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PubMed2003

[Child and adolescent gynecology. Introduction to the focal topic 'Child and adolescent gynecology'].

Valuable knowledge from the subspecialty of child and adolescent gynecology is of considerable importance for the clinically active pediatrician and gynecologist. Focal topics such as sexual violence to children and young adults, undesired pregnancies and pregnancy termination should not only be made known in the media, but also to specialists, so that successful prevention and treatment can be carried out. Furthermore, endocrinological problems and genital malformations in adolescence should be detectable and treatable.

Adolescent↗
PubMed2003

[A newly opened palliative care ward and the nursing of terminal patients with gynecological cancer at our Department of Obstetrics and Gynecology in Tokyo Women's Medical University Hospital].

Seventy-nine terminal patients with gynecological cancer treated in the past 5 years in our hospital or their families were interviewed on where those patients died and the reason why they chose to die in the place. Fifty-two patients (65.8%) were died at our hospital, 18 patients (22.8%) at other hospitals, 5 (6.3%) at other hospice and 4 (5.1%) at home. The 52 patients who died at our hospital were asked why they chose to die there. 42 of them (80.8%) wanted care at our hospital to the death. 10 (20.2%) had no time to think of home care or other institutions because of the sudden change of the condition. The 18 patients who died at other institutions were also asked about the reason. 9 of them (50%) wanted to die in their hometown or close to their home. 5 of them (27.8%) were referred to other hospitals due to brain metastasis or the necessity of undergoing dialysis. 2 of them (11.1%) were referred to the institutions which provide long-term care. 2 of them (11.1%) were brought into a nearby emergent care hospital and died after the sudden change of the condition. The palliative care ward in our university hospital can provide continued relationship with cancer patients. We had time to talk enough with carcinoma patients and their family in the ward, which widened choices of their death place, including home death.

Attitude to Death↗
PubMed2003

[A newly opened palliative care ward and the nursing of terminal patients with gynecological cancer at our Department of Obstetrics and Gynecology in Tokyo Women's Medical University Hospital].

Seventy-nine terminal patients with gynecological cancer treated in the past 5 years in our hospital or their families were interviewed on where those patients died and the reason why they chose to die in the place. Fifty-two patients (65.8%) died at our hospital, 18 patients (22.8%) at other hospitals, 5 (6.3%) at other hospice and 4 (5.1%) at home. The 52 patients who died at our hospital were asked why they chose to die there. 42 of them (80.8%) wanted care at our hospital to the death. 10 (20.2%) had no time to think of home care or other institutions because of the sudden change of the condition. The 18 patients who died at other institutions were also asked about the reason. 9 of them (50%) wanted to die in their hometown or close to their home. 5 of them (27.8%) were referred to other hospitals due to brain metastasis or the necessity of undergoing dialysis. 2 of them (11.1%) were referred to the institutions which provide long-term care. 2 of them (11.1%) were brought into a nearby emergent care hospital and died after the sudden change of the condition. The palliative care ward in our university hospital can provide continued relationship with cancer patients. We had time to talk enough with carcinoma patients and their family in the ward, which widened choices of their death place, including home death.

Attitude to Death↗
PubMed2006

Ovulatory failure, fertility preservation and reproductive strategies in the setting of gynecologic and non-gynecologic malignancies.

The advances in assisted reproductive technology over time have paralleled the insights gained into the natural history of different gynecologic malignancies. Subgroups of young patients with early stage ovarian cancer, endometrial carcinoma and cervical carcinoma may be considered to be at relatively low risk of recurrence and may be treated conservatively with the aim to preserve fertility when this is of prime concern. Unilateral adnexectomy with preservation of the contralateral ovary and uterus may be appropriate for some patients with epithelial ovarian cancers, and certainly should be the procedure of choice for those young women with borderline tumors and early stage sex cord-stromal and malignant germ cell tumors. Administration of high-dose progestins may obviate the need for immediate hysterectomy in a young patient with a well-differentiated endometrial carcinoma desirous of childbearing. The performance of vaginal radical trachelectomy in conjunction with laparoscopic pelvic lymphadenectomies has emerged as a real breakthrough for a highly select group of young women with early invasive tumors of the cervix. In this review, we also discuss reproductive strategies for women who experience chemotherapy-induced ovulatory failure and also address the potential for ovarian cortex cryopreservation and transplantation, and uterine transplantation, all of which are looming on the horizon.

