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Plaja A, Teruel I, Ochoa-de-Olza M, Cucurull M, Arroyo ÁJ, Pardo B, Ortiz I, Gil-Martin M, Piulats JM, Pla H, Fina C, Carbó A, Barretina-Ginesta MP, Martínez-Román S, Carballas E, González A, Esteve A, Romeo M. Prognostic Role of Neutrophil, Monocyte and Platelet to Lymphocyte Ratios in Advanced Ovarian Cancer According to the Time of Debulking Surgery. Int J Mol Sci 2023; 24:11420. [PMID: 37511180 PMCID: PMC10380459 DOI: 10.3390/ijms241411420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Despite a multimodal radical treatment, mortality of advanced epithelial ovarian cancer (AEOC) remains high. Host-related factors, such as systemic inflammatory response and its interplay with the immune system, remain underexplored. We hypothesized that the prognostic impact of this response could vary between patients undergoing primary debulking surgery (PDS) and those undergoing interval debulking surgery (IDS). Therefore, we evaluated the outcomes of two surgical groups of newly diagnosed AEOC patients according to the neutrophil, monocyte and platelet to lymphocyte ratios (NLR, MLR, PLR), taking median ratio values as cutoffs. In the PDS group (n = 61), low NLR and PLR subgroups showed significantly better overall survival (not reached (NR) vs. 72.7 months, 95% confidence interval [CI]: 40.9-95.2, p = 0.019; and NR vs. 56.1 months, 95% CI: 40.9-95.2, p = 0.004, respectively) than those with high values. Similar results were observed in progression free survival. NLR and PLR-high values resulted in negative prognostic factors, adjusting for residual disease, BRCA1/2 status and stage (HR 2.48, 95% CI: 1.03-5.99, p = 0.043, and HR 2.91, 95% CI: 1.11-7.64, p = 0.03, respectively). In the IDS group (n = 85), ratios were not significant prognostic factors. We conclude that NLR and PLR may have prognostic value in the PDS setting, but none in IDS, suggesting that time of surgery can modulate the prognostic impact of baseline complete blood count (CBC).
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Affiliation(s)
- Andrea Plaja
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-Badalona, Badalona Applied Research Group in Oncology (BARGO), Institut d'Investigació Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Iris Teruel
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-Badalona, Badalona Applied Research Group in Oncology (BARGO), Institut d'Investigació Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Maria Ochoa-de-Olza
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-Badalona, Badalona Applied Research Group in Oncology (BARGO), Institut d'Investigació Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Marc Cucurull
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-Badalona, Badalona Applied Research Group in Oncology (BARGO), Institut d'Investigació Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Álvaro Javier Arroyo
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-L'Hospitalet, Hospital Duran i Reynals, Institut d'Investigació de Bellvitge (IDIBELL), 08908 Barcelona, Spain
| | - Beatriz Pardo
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-L'Hospitalet, Hospital Duran i Reynals, Institut d'Investigació de Bellvitge (IDIBELL), 08908 Barcelona, Spain
| | - Irene Ortiz
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-L'Hospitalet, Hospital Duran i Reynals, Institut d'Investigació de Bellvitge (IDIBELL), 08908 Barcelona, Spain
| | - Marta Gil-Martin
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-L'Hospitalet, Hospital Duran i Reynals, Institut d'Investigació de Bellvitge (IDIBELL), 08908 Barcelona, Spain
| | - Josep María Piulats
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-L'Hospitalet, Hospital Duran i Reynals, Institut d'Investigació de Bellvitge (IDIBELL), 08908 Barcelona, Spain
| | - Helena Pla
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-Girona, Girona Biomedical Research Institut d'Investigació Biomèdica de Girona (IDIBGi), 17007 Girona, Spain
| | - Claudia Fina
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-Girona, Girona Biomedical Research Institut d'Investigació Biomèdica de Girona (IDIBGi), 17007 Girona, Spain
| | - Anna Carbó
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-Girona, Girona Biomedical Research Institut d'Investigació Biomèdica de Girona (IDIBGi), 17007 Girona, Spain
| | - Maria-Pilar Barretina-Ginesta
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-Girona, Girona Biomedical Research Institut d'Investigació Biomèdica de Girona (IDIBGi), 17007 Girona, Spain
| | - Sergio Martínez-Román
- Obstetrics and Gynecologycal Department, Hospital Germans Trias i Pujol, 08916 Badalona, Spain
| | - Elvira Carballas
- Obstetrics and Gynecologycal Department, Hospital Germans Trias i Pujol, 08916 Badalona, Spain
| | - Andrea González
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-Badalona, Badalona Applied Research Group in Oncology (BARGO), Institut d'Investigació Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Anna Esteve
