Ectopic pregnancy.
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Clinical Laboratory Techniques↗
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Results for “Gynecologic Surgery--indications”
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The use of adjuvant radiation therapy in early endometrial cancer by members of the Society of Gynecologic Oncologists in 2005.
OBJECTIVES: To determine current patterns of care for early stage endometrial cancer by the members of the Society of Gynecologic Oncologists (SGO). METHODS: A survey detailing the use of adjuvant radiation in early stage endometrial cancer was conducted. Details of surgery, indications for staging, and use of adjuvant radiation for cases primarily seen by the respondent and for those cases referred postoperatively without staging information were collected and compared to a similar survey from 1999. RESULTS: The practice demographics of the respondents are similar to the 1999 survey. SGO members are now more likely to perform complete surgical staging during all surgeries for endometrial cancer than in 1999 (71% vs. 48%; P<0.0001). A higher percentage of respondents now describe surgery as a complete lymphadenectomy (76% vs. 44%: P<0.0001) and believe this is therapeutic (71% vs. 66%: P=0.04). Approximately half of SGO members now use laparoscopic assisted staging in the primary treatment of endometrial cancer. Since 1999, there is a significant decrease in the recommendation for postoperative RT. In almost all cases where RT is recommended, the use of vaginal RT is now more common than pelvic RT. In all situations, consult recommendations for additional intervention were more likely if complete surgical staging had not been performed, suggesting that all patients with endometrial cancer would benefit from surgery by a gynecologic oncologist. CONCLUSIONS: There is an increase in complete surgical staging of endometrial cancer, an increase in the use of laparoscopy, and a marked decrease in the use of pelvic RT since 1999.
Endometrial Neoplasms↗
A survey of blood transfusion practices of gynecologic oncologists.
OBJECTIVE: To survey the attitudes of gynecologic oncologists about indications for blood transfusion, and compare them to current recommendations about transfusion practice. METHODS: With the permission of the Society of Gynecologic Oncologists (SGO), a study questionnaire was mailed to 548 members and candidates in their directory. The questions asked about transfusion threshold before chemotherapy, following ovarian debulking, and after endometriosis surgery. Indications for transfusion were assessed using a qualitative/quantitative scale. Responses were analyzed with respect to years of SGO membership and practice setting using the chi 2 test and analysis of variance. Results were compared to the 1992 guidelines for transfusion of the American College of Physicians (ACP). RESULTS: Two hundred eighty-five forms were returned (52% of total). Fifty-one percent of respondents were in full-time academic positions; 36% were in private practice. Sixty-one percent were full SGO members, and 35% were candidates. The average prechemotherapy transfusion threshold (TT) was a hemoglobin concentration (hgb) of 7.9 +/- 0.7 g/dl (g). At that level the mean transfusion was 1.9 +/- 0.5 units of packed red blood cells (U). For the ovarian debulking scenario, the mean postoperative TT was 8.1 +/- 0.8 g with a mean transfusion of 1.9 +/- 0.4 U. For the endometriosis case, the mean TT was 7.0 +/- 0.8 g, with a mean transfusion of 1.9 +/- 0.5 U. Analysis showed no difference in practice based on years of SGO membership or practice setting. CONCLUSION: A majority of the gynecologic oncologists surveyed offers transfusion at levels of anemia similar to ACP recommendations, but frequently transfuse more units than recommended. A substantial minority does not follow the guidelines at all.
Blood Transfusion↗
Preemptive analgesia does not reduce pain or improve postoperative functioning.
