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PubMed2000

Antithrombotic therapy in gynecologic surgery and gynecologic oncology.

The European Consensus Conference has assessed the risk for thrombotic complications for most women undergoing gynecologic surgery and found it to be moderate. Nonetheless, it is important to analyze a patient's individual risk before surgery so that appropriate thrombosis prophylaxis can be given if increased risk is determined. Malignancy accounts for most thrombotic complications among gynecologic patients. Patients with known malignancies should receive prophylaxis during surgery, and some patients with breast cancer should receive prophylaxis during chemotherapy. Heparin, and low-molecular-weight heparin in particular, may favorably influence the outcome of cancer in some patients and treatment with these agents is currently under investigation in a number of trials as a new approach to anticancer therapy.

Antineoplastic Agents↗
PubMed2000

[New communication platforms in gynecology exemplified by the Professional Group for Information Processing in Gynecology and Obstetrics and the German IVF Registry].

Main reason for acceptance and distribution of the internet is the possibility to present information in a reasonable and contemporary way. Therefore the internet changed the way of decision making techniques in medicine. Two different information platforms for gynecological and reproductive topics have been created. The German Register for In-Vitro-Fertilization (DIR) collect data for quality assessment in reproductive medicine. The Work Group for Information Technologies in Gynecology and Obstetrics (AIG) will establish methods and new techniques to support treatments and science.

Data Collection↗
PubMed2004

[Surgical operations in women over 60 years of age in the gynecological practice (according to the data from Obstetric and Gynecology Clinic of Stara Zagora during 1998-2002 years)].

In period of 1998 to 2002 year in Klinik of Obstetric and Gynecology Stara Zagora was performed 2161 small and 1122 great gynecologic operations in women older 60 years. The most patients was in age of 60 to 70 years (79%), 17.9% was in age of 70 to 80 years and over 80 years was 2.9%. The neoplasm disorders perform 34.6% and static disorders--29.6%. By 84.5% in women with postmenopausal bleeding no established neoplasm and by 15.5% was established endometrial cancer. The great operations included 55.6% abdominal hysterotomy, 13.6% vaginal hysterectomy and 9.8% urogynecologic operations. Postoperative complications perform 3.7% (2 patients).

Age Factors↗
PubMedDate not supplied

[Andrological-gynecological cooperation. (Report on interdisciplinary collaboration for the care of involuntarily childless couples after introduction of the gynecological examination form developed by C. Schirren and H.J. Lindemann].

471 gynecological examination forms (Schirren and Lindemann 1972) were distributed to andrological patients in 1977. 157 were returned by the attending gynecologists (33,3%), and evaluated. Basal temperature was taken in 114 patients (72,6% of the returned forms), in 41 of them primarily monophasic cycles were found (26.1% of the ret. forms). Basal temperature was not taken in 43 patients or there were no statements (27,4% of the ret. forms). The postcoital test was performed in 24 patients (15,2% of the ret. forms), being pathological in 6 of them. Examinatio of tubal patency (Pertubation, hysterosalpingography, and pelviscopy) was performed in 69 patients. (43,9% of the ret. forms). 3 women had a tubal obstruction. (1.9% of the ret. forms). Altogether the results show good disposition to further productive andrologic-gynecological cooperation.

Adult↗
PubMed1993

[Adolf Gusserow (1836-1906), founding of the 2d University Gynecologic Clinic of the Charité and the Berlin Society of Obstetrics and Gynecology. IV].

Adolf Gusserow was one of the outstanding German gynecologists at the end of the XIX. century. Although interested in the entire discipline of obstetrics and gynecology including related areas, he is merely unknown today. This paper describes the biography of Prof. A. Gusserow, but also his importance for the Berlin Society of Obstetrics and Gynecology.

Berlin↗
PubMed1995

The utility of the revised International Federation of Gynecology and Obstetrics histologic grading of endometrial adenocarcinoma using a defined nuclear grading system. A Gynecologic Oncology Group study.

