45 research outputs found
Pseudo-Meigs’ Syndrome Caused by a Uterine Leiomyosarcoma: A New Clinical Condition
No full text<i>Introduction:</i> Pseudo-Meigs’ syndrome is a rare condition characterized by female genital cancer, ascites, hydrothorax and tumors other than benign ovarian tumors. <i>Case report:</i> A 30-year-old woman arrived at our clinic with pelvic pain and dyspnea. She underwent an exploratory laparotomy for a large pelvic mass complicated by ascites and hydrothorax. Cytological examination of the effusions was negative for malignant cells. Histological analysis of the tumor mass revealed a uterine epithelioid leiomyosarcoma. After surgery, we observed resolution of the effusions. <i>Conclusion:</i> Uterine leiomyosarcoma and pseudo-Meigs’ syndrome are two rare entities. To our knowledge, there are no similar reports in the literature, and therefore we present this new clinical condition due to its high scientific evidence.</jats:p
Prolasso degli organi pelvici e sessualità: studio sulla qualità della vita dopo intervento chirurgico di correzione del prolasso [Pelvic Organ Prolapse and sexuality: study on quality of life after prolapse correction surgery]
No full textIntroduzione La sfera della sessualità è spesso gravemente inficiata nelle pazienti portatrici di prolasso degli organi pelvici. Scopo
dell’articolo è indagare la qualità della vita sessuale delle pazienti prima e dopo l’intervento chirurgico. Materiali e metodi È stato condotto uno studio osservazionale di coorte su pazienti sottoposte a intervento chirurgico di sospensione laterale laparoscopica (LLS) e isterectomia per via vaginale con colpopessi uterosacrale (USLs). È stata indagata l’attività sessuale, la comparsa di dispareunia e il grado di soddisfazione nel rapporto col partner al tempo 0 e a 6-12-24 mesi postoperatori nei 2 gruppi. Risultati Sono state sottoposte a intervento chirurgico 195 pazienti portatrici di prolasso: 145 nel gruppo USLs e 41 nel gruppo LLS. Al tempo 0 erano sessualmente attive il 59% del gruppo LLS e il 32,5% del gruppo USLs. La dispareunia era sperimentata dal 60,9% delle pazienti LLS (I grado: 30,4%, II grado: 21,7%, III grado: 8,7%) e dall’80% delle pazienti USLs (I grado: 44%, II grado: 20%, III grado: 16%). 6 mesi dopo l’intervento chirurgico tra le pazienti sessualmente attive, nel gruppo LLS il 15,8% sperimentava dispareunia (tutte di I grado), che nel 10,5% era persistente mentre nel 5,3% de novo; nel gruppo USLs il 37,5% presentava dispareunia, nel 29% dei casi di I grado, nel l’8,3% dei casi di II grado; la dispareunia era persistente nel 16,7%, de novo nel 20,8%.
12 mesi post-intervento nel gruppo LLS la dispareunia era riscontrata nell’ 11% delle pazienti attive (tutte di I grado e di tipo persistente); nel gruppo USLs la prevalenza di dispareunia era del 18,2% (I grado: 9,1%, II grado: 9,1%), di tipo persistente. Infine a 24 mesi post intervento, nel gruppo LLS nessuna lamentava dispareunia; nel gruppo USLs andate a controllo, 2 ( il 40%) presentavano dispareunia (I grado: 20%, II grado: 20%), in 1 paziente de novo, nell’altra di tipo persistente. In risposta al questionario pre operatorio per l’item Relazione col partner, la mediana dei punteggi era di 25 nel gruppo LLS (35 pazienti) e di 33 nel gruppo USLs (70 pazienti). Ai successivi controlli a 6, 12 e 24 mesi la mediana dei punteggi è stata di 0 in entrambi i gruppi in tutti e tre i controlli temporali. Conclusioni Gli interventi chirurgici di sospensione laterale uterina per via laparoscopica e di isterectomia per via vaginale con colpopessi uterosacrale si sono dimostrati efficaci nel migliorare la sessualità riducendo la dispareunia e aumentando il grado di soddisfazione soggettivo della paziente nel rapporto col partner.Introduction Psychological The sexuality is often seriously impaired in patients with pelvic organ prolapse. The aim of the article is to
investigate the quality of sexual life of patients before and after surgery. Materials and methods An observational cohort study was conducted on patients undergoing laparoscopic lateral suspension surgery (LLS) and vaginal hysterectomy with uterosacral colpopexy (USLs). We investigated sexual activity, the appearance of dyspareunia and the degree of satisfaction in the relationship with the partner at time 0 and at 6-12-24 months after surgery in the 2 groups. Results 195 patients with prolapse underwent surgery: 145 in the USLs group and 41 in the LLS group.
