Robotic radical parametrectomy and pelvic lymphadenectomy in patients with invasive cervical cancer

ObjectiveWe describe a series of patients diagnosed with invasive cervical cancer after undergoing simple hysterectomy who subsequently underwent robotic radical parametrectomy and bilateral pelvic lymphadenectomy. The goal of this study is to report on the safety and feasibility of robotic radical parametrectomy.MethodsA retrospective review was performed of all patients who underwent robotic radical parametrectomy and bilateral pelvic lymphadenectomy at our institution during the period December 2006 to February 2008. We analyzed our data to evaluate the safety and feasibility of performing robotic radical parametrectomy.ResultsThis analysis included 5 patients with invasive squamous cell carcinoma of the cervix. The median body mass index was 23.8 kg/m² (range, 17.7 to 26.5). The median operative time was 365 min (range, 331 to 430). The median estimated blood loss was 100 mL (range, 50 to 175). There were no conversions to laparotomy. There was 1 intraoperative complication—cystotomy. No patient required blood transfusion. The median length of hospital stay was 1 day (range, 1 to 2). One patient experienced two postoperative complications, a vesicovaginal fistula and a lymphocyst. No patient had residual tumor in the parametrectomy specimen, and no patient underwent adjuvant therapy. The median number of pelvic lymph nodes removed was 14 (range, 6 to 16). The median follow-up for all patients was 7.5 months (range, 1.3 to 13.8). There were no recurrences.ConclusionRobotic radical parametrectomy and bilateral pelvic lymphadenectomy is feasible and safe and can be performed with an acceptable complication rate.     

Soluble receptor for advanced glycation end products (sRAGE) and endogenous secretory RAGE (esRAGE) in amniotic fluid: modulation by infection and inflammation

Abstract Objective: The receptor for advanced glycation end products (RAGE) has been proposed to participate in the innate and adaptive immune responses. RAGE can induce production of pro-inflammatory cytokines and chemokines, as well as neutrophil chemotaxis in a manner that may be suppressed or stimulated by soluble, truncated forms of RAGE including the soluble form of RAGE (sRAGE) and endogenous secretory RAGE (esRAGE). The objective of this study was to determine whether intra-amniotic infection/inflammation (IAI) is associated with changes in the amniotic fluid concentration of sRAGE and esRAGE. Study design: Amniotic fluid (AF) was retrieved from patients in the following groups: 1) mid-trimester (14-18 weeks of gestation; n=68); 2) term not in labor (n=24); 3) term in labor (n=51); 4) preterm labor and intact membranes (n=124); and 5) preterm PROM (n=80). Intra-amniotic infection and inflammation were defined as the presence of a positive amniotic fluid culture for microorganisms and an AF interleukin-6 concentration >/=2.6 ng/mL, respectively. The AF concentration of sRAGE and esRAGE were determined using specific and sensitive ELISAs which measured total immunoreactive sRAGE and esRAGE, respectively. Patients were matched for gestational age at amniocentesis to compare the AF concentration of sRAGE and esRAGE in patients with and without IAI. Non-parametric statistics were used for analysis and a P<0.05 was considered significant. Results: 1) Patients at term not in labor had higher median AF concentrations of sRAGE and esRAGE than those in the mid-trimester (P<0.001 for both comparisons) and those at term in labor (P=0.03 and P=0.04, respectively); 2) patients with preterm labor and intact membranes with intra-amniotic infection/inflammation (IAI) had higher median AF concentrations of sRAGE and esRAGE than those without IAI (P=0.02 and P=0.005, respectively); 3) similarly, patients with preterm PROM with IAI had higher median AF concentrations of sRAGE and esRAGE than those without IAI (P=0.03 and P=0.02, respectively). Conclusion: Intra-amniotic infection/inflammation is associated with increased amniotic fluid concentrations of sRAGE and esRAGE. Changes in the amniotic fluid concentration of sRAGE and esRAGE may represent part of the immune response to intra-amniotic infection/inflammation.     

