Sentinel node mapping in endometrial cancer: Tips and tricks to improve bilateral detection rate. The sentitricks study, a monocentric experience.

Abstract Objective The objective of the study is to show some small tricks for bilateral sentinel lymph node (SLN) uptake in endometrial cancer. Materials and methods Each step of the sentinel lymph node technique was analyzed. The cervix was exposed through the use of vaginal valves and by Martin pliers stapling of the anterior cervical lip. Fifty mg Indocyanine Green (ICG) powder was diluted with 10 ml of physiological solution. The spinal needle was marked at 15 mm with a steri-strip. After 20 min from the administration, in case of no LNS identification, an additional 1 ml in the non-detected side was administered in the superficial cervical area. All cervical injections were made by a single (BR) surgeon experienced in oncological gynecology. Results Fifty patients undergoing sentinel lymph node research for endometrial cancer. The uptake of at least one side of the sentinel node was 98% (49 cases). Forty-six (92%) patients had bilateral lymph node uptake and 3 patients (6%) had unilateral uptake. Only one patient with pelvic and metastatic aortic lymph nodes had no sentinel nodal uptake. Conclusions Little tricks can increase the bilateral uptake of the SLN up to 92%. The reinjection could be a key element for the success of the SLN technique. Experienced surgeons could certainly play a fundamental role in raising bilateral SLN detection. Further prospective randomized studies are needed to achieve the best SLN infiltration strategy

Hemodynamic findings in normotensive women with small for gestational age and growth restricted fetuses

INTRODUCTION: Fetal growth restriction (FGR) in most instances results as a consequence of primary placental dysfunction due to inadequate trophoblastic invasion. Maternal cardiac maladaptation to pregnancy has been proposed as a possible determinant of placental insufficiency and impaired fetal growth. This study aimed to compare the maternal hemodynamic parameters between normotensive women with small-for-gestational age (SGA) and FGR fetuses and to evaluate their correlation with neonatal outcome.MATERIAL AND METHODS: observational cohort study including singleton pregnancies referred to our tertiary care center due to fetal smallness. At the time of diagnosis, fetuses were classified as SGA or FGR according to the Delphi consensus criteria and pregnant women underwent hemodynamic assessment by using cardiac output monitor (USCOM 1A Ltd). A group of women with singleton uncomplicated pregnancies ≥35 weeks of gestation were recruited as controls. Cardiac output, systemic vascular resistance, stroke volume and heart rate were measured and compared among the three groups (controls vs. FGR vs. SGA). The correlation between antenatal findings and neonatal outcome was also evaluated by multivariate logistic regression analysis.RESULTS: 51 women with fetal smallness were assessed at 34.8±2.6 weeks. SGA and FGR were diagnosed in 22 and 29 cases, respectively. The control group included 61 women assessed at 36.5±0.8 weeks of gestation. Women with FGR had a lower cardiac output -Z score (respectively, -1.3±1.2 vs. -0.4±0.8 vs. -0.2±1.0; p<.001) and a higher systemic vascular resistance Z-score compared with both SGA and controls (respectively, 1.2±1.2 vs. 0.2±1.1 vs. -0.02±1.2; p<.001), while no difference in the hemodynamic parameters was found between women with SGA and controls. The incidence of NICU admission did not differ between SGA and FGR fetuses (18.2% vs 41.4%; p=0.13), however FGR had a longer hospitalization compared to SGA fetuses (14.2±17.7 vs. 4.5±1.6 days; p=0.02). Multivariate analysis showed that the cardiac output Z-score at diagnosis (p=0.012) and the birthweight Z-Score (p= 0.007) were independent predictors of the length of neonatal hospitalization.CONCLUSIONS: Different maternal hemodynamic profiles characterize women with SGA or FGR fetuses. Furthermore, a negative correlation was found between the maternal cardiac output and the length of neonatal hospitalization