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-Badalona, Badalona Applied Research Group in Oncology (BARGO), Institut d'Investigació Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
| | - Margarita Romeo
- Medical Oncology Department, Institut Català d'Oncologia (ICO)-Badalona, Badalona Applied Research Group in Oncology (BARGO), Institut d'Investigació Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
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Martínez-Román S, Tarrats A, Carballas E, Romeo M. [How can we help our gynaecological cancer patients during the COVID-19 pandemic?]. Clin Invest Ginecol Obstet 2020; 47:91-95. [PMID: 32834305 PMCID: PMC7284229 DOI: 10.1016/j.gine.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- S Martínez-Román
- Unidad Funcional de Ginecología Oncológica, Hospital Universitario Germans Trias i Pujol, Institut Català d'Oncologia (ICO), Badalona, Barcelona, España
| | - A Tarrats
- Servicio de Ginecología, Unidad Funcional de Ginecología Oncológica, Hospital Universitario Germans Trias i Pujol, Institut Català d'Oncologia (ICO), Badalona, Barcelona, España
| | - E Carballas
- Servicio de Ginecología, Unidad Funcional de Ginecología Oncológica, Hospital Universitario Germans Trias i Pujol, Institut Català d'Oncologia (ICO), Badalona, Barcelona, España
| | - M Romeo
- Servicio de Oncología, Unidad Funcional de Ginecología Oncológica, Hospital Universitario Germans Trias i Pujol, Institut Català d'Oncologia (ICO), Badalona, Barcelona, España
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Romeo M, Pardo JC, Martínez-Cardús A, Martínez-Balibrea E, Quiroga V, Martínez-Román S, Solé F, Margelí M, Mesía R. Translational Research Opportunities Regarding Homologous Recombination in Ovarian Cancer. Int J Mol Sci 2018; 19:ijms19103249. [PMID: 30347758 PMCID: PMC6214122 DOI: 10.3390/ijms19103249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 09/29/2018] [Accepted: 10/16/2018] [Indexed: 02/07/2023] Open
Abstract
Homologous recombination (HR) is a DNA repair pathway that is deficient in 50% of high-grade serous ovarian carcinomas (HGSOC). Deficient HR (DHR) constitutes a therapeutic opportunity for these patients, thanks to poly (ADP-ribose) polymerases (PARP) inhibitors (PARPi; olaparib, niraparib, and rucaparib are already commercialized). Although initially, PARPi were developed for patients with BRCA1/2 mutations, robust clinical data have shown their benefit in a broader population without DHR. This breakthrough in daily practice has raised several questions that necessitate further research: How can populations that will most benefit from PARPi be selected? At which stage of ovarian cancer should PARPi be used? Which strategies are reasonable to overcome PARPi resistance? In this paper, we present a summary of the literature and discuss the present clinical research involving PARPi (after reviewing ClinicalTrials.gov) from a translational perspective. Research into the functional biomarkers of DHR and clinical trials testing PARPi benefits as first-line setting or rechallenge are currently ongoing. Additionally, in the clinical setting, only secondary restoring mutations of BRCA1/2 have been identified as events inducing resistance to PARPi. The clinical frequency of this and other mechanisms that have been described in preclinics is unknown. It is of great importance to study mechanisms of resistance to PARPi to guide the clinical development of drug combinations.
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Affiliation(s)
- Margarita Romeo
- Medical Oncology Department, B-ARGO Group, Institut Català d'Oncologia Badalona, Carretera del Canyet s/n, 08916 Badalona, Spain.
- Campus de la UAB, Universitat Autónoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Spain.
| | - Juan Carlos Pardo
- Medical Oncology Department, B-ARGO Group, Institut Català d'Oncologia Badalona, Carretera del Canyet s/n, 08916 Badalona, Spain.
| | - Anna Martínez-Cardús
- Health Sciences Research Institute of the Germans Trias i Pujol Foundation (IGTP), B-ARGO Group, Carretera del Canyet s/n, 08916 Badalona, Spain.
| | - Eva Martínez-Balibrea
- Program against Cancer Therapeutic Resistance (ProCURE), Institut Català d'Oncologia Badalona, Program for Predictive and Personalized Cancer Medicine (PMPPC), Health Sciences Research Institute Germans Trias i Pujo (IGTP), Carretera de Can Ruti, Camí de les Escoles s/n, 08916 Badalona, Spain.
| | - Vanesa Quiroga
- Medical Oncology Department, B-ARGO Group, Institut Català d'Oncologia Badalona, Carretera del Canyet s/n, 08916 Badalona, Spain.
| | - Sergio Martínez-Román
- Gynecology Department, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Francesc Solé
- Institut de Recerca contra la Leucemia Josep Carreras, 08916 Badalona, Spain.
| | - Mireia Margelí
- Medical Oncology Department, B-ARGO Group, Institut Català d'Oncologia Badalona, Carretera del Canyet s/n, 08916 Badalona, Spain.
| | - Ricard Mesía
- Medical Oncology Department, B-ARGO Group, Institut Català d'Oncologia Badalona, Carretera del Canyet s/n, 08916 Badalona, Spain.
