Rectosigmoid resection morbidity in ovarian cancer cytoreductive surgery.

This case series evaluated morbidity following rectosigmoid resection during cytoreductive surgery for advanced ovarian cancer at the Shaukat Khanum Memorial Cancer Hospital, Lahore. The data of 20 female patients with complications corresponding to the Clavien-Dindo classification was included; the patients received treatment between January 2016 and January 2021. The mean age was 45.05± 13.11 years. Complications were observed in 3 (15.0%) cases, i.e., urinary complications in 2 (66.7%), and intra-abdominal abscess in 1 (33.3%) case. Clavien-Dindo classification grade II was noted in 2 (66.7%), while grade III-B in 1 (33.3%) case. Surgical risk factors were noted as appendectomy in 6 (66.7%) cases, bowel resection in 1 (11.1%), left colectomy in 1 (11.1%), sigmoid colectomy in 1 (11.1%), and stoma formation in 11 (55.0%) cases. In this reported case series, significant complications were observed in women undergoing rectosigmoid resection as cytoreductive surgery for advanced ovarian cancer.

Incidence and Survival Rates for Female Malignant Germ Cell Tumors: An Institutional Review.

Background Germ cell tumor survival rates have improved over the past few decades. However, there is a lack of data on survival rates and the incidence of female germ cell tumors. This study aims to determine the incidence and survival rates of female germ cell tumors in our institution. Methodology This retrospective cross-sectional study was carried out at Shaukat Khanum Memorial Hospital and Research Centre, and the records over 10 years, from January 2010 to December 2020 were examined. The data of 290 females with malignant germ cell tumors were selected from 1387 females with ovarian masses, and their survival records were examined. For statistical analysis, SPSS software (version 24.0; IBM Corp. Armonk, NY) was utilized. The survival analysis was determined using the Kaplan-Meier method. Results The mean age of patients was 21.45 ± 9.28 years. The mean duration of diagnosis was 4.53 ± 2.59 years. In 245 (84.5%) patients, ovarian malignancy was involved while uterine malignancy was observed in 44 (15.2%) cases and there was one (0.3%) case of cervical carcinoma. The most common stage at diagnosis of malignancy was IA (96 (33.1%)), followed by IIIC (58 (20.0%)), IV (56 (19.3%)) and IC (26 (9.0%)). Chemotherapy was given in 244 (84.1%) cases. Out of 290 cases, 26 (9.0%) had a recurrence of the tumor while 264 (91.0%) did not have a recurrence of the tumor. Out of 290 cases, 46 (15.9%) died during follow-up, 129 (44.4%) had disease-free survival while 115 (39.7%) were healthy till the end of the study. The mean duration of survival was 3.56 ± 2.33 years. When patients' survival was compared between treatment groups, patients who did not receive chemotherapy fared better than those who did. Conclusion Female germ cell tumor patients have a good overall survival rate of more than 20% after 10 years of follow-up with effective adjuvant therapy and conservative surgery. However, more research is needed to determine the long-term effects of chemotherapy on ovarian function.

Prevalence and Risk Factors of Low Anterior Resection Syndrome in Epithelial Ovarian Cancer Surgery.

Background In this study, we aimed to determine the prevalence and risk factors of low anterior resection syndrome (LARS) in epithelial ovarian cancer (EOC) surgery. Methodology A descriptive cross-sectional study was conducted at the Gynecologic Oncology Section of the Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan. Using non-probability consecutive sampling technique, all patients who underwent cytoreductive surgery involving low anterior resection for EOC between January 2016 and January 2021 were included. Patients were assessed for LARS symptoms using the LARS score, along with its risk factors. Descriptive statistics, that is, continuous variables were expressed as the median and interquartile range, while categorical variables were expressed as frequencies and percentages. The LARS score was categorized according to a two-tier model with "no or minor LARS" and "major LARS." Univariate analyses were performed by the chi-square tests providing odds ratios and 95% confidence intervals to identify risk factors for major LARS. Results Overall, 95% of cases had LARS scores that fell in "no or minor LARS," while only 5% of cases had "major LARS." Univariate analyses relieved no statistically significant association between the occurrence of major LARS and any of the risk factors. Conclusions The prevalence of LARS was 5%, and no risk factors were associated with major LARS in our study population.

Granulocyte colony stimulating factor (G-CSF)-induced aortitis in a patient undergoing adjuvant chemotherapy for breast cancer.

Granulocyte colony stimulating factor (G-CSF) is used to prevent febrile neutropenia post chemotherapy. Usually well tolerated with minimal side effects but aortitis is an extremely rare side effect previously reported. A 64-year-old woman treated with adjuvant chemotherapy including G-CSF for left breast cancer was admitted with fevers, neutropenia and markedly raised inflammatory markers after 7 days of her first cycle. Initially diagnosed with neutropenic sepsis, she did not respond to broad spectrum antibiotics with subsequent CT imaging revealing marked periaortic inflammatory changes consistent with aortitis and periaortitis. Extensive investigations for other causes of large vessel vasculitis were negative and G-CSF was the only causative factor. She rapidly responded to steroids with almost complete resolution of inflammatory changes on repeat imaging within 4 weeks and no recurrence on tapering of steroids. This diagnosis must be considered in patients presenting with fever and raised inflammatory markers post G-CSF treatment.

Rare complication of COVID-19 presenting as isolated headache.

An 18-year-old man presented with persistent isolated headache 2 weeks after recovering from acute COVID-19 illness. Extensive cerebral venous sinus thrombosis (CVST) was detected on CT venogram despite him having no other thrombotic risk factors. CVST can complicate COVID-19. A high index of clinical suspicion is warranted as it can often have a subtle presentation with paucity of neurological symptoms.

Fibrin sealant for management of complicated obstetric lacerations.

BACKGROUND: Fibrin sealant commonly is used topically for hemostasis in cardiovascular surgery. Complicated vulvar and vaginal bleeding after vaginal delivery can be difficult to manage using traditional techniques. CASE: A 21-year-old primipara, after a spontaneous vaginal delivery of a twin gestation, was found to have expanding right labial swelling and ecchymosis extending from the superior part of the labia majora to the ischial fossa that was approximately 10 cm wide. Surgical exploration was pursued, but poor tissue quality limited the effectiveness of traditional hemostatic techniques. Prompt hemostasis was achieved with application of fibrin sealant. CONCLUSION: Fibrin sealant may be useful for hemostasis when traditional techniques fail in complicated lacerations of the vulva and vagina associated with obstetric delivery.

Concurrent cisplatin and radiotherapy in advanced head and neck cancer.

Management of Head and Neck Cancers poses a challenge inspite of several advances because of poor success in terms of response rate, survival and reduced morbidity of the patients. In the present study 30 untreated histologically proven cases of head and neck cancers were subjected to weekly radiotherapy with adjuvant chemotherapy (cisplatin 30 mg/m(2) intravenously). This study group was compared with a group of 30 patients who were given only radiotherapy. Results have shown that combination of chemotherapy with radiotherapy gives a significantly better results in tumour as well as nodal response with minimal toxicities.