101,921 research outputs found
Cytoreductive surgery followed by HIPEC repetition for secondary ovarian cancer recurrence.
No full textSecondary and tertiary cytoreductive surgery was associated with improved overall survival in platinum-sensitive recurrent ovarian cancer (ROC). Hyperthermic intraoperative intra-peritoneal chemotherapy (HIPEC) is considered an attractive method in the treatment of ROC to deliver chemotherapy with enhanced effect directly at the tumor site. However, another deserving aspect is the feasibility and the oncologic role of HIPEC repetition. Twelve patients affected by secondary ovarian cancer recurrence previously submitted to cytoreduction followed by HIPEC were enrolled for the present study to receive tertiary cytoreduction followed by HIPEC repetition. The median operative time, including time for HIPEC procedure, was 360 min (range 240–540). Average EBL was 325 ml (from 100 to 500 ml). The median hospital stay was of 5 days, from 4 to 10. Low-grade post operatory complications occurred in 2 patients (16.6%) and high-grade complication in 1 case (8.3%). Our study report encouraging data about safety of HIPEC repetition in ovarian cancer treatment
Laparoscopic findings and hormonal patterns in the treatment of endometriosis by danazol.
No full textCystopexy raises the post-operative complication rate during laparoscopic hysterectomy for uterine prolapse
No full textObjectives: This study aims to compare the outcomes of laparoscopic colposuspension sec Shull (LCSS) and laparoscopic colposacropexy (LCSP) with and without the addition of cystopexy for the treatment of pelvic organ prolapse (POP) in terms of postoperative complications, recurrence rates, and overall effectiveness. Materials and methods: A retrospective case-control analysis was conducted on women treated for grade 3–4 POP-Q uterine prolapse at the Academic Departments of Gynaecology and Obstetrics of “G. Martino” of Messina, Italy, and “L. Vanvitelli” of Napoli, Italy, between November 2020 and February 2022. Group A consisted of patients who underwent laparoscopic hysterectomy followed by LCSS or LCSP without cystopexy. At the same time, Group B included patients who had the same procedures with the addition of cystopexy. Data on complications were collected using the Clavien-Dindo classification, and prolapse recurrence was monitored according to the POP-Q system. Statistical analysis was performed using Fisher's exact, Chi-squared, and Wilcoxon rank-sum tests. Results: A total of 148 patients were included, with 125 in Group A and 23 in Group B. Group B showed a significantly higher rate of postoperative complications (16%) compared to Group A (2.4%) (p = 0.016), with an Odds Ratio of 7.62 (95% CI 1.59–36.51, p = 0.0017). No significant difference between the groups was found in the recurrence rate of prolapse at 24 months (p > 0.9). Conclusion: Adding cystopexy to LCSS or LCSP increases the risk of postoperative complications without reducing prolapse recurrence rates. Further research is needed to identify patients who may benefit from cystopexy and to evaluate its impact on stress incontinence and patient satisfaction
Laparoscopic findings and hormonal patterns in the treatment of endometriosis by danazol.
No full textRobotic isolated lymph nodal debulking of the pelvic side wall in a secondary ovarian recurrence
No full textOvarian cancer is the most lethal gynecological malig-
nancy due to its late detection and high recurrence rate.
Recurrences after 6 months of platinum based treat-
ment may have the most benefit from secondary and
tertiary cytoreductive surgery. Isolated and resectable
disease is the main significant predictor of successful
cytoreduction with subsequent survival benefits.1
Moreover, isolated lymphatic relapse represents the
main indication of surgical treatment, improving prog-
nosis. Localized lymph node recurrence is suitable for
minimally invasive surgery, providing better perioper-
ative and long term outcomes, but highly advanced
surgical skills and experience are required. 2 3
We present the case of a 59- year-
old patient with
a second high grade serous epithelial ovarian cancer
recurrence treated with robotic surgery. At the first
diagnosis (International Federation of Gynecology
and Obstetrics (FIGO) stage IIIC), the patient under-
went laparoscopic cytoreduction followed by plat-
inum based chemotherapy. The patient experienced the first right obturator lymphatic recurrence 50
months later, and laparoscopic complete debulking
and systemic therapy were performed. After 12
months from the first recurrence, imaging showed
an isolated lymph node relapse in the right obturator
fossa with pelvic side wall involvement. A complete (no residual tumor) robotic assisted laparoscopic cytoreduction was
performed, sparing the obturator nerve. No intraoperative or post-
operative complications were observed. No relapse was reported
after 2 years of follow- up.
