Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 15 de 15
Filtrar
1.
Anticancer Res ; 40(2): 1095-1100, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014959

RESUMO

BACKGROUND/AIM: Fibroepithelial lesions (FEL) of the breast include fibroadenomas and phyllodes tumors (PT). Their histologic characteristics on core needle biopsy can overlap, while their clinical management is different. The aim of this study was to develop and to validate a pre-operative score for the diagnosis of PT with surgical decision rules. PATIENTS AND METHODS: We developed a pre-operative score for the diagnosis of PT by performing logistic regression on 217 FEL of the Rene Huguenin Hospital. This score and the surgical decision rules were validated on 87 FEL of the Lariboisiere Hospital. RESULTS: Three variables were independently and significantly associated with PT: age ≥40 years, mammography's tumor size ≥3 cm and PT diagnosed by CNB. The pre-operative score was based on these three criteria with values ranging from 0 to 10. Surgical decision rules were created: the low-risk group of PT (score≤2) had a sensitivity of 92.6% and a LR- of 0.2, the high-risk group (score>7) had a specificity of 93.5% and a LR+ of 4.4. In the validation sample, surgical decision rules were applied. CONCLUSION: These surgical decision rules may prove useful in deciding which FEL needs surgical resection.


Assuntos
Neoplasias da Mama/diagnóstico , Mama/patologia , Fibroadenoma/diagnóstico , Neoplasias Fibroepiteliais/diagnóstico , Tumor Filoide/diagnóstico , Adulto , Biópsia com Agulha de Grande Calibre , Neoplasias da Mama/cirurgia , Tomada de Decisão Clínica , Diagnóstico Diferencial , Gerenciamento Clínico , Feminino , Fibroadenoma/cirurgia , Humanos , Mamografia , Pessoa de Meia-Idade , Neoplasias Fibroepiteliais/cirurgia , Tumor Filoide/cirurgia , Curva ROC , Estudos Retrospectivos , Adulto Jovem
2.
Bull Cancer ; 104(10): 892-901, 2017 Oct.
Artigo em Francês | MEDLINE | ID: mdl-28890124

RESUMO

Sentinel lymph node biopsy has replaced axillary lymph node dissection in those patients with clinically node-negative axilla without compromising their oncologic outcomes. Indication of neoadjuvant chemotherapy has been extended to patients to evaluate the pathologic response and to offer more conservative breast surgery. Sentinel lymph node dissection after neoadjuvant chemotherapy is feasible and accurate in patients with clinically node-negative patients. The timing of the sentinel lymph node biopsy, before or after medical treatment has been studied with benefits for each procedure. Sentinel lymph node dissection has been explored in different randomized prospective studies in clinically positive axilla with the aim of reduce axillary lymph node dissection. However, several studies are necessary to more accurately identify residual axillary disease and the sentinel lymph node after neoadjuvant chemotherapy, to adjust the adjuvant radiotherapy protocols and to evaluate the impact on oncologic outcomes.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Biópsia de Linfonodo Sentinela , Linfonodo Sentinela/cirurgia , Axila , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante , Feminino , Humanos , Excisão de Linfonodo , Terapia Neoadjuvante/métodos , Neoplasia Residual , Tratamentos com Preservação do Órgão , Fatores de Tempo
4.
Bull Cancer ; 104(4): 356-362, 2017 Apr.
Artigo em Francês | MEDLINE | ID: mdl-28214005

RESUMO

Management of breast cancer is based on national and international guidelines. These are defined on evidence-based medicine. The main purpose of this review is to compare the different guidelines for sentinel lymph node biopsy and completion axillary dissection after positive sentinel lymph node biopsy. This review of breast cancer guidelines led to identify consensus, but in some specific situations, they differ. The guidelines cannot be applied to all clinical cases, mandatoring multidisciplinary meetings are essential.