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Luna-Tomás MA, Solà-Suárez M, Mariscal-Martínez A, Castellà-Fernández E, Martínez-Román S, Pascual-Miguel I, Quiroga-García V, Julián-Ibáñez JF. Is OSNA better than imprint cytology for intraoperative diagnosis of cancer involvement of axillary sentinel node in breast cancer? Breast 2018; 38:181-187. [PMID: 29455041 DOI: 10.1016/j.breast.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/30/2017] [Accepted: 02/06/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The study aim was to establish Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value (NPV), and Accuracy Values of both imprint cytology (IC) and the OSNA assay for intraoperative assessment of axillary sentinel node (SN) cancer involvement in breast cancer. Specifically, we wished to find out if true positive and false negative results of IC were associated to axillary lymphadenectomy (ALND). Also, we addressed a comparative cost analysis between techniques. METHODS 244 patients treated for breast cancer in the Breast Unit of Hospital Germans Trias i Pujol from 2011 to 2015 were prospectively included. A transversal, consecutive design was applied to assess IC compared to the reference test (OSNA). Inclusion criteria were: T1 and T2 tumors with negative nodes, both clinically and on ultrasound. RESULTS Sensitivity of IC for macrometastases was 70%. The NPV of IC for macrometastases was 95,75%. Accuracy of IC was 96,12%. In the comparative cost analysis, the release time of results for OSNA doubled that of IC and was associated with an increased cost of € 370. CONCLUSIONS IC has been stated as a good technique for intraoperative cancer involvement SN with high sensitivity and NPV compared to the OSNA assay. It allows keeping the whole node tissue and thus the possibility of improved histopathological evaluation, which can be useful for adjuvant, and offers the advantage of being less time consuming. Cost analysis shows a higher cost for OSNA, which may exceed the benefit of sorting out false negatives from IC.
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Affiliation(s)
- M A Luna-Tomás
- Breast Disease Unit (BDU) and the Department of Gynecology and Obstetrics, Hospital Universitari Germans Trias i Pujol (HUGTIP), Badalona, Barcelona, Spain.
| | - M Solà-Suárez
- BDU and the Department of Nuclear Medicine, HUGTIP, Badalona, Barcelona, Spain
| | - A Mariscal-Martínez
- BDU Unit and the Department of Radiology, HUGTIP, Badalona, Barcelona, Spain
| | | | - S Martínez-Román
- Breast Disease Unit (BDU) and the Department of Gynecology and Obstetrics, Hospital Universitari Germans Trias i Pujol (HUGTIP), Badalona, Barcelona, Spain
| | - I Pascual-Miguel
- BDU and the Department of General Surgery, HUGTIP, Badalona, Barcelona, Spain
| | - V Quiroga-García
- BDU and the Department of Medical Oncology (ICO), HUGTIP, Badalona, Barcelona, Spain
| | - J F Julián-Ibáñez
- BDU and the Department of General Surgery, HUGTIP, Badalona, Barcelona, Spain
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Vidal-Sicart S, Valdés Olmos R, Nieweg OE, Faccini R, Grootendorst MR, Wester HJ, Navab N, Vojnovic B, van der Poel H, Martínez-Román S, Klode J, Wawroschek F, van Leeuwen FWB. From interventionist imaging to intraoperative guidance: New perspectives by combining advanced tools and navigation with radio-guided surgery. Rev Esp Med Nucl Imagen Mol 2018; 37:28-40. [PMID: 28780044 DOI: 10.1016/j.remn.2017.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/04/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023]
Abstract
The integration of medical imaging technologies into diagnostic and therapeutic approaches can provide a preoperative insight into both anatomical (e.g. using computed tomography, magnetic resonance imaging, or ultrasound), as well as functional aspects (e.g. using single photon emission computed tomography, positron emission tomography, lymphoscintigraphy, or optical imaging). Moreover, some imaging modalities are also used in an interventional setting (e.g. computed tomography, ultrasound, gamma or optical imaging) where they provide the surgeon with real-time information during the procedure. Various tools and approaches for image-guided navigation in cancer surgery are becoming feasible today. With the development of new tracers and portable imaging devices, these advances will reinforce the role of interventional molecular imaging.
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Affiliation(s)
- S Vidal-Sicart
- Nuclear Medicine Department, Hospital Clínic Barcelona, Barcelona, España.
