Fistula Campaigns-Are They of Any Benefit?

Objective Evaluation of the problems encountered during a voluntarily fistula campaign in a regional hospital of Niger (Africa) Materials and Methods Women underwent basic gynecological examination, methylene blue testing, and/or direct cystoscopy as necessary According to their clinical condition, women were informed and surgical options offered as appropriate Operations were performed under spinal or epidural anesthesia Immediate postoperative outcomes were followed during the stay of the surgical team in the country Results A total of 62 women were examined and 11 had causes of incontinence other than obstetric fistula In 9 8% of the women, severe local infection precluding any surgical intervention was evident In 58 8% of patients, the trigonal region and/or urethra were irreversibly damaged A proportion of patients (9 8%) with large lesions and intact urethra that were offered vaginal layered closure refused the intervention Of the women that were operated on (21 6%), six underwent vaginal layered closure with Martius fat flap and five women underwent a combined abdomino vaginal approach Conclusion It is extremely difficult to meet the needs of this global problem with short term programs and volunteers Directing these efforts to specialist fistula centers and creating reliable scientific evidence should be the main goal [Taiwan J Obstet Gynecol 2010,49(3) 291-296

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Efficacy of endocervical curettage and CA-125 measurement in endometrial serous carcinoma: A case series and literature review

Objective: This is a case series and literature review of patients with endometrial serous carcinoma (ESC) in which endocervical curettage (ECC) and CA-125 measurement were utilized as a diagnostic procedure in preoperative staging. Materials and Methods: The patients were treated in the gynecologic oncology clinic of İstanbul University Faculty of Medicine between January 2005, and January 2015. A total of 37 patients were included in the final analysis. Results: ECC accurately predicted ESC in 22 patients (59.5%). The mean pre-operative serum CA-125 level was 73.24±3.30 IU/mL; pre-operative serum CA-125 levels were elevated above 35 IU/mL in 25 patients (69%). Conclusion: ECC is an acceptable diagnostic tool to predict the presence or absence of cervical involvement in endometrial cancer. On the other hand, its accuracy in specific subgroups requires further analysis in carefully designed prospective studies. Furthermore, pre-operative serum CA-125 levels may be important for management and counseling in the subgroup of women with ESC

BAĞIŞIKLIK KONTROL NOKTASI İNHİBİTÖRLERİ: İRECIST, İRRC VE İRRECIST’İN PERFORMANSLARININ VE UYUMLARININ DEĞERLENDİRİLMESİ IMMUNE CHECKPOİNT İNHİBİTORS: ASSESSMENT OF THE PERFORMANCE AND THE AGREEMENT OF İRECIST, İRRC AND İRRECIST

Giriş ve Amaç: İmmün kontrol noktası inhibitörleri, özelliklerenal hücreli kanser, malign melanom, akciğer kanseri gibi kansertürlerine sahip hastaların tedavisinde tedavinin önemli bir bileşenihaline gelmiştir.İmmünoterapi tedavisi alan hastalarda,tedavi yanıtınıdeğerlendirmek üzere farklı yanıt kriterleri tanımlanmıştır. Literatürdebu kriterler irRC, immune-related response criteria; irRECIST, immune-related Response Evaluation Criteria in Solid Tumors; iRECIST,immune RECIST olarak isimlendirilmiştir (1-3). Bu çalışmada amacımızbağışıklık kontrol noktası inhibitörü tedavisi altındaki hastalardafarklı yanıt değerlendirme kriterleri arasındaki uyumu değerlendirmek,ölçtükleri yanıtı genel sağkalımla ilişkilendirmek ve progresehastalığın (PD) doğru tanıma oranlarını karşılaştırmaktır

Prognostic Factors Influencing Progression-Free Survival in HER2-Positive Metastatic Breast Cancer Patients Who Were Treated with A Combination of Lapatinib and Capecitabine

