RESUMEN
Presentation of uterine prolapse is a rare event in a pregnant woman, which can be pre-existent or else manifest in the course of pregnancy. Complications resulting from prolapse of the uterus in pregnancy vary from minor cervical infection to spontaneous abortion, and include preterm labor and maternal and fetal mortality as well as acute urinary retention and urinary tract infection. Moreover, affected women may be at particular risk of dystocia during labor that could necessitate emergency intervention for delivery. Recommendations regarding the management of this infrequent but potentially harmful condition are scarce and outdated. This review will examine the causative factors of uterine prolapse and the antepartum, intrapartum and puerperal complications that may arise from this condition as well as therapeutic options available to the obstetrician. While early recognition and appropriate prenatal management of uterine prolapse during pregnancy is imperative, implementation of conservative treatment modalities throughout pregnancy, these applied in accordance with the severity of the uterus prolapse and the patient's preference, may be sufficient to achieve uneventful pregnancy and normal, spontaneous delivery.
Asunto(s)
Complicaciones del Embarazo , Prolapso Uterino , Femenino , Humanos , Complicaciones del Trabajo de Parto/etiología , Embarazo , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/fisiopatología , Complicaciones del Embarazo/terapia , Trastornos Puerperales/etiología , Factores de Riesgo , Prolapso Uterino/etiología , Prolapso Uterino/fisiopatología , Prolapso Uterino/terapiaRESUMEN
The approval of the first specific drug catumaxomab for the treatment of malignant ascites is the subject of this review. This trifunctional antibody is known to kill EpCAM-positive tumor cells and therefore attacks the primary cause of malignant ascites formation in the peritoneal cavity. Until today catumaxomab is the only EpCam-targeted antibody approved by the European Medicines Agency. Ovarian cancer is caused by epithelial tumors cells which overexpress epithelial cell adhesion molecule (EpCAM). The existing literature concerning the use of catumaxomab for the treatment of malignant ascites associated with ovarian cancer until today is reported in this article. It is very encouraging that different prospective studies from diverse scientific teams recently presented positive results concerning the efficacy and the safety of catumaxomab in the treatment of malignant ascites in patients with ovarian cancer. A case of a patient with ovarian cancer FIGO IIIc is also referred in this article. A complete remission and stable disease was found after 4 i.p. infusions of catumaxomab.
Asunto(s)
Anticuerpos Biespecíficos/uso terapéutico , Ascitis/tratamiento farmacológico , Carcinoma/tratamiento farmacológico , Neoplasias Ováricas/tratamiento farmacológico , Ascitis/etiología , Carcinoma/complicaciones , Femenino , Humanos , Infusiones Parenterales , Neoplasias Ováricas/complicacionesRESUMEN
Endometrial cancer (EC) is the most commonly diagnosed gynecologic malignancy. Although early-stage EC is effectively treated surgically, commonly without adjuvant therapy, the treatment of high-risk and advanced disease is more complex. Chemotherapy has evolved into an important modality in high-risk early-stage and advanced-stage disease, and in recurrent EC. Multi-institutional trials are in progress to better define optimal adjuvant treatment for subsets of patients, as well as the role of surgical staging in reducing both overuse and underuse of radiation therapy. Understanding and identifying the molecular biology and genetics of EC are central to the development of novel therapies. A number of molecular and genetic events have been observed in ECs, which have enabled us to have a better understanding of the biology and development of the disease. For example, the PTEN/AKT pathway and its downstream targets and the mTOR pathway have been shown to play an important role in EC pathogenesis. This review summarizes the background of the known molecular alterations, and the management of patients with EC.
Asunto(s)
Neoplasias Endometriales/genética , Neoplasias Endometriales/terapia , Quimioterapia Adyuvante , Fosfatidilinositol 3-Quinasa Clase I , Terapia Combinada , Neoplasias Endometriales/tratamiento farmacológico , Neoplasias Endometriales/patología , Endometrio/fisiología , Femenino , Fertilidad , Humanos , Fosfohidrolasa PTEN/genética , Fosfatidilinositol 3-Quinasas/genética , Cuidados Posoperatorios , Receptor ErbB-2/genéticaRESUMEN
AIM: The aim of this study was to evaluate the outcome of pregnancies in adolescents in the Department of Obstetrics and Gynaecology of Democritus University of Thrace, North-Eastern Greece. MATERIAL AND METHODS: We retrospectively reviewed 194 cases of adolescent pregnancies, with an average maternal age of 16.5 years, from 1st January 2006 to December 30th 2008. Socioeconomic characteristics, type of delivery and complications, such as preterm labor, preeclampsia, intra- and post-partum complications, were evaluated. RESULTS: The median age at first intercourse was 14.2 years and the average period between first intercourse and pregnancy was 1.2 years. Most teen mothers (86.6%) did not use any contraceptive method. Among the teen mothers recruited for the study, 89.7% were married. Adolescent pregnancies accounted for 9.02% of all deliveries (2150) in our Department. In 49 (25.3%) of the pregnant adolescents, no previous pregnancy was reported. The rates of preterm birth of teen mothers were 11.3%, 41.3% and 47.4% in correlation to <32 weeks, 32-34 weeks and >34 weeks, respectively. In 95.4% of the cases, deliveries were not complicated. According to our results, the main complications, especially in very young girls, are preterm labor, anaemia, hypertensive disease, obstructed labor after premature rupture of the membranes and increased neonatal mortality and morbidity. Antenatal care is often inadequate. CONCLUSION: Early teenage pregnancies have always been considered of increased risk for obstetric complications. Prevention of adolescent pregnancy, by wide use of effective contraception programs, would decrease its frequency and intensive care of pregnant adolescents may reduce the pregnancy complications.