Assuntos
Neoplasias da Mama/cirurgia , Guias de Prática Clínica como Assunto , Biópsia de Linfonodo Sentinela/normas , Axila , Neoplasias da Mama/patologia , Consenso , Diagnóstico por Imagem/métodos , Feminino , França , Humanos , Internacionalidade , Excisão de Linfonodo/normas , Gravidez , Complicações Neoplásicas na Gravidez/patologia , Complicações Neoplásicas na Gravidez/cirurgia , Sociedades Médicas , Carga Tumoral
5.
Gynecol Oncol ; 144(3): 647-648, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28081882

RESUMO

OBJECTIVE: To show laparoscopic surgery to treat vaginal shortening, with functional sequelae (sexual disorders), after radiotherapy and brachytherapy for vaginal carcinoma. METHODS: Davydov's procedure was initially described to treat vaginal aplasia (Davydov & Zhvitiashvili, 1974). This surgery was then improved for the upper part of the vagina, performed by laparoscopy (Leblanc, 2010; Adamyan, 1995) [2-3]. We used surgical technique, based on Davydov's procedure, by laparoscopy, to cover the upper neovagina, with two large peritoneal flaps, one anterior with the pre-vesical peritoneum and a second one posterior with the peritoneum of Douglas pouch. This surgery can be performed with no use of intestinal gesture, skin grafting, flap or any foreign material. Leblanc et al. (2016) [4] reported promising results about eight patients with this technique. RESULTS: A 36-years old patient had been treated by chemotherapy, radiotherapy and brachytherapy for a vagina cancer with a para-rectal extension. After four years of remission, she was worried about an important vaginal atrophy related to a significant vaginal shortening (about 5cm), causing major dyspareunia. This situation had caused sexual disorders with a real impact on the quality of life. All non-invasive techniques (dilatators, lubricants…) had led to failures. A colpoplasty by laparoscopic modified Davydov's procedure was performed. The post-operative follow-up was simple without complication. The vaginal mandrel was removed after 12days. The clinical examination after 4months demonstrates that size and elasticity of the neovaginal cavity was rewarding. CONCLUSION: This surgical technique requires training and experienced team, but seems to be promising way to restore a normal vaginal length.


Assuntos
Laparoscopia/métodos , Neoplasias Vaginais/cirurgia , Adulto , Feminino , Humanos
6.
Bull Cancer ; 103(6): 513-23, 2016 Jun.
Artigo em Francês | MEDLINE | ID: mdl-27238445

RESUMO

OBJECTIVE: The "Institut national du cancer" has established since 2007 a minimum threshold of 20 patients per year per center to treat patients with gynecologic cancer. This review aims to assess whether the literature data validate this approach, and specifically for ovarian cancer. METHODS: A search of the MEDLINE database was conducted, to reference all relevant articles evaluating one hand the links between the survival of patients with ovarian cancer and the average volume of patients per center and by operator; and secondly the relationship between quality of oncological surgery and these volumes. RESULTS: Nineteen studies met our inclusion criteria; seventeen were retrospective and two were prospective; population samples ranged from 476 to 96,802 patients. The most important data, quantitatively and qualitatively, concern the evaluation of survival based on the average volume per center, with 8 out of 13 studies finding a statistically significant correlation between average volume per center and survival. Data on the quality of surgery are less abundant and more heterogeneous, depending on the definition of the "optimal" surgery by the authors. CONCLUSION: The establishment of threshold centers appears to be an effective way to improve survival in ovarian cancer. However, these thresholds would have to be specific to ovarian cancer and not extended to "gynecological cancers."


