Early stage epithelial ovarian carcinoma is defined pathologically as a tumor strictly limited to one or both ovaries without any extra-ovarian disease (i.e., Stage IA or B of the International Federation of Gynecology and Obstetrics (FIGO) classification). This diagnosis can be obtained only after an exhaustive surgical staging procedure, performed as soon as the diagnosis of epithelial invasive ovarian carcinoma is established. This staging surgery currently encompasses a peritoneal cytology, the thorough inspection of all the visceral and parietal peritoneal surfaces with biopsy of any abnormality, total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO), random peritoneal biopsies, omentectomy, appendectomy and bilateral pelvic and para-aortic lymphadenectomies, up to the left renal vein. The results of this staging procedure and its indications are discussed. In all of the cases, the radical removal of the pathologic adnexa is indicated, along with the complete peritoneal and retroperitoneal staging. While fertility-sparing surgery (avoiding hysterectomy and contralateral adnexectomy, if possible) seems to be safe for young women, a TAH + BSO is the rule for the others. Adjuvant chemotherapy can be omitted in well-differentiated tumors with a negative staging operation, but currently it remains indicated in all other cases. Indeed, the ultimate goal in early stage ovarian carcinoma is to not impair by inadequate management the high chance of a cure.

Carcinoma↗

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[Sleep in adolescents and its disorders. A survey in schools].

OBJECTIVES: Numerous studies emphasized the high prevalence of sleep problems in adolescents. However, it remains to be seen whether these problems are developmental or if they are related to pathological conditions. In order to try to answer this question, we conducted an epidemiological study investigating the prevalence and correlates of sleep disorders in a population of high school adolescents. METHOD: The sample for this investigation consisted of 652 high school students (344 males and 308 females), aged 13 to 19 years (mean age: 15.1 1.2 years), attending colleges in the North of France. Data for the study were obtained by means of revised versions of the INSERM self-report questionnaires for adolescents. One questionnaire included 113 response choice items investigating the sleep parameters and the sociodemographic, behavioural, health, and environmental condition of the subject. This questionnaire was completed by a self-portrait questionnaire including 27 response choice items about mood, anxiety, instability and the quality of relations with others. In addition, a clinical examination was performed by the clinicians of the school health department in order to investigate the medical history of the subject and his (her) pubertal development. RESULTS: In a first step, statistical analysis showed some significant differences in sleep rates and troubles between males and females. If the total sleep time was found similar in males and females, females were found exhibiting significantly earlier bedtime (p<0.01) and waking time (p<0.005) than males. In addition, trouble falling asleep (p<0.0001), nightmares (p<0.001), need for daytime sleep (p<0.05), and stimulant pill intake (p<0.05) were found significantly more frequent in females. Then, the adolescents were classified into two subgroups. "Insomnia group" included the students who answered "often" or "always" to one of the five questions about: having trouble falling asleep, the occurrence of early awakenings, their need for daytime sleep, sleeping pill intake, and bad sleep quality. "Non insomnia group" included those who answered "never" or "sometimes" in response to the five questions. Results showed that 233 adolescents (35.7%) exhibited persistent sleep disorders, insomnia type. 40.2% of females and 31.6% of males were included in the "insomnia group" (p<0.05). Pubertal development was found significantly more advanced in the "insomnia group" adolescents, more particularly in females. In the same way, concerns about body weight (46.7% vs 38.8%; p<0.005), size and shape (15% vs 8%; p<0.01) were found significantly more frequent in the "insomnia group"; 32.3% of the "insomnia group" adolescents vs 17.9% in the "non insomnia group" reported health problems (p<0.0001). School difficulties were found significantly more frequent in the "insomnia group" compared to the "non insomnia group". The proportion of subjects who have previously repeated at least one school year (p<0.01), who reported bad school performances (p<0.01), and who reported to be "sometimes" or "often" away from school (p<0.01) was significantly higher in the "insomnia group" than in the "non insomnia group". In the same way, data showed that school investing was also significantly weaker in the "insomnia group" adolescents (p<0.01). The proportion of subjects who believed that their relations with parents (12.4% vs 6%; p<0.05), teachers (21.4% vs 10.5%; p<0.0001), or peers (10.2% vs 4.1%; p<0.002) was found significantly higher in the "insomnia group". Risk behaviours were also significantly more frequent in the "insomnia group" adolescents: suicidal ideation (25.1% vs 11.7%; p<0.001), suicide attempt (7.3% vs 3.6%; p<0.05), psychotropic drug use (11% vs 4.9%; p<0.02), regular stimulant drug use (10% vs 5.1%; p<0.005), regular tobacco use (7.8% vs 2.2%; p<0.001), regular alcohol use (13.3% vs 8.3%; p<0.05), and illicit drug use (5.2% vs 1%; p<0.001). Lastly, all the dimensions of the self-portrait were found significantly more affected or negative in the "insomnia group" than in the "non insomnia group". For example, the proportion of subjects who described themself usually sad (10.2% vs 3.4%; p<0.001), anxious (54.9% vs 40.5%; p<0.0001), downcast (41.1% vs 32.6%; p<0.05), or instable (56.9% vs 41.7%; p<0.0001) was significantly higher in the "insomnia group". CONCLUSION: In this descriptive study, if some data suggest that pubertal development may be involved in the sleep rates or troubles observed in adolescents, the results also show that persistent sleep disorders are significantly associated with physical, psychological or social difficulties. In summary, this study shows that it is essential to take an interest in the quality of sleep in adolescents, which may be a way to approach their psychosocial difficulties.

