14 research outputs found
Quality of life and sexual function in patients aged 35âyears or younger undergoing hysterectomy for benign gynecologic conditions: A prospective cohort study
Objective: To evaluate how hysterectomy performed for benign gynecologic pathologies affects the quality of life and sexual function of patients aged 35âyears or younger,
and if outcomes differ according to the surgical technique.
Methods: Seventy-three patients who underwent total laparoscopic hysterectomy
(TLH), supracervical laparoscopic hysterectomy (SLH), or vaginal hysterectomy (VH)
for benign uterine disorders between April 2014 and June 2020 at the Department of
Gynecology and Obstetrics, Saarland University Hospital, Homburg, Germany, were
enrolled in this prospective observational cohort study. Quality of life and sexual
function were assessed preoperatively and 6 months postoperatively using standardized validated questionnaires: the European Quality of Life Five-Dimension Scale
(EQ-5D) and the Female Sexual Function Index (FSFI).
Results: Thirty-three (45%) patients underwent TLH, 25 (34%) underwent SLH, and
15 (21%) patients underwent VH. The median preoperative EQ-5D score, FSFI score,
and EQ-5D visual analog scale were 0.9 (range 0.62â1), 19.25 (range 2.4â27.4), and 50
(range 0â100); postoperative scores were 1 (range 0.61â1), 24.15 (range 3.9â29.3), and
90 (range 30â100), respectively (P â€â0.001). Postoperative scores were significantly
higher than preoperative scores, with no significant difference according to the surgical technique.
Conclusion: Hysterectomy for benign indication in women aged 35âyears or less significantly improved the patients' quality of life and sexual function with no differences regarding the surgical technique
Laparoscopic Fertility-Sparing Surgery for Early Ovarian Malignancies
The demand for fertility-sparing surgery (FSS) has increased in the last decade due to
increased maternal age, increased incidence of ovarian malignancies in younger patients, and technical advances in surgery. Data on oncological safety and fertility outcomes of patients with ovarian
cancer after laparoscopic FSS are sparse, but some retrospective studies have shown that open FSS
may be offered to selected patients. We assessed the role of minimally invasive FSS in comparison
with radical surgery (RS) in terms of oncological safety and reproductive outcomes after FSS in this
multicenter study. Eighty patients with FIGO stage I/II ovarian cancer treated with laparoscopic
FSS or RS between 01/2000 and 10/2018 at the participating centers (comprehensive gynecological
cancer centers with minimally invasive surgical expertise) were included in this retrospective analysis
of prospectively kept data. Caseâcontrol (n = 40 each) matching according to the FIGO stage was
performed. Progression-free survival [150 (3â150) and 150 (5â150) months; p = 0.61] and overall
survival [36 (3â150) and 50 (1â275) months; p = 0.65] did not differ between the FSS and RS groups.
Eight (25.8%) women became pregnant after FSS, resulting in seven (22.5%) deliveries; three (37.5%)
patients conceived after in vitro fertilization, and five (62.5%) conceived spontaneously. Laparoscopic
FSS seems to be applicable and oncologically safe for patients with early-stage ovarian cancer, with
adequate fertility outcomes
Neurologic Consultations and Headache during Pregnancy and in Puerperium : A Retrospective Chart Review
Headache is a common symptom during pregnancy and in puerperium that requires careful
consideration, as it may be caused by a life-threatening condition. Headaches in pregnant women
and women in puerperium are classified as primary or secondary; acute, severe and newly diagnosed
headaches should prompt further investigation. We aimed to further characterise the demographic
features, symptoms, examination findings, and neuroimaging results of cases of headache during
pregnancy and in puerperium. All pregnant women or women in postpartum conditions who
attended neurological consultations at the emergency department of the clinic for Gynaecology,
Obstetrics and Reproductive Medicine of Saarland University/Germany between 2001/2015 and
2012/2019 were enrolled in this retrospective chart review. Data collected from the charts included
demographic/pregnancy characteristics, clinical features and imaging findings. Descriptive statistics
as well as binary logistic regression were performed. More than 50% of 97 patients had abnormal
findings in their neurological examination. Magnetic resonance imaging findings were pathological
for almost 20% of patientsâindicating conditions such as cerebral venous thrombosis, reversible
posterior leukoencephalopathy, brain tumour and intracranial bleeding. The odds of abnormal
neuroimaging results were 2.2-times greater among women with abnormal neurological examination
findings than among those with normal examination results. In cases of headache during pregnancy
and in puerperium, neuroimaging should be indicated early on. Further research is needed to
determine which conditions indicate a need for immediate neuroimaging
Acute lower limb compartment syndrome after Cesarean section: a case report
