Assesment of selected parameters depending on the size of abdominal wall incision in patients subjected to minilaparotomy due to benign gynaecological diseases

OBJECTIVES: Considering the enormous advantages of minimally invasive surgery, attempts to introduce less invasive trans-abdominal incisions might represent an alternative to classic gynecologic surgery. The aim of this study is to assess the feasibility and clinical outcome of minilaparotomy in patients operated due to benign gynecological diseases and to analyze selected parameters with regard to the abdominal wall incision size. DESIGN: In this retrospective study, we have described our experience with 26 patients, undergoing minilaparotomy for benign adnexal or uterine diseases. MATERIAL AND METHODS: 26 patients with benign uterine or adnexal diseases, hospitalized from November 2003 until March 2006 at the Department of Surgical and Endoscopic Gynecology at the Polish Mother's Memorial Hospital--Research Institute in Lód?, had undergone successful surgical treatment by means of minilaparotomy. The following procedures were included in the analysis: myomectomy (17 patients), ovarian cystectomy (3 patients), myomectomy and ovarian cystectomy at the same time (3 patients), bilateral salpingo-oophorectomy (1 patient), supracervical hysterectomy (1 patient) and total abdominal hysterectomy with salpingo--oophorectomy (1 patient). RESULTS: The patients' mean age and BMI were 33.85 years (14-50) and 22.95 (18.73-45.17), respectively. The mean operative time was 72.69 min (45-120). The diameter of trans-abdominal incision was 3-6cm and the mean diameter of removed lesions was 76.88 mm (47-200). The mean intraoperative decrease of haematocrit and haemoglobin value was 4.8% (0.2-12.4) and 1.4 g/dl (0.2-3.7), respectively. Blood transfusion was required in case of 3 patients but only in one case it was caused by intraoperative blood loss. There were no significant intra- or postoperative complications. 16 patients needed analgesics for 2.33 days after surgery. Body temperature up to 38 degrees C was observed in 4 patients for 2.5 days. The average time of hospitalization after the surgery was 4.58 days. We have noted a negative correlation between the size of trans-abdominal incision and several factors: operative time, intraoperative blood loss, period of analgesic therapy and time of hospitalization after the surgery. None of these factors was correlated with patients' age or BMI. One-month follow up after the surgery revealed satisfactory wound healing and no complains in case of all patients. All patients deemed the cosmetic effect of the surgery very good. CONCLUSION: Minilaparotomy seems to be a very simple, useful and safe surgical technique which might be an alternative to laparotomy in the management of benign gynecologic diseases. Minilaparotomy is of great value, especially in situations when laparoscopic or vaginal approach is too complicated or too dangerous due to technical reasons.     

Associations between p53 overexpression and multiple measures of clinical outcome in high-risk, early stage or suboptimally-resected, advanced stage epithelial ovarian cancers A Gynecologic Oncology Group study

ObjectiveThe Gynecologic Oncology Group (GOG) performed a detailed analysis of p53 overexpression in previously-untreated women with invasive early or advanced stage epithelial ovarian cancer (EOC).MethodsWomen were eligible for the study if they provided a tumor block for translational research and participated in either GOG-157, a randomized phase III trial of three versus (vs.) six cycles of paclitaxel + carboplatin in high-risk, early stage EOC, or GOG-111, a randomized phase III trial of cyclophosphamide + cisplatin vs. paclitaxel + cisplatin in suboptimally-resected, advanced stage EOC. The N-terminal DO-7 p53 antibody was used to examine the expression of the major normal and mutant p53-isoforms. p53 overexpression was defined as ≥ 10% tumor cells exhibiting nuclear staining.Resultsp53 was overexpressed in 51% (73/143) and 66% (90/136) of cases in the GOG-157 and GOG-111 cohorts, respectively. In the GOG-157 cohort, p53 overexpression was not associated with any clinical characteristics or overall survival (OS) but was associated with worse progression-free survival (PFS) (logrank test: p = 0.013; unadjusted Cox modeling: p = 0.015). In the GOG-111 cohort, p53 overexpression was associated with GOG performance status (p = 0.018) and grade (p = 0.003), but not with age, stage, cell type or with tumor response and disease status after primary chemotherapy, PFS or OS. Adjusted Cox regression modeling demonstrated that p53 overexpression was not an independent prognostic factor for PFS or OS in either cohort.Conclusionsp53 overexpression assessed by DO-7 immunostaining is common in early and advanced stage EOC, but has limited prognostic value in women treated with surgical staging and platinum-based combination chemotherapy.     

How important is consent in maternal serum screening for Down syndrome in France? Information and consent evaluation in maternal serum screening for Down syndrome: a French study

OBJECTIVES: To evaluate the level of information and informed consent for maternal serum screening (MSS) for Down syndrome (DS) in the second trimester of pregnancy and analyse the exercise of autonomy towards the test by the women concerned. METHODS: We studied the population of pregnant women attending obstetric consultations in two French hospitals over a 3-month period. The women were assigned to three groups according to MSS results for DS: women at high risk of having a child with DS (group 1), women at low risk (group 2) and women who did not undergo the test (group 3). A questionnaire was completed before the medical consultation, to assess the quality of consent before amniocentesis for the group at high risk and before the second-trimester ultrasound scan for the other two groups. RESULTS: We analysed 305 questionnaires for 89, 137 and 79 women belonging to groups 1, 2 and 3 respectively. In total, 123 women (40.3% [IC 95%, 35-46%]) were considered to be well informed; 33 (10%, [IC 95%, 8-12%]) had a high level of knowledge, but made choices not consistent with their stated attitude, and 149 (49.7% [IC 95%, 45-56%]) were considered uninformed. Logistic regression analysis showed that maternal consent depended on three independent components: The score attributed to the doctor for information about MSS (t = 4.216, p < 0.001).Whether the patient belonged to group 1 (t = -2.631, p < 0.009).Educational level (< high-school diploma, high-school diploma or at least two years of higher education after high school) (t = 2.324, p < 0.02). The rate of consent increased with educational level and was highest for the women in group 1 and for those whose doctor had a high information score. CONCLUSIONS: Our findings clearly show that women are provided with insufficient information concerning MSS screening for DS in the second trimester of pregnancy for real and valid consent to be obtained.     