Assuntos
Institutos de Câncer/estatística & dados numéricos , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/cirurgia , Feminino , Neoplasias dos Genitais Femininos/mortalidade , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Cirurgiões/estatística & dados numéricos , Análise de Sobrevida
7.
Gynecol Oncol ; 140(2): 372-3, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26621604

RESUMO

OBJECTIVE: To show the contribution of PlasmaJet™, technology using pur gaz plasma as electrically neutral source of energy to cut and coagulate tissue, in ovarian cancer surgery. METHODS: A forty eight years old patient was diagnosed with an ovarian cancer. The first laparoscopy allowed one to make histological diagnosis (ovarian high-grade serous carcinoma) and determine that the disease was resecable, with a PCI to ten. The film shows the upper abdominal time of the cytoreduction surgery, using PlasmaJet™. RESULTS: The surgery included: stripping of the peritoneum of the right diaphragm and full thickness diaphragmatic resection, stripping of the peritoneum of left diaphragm splenectomy, resection of the greater and the lesser omentums, pelvic lymphadenectomy and para-aortic lymphadenectomy, posterior pelvectomy (Hudson) and appendicectomy. There were no postoperative complications (short or medium term). CONCLUSION: The PlasmaJet seems to be a very interesting instrument in this type of surgery, particularly in the dissection of adherent pathological areas, as diaphragmatic domes can be.


Assuntos
Abdome/cirurgia , Diafragma/cirurgia , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Procedimentos Cirúrgicos em Ginecologia/métodos , Neoplasias Ovarianas/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade
8.
Int J Gynecol Cancer ; 24(8): 1486-92, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25191875

RESUMO

OBJECTIVE: The aim of our study was to report the technique, the feasibility, and perioperative results of robotic extraperitoneal paraaortic lymphadenectomy in gynecological cancers performed for isolated or combined procedures. METHODS: This is a retrospective study of 24 consecutive patients undergoing robotic extraperitoneal paraaortic lymphadenectomy using the Da Vinci Surgical system (Intuitive Inc, Sunnyvale, CA) (cervical cancer, n = 15; high-risk endometrial cancer, n = 8; and ovarian cancer, n = 2, including 1 synchronous tumor). Extraperitoneal paraaortic lymphadenectomy was performed using the surgical technique previously described by laparoscopy. RESULTS: Of the 24 included patients, 12 patients had isolated robotic extraperitoneal paraaortic lymphadenectomy, whereas the others underwent the following associated procedures: total hysterectomy with bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and omentectomy (n = 7); pelvic transperitoneal lymphadenectomy (n = 3), laparotomic Bricker procedure (n = 1), and colpectomy (n = 1). The median age of patients was 55 (42-64) years, and body mass index was 24.1 kg/m (20.9-26.1). The operation was completed in all patients except three with associated procedures. Perioperative difficulties were encountered in 9 patients (gas leakage, n = 7; adhesions, n = 2; and dissection difficulties, n = 1). The number of removed paraaortic lymph nodes was 18 (14-25). The operating times were 180 (150-210) minutes for isolated extraperitoneal paraaortic lymphadenectomy and 240 (180-300) minutes in case of associated procedures. There were 2 intraoperative (pneumothorax and renal artery injury) and 5 postoperative (3 grades 1-2 and 2 grade 3) complications. CONCLUSIONS: If robotic-assisted extraperitoneal paraaortic lymphadenectomy seems feasible in case of isolated procedure, further studies are required to prove its benefit compared with conventional laparoscopy.


Assuntos
Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Femininos/cirurgia , Excisão de Linfonodo/métodos , Procedimentos Cirúrgicos Robóticos , Adulto , Aorta , Terapia Combinada , Estudos de Viabilidade , Feminino , Neoplasias dos Genitais Femininos/diagnóstico , Neoplasias dos Genitais Femininos/epidemiologia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Excisão de Linfonodo/efeitos adversos , Linfonodos/patologia , Pessoa de Meia-Idade , Cavidade Peritoneal , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento
10.
Bull Cancer ; 101(4): 349-53, 2014 Apr.
Artigo em Francês | MEDLINE | ID: mdl-24793625

RESUMO

Sentinel node biopsy appears as a promising technique for the assessment of nodal disease in early cervical cancers. Selection of a population with a low risk of nodal metastasis, a minimal training, and simple rules allow a low false negative rate. Sentinel node biopsy provides supplementary information, such as anatomical information (nodes outside of routine lymphadenectomy areas) and histological information (isolated tumors cells and micrometastases).


