Complications of laparoscopic lymphadenectomy for gynecologic malignancies. Experience of 372 patients

Evaluation of lymph nodes is an integral part in the management of women with gynecologic cancers, which is why the pelvic and aortic lymphadenectomy is widely used as a staging and/ or prognostic procedure in such malignancies. The purpose of this study was to describe our experience with pelvic and aortic laparoscopic lymphadenectomy and evaluate the safety and feasibility of this procedure for gynecologic malignancies. From January 2004 to December 2015, a laparoscopic pelvic and/or aortic lymphadenectomy was performed in 372 women at the Department of Gynecology Oncology of the University General Hospital of Castellon and at the Department of Obstetrics and Gynecology of Sant Pau and Santa Tecla Tarragona Hospitals. Out of the 372 cases, 240 combined pelvic and paraaortic lymphadenectomies were performed, while 108 and 24 patients underwent pelvic and aortic lymphadenectomy respectively. The mean operative times were 40 min (20-89) in order to perform a complete pelvic lymphadenectomy, 62 min (21-151) for transperitoneal aortic lymphadenectomy and 45 min (35-65) for a retroperitoneal approach. A conversion to laparotomy was needed in 1.6% of patients. Twenty-three (6.1%) complications were encountered in 372 patients undergoing laparoscopic lymphadenectomy. Nine (2.4%) major complications occurred intraoperatively while fourteen (3.7%) appeared postoperatively. The most frequent intraoperatory complication was vascular injury (1.3%). Laparoscopic lymphadenectomy can be considered a safe and achievable procedure, and could be considered the golden standard procedure for staging gynecologic malignancies

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

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

European LeukemiaNet 2017 risk stratification for acute myeloid leukemia: validation in a risk-adapted protocol

The 2017 European LeukemiaNet (ELN 2017) guidelines for the diagnosis and management of acute myeloid leukemia (AML) have become fundamental guidelines to assess the prognosis and postremission therapy of patients. However, they have been retrospectively validated in few studies with patients included in different treatment protocols. We analyzed 861 patients included in the Cooperativo Para el Estudio y Tratamiento de las Leucemias Agudas y Mielodisplasias-12 risk-adapted protocol, which indicates cytarabine-based consolidation for patients allocated to the ELN 2017 favorable-risk group, whereas it recommends allogeneic stem cell transplantation (alloSCT) as a postremission strategy for the ELN 2017 intermediateand adverse-risk groups. We retrospectively classified patients according to the ELN 2017, with 327 (48%), 109 (16%), and 245 (36%) patients allocated to the favorable-, intermediate-, and adverse-risk group, respectively. The 2- and 5-year overall survival (OS) rates were 77% and 70% for favorable-risk patients, 52% and 46% for intermediate-risk patients, and 33% and 23% for adverse-risk patients, respectively. Furthermore, we identified a subgroup of patients within the adverse group (inv(3)/t(3;3), complex karyotype, and/or TP53 mutation/17p abnormality) with a particularly poor outcome, with a 2-year OS of 15%. Our study validates the ELN 2017 risk stratification in a large cohort of patients treated with an ELN-2017 risk-adapted protocol based on alloSCT after remission for nonfavorable ELN subgroups and identifies a genetic subset with a very poor outcome that warrants investigation of novel strategies

BCL3-rearrangements in B-cell lymphoid neoplasms occur in two breakpoint clusters associated with different diseases

