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1.
Int J Gynaecol Obstet ; 162(1): 333-338, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36744808

RESUMO

OBJECTIVE: To introduce the Perinatal Early Assessment and Communication system for Emergencies (PEACE), a dedicated internet-based system for sharing maternal and newborn health information during large-scale disaster. METHODS: PEACE was developed by the Japan Society of Obstetrics and Gynecology (JSOG) to enable internet-based sharing of maternal and newborn support information between facilities and rescue teams in disaster areas. PEACE input rates during prefecture-scale disasters and in disaster drills were surveyed for two facility categories: centers for perinatal medical care (CPMs) and combined clinics + regional general hospitals. RESULTS: The PEACE input rate was 60%-100% (mean 86%) for CPMs and 5%-86% (mean 47%) among clinics + regional general hospitals. After encouraging PEACE input from JSOG, the Japan Association of Obstetricians and Gynecologists (JAOG), and the disaster response departments of prefectural governments, input rates increased significantly from 74% to 98% in CPMs (P = 0.018) and from 14% to 80% in clinics + regional general hospitals (P = 0.020). CONCLUSION: JSOG has established the first national system for sharing health information of pregnant women and newborns for use during disasters. The cooperation of prefectures and experience during disaster drills were critical to improving PEACE input rates.


Assuntos
Planejamento em Desastres , Desastres , Humanos , Feminino , Recém-Nascido , Gravidez , Inquéritos e Questionários , Japão
2.
Case Rep Obstet Gynecol ; 2021: 1809017, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35127187

RESUMO

Metastatic uterine tumors originating from extragenital cancers are a rare clinical occurrence. We report a case of metastatic uterine cancer derived from small-cell lung cancer (SCLC) that necessitated surgical treatment. The patient was a 59 y/o female who had undergone chemotherapy for stage IIIB SCLC. A 15 cm uterine tumor lesion was initially detected on CT scans. The patient had previously been diagnosed with uterine fibroids, but compared to the most recent CT scans taken one and a half months earlier, imaging diagnosis revealed a sudden increase in the size of the tumor when compared to the 8 cm myoma fibroid noted previously. Additional work-up with MRI scans revealed T2-enhanced images of a tumor that had almost completely invaded the myometrium; the tumor presented with marked diffusion-weighted enhancement, and a flow void was noted within the tumor. A differential diagnosis of uterine sarcoma was considered, but due to the lack of focal hemorrhage or necrosis findings on MRI imaging, the possibility of differential diagnosis of metastatic SCLC was also noted. As the patient was experiencing abdominal symptoms including abdominal distension and tenderness due the tumor, a simple hysterectomy and bilateral salpingo-oophorectomy were performed to palliate the symptoms. During the surgical procedures, intra-abdominal findings noted peritoneal dissemination while intraoperative cell cytology diagnosis of ascites revealed small-cell cancer. The final histopathological diagnosis likewise revealed metastatic small-cell cancer from the primary lung cancer. The clinical status of the lung cancer was evaluated as progressive disease (PD), and a change in chemotherapy regimen was necessitated. Further disease progression was noted on CT scans at 2 and a half months after surgery, and with gradual systemic disease progression, the patient died of disease at 3 months postsurgery. Initial evaluation of rapidly enlarging uterine tumors should include a differential diagnosis of uterine sarcoma; additionally, it is necessary to also consider the rare possibility of metastatic disease as in the present case with a clinical history of extragenital malignancy.

3.
J Obstet Gynaecol Res ; 45(1): 189-194, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30152048

RESUMO

AIM: Leiomyosarcoma is the most common type of uterine sarcoma. In some leiomyosarcoma cases, preoperative diagnosis might be difficult, and they might be treated as benign lesions. We evaluated diagnostic values of preoperative serum lactate dehydrogenase (LDH), D-dimer and C-reactive protein for differentiating leiomyosarcoma. METHODS: From 2008 to 2013, leiomyosarcoma cases in three university hospitals were enrolled. Preoperative serum LDH, D-dimer and C-reactive protein were analyzed if tested. These markers of pathologically diagnosed leiomyoma cases presumed benign (group B) and presumed malignant (group PM) were compared with those of leiomyosarcoma cases (group S). RESULTS: Groups S, PM and B had 36, 28 and 69 cases, respectively. Positive rates of LDH were 66.7%, 14.3% and 0% in groups S, PM and B, respectively. Positive rates of D-dimer and C-reactive protein were 83.3% and 64.5%, 17.9% and 10.7% and 5% and 2.9% in groups S, PM and B, respectively. Positive rates of all three markers were high in the order of leiomyosarcoma, atypical leiomyoma and typical leiomyoma. In group PM, 12 (63.2%) cases were negative for all three markers, whereas 1 (3.3%) case was negative in group S. No case was positive for all markers in group PM, whereas 41.2% leiomyosarcoma cases were positive for all markers. When all parameters were positive, specificity and positive predictive value were 100% in differentiating leiomyosarcoma from group PM. CONCLUSION: Combination of LDH, D-dimer and C-reactive protein could be useful for distinguishing leiomyosarcoma from especially degenerated or atypical leiomyoma.


