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Open Journal of Obstetrics and gynecology 2017年第1期7卷 7-15页

作者： Alberto Biamonti Angela Saracino O. U. (operative unit) Obstetrics & gynecology Cristo Re Hospital Via delle Calasanziane Rome Italy

Vaginitis is one of the most recurrent conditions that afflict women and require medical care. Vulvovaginal candidiasis (VVC) is frequently related to vaginal carriage of Candida albicans, an opportunistic polymorphic fungus, which colonizes the human skin, the mucosa and the reproductive tract. Actually, standard treatments to counteract vaginitis include several topical and oral treatments. The aim of this study was to evaluate the efficacy of a new biguanide compound, polyhexamethylene biguanide (PHMB) in avaginal solution, in women affected by vaginal candidiasis. For this reason, 40 women showing the symptoms previously ascribed to vaginal candidiasis were recruited and treated with a single PHMB dose of vaginal solution. After a single dose of treatment, 80% of them had a complete resolution of the fungal infection;furthermore, all of them reported clinical benefits, statistically significant reduction in both clinical signs and symptoms of candidiasis and a score’s reduction of 50%.

关键词： Polyhexamethylene Biguanide Vulvovaginal Candidiasis Candida albicans Infection Biguanide Antiseptic

Electrical Storms after Levonorgestrel (Synthetic Progestin)-Releasing Intra-Vaginal Device Insertion. A Case Report and a Short Review of Literature

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Open Journal of Obstetrics and gynecology 2018年第4期8卷 338-343页

作者： Sergio Fasullo Giorgio Maringhini Piero Fasullo Filippo Ganci Arcangelo Giamporcaro Sebastiano Scalzo Fernanda Pipitone Vito Pinto Graziella Vetrano Gabriella Terrazzino Stefania Davì Nicolò Renda Antonio Maiorana Division of Cardiology “Paolo Borsellino” G.F. Ingrassia Hospital Palermo Italy operative unit of gynecology S. Antonio Abate Hospital Trapani Italy Chemistry and Pharmaceutical Technologies University of Palermo Palermo Italy Psychiatry CTA La Rinascita Palermo Italy operative unit of gynecology ARNAS Civico Palermo Italy

We report a case of arrhythmic storm in a patient with recent vaginal insertion of a device with release of levonorgestrel (synthetic progestin). A woman of 60 years was hospitalized for runs of monomorphic sustained ventricular tachycardia. She received a vaginal device levonorgestrel-releasing 2 days before admission. No history of associated cardiovascular or thyroid disease or risk factors was reported. Laboratory parameters as well as ECG and echocardiogram were normal. After 48 hours from removal of the vaginal device, the patient was asymptomatic and showed only single ectopic beats, sometimes in pairs. The subsequent coronary angiography, electrophysiological study and cardiac magnetic resonance resulted negative.

关键词： Levonorgestrel Progesterone Ventricular Arrhythmias

Outcomes of patients who have undergone laparoscopic abdominal cerclage:A retrospective study

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Laparoscopic, Endoscopic and Robotic Surgery 2022年第3期5卷 111-115页

作者： Cuiyu Yang Dong Huang Yang Yang Jingyan Yang Yuyang Chen Mei Pan Songying Zhang Assisted Reproduction unit Department of Obstetrics and GynecologySir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016China