Confounding factors of transvaginal ultrasound accuracy in endometrial cancer

Endometrial cancer is the most frequently diagnosed gynecological tumour. Transvaginal ultrasound has a leading role in the preoperative evaluation of endometrial cancer patients. The study aimed to identify factors that can worsen the diagnostic accuracy of transvaginal ultrasound in endometrial cancer patients. We retrospectively analysed 290 patients with histological diagnosis of endometrial adenocarcinoma. Two-dimensional (2D) gray-scale ultrasound and power Doppler imaging were performed. Age, menopause status, obesity, parity, Figo stage and benign uterine disorders were evaluated as possible factors worsening the diagnostic accuracy of the ultrasonography. FIGO stage IB was the main significant confounding factor in the univariate analysis (p = .004). Furthermore, 2D transvaginal ultrasound showed worse diagnostic accuracy in endometrial cancer patients with concomitant benign uterine pathologies.Impact statement What is already known on this subject? Many studies have analysed the reliability and diagnostic accuracy of transvaginal ultrasound in predicting myometrial invasion, but few studies have underlined the importance of confounding factors. Shin et al. () showed that diffuse fibromatosis is a quality ultrasound confounding factor. Furthermore, Fischerova et al. () showed that body mass index (BMI) did not influence the diagnostic accuracy of ultrasound assessment. What do the results of this study add? FIGO stage IB is the main factor worsening the diagnostic accuracy of transvaginal ultrasound in endometrial cancer patients (p = .004). Among the 82 patients with histologically proven FIGO stage IB, 27 (32.9%) had a wrong ultrasound prediction of myometrial infiltration. Twenty-one (36.2%) patients in whom there was no agreement between ultrasound prediction of myometrial infiltration and pathological analysis had fibromatosis and/or adenomyosis (p = 0.04). What are the implications of these findings for clinical practice and/or further research? Two-dimensional ultrasound represents a useful tool in the correct pre-operative setting of patients with endometrial cancer. In FIGO stages IB endometrial cancer patients and in conjunction with benign uterine pathologies, 2D transvaginal ultrasound has less diagnostic accuracy. In these cases, MRI still plays a leading role

Medicina di famiglia e assistenza primaria. Al crocevia del cambiamento della società

I moderni ambulatori dei medici di famiglia e i Centri di assistenza primaria stanno affrontando i problemi dell’aumento della globalizzazione e della migrazione. Allo stesso tempo, una cultura della paura sta nuocendo ai principi di solidarietà e giustizia sociale su cui si basano i sistemi sanitari. Gli ambulatori, e in particolare i medici e I professionisti sanitari di domani, hanno bisogno di una nuova visione per il futuro. Dagli anni ‘70, l’Assistenza primaria è diventata la pietra angolare dell’assistenza sanitaria, con una posizione fondamentale nella Medicina di famiglia. Medicina di famiglia e Assistenza primaria analizza questo sviluppo, e lo esamina in prospettiva sullo sfondo della società di oggi e di domani in rapido cambiamento. Basandosi su testimonianze concrete e un’analisi di casi clinici, questo libro fornisce una risposta ai più urgenti quesiti degli attuali medici di famiglia

Primary site disease and recurrence location in ovarian cancer patients undergoing primary debulking surgery vs. interval debulking surgery

Introduction: The natural history and patterns of ovarian cancer (OC) relapse are still unclear. Recurrent disease can be peritoneal, parenchymal, or nodal. This study aims to analyze the location and pattern of OC recurrence according to the primary site of disease and to the type of surgical approach used.Material and methods: All OC patients underwent primary debulking surgery (PDS) or interval debulking surgery (IDS), with 2014 FIGO stage III-IV, and with platinum-sensitive recurrence were included in the study. Primary disease location and site of recurrences were divided into peritoneal, parenchymal, and nodal, according to the presence of peritoneal carcinomatosis, parenchymal metastasis, and nodal involvement, respectively.Results: A total of 355 patients were initially considered; of them, 295 met the inclusion criteria. Two hundred thirty-three patients obtained no macroscopic residual tumor at the end of primary surgical treatment. Primary parenchymal disease relapsed in 84.6% cases at a parenchymal site (p < 0.001), 97.2% of peritoneal diseases relapsed on the peritoneum (p < 0.001), and 100% of nodal diseases had a nodal recurrence (p < 0.001). Stratifying by the surgical approach all these correlations have been confirmed both in the PDS (p < 0.001) and IDS (p < 0.001) groups.Conclusion: Our study shows that the site of relapse in cases of platinum-sensitive OC recurrence is closely related to the primary location of the disease, regardless of the type of initial treatment. Therefore, more attention during followup should be paid to areas where the initial tumor was present. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved

Primary site disease and recurrence location in ovarian cancer patients undergoing primary debulking surgery vs. interval debulking surgery

Introduction: The natural history and patterns of ovarian cancer (OC) relapse are still unclear. Recurrent disease can be peritoneal, parenchymal, or nodal. This study aims to analyze the location and pattern of OC recurrence according to the primary site of disease and to the type of surgical approach used. Material and methods: All OC patients underwent primary debulking surgery (PDS) or interval debulking surgery (IDS), with 2014 FIGO stage III-IV, and with platinum-sensitive recurrence were included in the study. Primary disease location and site of recurrences were divided into peritoneal, parenchymal, and nodal, according to the presence of peritoneal carcinomatosis, parenchymal metastasis, and nodal involvement, respectively. Results: A total of 355 patients were initially considered; of them, 295 met the inclusion criteria. Two hundred thirty-three patients obtained no macroscopic residual tumor at the end of primary surgical treatment. Primary parenchymal disease relapsed in 84.6% cases at a parenchymal site (p < 0.001), 97.2% of peritoneal diseases relapsed on the peritoneum (p < 0.001), and 100% of nodal diseases had a nodal recurrence (p < 0.001). Stratifying by the surgical approach all these correlations have been confirmed both in the PDS (p < 0.001) and IDS (p < 0.001) groups. Conclusion: Our study shows that the site of relapse in cases of platinum-sensitive OC recurrence is closely related to the primary location of the disease, regardless of the type of initial treatment. Therefore, more attention during followup should be paid to areas where the initial tumor was present