Assuntos
Biomarcadores Tumorais/sangue , Análise Química do Sangue/normas , Proteína C-Reativa/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , L-Lactato Desidrogenase/sangue , Leiomiossarcoma/diagnóstico , Neoplasias Uterinas/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Leiomiossarcoma/sangue , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Neoplasias Uterinas/sangue
4.
J Obstet Gynaecol Res ; 43(8): 1335-1341, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28557190

RESUMO

AIM: The maximum standardized uptake value (SUVmax) of primary tumors in positron emission tomography can be used to predict prognosis in various cancers, but its significance in recurrent tumors remains unclear. In the present study, we evaluated the utility of the SUVmax for predicting therapeutic effects in recurrent gynecological malignancies. METHODS: From February 2012 to July 2014, patients with recurrent gynecological cancer who were treated with chemotherapy or radiotherapy were enrolled in this study. The SUVmax of recurrent lesions before treatment were compared to the therapeutic effects. RESULTS: Fifty patients with recurrent gynecological cancer were enrolled. The mean SUVmax was significantly higher in patients with stable disease/progressive disease than in patients who achieved complete remission/partial remission (13.24 ± 9.78 vs 8.61 ± 5.34, P = 0.039). In patients who were administered chemotherapy, the SUVmax was significantly higher in those with stable disease/progressive disease than in those who achieved complete remission/partial remission (13.24 ± 9.78 vs 8.61 ± 5.34, P = 0.0392) as well as those administered radiotherapy or concurrent chemoradiation therapy (18.15 ± 3.25 vs 11.33 ± 3.98, P = 0.0073). In ovarian cancer patients administered chemotherapy, when the cut-off value of the SUVmax was set as 6.94, the sensitivity and specificity of predicting therapeutic effects were 0.75 and 0.846, respectively. CONCLUSION: Although the number of enrolled cases was small, our study revealed that the SUVmax in recurrent gynecological tumors might predict therapeutic effects. If the SUVmax is relatively high, multimodal therapy, including surgical removal, should be considered.


Assuntos
Carcinoma/diagnóstico , Neoplasias dos Genitais Femininos/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/terapia , Feminino , Neoplasias dos Genitais Femininos/terapia , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/terapia , Prognóstico , Estudos Retrospectivos , Adulto Jovem
5.
Int J Clin Oncol ; 22(3): 533-540, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28083737

RESUMO

BACKGROUND: Prognostic clinicopathological factors for type 1 endometrial cancer are unknown and the purpose of the current study was to determine the independent prognostic variables for type 1 endometrial cancer. METHODS: We performed a retrospective study of 168 patients with type 1 endometrial cancer primarily treated with comprehensive staging surgery. The median follow-up time was 68 (12-100) months. Independent risk factors for disease-free survival (DFS) and overall survival (OS) were determined using multivariate Cox regression models. Sub-group analysis of stage I was also performed. We also assessed the patterns of failure among patients with recurrences and investigated the associations with the prognostic variables determined by multivariate analysis. RESULTS: Twenty patients (11.9%) had recurrence and 13 patients (7.7%) died of the disease overall. Multivariate analysis revealed that grade 2 (G2) histology (p = 0.008) and positive peritoneal cytology (p = 0.001) predicted the recurrent event in type 1 endometrial cancer. G2 histology (p = 0.007) and positive peritoneal cytology (p = 0.003) were also found to be independent risk factors for tumor-related deaths. Among stage I patients, G2 histology and positive peritoneal cytology were also independent prognostic variables for DFS and OS. Patients with G2 histology and/or positive peritoneal cytology were more likely to have recurrence at distant sites. CONCLUSIONS: G2 histology and positive peritoneal cytology were independent prognostic factors for DFS and OS in type 1 endometrial cancer.