| | - R Valdés Olmos
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, Países Bajos; Nuclear Medicine Section, Department of Radiology, Leiden University Medical Centre, Leiden, Países Bajos; Department of Nuclear Medicine, Diagnostic Oncology Division, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Países Bajos
| | - O E Nieweg
- Melanoma Institute Australia, North Sydney, Nueva Gales del Sur, Australia; Central Medical School, The University of Sydney, Sydney, Nueva Gales del Sur, Australia
| | - R Faccini
- Physics Department, University of Rome La Sapienza, Rome, ItalyhIFNF Roma, Roma, Italia; IFNF Roma, Roma, Italia
| | | | - H J Wester
- Chair of Pharmaceutical Radiochemistry, Technical University Munich, Munich, Alemania
| | - N Navab
- Institute of Informatics, Technical University of Munich, Munich, Alemania
| | - B Vojnovic
- Department of Oncology, Cancer Research UK and Medical Research Council, Oxford Institute for Radiation Oncology, University of Oxford, Oxford, Reino Unido
| | - H van der Poel
- Urology Department, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Países Bajos
| | - S Martínez-Román
- Obstetrics and Gynaecology Department, University Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - J Klode
- Clinic for Dermatology, University Hospital Essen, Essen, Alemania
| | - F Wawroschek
- Urology Department, Oldenburg Clinic, Oldenburg, Alemania
| | - F W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, Países Bajos
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Rodríguez-Trujillo A, Martínez-Serrano MJ, Martínez-Román S, Martí C, Buñesch L, Nicolau C, Pahisa J. Preoperative Assessment of Myometrial Invasion in Endometrial Cancer by 3D Ultrasound and Diffusion-Weighted Magnetic Resonance Imaging: A Comparative Study. Int J Gynecol Cancer 2017; 26:1105-10. [PMID: 27177278 DOI: 10.1097/igc.0000000000000724] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The prognosis of endometrial cancer depends on the correct surgical staging. In early stages, 18% to 30% rate of positive lymph nodes is reported with a myometrial invasion of 50% or more. According to this, patients with International Federation of Gynecology and Obstetrics stage Ib would benefit from staging lymphadenectomy. Therefore, it is important to classify these patients preoperatively to plan the surgery. In the recent years, 3-dimensional (3D) ultrasound and diffusion-weighted magnetic resonance imaging (DW-MRI) have been incorporated in the preoperative management of these patients. The aim of this study was to assess the usefulness of 3D ultrasound and DW-MRI as predictor of myometrial invasion in endometrial cancer. MATERIAL AND METHODS We retrospectively compared the assessment of myometrial invasion by 3D ultrasound and DW-MRI with final pathologic evaluation on hysterectomy specimens, in 98 patients diagnosed of early-stage endometrial cancer, who underwent surgery at the Hospital Clinic of Barcelona between 2012 and 2015. RESULTS Evaluation of the depth of myometrial invasion with 3D ultrasound had a sensitivity, specificity, and accuracy of 77%, 83% and 81%, respectively. Evaluation of the depth of myometrial invasion with DW-MRI had a sensitivity, specificity, and accuracy of 69%, 86%, and 81%, respectively. Association of both techniques improved all the values, showing a sensitivity, specificity, and accuracy of 87%, 93%, and 91%, respectively. In both 3D ultrasound and DW-MRI, the presence of leiomyomas was the first detectable cause of false negative (3% and 4%, respectively) and false-positive (3% and 1%, respectively). CONCLUSIONS We conclude that the implementation of the 2 studies in early-stage endometrial cancer provides low false-negatives and false-positives rates. In cases of patients with leiomyomas, adenomiosis, or intrauterine fluid collection, definitive evaluation of myometrial invasion could be better deferred to intraoperative biopsy in an attempt to reduce false-negatives and false-positives rates.
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Affiliation(s)
- Adriano Rodríguez-Trujillo
- *Department of Gynecology and Obstetrics, Hospital Clìnic i Provincial, University of Barcelona, Spain; and †Department of Radiology, Hospital Clínic i Provincial, University of Barcelona, Barcelona, Spain
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Ros C, Barnes D, Fervienza A, Oses G, Alcázar JL, Martínez-Román S, Rovirosa À, Carmona F, Gómez F. Ultrasound-guided transvaginal thrombin injection of uterine arteries pseudoaneurysms. Br J Radiol 2017; 90:20160913. [PMID: 28466646 DOI: 10.1259/bjr.20160913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate the utility of transvaginal ultrasound-guided thrombin injection (UGTI) to treat uterine artery pseudoaneurysms (UAPs) as an alternative to emergency arterial embolization. METHODS Two females presenting with heavy vaginal bleeding were diagnosed with UAPs by pelvic CT scan. After UAP identification by transvaginal ultrasound, 2 cm3 of thrombin (Tissucol®; Baxter Healthcare Corporation, Munich, Germany) was slowly injected into the UAPs using a 30-cm long 22-gauge needle through a needle guide attached to the vaginal probe. The same procedure was performed in both cases, and the Doppler sign disappeared immediately and the bleeding stopped. RESULTS We describe two cases of UAPs treated with transvaginal UGTI: one after intrauterine tandem and vaginal colpostat insertion for brachytherapy after diagnosis of cervical cancer (Case 1) and the other after the insertion of a levonorgestrel-releasing intrauterine device (Case 2). CONCLUSION Transvaginal UGTI could be a minimally invasive tool to treat selected cases of UAPs with severe vaginal bleeding. Advances in knowledge: Transvaginal UGTI could avoid the need for uterine embolization and emergency hysterectomy in selected cases of UAPs diagnosed by CT scan.