Oncologic outcomes of conservative treatment of atypical polypoid adenomyoma of the uterus: A two-center experience

Objective Atypical polypoid adenomyoma (APA) is a rare uterine premalignant lesion mainly occurring in premenopausal and nulliparous women. Although hysteroscopic resection (HR) has showed promising results, the conservative management of APA in young women is not standardized, and few data are available in the literature. We aimed to assess oncologic outcomes of the conservative treatment of APA. Methods A multicenter observational retrospective cohort study was performed including all patients with APA who underwent conservative treatment from January 2006 to June 2020. Rates of each oncologic outcome (i.e. initial complete response, persistence, progression to cancer, recurrence, long-term treatment success, and treatment failure) were calculated for all conservative treatment together and separately. Results Twenty-five patients were included. Conservative treatments consisted of HR alone (n = 14) and HR + progestin (n = 11). Overall, 24 (96%) patients showed initial complete response, of which 21 (84%) showed long-term treatment success; four (16%) patients had progression to cancer, of which two (8%) first recurred as APA. Long-term treatment success was achieved in 13 of 14 (92.9%) patients with HR alone and 8 of 11 (72.3%) with HR + progestin. Conclusion Conservative treatment appears to be a safe option in women with APA. The four-steps HR might be considered as the first-line conservative approach, while the addition of progestin does not seem to improve oncologic outcomes. However, the risk of progression to cancer highlights the need for a close and long-term follow up with ultrasonography and hysteroscopic biopsies, and for hysterectomy in patients not desiring pregnancy

Le culture del neoliberismo. Retoriche pubbliche e nuove forme della soggettività

Il fascicolo 59/2020 della rivista semestrale «Sociologia della comunicazione» è dedicato alle culture del neoliberismo, in quanto forma del capitalismo attuale, che si articolano tra retoriche pubbliche e nuove forme della soggettività, in orientamenti di valore e concezioni della società e dell’individuo che si traducono in discorsi, pratiche e dispositivi, in modi di sentire, di pensare e di agire nel quotidiano e nei contesti istituzionali, di cui gli attori non sono necessariamente consapevoli. Diversi studiosi convergono nel riconoscere alcuni tratti comuni delle culture del neoliberismo che abitano e dominano trasversalmente i molteplici settori della società e le forme dell’esistenza quotidiana – l’economia, il lavoro, la cittadinanza e la partecipazione, i consumi, il genere, le emozioni e la vita intima, solo per citarne alcuni. La competizione diventa norma di comportamento generalizzata, uscendo dai confini dell’economico, e l’individuo viene esortato a governare se stesso come un’impresa – cui espressioni quali capitale umano e capitale emotivo rimandano, e come hanno messo in evidenza studiose della sociologia delle emozioni americane quali Illouz (2007) e Hochshild (2015). Si assiste contestualmente alla privatizzazione e depoliticizzazione di istanze di rilevanza collettiva e pubblica che collassano nella sfera individuale e domestica (come indagato ad es. in Zappino 2016) e alla contrattualizzazione dei rapporti sociali

Le culture del neoliberismo. Retoriche pubbliche e nuove forme della soggettività

Il fascicolo 59/2020 della rivista semestrale «Sociologia della comunicazione» è dedicato alle culture del neoliberismo, in quanto forma del capitalismo attuale, che si articolano tra retoriche pubbliche e nuove forme della soggettività, in orientamenti di valore e concezioni della società e dell’individuo che si traducono in discorsi, pratiche e dispositivi, in modi di sentire, di pensare e di agire nel quotidiano e nei contesti istituzionali, di cui gli attori non sono necessariamente consapevoli. Diversi studiosi convergono nel riconoscere alcuni tratti comuni delle culture del neoliberismo che abitano e dominano trasversalmente i molteplici settori della società e le forme dell’esistenza quotidiana – l’economia, il lavoro, la cittadinanza e la partecipazione, i consumi, il genere, le emozioni e la vita intima, solo per citarne alcuni. La competizione diventa norma di comportamento generalizzata, uscendo dai confini dell’economico, e l’individuo viene esortato a governare se stesso come un’impresa – cui espressioni quali capitale umano e capitale emotivo rimandano, e come hanno messo in evidenza studiose della sociologia delle emozioni americane quali Illouz (2007) e Hochshild (2015). Si assiste contestualmente alla privatizzazione e depoliticizzazione di istanze di rilevanza collettiva e pubblica che collassano nella sfera individuale e domestica (come indagato ad es. in Zappino 2016) e alla contrattualizzazione dei rapporti sociali