Abstract: Introduction Acute compartment syndrome of the lower limb is a rare but severe intra- and post-partum complication. Prompt diagnosis is essential to avoid permanent functional restriction or even the loss of the affected limb. Clinical signs and symptoms might be nonspecific, especially in the early stages; therefore, knowledge of predisposing risk factors can be helpful. Case presentation We present the case of a 32-year-old Caucasian woman with acute post-partum compartment syndrome. Conclusion: Acute compartment syndrome is an important differential diagnosis for the sudden onset of intra- or post-partum lower-limb pain. Predisposing factors for the manifestation of acute compartment syndrome in an obstetric environment are augmented intra-partum blood loss, prolonged hypotensive episodes and the use of oxytocin to support or induce labor because of its vasoconstrictive properties. Treatment is prompt surgical decompression by performing fasciotomy in any affected muscular compartments
Effect of the 3q26-coding oncogene SEC62 as a potential prognostic marker in patients with ovarian neoplasia
With approximately 220,000 newly diagnosed cases per year, ovarian cancer is
among the most frequently occurring cancers among women and the second
leading cause of death from gynecological malignancies worldwide. About 70%
of these cancers are diagnosed in advanced stages (FIGO IIBâIV), with a 5-year
survival rate of 20â30%. Due to the poor prognosis of this disease, research has
focused on its pathogenesis and the identification of prognostic factors. One
possible approach for the identification of biological markers is the
identification of tumor entity-specific genetic âdriver mutationsâ. One such
mutation is 3q26 amplification in the tumor driver SEC62, which has been
identified as relevant to the pathogenesis of ovarian cancer. This study was
conducted to investigate the role of SEC62 in ovarian malignancies. Patients
with ovarian neoplasias (borderline tumors of the ovary and ovarian cancer) who
were treated between January 2007 and April 2019 at the Department of
Gynecology and Obstetrics, Saarland University Hospital, were included in
this retrospective study. SEC62 expression in tumor tissue samples taken
during clinical treatment was assessed immunohistochemically, with the
calculation of immunoreactivity scores according to Remmele and Stegner,
Pathologe, 1987, 8, 138â140. Correlations of SEC62 expression with the TNM
stage, histological subtype, tumor entity, and oncological outcomes
(progression-free and overall survival) were examined. The sample
comprised 167 patients (123 with ovarian cancer and 44 with borderline
tumors of the ovary) with a median age of 60 (range, 15â87) years. At the
time of diagnosis, 77 (46%) cases were FIGO stage III. All tissue slides showed
SEC62 overexpression in tumor cells and no SEC62 expression in other cells.
Median immunoreactivity scores were 8 (range, 2â12) for ovarian cancer and 9
(range, 4â12) for borderline tumors of the ovary. Patients with borderline
tumors of the ovary as well as patients with ovarian cancer and an
immunoreactive score (IRS) †9 showed an improved overall survival compared to those presenting with an IRS score >9 (p = 0.03). SEC62 seems to
be a prognostic biomarker for the overall survival of patients with ovarian
malignancies
Augmented reality-enhanced navigation in endoscopic sinus surgery: A prospective, randomized, controlled clinical trial
Objective: Endoscopic sinus surgery represents the gold standard for surgical treatment of chronic sinus diseases. Thereby, navigation systems can be of distinct use. In our study, we tested the recently developed KARL STORZ NAV1 SinusTracker navigation software that incorporates elements of augmented reality (AR) to provide a better preoperative planning and guidance during the surgical procedure. Methods: One hundred patients with chronic sinus disease were operated on using either a conventional navigation software (n = 52, nonâAR, control group) or a navigation software incorporating AR elements (n = 48, AR, intervention group). Incidence of postoperative complications, duration of surgery, surgeonâreported benefit from the navigation system and patientâreported postoperative rehabilitation were assessed. Results: The surgeons reported a higher benefit during surgery, used the navigation system for more surgical steps and spent longer time with preoperative image analysis when using the AR system as compared with the nonâAR system. No significant differences were seen in terms of postoperative complications, target registration error, operation time and postoperative rehabilitation. Conclusion:
The AR enhanced navigation software shows a high acceptance by sinus surgeons in different stages of surgical training and offers potential benefits during surgery without affecting the duration of the operation or the incidence of postoperative complications
Instrument usage in laparoscopic gynecologic surgery: a prospective clinical trial