Adolescent↗

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Laparoscopy in gynaecological cancer.

The use of laparoscopy in the management of gynaecological malignancies has significantly increased over the last 5 years. Patients with cervical, vaginal, endometrial and ovarian cancer can be managed laparoscopically either for staging or for treating. The feasibility of procedures through the laparoscope (such as hysterectomies, bilateral oophorectomies, pelvic and para aortic lymphadenectomies, omentectomies, colostomies, bowel resections, oophoropexies, radical hysterectomies and ovarian cancer debulking) has been demonstrated by skilled gynaecologists. Many of these procedures have been heralded as avant garde 'surgical standards' without appropriate evaluation of efficacy, effectiveness and efficiency. Larger series of patients have now replaced case reports to try to answer the numerous unanswered questions regarding the value of these procedures. Several prospective trials were begun to compare laparotomy and laparoscopy. If the results of these trials confirm the hope, laparoscopic management of gynaecological malignancies will leave the limited club of specialists to become a widely used technique. But the patients will benefit from laparoscopic procedures only when in the hands of well-trained surgeons.

Female↗

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[Role of laparoscopy in the management of uterine cervix cancer].

At the turn of this century, the evidence of the benefits of a concurrent chemo-radiotherapy in locally advanced tumors and the development of mini-invasive surgery (laparoscopic and radical vaginal surgery) are the two main advances in the management of cervical carcinomas. From a personal experience of 304 cervical carcinomas, the different techniques of laparoscopy used in cervical carcinomas are addressed and discussed. Their long-term results when involved in the management protocols of cervical carcinomas at different stages are reported. From this series, some conclusions are drawn: 1) laparoscopy can spare a laparotomy in early-stage node-negative patients with low tumoral volume; 2) it can spare a systematic extended-field radiation therapy in high-risk patients with node-negative para-aortic exploration; 3) it can spare surgery in patients with a centro-pelvic advanced stage or recurrence, possibly candidates for an exenterative procedure, if occult spread is found in the intra- or retroperitoneal areas. The more and more frequent combination of the mini-invasive surgery for staging and treatment and radiotherapy or chemotherapy explains the need for new protocols of a more and more complex and specialized management.

Adenocarcinoma↗

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[Endometrial cancer: what's new?].

