Hormone therapy after risk-reducing surgery in patients with BRCA1/BRCA2 mutation: evaluation of potential benefits and safety

SUMMARY Women with mutations in the BRCA 1 and 2 genes are at increased risk for ovarian and breast cancer and therefore candidates for risk-reducing surgery, including salpingo-oophorectomy and mastectomy. Risk-reducing salpingo-oophorectomy (RRSO) is considered the most effective prophylactic measure for ovarian cancer prevention in this group of patients. This procedure involves loss of ovarian function and induced menopause. Estrogen therapy is the most effective treatment for controlling vasomotor symptoms and improving the quality of life of climacteric women. However, the potential hormonal stimulation of these tumors and the risk of breast cancer are a concern regarding the safety of hormone replacement therapy (HRT) in this population. This article aims to review the current evidence regarding the potential benefits and safety of HRT after RRSO.

RESUMO Mulheres portadoras de mutações nos genes BRCA 1 e 2 possuem risco aumentado para cânceres de ovário e mama e, portanto, são candidatas às cirurgias redutoras de risco, incluindo a salpingo-ooforectomia e a mastectomia. A salpingo-ooforectomia redutora de risco (SORR) é considerada a medida profilática mais efetiva para prevenção do câncer de ovário nesse grupo de pacientes. Esse procedimento implica a perda da função ovariana e menopausa induzida. A estrogenioterapia é o tratamento mais efetivo para o controle de sintomas vasomotores e melhora da qualidade de vida de mulheres no climatério. No entanto, a potencial estimulação hormonal desses tumores e o risco de câncer de mama constituem uma preocupação com a segurança da terapia hormonal (TH) nesta população. Este artigo tem como objetivo uma revisão das evidências atuais quanto aos benefícios potenciais e segurança da TH após SORR.

Recurrent ruptured ectopic pregnancy: a case report

Ruptured ectopic pregnancy is an emergency obstetric case which requires fast and correct management. Authors report an interesting case of a 27-years-old with recurrent ruptured ectopic pregnancy and underwent a laparoscopy and salpingostomy operation. The operation outcome was good with no perioperative complications and operating results. Ectopic pregnancy requires fast and correct management because this case is an emergency and can lead to mortality.

Comparación de embarazos ectópicos tubarios y cirugía laparoscópica por incisión transversal con la incisión longitudinal / Tubal Ectopic Pregnancy and Laparoscopic Transverse Incision Surgery Compared To Longitudinal Incision

Introducción: el manejo y tratamiento del embarazo ectópico ha evolucionado en los últimos años de forma impresionante. Actualmente predomina una terapia conservadora, tanto médica como quirúrgica. Esta última, se manifiesta en función de la fertilidad a pesar del incremento de las afecciones tubárica. Objetivo: determinar el uso de la técnica de salpingostomía transversal con respecto al número de embarazos intrauterinos y recidivas posteriores. Métodos: se realizó un estudio experimental, prospectivo y longitudinal, en pacientes con diagnóstico de embarazo ectópico desde el año 2007 hasta el año 2012 en el Centro de Investigaciones Médico-Quirúrgicas. Esta población quedó conformada por 251 pacientes en edad fértil, que acudieron al Cuerpo de Guardia del Centro de Investigaciones Médico-Quirúrgicas por presentar dolor en bajo vientre, sangramiento uterino anormal y/o amenorrea, a quienes se les realizó laparoscopía diagnóstica. De ellas, 204 fueron diagnosticadas de embarazo ectópico, con 167 ampulares. La totalidad de las mujeres a las que se realizó la salpingostomía transversal mostraron interés en conservar la fertilidad. La muestra control quedó constituida por 200 pacientes que presentaron embarazo ectópico ampulares. Estas pacientes fueron sometidas a la técnica de cirugía conservadora longitudinal, en un periodo inmediato anterior, 2004-2007. Resultados: se demostró que por la técnica de salpingostomía transversal se logró un mayor número de embarazos intrauterinos (60) y menos recidivas de ectópicos (10), con valores altamente significativos respecto a la salpingostomía lineal. Conclusiones: el beneficio de realizar la técnica de salpingostomía transversal, respecto al número de embarazos logrados fue cuatro veces superior al riesgo de desarrollar recidivas o complicaciones en el período de un año(AU)