Objective:This study aims to evaluate the surgical morbidity and obstetric outcomes following in-pregnancy or pre-pregnancy laparoscopic abdominal cerclage(LAC)for patients who were diagnosed with refractory cervical insufficiency or had a short ***:A retrospective study was conducted on patients undergoing LAC between May 2017 and May 2019 at the Department of Obstetrics and gynecology,Sir Run Run Shaw *** patients were diagnosed with refractory cervical insufficiency based upon a previous failed transvaginal cervical cerclage(TVC),or had a short cervix who were considered unsuitable for a TVC after a previous cervical *** patients were followed-up after surgery with transperineal ultrasonography until May ***,surgical and obstetric data were collected and ***:In total,44 patients underwent LAC,with 8 patients in-pregnancy and 36 *** the patient with pre-pregancy LAC,the pregnancy rate was 80.6%(29/36),including 3 patients with first-trimester loss,1 patient with an ectopic pregnancy,and 25 patients with a *** the remaining 7 patients,3 did not conceive,and another 4 had no pregnancy *** the patients with in-pregnancy LAC had a ***“take-home baby”rate was 89.2%(33/37),with a live-birth rate of 100%and a neonatal survival rate of 100%for both patients with in-pregnancy and pre-pregnancy *** patients with in-pregnancy LAC,75.0%(6/8)patients delivered at≥37 wk of gestation,12.5%(1/8)delivered between 34 and 36^(+6)wk,and 12.5%(1/8)delivered between 28 and 33^(+6)*** patients with pre-pregnancy LAC,80.0%(20/25)patients delivered at≥37 wk of gestation,16.0%(4/25)delivered between 34 and 36^(+6)wk,and 4.0%(1/25)delivered between 28 and 33^(+6)*** adverse-event intra-operative or post-operative sequelae were ***:LAC is an effective and safe procedure that results in remarkable obstetric outcomes for women with refractory cervical insufficiency,or with a sh

关键词： Cervical cerclage Cervical insufficiency Laparoscopic Conization Preterm birth

Gasless laparoscopy for benign gynecological diseases using an abdominal wall-lifting system

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2009年第11期10卷 805-812页

作者： Yue WANG Heng CUI Yan ZHAO Zhi-qi WANG Department of Obstetrics and gynecology Peking University People's Hospital Beijing 100044 China

Objectives: The use of gasless laparoscopy with an abdominal wall-lifting device for benign gynecological diseases was compared to conventional laparoscopy with CO2 pneumoperitoneum. Methods: From February 2007 to July 2007,76 women with uterine and/or adnexal benign diseases and candidates for laparoscopic surgery were recruited in this study. Thirty-two women underwent gasless laparoscopic surgery and 44 women underwent pneumoperitoneum laparoscopic surgery. Results: Diverse pathologies,including adnexal cyst,uterine myoma and ectopic pregnancy,were treated successfully with gasless laparoscopic surgery. Compared with the patients in the pneumoperitoneum group,the similar hospital stay (P=0.353) and intraoperative blood loss (P=0.157) were observed. However,the mean operative time in the gasless group was significantly longer than that in the pneumoperitoneum group (P=0.003). No severe intraoperative or postoperative complications were found in either group,except for one case of laparotomic conversion in the pneumoperitoneum group due to dense pelvic adhesions. The total hospital charges were significantly less in the gasless group than in the pneumoperitoneum group (P=0.001). In 38 cases of ovarian cyst resection,the mean operative time in the gasless group remained longer than that in the pneumoperitoneum group (P=0.017). The total hospital charges were also significantly less in the gasless group than in the pneumoperitoneum group (P<0.001). Conclusion: Our preliminary results demonstrated that the laparoscopic procedure using the gasless technique was a safe,effective method to treat benign gynecological diseases. Moreover,it was easy to master. As a minimally invasive treatment,gasless laparoscopic surgery provides a good choice to patients in the undeveloped regions in China without increasing the patients’ and the government’s burden significantly.

关键词： Gasless laparoscopy Pneumoperitoneum laparoscopy Ovarian cyst resection

Supraumbilical Transverse Incision for Cesarean Section in Severely Obese Patients:The Experience of a French Hospital from 2009 to 2014

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Open Journal of Obstetrics and gynecology 2017年第10期7卷 1024-1034页

作者： Zelda Stewart Patricia Dolley Gael Beucher Anne Villot Michel Dreyfus gynecology Obstetrics and Reproductive Medicine UnitCaen University HospitalCaenFrance

