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The contaminant mass discharge is a relevant metric to evaluate the risk that a groundwater plume poses to water resources. However, this assessment is often vitiated by a high uncertainty inherent to the assessment method and often limited number of measurement points to carry out the assessment. Direct-Push techniques in combination with profiling tools and dedicated sampling can be an interesting alternative to increase the measurement point density and hence reduce the mass discharge uncertainty. The main objective of our study was to assess if DP logging and sampling could be employed to get a reasonable estimate of contaminant mass discharge in a large sulfonamide contaminant plume (> 1500 m wide), compared to a more traditional approach based on monitoring wells. To do so, an Hydraulic Profiling Tool (HPT) logging with a dedicated site calibration was used to estimate the hydraulic conductivity field. The sulfonamide concentrations were inferred from the compound fluorescence properties measured by laboratory spectrofluorometry (λEx / λEm = 255/340 nm) and a dedicated log-log linear regression model. Our results show that HPT-derived hydraulic conductivity values are in good agreement with the monitoring well results, and within the order of magnitude reported in similar studies or indirect geophysical techniques. Fluorescence appears as a powerful proxy for the sulfonamide concentration levels. Ultimately, the contaminant mass discharge estimate from HPT and fluorescence techniques lies within a factor 2 from the estimate by monitoring wells, with 549 [274-668] and 776 [695-879] kg/yr respectively. Overall, this study highlights that DP logging tools combined with indirect methods (correlation with fluorescence) could provide a relevant contaminant mass discharge estimate for some optically active substances, given that a proper calibration phase is carried out.
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OBJECTIVE: To present and evaluate an unselected national single center strategy with fertility preserving trachelectomy in cervical cancer. In 2003 nationwide single-center referral of women for trachelectomies was agreed upon between all Danish departments performing cervical cancer surgery with the purpose of increasing volume, to increase surgical safety and facilitate follow-up. METHODS: Prospective data were recorded in the Danish Gynecological Cancer Database of all Vaginal Radical Trachelectomies (VRT) performed in Denmark between 2002 and 2013. Oncologic, fertility and obstetrical outcomes of 120 unselected consecutive VRTs were assessed. To obtain complete follow-up about fertility treatment, pregnancy and obstetric outcome the women filled out an electronic questionnaire. Median follow-up: 55.7 months. RESULTS: 85.8% of the patients had stage IB1 disease, 68.3% squamous cell carcinomas, 30.0% adenocarcinomas and 1.7% adenosquamous carcinomas. Six recurrences (5.1%) and 2 deaths (1.7%) occurred. Four women with adenocarcinomas (10.5%) had recurrences, compared to two women with squamous cell carcinomas (2.5%). Seventy-two women (60.0%) desired to conceive and 55 women obtained a total of 77 pregnancies. Of the 72 women 40 were referred to fertility treatment. First and second trimester miscarriage rates were 21.6% and 2.7%, respectively. A total of 53 children were born of which 41 were delivered after gestational week 34. CONCLUSION: This unselected national single center referral study confirms the oncological safety of Vaginal Radical Trachelectomy. The complete follow-up regarding reproductive data, reveals a surprisingly extensive need of fertility treatment and due to the rate of prematurity, these pregnancies must be regarded as high-risk pregnancies.
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Resultado del Embarazo , Neoplasias del Cuello Uterino/cirugía , Adulto , Dinamarca/epidemiología , Femenino , Preservación de la Fertilidad/métodos , Preservación de la Fertilidad/estadística & datos numéricos , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Procedimientos Quirúrgicos Ginecológicos/métodos , Procedimientos Quirúrgicos Ginecológicos/estadística & datos numéricos , Humanos , Embarazo , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/patología , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this study was to develop a global- and a procedure-specific rating scale based on a well-validated generic model (objective structured assessment of technical skills) for assessment of technical skills in laparoscopic gynaecology. Furthermore, we aimed to investigate the construct validity and the interrater agreement (IRA) of the rating scale. We investigated both the gamma coefficient (Kendall's rank correlation), which is a measure of the strength of dependence between observations, and the kappa value for each of the ten individual items included in the rating scale. DESIGN: Prospective cohort, observer-blinded study. SETTING: Departments of Obstetrics and Gynaecology in Zealand, Denmark. POPULATION: Twenty one gynaecologists or gynaecological trainees. MATERIAL AND METHODS: Twenty-one video recordings of right side laparoscopic salpingectomies were collected prospectively, eight from novices (defined as <10 procedures), seven from intermediate experienced (20-50 procedures) and six from experts (> 200 procedures). All operations were performed by the same operative principles and using a standardised technique. The recordings were analysed by two independent, blinded observers. MAIN OUTCOME MEASURES: Construct validity of the rating scale based on operative performance (median of total score) and interrater reliability. RESULTS: There were significant differences between the three groups: median score of novices 24.00 versus intermediate 29.50 versus expert 39.50, P < 0.003) The IRA was 0.83 overall. The gamma correlation coefficient was 0.91. The kappa values varied from 0.510-0.933 for each of the individual items of the rating scale. CONCLUSIONS: The procedure-specific rating scale for laparoscopic salpingectomy is a valid and reliable tool for assessment of technical skills in gynaecological laparoscopy.
