Reproductive outcomes in women opting for fertility preservation after fertility-sparing surgery for borderline ovarian tumors.

PURPOSE: What are the reproductive outcomes of women who had fertility preservation (FP) using either oocyte or embryo vitrification after fertility-sparing surgery (FSS) for a borderline ovarian tumor (BOT)? METHODS: A retrospective, single-center cohort study was conducted between January 2013 and December 2021. Patients with BOT who resorted to FP by vitrifying oocytes or embryos were included. Both clinical and reproductive parameters were reviewed. The primary outcome was live birth. RESULTS: In total, thirteen patients who performed 31 FP cycles were included. Of those, six patients achieved eight live births after a mean follow-up period of 79 months. Three further pregnancies are still ongoing. All pregnancies/live births were obtained without using their cryopreserved oocytes or embryos. CONCLUSION: Women who had FSS for BOT have favorable prospects of live offspring, even without the need to use their cryopreserved material. Fertility preservation in patients with BOT has to be considered as a tool to mitigate the risk of infertility that may arise in case of BOT recurrence requiring castrating surgery.

External multicentre validation of pseudomyxoma peritonei PSOGI-Ki67 classification.

BACKGROUND: Pseudomyxoma peritonei (PMP) is a rare malignant disease. Adding of the Ki67 proliferation index to the PSOGI PMP classification provided two different subcategories of the extensive HG-PMP group (HG-PMP ≤15% and HG-PMP >15%) with different survival in a previous unicentric study. This study aims to carry out an external and multicentre validation of this new proposed classification. METHOD: It was a prospective analysis of samples from a historical and international cohort of patients. A representative area with higher cellular density was used to determine the Ki67%. The Ki67 proliferation index (%) was determined in all the HG-PMP patients. A Cox proportional hazard models and multivariable COX models were used. The Kaplan-Meier method and the two-tailed log-rank test were used to analyse the effect of different PSOGI-Ki67 categories on OS and DFS. Its predictive accuracy was analysed using Harrel's C-index and the ROC curve. The calibration was performed using the calibration plots matching. RESULTS: After exclusions, 349 patients were available for analysis. The 5-years OS were 86% for LG-PMP, 59% for HG-PMP≤15, 38% for HG-PMP>15 and 42% for SRC-PMP (p = 0.0001). The 5-years DFS were 49% for LG-PMP, 35% for HG-PMP≤15, 16% for HG-PMP>15 and 18% SRC-PMP (p = 0.0001). The discrimination capability of PSOGI-Ki67 was validated. CONCLUSION: the PSOGI-Ki67 classification discriminates and predicts the OS and DFS in patients with PMP dividing the HG-PMP category into two well-defined sub-categories. The Ki67 proliferation index should be incorporated routinely in the pathology report for these patients.

The rationale of opportunistic bilateral salpingectomies (OBS) during benign gynaecological and obstetric surgery: a consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG).

Ovarian cancer (OC), is a disease difficult to diagnose in an early stage implicating a poor prognosis. The 5-year overall survival in Belgium has not changed in the last 18 years and remains 44 %. There is no effective screening method (secondary prevention) to detect ovarian cancer at an early stage. Primary prevention of ovarian cancer came in the picture through the paradigm shift that the fallopian tube is often the origin of ovarian cancer and not the ovary itself. Opportunistic bilateral salpingectomy (OBS) during benign gynaecological and obstetric surgery might have the potential to reduce the risk of ovarian cancer by as much as 65 %. Bilateral risk-reducing salpingectomy during a benign procedure is feasible, safe, appears to have no impact on the ovarian function and seems to be cost effective. The key question is whether we should wait for a RCT or implement OBS directly in our daily practice. Guidelines regarding OBS within our societies are therefore urgently needed. Our recommendation is to inform all women without a child wish, undergoing a benign gynaecological or obstetrical surgical procedure about the pro's and the con's of OBS and advise a bilateral salpingectomy. Furthermore, there is an urgent need for a prospective registry of OBS. The present article is the consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG) regarding OBS.

The impact of surgical resection of the primary tumor on the development of synchronous colorectal liver metastasis: a systematic review.