Female↗
PubMed1986

Medical students' gynecologic examination skills. Evaluation by gynecology teaching associates.

In the past it was assumed that medical students would be able to perform an adequate pelvic examination by the end of the third-year clinical clerkship. At the University of Virginia, students completing the clinical clerkship were evaluated by trained gynecology teaching associates (GTAs), acting as patients and chaperones, who systematically evaluated students' examination and interpersonal skills using both an objective scale including 86 specific items and two 12-point subjective rating scales. Interrater reliability was demonstrated, as was the correlation between the subjective scores and objective ratings. Thirty-two percent of the students were evaluated as having either inadequate or marginal examination skills, and 29% were rated as having interpersonal skills that fell into the same unsatisfactory category. GTAs can be used as evaluators of skills in a competency-based clerkship.

Breast Diseases↗
PubMed1994

Cyclosporin enhancement of cisplatin chemotherapy in patients with refractory gynecologic cancer. A Gynecologic Oncology Group Study.

BACKGROUND: Cyclosporin has been demonstrated to reverse resistance to several antineoplastic agents including cisplatin in vitro. The purpose of this Phase I trial was to study the potential clinical application of cyclosporin modulation of cisplatin and to establish a tolerable dose of cyclosporin when combined with a standard dose of cisplatin of 75 mg/m2. METHODS: A course of therapy consisted of two cyclosporin infusions over 2 hours each, 24 hours apart, with cisplatin given 6 hours after the first dose. Treatment was repeated every 21 days. Cyclosporin was studied in a Phase I fashion at five different levels, from 1-5 mg/kg per dose. Twenty patients with refractory gynecologic cancer received 81 courses of therapy. All patients had received extensive prior chemotherapy containing cisplatin. RESULTS: Grade 4 nephrotoxicity was seen in 4 of 20 patients: 1 treated at 1 mg/kg, 1 at 2 mg/kg, and 2 at 5 mg/kg of cyclosporin. The patient treated at the 1 mg/kg level was a partial clinical responder and tolerated six courses. The patient at the 2 mg/kg level had received 14 prior courses of cisplatin and tolerated only two additional courses before a Grade 4 renal toxicity developed. Grade 4 nephrotoxicity developed in the two patients receiving 5 mg after two courses of chemotherapy. Two of the 20 patients achieved a complete response (CR) and 3 patients achieved a partial response (PR), for a total response rate of 25% (5 of 20). The two women who achieved CR started treatment with symptomatic ascites; one of whom also had multiple pulmonary lesions that were no longer evident after three courses of therapy. CONCLUSIONS: Cyclosporin at a dose of 4 mg/kg per day given for 2 consecutive days in association with 75 mg/m2 of cisplatin can be given with reasonable assurance of safety.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Phase II trial of galactitol 1,2:5,6-dianhydro (NSC 132313) in the treatment of advanced gynecologic malignancies: a Gynecologic Oncology Group study.

Dianhydrogalactitol was administered intravenously to patients with advanced or recurrent gynecologic malignancies on a weekly schedule. The initial dosage was 60 mg/m2 with escalation to 75 mg/m2 if there were no adverse effects. Forty-two patients with ovarian epithelial adenocarcinoma (OEA) and forty-one patients with squamous carcinoma of the cervix (SCC) were entered into this study. Of these, 39 patients with OEA and 36 with SCC were evaluable for toxicity and response. Seven patients (19.4%) with SCC had an objective response, while six patients (15.4%) with OEA had an objective response. Adverse effects were frequent but tolerable. There were no drug-related deaths, and only two patients suffered life-threatening hematologic toxicity. Myelosuppression was observed more frequently among the patients with OEA. A higher percentage of OEA patients had received prior chemotherapy. The level of activity and frequency of adverse effects observed at this dose schedule warrant further studies of this drug in these two tumors.