Minimally invasive surgery is a valid option for secondary cytore-
duction in selected isolated ovarian cancer recurrence. Complete
debulking through minimally invasive surgery is feasible and
enhances the chances of a favorable result. The robotic approach
represents a technological advance over traditional laparoscopy,
allowing radical surgery even in a complex case of ovarian recur-
rence involving the pelvic side wall.4 Robotic surgery may be
considered for highly selected recurrent ovarian cancer cases in
referral oncological centers with extensive experience in minimally
invasive surgery
Oncovascular surgery in gynecologic oncology: en bloc metastatic lymph node and infiltrated inferior vena cava resection followed by patch reconstruction
No full textAdvanced or recurrent gynecologic cancers with retro-
peritoneal lymphatic disease may involve the inferior
vena cava (IVC) and achieving radical debulking of
the disease in this scenario is challenging.1 2 The
concept ‘oncovascular surgery’ defines the case of
tumor resection with simultaneous reconstruction of
the great vessels when the tumor infiltrates or firmly
adheres to the great vessels.3
The aim of this video is to demonstrate the surgical
procedures for radical en bloc resection of metastatic
lymph nodes and the infiltrated IVC with simultaneous
vascular reconstruction.
The indication for the debulking surgery was a
first isolated recurrence of endometrioid endometrial
cancer grade 2 (first diagnosis International Feder-
ation of Gynecology and Obstetrics (FIGO) stage IB
followed by pelvic external beam radiotherapy) in a patient with good performance status. Bulky precaval
lymph nodes with infiltration of the IVC were identi-
fied, while other distant metastases were excluded.
The multidisciplinary tumor board approved surgery as a treatment option. The lymph node metastasis infiltrated the
IVC with absence of a reliable dissection plane. After systemic
heparin infusion and proximal and distal clamping of the vessel,
we performed an en bloc resection of metastatic lymph nodes
along with the infiltrated portion of the IVC. Subsequent vascular
reconstruction was performed with a bovine patch. A running poly-
propylene suture (Prolene 5/0) was used to fix the patch in place
(Figure 1). An intravascular heparin bolus was injected at the end
of the procedure. Complete removal of macroscopic disease was
achieved. No intra- operative or post- operative complications were
observed.
Tumor debulking with en bloc vascular resection and subsequent
reconstruction is a feasible procedure but requires accurate pre-operative
planning and an experienced surgical team. Gynecologic
oncologists need to be familiar with the concept of ‘oncovascular
surgery’ in order to provide the best curative treatment even in the
challenging case of advanced cancers with vascular involvemen
HIPEC at interval debulking surgery in advanced stage ovarian cancer patients: impact of the ovhipec-1 trial in real life experience of a tertiary referral centre.
No full textThe role and molecular mechanism of D-aspartic acid in the release and synthesis of LH and testosterone in humans and rats
No full textAbstract Background D-aspartic acid is an amino acid present in neuroendocrine tissues of invertebrates and vertebrates, including rats and humans. Here we investigated the effect of this amino acid on the release of LH and testosterone in the serum of humans and rats. Furthermore, we investigated the role of D-aspartate in the synthesis of LH and testosterone in the pituitary and testes of rats, and the molecular mechanisms by which this amino acid triggers its action. Methods For humans: A group of 23 men were given a daily dose of D-aspartate (DADAVIT®) for 12 days, whereas another group of 20 men were given a placebo. For rats: A group of 10 rats drank a solution of either 20 mM D-aspartate or a placebo for 12 days. Then LH and testosterone accumulation was determined in the serum and D-aspartate accumulation in tissues. The effects of D-aspartate on the synthesis of LH and testosterone were gauged on isolated rat pituitary and Leydig cells. Tissues were incubated with D-aspartate, and then the concentration (synthesis) of LH and cGMP in the pituitary and of testosterone and cAMP in the Leydig cells was determined. Results In humans and rats, sodium D-aspartate induces an enhancement of LH and testosterone release. In the rat pituitary, sodium D-aspartate increases the release and synthesis of LH through the involvement of cGMP as a second messenger, whereas in rat testis Leydig cells, it increases the synthesis and release of testosterone and cAMP is implicated as second messenger. In the pituitary and in testes D-Asp is synthesized by a D-aspartate racemase which convert L-Asp into D-Asp. The pituitary and testes possesses a high capacity to trapping circulating D-Asp from hexogen or endogen sources. Conclusion D-aspartic acid is a physiological amino acid occurring principally in the pituitary gland and testes and has a role in the regulation of the release and synthesis of LH and testosterone in humans and rats.</p
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