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Affiliation(s)
- Cristina Ros
- 1 ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Barnes
- 2 Department of Radiology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Anna Fervienza
- 1 ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Gabriella Oses
- 3 Department of Radiotherapy, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Juan L Alcázar
- 4 Department of Obstetrics and Gynecology, Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | | | - Àngels Rovirosa
- 3 Department of Radiotherapy, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Francisco Carmona
- 1 ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Fernando Gómez
- 2 Department of Radiology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Martínez-Serrano MJ, Martínez-Román S, Pahisa J, Balasch J, Carmona F. Intestinal surgery performed by gynecologists. Acta Obstet Gynecol Scand 2015; 94:954-9. [DOI: 10.1111/aogs.12698] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 06/08/2015] [Indexed: 01/15/2023]
Affiliation(s)
- María José Martínez-Serrano
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Sergio Martínez-Román
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Jaume Pahisa
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Joan Balasch
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Francisco Carmona
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
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Carmona F, Martínez-Zamora MA, Rabanal A, Martínez-Román S, Balasch J. Ovarian cystectomy versus laser vaporization in the treatment of ovarian endometriomas: a randomized clinical trial with a five-year follow-up. Fertil Steril 2011; 96:251-4. [PMID: 21575941 DOI: 10.1016/j.fertnstert.2011.04.068] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 04/02/2011] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the effect of two laparoscopic techniques for treatment of ovarian endometriomas on recurrence rate. DESIGN Prospective randomized clinical trial. SETTING University teaching hospital. PATIENT(S) Ninety women with ovarian endometriomas. INTERVENTION(S) Patients were randomly selected to undergo either laparoscopic cystectomy (group 1) or laser vaporization (group 2) of ovarian endometrioma. MAIN OUTCOME MEASURE(S) Recurrence, evaluated by ultrasound scan examination, was assessed at 12 and 60 months of follow-up. RESULT(S) Endometrioma recurrence rate was higher, though not significantly different, in group 2 at 60 months of follow-up. Nevertheless, at 12 months of follow-up recurrences were statistically higher in group 2. CONCLUSION(S) The comparison between laparoscopic laser ablation and laparoscopic cystectomy for ovarian endometriomas after long-term follow-up showed earlier recurrences and a higher recurrence rate in the laser group, although at 5 years of follow-up there were no statistically significant differences.
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Affiliation(s)
- Francisco Carmona
- Institut Clínic of Gynecology, Obstetrics, and Neonatology, Faculty of Medicine, University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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Pahisa J, Martínez-Román S, Torné A, Fusté P, Alonso I, Lejárcegui JA, Balasch J. Comparative Study of Laparoscopically Assisted Radical Vaginal Hysterectomy and Open Wertheim-Meigs in Patients With Early-Stage Cervical Cancer. Int J Gynecol Cancer 2010; 20:173-8. [DOI: 10.1111/igc.0b013e3181bf80ee] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Vidal-Sicart S, Doménech B, Luján B, Pahisa J, Torné A, Martínez-Román S, Antonio Lejárcegui J, Fusté P, Ordi J, Paredes P, Pons F. Ganglio centinela en cánceres ginecológicos. Nuestra experiencia. ACTA ACUST UNITED AC 2009; 28:221-8. [DOI: 10.1016/j.remn.2009.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
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12
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de Ferrater MB, Vidal-Sicart S, Zanón G, Martínez-Román S, Sanjuán A, Fernández PL, Velasco M, Pons F. Importance of Intramammary Node Resection in Breast Cancer Staging. Clin Nucl Med 2007; 32:572-3. [PMID: 17581352 DOI: 10.1097/rlu.0b013e3180646a31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Martínez-Román S, Frumovitz M, Deavers MT, Ramirez PT. Metastatic carcinoma of the gallbladder mimicking an advanced cervical carcinoma. Gynecol Oncol 2005; 97:942-5. [PMID: 15943996 DOI: 10.1016/j.ygyno.2005.01.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Revised: 01/24/2005] [Accepted: 01/31/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Metastasis to the uterine cervix from a non-gynecologic neoplasm is extremely rare. To our knowledge, only three cases of primary carcinoma of the gallbladder with metastasis to the cervix have been previously reported. We report a case of metastatic gallbladder carcinoma mimicking a stage IIIB cervical carcinoma. CASE A 74 year-old woman presented with pain in her left lumbar area radiating to her left flank. On physical examination, a 6 cm cervical tumor involving the left parametrium was noted. A computed tomography (CT) scan of the pelvis showed left-sided hydronephrosis and hydroureter with distal ureteral obstruction. A Pap smear revealed adenocarcinoma, and a biopsy of the endocervical canal was consistent with poorly differentiated adenocarcinoma. The patient was referred to a tertiary care center. On review of the biopsy after referral, the carcinoma was felt to be unusual for an endocervical primary and immunohistochemical stains were ordered. The carcinoma was positive for cytokeratin 7, had only focal cytoplasmic staining for p16, and was negative for carcinoembryonic antigen and cytokeratin 20. Upon presentation, the patient complained of new onset of shortness of breath and cough. A chest CT revealed multiple lesions in both lungs suggestive of metastatic disease, and an abdominal CT revealed a gallbladder tumor with extension into the liver. The patient underwent a CT-guided biopsy of one of the lung lesions and the pathologic findings were consistent with metastatic adenocarcinoma. The patient was diagnosed with stage IVB primary gallbladder adenocarcinoma and was treated with capecitabine, but her condition deteriorated rapidly and she died 5 months later. CONCLUSION In patients with an atypical presentation for cervical adenocarcinoma, it is important to consider a metastatic tumor in the differential diagnosis and to perform a thorough work-up for metastatic disease before initiating therapy.
