Biotransformation enzymes and oxidative stress in preeclampsia

Contains fulltext : mmubn000001_35186282x.pdf (publisher's version ) (Open Access)190 p

Labor dystocia as First presentation of pelvic malignancy.

Contains fulltext : 98567.pdf (publisher's version ) (Open Access)2 p

Selective follicular reduction: what to do with the oocytes?

Contains fulltext : 25297___.PDF (publisher's version ) (Open Access

Para-aortic lymphadenectomy in advanced stage cervical cancer, a protocol for comparing safety, feasibility and diagnostic accuracy of surgical staging versus PET-CT; PALDISC trial

Contains fulltext : 190733.pdf (publisher's version ) (Open Access)Background: Currently, a PET-CT is used to assess the need for extended field radiotherapy of para-aortic lymph nodes (PALN) in International Federation of Gynaecology and Obstetrics (FIGO) stage IB2, IIA2-IVA (locally advanced stage) cervical cancer. A small study established a sensitivity and specificity estimate for PALN metastases of 50% (95% CI; 7-93%) and 83% (95% CI; 52-98%), respectively. Surgical staging of PALN may lead to a higher diagnostic accuracy. However, surgical staging of para-aortic lymph nodes in locally advanced stage cervical cancer is not common practice. Therefore, a phase 2 randomised controlled trial is needed to assess its safety and feasibility. Methods/design: In addition to standard imaging (MRI or CT scan) with PET-CT, 30 adult women with FIGO stage IB2, IIA2-IVA cervical cancer will be randomised to receive either surgical staging or usual PET-CT staging. Administering extended field radiotherapy will be based on lymphadenectomy results for the intervention group and on the PET-CT results for the control group. Follow-up visits at 0, 3, 6, 9 and 12 months will assess health-related quality of life and progression-free survival.Primary safety and feasibility outcomes of surgical staging will be assessed by calculating means with 95% confidence intervals for duration of surgery, number of complications, blood loss, nodal yield after para-aortic lymphadenectomy and treatment delay due to surgical staging. Secondary patient-centred outcomes on quality of life and first year survival will be documented and compared between the two groups. Estimates of sensitivity, specificity and negative and positive predictive values of MRI, PET-CT and surgical staging will be presented with 95% CI.. All analysis will be performed according to the intention to treat principle. Discussion: This study will assess safety and feasibility, expressed as the number and severity of complications, effect on quality of life and the treatment delay due to surgically staging para-aortic lymph nodes in locally advanced cervical cancer. It will provide insight in the diagnostic accuracy of the PET-CT and detection rate of missed (micro)metastases due to surgical staging. This information will be used to assess the necessity for a phase 3 study on the diagnostic accuracy of the PET-CT and surgical staging. If a phase 3 study is deemed necessary, current data can be used for sample size calculation of such a phase 3 study. Trial registration: Nederlands Trial Register/Dutch Trial Registry (www.trialregister.nl), NTR4922. Registered on 24 November 2014

Pretreatment Retroperitoneal Para-aortic Lymph Node Staging in Advanced Cervical Cancer: A Review

Item does not contain fulltextOBJECTIVE: The aims of this study were to evaluate the safety and impact of pretreatment surgical para-aortic lymph node staging (PALNS) in advanced cervical cancer (International Federation of Gynecology and Obstetrics stage IB2-IVA) and to evaluate the preoperative imaging of PALNs. METHODS: We searched in PubMed and the Cochrane Library to identify data investigating the role of surgical PALNS. Selection criteria included English-language and advanced-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IB2-IVA) articles. RESULTS: Twenty-two articles were included. Para-aortic lymph node metastases were present in 18% (range, 8%-42%) of all patients with cervical cancer stage IB to IVA. The proportions of positive para-aortic nodes on histological analysis with suspicious para-aortic nodes on imaging (positive predictive value) were 20% to 66%, 0% to 27%, 86% to 100%, and 50% to 75% for computed tomographic (CT) scan, magnetic resonance imaging (MRI) scan, positron emission tomography (PET), and PET-CT, respectively. The negative predictive values of the imaging techniques were 53% to 92% for CT scan, 75% to 91% for MRI, 87% to 94% for PET, and 83% to 92% for PET-CT. The proportions of histologically proven PALN metastasis with normal findings on imaging were 9% to 35% for CT scan and MRI, 4% to 11% for PET, and 6% to 15% for PET-CT. The mean complication rate of PALNS is 9%, with a range of 4% to 24%, with lymphocysts being the most common complication. CONCLUSIONS: Pretreatment surgical PALN dissection or sampling is feasible, with low complication rates and short delay in starting treatment. Pretreatment PET or PET-CT is the most accurate imaging method in detecting PALN metastases but has limitations detecting microscopic tumor volumes. Even with normal findings on PET-CT, PALN metastases are present in 4% to 15% of patients. Positive PALNs in stage IB2 to IVA cervical cancer will lead to modification of treatment and may lead to better overall and disease-free survival

De perinatale begeleiding van de meerlingzwangerschap

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Optimizing the treatment algorithm for sentinel lymph node mapping in endometrial cancer

Contains fulltext : 220457.pdf (Publisher’s version ) (Open Access)The incidence of endometrial cancer, the most common gynecological malignancy, is increasing as life expectancy and obesity both rise. Lymph node status is the most important predictor for outcome, yet routine lymphadenectomy does not confer a survival benefit and is associated with substantial surgical morbidity. In the last decade, sentinel lymph node (SLN) mapping has emerged as a feasible and accurate alternative to full lymphadenectomy. Yet, SLN has introduced a distinction between micro- and macrometastasis, and the entity of non-SLN involvement with their attendant impact on outcome. Included among the raised issues is the question of whether positive sentinel nodes should be followed by pelvic and/or para-aortic lymphadenectomy dependent on the presence of macrometastasis at frozen section or other criteria. Moreover, the proper adjuvant treatment for individual cases with micrometastasis and/or isolated tumor cells is unclear. Recently published data on this topic are summarized in order to optimize the current treatment algorithm as it relates to the results of SLN assessment in endometrial cancer