BACKGROUND: The histologic grade of endometrial adenocarcinoma is related to the aggressiveness of the tumor and probability of death from disease. However, the ideal system for assignment of histologic grade remains controversial. In 1988, the International Federation of Gynecology and Obstetrics (FIGO) revised its recommendations for grading typical endometrial adenocarcinoma, such that grade is determined primarily by the architecture of the tumor and secondarily modified in the presence of "notable nuclear atypia"; this phrase, however, has never been defined, and therefore the prognostic validity of this system is unknown. METHODS: Seven hundred and fifteen women with clinical Stage I and occult Stage II endometrial adenocarcinomas (excluding serous or clear cell type) entered on a Gynecologic Oncology Group protocol, and those treated by total abdominal hysterectomy, bilateral salpingo-oophorectomy, and selective pelvic and para-aortic lymph node sampling formed the study population. All cases were centrally reviewed and assigned an architectural grade and a nuclear grade using specific criteria. The FIGO grade was then determined. The various grading methods were examined based on ability to stratify patients into groups with differing rates of disease progression and relative survival at five years. RESULTS: The architectural grade, nuclear grade, and FIGO grade of tumors each were used to separate patients into groups with statistically significant different rates of progression of disease and relative survival. The FIGO modification of architectural grade resulted in the reassignment of 44 patients into a higher grade. The outcome for these 44 was worse than for the remaining patients in the initial grade but was similar to the group into which they were moved. CONCLUSIONS: If clearly specified criteria for architectural and nuclear grading are used and "notable nuclear atypia" is defined as grade 3 nuclei, the 1988 FIGO grading system has prognostic utility. The authors recommend this system as the standard method for the grading of typical endometrial adenocarcinoma.

Adenocarcinoma↗
PubMed2006

Quality of life considerations in gynecologic cancer. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer.

Quality of life (QOL) is a fundamental consideration for patients with life threatening diseases. Major evolving paradigms are discussed: improved QOL with laparoscopic surgery, the impact on QOL of intraperitoneal chemotherapy for optimally cytoreduced ovarian cancer, combination therapy, sexuality, and survivorship. The goals of treatment for many patients with gynecologic tumors remain largely palliative, and patient reported QOL is the primary outcome determining the utility of treatment. Particularly in this area, QOL endpoints are increasingly important in clinical trials. The QOL issues facing gynecologic cancer patients, the use of validated QOL instruments, recent advances in the evaluation of interventions, and changes in concepts related to QOL are reviewed.

Adaptation, Psychological↗
PubMed2002

Utility and cost-effectiveness of preoperative autologous blood donation in gynecologic and gynecologic oncology patients.

OBJECTIVE: To evaluate utility and cost-effectiveness of preoperative autologous blood donation in gynecologic and gynecologic oncology patients. METHODS: Pheresis unit records were retrospectively reviewed to identify all women who performed autologous blood donation. Clinical charts were abstracted. Use rate (number of units used/number of units donated) and quality-adjusted life years were calculated. Statistical analysis consisted of chi(2), Student t, and Fisher exact tests. RESULTS: A total of 106 women with benign (n = 63) and malignant disease (n = 43) donated 143 units (1.4 units per patient) of which 126 (88%) were discarded. Fifteen patients (14%) were transfused a total of 24 units, 17 autologous (71%) and seven allogeneic (29%). Those transfused had a significantly higher estimated blood loss (700 mL versus 275 mL, P <.001), lower nadir hemoglobin (7.9 versus 9.6, P <.001), and longer hospital stay (4.9 days versus 4.0 days, P =.05). Despite similar estimated blood loss (370 mL versus 310 mL), the use rate for malignant versus benign disease was significantly greater (0.31 versus 0.07, P =.005). Radical versus nonradical surgery had a significantly higher estimated blood loss (620 mL versus 250 mL, P =.001) and use rate (0.26 versus 0.11, P =.001) as well. Estimated cost per quality-adjusted life years for autologous blood donation for each category exceeded $1,000,000. CONCLUSION: Autologous blood donation is an expensive medical practice and does not guarantee that exposure to allogeneic blood will not occur. If pursued, it should be directed towards those who have a known malignancy or those for whom radical surgery is anticipated. Other methods of blood conservation may be safer and more cost-effective.