Assuntos
Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/patologia , Idoso , Citodiagnóstico , Intervalo Livre de Doença , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
6.
Redox Rep ; 22(6): 361-366, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27866464

RESUMO

OBJECTIVES: Endometriotic cyst fluid (ECF) contains a large amount of reactive oxygen species (ROS), and endometriotic cysts are exposed to strong oxidative stress, which may cause malignant transformation. In this study, ROS production by ECF was clinically analysed. METHODS: Human immortalized epithelial cells derived from ovarian endometrioma (EMosis-CC/TERT 1) were treated with ECF. In addition, ROS production in EMosis-CC/TERT 1 was measured, and its clinical significance was analysed. RESULTS: A total of 38 ECF samples were obtained from patients diagnosed with endometriotic cysts. In EMosis-CC/TERT1, significantly higher levels of ROS were induced by ECF than by the vehicle control and ferric nitrilotriacetate. There were no significant differences in ROS production by laterality and preoperative serum CA125 values. There were several patients whose cyst sizes were approximately 5 cm and had relatively high ROS production. Production of ROS by ECF was relatively higher in patients older than 40 years of age than in those younger than 40. DISCUSSION: Our study revealed that ROS are highly produced by ECF in EMosis-CC/TERT1 cells; therefore, exposure to ECF induced strong oxidative stress. Development of a therapeutic strategy to reduce ROS production might be useful for preventing malignant transformation of endometriotic cysts.


Assuntos
Líquido Cístico/metabolismo , Endometriose/metabolismo , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Adulto , Antígeno Ca-125/sangue , Linhagem Celular , Transformação Celular Neoplásica , Endometriose/sangue , Feminino , Humanos , Proteínas de Membrana/sangue , Estresse Oxidativo/efeitos dos fármacos
7.
Taiwan J Obstet Gynecol ; 54(3): 294-6, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26166344

RESUMO

OBJECTIVE: The marker for the early diagnosis of endometriotic cyst rupture is unknown. We report a preliminary study designed to evaluate the relationship between plasma D-dimer levels and endometriotic cyst rupture in clinical case series. MATERIALS AND METHODS: We reviewed the patients' records of endometriotic cyst rupture cases, and the background (i.e., age, body mass index, and parity) and preoperative laboratory assessments (i.e., white blood cell count, levels of serum C-reactive protein, serum CA125, and plasma D-dimer) of the patients were compared with those of unruptured cases. RESULTS: Emergency surgery cases of endometriotic cyst rupture (n = 6) and planned surgery cases of unruptured endometriotic cysts as controls (n = 16) were reviewed. Backgrounds of the patients were not significantly different between the two groups. The plasma D-dimer level was significantly higher in the rupture cases (8.5 µg/mL vs. 0.20 µg/mL, p < 0.001). Differences in white blood cell count and serum C-reactive protein level, but not serum CA125 level, were found to be statistically significant between groups. CONCLUSION: An elevation of plasma D-dimer level is associated with endometriotic cyst rupture.


Assuntos
Endometriose/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Cistos Ovarianos/sangue , Adulto , Proteína C-Reativa/metabolismo , Antígeno Ca-125/sangue , Endometriose/complicações , Endometriose/cirurgia , Feminino , Humanos , Contagem de Leucócitos , Cistos Ovarianos/complicações , Cistos Ovarianos/cirurgia , Ruptura Espontânea/sangue , Ruptura Espontânea/complicações , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/cirurgia
8.
J Obstet Gynaecol Res ; 41(7): 1145-8, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25656985

RESUMO

Brain metastasis from uterine cervical cancer is rare, with an incidence of 0.5%, and usually occurs late in the course of the disease. We report a case of uterine cervical cancer with brain metastasis as the initial site of presentation. A 50-year-old woman with headache, vertigo, amnesia and loss of appetite was admitted for persistent vomiting. Contrast enhanced computed tomography showed a solitary right frontal cerebral lesion with ring enhancement and uterine cervical tumor. She was diagnosed with uterine cervical squamous cell carcinoma with parametrium invasion and no other distant affected organs were detected. The cerebral lesion was surgically removed and pathologically proved to be metastasis of uterine cervical squamous cell carcinoma. The patient underwent concurrent chemoradiotherapy, followed by cerebral radiation therapy, but multiple metastases to the liver and lung developed and the patient died 7 months after diagnosis of brain metastasis.


