Nerve-sparing radical hysterectomy: time for a new standard of care for cervical cancer? / 부인종양

No abstract available.

Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer: a randomized controlled trial / 부인종양

OBJECTIVE: A prospective, randomized controlled trial was conducted to evaluate the efficacy of nerve-sparing radical hysterectomy (NSRH) in preserving bladder function and its oncologic safety in the treatment of cervical cancer. METHODS: From March 2003 to November 2005, 92 patients with cervical cancer stage IA2 to IIA were randomly assigned for surgical treatment with conventional radical hysterectomy (CRH) or NSRH, and 86 patients finally included in the analysis. Adequacy of nerve sparing, radicality, bladder function, and oncologic safety were assessed by quantifying the nerve fibers in the paracervix, measuring the extent of paracervix and harvested lymph nodes (LNs), urodynamic study (UDS) with International Prostate Symptom Score (IPSS), and 10-year disease-free survival (DFS), respectively. RESULTS: There were no differences in clinicopathologic characteristics between two groups. The median number of nerve fiber was 12 (range, 6 to 21) and 30 (range, 17 to 45) in the NSRH and CRH, respectively (p<0.001). The extent of resected paracervix and number of LNs were not different between the two groups. Volume of residual urine and bladder compliance were significantly deteriorated at 12 months after CRH. On the contrary, all parameters of UDS were recovered no later than 3 months after NSRH. Evaluation of the IPSS showed that the frequency of long-term urinary symptom was higher in CRH than in the NSRH group. The median duration before the postvoid residual urine volume became less than 50 mL was 11 days (range, 7 to 26 days) in NSRH group and was 18 days (range, 10 to 85 days) in CRH group (p<0.001). No significant difference was observed in the 10-year DFS between two groups. CONCLUSION: NSRH appears to be effective in preserving bladder function without sacrificing oncologic safety.

Conventional versus nerve-sparing radical surgery for cervical cancer: a meta-analysis / 부인종양

OBJECTIVE: Although nerve-sparing radical surgery (NSRS) is an emerging technique for reducing surgery-related dysfunctions, its efficacy is controversial in patients with cervical cancer. Thus, we performed a meta-analysis to compare clinical outcomes, and urinary, anorectal, and sexual dysfunctions between conventional radical surgery (CRS) and NSRS. METHODS: After searching PubMed, Embase, and the Cochrane Library, two randomized controlled trials, seven prospective and eleven retrospective cohort studies were included with 2,253 patients from January 2000 to February 2014. We performed crude analyses and then conducted subgroup analyses according to study design, quality of study, surgical approach, radicality, and adjustment for potential confounding factors. RESULTS: Crude analyses showed decreases in blood loss, hospital stay, frequency of intraoperative complications, length of the resected vagina, duration of postoperative catheterization (DPC), urinary frequency, and abnormal sensation in NSRS, whereas there were no significant differences in other clinical parameters and dysfunctions between CRS and NSRS. In subgroup analyses, operative time was longer (standardized difference in means, 0.948; 95% confidence interval [CI], 0.642 to 1.253), while intraoperative complications were less common (odds ratio, 0.147; 95% CI, 0.035 to 0.621) in NSRS. Furthermore, subgroup analyses showed that DPC was shorter, urinary incontinence or frequency, and constipation were less frequent in NSRS without adverse effects on survival and sexual functions. CONCLUSION: NSRS may not affect prognosis and sexual dysfunctions in patients with cervical cancer, whereas it may decrease intraoperative complications, and urinary and anorectal dysfunctions despite long operative time and short length of the resected vagina when compared with CRS.

Positional relationship between natural killer cells and distribution of sympathetic nerves in decidualized mouse uterus

Uterine natural killer [uNK] cells are the most abundant leukocytes in pre-implantation endometrium and early pregnancy deciduas in humans and rodents. They are associated with structural changes in maternal spiral arteries but regulation of their recruitment and activation is incompletely understood. The major subpopulation of uNK cells in humans expresses CD56, the neural cell adhesion molecule [NCAM]-l while their counterpart in mouse expresses asialoGMl, a brain ganglioside. Sympathetic nerves express NCAM-1 which mediates homotypic binding. Sympathetic fibers innervate the me-sometrial vasculature but their relationship to the myometrial and decidual uNK cell recruitment is unknown. The present study aims to explore positional relationship between natural killer cells and distribution of nerves in decidualized mouse uterus. Immunohistochemistry and mRNA expression for the enzyme tyrosine hy-droxylase were used to map sympathetic nerve fibre distribution within C57BL/6 implantation sites and to address a relationship with uNK cells. Tyrosine hydroxylase positive neurons were identified in the mesometrium closely associated with uterine arteries. Staining became gradually vanished as the nerves crossed the myometrium and entered the decidualized uterus. No neuronal stain was associated with the spiral arteries. Periodic Acid Schiff s reactive uNK cells were absent from the mesentery, but abundant in decidua basalis where they are associated with non-innervated vessels. Data suggest that the recruitment of uNK progenitor cells to the uterus is unlikely to be dependent on signaling by the sympathetic nervous system