Blood Donors↗
PubMed2000

Workshop Report: Combining the staging system of the International Federation of Gynecology and Obstetrics with the scoring system of the World Heath Organization for Trophoblastic Neoplasia. Report of the Working Committee of the International Society for the Study of Trophoblastic Disease and the International Gynecologic Cancer Society.

During the past 5 years the International Society for the Study of Trophoblastic Disease and the International Gynecological Cancer Society have moved to modify the staging system for trophoblastic disease by combining the staging of the International Federation of Gynecology and Obstetrics (FIGO) with the scoring system of the World Health Organization (WHO). By making significant changes in both, the classification will be more acceptable worldwide leading to uniform use by physicians reporting management results in trophoblastic disease. This is the report of the Rome Workshop, which will be presented for ratification to the FIGO Staging Committee in September 2000.

Journal Article↗
PubMed1992

[Maintenance chemotherapy using UFT and FT for gynecological malignant tumors. The Gunma Prefectural Society for Study of Chemotherapy for Gynecological Cancer].

The Gunma Prefectural Society for Study of Chemotherapy for Gynecological Cancer made a comparative study on postoperative supplementary chemotherapy including UFT and FT-E for gynecological malignant tumors. The number of cases registered totaled 182, which was broken down into ovarian cancer 53 cases, uterine cervical cancer 89 cases and endometrial cancer 30 cases. Complete cases among them consisted of ovarian cancer 53 cases, uterine cervical cancer 86 cases and endometrial cancer 27 cases for a total of 166 cases. Ovarian cancer was stratified into the completely and incompletely removed cases, uterine cervical cancer into postoperative non-irradiated and irradiated cases and endometrial cancer into the positive metastasis (+) group and negative metastasis (-) group. Then the UFT administration group and FT-E administration group were compared for postoperative survival. There were control groups for both ovarian and endometrial cancer. UFT administration showed a significant improvement in the survival rate (P < 0.05) compared to the FT-E administration group in the cases of ovarian cancer completely removed and the cases of endometrial cancer irradiated after operation. No significant difference was observed between other groups compared. The incidence of side effects was 20.6% (20/97) in the UFT administration group and 3.6% (2/55) in the FT-E group. Neither group showed any serious side effects.

Adult↗
PubMedDate not supplied

[Pelvic venous stasis. Gynecologic impact. Is it possible to individualize gynecologic phlebology?].

Pelvic phlebography, principally phlebography via endo-uterine access, can reveal states of chronic venous stasis in gynecological disorders. The existence of such stasis is reflected by the presence of varicoceles and of utero-vaginal and pampiniform plexuses. In some cases, dilatation of the ovarian vein raises the question of primary valvular insufficiency of these veins. The following were studied here on the basis of phlebographic data: the problem of pelvic pain and of Masters and Allen syndrome; pelvic stasis in the sequelae of phlebitis and of pelvic phlebitis; the problem of primary venous insufficiency (?); and the role of such stasis in various gynecological disorders. The pathogenic role of such stasis, either as the chief factor or as an accompanying or favouring factor, should be taken into consideration when determining the management.

Female↗
PubMed1981

[Clinical application of 6059-S in the field of obstetrics and gynecology. Effects on gynecological infection and infection of trimester of pregnancy (author's transl)].

