Biomechanics of human pericardium: a comparative study of fresh and fixed tissue

Glutaraldehyde is a fixing agent for heterologus pericardium used in cardiac surgery. It is known to sterilize and stabilize the material and change its properties. However, it is uncertain whether fixation of autologous tissue is necessary. Fresh human pericardium specimens were harvested from cardiac surgery and cut into four smaller samples: two were kept in the native (fresh) state and two chemically treated with Carpentier's Solution (0.625% glutaraldehyde) for 10 min. The equi-biaxial response of each sample was tested with a biaxial tensile machine. Samples of other patch materials (bovine pericardium, Dacron) were also tested. Fresh tissue was significantly stiffer than fixed tissue but was then shown to be the result of significant tissue swelling due to the treatment. The fresh and fixed pericardium tissue displayed anisotropy, with the longitudinal direction being stiffer than the transverse. Comparing human pericardium (fresh and fixed) to Dacron and bovine pericardium (commercially obtained), Dacron was found to be the stiffest material followed by bovine pericardium. Surgeons should be aware of the mechanical differences of patch materials when planning surgeryLe glutaraldéhyde est un agent fixateur utilisé dans la cardiochirurgie pour stériliser et stabiliser les péricardes hétérologues. Cependant, il n'est pas certain quant à savoir si la fixation du tissu autologue est nécessaire. Des spécimens humains du péricarde ont été recueillis de patients de cardiochirurgie et coupés en quatre petits échantillons. L'état initial de deux d'entre eux a été conservé alors que les deux autres ont baignés dans une solution de Carpentier (0.625% glutaraldéhyde) pendant 10 minutes. La tension équibiaxiale de chaque échantillon a été mesurée avec une machine à tension biaxiale. Il a été fait de même pour des échantillons de matériaux substituts (péricarde de bovin, Dacron). Le tissu conservé était manifestement plus rigide que le tissu fixé. Il a été établi que l'écart des résultats s'explique par le gonflement que le tissu fixé a subi lorsqu'il a été immergé dans l'agent fixateur. De plus, il a été démontré que les deux tissus sont anisotropes. Les mesures de tension en direction longitudinale étaient plus élevées que celles en direction transversale. En comparant les échantillons de péricardes humains à deux autres matériaux substituts disponibles sur le marché, il a été établi que le Dacron suivi du péricarde de bovin sont plus rigides. Les chirurgiens doivent connaître les propriétés de ces matériaux afin d'utiliser celui le mieux adapté à leur diagnostic

Innovations in the Management of Vaginal Cancer

Primary vaginal cancer is a rare gynecologic malignancy. Given the rarity of the disease, standardized approaches to management are limited, and a great variety of therapeutic conditions are endorsed. This paper reviews advances in surgical approaches, radiation, chemoradiation, and immunotherapy. Advances in surgical management including the increasing use of laparoscopic and endoscopic approaches, as well as the novel techniques in vaginal reconstruction, are reviewed. Concurrent chemoradiation remains a mainstay of treatment for vaginal cancer and has improved local control of disease and overall survival. Additionally, with metastatic disease or situations where toxicity from CCRT is unacceptable, systemic therapies including immunotherapy approaches are reviewed

Identifying Borderline Ovarian Tumor Recurrence Using Routine Ultrasound Follow-Up

Borderline ovarian tumors (BOTs) are non-invasive tumors frequently diagnosed in young patients. Surgical removal of the uterus, fallopian tubes, ovaries, and omentum is considered definitive management, however fertility-sparing approach is a recognized option. Surveillance is important due to known recurrence, but there is controversy over the effectiveness of follow-up modalities. The objective is to determine the efficacy of ultrasound screening in identifying tumor recurrence. This retrospective chart review evaluated all patients consulted and/or treated surgically at our institution from January 2015 to June 2020 diagnosed with BOT. Patients were excluded if concurrently diagnosed with another gynecologic malignancy, did not have yearly ultrasound follow-up, or were lost to follow-up. This study included 56 patients, 17 of whom underwent fertility preserving surgery. The overall rate of recurrence was 10.7%; with recurrence rates of 23.5% for the fertility preserving surgery population and 5.1% for the definitive surgery population. Ultrasound first identified 5 of the 6 (83.3%) recurrences. Overall time to recurrence was 51.5 months. In conclusion, recurrences were identified on routine ultrasound screening prior to symptom onset or detection via physical exam in 83.3% of cases. While the best modality of follow-up remains controversial, this review provides evidence supporting the use of routine ultrasound follow-up for early detection of BOT recurrence

Bevacizumab Treatment for Low-Grade Serous Ovarian Cancer: A Systematic Review

Serous epithelial ovarian cancer, classified as either high-grade (90%) or low-grade (10%), varies in molecular, histological, and clinicopathological presentation. Low-grade serous ovarian cancer (LGSOC) is a rare histologic subtype that lacks disease-specific evidence-based treatment regimens. However, LGSOC is relatively chemo-resistant and has a poor response to traditional treatments. Alternative treatments, including biologic therapies such as bevacizumab, have shown some activity in LGSOC. Thus, the objective of this systematic review is to determine the effect and safety of bevacizumab in the treatment of LGSOC. Following PRISMA guidelines, Medline ALL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase all from the OvidSP platform, ClinicalTrials.gov, International Clinical Trials Registry Platform, International Standard Randomised Controlled Trial Number Registry were searched from inception to February 2022. Articles describing bevacizumab use in patients with LGSOC were included. Article screening, data extraction, and critical appraisal of included studies were completed by two independent reviewers. The effect of bevacizumab on the overall response rate, progression-free survival, overall survival, and adverse effects were summarized. The literature search identified 3064 articles, 6 of which were included in this study. A total of 153 patients were analyzed; the majority had stage IIIC cancer (56.2%). The overall median response rate reported in the studies was 47.5%. Overall, bevacizumab is a promising treatment for LGSOC, with response rates higher than traditional treatment modalities such as conventional chemotherapy, and is often overlooked as a treatment tool. A prospective clinical trial evaluating the use of bevacizumab in LGSOC is necessary to provide greater evidence and support these findings

Canadian Guideline on the Management of a Positive Human Papillomavirus Test and Guidance for Specific Populations

The purpose of this paper is to provide evidence-based guidance on the management of a positive human papilloma virus (HPV) test and to provide guidance around screening and HPV testing for specific patient populations. The guideline was developed by a working group in collaboration with the Gynecologic Oncology Society of Canada (GOC), Society of Colposcopists of Canada (SCC), and the Canadian Partnership Against Cancer. The literature informing these guidelines was obtained through a systematic review of relevant literature by a multi-step search process led by an information specialist. The literature was reviewed up to July 2021 with manual searches of relevant national guidelines and more recent publications. The quality of the evidence and strength of recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The intended users of this guideline include primary care providers, gynecologists, colposcopists, screening programs, and healthcare facilities. The implementation of the recommendations will ensure an optimum implementation of HPV testing with a focus on the management of positive results. Recommendations for appropriate care for underserved and marginalized groups are made