Investigación anatómica de los plexos autónomos génito-vesicales; su importancia en la cirugía del cáncer del recto / Anatomic investigation of autonomous urogenital innervations: importance in rectum cancer surgery

Antecedentes: En la cirugía del cáncer de recto, próstata y útero es necesario conocer la inervación autónoma urogenital a fin de realizar una resección radical con preservación de dicha inervación. Objetivo: Determinar los jalones apropiados para la investigación del plexo presacro, nervios y plexo hipogástrico inferior, erectores en su origen y trayecto que siguen hacia los órganos genitourinarios. Lugar de aplicación: Hospital Público. Diseño: Trabajo de investigación anatómico. Población: 7 especímenes, 5 masculinos y 2 femeninos, se disecaron en total 10 plexos. Método: a) investigación del plexo presacro, nervios y plexo hipogástrico inferior y erectores; b) resección en bloque con un segmento de órganos vecinos; c) estaqueada la pieza es sumergida en formol y Complucad; d) disección de los plexos, fotografías y esquemas; e) biopsias de segmentos de dichos plexos. Resultados: Los erectores dependientes del 3§ y 4§ nervio espinal estuvieron presentes en todas las piezas. Los originados en S3 eran de mayor envergadura y alcanzaban el plexo hipogástrico inferior, los originados en S4 eran finos y discurrían directamente hacia el pene, 1 caso se integraba al plexo hipogástrico inferior; en 2 especímenes hubo anastomosis entre ambos plexos hipogástricos. Conclusiones: en todos los especímenes estaban presentes los nervios erectores. Los de mayor envergadura eran los del 3§ espinal. Los del 4§ espinal discurrían directamente hacia el pene. Las raíces espinales 2§, 3§ y 4§ y el músculo piramidal son jalones importantes en la localización de los erectores

Efeito da toxina de escorpião sobre o útero isolado de ratas / Effect of scorpion toxin on the isolated rat uterus

Oitenta e nove ratas albinas, virgens, adultas, pesando entre 100-200g eram injetadas, via intramuscular, com 0,5mg de benzoato de estradiol 72 horas antes de serem sacrificadas para o estudo da motilidade uterina isolada. Os segmentos de corno uterino ficavam suspensos em um banho de músculo liso e imersos em solução de Tyrode modificada a 34§C, borbulhada com ar atmosférico. A toxina do escorpião Tityus serrulatus, os agonistas, antagonistas e bloquadoes de canais de sódio eram adicionadas diretamente ao reservatório contendo o útero. O registro isométrico da atividade da musculatura uterina era feito com um transdutor FT03 conectado a um polígrafo da marca Grass, modelo 7D...

Inervaçäo autônoma do útero de mamíferos / Autonomic Innervation of the mammalian uterus

Apresenta-se uma revisäo sobre a inervaçäo autônoma do útero de mamíferos.

Polipeptídeo vasoativo intestinal (VIP) no útero de mamíferos: distribuiçäo, origem e efeitos / Vasoactive intestinal polypeptide (VIP) in the mamalian uterus: distribution, origin and effects

Procedeu-se a uma revisäo bibliográfica sobre a distribuiçäo, origem e possíveis papéis fisiológicos do neurotransmissor polipeptídeo vasoactivo intestinal (VIP), no útero. O VIP está presente no útero de mamíferos em geral, localizando-se em fibras nervosas, cujo número é maior na cervice uterina em comparaçäo com o restante do órgäo. As fibras nervosas vipérgicas orientam-se ao longo de células musculares lisas e ao redor de glândulas e vasos sanguíneos, e originam-se dos gânglios nervosos paracervicais, situados na junçäo cérvice uterina-vagina. Os efeitos do VIP no útero, encontrados até o momento, säo os seguintes: 1) relaxamento da musculatura lisa uterina; 2) vasodilataçäo; 3) possível participaçäo em processos secretores.