Assuntos
Colo do Útero/patologia , Linfonodos/patologia , Biópsia de Linfonodo Sentinela , Neoplasias do Colo do Útero/patologia , Feminino , Humanos , Metástase Linfática , Micrometástase de Neoplasia/patologia , Estadiamento de Neoplasias/métodos , Seleção de Pacientes
11.
J Minim Invasive Gynecol ; 21(1): 120-5, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23994715

RESUMO

STUDY OBJECTIVE: To compare the rates of intraoperative and postoperative complications of robotic surgery and laparoscopy in the surgical treatment of endometrial cancer. DESIGN: Unicentric retrospective study (Canadian Task Force classification II-2). SETTING: Tertiary teaching hospital. PATIENTS: The study was performed from January 2002 to December 2011 and included patients with endometrial cancer who underwent laparoscopic or robotically assisted laparoscopic surgical treatment. Data collected included preoperative data, tumor characteristics, intraoperative data (route of surgery, surgical procedures, and complications), and postoperative data (early and late complications according to the Clavien-Dindo classification, and length of hospital stay). Morbidity was compared between the 2 groups. MEASUREMENTS AND MAIN RESULTS: The study included 146 patients, of whom 106 underwent laparoscopy and 40 underwent robotically assisted surgery. The 2 groups were comparable in terms of demographic and preoperative data. Intraoperative complications occurred in 9.4% of patients who underwent laparoscopy and in none who underwent robotically assisted surgery (p = .06). There was no difference between the 2 groups in terms of postoperative events. CONCLUSION: Robotically assisted surgery is not associated with a significant difference in intraoperative and postoperative complications, even when there were no intraoperative complications of robotically assisted surgery.


Assuntos
Neoplasias do Endométrio/cirurgia , Complicações Intraoperatórias/epidemiologia , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Robótica , Cirurgia Assistida por Computador/efeitos adversos , Idoso , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Case Rep Obstet Gynecol ; 2013: 176124, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23607011

RESUMO

Tuberculosis can cause infertility when it infects the genital tract (e.g., endometritis). A 31-year-old woman (origin: Algeria) was referred to our academic gynecological institute for unexplained primary infertility. The patient presented with no complaint. Hysteroscopy showed a 10 mm sized endometrial polyp. The polyp was removed. Pathology showed lymphocytic and plasmacytic chronic inflammatory modification, granulomatous modification, and gigantocellular modification,which lead to the diagnosis of tuberculosis. No acid fast organism was seen on Ziehl-Neelsen staining. A chest thorax X-ray revealed no sign of pulmonary tuberculosis. The patient underwent antituberculosis therapy during one year. Posttreatment hysteroscopy revealed no abnormality. This is the first reported case of endometrial tuberculosis diagnosed following removal of a polyp with classical benign appearance.

13.
Ann Surg Oncol ; 20(2): 407-12, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23054119

RESUMO

BACKGROUND: There is some controversy about the relevance of lymphadenectomy in patients with early stage endometrial cancer. The aim of this study was to evaluate the contribution of sentinel lymph node (SLN) biopsy in staging patients with presumed low- and intermediate-risk endometrial cancer. METHODS: This retrospective multicenter study was conducted from July 2007 to December 2011 including 103 patients with presumed low- or intermediate-risk endometrial cancer who had undergone SLN biopsy. Concordance between preoperative staging and definitive histology as well as contribution of SLN biopsy and ultrastaging to upstage patients were assessed. RESULTS: SLNs were detected in 89 patients (86.4 %), 56 (62.9 %) of whom had presumed low-risk and 33 (37.1 %) intermediate-risk endometrial cancer. Of the 89 patients, 14 (15.7 %) had positive SLNs. Twelve (21.4 %) of the 56 patients with presumed low-risk disease were upstaged by definitive histology, among whom 3 (25 %) had pelvic positive SLNs. Seven (21.2 %) of the 33 patients with intermediate-risk disease were upstaged by definitive histology, 1 (14.3 %) of whom had positive SLNs. Ultrastaging detected metastases undiagnosed by conventional histology in 6 (42.8 %) of 14 of patients with positive SLNs. CONCLUSIONS: SLN biopsy associated with ultrastaging is relevant to stage low- or intermediate-risk endometrial cancer and could help guide adjuvant therapies.


