Prognostic impact of suspicious extraabdominal lymph nodes on patient survival in advanced ovarian cancer.

OBJECTIVE: To evaluate the clinical impact of suspicious extra-abdominal lymph nodes (EALNs) identified preoperatively on CT and/or PET/CT images in advanced ovarian cancer. METHODS: A retrospective study was conducted with 122 patients diagnosed with stage III or IV ovarian cancer with preoperative CT and/or PET/CT images from 2006 to 2022. Imaging studies were evaluated for the presence, size and location of suspicious EALNs. Suspicious lymph node enlargement was defined by a cut-off ≥5mm short-axis dimension on CT and/or lesions with maximum standardized uptake values of ≥2.5 on PET/CT. This study only included patients who did not have their EALNs surgically removed. RESULTS: A total 109 patients met the inclusion criteria; 36 (33%) had suspicious EALNs and were categorized as "node-positive". The median overall survival (OS) was 45.73 months for the "node-positive" and 46.50 months for the "node-negative" patients (HR 1.17, 95% CI 0.68-2.00, p = 0.579). In multivariate analysis, after adjusting for other variables selected by process of backward elimination using a significance level of p<0.20, suspicious EALNs still showed no clinical significance on OS (aHR 1.20, 95% CI 0.67-2.13, p = 0.537) as well as progression-free survival (aHR 1.43, 95% CI 0.85-2.41, p = 0.174). Old age (aHR 2.23, 95% CI 1.28-3.89, p = 0.005) and platinum resistance (aHR 1.92, 95% CI 1.10-3.36, p = 0.023) affects adversely on OS. CONCLUSION: Suspicious EALNs did not worsen the prognosis of patients with advanced ovarian cancer. However, its impact on survival is not yet clarified. Further investigation is required to assess the clinical significance of suspicious EALNs on preoperative imaging studies.

Risk Factors and Prognosis of Stroke in Gynecologic Cancer Patients.

Increased life expectancy and cancer prevalence rates expose patients to a higher risk of developing other comorbidities such as stroke. This study aimed to evaluate the risk factors for and prognosis of stroke in patients with gynecological cancers. A single-center retrospective cohort study was conducted on patients with cervical, endometrial, and epithelial ovarian cancers. Patients were classified into three groups based on the period of stroke onset: at least one year before cancer diagnosis, within one year before cancer diagnosis to six months after the last treatment date, and six months after the last treatment date. Among the 644 patients, stroke occurred in 54 (8.4%). In univariate analysis, stroke was significantly associated with overall survival. In contrast, in multivariate analysis, stroke was significantly associated with age and hypertension, but not with overall survival. Age, pulmonary thromboembolism/deep vein thrombosis, histological grade, and tumor stage were significantly associated with overall survival. Therefore, it is important to establish an appropriate examination and treatment plan for patients with gynecologic cancers using a multidisciplinary approach that incorporates the patient's age, medical condition, and tumor characteristics rather than excessively considering the adverse effects of stroke on cancer prognosis.

Long-Term Effect on Ovarian Function After Uterine Artery Embolization During the Postpartum Period: A Nationwide Population-Based Study.

Uterine artery embolization(UAE) is widely used in obstetrical indications, including postpartum bleeding and placental implantation abnormality, to manage many conditions to conserve the uterus. However, physicians are concerned about future fertility or ovarian function due to the occlusion of major pelvic vessels in the uterine artery embolization. However, there are limited data related to UAE usage during the postpartum period. This study was to evaluate the impact of UAE during the postpartum period on primary ovarian failure(POF), menstrual disorders, and infertility in women. Using the Korea National Health Insurance claims database, all pregnant women who delivered between January 2007 and December 2015 and underwent UAE during the postpartum period were identified. The occurrence of POF, female infertility, and menstrual disorders after delivery was evaluated. Using Cox proportional hazards models, the adjusted hazard ratios and 95% confidence intervals were estimated. 779,612 cases were analyzed in the study with 947 women in the UAE group. After delivery, the incidence of POF (0.84% vs.0.27%, P<.0001) and female infertility (10.24% vs. 6.89%, P<.0001) were higher in UAE group than in the control group. After adjusting for covariates, the POF risk was significantly higher in UAE group than in the control group (HR 2.37, 95% CI 1.16-4.82). The risk for the disorder of menstrual frequency (HR 1.28, 95% CI 1.10-1.50) and female infertility (HR 1.37, 95% CI 1.10-1.71) was significantly higher in UAE group than in the control group. This study confirmed UAE during the postpartum period is a risk factor for POF after delivery.

Diagnostic efficacy of aneuploidy markers correlated with early onset preeclampsia.