Asunto(s)
Resultado del Embarazo/epidemiología , Embarazo en Adolescencia/estadística & datos numéricos , Adolescente , Distribución por Edad , Parto Obstétrico/métodos , Parto Obstétrico/estadística & datos numéricos , Femenino , Grecia/epidemiología , Humanos , Mortalidad Infantil , Recién Nacido , Edad Materna , Complicaciones del Trabajo de Parto/epidemiología , Complicaciones del Trabajo de Parto/mortalidad , Selección de Paciente , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/mortalidad , Estudios RetrospectivosRESUMEN
OBJECTIVE: The aim of this comparative study was to ascertain the efficacy of the Sulmycin® Implant E, an antiseptic sponge, on the incidence of peri- and postoperative morbidity in patients subjected to vaginal hysterectomy. MATERIAL AND METHODS: This eleven-year study included 228 patients undergoing vaginal hysterectomy. The patients were divided into two groups. Group A included 169 participants with benign diseases (fibroids, dysfunctional uterine bleeding and prolapse) and group B included 59 patients with early stage endometrial cancer or atypical hyperplasia. Women of both groups were further divided into three subgroups: (a) receiving a single dose of intravenous cefuroxime (2 gr) (group A: 55, group B: 19), (b) receiving three doses of intravenous cefuroxime (2 gr) (group A: 54, group B: 19), and (c) locally placed a collagen sponge containing gentamycin (Sulmycin® Implant E) (group A: 60, group B: 21). RESULTS: The number of postoperative infections (mainly urinary tract infections) did not differ between women of the three subgroups of patients in both groups. There were no important differences affecting the postoperative hospitalization, healing procedure and adhesion of the cuff between women of the three subgroups in both groups. CONCLUSION: The local chemoprophylaxis with Sulmycin® Implant E, a collagen sponge containing gentamycin and placed on the vaginal cuff, is well tolerated and equally effective as intravenous antibiotics.
Asunto(s)
Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Cefuroxima/uso terapéutico , Colágeno/administración & dosificación , Gentamicinas/administración & dosificación , Histerectomía Vaginal/métodos , Adulto , Anciano , Antibacterianos/administración & dosificación , Cefuroxima/administración & dosificación , Femenino , Humanos , Infusiones Intravenosas , Persona de Mediana Edad , Estudios Retrospectivos , Estadísticas no Paramétricas , Adulto JovenRESUMEN
AIM: The aim of this study was to investigate the impact of radical lymphadenectomy as a prognostic factor in the management of uterine sarcomas. METHODS: Sixty patients with histologically-proven uterine sarcomas were recruited for this study. The patients were evaluated retrospectively, during the time period from September 1990 to June 2008, in the Department of Obstetrics and Gynecology of Aschaffenburg Clinic in Germany. The normality of the quantitative variables was tested using the Kolmogorov-Smirnov test. RESULTS: Of 60 patients, 35 (58.3%) underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic or para-aortic lymphadenectomy. The excision of iliac nodes was the strongest and most independent factor (ß = 0.64, P = 0.000) associated with survival. Recurrence of disease developed in 14 out of 25 patients (56%) who did not receive lymphadenectomy, but in only 10 out of 35 patients (29%) who underwent lymphadenectomy. The mean survival in years after surgery plus lymphadenectomy was 5.28 years, while in patients who did not undergo lymphadenectomy it was 1.56 years. CONCLUSIONS: Removal of lymphatic tissue in patients with early-stage uterine sarcoma significantly decreases the recurrence rate of the disease and improves the postoperative survival. However, there is a need for further prospective randomized controlled trials to investigate the adequate surgical management of uterine sarcomas and to clarify the prognostic value of lymphadenectomy at the initial surgery.
