A Case of Urethrocutaneous Fistula Following a Transobturator Tape Procedure for Stress Urinary Incontinence

The transobturator tape procedure (TOT) is a highly effective technique used to resolve cases of female stress urinary incontinence and is a safe procedure with relatively few per-operative and early post-operative complications compared to the tension free vaginal tape (TVT). Recent studies, however, have demonstrated that the late surgical sequelae following a TOT procedure are relatively common. Urethrocutaneous fistula is an unusual complication in the female population that is defined as an abnormal connection between the urethra and the skin, usually affecting the perineum. It may also develop secondary to urethral strictures, repair of hypospadias, prostate surgery, chronic untreated periurethral abscesses, trauma etc. It is usually diagnosed using retrograde urethrography and fistulography. We present a case of a 53 year old woman who developed a urethrocutaneous fistula after a TOT procedure four years ago as a surgical treatment of female stress urinary incontinence which was diagnosed recently after presenting various episodes of vulvar abscesse

The impact of neos and their fragments recorded from the ground : ongoing research lines of the spanish fireball network

A continuous monitoring of the night sky all over Spain will be completed in 2009. This involves the recording over a very large surface area of 500,000 km2, but new CCD and video cameras operated by the Spanish Meteor and Fireball Network (SPMN) allows this target to be achieved. Through the use of these new techniques the SPMN can obtain new information regarding the dynamical processes that deliver meteorites to the Earth. It transpires that the main asteroid belt is not the only source of these fireballs, Near Earth Objects (NEOs) and Jupiter Family Comets (JFCs) may also play a role. To obtain more information in this regard, new efforts are needed to compare the orbits of large meteoroids reaching the Earth with those of the members of NEO and JFC populations. By numerically integrating their orbits back in time it may be possible to identify meteoroids delivered by other mechanisms like such as catastrophic disruptions or collisions

Laterally Extended Endopelvic Resection (Leer) and Reconstructive Techniques for Treatment of Locally Advanced Cervix Cancer: A Case Report

The aim of this report is to describe the surgical procedure done in a 24-year-old woman who presents a locally advanced squamous cervix carcinoma and is proposed to laterally extended endopelvic resection (LEER), intraoperative radiation therapy with electrons (IORT) and urinary and colon diversion with vaginal reconstruction. A year after surgery the patient is alive, without disease and with and acceptable quality of life

Validation of three predictive models for suboptimal cytoreductive surgery in advanced ovarian cancer

The standard treatment for advanced ovarian cancer (AOC) is cytoreduction surgery and adjuvant chemotherapy. Tumor volume after surgery is a major prognostic factor for these patients. The ability to perform complete cytoreduction depends on the extent of disease and the skills of the surgical team. Several predictive models have been proposed to evaluate the possibility of performing complete cytoreductive surgery (CCS). External validation of the prognostic value of three predictive models (Fagotti index and the R3 and R4 models) for predicting suboptimal cytoreductive surgery (SCS) in AOC was performed in this study. The scores of the 3 models were evaluated in one hundred and three consecutive patients diagnosed with AOC treated in a tertiary hospital were evaluated. Clinicopathological features were collected prospectively and analyzed retrospectively. The performance of the three models was evaluated, and calibration and discrimination were analyzed. The calibration of the Fagotti, R3 and R4 models showed odds ratios of obtaining SCSs of 1.5, 2.4 and 2.4, respectively, indicating good calibration. The discrimination of the Fagotti, R3 and R4 models showed an area under the ROC curve of 83%, 70% and 81%, respectively. The negative predictive values of the three models were higher than the positive predictive values for SCS. The three models were able to predict suboptimal cytoreductive surgery for advanced ovarian cancer, but they were more reliable for predicting CCS. The R4 model discriminated better because it includes the laparotomic evaluation of the peritoneal carcinomatosis index

Primary T-Cell Non-Hodgkin Lymphoma of the Vagina

The primary vaginal T-cell non-Hodgkin lymphoma is a rare form of lymphoma. Most of the previously published cases were about B-cell non-Hodgkin lymphomas. We present the case of a vaginal mass in an 82-year-old patient presenting vaginal bleeding. The results of the immunohistological studies of the mass revealed the presence of a cytotoxic T-cell non-Hodgkin lymphoma, which is the least common subtype