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Affiliation(s)
- Sergio Martínez-Román
- Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Hospital Clinic, Universitat de Barcelona, Spain
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14
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Martínez-Román S, Ramirez PT, Oh J, Viciedo MG, MacApinlac HA. Combined positron emission tomography and computed tomography for the detection of recurrent ovarian mucinous adenocarcinoma. Gynecol Oncol 2005; 96:888-91. [PMID: 15721446 DOI: 10.1016/j.ygyno.2004.10.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The role of combined positron emission tomography and computed tomography (PET-CT) in the diagnosis of recurrent ovarian mucinous adenocarcinoma is uncertain because of previous reports that PET has limited sensitivity in the detection of mucinous neoplasms. CASE A 71-year-old white woman presented with complaints of right lower quadrant pain and a palpable adnexal mass. Physical examination and transvaginal ultrasonography revealed a 12 x 13 cm cystic mass in the left side of the pelvis. Exploratory laparotomy, optimal tumor-reductive surgery, total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendectomy, and omentectomy were performed. The diagnosis was FIGO stage IIIC well-differentiated ovarian mucinous adenocarcinoma. The patient was treated with 6 cycles of carboplatin and paclitaxel. Four months after completing chemotherapy, the patient was noted to have an elevated serum CA125 level (72 U/mL), being otherwise asymptomatic. Findings on abdominal and pelvic CT were compatible with postsurgical changes. PET-CT was performed and revealed increased metabolism along the posterior aspect of the right rectus abdominis muscle and abutting the anterior wall of an adjacent loop of bowel. CONCLUSION PET-CT may identify clinically occult recurrent ovarian mucinous adenocarcinoma.
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Affiliation(s)
- Sergio Martínez-Román
- Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Hospital Clínic, Universitat de Barcelona, Spain
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15
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Martínez-Román S, Balasch J, Creus M, Fábregues F, Carmona F, Vilella R, Vanrell JA. Transferrin receptor (CD71) expression in peritoneal macrophages from fertile and infertile women with and without endometriosis. Am J Reprod Immunol 1997; 38:413-7. [PMID: 9412724 DOI: 10.1111/j.1600-0897.1997.tb00320.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PROBLEM Hyperactivated macrophages are implicated in the pathophysiology of endometriosis-associated infertility. This study investigates transferrin receptor expression (CD71) as a marker of hyperactivity in peritoneal macrophages of infertile patients with minimal to mild endometriosis (group 1, n = 25). METHOD OF STUDY Expression of the activation antigen CD71 on peritoneal fluid macrophages was determined by a specific monoclonal anti-CD71 antibody using indirect immunofluorescence technique and was analyzed by flow cytometry. Three different control groups of women were used: women with unexplained infertility (group 2, n = 25), fertile women with endometriosis (group 3, n = 10), and fertile women without endometriosis (group 4, n = 25). RESULTS The percentage of CD71 positive cells was significantly increased in infertile women with endometriosis as compared with the three control groups. There were no differences among groups 2, 3, and 4 with respect to the percentage of CD71 positive macrophages. CONCLUSIONS Our results favor the concept that hyperactivated macrophages play a role in the pathophysiology of endometriosis-associated subfertility, a feature which is lacking in patients with unexplained infertility.