Introduction: The management and treatment of ectopic pregnancy has evolved dramatically in recent years. Presently, conservative therapy, both medical and surgical, prevails. The latter is manifested as a function of fertility despite the increase in tubal conditions. Objective: Determine the use of the transverse salpingostomy technique with respect to the number of intrauterine pregnancies and subsequent relapses. Methods: An experimental, longitudinal and prospective study was performed in patients diagnosed with ectopic pregnancy from 2007 to 2012 at Center for Medical-Surgical Research. 251 patients of childbearing age were the population of this study and they came to Center for Medical-Surgical Research emergency room for having low-grade pain, abnormal uterine bleeding and / or amenorrhea, who underwent diagnostic laparoscopy.This population consisted of 251 patients of childbearing age, who came to the Center for Medical-Surgical Research Guard Corps for having pain in the lower abdomen, abnormal uterine bleeding and / or amenorrhea. They underwent diagnostic laparoscopy. 204 of them were diagnosed of ectopic pregnancy, with 167 ampullaries. All women who underwent transverse salpingostomy showed interest in preserving fertility. 200 patients were the control sample ant they presented with ampullary ectopic pregnancy. These patients underwent longitudinal conservative surgery in an immediate previous period (2004-2007). Results: It was demonstrated that by the transverse salpingostomy technique, greater number of intrauterine pregnancies were achieved (60); fewer ectopic recurrences (10) with highly significant values ​​with respect to linear salpingostomy. Conclusions: The benefit of using transverse salpingostomy technique in relation to the number of pregnancies achieved was 4 times higher than the risk of developing relapses or complications in the period of one year(AU)

Hydrosalpinx treated by different laparoscopic surgeries and their pregnant outcome (77 cases) / 中国内镜杂志

Objective To study the reproductive outcome of infertile women suffered from hydrosalpinx treated by laparoscopic salpingostomy or salpingectomy.Methods There were 77 infertile women diagnosed hydrosalpinx by HSG or B ultrasonography and excepted for other infertile factors. Unilateral or bilateral salpingostomy or salpingectomy was performed after hydrosalpinx conifrmed by laparoscopy. Seventy seven patients were followed up for 1 ~ 4 years postoperatively.Results Among 77 cases 39 cases (50.65%) got pregnancy. Thirteen cases (16.88%) conceived spontaneously and 26 cases (33.77%) conceived by IVF-ETin. Thirty ifve cases delivered health babies and 3 cases of pregnancy, 1 cases of early abortion.Conclusion Both laparoscopic surgeries were effective treatment of hydrosalpinx results in infertility. After operation the pregnant rate of those conceived by IVF-ET is higher than spontaneously.

Laparoscopic tube-preserving surgical procedures for ectopic tubal pregnancy

OBJECTIVE: To present our experience with laparoscopic tube-preserving surgery for ectopic tubal pregnancy and evaluate its feasibility and efficacy. METHODS: This was a prospective study of 57 consecutive patients with ectopic tubal pregnancies undergoing laparoscopic tube-preserving procedures including salpingotomy, salpingostomy, segmental resection and reanastomosis, and fimbrial milking. The outcome measures were treatment success rates and homolateral patency rates. RESULTS: Of the 57 surgical procedures, 55 (96.4%) were performed successfully without any additional intervention. The number of patients receiving salpingotomy, salpingostomy, segmental resection and reanastomosis, and fimbrial milking were 24 (42.1%), 25 (43.9%), 4 (7.0%), and 2 (3.5%), respectively. Two case was switched to salpingectomy because excessive bipolar coagulation was required to obtain hemostasis at the tubal bleeding bed. Over a mean β-human chorionic gonadotropin resolution time of 18.3±5.9 days, no persistent trophoblast or postoperative complications occurred. A tubal patency test using hysterosalpingography was performed in 15 cases at 3 months postoperatively. Among these, the homolateral tubal patency rate was 75% (11 of 15) and the contralateral patency rate was 80% (12 of 15). CONCLUSION: Tube-preserving surgery is a feasible and safe treatment option for ectopic tubal pregnancy. However, considering that the optimal goal of tube-preserving surgical procedures is not the treatment success, some caution is warranted in interpreting results of this study.