Adenocarcinoma↗
PubMed2001

Phase I trial of escalating doses of paclitaxel combined with fixed doses of cisplatin and doxorubicin in advanced endometrial cancer and other gynecologic malignancies: a Gynecologic Oncology Group study.

PURPOSE: The primary objective of this phase I trial was to determine the feasibility of administering a combination of paclitaxel, cisplatin, and doxorubicin with or without granulocyte colony-stimulating factor (G-CSF) in patients with advanced endometrial and other gynecologic cancers. PATIENTS AND METHODS: Patients were chemotherapy-naive. Doxorubicin was administered as a brief infusion, paclitaxel for 3 hours, and cisplatin for 60 minutes. Treatments were repeated every 3 weeks. For most dose levels, the cisplatin and doxorubicin were fixed at 60 mg/m(2) and 45 mg/m(2), whereas the paclitaxel was escalated in successive cohorts from 90 to 250 mg/m(2). Patients who had received previous radiotherapy to the whole pelvis were escalated separately from those who had not. RESULTS: Eighty patients received 320 cycles of therapy. When G-CSF was not used, myelosuppression prevented escalation beyond the starting dose for patients with or without previous pelvic radiotherapy. When G-CSF was added, neurotoxicity became dose-limiting for both groups. Ten patients were removed from the study for asymptomatic declines in ejection fraction, but no symptomatic congestive heart failure was observed. Major antitumor responses occurred in 46% of patients (six of 13) with measurable endometrial carcinoma and 50% of patients (eight of 16) with measurable cervical carcinoma. CONCLUSION: The combination of paclitaxel, doxorubicin, and cisplatin at relevant single-agent doses is active and feasible with the addition of G-CSF. A regimen of cisplatin 60 mg/m(2), doxorubicin 45 mg/m(2), and paclitaxel 160 mg/m(2) with G-CSF support is recommended for further testing.

Adult↗
PubMed1996

Infections after hysterectomy. A prospective nation-wide Swedish study. The Study Group on Infectious Diseases in Obstetrics and Gynecology within the Swedish Society of Obstetrics and Gynecology.

BACKGROUND: An increased use of prophylactic antibiotics to avoid postoperative infections in women undergoing hysterectomy has been observed in Sweden. This investigation was performed a) to study the infection rate to enable future evaluation of the effect of prophylactic antibiotic regimens and b) to identify subgroups suitable for intervention. METHOD: A prospective study comprising all women undergoing pelvic surgery with hysterectomy during a two month period at forty-two Departments of Obstetrics and Gynecology in Sweden. Relevant information regarding the surgical procedure and the postoperative course was included in a standardized form at discharge from hospital and at a follow-up visit 4 to 6 weeks after surgery. RESULTS: Of the 1060 women included in the study, 23% developed postoperative infections: 9.4% had wound-, cuff-, and/or deep infections, 13% urinary tract infections, and 4% other infections unrelated to the surgical site. Only half of the wound/cuff-/deep infections were diagnosed before discharge from the hospital. Wertheim-Meigs procedures, bleedings per-operatively exceeding 1000 ml, and presence of bacterial vaginosis (BV) were associated with an increased risk of postoperative infections. Among women undergoing abdominal hysterectomy for benign reasons, (n = 159), wound-cuff/deep infection was significantly associated with preoperative BV, i.e. 7 of 28 (25%) vs. 11 of 131 (8%), respectively (relative risk = 3.0, p = 0.01). Infection was associated with prolonged postoperative hospital stay. Antibiotics were given pre- or postoperatively to 236 (22%) of the 1060 women. Reduction in the postoperative infection rate was seen among women undergoing vaginal hysterectomy who were given pre- or postoperative antibiotics. CONCLUSION: The postoperative infection rate after hysterectomy was clinically significant in this population. Wertheim-Meigs procedures, peroperative bleeding > 1000 ml and BV were identified as risk factors for postoperative infections after hysterectomy.

