Malignant disease as a risk factor for surgical site infection.

INTRODUCTION AND OBJECTIVE: Postoperative infections are a great constituent of surgical complications. The most common one is surgical site infection (SSI), as well as vaginal and/or urinary tract infections, infections affecting distant organs and systems and systemic circulation leading to sepsis and septic shock. Our aim was to emphasize the effect of malignant disease on postoperative infection and to establish malignant disease as a risk factor for SSI, per se. MATERIAL AND METHOD: We designed a retrospective study in which 538 women who underwent surgery in the Gynecology and Obstetrics Clinical Center of Serbia during a six-month period in 2009 were analyzed. We collected relevant data regarding SSI incidence (CDC definitions), malignant disease (primary site, type and stage) and other potential risk factors for SSI. We used descriptive statistics, chi-square and Student's t test for comparison of variables with statistical significance atp < 0.05. We also used univariate, multivariate logistic regression and ROC analysis. RESULTS: Surgical site infection was present in 40 patients (7.5%). Univariate analysis revealed that the following factors were significantly related to SSI: age, malignant disease, stage of malignant disease, surgery longer than 120 min, postmenopause, diabetes mellitus, positive preoperative vaginal culture, ASA score and intraoperative blood loss. Multivariate analysis showed that the most important risk factors that contribute to SSI with RR of 4 and 5 are, respectively, FIGO II and FIGO III/IV stage of malignant disease (FIGO II p < 0.05 RR = 4.097; FIGO III/IV < 0.01 RR = 5.061). CONCLUSION: In our study malignant disease erupted as the most important risk factor for SSI. This brings us to question the pathophysiological mechanisms and systemic effects associated with malignant disease. There are few studies discussing the issue of malignancy as an isolated risk factor that 4-5 fold increases the risk of SSIs. It is of utmost interest to define protocols of antimicrobial prophylaxis for gynecological malignancy surgery as are suggested for some other malignancies.

Two cases of immature teratoma with positive reproductive outcomes.

The peak incidence of immature teratoma is in the early reproductive period of a woman's life and fertility preservation is an inevitable topic when discussing treatment options. We present two cases of immature teratoma with positive reproductive outcome. Our experience supports the standpoint that surgery alone is curative in most cases, irrespective of tumor grade. Bearing this in mind, the long-term effect of chemotherapy on ovarian function can be avoided and fertility, an important factor in the overall quality of life, can be preserved.

[Comparison of granisetron and metoclopramide for prevention of nausea and vomiting following total cystectomy and ileal conduit].

The objective of this study was to examine the use of granisetron in actual clinical practice and to compare effect of dose of 1 mg granisetron after total cystectomy plus ileal conduit with group of patients which received metoclopramide. Granisetron established total contol of PONV in 93,33% patients. Granisetron is 40% more effective in PONV control than metoclopramide. Only minimal nausea epizodes were observed in early postoperative period in patients who had received low dose of granisetron (1 mg i.v.).

Cervical and duodenal polyps and their malignant alterations--case report.

During routine examination of a 32-year-old patient, a cervical polyp was found and CIN III was confirmed by biopsy. After performing colposcopy, biopsy and establishing CIN III as well as performing gastroscopy where a duodenal polyp was found, thorough diagnostic exams and therapy were carried out. Complete duodenal resection and conization were performed. The medical board decided that neither further radiation nor chemotherapy was needed.

Solitary ovarian metastasis from cutaneous melanoma--case report.

A 47-year-old patient with two previous deliveries and three deliberate abortions was admitted to the Institute of Gynecology and Obstetrics, Clinical Center of Serbia with the diagnosis of a uterine myoma and left adnexal mass. Five years previously, she had undergone excision of a malignant melanoma from her left leg. Pelvic exemination disclosed a left adnexal solid mass measuring about 100 x 80 x 80 mm and enlarged uterus 120 x 50 mm in size with myomatosus nodes on the posterior wall. After ultrasound and computed tomography examination, the patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, intracolic omentectomy and selective pelvic lymphonodectomy. The final histopathological diagnosis was metastatic amelanotic malignant melanoma of the left ovary and uterine myomas. After surgery the patient was transferred to the Institute of Oncology and Radiology where she received chemotherapy.

[Outcome of Burch retropubic urethropexy and the effect of concomitant abdominal hysterectomy].

A prospective follow-up stady was performed to evaluate the effect of Burch colposuspension alone and a concomitant abdominal hysterectomy with Burch colposuspension. Twenty seven women underwent Burch colposuspension and 34 women colposuspension with abdomina hysterectomy. Subjective outcame was assessed with questionaire at 4 weeks, 6 months and 1 year. In the 1 year follow-up 81,4% were subjectively cured or improved in the Burch group and 76,4% in the hysterectomy group. No statistically significant difference in the frequency of any subgroup of complications was found.

Treatment of choriocarcinoma metastases by surgery and polychemotherapy - case report.