Study of Diagnosis and Management of Ectopic Pregnancy

The term ‘Ectopic pregnancy’ refers to the pregnancy that implants outside the uterine cavity). This work is aimed at the clinical study of diagnosis and management of 35 cases of ectopic pregnancy over a period of two and a half years. The main aims of the study are (1) to evaluate the efficacy of the various modalities of diagnosis, and (2) to determine the best treatment option depending on the severity of presentation. A combination of accurate history, meticulous physical examination, serum β-HCG levels, culdocentesis and ultrasound will aid in early diagnosis. Management of the cases depends on the severity of the presentation. Conservative approach includes medical management with methotrexate or laparoscopic salpingostomy. Laparotomy involving salpingectomy was done in ruptured ectopic pregnancy.

Analysis of the effect of laparoscopic salpingostomy in the treatment of infertile caused by hydrosalpinx / 中国基层医药

Objective To analyze the effect of laparoscopic salpingo.stomy in the treatment of infertile caused by hydrosalpinx,and explore the reasonable treatment method for improving pregancy rate.Methods 130 infertile women with hydrosalpinx were treated with salpingostomy firstly,some unsuccessful cases were treated with salpingectomy.The pregnancy rate between successfully salpingostomied patients and unsuccessfully salpingostomied patients was also compared.Results 85 cases were salpingostomied successfully,the successful rate was 65.4％,among these patients 40 received IVF-ET,there was no difference in the natural pregnancy rate between singly hydrosalpinx (17.9％) and double hydrosalpinx(16.7％) (x2 =0.06,P ＞ 0.05),but the artificial pregnancy rate in single hydrosalpinx(70.0％) was higher than double hydrosalpinx (35.0％) (x2 =4.912,P ＜ 0.05).Among 45 unsuccessfully salpingostomied patients,14 cases underwent salpingectomy,all patients received more than two times of IVF-ET treatment,the pregnancy rate in salpingectomied patients (21.4％) was higher than unsalpingectomied (3.2％) (x2 =3.946,P ＜ 0.05).The artificial pregnancy rate of successfully salpingostomied patients (52.2％) was higher than unsuccessful patients (21.4％) (x2 =4.055,P ＜ 0.05).Conclusion Salpingostomy can raise the pregnancy rate (natural or artificial),it is beneficial to do salpingectomy for unsuccessfully salpingostomied patients who want to receive IVF-ET.

Contrast analysis of different laparoscopic surgical treatments for tubal pregnancy outcome and repregnancy / 中国医师进修杂志

ObjectiveTo investigate the outcome and repregnancy after different laparoscopicsurgical treatments for tubal pregnancy,and analyse the influential factors. MethodsIn 56 tubal pregnancypatients,28 cases performed laparoscopic salpingostomy (group A) and 28 cases peoformed laparoscopicsalpingectomy (group B). The perioperative condition, the rate of repregnancy and re-ectopic pregnancy was compared and analyzed. Logistic regression analysis was used to detect the effect on subsequent repregnancyof influential factors such as pelvic adhesion. ResultsMore bleeding and longer operative time were needed in group A than group B, there were significant differences between two groups (P ＜ 0.05 ). In follow-up of 6months to 6 yeats,the rate of repregnancy in group A and group B was 46.4％(13/28) and 32.1％(9/28)respectively,there was no significant difference between two groups (P ＞0.05). The rate of re-ectopic pregnancy in group A and group B was 10.7％ (3/28) and 28.6％ (8/28) respectively,there was significant difference between two groups (P ＜0.05). In the single factor analysis,the repregnancy in group A was significantly associated to pelvic adhesion and patency of the contralateral oviduct (P ＜ 0.05 ). Conclusions The rate of repregnancy of laparoscopic salpingostomy is higher than laparoscopic salpingectomy for tubal pregnancy. Each of pelvic adhesion and the patency of the contralateral oviduct is a factor that affects the postoperative fertility. The conservation operation is not recommended for those patients with extensive pelvic adhesion or seriously destroyed tube but normal contralateral oviduct.

