1,721,139 research outputs found
Advances in gynaecological oncology surgery
No full textLatest surgical advances in the field of gynaecological oncology, a sub-specialty of gynaecology, are reviewed in this chapter. The surgery is mainly practised in cancer centres by board-certified gynaecologists, and requires a 2-3 year period of additional training in gynaecological oncology. Surgical treatment of gynaecological malignancies has progressed in two directions: reduction of the invasiveness of the surgery and expansion of the number and type of procedures performed. Gynaecological oncology focuses on the pelvis to the upper abdomen and the thorax to target (all visible disease) the last cancer cell in women with advanced ovarian cancer. Minimal-access surgery has evolved to include any operation by laparoscopy. It uses fewer ports (single-port surgery), and robotic assistance improves the comfort of the surgeon. The concept of fertility-sparing surgery for women with cervical cancer is now supported by mature data. The indication and the aggressiveness of the exenterative surgery are also broader than originally recommended. The ideal timing of surgery is under investigation in several areas, mainly in women with ovarian and cervical cancer. The aim is to reduce morbidity and mortality of surgical procedures while maintaining the survival outcome. © 2013 Elsevier Ltd. All rights reserved
Laparoscopic treatment of early ovarian cancer
No full textPurpose of review: Recently some studies have reinforced the arguments supporting the laparoscopic management of early ovarian cancer. These studies and reports questioning the use of laparoscopy in patients with early ovarian cancer will be reviewed. Recent findings: Advances in laparoscopic techniques have enabled the surgeon to meet the staging criteria for early ovarian cancer as proposed by the International Federation of Gynecology and Obstetrics (FIGO) guidelines. Although some reports highlight the risk of ovarian cancer mismanagement, the safety and reliability of laparoscopic surgical staging has been demonstrated with encouraging results. However, the numbers of patients included in these studies are still insufficient to draw conclusions. Summary: Clinical evidence supports the use of laparoscopy in the treatment or completion of treatment in patients diagnosed with early ovarian cancer. If strict guidelines are respected, tumor rupture, dissemination and implant on the trocar insertion sites can be avoided and survival outcomes appear not to be jeopardized. Inadequate and hazardous laparoscopic management of early ovarian cancer is to be ascribed to the lack of guidelines and to surgeons without the competence to treat early ovarian cancer rather than to the surgical technique. The excellent outcomes could encourage studies with larger sample sizes to confirm the validity of laparoscopic treatment of patients with early ovarian cancer. Unfortunately, a clinical trial is unlikely to be undertaken due to the low incidence of this disease and the even lower number of events. © 2005 Lippincott Williams & Wilkins
Role of laparoscopy in the treatment of patients with endometrial cancer
No full textPatients with endometrial cancer (EC) are conventionally staged by surgery. Depending on the tumor risk factors and the surgical findings, adjuvant treatment is indicated in the form of radiotherapy or chemotherapy. The FIGO guidelines on surgical staging are clear on the importance of assessing the presence of extra-uterine spread of disease, but are elusive on how extensive the surgical staging should be. Also, the role of lymphadenectomy and adjuvant radiotherapy in these patients is the object of controversy, as confirmed by recent results of clinical trials. With surgery remaining the cornerstone of treatment, the surgical approach associated with the least complications should be pursued, particularly since the association of surgery and radiotherapy can escalate the overall treatment morbidity. Therefore, in the last 15 years, laparoscopy has slowly been replacing the traditional midline laparotomy. The results of the few clinical trials and several retrospective studies are unanimous. The laparoscopic approach is feasible, safe and effective and has a lower complication rate as compared to laparotomy in all patients. The number of patients with endometrial cancer included in published studies so far is too low to achieve statistical significance with respect to survival outcomes. However, for some groups of patients, there are results from clinical trials showing that laparoscopy is the method of choice in view of the outstanding reduced surgical morbidity. © 2007 Springer-Verlag
Genome Editing and Obesity
No full textDefined as a condition of body fat excess leading to significant morbidity, obesity is a chronic metabolic illness associated with a significant number of diseases. The incidence of obesity does not solely depend on dietary habits, with energy balance being regulated by the complex interactions between genetic, behavioural and environmental factors. Genome-wide association studies (GWASs) have demonstrated that several genes are linked to obesity, and these findings shed light on a growing number of novel potential therapeutics for weight management, including genome editing. In this regard, the cutting-edge technology known as clustered regularly interspaced palindromic repeats (CRISPR)/CRISPR-associated protein (Cas), thanks to its ability to edit DNA or modulate gene expression in eukaryotic cells, undoubtedly enables to understand the genetic mechanisms implicated in obesity and could be a promising tool for its treatment. This chapter summarizes the genetics underlying obesity and currently available obesity treatments, further discussing the research progress of genome editing in the knowledge and treatment of body fat excess
Beyond weight loss in nonalcoholic fatty liver disease: the role of carbohydrate restriction
No full textPurpose of review The low fat diet (LFD) is currently the first choice to treat nonalcoholic fatty liver disease (NAFLD) alongside with physical activity. However, low carbohydrate diets (LCDs) and ketogenic diets have gained attention lately, thanks to their favourable impact in reducing intrahepatic triglyceride content. We therefore aimed at providing an update on recent evidence evaluating the hepatoprotective effects of such dietary interventions. Recent findings Novel findings confirmed previous evidence by showing beneficial effects on liver fat content reduction for both LFDs and LCDs. The further restriction of carbohydrates to less than 50 g/day, usually leading to ketosis, confirmed to produce an improvement in NAFLD, with very low-calorie ketogenic diets possibly proving particularly beneficial thanks to the significant weight loss that can be obtained. Summary Most of the latest evidence shows that carbohydrate restriction plays a fundamental role in the modulation of lipid metabolism leading to similar efficacy in improving NAFLD compared with LFDs. The hepatoprotective role of carbohydrate restriction appears to be boosted when ketogenesis is induced, when the total calorie intake is extremely reduced, or, possibly, when dietary interventions have reduced content in free sugars, making such interventions valuable tools to deal with NAFLD
Laparoscopic surgery for gynaecological cancers in obese women
No full textThe use of laparoscopic surgery in the management of gynaecological malignancies has been growing for over a decade. Concomitantly the incidence of obesity has been increasing worldwide. This review summarizes the available studies on minimal invasive surgery in obese women with gynaecological malignancies. We undertook a literature search to identify the differences between traditional open methods and the laparoscopic approach in terms of intra- and postoperative outcome and patient safety. Only eight relevant studies were identified. Six of these focused on endometrial cancer, one study included early stage cervical and ovarian cancers with other benign conditions, while another paper included cervical and endometrial pre-cancers and only a few malignant conditions. Obesity is generally known to increase the risk of intra- and postoperative complications. However, several studies show that obesity, formerly precluding keyhole surgery, seems now to be an indication for the laparoscopic approach. As compared to laparotomy, laparoscopic surgery has a good postoperative outcome, reduced estimated blood loss (EBL) and pain and in some series an increased lymph node count. Laparoscopy has been shown to be cost effective with a shorter hospital stay and return to normal activity. Survival is reported to be the same with both laparotomy and laparoscopy. The benefits of minimal invasive surgery in gynaecological surgery are starting to be found with robotic surgery. © 2009 Elsevier Ireland Ltd. All rights reserved
Cardiac mast cells in the transition to heart failure: innocent bystanders or key actors?
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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