Klasyfikacja (3 klasy) limfadenektomii miedniczej i aortalnej u pacjentek z rakiem szyjki macicy

Abstract Currently, the extent of pelvic and aortic lymphadenectomy is currently described by numerous and ambiguous terms. The aim of this study is to present a classification of pelvic and aortic lymphadenectomy in cervical cancer patients. On the base of the data from the literature, pelvic and aortic lymphadenectomies have been assigned to three different classes, depending on surgical technique, the extent of the lymphadenectomy and the specificity of the removed lymph node groups. Class I equals removal of selected lymph nodes; Class II: removal of lymph nodes situated ventrally and laterally to large extraperitoneal vessels and the obturator nerve and of lymph nodes situated ventrally and laterally to the aorta and vena cava; Class III: total removal of lymphatic tissue around the iliac vessels and from the obturator fossa dorsally to the obturator nerve and from the presacral region and lymphatic tissue around the aorta and vena cava. The presented classification allows for a unequivocal assessment of pelvic and aortic lymphadenectomy.Streszczenie Zakres limfadenektomii miednicznej i aortalnej jest obecnie oceniany przez niejednoznaczne terminy. Celem pracy jest przedstawienie klasyfikacji limfadenektomii miednicznej i aortalnej u pacjentek z rakiem szyjki macicy. W oparciu o dane z literatury, limfadenektomia miedniczna i aortalna są zaliczane do trzech klas w zależności od techniki chirurgicznej, zakresu limfadenektomii i usuwanych grup węzłów chłonnych. Klasa I jest określana jako usuniecie wybranych węzłów chłonnych; klasa II jako usunięcie węzłów chłonnych znajdujących się po stronie brzusznej i bocznej w stosunku do dużych naczyń zaotrzewnowych miednicy mniejszej, nerwów zasłonowych i bocznie do aorty i żyły głównej dolnej; klasa III jako całkowite usunięcie tkanki limfatycznej wokół naczyń biodrowych, dołów zasłonowych w tym także grzbietowo od nerwów zasłonowych, z okolicy przedkrzyżowej oraz tkanki limfatycznej wokół aorty i żyły głównej dolnej. Przedstawiona klasyfikacja pozwala na jednoznaczne określenie limfadenektomii miednicznej i aortalnej

Nerve sparing radical hysterectomy

Abstract The aim of the study was to review the literature concerning nerve sparing radical hysterectomy (NSRH). The data about anatomical and physiological background of this operation, its history, technique and perspectives has been presented. In conclusion it has been estimated that the technique is new and its oncological efficiency is not yet fully established; it requires special anatomical knowledge and new instruments

Obesity as a risk factor of in-hospital outcomes in patients with endometrial cancer treated with laparoscopic surgical mode

Objectives: Obesity has been suggested to have a negative influence on procedural outcomes of endometrial cancer laparoscopic treatment. Obesity and other possible risk factors of laparoscopic endometrial cancer treatment has not been precisely described in the literature. The aim of the study is to determine the factors that have the greatest influence on the course of laparoscopic surgery for endometrial cancer, with particular emphasis on the influence of obesity. Material and methods: The study included 75 females who were treated for endometrial cancer by laparoscopic surgery. Preoperative body-mass index (BMI), waist circumference(WC), waist to hip ratio(WHR), and selected anatomical indices were measured. The duration of surgery and hospitalization stay, loss of hemoglobin, and procedural-related complications served as parameters of in-hospital outcomes. Results: Multiple linear regression analysis indicate the body mass as most sensitive parameter of obesity which influence in-hospital outcomes in patients treated with laparoscopic procedure. Procedural-related complications occurred in the group of patients with significantly greater WC and BMI. Multiple linear regression indicates also histological grading (G1–G3), external conjugate, intertrochanteric distance as significant risk factors. The multiple linear regression analysis confirmed also that implementation of sentinel lymph node procedure is related with decreased hemoglobin loss in patients with cancer of endometrium compare to lymphadenectomy without sentinel node biopsy(Est.: 0.488; 95% CI: 0.083–0.892, p = 0.018). Conclusions: The most sensitive risk factor of in-hospital outcomes in laparoscopic treatment of endometrial cancer is body mass. The implementation of the sentinel node procedure is associated with reduced surgery time and reduced hemoglobin loss

Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09‐related pneumonia: an individual participant data meta‐analysis