OBJECTIVES: To examine the effectiveness of preemptive analgesia in gynecologic laparoscopy patients. METHODS: A double-blinded, randomized trial was performed from June 2000 to June 2001. Preoperatively, patients were randomly assigned to 0.25% bupivicaine or normal saline control. Following anesthetic induction, the study drug or a placebo was injected prior to the proposed incisions. RESULTS: Of the 164 patients enrolled, 85 were randomized to the study group and 79 to the control. Age, surgery indication, and estimated blood loss did not vary significantly between groups. Overall mean pain score (+/-standard error of the mean) for study and control groups did not differ at 4 hours (3.2+/-0.3 vs 3.2+/-0.3) or at 24 hours (4.2+/-0.3 vs 4.2+/-0.3). Incisional pain scores also did not differ at 4 hours (3.0+/-0.3 vs 2.7+/-0.3) or at 24 hours (3.6+/-0.3 vs 3.6+/-0.3). Both groups were similar in activity limitation at 24 hours and oral narcotic consumption within 24 hours postoperatively. After stratifying surgery type for level of complexity, no difference was noted between groups. Multiple logistic regression analysis also noted no difference in outcomes. CONCLUSION: Preemptive analgesia in patients undergoing gynecologic laparoscopy does not reduce postoperative pain or decrease the time to return of normal activities.
Adult↗
Microsurgical reversal of female sterilization: a reappraisal.
The role of microsurgery in reversal of sterilization has been reassessed and 118 cases reviewed. The technical variations for tubo-tubal anastomosis necessitated by the condition of the oviducts have been outlined in detail. All 118 cases were included in the analysis without requirement for a minimal postoperative trial period. Seventy-six of these (64.4%) had achieved one or more intrauterine pregnancies. There was one ectopic gestation. Forty-seven patients, reported earlier, were resurveyed. These patients had a minimal postoperative trial period of 18 months. Thirty-eight (80.8%) had achieved one or more term pregnancies or were in the latter half of a normally progressing pregnancy. The mean time interval between the reconstructive surgery and the occurrence of pregnancy was 10.2 months. The longest time interval was 40 months. An inverse relationship was noted between the total length of the reconstructed oviducts and the occurrence of pregnancy.
Adult↗
Future directions in the surgical management of ovarian cancer.
OBJECTIVE: The surgical management of ovarian cancer is surrounded by controversy. This review summarizes our current understanding of these issues with the goal of improving survival, enhancing quality of life, and containing costs. METHODS: Six currently unresolved issues are addressed through a review of the existing literature: (1) the extent of surgery indicated in the primary surgical management of advanced-stage disease, (2) the prognostic features of ovarian cancer, (3) the role of interval debulking following neoadjuvant chemotherapy, (4) the role of fertility-sparing surgery, (5) the role of "second-look" surgery, and (6) the role of secondary tumor debulking. RESULTS: The criteria for justifying extraordinary measures to reduce the tumor burden in patients with advanced disease to an "optimal" state have not been established. Likewise, the factors that influence prognosis and treatment are not well defined or understood. Interval debulking following neoadjuvant chemotherapy is a promising approach to the management of advanced-stage disease, but no clinical trials have been conducted comparing it to primary surgery followed by chemotherapy. Fertility-sparing surgery may be appropriate even for women with frankly malignant epithelial cancers when disease is confined to one ovary. No convincing data are available showing that second-look surgery improves the chances for cure or prolongs survival. Finally, few data show a benefit from secondary tumor resection in patients who progress while undergoing first-line chemotherapy or have a recurrence soon afterward. CONCLUSIONS: Controlled clinical trials are needed to guide clinicians in making appropriate management decisions for their patients.
Female↗
[Methods of sterilization in women].
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Female↗
[Prevention of thrombosis. Surgical departments in Norway].
Routine perioperative thrombo-embolic prophylaxis was studied by means of a questionnaire to departments of abdominal, orthopedic, urological and gynecological surgery. 171 departments in university, central and county hospitals answered, giving a response rate of 92%. It was found that 90% of the departments in all hospital categories used routine prophylaxis. This practice was most frequent in orthopedics and least frequent in urology. Dextran was preferred in all three hospital categories. Central and county hospitals also applied heparin and heparin/dihydroergotamin. Heparin was always given as 5,000 IU subcutaneously twice daily. Heparin/dihydroergotamin was equally often given as 2,500 IU as 5,000 IU twice daily, irrespective of the kind of surgery. Indications of thrombo-embolic prophylaxis varied within each surgical speciality. The prophylaxis regimen was chosen mostly on medical grounds. The convenience of the nurses was seldom and economic differences only infrequently considered of importance for the choice of prophylaxis regimen.
