Cytopathologic follow-up of women with cervical cancer post-radiotherapy: case series / Citopatologia de seguimento em mulheres com câncer de colo do útero após radioterapia: série de casos

ABSTRACT Cytopathology, in addition to its role in cervical cancer screening programs, is also an important tool for controlling the efficacy of treatment in women with cervical cancer by monitoring and early detecting residual, recurrent neoplasms or benign reactive changes. In this study, we report eight cases of cytopathologic follow-up of women with cervical cancer post-radiotherapy, assisted by a Center of Oncology in Pernambuco. The main cytological findings post-treatment were described,as well as the histopathological characteristics at diagnosis and the treatments performed.

RESUMO A citopatologia, além de seu papel nos programas de rastreio do câncer cervical, é uma importante ferramenta para o controle da eficácia do tratamento em mulheres com câncer de colo do útero, monitorando e detectando precocemente neoplasias residuais, recorrentes ou alterações reacionais benignas. Neste trabalho, relatamos oito casos de citopatologia de seguimento em mulheres com câncer de colo do útero após tratamento radioterápico, assistidas por um centro de oncologia pernambucano. Os principais achados citológicos pós-tratamento foram descritos, assim como as características histopatológicas ao diagnóstico e os tratamentos realizados.

Long-term esophageal motility changes after thyroidectomy: associations with aerodigestive disorders.

BACKGROUND: Patients undergoing thyroidectomy often complain aerodigestive disorders. In a previous study we showed the associations between voice impairment and proximal acid reflux, swallowing impairment and Upper Esophageal Sphyncter (UES) incoordination and the decrease in UES pressure in thirty-six patients observed before and soon afterwards uncomplicated thyroidectomy. This study investigated the state of post-thyroidectomy esophageal motility changes and its associations with these disorders after 18-24 months. PATIENTS AND METHODS: The thirty-six patients prospectively recruited according to selection criteria (thyroid volume ≤60 ml, benign disease, age 18-65 years, previous neck surgery, thyroiditis, pre- or postoperative vocal cord palsy) underwent voice (VIS) and swallowing (SIS) impairment scores, esophageal manometry and pH monitoring once again. RESULTS: After 18-24 months, both VIS and SIS recovered (respectively: p=0,022; p=0,0001); UES pressure increased (p=0,0001) nearing the preoperative values. The persistence of swallowing complaints were associated with the persistence of esophageal incoordination (p=0,03); the association between voice impairment and proximal acid reflux was confirmed (p<0,001). CONCLUSIONS: Our study confirms that aerodigestive disorders after uncomplicated thyroidectomy, largely transient, are strictly connected with upper esophageal motility changes. In this viewpoint, the innervation of upper aerodigestive anatomical structures (larynx, pharynx, upper esophagus) and its variations should be focused.

Detection and localization of deep endometriosis by means of MRI and correlation with the ENZIAN score.

PURPOSE: To determine the accuracy of ENZIAN score, as detected on MR imaging, compared to surgical-pathologic findings. MATERIALS AND METHODS: This retrospective study was approved by the investigational review board and the requirement for informed patient consent was waived. 115 patients were included according to following criteria: tubo-ovarian and/or deep endometriosis suspected at physical examination and transvaginal ultrasound; availability of MR examination; histopathological results from laparoscopic or surgical treatment. EXCLUSION CRITERIA: lack of available MR examination, and/or (b) lack of a definitive histopathological results. Histopathological findings from bioptic specimens obtained during laparoscopic or laparotomic treatment were considered as reference standard. For all detected lesions a score according to ENZIAN score (revised 2010) was assigned both for MRI and histopathological findings. By comparing MRI-ENZIAN score and histopathological-ENZIAN score the overall sensitivity, specificity, accuracy, positive and negative predictive values in relation to presence/absence of deep endometriosis in each patient were calculated. k-Cohen to evaluate the degree of concordance between MRI-ENZIAN score and histopathological-ENZIAN score was also measured. Moreover the sensitivity, specificity, accuracy, positive and negative predictive values for each specific localization provided by ENZIAN score were also calculated. RESULTS: At histopathology, the diagnosis of deep endometriosis was confirmed in 82/115 (71.3%) patients. The sensitivity, specificity, accuracy, PPV and NPV of MRI were 94%, 97%, 95%, 99%, 86%, respectively. The highest accuracy was for adenomyosis (100%) and endometriosis of utero-sacral ligaments (USLs) (98%), slightly lower for vagina-rectovaginal septum an colo-rectal walls (96%), and the lowest for bladder endometriosis (92%). The concordance between histopathological and MRI ENZIAN score was excellent (k=0.824); in particular it was 0.812 for lesions in vagina-rectovaginal space, 0.890 for lesions in USL, 0.822 for lesions in rectum-sigmoid colon, 1.000 for uterine adenomyosis, and 0.367 for lesions located in the bladder wall. CONCLUSION: MRI correlates with the ENZIAN score and has an accuracy of 95% in the detection and localization of deep endometriosis, allowing to minimize false negative results (4%) in patients with deep endometriosis and to obtain a correct preoperative staging.