A radiologic-laparoscopic model to predict suboptimal (or complete and optimal) debulking surgery in advanced ovarian cancer: a pilot study

Antoni Llueca,1–3 Anna Serra,1–3 Katty Delgado,2,4 Karina Maiocchi,2,5 Rosa Jativa,2,6 Luis Gomez,2,5 Javier Escrig2–3,51Department of Obstetrics and Gynecology, University General Hospital of Castellon, Castellón, Spain; 2Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellón, Spain; 3Department of Medicine, University Jaume I(UJI), Castellon, Spain; 4Department of Radiology, University General Hospital of Castellon, Castellón, Spain; 5Department of General Surgery, University General Hospital of Castellon, Castellón, Spain; 6Department of Anesthesiology, University General Hospital of Castellon, Castellón, SpainIntroduction: Medical models assist clinicians in making diagnostic and prognostic decisions in complex situations. In advanced ovarian cancer, medical models could help prevent unnecessary exploratory surgery. We designed two models to predict suboptimal or complete and optimal cytoreductive surgery in patients with advanced ovarian cancer.Methods: We collected clinical, pathological, surgical, and residual tumor data from 110 patients with advanced ovarian cancer. Computed tomographic and laparoscopic data from these patients were used to determine peritoneal cancer index (PCI) and lesion size score. These data were then used to construct two-by-two contingency tables and our two predictive models. Each model included three risk score levels; the R4 model also included operative PCI, while the R3 model did not. Finally, we used the original patient data to validate the models (narrow validation).Results: Our models predicted suboptimal or complete and optimal cytoreductive surgery with a sensitivity of 83% (R4 model) and 69% (R3 model). Our results also showed that PCI>20 was a major risk factor for unresectability.Conclusion: Our medical models successfully predicted suboptimal or complete and optimal cytoreductive surgery in 110 patients with advanced ovarian cancer. Our models are easy to construct, based on readily available laboratory test data, simple to use clinically, and could reduce unnecessary exploratory surgery in this patient group.Keywords: advanced ovarian cancer, medical model, peritoneal cancer index, cytoreductive surger

Predictive model for major complications after extensive abdominal surgery in primary advanced ovarian cancer

Antoni Llueca,1–3 Anna Serra,1–3 Karina Maiocchi,2,4 Katty Delgado,2,5 Rosa Jativa,2,6 Luis Gomez,2,4 Javier Escrig3–5 On behalf of the MUAPOS working group (Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery) 1Department of Obstetrics and Gynaecology, University General Hospital of Castellon, Castellon, Spain; 2Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, Castellon, Spain; 3Department of Medicine, University Jaume I (UJI), Castellon, Spain; 4Department of General Surgery, University General Hospital of Castellon, Castellon, Spain; 5Department of Radiology, 6Department of Anaesthesiology, University General Hospital of Castellon, Castellon, Spain Background: Surgery for advanced ovarian cancer (AOC) frequently results in serious complications. The present study aimed to determine the importance of various factors and complications in cytoreductive surgery for AOC. Patients and methods: The present study included 90 patients with AOC who underwent primary cytoreductive surgery in a single institution from January 2013 to August 2017. Demographic and clinicopathologic characteristics, surgical procedures, residual disease, and follow-up data were analyzed. Cytoreductive surgery was defined as complete (no residual tumor), optimal (residual tumor 1 cm in diameter). Grade III–IV complications were considered major. Patients were evaluated every 3–6 months. Results: Surgical outcome was complete in 75 (82%), optimal in 5 (6%), and suboptimal in 11 (12%) patients. Major complications occurred in 28 (31%) patients. Independent risk factors for major complications were ≥five visceral resections, rectosigmoid resection, glissectomy, and pelvic peritonectomy. A score created by weighing the multivariate OR for each risk factor correctly predicted major complications in 67% of cases. A score cut-off of >2 discriminated between patients with and without complications in 79% of cases (95% CI: 70%–86%, P<0.001). Adjuvant chemotherapy was performed as planned in 67 patients (74%), including 50 (75%) without major complications and 17 (25%) with major complications. Conclusion: Risk factors for major complications in cytoreductive surgery for AOC are ≥five visceral resections, rectosigmoid resection, glissectomy, and pelvic peritonectomy. Our model predicts morbidity based on major and minor classifications of complications. Keywords: advanced ovarian cancer, debulking surgery, peritoneal cancer index, residual tumor, complications, predictive model, carcinomatosis, cytoreductive surgery, morbidit