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Affiliation(s)
- S Martínez-Román
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Barcelona, Hospital Clínic i Provincial, Spain
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Balasch J, Creus M, Fábregues F, Carmona F, Martínez-Román S, Manau D, Vanrell JA. Pentoxifylline versus placebo in the treatment of infertility associated with minimal or mild endometriosis: a pilot randomized clinical trial. Hum Reprod 1997; 12:2046-50. [PMID: 9363727 DOI: 10.1093/humrep/12.9.2046] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The present study is the first prospective randomized controlled trial of the effect of pentoxifylline on future fertility in infertile women with asymptomatic minimal or mild endometriosis. After completion of a basic infertility workup and laparoscopy, patients were entered into the study and randomly allocated to receive either a 12 month course of oral pentoxifylline (800 mg/day) (n = 30) or an oral placebo (n = 30). Those patients with other infertility factors were included in the study only if the factors were correctable and ultimately determined to be non-contributory. Life-table analysis was used to compare pregnancy rates between the two groups over a 12 month period that started immediately after laparoscopy. The 12 month actuarial overall pregnancy rates were 31 and 18.5% in the pentoxifylline and placebo groups respectively. However, this difference was not statistically significant by the chi(2)-test. Similarly, the Cox regression method showed no differences between the hazard of pregnancy in the two groups studied (odds ratio, 0.56; 95% confidence interval, 0.18-1.67). Therefore, there is no evidence from this study that immunomodulation with pentoxifylline aids fertility in those women with minimal or mild endometriosis. Further studies including more infertile patients with endometriosis are desirable in order to confirm our results.
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Affiliation(s)
- J Balasch
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Barcelona, Hospital Clínic i Provincial, Spain
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17
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Martínez-Román S, Balasch J, Creus M, Fábregues F, Carmona F, Vilella R, Vanrell JA. Immunological factors in endometriosis-associated reproductive failure: studies in fertile and infertile women with and without endometriosis. Hum Reprod 1997; 12:1794-9. [PMID: 9308814 DOI: 10.1093/humrep/12.8.1794] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Immunopathophysiological mechanisms in endometriosis-associated reproductive failure were studied in appropriate populations: infertile and fertile women with and without endometriosis. The incidence of sera positive for any of the autoantibodies tested among infertile women with endometriosis (n = 25) was similar to that observed in the three control groups [unexplained infertility patients (n = 25) and fertile women with (n = 10) and without (n = 25) endometriosis]. The mean volume of peritoneal fluid was significantly elevated in women with endometriosis (both fertile and infertile) as compared with patients without endometriosis (fertile or infertile). The concentration of peritoneal fluid leukocytes and the percentage of cells positive for macrophage markers were significantly increased and the percentage of T lymphocytes significantly decreased in infertile women with endometriosis but not in patients with unexplained infertility and fertile women with endometriosis, as compared with fertile controls without endometriosis. Macrophages from infertile patients with endometriosis had higher sperm phagocytosis than did those from infertile women without endometriosis or fertile subjects with or without endometriosis. Incidences of serum and peritoneal fluid samples embryotoxic to the in-vitro development of 2-cell mouse embryos were significantly higher in infertile patients with endometriosis than in unexplained infertility patients and fertile women with or without endometriosis. It is concluded that immunological mechanisms of endometriosis-associated infertility exist but that these peritoneal immunological factors in infertile women with endometriosis are related to their subfertility rather than to the presence of ectopic endometrial implants. This is supported by the lack of immunological abnormalities observed among fertile women with endometriosis. These immunological abnormalities are lacking in patients with unexplained infertility.
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Affiliation(s)
- S Martínez-Román
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Barcelona, Hospital Clínic i Provincial, Spain
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Martínez-Román S, Gratacós E, Torné A, Torra R, Carmona F, Cararach V. Successful pregnancy in a patient with hemolytic-uremic syndrome during the second trimester of pregnancy. J Reprod Med 1996; 41:211-4. [PMID: 8778426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hemolytic uremic syndrome (HUS) is a rare, well-characterized complication of the puerperium constituting a cause of acute renal failure after an uncomplicated delivery. However, its presentation during pregnancy is unusual, with only four cases before the 20th week of gestation reported. CASE A case of HUS occurred at 18 weeks' gestation. Despite the initial severity of the clinical presentation, therapy, consisting of corticosteroids and plasmapheresis, resulted in complete recovery of renal function, with a rapid improvement in thrombocytopenia and hemolysis. No remarkable events occurred after this episode, and a full-term pregnancy with a normal fetal outcome was achieved. CONCLUSION We are aware of no other reports of successful pregnancy after the development of HUS during the first half of pregnancy. This provides evidence that continuation of pregnancy until term is possible. Rapid diagnosis and intensive treatment with plamapheresis, corticosteroids and dialysis, when required, may improve the maternal and fetal prognosis.