Evaluating the efficacy of current treatments for reducing postoperative ileus: a randomized clinical trial in a single center.

AIM: Postoperative ileus has been considered an inevitable consequence of abdominal surgery. The aim of the study was to investigate the efficacy of same treatments in resolving postoperative ileus in various surgical approaches. METHODS: A total of 360 patients underwent abdominal surgery, and was divided into four groups: videolaparoscopic cholecystectomy, laparotomic colo-rectal surgery, laparotomic Hartmann procedure, laparotomic gastric surgery. In each group, patients received different postoperative treatments: chewing gum, olive oil, both, and water. Each group was compared with a control group. RESULTS: In patients who underwent videolaparoscopic cholecystectomy, median postoperative first passage of flatus and stool in the water group was 10 and 34 hours, respectively (P=0.006, P=0.021) and significantly earlier than in the control group (median postoperative 24 and 72 hours). Postoperative stay for the water group was lower (median day 1, 3rd interquartile 2.5) compared with control (median day 3; 3rd interquartile 7.0, P=0.01). In patients who underwent gastric surgery, median postoperative first passage of stool in the olive oil and chewing gum group was 48 hours, significantly earlier than in the control (median postoperative hour 120, P=0.04). Median time to first passage of flatus and stool was also earlier in the other groups compared with the control group, though this difference was not significant. CONCLUSION: Chewing gum, olive oil or both do not induce a relevant reduction of ileus after surgery. Water may be a safe and inexpensive option in reducing ileus. (United States National Institutes of Health, www.clinicaltrial.gov, number NCT01869231).

Minimally invasive video-assisted thyroidectomy: four-year experience of a single team in a General Surgery Unit.

AIM: Minimally invasive video-assisted thyroidectomy (MIVAT) is a surgical technique that has showed increasingly good results, particularly in endocrine surgery centers. The aim of this prospective, non-randomized study was to evaluate feasibility, advantages and critical aspects of MIVAT in a general surgery unit. METHODS: Two hundred twenty-four patients underwent total thyroidectomy for benign thyroid disease from May, 2008 to April, 2011. They were divided into two groups: one underwent conventional thyroidectomy (CT), and the other underwent MIVAT. The inclusion criteria were thyroid volume ≤35 mL and main nodule size ≤35 mm. For each patient, socio-demographic variables, hospitalization data and outcome measures (complication rate, operating time, post-operative pain, observer and patient scar assessment scale [OSAS and PSAS, respectively]) were collected. Multivariate regression analyses were done to assess the principal covariates affecting these outcome measures. RESULTS: There were 125 MIVATs and 99 CTs performed. The two groups were characterized by difference in age (38.4 vs. 50.9 years) and thyroid volume (18.6 vs. 23.3 mL). OSAS/PSAS scores were statistically significant in the MIVAT group (P<0.001 and P<0.001, respectively) even after adjusting for age and thyroid volume. Complication rate was similar in the two groups. CONCLUSION: MIVAT significantly decreased postoperative pain and improved cosmetic results. It can be performed in younger patients and in all cases in which there is a clear indication for the procedure. Its advantages were confirmed in a general surgery unit where correct indications were followed.