Anti-Bacterial Agents↗
PubMed1991

[An early phase II study of CPT-11 in gynecologic cancers. Research Group of CPT-11 in Gynecologic Cancers].

An early Phase II study of CTP-11, a new derivative of Camptothecin, in gynecologic cancers was carried out by a cooperative study group of 9 institutions. Forty-six patients were enrolled, and there were 14 cases of ovarian cancers, 7 of cervical cancer, 6 of uterine body cancers and 1 of endometrial stromal sarcoma which satisfied study criteria. The response rate in ovarian cancers was 21.4%, and in cervical cancers 42.9%, among an overall rate of 21.4%. Three out of 6 patients with objective response had undergone previous chemotherapies including cisplatin, suggesting that CPT-11 was effective for patients with no response or refractory to these therapies. Leukopenia was a major adverse reaction with an incidence of 60.0% (grade 2 or more). Gastrointestinal symptoms such as nausea vomiting, anorexia and diarrhea were frequently observed (grade 2 or more; 13.3-43.3%). These were generally tolerable except in a few cases. Besides these reactions, alopecia was also observed (33.3%), but severe adverse reactions such as nephropathy were not. These results suggested that CPT-11 was effective against ovarian cancer and cervical cancer. The recommended dose regimen for a late phase II study is considered to be 100 mg/m2 once weekly and 150 mg/m2 once every 2 weeks.

Adult↗
PubMed1979

[Ozone-oxygen therapy for gynecologic carcinomas. The effect of parenteral-ozone oxygen mixture administration on free fatty acids and triglycerides in patients with gynecologic carcinomas].

As some authors suspect that ozone influences the metabolic process of fat, we tried to analyse the influence of an ozone-oxygen gas which was applied parenterally. 40 patients with gynecological cancer received 10 ml ozone-oxygen gas with a content of 450 gamma ozone and venous blood was removed before and 10 minutes after application. The serum was lyophilized and the level of fatty acids and triglycerids was determined by the method of Randerath (1965). a statistically significant decrease of the concentrations was observed after application of ozone. Different theories as to the cause of this action are discussed.

Clinical Trials as Topic↗
PubMed1981

[The psychosomatic-gynecological outpatients department of the II. Gynecological Clinic of the University of Vienna (author's transl)].

A report is given on the organization and practice of an outpatients departments for psychosomatics in gynecology. The data of 284 patients concerning social status, possible trigger mechanisms (life events), diagnosis and treatment are presented. The applied therapeutic technique can be described as client centered counselling basing on psychoanalytic theory. the importance of cooperation between psychotherapist and gynecologist to the woman's benefit is emphasized.

Adult↗
PubMed1998

[Change of cytokines and clinical efficacy of panipenem/betamipron in obstetric and gynecological infections. Yamagata Study Group of Panipenem/Betamipron in Obstetric and Gynecological Infections].

Efficacy and safety of panipenem/betamipron (PAPM/BP) in treatment of obstetric and gynecological infections, and change of interleukin-6 (IL-6) and interleukin-8 (IL-8) levels in blood, as markers of infection, were investigated. The results were as follows; 1) Clinical efficacy of PAPM/BP by drip infusion of 1-2 g/day for 3-14 days against 52 patients with intrauterine infection (n = 29), pelveoperitonitis (n = 19), and other infections were 14 "Excellent" in 14 cases, "Good" in 35 cases, and efficacy rate was 94.2% (49/52). Both efficacy rate analy by causative organisms and eradication rate were 35/37 (94.6%). No subjective or objective side effects and no abnormal labolatory findings were observed. 2) Changes of IL-6 (> 4 pg/ml) levels in serum, as an infection marker, were observed in 8 cases out of 14 cases (57.1%), and correlation between CRP and IL-6 in the treatment process was noticed. However, changes of serum IL-8 (> 12.5 pg/ml) were observed in only 2 cases of those 14 cases (14.3%), indicative that IL-8 has no significance as a marker of infection.

Adolescent↗