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Affiliation(s)
- S Martínez-Román
- Department of Obstetrics and Gynecology, Hospital Clinic, University of Barcelona, Spain
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Torné A, Martínez-Román S, Pahisa J, Manau D, Coll O, Ramírez J, Iglesias X. Massive metastases from a lobular breast carcinoma from an unknown primary during pregnancy. A case report. J Reprod Med 1995; 40:676-80. [PMID: 8576890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Carcinoma of the breast during pregnancy represents 2-5% of all breast cancers. The frequency and histopathologic spectrum of breast cancer are similar in pregnant and nonpregnant women. Infiltrating lobular carcinoma is one of the less understood types of breast cancer, and its metastatic pattern seems to be different from that of infiltrating ductal carcinoma. Breast neoplasms rarely present as cancer from an unknown primary site. CASE A woman in the third trimester of pregnancy developed carcinoma massively metastatic to the bone marrow and liver from an unknown primary tumor. At 32 weeks' gestation a healthy male was delivered by cesarean section. The patient died 12 hours after delivery. The autopsy revealed an infiltrating lobular carcinoma, 1.5 cm, of the breast. CONCLUSION Massive metastases from an occult lobular breast carcinoma in a pregnant woman are very rare. Diffuse metastatic spread, which often complicates or delays the diagnosis, is a characteristic pattern of infiltrating lobular carcinoma. Cancer from an unknown primary site during pregnancy is an exceptional finding. If a metastatic adenocarcinoma is diagnosed in a pregnant woman, a breast primary should be strongly suspected.
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Affiliation(s)
- A Torné
- Department of Obstetrics and Gynecology, Hospital Clínic i Provincial, University of Barcelona, Spain
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Carmona F, Martínez-Román S, Manau D, Cararach V, Iglesias X. Immediate maternal and neonatal effects of low-forceps delivery according to the new criteria of The American College of Obstetricians and Gynecologists compared with spontaneous vaginal delivery in term pregnancies. Am J Obstet Gynecol 1995; 173:55-9. [PMID: 7631727 DOI: 10.1016/0002-9378(95)90169-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Our purpose was to investigate the maternal and neonatal effects of elective low-forceps delivery, as currently defined by the 1988 criteria of The American College of Obstetricians and Gynecologists. STUDY DESIGN During a 6-month period we conducted a prospective study that included 50 nulliparous term parturients who were randomly allocated to spontaneous or elective low-forceps delivery. Patients with either maternal or fetal disorders that could affect the outcome were excluded. All deliveries were attended by three experienced obstetricians. RESULTS Spontaneous and forceps delivery group were similar regarding maternal or gestational age, fetal scalp pH, antepartum maternal hemoglobin and hematocrit levels, maternal outcome, mean birth weight, and number of neonates with low Apgar scores or cord arterial pH < 7.20. In the spontaneous delivery group the time elapsed since randomization to delivery was significantly longer (18 vs 10.2 minutes, p < 0.001) and the mean cord arterial pH was significantly lower (7.23 vs 7.27, p = 0.01) than in the forceps delivery group. CONCLUSION Elective low forceps delivery may be used to shorten the second stage of labor without immediate maternal or neonatal side effects.
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Affiliation(s)
- F Carmona
- Department of Obstetrics and Gynecology, Hospital Clínic y Provincial-Medicine School, University of Barcelona, Spain
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Abstract
A case report of a Nigerian woman having an unusual cause of tubal infertility is presented. On histological examination of the Fallopian tube, ova of Schistosoma haematobium enclosing living miracidia were found in the smooth muscle layer of the Fallopian tube and its mesosalpinx. Mechanisms of tubal involvement are analysed. The case indicates the need to consider schistosomiasis as a possible aetiological factor in patients with tubal infertility coming from areas where the disease is endemic.
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Affiliation(s)
- J Balasch
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Barcelona, Hospital Clínic i Provincial, Spain
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Carmona F, Martínez-Román S, Mortera C, Puerto B, Cararach V, Iglesias X. Efficacy and safety of indomethacin therapy for polyhydramnios. Eur J Obstet Gynecol Reprod Biol 1993; 52:175-80. [PMID: 8163032 DOI: 10.1016/0028-2243(93)90068-n] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The maternal and perinatal outcome of seven gravidas receiving 2.2-2.5 mg/kg per day of indomethacin for polyhydramnios are reported. Such therapy was started between 26 and 33 weeks of gestational age (mean, 30.4 weeks) and lasted for 20.1 days (range, 2-37 days). Median of amniotic fluid index ranged from 47 at the start of therapy (range, 32-53) to 15 (range, 2-50) when indomethacin was ended. Interval between the end of the therapy and the delivery ranged from 0 to 45 days (mean, 15 days). On average, pregnancies were prolonged by 5.1 weeks (range, 2-8 weeks). The newborn weight was 2678 g on average (range, 620-3700 g). Oligohydramnios was seen in two instances; one patient developed constriction of the fetal ductus arteriosus, which returned to normality after indomethacin suppression; one newborn in which other causes of neonatal bleeding could be excluded, developed a disseminated intravascular coagulation and died 15 h after birth. Finally, one mother presented an acute renal failure immediately after indomethacin administration; this patient completely recovered after indomethacin withdrawal. Thus, the benefit of pregnancy prolongation should be balanced against the increased risks for the newborn, mainly fetal ductus arteriosus constriction and possible bleeding disorders. A causal relationship of indomethacin administration to the latter complication warrants further investigation.
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Affiliation(s)
- F Carmona
- Department of Obstetrics and Gynecology, Hospital Clínic i Provincial, Faculty of Medicine, University of Barcelona, Spain
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