Objective: The aim was to assess the prognostic variables in human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer patients receiving lapatinib plus capecitabine. Materials and Methods: Retrospective data on HER2-positive metastatic breast cancer patients who received lapatinib and capecitabine were analyzed. Survival outcome was obtained with Cox regression analysis and the Kaplan–Meier method. Results: The study included 102 patients. Forty-four (43.1%) patients had de novo metastatic disease. The most frequent metastatic sites were, in order, bone (61.8%), brain (57.8%), liver (35.3%), and lung (34.3%). All of the patients had previously received chemotherapy based on trastuzumab. With combined lapatinib and capecitabine, complete response was observed in 7.8%, partial response in 30.4%, and stable disease in 24.5%. Progression-free survival was 8 (95% confidence interval, 5.1–10.8) months. In multivariable analysis, endocrine therapy (p = 0.02), de novo metastatic disease (p = 0.02), and age (p = 0.02) were prognostic factors for progression-free survival. However, the number of chemotherapy cycles with trastuzumab, palliative radiotherapy, history of breast surgery, and the number of metastatic sites were not significant in this respect. Conclusion: These results have demonstrated the effectiveness of lapatinib plus capecitabine in metastatic HER2-positive breast cancer patients. Furthermore, unfavorable prognostic factors for progression-free survival were shown to be hormone-negative tumor, de novo metastatic disease, and young age

Fertility sparing approach to vaginal clear cell adenocarcinoma: a case report

Introduction: Four to nine percent of vaginal adenocarcinomas are clear cell adenocarcinomas. The most frequently used therapeutic approach for Stage I vaginal clear cell carcinoma is partial or total vaginectomy combined with radical hysterectomy and pelvic lymphadenectomy. Radical trachelectomy has also become a preferred treatment modality in recent years especially for patients who wish to retain fertility. Case: A 22-year-old nulligravid women was presented to hospital with the complaint of infertility. Gynecological examination revealed two eccentric masses extending from proximal part of the anterior vaginal wall with a diameter of 0.5 cm and 0.5 cm. Histopathological evaluation resulted as clear cell adenocarcinoma. Positron emission tomography/computed tomography (PET/CT) and abdominopelvic magnetic resonance imaging (MRI) revealed no pathologic lymph node involvement and metastatic lesion. Patient was diagnosed as vaginal clear cell adenocarcinoma, FIGO Stage 1, T1N0M0. The patient was informed about each treatment option and patient was scheduled for radical abdominal trachelectomy and lymph node dissection. Frozen section procedure of bilateral pelvic lymph nodes were consistent with the absence of metastasis. Then a radical abdominal trachelectomy was performed. Definitive pathology revealed clear cell adenocarcinoma of the vagina. no pelvic lymph nodes involvement, and negative surgical margins. Adjuvant treatment was not needed. Patient has been followed up every three months by vaginal and cervical smear for 30 months. Postoperative 30th month control revealed no pathologic findings and patient had been menstruating regulary. Conclusion: Strict treatment guidelines however, cannot be formulated and optimal therapeutic approaches must be individualized; radical trachelectomy is a potential fertility sparing procedure described for early stage clear cell carcinoma

Efficacy and tolerability of vismodegib treatment in locally advanced and metastatic basal cell carcinoma: retrospective real-life data.

The study aims to evaluate the vismodegib treatment in local advanced (laBCC) and metastatic (mBCC) basal cell carcinoma. The data of 29 patients were retrospectively reviewed. The clinical and histopathological features of the patients and adverse events of vismodegib were recorded. Overall survival (OS) and progression-free survival (PFS) were evaluated with Kaplan-Meier analysis. The median follow-up period was 17 months (range: 1.6-57.3), and the median age at diagnosis 73 years (range: 39-88). The most common disease location was head and neck (86.2%), and the most common non-skin sites of disease were lymph nodes (13.8%), bone (13.8%), lung (6.9%), and brain (6.9%). Three (10.3%) patients had Gorlin's syndrome. The number of metastatic patients was 5 (17.2%). With vismodegib treatment, the complete response rate was 27.6%, partial response 55.2%, and stable response 10.3%. Treatment responses were most frequently seen within 2 months from the beginning of vismodegib. The median OS was 43.3 +/- 9.0 months (25.6-61.1) for all patients. The median PFS in the laBCC was 15.7 +/- 1.8 months (12.2-19.3), and 12.1 +/- 4.6 months (2.9-21.2) in the mBCC. In the univariable analysis for the OS, only the treatment after the vismodegib was statistically significant, showing chemotherapy was better comparing to no treatment or surgery. The most common adverse events were fatigue-58.6%, muscle spasms-48.3%, alopecia-13.8%, and weight loss-13.8%. This real-life data study shows that vismodegib treatment in locally advanced and metastatic BCC was well tolerated and effective