Salpingostomy for ectopic pregnancy in National Hospital of Obstetrics and Gynecology

Background: Salpingostomy for ectopic pregnancy in patients who has aspirations to having a baby is a necessity. Objective: To discover the factors affecting the outcome of salpingostomy. Subjects and method: 400 patients with none or one baby treated by salpingectomy or salpingostomy for ectopic pregnancy in National Hospital of Obstetrics and Gynecology from July 2006 to June 2007 were studied. The data was analyzed with T test and logistic regression. Results: 92 of 400 patients (23%) were treated by salpingostomy. The risk of salpingectomy for patients with size of pregnancy mass >2 cm (measured by ultrasound) was 2.48 times higher than that of mass <=2 cm (95% CI: 1.50-4.12). All of cases with positive fetal heart beat were treated by salpingectomy. The danger of salpingectomy for patients with preoperative level of bhCG >3000 UI/L increased by 6.65 fold in comparison with that of bhCG <=3000 UI/L (95% CI: 2.99-15.27). The risk of salpingostomy for patients with the size of pregnancy mass >3 cm is 7.43 times as much as that of mass <=3 cm (95% CI: 3.89-14.39). Conclusion: The chance of salpingostomy for patients having the size of pregnancy mass <=3 cm and bhCG <=3000 UI/L was 24.1%.

Modified tubo-uterine implantations for proximal tubal occlusive infertility after femal sterilization with mucflago phenol / 中华妇产科杂志

Objective To explore the effects of modified tubo-uterine implantations performed on women with proximal tubal occlusive infertility after femal sterilization with mucilago phenol.Methods Two hundred and eight infertile women who were admitted to the Second Affiliated Hospital of Sun Yat-sen University between 1986 and 2004 were included.They all accepted modified tubo-uterine implantation after occlusion of fallopian tubes with mucilago phenol.Results It was found that the occlusions were all located in the interstitial portion or isthmic portion of the fallopian tubes.Different degrees of pelvic adhesions were found in 65 cases.Fifty-seven cases were slightly adhesive,seven cases were of moderate degree and one case was severe.One hundred and ninety-nine cases were followed up after operations(95.7%).One hundred and ninety-three women accepted hydrotubation in the following month just after the operation and 185 women were found to be unobstructed(95.8%).One hundred and forty-three women became pregnant, the pregnant rate being 71.9%(143/199).One hundred and twenty-five women had term deliveries (87.4%),three women were in early pregnancy and two in midtrimester pregnancy.Eleven women had spontaneous abortion(7.7%).Two women had tubal pregnancy(1.0%).None of the 199 cases had any signs of endometriosis.Conelusions Modified tubo-uterine implantations are quite effective for proximal tubal occlusive infertility.It may be a favorable method for such kind of tubal occlusions.

Efficacy of laparoscopic treatment of patients with infertility and distal tube obstruction / 中国微创外科杂志

Objective To assess the efficacy of laparoscopic salpingostomy in infertile women with distal tube obstruction. Methods 109 women with infertility underwent laparoscopic salpingostomy and the results were retrospectively analyzed. Results The total cumulative pregnancy rate was 32.9%.The cumulative pregnancy rate was 44.4% in the unilateral distal tube obstruction group after laparoscopic salpingostomy,while it was 20% in the bilateral distal tube obstruction patients(p

An analysis of the effect of microsurgical salpingostomy and its relevant factors / 中华显微外科杂志

Objective To report the clinical effect of microsurgical salpingostomy Methods Follow up 116 patients who used microsurgical techniques and analyzed its relevant factors,such as age,sterilization time limit,the length of the reconstructed fallopian tube,microsurgical techniques,and the site of salpingitis. Results Pursuit 116 cases,the re-pregnant rate was 86.2%(110/116). Conclusions The success of microsurgical salpingostomy depend on several factors including the length of the reconstructed fallopian tube,microsurgical techniques and the site of salpingitis.