Aim: To describe our experience in supraumbilical cesarean deliveries in severely and morbidly obese patients (body mass index > 35 kg/m2) with a voluminous abdominal panniculus. Methods: A retrospective study in France between January 2009 and May 2014. Every woman who underwent a cesarean delivery with a supraumbilical incision was included through her digital medical record. A senior doctor made the decision for a supraumbilical skin incision after careful examination of the patient’s anatomical conditions. Results: Twenty patients were included, for a total of 21 cesarean deliveries. Their mean body mass index 50 (40 - 61.7). Nineteen of them (95.0%) had an abdominal panniculus in supine “apron” position. Twelve patients (57.1%) had a scarred uterus. During the cesarean section, 14 (66.7%) had a segmentary hysterotomy. The median operative time was 49 minutes (32 - 70). Four patients (19.1%) had a postpartum hemorrhage and 4 (19.1%) a postpartum infectious complication, none of which were severe. Conclusions: In this specific population of severely obese women undergoing cesarean procedures, variations in anatomy require each patient’s incision choice to be individualized. In women with a voluminous panniculus the supraumbilical skin incision seems to offer an adequate exposure to the peritoneal cavity and the lower uterine segment, therefore allowing to safely carry out the procedure. However a prospective study on a larger sample remains necessary to compare this technique to the classical cesarean procedure.

关键词： Cesarean Supraumbilical Obesity Surgical Technique Morbidity

Clinical features and outcome of 15 patients with recurrent endometrial cancer or atypical endometrial hyperplasia received primary fertility-sparing therapy followed by hysterectomy

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gynecology and Obstetrics Clinical Medicine 2021年第1期1卷 44-48页

作者： Yuanting Li Yiqin Wang Yijiao He Rong Zhou Huiru Tang Lijiang Xu Mian He Weili Li Chunlin Chen Weifeng Zhang Jianliu Wang Department of gynecology and Obstetrics Peking University People's HospitalBeijingChina Department of gynecology and Obstetrics Peking University Shenzhen HospitalShenzhenChina Department of gynecology and Obstetrics The First People's Hospital of FoshanGuangdongChina Department of gynecology and Obstetrics The First Affiliated HospitalSun Yat-sen UniversityGuangdongChina Department of gynecology and Obstetrics Nanfang HospitalGuangdongChina Department of gynecology and Obstetrics Ningbo Women&Children's HospitalZhejiangChina

Objective To investigate the clinical features and outcome of recurrent endometrial cancer(EC)or atypical endometrial hyperplasia(AEH)patients who underwent hysterectomy after fertility-sparing *** Clinical data was retrospectively collected for 15 recurrent endometrial cancer or atypical endometrial hyperplasia patients who underwent hysterectomy in six hospitals from 2003 to *** to the indicators of hysterectomy,patients were divided into four groups:7 patients who underwent direct hyesterectomy after the first relapse,4 due to re-treatment failure,1 after full term live birth,and 3 because of multiple *** coexisting conditions,regimen and outcome of fertility-sparing therapy,pre-and post-operative pathological results,and prognosis were ***(1)Fertility-spraring treatment was given to a total of 15 eligible patients,including 6 with EC and 9 with *** time interval from remission to recurrence was 12 months(range 3–92).Oral progestin-based medicine was the main fertility-sparing therapy in both primary treatment and re-treatment after ***(6/8)patients received progestin combined with gonadotrophin releasing hormone agonist or metformin in three re-treatment groups.(2)Nine patients underwent hysterectomy and 6 staging *** patients had pathological upgrade after ***(5/10)EC patients had superficial myometrial invasion in postoperative *** patients showed no evidence of disease in the median follow-up of 17 months(range 3–118).(3)Among seven patients who failed to re-treatment and had multiple recurrence,six were overweight/obesity and six had insulin *** of these patients had synchronous ovarian cancer in the postoperative *** For the patients with recurrent EC or AEH after primary fertility-sparing therapy,overweight/obesity and insulin resistance might be the risk factors for re-treatment *** is recommended when patients ha

关键词： Endometrial cancer Atypical endometrial hyperplasia Fertility-sparing Recurrence Hysterectomy