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Procedimientos Quirúrgicos Ginecológicos/normas , Ginecología/normas , Laparoscopía/normas , Competencia Clínica/normas , Femenino , Humanos , Estudios Prospectivos , Método Simple Ciego , Grabación en VideoRESUMEN
Autotransplantation of frozen/thawed ovarian tissue in women undergoing cancer therapy has so far led to the birth of two healthy babies. In both cases, it can be discussed whether the fertilized oocyte originated from the transplant or from the native ovary. We now present a biochemical pregnancy achieved after heterotopical autotransplantation of cryopreserved ovarian cortical tissue and hence the unquestionable proof that pregnancy can occur after transplantation of cryopreserved ovarian tissue. A woman diagnosed with Hodgkin's lymphoma had ovarian tissue cryopreserved at the age of 28, before receiving chemotherapy and radiation therapy that rendered her amenorrhoeic. After complete remission, she had autotransplantation of ovarian tissue to the remaining ovary, to the right pelvic wall and to a midline subperitoneal pocket on the lower abdominal wall. The transplanted tissue resumed hormone secretion and follicles developed in all three locations. Three times during 8 months, when follicles could not be visualized in other locations, oocytes were aspirated from the subperitoneal autotransplanted tissue on the lower abdominal wall. Twice, an oocyte was retrieved, fertilized by intracytoplasmatic sperm injection (ICSI) and transferred to the woman's uterus. One of the treatments resulted in a positive pregnancy test 14 days after transfer. Clinical pregnancy, however, was not achieved. In conclusion, heterotopic autotransplantation of cryopreserved ovarian tissue can sustain follicle development. The oocytes of aspirated mature follicles are capable of fertilization after ICSI, and the resulting embryo is competent of producing hCG at detectable levels.
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Criopreservación , Oocitos/fisiología , Ovario/trasplante , Adulto , Femenino , Enfermedad de Hodgkin/tratamiento farmacológico , Humanos , Ovario/fisiología , Embarazo , Insuficiencia Ovárica Primaria/inducido químicamente , Insuficiencia Ovárica Primaria/cirugía , Inyecciones de Esperma Intracitoplasmáticas , Trasplante Autólogo , Resultado del TratamientoRESUMEN
A management program for FIGO stage I-II nonserous, nonclear-cell adenocarcinomas was evaluated. Histopathology and DNA ploidy were used to estimate postoperatively the risk of progression or death of disease and to tailor treatment. The patient material was a population-based consecutive cohort of all women with endometrial cancer in the Southern Swedish Health Care Region diagnosed between June 1993 and June 1996 (n = 553). Of these, 335 were eligible for the management program. Patients estimated to be at low risk were treated by surgery only, while high-risk patients also received vaginal brachytherapy. A large low-risk group consisting of 84% (n = 283) of the patients with an estimated disease-specific 5-year survival of 96% (95% CI = 93-98%) was identified. The high-risk group (n = 52, 16%) showed a worse outcome with an 80% 5-year disease-specific survival (95% CI = 65-89%). The difference in survival between the groups was highly significant (P < 0.0001). Half of the progressions were distant in the high-risk group. Although there is a clear indication for adjuvant therapy for this group, locoregional radiotherapy could be expected to fail in cases with distant progression. Thus, effective systemic treatments need to be developed. Low-risk patients, constituting the majority (84%) of the patients, can be safely treated by surgery only.