Asunto(s)
Escisión del Ganglio Linfático , Ganglios Linfáticos/cirugía , Recurrencia Local de Neoplasia/prevención & control , Sarcoma/cirugía , Neoplasias Uterinas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Histerectomía , Ganglios Linfáticos/patología , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Sarcoma/mortalidad , Sarcoma/patología , Tasa de Supervivencia , Resultado del Tratamiento , Neoplasias Uterinas/mortalidad , Neoplasias Uterinas/patologíaRESUMEN
BACKGROUND: Endometrial carcinoma is the most distressing cause of abnormal vaginal bleeding. The intention of clinical management in the case of postmenopausal bleeding is to achieve an accurate diagnosis without overinvestigation. METHOD: We studied the available literature on the diagnostic evaluation of postmenopausal women with vaginal bleeding, accentuating the most important aspects on this topic: the accuracy of sonography and endometrial biopsy in predicting endometrial hyperplasia and endometrial carcinoma. RESULTS: The accuracy of the above tests in predicting endometrial hyperplasia and endometrial carcinoma is a subject of continuing debate. Μοreover, in the last decades, there has been an explosion of publications indicating that ultrasound may be useful in predicting endometrial pathology. CONCLUSION: Since advanced endometrial carcinoma has been known to occur in cases without noticeable endometrial thickness on ultrasound, the clinician should beware of the diagnostic evaluation of postmenopausal women with vaginal bleeding.
Asunto(s)
Biopsia con Aguja , Hiperplasia Endometrial/diagnóstico , Neoplasias Endometriales/diagnóstico , Endometrio/patología , Posmenopausia , Hemorragia Uterina/etiología , Hiperplasia Endometrial/complicaciones , Hiperplasia Endometrial/diagnóstico por imagen , Neoplasias Endometriales/complicaciones , Neoplasias Endometriales/diagnóstico por imagen , Femenino , Humanos , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
Arthrogryposis Multiplex Congenital (AMC) is a group of muscular, neurologic and connective tissue disorders, characterized by multiple severe joint contractures and decreased mobility. The incidence of this condition is 1/3000 births while the etiology is variable. Prenatal assessment of arthrogryposis has focused primarily on diminished fetal movement and the presence of joint contractures or skeletal deformities. These findings may not become evident until after 16-18 weeks' gestational age, subsequently, early prenatal diagnosis is difficult. Nowadays, modern ultrasound techniques and special sonographic markers help the clinicians with the prenatal detection of arthrogryposis in every gestational trimester.
Asunto(s)
Artrogriposis/diagnóstico por imagen , Femenino , Humanos , Embarazo , Ultrasonografía PrenatalRESUMEN
Uterine sarcomas are rare and aggressive gynaecologic malignancies with poor prognosis, arising from myometrial or endometrial tissue. These rare cancers can be aggressive, and account for a greatly disproportionate amount of deaths from uterine cancers. The histological uterine sarcomas classification includes carcinosarcomas (malignant mesodermal mixed tumors), accounting for 40% of cases, leiomyosarcomas (40%) and endometrial stromal sarcomas (10-15%). Each group of these tumors presents differences in diagnosis, prognostic factors, treatment, and outcome. Uterine leiomyosarcomas typically affects women in their sixth decade of life, presenting with atypical symptoms such as abnormal uterine bleeding and abdominal pain. The optimal treatment of uterine leiomyosarcomas is surgery, including total abdominal hysterectomy and bilateral salpingooophorectomy. The aim of this study was to conduct a systematic review of the literature regarding the standard surgical procedure of uterine leiomyosarcomas and investigate whether lymphadenectomy affects the 5-year DSS, as well as other relevant clinical outcomes, in women with uterine leiomyosarcomas. For this purpose, MEDLINE, EMBASE, and the Cochrane Library databases were reviewed, and a critical account of the management strategies of these tumors is presented.
Asunto(s)
Carcinosarcoma/cirugía , Leiomiosarcoma/cirugía , Escisión del Ganglio Linfático , Neoplasias Uterinas/cirugía , Carcinosarcoma/patología , Femenino , Humanos , Histerectomía , Leiomiosarcoma/patología , Estadificación de Neoplasias , Análisis de Supervivencia , Neoplasias Uterinas/patologíaRESUMEN
PURPOSE: To investigate the effect of age and smoking on the AMH levels in normal cycling healthy women with normal reproductive history. MATERIALS AND METHODS: In 137 women, blood samples were taken on day 3 of a spontaneous cycle. Serum FSH, LH, E2, progesterone and AMH were measured in all blood samples. For the statistical analysis of the data, t test, Pearson's correlation and linear regression analysis were performed. RESULTS: Of 137 women (43%), 59 were smokers. Age was positively correlated with serum FSH and LH levels (r = 0.584, P < 0.001 and r = 0.330, P < 0.001, respectively) and negatively correlated with serum AMH levels (r = -0.882, P < 0.001). There were no significant differences in FSH, LH, E2, progesterone and AMH levels between smokers and non-smokers. Multiple stepwise linear regression analysis showed that in both smokers and non-smokers, age was the most significant determinant of AMH levels (r = -0.889, P < 0.001 and r = -0.944, P < 0.001, respectively), while smoking was not related to AMH levels. CONCLUSIONS: Aging significantly decreases AMH levels in women with normal cycles and normal reproductive history, while smoking does not seem to have significant effects on AMH levels.