Humans↗
[Continuous monitoring of spontaneous respiration in the postoperative phase. 4. The effect of postoperative pain therapy on cutaneous oxygen and carbon dioxide partial pressure following gynecologic surgery with neuroleptanalgesia].
METHODS: Cutaneous O2 and CO2 pressures were monitored for 16 h in 55 female patients recovering from major gynaecological surgery performed under neurolept anaesthesia. Postoperative pain was managed either with an antipyretic analgesic (i.m. or i.v. metamizol up to 2.5 g/4 h; group NLA) or with i.v. patient-controlled analgesia using fentanyl (demand dose 34 micrograms, infusion rate 4 micrograms/h, hourly maximum dose 0.25 mg, lock-out time 1 min; group NLA/PCA). In addition, 11 patients received a single i.v. bolus injection of 150 mg amiphenazole, a respiratory stimulant, at the beginning of PCA treatment (group NLA/PCA/AMI). Data were collected and stored by a personal computer, using the TCM3 system with a combination electrode for simultaneous measurement of cutaneous oxygen and carbon dioxide partial pressures (TINA, Radiometer) at 30-s intervals. The overall observation period was four times 240 min; patients from the NLA group who required additional opioids were excluded from the analysis. Means and standard deviations were calculated for individual data and data pooled for 15- or 60-min intervals. Groups were compared by means of the chi-square test, Student's t-test or analysis of variance (level of significance, P < or = 0.05). RESULTS: The 55 patients were classified as ASA I-II. The study groups were comparable with respect to demographic and anaesthesiological data, except that those in the NLA group were younger and had received less intraoperative fentanyl (Table 1). Mean PCA fentanyl consumption was 0.6-0.7 mg in the 16-h observation period (Table 2). In all groups, pctO2 levels were decreased and pctCO2 levels elevated in the first observation hours and slowly returned to normal within the first observation period (Figs. 1, 2, Tables 3, 4). Episodes of hypercapnia (pct-CO2 > 50 or > 55 mm Hg) were frequent in the first 2 h (8-29% of individual values for pctCO2 > 50, up to 5% of values recorded for pctCO2 > 55; Table 4). There were no statistically significant differences between patients treated with metamizol and those treated with fentanyl. Amiphenazole did not significantly improve postoperative respiration. PCA patients had occasional episodes of hypercapnia (up to 19% of all values for pctCO2 > 50, up to 5% for pctCO2 > 55) even in the last observation period (13-16 h after surgery), indicating the need for close monitoring of spontaneous ventilation during PCA following neurolept anaesthesia. DISCUSSION AND CONCLUSIONS: The present study confirmed that spontaneous respiration in the early postoperative period can be monitored non-invasively by measuring cutaneous partial pressures of carbon dioxide and, less precisely owing to wide individual variations, oxygen. It showed that spontaneous respiration is less effective immediately after termination of surgery under neurolept anaesthesia and recovers slowly over the next 4 h. During the first observation period, ventilation was no worse with i.v. PCA using fentanyl than with conventional pain management using the antipyretic analgesic metamizol, confirming the hypothesis that opioid-induced respiratory depression occurs only at overdosage (which is not a problem with individualized dose titration using PCA). Since all patients in the NLA group required additional opioids after the first observation period and had to be excluded from further analysis, it cannot be decided from the present data whether late hypercapnia was due to PCA or to residual effects of surgery and anaesthesia. The respiratory stimulant amiphenazole (150 mg i.v.) was not helpful in improving ventilation; there was no indication of analgesic effects or interactions of amiphenazole.
Adult↗