BACKGROUND: The impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection. METHODS: A worldwide meta‐analysis of individual participant data from 20 634 hospitalised patients with laboratory‐confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. RESULTS: Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)]. CONCLUSIONS: Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support

Evaluation of the hospital environment for women with endometrial cancer

Introduction and objectives The aim of the study was describe the factors determining the evaluation of the hospital environment, especially satisfaction with care and individual needs of cancer patients. Material and Methods The study comprised 80 women with endometrial cancer diagnosed and treated surgery in the Clinic of Gynaecology and Obstetrics in Rzeszow, Poland, between 2011–2012. The study used 3 questionnaires: the Goals Attainment Scaling (GAS) questionnaires, and questionnaires developed by the EORTC Quality of Life group, i.e. the QLQ C-30 (general module) and the In- PATSAT-32. Results Respondents indicated 36 goals/expectations and the most common (over 50%) concerned the normal course of the post-operative period. The overall index of all goals which were met was 7.0 points. General quality of life reported by respondents before surgery was at a medium level (52.3+16.8%). Emotional functioning received the lowest scores (61.0+18.8%). Most respondents assessed manual skills of hospital doctors and nurses as the best in the In-PATSAT 32 scale i.e. 69.9±14.7% and 67.3±16.1%, respectively. The worst ratings concerned access to hospital from the outside (50.8±16.9%) and easy orientation inside the buildings (55.9±16.0%). Conclusions Analysis of correlations between GAS and the In-PATSAT32 scales proved that they cannot be used interchangeably since they measure different aspects of a patient’s satisfaction with hospital care. For this reason, the application of idiographic and nomothetic tests among cancer patients is helpful for evaluation of the hospital environment

Evaluation of the hospital environment for women with endometrial cancer

Introduction and objectives The aim of the study was describe the factors determining the evaluation of the hospital environment, especially satisfaction with care and individual needs of cancer patients. Material and Methods The study comprised 80 women with endometrial cancer diagnosed and treated surgery in the Clinic of Gynaecology and Obstetrics in Rzeszow, Poland, between 2011–2012. The study used 3 questionnaires: the Goals Attainment Scaling (GAS) questionnaires, and questionnaires developed by the EORTC Quality of Life group, i.e. the QLQ C-30 (general module) and the In- PATSAT-32. Results Respondents indicated 36 goals/expectations and the most common (over 50%) concerned the normal course of the post-operative period. The overall index of all goals which were met was 7.0 points. General quality of life reported by respondents before surgery was at a medium level (52.3+16.8%). Emotional functioning received the lowest scores (61.0+18.8%). Most respondents assessed manual skills of hospital doctors and nurses as the best in the In-PATSAT 32 scale i.e. 69.9±14.7% and 67.3±16.1%, respectively. The worst ratings concerned access to hospital from the outside (50.8±16.9%) and easy orientation inside the buildings (55.9±16.0%). Conclusions Analysis of correlations between GAS and the In-PATSAT32 scales proved that they cannot be used interchangeably since they measure different aspects of a patient’s satisfaction with hospital care. For this reason, the application of idiographic and nomothetic tests among cancer patients is helpful for evaluation of the hospital environment

Assessment of preoperative counselling and quality of life of patients with endometrial cancer