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Central nervous system involvement in sle

The clinical course and diagnostic profile of 13 patients with central nervous system involvement and systemic lupus erythematosus (CNS-SLE) are presented. The diagnostic yield for each procedure was measured as the percent abnormal: CSF total protein was 38%; increased CSF IgG 69%; decreased CSF hemolytic C4 10%; increased CSF anti-DNA 64%; electroencephalogram 80%; flow brain scan 50%; and static brain scan 0%. No single procedure was consistently abnormal, but the battery of tests provided a useful and specific CNS-SLE diagnostic profile.     

The role of miRNA-210 in pre-eclampsia development

MicroRNAs (miRNAs) are a class of small non-coding, single-stranded RNAs (ribonucleic acids) that play important roles in many vital processes through their impact on gene expression. One such miRNA, miR210, represents a hypoxia-induced cellular miRNA group that hold a variety of functions. This review article highlights the importance of miR-210 in the development of pre-eclampsia.

KEY MESSAGE

• miR-210 is a promising biomarker for monitoring pregnancy with pre-eclampsia. Overexpression of miR-210 had a negative impact on the process of cell migration and trophoblast invasion.

     

Imaging Therapeutic PARP Inhibition In Vivo through Bioorthogonally Developed Companion Imaging Agents

A number of small-molecule poly (ADP-ribose) polymerase (PARP) inhibitors are currently undergoing advanced clinical trials. Determining the distribution and target inhibitory activity of these drugs in individual subjects, however, has proven problematic. Here, we used a PARP agent for positron emission tomography-computed tomography (PET-CT) imaging (¹⁸F-BO), which we developed based on the Olaparib scaffold using rapid bioorthogonal conjugation chemistries. We show that the bioorthogonal ¹⁸F modification of the parent molecule is simple, highly efficient, and well tolerated, resulting in a half maximal inhibitory concentration (IC₅₀) of 17.9 ± 1.1 nM. Intravital imaging showed ubiquitous distribution of the drug and uptake into cancer cells, with ultimate localization within the nucleus, all of which were inhibitable. Whole-body PET-CT imaging showed tumoral uptake of the drug, which decreased significantly, after a daily dose of Olaparib. Standard ¹⁸F-fludeoxyglucose imaging, however, failed to detect such therapy-induced changes. This research represents a step toward developing a more generic approach for the rapid codevelopment of companion imaging agents based on small-molecule therapeutic inhibitors.     

Skull base: pseudolesion or true lesion?

The skull base is a complex anatomical structure. Therefore, radiologists often use “side-to-side” comparison for detection of abnormalities. This approach is compromised by the high frequency of anatomical variations involving the skull base and the common presence of flow-related artifacts within vessels at the skull base that might mimic true lesions. The spectrum of “pseudolesions” ranging from different anatomical variations, such as unusual arachnoid granulations, asymmetric pneumatization and/or appearance of neurovascular foramina, to flow-related artifacts will be discussed in this review article, and tips for their distinction from a true lesion in a similar location will be given.     

Quality of life after acetabulum and pelvic ring fractures. Correlation of long-term results with the "Injury Severity Score" (ISS)

Patients with acetabular (AF) and pelvic ring fractures (BrF) make heavy demands on hospital resources and face difficulties in rehabilitation. From the patients' point of view, milestones in recovery are quality of life and return to productivity. We studied 42 patients with acetabular and 64 patients with pelvic ring fractures over a period of 10 years. The average follow-up took place 4 years after discharge. The injury severity score (ISS) did not correlate to long-term disability and quality of life (QoL) based on the Rosser index, data on return to productivity, or to radiological and clinical outcome. This study emphasizes the need for new injury scoring systems that better predict the recovery and ability to return to work of trauma patients after surviving pelvic fractures. Proper follow-up evaluations should analyze the patients' quality of life and working activity beside traditional items such as radiological and clinical findings.     

The Aachen MiniHLM--a miniaturized heart-lung machine for neonates with an integrated rotary blood pump

The operation of congenital heart defects in neonates often requires the use of heart-lung machines (HLMs) to provide perfusion and oxygenation. This is prevalently followed by serious complications inter alia caused by hemodilution and extrinsic blood contact surfaces. Thus, one goal of developing a HLM for neonates is the reduction of priming volume and contact surface. The currently available systems offer reasonable priming volumes for oxygenators, reservoirs, etc. However, the necessary tubing system contains the highest volumes within the whole system. This is due to the use of roller pumps; hence, the resulting placement of the complete HLM is between 1 and 2 m away from the operating table due to connective tubing between the components. Therefore, we pursued a novel approach for a miniaturized HLM (MiniHLM) by integrating all major system components in one single device. In particular, the MiniHLM is a HLM with the rotary blood pump centrically integrated into the oxygenator and a heat exchanger integrated into the cardiotomy reservoir which is directly connected to the pump inlet. Thus, tubing is only necessary between the patient and MiniHLM. A total priming volume of 102 mL (including arterial filter and a/v line) could be achieved. To validate the overall concept and the specific design we conducted several in vitro and in vivo test series. All tests confirm the novel concept of the MiniHLM. Its low priming volume and blood contact surface may significantly reduce known complications related to cardiopulmonary bypass in neonates (e.g., inflammatory reaction and capillary leak syndrome).