Abnormal cervical cytology: a risk factor for endometrial cancer recurrence

The objective of this study was to evaluate the relationship between cervical cytology, histologic type, and risk of endometrial cancer recurrence. We performed a retrospective study of patients undergoing surgery for endometrial carcinoma. Risk factors for recurrence including histology, tumor grade, nodal status, myometrial invasion, peritoneal washings, stage, and cervical cytology were assessed. Abnormal cervical cytology was defined as the presence of any endometrial cells on Pap smear. Papillary serous and clear cell carcinomas were considered high-risk histologies. Univariate and multivariate analyses of risk factors for recurrence were performed. Thirty-nine (9%) patients developed recurrent endometrial cancer. More patients with abnormal Pap smears recurred (12% versus 4%, P < 0.05). For endometrioid adenocarcinoma, abnormal cervical cytology occurred in 61% and 7% recurred, while with high-risk histologies, 84% had abnormal cervical cytology and 19% recurred (P < 0.05). Other significant predictors of recurrence on univariate analysis were myometrial invasion, nodal status, washings, stage, and histology. On multivariate analysis, only nodal status remained a significant predictor of recurrence. Abnormal cervical cytology is associated with increased risk of endometrial cancer recurrence. Abnormal cervical cytology occurs more frequently in high-risk histologies, which are known to have a higher risk of recurrence. On multivariate analysis, only nodal spread remains a significant predictor of recurrence.     

Child-bearing beyond age 50: pregnancy outcome in 59 cases “a concern?”

Objective To study maternal and perinatal outcomes in healthy women aged 50 years and older.Method This study was of 59 clinical pregnancies, of which 10 ended in first trimester spontaneous miscarriage (and were excluded from further studies) and 58 live births. This retrospective review of 58 live births in 49 essentially healthy women (mean [SE] age, [52±2.5] years; range 50–55 years), with no chronic medical conditions (of which 28 were primigravids). Pregnancy outcomes were ascertained by chart review and telephone follow-up.Results Of the 58 live births, 41 were singletons, and 7 were twins, and 1 triplet, for which the mean±SE gestational age at delivery were 38.1 weeks ±0.4, 36.2 weeks ±0.1 and 34.1 weeks respectively. Birth weights (mean ± SE) were 3,201 g±10, 2,252 g±4 and 1,998±95 g respectively. Mean Apgar score ± SE at 1 and 5 min were 9.2±0.8 and 8.8±0.6 respectively. Total cesarean deliveries were 73% (36/49). Of singletons 68% (28) were delivered by cesarean section as were all multiples. The incidence of pre-eclampsia was 30.6%: mild pre-eclampsia 20.4% (10/49), severe pre-eclampsia 10.2% (5/49). Gestational diabetes required insulin in all 19.5% of women. Anemia was noted in 6.5%.Conclusions Appropriately screened women, aged 50 years or older, can deliver successfully. During pregnancy, they appear to be at increased risk of pre-eclampsia and gestational diabetes. A significant majority can expect to deliver via cesarean.     

Bilateral iliococcygeal fixation for vaginal vault prolapse and enterocele repair using a new suturing device--the digital needle driver

The objective of our study was to evaluate the surgical feasibility, efficacy and safety of the digital needle driver (DND 202), a modified, flexible surgical device, during iliococcygeal fixation (ICF) for vaginal vault prolapse and enterocele repair. A prospective longitudinal study was carried out among 21 consecutive patients who underwent bilateral iliococcygeal fixation at St George's Hospital, London. All patients filled a comprehensive questionnaire for pre- and post-operative prolapse, urinary, bowel and sexual symptoms and underwent pre- and post-operative site-specific vaginal examination, following the standardized International Continence Society scoring for prolapse, pre-operative urodynamic studies and analysis of the surgical results. The outcome measures were the feasibility of the procedure, the time needed, intra- and post-operative complications, short-term post-operative prolapse-associated symptoms and pelvic organ prolapse quantification. The mean age of the patients was 65 [5] years and the mean body mass index (kg/m(2)) was 23 [2.7]. In addition to ICF, 8 patients underwent vaginal hysterectomy, 18 had posterior repairs, 7 had anterior repairs and 6 had TVT. The mean time for ICF was 20 [11] minutes, the mean blood loss per surgical procedure was 264 [225] mL and the mean hospitalization time was 4.6 [1.2] days. Postoperatively, one patient had mesh erosion. At short-term post-operative evaluation none of the patient had prolapse symptoms. There was a statistically significant improvement in all stages of the apical and posterior walls prolapse (p < 0.001). The mean total vaginal length was significantly shorter postoperatively (7.8 [1.0] cm vs 6.6 [1.4] cm, p < 0.001). Thus, we can conclude that the use of DND device may facilitate the vaginal approach for vaginal vault prolapse and enterocele repair.     

Rupture of rudimentary horn pregnancy at the 15th week of gestation: a case report

A patient with acute abdomen at 15th week of gestation underwent an emergency laparatomy. A ruptured rudimentary horn pregnancy was diagnosed, and the rudimentary part including the fetus and the accessories was resected. The mother survived without any complications.     

Post-marketing safety surveillance and reevaluation of Motherwort injection: A clinical study of 10 094 cases

OBJECTIVE

To investigate the safety profiles of Motherwort injection (MI).

Overcoming the obstacles of visualization in robotically assisted abdominal cerclage using indocyanine green

Abdominal cerclage is found to have success rates of 85–95 % with lower incidence of preterm delivery and preterm premature rupture of membranes when compared to the vaginal approach. However, since it is more invasive, its use has been limited to selected cases. Robot-assisted abdominal cerclage is a relatively new minimally invasive technique that gives the opportunity for less invasive procedures when compared to the open technique and, when compared to conventional laparoscopy, has the advantages of 3D visualization and endowristed instrumentation. The distinctive feature of our case is the use of near infrared camera system, which is a relatively new modality in robotics and, to the best of our knowledge, this is the first report in the literature that indocyanine green dye was used to help to visualize vascular anatomy during a robotic cerclage procedure in a pregnant patient.