21 research outputs found
Preoperative Sonographic Prediction of Limited Axillary Disease in Patients with Primary Breast Cancer Meeting the Z0011 Criteria: an Alternative to Sentinel Node Biopsy?
Purpose
To assess the accuracy of preoperative sonographic staging for prediction of limited axillary disease (LAD, one or two metastatic lymph nodes) and to identify factors associated with high predictionâpathology concordance in patients with early-stage breast cancer meeting the Z0011 criteria.
Materials and Methods
Patients treated between January 2015 and January 2020 were included in this retrospective, multicentric analysis of prospectively acquired service databases. The accuracy of LAD prediction was assessed separately for patients with one and two suspicious lymph nodes on preoperative sonography. Test validity outcomes for LAD prediction were calculated for both groups, and a multivariate model was used to identify factors associated with high accuracy of LAD prediction.
Results
Of 2059 enrolled patients, 1513 underwent sentinel node biopsy, 436 primary and 110 secondary axillary dissection. For LAD prediction in patients with one suspicious lymph node on preoperative ultrasound, sensitivity was 92% (95% CI 87â95%), negative predictive value (NPV) was 92% (95% CI 87â95%), and the false-negative rate (FNR) was 8% (95% CI 5â13%). For patients with two preoperatively suspicious nodes, the sensitivity, NPV, and FNR were 89% (95% CI 84â93%), 73% (62â83%), and 11% (95% CI 7â16%), respectively. On multivariate analysis, the number of suspicious lymph nodes was associated inversely with correct LAD prediction ([OR 0.01 (95% CI 0.01â0.93), pââ€â0.01].
Conclusions
Sonographic axillary staging in patients with one metastatic lymph node predicted by preoperative ultrasound showed high accuracy and a false-negative rate comparable to sentinel node biopsy for prediction of limited axillary disease
A Prospective Observational Cohort Study
Introduction Uterine leiomyomas are the most common benign gynecologic tumors.
To date laparoscopy myomectomy is the gold standard for treatment of
symptomatic fibroids in reproductive-aged women. Detailed counseling about the
effects of this procedure on postoperative sexuality and quality of life is
important in these patients. However, available data on these subjects are
limited and contradictory. The aim of this study was to assess sexual function
and quality of life in premenopausal women undergoing laparoscopic myomectomy
for symptomatic uterine fibroids. Material and Methods All premenopausal women
who underwent laparoscopic myomectomy for symptomatic fibroids between April
2012 and August 2014 at a tertiary university center were enrolled in this
prospective observational cohort study. Sexual function and quality of life
were assessed for the pre- and postoperative (six months post-operatively)
state using two validated questionnaires, the Female Sexual Function Index
(FSFI) and the European Quality of Life Five-Dimension Scale (EQ-5D). Results
Ninety-five of the 115 (83%) eligible patients completed the study. Overall a
significant improvement in quality of life and sexual function was observed in
the study cohort: Median FSFI (28 (18.7â35.2)) and EQ-5D scores (1 (0.61â1)
after laparoscopic myomectomy were significantly higher than preoperative
scores (21.2 (5.2â33.5); 0.9 (0.2â1); p †0.01). The number, position and
localization of the largest fibroids were not correlated with pre- or
postoperative sexual function or quality of life. Conclusion Laparoscopic
myomectomy might have positive short-term effects on postoperative quality of
life and sexual function in premenopausal women suffering from symptomatic
fibroids
Students' attitudes toward digital learning during the COVID-19 pandemic: a survey conducted following an online course in gynecology and obstetrics
Purpose
The purpose of this survey was to assess medical studentsâ opinions about online learning programs and their preferences for specific teaching formats during COVID 19 pandemic.
Methods
Between May and July 2020, medical students who took an online gynecology and obstetrics course were asked to fill in a questionnaire anonymously. The questionnaire solicited their opinions about the course, the teaching formats used (online lectures, video tutorials featuring real patient scenarios, and online practical skills training), and digital learning in general.
Results
Of 103 students, 98 (95%) submitted questionnaires that were included in the analysis. 84 (86%) students had no problem with the online course and 70 (72%) desired more online teaching in the future. 37 (38%) respondents preferred online to traditional lectures. 72 (74%) students missed learning with real patients. All digital teaching formats received good and excellent ratings fromâ>â80% of the students.