Assuntos
Adenocarcinoma/patologia , Neoplasias do Endométrio/patologia , Linfonodos/patologia , Neoplasias Pélvicas/secundário , Biópsia de Linfonodo Sentinela , Adenocarcinoma/epidemiologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Linfonodos/cirurgia , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Pélvicas/epidemiologia , Neoplasias Pélvicas/cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de Risco
14.
World J Urol ; 30(3): 393-8, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21858540

RESUMO

OBJECTIVE: To prospectively compare short-term functional outcomes achieved by laparoscopic or robot-assisted sacrocolpopexy for pelvic organ prolapse. MATERIALS AND METHODS: We prospectively collected clinical and operative data over 24 months for female patients who underwent either pure laparoscopic sacrocolpopexy (LSCP) or robot-assisted laparoscopic sacrocolpopexy (RALSCP). Clinical data included age, BMI and assessment of PFDI-20 score. Perioperative data included operative time and complications. Post-operative outcomes included hospital stay, length of catheterisation, pain and functional outcomes as assessed by clinical examination and PFDI-20 score assessment. RESULTS: Overall, 67 women with a median age of 65 were included: 47 in the LSCP arm and 20 in the RALSCP arm. RALSCP was superior in terms of blood loss (median 55mls vs. 280; P = 0.03) and strict operative time (median 125 min vs. 220; P < 0.0001), but this time advantage was nullified when comparing overall operating room time (215 min vs. 220). With a median follow-up of 16 months, the overall anatomic repair rate was 98.5%, and there was an improvement in overall PFDI-20 score before and after surgery (P = 0.001) but with no difference between the two surgical approaches. CONCLUSIONS: RALSCP allows for a safe and effective repair of pelvic organ prolapse in female patients. Whilst being equivalent to LSCP in terms of functional outcome, it is superior in terms of blood loss and strict operative time. These results are based on short-term assessment, and further studies of larger populations with longer follow-up and objective assessments of outcome are needed to make any definitive statement.


Assuntos
Colposcopia/métodos , Laparoscopia/métodos , Avaliação de Resultados em Cuidados de Saúde , Prolapso de Órgão Pélvico/cirurgia , Robótica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colposcopia/efeitos adversos , Feminino , Seguimentos , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Prevalência , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
15.
J Neuroophthalmol ; 30(1): 12-7, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20182200

RESUMO

A 40-year-old man developed a Horner syndrome as part of a dorsolateral medullary brainstem infarction. Thirty-six hours after the onset of the stroke, topical instillation of 0.5% apraclonidine produced reversal of anisocoria. This is the first case in which apraclonidine testing has been applied to a patient with a Horner syndrome caused by a lesion in the first segment of the oculosympathetic pathway and the shortest reported interval between clinical manifestations of the lesion and apraclonidine-induced reversal of anisocoria. A review of all reported cases of apraclonidine testing in Horner syndrome suggests that this is a promising diagnostic adjunct that must be validated in larger studies.


Assuntos
Agonistas alfa-Adrenérgicos , Clonidina/análogos & derivados , Síndrome de Horner/diagnóstico , Ponte/patologia , Acidente Vascular Cerebral/patologia , Adulto , Síndrome de Horner/etiologia , Humanos , Angiografia por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética , Masculino , Acidente Vascular Cerebral/complicações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...