6059-S, a new oxacephem antibiotic was applied in the clinical use of gynecological and obstetrical infection. 1. In obstetrical field, attention should be paid on choice of antibiotics in the case of maternal infection. Especially in the trimester of pregnancy, such drugs as ampicillin (ABPC) has been reported apparent unfavourable effects by decreasing the estriol (E3) level. 2. The comparative study between 6059-S, SBPC and ABPC was performed by various hormone level, including E3 (blood and urine), blood progesterone, alpha-fetoprotein, human chorionic gonadotropin (HCG), cortisol and human placental lactogen (HPL). 9 cases of intrauterine fetal growth retardation (IUGR) (ranging from 28 approximately 36 weeks of pregnancy) was selected, including toxemia of pregnancy or complicated pregnancy of myoma of uterus and diabetes mellitus. The determination of hormone level, one drug (2g) out of three test drug was chosen at random and administered by intravenous infusion on 3 approximately 4 days after admission. After 5 days of interval, another test dose was given, and the evaluation between the drug effects was performed on the hormonal level. 3. Following the single administration of ABPC (2 g) by intravenous infusion, the decrease of urinary E3 reached 26% on the 2 days after injection. As for SBPC the decrease was 21%, while in cases 6059-S, no apparent change was determined. Statistical difference between 6059-S and ABPC 5% by chi 2 determination was found. On the other hormonal level, there was relatively great individual difference, and the apparent day by day change was undeterminable. 4. Clinical estimation of 6095-S on the gynecological infection was also performed on the 7 cases of patients. The overall efficacy rate was 85.7%. No adverse reaction was observed except one case elevation of S-GPT.

Adult↗
PubMed2003

Assessment and prevalence of depression in women 45-55 years of age visiting gynecological clinics in Poland: screening for depression among midlife gynecologic patients.

The aims of the Polish survey were to assess efficacy of screening for depression in gynecological practice and to estimate prevalence of depressive disorders in midlife women visiting gynecologists. The study included 2262 female outpatients aged 45-55, who were screened by 120 gynecologists throughout Poland. Patients completed the Beck's Depression Inventory (BDI) and were assessed by gynecologists to verify the presence of symptoms of a current Depressive Episode according to ICD-10 diagnostic criteria. Patients who obtained a score of 12 points or more on the BDI were referred for psychiatric evaluation, including the modified version of Mini International Neuropsychiatric Interview (MINI). The study showed that gynecologists in Poland are able to perform screenings for depression effectively in outpatient settings. Results also suggested that about 19% of women aged 45 to 55 years visiting gynecologists may suffer from depressive disorders.

Ambulatory Care Facilities↗
PubMed1987

(Sub)specialization in obstetrics and gynecology: results of a survey by the American Board of Obstetrics and Gynecology.

Survey of department chairmen (n = 113) and former fellows (n = 599) revealed that from 1974 to 1984 the mean number of full-time faculty doubled and the increase was in subspecialists (5.1 per department). More than 60% of departments report trained subspecialists in three areas and 92.9% in one or more areas. Twenty-two chairmen report zero laboratory research funding. Of former fellows, 82% are certified in obstetrics and gynecology; 44% are certified in a subspecialty; 86.3% have passed the subspecialty written examination. Employment is full-time faculty for 60.8% and full-time private practice for 16.1%. They devote 49.1% of professional time to the subspecialty and 15.9% to research, most of which is clinical; 56.6% spend no time in laboratory research. While 40.3% have submitted no research grant applications since completion of fellowship, of all grants submitted to the federal government, 63.5% were approved and 34.5% were funded. The mean number of papers published since fellowship is 7.8. The number of fellows graduating may meet estimated need. The initial objectives of this new certification are being achieved.

Certification↗
PubMed2006

The effect of the obstetrics and gynecology clerkship on students' interest in a career in obstetrics and gynecology.

OBJECTIVE: The goal of this study was to determine the influence of the third-year obstetrics and gynecology (OB/GYN) clerkship on male and female medical students' interest in a career in OB/GYN. STUDY DESIGN: Third-year medical students were surveyed about anticipated career field before and at the completion of the OB/GYN clerkship. The percentage of students considering OB/GYN as a career was computed before and after the clerkship. A multiple regression analysis was performed to examine the influence of various demographic factors on interest in OB/GYN. A Chi-square test was performed to establish different effects on males and females. RESULTS: A total of 268 students (55%) completed both surveys. Eight percent (mostly females) considered an OB/GYN career pre-clerkship and 15% post-clerkship. Interest in OB/GYN pre-clerkship was the strongest predictor of interest post-clerkship. CONCLUSION: The OB/GYN clerkship increases students' interest in a career in OB/GYN. Most males are not considering OB/GYN as a career choice before the start of the clerkship.