PurposeTo evaluate instrumental usage in laparoscopic gynecological surgeries and to develop key timesets of a laparoscopic operation, which allows categorization of the operation time into different sections.MethodsIn this prospective clinical observational study, frequency of instrument usage, time for instrument switches, and instrument utilization time were recorded in a standardized manner for laparoscopic surgeries in 103 endoscopic surgeries.ResultsA standard equipment (including atraumatic grasping forceps, irrigation and suction device, bipolar clamp, and laparoscopic scissors) was used for nearly all interventions. Bipolar clamps and scissors were changed most frequently. The tool used for the longest amount of time was the atraumatic grasping forceps. Laparoscopic instruments were switched 51 times per surgery (range 2-250 times). One instrument switch lasted for a median of 0.13min (0.08-1.2min). Median time for instrument switch for a single surgery added up to 6.83min. Instrument switches required 10.5% of the overall operation time.ConclusionWe analyzed the current instrument usage in laparoscopic gynecological surgeries. The results of our standardized investigation suggest ways to reduce the time required for surgery and provide starting points for the standardization of the work routine
Influence of androgen levels on conception probability in patients undergoing fertility treatment: a retrospective cohort study
PurposePrimary and secondary sterility have become an issue of increasing importance due to demographic and social changes in society. Data regarding the association between female androgen levels and the probability of successful conception after fertility treatment are sparse and contradictive. This study was designed to assess this clinical question.MethodsIn this retrospective single-center cohort study concentrations of androgens androstenedione, dehydroepiandrosteronsulfat (DHEAS) and testosterone (ng/ml) were investigated in the serum of patients presenting for sterility at the department of reproductive medicine of Saarland University hospital Homburg between January 2015 and December 2017. Androgen levels were correlated with reproductive outcomes. Statistical analysis was performed with the aid of SPSS version 24. Significance for conception rates in dependence of androgen concentration was assessed using Kruskal-Wallis test (significance was estimated with p<0.05).ResultsThe laboratory values of a total of 301 patients were examined (64% primary, 36% secondary sterility). Median age at first visit at the fertility department was 32.7years (range 20-47years). 64 pregnancies were observed during the study period (conception rate 21.3%). 23 out of 301 patients (7.6%) suffered from hypoandrogenaemia, 248 (82.4%) had normal androgen levels and 30 (10%) showed hyperandrogenaemia (p=0.25). Regarding patients in whom fertility treatment was successful 3 (4.7%) showed hypoandrogenaemia, 54 (84.4%) were normoandrogenaemic and 7 (10.9%) had hyperandrogenaemia (p=0.40 Kruskal-Wallis test).ConclusionsWe found no association between female androgen levels and sterility and reproductive outcomes
Impact of Tumor Localization and Method of Preoperative Biopsy on Sentinel Lymph Node Mapping After Periareolar Nuclide Injection
<div><p>Background</p><p>To evaluate whether tumor localization and method of preoperative biopsy affect sentinel lymph node (SLN) detection after periareolar nuclide injection in breast cancer patients.</p><p>Methods and Findings</p><p>767 breast cancer patients were retrospectively included. For lymphscintigraphy periareolar nuclide injection was performed and the SLN was located by gamma camera. Patient and tumor characteristics were correlated to the success rate of SLN mapping. SLN marking failed in 9/61 (14.7%) patients with prior vacuum-assisted biopsy and 80/706 (11.3%) patients with prior core needle biopsy. Individually evaluated, biopsy method (p = 0.4) and tumor localization (p = 0.9) did not significantly affect the SLN detection rate. Patients with a vacuum-assisted biopsy of a tumor in the upper outer quadrant had a higher odds ratio of failing in SLN mapping (OR 3.8, p = 0.09) compared to core needle biopsy in the same localization (OR 0.9, p = 0.5).</p><p>Conclusions</p><p>Tumor localization and preoperative biopsy method do not significantly impact SLN mapping with periareolar nuclide injection. However, the failure risk tends to rise if vacuum-assisted biopsy of a tumor in the upper outer quadrant is performed.</p></div
Dkk1 as a Prognostic Marker for Neoadjuvant Chemotherapy Response in Breast Cancer Patients
Purpose: To investigate the role of Dkk1 as a predictor of response to NACT in BC patients.
Methods: This retrospective monocentric study included 145 women who had undergone NACT
followed by breast surgery. Dkk1 protein expression was assessed using immunohistochemistry
staining in core needle biopsies and mammary carcinoma specimens. Results: Dkk1 levels were
lower in treated BC tumours than in untreated tumours. The outcomes of 68 matched pre- and
post-therapy tissues showed that Dkk1 levels in mammary carcinoma tissues were significantly
predicted by levels in core needle biopsies and that Dkk1 expression was reduced in 83% of cases.
Smaller cT stage, positive Her2 expression, and decreased Dkk1-IRS in core needle biopsy tissues
were all independent predictors of regression grade (R4), according to Sinn. However, the percentage
of Dkk1 expression differences prior to and following NACT had no effect on PFS or OS. Conclusions:
In this study, we demonstrated for the first time that Dkk1 could be identified as an independent
predictor of NACT response in BC patients, particularly those with TNBC. Further research with a
multicentric expanded (pre-/post-therapy) sample set and better-defined populations in terms of
molecular subtypes, therapy modality, and long-term follow-up is recommended to obtain more
solid evidence