Assuntos
Neoplasias Encefálicas/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Amnésia/etiologia , Anorexia/etiologia , Doenças Assintomáticas/terapia , Neoplasias Encefálicas/fisiopatologia , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Carcinoma de Células Escamosas/fisiopatologia , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Diagnóstico Tardio , Evolução Fatal , Feminino , Neoplasias de Cabeça e Pescoço/fisiopatologia , Neoplasias de Cabeça e Pescoço/secundário , Neoplasias de Cabeça e Pescoço/terapia , Cefaleia/etiologia , Humanos , Japão , Pessoa de Meia-Idade , Carcinoma de Células Escamosas de Cabeça e Pescoço , Neoplasias do Colo do Útero/terapia , Vertigem/etiologia , Vômito/etiologia
9.
J Obstet Gynaecol Res ; 40(6): 1754-8, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24888944

RESUMO

AIM: The incidence of preoperative deep venous thrombosis (DVT) was examined in patients with pelvic organ prolapse (POP). MATERIAL AND METHODS: Preoperative screening for DVT was performed on the basis of D-dimer levels; if D-dimer levels were beyond the cut-off limit (0.5 µg/mL), ultrasound examination of the lower extremities was performed. A total of 75 consecutive patients who were scheduled for POP operation in our department were examined retrospectively. RESULTS: D-dimer levels were elevated in 24 patients (31.6%). Further, DVT was detected in 10 of the 75 patients, resulting in an incidence rate of 13.3% in the present study. D-dimer levels were significantly higher in the patients with DVT (1.25 ± 0.52 µg/mL vs 0.41 ± 0.26 µg/mL). There was no significant difference in age, and although body mass index and the number of diabetes mellitus cases were relatively higher in the patients with DVT than in those without DVT, there were no statistically significant differences. According to a receiver-operator curve, the suggested cut-off D-dimer value was 0.71 µg/mL (sensitivity and specificity was 0.9 and 0.877, respectively). CONCLUSIONS: Although this was a preliminary study, to the best of our knowledge, this is the first report describing the incidence of preoperative DVT in patients with POP. Our study indicates that the incidence of DVT in patients with POP might have been underestimated thus far. Therefore, every surgeon should evaluate patients for DVT prior to any surgical procedure for POP, particularly in those patients with obesity or diabetes mellitus.


Assuntos
Prolapso de Órgão Pélvico/complicações , Trombose Venosa/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Japão/epidemiologia , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/cirurgia , Período Pré-Operatório , Estudos Retrospectivos , Trombose Venosa/epidemiologia
10.
J Obstet Gynaecol Res ; 40(6): 1823-7, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24888958

RESUMO

Primary retroperitoneal Müllerian adenocarcinoma (PRMA) is an extremely rare tumor and the cause remains unknown. We report a case of PRMA arising from endometriosis. A 52-year-old woman with a history of malignant lymphoma underwent a follow-up computed tomography scan, which revealed a retroperitoneal tumor. Immunohistochemical analysis of tumor resected during laparoscopic surgery showed adenocarcinoma positive for cytokeratin 7 and negative for cytokeratin 20. The patient had undergone hysterectomy and bilateral salpingo-oophorectomy 14 years ago for myoma uteri and endometrial cysts and was treated with estrogen-replacement therapy. The size of the tumor increased and laparotomy was performed. Histopathological examination showed adenocarcinoma resembling endometrial adenocarcinoma, which stained positive for cancer antigen 125, cancer antigen 19-9, estrogen receptor, and progesterone receptor immunohistochemically. The focus of the endometriosis was found at the edge of the tumor, and the stromal cells around the tumor cells were CD10 positive. The patient was diagnosed as having PRMA arising from endometriosis, and treated with adjuvant chemotherapy.


Assuntos
Adenocarcinoma/etiologia , Endometriose/complicações , Neoplasias Retroperitoneais/etiologia , Adenocarcinoma/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Retroperitoneais/patologia , Espaço Retroperitoneal/patologia
11.
J Obstet Gynaecol Res ; 39(8): 1363-6, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23800271

RESUMO

We report an extremely rare case of primary ovarian Burkitt lymphoma. A 15-year-old girl was referred to our department because of persistent constipation and abdominal distension. Abdominal computed tomography and magnetic resonance imaging revealed a 10-cm-diameter solid tumor located on the right side of the uterus. Serum lactate dehydrogenase and carbohydrate antigen-125 levels were elevated at 3250 IU/L and 235.7 U/mL, respectively. Initially, ovarian dysgerminoma was suspected, but poor performance and progressive disease were suggestive of malignant lymphoma. However, bone marrow aspiration and ascitic fluid cytology findings were not indicative of lymphoma. Laparotomy was performed to confirm pathology. On laparotomy, the right ovary was firm and enlarged, but the uterus and left ovary were normal. Diffuse thickness of retroperitoneal space was observed. Right salpingo-oophorectomy was performed, and the tumor was diagnosed as Burkitt lymphoma. Although intensive chemotherapy was administered, the patient died 171 days after the initial operation.