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Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/cirugía , Neoplasias Endometriales/tratamiento farmacológico , Neoplasias Endometriales/cirugía , Adenocarcinoma/genética , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Neoplasias Endometriales/genética , Neoplasias Endometriales/mortalidad , Neoplasias Endometriales/patología , Neoplasias Endometriales/radioterapia , Femenino , Humanos , Persona de Mediana Edad , Metástasis de la Neoplasia , Estadificación de Neoplasias , Ploidias , Estudios Prospectivos , Radioterapia Adyuvante , Sistema de Registros , Factores de Riesgo , Análisis de Supervivencia , Suecia/epidemiologíaRESUMEN
OBJECTIVE: To detect differences in clinical short term outcome between total abdominal hysterectomy, vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy. DESIGN: Randomised controlled trial. SETTING: Department of Obstetrics and Gynaecology, Hospital of Helsingborg, Sweden. SAMPLE: One hundred-twenty women scheduled for hysterectomy for various indications. METHODS: Randomisation into three treatment arms: total abdominal hysterectomy (n = 40); vaginal hysterectomy (n = 40) and laparoscopic assisted vaginal hysterectomy (n = 40). During traditional abdominal and vaginal surgery, laparoscopic assistance was kept to a minimum. Substantial number of cases needed volume-reducing manoeuvres due to uterine size. MAIN OUTCOME MEASURES: Duration of surgery, anaesthesia, time in hospital and recovery time. RESULTS: Mean duration (range) of surgery was significantly longer for laparoscopic assisted vaginal hysterectomy compared with vaginal hysterectomy and total abdominal hysterectomy, 102 min (50-175), 81 min (35-135) and 68 min (28-125), respectively. Mean stay in hospital and mean time to recovery was significantly longer for total abdominal hysterectomy compared with vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy. The difference between vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy was not significant. It was possible to remove uteri under 600 g with all three methods. Four laparoscopic assisted vaginal hysterectomies and one vaginal hysterectomy were converted to open surgery. Reoperation and blood transfusion were required after two vaginal hysterectomies and one laparoscopic assisted vaginal hysterectomy. One woman needed blood transfusion after total abdominal hysterectomy. CONCLUSIONS: Traditional vaginal hysterectomy proved to be feasible and the faster operative technique compared with vaginal hysterectomy with laparoscopic assistance. The abdominal technique was somewhat faster, but time spent in theatre was not significantly shorter. Abdominal hysterectomy required on average a longer hospital stay of one day and one additional week of convalescence compared with traditional vaginal hysterectomy. Vaginal hysterectomy should be a primary method for uterine removal.
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Enfermedades de los Genitales Femeninos/cirugía , Histerectomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Enfermedades de los Genitales Femeninos/patología , Humanos , Histerectomía/efectos adversos , Histerectomía Vaginal/efectos adversos , Histerectomía Vaginal/métodos , Laparoscopía/métodos , Tiempo de Internación , Persona de Mediana Edad , Tamaño de los Órganos , Estudios Prospectivos , Resultado del TratamientoAsunto(s)
Histerectomía Vaginal , Histerectomía , Competencia Clínica , Contraindicaciones , Femenino , Humanos , Histerectomía/métodos , Histerectomía/estadística & datos numéricos , Histerectomía Vaginal/métodos , Histerectomía Vaginal/estadística & datos numéricos , Persona de Mediana Edad , Suecia/epidemiologíaRESUMEN
The aim of this open prospective randomized study was to compare two non-invasive methods for second trimester abortion using gemeprost pessaries (Cervagem) and dinoproston gel (Cerviprost) concerning effectiveness, time for abortion, consumption of analgesics, infection-rate and side-effects. Forty women admitted for second trimester legal abortion were allocated to treatment with either gemeprost (20) intravaginally or dinoproston (20) intracervically. All patients were pre-treated with a 3 mm in diameter Lamicel tent applied intracervically for about four hours. The success-rate was 95% for gemeprost and 75% for dinoproston within approximately 48 hours. The median abortion time calculated from the insertion of the Lamicel tent for the successful cases was 22 h 0 min for gemeprost and 24 h 5 min for dinoproston (not significant). The shortest abortion time was found among parous women in the Cervagem group. The difference between Cerviprost and Cervagem in parous women was statistically significant. For nonparous women there were no significant differences in abortion time between the two regimes. No significant difference was found in the demand of Pethidin and the infection-rate between the two groups. No major side effects of the treatment were found. Even if no significant difference in successful abortions was found, probably due to the small patient material, Cervagem seems to be the most appropriate of the two non-invasive methods, because of a 95 per cent success-rate within 48 hours, but also due to its simplicity in design.