Purpose: The main aim of the study was to obtain feedback from patients with endometrial cancer on the quality of information provided to them prior to surgery. An additional aim was to correlate these opinions with sociodemographic factors. Material and methods: One hundred and twenty-three patients with endometrial cancer diagnosed by means of tissue sampling, treated surgically at the Department of Gynecology and Obstetrics in Rzeszów, Poland in 2012–2014 were enrolled in a prospective cohort study. The questionnaires used were: EORTC QLQ-C30 and QLQ-INFO25, completed before discharge from hospital. Statistical analysis assessed the influence of ordinal categorical variables by means of rank correlation analysis. For nominal variables, the mean and median values in the groups compared were calculated, and then the difference in the distribution of the domains of information quality in these groups was estimated using the Kruskal–Wallis test or the Mann–Whitney test. Results: According to data supplied by the patients who filled out INFO-25, they received the largest amount of information about medical tests (60.3%) and the disease itself (55%). They were informed less adequately about treatment (43.4%), and the scarcest information was provided in regard to follow-up (28.5%). The helpfulness of the information received (64.5%) was assessed the highest. Overall quality of their life amounted to 55 ± 22. A low correlation was found between the assessment of information and the quality of life. A younger age, higher level of education and having a partner correlated with a higher score awarded to the information received. Conclusion: The assessment of the quality of the information provided preoperatively depends on the individual characteristics of the recipient, which should be taken into account in the information process. In addition, more attention should be paid to the provision of information concerning the treatment protocol and follow-up.Cel: Głównym celem niniejszej pracy było uzyskanie od pacjentek z rakiem endometrium opinii na temat jakości informacji przekazanych im przed operacją. Dodatkowym celem było skorelowanie tych opinii z czynnikami socjodemograficznymi. Materiał i metody: Prospektywnym badaniem kohortowym objęto 123 chore z rakiem endometrium potwierdzonym w badaniu histopatologicznym, leczone operacyjnie w Klinice Ginekologii i Położnictwa w Rzeszowie w latach 2012–2014. W badaniu zastosowano kwestionariusze EORTC QLQ-C30 i QLQ-INFO25 wypełniane przed wypisem z oddziału. W analizie statystycznej za pomocą analizy korelacji rang oceniono wpływ czynników mających charakter porządkowy. W przypadku czynników o charakterze nominalnym wyliczano wartości średnie i wartości środkowe w porównywanych grupach, a następnie za pomocą testu Kruskala–Wallisa lub testu Manna–Whitneya oceniano różnicę w rozkładzie miar jakości informacji w tych grupach. Wyniki: Z danych uzyskanych od pacjentek, które wypełniły moduł INFO25, wynika, że najwięcej informacji otrzymały one na temat badań (60,3%) i choroby (55%), mniej dowiedziały się o leczeniu (43,4%), a najmniej o jego kontynuacji (28,5%). Chore oceniły najwyżej przydatność informacji (64,5%). Ogólna jakość ich życia wynosiła 55 ± 22. Wykazano niską korelację między oceną informacji a jakością życia. Z lepszą oceną uzyskanych informacji wiązały się młodszy wiek, wyższy poziom wykształcenia i bycie w związku partnerskim. Wnioski: Ocena jakości informacji przekazywanych w okresie przedoperacyjnym jest uzależniona od indywidualnych cech odbiorcy, co należy uwzględnić w procesie informowania. Ponadto należy zwrócić większą uwagę na przekazywanie informacji odnośnie do zasad leczenia i jego kontynuacji

Endometrioza o potrójnej lokalizacji: w przegrodzie odbytniczo-pochwowej, w bliźnie po cięciu cesarskim oraz w jajniku – opis przypadku

The authors discuss the symptoms, pathogenesis and treatment of endometriosis of multiple localization:in the recto-vaginal septum, in a post-caesarean scar and in the ovary. In the available literature we found nodata on the prevalence of endometriosis in triple localisation. The authors discuss symptoms, pathogenesis andtreatment of endometriosis concerning the described localisation

Prospective study concerning 71 cases of caesarean scar endometriosis (CSE)

A prospective study was undertaken involving 71 patients with caesarean scar endometriosis (CSE) between the years 2007 and 2013. A prospective study enabled us to find out: mean age of patients with CSE; 34.0 years (range 22.0–48.0), time between CS and diagnosis of CSE; 12.0 months (range 19.0–39.0), duration between symptoms and surgery; 24.0 months (range 1.0–204.0), mean operation time; 40.0 min. (range 15.0–160.0), and mean lesion size; 54.4 ± 42.3 mm3. In three patients (4.2%) a large deficit in the abdominal wall was closed by means of polypropylene mesh. One of them conceived a year later. Surgical excision is the only effective treatment in patients with CSE. Wide local excision with clear margins is the key to prevent recurrence. Repair of large post-excisional deficits with mesh may also be offered to woman planning their next pregnancy.Impact statement • What is already known on this subject? Endometriosis in the scar may occur after various abdominal surgeries, more frequently after caesarean sections. The excision of large nodules is connected with suboptimal cosmetic outcomes and the possibility of recurrence. • What the results of this study add? In this study including 71 patients with CSE, wide excision with electrocoagulatory was associated with a single recurrence in 12-month follow-up. In three patients (4.2%) large deficits in the abdominal wall were closed with the use of polypropylene mesh. One of them conceived a year later and had a successful pregnancy. • What the implications are of these findings for clinical practice and/or futher research? Surgical excision is the only effective treatment in patients with CSE. Wide local excision with clear margins is the key to preventing recurrence. Repair of large post excisional deficit with mesh may be offered also to woman planning pregnancy