14 research outputs found
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