Successful robot-assisted surgery for treating endometrial cancer affecting bicornuate-bicollis or didelphic uterus

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Open Journal of Obstetrics and gynecology 2013年第5期3卷 15-18页

作者： Annamaria Maglione Sergio Montanaro Francesco Petruzzelli Obstetrics and gynecology unit IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo Italy

Uterine anomalies are mainly associated with improper development of Mullerian ducts. To our knowledge, reports describing the use of a da Vinci Robot System for treating an endometrial cancer in a woman with an abnormal uterus are lacking. Here, we reported the description of two extremely obese women, affected by endometrial cancer and presenting bicornuate-bicollis and didelphic uterus have been treated by Robot System-assisted surgery. No operative and postoperative complications were recorded. Both women are disease-free to follow-up. A robot-assisted surgery could represent an effective treatment option for complex hysterectomies and in complicated patients, as those showing an extreme obesity.

关键词： Uterine Malformations Endometrial Cancer Robot-Assisted-Surgery

Peritoneal adhesions after laparoscopic gastrointestinal surgery

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World Journal of Gastroenterology 2014年第17期20卷 4917-4925页

作者： Valerio Mais Division of gynecology Obstetrics and Pathophysiology of Human ReproductionDepartment of Surgical SciencesUniversity of Cagliari09124 CagliariItaly

Although laparoscopy has the potential to reduce peritoneal trauma and post-operative peritoneal adhesion formation, only one randomized controlled trial and a few comparative retrospective clinical studies have addressed this issue. Laparoscopy reduces de novo adhesion formation but has no efficacy in reducing adhesion reformation after adhesiolysis. Moreover, several studies have suggested that the reduction of de novo post-operative adhesions does not seem to have a significant clinical impact. Experimental data in animal models have suggested that CO2 pneumoperitoneum can cause acute peritoneal inflammation during laparoscopy depending on the insufflation pressure and the surgery duration. Broad peritoneal cavity protection by the insufflation of a low-temperature humidified gas mixture of CO2, N2O and O2 seems to represent the best approach for reducing peritoneal inflammation due to pneumoperitoneum. However, these experimental data have not had a significant impact on the modification of laparoscopic instrumentation. In contrast, surgeons should train themselves to perform laparoscopy quickly, and they should complete their learning curves before testing chemical anti-adhesive agents and anti-adhesion barriers. Chemical anti-adhesive agents have the potential to exert broad peritoneal cavity protection against adhesion formation, but when these agents are used alone, the concentrations needed to prevent adhesions are too high and could cause major post-operative side effects. Anti-adhesion barriers have been used mainly in open surgery, but some clinical data from laparoscopic surgeries are already available. Sprays, gels, and fluid barriers are easier to apply in laparoscopic surgery than solid barriers. Results have been encouraging with solid barriers, spray barriers, and gel barriers, but they have been ambiguous with fluid barriers. Moreover, when barriers have been used alone, the maximum protection against ad

关键词： Peritoneal adhesions Laparoscopy Abdomen Gastrointestinal surgery Inflammation Learning curve Anti-adhesion Animal models Clinical studies Laparoscopic resection of gastrointestinal

Adjuvant chemotherapy versus adjuvant concurrent chemoradiotherapy after radical surgery for early-stage cervical cancer:a randomized,non-inferiority,multicenter trial

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Frontiers of Medicine 2023年第1期17卷 93-104页