Low-dose aspirin administration before 16 weeks of gestation can prevent preeclampsia (PE) more effectively. In order to determine if aspirin should be administered, this study aimed to investigate the predictive value of pregnancy-associated plasma protein A (PAPP-A) and aneuploidy markers for the onset period of PE. 1053 singleton pregnant women were included in the study, and serum PAPPA-A and aneuploidy markers were analyzed between 3 group (normotensive, late-onset PE, and early-onset PE). The utility of these markers for predicting early-onset preeclampsia (EOPE) was compared using each marker and their combination. Alpha-fetoprotein (AFP)/PAPP-A > 6.89 and human chorionic gonadotropin (hCG)/PAPP-A > 7.94 were associated with EOPE with a positive likelihood ratio (LR) (6.52, 95% confidence interval [CI] 4.9-7.1), and (5.77, 95% CI 3.9-6.4). The combination of markers could predict EOPE more accurately compared to the single markers. AFP/PAPP-A > 6.89 and hCG/PAPP-A > 7.94had a predictive ability for EOPE, and these cutoff values can help determine the use of aspirin at an earlier gestational age (GA).

Prenatally Ruptured Patent Urachus: A Case Report and Review of Literature.

Patent urachus is a type of urachal anomaly in which the urachus does not tail off but remains connected to the bladder in the umbilicus. The prevalence of patent urachus is very low. Herein, we report a case of patent urachus ruptured and exposed to amniotic fluid in utero. In this case, the size decreased after the second trimester, which was thought to be due to rupture in utero. After delivery, patent urachus was confirmed by inserting a foley catheter, which runs through a ruptured cyst on umbilical cord insertion. The day after delivery, the neonate underwent surgical excision of the urachal cyst and closing umbilicus. The mechanism of patent urachus rupture is unknown. As the fetus matures, it is thought that the higher intravesical pressure may affect the rupture of the cyst. Patent urachus could be ruptured in the uterus spontaneously, and surgical correction is needed. Therefore, prenatal differential diagnosis is important.

Bilateral superficial cervical plexus block for parathyroidectomy during pregnancy: A case report.

BACKGROUND: Primary hyperparathyroidism (PHPT) is the most common cause of pregnancy-related hypercalcemia. PHPT can cause maternal and fetal complications in pregnant women. General anesthesia for non-obstetric surgery in pregnant women is associated with maternal hazards and concerns regarding long-term neonatal neurocognitive effects. Surgical removal of the lesion in mid-pregnancy is currently the primary treatment option for pregnant patients with PHPT. However, the blood calcium concentration at which surgery should be considered remains under discussion due to the risk of miscarriage. CASE SUMMARY: A 31-year-old nulliparous woman at 11 wk of gestation was admitted to our hospital for parathyroidectomy. The patient had a history of intrauterine fetal death with unknown etiology at 16 wk of gestation 1 year prior. Her blood test results showed that the serum calcium level was elevated to 12.9 mg/dL, and the parathyroid hormone level was elevated to 157 pg/mL. In a neck ultrasound, it revealed a 0.8 cm × 1.5 cm sized oval, hypoechoic mass in the upper posterior of the left thyroid gland, which was compatible with parathyroid adenoma. Superficial cervical plexus block (SCPB) for parathyroidectomy was performed. After surgery, the obstetrician checked the status of the fetus, and there were no abnormal signs. Since then her calcium level returned to normal values after one week of surgery and a healthy male neonate of 2910 g was delivered vaginally at 38 wk of gestation. CONCLUSION: Our case suggests that SCPB can be an anesthetic option for parathyroidectomy during the first trimester of pregnancy.

Effect of delayed palliative chemotherapy on survival of patients with recurrent ovarian cancer.

For patients with recurrent ovarian cancer, the goals of chemotherapy include palliation of disease-related symptoms with minimum treatment-related side effects. However, there is currently a paucity of data regarding the initiation of palliative chemotherapy. This study aimed to compare the differences in survival rates and toxicities between patients with recurrent ovarian cancer who started palliative chemotherapy immediately versus those who received delayed chemotherapy. Through a retrospective chart review, patients who received more than three lines of chemotherapy were included. Based on the timing of third-line chemotherapy initiation, the patients were divided into two groups: delayed (DTG) and immediate (ITG) treatment groups. The chi-square test or Fisher's exact tests, and t-test or Mann-Whitney U test were used for comparing variables, as appropriate. The Kaplan-Meier method was used for survival analysis. P-value of <0.05 was considered significant. Although there was no statistically significant difference, the total number of regimens and cycles was lower in the DTG than in the ITG. No differences in toxicities and survival rates were observed between the two groups. Overall, survival and toxicity did not differ significantly between the two groups. In a palliative care setting, our findings suggest that delaying the treatment had no adverse effect on survival. Despite the lack of evidence of a survival benefit with aggressive treatment, patients chose to continue chemotherapy. Because recurrent ovarian cancer is a complex condition, patients require sufficient explanation and time to fully understand the costs and benefits related to aggressive chemotherapy.

Abnormally high level of CA-19-9 in a benign ovarian cyst.

CA-19-9 antigen is mainly elevated in cases of gastrointestinal tract malignancy, including of the pancreas, colorectum, and biliary tract. CA 19-9 antigen can also be elevated in ovarian mucinous neoplasms, however, as well as in many benign conditions. Markedly raised levels of more than 10,000 U/mL were almost observed in advanced stage of malignancy. We report herein the case of a 37-year-old woman who presented with an abnormally high level of CA 19-9 antigen associated with benign mucinous cystadenoma.