OBJECTIVES: New and much debated data of the endometrial cancer concerning the preoperative assessment of myometrial invasion, the surgical staging, and the adjuvant treatment. PATIENTS AND METHODS: Medline (1998-2002): searching for "endometrial carcinoma". RESULTS: The pap smears are useful when it is difficult to have a transvaginal ultrasonography or an MRI. We can perform the pap smears and the endometrial biopsy in the clinic. If a patient has pap smears with malignant cells or elevated preoperative CA 125, it probably is a cancer with poor prognostic factors. Surgical staging with abdominal and node evaluation is necessary. The MRI seems to be the best preoperative imaging because we have information about adnexal and abdominal metastases, pelvic or aortic nodes and the invasion of the myometrium. So it gives us information on the surgical route, and provides indication for a lymphadenectomy. The surgical staging is a part of the treatment of the endometrial cancer: an exploration of the peritoneal cavity, a pelvic lymphadenectomy, a para-aortic lymphadenectomy if the pelvic nodes are positive or if there are factors of bad prognosis (deep stage IC, grade 3, adnexal or abdominal involvement, serous carcinoma of the endometrium). It can be performed if technical conditions are correct. The adjuvant teletherapy in the documented stage IpN0 (surgical staging with pelvic lymphadenectomy) does not seem to be necessary. But we can perform an adjuvant brachytherapy (high-dose rate if it is possible) in patients with a high local recurrence (stage IC, stage I with grade 3, stage IB grade 2). CONCLUSION: The preoperative MRI is useful choosing the surgical approach, and the depth of the myometrial invasion, which can be an indication for a pelvic lymphadenectomy. The surgical staging must be a part of the treatment of the endometrial cancer. So the adjuvant teletherapy in patients with stage IpN0 documented should not be used.

Adenocarcinoma↗

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Impact of initial surgical access on staging and survival of patients with stage I ovarian cancer.

The aim of this study was to compare staging by laparoscopy and laparotomy, and to compare survival in patients with laparoscopy versus laparotomy as the first surgical access. We conducted a retrospective analysis of patients with stage I ovarian cancer treated surgically between 1985 and 2001, and we included those patients with stage I epithelial cancer for whom follow-up data were available. For each patient, we recorded whether initial surgical staging was by laparoscopy or by laparotomy, the procedures done at initial staging surgery, and the outcomes. The data were evaluated by analysis of variance, Chi-square test or Fisher's exact test, logistic regression, Cox model, and log-rank test, using SPSS 7.5 and STATA. Initial staging was by laparoscopy in 34 patients, laparotomy in 114 patients, and laparoscopy converted to laparotomy in 30 patients. In the laparotomy group, patient age was significantly greater and tumor size significantly larger, as compared to the laparoscopy group. Staging after first surgery was often inadequate; most notably para-aortic lymph node dissection was done in 0% of laparoscopy patients, 18% of laparotomy patients, and 33% of conversion patients. Restaging surgery has been indicated in 88% of laparoscopy patients, 48% of laparotomy patients, and 46% of conversion ones. After a mean follow-up of 40 months, survival rates were not significantly different among the three patient groups. No deleterious influence of laparoscopy as first surgical access was detected by univariate or multivariate analysis. Despite of inaccurate radicality and staging during initial laparoscopy, this study found no harmful influence of laparoscopy as first initial access on outcomes of patients with stage I ovarian cancer.

Adult↗

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Abdominal wall metastasis of ovarian carcinoma after low transverse abdominal incision: report of two cases and review of literature.

Occurrence of parietal metastases after surgery for a suspect adnexal mass may worsen the prognosis of the disease. However, it is not clear whether abdominal wall metastases is related to specific biologic features or simply to surgical mismanagement involving small incisions and traumatic extraction of the specimen, resulting in direct seeding of cancer cells. We report two cases with development of parietal dissemination of ovarian carcinomas after Pfannenstiel incision. The two patients needed parietal resection to obtain optimal surgical cytoreduction. Pfannenstiel incisions for exploration of suspicious adnexal masses increase the risk of extensive parietal metastasis in case of malignancy because they require reflection of several sheaths of tissue. The parietal extension of the disease may need major parietal resection that can worsen the functional and general outcome of the patients.

Abdominal Wall↗

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[Treatment of pelvic lymph node involvement in early stage cervical cancer].

OBJECTIVES: Results of a retrospective paired study comparing the outcome of patients irradiated for lymph node involvement according to the method of node assessment: laparotomy or laparoscopy. MATERIAL AND METHODS: Twenty-six patients with cervical cancer managed by postoperative radiation therapy for pelvic node involvement during the Wertheim-Meigs operation (historical group) were compared to 26 patients in whom lymph node involvement was discovered at the time of laparoscopy and managed by definitive radiation therapy without hysterectomy (laparoscopy group). The patients were matched according to age, stage, tumor histology and tumoral volume. RESULTS: No difference was observed in the five-year survivals. Although it was not significant there were more grade 3-4 radio-induced complications in the historical group. CONCLUSIONS: The introduction of laparoscopy and the absence of hysterectomy did not impair the outcome of our patients. Laparoscopic lymphadenectomy reduces the risk of radio-induced adverse effects.