Conclusion
The survey results show medical studentsâ broad acceptance of the online course during COVID 19 pandemic and indicates that digital learning options can partially replace conventional face-to-face teaching. For content taught by lecture, online teaching might be an alternative or complement to traditional education. However, bedside-teaching remains a key pillar of medical education
ASO Author Reflections: An Alternative to Sentinel-Node Biopsy? Preoperative Sonographic Prediction of Limited Axillary Disease in Breast Cancer Patients Meeting the Z0011 Criteria
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Incidence of and risk factors for vaginal cuff dehiscence following total laparoscopic hysterectomy: a monocentric hospital analysis
Purpose
Vaginal cuff dehiscence (VCD) is one of the major surgical complications following hysterectomy with data on incidence rates varying largely and studies assessing risk factors being sparse with contradictive results. The aim of this study was to assess the incidence rate of and risk factors for VCD in a homogenous cohort of women treated for benign uterine pathologies via total laparoscopic hysterectomy (TLH) with standardized follow-up.
Methods
All patients undergoing TLH at the Department of Gynecology and Obstetrics, Saarland University Hospital between November 2010 and February 2019 were retrospectively identified from a prospectively maintained service database.
Results
VCD occurred in 18 (2.9%) of 617 patients included. In univariate and multivariate analyses, a lower level of surgeon laparoscopic expertise (odds ratio 3.19, 95% confidence interval (CI) 1.0â9.38; pâ=â0.03) and lower weight of removed uterus (odds ratio 0.99, 95% CI 0.98â0.99; pâ=â0.02) were associated positively with the risk of VCD.
Conclusion
In this homogenous cohort undergoing TLH, laparoscopic expertise and uterine weight influenced the risk of postoperative VCD. These findings might help to further reduce the rate of this complication
VEGF-A165b levels are reduced in breast cancer patients at primary diagnosis but increase after completion of cancer treatment
The antiangiogenic splice variant VEGF-A165b is downregulated in a variety of cancer entities, but little is known so far about circulating plasma levels. The present analysis addresses this question and examines circulating VEGF-A/VEGF-A165b levels in a collective of female high-risk breast cancer patients over the course of treatment. Within the SUCCES-A trial 205 patients were recruited after having received primary breast surgery. Using ELISA VEGF-A/VEGF-A165b concentrations were determined and correlated to clinical characteristics (1) before adjuvant chemotherapy, (2) four weeks and (3) two years after therapy and compared to healthy controls (n = 107). VEGF(165b) levels were significantly elevated after completion of chemotherapy. Within the breast cancer cohort, VEGF-A165b levels increased two years after completion of chemotherapy. VEGF-A plasma concentrations were significantly elevated in the breast cancer cohort at all examined time points and decreased after treatment. VEGF-A levels two years after chemotherapy correlated with increased cancer related mortality, no such correlation could be found between VEGF-A165b and the examined clinical characteristics. Compared to controls, VEGF-A/VEGF-A165b ratios were decreased in patients before and after chemotherapy. Our data suggests that circulating VEGF-A165b is significantly reduced in women with primary breast cancer at time of diagnosis;furthermore, levels change during adjuvant treatment
Acute Sheehan's syndrome manifesting initially with diabetes insipidus postpartum: a case report and systematic literature review
Purpose
Acute Sheehanâs syndrome is a rare, but potentially life-threatening, obstetric event that can be complicated by diabetes insipidus. Little information on the diagnosis and treatment of Sheehanâs syndrome with diabetes insipidus is available. We report on a 28-year-old patient who developed acute Sheehanâs syndrome with diabetes insipidus after giving birth, and on a systematic review of similar cases.
Methods
We performed a systematic review of the literature cataloged in PubMed and Google Scholar using the keywords âSheehan syndromeâ OR âSheehan's syndromeâ AND âdiabetes insipidusâ to identify relevant case reports published between 1990 and 2021. Eight Reports met the inclusion criteria (English-language abstracts available, onset in the puerperium, information about the day of the onset).
Results
In the present case, postpartum curettage was necessary to remove the residual placenta. The total amount of blood loss was severe (2500 ml). On the second day postpartal, the patient developed polyuria. Laboratory analysis revealed hypernatremia with increased serum osmolality and decreased urinary osmolality. Hormone analysis showed partial hypopituitarism involving the thyroid, corticotropic, and gonadotropic axes. The prolactin level was elevated. Brain magnetic resonance imaging showed pituitary gland infarction. Desmopressin therapy was initiated and resolved the polyuria. Hormone replacement therapy was administered. Four months later, the patient was well, with partial diabetes insipidus. The literature review indicated that this case was typical in terms of symptoms and disease onset. Most reported cases involve hypotension and peripartum hemorrhage, but some patients without hemorrhage also develop Sheehanâs syndrome. Elevated prolactin levels are uncommon and associated with poor prognosis in patients with Sheehanâs syndrome.