Embryotoxicity of serum from women smoking cocaine base paste (CBP)

OBJECTIVE: Using a mouse embryo bioassay, we examined the embryotoxic properties of serum obtained from eight women who had ingested cocaine base paste (CBP) for a period of 1-3 years. STUDY DESIGN: Two-cell stage mouse embryos were cultured in the presence of serum extracted from eight CBP-smoking or control women. After 48h, embryos were evaluated to determine their developmental stage and then processed by Tarkoswki's technique to determine the proportion of embryos with micronuclei, in order to establish the number of micronuclei/embryo. RESULTS: Serum from CBP patients diminished the percentage of embryos progressing to the compacted morula stage, while increasing the proportion of embryos with micronuclei and the corresponding micronuclei/embryo ratio. CONCLUSION: These findings provide the first experimental evidence of embryotoxic compounds in the serum of CBP-smoking women. This study highlights the reproductive risk of chronically ingested CBP and demonstrates the need for further studies.     

Encuesta SEGO. Tratamiento de la amenaza de parto pretérmino en los hospitales españoles

Objective

To determine how threatened preterm labor is treated in Spanish hospitals.

Material and method

Under the aegis of the Spanish Society of Obstetrics and Gynecology, an Internet questionnaire on basic aspects of the treatment of threatened preterm labor was sent to 41 Spanish hospitals (37 public and four private hospitals).

Results

All hospitals use tocolysis in threatened preterm labor before 34th weeks. The most widely used tocolytic agent is atosiban (73,7%), followed by betamimetics (21.9%) and nifedipine (4.9%). Only 7.3% of the hospitals use tocolytics in threatened preterm labor after 34 weeks. All the hospitals use corticosteroids to accelerate lung maturation: 92.7% use betamethasone and 7.3% prefer dexamethasone. In 90% of the hospitals, steroid therapy is not repeated. In multiple pregnancies, the same steroid dose as that used in single pregnancies is administrated in all centers.

Conclusions

The most widely used tocolytic agent in Spanish hospitals is atosiban and the preferred corticosteroid is betamethasone.     

Chondrosarcoma of the uterus: case report and literature review

BACKGROUND: Pure heterologous sarcomas of the uterine corpus are extremely rare, accounting for 4% of all uterine sarcomas. Primary chondrosarcoma, which is characterized by the absence of epithelial or other heterologous mesenchymal elements, is included in this group. To this date, only 17 cases, including the presenting case, have been reported. CASE: A 55-year-old female presenting with post-menopausal bleeding was diagnosed with chondrosarcoma of the uterus, after abdominal hysterectomy and bilateral salpingoophorectomy. After 8 months of surgery, there is no evidence of recurrence after receiving external radiotherapy and brachytherapy. CONCLUSION: Primary chondrosarcoma of the uterus is an extremely rare uterine tumour most frequently diagnosed by the pathologist. They are usually aggressive malignant tumours with an early relapse and metastases.     

Supracervical hysterectomy in patients with advanced epithelial ovarian cancer

OBJECTIVE: To assess whether supracervical hysterectomy (SCH) is a reasonable alternative to total abdominal hysterectomy in patients with advanced ovarian cancer. METHODS: We reviewed the records of patients with advanced ovarian cancer who underwent a SCH at one institution between 1993 and 2004 and a similar cohort who underwent total abdominal hysterectomy (TAH) at the same institution during the same period. Patients without complete surgical staging done at the institution were excluded. Independent-sample t tests, Fisher exact test, and log rank tests were used for statistical analysis. RESULTS: The study included 47 patients who underwent SCH (mean age, 59.6 years) and 190 who underwent TAH. There were no significant differences between the two groups in age (P=.51), preoperative CA 125 level (P=.55), or receipt of taxane-based and platinum-based chemotherapy (P=.84). Although limited by sample size, there were no significant differences between the two groups in rates of intraoperative complications (4 of 47 in the SCH group, or 8.5%, compared with 7 of 190 in the TAH group, or 3.7%; P=.24), vaginal or cervical recurrence (5 of 47 in the SCH group, or 10.6%, compared with 22 of 190 in the TAH group, or 11.6%; P=1.00), or in progression-free survival (SCH of 1.01 years compared with TAH of 1.19 years; P=.64) or overall survival (SCH of 3.28 years compared with TAH of 3.36 years; P=.12). CONCLUSION: Supracervical hysterectomy may be a reasonable alternative to TAH in patients with advanced ovarian cancer. LEVEL OF EVIDENCE: II.