Choriocarcinoma is present in one out of every 40,000 pregnancies. There is a great risk for incidence of the disease in women who become pregnant after 45 years of age. The clinical picture may vary and is related to the destruction of tissue and bleeding. New chemo protocols containing etoposide, cisplatin, ifosfamide, together with a resection of the focus resistant to chemotherapy, lead in most cases to the complete recovery.

Diagnosis and surgical therapy of uterine sarcoma.

INTRODUCTION: Uterine sarcomas are rare gynaecological neoplasms and their classification is complicated. Uterine sarcoma is usually diagnosed in postmenopausal women and the diagnosis is often accidental and postoperative. Aim of this study was to present clinical and pathological characteristics of uterine sarcomas, diagnostic procedures, treatment and two-, three- and five-years cumulative survival rates. MATERIALS AND METHODS: The retrospective study of 61 cases of uterine sarcomas was conducted. Cases were distributed into groups based on definitive diagnosis of uterine sarcoma: group of leiomyosarcomas (LMS), carcinosarcoma (CS), endometrial stromal sarcomas (ESS), adenosarcomas (AS) and other rare uterine sarcomas. We investigated patients with clinical and pathological characteristics of uterine sarcomas, diagnostic procedures and treatment. Survival rate was calculated by Kaplan-Meier method. RESULTS: From 61 patients 43 patients (70.49%) were postmenopausal. Mean period from menopause until appearance of symptoms was 14,63 years. One or more risk factors were present in 46 (75.4%) patients. Diagnosis of uterine sarcoma were established averagely 7.38 months after appearance of symptoms. 50 patients (82.0%) underwent one or more diagnostic procedures. Preoperative diagnosis of uterine sarcoma was established in 42.5% of patients. 53 (86.9%) of patients were treated operatively. The most used operative procedure (60,7%) was total hysterectomy with bilateral salpingooophorectomy. Postoperative pathohistologic analysis showed that low grade (LG) leiomyosarcoma were present in 19 (35.9%) cases, high grade (HG) leiomyosarcoma in 1 (1.9%) case, carcinosarcoma in 14 (26.4%) cases, low grade (LG) endometrial stromal sarcoma in 5 (9.4%) cases, high grade (HG) endometrial stromal sarcoma in 9 (17.0%) cases, adenosarcoma in 2 (3.8%) cases, and 2 cases of rare uterine sarcomas: 1 (1.9%) MALT HG lymphoma and 1(1.9%) malignant hemangiopericytoma. In one case of ESS (1.9%) only adenomyosis was found postoperatively suggesting that the whole tumour was removed during diagnostic procedure. Eight patients were not treated operatively. Two-years cumulative survival rate was 74.3%, three-years cumulative survival rate was 71.1%, and five years survival rate was 64.3%. DISCUSSION: Average age, percent of postmenopausal patients and the mean age at the time of menopause in our studied correlate with current data. Clinical presentation of uterine sarcoma is associated with obesity and hypertension in more than 30% of cases, which is approved in our study. For early diagnostics it is important to notice that risk factors are similar to those connected with far more frequent endometrial carcinoma. Postmenopausal abnormal bleeding was the main reason for medical examination, explaining relatively short period for establishing the diagnosis in this group of patients. The variety of clinical findings in our studied group showed that the diagnosis must be based on preoperative pathohistology. CONCLUSION: Adequate diagnosis and treatment of uterine sarcoma is possible with regular yearly or more frequent follow-up, especially in postmenopausal women with known risk factors present. We need special attention for unclear symptoms and postmenopausal bleeding and we need to use all diagnostic procedures soon as possible including preoperative histology because early metastases are characteristic for uterine sarcomas. Factor of the most important predictive value is histologic grade.

[Transvaginal sacrospinal colposcopy in treatment of uterovaginal and vaginal wall prolapse]. / Transvaginalna sakrospinalna kolpopeksija u resavanju uterovaginalnog prolapsa i prolapsa vaginalnih zidova.

Investigation has been performed upon 29 patients of average age of 62.7 years who have undergone sacrospinous colpopexy because of different degree of uterovaginal prolapse (26 patients) and vaginal vault prolapse (3 patients) after having abdominal or vaginal hysterectomy. In patients with uterovaginal prolapse, 23 of them have vaginal hysterectomy with high ligation of the enterocele sac, anterior et posterior vaginal repair and sacrospinous colpopexy, while 3 patients had conservation of uterus following previous reparation of vaginal walls and cervicosacrocolpopexy. Only in one patient we had intraoperative lession of the bladder with no other intraoperative complications so far. Aveage time duration of the operation was 112 minutes. All patients were scheduled to be seen at 4 weeks, 6 months and 12 months after operation and then yearly therafter. The mean follow-up period was 16.8 months (6-27). We have achieved satisfactory results in 25 patients while 4 patients have bladder instability, 3 patients suffered from urinary infection, 2 have febrile morbidity and 2 bottock pain. Sacrospinous colpopexy can be performed together with vaginal hysterectomy and anterior and posterior vaginal wall repair in patients with marked uterovaginal prolapse because of its high success in avoiding possible vault prolapse and low intra and post-operative complication rates.