher in the robotic group (72%) than the laparoscopic (57%) or abdominal groups (49%) (p = 0.0052). Stiffness (p = 0.0373) and fatigue (p = 0.0125) were more common in the robotic group. Female sex (p < 0.0001), higher caseload (p = 0.0007), and academic practice (p = 0.0186) were associated with increased symptoms. On multivariate analysis, robotic surgery (odds ratio [OR] 2.38, 95% CI 1.20–4.69) and female sex (OR 4.20, 95% CI 2.13–8.29) were significant predictors of symptoms. There was no correlation between seeking treatment and surgical modality (laparotomy 11%, robotic 20%, laparoscopy 25%, p = 0.12).

Conclusions

Gynecologic oncologists report physical symptoms due to MIS at an alarming rate. Robotic surgery and female sex appear to be risk factors for physical discomfort. As we strive to improve patient outcomes and decrease patient morbidity with MIS, we must also work to improve the ergonomics of MIS for surgeons.     

Comparing grades of urgency for classification of cesarean delivery

Objective

To evaluate the agreement between the traditional binary system and a new system for classifying urgency of cesarean delivery among obstetricians in The Netherlands and Belgium.

Methods

A total of 212 obstetricians were requested to grade a list of 18 obstetric scenarios using 3 classification systems: traditional binary classification; a new classification using 4 grades of urgency without additional interpretation; and the new classification with additional interpretation. Agreement was assessed by weighted kappa.

Results

Seventy-nine obstetricians responded (The Netherlands 62.2%, Belgium 9.9%). There was substantial agreement among them for all 3 classification systems (κ = 0.71, traditional classification; κ = 0.70, new classification; κ = 0.67, new classification with additional interpretation).

Conclusion

The traditional binary system and the new classification of cesarean delivery based on 4 grades of urgency, with and without additional interpretation, have similar but relatively low interobserver agreement. We suggest that the new classification should be used, but future studies are necessary to evaluate the effect of this implementation.     

Prevalence of gestational diabetes mellitus and gestational impaired glucose tolerance in pregnant women evaluated by National Diabetes Data Group and Carpenter and Coustan criteria

Objective

To determine the prevalence of gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) using National Diabetes Data Group (NDDG), and Carpenter and Coustan (CC) criteria.

Method

Retrospective study of the prevalence of GDM and GIGT in 21 531 pregnant women screened for GDM between 2005 and 2007 using NDDG and CC criteria. Linear trends in prevalence of GDM and GIGT by age were calculated using logistic regression.

Results

Mean prevalence rates for GDM were 3.17% (95% CI, 3.05-3.29; n = 683) and 4.48% (95% CI, 4.36-4.6; n = 964) according to NDDG and CC criteria, respectively. Mean prevalence rates for GIGT were 1.97% (95% CI, 1.85-2.09; n = 426) and 2.46% (95% CI, 2.34-2.58; n = 529) according to NDDG and CC criteria, respectively. Prevalence of GDM and GIGT increased with increasing age with both criteria (P < 0.001). The prevalence of GDM increased by 41.1% and GIGT increased by 24.2% using the CC criteria compared with the NDDG criteria.

Conclusion

The prevalence of GDM and GIGT was higher when CC criteria were used compared with NDDG criteria, particularly in younger age groups. The prevalence of both GIGT and GDM increased with increasing age with both criteria.     

Response to an exercise intervention after endometrial cancer: Differences between obese and non-obese survivors

Objective

The objective of this paper is to describe baseline differences between obese and non-obese endometrial cancer survivor in anthropometrics, exercise behavior, fitness, heart rate and blood pressure, and quality of life, and to analyze whether the effect of a home-based exercise intervention on these outcomes differed for obese and non-obese participants.

Methods

One hundred post-treatment Stage I–IIIa endometrial cancer survivors participated in a single arm 6 month study in which they received a home-based exercise intervention. Cardiorespiratory fitness, anthropometrics, and exercise behavior were measured every two months, and quality of life (QOL) and psychological distress were measured at baseline and 6 months.

Results

Adjusting for potential confounders, at baseline obese survivors had poorer cardiorespiratory fitness (p = .002), higher systolic blood pressure (p = .018), and lower physical functioning (p < .001) and ratings of general health (p = .002), and more pain (p = .037) and somatization (.002). Significant improvements were seen in exercise behavior, resting heart rate, systolic blood pressure, and multiple QOL domains over the course of the intervention. Obese survivors had less improvement in exercise behavior and cardiorespiratory fitness than non-obese survivors, but there were no differences with regard to improvements in QOL and stress.

Conclusions

Home based exercise interventions are beneficial to endometrial cancer survivors, including those whose BMI is in the obese range. While obese survivors have lower levels of physical activity and fitness, they experienced similar activity, fitness, quality of life and mental health benefits. Exercise should be encouraged in endometrial cancer survivors, including those who are obese.     

Single access laparoscopy for adnexal pathologies using a novel reusable port and curved instruments

Objective

To present our initial experience using single access laparoscopic surgery for the treatment of benign adnexal pathologies.

Methods

Sixteen patients with benign adnexal pathologies underwent salpingoophorectomy (n = 9), ovarian cyst enucleation (n = 5), or salpingectomy (n = 2) using a laparoendoscopic single site approach with a new multiport reusable trocar and flexible and curved—as well as standard—laparoscopic instruments.

Results

Conversion to a multi-access standard laparoscopic technique was not required in any patient and no intraoperative complications were observed. Postoperatively, one umbilical scar infection was detected. Mean operative time was 42 minutes.

Conclusion

Laparoscopic single site enucleation for adnexal pathologies is feasible, safe, and effective, and has good results for cosmetic appearance and postoperative pain. Use of specialized instruments and standardization of the technique affect surgical ergonomy and operating time.