Assuntos
Linfoma de Burkitt/diagnóstico , Neoplasias Ovarianas/diagnóstico , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma de Burkitt/tratamento farmacológico , Linfoma de Burkitt/patologia , Linfoma de Burkitt/cirurgia , Resistencia a Medicamentos Antineoplásicos , Evolução Fatal , Feminino , Humanos , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia
12.
Int J Gynecol Cancer ; 21(6): 1143-9, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21792017

RESUMO

BACKGROUND: Diagnosis of cancer causes psychological distress. The present study investigated the safety and efficacy of fluvoxamine therapy in gynecologic cancer patients with either adjustment disorder or major depression after cancer was diagnosed. METHODS: Screening with the Hospital Anxiety and Depression Scale (HADS) was conducted at least 2 weeks after notification of the diagnosis of cancer in 214 gynecologic cancer patients hospitalized between January 2007 and December 2008. The HADS cutoff score was set at 11 points or greater. Informed consent to the study was obtained from 10 patients, and fluvoxamine was administered for 8 weeks. As primary end points, the safety and efficacy of fluvoxamine were evaluated using the HADS and the SF-36. As a secondary end point, the Clinical Global Impression was determined. RESULTS: The total HADS score, the anxiety score, and the depression score were significantly reduced after 6, 4, and 6 weeks of treatment, respectively. The SF-36 revealed significant improvement in vitality, mental health, and role (emotional) after 8 weeks of treatment. In the 5 patients with adjustment disorder, only the HADS anxiety score was significantly reduced after 4 weeks. In the 5 patients with major depression, the total HADS score, the anxiety score, and the depression score were significantly reduced after 6, 8, and 6 weeks, respectively. According to the SF-36, the adjustment-disorder groups showed significant improvement in mental health after 8 weeks of treatment, whereas the major-depression group showed significant improvement in vitality and role (emotional) after 8 weeks. No adverse events occurred in any subject. Assessment of the Clinical Global Impression suggested that fluvoxamine improved psychological distress in all 10 subjects. CONCLUSIONS: The present findings suggest that fluvoxamine is useful for alleviating psychological distress, including adjustment disorder and major depression, in gynecologic cancer patients. Management of psychological distress after diagnosis of cancer is important.


Assuntos
Ansiolíticos/administração & dosagem , Transtornos de Ansiedade/tratamento farmacológico , Fluvoxamina/administração & dosagem , Neoplasias dos Genitais Femininos/psicologia , Adulto , Idoso , Terapia Combinada , Feminino , Neoplasias dos Genitais Femininos/tratamento farmacológico , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Pessoa de Meia-Idade , Psicometria , Qualidade de Vida , Índice de Gravidade de Doença , Inquéritos e Questionários , Resultado do Tratamento
13.
J Obstet Gynaecol Res ; 37(7): 800-8, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21450027

RESUMO

AIM: Anxiety and depression are common in cancer patients, because diagnosis of cancer raises the fear of death. Although mental problems are often overlooked in cancer patients, it is important to control psychological distress, improve the quality of life, encourage patients to express requests about cancer therapy appropriately, and reduce the burden on family members. MATERIAL & METHODS: There were 214 patients admitted to the Department of Obstetrics and Gynecology of St. Marianna University Hospital for treatment of cancer between January 2007 and December 2008. At 2 weeks after learning the diagnosis of cancer, these patients completed a Hospital Anxiety and Depression Scale (HADS) questionnaire, and their psychological characteristics were investigated in relation to age, tumor type and time after learning the diagnosis. The cut-off value for intervention to manage maladjustment and major depression was set at a HADS score of 11. RESULTS: The HADS score was 11 in 118 of the 214 patients (55.1%). The HADS score for anxiety was higher in younger patients, while the HADS score for depression was higher in older patients. There were no significant correlations between the HADS score and the type of gynecologic cancer (cervical cancer, endometrial cancer and ovarian cancer) or the time after learning the diagnosis. CONCLUSION: Assessment based on the HADS score revealed a high prevalence of psychological problems after announcement of the diagnosis of gynecologic cancer. This emphasizes the importance of psychiatric intervention when patients are informed of their condition.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Neoplasias dos Genitais Femininos/psicologia , Adulto , Idoso , Atitude Frente a Saúde , Feminino , Humanos , Japão/epidemiologia , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , Estresse Psicológico/psicologia
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