Adult↗
PubMed2004

Laparoscopic training and practice in gynecologic oncology among Society of Gynecologic Oncologists members and fellows-in-training.

OBJECTIVE: To determine the proportion of Society of Gynecologic Oncologists (SGO) members performing laparoscopic procedures and to determine SGO members' and fellows' opinions regarding indications for and the adequacy of training in laparoscopy. METHODS: Surveys were mailed to SGO members and fellows-in-training in December 2002. Anonymous responses were collected by mail or through a Web site. The survey was mailed twice and was estimated to take 5 min to complete. The data were analyzed using frequency distributions and nonparametric tests. RESULTS: Three hundred thirty-six SGO members (45%) and fifty-seven fellows (49%) responded. Among SGO members, 272 (84%) currently performed laparoscopic surgeries. Reasons cited for performing laparoscopy were decreased length of hospital stay (74%), improved patient quality of life (57%), patient preference (48%), improved cosmesis (46%), and better visualization (18%). Among those who did not perform laparoscopy, 50% cited increased operating time as their main reason. When asked to indicate the laparoscopic procedure most commonly performed in their practice, 69% reported diagnosis of an adnexal mass; 11%, prophylactic bilateral salpingo-oophorectomies; and 10%, laparoscopically assisted vaginal hysterectomy and lymph node staging for uterine cancer. Only 3% of SGO respondents performed more than 50% of their procedures laparoscopically, and all respondents reported converting from laparoscopy to laparotomy less than 25% of the time. Most respondents had limited laparoscopic training during their fellowships: 39% received none, and 46% received limited (less than five procedures per month) training. Nevertheless, 78% of SGO respondents rated their laparoscopic skills as either very good or good. Among fellows, only 25% believed they were receiving very good or good laparoscopic training. Eighty percent of SGO respondents believe that at least six procedures per month were necessary for adequate training, yet only 33% of fellows performed that many procedures. CONCLUSIONS: Most SGO respondents used laparoscopy for selective indications, and most developed their laparoscopic skills after their fellowship training. SGO respondents believed laparoscopic instruction is an important part of training, but most fellows perceived their laparoscopic training as inadequate.

Adult↗
PubMed2002

Phase I escalation of gemcitabine combined with protracted oral etoposide in gynecologic malignancies: A Gynecologic Oncology Group study.

OBJECTIVE: Although improvements have been made in the management of patients with advanced ovarian cancer, long-term survivors are still uncommon. Gemcitabine and prolonged oral etoposide have shown reproducible single-agent activity in patients with platinum/paclitaxel-resistant ovarian cancer. This, combined with preclinical synergism, prompted the Gynecologic Oncology Group to determine the maximum tolerated dose (MTD) of this combination. METHODS: Eligible patients had recurrent epithelial ovarian cancer, primary papillary peritoneal, or fallopian tube carcinoma. All had received prior platinum/paclitaxel-based chemotherapy and had adequate hepatic, renal and bone marrow function. Oral etoposide was administered at 50 mg/m2 for ten days, with three proposed dose levels for gemcitabine on days 1 and 8: 400, 550 and 700 mg/m2. Cycles were to be repeated every 28 days. Three patients were to enter at each dose level. RESULTS: Patients were enrolled only to dose level 1 as this dose exceeded MTD. Of six patients initially enrolled, one was removed after three days with fever, ascites and decreased albumin believed not to be treatment related. Five patients were evaluable for toxicity and response. One of the first three patients developed dose limiting toxicity (DLT) manifested as grade 4 neutropenia. A second DLT (neutropenic fever and thrombocytopenia associated with bleeding) occurred among the next three patients: therefore, MTD was reached at dose level 1. Grade 4 toxicities included episodes of neutropenia (4) and thrombocytopenia (3). No objective response was observed. CONCLUSIONS: Oral etoposide and gemcitabine at this dose and schedule was associated with substantial toxicity in this population. Patients who are previously treated with platinum/paclitaxel-based chemotherapy may be at particular risk for toxicity.

Administration, Oral↗