Adult↗

PubMedDate not supplied

Laparoscopic sacrocolpopexy, hysterectomy, and burch colposuspension: feasibility and short-term complications of 77 procedures.

OBJECTIVE: To report our first cases of laparoscopic sacropexy and assess the feasibility and short-term complications. METHODS: We retrospectively studied 77 laparoscopic sacral colpopexies performed from June 1996 to May 1998. Suspension was reinforced with 2 strips of synthetic mesh. Five patients had previously undergone hysterectomy, and 4 others had experienced failure of surgery for prolapse of the uterus. RESULTS: Laparoscopy was performed in 83 women with symptomatic prolapse of the uterus. Six cases required conversion to laparotomy because of technical difficulties. All of the remaining 77 patients underwent laparoscopic sacropexy that included anterior and posterior mesh reinforcement. Subtotal laparoscopic hysterectomy was performed in 60 cases, laparoscopic Burch colposuspension in 74, and levator myorrhaphy via a vaginal approach in 55. Operative time decreased from 292 to 180 minutes as experience was gained. The main operative complications were 1 rectal and 2 bladder injuries. Three patients required reoperations for hematoma or hemorrhage. One patient complained of chronic inflammation of the cervix, and another experienced rejection of the posterior mesh 6 months after the operation. Mean follow-up was 343 days. Three other patients required reoperation, 1 for a third-degree cystocele and 2 for recurrent stress incontinence. CONCLUSION: Laparoscopic sacrocolpopexy is feasible. Operative time and postoperative complications are related to the surgeon's experience but remain comparable to those noted in laparotomy. Long-term assessment is required to confirm the results of this procedure.

Adult↗

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[In response to the article by M. Canis et al. Laparoscopy and cancer in gynecology. Should it be debated again or only convince the disbelievers? Gynécol Obstét Fertil 2001; 29: 913-8].

Explore the source record for details and available documents.

Female↗

PubMedDate not supplied

[Danger of iodine drugs in the pregnant woman].

The authors draw attention to the fact that the possible effects of drugs containing iodine are often neglected during pregnancy. As an example, they report the following observation : "A young woman with benign asthma, treated for 14 years Asthmasedine and Asthmaligne, gave birth, on the 36th week of pregnancy, to a child apparenty dead but who was able to be reanimated. The child showed two types of signs : respiratory distress due to higher neurological disorders and a multinodular, non-compressing goiter. These two complications were caused by a congenital hypothyroidism corroborated by laboratory tests and due to the prolonged absorption of iodinated drugs by the mother". In conclusion, in cases of women receiving during pregnancy high doses of drugs containing iodine (250 such drugs are recorded in the Vidal), it is desirable to control the effect on the fetus and to propose an intra-amniotic therapy with L-Thyroxine, thus allowing a cerebral development close to normal.

Adult↗

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[Celioscopic pelvic and para-aortic lymphadenectomy].

Because small volume lymph node metastases are difficult to recognize despite modern imaging techniques and since staging laparoscopy is costly and leads to important patient discomfort, pelvic then para-aortic lymph node endoscopic dissection has been introduced for staging gynaecological cancers. Since 1988, we have performed 110 pelvic and 17 para-aortic lymph node dissections using this technique. Pava-aortic endoscopic biopsy is indicated for advanced cancer of the cervix and subrenal biopsy for cancer of the ovary. Pelvic node dissection alone is useful in early stage cancers of the uterus and in cancers of the endometrium as well as in urological indications.

Adult↗

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[Value and limits of conventional or cumulative meta analysis in obstetrics and gynecology].

The authors describe some situations where meta-analyses would have been of great benefit if they have been done or sufficiently published. They emphasize several problems ensued by this new method: if possible, meta-analyses have to be done each time a new trial is analysed, according to a precise method. Cumulative meta-analysis should rely on a regular and prospective registration of clinical trials. In all cases, meta-analyses should be available to a large number of physicians, in the main interest of patients.

Betamethasone↗