Conclusion
Acute Sheehanâs syndrome with diabetes insipidus involves nearly all pituitary hormone axes, indicating severe disease. Prolactin elevation could suggest that a case of Sheehanâs syndrome is severe
The Prevalence, Management and Impact of Dysmenorrhea on Medical Studentsâ LivesâA Multicenter Study
Introduction: Dysmenorrhea is defined as the presence of painful menstruation, and it
affects daily activities in different ways. The aims of this study were to assess the prevalence and
management of dysmenorrhea and to determine the impact of dysmenorrhea on the quality of life
of medical students. Material and methods: The study conducted was prospective, analytical and
observational and was performed between 7 November 2019 and 30 January 2020 in five university
centers from Romania. The data was collected using an original questionnaire regarding menstrual
cycles and dysmenorrhea. The information about relationships with family or friends, couplesâ
relationships and university activity helped to assess the effects of dysmenorrhea on quality of life.
The level of significance was set at p < 0.05. Results: The study comprised 1720 students in total. The
prevalence of dysmenorrhea was 78.4%. During their menstrual period, most female students felt
more agitated or nervous (72.7%), more tired (66.9%), as if they had less energy for daily activities
(75.9%) and highly stressed (57.9%), with a normal diet being difficult to achieve (30.0%). University
courses (49.4%), social life (34.5%), couplesâ relationships (29.6%), as well as relationships with family
(21.4%) and friends (15.4%) were also affected, depending on the duration and intensity of the pain.
Conclusion: Dysmenorrhea has a high prevalence among medical students and could affect the
quality of life of students in several ways. During their menstrual period, most female students feel
as if they have less energy for daily activities and exhibit a higher level of stress. The intensity of
the symptoms varies considerably and, with it, the degree of discomfort it creates. Most student
use both pharmacological and non-pharmacological methods to reduce pain (75.7%). University
courses, social life, couplesâ relationships, as well as relationships with family and friends are affected,
depending on the duration and intensity of the pain
HPV Status as Prognostic Biomarker in Head and Neck CancerâWhich Method Fits the Best for Outcome Prediction?
The incidence of human papillomavirus (HPV)-related head and neck cancer (HNSCC)
is rising globally, presenting challenges for optimized clinical management. To date, it remains
unclear which biomarker best reflects HPV-driven carcinogenesis, a process that is associated with
better therapeutic response and outcome compared to tobacco/alcohol-induced cancers. Six potential HPV surrogate biomarkers were analyzed using FFPE tissue samples from 153 HNSCC
patients (n = 78 oropharyngeal cancer (OPSCC), n = 35 laryngeal cancer, n = 23 hypopharyngeal
cancer, n = 17 oral cavity cancer): p16, CyclinD1, pRb, dual immunohistochemical staining of p16
and Ki67, HPV-DNA-PCR, and HPV-DNA-in situ hybridization (ISH). Biomarkers were analyzed
for correlation with one another, tumor subsite, and patient survival. P16-IHC alone showed the
best performance for discriminating between good (high expression) vs poor outcome (low expression; p = 0.0030) in OPSCC patients. Additionally, HPV-DNA-ISH (p = 0.0039), HPV-DNA-PCR
(p = 0.0113), and p16-Ki67 dual stain (p = 0.0047) were significantly associated with prognosis in uniand multivariable analysis for oropharyngeal cancer. In the non-OPSCC group, however, none of the
aforementioned surrogate markers was prognostic. Taken together, P16-IHC as a single biomarker
displays the best diagnostic accuracy for prognosis stratification in OPSCC patients with a direct
detection of HPV-DNA by PCR or ISH as well as p16-Ki67 dual stain as potential alternatives
The Onset of Urinary Incontinence in Different Subgroups and its Relation to Menopausal Status: A Hospital-based Study
Background/Aim: Numerous risk factors have been reported to influence the development of urinary incontinence (UI). In this study, we took a closer look on the different forms of UI and tried to identify differences in regard to potential risk factors. Of special interest was the onset of UI symptoms and its relation to menopausal status. Patients and Methods: This was a hospital-based analysis of patients who presented with urinary incontinence in the outpatient ward of a tertiary hospital. The diagnosis of urinary incontinence was based on the subjective complaints of patients. Data concerning menopausal status, hormone replacement therapy, prior hysterectomy were assessed. Results: The mean age was 53.8 years in the SUI group, 62.7 years in the MUI group and 66.1 years in the UUI group, respectively (p<0.001). The proportion of patients with UUI was higher in the postmenopausal group, whereas the proportion of SUI was higher in the premenopausal group (p<0.001). The mean age in which complaints occurred was significantly lower in the SUI group (45.4 years) compared to the MUI (51.0 years) and UUI groups (54.7 years) (p<0.001). There was no correlation between menopausal status and onset of urinary incontinence (p=0.143). Conclusion: Additional anamnestic information help further characterize the different types of urinary incontinence that can lead to an optimization of treatment options. Younger age and premenopausal status were accompanied by milder forms of UI while menopausal status itself had no influence on the onset of UI symptoms indicating that age-related changes may lead to different types of incontinence