BACKGROUND: In recent years different therapeutic strategies for synchronously liver metastasized colorectal cancer were described. Apart from the classical staged surgical approach, simultaneous and liver-first strategies are now commonly used. One theoretical drawback of the classical approach is, however, the stimulatory effect on liver metastases growth that may result from resection of the primary tumour. This systematic review, therefore, aims to investigate the current insights on the stimulatory effects of colorectal surgery on the growth of synchronous colorectal liver metastases in humans. METHODS: The systematic review was conducted according to the PRISMA statement. A literature search was performed using PubMed and Embase. Articles investigating the effects of colorectal surgery on synchronous colorectal liver metastases were included. Primary endpoints were metastatic tumor volume, metabolic and proliferative activity and tumour vascularization. RESULTS: Four articles meeting the selection criteria were found involving 200 patients. These studies investigate the effects of resection of the primary tumour on synchronous liver metastases using histological and radiological techniques. These papers support a possible stimulatory effect of resection of the primary tumor. CONCLUSIONS: Some limited evidence supports the hypothesis that colorectal surgery might stimulate the growth and development of synchronous colorectal liver metastases.

The role of appendectomy as part of the treatment of a mucinous borderline ovarian tumor.

UNLABELLED: Guidelines in surgical treatment of mucinous ovarian neoplasms recommend the use of appendectomy as a measure to rule out a primary appendiceal origin of the ovarian tumor and proper staging. In extension this guideline is also applied for mucinous borderline ovarian tumors (mBOTs). As borderline ovarian tumors (BOTs) are often diagnosed postoperatively, most patients must undergo a second surgery to add appendectomy and staging to their surgical treatment. OBJECTIVE: To assess the role of appendectomy as part of the surgical treatment of mucinous BOTs. MATERIALS AND METHODS: A retrospective single institute based study was carried out. The authors evaluated the clinical charts of patients undergoing surgical treatment by a gynecologic oncologist in their institution for a mucinous BOT between January 1990 and January 2014. RESULTS: Twenty-seven patients were included. Appendectomy was performed in 30% of patients during primary or secondary surgical treatment. No appendiceal carcinoma was identified in any of the cases. Five patients already had a previous appendectomy. In eight patients the appendix was described as normal during surgery and left in place. For six patients the authors did not retrieve any information on previous appendectomy neither on the intraoperative state of the appendix. In the present overall study population, 78% showed no appendiceal involvement. For the remaining patients this information was missing. CONCLUSIONS: Secondary appendectomy to rule out a primary appendiceal origin of the mucinous BOT should not be performed when the appendix is described as grossly normal during primary laparoscopic surgery.

Protective effect of exogenous nitrite in postoperative ileus.

BACKGROUND AND PURPOSE: As the pathogenesis of postoperative ileus (POI) involves inflammation and oxidative stress, comparable to ischaemia/reperfusion injury which can be ameliorated with nitrite, we investigated whether nitrite can protect against POI and explored the mechanisms involved. EXPERIMENTAL APPROACH: We used intestinal manipulation (IM) of the small intestine to induce POI in C57BL/6J mice. Sodium nitrite (48 nmol) was administered intravenously just before IM. Intestinal transit was assessed using fluorescent imaging. Bethanechol-stimulated jejunal circular muscle contractions were measured in organ baths. Inflammatory parameters, neutrophil infiltration, inducible NOS (iNOS) activity, reactive oxygen species (ROS) levels, mitochondrial complex I activity and cGMP were measured in the intestinal muscularis. KEY RESULTS: Pre-treatment with nitrite markedly improved the delay in intestinal transit and restored the reduced intestinal contractility observed 24 h following IM. This was accompanied by reduced protein levels of TNF-α, IL-6 and the chemokine CCL2, along with reduced iNOS activity and ROS levels. The associated neutrophil influx at 24 h was not influenced by nitrite. IM reduced mitochondrial complex I activity and cGMP levels; treatment with nitrite increased cGMP levels. Pre-treatment with the NO scavenger carboxy-PTIO or the soluble guanylyl cyclase inhibitor ODQ abolished nitrite-induced protective effects. CONCLUSIONS AND IMPLICATIONS: Exogenous nitrite deserves further investigation as a possible treatment for POI. Nitrite-induced protection of POI in mice was dependent on NO and this effect was not related to inhibition of mitochondrial complex I, but did involve activation of soluble guanylyl cyclase.

Heme deficiency of soluble guanylate cyclase induces gastroparesis.