At time 0, 59% of the LLS group and 32.5% of the USLs group were sexually active. Dyspareunia was experienced by 60.9% of LLS patients (I degree: 30.4%, II degree: 21.7%, III degree: 8.7%) and 80% of USLs patients (I degree: 44 %, II degree: 20%, III degree: 16%). 6 months after surgery among the sexually active patients, 15.8% in the LLS group experienced dyspareunia (all grade I), which was persistent in 10.5% and de novo in 5.3%; in the USLs group 37.5% had dyspareunia, in 29% of cases of I degree, in 8.3% of cases of II degree; dyspareunia was persistent in 16.7%, de novo in 20.8%. 12 months postoperatively in the LLS group, dyspareunia was found in 11% of active patients (all grade I and persistent type); in the USLs group the prevalence of dyspareunia was 18.2% (I degree: 9.1%, II degree: 9.1%), in all cases persistent. Finally, 24 months postoperatively, none of the LLS group complained of dyspareunia; in the USLs group that went to control, 2 (40%) presented dyspareunia (I degree: 20%, II degree: 20%), in 1 patient de novo, in the other one persistent. In response to the preoperative questionnaire for the item Relationship with partner, the median scores were 25 in the LLS group (35 patients) and 33 in the USLs group (70 patients). At the subsequent controls at 6, 12 and 24 months the median scores were 0 in both groups in all three time controls. Conclusions Laparoscopic lateral uterine suspension surgery and vaginal hysterectomy with uterosacral colpopexy proved to be effective in improving sexuality by reducing dyspareunia and increasing the patient’s subjective degree of satisfaction in the relationship with her partner
Outcome of endometrial cancer after lymphadenectomy: A single center retrospective analysis with long-lasting follow-up
No full textBACKGROUND: Role of lymphadenectomy in endometrial cancer is unclear. Our objective is to assess the role of lymphadenectomy in endometrial cancer. METHODS: The study reviewed retrospectively 829 cases of endometrial cancer from a single non-oncological center from 1981 to 2014. Multivariable Cox regression analyses were performed. Independent variables were: 2009 FIGO stage, histological type of endometrial cancer (non-endometrioid, endometrioid, grading 1, 2 and 3), radicality on parametria, lymphatic dissection (any kind) (yes/no), any kind of chemotherapy, any kind of radiotherapy, brachytherapy, patients' age. Dependent variable was death for endometrial cancer and first relapse. Time variable was the semester of follow-up. P value for significance was set <0.05. RESULTS: Many data about the extension of node dissection were missing. Pelvic node dissection or sampling seem the more common procedure performed. At the 10-semester of follow-up, at the 20-semester of follow-up and at the 30 semester of follow up, lymphadenectomy does not improve overall survival at a p value of less than 0.05. Lymphadenectomy reduces the risk of relapse at the 10 semester and 20-semester of follow-up. CONCLUSIONS: Lymphadenectomy plays a role in preventing relapses but it is not proved that non-aggressive lymphadenectomy in endometrial cancer improves overall survival at p level of 0.05. Therefore, it cannot be excluded that a very small improvement in long lasting survival in few cases of endometrial cancer could be due to node dissections
Management of the pelvic floor disfunctions: combined versus single surgical procedure in a multidisciplinary approach: a retrospective study
No full textThe objective of this study was to compare the outcome of combined surgical treatment of multicompartmental pelvic floor defects versus single procedures
within a multidisciplinary path in order to try to clarify what is
the most effective surgical approach
Evaluation of postoperative pain after gynecologic surgery: a dedicated form
No full textIntroduction:Aim of this study is to evaluate the prevalence and intensity of postoperative pain and to find pain-related factors in women undergoing gynecologic surgery, using a dedicated form.
Methods: The sample is divided into three groups, according to the type of surgical access (transversal laparotomy TL, longitudinal laparotomy LL, vaginal VAG). Each patient received postoperative painkillers according to hospital therapy protocols.
Postoperative pain episodes that have been recorded during the first three days after surgery (days 0,1,2)) were studied. Pain intensity was measured using Numerical Rating Scale (NRS).
Results:The 64% of operated women complained at least one episode of pain during the three days after surgery. Among women complaining pain, its intensity was moderate for the 89% (NRS 4-7) and it was severe only in few cases (11%), mainly in the VAG group. The due-hour painkillers administration was associated to a lower percentage of pain episodes if compared to the "rescue doses".
