Conservative treatment and long-term follow up of endodermal sinus tumor of the vagina

Objective

Six cases of endodermal sinus tumor (EST) of the vagina were reported focusing on the results of conservative treatment and outcome of long-term follow up.

Methods

We reviewed a cohort of six cases with EST of the vagina diagnosed and treated in our hospital. CT scan, detection of serum AFP level, examination under anesthesia and biopsy were performed before and after treatment to evaluate the tumor status. The diagnoses were confirmed by pathological and imaging findings. All patients were treated with bleomycin, etoposide and cisplatin (BEP) combination chemotherapy alone. Complete remission (CR) includes the normal level of serum AFP, no tumor detected by CT scan and the negative result of pathology. Long-term follow up was carried out according to our regulation.

Results

The mean onset age was 18.2 months. The average tumor size was 4.5 cm. Serum AFP level was markedly elevated before treatment and decreased dramatically after chemotherapy and drop to the normal level after two to three courses of chemotherapy (average 2.5 courses). The patients received averagely six courses of chemotherapy and all the six patients obtained CR. The mean follow-up time is 75.5 months and there was no evidence of recurrent disease.

Conclusion

The result of this conservative treatment for EST of the vagina is excellent. BEP chemotherapy without surgery should be considered as a good choice of treatment. Close follow up with serial determinations of serum AFP level together with imaging tests and physical examination in the first two years of follow-up are recommended.     

Does early morphology provide additional selection power to blastocyst selection for transfer?

Routine early developmental parameters are widely used in IVF centres to evaluate embryo development and fresh single-blastocyst transfer currently seems superior to single-embryo transfer. Would early morphological parameters help to choose the single blastocyst to be transferred, thereby improving the chances of implantation and live birth rate? This prospective observational study analysed the individual outcomes of 2617 embryos from 511 IVF couples scheduled for a single-blastocyst transfer. Embryo and blastocyst scores were constructed. There was a clear relationship between the kinetics and morphology of blastocysts and further implantation and live birth rate. There was a limited predictive value of embryo score with regard to blastocyst development and growth kinetics. Implanted and non-implanted blastocysts showed similar embryo scores. Thus usual morphological parameters on days 1 and 2 seem to have no additional value in indicating the right blastocyst to transfer. Non-invasive approaches might be helpful to increase the chances of implantation in the future.Routine early developmental parameters are widely used in IVF centres to evaluate embryo development, and fresh single-blastocyst transfer currently seems superior to single-embryo transfer. Would early morphological parameters help choose the single blastocyst to be transferred and thereby improve the chances of implantation and live birth rate? In this prospective observational study, we analysed the individual outcomes of 2617 embryos from 511 IVF couples scheduled for a single-blastocyst transfer. Embryo and blastocyst scores were constructed. There was a clear relationship between the kinetics and morphology of blastocysts and further implantation and live birth rate. There was a limited predictive value of embryo score with regard to blastocyst development and growth kinetics. Implanted and non-implanted blastocysts showed similar embryo scores. Thus usual morphological parameters on days 1 and 2 seem to have no additional value in indicating the right blastocyst to implant. Non-invasive approaches might be helpful to increase the chances of implantation in the future.     

Advances of dual source,dual-energy imaging in postmortem CT

This paper focuses on the use of multi-detector row dual-energy computed tomography (DECT) in the evaluation of postmortal examinations. The use of dual energy moves postmortem CT to an entirely new dimension of diagnostic sensitivity where contrast in the image is not merely limited to X-ray attenuation differences, but may include elements of functional and tissue characterization. This additional information may be used to improve the benefit postmortem imaging can provide to supplement and simplify the conventional autopsy.     

Splenectomy in cytoreductive surgery for advanced ovarian cancer

Methods To evaluate the series of advanced ovarian cancer patients who underwent splenectomy as part of their surgery, a retrospective file review of 258 ovarian cancer cases were examined.Results There were 13 cases that underwent splenectomy. These patients constitute 5% of all and 8.8% of the advanced ovarian cancer patients. Seven cases had splenectomy as part of their initial cytoreductive surgery while 6 had surgery for recurrent disease. Splenectomy was performed to resect hilar and/or capsular involvement in 9 (69%) cases, while in 3 cases (23%) splenic injury during adjacent tumoral resection required splenectomy. One patient had splenectomy for infarcts and died after the surgery with systemic complications nonrelated to the surgery. No other serious morbidity was detected. Median survival of the patients was 34 months (1–120 months) from the initial diagnosis. Median survival was 18 months (1–78 months) after the splenectomy. Three patients were still alive with no evidence of disease 2, 5 and 6.5 years after the splenectomy.Conclusion Splenectomy is a feasible and safe procedure. However, it should be reserved for patients in whom optimal cytoreductive results could be achieved.     

米索前列醇对早期妊娠负压吸引术中软化宫颈的作用

负压吸引人工流产术经长期临床应用已证明其具有安全性和有效性,并简便而快速,但仍有少数人手术时或术后发生并发症。特别是未产妇或剖宫产无阴道分娩者,宫口紧以及子宫极度屈曲、畸形等高危妊娠时,并发症发生的机会就更多。虽然米非司酮药物流产的出现在一定程度上减少了手术流产并发症的发生,