Peritoneal carcinomatosis index as a predictor of diaphragmatic involvement in stage III and IV ovarian cancer

Antoni Llueca,1–3 Anna Serra,1–3 José Luis Herraiz,2 Isabel Rivadulla,1,4 Luis Gomez-Quiles,1,4 Juan Gilabert-Estelles,5,6 Javier Escrig1,3,4On behalf of the MUAPOS (Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery) working group 1Multidisciplinary Unit of Abdominal Pelvic Oncology Surgery (MUAPOS), University General Hospital of Castellón, Castellón, Spain; 2Department of Obstetrics and Gynecology, University General Hospital of Castellón, Castellón, Spain; 3Department of Medicine, Universitat Jaume I, Castellón, Spain; 4Department of General Surgery, University General Hospital of Castellón, Castellón, Spain; 5Department of Obstetrics and Gynecology, University General Hospital of Valencia, Valencia, Spain; 6Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain Objective: To analyze the surgical outcomes and diaphragmatic involvement in stage III and IV ovarian cancer.Patients and methods: All patients with stage III–IV ovarian cancer between January 2013 and January 2016 were included. The outcomes of interest reviewed were as follows: surgical (complications, mortality), peritoneal carcinomatosis index (PCI), rate of complete resection, and disease-free interval and survival.Results: Fifty-seven patients were included, 38 (67%) with diaphragmatic involvement; in 10 cases (18%), diaphragmatic resection was required. Optimal cytoreduction (OCR) was obtained in 49 cases (86%). The PCI was >10 in 31 cases (54%). Respiratory complications occurred in 10 cases (18%) and mortality in 3 (5%). Disease-free survival rate in 3 years was 53%, being 87% in cases without diaphragmatic involvement. The overall survival rate in 3 years is 46%, 83% in the cases without diaphragmatic involvement and 27% in cases with affectation (p<0.05). In cases of OCR, 3 year survival rate was 65%. In the multivariate analysis for the overall survival of cases with OCR, the only independent prognostic factor found was the operative PCI. A strong correlation was found between the total PCI and the diaphragmatic PCI (p<0.001). With a PCI >10, virtually all cases will present diaphragmatic involvement (p<0.05).Conclusion: The tumor burden is different in stages III and IV of advanced ovarian cancer and the PCI is an effective method to quantify it. The PCI constitutes an independent prognostic factor for the advanced stages of ovarian cancer. A PCI >10 constitutes a useful prognostic factor of the affectation and forces the surgeon to thoroughly review both diaphragms.Keywords: advanced ovarian cancer, peritoneal cancer index, diaphragmatic involvement, upper abdominal surgery, carcinomatosi

Vulvar reconstruction in vulvar cancer: “lotus petal” suprafascial flap

The purposes of this study are to demonstrate our experience in using the “lotus petal” suprafascial flap and to evaluate the postoperative complications. During the period ranging from July 2012 to March 2015, nine patients diagnosed with primary or recurrent vulvar cancer have undergone radical vulvectomy followed by reconstructive surgery. Seventeen lotus petal suprafascial flap surgeries were performed. The average age of the patients was 79 years. No intraoperative complications were reported. The surgery length was 180 min with an estimated blood loss of 400 cc. Severe postoperative complications were rare. There were no complications associated with the donor site, nor were there any losses due to total or partial flap tissue necrosis. There were 2 (22.2 %) cases of partial wound dehiscence, which did not require re-intervention. The lotus petal suprafascial flap is a simple procedure that can be done during the same surgery as the radical vulvectomy, improving the aesthetic results and reducing both the rate of complications and hospital stay