The t(14;19)(q32;q13) often juxtaposes BCL3 with immunoglobulin heavy chain (IGH) resulting in overexpression of the gene. In contrast to other oncogenic translocations, BCL3 rearrangement (BCL3-R) has been associated with a broad spectrum of lymphoid neoplasms. Here we report an integrative whole-genome sequence, transcriptomic, and DNA methylation analysis of 13 lymphoid neoplasms with BCL3-R. The resolution of the breakpoints at single base-pair revealed that they occur in two clusters at 5' (n=9) and 3' (n=4) regions of BCL3 associated with two different biological and clinical entities. Both breakpoints were mediated by aberrant class switch recombination of the IGH locus. However, the 5' breakpoints (upstream) juxtaposed BCL3 next to an IGH enhancer leading to overexpression of the gene whereas the 3' breakpoints (downstream) positioned BCL3 outside the influence of the IGH and were not associated with its expression. Upstream BCL3-R tumors had unmutated IGHV, trisomy 12, and mutated genes frequently seen in chronic lymphocytic leukemia (CLL) but had an atypical CLL morphology, immunophenotype, DNA methylome, and expression profile that differ from conventional CLL. In contrast, downstream BCL3-R neoplasms were atypical splenic or nodal marginal zone lymphomas (MZL) with mutated IGHV, complex karyotypes and mutated genes typical of MZL. Two of the latter four tumors transformed to a large B-cell lymphoma. We designed a novel fluorescence in situ hybridization assay that recognizes the two different breakpoints and validated these findings in 17 independent tumors. Overall, upstream or downstream breakpoints of BCL3-R are mainly associated with two subtypes of lymphoid neoplasms with different (epi)genomic, expression, and clinicopathological features resembling atypical CLL and MZL, respectively

Ultra-processed foods consumption as a promoting factor of greenhouse gas emissions, water, energy, and land use: A longitudinal assessment

Background: Dietary patterns can produce an environmental impact. Changes in people's diet, such as the increased consumption of ultra-processed food (UPF) can not only influence human health but also environment sustainability. Objectives: Assessment of the impact of 2-year changes in UPF consumption on greenhouse gas emissions and water, energy and land use. Design A 2-year longitudinal study after a dietary intervention including 5879 participants from a Southern European population between the ages of 55-75 years with metabolic syndrome. Methods Food intake was assessed using a validated 143-item food frequency questionnaire, which allowed classifying foods according to the NOVA system. In addition, sociodemographic data, Mediterranean diet adherence, and physical activity were obtained from validated questionnaires. Greenhouse gas emissions, water, energy and land use were calculated by means of the Agribalyse® 3.0.1 database of environmental impact indicators for food items. Changes in UPF consumption during a 2-year period were analyzed. Statistical analyses were conducted using computed General Linear Models. Results: Participants with major reductions in their UPF consumption reduced their impact by −0.6 kg of CO2eq and −5.3 MJ of energy. Water use was the only factor that increased as the percentage of UPF was reduced. Conclusions: Low consumption of ultra-processed foods may contribute to environmental sustainability. The processing level of the consumed food should be considered not only for nutritional advice on health but also for environmental protection

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

Intravesical mini-laparoscopic repair of vesicovaginal fistulas

Vesicovaginal fistulas (VVF) constitute the most common type of genitourinary fistulas. In developed countries, VVF are almost always iatrogenic and frequently a secondary result of gynecological surgery. Some minimally invasive techniques have been introduced to decrease the morbidity related to standard open procedures for the treatment of VVF. One such procedure is the intravesical minilaparoscopic approach. The aim of this study was to present our initial clinical experience using this technique for transvesical VVF repair. In 2013 and 2014, we carried out mini-laparoscopic repair of VVF in two women who did not respond to conservative treatment with a Foley catheter. The procedure was performed transvesically with a 3-mm instrument and a 5-mm, 30° scope. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with two separated continuous barbed, resorbable 3-0 sutures (V-Loc 90 Absorbable Wound Closure Device; Covidien, Norwalk, CT, USA). The median operative time for the two patients was approximately 100 min, and the blood loss was not clinically significant. The patients were released from the hospital 24 h after surgery. A Foley catheter was left in place for 14 days. Imaging examinations performed 6 weeks postoperatively revealed no VVF. In patients with simple fistulas, this technique provides a minimally invasive, easily reproducible approach with few associated complications. Nevertheless, further experience and observations are necessary