Conclusions: Pain control is important to promote safe surgery. A dedicated form is useful to assess this vital sign. The results present a detailed pictureof this extremely subjective symptom and they suggest how to improve the analgesic therapies when necessary
Ovarian Endometrioid Adenocarcinoma With a Yolk Sac Tumor Component in a Postmenopausal Woman: Case Report and Review of the Literature
No full textYolk sac tumors (YSTs) of the ovary are rare and highly malignant germ cell tumors of utmost importance, occurring
in children and young adults. They are characterized by endodermal differentiation. YSTs coexisting with a variety of histologic patterns
have been described but those with an epithelial malignant component are extremely rare, especially in
postmenopausal women. We describe a rare case of ovarian endometrioid adenocarcinoma
(EOC) with a YST component occurring in a 73-years-old woman (pT1aN0M0) that was treated with a combination of paclitaxel and carboplatin
for 6 cycles. At 22-months’ follow-up, the patient was free of recurrence. This is the longest diseasefree survival seen when compared with other reported
cases in the literature. No conclusions could be drawn from this case report; we hope that other authors describe their experiences
to define the most appropriate approach to this rare tumo
Papilloma and Polyoma DNA tumor virus sequences in female genital tumors.
No full textHuman papillomaviruses (HPVs) and BKV, JCV, and SV40 polyomaviruses (PYVs) are oncogenic viruses associated with different human tumors. Our aim was to determine if PYV and HPV sequences could be detected in human genital tumors. HPV types 6b, 11, 16, and 18 and PYV were investigated in 22 genital tumor samples and the corresponding adjacent normal tissues, by PCR and filter hybridization. HPV and PYV sequences were also searched in six sperm fluid and four peripheral blood cell (PBC) samples. HPV-16 sequences were revealed in 7 of 14 cervical tumors and 1 of 1 vaginal adenocarcinoma, whereas 1 of 14 cervical carcinoma tested positive for HPV-18. Interestingly, each normal cervical tissue surrounding the neoplasm obtained from the same patient was positive for HPV type-16 and -18 with the same prevalence detected in tumors. BKV sequences were found in 9 of 14 cervical tumors, 1 of 7 vulvar tumors, and 1 of 1 adenocarcinoma, but also in normal tissues from cervix (13 of 14), vulva (6 of 7), sperm fluid (5 of 6) and PBC (3 of 4) samples. SV40 sequences were detected in 1 of 14 normal cervical tissue, 2 of 6 sperm fluids and 1 of 4 PBCs. None of the samples were JCV positive. To our knowledge, this is the first investigation reporting on the simultaneous association of both HPV and PYV with human genital tumors. These results suggest that PYV, together with HPV, may be involved as a cofactor in the onset/progression of human genital tumors, and raise the possibility that PYV act synergistically with HPV to enhance their pathogenicity in vivo. In addition, HPV and PYV may complement each other in infecting human genital tissues
KID Syndrome and Hidradenitis Suppurativa: A Rare Association Responding to Surgical Treatment
No full textBackground: Keratitis-ichthyosis-deafness (KID) syndrome is a rare genodermatosis characterized by keratitis, neurosensorial auditory impairment and ichthyosiform skin involvement. Frequent complications of the syndrome are chronic, opportunistic cutaneous infections, and the development of skin cancers. Several cases of association between KID syndrome and other conditions, including hidradenitis suppurativa (HS), are described in the literature. This correlation could be explained by the hyperproliferative state of the epidermis, which occurs in KID syndrome and may favor follicular plugging. Objectives: The aim of this study was to describe a very rare case of association between KID syndrome and HS and its complex therapeutic management. Results: The failure of the drugs commonly used in HS and the excellent results of surgery, although difficult to achieve, were experienced. Conclusion: Despite the technical difficulties related to surgery, namely, cutaneous superinfections, frequent dehisce of the suture, and closure by secondary intention, the authors strongly recommend the surgical approach in these patients
LOH of Chromosome 6q compared with LOH of 17q and 18q in ovarian cancers: relationship to p53 expression and clinicopahological findings
No full textIn 41 ovarian epithelial tumors (7 borderline and 34 invasive), loss of heterozygosity (LOH) of chromosomes 6q, 17q, and 18q was examined using 4 microsatellite markers: ER (6q 25-1), BRCA1 (17q21), DCC (18q21), and D18S58 (18q23). The LOH was compared with clinicopathological findings, including p53 and ER expression. In borderline tumors, LOH and p53 expression were never found, while in invasive carcinomas LOH and p53 were found in 71% and 59% of cases, respectively. In particular, in invasive carcinomas 6q LOH represented a marker distinguishing two groups of tumors; those with 6q LOH were only of serous histotype and at advanced stages (III/IV). No significant difference was found for any of genes in 5-year survival of the patients. No correlation was found between ER expression and ER LOH, as well as between biological aggressiveness and 17q and/or 18q LOH. We conclude that p53 and LOH of the investigated loci distinguish borderline from invasive ovarian carcinomas; moreover, the..
Combined rectal and gynecologic surgery in complex pelvic floor dysfunction: clinical outcomes and quality of life of patients treated by a multidisciplinary group
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