作者： Danhui Weng Huihua Xiong Changkun Zhu Xiaoyun Wan Yaxia Chen Xinyu Wang Youzhong Zhang Jie Jiang Xi Zhang Qinglei Gao Gang Chen Hui Xing Changyu Wang Kezhen Li Yaheng Chen Yuyan Mao Dongxiao Hu Zimin Pan Qingqin Chen Baoxia Cui Kun Song Cunjian Yi Guangcai Peng Xiaobing Han Ruifang An Liangsheng Fan Wei Wang Tingchuan Xiong Yile Chen Zhenzi Tang Lin Li Xingsheng Yang Xiaodong Cheng Weiguo Lu Hui Wang Beihua Kong Xing Xie Ding Ma Department of Obstetrics and gynecology Tongji Hospital of Tongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Department of Oncology Tongji Hospital of Tongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Department of Gynecologic Oncology Women’s HospitalSchool of MedicineZhejiang UniversityHangzhou 310006China Department of Obstetrics and gynecology Qilu HospitalShandong UniversityJinan 250012China Department of Obstetrics and gynecology Xiangyang Central HospitalHubei University of Arts and ScienceXiangyang 441021China Department of Obstetrics and gynecology The First Affiliated Hospital of Yangtze UniversityJingmen 448000China Department of Obstetrics and gynecology The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061China Department of Obstetrics and gynecology The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhou 510120China Department of Gynecologic Oncology Affiliated Tumour HospitalXinjiang Medical UniversityUrumqi 830000China Department of Gynecologic Oncology Hunan Province Tumor HospitalChangsha 410013China

We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB–IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415–1.757;P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.

关键词： chemotherapy cervical cancer lymph node metastasis concurrent chemoradiotherapy quality of life

Cytoreductive surgery and HIPEC after neoadjuvant chemotherapy for advanced epithelial ovarian cancer

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World Journal of Obstetrics and gynecology 2013年第4期2卷 167-175页

作者： Marco Lotti Luisa Maria Busci Luca Campanati Fausto Catena Federico Coccolini Naoual Bakrin Pierandrea De Iaco Giorgio Ercolani Giuseppe Grosso Michele Pisano Elia Poiasina Diego Rossetti Martina Rossi Claudio Zamagni Paolo Bertoli Antonio Daniele Pinna Luigi Frigerio Luca Ansaloni unit of General Surgery 1 Papa Giovanni XXIII Hospital 24128 Bergamo Italy unit of gynecology and Obstetrics Papa Giovanni XXIII Hospital 24128 Bergamo Italy unit of General Surgery St.Orsola-Malpighi University Hospital 40138 Bologna Italy Department of gynecology Lyon Sud Hospital69310 Pierre Benite France unit of gynecology and Obstetrics St.Orsola-Malpighi University Hospital V40138 Bologna Italy Medical Oncology St.Orsola-Malpighi University Hospital 40138 Bologna Italy

AIM: To reduce postoperative complications and to make possible an optimal cytoreduction, neoadjuvant chemotherapy(NACT) followed by interval debulking surgery has been applied with encouraging results. METHODS: Between December 2009 and February 2012, patients with stage ⅢC-Ⅳ epithelial ovarian cancer(EOC) underwent diagnostic laparoscopy, to assess the feasibility of optimal debulking surgery. The modifi ed Fagotti score was applied to assess the feasibility of resection with zero residual tumor. Patients who were not candidate for upfront debulking surgery were submitted to NACT, then reassessed according to the RECIST 1.1 criteria and submitted to cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC) if they showed clinical response or stable disease. The remaining cycles of adjuvant systemic chemotherapy(ASCT) were administered postoperatively, to complete 6 cycles of systemic ***: Nine patients were included. Clinical response to NACT was complete in 3 patients and partial in 5 patients; one patient had stable disease. All patients underwent CRS resulting in CC0 disease prior to HIPEC. Average operative time was 510 min. Average intensive care unit stay was 2 d. Average postoperative hospital stay was 25 d. No postoperative mortality was observed. One patient experienced pelvic abscess. One patient refused ASCT. The remaining 8 patients started ASCT. Average time to chemotherapy was 36 d. All patients are alive, with an average follow up of 11 mo. Eight patients are disease-free at follow ***: HIPEC after CRS for advanced EOC is feasible with acceptable morbidity and mortality. NACT may increase the chance for achieving complete cytoreduction. Phase 3 studies are needed to determine the effects of HIPEC on survival.

关键词： Peritoneal carcinomatosis Ovarian cancer Cytoreductive surgery Intraperitoneal chemotherapy Hyperthermic intraperitoneal chemotherapy Hyperthermia