BACKGROUND: Soluble guanylate cyclase (sGC) is the principal target of nitric oxide (NO) to control gastrointestinal motility. The consequence on nitrergic signaling and gut motility of inducing a heme-free status of sGC, as induced by oxidative stress, was investigated. METHODS: sGCß1 (H105F) knock-in (apo-sGC) mice, which express heme-free sGC that has basal activity, but cannot be stimulated by NO, were generated. KEY RESULTS: Diethylenetriamine NONOate did not increase sGC activity in gastrointestinal tissue of apo-sGC mice. Exogenous NO did not induce relaxation in fundic, jejunal and colonic strips, and pyloric rings of apo-sGC mice. The stomach was enlarged in apo-sGC mice with hypertrophy of the muscularis externa of the fundus and pylorus. In addition, gastric emptying and intestinal transit were delayed and whole-gut transit time was increased in the apo-sGC mice, while distal colonic transit time was maintained. The nitrergic relaxant responses to electrical field stimulation at 1-4 Hz were abolished in fundic and jejunal strips from apo-sGC mice, but in pyloric rings and colonic strips, only the response at 1 Hz was abolished, indicating the contribution of other transmitters than NO. CONCLUSIONS & INFERENCES: The results indicate that the gastrointestinal consequences of switching from a native sGC to a heme-free sGC, which cannot be stimulated by NO, are most pronounced at the level of the stomach establishing a pivotal role of the activation of sGC by NO in normal gastric functioning. In addition, delayed intestinal transit was observed, indicating that nitrergic activation of sGC also plays a role in the lower gastrointestinal tract.

Invasive recurrence of an intestinal-type mucinous epithelial neoplasm of low malignant potential: case report and review of the literature.

Pseudomyxoma peritonei is only rarely seen in conjunction with primary ovarian tumors. It has been suggested that only ruptured mucinous tumors arising in ovarian mature cystic teratomas can result in this clinical picture. We describe a case of a late invasive recurrence of a mucinous intestinal-type borderline ovarian tumor arising from a mature teratoma after complete surgical debulking. Borderline ovarian tumors behave indolently in the overwhelming majority of cases, and the prognosis is therefore usually outstanding.

[Psychological aspects of ulcerative rectocolitis (author's transl)]. / Aspect psychologique de la recto-colite hémorragique

Ulcerative rectocolitis has been known for quite some time as a psychosomatic disease, it is an organic disease occurring in people with a particular personality rendering them susceptible to certain conflicts or stress which would be able to play a causing role in the appearance or exacerbations of the disease. Insofar as the psychological study is concerned, there are two important points to keep in mind: the role of psychological trauma as a stimulating factor and the basic personality. In 90% of the cases observed, psychological factors are found as provoking the hemorrage, as found by Groen and confirmed by the author. The basic personality is generally the obsessional type with a hypersensibility to rejection and hostility, sometimes of a paranoid dimension. The aggressivity is almost always repressed. The doctor-patient relationship indicates an important dependency as well as a passivity on the part of the patient. Furthermore, these patients rarely express their feelings, even if their behavior is indicative of experiencing intense emotion. By further experimentation, it has been established that these patients have a greater neuro-vegetative fragility than controls, thus demonstrating a greater vulnerability to stress. A pathological relationship between mother and child has almost always been proven. Finally, the principal causal psychological factor in this disease seems to be a relational conflict unresolved between specific figures. The role of psychotherapy influences greatly the disease evolution. the author recounts an interesting research of 900 ulcerative colitis patients, undertaken by O'Connor. In order to insure favorable therapeutic results in ulcerative rectocolitis, one must carefully coordinate a psychological and somatic treatment.

[Therapeutic approach in psychosomatic gastroenterology (author's transl)]. / L'approche thérapeutique en gastro-entérologie psychosomatique

The therapeutic approach in psychosomatic medicine requires the somatician to keep psychological factors in mind and the psychiatrist to recall the somatic complaint. The therapeutic attitude will be different according to the psychofunctional problem or an authentic psychosomatic disease. However, in every case, the total patient must be considered and a good doctor-patient relationship must be established. Thanks to this relationship, the doctor can better understand the emotional and intellectual aspects of his patient and therefore plan his therapeutic purposes. Thus it takes into consideration the following: 1. reducing the anxiety by explaining to the patient the possible correlations between his complaints and emotional factors; 2. adopting a supportive attitude; 3. offering to the patient the possibility to explain verbally certain repressed ideas (ventilation psychotherapy); 4. manipulating, if necessary, the milieu in which the patient lives (treatment centered on the environment); 5. starting a deep rooted psychotherapy in certain cases. The problem of psychosomatic diseases in gastro-enterology, like duodenal ulcer and hemorragic ulcerative colitis, is discussed in more details. Concerning duodenal ulcer, one can distinguish between two levels of psychotherapy: 1. psychological approach for the gastro-enterologist with a proper background in the psychological approach of patients; 2. psychotherapy. Anyway, the treatment of this disease is always multidimensional, utilizing both psychological and drug treatment. Concerning hemorragic ulcerative colitis, supportive psychotherapy is crucial during the acute phase. It takes effect by an entire affective relationship with the patient and the all therapeutic team. During a remission, the therapist must provide the patient with the type of relationship he desires, and be available to the patient. In some cases, a deep psychotherapy should be used, even in conjunction with somatic care.